The Lancet 1887,1

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Th* Lancbt,]

[Junk 26, 1887.

THE LANCET.

3 Sournal of asrittef) aitb foreign iffletrume, &urgrrp, Obstetrics, JJbpSfologp,
Cbem&trp, Jftarmacologp, public feealtb, anti #eto$.

MDCCC LXXXVII.

IN TWO VOLUMES ANNUALLY.

VOLUME I.

EDITED BY THE PROPRIETORS:

THOMAS H. WAKLEY, F.R.C.S. Eng.,

AND

THOMAS WAKLEY, Jun., L.R.C.P. Lond.

LONDON:

PUBLISHED BY JOHN JAMES CROFT, AT THE OFFICE OF “ THE LANCET,” 428, STRAND.

Digitized by CjOOQIC

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THE LANCET, January 1, 1887.

Cmisi&mtwns

KK3PKCTINO THK

MANAGEMENT OF SIMPLE CONSTIPATION.

Bt SIR ANDREW CLARK, Bart., M.D., F.R.S.,

OTt OF THK 1.KCTURKKS OK CLIXICAL MEDICO* AT THK
LOKDOK HOSPITAL.

Thb untoward consequences of constipation are always
coasiderabls and sometimes serious; but greater than they—
greater than the anaemia, the blood-poisoning, the head¬
ache, the nervousness, and the heart disorder which arise
out of focal retention—are the untoward consequences of
ignorant and unskilful domestic management.

Far two days a patient has had no relief to the bowels.
Be has been travelling, or he has changed his diet, or Us
accust ome d routine has been in some other way interrupted.
Tbe subject is seriously considered: in the light of an existed
mlf-consciousness impending dangers are seen, and forth¬
with he determines to take " a dose.” Bat the taking of
daeee is an inconvenient and a disagreeable procedure, and
so it is settled that the dose shall be a good one—such a one
as will speedily and effectually overcome the constipation and
relieve the patient of his trouble. Tbe dose is taken, tbe
bowels (small, perhaps, as well as large) are emptied of
their contents, the object of treatment has been achieved,
sad all for a time seems well. But the next day arrives,
sad there is no fresh movement of tbe bowels; even a second
day pseees, and they are still inactive. The patient is more
uncomfortable than he was before he took his “dose.”
What is to be done ? Matters cannot continue as they are.
Plainly the medicine first employed has confined the bowels,
aad.ao another must be taken which shall be free from thiB
disadvantage. The other is taken; again the bowels are
freely moved, and a liquid, light-coloured, mucoid, and
feculent discharge attests the success of the new endeavour.
Bat the bowels fail to resume tbeir periodical discharges;
the patient becomes worse than ever; again he flies to arti¬
ficial help for relief; again he is disappointed in recalling
Xatnre to her own ways; and at last the bowels, robbed of
their normal conditions of action and exhausted by frequent
irritation, refuse to act at all except under tbe spur of
strong aperients frequently repeated. With few exceptions,
no person has passed through this experience and fallen
under the tyranny of aperients without finding his life
invaded by a pack of petty miseries which lower his health,
vex bis temper, and cripple his work. Now for the most
part all these troublesome consequences of constipation may
be avoided by attending to tbe conditions of healthy
defecation. The chief of them requiring consideration at
this tame, and assuming the integrity of the nervo-mnscular
apparatus of tbe bowels, are plenty of solid and liquid
digestible food, a fair amount of refuse matters in the
colon, regard to the promptings of nature, daily solicitation
at an appointed time, tbe co-operation of expectation and
will, and contentment with a moderate discharge. 1
propose to discuss briefly each of these conditions.

1. Plenty of solid and fluid digestible food. People lead¬
ing a sedentary or a society life beeome disposed to eat too
fine foods, and to drink too littla liquid. Among the results
of such habits are a general want of nervo-mnscular vigour,
a deficiency of intestinal secretion, and an insufficient
a count of refuse matter in the bowels to secure daily relief.
To correct this without^the help of drags, coarse and irri¬
tating foods are taken. For a day or two perhaps they
succeed; but after a time they provoke catarrhal irritation,
and either increase the constipation or bring about lienteric
diarrhoea. As a rale, it is a practical error to treat constipa-
tio a^ r means of hard, indigestible, and irritating articles

3. A moderately fall colon is essential to tbe sufficient
periodical discharge from the bowels. It is true that the
ordinary peristaltic action of the bowels is automatic, and
substantially independent of external stimulation; but it is,
1 think, equally true that for the stronger peristaltic action
-wfcach, accompanied by inhibition of tne.associated lumbar

Jo. 3906,

centre and relaxation of tbe anal sphincter, issues in normal
defecation, an external stimulus, tbe stimulus of an adequate
amount of retained fasces, is necessary. If by an aperient
or by any other means the colcm is more or less completely
emptied of its contents, defecation will be suspended until
tbe colon becomes again more or lees full; it cannot act
independently of the appointed conditions of action; it
cannot make brioks without straw.

3. Regard to the promptings of nature. When the lower
part of tbe sigmoid'flexure is full, sensory impulses axe seat
to the nervous centres, and these are responded to by dis¬
charges which not only excite vigorous peristalsis in the
upper part of the colon and solicit the oo-operation of the
Will, but tend to inhibit the lumbar centre and to. bring
about relaxation of the anal sphincter. The conditions of
defecation are present, and it needs only a patient effort of
will and concurrent expectation to originate and complete
the operation. But when attention to these promptings of
nature is denied they oeaee for the time; and although they
recur and suffice for action, the denial, if often repeated,
blunts tbe sensibilities of the parts concerned; deprives us
of the normal intimations of the need for relief, and brings

I about a form of constipation difficult to cure.

4. Daily solicitation of nature at an appointed time. It
has been found that for the great majority of people the most

i favourable, and also the most convenient, time for procuring
relief to the bowels is after breakfast, and it is one of tbe
greatest helps to sufficiency and regularity of action that
the drily solicitation of nature should be practised at that
time. In order that both solicitation and action should .

| become developed into a habit, it is necessary that nature
should not be listened to at any other than the appointed
time. And in this preuept there is no contradiction of the
statement made in tbe previous paragraph; for it is not the
temporary and exceptional denial of nature with the view
of establishing a regular habit of defecation,—it is the
repeated denial of nature with no such object in view which
blunts the reflex sensibilities of tbe parts concerned and
brings about an obstinate constipation.

5. The co-operation of expectation and will. Many
persons seek relief to the bowels without taking any pains
to secure suocess. With some persons, indeed, such pains are
unnecessary. A certain automatism has been established;
and it needs only time, place, and position to set it in suc¬
cessful motion. Bat in persons whose defecation is difficult,
direct attention, expectation, and effort are essential, and
when patiently practised seldom fail. The practice of alight
alternate contraction and relaxation of the anal sphincter
sometimes provokes exceptionally active peristalsis of the
lower colon; and so, with concurrent effort, secures relief
which could not otherwise be obtained.

6. Contentment with a moderate discharge. Ignorance
of tiie average amount of feeoes required for tne drily
h9&Uhy relief of the bowels is one of the main causes of
constipation, the unnecessary use of aperients, and the
evils that arise from both. For a man of average weight,
consuming an average amount of food, the average
amount of feces ready for discharge in twenty-four hours
is about live ounces. This should be formed, sufficiently
aerated to float, and coherent. According as the cylinder
is moist or dry it will measure from four to six inches in
length. Now, many people expect to have a much more
abundant discharge, and are dissatisfied or anxious if they
do not get it. They oomplain of their insufficient relief,
and take aperients to make it larger. For a day or two
larger dischargee are procured, but then, when the reserves
of faeces are removed and tbe orion is empty, and the
conditions of defecation no longer exist, more or less
complete inaction of the bowels ensues, constipation (as it
is here erroneously called) becomes confirmed, new and
stronger aperients are bad recourse to, and at last the
patient falls into a pitiable condition of physical suffering
and moral wretchedness. And from this condition there

is no escape except through the complete suspension of '
aperients, the renewal of obedience to physiological laws,
and a courageous patience in waiting upon Nature.

I will conclude these imperfect remarks by putting down
as briefly as possible tbe instructions which I ask my pupils
to give to tbeir patients for the management of simple con¬
stipation :—1. On first waking in tbe morning, and also on
going to bed at night, sip slowly from a quarter to half a
pint of water, cold or hot. 2. On rising, take a cold or
tepid sponge bath, followed by a brisk general toweling.

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2 The liANcgr,] _ DR. W. RUTHERFORD ON THE SENSE OF -HE&R INfr [Jan. 1,1887.

OR THE

3. Clothe warmly and loosely; see that there is no constric¬
tion about the waist. 4. Take three simple but liberal
meals daily; and, if desired, mid it does not disagree, take
also a slice of bread-and-butter and a cap of tea in the
afternoon. When tea is used it should not be hot or strong,
or infused over five minutes. Avoid pickles, spices, curries,
salted or otherwise preserved provisions, pies, pastry, cheese,
jams, dried fruits, nuts, all coarse, hard, and indigestible
foods taken with a view of moving the bowels, strong tea,
and much hot liquid of any kind, with meals. 5. Walk at
least half an hour twice daily. 6. Avoid sitting and working
long in suoh a position as will compress or constrict the
bowels. 7. Solicit the action of the bowels every day after
breakfast, and be patient in soliciting. If you fail in pro¬
curing relief one day, wait until the following day, when you
will renew the solicitation at the appointed time. And if
you fail the second day, you may, continuing the daily
solicitation, wait until the fourth day, when assistance
should be taken.' The simplest and best will be a small
enema of equal parts of olive oil and water. The action of
this injection will be greatly helped by taking it with the
hips raised, and by previously anointing the anus and the
lower part of the rectum with vaseline or with oil. 8. If
by the use of all these means you fail in establishing the
habit of daily or of alternate daily action of the bowels, it
may be necessary to take artificial help. And your object
in doing this is not to produce a very copious dejection, or
to provoke several smaller actions; your object is to coax
or persuade the bowels to act after the manner of nature by
the production of a moderate more or less solid formed dis¬
charge. Before having recourse to drugs, you may try, on
waking in the morning, massage of the abdomen, practised
from right to left along the course of the colon; and you may
take at the two greater meals of the day a dessertspoonful or
mere of the best Lucca oil. It is rather a pleasant addition
to potatoes or to green vegetables. 9. If the use of drugs
is unavoidable, try the aloin pill. Take one half an hour
before the last meal of the day, or just so much of one as
will suffice to mere the bowels in a natural way the next
day after breakfast. If it should produce a very copious
motion, or several small motions, the pill is not acting
aright; only a fourth, or even less, should be taken for
a dose. When the right dose has been found it may
be taken daily, or on alternate days, until the habit of
daily defecation is established. Then the dose of the pill
should be slowly diminished, and eventually artificial help
should be withdrawn. The aloin pill is thus composed:
E Aloin®, £gr.; extr. nucis vom., i gr.; ferri sulph., $ gr.;
pulv. myrrh®, £ gr.; saponis, $ gr .; flat |>il. 1. If the feeoes
are dry and hard, and if there is no special weakness of the
heart, half a grain of ipecacuan may be added to each pill.
Should the action of the pill be preceded by griping and
the character of the action be unequal* half a grain of
fresh extract of belladonna will probably remove these
disadvantages. If the -aloin pill gripes, provokes the
discharge of much mucus, or otherwise disagrees, sub¬
stitute the fluid extract of cascara sagrada, ana take from
five to twenty drops in an ounce of water either on retiring
to bed or before dinner. And when neither aloin nor casoara
agrees, you may succeed by taking before the mid-day meal
two ox three grains each of dried carbonate of soda and
powdered rhubarb.

The exact agent employed for the relief of constipation is
of much' less importance than its mode of operation. If,
whatever the agent may be, it succeeds in producing after
the manner of nature one moderate formed stool, it may be,
if necessary, continued indefinitely without fear of injurious
effects. But, treated upon physiological considerations, I
have the belief that in the great majority of cases simple
constipation may be successfully overcome without recourse
to aperients.

Glasgow Poor and Private Nursing

Association. —-The eleventh annual meeting of the sup¬
porters qf this Association was held on the,24th ult., when
it was reported, that exclusive of midwifery cases the
number of patients attended during the past year was 1621.
The number of midwifery patients attended was 1438 and
nurses had been engaged by 366 private families. The total
ordinary, expenditure for the, year was £4<M(b .the ordinary
receipts' amounting to .£8371, Donations and legacies
amounted fcp42307,and a balance of .£635 iB now due to the
bank: ; t- •• •- ,• ••

SENSE OF HEARING,

Delivered before the British Association at Birmingham
on September 6th, 1886,

By WILLIAM RUTHERFORD, M.D., F.R.S.,.

PROFK8SOB OF PHYSIOLOGY IR THE tCOVKBSITY OF EDIRBUBGK.

Mr. President, Ladies, and Gentlemen, —I am privi¬
leged this evening to address you on a subject that lies in
the borderland between ths realm of physics and that of
consciousness. Our sense organs we the portals whereby
the movements of the world around us find an entrance to
ouT minds. We are so accustomed to the inflow of impres¬
sions through these organs; we are so familiar with light
and darkness, with sunshine and shadow, with the colour*
and forms of objects; we are so accustomed to hear a multi¬
tude of sounds, and to readily apprehend the various-
meanings attached to them by oar minds—that we con¬
stantly forget that but for .the eye the world would be in
darkness, and but for the ear nature would be silent.

That mode of motion which we term Light does not
dispel the darkness until it falls on a living eye. Thttfe
other mode of motion which we term Sound does not break
the silence of nature until it enters a living ear. It is diffi¬
cult to estimate how much we owe to the sense of sight for
a revelation of the secrets of nature. It is still more
difficult to form any just conception of what we owe to the
sense of hearing. Far down in the scale of life, in long ages
that are past, the first rudiment of an ear was developed *
through its agency the vibrations of sound were enabled to
influence the nervous system, and there to produce sound-
sensations. As time went on, the organ became mpr»
highly developed, and no doubt more refined in its power
of receiving and transmitting sound-impressions. At first
there was no organ whereby the animal could produce
sound as a mode of expression. But when an organ, for
sound-production was evolved, and when the animal became
able to use that organ in suitable response to its various
sensations of soutn, the highest phase of brain action
became possible. It needed only the higher development of
the intellectual operations of the brain to make the percep¬
tion of the different sound-sensations sufficiently refined to
render possible the invention of language, with its manifold
meanings and wonderful results. And at last it has oome
about, so closely are the impressions of sound associated with
our mental operations, that we think in unspoken words.

I desire this evening to direct your attention specially
to the sense of hearing—a subject full of interest, but at the
same time so full of difficulty that I shall have to be care¬
ful lest I involve you in a maze of complex detail and baffle-
your perception of the main points. Those of you who have
studied acoustics will have no difficulty in following my
discourse. Therefore, 1 trust they will allow me to endeavour
to carry with us those who may not be in a position so
advantageous.

Nature of Sound.

Let us in the first place attend to the nature of the phy¬
sical agent that stimulates the organ of hearing. Strictly
speaking, sound is a sensation produced in the brain by the
activity of its nervous mechanism. But for convenience the
term Sound is commonly applied to that mode of motion
which enters our ears and throws the hearing apparatus into
action. 1 shall use the word in that sense, and employ the
term Sound-Sensation to indicate that state of conscious¬
ness which consists in bearing a sound. Sound is a wave
motion, and therefore consists in vibration. Every sounding
body is in a state of vibration. The vibration may be simple
or compound in its nature, and it will be neoeeaary for me
at the outset to explain what is meant by simple and com¬
pound vibrations, otherwise you cannot understand the sente
of hearing.

Simple Sound- Vibrations.—The motion of a pendulum is
a familiar example of the sort Of vibration that produeeiB
sound. The pendulum oecillatefi-to and fro. When it swings
I from one side to the other and . batk again, it makes one-

4 Thb Lawort,]

DR. W. RUTHERFORD ON THE 8EN8E OF HEARING.

[Jan. 1,1887.

the centre for Bound-sensation is definitely known in the
ape’s brain. Destruction of it on both sides of the brain
produces total deafness. These three parts constitute the
sensory mechanism for sound-sensation.

4. But we must add to this sensory mechanism other
nerve cells in the brain concerned in perception—an intel¬
lectual act far higher than mere sensation, whereby the
consciousness examines the various sensations of sound, and
attaches to them various significations, with which they
are afterwards associated. The centre for perception is
probably placed in the front part of the brain.

Further details regarding* thb Peripheral
Mechanism.

I must now state some further details regarding the peri¬
pheral mechanism of the organ of hearing.

The Invertebrate Ear.—A hearing apparatus is found in
the Medus®, and in all animals above them. Stated briefly,
its most general condition is that of a minute sac with a
membranous wall. The sac is full of fluid, and lined by a
layer of ectodermic cells, some of them modified into hair
cells. The auditory hairs may project free into the fluid,
but that is rare. Most commonly they project into a
calcareous mass, termed an Otolith or Earstone. The otolith
consists of about 75 per cent, of lime salts in the form of
grains or crystals, held together by a bmall amount of
mucous jelly. The effect of the otolith is not well under¬
stood. It has been thought that the hard calcareous particles
may rattle against the hairs, like the shingle on the sea
beach when the wave breaks over it. If that be so, we may
reasonably suppose that the periodic vibrations of a musical
tone must be changed into indefinite vibrations, and produce
nothing but noise. It may be, however, that there is no
rattling of the particles, and that the otolith and hairs
move to and fro as one mass when the sound wave reaches
them. If that be so, the mechanism is probably not
advantageous for the hearing of faint sounds, because it is
difficult to throw a heavy mass into movement. Otolith
sacs are found in the ear of every vertebrate, but when in
the vertebrate series the ear becomes an organ for the
delicate appreciation of musical sounds there is a great
development of hair cells without any otolith in connexion
with tnem.

The Vertebrate Ear .—Let us turn to the structure of the
ear in the vertebrate series of animals. In the lowest group
of fishes the otolith sac has in connexion with it a mem¬
branous semicircular canal, with a swelling at each end of
it containing hair cells with nerves passing to them. In
the higher fishes, and in all other vertebrates, three semi¬
circular canals are developed in each ear. Each canal has
a swelling at one end of it containing hair cells without any
otolith. These canals are nearly always placed in the planes
of a cube—that is to say, in the three dimensions of space,—
and are now supposed to be peripheral organs, not of the
sense of hearing, but of a sense that renders us acquainted
with the movements of the head, and so helps us to main¬
tain the equilibrium of the body. The otolith sac becomes
divided into two: one termed the Utricle, connected with
the semicircular canals; the other termed the Saccule, from
which a single membranous canal, the cochlear canal,
becomes developed in reptiles, birds, and most of all in
mammals. In reptiles ana birds it is short and nearly
straight. In. mammals it is much longer, and coiled up
like a snail’s shell. Hence the term Cochlea. The cochlear
canal contains an immense number of hair cells, with a
multitude of nerve fibres passing to them. The membranous
sacs and canals that I have mentioned constitute the mem¬
branous labyrinth, and are found in the innermost part of
the ear. They are all filled by a watery fluid, and nearly
surrounded by another watery fluid enclosed in the bony
labyrinth. The sound waves are conveyed to the outer
fluid of the labyrinth. They then pass through the mem¬
branous walls of the otolith sacs and the cochlear canal into
the fluid within them, from which they are caught up by
the hair cells.

Much as I should like to indicate to you the structure
and action of the beautiful mechanism by which sound is
conducted to the labyrinth, the shortness of the time at my
disposal compels me to limit your attention to the cochlear
canal which contains the hair cells that enable us to appre¬
ciate musical sounds. It is a canal of somewhat triangular
shape when cut across. Two sides of the triangle are
bounded by thin membranes that are traversed by the sound
waves. The chief of these two membranes is termed the

Basilar Membrane. It Is composed of fibres of connective
tissue, that stretch across the general cavity of the cochlea,
and are continuous at both ends with the periosteum
that lines it. The membrane somewhat resembles a
slender suspension-bridge stretching across a ravine. This
cochlear suspension-bridge, if I may so term it, extends
through the whole length of the cochlea in mammals, but in
birds it is wanting at the upper or closed end of the tube.
It is covered on both surfaces by epithelial cells. Very many
of those on the upper surface are hair cells, with ordinary or
somewhat modified fepithelial cells placed between them to
support them in their places. There is an immense number
of these hair cel la In the cochlea of the cat four rows of 1
them run the whole length of the cochlear canal. In the-
human subject there are five or six rows of them, and the
total number of the cells is estimated at about 15,000. These
hair cells of the cochlea seem placed in a position of advan¬
tage, inasmuch as they are supported on a membrane that
can vibrate with the sound wave. It is otherwise with the
hair cells of the otolith sacs. They are planted on a membrane
that is fixed in the periosteum fining the bony wall of the
labyrinth. Immediately over the free ends of the hair cells
there is a thin covering membrane, the use of which it is
difficult to comprehend. During life it is probably soft, but
when the soft parts of the cochlea have been hardened to
permit of thin slices being made for microscopical observa¬
tion, the membrane has a laminated appearance, with a
distinct bem at its lower surface. In other respects it is
homogeneous. One margin of it is always firmly attached
to the periosteum at the inner angle of the cochlear canal.
The other margin is usually free and turned up like a scroll.
But it may be that, in a cochlea which has not been injured-
by slicing it with a knife, the outer margin dips down, and-
is attached to the supporting cells outside the hair cells. It
is also difficult to say what may be the relation of this-
covering membranfi to the hairs of the auditory cells. It is
not definitely known whether the ends of the hairs are free,
or touch the covering membrane, or project into it. I have
never seen them projecting into it, nor have I seen any
hairs torn off and adhering to the membrane. It must be
admitted that the function of the covering membrane is
quite obscure, and must remain so until we know its precise
position with reference to the hairs. It has been suggested
that its function is to damp the vibrations of the hairs, and
so prevent their vibrating too long. But it may be supposed-
that structures so excessively short as these hairs need no-
damping apparatus. However that may be, the sound-wave-
comes into the cochlear canal on the side of this covering
membrane, and travels through it to reach the auditory hairs.

Thb Action of thb Cochlea.

I^ have now, in the last place, to criticise the present
accepted theory of the action of the cochlea in the recep¬
tion of sound, to point out its shortcomings, and to offer for
your consideration a new theory. Helmholtz, in his great
work on the “ Sensations of Tone,” supports the theory that
the nerve terminations in the cochlea are affected by sound,
on the principle of sympathetic vibration; that is to say.
there is a finely graduated series of nerve terminations that
individually respond to tones of a pitch varying from six¬
teen to many thousands of vibrations in a second. That
theory is based on the analogy of the sympathetic vibration
of tuning-forks and strings. No doubt it has been shown
by Professor Hensen of Kiel that the free auditory hairs of
some crustaceans vary in length, and that when he sounded
different notes with a horn some hairs vibrated more than
others to particular notes; he admits, however, that when he
sounded any note very loudly all the hairs vibrated. But
when we turn to the cochlear hair cells, especially those of
mammals, we find that the hairs are all nearly of the same
length and all exceedingly short. It would take from 120 to
220 of them placed end to end to make the breadth of one milli¬
metre. The shaft of an ordinary pin is just about the breadth
of a millimetre. The hairs are therefore exceedingly short,
and their variation in length so trivial that no one has ever

3 ested that the different hairs can be expected to make
active response to sounds of different pitch. But in all
animals auditory hairs are the recipients of sound vibrations.

In the organ of taste also, delicate hairs at the free ends
of epithelial cells are the parts impressed by molecular
motion. Why, then, is the theory still maintained, although
the condition of the auditory hairs gives no countenance to
it? Hensen has endeavoured to show that, as the fibres of
the basilar membrane slightly increase in length from the

IJan. 1, 1887. 5

Th* Lahobt,] DE. W. RUTHERFORD ON THE SENSE OF HEARING.

base to the apex of the cochlea, they answer the conditions
required for the sympathetic responses to tones of different
pitch. But the fibres are at most very short, and their
variation in length very slight. They vary from one-fifth
to rather more than a third of a millimetre—that is to say, it
would take from three to five of them put end to end to
make the breadth of a common pin; and yet within the
limits of dimensions so minute we are expected to find a
aeries of vibrating bodies that. with unfailing precision
aelect particular vibrations, varying from 16 to 40,000 in a
second. But the fibres of the basilar membrane are
regarded by no one as the terminations of nerves, and
although an attempt has been made to show how the
vibrations of certain fibres may be communicated to cer¬
tain hair cells, the explanation is so far-fetched that I
need not trouble you with it. I am convinced that this
theory of sound analysis in the cochlea, or in any other part
of the peripheral mechanism of the ear, must be abandoned.
But even supposing the theory a feasible one, see wha;
would be the result of its acceptance. Imagine a great
camber of sensory nerve cells, all in a row, for the sake of
simplicity, with a nerve fibre going from each one of them
to a hair cell in the cochlea. A tone of say 100 vibrations
per second arrives at the hair cells and stimulates its par¬
ticular cell. Its nerve is then stimulated. A particular
sensory cell is in turn excited, and we hear a tone of a low
pitch. On this theory, the pitch of the tone we hear is not
due to 100 impulses per second coming along the nerve to the
sensory cell. Not at all; that is no part of the theory. It is
the excitement of a particular nerve cell or group of cells
that is supposed to give the sensation of this particular tone.
Suppose a tone of 101 vibrations per second entering the ear:
we have the sensation of a tone of higher pitch than the
other. On this theory, the sensation of this higher tone is
supposed to be due to the stimulation of another sensory
nerve cell. So that for every different sensation of pitch,
■even although the exciting cause differ only by one, or even
half a vibration* there must be a different sensory cell in the
brain to give it.

Let us see how the theory of concord and discord fares on
this theory. I sourfd two organ pipes tuned to give the
same note. You hear an even flow of sound. I throw them
■out of tune by causing the one to vibrate a littlo more
rapidly than the other. The even flow of sound is lost, aqd
you hear a harsh discord due to alternate risings and fallings
iq the loudness of the sound—commonly termed Beats.
The beats result from the action of the two sets of sound
waves upon each other. Suppose we have two sets of
waves started at the same moment, one having the fre¬
quency of 100, the other of 101 per second. The crests, so
to speak, of the two sets of waves will coincide only once in
a second, and give a flash of sound. At all other periods in the
second the two sets of waves interfere with each other and
diminish the sound; therefore once every second the loud¬
ness of the sound would rise from a minimum to a maximum,
fall again to a minimum, and so produce one beat per
second. The absence of beats is essential for the concord of
sound. If I sound three forks whose vibrations are in the
proportion of 4, 5, 6, we get the common chord of Do, Mi,
Sol in the major mode. We recognise these three tones
individually; yet they blend, and the compound vibration
flows smoothly on without beats, and is therefore harmonious
and agreeable. It is admitted that this agreeable sensation
of harmony is entirely due to the relative numbers of the
vibrations. Its cause is strictly physical and mathematically

^Sof^see whatls'supposed to happen in the ergan of
hearing on the theory I am criticising. The complex
vibration is supposed to be analysed in the ear and the
vibrations of Do, Mi, Sol are caught up by at least three
different fibres of the basilar membrane and transferred to
at least three different hair cells. The nerve impulses are
sent along at least three nerve fibres to the brain, and at
least three sensory cells are excited there, and so give the
three sensations of Do, Mi, Sol. But the three sensations
are blended into the compound sensation of a harmony.
How and where can they blend? No doubt the sensory
cells send their impulses to the common centre for per¬
ception, and we can imagine the blending taking place there.
But if the motions in the three sensory nerve cells are
eventually to be blended, it seems unnecessary that the
already blended sound-vibrations should have been analysed
in the cochlea. And if the sensation of a harmony so oleorly
depends on the relative number of vibrations, it seems neces¬

sary to suppose that in the three sets of nerve fibres there
are vibrations of nerve molecules at frequencies in the pro¬
portion of 4, 6, 6, and that these pass to the sensorium, and
are eventually blended into a harmonious sensation. If this
be not so, then we have really received no explanation of
the physiological causes of harmony and discord.

This theory of sound-sensation, then, is so full of difficulty
when applied to the peripheral mechanism in the ear, and so
unsatisfactory when we pursue it into the brain, and it seems
so hopeless to adapt it to the facts, that I think it must be
abandoned. But before I propose another theory, I would
pay a humble but sincere tribute to the genius of Helmholtz.
His magnificent services to science have long since placed
his name amongst those of the immortals. His theory of
sound-sensation may be faulty, but that can never tarnish
the splendour of his many wonderful contributions to the
progress of scientific knowledge.

A New Theory op thp. Sense op Hearing.

Some five years ago it struck me that the case of the tele¬
phone may throw light on these difficulties regarding the
sense of hearing. In the telephone there is a thin plate of
iron placed near the end of a permanent steel magnet. A
bobbin of thin copper wire is coiled round the end of the
magnet nearest the plate, and is connected with a bobbin of
wire around the magnet of a second telephone in every
respect similar to the first. When sound-waves fall on the
plate of the transmitting telephone it vibrates. The vibra¬
tions of the iron near the magnet affect the magnetism, and
so induce in the wire currents of electricity whose frequency
and amplitude correspond to those of the vibrations of the
iron plate induced by the sound. The currents travel to the
receiving telephone and induce oscillations of its magnetism,
which in turn cause its iron plate to vibrate and produce
sounds similar to those communicated to the first telephone.
There is no analysis of the sound-waves. The transmitting
telephone takes up simple or complex _ vibrations. The
harmonies of an orchestra may fall upon it, and it does not
fail to convert the complex sound-vibrations into electrical
vibrations, and these again into the complex sound of the
orchestra in the receiving telephone. It.is, indeed, one of
the most wonderful inventions of recent times. Can it throw
light on the sense of hearing?

The theory which I have to propose may be termed the
Telephone Theory of the Sense of Hearing. The theory is
that the cochlea does not act on the principle of sympathetic
vibration, but that the hairs of all its auditory cells vibrate
to every tone, just as the drum of the ear does; that there
is no analysis of complex vibrations in the cochlea or else¬
where in the peripheral mechanism of the ear; that the
hair cells transform sound-vibrations into fierve-vibrations
similar in frequency and amplitude to the sound-vibrations;
that simple and complex vibrations of nerve-molecules
arrive in the sensory cells of the brain, and there produce,
not sound again of course, but the sensations of sound, the
nature of which depends not upon the stimulation of
different sensory cells, but on the frequency, amplitude, and
form of the vibrations coming into the cells, probably
through all the fibres of the auditory nerve. On such a
theory the physical cause of ha rm ony and discord is carried
into the brain, and the mathematical principles of acoustics
find an entrance into the obscure region of consciousness.
Now if nerve energy were only electricity, that theory
would probably be accepted at once. But nerve motion is
very sluggish when compared with electricity.

I have kept this theory back for five yean, because I felt'
T had no evidence of the possibility of sending a rapid'
succession of vibrations along a nerve. It cost me a good
deal of thought and experimental observation to find the
evidence I required. If we give to a motor nerve of a frog
or rabbit ten instantaneous shocks of ind uced electricity in
a second, ten impulses-will pass along the nerve to the
muscle, arid produce tea distinct- contractions in the same
period. If we send forty impulses along the nerve, we.
get, not forty contractions of the muscle, but a single con¬
tinuous contraction, because the several contractions are
fused together. Now, if we listen to the muscle so stimu¬
lated, we hear a musical note having the pitch of forty
vibrations per second. Each sound-vibration results from
the sudden shock of chemical discharge due to the arrival
of each nerve impulse in the muscular substance. If wo
stimulate the nerve, say, 200 times per second, by causing
a tuning-fork to make and break the primary circuit
of an induction machine, and so send 200 shocks per

O

6 The Lancet,]

DR. J. WILLIAMS ON CANCER OP THE UTERUS.

[Jan. 1,1887.

second into the nerve, the pitch of the note in the muscle
exactly corresponds. It has the same pitch as the fork.
I experimented in this way, and eventually found that 1
could send as many as 352 impulses per second along the
nerve of a rabbit and get a note from the muscle of the
pitch of 352 'vibrations per second—that is, a note of the

F itch of P in the lowest space of the treble clef. But when
tried by more rapid stimulation of the nerve to get a
higher note from the muscle, I failed; there was nothing
but a noise heard. That a low rumbling sound is produced
by a contracting muscle is known to every physiologist.
You can hear it if you firmly clench the jaws during the
stillness of night, when other sounds are hushed. It is a
sound of very low pitch due to vibrations certainly below
40—perhaps not more than 10 or 12 per second. There is
therefore nothing new in my statement that a note may be
heard in a muscle; the new point is that the pitch of the
note may be increased by a more rapid stimulation of the
nerve, and that as many as 352 impulses may be sent along
a nerve and retain their individuality so sharply that they
can produce a note in a muscle having a pitch number of
352. That fact will give support to a vibrational theory of
nerve energy.

Now, am I to conclude that, because I failed to get a higher
note than one of 352 vibrations from the muscle, it is not
possible to send more than 352 vibrations per second along
a nerve? By no means; the fibres of a muscle are very
different from those of a nerve, and also very different from
nerve cells. The molecules in both of them can probably
vibrate far more rapidly than 352 times per second.

I have therefore directly proved that vibrations of the
same frequency as all the lower tones of the scale, from the
ldwer P of the treble clef downwards, can be transmitted
by a nerve. A short time ago it occurred to me that the
note produced by the wing of an insect furnishes a simpler
proof of the possibility of transmitting a rapid series of
impulses along a nerve. The wing of the humble-bee pro¬
duces the note F in the lowest space of the treble clef. It
gives, therefore, 352 complete vibrations in a second. Every
downward motion of the wing doubtless results from an
impulse sent along the nerve to the muscles that lowers the
wing. Therefore we may conclude that about 352 impulses
per second traverse the motor nerves of the humble-bee’s
wing during flight. In the honey-bee the note of the wing
i? A in the treble clef—that is, two notes higher than in the
humble-bee, so that 460 impulses appear to pass along its
motor nerves in a second. In a human motor nerve the
impulses transmitted by it during voluntary effort are not
more than 10 or 12 per second (Schaefer). I have there¬
fore some substantial evidence in support of my theory of
sound-sensation. And I cannot but think that the evidence
in favdur of it will increase. I do not wish you to suppose
that on my theory of hearing difficulties disappear { far
from it. 1 merely assert that the difficulties which seem
insurmountable on the theory of Helmholtz are diminished
bv the theory which 1 have submitted. Should my theory
oi the sense of hearing And acceptance, it will lead to a
reconstitution of theories regarding the other sense organs.

partekn hectares

OK

CANCER OF THE UTERUS.

By J. WILLIAMS, M.D. Lond., F.R.C.P.,

' OBSTKTB1C PHTBICIAX TO TTKTTgRg f TT COLLfcOT HOSPITAL, LOHDOH.

LECTURE I.

Gentlemen, —No apology is needed for making cancer of
the uterus the subject of the Harveian Lectures; the disease
has been, and always will be, one of great interest to the
practitioner and. the pathologist. The frequency with
which it is met, its irresistible progress, the horrible suffer¬
ings which it entails upon its victims, the utter helplessness
of medicine in its presence,'and its fatal character, all alike
join hi demanding a careful study of its insidious onset and
destructive habits. I should have liked to have reviewed
the history of cancer, to have summarised the views which
have been held with regard to it, and the various method*

of treatment which have been suggested and practised with
a view to its cure and the relief of the symptoms and
sufferings caused by it, and to have traced the progression and
retrogression of knowledge with reference to it; but time
will not permit me this indulgence. I must be satisfied
with endeavouring to depict to you the present state of
scientific knowledge with regard to the disease. To do this
I must invite your attention more particularly to the early
stages of cancer—the curable stages, if there be any such—
before the diseased process has passed beyond the limits of
the uterus itself.

Before beginning the consideration of the subject we must
have a clear and exact knowledge of what we mean by
cancer; and to avoid misunderstanding I will explain the
meaning I shall attach to the word. I adopt that meaning
which is given to it by one school of pathologists, and which ;
appears to me to he the most reasonable, and the most
likely to favour the growth of our knowledge of malignant,
diseases. Cancer, then, is a new growth possessing malignant
properties—that is, it possesses the power of invading
neighbouring tissues, and of reproducing itself in the form
of secondary growths in other and distant parts. It is not
so very long—not more than forty years—since the term
was applied to growths which are now known to be devoid
of any malignant properties. Fibroid tumours of the uterus
were then regarded as cancer, but without good reason.
They possess none of the peculiar properties, anatomical or
clinical, which are possessed by the more serious affection.
The distinction between growths which possess malignant
properties and those not possessing them is to be made by
two kinds of observations—those made at the bedside and
those made at the laboratory. Clinical observation alone is-
sufficient to decide whether a growth be malignant or not.
provided one conditionisfulfilled—viz., that time is not stintedl
Weeksor months of watching will solve the question; but ex¬
amination of the growth by means of the microscope enables
us to solve it at once. All malignant growths, however, are
not cancer, and clinical observation, as a rulfe, is not equal
to making the distinction between the different kinds of
malignant disease. Here the work of t£e laboratory, and, I
above all, that done by the help of the microscope, comes to
our aid. It is by the microscope alone that we are enabled 1
to distinguish them. Progress in our knowledge of malig¬
nant disease in the future will depend in a great degree I
upon microscopic or laboratory work. Its revelations must I
form the basis of the classification of oar clinical obser- i
vations. During the early stages of cancer, or of other l
malignant growths, the microscope, I believe, will enable ns I
to recognise and make sure of the disease long before
clinical examination; and it is by no means improbable
that in any given case, even in the most advanced stages of
cancer, the structures revealed by the microscope will em¬
power us to read back the whole of its past history, when
clinical examination and observation of the living growth
have failed to cast a fay of Hght upon the previous progress
of the disease.

The varieties of malignant disease which affect the uterus I
are three—namely, sarcoma, carcinoma, and adenoma. Sar- 1
coma and carcinoma are always malignant; adenoma often,
but not always, but perhaps alVays in the uterus. Sarcoma 1
is a growth of the connective tissue type. “It originates in 1
a structure of the connective tissue group, and grows from
its constituent cells. Carcinoma and adenoma, on the other
hand, contain epithelial elements, and these elements are
the structures which give its special characters to the
class. All these tumours consist of epithelial cells on the I
one hand, and of vascular connective tissue on the other.
The latter tissue goeB to form the framework or Stroma I
in which the epithelial elements are embedded. Some of |
these are built exactly on the plan of some particular
gland; the new-formed tissue corresponds to a definite
glandular type. These are called adenomata. Another
group never reaches this perfection ; they exhibit, as it
were, only the first stage of the gland-making process.
Epithelium and fibrous tissue interpenetrate each other
in an inchoate way. The process is never carried higher.
By the multiplication of epithelial cells we have pro¬
duced nests and clusters and strings of cells, and these
are embedded in connective tissue whose elements are like¬
wise multiplying. The result is a neoplasm consisting of a
fibrous network or framework, in the meshes of which are
lodged a multitude of variously shaped epithelial cells.
But there is no orderly arrangement of these epithelial
cells. In the adenomata they tend to clothe the alveoli in

Digitized by GoOgle

UraecJ

DR. J. WILLIAMS ON CANCER OK THE UTERUS.

[Jan. 1,1887. 7

a nfoarw. open a central ltunen in the acinus

o* a giand.” (Ziegler.) It might be thought that -with
asattifcnl ehtnctwt apparently so distinctive there would
to at difficulty in diwtanguiahing between the different
ktokof malignant growths. Such, however, is not always
the cm, becauee growths of the connective tissue type or
a arc o— f sometimea aaaume an alveolar form, and their
•limit contain groups of cells which are indistinguishable
by tbs mfemaoope from epithelial cells; so that, judging by
saMosrical evidence alone, a sarcoma may be mistaken for
s cnchwma, and a carcinoma for a sarcoma. This fact has
ted to djfcmnt views with regard to the origin of cancer.

a maintain that it originates only in tissues
epithelium is present, white others hold that it
lectWe tissue in the absence of epithelium.

1 vffitot enter upon a discussion of these views, for the
daMtitoef eanoer which I adopt obviates the necessity for
ic. iMm cancer not anatomically only, bat anatomically
j —that is, cancer is an alveolar new growth
j epithelial structures which have originated from
fMkmatj crating epithelium. In this sense only will the
ibs used in these lectures. ■

classifying and describing the various forms of
as they affect the uterds, we must enumerate the
puts into which the organ is divided, and note their limits,
ns atsus is divided into three parts, according mainly to
to riwcter of the epithelium and of the glands met with
a sash part. The first is the vaginal portion. This is the
pat of the uterus exposed in the vagina. It is bounded
osifw by the stratified epithelium covering the vaginal
■ban the cervix, and above by a line drawn from the
chmal orifice, or a little above that point, to the insertion
dfis vagina The discovery of the position of the original
axillae is, however, in many cases difficult, and
imposmble. The position of it alters, and its
_ are liable to be destroyed by tears and by “ erosions.”
ion of the external orifice is that place where the
enathdrain covering the cervix ends and the
d tmgim This transitional epithelium disappears
and is replaced by a glandular “erosion ”
i co vere d by columnar epithelium, and the columnar
sine squamous of the portioil without the
of the transitional, and may even extend over
I which m health was covered by squamous epithelium.
oaahMrfooes contain glands, and present the characters of
the — sous membrane of the canal of the cervix. They
dasid, ! think, be treated as parts of the mucous membrane
of the cervical canal, and therefore I shall limit the term
qghal portion to that part of the cervix which• is covered
by apiatiHinm of the squamous and transitional kinds. This
wBl gave the inner end of the line limiting the portio
above, a little within the cervical canal, in cases of
’ es externum; and somewhere on the surface
to the vagina, in cases of “ erosion” or of lacerations
«< thneervix With aversion. This portio vaginalis is really
«en»nf stratified epithelium resembling a tailor’s thimble,
k Ate cm the lower end of the cervix proper,
next pert is the cervix. It is limited below by the
▼aginailB, - above by a plane drawn transversely
‘. the mnsr orifice, or more accurately through that
the foilietes characteristics of the mucous mem-
i mi the oetffix end and the tubular glands characteristic
cf the dr rid ua begin. The portion of the organ above this
matitntae the body and fundas of the uterus. This
of the mens; with the boundaries mentioned is of
became ca n do r may begin in any one of them,
i appears that the dise ase generally presents different
runs a dUBarent course, ana is amenable to
. in diffesea& degree*, according as it begins in one
of tbeee dtCMons. To trace the life history of
s always beesfonnd to be a difficult task, and the
_ ; baS nriseacfiBBm two noses:—Firstly, because
i rarely come under our notice at a period sufficiently
1 observations of the first beginnings of the disease
cmade; they coma at an advanced stage, when it has
\ impossible to guess even at their earlier course;
L *“ time on to it - certain and uniform termination we
pie knowledge of the disease, of a kind. The
of difficulty is that when cases are examined
their true nature is overlooked. I believe this to occur
oftener than is generally supposed. The result is a
knowledge of the natural history of cancer,
perfect descriptions of it.
to usually classified into scirrhus, encephaloid,

medullary, and epithelioma. This classification has no value*
and little meaning, as far as the uterus is concerned. Names
have also been given to the disease descriptive of the mor¬
phology of the new growth—such as cauliflower excrescence,
polypoid, diffuse cancer, &c.; but no classification of cancer
of the uterus according to its structure has been made with
the exception of that made by Ruge and Veit. I shall not
refer again to the usual division into scirrhus, encephaloid.
See., but shall describe the structures met with in cancers of
the several parts of the uterus, and then I shall arrange
cancers according to the structures we shall have met with.
The observation of structure alone is not sufficient. We
want to trace the course of the disease, the lines along which
it moves, discover the tissues which form its favourite pas¬
ture—in short, to read its history. When we shall have
done this, we may hope to know something about it, and to
be in a position to estimate, in some degree at least, the value
of any proposed method of treatment. Cancer of any one
part of the uterus is cancer which has originated in that
part, and not cancer which has invaded it from some other
source. Now cahcer may begin in the vaginal portion, in
the cervix, or in the body of the uterus, and these I shall
describe by examples of each. Cancer of the vaginal portion
and of the cervix have been described together until Ruge
and Veit published their work on Cancer of the Uterus—a
work which marks an epoch in the study of the disease.

Canckr op thb Pobtio Vaginalis.

Cancer of the vaginal portion begins in the stratified
epithelium on the vaginal surface, or in the transitional
epithelium at the os externum. Cancer involving this part
is common enough; indeed, most of the cases of so-called
cancer of the cervix are instances of cancer involving this
part, but not originating in it; the instances, however, in
which cancer had originated in the portio, and in which the
disease was observed at an early period, are very few.
Ruge and Veit, to whose work I have already referred, and
to which 1 shall have to refer again, describe twenty-one
cases of what they consider cancer of the portio. Among
them are included glandular cancers, originating in erosions,
as well as certain malignant growths, originating in the
connective tissue—which they include among cancers. The
glandular cancers I shall range among cancers of the cervix
proper, and the connective tissue growths among sarcomata.
If we exclude these from among Ruge and Veit's cases, We
find they have seen no case of cancer of the portio, or only
one surrounded by doubt. Of cancer of the vaginal portion
I have observed eight cases only, and have seen specimens
from several others; and it is upon these cases mainly will
depend the account I have to offer of cancer of this part.
I know of no better way of giving you an idea or the
disease than by describing typical cases as fully as
possible.

Cash 1.—This case presented perhaps the earliest instance
of cancer which can be distinguished with certainty.^ It
was a patient in whom the cervix had been divided into
three lobes by laceration. She improved greatly under
treatment; so much so, indeed, that she complained of no
uterine symptoms at all. Two of the lobes into which the
cervix had been lacerated assumed a healthy appearance,
but the 1 third remained in an unsatisfactory condition, and
I cannot tell you what was unsatisfactory about it. It was
not hard, it was not unduly red, it did not bleed on digital
examination, it did not enlarge, and yet it looked vicious;
and the vicious character seemed to be expressed by a
slightly livid appearance of the part only, and scarcely that
even. But I will read brief notes of the case to you.

The patient was thirty years of age, married, and had had
fcwx> children and one miscarriage. She was admitted into
University College Hospital on Jan. 12th, 1886. She knew
of no cause for her illness; hut she began to bleed in
February, 1884, when she was two months pregnant: she
had several irregular floodings until May, when she mis¬
carried, and was laid up afterwards for six weeks with what
she called “ rheumatism ” in her foot and elbow. She after¬
wards improved, but since the miscarriage menstruation has
been irregular, returning at too short intervals, and lasting
longer than usual. She did not feel any the worse for it
until eight or nine months ago, when the flow began to be
so excessive and prolonged as to give her only one week
clear. Her strength and general health failing, she sought
advice. She had lost flesh of late. She said she had sore-
throat and loss of hair in 1884, but no rash. She began to
menstruate at twelve years of age; was regular every four

8 Thx Lanoht.J

DR. J. WILLIAMS UN CANCER OP THE UTEEDS.

fJ aw. 1,1887.

weeks, the flow lasting a week in considerable quantity, but
without pain. She was married at twenty-two. Her second
labour was accompanied by a flooding, but she made a good
recovery. No family history of cancer was obtained. Her
mother died of consumption.

The cervix was low in the pelvis; it was tom on the
right side and on the left, and deeply through the anterior
lip; there was considerable eversion ; there were granules
on the everted surface like enlarged and closed follicles.
The body of the uterus was ante verted and normal. Through
the speculum the vaginal portion appeared pale and covered
by squamous epithelium; the left three-quarters of the
anterior lip was everted, and bled when touched. The right
quarter formed a projection like a nipple; the posteriorlip
was everted and paler than the everted portion of the
anterior. It did not bleed on examination. There was a
considerable quantity of muco-puruleot discharge on the
surface. Temperature 98 4® to 100° F.

By the application of a solution of sulphate of copper
to the cervix and canal of the body, menstruation became
normal, the discharge ceased, and the lips of the cervix
assumed a healthy appearance, with the exception of the
left portion of the anterior lip. In July this portion of
the anterior lip was removed for reasons already given.
This was examined under the microscope, and a very interest¬
ing state of things was found. Beginning our examination
on the vaginal surface, we found the stratified epithelium
intact and somewhat thickened. At the reflexion of the
vagina, however, the deeper layers of the epithelium sent
processes into the subjacent tissue, and beyond this, on
the surface of the portio, several such processes were met
with; these processes branched, and some entered glands,
which were evidently the glands of an erosion ; further on
were found swellings of the deeper epithelial layers and
glands lying in them; glands again running more or less
parallel to the surface, branched or simple; then a gland,
one side of which was invaded by squamous epithelium,
the rest being lined by epithelium of the columnar form;
then irregular thickenings of the deeper strata of the
epithelium of the surface, running into and between the
glands; the cells of such glands were partially replaced
by the squamous variety and were rapidly proliferating;
then we came upon a part of the oervix in which the
papillas were everywhere enlarged, and beneath which were
found numerous glands. The cervical tissue near the
whole of the surface I have described was everywhere
infiltrated with small cells, but this was not seen under
those portions over which the superficial epithelium was
healthy. In some places the glands were filled with secretion,
and some were changed into closed follicles. This is the
earliest condition of undoubted cancer of the portio which I
have met with, and it is the earliest condition which is
recognisable as cancer. It presented no symptom, and was
discovered accidentally. Its nature was not recognised with
certainty, but was held in suspicion.

Case 2.— -In this case there was no difficulty in coming to
the conclusion that the disease was cancer, for there was a
new growth which progressed so rapidly as to leave no
doubt as to its [nature. It was in an early stage, but it
differed in several respects from the one I have just related.
In the first case cancerous processes appeared to enter the
cervix from several points on the portio. In the case we
deal with now there was a distinct papillary growth situated
at the external orifice on the posterior lip.

The patient, aged thirty-nine, married, was admitted into
University College Hospital on Dec. 10tb,1883; and she gave
the following account of her illness. About Sept. 1882, she
noticed a yellow discharge from the vagina, and since that
time she had been getting thinner. She attended as an out¬
patient in June, 1883, ana was prescribed a vaginal injec¬
tion containing Condy’s fluid. About a fortnight later, when
administering to herself an injection, she noticed blood in the
discharge. The blood appeared again when an injection was
administered, and varied in quantity from time to time, and
'afterwards appeared independently of the injections. For
nine months there had been pain during, ana beemorrhage
after, sexual congress. For five weeks before admission the
blood had increased in auantity and the discharge had been
offensive. The patient began to menstruate at eleven years
of age, and liad always been regular until nine months before
admission, the quantity lost being moderate. She had been
married eighteen years, had had one child seventeen yeart
--jp, an,d one miscarriage a year later. She said that she haa
immation of the womb three time?, and .had-auffewd

slight scalding with micturition since she had rheumatic
fever nine years before.

On admission she was thin, but looked fairly healthy, and
weighed 6 st. 1 lb. External examination of the abdomen
revealed nothing abnormal. On vaginal examination there
was found what was taken for a red ulcerated surface, raised
about one line above the level of the surrounding parts, and
situated on the posterior lip and part of the anterior. There
was a narrow strip of healthy mucous membrane on the
posterior lip, between the growth and the insertion of the
vagina, and another abont three-quarters of an inch in
width on the anterior lip. The red surface had the diameter
of a florin. Four days before it was not bigger than a
shilling, and affected chiefly the posterior lip. On the left
aide there was a fissure in the cervix, and the lips were
everted.

The cervix was amputated above the internal orifice.
The part removed was an inch and a half in length. On the
posterior lip was no ulcer, but a raised papillary growth,
about three-quarters of an inch in diameter, and on section
its thickness was seen to vary from one-third to one-sixth
of an inch. It was rough on its surface; and on its sides!
towards the oommiBsure, and on the anterior lip, was a shal¬
low, narrow, depression. At the border of this depresion the
stratified epithelium terminated abruptly; the bender of the!
epithelium wassinuouB and somewhat swollen, as if thickened.
Posteriorly the stratified epithelium was retained up to the I
growth. The lips were everted, so that the disease appeared
to affect the lowest parts of the lip; this was, however, not
really the case, for it originated at the os externum, and was
advancing along the posterior lip. On examining this speci¬
men with the microscope, and beginning on the healthy
surface of the portio, this was found covered by stratified
epithelium; beneath the epithelium were the papillse, some¬
what enlarged : beneath these, again, was what appeared to-
be the healthy tissue of the cervix. As we approached the
diseased part, the deeper layer of the stratified epithelium
was found increased in thickness; small cells and nuclei,
appeared in great numbers in the tissue immediately beneath
the thickened epithelium. Close to the new growth the
stratified epithelium became greatly increased in thickness
here the papillae became longer, and strings of epithelial
cells ran into the tissues beneath, and papillae grew upwards
from the tissue beneath towards the surface, and penetrated
the superficial thickened layer of squamous epithelium, as
the processes from that epithelium penetrated the tissue of
the oervix. These papillae grew very rapidly, and over their
points the horny layer of the squamous epithelium was, in
the main, lost. It should be borne in mind that the!
deepest layer of the stratified epithelium of the cervix
is formed of columnar cells, the cells of the middle layers
are variously shaped, and the superficial cells only are flat.
At the point where the deeper layers began to proliferate
the superficial layer of flat horny scales was lost. As the
growth proceeded the columnar cells forming the deepest
layer lost their character, 9 and abutting against the pro¬
liferating stratified epithelium was a thickness of what
appeared to be indifferent tissue; beyond this was a string
or cancerous cells, then again what appeared to be indifferent
tissue. This might lead us to the conclusion that the cancer 1
[ was really developed from connective tissue, both the con- '
nective tissue and the epithelial having been first trans-t
formed into indifferent tissue. The loss of the flat horny,
layer of the epithelium, and the apparent termination of
the proliferating epithelium in indifferent tissue, appears to
favour this view—a view which has been adopted by Rage*
and Veit. A little closer examination, however, will, 11
think, show that the layer of indifferent tissue in which the,
proliferating epithelium seemed to end was a rapidly
growing papilla—that this was making its way through the 1
thickened epithelium to the surface, and that in the course*
of this process the horny epithelium fell off. The surface!
epithelium falls off as the result of the growth of t*ssaes|
from beneath towards the surface, as I shall have occasion (
again to point out. The cords and strings of cancerous,
tissue which appeared in the growth, and which anastomosed
freely, were not cancerous tissue developed from connective •
or indifferent tissue, but thethickehed cancerous epithelium!
of the part penetrated through and through and in ell'
directions by papillte growing towards the surface, and the!
loss of the epithelium in places on the surface was the direct!
effect of the growth of tee papHlse. The accuracy of this
view of what occurs is shown by the fact that in other
plapea the epithelium was cootie no us from the healthy

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DR. J. CURXOW ON THE TREATMENT OF TYPHOID FEVER.

[Jam. 1 1887. 9

surface to the diseased, and that in many places in the
diseased surface points were found denudea of epithelium.
It is a curious fact that when papilla) grow on a uterine
surface covered by columnar epithelium they are always
covered by columnar epithelium; whereas when they grow
on a surface covered with stratified epithelium the surface
epithelium is lost-the horny layers are not compatible with
growth.

Cask 3. — The third patient, a widow, aged forty-two,
was admitted into University College Hospital on Nov. 26th,
1883. She had been treated on ana off for perimetritis for
several years. She said that twelve months ago the pain in
the side for which she had been treated returned with great
severity; it radiated from the left side of the lower abdo¬
men. At the same time she had a dragging pain in the left
a xill a Poor months ago she noticed a greenish discharge
from the vagina, which became offensive two months ago.
The discharge was in considerable quantity during the aay,
sad contai n ed blood. During the last week the blood had
diminished, while the discharge had increased, but the latter
had to a great extent lost its fetor. The catamenia appeared
Urn* at eighteen; they had returned regularly since, in
moderate quantity and without pain. Tire patient was mar¬
ried at twenty-two years, and had had seven children The
third labour was hard, but delivery was accomplished with¬
out the use of instruments. It was followed by a flooding.
After this she said that she had inflammation of the womb
and bowels. In her fourth confinement she was delivered
of twins. . She had had no miscarriages. The father died of
asthma; the mother of a cause unknown to the patient;
one sister died of cancer of the womb. The patient was
fairly nourished; the heart and lungs were heal toy. The
eemx of the uterus was flattened and circular, almost like
the head of a mushroom. There was a deep laceration in
the left commissure, but the anterior and posterior lips and
the right commissure were not tom. The cervix was
amputated just above the internal orifice. The portion
removed was an inch and a half in length. The posterior
Hp was the seat of a papillary growth one inch in diameter.
There was a narrow strip of healthy mucous membrane
between the disease and vaginal vault posteriorly. The
vaginal ca n a l appeared healthy. On microscopic examina¬
tion, it was found that in places the superficial layers of
tha stratified epithelium were lost, and the deeper layers were
exposed; in other places the superficial layers were retained,
and the deeper layers were thickened and presented a wavy
border. The disease was quite superficial, its thickness being
mot more than one-sixth to one-third of an inch.

(Tb b* conclttdtd.)

THE TREATMENT OF TYPHOID FEVER BY
THE COED WET PACK AND ALCOHOL.

By JOHN CURNOW, M.D. Lond., F.R.C.P.,
iejut or nre medical taccltt ix kixg's college, loxdox ; physicus
TO use's COLLEGE AND T1IK SKAMES'S HOSPITALS, ETC.

Durikg the past few years I have had under my charge
at the two hospitals with which I am connected more than
three hundred cases of typhoid fever, and my experience
has led me to a line of treatment in severe cases which has been
v er y successful, but which is not quite in accord with the
statements laid down by some of ofcr most recent authorities
oo this disease. In “Quain’s Dictionary of Medicine”
Dr. Broad bent urges most forcibly the advantages of the
add-bath treatment, and states that “ the cold wet pack
has been tried as an alternative to the bath, but without
effects adequate to the requirements of the case.” I shall
iu>« that, when the cold wet pack has been carefully and
systematically applied, it is not only more easily made tise
of, and is lees distressing to the patient than the cold bath,
bat that it is an adequate and effectual alternative. I have
naed it not only in cases with high temperature, but even
in cases complicated with hemorrhage, and in the latter
any movement' of the patient, so as to place him in a
hath, would have been attended with grave risk. My first
experience of the cold wet pack as a remedy was in
187A. 1 was called in consultation with Dr. Massey,

rf C amb erw el l, to a case of acute rheumatism and hyper¬

pyrexia. At 2.45 p.m. the temperature was 106 8° F., and
waa rising so rapidly that at 3.5 p.m. it was 107'2°. The
patient, a young man about twenty-five years of age, was
quite unconscious, and his pulse was so rapid that it could
not be counted. It was impossible, for want of the necessary
assistance in an emergency in a private house, to put him
into a cold bath, so he was stripped naked, a mackintosh
sheet placed under him, and he was wrapped in a linen sheet
wrung out of cold water, kept at 32° by the addition of
lumps of ice. The first application stopped the rapid rise in
temperature, but the sheet began to get warm in two or
three minutes, when another was substituted for it. On
this being replaced by a third the temperature began to fall,
and on further reapplications this fall became very decided
and the patient’s condition rapidly improved; nis pulse
fell, and he was soon quite conscious. After a continuous
packing in this manner for four hours, and intermittent re¬
applications during the night, the tendency to an excessive
me in temperature gave way, and the patient recovered
without any further complication or relapse. He had no
cardiac mischief, and I saw him in perfect health only two
weeks ago.

In typhoid fever the rise in temperature is more gradual,
and the risk of a rapid death from hyperpyrexia is not nearly
so imminent as in rheumatic fever. 1 therefore pack only
the chest and abdomen, leaving the head and the extremities
free, and a thin linen sheet is wrung out of ice-cold water and
folded double, and used as in the case just recorded. This
method o( treatment is adopted whenever the tempera¬
ture remains above 103 5° for any time (say twelve hours),
and is continued until it falls to 102° or less. The pack
is changed before it gets in the least dry, and another,
wrung out as before, replaces it. When the temperature
falls to 102° or less the patient is wiped dry, and the packing
is stopped until the temperature again rises to 103'5°.
In very severe cases the temperature is taken every half-
hour or every hour. In a very protracted and severe case

(J. A-), to which I shall presently refer, the patient

was in the pack continuously for eight days and at intervals
for five days longer, so that this treatment can evidently be
carried out with benefit fof a much longer time than is
usually supposed.

la many cases,-when the cold wet pack has been used
to diminish the temperature, and to prevent it from
rising above 104°, I have given no stimulants or drugs,
excepting two or three grains of quinine two or three
times daily. The patient is kept in bed, on a milk and
beef-tea diet, and in an uncomplicated and ordinary
case nothing else is required. I mention this particu¬
larly, because I do not prescribe alcohol in every case of
typhoid. I have treated nearly 100 cases without any alcohol,
and considerably more than this number with less than
twenty ounces of brandy throughout the whole course of the
illness and convalescence. I am quite convinced, however,
that in exceptionally severe cases a much larger quantity
of alcohol may be administered than is usually the practice,
and in some desperato and apparently hopeless cases it is
the only remedy that will save the life of the patient. It
must be given with discrimination, and if its administra¬
tion be carefully watched, and if the patient is improving
or not becoming worse, there can be no valid reason why we
should not push brandy as we do quinine, iodide of
potassium, or opium in suitable cases. I quite agree with
the late Dr. Murchison, that “ fever may be treated success¬
fully with little or no alcohol,” and that it is " very rarely
necessary to give more than eight ounces of brandy at any
period of the fever”; but I must take exception to another
of his statements, that “ if, notwithstanding this amount
(12 oz), the patient die, it is doubtful if any amount of
brandy would nave saved him, and-a larger amount would pro¬
bably only have contributed to the fatal event.” The cases
which I record will prove that much larger amounts have
not contributed to a fatal result, and I further believe that
in these exceptionally severe cases, the patientB owe their
lives to the large quantities of alcohol which were adminis¬
tered to them, and that they would not have recovered if
any limit such as 12 oz. bad been enforced, and 1 know that
this opinion is shared by those who watched and nursed
them.

The first case of typhoid fever in which I saw very large
quantities of stimulants administered was during my house-
physiciancy at Ring’s College Hospital, when a domestic
servant about twenty-two years of age was given one p>nt
of brandy and some champagne daily for three or four

10 The Lancet,]

dk. j. ccrnow on the treatment op typhoid fever.

Man. 1. 1887.

successive days. She recovered from one of the most severe
attacks whicn I have ever witnessed. I saw her some years
after, and she told me, in reply to my inquiry, that she bod
never tasted spirits after leaving the hospital, and that even
taking them up to her master’s study at night nearly made
her sick, so much did she dislike their sight and smell. In
another case, in which a nurse at the Seamen’s Hospital in
somewhat delicate health fell ill with typhoid fever, I was
summoned by au urgent message and found her almost mori¬
bund, with a double hypostatic pneumonia, reaching on both
sides as high as the spine of the scapula. Brandy in milk or
beef-tea was given to her every twenty minutes for two days,
and at gradually increasing intervals for some days after, with
occasionally some champagne, and she made a good recovery.
She isjpow'the Bister matron of a large provincial hospital,
and has been actively and constantly engaged in nursing since
her illness some eight or nine years ago. With the excep¬
tion of taking a glass of beer with her luncheon, she has
taken no stimulants since then. These cases show that
brandy given in such large doses, instead of inducing people,
especially women, to become drunkards, really have an
opposite effect.

The method of administration which I follow in my
worst cases is this: About three or four tablespoonfuls
of milk or strong beef-tea are given regularly every
twenty minutes or half-hour, and to these brandy is
always added, the quantity being calculated so that the
full amount of twelve, sixteen, twenty ounces, or even
more, in the twenty-four hours, is equally distributed. If
the patient refuses milk and beef-tea, as is occasionally
the case, or the pulse becomes smaller and intermit¬
tent, a tablespoontul or a little more of champagne is
used in their 6tead, and the brandy added to it, or if
sickness be au urgent symptom the champagne is given
freely for a few hours without brandy. In no instance has
the brandy been given alone. The following cases are
appended as typical of the advantages that have been
derived from this plan of treatment.

Cask 1.—J. It -— was admitted on October 14th, 1884,
having been ill with diarrhoea, occasional epistaxis and
headache for nearly a fortnight. He had taken several
doses of castor oil. On admission, there were tender¬
ness and gurgling over the right iliac fossa, a few typical
Spots, and diarrhoea. His pulse was 9G°, regular, and the
temperature 1024°. The diarrhoea continued. Next morn¬
ing a smart attack of epistaxis occurred, and in the evening
his temperature rose to 101-8°. lie was constantly packed
for twenty-four hours until the temperature was reduced to
102-4°, and, on its rising to or above 103-8°,.this was repeated
for the next seven days, after which he gradually improved.
He had several attacks of epistaxis during this period, and
his condition can be best appreciated from the notes for
Oct. 23rd and 24 th:— Oct. 23rd: Tne patient is very restless;
tongue dark brown, covered with sordes; skin dry; bowels
open three times; respiration 36; pulse 120, very small.
24th: Tongue black; muttering delirium throughout the
night; quite unconscious; passes everything involuntarily ;
bowels open three times; he still takes milk well, although
swallowing seems laboured. Respiration 40; pulse 128, bo
small as to be hardly counted. On the 27th his pulse was
slower, temperature iower, and his tongue began to clean,
and from this date his recovery was uninterrupted. The
amount of etimulants which was given to him was as fol¬
lows:—18th,brandy. 4oz.; 19th, 4oz.; 20tli,6oz.; 21st, 10oz.;
22nd, 12 oz.; 23rd/14 oz.; 24th, 14 oz., and a pint bottle of
champagne; 25th, 14 oz., and 2 pints of champagne;
26th, 14 oz, and 2 pints of champagne: 27th. 10 oz.;
28th, 6oz ; 29th, G oz.; 30ib, 4 oz.; 31st, 4 oz.; Nov. 1st,
2 oz.; making a total of 5 pint bottles of champagne, and
124 oz. of brandy. The temperature chart will show- the
severity of the case (by no means one of the worst), and
the advantages of the cold wet pack and alcohol, which
were freely used in the earlier stages of Ms illness.

Cask 2.—T. 11-was admitted on Oct. 3rd, 1884, after

an illness of about fourteen days, but the patient was so
prostrate that no reliable history could be obtained. lie
had some abdominal tenderness; his face was cyanosed ;
there was marked subsultus, a dry brown tongue, and a
weak fluttering pulse of about 120. The temperature, which
was 101‘4° ou admission, quickly rose to 104-2°. The area of
splenic duluess was increased, and there were a few rose-
spots. fliscondition from Oct. 9th to 15th is thus described
in the case-book: “Patient lies quire unconscious; face
blue; subsultus very marked; diarrhoea continues, and

TEMPERATURE FAHRENHEIT

PACK

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Trim LAjfOBT.j

MR. T, PRIDG1N TEALS .ON SURGICAL MISHAPS.

[Jan. 1,1887. 11

occasionally a little blood in tbe motions, which, as well as j
the urine, are passed involuntarily; tongue black apd dry;
pulse 144, almost imperceptible.” On the 15th be began to
show some signs of improvement, and from this date he
slowly progressed towards recovery, although there was a
relapse lasting eighteen days. He was packed whenever
the temperature rose above 103-5°; and the daily quan¬
tity of stimulants given to him was: .on Oct. 3rd, 4th,
ana 5th, 10 oz.; 6th and 7th, 15 oz.; 8th, 15 oz. and
2 pints of champagne; 9th to 14th, 20oz. and 2 pints
of champagne; 15th, 15 oz.; 16th, 10 oz.; 17th to 22nd,
6oz.; 23rd to Nov. 5th, 4oz.; and Nov. 6th to 8tb, inclu¬
sive, 2 o*.: making a total of 310 oz. of hrandy and 14 pints
of champagne.

Cask 3. — J. S——, aged nineteen, was admitted on
Sept. 15th, 1884, after a week’s illness. On admission his
temperature was 103*6° ; his pulse 120; tongue brown and
dry; abdomen tumid; pain and tenderness on pressure over
right iliac fossa; bowels loose; and there were a few rose
spots scattered over bis chest and abdomen. He became
rapidly worse, with low muttering delirium; and on tbe 19th,
at 9 a.m , bis temperature having risen to 104 4 0 , be was
packed, and this was renewed again and again, when his
temperature rose above 103 6°. From Sept. 17th until the
27th inclusive he was quite unconscious : his pulse was 140
on the average, fluttering and irregular; he bad some
diarrhoea: and on the night of the 22nd bis temperature fell
8° (from 105° to 97°), without any haemorrhage, and every¬
one expected his immediate death. By the persistent
application of warmth and the use of stimulants Be rallied,
and his temperature at 9 p.m. on the 23rd had risen to 103-8°.
On the 27th be began to improve, and progressed favourably
until Oct. 12tb, having been allowed some custard on the
preceding day. A relapse took place and continued until
the 26tb, and he then again went on satisfactorily until
Nov. 12th, a slice of mutton having been given to him for
dinner on the 9tb, lOtb, and 11th. A second relapse now
occurred, but it lasted only three days. From this date be
slowly convalesced, and was sent home to Norway on
Dec. 12tb. He was put on 4 cz. of brandy on Sept. 15th,
16th, and 17th; on the 18th, 6 oz ; on tbe 19th, 6 oz. and
2 pints of champagne; on the 20th and 21st, 10 cz. and the
same quantity of champagne; on tbe 22nd and 23rd, 12oz ;
from the 24th to tbe 30th inclusive, 16 oz. daily; from
Oct. let to tbe 4tb, 12oz.; from 5th to 8tb, 8oz. and 2pints
of champagne; from 9th to 17th, 4 oz. and 1 pint of cham¬
pagne ; on the 18th tbe brandy was raised to 6 cz, and
again reduced to4oz. on the 25tb, when the champagne
was- stopped; on Nov. 6th, 2 oz. only of brandy were given
daily, and on the 9th its use was discontinued. Tbe total
quantity consumed by this patient was 388 oz. of brandy—

2 gallons, 3 pints, 8 oz.—and 21 pint bottles of champagne.

Cask 4.—In the case of J. A-, who was admitted on

Feb. 16th, 1884, we had to deal with the most protracted
case which bas come under my notice. He had be-n ill
some nine or ten days previous to his admission, and the
case ran a severe course for five weeks, after which he had
ayery severe relapse for about, twenty days. During the
first stage of tbe illness he was occasionally packed, and
from 4 oz. to 8 oz. of brandy were administered daily. In
the relapse he was packed almost constantly for eight days,
and intermittingly for five days following, as his tempera¬
ture when not in the pack was almost always 104°, and rn
two occasions reached 105°. Ten ounces of brandy and two
pints of champagne were given daily throughout this
relapse. His temperature for a fortnight was almost
steadily above normal at some time of the day, and again
rose after this, so that it was only on tbe 130th day, or after
eighteen weeks of illness, that it became normal and steady.
An exacerbation on the 128th day was probably malarial, as it
gave way to 20grs. of quinine administered in a single dose.
He took brandy daily from his admission to April 14th,
and 6oz. of Tarragona port from that date until June 21«*,
when he was able for the first time to sit lip in bed. His
temperature fell suddenly on one night daring the first
relapse from 105° to 96 2°, and the fall coincided with severe
vomiting,but there was do breraorrhRge, sweating, or pro¬
fuse diarrhoea. For the last nine weeks of his illness, during
his third pyrexial rise, he took 5grs. of quinine every four
boors. Fresh spots came out during noth h*s relapses.
He was kept on milk, with occasionally beef-tea, from
Feb. 15th to April 19tb, when some custard was allowed.
On the 24th a little bread, was given, but this and tbe
epatard were stopped o i the 26th; they were returned on

May 10th. Fish was added on tbe 21st. A mutton chop
replaced the fish on June 2nd, and on tbe 26th be was put
on the ordinary hospital regimen.

I have selected these cases as typical examples of the
advantages derived from wet-packing and free stimulation,
as they were for longer or shorter periods in the most
imminent peril, and in all of them complete recovery took
place, notwithstanding, as some would say—or in conse¬
quence of, as I should say,—the amount of alcohol which
was administered. A11 credit must be given to my house-
physicians—Dr. B. Penny and Dr. B. H. Booth—for their
assiduous attention, and to the excellent nurses who
watched over these sailors. It must be remembered that
the cases of fever admitted into the Seamen’s Hospital are
on an average more eevere than those seen in general
hospitals, for tbe patients have usually been kept at work
as long as they could move about the vessel; tb&t they have
had no rest, medical attendance, or proper dieting previous
to their admission; and that they are all adults, in whom a
high rate of mortality Is to be expected. In tbe past seven
years I find that only eight deaths have occurred in the
cases under my care, of which four were due to haemorrhage,
two to perforation of the bowel and peritonitis, one to
exhaustion and thrombosis of tbe veins duripg a relapse
and one to pneumonia.

SURGICAL MISHAPS.

By T. PRIDGIN TEALK, M.A, F.R.C.S.

Surgical mishaps are happily not always identical with
surgical calamities, as the following three cases, slightly
sketched without much detail, will show. The narration
may be useful, and may bring comfort to others who meet
with similar occurrences.

Cask 1. Disappearance of ■ Tumour aftet ineffectual
attempts at Removal .—I cannot do better tha.n describe
this case in tbe words of a letter which I wrote to Sir James

Paget on Jan. 11th, 1878: “Mr. H-, of H-, consulted

me three weeks ago about a tumour behind the angle of the
left lower jaw. After existing for several years as & small
movable lump, the tumour baa within a few weeks begun to
grow with .an increasing rapidity. It was fairly movable in
all directions, and I advised its removal. A fortnight later

1 went over to R- to remove it, and then found that

the tumour had become at least double in size, was very
elastic, and more fixed. 1 cat down upon the tumour,
and found that it involved, and seemea to be growing
in, the anterior portion of the sterno-mastoid, and that
it had no limiting capsule, as I hoped. Having stripped
the outer side of the tumour with the finger, separating it
from contiguous fibres of the muscle, I followed it deeply
until I could almost touch the transverse processes, where
it was firmly attached to deep structures in tbe neighbour¬
hood of the large vessels. I therefore thought it more

K rudent to abandon any farther attempts at removal. Having
iserted a drainage-tube, I closed the wound, and all healed
satisfactorily. Curiously, tbe rapid growth seems to have
been checked, and this makes me regret that I did not strip
the opposite side also, with a view to cutting off supplies.”
Sir James Paget and Mr. John Wood, who saw the patient,
after hearing my deecription of the operation, agreed that
no further surgical interference was advisable, and tbe
former suggested a course of small doses of iodide of

E otassium, with large doses of Hq. potass®. On April 24th
[r. H-— wrote that, apparently under the influence of tbe
medicine, the tumour had decreased so rapidly that ten days
previously he had omitted the medicine, and that ♦‘it is now
scarcely feelable and not perceptible.” In December, 1878, be
again wrote, “Tbe tumour,or whatever it was, has departed
in peace, seemingly never to return.” I have beard of him
from time to time, but never of any relapse.

Dec. 25tb, 1886.—Mr. H—-writes: “The tumour bad
exited two years before tbe operation. There is not a'
trace at present. 1 took about six bottles of the medicine,
and the tumour disappeared in six months."

Cash 2. Chronic Int'crsion of the Uterus; Attempted
Reduction by Taxis: Laceration of Vagina into Douglas's

Pouch; Rccoven;. —Mrs. J-, aged twenty, was sent to me

in November, 1884, by Dr. Blair, of GooJe,.eoffeflt>g from
inversion of the uterus resulting from %*r second confine¬
ment four months before. Tbe labour was prolonged and
difficult. She remained in bed .for a week after delivery,

12 Thi Lancbt.J

DR. D. DRUMMOND ON CEREBRAL LESIONS.

[Jan. 1, 1887.

and on getting up for the first time the womb came down
and protruded nearly two inches. The womb was returned,
and never prolapsed again, but it was afterwards dis¬
covered that she was suffering from inversion of the
uterus. The patient was ansemic and frail-looking. In
consultation with my colleagues, it was considered that
the os and cervix were so much relaxed that I might
attempt to reduce the inversion by taxis whilst the
patient was under ether. I therefore at once made the
attempt, using, as I believed, no immoderate force,
and fully realising the need of caution so as to avoid the
danger of laceration. After careful pressure with the
fingers upon the fundus, which in about a quarter of an
hour had been reduced to within the level of the os, and
just as it seemed that complete reduction was being effected,
the whole receded within the peritoneal cavity through a
rent in the roof of the vagina, posterior to the cervix. I
was then face to face with a most difficult problem, and
called to my aid Mr. Robson, who was in the Infirmary at
the time. After some deliberation, we came to the conclusion
that the safest course would be to transfix, tie, and cut off
the inverted womb. This having been done, one stitch was
inserted into the rent in the vaginal wall as a safeguard
against prolapse of the bowels, and a large drainage-tube was
inserted within the lips of the wound so as to project for
about an inch into the peritoneal cavity, and was fixed by
catgut sutures to each side of the ostium vaginas. The
vagina was carefully syringed with weak carbolic acid lotion,
ana well charged with iodoform. Her further progress was
satisfactory. There were never any symptoms of peritonitie.
In a few days her temperature rose to about 103°, and then
slowly fell, and she returned home within three weeks of
the operation. I have since heard that she is in good health,
and menstruates regularly.

Dec. 26tb, 1886.—Dr. Blair writes me: “ Mrs. Q-is quite

well; menstruates regularly, and suffers neither pain nor
inconvenience.”

Cask 3. Wound of Popliteal Artery and Vein during an
Operation for Necrosis of Femur; Recovery without Gangrene.
A young man, aged about twenty-one, came under my care
at the Leeds Infirmary about six years ago, on account of
necrosis of the femur. The sinuses led to the back part of
the femur, about the bifurcation of the linea aspera. Having
enlarged the sinuses, I had considerable difficulty in reaching
the denuded bone. In trying to release what seemed to be
an indurated edge of fascia or a ridge of new bone, I passed
the knife along this edge, loosening it, as I thought, from
its apparent attachment to the bone, when a gush of bmmor-
rhage startled me. To my dismay, the cord proved to be the
popliteal vessels coated with a tough hard case of cicatricial
lymph, and both artery and vein were wounded. Having
commanded the bleach in the vessels by the finger, I sent
for my colleague Mr. Wheelhouse, who fortunately was
paying his visit to the wards, and most kindly came to my
assistance and gave me timely aid and counsel. Finding it
impossible to deal effectively with the wounded vessels
through the lateral wounds, I made a vertical incision about
four inches long in the middle of the popliteal space, and
so exposed the wounded vessels. Having severed the
vessels at the seat of injury, l tied both ends of the artery
and vein. The whole proceeding was both difficult and
tedious. For some days I watched the case with grave
anxiety, fearing gangrene and the need of amputation. '
Fortunately my fears were disappointed. The foot soon be¬
came warm, was never blue, and gave me po cause for anxiety.
The wound healed favourably, and the patient recovered the
use of the limb. .Knowing the frequency with which gan¬
grene results from arrest of circulation through both the main 1
artery and vein of a limb, the impunity which resulted in
this case was unexpected, and gave great relief to my mind.

Lewi*.

Presentations. —On the 21st ult., at Camberwell,
Mr. Oldfield was presented with a marble timepiece and a
urse containing £150, as a token of the esteem in which
e is held, and as a mark of sympathy with him in the
trouble entailed by an action which was brought against
him, and summarily disposed of by the Grand Jury at the
Central Criminal Court.—Mr. H. E. Richardson, who has
recently resigned the post of senior house-surgeon to tbe
Birkenhead Borough Hospital, has been presented by the
nurses and others connected with that institution with a
surgical case and other gifts, as a token of the high esteem
felt for him.

CLINICAL AND PATHOLOGICAL ILLUS¬
TRATIONS OF CEREBRAL' LESIONS.

By DAVID DRUMMOND, M.D.,

PKYSICIAH AWD PATHOLOGIST TO THK HEWCASTLE-OS-TTH* IHFIRMAHY.

Case 1. Double Cerebral Lesion simulating an Apopletic
Bulbar Lesion— A boiler-smith, aged sixty-five, complained
of nothing of importance until he reached the age of sixty,
when he experienced “ a very slight stroke,” which affected
his left side somewhat. Eighteen months later another
somewhat similar seizure overtook him, also affecting the
left side. His articulation now became difficult, and it was
observed by his friends that his face was smooth and
expressionless. Soon after this attack he came for the first
time under observation, when the following points were
noticed. The patient could walk, but he dragged the left
leg slightly, whilst his grasping power was decidedly weaker
on the left side. The face presented a stupid, stolid ex-
ression, the result of incomplete double facial paralysis,
be tongue was protruded straight, but with undoubted
difficulty, for the tip scarcely reached beyond the lips. The
saliva constantly dribbled from his mouth. The speech was
exceedingly indistinct, but there was an absence of true
aphasia. One could imitate his attempts at articulation
very readily by speaking with the mouth open and the
tongue still. Both vocal cords were seen with the laryn¬
goscope to be considerably relaxed. His attempts at swal¬
lowing were attended with great difficulty, and fluids
frequently regurgitated through the nasal passages. 1
observed this patient for a considerable time before more
alarming symptoms set in, and by degrees the signs sug¬
gestive of abulbarlesionbecameintensified. The double facial
and hypoglossal paralysis, the imperfect articulation, the
difficulty in swallowing, all advanced together, whilst as
time went on there was comparatively little alteration in
his locomotion and grasping power. At length one day he
was brought into tbe infirmary, having just had, it was
stated, another seizure. It was then observed that, although
conscious, he was almost speechless; the tongue could not
be protruded; the lower facial muscles were completely
paralysed; swallowing was almost impossible; both legs and
the left arm were markedly paralysed, and the right arm
enfeebled. After lingering in this condition for about three
weeks, he sank and died comatose.

It was obvious that we had in this case to do with
many of tbe features of an acute labio-glosso-laryngeal
paralysis, such as Leyden and others have described
as resulting from hremorrhage or softening in the medulla.
At tbe necropsy, however, the medulla and pons were
found to be normal. The dura mater was thickened
and firmly adherent along the edges of the longitudinal
fissure; the pia mater and arachnoid were also thick¬
ened and presented the sodden wash-leather appearance
so suggestive of general paralysis of the insane. The brain
substance was of soft consistency. The vessels at the base
were atheromatous, and in places markedly thickened,
especially the termination of the internal carotid, the middle
cerebral, and the posterior communicating on the left side.
On cutting the cerebral hemispheres in the usual way, two

f tatches of degenerated brain tissue were observed as the
ower levels of the centrum ovale majus were reached, one
in each hemisphere; these resembled cicatricial tissue. That
on the left side appeared to be placed just above the pos¬
terior and middle portion of the optic thalamus, and that on
the right was situated a little in front and to the outside of
this point. The next section brought into view two
cicatricial and cyst-like areas of degeneration. In the left
hemisphere the disease occupied the anterior and inferior
portion of tbe optic thalamus and the adjacent centre of the
internal capsule, almost at its lower part; whilst in the right
hemisphere it was found to implicate the lenticular nucleus
of the corpus striatum (especially its middle and posterior
portions), the middle of the internal capsule with the
posterior part of its anterior division, and the external
capsule. Thus it will be seen that the symptoms were due
to two lesions which were almost symmetrically situated in
each hemisphere. The diagnosis from bulbar disease was by
no means easy, and practically rested alone upon the history
of distinct hemiplegic seizures; but it must be borne m
mind that there was no account obtained of a right-tided

DR. D. DRUMMOND ON CEREBRAL LESIONS.

[Jan. 1,1887. 13

Ed. H

1 am inclined to think that the lesion in
iere was not followed by hemiplegia proper,
paralysis of facial and hypoglossal nerves,
paralysis developing later. This opinion is
fact that the lesion was an old-standing
rhiist the paralysis of the right arm and leg
a few week8 before the case terminated,
probability, to an extension of the softening
rnrhood of the primary lesion.

i mated Cerebrospinal Sclerosis ; Glycosuria.
boy, aged eight years, first came under
July, 1885, for headache and a stagger-
waa stated that he had been ill for three
was neither vomiting nor optic neuritis,
i slow and hesitating. There was very slight
>arms, but no pronounced paralysis or either
extremities, and the legs were free from
was no nystagmus. The urine was normal;

. however, it increased in quantity, and sugar
•wmd..Dbout this time be became gradually blind, and
tWfea jtfew white. The aaditory nerves also became
deafness The legs grew very feeble, but
flaccid, though the knee-jerk was increased,
before his death, which occurred thirteen
.‘the onset of the cerebral symptoms, the patient
I to bed with paralysis of both arms and legs,
1 tl|| former were affected to a slighter degree. His
1 towards the end grew very feeble, but diabetic
coma wcfjipe made its appearance. At the post-mortem
did wMinoomplete, as it bad to be made in the patient’s
Emm u»4pi rather trying* circumstances, the body was seen
to ha manedly amaciated. The brain weighed 4fi oz. The
bMal articles ware normal, but the small vessels of the pia
congested. The convolutions were flattened,
the posterior parts of the hemispheres were
• anterior. Sections exposing the upper part
(ganglia revealed in the white matter symmetri-
1 patches of sclerosis, which passed backwards
■ the middle of the optio thalami on each side.

areas were very extensive, and were found
i occipital lobes to a marked degree. The grey
normal. Nodules were found in the upper part
(cord, and one was observed in the white matter
• .hemisphere of the cerebellum, whilst another
medulla, appearing on the surface of the floor
itride about its oentre. The spinal canal

to the Head; Chronic Meningitis; Ven-
\: Minute Haemorrhage in the Upper Part
famrth Ventricle; Diabetes.—k boy aged seven
1-into the infirmary in a very emaciated con-
_ of great thirst and other symptoms of
^^b W^sstated that he had received a blow on the
_ «%or five months previously, and that he had
over since from headache. The urine was full of
o igw . Bs in a state of diabetic coma two days
after his admnnoa; At the necropsy the body was
foaad'gSfStlj vaeted and post-mortem rigidity very pro-
■n a nre iL- ns stomach was considerably dilated, and its
vaBs were very th y, The liver was pale, but a large
qusmtity of blood poured out from the cut veins. Brain:
Tbs dura mater war strongly adherent to the upper part of
the occipital bean There was a slight amount of sub-
amefcnoid effosk*?. The pia mater beneath the cerebellum
was much thickened and congested, especially the portion,
focmfeg the rodf^f the fourth ventricle. The lateral ventricles
■ Mt i M ated anttoontalned fluid. The iter e tertio ad quartum
r m tyle n lam W^g bhasider&b]y dilated, and the usually
. surface MAe floor of the fourth ventricle presented

number
r sas mfcBa g the
■o dmrstteristic oT
oeCMtted the can
aad ffwa above
Cams *. TvmMtr
xitk Rotatory
triouSar J3Tus:

p->» fiW

glistening elevations, the whole
glass appearance of the ependyma
* paralysis. A small haemorrhage
4 mm. above the linese transversa
us scriptorius.

Ltft Cerebellar Lobe ; Convulsions,
from Left to Right; Ven-

i .— Henry M-, aged seven

the infirmary complaining of
years’ duration. Twelve months
■ L * the symptoms vomiting and
appearance, and the attacks
mate severe. On admission
Sphere occipital pain, which
the height of which he gene¬

rally vomited. The knee-jerk was absent. The optic
discs were markedly atrophied. There was no nystagmus,
nor was there any retraction of the head. The urine
contained sugar, but not in large quantities; the specific
gravity was.never above 1025. The day before his death
two fits occurred; he lost consciousness during the con¬
vulsions, and each time rolled from left to right. At the
necropsy the body was found to be well nourished; rigor
mortis marked. The head only was examined. The convolu¬
tions of the convex surface were flattened. The veins were
full. The pia mater covering the pons was thickened. The
optic nerves were greyish and firm/ The lateral ventricles
were considerably dilated, and contained fluid. T1 e veins of
the ependyma were distended. The left hemisphere of the
cerebellum contained a firm tubercular growth the size of
a walnut. This tumour extended slightly over the middle
line to the right side, and to within half an inch of the
lateral surface of the left. The effusion had evidently
reached the fourth ventricle.

Case 5. Complete Hypoglossal Paralysis depending upon
a Lesion in the Left Internal Capsule— A labourer, aged flity,
had what was described as a “stroke” three months before
lie came under observation. Consciousness was not lost in
this attack, and the only result was paralysis of the right
side of the face, with inability to protrude the tongue, and
'difficulty of articulation, so that his friends did not under¬
stand what he said. Seven weeks subsequently he had
another attack, in which hie face became more profoundly
paralysed and his right arm and leg were affected. He wai
now, it was stated, deprived completely of his speech. On
admission into the infirmary the right leg and arm were
almost helpless and l*te rigidity was commencing. The
right side of the face was also paralysed, and the power of
protruding the tongue was lost. Even efforts such as are
wont to arouse automatic tongue movements failed—such,
for example, as holding a lozenge near his lips, and at the
same time showing him what was required of him. For
some'^eks he,lav in this condition; but by degrees the
generi nutrition failed, the tongue as it lay in the mouth
became foul and covered with a thick dry crust, and he
began to refuse food. In a short time he died, without the
development of any further seizure. At the post-mortem
examination a considerable quantity of fluid escaped when
the dura mater was opened. The superficial veins of the
hemispheres were much congested. The arachnoid was
cloudy, and enclosed some serous effusion. The basal vessels
were much degenerated—viz., the vertebrals, basilar, pos¬
terior cerebrals, and especially the middle cerebrals. The
lenticulo-striate branch of the left middle cerebral was
completely blocked and thrombosed. A patch of softening
was found occupying the posterior part of the caudate
nucleus and adjacent anterior portion of the optic thalamuf,
as well as the central division of the fibres forming the
internal capsule. The right hemisphere appeared to be free
from disease.

In this case the aphasia scarcely corresponded with
Lichtheim’s published views on the variety of aphasia that
results from a lesion of the afferent fibres connecting the
“ speech centres ” with the medulla, 1 inasmuch as the
patient had not quite lost volitional speech or the power
of repeating words. He could always, for example,
when asked his name, mumble it in such a fashion that
anyone familiar with its sound could recognise the attempt
at articulation, and efforts were made to reply to other
questions in the same imperfect manner. The case is im¬
portant as showing that the impression that “a bilateral
lesion is required to produce paralysis of the motor organs”
(of speech)—to quote from a recent writer- is not always
the case, for in this particular instance bilateral move¬
ments of the tongue would appear to have been excited by
innervation from the left hemisphere alone. ,

(To b* concluded.')

1 Brain, January, 1885, p. 449.

Manchester Royal Infirmary.^-A n addition has
just been made to the collection in this infirmary of
porlraits of distinguished members of the medical pro¬
fession, by the presentation by Mr. Charles Jordan of
memorial busts of two eminent surgeons, Charles White and
Joseph Jordan, who did much during their lifetime to
advance the importance and value oi the charity to the
city.

A 2

1«4 Th* liANCTfr,]

MR. J. G. SMITH: REMOVAL OP A CANCEROUS UTERUS.

[JAW. 1,1887.'

CASK OF

SUCCESSFUL REMOVAL, PER VAGINAM,
OF A CANCEROUS (AND PREGNANT)
UTERUS.

By J. GREIG SMITH, M.A., F.R.S.E.,

SURGEOX TO THE BRISTOL BOTAL INFIRMARY.

The patient, a well-nourished woman, aged thirty-four,
was admitted to the Bristol Royal Infirmary in September,
1886, with characteristic and well-marked signs of uterine
cancer. She had had eight children (twins on two occasions),
and her frequent and excessive haemorrhages had been
attributed to miscarriages. It is very probable that she had
had miscarriages; indeed, it was suspected before operation
that she was pregnant, though bleeding had been almost
continuous up to the date of admission.

The epitheliomatous growth was for the most part con¬
fined to the cervical canal. Hard cauliflower granulations
sprouted from the os, and the whole of tne posterior
lip was occupied by nodular growths, which bled freely
on being touched. The vaginal portion of the cervix,
and the growth in it together were in bulk about
as large as a tennis-ball. The contiguous vaginal
surfaces were healthy; the uterus was freely movable,
though it was considerably enlarged (the sound entered
foiir inches); signs of implication of glands, broad liga¬
ments, bladder, or rectum were absent; and the patient was
in good condition, though ansemic. Gn the whole, it seemed
to be a suitable case for operation. The decision was not
definitely to remove the whole uterus, but to begin as if
for supra-vaginal amputation, and, if this operation did
not seem radical enough, to perform total hysterectomy.
The first steps of partial amputation, as I perform it, are
identical with the first steps of total amputation. When
the cervical mucous membrane is detachwl the finger oan
reach as high as the internal os outside, and, being in actual
contact with uterine fibres, can diagnose the condition with
accuracy. Pregnancy would have little influence either
way; probably its existence would favour complete removal.
After partial amputation abortion would take place, and
the bleeding and discharging woald add to the patient’s risk.

Preliminary cleansing of the parts was carried out for three
days before the operation, and immediately before operating
the whole of the genitals were washed with 1 in 20
carbolic lotion. The patient was placed in the lithotomy
position. The cervix was caught in strong vulsellum forceps,
which -Were entrusted to an assistant, who pulled down the
uterus, and manipulated it according to direction. The
mucous membrane surrounding the cervix was divided all
round by scissors at a safe distance from the new growth,
and was dissected upwards by scissors and fingers, catch
forceps being placed on bleeding points. As high as dis¬
section could be carried without entering the peritoneal
cavity induration was felt in the uterine tissue; it was
therefore decided to remora the whole organ. The
periteneum behind was perforated by the finger close
to the uterus, and enlarged laterally by tearing. In
front the peritoneum was opened by pushing a Lister's
sinus forceps through it; close to the uterus, and the
opening enlarged sufficiently to admit the finger by sepa- >
rating the blades. The finger, inside the abdomen, readily j
tore the peritoneum from the uterus close down to the ;
broad ligaments. I then endeavoured to hook the finger
over 'the top of the broad ligaments so as to place on \
them the clamp forceps which 1 had some time previously
devised for the purpose. But the ligaments were so
much elevated by tne enlargement of the uterus that
I could not reach high enough; and, besides, they were so ,
voluminous that the clamp could not have efficiently grasped j
them; 1 therefore proceeded to sntevert>the uterus. This
was done by taking successive grips of its anterior surface
by means of powerful catch forceps, .placing one above the
other, and so gradually, and completely anteverting the ,
Whole organ. A. sponge had been previously placed in the •
.'abdominal cavity,through the posterior opening to keep the
-bpwels out of the way and absorb any fluid that might be
off used. .' The fundus now lay between the labia, distending .
the vagina. By dragging, it co one'side and retracting the ;
labia the top of oner of the broad ligaments could be brought ,
within reach. A powerful Wells’* for^ps was made to grasp

as much as possible of the ligament (including the Fallopian
tube and round ligament of course) dose to the uterus.
A corresponding depth of the ligament was then caught 1
in a silk ligature at a distance of about a third of an
inch from the forceps and divided between. This division
enabled the uterus to be drawn down a little further.
Three other ligatures were successively placed in the
same way, and one side of the nterus was thus fixed,
the catch forceps being left on the uterus. The same¬
proceeding was then carried out on the other side,
and the uterus was removed. Th'e vessels in the broad
ligament Were very large and very numerous, and it was-
deemed wise to leave the catch forceps attached to the
ligaments where the vessels were most numerous, so as to
give extra security against haemorrhage. These were
removed after twenty-four hours. The sponge was now
removed from the abdominal cavity; a clean sponge re¬
introduced removed all blood clot, and at the same time
palled the peritoneal flaps downward over the mucous flaps,
so that the rawed surfaces lay in contact and the serous
surfaces were apposed. No stitches were used. The
vagina was Anally cleansed; iodoform powder was insuffla¬
ted, and pure boroglyceride smeared all over the external
parts. A small plug of iodoform wool in a fold of carbolic
gauze was placed in the vagina to fix the forceps. The
operation occupied about forty minutes.

Next day the vaginal plug was taken out and the forceps
removed. In the track Of the forceps an ordinary glass
drainage-tube was carried inside the abdominal cavity, the
end lying outside the vulva. By means of an irrigator the
cavity was washed cut through the tube with warm boro-;
glyceride solution every six hours. Before each cleansing
the urine was drawn off; then the genitals were washed, the
tube isolated with sal. alembroth wool, and plugged with a
roll of wool, which at onoe acted as a capillary exhauster
and as an antiseptic. After four days the tube was removed,
as there was no discharge; but vaginal irrigation was con->
tinued for a few days longer.

The patient’s reoovery was most easy and straightforward.
On the second day there was some tympanites, which was
relieved by a turpentine enema. On the third day a saline
purge was given, followed by another enema, and thereafter
tympanites gave no trouble. There was no sickness. Her
progress was, in fact, as rapid and as satisfactory as that
seen after an ordinary ovariotomy. • . . .

The uterus, on bisection, was found to contain two
foetuses and their membranes, about six weeks or two
months old. Bat its measurements were larger in propor¬
tion, as might be expected. The Cancerous growth in the
cervix was much crushed by forceps, and the fundus and
sides were also compressed and flattened by instruments, so
that the measurements were inexact. Roughly its length was
about seven inches, the otherdimensions being proportionate.
The disease extended up the whole of the cervical,, cavity,
and abutted on the foetal membranes.

Appended is a drawing of the forceps Which Weiss made

for me some months ago for the purpose of clamping the i
broad ligaments. It consists of two grooved blades, which
lock over the top of the broad ligaments, and are tightened
by a Bcrew at the end of handles which lie in the vagina and .
pass outside the vulva. On the inner aspect of the clamp
grooves are placed to carry a small knife, with its edge set 1
obliquely to the handle. When pushed up the grooves it
cuts the broad ligament away from the uterus. The J
clamps, one on each side, are placed and tightened, and
when the circulation is thus completely stopped the uterus
is cut loose by simply pushing the knife up the grooves on
the clamp, first on one side and then on the other. The
compressing edges of the clamps are deeply slotted to pre¬
vent the possibility of their slipping; elsewhere they are
rounded and smooth so as to avoid irritation of peritoneal
surfaces. It matters little whether the anterior or the
posterior blade is first placed; only the grooves must be
placed towards the uterus. • * : .V,

It ,has been abundantly proved that crushing dir com¬
pression maintained for forty-eight hours on vessels the size
of the uterine arteries is efficient and trustworthy for per-

O

Tkb Lawcbt.J

DE. F, E. FAIBBANK ON ACUTE DIFFUSED MYELITIS.

[Jan. 1, 1887. 15

m&nent haemostasis. The instrument is intended to avoid
the chief difficulty in kolpo-hysterectomy—the applica¬
tion of ligatures to the broad ligaments. It also Venders the,
operation an extremely easy one. On the dead body it is
possible to remove the uterus in five minutes and leave the
parts in a satisfactory surgical condition.'

Remark *.—The latest statistics of kolfco-^bjrsterectomy
show, in a total of 350 cases, a general mortality of about
>20 pet cent. This mortality is steadily decreasing; In the
hands of specially skilful operators the percentage of deaths
is under 10; indeed, a hundred cases could be gathered as
representing the whole of the operations of four men, with
a death-rate of only six. Brennecke and Schede can show
records of 18 and of 16 operations respectively, all success¬
ful; Fritsch has lost 2 out of 24; Martin is well through
his second 50 operations, with a mortality under 9 per cent.;
and Sanger, with a few others, have almost equally brilliant
results.

The amount of literature which has accumulated around
the operation is truly enormous. The variations in details
are very numerous and very confusing; but unessential
details are being eliminated, and the methods are now
.settling down to a few definite practices which are fol¬
lowed by the most noted operators. The essential details
in the operations I would shortly describe as follows:—
1. Thorough preliminary cleansing of the accessible genital
parts. This ought to include the vulva and labia, as well as
the vagina and cervix, and ought to be particularly exact in
the deep sulci of the external parts, which are so liable to
harbour filth. 2. A bladder and rectum perfectly empty and
collapsed. A sound in the bladder is quite unnecessary.
The forefinger, after a little practice on the cadaver, can
readily feel and recognise the bladder wall, and easily dia¬
gnose its relations. 3. Circular denudation of the mncous
membrane surrounding the cervix, and separating it, close
to the uterus, as high as it will go without force. 4. Per¬
foration with finger or blunt instrument of the peritoneum
behind and in front of the uterus, and close to that organ.
If a blunt instrument is used the bowels cannot be wounded,
and if perforation is made close to the uterus, the rectum
cannot be wounded behind nor the bladder or uterus
in front. The peritoneum is to be separated from the uterus
laterally as far as the broad ligaments, and no further.
5. Efficient surgical haemostasis of the vessels in the broad
ligament: This may be done by temporary foroipressure, or
by compression instruments such as those -I propose, the
uterus being cut away between them. If deligation be
decided upon, inversion of the uterus renders the method
easier. Silk is a trustworthy ligature, and simpler of appli¬
cation than any other. 6. Apposition of serous and of raw
surfaces. This may be effected by : simply pulling out of the
abdomen into the vagifca a sponge placed there at an early
stage of the operation; stitches are unnecessary, as the
parts lie naturally in apposition. This arrangement of flaps
permits of free drainage from the peritoneum, and from the
denuded surfaces back into the vagina. 7. Abdominal
drainage per vaginam for a few days is expedient, if not
necessary. If clamp forceps are used drainage may be dis¬
pensed with. A simple straight tube is quite efficient*

Bristol.

NOTES OF A

CASE OF ACUTE DIFFUSED MYELITIS;
RECOVERY.

Bv F. B. FAIBBANK, M.D., L.E.C.P. Lond.,

SITMEOX TO ran BOKCWTBB 0KNKKAL UmRMAHV.

Diseases of the spinal cord are now attracting so much
attention that the notes of the following remarkable case
may be perused with interest. It is probably seldom that
recovery—complete recovery—takes place in so severe an
attack as that which is the subject of these notes. The
absence of the complications in the chest and on the surface,
which so commonly occur in cases of myelitis, was greatly
due to the high character of the nursing which the patient
was fortunate in receiving. Shewas unable to lie on her
side on account of .the-pain which it occasioned. She was
therefore kept with her shoulders raised as much as possible,
and moved frequently. The nates were, carefully protected
with pads of eotton-wool, and the utmost cleanliness was

observed. At one time the paralysis was so complete that
she was unable to' move any part of her body, and the re¬
spiration was of the shallowest possible character. Careful
iuquiry elicited an exposure to cold as the cause of the mis¬
chief. But there was no reason apparent why the spinal cord
should specially suffer. Much care was taken with the use
of galvanism, and its effect on the patient was carefully
watched; 1 have seen much mischief occasioned by the too
early use of it in cases of myelitis. The notes appended by
Dr. Clifford Allbutt, who saw the case with me, and by Dr.
Gowers, who has been kind enough to criticise the case from
my notes, will be read with interest

Miss --, aged sixty-five, was first seen on Oct. 25th,

1885. A short, spare woman, hair white, of a kind disposi¬
tion, cheerful, and thoughtful for others. Has enjoyed
good health; father suffered from gout. Called me in to see
her for pain in the lower end of the oesophagus on swallow¬
ing, “ as if something had stuck in her throat.” There were
symptoms of subacute gastritis. In the course of three
days the gastric symptoms were relieved, but the pain on
swallowing remained. Bight sciatica now came on, followed
next day by extension to the left side, and the, day follow¬
ing she faltered in rising from her seat. I sou nded a note
of alarm, ahd requested a consultation with Dr. Clifford
Allbutt. She rapidly became much worse. The legs became
paralysed, the arms painful down the course of the main
nerves, the breathing shallow, and there was a feeling as of
a cord being round tne waist and alstrifbund the legs. When
her legs were lifted from the bed they “ flopped about.”
There was great weakness of hands and arms. Bowels con¬
fined ; urine escaped involuntarily. The pain in the limbs
was much worse after movement. There was considerable
cerebral excitement.. My diagnosis was " spinal meningitis
—myelitis.” I gave her bichloride of mercury, iodide of
potassium, and cinchona. This was her condition when on
Nov. 3rd I saw her with Dr. Allbutt. We then examined
her together. She was able to say which leg was touched,
and felt the difference in succession when touched with
sharp points. When seen it was afternoon, and she
expressed herself and appeared slightly better than she had
been in the morning. This suggested to Dr. Allbutt the
idea that the case might be one of peripheral neuritis, and
inquiry was made as to the patient’s habits, with negative
results. But for this he would have diagnosed acute
ascending paralysis. The improvement was, however, most
transient. She rapidly got worse and could not raise
her head, and when it was raised it moved powerlessly
about. The patient’s breathing was shallow in the extreme,
and hurried. The pains in the limbs subsided as the para¬
lysis increased. The fieces had to be scooped out of the
rectum by the nurse. The urine would only flow through
the catheter when the body was firmly pressed by the hand,
t^ben either knee was touched she could tell the difference,
but if one was touched after the other she was not aware of
the change. When at the worst, she appeared unable to see
the night throngh on account of tbeinability to breathe. She
was then entirely powerless from head to foot. There was
extreme emaciation. I gave her dilute phosphorus acid,
ammon. carb., and cinchona, with a draught of hydrate of
chloral with bromide of ammonium at night, as she could
not sleep. Beflex contraction was lost at the knee and the
sole of the foot. From the worst point she gradually im¬
proved. The breathing gradually became deeper, then ah©
could swallow a little better, then, move a finger. Her
hands, as she improved, were held straight (unbalanced
action of extensors), and were stiff and tremulous, and felt
soft and puffy. She gradually got power of control over the
bladder; first she could empty it herself when the catheter
was introduced, then she could control the action of it. The
urine bad become muco-purulent; this improved. The legS
could after a time be moved, "after the nurse had worked
them abo’nt freely first.” Power returned in the flexors of
the legs before the extensors; the reverse in the hands. I
changed the modioine to bromide df ammonium With dkide
of zinc, with sleeping draughts of morphia and belladonna.
There had been no indication of lung mischief apart from the
paralysis. The temperature had not exceeded normal. There
was no facial paralysis. This report ie to Dec. lltb, 1886.

On Dec. 21at the report was as follows:—Can move her
left hand above her head. Able to sit on tbe edge of the
.bed with assistance. Has not passed urine involuntarily for
the last fortnight; it bos been drawn off by catheter. More
control over the rectum; faeces have not now to be scooped
out. Can raise her thighs to a right angle. Haa very

cV C

D

16 The Lancet,] ME. A. G. P. G1PPS: WOUND OP TENDO ACHILLIS AND ANKLE-JOINT. [Jan. 1, 1887.

little power over the muscles of the leg, and the feet fall.
When the front of, say, the left leg is rubbed, can tell which;
if the right be then rubbed also with the other, does not
detect any difference; then when the right is continued to
be rubbed and the left is let alone, is not aware of the
change. Has all along, with the improvement, suffered
from painful sensations over her body, which she has spoken
of as “ fidgets ”; these were almost continuous, but have
now changed into paroxysms, more severe while they last,
but with intervals of ease. Along with the bodily improve¬
ment her mind has become alienated, and her disposition
entirely changed. She screams at- the top of her voice
frequently through the night and day, and when told how
seriously this interferes with other people’s comfort, says
she does not care; it is nothing to her if they are kept awake
all night by her noise. As she has become able to move her
hands, &c , they have become subject to fits of uncontrollable
movement after voluntary effort. There has throughout
been no tendency to bedsores; very great care has been
taken to guard against this.

March, 1836.—Has had a long, weary time of it. Can now
walk about'her room ; at first with assistance, now without.
Can feed herself, and write letters with great effort. Has
still pain after movement, and general feeling of distress all
over ner body. Disposition again natural. Bowels usually
moved without enema, with a pill every other night. Has
severe pain after peg^iqg urine. Small quantities of pus
come from the vagina (there had been symptoms of a small
pelvic abscess which burst through the vagina). Legs are
plump again ; pain in the joints, knees especially, much less.
There had been considerable redness about the right patella.

The patient subsequently went on improving. Great care
was taken with the muscles to prevent degeneration—by
movement, rubbings, galvanism, &c. The medicines during
the later period of convalescence were nux vomica, arsenic,
iron, and valerian. Went away to the seaside and elsewhere
for change of air, and returned home by midsummer well.

My patient had the advantage of first-rate trained nurses
from the Leeds Nursing Institution, and I wish to acknow¬
ledge their care and faithful discharge of their duties, with¬
out which she could hardly have escaped the various
accidents which are liable to occur in such a case. From
time to time I reported her condition to Dr. Allbutt,
and ho has kindly favoured me with the following
criticism:—“As the later history of this remarkable case
unfolded itself, of course I gave up the idea of peripheral
neuritis. Ascending paralysis (so-called Landry’s palsy) was
set aside for several reasons, among others the profound
anaesthesia, the palsy of rectum and bladder with cystitis,
and the age of tne patient. It is clear that the disease in¬
volved the whole thickness of the cord, including the grey
matter, and was probably a myelitis— either an ascending
diffused myelitis, or a myelitis ascending in patches. In
any case the recovery is very remarkable. The symptoms of
returning health in the cord are full of interest.

Dr. Gowers, who has seen my notes, has kindly favoured
me with the following criticism of the case founded upon
them, which is too interesting and valuable to be omitted.
Dr. Gowers remarks on the absence from the report of
“some information as to the electric irritability of the
muscles at various stages, because this is an important
element in the diagnosis.” “The diagnosis rests between
true acute ascending paralysis and acute ascending dissemi¬
nated myelitis, and I should incline to the latter, partly
on the ground of the cerebral complication, which points
to either meningitis or to disseminated inflammation of the
cortex. Coincident cerebral and spinal inflammation is not
rare, while the brain functions are usually—it is said always—
unimplicated in true ascending paralysis. At the same time
no malady is sharply defined, and aberrant forms are met
with, differing more or less widely from the customary type.”

An Unhealthy House. — At the Nottingham
County Court a woman was reoently sued for the rent of a
cottage in Which she had resided. The defendant admitted
the debt-, but alleged that, owing to defective sanitary
arrangements, the place was unfit to live in, and she pre¬
sented a counter-claim for medical charges and funeral
expenses in respect of a child whose death was proved to
have been caused by an illness arising from defective drain¬
age. The judge gave judgment for the rent due, and
allowed the counter-claim, on the ground that the cottage
was not reasonably fit for habitation.

WOUND DIVIDING THE TENDO ACHILLIS
AND OPENING THE ANKLE-JOINT.

8UTUBE OF TENDON; RESULT.

By A G. P. GIPPS, M.R.C.S., &c.

F. S——, a carpenter, was working with an adze on
July 30th last, when the tool slipped and struck him over
the posterior and inner portion of the left ankle-joint. The
result was a transverse wound of about 1£ in. long, dividing
the tendo Achillis immediately above its insertion into the
os calcis, “ nicking” the edge of the tendon of the flexor
longus pollicis, and the corner of the adze entering the
ankle-joint. There was also considerable bleeding from a
branch of the posterior tibial artery, divided close to its
junction with the main artery. The patient was a very
muscular man and the cut tendon at once receded some
distance into the calf of the leg. He was as soon as possible
placed under theinfluence of chloroform, and, the parts having
been thoroughly examined, I made an incision two
inches and a half long at right angles*to the wound,
and parallel to the edge of the cut tendon, this being re¬
quired before it was possible to catch hold of the upper end
of the tendon. When this could be grasped by the fingers,
it was forcibly pulled down till it was almost in contact
with the lower end, when three silver sutures were passed
through both ends and secured by twisting. The wounded
vessel had previously been secured by torsion; the silver
sutures were cut off long. The whole wound and
joint were now freely syringed out with a solution of
perchloride of mercury (1 in 1000); the skin wounds were
brought together with silver wire, leaving only the lowest
portion of the wound open, through which were brought
the ends of the wires used to unite the tendon, and which
served for drainage purposes. The whole wound was well
dusted with iodoform, covered with a pad of lint wrung out
in the mercurial solution, and the joint surrounded with
absorbent wool. The limb was placed on a metal back
splint extending above the knee, and the foot secured to the
foot-piece in a state of extreme extension, and the patient
put to bed.

Aug. 6th: Wound dressed for the first time since the
operation (a week). The lint over it was found dry, the
wound quite aseptic, and no discharge of any kind present.
The upper part of the wound was healed, and all the wires
in position. The solution of perchloride of mercury was
again used, the wound dusted with iodoform, and the whole
replaced as before.—13th: Wound re-dressed. No discharge
of any kind. Except at the spot 'where the inner sutnres
project, both wounds have united entirely. The skin
sutures were removed, and as any attempts to get at the
sutures in the tendon- only produced a good deal of
bleeding from the newly-formed material, those were
pulled out as far as possible and cut off short,
the small unhealed point being dressed as before.—
17th: As the ship was going to sea, the foot was taken
down and readjusted, the foot being flexed in order to
stretch the tendon. Patient can move the joint himself,
and the reunited tendon can be felt in continuity as he
extends his foot. There is but little stiffness in tne joint
itself.- - 26th : The cicatrix being now firm, everything was
removed from the joint, and the patient told to work it
freely in bed.—31st: Patient up to-day, and commenced to
walk about. He has complete use of the joint as far as
movement goes in all directions, and complains only of some
weakness and a feeling at present of insecurity.—Sept. 9th :
Patient can now walk fairly well, go up and down
ladders, &c.

Remarks .—With regard to the temperature, the first two
nights it went up to 100°, being normal in the mornings.
On the third day it was normal, and remained so for tne
rest of the time. The bowels were opened on the eighth,
tenth, eighteenth, and twenty-fourth days, to avoid all pos¬
sible disturbance; after that they were allowed to act
naturally. With regard to the silver sutures cut off and
left in the tendon, so far no effect has been felt from them :
firm pressure gives no sensation of “pricking,” so they are
probably completely buried. The tendon has complete and
free play, and the wounded ankle-ioint its natural mobility.
The treatment by means of the solution of the perchloride
of mercury and iodoform proved completely antiseptic, its

I

i

i

CLINICAL NOTES.

[Jan. 1, 1887. IT

[easy preparation being a great boon in a
patient’s confinement to bed he was kept
lg cot by an open port.

<&liiurai flutes:

SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

THE CAUSE AND CURE OP A FORM
OF BACKACHE.

}ai£es Sawyer, Knt., M.D. Lord., F.R.C.P.,

U» TO THE QCKKS'S HOSPITAL, AlfD PBOFESSOB OF
IX IJUSEX’S COLLEGE, BIRMINGHAM.

the year 1881, in a note which was published in a
journal, I asked the attention of my
i form of backache which had not, so far as I know,
before. 1 I desire now to refer to this subject
i record that my further experience in practice
my previous remarks upon the point in ques-

symptoms are always important diagnostic
they are often clear therapeutic indications,
sensations backache is frequently a leading
also one which is pressingly dwelt upon by
backache there are divers forms. Dr. George
an able clinical lecture, and Mr. William
, practical memorandum, have drawn the atten-
profeesion to many of these. 1 But they have
oied a variety of backache in which the cause of
^traceable to the condition of the large bowel. I
i patients complain of a pain, aching, dull, and
Kter, and extending “right across the back.”
to point out its position, they indicate this by
hand m»hind the trunk and drawing the extended
“ jht across the back, in a transverse line, about
tween the inferior angles of the scapulae and the
This pain I venture to attribute to a loaded
lode I navecorrectly found its proximate cause
laudation in the large intestine. I have found it
1 the exhibition of an efficient cathartic. This
* is a concomitant of habitual constipation,
ly significant of the alvine sluggishness of
oas. In such a condition, as I nave stated
find aloes, given in combination with iron, to
beat molts . 1 We owe the valuable suggestion
; boa with aloes, when aloes is given for laxa-
, to the late Sir Robert Christison. He showed
tic property of aloes is much increased by
ttion witn sulphate of iron. Dr. Neligan, Dr.

r, and Dr. David Bell have confirmed this ex-
I pref e r socotrine aloes, and I give of it one, two,
tins in a pill, combined with a quarter of a grain
i of iron and one grain of extract of hyoscyamus.
should be taken every night. We must aim at
a fnH shine evacuation after breakfast. When
ttaartic is indicated, I usually employ the old-
Rochelle salt. This “goes ” well with tea, coffee,
)ne or two teaspoonfuls may be taken at breakfast,
large cupful of one of these beverages.

IE Of COCAINE POISONING. 4
By CL & Kilham, L.R.C.P., &c.

9th, 1886, at 12.10 noon, John B - accidentally

of aoeateerbydrochl orate in the form of solution,
was sefita&trith severe cramps in the stomach,
and. feeling of bursting in his head,
Ims of use of his legs, incoherence of
co o fin ion of Mn§, and drowsiness, but could
1 qoaMfetikijf reused. No delirium; appeared

l^oonwl. Feb. 19th, 1881.

. 12th, 1881.

, p. 48. Cornish Brother*, 1886.
irgfcal Society, Nov. 25th, 1886.

as if drunk, and got quite helpless. Brandy was given to
him, and he vomited after it, but only the remains of
food. About 12.50 he commenced sweating most profusely,
shirt Ac. being soaked through, perspiration streaming
down his face and body, and nis head steaming. Pupils
were normal and equal. No loss of taste. The sweating
lasted some time, and was succeeded by very severe pros¬
tration, shivering, and feeling of impending death. At
intervals the patient had severe cramps in the stomach, with
retching and vomiting of a quantity of clear mucus, which
relieved the pain. About 1.16 p.m. the pulse became inter¬
mittent (missing every fifth beat). This was accompanied by
cyanosis of the face, and intense feeling of suffocation over
the cardiac region. Relief was afforded by sinapisms. The
pulse varied from 80 to 86, never more, and became gradually
regular. About 1.45 p.m. he began to have cramps in the
legs and feet (especially on dorsal surface of right loot), and
tingling and numbness in both hands. Later on the pupils
became dilated. The vomiting and cramps ceased about
4 p.m. (unless food was taken), but the drowsiness, throbbing
of head, and prostration continued up to 6 p.m., when the
patient began to get warm and feel relieved. The improve¬
ment continued, and he could be moved at 8.30 p.m. There
was great weakness, with swimming of head all night.

Next day there was still weakness, continual vomiting,
a dry leathery feeling in the mouth, with loss of taste,
partial loss of power in the legs, and tingling and numb¬
ness of the fingers, especially of the right hand. These sym¬
ptoms commenced nearly thirty-six hours after taking the
cocaine, and most of them disappeared in twenty-four hours.
The loss of power in the legs lasted three days, and the
tingling and numbness of fingers longer. He was not able
to write a letter until the sixth day, as he could not feel the
pen between his fingers before. An emetic was at first given,
with sinapisms over the heart and stomach; afterwards
warmth and stimulants (principally oompound spirit of
ammonia).

Remarks .—The solution of cocaine had been made at
least twelve months, but appeared all right. The patient
was in the habit of taking ± gr. of cocaine for neuralgia of
the stomach. The dose taken was 4^ gr. of bydrochlovate
of cocaine. The official dose is up to f gr. Martindale, in
his book on “ Coca and Cocaine, &c.,” mentions two cases
where larger dosds were taken. In one case (of attempted
suicide) 23 grs. of cocaine were taken without “ seriously
iniurious effect.” In the other case 32 grs- of cocaine were
taken within three hours, but the symptoms varied con¬
siderably from those in the case under notice. The most
remarkable symptoms were the severe sweating, the intense

f rostration, and the intermittent pulse. The last symptom
have not seen mentioned before.

Sheffield. _

A CASE OF RETRO-QSSOPHAGEAL ABSCESS, CAUSING
DEATH BY PRESSURE ON THE TRACHEA.

By Philip D. Turner, M.B. Lond.,

LATE HOCSE-eUBGEOX, VICTORIA HOSPITAL FOB CHILD HEX.

I am indebted to Dr. Julian Evans for permission to
publish this case, which occurred at the Victoria Hospital
in April last.

T. H. M-, an infant, aged three months, had been

attending the hospital as an out-patient for some weeks for
congenital syphilis. It first came towards the end of March
with a strongly marked syphilitic ernptioD, which was
followed in the beginning of April by the appearance of
multiple subcutaneous phlegmons in the limbs. On April
19th there was an attack of dyspnoea, which passed off in a
few minutes. On the 22nd, as the mother was bringing it
to the hospital, the child was seized, according to her
account, quite suddenly with dyspnoea, and became of a
very dusky colour. 8be hurried to the hospital, where it
was at once admitted. There was, on admission, great
dyspnoea, with considerable retraction of the thorax; colour
very dusky; pulse rapid and feeble; voice not at all hoarse.
Hot fomentations were applied to the neck, and the child
placed in a steam tent. An hour after admission the re¬
spirations became more nnfreqnent and gasping, the colour
very bad, and the pulse scarcely perceptible. Tracheotomy
was therefore at once performed. After the operation the
child rallied considerably. The recession almost ceased
and the colour improved. About three hours later, however,
the breathing got worse, the recession increasing again, and

Googl

18 The LXncbt,]

CLINICAL NOTES.

[Jan. 1,1867.

a cold sweat appeared on the forehead, the patient becoming
very feeble. There waa not. an; greet difficulty in swallow¬
ing, and' tlpe child took milk and brandy 'With aridity. The
symptoms increased in severity, and death took place four
hours after the tracheotomy, and about six hours after the
onset of the dyspnoea.

- Necropsy.— Heart: Left ventricle contracted and empty.
Eight side flaccid and. distended with post-mortem clot.
Heart substance and ralvee normal. Longs: Marked emphy¬
sema of anterior margins and upper lobes. Lower lobes of a
dark purple oolour, devoid of crepitation; portions cut off
sinking readily in water. Liver about normal sire. Intra¬
lobular veins distended; substance rather tough. Spleen
about twice the normal size; friable, but somewhat tougher
than natural. Kidneys normal. On endeavouring to dis¬
sect out the trachea and oesophagus, the knife entered
dn abscess cavity on the right of the latter. On further
examination, it was found that there was an abscess the size
of a large walnut in the areolar tissue behind the oesophagus
and lower part of the pharynx. It had no distinct sac
posteriorly, being bounded by the bodies and transverse
processes of the vertebrae, no disease of which could be
detected. The abscess extended from the level of the
cricoid cartilage to within a quarter of an inoh of the
bifurcation of the trachea. On opening the larnyx and
trachea from the front, no disease could be found in them.
The tracheotomy wound was low, commencing about the
third ring of the trachea. There was slight flattening of
the trachea.

. Remarks .—The case appears worthy of record both on
account of the rarity of the condition as a cause of death,
and of the difficulty of diagnosis in consequence of the
low position of the abscess in the neck. A remarkable
feature of the case, also, is the almost entire absence of
dysphagia. The subject of retro-pharvngeal abscess is
treated at some length by Despines and Picot (“ Trait6 des
Maladies de l’Enfance”), who state that dysphagia is the
most prominent symptom, placing it before dyspnooa. The
dyspnoea might be referred to reflex spasm were it not that
it returned (with recession of the chest, &c.) after tracheo¬
tomy had been performed. Death was probablyimmediately
due to the condition of the longs See., as much, as to the
obstruction. No cause for the abscess wa9 discovered, so it
was probably dne to suppuration of the post-pbaryngeal
lymphatic glands which exist in infants, and are, according
to Bokai, the commonest cause of retro-pharyngeal abscess.
It is interesting to note that the child had suffered from
multiple subcutaneous phlegmons only a week or*two before
its death..

NOTE ON HYSTERECTOMY.

By Lawson Tait, F.R.C.S., M.D., &c.

Tins operation, which only a few years ago looked as if
we never should achieve with it; the success which alone
could justify its continuance, has .now, thanks to a large
number of small improvements, come within the limits of
ranking alongside the operation for removal of ovarian
tumonrs, and, according to my own recent experience, has
become almost as successful. It is strange that this success
should have been arrived at under conditions almost the
exact opposite of those which have contributed to our
success with ovarian tumours. In the latter it has been
the ligature and its displacement of the clamp which have
brought about our triumph. In the removal of uterine
tumours, on the contrary, it is the displacement of the
ligature by the clamp which has given us the great
success.

More than one writer in, your columns, in speaking of
these operations, has stated that the clamp devised by
myself some years ago forms the best method of dealing
with the uterine pedicle. This , for many reason? I think
still to be correct, but there is one reason which makes
Kieberle’e form of clamp much superior, and I have there*-
fore discarded my own instrument in favour of Kveberk-'st
I have, however, found it necessary to make in the latter
two very importantrmodiflcations, and these seem to 1 make
the instrument as perfect as anything we are ever likely to
possess. The difficulty with my own elamp is that its
power ia so enormous that it is difficult to estimate exactly
the amount of constriction which it is exercising and tfle

arrangement, therefore, becomes a difficult One to adjust,
specially if it has not been tightened enough, and haemor¬
rhage should set in a few hours after the operation. At
such a time only the nurse may be present, and nurses are
not to be trusted to tighten up my clamp. The modifica¬
tion, however, which I apeak of in Kceberl£’s instrument
is one which may he tightened by any nurse, even the most
inexperienced, without any risk.

The defects in Koeberl»5’a
original instrument are, first, a
movable head, which has an
inconvenient habit of dropping
off at most inopportune times;
and, second, the button upon
which the wire is fastened
necessitates a twisting of the
wire, which loses time and
makes it extremely difficult
and inconvenient to haul in
the slack of the wire, if that
Should become necessary. 1
have, I think, completely obvi¬
ated these two difficulties by
making the ecfew and the head
in one piece, and so arranging
it that the point of resistance
is at the end of the screw,
and not in a collar. The new
method of fastening the wire
is easily explained. It is exactly
on the same principle as the
cleats of a Canterbury hammer
arranged forwitbdrawing nails.

There are two cleats right and
left, the wire is firmly bitten in
each of them, no loop being in the least necessary, and a
slight turn of the wire outwards renders this fastening
absolutely secure. I am now in the habit of removing the
clamp arid wire on the third or fourth day, leaving the
pedicle entirely to the care of the needles, and this enable?
the dressing of the stump to be much more easily effected.

Birmingham. __________________

% Ulirrmc

or

HOSPITAL PBACTICE,

BRITISH AND FOREIGN.

Nullaautem ast alia pro oerfco nosoendi via, nisi quamplurimaa et mor-
borum et dUsectionura historias, turn aliorum turn propria* eollec ar-
habere, et inter se oomparare.—MoRaaOifl De Sed. et Cant. Morb.,
lib. iv. Proasmium. --

LONDON HOSPITAL.

A CASK OF GKNBRAL TUBBBCCI.03IS ; NECROPSY ;

' ' REMARKS.

(Under the oare of Mr. Frederick Treves.)

The following case of general tuberculosis will be found'
to present several points of considerable interest, and is a
good example of a form of the disease. We would draw
attention to the remarks by Mr. Treves, especially to those
bearing on the etiology of some forms of tuberculosis, the |
condition of the spine, and of the right knee-joint.

The patient, a young man, aged nineteen, was admitted'
on Sept, 30th, 1886, suffering from disease of ifle right i
knee, paraplegia, and great emaciation, lie died on I
Dec. 6th, 1886. The account of the case can be simplified |
by commencing with a description of the post-mortem \
examination. ' • i

Necropsy. —The body was extremely emaciated. Five
large and deep bedsores had formed over the sacrum And |
tlie great trochanter. The former bone was bare. A i
lymphatic gland in the right groin and another in the left |
side of the neck had sloughed outpand had left deep ;, holes,..
fcurrounded by thin, purple, and Undermined skin. .There
waa a. general but slight enlargement of the cervical,. |
inguinal, and axillary glands. The right knee-joint was |
filled with pus. The cartilage Wte gone over t£ie inner hAlf
of the patella, and over both condyles of the femur.. It |
was fairly sound over the ,tibia. The bared bone was-

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Dii

HOSPITAL MEDICINE AND SURGERY,

[Jan. 1,1887. 19.

ligaments were destroyed. Remarks by Mr. Treves. — Without entering upon tha
was flexed, but not dislocated. The othet articula- vexed question of the pathology of tuberculosis, the case
as 11 the body were normal. The left epididymis was presents certain notable clinical features. In a patient

co r-d into a caseous mass. The left testis was nearlv disposed to tubercular disease a simple injury may induce

k is, and in the centre was a collection of thick and localise the first manifestations of the trouble. From

pi ' il. The light epididymis was caseous, but the this primary centre the specific affection may slowly spread

n, - appeared to be normal. Both the vesicul® to other parts of the body, assuming the mode of progress

sc ' ere blocked with caseous matter. A like of a very chronic type of pyaemia. It is allowed that in

a - xl occupied a considerable part of the prostate. The subjects predisposed to tuberculosis a simple lesion like
y :• r ip; ared to be in every respect normal. Both catarrhal pneumonia may be the initial local factor in pul-
fc were studded throughout with miliary tubercles, monary phthisis. Rabbits appear to be naturally predisposed
T • ant. r r parts of the bodies of the last two cervical and to tubercular processes, ana in these animals the long reten-
•J l • a dorsal vertebrae bad beendestroyed by caries, tion of a simple seton may induce tubercular changes that
-tebral discs had also disappeared to an extent in time become general and fatal. Moreover, if rabbits be

c ng to that of the caries. There was no anterior

i -r, indeed, was any real pus found in the vicinity

i-s. There was no angular deformity of the
The spinal canal opposite the affected dorsal
r- r- vos occupied by a soft caseous mass. By means of
:■ ir-1 had been compressed, and in this region it was
i -: ^t-atiy softened. Both lungs were studded through-
m iary tubercles. Here and there was a caseous
zest. : ere were no cavities, There had been slight
r.~y ■ >ld) on one side. The peritoneum covering the
xi m was dotted over with miliary nodules. It is
hat no other part of this membrane was affected.
and its membranes were normal, as were such
^ -ra a* have not been already referred to. ■ ■ '

history. —The patient was a native, of Windsor.
L. uth-jr and mother hied when he was young, and he
1 • nothing of the causes of their deaths. Of four

t ■ r- one only is living. Of the other three, one died of
« aff< ition, one of fever, and a third of abscesses. He
1 nt-ver been strong, and bad not been able to follow a
i- ,.•••. - lx »loyment. At the age of fourteen, when walking
t ..are .eet, a rusty nail penetrated the left great toe.
>: . - .v- - - resulted and discharged. The parts did not
1: . . .<1 at the end of four months the toe was amputated

a m 'Jtcarpo-ph&langeal joint. From this time the

l was never free from suppurative trouble.- A few
^ after the operation an abscess formed in the palm of

made to breathe on atmosphere charged with atoms of the
sputum from a tubercular patient (diffused by spray), and if
their joints be contused, those articulations may become
the seat of tubercular disease even when the lungs remain
unaffected. In the present patient the mischief appears to
have been induced by an injury to a toe, and I nave no
doubt that the subsequent changes in that part that led to
amputation were of a tubercular nature. From this
primary focus the trouble spread from one part to
another. Certain of the superficial lesions underwent spon¬
taneous cure. It is clear that the infection of the lungs,
kidneys, and peritoneum were the latest phases of the
disease. It is interesting to note that the vertebral affection
remained quiescent for nearly two years. The knee became
diseased after the onset of the paraplegia; it was never
injured, and had long been retained in a position of com¬
plete rest. The occurrence of joint affections in limbs, the
seat of nerve disturbances, is always a matter of interest.
It may be surmised that the paraplegia served to localise
the trouble in the knee, and that the relation between the
affection in the Cord and that in the joint was of a character
allied to that assumed by many to exist in the case of
Charcot’s joint disease. It may be observed also that the
weakness in the lower limbs bad commenced, on the light
side, and was more marked in that extremity until the
paraplegia became complete. One point remains: The
diseased knee was flexed almost at a right angle. The

lei: h id. Similar abscesses appeared at various parts knee disease had not commenced until the paraplegia wad
; ih- b<xly without intermission from this time. Before complete, and therefore the flexion must have beeninde-
_. Lcaltri another would appear, so that there were usually 1 pendent of muscular action. Its occurrence in a paralysed
pr - ;nt at one time. On admission there were two such extremity serves to illustrate Braune’s experiments of
>v— rs, - ne on the dorsum of the right hand and one on injecting fluid into the knees of post-mortem subjects.
- n-i k. fhey had all the characters ascribed to superficial These experiments show that the flexed joint can accom-
.i.Ur abscesses. Before his death the abscess on the modate more fluid than the extended one, and that disten-
uid Heal- d,.but another appealed.in the groin. Two years: sion of the cavity leads to flexion of the limb. The flexion
. ::.e \ .dent began to be weak in the legs aqd to expert-, in the present instance may be taken to represent that
- . m re ising difficulty in walking. There were no dis- produced by distension alone, for the articulation was filled
an >f sensation and no bladder or rectum troubles, with pus.

t i • body without intermission from this time. Before
c -al> another would appear, so that there were usually 1
t present at one time. On admission there were two such
a - ne on the dorsum of the right hand and one on
; n-> k. fhey had all the characters ascribed to snperflcial

: [.-reulat abscesses. Before bis death the abscess on the
i1 healed,. but another appealed .in the groin. Two years:
a. p : .-ient began to be weak in the legs aqd to expert-.
* .nert tsing difficulty in walking. There were no dis-
- stances >f sensation and no bladder or rectum troubles.
- became an in-patient of St. Mary's Hospital, where he

--—j thirteen weeks. Blisters were applied over the

donal spine, and be was sent out with a Sayre’s jacket and
ajwy -mast. He left the hospital quite well. lie wore the
aekc< for four months, and when he left it off he
vaa able to work. The weakness of the legs bad quite
disappeared. He remained well in this respect until April,
L88£.when the legs again commenced to feel weak. The
wibiess increased, and by July the patient had entirely
isA all power in both lower limbs. At the same time be
bsaaa to experience difficulty in retaining his faeces and

twrteen weeas. "listers, were appiieo over tne DEACONESSES’ INSTITUTION AND HOSPITAL,

l spine, and be was sent out with a Sayres jacket and 'rrvr-rr vir *

f-mast. He left the hospital quite well. lie wore the lu«nA.J .

t for four months, and when he left it off he cerebral embolism following parturition, tbrmi-
ible to work. The weakness of the legs had quite nating in haemorrhage into la teral

peered. He remained well in this respect until April, vbntriclb ; nbcropsy.

when the legs again commenced to feel weak. The (Under the care of Dr. Rdbch.)

S£$ .“1 th0 ,ollowing WB " ind6bted “

L to experience difficulty in retaining his faeces and Mr * Uoyd G. Smith .

h ^ C. C.-, aged thirty-three years, married, was admitted

tan admitted Into the London Hospital he was very on Oot. 26th, 1886. She complains of weakness of the upper
weak, and anemic. There was complete loss of power lower extremities on the right side and giddiness, and is
» lower limbs, but no loss of sensation. There was con- aphasic (of the amne eic type). The Ulness began two weeks

able loss of power in the right arm, but no anaesthesia. r , ... , r f ‘ _... . . „ v_. _»• '»,

H» p^ient hJlet control ov„ ephinctcr.. Lug. “ d *S°- “ er , fKh “ dl ^, oE * , h f ea !, a ? ec '

■ f| bad formed over the sacrum. The right knee-joint several members of her family are subject to fits. She is
disorganised and filled with pus. and wa> flexed nearly in comfortable circumstances, and of satisfactory habits.
atoMight angk-. A swelling had appeared in the left testicle Four years ago she was burnt and frightened by the explo-
sUt months p viou-iy, and another in the right testicle »ion of a fog-signal in the fire, which had got in among the
soam three mo - before admission. Fain was complained coals; this laid her up for two months. Has bad no previous
-jt y-— the upper dorsal spinous processes. The column in illness. Her present illness began three weeks after her last
tdhjiituariou was rigid, and presented a trifling projection confinement (ninth), which took place five weeks before
taPKrards, admission. The puerperium was quiie normal, and lasted two

.Abe case admitted of none but general treatment. The i .weeks. After being up a few days, she fell while walking
s&iat became weakeif and more emaciated. Hte tempera- 1 along the passage of the house (no known cause - supposed

along the passage of the house (no known cause - supposed

varied from 99 c to 108°*. He was the subject} of severe giddiness); was able to get up herself, and suffered no
m&t swrals, bat hadno. rigors. Heauffered occasion ail y. apparent Ui effect, but in four days afterwards she bad “a lit,"
tafcm diarrhoea. Ob Nov. 26th he developed a slight cough, ; the hands being clenched and the mouth drawn to the right
persisted unti) ihi^ .death. He died of increasing side. A streak of blood was seen on the lip. On recovery
on Dec. 5th. from the fit her right side was said to have been para-

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20 THJI LANCET,]

UOSPITAL MEDICINE AND SURGERY.

IJan. 1,1887.

lysed ; the face on that side had improved since, while the
aphasia remained stationary. Ha9 had nine children; no
miscarriages. Two children died, one of measles and one
of bronchitis. Labours and puerperia always noimal. No
specific history.

On admission she had a heavy and vacant expression, but no
paralysis of face. She was pale, and well developed, tending to
obesity; tongue protruded straight out, but with difficulty;
bowels constipated; no abnormal, physical signs in alimen¬
tary, respiratory, or circulatory systems. Temperature
100° ; became normal afterwards. Pupils equal; somewhat
dilated; no strabismus. Organic reflexes normal. Patellar re¬
flexes exaggerated on both sides. Slight ankle-clonus. Plantar
reflex absent on right side; marked on left. The grasp of
the two hands appears to be equally strong. Extremities of
right side redder and of higher temperature than those of
left. She attempts conversation, but is quite unable to ex¬
press herself; uses word} of few syllables only; time and
quantity appear especially difficult to express, her attempts
ending with “IIow stupid I am.” Is unable to write her
name, but begins first two letters correctly, and then says
she “can’t see.” The case was diagnosed to be one of em¬
bolism in the middle cerebral artery or one of its branches,
and the treatment was mainly expectant.

The patient’s condition remained as above until Nov. 4th,
when in the evening 6he became restless, imagined her child
was dead at home, and was depressed and emotional; had
a good night. On the morning of the 5th, while taking
breakfast, she became suddenly unconscious. The right side
was limp and motionless, while the left hand was raised up
to her face as if to wipe away something. Right eyeball
insensitive. Left ocular reflex normal. Pupils equal at first;
later on, right dilated and left contracted. Two hours after¬
wards the patient became unconscious, the face dark and
livid, and respiration ceased, the heart’s pulsation con¬
tinuing a few minutes longer.

Necropsy, seven hours after death .—Vessels of scalp and
meninges very congested. Large clot distending the left
lateral ventricle; an area the size of a walnut in the left
third frontal convolution near the posterior part and in sur¬
rounding part of brain, softened into a red diffluent mass,
witl\ vessels passing through it. In the middle cerebral
artery, at its origin, a large embolus was easily detected.
There was effusion of lymph at the base of the brain. With
the exception of a small blood cyst on the surface of tho
liver, all the organs (including the uterus) appeared healthy.
No signs of atheroma were found.

SOUTH DEVON AND EAST CORNWALL
HOSPITAL, PLYMOUTH.

REMOVAL OF THE UPPER EXTREMITY, AND LATER OF THE

SCAPULA AND PART OF THE CLAVICLE, FOR 8ARCOMA.

(Under the care of Mr. Paul Swain.)

For the following notes we are indebted to Dr. Buchan,
house-surgeon.

Louis G-■, aged eighteen years, picture-frame maker,

was admitted on Feb. 7th, 1886, for tumour of left shoulder.
The patient was a pale, delicate lad, much emaciated, with
an anxious expression. The family history and previous
pereonal history were good. He complained that six months
before admission be used to be frequently pinched in the
left deltoid by a fellow-workman. About two months
afterwards he first noticed pain and swelling oyer the
deltoid. This swelling had increased rapidly during the
following two months, with great increase of pain. On
examination (Fig. 1) there was a large firm swelling
involving the whole upper part of the left humerus, and
extending somewhat over the scapula and clavicle. The
humerus moved with the scapula, almost entirely. There
were enlarged veins over the tumour, but no glands were
involved.

On Feb. 11th, under methylene, a V-sbaped incision was
made over the scapula, as if for excision of that bone.
However, on cutting down to the joint, the humerus only
was found to be involved, and it was removed at the joint.
All arteries were tied with chromic catgut, the wound
dressed with iodoform and carbolic oil on lint, and a drainage-
tube inserted. Morphia and stimulants were freely used
from the time of the operation. On the evening of the
12th the temperature was 101'2° F., the highest point.

For the first fortnight the wound was dressed under the
carbolic spray, by which time it was practically healed.

The patient was discharged cured on March 13th, and
had no return of the disease. The tumour was a myeloid
sarcoma, arising from the periosteum and causing erosion of
the bone.

On April 22nd the patient was readmitted with a recur-
Fig. 1.

rence of growth in the left scapula. On April 24th, under
methylene, a V-shaped flap was made over the scapula
and the whole bone removed, together with the acromial
end of the clavicle. Wound dressed as before. A slight
skin slough formed at the lowest end of the flap, but with
this exception the wound healed rapidly. The patient was
discharged on May 27th.

Fig. 2.

After recovery from seoond operation.

Remarks by Mr. Paul Swain.—1 regret to say that some
weeks after his discharge from hospital the patient caught
a severe chill while boating. Pneumonia of the right lung,
set in, and he gradually sank. (The woodcuts are from
photographs kindly taken by Fleet-Surgeon Longfield
H.M.8. Royal Adelaide).

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TiiLucr,]

PATHOLOGICAL SOCIETY OP LONDON.

L Jan. 1,1687. 21

EDINBURGH ROYAL INFIRMARY.

• MSB OF TRAUMATIC TETANUS CURED BY REMOVAL OF THE
CICATRIX AND SURROUNDING PARTS.

trader the care of Mr. J. Montagu Cotterill.)

'iBOiGE McC--, aged thirty-nine, was admitted on

lug. 2nd with a history of having stabbed the ball of his
nghl thumb with a piece of broken glass on July 17th.
faun* began to manifest itself on the twelfth day after
the inflection of the wound, the first symptom being diffi¬
culty in mastication accompanied by pains in the back. As
the disease progressed rapidly lio consulted his medical
aUendut who treated him with Calabar bean (half a grain
o! the edict every three hours). In spite ot this treat-
matt Wing carried on for four days, the symptoms became
man tetteesing. He consequently applied to the infirmary
<or afore.

Tie nun’s condition on admission was as follows. Trismus
aw veil marked; deglutition was difficult; the muscles of
tfc face, neck, and back were in a state of rigidity; his
wts tottering, and he had to support himself with his
tmds to avoid falling. lie complained of considerable pain
a the face, neck, chest, and back. The tongue was moist,
write, and furred; the bowels costive. The temperature
vm slightly subnormal. There was a V'shaped scar, some
tires inches in length, bluish in colour, knotty, and painless
■v pressure, situated over the ball of the right thumb.

During the first few days of his stay in hospital he was
'rested by full doses of chloral and bromide of potassium.
Thu treatment certainly subdued for & time the intensity of
che symptoms, though ne had frequent spasmodic contrac¬
tions of the muscles of the back and legs. These spasms
coaid be induced at once by pressure over the ulnar nerve
•: the bend of the elbow on the affected side, though pres¬
sure over other nerves or over the cicatrix itself had no such
effect. The application of ice-bags to the spine was tried,
*<ct appeared to have a rather prejudicial effect than other¬
wise. The hypodermic injection of one-fifteenth of a grain
of eserine was next tried; this caused alarming cardiac
depression, which necessitated very free stimulation for some
The eserine seemed to have no effect on the tetanus,
and as increased difficulty in deglutition, more frequent and
more severe attacks of opisthotonos, and retention of urine
occurred, on Aug. 20th Mr. Cotterill freely excised the
cicatrix, taking away a considerable slice of the muecles
and skin in its immediate neighbourhood. The result was
mast satisfactory; the patient at once began to mend in
iH respects, and with the exception of one slight attack of
opisthotonos, brought on by the indiscretion of a visitor,
he made a rapid and uninterrupted recovery.

Remarks by Mr. Cotterill. —The interest of the case
mtres in the fact that though the operation was delayed
for twenty-two days after the tetanus set in, and though
the central nervous system was seriously implicated, the
nere removal of the cicatrix effected a rapid cure. Speaking
of this line of treatment, Fayrer* says: “I believe that
though this treatment would frequently be of service if
practised early, it would become pseless if resorted to after
the disease has become thoroughly developed for even two
or three days.” Science* also writes: “ If the operation be
p e r form ed at the very first before the symptoms have made
my very great progress, the result may be favourable; but
liter the disease has progressed - when the trismus and
<paems have become marked, or when the disease has passed
beyond stiffness in the neck and difficulty in swallowing,—
then amputation will do no good, as by that time the disease
has been propagated to the nervous centres.” On the other
hand, M. Nicaiee of Paris says: “ Neurotomy is especially in¬
dicated when the spasms begin near the seat of injury before
their generalisation; hut it may still contribute much to
recov ery when generalisation has occurred by removing the
cause which keeps up the spinal irritation.”* Brown-Sdquard
writes: “Those who maintain that tetanus, when it has
fairly begun, and attacked not only the head hut the trunk
tad limbs, cannot be cured by these operations (amputation
tad neurotomy), have not read the details of the cases

wMeh have been published.It is most important to give

the chance to the patient.” Amongst others, Mr. Annandale
has reported a case 4 in which a case of acute tetanus affect-

• CttnJeal S u re w y In India. * Lectures on Snrgery.

*l*Mrtea and Diseases of Nerves, In Asbhunt’s Encyclopaedia of
Sarpsy. * Edinburgh Medical Journal, 1873.

ing the whole system was cured by the free removal of the
cicatrix. In the case now reported, though not of the moat
acute form, the tetanus was decidedly severe, and, in spile
of energetic medical treatment, was becoming rapidly worse.
Its cure under these circumstances encourages one to operate
more hopefully even in what are usually considered un¬
favourable conditions.

jjtg frirail Sati eties.

PATHOLOGICAL SOCIETY OF LONDON.

Ulceration and Endocarditis of Right Side of Heart .—
Syphiloma of Heart—Rare Aneurysm of Undefended
Space with Cerebral Tumour of Brain (/ Syphilitic).—
Alcoholic Paralysis .— Ulcers of Stomach in Infantile
Tuberculosis.—Epithelioma of Bladder— Tumours of
Testes and Cord.

An ordinary meeting of this Society was held on the
21st ult., Dr. J. S. Bristowe, F.R.S., President, in the chair.
The next meeting will be the annual one, and the new Pre¬
sident is to be Sir James Paget, Bart.

Dr. Hale White exhibited a specimen of Right-sided
Malignant Endocarditis. It came from a man, aged thirty-
nine, who had been ill for four months with rigors. On
admission he was found to have a basic systolic bruit, audible
chiefly over the pulmonary area and conducted upwards to
the left. The rigors continued; the temperature, which was
not easily controlled, sometimes reached 105°. The diagnosis
of malignant endocarditis of the pulmonary valve was made.
At the necropsy the right ventricle was found dilated and
hypertrophied. The two anterior pulmonary valves were
ulcerated and perforated; a large mass of vegetations sprang
from the right one. The liver was fatty; the spleen en¬
larged ; but nothing else abnormal was noted.

Dr. W. Pasteur showed a specimen of Syphiloma of
Heart from a woman aged thirty, who was taken to Mid¬
dlesex Hospital in articulo mortis. She was probably a
prostitute. None of the ordinary sips of syphilis were
visible except in the heart. The liver had a peculiar
marbled appearance. There was some recent lymph on the
surface of the left ventricle, which was hypertrophied and
dilated. Greyish opaque patches of varying size and distri¬
bution were seen in the wall of the ventricle and septum.
At least one half of the ventricle was diseased. The right
ventricle was less diseased. The patches were ill-defined
and translucent at the edges. There were milky-looking
patches on the endocardium. Microscopical sections showed
infiltration of corpuecular growth, which was very vascular
at the margin; the nuclei were spherical and distended. In
some of the vessels of the heart doubtful evidences of pen-
arteritis were to be seen, and possibly also of endocarditis.
The liver showed numerous accumulations of small round
cells, like that met with in some forme of interstitial hepatitis
of congenital syphilis.—Dr. Carrington demurred to the
syphilitic view of the disease. Why could it not have been
an early case of fibroid disease of the heart ? The micro¬
scopical appearance in the liver was not evidence of
syphilis—Dr. A. Money said the specimens were just like
those seen in inherited syphilis of liver and heart, and
thought that this was in favour of the view that they were
syphilitic.—Dr. Barlow agreed with the last speaker. He
spoke of the macroscopical appearance being like that caused
by the action of strong carbolic acid on the heart substance
and endocardium. With regard to fibroid heart, he asked
what was so likely to produce it as syphilis ? There was no
evidence of old pericarditis, which was a common cause of
fibroid lesion of the myocardium. Alcoholism should also
be considered in this connexion.—Dr. Dawson Williams
mentioned a case which nearly resembled that described by
Dr. Pasteur. The patient was a boy aged thirteen, who
suffered from emphysema and died of bronchitis. At the
necropsy it was found that the heart was larce and heavy;
the pericardial cavity was obliterated over a large extent of
surface. In the substance of the heart were numerous
nodules. The nodules varied in siae from that of miliary
tubercle to nodules fully an inch long and half an inch
thick. The patient was an only child and had a syphilitic
aspect, and the mother had had miscarriages; bat there
j was no direct evidence of syphilis. The changes were sup-

O

22 Thx LlKQrt,]

PATHOLOGICAL SOCIETY OF LONDON.

[Jan. 1,1867.

posed at the time to be syphilitic, although the appearance
on section somewhat suggested sarcoma.—Dr. Sidney
C o upland adopted the syphilitic view because there was no
other alternative. He thought the resemblance of the
changes to those of inherited syphilis would not be sufficient
to remove them out from category of acquired syphilis. It
waa an infiltrating form, rather than the better Known cir¬
cumscribed lesions of syphilis. Alcoholism as a cause of
heart lesions was still involved in obscurity.—Dr. Goodhabt
argued from the liver to the heart. He had seen such ap¬
pearances in adults from syphilis of the acute form.

Dr. Angel Money showed a rare specimen of Aneurysm
of the Heart and large Tumour of the Brain, taken from an
idiotic female child aged five years. The aneurysm occupied
the “undefended space”; its walls were formed by the
opened-up lamina) of the septal cusp of the tricuspid valve.
All the valves of the heart were in a sacculated or “pouchy”
condition, and irregularly thickened. The tumour in the
right cerebral hemisphere was of the size of a small
orange, and probably gummatous; no bacilli had been found.
There were a few fibroid nodules in the right lung, and both
lungs were very small and flat. The child was micro-
somatic, weighed only 13 lb., and measured 31 in. The head
measured 18 m. in circumference and 12 in. over the vault
from ear to ear. The forehead Was almost covered with
hair. The child had never walked or talked, and could
not even sit up. The anterior fontanelle was still open,
and measured one inch and three quarters by one inch
and a quarter. There was a loud systolic murmur
heard over the prsecordia. -Dr. Bah low thought that the
tumour was much tougher than a scrofulous mass, and had
a firm chestnut section. The probable very early origin of it
was also in favour of syphilis; the evidence of foetal tubercle
was inconclusive. He had seen a specimen of undoubted foetal
syphiloma of the brain. The aneurysm was a unique specimen,
and had been shown as such by Dr. Wickham Legg in his
Bradshawe Lecture. The question of the origin of aneurysm
of the heart in syphilitic changes was a most interesting one,
that would repay study. A subacute endocarditis might
result from syphuis. He had seen only a second case of aneu¬
rysm of the heart in a child in the anterior wall of the right
ventricle about the size of a shilling; it was accompanied by
mitral stenosis; the syphilitic origin of it was doubtful.
—Dr. S. Coupland asked whether the aneurysm could have
had an origin in an error of development, but deferred to the
syphilitic view.—The President asked whether there was
evidence of syphilitic disease in the heart.—Dr. Money, in
reply, said the syphilitic history was inconclusive. He
adopted Dr. Barlow’s view that the heart changes might
have been of syphilitic origin, and possibly that this may
have arisen during intra-uterine life. The myocardium
showed no sign of congenital syphilis to the naked eye, but
it had not been examined microscopically. The presence of
bone-thickening in the skull favoured the syphilitic view.

Dr. Hadden described three fatal cases of Alcoholic
Paralysis. The first patient was a woman, aged twenty-
seven, who had been drinking to excess for at least four years.
For a year before admission her arms and legs had been
growing weak. The lower limbs were paralysed and wasted,
especially the .extensor muscles. The limbs were bent at the
knees, and much pain was felt on trying to straighten them.
Sensation was unimpaired. The knee-jerks were absent.
The muscles were tender, and gave no response to strong
faradaic or galvanic currents. There were evident signs of

r thisis. On microscopical examination of the spinal cord,
was found to be quite healthy. The myelin of the
peripheral nerves had broken up into a finely granular
material, and the axis cylinders were quite obscured. The
nuclei of the fibres were enlarged. The nerve tubes were
irregular in shape, enlarged in some parts, reduced in others,
in consequence of the removal of the granular material.
The muBaes showed an increase in the sarcolemma nuclei
tuid nuclei of the interstitial tissue. In some places there
ivrere groups of small round cells, which gave rise to local
•trophy of the fibres; slight granular change was seen in
some of the fibres, but as a rule the structure was good. In
another pat ren*. aged fwfcy-fqar, who had suffered from alco¬
holic paralysis for about a month, the spine', cord was found
-heflilthy, but the nerves exhibited mixed parenchymatous
And interstitial degeneration. The muscles were affected as
in the first case. The third case was that of a gentleman,

3 fed fifty-six, who had relapsed after a severe attack of
ooholic paralysis. lie wan admitted into St. Thomas’s
Hospital for a deep ulcer on the dorsum of the left foot,

opening into the small joints of the toe. He had well-
marked paralysis of the legs, with impaired sensation. In
this case also the spinal cord was healthy, and the nerves
and muscles diseased. There was well-marked phthisis in all
three cases. The results of five fatal cases were summed up.
The spinal cord was healthy in all. In four of the five the
nerves were examined and found degenerated, but in two
the change was rather that of a perineuritis. The muscles
simply showed increase of nuclei, and occasionally appeared
granular. In two cases the medulla was examined and found
healthy, and in two the motor convolutions were healthy.
The association of phthisis waa observed in four cases,
and in one the lung mischief was early. Dr. G. N. Pitt, Dr.
Finlay, and Dr. A. Money corroborated the statements of
Dr. Hadden in regard to the nature of the microscopic
changes in alcoholic paralysis.- Dr. Bbistowe asked whether
the changes obtained were more in the distal or proximal
parts of the nerves.—Dr. S. Coupland referred to the
occurrence of peripheral neuritis in association with
tubercular disease. Were the changes inflammatory or
degenerative? He thought rather the latter.—Mr. A. A.
Bowlby thought the term “neuritis” misleading, for the
changes were like those found in Wallerian degenera¬
tion.—Mr. H. T. Butlin said that sometimes the change
might be chiefly in the connective tissue of the nerve. In
a specimen of Mr. Savory’s there was but little change in
the parenchymatous part of the nerve ; the case was one of
perforating ulcers. The sensory fibres of the nerve were
smaller and more affected in some cases than the larger
motor fibres.—Dr. Hadden said that the changes probably
began in the smaller nerve fibres, and were less evident in.
the larger nerves, whilst the anterior roots of the cord were
usually free. He rather thought there were sensory
changes in some cases of alcoholic paralysis. A considerable
thickening of the endoneurium obtained in the sciatic
nerve in a case of locomotor ataxy that he had examined.
He opined that Mr. Butlin’s view might be correct, that in
some the changes were more interstitial than parenchyma¬
tous. He carefully avoiijed the discussion of the inflam¬
matory or degenerative nature of the nerve changes.

Dr. Barlow showed a specimen of Tubercular Ulcer in
the Stomach of a child, twenty-one months old, affected with
general tuberculosis. It was situate near the cardiac end
in the great curvature; had undermined edges, but no
thickening around. There were also follicular ulcers at the
mid-point of the great curvature, and two near the pylorus.
In the first ulcer there \yas a minute elevation under the
mucous membrane, whipli might have been a miliary
tubercle, but had not yet been searched for bacilli. The
interest of the case lay in the relation of the small tubercle
to the ulcer. Small ulcers of the stomach had been found
in adult phthisis. Louis said he had never once seen any¬
thing like tubercle in theqe, and Andral had only once found
tubercle of the stomach.. Of 146 cases of tuberculosis in
children, Barthez and Riuiet found 21 with the stomach
affected, and in 7 of these there were miliary tubercles.
They had no doubt that the ulcers were caused by tubercle.
He had seen two other cases of this kind, but not with
miliary tubercle in their base.

Mr. Bruce Clarke showed a specimen of Epithelioma
of the Bladder. There were two separate tumours. The
question was discussed whether the one tumour might
have been the cause of the other.—Mr. H. T. Butlin
mentioned a similar case.—Mr. A. Bowlby referred to
two other specimens in St. Bartholomew’s Hospital of
multiple growths in the bladder.—Dr. Hadden had seen an
epitheliomatous ulcer of the oesophagus associated with a few
other growths in the lower part pf the gullet.

Mr. Swinford Edwards . showed specimens of Tuber¬
cular and Malignant Disease of the Testis and Spermatic Cord.
The first specimen was taken from a man aged fifty; the
microscopical appearances Were doubtfully those of round-
celled sarcoma, and the growth was seen extending chiefly
along the vessels. The second specimen was from. a man
aged forty-five; it began as a painful nodule; the aeotion
was obscurely fibrous; it waa probably of a. tuberculous
nature. .There were no sign^ of ^ubercle elsewhere., The
.third specimen came fro?} a man aged thirty;, it a
round-celled sarcoma of the test!*—Mr. A. Bow lby referred
to the fat aad fibrous tissue appearance as of an inflammar
tory growth in the first specimen, which he thought was
not sarcomatous. . • , ...

The following card specimens were shown: - Mr. S. Peget:
Recurrent Epithelioma of the Foot." Mr. Shattock: Hammer

LLfcJKafcQ HARVEIAN SOCIETY.—MEDICAL OFFICERS OF HEALTH SOCIETY. {Jaw. 1* 1867. 2%

Toe*. Hr. Target*: Congenital Deformity of Hip. Dr. Beavan
Sake: Spontaneous Cure of Thoracic Aneurysm in a case of
An aesthetic Leprosy. Dr. G. N. Pitt: Round-celled Sarcoma
of Thyroid growing round (Esophagus and into Left Vagus
and Internal Jugular Vein.

^ ' [U l V , . HAJRVEIAN SOCIETY.

t.V’Iiiln ———

peripheral Neuritis. — Paraplegia in Pott's Disease .—
Pityriasis Versicolor. — Dyspnoea from Pressure of
Enlarged Bronchial Glands. — Chylous Ascites.

Ambbtino of this Society was held on Thursday, Nov. 4th,
1886, Dr. J. Hughlings Jackson, F.R.S., President, in the chair.
' Dr. Buzzard exhibited a patient who had been affected
with Paraplegia of neuritic and not of spinal origin. He was a
carpenter, and had been exposed to wet and cold in September,
1886. This was followed by pain: and weakness, in the right
side at first and then in the left, with some tenderness on
pressure. In three months’ time he had lost power to such
an extent that he could not walk ; he complained of* numb¬
ness and tingling, and the soles of the feet were tender.
Sometimes also he had tingling in the hands. When seen
hr March, 1886, he was able to get about on crutches, but did
not raise the toes in walking. The knee-jerk was absent.
The muscles in the front of the legs did not respond to a
very strong induced current, its application not being even
felt. The peronei acted slightly, the calf muscles still
better, those of the thigh reacting normally. Slight reaction
returned in the anterior tibial muscles, a stronger current
being required when the negative pole was placed on the
muscle. Steady improvement took place. There was slight
plantar reflex, but all the superficial reflexes were normal,
and the vesical functions were not in any way affected. All
portions of the cord, therefore, were probably intact. A large
quantity of urine was passed, which contained sugar.
Treatment had consisted mainly in the application of the
constant current. The patient could now walk a mile, and
was still improving. Dr. Buzzard pointed out that the
local pain and tenderness, the loss of electrical reaction and
of pain in the affected muscles, all combined to indicate
peripheral neuritis, while the presence of the superficial
reflexes was inconsistent with a lesion of the cord sufficiently
grave to produce the other symptoms.

Dr. D. B. Less exhibited a case for Diagnosis between
Peripheral Neuritis and Tabes Dorsalis.—Tne PrbsidhVt
thought that in all future cases the possibility of peripheral
neuritis should be borne in mind. He thought the new
name of neuritic paraplegia was quite justified as descriptive
of a fairly common class of cases.

Dr. Hughlings Jackson showed a boy, aged twelve,
recovering from a second attack of Paraplegia associated
with Pot ts Disease of the Spine. Ib e prognosis in such cases
was good when rest was enforced. He also exhibited a boy,
aged eleven, who had become paraplegic in Sept. 1684, in
consequence, it was supposed, of a transverse myelitis.
There was no discoverable disease of the vertebrae. He was
admitted into the London Hospital, in Jan. 1885, without a
trace of movement in the legs, and with extreme rigidity. Not
until Oct. 1885 was the slightest movement observed, and
then only in the toes. From that time improvement bad
been steady, but the boy could only now fust walk. Dr.
Hughlings Jackson remarked on the great length of time
during which a patient might remain paraplegic and yet
recover, sometimes as long as twelve months. He trusted
to rest in bed, not thinking that any drugs or local applica¬
tions to the spine had any beneficial effect upon the spinal
cord disease. He hoped at a subsequent meeting to show
both the patients walking well.

Dr. Sidney Phillips showed a. case of Pityriasis Versi¬
color in a child. The bov, aged seven years and nine
months, exhibited symmetrical patches of a fawn colour on
the chest and back. Scrapings from these examined micro¬
scopically were found to consist of mycelium and spores.
There was no ringworm of the scalp or any history of its
-existence.—Dr. Thin threw some donbt upon tbe diagnoais,
and pointed out that the disease was equally uncommon in
very old as well as in very young people.

Dr. W. Ewart exhibited a case of Dyspnoea with Metallic
h and Stridulous Inspiration. The patient, A woman
thirty-six, had Buffered from cough for ten months, at
first uncomplicated with dyspnoea. As the cough ; became
. more paroxysmal, the difficulty in regaining breath was pro¬

portionately increased. Inspiratory dyspnoea also followed
upon any severe exertion. The physical signs were dulness
in the upper sternal and parasternal regions (especially on
the right side), and dulness in the right iuterscapular/region.
In all these places there was tracheal breathing, and also in
the left upper interscapular region. The patient had had
syphilis, and might therefore be the subject of cicatricial
bronchial stenosis. This alone, however, would not explain
the presence of dulness, which was more probably due to
enlargement of bronchial glands, from syphilitic or other
cause, which were exerting pressure upon the bronchi, with
the above results.

Dr. Robert Maguire showed a case of Chylous Ascites, in
a man aged forty-two, who bad suffered from oedema of the
feet twelve months before admission into hospital, but this
had subsided with rest iu bed. Nine months later he was
seized with sudden pain in the epigastrium, whidh, though
less intense, lasted for five weeks. Two months later tnC
abdomen began to enlarge. There was history of alcoholism!
but not of syphilis,' and the patient had never lived out of
England. On admission there was general distensibn of the
abdomen with fluid, enlargement of superficial veins and of
spleen, but not of the liver. • Two hundred and twenty
ounces of milky fluid were removed by tapping. The fluid
was slightly albuminous, contained a large amount of fatj
and peptones, and did not coagulate on standing. Fat
globules, granular matter, and leucocytes appeared under the
microscope. In three weeks’ time 218 oz. of similar fluid
were removed; the fluid did not return, and there was then
discovered prominence in the epigastrium, with some
increase in the liver dnlness. (Edema of the legs still
remained. Dr. Maguire diagnosed cirrhosis of the liver ?
with some inflammatory material behind it, pressing upon
the vena cava and the receptaculum chyli, causing rupture
of the latter. It seemed very anomalous, however, /that
lymph, which ordinarily flows finder such very slight
pressure, should in these cases accumulate to such an extent
as to burst both the thoracic duct and the peritoneum.—
Dr. Ewart, commenting upon the case, believed that the
collective fdree exercised by the muscular coats of the villi
might be sufficient to cause the rupture, although, tha^
exercised in each individual villus was very small.

The following is a . list of the officers of the Society for
the coming year:—President: Mr. Edmund Owen. Vice-
Presidents: Mr. T. Bryant, Drs. Cavafy, Buzzard, and John
Williams. Treasurer: Mr. G. P. Field. Hon. Secretaries;
Drs. Clifford Beale and llandfleld-Jones. Council: Drs. W.
Ewart, T. Morton, Champneys, Hughlings Jackson, ,R. S,
Mair, R. H. Milspn, J. R. Walker, H. W. Page, J. Ernest Lane,
C. W. Mansell-Moullin, F. J. Marshall, and A. J. Pepper.

MEDICAL OFFICERS OF HEALTH SOCIETY. ,

At a meeting held at the Scottish Corporationllall, Crane-'
court. Fleet-street, on Friday, Dec. 17th, Dr. Alfred Hill*
President, in the chair, - -

Dr. AsHby read a paper on the ContagiouB Diseases
(Animals) Act, 1886, of which the following is an abstract:—■
The author began by pointing ont that the changes
effected by this Act in existing statutes had been rendered
necessary by the complete failure of the previous Act
to produce any effectual control of dairies and cow¬
sheds. He gave the provisions of the Oth section of t,nat
Act* which embodied the 34th section of the Contagious
Diseases (Animals) Act of 1678, and which alone affected
sanitary authorities. For the purpose of that section, the
Privy Council were replaced by the Local Government
Board as the central authority. Local authorities in the
metropolis were the same as formerly, and in other parts of
England and Wales they were now urban and rural sanitary
authorities. He pointed out that the wording of the section
only conferred on local authorities and their officers a right,
of entry to any premises between 9 a.m. and 6 r.w., for the
purpose of enforcing Orders and Regulations, and not for,
any other purpose, such as for examining as to the existence
of any infringement of Orders or Regulations. He stated,
that it would De convenient for the officers of the sanitary
authority most concerned with duties under the Act to r
obtain from the local authorities, under the Act of 1878, of'
their districts a general authorisation to enter any, premises
in which there was a diseased animal in an infected'
place. No officeA in particular were mentioned, but

84 The Lancet,]

MEDICAL OFFICERS OF HEALTH SOCIETY.

[Jak. 1, 1887.

the clerks of sanitary authorities 'would be concerned
with all legal questions or proceedings arising out
of the administration of the Act. Upon inspectors of
nuisances would probably devolve the chief part of the work.
Medical officers of health would have to advise sanitary
authorities on questions arising out of the enforcement of
Orders and the framing and enforcing of Regulations. They
would advise the inspectors whan in doubt, and exercise a
general supervision over the administration of the Act. In
the event of an outbreak of infectious disease, they would
have important duties to perform in making inquiries into
the causes of epidemics, and advising such measures as
might be necessarv to check the spread of disease through
contaminated milk. It would behove them to exercise much
tact in prosecuting such inquiries, for in the absence of it
great injury might be done to persons in the trade. A
surveyors advice would be necessary when important
structural alterations were contemplated. Should the work
prove to be heavy, the officers chiefly concerned might fairly
be entitled to extra remuneration, and, if required, addi¬
tional officers might be appointed. The Dairies, Cowsheds,
and Milkshops Order of 1885, and regulations made there¬
under, remained in force; those already made might be
adopted by the new authorities, but it might be deemed
advisable to revoke them and make new ones. Registers
kept by the authorities under the Act of 1878, or copies,
were to be delivered to the new authorities. The speaker
pointed out that there were no definitions of terms used in
the 34th section of the Act of 1878, except “ cattle,” which
meant bulls, cows, oxen, heifers, and calves. “Animals”
meant cattle, sheep, goats, and all other ruminating animals
and swine. Horses, asses, mules, and dogs were included in
certain Orders. “ Disease ” meant cattle plague, pleuro¬
pneumonia, foot-and-mouth disease, sheep-pox and sheep-
scab. Glanders, farcy, swine fever, anthrax, and rabies were
also included in certain Orders. The want of exact definitions
of other terms would cause doubt as to the interpretation of
parts of the Acts and Orders. It was much to be regretted
that this’defect had not been remedied in the Act of 1886.
It did not appear that any effectual provision had been
made to compel defaulting authorities to carry out the Act.
Local authorities had to deal solely with occupiers, and not
with owners. They could adopt any forms of register or
notice they pleased. _ They and their officers still had no
concern with contagious aiseases amongst animals, except
so far as related to milk from diseased cows. Cowkeepers,
dairymen, and purveyors of milk only were named in the
34th section or the Act of 1878. The Privy Council had
added much confusion by using in their Order of 1885, with¬
out definition, the further titles of “occupier of a milk store
or milk shop” and “persons selling milk by retail.” That
Order required every cowkeeper, dairyman, or purveyor of
milk to be registered. Every local authority had to keep a
register of such persons, and were empowered to make their
own regulations on specified matters. Dr. Ashby next
commented on the various articles of the order exempting
certain persons from registration,requiring certain provisions
for regulating the sanitary condition of new and old cow¬
sheds, and precautions to be observed against contamination
of milk. The milk from diseased cows, those ill with cattle
plague, pleuro-pneumonia, or foot-and-mouth disease only
might not be mixed with other milk, or be sold or used for
human food, or be sold or used for food of any animal with¬
out being boiled. It would seem desirable that the meaning
of “ disease ” should be from time to time extended so
as to comprise tuberculosis, scarlet fever, diphtheria, or
any other disease which might be observed to dangerously
affect the milk of cows. It might be thought that the
Local Government Board should have done this by order,
but they had not the power; only the Privy Council
could make such an Order under the Act of 1878. The
Local Government Board had issued the Dairies, Cow¬
sheds, and Milkshops Amending Order of 1886. It pro¬
vided a penalty for the enforcement of the Order of
1885. It would have been more acceptable if it could
have assigned a definite meaning, in default of the Act of 1886
having done so, to all the terms in the 34th section of the Act
of 1878, and in the Order of 1885, which had not been else¬
where defined. Dr. Ashby observed that it was incumbent
upon sanitary authorities and their officers to exercise these new
powers and duties with due regard to the enormous interests
involved, and whilst it behoved them to use all vigilance to
diminish human preventable diseases in every lawful way,
these remarkably trying times did not admit of landlords

and farmers, already hampered, being further harassed
through being called upon to reconstruct almost every dairy
and cowshed, as would be the case if too stringent regula¬
tions were made. Medical officers of health would be called
upon for advice in the framing of regulations, and it was
most desirable that in their laudable efforts to annihilate pre¬
ventable diseases they should not be led so far as to annihilate
the unfortunate cowkeepers and dairymen instead. The
general principles to be kept in view in framing regulations
were -.—They must adhere rigidly to the letter of the law,,
they might not go outside the matters in respect of which]
powershad been given for making them; they must not:
include anything specifically enacted in an Act of Parlia- (
ment; and they must not be of too restrictive a character;
or repugnant to the laws of England, but must be reason-,
able, certain, and determinate. The powers for making,
regulations specifically defined by the 34th section of the Act
of 1878 and the Order of 1886 could not be exceeded or departed,
from in any way. The regulations were of a penal character,,
and local authorities must not in framing them invent,
offences. In drawing up regulations, he would say be strong'
in things really essential for preventing disease; in other
things be less stringent. Although they might consider that
matters beyond those actually named in the Acts and Order
had a bearing on disease prevention, j et they might not be
comprised in regulations, because they would be ultra vires.
Since it appeared to the author that some of those points
had not been sufficiently kept in view in making regulations,
and that the powers of local authorities had thus been ex¬
ceeded, he proposed to consider the matters under the several
headings of the 13th Article of the Order of 1885, which
authorised regulations “for the inspection of cattle in 1
dairies.” Under that a regulation giving a general power '
of entry could not be made, but only one “for the inspec- 1
tion of cattle.” It might not provide for the inspection of 1
buildings or premises or animals, as the latter term would i
include something more than “cattle.” The inspection i
must be of cattle in “ dairies” only. That was a most un- I
fortunate term in the absence of any definition. It was i
evidently intended to signify a dairy farm, but he thought i
in most districts it would excite the risible faculties of
farmers if they were asked to allow cattle to be inspected in i
their dairies. The use of the term was due to the
wording of the Act of 1878. The speaker submitted a
set of regulations he had drawn up, from which he
bad endeavoured to exclude all the points he believed
to be ultra vires. It was difficult to conceive that the Legis- I
lature ever intended that such vast structural alterations |
as would be entailed by some regulations should be enforced
upon the owners of buildings already erected. Their powers
were not very satisfactory or well defined, and would
remain so until Parliament could spare time to amend such
a Parliamentary curiosity of literature as the ninth section
of the Act of 1886, and until the Local Government Board
should have defined, by Order, the terms in the Order of
1885, if they had power to do so.

The discussion was adjourned until the next meeting.

Sanitary Registration of Buildings.

At the adjourned meeting of the Society the President,.
Dr. Alfred Hill, again occupied the chair. The attendance
was not so large as on the former occasion.

Dr. C. E. Saunders read the report of the Council, which
was as follows “Your Council find themselves quite
unable to approve the principle of compulsory registration
involved in the Sanitary Registration of Buildings Bill, and
having given the details of the measure a very full and
careful consideration, they regard it as impracticable, and
recommend the Society to petition against the Bill, should
it be necessary to do so.”

The President said that as the Council have expressed
an opinion so adverse to the Bill, it would be useless and
supererogatory to enter into any further discussion of its
clauses and provisions.

Mr. Mark H. Judge then made a few remarks in favour
of the Bill, and afterwards,

Mr. Shirley F. Murphy, lion, sec., read a letter from
Mr. Ernest Turner, F.R.I.B.A„ who regretted his inability to
be present. Mr. Turner wrote as follows: “ The scheme
presented in the draft Bill promoted by the Sanitary
Assurance Association is, in my humble opinion, not only
totally impracticable, but is also calculated to do much
harm to the cause of sanitary progress. The principles of

Cn Lajkmt,]

ACADEMY OF MEDICINE IN IRELAND.

[Jan. 1,1887. 25

hoaw sanitation are only just beginning to be understood
by a taw, and the practice is understood by fewer still—
although amongst those who have made a special study of
the snbject any difference of opinion is confined to detail—
amoagst those engaged in building operations, and amongst
sanitary officials there appears to be at present too wide a
divergence of opinion even upon general principles to admit
of any hope that such a compulsory measure would
be satisfactorily carried into effect. As an instance, 1
may mention tlie views of the surveyor of a large London
parah, who, a short time since, expressed the opinion, at
ana of the meetings of the Society of Medical Officers of
Health, that the public sewers should be ventilated through
the drams and soil-pipes of private houses, and that dis¬
connecting chambers were objectionable. Again, I know
arch&cu in extensive practice who are still of opinion
that the pan-cloeet is a desirable appliance, and this view
obtain* amongst some of the officials in Government depart-
meata When we know that even sanitary officials and men
of iigh standing in their profession hold such opposite
new, we may fairly conclude that if sanitary reform were
beaded over to the persons proposed by the Bill, insanitary

■addle would be the result. I hope the Society

rill take the view that the right held of labour is
first of all with the sanitary education of the officials
vbo have to administer the laws, and of those to whom
the erection of buildings is entrusted, and then the
tawndment of existing Acts or passing of new Acts of
Parliament. The Metropolitan Building Act is ably ad¬
ministered by a body of trained officers, who are not elected
to office until they have given proof of their competency to
discharge the duties. Surely any comprehensive Sanitary
Act such as is proposed would he premature until sanitary
education has advanced sufficiently far to provide a similar
•fegnard to the public.”

The motion for the adoption of the report of the Council
m then carried, with one dissentient; and on the motion of
Prof amor Cohkikld, it was unanimously resolved that
copies of the report be sent to Dr. R. Farquharson, M.F.,
Sr Henry E. Roecoe. M.P., F.RJ3., Sir W. Guyer Hunter,
M.P.. M.L)„ and P. Charles Cameron. M.P., by whom the
Bill is to be brought into the House of Commons.

ACADEMY OF MEDICINE IN IRELAND.

Narcolepsy. — Myxoedema.

At the opening meeting of the Medical 8ection on Nov. 19th,
the President delivered a short, address on some of the
circumstance* which have prevented a precise knowledge of
the Action of Medicine.

Dr. A. W. Foot read a paper on Narcolepsy (so called by
M. G&ineau in 1880) and narrated the case of a youth, aged
eighteen, who had been under his observation for three or
four vemre, during which time he was subject to sudden
attacks of morbid somnolence, which came on whether he
was sitting, standing, walking, eating, driving, railing, or
playing the piano. He had no tonic or clonic spasm, retained
common sensation, and did not lose consciousness. His
personal history was good, but he came of a neurotic family.
>o treatment availed to relieve him. Dr. Foot referred to
two other cases which had been observed in Ireland by Prof.
Mtcnamnra and the late Dr. Graves; and concluded by suggest¬
ing that the word “hypnolepsy” would be more correct than
■areolepey; that this condition was quite different from the
dwiping sickness of Western Africa, and by pointing out the
distinction between it and epilepsy.—Dr. Henry Kennedy
said that in Simpson’s Hospital he had frequently observed
Mesons, more or lees advanced in life, showing a tendency to
fall asleep under unusual conditions—for instance, at dinner.
Reconsidered this tendency to be due to the blood being over¬
loaded with the purest kind of fat, as described by the late
R- Smith.—Mr. Corley mentioned a case which he bad bad
ander treatment that agreed in every respect with the
description of the disease given by Dr. Foot. Three or four
years ago a dairyman’s labourer was admitted into the
Richmond Hospital. He had some months before fallen
from a dairy cart on the hack of his head. While eating he
suddenly let his knife and fork fall and went to sleep. He
had evidently cerebral pressure. His family history sug¬
gested that he had something in the nature of a tumour,
probably out of reach of the surgeon’s knife. The case
md a fatal result. Dr. Abraham made a post-mortem

examination, which confirmed this diagnosis. There was a
small abscess, twice the size of a walnut, in the posterior
right lobe of the cerebrum; and no doubt the symptoms
depended upon that. The striking similarity in the symptoms
described by Dr. Foot indicated that some part, of the cere¬
brum was affected in his case also. —Dr. ('. J. Nixon had
recently seen a member of his own profession who was
suffering from attacks like angina pectoris. Close on sixty
years of age, the gentleman in question had been for several
years, whilst in the Army Medical Service, subject to sudden
attacks of periodic sleep at extraordinary times, even on
duty. The intervals between the attacks greatly decreased,
and he was obliged to leave the service.—The President said
he had seen only one such case -that of & powerful young
man, aged twenty-seven or twenty-eight, who managed suc¬
cessfully a great business in the city. He was of a family in
whom neurotic affections abounded consequent on close in¬
termarriage, his father and mother being first cousins.—Dr.
Foot, in reply, said he was aware of Smith’s observations on
fat and free oil, which that writer had used not in connexion
with extreme tendency to sleep, but with fatty degeneration
of the viscera, and thus he had described free oil flowing out
of the body. Sleepiness at meals had nothing to do with
narcolepsy. A good dinner, a warm fire, and a comfortable
chair invited sleep. Following Gdlineau and Dana, he had
used the word “ neurosis.” One of Gelineau’s patients, who
was a soldier.had started a nice medico-legal question, “ What
would become of me,” he asked, “ if the sleep attack came
on me whilst I was on sentry or on guard? I should be
shot, and not for any fault of mine.”

Dr. C. J. Nixon read a paper on a case of Myxoedema,
having previously exhibited the patient.—Dr. M'Swiney said
the paper proved, as also did a recent case operated on by
■Sir William Stokes, that the crucial experiments performed
by the surgeon often disproved theoretical conclusions which
were the result of mere observation.- Sir Wm. Stokes said
his case was that of a female with a rapidly increasing
bronchocele. Owing to the mechanical effects of pressure
of the tumour, lie deemed it necessary to relieve her. The
operation consisted of two parts. He first removed the left
lobe of the thyroid gland as the largest of the two. The
wound healed, and. tne patient perfectly recovered. After a
considerable interval she presented herself again for admis¬
sion into hospital. The tumour on the right side having
undergoneremarkablediminutiotJ, increased rapidly, and gave
rise again to the serious symptoms referable to mechanical
pressure. Thereupon he removed the remaining lobe of the
thyroid. The wound completely united, and thepatient seemed
to go on favourably till the remarkable symptoms detailed in
Dr. Nixon’s case supervened—pallid face, puffy eyes, and
swelling about the wrist and ankles, which pitted on pres¬
sure. while the intellect became impaired, as indicated by
the length of time it took her to answer a question. At
length, as the symptoms became urgent, she had convulsive
seizures, somewhat epileptiform, respiration became diffi¬
cult, and she expectorated large quantities of mucus
these conditions increasing till she died from exhaustion.
He had little doubt there was a distinct connexion between
the complete removal of the thyroid gland and the sym¬
ptoms which subsequently developed. Still, he would not
take a gloomy view of the future of thyroidectomy. There
had been a large number of cases of removal of the thyroid
gland unattended by the development of myxoedema.

MANCHESTER PATHOLOGICAL SOCIETY.

A meeting of this Society was held on Wednesday,
Dec. 8th, 1880, Dr. J. DreschfeM, President, in the chair.

Broncho-pneumonia in Children. —Dr. H. Ashby showed
the lungs of a child who died from broncho-pneumonia.

Epithelioma of the Tongue—Dr. W. Thorbcrn showed a
number of sections of an epithelioma of the tongue, which
had apparently developed from an ulcerating gumma* The
sections, being cut continuously, demonstrated the method
of growth ana invasion of the tumour. ,

Diaphragmatic Hernia. —Mr. A. H. YotrNO exhibited a
preparation of a case of diaphragmatic hernia, which had
been discovered in the dissecting room. He pointed out the
impossibility of diagnosing such a case daring life.

Surgical Kidney. —Mr. C. E. Richmond showed specimens
of surgical kidney, together with the bladder and ureters.
The bladder was chronically inflamed, much dilated, hyper¬
trophied and fasciculated. The ureters and pelves of the

O

26 'The Lancbt,]

LEEDS AND WEST RIDING MEDICO-CHIBURGICAL SOCIETY.

[JAn. 1,1887. 1

kidneys were dilated and inflamed, and contained a mixture
of foul urine and pus. The kidneys were enormously en¬
larged ; the whole parenchyma was macerated in pus, and
the capsules separated easily. There were large peri-
nephritic abscesses. There had been a history of chronic
retention, with much ropy mucus in the urine. Death had
occurred from unemia alter the use of the catheter. There
was no stricture or prostatic disease; hence it was inferred
by Mr. Richmond that retention and consequent dilatation
of the bladder had been due to the obstruction caused by
ropy mucus.

Phosphatic Intestinal Calculus. —Mr. A. H. Young showed
for Mr. Wren, M.R.C.Y.S., an enormous calculus found after
death in the large intestine of a pony.

Dr. J. Dbkschfkld gave an account of some recent
researches on thrombosis.

LEEDS AND WEST RIDING MEDICO-
CHIRURGIOAL SOCIETY.

An ordinary meeting of this Society was held on Nov. 8th,
Mr. Edward Atkinson, Vice-President in the chair.

Mr. Mayo Robson showed a specimen of Hydrosalpinx
which he had removed from a patient ten days previously.
She had had pelvic pains which prevented her from working
for several years. The patient was recovering.

Mr. Robson also exhibiteda specimen of Ruptured Jejunum,
caused by a fall from a scaffold. The man presented no
external signs of injury, but had symptoms of intestinal
strangulation and peritonitis, for which laparotomy was
performed.

Mr. W. H. Brown showed a Ruptured Bladder, apparently
spontaneous, for there was no history of injury. The
patient survived four days.

Mr. Edwabd Atkinson showed a patient from whom he
had excised the Sternal End of the Clavicle for dislocation
upwards. The man, who before the operation was unable
to use his arm, bad now a very useful limb.

Mr. Mayo Robson brought forward a patient, twenty
years of age, in good health, on whom he had performed
Supra-pubic Lithotomy three weeks befcrre, the interesting
feature of the case being the suture of the bladder and
primary union of the wound.

! Oophorectomy. —Mr. W. H. Bhown read notes of a case of
Oophorectomy undertaken for indefinite nervous symptoms,
which had existed for ten years, and which were chiefly
referred to the pelvis. During the whole period the patient
had been, attending some charitable institution, and the
operations of stretching the sphincter ani and the urethra
and scooping out the uterus bad been performed in vain.
The last operation, in which normal ovaries and tubes were
remove^, was also without effect. — Dr. Bratthwaitb
thought the case was not a proper one for oophsrectomy.—
Mr. Wheblhousb considered it unjustifiable to perform
such operations for such indefinite symptoms.—Mr. Mayo
Robson thought it was very seldom justifiable to remove
healthy ovaries, as in the operation known as Battey’s; but
he was quite sure that a great advance had been made in
surgery by the removal of diseased uterine appendages
known as Tnit’s operation. He bad operated on a number
of cases df pyosalpinx and hydrosalpinx with great
benefit, and as yet with no mortality. He always bad a
full consultation on the case previously, and explained the
naturd of the operation fully to the patient.

Removal of Ingrowing Eyelashes by Electrolysis. — Mr.
BsUKtoLiACK Hbwkts6n described this method, and showed
the apparatus. The needle attached to the negative pole
was inserted for twenty seconds.— Mr. Snell referred to a
paper in which he had described this operation three years
before. lie had used the method for removing superfluous
hair on the face in 'females, and In one case he had
removed a moustache from a young lady.

Cataract.— Mr. Snell read, a paper on the Treatment of
Cataract and other eye operations, to the exclusion of dark
rooms,’ bandages, &c. He referred to his article in The
Lancet, of Sept, 18th, and said that experience bad taught
him the value of plaster as a means of closing the eye as’
superior to the method by bandage. He had used the
method in fifty-three cases, thirty-two being operations on
the - le*sfi',the remainder being iridectomies, iridotomies,
selejyboinieB, and operations for anterior synechi®. Refer-
enceiyvae made to its utility in injuries of the eyeball, and
in other cases where it was desirable to keep the eye at

rest. He explained the method of cutting the plasters,
which was that known as “ salicylated isinglass plasters.”

Hemiplegia.— Mr. J. W. Tealb read notes of a case of a
lady of sixty-four, who, after prolonged and obstinate con¬
stipation with albuminuria, was seined with hemiplegia on
the left side, accompanied by convulsive movements of that
side. In the deep unconsciousness which followed the
attack Hasting fifty-four hours) the sphincter ani was
stretched. This was followed by copious action of the
bowels. The patient recovered a considerable amount of
movement, and the albumen was reduced to a trace.—Dr.
Hutchinson remarked on the great difficulty of estimating ■
the value of remedies in nervous disease.—Mr. T. P. Tealb'
described cases of rigid sphincter without spasm, giving the
sensation to the finger of a cartilaginous ring, and relieved
by stretching.—Mr. Tletcheb Little remarked on the less
frequent occurrence of obstinate constipation among French'
women, due to the more general use of enemata.

Dr. Ernest Jacob showed a Papillomatous Tumour which
he had removed from the larynx of a young man, where it
greatly interfered with the voice. It was a return growth,
the first having been removed by him eight months
previously. He showed various forceps used in sqch
operations, and remarked on the value of endo-laryngeal
operations over thyrotomy.

Dr. Griffith exhibited the temperature chart from a
case of Enteric Fever, showing two complete relapses, each
of three weeks’ duration.

MIDLAND MEDICAL SOCIETY.

A meeting of this Society was held on Wednesday
Dec. 6th, 1886, Mr. Lloyd Owen, President, in the chair.

Radical Cure after Strangulated Hernia. —Mr. Barling
showed a man aged thirty-five on whom he had operated
for congenital inguinal hernia eighteen months ago. At the
operation blood was found in the sac and walls of the
intestine, in which there was also a slight laceration. After
the strangulation was relieved a tunica vaginalis was made
from the lower part of the sac, and the upper part was
ligatured and left in the inguinal canal. Two short wire
sutures were then passed through the pillars of the ring and
walls of the inguinal canal; there were tightened up and
cut short. The wound healed by first intention; the patient
got up with a truss on in three weeks, and has since,
worn a truss, until a month ago, when he was instructed to
discard it. At the present time there is no return of the hernia,
and the external nng is tightly closed; the wire sutures can
be felt in situ, the testicle feels normal, and slides easily in
its tunica vaginalis. '

Foetal Abnormality.— Mr. A. F. Hawkins showed an eight
months’ foetus which presented the following abnormalities:,
the umbilical cord was in. long; there was ectopia
abdominale, the lining of the bladder being covered with a
mass of meconium. The intestine opened into the left Upper
corner of the bladder, there being no distinction between
the large and small gut; the penis was undeveloped, im¬
perforate, and above the pubic arch, the latter being in¬
complete, and the halves joined by a ligamentous band.
The scrotum was divided, the right testicle lying loose in
the abdominal cavity, with a stalk about an inch long; the
left testicle was in front of the left kidney under the peri¬
toneum. At the back a large cyst extended from the angles of
the scapulas above to the buttocks below; it was in the median
line, about the size oPa tennis-ball, and was lined by a smooth
vascular membrane; this contained a perfectly clear limpid
fluid; no nerves Btretched across it. In the anterior portion
were two depressions, one the size of a crowquill, } in. in
depth and apparently blind; the other, which was higher,
was an opening with circular and well-defined edges 4 in.in
diameter; a probe could be passed through this upwards
into the vertebral column. Both feet were clubbed; the
hands were normal.

The leg Type of Progressive Muscular Atrophy.—Mr.
Suckling exhibited a woman,aged forty,suffering from Pro-'
gressive Muscular Atrophy, which had commenced in the
feet and legs. There was marked emaciation of the leg
muscles, the feet being dropped, inverted, and useless. The

f ait was of a “ high-action” or “equine” character, and the.

nee-jerk was lost. The thenar and hypothenar eminences of
both bands were ,w»ted, and the main en grjffe was present.
The “ reaction of degeneration" v;as also present in the tibialis
antieus, extensor longus digitorum; and peronei in both'

30

& 1 '

[Jail 1,1887. 27

RJ&VTBWBANDlfOMCBS OF B^KS.

Dw patient’s two sisters were affected in an exactly
Banner, and her uncle and father Buffered from
_ of the legs.

flsTi/i Disease .— Mr. Chavasmb showed a case of
Dieeaac in the ankle of a man who some years
had his thigh amputated for some disease of the

Be. CL J, Lbwis read a paper entitled “ Clinical Observa-
, Syphilis of the Larynx.”

HOTIOMBAM MEDICO-OHIRURGrICAL SOCIETY.

luuc of this Society was held on Friday, Dec. 3rd,
«k wUri twenty-two members were present.

!■ fan showed the following specimens, with notes
of #■ oaaea :—1. Case of unexpected Hysterectomy, in
■msfcrtnminsl section was made to remove a pyosalpinx.
Mag the operation a small subperitoneal myoma was
Bmaored. The pedicle was secured by tbe Staffordshire
lmt. During the tightening of tbe ligature tbe peritoneal
ant at the uterus was fissured, from which a slight oozing
<i Hood took place. This was stopped by sponge pressure,
■i the operation was completed, a drainage-tube being left
n. Finding that the bleeding continued, the abdomen was
■glia opened in the evening, and, the actual cautery and
continuous suture proving ineffectual, hysterectomy was
i cifa r m ed. Tbe patient made a good recovery. 2. Two
biaeaeed Ovaries : one an example of a very small multi-
locular cystoma; the other a cirrhotic ovary removed from an
■Marri ed woman, who had been almost entirely disabled for
five years. 3w A section of Diseased Mammary Gland, which
pr o v e d to be malignant, and an Axillary Gland, likewise
Hfoeted, from a patient otherwise in better health than she
had been far years. There was only a seven months’ history
«f the growth. 4. Uterine Polypus, three-quarters of a
■Bd in weight, separated from its connexions by the
?—nr, and delivered by midwifery forceps.

Bfc. Hahttfobd showed a boy, aged nine, in the early
Waa of Pseudo - hypertrophic Paralysis. Difficulty in
vAring was first noticed at five years of age ; he has had
Mual fits; the mental 1 acuities are deficient. No other
Makers of the family have had a similar affection. Patellar
tBki reflex was absent; electro-sensibility was unaltered ;
Hadao-contractility to both currents much diminished and
dahged. Dr. Hsndford showed photographs of a second case.
T hey w ere taken in 1882, and the boy was then aged eleven.
Hie elder brother died two years ago of the same disease,
la lovember, 1886, this boy was again seen and found to be
— rfc gro wn and well nourished, hut unable to stand or
Wee hTs legs when lying in bed.

Dr. HAjnnKmo exhibited photographs and coloured draw-
ing. of two eases of Pemphigus, and one of Uydroa Herpeti-
fiaoae. In pae of the cases of pemphigus attention was
culad to a masked pigmentation of the skin, and to a very
*»—tt"* 1 condition of the cicatrices left by the bullaa.

Hr. W. T. Cuv, read a paper upon Anaesthesia and
AuMthetics. An interesting and prolonged debate followed,
wktefe was atytaned to a special meeting.

THE GLASHOW OBSTTETRICAL AND GYNjECO-
•' LOGICAL SOCIETY.

fn third iWflrtug of the session was held in the Faculty
Hrit cm the cvea fai g of Dec. 22nd. Drs. W. W. Anderson,
LEA WhitdoA,lSkene Keith, F.R.C.S.E., and S. George

ing ordinary healthy placental tissue, and the smaller being
markedly white. There was one chorion and one amnion.

Dr. R. Pollock exhibited a foetus which bore signs of
maceration.

Dr. W. L. Rkid exhibited the Head of a Foetus which he
had extracted after BasilyBis, and a discussion ensued as to
the respective merits of basilysis and cranioclasm, or
craniotomy. The balance of opinion was against the
former.

A Review of Thirteen Years' Private ( Obstetric) Practice —
Dr. J. K. Kblly read a paper on this subject. Guarding
himself, firstly, by stating that his results, owing to the
imperfections not only inherent in every recorder, but also
due to the conditions of general practice, must be regarded
as approximately and not absolutely correct, he said he
had attended, between the years 1873-86, inclusive, 2823
confinements, at which 2868 children were born. In all
these the maternal mortality had only been seventeen, or
one in 166. Five of these were due to causes unconnected
with parturition, thus reducing the true childbed mortality
to one in 235 2. Taking the last six years only, the maternal
mortality had only been one in 411. In 762 primiparte,
the mortality was eight, or one in 951, and in 2061 pluriparse,
nine, or one in 229. But in his last six years practice he had
284 primiparm, with no deaths, and 949 pluriparse, with
three deaths. The paper was full of scientifically interest¬
ing statistics, was listened to with great interest, and the
discussion upon it was adjourned.

IWriefos aub ftoiias of $aoks.

The Parasites qf Man and the Diseases which proceed from
them. By Rudolf Lecckart. Translated from the
German by William E. Hoylb, M.A. Oxon., M.R.C.S.,
FJt.S.K. Edinburgh; Young J. Pentland. 1886.

Therr is no more interesting subject in natural history
than that of parasitism. It embraces the whole of the
animal and vegetable kingdoms, and illustrates in a remark¬
able way the laws of adaptation. In relation to mankind,
the subject has, moreover, a special interest for the medical
profession, for it not only explains the origin of certain
obscure diseases and points the way to the prevention of
others, bat it embodies a doctrine which is capable of being
most widely applied. For the “ term ‘ parasite ’ so runs
the opening sentence of the work before us—“ in its widest
sense includes all those creatures which inhabit a living
organism and obtain nourishment from its body.” This
definition is wide enough to take in all the bacterial
organisms that modern investigations have shown to
play so important a part in the etiology of disease, an4 at
present we are doubtless far from embracing in our view
the whole range of their activities. It is, then, all-important
that we should be well instructed upon the subject of para¬
sitism, and yet it is a subject whieh has attracted the study
of comparatively few. In the late Dr. Cobbold England
lost almost her only exponent of the subject, for he was one
who had devoted time and labour to its investigation. His
great work on the Entozoa remains as a monument of his
industry, which was further shown in the numberless
monographs upon special branches of helminthology that he
contributed from time to time. But even Cobbold would

OMpkf ll were inhWtul Fellows.

iHnyw Tt cbf T ng na ncy. - Dr. Glaistkr exhibited (1) a
ImmI Ba t tl e dore, Placenta, and (2) a Placenta and Foetus,
nqftzntiva o l the Asets of injury in a twin pregnancy. In
thfa eeee the mqthsr. When three months and a half preg-
Mtt klth twin* bd a Severe fall, which caused tbe death
■fate, Oephafic Extremity of which presenting along
VlflMto flew dt MeArtber at labour caused some dubiety
i to mtefclt emM he. The foetal remains exhibited
i dfioni{attached shewed signs of post-mortem
' **■" .ant of .the 'feet being found attached
Bathe form of a band, to the body, as
: f o rmatio n. The placenta was in 1 one
two portions; one, the laiger, contain¬

admit that the work of Rudolf Leuckart was greater than
his own, and it is therefore with peculiar gratification that
we welcome the appearance of this classical treatise in an
English dress. Professor Leuokart is a naturalist, and he
deals With the subject from the point of view of a natu¬
ralist, but this is no disadvantage; on the contrary, it is a
Yeal gain,-since he clearly traoes the origin and nature of
the variotis forms of parasites, and dwells upon their dis¬
tinctive features in a way that not only imparts new
knowledge, but also points to the most effectual means for
coping with these Unwelcome guests of the human body. •
The bulky volume before us does not comprise the

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Diqiti;

28 The Lancwp,]

REVIEWS AND NOTICES OP BOOKS.

[Jan. 1, 1887.

whole of Leuckart’8 great work. It contains a general
account of the natural history of parasites, and a special
description of all the forms from protozoa to cestoda. The
second volume, which will include the nematode and tre-
matode helminths, as well as the arthropod ectozoa, is at the
present time appearing in the second German edition ; and
Mr. Hoyle tells us that the translation will proceed pari
passu with that publication. The English edition has also
had the benefit of further revision by the author himself,
who contributes to it a preface. The work is confined to
animal parasites. These, we are told, are either “ occasional’’
or “ constant,” the former varying their habitat according to
circumstances, and forming a link between the true parasite
and the free-living animal. Then, as regards their relation
to their hosts, parasites may be “ temporary” or “ stationary,”
terms which explain themselves; and the stationary forms
may be “ permanent" in their attachment, or “ periodic" and
wandering. Many examples of these varieties must be
familiar to all; and what is of especial interest is the fact
that the more stationary a parasite is, the more does it lose
all the features characteristic of an independent animal
organism. It becomes degraded in type, and assumes more
the form of an appendage to its host than a separate indi¬
vidual. A very interesting chapter in this connexion is that
upon the origin of parasites, where the author traces the
changes undergone in organisms that depart from the nature
of free-living beings to become dependent upon others for
their sustenance, retaining often (e.g., trematodes) in their
larval state the attributes and powers of the independent
creature. The effects produced by parasites upon their
hosts are multifarious, depending for their gravity largely
upon the situation which is selected by the entozoon for its
habitat, as in the case of Coenurus cerebralis, Syngamus
trachealis, or the Strongylus equinum that infests the
mesenteric arteries of the horse, leading to aneurysm; or
else depending on the injuries inflicted by them upon the
body, a9 in the case of Dochmius duodenalis, which not
only extracts blood for its own nutriment, but is the cause
of intestinal hfemorrhage and a fatally progressive anaemia.
Nor need we do more than mention the agency of such
parasites as Bilharzia haematobium, Trichina spiralis, Taenia
echinococcus, and the haematozoon Filaria sanguinis homing,
with which medical literature is now so fully familiar.
From general considerations such as these we turn to the
detailed and systematic account that forms the bulk of the
volume. It is here that the reader will be especially struck
by. the thoroughness and knowledge which the author
brings to his work. A large number of protozoic organisms
are described, the majority of which are of but slight
importance; but the attention of the pathologist should
be especially directed to the gcegarines or sporozoa, of
which the coccidia infesting the liver of rabbits and
mice are perhaps the most striking examples. Man also
may.be infested by these minute organisms, probably by
contamination of food through the excreta of the rabbit.
A fatal case in a man, marked by enlargement of the
liver, is recorded by Gubler; and drawings are given of
coccidia from the human liver from another case. Several
infusoria occur in the intestinal canal, the Balantidium coli
discovered by Malmesten in 1856 being one of these. It
occurs in the pig very abundantly, as well as in man; but it
is interesting to note that it has only been found in cases
where the intestines are already diseased. The cestode
worms receive, commensurate with their wide distribution
and importance, a very large share of attention their re¬
markable metamorphosis and life-history preceding the
special anatomical description of each genus. Here will be
found a full discussion of the views of other writers and the
records of the author’B own work, which have thrown such
a clear light on the history of these organisms. The Taenia

saginata (better known in this country as T. medio-canel-
lata), perhaps the most common, is first described, and then
Taenia solium, with its larval cysticercus. Later we meet
with an ample discussion of the TaBnia echinococcus, and
then of the interesting Bothriocephalus latus with its ciliated
embryo, and the much-debated question of its intermediate
host. 1 The zoological account is followed in each instance
by sections upon the distribution and medicinal significance
of the tapeworm under consideration.

Such, theD, is the scope of a work which, holding the first
rank among treatises upon the subject, is to be welcomed as
a great addition to our literature. It is a book to be widely
read and studied, and we may congratulate both Mr. Hoyle
upon the excellent translation which he has effected, and
his publisher for presenting the volume in so attractive a
form, with the numerous illustrations that add greatly to the
interest and value of the text.

The Diseases of the Prostate: their Pathology and Treat¬
ment. Comprising the Jacksonian Prize Essay for the
year 1860. By Sir Henry Thompson, Consulting Surgeon
and Emeritus Professor of Clinical Surgery to University
College Hospital. Sixth Edition. London; J. and A.
Churchill. 1886.

This work is so well known that we are absolved from the
duty of doing much more than noting the fact of the publica¬
tion of a new edition. Some of the chapters show signs of
revision and addition, but for the most part it is a reprint of
the former edition. Four new illustrations have been added.
One notable change in the nomenclature is to be observed.
We no longer read of “ hypertrophy of the prostate,” but
of the “enlarged prostate of elderly men.” Sir Henry
Thompson does not think that the contour of the prostatic
urethra can be modified by the passage of instruments, and
he leaves his readers to infer that he does not believe that
the passage of soft bougies will prevent the obstruction of
the canal by outgrowths of this organ. In the cases of this
disease where life is rendered a misery by very frequent
and painful efforts at micturition, in spite of the proper use
of the catheter, the draining of the bladder by an incision
into the membranous urethra is recommended in preference
to epicystotomy, which Sir Henry Thompson previously
advised. We do not think that sufficient importance is
attributed to the effects of the atony of the bladder so often
associated with chronic enlargement of the prostate. There
is much to show that in a large number of cases the
symptoms are really the outcome of the atony rather than
of the hypertrophy, and that the benefit obtained by daily
catheterism and emptying of the bladder is to be explained
by the recovery of power in the bladder which this causes.

The more recently recorded cases of malignant disease of
the prostate have been added to the table of cases of this
disease but cancer is stated to be more common than
sarcoma. We doubt the accuracy of this view. It is
more than probable that, as in the testicle, all the cases
of malignant disease of the prostate in children are cases
of sarcoma, although recorded originally as cancer, and
some of the cases in adults which have been described
as “medullary cancer” have probably been sarcomatous
in nature. The chapter on Tubercular Disease of the
Prostate opens with this sentence: “ The prostate i9
very rarely the seat of the tubercular deposit,” whereas
"prostatic cancer” is spoken of only as “a rare affection."
Surely these expressions do not represent the facts with
sufficient accuracy. As a primary disease tubercle of the
prostate is no doubt very rare, even if it ever occurs, but
we have often observed the prostate enlarged secondarily
to tubercular disease of the testicle, and Curling writes
that the disease in the testicle is "often associated with

1 Lenckart hold* it to bo th* pike and turbot, but has failed to prove
thla experimentally.

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REVIEWS.—ANALYTICAL RECORDS.

fJ ax. 1,1887. 29

>n« of other parts, especially of the vesiculse

state.”

is oversight the much-used flexible rubber
tarice spoken of as “vulcanised” rubber
itake which might possibly give rise to trouble
ler were sent to an instrument-maker. One
feature of this book is the absence of
writings of contemporary British surgeons,
and American surgeons are named, and
iturned several times; and we notice th^t the

of Philadelphia is referred to as Gross of

lire de Mtdecine et de Chirurgie Pratiques.
Zym. Supplement. Table Analytique.
de la Redaction le Dr. Jaccoud. Paris:
are et Fils. 1886.

completes the Dictionary, and we may make
observations upon its scope and character,
kind may belong to one of two types. It
tve short explanations of every important
it under such a term as “ anmsthesia” the
r find the etymology and explanation, or the
laractere of anaesthesia may be included under
term, such as “nerve” or “ nervous system,” or
or “sensibility.” Each method has its advan-
I disadvantages. If a reader meet with a term
i is unacquainted, he has only to refer to hi9
finds, if it be a good one and framed on the
brief and explicit account of it; but the
course completely isolated and unconnected.

■ band, a dictionary constructed on the second
$h it renders it difficult for the reader to
\meaning of a particular term unless the index
good, yet supplies the busy man with a
tworthy and, if we may use the term, read-
the various diseases; and if be have time to
' such articles, he can make himself acquainted
ltly introduced words and phrases, and
Blf with the existing state of medicine and
Dictionary before us belongs to the latter
feel bound to state that, owing to the
le contributors and the care which has
upon the several articles, the purchasers
will find that they, obtain a thoroughly
equivalent for their money. It was com-
1884, and has been published with much
the rate of about two volumes a year. The
deaths amongst the contributors, considering
has elapsed since the first volume was
itf not been great. It includes, however, the
of Demarquay, Gintrac, Hirtz, Laugier,
fdlatoa, Maurice Raynaud, Amb. Tardieu, Trousseau,
te recently one of the most original and hard-
coadjuton, Paul Bert, whose too early death
icgrettai by all who have an interest in the ad¬
it of sdenae. Tbe Dictionary has been published
>Iy riiaap price of seven shillings and sixpence
and iwMiiiing that each volume makes about
a, it contrasts favourably with any
American, or German work of a similar character,
in our notices of the several volumes as they
caDo&tke attention of our readers to the
■slides, it is rianeoessary that we should recapitu-
saaarks pcevto ori y made. In respect of the present
i to be regarded as & supplement containing ee vend
i aa Miotebaa, Chloral, Jequirity, Cocaine, and
have nWwrhrnn accidentally omitted or which
yfhto beln # Bl frh td general use subsequently to the
» titUM having the same initial letters were
l WodftsWsinttee with an accurate and very

complete Analytical Index by Dr. Decaye. Great praise is
due to the able editor, M. le Docteur Jaccoud, for the ad¬
mirable manner in which the editing has been accom¬
plished. The general arrangement of the articles is excellent.
The typographical errors are few in number and trivial
in their nature, especially in regard to the spelling of
the names of English and German authors, in respect to
which the French are, as a rule, extremely careless, in proof
of which we may just observe in passing that we saw in a
work of repute some time ago Faraday referred to as
Professor “ Farrhadouy.” We must not conclude our observa¬
tions without a word of praise to MM. Bailliere et File, for
the good paper, clear print, and excellent illustrations with
which the work has been published. Those who desire a
good French dictionary of medicine and surgery cannot do
better than place a copy of the “ Dictionnaire de Mtdecine
et de Chirurgie Pratiques” on their bookshelves, and consult
it whenever they have the misfortune to meet with a rare,
a refractory, or an inexplicable case.

^naljtical ^.fcorits.

BENDERS PBPTONISBD CHICKEN JELLY.

(Mottkrshkad A Co., Mahchester.)

Mr. Benokr’s preparations are now so well known,
that all we need say of the sample before us is that it is
excellent. It has a delicate chicken flavour, free from the
bitterness which used to interfere with the employment of
peptonised articles. We gave some to a patient in a critical
stage of recovery from typhoid, and found that it was taken
easily.

CABNRICK’S LIQUID PBPTONOIDS WITH COCA.

(Carxrick A Co., Limited, Hart-street, Loxdox.)

Like the preparation noticed above, this is only a new
adaptation of a well-known and highly esteemed article.
The idea, which seems to have been successfully carried
out, was to unite the powerful nerve stimulant coca with
an equally powerful and easily assimilated food stimulant.

FINEST MONINQ QLENBLG TEA, 1884-95.

(T, F. Axlex, Church-passage, Guildhall.)

Small clean leaves, quite free from adulteration; delicate
flavour. Analysis gave the following percentages:—Ash 6 - 27.
insoluble ash £-83, alkalinity of ash (as KOH) 132.

FINEST MONING GLENOGLB TEA, 1836-87.

Closely resembles the last, but with somewhat smaller
leaf. Is a very flue tea. AnalysisAsh 6*59, insoluble
ash 2*65, alkalinity of ash 1*23. It will be seen that there
is no important chemical difference between the two samples*

VOLTMBR’S ARTIFICIAL HUMAN MILK.

This preparation deserves to be given an extended trial,
by which method alone can its value be determined. It has
for five years met with some success in Germany. There
is no doubt of its containing the necessary principles of
food. It is sold in packets that look something like soft
toffee or butter-scotch. One of these makes half a pint of
milk. The cream rises to the surface, and the casein sinks
to the bottom if the fluid be allbwed to stand. The peptone
reaction comes oat well.

Royal College of Surgeons of England. —The
library of the College will be closed on Tuesday, Wednesday,
Thursday, and Friday, the 4tb, 5th, 0th, and 7th of January,
and on Friday, Jan. 14th, for the purposes of tbe examina¬
tions of the Examining Board in England and the Primary
and Pass Examination for the diploma of member of the
College. We believe these will be the last occasions on
which the library will be closed for examination purposes,
as-the new Examination Hall is expected to be ready by
the end of March.

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30 THJI LiKClT,]

NEW INVENTIONS.

[Jan. 1, 1887.

Jnfetttitras.

A NEW STYLE FOR FACILITATING THE TREATMENT
OF STRICTURE OF THE LACRYMAL DUCT.

The many difficulties in the way of satisfactorily
treating obstinate cases of this apparently simple affection
have induced me to devise the instruments which 1 have
the honour of bringing before the notice of the profession.
These instruments are grooved styles of various sizes, as
shown in Fig. 1, are made of silver-gilt, and are each
arranged to slide along Bowman’s bulb-ended lacrymal
probes. They are so constructed that the probe and its
corresponding style will together pass through an opening
which will not admit the next-sized probe. In performing
the operation, as soon as the canaliculus has been slit up
and a probe inserted, a style of corresponding number can
be gently pushed along the probe through the stricture.

Fig. 1. Fig. 2.

Showing grooved style*.
Nos. 5 and 0 have been
selected for the diagram.

The probe is then with¬
drawn, leaving the style
In position. After a few
days’ interval the probe
may again be passed
along the grooved style,
and the small style re¬
placed by a larger one.
This process may be re¬
peated until as large a
style as may be wished
has been inserted. This
may then be left in the
dilated stricture. Incase
of irritation produced
by the presence of the
style, it may be with¬
drawn and replaced in
a similar manner as
before when the irrita¬
tion has subsided. The

Showing probes and grooved styles.

cases in which these grooved styles will be found most
useful are: (1) Very tight or almost impermeable strictures.
(2) Strictures complicated with fistulous openings and dis¬
placement of the natural passages. (8) Strictures in
children or very nervous subjects. The advantages claimed
by using these instruments are: • (a) Greater facility of
introduction. (6) It is more advantageous where rapid
dilatation is required, (c) There is a more perfect system
of drainage, of natural as well as of inflammatory secretions.
In those cases in which I have had an opportunity of
-putting the instruments to a practical test the result has
fully realised the expectation formed of them, and I venture
to think that their use in dealing with almost intractable
«ase« will be attended with.much benefit.

Fkbdebic Dale, M.D. Cantab., F.R.C.S. Eng.,

Surgeon to the Scarborough Hoep. and Disp.

BISHOP’S PATENT DISINFECTANT DISTRIBUTOR.

The simple apparatus of which we give an illustration
has recently been invented by Mr. Bishop, of the pharma¬
ceutical department of Charing-cross Hospital. It appears
to us to be as valuable as it is simple, and we have no doubt
that it will be extensively employed. One of the chief diffi¬
culties in the use of all liquid disinfectants is the uniform
and accurate dilution of the fluid selected. “ Directions for
use” are of course given on each bottle, but they are very
irregularly followed, and injuriously large or absurdly
small quantities are often added by those who have to do
the actual work. With Mr. Bishop’s disinfector mistakes
can easily be made impossible, and the danger of neglect is
reduced to a minimum. It will be seen from the drawing
that an ordinary rose jet, capable of attachment to an india-

rubber |hose or to the cock of the water-supply, is made to
draw in by lateral suction a definite quantity of any liquid
disinfectant. The lateral tube is provided with a small
stopcock, by which the supply of disinfecting liquid is
regulated. We have seen the apparatus tried with strong
carbolic acid and with permanganate of potash, and can
testify to the ease with which the proportion of disinfectant
to water may be controlled and a perfect mixture effected.
The apparatus can be set so that, for example, 1 in 40,
1 in 80, or 1 in 160 parts of the disinfectant can be introduced
with the water without the possibility of variation by the
operator. This is exactly what is wanted in public urinals,
ships, stables, and many other places where frequent dis¬
infection is required. By a simple modification the
automatic disinfection of waterclosets can also be effected.
The apparatus can be obtained of the inventor (47, Maygrove-
road, Brondesbury). _

MENTHOL INHALER.

Cushman’s patent menthol inhaler has been submitted
to us by Messrs. Christy and Co., 155, Fenchurch-street,
E.C. It is of pocket size, and consists of a strong glass
tube four inches long, with a tapering nozzle at one
end, which can be introduced into one nostril. The tube-
is filled in the central three-fourths by menthol crystals, and
a free passage of air through these is possible by the aid of
a spiral of metallic wire. Perforated corks and a kind of
grate at either end of the crystals allow of ingress and-egress-
of air without the falling-out of the menthol. Each end of
.the tube is fitted with corks to prevent .evaporation of the
menthol when the inhaler is not being need. The inhalation
of air drawn through the menthol is skid to prove of service-
in mitigating headache and lassitude resulting from exces¬
sive head-work and deficient exercise. Various neuralgias
and nervous affections, hay fever, influenza, and catarrh
may be relieved or cured by the inhalations. ■ _

Alcoholic Poisoning.— A child, aged five, died in
Dublin last week from having swallowed a noggin o£
whisky administered by his father while intoxicated.

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THE OUTLOOK, 1887.

[Jan. 1,1887. 31

^THE LANCET.

VBON: SATURDAY\ JANUARY 1, 1887.

f -

ifimwfc to prophesy without being able to ensure the
faUfeMflft eft. the predictions made. The year 1887 is
<Mpatf|ftjeed in respect of which no observer having any
coaffillNftfe experianoe of the vicissitudes of politioo-
noonffik would willingly hazard a forecast. It may
hs^jpAfl the intentions of undoubtedly well-meaning,
bofffiAbly too sanguine, statesmen and administrators
wffiA* be carried into effect, and that, after all, the
mdflMf Parliament to be held in the year on which we
■r Mming will mot prove the most productive of bene-
flntflmd I meting results. It may chance that no measure
A Am reconstruction and amendment of the'laws relat-
ng •». kmnties will be brought under the consideration
i tbs Legislature; or that if such a measure should be
■tniAaed it will either fall through for lack of time
hr Us discussion, or be thrown out by one of the two
Banana; besides which, it may prove to be either ob-
jwtianmhle in itself or worthless. Whatever its fate, there
cm precedents for each and all of these destinies of a
' nasrj BilL It Is probably fair to assume that, whatever
petty may be in office, and whether or not there be any
<m(flsul parliamentary enterprise in the coming session,
thstewfil be t^ua year a formulated scheme, of some sort,
him the H oasas for the development of local govern -
oet;jnd it cam scarcely be that a measure of this class
to raise issues, affecting the health of the com-
anife which; will demand the very serious attention
rf thifls tbn are engaged in the practice of medicine in its
ermmi dsffltlMBU. Without anticipating, it may be stated
beaSy ah■* mo proposal to alter the laws controlling the
gsmaflapemt Off localities can bp satisfactory unless it,include
saapROMits {mtir more rospoesible and efficient adminis-
tmtftofloft kaaldUn relating to health-preservation and the
Mfhg out aadpwiphylaxis of disease. We heartily wish it
am maShnahle fee hope that the statesmanship of 1887
Tsnidrien to the dignity of that comprehensive and fore-
d0fts& visw eft ear public needs which perceived
As (seat and mgsnt necessity of a Ministry of Health—
Am Itpeaf outcome aft a policy which once found ex-
pmaAOm in the phrase* Sanitaa sanitatwn, omnia sanitaa.
-Aflftprda xaedafli Aftoaoa, m cannot look upon what. h*s
Asymm—pii shaft ia this provinoe in any light other than <
Aa<A|fl ptoiiAAUMAwMnt. Sooner or later, and the
flribflAftia beiktmtv AaA iaust be another step of progress I
W^jja'afollerdi^ipmiiit of the single-portal System. |
snipt)Aft,ftA can be said for the claims of
mAlfcftNMAe sa^Jha. So-called .rights, of the many
hflft^pfwdiMi ssfh lii nil of which give admittance to
AA^pBatitimmUh affirmed that ihe real and permanent
nflflflflAflft thagpfwadoninimnnity require that there shall
hMVPBMtffihAVffcflAMfclatioii which all most pass who
AftilAjpglM IlflAft fllbpalittg in Ifci in realms, and which.

r g A ffilffipp llfl l m t iii M The acquisition of higher
ciflBMNAiffilMffiflltfOKblffidAaBlftflmlflr universities are doubtless

to be encouraged, and the qualifications thus obtained may be
held as honours; but it is unsafe in the interests of the public
and the general health of the community to assume that what
seems the greater attainment must necessarily include the
lesser qualification for all-round practice; and it is therefore
imperative that there should be one pass examination of a
thoroughly practical character, whieh shall ensure a safe
minimum of knowledge and capacity, and to which every
member of the profession must submit himself, let his
“ superior ” qualifications or special learning be what
they may. It would be fortunate if it were pos¬
sible to include a measure to establish this one-portal
system in the legislative programme of 1887. Among the
reforms whieh lie, to a large extent at least, within the
province of the profession itself, is a sagacious concession
to the conspicuously reasonable demand which has been
urged on behalf of the great bulk of the medical students
of the metropolis, for a degree in medicine attain¬
able in London itself. It has been deemed undesirable
that the University of London should lower the level
of its high scientific standard to the needs of the
average practitioner, and it is proposed that the
Royal Colleges of Physicians and Surgeons should com¬
bine to constitute a Senatus Academicus conferring an
average degree. This project has now been finally cast as
a practical measure, and it remains only to obtain legal
authority for the function. We trust that the steps taken
with this view will be successful. It is manifestly unfair
and unreasonable that the capital should be almost the only
available city in this country wherein a “pass” degree in
medicine cannot be fairly obtained. The exclusion of
the Apothecaries’ Society from the confederation of the
Colleges for this enterprise is, we venture to think, an act
unworthy of the Physicians and Surgeons on the one hand,
and unjust to the Apothecaries’ on the other. It should
never be forgotten that the Apothecaries Society was the
first body to protect the interests of the great mass of
practitioners, and it has borne the burden and heat of
the day’s work since the passing of the Act by which
“The Hall" was constituted.

In the “Prefatory Address” which appeared in Thk
Lancet of Sept. 28th, 1838, while referring to the evidence
afforded—by the rejection of a Medical Bill “ because it did
not go far enough,”—that the Legislature was at length
beginning to recognise the claims of a previously neglected
profession, the founder of this journal made the following
reflection: “ Thus we observe a chain of effects, all referable
to one important cause—a feeling which is wholly indebted
for its origin to the exertions of a fbablbm medical
press.” It was to sustain this character and to assert and
defend the rights and privileges of the medical body as “ a
profession to which is entrusted the guardianship of the
public' health,” while acting the part of a friendly censor
and critic, and striving to break down all injurious
monopolies and reform abuses, that Thk Lancet was
established. The idea of creating a thoroughly independent -
and free organ for the profession was the dominant purpose
of Mr. Wajclhv'6- mature life 1 , and to render the attainment
of his purpose the more certain, his desire was that the pro- '
prietorahip of the journal should continue in his family'

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32 Thr Lancet,]

PR0FE3S0R VIRCHOW OX TABETIC ARTHROPATHY.

[.T an. 1,1837.

By the lamented death of Dr. J. G. Waklby, who, being
joint proprietor with Thomas Waklby, F.R.C.S., had also
acted as Editor since his father’s decease in 1862, the
proprietorship devolves on Thomas Waklby, FJt.C.S., who
has now brought in his sod, Thomas Wakley, jun.,
L.R.C.P. Lond., and the editorial direction will from this
time rest in their hands. As in the past, so in the future,
The Lancet will be conducted as the organ of the profession
as a whole, and not of any association, society, company,
party, or clique. That the distinctive position occupied
by this journal is appreciated by the profession is apparent
from the striking fact that, although in every instance
subscribed for, or purchased, for its own sake purely, and
not distributed as the organ of a special body, it has attained
a steadily increasing circulation, and is now more largely
read and quoted than any other medical journal in the
world. To meet the requirements of a widening circle
of readers, the capacity of the journal has been enlarged,
so that it now contains more matter than occupied its
pages Beven years ago, to the extent of about 20 per cent.
And this very considerable increase calls for further develop¬
ment, to meet which the journal will be permanently enlarged
to ninety-six pages in the present and subsequent issues, thus
affording augmented facilities for the publication of original
papers and the communication of new and useful facts and
opinions, to the advantage of the profession, and, indirectly,
of the public. The several departments in which the work
of the journal is cast will be extended and strengthened as
opportunity offers, and with a view to its increased useful¬
ness as a medium of medical news second editions will be
issued whenever it seems desirable, as on the occasion of the
recent election to the Medical Council. No pains will be
spared to enhance the value of the periodical to its readers,
while nothing will be allowed to impair its efficiency as
a representative and leading organ of the great body of
medical practitioners. It might be unseemly to say more, but
this much needs to be said, at the commencement of a year
on which The Lancet enters under, to some extent, new
allspices. The modifications which have been made, or are con¬
templated, will be apparent to our readers; but the purpose
we cherish and are seeking to carry into effect is that which
the founder of the journal conceived and so successfully com¬
passed during his lifetime (and which the late Dr. Waklby
still further developed); and it cannot be better expressed than
in his own words— namely, to ensure “ that, as far as it is
possible for the cultivation of the science of medicine to
alleviate human suffering, the agonies of our fellow-creatures
shall be made to succumb to the power which the human
mind is capable of exercising when fortified by a knowledge
of that science." In a very special sense it is true of all that
interests us as a profession, and which makes our function
one of the highest in the service of humanity, that “ know¬
ledge is power." To extend this knowledge, and to develop
and secure the free exercise of that po wer which is antago¬
nistic to disease, relieving suffering and prolonging life, has
been and must ever be the one worthy object for which a
fearless medical press exists, and its promoters strive.

The peculiar joint affection that complicates certain
cases of tabes dorsalis has been a fruitful souree of con¬
troversy, and its precise pathogeny can hardly yet be

considered established. Professor Charcot, who first
described it, compared it to other nutritive changes
depending upon nerve lesion, and has always maintained
its peculiar specific character. The debate at the Clinical
Society two years ago served, however, to show that, at
any rate in this country, this view was not universally-
held. It would seem almost as if there was a natural
divergence of opinion, according to the point of view from
which the subject was regarded. The neurologist takes Iris'
stand on the primary disorder of the spinal cord, and
deems the articular and osseous changes to be essentially
secondary; the surgeon thinks mainly of the joint disease,
and sees no essential difference between its anatomical
features and those of arthritis deformans. To him the
connexion is little more than a coincidence; the cord,
changes are independent of any direct relation to the
articular. The Society still awaits a report from a
committee appointed on that occasion, but if rumour
be true, the- committee are unable to arrive at any
definite conclusion. It may then be useful briefly to revert
to the opinions upon the subject expressed by Professor
Virchow at a late meeting of the Berlin Medical Society,,
especially as his standpoint is strictly that of the patho¬
logist who investigates the nature of a disease from the
lesions that mark it. It must, however, be observed that
the clinical cause of tabetic arthropathy is in itself different
from the joint affections with which it is contrasted,
mainly in the rapidity with which the extensive joint
destruction is evolved, and the entire absence of any
inflammatory phenomena, characters which, taken with
others, all point, as Dr. Rotthr, who introduced the subject
at this meeting, stated, to something special and peculiar to-
tabes.

Professor Virchow began his remarks by holding that it
was quite legitimate to compare this affection with arthritis
deformans; a condition, however, which is by no means
well defined. Thus, it may be a general or multiple
affection, idiopathic in origin, or it may be purely local,,
limited, and traumatic; and, moreover, changes similar to
those of rheumatoid arthritis occur in old-standing dis¬
locations, and (rarely) in syphilis. Between arthritis
deformans and arthropathia tabidorum (as Prof. Virchow-
prefers to style it), no marked anatomical distinction is
possible, and it is owing to the disease being described in
all stages that stress has been laid by some on variation?
which do not actually exist. In tracing out the series of
changes that eventuate in the characteristic destruction of
the joint, Professor Virchow stated that the earliest
change is in the cartilages, then follow synovial changes,
then capsular, and finally extracapsular; and throughout
the whole process no distinctive inflammatory lesions may
arise. It is a progressive tissue change, but bo masked and
altered by degenerative processes that, looking only to the
final result, it might be attributed merely to mechanical fric¬
tion, to ‘ wear and tear.” (It is of interest to note here that
Mr. Arbuthnot Lane contributes to the current volume of
the Pathological Society’s Transactions a paper in which he
argues strongly in support of the view that mechanical cause»
alone may suffice to induce the joint-lesions characteristic
of rheumatoid arthritis.) But the erosion and final entire-
destruction of the cartilages are preceded by a hyperplastic

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TH» Lajkzst,]

MEDICAL SUCCOUR OF THE SICK POOR.

[Jax. 1,1887. 33-

procear. which begins at various points of the surface layers,
•ad it is after this stage (too early to be often noted) that
the detraction takes place, through fatty degeneration
of the proliferated cells. Similar hyperplasia occurs at
the aaigins of the cartilage, and here ossification may
•ana, the new-formed bone often extending on to the
■dk of the bone itself. Later on the head of the bone is
laid hare and gradually wastes, and from ossification of the
■arrow the exposed end becomes ’dense and porcellaneous;
whilst the synovial membrane becomes the seat of villous
growth*ia which bony or cartilaginous nodules may form.
LariJy, the ligamentous structures are destroyed or ossified,
eafth* disorganised joint loses all its normal characters,
faro the osteophy tic formations that surround it and the
ro^hic changes that have destroyed the extremities of the
taro*. Now in the tabetic joint the chain of events is pre-
rodythe same, but the processes are hastened, and evidently
she result of more irritation. To illustrate this Professor
rotcHow exhibited two specimens, in one of which only the
(■riy stage of cartilage lesion was present; in the other the
■Carnal changes were extreme, with a great amount of ossi-
imtina outside the rest of the capsule. The reason for the
■ore rapid destruction of the joint in tabes is, he thought,
to be found not in any direct trophic disorder affecting the
particular joist, but in the general loss of nutrition of the
nbject of this disease. Tabes, then, would be a predispos-
■g cause to the arthropathy, but the arthropathy itself
woald depend on local influences, which in consequence of
the deranged nutrition operate with increased severity. He
wro sceptical as to the alleged occurrence of arthropathy in
the early stages of tabes having any connexion with the
ehaagee in the cord, and suggestively alluded to the influ-
ean of syphilis as being competent to initiate the articular
I aria—; just as it is also doubtless in many cases the cause
of the spinal sclerosis. The opinion of so high an autho¬
rity as Professor Virchow on this subject is worth atten¬
tion, and hk statements may do something to dear
the way to the adoption of more tangible views than
at present prevail as to the nature not only of tabetic
arthropathy but also of rheumatoid arthritis.

Tir.u are few more pressing matters than the medical
socceur of the rick poor. The questions which challenge
attention in c onn e xi on with.thia subject are urgent, and of
public not leas than professional interest. We may be excused
fat looking at the matter from a point of view specially
■portent to thepractitionera of medicine, albeit we would
no* ignore the roots popular aspects in which it is desirable
thro it should be regarded.

It most be freely admitted at the outset that the medical
ptafaroion in not animated solely by sentiment and the im-
prifae of benevolence, in lavishing its time and skill on the
treatment of case* o cc ur ring among the indigent. We are
not kaa humane than our fellow-men, but it would be absurd
la lag claim to exelnrifriy charitable motives. A field muBt
ha farod for practical- it our students are to be trained in
•rim work, awl it ft only by clinical labour to a large

tfaat such experience as qualifies a physician
oH& tdvxfe to his colleagues can be acquire
ties fijfifteetudy of our art and the maatei
demands ean only be secun

by the organisation of an extensive system of hospital
relief for the poor, and therefore it most be conceded that
the interest of the medical profession, as a profession,
in hospital work is professional. In saying this we do
not abate one jot of our claim to be credited with a full
share of the philanthropy which animates the mass of
right-minded citizens, but it is inconsistent with that feel¬
ing of self-respect which has its foundation in honesty of
view and purpose to lay claim to more than this.

Having said thus much by way of clearing the position,
it may be asked why—seeing that professional enterprise
in hospital charity is in the main a business undertaking—
should we, of all other professional men, affect to recoil-
from the idea of business ? It cannot be that there are no
limits to this enterprise marked out by prudence and sound
policy. In plain truth, there must clearly be a point beyond
which it is selfish on the part of any one class of'
practitioners to push their ambitions and endeavours to
the damage of their fellow-practitioners and the profes¬
sion as a whole. Unless we are to assume that the
great body of the medical profession is composed of men
who labour solely for the love of science and humanity, and
that they are not, in large measure at least, dependent upon
the emoluments derived from professional business for their
support and that of their families—propositions too ridicu¬
lous to be entertained,—it must be manifest that the exten¬
sion of hospital charity further than the boundary line
determined by the actual indigence of the subjects of relief
is a direct injury to the profession. We cannot even admit
that it is legitimate to afford facilities for the gratuitous
supply of advice to the sick poor unless such advice
is actually needed. There is a great deal of spurious
sentiment about the glamour cast over this subject on
platforms and in the reports of committees. No one for an
instant doubts that it is proper to give medical succour to
those who cannot otherwise procure it, nor is it questioned
that all the successful'treatment a case demands ought to
be furnished in every instance of real need. The medical
profession is fully prepared to make any sacrifice to these
ends. What the groat mass of practitioners are not prepared
to do is to bolster up a system by which they are required to
look on with amiable equanimity whilst a vast proportion
of the classes who can pay, reasonably well, for advice and
medicine are not simply supplied with both gratuitously,
but persistently touted for by rival charities administered by
injudiciously philanthropic committees. We are not in the
least degree surprised, nor can we say that we are sorry,
that this feeling has at length found expression, and that
the body of practitioners are beginning to move in the
matter.

Hospital charity, as regards both in and out-patients—
though more particularly, perhaps, the latter,—is rapidly
becoming an abuse. The aggregate of relief given, and
boasted of, has reached a total which constitutes a very
heavy drain on the resources of the profession as a whole.
It would perhaps be under the mark to estimate that
fully five-and-twenty per cent, of the relief given is
not actually required. By this we mean that if it were
impossible, or even a little less easy than it now is,
to obtain gratuitous medical and surgical aid at the hos¬
pitals, probably one-foarth of the total number of persons

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-34 The Lancbt,]

DEGREES FOR LOUDON MEDICAL STUDENTS.

[Jan. 1,1887.

now relieved gratuitously would obtain assistance at the
hands of the profession generally, and pay for it. It is not
succour necessary to save life the hospitals are giving, but
something to spare the pockets of persons who could, if they
needs must, find the means of obtaining it by reasonable
payment.

We offer no apology for speaking thus plainly on a sub¬
ject of very immediate and widespread interest. It is time
to cast aside traditional prejudices, and set the truth before
our readers, and, through them, before the public. The
medical profession is long-suffering, but it must sooner or
later defend itself against' the development of a policy
which exaggerates self-sacrifice until it verges on the
suicidal. We cannot hesitate to affirm that the amount of
gratuitous relief afforded almost indiscriminately by medical
charities has reached proportions which are not simply
formidable but overwhelming, and the majority of practi¬
tioners will agree with us that this is rapidly becoming a
cause of scandal. It is neither wise nor kindly on the
part of the medical staffs of hospitals to shut their eyes,
or affect to shut their eyee to the fact that they are in¬
flicting a very serious and increasing injury on their
fellows by assisting in the folly of pushing unnecessary
charity beyond all due bounds.

- + -

. We are very pleased to be able, in this our first issue for
a new year, to record the completion of the initiatory step
towards the securing of degrees for medical students
educated in London on the same terms as those which
obtain in the great medical teaching centres in Scotland and
the provinces. The Royal College of Physicians of London
and the Royal College of Surgeons of England have now
finally settled that it is “desirable and practicable to grant
degrees in medicine and surgery to persons who have
passed the conjoint examinations of the two Colleges”; also
that “an application be made to the Crown by the two
■Colleges, acting conjointly, for power to confer degrees in
medicine and surgery.” The grievance of the average
London medical student, that he is unable to obtain a degree
under conditions similar to those which prevail elsewhere, is
now definitely admitted, and the official authorities who
determine his curriculum and period of study are pledged
to its removal, if they can do so.. A decisive step hiss been
taken, and from this there can be no retreating. An appli¬
cation to the Crown for a Charter, empowering the two
Colleges, acting ’Conjointly, to grant degrees, has been;
determined on. This conjoint action preserves the
individual character of the tWo ocuparatioub respec¬
tively, and is, only a necessary move, forward in
harmony with the spirit and the needs of., the
time. : The Committee of Delegates appointed by
tbe tw<? Colleges, [will' now have to consider upon 'what
terms, the degrees shall be granted, and those will have
to be practically decided bn when the application for
power# is made. The principle is agreed to, bnt the
working out of > the details will require most grave
and serious consideration,. and must be settled speedily
mid without .any waste - of, precious, time. It will
probably be dependent on the nature of the detailed
scheme whether the opposition which is sure to be forth¬
coming will be successful or futile, and whether the

application for powers will be supported earnestly and
thoroughly by the teachers and the profession as well as by
their leaders in the Colleges. No thought of an “inferior
degree ” can be entertained for a moment, and doubtless it,
was a fear lest > some such result might be the outcome
of the movement that caused the taking of a hostile
vote to be insisted on by the very small minority at
the College of Physicians on the 23rd nit. The degrees
must be equal to the Scotch and provincial degrees, and
when this equality is secured, no higher level is required or
called for. The degrees must be “pass” degrees only. The
Senate of the University of London has over and over again
affirmed that all its degrees must be considered “ honours ’*■
degrees, and it is from its determination to remain immovable
at this standpoint that the present difficulty and grievance
have arisen. The lowest preliminary examinations in Arts
recognised by the General Medical Council are quite insuffi¬
cient for a degree, apd candidates for the distinction must be
compelled to show a higher standard of general education.

A revision of the present examinations for the qualifications
of the combined Colleges is also necessary, so that some
biological knowledge on the part of the intending graduate
should be secured. The degrees of M.B. and B.S, might
then be given on the existing professional examinations, and.
a decided tone would be added to the higher degree if some
such suggestion as Sir William Gctll’s were adopted—that
a further examination in clinical medicine and surgery be
instituted for the M.D. and M.S. respectively.* If the details
of the scheme follow these lines, no one will be able to sneer
at the degree as an “inferior” one, and much will be done'
towards raising the general and special education of the
average London student. This is a reason for its existence
which is too important to be overlooked.

Before'leaving the subject, we must point out the great
assistance to the movement, both in council and debate, •
which has been afforded by Sir Willtam Jbnttrr and Mr.
Savory, the Presidents of the two Colleges, and by Sir H.
Pitman, the Registrar of the College of Physicians. Dr.-
Welson Fox and Mr. Durham led the movement by first
bringing it before the Colleges for their official considers— •
tion, and it has been most generously supported, among
others, by Sir Andrew Clark, Dr& Bristow* and Wilks,
by Sir Joseph Lister and Messrs. Marshall and Mac- •
namara. Sir William Gull and Drs. Latham and
Priestley, by an acknowledgment during the recent
discussion of their oonverSion to the necessity of some such
scheme, have rendered it a conspicuous service. We must
also refer to the late Dr. MoxON, who at once saw the justice
of the agitation in its favour, and by his articles in our
columns and his speeches gave it an impetus such as only
bis Characteristic fervour and singleness of purpose could
impart. His wise counsels in directing and assisting the
progress of the movement will be much missed.

It was decided at a meeting on; Dec. 27th last of the
governors of Addenbrooke’s Hospital, Cambridge, that *■
dental department with two dental officers should be insti-,
tuted, the cost not to exceed £50.

The Queen has been pleased, on the recommendation of
the Secretary for Scotland, to appoint John Theodore
Cash, M.D., Professor of Materia Medica in the University of
Aberdeen, in the room of Dr. Dyce Davidson, deceased.

e

7

WOOLWICH AND 8ANDHUR8T.

[Jaw. 1,1887. 35

^raurtaturas,

"Ke quid nlmla.**

WOOLWICH AND SANDHURST.

Tn information given in the reports of the Board o£
Yinton reepecting the health of the cadets at the Royal
Kfitay Academy, Woolwich, and the Royal Military Ool-
is of the most meagre character. Prior to
MS85, antra, by the medical officer, of the cases of sickness
oecarriaf among' the cadets was always appended to the
report «f the Visitors, and occasionally remarks by the
malm eAoera were incorporated in it. Last year the
! r etur n was omitted for the first time, and it has not
in the reports just issued for 1880. We are
to attribute the omission to the remarks, not
iaayiof a complimentary nature, which we have felt it
m d a ty to-make upon the hfealth-condition of the two
adattfements, and the necessity for a careful inquiry on
depart of the military authorities into the causes of the
rtaocmal amount of richness which the returns showed to
prevail, especially at Woolwich. In this view we are con¬
fu s e d by a remark in the report of the Visitors to Wool wich
ia 1885: “ It is not possible to draw a comparison between
the cadets of the Royal Military Academy and those of the
loyal Military College, as the position and the surround¬
ings of Woolwich will in no respect compare with those of
Sandhurst. 1 ' Hot sorely, when there is such a difference in the
eaaaa of sickneas as Was shown by the medical returns in
IMA when Woolwich had 1337 cases per 1000 against 639 at
UnAarat (see Tsb Lancet, Dec. 20th, 1884), it is only a
fitr p res um p ti on that some other causes of sickness are in
Operation besides “ the position and surroundings'’ of Wool-
vieh. We cannot but think that it would be a much more
Jadioous course to furnish correct information respecting
the health of the cadets, than to give grounds for the
■fawyira that it is so unsatisfactory as to require
the e u p pac aafan of the established returns respecting it;
fe the repea ts for 1866 the only definite information
respecting the- health of the Woolwich cadets is, “The
tee dical r eport shows & daily average of 2 90 on an average
of 319 gentlemen cadets”; and of Sandhurst, that “the
medics! officer reported their health to have been good
during the past year, that there had been no cases of
serious Ulnewy and that the average daily sick was 3*78 on
an average stomgth of 304 cadets.” These figures show the
eomrtantly rick at Woolwich to have been in the proportion
af 13*2, and at Sandhurst of 12*4 per 1000, a sufficiently
Ugh ratio, farid tritich it is impossible, however, to draw
^aj oanelnamof ka(the absence of all information as to the
dhausa by mNcMfcwas caused. The want of this is the
vpmafeobomgpttaft as the conditions in which the cadets
urtl placed at Sand hu rst, as regards their rooms and the
lwpifl aoco ■ i rtOdmlun, appear to be much more satisfactory
*flH •’WoblwttSHf We trust that-in future reports of the
*VHtoCs the letoSnif of the medical officers may again be
the satisfaction of the parents and
We were much pleased to see that at
tea(»efct k<k itt Sandhur8t the Duke of Cambridge
^ sk-A-v^ tke medical officer should receive
for the skilful manner in which
threatened to be an epidemic of
sinc&” It was a well-earned
* HkkpfW Sturgeon Clarke, (he able and zealous

INTER-COLONIAL MEDICAL CONGRESS.

The South Australian Branch of the British Medical Asso¬
ciation recently appointed a committee to take steps in the
initiation of an Inter-Colonial Medical Congress, to be held
at Adelaide this year during the Jubilee Exhibition period.
The cordial responses received from South Australia and the
adjoining colonies to the preliminary announcement of this
committee warrant, we understand, the prosecution of the
scheme with every anticipation of good results. It has been
decided to hold (he Congress in August and September, during
the University vacation, the meeting to last not more than six
days. The promoters of the Congress, we are glad to learn,
wish the meetings to be under the direct guidance of the
whole body of the profession in the colony, as it is most desir¬
able that the Congress shall be of a thoroughly representa¬
tive character. It is anticipated that the attendance from the
sister colonies will be large and influential. We congratu-'
late our colonial brethren upon their enterprise and courage
in organising a rival to the great meeting of the profession
which is to be held about the same time in the United
States, and sincerely trust that their anticipations of success
in their undertaking may be realised : though they cannot
command success, they may at least deserve it.

THE REGISTER OF MEDICAL STUDENTS.

The third report by the Statistical Committee of the
General Medical Council has just appeared. It contains a
summary of statistics regarding medical students registered
as commencing their curriculum in the qninquennium of
1871-75. The investigation of the committee, to the success
of whose labours, it is scarcely necessary to say, the aid of
the registrar, Mr. W. J. C. Miller, has been indispensable, has
included the tracing of 0403 registered students, of whom
4472 were found to have gained a place in the Medical
Register. The committee propose to elaborate their work
by constructing a census of the profession at two selected,
annual periods, the years chosen for this purpose being 1881
and 1886. “ In such quinquennial censuses,” remarks Mr.
Marshall (chairman of the committee), “ many most interest¬
ing points will be cleared up, such as the strength of the
profession, its distribution amongst the population of town
and country, its fluctuations, its migrations, and many other
details relating to titles, qualifications, age, mortality, and
so forth. The construction of these censuses will be a com¬
paratively easy task, as compared with that already accom¬
plished. It will be undertaken by the same diligent and
accomplished agbnts as we have hitherto had the advantage
of engaging, and care will be taken to make the basis and
outcome of the inquiry as sound and accurate as possible."

SMALL-POX INOCULATION.

In a lecture recently delivered at St. Mary’s Hospital
Mr. Shirley Murphy adduced some evidence to show that
there was a probability that the virus of small-pox
obtained from the initial vesicle produced by inoculation
of small-pox differed in its action from that obtained
from the general eruption; and he expressed the opinion
that it was probable the different results attending the
operation of inoculation by various operators might be
dependent upon the use of virus procured from the one
or the other source. Thus of 182 inoculations performed
in the years 1721 and 1722, three persons died, or nearly
one in sixty; and ii\ Dublin, in1723, of twenty-three persona
inoculated, three died. The not infrequent death from
inoculated small-pox led at first to much opposition to this
method of protection against natural small-pox, but later
it was found that inoculation could be performed without
risk. In an account given by Sir George Baker of the

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THE METROPOLITAN PUBLIC GARDENS ASSOCIATION.

[Jan. 1,1887.

extraordinary success attending the inoculations of Daniel
Sutton, of Ingatestone, in Essex, who in three years inocu¬
lated some 20,000 persons without bad result, he attributed
this success to the fact that Sutton allowed his patients to
enjoy fresh air during their illness ; while Dr. Glass of
Glasgow believed that Sutton’s treatment in encouraging
perspiration was responsible for their recovery. It is clear
that Sutton professed to have a secret in his treatment,
although this secret is only mentioned in relation to
the composition of certain medicine; but Sir George
Baker, curiously enough, observed that “ What is ex¬
tremely remarkable, he (Sutton) frequently inoculates
people with the moisture taken from the arm before
the eruption of small-pox”; and Dr. Chandler, who also
witnessed Sutton’s work, referred the chief benefit of
his plan to the infecting humour being taken in a
crude state “ before it has been ultimately variolated by the
succeeding fever.” Baron Dimsdale, who took much interest
in Sutton’s proceedings, and subsequently himself practised
inoculation, closely imitated his method, and was very suc¬
cessful in his results. If, a8 Mr. M urphy pointed out, the
virus of the initial vesicle differs in any respect from that of
the general eruption, some difference may also be found in
the ease with which the bovine animal is inoculated with the
one and the other virus. Certainly this point deserves
further investigation. _

M. VERNEU1L AT BRUSSELS.

M. Verneuil has been paying a short visit to Brussels,
where, in return for the hospitality of his Belgian confreres ,
he treated them to several interesting and instructive
speeches and lectures. They seem to have kept him some¬
what hard at work, for on tbe Saturday (Nov. 27th) he was
present at a meeting of the Royal Academy of Medicine,
where he gave an important address on Vertebral Disease,
in which he insisted on the importance of prolonged rest
and immobility of the vertebral column, mentioning that
when absolutely necessary he let out pus, injecting sub¬
sequently a 5 per cent, solution of iodoform in ether. On
the Sunday he gave a lecture on Tuberculosis at the Hospital
St. Jean, and on the Monday visited the surgical and
children’s wards in the Hospital St. Pierre, where he gave
clinical lectures on cases of Comminuted Fracture, Abdominal
Tumours, and Hip Disease which were shown him, delighting
his audience with his diagnostic acumen and his happy
phraseology. _

“COUP DE VENT.” .

Our neighbours, the French, have the advantage of a
language which is both epigrammatic and comprehensive,
and is capible also of giving expression to an idea with
the greatest scientific exactness. It has therefore been
acknowledged to be the best language for European diplo¬
macy, as well as that of polite intercourse at nearly every
Court of Europe. The “coup d’oeil," the “coup d’etat,”
and the “ coup de vent” of the French have no such expres¬
sive equivalents in any other European language. The
sudden changes in the weather of the past few weeks, from
days of bright sunshine to murky nights, from days of damp
and fog to sharp frost with dry and bracing air, from
wind rising to a hurricane to atmospheric stagnation, with
scarcely sufficient movement to divert the upward current
of the smoke from our chimneys, and these alternations varied
from time to time by a keen piercing north or north-east
wind, have brought home to many of us fhe chilling influence
of a “ coup de vent.” A very much lower temperature can
be borne when the atmosphere is at rest than when it is in
active motion. In Captain Parry’s account of his voyage to
the North Pole it is stated that the crew suffered less when
the thermometer was 65° below zero—Le„ 87° of frost—in a

still atmosphere, than when the thermometer was as high as
zero, with a keen wind blowing. Stagnant dry air is a very
bad conductor of heat: thus the film of the atmosphere
immediately surrounding the body parts very slowly with
the warmth which is abstracted from the body; it becomes,
indeed, an intermediate temperate coating between the
colder atmosphere and warmer body; but when air is in
motion this intermediate protecting film is removed, and a
chilling atmosphere is repeatedly brought nearer the surface
of the warmer body, with a risk of producing what the
French graphically call a “coup de vent.”

THE METROPOLITAN PUBLIC GARDENS
ASSOCIATION.

The fourth annual report of the Metropolitan Public
Gardens Association has just been published,and is a highly
satisfactory one in every respect. The Association, which
works in conjunction with the National Health Society*
was formed, as most of our readers are doubtless aware, for
the purpose of supplying one of the most pressing wants of
the poorer districts within the metropolitan area—namely,
to provide breathing and resting places for the old, and
playgrounds for the young, in the midst of densely
populated localities. The following is a brief summary of
the work accomplished during the past year:—Seven
recreation-grounds have been laid out and opened to the
public; trees have been planted in one garden and one
thoroughfare; seats have been placed in ten public gardens;
grants of money have been made to five public gymnasia ;
two commons have been improved; and assistance has been
given in the formation of a swimming-bath and a recreation
club. The income has been raised from .£7283 in 1885 to
£10,917 in 1886, and the membership has increased to 448.
London is year by year becoming more and more
populated and extended. The ever-widening girdle of
bricks and mortar, the ever-increasing height of dwellings
and warehouses, the tendency that there is for the current
of human life from all directions to flow towards the metro¬
polis aa a centre, can have but one possible effect, and that is
to render London less and less a place where the bodily
functions can have full and natural play, where bone and
muscle in the young may be developed, and where consti¬
tutions are able to ward off disease and postpone decay. The
Association, by securing open spaces, is adopting the best
method to meet this threatened evil, and those who have the
health and welfare of the toilers in this modem Babylon at
heart will be unable to resist Lord Brabazon’s appeal for
renewed, increased, and fresh donations and subscriptions
to the funds of this most useful and deserving Association.

HOSPITAL REQUIREMENTS.

Sir Rutherford Adcock writes a long letter to The
Times on the present serious deficiency in hospital support,
the chief burden of which is to suggest the urgency of inquiry
into the whole subject by a Royal Commission. The
medical profession has had very recent experience of
the limited powers of a Royal Commission. Such a Com¬
mission, composed of most influential men, took a great
deal of trouble and a great deal of evidence, and came, by
a majority, to certain recommendations for legislation on
medical matters. But the legislation which followed came
grievously short of the recommendations. The best portion
of Sir Rutherford’s letter is that in which he elucidates the
grievous deficiency in the incomes of all the hospitals. He
thinks the urgency of the case is not realised by the public.
We hope his letter will help the public to do so. If not by
a Royal Commission or otherwise, the facts must be faced
and the remedies pointed out.

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REFORM OF THE SCOTTISH UNIVERSITIES.

[Jan. 1,1887. 37

AKLAIDE UNIVERSITY AND MEDICAL
> EDUCATION.

Thz llkiveraity of Adelaide has recently instituted a
medical school, not without some opposition, it being con¬
tended tlet the Universities of Melbourne and Sydney are
amply sufficient to supply medical graduates to the colony,
which as already becoming as much overstocked by the pro-
hamsvie the mother country. The scheme, however, has
been imply taken up, and subscriptions to the amount of
£L6jOQ(>0pe announced at the meeting of the Senate, which
ilariiledtiainVn thi« new departure. Such private endow¬
ments ultaow be supplemented by grants of public money.
Fa wr#m part, we do not see why South Australia should
taiurther the cause of higher medical education, or
why ifit resources are not adequate to supply a properly
^qppffroedical school. The question of overstocking the
pJMoa ia one which can always be met by the stringency
afffatesfco imposed on those who seek to enter it.

THE CROWN SEAT FOR IRELAND IN THE MEDICAL
COUNCIL.

Atx. who knew Dr. Lyons will deeply regret his death.
Ss was erne of those genial Irishmen who could hold a
different creed without bating any of his respect for those
bom whom he differed. It would have been better for Ireland
if more ef her representatives had had more of his nature.
The (romanmeat will have to till his place in the Medical
Council. Many provincial Irishmen are hoping that advantage
■ay be takrn of the vacancy to give the Irish practitioners
ia the Provinces a representation which even Direct Repre-
uutslirm has not disposed them to secure. We should be
*4 to auo the Government take this liberal view of their
opportunity. We must admit that the practitioners of
Inland, by failing to elect one of their own rank when they
had the chance, have given occasion for the remark that
tiuy prefer Dublin consultants to provincial fellow-practi-
tjanare. Bat the Government should make allowance for
the enormous vantage-ground enjoyed by the Dublin fiaag-
■ta in an election ; and it would act generously in supplying
the conspicuous defect of the Medical Council—a typical
wp w iean tativeof the general body of practitioners in Ireland.

TOOTH POWDERS.

Prophylactic medicine is of greater value to the public
than curative,although they are slow to give it its due;
hence the subject of tooth powders may be of some interest.
Tha necessity of keeping the teeth clean, with a view to the
prevention of future trouble, is overlooked by too many,
even in the higher classes, sometimes from carelessness,
sometimes from ignorance. Now, cannot the medical
attendant do a gnat deal to combat this state of things?
The dental surgeon is often asked, “ How soon should the
tint tooth-brush be used?” “ As soon as there are teeth to
omit upon” should be the reply. An ideal tooth-powder
should be alkaline, since acids dissolve the tooth substance;
tiasiy pulverised, that it may not mechanically abrade; anti-
■Ptie, to prevent decomposition of food lodged between the
tooth, and perhaps to destroy the microbes which are always
hsmd choking the tubules of carious dentine; it should
contain nothing irritating to the gums; and, lastly, it should
W ploaaant to the taste, or it will not be used. Fluid
iroiifiK'sn do not* as a rule, clean the teeth effectually,
■Rime they contain .some ingredient which acts upon the
iUBSMi it s elf ;and thoes preparations which are eulogised
ae ^making tenth -while or preventing deposit of tartar,
dosB. he avoided. '^Charcoal was at one time a very
PSkMto&tm si i dfltitifrice, and is even now largely
;tha>i<Hhoqpt of silica it contains it will

rapidly wear away teeth that are not of exceptional
hardness; and, moreover, the gums in some instances
become tattooed in a curious manner from absorption of
minute particles. Pumice-powder, again, is too gritty; and"
camphorated chalk is said to make the gums spongy. Pre¬
cipitated chalk forms the best basis for a tooth powder, to
the base of which may be added pulv. saponis and ol.
eucalypt., a drachm of each; and, if there is no objection
to the taste, half a drachm of carbolic acid.

REFORM OF THE SCOTTISH UNIVERSITIES.

A movement very similar to that of the Members of the
Royal College of Surgeons in England for representation in
the. Council now obtains in the Scottish universities. The
members of the University Council, consisting chiefly of the
graduates, desire to have a larger representation than they have
at present in the University Court. They protest that this
desire is not based on any selfish or revolutionary purpose,
but on a conviction that such representation will give an
impetus to important changes in the regulations and ad¬
ministration of the University, tending to raise their
standards, especially in Arts. It is not proposed to interfere
with the vested interests of existing professors, but to
endeavour to give the University Court more power over
the curriculum and the recognition of extra-mural teach¬
ing. Lord Wemyss has accepted the office of President of
the Association of the Council of the University of Edin¬
burgh, and from the chair of the Association has expressed
hie agreement with the objects of the Association, and
several of the professors have already done the same. A
similar Association exists in Glasgow, and Professor Edward
Caird has given it valuable assistance. The Scottish
universities are being, and will be, subjected to much
criticism, the best answer to which will be the readiness of
their professors to accept any reasonable improvements in
their constitution, even if involving some control of the
powers of the Senatns.

HOME FOR LOST DOGS.

Even those who objected to the muzzling of dogs will
not complain of the translation of ownerless animals from
the streets to comfortable quarters. The temporary Home for
Lost and Starving Dogs, Battersea, has received into its
kennels over 40,000 animals in the coarse of the year and
ten days daring which the muzzling order has been in force.
This institution, is not responsible for the seizure of dogs;
it acts as a trustee of public property. We are sorry to
learn that there is a debt of some .£1500, the result chiefly
of the great demand on the Home during the period of the
police edict. The committee appeal for subscriptions to
meet theiT present difficulty. Assuredly the object to which
the money has been applied was in the highest degree
humane; the results, both for human beings and dogs, have
been entirely betieftcial. There can be little doubt that the
purse of the charitable will be opened with the usual
liberality of the British heart.

BULLET WOUND OF ABDOMEN.

Early on the morning of Dec. 2oth a man aged twenty -
three was admitted into St. Thomas’s Hospital, under the
care of Mr. M&ckellar, suffering from a bullet wound of the
abdomen inflicted about two hours previously. The bullet,
which had been tired from a revolver at a distance of about
18 ft. above and to the left of the patient, had made a small
opening 2 in. above and 1 in. to the inner side of the left
anterior superior spine of the ilium. There was no evidence
of wound of the bowel, and there was comparatively a
small amount of shock; but on the following day cym-

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38 Thb iiANCBT,] HOSPITAL SATURDAY FUND.-THE MEAT-SUPPLY OF MARSEILLES.

ptoms of peritonitis developed, and the abdomen was
explored. Mr. Mackellar found two perforations with
bruised edges in the lower part of the sigmoid flexure, from
which there had been an escape of contents of the bowel;
these openings were secured by ligature, the effused blood and
other fluid carefully washed out, and the wound closed and
drained. The patient rallied from the operation, but died a
few hours later. At the post-mortem examination the bullet
was found lodged in the right side between the bladder and
rectum. No other portion of bowel had been wounded.
The openings in the bpwel were not sutured on account of
the collapsed condition of the patient, the distance of the
wounds from the surface, and the fixation of the gut, which
prevented its being brought out of the abdomen. For
similar reasons the question of excision of the wounded
part was dismissed. The man was acting as a “wait” at
the time of receipt of the wound, and his sad death ought
to act as a warning to those who are in possession of fire¬
arms and careless in their use.

LIFEBOAT CREWS AND LIFE INSURANCE.

While the recent terrible disaster to the Southport and
St. Ann’s lifeboats still remains fresh in public sympathy,
it may be well again to refer to the subject of life
insurance as a provision against the death of the bread¬
winner for the maintenance of his widow and orphans.
By this sad misadventure twenty-seven valuable lives
have been lost, and what makes it even more deplorable
is thet the men to save whose lives they lost their
pwn were all rescued before the latter started on their
mission of mercy. Among other lessons to be learned from
this disaster, we may trust that it will not in future be per¬
mitted that a man suffering from well-advanced phthisis
shall be entrusted with the responsible duties of coxswain—
a position requiring, the soundest mind in the soundest body.
We may also expect further improvements in the construe-*
tion of lifeboats, and better means of communication between
lifeboat stations within view of the same points of danger,
though out of Sight of each other.. But when all this has
been, done, and the lifeboat service has been made as perfect
as possible in human hands, we must still expect that acci¬
dents and misadventures will happen in the future. It is
very gratifying that a sum has beep raided, not only suffi¬
cient to provide amply for all the bereaved families, but
even to leave a surplus, which a contemporary suggests *
should form a nucleus of a fund for the relief of sufferers
from future similar disasters. Would it not be better, how¬
ever, to apply any such surplus in aiding lifeboat men to
effect an insurance on their lives against all risks, or, if this
be not practicable, specially against the risk to which they
are necessarily exposed? We would earnestly commend to
the Royal National Lifeboat Institution the adoption or
modification of the plan carried out for many years by the
Ootnmissioners of Northern Lighthouses. Each lighthouse-
keeper is insured for £100 in the Edinburgh Life Assurance
Company. He must be an “ insurable life ”, before he can be
admitted into the service, and from his wages there is an
annual deduction of £3 to pay the premium. In the event
of his death, the principal sum is given as he may by will
direct, or, if he die intestate, to his next of kin. At present
the rate of premium for lifeboat men is no doubt high; but
it may also be suggested to insurance offices whether it
would not be to their advantage to offer facilities for such
insurance. Should this suggestion be carried out and
become as national as the lifeboat itself, great benefits would
■accrue. The men. could not be braver,' but they would go
-on their errands of mercy With dightet hearts, knowing that
those dependent on‘them for their b¥ead Would 5 be amply
provided for. We cannot expect to Bee often such muni¬
ficence as has been shown in the recent cose; but by a

system—partly compulsory, partly voluntary—every life¬
boat man may provide for his wife and children without
leaving them to the charity of the public. Nothing can be
more reasonable than that the men in the service shall be
insurable lives, and not only so, but insured as well.

HOSPITAL SATURDAY FUND.

The delegates of the Hospital Saturday Fand for 1886 have’
seen their way to distribute £9750 out of about £11,000
realised up to a few days ago. The institutions to be bene¬
fited are seventy-five hospitals, thirty-nine dispensaries,'
and eighteen convalescent homes. The Board reserve 5 per
cent, of the sum distributed for surgical appliances and
other purposes. The chief awards to hospitals are :—'
Brompton Consumption, £589; London, £588; Victoria Part
Chest Hospital, £288; Middlesex, £276 3s. 6d. ; St. George’s,'
£267 8s. 10c?.; St. Mary’s, £224 17s. Id. ; Metropolitan Con-»
valescent Home, £211 Os. bd.\ Westminster, £208 Os. Id. j
King’s College, £175 13s. 8<2.; Royal London Ophthalmic,
£174 2s. 7c?.; North London, £176 12s. lc?.; Charing-cross.
£162 11s. lc?.; University College, £204 8s. 8d. ; Royal Free,
£168 5s. 8 d.\ Hospital for Sick Children, £129 Os. 2<?.;
German, £115 19s. 10 d .; Royal National, £108 4«. 10<?.;• tJifcy-
road (Chest), £96 ls. 9c?.; North-West London, £81 Is. 10<?.;
St. John’s, £82 7s. 6 d .; Royal Orthopaedic, £89 Os. 8 d. The
great efforts of the Board to increase this Fund must be
recognised; but it is disappointing to notice that they have
not been more Successful. The sums distributed do not
exceed those of last year by more than £250. A sum of unde*
£10,000 is altogether disproportionate to the ability of the
working classes of the metropolis and to their obligation to
the hospitals, which exist chiefly for them. A committee has
been appointed to take the necessary steps for registering
this Fund under the Friendly Societies Act. It is thought—
though there is some difference of opinion on this subject— 1
that some advantages will be gained by this, especially in
acquiring greater facilities for dealing with occasional
defaulters. But what is seriously wanted is a better method
of organisation to gather weekly and regular subscriptions
to the Fand. The present condition of the hospitals ought
to make the time favourable for such action.

THE MEAT-SUPPLY OF MARSEILLES.

Among many other causes that contribute towards the
exceptional insalubrity of Marseilles must be noted the
fraudulent sale of meat unfit for human consumption. This
is a grievance which affects not only the inhabitants, but
also the crews and. passengers of the ships, many of them
English ships, that take provisions on board at Marseilles.
It appears that in the district of Aveyron, and notably at
Saint Afriqiie, the principal industry is the making of the
celebrated Roquefort cheese. For this purpose the sheep as
well as the cows are valuable principally on account Of
their milk. It is to the interest of owners to kill both
calves and lambs before the flesh is sufficiently formed to
constitute wholesome food. But a calf will oonsume an
'amount of milk which, in the Aveyron district, is eqaal to
three francs a day, while augmenting in meat value at the
rate of only one franc per day. Thus a calf, which should
be kept at least thirty days, would cost ninety francs, and
yield an increased value of only thirty francs. With respect to
lambs, the loss is in the same proportion. It has therefore
been the practice to kill lambs and calves at once, and im¬
port the meat direct into Marseilles. After the ravages
made by the cholera the Mayor decided to issue a special
decree against this practice. Henceforth the head must nob
be detached from the careaie, so that the presence of tbe
teeth may testify to the age of the lamb or Calf.; But the above
was not tbe only grievance. A bullock brought into Mirae ilies

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Thb Lancet,

PENURIOUS TREATMENT OP MEDICAL OFFICERS,

[Jan. 1,1887. 39

and killed at the municipal slaughter-house paid, in all,
dues to the amount of thirty-two francs. If the same bullock
were killed outside the town and the meat imported, the
^1 ues to be paid would amount to no less than a hundred francs.
Yet, in spite of this prohibitory tariff, a great quantity of
dead meat was brought into Marseilles. The fact is, the meat
came from animals that had been killed while ill, or that had
died before they could be killed. Taught by the epidemics
the necessity of attending to such matters, the Mayor has
also decreed that beef, mutton, and pork can only be brought
into the town if the owner has first secured the certilicate
of a veterinary surgeon who shall have seen the animals
before they were slaughtered. These new regulations have
not long been in operation, and it is too soon to speak of the
effect produced. Few persons, however, will be found
to cavil at their severity; and, in this respect at least, we
can venture to congratulate the local authorities. Unscrupu¬
lous meat merchants will find, we trust, their trade destroyed,
and the municipality has done well to protect the popula¬
tion and strangers who visit the port from their nefarious
practices. _

REPORTED CURE FOR LEPROSY.

Under this heading the St. .Tame* 8 Gazette of Dec. 17th
Quotes a portion of a letter from Father Damian, of the
Molokai Leper Settlement, to a German publication, in which
he shortly refers to and extols the wonderful effects of ia
treatment carried out at the Kakaako Leper Hospital by
by Dr. >1. Goto of Japan, who was invited over by the king.
The treatment referred to is similar to that long carried
out by Dr. S. Goto, of the Kihai Hospital, Tokio, Japan. It
is hygienic, dietetic, and medical. Strong patients are
bathed thrice daily, and weaker ones twice daily, in warm
fresh water at 90° to 100° F., into which has been placed an
infusion of a few ounces of nichiyou bark (zEsculus turbi-
natal, together with certain proportions of Taifuushi,
sulphur, and other ingredients. The patients are fed
generously, but not excessively, thrice daily, on rice, milk,
beef, mutton, chicken, eggs, good strong broth, boiled taro,
vegetables, and fruit; but sour poi and also raw fish, when
used with the usual native condiments, are forbidden. The
medical treatment “ varies according to the condition of
the patient and the stage and character of the disease.” The
two chief medicines used are, in all cases, Seiketsu-ren as pills
and in large doses (? the bark of the Hoang-nan tree with
realgar and alum), and yoku-yaku for baths. Dr. Goto also
employs tincture of the perchloride of iron, sulphate of
quinine, iodide of potassium, vegetable tonics and bitters,
and the carbonate of soda and potassium, especially the
alkaline salts. Under this treatment he reports, under date
of April 20tb, 1886, five cases as “almost cured," nineteen
as “improving,” and seventeen as “relieved.”

THE VACCINATION OF THE AUSTRO-HUNGARIAN
ARMY.

Struck by the wonderful fact that in the German army
the compulsory vaccination had reduced the mortality from
amall-pox to nil, the Crown Prince Rudolph of Austria had
been led to urge a similar precaution for the Austro-Hun¬
garian army, and within the last few months, the Evening
Standard observes, every soldier has been compulsorily
vaccinated. The result is that whereas in l’esth a small-pox
epidemic of great severity has been raging among the civil
population (who are under no compulsion), there has not
been a single case among the numerous troops of the garrison
at Festh. Of course all this will be explained away by our
anti-vaccination friends, and the many who have died of
small-pox will be regarded as better off than those who
have been saved by vaccination. But the majority of people
will not go wrong over such plain facts.

THE NEW REICHSTAG BUILDING AT BERLIN.

An account of the proposed ventilation of the new Reich¬
stag at Berlin has recently been published by Mr. W. H.
Tyler, who gives an interesting description of the efforts
that are being made to ensure the ventilation of the Houses
of Parliament being as perfect as possible. The Grand Hall
is to be ventilated by air admitted through the roof and
drawn out through the floor, the air being drawn from a
height of 250 ft. to ensure its purity. It will be first con¬
veyed into a large chamber, where it will be prepared for
admission into the hall. The preparation will consist of
exposing it in winter to hot pipes, a surface of -13,000 square
feet being required for this purpose. The same pipes in
summer will contain a liquid at nearly freezing-point, so
that the temperature of the hall cannot during this season
of the year become unduly high. Here also it will be dried
or moistened as occasion may require, and by a simple
arrangement of valves the necessary quantity will be
admitted. The hall is to contain nearly 1000 persons,,
each of whom is to be provided with 1420 cubic feet of air
per hour. When the House is sitting, the air will be con¬
stantly examined by four assistants, who will report on the-
thermometer, hygrometer, and anemometer indications, and
thus enable the engineer to modify it whenever this is
required. It is thus expected that the condition of the
atmosphere-of the houses will be maintained in proper
condition. _

PENURIOUS TREATMENT OF MEDICAL OFFICERS.

We have frequently hod occasion to refer to the paltry
remuneration which is offered for medical services by many
municipal and parochial bodies. At a recent meeting of
the Darlington Town Council a fact was incidentally men¬
tioned which affords a fresh example of this short-sighted
economy. It appears that the three medical officers who
attend the poor of this considerable town, numbering about
13,000, and who with curious assurance are required to
supply medicines and appliances, receive each per annum
for these attentions the utterly insignificant sum of .£35.
With every allowance made for hard times and for work
among the poor which may be done by medical men
in independent practice, the sum above mentioned is,
we repeat, unjustifiably small in comparison with the duties
exacted in return. _

NEW FOREIGN MEDICAL JOURNALS.

A new French weekly medical journal commences with
the new year. Its object is to assert the importance of pro¬
vincial medical science and to assist in the decentralisation
of French medicine, which it is considered is concentrated
too much at Paris. The title is La Province Mldicale, and it
is published at Lyons.

The appearance is announced in Vienna of two new
medical journals— Klinische Zeit- und Strcitfrajen, edited by
Professor Schnitzler; and a weekly entitled Internationale
klinische Pundschau, edited by Drs. Bela Weiss and
A. Schnitzler. _

A SURGEON FINED FOR CERTIFICATE OF
STILL-BIRTH.

The writing of certificates is one of the chief way6 in
which medical men come into contact with public offices
and public law. It is a duty which they cannot discharge
too carefully. We regret to see that a medical practitioner
has been fined £o and costs for signing a certificate of still¬
birth for a baby that had lived a few hours. The mother
was attended in her confinement by a midwife, though for
phthisis, of which she died in the evening, she had been
Been before and after her labour by the medical man. The

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40 The Lancet,]

THE SANITARY CONDITION OP ROCHESTER.

[Jan. 1,1887.

child lived a few hours. Statements varied as to whether
this had been made clear to the signer of the certificate.
But the magistrates imposed the above fine. It is a great
temptation to save poor people all the paraphernalia and
expense of a funeral for a child that can scarcely be said
to have lived. But it would have been better to have left
the midwife to state the facts, and in any case the utmost
care to he accurate is necessary.

THE CARRIAGE TAX.

The movement to repeal, or at least modify, the tax on
-carriages is one that deserves success, if it were only for
the pertinacity with which it has been, and still is, carried
on in the face of unaccountable neglect and opposition. A
great mistake is made by those who think this is a “ rich
man’s question.” The profession of medicine is in this way
undoubtedly unduly taxed, but it is the coachbuilders’ class
that suffers most, and the tax is a burden on industry.
It ought to be abolished, and the magnitude of the revenue
derivable from the tax is not so stupendous as to be over¬
whelming to any spirited Chancellor of the Exchequer.

THE ACCURACY OF THE NEW MEDICAL REGISTER.

The Registrar of the Medical Council is very anxious to
secure the greatest possible accuracy in the new volume of
the Medical Register. This can only be attained by the
co-operation of the profession, and especially of all those
who have changed their addresses or added to their titles.
If such gentlemen will immediately intimate such changes
they will be duly registered; otherwise inaccuracies will
remain which not only discredit the Register, but may dis¬
qualify practitioners. _

THE PROGRESS OF CHOLERA.

It is stated that there has been no recurrence of cholera
in the neighbourhood of Tirnova since the first report, when
eight deaths occurred. The sanitary authorities are, how¬
ever, still maintaining a quarantine round the infected
locality; and since the Bulgarian authorities decline to
admit that any cholera has occurred within their princi¬
pality, Roumania has placed Bulgaria in quarantine.

CHONDROMA OF THE LIP.

In the Transactions of the American Dermatological
Association for 1886 Dr. A. R. Robinson reports a very rare
case of chondroma of the right side of the upper lip of a man
thirty-six years of age. This affection has been described
by Pagot under the term “ labial glandular tumours.”

OVERHEAD TELEGRAPH AND TELEPHONE WIRES.

The recent heavy snowstorm has emphasised the lesson of
warning as regards overhead wires. Many have fallen, and
great damage has been done; but probably some consider¬
able loss of life will be required to bring the facts clearly
before the Legislature and to rouse public indignation to the
boiling point. _

FOREIGN UNIVERSITY INTELLIGENCE.

Bern. —Dr. Demme has been appointed Professor in
■Ordinary of Pharmacology and Children’s Diseases.

Bologna. — This University will celebrate its seven
hundredth anniversary in the Spring.

Bonn. —Dr. Franz v. Leydig, Professor of Comparative
Anatomy and Zoology, will retire in April.

Freiburg. —Dr. Baumgartner, formerly Professor of Patho¬
logy and Director of the Medical Clinic, died at Baden-Baden
■on Dec. lltb.

St. Petersburg. — It is now announced that Professor
Nasiloff is to take charge temporarily of the surgical clinic—
not Dr. Beltsoff, as originally stated. The report that Pro¬
fessor E. Bergmann of Berlin had declined an invitation to
St. Petersburg is confirmed.

BERI-BERI IN THE DUTCH INDIES.

It is officially stated that daring the year 1885, there
were 5388 persons in the Atchin colony treated for beri¬
beri, of whom 235 died and 842 were incapacitated for duty
Up to the present time no regulations seem to have had any
effect on the ravages of this strange malady.

From the report of the examination made by Colonel Sir
Francis Bolton of the water supplied by the several metro¬
politan water companies during the month of November,
1886, it appears that the Thames water sent out by' the
Chelsea, West Middlesex, Southwark, Grand Junction, and
Lambeth Companies contained rather more organic matter
than the previous month’s samples, although the actual
amount present was in every case small for the season of
the year. The water taken from the Lea and distributed
by the New River and East London Companies also contained
only a very small proportion of organic matter. All the
waters were clear and bright on delivery.

Dr. Rayner's plea, in The Times , for the treatment of
mental disease at general hospitals deserves the attention
of the profession. It is precisely what we have urged upon
the consideration of our readers for many years past; but
the subject has so many aspects that it cannot be at present
adequately discussed. _

Dr. Alfred Meadows has been elected an honorary
member of the Washington Obstetrical and Gynecological
Society. _

Mr. Charles A. Ballance, M.S. Lond., F.R.C.S., has been
elected Surgical Registrar to St. Thomas’s Hospital, in the
place of Mr. G. H. Makins, F.R.C.S., resigned.

The Deutsche Medicinische Wochenschrift, which has
•hitherto been published by G. Reimer of Berlin, will now be
published in Leipsig by G. Thieme.

funcrf Sanitanr Commission.

THE SANITARY CONDITION OF ROCHESTER.

England has recently had much cause for congratulation
that she has escaped the terrors of a disease which has
visited with calamitous results France, Italy, and Spain.
She has been able to regard with equanimity the possible
introduction of cases of cholera into her midst, and has
witneesed, without feeling the necessity for interference
with her trade, the epidemic prevalence of th : s milady in
continental seaports with which she is in constant com¬
munication. For this security she has undoubtedly paid a
price, but the money expended has not procured for her
safety in regard to this disease alone, but has given her
inhabitants prolongation of life, and has raised the stairiatd
of health in all parts where the teachings of sanitary science
have been allowed to prevail. But this security is not shared
alike in all parts of the kingdom: in some, local authorities
have striven to guard to the fullest the health interests of

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TXM LANCET,]

PHARMACOLOGY AND THERAPEUTICS.

[Jan. 1,1887. 41

those who are dependent on them; in others, there has befen
lea* willingness to incur the expenditure which is necessary
fir this purpose, and, strangely enough, amongst those whicn
kiTe been leas active in this direction are localities that
an more immediately exposed to risk of infection from
without than are some others.

Here are probably no towns more exposed to risks of the
sort w« have indicated than those which are situated on the
waterside between London and the mouth of the Thames.
Oraretend is known to be a special defaulter in this respect, !
but it bv no means stands alone; the report recently issued
by the Local Government Board gives but too grave an
account of sanitary negligence in other districts of that neigh¬
bourhood We have therefore thought it well to discuss in
these Od ums the sanitary condition of other waterside
towns m Kent, and we have directed our attention, in the
first laaxace, to the towns of Rochester and Strood, which are
situaud respectively on the right and left banks of the river
kednj.

Earfkster forms part of a sanitary district which includes
not aily the parishes of St. Nicholas, Rochester, Precinct
Cktiednl, St. Margaret, and Chatham ( inlra ) on the one
si of the Medway, but also the parishes of Strood and
Fmdabary on the other side of the river. The sanitary
-iucnet is not therefore coterminous with either theregistra-
iaa districts of Medway or North Aylesford, but includes
apart of each. The total population of the district numbered
c die last census 21,307 persons, that on the right bank of
tze river being 14,240 in 2582 inhabited houses. During the
war 1S85 the death-rate for the whole district was 18 5 per
!"J) of population; but if the deaths occurring in public
zKitutions receiving patients from other districts be
'icloded, the rate is reduced to 14 9 per 1000. During this
icer. of a total of nine deaths from diphtheria in the whole
istriet eight occurred in the Medway division, and of four
txal deaths from enteric fever three occurred in the
Medway division. Of these two diseases, therefore, the
M-dway or Rochester division, as distinct from the North
Ayl-sdord or Strood division, suffered out of all proportion
to the extent of population.

Rochester and Strood have shared with other towns the
benefits of an improved water-supply. Thirty years ago
two companies began to give facilities to the inhabitants
ter procuring water from deep wells in the chalk. Until
tii? timp the townspeople had nothing but wells in con¬
nexion with each bouse for their supply. These wells,
stunted in many instances in close proximity to cesspools,
readily became contaminated, and proved a fertile source of
to the inhabitants. Gradually the majority of these
wdls have been abandoned, and at the present time some
tijree-fourths of the houses in Rochester and nine-tenths of
the houses in Strood derive their water from the public
-apply. In 1880 the waterworks supplying the latter town
passed into the hands of the Corporation, who thereupon
expended £11,000 in their extension, and provided a
•efficient qoantity of water both for Strood and Frindsbury,
and for more than three years a large majority of the
looses in these three towns have been on constant service.
The attention of the medical officer of health, Dr. Sladen-
Kaigbt. and of the surveyor, Mr. Banks, is being directed to
Use remaining houses receiving their water from local wells;
tr« pa have been prepared, showing for each the relative
noauioas of wells and cesspools and the distance between
them, «ml efforts are being made to induce the inhabitants
to have their hoasee connected with the mains of the
waterworks. Thus, during the year 1885,117 samples of
w-ter were examined by the former officer, and some 60
wells were closed. ....

Bat while the local authority deserve credit for their
recognition of the necessity of an ample supply of whole¬
some water, they have failed to keep pace with other towns
ia providing proper means for the disposal and removal of
excrement*! matter. Speaking generally, the whole of the
sanitary district depends solely upon cesspools. These
receptacles vary from ten feet and more in depth. They are,
a rule, bricked, but must nevertheless afford ample means
for the pollution of the soil beneath the towns. The smaller
o-mpoou are emptied every year, but the larger retain their
lith for four or five years. The contents are removed at
sight ia buckets, which in some instances have to be con¬
veyed through tbs boases to enable them to be emptied
into the cart. Tbe sanitary authority exercise little or no
■'■ostrol over tbe operation, the inhabitants making their own
arrangements with a contractor, who charges from £1 to £6

for the business of emptying each cesspool, the charge being
proportioned according to its size. Tbe surface-water is
removed by means of drains, which discharge into the river
Medway, and are carried on the foreshore to a position
between high and low water mark. In some instances the
inhabitants have connected their cesspools with these drains,
and thus the overflow passes on to the banks of tbe river.
The unsatisfactory nature of these arrangements appears to
be well understood, and recently a firm of engineers sub¬
mitted to the sanitary authorities of Rochester, Chatham,
and Gillingham a scheme for the combined sewerage of these
towns. It was proposed that the sewage should be utilised,
and that the effluent, after purification, should be discharged
into the Medway, not far remote from Gillingham. But the
estimated expenditure proved a stumbling-block. The
greatest opposition came from Chatham and Gillingham,
and in the end the scheme was abandoned.

(To bo continued.')

|!{rcnnatolop anh ffijcrajjetttks.

MBNTHOL PLASTEB.

The menthol plaster recently introduced into England by
Messrs. Burroughs, Wellcome, and Co. for the American
National Plaster Company is a good preparation. The
specimen submitted to our inspection has the agreeable
odour of peppermint, and indicates its nature also by the
action of the menthol vapour on the conjunctivas. We gave
a plaster of it to a patient who complained of pain
below the left breast. She expressed herself as greatly
relieved by the application, which appeared to be more
agreeable and to have greater effect than the belladonna
piaster which she had previously worn. The writer applied
a strip of the plaster to his brow whilst suffering from an
attack of megrim. The action of the menthol was decidedly
refreshing; it did not cure the headache, but seemed to abate
its intensity, and even rendered movement less distressing.

ACETANILIDE, OB ANTIFEBBINE.

M. R. Lupine has published in the Lyon Medicate an
account of a number of observations he has made both on
animals and on patients of the action of this drug. He finds
that it ia a very valuable “ nervine” in doses of seven imd
a half grains, producing as great an effect on the lightning
pains of patients suffering from locomotor ataxy as a drachm
or bo of antipyrin. Like the latter, it lowers the temperature
in fevers, and is preferred to antipyrine by patients because
it does not produce a condition of semi-intoxication, as
antipyrine in large doses is apt to do.

BICABBONATE OF SODA IN TONSILLITIS.

The treatment of tonsillitis by frequent local applications
of carbonate of soda, which has been practised and recom¬
mended by Dr. D. Juan Gint?, has been put to a series of tests
by another Spanish physician, Dr. D. Rovira y Oliver, who
deduces from them the opinion that, thongh it is often bene¬
ficial in cases where the parenchyma of the tonsil is affected,
it is of much less value than many other applications in cases
which are merely superficial, and catarrhal.

QUILLAJA SAPONABIA AS 4lN EXl'KCTOBANT.

Dr. Masloveki has used the root of quillaja sapon&rin,
which was recommended by Robert, as a substitute for
senega in a number of different pulmonary affections, and
finds that it is a valuable expectorant. It is, however
contra-indicated where haemoptysis is present.

BENZOIN BESIN IN ULCBBS.

Dr. Woskresen6ki, writing in the Russkaya Meditsina on
the use of benzoin resin as a popular remedy for ulcers, says
that he has frequently employed an ointment of the strength
of four drachms to the ounce spread on lint, and renewed
twice a day, with excellent results.

BBSOBCIN IN CONDYLOMATA AND MUCOUS PATCHES.

Dr. Gachkovski mentions in a Russian medical journal
that he has applied resorcin as a dusting powder to thirty-
four cases of acute condylomata which ne has met with in
the last five years, with the most satisfactory results. In
one case where there were no less than thirty condylomata

42 tH* UAflCET,]

THE (COLLEGE OF PHYSICIANS AdJ MEDICAL DEGREES.

[Jan. 1,1887.

.on the prepuce, one of them as large as a raspberry, a daily
'application of resorcin reduced them all in the course of a
week. Mucous patches, too, were easily cured by resorcin,
though the cure was not permanent, as recurrence always
took place.

TREATMENT OF ERYSIPELAS.

For the treatment of erysipelas Dr. Archangelski has tried
a number of applications, and tinds that their comparative
efficiency is represented by arranging them in the following
order: (i) benzoic acid; (2) tincture of iodine and turpentine,
as ointment; (3) sulphate of copper; (4) sulphate of iron;
(5) oxide of zinc; (6) naphthalin; (7) solution of perchloride
of mercury, 1 to 300; (8) chloride of zinc; (9) iodoform.

CASCABA PASTILS.

The liquid extract of ca9cara sagrada though a valuable is
not a palatable drug. Mr. Martindale has prepared some
pastils containing the liquid extract. These gelatinous
morsels can be rapidly swallowed without effecting the
sensation of taste in any noticeable -degree. That the
pastils possess purgative properties we know from personal
experience.

FORMIC ACID A DISINFECTANT.

Formic acid, according to Dr. Voitoff, who has made a
number of experiments on cultures of pyogenic micro¬
organisms, is a specific against their success, and so may be
considered as an excellent disinfectant.

THE COLLEGE OF PHYSICIANS AND MEDICAL
DEGREES.

Thb adjourned debate upon Dr. Allchin’s amendment to
the repbrt of the Committee , of Delegates upon Medioal
Degrees took place at the Royal College of Physicians on
Dec. 23rd, Sir W. Jenner, Bart., President, in the chair. There
was a large attendance of Fellows.

Sir H. Pitman spoke first, and passed in review the pre¬
vious resolutions of the College upon the subject, which,
judging from the debate, he feared had been lost sight of
by some of the Fellows. In 1884, upon the motion of Dr.
Wilson Fox, the College referred to the Medical Bill Com¬
mittee to consider how far it was desirable that the College
should obtain powers to confer the title of Doctor of Medicine
upon its Licentiates. To this resolution there was no oppo¬
sition, the only material change being a further reference
for suggestion of any other means whereby the alleged
grievance to medical students, so thoroughly educated and
examined, might be remedied. That Committee reported
that it was desirable that increased facilities should be
afforded for obtaining the degree of M.D., and recommended
that the two Colleges should immediately take steps, either
in co-operation with an existing University or by indepen¬
dent action, to secure this end. An interval now elapsed
pending the scheme for the conjunction of the Colleges
and its sanction by the Medical Council; and, this
done, a further remarkable and instructive portion of
the history of the question occurred. This was the recep¬
tion of a letter from the Royal College of Surgeons request¬
ing the College of Physicians to nominate seven delegates
(later increased to ten) to meet the same number from their
College, in order to determine what steps, if any, could be
taken to enable the two Colleges to obtain the legal right
of granting the title of Doctor to persons who have passed
the examinations of the Conjoint Board. It was scarcely
possible that the College of Surgeons would have proposed
this unless they had known that the College of Physicians
had previously viewed the matter favourably. No question
was raised as to the desirability of this step, and the report
bf the delegates was now before the College. He thought
the Fellows could hardly have recollected this history,
when they were asked to assent to an amendment which
Was so adverse to the spirit in which the College had been
acting. Moreover, the College had some time ago received
a most influential memorial urging the combination of the
Colleges to form one Royal College of Medicine with power
to grant degrees. It was for the advantage of the profes¬
sion, and it would be to the honour of the College by being
useful to the profession, that the candidates approved by
Ahem should have something more than a bare qualification

to practise. At the same time they could not object to any
possible opposition. Naturally opposition might be expected
from the Universities, for those who possess power are lotj*
to see it shared by others. When Durham University was
established it was opposed by Cambridge and Oxford. 11s
did not believe that such opposition would arise from any
feeling of jealousy of the Colleges; but he could under¬
stand that the Universities would be unwilling to see
any degree granted on conditions less honourable than
those ot other bodies. In this he himself concurred,,
holding that a degree should be a distinction as well
as a title. That was the question they had to settle.
A degree would have to be obtained somewhere or other,
whether through a teaching university or through the;
Colleges; and if a university were independently started;
in London, the Colleges would stand in a peculiar position,
with regard to it. Sir W. Gull’s suggestion was opportune,
for if they instituted an additional examination as the basis
of the degree, the opposition of the Universities would be
disarmed; and no doubt such a step would benefit the
public as well as the profession, by stamping men as fully
qualified in clinical medicine ana surgery. The College
owed a duty to the profession, but if it nad to abandon the
scheme, let it abandon it altogether. The College could of
course change its opinion, but it had already gone too far
to retreat with honour, and if it deserted the profession now !
it would do an injustice, and bring discredit on itself. If the
College sought the powers and failed, it would have done its
best to remedy this acknowledged grievance. But why
should it not succeed? Some thought it anomalous for'
Colleges to grant degrees, but they forgot that the University 1
of Edinburgh was founded as a College, and existed as such i
for over a century; aud, to come down to modern times,
they had seen instituted in London bv Royal Charter a
College of Music, with power to confer degrees of Bachelor,
Master, and Doctor of Music. If a College can be insti¬
tuted by Charter, why not a Medical Faculty ? As regards |
the teaching university, it must be remembered that all
things develop by degrees. They would endeavour
to get power for the two Colleges to grant degrees in
medicine, and other faculties would in time crystallise
around them. But if they held their hands, and waited
until a complete university was established, they might
very possibly be left outside altogether, and would lose
their acknowledged position at the head of medical educa¬
tion ; and if they failed to grasp the present opportunity,
their claim to deal with the question would be gone for
ever.

Dr. Matthews Duncan, whilst agreeing with nearly all
of Sir H. Pitman’s remarks, still maintained that the essence of
the question had not yet been touched. The report contained
statements which were far from being confirmed. It spoke
of the “ schools associated with the Colleges,” but was it
sure of the co-operation of the schools and of their hospitals ?
How could a teaching university be instituted without
teachers ? The project evidently aimed at such a university
but there was no word as to its constitution, who were to
form its senators, or in what relation the College councils
were to stand to it. All were agreed as to the grievance,
and that the Colleges would be honourably engaged in
trying to remedy it, but there the difficulties of the question
arose. They had to distinguish between a university and
a college, and he held that a College such as this was
distinct from a university, and its functions would be
swamped in the new body. The College would lose its
established position, and become a rival of other Universi¬
ties. No doubt it would have done a great work, but it
would be work foreign to the duties of the College; it
would create a new body and would involve its own ruin.

Dr. Ord congratulated Dr. Allchin on his speech, but
maintained that, although himself greatly interested in the
work of the Teaching University Association, he could not
support the amendment, for he felt that the Colleges, if
they prosecuted this matter earnestly, would be working in
harmony with the objects of the Association. The power
and influence of the Colleges would be of great value in
effecting this quickly; and it was m the belief that a univer¬
sity organisation would thus be originated that he urged the
rejection of an amendment the effect of which was to stop
all progress.

Sir Andrew Clark did not think that perfect unani¬
mity could be expected, but considered that in discussing the
principle it was important not to anticipate the details of a
scheme. He warned the College that if Dr A'lchin’s amend-

>ogle

Th* Lanobt, J

DONATIONS AND LEGACIES TO MEDICAL CHARITIES IN 1886.

[Jan. 1,1887. AS

ment were adopted it woald be bound to apply to a uni¬
versity, and be quite unable to act independently; its offers
anight be rejected or might only be accepted on terms
humiliating to the College. That it was unreasonable for
the Colleges to become a university was no argument
Against the course proposed, which was urged on not
only by practitioners, or by London teachers, but by
a reasonable demand on the part of London students.
The argument that the scheme was “without precedent”
was made in ignorance of the history of universities. Was
Any precedent ever required to found a university? and os
to the Colleges not representing the teaching body, were
they not constituted of teachers! Nor would it be an
“inferior degree,* for had not the whole action of the
Colleges been one to raiAe and improve the standard of
medical education? He was sore tnat such training, par¬
ticularly in clinical. work,. would be advanced and im¬
proved by this scheme. Nor would this be gained at the
-cost of tne autonomy of the College. The degree would be
given in unison with the College of Surgeons, and each
College would retain, as at present, its individuality. The
■question should be dealt with on the ground not of what is
theoretically desirable, but on what is just and practicable.
It could not detract from the dignity of the College.
If an institution such as theirs did not progress, it would
Certainly decay. He maintained that the grievance they
had to remedy was * just one, and that it was reasou-
Aljle and natural that it should be remedied by those who
were at the head of the profession. If the Colleges did not
seek the powers by themselves, they might be supported by
A third body constituted by the State and representative of
the schools; or a third alternative would be that shadowed
forth in the amendment—affiliation with a university. The
College was in the midst of a crisis, and he felt that if they
were to be loyal to their inheritance and hand down its
traditions unimpaired, they must take the lead in this great
movement.

Dr. Stueqbs asked for a definition of the phrase " Arts or
Science ” in the resolution, and was proceeding to criticise
a previous report suggesting details of a proposed Arts
examination, when it was pointed out that the College had
riot at present considered such details.

Dr. Quain contended that Dr. Allchin’s amendment did
not point out how the object they aimed at was to be
secured. The College was bound to give a degree, and the
•details of the scheme could be referred for further considera¬
tion.

Sir Risdon Bbnnktt said his loyalty to the College and
Anxiety on its behalf prevented him accepting the resolution
■of the delegates. He thought that if the opportunity now
before them of acquiring these powers were lost for ever, it
•would be to the advantage of the College ; yet he qnite
Admitted there was a grievance, and that it was the dnty of
•the College to assist in getting rid of it. He could vote for
the second resolution, which, involved an application for
powers to grant degrees, but could not concur in the
details of the first resolution. He would consent to nothing
which tonched on the rights and privileges of the College,
And he maintained that the first effect of creating a new
class of graduates would be to break down the partition
•between the Licentiates and the Members, and would
-entirely alter, the value of the Pellbwship. How could this
be done without converting the College into a new-fangled
university, with thd consequent loss of its prestige? What¬
ever is done, it must tend to raise the examinations, and
would lead to the establishment of an inferior body, whilst
doing away with - one high-class examination. He felt that
they were very imperfectly acquainted with the probable
outcome of such a scheme.

Dr. Dickinson said there was a great work before the
College, and that if they obtained powers to confer a degree,
it must be a worthy one, embracing a higher examination
in ArtA, a clinical examination, and a requirement that
candidates should have had part of their education in
London. r-L — ....

Dr. Latham had formerly opposed the project, but had
been converted to it, arid hopea that,' for the advantage of
the general public, o? the medical' students in London, of
the Colleges of Physicians And Surgeons, and especially of
the old Cnivetfeities,' it Would be carried into effect. He
believed that any opposition tbat might come from the
old Universities would proceed from a sentimental grievance,
and tbat they would hold their own ground. The graduates
of the Universities were proud to become Fellows of the

College; and was there any reason why that relationship
should not be still maintained ? Were not the two Colleges
in a better position to judge of medical education than the
small bodies of the Universities; and would they not seek;
to maintain the standard of medical learning; whilst they
certainly could not lower the value of University degrees? '

Dr. Babnbs said that it was wrong to fear that the Col¬
leges would suffer in reputation by taking this course. If
they have a leading part in the project, how could they
suffer degradation ? They had gone too far to retire with
any decency or safety. He held that medical education was
superior in London, and the student life in London could be
compared with the life at a University.

Sir W. Gull said it was the duty of the College to advance
the profession of medicine, and to minister to its wants. If
students are driven away from London for want of a degree,
the Colleges should meet this. They had already accepted
this, and had to consider oirwhat terms such a degree should
be given. He suggested the title of M.D. Lond. as one
worthy of adoption, that of M.D, Uniy. Loud, standing for
the present University. The time had come for granting a
degree on professional merits.

Dr. Bboadbbnt pointed out that the question was
whether they were going to delegate this power to others
or do it themselves. If the College decided not to take
powers, according to the amendment, then the whole ques¬
tion would fall. If the decision were otherwise, then they
must expect that all who now objected would co-operate
to make the degrees worthy of the Colleges. To all intents
and purposes, the Colleges at present exercised the functions
of a medical-university; so that the step proposed was
merely a further development of their powers, the real
revolution being when the College began to examine
Licentiates. That action of thq College had raised the whole
tone of medical education. If the amendment were carried,
another body would be called into existence, and the
Colleges would sink into a secondary place.

Dr. Priestley had been much influenced by Sir H 1 .
Pitman’s speech, and having no doubt that this would be
the starting point'of a new university, he should support
the resolution.

The College then divided, and Dr. Allchin’s amendxhent
was rejected by a large majority, only nine Fellows voting
in its favour.

Dr. Bboadbbnt moved, and Sir W. Gull seconded, the
next resolution—viz., “That an application be made to the
Crown bv the Royal College of Physicians of London and
the Royal College of Surgeons of England, acting conjointly,
for power to confer degrees in medicine and surgery.’’ This
was unanimously acceded to, and ^ further motion referring
the resolutions and Sir TV. Gull’s amendment to the Com¬
mittee of Delegates was also carried, on the motion of Dr.
Qnain, seconded by Dr. Priestley.

DONATIONS AND LEGACIES TO MEDICAL
CHARITIES IN 1886.

The following is a list of the. principal legacies and gifts
during the past year to the various medical charities and
institutions of Great Britain:—Mrs. Mary Anne Curweo
(in default of her daughter having issue), £40,000 to 8U
George’s Hospital, £6000 each to two and £2500 each to
about twenty other London medical charities; Mr. Richan)
Henry Vade Walpole, over £185,000, in equal shares, to tfre
Westminster Hospital, Charing-cross Hospital, King's College
Hospital, St. Mary’s Hospital, the London Hospital, the
Royal Free Hospital, the London Fever Hospital, the City of
London Hospital for Diseases of the Chest, the Norfolk and
Norwich Hospital, the Cheltenham Hospital, the Great Yar¬
mouth Hospital, and the British and Foreign Sailors' Home,
Great Yarmouth; Mr. Henry Chisley of Hastings, £13,650 to
the London Hospital; Alderman Thomas Rose, Mahchester,
£10,000 to the Manchester Royal Infirmary, £5000 to the
Salford Hospital, £2000 to St. Maty's Hospital ft»r Women,
Manchester, and £1000 each to tne local Eye, Lock, ant)
Clinical Hospitals; Mr. James M‘Ewsn, £5<X)0 each to the
Glasgow Royal Infirmary and the Western Infltmary, Glas¬
gow; Mr. Beardwood, £5000 to the Blackburn and East
Lancashire Infirmary; Mr. Alfred Burges, Worthing, £3500
to such institutions or societies - as his trustees shall think

O

I

44 The Lancet,J CHRISTMAS FESTIVITIES IN THE HOSPITALS. [Jan. 1.1887. \

fit; Miss Mary Elizabeth Tanner, £3000 to the Royal Hos¬
pital for Incurables, Putney, and £500 to the German Hos¬
pital, Dalston; Mr. Charles Johnson da Silva, such part of
the residue of his personal property as may by law be applied
for charitable purposes to the Royal Medical Benevolent
College, to found three exhibitions of £50 per annum, each
tenable for three years, for boys educated at the College and
proceeding to the Universities, and to pay £20 per annum
each to twenty-six poor pensioners of the said College; Mr.
William de Hague, £3000 each to St. George’s Hospital, the
Middlesex Hospital, the London Hospital, the Hospital for
Incurables at Putney, the Westminster Hospital, and the
City of London Hospital for Diseases of the Chest; Mrs. Mary
Gatley Litler, £1000 each to the National Hospital for the
Paralysed and Epileptic, Queen’s-square, Bloomsbury, and
the Royal Hospital for Incurables at Putney, and £600 to the
Warheford Hospital, Leamington; Harvey Kimpton Owen,
M.D., F.R.C.S., £1800 to the Royal Medical Benevolent
College at Epsom to found a scholarship, and £500 to the
British Medical Benevolent Fund; Mr. William Augustus
Guy, M.B., F.R.S., F.R.C.S., £250 each to King’s College
Hospital and King’sC jllege Hospital Convalescent Institution,
and on the death of his wife, or twenty-one years after his
decease, whichever happens first, one-naif of a moiety of the
residue of his real and personal estate which is left in trust
for accumulation in the meantime to King’s College Hospital
Convalescent Institution; Mr. Samuel Taylor, £1050 to the
Bedford General Infirmary; Mr. Thomas Phillip Danson,
£1000 to the Endowment Fund of the Bootle Borough
Hospital and £500 to the Liverpool dispensaries; Mr. Henry
Boddington, £1000 to the Manchester Royal Infirmary and
Dispensary; Mrs. Harriett Anne Richardson, £1000 to the
Hospital of St. John of Jerusalem and St. Elizabeth,
Ormond-street; Mr. Richard Towne, £1000 to the National
Orthopredic Hospital; Mr. Joseph Stevens, £1000 to the
Nottingham General Hospital and £500 to the Midlands
Institution for the Blind, Nottingham; the Right. Hon.
Katherine Anne Viscountess Cranley, one moiety of £1000
Consols to the Brompton Hospital for Consumption; Mr.
Abraham Altham, £500 towards erecting a children’s ward
at the Victoria Hospital, Burnley, and £500 to the endow¬
ment fund of the said hospital; Mr. James Fletcher, £500 to
the Northern Infirmary, Inverness; Mrs. Frances Acton,£500
to the Royal Hospital for Incurables, Putney; Dame Anna
Maria Hare-Clarges, £500 each to the Putney Hospital for
Incurables and the Taunton Hospital, Somersetshire; Mr.
Foster Connor, £500 to the Belfast Royal Hospital; and
Mr. Charles Charlesworth, £500 to the Bradford Fever
Hospital. In respect to donations, Mr. Philip Horsman
defrayed the cost (about £4000) of the in-patient depart¬
ment of the new Eye Infirmary at Wolverhampton; the
Duke of Westminster contributed £1000 to the Hospital for
Women, Soho-square; Miss Cooper of Southport, £500 to the
endowment fund of the children’s ward at the local hospital;
and Mrs. Booth, £500 to the Manchester Clinical Hospital
for Women and Children.

CHRISTMAS FESTIVITIES IN THE HOSPITALS.

Charing-cross Hospital. —The annual Christmas enter¬
tainment to the inmates of this hospital was given on the
17th ult., when the principal item in the performances was
Mr. Maddison Morton’s rather old-fashioned, but interesting
little comic drama, “A Husband to Order,” which was acted
with care and judgment, and was received with the heartiest
demonstrations of approval. An amateur orchestra of strings
and pianoforte performed a selection of music during the
evening, and in the interval between the performances
the visitors made a tour of inspection through the wards of
the institution.

Guy’s Hospital. —In accordance with the annual custom,
Mr. E. H. Lushington, the treasurer, and Dr. Steele, the
medical superintendent of this institution, accompanied by
a party of visitors, made a tour through the wards of the
hospital at dinner-time on Christmas Day. The effect of
the lack of funds at this institution was, to some extent,
perceptible in an increased number of empty beds, and in
the diminished display of evergreens in one or two of the
wings of the hospital, but otherwise Christmas was as gaily
kept up as in other years. The dinner, consisting of roast

beef, turkey,plum pudding, and dessert, was served promptly ,
at one o’clock, and apparently enjoyed by the inmates. In.,
all the wards there were Christmas trees, and in the evening.,
concerts were improvised in the wards in which the*
attendant noise could safely be permitted. _ •

St. Thomas's Hospital. —The Christmas dinner at this,
hospital consisted of beef, weighing over 300 lb., and plum¬
pudding, weighing 475 lb. The wards were all artistically,
and tastefully decorated with flags and evergreens. In tbe^
Victoria ward, solely occupied by children of tender age,
were two large Christmas trees, the toys from which were,
distributed to the convalescent children on the 27th ult. In.
the evening carols were sung by the probationer nurses in
all the wards with the exception of the Victoria, and the
efforts of the staff to render their Christmas Day as enjoy¬
able as possible seemed to be fully appreciated by the sick-
inmates of the institution.

Royal Free Hospital , Gray't-inn- road.— The various wards '
of this hospital presented a very pleasing appearance, the ^
nurses and convalescent patients having decorated them
with holly, evergreens, mottoes, and Scriptural texts. On. |
the morning of Christmas Day the usual short service was |
held in each ward, and carols and hymns were sung. The
patients were allowed to receive visitors at any time of the
day and various extras were permitted. In the evening the
convalescent patients, with their friends, had an entertain¬
ment in the Calthorpe ward, in which the medical staff and
nurses took part.

Seamens Hospital (late Dreadnought), Greenwich. —At
this hospital a Christmas dinner, consisting of turkeys,

S heasants, plum pudding, &c., was served to 202 patients.

f this number 126 were natives of Great Britain and
Ireland, 20 were Norwegians, 12 Swedes, 12 Germans, 6
Fine, 4 Russians, 4 Frenchmen, and 4 natives of the West
Indies, 5 citizens of the United States of America, 3 Danes,
and 3 Portuguese, while Austria-Hungary, New Zealand,
and St. Helena had each a representative. On the 28th ult.
a conjuring entertainment and concert was given by the
officers of the institution and their friends for the amuse¬
ment of the nurses and servants, and on the 29th the same
performance was repeated for the benefit of the patients.

The London Hospital.— At this hospital, whicn has room
for nearly 900 beds, there were on Christmas Day 592 in¬
patients distributed over some fifty wards, the whole of.
which were decorated, and special fare was provided. The
children were specially cared for in the way of toys.,
sweets, &c., and carol-singiDg was indulged in at intervals
throughout the day.

Forth-Eastern Hospital for Children, Hack net/- road
East London Hospital for Children; the German Hospital;
and the Hospital for Diseases of the Chest, Victoria-park. --
At all of these institutions there were the usual Christmas
festivities and indulgence. The wards were decorated,
special fare was provided, and toys distributed to the
juvenile inmates.

University College Hospital.— The usual Christmas enter¬
tainment at this institution took place on the 29th ult.,
when the children were entertained by a Punch and Judy
show, and the adults by a miscellaneous performance. Mr.
Corney Grain, who kinaly gave his services for the occasion,
amused a large gathering of patients and visitors^ with a
musical sketch, and Mr. Horace Chester gave a musical and
mimetic entertainment entitled “ Broad Grins.” Later on ft
miscellaneous concert was held. The wards were effectively
decorated with holly and evergreens, and all the children
were presented with toys. Money has in addition been
collected to enable welcome gifts of bats, boots, and clothing;
to be made to other patients.

Mr. Barnardo's Homes.— A Christmas dinner was given to-
all the inmates of the London branches of these homes, and
afterwards sundry prizes for good conduct and diligence-
during the year were presented. In the evening a general
Christmas entertainment was given, which met with evident
and well-deserved appreciation.

The Mode of Capital Punishment.—T he New
York Legislature at its recent session appointed a commis¬
sion to investigate and report upon the moet practical and
humane method known to modern science of carrying into
effect the sentence of death in capital cases. The present
method of execution by hanging is for many reasons re¬
pulsive to the citizens of New York, and. the report of the
commission is awaited with considerable interest.

Digitized by

tnkjorj

EEPORT8 07 MEDICAL OFFICERS OF HEALTH.

[Jan. 1,1887 45

foirlic anb '$mt Jato.

LOCAL OOVKBNMENT DEPARTMENT.

or medical officers of health.
Sitwdmini .—This borough is now estimated to contain
tarty 135,300 people. The birth-rate of 377 per 1000 ex-
kfciu i decline; that of deaths, which was 23 7, shows a
^fetiaoeaK; and Mr. Ilarris, in an interesting study of the
ulae of itatittics as affecting Sunderland, urges that when
«irrrttly apprehended they indicate the need for further
g war against every circumstance that leads in any
j to interfere with the health of the community,
dyidecnease in the infantile and in the diarrhoea mor-
y vadi to show that results have been obtained from
■^nnsnenta effected in the sanitary condition of the
-=nj, ad Leaseholders are urged to second the efforts of
Jtkrity in the matter of disposing of vegetable and
lass refuse by burning. With regard to the zymotic
-a. mall-pox, diphtheria, and measles were the only
Ast daring 1885 showed any excess over theaverage
(preceding ten years. The borough Act compelling
Qfcation of infectious diseases, only came into opera-
j the latter half of the year. The cases of small-pox
red 126, and of these 17 died. Of 98 vaccinated persons

- ad 2, or 204 per cent, died ; whereas of 17 unvaccinated
» 5, or 29 4 per cent., died. In 11 cases nothing could
a or heard of vaccination, and of these 99 9 per cent.
In only three cases did small-pox attack revaccinated
t*. and in each cese the revaccination was performed
he patients had contracted the poison of small-pox.
-56 is known to have caused 1310 cases and 385 deaths;

became an important question at one time whether
mentary schools should not be closed. But Mr. Harris
at the evils of this course might, at the stage of the
dc in question, exceed any good that could result, and
view he was supported by the medical officer of the
(JoTernment Board, to whom the facts were submitted.
ieria caused 12 deaths, but this only just exceeded the
t During the year 183 patients were removed to

--ital, including 105 from small-pox and 46 from typhus.
;-j rconately hospital isolation has for years past been
hindered in Sunderland, owing to the permanent
.* itioo of a temporary arrangement inaugurated under
’ ~ influence of panic; but steps are now well forward for
’Tiding a hospital in everyway creditable to the borough.
* prevents our doing more than giving a superficial
•-■nary of Mr. Harris’s report, which is one of the most
f xprehensive and carefully prepared documents which
recently come under our notice.

3tll .—During 1885 the birth- and death-rates for this
trough were 337 and 173 per 1000 living respectively,
'•» population being 186,292. Both the general and the
^sotic death-rates were exceptionally low, the latter only
-anting to 106 per 1000, and the infant mortality was
127 per 1000 registered births, as opposed to 155 for
^'«nd and Wales as a whole. Of the zymotic deaths
aurhcea was the most fatal, 59 deaths resulting from it;
fc- -Sia yras by no means a large number when contrasted
r± previous years. Great interest, however, attached to
c a tack of diarrhoea in the borough, which occurred during
exceptional month of March, 1885, and which was
-red to have been associated with the pollution of the
water-service. Suddenly, on the 21st of the month,
'like a storm,' diarrhoea manifested itself in Hull, and
.pril 5th, when the disease subsided, no less than

- 18,000 to 20,00*» persons had been attacked. The out-
- ik was peculiar in its special incidence on adults, but
- few children in the affected areas were attacked. The
. icteristic symptoms were purging, vomiting, and pain

>« bowels, attended with great prostration. But the
“Aiiy was trivial. The comparative absence of the
amongst those of old age and in youth is regarded
>. Mason as pointing to the fact that the poison
::*aded itself mainly on that portion of the intestines
pied by Peyer*s patches. The cause of the outbreak
:p!amed as having been due to the admission into
• ttBflwater service, during certain operations at the
■<u of polluted and noxious matters from a beck and

from Wood’s drain; these receiving some of the drainage
from the village of Willerby and the drainage from
& farmstead. The disease, although in the first instance
limited to houses supplied by the Hull water, or to persons
using that water either in their own houses or elsewhere,
subsequently indicated its contagiousness by spreading in
the houses of persons who had drunk the water at their
places of business and elsewhere than at home; but the
question as to the origin of the infection is, unfortunately,
dismissed in a few words, to the effect that there was possible
contamination of the Hull water by admission into it of the
excreta of persons suffering from diarrhoea just anterior to
the epidemic. During the year 261 patients were admitted
into the isolation hospitals. These are inefficient, and a
ground plan is submitted in the report showing a new sana¬
torium which is in contemplation. The arrangement indi¬
cated appears to us defective, in so far as all personsentering
the grounds must pass by the wash-house, one of the most
infected of all hospital buildings, before reaching the ad¬
ministrative block, the approach to which should always be
so arranged that persons passing to it will have no chance
of communicating with those who deal with infected
articles. There appears also to be, in connexion with the
administrative building, which should be kept free from
infection, a ward for probationers. This is a mistake, for
probationers need as much isolation as those whose diseases
have been fully recognised.

VITAL STATISTICS.

HEALTH OF BNGL18H TOWNS.

In twenty-eight of the largest English towns 4589 births
and 3745 deaths were registered during the week ending
Dec. 25th. The annual death-rate in these towns, which had
been equal to 22 9 and 20 7 per 1000 in the preceding two
weeks, rose again last week to 21-4. During the first twelve
weeks of the current quarter the death-rate in these towns
averaged 19'9 per 1000, and was 2 3 below the mean rate in the
corresponding Derioda of the ten years 1876-85. The lowest
rates in thes# towns last week were 117 in Brighton,
187 in Birmingham, 181 in Birkenhead, and 186 in Sheffield.
The rates in the other towns ranged upwards to 29 4 in
Manchester, 30 0 in Plymouth, 307 in Wolverhampton, and
319 in Preston. The deaths referred to the principal
zymotic diseases in the twenty-eight towns, which had
been 424 and 386 in the preceding two weeks, rose again
last week to 433; they included 182 from measles, 71 from
scarlet fever, 75 from whooping-cough, 34 from “fever”
(principally enteric), 31 from diphtheria, 40 from diarrhoea,
and not one from small-pox. No death from any of these
zymotic diseases was registered last week in Derby ; whereas
they caused the highest death-rates in Leeds, Halifax, and
Wolverhampton. The greatest mortality from measles
occurred in Cardiff, Leeds. Halifax, and Wolverhampton;
from whooping-cough in Manchester, Bradford, Plymouth,
and Huddersfield; from scarlet fever in Newcastle-upon-
Tyne, Bristol, and Salford; and from “fever” in Preston.
The 31 deaths from diphtheria in the twenty-eight towns
included 17 in London, 3 in Portsmouth, 3 in Bristol, and
4 in Liverpool. No death from small-pax was registered in
London and its outer ring, or in any of the twenty-seven
large provincial towns. Only one case of small-pox was
under treatment on Saturday last in the metropolitan
hospitals receiving cases of this disease. The deaths re¬
ferred to diseases of the respiratory organs in London,
which had been 494 and 415 in the preceding two weeks,
were last week 436, and were 93 below the corrected
weekly average. The causes of 95, or 27 per cent., of the
deaths in the twenty-eight towns last week were not certi¬
fied either bv a registered medical practitioner or by a
coroner. All the causes of death were duly certified in
Bristol. The largest proportions of uncertified deaths
were registered in Huddersfield, Brighton, Blackburn, and
Halifax. _

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 22*0 and 22*5 per 1000 in the preceding
two weeks, further rose to 262 in the week ending
Dec. 25th; this rate was 47 above the mean rate during
the same week in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from 15*5
and 18 0 in Leith and Perth, to 24*8 in Aberdeen and 32*2 in.

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46 Thu Lancet, 1 MR. SAVORY’S PAPER ON LIGATURE OP THE FEMORAL ARTERY.

[JAM. L1487.

Glasgow. The 648 deaths in the eight towns last week
showed a further increase of 92 upon the numbers in the
previous two weeks, and included 16 which were referred to
whooping-cough, 13 to measles, 13 to scarlet fever, 11 to
diarrhoea, 7 to diphtheria, 4 to “ fever” (typhus, enteric, or
simple), and not one to small-pox; in all 63 deaths resulted
from these principal zymotic diseases, against 81, 63, and 75
in the preceding three weeks. These 63 deaths were equal to
an annual rate of 2'4 per 1000, which was 01 below the mean
rate from the samediseasesinthe twenty-eight English towns.
The fatal cases of whooping-cough, which had been 16
and 19 in the previous two weeks, declined again last week
to 15, of which 10 occurred in Glasgow and 4 in Aberdeen.
The 13 deaths from measles (of which 12 were returned in
Glasgow) showed a further increase upon recent weekly
numbers. The fatal cases of scarlet fever, however, which
had been 25, 17, and 16 in the previous three weeks, further
declined last week to 13, and included 8 in Glasgow and
2 in Aberdeen. The 11 deaths attributed to diarrhoea, of
which 6 occurred in Glasgow and 3 in Paisley, showed
a further decline from recent weekly numbers. The 7 deaths
from diphtheria, including 3 in Edinburgh and 2 in Glasgow,
exceeded those in the previous week by 1; while -the 4
referred to “fever,” of which 2 occurred in Edinburgh,
showed a decline of 7. The deaths referred to acute diseases
of the respiratory organs in the eight towns, which had
increased in the preceding four weeks from 125 to 174,
further rose last week to 188, and exceeded by 37 the number
in the corresponding week of last year. The causes of 89,
or more than 13 per cent., of the deaths in the eight towns
last week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 35 6 and
29'6 per 1000 in the preceding two weeks, further declined
to 28'5 in the week ending Dec. 25lh. During the first
twelve weeks of the current quarter the death-rate in the
city averaged 25 - 9 ; the mean rate during the same period
did not exceed 18 4 in London and 191 in Edinburgh. The
193 deaths in Dublin last week showed a further decline of
7 from the high numbers in the previous two weeks, and
included 6 which were referred to scarlet fever, 6 to whooping-
cough, 5 to “fever” (typhus, enteric, or simple), 3 to
diarrhoea, 1 to diphtheria, and not one either to small-pox
or measles. Thus 21 deaths resulted from these principal
zymotic diseases, against 23 and 22 in the previous two
weeks; they were equal to an annual rate of 31 per 1000,
the rates from the same diseases being but 21 in London
and V6 in Edinburgh. The fatal cases of whooping-cough
and scarlet fever showed an increase upon the numbers in
the previous week; whereas those referred to “fever" and
diarrhoea had declined. Six inquest cases and 6 deaths from
violence were registered; and 61, or nearly a third, of the
deaths occurred iU public institutions. The deaths of infants
showed a considerable decline, while those of elderly persons
exceeded those returned in the previous week. The causes
of 31, or 16 per cent., of the deaths registered during the
week Were not certified.

THE SERVICES.

'War Office. —Army Medical Staff: Surgeon-Major Sir
Samuel Rowe, M.B., K.C.M.G., from the Seconded List,
to be Surgeon - Major. This gentleman has also been
granted retired pay, with the honorary rank of Brigade
Surgeon.

Rifle Volunteers. —3rd Volunteer Battalion, the Lanca¬
shire Fusiliers: Acting Surgeon Richard Crean, M.D., to be
Surgeon.—1st Midlothian. (Leith) : Surgeon and Honorary
Surgeon-Major James Strothers, M.D., resigns his com¬
mission ; also is permitted to retain his ranir, and to con¬
tinue to wear the uniform of the Corps on his retirement.—
4th Middlesex (West London): Surgeon and Honorary Sur- :
geon-Major G. E. Norton resigns his commission; also is
permitted to retain his ranlc, and to continue to wear the .
Uniform of the Corps on his retirement.—5th Lancashire ,
(the Liverpool Rifle Volunteer Brigade): .Acting Surgeon
O.yf. Steeves resigns his appointment.

■ Volunteer. Medical Staff Corps.— London Division:
UnityWork Dodd, Gent., to be Surgeon.

C’orrespoithence.

“ Audi alteram p artem.”

MR. SAVORY’S PAPER ON LIGATURE OF THE
FEMORAL ARTERY.

To the Editors of The Lancet.

Sirs,— I am indebted to Mr. Holmes for calling attention
to the accidental omission of a few important words in the
short abstract of my paper lately read before the Medical
and Cbirurgic&l Society, for which I alone am responsible.
Instead of “ the artery is pervious throughout,” it should of
course have been “ the portion of the artery between the
ligature and the sac is pervious throughout,” See. I can
only hope that the omission was too obvious to mislead any
one. The point is, I think, made clear enough in the paper
itself. The title of this is, “ On the Effect upon the Femoral
Artery of its Ligature for the cure of Popliteal Aneurysm,’ 7
and it opens thus: “ When the femoral artery is tied at the
apex of Scarpa’s triangle for the cure of popliteal aneurysm,
what effect is produced on the vessel between the point of
ligature and the sac ? ” I say in my paper that I think the
majority of surgeons will hardly be prepared for the con¬
clusion which is to be drawn from the facts I report.
It need not be said that I may be wrong in this; but
I confess it is an impression I still retain. I cannot
here of course refer at length to evidence of this; but when
Mr. Holmes says it is stated in every text-book that the
artery remains pervious from the ligature to the aneurysm,
it may be enough if I answer him with a single passage
from one of the most recent and important works on
surgery. When the superficial femoral is tied in Scarpa’s
triangle for popliteal aneurysm, “the artery very often
becomes occluded by coagulum from the ligature to the
aneurysm, and beyond it to the first large branch below, while
in other cases a certain portion of that length remains
pervious. After a little time the aneurysm and the
obliterated vessel undergo a process of contraction and
absorption, so that they come to resemble a solid cord with
a knot on it.” In the discussion which followed, I meant
to say, in the remarks to which Mr. Holmes refers, that 1
do not remember to have seen in any work the facts (as
I find them) stated correctly. The passages in his own
works, which Mr. Holmes quotes, would, it seems to me,
hardly convey the idea that the portion of artery between
the ligature and Bac wa9, in the majority of cases, pervious
throughout.—I am, Sira, yours obediently,

Brook-street, W., Dec. 23th, 1880. W. S. SAVORY.

THE DENSITY OF THE TEETH AS INFLUENCED
BY THE FOOD, ETC.

To the Editors of The Lancet.

Sirs, —“ Every dental surgeon knows that the hardness of
the teetfh may vary greatly in the same individuals at
different periods; the most marked, although by no means
the only cases, are those of pregnant women; and this
cannot be explained solely on the ground that the secretions
of the mouth are vitiated by reduced acid from gastric dis¬
turbance. There is undoubtedly an absolute softening of
the whole tooth substance, due, probably, to the robbing of
the teeth of the mother of their lime salts in order to build
up the osseous system of the foetus.” This extract (appa¬
rently a quotation from the writings of Dr. Miller of
Berlin) occurs in an annotation in The Lancet of Dec. 18th.
It is certainly not the case that every dental surgeon
adopts these statements as true; and I venture .to affirm it
will be difficult to find one competent authority who.wilt
accept any or either of them. It is hardly possible to
imagine the occurrence of degenerative or nutritive changes
in a tissue like enamel—the tissue in which caries begin?.
To believe in such changes we must first conceive qf some
means by which this calcareous substance, as debse as quartz-
and devoid of cellular elements, could assimilate nutritive
material when conveyed to it; and we mtist next imagine
the conveyance of new and effete material to and from
the vessels of the pulp, through the odontoblast layer erf the
palp, mid through the dentinal fibrils to its destination

Digitized by LjOOQle

The Lancet,]

northern counties notes.

in the enamel. The evidence is overwhelming that dental
caries is due entirely to external agents ; that enamel and
dentine are perfectly passive under the process of disintegra¬
tion; manifesting neither pathological action nor vital
reaction of any kind. A dead tooth replaced in the mouth as
an artificial substitute is just as liable to caries as its living
neighbours; when it is attacked decay begins in those
situations where it would be most liable to disease were it
living, and the decay is true dental caries, identical in every
way with the disease in living teeth. There exist three
demonstrated predisposing causes of caries which enable us
to understand dearly its common association with diseases
and cachexias. Given, 1st, innate structural imperfections
in the tissues—from which few sets of teeth are lree,—vary¬
ing infinitely in different individuals; 2ndly, crowding and
irregularity of the teeth, equally varying in degree; andfirdly,
vitiation or the secretions of the mouth, not only varying in
amount, but highly irregular in its appearance and duration
through the Hfe of different individuals—and the facts are
fully accounted for without the invention of the question¬
able hypotheses which Dr. MiHer has adopted. These
hypotheses, which were held by early writers before the
anatomy of the teeth was made oat, have not been supported
by investigators working in the light of modem science.
They have, however, recently been revived by some few
American writers. Some of these state that they have been
enabled to demonstrate the presence of & distinct substance
between the prisms of enamel, having stained the tissue
with chloride of gold. On the strength of this they write
of a “ complete network of protoplasm extending from the
palp to the surface of the enamel.” If such a substance do i
exist, it must be in a condition of extreme tenuity, and it is
impossible to accept the gratuitous and unnecessary
hypothesis that this trace of organic matter is a medium
through which nutrition as well as gross degenerative
changes are brought about in enamel.

I am, Sirs, your obedient servant,

Wimpole-Btreet, D(*;. 20th, 1386. HENRY SkWILL.

%* To open up our columns to a discussion on the causes
of dental caries is not possible on account of want of space,
ft is a subject which is as yet by no means satisfactorily
explained; but Mr. Sewill’s theory that the teeth only play a
passive part has very few supporters (vide a discussion at the
Odontological Society some time ago). Experiments like
those of Dr. Miller will doubtless clear up many points that
are now difficult of explanation. In our annotation, tenth
line, “vitiated by reduced acid from gastric disturbance *
should read “vitiated or rendered acid by gastric dis¬
turbance.”— Ed. L._

THE RELATIONS OF MEDICAL PRACTITIONERS
TO THEIR PATIENTS.

To the Editor a c/Thb Lancet.

bias,—In your issue of December 25th, in an annotation
on “ The Lessons of the Campbell Case,” you draw attention
once again to the folly of practitioners making friends of
patients (clients). Few of any experience in the working
of general practices will be found ready to dispute this
point. A well-nigh . twenty years’ personal experience,
daring the whole of which time I have been a keeri observer
of the ways of other practitioners, has demonstrated to me,
over and over again, the wisdom of your strictures. The
Campbell Case" gives, of course, an extreme example of thq
complications which such friendships may lead a man into,
but many, and many a time, have 1 seen good-paying
patients lost to excellent practitioners over some trivial
matter, which a strict professional bearing during the whole
period of medical advisers hip would have entirely obviated.
At the same time, and this is what I wish to find out, how
is a general practitioner (a provincial or country one at all
events) to avoid the difficulty? He is truly between two
stools—if he does not make friends (socially) his practice
does not develop, and he is said to be a ‘ proud ’ man; if he
does make friends, he very likely makes clients (patients)
of them ultimately* but his very friendship, undoubtedly,
puts him in constant danger of losing them. Many a
tradesman’s and farmer’s^ family have I lost as patients
because they became friendly with some neighbouring
practitioner and his family. On the other hand, one’s better

(Jan. 1,1&87. 47

class farmer clients are seldom or never attracted unless
through a previous acquaintance of more or less friendly
intimacy; and unless this is kept up, they will in nine cases
out of ten discontinue to employ you. In these days of
depression a farmer of fair middle class education, and with
money, is a power in country districts, and he knows it, nor
does he hesitate to exercise his adverse influence, if he feels
aggrieved with his doctor, his parson, or his lawyer,
politically, municipally, or ecclesiastically,

Finally, I do not write as a disappointed practitioner. I
have a fair practice with good appointments, and 1 have
made money at it. I may also state that I am a gentleman’s
(a widely-known man) son, and have had a liberal education
in both general and professional subjects. I enclose my card.

I am, Sirs, yours truly,

Dec. 87th, 1886. GENERAL PRACTITIONER.

NORTHERN COUNTIES NOTES.

(From our oum Correspondent.)

THE NEW CHILDRENS HOSPITAL IN NEWCASTLE.

At a late meeting of the governors of the Children’s
Hospital, held in Newcastle last week.it was stated that the
contract was ready to sign with the builder, and that all
legal formalities were now complete. It was announced
that the new buildings, apart from the land, would cost
£15,000, all provided by the munificence of Mr. John
Fleming, of this city. The plans which were exhibited,
showed an entrance hall twenty feet square; close to which
will be a committee-room, housekeeper’s sitting-room, linen,
and work room, and matron’s room. These are to the right
of the entrance hall, and to the left will be a waiting-room,
porter’s room, consulting room, drug stores, surgery, and
medical officer’s room, the last being provided in view of
the possibility of a resident medical officer being appointed
at some time or other. Facing ihe entrance hall will be a
spacious dining-room, and beyond that will be rooms for the
necessary domestic work. On the first floor, over the
entrance hall, will be a day ward, and play room. To the
right will be a small ward, a nurse’s room, and a large
general ward for girls, twenty of whom may bf accommodated
there. To the left will be a similar provision for boys.
There will also be isolation wards, an operating room, and
other necessary conveniences, whiie the second floor will be
used as nurses’ and servants’ bedrooms. The front, which
will have an imposing appearance, will be of red brick with
stone dressings; and a belfry over the doorway.

DEATH OF HR. ALFRED ROBSON BENSON, M.R.C.6., OF
WHITBY.

I regret to announce the death, on the 9th of December,
after a rather long illness, of Mr. A R. Benson, M.R.C.S., of
Whitby, Yorks, at the age of seventy-two. Mr. Benson held,
for many years, an appointment in the Hudson Bay Com¬
pany’s Service at Fort York, Columbia River, Vancouver’s
Island. Whilst at Vancouver’s Fort, Mr. Benson became
intimate with the late General Grant, then a captain in the
United States Army. He frequently made journeys into the
interior amongst the Indians with whom he had much
influence. Mr. Benson returned to England about twenty
years ago, and settled in his native place, Whitby. He did
not practise after his return, but was ever willing to advise
the poor. He was known as an authority on local and
genealogical history, being himself a member of one of the
oldest families in Whitby. He was a genial and kind-
hearted man, whose portly form and friendly greeting will
be missed by many.

A NEWCASTLE DOCTOR IN BirRMAH.

Tbe special war correspondent of the Allahabad Pioneer
and Indian Mail of the late date says, that after four days
of hard marching, Yemethen was reached. The'man were
very much fatigued and pulled down by fever and sickness*
and from exposure to rain; and, had it not been for the
unremitting efforts of Surgeon Nichol, Medical Staff, 3rd
Brigade, who always had his medicines ready to dispense
hourly to a long line of patients who streamed in daily after
a long march, our lines would have been' sadly weakened.
Dr. Nichol is intimately connected with Newcastle, and it
Will be a pleasure to his many friends to see this honourable
( mention of his name from the Indian newspaper.

*

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D

48 Ihb LamostJ

MANCHESTER.—EDINBURGH.

[Jxn. 1,1887

POLICEMEN AS MEDICAL “ EXPERTS.”

Unless there is some change in the mode of conducting
coroner’s inquests, people will begin to ask what is their
use; for instance, an inquest was held in Newcastle last
week on the body of an itinerant dealer in medicine, or
“Quack Doctor,” who was found dead in his bed in his
lodgings. A policeman deposed that he forced open the
bedroom door, and found the body lying on a bed. On a
chair he found a bottle (produced); and also a tumbler
half full of water. The policeman further said that the
bottle and glass had a similar smell—that of laudanum. Upon
this very “conclusive” evidence a9 to poisoning, the jury
returned a verdict to the effect that the deceased was found
dead in his bed, but that the evidence was not sufficient
to show whether death was due to natural causes, or to
poisoning. The question naturally presenting itself in regard
to this loose verdict is, why—if evidence was required only
to show the cause of death—no medical man was called.

Newcaatle-on-Tyne, Dec. 27th.

MANCHESTER.

(From our own Correspondent.)

VICTORIA UNTVER8ITY.

The financial condition of the Victoria University is at
present by no means what it is desirable it should be, and
it is therefore satisfactory to note that some of our citizens
are not unmindful of its wants, as shown by the acquisition
to its funds of £1000 under the will of the late Mr. Bodding-
ton. At the last meeting of the Leeds Town Council it was
decided to support the application to the Government for
an annual grant in aid of the University funds. Leeds will
probably be the next place to become affiliated to the
University. Much surprise has been expressed at the
rumoured proposal to affiliate University College, London,
to the Victoria University. No greater reflection than this
can be made upon the present regulations in force at the
London University, and it shows now keenly the want of
facilities for London students to obtain a medical degree is
felt at the present time. Amongst the external examiners
appointed by the Council on Dec. lGtb, one was from Scot¬
land, one from Ireland, and one from London.

ROYAL INFIRMARY.

This institution also received £1000 under the above-
mentioned will, and smaller legacies were left to many of
the other hospitals, but amongst the numerous bequests and
donations made to our various medical charities, the Ancoate
Hospital, which is doing good and useful work in one of the
poorest parts of Manchester, appears to be singularly over¬
looked. A little more prominence and “pushing to the
front” on the part of those connected with this institution
would probably remedy this apparent neglect. What appears
to have been a case of hydrophobia from a cat’s bite was
recently admitted to the infirmary wards. The man was
bitten some four months ago on the right hand by a cat;
about a week before his admission he complained of much
ain up the arm. and rapidly became worse, and was only
rought to the infirmary a few hours before his death. It
would have been more conclusive as to the real character of
the disease had some corroborative evidence been obtained
by experiment on one of the lower animals.

INFANT MORTALITY.

A deplorable loss of infant life appears to be going on.
The coroner, when holding an inquest in 8alford recently
on the body of a child that had been overlain by its mother,
said that within the previous week or so he had held inquests
on about a dozen infante who had thus been found dead in bed.

, Manchester, Dec. 20th, 1884.

The J acob Testimonial. —The executive com¬
mittee met on Wednesday, Dec. 29th, Sir Wm. Stokes, Pre¬
sident of the Royal College of Surgeons in Ireland, in the
chair. Subscriptions amounting to over £90 were announced
by the Honorary Treasurers, Professor Edward Hamilton,
120, 8tephen’s-green, and Dr. Thomas Purcell, 71, Harcourt-
street, Dublin. The committee, having decided to imme¬
diately pnbliah the list of subscribers, adjourned for a
week.

EDINBURGH.

(From our own Correspondent.)

ROYAL SOCIETY OF EDINBURGH.

At the ordinary meeting held last week. Sir Willis
Thomson, the newly-elected President, took his seat. 1
subsequently made two communications to the Socie
upon wave motion, producing formul® which express t
relation of the velocity of propagation to the wave-leng
in cases where a stone is thrown into still water; and
calculation of the total disturbance, and its compone
elements, in the case of a ship gliding through a perfect
smooth tract of water. •

UNIVERSITY LIBRARIAN8HIP.

The Senatus Ac&demicus of the University have mat
an appointment fraught with most important issues i
regards its general status as a centre of learning. Throuf
the death ot the late Dr. John Small, the custodianship of tl
200,000 volumes, constituting the library, had becon
vacant, and the Senatus have made a very good use <
their patronage in appointing Mr. Hugh A. Webst
to the office. There were over seventy applicants for tl
post. Mr. Webster is a graduate of Edinburgh, and has
wide knowledge of books and of general literature. Fi
twelve years he has worked on the staff of the “ Encyclt
ptedia Britannica,” and has contributed articles on ver
varied subjects of general interest to that publication
amongst them articles upon Epigrams, Antiquities, Hamle
the Indian Archipelago, Mermaids, and Fortunatua. He hi
also contributed geological, botanical, zoological, ethne
graphical, and statistical accounts of various geographic)
areas to the same work, which are of high merit. H:
thorough knowledge of modem languages is also c
great importance, since it will enable him to auppl
the marked deficiencies of the library in moder
treatises and periodicals, especially in the department
of natural science and medicine. In addition to ac
quiring new treatises his duties in regard to those alread;
collected will not be slight, since there is at present no com
plete catalogue of the library available for the genera
public, a state of things which exists in no other collectio
of equal importance in Europe. If Mr. Webster succeeds, a
he doubtless will, in rectifying this deficiency, he will confe
a lasting benefit on his alma mater, and will greatly lightei
the task of those who seek knowledge in the volumes o
her rich though pathless collection.

DRINKING FOUNTAINS FOR BTUDBNT8.

An elaborate drinking-fountain for the use pf student
was recently erected in the upper quadrangle of th
New University Buildings, the gift of Mr. John Hop<
of Edinburgh ; and following closely upon this presentatioi
another fountain has been added to the attractions of thi
Quadrangle at the College Buildings in South Bridge-street
The latter is the gift of Dr. W. F. Camming. It was public]. 1
inaugurated by the Principal, Sir William Muir, and th<
members of the Senatus, last week, in the presence of i
numerous gathering, amongst whom were Dr. Cummins
the donor, Mr. Sydney Mitchell, the well-known Scottish
architect, who furnished the design, and his father, Dr
Arthur Mitchell, C.B.

STUDENTS AND PROFESSIONAL EXAMINATIONS.

At a recent meeting of the Students’ Jlepre 3 entatiy€
Council, the subjects of professional examinations in medi¬
cine, and the compulsory attendance of certain lectures
were under discussion. The outcome of their deliberations
were a series of resolutions, which were respectfully sub¬
mitted to the University Court, in favour of permitting
medical students to enter for the first part (anatomy and
physiology) of the second professional, or intermediate,
examination at the end of the second year of study, instead
of at the end of the third, as now obtains. The Council also
prays the Court not to sanction any further addition to
the number of compulsory courses in the medical curriculum,
while its conditions are as they are. Both these requests
are justified by the present state of medical study in tbe
University, where course after course of lectures or demon¬
strations has been added to the list of classes, attendance
upon which is compulsory, without any corresponding

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ABERDEEN.—IRELAND.

I Jan 1,1887. 4£

extension of the curriculum in respect to time. The con¬
sequence of this is overpressure in the esse of very many of
the students, and a sense of oppression in those who are not
actually overworked, which it would be well if the authori¬
ties could see their way to mitigate in the way requested,
or in other ways which might suggest themselves.

ROYAL HOSPITAL FOB SICK CHILDREN.

Directors of the Royal Hospital for 8ick Children
appointed Dr. Melville Dunlop to the post of extra-
upon the staff of the hospital, vacant through the
of Dr. Hodedon.

Dec. J8tb. 1886 .

ABERDEEN.

(From our own Correspondent.)

ROYAL INFIRMARY.

ft* quarterly court of the managers of the Royal
was held on Monday, Dec. 13th, when it was
on the motion of the president. Lord Provost
>, to make an appeal to the public for the funds
to carry out the proposed improvement and
fttSuriom of the infirmary buildings. It was left to the
CMmittee of management to select a large committee
tt —on ghly representative of town and country, who would
(ako the matter in hand, and it was hoped that an endeavour
Wrrultl be made to have the sum, £24,000, subscribed before
MM 20th, 1887. There is little doubt as to the success of
ffcae scheme of the Lord Provost to celebrate the Queen’s
jjtflw. He himself has subscribed £1000, and a subscription
ft £300 has also been intimated. Two vacancies in the
staff bad to be filled up at this meeting, and a large
»r <d managers attended to bestow their patronage,
the office of ophthalmic surgeon, rendered vacant by the
tted death of Dr. Dyce Davidson, Dr. MacKenzie
_ _ the only candidate, and be was appointed

tPMusknoualy. When Dr. Blaikie Smith was appointed
it physician be resigned the office of cbloroformist,
he had held for eleven years, and Drs. Booth,

.. jr, and Roxton were candidates for the appoint-
The first vote gave the following result: Dr. Booth,
1; Dr. MacGregor, 78; Dr. Ruxton, 16. A second .vote was
taken as between Dr. Booth and Dr. MacGregor, when
the former was elected by a majority of four votes.

THE UNIVKB8ITY COURT.

A meeting of the Aberdeen University Court was held
am Saturday, Dec. 18tb, when there was laid before the
meeting a communication from the Senatus, stating that at
^ meeting bald on the 11th, the Senatus resolved to repre-
SSat to the Court their desire to withdraw the proposals
, as to changes in the examinations in medicine. The court
anted consent, mid this, for the present et any rate, gets rid
at the difficulties raised by Prof. Stiuthers’ dissent end Prof.
Dgptou's tbreeteaed action.

■ * THE TRAINING OF PROBATIONER NUB8BS.

Tare or three months ago the late Dr. Dyce Davidson and
' jte. Garden weM appointed a subcommittee of the medical
• committee to male inquiries as to the training of pro-
tetfcmers in other hospitals, and as a result of their inquiries
Submitted a report upon the subject, and their
ions have so far been acted upon. The report says
)bationeTS ought to be engaged for two years, during
time they ought to receive a regular course of
tioa .both theoretical and practical. The theoretical
, at their instruction Is to consist of lectures, which are
> divided I nto't hree courses : first, a series of lectures
llRdfc SUpttj£$h4bat on nursing, the economy of the
"! ii to the preparation of food for the
UTM by one‘of the surgical staff on
‘•‘with lessons On surgical nursing,
tioa and preparation of instru-
j a course of instruction by one
mentary physiology and medical
[tvafd training is to he given by
by the' lady superintendent
he theoretical teaching. Drs.
_ appointed with Miss Lumsden

Ifr* differentlsetores. r

THE HEALTH OF THE CITY.

In October there was a decided decrease in the number of
cases of scarlet fever, but it has again begun to spread, and’
the report for last month shows a large increase. In October
78 cases of scarlet fever were reported, but during November
there were 107. In, the later month there were also 14-
cases of typhoid fever, as against 4 cases in October. The
death-rate tor October was 17 28 per 1000, but last month it
mounted up to 23 22 per 1000. Whooping-cough and measles
are also prevalent, and many cases have proved fatal,

Deo.. 1886. _

IRELAND.

JiFrom our own Correspondent.)

ROYAL UNIVERSITY OF IRELAND.

A meeting of Convocation takes place on Dec. 30th, and-
consequentiy will be held too late for me to record this week
the result of the election for a Member of the Senate. One
of the candidates (Major Fitzgerald) has withdrawn, and the-
contest will lie between Professor O’Sullivan, Mr. O’Connor,,
and Dr. McMordie. 1 have already given my opinion that
the first-named gentleman will probably be elected, and
therefore shall not refer further to this subject. At the
meeting this week, several notices of motion have been
given, the principal being as followsDr. Knight will
move that the Senate be requested to consider what pre¬
cautions can be taken to eusure that only the votes of
members of Convocation are recorded in senatorial elections.
Dr. Thompson will move a resolution requiring that at
elections of a Senator by Convocation each voter shall
affix his name to his voting paper in preeence of a justice
of the peace or a clergyman, who also shall sign his name
as witness. The recent rules adopted by the Senate for tbs
medical curriculum of the University have created con¬
siderable dissatisfaction, and it is gratifying to learn that
Professor Pye has a notice relative to this matter, in which
he will call attention to it, and move, that in the opinion
of Convocation it should he repealed, and rules framed tor the
guidance of medical students in accordance with the direc¬
tion of the General Medical Council be adopted. The pro¬
ceedings are expected to prove very animated, and ft is
to be hoped that the Chairman will exercise the powers
entrusted to him in repressing all unseemly attempts at
disturbance.

THE EPIDEMIC OF ENTERIC FEVER IN CORK.

The Public Health Committee will this week have under
their consideration a very important report, prepared by an
inspector of the Local GoTCrnment Board (Dr. O’Farrell),,
which deals with the present sanitary condition of the city
of Cork. Additional interest must be attached to the com¬
munication in view of the epidemic of enteric fever which
has prevailed for some time poet. Cork is supplied with
water from the river Lee, taken about a mile above the city.
A filtering tunnel has been erected, but sufficient precautions
are not adopted to prevent contamination from the houses
and towns and villages situated on the banks of the river
from its source to the point of intake at the wajer-works.
The physical features of the site on which Cork is built
render it extremely difficult to drain the hills, causing steps
and abrupt gradients, while the flat of the city is below
high water of spring tides. The rubble sewers in the older
parts of Cork are defective in every respect—rat-eaten and
blocked, so that they are no better tnan elongated cesspools,,
saturating the porous alluvial soil, which surround them
with organic matter, and throwing back foul sewer air on
the higher levels, thus producing zymotic diseases in those
parts of the city which ought to he most healthy. There
are about 1700 tenement houses in Cork, and many of them,,
especially in the centre of the city, are old and structurally
bad. The public cleansing of the streets is carried out in a.
most unsatisfactory manner; this is partly due to the want
of funds, the soft character of the limestone used for repairing
roads, and to the large rainfall. The want of apublic anattoir-
and the condition of the private slaughter yards must exercise
an injurious influence on the health of the citizens. Dr.
Donovan, the medical officer of health, is inclined toattribute-
the prevalence of typhoid fever to the cleansing of old drains
and the dispersion of their contents over the surface of the
public park and other places of public ffeeort. Dr. O’Farrell

Digitized by

60 - Thb Lancet,]

IRELAND.—PARIS.

[Jan. 1,1887.

thinks these views very probably to be correct, and that
the present outbreak is due to the faulty condition of the
sewers and to the effluvia arising from them and from a soil
saturated with organic matter and specific germs, acting at
a time when in many parts of the United Kingdom tbere
would seem to be an “ epidemic tendency ” to the develop¬
ment of enteric fever. These are th* chief points referred
to in Dr. O’ParreH’s report, and in addition he makes the
following suggestions for the consideration of the Public
Health Committee:—1. That street cleansing be improved,
and that a complete system of domestic scavenging be
undertaken by the Corporation. 2. That the sewers of the
city be completed and modernised, and that a map
of the city be provided, in accordance with the 23rd
section of the Public Health Act. That all main sewers
be ventilated at their highest levels, and that they
be provided with side entrances, manholes, and not
less than twenty ventilators for each mile of sewer.
3. That lodging-house and tenement yards and premises
be kept in proper sanitary condition, and that the bye-laws
made under the 41st, 91st, and 100th sections of the Pablic
Health Act be strictly enforced. 4. That a public abattoir
be erected on a suitable site, such as the old Passage Railway,
with proper appliances for drainage, ventilation, and clean¬
liness. 5. That the sewage matter removed from drains and
deposited in the Park, and elsewhere, be thoroughly dis¬
infected; and, in future, that all scavenged materials be
immediately removed from the city by water carriage, or
else that they be deposited and disinfected in suitably placed
and properly constructed manure depots. 6. That the water-
supply of the city be protected, as far as possible, from
contamination by the means already suggested in this report.
7.' That the Medical Superintendent Officer of Health
should devote his whole time to the duties of his office.

Dublin, Dec. 27th, 188S.

PARIS.

{From our own Correspondent.)

EXPERIMENTS WITH THE VIRUS OP RABIES.

The most important news of the week comes to us from
Vienna in the account of Professor von Frich’s experiments
with thp virus of rabies supplied to him for that purpose by
Monsieur Pasteur. M. von Frich finds: 1. That in animals
which have died from rabies the virus exists in its most
concentrated form in the central nervous system. 2. That
small quantities of the cerebro-spinal substance of animals
which have died from rabies injected under the dura mater
by trephining are sure to be followed after a latent period of
from fourteen to twenty-one days by the same disease, and
. this may be transmitted from these to other animals.
3. That the same disease, with the same symptoms and the
same period of incubation, may be induced by intra-cranial
inoculation with particles of medulla from human beings
who have died of rabies, showing the identity in man
and in the lower animals. 4. That infection is’ less sure
by the subcutaneous method, and the period of incubation
longer than with intra-cranial inoculation. 5. The length
of the period of incubation depends upon the quantity of
virus injected under the skin ; the less the virus, the longer
the incubation. 6. By the continuous intra-cranial trans¬
mission of the virus taken from the cerebro-spinal substance
of rabbits, after a series of generations the period of incuba¬
tion is shortened and its invasion is irregular. Later on the
incubation still decreases, but the invasion becomes regular.
7. The fixed virus of an incubation period of seven days,
which M. Pasteur obtains by inoculation from rabbit to
Tabbit through forty or fifty generations exceedsin intensity
the virus of street rabies , not only in that the invasion of
the disease is earlier, but also because the animals die
without exception as well after subcutaneous injection as
with inoculation of the dura mater. 8. The fixed virus
does not seem to acquire by further _ transmissions any
noteworthy shortening of its period of incubation. Some¬
times the disease begins after six days; but, on the other
hand, it may extend to eight, ten, or even twelve days. An
incubation period of from eight to twelve days, and con¬
sequently a virulence of the same intensity as that of the
fixed virus, may also be obtained by the transmission of

street rabies, and this sometimes at the second or third
generation. 9. M. Pasteur’s method of obtaining a fixed
virus of seven days’ incubation ie, perhaps, not the only one,
for the said virus may sometimes be obtained much earlier,
independently of the transmissions, and this virus is con-
' stant in its effects and in its period of incubation. 10. The
virulence of particles of medulla diminishes daily under
desiccation at 20° Centigrade over caustic potash, and is en¬
tirely destroyed after from fourteen to sixteen days. 11. Ani¬
mals which have been subjected to hypodermic injections of
a series of virus attenuated by desiccation become re¬
fractory to the stronger virus by the previous inocu¬
lations with the weaker virus if the stronger virus
have not been used in too rapid succession. 12. Animals
which have been inoculated hypodermically during ten days
with virus of progressive virulence (medulla from ten days
to one day) have not been refractory to infection with the
fresh virus of street rabies, and have only exceptionally
escaped after intra-cranial infection. 13. Rabbits and dogs
inoculated by trephining with the virus of street rabies of
sixteen days’ incubation have always succumbed, notwith¬
standing the preventive treatment already described.
14. M. Pasteur attributed to the method of slow vaccina¬
tions the unsatisfactory results obtained previously by
M. von Frich, and reoommended a more intensive mode of
treatment. The experiments carried out conformably to
M. Pasteur’s instructions have given no more favourable
result; all the animals died of rabies. 15. The experi¬
ments have demonstrated a most important fact—that
is, that in the rapid process the weaker preserva¬
tive medullee do not confer the same certainty of
immunity from the effects of inoculation with the stronger
medullas. Of a series of dogs and rabbits inoculated as a
control-experiment to that described in the preceding para¬
graph, and in which the rapid process was carried out
without previous infection, most of the animals died of
rabies. 16. Most of the animals which were submitted to
the preventive treatment after subcutaneous jpoculation
with street rabies, died of the disease even when the period
of incubation was thirty-four days. These experiments
show, says M. von Frich, that Pasteur’s method of render¬
ing animals refractory to rabies is not yet either sure or
certain. There is not yet a sufficient scientific basis for the
application in man of a preventive treatment after the bite
' of a rabid animal. It is, moreover, quite possible that the
preventive treatment, at any rate the intensive method
recently recommended by M. Pasteur, may itself transmit
the disease.

A PATHOGNOMONIC 8IGN OF CANCER OF THE STOMACH.

A patient was shown at the last meeting of the Soci6t<5
Mfidicale des Hopitaux who exemplifies the Oondition said
by German writers to be characteristic of cancer of the
stomach, a condition found by M. Debove to be constant hi
such cases, and ■fchich he proposes as a pathognomonic sign
of the disease. In malignant disease of the stomach it will
be fbund that hydrochloric acid is always wanting, whereas
it laSts constantly daring digestion in every other case.

In M. Debove’s patient this absence of hydrochloric acid
enabled a diagnosis to be made at a period when there was ho
other symptom of cancer, and the disease was looked upon as
dyspepsia, an opinion shared by M. Debove himself until he
had ascertained the composition of the gastric juice. Since the
beginning of the year the man has been under observation,
and the real nature of his disease now constituted by a
characteristic tumour the size of an egg, is no longer doubt¬
ful. In reply to questions M. Debove said that he obtained
the liquid for examination by means of the oesophageal tube,
and that the test used for distinguishing the acids were
those recommended by the Germans. A solution of gentian
violet (1 in 5000) gives a blue coloration with HC1.

“ 1’orange Poirier ” in saturated solution gives a red
reaction with the same acid. Lactic acid is recognised by
the increased yellowing of perchloride of iron, and by
change in colour of a mixture of perchloride of iron and
carbolic acid, from amethyst blue to yellow.

TREATMENT OF EPILEPSY.

M. Dujardin-Beaumetz is using antifebrine extensively in
the treatment of epilepsy. As far as I know nothing has as
yet been published on the subject, but I am told that in
antifebrine we possess one of the most powerful
“ moderators ” of the spinal centres. ,

Paris, Dec. 29th, 1836.

D

^ed by Goog

The Lancet,]

THE CLIMATE OF HY&RES.

[Jan. 1*1887. 51

THE CLIMATE OF HYfiSES.

(From our Special Correspondent.)

•Among the health-resorts of the Riviera, Hydros holds its
own for its climatic advantages. While Cannes was but a
miserable fishing village, and Mentone and Nice almost un¬
known, French doctors sent their patients to Hydros, and it
was the first town on the Riviera where experiments were
made in the climatic treatment of disease. It has the double

observations are taken in the fairest possible manner. The
record of the results acquired will be seen in Table I. The
climatic advantages, as demonstrated by these statistics, are
further set forth by a comparison with other health-resorts.
(See Table II.) The statistics in this table are open to ques¬
tion so far as the San Remo record of the number of days on
which rain fell is concerned. As the amount of rain which
fell was in excess of the other Riviera stations, probably
those days when the showers were very slight were not in¬
cluded in the calculation. It will be seen that Hydras is at
once warmer and yet colder than the other Riviera resorts
mentioned. This unplies that greater care must be taken

Tabus I .—Sic Months of the Winter Season at Hylres during the Years 1879 to 1885.

Mean dally temperature of the *ix year* ...
Average maximum temperature of the day

Average daily minim um temperature.

Average relative humidity (saturation = 100)

Days of sunahine..

Days on which rain fell ...

Days of calm.

Days of light wind ...

Days of strong wind ... _
Rainfall in inches.

January.

February.

March, j

473 °

W‘5°

52 - 5 °

. 35 - 0 °

58 - 2 °

61 5°

39-5°

42-8°

434°

780

770

73-0

20-6

19-3

25'6

7'0

7-83

5-43

i 9 -«

136

14-6

9-0

11-16

138

2-4

3-8

2-38

3-41

1-48

3-13

I Mean per six
winter months.
134-8
30-96
97-8
64-66
18--88
14*96

Tablk II. —-Climatic Advantages of Hyeres as compared with other Health-resorts.

Mean dally temperature in the shade.

Mean of dally maximum shade temperature
Mean of dally minimum shade temperature

Mean relative humidity .

Total daya of sunshine .

Total days on which rain fell.

Total daya without any wind.

Total days with slight wind .

Total daya with strong wind ... ._ .

Rainfall in Inches .

advantage of being more to the south that any of the other
towns on this line, and yet it is the nearest to London and
Paris. Dr. W. P. Biden, the resident English physician, haa
favoured us with the meteorological observations ha has
made during the last six winters. His Sberingdon screen
or box is well exposed to the north in the garden of the

2 6tel des Isles <f Or. . There are no plants near to afford
lelter, and having visited the Bpot I can testify that the

HjSrea.

t

Canned. |

Nice.

Mentono.

San Demo. |

|

Pau.

Greenwich.

51-4°

30-8° 1

50-9°

51-5°

51-3° i

45-7°

41*8°

59-0°

50-7° i

—

68-2°

—~ >

55-02°

__

43-8°

44-0°

—

45-9°

_

39-17°

_

74-0

730 .

—

72'8

68-0 !

_

_

13.V0

117-0

970

—

108-0

_

120

37-0

45-6

36‘2

47-0

26*0 j

690

90*0

97-0

48-0 i

—-

- —

—

_

66-0

88-0

1

—

—. t

_

_

170

41 8 1

—

— 1

_

_

1461

30-3 1

1

19-45

19-87

fl'O j

20-87

10’69

at night, and then the Invalid will derive all the profit of
the higher day temperature and the higher mean tempera¬
ture. For all practical purposes this to juet the advantage
required. In conclusion, it may incidentally be mentioned,
that the great storms of Dec. 8tn and 9th bad altogether lost
their fury when they reached Hydros. The weather has, on
the whole, remained fine throughout this trying period.

December 11th.

ALFRfcD WILTSHIRE M.D., F.R.C.P.

The loss sustained by the early death of Dr. Wiltshire—
aloes scarcely lees felt in the world of science than by bis
friends and family—cannot be pained by without record.

Alfred Wiltshire was a native of Gloucester. Members of
Ids family had been yeomen in that county and in Worces¬
tershire. . He, received his .early education at a private
school. His medical studies were pursued at University
College in London. The tes angusta perhaps frustrated his
desire to graduate at the University of London. The loss of
so earnest and capable, a member is but one of many
examples of the injury suffered by the London schools
through the narrow and exclusive policy of this University.
Like many other men distinguished as suocesaful students,
he found it desirable to seek superfluous attestation of the
theoretical knowledge and clinical skill acquired in London
by going to Scotland for a university degree. He was
enrolled If.D. at St. Andrews in 1803.

- In the following year he passed the more real, but less
honorific, examination for the licence of the Royal College of
Physknana. Thus equipped, he started in the north of
London as a,general practitioner, fought bravely the battle

of life, urged by the consciousness of being fitted fora higher
position, and resolute to achieve it. His first step upwards
was made when he was appointed a medical inspector of the
Privy Council. This position helped him materially on the
road towards the goal to which his ambition pointed. In it
he did good Work In the cause of vaccination. He next took
the bold step of entering in the competition for consulting
practice. So he took the Membership of the Royal College
of Physician* m 1868, and when he had made bis mark he
was elected a Fellow in 1878. Fairly launched on his new
career, and working hard in scientific pursuits, he was made
treasurer of the Medical 8ociety. He rendered valuable
service in the administration and reorganisation of that
Society, and was appointed to give the Lettsomian Lec¬
tures in 1877.

The bent given to his studies by his opportunities, rather
than perhaps by his inclination, led him to cultivate obstetrics
more especially. But he was accomplished as a general
physician, and became distinguished as a surgeon. He
joined the Obstetrical Bociety m 1866, was made librarian
in 1871, secretary in 1874, and vice*president in 1877. He
contributed five papers to the Transactions of this 8ociety,
ail markad by the qualities of keen observation, earnest
study, and judicious deduction. Amongst the most valuable
of these to the memoir on "Tetanus after Abortion,” written
in 1872. Amongst less formal communications two are more
especially Interesting. In vol. xx. for 1878, Dr. Wiltshire
referred in discussion to Che "normal asymmetry** of the

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52 The Lancet,]

OBITUARY,

[Jan. 1,1887.

child’s head at birth, and to the blue colour of the eyes as
a constant condition. Ue had originally described this
phenomenon in The Lancet in 1871. He said that, from
information received from physicians practising amongst
negroes, every black child was born with blue eyes.

Diagnostic skill and surgical enterprise have seldom been
more strikingly exhibited than in an operation which made
him famous amongst ovariotomists. In the nineteenth
volume-of the “ Transactions of the Pathological Society,
1868,” is recorded the history of a case of “ A large multi-
locular ovarian cyst removed by operation from a patient
with acute peritonitis.” Hie merit in the initiation of this
practice of looking upon collapse and peritonitis from
bursting or other injury of the tumour as a reason for
prompt action rather than for regarding the case as beyond
hope, has received just recognition from Olshausen in his
work on “Diseases of the Ovaries.” This distinguished
authority says: “ Wiltshire appears to have been tne first
who had the courage to operate during collapse caused by
torsion of the pedicle.” It is given to few men to deserve
the triple praise due to pathological sagacity, surgical
boldness, and originality.

In 1883, when the first blow had already been struck at
his health, he published a series of lectures on the “ Com¬
parative Physiology of Menstruation." He was always
.given to visiting the Zoological Gardens, and he turned to
account the opportunities there afforded to study the habits
and physiology of the animals. The knowledge so acquired
was extended by observations made in the country, to which
his shattered health often compelled him to retreat. These
lectures constitute the most original and instructive acces¬
sion to our knowledge of menstruation—a function which
lies at the foundation of gynaecology—that has appeared in
this generation. We cannot in this place attempt an
adequate analysis of it. The leading theme is to illustrate
and accentuate the general law insisted upon by Darwin,
that Periodicity rules alike over the physical, animal, and
vegetable worlds.

Dr. Wiltshire held various public appointments. First he
became attached to the St. Mary’s Hospital School as assistant-
physician, and subsequently he was made physician to the
out-patients and joint lecturer on obstetrics with Dr.
Meadows. He was physician for diseases of women to the
West London Hospital, and was for a short time physician
to the Samaritan Hospital. He also held the post of
physician to the British Lying-in Hospital. About four
years ago symptoms of locomotor ataxy appeared. The
significance of these symptoms became plain to his
colleagues and immediate friends, although, with the
hopefulness and tenacity of a sanguine nature, he
battled against the enemy, refusing to yield. And more
than once his resolution seemed to have conquered.
But the remissions inspired little confidence in anyone but
himself, and at last body and mind gave way. In the
summer of 1885 he resigned his appointments arid the hope
of resuming practice. He had married a daughter of the late
Mr. Albert C. Waterlow, thus becoming the brother-in-law
of Dr. Perrier. His widow and two sons survive him.

De mortuis nil nisi bonum. We need not hesitate at the
-qualification: nisi verum. What is true of him is mostly
good.. He had a warm heart for his friends. If he at times
exhibited some jealousy, tinged even with bitterness towards
those who he thought opposed his progress, the failing will
be explained and pardoned by the reflection that it is not
uncommon in men who have been forced to struggle hard
in early life; and who, in their impatience to succeed, are
apt to be irritated by opposition which they feel is unde¬
served. And those who smew him best would trace not a
iittle of his asperity to the disease which was insidiously
sapping his nervous centres. At any rate, Alfred Wiltshire
leaves behind him sterling work enough that will endure,
bearing no trace of ungenerous feeling.

THOMAS WALKER, M.D., J.P.

Da. Thomas Walkeb, who died at Peterborough on the
16th inst., was born in Dumfriesshire in September, 1796,
-end was therefore in his ninety-first year. He had been for
eeventy-one years a qualified member of the medical profes¬
sion, having become a licentiate of the Edinburgh College of
Surgeons in 1815. At the time of his death he was the
oldest lioentiate of ^hat College, and also father of the
Faculty of Physicians and Surgeons of Glasgow. The oldest

son of the late Josiah Walker, M.A., Professor of Humanity
(Latin) in the University of Glasgow, Dr. Walker was
descended from a long line of ministers eminent in the
Scotch Church, his ancestor in the seventh generation being
that most celebrated of sixteenth century Scotchmen, the
great reformer, John Knox. In stature tall, square-built,
muscular, with a countenance expressive of strong indi¬
viduality, endowed with abilities far above the average,
courteous, honourable, and just to everyone, he was phy¬
sically, intellectually, and morally a notable man. Most
hospitable, highly educated, of refined tastes, bis mind
stored with accurate and widely-ranging information, his
society and friendship were at all times highly valued by
those of all classes aud ages with whom he was brought in
contact. He was especially fond of associating with men
younger than himself, and, as was remarked by us of him
in our memoir of his pupil, the late Dr. Harry Leach, he waa
“a physician who had been peculiarly fortunate in the
number of honoured and successful men trained by him for
the profession.” Although Dr. Walker was, in his own town
and district generally, universally esteemed and regarded
with strong personal affection, it was given perhaps to only
a privileged few to know the almost feminine tender¬
ness of heart which lay beneath the somewhat austere
exterior.

Dr. Walker studied in Edinburgh, and qualified at the
earliest possible date with a view to entering at once on
active medical service in the army; but the battle of
Waterloo and the subsequent general peace defeating this
ambition, he went to Paris, and there, under Roux,
Dupuytren, Dubois, Larrey, and other eminent surgeons
(of whom he wrote in letters still extant life-like descrip¬
tions), continued his medical studies. On his return from
the Continent he became house-surgeon to the Westminster
Hospital, and at the same time attended the School Of Medi¬
cine in Great Windmill-street. Thus specially qualified for
the practice and teaching of surgery, Mr. Walker returned
to Glasgow, intending to become a candidate for the Chair
of Surgery which was shortly to become vacant. The
success of his candidature was considered certain, but an
attractive offer of a practice at Peterborough induced him
to change his plans. He commenced practice at Peter¬
borough in 1819, and the Chair of Surgery, on becoming
vacant, was filled by his most intimate friend, Profeseor
James Laurie. Mr. Walker speedily acquired the confidence
alike of his medical brethren and the public, and was
appointed the first surgeon to the Peterborough Infirmary—
■an office which he held for forty-three years.

In 1843, Mr. Walker added to his other qualifications that
of M.D. of Edinburgh. Dr. Walker was a most successful
surgeon, and although he himself wrote but little, the first
hints of many a step in modem surgery are to be found in
the note-books of the young men who were from time to
time either his private pupils or house-surgeons to the
Peterborough Infirmary. In his operations, as in all else he
did, there was an utter absence of attempt at display.
Thorough anatomical knowledge, a skilful hand, a clear
judgment, and a cool temperament ensured success. He
was an excellent lithotomist, and operated eighteen times
successfully before losing a case. Fond of mechanics,
and himself a practical adept, he continually devised new
surgical appliances and methods of treatment. As a
physician Dr. Walker was no less successful than as a
surgeon, early discarding the indiscriminate and empirical
use of remedies. He continued in full practice uutil the
year 1876, when a severe illness laid him aside for some
months, and he never resumed active work. He was a
Justice of the Peace for the Peterborough division of
the County of Northampton, and for some forty years
served as an active and efficient magistrate, filling aleo
various public offices, until partial deafness made him doubt
his own capacity for business. He leaves fifty-five direct
descendants, of whom two sons and a grandson are members
of the profession. An early riser, temperate in his habits,
taking pleasure in strong physical exercise, he occupied his
leisure in gardening, carpentering, and drawing. He was a
great reader, and retained his vigour of intellect and body
almost to the last. When in his eightieth year, he, with his
friend Mr. O’Connor of March, Cambs., went at night on foot
across a fen drove and fields too bad for wheels, and in a
cottage by the light of a tallow candle performed hernio¬
tomy.

The funeral took place on the 21st inst. at Peterborough,
amid every sign of respect from the inhabitants.

Tn LiwarJ

MEDICAL APPOINTMENTS.—BIRTHS, MARRIAGES, AND DEATHS.

[Jan. 1 , 1887 . -53

jgltbital jgCjefaa.

Royal College or Surgeons in Ireland. —At
a recent meeting of the Court of Examiners, the following
was admitted a Fellow of the College:—

Joseph Byrne.

Society or Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise, on Dec. 23rd: — *

Barton, O. A. Heaton. Wenlock House. Barton-road, Kllburn.

Bid well. Leonard Arthur, Lee-terrace, Black heath.

Bienklnaop, Alfred Percy, HUIdrop-creaoent, N.

Carvalho, Alberto Pedro de, M.R.C.8., Udllngton-plaoe,
Ampthlll-square.

Fox. Geo. Martin, Oxford-* tree t. Bill ton, Staffordshire.

Harris, Bdward Bernard, Alkham-road. Stoke Newington.

Hensley, Philip Henry, Ooleherne-road.

Phillips. Thomas, Newcastle Emlyn, South Wales.

Slater, William Arnlson, Green-lane*.

VIdler. Albert Bdward, Hagdala Hoose, Rye, Sussex.

Passed on the 30th ult.:—

Cook, Bdward Thomas, M.R.C.S., Soutbsea.

Jons. Bdward Meyer die, Blackpool.

Walls, James, Wigan.

Scarlet fever is reported to be spreading rapidly
hi the locality of Treharris.

A legacy of £200, free of duty, left to the Leeds
Infirmary by the late Mr. William Neal, has recently been
paid over to the treasurer of that institution.

The Queer’s Jubilee is to be recognised at Bristol
by the founding of a Maternity Hospital, and at Folkestone
by the erection of a public hospital.

Meath Hospital, Dublin. —It has been deter¬
mined by the governors to build a special ward, to be called
the “John Barber Ward,” as a token of appreciation of the
late Mr. Barber’s generosity.

On the 21st ult. a property owner at Ramsgate
was summoned for neglecting to connect his property with
the sewers. The msgistrates ordered the nuisance to be
abated.

A Roman Catholic Home for Female Inebriates
was formally opened at Hammersmith on the 21st ult., the
premises recently occupied at Kilbum having proved
unsuitable.

An inquest was held at Sutton Coldfield on the
23rd ult., on the body of Mr. Charles Barlow, surgeon, whose
death occurred suddenly on the 21st. Medical evidence
having been given to the effect that death bad resulted from
syncope, the jury returned a verdict accordingly.

Kilmarnock Fever Hospital and Infirmary.—
The annual meeting of the subscribers to this institution
was held on the 16tb ult. The annual report showed an
income for the year of £1521 and an expenditure of £1028,
which, with the deficit of previous year, left a balance due
to the bank of £319. The invested capital amounts to £5605.

At a meeting of the Board of Management of the
Manchester Royal Infirmary on the 23th ult., it was
resolved that one of the wards of the Institution be named
the “Thomas Bose Ward,” to perpetuate the name of
Alderman T. Rose, from whom the hospital recently received
a munificent legacy.

Prosecution under the Food and Drugs Act.—
At the Dale-street Police-court, Liverpool, last week two
grocers were fined each 10s. and costs for selling adul¬
terated pepper. The foreign ingredient—a mixture termed
“poivrotte,” which waa found in one case to the amount
of 65 per cent., and in the other to 55 per cent.—appeared to
consist of ground nutshells and olive-stones.

At the Greenock Police-court, on the 18th ult., a
lodging-house keeper was fined 10»., with the option of
going to prison for seven days, for neglecting to report to
the sanitary inspector the presence on her premises of a
child who waa suffering from enteric fever, although she
had been warned to do so by a medical man.

“The Value op Analysis.” —Dr. Thomas Steven¬
son has sent in his resignation of the office of analyst for
Bedfordshire in consequence of the Town Council having
tacitly declined to take any further action in respect of the
late dispute regarding the analysis of a sample of beer. The
resignation has been accepted.

Htttriral Stpaintmcttts.

Intimationsfor thii column must be mat direct to the Office ofTuM Lancet
before 9 o'clock on Thursday Morning at the latest.

Dunlop, G. H. Melville. M.D.. M.H.C.P.B., has been elected an
Extra Physician to the Royal Edinburgh Hospital tor Slok Children.

Durr, A. C.. B. A. Cantab., L.8.A.. has been appointed Resident Med leal
Offloer to the Morpeth Dispensary.

Douty. Jokl Hamhxotox. M.R.C.S. (late Senior Assistant Medtoal
Officer to the Woroester County Asylum), has been appointed Medical
Superintendent of the Berks County Asylum, vi'e R. B. GUland,
M.I)., resigned.

Hovkll, Dennis Dk Berdt. F.R.C.S.B., has been appointed Consulting
Surgeon to the London Orphan Asylnm, Watford, Herts.

Hudson, Leopold. M.R.C.S., L.R.C.P. Lond., has been appointed
Pathologist and Curator of the Museum to the Middlesex Hospital.

Hurlbuit, Spencer, M.R.crs.. L.R.O.P.Lond., L.S.A., has been
appointed Assistant Medical Superintendent and Dispenser to the
Fulham Union Infirmary, Hammersmith, W., vice H. Bomber,
M.B., C.M.. resigned.

Lloyd, John Jexkin, L.R.O.P., So., has been appointed Medical Officer
to the Prince of Wale* Lodge of Oddfellows, Llanelly.

Locks, George, M.R.C.S., L.B.C.P.Bd.. L.S.A., has been appointed
Medical Officer to the Dalston and Haggerstone Branch of the
Metropolitan Provident Medical Association, vice Towne, resigned.

Morgan. William Pringle, B.A., M.B., B.Oh.Univ.Dub., ha* been
appointed Medical Offloer and Publlo Vaccinator to the Seafoid
District of the Bastbourne Union, vice Bookmaster J. Tuck,
M.B.G.S.. L.8.A., J.P- deceased.

Peabson, Riohard, M.R.O.B., L.R.O.P.Lond., has been appointed
Junior Assistant House-Surgeon to the Hull Royal Infirmary.

Prang eb, B. A., L.F.P. A S.Qlaa., LA A., has been appointed 8urgeon to
the Vancouver Coal Company s Collieries at Nanatmo, British.
Columbia.

$irt{rs, Hlarriages, ant) $jeat{rs.

BIRTHS.

Carter. —On the 24th nit., at Dllkusha, Lucknow, the wife of Surgeon-
Major Sidney H. Carter, M.B., Army Medical Staff, of a daughter.

MacLrhosk.—O n the 17th ult., at The Croft, Sevenoaks, the wife of
Norman M. MacLehose, M.B., of a son.

Meters.— On Nov. 18th. at Rusbwortb. Victoria. Australia, the wife of
Herbert Henry Meyer*. M.R.C.S.. L.B.C.P., of a son.

Pigeon.—O n the 26th nit., at 6, Alblon-street, Hull, the wife of Henry
W. Pigeon, M.A., M.B., B.O., F.R.C.S.. of a eon.

Platt.— On the 16th ult., at St. James’s Lodge, West Hampstead, the
wife of William H. Platt, L.B.C.P.Ed„ L.R.C.8.I.. of a daughter.

MARRIAGES.

Huntington — Bowles. — On the 16 th ult., at St. Mary’s, West
Kensington, William Huntington, M.R.C.S., L.B.C.P.Lond., to
Charlotte MacLeod, daughter of Joseph Bowles, B*q., late of
Sydenham.

Merces— Bow.—On the 15th ult.. at the Parish Church, Stoke Damerel.
by the Rev. W. H. AUln. James Merces, M.R.C.S., L.R.O.P.Lond.,
of Drayton-park, Highbury, to Florence Bverard, seventh daughter
of the late Fred. Bow, M.D., J.P., of Devonport.

Morton—Hall.— On the 16th ult., at St. Paul's Church, Edinburgh.
John Morton, M.D.. L.B.C.8., L.R.C.P., to Agnes, only daughter of
the late John Hall, Esq., of Birmingham.

Murray—Matheson. —On the 29th nit., at 26, Abercromby-place. Bdin.
burgh, by the Rev. Alexander Whyte, D.D., Free 8t. George's Church
Edinburgh, assisted by the Rev. Donald Murray. Free Church’
. Tarbat, Boss-shire, father of the bridegroom, Donald Roderick
Murray, M.B.. C.M., Admiralty Surgeon and Agent, Leith, to
Johanna (Bnntv). daughter of £he law Robert Matheson. Esq., of
H.M. Board of Works, Edinburgh.

Rkkks—Thornton.— On the 23rd uit., at the Cathedral of the Holy
Trinity, Gibraltar, by the Ven. Archdeacon Govett, assisted by the
Rev. D. Nickerson, Chaplain to the Forces. John Reeks. M.R.C.S.K.,
Aw., of Forest-gate, Essex. to Mary Rosa, elder daughter of Henry
Thornton, Esq , of Ashtead Cottage. Gibraltar.

DEATHS.

Bell.— On the 14th ult.. at his residence. Merlin, Eastbourne, William
Bell. M.a. L.B.O.S.I., in his Sint year.

Dickinson.— On the 27th ult.. at M2. Bedford-street. Liverpool, Annie.

the beloved wife of Bdward H. Dickinson, M.A.Oxon., M.D.
Grkavev — On the 10th ult., at Borton-on-Trent, George Greaves.

L. 9.A., in his 82nd year.

Grover. — On Christmas Day. suddenly, at St. Anne’s. Lewes, John
Polllngton Grover, M.R.C.P.Bd., M.R.C.8., L.S.A., aged 38.
NankiVell.— On the 24th nit., at Ashley Lodge, Torquay, Chat. Benjamin
Nanklvell, M.D., aged 81.

Taylor.—O n the 17th nit., at 5, Ashley-road, Bristol, Frank Taylor.

M. R.C.S.. L.S.A.. late of RedoBff, Bristol, aged 30.

Thaill.— On the 10th ult.. at North-street, 8t. Andrew’s, Fife, William
Traill, M.D., of Woodwick, Orkney, aged 68.

N.B .—A fee of 6s. it charged for the Insertion of Notices of Births,
Marriages, and Deaths.

Digitized by G00gle

54 Thi Lawcnt,]

NOTE8, COMMENTS, aifD ANSWERS TO CORRESPONDENTS. [jan. 1,1887.

Hfcirintl $jrarj for % rustling Mttli.

Monday, January 3.

Bcrr al London Ophthalmic Hospital, MooarxxLM.— Operations,
10.30 A.M., and each day at the same hour.

BoyaL Westminster Ophthalmic Hospital,—O peration*, 1.30 p.M.,
and each day at the tame hour.

8*. Mark's Hospital.—O peration*, 3 p.m. ; Tuesdays, same hour.

Ohklska Hospital for Women.—O perations, 3.30 p.m.; Thursday. 3.30.

Hospital for Women, Soho-squars.— Operations. 3 p.m., and on
Thursday at the same hour.

Metropolitan Peer Hospital.—O perations, 3 p.m.

Rotal Orthopedic Hospital.—O perations, 3 p.m.

Central London Ophthalmic Hospitals.—O perations, 3 p.m., and
each day In the week at the same hour.

Medical Society op London.—8.30 p.m. Dr. 3. Langdoa Down: On
some of the Mental Affections of Childhood and Youth (Lettsomlan
Lecture).

Tuesday, January 4.

QtnrtHospiTAL^—Operations, 1,30 p.m.,' and on Friday at the same hoar.

Ophthalmio Operations on Mondays at 1.30 and Thursdays at 3 p.m.
St. Thomas’s Hospital. —Ophthalmio Operations. 4 p.m. ; Friday, 8 p.m.
Cancer Hospital, Bbompton.— Operations, 3.30 pjc.; Saturday, 3JO p<m.
Westminster Hospital.— Operations, a p.m.

W*sr London Hospital.—O perations. 8.80 p.m.

® T - —Operations. 1.30 p.m. Consultations, Monday,

1.30 pm. Ski n Department! Mondays and Thursdays, 9.30 a.M.
Kor *-** ,h ? t1 Ti'tion op Great Britain.—3 p.m. Prof. Dewar : The
ot Light and Photography (adapted to a juvenile

auditory).

Society for the 8tudy and Cure op Inebriety.—4 p.m. General
Quarterly Meeting. Mr. Tudor Trevor: The prevailing Indifference
to Inebriety.

Pathological Society of London. — 8,36 pIm. Annual' General
Meeting for election of Offioers and Council. Mr. Bve: Multiple
Cavernous Angeiomata In Deformed Leg.—Dr. Griffith: Bxtra-
uterlne Foetatlon.—Mr. Batlin : Melanotic 8arcoma of Breast.—
Carrington: A case of Recovery from Tubercular Meningitis.—
IJr. Wiglesworth : Peripheral Neuritis in Raynaud's Disease.—
Ur. Bruce Clarke: Subperitoneal Rupture of Bladder. Card Speoi-
' r ’ ar « ett: Congenital Deformity of Lip.—Mr. five:
O) Multiple Painful Llpomata of Arms; (3) Diffuse Unilateral
Papilloma of Tongue.—Mr. Charters Symonds: Hydatid of the
Breast.

Wednesday, January 5.

National Orthopedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

8*. Bartholomew’s Hospital.—O perations, 1 JO p.m. j Saturday, same
hour. Ophthalmio Operations. Tuesdays and Thursdays, 1 JO p.m.
8t. Thomas’s Hospital.—O perations. 1.30 p.m. ; Saturday, same hour.
London Hospital.—O perations, 3 p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital.—O perations, 3 p.m.

Faj “ Ho6PITAL f°» Women and Ohilpren.—O perations.

College Hospital.—O perations, 3 p.m. ; Saturday, 3 p.m
“ kin Department, 1.45 p.m. ; Saturday, 9.15 A.M.

®° T1 * Frbh Hospital.—O perations, a p.m., and on Saturday.

Kino’s College Hospital.—O perations. 3 to 4 p.m.; and on Friday
3 P.M.; and Saturday, 1 p.m.

Childrens Hospital, Great Ormond-Street.—O perations, 9 a.m.
Satnrday, same hour.

Thursday, January 6.

St. George’s Hospital.—O perations, l p.m.

St. Bartholomew's Hospital.—S urgical Consultations, 1.30 p.m.

Charino-choss Hospital.—O perations, 3 p.m.

North-West London Hospital.—O perations, 3.30 p.m.

Institution op Great Britain.—3 p.m. Prof. Dewar: The
Chemistry of Light and Photography (adapted to a juvenile
auditory).

Harveian Society op London.—8.30 p.m. Dr. T. Morton: The Analogy
between Croup and Asthma.—Dr. Goodhart: Cases of Peritonitis!—
Ur. Blenklnsop: Some remarks on Cancer and its Treatment.

Friday, January 7 .

8t. Georges Hospital.—O phthalmio Operations, 1 JO p.m.

Bopal. South London Ophthalmic Hospital.—O perations, a p.m.

West London Medioo-Chirurgioal Sooiett.—8 p.m. Dr. Blenklnsop:
Phthisis and lbs Treatment.—Df. 8eymour Taylor: The Btiology of
Phthisis, and its Treatment from a Hygienic Standpoint.—Mr. Bruce
Clarke: The Operative Treatment of Intercurrent Disease In
Phthisical Patients.—Mr. H. Percy Dunn : Card Specimens of Pul¬
monary Tuberculosis. — Dr. P. S. Abraham: Specimens of the
TuberHc Bacillus, and Microscopical Sections of Tubercular Organs
In Man and the Lower Animals.—Messrs. Wright and Co.: An
Exhibition of Oro-nasal Inhalers, Sprays, and Instruments.

Saturday, January 8.

Middlesex Hospital.—O perations, a p.m.

Royal Institution or Great Britain.—3 p.m. Prof. Dewar: The
Chemistry of Light and Photography (adapted to a juvenile
auditory).

METEOROLOGICAL READINGS.

(Token daily at 8 JO a.m. by Steward'I Instrument*.)

The Lancet Office, December 30th, 1886.

DaM.

Barometer
reduced to
Sea Level

and IP* F.

Direc¬

tion

of

Wind.

Bail.

Wet

Bulb.

Solar

Badla

la

Vacuo.

Max.

Temp.

Shade.

Mia.

Temp

Rain

fall.

Remarks at

8 SO AM.

Dec. 34

39-63

w.

40

39

40

37

„ 25

29-94

w.

39

37

43

31

•33

20

39-90

B.

40

89

41

34

Raining

M

29-75

N.

30

35

41

33

1-04

.. 28

39-88

W.

40

40

49

34

„ 29

29-80

W.

40

38

44

35

—A

„ 30

30-30

N.B.

34

33

39

Overcast

lirtts, Sjwrt Commticts, ft gofers to
Cmtspmbtnts.

It it especially requested that early intelligence of local events
having a medical interest , or which it m desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editor.”

Lectures, original articles, and reports should be mitten on
one side only of the paver.

Letters, whether intendedfor insertion or for private informa¬
tion, must be authenticated by the names and addresses of
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked.

Letters relating to the publication, sale, and advertising
departments of Thh Lancet to be addressed “ Tj the
Publisher”

We cannot undertake to return MSS. not used.

Health or the United States Army.

The annual report of the Surgeon-General of the United States Army
for 18R5 shows that the American soldiers, like the greater part of the
rest of the world, were nnusually healthy during that period. The
actual number of admissions to sick was 32,990, or 3839 less than
for the preoeding year. Compared with the average rate for ten yeara
preceding, the admissions were about one-fifth leas. A greater pro-
portion of Invalids was furnished by troops under thirty-one yeara of
age, while up to the age of twenty-five the rate proved so much above
the mean ror the whole army that the Surgeon-General states it may
be fairly questioned whether the Services rendered by these young
men are equal to the cost of their maintenance. Men of Irish birth
furnished the highest mortality rate, or 7'9 per 1000; the EugUsh
stood next, and the Germans third.

H. W. Verdon, M.D., and IK. Gibson Bott. L.H.C.P., M.B.C.S.—O ur
correspondents' letter arrived too late tor pnblloatlon this week.

Mr. B. M. Harwood is thanked.

VACCINE LYMPH IN TROPICAL CLIMATBS.

To the Editors of The Lancet.

8ibs,—A t the request of Bishop Smythies in H. Central Africa—lat. 4°
to 15° S.—I would ask you to give me space in your columns to solioit
information as to the best way of preserving and transmitting vaccine
for use in that tropical climate. We send out quantities every month,
and have tried various kinds, and also methods of storing. The mail is
monthly only, and the voyage Is twenty-eight days to the neareet port,
with a fortnight further on the inland journey to our stations. Only
quite a small peroentage Is any good on arrival. If any of our home
authorities can help us to discover the right kind and method it will be
a great boon, and of public advantage.

It may interest your readers to know tliat Archdeacon Foster. In
lat. 5°, has lately vaccinated thousands by means of several assistants
and one qualified medical man. He has kept a district round his stations
free from small-pox, whilst the belt of the country just beyond is badiv
troubled with the disease. I will gladly give further Information to any
who care for it. I am. Sirs, yours faithfully.

The Universities' Mission to Central Africa, W.M. H. Penney.

Delahay-st., 8.W., Dec. 20th, 1880.

V II lymph has to be kept for a long period. It is best preserved in
sterilised tubes, and should be stored In the Icehouse of the vessel con"
veying it to Its destination. The cultivation of vaccine lymph at the
place where It will be used gives a better promise of success than Its
transmission from England.—E d. L.

Digitized by CjOO^Ic

TD uamcht,]

NOTES, CX3MMEWT8, AND ANSWEB8 TO CORRESPONDENTS. _[Jan. 1,18S7. 55

THB MOOT KXTKB8IVBLY QUOTBD MEDICAL JOURNALS
IS TSB WORLD.

T» 0 Is Waters of Tax Lancet.

Boa.—A short time ago I bad the curiosity to count the number of
edncta boa foreign source* in Mine Russian journals which are
■iliHl for their copious and Impartial precis writing from the
nstaal jonrnal* of all other countries. The numbers were as follows
7*1 Luar, 11; Brit. Met . Jour., 7; La Semmne Mid., 7; Deutsche
Mid. 7 m /. , S; CesUralbl. fir Chir., 3; Med. Press, 2 ; Journ. tf Cut. and
r mar. Din, 1 ; Lm Prance MOL, 2j Centroldl. f. NerocnheUk., U. Beaidea
i single sxtraotaf rom 1 English, 4 American, 1 Canadian,
, * German, and 9 Italian medical journal*. Again. I have just
the fa otatton a from non-Russian journals in the last lour
i si tba Track, with the following results i—Thk Lancet, 11 ;
Brit. Mti.Meee^, 7 i Minchener Medict n. Woch* 11; Allgem. Med. Cent.
Zeit, 8; lm immune MUicale, 8; and a large number of other Bngllsh,
kmm rtaan. Barman. French, and Italian medical journals from 1 to
t aadh ttk all tends to show that though our English medical
jininalr tm km numerous than those of several other countries, our
pwak ssridhs -are extensively read and appreciated abroad. A pro pot
of ssddn S la not, I suppose, generally known that there is in
odsMnaena <fend one only, as far ae I ean learn) daily medical journal.
1 haaMar me a oopy of A Dtarie MHiieo-Farmaceutico, published at
Ij bat I o anno t say that I feel any longing for the time when it
in Kngfand. Thera is more valuable and original
aber of Thk Lancet than would probably be found
ia a one of the Dusrxo.

I am. Sirs, yours truly,

, Dec, 22nd, 1886. Theodors Maxwell.

C andidate will find the information he desires In our last
Wamber, published in September, 1886.

THE BIDDHLL FUND.

7b the waters of Tax Laxcjit. .
tat-WU you kindly insert the enclosed list of subscriptions to the
Aim tai. and obttga. Yoon truly,

Dae. 19th, 1888. J. Wickham Barer*.

last stated In the last
mmmt Tax: Luton ... £3 18 0

S-Hsar. Baq.3 3 0

irthsr K. Stokes. Baq. ... 1 1 0

lm- t am er . Baq.110

>-Bamy Sfcelsoo ...110

f A. Ocay. Baq .110

LACbarke, Kao.. 0 10 6

ImmB Hlataii. Keq. ... 0 10 0

C tteatna .0 10 0

c B. Ishaaosu H»q. ... OM 0
lag Bamaasf la tin Tyne 0 10 0
ireeatvadby Dr.

Bxate r:—

...3 3 0

J. E. Whidbome, Esq. ... £3 0 0

Dr. G. BothweU . 2 2 0

Miss Farmer . 2 0 0

J. Woodman, Esq. ..,110

Dr. F. Nanklvell. 110

A. Canning, Esq. 110

J. Ackland, Esq. 110

G. C. King don, Esq.1 1 0

T. H. .1 0 0

T. B. ... .10 0

Priends . 10 0

H. W. Gould, Esq. ... 0 10 6

J. T. Tucker, Esq., J.P.... 0 10 0

— Patti neon, Esq. 0 10 0

W. C.0 2 0

Complaint against a Physician nr Jamaica.

A correspondent writes reflecting on a medioal practitioner for not
responding to the call of a lady in her labour, on the ground that he
was going to devote himself to black and brown women who appeared
to appreciate him more. It is asserted that the physician tn question
was the family attendant, and that in consequence of his refusal, of
which be had given no notice, the labour became protracted and com¬
plicated. We do not think that this can be a complete statement. It 1s
Incredible that a physician engaged to attend a lady in her oonfine-
ment would make suoh a frivolous excuse for not doing so.

Mr. Clark Bell (New York).—It will always be impossible to define
insanity, because It Is a negative quality. Like disease, insanity simply
means unsoundness. It ia only In respect to special forms of disease
or uneoundness there can be definitions.

M.D.Edin. will see by reference to our Issues of Dec. 18th and 25th,
pp. 1208, 1257, that the matter has been already noticed.

A PLAN OF CA8B-MAKING.

To the Eaters of Thx Lancet.

Sirs,—S lnoe entering Into practice It has nlways been my wish to keep
notes of every case treated; but I have found this very difficult to do,
partly from want of time, and partly from want of a convenient method
of taking and keeping the note*. After trying a great many plans I
arranged, about a year ago, a case-sheet with convenient headings, and
had a number printed. These I have used daring the present year, and
have found them very convenient. The oases being entered on loose
sheets. It is easy to write them np at odd moment*; the Subdivision*
make the writing of them more rapid, and the arrangement of them In
portfolio* readers reference to old eases easy. The sheets have the usual
heading, with spaces for name, address, age, occupation, disease, result,
date; also spaces for a letter and a number. The former Is filled In with
the Initial of the surname, the latter with the number the oase occupies
amongst those of the same letter. Thus if the name is Smith, and it Is
the tenth oase commencing with S, notes of wbloh have been taken, the
case-sheet Is endorsed—Letter S, No. 10. On the first page, under the
heading, are spaces for family history, personal history, present con¬
dition, and ad viee and treatment. The second page is oeoapied with pro¬
gress of case, whilst the third and fourth pages are utilised either for dia¬
grams, charts, or for any particulars which ha ve to be given more fully than
the first and second pages admit of. The sheets as filled are placed In a
portfolio, which has separate compartments for each letter. Thus, If It
is wanted to look up the case of Smith. It Is only necessary to take the
case-sheet* oat of compartment S. There are also compartments for
unfilled case-sheets, blotting-pad, and diagrams and charts. The label
outside the portfolio shows the period of time covered by the sheets
within. I showed a specimen to Messrs. Danlellson and Co.. London, and
they have undertaken the publication of the case-sheets and portfolios.

I am, Sirs, your* faithfully,

December, 1886. B. MacDowbl Cosorave, M.D.

B. fOshvioh).—Our c o rre s pondent will find sufficient Information in a
on Diabetes by Dr. Phllpot, published about a year ago.

MR8I8TEWT DIARRHOEA.

7> the Waters ef Tax Lancet.

Sat—1 reoeotiy bad a oase similar to the one described by your cor-
wpemdont. “A. H..“ ha your last issue (p. 1202), but of so much more
were a type as to bring the patient In the course of two years into a
uiilHim of extreme prostration and emhetation. My patient—also a
T*mg lady—consulted mo about six months ago, and shO ia now quite
wdL I p ses cr ibed the perchloride of Iron in four-minim doses, and
t?ih■chimin acid tn ton ifntni doses, after meals. The diet ordered
■SB sos of milk and fartnaeeoos foods, at regular intervals of four hours
slj. When the dfarzbasabad considerably abated and. the patient was
Mffcotef to pot on flesh, massage was used, on the recommendation of
Jr. Whffiabead of Msanhesiir, with the effect of rapidly restoring the
f* flash and strength.

I an, Sb*. your obedient servant,

- Moon , Dee. Had, 1886. C. R. Illingworth, M.D.

Jf ATBRtAL ! IMPRESSIONS.

Te the Wtftere xf The Lancet.
•dUfsrenosefopiBlon exists in reference to the Influence of
tons on thn fo rmat i on ef the foetus In utero. Tbefol-

I at least shown reasonable propter hoc.

. fled Hill IJ Hfh Was delivered of her first child minus
.fisaWt fo r e arm t —MlAtfn g at the wrist in a perfect stump,
her directly after delivery as to any impression she may
1 during pregn anc y; but she could call none to mind. The
r, sbevMhriMMd that two men presented themselves
Bibs tor «r m ban , of which shews* then landlady, and showed her
teHtog^MfetefcleMshdltoto'MNBieaoeident. At the thne, she seta,
* waste*—*alle a tarn." flhs w a s then In about her seoond month of
H neuli a i tototoMS/il nothing nMre.
■Ans>^t;7,fli,igBlgljwf«tedttetly. ■

-***

CONSULTANTS.

7b the waters of The Lancet.

Sirs,—I s it usual for a consultant in London to write a reply, direct a
patient, advise and prescribe, asking and taking a guinea fee, when the
patient is under the care of the ordinary family attendant, and when
that gentleman has been in communication on several occasions with
the said consultant In this particular case?

I am. Sirs, yonrs faithfully,

December, 1880. M.D.

%* The above action on the part of the consultant Is not usual, and

cannot be commended.—E d. L.

MEDICAL BURSARIBS.

. Xo the Editors of Tux Lancet.

Sirs,—I n your issue of Oct. 30th I see that some of our old graduates do
not forget their alma nutter even when faraway. It Is to be hoped that
more will follow Dr. G unning ’s example in founding bursaries for
graduate* of the University. There is only one thing that I, as an old
university man. regret, and that is that the name* of Syme and Spence
were omitted In denominating the different bursaries. “Honour to
whom honour is due," and no two men together ever did more, in my
humble opinion, for clinical and practical teaching than those two.

I am, Sira, yours faithfully,

Uniondale, Cape Colony. John Brown, M.B.

DEGREES FOR LONDON MEDICAL 8TUDBNT8.

To the Editors of Thr Lanckt.

Sirs,—I have been rather surprised at the seeming apathy of the London
medical students with regard to the movement which has been, and Is
being, made In Lhertr favour. I refer, of course, to the scheme for
granting degrees In place of the present, double qualification. As the
present movement concerns all London medical students, does it not
seem strange that they have never held a meeting among themselves to
pass resolntlons which would serve to strengthen the hands of these
agitating on their behalf. I am. Sirs, yohn truly,

, D^o. 27th, 1880. Student.

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A6 Th» Lamow,] NOTES, COMMENTS, AND ANSWEBS TO (CORRESPONDENTS. [Jan. 1, 1887.

Action bt a Medical Max against ax Inspector of thx Poob
at Kirkwall.

Wk are glad to see that the judge expressed hli sense of the “ te chni c a l,
not to say harsh," way In which the Board of Birsay had treated their
medical officer in terminating one engagement, without notice, to put
him upon lower and lees advantageous terms. The judge thought the
board should pay their own expenses.

Mr. H. Anderson. —The observations which were made upon the Llan¬
dudno Cottage Hospital In our issue of Dec. 11th, 1886, were based
upon the last report, issued that year, and also on a comparison
between that and the one for the previous year.

<7. /’.—There is no invariable rule. It Is better to follow the custom that
has been in vogue in the locality.

T. P. R .—The question is discussed pretty fully in our present number.

EPITHELIOMA OF THE UP REMOVED BY THE AID OF
COCAINE.

To the Editors of Thk LaxcbT.

Sirs,—P erhaps the following case of epithelioma of the lower lip,
removed by the aid of cocaine, may interest some of your readers.

A man came to me a few days ago with a growth on his lower lip. It
had been there for some time, but within the last month had rapidly
Increased in size. On examination I found it to be an epithelioma, and
decided to remove it. He objected to the administration of chloroform ;
so I injected on either side of the growth a 4 per oent. solution of
•cocaine, and dusted the mucous membrane of the lip with hydrochlorate.
After waiting ten minutes I removed the growth, and such was the good
•effect of the cocaine that I was enabled to take time and perform the
operation with great exactness. The man expressed himself as feeling
no pain, and the after progress was excellent.

I am. Sirs, yours truly,

Leighton Buxxard, Dec. 13th, 1886. Johxstoxh Harris.

Dr. Glacier.— The Swiss authorities will not allow a foreigner to practise
even amongst his own countrymen in Switzerland without passing the
State examination at Bern or Geneva; and this is by no means a mere
matter of form.

Caligraph. —Our correspondent should consult his ordinary medical
attendant. We do not give advice.

J. R .—We regret we cannot satisfy our correspondent. The data for a
reply are want ing.

E. S. had better address the author named.

INCOME-TAX ASSESSMENT,
re the Editors sf Thk Lancet.

Sirs,—W ill you allow me to suggest to your readers who may be dls-
eatlsfled with their income-tax assessment that they should apply to the
Income-tax Repayment Agency, 16, Artesian-road, W. Acting upon
advkse received therefrom I have lately recovered £7 8s., and obtained a
tower assessment. I am. Sirs, yours faithfully,

December 34th, 1866. 8. W.

Viator. —So far as we are aware. Dr. Fsttorini Is the latest Italian writer j
'on the probable causes of enteric fever in Rome. That author, in a
comparatively recent essay, laments the abolition of the old cloaca,
and attribute* the existence of typhoid in the Eternal City to the
introduction of the English watercloset system.

R. C. —Such breaches of good taste are oflen to be attributed to the
enthusiasm of injudicious friends.

Actiox of Drugs ix Albuminuria.

Dr. Robert Saundby writes, in reference to our annotation on this subject
last week, that the solution of bitartrate of potash employed was half
an ounce to a pint, not an ounce and a half, as there stated.

J. C. is referred to our advertising columns.

Comm irrigations not notloed In oar present number will reoelve atten¬
tion In our next.

Communications, Letters, Ac., have been received from— Sir Andrew
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Kerr, London; Mr. Barlow, London; Dr. Elliott, Andover;- Dr. W.
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TM® LAN0ET, January* 8$ 1887:

Sector*

jKHOLOGY OF OONSTITtmoNAl, DISEASES
OF THE EYE.

Being an Introduction ts a Systematic Course of Lectures
on Ophthalmic Medicine and Surgery, delivered
in University College, London,

By JOHN TWEEDY, F.RC.S.Eng.,

or OPOTHXUUC MEDICLNK AND SUKUJIRI US UKIVSHSIXIT
count, XlTf) SVBOKON TO THK ROTAI. LONDON
omrnuunc howital. moobpjki.ds.

Gx^tlxjlen,—V« y little experience in the observation
at iti reason of the eye is needed in order to discover that
mftiia some of these d io ptres are strictly local or due to
eames, there are others which are associated
mor bi d constitutional states and apparently depen-
; thereon. Oootagioua ophthalmia, the effects of injuries,

1 of refaction, and presbyopia are commoo examples
loaal affections; and the ophthalmia of strumous
the 1 keratitis, iritis, and chortriditia which occur
hr syphilis, the retinitis met with in kidney disease,
tfts Cataract of diabetes* are equally common examples of
oonlar lesions associated with abnormal constitutional states.
▲ still closer observation discloses the additional fact that
not only are the grosser parts of the eye, such as the cornea,
tlM iris, the choroid, the retina, or the lens, affected in
eonstitntional disorders, but that particular portions of
these parts are implicated in particular constitutional con-
dttions. The form of inflammation of the cornea which is
SO common in strumous children is altogether different, both
oe regards its site and the mode of its manifestation, from
that form of inflammation, which is met with in the subjects
at hereditary syphilis; and both these in turn differ from
the special form of keratitis which occurs in sympathetic
lalmitia, sad in some cases of toxaemia, septicaemia,
it’s disease, and gonorrhoeal rheumatism. Similar
are observable in the various forms of iritis,
Choroiditis, and retinitis associated with different morbid
diatheses.

What is the explanation of these coincidences and these
differences? The answer to this question is by no means so
or so obvious as might at first sight appear. But the
s ngg Brte d by the question is worth undertaking,
tha ceaclosioas at which we may arrive will not
dn^f explain ths retiology of the constitutional diseases of
Use m bat wifi also throw light upon the nature and origin
aflotnsr localised foci of eonstitntional diseases.

I oof perhaps so far anticipate the result of the inquiry
a»t»atat4 that-I believe the association of ocular lesions
with gaoaral diseases is determined partly by anatomical
awineftrins, ptrtlyby histological peculiarities of the tax-'
tares aaraadly wrerrad, hot chiefly by their embryoJogioal
sfjm*. relatinrertsps) sad affinities.

The eve is psosmriy adapted for such an investigation as
titio. The optihasetn and retina are genetically direct and
Wore early outgrowths from the brain; and physiology and’
pathology havwboth demonstrated whet might have been
a-p rio n anticipated^that there is aii intimate 'correspond-
t bet we e n t ae nd e s slopment and functions of tire brain;
if the qfchrmsrreaid retina; ‘Thiscorrespondence
an n wad jlwr the oommtmication which estate
tbs lymph spaces of the eye and those tff the hnEh
liprd. These embryological and anatomical com*-’
only account, for the occurrence; of nettre-
1 and other ocular changes in diseases or injuries of
t ana-oi mw ii'wo m bat, uw for the eoncomitancy of

_j-——y osterhsma of the retina and choroid*

• coaponita} defects sf thee eye.
ivelopment ami growth of the brain,
and its appendages draw tbeir driood-supply
|n sources -the internal and OM&MMihl carotid

Particles of fat, clots, debris, parasites, and emboli may block
the central artery or other vessels, or be deposited in other
parts; or haemorrhages may occur in the retina or choroid
in those states of altered blood, or altered, relations between
the hlood, and the vascular tunics, which occur in Bright’s
diseases, in leucocythsemia, in diabetes, &c.

Of the twelve pairs of cranial nerves, the eyebull and
its appendages receive the whole or parts of six. as well «ub
many fibres of the sympathetic, which influence the
nutrition of the eye, .controlling the size of the blood¬
vessels, and regulating the size, equality, and mobility
of the pupil. It is not surprising, therefore, that the
eye is very susoeptihle to aU those influences, healthy
and morbid, which affect the nervous system generally,
or the special innervating, apparatus of the eye, either
at the centres, the periphery, or in any part of its course.
Paralysis or spasm of the muscles of motion, of accom¬
modation, or of the iris, with the attendant phenomena
of strabismus, diplopia, myosis, mydriasis, nystagmus, ophr
thalmoplagia, pain, photophobia, neuralgia, anaesthesia, and
some forms of trophic enanges, such as inflammation and
ulceration, are some of the more common neurppathic
Ophthalmic lesions associated, with, cerebro-spinal disease or
with general diseases which especially affeot the nervous
system.

There is another factor in the aetiology of constitutional
diseases of the eye which has not received, as far as I know,
the consideration and, attention which it deserves. There
is a constant relationship between the differentiation of th*
muscular layer of the body and that of the nervous system.
Muscles imply the existence of nerves, and throughout the
whole animal kingdom an intimate connexion may be
observed between the power of locomotion and the sense of
sight. Sessile animals do not, as a rule, possess visual
organs; while free and active animals, even .of Iwwer
organisation, have well-marked eyes. Some organisms which,
like the medusae, have an early sessile stage and are then
byeless, acquire ocelli whin they assume a free mode of lift;
other organisms, like young barnacles and b&lani, in passing
from a free to a fixed state lose their eyes ^vith their other
higher sense organs. It is, at' least* noteworthy that in most
cases of locomotor ataxy the sense of sight is sooner or
later lost. Indeed, not infrequently blindness occurs very
early, and before the appearance of actual ataxia.

So that we see the eye is hot a separate and autonomous
organ, living, as it were, a life apart. Nor is it a mere
appendage or accessory convenient and advantageous to the
rest of the organism. On the contrary, it is in the closest
relationship with the rest of the body, and participates in
its various moods. This inter-dependence of the several
organs of the body is at once an acknowledged fact in
physiology and pathology and the basis of the doctrine of
evolution^

The conditions which I have already enumerated aft, how¬
ever, only some of the factors in the production! of'so-called
constitutional diseases of the eye; they are not all the
factors. They are, indeed, only accidentals, as it were; the
essential factor being the nature and constitution of the
tissue-elements themselves.

No other organ of the body contains so many, different
kinde of histological elehients or textures of so hf^h a
quality as the eyfe. Not wily are there the coarser consti¬
tuents of bloodvessels, nerves, muscles, and fibrous tissues,
bot there win the cornea a rich network of protoplasm and
lymphatic channels, jn the choroid a collection of peculiar
pigment cells, m the crystalline lens specialised transparent
fibres, and in the retina sdme of the most highly differentiated
tissue-elements in the whole body. It is, f repeat., the
mnflber and complexity of the different kinds of tissue-
elettrentB (md their kinship with many systems of similar
elements distributed throughout the body which tender the
eye so apt to participate m constitutional diseases. ,

HOuItbY'life and nutrition depend upon two conditions
first, the inherent properties of the organism; and second,
the envhmnment. So long as there is a sufficient correspon¬
dence between the organism and its surroundings health is
! fairly maintained, hut when these relations fall out of
correspondence, disease, decay, or death takes place. No
organism, whether unicellular or multicellular,.13 eadowed
with the power of indefinite life. In complex organisms of
even the best ancestry it it( .scarcely likely tnat $1 the

:VBd from the division! of the

means of the bloodvessels aafttfae Iftid which

wor emam tmoiWflc tt . .

fcmraat mto. the tdybH parent cell receive aT bmfieefeWty the same shaft of vital

Digitized by vrOC ~

x -

58 The Layout,] ME. J. TWEEDY: ETIOLOGY OP CONSTITUTIONAL DISEASES OP THE EYE. [Jan. 8,1887.

energy (Ziegler). Other things being equal, the lees favoured
cells will succumb sooner than the more favoured to all
those external agencies which are antagonistic to cell life.
If these agencies exist as morbific qualities of the blood, the
changes will, in accordance with what is called the law of
selective assimilation, affect all the faulty elements in
whatsoever parts of the body they may be located. Mr.
Herbert Spencer has generalised the facts of selective assi¬
milation somewhat as follows: “Just as the growth of an
entire organism is carried on by abstracting from the
environment substances like those composing the organism,
so the production of each organ within the organism is
carried on by abstracting from the substances contained in
the organism those required by this particular organ; like
units tend to segregate?

The law of organic assimilation prevails in pathological
states no less than in physiological, and just as in healthy
nutrition the structural elements of the body select from the
nutritive particles and fluids circulating round them the
pabulum proper to their composition and constitution, so in
pathological states kindred elements in all parts of the body
will be affected in a similar way. This is demonstrably the
case in so-called blood diseases; the altered physical,
chemical, or vital properties of the blood manifest them¬
selves in local lesions of textures similar in constitution
or function. The similarity of constitution is ultimately
determined by the embryological origin of the tissues.

The blastoderm consists of three layers, called the epiblast,
the mesoblast, and the hypoblast. From the epiblast are
developed the brain, spinal cord, and nerves, the retina and
optic nerve, the crystalline lens, the epithelium of the

In applying this doctrine to actual facts, it should be
remembered that all the organs and tissues of the body
are not indiscriminately affected in constitutional dis¬
orders, but that in each disorder the local lesions hare
determinate seats, and involve only tissues or organs of
a particular kind. So .it is with the constitutional diseases
of the eye.

In elucidation of what I have stated, it may be mentioned
that Waldeyer has pointed out that sections of the cornea
treated with chloride of gold and carmine present three
well-defined strata 6f different tints. The anterior layer
comprises the corneal epithelium, the anterior elastic mem¬
brane, and the immediately adjacent portions of the stroma ;
j the posterior includes Descemet’s membrane and the adjoin¬
ing portions of the stroma; while the intervening layer con¬
sists of the principal mass of the proper substance. This
experience, taken in conjunction with the observations of
M&nz, Langerhans, and others on the development of the
cornea, has led Waldeyer to designate these layers respec¬
tively, cutaneous, choroidal, and scleral. As already indicated. •
it is oertain that the anterior layers of the cornea are almost,
if not entirely, epiblastic, and are therefore related very closely.
with the epidermis and superficial layers of the dermis, and
more remotely with the cerebro-spinal system, and with the
lens. The rest of the cornea is mesoblastic, the posterior'
layer having acquired the character and properties of & ;
serous membrane, and being at an early stage of embryonic
life apparently continuous with the choroid. It is an inter¬
esting fact that this chemical and embryological differentia¬
tion of the layers of the cornea is very closely imitated by
the various forms of inflammation of the cornea. In

Blastoderm.

Bp! blast.
Medullary tube.

Mesoblast.

External

tegument.

Kibro-vascular
tissues.

I I

Muscles Ac. Cutis.

Hypoblast.

Cenlto-arlnary apparatus.

Brain and Nerves. Retina and Lens.

»pinal cord. optlo nerve. I

Kpli

dermis.

Corneal Cuticle,
epithelium.

Cornea. Sclerotic. Iris. Choroid. Vitreous. Capsule of lens. Muscles.

} _l__ _ _ I _ I I _ I _ I

Supporting and nutritive system of eye.

Organ

of special

sense of sight.

I

Eyeball and Its appendages.

cornea, the sense-organs, the enamel of the teeth, and the
cuticlo. From the mesoblast the osseous skeleton, muscles,
bloodvessels, lymphatics, the muscular and fibro-vascnlar
portions of the skin and of the alimentary canal, and the
genito-urinary apparatus. The hypoblast gives rise to
the epithelium lining the air passages, the alimentary canal,
and the principal gland ducts, and cellular elements of the
associated glands. (See schema.)

A glance at the accompanying schema will show that the
retina and optic nerve are not only closely related to the
cerebro-spinal system, but that they and it, together with
the crystalline lens and the corneal epithelium, have also a
kinship with the cuticle through their common origin
from the epiblast. With this help we can understand the
frequent association of zonular cataract with fits and other
neuroses, and a deficiency of dental enamel. So also it will
be seen that the stroma of the cornea, the sclerotic, the iris,
choroid, vitreous, capsule of the lens, as well as the vascular
and moscnlar tissues of the eye, have relationship with all
the other textures of the body, including the genito-urinary
apparatus, which are derived from the mesoblast. The eye
has no elements derived from the hypoblast. Thus we see
how h histological, physiological, and also a pathological
relationship is established between the epiblastic elements
of the eye and epiblastic tissues in the rest of the body,
and between the mesoblastic tissues of the eye and all
other mesoblastic tissues. All the textures of kindred origin
retain a strong family likeness throughout their existence
Mid behave more or less similarly in similar contingencies,
in spite of differentiation of structure and specialisation of
function. The qualities which they have in common manifest
themselves in disease as well as in health.

strumous children cutaneous eruptions are common; hyper-
lemia, eczema, herpes, and impetigo about the lids, lips, and
nose being almost invariable concomitants of the so-called
strumous ophthalmia. The essential lesion in this form of
ophthalmia is a vesiculo- pustule ( phlyctenula ) on the cornea,
or at its margin, or on the circumoorneal zone of conjunctiva.
The phlyctenula involves only the epithelial and anterior
elastic layers of the cornea, or portions corresponding to
those affected in the skin. So, likewise, in inflammation of
the cornea dependent upon neuropathic causes, as disease of
the fifth nerve, or ophthalmic herpes, the corneal change is
here also primarily superficial—the epiblastic portion. In
the keratitis of hereditary syphilis, on the other hand, it is
the stroma of the cornea and the posterior layer which
are involved—the mesoblastic portions. Now, syphilis is
essentially a disease of mesoblastic textures; and those
portions of the cornea, and indeed of the whole eye, which
are affected in syphilis will be found to be of meeoblastic
origin. The notched, pegged, and stunted teeth of inherited
syphilis depend not upon faults of the epiblastic enamel,
but upon those of the mesoblastic dental pspillse. The
epiblastic portions of the eye may become secondarily
involved; but here, as in the brain and spinal cord, the
lesion begins in tbe mesoblastic elements—bloodvessels, &c.
Inflammation of the posterior layer of the cornea (which
is called by the various names—keratitis punctata, aquo-
capsulitis, and serous iritis) will in the majority of cases be
found to be associated with constitutional states in which
inflammation of serous membranes are apt to occur—namely,
rheumatism (simple or gonorrhoeal), Bright’s disease, septi¬
caemia, &c. Corresponding differences and coincidences could
easily be pointed out for all other parts of the eye, and for

joogle

Di.

IK* LAlfOBT,]

DR. J. WILLIAMS ON CANCER OF THE UTERUS.

[Jan.8,1887 t 59

all its constitutional diseases, but these must suffice as general
illustrations.

In conclusion, however, I would suggest that the doctrine
which I have propounded is available not only for the
purposes of aetiology and nosology, but also for those of
practical and didactic therapeutics. Many drugs and other
remedial agents are already known which appear to have
a special affinity for particular tissue-elements, and as
therapeutical science advances their number will increase.
The phenomena of “selective assimilation” would seem to
indicate in localised lesions of constitutional diseases the
exhibition of those remedies which are known or believed
to influence the nutrition and action of kindred elements
in any and every part of the body.

garlic tan: lectures

ox

CANCER OF THE UTERUS.

by j. Williams, m.d. Lond., f.r.c.p.,

OBJTETRIC PHTSICIAX TO UMVKRSITr COLLROK HOSPITAL, I.OITOOK.

LECTURE I.

(Concluded from page H.)

Cask 4. —-The foregoing two cases illustrate the tendency
of the disease to extend along the vaginal surface of the
portio rather than up into the cervical canal; the next case
shows this tendency in a still more marked manner.

The patient was married, forty-seven years of age, and
had seven children. She had had some pain and discharge
for three months, but no hiemorrhage. Menstruation was
regular. The body and cervix of the uterus were enlarged*
bat not harder than natural. There was an ulcer on
the left commissure about the size of a shilling ; its base and
edges were not indurated. The external orifice was open,
and admitted the tip of the Anger as far as the first joint,
and the pal note plicitao felt swollen. The lips were not red,
bat of a slightly livid hue, and there were a few points in
the anterior like suppurating follicles. A small portion of
the anterior lip at the os externum was rethoved for dia¬
gnostic purposes, and in a fortnight afterwards induration
was felt in the anterior vaginal vault, without other recorded
changes in the cervix. 1 would observe here that indu¬
ration, which is so frequently mentioned os a sign of cancer
of the uterus, was not present in these cases. Indeed hard¬
ness does not appear to be marked until the cellular tissue
is involved in the disease. Under the microscope the flat
epithelium on the surface was found to be intact, and its
deeper strata sent processes into the tissues beneath and
formed therein cancerous masses. It was a typical case of
squamous epithelioma. The depth to which it reached could
not be ascertained, inasmuch as only a small piece was re¬
moved for diagnostic purposes. The disease, however, clearly
spread towards the vaginal vault, for the connective tissue
in that situation became soon involved.

Cask 5. —This case is one of great interest, showing a
farther step in the progress of cancer of the portio. The
patient was married ana sixty-seven years of ace. She was
admitted into University College Hospital in iLarch, 188G,
with the following history: Thirteen years ago she was
knocked down by a bale of goods, and almost directly after¬
wards she noticed that the womb came down. At first it
used to go back of itself, but for the last two or three years
the patient has had to return it herself. There has been
occasional slight hamorrhage for twelve months, but not
much at a time. During the last three months she has
become worse: there has been a continuous discharge—some¬
times blood, sometimes matter. She used to suffer from a
yellow discharge before she began to bleed. She could
always return the womb until a few days ago, when it came
down during the act of defecation, which was followed by
a profuse haemorrhage. She has lost flesh rapidly during
the last six weeks. She began to menstruate in her four¬
teenth year; was regular every four weeks, the flow lasting
five days without pain. The catamenia ceased about forty-
five. She was married at twenty-eight, and has had one
child and two miscarriages. There is no history of cancer or

tumours in her family. There was marked rheumatoid
arthritis of the inter-phalangeal joints and of the metacarpo¬
phalangeal of the thumbs, but not of the other digits; ihe
wrist and elbow were also affected. The joints of the lower
limbs were not affected in any marked degree. The vagina,
was inverted; the mucous membrane of it was pale and
horny. Tho cervix was outside the vulva, ami on the
anterior part of if, and extending over the posterior half of
the anterior wall of the vagina, was what appeared to be a
large ulcer. This was red, and bled readily; its surface was
not depressed, but the horny layer of the epithelium
appeared to the naked eye to cease at its margin. The
sound passed into the uterus for four inches. Temperature
99° to 100° F.; pulse 80.

An incision was made through the anterior vaginal wall
about half an inch from the diteased surface, and the mass
was dissected from the base of the bladder. The incision
was carried round behind the cervix through the posterior
wall of the vagina, and the cervix was amputated. On
microscopic examination the stratified epithelium of the
vagina was found thickened, and the superficial layer horny.
On approaching the diseased part, the lower strata were
proliferating and sending processes into the subjacent
tissue. Advancing further into the disease, theee processes
increased in length, and cords, masses of cancer cellp, and
nests with horny cells in their centre were abundant. The
disease terminated at the external orifice where the stratified
epithelium ended; a few glands lined with columnar epi¬
thelium and a few closed follicles filled with secretion, and
with their lining epithelium intact, were found in that
situation. Theee were not involved in the cancer. In some
places the stratified epithelium was very little thickened,
while in others, where the disease was more advanced, it
was more or less completely lost. The surface of the ulcer
was generally tubercular. The'disease was superficial, its
greatest thickness being about three-fourths of an inch.
Owing to the extrusion of the cervix and vagina through
the vulva these parts were swollen and oedematous, and this
naturally increased the apparent thickness of the diseased
tissue.

Cask 6.— This patient, fifty-three years of age, married,
was admitted into University College Hospital in May, 1884.
She said that four years previously she had a slight discharge
from the vagina, accompanied by pain, but had seen nothing
since. Three weeks before, while in bed, she woke up with a
severe dragging pain in the right inguinal region, which
gradually worked round to the left hypochondriac region
and then passed off. It lasted about naif an hour, and
left her prostrate and powerless. She had a similar
attack the following night. She had had three such
attacks up to the time of her admission into the hospital,
one since. There was no vaginal discharge until May 7tb,
the day after her admission, when she observed a slight

E ale yellow discharge, which lasted for one day only. She
ad had some difficulty in passing her urine, especially
when it had been retained for a long time, but there had
been nothing unusual in this respect during the previous
three weeks. She had suffered from nausea and eructations,
dyspnoea on exertion, great depression of spirits at times
which passed off after a good cry. Seventeen years ago she
had pain in tho supra-pubic region, but no vaginal discharge.
Menstruation began in her fifteenth year, was regular every
four weeks, lasting three or four days, moderate in quantity,
with slight pain. It ceased at the age of forty-four. She
was married at nineteen, and had four children during the
first seven years of married life She had had no mis¬
carriages. fier labours were lingering and severe, but not
instrumental. She nursed each of ner children sixteen
months. She had bepn stouter since she ceased child¬
bearing, but had lost flesh during the last twelve months,
and had for the same period been nervous and irritable.

On admission she was well nourished, there being about
one inch and a half of fat on the abdominal wall. The
mucous membranes were well coloured. There was slight
prolapse of the posterior wall of the vagina, and this wall
was red and apparently ulcerated to within an inch of the
skin of the periueum. The anterior wall seemed to be
ulcerated to within half or three-fourths of an inch of the
meatus urinarius; bn the left side the ulcer was prolonged
a little further along the wall of the urethra. At the
apparently ulcerated part the vagina was greatly narrowed
and its walls were rigid, so that the finger could be introduced
only as far as the second joint. The lips of the cervix could
not be felt. The vaginal vni'» were not fixed. The exami-

60 The Lancet,]

DR. J. WILLIAMS ON CANCER OP THE UTERUS.

[Jan. 8 , 1887.

nation caused slight bleeding. Examination by the rectum
showed that there was no appreciable thickening of the
posterior septum.

In-October, 1884, she had a slight discharge of blood for
the first time since the menopause, nine years and a half
before. It lasted one day. She had a dragging pain before
it came on. She had had free hemorrhage since with clots,
and constant pain in the stomach, shooting down the legs.
Defecation had become difficult and the urine escaped
involuntarily. Vaginal examination at this period showed
much the same condition of parts as was found at the exami¬
nation made six months previously. On examination by
the rectum, however, the parts appeared to be thickened,
and the mass in the situation of the uterus seemed to consist
of three lobes, two of which were very distinct; the mass
was movable; there was some thickening on the right side.
The growth was scraped with a sharp spoon and the diseased
tissue was found to extend backwards into the mass just
mentioned. Temperature 99 4° to 99'6°F.

Specimens of the growing part as well as of the higher and
-evidently older portion of the disease were submitted to
microscopic examination. Beginning on the healthy surface,
the squamous epithelium was found to be normal. Proceed-
ving backwards towards the disease, the deeper layers became
■ thicker and thrown into the appearance of folds by the
.papillae growing beneath, and in the diseased part these
.processes became longer and entered into the tissues beneath,
and masses of epithelial cells were to be discovered in the
vaginal wall. The tissues adjacent to the proliferating
epithelium were infiltrated with nuclei and small cells.
The superficial and horny layers of the epithelium were
i i etained almost to what appeared to be the ulcerating
part; there they became thinner and thinner and ceased
altogether. The scraping? from the older portions of
the growth consisted largely of fibrous tissue, with what
. appeared to be muscular fibre cells in bundles, which formed
small irregular meshes or alveoli, containing abundant
nucleated small cells often presenting a granular character.
In some places well-defined spaces were seen filled with
nucleated cells, variously shaped, but apparently epithelial
in character. Sections of these Bpaces presented various
forms; sometimes long string-like collections of cells were
seen running from them, showing apparently that these
were sections of altered epithelial cords which had grown
into the stroma around.

Case 7. —This patient was forty-one years of age, married,
and had had three children and one abortion. She began to
menstruate at thirteen, was regular every four weeks, the Wow
lasting four days, in moderate quantity, and before marriage
being accompanied by pain. She was married at twenty-
seven. Her first labour was severe; it lasted sixty hours,
and was finally terminated by forceps. She had a flooding
ten days afterwards. She kept her bed for a month, ana
had a bad getting up. She has had leucorrhcea for three
months after the periods. Four days ago she had a flooding.
There is no history of tumours or cancer in her family.

On examination the vagina was found to contain much
purulent discharge. The cervix was red, angry-looking,
and ulcerated. There was no swelling or induration around
the uterus. The sound was passed for a distance of three
inches. The cervix was amputated above the insertion of
the vagina. The piece removed weighed 3oz. ldr. It was of
a conical shape, and measured two inches and a half from
apex to base. The base measured an inch and a half from
before backwards, and two inches and a half from side to
aide. On the lips was a kidney-shaped ulcer, the part corre¬
sponding to the pelvis of the kidney being on the anterior
lip, which was less affected than the posterior. On the pos¬
terior lip the ulcer was an inch in depth, and it split the
lip in its whole length into two layers. On the anterior lip
the disease burrowed in its substance from the left to the
right, and had the parts been left untouched it is probable
that the anterior lip would have been split in the same
manner as the posterior. In some places the edges of the
ulcer were everted; in others they sloped somewhat abruptly
.towards the healthy surface. The margin for about one-
rixth of an inch felt slightly-raised • the floor was irregular.
The external os was near the centre of tho diseased mass,
-dose- to the part corresponding to the pelvis of the kidney.
St .was a slit-like opening. The most mtterisive destruction
«f tissue had taken place in the posterior lip. The disease
Was everywhere surrounded by what BSpnied to be healthy
tissue. On slitting up the carvix, the ittocous membrane of
the canal was injects, bub did not appear to be diseased.

Tfce amputation seemed to have been made through normal
tissue. Temperature 100 c to 101°F.

On examining the specimen microscopically the squamous
epithelium on the apparently healthy surface Was found
irregularly thickened and the papilla? enlarged. Close to the
diseased part there was a very marked thickening of its
deeper strata, and small papilla? penetrated into it. Between
this thickened part and the edge of the ulcer the surface
epithelium was extremely thin, and at one point it appeared
to have been entirely lost. This narrow space was occupied,
not by indifferent tissue, but by cervical tissues somewhat
altered by the presence of small cells in its substance;
beyond this, again, were large strings of epithelium, and
between these strings cords of cervical tissue or papilla ran.
Some of these cords or papilla ran right to the surface,
having their points bare and not covered by epithelium;
tbe points of others were covered by a thick layer of
cancerous epithelium, the papilla not having yet penetrated
through it; they were bounded on each side by a similar
cancerous cord. This clearly shows the mode of growth in
this case. There is no indifferent tissue. Tbe cancerous cords
are formed by tbe ingrowth of the surface epitbeljum. Papillre
often break through this proliferating epithelium, and this
gives rise in sections to the apparent want of continuity of
the surface epithelium with the diseased epithelium. The
disease was everywhere superficial, being not more than a
quarter of an inch in depth at any point; but the whole of
the excavation was lined by such a layer. Tbe new growth
appeared to have ulcerated almost as soon as it was formed.
The mucous membrane of the cervix was healthy, except at
one part close to the disease, wlierejthe columnar epithelium
had grown into several layers. On its surface were many
papilla?, with an erosion presenting large branching papil-
liferous glands. Between the glands aad the cancer there
was a distinct layer of healthy tissue. The growth waa
independent of the glands, although in many places it
assumed a form having a central lumen, which suggested
a glandular origin. The disease evidently began on the
surface, and then took a very unusual course for equamoua
epithelioma by burrowing into the substance of the
cervix and then running m a circle more or lees in the
substance of its wall, dividing the wall into two annular
layers.

I have seen but one other case which presented conditions
of cervix similar to this. In that case the cervix was split
completely intg two circular layers. The vaginal surface
of the outer layer appeared healthy to the finger. In the
course of a few days the inner layer fell off completely,
leaving a great conical ulcer in the place of the cervical
canal. No specimen was obtained in this instance for-
microscopic examination, and I am unable to state the exact
nature of the cancer.

Case 8. -The patient in this case, who was thirty-five
years of age, was admitted into University College Hospital
in June, 1880, under the care of Dr. Graily Hewitt. She had
been married sixteen ye{irs, had had nine children, but no
miscarriages. The last child was horn ten months previoasly
to admission, after an easy labour. The patient had had &
leucorrhoeal discharge during her last pregnancy, and for
the last two months she had had a bloody discharge from,
the vagina. She dated her illness from the first appearance
of the catamenia since her confinement, eight weeas before.
Tbe flow lasted three hours, was normal, and without pain.
After this she passed a clot of light colour, and subsequently
larger and darker ones. The bleeding continued for four
weeks, and she kept her bed and applied ice. Tbe bleeding
stopped for a fortnight, and during this time she bad ie
white discharge; then flooding returned, but lasted only
twenty-four hours; it returned again, and had continued
since. She was getting weaker, but bad no pain. She began
to menstruate in her eighteenth or nineteenth year, and was
regular until eight weeks before admission. Her periods
were normal in every respect, and were almost quite free
from pain. The mother aied in an asylum, and the father
of dropsy ; brother and sisters are healthy.

Tbe patient looked healthy; she was not &na?mie, bat was
somewhat sallow. She had lost some flesh. On vaginal
examination a tumour the size of a turkey’s egg was felt
projecting from the cervix; it was of tbe shape of a mush¬
room, and was everywhere hard, firm, and smooth. It grew
from tbe right commissure and anterior lip. Tbe sound
could be introduced in the normal direction to tbe normal
distance. The tumour, together with * portion of tbe
anterior lip, was removed with the dcraaeur. It measured

DR. J. WILLIAMS UN CANCER OP THE UTERUS.

[Jan. 8.1887. 61

two indies by one inch. When cut through it was found
that its surface was decidedly softer than its central part,
which cat like a fibroid. On microscopic examination the
growth proved to be a fibroid polypus or a hypertrophy of
the lip of the cervix, for it was covered on one side by
aqaamoas epithelium, and its surface was the seat of a
■nperftcial epithelioma of a typically squamous character.
The flat epithelium was retained, and great processes were
at from it into the substance of the tumour, but they did
aot penetrate deeply.- They formed strings and groups of
oncer cells and nests, many cells among them being horny.

On looking through these cases, we find that cancer may
bogin at any poiat of the vaginal portion, from the os uteri
to the vaginal vault. It may begin at more than one point—
at several spots close together, as in the first case; or it may
originate at the external orifice, as in the second and third
cases ; or it may commence on the surface of a polypus
growing from the lip; it may begin, in fact, on any point of
cervix covered with stratified epithelium. The forms
which it assumes in its early stages are few. Ruge and
▼dt state that cancer of the portio forms nodules, but
flto eases they describe in which the disease took this
fcSwa are instances of cancer developed from connective
fiaanet and if they are correct as to its mode of development
wo most class the disease as sarcoma. Of the eight specimens
I have seen, three had no special form; there was some
asla rgcment of the lips only. In one the disease was
p a pill a r y, and it was possibly the beginning of a cauliflower
excrescence. True cauliflower excrescence is, I believe, rare,
XUd is a squamous epithelioma growing from the portio.
Chna xre met with not infrequently presenting growths not
alike the head of a cauliflower, but they are wi'hout a
riafk, and they present a firm solid structure after removal,
toUle a cauliflower growth is a soft spongy mass which
■oBapses after removal, and has the cervix for a peduncle.
I have only met in practice with one instance of true
dtodiflower excrescence, and that was twelve or thirteen years
and the specimen was not examined microscopically.
Jjfiabagh the kindness of Dr. Godson, however, I have had
■to o pportunity of examining this disease in a specimen
ritoen he had removed with the ^craseur, with the best
Writs. About half to three-quarters of an inch of healthy
tltlae of the portfo wa9 removed together with the disease,
fha excrescence appeared to grow From the lip around the
oa atari, was about an inch in diameter at the base when
kwdened in spirit, and to be altogether of the size of a small
Wnlaiil. It appeared almost like a mass of tangled thread,
atoA was entirely villous and soft. Microscopical!y it proved
a squamous epithelioma growing apparently from the
■Efface covered by transitional epithelium. One of the

Warfare covered by transitional epithelium. One of the
cases presented a red, tubercular surface, and one an
Wfawan surface having a granular appearance. It should be
Stosin mind that a portio having a thin layer of cancer on
ItoMKface may be perfectly smooth and look fairly healthy,
friMB Mtlug perhaps only a little lividity. In no instance
ova 1 seen the disease start from a tear, nor is there any
WrMwxce that a laceration plays any part whatever in the
•Holqgy of the form of cancer we have been discussing.

;Ths next point for consideration is the direction of the
Ofrwth of the disease. Does it grow deeply and involve
ok uterine tissues, or does it extend superficially, and, if
flatter, in what direction? In all the cases—six in
—in which the depth of the growth conld be ascer-
the disease was found to be superficial, from a
to a third of an inch in thickness only, with one
in which it was three-quarters of an inch in
at its deepe st part; in this instance, however,
a was inverted and the cervix outside the vulva
id, and the incroftsed thlokneng was probably due
todemn and swelling caused by the displacement.
Xs at a later stage, when the disease has destroyed
Ufafiuto and invaded the cellular tissue, deeper parts are
H0, hot even at a late stage it may remain superficial
»«WI>erid d, aa in the case in which almost the whole
‘ lal surface was imolved in the disease without
thickening. Later the cellular tissue in the
:s, and perhaps the sacro-uterine ligaments,
ed in the disease, but in none of my cages
Httm aff^cte !.

which the growth takes is another important
ect, of treatment especially. In none of the
cervical canal involved, so far as conld be
n two of the eight cases this point conld
- iD Xt'jW c anal was healthy, so that

the lines of the growth are not towards the cavity of the
uterus, but outwards and downwards towards the vagina.
It creeps towards the vaginal vault and then down along the
surface of the vaginal walls. Various stages of its progress
in this direction are shown by the cases given. In the first it
is just beginning at several points; in the second it is grow¬
ing from the os externum along the posterior lip towards the
vagina; the third shows it more advanced in the same direc¬
tion ; in the fourth it has advanced to the vaginal vault, as
shown by the thickening in that situation; in the fifth it
has involved the upper part of the anterior wall of the vagina,
and in the sixth it has invaded both walls for the greater
part; so that the tendency of cancer of the portio—which is
a squamous epithelioma—is to affect the parts superficially,
and to spread on to the vagina and downwards aloDg the
walls of that tube. Whether it affects the anterior or the
posterior lip most frequently I do not know, and my cases
throw no light upon this point. When it grows like a
cauliflower it is superficial, and enters but for a short depth
into the cervix, as is shown by the cases which have re¬
covered after removal of the growth by the dcraseur, which
removes, as a rule, a very superficial portion of the cervix.

There is among these cases one which has run a course
differing entirely from that of all the others. I mean the
seventh case. In this instance the disease appears to have
commenced on the vaginal surface of the portio midway
between the external orifice and the vaginal vault, and to
have bored its way into the substance of the cervix,
ulcerating as it grew until it had entered into the cervical
wall to a depth of about one inch. It presented no tendency
to spread superficially, nor to affect the tissues extensively,
for the depth of the diseased tissue at any point was not
more than a quarter of an inch.

In most of these cases the disease was in too early a stage
for us to expect secondary deposits, and in none of them
were any discovered; but in the sixth case, in which
most of the vagina was affected, such deposits might have
been looked for with the expectation of finding them. None,
however, were discovered except some thickening in the
broad ligament; the uterus was still movable, and the
obturator gland and the glands in the groin were unaffected.
I have seen two other cases in which the disease had spread
down the vagina, but no specimens were obtained for>
microscopic examination, and therefore I cannot speak
positively of their histological structure, although I suspect
them to have been cases of squamous epithelioma of the
portio. In one of these the glands in the groin were enlarged.
The structure of the cancer in all the cases was squamous
epithelioma. I have seeu no other form commencing in the
portio vaginalis, although I have seen it invaded by other
forms. My cases are so few that it is but little use to
discuss them further, but I must make one or two observa-.
tions upon the etiology of this form of cancer. We find the
earliest subject of it was thirty years of age, and the oldest
sixty-seven; in two it appeared long after the menopause;
while the remaining six were between thirty and forty-
seven years of age: so that this form of cancer appears,
much more frequently during menstrual life than after the
: menopause.

All the patients were married except one, who was a
widow. It does not seem clear that, child-bearing has much
to do with the disease, for one had had one child and one
abortion, two Jtad had two children and one abortion, one ■
had had three and one abortion, one had had four, two had
had seven, and one nine. Here we have five women with
less than the average number of children, and three with
more. Again, among all the labours none appeared to have
been very bad; one or two were described as lingering and
severe, but none were instrumental. In one case only was
a hereditary tendency traced, a sister having died of the
disease.

The previous history of. the patients gives no clue to the
cause of the disease. Menstruation begins early and late—
at eleven and twelve, and eighteen and nineteen; and it may
be regular, painless, and normal in every respect; so that,
as far as these cases show, early or late development makes
no difference, nor many or few children.

The symptoms are few during the early stages. Haemor¬
rhage appears to have been an early, perhaps the first,
symptom in four, after coitus in one, independently of it in
three. Discharges, white and yellow, are so common in
Women as to be unreliable as a symptom of cancer. There
was one case in which htemorrhage was present, but it may
have been caused by the polypus present, and not by the

62 ' Tub Lancet,] DR. J. L. DOWN: MENTAL AFFECTIONS OF CHILDHOOD AND YOUTH. [Jan. 8,1887.

cancer, though against such a view is the fact that the
polypus must have existed for some time before the bleeding
appeared, and it is not improbable that it began soon after
the commencement of the cancerous change on the surface
of the polypus.

A white or yellow discharge was present in every case in
a greater or less degree, with one exception: it had been
present long before any evidence of the disease existed in
some. It appeared before or at the same time as the
bleeding in four, and it was offensive at a very early stage
in two. It Was absent throughout in one, even when
almost the whole of the vagina was diseased. Fetid dis¬
charge is generally regarded as a sign of a late stage of
cancer, and as depending upon sloughing and breaking
down of the new growth. It may, however, be present
during the earliest stages, and be quite independent of
sloughing of the tissues. The fetor under these circum¬
stances is perhaps due to slight haemorrhage retained in the
vagina, and undergoing decomposition and then appearing
asfetid discharges.

There were few bladder symptoms of note. One had had
slight scalding for many years, which she attributed to rheu¬
matism ; and one had had slight difficulty of micturition for
many years, when the urine had been retained long, which
may have been due to the disease, for the disease had pro¬
bably existed for many years. Of the exact duration of this
form little or nothing is known. The patient in one of the
cases died twolve months after an operation for the removal
of the disease, and the disease had existed for four months
at least before the operation was undertaken ; in one almost
the whole of the vagina was cancerous when first seen two
years and a half ago, and she was still living and in
much the same condition last summer. The disease had
existed in this instance probably for many years.

ABSTRACT OF THE

ftitsorahm Statures

OX SOME OF THE

MENTAL AFFECTIONS OF CHILDHOOD
AND YOUTH.

By J. LANGDON DOWN, M.D. Loro., F.R.C.S.

LECTURE I.

Paucity of Early Literature. —There is not much to be
found on this subject in the early records of medicine. The
earliest attempts at the education of idiots were made in
France by M. Sdguin at the Bicetre. A school was
established in 1842 at Abend berg, Switzerland, by Dr.
Guggenbiihl; but great neglect prevailed there, and the
Commune had to intervene on behalf of the wretched
children. M. Sfegert, at Berlin, had not only been engaged
in the education of deaf-mutes, but had extended his
efforts on behalf of mutism from mental disease. In 1846
Germany established a special school at Leipzig; Mrs.
Plumbe, Dr. Conolly, and Dr. Andrew Reed in England
secured attention to the subject; whilst the claims of the
feeble-minded children in the United States were brought
to a practical issue by the enterprise of the late Dr. Wilbur.
A school was instituted at Bath, and others in 1848 at
Highgate and Colchester. Earlswood was built in 1858, and
Dr. Langdon Down undertook the superintendence of this
institution.

Terminology.— The term “idiot” was always avoided by
parents and medical men. Idiot means “solitary,” but a
typical idiot who led a purely vegetative existence was
scarcely ever met with except in anencephalous monsters.
Imbeciles were usually regarded os less grave cases than
idiots. There is, however, no definite limitation between
so-called idiocy and so-called imbecility. Feeble-minded
was the best term to use.

Classification of Feeble-minded. —There is a resemblance
between feeble-minded children and the various ethnic
types of the human family. The Negroid have character¬
istic malar bones, prominent eyes, puffy lips and retreating

chins, woolly hair, but not black; no pigmentation of skin.
The Malay variety have soft black curly hair, prominent;
upper jaws, and capacious mouths. The North American
Indian type have shortened foreheads, prominent cheeks,
deep-set eyes, and slightly apish nose. The Mongolian type is
largely represented. Their characteristics are very marked.
The hair is brownish, straight, and sparse; face flat and.
broad, without prominences; cheeks rounded and widened
laterally; eyes obliquely placed, and internal canthi too far
apart; palpebral fissure very narrow; forehead wrinkled
transversely; lips large and thick, with transverse fissures ;
tongue long and thick and very rugous;. nose small; skin
tawny and somewhat inelastic.

Causation. —Accidental causation by malpraxis, by falls
and blows, or opiates was possible, but the beiDg able to
refer a child to an ethnic type other than Caucasian pre¬
cluded such a possibility. The congenital and accidental
cases are well-defined from one another. But a develop¬
mental group must be recognised. Children may become
feeble-minded, especially at the crisis of first or second
dentition and puberty. The speech may be deferred or lost,
and epilepsy may appear. The mind may cease altogether
to develop. Those that break down at puberty usually have
characteristic crania; they are dolichocephalic and prow-
shaped anteriorly, the line corresponding to the medio-frontal
suture being a prominent ridge. In these cases there may
have been intra-uterine arrest of development of the medio—
frontal Bynostosis; and the same cause may h*ave also
arrested the development of the cerebral centres. Over¬
excitement in babyhood and “ over-pressure ” at schools at
the second dentition and puberty may be the cause of mental
break-down. But, forewarned by the characteristic cranium,
catastrophes may be averted. A large number of boys and.
girls come under Dr. Langdon Down’s notice who are not
feeble-minded, but who have the prow-6haped forehead.
These are of unstable mental equilibrium. Severe frontal
headache, wayward petulance, and incapacity for sustained
mental, work are some symptoms frequently noted. These
children should not perform any serious intellectual work
during the important developmental periods. “ I never
knew a child stammer before the commencement of the
second dentition,” wrote Dr. C. West, and the lecturer con¬
firmed this statement. Dr. Down also said that he had
never met with a case of stammering at that period, which
did not bear evidence of its neurotic origin, which could be
traced back to a period anterior to birth.

The Accidental Type.— Traumatic lesions, medications and
inflammatory diseases may cause feeble-mindedness, even in
children born, or ready to be bom, with all the potentiality
of intelligence. In these coses there is an absence of any of
the physical aspects of feeble-mindedness. They may be
bright in expression, active in movement, mobile in tem¬
perament, fearless of danger, persevering in mischief, and
petulant. But their language is one of gesture only.
Living in a world of their own, they are indifferent
to ordinary changes, and yield only to the counter-fascina¬
tion of music. Mothers and doctors often entertain the
strongest hope of these cases, but prognoses based on
the mobility and agility will prove utterly fallacious.
There may be no outward sign of mental vacuity.
They are cases with a vast amount of surplus nervous
energy. Much may be done by training. The energy’ may
be directed into better channels. The improvement, how¬
ever, will be smaller than may be obtained from children
with less promising looks. Far more improvement is to be
obtained from an ill-developed than from a damaged brain.
Griesinger describes the apathetic and the excited varieties
of idiots. Some of his latter class doubtless correspond
to Dr. Down’s accidental type.

The Congenital Type group is a large one. The members
of it are less interesting in appearance, but more amenable
to treatment, than those of the preceding groups. Many
years ago Dr. Down gave great attention to the physical
aspects of idiocy, and contributed a paper to The Lancet
on a cause etthbre. Dr. Down insists on the small size of the
head. Dolichocephaly rather than brachycephaly is the rule.
It may be scaphocepbalic, the line of the sagittal suture
being raised into a “keel.” Rapid shelving from the vertex
posteriorly is common, corresponding to arrest of the pos¬
terior cerebral lobes. Not unfrequently the cranium is
extremely small,"reverting to the Aztec type. Even these
cases are sometimes susceptible of some amount of education.

Macrocephalic Crania may be due to hydrocephalus .or to
an increase of the neuroglia of the cerebral mass. The

oogle

ME. F. TREVES: A SIXTEENTH CENTURY AMPUTATION.

[Jan. 8, J 887. 6S

£“®j** 0 '** pare in noma of the heavy brains is pale, and the
' wwi 'waight appears to be due to increase of the white
wnSrn c e , especially of its connective tissue.

Asymmetry of the cranium was a notable deformation.
Tlwe aay be increase of the facial development in contrast
vidi tire cranial, the ears being planted relatively farther
takthsa usual. At the inner canthi the skin often forms
MOhnax folds —epicanthic folds. These are more frequent
m the feeble-minded. The importance of the physical
Wonnity of the palate was now generally admitted. High
Y-tireped palates were taken exception to, however, in some
waters. The front teeth may not be on the same plane as
uamolars. Dr. Down did not contend that all the feeble-
' toahjfl had high-arched palates, bat that a large proportion
ot those of intra-uterine origin had this physical deformity.
Tfct feeble-minded have a tendency to become stout. Sensa¬
tion, both common and special, is often blunted and obtuse.
Congenital cataract is commonly associated with congenital
i 1mm mindedneaa, as also are strabismus, nystagmus, myopia
ad hy p en netropia, weakness of muscular system, automatic
rhythmics 1 movements, lateness in learning to walk, im-
prehension with the upper extremities, postponed
or abmnt speech, obtuse-angled jaw, large ill-controlled
, and defective hearing.

A SIXTEENTH CENTURY AMPUTATION.
By FREDERICK TREVES, F.R.C.S.,

sracsox TO, ARD LECTURER OR AWATOMY AT, THE LORHOR
HOSPITAL.

Tira present taste for revivals has not extended to the
re-introduction of ancient surgical procedures. It is im¬
probable that we shall return to the “ button” for arresting
haaanrrhage, or to the falciform knife for excising breasts,
or to the chisel and mallet for “ dismembering ” toes. There
is Stole doubt, moreover, that we have seen the last of the
stttObSag quill, the phlegme, the terebellum, and the buccas
F*P«- It is only by the occurrence of some such remarkable
in ci dent as is here recorded that it is possible to have any
Ccapital experience of the surgery of the past. The ampu¬
tation performed in the present instance resembled in all
«resretial points the operation as it was carried out in the
fSBcabethan period. For the opportunity of seeing the
patient I am indebted to the kindness of Dr. Boyter Johnson,
of Jfarthumberland-avenue.

A photographer, aged thirty-five, carrying on business
to ijtralin, having amassed a fair competency, resolved to
tabs n long holiday. He had no children, and he and his
wife determined to start for England in a sailing ship.
Be left Australia in May, 1886. On June 11th the ship
was off Oepe Horn, and was being driven before a furious
■tie.- Before the storm subsided one of the crew had
mm kilted and the captain and first mate injured. One
renewapt the docks while the photographer was stand-
tow amidships. He was thrown violently over the sky-
tipak - wad carried into the mizen rigging. When the
wwtoB left the ship the man found himself suspended by
thw wtin» and evidently much injured. After he had been
atiWtd to the deck, it was found that there was a com¬
peared fracture of the left forearm. The limb had been
crashed, and a large part of the skin torn away so
the Undone bare. The damage did not extend
elbow. Tharewas but slight bleeding. The ship
anrgeon, and the treatment was undertaken by
mate, who had no knowledge of surgery other
diets ted by common sense. The forearm was
to a board, and the wounds Covered with wet
medicine sheet contained some laudanum, but
appeared to have gone out of it, for it in no way
Ike acute paint- Foot days after the accident the
“ fo r earm were gangrenous, and the gangrene was
» The patient bad Wiffered intensely, and had bad
saosaltatiow'drtofcekl between the patient, the
~ the eeoowd mite, and it was decided that an
to patterned. None of them had ever
‘ mffaeUsii ■ point that was probably
f. iltetatowreasived that'the amphta*
do i g te dhe arm at the Junctiod
tower third* >,-She reasons were these:

The gangrene had not reached the elbow, and it was
considered wise to cut well above the mortified
parts. (This decision was certainly in advance of th
surgery of the sixteenth century.) In the second place,
the brachial artery could be felt beating most easily
at the place named, and it was deemed well to keep a
careful eye upon the vessel when the amputation was
carried out. Tne patient came up on the deck, which at
the time was covered with snow, and took his seat upon a
pile of sails. The instruments were provided by the car¬
penter, and consisted of a shoe knife, a saw, and a sail
needle. The patient’s wife furnished a sewing needle and
some silk. A cord was bound tightly round the limb above
the operation line. The operal ion was commenced by the
carpenter, but his courage soon failed, and he handed the
knife to the second mate, who performed the amputation
with considerable skill and nerve. A circular incision was
made through the skin with the shoe knife. The site of the
pulsating artery had been previously noted, and the cut was
cautiously deepened until the vessel was exposed. It was
isolated by the sail needle, and secured in its continuity by a
thread ligature. Afterit had been firmly tied the vessel was cut.
It is probable that the ligature included the veins and the
nerve. The incision was then cautiously deepened around
the other parts of the limb, and a careful search made for
vessels or equal magnitude that could be secured in the
same way. None were found, and it is to the credit of the
operator that he did not mistake the ulnar nerve for a blood¬
vessel. The muscles were now divided down to the bone
by the same circular cut. The biceps retracted more than
the triceps of course, and the mate removed an inch
or so of the latter muscle to make the section even.
The divided soft parts were protected and retracted by
strips of linen, ana the bone was then sawn through

by the carpenter. After the ligature was removed from the
limb there appears to have beeu but little bleeding. The
mate rounded off the end of the bone with the shoe knife so
as to make it as smooth as possible. Finally, four vertical
cuts were made in the stump so that the edges of the
divided skin Bhould meet over the bone in a point. All
parts of the wound were now brought together with
sutures, a sewing needle and the silk provided by the
patient’s wife beiDg used for the purpose. The stump was
further supported by some plaster that waft found iu the
medicine chest. The operation was completed in the some¬
what unusual time oi one hour and forty-five minutes.
Amputations of the arm have been performed in lees time
than this, bat the procedure can seldom have been carried
out with greater ingenuity and courage. As for the patient,
it is scarcely possible to speak in too nigh terms of admira¬
tion of his splendid pluck and marvellous powers of
endurance. The records of surgery can provide few more
remarkable pictures than this: a ship on the high seas, and
on the snow-covered deck a photographer, seated on a pile
of sails, critically supervising the amputation of his arm by
a ship’s mate and a carpenter.

The patient’s recovery was slow. The stump was kept
covered with muslin bags filled with snow. For eight days
following the operation he had little or no sleep. Many of
the stitches gave way and suppuration followed. The parts
were kept scrupulously clean. In time the wound healed by
■granulation, and the patient began to regain his strength.
When I saw him early in September be was in excellent
health. The stump was well and firmly healed, and was
devoid of pain. A side view of the stump is shown in
Fig. b, and: a rough drawing of iu extremity in Fig. A. (The
two are not drawn to -the same scale.) It will be seen that
Ct had no tendency to assume a conical outline. The bone
Was well oovered, and the chief peculiarity of the fcart was
given it by the deep furrows left by the four vertical

64 Thi Lab.obt,J

DR. D. DRUMMOND ON CEREBRAL LE8ION8.

[Jaw. 8, 1887.

incisions. Apart from its unusual aspect, it was an admir¬
able stump, and reflected great credit upon the operator.
The patient, a rigorous and most intelligent man, showed
no other traces of his terrible holiday.

The following is the account of amputation as given by
Master Clowes in his “ Profitable and Necessarie Booke of
Observations,” published in 1596:—“You shall haue in
readiness a good strong and steady fourme, and set the
patient at the very end of it; then shall there bestride the
fourme behind, a man that is able to holde him, or hir fast, by
both the armes; which done, if the leg must be taken off
beneath the knee, let there be also appointed another strong
man to bestride the leg, that is to be cut off, and he must
hold the member very fast aboue the place where the
incision is to be made, and very steadily, without shaking,
drawing up the skin and muscles; and he that doth so hold
should haue a large strong hand, whereby he may the better
stay the bleeding, in the place and steede of a straight band
or ligature, which band indeed is also very necessarie, for
by reason of its hard and close binding, it doth so benum
that part, that the paine of the binding doth greatly obscure
the sence and feeling of the incision; and the foresaid band is
also a good direction for him that doth cut off the member;
but yet in some bodies, it will not be amisse to admit bleeding
according to discretion, specially in such bodies as are of hot
complexions, and do abound in blood, and 1 have often
seen, by the skillfulnes of the holder, there hath not been
lost at a time fower ounces of blood; for in weake bodies it
is not good to loose much blood; for blood is said to be the
treasure of life. In like manner, there must be chosen
another skilful man, that hath good experience in holding
the leg below. And he that is the master or surgeon, which
doth cut off the member, must be sure he haue a sharpe
sawe, also a very good catlin, and an incision knife, and then
boldly, with a steddy and quicke hand, cut the flesh round
about to the bones, without staying, being sure the
periosteum, or panicle that covereth and compasseth the
bones be also incised and cut. All this being orderly per¬
formed, then set your sawe as neere unto the sound flesh as
well you may, and so cut asunder the bonep, which done,
Ambrose Pard, a man of great knowledge and experience in
cbirurgie, willeth, presently after the bones are cut asunder,
that you then draw the sides of the wound together, with
fower stitches, that are deepe in the flesh, and made cross¬
wise over the member, like unto the letter X, for, saith he,
you may easily draw the portions of the skin and their
divided muscles, which before the section were drawne
upward, ouer the bones, and couer them close on euery side,
that they may take the less aire, and the wound sooner con-
glutinate.” To arrest the bleeding Clowes used a certain
“ restrictive.” Later “ buttons ” were more generally used.
It was about 1560 that Ambrose Pard urged the use of the
ligature to cut or wounded bloodvessels, but more than a
century elapsed before the practice came into general use.

In the “Marrow of Chirurgery,” published at the com¬
mencement of the seventeenth century by “ James Cooke,
lover of Pbyaick and Chirurgery,” the following observa¬
tion appears: “The third [mode of arresting bleeding] is
stitching, which is troublesome and dangerous, on which
the vessels are to be taken up and after bound, above the
place amputated.” This method was employed in the
present instance. The curved shoe knife is probably the
nearest modem representative of the falciform dismembering
knife used in the sixteenth, seventeenth, and eighteenth
centuries, and for which great antiquity can be claimed.
The first flap operation appears to have been performed by
Lowdham of Exeter, and an account of it to have been
given in 1679.

In the present case the clear intelligence and shrewd sense
of these inexperienced operators placed them far in advance
of the primitive practitioners of surgery, and the excellent
result obtained is not a flattering criticism upon the
niceties of modem handicraft.

Wlmpole-Btreet, Cavendiah-«qu*re, W.

Ilk ley Hospital.— A sum of ^£1000, which, under
the will of the late Mr. Thomas Emsley of Burley was left
to the Ilkley Convalescent Hospital, and was paid over
under a misapprehension by the executors of the deceased
to the Bradford Corporation as trustees of the Semon
Convalescent Home at Ilkley, has been paid over by the
Bradford Corporation to the trustees of the Ilkley Bath
Charity Hospital, it having been satisfactorily ascertained
that the legacy was intended for the le^cr institution.

CLINICAL AND PATHOLOGICAL ILLUS¬
TRATIONS OF CEREBRAL LESIONS.

By DAVID DRUMMOND, M.D.,

PHYSICIAH AXD PATHOLOGIST TO THE SEWCASTLB-ON-TTKE Ilfl SVlH V-
(Concludtd from page IS.)

Case 6. Cerebral Tumour complicated by Brights Disease
of the Kidneys ; Difficult Question of Diagnosis. —In Sep¬
tember, 1883, a labourer, aged forty-two, was admitted into
the Newcastle Infirmary complaining of severe headache,
marked prostration, and loss of memory, of about six weeks’
duration. His manner was exceedingly stupid and heavy*
and it wa9 with great difficulty that any history could be
procured of his case. The urine was diminished in quantity,
and was highly albuminous. In a few days the headache
became greatly intensified, and delirium was added to his
other nervous symptoms, which, from the obvious kidney
mischief and total absence of all localising cerebral symptoms,
were believed to be of uraemic origin. The delirium was
occasionally of the mo9t boisterous character, and it was
with great difficulty he was kept in bed. Bv degrees the
flow of urine increased, and pari passu the headache and
delirium subsided. He left the hospital very much improved',
but with the urine still albuminous. On Nov. 6th, 1884, he
again presented himself for admission. Now, as before, be
was complaining of pain in the head and weakness; his
mental state was much obscured, so that he was unable to
give a clear account of himself, and, with the addition of
some emaciation, his symptoms resembled closely his con¬
dition when he first came under observation fifteen months
previously. There was no dropsy. The urine contained a
large quantity of albumeD, but no casts, and, as he voided it
in bed, it was impossible to compute the quantity passed in
twenty-four hours. There was no optic neuritis, or other
material alteration of the fundus oculi. There was an entire
absence of paralysis, and vomiting did not form a feature of
the case. The headache, which was general, continued, and
the mental hebetude gradually deepened. He died in a
fortnight from the date of his second admission.

At the necropsy, the kidneys were found to be striking
examples of the so-called large pale form of Bright's disease.
They weighed from 13 oz. to 14 oz. each. There was no
evidence of lardaceous degeneration. The microscopic
examination made subsequently of pieces hardened bore out
the post-mortem-room diagnosis. The heart wa9 not hyper¬
trophied. The brain was soft and cedematous. At the
anterior extremity of the right frontal lobe there was &
gummatous tumour the size of a large fig, which was
incorporated with the dura mater on the one hand and with
the brain substance on the other.

In this case the symptoms of gross cerebral disease were
masked by the kidney condition, for granular kidney was
suspected, with a considerable show of reason. It may be
said that the severity and persistency of the headache should
have pointed to some cerebral affection implicating the
membranes, but I have met with pure kidney cases with
just as violent and obstinate a headache as in the present
case. It is interesting and instructive to notice the absence
of retinal changes and vomiting. I may add that I have
failed in several cases of tumour of the frontal lobes to elicit
a history of vomiting.

Case 7. Hemiplegic Ilypercestkesia. — The patient was a
remarkably well-preserved and intelligent old lady, aged
seventy-five. She had led an active life, and, until quite
recently, had been extensively engaged in literary work.
Dyspepsia had been her only ailment until the occurrence of
the attack I am about to describe. Twelve weeks before I
saw her she was suddenly seized, while standing in her
room, with numbness and a sense of weakness in the right
arm, leg, and face, which rendered walking to the sofa
a matter of great difficulty. Next day the right side was
distinctly affected, especially the arm, which was numb and
feeble. This condition remained for a day or two unchanged,
when the feeling of numbness became aggravated, and was
accompanied by an intense prickling sensation, with great
tenderness. The hypersesthesia affected the hand and foot
particularly, but also the whole of the right side more or
less, and continued unaltered for nearly three weeks, when
it subsided to a considerable extent. With the diminished

Digitized by GOOgle

An Uran,]

DR. D. DRUMMOND ON CEREBRAL LESIONS.

[Jan. 8,1887. 65

SR

. there mi a decided improvement in the motor
ES?! 8 *** to that riie could walk about and write a little.
rMi improvement was only temporary, however, for, five
iMu before she came under my notice, the hypenesthesia
aari prickling returned, and with it a slight renewal of the
m&or paralysis. 1 found her a lively and very intelli-

C old lady. As she lay in bed she kept the right
on the top of the bedclothes, and exercised a watch-
Mbfaperrision lest anything should come in contact
^■r it. The speech appeared to be slightly thick and
aaaal, though Dr. T. W. Barron, her medical attendant,
with whom I saw the case, and her friends, assured me that
then was no real impairment. The forearm and the fingers
men somewhat flexed, and the latter, with the dorsum of
the hand, were distinctly swollen. A marked feeling of
- with tenderness and prickling in the arm, face, and
lag was complained of. The slightest touch ou the tips of
the fingers, especially in the distribution of the median
caused great pain, with an exaggeration of the
g. The power of grasping was considerably
i, but it was difficult to test this point accurately
to the hypermsthesia. The cutaneous sensitiveness
mewed to be particularly well marked on the application
Ithermal stimuli. The teeth on the right side, especially
o t the upper jaw, were exceedingly sensitive, whilst the
is and face were somewhat anaesthetic though tender,
i was unimpaired, but everything taken into the mouth
'rough ” on the right side. The urine was normal. The
i was dilated, with an aortic systolic bruit. The knee-
jwfc was considerably diminished on the right side as com¬
m a nd with the left, which was by no means exaggerated,
la apite of the marked hypersesthesia of the sole of the
foot, the plantar reflex was absent. There was no
it loss of power of the right leg.

; it not for the distinct hemiplegic seizure involving
I nerves, the features of this casecould best be explained
W the assumption of an extensive peripheral neuritis, in
w m ch hypersesthesia is often so pronounced a symptom.
Bat the attack was so obviously cerebral that it seems neces-
mry to assume some vascular lesion, probably haemorrhage,
the rituation and modus operandi of which, in the absence
of post-mortem evidence, are matters of pure speculation.

Can 8. Thrombosis of the Basilar Artery of unusual
■nrjjim, — A man aged fifty was lately brought into the
Saweastle Infirmary in an unconscious state by the police,
vhft ascertained that he had suffered for a few days pre-
vigMly from attacks of giddiness, in one of which he had
ftka in the street an hour before his admission. When seen
bffiw house-physician (Dr. Waldy) his breathing was slow
amk laboured, the pupils were contracted, the pulse was slow
(about 60) and irregular, and the left side was paralysed. Very
the limbs on the right side also became affected, so
ere was almost complete paralysis of all four extre-
i and face. He died about three hours after the seizure
ia tbs street. No rise in temperature was observed.

At the necropsy the right vertebral and basilar were seen
tabo filled with firm clot (thrombosed). The arteries form-
Aflm circle of Willis were empty. A small quantity of fluid
emttied the lateral ventricles, and the pons was slightly
Mkr and paler than the remainder of the brain substance.
Uplift vertebral artery was absent, so that the thrombosed
vttttf waa simply the continuation of the right vertebral,
vnpcb was dilated, except at its origin, from the subclavian,
«a annular thickening of atheromatous deposit con-
' f diminished its Calibre. This atheromatous patch
starting-point of the thrombosis, the clot having
I from the subclavian and passed into the basilar,
vessel was entirely free from atheroma; indeed, the
lOry apparatus Wlf normal, except for the absence
vertebral dad the limited patch of atheroma
FihRMnmem cement'Of the right vertebral. The itnpres-
time of the necropsy was that the latter was

as showing how a congenital
on the one hand, and a very
the other, may determine a
llity, had the basilar received
tttr ehyt arising from the patch of
the* basilar.

1 • Death from Meningeal
t aged twenty-nine, was
Jane 3rd, 1886, in an un-
„ L tt«tery was supplied by
iflted that to/was supposed to have been

assaulted by one of the force. The patient was a confirmed
tramp; be frequented a limekiln, in the neighbourhood of
which he had lived for some time on tea and bread supplied
by neighbours. A policeman was accused of striking him
when removing him from the premises, and very soon after
his expulsion he became unconscious. When admitted he
was bleeding from spongy gums. The pupils were dilated
and insensible to light. The skin was covered with petechiro,
and several well-marked brawn-like bruises were noticed
on the legs and feet. From time to time a general con¬
vulsion ensued, whilst in the interval the limbs were rigid
and the arms were moved spasmodically. The respiration
waa stertorous, and the right side of the face was puffed out
with expiration. The Knee-jerk was present, but not
increased. There was almost constant diarrhoea. The
urine was normal. The pulse was rapid aud compressible;
the temperature waaraisea, being about 100°. On the following
day he appeared to recover consciousness slightly, and was
able to sit up in bed, but could not be persuaded to protrude
his tongue. He died twenty hours after his admission.

Necropsy .—Rigor mortis pronounced. The heart weighed
16 oz.; left ventricle hypertrophied, and right dilated ;
tricuspid orifice admitted five fingers. The lungs were
(edematous and congested. Kidneys suggested commencing
sclerosis. Brain : Bone unusually thick; the whole of the
upper surface was covered by a thin layer of coagulated
blood, which appeared to occupy the subarachnoid space.
The clot was best marked over the left hemisphere, where
it was £ in. in thickness in some parts over the parietal lobe.
A considerable quantity of fluid blood was found in each
Sylvian fissure. The blood clot penetrated between the
convolutions, but did not lacerate the brain surface. The
substance was somewhat soft and (Edematous, but waa
otherwise normal. There was no fracture or other evidences
of injury.

Cask 10. Acute non-Tubercular Idiopathic Cerebrospinal

Meningitis in an Adult. —H. M-, aged thirty, a billiard-

marker in a club, was admitted into the infirmary in
a state of semi-unconsciousness, in which condition he
had been found in his bedroom on the morning of
his admission. It was stated that he had been engaged,
as usual, on the previous night in the billiard-room,
having retired to bed about 12 o’clock in his usual
health. As one or two bottles containing patent cough
mixtures were found in his room, it was supposed, when
he was seen by the medical man who sent him to hos¬
pital, that he might possibly be suffering from some form
of narcotic poisoning. On admission the patient was
observed to be exceedingly stupid and drowsy; he could
be roused with difficulty, but was quite unable to respond
to questions. The pupils varied from a state of contraction
to medium dilatation; to light they acted sluggishly, but
responded better to efforts at accommodation. The legs
and arms were occasionally moved voluntarily. There was
no rigidity. The tendon-jerk phenomena were increased in
the arms and legs. On the following day the patient was in
a most extraordinarily fidgety state. He moved his legs about
incessantly, and uttered groans as though he were in pain.
When spoken to loudly, he replied in a sleepy way, stating
that he had pain in his head and legs. lie could now protrude
his tongue, which was dry and brown. The pupils were
dilated and more fixed. The temperature was raised, but never
rose above 101° until the fourth day after his admission,
when pulmonary oedema and congestion developed. On the
third day slight internal eqaint was detected in the right
eye, and commencing double optic neuritis was made out.
A petechial eruption appeared over both knees. Talkative
delirium set in. Next day a copious herpetic eruption made
its appearance in the left side of the mouth, and distiuct
signs of congestion of the right lung were discovered. The
head was now fixed, and the muscles of the back and
extremities were rigid. The right side of the face was
evidently paralysed, though the forehead was frequently
drawn into a frown. The pupils were widely dilated. Pulse
120, compressible; muttering delirium. Next day the patient
became profoundly comatose, and died on the fifth day after
the onset of the attack.

Necropsy. —Brain: The veins on the surface were much
distended. Some pus aud greenish purulent lymph lay
beneath the arachnoid. At the base a considerable quantity
of the same purulent matter covered the pons and medulla,
«nd descended the spinal canal. The same appearances were
found in the 8ylvian fissure and on the surface of the
cerebellum. The lateral ventricles contained some turbid

6 6 The Lancet,J

DR. J. K. SPENDER ON THE TREATMENT OF ACNE.

[Jan. 8 , 1887 .

fluid, and the vessels of the plexus were remarkably con¬
gested, No signs of bone disease or fracture were observed,
nor was there any ear disease or tubercle.

Newrautle-on-Tyne._

SOME POINTS IN THE TREATMENT OF
ACNE, ESPECIALLY OF THE FACE.

By JOHN KENT SPENDER, M.D.Lond.,

PHYSICIAN TO THE MINERAL WATER HOSPITAL, BATH.

If a doctor may strive to rival an artist in idealising the
human face, there are few functions for which he will earn
stronger gratitude than in removing the traces of disfigure¬
ment and deformity. There are, indeed, deformities which
have almost classical tradition to consecrate them; and
there is a native ugliness which may be to some extent
glorified by the powerful lineaments of emotion and
character; but most disfigurements are associated with
pettiness or vulgarity, and there are few consolations for
the unhappy man or woman who has a big red nose or a
heavy crop of pimples on the forehead. Pimples, though
veiled under the elegant Greek of the word “ leichen ”
(X6txi7v), are supposed to denote the glutton or the wine-
bibber, and to be beyond the rhetoric of the most subtle
special pleader: for mstance, if they are red, they are said
to tell the tale of excess; if dotted with black spots, they
proclaim uncleanliness and struma; and if only pale
and insignificant, there is always the dark hint or a bad
constitution in the background. Popular pathology is not
always logical; and it would be difficult to convince some
patients that their Bkin trouble is, after all, a purely local
affair, depending upon inflammation or inaction of the small
cutaneous glands. The purifying action of the skin is an
obscure dogma to the popular understanding; and therefore
people are slow to take in the fact that when Nature is
baffled in her duties by too much wind, or dust, or sun, and
too little soap and water, she takes her revenge by desqua¬
mations and efflorescences, and perhaps more serious things
than these.

Acne (the Greek original means the “ bloom of anything”)
is the term given to a retention of the secretion of the
sebaceous glands of the skin, with secondary inflammation
and deposit in them and in the hair follicles. It is charac¬
terised by red conical or hemispherical elevations or
nodules; some are solid, others are filled with pus; they are
found everywhere except upon the palms and soles, and
affect chiefly the skin of the face, chest, and back; and they
occur mostly in young persons. The disease appears to be
due to the occlusion of the orifice of'the hair follicles or of
the ducts of the sebaceous glands opening into them. The
retained secretion then becomes a source of irritation and
inflammation, and suppuration follows in and around the
hair sac and its appendages . 1 This, expressed in the fewest
words, is the pathologioal anatomy of simple or uncompli¬
cated acne.

■'' Omitting for the sake of brevity and clearness all the
intermediate forms, we may go at once to a type of disease
at the other end of the scale, and speak of the so-called
acne rosacea. This attacks the face and scalp alone, and is
characterised by an intense reddening of the skin, due to an
injection of the bloodvessels, without much swelling or
tension. The serpentine vascular lines, the blood in which
may be momentarily driven out by pressure, are most
abundant on the sides and the bridge of the nose. This is
an obstinate disease, occurring chiefly in advanced age,
though not unknown in youth. However great may be the
hypertrophy of the skin the disease never extends deeper
than the skin, nor does it lead to ulceration . 3 Between the 1
extreme phases of local disease thus delineated there are
countless grades and shades which ought to be recognised;
for they are so many tokens of constitutional power or
inertness, as the case may be.

‘■-My notes of treatment profess, then, to deal only with
niche punctata, acne vulgaris or indurata, and the acne
rosacea, which betrays a grave alteration in the nutritive
•function of the skin. » '

^'ghe object of the practitioner should be to prevent acne

®y denJla,n Sodfty's Lexicon of MeJUogJ and the Allied

punctata from passing on to acne vulgaris by getting rid of
obstruction in the glands and checking the hypenemic
condition; in acne indurata, to lessen hyperiemia and
promote the absorption of inflammatory products; and
in acne rosacea to destroy the new growth of connective
tissue.

The therapeutic points may be expressed thus:—Quiet
dormant acne requires stimulation and a spur to more
healthy action, while those species of acne which are marked
by heat and tension call for soothiDg local measures. In
the one case the medicinal and dietetic plan should be tonic
and supporting; in the other we should advise a combina¬
tion of tonic and aperient remedies and a cooling abstemious
regimen.

In order to promote a healthy action of the sebaceous
glands, and to prevent the formation of what are called
“ comedones,” the following plan should be adopted, as origi¬
nally described by Br. Liveing. The steps of his method are as
follows: (a) Steam the face every night by holding it over
a basin of hot water for a few minutes. ( 6 ) Rub the skin for
five or ten minutes with soap (I prefer terebene soap) and
flannel, or with a soft nail-brush; then sponge off the soap
with warm water, (c) When the face has been dried, a
lotion should be thoroughly applied, composed as follows :
half an ounce of precipitated sulphur, two drachms of
glycerine, one ounce of spirits of wine, with three ounces
each of rose-water and lime-water. This is allowed to dry
on the skin and to remain on all night. In the morning
the face is cleansed with warm oatmeal and water or weak
gruel. If, for any reason, an ointment seems preferable to
a lotion, a combination of precipitated sulphur and vaseline
is very useful. The treatment must be modified or suspended
for two or three nights if the skin becomes sensitive and
somewhat tender. Dr. Liveing contends that the most
common cause of failure is want of perseverance or timidity
on the part of the patient or of the doctor; and that we
ought not to be frightened from continuing efficacious
remedies by a temporary increase in the redness and irrita-
tability of the skin . 3 If, by any chance, this plan be un¬
successful, nothing is so effective as the application of potash
soap in the form of a lotion. The lotion is composed of one
ounce of soft soap, one ounce of rectified spirits of wine, and
seven ounces of rose (or distilled) water. This should be
rubbed in vigorously with a piece of flannel for a short
time, taking care not to make the skin sore. According to-
Dr. Liveing, the worst cases of acne will yield to the soft
soap treatment if practised with necessary caution.

For eight years and more I have followed in its main out¬
lines Dr. Liveing’s plan, and with great success. But the
experience which only actual work brings has led me to
make modifications to suit the various susceptibilities and
irritabilities of human nerves and skin. Some of these
modifications I will now relate in the fewest words.
In the first place, something is often required to be done
during the daytime to pacify the heat and throbbing, which
are part of the usual history of acne. An excellent lotion,,
the heritage of nearly every dermatologist, is made by com¬
bining oxide of zinc, calamine, prepared chalk, lead lotion,,
and lime water, to which may be added a small quantity of
glycerine. Let the bottle containing this be gently waved
about so as to diffuse the materials, which are only held in
suspension; then pour a little into a saucer, and with a
sponge (reserved for the purpoee) sprinkle the face from
time to time. Wipe off, when necessary, with a bit of fine
muslin the powder which remains on the skin after the
evaporation of the fluid, and the face may be washed occa¬
sionally with a little starch gruel. In the second place,
the cases are not a few in which it is better not to use any
kind of soap as part of the evening ceremonial. After the
face has been steamed, we may put on a medicated jelly
composed of oxide of zinc, gelatine, and glycerine. It must
be liquefied by putting the vessel that holds it into hot
water, and then applied with a brush. Then, thirdly, there
.are some sensitive skins intolerant of sulphur in any guise.
When this is 60, we should think of combinations of
lead and chalk atid *inc- blended as
with the finest vaaelme. ' There are flevi
in London and the provinces who
and oleate of bismuth ; and Dr. McC
of oleate of bismuth with Vh#**'
been aptly described as “ one of t
Sometimes nothing agrees better

a quasi-ointment
pharmaceutists
oleate of lead
’g formula
wax has

,_.ling of salves.” -

i old-fashioned but

» The Lancet, Jari.'iitti. 1878. ~

‘

i

Tbm Labcbt,]

DE. ELLIOTT ON THE TREATMENT OiP INTUSSUSCFPfK• - .

capital substance called Kirkland’s “ neutral cerate,” which
is co m posed essentially of lead plaster and olive oil. What¬
ever combination may be chosen (and only a ripe experience
with a sound judgment can decide), the ointment should be
smeared over all the affected parts of the face immediately
after the process of steaming, and allowed to remain during
the whole night. For the acne which is often a trouble to
youag women at the time of commencing menstruation I
prescribe the following ointment with much confidence
Ammoniated mercury, a scruple; precipitated sulphur, a
drachm; oil of the sweet almond, half an ounce; and
white vaseline to make two ounces. By methods such
as the above, industriously carried out, an ugly, blotchy
iv» may be commonly restored to a fair share of
comeliness.

In the treatment of acne there is still room for those
emollient “ dusting powders ” which once occupied an
important place in tne therapeutics of the skin. Equal
quantities of oleate of zino and pulverised starch, with a
small percentage of precipitated sulphur, may be put on
several times a day after moistening the surface with a
warm damp sponge. Now and then a quiet acne may dis¬
appear entirely in a few weeks without any other appli¬
cation. But the extreme forms of the so-called acne
rosacea require a whole battery of new remedial forces,
as it seldom yields to mild and coaxing means. 1
refer with much satisfaction to a paper published
in the early part of 1886 by Mr. Tom Robinson.'* He
advises no parley with an enemy which cannot be tamed
or dislodged after inflammatory hyperplasia of connective
tissue has once been set up. When inflamed papuled are
developed, & lotion should be applied occasionally, com¬
posed of biaulphuret of mercury and almond emulsion (two
grains of the former to one ounce of the latter). When the
congestive process goes on to suppuration the face may be
fomented with hot water; and after the acute stage has sub¬
sided a combination of a scruple of yellow oxide of mercury
ind one ounce of lard ought to be rubbed into the face, and
continued every night so long as it may seem necessary. Mr.
Robinson's favourite means for tranquillising an angry skin
us lotion composed of bismuth and glycerine of starch,
’lessening the starch by three-fourths.

It is time to say a few words about internal remedies. It
« a pity that so much attention must be given to the diet
sad the details of cooking, as this is the red impediment in
many instances to the attainment of even a moderate
success. All food which is difficult to digest must be
avoided, as the waste stuff which it contains is a source of
physiological irritation and worry. Simplicity will best
suit that “ conscience of the body ” called tne stomach; and
regularity in the meals is of high importance. Alcohol and
tobacco are usually superfluous, and sometimes poisonous;
but concerning the former an exception may be made in the
case of strumous young men and women, to whom a little
beer (taken with meals) is often quite valuable.. I must
insist upon tbe daily oonstitutionai walk as a necessary
•irticle of faith and practice; and I venture to add that
systematic writers ou diseases of the skin do not lay
sufficient stress on the proper ventilation of houses and
rooms (especially tbe bedroom) as essential to the respira¬
tory function of the skin. This function is thwarted and
blocked when the surrounding air is deficient in quantity
and chemically bad in its quality; and we cannot wonder
at the prevalence of acne and other similar skin diseases,
when we call to mind the polluted elements which some
people love to breathe.

With regard to the Pharmacopoeia, the rule is almost
absolute that arsenic is nearly the last drug which a prac¬
titioner should think of. Combined with perchloride of
■eroury, arsenic has a useful place in the management of
dull inert acne in plethoric persons. Iron is often necessary,
and can be conveniently given in one of two forms: either
<°) as the ammonio-citrate, with an effervescing draught of
atari* arid and bicarbonate of potaeh; or (6) as the sulphate
of iron, with dilute sulphuric acid and sulphate of magnesia.
The mild aperient action of the latter combination is a dis¬
tinct help; and farther aid in this direction is afforded by
the pill of aloes and myrrh. Residents in Bath can enjoy a
regular and prolonged administration of the thermal waters,
it is lucky that there are no reputed “specifies” in the
Weatasnt of acne; there is less scope for secret nostrums
*ad remedies of donbtful fame; and the culture of the

4 Brit. Med. JonnuU, Jan. 17th, 1985.

Si -7-

“general health” becomes not a vague ana ucouu,
but the expression of an axiomatic truth. 5

Falstaff calls Bardolph’s red nose “ a perpetual triumph,
an everlasting bonfire-light.” Most people are only too glad
to get rid of this uncanny illumination. The cure or allevia¬
tion of an old acne on the face is sometimes such a trans¬
figuration from ugliness to comparative beauty as to bring
credit to the medical adviser, gratitude from the patient,
and a substantial addition to the historic glory of thera¬
peutic art. _

THE TREATMENT OF INTUSSUSCEPTION.

By F. H. ELLIOTT, M.D. *

The condition known as intussusception is at all times so
serious, and in so many cases fatal, that it is incumbent
upon those who have had experiences similar to those
recorded in The Lancet of Oct. 23rd by Dr. Cheadle to
place them on record. The following case occurred in private
practice, and the facts are given from rough notes taken at
the time.

On Sunday, Nov. 8th, 1885,1 was sent for to see the child
(eight months old) of a friend.. The child, it appeared, had
been quite well until the previous day, when it had been
sick, for which a dose of castor oil had been given, after
which a little blood had been passed by way of the bowels.
When I saw it on the Sunday morning there was sickness
with frequent straining, and the passage of small quantities
of blood and mucus. The case appeared at first to be one of
dysenteric diarrhoea, produced probably by improper feeding
&c.; but on a second visit, however, the same day, I made a
more careful examination, and, in addition to a sausage-like
tumour, which could be distinctly felt in the left iliac region,
I discovered the presence of the intussusception about three
inches up the rectum. Most fortunately, I was able to avail
myself of the advice and assistance of my friend Dr. G. V.
Poore, who ou arrival confirmed the diagnosis. By this
time, in addition to the above symptoms, the child was much
exhausted, and evidently in a critical condition. We decided
to see what could be done for its relief, and in this we
received great assistance from the father, who behaved
throughout with much self-restraint and judgment. Chloro¬
form being administered, the father held the child up by
the legs, so that the force of gravity might be turned to
account, and I gently inflated the bowel by means of an
ordinary pair of bellows, whilst Dr. Poore kneaded the
abdomen. After the lapse of a few minutes intestinal
movement was audible, and on examination neither the
sausage-like swelling in the iliac region nor the tumour in
the rectum could be discovered, and in a short time after
recovery from the chloroform it was evident that the general
state of the child had considerably improved. By the next
morning, however, all the signs and symptoms had returned,
and the child was as bad as—indeed, worse than—before.
Regarding it as a hopeless case, I did not propose to proceed
further; but as a day or so passed without death resulting,
I determined to repeat the operation. The inflation with
the bellows this time had no effect. The tumour in the
rectum did not move. I therefore fixed an indiarubber
tubing on to an ordinary funnel, and, the child being
inverted and the end of the tubing inserted in the bowel,
had warm water poured from a considerable height, as
recommended by Dr. Day in his work on “ Diseases
of Children.” This had the effect of displacing the
intussusception, but not really overcoming it, as a swell¬
ing conld still be detected an inch or so above the left
iliac region; I therefore fixed the indiarubber tubing on to the
bellows, and passed it, well oiled, gently up tbe bowel until
it met the obstruction. I then inflated, and in the course of
a minute or so a sadden and general distension of the
whole abdomen told me that the passage had been restored.
Tbe vomiting, tenesmus, &c., were almost at once relieved;
milk with lime-water was retained by the stomach, and
quiet, refreshing deep ensued. For five days, althbugh no
motion was passed, everything went well; but on the evenr
ing of the fifth day the child suddenly began to shriek as if
in great pain, and the whole of the symptoms and physical
signs of intussusception returned. I at once t ook tbe same

5 I am Imagining an Ideal patient who has no apodal diathetic ten¬
dency, as any complication of goat or of syphilis most be treated on Its
own merits and needs.

Digitized by

Googli

CLINICAL NOTES.

[Jaw. 8, 1807.

68 Thh Lancet,]

steps to reduce it as before, and witb success. Tbe most
minute care in diet was observed. The child was kept abso¬
lutely still on a nurse’s lap night and day. No untoward
symptoms appeared, and, to my delight, on the ninth day
from the last operation, and the twenty-first from the
original attack, a natural motion took place. I now hoped
for the best, but was doomed to disappointment once more,
as in four days, without any assignable cause, the intus¬
susception had returned again. Once more I replaced it by
the means previously adopted, although I began not
unnaturally to regard it as a useless effort; this time, how¬
ever, it kept back, although the general condition of the
child was so critical that when four days later Dr. Poore
again saw it with me, we both concurred in telling the
parents tuat we thought the chances of recovery extremely
small. By the gentlest and most careful nursing in all, even
the minutest, details, a gradual improvement occurred, and
in two or three days another natural motion took place. A
good deal of distension of the abdomen with pain—both of
which were relieved by painting the walls with extract of
belladonna and glycerine night and morning—remained for
some few days, after which an uninterrupted recovery took
place. At the date of writing this, more than a year after
the events recorded, the child—a fine specimen of infantile
humanity—is in the best of health, the functions are regular
and natural, and, above all, the action of the bowels is
unimpeachable.

I think the above details show how clearly it is our duty
to persevere in all such conditions, and ho w much we may ex¬
pect from mechanical means, carefully conducted, in reducing
what may appear almost hopeless cases of intussusception.

Andover.

Clinical Holes:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

ON THE RELATION OP INSANITY TO EXOPHTHALMIC
GOITRE.

By M. Colman Collins, M.D., M.R.C.P. Lond.

Fob the purpose of synthesis, and to further accentuate
important clinical and pyschological researches, I cull from
my case-book the subjoined report, with remarks, on a
patient of mine.

Miss A. B- consulted me in 1879. Palpitation was

then the most troublesome subjective symptom. The heart
beats were regular, loud, and ringing. Pulse 130. The area
of cardiac dulness wa9 very slightly increased; the heart’s
impulse violent on exertion. There was evidently dilatation
with hypertrophy. Exophthalmos tolerably well marked,
and equal on both sides. The thyroid was slightly enlarged.
“ It never amounted to actual deformity. It simulated a
bronchocele which has become stationary just at the period
of its development.” Its vessels and those of the neck
pulsated visibly, and a hromic murmur—the beehive hum—
was heard over them. The patient was also fretful, sleep¬
less, and dyspeptic, and suffered from amenorrhoea. Iron,
digitalis, and nux vomica were prescribed, draughts of
chloral and bromide were given when necessary, out-door
exercise was enjoined, and the diet was attended to.
Relief was so far obtained that during her sojourn at the
seaside the distressing symptoms were held in abeyance,
but the patient was Dy no means cured. On her return
to her former surroundings aggravated phenomena of
Graves’ disease supervened. She was tried by domestic
troubles, and her mind, already in a state of unstable
equilibrium, gave way under the excessive strain. Physical
and mental deterioration appeared to advance pari passu
under the influence of depressing agencies. Her mind
became ultimately unhinged, and she gradually lapsed into
melancholia. Feelings of profound misery engendered
delusions—delusions which nad special reference to the
necessity of joining her friends in Paradise. Consequently
she “ felt called upon to starve hersel f to death.” Per contra,
as if in still further exemplification of the morbid state of
nrtnd; Bhe had a delusion that she was being done to death
with food and physic. Thi9 amounted to a definite delusion,
( lypemenia. ) There she Bat, sad, moody, and suspicious of her
dearest friends. 1 had to feed her for a month with the stomach-

pump. Obstinate constipation added to her troubles. Here
I found belladonna usetul; and, moreover, it appeared to
mitigate occasional outbursts of maniacal excitement. (At
no time did she manifest the remarkable disturbance of tho
affective functions, or the accompanying incessant activity,
so typical of mania.) At the end of a month there was
some surcease of her sorrow. A rift appeared in the cloud.
The melancholic gloom was lifted, the atmosphere cleared,
she no longer refused food, and she felt interested in the
kind ministrations of her friends and in her comfortable
surroundings. She ultimately recovered, as far as recovery
was possible. I saw her lately. The palpitation, the exoph¬
thalmos, and the goitre are in statu quo. The melancholia
has certainly left in its wake slight traces of mental weak¬
ness. She is male sana.

I never could elicit a clear family history or any record of
insanity, epilepsy, &c. Goitre was not endemic in the dis¬
trict where she was bom and bred. Still, it is not a work
of supererogation to inquire into the obscure connexion
between Graves’disease and mental alienation. Emotional dis¬
turbance, shock, and bodily and mental exertion appear to be
active agents in the production of both. The cases reported
by Graefe, Trousseau, Laycock, Begbie, and Friedreich may
be put in evidence to support the one, and those reported by
Savage and Bruck to support the other. Cretinism is, as is
well known, frequently associated with bodily deformity
and goitre. Dr. G. H. Savage 1 has drawn particular atten¬
tion to the fact (which has previously been observed) that
patients with exophthalmos sometimes become insane, and
that their insanity is usually acute mania, and often proves
fatal. Brock’s patient exhibited paroxysms of vertigo and
mania; Geigel’s was) attacked by monomania de grandeur :
mine was afflicted with melancholia, and happily so far
recovered as to be able to enjoy life and earn her livelihood.

Nottingham. __

EXTREME DISPLACEMENT OF THE HEART TO THB
RIGHT SIDE FROM PURULENT EFFUSION
INTO THE LEFT PLEURA.

By Courtney Nedwill, M.D., M.RC.S.

Tub following case seems to me to have several points of
interest, and to be worthy of record:—

A little girl, aged seven years, was brought from the
country to my consulting-room on May 20th for advice-
with regard to “ shortness of breath and curvature of the
spine.” The history given me by the child's mother was
that in November last she had had an attack of mumps,
followed in February by whooping-cough, from which she
was then scarcely recovered. For nearly two months, the
mother stated, she had noticed that the child’s breathing
was very short, and that the spine was getting worse day
by day. The child was of fair complexion, scrofulous-
looking,'and ill-nourished, had a well-marked hectic flush,
was puffy over the face, and had a temperature of 100 - 5°.
The left side was greatly distended, and the spine had an
enormous lateral curve. The heart’s beat was most dis¬
tinctly felt at a point to the right of tbe right nipple.

The child was taken to a small cottage in the suburbs of
the town, where I visited her the next day, accompanied by
my friend Dr. Moorhouse, who administered an anaesthetic,
as we found her very nervous and apprehensive of pain. A
large-sized aspirating needle was thrust into the chest in the
mid-axillary region between the sixth and seventh ribs, and
withdrawn as soon as it was seen that pus formed the
effusion, a free opening being made in the same place with a
scalpel and about six inches of rubber drainage-tube inserted.
Some oakum was loosely packed over the tube, which was
secured to the chest by a piece of plaster. About three pints
of pus escaped during the operation and on tbe following
night. The temperature next morning was 99 2°, but fell to
normal on the succeeding day, and remained so throughout
the treatment, which consisted principally of milk and cod-
liver oil. The child rapidly gained flesh, the discharge day
by day decreased in quantity, and the tube was gradually
extracted and cut off until its last piece was withdrawn on
June 25th. On the 30th the fistula had healed; and on
July 7th she returned to the country with the respiratory
murmur clear, the heart in its normal position, and the
curvature gone.

On September 1st, Dr. Moorhouse and myself had an

1 Guy'* Hospital Reporta, vol. xsvl.

Digitized by GoOgk

fin Lancet,!

HOSPITAL MEDICINE AND SUBGERY.

[-

yjportonity of examining her, and found no departure from
normal condition save the scar where the ecalpel had
mb introduced between the ribs.

ChiMcharch. Hew Zealand.

1 REMARKABLE MIDWIFERY CASE: EXTRAORDINARY
THICKENING AND INDURATION OF THE
OS UTERI.

By Wm. Wigmobe, M.R.C.S., L.K.Q.C.P.I.

I think the following cise is worth recording:

At 3 a.m. on Dec. 8ch I was called to Mrs. H-, aged

tiurty-nine, in labour with her third child, the last being
:vo yean old; pains had been going on since the afternoon
■if the day before. On examination, I found the os dilated
t) about the size of a fire-shilling piece, head presenting;
interiorly, the os was thickened and swollen into a mass
laKlor the pubes, the rest being quite an inch thick and
tough. The liquor amnii had escaped a short time before.

1 tried for some time to dilate, but hading I could make no
i ipreesion. and the pains getting stronger and almost in-
t went. I applied the long forceps, hoping that with the aid
of them and the Ungers I might oe able to dilate; but directly
1 used any traction, the os came quite outside the vulva,
tod I found it useless to attempt it. If I had used more force
1 should have pulled child and uterus away together. The
paiae were still incessant, the patient calling out for some-
iiag to be done. I saw there was nothing left but to divide
die os. Before doing so 1 wished for another opinion, and
for Dr. Griffith of Harrow-road. He asked me to
remove the forceps and let him try to dilate; but, like
myself, be found it perfectly useless, and agreed with me
:aat nothing but division would give her a chance of being
Mirered. I accordingly re-applied the forceps, and, pulling
•.he os outside the vulva, proceeded to divide it posteriorly,
“fie procedure was like cutting cartilage or tendon, and
there was no bleeding; directly it was divided the uterus
•piit right up over the head of the child, which was
immediately expelled. The child was dead. I was now
fearful of the consequences, daily expecting to find
lymptoms of metritis, cellulitis, or peritonitis; but, ou the
contrary, the temperature never rose above 101°. She never
*ad any abdominal tenderness, nor even a fetid dischargo,
and is now quite convalescent.

Remarks .—After the birth of her first child the patient
t offered from & fall of the womb, and after that of the second
it became worse, and eventually quite prolapsed. She never
■ooght any advice for it. During the whole of her present
pregnancy she was sitting on it, which gave her much
pain, and her favourite seat was a cane chair with a hole in
it. I suppose, by the continual exposure and friction its
character was quite altered. Having had a very large mid¬
wifery experience, and never meeting with a similar case,
I am anxious to know what else 1 could have done. Cranio¬
tomy would have been of no avail, and I do not think that
dismemberment would have been successful. I should also
like to know how the peritoneum escaped—whether the
recto-vaginal and vesico-vaginal folds were stretched by
the gradual rise of the fundus and being held down below.
I may here mention that after the birth of the child the uterus
contracted well, the placenta came away without difficulty
«r haemorrhage, and the os was drawn well into the vagina.

Ibvwbsw- terrace, Kensington- gardens, W.

Tnx JuniLKK AND Sanitary IMPROVEMENT.— Mr.
Mark EL Judge, as a member of the Paddington Victoria
Jubilee Committee, has given notice that he will propose
'.be fallowing reeolation: “ That in the opinion of this com¬
mittee the dust-collecting and other trades which are carried
on In connexion with the canal basin between Warvrick-
"jsecent and Praed-street, besides being a continual nuisance
to the health of the parish, are during the summer months
a aariosu danger t<f the inmates of St. Mary’s Hospital and
a a oor ce of annoyance to the Great Western Railway Ter-
nrieee, which is so often visited by Her Majesty the Queen
ud the Ministers of the Crown; that the committee, there¬
fore* eoneidera that no better memorial of the Victorian
Jofeiht eoold be devised in Paddington than for the vestry
to peMhaee the canal basin and adjacent property, in order
that fafafaag afamllng nuisance may be abolished, and the
site pnihnj utilised foe residential and other purposes ”

% Utirror

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Holla intern eat alia pro oerto oosoondl via. nit! qoamplnrlnuu at mor-
boram et diuectlonum htitorias, turn allorum turn propria* collect a*
habere, et Inter te oomparare.—H ohqaoni Da Sad. at Catu. iiarb.,
Ub. Iv. Prooemium. -

ST. THOMAS’S HOSPITAL.

A CASE OP INGUINAL AND TWO OF UMBILICAL HERNIA
IN WHICH RADICAL CURE WAS PERFORMED;

REMARKS.

(Under the care of Mr. Sydney Jones.)

The following cases are of interest as illustrating the
radical cure of hernia by ligature of the neck and excision
of the rest of the sac. In the first case the operation was
performed on a boy aged three years and a half for a large
inguinal hernia which could not be controlled by a trass;
in the other two cases of umbilical hernia operation was
urgently called for by symptoms of strangulation.

Case 1. Inguinal Hernia. —A boy, aged three years and
a half, was admitted on Sept. 27th, 1886. He had a right
large inguinal hernia, which had existed since he was six
months old. The external abdominal ring was large and
patent. The hernia was easily reducible, but it had been
found impossible to keep it up with a truss. The testis
could be felt below the hernia, not overlapped by the latter,
and appeared to be in a distinct sac.

On Oct. loth an operation was performed under spray.
The intestine having been returned, the sac was freely laid
open. A comparatively narrow communication was found
between the sac containing the hernia and that containing
the testis. The hernial sac was divided transversely by a
few light touches of the knife; the upper part was raised
and ligatured at the neck, the excess of the upper part of
the sac being cut away. The lower portion of the sac waB
turned down, and the edges accurately adapted with catgut
sutures. Thicker catgut sutures were made to connect the
columns of the ring. A drainage-tube was introduced, and
the edges of the wound brought together by alternate silk
and catgut sutures. Iodoform, iodoform gauze, and salicylic
wool were used as dressings. The wound required dressing
at 9.30 p.m., as the discharges were through and there waa
some oozing of blood.

Oct. 16th.—The temperature at 8 a.m. was 102°. There
waa no pain in the abdomen, but the tonsils were con¬
gested and swollen. Urine of specific gravity 1025, with no
albumen.

17th.—The temperature in the night rose to 104°. The
patient was restless and had little sleep, although quieter
after a dose of bromide of potassium.

18tb.—Tongue foul, but moist; no sickness; no distension.
Ordered a pill composed of four grains of mercury and
rhubarb.

19th. — Wound dressed and stitches removed; some
accumulation of aero-sanguineous fluid.

20 th.—Temperature 101° this morning; 101° last night;
tongue cleaner.

21st.— Dark brown semi-purulerit discharge from the
wound. Temperature at 8 a.m. 98 4°. Patient much better.

22nd to 24th.—Much better; wound dressed with chlo¬
rinated soda lotion. Temperature normal.

25tb.—Drainage-tube left out.

Nov. 9th.—No interruption to recovery since the last note.

In the course of about a week the yvound was healed;
very firm cicatricial tissue existed in the situation of the
old hernia, and the testicle was freely movable in its
own tunica vaginalis. It was not thought necessary or
advisable to recommend the application of any truss.

Remarks.— The above seemed a very good case to attempt
a radical cure. The hernia was a very large one ; no truss
could keep it up, and later in life it must have assumed a
very much larger size. At no time after the operation was
there any reason to suspect any abdominal irritation. The
high temperature shortly after the operation was, no doubt,
due to congested and swollen tonsils from exposure to spray
and in the operating theatre. Later on it was evident that
some collection of blood and serum had accumulated in the
scrotum below the tied neck of the sac.

Digitized by GoOgle

v

HOSPITAL MEDICINE AND SURGERY.

I Jan. 8,1887.

68 Thb Lanckt - *]

Cask 2 . —Strangulated Umbilical Hernia complicated with
Pregnancy; Ligature of Neck of SacRemoval of rest of Sac

and of redundant Skin; Cure. —E. D-, aged forty-one,

married, was admitted on Nov. Sth, 1886. The patient first
noticed projection of the umbilicus after the birth of her
fourth child, about eight years ago. Since then it has
gradually grown larger and larger, and has lately increased
a good deal in size. She says she has had what she calls a
“ slight touch of the cramp ” in it before, but never
anything like the present pain. She first began to feel
bad yesterday (Nov. 7th), about 5 p.m., when she had
severe pain and retching after going to the closet. She
took two doses of castor oil, both of which were returned,
and she was sick pretty constantly till she applied for
admission. After the first attack she passed nothing per
rectum, but she passed urine. She is five months preg¬
nant, and says she always “has a very bad time” during
gestation, being sick and troubled with diarrhoea nearly
to the end.

On examination there was a large umbilical hernia about as
big as an ordinary sugar-basin, and compared by Mr. Jones
to a large mushroom, it having a somewhat constricted
base. The skin over it was uneven, dimpled in places, and
apparently adherent to the parts beneath. In pans it was of
a deep reddish colour. It was very tense, and gave no
impulse on coughing.

The patient was admitted about 2 a.m, Mr. Sydney
Jones was sent for, and decided to operate at once. The
patient, however, demurred, asking to be allowed to wait
until the morrow. As the symptoms did not seem of a
very urgent nature, her request was acquiesced in, and the
operation was accordingly put off until the next after¬
noon. In the meantime a long narrow ice-big was put on
the tumour so as to encircle its base, but no ice was applied
to the surface, as the red adherent patches of skin seemed
inclined to slough. The patient after admission continued
to be sick more or less, and to have severe pain at the
umbilicus. The vomit was chiefly mucus, and not fascal
in odour.

At 4.15 p.m. on the day after admission, the woman
agreed to be operated on. Accordingly Mr. Jones (the woman
being under ether) made a longitudinal incision down the
whole length of the tumour, cut through the sac by a similar
incision, and exposed the hernia, which consisted of a large
mass of omentum partially adherent to the sac walls, with
a loop of intestine, about five inches long in the middle. The
intestine was deeply congested, of a purplish colour, but
shining and fairly healthy. The greater part of the omen¬
tum was ligatured and removed, and the sac walls cleared.
The sac was then dissected away from the skin and removed,
all but a short neck, the constriction having been relieved
by an incision directly upwards from the umbilicus, which
allowed a small piece of healthy intestine to come up. The
intestine was replaced, and the neck of the sac secured by a
stout green catgut ligature tied firmly twice round it. As
this seemed to cut the neck of the sac, and a small quantity
of fluid continued to regurgitate, three or four catgut
sutures were used till the opening seemed to be completely
closed. The margins of the umbilical aperture were
brought together by three catgut sutures. The greater part
of the skin which had covered the hernia was then cut
away, leaving sufficient to allow the margins to be brought
loosely together; and the incision was closed by alternate
silk and catgut sutures, a drainage-tube being placed along
about three-quarters of the length, and opening below.
The operation was performed under spray, with antiseptic
precautions, and the wound was dressed antiseptically with
iodoform and salicylic wool. The patient being very stout
and the abdominal walls loaded with fat made the operation
more difficult.

Nov. 10th.—The patient was sick once last night after the
operation. Temperature at 8 p.m. to-day is 100 - 4°. She
slept fairly well last night, having in all seven hours’ sleep.
A catheter was used.

11th.—The patient has been able to pass urine since
the night of operation. Last night (Nov. 10th) she was
sick three times—first time at 8 p.m., then at 10 p.m., and
again this morning at 4. She had not been taking any food,
and the vomit is small in quantity and looks like contents
of stomach. There has also been a little diarrhoea. Tongue
dry, but not so dry as yesterday. Pulse 108, full, soft. She
slept fairly well last night (four or five hours), and feels
this morning quite comfortable. Temperature 09-4°. She
takes two teaspoonfuls of milk every half-hour, also four

teaspoonfuls of meat juice in the twenty-four hours, and
some barley-water.

12th.—Wound dressed under spray ; its edges seem to b©
united, and it looks very healthy. Drainage-tube left in ;
not much discharge.

13th.—The patient was sick two or three times during
the past twenty-four hours. Some diarrhoea; bowels
open four or five times. Enema of starch and opium given
at 2 p.m. yesterday. Temperature this morning 99° ;
pulse 98.

14th.—Bowels open twice yesterday; not much diarrhoea.
Temperature 99 , 6 f ’; pulse 112. The patient feels weak,
but otherwise well. Tongue pale and moist; no pain or
tenderness in the abdomen.

15th.—Morphia injections have been used until to-day ;
they are now stopped. She sleeps better ; she has-
slept about from three to five hours each night since the
operation. Her sleep is not continuous.

16th.—The wound was dressed to-day under spray.
It is healed except where the tubing was inserted. Tubing
left out and stitches removed. Temperature 99°. Tongu»
brownish fur but moist. The patient was sick at 2 a.m.
yesterday, and again to-day at 8 p.m.

17th.—Bowels open five time3 yesterday; very loose-
motions. Pulse 112. Three or four hours’ sleep last night.

18th.—Patient bad a better night; slept five hours-
Pulse 80, fairly strong. Tongue moist, covered with
brownish fur. Temperature 98‘4°. She has had a little
bread-and-butter and tea this morning. She has complained
a good deal for the last day or two of being hungry.

20th.—The wound was dressed yesterday afternoon under
the spray, and is now healed. She has not been sick
since the 18th. Sleeps better, four or five hours a night.
Pulse 92; tongue furred, but moist. Temperature 98*8°.
Custard was given yesterday, besides bread-and-butter.

21st.—Bowels opened nine times yesterday and last night.
An enema of starch and opium was given last night.

22nd.—Bowels moved six times yesterday. Motions-
loose, but not much in quantity. Pulse 108, full and
strong. Temperature 98°. Fish and costard diet ordered.

23rd.—Breod-and-milk diet to-day, and chicken. Bowels
not relaxed last night. She slept much better last night..
Temperature 98 - 4°.

24th.—Wound dressed with iodoform and salicylic wool.
No spray. Wound healed in greater part. Very little
discharge. Temperature 97 - 8°. Bowels opened twice in
twenty-four hours; not loose.

26th.—Patient much improved; no sickness or diarrhoea.
The dressings were left off except a little iodoform gauze.
The edges of the wound are strapped together, and have been
from the first. An abdominal belt, with an oval stiff plate
corresponding to the wound, has been applied. The patient
feels much more comfortable, and got up at mid-day.

27th.—Full diet ordered.

29th.—Patient is better; no sickness or diarrhoea. She
feels quite well when up, and is to go out to-morrow.

Cask 3. — Umbilical Hernia ; Operation ; Removal of
Omentum; Ligature of Neck and removal of rest of Sac
Removal of redundant Skin; Cure. —A fat woman, aged
thirty-five, was admitted on Dec. 4tb, 1886. The first appear¬
ance of swelling was about five years ago, during a confine¬
ment. She has had two children. About ten months ago
she had an attack of severe symptoms in connexion with
her hernia; but the latter was then reduced, and she has-
worn a belt ever since. On Dec. 1st, at 7 a.m., she had
sudden vomiting, preceded by pain in, and enlargement of,
her hernia. The vomiting continued, beooming much worse
on the 3rd, and the pain was so great about the umbilical
and epigastric regions as to make her, as she said, “raving
mad.”

On admission there was seen a large lobulated tumour,
fairly circular, about 4 in. in diameter; it was sessile,
except below. The skin was soft, but not discoloured. The
tumour appeared omental, but it was difficult with certainty
to say. There was some impulse; the skin was puckered, and
the sac evidently much pouched. An ice-bag was applied for
some hours, but without relief to the pain, which seemed very
great. ,At 2.30 p.m. she was operated on by Mr. Sydney Jones.
No attempt was made to divide any structure external
to the neck of the sac, but a median incision was made
to lay open the whole interior of the sac. There was much
fatty omentum, which had long been adherent to the interior
of the sac, with, in addition, a very large piece of omentum,
much congested, with laige engorged vessels. No intestine

Tine Lancet,]

HOSPITAL MEDICINE AND SURGERY.

was found in the sac. The old adherent fatty omentum was
removed. The recently protruded omentum was ligatured
with catgut, and the stump passed into the abdomen. The
sac was dissected out, the neck was ligatured, and the excess
removed. The pillars of the ring were brought together by
three catgut sutures. The excess of skin was removed, and
the margins of the skin wound, after the insertion of a
drainage-tube, were brought together by ailk and catgut
sutures. Iodoform and salicylic wool were used as dress¬
ings. Her pain ceased directly after the operation. 8he had
some sickness and restlessness, which were remedied by
subcutaneous injections of morphia.

Dec. 7tb.—Fairly well since the operation. No tender¬
ness. Temperature 101° to 102°; wound disposed to
suppurate.

11th.— The wound was dressed last night; much
discharge; suppuration around the sutures; these were
removed and strapping applied. Boracic dressings were
nsed. The suppuration gradually diminished, and she left
the hospital well, with an abdominal bandage, before
Christmas.

Remark*. —The two above-described cases of umbilical
hernia indicate pretty well the plan of treatment which
should be adopted in cases where umbilical hernia call's for
operative treatment. In these cases in former times opera¬
tion had a serious result, and on this account, surgeons under¬
took such operations with fear and trembling. No doubt the 1
proper plan to pursue, when operation is called for, is to cut ,
at once, under antiseptic precautions, into the sac ; to divide 1
the constricting neck of the sac and return any strangulated 1
intestine ; to remove the omentum, ligaturing it at its neck, :
and return the stump into the abdomen; then to dissect 1
away the sac, ligaturing this at its neck. In this way any
blood or inflammatory products are prevented getting into
the peritoneal cavity. To complete the operation the mar¬
gins of the umbilical aperrure are bronght together by catgut
sutures; the redundant skin is removed, and theedgesof the
skin wound are brought together by alternate silk and catgut
sutures, drainage under the shin wound being used, and anti¬
septic dressings afterwards applied. In the above two cases,
after returning the hernial contents a ligature of the neck of
the sac was first employed, next sutures connecting together
the margins of the umbilical aperture, and lastly sutures
connecting the skin wound after the excess of skin
had been removed. Both cases did well, although they
were, as is usually the case, bad subjects for operation.
In the first case, after operation there was more or less sick¬
ness ; but she was pregnant, and it was her usual condition
in previous pregnancies to suffer from sickness and diarrhcea
from the beginning to the end of such period. This caee
healed by first intention, as is usual in cases after ovariotomy.
In the second case there was some suppuration during the
healing of the wound. In this latter case there was no
strangulated intestine in the sac, but there had been a large
addition of omentum in its interior. This omentum showed
signs of intense congestion, and might have exerted pres¬
sure in some way upon intestine. The patient’s pain was
excessive, as was her vomiting, so as to call for operative
interference; and this interference has resulted in her having
got rid of her hernia.

SWANSEA. HOSPITAL.

SIGH ANEURYSM OP FEMORAL ARTERY ; LIGATURE OF
EXTERNAL ILIAC ARTERY; CUBE.

(Dnder the care of Mr. H. A. Latimer.)

E. A. H-, aged thirty-four, a fitter by occupation, was,

admitted on Sept. 7tb, 1883. He had that day made the
journey to Swansea from Bridgend by rail. About twoy ears'
before admission he severely strained himself in his work,
and on the same night he felt a pain in the groin, which was
followed by swelling of the scrotum. He states that this
swelling was due to a rupture, and that he was able to
.return the bowel into the abdomen, but he never bad any
advice on the subject, and a trass which be applied and wore
five months before his admission was of a very primitive
nature. The wearing of this truss caused great pain,
extending from the hip-bone to the feat of the aneurysm.
He bore with this up to two months before admission, when
he consulted a medical man, who immediately ordered him
to bed. He states that, “ when lifling anything heavy, when
1 bad the truss on and my bowels oame down, the beating

and pain was unbearable.” He first noticed this pulsation
one month after taking to the use of the instrument. Has
always been a great walker, lias never had syphilis. Had
acute rheumatism at the age of sixteen, and gonorrhcea at
seventeen years of age. Is married. Is generally abstemious,
and has never drank spirits. The family history is scanty.
A sister died of phthisis pnlmonalis.

On admission there was a tense, pulsating tumour at the
upper and inner'part of the right thigh, of irregular outline
and well elevated; it extended from Scarpa’s triangle right
up to Poupart’s ligament, and thence to the side .of the
pubis. The impulse proceeding from it was eccentric. The
right leg was swollen throughout. Comparative measure¬
ments gave the following: Bight thigh over tumour 23} in.,
left 18}in.; right thigh at Hnnter’s canal 19} in.,” left
15} in.; right knee 15} in., left 13 in.; right calf 15} in.,
left 12} in.; right instep 11 in., left 9} in. The patient
had suffered much pain of a continuous aching character,
and extending along the right thigh from the anterior
superior spine of the ilium downwards to the outer side of
the knee-joint. No pain at any time in the aneurysm. No
albumen in the urine. The heart was free from any abnormal
bruit. The temperature by the mouth on the evening of
Sept. 8th was 101°.

The external iliac artery was tied on Sept. 9th under
carbolic spray. The incision practised by Sir Astley Cooper
was made. The artery was ligatured with a double layer
of No. 4 carbolised chromicised cafgut, and the dressings
employed were protective and gauze. His leg was then
bandaged with liannel over cotton-wool, and he was placed
on a water-bed with the limb elevated and surrounded with
hot-water bottles.

The after-progress of the case was one of uninterrupted
recovery. No pulsation at any time again showed itself iff
the aneurysm, and after a day or two all pain subsided.
He was allowed to rise on Oct. 2<>th. The swelling in the
limb began to subside very quickly after the operation had
been performed, but it was found later on, on removing the
flannel bandage, that two ulcers had formed on the outer
side of the leg, no doubt from trophic nerve disturbance.
They were situated over the peronei muscles at about the
middle of the limb, the upper one being half an inch in
length, and the lower one an inch and a halt inlpngf.h. Deep-
seated suppuration and limited gangrene of the muscles at
that spot took placp, and on Nov. 4th a rigor, With rise of
temperature to HH'i 0 , took place; all this trouble was
immediately relieved by preventing the bagging of matter by
means of carefnlly placed drainage-tubes. He was discharged
on Dec. 6th, when the aneurysm sac was Still to be felt as a
hard lump, absolutely devoid of impulse, and painless on
handling. The larger of the ulcers was still very slightly
open; the smaller ulcer had healed perfectly.

STAMFORD INFIRMARY.

CALCULUS IN A HOY; REMOVAL BY LATERAL
LITHOTOMY; CURE.

(Under the care of Dr. Newman.)

H. I-, aged thirteen, was admitted on Aug. 25th, 1885

A stunted, white, unhealthy lad. Is said to have had
symptoms of urinary irritation for a period of seven years.
Constant incontinence, always in pain after passing urine.
He has a long prepuce, with minute orifice,

On Sept. 1st circumcision was performed, and the patient
sounded. A calculus of some «ze was readily struck.
On Sept. ' 9th lateral lithotomy was performed,_ using
Chienee staff and a plain ecBlpel. The finger following the
knife at once came on the stone, lying! across the wound.
This position was rectified, and the vesical wound enlarged
with a probe-pointed hernia knife. The stone was seized
with a pair of small straight forceps (in its long diameter),
and very slowly extracted. Little bmmarrbago followed.
The calculus wbb flattened, oval, and weighed 680 grains.
Had not ode bad symptom. Oa the fourth day. urine was
passed per urethr&m. On the tenth day it was noted that
nil the urine passed per urethrem, and on the fourteenth day
the wound of the operation was perfectly healed. On
Oct. oth the lad went home quite Well.

Jiemar/t*.~The> case noted above eefifms to be worth putting
on record* The points of special interest are’ the long dura¬
tion of very severe symptoms, the size of the stonpj and th©
rapid-repair of the surgical wound. '•

Digitized by GoOglc

6S .<??■ Lonoke,]

PATHOLOGICAL SOCIETY OP LONDON.

LJan. 8,1887.

Htgfrk al S ocuties.

PATHOLOGICAL SOCIETY OF LONDON.

Multiple Cavernous Angiomata. — Melanotic Tumour of
Breast .—(?) Recovery from Tubercular Meningitis .—
Raynauds Disease and Peripheral Neuritis.—Rupture of
Syphilitic Cardiac Aueurysm.

The annual general meeting of this Society was held on
Tuesday last, Dr. J. S. Bristowe, F.R.S., president, in the
chair. The list of officers and Council for the ensuing year
is appended to this report. The rote of thanks to the
retiring President was proposed by Dr. T. Barlow, seconded
by Mr. James Black, and carried by acclamation. The vote
of thanks to Mr. Butlin, proposed by Dr. Goodhart and
seconded by Mr. R. W. Parker, was also warmly received.

Mr. F. S. Eve showed a specimen of Multiple Cavernous
Angiomata of Leg. They were distributed along the internal
and external saphenous veins, chiefly subcutaneous, but
some were lying deeply in the popliteal space. On three of
the digits were calcified enchondroma; exostoses were found
on each end of the tibia. A sarcomatous tumour sprang from
the back of the tibia and included an angioma. Spaces
bound with connective tissue were seen under the micro¬
scope, and these spaces could be injected from the vein.
The sarcoma was a round-celled one. The tibia was bowed
backwards, and showed a defect in organisation of osseous
tissue. Phleboliths were contained within the angiomata.
In Billroth’s last edition some mention was made of mul¬
tiple angiomata. Dependence of tumours on defective
development was illustrated by the present case.—Mr. C. J.
Symond8 said Mr. Howse had recorded a similar case in the
Guy’s Hospital reports.

Mr. H. T. Butlin showed a Melanotic Tumour of the
Breast taken from a woman aged sixty-four, who was first
operated on in 1880. The tumour was of seven months’
duration. There were no adhesions, no enlargement of
glands, no retraction of nipple, and no peculiar colour of skin.
The breast was removed. Recurrence took place, and a fresh
operation was performed in 1882; from beneath the scar the
recurring tumour was removed. In 1884 a third tumour
from the same situation was excised; and recently another
tumour was cut away. There was no sign of disease of
any internal organ. The section was brittle and rendered
microscopic preparations difficult. There were many tiny,
very bright naevoid spots in the skin that were considered to
suggest carcinoma. He believed it was a sarcoma with a
distinct alveolar structure. There was a similar case in a
woman aged sixty-eight in Billroth’s article on the Breast
in the DeuUch. Chirurg. Gross allowed of melanotic car¬
cinoma, but not sarcoma. The melanotic granules appeared
to be in the intercellular substance in the fibroid bands.—
Mr. A. A. Bowlby said that there were many small pigmented
spots. The growth was exceedingly friable. He did not
think there was true melanosis. He concluded that it
was a sarcoma from the distribution of the blood¬
vessels.—Mr. D’Abcy Power said that the structure was
peculiar; a base of connective tissue existed on which
filaments sprouted, as happened in the growth of some
fungi.—Mr. Butlin wished to have the specimen submitted
to the Morbid Growths Committee.

Dr. Carrington read a case of old Phthisis and recovery
from Tubercular Meningitis. He admitted that the case was
open to criticism, but, inasmuch as it must have occurred to
most to have at least suspected meningitis in cases that
eventually recovered, be thought that any post-mortem
evidence bearing on the point was worthy of discussion
by the Society. The patient was a boy aged sixteen, a
clerk. Three sisters had died in infancy, but the family
history was otherwise good. On July 4th he was knocked
down by a tricycle, which struck him on the right knee, but
he only kept his bed for a week. Still, however, the knee
continued to swell, and in tbe course of a year movement
became much impaired. Fifteen months after the accident
the left knee became affected, and eventually this joint also
became to a degree fixed. The boy improved under treat¬
ment, but on Jan. 26th, 1886, be was readmitted with psoas
abscess on the right side. He again improved by treatment,
and was discharged on April 24th, but was readmitted on
Oct. 2nd with another abscess on the left side; he gradually

sank and died. After death tbe pi-arachnoid was found
to be generally thickened, and the sulci were matted to¬
gether. The membranes were granular, and exhibited small
yellow tubercles, as was confirmed on microscopical
examination. There was meningitis, probably of more recent
origin, of the lower third of the cord; the brain and
cord were healthy, except that the latter was softened.
At the apex of each lung there were old phthisical lesions.
The fourth and fifth lumbar vertebra! were carious, and the
right knee-joint completely disorganised. With tbe excep¬
tion of lardaceous disease of the spleen and small intes¬
tine, the other viscera were healthy. As regards the
tubercular nature of the old meningitis, Dr. Carrington was
inclined to lay much stress upon the concomitance of old
tubercular phthisis, old cerebral meningitis, caries of the
spine, and chronic joint disease, as evidence of the tubercular
nature of the meningitis, which he believed had been
recovered from, but he thought the naked-eye and micro¬
scopical appearances were equally distinctive. The spinal
meningitis was probably of more recent origin, and due
directly to the cause. If the origin of tbe disease was
claimed as due to the accident, it was curious that the
second knee was not affected until fifteen months after¬
wards, and there certainly could not have been any
cerebral meningitis at the time, for the man only kept his
bed for a week, and then went to his work as a cleric On
the whole, he suggested that there was evidence of bygone
tubercular meningitis, probably approaching in date the old
phthisis.—Mr. S. G. Shattock suggested that the meningeal
appearances were somewhat like those of periarteritis, as
shown by Dr. C. Turner.—Dr. J. S. Bristowe raised the
question whether the nodules of tubercles were necessarily
ancient.—Dr. Carrington said that the tubercles were
yellow and caseous, and adherent by fibrous tags. He felt
sure that they would be found to have no connexion with
the arteries.—In reply to a question, Mr. Tabgett said
the intellect was unclouded.

Dr. Coupland showed for Dr. Wiglesworth specimens of
Peripheral Neuritis in Raynaud’s Disease, the subject being
a female inmate of Kainhill Asylum, aged twenty-six, who
suffered from chronic Bright’s disease and dementia, with
epilepsy. Before her admission in December, 1884, she had
sustained amputation of several of the fingers and toes for
gangrene, and whilst under observation she suffered from
ulceration of these extremities, and in January, 1886, the
terminal phalanx of the fourth left finger became gangrenous
and required amputation. The patient died suddenly in
May, 1886, after an epileptic fit. The kidneys were markedly
granular. The spinal cord and several of the nerve
trunks of the limbs were examined microscopically. In the
cord the chief change was in the posterior vesicular column
of Clarke, where the cells were rounded, their processes being
ill-defined; and the neuroglia of tbe white substance
appeared slightly thickened. In the nerves there was an
overgrowth of the fibrous elements, with atrophy and degene¬
ration of the nerve fibres—e.g., the left posterior tibi&l
nerve presented thiokening of the epineurium, perineurium,
and endoneurium, with atrophy of the nerve tubules. Similar
changes occured in other nerves, and were better marked in
those of the left limbs than in those of the right. The changes
were more marked at the peripheral than in the larger nerve
trunks. Dr. Wiglesworth left the question open whether
the change was primarily a chronic interstitial inflamma¬
tion invading the nerve bundles and causing their atrophy,
or whether it was a primary degeneration of nerve tubules
with secondary hyperplasia of the fibrous framework;
but he considered that the case removed Raynaud’s
disease from the category of neuroses, and showed that
structural lesions of the peripheral nervee underlay it.—
Mr. A. A. Bowlby bad examined the nerves, and found
indentical changes. He thought it was very likely to be a
disease dependent on lesions in the_ peripheral nerves; the
stiffening of the joints pointed in the same direction.
M. Pitre3 bad recorded a similar case—Dr. Thomas Barlow
said similar cases had been recorded by Pitres and Mount-
stein of Strasburg, but the changes were not so extensive as
in Dr. Wiglesworth’s case. Though important contributions,
they did not solve the difficulties. Raynaud’s disease was
divisible into several classes. There were chronic cases like
Dr. Wiglesworth’s, and tbe genuine or paroxysmal cases,
which were as fit-like as a rigor in an attack of ague. The
occurrence qf paroxysmal hemoglobinuria and attacks of
amblyopia and jaundice seemed to show that there mnst be
a wider pathology than a peripheral neuritis. It seemed aa

TH1 LtAACBT,]

EPIDEMIOLOGICAL SOCIETY OF LOS DON.

[Jan. 8.1887.- r 3$

though there were vascular storms, perhaps dominated by
▼sso-motor centres of the cord.—Dr. Harrington Sajns-
bi*bt ashed whether there was any Bright’s disease, and
what the condition of the peripheral vessels was.—Dr. J.
A. Ohmrbod said that in these cases there were not the
symptoms of peripheral neuritis, lie had recorded in the
St. Bartholomew’s Hospital Reports some paroxysmal dis¬
orders that seemed to be dependent on mild neuritis : logs of
power, with pains, and the backs of the hands swelled. It
would be interesting to associate such conditions with other
paroxysmal ones like Raynaud's disease.

Mr.‘W ithers Grebn showed a specimen of Ruptured
Aneurysm from a barrister, aged thirty, who had drunk
hard, but there was a clear history and evidence of syphilis.
The patient died suddenly. The pericardium was distended
with black clot, and a soft fawn-coloured bulging of auri¬
cular shape, the sac of an aneurysm of the wall of the right
ventricle. A yellowish-white gummatous-looking swelling
was seen around the aneurysm. The clear dependence of
the ruptured aneurysm on syphilis was the great interest
of the case.

The following card specimens were shown :—Mr. Butlin
far Dr. Davies: Maternal Impressions; Purpura of Hands
and Face in a New-born Child, who died in three hours. The
mother was said to bare been strongly impressed by the
sight of a case of haemorrhagic purpura one month before
h-r delivery. Mr. Targett: Congenital Deformity of Leg
and Foot. Mr. Eve: (1) Multiple Painful Lipomata of
the Arms: (2) Diffuse Unilateral Papilloma of the Tongue.
Mr. Charters Symonds: Hydatid of the Breast. Mr. J. R.
Lunn : Tumour of the Clavicle displacing the Larynx. Dr.
Drewitt: Aneurysm of Mitral Valve. Dr. Sainsbury:
Bsematoraa of Dura Mater. Dr. G. N. Pitt: Carcinoma of
the Spine and Liver, with Deposit in Douglas’s Pouch.
Recent specimen.)

The following is a list of office-bearers for the ensuing
Tear:—President: Sir James Paget, Bart., D..C.L., LL.D.,
F R.S. Vice-Presidents: Dr6. Henry Charlton BastiaD, Syer
Bristowe, T. II. Green, Douglas Powell, 3ir Joseph Lister,
Bart„ D.C.L. LL.D., F.R.S., Messrs. Morrant. Baker, Sydney
Jones, and T. P. Pick. Treasurer: Mr. John Wood. Honorary
Secretaries: Dr. Sidney Coupland, Mr. Rickman Godlee.
Council : Dra. Robert F.dmund Carrington, Henry Radcliffe
Crocker, David White Finlay. James Kingston Fowler, James
Frederic Goodhart, Walter Baugh Hadden, Arthur Edwin
Temple Longhurst, Norman Moore, Joseph Arderne Ormerod,
Felix Semon, Messrs. A. A. Bowlby, H. Butlin, W. Cheyne,
Frederic 8. Eve, H. Oolding-Bird, J. H. Morgan, 8. G. 8hat-
tock, J. B. Sutton, Charters J. Symonds, Frederick Treves.

EPIDEMIOLOGICAL SOCIETY OF LONDON.

Typho-malarial Ft-cr.

At a meeting held on Dec. 8th, Dr. W. Dickson, R.N.,
President, in the chair.

Dr. J. E. SqciRE read a paper on the above subject, of
which the following is an abstract. When observing the
fever which occurred amongst the troops round Suakim
during the campaign last year, Dr. Squire realised that
there were two diseases present, both possessing similar
symptoms, which led to their being diagnosed as enteric
fever. Post-mortem examination showed the diagnosis to
be correct for some of the cases, but in others, similar as to
symptoms, ihe absence of the enteric lesions which were
expected to be present proved that these latter were not
enteric fever. The definition of tbe term “typho-malarial
fever* requires to be agreed upon before proceeding, for
opinions differ as to its signification. The College of Phy-
■icians, fallowing the opinion expressed by the International
Medical Congress at Philadelphia in 1870, places tbe name
as a subdivision of enteric fever and describes it as a “com¬
bination of malarial snd enteric fevers”— in other words, a
compound fever resulting from the simultaneous action of
two distinct poisons. A somewhat similar view was upheld
before this Society in 1881 by Dr. E. G. Russell, who speaks
of typho-malarial fever as an example of the parallelogram
of forces, it being, as he considers, tbe resultant of the two
poisons of malaria] and enteric fevers. Dr. Woodward, who
gave us tbe name, considers it a hybrid between these two
diseases. Against these views the writer protests and gives
preference to the opinion that typho-malarial fever is not a

result of the enteric fever poison, but a form of malarial
fever, and he gives os a definition that “typho-malarial
fever is an expression of the malarial poison (or a malarial
fever) in which intestinal and adynamic symptoms are
prominent, causing the illness to simulate enteric fever.”
Tbe College of Physicians, in saying that typho-malarial
fever is a combination of malarial and enteric fevers, pro¬
bably intend to signify that the one is modified by the othtr;
not that a distinct disease- a hybrid, in fact—is produced,
os would be suggested by Dr. Russell’s simile of the paral¬
lelogram of forces. The belief in hybrid diseases should be
passed for ever. A specific poison produces a specific disease
with certain pathological results. The symptoms may be
modified by a variety of causes within or external to tbe
patient; or two poisons may enter tbe system at the same
time, and one may then delay or modify the manifestation
of the other, but no new disease is thereby produced. If
the term “ typho-malarial fever” expresses nothing to men’s
minds beyond a modification of enteric fever, or a hybrid
disease, it is not worthy a place in our nomenclature. But
if a poison absolutely distinct from that which produces
enteric fever, and with a different pathological manifesta¬
tion, may, under certain conditions, cause symptoms closely
resembling enteric fever, and an illness often mistaken for
this disease, then we have a morbid state of much interest
and of great importance, and one which has a claim to
special recognition. This would appear to be the case with
regard to the subject of this paper. The term “typho-
malarial fever,” having at length been included in our
nomenclature, should remain; but it should be trans¬
ferred from its present position under “enteric fever,”
and be placed as a subdivision of malarial fever. The
pathological signs, rather than the symptoms, serve to
show the differences between typho-malarial and en¬
teric fevers; and where the necropsies disclose the
Peyerian ulceration of enteric fever, the latter disease is indi¬
cated. Dr. Squire's experience at Suakim showed that
besides cases of true enteric fever, verified post-mortem, there
were other cases diagnosed as such in which the necropsy
showed an absence of ulceration in Peyer’s glands, even after
three weeks’ illness, and only a general congestion of the
intestinal mucous membrane. Other instances were referred
to, especially an putbreak of fever in two regiments in the
Bengal Presidency, recorded in the Army Medical Report
for 1879, in which similar experience showed the existence
of enteric fever side by side with cases closely resembling
this disease, but in which the intestines were unaffected.
The course of typho-malarial fever is thus described : Ton¬
sillitis may occur as a premonitory sign. The onset is some¬
times more sudden than that of enteric fever, and bilious
vomiting is often an early and persistent symptom. Diarrhoea
is frequently, but not invariably, present, the stools
being greenish or resembling those seen in enteric
fever. Congestion may extend along the whole length
of the alimentary canal, causing nasal catarrh, or
symptoms resembling dysentery. Later on the tongue
becomes dry and brown, and sordes appear. Mental apathy
gives place to low muttering delirium, with subsultus and
other signs of the typhoid condition ; and death may result
from exhaustion, or a prolonged convalescence keeps the
patient in hospital for weeks or months before the absence
of diarrhoea and evening fever allows of dismissal from
hospital. The temperature, though often resembling that
of enteric fever, reaches a high point earlier in the illness,
and the daily range is greater. The absence of rose spots is
invariable. The symptoms being thus so similar to those of
enteric fever, we must turn to the pathology of the disease
to see the great distinction between the two, their differen¬
tiation being of importance from the differences in etiology.
Speaking generally, the difference is found in this: that
whereas cell-proliferation and subsequent ulceration in
Peyer’s patches and the solitary glands of the ileum is the
pathological sign of enteric fever, such ulceration is rarely,
if ever, found after death from typho-malarial fever. As m
other malarial fevers, ulceration may be found in the intes¬
tines in typho-malaria, bnt it does not select, and is not
confined to, Peyer’s patches and the solitary follicles. These
ulcers may be found in any part of the alimentary canal,
and may be of any shape and of almost any size. The other
pathological signs are those of malarial fevers: congestion
and ecchymosis of the intestinal mucous membrane,
especially in the duodenum and upper jejunum, enlargement
of the spleen and of the mesenteric glands, and congestion
of the liver. Among the complications met with, hcemor-

O

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CAMBRIDGE MEDICAL SOCIETY.

{Jan. 8,188*/.

rhaga from the bowels, urinary organs, and other parts is
not uncommon. Pulmonary congestion or pneumonia may
occur. Jaundice may be present. Purpuric blotches, with¬
out scurvy, were seen in some of the cases at 8uakim.
Rheumatism, sometimes with effusion into the joints, has
been observed. Typho-malarial fever may occur wherever
malaria is found ; imperfect sanitation, or the prevalence of
enteric fever, may determine the intestinal symptoms. Over-
fatigue and excitement are predisposing causes. Typho-
malarial fever is not communicable from person to person.
It is probable that the fever of Gibraltar, Malta, and the
Mediterranean may sometimes be of the nature of typho-
malarial fever. The author’s experience was gained at
Suakim, where malaria in other forms is also met with.
Much difference of opinion exists as to what cases should be
included under the term M typho-malarial fever." Dr. 8quire
proposes that the term should be restricted to malarial fevers
which in their symptoms closely simulate enteric fever, aijd
that those cases should be excluded which are found post
mortem to have the pathological appearances of enteric
fever. Temperature charts illustrating the cases were
exhibited.

In the discussion which followed, the President, Drs. Hunt,
Magill Dwyer, Phillips, and Buchanan took part.

CAMBRIDGE MEDICAL SOCIETY.

A meeting of this Society was held on Nov. 5th, Dr. J. B.
Bradbury, President in the chair.

Pseudo-Hypertrophic Paralysis. —Dr. Bradbury showed
a boy, aged twelve, from Castle Hedinghatn. Two first cousins
were said to have died with this disease. The patient was
Always well and active before the present illness, which was
first noticed in 1881. A tendency to fall down frequently
when running down hill was observed, and his legs had
been gradually getting weaker, so that he was unable to get
off the floor when in a sitting posture. He suffered from
nocturnal incontinence of urine nine months ago. His
intellect has gradually been getting weaker, and his eyesight
has been failing for the last three months. He is said to
have had large calves since birth. His appearance is fairly
healthy, but he complains of weakness in the legs, and pain
in the back on sitting up. His calves and buttocks appear
large, and he walks with a swinging movement of his body
from side to side. When placed on the floor he has great
difficulty in getting up, and pulls himself up with his handB
or climbs up his thighs in the characteristic fashion. He
stands on his toes with his heels off the ground, and the
abdomen arches forwards. Some of the muscles are atrophied
—namely, the deltoids, erector spin®, latissimi, and chondro-
sternal portion of pectorals; and the gastrocnemii and
latissimi do not react to the faradaic current. Sensation is
good, but the tendon reflexes absent. Optic discs appear
normal, but there is slight internal strabismus when reading.
Urine normal—Mr. Marten showed for Dr. MacAlister a
boy, aged ten, who was suffering from the same disease.

General Sarcomatosis; Death from Acute Myelitis.- -Mr.
Laubencb Humphry related the case of a gardener, aged
nineteen, single, who was admitted into Addenbrooke’s
Hospital on July 14th, 1886. He had always enjoyed good
health until the present illuess, and there was no history of
heritable disease in the family. The present illness com¬
menced about the beginning of June, 1886, with pain in the
loins and weakness in the legs; lie had to give up work,
but was able to walk about. The patient on admission was
pale and weak, and had evidently lost flesh; he complained
of aching pains in the knees and hips. The evening
temperature was 102°, the morniug 98°, and there were
alight sweats. In'the submaxillary region on the right 6ide
was a freely movable swelling about the size of a walnut,
which he had hardly noticed. The muscles of the legs were
small and flabby, but there was no loss of sensation, and no
swelling of the joints. The patellar reflex was normal, and
slight ankle clonus could be obtained. The urine was normal,
and there were no physical signs of disease in the chest. On
July 17th, four days after admission, the legs became
suddenly numb and all motor power in them was lost; the
urine was retained, and had to be drawn off by the catheter.
A few hours after he suffered from severe girdle pains at the
level of the umbilicus. On July 19th the pain8 were

subsiding, there wc of hyperesthesia at the

umbilicus, and more or less complete loss of sensation from
this downwards. Tendon reflex gone; plantar reflex absent.
Cremasteric delayed; epigastric present. The bowels acted,
unconsciously. The symptoms now all pointed to sudden,
compression of the spinal cord and rapidly ascending
myelitis. During the day a crop of subcutaneous sarcomatous
nodules appeared on the front of the abdomen and chest,
with flat tops and a surrounding zone of redness. There
was copious sweating, and the temperature varied,from
98° in the morning to 104° in the evening. On the 20th.
a bedsore developed over the sacrum and rapidly enlarged.
The muscles of the lower limbs wasted rapidly, and had lost
their electrical reactions. On the 22nd there was weakness
in the arms, and the intercostal muscles were paralysed.
The subcutaneous nodules were increasing in number, and
extended to the scalp, but there were none larger than a
sixpence. The tumour in the neck had increased considerably.
The patient became gradually weaker and more drowsy
during the next fortnight, the bedsores rapidly increased,
the Jurine became offensive, and he died on August 18tb.—
Mr. J. Griffiths gave the account of the necropsy. The
tumour in the neck was beneath the sterno-mastoid muscle,
and was sarcomatous, of the small round-celled variety.
The dura mater of the brain presented on its outer surface
very numerous flattened growths of small size, situated
for the most part along the course of the longitudinal
sinus and slightly adherent to the inner surface of the
skull. There were small nodular growths also on the
inner surface of the dura mater in front of the fissure of
Rolando. On the inner surface of the seventh, eighth,
and ninth dorsal vertebral there was a mass of new growth,
extending to the outer surface of the dura mater and.
attached to it. This was so thick as to produce evident
compression of the corresponding part of the cord. In the
rest of its extent the spinal dura mater was free from
growths. The spinal cord below the mid-dorsal region dis¬
tended its membranes, and below the seat of compression,
was soft and granular-looking. In the upper dorsal region
the softening only involved the central part of the cord, and
there was a focus of softening in the lower cervical region.
In the upper part of the dorsal region and throughout the
cervical the postero-median columns and direct cerebellar
tract showed commencing degeneration, and in the cervical
region, in addition, the tract of Gowers showed the same,
change. In the medulla, just above the decussation of the
pyramids, there was a small band of degeneration laterally
at the external border, and tracing this upwards it gradually
spread outwards into a thin band and became lost. There
were small secondary nodules on the pleura and pericardium..
In the kidneys were small secondary growths, chiefly in the
cortex; and in the medulla were numerous pmall abscesses,
surrounded by well-marked congestion. The ureters and
pelves were thickened and inflamed. The bladder waa
thickened, and the inter-muscular connective tissue much
increased. The small abscesses in the kidneys contained
micro-organisms, and minute embolic abscesses were found
commencing in the liver and wall of the heart. The vessels
supplying the softened area in the cervical region were
found to be plugged with the same bacteria. All the
secondary growths and subcutaneous nodules had the same
structure as the tumour in the neck. The thymus gland
was not enlarged.

Death folloteing soon after Washing out Dilated Stomach .—
Mr. Marten brought forward the case of a patient who waa
admitted into Addenbrooke’s Hospital, under Dr. Bradbury,
for stricture of the pylorus. He was forty-eight years old,
and seven years previously had been an in-patient, with
symptoms of pyloric ulcer. His stomach was now much
dilated, and he suffered from flatulence, vomiting, pain, and
increasing weakness. He vomited large quantities of frothy
fluid, containing sarcin®. Ten days after admission it waa
decided to wash out the stomach. Soon after passing the
tube into the stomach the patient became very faint, so it
was withdrawn. About two hours afterwards he complained
of stiffness in the jaws, with inability to open the mouth,
and rigidity of the arms, which were strongly pronated and
flexed, the thumbs being turned on to the palms. The
patient was conscious, and sweated profusely. The rigidity
spread to all the muscles of the limbs and trunk, and tho.
temperature rose to 103-4°. He became pulseless and livid,,
the temperature rising to 107'2° before death, which occurred
six hours and a half after washing out the stomach. Post¬
mortem examination showed a simple stricture of the
pylorus, with the scar of an old nicer, and a much-dilated

ZdLaxck,]

SHEFFIELD MBD1C0-CH1RURGICAL SOCIETY.

{Jan. 8,1887. 75

•toouch. There tu no injury or abrasion of the mucous
sura brace. The other organs were healthy, and no lesion of
the brain was dif covered.

SHEFFIELD MEDICO-CHI RURGICAL SOCIETr.

A MKJtTlNG of this Society was held on Nov. 25th, 18S0,
Dr. Cleaver, President, in the chair.
large ThrombusofRight Labium.— Mr. IF . M. Jonbs reported
this case, which be was called to see about six hours after
labour in a young primipara. He opened it and evacuated
more than is pint of clot, and applied carbolic dressings
and pressure. Severe eclampsia and suppression of urine
followed, but the woman made a good recovery. There was
slight suppuration, but in a fortnight’s time the wound bad
quite healed, leaving the parts in a normal state.

Poisoning by Cocaine. —Mr. Kelham related this case. A
nan aged thirty took 4} grs. of hydrochlorate of cocaine in
solution by mistake. In twenty minutes he was seized
with severe pain in the stomach, thobbing of heart, loss of
eyesight and of power in the lege, with incoherence of speech
and confusion of ideas; no unconsciousness. Severe vomit¬
ing came on with cramps in the stomach and legs, very pro¬
fuse perspiration, intermittent action of the heart, cyanosis of
the face, and feeling of suffocation; then severe prostration,
shivering, and coldness of the skin. The severe symptoms
passed off in about three hour?, but the prostration and
vomiting lasted all next day. Thirty-six hours after takiDg
the cocaine he began to lose taste, and had a leathery feeling
in the mouth and tingling of the Angers. The treatment
consisted in emetics and stimulants.—Remarks were made
by Mr. Snell, Dr. Roberts, Mr. Jones, and Mr. Pye-Smith.

At the meeting on Dec. Oth Dr. Cleaver again presided,
and the following cases were narrated
Biliary Calculi.—Mr. Pyb-Smith exhibited the morbid
specimens and related the notes of a case of biliary calculus,
which had lodged in the neck of the gall-bladder of a
woman aged forty-two. The right leg Had become gan¬
grenous and had been amputated, but the patient slowly
sank. He also showed a facetted gall-stone, passed per
taam, from a patient who had presented signs of abscess of
tbs liver or bile passages, and who had for some days acute
intestinal obstruction, and had since coughed up suddenly a
quantity of pus coincidently with shrinking of the abscess
and the development of a pleuritic rub on the left side. The
patient, a man aged sixty-three, was now convalescing.

Locomotor Ataxy.—Hr. Gwynne gave notes of the case
of a woman aged forty-seven, in whom the patellar reflexes
were exaggerated. Girdle pains were present, with frequent
micturition, impaired sensation, and incoordination of move¬
ment. Dr. Gwynne explained the symptoms by supposing
disease of the lateral columns to exist; and while the reflex
loop* in the posterior columns were more or leas affected, the
disease was probably mainly centred in the groups of cells,
which by their connexions preside over coordination of
muscular actions.

Locomotor Ataxy (Acute). —Dr. Porteb showed a patient
suffering from ataxic symptoms and diminution of muscular
seise in both upper and lower extremities, and affection of
■peeeh of the same character, coming on rapidly within four
months. The patellar tendon reflex was diminished. There
vii no paresis, wasting, or sensory disorders. The early
symptoms bad bepn stiffness, rather than pain, in the knees,
ieet, and shoulders, with gastric irritability, nausea, and
occasional vomiting. There was no history of lightning
paisa. The pupils were equally dilated, and irresponsive botE
to light ana accommodation; discs atrophic. Sexual power
had disappeared completely. Dr. Porter considered the case
to be of the nature of locomotor ataxy as regarded the
symptoms, but too acute for sclerosis, and somewhat
irregular. Although he could not obtain any history or
sridsoce of syphilis, he thought it might be of that nature,
ud was treating the patient with large doses of iodide.

The immediate Cause of Death in Malignant Cases of
Peter.— Dr. C. II. Willey, of the Borough Fever Hbspital,
ia reading this paper, said that the cases under considera¬
tion were those of scarlet fever and small-pox, in which
uaeonacknisness and death ensued at an extremely early
*aoe. The pathology of this condition has not been
upwined. The conclusions to which Dr. Willey had
drived were based on clinical observations and post-mortem

examinations in twenty-five of thebe malignant cases. The
chief factors in the investigation appeared to him to be that
the fatal symptoms in each case were those of a rapidly
failing circulation, and that after death the chambers of the
heart, and particularly the right ones, were completely filled
with white, jelly-like clot, which was, be said, clearly of
ante-mortem formation. The failure of the circulation ensues
(particularly in small-pox cases) with great suddenness; and
the question arose, Was this failure or the thrombosis the

f irimary condition? Evidence from the main symptoms and
rom such invariably accompanying ones as pulmonary
oedema and copious diarrhoea. Dr. Willey said, goes to show
that failure of the circulation is the primary cause of
death; and, further, that not only is the heart paralysed, but
also the entire arterial system; in fact, that an entire
collapse of the blood-pressure throughout the vascular
system is brought about with more or less suddenness by
a functional failure of the sympathetic nervous system,
governing as it does the cardio-motor and vaso-motor
functions. Tbo pulmonary oedema and the profuse intes¬
tinal flux are due to the same cause: they are undoubtedly
associated with a greatly diminished blood-tension in the
arterial system.—Remarks were made by Mr. Walker, Dr,
Gwynne, Mr. Baldwin, Dr. 8. White, Mr. James, Dr. S,
Roberts, and Mr. Pye- Smith.

LEEDS AND WEST RIDING MEDICO-
CHIIUJRGIOAL SOCIETY.

An ordinary meeting was held on Dec. 3rd, Dr. C. S. Smith,
President, in the chair.

Supra-jmbic Lithotomy.—Hr. McGill read a paper on
three cases in which he had recently operated. In the first,
the patient, aged forty, underwent lithotomy seven years
before. Three stones, weighing respectively 3 oz., 2 drs., and
10 grs., were extracted. Urine passed by the urethra on the
twentieth day, and recovery was complete. In the second
case the stone weighed £ oz.. The wound was healed on the
tenth day. The patient was aged. In the third case there
was considerable doubt as to whether a stone was really
present, but eventually a calculus weighing 10 grs. was
removed. The bladder wound was stitched up, but the
unne escaped. Mr. McGill pointed out that tnere was a
singular coincidence between the mortality after lithotomy
in ancient and modern statistics; and this was borne out
by the accounts kept in the Leeds Infirmary during the last
fifty years. According to the Norwich statistics, 66 per
cent, of cases when the 6tone was over 3 oz. proved fatal,
and 25 per cent, in cases over forty. He thought the opera¬
tion contrasted very favourably with the lateral operation
in facility of performance, convenience in thoroughly
exploring the bladder, and in the risk of haemorrhage, and
that shortly the operation would completely take the place
of the older method. With regard to lithotrity, he pointed
out that there was a return of the stone in one in seven
cases according to Sir H.Thompson’s statistics.—Mr. Wheel-
house pointed out that lateral lithotomy held its ground in
former times because of the rapidity with which it could be
performed in the pre-an aesthetic period. At one time
median lithotomy threatened to monopolise the field; but
he held now that with a small stone and a healthy bladder
lithotrity was to be preferred, but with a large stone and an
aged patient the supra-pubic incision was the best.

Experimental Researches respecting Pasteur's Anti-rabic
Method—Dr. Himk gave an account of some experimental
researches he had lately conducted on this subject. (See
The Lancet, Dec. 11th, 1886.

Toxic Effects ofifath of a grain of Sulphate of Duboisin.
Dr. Chadwick related a case where this amount of the drug,
instilled for examination of a senile cataract, produced a
state of delirium lasting many hours, leaving the patient
totally unconscious of wnat had occurred. There was great
muscular weakness, and many strange actions were per¬
formed. It was suggested that the susceptibility to this
drug reached its maximum in old age, and that the aiihilarity
between the symptoms and those of senile atrophy, popu¬
larly known as “ softening of the brain,” might suggest that
its action was by causing spasm of the cerebral arterioles,
and might indicate a possible liability to that form of patho¬
logical change.—Dr. Major said the symptoms closely
resembled those he bad noticed in a medical friend, who
took for experimental purposes a large dose of byoscyan:?'**

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being characterised by strange antics, 'with curious un¬
reasonableness. lie attributed much of the effect to delusions
of vision. __

NOTTINGHAM! MEDICO-CHIRURGICAL SOCIETY.

A meeting of this Society was held on Friday, Dec. 17th,
Mr. Hatherly, President, in the chair.

Mr. E. Powell showed a case of Cervical Rib in a woman,
the patient of Dr. Handford.

Mr. Pryor brought forward a young woman, aged twenty-
three, who presented the condition of Cervical Rib on both
sides of the neck. ■ .

Mr. Pryce also exhibited the following specimen Pyelo¬
nephritis, Inflammation of Right Ureter, Cystitis and Caseous
Deposit in the Prostate, probably of a tubercular origin,
from a man aged twenty-four, who during life had suffered
from intermittent attacks of hfematuria, great prostration
and loss of flesh; likewise a water-colour drawing of the
same by Mr. Geraty.

Dr. Whiteleggb read a paper on Disinfection. The
experiments of Koch, Klein, and Parsons were summarised,
and shown to disprove the efficacy of almost all the ordinary
chemical disinfectants. Some were practically useless-
sulphate of iron and chloride of zinc, for example ; while
others were mere deodorants, without any true disinfectant
action. Some, again, were antiseptics only—that is, they
held in check the multiplication and growth of germs for
the time being ; and many of the true germicides were
employed in such insufficient strength or duration of
exposure that their action must necessarily be nil. The only
trustworthy chemical disinfectant or germicide at present
available seemed to be mercuric chloride. Of aerial disinfect¬
ants or fumigants, chlorine was by far the most satisfactory,
and, unlike sulphurous acid, could at least be relied upon to
disinfect all exposed surfaces, but the practical difficulties
attending its efficient use were very great. No fumigant
could disinfect bedding or clothing. Articles such as blankets,
which could not be boiled without injury, should be dis¬
infected by steam, in a special apparatus. Although hot-air
disinfecting stoves had been of the utmost service in the
past, they would not deal with such refractory organisms
as spores of bacilli, even if exposed freely, without injury
to fabrics. Finally, it was pointed out that, with the
exception of boiling and treatment by mercuric chloride, no
real disinfection was possible by unskilled persons in private
houses; and, further, that isolation must be regarded as the
sheet-anchor in dealing with infection, its importance
becoming more and more manifest as we realised the futility
of ordinary disinfection. In private houses it was rarely
possible to maintain isolation for more than the commence¬
ment of the long and tedious period of still infectious con¬
valescence.

YORKSHIRE ASSOCIATION OF MEDICAL
OFFICERS OF HEALTH.

The annual meeting of the members of this Association
was held on Dec. 21st at the Town Hall, Bradford, Mr. S. W.
North (York) presiding.

Dr. J. M. Wilson (hon. secretary) read the report of the
committee, which was adopted. Mr. North having intimated
his desire not to seek re-election as president, Mr. Roberts
moved: “ That the cordial thanks of the Association be given
to Mr. North for the valuable aid he has given to it during
the eleven years he has been President.” The resolution was
seconded by Dr. Giddings, and carried. Dr. T. W. Hime
(Bradford) was elected president, on the motion of Dr.
Giddings, seconded by Dr. Edwards, and supported by Dr.
Britton and Dr. Byles. On the proposition of Dr. Cameron,
Mr. North, Dr. Giddings, and Dr. Britton were elected vice-
presidents, Dr. J, M. Wilson (Doncaster) was re-elected hon.
secretary, and Dr. Bruce Low hon. treasurer.

Dr. J. M. Wilson read a letter from Dr. Alfred Hill
(Birmingham), who said he had felt for some time that it
would be to the advantage of the whole body of the medical
officers of health if they were to form themselves into one
society; and Dr. Britton moved, and Dr. Htme seconded,
the following resolution: “ That this meeting, having heard
the pommunicatlon of Dr. Hill on the. subject of the pro¬
vincial Societies of Officers of Health joining the Central
Association in London, desires to express its concurrence in

his views, and that we appoint the president, ex-president,
treasurer, and secretary as a subcommittee to arrange the
details.” The motion was carried.

Dr. J. M. Wilson read a paper, giving an account of an
Outbreak of Diarrhoea caused by the emanation of noxious
gases from tide-locked sewers.—Dr. Byles called attention
to the extra duties required of medical officers of health
under the Cowsheds and Dairies Order, by which the inspec¬
tion of these places has been transferred from the county
constabulary to the local authorities in each district. He
said he foresaw that if they were to carry out the duties
imposed upon them by the new Order they would have a
largely increased amount of work to perform, and a deal of
it of a dirty, disagreeable, and dangerous character. It
looked as if medical officers were about to be called upon to
perform the duties of veterinary surgeons. Another matter
for medical officers to consider was as to how they were to
be remunerated for their services.—Dr. Hime said that it
had been his practice in Bradford, when a person made an
application for a licence, to go to the premises and see if
they were suitable. Tue power they possessed over dairies
and cowsheds was very inadequate, and they were sadly in
want of stringent bye-laws for their regulation.—Dr. Britton
said that he had received no information on the sub jeer,
either from the Local Government Board or his own board,
and until he did he should not feel called upon to act in the
matter. In his opinion the examination of dairies and cow¬
sheds ought to be left in the hands of the nuisance inspector.
—Dr. J. M. Wilson remarked that his inclination would be
to superintend the work, which should be done by the
nuisance inspector. As medical officere, they ought not to
forget that they were advisers on matters of health to
sanitary authorities. After they had made themaelves
acquainted with the requirements of the new Order they
could consider the question of remuneration,—The Chairman
said it was part of his duty as a medical officer to inquire
into the causes of disease within the area of his local
authority, and he had never hesitated to go into dairies and
cowsheds to see whether they were kept in a satisfactory
manner.—Dr. Scott believed that the new Order would
involve very little extra labour upon medioal officers.

Dr. Hime afterwards exhibited a Pasteur-Chamberland
filter, and the Secretary a sample of peat duet for use in
earth-closets.

H^frufos anh Notices of ^ooks.

General Paralysis of the Insane. By Julios Mickle, M.D.,
&c. Second Edition, enlarged and rewritten. London:
EL K. Lewis.

The second edition of this exhaustive monograph is to a
large extent a new book, contains nearly double the amount
of matter presented in the first edition, introduces many new
points, and also treats old subjects on entirely new lines.

With regard to the nature of general paralysis of the
insane, the chapter on Pathology considers this from every
point of view. This chapter has been entirely rewritten,
and deserves the most careful perusal by the student. It is
here stated that, with regard to the essential nature of the
disease, it may be a mere complication of insanity, or, what
is more likely, a distinct and special form of mental disease.
It may be a disease with and also without insanity; it may
be of an inflammatory or of a degenerative nature ; its seat
may be in the brain, the cord, or the sympathetic nerves;
but its point of departure appears to be almost invariably
from the cerebral cortex.

Let us now briefly glance at the novelties most con¬
spicuous in the new edition of this valuable work.
Hallucinations, formerly declared not to exist in general
paralysis, are found by the author to be occasionally vivid,
though at other times by no means obvious. Fifty-five out
of a hundred cases possessed them. The handwriting
becomes illegible and shaky, Bacon’s illustrations and
Blandford’s recognition of the omission of words being
here mentioned. Athetosis and choreiform movements
frequently follow epileptic attacks, and reflex activity
becomes lowered later on. Anosmia, with wasting of the

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76 The Lancet,] NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY (Jan, 8,1887.

Tr* L£nc*t,l

REVfEWS AND NOTICES OP BOOKS.

[Jan. 8,1887.' f?

olfactory bulbs, is present in chronic cases, and here the
lather's expe rim ents -with onions, camphor, and pepper are
quoted. This is often- attended with a defect of taste,
auditory hyperesthesia, and sometimes deafness. Tactile
inability in the last stages is abolished, yet hyperalgesia
end nduralgia paay tobrist. Cataneous illusions, such as
Uows, kicks, or lightning ^ains, are now complained of,- aqd
in Connected probably wirir tonie spinal disorder. ’ ,

The remrefcs 1 on bedsored 'are very complete. These
eidcAy attack the sacrum, trdchanters, heels, ankles, knees,
dhows, toed, Wrtebrae, scaphlse, and even the occiput. ,
Surgical measures are occasionally callMf&r, as when pus
tottxrtTmfneetn&lly atfiongst the tissues. Htematoma
nrfd usually begins In the foesa of the helix, but it is Bot
peculiar to general paralytics,’ as it has been seen in the ear
of * v prize-ftgfcterf Sutherland), add amongst schoolboys
frcna violehce at footbal! (Farquharaon).

Dr. J. 6. Davey seems to hare 1 been the first observer of
boac ; Mreiwo in insanity (1843), and Dr. J. W. Ogle has drawn
ilteWtidft to experiments in Which the interference with
aar re s u pply ‘brought oh hyperostosis, Dr. Ormerdd -has
fnwsd the riba in general paralytics dark, wot, greasy, and
kftUs, with small Haversian systems. - Drs. Cloiiston and
WflBaas have noted that these ribs break more easily than
these’ of 'a beelthy'man, which Dr. J. L: Rogers considers
death the diminution of calcic salts. There are, moreover,
special arthropathies in this- disease, which are here illus-
tmtodby cased.

M the bloOdef the general paralytic there is obviously a
ipMfamis ih the last? staged Thakrah and Hittorf observed
it* hydrediia; Mtchdb found the- seruin solids increased;
A 3. SutheHand and. Boned Jdnds found a diminution of
aRxmtte;' and H. Sutherland beiieVed that an absence of
nxdeatix, together with an increase in the colourless dbi*-
puedea, Were conditions almost peculiar to general paralysis;
ad the researches of Voisin, Brunet, mid lately of Maephail,
agree with these result*.

That the temperature in gen eral paralysis is increased in
the maniacal and apoplectic attacks has been remarked by
the author and by Meyer j Dr. Clous ton has also observed
that the average evening temperature is always above that
of the morning. The pulse, in the early stages is full and
hard, and the second sound of the heart accentuated, the
author's remarks here coinciding with those of Dr. Sevan
Lewis. Generally speaking, the average evening tempera¬
ture, poise, and respiration are above the normal. Sometimes
the poise goes up to SO, 90, and 100, and in other cases descends
to <M and 66. Dr. G. Thompson’s able remarks on the
■pbygmographic tracing. of the pulse in general paralysis,
which he considered indicative of spasm of the arteries,
sre denied by the author. In 1877 tho author placed on
mooed some example* of unilateral sweating in general
paralysis, affecting one aide of the face and head.

The terminations of general paralysis may be death,
rhrosaic mental disease, or (2) recovery. The modes of
death may be exhaustion, septicemia, pyemia, spinal
taaeaegitie, pulmonary or abdominal diseases, such as pneu-
maftia, phthisis, diarrhoea, nephritis or cystitis, hamor-
rhggeet epileptiform otmvalsions, apoplectiform attacks,
chokihg by food. Suicide , is rare, but rib
frseteTt ia so m et i mee a cause of death. In a large share of
caaes e s Wsre l factore are eonesmed.

Urthe chapter on Diagnosis We have these additions: The
iTi^iflfinn be t wee n general paralysis and acute alcoholism
wapw^dtt&atioct, deliriu# tremens, melancholia with Btupor,
Jteetipflfn dementia, and poisoning by
i rmplBi -ifepmides, utf.jq; tide, Qtpqf, disease* simulating
pOtfMtpwnltpsis havaato keen described at greater length-

MaOnhad of OnidagDu Miekl*^ has computed, that

of g^ilB hl WdisIhiifilii^lliPtnghthd ana Wdles of insane
pmAi|p|^fV^hSh ; foitt years—viz., 26,658 males add

- - <aCb

27,984 females, or a total of 64,642 persons— 3374 males and
910 females 'were general paralytics, or A total of 4284
persons. The average proportion per cent, of the number
of general paralytics of each sex admitted to the total
number of patients of each sex admitted during these four
years was 12-65 percent, for the males and 8’26 percent.
for 1 the females, or 7*8 of the total admissions of both sexes.

' Under Hotbid-Anatomy the author-has enumerated his
observations most minutely. The adhesions were marked or
extreme in 30 per cent, of all cases of general paralysis. The
brain-weights of Crockley Ciapham are here quoted, butj
curiously, the average Weight- of the entire OncSphalon fdr
dll classes in society of males is 4461 oz., whilst the’military
standard- is 44*15 oz. Additions have been made to the
remarks concerning the state of the heart, lungs, and kidney *
in general paralysis.

The microscopical appearances are given Mly. The
brain may be first affected, the brain and cord may
be attacked simultaneously, or the cord may be fis»t
affected;’which is rate. We wuet,,ho,wew* draw, atten¬
tion to Toczek’s work on the atrophy of the nervq-fibpqc
qf the cerebral cortex; Baillargeirs and Horn's ideas that
general paralysis, oan be eaueed by propagation, as from
simple tabes dorsalis;. Sir Crichton Browne's and Blsndford’s,
theories that general paralysis is a disease of inflammation *
Boinet and Poincare's notion that it is & vasomotor disorder;
and the author's statements that it may be viewed a* a
meningeal, a spinal, or a neurotic, affection. Post mortem,
the inflammatqryitheory is constantly upheld, as,shown by.
the opacities, -adhesions, coloured skull-cap, and arachnoid
cysts so common in general paralysis. Which part is first or.
mainly inflamed ? Some say the meninges, some the cortex,j
some both, some the cord, and others, again, the cerebro¬
spinal nervous system.

Tho chapter on Th eyapeutiea, has been rearranged, and
expanded. The apparently new points here are the remarks
upon ergot, physostigma, digitalis, and nitrate of silver.
Maniacal excitement may be. dealt with by quickly acting
purgatives, warm baths, the bromides, veratrum viride,and.
Sther spray to the head. Opiates and henbane are not,
recommended, and the ill ieffects of chjoral, where oontrar
indioated, are alluded to. , t .. i..«.

. The chapter on the varieties ol gpeefraj. paralysis, and also
the illustrative cases have been very wisely .curtailed. -

As we have said, this manual qf General Paralysis. i*
exhaustive. It is a book which must necessarily find a place ’
upon the shelf of every medical man who desires to keep up.
to the standard of the time, be he physician, surgeon.
obstetrician, or psychologist,.

Functions of. the Brain. By David Ferbieb, M.D.,
F.R.C.P. Second Edition. London: Smith, Elder, and
Co. 1886.

This work is well known to all who take an interest in
the science of neurology, of which the functions of the brain
form no small part. It is needless to say anything in praise
of the work, the second edition of which is brought well up
to the times. No scientific medical man’s library can be,
said to be complete without Dr. Farrier's book, which con¬
tains the records of the author's own work, as well as those
of other observers of repute.

Dr. Ferrier is careful to give the different views of authors
concerning disputed anatomical and physiological matters,
and in places helps the reader to discriminate between
opposing or apparently antagonistic opinions. The book is
abundantly illustrated, and most of the figures convey in a
definite manner the points referred to in the text. The
definition of some of the figures is really excellent—Figs. 28
ct teq. —from sections of the monkey’s cerebral cortex, by
fiervan Lewis. That the work is well up to date is shown
by frequent references to investigations of the past year.

Digitized by GoOgle

78. Tm Lance*,]

REVIEWS AND NOTICES OP BOOKS.

[Jan. 8,1887.

Beevor’s observation is given that the fibres from the
internal capsule and those from the corpus callosum do
not interweave with each other in proceeding to the grey
matter of the cortex. This is taken from the October number
of Brain (1885). Spitzka’s observations on the Comparative
Anatomy of the Pyramidal Tract (Jan. 188G) are also quoted.
The work is one of great and peculiar value; for, even sup¬
posing that one had at hand a record of all the recent re¬
searches into this subject, it would be an exceedingly tiresome
anr( laborious task to cull from the various works all that
had been written, say, about the functions of the cerebellum
Dr. Ferrier does this for us, and arranges the matter in
harmony with his own observations and experiments; so
that in the space of sixty pages (174 to 234) we have a
connected account showing the present state of knowledge
of the subject. It is needless to say more concerning a work
which no neurologist can afford to be without.

Transaction* of the Society of Medical Officers of Health.

The volume of the Transactions of the Society of Medical
Officers of Health which has just been issued contains
several papers of especial interest. A historical account of
house sanitation formed the subject of the inaugural address
of the President, Dr. W. H. Corfleld, who told therein the
story of house-drainage from early Roman times up to the
present, and who discussed the great advance which has
recently been made in legislation affecting the sanitary con¬
dition of dwelling-houses. Dr. G. A. Heron contributed an
excellent paper on Koch’s cholera bacillus, in which he
strongly supported the view that the organism described by
the German savant deserved the position which he attri¬
buted to it, and urged the arguments which are afforded by
the effect of this bacillus on cultivating fluids. Professor
G. Bischof also read a paper on Koch’s gelatine-peptone
water test, which appears in the same volume. As a result
of much experimental work, Professor Bischof has come to
the conclusion that the test is untrustworthy, and that
the number of colonies ordinarily found in Water has
no necessary or invariable connexion with wholesomenees
or pollution; but be admits that with further develop-!
ment the test may have a value which it does not at
present possess. A very original paper by Mr. Eassie, on the
waters derived from the Bagshot beds considered as drink-
ing supplies, discusses the impurities contained in these
waters and their cause. After careful investigation, Mr.
Eassie concludes that although many of the Bagshot beds
are capable of furnishing a supply, more or less abundant,
of water for dietetic purposes, yet he says there are other
strata in the same formation which secrete and supply
waters unfitted in their natural state for potable use. He
therefore argues that every supply of water derived from
the Bagshot Beries, and especially from the middle and lower
beds, should be carefully analysed, and the deeper the source
of supply the greater the need for analysis, for the reason
of want of nearness to oxidating powers. Other papers of
importance to health officers are published with those to
which we have referred : the recommendations of the Royal
Commission on the Housing of the Working Classes as
affecting the status of the medical officer of health was
the text of a paper by Dr. Seaton; the suction of sewer
gases into service-pipes conveying drinking-water, by
Dr.Swete; the protection of milk-supplies from contami¬
nation, by Messrs Wynter Blyth and Alfred Spencer;
regulations as to lodging-houses were discussed by Mr.
Lovett; and the sanitary condition of poor districts in
the metropolis, by Dr. Parkes. We note with satisfaction
the development of this Society and its increasing powers of
usefulness to medical officers of health in all parts of the
country. The appointment of Dr. Alfro$M^il of Birmingham
as president, following that of Dr. C. & Saunders as one of

its secretaries, is ample evidence that the work of the Society
has not more relation to sanitary work in the metropolis
than in other parts of the country.

Indian Veterinary Manuals. 1. The Elephant. By John

Henry Steel, V.S„ A.Y.D. Madras: W. U. Moore.

Pp. lxiv-100. With many Illustrations. 1885.

This is the first of a series of manuals that promise to be
of much use, being written in a semi-popular style, yet con¬
taining a large quantity of not readily accessible information.
Elephants have been used in Asia and Africa from very
remote periods as animals of war, as by the Carthagenians,
Romans, and Persians; and in old times, when these could
be protected by some sort of defensive armour from such
implements as arrows, stones, and the like, they may have
proved serviceable, their huge bulk and impressive appearance
when in long ranks striking terror into those who were not
accustomed to them, or who had, perhaps, never seen them.
But Mr. Steel remarks that their use is becoming much
restricted. The elephant’s terror of firearms renders his great :
bulk and his great strength terrible rather to friends than to <
foes, and in the Burmese wars formidablelines of these animals
have been put to rout by small bodies of cavalry. Then,
again, their weight renders it difficult to transport them
from one place to another. Their keep is very expensive,
their original cost considerable, and they are liable to
various diseases. Still, elephants are extremely useful in
carrying the impedimenta of war, including not only tents .
and baggage, but cannon; whilst they can often free .
in a few minutes a gun or a waggon fixed in the mud,
which would require much time if ordinary means were
used. The work is divided into two parte, both of which 3
contain much highly interesting reading. The first, or .
introductory part, deals with the natural history of the q
elephant and his use in modern armies, whilst the second t
part treats of his diseases. We commend the perusal of ^
this book to all who are interested in this remarkable _
quadruped. __

THE EFFECT OF A DIET WITHOUT LIME UPON

THE TEETH. '

To the Editors of The Lancet. ‘

Sirs,— Far be it from me to throw cold water upon any 1
honest experimentation, especially upon the work of an 1
observer who has won bis spurs, as Dr. Miller has, by years I
of careful experimental work in the field of bacteriology, i
Still, it appears to me that more weight has been attributed
to the three experiments upon the feeding of dogs on a diet
deprived of lime salts than is legitimate, and, indeed, than !
Dr. Miller himself claims for them. He used for analysis, ,
at intervals, two upper canines and one lower, or wee versA.

Dr. Galippe has shown that the specific gravities (which
correspond pretty closely with the chemical composition) of I
corresponding teeth on the two sides of the mouth differ, as .
do those of the upper and lower jaws, in the same individuals.

Dr. Miller’s results show only small differences in the 1
percentage compositions of the teeth during the period of j
his experiment, and these differences are disoordanc. It need
hardly be pointed out that an average drawn from nine 1
discordant analyses has not the faintest significance. If any I
inference as to probabilities is to be drawn from so small a
number of cases, the one which suggests itself to me is that
the feeding was productive of no traoeable result at all upon
the teeth. It is also said that it is a fact familiar to dentists
that the teeth of an individual undergo alterations in
character as to density &c. at various periods during life.
Everyone knows, of course, that caries advances with very
varying rapidity at various periods; but it is a mere begging
of the question to assume that this is due to alterations in
the teeth and not to alterations in their surroundings. This
matter is, however, too wide a one to enter upon in this place,
so I will only say that, personally, I have never teen any case
lending support to this idea,—Yours faithfully,

Jan., 1887. Charles S. Tomes.

Digitized by CjOO^Ic j

tM Lajkj*t,1

REFORM OF THE CORONER’S COURT.

[Jan. 8, 188?. tfi

THE LANCET.

LONDON: SATURDAY, JANUARY 8, 1887.

That there must soon be a considerable reform in all
tkat relates to the office of coroner in this oountry cannot
be doubted by those who have paid any attention to the
•abject. The offioe is one of the greatest antiquity, but,
■libs some other ancient institutions, it does not admit
sf the sweeping reform of abolition. On the contrary, it
■ a moat important office, which in the very nature of
thfaga must, reformed or unreformed, endure as long as
huaaaity itself; for it must always happen that deaths
wfll from time to time occur under circumstances calling
far a* inquiry into their cause. We cannot hope for a
time when there shall be no sadden or violent deaths.
U follows therefore, that there must be some official
appointed to make inquiry into the cause of all those
d e ath a which from the surrounding circumstances demand
it It is true that in cases where a charge of murder or
manslaughter is made there is an investigation before the
magistrate; but while this has the inconvenience of a
double inquiry, it is no argument, as some contend, for
a boli s h ing the office of coroner. There are many cases in
w hich a death has occurred the cause of which is unknown,
and can only be ascertained by a searching inquiry into
ad the circumstances, including medical evidence and
a post-mortem examination, but which do not go beyond
the coroner's court. As an illustration of this, we may
■—firm the case which occurred more than forty years
ago, and was generally known as the “ Hounslow flogging
ease.* The late Mr. Thoxas Waklky, the founder of this
journal, held an inquest and made a searching inquiry into
the dea th of a soldier who had died soon after receiving
the punishment of flogging. Although no specific charge
against any individual was involved in the verdict of
the jary, and though the case did not go beyond the
e—ones’* court, the inquiry was one of the most important
evur bsH, and led to the abolition of flogging in the
Other i nstances might be given. It is plain, how-
that there mast be a preliminary inquiry into the
cause of noose deaths, and even in countries where there is
■e—rmpr’s inquest there is a modification of it, to which
we ffimflkdiude presently. It being clear, therefore, that the
mast remain, What are the reforms needed ?

' (fail let ns see what are the defects of the present

__ _ > is a total want of uniformity, from-the

■■feta* gpption to tfe dp* of the coroner’s career, whether
‘ with his office or with his life. Judges,

[ m a gistr a t e * sm ; appointed with some regard
ri so aroshuiffn^ But town and city coroners
Mffithe hxni mpjntotpal council, those of Oxford
\ Wd the Admiralty coroner

There is still soother
coroner is elected by the
of the candidates
:the eastern division of

Middlesex, intends to bring in a Bill to amend this mode of
election* and will no doubt be heartily supported. Passing
on to the qualifications for the office, we find still the some
want of uniformity. No peculiar qualification is npw
required, though in Hawkins’ “Pleas of the Grown” the
author seems to express an opinion that the persons chosen,
though not knights, must be “of good subetauce and credit.”
Praodcally, however, the office is now held chiefly by
barristers, solicitors, or members of the medical profession.
Of a total of 286 coroners whose qualifications are stated,
236 belong to the legal and 48 to the medical pro¬
fession—a disparity which cannot be justified in these days.
We have always contended that, as the primary duty of a
coroner is to ascertain with the aid of a jury the cause of
death, such duty comes more within the province of a
medical man than of a lawyer. The old objection to a
medical coroner, that bis. duty is not so much to ascertain
the cause of death as to find out who caused it, never had
any real foundation, and at the present time is wholly
untenable. It will not strengthen the ease for legal coroners
to argue, os some do, that they understand evidence and
legal formalities better than medioal men, forinquests held
even by lawyers bave been quashed for legal informalities.
And that the average solicitor is by no means well
posted up in the law of evidence is well known both to
judges and counsel, the depositions of legal coroners having
frequently been complained of as being most unsatisfactory.
Beeides all this, there is the most formidable objection of all
to legal coroners, that the duties are extremely repulsive to
the average lawyer, and the office does not attract those
who are likely to be successful in their profession. On the
other hand, the meet repulsive part of the duties—that of
viewing the bodies and taking medical evidence—is what
most medical men have been well trained to, while the office
has attracted and still attracts medical Candida tee with the
highest qualifications. Nothing can be more trying or
disheartening to medical witnesses than the impatience
with which their evidence is too often received by legal
coroners. The late Charles Dickens was a severe critic
of our profession and its members, but in the serio-comic
narrative by the “ Uncommercial Traveller,” “ On a Coroner^
Jury,” be gracefully alludes to. “ the Coroner who was nobly
patient in receiving the evidence, and humane: he was the

late Mr. Waklby .for which,” he adds, “ I ever afterwards

felt grateful to him, as I do now to his memory.” Continuing
the defects of the present state of the law; county coroners
are appointed for life, and cannot resign, like most officials.
An antiquated procedure, the writ de coronaton exonerando,
has to be obtained, and by this means only can a county
coroner be relieved from his duties, old age and infirmity
notwithstanding. Again, on the death of a. coroner his
deputy cannot act; the duties must be performed by another
coroner at considerable inconvenience both to himself and
others

But where uniformity is most wanting: is in the maimer
in which inquests are held. Coroners are paid by fees,
upon a three years’ average; thus there may be an induce¬
ment to multiply inquests. Some coroners bold inquests
in every cose of sudden death; others exercise a dis¬
cretion. Some require the jury always to view the body;
others have dispensed with this legal requirement in a few

80 Isa Lajtom,]

* PAUL BERT’S SCIENCE IN POLITICS.'

[Jaw. St 1887.

cases, thus rendering the inquest nail and- void. Some
coroners have a beadle or officer; others depend on the
police far information of deaths requiring an inquest. Some,
especially medical coroners, require medical evidence at
almost every inquest; legal coroners dispense with it as
much as they can to save the rates. All this confusion
arises partly from the very antiquated statute under which
coroners still act—the 4th Edward I., stat. 2,— a statute
passed six centuries ago; partly also because the sources
whence the coroner derives his information are various.
He may learn it from his beadle, from the police, from a
medical practitioner, from a registrar of deaths, or from a
relative or friend of the deceased.

The obvious remedy for most of these evils is to provide
for greater uniformity, care being taken that the new
system shall possess all other needful reforms. In Scotland,
where the duties of coroner are performed by the procurator
fiscal, complaints have arisen that many cases which ought
to be inquired into are Withheld from him, and we have bad '
a recent instance of the defect of the Scotch system in what
Was known as the Carlisle poisoning case. The body of the ,
unfortunate woman, who was poisoned by some ham which
she had eaten at her own wedding breakfast, was removed
from Edinburgh to Carlisle for burial without the know¬
ledge of the fiscal authorities. Hence arose a deadlock
when the full particulars were fully known. The Edinburgh
Procurator Fiscal could not act, as the body had been removed
out of his jurisdiction; the coroner for Carlisle could not
act, because the death occurred beyond his district. It is,
moreover, a source of complaint that-the inquiry of the
Procurator Fiscal is a secret one. A similar secret mode
of inquest prevails in the Channel Islands. In the Isle
of Man inquests are held by the high bailiffs of the four |
principal towns; the inquiry is public and with a jury. In
-Iceland the system is the same as in England, though the
proportion of medical coroners is, we believe, greater than
in England and Wales.

Coroners should be permitted to resign at a reasonable
term of notice, and deputy coroners should act on the;
death of the coroner until his successor be appointed.!
■The claims of medical candidates should be duly considered,
since experience has shown that medical coroners have
discharged their duties with the greatest satisfaction, and
to'the interests Of all concerned. The Births and Deaths
Registration Act should be farther amended, so far as'
deaths are concerned. It should be required that notice of
every death be given to the registrar within a certain 1
interval after death* and that all violent or sudden deaths
be notified directly t» the coroner of the district. More
stringent regulations are required as to the burial of still¬
born infants,-as recently noticed in these columns; printed*
forms of certificates of stilt-birth should be issued to all j
medical practitionere, and forms of declaration to all certified
mid wives. The rights of general practitioners should be i
strictly respected; a second medical witness could be called!
in cases where a criminal charge is preferred against any¬
one ; and preference should be given to skilled pathologists
and medical jurists, the general practitioner first called-in
making the post-mortem examination in conjunction with 1
the firmer, .....

These mfowxu would ensure considerable Improvements, 1

with but little expense or inconvenience to anybody. Other
improvements would suggest themselves, and by a little
mutual concession, coroners, and medical practitioners
working together for the common weal, we should get
rid of all the defects and abuses now prevalent, and
coroners’ inquests would become what they ought to be,
solemn and searching inquiries.

- » .

Thbrb is a papier in the January number of the Con¬
temporary Review by Mme. Adam, who has long posed as
“the enemy” of Pato Bert, while trying to run with the
hare and hunt with the hounds in relation to the movement
which Bert is alleged to have inaugurated against the clerical
party in France. The doctrine this lady philosopher lays
down is that the two castes, the religious and the scientific,
should be “equally excluded from all participation in
politics.” While affecting to cherish an intelligent respect
for both Religion and Science, Mme. Adam holds that the
one is necessarily idealistic and the other materialistic, that
they cannot possibly be reconciled, and that they must
accordingly he manipulated, as elements in the national
constitution and life, by statesmen who are neither priests nor
scientists, but superiors both. The argument is plausible,
and it is effectively stated by the advocate, but the pre¬
misses are bad; and when we come to look closely Into the
facts the inferences must be seen to be fallacious. “The
equilibrium of a society,” writes Mme. Adam, “ depends on the
equal proportion of the scientific and the religious element
in it. When the priests tip over the balance on their side,
society suffers in its material needs, and is impoverished ;
when science gets ahead of religion, society grows rich,
gives itself up to luxury, and soon becomes corrupt. The
men of science sacrifice everything to the play of forces,
the acceleration of movement. Reason and logic are the
only compass they steer by, and their ideal for the indi¬
vidual is the facing of difficulties and the achievement of
success. But in all this, goodness (which is Instinctive
religion), heroism, self-devotion, the love of one’s neighbour,
go for nothing.” It is very plain that the view propounded,
and the starting-point from which this conclusion is reached
are narrow and mistaken. Was there ever a grosser libel
on science, particularly the science of Medicine, which i«
Mme. Adam’s betc noire, than to say that it excludes, nay
does not foster, heroism and self-devotion ? It is a mattei
for thankfulness that the doctrine taught has not beer
turned to worse purposes than that to which Mme. Adam
has striven to apply it—namely, the subordination o:
facts to theory and the glorification of a particular sor
of cleverness at the cost of depreciating tfae value o
true knowledge. The essence of the idea is that “ politics '
consists in government as something apart from the natioi
governed. It is the reduetio ad absurdtm of the Platonii
notion of a bureaucratic system of administration. Mme
Adam’s fundamental proposition embodies an idea whicl
is at once the pride and weakness of the French system
and has run through successive developments of Monarchy
Imperialism, and Republicanism. Statesmanship ifc re
garded as a profession across the Channel. Oovermneu
is the supposed work of genius. The notion of A Stat
having its affairs administered on constitutional princi
1 Pies, without some constructive ulterior pufpbOeto vrhicl

IiAJICBT,]

PAUL BERT’S SCIENCE IN POLITICS.’

[Jan. 8,1887. 81

ererything else is subordinate, is one that has no place
in the philosophy of the grand nation. Statesmanship
is a fanction apart from all else, and statesmen compose
a class or easte, the highest in the land, and from this order,
according to Mme. A PAM, priests and men of science ought to
be rigidly excluded because they represent elementary and
constituent parts or principles. They may contribute plums
to the pudding, but they may not be cooks, and it is for the
cooks exclusively to determine how much or how little of
each particular ingredient is to be compounded. Now, we
directly join issue on this ground, and must take leave to
characterise it as an unwarrantable assumption, based on, or
excnsed by, a total misconception of the very first prin
eiples of self-government. The bare fact that such a notion
is widely tolerated among the thinking classes in France
is a proof that her people are not ripe for self-govem
meat. The truly intelligent classes among our neighbours
as among ourselves, must see that Mme. Adam's idea—which
is unhappily the idea of a very large proportion of the more
active people across the Channel—is fatal tt> the realise
lion of true liberty. It involves a transference of power
from one section of the “governing caste” to another, the
real business classes of the people being systematically
denied a share in the control of public affairs. So far from
its being true that priests and men of science should be
excluded from the government of the State, these classes
ooght to be duly represented in the governing body
Although we cannot go so far as Auguste Comte, and
affirm “ that a State should be governed by men of science, 1
wo are very far from thinking with Mme. Adam that no
•* falser theory of government ever entered a wise man’s
bead”; and we believe that it will never be well with pro¬
gressive Statee until the claims of science to a larger voice
fas the administration of public affairs is recognised, and
allowed to take effect in the formation of Governments and
Qabinete.

The phrase “science in politics is politics in science,” on
which Mme. Adam seems to plume herself, has no precise
■wining that we can discover. She contends it implies “ a
very bad warping of the mind twice over.” Her notion seems
to bo that the method of inductive reasoning by which the
troe acton tist ascertains his facts and draws and corrects his
fafamtces is inapplicable to the system of government. A
—tfoo must not have its affairs administered on natural
Principle*. There must be no attempt to reason from the
to the unknown, or to guide the vessel of State on a
projected on scientific principles. The statesman
. like the poet, be bom, not made. He must evolve the
i of government with which he rules the nation from
consciousness or gain them by inspiration. The
frpifl£f 4 .af poli t ical eoonomy is to minds of the class repre-
i by this gifted lady a crude and pitiable attempt to
i whatongb^ to be treated as the sublime outcome
It is to the.ascendancy of such ideas as these our
owe thefa£tfhat there is no distinctly practical
-like p<%r* underlying their system. They
"fryfirm of ahnj^Baepeis,”—because the commercial
_ font backbone of other nationalities,
■flfrjjfrjlMwapnted adequately in their
L-exnlttSd.&om tbs function of states¬

manship. When we speak of the commercial classes, we
include the whole composite body of producers and manu¬
facturers, and the classes that exercise an active influence
on the constitution pf society. Among these classes must
needs be included the “ priests ” and ministers, who
supply the religious element to the national organisation,
and conserve the morals of the people, and the “ men
of science” to whose enterprise and achievement every
branch of industry in these modern times owes its precision
and success, and without whom the body politic would
be disintegrated in spite of the supreme sagacity of
the most gifted order of professional statesmen. Paul
Beet was & medical scientist, and it is against the special
class of workers in science he represented that the ani¬
mosity of Mme. Adam is particularly directed. Under¬
lying her antagonism to the scientists there is, of
course, the anti-vivisection idea. Mme. Adam is especially
aggrieved by the demonstration of the grafting process.
She brings it in at every twist and turn in this article,
and would seem to have alluded to it in nearly every
conversation she had with Gambetta or Paul Beet.
It is a "fixed idea” with her, and obtrudes itself so
frequently as to break the thread of every argument.
We strongly recommend those of our readers who have not
read the paper on which we* are commenting to do so. It
cannot fail to afford them amusement directly, and instruc¬
tion indirectly. Madame Adam’s hatred of Paul Beet—
not personally, perhaps, but os a representative man- -
is as Gambetta had the honesty to tell her, “truly
feminine."

In one regard Mme. Adam differs from some other lady
agitators—namely, in favouring, or affecting to favour,
the idea of religious education. The sort of “religious
education ” permitted under the regime she would establish is
not, indeed, likely to be very satisfactory to those who desire
religious instruction for the rising generation, but Mme.
Adam's recoil from the Materialistic School, as represented
by Paul Beet, has been so violent that she is perforce driven
back almost, if not quite, into the arms of the clerical
party. This is what we mean by saying she has tried to
run with the hare and hunt with the hounds, in relation
to the anti-clerical movement. She throws the whole re¬
sponsibility of Article 7 of the decrees of March 29th
upon Paul Beet, and then taunts him with wanting “just
th^t element in which his scientific experiments have
been wanting too—success.” She contends that “you
cannot reckon among the assured acquisitions of science
discoveries which are neither incontestable nor uncon¬
tested.” This remark is in itself conclusive evidenoe of
Mme. Adam’s incompetenoy to discuss the subject of Paul
Beet’s achievements and failures, or to form an aocurate
estimate of his work as a whole. She is ignorant of
the fact that not a few of the most priceless treasures of
science have been found among the ashes of exploded ideas.
The very fi&scoes of the honest and earnest scientist are
more productive thpn the chimerical dreams of the theorist.
Mme. Adam may be excused for not knowing this, for
it is manifest that her acquaintance with even the history
of scientific discovery is extremely limited; but she cannot
so readily be pardoned for the bad taste of an article which

(5 l

ized by

82 This LAWOn,] VENTILATION OF THEATRES.—HOSPITAL FOR WOMEN, LIVERPOOL. [Jan. 8, 1887.

seems to have been indited on the novel and, let us hope,
exclusively French idea —De mortuis nil nisi—malum.
--

It would be interesting to know the number of those who
are prevented from visiting our theatres because of their
unwillingness to encounter the stifling atmosphere which
as a rule prevails in them; and it would, we have little
doubt, much astonish theatrical managers if they could
realise the amount of hard cash which is kept out of their
exchequers by those absentees who weigh the pleasures of
the evening against the morning’s headache, and arrive at
the conclusion that these few hours’ pleasure is not worth ,
the price in physical Buffering which is paid for it. We (
are well aware that our pleadings for ventilation may le
met by the objection that the theatres mostly fill well, ■
and that this may be taken a9 an indication that the
public is satisfied in all particulars. The success of our
theatres—the long runs and the crowded houses -is due,
however, in a great degree, to the extension of our rail¬
way system, and to the enormous influx of visitors from
the suburbs and the distant country, who come to London
for their theatrical pleasures, and are willing to brave a
few nights of suffocation for the Bake of witnessing perfor¬
mances the recollection of which serves to relieve the dulness
of the country. It is notorious that many London residents,
and notably the professional classes, to a large extent, keep
away from the theatres because they find that after stew¬
ing in some overcrowded and heated theatre on the previous
night their brains are not sufficiently clear in the morning to
allow of the faithful performance of their duties. We say
it with all humility, but with the certainty that we are
right, that theatrical managers are thus deprived of the
most intelligent and moBt discriminating portions of their
audiences, and that the lack of patronage of theatres by
the professional classes must tell against the beet interests
of the drama, for every educated person must admit that
there are dramatic interests which are higher than pounds,
shillings, and pence. We doubt if any theatre has yet been
built in London in which the question of ventilation has
been considered of prime importance by the architect.
Theatres have been built in New York and on the Continent
(notably, we believe, at Frankfort) in which the ventilation
has been efficiently provided for, and in which the visitors
get fresh air of a regulated temperature without draughts.

Surely the ventilation of a theatre is no very difficult
matter. The Board of Works now compels every theatre to
have outlets on every side, and where there are outlets for
visitors there must be room for inlets of fresh air. The
vertical delivery of fresh air (if the tubes be large enough
and in sufficient quantity) maybe managed without causing
draughts, and no building lends itself better to the escape
of foul air than does a theatre, provided holes be made for
its escape. The central sunlight of a theatre is a most
efficient outlet for foul air, and there ought to be no
difficulty in providing other outlets of a similar kind
in the lobbies and above the stage, and at the back of
the dress circle, boxes, and galleries. Outlets, of course,
are not alone sufficient; there must be inlets; and if
these be provided in the proper place and proper quantity,
there ought to be no draught when a door is opened, which
is now one of the greatest nuisances experienced in our

theatres. In our variable climate it is necessary that the
temperature of the in-coming air should be regulated, and in
this there ought to be no difficulty with the aid of steam
coils and ice. It is needless to say that every theatre
ought to have an officer whose special charge it should be
to regulate the ventilation and temperature of the house.
This is very necessary, because of the constant variation in
the numbers present in the house and the extreme uncer¬
tainty of the outside temperature in our climate.

There is no doubt that something has been done to improve
the condition of our theatres by the introduction of the
electric light. This does not foul the air as does a gas light,
but it does not assist—at least to the same extent as a gas
light may be made to assist—in carrying off the exhalations
from the 1200 or 1500 persons who are crowded into a very
confined space. We feel tolerably sure that if the sum (a
very large one) which is spent upon the electric lighting of
a theatre were spent upon its ventilation on a rational plan,
and the supervision of it, the gain in comfort and health to
the public would not fail to be appreciated and would
result in a gain to the manager.

Thk Liverpool Mercury lor Dec. 31st, 1S3G, contains the
report of the committee to be submitted to the governors
and subscribers to the Hospital for Women, Liverpool, upon
the practice of frequent spaying in this institution. The
members of the committee appear to be laymen, and when
they came face to face with this question they found them¬
selves in a very uncomfortable position. The funds fell
away, subscriptions did not come in, and what appeal could
be made to the public on behalf of an institution in which a
noticeable part of the work done was the removal of the
uterine appendages? Under these circumstances the com¬
mittee appears to have lost its head, and to have sought
guidance chiefly from those who either claim to be inventors
of the operation, or who are regarded as adepts in its
performance. The replies of several of those who were
consulted are given in the report; they all, with one
exception, tend in one way—that is, to justify the fre¬
quency with which spaying was performed in the hospital.
The exception was the reply of Sir Spencer Wells, which
appeared in our columns last year. He stated that he regarded
the statement that 111 (it Bhould be 1G9) of 347 in-patients
were subjected to abdominal section as so shocking as to
be almost incredible. The committee endeavours to lessen
the value of this letter by the statement that the number
operated upon was really taken out of 3800 patients, and
that all in-patients might have had to undergo abdominal
section. Hospital patients, however, in Liverpool, differ
but little from those in London and elsewhere; they suffer
from the same diseases, and the proportion of those requir¬
ing abdominal section is much the same in every large town.
Sir Spencer Wells is intimately acquainted with this
class of patient in a hospital for women in London and his
criticism must be considered to have much weight.

As soon as the question of the too frequent resort
to the operation came before the committee, it at once
gave every assistance and facility for inquiry to the
committee appointed by the Medical Institution, and at
the same time passed a resolution calling upon the
medical officers of the hospital M to keep a record of
Digitized by

C

Tn Lakcbt,] FELLOWS, MEMBERS, AND COUNCIL OF TIIE COLLEGE OF SURGEONS. [JaN 8,1887. 83

the operation* performed, stating the circamstances of
«ich ease, the name of tbe medical officer asked in
r?tumltation, and the fact that the patient or her relatives
“sve be«*n informed, of the nature of the operation per-
f. rased." The committee accepted the report of the com¬
mittee of the Medical Institution (which appeared in our
i j'.amaa on Dec. 11th), and, with a view to carry out its
recommendations, resolved that “no operation of a dan-
^rous character, or that involves abdominal section, shall
•“performed (except in extreme emergency), without pre-
lirosly summoning a consultation of the consulting and
acting surgeons for in-patients."

These resolutions are good so far as they go, but they
are insufficient. It is not enough to tell the relatives and
friends what the operation is; the patient herself, being of
alilt age, should be told, and have tbe opportunity to
'-■naent or refuse to undergo the operation, after a full
• xplanation of its nature has been given to her. Further,
•>: is not enough to describe the operation in words the
[acient cannot understand, and tbe consequences of it as
•wility. Women do not know what the removal of the
iterate appendages, ovaries, and tubes means, or what it
nrolvee; when told it would prevent conception, many
think it on that ground alone a highly desirable operation.
They should be made to understand that the operation
U really spaying, and thus be placed in a position to
refuse or consent to it. Should this recommendation be
nrried out, we shall look with interest to tbe future
records of spaying in the Hospital for Women, Liverpool.

^tmotations.

"We quid nlmli."

THE FELLOWS, MEMBERS, AND COUNCIL OF
THE COLLEGE OF SURGEONS.

Wn would once again draw attention to the petition now
being circulated by the Association of Members of the College
of Surgeons amongst the Members of the College throughout
the country, and urge on them the desirability of at once send¬
ing in their signatures and their adhesion to the principle
for which it contends—viz., the right of Members of a certain
nanding to vote in the election of Council, and to be them-
^lves directly represented on the Council. The latest action
of the present Council, in polling the Fellows on questions
eot actually raised by the Members, or raised by them in a
different sense, looks so suspiciously like an attempt to
iafluence their voting in a manner prejudicial to the interests
of the Members, that nothing, we fear, now remains but for
the latter to rely on that “ self-h6lp ” which, after all, is
the mainspring of every real success. It seems very impro¬
bable that the Council will make any such concessions as will
satisfy tbe Members, or meet their just aspirations. lienee,
the Members must take the matter seriously in hand and
art mi their own behalf. Under these circumstances, the
moner this petition is presented the better for its success;
tnd it is important that it should be well and universally
signed. We bear, with pleasure, that many of the larger
towns, such as Manchester, Bradford, and Shrewsbury,
hive already responded with something very like unani¬
mity. Nevertheless, many names are still required in
order to get even a majority of the total number of Members
st p wmi t enrolled, and this can only be done by a fairly
Era seal Mgaature of surgeons at home, seeing that a large
oaadmr of Members of the'-OoUege are established in the

colonies or are on foreign service. We would therefore
impress diligence on all the local secretaries, as much for the
purpose of securing signatures as of expedition and tha
saving of unnecessary expense. The statement of accounts
for the past year shows a “ balance deficiency ” of £b, with
outstanding liabilities for printing &c. of a further £20.
Such a work as the present cannot be carried on without
funds; and while we may congratulate the Association on
the work they have already accomplished at so small an
outlay, we must impress on all those who have not yet sent
in their contributions, that as the advantages which will be
gained by this movement are to apply to all the Members of
the College, it is only fair and just to the promoters that
Members should at least guarantee them against pecuniary
loss in the proper carrying out of this work.

FEVER CASES IN GENERAL HOSPITALS.

Ax animated meeting of the governors of the Sussex
County Hospital was held on Dec. 20th, under tbe pre¬
sidency of the Mayor of Brighton, on the question whether
the hospital should be utilised in the future for the recep¬
tion of cases of scarlet fever, typhus fever, and measles. A
resolution for the exclusion of such cases was moved by
Mr. Furner, seconded by Mr. Boxall, and supported by
several governors. It was, however, somewhat strenuously
opposed by other speakers, mainly on the ground that the
hospital was a county one, and should be open to all classes
of disease. It was pointed out that since the hospital was
founded sanatoria had been established in Brighton and
Hove, where such cases can be treated; and seeing that tbe
hospital cannot afford special accommodation for fever cases,
or furnish a special staff, the meeting did well to adopt
the resolution, which it did by 66 votes against 2*2. It Is
needless to dwell upon tbe undesirability of admitting
contagious fevers into a general hospital where pro¬
visions for complete isolation do not exist; and in arriving
at this decision, the governors of the Sussex County
Hospital have only followed, although somewhat tardily, an
example which has been set them years ago by the majority
of such institutions. It is, of course, another question
whether a fever block could not be added to the existing
buildings, so as to remove the reproach that a county
hospital could not provide accommodation for all classes
of disease; but this is a matter involving a considerable
outlay. . Moreover, in tbe case of Brighton there seems
to be sufficient accommodation for fever patients at
other institutions in the town: and if this be not the
ease the Corporation should not delay to make the neoessary
provision. _

MELANOTIC SARCOMA.

The study of pigmented new formations can hardly as
yet be said to have resulted in a thoroughly clear and
satisfactory explanation of the reason for their pigmenta¬
tion or its source. It is admitted that such growths are
almost invariably sarcomas, and that their primary seat is
in connexion mostly with tissues that normally contain
pigmented cells—e.g., the retina and choroid, and the rete
mucoaum of the skin,—although it may be remarked, in
passing, that these are not invariably mesoblastic tissues.
But even the source of the pigment is questioned. All
body pigment comes, we suppose, from the blood; bnt in
melanotic sarcoma this may be either direct (i.e., actual
heematin) or indirect (i.e., melanin), due to the special
operation of the cells composing the neoplasm. The subject
has lately received fresh investigation at the hands of
Dr. Oppenheimer of Berne (Virchow’s Archiv, Bd. 106,
Hft. 3), who proves that cases of melanotic sarcoma may
be ranged in two groups. In the one, the pigmentation is

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PROMOTION IN THE ARMY MEDICAL STAFF.

[Jan. 8,1887.

clearly referable to local conditions of blood-supply, in the
distribution of the bloodvessels and the diapedesis of red
corpuscles. In the other, the formation of pigment takes
place from the first within the cell protoplasm; and in one
each case a chemical analysis proved an absence of iron, but
the presence of a considerable quantity of sulphur, thereby
excluding a direct relation of the pigment to hsematin.
Chemical analyses, however, seem to be rather defective
upon the composition of melanin, and it would be well if
they were repeated, with a view to determine whether the
relative proportions of iron and sulphur do vary as sug¬
gested, and also with a view to the comparison of melanin
and htematin. Upon the result of such inquiry may depend,
according to Oppenheimer, whether we may have to break up
the unity of melanotic sarcomas. He has no fear himself
that this unity will be disturbed, considering that an ex¬
planation of varieties in chemical composition of the pig¬
ment may be found in the operation of the cell protoplasm
—in the one case leading to new combinations with haamo-
globin, whereas in the other the blood pigment is left more
or less unaltered, as hmmatin. In any case iron ought to
be present, if not in the pigmented, at least in the non-
pigmented portions of the growth, if the doctrine that the
red corpuscles are the primary source of the pigment is to
be retained. This, therefore, is eminently a question for
pathological chemistry. Histology has done its work, but
there are limits to the information it can yield, and it
seems as if in the end many vexed questions will have to be
solved by other methods than microscopical examination.

PROMOTION IN THE ARMY MEDICAL STAFF.

- Ocb attention has been called by a correspondent to the
existence of a regulation, bearing dato Nov. 1st, 1884, that
“ medical officers of any grade promoted for distinguished
service will be exempt from further examination.” W e regret
that we had overlooked this, owing to its not being included
in Vol. I. of Army Regulations, published by the War Office
in .1884. The promotion of Surgeon-Major Mackinnon,
therefore, without undergoing an examination, would not
have been against the regulations, but it would have involved
an act of great injustice to the large number of officers over
whose heads he would have passed. We have always advo¬
cated the system of substantial rewards to medical offioers
for valuable professional work, but such rewards ought not
to inflict unmerited punishment upon their less fortunate
brother officers. We rejoice at Surgeon-Major Mackinnon’s
having; been granted the distinction of Companion of the
‘/ Distinguished Service Order,” while we feel that his pro¬
motion to brigade surgeon over the heads of above ninety
officers of his own service would have been an act of great
injustice to them. __

THE COTTON COMPRESS IN ORCHITIS.

In a recent number of the Revista Argentina de Ciencias
Mtdicas Senor Jos6 M. Escalier gives an account of a very
successful method of treating orchitis and epididymitis by
means of a cotton compress, which has been for some time
in use in Dr. Montes de Oca’s wards in the Hospital de
Clinicas in Buenos Ayres. The idea was token from the
cotton cap or suspensory bandage of Langlebert. The appa¬
ratus is applied as follows: The neck of the scrotum is first
secured by a bandage and ^trapping, the testicles being thus
driven downward^. The scrotum is then enveloped in a
silk handkerchief, outside which a thick layer of cotton¬
wool is applied, and the whole covered with a gutta-percha
cap. Strips of plaster are now passed round in a circular
manner, so that the ends can be drawn more or less tightly
before being fixed,in order to exert a compressing force on the
glands. In the first stage of orchitis, when there is not much

epididymitis, the compress arrests the inflammation and
brings about resolution rapidly. The cases in whieh this
occurred, however, were but few, as nearly all the patients
who presented themselves at the hospital had passed that
stage. In some cases of acute orchitis very moderate com¬
pression was resorted to with success, but of course the pain
was very great and the patients did not bear it well. In
these cases the best treatment was found to consist in making
a number of punctures to give exit to the liqnid in the
tunica vaginalis together with some blood, then to surround,
the scrotum with ice, and to give a purgative. After this
treatment has reduced the inflammation the cotton compress
can be applied with advantage. With practice the degree of
tension required in each case can be adjusted to a nicety,
and in twenty-four hours the swelling will generally have
diminished so much that it is necessary to reapply the com¬
press. After two or three of these reapplications the testes
return to their normal size, and a slight induration of the
epididymis is all that remains. The cure is usually complete
in a week, or even less. The cotton compress has been used
in more than a hundred cases, and is, according to the writer,
far more satisfactory than any of the ordinary methods of
treatment. Even in chronic cases it is astonishing to see
the rapid effect that it produces. It has also been .success¬
fully employed after tapping hydroceles.

COUNTRY PRACTICE AND PRACTITIONERS.

Thk duties which belong to the province of the busy
practitioner of medicine are under any circumstances
sufficiently arduous. The frequent difficulty of the work
itself, its accidental and untimely character, and the
necessity for study during snatched intervals of leisure,
combine to form a whole which must fairly tax the
resources of human energy. These observations apply with
particular force to the lot of the general practitioner in a
country district. The circumstance of position, while it
increases his responsibility, usually diminishes in the same
proportion his facilities for meeting it. Roads, weather, and
distance are obstinate realities to him, and are apt at critical
times to magnify surprisingly the meaning of emergencies.
Distinctions between one department of practice and another
are necessarily but nominal in his experience. In him the
surgeon and physician are combined, and we are reminded
that the art of healing is one whole. It is this fact mainly
which gives to his life its peculiar character, and it is this,
too, which constitutes its chief honour. The brilliant results
of success in a limited field are not his; the emoluments
of a wealthy and distinguished clientble may not reach him;
but it belongs to him that he may and does satisfy as fully
as his most favoured brethren the needs of suffering man¬
kind, whether incurred by injury or sickness. The man
who is sufficient for such duties must be no weakling of his
kind. Strong—that is robust—in frame, perhaps, be need
not be, often he is not; but endurance he must have.
Whatever his person, there must be in him the capacity for
work, for standing wear and tear. His mind, too, must be
of the right temper. It is not enough that some one or two
faculties should rule his character and conduct. Courage,
energy, coolness, reserve, firmness, cheerfulness, must meet
in him to ensure no more than practical efficiency in the
ordinary round of a well-filled day. Nor is the moral
nature untried. There will be many occasions on which
each man’s perception of justice and humanity will become
evident in the presence of doubt or provocation—times
even when manhood will seem wanting without some faith
in a higher wisdom. We have seen it stated that the old
type of practice such as we have sketched is disappearing,
and with it the old practitioners. We should much regret
if it were so, and we think otherwise. Developments in

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BISULPHIDE OF CARBON. HHSGNQrG.—THE REMOVAL OP SNOW.

[Jan. 8,1887. 85

theory and practise there hare been, and facilities are more
nwaerous than of yore, but there is, and will long remain,
ample aoope for the exercise of well-directed energy and
friendly feeling, and we maintain that the mantle of a
mnnly and unselfish ancestry has descended on a genera¬
tion worthy to succeed it.

BISULPHIDE OF fcARBON POISONING. |i

Ik the narration of two cases of chronic poisoning by |
aarbea bisulphide, contributed to the current issue of the
Medical Chronicle, Dr. Roes directs public attention to the.
risks ran by workers in mdisrubber factories, where that<
—balance is largely employed. As clinical records, also, the■
mass are of considerable interest. The first was that of a •
naan, twenty-four years of age, temperate, and of previously!

health, who for about eight months had been engaged in i
aa indiarubber factory. He was employed in the “ oaring- 1
room,” and subjected to the fumes of the bisulphide. After.
a. few weeks he suffered from a burning sensation in the'
bawds and face, which were hot to the touch and of a red
eolour. When the bands were put into oold water they'
immediately became livid and cold and nnmb. He became
met less and fidgety, and a few weeks later experienced
tingling sensations and numbness in the feet and hands,,
with progressive weakness of the limbs. He now rested for
two or three weeks, during which be recovered; but a few
wanks after resuming work the old symptoms returned. He
now had great difficulty in walking, and could scarcely hold
anything in his bands, attempts at grasping being accom¬
panied by much tremor. He could not get rid of the odour'
mt tbe gas ; his food seemed to taste of it, so that he had a
laa thing for food. HeJoetfleab, the wasting of the arms and legs
Mag disproportionate to that of the rest of the body. His,
memory failed him, and he passed restless, disturbed nights.
At last be became too feeble to walk, and left tbe factory
fear weeks before Ins admission last May into the Royal |
Infirmary, Manchester, where be remained a month. He
there improved considerably, but was still unable to produce
dorsal flexion of the feet, and the knee-jerks remained
absent. After a eo j tf urn at the Cheadle Convalescent Home
bs return ed, showing hardly a trace of the previous paralysis.
Tbs second case, which was under observation at the same
time, was also of a young man twenty-four years of age, with
• *ood health record. He bad been working for nine months
In tbs “curing-room,” bat it -Was three months before be
Mgan to suffer any ill effects. Then he complained of tbe
sfioor of the gas, cad of bis food tasting of it. He became
mmble to read. and deaf inrthe left ear. His legs felt heavy :
and weak, and fte had tingling sensation and numbness in ;
tbs hands and feet, the efteot ef odd water upon them being
tiariiar to that noticed in the first ease. His deep also Was ’
fijctiuluri by dreams, and he became depressed and miser- .
ahh^bot found, as did the other-patient, that inhalation of the'
fades brought temporary relief to his sufferings. His memory
bcCamedefective and be had delusions. It appears that other
tfiribriaen employed in the factory have been similarly
sBcdnd,andoneortwo have beoomeinsane. DARom points
cprii lhat the paza^aisresembles alcoholic paralysis more than
aa^WCherfotm of progressive multiple neuritis; but the mua-
—isi byperwsthesia anted in alcoholic paralysis imiii entirely'
aiefit in- these Mi.. The amblyopia and IoSb of colour
ifibs notad in thesbcond.ease do not occtir. in alcoholic

caused by both alcohol and lead—which are tbe usual sources
of such poisoning in this country—I have no hesitation in
saying that the disease from which these men suffered was
not caused by either of those agents. If. it be true, then,
that we have in our midst certain workshops in which the
process of manufacture is so deleterious to the-health of
the workman that a certain proportion of them is reduced
in a few months to the pitiable condition of paralytic help¬
lessness manifested by these two unfortunate men, it is
hardly necessary for me to maintain, in the face of all
recent factory, legislation, that these workshops ought to bp
placed under the most stringent regulations, and be subject
to the frequent visits, of a Government inspector.”

SIR JAMES PAGET ON SCIENCE v. CLASSICS.

Thu just issued number of the Educational Tima (edited
by Mr. W. J. C. Miller, B.A., registrar of the General Medical
Council) contains a speech by Sir James Paget on the occa¬
sion of delivering the prizes and certificates to the London
Centre for the Oxford Local Examination in the theatre of
the London University, which deserves attention. It is
remarkable for the strong assertion of the claims of science
in education. He speaks in a tone of warning as well as
complaint. Under our present system, with only classical
scholars at tbe head of schools, men of science have no
chance. And he is not prepared to admit that the study
of classics or literature is a more efficient instrument for
training the minds and powers than the study of natural
science. Yet men of science are wanted everywhere, and
when it is asked where they oome from, the answer is,
‘‘they all come from Germany.” Let the schools, says Sir
James, take warning in time. Nor will he agree in common
education to postpone science to a late age when work has
to begin and the problem of living has to be faced. Sir
James was questioned by Sir Thomas Fowell Buxton , on the
subject of school-pressure on girls, and of the effect of
higher education on women. Sir James Pagetdid not believe
that there was need for so much fear as is felt on this
question, and in the cases of the successful candidates of
London he never saw any signs of physical exhaustion or
any evidences of overwork, nor had he seen a single case to
lead him to believe that the higher studies were detrimental
to the charm or beauty of women.

THE REMOVAL OF SNOW. .

The recent heavy fall of snow, which has not yet entirely
passed away in thaw, and may not soon altogether disappear
in this way, has not failed to bring out suggestions as) to tbe
means beet suited fbr its artificial removal. 8pade, sand,
and salt have each been freely and effectually need, and tbe
last of these, as employed in this country, has been made
by more than one observer a subject of censorious com¬
ment. The censure, indeed, is not undeserved, for there are
distinct disadvantages connected with this use of salt. It
has been urged, with good reason, that its effect in pro¬
ducing a freezing mixture must not be forgotten when we
thus avail Ourselves of its primary action as a snow. Solvent.
The absorption of heat from the surrounding atmosphere,
and the hting bodiee which inhabitit, most be considerable
even in a natural thaw, but it is clearly much greater
when the same effort of nature ia imitated in an atmo-

pa—tgria unleas obrepheated with tobacco amblyopia. Horae-
li—fehaiataan ofcthB James of bisulphuie of carbon gives
rirefimyfisptoiiiSTUShmhUng those of acute alcoholic' paiaon-
jQpABUrflftur meoSidaad by the second patient closely re-
“ There oan? be no dodbt,” adds
tdMMppff tlsaS ffhspi ■riurnlfirad from a. severe paralysis,
thpfc. is caused by . several toxic
*B6k rijjnflls dnrriukHrnMfl experience of the paralysis

sphere already cold by means, of an agent tvhich secures
its rapid Ond thorough accomplishment. This is what
happens when salt ia used for clearing snow from, pave¬
ments, tvatnway lines, and the like, and the fear of con¬
sequent chill , to man and. beast while travelling thereby
is not imaginary. Another objection might be urged against
this use- of 'salt. The freezing action to which we have
[ referred must act upon surrounding snow and water, so

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THE PREVALENCE OF SCARLET FEVER AND MEASLES.

[Jxsr.S, 1887.

that outside the area of artificial thaw there is formed a
zoue of artificial ice. This may not much signify in every
case. In the case of pavements and footpaths it must be
guarded against. For clearing all such, and assuring a firm
foothold, there is nothing better, in out opinion, than the
combined use of spade and sand. For frozen roadways ash
or sandy gravel is, on a similar principle, deservedly
esteemed, and though salt appears to be still the best means
of treatment for tramway lines, it is only necessary that
here, as in France, when once its work is done, the resulting
chill should be obviated by sweeping the road.

ABSORPTION OF FAT IN ACUTE INTESTINAL
CATARRH.

Dr. ViAzmiNsitt, who has been working in Professor
Ivanovski’s laboratory of pathological anatomy in St. Peters¬
burg. has published an interesting paper on the question of
the absorption of fat in acute catarrh of the small intestine.
The literature which he first alludes to comprises more than
ninety papers &c., including those published by Goodsir
Schafer, and Watney in this country. His own observa¬
tions were conducted by inducing acute intestinal catarrh
in animals by means of irritant drugs, and then feeding
them with milk or other fat-containing food, after which
the animal was killed and the intestinal villi examined
with the help, of osmic acid, which he found the most
satisfactory agent for making the preparations. The drugs
used were colchicin and croton oil. Several animals (cats
and dogs) died, so the quantity of colchicin was reduced
from one-thirtieth to one-sixtieth or one-hundredth of a
grain, which produced choleraic Btools. Croton oil was
given in repeated doses of five or six drops, producing
diarrhoea with exhaustion. When the animals presented,
besides diarrhoea, an inflated abdomen, constant borborygmi,
and a considerable degree of exhaustion, an acute catarrh of
the small intestine was considered to have been established,
and the fatty food was administered. The microscopic
observations showed that in catarrhal conditions, as well as
in health, the fatty particles are absorbed by their inclusion
within round or amoeboid cells — ie., leucocytes, — the
difference in the diseased state being merely a quantitative
one. No evidence could be obtained of any part being taken
by the epithelial cells in the absorption of fat.

INQUESTS WITHOUT NECROPSIES.

A short time since Mr. William Carter, coroner for East
Surrey, held an inquest on the body of a man named Turner,
aged thirty-nine years. Deceased “had always enjoyed
remarkably good health,” and on the day of his death left
home for work apparently quite well. He was found in the
street with his face downwards, and when Dr. Sterling saw
him he was quite dead. There was absolutely nothing to show
the cause of his decease. It might have been from rupture
of an aneurysm, apoplexy, epilepsy, or other natural disease,
but beyond the fact that there were no signs of violence, it
might equally well have been from injury, poison, or what
not. Dr. Sterling very properly refused to certify without
a post-mortem examination. The coroner left it to the
jury to decide whether this was necessary, and the latter
returned a verdict of “Death from natural causes.” If
«ver there was a case that called for further inquiry it
was this. A man in the prime of life, who up to the
time of his death was not known to be suffering from
any ailment, dies suddenly and from some unknown
cause, and yet bis case is not deemed worthy of that
particular investigation which alone could have furnished
evidence to justify the verdict returned. The inquiry,
if oorrectJy reported, seems to us to have been a mere
farce.

HEALTH OF CALCUTTA.

Thr report on the health of the town of Calcutta for tfao
third quarter of 1836, by the health offlc9r Dr. Simpson
shows a satisfactory reduction of the death-rate compared
with the average of the preceding ten years, in only three
of which it was lower. But the deaths from cholera were
more numerous than in any of these years; they amounted
to 230, of which 95 occurred in July, 65 in August, and
80 in September. We regret to add that this high rate
of deaths from cholera has continued in Calcutta, for the
weekly returns show them to have risen in October to 286,
and in the four weeks of November to 326. The great increase
in July was supposed to be due to “an influx of infected

pilgrims. The cholera of August and September must

be attributed to C'aloutta only.” Although much has been
done of late to improve the sanitary condition of the town
and suburbs, there appears still to be great room for active
operations in this direction. Dr. Simpson points out, as a
condition unfavourable to health and favourable to cholera
in the bustqes, the impure water-supply. “ The recourse
had to polluted well and tank water is, without doubt, a
very fruitful cause of disease.” Their drainage also is very
unsatisfactory. The huts and their surroundings are kept in
a most filthy condition; they are greatly over-crowded, and
it is impossible for fresh air to gain access to them. “ Two
of the most important factors in the health of a locality-
efficient ventilation and scavenging—are wanting; and two
of the most potent factors favourable to cholera are present
—viz., stagnant air and filth.” The measures already*taken
seem to have produced satisfactory.results in reducing the
death-rate of the town, and it is to be hoped that the
extension of the supply of pure water, the adoption of an
efficient system of drainage, and the introduction of building
regulations into the Municipal Act may be productive of
similar beneficial effects in the suburbs. During the quarter
under review the deaths were in the annual ratio of 23*1
per 1000 of the population in the town of Calcutta, awl
33 5 in the suburbs. ___

QUARANTINE AND SMALL-POX.

On the arrival of the Norddeutscher Lloyd steamer
Preussen at Adelaide from Southampton the occurrence of
a cose of small-pox was reported, the result being th it the
vessel was placed in quarantine. According to a telegram,
however, it would appear that, ia addition to twenty-four
cases which subsequently occurred, thirty persons who
landed at Sydney are sickening, besides Beveral at Melbourne.

THE PREVALENCE OF SCARLET FEVER AND
MEASLES.

It would be premature to assert that the extensive local
prevalences of scarlet fever and measles which are now
being reported from time to time indicate a general exten¬
sion of these diseases. But it is certainly noteworthy that
in special localities very large outbreaks have been taking
place during the past few months. At Merthyr Tydfil 95
fresh attacks from scarlet fever were reported at the
December meeting of the local board, and efforts are being
made to check it by an extension of the Christmas holidays
and by the cleansing and disinfection of schools. At
Aberdeen 107 cases were reported in Ssptember, 78 ia
October, and 107 in November. At Kirkcaldy both scarlet
fever and measles are exceptionally prevalent. And, again,
an alarming and sudden outbreak of scarlet fever is
reported to have occurred at Wimbledon and Merton,
some 400 cases having shown themselves since Christmas.
In this latter case whole families are. stated to hare been
attacked, and it is suggested that the epidemic has had its
origin in an infected dairy. As regards measles, it
was a heavy factor in the Leeds death-rate for the

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THE BRISTOL MEDICAL SCHOOL.—STAWELL HOSPITAL.

[Jan. 8,1887. 87

■nnth of December, the inclement weather tending
to increase its fatality. At Hexham the occurrence of
1AO cawa has led to the closure of both day and Sunday
rchoo li , bat the type is said to be mild and non-fatal. The
lest qua rt e r ly return of the Registrar-General had to do
with the third quarter of 1836, and it then appeared that,
although the scarlet fever death-rate was exceptionally
heavy in certain places, the annual rate was only one-
half of that which constituted the average for the ten
pceceding third quarters. Measles was also very fatal in
a few places, such as id Illogan, Camborne, Newcastle-under-
Lyme, and Tamworth subdistricts, but the annual rate was
pcsciiulj the same as that which constituted the mean for
the previous ten similar quarters. When the next return is
esasd it will be seen bow far these severe local outbreaks
am Associa ted with any general prevalence of the diseases
m que stion, bat in the meantime sanitary authorities would
do well to arrange, as far as possible, for early isolation in
the case of drat attacks.

THE BRISTOL MEDICAL SCHOOL.

Th* Principal of University College, Bristol, has recently
made an argent appeal to the wealth? inhabitants of Bristol
md its neighbourhood for £5000 or £6000, in order to pro¬
vide proper buildings and equipment for the Bristol Medical
S cho ol , which has existed since tbe year 1828, and has fnr-
»shsd a large proportion of practitioners of tbe highest
mending to Bristol, Clifton, and the adjacent districts. The
Bristol 8chool in times past has been a most flourishing one,
■nd, even with tbe great competition which now exists,
mail sarijen nearly a hundred students, and performs a most
asafol and honourable function for tbe west of England and
So u t h Wales. Following the example of other provincial
■r ho oia , it has associated itself with the University College
at Bristol for tbe ins tract ion of its students in the less
•trictiy medical branches of soitotidc education, and tbe
appeal ef Principal Ramsay comes therefore with much
pm and weight. A medical school without adequate
laboratories, class-rooms, and dissecting-room is as inefficient
far the teaching of .the necessary scientific subjects of a
Undent's curriculum as is a hospital for clinical instruction,
raieee it possess e s a fair proportion of beds to the number
at ita st uden ts. Tbe tendency of the present day is evi¬
dently to congregate all schools of medicine around a
University as a centre, and to secure the efficiency of the
■ppHancoa and teaching of such schools under some form of
Cdtvamty supervision; and it is therefore especially impor¬
tant to the Bristol teachers that they should be able to insist
in every respect an their claim to a proper consideration and
recogn i tion in this University question. Feelings of grati-
tade for many services rendered to the citizens by medical
man educated at this old provincial school should lead to
mb a comparatively small sum being readily subscribed by
the merchants of the ancient city.

STAWELL HOSPITAL

Twaport of this institution—which is situated at Stawell,
Vhfoala, and was formerly known as the Pleasant Creek
Tl ayjto j far the year ending July, 1886, has recently been
hmed| sad, ooosidexiag the general depression existing in
■MgE aftrirnllnrsl, and pastoral industries throughout the
fatfldifa a highly satisfactory one. The number of in-
fattmto Joe tbe year WB428I as against 221 for the pzeced-
ieg 1,1*4** months, and of oat-patients 283 as against 231.
I>Hjmq<pwra«noed vjUi a debit balance of £224, but, we
■VMh&tq *ote, sodedtWftjh a credit balance of £89. Tbe
Iprivate.; to Aeai ipilou s to the hospital have

s od ■ ff ^pd s strong testimony to the energy
ol tbn Moratory, Mr. C. B. Playford.

THE PROVISION OF SPECIAL HOSPITALS BY
SANITARY AUTHORITIES.

The Local B:>ard of Health of Winsford having given a
subscription of five guineas to the Manchester Eye Hos¬
pital, the members of the Board were surcharged that
amount by the Government auditor on the ground that the
institution in question was not one for the reception of
infectious diseases, for which sanitary authorities are legally
entitled to make provision. Tbe auditor’s decision has,
however, been reversed by the Local Government Board,
and the fact is worth noting. It is quite true that,
Section 131 of the Public Health Act, 1875, which gives
power to local authorities to provide hospitals, is one of a
group of sections included under the heading ** Provisions
against Infection,” but it has long ago been decided that
the interpretation of an Act of Parliament is to be governed
by the wording of its sections, and not by headings which
are merely inserted for the purposes of convenience. Now
Section 131 in no way limits the class of hospital which
may be provided or supported by a local authority, and
hence there is no reason, in so far as the Public Health Act
itself is concerned, why sanitary authorities should not pro¬
vide other than infectious hospitals. Indeed, wo believe
there is an instance in which the Local Government Board
were willing to aid an authority, by way of loan, to pro¬
vide an accident hospital, and we can quite conceive that
there may be districts where special trades are carried on,
in which it would be a distinct gain to public health that
special hospitals for other than infectious diseases should be
provided at the public cost. The alternative often is the
use of a workhouse infirmary for those who sicken in the
performance of work on the success and amount of which
the prosperity of a district and of its population depends.

“NERVI NERVORUM PERIPHERICORUM.”

Dr. 3: Prtt* of Craoow has described in the Przeglad
lekartki a nervous network existing in tbe perineurium-of
nerve-trunks, which he calls “nervi nervorum peripheri-
conini," and which, he says, must not be confounded with
other nervi nervorum which have been previously described,
those mentioned by Bourgery and by Hirschfeld referring
to nerve centres only, and those misnamed nervi nervorum
by Krause being merely nervi vaeorum. Dr. Prus’s observa¬
tions were conducted by injecting methyLblue, according to
Ehrlich’s method, into the bloodvessels of living animals.
By this means the nerve tissue became ooloured, so that the
beautiful nervous network in the perineurium became visible
on microscopic examination. The endoneurium is also pro¬
vided with this network, but to a much smaller extent than
the perineurium. _

DECOMPOSITION IN TINNED MILK.

It would be superfluous in these days to enlarge on the
utility of condensed milk and the necessity that it should
be prepared and preserved in the best manner, and sold
only of the best quality. Less liable to fermentative change
than fresh cow’s milk, and preferable, as being lighter, to
the majority of prepared foods, it is practically one of the
essentials of infant life. Diarrhoea is well known to be
one of the commonest and most fatal illnesses of ohildhood.
Among its known causes, probably none is so usually
effective as the souring of milk, the staple diet at this age.
Such an accident is unfortunately only too common when
a feeding-bottle is managed by a careless nurse. Its worst
consequences are assured when tinned milk actually becoming
putrid from fermentation is bought and used by the poor,
and that this has happened we have proof in at least one
case. At the Edmonton sessions last week a grocer was
convicted of selling, at a nominal cost, condensed milk in

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88 Thm LJlNOW.J INFLUENCE OP COCAINE ON THE ACTION OF ESERINE ON THE EYE. [Jan. 8, *887.'

tins, the very appearance of which indicated the process of
decay within them. On opening some of these a spurt of
gas and milk escaped, and the taste and smell of the contents
were very disagreeable. The poisonous trash was being
rapidly sold, especially for the use of children. There was
evidence enough to show that the vendor was aware of the
condition of the milk, and there can be no doubt of the
justice of the penalty imposed upon him. In the circum¬
stances we may be excused for alluding to the obvious
caution conveyed by this incident, that purchasers, parti¬
cularly of this kind of food, should buy wisely rather than
too cheaply.

ABOUT CHILDREN.

Loan Young, when recently occupying the chair at a
lecture delivered by Dr.Kussell, the medical officer of health
in Glasgow, before the Edinburgh Health Society, expressed
an opinion that the views of M&lthus had better be im¬
pressed on those who are responsible for the existence of
children. Without doubt this is a practical view of the
matter, and it is one that goes to the very root of the diffi¬
culty as to the management of children—“ Don’t have so
many of them." As it is, we must take things as we find
them, and hence the necessity for bestowing more than
ordinary care on the preservation of child-life, especially
in cities^ We are glad to know that attention is being
pointedly directed to these matters by coroners and medical
officers whenever opportunity offers. Some remarks made
not long ago, at an inquest held by Mr. Price, the coroner
for Oldham district, are particularly worthy of note. He
insisted strongly on the need of prosecuting inquiries
rigorously into the causes of death in cases of infants found
dead in bed with their parents, life having ceased in the
early morning. Mr. Price was of opinion that these
children were suffocated, and he very properly urged the
expediency of having medical evidence in all cases of this
class. The Society for the Prevention of Cruelty to Children
have just issued a little paper entitled the Chad’s Guardian,
which will be devoted to the best interests of the little ones.
We heartily wish the venture success, and feel sure it has a
wide sphere of usefulness before it.

THE INFLUENCE OF COCAINE ON THE ACTION
OF ESERINE ON THE EYE.

It was remarked by Wecker in the Artnales dOculistujue
(1884, t. xcii., p. 218) that the action of eserine on a
cocainised eye is greater than when no cocaine had been
used. This difference he attempted to explain by suggesting
that the slight cocaine-anaesthesia of the iris. ahd ciliary
body may cause a somewhat similar effect on the pupil to that
of eserine.- Df, E f L. Turevich, however, who has recently
published a “ preliminary communication” on this subject in
the Track , points out that the action of cocaine by itself on
the pupil and accommodation is exactly the reverse of that
due to eserine, cocaine dilating the pupil and paralysing the
accommodation, while eserine contracts the pupil and causes
spasm of the accommodation j besides, it has been con¬
clusively shown that a combination of atropine and cocaine
produces a more powerful dilating effect on the pupil than
atropine alone; and Ad. Weber has even given the equiva¬
lents of eserine and pilocarpine as antagonists of cocaine,
these being 1: 25—30 in the case of eserine and 1: 4 in the
case of pilocarpine. The fact of eserine acting more power¬
fully on a cocainised eye is therefore paradoxical, and by no
means easy to explain. How, writes Dr. Turevich, can the
anaesthesia of the ciliary body, even if cocaine ddes produce
such an effect, which is extremely doubtful, favour the
action of eserine, as Wecker suggested ? We should a priori
expect that the contraction of the pupil By eserine in

a cocainised eye would be, if anything, less than in an
ordinary eye; and indeed it was shown by Weber that
when a drop of a 2 per cent, solution bf eserme was com¬
bined with twenty-five to thirty drops of a similar Relation
of cocaine, its effect bn the pupil was entirely masked. In
the hope of clearing up the paradox Dr. Turevich under¬
took a series of observations on the paralysing effects of
eserine and pilocarpine on his own eyes and on those of
others, both with and without the previous instillation of
cocaine. The course of the accommodation-spasm was
observed by measuring the refractive power of the eye
every five minutes from the application of the eserine or
pilooarpine to the time when the effects had passed off.
Fifteen comparative observations were made, which com¬
pletely confirmed Wecker’s statement as to the greater
effect of eserine on a cocainised eye, showing also that the
same is true of pilocarpine. The explanation suggested
of the apparently opposite action of cocaine when applied
previously to the eserine and when combined with it is that
when anaesthesia of the conjunctival sac is present—first,
the surface absorbs more of the eserine than when the eye
is as sensitive as usual, the introduction, of a foreign liquid
causing less winking with less consequent expression of
the liquid between the lids; secondly, the secretion of
mucus is smaller, and thus the solution is less diluted and
less likely to be washed away; and thirdly, the conjunctiva
and cornea are drier, and thus absorb the eserine more readily.
The author convinced himself by special experiments of the
difference in the behaviour of cocaine according as it was
applied before or simultaneously with the eserine or pilo¬
carpine, and the above explanation is the only one which
appears to him adequate to explain the apparent paradox.

SPEECH DAY AT THE ST. PETERSBURG MEDICAL
ACADEMY.

Tht? annual speech day 6f the St. Petersburg Military
Medical Academy was held on Dec. 7th, when Professor Botkin
gave an address on the General Bases of Clinical Medicine.
The statistical report, which was read by the Secretary,
Professor Pashntin, contained the following information:
The present staff consists of 33 professors, 30 privat-docents,
and 7 prosectors. During the year 7 privat-docents had
obtained professorships, either in the Academy or in Russian
universities. The number of students amounted to 935.'
87 diplomas as Track were given, also 57 M.D. degrees. (The
higher grade is only conferred on those who have already
taken the lower.) No less than 454 of the students had
scholarships from publicoir private sources. The Academy
has during the year lost two of its staff by death—Prof essors
Butleroff And Kolomnin. The proceedings terminated by
the usual distribution of medals and prizes to the Students.

LOCAL ASPHYXIA OF VISCERA.

Thb coexistence .in the same individual of Raynaud’s
disease and paroxysmal hemoglobinuria is a well-attested
and thoroughly authenticated occurrence. It is tempting to
translate the renal change in the light of 'the nature of the
local asphyxia of the peripheral parts of the body. The
dependence of the skin and kidney conditions en the
influence of cold, as perhaps the most important etiological
factor, seems to stand in favour of this view. Hr.'John Aber¬
crombie, m a lecture on this subject delivered at the
Hospital for Sick Children, and afterwards published in the
Archives of Padiatrics, writes as follows:—“Are we War¬
ranted in saying that paroxysmal haemoglobinuria and Bey-
riaud’s disease are the same thing ? I believe we are—Le., I
believe hemoglobinuria is a symptom-of the mare general
affection, and, being 1 the- one that most attracts the

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goitre and cretinism in peru.—the pood op man.

[Jan. 8,1887. 89

ptiinft attention, the other phenomena escape observa¬
nce.* D*. Ab e rcr o mbie also draws attention to the occur-
naee of slight jaundice in some cases of paroxysmal
hc—gtoftinoria, and the inference that this may be a kind
at Raynaud's affection of the liver is suggested. Attacks
of amblyopia also occur. Ague has undoubted relations to
hemoglobinuria and Raynaud’s disease. Disposed as we
are to agree in the main with Dr. Abercrombie, yet in
che hemoglobinuria there need not necessarily be a
£msral affection of the whole system. The incidence of the
rreseo may be varying, both in time and site—now this
xgam, now that, being the seat of local asphyxia; and
occasionally there may be the wider distribution of the
p u of ym sl changes, as, indeed, is witnessed in the skin in
different cases. To explain the special frequency with which
the kidney appears to be affected, the remarkable physio-
kgieal connexion, that is illustrated in many ways, between
ths anal and the cutaneous arteries and tissues should be

i n— 1.. An interesting contribution to the study of

Say—lid’s disease may be read in our report of the Patho-
ofioai Society. _

THE PATHOLOGICAL SOCIETY.

Tnt Council has decided to make some efforts to deal with
A enaftorro* de richMse which overwhelms the proceedings
■£ this Society and yearly grows greater. Some .kind of
•crstiny is to be exercised, but the precise machinery and
methods have not yet been constructed. We have for many
jests past urged the necessity for some action of this kind,
in adoption of the principle of card specimens without
pohtieatioa of descriptions in the Society’s Transactions
■ay perhaps meet apart of the difficulty. This year the
misty loses the services of Dr. Bristowe and Mr. Butlin.

ii can be no exaggeration to say that the Society was never

Attar served by a president and a surgical secretary than
iy the two gentlemen named. Dr. T. Barlow certainly gave
txpmsskm to a widespread feeling when propoeing the vote
jf to Dr. Bristowe. It must be regarded as one of

As boat traits of the past president’s estimable oharacter,
Ait. be keeps in touch with the young and hard-working
ambers of the profession, and shows in this sympathy an
«z—at and successful endeavour to cope with the patho-
ogieal aspirations of the times.

GOITRE AND CRETINISM IN PERU.

Avtefcsreeting paper on Goitre and Cretinism in Peru was
—ffyread to the* 4 Union Femandina,” a Lima medical
p, by Senor Antonio Lorens, who seems well acquainted
i European literature of the subject and the various
which have been proposed to account for the
t origin of these affections. He himself believes that
io mmm of the suggested causes is alone sufficient to induce
Asm, bat that a most important factor in their etiology is
t p— fty vegetable diet, He gives a detailed description of
of the VUcamayo, In part of which goitre and
are abundant, while in other parts they are
near l y so, the general conditions remaining the
tin exception of greater civilisation and
of animal diet in the localities where goitre
In some places, where forty years ago goitre
was ——a enough, it ha e now nearly disappeared, the
■Mt*Mtifigent inhabitants themselves attributing the
dm—ft tile improved diet pf the people. The author

AM—HM feast prophylactic measures consist in opening up
tba tijWftb fthiu i goitwitidCretinism are rife by means of
>itifttiriatiirgtiMHinDfttn«ce of the district, which
'At pwrtiftftr’Cfitftliilng a more varied and
ffe— thw-lftUW,- -which is ljow their sole
'flambdfiiVHt ideoWing to Senor Lorefia,

misinformed when he was told that goitre was unknown in
South America before the eighteenth century, for there are
preserved in many private museums wax figures with im¬
mense goitres dating from the times of the Incas, and there is
now no doubt that goitre and cretinism existed during the
empires of the Incas and Siris just as they do at the present
time. _

THE SANITARY STATE OF FOLKESTONE.

Mr. Clement E. Priestley, late medical officer of health
for Halstead, is found fault with in the Folkestone local
press for having contributed an article to Thb Lancet on
the subject of an outbreak of typhoid fever in his practice.
He fully justifies his action in the matter, and he then goes
oh to state that both typhoid fever and a mild form of
diphtheria are present in Folkestone, and that it is fat
better to acknowledge it openly and to apply the needed
remedies than to make a secret about it. Folkestone
suffered somewhat severely a few years ago. Between
October, 1831, and Jane, 1882, as many as sixty fatal
attacks of diphtheria took place there, and the non-fatal
attacks were also very numerous. The proper ventilation
of the sewers was then a matter which the sanitary autho¬
rity were urged to carry out, and the reconstruction of
house-drains was also found to be necessary. How far
these still need attention we cannot say, but it is implied
that a house-to-house inspection, proper control of slaughter¬
houses, dairies, and milkshops, and the prevention of over¬
crowding are required.

THE FOOD OF MAN.

There is no doubt that man. can exist on a vegetable
diet. He can obtain from the plant world, digest, and
assimilate those materials which are needful for the repair
of his own tissues. The arts concerned in the preparation
of food will also undoubtedly aid him in his conversion of
vegetable into animal equivalents, and will supplement bis
powers by shortening considerably the period required for
gastric digestion. Still, after all has been said, it must be
allowed that the labour of the alimentary tract is better
adjusted and the formation of sound tissue more assured
by the use of a mixed diet. If on the one hand we assort
the proved value of hydrocarbons in organic combustion
not merely as heat producers but as sources of energy, In
support of our use of vegetables, we must also maintain that
meat which yields us most easily the formative and stimnlaiit
proteids can hardly be discarded. Our internal physical
conformation, which-is intermediate between fhafc of the
carnivora and herbivora should afford at least a sugges¬
tive clue in our.choice of a diet. ,. ^

SPINAL DISEASE AND INSANITY.

Disease of the spinal oord has been frequently discovered
in cases of general paralysis. Commonly enough, locomotor
ataxy precedes the mental disease. The spinal disease is
not, however, always of the ataxio type; other strands than
the posterior are affected in general paralysis. Although
familiar to some, the knowledge is not general that
chronic insanity seldom spares the spinal cord. This fact is
excellently illustrated by a thesis for the degree of M.D. Glas.
by R. S. Stewart, M.B. Records are given of six cases of
general paralysis, six of dementia, and four of melancholia,
with four of imbecility, in all of which the spinal cord was
examined after death. Changes were found in the brain and
cord in all cases. Of the changes in vascularity little
that is definite can be said, but we are disposed to pay more
attention to conspicuous changes in the nerve cells of the
cord. Dr. Stewart has discovered alterations in the large
multipolar motor cells of the anterior horns in most of the

e

90 Thji Langbt,] THE GOVERNMENT EMIGRATION OFFICE.—METROPOLITAN CHARITIES. [Jan. 8,1887.

cases. He is inclined to think that degenerative atrophy of
cells is a constant feature of almost all cases of insanity
which have lasted some time. The atrophy is not purely
pigmentary, but fatty also; the cell is smaller, with
rounded angles, wasting of processes, and breaking down of
edges. The subject is certainly of much scientific interest.
We are impressed with the carefulness of the author, so far
as can be judged by a perusal of the thesis. Dr. Stewart is to
be congratulated on the direction which his studies have
taken, for it is, comparatively speaking, terra incognita, and
diligent labour is sure to be rewarded with rich results.

THE GOVERNMENT EMIGRATION OFFICE.

Emigration may or may not be a panacea for the evils
attending the existence of a surplus population in large
cities, and especially in London; but that the institution of
an Emigrants’ Information Office like that established by
the Government in Broadway, Westminster, is a wise step
in the interests of intending emigrants, as well as one con¬
tributing, indirectly, to the comfort and well-being of those
who remain at home, there cannot be a reasonable doubt.
We have just received copies of a “General Circular” and
“Circular No. 1,” which contain full information on all
points in respect of which inquiry would naturally be made
by those who are about to seek a home in either of the
British colonies; and as among this class there will pro¬
bably be some belonging to our own profession, we think it
well in this place to call attention to the important work
being carried on by the office in question.

METROPOLITAN CHARITIES.

The editor of the Classified Directory of the Metropolitan
Charities gives some statistics for the past financial year.
The Bible and Book Societies have an approximate income
of £299,460; Home and Foreign Missions, of £1,683,706;
Hospitals for the Blind, Deaf and Dumb, the Incurables,
and Idiots, £198,436. The next group interests us much
General Hospitals receive £283,439; Special Hospitals
£264,044. It will thus be seen that Special Hospitals receive
only some £20,000 less than General ones. Of these the
moat favoured are Hospitals for Women and Children, which
get £70,607; and Hospitals for Consumption, which receive
£59,261. Convalescent Institutions receive £48,795. There
are 158 Pensions and Institutions for the aged, representing
£442,685 ; 98 Institutions for Education, receiving £428,629.
The Institutions enumerated are 1024, and their united
income is £?4,680,654. _

COLLECTIVE INVESTIGATION OF VERRUGA.

Thb Lima Academy of Medicine has issued the following
collective investigation card in the hope of clearing up the
etiology and pathology of the obscure but terrible disease
“ verruga,” with which, it will be remembered, a Peruvian
student inoculated himself some months ago, with a fatal
result:—(1) In what regions of Peru, and up to what limits,
does verruga exist? 2. At what height above the sea does
verruga commence, and to what elevation does it extend ?
3. Does it exist in other localities besides Peru ? 4. Did it
exist before the Conquest, and can the disease described by
Zarate and Herrera refer to it ? 6. Climatology of places
where it is rife. 6. Analytic researches on the air and
water of such places. 7. Etiology and symptomatology of
verruga. 8. Pathological anatomy of verruga and micro¬
scopical studies of the microbe, considered by Izquierdo to
be pathogenic. 9. Transmissibility of verruga and the
modes in which transmission is effected. 10. Incubation of
verruga. 11. Its relation to or identity with “ Oroya fever.”
As verruga is but little known, and is undescribed in

most text-books, it may be well to add that a paragraph on
the subject appeared in The Lancet of Jan. 9tb, 1880, in
which it is stated that the disease is “ febrile and charac¬
terised by anaemia and by the appearance of red tubercles of
variable size on the cutaneous surface of the body.” It is
mentioned in Dr. Pye-Smith’s chapter on Skin Diseases in
Fagge’s Principles of Medicine as probably synonymous
with yawp, and with the disease known as “pian” in Java,
also as being possibly related to “parangi,” which is endemic
in Ceylon. _

AN EPIDEMIC OF PNEUMONIA.

A somewhat remarkable epidemic of pneumonia is
reported as having occurred in the Hexham rural sanitary
district. The outbreak mainly affected Wylam, and
Dr. Foulis reported to Dr. Maclagan, the medical officer of
health, that the disease was epidemic in character, and that
although some adults had been affected, its incidence was
mainly upon children. Already the cases have exceeded a
hundred in number, but when the report was received no
fatal attacks bad occurred, although some of the cases were
very severe. All classes, irrespective of social status, had
been affected; and it has been locally suggested that the
weather, which is referred to as having been remarkable,
bad bad some influence in bringing about the epidemic.
We hope to learn more of the conditions under which the
disease occurred. _

ABSORPTION OF CORROSIVE SUBLIMATE BY THE
SKIN.

Dr. Kopff states in the Przeglad leJcartld that, having
mode seven experiments with careful analyses according to
the methods of Schneider, Schridde, and Lehmann, with the
view of determining the power of absorption possessed by
the skin for corrosive sublimate, he has found that healthy
skin can absorb small quantities from aqueous solutions
containing from 1 to 2 per cent, of the salt. The quan¬
tity absorbed, which, however, is never large, seems to
depend mainly on the degree of concentration of the
solution. The chloride of mercury is also invariably
excreted very soon after it has been absorbed.

A CHEMIST CENSURED FOR MEDICAL
PRACTICE.

Dr. C. W. Iliffk, coroner, at Bed worth, has just had
before him and a jury a bad case of medical attendance by
a chemist on a child four years old. The chemist visited
the child eight or nine times, between Dec. 8th and 17th.
The case was certified by him to be one of quinsy. The
child finally died. At the inquest, the chemist, Mr. A. Homer,
gave bis opinion that the child died not from the bursting
of the quinsy, but from congestion of the lungs. Half an
hour before death he said he saw no danger. The case
is aggravated by the fact that it was not the first of
the kind, and that Mr. Homer had had several previous
warnings from the coroner that in the event of another such
case an inquest would be held. Nor is his conduct excused
by his statement that he had sat for “medical examination,
but had failed to get his diploma,” or by the production of
thirty testimonials. The father was a responsible trades¬
man in the town. It is to be regretted that he did not get
proper advice. But Mr. Homer’s conduct had misled him.
He said he had always looked on Mr. Homer as one of the
doctors of the place, “ as he was constantly practising."
The jury found that the deceased died from asphyxia by the
bursting of a quinsy, and that Mr. Homer has committed a
breach of the law by attending, prescribing, and giving a
certificate of death. Here their kindness came to the rescue,
and they ended the verdict by expressing a hope that the

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THE RECENT EXPLOSION AT PORTSMOUTH.

[Jan. 8,1887. 81

panfry ai Mr. Horner's conduct might be waived if he gave
« writ te n undertaking that he would not in future, under
say circumstances, infringe the law, which undertaking he
give. The coroner’s remarks were at once severe and just,
tod Ms determination will not be misunderstood because he
vmaaxxtA in the lenient suggestiou of the jury. Perhaps
tie Apothecaries’ Society should be stayed by the same
eoanderation ; otherwise, the case is eminently one for
tirir action. _

“PLACES OF STUDY” AND THE CONJOINT
EXAMINATION.

It may not be inopportune to again call the attention of
rejected by the Conjoint Examining Board in
faglarr* to a resolution passed last mouth by the Council
«f the Royal College of Surgeons of England recognising
Mr. Thomas Cooke’s School of Instruction in Anatomy and
Fkysiology as a “ place of study” for candidates rejected at
dte second examination of the board. This official recogni¬
tion of Mr. Cooke’s School after he has laboured for some
iftean years in the advancement of medical education is
vail deserved, and it cannot be too widely known amongst
rejected candidates that the three or six months’ additional
v«k which they are required to do can now be performed
nto the tuition and supervision of Mr. Cooke, of whose
*rriees beyond doubt, many will find it convenient and
advantageous to make use._

THE RECENT EXPLOSION AT PORTSMOUTH.

A amors gas explosion occurred on the evening of the
ikdiast. at Cambridge Barracks, Portsmouth, occupied by
dte lad Battalion, Worcestershire Regiment; four men being
MDeri, and eighteen injured and admitted to Station Hospital.
Both at the barracks and hospital the medical officers were
ap gal from 9 p.u. until 6 a.m. the following morning, and
w« believe that all that skill and attention could do was
iom for the unfortunate sufferers. There have been two
deaths out of those transferred to hospital; one with internal
hemorrhage from rupture of spleen and right lung, and the
oikm from multiple injury after amputation of leg. The
remainder, with the exception of one case of extensive
atjary of the face and head, are doing well.

SCARLET-FEVER EPIDEMIC AT WIMBLEDON.

Ws have elsewhere incidentally referred to an epidemic
of scarlet fever in Wimbledon and Merton. The disease has
tffm bred suddenly, and within the period of a few days
owfy tome 400 persons have been attacked, all classes being
•ftdad. There is reason to believe that the epidemic is due
Wfts communication of the infection by means of milk.
I Mnsdly stated that a medical inspector from the Local
gsMtMMbt Board id about to institute a complete inquiry
iafaitife subject. _

BEGGING CHILDREN.

i before had’occasion to comment upon the bar-
hwii— L—Cniii of usingyoong children for begging purposes
Trfifcifaiirft severe weather as We have lately experienced.
A Which wouia be criminal under any conditions

' v . worst aspect when its helpless and miserable
so orueUydisposed. Its inhumanity is further
fin some catrir by the fact that these Children are
of 'tifcMb Whom they accompany, but
as obf&Mtprf commiseration to impose upon
.Even.' defijere the parentage is undoubted,
of vinjary to the child is not less.
I’dtaire Ss T—frn allowance fur the distress of
B destitution resulting'from
' of r ihe children must be

regarded, and we must look to the polioe to find some shelter
for at least the infant section of the begging poor.

CHOLERA IN CHILI.

Accobding to a despatch from Valparaiso, dated the
31st ult., some cases of cholera have been reported in Chili.
This is not the first occasion since the commencement of the
last European epidemic that the occurrence of the disease
in South America has been noted.

FOREIGN UNIVERSITY INTELLIGENCE.

KharJzoff. —Dr. Shchelkoff, Professor of Physiology, has
been appointed Emeritus Professor.

Kieff. —Dr. Mering, Professor of Special Therapeutics, haa
been reappointed for five years.

Kdnigsberg.—Y’totesaoT Madelung, of Rostock, has declined
the invitation to the vacant chair.

Rostock. —The Mecklenburg Government has promised to
supply Professor Madelung with adequate material for
teaching purposes, and by this means induced him to deoline
the call to Konigsberg.

St. Petersburg.— The following names are mentioned in
connexion with the vacant chair of Clinical Surgery:—
Dr. A. Beltsoff, Dr. E. Pavloff, Dr. Xusmin of Moscow, and
Dr. Nasiloff, Professor of Operative Surgery in St. Peters¬
burg, who is, aS stated last week, temporarily fulfilling the
dufies.

Dorpat. —Dr. Rudolph Kobert, Extraordinary Professor of
Materia Medics, Dietetics, and the nistory of Medicine, has
been appointed Ordinary Professor. Dr. Carl Schmidt, Pro¬
fessor of Chemistry, has been reappointed for five years.

Zurich. —The death is announced of Dr. F. Horner, Pro¬
fessor of Opthalmology. _

A be pout has been presented to the Council of Health of
the Seine on the subject of the water-supply of Paris. The
following are the recommendations of the reportTo
hasten the works for bringing in water from the new springs
acquired by the city, aud to impose on owners of house
property the obligation of subscribing for the spring water;
to dispense with the water from the Ourcq for the private
service; to use Seine water, as far as possible, exclusively
for cleansing purposes; to hasten the construction of
appliances for purifying the Seine water; and to erect
drinking fountains supplied with spring water at the
entrance to all the barracks in the city, without prejudice
to the negotiations in hand for supplying the interior of
these buildings. _

The London Gazette of the 4th inst. contains an
announcement of the fact that the Queen has been pleased
to grant Edward Divers, M.D, F.R.S.. Principal and Pro¬
fessor of Chemistry at the Imperial College of Engineering,
Tokyo, permission to accept and wear the insignia of the
Order of the Rising Sun of the Third Class, which His
Majesty the Emperor of Japan has conferred upon him in
recognition of his services whilst actually and entirely
employed beyond Her Majesty’s dominions in His Imperial
Majesty’s service. __

Accobding to the Publishers' Circular the numbers of new
books and new editions published in 1886 in the three
divisions of Theology, Law, and Medicine were as follows;
Theology, 616 new books and 136 new editions; Law, 18 new
books and 15 new editions; Medicine, &c., 114 new books
and 57 new editions. The number of novels, tales, and other
works of fiction published daring the twelve months was 755,
exclusive of new editions of 214 works which had appeared
In previous years.

Digitized by ^.ooQle

92 Thb Lancet,]

STATISTICS RELATING TO MEDICAL STUDENTS.

[Jan. 8,18b7.

The Provincial Utrecktsch Genootschap van Kwwten en
Wetenschapen (Utrecht Association of Arts and Sciences)
offers 300 gulden for the best research on the Action of Pur¬
gative Salts on the Intestine, compared with the Action of
Senna and Calomel. The essays (which may be in English)
are to be sent to the secretary, Herm R. Melvil, Baron van
Lynden, Utrecht by Dec. 1st, 1888.

The death is announced of Deputy Surgeon-General
Richard Wolseley, M.D., who was killed by a fall from his
horse at Meerut a few days since. The deceased officer was a
brother of Lord Wolseley. _

A piece of sacred music has recently been composed and
performed in private by one of the professors of the medical
faculty of Madrid, which is highly spoken of by the press
of that capital. _

News has been received of the death of Seiior Don Dr.
Sandalio Poreda, member of the Council of Public Educa¬
tion, and for more than twenty-five years Profeesor of
Natural History in the Institute of San Isidro, Madrid.

Tiif. Order of Companion of the Indian Empire has been
conferred upon Brigade Surgeon Henry Elmsley Busteed,
M.D., late Assay Master of the Calcutta Mint.

Mn. Thomas Salt, M.P., has been elected to be permanent
chairman of the Commission in Lunacy.

STATISTICS RELATING TO MEDICAL STUDENTS
DURING THE QUINQUENNIUM 1871-75.

The facts about medical students which have been
elicited by the further investigations of the Statistical
Committee of the Medical Council deserve more attention
than we have hitherto been able to give them. The Report
of the committee is an important document, and will well
repay the attention of those who take an interest in medical
education. It will be understood that the statistics of this
Report (the third) of the Statistical Committee refer to the
quinquennium 1871-75 as a whole. The investigation in¬
cludes the tracing of (5403 students who were registered in
this quinquennium. The number gives an annual average
for these five years of 1280-6, an average which in the corre¬
sponding five years of this decennium is exceeded by no less
than 651. It is interesting to notice the chief Places of
Study arranged according to the percentage (of the total
number of medical students) registered as entering at
each. They are as follows University of Edinburgh,
13 21 per cent.; University of Glasgow, 8 70 per cent.; Uni¬
versity College Hospital, 5 53 per Cent.; St. Bartholomew’s
Hospital, 548 per cent.; Guy’s Hospital, 5-26 per cent.;
University of Aberdeen, 4-39 per cent.; School of Physic,
Ireland, 4-28 per cent.; Queen’s College, Belfast, 411 per
cent.; Ledwicn Medical School, Dublin, 3-90 per cent..; St.
Thomas’s Hospital, 3 50 per cent.; Queen’s College, Cork, 3 39
per cent.; Royal College of Surgeons, Ireland, 2-61 per cent.;
Queen’s College, Galway, 2 59 per cent.; King’s College Hos¬
pital, London, 2 47 per cent.; St. George’s Hospital, 2-41 per
cent.; London Hospital, 212 per cent.; Queen’s College,
Birmingham, 2 00 per cent.; Liverpool Royal Infirmary, 1-89
per cent.; St. Mary’s Hospital, 167 per cent.; Owens Col¬
lege, Manchester, l'55 per cent.; the Catholic University
Medical School, 1-53 per cent.; Leeds Medical School, 1-52
per cent.; University of Cambridge, 1-33 per cent,.; Middlesex
Hospital, l - 28 per cent.; Manchester Royal Infirmary,
1-20 per cent.; Charing-croes Hospital, 1 06 per cent.;
Addenbrooke’s Hospital, Cambridge, 103 per cent.;
Bristol Medical School, 095 per cent. But Part II.
of the Report shows that of the 6403 students regis¬
tered as entering the various places of study in the quin¬

quennium, 1871-75 no less than 1931, or 30.16 per cent
had not up to 1835 registered any qualification. This is a
sad history of miscarriage, and gives importance to the
question of a visitation of the schools. There are tables
(Table II. and Table 11 .a) giving the percentages of failure
to qualify of those beginning their medical studies at the
more important schools. These failures, summarily, are, in
England, 27*50 ptr cent.; in London, 26 28 per cent.; in the
provinces, 29 70; in Scotland, 80 - 98 per cent.; in Ireland,
34 33 per cent.; abroad, 4412 per cent. It would be wronfc
to attach too much importance to these statistics of failure.
The significance of them must be a complicated matter.
But they will excite a wholesome criticism, out of which
light and good will come. As a matter of figures, in Lon¬
don, for example, the largest percentage of failures to pass
was in those who began their studies at St. Bartholomew’s,
and the smallest in those who began at Westminster.
In Scotland the largest proportion of failures to qualify
(3462 percent.) is in those who began their medical studies
at Anderson’s College, Glasgow; the smallest, in those who-
began in the University of Glasgow. In Ireland the smallest
proportion of failures (25 00 per cent.) was in those beginning
medical 6tudy at the City of Dublin Hospital; the largest,
in those beginning at Ledwich Medical School, Dublin. Of
the 6403 gentlemen whose medical education began in some
year of the quinquennium 1871-75, and whose destinies
have been the subject of so much attention by the Statis¬
tical Committee, 4472, or 69 54 per cent., have at some time
appeared in the MedicalRegister as Practitioners. Of these
50 per cent, were from places of study in England; 33 per
cent., or one-third of the practitioners, began in London
schools. The school which has the satisfaction of having
the largest proportion of its students proceed to obtain a
qualification is Charing-croes, 8806 per cent, having so
succeeded. Addenbrooke's Hospital, Cambridge, has the
smallest proportion (48'48).

We come next to a class of students who are regarded
with much disfavour by the corporations — i.e., those
who content themselves with One Qualification. There
are 607 gentlemen who up to the end of 1885 had
not registered more than one qualification. Of these,
42 per cent, took the diploma of the English College of
Surgeons. Mercifully for the corporations, of the 640$
students registered in the quinquennium 60 36 per cent,
have already become doubly qualified. This is characterised
by the Statistical Committee as “one of the most important
facts” brought out by the investigation. St. Thomas’s
Hospital heads the list of those getting a double qualifica¬
tion, and Addenbrooke’s Hospital closes it. The next point
elucidated by the statistics is of real interest—the length
of time taken by students of the quinquennium to qualify.
No less than 153, or 3 39 per cent., managed to shorten their
curriculum. Eighteen students accomplished the feat of
qualifying in the same year they began their studies; on©
came from London, three from Scotland, thirteen from
Ireland, and one from abroad.

The Irish seem to know better than English or Scotch
students how to get through in les3 than the prescribed
time, and it is desirable that light should be thrown on their
way of doing it. Thus of 151 students who accomplished
this feat, 25 were from England, 21 from Scotland, and 105
from Ireland. The average interval taken to get qualified
is five yearp, and it is noticeable that those who never get
more than a single qualification, take rather more than
twelve months over the time taken by those who become
doubly qualified. Our space being exhausted, we must pass
over Fart VII. of the Report, which deals with the interval
between the two qualifications in those doubly qualified,
and Part VIII. on the various methods of qualifying. We
end by a notice of the important phenomenon described as
the Migration of students out of their oicn Division in search
of licences to practise. Some very interesting facts came out
in Table XI. From this it is seen at a glance that of the
997 students of the Quinquennium who qualified at the Royal
College of Physicians, Edinburgh, 502, or over 50 per cent.,
came from places of study in England, or, putting it differ¬
ently, that, of 2262 English students of the quinquennium
who became registered practitioners, 2219, or well on to a
quarter, qualified at the Royal College of Physicians of
Edinburgh. From Table XI.a it appears that, of 4453
qualified practitioners, the total outcome of the students of
this quinquennium, no fewer than 1227, or 27*65 per cent.,
went tor one or other of their diplomas to another division
than that in which they registered as students. This fact

FELLOWS AND MEMBERS OF THE ROYAL COLLEGE OF SURGEONS. [Jaw. 8,1887. 93

Zhb Lahcbx,]

t>t*ina where geographical convenience does not explain it;
iiU*, no leas than 66 81 per cent, of the students of the
Bristol school went to Scotland for their qualification. A
rw Scotch and Irish students qualify in England. But
his is nothing to the number of English and Irish students
\ ho take one or both of their qualifications in Scotland. Of
ioee students who qualified in Scotland, no fewer than
'17. or 4SO per cent., came from other divisions of the
. ingdom. The 8cotch bodies whose examinations were most
-^active to the English are, not those of the Edinburgh
niversity, but the Royal College of Physicians of Edin-
argb, the College of Surgeons, the Faculty of Glasgow,
*d the University of Aberdeen. We must for the present
-ave the Report at this point, commending it and its tables
• the study of all medical educationists, and thanking the
at i ati c al Committee for the tables, and especially for the
-xt which explains them. The facts brought to light are of
igh importance in view of the discussions going on for
'Curing for England her fair share of work in giving
-rgreee to her own students. The Report abounds in other
t.formation, which we may give our readers at a future

13M.

I IE FELLOWS AND MEMBERS OF THE ROYAL
COLLEGE OF SURGEONS.

Th* following is a copy of the petition now being circu¬
ited *»y the Association of Members of the Royal College of
'irgeons for signature by the Members of the College
bronghout the kingdom :—

To the Queen's Most Excellent Majesty in Council .

7ae humble petition of the undersigned Members of the
Royal College of Surgeons of England showetb:

That whereas a petition has been prepared for presentation
-v the President and Council of the Royal College of Snr-
.-ous of England, praying for a supplemental Charter, or
iterations in the existing Charters previously granted to
ae said Royal College, your humble petitioners approach
our Most Gracious Majesty respectfully to point out that
y the present Charters the Members of the said College
who are in proportion to the Fellows as 14 to 1) have no
•‘ata* of any kind in connexion with the governing body.

Yonr petitioners most humbly submit that it would be
-oth equitable and politic that the Members should have a
mice in the conduct of a corporation of which they are, and
dways have been, numerically and financially the mainstay.
U present the Council, elected by the 1200-Fellows only,
;«us absolutely with the interests, property, and moneys
.f the College, whilst 16,000 Members are wholly unrepre¬
sented.

Your petitioners do, therefore, moet earnestly pray that
before granting any Charter or supplemental Charter to the
.-aid Royal College, the present position of your petitioners
■nay receive your Majesty’s gracious consideration for suoh
provisions as will create and secure for the Members (who
o largely contribute to the prestige and welfare of the said
'.ollege) the right of representation and other privileges
which should belong to the Members of a corporate body;
farther, that an inquiry may be instituted into the consti-
tation of tbe Council, the management of the College, the
viaduct of examinations, and the expenditure of the College

Finally, your petitioners very humbly pray that in the
?v«t of no petition for a Supplementary Charter or other¬
wise being presented by the Council of your Royal College,
jour Majesty may be graciously pleased, in your wisdom,
-quity, and discretion, to sanction and provide for certain
alterations being made in the present existing Charter so
that it may contain such provisions as are hereinafter
aentaooed L That all Members of a certain number of
years’ standing, to be determined by your Gracious Majesty,
way, after haring been registered, conjointly with Fellows,
exercise the privilege of electing the Council. 2. That a
certain proportion of tbe Council may consist of Members.
1 That the period of office of members of the Council be
considerably shortened. 4. That Members and Fellows be
permitted to vote by voting papers. 6. That no fees of any
aind be paid to any College fund by Fellows or Members
oo their election to office. 6. That the Council prepare a
yearly report, together with an account of income and
expenditure of the College funds duly audited by a public

accountant, which, after its submission for approval to the
Fellows and Members (annually summoned for this purpose
by the President of the College), shall, on adoption, be
required to be published in the medical journals. 7. That
enlarged power may be given to the Council to suspend or
revoke the licence of any Fellow or Member on proof of
discreditable conduct, whether professional or otherwise.

And your petitioners, as in duty bound, will ever pray, &c.

THE HIGH ALTITUDE TREATMENT OF PHTHISIS.

(From a Spbcial Correspondent.)

The Alpine Health-Resorts— Davos, Wiesen, St. Moritz,
The Maloja; Present Condition of these Sanatoria;
Ileeent Results of Treatment there; Lidications and
Contra-indications for and against the adoption of the
Method of Treatment.

The high altitude treatment of phthisis—the Altenkur or
Luftkur of German writers—has already attained so much
popularity, and contains such promise for the future, that
your readers will be interested in learning the present posi¬
tion of this method of practice and the nature of the results
now being obtained. The following remarks are based on per¬
sonal observations made in the Davos valley and the Engadine.

Among the high altitude sanatoria of the Alps Davos is
still facile, princeps. It was the reputation acquired by this
little Alpine village which first gave the impetus in Europe
to the mountain treatment of consumption, and it still
retains its early popularity and pre-eminence over similar
health-resorts. Twenty years ago Davos was one of the
most secluded valleys in the Alps, with a population of
barely one hundred souls, rarely ornever visited by tourists,
who found little or nothing to attract them in its somewhat
sombre scenery. Now the valley boasts a winter population
of 3000 (nearly one-half of whom are invalids), six or seven
first-class hotels and numerous smaller ones, and some nine
or ten resident medical practitioners. Its growth has been
rapid, and in the opinion of some competent authorities it
cannot proceed any longer unchecked, without the inevitable
forfeit of that perfect purity of the atmosphere to which
Davos undoubtedly owes no small portion of its fame.

The main features of tbe Davos climate, and their adapta¬
bility to certain morbid states, have lately been dwelt upon
in your editorial columns. The meteorological conditions
include aerial rarefaction, great purity of the atmosphere,
low relative humidity, coldness of the air, with much
brilliant sunshine and a high range of sun-heat, and com¬
parative immunity from wind, fog, and miasmal emanations.
These characteristics are more or less common to all tbe
high Alpine resorts, but it is to its admirably sheltered
position and the consequent stillness of tho atmosphere
that Davos mainly owes its indisputable pre-eminence over
rival health stations. The valley, while singularly destitute
of the Alpine charm of scenery, is marvellously adapted to
the needs of the invalid in this regard. During his winter
sojourn he must have sunshine and shelter, and it is obvious
that these two indications are to a certain extent incom¬
patible. An open valley like the Engadine is sure to be
wind-swept, while a deeply secluded valley will lack the
necessary quantum of sunshine. Davos admirably fulfils
the condition of necessary mean between undue exposure
and excessive shelter. The valley is protected on the north
by the elevation of the Davos-Kulm, and on the south it
terminates in the narrow and tortuous gorge of the Land-
waeser, so that any strong valley current of air is impossible.
While thus protected from wind, Davos receives a large
amount of sunshine, owing to the fact that the valley lies
open—varying in breadth from half a mile to a mile,—and
the surrounding mountains are neither very lofty nor do
they form a continuous investment.

Opinions differ as to what constitutes the most important
factor in the unquestionably beneficial influence which the
Davos climate exercises upon consumption. Some good
authorities regards the purity of the air, consequent upon the
sparseness of the population (with a correlative immunity
from morbific germs), as the main point, and hence they
view with great apprehension the yearly increasing ingress of
consumptives to the once quiet valley of Davos. Others, again,
think that the main point is the aerial rarefaction, leading to
increased respiratory activity and consequent expansion of the

Gck

Du

94 The Lancet,]

THE fflGH ALTITUDE TREATMENT .OF PHTHISIS. . ax. 8,1887.

thorax. Under this head I may mention that Dr. Ruedi,
whose name is already quite familiar to the profession in
England, reports that of GOO consumptives under his care
distinctive thoracic expansion took place in no less than
584 cases. Other authorities, again, attribute the beneficial
results obtained at Davos to the tout ensemble of tonic con¬
ditions promotivo of appetite, sanguification, and improved
nervous tone.

The accommodation at Davos is in the main surprisingly
good. The hotels most frequented by English visitors are
the Belvedere, the Angleterre, the Victoria, and the Buol—
all first-class; and the food-supply leaves little to be desired.
In the depth of winter fresh green vegetables are somewhat
scarce, but in other particulars the hotels are as well pro¬
vided as in the most favoured resorts for consumptives. The
rooms are fitted with double windows, and are heated by
Stoves. The “ stove question ” is one of the controversies at
Davps, and the advantages and defects of this method of
heating are much canvassed. On the one hand, it is un¬
questionable that so wasteful and inefficient a method as
our open fireplaces would be powerless to cope with the
extreme cold of Davos; while, on the other hand, it cannot
be denied that the stoves unduly absorb the moisture of the
air, and are useless for promoting ventilation. On the whole,
the necessity for spending a large proportion of time in
stove-heated apartments is a serious (and apparently an
inevitable) drawback to the high-altitude treatment.

All information tends to prove that life under the novel
climatic conditions which prevail at Davos, so far from
involving serious hardship, is, on the contrary, most enjoy¬
able. Day after day the sun shines with cloudless splendour,
perfect stillness reigns in the valley, while the keen bracing
air and the dry crisp snow invite to exercise and pleasurable
activity. Almost all invalids, except the most prostrate and
utterly hopeless cases, profess to enjoy the Davos life; and
one encounters in the hotels not a few persons in perfect
health, who, having once visited the high altitude resorts,
return again and again to quaff fresh draughts of that
subtle intoxicant, the air of the Higher Alps. Skating,
toboganning, and sleighing are among the most favourite
amusements, and are freely indulged in. Whether this
free participation in vigorous out-door amusement is a
prudent proceeding on the part of consumptives is another
point about which the visitor to Davos finds a lively con¬
troversy raging. The English invalids incline to these
methods; the Germans regard them with some suspicion.
It strikes the stranger to Davos that the alleged cases
of mischief which are said to have followed this
vigorous therapy are probably in a large measure
attributable rather to dancing, theatricals, and other
amusements carried on in heated and overcrowded
assembly-rooms. Davos has already shared the usual fate
of the popular health-resort, and advertises its concerts,
theatricals, and similar meretricious attractions—as if the
consumptive should seek such pleasures rather than regard
them as a snare to be studiously shunned. No one can
doubt that the early fame of Davos owed much to simplicity
of manners and immunity from so many of the temptations
of life.

There are very few days at Davos throughout the winter
season upon which the invalid cannot take out-door exer¬
cise. Even during a heavy snowfall walking is possible and
pleasurable, as the snow is perfectly dry and can be shaken
off as it falls. During the day the sun heat is so great that
invalids Bit for hours without furs or other extra muffling
upon the hotel balconies enjoying the grateful warmth,
while at the same moment the shade temperature is far
below freezing-point. In a moist atmosphere this dis¬
crepancy between sun heat and shade temperature
would involve a dangerous amount of chill, but all
authorities agree that chill, with its usual consequences of
bronchial catarrh, pneumonia, See., is extremely rare at
Davos. The explanation is to be found in the dryness of the
air, which renders it so promotive of cutaneous and mucous
transpiration. Aa illustrating this peculiar feature of the
Davos climate, the writer may cite an incident related to
him by Mr. Symonds, the eminent critic and poet, who may
be regarded as the parent qf whatever reputation Davos
possesses with the British public. Mr. Symonds was sitting
one day upon his balcony engaged in literary work, and
enjoying the pleasant sunshine. A cup of coffee stood on
the table beside him. He chanced to stand up for a few
paoments in such a position as to intercept the impact of
the sun’s rays upon the table, and, on turning to finish his

coffee, he found it frozen into a solid mass of ice. Here ar
illustrated some of the essential peculiarities of the D&vo
climate— intense coldness of the air combined with aBtillnesfi o
the atmosphere which makes that cold practically unfelt, an<
a powerful sun beat which makes us hesitate whether to clas
the climate as hot or cold. Stranger still is the fact that ii
the evenings many invalids are able with impunity to leav<
a room heated to G0° and go out into the wintry night witl
the thermometer at zero. The nights at Davos are oftei
hardly less brilliant than the days. The moon rides higl
through cloudless skies, the air is perfectly still, and so littli
is the cold felt that one can hardly credit the low reading;)
of the tbermom?ter. Frost-bite occasionally occurs a'
Davos, but is rare, and hardly ever leads to serious results.

Davos is just now threatened with a railway, but th«
project, although favoured by the communal authorities
is viewed with much suspicion by those who are jealous foi
the preservation of the simple manners and pure air which
laid the foundations of the reputation of this altenkurort.
The railway is objected to, not merely because the smoke
would add to the sources of air contamination, but because
such increased facilities of communication would be likely tc
augment with perilous rapidity the yearly-increasing advent
of consumptives. This leads us to consider the most burning
of all the controversies at Davos—viz., the question of over¬
crowding. Mr. Symonds gave the first warning on this
subject some years ago in the columns of the metropolitan
daily press, and his views are shared by Dr. Ruedi, Mr.
Arthur William Waters, and other competent authorities.
At first sight, the visitor to Davos in inclined to be sceptical
about the dangers of overcrowding in a valley twenty miles
long by half a mile to a mile wide, whose population has
reached only to the figure of 3000i But when he has fully-
appreciated the peculiarities of the Davos climate, he begins
to realise that such fears are far from beiug groundless.
The reasons why, with & comparatively scanty population^
Davos is threatened with the evils of overcrowding are a a
follows

1. The stagnation of air during the winter, and the conse¬
quent accumulation of the products of combustion, putre¬
factive particles, &c.'

2. The large amount of fuel consumed owing to the cold.

3. The nature of the invalid cases, every consumptive
being a focus of air contamination.

4. The impossibility of thorough ventilation owing to the
cold.

5. The pulverisation of sputum owing to the dryness of the
atmosphere, and its consequent dispersion through the air.

6. The presence of numerous cattle, and the accumulation
of their dejecta.

This last source of contamination is one which admits of
ready removal, and the inhabitants of Davos would do well
to give their attention to this matter.

No doubt some of the above sources of contamination are
minimised bv the dryness of the air and its tendency to
check putrefactive change, but looking impartially at the
whole question, I am decidedly of opinion that if ever
Davos is transformed into a densely populated valley its
virtues as a sanatorium will have become mere matters of
history.

Efforts are now being made, especially by Mr. Waters, to
suggest some alternative sanatorium. Of the virtues of
Wfesen, St. Moritz, and the Maloja 1 propose to speak in &
subsequent article. Mr. Waters thinks a village near Schnls
in the Engadine offers special advantages, and attention haa
lately, been drawn to the merits of the beautiful and secluded
Valley of Arosa.

' The sanitation of Davos, which not long ago, was most)
defective, has been thoroughly rectified—thanks to the
vigorous protest® of Mr. Symonds,—and may now be pro¬
nounced excellent.

Adulteration in Paris.—I n spite of the keen
Watchfulness of the authorities, adulteration is still ex ten-.
sively practised in Paris. Out of 645 samples of wine
examined in November last, 450 were declared injurious;
out of 88 samples of beer 5 were bad; and of 18 samples of
spirits only one was condemned. More than half the samples
of water were reported to be dangerous, and 80 out of 370
specimens of milk were placed in the same category. Out
of 81 loaves of bread 30 were worthless, and out of 22 speci¬
mens of wall paper only 5 were good. Coffee was very little
adulterated, and the butter was also reported to be fairly
satisfactory.

LL

Du

Tin Lascxt,]

CHRISTMAS FESTIVITIES IN THE HOSPITALS.

[.Tax. 8.18S7. 95

u VALUE OF MEDICAL EVIDENCE IN LIFE
ASSURANCE.”

Thh following communication baa been received for pub¬
lication :—

“ Mr. Chisholm presents his compliments to the Editors of
Tan Laxckt, and bees to forward to them a copy of the
paper read before the Institute of Actuaries, to which
reference is made on pages 1093 and 1094 of the issue of
Th* Laacbt of Deoember 4th. Mr. Chisholm has not seen
the article in the Scottish Banking and Insurance Magazine,
which forma the basis of the note in Thk Lancet, but he
thinks that the statements in that article may have misled
the Editors of Th* Lancbt as to the object of Mr. Chisholm’s
taper. Mr. Chisholm does not hold the opinion imputed to
aim that it is either possible or desirable to dispense with
he teat of mod ical examination in the general practice of
life insurance, and his paper was written rather with the
opposite view of discussing measures for making medical
yrarainations more effective. There are cases—the insurance
of the lives of a great number of employes , for example—in
which actuarial opinion is favourable to the idea of dis¬
pensing with medical examination, but these are necessarily
rue in their occurrence, and Mr. Chisholm, at the outset of
his paper, endeavoured to define the conditions under which
alone such dispensation might be allowed. The quotation
cf the words embodying this opinion without qualifying
conditions, and leaving it to be understood that a course
which might be followed on rate occasions should be treated
as of uni versed application, amounts not to a representation,
but to a travesty of Mr. Chisholm’s views. The Editors of
Thk Lxnckt will no doubt deem it right to give equal
prominence to this disclaimer as to the original notice that
appeared in their journal, and it is hoped that they will lend
the weight of their high authority to the promotion of a
common understanding (which the eminent physicians who
act as the chief medical advisers of our life insurance
companies, do so much to encourage) between medical
examiners and actuaries as to their respective spheres in
the delicate and difficult task of assessing life risks—a task
which it is not possible for either the one expert or the
•Cher completely to undertake by himself.”

We are glad to learn that the opinion attributed to
Mr. Chisholm as to the doubtful advantage of a medical
examination in case3 of life assurance is incorrect. We
cannot but regret, however, that he was not more clear in
the statement of his views, for we find that two of the
gentlemen who were present at the reading of his paper
understood him to hold the opinion attributed to him in
the Scottish Banking and Insurance Magazine. Dr. Selfe
Bennett said that “Mr. Chisholm had praised past times, and
looked back with regret upon the old days when the pro¬
poser simply went before the board of directors, who

uked him a few questions and accepted or declined him.

They were not likely to get statistics such as the author
hoped for, to an extent and sufficiently reliable to enable an
actuary to step in and dispense with the doctor’s services.”
And, again, Dr. Tirard said “ that Mr. Chisholm appeared to
two opposite views: first of all, that they ought to
do without medical examination at all; and secondly, that
they ought to make the medical examinations much more
tfxict in their work than they have hitherto been.” It is
atisfactory to be informal by Mr. Chisholm that he does
aot think it either possible or desirable to dispense with the
medical examination in cases of life insurance.

CHRISTMAS FESTIVITIES IN THE HOSPITALS.

Great Northern Central Hospital, Caledonian-road. —The
asoal Christmas entertainment was given to the patients in
this institution by the members of the Ladies’ Association
in connexion therewith, and to those inmates who- were
abia to attend a concert of vocal and instrumental music was
given. A Christmas-tree was provided for the children who
were, or had been during the year, inmates of the hospital,
and presents of warm clothing were also distributed.

Paddington-green Hospital for Children. —On the 29th ult.
a Christmas entertainment was given to the in-patients and
convalescents at this institution. The proceedings, which
began with a Punch and Judy show and a magic lantern
exhibition, were concluded by vocal and instrumental music,
and an exhibition of dogs.

Brompton Hospital. —Christmas at this institution was
inaugurated by a Confirmation held by the Bishop of London
in the chapel of the hospital on the 23rd ult., at which
fifteen of the patients were presented. On the 23th carols
were sung, and after service in the chapel extra rations of
seasonable food were provided for the inmates. In the
evening an entertainment of voc&l and instrumental music
was given. On the 28th carols were sung by a trained
choir, and on the 30th ult. a Christmas tree was provided.

London Hospital .—The annual festival of the children’s
Christmas-tree was celebrated in this institution on the
4th inst., when toys and other suitable presents were dis¬
tributed to the juvenile patients, who number about 130
Previous to the distribution an entertainment was given.

WILLS OF MEDICAL MEN.

The will and two codicils of Archibald Gordon, M.D., C.B.
formerly Inspector-General of Hospitals at Bombay, then of
Halmyre, Peeblesshire, N.B., but late of 70, Comwall-gardens,
South Kensington, who died on August 3rd last, at West
lloathley, Sussex, were proved on Dec. 8th, by Mrs. Mary
Preston Gordon, the widow, and Mr. Charles Bowman Logan,
the executors, the value of the personal estate in the United
Kingdom amounting to over £17,000. The te.-tator gives his
household furnishing, plate, books, pictures, and plenishing
of every kind to his wife absolutely; and £200 to his
executor, Mr. Logan. The residue of his real and personal
estate he leaves upon trust for his wife for life, she main¬
taining and educating children residing with her; and at
her death for the whole of his children by her, share and
share alike.

The will of Richard Sharpe, M.D., formerly of Cheshunt,
Herts, but late of The Ferns, Oakleigh-roud, Whetstone,
Middlesex, who died on Nov. 9th, was proved on Nov. 27th
by Mr. Henry Perceval Mackrell, and Mr. Ernest Rolls
Sharpe, the son, the executors, the value of the personal
estate exceeding £9000. The testator makes some specific
bequests to his wife and children ; and leaves the remainder
of his furniture and effects and £4000 to his wife for life or
widowhood. The residue of his property he gives to all his
children equally.

The will of Joseph Seaton, M.D., late of Halliford House,
Sunbury, Middlesex, who died on Sept. 30th last, was proved
on Dec. 2nd by John Joseph Joscelyn Seaton, M.D>, the son,
and Mr. George Thomas Haigh, the executors, the value of
the personal estate being over £4500. The testator bequeaths
a picture to his said son, aud a legacy to a granddaughter.
As to the residue of his real and personal estate, he leaves
one-fourth to or upon trust for each of his children, Ernest
William Attree, Katherine Jane, and Robert Winslow; and
one-fourth upon trust for his daughter, Mrs. Ellen Dickinson,
until she shall succeed to certain property, and then to be
divided between his three last-named children.

The will of Mr. Joseph Sampson Gatngee, Surgeon, late of
22, Broad-street, Birmingham, who died on Sept. 18th last,
has been proved at the Birmingham District Registry by Mrs.
Marion Gamgee, the widow, and one of the executors. The
testator leaves all his real and personal estate upon trust for
his wife for life or widowhood, and then for his childreu in
equal nhares.

The will of John Burke, M.D., late of Hatfield, Herts, who
died on Nov. 9th, was proved on Dec. 2nd by Mr. Arthur
Edmund Sharp, the sole executor. The testator gives all
his real and personal estate to Mary Ann Charlotte Chiffelle

The following legacies have recently been left to hospitals
and other medical institutionsAir. Henry Boddington, of
The Cove, Silvardale, Lancashire, and of St range ways,
Manchester, brewer, £1000 to the Manchester Royal Infirmary
and Dispensary, £250 each to St. Mary’s Hospital and
Dispensary, Manchester, and the Salford and Pendleton Royal
Hospital and Dispensary; and £150 to the Stockport
Infirmary.—Mrs. Eflirabeth Fisher of The Avenue, Colchester,
Essex, £100 to the Essex and Colchester Hospital.—Mrs.

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96 The Lancet,J

REPORTS OF MEDICAL OFFICERS OF HEALTH.

[Jan. 8,1887.

Mary Ann Garston, of High Pastures, Crigburth near
Liverpool, .£100 each to the Royal Infirmary and Children’s
Hospital, Liverpool._

^Public lealtji anh %ak

LOCAL GOVERNMENT DEPARTMENT.

BBPOSTS OP MEDICAL OFFICKBS OF HEALTH.

St. Pancras .—The annual report for1885 is the first one sub¬
mitted to the vestry by their newly-appointed medical officer
of health. Dr. J. F. Sykes, and as he only held office during
a portion of the year he does not profess to deal with the
district in such detail as he could have wished. Making the
necessary corrections, the annual death-rate from all causes
was 1989 per 1000 liviug, that from the zymotic group
being 2-6. Small-pox caused G3 deaths in the latter group,
the outbreak being a continuance of that which commenced
in 1884. As to this disease, Dr. Sykes specifies how the
metropolis is to be benefited by the prompt removal to a
distance of London small-pox patients by the Metropolitan
Asylums Board. But this will not affect the Highgate
hospital, which lies on the boundary of St. Pancras, and the
inlluence of which on this district was shown in Mr. Shirley
Murphy’s last report. As to water-supply, we learn that
before another year elapses the whole parish will be provided
with a constant water service, except a few houses supplied
by the West Middlesex Water Company. The improvement
is stated to be accompanied by conditions which are regarded
by the inhabitants as excessively stringent, but from a sani¬
tary point of view the gain will be considerable. A new
mortuary and disinfecting buildings are being provided.
The rapid steam process of disinfection is not to be supplied,
apparently on the ground of expense, both the initial cost
and that of retaining the services of a skilled servant being
held in view. This is to be regretted, because the alternative
dry-heat system is so much more slow; and since there are
many articles which cannot be thoroughly penetrated by the
necessary temperature, except after the lapse of from six to
eight hours, there is danger of undue haste leading to
imperfect results. In a district where already some 4000
articles are sent for disinfection, we should have thought
that the steam-pressure system was called for on the grounds
of economy of labour and of time, if not also on the score of
ultimate expense.

Birkenhead Urban District .—Allowing for increase of
population, the birth- and death-rates for this borough
during 1835 were 34 6 and 19 5 per 1000 respectively, the
zymotic rate being 2 4. Mr. Vacher discusses at consider¬
able length the meaning of these rates from different points
of view and in relation to the different portions of the
district, and he then proceeds to give details concerning each
group of diseases. Of small-pox there were 24 fresh cases
during the year; each was isolated. When a case came under
notice the public vaccinator was immediately acquainted with
the fact in order that the requisite means of protection might
be afforded to those who ran the risk of exposure to infection.
Under the compulsory system of notification, 1580 cases
were reported. The majority were cases of measles, but
scarlatina accounted for 556, typhoid fever for 38, and diph¬
theria for 21 cases. It is noteworthy that, although the
dual system of notification by householder and medical
attendant is in force, there were only nine instances of notifi¬
cation by householders; and Mr. Vacher also points out that
the allegation so often made, to the effect that in places
where notification existed the proportion of deaths from the
diseases notified to cases reported would show an increase,
is certainly not correct in the case of Birkenhead. In
short, compulsory notification has not led to cases being
hidden and left without medical attendance. There has, on
the contrary, been a decided diminution in the deaths in
Birkenhead, and a corresponding saving of life. There is,
unfortunately, a large amount of unregistered deaths among
infants, and it is almost impossible not to suspect some
sinister motive as influencing this failure to seek medical
help in infantile diseases. Tbe infections hospital, now
enlarged, did good service during the year; the sanitary
work included the disinfection of 696 bouses and 234
paroels of clothing, and the destruction of bedding, &a, in 28

cases, the arrangements for all this work being well
organised. Lodging-house inspection needs reform, for there
is no night-inspector, and it is well known that without
such an officer efficient control of common lodging-houses
and occupiers of cellar dwellings cannot be carried out.
Improved arrangements have been made for slaughtering,
and the report for 1885 shows, in other respects, excellent
progress.

Portsmouth Urban District.— Dr. B. H. Mumby was only
appointed medical officer of health for Portsmouth towards
the close of 1885, and hence he is only able to deal with
such facts and figures for that year as nave been brought
under his notice. The birth- and death-rates were 34 o and
19 79 per 1000 respectively, in a population of 131,659. New
works of sewerage are in progress; and, referring to the
position which Portsmouth formerly held in the list of
English towns, as quoted by the Registrar-General, Dr.
Mumby expresses the hope that, with their completion,
Portsmouth will regain the place which she formerly
occupied. Portsmouth is a very oomposite borough, and
this is especially marked in the case of euteric fever. Thus
at Southsea, where the sanitary arrangements of the houses
are mostly on an improved and modern system, with good
drain ventilation, the fever death-rate is 039 per 1000;
whereas in Kingston, where the sanitary arrangements are
not nearly so good, the rate is more than double. And,
amongst the causes of enteric fever, the pollution of the
subsoil by cesspits and by a faulty main sewer are specially
adverted to. Such pollution must also be regarded as one
of the main factors in the production of fatal infantile
diarrhoea. This latter disease was also twice as fatal in
Kingston as in Southsea. Under a system of compulsory
notification of infectious diseases the following were heard
of;—Typhoid, 762; scarlet fever, 314; diphtheria, 173; small¬
pox, 2; puerperal fever, 2—in all 1253. And yet only 37
patients were admitted into the infectious diseases hospital,
a number so small that the institution can hardly have
influenced the state of infection in the borough to any
noteworthy extent. Dr. Mumby hopes the buildings will
come to be more used, and he goes on to show how small are
the payments demanded by the sanitary authority. We
expect these payments are the main hindrance to the proper
use of the hospital, and it would be well for the Town
Council to consider whether it is desirable, for the sake of
£53 odd, to run the risk of deterring people from seeking
isolation. Over and over again it has been shown that even
small payments are a hindrance; and in some places it has
very properly been decided that ratepayers and their house¬
holds—that is to say, those who built and who maintain the
hospital—should be admitted free. Masters sending servants
are required to pay 10s. 6 d. a week in Portsmouth. A
greater inducement to pack a maid off to her own home as
soon as possible could hardly be devised. What does the
master in his capacity as ratepayer pay for, if it be not the
right to use the hospital for the protection of his household?

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5397 births
and 4374 deaths were registered during the week ending
Jan. 1st. The annual death-rate in these towns, which had
been equal to 20 7 and 21-5 per 1000 in the preceding two
weeks, further rose last week to 261. During the thirteen
weeks ending last Saturday the death-rate in these towns
averaged 20-3 per 1000, and was 21 below the mean rate in the
corresponding periods of the ten years 1876-85. The lowest
rates in these towns last week were 16 8 in Blackburn,
17 6 in Derby, 184 in Sunderland, and 19 5 in Bradford.
The rates in the other towns ranged upwards to 32 3 in
Manchester, 32-4 in Liverpool, 35'2 in Cardiff, and 36 0 in
Halifax. The deaths referred to the principal zymotic
diseases in the twenty-eight towns, which had been 386
and 433 in the preceding two weeks, further rose last
week to 537; they included 244 from measles, 90 from
whooping-cough, 80 from scarlet fever, 56 from “fever"
(principally enteric), 36 from diarrhoea, 30 from diphtheria,
and 1 from small-pox. No death from any of these zymotic
diseases was registered last week in Derby; whereas they
caused the highest death-rates in Portsmouth, Halifax,
Wolverhampton, and Leeds. The greatest mortality from
measles occurred in Newcastle-upon-Tyne, Liverpool,

O

LAJKnrx,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

rJAN.8,1857. 97

H a lifax . Leeds, and Wolverhampton; from scarlet fever in
Salford, Newcastle-upon-Tyne, Bradford, and Manchester;
from whooping-cough in Sunderland, Manchester, Oldham,
and Huddersfield ; and from “ fever” in Portsmouth, Preston,
Norwich, and Cardiff. The 30 deaths from diphtheria in the
twenty-eight towns included 9 in London, 5 in Portsmouth,
3 in Birmingham, 3 in Birkenhead, and 2 in Newcastle-upon-
Tyne. Small-pox caused one death in Portsmouth, but no
death from this disease was registered in London and its
outer ring, or in any of the twenty-six other large pro¬
vincial towns. No case of small-pox was under treatment
cn Saturday last in the metropolitan hospitals receiving cases
of this disease. The deaths referred to diseases of the
respiratory organs in London, which had been 494, 41(5, and
in the preceding three weeks, rose last week to 577,
asd exceeded the corrected average by 35. The causes ot
129, or 2-9 per oent., of the deaths in the twenty-eight
towns last week were not certified either by a registered
mrdical practitioner or by a coroner. All the causes of
death were duly certified in Leicester, Wolverhampton,
Birkenhead, and Cardiff. The largest proportions of un¬
certified deaths were registered in Halifax, Sheffield, Oldham,
asd Sunderland. _

HEALTH OF SCOTCH TOWNS.

Tie annual rate of mortality in the eight 8coteh towns,
which had been 22*0, 22 5, and 26’2 per 1000 in the pre¬
ceding three weeks, was 26-0 in the week ending Jan. 1st;
this rate exceeded by 0*9 the mean rate during the same
week in the twenty-eight large English towns. The rates
ia the Scotch towns last week ranged from 16-4, and 18 5
id Perth and Leith, to 24 6 in Greenock and 32 9 in Glasgow.
The 641 deaths in the eight towns last week showed a
4scHne of 7 from the numbers in the previous week, and
included 21 which were referred to whooping-cough, 16 to
wastes, 13 to diarrhoea, 12 to scarlet fever, 10 to “ fever”
typhus, enteric, or simple), 1 to diphtheria, and not one to
mall-pox; in all 73 deaths resulted from these principal
rymotic diseases, against 75 and 63 in the preceding two
weeks. These 73 deaths were equal to an annual rate of
39 per 1000, which was 01 below the mean rate from
the same diseases in the twenty-eight English towns.
The fatal cases of whooping-cough, which had been 19
tnd 15 in the previous two weeks, rose last week to 21, of
which 18 occurred in Olasgow. The 16 deaths from
tesslee, all of which were returned in Glasgow, also
showed a further increase upon recent weekly numbers.
The fatal cases of scarlet fever, which had declined in the
preceding four weeks from 25 to 13, further fell last week
V) 12. which included 5 in Glasgow and 5 in Dundee.
The 13 deaths attributed to diarrhosa somewhat exceeded
the numbers in recent weeks; 6 occurred in Glasgow, 3 in
Edinburgh, and 2 in Aberdeen. The 10 deaths referred to
•fever,’' exceeded the number in the previous week by 6,
tnd included 3 in Glasgow and 2 in Greenock. The deaths
referred to acute diseases of the respiratory organs in t.he
eight towns, which had increased in the preceding five
weeks from 125 to 188, declined last week to 179, but
exceeded the number in the corresponding week of last
year by 30. The causes of 88, or nearly 14 per cent., of the
deaths in the eight towns last week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 35 6,29 6,
tad 28-5 per 1000 in the preceding three weeks, rose to 88 0
in the week ending Jan. 1st. During the thirteen weeks
mding last Saturday the death-rate in the city averaged
5*7; the mean rate during the same period did not exceed
1*8 in London and 195 in Edinburgh. The 257 deaths in
Dublin last week showed an increase of 64 upon the number
in the previous week, and included 11 which were referred
ro scarlet fever, 4 to “fever” (typhus, enteric, or simple),
? to diarrhoea, and not one either to small-pox, measles,
diphtheria, or whooping-cough. Thus the deaths from
these principal xymotic diseases, which had been 23, 22,
ad 21 in the previous three weeks, further declined last
week to 17; they were equal to an annual rate of 2*5 per
1000, the rates from the same diseases being 2*6 in London
tad 12 in Edinburgh. The 11 fatal cases of scarlet fever
exceeded the numbers returned in recent weeks; whereas
those referred to “fever” and diarrhoea showed a further
decline. Thirteen inquest cases and 10 deaths from violence
wen registered; and 84, or nearly a third, of the deaths

occurred in public institutions. The deaths of infants corre¬
sponded with the number in the previous week, while those
of elderly persons showed a further marked increase. The
causes of 42, or more than 16 per cent., of the deaths regis¬
tered during the week were not certified.

THE HIGH DEATH-BATE IN PRESTON.

A paper entitled “ A Critical Inquiry into the Causes of
the High Death-rate of Preston ” was recently read by Dr.
J. A. Kigby before the Medico-Ethical Society of that town.
This subject, which is one of more than merely local interest,
has recently attracted, as it undoubtedly should do, con¬
siderable interest in the town. Dr. Rigby appears to have
convinced himself, on two grounds, that the true death-rate
of Preston is considerably overstated in the Registrar-
General’s returns : in the first place, by a large under¬
estimate of the population ; and, secondly, because, as he
asserts, the high death-rate is to a large extent the natural
result of the high birth-rate that prevails, and has long pre¬
vailed, in Preston. As regards the asserted under-esrimato
of the population of Preston, it may be pointed out that the
Registrar-General’s estimate of the population in the middle
of this year, based upon the usual hypothesis that the rate
of increase that prevailed between the last two censuses bus
since been maintained, is almost identical with the estimate
based upon the rate of increase of inhabited houses in the-
borough between the middle of 1881 and the middle of 1885.
It follows, therefore, that if the Registrar-General’s estimate
is very considerably below the actual number of the popu¬
lation, that the proportion of persons to a house must have
largely increased since 1881. Moreover, the Registrar-
General’s estimate of population shows a very large decline
in the birth-rate in Preston since 1881, which is scarcely con¬
sonant with the asserted recent exceptional increase of popu¬
lation by the immigration of 3000 dock labourers and their
families, tbe natural effect of which would be to raise the birth¬
rate. We do not doubt the immigration of the dock labourers;
but is it not very probable that they have merely supplied'
the place of other immigrants who would have been
attracted to this manufacturing centre since 1881 but for the
general commercial depression ? In the face of these con¬
siderations, we cannot accept the assertion of a large under¬
estimate of the population of Preston. But that Dr. Rigby
in his paper entirely ignores all that has been written and
said during the last ten years upon the vexed question of
the inter-relation of birth-rates and death-rates, it would
appear almost necessary to apologise for asserting once more
in these columns that the high birth-rate in Pre6ton, far
from explaining, only accentuates the high death-rato
in that town as evidence of insanitary condition. It
ought not to be necessary now, in criticising a “critical
inquiry ” into the causes of any high death-rate, to point out
this generally exploded fallacy which has once more been
asserted by Dr. Rigby. A high birth-rate in any population
necessarily implies, in the first place, an exceptionally large
proportion of young adults, who are liable to a low death-
rate, and also implies a smaller proportion of old people,,
whose death-rate is high ; moreover, although a high birth¬
rate does imply a large proportion of infants and young
children, it should be borne in mind that the death-rate of
children over four years of age falls below the mean age at
all ages, and that the death-rate of children between the
ages of seven and twenty years is lower than at any
other period of life. On those accounts the age constitution
of all populations having a high birth-rate is more favourable
to the death-rate than is the age constitution of a population
which has a low birth-rate. For instance, presuming
identical death-rates at each age period in Brighton and
Preston, the age constitution of the former town would
produce a death-rate at all ages more than 1 per 1000 in
excess of the death-rate in Preston, although, as is pointed
out by Dr. Rigby, the birth-rate in 1885 was only 261 in
Brighton, instead of 39-2, as in Preston. We hope, there¬
fore, that those most interested in the sanitary condition
of Preston will not be misled by Dr. Rigby's assertion of
the over-statement of the death-rate into relaxing their
efforts to arrive at the true explanation of the high rate of
mortality in the town. We have seen no attempt to deter¬
mine the death-rate of the town at different groups of ages,
or the rates of mortality from the different classes of
disease, which are both absolutely indispensable to deter¬
mine the true import of a death-rate. Dr. Rigby does not
attempt to controvert tbe existence of exceptionally high

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98 The Lancet,]

ARTERIAL PRESSURE.

[Jan. 8, 1887 *

infant mortality in Preston, but attributes it to excessive
proportions of illegitimacy, to the exceptional prevalence of
venereal disease, and to the effect of the large employment
of married woman in factory labour.

Comspottkena.

“ Audi alteram partem.”

THE EFFECT ON THE FEMORAL ARTERY OF
LIGATURE AT THE APEX OF
SCARPA’S TRIANGLE.

To the Editors of The Lancet.

Sins,—My best thanks are due to Mr. Savory for his
courteous reply to my inquiry with reference to the abstract
of his paper on this subject. Would you allow me space
for a few lines on the very interesting surgical point which
that paper treats ? I am wise enough not to wish to enter
into controversy with Mr. Savory, but if he will do me the
kindness of correcting any error into which I may have
fallen in treating of the condition of this artery after
ligature, or any inadequacy in the expression of my ideas,
I shall be very grateful.

I have always been taught, and have always taught,
that alter ligature of any artery on the old plan, where
the vessel is divided by the ligature as it separates, a
portion of the artery is obliterated, which in many cases
reaches to the first considerable branch above and below.
In some cases, however (as shown in the woodcut to
which I referred in my last, on page 86 of the first, or
page 90 of the fourth edition of my work on the “ Principles
and Practice of Surgery ’), the extent of artery obliterated is
much less. In the case of the superficial femoral, the tract
of artery obliterated is sometimes as much as two inches
(as in Porta’s case, referred to and figured in the “System
of Surgery," third edition, vol. iii, p. 62; and also described
in “Gray’s Anatomy,” tenth edition, p. 412), sometimes, as in
the case just mentioned, not more than a quarter of an inch.
In one of Hunter’s cases the whole artery was found
obliterated, including the aneurysm, and this is the case
which was probably in the mind of the writer whom Mr.
Savory quotes. But I have always regarded this as ex¬
ceptional, and probably caused in that case by the fact
that a larger part of the vessel was exposed than is
ever done now, and numerous ligatures perhaps used.
In all ordinary circumstances, the blood returns into
the portion of the artery below the ligature, and there¬
fore when the artery is tied for aneurysm there are
two arches of anastomosis: one, the higher, to carry
the blood round the portion of the artery obliterated by the
ligature; and the other, the lower, to carry the blood round
the aneurysmal part of the artery, which, I believe, has
been always found obliterated in cases cured by ligature,
though not always in those cured by pressure. The prin¬
cipal importance of these facts lies in this: that from a very
early period after the operation blood must be passing
through the artery below the ligature into the aneurysm. I
have always endeavoured to set out these facts in the plain¬
est possible language in the various text-books in which I
have treated of them—viz., in “Gray’s Anatomy,” “The
System of Surgery,’’ and my “ Principles and Practice of
Surgery,” and I confess I was surprised to hear from so
great an authority as Mr. Savory that no ordinary book stated
that “ the artery was pervious from the ligature to the aneu¬
rysm.” Construing the words quoted strictly, no book does
state this, for it is not true. Some part of the vessel
must be obliterated below its point of division, or haemor¬
rhage would take place. But 1 submit that the works above
referred to plainly state the facts as I have just put them,
and I think they are in exact accordance with the gist of
Mr. Savory’s paper. If, however, my words as they stand
in those books do not convey my meaning, 1 shall be glad to
be corrected. Text-book writers are peculiarly liable to
faults of expression due to condensation—" brevis esse
laboro, obscurus fio.”

I may add that the published descriptions are necessarily
taken from the dissections of cases in which the artery has
been divided by the ligature. In many of those where the
vessel has not been divided (as I believe is now common), the

portion of artery obliterated is probably very minute—n
more than a mere diaphragm across the tube,—as shown i
a case figured on page 93 of my “ Principles and Practice c
Surgery, fourth edition; and in such cases I myself believ
it to be probable, though the fact has not yet been ascer
tained, that the whole artery may again become pervious.

• I am, Sirs, your obedient servant,

Jan. 1887. T. HOLMES.

ARTERIAL PRESSURE.

To the Editors o/Thh Lancet.

Sibs,—I n endeavouring to master the mysteries of orteria
pressure, I have arrived at the conclusion that our physio
logists are scarcely consistent in themselves or with eacl
other. The text-books I have studied are Foster’s Physio
logy and Brunton’s Pharmacology, and should I have failet
to comprehend the meaning of these writers, any explana
tiona that may be forthcoming may benefit many others, a.
well as myself.

In the first place it seems to me that we have to deal witl
two main factors: (1) the pressure of the blood on thi
arteries, and (2) the pressure of the arteries on the blood
but it does not seem to me that either Foster or Bruntoi
has kept these two factors clearly in their mind’s eye, anc
a most puzzling confusion is the result. Thus we are tolc
by Brunton (page 226), that arterial tension and blood
pressure is one and the same thing, and that the more
tensely the arteries are stretched the greater is the pressure
they exert on the blood they contain; whereas Foster states
(page 203) that constriction of any vascular area increases
the blood pressure there; so that we may apparently have
increased pressure both with overstretched arteries and with
contracted arteries. It would simplify the matter if
we separate the terms arterial tension and blood pres¬
sure ; or, better still, if we do away with the term arterial
tension and substitute arterial pressure; making arterial
pressure correspond to the pressure of the arteries
on the blood; and blood pressure correspond to the
pressure of the blood on the arteries. Bearing this dis¬
tinction in view, it is ovident that the more blood there is
in the arteries the more the arteries will be stretched by the
pressure of the blood on them; here, it would be 6aid, the
blood pressure is high. On the other hand, were the quan¬
tity of blood in the arteries not increased but the arteries
constricted, then would the arterial pressure be high. It is
also evident that the manometer will not distinguish
between blood pressure and arterial pressure, but will simply
register the combined pressure—the action and the reaction
of these two factors. Bearing in mind the separate action
of the two factors mentioned, it is easy to understand the
statement of Foster that moderate bleeding does not reduce
blood pressure, for evidently the pressure is maintained by
the arteries contracting on the diminished volume of blood
in them; but this fact is not in accordance with Brunton’s
statement that arterial tension is synonymous with blood
pressure, for here we get a similar pressure with contracted
arteries. To my mind, it is a most unfortunate and con¬
fusing statement to make tonos and stretching one and the
same thing; nor is there any proof given that the more the
arteries are stretched the more pressure they exert on the
blood in them. The more the blood stretches the arteries
the greater is the pressure of the blood on them; but it
is doubtful if an over-stretched artery exerts relatively
higher pressure than one less stretched. On the contrary,
Foster states that the tone of any vascular area may be
augmented by constriction—that is, that the constriction
increases the pressure.

Then, again, the statements in Foster (page 185) relative
to the effects of constriction and dilatation of vascular areas,
are, to my mind, far from being clear, and scarcely in accord¬
ance with his statements (page 207) that throwing more
blood into the arteries does not increase the arterial pressure,
nor bleeding directly diminish it; because if A (being a
vascular area) be constricted, the effect of this constriction,
we are told, is to increase the pressure in the remaining
portion of the arterial system. But surely the effect of this
constriction in A must be similar to adding blood to the
circulation, which, we are told, does not raise the pressure.
If, on the other hand, A be dilated, the remaining portion of
the arterial system has its pressure lowered; but the effect
of this dilatation in A on the remaining portion must be

Digitized by Google

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CdLaxcbt,]

SUPPURATION IN THE APPENDIX VERMIFORMIS.

[ Jan. 8,1887. 99

Boilar to bleeding, which, we are told, does not reduce
pressure. Then we may get the following associations on
combinations— namely, increased pressure along with an
increased flow of blood into the veins, and increased pressure
with a diminished flow; diminished pressure with increased
flow, and diminished pressure with a diminished flow of
blood into the veins. These combinations are very
pooling until the two factors are separated, when they
beoome more easy to understand. Thus, increased pres-
rare, the result of an increased quantity of blood, is accom¬
panied by an increased flow into the veins; but increased
prereure, the result of contraction of the artries, is
accompanied by a diminished flow, and diminished pres¬
ume, the result of the arteries pressing less on the
blxxl (i.e., dilatation) is accompanied by an increased flow;
but a diminished pressure the result of less blood is accom¬
panied by a diminished flow. Without this distinction it is
aomewhat difficult to see what necessary connexion there is
between pressure and flow, but with this distinction it is
apparent. The last point I will discuss is the effect of
wction of the renal nerves on pressure in the vessels of the
mal glomeruli; this section causes the renal arteries to
dilate, and both Foster and Brnnton state that this dilata¬
tion leads to an increased pressure in the vessels of the
glomeruli, and Foster further states that this occurs,
the pressure in the renal arteries is lowered. This
r difficult to follow, and where the increased pressure
from I cannot conceive. It cannot come from the
arteries, whose tonoa or tension is gone; it cannot
■from peripheral resistance, for that is gone with the
of the nerves; and peripheral resistance being gone,
_. re from behind cannot cause it, as the renal arteries,
I'lowered pressure, intervenes. In my opinion section
‘is renal nerves does not cause increased pressure in the
Jsof the glomeruli, although more blood passes through

forbids mft discussing other interesting problems,
i conclusion, if my criticisms of such eminent authori¬
ties as Foster and Bronton are radically wrong, I can only
■press my sorrow for it,and spend two or three months more
iitnina to overcome the intricacies of vascular pressure.

I remain, Sirs, your obedient servant,

. Hav. 33*d. 18 S 6 . W. Nicholson, M.D.

U ( «*»»■■ I -

WITORATION Itf THE APPENDIX VERMI-
*' - ‘ FORMIS.

■ vJU Editors o/Thu Lancet.

— An instance of suppuration in the vermiform
ippendage of the caecum causing enteritis and peritonitis
is bo rare that I hope you may deem it worthy of record in
the pages of The Lancet. A man aged forty-two, occupy-
iag the position of an in-door servant as ball-porter, was
wired with severe pain in the abdomen, vomiting, and
«aeh prostration that he was scarcely able to stand. On
wring him the following morning, 1 found him with tender-
mm spread all over the abdomen and considerable tympanites.
The tenderness was more marked on the right half of the
ibdomen than on the left, and there was one spot, about an
inch to the right of the umbilicus, where the pain was
intensified; here, too, there was some slight bulging of the
•bdominal walls, but no additional haTdness. The pulse was
tad the temperature normal. An enema was given of
grari and castor oil, which was expelled free from faecal
matter; a hot linseed poultice was placed all over the
•Women, and changed every four hours; a grain of extract
ri opium was administered every six nours; simple
fsrinaceous nutriment was given in small quantities, but
ultimately all rejected. On the third day the pulse
remained at 80, and the temperature continued normal; the
abdomen was leas tympanitic, and less tender; the vomiting
continued, and there was a total inability to retain nourish¬
ment by the stomach. Nutrient enemas of an extract of
b«f, with port wine, were now administered every eight
bouts, and retained; and the opium was continued, though
1** frequently. On the fourth day the pulse had risen
• little, but the temperature remained normal; the bowels
•eted freely, the excretion consisting of yeast-like semi¬
solid material; the tympanites and tenderness both lea¬
rned, and the bulging to the right of the umbilicus had
disappeared; but the skin bad become bedewed with a cold
c la mm y perepirsuon, and -utere was great prostration. On

the fifth day the abdominal symptoms had somewhat abated ;
the bowels acted again, but violent retching continued, and
the vomit had become distinctly stercoraceous; the pulse
rose to over 100, and the temperature to 101°; the nutrient
enemas and opium were continued ; but the cold and clammy
perspiration did not abate. On the sixth day the abdominal
symptoms were less severe; the bowels acted again, with
evident relief to the abdomen ; but the retching continued,
and the vomited matter was still stercoraceous. The chief
distress was now referred to the epigastrium, apparently
caused by the violent retching. Cotton-wool was substi-
stituted for the poultice; the nutrient enemas and opium
were continued. On the evening of the sixth day sym¬
ptoms of collapse set in, and death ensued in the night.

An examination of the abdominal cavity was made twenty-
four hours after death; there was subacute inflammation
of the peritoneum and of the intestines, increasing in degree
towards the caecum, but was more marked in the small than
in the large intestines. The discolouration was most marked
around the vermiform appendix. The appendix was very
discoloured at its base, as if it had been constricted, but no
band could be detected. The body of the appendix was dis¬
tended, which, on being laid open, was found to contain a
small quantity of sanguineous pus, but no other foreign
material could be detected. A gooseberry-pip, a cherry¬
stone, a mustard-seed, the small pips of a fig, and a
piece of bard freeal matter have been Known to intrude into
the vermiform appendix, and set up fatal enteritis and
peritonitis, but I cannot find any case of suppuration
recorded. As the appendix exists only in human beings,
in the ourang-outang, and in the wombat, but, as far as is
known, in no other animal, its presence is probably not
essential to life. The question naturally arises, would
removal by operative interference afford relief in cases
similar to the one recorded when the symptoms pointed
sufficiently to the seat of mischief?

I am. Sirs, yours obediently,

Wokingham. Jan. 1SS7. _ J. G. BaufOUT).

THE GENERAL PRACTITIONERS OF ENGLAND:
THEIR COLLEGIATE RIGHTS AND
DUTIES.

To the Editors of The Lancet.

Sibs,—T he announcement which you have made of the
proceedings about to be taken by the College of Surgeons
and the* College of Physicians of England respectively
indicate an important crisis in the affairs of the profession.
It is one which avowedly concerns the general practitioners
of England above all others. The steps about to be taken
by the Colleges will affect for good or for evil the position,
the status, the rights, and the privileges of the general
practitioners now and in the future. Avowedly, and as we
are well disposed to believe, in fact, many of the changes
about to be introduced will give increased facilities for
graduation in London, and will thus bring the title of M.D.
within the reach of London students on reasonable terms.
This is much to be desired. On the other hand, corporations
continue to treat the great mass of the profession as though
they were persons without any right to a voice in their own
affairs and without any capacity ior controlling them. The
indignity with which the College of Surgeons treats its
Members and the calm contempt with which the College of
Physicians utterly ignores its Members and Licentiates are
likely to be perpetuated, so far as can be gathered from their
present proceedings, in the conditions under which they
will endeavour to frame the new Charters which they are
about to send from the Privy Council. It will be in the
power of the general practitioners of England, Members of
the College of Surgeons, and Licentiates of tne College of Phy-
sicianstodetermine whether they choose to be thus completely
ignored in the medical republic ot the future. We use here in¬
cidentally and involuntarily a phrase common enough in the
mouths of all, but which is in itself under existing circum¬
stances a bitter satire. W r e talk of the republic of letters and of
the republic of medicine, because it is a self-evident axiom that
the educated members of a profession stand for all the great
purposes of fraternity, of progress, and of self-government
upon an equal basis; but, in point of fact, the existing
government of the profession by the London corpora¬
tions is an oligarchy, consolidated by self-assertion, and
based upon the survival of mediaeval anachronisms.

Dioitized bv I ^

100 Tn Lancet,]

DEGREES FOR LONDON MEDICAL STUDENTS.’

[Jaw. 8,1887.

The ^College of Surgeons and the College of Physicians
-are alike mediaeval guilds, which bring to the adminis¬
tration of modern affairs a framework of effete guilds
of which the raison d'etre has long ceased to exist.
If anyone were now seriously to propose, in framing a
government for the profession of medicine, that the whole
power should be concentrated in the hands of a self-
nominated and self-elected clique of hospital surgeons and
physicians constituting less than 6 per cent, of the whole
body, that the whole funds, buildings, powers, and accumu¬
lated surplus of fees should be vested in their hands, such
a scheme would stand self-condemned. It has no basis in
reason or justice or any similitude in any constitution
framed in this century. This, however, is what the Colleges
of Surgeons and Physicians are now striving to create anew
by the favour of the Crown in the new Charters for which
they are asking. Sir Henry Pitman evidently saw at once
with his veteran acuteness the weakness and the strength
of the renewed effort of despotism which the College of
Physicians is making, when he j ubilantly reminded the comitia
that they would not have to go to Parliament for their Charter,
but that they would be able to obtain it by influence
with the Crown. No doubt some of the most eminent of
the present governors of the two Colleges are very near the
Crown, they are close to the steps of tne Throne, and they
are well acquainted with the avenues and staircases of the
Privy Council. What can be said, however, of a scheme
with which the promoters fear to face Parliament ? In fact,
this fear is the strength of, and should give courage to, the
practitioners of England. Nor need it even be feared that
the Privy Council will allow itself to be approached ex¬
clusively by the Councils of the Corporations, and will be
deaf to the representations of the many thousands who con¬
stitute the commonalty of both Colleges, and on whose
support, and by whose existence, these Corporations live,
move, and have their being. The Association of General
Practitioners will claim for that order, to which the State
is indebted for its medical work in all the great towns,
throughout the rural districts, in the Army, in the Navy,
and in the Poor-law service, that they shall be represented
in the constitution of the Colleges and of the new University.
They will claim that their voice shall be heard, and that
their influence shall be felt, and, unless these just conces¬
sions be made, they will ask that no new Charters or ;
additional privileges be granted until a Royal Commission i
has been appointed to inquire into the constitution of the
Colleges, into their relations to the whole profession, and
into the wishes and rights of the profession in the constitu¬
tion of the new University. To support this scheme, we
invite those of your readers who agree with us to shake off
the apathy which long years of submission to the Councils
have bred, and to claim for themselves a universal interest
and an individual power in the government of the body to
which they belong. We ask those who agree with us to
favour us by a post-card. We invite your support as having
always been the advocates of the rights of the general
practitioners. The traditions of The Lancet, to which you
have with justice lately proudly referred, are on the side of
the profession at large, and opposed to the sole possession
of exclusive privileges by small bodies of self-elected
■persons. We confidently count upon your aid in this great
matter.—We are. Sirs, yours faithfully,

H. Walter Vbrdon, 1

410. Brixton-road, B.W. I Hon. Sec*., Assoc.

W. Gibson Bott, j Q«n. Pract.

Jan., 1887. 414, Clapham-road, S.W. J

* DEGREES FOR LONDON MEDICAL STUDENTS.”

To the Editors of The Lancet.

Sirs,— It must be a matter of great gratification to all
those who take an interest in the matter that the Royal
College of Physicians of London and the Royal College of Sur¬
geons of England have now finally settled that it is “desirable
and practicable to grant degrees in medicine and Burgery to
persons who have passed the Conjoint Examination of the
two Colleges.” Yet, I am afraid the whole object will be de¬
feated if Sir William Gull’s suggestion be adopted—“ That a
further examination in Clinical Medicine and Surgery be
instituted for the M.D. and M.S. degrees respectively." Why
cut up the degree thus, after the fashion of the London

University, for this would be doing the very thing that ia
not wanted? The London student requires that he can
obtain the degree of M.D. on a par with the Scotch and
Provincial Universities. It is already acknowledged that
the Conjoint Examination is equal to that for their degree,
and in their case the only thing required in proceeding to
the M.D. degree after the M.B. is the writing and reading of
a thesis. Should Sir William Gull’s suggestion be adopted,
the new University will be thereby defeating its primary
object. I am interested to know upon what terms those
holding the two qualifications during past years would
obtain the new degree? Having obtained the double quali¬
fication, would the University confer the degree upon them ?
if not, unfairness might be complained of.

1 am, Sirs, yours faithfully,

R. W. Sutton Barraclouqh,

M.D. Brux., L.B.C.P. Loud., M.K.C.S. Kng.

Dulwich-road, Heme-hill, S.E., Jan. 3rd, 1887.

THE FILARIA SANGUINIS HOMINIS.

To the Editors of The Lancet.

Sirs, —It may interest many to know that I have at the
present time under my care at the London Hospital a
patient suffering from chyluria, whose blood and urine
contain living embryos of the ftlaria sanguinis hominis. The
number of embryos found in the blood are not so numerous
in this as in a previous case under my care at the hospital.
The “ periodicity of filarial migration,” however, is equally
characteristic, tne embryo filanso swarming into the blood
at night and disappearing from the general circulation
during the day-time. The patient, who contracted the
disease in India, was sent to me by Dr. Clay of Plymouth.
I propose to exhibit “ living specimens ” of the embryo
filaria sanguinis hominis at the Clinical Society on Jan. 14th.

I am, Sirs, faithfully yours,

Finabury-square, Jan. 4th, 1887. STEPHEN MACKENZIE.

THE BATH WATERS AND ARSENIOU3 ACID.

To the Editors of The Lancet.

Sirs,— The marvellous efficacy of a course of Bath waters
in amemia, nodular rheumatism, and chronic skin disease
has long been an established fact; but to what special
therapeutic agency this efficacy was due has, so far at least
as written evidence proves, been hitherto inadequately
accounted for. Indeed, had not the generally accepted
analyses of these waters utterly failed in my mind to account
for their undisputed curative action in the diseases referred
to, the experiments leading to the demonstration of the fact
hereafter detailed would never have been initiated by
me, and the publication of what, I trust, my professional
brethren may consider a useful contribution to thermal-
water therapeutics might have been reserved to another.
In endeavouring to account for the apparent specific action
of the Bath waters, I mentally passed in review those
therapeutical agents which, while exercising distinct action
in the diseases referred to, might at the same time be reason¬
ably expected to be held in solution in natural mineral
waters. Arsenic in some form took immediate promi¬
nence, and the fact which I subsequently ascertained, that
its presence would account for the tardy precipitation
of the iron after the escape of the excess of CO* 1 —
a peculiarity in the behaviour of tyese waters, otherwise
inexplicable—tended to confirm me in the opinion that in
spite of no allusion to the presence of arsenic in the region
of analyses of the Bath waters, it must be there. I imme¬
diately sought the analytical aid of my friend, Mr. Gatehouse,
the well-known and much-respected public analyst of Bath,
and after very careful and reliable tests, the particulars of
which I shall be glad to furnish on application, we have
demonstrated the presence of arsenic in minute quantities
in the Bath waters ; thus I hope rescuing one more of
nature’s own cures from the Cimerian darkness of empiricism.

I am, Sirs, yours truly,

Bath, Jan. 2nd, 1887. T. P. LOWE, M.R.C.S., L.R C.P.Ed.

1 A most Important fact when transmission of the water* for use at a
distance Is considered. Precipitation of the Iron does not take place for
several hour* after the escape of GO* which Is of course oontrary to the
behaviour of carbonate of iron held in solution by excess of GO* which
falls to the bottom almost directly the 00* has escaped.

The Lancet, J

LIVERPOOL.

[.T ait. 8, 1867. 101

LIVERPOOL.

(From our own Correspondent.)

HOSPITAL SUNDAY.

Skit Sunday is the seventeenth anniversary of Hospital
Sanday in Liverpool, and the result will be awaited with
considerable interest. It is hoped that additional evidence
will be afforded as to the real improvement in trade and
commerce by the increased amounts deposited in the collect¬
ing plates. Efforts have been made to bring about a change
in the date of Hospital Sunday from the second Sunday in
the year to a Sunday in May. Much is to be said both for
tad against the change, and the amount collected next
Sunday will no doubt guide those who will have to decide
whether the change shall be made or the date remain as at
present. Great efforts are being made to ensure the co¬
operation of all clergy and ministers this year, there having
been in past years several who have failed to make a collec¬
tion for the medical charities either on Hospital Sunday or
on any other Sunday. It is only just that every congregation
ihould have the opportunity afforded them of giving sub-
ttantial proof of their appreciation of the medical charities.

THE CHRISTMAS SEASON AND THE POOR.

In Liverpool, as elsewhere, Christmas was accompanied
with seasonable—that is to say, very severe—weather. It
ii very pleasing to notice the liberality with whioh the
public responded to the appeals made to them for aid in
rroriding Christmas breakfasts as well as Christmas dinners,
thousands of hungry men, women, and children have been
fed with substantial food, as well as supplied with coals—a
most acceptable gift.

THE BOYAL INFIRMARY.

For many yean past the present buildings of the Royal
Iaiinnary have been found to be wholly inadequate for their
purpose, and recently a large sum was raised by public sub-
jcription towards erecting a new one. A building com¬
mittee was appointed, and the greatest care has been
to ensure that the new infirmary shall comprise every
Ml modem improvement. Satisfactory progress has been
aide with the plans, which are now nearly complete. Con¬
tracts, it is expected, will shortly be entered into, and the
work commenced early in the spring.

THR ROYAL SOUTHERN HOSPITAL.

0a Tuesday night a gigantic Christmas tree covered with
uticlea of general usefulness—viz., petticoats, shirts, socks,
nra muffs, caps, and flannels of all descriptions—was
Gripped of all its ornaments, which were distributed to the
patients throughout the house and to everybody within the
hospital without distinction. Accompanying this was a
musical entertainment, with songs. Mrs. Geo. U. Horsfall,
the wife of the chairman of the hospital, attended and
presented the gifts with a few kindly words. Not
the least gratifying circumstance was that some of the
patients, hearing of the coming event, voluntarily knitted
an embroidered fancy work, which they desired should be
ifiren to the physician or surgeon under whose care they
were—a delicate attention which the latter were not slow
to appreciate. Mr. G. W. Moss has offered to present to the
hospital an ambulance, complete and free of cost. The offer
haa been accepted, it being understood that the manage¬
ment of the ambulance, which will be about £300 a year,
thill not encroach on the general funds of the institution.

THl RESULTS TO PLYMOUTH AND DEVONPORT OP THE
REPEAL OF THE CONTAGIOU8 DISEASES ACTS.

Before the Royal Commission, which sat in 1870 to inquire
into the Contagious Diseases Acts, a witness from Devonport
expressed an opinion that the total repeal of these Acts
would be “ disastrous”; and a memorial, which was signed
*7 magistrates, cleTgy, medical practitioners, and others in
the boroughs of Plymouth and Devonport and township of
Staoehouse, was forwarded in 1882 totne Commissioners for
•xeenting the office of the Lord High Admiral of the United
Kingdom. Its concluding paragraph is: “We cannot too
wrongly express our opinion that the repeal of these Acts
be a great misfortune to this district, and to any other
community where they exist at present.” How thoroughly
“me predictions have been fulfilled is shown by what is
in a contemporary of the 1st met., under the beading

Plymouth: “ To-day the whole of the patients in the lock
wards of the Royal Albert Hospital, Devonport, have been
discharged into the streets uncured, and the wards are
closed. This is in pursuance of the operation of the Act
for the Repeal of the Contagioas Diseases Acts passed last
session, and no ameliorative substitute of any kind has been
provided. Prominent agitators against the Acts deplore
this result, the disastrous effects of which have become
lamentably conspicuous; and almost every public body here
and in Devonport has expressed an opinion strongly against
the present condition oi affairs.” Mr. Stansfeld, speaking
in the House of Common* in 1876, expressed his conviction
that if the Acts were repealed voluntary lock hospitals would
be established and supported wherever they were required.
The Acts have now been repealed for some months, the Royal
Albert Hospital is closed, and we shall very likely soon hear of
thedosingof all the Government lock hoepitalsinPortemouth,
Chatham, Colchester, Cork, Kildare, and the Government
wards of the London Lock Hospital. The opponents of the
Acts succeeded in raising thousands of pounds every year
towards their repeal, but nothing whatever has been done
towards providing lock hospitals for the women who were
cared for by the Government, and who are now “literally
out in the cold.” That the Acts will have to be re-enacted
goes without saying, and even before this can be brought
about some aid will probably be afforded by the State to
enable the above-named hospitals to be kept open for such
patients as may apply voluntarily. Meanwhile the public
will have leisure to observe the unscrupulous nature of
the opposition to these Acts. Those who raised and persisted
in it have incurred a fearful responsibility, for which they
will most certainly have to answer. They have sown the
wind, and must reap the whirlwind. The Acts are repealed,
the Government hospitals are closed, the unfortunate women
who were in them are deprived not only of all means of cure
but also of reclamation. Venereal diseases have enormously
increased in the army and navy, and— although this cannot
be shown by statistics—among the civil population. And as
a set off against all these evils what good has been accom¬
plished ?—simply nothing.

COLDS CAUGHT AT FUNERAL8.

It is always an ungracious task to write in disparaging
terms of any good old custom, whatever inconveniences it
may involve. This is enhanced when the custom is founded
upon good motives ; but, as guardians of the public health,
it becomes necessary to speak plainly of the custom of
standing bareheaded at funerals round the grave, while no
small portion of the burial service is being read. Some
clergymen curtail this by reading in the church or chapel
all except what is known as the prayer of committal to the
ground. But the truth is that the average Englishman is
incapable of standing bareheaded in the open air, even for
the shortest interval, without incurring a serious risk. It is
to the colds caught in such weather as we are now ex¬
periencing that I would wish to call serious attention.
Even country doctors, whose constitutions have become
well seasoned to rides and drives in all weathers, feel it
trying to attend funerals on this account. The remedy is
simple and obvious. There is all the difference in the world
between the slightest covering to the head and no covering
at all, more especially to those who are partly or entirely
bald. Many clergymen and chaplains of cemeteries have
adopted the sensible practice of wearing'skull-caps of black
velvet or silk, and laymen would soon follow the example had
they some definite authority to do eo. But till then respect
for the dead and reverence to the solemn words being read
deter them from adopting a precaution which might save
many a severe cold, if not a more serious illness. Medical
attendants can surely speak authoritatively upon this point,
for health is much too precious to be sacrificed either to
reverence or respect for the dead. But it is desirable to
have ecclesiastical authority as well, and I would respect¬
fully suggest to the archbishops, bishops, and clergy
generally, that a few words from them would inspire the
laity with more confidence, and save many a mourner, pall¬
bearer, or other attendant at funerals, from what are
mildly designated colds, but which in not a few instances
have passed on to even fatal illnesses.

Liverpool, Jan. 1837.

An anonymous donor has contributed £200 to the
funds of the Hastings and St. Leonards and East Sussex
Hospital.

Digitized by LiOOgle

10^ ’ Emt l**Ncra.]

NORTHERN COUNTIES NOTES—DUBLIN.

[Jan. 8,1887.

NORTHERN COUNTIES NOTES.

(From our own Correspondent.)

THE CARRIAGE TAX AND DISINFECTANTS.

A curious case bearing on the carriage tax was tried and
decided at the North Shields Police-court last week. An
inland revenue officer summoned Mr. Harbottle, sanitary in¬
spector, Tynemouth, for using two carriages while he held
a licence for one only. Mr. Harbottle showed that in his
public capacity as sanitary inspector he was obliged to use a
conveyance for the purpose of carrying disinfectants to the
various townships in the district. On a certain occasion
the ordinary conveyance broke down, and, as he had to go
to the railway station for some disinfectants, he was com¬
pelled to use a four-wheeled vehicle, of which the inland
revenue officer now complained, and which he had been
absolutely compelled to do for the public safety. The
magistrates held that there was no evidence on the part of
Mr. Harbottle to act contrary to the law, and dismissed the
case. The carriage tax is very unpopular in the north, and
prosecutions of this nature are not calculated to raise it in
public esteem.

a vaccination case.

Ah inquest was held last week on a child aged three
years, in the Byker district of Newcastle. The mother said
that when it was three months old it was vaccinated by
the public officer. Afterwards an eruption broke out on its
head, and finally it suffered from a discharge from the ears,
for which it was duly attended by a medical man, and also
by the dispensary visiting assistant. There was no medical
evidence adduced at the inquest. The jury returned a
verdict to the effect that “ the deceased died from natural
causes, apparently accelerated by foul vaccination.” It is to
be regretted there is an often no medical evidence called in
these cases, as these verdicts have a mischievous tendency
when published, and may some day be the indirect cause of
great loss of life, as creating a prejudice against the only
known preventive of small-pox.

TYPHOID AND WATER HYDRANTS.

Dr. II. Ward, medical officer of Blyth and Tynemouth
rural sanitary districts, points out a cause of typhoid which
he believes has been hitherto overlooked in connexion with
water hydrants. He alludes to the apparatus known as the
self-acting ball hydrant, which he believes is defective when
applied to uuder-ground pipes. The self-acting ball is the
simplest of all hydrants; it consists of a ball of gutta-
rcha placed within a pipe projecting within the main,
hen the water is turned on, it is forced up against the
aperture, which is smaller than the ball, and so prevents the
water from escaping; but as soon as the water is turned off
at the main, the ball falls and allows air to pass into the
pipes, this being the object of the invention. Dr. Ward
states that when the hydrants are placed above ground
the apparatus is admirable, but the effect is totally
different when they are sunk under ground. The hydrants,
he says, in his district are sunk under the ground in the
middle and towards the end of back streets, at a distance of
about seventy yards apart, and are covered over by iron lids
loo so in an iron socket. They are also placed in many in¬
stances close to an ashpit door, so that when the scavengers
are at work the hydrants are frequently covered by the con¬
tents of the ashpit, the liquid filth of which must frequently
dram into and accumulate in the hydrant box, and con¬
taminate the water. That such is the case Dr. Ward is
satisfied from close observation, and points out that, in
connexion with a recent epidemic of typhoid, the people
living in close proximity to the hydrants suffered most,
the disease "being more virulent and fatal than in other
localities in the district. Dr. Ward’s remarks apply to the
Cowper sanitary district, and are of much importance in
connexion with water-supply and sanitation.

Newcastle-on-Tyae, Jan. 4th.

The Climate op the Lake District.—A clergy¬
man residing at Keswick, writing to a daily contemporary,
states that on the day (Sunday, the 26th ult.) when the
midland district^ and, indeed, almost the whole of England,
was snfferhig from all the horrors of an arctic winter, the
residents of the English Lake district were enjoying a day
of exceptional calmness and genial temperature.

DUBLIN.

(From our own Correspondent.)

ROYAL UNIVERSITY OF IRELAND.

On the 30th ult. an election for a member of the Senate
took place, and a statement in The Lancet of last week, in
which I remarked that most probably Professor O’Sullivan
would be successful, has turned out correct. The voting
was as follows: Professor O’Sullivan, 316; Dr. McMordie,
231; Mr. O’Connor, M.P., 166. The majority Professor
O'Sullivan obtained was far beyond the expectation of his
most sanguine supporter. It is stated that the following
resolution, which was passed at a meeting of the
executive committee, was sent to the graduates previous
to the election by “ The Graduates’ Reform Association
of the Royal University of Ireland”: "That, inas¬
much as it has come to our knowledge that a consider¬
able number of electors of the University pledged their
support to Dr. O’Sullivan while unaware of the candidature
of Mr. T. P. O’Connor, M.A., M.P., and inasmuch as such
pledges, given under a misapprehension of the facts, cannot be
binding, the committee trust that the electors from whom
promises to support Dr. O’Sullivau wore obtained under a
misapprehension and before they wore aware that Mr. O’Connor
was in the field, will not consider themselves bound thereby,
and will use their influence to secure Mr. O’Connor’s elec¬
tion.” At the meeting of Convocation a resolution was
adopted, by a narrow majority, to the effect that a special
committee should be appointed to frame new standing
orders of Convocation and discharge the duties hitherto
assigned to the Annual Committee. Prof. Pye’s motion
(see p. 49), in reference to medical degrees, was amended by
calling the attention of the Senate to the matter, and was
then adopted. The following resolution was also passed : —
“That Convocation is of opinion that hitherto honorary
degrees have been conferred much too liberally, and that the
Senate be requested henceforth to examine carefully the
Special claims of all upon whom it is about to confer such
honours.”

ROYAL COLLEGE OF SURGEONS IN IRELAND.

The question of the College conferring a diploma in
Sanitary Science has, I believe, been under the considera¬
tion of the Council, and a committee has been appointed to
confer as to the necessary details. As the College of Phy¬
sicians, the University of Dublin, and the Royal University of
Ireland grant these diplomas, there appears no valid reason
why the College of Surgeons should not do likewise. If the
Council determine to grant the diploma, four examiners
will be appointed to examine candidates in the required
subjects of examination.

THE CROWN SEAT FOR IRELAND IN THE GENERAL
MEDICAL COUNCIL.

I am informed that the Government have appointed Mr.
E. H. Bennett, Professor of Surgery in the University of
Dublin and an ex-President of the Royal College of Surgeon3
in Ireland, to be a representative on the General Medical
Council in the room of the late Dr. Robert Dyer Lyons. Mr.
Bennett has also been appointed a Medical Visitor in Lunacy
under the Court of Chancery.

REPORTS AND PAPERS RELATING TO PUBLIC HEALTH.

Sir Charles Cameron, medical officer of health for Dublin,
has recently published a volume consisting of nearly five
hundred pages, whose contents are chiefly reprints of papers
contributed at various periods to the Dublin Journal of
Medical Science. It would be impossible to refer to the
various articles, all on subjects of considerable interest to
the community, which Sir Charles Cameron has collected
into a single volume; but I may mention particularly the
following as examples: “ Cremation or Burial ?’’ “ Insanitary
Condition of Canal Boats”; "Contagion and Bacteria”;
"How Typhoid is Spread”; “Etiology of Diphtheria”;
“Colour Blindness”; " Sewage in Oysters ’’; " Lead Poisoning
among Workmen”; “ The Germ Theory of Phthisis”; “ Hos¬
pital Construction and Management, 5 ’ &c. Sir C. Cameron
has a facile pen, his Btyle is remarkably good, and bis com¬
munications are eagerly read by all classes of the community,
both lay and professional. Considering the various offices
and appointments the author of these reports holds, and the
duties of which he discharges in a thoroughly efficient
manner, it is a mystery to many how he can find time for

To Lancet,]

BELFAST.—PARIS.

[Jan. 8, 1887. 103

dw enormous amount of literary work he accomplishes.
Lift year he finished his “ History of the College of Sur¬
geons," a work which was reviewed in This Lancet and
^sher medical journals, and which was on all sides spoken
of in the highest terms.

TUB RICHMOND HOSPITAL, DUBLIN.

The appointment of a physician to this Hospital, in the
room of the late Dr. Lyons, will take place on the 13th inst.
! vis under the impression that the physicians were paid
oythe Government at the rate of £100 per annum, but if so
i change has taken place in the arrangements, as the gentle-
nan who succeeds Dr. Lyons will not receive any salary,
■f tether he may be allowed a share of the students’ fees is a
utter of which I am ignorant; but as one of the medical
■:tl he certainly would be entitled to it.

NATIONAL BYB AND BAR INFIBMABY, DUBLIN.

A childrens amateur theatrical entertainment, in aid of
o.t funds of this institution, will take place on the 6th inst.
Lae performance will be the “Sleeping Beauty,” and the
rnious parts will be filled by juveniles between the ages of
jo and thirteen years.

Samuel Connor, M.D., of No wry, has been placed on the
:*aiasioQ of the Peace for the county of Down.

Dublin, Ju. 4th.

BELFAST.

(From our own Correspondent.)

CHRISTMAS AT TUB HOSPITALS,
tax inmates of the various hospitals in town enjoyed a
pleasant Christmas Day, thanks to the exertions of the
Ladies and gentlemen who assembled at these local instita-
•-aai. and who used every effort to secure to the patients
-cau of the comforts of the season. At the Royal Hospital
Aa Board of Management and the resident staff paid every
ir-mrion to the patients, while at the Hospital for Sick
Audrenand at the Ulster Hospital the wards were most
dutifully decorated, and in each Christmas-trees, covered
rrary form and variety of toy suitable to the age and
the little patients, occupied prominent poeitionsi At
u* Birone Hospital, the Asylum, and the Union Workhouse
inmates were treated most sumptuously.

BELFAST DISPBNSARY COMMITTEE.

At a meeting of this oommittee held on Monday, it appears
tact the reports handed in that the health of Belfast is in a
aarfaetory condition. There have been a large number of
dxat eases owing to the intense cold and damp weather,
wd tame cases of scarlatina and enteric fever have occurred
o flos of the subdistricts. It was stated that there has
Kent slight decrease in the cost, of maintaining the various
Belfast dispensaries during the past year. It waa agreed to
cot Dr. Mehany, one of the apothecaries, an increase of
-5 per annum, subject to the approval of the Local Govem-
*nt Board.

ARMAGH LUNATIC ASYLUM.

1 learn that Dr. Graham, who for nearly three years
)*» been assistant medical officer at the Belfast District
lunatic Asylum, where he discharged his duties to the
utne satisfaction of the governors, has been appointed to
important post of resident medical superintendent of
ie Armagh Lunatic Asylum. Owing to Dr. Graham’s
■ ^notion there is a vacant post, and for it I hear
''-K Dr. Graham (a brother of the former assistant),
fr- Collier, and Dr. Thompson are candidates.

Jmanrj 4th._ • '

PARIS. 1

(Prom our own Correspondent.)

M. PETER ON THE INTENSIVE 'METHOD,

A brand discussion has taken place at the Academy
^ & case of hydrophobia communicated by M. Peter,
lbs mbjeet of the observation had been bitten six weeks
before, and had undergone the intensive treatment
*fthia fatty-eight hours. Four days before his death
k aaad with pains, which radiated, not from the

cicatrix of the bite, but from the points where the inocula¬
tions had been practised. He then fell into a state <5f stupor
and prostration, and died in a paralytic condition, foam¬
ing at the mouth. M. Dujardiu-Beaumetz contested the
value of the observation ou two grounds: in the first place,
because the existence of rabies had not been confirmed by
experimental transmission to the animals by inoculation with
diseased medulla; and, secondly, because most of the sym¬
ptoms usually seen, more particularly the spitting, bad not
been mentioned by M. Peter, and because the paralytic form
of rabies, of which the patient was said to have died, was
extremely exceptional in man. M. Yerneuil begged the
Academy not to be influenced by communications such aa
that of M. Peter. Let M. Pasteur’s work be disproved, if
such is its fate, said the speaker, by scientific argument, and
not by gossiping tales. M. Peter, in reply, remarked that no
one could contest the fact that the man was dead. That he
had been bitten and had undergone the intensive treatment
were equally sure. These circumstances formed a “natural
series,” and had the inoculations not been performed, no one
would have doubted that the case was one of rabies.
M. Dujardin-Beaumetz had pointed out that the paralytic
form of rabies—that which follows, as a rule, laboratory
inoculations--is excessively rare after a dog-bite. But, said
M. Peter, this is a point of great importance. The man had
been subjected to inoculations, and had died with symptoms
of rabies such as are not usually met with in hydrophobia,
but which are those that do occur in experimental rabies,
and that have already been observed in England in those
dying of the disease after Pasteur’s treatment.

PANEGYRIC OF FLOURENS.

At the annual meeting of the Academy of Sciences it is
customary for one of the perpetual secretaries to pronounce
the panegyric of an eminent predecessor. This year the
duty devolved upon M. Vulpian, who selected as his subject
the life and scientific wont of Flourens. The 6loge is an
analytical study of the most remarkable works left by the
illuetrious perpetual secretary, whose place M. Vulpian now
occupies, and the fullest justice is done to hi9 memory as a
physiologist—a title with which it was Flourens’ desire to
pass down to posterity. Allusions were made to his opposi¬
tion to the doctrine of cerebral localisation when first pro*
posed by Gall, and his adverse “ Examination of the book or
the Origin of Species”—a work which justified, said M.
Vulpian, the bitter criticisms bestowed upon it by Darwin.
M. Vulpian seems to me less remarkable for impartiality
when be assigns to Flourens the credit of the discovery of
the amesthetio properties of chloroform on the strength of
his experiments with it in the physiological laboratory. The
discovery of the value of chloroform in medicine undoubtedly
belongs to Sir James Y. Simpson, and is too well established
to admit of any Buch posthumous claims.

ELECTROLYSIS.

. The introduction of a medicinal agent into the body by
means of electrolysis is a possibility that has been entertained
by competent authorities, amongst whom 1 may mention
MM. Onimus, Couraerant, and Spellmann of Nancy. I may
confess, then, that upon reading the annotation in Thb Lancet
of Dec. 18th, “ On a New Method of Employing Electricity in
Neuralgia,” in which it is stated that Dr. Adamkiewicz had
found the passage of galvanic current through a cathode
saturated with chloroform exceedingly effective in various
kinds of neuralgia, I remembered that a communication had
been made some time back at the Academy of Sciences on
the Introduction of Medicines through the Skin by Electro T
lysis, and it occurred to me that the efficacy of the
Dr. Adamkiewicz treatment might be due to the same cause.
In the communication I allude to Dr. Brondel of Algiers
stated that when certain salts were placed upon the skin
under the cathode, the passage of the current producing
their decomposition caused the acid element, or rather the
metalloid playing the part of an acid, to dialyse through the
tissues to the anode, where its presence was easily demon*
strated by ordinary ehemical tests. By this process he hod
been able to apply iodine and bromine to any internal organ
selected, and had iodised the lung, the uterus, and the joints,
and “ brominised” the brain, Ac. In proof of his assertions,
M. Brondel adduced the following facts:—(1) The patients,
being submitted to the electrical introduction of iodine,
taste it; (2) its action is shown by the cures following the
treatment; (3) when the iodine salt (KI) is placed under
the cathode the starch at the positive electrode quickly
becomes blue from the passage of the iodine. These expert-

oogle

Dii

lot The Lancet,]

PARIS.—VIENNA.

[Jan. 8. 1887.

raents were repeated at the Cochin Hospital by M. Dujardin-
Beaumetz, whose therapeutie experience led him to set aside
M. Brondel’s first two reasons as susceptible of fallacious
deductions, post hoc ergo propter hoc being but a poor
argument, especially in medicine. Taking for granted the
exactitude of M. Onimus’s conclusions with respect to
animal electrolysis, and admitting a priori the possibility of
the penetration of chemical substances into the body by this
means, M. Dujardin-Beaumetz wished to ascertain if one
element of a salt decomposed under one electrode could
really pass as far as the opposite pole, and, if so, what
were the conditions of success? The manipulations were
made by MM. Brondel and Dujardin-Beaumetz, and every¬
thing turned out as was expected. But when the elec¬
trodes were applied by other persons, the iodine refused
to pass and the starch at the positive pole would not
turn blue. Had this perplexing result occurred at the
Paris Socidt6 de Biologie in tne month of December,
1886, I entertain no doubt whatever as to the explanation
that would have been afforded. We should have had an
interesting discussion upon “ the effects of suggestion upon
inorganic matter,” and the most curious, complicated, and
unexpected discoveries would have been made. As it was,
the experiments were repeated with renewed care again and
again, until it became evident that the blue colouration was
caused by decomposition at the positive pole itself when¬
ever a small quantity of iodide was accidentally deposited
there by insufficient care in manipulation. When the two
electrodes were held by different persons, and perfectly free
from iodide, no discolouration of the starch took place. The
whole question has been studied afresh by M. G. Bardet,
and, after repeated and careful experimentation, he concludes
that dielectrolyBis through organic tissues is impossible.

THK REMOVAL OF THE OVARIE8 IN HYSTERIA.

After meeting with considerable opposition here when
first made known, Battey’s operation is gradually coming
into favour, and though we cannot as yet compete in sur¬
gical activity with Liverpool, a number of speakers weTe
able to give their experience of the operation at the recent
discussion at the Socidtd de Chirurgie. M. Terrier mentioned
the case of a woman who, manifestly hysterical, suffered
from intolerable pains in the ovaries at the menstrual
periods. No relief being obtained by ordinary means, and
life being a misery, these organs were removed last
February. The right ovary caused no difficulty, bnt the left
was so bound down by adhesions that it could only be
extracted piecemeal. Since the operation there has been but
insignificant malaise at the catamenial periods, which are
perfectly normal. The hysterical condition, although it
remains, appears amended; there are no longer any abdomi¬
nal pains, and the general health is good. This is the second
success of the kind obtained by M. Terrier. M. Lucas-
Championnidre has also performed the operation in two
cases: one of his patients died three days after the opera¬
tion ; the other was relieved of her symptoms, and at the
same time cured of bad temper. Before the operation she
easily became angry at trifles, whereas she is now quite
calm. M. Monod said that he also had been successful in two
instances, and M. Pozzi was able to endorse the treatment by
one operation.

WATER IN INANITION.

The fallibility of authority is amusingly exemplified in
the utterances of the princes de la science , as it is the cus¬
tom here to style our leading physicians, concerning pro¬
longed abstinence. A couple of months since the flat went
forth that to attempt to live upon water for fifty days was
so insensate that no respectable member of the profession
should countenance such an experiment. The attempt was
made, however, and proved successful, whereupon, after a
great deal of big talk about hysterical anorexia and auto¬
suggestion, our teach era referred to their books, and made
the discovery that there was nothing new in the matter, and
the profession was urged not to lend themselves to another
experiment of the same kind, because they already knew all
about it. It is quite possible that the experiments recently
made upon animals would have been sufficient by them¬
selves to allow of therapeutical deductions, but it is equally
certain that the re-examination of this question, which is
not unlikely to lead to some important practical deduc¬
tions, is the direct consequence of the experiments sub¬
mitted to by the mucn-abused Succi, Merlatti, and
others. The Gazette Hcbdomadaire reminds its readers
of the case of Viterbi, who to esenpe the guillotine

allowed himself to die of hunger, an end which he
achieved after seventeen days of total abstinence both
from food and drink. After a few days without food the
desire left him entirely, and the only difficulty was in
refraining from drink, which he managed, however, by
strength of will, only giving way to the terrible requirement
of thirst upon two occasions whilst delirious. The author
of this article concludes that it is a prejudice to think that
hunger is a sensation. We eat by habit, and, as the saying i
is, Vappttit vient en mangeant. To conquer the feeling of
hunger it is simply necessary (1) not to eat, (2) to drink.
For my own part, I am convinced that r-bstinence from food
will become a recognised therapeutic agent in a near future
for the treatment of various diseases, such as those of the
stomach in which functional repose is required, and in certain
fevers where it may be indicated by anorexia, and possibly
also for the absorption of neoplasms. In his interesting code
of health and longevity, Sir John Sinclair says that the
French surgeon, M. Pouteau, alleviated the pain of cancer,
and in several cases even effected a complete cure, by an
exclusive diet of water cooled by ice. Pouteau, who was a
follower of our Cheselden, was an original worker, and his
energy in attacking disease was happily illustrated in the
inscription accompanying the portrait facing the title-page 1
of his posthumous works. Igne et ferro sanabat, said his
editor. Now that the treatment by over-feeding or garage
seems to be on the wane, the natural refl ux of scientific thought
should bring about a movement in favour of abstinence.

ANTIFKBHINK.

The use of antifebrine or acetanilide as a “ nervine” was
discussed at the last meeting of the Socidtd de Thdrapeu-
tique. M. Dujardin-Beaumetz said that it acted as a moderator
of the spinal excitability, particularly of the upper portion
of the cord. In doses of from 15 gra. to 30 gra. daily no appre¬
ciable physiological effect is observed. It cannot be detected
in the urine. In three cases of staxia the “lightning”
pains were greatly relieved. In one case of epilepsy the
attacks have entirely ceased since its administration. Being!
insoluble in water, it should be administered either in wine
or some other alcoholic vehicle. M. Constantin Paul said:
that he had tried antifebrine in doses of from 4 gra. to 8 gra.
per day, as recommended by Ldpine, but without result.
A slight improvement was, it is true, observed during the
first few days, but this was due, no doubt, to the “ moral
effect,” as exactly similar results were obtained with bread-
pills administered under a high-sounding name.

GASEOUS ENEMATA.

M. Blachez testified to the utility of gaseous injections of
sulphuretted hydrogen in two cases out of three in which
he had recently used them. In the third case some gastro¬
intestinal irritation was produced, and the improvement of
the lung symptoms was not quite satisfactory. M. Paul has
devised an apparatus for the administration of these injec¬
tions, in which the gas is contained in a metallic recipient
under pressure, and a manometer registers the quantity
which is allowed to pass out.

VIENNA.

(From our own Correspondent.)

TWO NEW 8UGAR TESTS.

At a recent meeting of the Vienna Chemico-Physical
Society, Dr. Hans Molisch, assistant at the Phyto-Physio¬
logical Institute of Vienna University, described two very
delicate tests for detecting sugar in liquids. The reactions
employed are the following: A half-cubic centimetre of the
liquid containing sugar is mixed with two drops of an
alcoholic (15 to 20 per cent.) solution of a-naphthol; then
concentrated sulphuric acid is added in excess. In presence
of sugar, the liquid if shaken, assumes immediately a
deep violet colour, and by adding water to the liquid a
blue-violet precipitate is formed. In the other reaction
thymol is employed instead of a-naphthol, and the liquid
containing sugar assumes a carmine-red colour. These
reactions are more delicate (as was shown by experiments)
than our common sugar tests, and are successful with moat
kinds of sugar; they can be also used for proving the presence
of sugar in the tissues under the microscope. It was shown
also that normal urine of man without any preparation gives

D^ed by GoOgfe

fnHwnrr,]

THE SERVICES.—OBITUARY;

[Jan 8,1887. 105

the reaction, even if diluted with water to the extent of
from 100 to 300 times its volume, and therefore the sug¬
gestion that normal urine contains sugar seems to be proved.
If normal human urine is diluted with water to more than
oOO times, it fails to give the reaction, while urine of diabetic
persons can be diluted to a higher degree to exhibit the
raction with a-naphthol.

PRBYBNTIVR INOCULATION8 IN 'HYDROPHOBIA.

Dr. UUmann, assistant of Professor Albert, who has spent
note weeks in Paris studying Pasteur’s method of pre-
rentire inoculations for hydrophobia, has recently estab¬
lished here a station for preventive inoculations. From
Jbm 28th till now eighty-five persons bitten by rabid
uumals were inoculated with the best success. The rabid
audition of the animals by which the patients had been
trucked was stated in all these cases. According to the
reports received, all the patients are in good health.

A NEW HYPNOTIC.

Dr. Ghillany, pharmacologist to the Vienna General Hos¬
pital, has succeeded in preparing an alcoholic extract from
the roots of Piper methysticum (kava-kava), which is called
'vxtractum kava depuratum.” Experiments made with this
■irig by some physicians of the hospital proved it to be a
tiluable hypnotic. In all the cases where it was ad¬
ministered sleep was produced, without any disagreeable
eonwquence; even headache, following generally the exhi¬
bition of hypnotics, did not occur. It was given, as a
powder, from 2 to 5 centigrammes being a dose; or as a sup¬
pository containing 2 centigrammes.

SURGICAL DRESSINGS.

In the clinical wards of Professor Albert, experiments are
side now with fossil meal (Kieselgubr) as a surgical dress¬
ing. The fossil meal is sterilised and mixed with the anti¬
septic solutions of carbolic acid, sublimate, See. The cavities
of tbe wounds are stuffed with the paste prepared in this
nj. The results obtained with this dressing are very good;
lie wounds show fair granulations, and the process of
teaming seems to be very much promoted by the mechanical
action of the minute particles of the meal.

Vienna, December 23rd.

THE SERVICES.

With the approval of the Commander-in-Chief the services
of Surgeon A. M. Kavanagh, Army Medical Department, now
tt Woolwich, and Surgeon J. R. Morse, at Netley, have been
pitted at the disposal of the Egyptian Government for
employment with the Khedive’s troops. The former will take
ep army duties at Abbasiyeh, and the latter will inspect the
nmiiuwho are being enlisted in consequence of the reduc¬
tion of the British garrison.

War Offick.—A rmy Medical Staff: Deputy Surgeon-
Geaeral Herbert Taylor Reade, V.C., to be Surgeon-General,
dee Sir Anthony Dickson Home, K.C.B., V.C.., granted
retired pay; Brigade Surgeon Jame9 Landale, M.D., to be
fieputy Surgeon-General, vice H. T. Reade, V.C.; Surgeon-
Mijor Alexander Francis Preston, M.B., to be Brigade Surgeon,
nee J. Landale, M.D.; Surgeon Herbert Cotton, from half-
pay, has been granted retired pay.

AmnRALTY.—Deputy Inspector-General of Hospitals and
Fleets John Breakey, M.D., has been promoted to the rank
of Inspector-General of Hospitals and Fleets in Her Majesty’s
fleet.

The following appointments have been made:—Fleet Sur¬
ma Charles Strickland, to the Plymouth division of Royal
-ainaee, and Fleet Surgeon Maxwell Rogers, to the Monarch.

Devonshire Hospital and Buxton Bath Charity.—
Tbe Committee of Management of this hospital have issued
their annual report for 1886, from which it appears that of
the 2449 in-patients admitted during the year no fewer
thsa 2325 were discharged as improved, and only 48 as no
better. The namber of out-patients admitted during the
veer was 248, or twelve fewer than the number admitted
6nmg the preceding year. Of these 218 were discharged as
improved, and only four as no better. The total receipts
from all sources were £276 lees than in the previous year,
ud Dm average cost per day of each patient has been
fractionally under 2s. or nearly one farthing per day

more than that o# 1886 .

WALTER FERGUS, M.D., M.R.C.6.,

1.ATK .WKDICJX OFFICKR OK MARLllOKOUOU t'OLl.KOK.

The vast amount of good work done, the untiring energy,
and unremitting care bestowed on many, call for more than
a passing notice of the death of the late Dr. Fergus, for
thirty-seven years the valued and trusted medical officer of
Marlborough College. Dr. Fergus was born at Newcastle-
on-Tyne in 1819. Educated at King’s College, London, and
at the University of Edinburgh, he took his M.D. of that
University in 1842, and his M.R.C.S. Eng. and L.S.A. in 1843.
He became house-surgeon of the Staffordshire General
Hospital in 1844, and only resigned this post on being
appointed to Marlborough College in 1849. The appoint¬
ment of Dr. Fergus to Marlborough College was practically
the first of its kind, no other public school possessing a
resident medical officer. The value of the appointment was
soon apparent. Scrupulously punctual and methodical to
a degree, he gave his undivided attention to the whole
establishment. Boys and staff alike, and all who sought
his aid, found a kind and sympathetic friend and adviser.
During the thirty-seven years he held the post of medical
officer he enjoyed the perfect confidence of the Council of
Marlborough College and the successive head masters. Fail¬
ing health compelled him reluctantly to resign the office
in the early part of last year. The uniform work of medical
officer, even to a large school, naturally somewhat restricted
general practice, but he always kept himself well read in
the scientific work of the day, and was a not infrequent
contributor to Thu Lancet, and his opinion on the subject
of public school life in its sanitary relations was highly
valued. In the sick-room he was beet known: here the
patient had not only the competent medical adviser, but the
kind and tender nurse; for vast numbers can testify how,
night after night, individual cases of gravity received his
constant presence and care. It would be impossible in a
notice like this to tell of the extraordinary sympathy that
existed between the College and Dr. Fergus, and also
between him and the town of Marlborough, to many of the
residents of which he had endeared himself by acts of kind¬
ness and by the interest he took in the parish of St. Peter
and Marlborough generally. He was pre-eminently a
Christian man, and devoted himself to every good work,
was very good and kind to the poor, aDd he has passed away
regretted alike by all.

He died almost suddenly at Ryton-on-Tyne on Dec. 8th.
His death, though sudden, was evidently not unexpected by
himself, for he had expressed an opinion a short time before
that he would not live long. For him death had no terror;
he was fully prepared to go forth to meet the shadowy
future without fear and with a manly heart. Doubtless, for
one like him, who, in his life as a medical man, must have seen
many lingering and painful cases, a sudden death may have
had its charms. His body was brought to Marlborough on
Tuesday, Dec. 14th. An imposing service was held in the
new chapel, and by 12 o’clock all that remained of the
“ good Doctor,” as he was familiarly called, was laid to rest
in the quiet and beautiful churchyard of Preshute. There
it rests close to many old friends, and by the side of some
few whose bright young lives had sped— lives which his care
and constant watching had failed to save. An immense
number of persons attended, testifying to the respect in
which he was held._

LAUCHLAN AITKEN, M.D. Edin.

For a wide circle of personal friends and former patients
the death of this able and benevolent practitioner invested
the closing year with peculiar sadness. Dr. Aitken went
to Rome about fourteen years ago—himself an invalid
from the sequela; of a severe attack of scarlatina,—and in
that genial climate he soon recovered strength enough to
resume the professional career which had become impossible
in “ the grey metropolis of the north.” He brought with him
many qualifications for the success he rapidly achieved.
Having graduated at Edinburgh with much distinction
both in surgery and in medicine in 1865, he took the
“ summi in medicina honores ” in 1868. Prolonged visits to

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i

106 Eaa Lajsce*,]

OBITUARY.—MEDICAL NEWH

[Jan. 8, 1887.

the chief continental schools, such as Berlin, Vienna, and
Paris, extended and deepened the medical proficiency
which had already attracted the attention of Sir J. Y.
Simpson, to whom he became assistant both in the class¬
room and at his private residence. A brilliant career was
now before him, until the malady above referred to com¬
pelled a complete change of plan, and induced him to
settle in Rome in 1872. He then applied himself with
characteristic energy and decision to master the climatic
conditions of the place, and his studies on the local fever
fructified in more than one able and instructive paper in
the London and Edinburgh journals. He was a trenchant
vindicator of the sanitary credit of Rome, particularly as to
her water-supply and (till lately) as to her immunity from
typhoid, and as soon as the growth of the city, the increase
of the population, and the altered conditions of the water-
supply and the drainage appeared to invite that scourge, he
endeavoured by interviews with the hotel proprietors, and
by letters in the local journals, to minimise the evil at its
source. A reprint of his papers on the Climate, the Malaria,
the Water-supply, and the Health Statistics of Rome would
be welcomed not only by English-speaking practitioners, but
by those of the many different nationalities domiciled in the
Eternal City.

About three years ago the cares of an extensive and
laborious practice—involving much mounting of hotel
stairs—began to tell on his imperfectly nourished heart, and
threatenings of asystole admonished him to relax the strain.
Intimate professional friends, indeed, urged him strongly to
withdraw from practice entirely, at least for a few seasons;
but nothing would shake his resolution to die at his post.
He lived for ministration at the bedside; it was his mental
resource and predilection, and all appeals to spare himself
were answered with a

Propter vitem vlvendi perdere causa* ?

The result soon became manifest in an increasing recourse
to substitutes, until his return to Rome at the commence¬
ment of the season, with “ the wheels of life run down,”
oonvinced him that his professional career was at its close.
He lingered for a few weeks under the sedulous care of Dr.
Edmonston Charles, sometime of the Bengal Army and late
of Cannes, to whom he had transferred his practice, and on
Sunday, the 19th ult., he sank, conscious to the last.

Dr. Aitken was but forty-three years of age when he died,
but he lived long enough to impress a wide clientele with
his admirable skill and success as a physician, and a still
wider circle of friends with his manly integrity, his catholic
tastes, and his benevolent heart. He was buried on the 24th
ult. in the Protestant cemetery between the Tiber and the
Gate of St. Paul.

W. A. N. CATTLIN, F.RC.S.

On the 13th ult. there passed away from our ranks one
whose name will long be held in honour for his scientific
attainments and his skill in dental surgery. No less durable
will be the memory of his single-hearted and unselfish gene¬
rosity, for he was ever ready to lend a helping hand when¬
ever a claim commended itself to his judgment.

Mr. Cattlin was born at Southend in the year 1814. He
was apprenticed to the late Mr. Porter, of Bishopsgaton¬
street, London, received his medical education at the London
Hospital, where he gained prizes in medicine, and was highly
esteemed for his acumen and sagacity by the late Dr. Billing.
He became a Licentiate of the Apothecaries’ Company in 183G,
a Member of the College of Surgeons in 1841, ana a Fellow in i
1856. He commenced practice in the City-road, London, j
but, on account of ill health, was compelled to abandon it '
and take a voyage. After his return, with renewed health
and energies', Mr. Cattlin became resident medical officer at
tbfc Holloway and North Islington Dispensary, and soon
afterwards, in Islington, entered upon the practice of dental
surgery, of which he had previously obtained good practical
knowledge. In this branch of the profession he soon
attained to eminence. He was one of the rounders, and some¬
time president, of the Odontological Society. It was mainly
to the untiring exertions of Mr. Cattlin that the Medical
Benevolent College owes its present satisfactory basis.

; In 1893 Mr. Cattlin removed to Brighton, where his great
•success followed him, but his health broke down under
stress of work, and he retired to Bournemouth in 1880, but
never recovered from the effects of an attack of paralysis, to
the later effects of which, indeed, he ultimately succumbed.

Mr. Cattlin's quick intelligence and decision in acting in¬
spired confidence in his professional opinion, whilst his genial
and kindly disposition gained him countless friends. He was
attended, at various periods of his illness, by Mr. Jonathan
Hutchinson, Dr. Hughlings Jackson, Dr. Wilks, Mr. Power,
and others. He leaves a widow and several children, one of
whom, Mr. Wm. Cattlin, follows his late father’s professionj

HU&ital tUtos.

The Gresham Lectures on Physic will be delivered
by Dr. Symes-Thompson, on Feb. 8th, 9th, 10th, and 11th.

Dr. A. Fraser has been appointed Deputy-Coroner
for the Totnes district. South Devon, vice Mr. Jelley, resigned.

The Hospital for Women, Soho-square, has peti¬
tioned Her Majesty in Council for a charter of incorporation.

On the 31st ult. a very successful fancy dress ball
was held at Faversham, in aid of the proposed local cottage
hospital.

A special service was held on the 26th ult. at the
Hope-place Synagogue, Liverpool, on behalf of the local
medical charities. The offertory amounted to £21.

Mr. Thomas Moore, F.L.S., who for thirty-eight
years was curator of the Botanic Garden of the Society of
Apothecaries at Chelsea, died there on New Year’s Day, in
his 66th year.

“ Hospital Saturday ” has been transplanted to
New York, and it is expected that by next year the work
will, by the aid of women’s auxiliary societies, be thoroughly
systematised.

On the 28th ult. Mr. Peter White, surgeon, of
Yetholm, near Kelso, suddenly fell down dead in the village.
It is noteworthy that Mr. White's wife also expired suddenly
on the previous Saturday.

At a largely attended meeting of the Great
Yarmouth Jubilee Committee on the 4th inst., it was agreed
that the local commemoration should consist of a jubilee
wing for the Yarmouth Hospital.

Action for Libeling Scientific Men.—A n action
has been brought by order of the German Chancellor against
Dr. Oidtmann, editor of the Impfxwanggegner (Anti-compulT
sory vaccinationist) for libeling Prof. Koch and Privy
Councillor Kohler.

The Canadian correspondent of the Liverpool
Journal of Commerce says, “Dr. Dodd has been making tests
of the mineral waters found near Regina, with the most
satisfactory results. He has now established beyond doubt
the fact of their strength and general curative purposes.”

The Birmingham Hospital Sunday Collection Com¬
mittee have handed over to the treasurer of the General
Hospital £4231 as the result of the last collection. The total
sum realised was £4662. The balance, after payment of
expenses, has been given to other charities.

Open Spaces in Manchester.—T he committee
far securing open spaces for recreation are just now making
increased efforts to obtain public support on behalf of the
work they are carrying on, and ask for £1500 to furnish
and lay out several spaces and gymnasia that they have
in hand. .

1 British Hospital at Port Said.—S ir John Stokes,
who is chairman of the London committee for building a
British hospital at Port Said, has, it is stated, obtained an
excellent site near the sea in exchange for the site formerly
granted. The hospital will now be begun at once, and, it is
hoped, will be opened in April.

Sanitation in Kidderminstbr.— During the past
year the improvements in the sewerage system of Kidder¬
minster have been completed and the new covered reservoir
opened. The provision of a sufficient water-supply from a
source free from sewage still,' however, demands attention.
The lower well, the.condition of which at the beginning of
last year caused much anxiety, is still being used, but we
trust that the Town Council is alive to its responsibility,
and that the provision of another source for the water-
supply may only be a question of weeks or months,

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Tn Laatcmt,]

MEDICAL APPOINTMENTS.—BIRTHS, MARRIAGES, AND DEATHS. [Jan. S, 1887. 107

Hospital fob Incurables, Manchester. —Tem¬
perance reformers will be pleased to note a statement made
at the recent annual meeting of the Manchester Hospital for
Incurables, that though the patients had numbered up¬
wards of eighty during the past twelve months, only £13
had been expended upon wine and spirits.

Infirm art Accommodation at Camberwell.— The
Camberwell Board of Guardians have adopted a report from
a committee, recommending that additional infirmary accom¬
modation should be provided for about 350 adults and fifty
children. The present infirmary, which is completely filled,
contains 230 beds.

TnE St. Marylebone Infirmary, Rackham-street,
N'otting-hill, was, on the 30th ult., thrown open for inspec¬
tion by the ratepayers of the parish and others interested
in the management of such institutions. At the close of the
visit entire satisfaction with the management of the build¬
ing was expressed.

Presentation. —On the 30th ult., at West Hartle¬
pool, James Atkinson, M.D., was presented by the brethren
of the Good Intent Lodge of the Manchester Unity of
Oddfellows with an address in recognition of his services
to the lodge during the thirty-four years he acted as its
medical officer, a post which he has recently resigned.

Society for the Study and Cure of Inebriety.—
A quarterly general meeting was held at 11, Chandos-
strwer, on Tuesday last, the president. Dr. Norman Kerr, in
the chair. Mr. Tudor Trevor read apaper on the Prevailing
Indifference to Inebriety. Dr. H. W. Williams, Mr. Hilton,
Mr. Kaper, Mr. Gustafson, and Mr. Frederick Trevor took
part in the discussion.

A Hospital as a Thank-offering.— The Nursery
Hospital, the Jubilee gift to Buckingham of Mr. J. G.
Hubbard, M.P^ and Mrs. Hubbard, and which has cost about
£4000, will be ready for opening in a lew weeks. It bears
an inscription to the effect that it is offered in thankful
remembrance of the pres e rv a tion from sadden death by an
accident to Mr. Egerton Hubbard, M.P., in 1874.

Utt&iral

InUavtUonsfor this rohcmn must be tent dibf.CT to the Office of The Lancet
before 9 o'clock on Thxrtday Homing at the latest.

Barri-tt. W. A. H., L.B.C.P.Lond., L. A M.S.A.. has been appointed
Medical Officer and Public Vaoelnator for the Littleport District of
the Ely Union, and the Sooth Weiner District of the Downham

. Union.

Blackett. W. CrnratBT. M.R.O.S., L.S.A., has been reappointed
Medical Officer of Health for the Durham Rural Sanitary District.

Bovs. Arthcr H., M.R.C.S., L.R.C.P.Kd., has been appointed Medical
Officer and Public Vaccinator for the Second District of the St.
Alban’s Union.

Campbkix, Donald, M.D., O.M.Glas.. has been reappointed Medical
Officer of Health for the Caine Rural and Urban Sanitary Districts.

Clarkk. A. B., L.R.C.S.Bd., L.S.A.. has been appointed Medical Officer
mod Public Vaoelnator for the Shebbear District of the Torrington
Union, Devon.

Collenettb, P. de B., M.R.C.S., L.B.C.P.Lond., has been appointed
Medical Officer of Health for the Wolstanton and Bunlem Rnral
Sanitary District.

Da’Ath. George H., M.R.C.S.. has been reappointed Medical Officer of
Health for the Buckingham Rural Sanitary District.

Drxoajr, David, M.B., C.M.Aber., 8.8c.Dur., has been appointed
Medioal Officer of Health for the Cherter-le-Street Rnral Sanitary
District.

Fenwick, Charles, L.R.C.8.. L.RC.P.Ed., has been appointed Medical
Officer for the Dunaford District of the Bxeter Union.

Geasam, Wm.. M.D.Roy.Univ.Irel., L.B.O.S.Hd., has bean appointed
Resident Medical Superintendent of Armagh District Lunatlo
Asylum.

H»w>r. Albert B.. M.B.C.S., L.8.A., has been appointed Senior House-
Surgeon to Charing-cross Hospital.

Hawkins, Francis, M.B., has been appointed Physician to the North
lamdon Hospital for Consumption and Diseases of the Chest.

Hit-sK-s, Chau. as, L.S.A., has been appointed Rlectrlcal Assistant to
Charing-cross Hospital.

Hockew. J. Presto*, L.8.A., baa been appointed Resident Obstetrical
Officer to Charing-cross Hospital.

Ht-owsiTH. Powell, L.K.Q.C.P.I.. has been appointed Medical Officer
of Health for the St. Anne-on-the-Sea Urban Sanitary District.

Laur, Chablks, L.F.P.S.QIes.. L.B.C.P. Bd., has been appointed
Medical Officer for the First District of the Leicester Union.

l.irrutwooD, John Oscroft, M.R.C.8., L.R.C.P. Lend., has been
appointed Medical Officer for the Borough of Walsall.

Ucy. Rkqewald H., M.B., C.M.Bdln., M.B.C.S., has been appointed
House-Surgeon to the 8oath Devon and Bast Cornwall Hospital,
Plymouth, vice W. A. Buchan, M.B., C.M.Bdln., L.S.A., resigned.

MacDonald, P. Wm„ M.D., C.M.Aber., has been appointed Medical
Superintendent to the Dorset County Asylums, vice J. G. Symes,
M R C.8 , Ao , resigned.

M a kins. G. H., F.B.C.S., Assistant Surgeon to St. Thomas’s Hospital,
has been appointed Demonstrator or Anatomy to that Institution.

Mason, 8amukl Bi’tlkr, M.R.C P.Bd., L.F.P.8.Glas.. has been re¬
appointed Medical Officer of Health for the Pontypool Urban 8auitary
District.

Mead, H. T. Harvky, M.R.C.8.. L.8.A., has been appointed Medical
Officer of Health for the Christchurch, Hants, Urban Sanitary
District.

Moork. Charles Arthur, M.D.Aber.. has been reappointed Medical
Officer of Health for the Barrow-on-Soar. Blllesdon. Blaby. Hinckley.
Lutterworth, Markct-Bosworth, Oakham, and Uppingham Rural
Sanitary Districts; and the Melton-Mowbray and Thurmaston Urban
Sanitary Districts combined.

Kklham, Aliiert K., M.R.C.S., L.S.A., has been appoint’d Junior
House-Surgeon to Charing-cross Hospital.

Norrls, Edwin J.. M.R.O.8., L.R.C.P., L.S.A., has been appointed
8enlor House-Physician to Charing-cross Hospital.

Oliver, W. Pyk, L.8.A., has been appointed Junior House-Physician to
Charing-cross Hospital.

Stabling, Edwix A., M.B., M.Oh., Ac., has been appointed Honorary
Medical Referee for the District of Tunbridge Wells, and to the
National Hospital for Consumption at Vcntnor.

T lexer, Frederick, M.R.O.S., L.S.A.. has been reappointed Medical
Officer of Health for the Buxton Urban Sanitary District.

Wilson, Robert A., M.D., O.M.Glas., lias been reappointed Medical
Officer of Health for the Lunesdale Rural Sanitary District.

Ilferrraps, anil $cat|js.

BIRTHS.

Haxi.ky.— On the31st ult., at 3, Upper Phiilimore-gardens, Kensington.

W., the wife of Edward Hanley, M.D., M.Cli., of a son.

Hebron.— On the 3rd inat., at Southwark-bridge-road, the wife of
J. Herron, M.D., of a son.

Hktlkt.—O n the 30th ult.. at Church-road. Upper Norwood, the wife of
Henry Hetiey, M.D., of a son.

Martin.—O n the 30th ult., at Brunawlck-street, Sheffield, the wife of
J. W. Martin, M.D., of a son.

Rick.—O n the 25th ult., at Sutton, Surrey, the wife of Geo. Rice. M.B.,
of a son. _

MARRIAGES.

Ande-Rson— Witching. - OnNov. 30th,at Cape Town, O. E. C. Anderson.
M.U.Lond.. late House-Physician, Guy’s Hospital, to Alice, eldest
daughter of C. W. Kltchlng, M.B.Lond., of Cape Town.

Dwight-Morris — Noaks. — On New Year's Day, at St. Stephen’s,
Hornsey, by the Rev. Joseph Kahn, M.A., Colin Dwight-Morris,
L.R.C.P.Lond., M.R.C.9.Bog., L.S.A.Lond., of Feltham, Middlesex,
to Nellie, eldest daughter of the late George Noaks, retired Captain.
B.M.P.S., Calcutta.

Erskine-Bisk—Paddv. — On the 13th nit., at St. Lake’s Church,
Jnlladhar Cantonment, Punjab, Surgeon B. J. Knklne-Blsk, Army
Medical Staff, to BUie Mary, youngest daughter of Maj. L. P. Faddy,
late 20th Regiment. Bengal, N.l.

Fox— Danger.— On the noth nit., at the Parish Church. Brisllngton.
near Bristol, Bonville Bradley Fox. M.A., M.D., to Annie, youngest
daughter of the late Thomas Danger, Esq., of Gottcy Lodge,
Brisllngton.

Porter—Cowax. —On the 7th ult., at Paget Parish Church. Bermuda,
James Porter, M.A., M.B., Surgeon, R.N. Hospital, Bermuda, to
Emma Louisa Kay, eldest surviving daughter of Deputy Inspector-
General M. W. Cowan, M.D., R.N.

White—Frii-p.— On the 30th ult., at the Parish Church, Tarrant
Rushton, Dorsetshire, by the Rev. James Penny, Rector, ancle of
the Bride, William Hale White. M.D.. of 65, Hariey-street, W.,
eldest son of Wm. Hale White, of Carsbalton. to Hdith Jane Spencer,
youngest daughter of Alfred Downing Fripp, Esq., R.W.8.. of
Hampstead. __

DEATHS.

Andrews.—O n the 3rd inst., at New Barnet, Charles Andrews, M.D..
of Hammersralth-road, W., aged 59.

Baron.—O n the 37th ult., at Woodland-terrace, Plymouth, Edward
George Baron, M.R.C.S., late of Ulccby, Lincolnshire.

Boh pas. —On Nov. 3rd, at Buatellon, Western Australia, Charles Smith
Bompas. M.B.C.S., formerly of Bristol and Manchester, aged 61.
Browse. —On the 30th ult., at Rhyl. North Wales, after a brief illness,
Harry Duncan Bouchier Browne, M.B., of University College.
Glasgow, and House-Surgeon to the Flintshire Dispensary, in his
24th year.

Clrmk.—O n the 2nd inst., at Dorchester, George Curme, M.R.C.S..

L. S.A., in the 80th year of his age.

Holmks.—O n the 31st nit., at San Remo, Surgeon-Major A. P. Holmes,
1st Sikhs Infantry, aged 51.

Jackson.—O n the 23rd nit., William Jackson, M.I)., late of Kingsland-
road, aged 75.

Linton.—O n the 29th ult., at Ashley-oourt-vllla*. Ashley-hill, Bristol,
Cornelius Clarke LintoD. Inspector General of Hospitals, late Indian
Medical Service, In his 81th year.

Mackenzie.—O n the 18th ult., at Eileannch, Inverness, N.H., John
MacKenrie, M.D.. aged 83.

Moork.—O n the 1st inst., at Much Hadhnm, Herts, Francis Moore.

M. D., aged 80. ,

Ranger. —On the 27th ult., at Bexley-heath, Kent, Frederick Ranger.

M. R.C.S., Iato of Cranbrook, Kent, aged 07.

Sellers.—O n the 28th ult., at John-street, Rochdale, William Burdett
Sellers, M.R.C.8.. L.S.A., aged 6T.

Smart.— On the 38th ult., suddenly, at Queen’s-crescent, Glasgow,
Robert Smart, M.D. ____

N. B.— A fee of Si. it charged for the Indian of Noticee of Births,

Homages, and Deaths.

Digitized by CiOOgle

106 T**LA*<wrJ Wm OOMffltm i«l>AIWP8 TO, OOPWTOHPPTP,,

[Jan. 8, 1S87.

Stoical Jiarj for % ensuing Meek.

Monday, January 10.

Botal London Ophthalmic Hospital, Moorfielda.— Operations,

10.30 a.m.. and each day at the tame boor.

Botal Wxstmxxktkr Ophtkalmic Hospital.—O perations, 1-30 P.M.,
and eacli day at the same hour.

8t. Hash's Hospital.—O peration*, 3 p.m. ; Tuesdays, same hoar.
Gkklska Hospital tor Women.—O perations, 3.30 p.m. j Thursday, 3.30. j
Hospital tor Women, 8oho-mjuarb. — Operations, 3 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 3 p.m.

Botal Orthopedic Hospital.—O perations, 3 p.m.

Central London Ophthalmic Hospitals.—O perations, 3 p.m., and j
eaeh day in the week at the same hour.

Odontologic.il Society of Gp.eat Britain.— fi p.m. Communications
bv Messrs. L. Mathcson, C. D. Davies, W. St. George Blliott, A. S.
Underwood, S. J. Hutchinson, Morton Smale, and Joseph Walker.
President's valedictory address.

Medical Society op London.—8.30 p.m. Dr. Half?: Photphutic Dia¬
betes.—Mr. A. Pearce Gould: A Case of Wound of the Common
Femoral Artery.

Tuesday, January H.

Gut's Hospital.—O perations, 1.30 p.m., and on Friday at the same hour.

Ophthalmic Ope ratio as on Mondays at 1.30 and Thursdays at 3 p.m.
8t. Thomas's Hospital.—O phthalmic Operations. 4 p.m.; Friday, 3 p.m.
Cancer Hospital, Brompton.—O perations. 3.30 p.m.; Saturday, 3.30 pji
Westminster Hospital.—O perations, 3 p.m.

West London Hospital.—O perations, 3.30 p.m.

St. Mart’s Hospital.—O perations. 1.30 p.m. Consultations, Monday, I

1.30 p m. 8kta Department. Mondays and Thursdays, 9.30 a.m.
Anthropo logical Institute or Gee at Britain andIreland.— 8.30p.m.

Mr. George Watt: A Brief Account of the Aboriginal Races of
Manipur and the Naga Hills.

Botal Medical and Chirurgical Society. — 8.30 p.m. Mr. Bland
Sutton : Suture of the Median Serve Ten Weeks after Division,
with Recovery of Function. — Dr. Eccles : Observation* on the
Physiological Effects of Massage (communicated by Dr. Lauder
Brunton).— Mr. Barwell : Oa Widely Incising by a Two-stage
Method Hydatids of the Liver.

Wednesday, January 12.

Rational Orthopedic Hospital,—O peration*, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital.— Operations, 1.30 p.m. ; Saturday, same
hour. Ophthalmic Operations, Tuesdays and Thursdays, 1.30 p.m.

St. Thomas's Hospital.—O perations, 1.30 p.m. ; Saturday, tame hour
London Hospital.—O perations, 3 p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital-—O peration*, 3 p.m.

Samaritan Free Hospital nob Women and Children.—O peration*,

3.30 P.M.

University College Hospital.—O perations, 3 p.m.; Satarday, 3 p.m
S kin Department, 1.46 P.M.; Saturday, 9.1ft A.M.

Botal Free Hospital.—O perations, 3 p.m., and on Saturday.

King’s College Hospital.— Operation*. 3 to 4 p.m.; and on Friday,

3 p.m. ; and Saturday, 1 p.m.

Children's Hospital, Great Ormqnd-Street.—O perations, 9 a.m.;
Saturday, same hour.

Hunterian Society.—8 p.m. The President Cases of Lead Poisoning
terminating rapidly with Cerebral Symptoms. — Dr. Pox : The ,
Nature of Asthma. — Dr. Turner: Aotiuornyoosl* of the Liver.—
Mr. Symondt: Further History of a case of Intestinal Obstruction.
Epidemiological Society of London. — 6 p.m. Mr. Bdward F.

Willoughby: Preventive Inoculations.

Obstetrical Society or London.—8 p.m. Specimens will be shown
by Dr. Amsnd Roitth and others. Dr. Pedley: Midwifery among
the Burmese.—Dr. Herman: Stricture of the Female Urethra.—
Dr. Gibbons: Case of Unilateral Galuctorrhcca.

Botal Microscopical Socikty.—8 p.m. Mr. A. W. Bennett: Fresh¬
water Alga: (including Chlorophvllaoeoua Protophytnr of North
Cornwall;, with Descriptions of Six New Species.—Mr. J. May all, jun.:
A Visit to Jena.

British Gynecological Society.—8.30 p.m. Annual Meeting. Pre¬
sidential Address.

Thursday, January 13.

St. George’s Hospital.—O perations, l p.m.

8t. Bartholomew's Hospital.—S urgical Consultations, 1.30 p.m.
Charing-cross Hospital.—O perations. 3 p.m.

Nobth-West London Hospital.—O perations, 2.30 p.m.

Friday, January 14.

8t. George's Hospital.—O phthalmic Operations, 1.30 p.m.

Botal South London Ophthalmic Hospital.—O perations. 3 p.m.
Clinical Society of London.—9.30 p.m. Annual General Meeting for
the Kleotion of Officers and Council.—Dr. 8amuel West: Right
Hemiplegia with Aphasia occurring during a paroxysm of Whooping-
cough, with slight rigidity, subsequently passing Into a condition ot
Athetosis.—Mr. Mayo Bobson (Leeds): (1) A Method of Treating
Thyroid Cysts ; (2) A Suggested Method of Operating on a Uniform
Frinciple In the Treatment of Imperforate Anus. Living Specimens:—
Dr. Radcliffe Crocker: A case of Athetosis after Hemiplegia.—Dr.
Stephen Mackenzie: Living Embryo FI lari* Sanguinis Horn Inis from
a case of Chyluria.

Saturday, January 15.

Middlesex Hospital.—O perations, 3 p.m.

METEOROLOGICAL READINGS.

(Taken doily at SJ0 ajn.by Steward'» Inst ru men t! .)

The Lancet Office, January dth, 1887.

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ftutes, SJmrt Comments, fdtskrs to
Ccmspitbents.

It it especially requested that early int<J>igsncc<f heal event*
having a medical interest, or which if is desirable to bring
under the notice of the profession, man be tent direct to
this Office.

Ail communications relating to the editorial business of the
journal must be addressed “ To the Editor*."

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for priv ate informa¬
tion, must be authenticated by the nam^s and addresses of
their writers, not necessarily for publication.

1 We cannot prescribe or recommend practitioners,.

Local papers containing reports or news-par agr units should
be marked.

Letters relating to the publication, sale, and advertising
departments Thb Lancih to be addressed “ 'lo the
Publisher."

We cannot undertake'to return Mtin. not us-d.

Tut Qlkbn'h Jriuuii .

How shall we houour, as we honour should,

A Quean whose reign has been so long, si good ?

By statue ; portrait; eulogistic verse ?

We might do bet ter, hardly could do worse.

Let's build a hospital In every town ;

Hndow it well, though carping niggards frown.

On every town impose a trifling tax,

That help, In time of need, be never lax.

Let all creeds, needing, share the nation's love;

So shall this Jubilee a blessing prove
To all on England's soil in time to come.

When England* Quean rest* In a royal tomb.

Then millions, yet unborn, shall thank kind heaven—

1 Our Queen was loved In eighteen eighty-seven.

Christmas Day, 18S6. Bart. Ecus.

Sir. A. F. Harrison.— Since the well-known works of Bozin anil Hardy.
French dermatological literature has. with the exception ot a few
manuals and volumes of lectures, been almost entirely limited to
monographs and contributions to periodicals. HUlairet's work was
not completed. French translations of Neumann’* well-known work
from the 4th edition (13 fr.). and of Kaposi's writings, have appeared.
Lailler's “Levons sur les Teiguei," 1878; Bazin s “ Lemons sur les
Affections Ootanee* Porantaires " (3 fr.), and tho articles in the large
French dictionaries are valuable. Any work required, or information.
could be obtained of the foreign booksellers.

G. B.— The report Is noticed on another page In our current issue.

DU. GOTO'S METHOD OF TfiEATING LEPROSY.

To tk* Editors of The Lancet.

Sire,—I n your last issue reference is made to Dr. Goto’s method of
treating lepers. The remedies he gave to a patient of mine 1 have
brought to England for analysis, and I hope shortly to plans them in
the hands of the College of Pnysldams, with a few remarks on the ease
of the boy to whom he gave them.

I remain, 8irs, yours truly,

G. W. Parker, M.B.C.P.L.. F.t*8.

(Late of the ffawaiiaa Board of Health Service.)
Christchurch. Hampshire, Jan. let, 1837.

Digitized by

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T*» Rnwdu. Ferro,'

adiBHoanl subscriptions to the shove hind hive been
r. J. WtoltbMD Buee*. 3. Bott-oourt, Fleebetrset, wishes
Intending subscriber* that the list wUl close oa the

V—*4r acknowledged... £33 It 6
8 T. Mn, Esq. ... 110

D- »*- *. Bswakhonse ... 110

• 1 id»sr.Ksq..F.il.C.S.Ed. I 1 0

• W Collier . 10 0

M W. Fttralnll. Esq. ... o 10 0

Per Or. Wood rain ; —

A H. A. HsHlaoo. Bsq^
i P- ... ~ ... 2 0 0

■ »'. _ ... 1 1 0

0 Porter. Bsq. ... ... 110
■f-'-n KHot, »q. 110

Dr. B. Walker .£10 0

Tire Bari of Devon ,.. 10 0

A. Steele Perkins..Baq.„. l o 0

The Hon. and Her. H.H.
Courtenay (Chairman
of St. Thoma*' Board

of Guardian*). 10 0

A Lady ... ... ... 10 0

Jito. Mortimer, Esq., M.B. 0 10 6

P- A.^. ... o 10 0

Mrs. Henry Ward ... o io o

T.F.M. 0 » «

• " Jt “-—Md* anmmo*i enough and right o no ugh lor dlUMeut member*
■d a femlty to have different medieal men. It ie neither right nor

•mon for medical men to allow or encourage touting on their
*4m9.

s ,<x *—Van. Two American physicians. Dr*. Nichols and Bailey, have
• v-nily nondueted experiments which, they believe, prove that the
’M of « m » U i* more acute in men than in women.

IMPERFORATE HYMEN.

T» tU Editor * of Th« LawoxT.

*— Hnvtng read recently In your journal »ome cases of Imperforate

- ' , ™ with Tneastra.il retention. I send you the following case that
-ninni to me whilst airgeen to the PanuleUlo Copper Companies'
ItohOhiM.

B - P-. eighteen, had never m en s tru ated. For twelve

-» xths abe had experienced acute pain In the abdomen at variable
-rta. I was culled In on Nov. 25th, 1882. by the father, who stated
to his daughter wan in great pain, and that something toft wto pro¬
's frag from the vulva. The patient refused examination j so an opiate
w* given, and relief •bUioed. On Dec. 18th I was called again, when
"--palawae so severe that an examination was readily consented to.
? - hypagastrium I foundahanl rounded tumour, the size of a small
vHrw. extendi or from the pelvis to within an Inch of the umbilicus,
•-m toe left ride of the upper extremity of this tumonr was a pro-
m* •»«*» In diameter, extending irt right angle* for about
toc*na. Per vulvam a tough red membrane projected from
*-■■■ the Ups, which was tense but fluctuated. A catheter was
•vn. sad the bladder emptied. A small exploring trocar was introduced
*■- toaosntra of the tumour, a flow of thick, almost Maok, retained
■aatraal fluid resulting. This fluid was allowed to flow from the
»i«Ja until relief from pain was obtained. On Dec. 18th a crucial
x-skm was made in the membrane, and an injection of Condy's fluid,
drachm to the pint of water, freely used. No clots passed. From
date the patient made an uninterrupted recovery, and I found her
: uoi about on Dec. 27th. She has since menstruated regularly and

* wui tremble of any sort, and married on March 28th. 1880.

I am. Sin. yours faithfully,

Axnrun Gjutixso, M.B.C.8., L.R.C.P. Lond.
Fwrat-hin. S.B., Dec. 27th, 1888.

BOXAD XBDICaL BENEVOLENT COLLEGE, BPSOM.

7b tie Editort o/Thj* Laxcbt.

Stto—I am desired by the Counell to send you a copy of a letter

- -ttom. by the master of the science class at Bpsom College to the head-
mrter. and to say that they will be extremely obliged to you If you will

ai room in The Laxcet for the communication, in the hope that In
way the want may be supplied.

I am. Sirs, yoor faithful servant,

Ju5 - >d. 1887. JIobekt Frskma.v, Secretary.

OtoR Mr. Wood.—W e ye greatly 1 tampered in the study of zoology
'he want of a number of skeletons. It has occurred to me that if
-* want were known to the medical profession in London, kt bv
o ( .*. Utt *? r lp ..^ e mescal papers, or by the intervention of i
temtm oi the Oou' ell. It might be remedied. I think It U not unlikely
•°™« •>* 5 hc ho *pltals there may be extra specimen# that they
*' ***• wHHng to present to Bpsom College. If asked what particular
to* wanted. I should say those mentioned in the honour* list for
tosrmnUaXe B.Sc. and In the B.Sc. Hat for the University of London.

flfm IYICTiP f nA vnrlr from aeKnlni^VI.. _j __ n. •• ■ w

COCAINB.

7b tit Editor t of Tsb Lua&

h* —WHh reference to the letter to year last issue relative to oooatoe
w.pn to iu- f* that U atoOtatofMmrtbnity of the patt I* required a
per on*. solution I* necreaasy. I have on two oration* removed a

y l. a i ss sa ring tra Inches to diameter, from the neck, and on
vkradH to* palldntcafaBt)' smoked a cigarette during the operation.

I am. Sirs, yours faithfully.

Viuthra, Tan. 1st ME. Amwrt Be.tham,.

Fhdtor TanuiiD idsnxtxs.

i Thk supervision of Freoqh toastie asylums appears, If recent accounts
i be true, to be exceedingly lax. It will be remembered that a short
s time ago a man was released from an asylum, having been forty years
previously confined by his relatives In order to aeoure his wealth. The
j reoape of another man is now reported, who, although sane, was ooa-
l flood for a year in an ill-lit room, bound hand and foot. Such treafc-
t • mart is strictly forbidden by law, and the matron and two keepem af
the establishment have been fined, and the medical superintendent
condemned to a fortnight’s imprisonment. Such regrettable and
I scandalous Incidents would be impossible If any control were exercised
| by the authorities ; and although our Gallic neighbours may manage

i things in general better than we do to Bngland, their most ardent

i admirers will be compelled to admit that the protection of lunatics
1 and the supervision of asylums do not redound to their credit.

Mr. Barnes Nowell writes os to explanation of his action as described by
“ Verax." We are of opinion that it was due to the gentleman In
attendance to have sought his concurrence In the step taken, or to
have communicated with him immediately to explanation of the
urgent circumstances.

A Subscriber. Such a place a* St. Mary Church, near Torquay, would
meet most of our correspondent’s requirements.

SUICIDE AFTER TAKING A DOSE OF CHLORAL.

To the Editors of The Laxckt.

aal UU ‘~ PerhaPa 7 ° U “ ay be aAte to find a corner for the following

On Nov. litli I visited P. D-, a somewhat anxmic man, about

thirty years of age, who was suffering from bronoliitis. There was a
history of an acute, painful, spasmodic disease of the cheat, which the
patient believed to be asthma, but which I thought was angina pectoris
He was treated for the bronchitis, and all went fairly well until the
morning of Nov. 22nd, when, being in acute painHie persuaded a friend,
an apothecary, to give him fifteen grains of chloral hydrate. Almost
immediately after taking the chloral be procured about six ounces of
French brandy, which he lmblb<-d In three doses during the space of
abent an hour. After the third dose of brandy a friend wbo n. with
him left, observing before leaving that the patient’s face was flushed in
patches. After the departure of his friend the patient shot himself
through the brain with a revolver, and was found dead in bed by myself.
ii 6 r. a3 J P °° r ’ but not ,n any dl ® cult 7 °f any conscqnenoe. and beyond
slight detpondeucy bad not shown any symptoms of insaaifcv either to
myaelf or to his friends. v

1 see that Dr. C. Browne mentions "deep flushing of the face,” and
Dr. Fuller “ violent delirium,” after the administration of chloral.
Perhaps wme of your readers would Inform me, first, whether any
case of suicide following the administration of chloral baa been recorded
and, secondly, whether it is their opinion that the chloral, or the mb
tu?e of chloral and brandy, was responsible for the suicidal action.

^ _ , I am, Sira, yours obediently,

South Africa, Nov. 35th, 1880. p 0

dtotort'wlll not be able to register the M.R.0.8. alone after 9me
He must show that he;ha» passed a quaHfylngexamtoattontomedlctoe.
surgesy. and midwifery, as defined by the Act; and this requires the
cooper at ion of corporation*.

Mr. Habjooi and Mr. Cooper .—An ounce powder was intended.

EXPLORATORY INCISIONS.

To tbe Sditorr of Trk Laxckt.

Sm.-In your Issue of Nor. 13th, page 810. second column, forty-

■ COU f ,d , **■; Ms admirable address on the value of

“ Th « ea'-lty was washed
out with iodine water and packed with st rips of iodoform gauze so as
to promote suppuration." Ho certain^ did not n,^ to rev this as
Iodoform gauze Is used to prerent, not " promote,” suppuration; ind
this Is corroborated a few lines lower down, where It is stated that no
pus was found when the packing was removed.

_ 1 *n». Sire, your* verytrety.

Chicago, Dec. M, 1886, ». A.

Mr. TOm. La fan. The University of Oxford recogrrfsw forftr dtofcmia
no medical examination* other than those conducted by Itself.

MEDICAL DEFENCE.

7» Ms Xdilort of Tbi Lancjst.

Sins,-In order to prevent possible misunderstanding, wUl you kindly
pwmlt me to Inform your readers that the Medieal Defence tlak«L
whose circulars are being sent to member* of the profession, has no
connexion whatever with the Medloal Defence Association, of which
Dr. B. V. Ric h a r dson, F.H.9., is president.

I am. Sirs, yours faithfully,

George Brow*,

tiainuM., s.c.. D "““

Google

110 Th* Lamck,]

sotrs.’OOMIubwb, hvd answers to oomtaaposDprm

MORPHIA HABITU&S.

To the Editors of The Lancet.

Sirs,—I an desirous of collecting u much information a* possible
concerning tbc after history of cured morphia hnbitu6s, particularly
(1) any special hygiene adopted by those who have passed some time
■without relapse, (3) evidence of the neoeesity (or the contrary) of subse¬
quent total abstinence from a'oohol, (3) any special tendency to relapse
in goaty subjects in oonsequenoe of some particular distress or restless¬
ness, (4) the value of valerian and its preparations, and (6) cases where
opiates have subsequently been given with benefit and impunity. I
should be greatly obliged to those Interested in this question who will
favour me by communicating their experience. Any information sent
to me personally would, of course, be acknowledged if used for pub'
lication. I am, Sirs, yours very truly,

Paris, Dec. 30th, 1888. Oscar Jennings, M.D.

Mr. G. W. Parker .—We fear our space will not permit of the publication
of the notes and statistics.

P. H. IF. -There does not seem to be anything novel in our corre¬
spondent’s suggestions.

Dr. C. F. Knight’s paper is marked for insertion.

-ABSCESS OF THE LIVER IN INDIA."

To the Editors of In Lancet.

have just seen Mr. Curran’s letter in your issue of Nov. 0th,
and I hasten to acknowledge that I have derived much valuable infor¬
mation from his exhaustive treatise on Hepatitis in India, a work to
which I have on more than one oocasion referred in print. As regards
the in question of seven abscesses found at the post-mortem exami¬
nation In the liver of an infant six months old, from the description
published in the Indian Medical Gazette it was a case of general peri¬
tonitis ; and it appears to me that the multiple abscesses must have
been either tubercular or pysemic, not true tropical abscesses, of which
class alone my paper treated.

I am. Sirs, yours truly,

A. Tombs, M.D., Surgeon, I.M.S.

Midrapore, Bengal, Dec. 8th, 1880.

Voyageur .—Montreal is not exempt from enteric fever, which usually
begins to assume an epldemto form in October.

.V. Y. Z.— We believe the evidence available is insufficient to warrant a
conclusion in the affirmative.

M.D. is referred to announcements in our advertising oolumns for infor¬
mation on the subject.

Communications not noticed in our present number will receive atten- j
tion in our next.

Communications, Letters, Ao., have been received from—Mr. Sydney
Jones, London ; Dr. Maclagan, London ; Mr. W. Curran ; Dr. Stephen
Mackenzie, London ; Dr. Savage, London; Dr. Norman Kerr, London;
Mr. Banetone, Torrington; Dr. Luca, Chelsea; Messrs. Lorimer and
Co., London; Mr. Pollard, Pulham ; Dr. Hearne ; Messrs. Armfield
and Sons, Loudon; Mr. Birchall, Liverpool; Messrs. Newbery and
Sons, London; Mr. Scatchard,Boston; Dr. Greenwell; Messrs. Cooke
and Co., London; Dr. Levermore, Accrington ; Messrs. Reynolds and
Co., Leeds ; Mr. Cook, London; Mr. Dow, Finchley; Mr. Maw, Brad¬
ford; Mr. 8hirmey, Coventry; Mr. Scraggs, London ; Messrs. Harris
and Co., Birmingham ; Mr. Brazier, Clerkenwell; Messrs. Richardson
and Co., Leioester; Mr. Shiels, Edinburgh ; Messrs. Burroughs and
Wellcome, London; Dr. Bell Taylor, Nottingham; Mr. E. de Vere
Mathew, London ; Mr. Vincent Jackson, Wolverhampton ; Mr. T. P.

[Jaw. 8,1887.

. T---StW

Lowe, Bath; Mr. R. Jeffries, Chesterfield; Mr. Collis Barry, CMsUi-
Bden; Mr. W. Parker, Bath; Mr. Hovell, Sunbury; Messrs. Bromley
and Co., Lincoln; Mr. McKinney, Nunhead; Mr. G. Moseley; Mr. A.
BeathaU, Southsea; Dr. Steele, Chicago ; Dr. Ward, Blyth; Mr. G.
Brown, London; Dr.Tomes, Midrapore; Miss Byron; Messrs.Austin
and Son, Clifton; Mr. Hagley, London; Mr. Stcllard; Messrs. J. and
H. Grace, Bristol; Mr. G. B. Douglas, London; Messrs. Badcllfle and
Co.,Liverpool; Mr. Blckerton, Liverpool; Dr.Hawkes,Northampton-.
Mr. Freeman, London ; Mr. Habgood, Banstead ; Messrs. Maggs and
Son, Yeovil; Dr. Barraclough, Dulwich ; Mr. Telford, Bury ; Dr. H.
White, London; Mr. Weymouth, Brondeabury ; Messrs. Boulton and
Paul, Norwich; Mr. Thorpe, Brisbane ; Mr. Plummer; Messrs. Hooper
and Co., London; Mr. Tumner, Harrogate; Messrs. Hopklnson and
Co., Notts; Mr. Milne, Lewisham; Dr. Magner, Rathkeale; Dr. Ward.
Ilford; Mr. Brooks, Hull; Dr. Hewer, Hornsey; Messrs. Pratt and
Co., London ; Dr. Carre, Omagh; Mr. Berthier, Paris; Dr. Delebez.
Brussels; Dr. Johnston, Sheffield; Mr. Walsh, Oxford; Dr. Trentler.
Uckfleld; Messrs. Churchill, London; Mr. Newsholme, Oapham ;
Mr. Teague, Manchester; Dr. Hardwick, Sheffield; Messrs. 8treet and
Co., London; Dr. R. B. Carrington, London; Messrs. Bennett and
Co., London; Mr. Bastes, London; Dr. Bruce, London; Mr. Wickham
Barnes. London; Mr. Evans, Wolverhampton; Messrs. B&lley and
Son, London ; Dr. Gray. Dalton-in-Fumess ; Dr. Sullivan, South
Kirkby; Mr. Kneebone, Bedford ; Mr. L. Propert, London; Mr. H. P.
White, Norwich ; Mr. W. T. Brooks, Oxford ; Messrs. Aecher and
Co., London; Mr. C. Keetley. London; Mr. Hughes, Denbigh; Mr. T.
Holmes, London; Mr. Wheeler, Manchester; Mr. Maw; Mr. Scott.
Manchester; Mr. Woodrow, London; Mr. Lloyd, Lampeter; Mons.F.
Alcan, raids; Mr. W. C. Bull, London; Mr. Balgarnle, Scarboro’;
Medical 8taff ; M.B.. Dawllsh; G. G. G.; Medicos, Clapham ; Lady
Superintendent, Cambridge ; Gamma ; A Subscriber; A. B. C., Sand¬
wich ; M.D., Gateshead-on-Tyne; L.R.O.P. Lond.

Letters, each with enclosure, are also acknowledged from—Dr. Wilson,
Bath ; Miss Terrill, Virginia, U.S.A.; Mr. Tett, London ; Mr. Guest.
Darlington; Mr.Davies,Cardigan; Mr.Sell, London; Mr.Knlghtley,
London ; Mr. Jones, Conway; Dr. Abraham, Aughnaeloy; Dr. Aubin.
Jersey; Mr. Roundtree, Islington ; Mr. Hayward, Corby; Mr. Dow,
Kensington ; Miss Harris, Leeds ; Miss Hunt, Dublin; Mr. Bates, New
York ; Mr. Robinson, Manchester; Mr. Pirkis; Mr. Rawlins, Great
Crosby; Mr. Warters. Alfreton; Mr. Robbins, Jersey; Dr. Lion, Fence
House; Mr. Thomas, Ripley; Mr. Geddes. London; Messrs. Wheatley
and Co., Huddersfield: Mr. 6omervllle, Edinburgh; Mr. 8tilBard.
Birmingham; Mr. Somerville. Lenham; Mr. Fenton, Colchester;
Col. Maurice, Feltham ; Miss Guinness, Maidstone; Mr. Weymouth.
Kilburn; Dr. Boswell, Faversham; Mr. Bloxham, Truro ; Mr. Cole,
Holywell; Dr. Smith. Kinnetty; Mr. Masefield, Ledbury; Mr. Brett.
Bridlington ; Mr. Jones. Darwen; Mr. Whitford; Messrs. Thomson
and Co., Liverpool; Dr. Sutherland, Salford ; Messrs. Maclachtan
and Co., Edinburgh; Mr. Appleby, Knutsford ; Mr. Leggatt, Wood
Green ; Mr. Coltman, Leicester; Dr. Redwood, Hhymney; Dr. Jones.
Pontardawe; Mr. Uttlng, Liverpool; Miss Payne, Leeds; Mr. Hand.
Macclesfield; Mr. Marsh, Hlndley; Mr. Davies, London; Mr. Laird.
Birkenhead ; Mr. Scattllng, Clapham ; C. B. H. ; G. P., Newport;
Medicus, London; M.D., Ulceby; W. H. M., Sydenham; Army; M..
Chelsea; Dispenser; Medicus; A. L. 8., Wimbledon; O.W., Cape
Town ; A. B.. Lynn ; R. N., Birmingham ; Stanton; W., Ashton-
under* Lyne ; X. Y. Z. ; Dual.

Kilmarnock Standard, Sussex Daily News, Newcastle Evening Chronicle.
City Press, Tenby Observer, South Wales Echo. Kidderminster Times,
Croydon Times, Liverpool Daily Post, Newcastle Daily Journal, $e., have
been received.

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THE IANCET, January 15,. 1887.

Clinical Mature

02f

SOME FOBMS OF DEFECTIVE SPEECH.

Delivered at St. Geonjc's Jlotpital,

By WARRINGTON HAWARD, F.R.C.S., Ac.,

SLUGKOX TO TUB UoSI'JTAL.

Gkxtj.rmkjt,—Y ou have lately seen two children operated
upon by me for cleft palate, when I devoted a clinical
lecture to explaining to you the character of that defect
and the method which I proposed to adopt for its cure. I
had not time then to do more than very briefly allude to the
management and instruction of these children which are
necessary when the operative treatment is complete. To¬
day, therefore, I wish to call your attention to the measures
which should be used for improving the speech after the
cure of a cleft palate, and also to say something about the
treatment of some other defects of speech in children.

Now you will frequently have occasion to observe, where
an erroneous habit is acquired in consequence of some defect,
deformity, or disease, that even when the cause of such
habit is removed, some pains are needful to overcome the
persistence of the habit itself. For instance, a child who
has been accustomed to wet the bed at night, in consequence
of the irritation of an adherent prepuoe, may be cured at
once by circumcision if the condition is but of recent
occurrence; but if the incontinence of urine is of long
duration, the immediate effect of the operation is not always
-a complete cure; - the habit of emptying the bladder early in
the night may still to some extent show, itself, and not until
a few weeks have passed, and some trouble has been taken, is
-the habit overcome. So, again, the awkward gait in some
forms of paralytic talipes, due to the distorted position of
the foot, is not instantly remedied by bringing the foot into
the normal, position. Some education is needed of the
muscles, which have long been acting under disadvantageous
mechanical conditions.

So, then, you will observe that a child with cleft palate uses
its tongue and palatal muscles in a manner quite different
from one with the natural condition of palate,'and that
even after a complete closure of the cleft there is still some
awkwardness of speech. This varies greatly in different
Individuals, partly because of differences in the shape of
the part, and partly because of variations in the intelligence
of the learner; but all of them will be greatly assisted by
proper instruction. This instructibn most be directed
towards unlearning the manner of using the tongue and
palate which has been resorted to by the child in oontequenee
of its cleft palate, and acquiring the right method of using
these parts. It nAtathe carried on by means of systematic
lessons and practice regularly gone through day by day for
months or even years; And is usually,’ therefore, among
intelligent persons, best managed by one or other of the
parents. But the parent must be taught how to proceed; and
it is often of great advantage, especially in bad cases, to obtain
at the commencement the help of one of the teachera specially
trained for teaching deaf-mutes to speak.

The plan I recommend for this, and for other defects of
speech to which 1 shall presently allude, is as followsThe
instructor should Bit directly facing the pupil; the pupil is
made to fix his attention thoroughly upon the face of the
teacher, and to copy slowly his method of articulation. This
should be displayed by the teacher in an exaggerated degree,
every movement of the lips and tongue being made as obvious
as possible to the pupil, and the more difficult sounds or
movements prolonged for the purpose. Thus, for instance,
suppose the word “sister” were to be practised, the
teacher, having filled his chest by a long inspiration, would
open his lips and draw back tne angles of the mouth, so
that the pupil could see well the position of the tongue
ainat the teeth; he could then prolong the hissing sound
the “s,” and finally, separating the teeth as the sound of
the “t” in the second syllable issues, allows the pupil again
to see the position of the tongue as the word is ended. :
Or, for another example, taka the word “ Hly.” Here the
teacher would separate, the lips, and teeth, .so that the

No. saw. ■ ■ - - r ■ -

tongue would be seen curved upwards, with its tip touching
the hard palate; the word would then be pronounced with a
prolongation of each syllable, the teeth and lips being kept
open so that the uncurling of the tongue and its downward
movement are clearly seen. So again, in teaching the proper
method of sounding such words as “nmg” or “youth,”
much aid is given by keeping the lips somewhat separated,
so that the relation of the tongue and palate can be made
manifest. The pupil must be made to fill his chest, and then
to imitate as closely as possible every movement and sound
of the teacher, and this may sometimes be assisted by
making the pupil feel with tlie finger, as well as observe
with the eye, the relative movement and position of the
teacher’s tongue and palate. There should be no other
person in the room to distract the attention of the pupil.
It is best to continue the exercise for a short time only, and
to repeat it frequently, rather than to fatigue the child by
a long lesson; and it is a good plan to take an ordinary
elementary spelling-book, ami to mark the words which the
pupil finis most difficult to pronounce, so that these may be
specially practised. 1 wish especially to insist upon the
importance of making the pupil fix his entire attention
upon the face of the teacher in all attempts to remedy
defective speech, for this does not seem sufficiently under¬
stood. Yet. if you will take an ordinary child of three years
old, and tell it to repeat a difficult word after you while you
stand behind it, and then make the child say the same word
while it looks at your face, you will see at once the great
advantage of the latter method. And this applies to adults
as well as children.

Instances are occasionally met with of children with very
highly arched palates who speak very much like those with
cleft palates. The speech of these children may be very
greatly improved by such-teaching as 1 have described ; but
if they are allowed togrow up without any such aid, it becomes
very difficult to make them speak plainly. In one such
case—a girl seventeen years of age—it was almost impossible
for one not accustomed to the speech of those with cleft
palate to understand what she said; so that at shops, railway
stations, and with strangers generally, she was obliged to
write down what she. wished to say. She was very anxious
to know if anything could bq done for her by surgery; and
so,.after explaining to her that the operation was an experi¬
mental one, I decided to try the effect of lowering the arch
of the palate by bringing down the soft parts from the hard
palate (as in the operation for closing a deft), cutting away
a piece from the middle line, and then sewing the edges
together again. The incision healed well, and the result of
the operation was that her palate was reduced to the ordinary
level. When the tenderness resulting from the operation
had subsided, she Was found to speak somewhat more dis¬
tinctly, The alteration, however, was not great at first; but
after a few weeks of practioe the girl’s speech very much
improved; and when I saw her some months afterwards she
gratefully told me that everyone could now understand her
quite well, and that her friends, as well as herself, were
much pleased with the improvement. Her speech was still,
however, far from perfect. <,

I have also seen a few cases in which, besides the palate
being highly arched and narrow, the inter-maxillary bone
has been thrust forward, as though squeezed out of place
by the approximation of the two halves of the upper jaw¬
bone. This condition is accompanied by indistinct speech
of the kind above described. In these cases great improve¬
ment may be effected bygraduallypushing back the projecting
process of bone by means of an apparatus adapted by the
dentist and constantly worn by the child, care being taken
at the same time to educate the child in the proper method
of speech.

Then there is another class of children who exhibit defects
pf speech dependent upon corebral causes. It is a not
uncommon occurrence to have children brought to one be¬
cause the mother has noticed with anxiety their extreme
backwardness in beginning to speak. The mother thinks or
hopes that there is something wrong about the mouth or
palate to account for this. But ope finds pn examination
that the parts concerned in speech are quite natural, 1 and
that the backwardness in speaking is only the more obvious
part of the general intellectual deficiency, of, which other
signs are discoverable on investigation. Very often the

1 The teeth of such children are usually late In their eruption, and
defective, and the jaw often narrow and ill-develaped; but this is only a
coaoc mi ta a t , n o t -a cause, of defective speech.

..

112 The Lancet,]

DR. OCTAVIUS STURGES ON SCHOOL-MADE CHOREA.

[Jan. 16,1887.

expression of the child’s face is in itself sufficient to indi¬
cate to the practised eye the imbecility which is the real
cause of the deficient powers of speech. Even for these
children something may be done as they grow older by
careful teaching; but of course the education of their
speaking powers is in such cases only part of the systematic
efforts required for the development and strengthening of
their intellectual faculties as a whole.

There is yet another class of children who are backward
and awkward in their speech, but whose cerebral develop¬
ment is in all other respects complete. These children are
bright and intelligent; but it seems as if the power of that
part of the brain concerned with speech was ill-developed
or latent. Some speak with an exaggerated lisp; others
very much like those with cleft palate, having special diffi¬
culties with the letters s and l; while others, again, simply
speak like younger children, a child of four talking in the
babyish manner of one of two years. All the children of
this class feel their difficulty, and avoid speaking as much
as possible, making signs and noises rather than facing the
trouble of articulate speech. These children all speak
eventually quite well, though some slight peculiarity of
speech may remain through life. They all improve greatly,
and are much helped, by the method of education by imita¬
tion which I have described.

Let me just remind you, in passing, of the necessity in all
cases of backwardness of speech to ascertain the condition
of the hearing. And remember that a child who has even
begun to speak may become dumb in consequence of losing
its hearing.

Another kind of defective speech is met with in persons
with nasal polypi, and in those with adenoid growths in the
naso-pharynx. This is recognised by the characteristic
want of resonance and the dull “ stuffiness ” of the voice,
this being especially noticed in words involving the sound¬
ing of the letters m, n, or the terminal ng ; thus “ morning”
would be sounded “ bordig.” In these cases the removal of
the growths is the obvious treatment. Somewhat similar
to this is the thick articulation of persons with enlarged
tonsils.

I now pass on to another sort of difficulty of speech—
stammering. You all know what I mean by stammering
speech. That peculiar spasmodic affection in which the
utterance is suddenly checked by th9 want of coordination
of, and control over, the varied movements concerned; so
that either the speaker suddenly becomes voiceless, or bis
efforts result in the rapid repetition of one sound from
which he cannot pass on, or in the production of an inarticu¬
late sound of considerable duration, after which come fresh
and still ineffectual efforts, or the attempted word is at last
pronounced. After this the speech may run smoothly for a
time until another spasm occurs. I need hardly tell you
that Btammering is extremely variable in kind, degree, and
frequency of occurrence. But that which is common to
all cases is a want of coordination in the muscles concerned.
Let me read to you Sir James Paget’s description of stam¬
mering in his suggestive lecture “ On Stammering with
other Organs than those of Speech.” It gives in bis usual
admirable manner the gist of the matter in a few lines
“ Stammering, in whatever organs, appears due to a w ant of
concord between certain muscles that must contract for the
expulsion of something, and others that must at the same
time relax to permit the thing to be expelled. Ordinary
stammerers cannot at the same time regulate the contraction
of the muscles of expiration for the proper expulsion of air,
and the relaxation of those of the glottis or (In different
cases) of the tongue or lips for permitting the expulsion of
the air while it is being made vocal and articulate. Nume¬
rous as are the varieties and modes of speech-stammering,
this discord of muscles is in them all.” 3 This gives you the
keynote of the difficulty. In some cases it is the muscles of
the glottis which are at fanlt; in others those of respiration;
white in another class, and this is by far the most common,
it is the muscles of articulation which are insubordinate.
Or all these different sets of muscles may be to some extent
concerned; and in some’ very bad cases the spasm may
spread to muscles not Concerned in speech at all, so that in
the efforts at articulation the person is thrown into all
sorts of distressing contortions.

Now in the treatment of stammering, it will be necessary
to observe in what manner, and under what conditions, it
occurs.. Soma people stammer chiefly or only when they are

nervous or in a hurry, or under some excitement, or are
fatigued. Others halt only at the sound of certain tetters ;
occasionally, but I do not think often, a sore tongue or
mouth will give rise to stammering. I have seen a case also
in which its occurrence was quite certainly connected with
dyspepsia. Children and young persons are the chief
sufferers; and you will find in a large proportion of cases
that they come of nervous families, and have been over¬
worked or have in some way been subjected to nervous
stress. Thus, intelligent boys anxious to satisfy an exacting
schoolmaster, or stupid ones nervous at not being able when
called upon to formulate their ideas, or even the impatient,
in too much of a hurry to express their rapid thoughts, all
furnish us with examples of stammering, which often
commences on their first going to school. I have said “ boys,’
because, for some reason which I cannot explain, stammer¬
ing is much more common in boys than m girls. I ought to’
mention that in a considerable number of oases it seems to be
connected with the habit of masturbation.

In the treatment of stammering, therefore, the first
necessity is to discover, and if possible remedy, any obvious
cause—especially any cause of nervous debility. And
remember that many young people are ill - nourished
and dyspeptic from being hurried over their meals; that
the same hurried mode of life often leads to irregularity
and constipation of the bowels; and that these are also
just the people who are apt to be over-studious, too
much in-doors, and to lack appetite; often, also, they
have bad teeth. So it oomes that you will notice many
stammerers to be thin, pate, and excitable. For these
you will do well to diminish their studies, to enforce out¬
door recreation and gymnastics, especially such as expand
the chest; to attend to their bowels, and to see that they
have plenty of nutritious food. And, as in most nervous
people, ood-liver oil often does them good. You must also
look to the state of the teeth, the tongue, and the digestion,
and remedy any defects in these. Bo, again, any bad habits
must be overcome, and the existence of phimosis ascertained
and attended to. Iron and other tonics may be useful, and
I have certainly seen benefit in cases with other indications
of chorea, from the administration of large doses of sulphate
of zinc and belladonna.. But whatever else you do, you
must subject the stammerers to the sort of education which
I have described in connexion with some of the other speech
defects. That is to say, you must teach them to speak
deliberately and with careful enunciation, practising by
imitation the difficult words or sounds, and following all
the muscular movements of the teacher. Above all, you
must teach them to avoid speaking with an empty chest
(which, as Charles Kingsley pointed out, is so commonly the
habit of stammerers), and to fill their lungs well at every stop.
All such treatment will be chiefly useful to those beginning
to stammer, and to those whose stammering is variable in
degree and frequency of occurrence. But there are some
habitual and confirmed stammerers for whom I must confess
I know of no cure.

SCHOOL-MADE CHOREA.

A RETROSPECT OF THE PAST TEAR.

By OCTAVIUS STURGES, M.D., F.R.C.P.,

PHYSICIAN TO THE HOSPITAL rOB SICK CHILDREN, GREAT ORMOND-STREET.

For the last two years, and at this season, l have been
permitted to make use of the columns of The Lancet for
the purpose of signalising certain sources of chorea very
common amongst the children of our London poor, which
by the exercise of a little care and circumspection, less on
the part of the poor themselves than of the class set over
them, might be altogether done away. There is little
new to be said, yet the circumstances may justify some
repetition. Gutta cdvat saxurn , non vi sed saepe cadendo.
The closing year is not without promise that the public
mind is becoming impressed by subjects akin to this. The
use and abuse of home lessons, penny dinners, and corporal
punishment have been much discussed of late in the interest
of school children, and in a calmer and more judicial spirit
than that which reigned some while ago wnen the word
“ over-pressure” was in everybody’s mouth and made two
camps.

I know full well that in the long run exaggeration of

* Clin. Lect. and Btsayi, p. 77,

Tub Lanckt,]

DR. OCTAVIUS STURGKS ON SCHOOL-MADE CHOREA.

[Jan. 15,1887. 115

statement does bat defeat its object. Let it be admitted at
the outset that 8t. Vitus’s dance is neither a dangerous nor
a painful affection with school ohildren, and that such nice
adjustment as shall prevent over-strain on the one hand and
over-indulgence on the other is practically unattainable;
still, it must be insisted that chorea, so long as it remains
undiscovered, is a source of injury to the child in many
ways, while the obtuseness of observation which so often
delays this disoovery is nothing short of marvellous. I wish
to show in few words—first, that a large and fairly constant
proportion of chorea is due directly to what may be called
injudicious schooling; secondly, that the chorea which owns
this exciting cause may be easily classified both as to its
precise modes of origin and as to the temperament of its
•objects; and, thirdly, that the rules for preventing chorea
in school children are simple and obvious.

Daring the past year twenty-three cases of chorea
(sixteen girls and seven boys) have passed through my ward
at Great Ormond-street, not reckoning read missions, the
number being very nearly the same as for the preceding
two years. Nine at least have a school' cause. For exam¬
ple, a boy of eleven, who some weeks before had been mnoh
shaken by a fall, was noticed just before his attack to
" bother aWtmt his lessons,” and “ got much caned at school.”
Another boy of eight, lean and delicate, was w caned at school
for some trifling offence. He was much frightened at the
time and had restless nights, talking in his sleep about school
work.” He then developed chorea. A third boy was of the
age of twelve. (I take boys by preference, owing to their far
leas liability to the disorder.) There had been family
reverses, and he had fallen with the rest into poverty.
"Complaints came from school that bis handwriting had
deteriorated, and that he was inattentive.” It presently
appeared that these offences had their origin in chorea. A
gin of eleven got her first attack (soon followed by a second)
* after a blow on the band.” A child of five, described by
her mother “as always excitable,” got chorea on being
removed to a higher form and having more difficult lessons.
A girl of eleven, not very quick, “became irritable in
temper during preparation for school examination,” and
then choreic.

It must be understood that these several statements, and
others like them, are put down as “ causes ’’ of the chorea
that followed only in the absence of any other explanation.
No example is included of selection from among several
possible causes. And for further proof that such descrip¬
tions tend to repeat themselves, and that they fall readily
into groups, let me quote from another hospital and a
different reporter. 1 In the year 1885, nineteen cases of
chorea were admitted into the Westminster Hospital (part
only into my own ward*). Five at least have a school cause
described by the medical registrar in the following terms.
A boy of ten was “ frightened by being struck at school.”
A girl of twelve was “kept in after hours every day for a
week for bad writing.” A girl of thirteen, admitted for a
second attack, contracted “ toe first from hard work at school.”
A boy of nine (a very severe and prolonged attack) was
“excited about school examination just before.” Another
boy of the same age (also a severe attack), described as
“always very nervous,” had been much distressed and
puzxled with his home lessons, and “ would lie awake
thinking of sums.” The attack of chorea which shortly
ensued followed a caning. The two series taken together
(Le^ Westminster and Great Ormond-street) give an annual
yield of forty-two cases, fourteen of them being of school
origin.

The example just quoted reminds me of a child in hos¬
pital at the present moment who, like the girl described last
year, who “could not get the sums right,” affords an excellent
specimen of the manner in which the factors are combined
that produce chorea. The patient comes from a neighbour-
Church school; she is eleven years old, thin and pale,
sod with a London aspect. There are six others at home as
wall as the mother, who is a widow and does charing. This
child used to help to support the family by going out after
school hours to nurse a neighbour’s baby. She was so em¬
ployed sometimes until past eleven at night. Lessons had
then to be prepared for the morrow’s school, so that it was
midnight by the time she got to bed. in the morning she
had to wash, dress, and despatch to school two younger
children, and thus sometimes reached her own school late, to

* He port on Chore*, by Dr. Byers. audio jl registrar, i». 348, vo\ U.,
Venm lM: B’.o *•.

incur the displeasure of her mistress and occasional punish¬
ment. So beset, and being probably ill-fed and by nature
weak and delicate, this child contracts chorea in a form
which, without being severe, is very intractable.

And even while 1 write there oomee into my ward &
small boy, aged fourteen, with very severe chorea, which
he has been caned into. He was represented by hie
parents as “ very nervous and unable to sleep without
a light.” He also suffered much from headache, but had
never had rheumatism, nor had his family. At a London
School Board school he was charged with speaking te
another boy, and for this alleged offence was cut four
times across the right hand, one of the strokes catching his
thumb and giving acute pain. He came home in a state of
high excitement, protesting that the caning was undeserved.
The next day chorea seized his right hand and arm, and
soon invaded the whole body. The movements are now
violent and distressing. He is just able to jerk out a word
or two, has wasted muoh, and is fed with great difficulty.

Speaking from the evidence, not only of the cases 1 am
now quoting, but of very many others precisely similar, it
ispertectlycertain that for a large proportion of chorea, a pro¬
portion that would be under-estimated at one-fourth, school
is responsible; and the modeof injury may be clarified pretty
much as follows(1) Over-schooling, where the hours are
too long or the lessons (especially sums) too hard; (2) ex¬
citement in schooling, especially at examination ; (3) home
lessons where there is no home to speak of or no home
leisure; (4) “ caning” and other modes of punishment, parti¬
cularly when unmerited. Such causes will be rendered more
or less efficient in individual cases from the feebleness of
resistance that comes of insufficient food, natural sensi¬
tiveness, previous attacks of the same disorder, tender age
or sex. So it goes on from year to year without variety or
shadow of change, and but for one reason it would be worse
than useless to dwell upon the subject at Christmas time.
That reason is, as I have said, that, unlike most of the suffer¬
ing with which poor London children are over-burdened, it
is remediable. There are other sources of chorea besides
these: family rows, drunken violence, home cruelty, semi-
starvation, the perils of the streets; and we can but total
them up at the close of each year and remark upon tbo
wonderful sameness of statistics. But in this school-made
chorea it is the friends and would-be helpers of the children,
teachers who ore responsible for their moral and physical
welfare, and anxious to promote both, who are, in fac f „
active agents in their suffering, and all for want of a little
thought.

The evil comes, 1 am persuaded, from the fact that.
teachers do not differentiate their material in respect of
temperament, ability, bodily health, and home circumstances.
Their rule of conduct is too rigid and uniform. They might
with advantage, and in a literal sense, take a leaf out of the
doctor’s book, setting down the family and personal history
of their pupils just as we do with our patients. Were that
done, children would not be put to home lessons which their
circumstances make impossible; those that err from disease
would not be confounded with those that err from wicked¬
ness; and the timid and sensitive would not be struck.
Masters tell us that no school can be kept in order without
some caning. That may be or not; but it is not the caning
that is complained of (although I believe the practice is
more common in school and more often injurious than is
supposed), it is that they cane the wrong boys, and are not
sufficiently alive to the vast difference of temperament,
even with near relatives, which makes the very same punish¬
ment tolerable, and even salutary, in one case, ana detri¬
mental in another. I think it is Marryat who describes two
brothers so differently affected by the same incident—parting
from home,—that while the one has his handkerchief satu¬
rated with tears and is of no further use, the other turns
to him with, “ Take mine, it’s as dry as a bone.” Such con¬
trasts are common enough, but there is ample proof that
school teachers too often ignore them. What is most to be
desired is that those who can speak with authority upon
educational questions should concern themselves with this
matter of injurious schooling and its nervous consequences.
There is at this season, as l have good reason to know, a
vast sympathy for poor sick children; it finds expressim
in many ways, and would be ready to respond to any sug¬
gestion for making their lives less miserable. The children
I am speaking of should enlist that sympathy to the utmost
in their easy forgiveness of the injury that has upset them :
cheerfulness under troubles that are apt to make their elder*

1H Tfiffi Lancet,] ME. JORDAN LLOYD ON EXTIRPATION OF THE LARYNX. [Jxn.15, 1887,

irritable, and persevering, bub abortive, efforts to utter
■words, to handle toys, or to smile their thanks. And if, not
a doctor, but some prominent educationist would take up
their cause and teach the teachers, the sum total of St. Vitus’s
dance would soon be sensibly lessened, and no more Christ¬
mas jeremiads would be needed on school-made chorea.

Wimpole-etreet, W.

CASE OP

EXTIRPATION OF THE LARYNX WITHOUT
PRELIMINARY TRACHEOTOMY.

By JORDAN LLOYD, F.R.C.S., M.B.,

SURGKOX TO THE QtJKKX’S HOSPITAL, BIRMINGHAM.

James B-, aged fifty-one, brass-worker, was admitted

into the Queen’s Hospital, Birmingham, under my care, on
Nov. 13th, 1884, having been sent to me by Mr. R. A. Fitch,
of Camp Hill Dispensary.

History .—Difficulty of breathing began twelve months
ago; stndo^ also noticed about the same period. No cause
assigned for commencement of illness. Cough and expecto¬
ration during great part of the time. For three or four
months he has had attacks of difficulty of breathing, some¬
times very alarming to himself and his friends, lias lost
flesh rapidly during the last two months, lias been under
treatment at several hospitals. He has worked amongst
brass for forty years, and has become so weak and emaciated
that he can work no longer. His habits have always been
regular and temperate. Had typhoid fever four years ago ;
no syphilis. No consumption or cancer in his family. Father
and mother both died in their seventy-first year.

Present state .—Inspiratory laryngeal stridor and cough ;
expectoration varying in quantity, never profuse, and occa¬
sionally 6treaked with blood; harsh voice; inability to lie
down; paroxysmal attacks of urgent dyspnoea. External
examination shows nothing; no enlarged glands. The
laryngoscope reveals a cauliflower-like growth of the size of
half a walnut springing from the left side of the larynx and
below the false cords. No adjacent cedema. Immediately
after admission the house-surgeon was summoned hurriedly
to him on account of laryngeal spasm to an alarming extent.
The difficulty yielded to ether administration. The chest
was examined by a medical colleague, and, with the excep¬
tion of a few bronchial rales, was pronounced to be quite
healthy. The man’s condition was so distressing that he
was eager to have anything done which would relieve him,
and on Nov. 22nd I performed the following operation.

Operation .—Chloroform was given on a towel as he sat
upright in bed; he was then carried to the operating
theatre, and laid on the table. A three-inch median incision
was made, with its centre opposite the middle of the thyroid
cartilage, and extending at once down to the walls of the
larynx. The exposed thyroid isthmus was tied with two
ligatures, and divided between. All structures were now
freed from both sides of the larynx with scissors, without
opening its cavity. There was no trouble with the bleeding
or with the breathing. A loop of stout wire was passed
through the top of the thyroid cartilage to enable the
operator to have full control over the larynx. The patient
was then drawn up the table so as to allow his head to hang
pendent over the end. The trachea was next divided just
below the cricoid cartilage with Paquelin’s cautery, and
no bleeding took place. Into the cut trachea the end
of a large curved glass tube, very much like an old-
fashioned vaginal syringe, about five-eighths of an inch
in diameter and eight inches long, was introduced for
about two inches, completely filling the air-tube. This
arrangement prevented blood from entering the trachea,
and enabled the antesthetiser to administer chloroform
without interfering with subsequent manipulations. The
thyroid cartilage was next split in the middle line, and the
lateral halves rapidly removed with scissors. The cricoid
was cut out, also with scissors, in a single piece. Bleeding
was not severe. The blood flowed into the dependent
part of the wound (pharynx and nares), scarcely a spot
being drawn past the glass tube up into the air-passages.
The sqperior laryngeal were the only vessels requiring
ligature. The trachea was sutured to the skin at the lower
angle of the wound, and a large-sized tracheotomy tube
substituted for that of glass. The operation lasted about

forty minutes. The patient was put in a covered bed, and
ordered to be fed on nutrient enemata every three hours.
When seen at night he had completely recovered from a
Blight amount of shock, and was breathing quietly, and
wrote on a slate that he was quite comfortable. _

Nov. 23rd.—Slept several hours during the night. Retains
enemata. Was fed with an elastic tube into the stomach
this morning.

24th.—Cougb, restlessness, coarse rales and ,rhonchi ove*
both lungs. Broncho-pneumonia set in, and, gradually
increasing, he died on the 2Sth, six days after the operation.

Examination of the larynx showed a large intra-laryngeal
outgrowth on the left side, probably of tubercular origin,
and the necropsy revealed a condition of purulent bron¬
chitis extending into the smallest bronchioles, infundibula,
and pulmonary acini. Both lungs were everywhere studded
with small miliary tuberclea There was no cellulitis about
the wound.

Remarks .—I am led to publish the above as an additional
case to those referred to at the meeting of the Clinical
Society, held on Nov. 12th. I think it is interesting from
the fact that no preliminary tracheotomy was performed,
the course of proceedings above practised rendering it
■unnecessary.. The larynx was freed from alj lateral attach T
ments before the air-tube was opened. The trachea was cut
across with the cautery and plugged with a large bent glass
tube. The patient’s head hung over the end of the table,
and allowed all blood &c. to escape from the lungs rather
than into them. . The removal with scissors expedited
the operation and reduced the blood loss to a minimum.
The broncho-pneumonia would have followed any other
method of procedure. The case was originally thought to
be one of laryngeal epithelioma; it presented all the signs
of this condition, and the report on the state of the lungs
supported thi* diagnosis. The operation of extirpation of
the larynx I regard as a serious surgical experiment, and
whether it will ultimately establish itself as a surgical
desideratum in any case, time and further experience
alone will enable us to decide. ,

Bir ming ham.

CASE OF '

GASTROSTOMY WITH TRACHEOTOMY FOlt
CANCER OF THE OESOPHAGUS AND
LARYNX.

By JOHN PENNEFATHER RYAN, L R.C.8.I., &c.

As a means of prolonging life in impassable stricture of
the oesophagus the operation of gastrostomy had up to 1872
been performed (according to “ Gross’s Surgery,” published
in that year, only ten times—twice each by Sddiilot, Forster,
and Sydney Jones, and once by Feiiger, Curling, Durham,
and Maury. In none of these cases was the result endourag*-
ing, as all the patients died within a'short time after opera¬
tion, either from exhaustion or peritonitis. Since 1872 I ain
aware that there have been several cases in which life hite
been prolonged for some months occurring in the practice of
Mr. Bryant and other surgeons, but of these I possess nb
record to which I can readily refer. In Gant’s work oil
Surgery (1878), the most recent I possess, the author states,
in writing of the operation (vol. ii., p. 368), that “it,has
hitherto always proved 'rapidly fatal.” Possessing this
meagre and not very encouraging information, it was with
great reluctance that 1 recently Undertook the operation, and
then only at the urgent request of the patient (an eldeWy
lady) and her near relatives.

Mrs. L -, aged sixty-one, a lady in good circumstances,

first consulted me at the beginning of 1886 for a difficulty
in swallowing, which' Was gradually increasing, and attri¬
buted by her to " spasm of the gullet.” If was now
impossible to swallow solid food, and liquids slowly 1 and
with considerable difficulty. Having made a careful exami*-
nation and failed in passing even a small-sized catheter, I
diagnosed a tumour of, or pressing on, the oesophagi*,
probably malignant, but possibly fibrous. Some weeks
afterwards 1 again saw the case ih consultation with say
friend, Dr. Power of Brisbane, who concurred with the v*iow
I had taken, and we then discussed the propriety of an opera-*-

was of a malignant nature. NO hope of ultimate reco'iei^

> British M#dto >1 foams', Oct. «b, 1884.

• IWd.

lt6 The Lancet,] MR. G. R. TURNER: APHASIA FOLLOWING FRACTURE OF HEAD. [Jait. 15,1887.

■other tissues in front. The stomach was firmly adherent to the
■abdominal -wall, in which was seen the small fistulous
opening through which life had been solely sustained for
more than seven months.

At the Clinical Society of London, on Nov. 27th last,
Mr. Barwell read notes of a very similar case, in which a
gastrostomy performed on April 25th was followed by a
tracheotomy on July 21st, the patient surviving the former
operation nearly five months, and the latter nearly two.
The necropsy demonstrated the existence of a cancerous
mass which “ extended back to the spine, and all but filled
the oesophagus from a little below the cricoid cartilage to a
level with the tracheal bifurcation ; it had also grown into
the trachea opposite the fourth cervical vertebra.” Dr. T. F.
Chavasseof Birmingham, in an excellent clinical lecture on
Gastrostomy for (Esophageal Cancer, 3 reports a case where
the patient survived the operation nearly six months. In
this case the obstruction was six inches from the upper
dental arch, but not impassable, as on Dec. 7th, more than
four months after the operation, we read “ the patient’s
swallowing has much improved, and now nourishment passes
freely into the stomach after ‘sticking a bit.’” There is no
account of the necropsy. Comparing these cases with
Mr. Dent’s (the notes of which were read on the same
occasion as Mr. Barwell’s), it seems to me that the higher the
seat of disease the better is the chance of prolonging life by
operation, and this consideration should greatly influence
the surgeon when deciding whether to operate or leave
nature to take its course. The operation is neither a very
difficult one nor nearly so trying to the pluck and resources
of the surgeon as an average ovariotomy. The incision should
be kept well away from the costal cartilages, or trouble will
be caused by retraction of the upper flap. The stomach
should be seized above the lower border of the great curve
and drawn into the wound in such a way that the point of
seizure may be that at which the final opening is made. It
is of importance that a considerable area (say about the size
of a five-shilling piece or larger, though of course not
the same shape) of stomach should be within the
ring of sutures in order to allow for subsequent contraction,
which is considerable and rapid (in my case at the end of
three weeks the portion exposed was not the size of a six¬
pence), and to permit of firm stitching. The opening
should be a narrow slit made as described. Only small
quantities of food (milk) should be given by the stomach and
at considerable intervals (say six or eight hours) for several
days, during which time the nutrient enemata must be
continued. Any regurgitation must be instantly mopped
up with absorbent wool laid round the'opening where the
catheter is introduced. Until union is firm and complete
the milk should not be forced into the stomach, but allowed
to gravitate in a manner like that which I adopted.

Gympie, Queensland.

above the summit of the occiput. The greatest depression
was perhaps Icbs than half an inch. The patient lay in bed
on his side, curled up, with the legs flexed on the thighs
and the thighs flexed on the abdomen. The pupils were
equal, and responded to light; the bowels oonstipated ; the
pulse slow. The scalp-wound rapidly healed, and he became
more intelligent. It was then found that he was deaf on
the affected side, and that there was some slight loss of

grasping power on the right side; otherwise there was no
evident paralysis.

The correct history of the case could not be obtained at
the time of the patient’s admission. Except that the injury
was three weeks old, and that he had been in a hospital at
Flushing, nothing could be ascertained. The Flushing
authorities* on being written to, reported that he was-
admitted in a state of unconsciousness, but recovered his
senses and power of speech in a few days, though only for a

A CASE OP

APHASIA FOLLOWING A DEPRESSED
FRACTURE OF THE LEFT SIDE
OF THE HEAD.

By GEORGE R. TURNER, F.R.C.S.,

VLJIT1XO Sl'BOKOX TO THE SKAMB5 S HOSPITAL, QRKlUfWIt'H.

Alexander F-, aged twenty, was admitted into the

Seamen’s Hospital, Greenwich, on June 7th, 1883. He was
in a drowsy, sleepy condition, requiring to be roused and
shouted at before he would answer, and then did not
apparently understand wliat was said to him. To every
question asked be answered, “ No,” and this was the only;
word he could articulate. There was a granulating scalp
wound in the left parietal region, which was nearly healed-
Around this, to the extent shown in Figs. 1 and 2, was a
depression of the subjacent bone. At the fore and upper
part of the margin of this there was some little elevation*
which made the neighbouring depression appear deeper
than it really was. The whole depression was bowl-like;
it had a curved lower border, extending from some two
inches behind the external angular process upwards and
backwards nearly to the sagittal suture, an inch or more

Tins Lancet,]

ME. G. B. TURNER: APHASIA FOLLOWING FRACTURE OF HEAD [Jan. 16 1887. m

tattigence appeared to be perfect or nearly so, though he
owkl still My bat few words. He collected some money
and bought himself some boots, explaining to me by signs
what ha wanted to do. On my telling him that I wanted
him photographed be at first objected, and when 1 asked
him u he understood me he replied by putting himself into
ma attitude as if he were being taken, and imitated the
camera. About this time, on being told to write, he made
“ pothooks” and “ hangers.” After this came a time when he
wrote “ yes ” and “ no ” (the first words he could say), some¬
times misplacing letters or running the words into each
other. He oould play draughts and dominoes, and corrected
the mistakes of other players. His use of words gradually
increased. He required teaching like a child to pronounce
them distinctly, and sometimes misplaced them—saying, for
example, “ scissors” instead of “sister.” He could soon write
words that he could not speak or apparently remember ¬
er-, his name and birthplace. He was very emphatic in his
utterance and annoyed at his mistakes. There was a want of
grammar in the construction of his sentences, and he used
only the important words. At first he was unable to count
more than “ one” and “ two.” On being taught, he acquired
this with facility, but could not say “ seven,” “ eleven,” or
“fifteen.” He got over his difficulty by saying "six one,”
“tan one,” “ten five.” Occasionally m counting he put the
numerals in the wrong order, but was aware of and annoyed
at bis mistake. When he saw figures written, he knew
what they meant; for instance, on one occasion he told the
water that I was in “ten five” watd. He could read, and
u nder s tand what he could not Bay. One day, whilst out of
the hospital, he was given eome port wine, which “ got to
hie head.” On being asked what he had had, he went to a
notice, “that no wine, beer, spirit, or porter, &c., was
allowed to the patients without permission,” and covered
up the last syllable of porter. He was easily taught
to my the word, and could repeat it after one. It was
about this time (Oct. 26tb, 1883) that I showed him as
s firing specimen at the Clinical Society. Mr. Adams
Frost was Kind enough to examine his eyes, and reported
m follows: “As far as I can ascertain, your patient’s
Tinion is }| in each eye. The visual field is good in each,
and the ophthalmoscopic appearances are normal.” Sir
Tifiism Dal by kindly examined him as to his deafness on
the left side, and reported that its cause was central,
“ web as you meet with in concussion.” He had an attack
«f scarlet fever, and was in the Fever Hospital, Stockwell,
from Nov. 9th, 1883, to Jan. 16th, 1881. His aphasia slightly
improved during this time. On hia return he used to make
himself useful about the hospital. He was often sent by
the patients outside the hospital to buy tobacco, and
was perfectly well aware of the value of money; as proof
«f this, it may be mentioned that he found a post-office
enter in one of the oorridors and brought it to the house-

^Snrcb, 188A— Shown a shilling, he calls it a “ bob”; writes
the word “shilling,” but is incapable of pronouncing it.
When words are repeated to him with a view of teaching
him, there seems tooe actual inability to regulate the requi¬
site movements of the vocal muscles for articulation. (This
was occasionally the case in November, 1886.) Learns new
-wordsimperfectly, and on returning to them after an interval
the same process has to be repeated. (In Nov. 1886 there was
groat improvement in this particular.) When told to copy two
v er ses of a song in which snch words as “ fascinating,” “ mis¬
fortune,” “consequently,” and “ panorama’ occurred, he did so
with the exception of two mistakes, which he was afterwards
able to correct. He cannot repeat the alphabet beyond/.
When letters of the alphabet were placed in order, he could
repeat and give their names, with the exception of A, l,
to, and z, and it was found that he was incapable of pro¬
nouncing any word in which any of these letters formed
a prominent element. (His condition was the same in
N ov e m ber, 1886, but he oould pronounce words containing
there letters better.) When letters were placed before him'
indiscriminately be oould only pick them out in order up to
y,bet knew the names of several others. (Nov. 1886: He
eia now pick them all out, and name them all, except A,
4and a.) Can count np to “ten,” with the exception
Of “*eve».” (Nov. 1886: Can count up to “ one hundred.”)
do a simple sum in addition, but has some little
y when he has to carry a number. (Nov. 1886:
itbasime.)

1886.—H la memory appears now to be quite
i about ayisf ago he could give no details

as to his early history, the accident, or admission into the
hospital. He says now he ran away to sea on account of
ill treatment from an aunt at home, and gives details of
this. He is able to give a clear account of Ms accident:
that a heavy sea came overboard, washed a companion
away, and took him off his legs; that he was whirled round
by the winch until the handle broke. He has no memory
of Flushing, but remembers coming to Greenwich on board
ship; vomiting after taking tea. See.; being carried from the
river to the Seamen’s Hospital by the captain, mate, and
two other men; his reception at the hospital by a gentleman
whose person he accurately describee, and who.it Happened,
was doing house-surgeon’s duty for the day; he remembers
also being asked his name by Mr. Johnson Smith, and being
unable to answer, although he knew it perfectly. He still
uses a few signs and occasionally comes across words which
he can write down but cannot say—e.fr, “ Village Belle" (the
name of bis ship), “ knife,” “ blotter.” When told to spell the
latter word, he spelt “ biotter,” yet wrote it down “blotter.”
Is able to name common objects about the room. Hia
vocabulary is altogether more extensive. His left band ia
now his best; formerly he was right-handed. Writes from
dictation and copies much better than he did. In copying,
he looks at the words and writes them straight off. He
does not copy each letter. He can hear every note in
the chromatic scale, and can sing every note within
hia compass which ranges from c below the treble stave
to f on the fifth line. He can sing several airs—such,
for instance, as the favourite tunes he has learned from
hearing them sung in the streets. He has a tolerably good
ear for music.

Present condition. —There is still paresis of the muscles
of the right upper extremity, lower part of right side of

Fig. 3.

face, and right side of tongue. The ring finger of the right
hand is also colder than the other fingers. Since he left the
hospital some months ago his speech does not appear to
have improved. Mr. Victor Horsley was kind enough to
examine the patient for me, and satisfied himself that
“ pressure is still exerted on the centres for speech, face, and
arm.” The point of severest pressure (just under the over¬
hanging edge of the upper border of the bowl-like depression)
is in the ascending frontal convolution nearly at the point
of junction of the face and speech centres. The lower
border of the depression follows the Sylvian fissure as nearly
as possible.

This case was no doubt originally one of compound
depressed fracture of the skull. When the patient was
admitted into the Seamen’s Hospital the aphastc condition
was not at once recognised; he seemed to be in a state of
slight cerebral irritation and semi-drowsiness, and this for a
short time masked the aphasia and paresis of the right
upper limb. Any want of intelligence or consciousness of
what was passing around him was more apparent than real,
as proved by his subsequent accurate description of the
details of his admission. He began very soon to regain his
speaking power. The depression of the skull was not very
deep, and extended over so large an area that trephining did
not seem to be urgently indicated as long as he continued
to improve. (See Fig. 3.) The patient, too, has throughout
been adverse to any operation, and it was three weeks after
the accident that I first saw the case. Now that he is no

Digitized by

Googli

118 to Lancet,] MR. W. COATES: TREATMENT OP ACUTE ABDOMINAL DISEASE.

[Jan. 15,1887.

Ibnger taught to speak new words his condition remains
the same, and all improvement seems to have ceased. He
still, however, refuses operation.

; 1 have been able to obtain the following eases of
aphasia resulting from injury. The case of Mr. Jalland
and that of Sargeon Basu most nearly resemble mine:—
H. Campbell Pope, M.D., and Rickman Godlee, M.S.: "A
cate of punctured wound of the left orbit, followed by
bph&sia; recovery.” (The Lancet, June 19ch, 1886.) Pro¬
fessor Fraser: “Aphasia from injury; subsequent hemi¬
plegia ; trephining ; death; necropsy.” (The Lancet,
Peb. 27th, 1886.) Mr. Morgan: “Compound depressed
fracture of skull, with loss of cerebral substance; aphasia.”
^British Medical Journal, vol. i. 1885, p. 1155.) Mr. Verrall:
“ Aphasia after injury.” Read at the Brighton and Sussex
Medico - Chirnrgical Society. ( British Medical Journal,
Sept. 1881.) East: “ Aphasia, with loss of ear for music.”
^Mentioned in The Lancet of Nov. 6th, 1886, p. 878.)
Basu: “Compound depressed fracture of skull; aphasia;
right hemiplegia.” ( Indian Medical Gazette, Calcutta, 1880,
•vol. Xv., p. 99.) Mr. Jalland: “ Compound fracture of skull;
elevation; aphasia.” {British Medical Journal, vol. ii. 1881,
p. 706.) Rex : “ Fracture of skull; hernia cerebri; aphasia;
hemiplegia” (Oregon Medical Society, Portland, 1882,
Vol: ix., p. 40.) Lloyd : “ Compound depressed fracture of
Skull; eight square incheB of bone- removed; wound of
longitudinal sinus; secondary aphasia; embolic pneu¬
monia; complete recovery.” (The Lancet, vol. ii. 1885,
)p. 892.)

Mr. Verrall’s case was one of several attacks of aphasia,
lasting for twenty-four hours and upwards, following
;a blow on the occiput. There was some slight right
hemiplegia. Complete recovery took place in live weeks’
time.

The case of Mr. Morgan.of Sunderland was one of aphasia
following a compound depressed fracture of the left parietal
bone, in which elevation was practised. A wound of the
superior longitudinal sinus occurred, and hernia cerebri
followed. The aphasia came on thirteen days after the
operation, and was permanent. There was also permanent
right hemiplegia.

In Professor Fraser’s case, although the aphasia followed
a blow on the left side of the forehead, it was found on
post-mortem examination to be due to a glioma involving
the temporo-sphenoidal lobe and Broca’s convolution.

In Mr. Jalland’s case there was a compound comminuted
depressed fracture a little above the left ear and temple ;J
dura mater uninjured. Elevation of depressed portion of
bone was practised. Subsequent aphasia was discovered on
the patient recovering consciousness; slight left facial
paralysis; deafness for ten days; unable to repeat from:
memory; broke down at fifth letter of alphabet, fourth
word of Lord’s Prayer, &c.; could not write from dicta¬
tion, See. Recovered completely in all respects in less than
two months. ■ This case more closely resembles the one Ij
have related than any of the others. 1

In Mr. Lloyd's case the patient was conscious, but could
not speak, Broca’s convolutions being compressed by blood-
'clot, which was subsequently removed. There was an
almost complete disappearance the following morhing of
the hemiplegia and aphasia, pointing to absence of grossj
lesion of the brain tissue itself. These symptoms returned,
however, on the fourth day, and subsequently somewhat ,
rapidly disappeared.

Surgeon Basu’s case was that of a Hindoo struck on the j
bead with a “lathi.” Insensible for two days. Right upper
limb completely paralysed. On recovering his senses he
r was found ,to be aphasic, answering “Yaam”to all ques-
t ions. He understood fairly, and expressed his desires by
hints and gestures. He had a contused wound in front of,
and internal to, the left parietal protuberance; at the
bottom of this was a depressed fracture of the skull, said to
be one-fifth of an inch deep. The aphasia got well first,
and then the paralysis of the arm. It should have been
mentioned that on admission his tongue pointed to the left
‘when protruded.

Dr. Charlton Bastian, who saw my case at the Clinical
Society, kindly showed me a photograph of a man who had
a depression on the right side of his head. “ This mhn was
not aphasic at all, though he Was partially hemiplegic on
the left, and subject to unilateral convulsions on this side
the depression in his case was mote uniform, and,T,think, a
trifle deeper than in yours.”, The above is an extta'rt; from
a letter of Hr. Bastian to me. 1 - ' J i

THE SUftGICAL TREATMENT O.F ACUTK
ABDOMINAL DISEASE.

Br WILLIAM COATES, M.R.C.S. Eng,, L.R.C.P.Ed.

The contributions that have recently appeared in Tax
Lancet on the above subject are full of interest and infor¬
mation, especially those by Mr. Lawson Tait and Dr. Wade,
which must engage the particular attention of the profes¬
sion. As it is suggested that some diseases which have
hitherto been left to the resources of medicine can 1 m. more
successfully treated by the surgeon, it is clearly a duty thxt
any case which bears at all upon the subject should %e
placed upon record. Such being so, perhaps the narratrv©
of the following two cases may be considered worthy of
perusal.

Cask l . 1 —Perforation of a small stone through the vermi¬
form awendic. followed bu acute fiscal abscess and uencral

was a member of a healthy family, and had never been
seriously ill. Five days before coming under my care, whilst
in service, she was suddenly seized with acute general abdo¬
minal pains, which were the most severe on the right side»
and continued for about six hours. She was free from pain
and slept well during the night, and, though feeling a little
soreness, resumed her duties on the following morning.
During the afternoon the pain returned in the right side of
the abdomen; it gradually spread all over the bowels, which
became, constipated, and she began to vomit. Purga¬
tives were administered, but, becoming worse day by day,
she was sent home in a cab, a distance of several miles..
When first seen on the evening of the above date she was
exhausted after the journey and very ill. Her face was
pinched and expression anxious; tongue dry and furred;
temperature 103°; pulse 130, small, quick, and thready;
chest healthy; knees drawn up; and she complained of acute
abdominal pain and vomiting. The abdomen was distended,.
tympanitic, and painful. The pain was severest in the
csecal region, but no swelling or resistance was detected.
The rectum, loaded with feeces, was relieved by simple enema,
opium administered, and poultices locally employed* On
the 12th hqr condition was unaltered. On the 13th there was
abdominal distension, and the pain on pressure over the
ctBcal region and the general signs of peritonitis were de¬
cidedly increased. On the 14th the temperature was 103'2°,
the pulse 120, and the vomiting and abdominal pain more
severe. There was a decided sense of deep-seated resistance
in the crocal region, where pressure produced much pain.
No swelling could be felt per rectum. There was retention
of urine. On the 15th the temperature remained high, the
pulse rapid and small, and the vomiting was exhausting
.her. the abdomen was more distended, and in the c&cni
region, covered by tympanitic bowel, in a position where
pressure was most resisted, an obscure swelling could be
felt. Under chloroform the swelling was more defined,
apparently deep seated in the iliac region. It could not be
felt per vaginam. On introducing the aspirating cannula
into the swelling a few drops of offensive pus oozed out, but
nothing was drawn into the aspirator. An exploratory
incision about three inches in length was made, beginning-a
quarter of an inch above the middle of Poupart’s ligament and
extending obliquely upwards and outwards above the anterior
iliac spine, and a dissection made upon the swelling. Out of
it about five ounces of offensive fsecal pus were evacuated.
On introducing a finger, it entered into a large irregular
cavity around tbe caecum, from which a small stone about
a quarter of an inch in length was removed. This was
oval in shape, and composed of faecal matter arranged in a
laminated manner, and surrounded by a hard, dense plioe-
phatic layer. There was a small opening into the peritoneal
cavity, which possibly was made during the dissection
upon the swelling. As no post-mortem examination was
, allowed, the exact condition was never determined, but
the distended bowel immediately over the swelling ap¬
peared to greatly increase the risks of grounding the peri¬
toneum. The patient’s condition appeared too critical to
. permit, any extension of the operation, so the cavity was
washed out with carbolic solution, drainage-tubes intrp-

r i Tills cue was mentioned before the Manchester Mfe
PeB.-tM-d.-

»1 Society on.

7U

Tits Lancet,]

MB. JAGOE ON ENTERIC AND TYPHO-MALARIAL FEVER. <■

[Jan. 15,1887. 11#

daeed, and tb« wound dressed. After - the operation the
patient rallied, her symptoms having been decidedly relieved;
oat after a time the vomiting returned, and she gradually
Mnk, dying m twenty-four hours.

Casb 2. Obscure abdominal symptoms and death, caused

by localised enteritis set up by a fish-bone. —M. W-, aged

seventy-one, the subject of chronic bronchitis, was as well
as usual until Feb. 6tb, when she complained of indefinite
pains. These becoming worse, she was first seen on the
7th. Defective articulation made it difficult for her to
describe her symptoms; but she was suffering from pains
in the abdomen, which region,' however, was neither dis¬
tended ndr very tender.' The'temperature was 98-4°, the
pulse 100, and the tongne a little furred. A calomel purge,
sedative mixture, and hot fomentations were employed.
On the following day the bowels were relieved, but there
was slight abdominal distension, with some tenderness. The
temperature was normal, but the pulse was 110. On the
9th the abdomen was more painful, vomiting set in, and she
died rather suddenly, probably from syncope, ninety hours
after the first onset of symptoms. On opening the abdomen
poet mortem, a discoloured portion of bowel eight inches in
length was found at the junction of the jejunum and ileum.
The central fourinchesof this were acutely inflamed and some¬
what indurated, but not at all gangrenous. The sharp end of a
small fish-bone (j in.) was projecting through the wall of
the bowel into the peritoneal cavity, and this nad originated
the mischief. The large intestine was occupied by hard
fteeee, and in the descending colon a large fish-bone (24 in.)
ru discovered travelling safely. The small intestine con-
tained a large quantity of a chymous fluid, which looked
very much like pus, but under the microscope it showed
vegetable debris—starch granules and stray phosphates.
There was no fluid or lymph in the peritoneal cavity, nor
other sign of peritonitis, except slight hyperaemia in the
immediate neighbourhood of the inflammation.

The age of this patient and the existence of subacute
bronchitis precluded the advisability of resorting to opera¬
tion ; bat if in a similar case in a younger subject an
exploratory operation were performed, the foreign body
irritating the bowel might readily be detected and removed,
the bowel itself dealt with, and a chance of recovery
afforded. It is interesting to note that the fish-bones had
enped digestion, and that the larger bone was travelling
safely in the midst of a mass of fwces, whereas the smaller
out, happening to be in a portion of the bowels where the
omtents were fluid, was arrested by contact with the wall
of the bowel, exciting local inflammation in and penetrating
through it. This fact favours the administration of aatrin-*
goat rather than purgative medicines after the accidental
swallowing of foreign bodies.

Referring to Case 1, it is reasonable to suppose that, had
its nature been clearly recognised at an early stage, before
the occurrence of acute peritonitis, an operation such as
the one performed might have been accomplished without
farther injury to the peritoneum, and with a fair prospect
of sucoees; or even at the later stage, when first she came
trader my care, before the iliac swelling was detected, if the
abdomen had been boldly opened, the pus might have been
evacuated, the abdomen thoroughly cleansed, free drainage
established, and recovery hopefully looked for. But, on the
other hand, what would have happened had the surgical
treatment been left alone ? Could not life have been sus¬
tained long enough by nutrient enemata &c. until the
near approach of the abscess to the surface allowed a
safe incision ? Cases of perityphlitis are readily recalled to
mind where, after patient waiting, the swelling has made
its way to the surface, and a simple incision has ended in
recovery. But in these cases the peritoneal complication
is usually of a milder type, and so they compare unfairly
with the above.

The treatment of acute abdominal disease, now that
surgery claims a part in it, is surrounded by difficulties,
especially to the general practitioner. The consequence of
an unsuccessful operation to him is of much importance;
but still no operation must be shirked which promises to
relieve suffering and prolong life, and still more should he
avoid operation where such is not necessary to recovery.
Modern sn rgery lessens the risks of these great operations,
but how most the cases be decided in which it is justifiable
to perform them ? If an operation be delayed until after the
failure of medicine the prospects of successful surgical
interference are greatly minimised, whereas if a much larger
p ropor t ion of the cases are treated surgically many will have 1

to submit to an operation which would have recovered with¬
out. Eveiy week cases of acute abdominal disease come
under notice—some mild, others most severe,—and the larger
proportion by far recover. Even the most violent case is
not without hope. That being so, the responsibility of
advising an exploratory operation is indeed very great,- and
the practitioner at present looks in vain for some standard
rules to guide him. More accurate and detailed observa¬
tion of the course and symptoms of these diseases, and
the cultivation of the art of more minute diagnosis, must
eventually make it possible to differentiate between those
cases which will yield to medicine alone and those which
dmwnd the assistance of surgery. Meanwhile, it might be-a*,
good rule for guidance to imagine ourselves to be the patient, :
and to operate accordingly. It is hoped that the above cases <
may be of use to those who are working at the subject.

Manchester;

NOTES ON

ENTERIC AND TYPHO-MALARIAL FEVER.

By SURGEON-MAJOR II. JAGOE, M.S. •

The discfassion at the Medical and Chirurgical Society on^
enteric fever at Suakim, reported in The Lancet of i
Feb. 13th, 1883, induces me to forward this communication* j
with the hope that it may prove interesting.

The cases and necropsies which I rive are from notes
taken in Zulul&nd, Afghanistan, and India, and the tem- :
perature charts attached to elucidate the cases are two
out of a very large number that I. took to try to clear up
the distinction between enteric and what is called typho-i
malarial fever. I agree with Dr. Squire that the large?
majority aite as clear and distinct cases of enteric fever as 4
those seen in this country, but I doubt very much the
advantage of the term “ typho-malarial” to express a.fever ‘
which, to toy thinking, is far more fairly expressed by \
the name “ bilious-remittent.” As Dr. Broadbent stated, i
there is nothing typhoid about it, “nothing in common?
with enteric fever, if we except the fact of a pro -1
trocted high fever with some intermissions.” There is ,
a protracted fever of about forty-six days, with an *
interval of eleven days, during which there is a total'
absence of any rise of temperature; or in its course there*
may be two intermissions. It has been suggested that
these are mild cases of typhoid with relapses, but there is
not a single symptom of enteric fever about them; on the
contrary, they seem to be more of a bilious-remittent type.
There is frequently yellow tinging of the skin and conjunc¬
tivas, often vomiting, and the tongue pale, clean, sometimes
coated with a yellow fur, and frequently large and indented
by the teeth; at no time is there any degree of the red"
irritable, and contracted tongue of enteric fever, or any
other mild characteristic symptom of the disease. These
are the class of cases that I understand it is proposed to call,
or have been called, “typho-malarial." I have never seen a
death caused by them, if I except one patient who died during
the last march into Candabar on Sept. 18th, 1879. Chart I
shows the last nine days of the fever; the previous eight
days had been spent under the care of the regimental
surgeon. The patient was very much in the condition
described above when admitted into the field hospital.
There was diarrhoea; the upper surfaces of the conjunctivro
were slightly jaundiced; there had been some vomiting; and
the pulse was small and weak (about 8G); the tongue was
moist, large, and indented by the teeth. The man was
perfectly sensible and intelligent up to half an hour
before his death. In Candahar I could only make a very
hurried necropsy, but I found the lower part of the ileum
perfectly healthy, not even congested ; the liver and spleen
were enlarged, but I had no qieans of weighing them.

The cases above referred to are very different from that
shown in Chart 2, which may appropriately be termed “ typho-
malarial,” or, without using this compound, is fully accounted
for by Trousseau when he states that enteric fever in its early
stage may simulate malarial fever. Here, at all events, was
a case of enteric fever in which, the morning temperature
was normal on the ninth, tenth, and eleventh days of the
disease, while in the second week the variation between
the morning and evening temperature ran from three to four
degrees. The stools were not considered to be like those of
typhoid, but on the fifteenth day spots, both rose and blue.

Digitized by GoOgle

120 The Lancet,] ME. L. HUMPHRY: PUNCTURE OP HYDATID CYSTS OFTHE LIVER. [Jan. 16,1887.

were noticed; the tongue was dry, brown, and cracked, and | climates, are: (1) That enteric fever is in the very large
the nervous stage was well developed ; on the twenty-fifth majority of cases as readily recognised abroad as at home,
day the man died,from intestinal haemorrhage. The necropsy,, That some cases of enteric fever are masked by malaria,,
contrary to what one might expect from Surgeon-Major chit-fly at the onset, but that some enteric fever symptoms.
Meyer’s suggestion, showed Peyer’s patches and solitary will become prominent at some stage of the disease, and
glands ulcerated for a distance of six feet above the valve; i when death occurs the character of the gut lesion will, I
the hfcmorrhage came from a patch a few inches above the believe, disappoint those who expect it to differ from that
valve. But 1 presume this last type of case is not the kind in the most easily recognised case. I have notes of a.
that is called “ typho-malarial”; it seems to me that one ; case that was not returned as enteric fever, though to my

Chart 1. Chart 2.

AN INQUIRY INTO THE SEVERE SYMPTOMS
OCCASIONALLY FOLLOWING PUNC¬
TURE OF HYDATID CYSTS OF
THE LIVER.

By LAURENCE HUMPHRY, M.B.,

ASSISXAJlT-PHTSICIAlf TO ADDKN‘nROOKE‘8 HOSPITAL, CAMDRIIXiB.

It is a familiar fact that an outbreak of urticaria or an
erythematous rash not uncommonly appears on the skin of
patients a few hours after puncture or tapping of a hepatic
hydatid cyst. This may be the only discomfort experienced,
but occasionally symptoms of an urgent nature, or even
fatal, occur within a few minutes after the most simple
operation on these cysts. An instance in which the sym¬
ptoms were very alarming, occurred in a patient lately
under my care in Addenbrooke’s Hospital.

G. S -, a tailor, aged twenty-three, living at Newmar¬

ket, was admitted on July 14th, suffering from well-marked
jaundice, and with a painless enlargement of the liver. The
upper limit of dulness was at the fourth rib, and the lower
border of the liver could be felt a hand's breadth below the
ribs. In order to clear up the diagnosis, a hypodermic
needle was inserted at the eighth interspace in the mid-
axillary line, and half a drachm of clear hydatid fluid drawn
off. The patient hardly felt the puncture, but a few minutes
after he was seized with extreme faintness and dyspncea,
his face became livid and pale, and his lips blue; he vomited
two or three times, and the pulse failed at the wrist; his
extremities became cold, and the heart sounds were almost
inaudible. Stimulants were given and a sinapism applied
over the heart, but he remained in this collapsed condition
for nearly half an hour. A profuse irritable urticaria then
appeared on the abdomen and legs, and on the extensor
aspect of the arms. The chest and face were free from
eruption, but were covered with a copious sweat. The rash
persisted for a few hours, then gradually subsided, and the

important symptom or symptoms are absent the case cannot i
be one of enteric fever, and the lesion after death, because \
it is confined to the lower six inches or so of the ileum,
which is thickened and extensively ulcerated, is asserted
not to be the ulceration of typhoid. I cannot explain why j
the ulceration should be so limited; but undoubtedly in !
some cases it is so, and there is nothing beyond but some j
degree of congestion.

The conclusions I am inclined to arrive at, after twelve J
years’ experience and notes in tropical and subtropical |

thinking some symptoms of the disease were present;
during a relapse on the forty-seventh day of the disease
phlegmasiadolens of the left leg occurred, which strengthened,
and verified the belief that it was a case of enteric fever.
(2) That what is called “ typho-malarial fever” would be
more aptly expressed by “ bihous remittent.” (3) That what
I understand by the affection termed “typho-malarial. fever”
causes almost no mortality; I never saw a death from it
in nine years’ Indian service.

Londonderry.

J

Thk Lancet,]

CLINICAL NOTES.

[Jan. 15,1887. 121

pAtieoC had fairly recovered by the next morning. Rather
more than a fortnight afterwards, there being no alteration
in the size of the cyst, I was anxious to aspirate; but being
apprehensive of a recurrence of the previous urgent sym¬
ptoms, it was decided, with the hope of averting them, to
inject subcutaneously a small dose of atropine before the
operation. A fiftieth of a grain was given hypodermically,
and fifteen minutes afterwards the aspirator needle was
introduced and nineteen ounces of clear hydatid fluid
drawn off. The patient had no bad symptoms, although
he was in great alarm, and soon afterwards the jaundice
1, the cyst contracted, and he left the hospital

Ldfiofoqnally happens that puncture of a hydatid cyst
>HVer is immediately fatal, and I remember once to
ed such an unfortunate accident. A fatal case
led by-Mr. Bryant in the Clinical Society’s
vol. xL, in which sudden death occurred five
the operation of tapping a hepatic hydatid,
i cases are mentioned in Dieulafoy's treatise on
! Aspiration, in which the patient was seized with

f spnoea, and urticaria soon after tapping these
e appearance of an erythematous rash orurticaria
sg day, with rise of temperature and sore-throat,
erved. I am not aware that these complications
, after puncturing other tumours of the liver or
gating hepatic abscesses, and the assemblage of
closeiv resembling those sometimes met with
shell-fish would point to the conclusion that
a hydatid cyst contains some poisonous 6ub-
Ch. obtains entrance to the system at the time the
ptnired. In the hope of determining this, 1 pre-
i of the fluid from the cyst after aspirating my
" asked professor Roy the same*day to inject it
oneal cavity and veins of some animals. This
. with me, with the following results:—

-An Injection ofGcc. of hydatid fluid was made
I'lugolar vein of a guinea-pig, previously chloro-
.Jfaus was followed by some increased frequency of
ttka, and the heart’a beats were observed to be
A farther dose of 8cc. was given, with the same
• slow recovery ensued from the narcosis. The
ill«(L within about one hour.

-Ail Injection of 6cc. oftho fluid wr.9 made into
neal cavity of two guinea-pigs, but no obvious
>wed within the half-hour during which they were
Both died during the night.

-Fairly large dog (cross from a Colley). Chloroform
rnarcosis was continued during the whole of the ex-
Cannulrc were fastened in the jugular and carotid,
sr being connected with the kymograph. Blood-
i equal to 140 mm., mercury. Pulse GS; respiration
gar minute. 12 cc. of fresh hydatid fluid were slowly
iijwted into the vein. In about five minutes the blood-
ptamre, which showed variations in height, after the injec¬
tion, was found to be 135 mm. (hydrarg.). Pulse 70; respira¬
tion 37. Ten minutes later 14 cc. ot hydatid fluid were
injected into the jugular. No marked change resulted.
Twenty minutes after the first injection 20 cc. of hydatid
fiokl were injected into tbe jugular, causing the blood-
pnenare to sink gradually during the five minutes following
the injection from 137 mm. to 63 mm. (hydrarg.). Pulse
dowedto33; respiration slowing down to 17 per minute.
A* the animal appeared to be dying, a small dose of sulphate
of atropine was injected into its vein, which was followed
by a gradual bat continual rise of blood-pressure until it
renamed at about 125 mm, (hydrarg.), although during the
rise 40 cc. of hydatid fluid were injected at an interval of
•bont five minutes between the injections. The pulse rose to
72 nd respiration to.28. The animal was killed. The chief
characteristics of the necropsy were the enormous con-
gwUoftof the liver and the free flow of urine from the cut
surfaces of tbe kidneys.

Professor Roy remarks: “ It may be concluded from this
sxperuMnt, so far as is possible from a single experiment,
that there is in hydatid fluid some substance ^ich has a
powerful effect on both the heart and the respiratory
■ethfadsv. From the first two doses bat little effect on
tbsntnof the heart beat Was produced, but on giving a larger
fless.the slowing of the heart from 70 to 33 per minute is
ray striking. The acceleration of the respiration by the first
fie* nd its great slowing by the dose of 20 cc. of hydatid
SoidsHslao iwmwable. The great fall of the blood-pressure
sfter tfe third dose shows that the fluid from hydatid cysts

contains some substance which can affect the blood-pressure
in the systemic arteries to a very serious extent. The
marked change in the rate of heart beat, the respiration, and
tbe blood-pressure after atropine seems of much interest as
well as ot' practical importance.” The hydatid fluid may
enter a wounded vein at the time of puncture, or escape
into the peritoneal cavity and be subsequently absorbed,
and the rapidity of onset and urgency of the symptoms
would be tbe indication. In the post-mortem account
of the fatal case recorded by Mr. Bryant, it was found
that immediately inside the hydatid capsule the trocar
had transfixed a very largo vein, which on subsequent
dissection was found to be the trunk of the portal vein,
and it was supposed that, after withdrawal of the
trocar, hydatid fluid escaped into the portal vein and
acted as a fatal poison. It may be questioned whetherthere
Is not a greater liability, where the close method of tapping
is employed, for the fluid to find entrance into one ot the
dilated veins, which are sometimes found in the fibrous
atrophied liver tissue round the cy6t, should one happen to
be wounded ; and whether the treatment by incision advo¬
cated by some may not be found safer.

Cambridge. _

Clinical ftotes:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

INDIARUBBER TUBING- IN THE BLADDER;
SUCCESSFUL REMOVAL.

By Walter Fowler, M.A., M,B., F.R.C.S.,

LATE CASUALTY' SCRGKO.V. yUKKN's HOSPITAL, BIRMINGHAM

The case published by Dr. Henry O’Neill in The Lancet
of Oct. 30th, 1836, reminds me of a somewhat similar one that
came under my care in the Queen’s Hospital, Birmingham. ,

J. G-, aged thirty-two, was admitted on Oct. 17tb, 1885,*

with the following historyFor the last nine months he
had been in the habit of passing about six inches of india-
rubber tubing from a baby’s feeding bottle down his urethra,
Three days before admission, while indulging in this habit,
the tube slipped from his grasp and disappeared from view.
Since then he had complained of pain in the hypognstrium
painful micturition, very red urine, and diarrhoea, and had
also hod several shivering fits.

On admission there was evidence of severe cystitis. A
No. 9 catheter was easily passed into the bladder.

October 18th.—Under chloroform I introduced a No. 12
steel sound, and then a No. 14 after incising the meatus.
1 then passed a small flat-bladed litbotrite; and, after three
or four unsuccessful attempts, I managed, by reversing the
blades of the litbotrite, to pick the tubing up off the floor
of the bladder, and extracted 8^ in. of tubing such as the
patient had described. In the evening he had a rigor
and a temperature of 106°, which speedily yielded to ten
grains of quinine.

On the 19;h and 20th he only complained of a slight dis¬
comfort on passing urine, and on the 21st was discharged well.

Old Burlington-8tr*et,_W._

MENORRHAGIA A FREQUENT SYMPTOM O*
PYONEPHROSIS.

By James Oliver, M.B., F.R.S.Edin.

In the human female the reproductive and urinary organa
Are evolved from the same fcetal structures—the Wolffian
bodies. When fully formed, these bodies occupy nearly the
whole extent of the abdominal cavity of the feetu^, and
constitute a pair of symmetrical organs in structure closely,
analogous with that of the permanent kidney. Whenever
in the animal economy we find organs developed from a
common primordial structure, we can invariably prove the
perpetuation of a direct nerve communication, whereby
impressions originating in one may be forthwith transmittec
to the others of a like structural evolution. By acute
irritation of the renal and uterine nerves we are able to
produce experimentally, through an existing nerve anasto-

zed byGoOgl

e

Di.

122 Tub Lancet,

HOSPITAL MEDICINE AND SURGERY

[Jan. 15,1887.

mosis, a temporary paralysis in the lower limbs—a so-called
reflex paraplegia. In the Planaria the primordial liver
consists of nothing more than a few cells scattered along a
tract of the intestinal surface, which secrete efficiently for
the requirements of the organism. As we ascend the scale
of animal life, however, we find these cells by agglomeration
and multiplication forming a distinctly projecting nodule
from the perivisceral wall of the bowel into the perivisceral
cavity, and eventually culminating in the production of
that large and apparently indepehdant organ—the liver. It
is therefore a gland which, secreting into the intestinal
canal, is developed from the coats of the gut. The existence
here of a free nerve inter-communication is evidenced by
the fact that the passage of a slightly acid fluid into the
duodenum determines forthwith a copious secretion of bile,
whilst that of an alkaline fluid produces little or no effect.
Menorrhagia is a symptom frequently associated with
pyonephrosis in the early days, and more especially when
this disease appears on the left side of the body. It is the
manifestation of a mere augmented and prolonged functional
activity of the uterus and Fallopian tube, determined in
some occult manner by the condition of the renal organ,
whilst the periodicity of the flow itself is undisturbed. In
such cases I have failed during life to detect any evidence
of disease in the generative tract, and have twice verified
this fact by a careful examination of the body after death,
the uterus, Fallopian tubes, and ovaries being perfectly
healthy.

Montague-street. Bu»aell-»quare, W.C.

PREGNANCY COMPLICATED WITH OVARIAN TUMOURS;
TAPPING, DELIVERY, AND SUBSEQUENT
REMOVAL OF CYSTS.

By H. F. Bailey* M.R.C.S., L.S.A.

On June 5th last I was called to a lady, aged twenty-nine,
whom I was to attend in her first confinement. This was
About a fortnight before term. I found the abdomen
excessively large, and both legs cedematous, blue, and mottled.
Palpation revealed fluctuation with distinct thrill, and
percussion resonant flanks, with dulness over the rest of the
abdomen.

The diagnosis was left ovarian cyst, and, as the tumour
was very tense and the patient evidently in imminent
danger from rupture of cyst, I tapped about two inches
above the umbilicus and removed two gallons of ovarian
fluid. Five days later labour came on, and with forceps a
healthy female child was bom. Lactation was permitted
for three months, but the tumour again filling rapidly, the
Child was weaned.

On Sept. 14th I operated, aided by my partner, Dr. J. N.
Miller, Mr. Cooper giving methylene. On opening the
abdomen by a four-inch incision, not only was there the
left cyst as diagnosed, but the right ovary was the seat of a
second tumour, a very dense-walled dermoid cyst weigh¬
ing 2 lb. I removed the left cyst in the usual way,
tying the pedicle by transfixion -frith Chinese twist and
returning it. The tumour of the right ovary was next removed
in like manner, 'and its -pedicle also returned. Only one
adhesion of omentum required ligature and division. After
thorough sponging of the cavity, the incision was Closed
with silk sutures passing through the whole thickness of
the abdominal wall, a Ifcath/atube inserted, and the- wound
dusted with iodoform anil dressed with Gamgee pads and
strapping. The tube was emptied of coloured aerum every
six or eight hours for- a couple of days, and then removed.
The dermoid cyst contained epithelial matter and much
hair, the whole mass having the appearance and con¬
sistence of mortar; the cysts and contents weighed over
2$lb. Recovery was uninterrupted; the evening tempe-
fStttre on the day of operation was 100°; pulse 88. The
next day the pulse and temperature were normal, and
retaain^d so.

' Dr. Fenwick begs To* infoftfaattfon as td the relatibn of
pulmonary phthisis to oYariatt’dfatoee. In, this case careful
inquiry failed to elicit any famHy history of phthisis, but
thU patient's parents J frerd first cotr^ha I suppose the
right cyst had remained’nfeUriystaMopafy in sire for years,
nd that gestation defcfcrkiaed the rttpW grOfrfch ot the left.

‘ BUckheatfa. ■ ny.i .j ! - I - ’ r •

& HUrrtrr

OF

HOSPITAL PEACTICE,

BRITISH AND FOREIGN.

Nullaaatem est alia pro oerto nosoendl via. nisi qoamplaiimu et mor-
borum et dltMOtlonnm hUtortaa, turn allorum turn propria* eolleetM
habere, et inter ae oomparare.—MoBoaruri Dt Bed. ft Cam. Herb-*
Ub. lv. Procemium. -

ST. GEORGE’S HOSPITAL.

COMPOUND DEPRESSED FRACTURE OF THE VAULT OF THE
SKULL; PARALY8I8 OF THE RIGHT ARM;

TREPHINING ; RECOVERY.

(Under the care of Mr. Pick.)

The following belongs to the class of head injuries about
which the rule as to operating is simple. The exact locality
of the cerebral hemisphere on which there was pressure was
doubtful, owing to the large area of bone depressed; but
the centre of this area was easily ascertained by reference
to Reid’s base line. For the notes we are indebted to
Mr. Bull, surgical registrar.

G. W——, aged sixteen, a milk-carrier, while delivering
milk at some area steps was struck on the head by a falling
ladder. He was picked up insensible. On admission
(April 7th, 1886) he was unconscious, and bleeding from the
nose and mouth. There was a semicircular scalp wound
about two inches long over the left parietal bone, and at the
bottom of this there was a ridge of bone and a depression
about a quarter of an inch in depth. The extent of this
depression couftl not be ascertained, as it passed beyond tho
full length of the scalp wound. There was slight twitching
of the right arm. He vomited some blood, and became
conscious four hours after admission. Next day he was
restless and irritable. He answered questions, but was
drowsy at timee. There was slight paresis of the right arm,
but no marked paralysis. He was able to move his legs, and
had entire control over his sphincters. The bleeding from
the nose and mouth had ceased. The wound was dressed
and was looking quiet. Next day, forty-eight hours after
the accident, the lad was more drowsy, and unless roused
he lay quietly on his back. There was marked paralysis of
the arm, and the grasp of the hand was very feeble.

After consultation, Mr. Pick (ether having been adminis¬
tered) made an incision across the wound, and reflected
the soft tissues. A piece of bone measuring about 3in_
by 2 in. was depressed and wedged below the non-depressed
part. The centre of this area was 2^ in. behind the left
external auditory meatus, and 3 in. above Reid’s base line..
A crown of trephine was removed, and after a ridge of bone
had been sawn off by a Hey’s saw Mr. Pick was able to
prise up the depressed bone to its proper level. There was
no injury to the dura mater. No ligature was required. A
drainage-tube was inserted, the flaps united with silver
sutures, and wet carbolised gauze dressings applied.

The patient passed a good night, and was cheerful and
conscious next day. His temperature was irregular for a
few days, and the wound was foul for four days. At- the
end of the first week the paralysis began to diminish, and
from this time he slowly improved. The wound did well,
and in five weeks the lad was sent to a convalescent
hospital, on May 12th. At this time there was slight
paresis of the arm and hand. He remained in the country*
five weeks, and on returning was found to have completely
recovered the use of his hand and arm.

GENERAL LYING-IN HOSPITAL.

CASE OF CERVICAL BMPHtBBMA FOLLOWING PARTURITION
REMARKS. .

(Under the care of Dr. R. Boxall.)

For the following notes we are indebted to^fc. W. G.
Holloway, house-physician. ,

Mrs. S——, nged nineteen, a well-developed but somewhat
delicate-looking primipara, was admitted towards the end
of the firststage of habour on August 26tb, 1886. Fall dila¬
tation of the cervix was reached at 10.20 a.m., And the head
passed slowly through the pelvis in the fiatficranial position.
It remained two hours on the perineum, JHh was eventually

Digitized by Vj ooQle

Tmm Lanckt,]

HOSPITAL MEDICIUB AND SURGERY.

[Jan. 15,1887. 123

expelled without artificial aid at 1.50 p.m. The labour pains
were very strong, and towards the end became almost con¬
tinuous. The patient meanwhile screamed violently. The
child, when born, weighed 6±lb. The placenta was ex¬
pressed a quarter of an hour after the birth of the child.
The uterus subsequently contracted well.

About threa hours after delivery the patient herself was

S wans of a soreness in the neck and upper part of the chest.

t began about the left sterno-clavicular articulation, and
thence spread upwards and to the opposite side of the neck.
Next morning (27th) a puffy swelling was observed at the
root of the neck over the manubrium sterni; it was a little
tender on pressure. The skin retained its natural colour.
At the apex of both lungs, and especially the left, the per¬
cussion note was hyper-resonant and the breath sounds
feeble. The patient had a slight cough, but no disturbance
of breathing. The heart sounds were normal, but at the
base were masked by crackling.

. On Aug. 29th, during the physician’s visit, the following
poles were made:—Slight fulness is apparent about the
lower part of the neck on either Bide, but especially the left.
The respiratory movements are rather less marked at the
loft than at the right apex. Over the puffy area emphy¬
sematous crackling is easily distinguished by the finger. It
is most marked over tbe manubrium sterni, but does not
extend below its junction with the body of the sternum. It
can be felt on either side immediately below the clavicle,
extending as low as the upper border of the second rib and
outwards as far as the coracoid process. It is more prominent
on the left side, extending backwards as faT as the edge of
the trapezius (where it appears to end abruptly) and
upwards to within an inch of the mastoid process, but is
lass distinct and only brought out by deep palpation. In
the anterior triangle it again becomes distinct, extending
upwards quite as far as the ramus of the jaw and aoross the
mid dle line to the opposite side. On tbe right side of the
neck it is as distinctly felt in tbe anterior triangle as on
the left side, but cannot be felt in the posterior triangle.
No crepitation can be felt under the trapezius, over the
mamrnte, or down the front of the sternum below the
junction of the manubrium and body. Over both anterior
and posterior triangles on the left side, and over the
anterior on tbe right, a high-pitched hyper-resonant note
is readily produced. Tbe percussion note below the
clavicle on tne left is slightly higher pitched than on the
opposite side. Over the whole area above described super¬
ficial crepitation sounds are audible. These are especially
numerous on first applying the stethoscope to tbe surface,
and are readily brought out by shifting its position, and
an produced, though to a less degree, by the inspiratory
movements. In addition, over the pulmonary cartilage
they accompany each systole of the heart. No corresponding
sound is beard over the aortic cartilage, though no
emphysematous crackling can be felt; nor can any sounds
be produced by pressure- of the stetbosoope below the
junction of the manubrium with the body of tbe sternum;
crepitation sounds are audible, synchronous both with each
Inspiration and with each systole of tbe heart, and extending
as far down as tbe xiphi-sternsl articulation, on the right
aide to the border of the sternum, and on the left a finger’s
breadth beyond it. In the neck, over the whole area affected,
alight pectoriloquy is audible, and the voice assumes some¬
what an ngophonic character. The skin still preserves its
nataral colour. The soreness is diminishing.

- Aug. 31st.—No emphysematous crackling can now be felt
below tbe right clavicle, and only very little.abqve it.,, Over
tbe manubrium and in the supra-sternai notch it is still
distinct, and also in the left supra- and infra-clavicular
de p r es sions. It is disappearing from below the ramus of
the jaw on the left side. 1

Sept. 1st.—Tbe fulness about tbe neck has subsided;
the hollows are more apparent. Slight emphysematous
cockling is still present on the left side in tlie posterior
triangle, and*very little over the situation of the sterno-
maatoid, but) is still distinct at the sterno-clavicular
artieuMkm. in the supra-sternai notch, and immediately
bela^Hpe Clavicle. On the right side it has disappeared
fro^Pelow the clavicle and from the anterior triangle of
tbe neck, butr can be indistinctly felt over middle pf
.the stemo-mastoid and along the ..ahtorior border of the
-trapezius.

2A&.—The emphysematous crackling has entirely disap¬
peared from thteflgbt side, and on the left is limited to the
situation of thWtemo-clavie alar joint and infra-clavicular

depression. The crackling sounds accompanying the systole
of the heart have also disappeared. The soreness has gone.

3rd.—No trace of emphysema can be detected.

8tb.—Mother and child discharged well.

No special treatment was adopted. The temperature re¬
mained normal throughout; the pulse varied from 72 to SO,
and the respirations from 20 to 24 per minute.

Remarks by Dr. R. Boxall.— Few cases of cervical
emphysema, the result of bearing down during labour,
though not very rare (about 1 in 2000 deliverances), have
been fully reported. Dr. F. II. Champneys, in an elaborate
scientific inquiry on this subject, 1 refers to some twenty
cases or more reported by various observers. As the result
of experiments made on still-born foetuses, the same observer
concludes that “the cause of emphysema of the neck
during labour is rupture of the lung tissue—the air
escapipg near the root of the lung, passing beneath the

E ulmonary pleura into the anterior mediastinum, and so
Bneath the deep cervical fascia into the neck”; and further,
that “ the air emerges from the thorax along the great vessels,
but may not become superficial till it has travelled higher
up.” The clinical facts of the case quoted above are entirely
in accordance with Dr. Champneys’ observations. It seems
highly probable that air escaping at tbe root of tbe lung
found its way into the anterior mediastinum; hence the
crepitation sounds, synchronous with both inspiratioh and
with the heart’s systole, audible over the front of the sternum,
where no air had escaped into the tissues superficial to
the bone. The air travelling upwards along the pulmonary
artery would give rise to similar sounds, heard over the
pulmonary cartilage with each systole of the heart; thence
travelling onwards and directed upwards by the deep cervical
fascia, the air entered both anterior triangles of the neck,
and on the left side < where it commenced, and which through¬
out was more affected than the right), passing beneath
the sterno-mastoid, inflated the posterior triangle, and on
either side passed over the clavicle as low as the upper
border of the second rib and corresponding part of the
sternum. Subsequently a little air appears to have found
its way also beneath the right sterno-mnstoid into the
posterior triangle of the same side. In the primiparity of
the patient, the severe expulsive pains, the onset of the
emphysema soon after labour (often during the second
stage), its proclivity for the region of the supra-sternai
notch, the absence of disturbance to the respiratory
function and of the other serious symptoms beyond the
disfigurement, together with the invariable tendency to
absorption of the air by the end of a week or ten days, this
case, though much less severe in character than many,
agrees with the majority of those previously recorded.

NEWCASTLE-ON-TYNE INFIRMARY.

TWO CASES OF SCPRA-PURIC LITHOTOMY; REMARKS.

(Under the care of Dr. Dumb).

Thb following are reported on the ground that the posi¬
tion of the supra-pobic as an alternative to lateral lithotomy,
as well as some of the details of procedure in the first
operation, being still unsettled, it is desirable that the record
of cases should be as full as possible.

Case 1.—T. M.-, aged thirty, was admitted on Sept. 4th,

1888, suffering from the usual symptoms of stone in the
bladden These symptoms had been present for twelve
months; during the last two months the urine had been
turbid and micturition very frequent. At the time of ad¬
mission the urine was alkaline and muoo-purulent. The
stone was readily detected by the sound, and seemed to give
a hard ring. Measured with the lithotrite it was found to
be an inch and a quarter in what was thought to be its shorter
diameter; but on account of tbe sensitiveness of the bladder
some little difficulty attended this examination. It Was
determined not to crush but to remove the stone by the
supra-pubio method as an alternative to lateral lithotomy.
The operation was performed on Sept. 9th. Tb6 rectum
was first distended by Petersen’s teg, into which were
thrown twelve dunces of water., A like quantity of corro¬
sive sublimate solution (1 in 2000) was then injected into
tbe bladder, causing it to rise half way to the umbilicus.
An in&Bioh three'inches long was made above and Over the
margin bf the pubic bone and the dissection carried down
to the bladder walL The plexus of veiha in the overlying

l Med. Chlr. Trans., vol. lxvii., 1884. •

124 The Lancet,]

ROYAL MEDICAL AND C&IRURGIOAL SOCIETY.

f Jak. 16,1887.

fat and in the wall of the bladder was large, and required
careful separation with the finger-nail and a director. A
sufficient surface being cleared, a sharp hook was fixed in
the wall and a puncture made. Into this the right
index finger was insinuated, and by the side of it the
index of the other hand. The stone was then caught
with ease between the two fingers and lifted out. On the
collapse of the bladder the peritoneal reflection came into
view. A drainage-tube was placed in the bladder, and the
opening into the viscus was not sutured. Two stitches were
placed in the upper part of the wound in the abdominal
wall. The after-treatment consisted in retaining the patient
alternately on one side and the other, and in the use of
salicylic wool to absorb the urine. The patient’s progress
was satisfactory. The temperature on the evening of the
operation was 101°; on the following day it was 99° in the
morning and 101° in the evening, from which time it fell,
and continued a little above normal. The tube was removed
from the bladder on the fourth day, and a soft catheter in
the urethra, which had proved quite useless, was discon¬
tinued. Urine was passed by the urethra on the fourteenth
day. The quantity so passed gradually increased as the
wound closed. This, however, proceeded slowly, and was
not complete till Oct. 21st. The stone was a uric acid cal¬
culus, with phosphatic coating, measuring an inch and a half
in its long diameter.

Case 2.—J. G-, aged sixty-four, was admitted on

Oct.28tb, 188G. Had symptoms of stone for four years. With
the sound an irregular stone, giving a very clear metallic
ring, was detected. It was thought to be an oxalate of lime
calculus of considerable size. The patient’s prostate was
markedly enlarged, and on account of this fact, as well as
the character of the stone, the supra-pubic operation was
chosen. The operation was done on Nov. 2nd, the details
being precisely the same as in the former case. But the
veins in front of the bladder were larger and more engorged,
as was to be expected; and their walls seemed friable, so
that they were torn even with the gentlest handling.
Bleeding was thus a troublesome feature of the operation,
and some time had to be spent in arresting it. The peri- ;
toneum was not seen. The after-progress was satisfactory; ;
but the wound granulated slowly, and till its complete closure j
on the thirty-seventh day after the operation no urine was
passed by the urethra. A few days afterwards the patient
returned home in good health, with the wound soundly
healed, and entirely free from urinary symptoms. The stone
was a mulberry calculus, weighing 6 drs.

Remarks by Dr. Hume.-- -In the first of these cases a
mistake was made as to the character of the stone. It
might have been dealt with readily by lithotrity. But,
looked at in comparison with an ordinary case of lithotomy
by the lateral method, the point which it chiefly offers
in contrast is the length of time taken in healing. The
supra-pubic wound is at a great disadvantage for healing,
in point of position and drainage, compared with the wound
in perineal lithotomy. Several cases of primary union after
the supra-pubic operation have now been recorded, but
these, I believe, have all been in children. In them the
abdominal position of the bladder, leaving it even
when collapsed in direct relation to the wound in
the external parts, and also the natural rapidity of
the healing process in early life, render union by
first intention probable, and therefore to be aimed at.
But in the adult, the bladder, when its contents have all
«#caped, lies at the bottom of a deep hole, and it is difficult
that in such a wound primary union can be other
than the rarest event. And when the attempt to secure it
fails the accurate suturing of the external wound will tend,
as Sir H. Thompson has pointed out, to increase the risk of
urinary infiltration. One may therefore look on it as
-probable that in the adult the supra-pubic wound will con¬
tinue to be treated as an open wound, and that slowness in
healing will be an unimportant drawback—but still a draw-
t-b® operation. The second case was typically one
an which, according to the views now gaining acceptance,
the high operation would be selected. The stone was a hard
one, large for lithotrity, in an elderly patient with
enlarged prostate. In this condition of the prostate the risk
of haemorrhage in the lateral operation is considerable, and
~ 0 ® 8 .* 8 » tendency in these cases for cystitis or other
wwomc urinary trouble to be left behind. The first of these
dangers is certainly smaller in the high operation, and it
iSAy"prove also that the tendency to after-troubles is less
marked.

S toical jgfltk tieg,

ROYAL MEDICAL & CIIIRURGICAL SOCIETY.

Suture of Divided Nerves.—Physiological Effects of Massage.

An ordinary meeting of this Society was held on Tuesday
last, Mr. G. D. Pollock, F.R.C.8., President, in the chair. The
discussions on both papers were lengthy, and the meeting
was prolonged till 10.30.

Mr. J. Bland Sutton read a case of Suture of the Median
Nerve ten weeks after division, with recovery of function.
This paper contained the details of the case of a porter, who
through the bursting of a soda-water bottle sustained a
deep wound of the wrist. The median nerve had been com¬
pletely divided, and the parts supplied by it were deprived
of motion and sensation below the point of section. Ten
weeks after the accident the ends were found by dissection,
the cut ends vivified and united by suture. Sensation
began to return in five days. The most important feature
m the case was the ease with which the ends of the
severed nerve were found by following the rules which
had been gained by studying the effects of neurotomy
in horses. A list of previous cases of secondary nerve
suture accompanied the paper. The time taken in the
restoration of function may vary from one day to a year.—
Mr. Howard Marsii said that the operation indicated by
the author had been practised a great many times with
success at St. Bartholomew’s Hospital, both by himself and
colleagues. — Mr. T. Holmes said that it was doubtful
whether the fibrous band alluded to by Mr. Sutton was
even generally present. In cases where there had been
considerable laceration the operation proposed would be
very difficult, and any such guide in human subjects would
probably be absent. It was only in a few cases that the
nerve could he clearly defined. But the operation was
urgently needed in any case of division of nerves. In a
case of division of the musculo-spiral nerve, in which many
months bad elapsed before the secondary suture was per¬
formed, complete restoration of function ultimately took
place. Where the division had been recent, perhaps the
function of the nerve would be restored soon. The simplicity
of the injury that divided the nerve would certainly have
some influence on the rapidityof restoration of function.—
Mr. Bowt.by said that he sgreed with Mr. Holmes that as a
rule there was no definite band of fibrous tissue uniting the
nerve ends, and this was especially the case when there had
been mnch suppuration following the original accident.
The operation was comparatively easy in some cases, but in
others the difficulty in finding the lower end of the nerve
was very great. In order to arrive at any conclusion as to
the result of an operation it was necessary to follow cases for
a sufficient length of time, even for years. If there was no
sloughing or suppuration the final result was generally satis¬
factory. In Mr. Sutton’s case there was not enough informa¬
tion to decide whether the success was complete. He would
like to hear more about the state of the muscles. It was
evident that in cases where the injury was an old one not
only the nerve but muscle had to be remade. The first sign
of restoration was a return of voluntary power, and this
might precede the return of electrical reaction by months,
even a year. lie was convinced that the lower end of the
nerve could be regenerated without being brought into con¬
tact with the upper end of the divided nerve. Thus it might
happen that union of divided ends, even after a long time
had elapsed, would be followed by very rapid restoration of
function. There was no danger of tetanus following primary
or secondary sutures of nerves, and as cases of improvement
after secondary suture had been recorded as long as fourteen
years after injury, the operation should never be refused.—
Mr. R. Barwbll related a case of division of the ulnar
nerve in a girl aged sixteen, in whom he sewed the two
ends together with strict antiseptic precautions, and with
the result of rapid and finally complete restoMtion of
function.—Dr. W. H. Murray said that in Mr. nttwell’s
case there was the reaction of degeneration in the Sncles
supplied by the divided nerve, but the abductor indicia
retained faradaic irritability.—Mr. J. W. Hulkb referred
to a point of practice which had not been touched upon.
If there were so wide a separation that it was difficult,
if not impossible, to bring the two ehifr together, what
should be done? Foreign surgeons had united them by

Digitized by G005le

Tkb Lanckt,]

MEDICAL SOCIETY OP LONDON.

[Jan. 15,1887. 125

)’» sciatic And dog#’ sciatic nerves, and apparently with
ma. A method of aide-splicing the divided nerve,
b ri n gin g down this so as to join the two ends, had also
" poetised. Cylindrical decalcified bird’s bone had also
The Germans reported successful results in
L—Mr. W. Hawabd remarked on the great varia¬
tion in the time that elapsed between operation and restora¬
tion of function. This variation was doubtless due to many
ea rn inst a n ces, some of which he considered. Considerable
separation about the original wound might cause the
oaniral end to undergo an inflammatory change, and inter¬
fere with restoration when secondary nerve suture was
attempted. Again, suppuration attending the operation for
anion would also interfere with the result. In a case of
neuroma of the median nerve, requiring removal of an inch
of the nerve, function was restored in five days. This was
doubtless due to accurate apposition, but soon after
erysi pel as set in, and the function of the nerve was
gradually lost again, and two months elapsed ere it was
re-established. The value of shampooing, friction, and
eiereise in promoting restoration to health was referred
tot Mr. B. Sutton, in reply, said that his patient
could perform the delicate operation of writing. He con¬
sidered this a sufficient test of restoration of muscular
Inaction.

Mr. Symons Ecclks contributed a paper on the Physio¬
logical Effects of Massage (communicated by Dr. Lauder
Braaton, F.R.S.). Four distinct manipulations are briefly
d es cri bed, and their immediate effects on the human tissues
and functions, as observed by the writer in a series of
experiments on healthy persons, are noted : Effleurage
stimulates the skin muscles, produces dilatation of the
superficial vessels and insensible perspiration, excites the
akin reflexes, and, acting through the cutaneous nerves,
increases the rapidity of the circulation and heart’s beat.
Pttrusage forces the lymph out of the muscles, increases
the velocity of the blood-current through the part, tempo¬
rarily decreases the size of a limb, and increases its muscular
power. The pulse-rate is reduced, especially in abdominal
kneading. Manage a friction produces the same local effects
as pttrusage, and is peculiarly applicable to joints. Tapote-
ment excites muscular contractions. The immediate and
remote effects of massage as a combination of the above-
aame d manipulations are: that the texture of the skin is
improved, the sense of locality is increased, the general
body temperature is raised, and the free surface tempera¬
ture of a part under massage is higher than that of the rest
of the body, while abdominal massage decreases the surface
temperature of the extremities. A course of massage of one
mouth’s duration increases the body weight, the appetite,
muscular strength, and ability to sleep and work well.—
Dr. Hermann W ebf.r thought the paper of great value.
Medical men should themselves superintend and instruct
in the treatment, which has often been wrongly used, as in
care s of rheumatic fever, acute joint inflammation, acute
sribti ca . and other affections.—Dr. W. S. Playfair said that
the paper was one of great value. He had taken, however,
more interest in the forms of the disease in which massage
coold be used than in massage itself. As one remedial agent in
aoartain class of cases—neurasthenia—it was most important,
bat not more important than other methods of treatment, such
•sremoval of unwholesome domestic surroundings. He fully
recognised the importance of scientifically studying the
physiological effects of massage. Many patients put on
strrsral pounds a week. In many cases the total weight of
the body has been doubled in six or eight weeks. The proper
mltrtinn of cases for massage was very necessary. In a
few uterine cases he had seen good, bat not very remarkable,
r— Its Reference was made to a case of destructive disease
of sue lung regarded as hopeless, in which 6 st. weight
was pat on m the course of some weeks. This hyper-feeding
in phthisical cases was well worth further investigation.
He believed that any hysterical apeptic could by this
treatment be made m the course of two weeks to eat,
—imitate, and digest more than a private in the Life
Guards could in a similar space of time. It was per¬
fectly ridiculous to suppose that two years were neces-
mtj to acquire the masseur’s art. One who has not
the aptitude never would learn it. But it may be learnt in
a mouth. —Mr. W. Ha ward thought that Dr. Weber's sug-
— tkm that medical men' should have charge of cases was
highly necessary. In lateral curvature of the spine and
— tattle palsy massage Was most valuable.—Dr. Douglas
PunMimf the p atteu C Jhfttted to by Dr. Playfair showed

evidences of extensive disease in the lung. Cases in which
such a treatment could prove valuable were few in number.
The phthisis must be one-sided and past the stage of active
process, and in that of “ elimination ” with hectic, not con¬
tinued fever. The patient was unable to take sufficient
food, and suffered in consequence. It would be extremely
valuable in bringing a patient through this eliminative
period of disease. Writer’s cramp was another affection
favourably benefited bv massage. Medical supervision
was moat necessary. He had known a nurse to induce
hfematuria by rubbing, contrary to instructions, an abdo¬
minal tumour.—Dr. Arthur Gamokb said that there wan
a difficulty in acquiring all the methods of application
of massage. A thorough anatomical education was neces¬
sary in treating infantile paralysis by massage, in which
disease no method of treatment was so valuable. In
Scrivener’s palsy it was of great value. Massage could
modify the condition of internal organs. A case of severe
gastric symptoms was related, following on consolidation of
lung, winch had subsided under treatment at the Riviexa.
The gastric dilatation and functional albuminuria dis¬
appeared, and the patient gained three stone in weight. In
many cases of phthisis massage and attempted byper-feeding
would fail.—Mr. Ecclks, in reply, said his observations
dealt with healthy persons alone.

MEDICAL SOCIETY OF LONDON.

Phoephatic Diabetes. — Wound of Common Femoral Vein.

An ordinary meeting of this Society was held on Monday
last, Mr. R. Brudenell Carter, F.R.C.S., President, in the chair.

Dr. tt a.lfk introduced to the notice of the Society a
patient suffering from Pbosphatic Diabetes, and read par¬
ticulars of twelve others. These he arranged in groups
according to the classification of Professor Teissier, who
first gave a systematic aocount of the affection. Group 1.
Excessive elimination of phosphoric acid associated with
nervous derangements; three cases. Group 2. Excessive
elimination of phosphoric acid associated with phthisis;
three cases. Group 3. Kxceesive elimination of phosphoric
acid alternating with saccharine diabetes; three cases.
Group 4. Excessive elimination of phosphoric acid run¬
ning a distinct course, like saccharine diabetes, only
without the sugar; five cases. All the cases, with
the exception of two, were young adult males. The
symptoms common to all were great emaciation, aching
rheumatic pains in loins and pelvic regions, dry, harsh
skin, with tendency to boils, and ravenouB appetite;
in some cases cataract develops. In the majority there
was polyuria; in others the urine was normal in quantity,
with a high specific gravity. The urea was increased in
some cases Slightly, in others to a greater extent; but
the great feature of all the cases was the very con¬
siderable and constant elimination of phosphoric acid,
with or without increase of the other constituents of
the urine— a feature which distinguishes it from insipid
diabetes on the one hand and azotnria on the other,
with both of which it has been improperly confounded.
The pathology, Dr. R&lfe thinks, depends not so much
on increased metabolism of nervous matter as on de¬
fective nutrition, so that the tissues are not able to
utilise the phosphorus brought to them, and conse¬
quently a greater amount passes through the system daily.
In thoee cases, in which an excessive excretion of phos¬
phoric acid replaces saccharine diabetes, it is probable that
acids like oxy-butyrie-glyoollic, &c., formed by imperfect
oxidation of the sugar, dissolve out the earthy phosphates
from the tissues, which appear in excess in the urine. As
regards the prognosis in these cases, it is most unfavourable
in the first two groups; country air, massage, cod-liver oil,
may for a time do good, but the patients rapidly fall back,
and either are carried off by some acute attack proving
fatal in their exhausted condition, or drift on into phthisis,
or into diabetes mellitus. The prognosis of the last two
groups is much more favourable: or the three cases re¬
corded in Group 3, two got completely well; the third still
suffers from saccharine diabetes, but it remains in a mild
form.—Mr. W. A. Mkrsdith and Mr. A P. Gould made
some remarks. In reply to Mr. B. Carter, Dr. Ralhb said
that there was only the volumetric method, uranium nitrate
being the agent used to precipitate the phosphates. Care
must be taken that a specimen of the mixed twenty-four

' 126 The Lancet,]

CAMBRIDGE MEDICAL SOCIETY.

[Jan. 15,1887.

hours’ urine is used to estimate the daily discharge of
phosphates.

Mr. A. P. Gould read a paper on Wound of the Common
Femoral Vein, which will appear in full in a future number
of The Lancet. —Mr. J. II. Morgan spoke of a case of
perforating bullet wound of the sternum, that led to throm¬
bosis of the left innominate vein and pysemia.—Mr. Mahma-
duxe Sheild doubted whether the septic processes were
directly due to the wound of the vein with the cat’s-meat
knife. He thought iodoform should have been freely used.—
Mr. Gould, in reply, said the wound went right across the
front of the vein and admitted the finger easily. Iodoform
had been dusted around the wound, but not on it. He
could not help thinking that the septic poison was intro¬
duced at the time of the infliction of the wound.

CAMBRIDGE MEDICAL SOCIETY.

At the meeting on Dec. 3rd, James Carter, F.R.C.S., in the
chair, the following communications were made:—

Abortion. —Dr. Boxall read a paper on this subject, and
exhibited the foetus and appendages from a complicated
case of miscarriage. During the tenth week of gestation,
and as the result of over-exertion on the part of the patient,
haemorrhage set in and miscarriage threatened. The patient
kept about for six weeks, butduring the succeeding five weeks
she was laid up, and ergot was given persistently. The haemor¬
rhage, however, continued, and her general health suffered.
Meanwhile neither the patient nor her medical attendant
had suspected the persistence of pregnancy, especially as
the menstrual periods had continued regularly during the
early months of gestation. An early miscarriage was sup¬
posed to have occurred at the onset of the bleeding, and the
patient was thought to be suffering from subinvolution
consequent upon it. Careful examination, however, detected
a feebly-acting fcetal heart, and the uterus was found to
reach as high as the umbilicus, and to be partially dis¬
tended with blood-clot. Two days after this examination the
foetus appears to have succumbed. The product of conception
with a great quantity of clots was expelled within the week
—i.e., at the end of the fifth month of gestation. It was then
apparent that the placenta, though normally situated, had be¬
come partially detached; the lower portion had consequently
atrophied, while the upper half had undergone a compen¬
sating hypertrophy. As regards the causation of miscar¬
riage, the author, referring to the action of ergot on the
pregnant uterus, pointed out that, though under certain
conditions ergot is a powerful oxytoxic, the drug, being
incapable of initiating uterine contractions, is in itself
unable to produce premature labour or miscarriage; more¬
over, that, apart from the various affections peculiar to the
pelvic organs of the female, the cause of miscarriage is far
more frequently the result of accident than is generally ad¬
mitted ; but, on the other hand, with respect to the syphilitic
taint, miscarriage, and especially early miscarriage, is not
so generally the direct effect of the syphilitic virus as is
supposed, and certainly not to such an extent as to warrant
a diagnosis of syphilis from one or more miscarriages when
other evidence is not forthcoming.—Dr. W. Duncan thought
the case reported was a good illustration of the importance
of making a careful abdominal examination. He agreed
with Dr. Boxall in thinking that early abortions were not
nearly so frequently the result of syphilis as is stated in
books; but at the same time he had seen caeesin which thesys-
tematic employment of anti-syphilitic remedies, both before
impregnation and during the whole period of gestation, had
been attended by the happiest results. • Dr. Duncan con¬
sidered that. absolute rest in the horizontal posture, with
exhibition of opium provided there were pains, was the best
treatment for threatened abortion; but if there were no
pains whatever, and haemorrhage only, he had found that the
administration of five or ten drops of the liquid extract of
ergot every three hours was of the greatest service.

Oystic Ovaries removed for Dysmenorrhea. —Dr. William
Duncan showed the ovaries, studded with cysts, which he
had removed from a young woman, aged twenty-three, on
account of intense dysmenorrbma, from which she had
suffered ever since the onset of the catamenia. She had
been subjected tc various treatment in different hospitals—
vix n blistwM'to ovarian regions,division of the cervix, intro¬
duction •feStem pessaries, puncturing the cervix, &0.;—and
all to no?effects Br. Duncan kept her in the hospital for a
■couple of months, with the daily use of the hot douche; but

at the end of that time he recommended abdominal section,
having first carefully explained to the patient and her
mother what it was proposed to do. Six months subse¬
quently she was perfectly well and absolutely free from
any pain. The various conditions which demanded the
operation (removal of ovaries and tubes) were then discussed.
Dr. Duncan considered that it was perfectly justifiable in
(a) chronic disease of the ovaries and tubes, especially
where there is a history of antecedent pelvic inflammation
and a prolonged course of other treatment has proved of no
avail, and (6) in excessive metrorrhagia due to uterine myoma
which is threatening the patient’s life, and where the meno¬
pause is not likely to ensue for some years. Dr. Duncan
disapproved of the operation in hysterical epilepsy.

Hcematocclc from a Ruptured Graafian Follicle. —Dr. Wwr.
Duncan showed a specimen consisting of a left ovary with
a hajmatocele due to a ruptured Graafian follicle and limited
by a piece of omentum. The right ovary contained a cyst
about the size of a walnut, which had been ruptured. The
patient from whom they were removed had been under Dr.
Duncan’s care in the out-patient department of the Middle¬
sex Hospital for about a year. She was a married woman,
aged twenty-six, with three children, the last two years old.
Since list confinement she had suffered from pelvic pains of
the usual kind, accompanied by menorrhagia and much
dysmenorrhoea. On examination, an elastic, elongated
swelling, about the size of a tangerine orange was felt
to the left of the uterus, and it was thought to be
probably a dilated Fallopian tube. The condition locally
remained exactly the same during the whole time the
patient attended the hospital, but her general health was
much deteriorated. She was advised to submit to operation,
to which she consented. Abdominal section was performed
by Mr. Bland Sutton, who had no difficulty in removing both
ovaries and tubes, together with the hajmatocele and sur¬
rounding omentum. The patient made an uninterrupted
recovery.

ACADEMY OF MEDICINE IN IRELAND.

Placenta Prcevia.

A meeting of the Obstetrical Section was held on
Nov. 26th, 1886.

Dr. Fleming read a paper on the Etiology of Placenta
Prcevia, and then went on to enumerate the various ideas as
to the source of the blood, giving as the most feasible that
of Schroeder—namely : 1. That uterine contractions impel
the blood from the place from whence the placenta has been
separated. 2. That from the separated portion blood circu¬
lating through the chorion villi becomes lost. 3. That un¬
guarded examination may lacerate the placental tissue and so
cause foetal hcemorrhage. The separation of the placenta is
most satisfactorily explained as follows:—1. Owing to its
formation the placenta cannot adapt itself to the extension
of the organ. 2. It is unable to retract with the cervical
zone during labour, the membranes being still intact. With
regard to the treatment, until within recent years the obste¬
trician’s choice was limited in the early stage, before the os
was much dilated, to the following methods:—1. Plugging
the vagina, which is ineffectual, andmcreases the risk of sepsis.
2. Forcible dilatation, version, and immediate extraction—
fraught with extreme danger to the mother, as it increases
tenfold the risk of post-partum haemorrhage, owing to
laceration of the soft parts. 3. Forcible dilatation and
extraction by instruments; this method is, of course, open
to the same objection as the last. 4. Separation of tha
entire placenta; this certainly controlled the haemorrhage,
but inevitably destroyed the child. Dr. Fleming then drew
attention to the methods adopted in the Rotunda Hospital
for several years past. 1. The membranes are Tuptured if
the presentation is normal. This acts by allowing the
placenta to retract within the lower segment, and by causing
the presenting part of the fostus to act as a plug. This is
sufficient in a large number of cases. 2. Intero-external
version is performed, a leg is brought down to act as a plug,
and expulsion by natural efforts is waited for or aided very
cautiously when the os is sufficiently dilated. Expulsion
may not take place for a considerable time. The advantages
claimed for this treatment are— (a) it abolishes the use of the
tampon and lessens the risk of sepsis; (b) it allows early
operation before much blood has been lost; (c) it arrests
haemorrhage; (tJ) it enables the patient to rally, gives the
os time to dilate, and lessens the risk of post-partum

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REVIEWS AND NOTICES OP BOOKS.

[Jan. 15, 1887. 127

bmmorrhage from lacerating the cervix or vaginnl soft parts.
3. In some cases—when everything favours extraction, such
•a a well-dilated os, and head low down—delivery is some¬
times practised with forceps; and, in other cases, it is found
necessary to diminish the calibre of the head by perforation
aad extract rapidly. With reference to the statistics of the
cases occurring in the Rotunda Hospital for the past three
years, ending Nov. 3rd, 1586, 4514 coses were delivered during
«He period, and in this collection twenty-three cases of
placenta pnevia were observed in whioh there was a
maternal mortality of four deaths, three ol which were
complicated with other serious affections, such as pleuro¬
pneumonia, sloughing fibroid tumour, and multiple fibroid,
preventing contraction subsequently; and one patient was
a a collapsed state when admitted. Out of these twenty-
three cases eleven infants were lost.

▲ short discussion, in which Drs. More Madden, Byrne,
Kidd, and Mason joined, followed the reading of the paper.

WOLVERHAMPTON AND DISTRICT MEDICAL
SOCIETY.

At the meeting on Thursday, Dec. 2nd, 1886, Dr. S. A.
Smith, in the chair.

Dr. Evans showed the spleen and kidneys from a case of
typhoid fever characterised during life by extremely high
temperature and treated by cold packing. The organs con¬
tained numerous infarcts of various ages. The spleen
contained an abscess with ill-defined walls.

Mr. Gouoh read a paper on the Use of Axis-traction
Forceps in Midwifery. He described the object, mechanism,
method of application, and special advantages of these
forceps, and showed that their superiority was not merely
confined to the simpler forceps cases, bat was of the greatest
▼aloe in face, brow, and occipito-posterior cases, and
occasionally where the after-coming head is arrested at the
brim in breech cases. He felt sure that as the old-fashioned
straight forceps gave way to the double-curved instruments,
*o would these eventually be superseded by axis-traction
forceps. _

anb Balias of Books.

Lecture* on Medical Pathology. By H. Gawen Sutton,

M.B., F.R.C.P. London: Baillidre, Tindall, and Cox.

1886.

¥b must be grateful for any contribution that tends to
present our conceptions of disease in & new light, for there
Is no denying that our pathological ideas are much restricted
by the habit of dwelling upon the proved facts of morbid
lesions rather than on the functional derangements which
underlie them. Therefore a book like the present is of
great value both for what it contains and for what it
suggests, awakening thoughts upon trite subjects and pre¬
senting familiar facts in a new guise. These lectures,
moreover, which have been published from stenographic
reports, possess a freshness and a spontaneity which distin¬
guish them very agreeably from the cold formalism of the
set treatise. Dr. Sutton is not only a physician, but a
philosopher, and, if such a combination be allowed, a poet
also. At any rate he exercises freely the imsgination of
the one mingled with the reasoning of the other. And the
whole is welded by the practical mind of the physician, who
deduces from the facts of pathology the lineB of sound
treatment in disease. The lectures traverse a wide field, but
they forma connected whole; the same thought runs through
them of the nature of disease, and the student is constantly
reminded of the influences which act on the organism
from without as potent factors in the derangement of health.
Asm it not a page that is not readable, and often one meets
vrtth a phrase or sentence that deserves to be recorded as an
ifto/Mism, embodying in s few words the sum and substance
of t psttalogical idee.' It seems to us that such a work is
be dealt Wftfcby the captious pen of the critic.

It is rather to be accepted with gratitude for the thoughts
it contains and the facts on which they are based ; and he
would be bold who would venture to dispute the latter,
however he might differ from the former. The simplest and
best course, then, for us to take will be to select, almost at
random, a few passages, so that our readers may judge for
themselves of the style and matter here presented

“By pathology is meant ‘a knowledge of suffering and
disease.’ Then comes the question : ‘ What is diseases The
great power of nature, unhindered by human ignorance, is
always acting 'easy'; this is seen beyond dispute as we
study the human body in the construction of the joints,
serous surfaces, the heart and vessels; but we in our igno¬
rance hinder the working, and bring about uneasiness, dis¬
ease, incapacity—and that is the origin of pain.” (Page 1.)

“ There are many causes of disease; we can never say there
is odo cause of disease; therefore it is exact to say * This
disease has arisen in these conditions.’ As much as possible
in thinking about pathology, endeavour to get rid of the
word * cause.’ ” (Page 3.)

A striking statement in these days of etiological research!

“ Blood-circulation is carried on by light and heat, and
both are rhythmical.” (Page 6.)

“ Experience has shown beyond all question that acute
inflammation does not supervene in the healthy body. What
are the facts which have led to this conclusion? It has
been noticed for many years that when death results from
acute inflammation there has been antecedent disease, and
the exceptions are so few that we cannot but consider that in
these we have overlooked the antecedent disease.” (Page 10.)

Again, in & few words—but the whole passage is too long
to quote—the author sketches the nature of phthisis, and
brings into prominence the contending views of its pneu¬
monic or tubercular basis. “ The best way,” he says, “ of
regarding phthisis is to recognise that there are external and
internal morbid actions taking away the health and sub¬
stance of the body.” (Page 38.)

Here is a remark on bronohitis which illustrates the
doctrine held by Dr. Sutton upon inflammation, as quoted
above: —

“I know nothing about bronchitis produced by cokl in
healthy people. Some would say, * Don’t you find primary
bronchitis in children?’ When 1 have found bronchitis in
children, I have usually been able to trace rickets, struma,
or tubercle. Idiopathic bronchitis I know nothing about.
Further, ‘Does not bronchitis usually prevail in the wet and
cold weather of spring and autumn, and is it not produced
by those conditions ?’ Yes, no doubt that is so; but it is in
persons who have clear evidence of other disease.” (Page 71.)

And many will confirm the truth of this statememt—viz.:
“ Usually persons recover from acute pneumonia, if there be
no antecedent tissue degeneration of the lung, extreme
blood-poisoning, or violence.” (Page 82.)

The lecture on Heart Disease opens with some good
advice as to the dealing with persons who have valvular
mischief, but in whom the heart is acting with perfect ease
and regularity. “ So long as the heart is able to carry on
the circulation and breathing, whatever sign of damage we
may find in the heart, we must avoid discouraging the
patient.” (Page 84.) Elsewhere, too, we are constantly
meeting with shrewd practical remarks which are well worth
bearing in mind. Take, for instance, the following, with
reference to dietetics and dyspepsia:—

“I nsed to be in the habit of saying people ought to ‘eat
properly’; that they should only eat every three or four
hours; they should not eat between meals; they should eat
and live by rule. But year by year many poor creatures com¬
plained dreadfully of their stomachs, ot its sinking, and they
became so miserable that their days were almost unbearable.
The big bell of Westminster tolled hourly on—that is, pro¬
perly, and their times for eating were regulated accordingly.
But as I grew older I looked at the animals, and they were
eating and eating, and evidently whenever they could. I
learnt at last to tnank Heaven that I and others had been
made as animals, and with use of reason. Let people eat
when it is necessary, let them take food when they want it.

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J28 The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Jan. 15,1887

The stomach proceeding with healthy digestion is an
immense encouragement to the human mind.” (Page 123).

We could multiply quotations from this truly fascinating
book, but must for obvious reasons bring them to a close
in the hope that those we have given may send many to
peruse and think over the pages of the work themselves.
To show, however, the poetic side of the author’s teaching,
we may conclude by, a quotation from the lectures on
Kidney Disease, when, after speaking of oedema and its
association with impoverished blood, he goee on to say:—

“ Again, let us recall that removing oedema by heat, when
oedema was most extreme, has demonstrably on the whole
been a failure ending in death. So we have been brought
to see that colour in the human circulation, as in the
vegetable circulation, is significant of power, simply speaking,
of immense power; and we have to recall that colour is
due to light, and that the blood owes its colour to light;
and that the activity of blood, and the greatest activity of
respiration, with its influence on serous circulation and
general nutrition, prevail aild are manifested when light-
energy is most powerful on th^ earth—in daytime and in
spring. And it is beyond question that in anaemia there is
failure of respiration in consequence of the corpuscles of the
bloo^ being deprived of colour (light) energy.” (Page 170.)

And he goes on to point out how plant and animal life
is dependent upon light, in passages of much power and
beauty, so that one is tempted to say if this be fancy it is
fancy controlled and founded on actual scientific fact.

The Refraction and Accommodation of the Eye and their
Anomalies. By E. Landolt, M.D. Paris. Translated under
the Author’s supervision by C. M. Culver, M.A., M.D.
With 147 Illustrations. Pp. 600. Edinburgh : l'oung J.
Pentland. 1880.

Tara is undoubtedly the most exact and the most com¬
plete treatise on the difficult subject of the refraction and
accommodation of the eye that has hitherto appeared. We
have every reason for commending the efforts of Mr.
Hartridgeand others to familiarise students with this branch
of ophthalmic practice, but their works are at most rudi¬
mentary and are intended only as introductions to its fuller
study; but in the work before us we have as precise and
complete an exposition as it is possible to give in the present
State of science, and there are probably few amongst those
who are regarded as professed ophthalmologists who will
not derive advantage from, a careful perusal of Professor
Landoltfs well-written and thoroughly practical work.

In bygone times it has been sufficient to enable a man to
take a high, if not the highest, rank as an ophthalmic
surgBon that he should have had, and should have availed
himself of, the large opportunities afforded by a special
hospital to acquire a practical knowledge of the principal
diseases of the eye, and some degree of expertness in the per¬
formance of the ordinary operations. In future something
more than this will be demanded of the accomplished ophthal¬
mologist. He should be well grounded in mathematics, and
especially in that branch which deals with optics; and be
should be perfectly familiar with all that physiology has to
teach, which, as the last edition of Funke’s Physiology
showB, is not a little., He may then hope to deal successfully
with some of those forms of defective vision which other¬
wise present insuperable difficulties to the mere empiric. If
there-ware any additional reason to be assigned for the
special study of physiological optica, it wonld be found in
the Sf&tkment made by Professor Landolt, that at least two-
thirds of the patients who consult an oculist suffer from
.optical disturbances.

. The volume before ub is divided into three parts: (1) the
physical portion; (2) the theoretical portion; and (3) the
OlinibttI portion. The first portion deals with refraction,
Idle n&tttTe ind'action of lenses, the formuhe for their refrac¬
tion, 4nd the dioptrics of the eye. The second portion
treats of the mechanism of acoommodatlon, its measure and

amplitude, the nature of the chief defects of refraction,
and the methods in use of determining the refraction and
accommodation of the eye, a special chapter being devoted
to astigmatism. The last part is occupied with the more
practical side of the subject, with the therapeutics of the
chief defects of vision, and the physical means by which
they may be corrected. The large number of illustrations,
which are excellently drawn, adds greatly to the value of
the work. As might be expected, all recent physiological
data recorded in the Archives of Ophthalmology and the
various ophthalmic journals are well and accurately given,
and the author has specially dwelt upon the relations
existing between accommodation and convergence.

In conclusion, it is only requisite to state that the trans¬
lator—Dr. C. M. Culver, of Albany, U.S.A.—has performed
the work of translation in a very creditable manner, and that
the English presents few or no indications of French pecu¬
liarities or idioms, though, from the time that has been
occupied in the accomplishment of his task, Dr. Culver must
have worked with remarkable assiduity.

OUR LIBRARY TABLE.

Evperimental Chemistry. By Dr. Stockilardt and C. W.
Heaton. New Edition, revised. London: G. Bell and Sons.
1886.—This book is intended as a guide in the study of
experimental chemistry under difficulties. The difficulties
consist in the student's not having elaborate and expensive
apparatus. The work has been for many years before the
public, and has unquestionably proved of service to those
students who, in spite of limited means and opportunities,
are anxious to acquire some experimental knowledge of
chemical science. ■ Mr. Heaton, in producing a new edition,
has retained the old methods of Dr. Stockhardt’s principles.
Many new details have been introduced in the revised
edition. Although written in a popular style, there is
nothing that is not in harmony with orthodox chemistry.
The first two chapters give a good outline of chemical
physics freely illustrated by simple well-described experi¬
ments. The third chapter gives an account of the funda¬
mental laws of chemistry, and explains clearly the atomic
and molecular hypotheses. The other three-fourths of the
book deal with chemical elements—non-metallic, metallic,
and organic. The book is neatly got up, and is of convenient
size for holding in the hand. It has been carefully edited.

Outlines of Lectures on Physiology, with an introductory
chapter on General Biology, and an appendiv containing
Laboratory Erercises in Practical Physiology. By T. W kslev
Mills, M.D., L.R.C.P. Pp. 200. Montreal: W. Drysdale
and Co. 1886.—This work contains the headings of the
lectures delivered by the author for the five past years
in the M'Gill College, and will prove serviceable to the
students attending Dr. Mills’ lectures, but are of compara¬
tively little service to others. We give an example which
will allow our readers to judge for themselves. Under the
head of gastric secretion Dr. Mills has the following:—
“How obtained. Fistulse. Flow only during digestion.
Physical and chemical properties of the secretion. The
ferment is pepsin. The acid reaction is owing to HC1 present
to the extent of 0 - 2 per cent. The HC1 is free. The presence
of butyric, lactic, and other acids is traceable to fermenta¬
tion. Quantity of gastric juice; variations during digestion.

St. Thomas's Hospital Reports. New Series. Edited by
Dr. Gulliver and Mr. Clutton. Yol. XV.— The longest and
perhaps the most intesting article in this volume is an out¬
line of the history of Art in its relation to medical science,
the substance of an introductory address delivered at the
Medical and Physical Society of St. Thomas’s Hospital, in
Oct., 1885, by Mr. William Anderson. There are also further
records of surgical experience by Mr. Le Gros Clark; medical
cases in which two or more aneurysms were present, by
Dr. Sharkey; some cases of neuroraphy or nerve-suture, by

Google

Die

Tuk Lancet,]

POST-MbRTEM IRRITABILITY 6 p MUSCLE.

?ir William Mac Cormac; osteotomy of the femur'for the
relief of deformity caused by ankylosis of the hip, by the
woe surgeon; obscure nervous affections in children, by
Dr. Hadden; sanitary science, by Dr. Ed. Seaton; cocaine in
•bwiUl practice, by Mr. C. £L Truman; some aspects of the :
vaccination question, by Dr. Robert Cory; results of pre- |
prostatic puncture of the urethra in forty-six cases in which i
the operation has been performed in the hospital during the |
past few years, by Mr. G. H. Makins; coses of perforation of j
the vermiform appendix, by Dr. M. H. G. Mackenzie; surgical |
cases, by Mr. Charles BallaneO; nerTe-stretching for nau-
nlgia, by Mr. Bernard Pitts; neurectomy of second division
d fifth nerve, by Mr. IL H. Clutton; museum report, by
Mr. Shattock ; and reports of the obstetrical, medical,
rirgical, and ophthalmic departments, by Drs. Cory and
Hidden. and Messrs. W. IT. Battle and G. D. Johnston.

Alpine Winter in it* Medical Aspect* .- 7 trith Note * on
Iktrxtt Platz, Wiesen, St. Moritz, and the Maloja. By
A. Titckieh Wise, M.D. Third Edition. Pp. 138. London:
Lharchill. 1886.—This appears to be merely a reprint of
the second edition, published, J,ast year, with the addition of
the meteorological observations taken in the Maloja by Dr.
'Vise from the 7th November,'1885, to the 2Yfli March, 1836,
and a few unimportant alterations in the description of the
summer attractions in’ the' nelgtrbourtiood of the Maloja.
W e cannot commend; the insertion at the and of the book
of four pages of lafidpftory notice* of tbe pfevloua editions,
called from the newspapers. - ,

1 duet rated Lectures on Ambulance Work. By R. Lawton
Eberts, M.D. Second Edition, with Illustrations, pp. 170.
London: Lewis. 1886.—This is' a edition of Dr.
Egberts’ excellent work. Hd has added to it a brief Sketch
of Military Ambulance Organisation, based bn materials fure
mabed bo him by Dr.Bratfcand the Army Medieal Regulations.
We rspret to say that we do not think this has in any degree
*dded to the yalue of the book, which was originally drawn
rp as & practical handbook for the use of the working classes,
reenable them efficiently to give lmtnediatehelptotheihjured
in cnees of accident. If all the extraneous matter ‘were cdt
oat sod a cheap edition published for the use of the. working 1
portion of the population, for whom the laotunes -were origi¬
nally prepared, it would; fprm,.» valua^lje.addii^eq.fcQ th^
work* on the subject of first aid to th? wounded. M . .

Ambulance Lfptures, to which is added a Nursing Lecture.
By John W. II. Martin, M.D. With Illustrations. . Pp. 120.
London: Churcbili. 1836.- 7 This addition to the list of
puMbbe*! lectures on ambulatice Work sedms fairly Adapted
to the purpose iot vBdh it Was originally' intended, of pro¬
viding “nw fcro ncp book of immediate aid to the in jmred/’
but we would scarcely accept it also “as.a .guide to .thppp
Liu-ading to ©ve ^uph lectures." The lecture on Nursing
aught be improved without much trouble. In describing
the method of changing the upper sheet in abed, instructions
ire given bow to Blijj in the clean sheet, but hot a word as to
the removal of the dirty onO. . Her is shytiling Mid *8 to
tls n o n B low method of pitting-steals am the ifisejtty. means
of email paper bagf.i We. wooder where.;the author:found
the statement tbft fbe, .appienta na,med.irom / rt £ 9 , 5a~ji.
:be ‘ Hor® Fatae* or hours of-fate,” . ;;

Dictionary of National 'Biography. " Edited' by Leslie
8 r»prfEN. Vo!. IX. London; Smith, Elder, and Cd. —This
volume contains biographical notices extending from Chfaotte
to Hi slang. Ita content* show no falling off divfceoulfccy
•ad oompletenoM, so far as.-by a critical examination, we
have been able to discover, from those of the previous
volumes, of which we have on all occasions spoken with
praise. When completed the Dictionary will be well-nigh
invaluable.

‘Ow Young TxuKe*? by Miss Lujxih Harris (London,
Walter Scott), contain* tmefa useful and pertinent advice

[•Jan. 1$, '1837:' 120

to the class of readers for whom it is intended. There is
much sound sense in the suggestions offered to young
persons of the gentler ?ex, who jvould' do well* to take to
heart the somewhat sharp, though not unkindl^, criticism
which pervades the pamphlet. ._

POST-MORTEM IRRITABILITY OF MUSCLE.

To the Editors of The Lancet.

Sirs,— Perhaps the following short account of post¬
mortem irritability of muscle, observed ih a yOung Hindoo
two hours after death, might be of sufficient interest to
merit insertion in your columns.

A young Hindoo, aged twenty, was admitted into out
wards on Feb. 23th, 1886, and died on Oct. 3lst of phthisis
pulmonalis. lie was a remarkably thin and weakly-looking
individual; but although he had a decidedly, phthisical
aspect, and suffered, from cougb, general emaciation, and
diarrhcea, no dulness was perceptible on percussion of the
chest walls. The post-mortem examination revealed a large
vomica with infiltrated edges, situated at the root of the
left lung, which sufficiently accounted for our inability in
detecting any marked alteration on percussion. Numerdus
small abscesses were also found throughout the sntn
stanoe of the left lung. The intestinal walls werp p£ ja.dul]
clay colour. A most peculiar phenomenon in connexion
with the voluntary muscles, however, more 1 ^Specialty
attracted our attention. About, two hours after death had
taken place, one of our students, who was inspecting thq
body,percussed the pectoral region,and, to his great astonish-*
menfc, not,iced that the touecles responded most energetically
to the stimulus conveyed by the percussing finger, and con¬
tracted very promptly. On examining, the muscles, I was able
to produce most vigorons contractions of the biceps and
flexor muscles of > the arms, the pectorals, tbs/sterna*olaidot-
mastoids, the nuts severs and temporals, and also of the rectus
femoris and other muscles of the lower extremity. - The
biceps and pectorals, especially, responded very promptly,
and the contracting muscular fibres of .the biceps in spue
instances rose to certainly half an inqh above the level of
the quiescent portion. The muscular substance itself wah
very soft and doughy Ito.the feel, and' of s pink' colour.
Although I havewery frequently seen a,stimulus call foyt^
fibrillary muscular contractions ..in emaciated persens
buffering from phthisis,’I havtf iifcvbF before observed irhb
same phenomenon in ouch a remarkable degree of intensity
.on the body of a person in whom life had already been
extinct for two hours, and I'should be fiiuch interested to
know if this post-mortem pbehomhnon is common 1 In c«*ei
in which! the patient, hue very. -succupibed tOvP

chronic exhausting disease. . Perhaps I should also add
that the temperature at the tiffie these observations Were
made was 90^ F., and that tbs i timet of, tile year Was what
is.here called-the 2 d.ry season.’’.,. ., j ,
I am, SirsA’oitrs truly,

1 .; re John H. SptTzxY. LiR.C.P., M.R.O.S. Eng. I

1 ,, MHitW Hospital, fPfcraHuwlbO, SuriJj^m, Ifov. 30tU, )$<#}. ; ,, ; ■,

n ~ : T . ,’i i. . 7

i “UNUSUAL CASE.OF ORBITAL TUMOUR."

, To tM Editors gf The Lancet. >f ,. i( .

Sirs,—U nder thU heading Mr. T. H. Bickerton in youy
issue of Dec. 11th, publishes a very interesting case of
orbital tnmour, much resembling one fully described' ik
“ Eriehsen’s Surgery ” (last edition ). 1 The tumour; however,
*malignant larooma, was removed by Mi, Heath;: and again
enormously ide.velcqied, ppnatifiting. the ethmoid, froutal
cells of frontal bone, nares, and pharyDX, the patient (a
‘kelatiVe of tny owb)'dying at the age of twenty-one, having
-suffered from tho age «f four years; when several ,-poiy pi were
fenioved from, the nose. L Previously to death,pcoptosis of the
right - eye amounted to about three inches, and df the left
about five tndtiee, having the appearance of an eye'fixed bn
a tumour the size of a cricket-bail. Sight was perfect in the
right and fairly normal in the left—a remarkable feature,
considering the necessary enormons amount of lengthening
of the optic nerve. The brain was clear even at bar death;

. . I remain, Sirs, yours,truly,

W, C. RocklikFe,

January, 1887. Ophthalmic SUrgaon, Hull Royal Igflnrtuuy.

O

130 The Lancet,]

CHOLERA IN EUROPE DURING 1886.

[Jan. 15,1887.

THE LANCET.

LONDON: SATURDAY, JANUARY 15, 1887.

Ant complete or accurate account of the cholera epidemic
of 1886 will be impracticable until official reports on the
subject have been issued by the Governments of the
countries concerned. But the statistics issued from time
to time from official Italian sources have proved during the
two previous years to be in the main correct, and, in so far
as they have erred, it has not been in the direction of
exaggerating the extent of the previous prevalences. The
1886 returns, which we are now able to summarise, may
therefore be taken as affording a fairly true account of the
diffusion of cholera in Italy. As regards Austria-Hungary
the matter is different, for whilst reasonably regular
returns were received from some parte of the empire,
only the vaguest rumours were made public as to the
extent of the disease in many large provinces. Subject
to the limitations here indicated, it will, however, now be
possible to give some general account of the diffusion of
cholera in Europe during the third year of the epidemic of
1884-86.

During the close of 1885 and at the commencement of
1886 cholera was lingering about the southern portion of
Spain and the north of France; but in neither of these
countries did it exhibit any tendency to spread as the
spring and summer advanced. From Italy there was no
cholera news during the early months of last year, and it
was not until the middle of April that the public learnt
for the first time that fifteen deaths had occurred in the
important port of Brindisi, and that the disease was rapidly
extending. Bari, a neighbouring port town, was next
attacked, and very soon it was found that cholera was also
prevailing in the city and province of Venice, and that it
was extending towards the Austrian frontier. Including
the province and the city of Veniee, 235 cholera deaths had
occurred before the end of May. With the months of June
and July the disease steadily spread, a number of additional
plaoes were attacked in the south; and in the north, whilst
the infection was persistently maintained in the province of
Venice, it had also become widely diffused in the provinces
of Ferrara, Padua, Bologna, Vicenza, and Ravenna; it also
clung with special tenacity to a number of places lying on
the low lands near and to the south of the mouths of the
Po. In these districts the disease gave evidence of further
extension during the month of August, although to the
south, at Bari, Brindisi, and in the province of Leece, there
were Bigns of abatement. But at the same time extension
also took place in the south, and at Barletta, San Marco in
Lam is, and Acquaviva the disease prevailed with great
virulence. The disease also made its way into the vicinity
of the Bay of Naples, but its progress there was fortunately
not great. Even its extension into the city of Naples was
each time controlled, and it is to be hoped that the
Neapolitans may be led to see how even one great sanitary
improvement, such as the provision of a fine service of
w%ter, probably saved the southern city from renewed

disaster. In all there had by this time been about 546
cholera deaths in Italy.

Then came the beginnings of a general abatement of tb
disease throughout the kingdom, and in the main it may b
said that the epidemic still remained confined to the sain
northern and southern districts which had been invade
earlier in the year. As October set in a further diminutio
became evident, and this continued into November, excej:
in so far as a sudden and somewhat violent outbreak e
Genoa is concerned. The movement of troops from infecte
localities into the northern port is alleged to have brough
about this extension, which caused nearly 115 deaths befor
it ceased. Forming a rough estimate of the total extent o
the disaster in Italy during 1886, it may be stated that no
less than 15,700 persons were attacked with cholera, an<
that nearly 6500 died.

In Austria-Hungary cholera appeared in the province o
Trieste very soon after the disease had established itself ii
the province of Venice, and during the month of July tb<
malady had already caused a very considerable mortality
in Trieste and its neighbourhood, and at Fiume. In th«
provinces of Trieste and I stria the disease was maintainec
throughout the whole course of the epidemic, the principa
places attacked being Trieste city, Fiume, Pols, I sola
Rovigno, Grado, G rad i sc a, and Gorizia. But the disease alsi
made its way into Croatia and Dalmatia, and a continuoui
mortality was for a long time maintained in the Croatiai
villages, the only available statistics as to which wen
statements of total deaths during specified periods. During
the month of September the important town of Raab became
infected, and owing to ite situation fears were at one timf
expressed for the safety of Vienna on the one hand and
Buda-Pesth on the other. The outbreak at Raab ceased wit!
a total of 24 deaths, but Pesth was very soon invaded, the
mortality being steadily maintained there from the middle oi
September to the third week in November, when over 120C
persons had been attacked, and nearly 500 had died. The
extensions to Vienna were fortunately quite unimportant, and
they were in each instance at once checked. Whilst the disease
was still in progress in the provinces in the north-east of
the Adriatic, the province of Carniola was attacked ; and at
Szeged in, in the heart of the empire, a serious outbreak in¬
volving some 200 lives took place. Later on, and quite into
the month of November, scattered outbreaks were occurring,
and the disease spread into Galicia to the north and across
the Servian and Roumanian boundaries to the south and
east. Accurate statistics as to this epidemic are at present
quite unobtainable. It may, however, be stated that in the
city and province of Trieste nearly 700 fatal attacks occurred,
and that it was in this neighbourhood that the disease most
persistently maintained itself. Quite up to the dose of the
year cholera was still heard of in various parts of AuBtria-
Hungary, and its reappearance there next summer is by no
means improbable.

It only remains for us to refer to a statement made
that during the later portion of the epidemic in Veneris
the disease, as then observed, bore little or no resem¬
blance to true Asiatic cholera, although it was so regarded
in official places, all deaths being included under the
heading of cholera. How far this may have been due to
the fact that with an abatement of cholera another fatal
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Tax La.vcrt,]

THE PROVIDENT PRINCIPLE AND THE MEDICAL PROFESSION. [JaK. 15,1887. 131

d mease, haring a diarrhceal character, had occurred in the
province, or that during the final stages of an epidemic
which had prevailed in Italy during portions of three
necesdvs years true cholera had lost its essential character¬
istic*, and was, under the circumstances of Europe, lapsing
into an ill-marked form of disease, we cannot as yet say.
We believe that a report on the subject will soon be forth-
coning, and it will be looked for with considerable interest
by those who desire to learn all that can be ascertained
concerning the etiology of cholera in Europe.

A obeat many circumstances conspire to make the
qvstion of medical providence on the part of the working
duses one of unusual interest at the present time. The
question is al ways one of deep interest to our profession.
Other professions can be largely dispensed with by the poorer
duses. Not so with ours. Poverty only increases the
nedieal wants of its victim®, rendering them more liable to
may infectious diseases, as well as to many seasonal ones,
dm those who are more comfortably situated. As medical
■*». are sought for by the poor, by night and day.
And, for love or for money, we have to obey the summons.
And there is no fear of getting so much money for our
wrrices by any scheme yet propounded, that we shall be
iMs to dispense with that great kindliness which has
bitbeno done so much gratuitously for the poor. But
then are special reasons why we should at present
(render the question deeply. Our gratuitous services are
»ct appreciated as much as if they were the subject of a
proper contract. The poor themselves are said to be
deaonlised by not being required to pay what they can for
redial services. The hospitals are said to be impoverished,
directly and indirectly, by doing for the poor what medical
practitioners should be paid for doing. Medical practitioners
^rrap h in bitterly of their patients and their occupation
beiag taken away by the abuse of the Out-patient Depart-
Mat of hospitals, special hospitals, and dispensaries. There
•re »«ple reasons for believing that the working classes
caa and should pay much more to the medical profession
than they do. One of these reasons is to be found in the
fact that many forking men make excellent private
patients— reasonable in their demands, grateful for atten¬
dee, aad honest and prompt in the payment of their bills.
They pay with cheerfulness bills which mock the pittance
with which industrial medical societies have lately
««rred rather than paid their medical officers. Another
proof of the ability to pay is the readiness with which the
working elaasea will expend large sums for quack medicines
which take their fancy or excite their faith, to say nothing
of tha enormous sums they waste, and worse than waste, on
drink. All these considerations and many more unite to
pre this question an urgency which it has not had for years.
It is receiving a corresponding amount of attention. As our
"•dere know, a committee was lately appointed to study it
““Hits beatings, and it has already had one or two sittings
the last on Tuesday) under the presidency of Sir Spbxcbb
Wells, Two or three papers on the subject are before us as
writ*, (hoe, on the “ Wants of the General Practitioners
^ Pay,* an abstract of an address to the West London
Mwliaa Hljpngical Society by its president, Dr. F. U. Aldbr-
•oi.najbareed in Thb Lancet of Oct 30th, 1886; another,

the Sturge Prize Essay, on the "Causes of the Financial
Depression in London Hospitals, &c ,” by Mr. Nblson Hardy,
will be found in the Philanthropist for January. Atbird paper
is by Dr. Maunskll, whose experience of Friendly Societies’
provident medical institutions has been great, and whose
paper is entitled “ Summary Views on Medical Aid." DP.
M a unsell found it difficult to work under the hard and
exacting conditions now popular with such societies; but,
to his credit be it said, he has not allowed hia experience to
embitter him, or abate a most kindly interest in the reason¬
able settlement of this question.

We wish we could see in any of these papers a sign of the
settlement of the questions now agitating the profession.
Mr. Hardt looks chiefly to a better understanding between
hospitals and provident dispensaries, in virtue of which
hospitals shall decline most of their out-patients, relegating
them to one or other of a list of provident dispensaries that
is to be kept on the premises. There is something to be said
for this recommendation, and it would tend to help the dis¬
pensaries. In acting in this direction, though perhaps not to
the extent indicated by Mr. Hardy, the hospitals would
excite much public gratitude and create a claim for more
liberal support. But we do not see that it would greatly
diminish their financial depression. It is notorious that hos¬
pitals do not spend much money on out-patientr. Mr. Habdt
himself does not estimate the direct expenditure in this way
as more than £15,000 a year, which would not go far to
meet the deficiency which so harasses their treasurers. He
despairs of any adequate attention to this great question
from Governments which are influenced mainly by what will
bring parties into office and keep them there. But he has
hopes that the Royal Family, especially in the Jubilee year,
may bring their great influence to bear on the problem, and
relieve the hospitals of an incubus that cripples them sadly
Her Majesty the Qubbn has never been insensible to suffer¬
ing, especially among tbe poor, and if hospitals bave not
had so much direct help from her as they sorely need, it
is probably largely because tbeir wants have not been
brought adequately under her notiee. We should be sorry to
see the Jubilee misused or abused to endless indirect pur¬
poses, but of metropolitan charities that deserve to profit by
it in this glorious year we plaoe hospitals far above all tbe
rest. One of the best features in Dr. Maun sell’s treatment
of the subject is his clear recognition of the unsatisfactory
working of many so-called provident experiments, notably
those by the great Friendly Societies acting in combination
and exacting enormous labour for the lowest possible
remuneration, with the result of having to appoint chiefly
young men in urgent want of employment, who generally
resign before long, exhausted or offended by the nature
of tbeir work and the ungenerous treatment of tbeir
employers. It is fairly to be doubted whether the medical
profession on the whole was not better off before any of the
provident experiments were in vogue than at the present
moment, when providence seems another name for shabbiness.

It is singular and not without instruction to note bow
the pathological ideas of one generation, after being dis¬
carded and rejected, are often revived and flourish under a
new guise. The progress of discovery seems to bring to
light these older notions, and to prove how near the truth

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132 Thb JjANCBT,

INFLAMMATION AND REPAIR

[Jan. 15,1887.

they were in spite of the disadvantages under which their
.promulgators laboured.. It .has been reserved for these latter
-days to restore the Hunterian doctrine of inflammation,
allowance being made for wider knowledge of morbid pro¬
cesses, to its pristine condition. That doctrine for a time
.dominated pathology, but it came to be modifted and ulti¬
mately replaced by ideas based upon the facts of cell life
.and nutrition. An approximation to the teaching of John
Hontbr was made when Cohnheih dwelt on the share
-taken by changes in the bloodvessels as the essential
feature of the inflammatory process; but it was not until
-the full farce of the presence of .micro-organisms in relation 1
to inflammation was appreciated that the real truth under¬
lying Hunter's views came to be again recognised. Dr. Kahl
Rosbr of Marburg has drawn attention to the bearings of the
new teaching upon the old in a monograph which is devoted to
a clear and concise criticism of theteachings of John Hunter
and of isubseqUent pathologists (Enteundung und Htilung,
Leipzig, 1886). His essay forms a complete vindication of
‘Hunter's prescience,. and it is gratifying to note how
thoroughly the German surgeon has familiarised himself !
with the teaching of our great countryman. The keynote 1
of the essay is to show that Hunter was correct in asserting
that repair by primary union runs its course without;
inflammation, and that inflammation is not only totally
distinct from the reparative process, but is to be regarded
as & secondary complication —a disease which retards rather
than promotes repair. For a century, says Rosbr, has
Hunter's teaching upon these subjects been misunder¬
stood or wholly forgotten [with, it must be added, one notable
exception—Sir J. Paget], even by those who have claimed
to be his exponents; and the doctrine of inflammation has
been by so much oonfased and perverted. The result has
been the greatest diversity of view upon the subject. , Some
hold that callus is the result of inflammation; others that
inflammation is absent in the repair of Bimple fractures, but
Oocutb in Compound fractures from the infection of the
■Wound. Even Cohnheim, who discriminates between
infective and traumatic inflammations, does not detach
■“repair" from “inflammation." The reason for this
confusion lies, it is held, in the neglect of the study
of the etiology of inflammation. Too much attention
has been bestowed upon the process —too little upon
its cause. It Would seem that' a mere anatomical de¬
finition is inadequate. To attribute the whole series of
phenomena to changes in the vessel wall, as CouNHEmi
and Samuel did, tends to both unnecessarily limit the,
process and to unnecessarily widen it. It confines it within
the limits of vascular supply; it extends it beyond the
limits of actual inflammatory change. Virchow was nearer
the truth in rejecting the lesion as the essential factor, and
Teplacibg it by the “irritant." If by “irritant” we mean
“ microbe,’' we get the key to the etiological definition, and
the solution, according to Rosbr, of the disordered action
known to us as inflammation. Practically, the acceptance
of this view, which draws a sharp line of demarcation
between the reparative process and the inflammatory,
is of considerable value. It introduces into inflam¬
mation, as its essence, the principle of infectiveness,
'and of destructive processes dependent on the action of
External living agents. It loaves the healing process as the

natural outcome of the nutrition of the tissues—a restorative
process to be fostered and; guarded from the invasion of
those external agents which would excite inflammation in
the healing wound and derange the normal course of its
repair. Union by first intention occurs in the protected
clean wound; it is non-infective and nan-inflammatory.
Healing by second intention is complicated by the interven¬
tion of inflammation; the wound has become infected. This
is the modem interpretation of Hunter's doetrine, and the
standpoint which must be assumed in regard to repair and
inflammation. The old terms have lost their former signifi¬
cance, but the facts they described, when considered by the
light of modern discovery, seem naturally to fall into place.
Fifteen years ago HUtkr and Klbrs were the first to point
out the; importance of infectiveneaa—i.e., the interven¬
tion of miora-organisme in the inflammatory process; but
naturally such teaching could not conform with views like
CoRnheim’s.

In pursuing the subject farther, Dr. Rosbr shows that
Hunter does not say much regarding the causes of inflam¬
mation. He refers to local or constitutional tendencies as
altering the blood and interfering with primary union, and
does not consider that air itself could excite inflammation.
And we now know that he was right; . for if air be
thoroughly aseptic, it is innocuous (Zahn). Again Hunter
distinguished between inflammation and suppuration. We
now know that both are due to the presence of micro¬
organisms. Ooston found that all acute abscesses contained
micro-organisms, but did not detect them in cold abscesses;
but since Koch’s discovery of the bacillus tuberculosis,
renewed investigations have resulted in the detection of
micro-organisms in the walls of cold abscesses (8chuchardt
and Krause). It was pointed out by Cohnheim that
inflammation and suppuration con be excited by irri¬
tants injected into bloodvessels; but it is a question
whether such results can be regarded as inflamma¬
tory apart from the presence of micro-organisms. Hunter
even conceived of pus being of vascular origin, and was in
this sense as much a precursor of Cohnheim as he is of
Lister; for Rosbr points out that the Hunterian distinc¬
tion between inflammation and repair is precisely that which
governs the Listerian methods. As regards other points in
the inflammatory process in which Hunter’s observations
and opinions have been verified by the germ theory, reference
is made to the fact of inflammatory oedema and tlve allied
process of serous inflammatory effusions. It is doubted
whether in either case it is essential for the micro-organism
to be present at the actual seat of effusion; but we confess
to a difficulty in accounting on this view for the inception of,
say, a simple pleurisy. The progress of bacteriology, which has
demonstrated the presence of microbes in the pneumonic lung
and in the valvular vegetations of endocarditis, will doubtless
in time olear up this and similar difficulties; but the essent ial
principle that inflammation owes its origin to micro¬
organisms is likely to prevail. Another question of interest
is the fact of heightened temperature of an inflamed part.
Without entering into this question, which has been much
debated, and is discussed with tolerable fulness by Rosbr, it
may suffice to mention that according to this writer the
phenomenon depends upon two factors. The one ifr the old
dnd generally accepted fact of the increased vascularity of

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The Lancet,]

MEDICAL STUDENTS OP 1871-76 IN SEARCH OF QUALIFICATIONS. [Jan. 16,1887. E33

the inflamed area; the other is that it is due to the vital
activity of the microbes themselves. Here, however, we
are in the presence of theoretical considerations, which are
of lees importance than the recognition of the essential facts
which the practice of antiseptic surgery has done so much
to demonstrate—viz., that repair is not inflammation.

Tim report of the Statistical Committee of the General
Medical Council, to which we referred in our last week's
issue, contains some tables which are peculiarly interesting
just now in reference to the movement for granting degrees
to the London medical student. The figures given therein
trace most accurately the career of those who commenced
their professional education on their registration as medical
rtndenta during the period 1871-75. We regret that there
eaa be no statistics for the next quinquennium, although
comparatively few of those who began in 1875-80 will still
be without a registrable qualification, if they can ever expect
to enter our ranks. The report deals with 6403 students
who were placed on the Students’ Register during the five
years 1871-75, and classed as follows: England (London
2009, at 3133 per cent.; provinces 1111, or 17 35 per cent.),
3114), or 48'75 per cent.; Scotland 1717, or 2082 per cent.;
Ireland 1532, or 23 93 per cent.; abroad 84, or 0’53 per cent.
It thus appears that one-half of the medical students
of those years began their education in England. Of the
JI30 English students, 3-19 began in other places of study
and pupilage than the large metropolitan aud provincial
school*, or, in other words, 1 in every 9 was placed on the
register either as a pupil at a provincial hospital or as being
with a general practitioner. In Scotland only 7, and in Ire¬
land 73, thus began their medical education, and in this
respect the English student would have no mean advantage.
Commencing professional education in the country and not
at a university is practically unknown in Scotland. Out of
the total 6403 students, 4472 have registered one or more
qualifications, whilst 1931 (30 16 per cent.) have failed to
find * place on the Medical Register. The failures are thus
distributed : England S5S, or 27 50 per cent;.—viz, London
523, or 26 28 per cent.; provinces 330, or 29;70 per cent. ;
Scotland 532, or 30 98 per cent. ; Ireland 526, or 34 33
par cent.; abroad 15, or 4412 per cent. The largest per¬
centage of medical students has qualified who commenced
in l*oadon, those who commenced in the provinces come
next, then Scotland, then Ireland, aud lastly those who
begin abroad, of whom less than one-half ever obtain
a British diploma. Of the 4472 registered practitioners 607
only took a single qualification, and of these no less than
25A became M.R.C.S. Eng. and 99 L.S;A. Lond., and are now
yf ovum ably practising on one of these qualifications only.
Stogie qualifications are very much less common among
Scotch aqd Irish students. Recognising that the education
of tho student is practically completed when he obtains a
doable qualification, we are next told in what? division of the
klogd fr m each of the 3865 doubly qualified practitioners
began their education, and what proportion migrated into
nptiiar division for one dr both qualifications. The 3865
began thus;- London, 1250 ; provinces, 603; Scotland, 1099;
fra l wi, $8$; abroad, 17; qf these only 7 per cent, in Scotland
Mill fraJnUnfl remain ttflth a single qualification. The
wty clearly placed before us by the following

statistics—viz, to England, 90 out of 1185 Scotoh students,
and 53 otit of 1006 Irish students ; to Scotland, 464 out of
1481 London Btudents, 419 out of’ 781 provincial, and 494
out of 1006 Irish students; whilst to Ireland there only
crossed 21 from London, 58 from the provinces, and 12 from -
Scotland who obtained a qualification. If the analysis be
carried still further, it will be seen that of these studentflof
•1871-75, 45 from Scotland and 31 from Ireland have become
M.R.C.S.Eng.; 4.1 from Scotland and 19 from Ireland,
L.S.A.Lond.; whilst only 4 from Scotland and 3. from Ireland
have taken the L.R.GP.Lond. Of those who went to Scotland
,for qualifications, 276 from London, 227 from the provinces,
and 232 from Ireland became L.R.C.P. Ed. (against 257Scotch¬
men) ; 98 from London, 119 from the provinces, and 228 from
‘Ireland became L.R.C.S.Ed.; whilst 40 from London,35 from
ithe provinces, and 27 from Ireland qualified at the Faculty of
• Physicians and 8 urgeons of Glasgow. The only real attrac¬
tion in Ireland to those on this side of St. George’s Channel
'is the L.K.Q.C.P.I, which was obtained by 64 English
students (Liverpool and then Manchester being the only
^schools practically represented), and by 10 Scotch students,
chiefly from Edinburgh. Of Euglish students 354 qualified
at the London College of Physicians, and 502 at the Edin¬
burgh College.

, In addition to the question of relative difficulty of examina¬
tion, we cannot lose sight of the fact that the use of the title
of “ Doctor ” by the licentiates, although not really claimed,
was tacitly permitted of the Scotch and Irish Colleges, and
is used to-day by very many of these practitioners of
1871-75 on their visiting-cards and door-plates. The feeling
'of the authorities of the London College against this unfair
appropriation of a title was very strong, and most explicitly
laid down. The recent combination of the Colleges both in
!England and Scotland has made a marked difference in the
'number of London students who now seek the L.R.C.P.Bdin.-,
and it will still further affect it.

With regard to the migration fer a degree, the figures
are no less instructive. The students who entered daring
1 the quinquennium 1871-75, and obtained a double qualifloa-
jtion.have moved from one place of study to another to gwin
|an M.D. degree as follows:—From London to Durham, 11;
jto Edinburgh, 8 ; to Aberdeen, 17; to Ireland, 10. From
the provinces to Durham, 3; to Edinburgh, 14; to Aber¬
deen, 2; to Ireland, 4. From • Scotland to the University
Jof London, 2; to other English or Irish Universities, 0.

; From Ireland to English or Scotch Universities, 0.
(The only students, therefore, who migrated in search
of a degree were English students, and these, with the
exception of those going from provincial schools to Rdin-
■ burgh* were mainly from LOnddn. The Aberdeen degree
. of M.B. could then be taken after' one year’s residence, and
I this explains why so many students took a long journey into
the north. Aberdeen now demands two years’ residence,
as do Edinburgh and Glasgow, and the number of London
' students who now go there, as to Glasgow, is practically nil.
Durham has come to the rescue, and a year at Newcaetle-
on-Tyne is for the students of the past decennium a suffi¬
cient residential qualification forits degree. Tbelast calendar
( of this University shows that this short period is an
efficient attraction'to our average London students, for. out
i of 52 graduates at the M.B. examination in December, 1685,

1$4 Thu Lancet,]

SCHOOL-MADE CHOREA.

[Jan. 16,1887.

and Jane, 1886, 34 bailed from London and 2 from Birming¬
ham, whilst only 16 were trained at home. Only 36 candi¬
dates passed at the recent M.B. examination at the University
of London; so that practically Durham now guarantees the
efficiency of as many London men in a year as does the Uni¬
versity of London itself. Students from every medical school
in London are included in the Durham list, whilst only seven
schools are represented at their own University. The useless¬
ness of the University of London to the majority of London
medical students could not bs more conclusively shown.

Db. Stuboes has made out a good case. He strikes hard
against the medical ignorance of teachers, guardians, and
friends of children. A year or two ago a book was published
by a schoolmaster who advocated the appointment of doctors
to head-masterships. This no doubt was going too far in
the right direction. To all our public schools there are
attached medical officers. The Association of Medical Officers
of Schools has already done much to place before its members
certain codes of rules for uniform observance, especially in
the matter of infectious diseases. A not unimportant part
of the duties of medical officers of schools should be, and
doubtless is, care for and consideration of the hygiology of
the nervous system.

We do not suppose that Dr. Stubges' arguments are
founded on statistics favourable to the view of the pathology
of chorea of which he has been a consistent and ardent
advocate. Our contributor cannot be suspected of having
so grouped his statistics as to defend his own positions.
Yet we might urge that the school, far from being a cause
of chorea, was really a preventive of it. We might quote
many authorities to show that schooling secured immunity
from chorea, or rather that mental training was conducive
to the health and nutrition of the cerebral cortex—which
last-mentioned organ would certainly not be objected to by
l)r. Stubqb8 as the primary focus of the “ fidgets and rest¬
lessness.” We have conceded that there is truth in the author’s
arguments. The whole fault, however, does not lie in the
schooling any more than the whole truth lies in the notion
of aohool-made chorea. Eight of the twenty-one coses of
chorea attributed to schooling may have been at least partly
due to insufficient ingestion of food. The brain may have
been forced on inadequate diet, and, likely enough, defective
supply of fresh air, or, what is the same thing, overcrowd-
ng either at home or at school. Again, we must take
account of the family and personal history of each case. In
the eight cases inherent instability of the nervous tissues
may have been derived from ancestors or acquired from
actual disease. Even if all this be granted, still the school¬
ing may have been a not inconsiderable item in the actual
production of the affection. The whole causation, so far as
external environment goes, is indeed fully familiar to and
rightly recognised by Dr. Stobgbs. Family rows, drunken
violence, home cruelty, semi-starvation, the perils of the
street, may undoubtedly cause chorea in the presenoe of the
predisposing physiological (or is it pathological ?) condition
of the cerebral cortex.

The evil comes, as is wisely remarked, from the fact that
teachers do not differentiate their material in respect of
temperament, mental activity, bodily health, and home
circumstances. Mental dulness and wayward behaviour

are mostly ascribed to wilfulness and wickedness. Perhaps
in nine cases out of ten the teacher thinks that “ caning ’’
may arouse mental activity and abate abnormal irritability
of temper. When d ulness and irritability supervene suddenly
about the period of examination, it may not seem unlikely,
from the teacher's point of view, that a boy or girl may
shirk work and prove troublesome from simple idleness and
wilful dislike. The teacher ought to remember that the
examination may pervert temper and increase dulness, and
this altogether apart from the child’s control. The necessity
for proper food, clothing, and air being admitted, surely
the remedy lies not in teaching the teachers, who have
already enough to learn, but in providing competent
medical officers to inspect the children from time to time,
or to be called in consultation whenever any case of irri¬
tability and fidgetiness attracts attention.

^mtoiatians.

“He quid nlmU.“

THE WIMBLEDON SCARLATINA EPIDEMIC.

In accordance with the announcement which we made
last week, the Local Government Board have instituted an
inquiry into the epidemic of scarlet fever at Wimbledon and
Merton, and it is satisfactory to find that the inspector
appointed to this duty is Mr. W. H. Power, who is so well
known in connexion with similar investigations. It is now
believed that the first announcements somewhat exaggerated
the actual number of persons attacked; but since the in¬
quiries, which will show what was the actual amount of
disease, have only just been properly organised by the sani¬
tary authority, it would be premature to express any
opinion on this point. In the meantime we would point
to the fact that the incidence of the disease has been shown
to be directly connected with a local milk distribution, the
milk coming from a duiry-farm, and being distributed by a
tradesmau whose only counexion with the farm was that he
procured his supply of milk there. The actual means by
which the milk became infected is not yet quite cleared up.
At first sight, it appeared that it might have been due to an
actual case of scarlet fever, for the disease appeared in the
families both of the dairy-farmer and of the milk-vendor.
The precautions which were taken at the dairy-farm seem
to have made it all but impossible that the infection could
have emanated from the lad who lay ill there under the
closest isolation; and as regards the case in the milk-
vendor’s family, it appears that milk which was delivered
by his men without over having Coma near to his premises
conveyed infection just as much as that which passed
through his premises. Probably the actual dates of these
two cases of scarlet fever will go to show whether
there is any chauce of their being regarded as causes
of the epidemic, or whether they were merely two attacks
having the same cause as the epidemic as a whole. And
this consideration leads us to say that suspicion already
attaches to the cows themselves. True, they were examined
and declared to be healthy, but examination such as that
which sufficed to. detect the disease which some time since
led to the distribution of scarlet fever from the Hendon
dairy will be wanted in order to set this question at
rest. It is, however, noteworthy that the epidemic is an
exceptionally mild one. Now, this mildness of attack will
probably prove to be one of the leading characteristics
of scarlatina passing directly from the cow to the human
subject by means of milk. When Dr. Buchanan, in his
report for 1882, first drew attention to the fact that

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T MX Lakcbt,]

THE LATE LORD IDDESLEIGH.

f Jan. 15,1887. 135

evidence was gradually accumulating to show that milk
carrying scarlatina actually possessed the power of pro¬
pagating that disease at the very moment when it was
received into the pail, and that the cow herself suffered from
a disease having strong analogy with scarlatina in the
human subject, it was the occurrence of certain mild epi¬
demics of that disease which had led to this conclusion.
Tm fact that there is a cow disease having the effect fore-
; >ld has since been proved, and the mild epidemic at
Wimbledon and Merton may be another example of it. •

THE LATE LORD IDDESLEIGH.

Tdr sudden death from syncope of Lord Iddesleigh,
which occurred on the 12th inst. at the official residence of
the Prime Minister in Dowaing-3treet, under, we may
*sr, dramatic circumstances, although startling to those
around his lordship, had not been unforeseen by his
immediate friends, and had been anticipated by his medical
attendants. The incidence of symptoms pointing to such a
termination of the life of so eminent a statesman and so
listinguished a public servant may be dated from 1832, on
Sot. 23rd of which year the following reference to the
matter was made in our columns:—“ We regret to learn that
Sir Stafford Northcote and Mr. Childers have both broken
down in health, and have been ordered abroad for change
aad complete rest. We are not surprised at it. The work
whieh has devolved upon the former as leader of his party
daring the last session, and the l&te hours which were the
rale of the House, the very short intervals of relaxation, and
the renewed work and worry of the autumn session, would
be sufficient to use up the physical strength of even a
younger man.” The circumstancss attending Lord Iddesleigh’s
decease will doubtless, ere these words are read, be known to
r-ar readers, but may be briefly summarised as follows. Lord
I Jdaeleigh left his residence near Exeter on the 11th inst.
sad came to London, first to make final arrangements with
Latd Salisbury with respect to the transfer of the seals of
toe Foreign Secretaryship and afterwards to attend a meet¬
ing at the Mansion House. During his visit to town he was
theguestof Earl Fortescue, and on the evening of his arrival
appeared to be in good health and spirits, and talked with
hi* usual animation. On the following day (the 12th) he
visited the Foreign Office to take leave of the permanent
officials, and spoke most cheerfully to his late colleagues
m that department, llis lordship afterwards crossed to
1<L Downing-street, and while waiting to see Lord Salisbury
ha became faint and fell into the arms of Mr. Henry Manners,
Lord Salisbury’s private secretary, who ha<j hastened into
the room at the first alarm. Medfcal assistance was at once
■uaunaned, and Mr. Langston was early in attendance, being
doaaij followed by Mr. Hebbert. On their arrival the case
was at once seen to be hopeless. The beating of the patient’s
heart was imperceptible; he was indeed completely pulse-
1ms. He was lying on his back, absolutely pallid, and just
bre a thing . At the suggestion of Mr. Langston, hot-water
■tap es were applied over the heart and ether was iojected
into the forearm. There were no evidences of cerebral dis¬
turbance, and an entire absence of convulsive movement.
Ths restoratives administered were absolutely without
effect, and after two feeble gasps his lordship passed away
poaoafolly and without a struggle. Lord Salisbury was in
tha room. Dr. Mortimer Granville, who had previously
heenaonsolted by Lord Iddesleigh, was also summoned, but
did not arrive until death had occurred. An inquest will
aefc bo acc e ssa r y, as Dr. Granville has given a certificate
attributing death to gout, cardiac disease, and syncope.
The «ri<taira of advanced mitral disease with aortic valvu¬
lar complication had been clearly recognised. The aortic
ta*Ofe,w*a,the immediate cause of death. Few statesmen
hare bjtm so rinoorely honoured and respected by the people

of England ; and for uprightness of character, candour, and
all the virtues which combine to make, in the highest sense
of the word, a man, Lord Iddesleigh has left a name
which will not soon be forgotten.

A TRIBUTE TO ENGLISH SURGERY.

Mil. Tkalk's “Dangers to Health” has long ago reached
a fourth edition, and has baen translated into several con¬
tinental languages—Spanish, French, and German. In the
matter of the German edition Mr. Teale has been highly
honoured. The book so interested Prof. Esmarch on his
visit to England that he determined to translate it. But
soon after, he tells us in his preface to the German edition
he had the honour of an interview with H.R.U. Princess
Christian of Schleswig-Holstein on this subject, and she
at once offered to translate the work Into German,
which she speaks as well as 6he does English. Esmarch’*
preface gives an interesting account of the difficulties which
arose in getting any German publisher to undertake its
publication owing to the cost of the pictures, and from the
fact that Germans buy fewer books than the English and
French, and thateven German doctors take small interest in
these questions, German architects still less, and German land¬
lords least of all. He was wellnigh in despair, (ill on going to
the last International Medical Congress in Copenhagen, and
being the guest of a noble Danish merchant, Herr Augt.
Gam61, he and his brother, Herr Arnold Gam61, on hearing
from Esmarch the difficulties of getting the book published,
undertook to place the necessary sum at Esmarch’s disposal.
This is a very pleasant illustration of the uses of an
International Medical Congrese. We congratulate Mr. Teale
on the honour conferred on his book, by having a Princess
for translator, a preface by Esmarch, and such enlightened
co-operators as the brothers Gam<?l. The sound common-
sense of English surgery is thus seen to be appreciated
and will find imitators, as the antisepticiam of Lister has in
every country where men wish to advance in health and
civilisation. _

LONDON MORTALITY IN 1886.

A summary of the facts published in the Registrar-
General’s fifty-two weekly returns for 1886 shows that the
rate of mortality in London during the year was equal to
10 9 per 1000 of the estimated population in the middle of
the year. This rate slightly exceeded t}ie rate in 1835
(which was 19 6, and lower than that recorded in any pre¬
vious year), but was 1'8 below the mean annual rate in the
ton years 1876-85. In the twenty-seven large provincial
towns dealt with in these weekly returns, having an
aggregate population rather greater than that of London,
the mean death-rate last year was 218, and 1'9 higher
than the rate in London. Previously to 1833 the Loudon
death-rate had never fallen below 21 per 1000, whereas
in the four years 1883-86 the rate was successively
20'5, 20-4, 196, and 199. The death-rate in London
lost year from the principal zymotic diseases was 27
per 1000, and was almost identical with that which
prevailed in the preceding year. The two most striking
features in the mortality statistics of London in 1836 were
the comparative immunity from fatal small-pox, and the
further considerable decline in the mortality from scarlet
fever. Only 5 deaths from small-pox were registered in
London during la9t year, against 893 and 890 in the years
1884 and 1835. Only twice previously since the Ragistrar-
General's Returns were first issued in 1833 have the annual
deaths from small-pox fallen below 100,; they were 57 iu
1874 and 46 in 1875. The deaths from scarlet fever last
year were 688, and lower than In any previous year on
record, excepting 1841 and 1873, when they were 663 an d 645

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Di.

136 The Lancet,]

NASAL TREATMENT OP WHOOPING-COUGH.

[Jan. 15,1887.

respectively. Allowing for increase of population, how¬
ever, the mortality from this disease was lower both in 1885
and 1886 than in any previous year of which we have
record. The marked decline in the death-rate from this
disease in recent years is especially noteworthy; it was
ri3 per 1000 in the ten years 1861-70, fell to 060 in
the following ten years 1871-80, and during the first
six years of the current decennium it further fell to
0 42 per 1000. It may be pointed out that this fall in scarlet
fever mortality has been coincident with the existence and
increasing use of the isolation hospitals of the Metropolitan
Asylums Board. With regard to the other zymotic diseases,
it may be stated that the fatal cases of measles and diph¬
theria last year had declined, while those of whooping-
cough and diarrhosa showed an increase upon the numbers
in 1885. The 701 deaths referred to fever included 618 from
enteric fever, 13 from typhus, and 70 from ill-defined forms
of fever; these numbers did not materially differ from those
in 1885, but the deaths from typhus were fewer than in
any year on record. Infantile mortality, owing to the
greater fatality of infantile diarrhoea, showed an increase
last year, and rose from 156 and 1-13 per 1000 registered
births in 1884 and 1885 to 159, which was higher than the
recorded rate in any year since 1878, when the hot summer
raised it to 164. On the whole, the mortality statistics of
London last year afforded renewed evidence of constantly
improving sanitary condition, and bear most favourable
comparison with those of any of the other large European
cities. _

NASAL TREATMENT OF WHOOPING-COUGH.

A ekfinitk idea has of late gained ground as to the
nature and origin of whooping-cough. The idea may or
may not be pathologicallly correct; but the treatment
founded on it is decidedly of a rational description. What
is more to the practitioner, this treatment is said to prove
remarkably successful. Correctly speaking, the idea is
compounded of at least two factors. One of these is
fully as familiar as whooping-cough is common. Micro¬
organisms are the cause of the affection. The microbe
effects an entrance into the economy from a special site,
and that site of entrance is the soft tissues of the nasal
fossse. The rational therapeusis is founded on formula of
an equally explicit character. Antiseptics or germicides will
destroy the living germs. They should be used early, and
their sites of action are the nasal fossae. The number of
remedies already recommended is sufficiently striking. The
method at present in greatest favour appears to be in¬
sufflation. Convenient contrivances of different designs
for effecting the insufflation may be met with in great
variety at the surgical instrument makers. A clumsy but
successful insufflator may be contrived by rolling a spill of
paper, inserting a little of the powder to be employed
at the end that enters the nostril, and supplying the
motive force by the parent’s or operator’s puff of breath.
But the puff-balls or regular insufflators are effective
and not oostly. Iodoform, salicylic acid, and boracic acid
are the three antiseptics that appears to be most in
vogue. They should all be very fine, almost impalpable
powders. Naeal douches are very effective if they can
be managed, as in older and not too nervous children.
The most effectual douche of antiseptic kind appears to be
the 1 in 600 corrosive sublimate. Care is to be taken that
no appreciable quantity of this solution is swallowed. Some
practitioners employ simple nasal douches in the earliest
stages—say, a drachm of Condy’s fluid or of common
salt to the pint of water. And this is done as much
to mechanically Wash away secretions with contained
eontagia as to destroy the germs. Weak solutions of
tincture of iodine and of alum are also used. These
lotions may be syringed into the nasal 1 passages, or the

children may be induced to snuff the lotion up from
the palm of the hand. Older children may be taught
to take the powders as “ snuff.” Repeated applications of
any of these methods are necessary to ensure thorough
topical treatment in the early stages of the catarrh. The
antiseptic agents may also be applied, as in youog infants,
by means of camel-hair brushes charged with ointments,
lotions, or glyceroles. It is necessary to clear away all
secretions and scabs first, by syringing or anointing with
oil. The agent is then directly applied to the bare congested
surface of the mucous membrane. An ointment of half a
drachm each of iodoform and eucalyptol to an ounce of
vaseline is highly commended by some. The boroglyceride
may be used in similar fashion, also lotions of corrosive sub¬
limate. Any of the antiseptic solutions may be atomised by
the steam- or hand-spray, and inhalations effected through
the nostrils. It is doubtful whether the theory of this
fashionable method is correct; but supposing it should
be, it is equally dubious whether the good that results
may not be from the mere treatment of the catarrh as such,
apart from its supposed cause. A pledget of cotton-wool
or a chamomile flower placed in the nostril to prevent
the access of air alleviates the symptoms of an ordinary
rhinitis. So it may be with the various applications, the
principal of which we have mentioned. Cocaine is now
widely used as a 4 or 5 per cent, solution painted on to the
nasal and pharyngeal mucous membranes, not only in
whooping-cough, but in simple or severe catarrhs.

THE DEGREE FOR LONDON MEDICAL STUDENTS.

At the last meeting of the Medical Society of St. Mary's
Hospital, Mr. A. J. Pepper, M.S., President, being in the
chair, the following resolution was proposed by Mr. Edmund
Owen, and seconded by Mr. J. .7. Clarke: “That, in the
opinion of the Medical Society of St. Mary’s Hospital, it ia
expedient that a Degree in Medicine be placed within the
reach of the general run of London medical students; and
that this Society ventures to express the hope that this may
be accomplished through the conjoint influence of the Royal
Colleges of Physicians and Surgeons.” To this several
amendments were proposed, and fully discussed by members
of the hospital staff and by the students, but at the con¬
clusion of the debate, which had to be adjourned to a second
meeting, the original resolution was carried at a late hour,
amidst much enthusiasm, by an overwhelming majority.
This is probably the first occasion on which the London
medical students have collectively expressed their opinion
on this question. _

LONDON HOUSE DRAINAGE.

A complaint has been made by Mr. D. J. Ebbetts
against the Commissioners of' Sewers of the City of London,
to which, no doubt, the attention of this body will be
directed. Mr. Ebbetts, in a paper which he styles “ a
protest,” while giving credit to the Commissioners for the
efficiency with which the roadways are scavenged and
the sewers constructed, says they neglect to exercise any
supervision over the manner of construction of house
drains, that the builders of new houses are required to
deposit at the City office a plan of the proposed house
drains, hut that the Commissioners limit their action to
determining the size of that part of the drain which enters
the sewer, and to constructing it as far as the wall of the
house; hut beyond this they do not concern themselves.
The interior drainage and its ventilation, the use of proper
fittings, the avoidance of pan-closets and D traps, are not
deemed matters for supervision; and hence the City is
wanting in one of the most important details of sanitary
administration. In the rest of London, as distinct
from the City, ample powers are given to the earn-

ta LincxtJ

• THE INEQUALITY OF THE PUPILS IN VARIOUS DISEASES. [Jan. 15,1887. 137

u rj authorities to enforce all regulations which they
nay think At to make, but, with very few exceptions,
the subject is generally neglected, and certainly the prin¬
ciples embodied in the Model Regulations of the Local
torenunent Board, which are largely recognised by pro¬
vincial sanitary authorities, are disregarded, London so
far as house drainage is concerned is deplorably careless,
and Mr.Ebbetts’ allegation shows that the City cannot claim
any exemption from this condemnation. It is, however, only
fair to note that building operations in the City are so costly
audio well executed, that probably in new houses nearly all
that is necessary is done voluntarily by the owners. Much
difficulty stands in the way of any London improvement
swing to the numerous authorities in whom are vested the
tight to control house drainage. The Society of Medical
Officers of Health have always endeavoured, so far as the
datieeof health officers are concerned, to reduce to a minimum
the disadvantages attendant upon this division, by taking
eoansel of each other, and we would gladly see a con-
fnaoce held between Metropolitan surveyors with the
object of determining a. uniform plan which would be
accepted by all the local authorities. There appears to be
■o other method of attaining this object except that of
transferring to the Metropolitan Board of Works the duty
of regulating and supervising the planning and arrangement
#f the drainage of newly-built houses.

THE INEQUALITY OF THE PUPILS IN VARIOUS
DISEASES.

Db. Pasthrnatski, who has been working in Professor
Chodnovaki s clinic iu Su Petersbu zg, has published in the
Vraek an account of a number of observations he has been
■taking on the inequality of the pupils in various diseases,
thus c a r ryin g out a suggestion made by his chief in a work
m the methods of examining medical patients, published
it 1883, in which be expressed an opinion that careful
rumination of the pupils would lead to interesting results.
Dr. Pasternatski examined a number of methods which have
been proposed, but did not find any of them suitable for
bn purpose, and Ultimately a much simpler plan, suggested
by M. FolHn, was adopted. This consists in bringing a
catheter gauge card dose to the eye, and comparing the sire
of the pupil with the apertures in the card. By this means
tbs uxe of the pupil in millimetres can be ascertained with
a degree of accuracy sufficient for the purpose. It is
important to make the observations in the shade, for the
difference, when there is any, between the diameters of the
pnpB* increases as the light is diminished. The best
method of conducting the examination is to close the
eye which is not being observed, for this causes a
slight increase in the diameter of the pupil of the laiter,
u was indeed remarked by Hippocrates. It was found,
for example, in a case in which this was tested, that
when both eyes (being in the shade)- Were fixed on an
object at & distance, the diameter of the right pupil was
tyanL, and that of the left 6 mm.; when, however, the
cjsaot under examination was covered up, the diameters
bemused to 6 taut. and 6f mm. respectively. As to the
finesse in Which inequality of pupils has been observed,
Db Pfeateraatski quotes a number of cases mentioned by
Malinentsl -physicians; also one of aneurysm shown by
Profeasor Gshtlner to the Edinburgh Medical Society; as
»*U as two reported by Professor Finlayson in The Lancet
of Jfeauary 3rd, 1885, in both of which aneurysms were
band st the necro p s y . His own observations gave the per-
othgeof cases in which inequality was found in various
AMhats follows: EAmpOus pneumonia 85, heart diseases
toeary pktfrisy* 52, chronic catarrhal

Phbai MUa m, acute- ttdOUlaf rheumatism 25, catarrh Of
fc, : *c«r*y 10, typhus 16, recurrent

typhus (relapsing fever) 15, abdominal typhus (enteric
fever) 13. Inequality of pupils was also found in half
the cases of catarrhal and hepatic jaundice and renal
colic. The largest percentage occurred in croupous pneu¬
monia, and study of the cases showed that the position and
stage of development of the disease has a remarkable
effect upon the pupils. At the very commencement the
pupil on the same side as the affected lung is, as a rule,
larger than the other. The difference generally increases
with the lung inflammation, reaching its height on the
third, fourth, or fifth day; before the crisis the difference
decreases, sometimes even disappearing. Afterwards, during
the stage of resolution, a difference is again manifest, the
pupil on the affected side being now contracted. Not only
do the pupils in pneumonia differ in size, bat also in
sensibility to light. Speaking generally, the author’s
observations lead him to believe that inequality of pupils is
most frequently met with in those internal diseases which
not only affect the system generally, but Which, like pneu¬
monia, pleurisy, and hepatic and renal colic, are definitely
localised as well. It is also very usual in heart diseases
and aneurysm, bat comparatively rare in scurvy and infec¬
tious diseases such as typhus, and when it does occur in
these it L generally consequent on some complication.

UNREASONABLE CHARGES AGAINST POOR-LAW
MEDICAL OFFICERS.

When a Poor-law medical officer has to go nine miles to
see a patient, and goes as often aa is necessary, it is hard to
be found fault with. This was Mr. Gordon Laing’s case at
Barnstaple. Fortunately, he was able to satisfy the Board
that he had been very attentive, and that both the patient
and his wife had thanked him for being so. The case of
Mr. A. B. Jfunro of Bradford is similar. He is a district
medical officer of many yeara’ standing, and makes “a
hobby,” as all good Poor-law medical officers do, of having
their parish patients atten ded to as well aa their private ones.
Mr. Munro complains that the guardians have taken for
granted depositions in the coroner’s court forwarded to them
which “would have been denied on oath and disproved.’’
This is a short way for guardians in dealing with their
medical officers, but it is a very unjust one. The Caistor
Board of Guardians have had what one of their number
characterised as a “ storm in a teapot” over the great ques¬
tion whether their medical officer, Dr. Cameron, should
“initial on Wednesday or Saturday each alternate week, or
after the expirati on of Saturday as the close of the week.”
Surely this is a question which a body of gentlemen
could discuss quietly, even if the officer in question be, as
one of them said, a “dogged Scotchman” with his own
notions of the time for initialing books.

SANITARY CONDITION OF FLORENCE.

The Time » has recently given publicity to a number of
statements seriously reflecting on the sanitary condition of
Florence. It is impossible in the midst of much which is
contradictory to discuss this subject, but certainly English
people will be slow to visit this city until a thorough inspec¬
tion has shown that the alarm is groundless or that a remedy
has been found for the alleged insufficiencies. The outcome
ef the discuss ion is t hat Dr. Baldwin of Florence is raising a
fund to provide Florence with the advice and assistance of
an English expert,and has himself liberally contributed to the
expenaris which would be thus incurred. We trust that those
who are interested in its welfare will not relax their efforts,
and that through an impartial statement of facts the muni¬
cipal authorities may be en abled either to acquit their city
of the reproach which now attaches td it, or to render it a
safe resort f of the many who desire to enjoy its beauties.

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138 The Lancet,] DEAF-MUTE CHILDREN.—LORD FRASER ON MEDICAL EXPERTS.

[Jan. 15,1887.

PREMATURE BURIAL.

Much has been Baid and written concerning the danger
of premature burial, and the subject has even become to
some nervous persons the persistent horror of their lives.
That a few authenticated cases have occurred in which the
still living body has been by some strange oversight con¬
signed to the grave we are not disposed to deny. It is pro¬
bable, however, that the number of such cases has been
exaggerated. Too much has possibly been made of the
evidence of movement in corpses which have been exhumed.
A critic writing on this subject throws the whole respon¬
sibility for live burials on our professional brethren. This
is a sweeping and certainly an unfair judgment. He
accuses them solely on the ground that in many cases
they do not, i n order to certify death, proceed to make
an examination of the supposed corpse, and suggests that
certificates of death might be fraudulently obtained by
unprincipled attendants on the sick as a preparatory step
to murder. Now, this is one of those arguments which,
however they may sound in theory, have little, if any,
practical meaning. Medical men, we admit, do not always
think it necessary to view the body of a deceased
patient before certification. In many instances there is
no need that they should do so. They have been in
regular attendance; have ascertained the nature of dis¬
ease; have gauged its probable issue; and, finally, have
seen the actual approach of death, which in a few hours’
time has occurred, and of this they are assured on the
testimony of persons whom they know to be well principled
and judicious. Surely they are entitled in all the circum¬
stances to accept the statement as true. Where there is
doubt either as to the signs apparent or the character of
informants, it is the duty of every practitioner to inspect
the body of his patient, and any departure from this rule
must, we are sure, at all events in this country, be very
exceptional. _

DEAF-MUTE CHILDREN.

In August, 1835, Lord Salisbury addressed a circular
despatch to Her Majesty’s representatives at Paris, Berlin,
Rome, Vienna, Brussels, Berne, the Hague, and Washington,
requesting them to procure a return showing the number of
deaf-mute children in the countries where they resided, and
the nature and amouut of public aid given towards their
education, distinguishing between the sums contributed in
each case by the State, province, and commune. From the
returns which have been received and recently issued as a
Parliamentary paper it appears that in France there are
sixty institutions for such instruction, and information was
obtained respecting thirty-six. Three of the institutions—
at Parte, Bordeaux, and Chamb^ry—are under the immediate
authority of the Minister of the Interior; one is for the
benefit of Protestant children, seven are 6tyled “institu¬
tions r^gionales,” seven are departmental institutions, one
is communal, eighteen are private enterprises, but the
majority possess departmental or communal scholarships.
In Germany, at the last census in December, 1880, there
were 2900 deaf-mutes betweed five and ten years of
age, and 4409 between ten and fifteen years of age.
At that date Prussia possessed twenty-four deaf and
dumb asylums. There appears to be no uniform system
adopted throughout tfie country for the support and manage¬
ment of its deaf and dumb institutions, but it is left to the
provinces to manage their own establishments in the most
advantageous manner. The Royal Deaf and Dumb Institu¬
tion in Berlin is the only one to which the State contributes
directly. It receives pupils from all parts of the empire,
and trains teachers for the provincial institutions, this last
being a duty which devolves upon the State. In Italy, the
greatest number of deaf-mutes are between twenty and

fifty years of age. Up to the present time thirty-four
establishments for their education have been opened. Half
of them are charitable institutions under Government
supervision, three are State institutes, and the remainder
private ones. Eleven of them receive aid from the Treasury,
and others are pecuniarily assisted by the provincial and
communal administrations, as well as from private sources.
According to the returns furnished by the Ministry of Public
Instruction, there were in Austria at the census in 1880, 637
deaf-mutes under five years of age, 3390 from six to ten
years, 39.39 from eleven to fifteen years, and 3489 from six¬
teen to twenty years of age. The institutions, whiqh number
sixteen, receive considerable grauts from provincial funds,
while several are, moreover, assisted directly by the State.
In Belgium, the proportion of deaf-mutes to the rest of the
population appears to be increasing. In 1870 only 2070 were
returned as deaf-mutes, while on Jan. 1st, 1883, there were
2934 so afflicted. There are tea private institutions under
Government inspection and control, and the expenses are,
generally speaking, shared between the provincial common
fund, the commune the province, and the State, the latter
contributing a sum equal to that granted by the provincial
authorities. In the United States, as ascertained by the
census of 1880, the number of deaf-mutes was 33.878, 18,667
males and 15,311 females, orO 007 per cent, of the whole popu¬
lation. In the fifty-three public aud eleven denominational
and private schools for tho education of the deaf, tuition is
free or practically free, to rich and poor alike, and in general
the only expense incurred by the parents is for clothing and
cost of removal.

LORD FRASER ON MEDICAL EXPERTS.

On January 7th a case was tried in the Court of Session,
Glasgow, before Lord Fraser and a jury, in which a horse-
dealer claimed damages for injuries sustained by an accident
on the Caledonian Railway. The defenders admitted their
liability, and the only question to be determined by the
court was the nature and extent of the disability the pur¬
suer was suffering from. The arm was injured, and was
further affected by crutch-paralysis, but the medical
witnesses agreed that the lesions were only of a temporary
character. Tbe point on which there was so wide a dis¬
crepancy of opinion referred to the leg. Drs. Littlejohn,
Joseph Bell, and Cameron contended that “the leg was
permanently injured through rupture of a muscle, and
that the muscle had in consequence lost its contractility.’’
On tbe other side, Drs. Dunlop, Heron Watson, and Macleod
asserted that the injury was of a temporary character,
and that tbe loss of continuity of the muscular fibres would
be restored by the natural reparative process. Dr. Dunlop,
surgeon to the company, went further, and, in face of the
contention that the man could not get his foot to the
ground, submitted that tbe best thing the pursuer could do
would be to ride at a gallop on horseback. It is not altogether
surprising that to a lay individual the difference exhibited
by the medical men on the two sides as regards their respec¬
tive views of the merits of the case should appear greater
than warranted by the apparently simple nature of the
injury, and Lord Fraser must be held quite within his
rights in passing the strictures he did upon what he termed
“extraordinary contradictions and statements.” But the
practical surgeon knows it is often difficult to determine the
exact nature and the extent of an injury to a muscle. Of
course, there are some cases in which the sigos are too obvious
to be misunderstood—e.g., where there is extensive or complete
rupture of a muscle, such as the biceps brachii. The mere
fact of considerable muscular wasting is not of itself neces¬
sarily of great import. Injured muscles waste from disease, as
well as from traumatic disturbance of their innervation. The
case under discussion reminds us of Sir James Paget’s lecture

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THE FINANCIAL POSITION OF. THE UNIVERSITY OF CAMBRIDGE. [Jan. 15,1887. 139

“ On Caaes which Bone-setters Cure.” It is well known that
a man may be a helpless cripple from lesion or displacement
of a muscle or tendon, and that forcible passive movement
and rigorous exercise may, in a surprisingly short period,
restore the function of the part. We are not calling into
question the bona fid<« of the medical witnesses on either
side, but we wish to explain that the divergence of their
evidence may have arisen—and probably did arise—from
the fact that they could not accurately tell the amount of
laceration the muscle had undergone. It certainly was an
unfortunate incident that the opinions should have been
grouped as they were, those of the surgeons appearing for
the pursuer being arrayed against those of the witnesses for
the defenders. We have frequently asserted that in all
caaes of criminal action the medical experts should be
appointed by the court of assessors; and we believe that it
would be of unmixed good to the community and to the
medical profession if the same practice obtained in civil
trials. _

THE FINANCIAL POSITION OF THE UNIVERSITY
OF CAMBRIDGE.

In his address made to the 8enate of the University of
Cambridge on resigning his office on Monday last, the Vice-
Chancellor, alluding to the financial difficulties of the
University, remarked: “We need that it should be pro¬
claimed through the length of England that instead of our
University being a wealthy body we are hampered on every
aide by the want of funds. We want money for our library;
wa want money to build museums; we want money to build
lecture rooms; we want money for laboratories; money to
build examination-balls. The increased numbers of our
students show the estimate in which our teaching Btaff is
held; surely we mayappeal to the wealth of England to enable
as to accommodate these numbers suitably, to enable them
to partake, in the, to them, most convenient fashion, of the
instruction which our professors convey. I conceive that we
want at present at least £100,000 placed at the disposal of the
University to carry on our work. J udge, then, of the sorrow
with which I mentioned that our income falls short by
nearly £25,000 a year of that which it was calculated it would
be in 1886 .” _

THE FRENCH CENSU3.

Th* first official publication of the results of the French
census taken on May 30th last has just been issued, and
shows the population of France to be 38,218,903. The
previous census in France was taken in December, 1881,
when the number was returned as 37,672,048 ; the increase,
therefore, during the four years and five months intervening
between the two censuses did not exceed 546,855, whereas
in the five years of the preceding intercensal period the in¬
crease had been 766,000. It is worthy of note with regard
to the small increase of population in France in recent years
that the recorded excess of births over deaths in the four
yean 1882-85, with due correction for the additional five
months of 1886, was only 395,568, implying that between the
last two censuses the balance of immigration over emigration
was no less than 151,287. It is known that in recent years the
«mml number of emigrants from France does not exceed
5000, bat it is now apparent that the immigrants to Franee in
recent years most have averaged nearly 40,000 per annum. It
appears that the population of Paris has increased but 75,000,
whereas from the increase of the population of the Seine
department it is evident that the suburbs of the city have
gro w n far more than the city itself. The increase in the
population of Lyons, Marseilles, Bordeaux, and Lille, was in
aabh dtafe proportionately*larger than in Paris; and in the
8B te t fo ii haring a population exceeding 90,000 the
aggie£ufh IIicmn exceeded 900,000. As in England, the

towns in France have mainly increased at the expense of
the rural districts; but in France this has caused (which is
not the case in England) an actual decrease in the popula¬
tion of the rural districts. In 32 agricultural departments of
France the recent census shows a decrease of 110,000 in the
population. Of the 87 departments, 53 now show on
increasing and 29 a decreasing population, the numbers at
the previous census having been 53 and 34 respectively.
The increase of population in Brittany (mainly rural), which
has a birth-rate considerably exceeding the general rate in
France, stands out in conspicuous contrast with the marked
decrease of population in the rural portion of Normandy.
In still greater contrast is the rate of increase of population
from excess of births and deaths in England and France.
In the year 1885 the excess of births over deaths in England
was equal to 135 per 1000 of the population, while in
France in the same year it was but 2‘1 per 1000.

CHANGE OF COLOUR OF THE SKIN.

K contemporary recently drew attention to the decease
of a coloured woman at Michigan, whose case seemed to
have strangely perplexed the public, and was believed to
be without a parallel. When well advanced in years a white
patch appeared on the leg; others followed, increased and
coalesced until most of her body became white, the face
being the last to change colour. From the accounts, it is
evident that the case was one of leucoderma, a disease well
known amongst whites, but peculiarly frequent in the dark-
skinned races, though the relative frequency has been
doubted by distinguished authorities, and the impression
attributed to the more striking character of the affection.
Erasmus Wilson gave its frequency in London as 1 in 4«K>
cases of skin disease, aad in another place as 1 in 291;
according to Kaposi, it is in Vienna 1 in 500 ; but Garden, in
In<}ia, met with 1 in 33 2 cases of skin disease, and the
Bombay inquiries into leprosy disclosed a great number of
these cases. _

TOTAL ABSTINENCE LODGES AND MEDICAL
PRESCRIPTION.

Thk public has been very much shocked by a recent
County Coart trial in which a certain benefit society, bearing
the concise name of the “ Benjamin Hatfield Lodge of the
Original Grand Order of the Total Abstinent Sons of the
Phoenix,” appeared as refusing the representatives of one
of its deceased members the sum due to them on his

account, on the ground that he had in his last illness,
arising from cancer of the bowels, on the advice of all bis
medical attendants, taken medicinal quantities of alcohol.
The judge, who spoke very strongly against the Lodge,
was compelled to yield to the defence on a legal point, the
deceased having taken back his subscription. It is
behaviour like this that constitutes the intemperance
of teetotalers, and estranges so many reasonable
people from them and the cause they advocate. We
are glad to find that even good teetotalers like Dr. Kerr,
whose letter we insert elsewhere, feel as indignant at this
Lodge as does the public. In the last extremities of cancer
and exhaustion, to deny a poor creature the advantage of a
little wine or brandy, ordered by a medical man, is a piece
of senseless cruelty; and the sooner all total abstinent
benefit societies disown such views absolutely and entirely,
the better for them and the cause of temperance. There
has been far too much interference of late with the
functions of medical men. We shall never fail to point out
that their responsibilities are very great. But they are
theirs, and must be left with them, not shared by every
teetotal prophet who thinks himself an equal authority in

medicine and morals.

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140 The Lancet,]

THE MEDICAL HISTORY OP CEYLON.

REMARKABLE MAGISTERIAL DECISIONS UNDER
THE FOOD AND DRUGS ACT.

At the Sheffield Town Hall a druggist was recently
summoned under the Sale of Food and Drugs Act, at the
instance of the Health Committee, for selling tincture of
opium which was not of Hie nature, substance, and quality
of the article demanded. The deputy town clerk conducted
the prosecution. Dr. Sinclair White, medical officer of
health, proved that he personally purchased at the defen¬
dant’s shop three ounces of tincture of opium. The sample
was duly divided, and a portion submitted to the borough
analyst, Mr. A. H. Allen, who certified that “ the proportion
of opium in the sample was less than one-third of that
contained in the tincture of opium of the British Pharma¬
copoeia, While the proportion of alcohol was somewhat
more than one-half the proper quantity.” The stipendiary
magistrate said that no doubt the action of the Health
Committee was very laudable, but he was of opinion that if
a preparation contained any opium and any alcohol what¬
ever it could be legally sold as tincture of opium, and he
accordingly dismissed the case. At the same time and
place a shopkeeper was summoned under the Act for selling
paregoric elixir, which, according to the certificate of the
analyst, was “ wholly destitute of opium, the most impor¬
tant ingredient of paregoric elixir.” Mr. Allen, Dr. White,
and Mr. G. E. Newsholme, President of the Sheffield Phar¬
maceutical and Chemical Society, gave evidence in support
of the prosecution, and adduced various authorities to show
that opium was an essential ingredient of paregoric elixir.
Mr. Allen stated that the existence of paregoric without
opium was as impossible as that of whisky without alcohol.
If the preparation had no opium in it, it had no right to be
called or Sold as paregoric. For the defence a druggist was
called, who said that he supplied “ paregoric elixir guaranteed
free from opium” to shopkeepers, so that they might not
infringe the Pharmacy Act, they having no licence to sell
poisons. He could not name any ingredient of a medicinal
value that the paregoric supplied by him contained. The
stipendiary said that the name “ paregoric ” fAiled to give
him any definite impression, any more than “ soothing
syrup." The prosecutor pointed out that, for all the defence
amounted to, they might simply sell coloured water and call
it paregoric. The magistrate said he did not see that the
law prevented it, and dismissed the case. Mr. J. F.
Burnett, F.C.S., in a letter to the Pharmaceutical Journal,
states that he was present in court during the hearing of
these cases, and can testify that the reports are not in the
least exaggerated, but are, on the contrary, somewhat
underdrawn. These decisions seem to us to be so extra¬
ordinary that an application will doubtless be made for a
case .for the higher court, and we accordingly reserve our
comments. _

THE MEDICAL HISTORY OF CEYLON.

An interesting paper, giving a sketch of the medical
histtiry of. Ceylon, has been communicated to the Ceylon
branch of the . Royal Asiatic Society by Dr. Vanderstraaten,
the sketch being divided into a.re view of the Singalese, the
Portuguese, the Dutch, and the British periods. The Buddhist
doctrines early Jed the rich and wealthy to make some
provision for the destitute and the maimed, and thus
hospitals and medicine-houses came to be established.
Native practitioners of medicine also sprang up, and the
system received impetus from the example of eome of the
kings i of Ceylon who, by practising medicine, made it a
noble- calling. Portuguese priests and others brought in
more modem notions, and daring the Portuguese period
some consider able progress wAsihade. The. habit, of jMtebi
chewing is spoken of by the author as Wholesome, and the
Singalese at that time attributed th<*G' nng and healthy lives

[Jan. 15,1887.

- ■ r- ■»

to its use; men and women could also be seen who had uot.
lost a single tooth. But small-pox was an invincible disease,
and was regarded as an “affair of God.” During the Dutch,
period the Leper Asylum at Hendda was established in
1708, but the medical records of this period are very scanty,
in their information. During the British period 221,082
persons were vaccinated between 1802 and 1812, and thia
effort was so successful that for eleven years no small-pox.
occurred in the island. A striking contrast is shown between
the state of the island in 1803, and at the present time. At;
the earlier date, of seventy-five men, together with the
usual complement of officers, all fell victims to the
climate except three, during a march from Colombo to
Cattadina; whereas Dr. Kynsey is now able to report that
the average annual mortality for the whole army is only
9 per 1000. Dr. Kynsey has published some very valuably
information as to the sanitary condition and mortality ia
Ceylon, which taken together with Dr. Yanderstraaten’s
review of the earlier conditions affecting the island form an
interesting chapter in the. medical .history of Gey lorn - - t

THE WALTER MOXON MEMORIAL.

A ornehal meeting of the friends of the late Dr. Afoxort
will be held at the Royal College of Physicians on Tuesday,
Feb. let, at 5 p.m , to determine the form of memorial best
suited to perpetuate his memory. At this meeting &ir
William Jenner, who has consented to act as president of
the fund, will take the chair. Among those who havs
already given their names in support of this object sire
the President of the Royal College of Sargeons, Sir Wiiliarii
Gull, Sir James Paget, Sir Andrew Clark, Sir Thomas Adand,
Sir Henry Acland, the Registrar and Treasurer of the
Royal College of Physicians, the President and Treasurer
of Guy’s Hospital, Professor Humphry, Sir William M‘Arthur,
Dr. Pavy, and Mr. Bryant. We understand that upwards of
a hundred gentlemen have already expressed their wish to
join in this memorial, and we have been requested to state
that previously to the meeting Mr. Clement Lucas will receive
the names of those desiring to contribute.

HOSPITAL WANTS AND THE QUEEN’S JUBILEE.

If the Jubilee of the Qcteen is to bear allTthe burden that
is proposed to be put upon it, it will be heavily weighted.
The editor of the Hospital supports the suggestion of The
Times that the occasion be used for raising a million, to
yield £40,000 a year, to meet the deficiency in the income
ot the metropolitan hospitals. We certainly think that
this suggestion is much more to the point than many which
have been made. But Her Majesty’s own views have yet to
be ascertained. She herself and her own personal claims axe
entitled to first consideration. But it is to be hoped that
she will show her sympathy at a time of unprecedented
trial for these admirable institutions, which receive no State
aid, and which do for the sick poor what in nearly all other
countries is done for them by the State. . .

SYPHILITIC BONE AFFECTIONS AND PRECOOfOU*
GUMMATA.

The Transactions of the American Dermatological Associa¬
tion for 1883 contain some interesting discussions on syphilis.
Dr. R. W. Taylor finds that, like certain osseous and nervous
lesions, malignant syphilides in general, and many other
affections, the gummatous syphilide may occur as early as
the second month of infection, but usually in the third pr
fourth month and beyond that tujne;, th^t there are thre^>
clearly marked t forms of these precqpiousgummata: -firpfe,
an early general and quite copious form; secondly, a ipore
localised form, which may invade several regions of the body,
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THE FOOCIIOW HOSPITAL FOR WOMEN AND CHILDREN.

[Jan. 15,1887. 14l

icd is usually symmetrically distributed, but sometimes is
confined to one region, particularly one side of the face or
■calp and the roof of the mouth ; and thirdly, a form in
which more or less severe neuralgias precede and accompany
:lie eruption, which in many particulars possesses points of
resemblance to simple erythema nodosum, but is a direct
outcome of the syphilitic diathesis. In a further discussion,
Dr. Taylor stated that he believed, from a careful gathering
if the paternal history, that dactylitis occurs in about an
-qual number of syphilitic and non-syphilitic children.
With regard to “ syphilitic Pott’s disease,” he did- not think
•: would prove to be so rare as would appear from hitherto
™.blished evidence. _

THE FOOCHOW HOSPITAL FOR WOMEN AND
CHILDREN.

The first annual report of this institution, which is in
nnnexion with the Woman’s Foreign Missionary Society of
•-he Methodist Episcopal Church, has just been published.
Although the report now before us is the first one that has
bten published, the hospital was founded so far back as
1'77. It comprises on the first floor a drug-room, dispensary,
waiting-room for patients, four small rooms for native
assistants and medical students, and a surgery; and on the
second floor three wards, affording accommodation for about
twenty patients. The number of out-door patients treated
fr>m September, 1835, to July, 1886, the period dealt with
:a the report, was 4832, and of in-patients 213, this last
number being an increase of almost 100 per cent, on the
figure* for any previous year. More accommodation is
greatly needed, especially for patients who are able and
willing to pay for their treatment, and the executive con¬
template the purchase of additional land and the erection of
mother building. Instruction has been given to four native
women in medical subjects, and the establishment of a
training school^or nurses is contemplated at an early date.
The report contains a careful analysis of the cases, medical
and surgical, which have come under notice, and gives ,
■ivideoco that satisfactory work is being, and has for nine
yean past been, carried oh by the promoters and active
otfidala of this hospital. '

. THE TYPHOID BACILLUS-

MM. Widal and Chantemesse have succeeded in carrying
reseaxchsa on the bacillus of typhoid rather, further than
Gaffky, who described it. The centre clear space is not, they
say, characteristic, as Artaud supposed, for it is found in
other bacilli, especially in those of old cultures; and it is,
they believe, the beginning of the death of the microbe.
Spore* are produced between 37° and 38° C. It does not
liquefy gelatine, and is easily cultivated on potato. Gaffky
was unable to find the bacillus in the living subject, or to
moculate it. MM. Widal and Chantemesse have found it
during life by making a capillary puncture of the spleen,
tnd they have been able to inoculate both mice and guinea-
pigs so as to find the bacillus in the abdominal viscera and
longs. In a case where a typhoid patient aborted in the
fourth month the bacillus was found in the placenta.

A CORONER ON THE MEDICAL PROFESSION.

On the Gth inst. Mr. W. Muller, coroner, concluded an
inquest at the Town Hall, Glastonbury, on the body of a
man who had died somewhat.suddenly and in connexion
with whose illness the parish doctor, Mr. J., A. Bright, hod
been accused.of neglect., After the evidence of deceased’s
friend* b*d beenjtaken, the. oproqar expressed the, opinion
ihU Umre was^'thq. sUghi^t Jj^flcatiqn for'reflection
on Mr. ogMctaon, although/It < .was very important to
have rumouf* thtt kind thoroughly sifted. Medical men

were, he remarked, looked upon as “ beasts of burden,” and
he frequently found that people were most exacting as to
the work required of a medical man. The jury returned a
verdict of “ Death from natural causes, probably synoope, or
failure of the heart’s action.”

REMEDIES FOR PROFESSIONAL OVERCROWDING
IN BELGIUM.

Oun Belgian confreres keep lamenting the overcrowding
and the consequent poverty of the profession, and various
propositions are brought forward in the medical journals for
improving matters. The scheme for obtaining colonial
surgeoncies in Algeria having been shown to be impossible,
it is now suggested that Belgian practitioners should emi¬
grate to Canada, the United States, Brazil, Australia,the north
of Italy, and especially to the Dutch Indies, about which last
colony some information is given. It appears that in ordeT
to obtain an appointment from the Dutch Government it is
not necessary to be a Dutchman. Candidates must be qua¬
lified to practise in their own country; they must be under
thirty-five years of age and unmarried, and must know
German, Flemish, or Dutch. They must be physically suit¬
able for military service in the Indies, and must pass a very
short vivd voce examination. Applications have to be add reseed
to the Colonial Department, the Hague. The emoluments
are a bonus of £320 and an allowance at the rate of £112
a year until embarkation ; after landing the salary is £288,
with an allowance of £29 for forage. On return to Europe
after an absence of five years a bonus of £160 is given. In
addition to Government pay, private practice is allowed. In
Batavia, where new-comers are usually sent, the medical men
and lawyers are said always to try to establish themselves
near the Chinese quarter, the Celestials paying good fees; the
Arabs having, on the other hand, the character of being very
parsimonious, while the Europeans, it is reported, scarcely
ever pay at all! Another writer, looking tothe condition of the
profession in Belgium, suggeststhree main reforms as impera¬
tively required in order to save practitioners from impending
destitution: (1) that pharmacists should be forbidden ti
supply medicines, except on a prescription from a medical
man; (2) that proprietary and patent medicines should ho
longer be sold; and (3) that quacks should be put down.
He also thinks that the examinations should be made more
stringent, so as to reduce the number of men entering the
profession in the future. It is thought by some person* in this
country that all our own professional troubles and difficulties
would disappear as if by magic if we were to adopt the
continental system of non-didpefiding practice; but this
and a good deal more whieb is constantly appearing- in
foreign journals show pretty plainly that our low fees and
other troubles are not due merely to the system of prac¬
titioners dispensing their own medicines.

INTESTINAL DISPLACEMENT A CAUSE OF
DY8PEPSIA.

M. Gl£naed, a Vichy physician, believing that displace¬
ments of the intestine or "enteroptoses” are a good deal more
frequent than is generally supposed, and that they are, indeed,
a common cause of dyspepsia, has been in the habit of examin¬
ing the dyspeptic and neurotic patients who consult him by
making 'them stand up, and then going behind them and
pressing on the abdominal wall when in a relaxed condi¬
tion. If this produces a distinct alleviation of the discom¬
fort he considers that enteroptosis is present, and orders a
binder, which in these cases gives great relief, only lasting,
however, while it is actually worn. A discussion on this
subject has just taken place at a meeting of a Paris Medical
Society, but M. GlSnard did not find many of his colleagues
prepared to accept his views.

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142 Tub Lancet,]

VACCINE SHIELDS.—FOREIGN UNIVERSITY INTELLIGENCE.

[Jan. 15,1887.

AN ANTIDOTE FOR ARSENIC AND ACONITE.

In a recent number of the Indian Statesman there appears
a communication from Syed Walayet Ali Khan, of Patna,
Bengal, on a specific antidote for poisoning by arsenic and
aconite. It is described as being the bark of the common
goolar tree, generally known to Europeans as the Indian
fig. It is administered in doses of from ten to twelve
drachms, ground fine, and mixed with water. In severe
cases it may be necessary to repeat it at short intervals three
or four times, but it is said never to fail. It has been found
successful, according to the author of this statement, in
every case in which it has been tried. We have consulted
Dymock’s “ Vegetable Materia Medica of Western India,”
Waring’s “Bibliotheca Therapeutics,” and other works, but
can find no reference to its use for this purpose. It seems
strange that it should be an antidote both for arsenic and
aconite, as these drugs do not produce the same symptoms,
and are not allied physiologically. The matter requires
further investigation, and we must admit that we ore at
present sceptical as to its value.

EXISTENCE OF THE CANAL OF PETIT
QUESTIONED.

M. Claeys has commuuicated to the Royal Academy of
Medicine of Belgium an account of some elaborate researches
he has been making, with the help of all the most improved
methods of microscopical manipulation, on the anatomy of
the eye, and especially on the construction and attachments
of the ciliary ligament. The canal of Petit, he believep,
does not exist. _

“ UNMUZZLED.”

Sia Charles Warren’s well-written article on “Dogs
in London” must have chagrined the hysterical and de¬
pressed the sentimental. We have already doubted the
advisability of abrogating the police order just now; but
we are pleased to read that Sir Charles recognises the
possibility of the necessity for an early renewal of the
really merciful and not seriously inconvenient muzzle. We
go a step further, and urge its immediate replacement, not
only on all London but all provincial dogs. Evidence is
forthcoming to show that rabies is rife in the immediate
and remote environments of the metropolis. Why should
London wait until more dogs and other human victims are
sacrificed to the dire disease ?

THE QUEEN’S JUBILEE HOSPITAL.

Wb are actually threatened with another hospital, as if
we had not too many already, and the existing ones had a
superfluity of support. As we have Baid elsewhere, the
Jubilee of the Queen may not be without bearing on our
hospitals. But we respectfully advise Her Gracious Majesty
and all her subjects to have regard to existing institutions,
and to those great general Hospitals which have so nobly
earned a claim to generosity and consideration.

VACCINE SHIELDS.

We have been asked to call attention to a new form of
vaccine shield. It consists of a piece of spongio-piline, in
which is cut a circular hole covered over with transparent
goldbeater’s skin; to one side of the spongio-piline is added
a layer of adhesive mixture, to enable it to be fixed to
the arm, so that the vesicles are situated in the central hole,
and are surrounded by the spongio-piline. We are unable
to recommend its use. In the first place, shields are not
required; and in the second, they readily become soiled,
and thus potent for septic mischief. Shields, however cheap,

in the hands of the poor are frequently lent from one to
another, and it is a common experience that they are a con¬
stant source of mischief. We may remind our readers that
not long since the medical officer of the Local Government
Board directed public attention to the dangers attendant
upon their use. _

SCHOOL SANITATION.

A GENERAL mketing of the Medical Officers of Schools
Association was held in the rooms of the Medical Society on
Tuesday, Jan. 11th. The President (W. S. Savory, Esq,
F.R S.) occupied the chair. A paper was read by Mr. Charles
E. Paget, medical officer of health for Westmoreland, on
the “Arrangement and Construction of School Sanatoria
for Infectious Diseases.” The paper, which dealt clearly
and exhaustively with the subject, and which included n
description of some novel and ingenious details of construc¬
tion, gave rise to a full discussion; and a general opinion
was expressed that the public, no less than school autho¬
rities, would derive benefit from a more intimate acquaint¬
ance with the necessities and the claims of this impor¬
tant branch of school sanitation.

UNIVERSITY OF LONDON.

Convocation will meet on Tuesday next, the 18th inst
at 5 p.m., when Sir Philip Magnus will present a report fron
the sub-committee for reconstituting the University, am
will move its adoption. The Annual Committee will sugges
to Convocation the acceptance of “Spiritus intus alit”&
the motto for the University. There is no further matte
affecting the medical graduates on the agenda paper.

NEW MEDICAL CORPORATION IN SPAIN.

A new “college” or medical corporation for the promotioi
of the study of the medical sciences, from both a practice
and a theoretical point of view, as well as for the pro
motion and protection of professional interests, has bee;
established at Lerida in Spain. It is entitled El Colegi*
MtSdico Quirurgico de Lerida.

GENERAL MEDICAL COUNCIL.

Professor Bell Pettigrew, LL.D., F.R.S., Dean of th
Medical Faculty, has been appointed by the Senatus Aca
demicua to represent the University of St. Andrews at th
General Council of Medical Education and Registration c
the United Kingdom for a period of five years.

Our Dublin correspondent telegraphs that Sir Georg
Porter, Surgeon-in-Ordinary to Her Majesty in Ireland, hj
been offered and has declined the post of Crown Komim
for Ireland on the General Medical Council.

THE PATHOLOGICAL SOCIETY. 1

At the meeting of the Society on Tuesday next the new]j
elected President, Sir James Paget, Bart., will deliy;
an address on taking the chair.

FOREIGN UNIVERSITY INTELLIGENCE.

Lyons. —M. Berne, professor of external pathology, b
been obliged by ill health to obtain leave of absence durifc
the present academical year. *

Paris— The candidates for the Chair of Internal PatholoJ
vacated by M. Peter on his appointment to the Professorel
of Clinical Medicine at the Hopital Necker, were MM. Debo(
Dieulafoy, Duguet, Joffroy, Lancereaux, Landouzy, QuJ
quand and Strauss. From these the faculty has select^
(1st) M. Dieulafoy, (2nd) M. Strauss, and (3rd) M. Dugd

Digitized by |

Tub LaxchtJ

THE SANITARY CONDITION OP ROCHESTER.

[Jan. 15,1887. 143'

The selections for the Professorship of Anatomy are
• 1st) M. Farabeuf and (2nd) M. R<$my; and those for the
C^iair of Physics are (1st) M. Gariel and (2nd) M. Desplats.
A new professorship, the chair of which Tvill be filled by
Dr. Dnbuisaon. is about to be established at the School of
Law. He will treat of ** Mental Maladies” from the point of
riew of the legal responsibility of criminals effected in their
mind.

Si. Patertburg.—TvoL Sorokin’s term of office has been
prolonged for a period of five years.

—After a good deal of delay and uncertainty about
the establishment of a medical faculty, the Town Council
has decided to grant the sum of .£900, which is required to
enable the university architect to visit and inspect foreign
buildings of a similar nature, and to prepare the plans, on
the express condition, however, that the Russian Govern¬
ment will promise definitely to authorise the establishment
of the proposed medical faculty.

Ox the 5th inst. the death occurred at Bournemouth of
Colonel Sir Francis Bolton, who since 1S71 had been the
examiner under the Board of Trade of the water-supply of
the metropolis. The deceased, who was bom in 1831, had
f» some time past suffered acutely and undergone several
operations, which, however, unfortunately proved unavailing
to prolong what was undoubtedly a useful life.

Tine total number of students in the medical faculties of
the German universities is about 300 in excess of what it
was last winter session, the largest increase (seventy-six)
being at Wiireburg. Berlin shows a decrease of eight, and
Konigaberg a decrease of four.

Anoththr extensive outbreak of measles is reported. The
village affected is called Sebastopol, Monmouthshire, and
over 100 children have already sipkened. Efforts are being
made to stay the spread of the infection by means of school-
ckraag and other precautions.

Thb Faculty of Medicine of Paris has conferred the
Lacare Prize of 10,000 fr., awarded every four years for the
best work on the treatment of fevers, typhoid in particular,
to M. Albert Robin, for his “ Lepons de Clinique et de
Thcrapeutique M6dicalee.”_

At a recent open competition for two colonial surgeoncies
in the Phillipines held in Madrid, more than thirty practi¬
tioners presented themselves as candidates, several of them
evincing, as the Spanish medical press states, proofs of
exceptional merit. _____

A icketino of the delegates appointed by the Boards of
the various Medical Schools to confer on the question of
degrees for London medical students will be held to-day
(Saturday), at 4 p.m, in the Board-room of the Middlesex
Hospital. _

Cholera is evidently extending in Chili, the disease
having appeared at several points in the coast province of
Valparaiso, where within the past few days seventy cases
and twenty deaths have been recorded.

Processor Arthur Gamoeb, M.D., F.R.S., Mil begin a
course of eleven lecture, on the Function of Respiration on
Tuesday, the 18th inst, at the Royal Institution.

The Commissioners of 8ewers have resolved to expend
£2300 in sinking wells to supply artisans’ dwellings at the
east-end of the city with water.

®&e faucet Sfonitanr Ccmntissm

THE SANITARY CONDITION OF ROCHESTER.

No. II.

Other local improvements than those we have enumerated
deserve recognition. A considerable expense has been,
incurred to prevent the inundation of that part of Strood
which is below high water spring-tide; a well-constructed
embankment now protects this part of the district from the
flood which had previously detracted from its healthiness.
Again, a hospital for infectious disease has been erected,
and accommodation thereby provided for the isolation of
persons suffering from infectious disease, as well as an
ambulance for their removal. But Dr. de Chaumont recently
reported the hospital accommodation to be insufficient. At
this institution also is the necessary apparatus for the
disinfection of clothing and bedding which require this
treatment. If the Sanitary Authority of Rochester may
therefore claim in several respects to have shown some
diligence in protecting the inhabitants of their district
against disease, in other respects they have been grievously
negligent; and the chief failing, as already pointed out,
relates to the existence of cesspools for the retention of
excremental filth throughout practically the whole of the
district. We have thought it would- be well to consider this
subject more in detail, and have therefore directed our
attention to certain special localities. In these places, we
regret to say, we have found houses the condition of which
is simply deplorable, and where the cesspool system gives
rise to nuisance which should not be tolerated by any
authority claiming to do its duty.

Turning out of King-street is Benster-court, in which are
situated nine houses; the court is unpaved, and, as a result,
the ground is more or less sodden at times of rainfall.
Four are small brick houses, each consisting of two rooms
of a cubic capacity of 030 ft. In one of these houses live
a father, mother, and five children. In this house the
family complained of the dampness, and the plaster and floor
are broken in places. Opposite these bouses, a little over
twenty feet distant, is an offensive privy in connexion with
a cesspool, and adioining is a washhouse, the roof and walls
of which are broken in, rendering it absolutely unusable.
In only one of these four houses are the windows not
broken. Another house in the court is in a condition
absolutely unfit for human habitation; it appears to
have been originally simply a wooden structure; the
walls have, however, been partially covered with cement,
as if with the object of keeping out the wet, but
the cement is broken, and the interior of the house
presents a melancholy spectacle. The house is dirty
to a degree, and the plaster crumbling ; holes in the
walls admit but too freely the cold air and wet, in
spite of the efforts made to stuff them with flock. The
window-sashes have perished, the windows are broken,
and the interior woodwork generally rotten. The remain¬
ing houses are in better condition, but two of them
are but eleven feet distant from another offensive privy,
which further serves to pollute the air. Adjoining is a
house in King-street, having an unpaved and apparently
undrained yard, for the rain percolates beneath the house,
and renders it so damp that the inmates complain bitterly
of its condition. There is no dustbin; the household refuse
is thrown on the ground; and, again, a similar offensive
privy and cesspool only ten feet from the house send their
emanations into its_ open windows.

In close proximity to this court is Kettle-court. This
place is very imperfectly paved, and the damp easily finds
access to the houses. One of them is in wretched repair; the
plaster is crumbling, the floor broken, and the paper on
the walls hanging in shreds. This is indeed no wonder, for
the windows are broken, and the window-sashes so rotten
that it is almost impossible to make them hold the glass.
The inhabitants complain strongly of the offensive odouxs
which emanate from a privy and cesspool only eleven feet
distant, and evidently not without cause. The inmates of
another house complain of the offensive cesspool and privy
at the rear of a house in King-street, from which they aw
but ten feet distant. The mother of the family in the King-

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144 The Lancet,]

TRANSFUSION FOR HAEMORRHAGE IN MILITARY SURGERY.

[Jan. 15,1887.

street house describes the smells a* terrible; Bhe states that
her husband and children have never been well since they
entered the house, suffering from sore-throat, headache, and
loss of appetite; moreover, she told the story how on one
occasion the wainscoting of the back room of the house
gave way, and how through the opening they could see
into the cesspool, from which swarms of flies entered the
house.

In another part of the town is Ironmonger-lane, where
the same arrangements for the retention of filth exist. In
an unpaved yard is a large cesspool, which the inhabitants
state contains two large cart-loads of filth ; this cesspool is
in communication with some privies, which stink abominably,
and which are almost choked with excreta. Ineffectually
covering it is a paving-stone, but the stone is loose and the
odours freely mingle with the air. The residents in the
court state they can scarcely live here at all in the summer,
one woman remarking that at night she was frequently
compelled to get out of bed on account of the stench which
found its way into her house. For the whole of this court
there is no dustbin, the refuse lies piled in a comer, and the
washings add to the offensiveness of the soil.

In another court—Nye’s Cottages—where there are ten
two-roomed houses, the ground is unpaved, the rain-water
from the roofs has to traverse a considerable distance before
it can find its way to a gully, there is no dustbin, and the
house ashes are used for filling up holes in the yard. In
the centre is a large cesspool, in connexion with which are
four privies, two of which at the time of our visit were
almost choked with excreta. The stench from these places
can be better imagined than described. As one woman said,
"they smell wonderful; in summer, if you only go inside,
you come out and retch your very inside out.” The cottages
are more or less damp; in one which was entered the paper
was separating from the walls, although we were told it had
only been renewed last April. Here, too, the flooring was
broken and the window-sashes were decayed.

Other houses in King-street must be equally condemned.
Of four we inspected, in one the plaster in the basement
was found to be dropping, and, owing to the flooring being
lower than the level of the court behind, the surface water
freely entered. Behind it, and but a few feet distant, is a
privy, which we were told “ smells very badly ; smells come
in horrid at back windows.” In another, owing to a defec¬
tive roof, the water simply pours into the back room at the
top of the house; thence it runs to the back room on the
ground floor, and then to the corresponding room in the
basement, where the plaster of the ceiling is crumbling.
These rooms are not occupied by the family living in the
house, nor could they be occupied, for they are unfit for
human habitation. The family here also complain of the
stink from a privy and surface drain in the rear of the house.
This drain apparently empties itself into an adjoining
cesspool, and its mouth is merely protected by an ordinary
bell-trap. In a fourth house the inmates receive their water
from a private well situated in the back yard, which also
supplies water to an adjoining house. Within a few feet of
it is a cesspool receiving washing water and the water used
for the boiling of tripe. At the time of our visit the cess¬
pool was overflowing, and its liquid contents had reached to
within seven feet of the edge of the well.

It is needless to multiply these instances further, but they
serve well to show the deplorable condition to which a town
is brought that does not provide itself with adequate means
of drainage. There is obviously but one effectual remedy—the
adoption of a sewerage system and the abolition of all cess¬
pools. But this is not all. The sanitary authority are armed
with ample means for compelling landlords to maintain
houses in habitable condition, and no possible excuse can be
found for the state in which many houses in the Rochester
urban district are at the present time. For many of the
defects such as we have described, the Artisans and
Labourers’ Dwellings Act, 1868, alone will afford sufficient
remedy, and there is no reason why the provisions of this
Act should not be duly enforced.

Rochester evidently possesses a medical officer and a sur-
teyor who are warmly interested in the sanitary condition
of the town; but the estimation in which sanitary services
are held by the local authority may be understood from the
fact that the former of these gentlemen receives but fifty
pounds a year for duties which relate to the whole urban
district. There is, moreover, but one sanitary inspector, and
it is obvious that his energies would be sorely taxed in any
serious attempt to maintain Rochester houses and localities

in proper sanitary condition. Can surprise be felt that Dr.
de Chaumont has reported the administration of the Sani¬
tary Authority to be “ unsatisfactory and inefficient ” ?
Probably the influence that is most wanted is public opinion,
for officers can do little without the support of those
among whom they work; but Rochester is a cathedral’
town, possessing a dean and resident clergy, besides many
influential inhabitants. We have had experience else¬
where of the good that may come from such influences
being brought to bear upon local authorities, and we would'
venture to submit that the conditions under which the poor
and indeed all classes live have an intimate relation with
their moral as well as their physical welfare, and that the
neglect we have described reflects upon every resident.
We would fain hope that our inspection and the sad story
we are compelled to tell of Rochester may awaken a wider
interest in matters which so deeply concern its population.

ABSTRACT OF ADDRESS ON

TRANSFUSION FOR H/EMORRHAGE IN
MILITARY SURGERY.

Delivered at Woolwich, before th n Medical Officers of th?
Army Medical Department, Oct. 28th, 1886.

By Charles E. Jennings, F.R.C'.S. Eng., M.S.,

ASSISTATT-St'ROEON TO THK CANCER AND NORTH-WKST LONDON
HOSPITALS.

Gentlemen, —When I accepted the kind promise of Sir
Thomas Crawford to arrange for my addressing you this
evening, I did so to learn rather than to teach, feeling con¬
vinced that what little information 1 may impart on the
subject of transfusion for hsemorrhage will be more than
counterbalanced by what I shall learn from you as to the
applicability of the operation to the exigencies of military
practice. By means of demonstrating a reliable method of
transfusing blood and of proving that the simple injection
into the veins of other fluids—notably saline fluid, or even
water—may be safely trusted as an efficient substitute for
the more complex operation, I shall be able to remove from
your minds that prejudice against these therapeutic
measures, which doubtless exists on account of the defective
instruments, which in the past rendered the operation un¬
certain in its results aud almost useless.

It is scarcely necessary to point out that in all cases
where either transfusion of blood or intravenous injections
of saline fluids is resorted to as a means of combating
acute ansemia, the simultaneous or previous arrest of the
haemorrhage must be regarded as a sine gud non. There
seems no question that saline fluids may be substituted for
blood in the human subject with impunity, such substitu¬
tions not exceeding an amount, which bears a definite ratio
to the body weight; but if the loss of blood by hemorrhage
have exceeded this quantity (probably about one-fifth of
the entire amount in the body) the transfusion of blood to
restore and maintain re-animation becomes indispensable.
The important fact remains that life may be jeopardised by ■
haemorrhage and succeesf ully restored if fluid be injected into j
the veins even after the heart has ceased to beat, in illustra¬
tion whereof I can refer to a series of experiments which 1
I performed with a view of ascertaining the beet plan of
procuring resuscitation after chloroform and narcotic
poisoning. 1

The idea of endeavouring to resuscitate animals bv
establishing an artificial circulation after apparent death
was suggested to me by the fact that in 1848, a at the
St. Giles’s Workhouse, Sir Spencer Wells (then Mr. Wells) j
injected saline solutions into the veins of some cholera
patients there, with Mr. Bennett, who was at that time ,
resident surgeon. Sir Spencer Wells has informed me that
in one case the injection was performed with considerable
difficulty upon a man apparently dead some few minutes
after the heart had ceased to beat, but it was followed by a
return of pulsation, warmth, and consciou sn ess, and the
patient lived for a few hours afterwards.

On Aug. 20tb, 1882, 3 1 injected 16 oz. of saline fluid with

1 THK Lancet, 1885, vol. 1., pp. 245, 289.

* Jennings: On Transfusion of Blood and Saline Fluid*, »eoon®
edition, p. 34. » Ibid., p. 86.

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Thk Lancet, J CLERICAL, MEDICAL AND GENERAL LIFE ASSURANCE SOCIETY.

[Jan. 15, 1887. 145

* 3 cm. metal syringe into the veins of e patient about to die
:rom the effects of ante-partum hremorrhage. The cylinder
d the syringe bad to be detached from the nozsle and
refilled several times during the procedure, the nozzle being
.stared within the median baailic vein. In this case
mniTnaf.ion speedily followed the saline infusion. The
voman was happily delivered an hour and a half later, and
r ecovered perfectly. The lesson here taught was that 16 oz.
of saline fluid proved to be the minimum quantity necessary
to restore reanimation.

Oa Sept. 29th, 1885,1 saw a case of uterine haemorrhage
<* consultation with my colleague, Mr. Elam, at Forest-
fite. The patient was almost moribund, when about
— os. of saline fluid were injected into a vein of the
am, and reanimation immediately followed. This lady
kas recovered completely, and the quantity of saline
•oid injected was the minimum amount necessary to effect
cs purpose.

Another case 4 may be cited where “ 22 oz. of simple xoater
H a temperature of about 100° F.” were injected into the
vans of a woman moribund from the effects of severe
ferine haemorrhage, which occurred nine days after
tichvery. Mr. Coates performed the trifling operation, and
reports that the result was marvellous. This patient also
recovered.

I think, therefore, we are justified in maintaining that the
rejection into the veins of a fair quantity of fluid will
•usfactorily restore reanimation in cases of very acute
sngaiia where other restoratives have failed, for potent
restoratives had been tried and had failed in the coses
quoted. The apparatus, whether syringe, irrigating-can, or
fjpbon, designed for intravenous injection, should be one
by which more than a pint of fluid at least can be
expeditiously injected.

Though a description of my method of transfusing blood
reixed with saline fluid and of replenishing the veins of the
blood-giver with saline fluid, with the results of experi¬
ments upon animals, which have clearly shown the safety
•ad utility of the method, has been published long ago, it
m only in 1885 that this operation was actually performed
cpon the human subject.

Ia December, 1884, J. B-, a widower, manifested the

ngas and symptoms of progressive pernicious aneemia. Mr.
Wo. Wickham,of Tetbury, finding his patient’s condition was
not ameliorated by a careful trial or the various forms of
treatment ordinarily recommended for this disease, sent the
patient to me at the Cancer Hospital, in the hope that
benefit would accrue from the transfusion of blood. Tho
dia gnosis being carefully and accurately established, trans-
fussoo was performed on April 17th, the patient and bis
friends having been previously informed that only transient
improvement could be expected from the introduction into
the system of fresh blood in the case under consideration.
About 14 oz. of blood, drawn from the giver by the apparatus
dattnded in Thk Lancbt (1883, vol. ii., p. 365), were
tratthased into the left cephalic vein of the receiver, mixed
vith about 10 oz. of ammoniated saline fluid. About 14 oz.
of saline fluid (temperature 75-80° F.) were infused into the
right median basilic vein of the donor, this being the vein
from which the blood was drawn. The actual transfusion
•ad infusion of saline fluid were entirely painless both to
tbs river and receiver. No coagula formed in the instrument,
so air was injected into the veins, and there were no signs
of dyspnoea or cardiac embarrassment. The operation being
completed, the man who gave the blood arose, drank a cup
of tea, and walked home, a distance of four miles, without
nma pv Bptence. The wound in his arm healed quickly, and
no bad effects attended the substitution of saline fluid for
his Mood. With regard to the receiver of the blood, a
merited improvement followed the operation; but, a re-
lapse occurring, tbe man died on April 24tb. A necropsy
mads ob tbe following day disclosed that the morbid
rhanrpit were consistent with those of oligocythsemia
min*.

to conclusion, 1 would submit that the cases are rare
mien it becomes neeesecry to transfuse blood for acute
■mania, the intra-venous injection of a simple saline fluid,
wifh or without tbe addition of ammonia or alcohol, accord¬
ing to efrcttmstances, being usually sufficient to restore
naaimstlor Tbe valor of the addition of fresh blood lies
mssoly to its nutritive properties, and if it be considered
-to transfuse Mood, the operation can readily be

performed in the manner indicated by any surgeon with
the aid of skilled assistants, as in the case, already ielated,
of pernicious anaemia.

[We regret we are unable from lack of space to publish
the discussion which followed the reading of the above
paper.]

CLERICAL, MEDICAL, AND GENERAL LIFE
ASSURANCE SOCIETY.

We have received the report of the Directors read at an
extraordinary general meeting of proprietors and assured,
held at the Society’s office, Jan. 6tb, 1887, on the occasion of
the twelfth division of profits. The present prosperous
financial position of the Clerical, Medical, and General Life
Office must be very gratifying, not only to the share¬
holders and policyholders, but also to the directors,
their actuary and secretary, Mr. Newbatt, and the staff
generally. The elaborate and comprehensive report rela¬
tive to its growth and successful progress is most interest¬
ing, and will help to maintain the general confidence in the
Society which has lead to these exceptionally favourable
results.

The Directors presented to this meeting the report of
the quinquennial period which terminated on tbe 30th
June, 1886, and the result of the investigation into the
financial condition of the Society at that date.

Dealing with the transactions of the five years, the
following facts present themselves: The new assurances—
2706 in number, a.-suring £1,759,771 and yielding £59,280 in
annual premiums—were larger by £157,903 in amount
assured, and produced £4415 more in premiums, than those
of any former period. The yearly revenue progressed in an
increased ratio, and reached £316,164 in 1886, as against
£286,512 in 1881. Of the total increase of £29,652 here
shown, £16,825 arose from premiums and £12,827 from
interest. The interest earned during the quinquennium on
the whole of the funds, whether invested or uninvested,
was at the average rate of £4 2s. 2d. per cent, per
annum, as compared with £4 3s. lid. per cent, in the pre¬
vious five years. Having regard to the continuous decline
in the value of money daring the period under re¬
view, and to the fact that the integrity of the Society’s
calculations will be maintained by a net earning of 3
per cent., the rate thus actually realised is highly satis¬
factory. The claims by death were 947 in number and
£812,127 in amount. Though both larger and more
numerous than in the previous five years, when they
amounted to £739,684 on 886 lives, they fell short of those
expected by 268 in number and £283,441 in amount. They
were, moreover, exceptionally profitable in character, owing
to their having fallen on older policies held on older lives.
The total expenses, in spite of the growing cost of obtain¬
ing new business and of the much larger new business which
was secured, were again moderate and well within the pro¬
vision made for them in the premiums. They were practically
identical with those of the last quinquennium when com¬
pared with the total revenue, and were but fractionally
higher—11*75 per cent., against 11-49 per cent.—when taken
as a percentage on the premium income alone. The Assur¬
ance Fund, thus favourably affected both by income and
expenditure, rose from £2,433,398 in 1881 to £2,715,760 in
1886.

It is stated that tbe total assurances subsisting on
June 30th last were 10,531 in number, assuring, with
their bonus additions, the sum of £6,849,646, as com¬
pared with 9925 policies, for £6.345,374, in 1881. These
assurances, and annuities for £2660 per annum, consti¬
tuting together the whole of the engagements of the
Society, have been the subject of the present investiga¬
tion.

The value of the assets of the 8ociety being a matter of
no less importance than that of the obligations which
they have to meet-, the securities have all undergone
the usual careful examination by the directors. As has
been seen, the Assurance Fund on the 30th June amounted
to £2,715,760.

Particulars of the valuation, as well as of the various
assets of tbe Society, are set out in detail in annexed
schedules, prepared for tbe Board of Trade pursuant to the

Digitized by GoOgle

J46' THR LAKCKT,]

HEALTH OF ENGLI8H AND SCOTCH TOWNS.

[Jan. 15,1887.

Life Assurance Companies Act 1870. From these it will be
seen that

The Assurance Fund on June 30th

having been . .£2,715,759 13 6

And the calculated liability at the

same date. 2,232,586 8 8

There was a surplus of _. £483,173 4 10,

Deducting from the last-named sum the Permanent Reserve
of £30,000 required to be set aside by Section 32 of the
Society’s special Act of Parliament, the net surplus becomes
£433,173 4 a-. 10 d.

This surplus is larger by £66,479 5*. 5 d. than any hereto¬
fore exhibited.

In furtherance of this policy, which will at once protect
the interests of existing members and render the Society
additionally attractive to future assurers, the directors pro¬
pose now to divide £375,000, a sum larger by £30,000 than
that divided in 1882 and sufficient to give to the proprietors
£12 10s. a share, and to the assured the largest cash distri¬
bution ever allotted to them, leaving the balance of
£58,173 4a. 10 d. to fall back into the Assurance Fund as
undivided surplus* This amount thus divided, £312,500,
will fall to the assured, yielding a cash bonus averaging 38J
per cent. _

POOR-LAW INFIRMARIES.

At the adjourned meeting of the medical superintendents
6f Poor-law infirmaries held at St. George’s Union Infirmary,
Fulham-road, on Dec. 18th, 1886, Dr. Lloyd in the chair, the
following resolutions were adopted:—

• Moved by Dr. Spicer and seconded by Dr. Neal: 1. That
it is desirable that the medical superintendents of the
metropolitan infirmaries be authorised to call into consulta¬
tion a specialist of eminence, when the circu instances of
any case under their charge may be deemed by thjem to
render such a course advisable. 2. That it is desirable such
consultant should receive a fee in each case. 3. That any
such consultant called in should be on the permanent staff
of a London hospital. 4. To advise in the treatment of
cases, and only when they have been called upon to; do so
by the medical superintendents.—Moved by Dr. Webster
and seconded by Mr. Liutn: 5. That it is desirable, in view
of the large amount of clinical material in the metropolitan
infirmaries, both in the interests of the patients and of
medical science, that one or more qualified clinical assistants
be appointed in each infirmary, in addition to the present
medical staff.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6090 births
and 4690 deaths were registered during the week ending
Jan. 8th. The annual death-rate in these towns, which had
been equal to 207, 21*5, and 251 per 1000 in the preceding
three weeks, further rose last week to 26-5. During the
thirteen weeks of last quarter the death-rate in these town*
averaged 20-3 per 1000,and was 2-1 below the mean rate in the
corresponding periods a# the ten years 1876-85.. The lowest
rates in these towns last week were 15-7 in Sunderland,
17-2 in Derby, 18-4 in Nottingham, and 18-5 in Brighton.
The rates-in the-other towns ranged upwards to 33-2 in j
Newcastle-upon-Tyne, 340 in Leeds, 36-4 in Manchester, arid I
40-6 in Plymouth. The deaths referred to the prihcipgl |
zymotic>diseases in the twenty-eight towns, .which had!
been 386, 433 , and 587 in the preoeding three weeks, declined.
again last week to 475 ; they included 235 from measles, j
81 from whooping-cough, 63 from scarlet fever, 47 -from
*'fever” (principally enteric), 28 from diarrhoea, 21 frbm
diphtheria, and not one from small-pox. These zymotic
diseases caused the lowest death-rates last week in
Nottingham, Brighton, and - Leicester; and the > highest
death-rates In Manchester, -Bristol, Leeds; andrNew-j
castle-upon-Tyne. The greatest mortality from ’ measles)
debarred in Liverpool, Manchester, Newcastle-\fpon-T^ne,;
-and Leeds; from soarlst fever in Norwich, Liverpool; and
^Bristol; from Whcoping-'cohgh in Bristol, Manchester,;

Oldham, and Plymouth; and from “ fever” in Liverpool an-
Preston. The 21 deaths from diphtheria in the twenty
eight towns included 9 in London, 2 in Bristol, 2 in Man
Chester, and 2 in- Preston. Small-pox caused no death ij
London and its outer ring, or in any of the twenty-aevei
large provincial towns. Only 2 cases of small-pox wer
under treatment on Saturday last in the metropolitan hos
pitals receiving cases of this disease. The deaths ref err
to diseases of the respiratory organs in London, wfrioh hoc
been 416, 436, and 573 in the preceding three weeks, ftutbe:
. rose last week to 731, and exceeded tha corrected average by
221. The causes of 1*20, or 2 5 per cent., of the deaths ii
the twenty-eight towns last week were not certified either
by a registered medical practitioner or by a coroner.: AL
the causes of death ’were duly certified in Sunderland.
Portsmouth, and Dierby. The largest proportions ot un¬
certified deaths were registered in Oldham, Preston, Sheffield
and Hull. _

HEALTH OF SCOTCH TOWNS. .1 ■ /

The annual rate of mortality in the eight Scotch ‘to wn?,
which had been 26-2 and 251 per 1000 in the “preceding
two Weeks, rose to 29-9 in the week ending JAhl 8th;
this rate exceeded by 3‘4 the mean rate during the same
! week in the twenty-eight large English towns. ' The rates
'in the Scotch towns last week ranged from 187 and 21-1
‘in Leith and Perth, to 35‘0 in Glasgow and 40-2 id Paisley.
The 746 deaths in the eight towns last week showed an
increase of 111 upon the number in the previous week, and
included 27 which were referred to whooping-cough, 18 to
■ diarrhoea, 17 to measles, 13 to scarlet fever, 12 to diphtheria,
7 to ‘'fever” (typhus, enterio, or Simple), and not one to
small-pox; in all 94 deaths resulted from these principal
symotic diseases, against 63 and 73 in the preceding two
weeks. These 94 deaths were equal to an annual rate of
38 per 1000, which was 1-1 below the meat^ rate from
the same diseases in the twenty-eight English towns.
Tjie fatal cases of whooping-cough, which had been 15 and
21 in the preceding two weeks, further rose last week to 27,
which included 18 in Glasgow, 3 in Edinburgh, 'and 3 in
Paisley. The 18deathsftttributedtodvarrbcea8howedafurther
increase upon recent weekly 1 numbers ; 10 occurred in Glas¬
gow and 3 in Edinburgh. The 17 fatal cases of measles
also showed an increase upon the numbers in recent
weeks, 16 being recorded in Glasgow. The deaths from
scarlet fever, which had been 13 ana 12 in the previous two
weeks, rose again last week to 13, of Which 9 occurred in
Glasgow and 3 in Edinburgh. The 12 fatal cases of diph¬
theria (only one had been returned in the previous week)
included 7 in Glasgow arid 4 in Edinburgh. The 7 deaths
referred to “ fever” showed a decline of 3 from the number
in the previous week; 3 were returned in Aberdeen and

2 in Glasgow. The deaths from acute diseases of the

respiratory organs in the eight towns, which had been
188 arid 179 in the preceding two weeks, rose last week to
213, and exceeded the number in the corresponding week
of last year -by 81. The causes of 98, or more than IS per
cent., of the deaths in the eight towns last week were not
certified. _

HEALTH Of DTTBLTN. '

The rate of mortality in Dublin, which had been 29 6,287,
and 380 in the preceding three weeks, declined again to3P3
in -the week ending Jan, 8lh. During the thirteen weeks
of last, quarter the death-rate .in tb e , cUy ,. averaged
26 7; the mean rate during the same period .did not exceed
18*8 in'London sad 19 5 in Edinburgh. The 212 deaths in
Dublin last Week showed-a decline of 45 from the number
in the. preceding week, and included 6 which were referred
to scarlet'fevdr, 4 to “ fever ” (typhus, enteric, or simple),

3 to diarrhoea, arid not one either to Small-pox, measles,
diphtheria, 6r Whooping-dough. Thus the . deaths from
these principal zymotic diseases, which had declined, in the
preceding few wtaeka&om 23bo 17,' iurthfcr.fell last-week the
to 13; they were equal to-an annual rate of. 1-9 per IOQ0,
the rates from the same diseases being -2 4 in London aqd
2-8 in Edinburgh. The fatal cades Of scarlet fever, which
had been 6 and If in the preoeding tfwo weeke^iJecUntritagaip
lastweekiefi; while the 4 dearths referred, |tjp “lever” ww
sponded -wifchL the number in the,,previous week./- Nine
iri midst cases-.and 6 deaths from tiolerice were, registered;
ana 54, or rather more than a quarter, of the deaths occurred
in public institutions. .The deaths both of infants and of

Digitized by kjOOQle

T*e La^crt,]

“ARTERIAL PRRSeURE.’

[Jaw. 15,1887. 147

elderly persons showed a considerable decline from the
numbers returned in the previous week. The causes of 36,
or nearly 17 per cent*, of the deaths registered during the
week were not certified,

CormpnlrtitM.

‘‘Audi alteram partem.”

“ARTERIAL PRESSURE.”

To the Editors qf The Lancbt. ,

Sow,—If no other correspondent replies to Dr. Nicholson’s
letter on the above subject, you will perhaps allow me in a
few sentences to suggest to him that the solution of the
difficulty which he feels in reconciling the statements which
he quotes from Drs. Brunton and Foster is to be found in
the distinction between the large elastic arteries and the
terminal muscular arterioles. The blood-pressure with
tension referred to in the passage from Dr. Brunton is that
which exists in the larger arteries; while, on the other,
hand, the constriction in the vascular area of which
Dr. Foster speaks is the contraction of the muscular
arterioles, the effect of which is to lessen the flow of blood
through the capillaries of the particular area, and in the
same degree to heighten the pressure and tension in thei
larger arteries which convey the blood to the contracted
and resisting arterioles. It would doubtless tend to
prevent misunderstanding if, in referring to parts of the
vascular system, in most respects so diverse in structure
and so opposed in function as the larger arteries and the
arterioles, they were always designated—the first “the
elastic arteries,” and the latter “ the musoular arterioles.”
The large arteries, by their elastic resiliency, aid the heart
in propelling the blood onwards; while, on the other hand,
the muscular arterioles, in tbe exercise of their regulating
and so-called "stopcock” function, often antagonise tbe
heart and the elastics arteries, and, in proportion to the
degree of their contraction, resist the onward movement of
the blood. The result, of course^ is, as I have before Said,
that the contraction of the arterioles increases the fulness,
tension, and pressure in the associated larger .elastic arteries.

I am, Sirs, yours faithfully,

SMlle-row, Jan. 8th, 1387. GEORGE JOHNSON.

THE EFFECT OF LIGATURE OF THE FEMORAL
ARTERY. I

To the Editors of Thb Lancet. |

Sms, —I am bound to repeat that the facts, as I find them,
do not appear to me to be in accordance with the views set’
forth by Mr. Ilolmes; and, further, that the difference is not an
insignificant one, for it bears upon a point of practice which
is suggested in the paper. Of course the artery is obliterated
at the place where it is tied, and Mr. Holmes makes it clear
-that blood finds its wav again into the artery between the'
ligature and the sac, and therefore that a part of that
portion of the artery must remain pervious. But I submit!
that his description does not convey the idea that in the!
majority of cases the portion of artery between the cldt of
the ligature and the esc remains pervious throughout its
whole length. This and .other facts in regard to the con¬
dition of the portion of artery in question, are, I believe,
made evident in the paper, to which I hope Mr. Holmes will!
allow me to refer him instead of taking up your space by;
repeating much of it here. And if I am silent on other
questions raised by 1 him in his last letter, let me assure
aim that it is not because I am insensible to their interest.
My admiration of Mr. Holmes’s surgical works, especially of
his articles on aneuryBm, is so great that this kind of criticism
i» very distasteful to me. But Mr. Holmes insists on it.
I must be allowed, however, with this letter to close my
part of the correspondence.

I am. Sirs, yours truly,

Brook-street, W., Jan. 10tb, 1337. Wm. S. SAVORY.

\ THE LATE PREVALENCE OF SHINGLES.

To the Editors of The Lancbt.

Sins,—The following cases of herpes, which have lately
come under my notice, present, I think, some features of
interest, and may help to furnish some material towards
elucidating the etiology of this disease.

, A K., male, aged forty, has been . subject to herpes
preputialis for tbe last twelve years. For about eight years
previously to the year 1884 the attacks were frequent. Some¬
times they occurred at intervals of only a few months, and
he does not think that a year ever passed without his
haying one. The crop of vesicles always occurred, so far as
he is aware, on the same spot on the outer aspect of the
prepuce. In February of 1886 be had an outbreak of herpes
on the back of his left forearm, which was preceded for
several days by neuralgic pains felt in the back of the hand.
In the beginning of December, 1886, he had an attack of
herpes preputialis, which had not occurred for more than
three years, and about ten days after this he had also an
outbreak of herpes on the left forearm, the orop of vesicles
being in the same place as, and resembling in every respect,
the eruption which occurred the previous February.

C. K., age about sixty-seven, aunt to A. K., had an attack
of herpes in November, 1886, tbe eruption being over the
shoulder-blade and under the arm, followed by much
neuralgic pain and general prostration.

.The mother of C. K., when about seventy years of age, had
a severe attack of herpes zoster.

In considering these cases with reference to the etiology
of the disease, the following points may be noticed:—1, The
manifest hereditary predisposition to this complaint, in the
mother and daughter the attacks assuming the same form at
about the same age. 2. The apparent influence of some
causes which determine the occurrence of a number of cases
at about the same time. At a time when herpes is parti¬
cularly prevalent C. K. has an attack, while A. K., who may
be said to be subject to this form of eruption, has a double
Attack, a thing which has never happened with him before.
3. Connexion with other diseases. Gout: No case of gout on
either side of A. K.’s family. Rheumatism: There seems to
be almost as little tendency to this complaint, the only case
in the family being that of a sister of C. K., a lady of seventy
years of age, who naa been troubled with rheumatism for
the last few years. Scrofula. On the other hand, there is a
distinct connexion with this disease. A. K. has had glan¬
dular abscesses in the neck. C. K. has had diseased bone in
the foot, and suffers from lupus. 4. As to the immediate
predisposing cause: A. K. has not been able to connect his
attacks with a chill, although he has taken notice of this,
his attention having been drawn to this point. He has
always connected an attack of herpes with some change in
his general state of health, always feeling in better health
and spirits after tbe attack than immediately before. 6. The-
case of A. K. shows the tendency of herpes, in those
instances in which it recurs, to appear in the same situa¬
tions. I am, Sirs, yours obediently,

A W. Harding, B.A., M.B. Lond.

Ealing, W. t Jan. 11th, 1887.

A “ NEW ” METHOD OF EXCISING THE KNEE-
JOINT.

To the Editors of The Lancet.

Sirs, —Mr. Allingham, in saying that he “ was fully aware
-that Professor Ollier suggested ” the operation, scarcely does
that surgeon complete justice. He had minutely described
it and definitely given his views of the indications for its
use. Even in 1883 he had evidently practised it on the dead
subject. His description of it is most precise and detailed,
and occupies two pages, one of them small print, of the
Revue de Chirurgie. If, in spite of his great opportunities,
he has really not yet done it on the living, It most be
because he considers it suitable for only a very narrow
range of cases. It is not quite clear whether Mr. Allingba^n
mentions his inability to find a report of my case as a de¬
fence for himself or as a reproach to me. It the .former, J.
do not grudge birij any defence; if tbe latter, I reply that
when I found 1 had been anticipated by Ollier, whose article
on the subject had even been noticed in your own column*,
and that I had nothing to add to his remarks, 1 was content

Digitized by GoOgle

148 Tire Lancet,!

REMOVAL OP THE UTERINE APPENDAGES.

[Jaw. 15,1887.

to exhibit my patient without writing about him. But tbe
third edition of my index of Surgery contained thi follow*
ing sentence: “Ollier, when resecting for injury, makes a
longitudinal incision and saws longitudinally through the

f atella.” When I confess to this reticence, I feel more as if
were boasting than acknowledging anything to be ashamed
of. My operation was done on a boy, aged sixteen, on
Sept, lltb, 1883, and the following extract is from the notes
of Mr. H. H. Taylor, then house surgeon at the West London,
now at Brompton Hospital: “ U nder ether, and antiseptically,
a longitudinal incision was made over the joint. The patella

was sawn through in the same direction. The patella

was wired.” I thought at the time that 1 had done some¬
thing new, and 1 should be the last person to reproach Mr.
Herbert Allingham for making the same mistake. 1 have
made it a rule to avoid wasting my time in contesting
■claims of priority, and should perhaps have not begun this
correspondence if I did not strongly disagree with Mr.
Allingnam’s estimate of the value of the procedure, which
it would now be a graceful act of his to join me in naming
“Ollier’s.” The mistake of crediting your journal with a
report which did appear in a contemporary is 6urely of no
significance. With your kind permission, I will, at an early
date, publish in your columns a briefly reported series of
erasions and excisions of the knee-joint, including the case
just mentioned, and then state more fully than I can in this
correspondence what experience has taught me about the
choice of methods. I remain, Sirs, yours obediently,

Jan. 1887. C. B. KERTLBY.

REMOVAL OF THE UTERINE APPENDAGES.

To the Editors of The Lancet.

Sirs,— It is only just now that I have seen the report
published in Tub Lancet for Jan. 1st, of the Leeds and
WestRidingMedico-Chirurgical Society’s November meeting,
in which Mr. W. H. Brown is stated to have read notes of a
case of removal of the uterine appendages under circum¬
stances calling forth the unanimous condemnation of sub¬
sequent speakers. Had I noticed the record sooner I should
have lost no time in asking to be allowed to remove the
responsibility from Mr. Brown’s shoulders to my own, inas¬
much as the operation was mine, and Mr. Brown had
obtained my full permission to relate the case at the
Society’s meeting. Unfortunately I was not present that
evening, or the remarks which I should have had the oppor¬
tunity of making might possibly have materially modified the
criticisms and consequently the report, which, as it stands
in your columns, must convey the impression that Mr.
Brown has been guilty of performing an unnecessary and
an unjustifiable operation. Moreover—although I am sure
Mr. Mayo Robson, who, as secretary, is, I believe, responsible
for the published abstract, had no desire to suggest that the
operation had been undertaken without consultation—the
stress he lays upon his own practice of always having a full
consultation (whatever that may mean) before operating
will lead many to the erroneous conclusion that in this case
so necessary a precautionary measure had been omitted.

I am not concerned_at-present to discuss the ethics of
pelvic surgery. I will only say on that point that, under
recisely similar conditions, I should again act exactly as I
id in this particular instance; and it may not be super¬
fluous to add that in the case related by Mr. Brown, although
as the operator I am prepared to assume my full 6hare of
responsibility, no fewer than three unanimous consultations
were held with my colleagues, among whom are Mr. Wheel-
house and Mr. Mayo Robson, as well as Mr. Brown.

I am, Sirs, very faithfully yours,

Leed», Jan. 8th, 1887._T. R. JbSSOP.

ALCOHOL AS MEDICINE.

To the Editors of Thb Lancbt.

Sirs,—A recent remarkable County Court trial has
attained a wide publicity. The widow of a member of a
Phoenix total abstinence society brought an action against
the society for the amount of death claim due on her late
husband’s decease. The society’s defence was that the man
had broken his total abstinence pledge (the Phoenix insisting
on absolute abstinence without medical exception) by
taking some intoxicating wine ordered by his medical

attendant. The judge was most righteously indignant at
this truly infamous defence, but was compelled to yield to
the defence on the ground that the man himself on his sick
bed had accepted tho return of his subscription and his
exclusion from benefit.

On inquiry I am happy to find that this is an isolated
society, and is not one of the great Phcenix orders, leaders
of which general bodies assure me that their action in such
bond-fde circumstances would have been to pay the widow’s
claim. We all know the false medical pretences on which
people are apt to father their teetotal pledge breaking, and
also the loose way in which alcoholic intoxicants are some¬
times ordered; but it ought to be thoroughly understood
that the temperance cause is not responsible for such
shocking, disgraceful, and unjust treatment of a m&n on his
death-bed and his widow in her sorrow.

I am, Sirs, your obedient servant.

Grove-road, N.W., Jan. 8th, 1887. NORMAN KkRR, M.D.

* # * For the correct name of the particular “ Lodge ” see
an Annotation on p. 139 .—Ed. L.

PROMOTION IN THE ARMY MEDICAL SERVICE.

To the Editors of Thb Lancbt.

Sms,—Referring to your remarks regarding the Army
Medical Service, will you permit me to say that your
original comment, to the effect that a medical officer
could not, by regulation, be promoted to the rank of
Brigade Surgeon without having passed the required exa¬
mination, was, in my opinion, perfectly correct, and your
correspondent who took exception thereto wrong. If you
will turn to those regulations, you will find that he has, not¬
withstanding the use of inverted commas, made an important
omission. The words are not “promoted for distinguished
service,” but “ medical officers of any grade promoted for
distinguished professional service will be exempt from
further examination.” Moreover, paragraph 8 of the same
regulations is that which is applicable to such a case, and it
seems clear and specific enough. It runs : " lie must, before
he can be selected for promotion to the grade of Brigade
Surgeon, establish before an examining board, appointed for
the purpose by the Director-General, his efficiency in the
following subjects”—viz., those of the examination.

I am, Sirs, yours truly,

J«n. 10th, 1887. A MEDICAL OFFICER.

FRIENDLY SOCIETIES’ MEDICAL ASSOCIATIONS
AND THEIR INJURY TO MEDICAL FRACTICE.

To the Editors qf The Lancbt.

Sirs, —Having seen several letters in your valuable paper,
complaining of the difficulty of qualified men getting work
to do, and the replies stating that it was greatly owing to
the employment of unqualified assistants, I must in justice
say that I consider it is more due to the springing up of
late years of amalgamations of clubs called “ friendly
societies’ associations,” and on which head I have a right
to speak, having unfortunately for many years been
connected myself with one until lately, where the pay¬
ments of the members and their wives are four shil¬
lings, and of children under eighteen two shillings a
year, for which small amount visits and medicine are
included, and patients seen within a radius of three
miles. I do not believe there are any provident dis¬
pensaries conducted at so low a rate of payment. We
certainly had the honour to have two town councillors, and I
do not believe I shall be wrong if I 6ay three belonging to us,
also some of their wives and children, all of whom derived
the benefits of the association at the same magnificent scale
of payment. There were numerous other members in good
stations of life in the like category. The secretary, a paid
official, an officer under the Local Government Board, also
allowed his family to partake of the benefits of the society.
The association numbered nearly 4000 members, and to
visit, dispense, and attend midwifery there was the large
staff of two medical officers, who did not get half the annual
receipts or any augmentation of income from increase of
members.

All I can say in conclusion is, that I warn young medical
men from taking up such appointment*, as they lower the

, y Google

The Laxcbt,]

NORTHERN COUNTIES NOTES.—EDINBURGH.

[Jan. 15,1887. 149

status of the profession; and if the salary seems good, it is
more than counterbalanced by the enormous amount of
work expected and by the insults received.

I am, Sirs, yours faithfully,

Dec. 38th. 1888. _ SUBGKON.

SUPPURATION IN THE APPENDIX VERMI-
FORMIS.

To the Editors of Thb Lancet.

SrBf,—With regard to the query contained in the last
wntence of Mr. Barford’s communication to you on his most
interesting case, I think there can be only one answer, and
that is to remove by abdominal section the purulent
appendix, and drain the abdominal cavity. Sufficient cases
hare been put on record to attest the wisdom of trusting to
timely and bold surgery such as 1 suggest, rather than to
opium or other medicaments.

I am, Sirs, yours truly,

Ssttlngluun. Jan. 9th, 1837. GeOBGE ELDEB.

NORTHERN COUNTIES NOTES.

(From our own Correspondent.)

NEWCASTLE THBOAT AND KAB HOSPITAL.

The annual meeting of this charity was held to-day, the
Sheriff of Newcastle, W. H. Stephenson, Esq., presiding.
The number of patients entered for the first time was 1482,
while 546 remained on the books from 1885, making in all
2008 cases treated daring the year. A most gratifying
feature in the past year’s work has been the important
amount contributed by the patients, the financial state¬
ment showing that £233 10s. 9 d. had been handed in by the
patients to the dispenser in this way. Advice and medicine
had been given 912 times free. No case is refused aid, how¬
ever poor. The medical report presented the usual features
of a special hospital of this nature, but the etaff complain of
want of room, and it has been decided to appeal to the
public for aid to erect a new building. Plans, which have
been prepared by Mr. J. C. Parsons, architect of this city,
have been approved by the Committee, and immediate
steps are to be taken to carry them into effect.

NEWCASTLE HOSPITAL SUNDAY FUND.

The final lists of the Hospital Sunday collections have
been published, and show that the total amount collected at
places of worship is £2119 12*. 6<f., as against £1437 5*. 3d.
last year. The amount subscribed at the factories and work¬
shops was £1770 7s. Id., as against £1437 5*. 9 d. The amount
raised is £3889 19*. 6 d., the largest figure ever reached in any
year's collection. The Newcastle Journal, in commenting on
the collection, says, “ It is a satisfactory result, no doubt; but
in view of the greatly enhanced requirements of the hospital
charities, we cannot but feel that more will have to be done.
The church and chapel collections are not likely to prove
very much more elastic. They have now again very nearly
touched the highest amount they have ever reached, and
from which they had subsided in former years. If they can
b» kept up to the amount subscribed last year it will be very
well, but we must trust to more liberal and better organised
effort* amongst the working classes to expand the fund.”

ACCIDENT TO DB. 8HEBWOOD OF WHITBY.

Dr. Sherwood of Whitby, well known to many in North
Yorkshire and beyond as a genial and successful practitioner,
had the misfortune, on Dec. 27tb, to fall on leaving his
surgery. and, his leg being bent under bis body, he sus¬
tained a fracture of the tibia v and fibula. He did not lose
bis presence of mind, but at once requested the attendance
of the Ambulance Corps, which be had himself trained
while surgeon to the local Artillery Volunteers, the mem-
bos of whom, under the guidance of Dr. Tinley, removed
him to his private residence, a considerable distance from the
s ur ger y where the accident befel him. It required no little
•are to prevent the bone in transit coming through th« skin,
the fracture being oblique; but so far, under the care of his
friend, Dr. Tinley, he has been saved the trouble of a
compound fracture, and is, I hear, doing well.

5t*wc»*tl»-on-Tyiie, Jan. 10th.

EDINBURGH.

{From our own Correspondent.)

THE BOYAL SOCIETY.

A plebiscite of the Fellows was recently taken in regard
to a proposal to change the hour of meeting from 8 p.m. to
4 p.m. The proposal was negatived, but the minority was
so numerous that a compromise has been effected, and a
series of interim meetings arranged for the afternoon hour.
The first of these was held last week, and Sir Douglas Mac-
lagan, one of the vice-presidents, presided over a gathering
of some fifty of the Fellows, the numbers showing that the
afternoon hour is not an impossible one, and demonstrating
how wide an interest was felt in Mr. Coleman’s address upon
Processes of Refrigeration. In his address, Mr. Coleman
covered a wide area; he dealt first with the purely scientific
aspects of the subject, describing the various processes
employed and quoting results obtained. Recent French and
Russian observers find that atmospheric air liquefies at &
temperature of -242° F.; they have also fixed the boiling
points of liquid air and liquid nitrogen. Turning to the
economic aspects of refrigeration, the lecturer described,
apparatus for continuous freezing, ether freezing machines,
ammonia freezing machines, and compressed air machines.
The last are in general use for the conveyance of fresh
meat on board ship; they depend for their efficiency on
the fact that a great fall of temperature occurs in air
that is suddenly allowed to expand after compression.
These machines maintain a temperature of from 10° to
20° below freezing point, at which meat can be kept
good for an indefinite period. Over two million frozen
carcases of sheep have been brought to this country, chiefly
from New Zealand and South America. Interesting results,
which are quite new, also accrued to some experiments
made by Mr. Coleman and Prof. McKendrick as to the
influence of cold upon the vitality of micro-organisms.
They found that vitality was retained and activity regained
by organisms that had been exposed to a temperature of
-120° F. for 100 hours. Prof. McKendrick, speaking at tho
end of the address, said that, much as had been done in
developing refrigerating processes, there was still great
room for further important advances fraught with great
scientific interest and practical benefit.

POLICE CASES AND THB DUTY OF MEDICAL MEN.

A recent homicide by stabbing in a public street in Edin¬
burgh has created some discussion as to medical responsibility
in police cases. A week ago, a man was severely stabbed in
the region of the chest, whilst quarrelling, in the presence
of eeveral bystanders. He was found by his friends to be
seriously injured. It is stated that they applied for aid at
the houses of two medical men in the neighbourhood. In
each case they were told to take the sufferer to the Royal
Infirmary. They did so, and upon arriving there he waa
found to be dead. Some important letters on the subject
have appeared in the local newspapers. On the one
hand, it is urged that the doctors have been guilty of in¬
humane conduct in declining to attend the case; on the other,
that, leaving out of account the extreme ambiguity of the
term “doctor” in the district in question, where herbalists
and others receive that courtesy title, the public have only
themselves to blame if they find a medical man unwilling
to hasten at their call to patch up the victims of riotous
and drunken brawls. As a rule in such cases, unless he be
requested to attend by the police authorities, a medical
man is not only justified, but almost bound in self-defence,
to let the injured combatants receive treatment at the
police-station or the infirmary, to which they naturally
gravitate. In this case the police do not seem to have made
any such application, and there is no reason to believe that
the medical men in question received any more urgent
summons than an indistinct statement from an irre¬
sponsible individual. This occurrence has opened another
important question, whether there ought not to be
district police surgeons in the various wards of the
city, to whom application for assistance in street acci¬
dents or emergencies might be made, without any risk
of attendance being refused. This course is urgea upon
the city authorities in an able letter by Dr. Peel Rltcnie,
who agitated in the same direction some years ago, and he

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150 The Lancet,]

DUBLIN 1 .—PARIS.

is supported by the opinion of several local medical men.
There is cause to regret that the discussion of this proposal
by the Public Health Committee has not ended in some
modification of the present system, -which is, that in an
emergency the nearest medical man is called by the police
authorities, who remunerate him for his services in accord¬
ance with a definite scale of payment. The defect in this
system is that upon the police devolves the onus of deciding
as to the urgency of the case, and they are naturally prone
to take the view least at variance with the strict notion of
economy that is very properly instilled into the force, and, as
a result, mistakes are apt to occur occasionally of the nature
of that now described.

EDINBURGH VITAL STATISTICS.

Dr. Littlejohn’s annual report for the year 1886 has just
been published. It shows a total of 4555 deaths in the year,
or at the rate of 17 - 89 per 1000 of the estimated population.
The births numbered 7457, giving a rate of 29 26 per 1000.
Of infectious diseases 7623 cases had occurred, classified
thus:—Measles, 5843; scarlatina, 1306; typhoid, 224; diph¬
theria, 212; small-pox, 26; and typhus, 12. Of these 7623
case8 380 proved fatal.

PRESENTATION.

Mr. A. G. Miller, F.R.C.S.E., Honorary Surgeon to the Royal
Infirmary, and Lecturer on Surgery in the Extra-academical
School, has been presented by his students with an address
expressing their respect for him personally, and the high
• esteem in which they hold him as a teacher.

Edinburgh, Jan. 11t h.

DUBLIN.

(From our own Correspondent.)

THE DUBLIN HOSPITALS COMMISSION REPORT.

Although the report of the Commission appointed to
inquire into the condition and working of the Dublin hos¬
pitals has not yet been published, it is understood that the
following recommendations are included in the report. It
is suggested that the sum of money hitherto granted by the
Government to the House of Industry and other hospitals
in the city of Dublin should in future be distributed
pro rata among the principal hospitals, according to their
general public usefulness and the extent of their accommo¬
dation for patients. A portion of the report will refer to
the system of clinical instruction and the necessity of having
special wards set apart in the large hospitals for the treat¬
ment of special diseases. The Commissioners do not recom¬
mend an amalgamation of the medical staffs of certain
hospitals, as wa» proposed by some of those examined
during the inquiry. Theee are the chief items of interest
in the report, and in addition it is believed that an effort
will be made to induce the Treasury to increase the Govern-,
ment grant in consequence of the larger number of institu¬
tions it is proposed to have the money allocated to in future.

THE SANITARY STATE OF CORK.

A special meeting of the Public Health Committee was
held last week, to consider the report lately furnished by
Dr. O’Farrell, Local Government Board Inspector, in relation
to the sanitary condition of the city. The first recom¬
mendation in the report was: “ That the street cleansing be
improved, and that a complete system of domestic scaveng¬
ing be undertaken [by the Corporation.” It was resolved
that the executive sanitary officer and other officers should
prepare a report as to the best means of undertaking the
domestic scavenging to its fullest extent. The next recom¬
mendation was: “ That the sewers of the city be completed
and modernised, and that a map be provided in accordance
with the 22ad section of the Public Health Act; that all
the main sewers be ventilated at their highest levels, and
that they be provided with side entrances, manholes, and
not less than twenty ventUators for each mile of sewer.”
No action was taken on this, it being understood that the
map referred to would soon be completed. The third recom¬
mendation was in reference to lodging-houses and tene¬
ment-yards being kept in a sanitary condition. The fourth
recommendation was that a public abattoir should be
erected, but this the Committee considered to be unwork¬
able. The other suggestions .referred to the disposal of
sewage, and the protection of the water-supply from con¬

tamination. The seventh and last recommendation was:
“That the medical staff officer of health should devote his
whole time to the duties of his office.” This the Committee
unanimously declined to adopt.

Cork workhouse.

Colonel Spaight (LodaL Government Board Inspector) in
his half-yearly report on the condition of this workhouse,
draws attention to the breaches of the rules, and the absence
of strict discipline in the management of the institution.
In reference to the system of admissions, Colonel Spaight
remarks:—“ I believe a very great number are admitted for
treatment in the hospitals who might well pay for their
maintenance. Not only are the ratepayers loudly com¬
plaining, but the accommodation in the male hospital is
limited, and in such cases the beds are occupied by those
who could be provided for elsewhere, to the discomfort
and exclusion of those for whom they were intended. As
far as I could ascertain, no question is asked or inquiry
made as to the means or condition of those admitted?’
This is a condition of affairs which certainly should not
exist, and the special committee to whom the report has
been referred will, it is to he hoped, take prompt measures
to rectify any irregularities which may be found to prevail.

MEBCER8 HOSPITAL, DUBLIN.

I recently referred to Mr. Newcomen’s exclusion from
this hospital, and have now to add, in reference to the sub¬
ject, that the Board of Governors, in consequence of a public
investigation having been suggested by the press, lately
passed a resolution requesting the Corporation to nominate
three members to investigate the charges in which Mr. New¬
comen is interested. This request of the governors was
under the consideration of the Hospital Committee of the
Corporation last week, and three members, one of whom is
a medical man, were nominated to act.

NORTH DUBLIN UNION.

At a meeting of the guardians of this union last week,
applications were received from the medical officers for an
increase of salary. After some discussion the following
resolution was passed by a large majority: “ That all appli¬
cations for increase of salary by the officers of this union be
postponed for twelve months, in consequence of the very
distressed circumstances of the union.”

Dublin, Jan. 11th. _

PARIS.

{From our own Correspondent.)

THE ALLEGED FAILURE IN M. PASTEUR’S INTENSIVE METHOD.

To judge by the crowded state of the public gallery at the
Academy of Medicine at a recent meeting, an unusual
amount of interest was taken in the discussion on the case
of death from hydrophobia recently communicated by
M. Peter, and mentioned in my last letter. Although the
debate did not degenerate into a positive quarrel, M. Peter
was interrupted frequently by protestations from more
than one learned academician, and the gallery was all
the time against him. Murmurs of disapprobation were
heard when he hinted that the suppressio veri was not un¬
known to the directors of the anti-rabic laboratory, and the
contradictions of MM. Grancher, Brouardel, and Dujardin-
Beaumetz were received with applause. The discussion
commenced by a statement from M. Grancher concerning
the patient whose case had formed the subject of M. Feter’s
communication. M. Grancher said that it was affirmed, by
M. Peter that the patient had received thirty-six inocula¬
tions in twelve days; this was not correct, the register of
the laboratory showing that nineteen inoculations only had
been made, a treatment much less thorough than was neces¬
sary in bites about the face. M. Peter had insinuated that
the intensive method might give rise to accidents, a pos¬
sibility which the partisans of the inoculations were
perfectly prepared to accept, and with which every new
therapeutic method is obliged to reckon. Each of the rare
failures brings its lesson, and it would seem that alcoholism,
the nervous temperament, and epilepsy are unfavourable,
whereas youth is a favourable condition for tha treatment.
The treatment waanow graduated for eachjpotient by taking
into consideration the special risks resulting from the bite,
and the special susceptibility of the individual. M. Brouardel

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SANITATION AT TOULON.

[Jaw. 15,1887. 151

■aid that allusion bad been made in X* Peter’s communica¬
tion to a child who-was said to have died of hydrophobia.
This child had been bitten on Oot. 8th by a stray dog.
Inoculations were made from the 20th and lasted twelve
days. On Nov. 23rd the child was struck by one of his play¬
mates in the loins. lie fell ill thirty-six hours later, and
died the following day in collapse, with diaphragmatic
•paems; there had been no “ hydrophobia,” but there had
been an impossibility to swallow liquids. In this case,
tha poet-mortem examination showed symmetrical ecehy-
aoses at the back of the kidneys, and the urine con¬
tained albumen. The inoculation of two rabbits with the
child's medulla did not give rise to rabies. The child had,
ao doubt, died of •uraemic poisoning due to albuminuria.
1L Duj&rdin-Besnmetz related his investigation into the
case under dispute. His communication threw no light
upon the subject. M. Peter’s facts do not seem to have
bean contested, and it is of no interest to record the
opposite judgments passed'upon them by different observers.
m Peter, in reply, said that he had felt compelled to make
kabwn the ease related by him to-the Academy on account
of the danger of the new intensive method, andof the
secrecy with which all the deaths following upon it were
concealed by the persons concerned. ' As long as M. Pasteur
had confined himself to hia first method of treatment, he
(M. Peter) had merely looked upon it as inefficacious; but
since the modified plan had been adopted the inoculations
had become dangerous. A new form of rabies occurred after
the so-called preventive inpoulationf, a form whioh he
would call “ canino-expenmentaV’and according to the pre*-
domineace of action of the canine or Paeteurian virus the
predominating symptoms were either those of ordinary or
of laboratory rabies. ; It .was precisely because a new, and as
yet unknown, paralytic form of the disease was usually met
with that the difficulty of diagnosis was so great, and that
death was generally attributed to some grave affection of
the nervous centres. As regarded the presence of albumen
la the urine of the patient examined by M. Brouardel, it
was perfectly well known, as had been shown by M. Robin,
that albumen is always found in the urine of the dead
•abject. Since the last sitting of the Academy, notwith¬
standing the attempt mads by the authorities to oonceal
the facta, M. Peter had, he said, become acquainted with
three new cases of “ cure ” by the intensive method that had
terminated fatally. The first was a man forty-seven years of
ace, as Dunkirk, who was bitten by a mad dog on the 18th
oi August. He had not beeu cauterised, an operation which,
observed the speaker, thanks to the false security inspired by
the inoculations, is at present too often neglected. On the
21st he went to the laboratory, and was submitted to the
intensive treatment. On the 29th of December, 112 days
after the bite, he first fell ill, and was unable either to eat or
•lrink. In the coarse of the night he was seized with violent
attacks of suffocation. On the 30th there were hydrophobia
and eonvulsicms, and the following day he died. The post¬
mortem examination showed the usual evidence of asphyxia.
This, M. Peter considered, was a typical case of ordinary
rabies. The second case was at Constantine. A man, forty-
ax years of age, was bitten on Oct. 12th. From the 20rli
be waa treated by the intensive method. - On Nov. 20th
puns appeared at the seat of the bite; on the 23rd, pain was
felt where the inoculations had been made, and there was
sleeplessness. Breathing was impeded by the accumula¬
tion of mucus, difficult to expectorate, in the bronchi. There
was aversion to fluids. The urine was albuminous. The
patient died next morning. The post-mortem revealed
intense congestion of the brain, including the cerebellum,
and softening. Sections presented a nutmeg appearance.
There was serous effusion into the ventricles. The lungs
were congested. Here was a case of modified rabies of
the canino-experimental hind, showing the m efficacy of the
treatment, and the combined effect of the two viruses. The
third death occurred at Arras, and a veterinary surgeon had
said that the dog in question was not rabid. (M. Vulpian
correc'ed this statement. Further investigation, he said, had
proved that the animal really had had rabie3.) The sufferer
was forty-two years oW, ana was bitten on Nov. 12th, and
■nderwent the intensive treatment on the I7th. On
Dec. 10th be felt great pain at the seats of the inoculations,
which extended from the loins up the spinal column. He
vm nervous and depressed, saying that he felt the same
symptoms as at the time of inoculation, and felt very tired.
No pain at the Meat of the bite or in the corresponding limb.
A doctor called in on the 13th thought he was ^ufferfogfrom

lumbago, and & few days later changed this diagnosis for
.myelitis. The symptoms were accompanied later by difficulty
of breathing, a feeling of weight in the front of the chest,,
and spitting. Speech became short and jerky, and was inter¬
rupted by involuntary respiratory movements. Convulsions
occurred in the face, trunk, and upper extremities, but there
were no general convulsions or hydrophobia. Paralytic
symptoms eet in, and the patient died on the 17ch. Although
there wasno “ hydrophobia,” Al. Peter considered that the case
was one of rabies; and from an analysis of the symptoms
that it was extremely probable that the onset of the disease
•was caused by rabbit-derived virus. The sconce ended after a
protest from MM. Trelat and Brouardel against M. Peter’s
inaccuracies, which, they said, he might have guarded against
by consulting the records of the Pasteur institute.

tiie pasteuq institute.

The public subscription for this Institut now amounts
to more than 1,500,000fr., the seventy-fourth, seventy-fifth,
and seventy-sixth lists published by the Journal Officiel
having made up 25,916 fr. The Conseil d’Etat, which had
been asked to decree the institute us one of public utility,
had adjourned its decision for further inquiry.

Parla, Jan. llth.

SANITATION AT TOULON.
(From our Special Correspondent).

Tub authorities of Toulon have made some slight im¬
provement in the sanitary condition of this most unhealthy
town. They profess to have spent £16,000 during the last
year in sanitary work. A very large proportion; however,,
of this sum has been used to defray the cost of filling up a
ditch called the “Rode” and in destroying the old fortifica¬
tion which stood close by. The foul deposits at the bottom of
this ditch are in many places two yards deep, and the ditch
itself measures four yards in width and about 300 yards in
length. No attempt has been made to remove the foulness
accumulated here in the course of ages.. It was thought
sufficient to cover it all up With some three feet of earth.
Even this would have cost about £20,000 bad the earth been
brought into the town expressly for the purpose. But by
simply tumbling the fortifications into the ditch the work
was accomplished for the comparatively small outlay of
£5000, or lOd. the cubic metre or earth removed. The town
of Toulon can now enlarge itself in this direction, and a
better current of air is established in the streets that were
formerly blocked up at.one end by the city wall. But it is
to be hoped that trees only will be planted on this covered
ditch. They might help to purify the subsoil; houses, on
the contrary, if resting, on such foundations, would expose
the health of their inhabitants to the gravest danger.

This work was hardly terminated before its disadvantage
became painfully evident. Iu times of heavy rainfall the
ditch served to carry some of the water away. Now the
only remaining ditch in the neighbourhood empties into the
port by a covered way and therefore can only carry off a
limited amount of water.: This brook consequently over¬
flowed, the Rode ditch could no longer relieve the pressure,
and extensive floods in the suburbs of Toulon resulted. It
is even said that the damage done by these floods equals the-
cost of filling up the Rode. ,

Another ditch; called the Egoutier, is now being canalised,,
and this work .will be finished by next April. The earthern
banks will be walled up, and the bottom cemented and made
concave, so that the water will be able to flow easily and leave
little or no deposits. This is the only way of treating these
brooks, whioh remain nearly dry the greater part of the year,
and yet at certain times have to bear the pressure of an
enormous quantity of water. Most of the towns on the
Riviera, Nice and Cannes, for instance, are traversed by
several of these small watercourses, and they have always
been a source of nuisance. Dirt of all sorts is thrown into
the river bed, and there is not water enough- to carry it
away. With eemented walls and a sharp invert the case is
different, and the subsoil is also protected from contamina¬
tion.

Though less costly, a more important improvement has been
achieved with regard to the general cleanliness of .the town.
It is well known that many houses at Toulon have no
closet -accommodation whatever. The night-soil iaallowed

152 The Lancet,]

NOTES ON THE CASE OP THE LATE LORD IDDESLEIGH.

[Jan. 15, 1887.

to accumulate in deep earthenware jars, and these were
generally emptied in the street gutter, whence the water,
which flows plentifully, carried the sewage into the harbour.
Now, however, a cart goes round every street of Toulon
three times a day. This cart, or rather metallic tank on
wheels, receives all the soil from the houses, and anyone
now found befouling the gutter is prosecuted. 1 was
assured by the local authorities that before the population
could be taught to avail themselves of these tanks it was
necessary to prosecute fifty people in a week, and still there
are summonses issued daily for infraction of the law.

Again, it is worth noting that the scavenging of the town
is now done by men in the employ of the municipality, and
is no longer entrusted to contractors. The latter it was
found were more apt to think of their profits than of the
health of the town. As a result of these changes the water
of the gutters falls into the port in a much purer state. As
each street reaches the old port it will be noticed that the
giftters fall into a sort of tank covered over with a grating or
with wooden boards. Here leaves and refuse of all sorts are
retained, for the water passes out into the port through iron
bars, which act as a sieve. Formerly the water of the gutters
was so heavily charged with refuse that from fifteen to sixteen
cubic metres were withdrawn daily from these filtering tanks.
Now, however, that the scavenging within the town is so
much better managed, the amount of solid deposit made by
the gutters as they reach the tanks close to the port only
amounts to about two cubic metres per day.

In spite, however, of these slight improvements, the town
of Toulon remains in an extremely unhealthy condition.
Typhoid fever, always present, is more than usually preva¬
lent at this moment. Some of the best quarters are often
the most affected. Considerable fear is also entertained lest
epidemics should arise from the careless treatment of the
soil collected in the town and deposited a little way out in
the country, where it is given to farmers for manure. This
manure, consisting in part of the dejections of typhoid
patients, may, if spread about on fields, contaminate neigh¬
bouring wells or watercourses. The depdt is managed in so
primitive a manner that not unnatural fears are enter¬
tained as to the possible consequence.

Toulon, Jan. 2nd.

THE SERVICES.

War Office.— Army Medical Staff: Surgeon-Major F. A.
Turton, from half-pay, to be Surgeon-Major, vice Duke Parke,
retired. Q. Burnett Currie (Insch, Aberdeenshire) has been
appointed District Medical Examiner of Recruits for the
Regular Army and Militia, vice Geo. Mackie, M.D., deceased.

India Office.— The Queen has approved of the retire¬
ment from the Service of t.be undermentioned officers:—
Deputy Surgeon-General Charles Planck, Deputy Surgeon-
General John Brake, and Brigade 8urgeon James Fair-
weather, M.D., all of the Bengal Medical Establishment.
The Queen has also approved of the following transfer from
the temporary Half-Pay List to the Retired List:—Surgeon
Ernest Lawne Robinson, Bengal Medical Establishment.
The undermentioned officer has been granted a step of
honorary rank on retirementBrigade Surgeon Charles
Kelwav Colston, of the Bombay Medical Establishment, to
to be Deputy Surgeon-General.

Admiralty. — The following appointments have been
made:—Deputy Inspector-General Edward T. Mortimer, to
the Hong Kong Hospital; and Deputy Inspector-General
Charles H. Slaughter, to the Haslar Hospital.

Artillery Volunteers.— 3rd Volunteer (Lincolnshire)
Brigade, Eastern Division, Royal Artillery: Edward Sharpley,
Gent., to be Acting Surgeon.

Rifle Volunteers.— 1st Battalion,the King’s Own (Royal
Lancaster Regiment): Surgeon J. Robinson is granted the
honorary rank of Surgeon-Major.

Bequests.—M r. Crowther Smith of Newbridge
House, who died on the 26th ult., has bequeathed £1000,
free of duty, to the Wolverhampton and Staffordshire
General Hospital, and the same amount, also free of duty, to
the Wolverhampton Orphan Asylum.—By the will of the
late Mr. George Fielder £500 is, on the deaths of certain
relatives, left to each of the following hospitals: Cbaring-
cross Hospital. Middlesex Hospital, Surrey County Hospital,
and Seamen’s Hospital (late Dreadnought ), Greenwich.

NOTES ON THE CASE OF THE LATE LORD
IDDESLEIGH.

Dr. J. Mortimer Granville, who was first consulted
by the late Lord Iddesleigh on Feb. 23rd, 1886, has allowed
us to make the following extracts from the notes tulran by
him whilst acting as his Lordship’s medical adviser:—

Feb. 23rd.—Gouty history on father’s side; agitation of
right arm resembling paralysis agitans; he is able to hold his
hand perfectly still for six or eight minutes. Left arm and
right leg tremble very slightly; some deafness, left ear the
best. Hears 28,000 vibrations per second with left. Stands

well with eyes shut. Patellar-tendon reflex normal.

Cardiac dulness nearly normal; mitral also aortic bruits.
Breathing rather rough, but free. Pulse characteristic. Two
Bphygmographic tracings taken decidedly mitral. Mano¬
meter : left hand, 44 lb.; right, 40 lb. Extremities cold.
Urine passed at same time contains no albumen. Has been
living somewhat low, and is mentally and physically de¬
pressed. Falls asleep quickly, but starts a great deal, and
has once or twice jumped out of bed while half conscious.
Never had epileptiform disturbances.

27th.—Sphygmographic tracing shows improvement.

March 15th.—Much better generally, and hand trembling
less, assuming more the character of a choreic movement,
but much less frequent. Manometer: right hand, 671b.;
left hand, 55 lb.

May 14th.—Better considerably. Urine of twenty-four
hours: _ sp. gr. 1020; acidity, 3 - 465; urea, 10 grs. per or.;
uric acid, - 3600 gr. per or.; no albumen; no sugar.

Notes of case from this point show steady improvement
until Oct. 8th, when he had Blight attacks oi giddiness, but
never involving loss of consciousness, and apparently anaemic
in character. At this time the physical signs were found
to have improved, the heart’s action being regular, less
laboured, and the bruits less strongly marked. Sphygmo-
grams of this date are less of the mitral type. Urine of
twenty-four hours: sp. gr. 1023; acidity, 3 700; urea, 12 grs.;
uric acid, '3087 gr. per or.; no sugar; no albumen; no excess
of phosphates.

Dec. 1st.—Was sent for to see his Lordship after his
return from Windsor. Believes himself to be suffering from
a slight chill. Much wearied, and complains of undefined
pains in abdomen. Heart sounds as before. Not sleeping
well the last few nights. Has sensation of cold water
running down the back.

2nd.—Much better.

8th.—Slight giddiness when going upstairs after break¬
fast. Did not lose consciousness or stagger, and expressed
his belief that it was owing to the pressure of his cravat.
Heart sounds as usual; no irregularity or intermission.
Has at no time while under observation had either
irregularity or intermission. No albuminuria at any time;
no swelling or oedema, and no enlargement of any of the
viscera.

This was the last occasion on which Dr. Granville saw his
Lordship alive. On the 12th inst., at about ten minutes to
three in the afternoon, he was summoned to Do wning-street,
and found him dead. Mr. Langston, of Broadway, West¬
minster, had seen him just before he died, and communicated
the following statement to Dr. Granville:—“ On my arrival
Lord Iddesleigh was lying on a sofa, perfectly straight;
extremities not drawn ; no turning in of the thumbs;
no distortion of the features; pupils dilated and fixed;
no stertor; skin pallid, cold, and clammy; lips very
slightly blue tinged; no venous engorgement; quite
pulseless; no cardiac sounds discernible. He gave a gasp,
and with an expiratory effort died. Hot flannel stupes were
laid over region of the heart, and sulphuric ether in water
was applied to the nose and mouth. It was found that he
could not swallow.” Mr. Hebbect, of the Westminster Hos¬
pital, arrived in a short time, after which, at Mr. Langston’s
suggestion, ether was injected into the left forearm, and
Silvester’s method of artificial respiration tried, but none of
these remedies had the slightest effect. Dr. Granville, on
his arrival, applied nitrite of amyl to the nose, but without
result. His Lordship evidently died from tlj$ aortic valvular
complication.

The Lancet,}

ROYAL COLLEGE OP SURGEONS OP ENGLAND.

[Jan. 16,1887. 15S

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At a quarterly meeting of the Council held on Thursday,
Jan. 13th, the Council agreed to purchase the Cobbold
Collection of Entozoa, with the accompanying manuscript.
This collection was made by the late Professor Spencer
Cobbold. One essay has been received for the Jacksonian
Prize on the Pathology &c. of the Thyroid Gland.

The following is the result in reply to the questions
contained in the Circular addressed by the Council to
die Fellows of the College:—

Analysis of the Answers.

Number of circulars sent out . 987

Answers received. 706

Difference . 281

Returned through post for various reasons ... 21

Unanswered. 2GQ

From the 706 answers 6 must be deducted as giving no
decision one way or the other.

Of the remaining 700 answers, it appears that in reference
to Question A—In your opinion should Members of the
College be allowed to Vote for Fellows as Members of the

Council ?

Fellows voting" No” . 419

Fellows voting “ Yes”:

Answers unqualified .181

Answers qualified . 96

Total Fellows voting “ Yes” . 276

Majority of “ Noes” . 143

And that in regard to Question B—In your opinion
should Members of the College be eligible for seats on the
Council ?

Fellows voting “ No” . 626

Fellows voting “Yes":

Answers unqualified , . 84

Answers qualified . 88

Total Fellows voting “ Yes”. 172

Majority of “ Noes”. 364

It was resolved that the Committee of Charters and Bye¬
laws be requested to send a further report as soon as possible
in reference to the proposed changes in the Charter and
Bye-laws.

The resignation of Professor Humphry as a Member of
the Court of Examiners was accepted, and the election of
a successor will take place at the next ordinary meeting of
the Council.

The Council of the Metropolitan Central Branch of the
British Medical Association was informed that their letter and
accompanying resolutions had been laid before the Council.

A memorial signed by several medical men and men of
Kieoce, referring to the disposal of the funds received by
the Council under the will of Sir Erasmus Wilson, was
brought forward and referred to the Committee on-th»
question as to the disposal of such funds.

The following resolution, proposed by Sir T. Spencer
Wells and seconded by Mr. J. Hutchinson, was passed by
11 to 8, subject to confirmation at the next meeting:
“ That— although the Council are not prepared to give effect
to the recommendation contained in the first resolution
carried at the meeting of the Fellows and Members held at
the College on the 4th of November, 1886—the Council are
prepared to act upon the second resolution, so far as to
appoint a small committee to confer on the subjects of the
first resolution with representatives appointed by the Asso¬
ciation of Fellows and the Association of Members.

From the above report it appears that 706 Fellows have
responded to the questions propounded by the Council in
their recently-issued circular: 1. In your opinion should
Members of the College be allowed to vote for Fellows as
Members of the Council? 2. In your opinion should
Members of the College be eligible for seats on the Council ?
This may, under the circumstances, be considered as a very

full poll. The first question has been answered iu the nega¬
tive by a majority of 143. The second, also in the negative*
by a majority of 354. We have from the first anticipated
what the result would be; but we find cause for consider¬
able satisfaction in the figures actually before us, especially
when we consider the very misleading terms of the interro¬
gations. That of a poll of 987 of the Fellows, only a
majority of 143 were unfavourable to an extension of the-
voting franchise to Members of the College, whilst of the
276 Fellows who voted “Yes” 181 answers gave an “un¬
qualified” affirmative reply, affords a remarkable indication
of the growth of a liberal and enlightened spirit. This testi¬
mony is emphasised by the fact that, in reply to the second
question, 172 Fellows (84 of whom returned “unqualified^
answers) expressed an opinion that Members should be
eligible to sit on the Council. Bearing in mind the restric¬
tions as to standing which the Members themselves would,
impose, and which the Council in polling the Fellows left
out of consideration, we cannot but regard the result of this
appeal to the Fellows as eminently satisfactory, and as
proof beyond all cavil of the sympathy of the Fellows in
the reasonable aspirations of the Members.

Society of Apothecaries.—T he following gentle¬
man passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received a certificate
to practise, on Jan. 6th: —

Strickland. Percy Charles Hutchison, M.R.C.S., Ilderaly-grove,
West Dulwich.

The annual ball in aid of the funds of the Scar¬
borough Hospital and Dispensary was held on the 4 th inst.

A death from eating tinned salmon is reported
from Dent, near Sedbergh, in the North Riding of Yorkshire.

The distribution of prizes at the Imperial School
of Medicine, Constantinople, took place in the presence of a
large assembly on the 2nd nit.

Hospital Saturday Fund.— Lord Brabazon has
consented to preside at the thirteenth annual meeting of
this fund, to be held at the Memorial Hall on Feb. 8th.

Superannuation Grant.—T he Poplar Board of
Guardians have decided to grant Dr. d. Gray a super¬
annuation allowance of £67 per annum for life.

On the 8th inst., at the City and Guilds Technical.
Institute, Finsbury, a practical examination was held of
plumbers from different parts of the country, who desired
to qualify themselves for registration.

The Japfray Suburban Hospital.—M r Jafiray,
of Birmingham, has received from an anonymous donor the
sum of £1000 towards the endowment fund of the Jaffray
suburban branch of the Birmingham General Hospital.

The Harveian Society of London.— The annual-
general meeting of this Society will be held on Thursday,
,Jan. 20th, at 8 p.m., at the Stafford Rooms. Titchborne-
street, Edgware-road, on which occasion an address will be
delivered by the retiring president, Dr. Hughlings Jackson,
F.R.S., after which a conversazione will be held.

Sewage Irrigation.—A t a meeting of the members,,
of the Association of Public Sanitary Inspectors at the offices
of the Society on the 1st inst., Mr. James Bateman read a.
paper on "Sewage Irrigation Applicable to Small Areas.”
A short discussion followed, and the proceedings closed with
a vote of thanks to Mr. Bateman.

Small-pox at Walsall.—A t a meeting of the
Walsall rural sanitary authority on the 7th inst., it was
reported that small-pox had again broken out in the locality.
An arrangement has been made with the Town Council to
treat non-pauper cases in the borough epidemic hospital
at the rate of £1 a week.

A Medical Magistrate.—A t the last quarter
sessions for Carlisle, Dr. Henry Barnes qualified as a justice
appointed by the Lord Chancellor. Dr. Barnes has long
occupied a prominent position as a physician in the north
of England, and has interested himself in all aaedioal
and many public movements. His medical brethren in the.
north feel pleased at this recognition of bis work.

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154 Tub Lancet,]

MEDICAL NEWS.—BOOKS ETC. RECEIVED.

[Jan. 15,1887.

On the 6th inst. a complimentaiy dinner was given
at Manchester to Mr. Malcolm Webb on the occasion of his
resigning the post of resident medical officer at the Man¬
chester Royal Infirmary, a position which he has occupied
for upwards of two years.

St. Mary’s Hospital.—O n the 12th in&t. the
annual Christmas entertainment was given to the con¬
valescent patients of this hospital. The dimensions of the
board-room proved scarcely adequate to accommodate the
large and appreciative audience.

• Manchester Medical Society.—T he following
gentlemen have been elected office-bearers for 1887:—Pre¬
sident: Dr. James Ilardie. Vice-Presidents: Drs. C. J.
Cnllingworth, Julius Dreschfeld, James Ross, and Mr. A. W.
Stocks. Treasurer: Dr. C. E. Glascott. Secretary: Mr.
F. Armitage Southam.

The National Hospital for the Paralysed and
Epileptic.—T he Lord Chancellor will preside at a festival
dinner at the Holbom Restaurant, on Wednesday, Feb. 9tb,
in aid of a jubilee fund for opening the whole of the wards
in the new building of the National Hospital for the Paralysed
and Epileptic (Albany Memorial).

Wholesale Poisoning.— A large number of people
—nearly one hundred in all—are stated, to have suffered
from food poisoning near Carlisle. After a dinner given at
-a sale of farming stock last week, all the guests who partook
of peas-pudding, served with boiled beef, were seized with
ain, vomiting, and other symptoms of irritant poisoning,
he poison has, it is said, been traced to washing-soda
used in cooking to soften the peas. All the patients are
recovering.

.. Treatment of the Metropolitan Sewage.—T he
Duke of Westminster, in reply to an invitation to attend a
meeting of the ratepayers of the metropolis to protest
against the expenditure contemplated by the Metropolitan
Board of Works for the treatment of the sewage at Barking,
has expressed his opinion that the costly scheme of the
Board requires a more searching examination than it has yet
received. His Grace advises that memorials should be pre¬
sented to the Board calling attention to the objections which
have been urged against the scheme.

Odontoloqical Society of Great Britain. —
The following constitute the members of the Council for
the year 1887:—President: Charles S. Tomes, FJt.S. Vice-
Presidents : Henry Sewill, S. J. Hutchinson, J. H. Mummery,
Andrew Wilson (Edinburgh), Richard Rogers (Cheltenham),
-and G. C. McAdam (Hereford). Treasurer: James Parkinson.
Librarian: Felix Weiss. Curator: Storer Bennett. Editor
of the Transactions: Frederick Canton. Hon. Secretaries:
R. H. Woodhouse (Council), Willoughby Weiss (Society),
and C. J. Boyd Wallis.

The Royal Colonial Institute held a meeting
at Princes’ Hall, Piccadilly, on Tuesday evening, when a
very interesting paper on New Guinea was read by the
Rev. James Chalmers, missionary and explorer. Dr. Doyle
Glanville, who was medical officer pn the staff of the Royal
Commission for New Guinea, and whose pictures and
writings in the Graphic have from time to time long been
familiar to the public, addressed the meeting at some length.
After describing the object of the expedition and giving a
general outline of its proceedings, he spoke of the London
missionary labours in New Guihea in terms of the warmest
praise, and concluded his remarks by alluding in feeling
terms to the memory of the late Sir Peter Scratchley, who
■died out there.

TnE Vienna Hospital.—F rom a statistical report
of the great Vienna Hospital, which has just been pub¬
lished, we learn that during 1885, 26,448 patients were
treated there. Of these, 13,000 were discharged cured and
4000 improved. Some were removed to other institutions,
as many as 1000 being sent to lunatic asylums and more
than 500 to the smaH-pox hospital. There were 2898 deaths.
The total number of patients during the last hundred years
was -1,0W, 7-29* amongst whom the mortality was 237,218, or 1
14-83 per cent; In 1885, which was the first year of the ,
second century of the hospital’s existence, the number of
admissions was 8000 ini eteees of'the Annual average for the' 1
preceding hundred yea rk, and 38(K) in e*fce«a of -that of the
lasACeding ten years, the mortality being 0 95 less than that
■of the centiuy, and 003 less than that of the lost ten years.

Canterbury Dispensary.—Ou the 9th lust., thdl
fiftieth annual meeting of subscribers to this institution
was held, when the report showed that during the existente
of the dispensary 76,210 persons had been attended, a pro-f.
portion of nearly 90 per cent, of that number having been .
visited at their homes. In consideration of the fifty years’
services of the medical officer, Mr. George Rigden, it was
recommended by the Committee that be should be pro-'
sented with.£50. The report was adopted unanimously.

Sanitary Registration of Buildings Bill. —At
th» monthly meeting of the Council of the Sanitary Assur- •
ance Association on January 10th, a report on the draft;
Bill was submitted with several clauses redrawn. The Bill
was further amended, and ordered to be printed for final
consideration at the next meeting of the Council. The new
Bill is proposed to be compulsory with regard to schools,
hotels, asylums, hospitals, and lodging-houses, while Clause 6
has been made much , more stringent in the matter of qualifi¬
cation of persona entitled to give sanittlry certificates.

BOOKS ETC. RECEIVED.

Baillifre, Tindall, A Cox. King William-street, Strand. London.

On Irritable Brain in Children. By W. H. Day, M.D. pp. 33.

Some Remarks on the Classification and Nomenclature of Diseases.'
By A. Habagliata, M.D. pp. 60.

Brief Statement of the So-called •* Salisbury Plans" of Treating
Diseases produced by Indiscreet Feeding. By J. H. Salisbury,
M.D. pp. 64.

The Bovins Prescriber. By J. B. and A. Gresswell. pp. 77.

t Cassell A Co., London, Paris, New York, A Melbourne.

Health at School considered in its Mental, Moral, and Physical
Aspects. By Clement Dukes, M.D.Lond. New and Bnlargoa
Edition, pp. 321.

Churchill, J. A A., New Burlington-street, London.

Transactions of the Oplithalmological Society of the United
Kingdom. Vol. VI. pp. 531. with Illutratlotts.

Diseases of Bones and Joints. By C. N. Macnamara, F.R.C.S.Bng.
Third Edition, pp. 535, with Plates (some coloured) and Wood

• Engravings.

8t. Thomas's Hospital . Reports. Edited by Dr. Gulliver and
Mr. Clutton. Vol. XV. pp. 360.

i Mental Disorders and Nervous Affections treated by a new
Method. By George Moseley, F.R.C.S.Bng. pp. 63.

A Treatise on the Principles ana Practice of Medicine. By Austin

• Flint, M.D., LL.D. Sixth Edition, Revised and largely Re¬
written by the Author, assisted by Profs. Welch and Austin
Flint, pp. 1160 .'

A Manual of Obstetrics. By A. F. A. King, A.M., M.D. Third
Edition, pp. 379, with 102. Illustrations.

Delahaye A Croshieb, Paris.

Stcur Jeanne des Anges. Autobiographic d'unc Hyshsrlqua
Possddee. Annot£ et publid par le« Drs. G. Legue et G. de la
Tourette; Preface par Jf. le Prof. Charcot, pp. 321.

Faxhix & Co., Grafton-street, Dublin.

Transactions of the Academy of Medicine in Ireland. Vol. IV.
Edited by W. Thomson, M.A., F.K.0.8. pp. 463, with Illustra¬
tions.

Kbexk A Ashwbll, New Bond-street, London.

The Prescribsr; a Dictionary of the New Therapeut ics. By John
H. Clarke, M.D.Edin. Second Edition, pp. 207.

The Revolution in Medicine. By J. H. Clarke, M. D. pp. S3.

Kbgan Paul. .Tbexoh, A Co., Paternoster-square, London.

' Anatomy and Physiology in Character. By Furneauz Jordon.
F.R.U.S. pp. 185.

Lewis, H. X., Gower-street, London.

Gout and its Relations to Diseases of the Liver and Kidneys. By
Robson Boose, M.D., F.C.S. Third Edition, pp. 161. ■

On Fevers, their History, Etiology, Diagnosis, Prognosis, and
Treatment. By Alex. Collie, M.D.Aber. pp. 288 with Coloured
Plates.

Lohomahs, Green, A Co., Paternoster-row, London.

Thomson’s Conspectus, adapted to the British Pharmacopoeia of
1385. Edited by Nestor Tlrard, M.D.Lond., F.K.C.P. New
Edition, pp. 251.

Macmillay A Co., London and New York. <

A Text-book of Pathological Anatomy and Phfcbo genet is. By
Prof. Ernst Zelgler. Translated and^Edited by Donald Macalister,
M.A.. M.D. Part II: Special Pathological Anatomy, pp. 391,
wttlr Illustrations. '

A Treatise on Chemistry. By Sir H. E. Roscoe, F.R.S.. and
C. ^choriemmer, F.R.S. Vol. Ill; Organic Chemistry, pp.
383.

Mack IVEY A Wallace, Edinburgh.

Aiexiuiil6r Wood, M.D., F.'ft.C.P.lt;, Ac.’: a Sketch of his Life and

" Work. By the Htk. Thos. Broton, F.R.B.B. pp. 401.

QtiVER A ‘Boyd, Edinburgh. " ..

Th9 Transactions of the Edinburgh Obstetrical' Society. Vol. XI.
pp. 138, with Illustrations.

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Tub Lancet.] APPOINTMENTS.—VACANCIES.—BIRTHS, MARRIAGES, AND DEATHS. [Jan. 15, 1887. 155

tassHAW, Hbkt, Strand; Churchills, New Burllngton-atreet.

Druiti’t Surgeon's Vade-Mecum. Edited by Stanley Boyd, M.B.

F J t0 * 8 E4 * Twelfth Bdltion. pp. 1000, with 373
Wood Engravings.

Siri Til. Elder A Co., Waterloo-plsce, London.

Transactions of the Pathotoeinal Society of London. Vol. 37. pp.
•17. with Illustrations.

Dictionary of National Biography. Edited by Leslie Btephen.

Vol. IX. Canute—Chalouer. pp. 460.

A Ooorae of PracUcal Zoology. By A. MUnes Marshall,

M.D. Ac., assisted by 0. Herbert Hurst, pp. <40, Illustrated.
Star ford, B., Charing-cross.

Transactions of the Sanitary Institute of Great Britain. Vol, VII.,
1885*. pp. 460.

Mrxs SoxsKXSCHEBf, Lowsky A Co., Paternoster*square, London.

An Elementary Text-book of British Fungi. By W. Del Isle Hay.
P.R.G.8. pp. 238,. with 5» Plates.

ItlEWH,* G., Leipzig.

Dr. Paul Boerner’s Relchs-Mediclnal-Kalender fiir Deutschland auf
das Jahr 1887. Herausgegeben vou Dr. 8. Guttmann. Theil

Williams A Noboatk. Henrietta-street, Covent-garden, London.

Near Theory and Old Practice in Relation to Medicine and
Certain Industries. By 6urg.-Gen. 0. A. Gordon, M.D., C.B.
pp. 151.

W- -3D. Wsr. A Co., New York.--

The Healing of Arteries after Ligature in Man and Animals. By
J. Collins Warren, M.D. pp. 1&4. trlth Plates.

Thomson, D. G., M.D.Ed., Senior Assistant Medical Officer at the
Surrey County Asylum, Cane-hlll, Coulsdon, has been appointed
Medical Superintendent of the Norfolk County Asylum.

Thornton, Bertram. M.B.O.S.. L.B.0.P.Lon<L, has been appointed
Surgeon to the Royal Sea-bathing Infirmary, Margate, vice Dr.
T. Smith Rowe, appointed Consulting Surgeon.

Walters, C. Asti.ey, M.R.C.8., L.S.A., has been reappointed Medical
Officer for the Second District: ofthe Cheltenham Union.

serrations on the Spinal Cord of the Insane; by R. S. Stewart, M.B.,
and AM. (Macdougsll, Glasgow).—Spiritualism ; by J. McLeau.—The
Moloch of Paraffin; by Charles Marvin.—Scribner's Magazine for
January, 1837.—Journal of the Scottish Meteorologloal Boclety for
1-85 (Blackwood and Sana, Edinburgh).—Some Phases of Cerebral
Syphilis.—On Tinnitus Aurium and its Treatment by Electricity; by
Juiiua Althous, M.D. (Longmans). — Doctor Johann Meyer, eln
rhtiniscber Arzt, der erste Bckkmpfor des Hexenwahns; von Prof.
Carl Blnz (Marcus, Bonn;.—The Bronchial Catarrh of Children; by
J«. Carmichael. M.D. (Oliver and Boyd, Edinburgh).—Home Buie
Wrinkles for Ladies; by Aunt Betny (Swan 8<mneeohein).—Le Kephlre-
Boimoa Medicinale du Lalt de Vache; par Dr. V. Dmltrieff.—Prescrip¬
tions : by M. CharUris, M.D.—The Microbio Revolution In Surgery ;
ty Dr. Dr. A. K. Steele, M.D.—Magazines for January, 1837: Good
Wools, Sunday Magazine, Leisure Hour, Sunday at Home, Boys' Own
Paper, G iris' Own Paper.—Observations with the Sphygmograph on
A>ylnm Patients; by T. D. Greenlees, M.B.Edin.

'**ssfal applicant* for Vacancies, Secretariat of Public InttiUdions, and
Vj^rt possessing information tuilnble for this column are incited to
forward It to The Lancet Office, directed to the Sub-Editor, not later
'v™ 9 o’clock on the Thursday morning of each, tooth for publication in
•he next number.

\KEtvKLK. Hloh Wioht, M.D.Aber., L.F.P.S.Ghts., has been re¬
appointed Medical Officer for the Stalnforth District of the Thorne
tnion ; and also Medical Officer of Health for the whole Union
District.

Eiti, Jisss, M.D.Glaa., has been appointed Honorary Physician to
the Liverpool Northern Hospital.

BiavsTO. A. O. P.. M.R.O.S.. L.S.A., has been appointed Medical Offlodr
it Health for the Mere Union.

ttrrjT. George Mallack, M.R.O.S., L.R.C.P. Lond., has been
appointed Uouse-Ph.vsician to the General Lylhg-in Hospital, York-
read. Lambeth, vice W. G. Holloway, M.B.Cantab., resigned,
list■*•»■, Jure, L.B.C.S., M-R-C-PEd., lias been appointed Medical
Officer for the Laughton District of the RothCrhath Union, vice Ward,
resigned.

-iXIa*. F. G. C., L.R.C.P.Lond., M.R.C.S., has been appointed House-
Sargeon to the Grimsby and District Hospital.

Jiu.faoEss. M.D.St.AmL. M.R.C.8.. has been reappointed Medical
Officer of Health for the Burnley Rural Sanitary District.

■h ->ktt. Harry Eugene, L.lt.C.P.Lond., M.K.C.S., has been appointed
Medical Officer and Public Vaccinator to the Gordon District of the
Chodton Union. Manchester, vioe R. B. Hammond, resigned.

Thomas, M.B., B.Oh. Unlv. Dub., has been appointed House-
Surgeon to air Patrick Dun's Hospital, Dublin.

I mm. George A., M.D., *LR.C;P^ has been appointed Physician
to Use Spanish Mutual Benevolent Boclety of Viedma, Patagoues,
Argentine Republic, South America. ,

Inu.-.i* TX . Spencer. L.K.C.P.Lond., M.R.C.8., has been appottWd
Arafstartt Medical Superintendent of the-Fulham Unton I nil mUrr.i
isails, HhmBBBt. M.R.C.-8., L.8.A., .Assistant Medical Officer to the
Marylobona. InArmasy. Notting-hiU. has been appointed Medical
bupsai n ga n tf en t at the Whitechapel infirmary, Bsker's-row. E.

-*&». W»;LLlM«rroN, M-R.C.S., L.S.A., has been appointed Divisional
Pol Ice-Surgeon to Walthamstow and Leyton, vice Mr. Henry Oouid,
retired. , "

•J 1 - ER. C. Pte, has been appointed Hoase-Physician to C baring-cross
HctpitaL . • • ,

^dii, HeXbY W., M.K.C.S.. L.S.A., has beep reappointed Medical
Officer for the Belton District of the Thorne Union.

'a. Arthur Walton, M.S., M.fi.Dur.. M.R.C.S., hss been appointed |
Surgeon to the Royal Sea-bathing Jrtflrmary, Margate, vice W. H.
Iburnton, appointed Oonsnltlng Burgeon.

In compliance with the desire of numerous subscribers, it .has been decided to
resume the publication under this head, of brief particulars of the variuuci
Vacancies which art announced in our adiertising columns. For further
information regarding each vacancy reference should be made to t/uf
advertisement.

Chelsea Hospital for Women, Fulham-road.—Assistant-Physician.

Cuo rley Dispensary. — House Surgeon (for term of three years).
Salary £130 per annum, with house, rates and taxes, but not coal
and gas. . . .

City of Loxoox Hospital fob Diseases of the Cuest.—R esident
Clinical Assistant. Salary £30 for six months.

East Suffolk Hospital.—H ouse Surgeon. Salary £100.per annum,
with board, lodging^-and washing.

Es sex amp Colchester General Hospital.—A Physician.

Flintshire Dispensary.—H ouse Surgeon. Salary £100 per annum,
with furnished house, &c. * J

Great Northern Central Hospital, Caledonian-roud, N.—Surgeon
to the Out-patients.

Huck.vall, Huthwaitk, near Mansfield, Notts.—A Qualified Medical
Man.

Jaffkay Suhurban Branch of the General Hospital, Gravelly-hill*
near .Birmingham. — Resident Medical Oilicer. Salary £lo0 per
annum, with board, residence, and washing.

Lampeter U Nioft, ,Lla.n yuythkk Districtoi .—MedicalOfficer. Salary
£30 p«r annum, exclusive of extra medical fees.

London Temperance Hospital, Hampstead-road, W.W.—Junior House
SurgeoM. Board and residence In the hospital. 11

Newcastle-On-Tynb Dispensary.—R esident Medical Officer (for term
of not less than three years). Salary £250 per annum, with furnished
house..

Retford Dispensary.—R esident Surgeon. Salary £150 per annum,

: with rooms, coals, gas, aud attendance.

Seamen’s Hospital (Ute Dreadnouoht). Greenwich. S.K. —House
Surgeon. Salary £60 per annum, with board, furnished rooms, and
attendnnoe.

Worcester General Infirmary.— House Surgeon. Salary £1Q« per
a nnum with board and residence.

litaniages, atti) Jtat^s. .

BIRTHS.

Church.—O n the 11th Inst., at Harley-street, the wife of W. 8. Church,
M.D., of a son.

Greathkad.—O n the 8th nit., at Graham’s Town. 8outh Africa, the

_ of J- B. Greathead, M.B.Bd., M.R.C.S., of a son.

Hilu.—O n the 27th ult., at Carlton House. Prince of Wales Bond,
Battersea-perk. S.W., the wife of A. Phillips Hills, M.R.C.S.B*,
F.S.Sc., of a daughter (Lorna).

Scully.—O n the 9th inst... at Calcutta, the wife of Surgeon-Major
J. Scully, of a daughter.

Silk.—O n the 31st ult., at Pemberton-road, Upper Holloway, the wife
of Fredk.Silk, M.D.,ofason.

MARRIAGES. ■»

Cahill—Krith.—O n the .jth Inst., at St. Mary of thb Angels. Bays-
water, John Oahill, F.R.C.S., to Lucy, youngest daughter of Thos,
W. Keith, of Ladbroke-gardens', Kensington-park, W.

Crekhy—Stirling.— On the 6th Inst., at St. John's Church. Killoww*
Coleraine. John Tate Creery, M.B., to Juiia Mary, only child of the
late Major Thomas Stirling. H.M. filth Regiment.

Harris—Buhrowes. —On May 11th, at Rondebojeh, South Africa, by
the.ltev. Dr. Rooney, David Harris, M.R.C.S.Eng., of Beaconsfield.
Diamond Fields (late of Leeds, Yorkshire), to Cecilia Mary, daughter
of Thomas Burrowes, Esq., Solicitor, of Downpatrick, Ireland, and
niece of F. W. Burrowes, Esq., J.P., Collector of Customs for tirik
colony. .

Poldkn—Axoklo. —On Nov. 23rd, a b Christ Church, Rawul-Pindee,
Punjauh, Upper India, Robert James Poldeu, M.B., Surgeon, Indian
Medical Staff, to Lilian Evelyn, youngest daughter of Major John
Angelo, late Bengal Staff Corps, retired.

Waohorn-Halh.—() n ihe 80th ult- at the Memorial Church, Colaha.
Bombay, Henry Wsghorn, Surgeon-Major, Armv Medical Staff, to
Florence Isabel, youngest daeghter of the late J<&n Hirtde Hale. Of
Cbesham, Bucks. __

' ’ DEATHS. •

C.ejAR.—Cu the 9th hwt- at Totbenhsm, Charles Augustus Cs^ar,
L.R.C.P.Ed., L.F.P.S.Glas., aged 41.

D °'aged-73?^' eti * Ia8t - Muhlealy. Robert Dowell. M.B.C.S., L.S.A^

Bke.—O n the 4th Inst., Fredk. George Ree, L.R.C.P., M.R.C.S.

N.B .—Afmof St. it charged for the Insertion of notices of Birth*

Homages, amt Death*. i

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156 Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jan. 15,1887.

fjfototal §iarj for % tnsuittg Mttk.

Monday, January 17.

Royal London Ophthalmic) Hospital, Moortields.—O perations,

10.30 a.m., and each day at the same honr.

Royal Westminntkh Ophthalmic Hospital.—O peration*, 1.30 P.M..
and each day at the tame hour.

St. Mark’s Hospital.—O peration*, 3 p.m. ; Tuesday*. *ame hoar.
Ceklska Hospital fob Women.—O perations, 3.30 p.m. j Thur*day, 3.30.
Hospital yob Wombs, Soho-squahe. — Operations, 3 p.m., and on
Thursday at the same hour.

Metropolitan Fbbb Hospital.—O peration*, 3 p.m.

Royal Orthopedic Hospital.—O peration*. 3 p.m.

Obvtbal Lo it do s Ophthalmic Hospitals.—O peration*. 3 p.m., atd
each day in the week at the tame hour.

Medical Society op London—8.30 p.m. Dr. J. Langdon Down: On
some of the Mental Affections of Childhood and Youth (Lettsomian
Lecture).

Tuesday, January 18.

Shy's Hospital.—O peration*, 1.30 p.m., and on Friday at the same hoar.

Ophthalmic Operation* on Monday* at 1.30 and Thursdays at 3 p.m.
8t. Thomas’s Hospital.—O phthalmio Operation*, 4 p.m. ; Friday, 3 P.M.
Gahcbb Hospital, Bbompton.—O perations, 3.30 p.m.; Saturday, 2 JO p.m
Westminster Hospital—O perations, 3 p.m.

West London Hospital.—O peration*. 3.30 p.m.

St. Mart’s Hospital.—O peration*. 1.30 p.m. Oon*ultations, Monday,

1.30 p m. Skin Department. Monday* and Thursday*, 9.30 A.M.
Royal Institution op Great Britain.—3 p.m. Prof. Arthur Qamgee:

The Function of Respiration.

Pathological Society of London. — 8.30 p.m. Address by the
President. Mr. Fenwick: Section of Hypertrophied Bladder from a
case of Stricture—Dr. Handford: Fatty Tumour of Heart—Dr. Ord:
Spontaneous Disintegration of Vesical Calculus—Dr. Sharkey:
Infantile Paralysis of Long Standing—Mr. Bland Sutton : Diseases
of Genito-urinary Organs of Animals—Mr. D’Arcy Power: A
Neglected point in the Pathology of Colles’ Fracture. Card
Specimens Dr. Handford: Specimens of CEsophogeal Disease-
Dr. Sharkey: Syphilitic Arteritis—Dr. Maudsley : Ulceration of
Trachea with Perforation of Aorta—Dr. B. O’Connor: Mediastinal
Tumour.

Wednesday, January 19.

Rational Orthopedic Hospital.—O perations, 10 a.m.

Middlesrz Hospital.—O perations, 1 p.m.

Bt. Bartholomew’s Hospital.—O perations, 1.30 p.m.; Saturday, same
hour. Ophthalmia Operations, Tuesdays and Thursdays, 1.30 p.m.
St. Thomas’s Hospital.—O perations, 1.30 p.m.; Saturday, same hour
London Hospital.—O perations,3 p.m.; Thursday*Saturday,samehour
Great Northern Central Hospital—O perations, 3 p.m.

Samaritan Free Hospital for Women and Children.—O perations.

3.30 p.m.

University Coll bob Hospital.—O perations, 3 P.m. ; Saturday, 3 p.m
S kin Department, 1.45 P.M.; Saturday, 9.1& a.m.

Rotal Free Hospital.—O perations, 3 p.m., and on Saturday.

Kao’s College Hospital.—O perations. 3 to 4 p.m.; and on Friday,
3 p.m. ; and Saturday, 1 p.m.

Childken’s Hospital, Great Ormond-Strket—O perations, 9 a.m.j
S aturday, same hour.

Society of Arts.—8 p.m. Mr. J. B. Marsh i Cameo-cutting as an
Occupation.

Thursday, January 20.

Sr. Georg it’s Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital.—S urgical Consultations, 1.30 p.m.
Chasing-cross Hospital.—O perations, 3 p.m.

North-West London Hospital.—O perations. 2.30 p.m.

Royal Institution of Great Britain— 3 p.m. Prof. A. W. Rucker :
Molecular Force*.

Parses Museum of Hygiene.— 5 p.m. Mr. M. Ogle Tnrbotton:

Bngineeriag and Architecture in relation to Sanitary Science.
Hartkian Society of London.—8 p.m. Annual General Meeting.
Election of Officer*; President's Address ; Conversazione.

Friday, January 21.

Bt. George's Hospital— Ophthalmia Operations, 1.30 p.m.

Royal South London Ophthalmic Hospital.— Operations, 3 p.m.
Socibtt of Medical Officers of Health—7.30 p.m. Dr. O. B.

Saunder*: Legislation for the Purification of Rivers, and its Failure.
Rotal Institution of Great Britain— 9 p.m. Sir Wm. Thomson:
The Probable Origin, the Total Amount, and the Possible Duration
of the Sun’s Heat.

Society of Arts.—8 p.m. Mr. Trelawney Saunders: The Upper Oxus.

Saturday, January 22.

Middlesex Hospfial.— Operations, a p.m.

Rotal Institution of Great Britain.—3 p.m. Mr. Carl Armbruster:
Modern Composers of Classical Song—Liszt (with Vocal Illustrations).

METEOROLOGICAL READING 8.

(Taktn daily at 8J0 ui .by Steward's Instrument!.)

The Lancet Office, January 13th, 1887.

Dais.

Hsrometer
reduced to

Has Levs]

aaSEPP.

Direc¬

tion

of

Wind.

BaX

Wet

Balk.

Solar

Radis

In

Vaeuo.

Max.

Temp.

Shade.

Mia.

Temp

tail.

Remark! si

asos.it.

Jan. 7

29 03

8 .W.

36

35

40

82

Overoast

„ 8

2907

W.

36

35

39

34

-14

Overcast

„ 9

29 33

w.

37

36

33

35

•02

Overcast

„ 10

29-79

w.

35

31

39

33

•07

Overcast

.. 11

2991

s.

33

37

45

35

Overcast

.. 12

30-25

N.

40

40

42

40

■00

Raining

,. 13

30-45

N.E.

31

34

...

33

•01

Foggy

fto, Sjrort Comments, # pushers to
Coraspmthnts.

It it especially requested that earlu intelliysnce of local evente
having a medical interest, or wnich it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors."

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private informa¬
tion, must be authenticated by the names and addresses of
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of Thb Lancbt to be addressed “ 1 o the
Publisher. n

We cannot undertake to return MSS. not used.

The Use of Cocoa.

The total consumption of cocoa is 80,000,000 lb. per annum, supplied
mainly by the West Indies and South America. France heads the list
with 23,000,003 lb.; Spain comes next with 16,000,000 lb.; then follows
England, 14,000,000lb.; and the United State*. 8,500,000 lb. In this
last country the use of cocoa ha* increased more than sixfold sinoe
1860, while that of tea and coffee within the same period has not
quite doubled.

Hr. Gillclt (Paris) will see from a general notice published above that
we do not undertake to return MSS. not used.

Hr. Arthur HattJiey.—Yfe regret we are unable at present to answer the
question.

R. S . II*. has not enclosed his card.

“ SUICIDE AFTER TAKING CHLORAL."

To the Editors of The Lancet.

Sirs.—Y' our correspondent, “ A. P. G-,” asks, In your last issue, two
questions about suicide after chloral, In reply to which I submit Um
following.

All narcotics, including alcohol, may predispose to suicide, and I pre¬
sume most practitioners could instance cases tending to prove the fact
I will record one in recent experience. On Dec. 2Uh, 1886, I waa called
to see a young Japanese gentleman, aged twenty-one, who had shof
himself with a pistol, and who died two honrs and a half after m;
arrival from the wound In the brain with compression. I had neve
attended him before, but he had been seen by Sir Andrew Clark, an
also by another practitioner. Although the symptoms might b
aocounted for only by cerebral hemorrhage, 1 thought It probabl
that there was the complication of some narcotic, and as the oondltio
of the pupils negatived opium I inquired particularly about chlora
No satisfactory evidence could be obtained at the time, bat after deatl
when examining proicriptions that were found, I saw that chloral ha
been given. As no reasonable cause for suicide could be discovered
save occasional depression, but, on the contrary, with position, wealtl
Ac., there were many things calculated to make life desirable, it seed
likely that the narcotics lessened self-control, and the publication 0
such cases may do some good by cautioning all of us to be careful t
their administration. I am. Sirs, yours faithfully,

Ph'lbeach gsrdeus, S.W., Jan. 9th, 1887. J. A. Owxsa.

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Thb Lanckt,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jan. 15,1887. 157

FVBXBAtlX JOBDAH TKaTIMOXlAL FOXD.

To following b a Uat of subscriptions already promised to the above
fond. Subscriptions may be forwarded to the hon. treasurer, Ur. T. H.
Bartleet, 27, Newhall-street, Birmingham; or to the bon. secretaries,
Mr. Bennett May, 81, Bdmond-st., and Mr. Jordan Lloyd, 23, Broad-st.

Bartleet. T. H., J.P.,

F.H.C.S.£10

Carter. Harold, J.P. ... 10
Chavaaae, T. F., M.D. ... 10
Tangre, Hichard, K*q. ... 10
Wsasett. John. M.D. ... 6

Blunt, O. V.. M.D. ... 5
Bradford, Oordley, Bsq... &

Lloyd, Jordan, F.K.C.S. 8
May. Bennett, F.K.C.S. 5
Msddlesnore, Wm., J.P. 8
Jlavton, K. A., Bsq. ... 5

Oaks*. Arthur, Bsq. ... 8

Thompson, Thos., Bsq.... 5

Wilders. J. 8t. 8., Bsq.... 6

Bnsoey. C. J.. M.B. ... 3

B*wna,T.G..Bsq. (Uverpl) 3
Hawkins, Alex., Bsq. ... 3

Hallwright, M., Bsq. ... 3

Sawyer, Sir James ... 3

Smith. Priestley, Bsq. ... 3

** A Friend ” (per J. P.

Ba-lley. Ksq.). 3

Bliasard. Rev. J. 0., M.A. 3
Bad ley, J.P., Bsq.(Dudley) 3
Brown. Jaa.. Bsq. (Tipton) 3
Carter. A. H.. M.D. ... 3

Clayton, Councillor ... 3

Harvey, Alfred, M.B. ... 3

Harrtaon. A. J., M.B.

(Clifton). 3

Hunt. Joseph, Bsq. ... 3

Marriott, O. W., M.D.

(Leamington). 3

Moxoo. W., Bsq. 2

Buckling, C. W., M.D.... 2

Williams, Joshua, Esq.... 2

Allen. H. G.. Bsq. ... 1

Baines, John, Baq. ... 1

Barfing, Gilbert. F.R.C.8. 1

Bradley, Daniel (Dudley) 1
Com bill. John, Bsq. (Ilfra¬
combe) . 1

i Clarke, W. J„ M.B. ... £l 1

10 0 , Olay, Langsford, Esq. ... 1 1

10 0 Clay, A. F, Bsq. 1 1

10 0 ' Clarke, J. Fenn, Bsq. ... 1 1

10 0 I Dunoalfe, Henry, M.D. 1 1

6 0 Ellis, Fredk., Bsq. ... 1 1

6 0 Fairley, 8. B., Bsq. ... 1 1

6 0 Haslam, Mr. F,F.K.C.S.. 1 1

5 0 Holllnshemd, F., Bsq. ... 1 1

6 0 Holloway, G., Bsq. ... 1 1

8 0 Jobes, Thos., Ksq. (Ruthin) 1 1
6 0 Ker, H. K., Esq. (Halea-

8 0 owen) . 1 1

5 0 Marsh. F., F.K.C.S. ... 1 1

8 0 Middlemore, Thomas, Bsq. 1 1

3 0 Norris, R.. M.D.1 1

3 0 Nason,John, M.B. (Strat-

3 0 ford) . I l

3 0 Nlcholls, Gordon, Bsq.... 1 1

8 0 Prosser, K. A. 8., Bsq. ... 1 1

3 0 Payton, Thomas, Bsq.

(Smethwick) . 1 1

2 0 Riley, T.W., Bsq., (Pontes-

2 0 | bury) .. 1 1

3 0 j Richards. T., M.D. ... 11

3 0 | Sims, Chas., Bsq. 1 1

3 0 Sansome, Thomas. Bsq.

3 0 (West Bromwich) ... 1 1

3 0 Swann, A., M.D. 1 1

Thomas, William, F.R.C.8. X 1

3 0 Turner, Edwin, Bsq.

2 0 (Wordesley) . 1 1

Underhill, A. S., M.D.

2 0 (Great Bridge). 1 i

3 0 Webb, T. Law, Esq. (Iron-

3 0 bridge).. 1 1

3 0 Woodcock. J. B.. M.D.... 1 1

1 0 Cant, W.J. Ksq. (Lincoln) 0 10

1 0 Harvey, John, M.D. ... 0 10

1 0 • Hall, T. Lambert, Esq. ... 0 10

1 0 j Horton, Henry, Ksq.

, (Bromyard) . 0 10

1 0 i Oldacrea, C.B., Bsq. ... 0 10

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

6

8

8

6

6

Cmmnta can claim one guinea for making the post-mortem examination,
and ooe guinea for giving evidence. The number of attendances at
the inquest does not affect the fee.

Ur. Latoson Tait .—The Editors are alone responsible for ail that appears
in the editorial oolomns of The Laxcbt.

“ COCAINR IN DBNTAL SURGERY.”

To the Editors of Thb Laxcbt.

Sia.s.—Having seen in your issne of Deo. 18th that M. Georges Vlan
hat only just established cocaine as an anaesthetic in dental extraction, I
think it perhaps fair to state that some six months ago I had a tooth
extracted In Plymouth, cocaine being injected, with no pain. Sinoe
then I have used it frequently, and only In one case were there any
toxic effect*—vlr., in the case of a stoker who had previously, on one or
two occasions, fainted In the coal bunkers. A draught of ether and
ammonia quickly brought him round. Whether syncope was due in this
rase to the drag, or to slight shock, the result of the operation, I could
cot say. Anmthesla appears to be complete, unless tliere is much
iadansmation at the root of the tooth.

In some forms of neuralgia, depending on a local lesicn, it seems to be
a valuable drug. I just quote one case where Its success was very

marked. J. H-complained of intense pain in the lower jaw. The

(are wss suffused on the tame side, with Injected conjunctiva and
swollen lids. Heappetred In great pain. I examined his teeth, which
were perfect, except for one which had been removed a few weeks
previously on shore. As it was just possible that the pain was due to
some irritation at the site of the removed tooth. I injected a grain of
cocaine into the gum. Visiting him about half an hour afterwards, he
said be was quite free from pain. There was no recurrence of it. The
following morning the congestion of face, Ac. had passed off.

1 am. Sirs, yours obediently,

G. F. Deax, Surgeon, R.N.

H.K.8 Polyphemus, Malta, Jan. 4th, 1887.

LIMITS OF THB CHILD-BEARING PERIOD.

To the Editors of The Laxcbt.

Snw,— I shall be obliged if any brother practitioners can give me any
'Heftntte information on the following question, either from books or
personal knowledge. Is there any infallible sign that a woman Is past
ohUd-bearing ? Here is a ease In point. A patient forty-seven years of age;
last child eight years ago ; irregular menstruation for some time post;
nothing seen for five months, than scarcely anything, only lasting a few
.hours. She wishes to rairry, but has the greatest objection to another
young family. I am, Sirs, yours faltbfally,

December 29t\ 1889. M.D.

Thb Phylloxera.

Thb average yield of the French vintage for the four years from 1875 to
1878, Inclusive, was 1,378,000,000 gallons. The last three vintages have
decreased at a greater rate than 100,000,000 gallons per year, and now it
is reported that In the vintage of 1888 more than one-fifth of the yield
was produced from dry raisins and dregs of the first and second press.
Although it is beginning to be the fashion to ascribe this decrease
ohlefiy to mildew and other causes, the presence of the phylloxera
must be regarded as one of its principal causes. After a variety of
research vs only one method has been found to effectually kill this
insect, and that Is by inundation, begun In November and continued
for forty days. The vineyard on which this experiment was tried was
one of the first to be attacked. In 1887 the wine produced was
935 hectolitres ; In 1868, 40; in 1899. 35; in 1870, the flrat year of sub¬
mersion, 130 hectolitres. Since that year the quantity produoed has
gradually increased, until it has nearly reaohod its normal figures, and
the vines have regained their vigour. The Commission appointed
In France, which pnbllth every year such a heavy report, have
chiefly studied methods for killing the insect underground, and but
little practical benefit has attended their action. Had th'y directed
their energies to a policy of extermination above ground very different
results might have been attained.

A Member .—Our correspondent, having been suspended on Jan. 1st and
having resigned offloe on the 8th, cannot claim payment of his salary
beyond the 6th for deprivation of office which he did not feel disposed
to resist. The only case to whloh the rule applies is where the guardians
have suspended the officer and it is referred to the Department for
their decision, when it Is competent for the Department to allow
payment of salary np to the time of removal, of suspension, or con¬
firmation of the same.

Dr. Fraser .—The case seems hard, and the decision Is probably wrong,
but we fear our correspondent is without redress.

PERSISTENT DIARRHCBA.

To the Editors of The Laxckt.

Sins,—I should feel greatly obliged If some of your readers who have
treated similar cases successfully would give me a few suggestions to
help me out of my trouble.

I am suffering from diarrhoea, with griping and flatus, the result, I
believe, of superfluous bile from an enlarged and unusually active liver.
I cannot say that I have any other symptom specially worthy of note.
In 1873 I went to the West Indies, and remained there till January, 1877,
faring somewhat hardly as regards food, and in consequenoe drinking
brandy pretty freely, though never to intoxication. During this period
I had several attacks of the ordinary Intermittent fever of the island,
but none of any noteworthy severity. On my return to England in
January, 1877, I was suffering from atonic dyspepsia and congestion of
the liver. Shortly after my return I got a severe chill, and this brought
on a violent attack of ague, which recurred at Intervals with gradually
decreasing force for upwards of a year. I remained in Eoglaad until
June, 1881, when I returned to the West Indies, apparently in perfect
health, the congestion of the liver having disappeared in deference to
podophyllin when indicated. I remained in the West Indie* until Juno
of last year, living very temperately but working very bard, both
mentally and bodily, having many Irons In the Are requiring my
personal supervision. In November, 1885, I hid a severe attack of bilious
remittent fever, and'ln April last an eqnally severe attack of obstruction
of the bowels, followed by a less severe attack of obstraction on my
passage home in June. Since that time the diarrhea* has been almost
constant. I am unable to take opium In any of Its ordinary farms ; but
from time to time I have had relief from small doses of akolethe, of
which I oan speak In the highest terms. Still, I do not care to be
dependent on any opiate, and I should like to get something more than
temporary relief. I am, Sirs, your obedient servant,

January, 1387. L.R.C.P.

To the Editors of Thb Laxcbt.

Sins,—I have just seen a letter In your issne of the 18th ult., signed
“ A. H.,’\ asking advice as to the treatment of an obstinate case of
diarrhoea. I would advise your correspondent to examine the rectum,
as I have known several instances in which obstinate diarrhoea was
caused by uloers, fissures, or even very slight abrasions of the mucous
membrance of tills gut, and which at once got well when the rectal
ailment was cared. I am, Sira, yours truly.

January 10th, 1887. J. I.

BRITISH MBDICAL BBNBVOLRNT FUND.

To the Editors of Thb Laxcbt.

Sirs,—T he annual general meeting of subscribers to this fund, which
was held yesterday, commissioned me to offer you an expression of
thanks for the servioea you have rendered to the fund during the past
year, by to freely and geueroiuly opening the columns of your valuable
journal to the communications Addressed to yon with regard to the fund,
and to express a hope that so useful an indulgence may be continued.

I am, Sira, your* truly,

Dpp?r Berkeley-**., W„ Jan Jlth, 1887. Bdwahd Bast, Hen. Seo.

Digitized by GoOglC

158 TiiK Lanckt.I NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. fjAN. 15, 188?.

Riddell Fund.

Tjii, following additional subscriptions have been received:—Amount
already acknowledged, £->0 3s. &/.; D. P. (per Dr. Dolan), £1 1j. ;
Dr. WhltweU, £1 Is.; Dr. Fegan, £1 Is.; M.D., 10s.; H. T., 3s. 6d.
The list will close on Jan. 19th.

Mr. Easterbrook. — We are not in a position to give a reply. Perhaps a
letter to the Kev. Dr. Forrest, of St. Jude's. South Kensington, would
elicit the information desired.

J. R. P.— Allen’s Commercial Organic Analysis, [published by J. and A.
Churchill, would probably answer the purpose.

PARISH PRACTICE AND ITS REMUNERATION.

To the Editors of This LANCET.

Sirs,—I would direct the attention of.the profession to the advertise¬
ment of the Lampeter Union in your issue of Jan. 8th. No doubt there
will be a great rush of the unemployed to secure Buch a lucrative and
easily-worked appointment. For the privilege of physicking the
paupers of the parisli of Llaniihangelrhosycorn and the adjoining
parishes the guardians offer, forsooth, a salary of no less a sum than £30
per annum, and at the same time gently announce the acreage of the
district. The area of the combined parishes is stated to be 34,200acres.
The advertisement calls to mind some lines of Albert Smith

“ The parish is small—ten miles by sixteen,

With some commons and gravel-pits scat tered between;

And respecting the cases, to state ’tls p’raps right,

That tney always occur at the dead of the night."

I am. Sirs, yours very truly,

Pucgbourne, Reading, Jan. 10th, 18S7. W. T. Freeman.

Tooth Powders.

In reply to several correspondents, we may say that the amount of pre¬
cipitated chalk implied in the formula which we gave in our issue of
the 1st inst. was 2 oz. (not 1 oz. as was erroneously printed in our last,
in answer to Messrs. Habgood and Cooper).

M. J. Knight.— Reynolds’ System of Medicine. Pepper’s System, Hirsch’s
Practical Pathology, Dr. D. Friere’s Monograph.

EMASCULATION OF FOWLS.

To the Editors of The Lancet.

Sirs,—I would be very much obliged if any of your readers could give
me some information about the emasculation of fowls, and if there is
any book which gives directions as to how the operation is performed.

• I am, Sirs, yours faithfully,

January, 1887. B. L. T.

Communications not noticed in our present number will receive atten¬
tion in our next.

Communications, Letters, Ac., have been received from—Mr. Lawson
Tait, Birmingham ; Sir W. MacCormac, London ; Dr. George Johnson,

, London; Dr. Bristowe; Mr. Jeasop, Leeds; Dr. Goodhart, London;
Dr. 0. W. Dulles. Philadelphia; Mr. F. Easterbrook ; Messrs. Arnold
and Sons, London; Mr. Rockliffe, Hull; Mr. Hussey, Oxford ; Mr. J.
, Bell, Suez; Mr. Benthall, Southsea ; Dr. Campbell, Carlisle ; Mr. S.
Snell, Sheffield; Dr. F. A. Smith, Cheltenham; Messrs. Burgoyne
and Co., London; Kev. W. Homfray, Retford; Messrs. Hopkinson
and Co., London ; Mrs. Learmonth, Kentish-town ; Messrs. Brin and
Co., London; Dr. Elder, Nottingham ; Mr. Mudge, Hale; Mr. J.K.
Lane, London; Dr. Sagons, Philadelphia; Messrs. Smith, Elder, and

Co., London; Mr. Hardman, Birmingham; Mr.Tdnnant. Matlock
Bridge; Dr. Lindsey,Belfast; Mrs. Smith, Caistor; Messrs. Delghton-
and Go., Cambridge; Mr. W. T. Grant, London ; Messrs. Wyley and
Co., Coventry; Mr. Buck, Sutton-in-Ashlield; Dr. Collins. Eegent’s-
park; Dr. Macnab, Stirling ; Mr. Dale, Scarboro’; Messrs. Wallace
and Co., Glasgow ; Mr. Newsholme, Clapham ; Dr. Penny, Marl¬
borough ; Mr. Thwaites. Bristol; Mr. Fuge, Taunton* Mr. Douglas,
Handsworth ; Mr. Weymouth, Brondesbury; Mr. Newham, London ;
Mr. Brooks, Kensington; Mr. Godfrey. Nortliampton ; Mr. Hardman,
Handsworth ; Dr. Owles, London; Mr. Gilleft, Paris; Dr. Norman
Kerr, London ; Mr. C. S. Jeaffreson, Newcastle-on-Tyne; Mr. Marous
Beck. London; Dr. Pasteur. London; Mr. Godwin \ Messrs. Lee and
Martin. Birmingham; Mr. K. Benham, London; Messrs. Bromley
and Co., Lincoln; Mr. Holloway, Worcester; Messrs. Simpson and
Go.,-London; Mr. Wyer, Hanley; Mr. Moore, Coventry; Messrs. Lee
and Nightingale, Liverpool; Mr. Martlndule, London ; Messrs. Austin
and Son, Clifton ; Mr. Hitch, St. Lconards-on-Sea; Messrs. Hearon
and Co.; Mr. Bornebrook. Loudon; Mr. Lyster; Messrs. Shanks and
Go., Loudon; Mr. Fox, Birmingham; Mr. Eist, London; Mr. C. S.
Shelley, Hertford; Dr. Cullingworth, Manchester; Messrs. Bennett
Bros., Salisbury; Dr. T. K. Clarke, Htrdderslield; Messrs. Christy
and Co., London; Mr. F. A. Southam, Manchester; Mr. D. Freeman,
London ; Dr. Sloan, Edinburgh ; Surgeon-Major Jagoe ; Mr. Bennett
May, Birmingham; Mr. A.W. Harding, Ealing; -Messrs. Reynolds
and Co., Leeds ; Mr. J. A. Gaven, London ; Dr. F. Page. Newcastle-
on-Tyne; Mr. W. Weiss, Loudon ; Dr. Hadden, London ; Mr. Lee,
Loudon; Mr. Woodland, London ; Mr. Mayhew, Ipswich ; Mr. Soott,
Manchester; Mr. Munday, Hampstead; Mr. Griffith; Messrs. Wi'son
and Son, Manchester; Mr. Greenish Wolverhampton; Messrs. Down
and Co., London; Mr. Ycldon, Ilfracombe; Messrs. Hopkinson and
Co., Nottingham; Mr. Blore, Leeds; Mr. J. Furley; Messrs. Triibner
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A

THE LANCET, January 22, 1887.

SI it ir r e s s

DELIVERED AT THE

PATHOLOGICAL SOCIETY OF LONDON

On Tuesday, January 18th,

By SIR JAMES PAGET, Babt., F.R.S.,

pres ident or Tin-: society.

Gbittlsmen, —I thank you heartily for the honour you
have conferred on me by electing me to be your president.
It is a great compliment that I should still be thought,
fit to be president of a Society of which the most active
members are much younger scientific men, some of whom
arc studying pathology in subjects and with methods
almost unknown to me. If I can be at all fit for the
office, it may be because, in my very imperfect know¬
ledge of many of the numerous methods in which patho¬
logy is now studied, I can look with full respect upon them
all; and, indeed, there are few tilings in relation to our
seiancs of which I aad more sure than of this, that every
possible method of studying it should be by all possible
means promoted. And while I am your president this shall
be my object, so far as I may have power.

1 hope I shall not prove myself unwise if I do not take
for the subject of my address that kind of knowledge in
which alone I might claim superiority over my hearers -
namely, the personal memories of the far distant past. It
would be very pleasant to me to tell some of them, and might
be amusing and flattering to those who can compare the best
modem knowledge with tbat’Whlchit has displaced. But
it may be more useful to think and speak of what may next
be done, and how to do it. For dvery increase of knowledge
brings before ns a larger and clearer view of the immeasur¬
able quantity which is still to be gained. The more we know,
the more can we see, if we will, how much more there is that
we do not know.

I wish I could indicate all or many of the ways in which
new knowledge is to be gained; but I cannot. - It is charac¬
teristic of modern pathology that, as it certainly surpasses
ail other sciences in the variety and complexity of its
problems, so it offers work sufficient for the employment of
nearly every variety and opportunity of the scientific mind.
Pathology, as distinguished from practical medicine, used
to be regarded as scarcely more than morbid anatomy; but
new there is in it work not only for the anatomist and
physiologist, but for the clinical observer; the experimen¬
talist, the minutest microscopist, the statistician, the
chemist, the naturalist, the historian, the psychologist, and
yet more. 1 cannot pretend to be all these; and I will not
pretend to decide who has done tbe best work or is most
likely to do it in the future. Only, it is certain that com¬
plete pathology must be constructed from the works of all
these; they are all mutually dependent, mutually corrective;
none can alone suffice, and none can safely be neglected.

But, of all the methods of study, there are only two with
which I have been much occupied—those, namely, of patho¬
logical anatomy and of clinical pathology in active practice.
I can therefore (peak of the future employment of only
. these two. Bat 1 will hope they m» suffloe, especially as
the neater part of tbe members of the Society are engaged
in them, ana because we may justly believe that practice
and pathological anatomy, if they be studied with the
scientific mind and methods, will still contribute largely to
the progress of the whole science of pathology.

I say practice studied with the scientific mind, because
practice is often spoken of as if it were altogether distinct
from science and inconsistent with it. We hear science and
practice spoken of as in opposition, and sometimes as if they
were mutually distrustful. I will not deny that strange
contrasts of the practical and the scientific may be found
among ns; bat these contrasts are constantly becoming
more rare; and it is an excellent influence of this Society
that it tends to cultivate the scientific mind and to maintain
it in the practical life. For what practioe may be depends,
in all respects, much more on the person .engaged in it than
-onits ewn subject-matter. /It may be for one a aoble pro-

Ho. 8806.

fession, for another a vile trade; and in equal contrast it
may be a mere useful art practised by one who has neither
love nor knowledge of any science, or to the man of
scientific mind it may be a thoroughly scientific study aa-
well as an applied science. I could name many living in
active practice of whose work a great part is as definitely
scientinc as is that done in any other section of biology.
And so are the works of many who are gone. . For example,
I know no reasonable definition of science which would ex¬
clude the researches by whioh Bright attained the knowledge
ol $he disease which beaijs his name; or which, in a just
history of pathology, would separate, as if they were of
different merits, the clinical and the experimental researches'
from which we have our knowledge of the diseases of
arteries and veins. Surely, it would be hard to name a dis¬
covery in biology which more deserves the name of scientific
than does Jenner’s discovery of vaccination; and yet it was
made in the plainest practical manner while he was a
country practitioner. But, observe, Jenner was a thorough
naturalist, trained by John Hunter; and I suspect it will be-
found that all the best advances in clinical pathology, tho
best not only in their utility but in their fitness for adjust¬
ment among the largest principles of our science, have been
made by practitioners who were either by nature or by
cultivation men of scientific mind. And it is as Sure as
anything of the kind can be that similar studies by men of
similar mind will still attain as good results.

Practice is full of opportunities for science. Let me
suggest only one group of them. Reflection on any day’s
work in practice may convince us that we have been using
a good deal of knowledge or belief which we pannot explain
by its relation with other knowledge, whether in pathology
or any other branch of science. We may have given what
are called specific medicines, or have advised some one in
the belief that he was predisposed to some disease, or may
have talked of functional diseases. Tet I doubt whether in
any of these things there are more than unexplained facts;
and if there are not, then we may be sure that the facts are
very hopeful beginnings for scientific, study by those en¬
gaged in practice. I may illustrate this by the example of
the use oi some of the specific medicines, such as that of
quinine in malarial diseases, of mercury and of iodide of
potassium in syphilis, of arsenic in many cases of psoriasis,
or of bromide of potassium in some cases of epilepsy. . Here
are sure facts, practical and useful, as sure as anything in
therapeutics. I would not call them scientific, for, so far as I
know, they are isolated facts, and separate from what may be
called general laws in biology. They are, indeed, the chief of
those facts which, in some minds, bnng our clinical pathology
into discredit; for, being only useful and not scientific, they
are cited as examples of unscientific practice. They are
called empirical, and the empiric is deemed equivalent with
the quack. Let me say, as in parenthesis, that I think we
have here an example of the common fate of words in our
language—that if a word acquires a discreditable meaning,
its better meaning is gradually lost, and only the worse
remains with it. For the enjpiric, and the experimentalist are,
I think, synonymous; and yet in pathology the one, having
a degraded name, is now deemed a hopeless hindrance to
progress, and the other is its hero.

But, however this may be, among these empirical facts
modem scientific work in practice may win great riches for
pathology. For the medicines 1 have named are not only
re mediae, but diagnostic tests; they prove differences among
diseased conditions that in other things appear alike. The
epilepsy which is averted by the habitual use of bromide of
potassium, cannot depend on the very same conditions aa
that which is not so averted; the ulcer which, heals under
fch* influence of mercury cannot be of the qame kind as that
which looks like it but does not so heal. Thus, as we all
know, these medicines are tests; and we may guess that
each of them detects the presence of some material belong¬
ing only to the disease which it cures. Here, then, is work
for the scientific practitioner; he may find the material and 1
more, if he will observe the facts in practice much more
minutely, and record and collect them, and bring to bear on
them as much light as possible from other sections of patho¬
logical science, They will yield more knowledge, and hia
practice.Fill he promoted a title than" empirical.

,,, Let me again refer to some facte which I have already
mentioned, and which are now accepted In the largest
principles of pathology. I remember that daring my appren¬
ticeship, more , than fifty years ago, in a post-mortem exann-

D

Googl<

160 The Lancet,] ^ PB. J. WILLIAMS ON CANCER OF-THB UTERUS. _ [Jan. 22 ,1887.

nation of one who had died with dropsy, a young Guy’s man
cut across one of the kidneys, and said “ Dr. Bright, of Guy’s,
says there is a form of dropsy which is always associated
with disease of the kidneys. This was accepted by the
practitioners standing by as a singular fact, and nothing
more. I should ftud it difficult to tell now into what, with
fifty years of scientific culture, that singular fact has grown.
Or, again, could any fact stand more alone than did that of
the use of vaccination as first observed by Jenner? And now
it may be honoured as the first knowledge attained in all
that wide range of pathology in which Pasteur’s great work
has been done, and to which Power and Klein have lately
annexed their admirable discovery of the true source of the
milk scarlatina.

There are many more of this group of the facts of ■tohich
we.have better knowledge in practice than we have in
morbid anatomy or any other section of pathology. We are
sure, for instance, that there are certain conditions which
axe justly called predispositions to dieease; but in what
many of these consist we are, I suppose, quite ignorant.
There are diseases or disorders which we must be content
to call functional, though I suppose none of us would hold
that there can be any change in the working of a part
without a change in its structure or composition. We know
that certain disorders, such as typhoid and scarlet fever, are
apt to be followed by certain other disorders, which we call
their sequels; but we have not yet shown the changes of
which the sequence is a necessary consequence. We Know
that different morbid conditions may be combined, as in
diseases which we may call hybrid or mongrel; we can
recognise many of these combinations during life; they are
things to be “attended to,” as we say, in treating cases; but
of the allied varieties of morbid changes of structure or
composition, and of the lessons they would teach, we know,
1 think, at present very little.

How may these defects be remedied ? Surely, the best
way will be by study and minute scientific work in practice.
I Eay emphatically minute work, for I think it can be
proved by the example of other sciences that the more
minute the inquiries and the facts obtained by them, the
more sure and complete will the fusion of pathology become
with the whole body of biological science, and the more will
it thence gain.

Now, these more minute investigations may be made cot
only in the records of clinical observation, which may be
far more minute than they are now, but, I venture to think,
even in microscopic examinations, especially if these be made
whenever it is possible on the living as well as on the dead
morbid structures. I would not, in any degree, depreciate
the value of the knowledge gained by examining the well-
defined structures which are shown in microscopic speci¬
mens prepared with hardening and staining and other fixing
processes. They ensure a more exact diagnosis, and they
may be studied deliberately and with comparison; but while
they have all the value, they have also some of the defects,
of botanical specimens dried and flattened in an herbarium.
These are essential to accuracy in descriptive botany, and to
the diagnosis of species and varieties, but the'vegetable
physiologist must study living things. The herbarium tells
little of the true plant-life, and of many processes in which
that life is expressed, such as the minute itttrt-cellular
movements and others of the liliti kind. Things of this
kind, and important differences among them, may be found if
the,method of examining still living tissues dan be improved,
and if it be the rule to examine each morbid growth or prc-
duot'bbfh directly after its removal from the living body’
while it may be deemed still alive, and after it has been
prepared for repeated examining by staining or other like
processes. , I venture to expect that by methods such as
these., and with improving microscopic power, the sight
may often reafeli far beyond the boundary of what has yet
'been, seen, and will detect differences of structure or of
movement in what, we are at present obliged to call struct ure¬
less. And, even beyond this, I would hope that the micro-
..SCppAwitb microscopic chemical tests, will detect, differences
'whicn must'be,referred to differences of composition rather
than. o£ anything that can be called structure, and yet not
less decisive of distinctive properties.

- i But”I wiH hot go on thus hoping, and perhaps only
ituewihg. Lit.me only add one warning suggested by that

(word “ sWucturelesi’.” It shhgests the recoHeeti<)1i• that we
art all apt at ji toed $0 ah phi it to the faadfnati on • of promises
. pf fl^Utyi T9 findco’mfbrt'hi beiievlngtfietwfe have rthHy
reached a boundary; that Something is rtally strtctnreleis;

or that there is a protoplasm which is the same always and
everywhere, at least in the same. species; or that in
apparently similar substances there may be differences of
potentiality; as if in things material there could be differences
of power or property without differences of structure or of
composition. We should get rid of these idle-making
fallacies. The protoplasm in every structure, or of every
embryo, must be as essentially different from that of every
other as is the structure or the creature which in due time
it may become; and these differences will be discovered by
our successors if we—I mean you—do not discover them.
And for one caution more. Let us never be content with
present utility. Glad of it we may well be, and even proud,
for science cannot be degraded by being useful in good
things, and I suppose that of all utilities none can minister
more happiness to those who most need it than ours may ;
but we must not be content with it as it ib ; it will be
increased by every increase of our real knowledge.

Let me, before I end, again express my regret that I have been
obliged tolimit myselfthusnarrowlyin speaking of pathology.
Let me repeat that it is only because I have too little know¬
ledge of other methods of study to speak of them definitely or
evensafely. ButI earnestly hope that in our meetings we shall
have contributions from them all, for all are essential to
the progress of our science, and it will be a singular pleasure
to me if, in my office as president, I can promote them.
To do so will make my office very happy and very useful
to me in helping me to avert that sad defect of old age, the
indifference or dislike to the changes which come of the
increase of knowledge. One sees that, as men grow old and
wish for rest, they are prone to ask, Where are we to 6top ?
t do not know more than this; that we must not stop where
we are; we must go on and on, and we may be sure that
they who work to find the truth will not work in vain—
sure that with true work true good will come. So I will
hope that it may be here during my presidency.

Jjjarfrmit fates

os

CANCER OF THE UTERUS.

; By J. WILLIAMS, M.D. Lorn, F.R.C.P.,

OBSTETRIC PHTSICIAK TO USIVER8ITT COLLEGE HOSPITAL, LOMDOH.

LECTURE IF.

CANCER OP THE CERVIX.

Grntlxken,—W e now pass on to the consideration of
cancer of the cervix proper, but before entering upon this
part of our subject we must take a rapid glance at a con¬
dition which has received a great deal of attention from
time to time, and for which many kinds of treatment have
been practised, but whose nature remained quite unknown
until revealed recently by the investigations of Ruge and
Veit. I mean so-called ulceration, abrasion, or erosion of
the os uteri.’ This is situated on the lips of the uterus, on
one or on both. It is of n ml colour, anil in some cases
forms a narrow ring around the. os; in others it is limited
to one Jip*; in others, again, it covers an area as large as a
-florin, and involves apparently the entire surface of .the
lips. The surface is soft and often covered by papillae,
which bleed readily. The condition is neither an Ulcer, nn
abrasion, nor an erosion. There is no loss of tissue, and the
surface is covered by epithelium, but it is epithelium of tin-
columnar kind. The columnar epithelium has encroached
upon tlife territory of the squamous and displaced it.

■ An erosion rriay present an. appearance.very like that, of
cancer, and, on the other hand; cancer may appear very like
> an erosion. In such cases it is not possible to recognise Un¬
real character of the morbid process at, once except by the
microscope. Clinical observation fails , here unless ample
time be given, and sometimes? this is done and-the. conse-
/ {plenties afro disastrous in those cases which prove-to, b<-
malignant, for,when time lias solved 4he difficulty it is too
late .to harp recourse to’any eueative treatment with -any
chance of success.. : - ». • > " < <

What is an erosion? and itttwhatdoes it differ from cancer

LjOOQlC

o

Thb Lancet,]

DE. J. WILLIAMS QN GANGER OF THE UTERUS.

[Jan. 22,1887.' 161

■ad adenoma? I cannot describe it better than by saying-
that it is like an extension of the mucous membrane of the
cervical canal through the external orifice on to tbe lips,
xrJsiafa are in health covered by stratified epithelium. In
some cases un appearance like that of au erosion is caused'
by a hypertrophy of the mucous membrane of the cervical,
canal, bulging downwards tlirough a more or less patulous
<ts with soft lij«s, as is sometimes seen in pregnancy. Iu
cases of this, kind the transitional epithelium is retained,
and it can be easily 6eeti in tbe space between the squamous
and columnar epitheliums. A true erosion, however, con¬
sists of a structure like that of the mucous membrane of
the cervix placed on a surface which in health is covered
by souamous epithelium. It may be, and often is, asso¬
ciated with a Hypertrophy of the mucous membrane of
the lower part ot the canal. It contains glands lined
'•y columnar epithelium, and its surface is covered by
epithelium of the same diameter. An erosion differs from
ruucer in that the epithelium on its surface and lining its
glands consists of a single layer and assumes no aberrant
forms, and from adenoma of the cervix in that tbe glands
are comparatively superficial, as well os iu some other
rejects which I shall refer to later.

Huge and Veit state that the glands of an erosion arise
from a change in the deeper layer of the stratified
epithelium which dips into the substance beneath and
forms glandular processes. I have not boen able to trace
this mode of gland formation,in erosions, and the process
appeare to be somewhat improbable. There are two ways
iu which erosions may arise, and ouo in which they are
certainly produced. On examining a cervix upon which
nn erosion is seated, yon will see Tittle red points on the
surface of the squamous epithelium near the edge of the
erosion, and sometimes aniull islets of pale squamous
epithelium in the midst of u red erosion. These points and
these islets dearly indicate the maimer iu which the
erosion has been formed. The little red points are small
glandular jirocesses from the cervical glands growing into
the superficial layers of the cervix, and making tlieir way
to the surface. In speaking of cancer of the vaginal
l»ortioii, 1 said that the squamous epithelium falls off at
the poiuts where papillae grow through the surface and
protrude. They do not carry a layer of the lioray
epithelium with them us a covering. The same thing
liappeus when, a glandular process iu the cervix abuts
against the epithelium; the epithelium becomes thinner
mid thinner, and ultimately disappears.

In cases of erosion the glands of the lower part of the
cervix ore greatly enlarged and multiplied. They.enter
deeper into the cervical wall, and their interior is frequently
covered by papillary processes. Although these glandular
processes penetrate into the wall of the cervix, their line of
itineration appears to be superficial, for.they run down-,
wards and outwards, anti invade the layer of tissue imrne-
•liately beneath the squamous epithelium covering the
portio. They burrow, as it were, in the tissue beneath the
epithelium, aud send processes through it to the surface.
This manner of growing gives to the border of the erosion
;m irregular out fine, and, moreover, occasions the presence
of the red points on the squamous surface, whore the
epithelium is thinned or wanting, as well as of the islets
• •f squamous epithelium in the midst of erosions where the
"rigiual squamous epithelium has missed transfixion by the
glandular growth. When the squamous epithelium lias
fallen off, its place is taken by columnar epithelium. The
glands are liued by columnar epithelium, which is usually
like the epithelium of the cervical follicles; its cells are
often oblong, but frequently they are elongated and,
apparently pointed, with tlieir points a little separated, und
the prominence of a papilla on the inner surface of a gland
then looks like the end of a brush with radiating hairs.

Another way in which an erosion may be produced is
hy direct extension downwards of the epithelium of the
cervical canal - a direct encroachment upon the territory of
the squamous hy the columnar epithelium, followed by the
growth of villi and the formation of glands. This mode of
production, however. I have not observed, but I tliink it by
oo means an improbable method.

The wealth of glands in an erosion is usually great; they
branch and divide and form clusters of follicles having one
tubular outlet. Some appear to remain simple. Tlidlr
interior is often, however, divided by pupillary processes in
such a manner that their lumen forms a very complex,
labyrinth. While the glamls are f has rapidly growing tlie

stroma around is not inactive, and takes not an incon¬
siderable part in tbe formation of the erosion, for it is
infiltrated witii nuclei and small cells, and from it art;
formed the basis of the numerous papillse which contribute
to the complexity of the glandular structures. But besides
the common glaudulur erosion there is occasionally found
around the os externum and in the lower part of the cervical
caual a villous growth. It is believed that such growths
have a great tendency to tuke on a malignant character,
though they are benign at the outset.. Scientific evidence
establishing this view 1 am not acquainted with. I have
seen three cases of villous growths at the os externum, anil
one in which the whole of the cervical canal was affected.
The two in which the parts around the os only were
affected presented no malignant structures; the other in
which the whole canal was diseased showed early cancer
in the glands. These cuses supply no evidence for or
against the view in question, and I have therefore formed
no opinion about it.

Cakf. 9.—The first case was a married woman twenty-
eight years of age, who complained of having had bearing-
down pains for eighteen months; they cume on every
fortnight; for two weeks before udmission she had had
continuous acliing pain iu the bottom of the stomach. The
catumenia were regular, and the patient had no other
discharge. She was married at nineteen, had had three
children, with good gettings up, and laid nursed all her
children. She hud had a tumour as large as a uut removed
from the forehead and another from a toe when a child.
The area of the lips of the cervix was as large as a florin.
The enlargement was limited to the lips. It was of a red
colour anu granular to the touch. This looked like hypt r-
trophy of the mucous membrane of the lower part of the
cervical canal. Posteriorly the growth was sharply defined,
but anteriorly it gradually shaded off into the healthy
surface covered with squamous epithelium. The uterus
was of normal size and freely movable. The cervix was
amputated: au inch was removed. The part removed wis
laid open by section of the anterior lip iu the middle line.
The disease was limited to the surface around the os anil
about a third of an inch up the canal. It wus of a villous
character, and grew from the whole circumference of the
cunal except the left side, which had been lacerated. Near
the edge of the growth there were islets of mucous
membrane covered by squamous epithelium; through some
of.thest* the growing pupillte were seen beneath.

Cask 10.—This patient was sent up to University College
llospital by Air. Pratt, of Leighton Buzzard. She was
twenty-three years of age, and not married. Her illness
began three years before, when severe pain began to
accompany menstruation, seated chiefly in the hypo-
gust rium, but extending into the iliac regions also. It was
of a sharp, shooting, burning character, lasting for five or
six hours, after which shooting pains continued for two or
three days after the period hud ceased. Menstruation first
began* in her sixteenth year; it wus irregular for twelve
months, moderate iu quantity, and painless. She was in
service until three years ago, but owing to her present
illness slm had to give up work. There was a great
deal of viscid mucus in the vagina. The lips of the
cervix looked like a red vascular growth, not unlike a
malignant growth. The os was a long transverse slit in
its centre. It bled on being touched! The cervix was
amputated half an inch above the disease. After removal
the disease was seen to be formed by an exuberant grow tb
of mucous folds, which grew from all the circumference of
the os, and extended up the canal for a third of an inch. Its
limit towards the vaginal portion was abrupt, and the folds
in this situation were smaller than at the os externum.

In both these cases microscopic examination revealed
nothing but rapidly growing papillae and glands. There
was no cancerous change in any part.

Glandular growths limited to superficial tissues lead us
naturally to glandular growths which are not thus limited,
and which involve deep structures, affect the whole thick¬
ness of the cervix, and invade the connective tissue beyond.
These are adenomata, and possess malignant properties.
They appear to be rare; for with the exception of Schneder,
Ruge, and Veit, who have described a caae. 1 know of no
other author who has referred to them. I have seen two
Cases of this affection, and both were taken for cancer*
Indeed, I know of no meiws by which they can be diagnosed
clinically, though tbe diagnosis can readily he made with
Ijhe MiPjnf ^he microscope.

tea The Lancbt,]

DR. J. WILLIAMS ON CANCER OP THE UTERUS.

[Jaw. 22,1887.

Cash 11.—The first case I saw was a married woman,
forty-nine years of age, who had had eight children and five
miscarriages. Menstruation had ceased two years before
ehe came to the hospital, and she had “ seen nothing ” since
until May, 1885—four months before admission. Since May
ehe had lost a great deal of blood and suffered much pain.
She had had a white discharge from the beginning of the
year, and lately this had become offensive. When admitted
ehe complained of pain in the bottom of the stomach, back,
and thighs, of a dull aching character; it was sometimes
severe. The duration of the attack varied; the pain always
-ceased on lying down. She had lost flesh lately. Micturi¬
tion was very frequent and painful. She began to menstruate
•in her sixteenth year; she was regular every twenty-eight
days; the flow lasted a week, and was moderate in quantity.
She had suffered from leucorrbcea all her life. She was
married at twenty-two. All her labours were good. There
•was no history of tumour or cancer in the family.

There was much purulent discharge in the vagina, and
the mucous membrane was red and injected. The upper
part of the vagina was occupied by a large mass, which was
the diseased cervix of the uterus. The disease involved
most of the posterior lip and a part of the anterior, and had
invaded the insertion of the vagina both anteriorly and
posteriorly. The vaginal surface of the cervix wa9 intact—
that is, the stratified epithelium was still retained, but it
was generallv thinner than it is in the absence of disease.
The degree of thinning varied; in some places it had almost
disappeared, while in others it was nearly of normal thick¬
ness. Immediately subjacent to it was a layer of tissue of
irregular thickness, which appeared to be the tissue of the
cervix infiltrated with small cells. This layer was every¬
where thin, though not everywhere of uniform thinness.
Thb rest of the tissue was formed of innumerable glands,
with a scanty framework between them of fibrous tissue
full of round cells. In fact, the cervix had been changed
into a glandular mass. These glands were of every shape
and form. Their cavities were often of great size; some
were like great collapsed sacs lined with columnar epi¬
thelium. They differed in a marked degree from the glands
in an erosion by the absence of papulas on their inner
surface. They were lined by a single layer of columnar
•epithelium, the cells of which were regularly oblong. The
cells generally presented no cancerous change. This appears
structurally to be a pore adenoma, but it possessed distinct
malignant properties. The whole thickness of the cervix
and the connective tissue beyond it had been invaded.

Cask 12.—The second patient was forty-four years of
age, married, and was admitted into University College
Hospital in August, 188G. She had been regular until
eighteen months before, when she had a flooding; since
that time she has had a profuse flooding every ten or
fourteen days. She has suffered from a thick, yellow
dischaige for the same period, but it has not been offensive.
She has had no pain. Micturition has been normal, as.Well
as defecation, but the bowels have been confined. She has
lost a stone in weight during the last two years, and lias
frequent nausea. Menstruation commenced at thirteen; it
was regular every month, lasting two or three days; the
flow was not much, and was painless. She had continuous
leucorrhoea. She was married at twenty-three, has had three
•children, the last twenty years ago; sire has had one mis¬
carriage since., Her labours were good, butshe regained her

months. Two brothers and one sister died of consumption,
but there was no history of cancer in her family. Pulse 99;
temperature 99-2°.

She was fsifrly' nourished. There was a thin watery dis¬
charge from the vagina. The Cervix was represented by a
mass which felt rough, like the head of a cauliflower. It was
half as big as a man’s flst, and grew from the whole of the
•cervix. It nowhere invaded the vagina, but on the sides
posteriorly it extended as for As the vaginal insertion. The
body of the uterus Was anteflexed and slightly enlarged.
There was no induration to be felt around the uterus on ex¬
amination by the vagina and tar the rectum. The obturator
glands could not be felt, and the glands in the groins were
not enlarged. The mass was Scraped away, and it was found
■that the whole of the cervix up to the inner orifice was dis¬
eased. The microscopic appearances presented by the growth
were similar to those in tne previous case; but the stratified
epithelium was everywhere thinner, though in part retained.

We now proceed to the study of true cancer of the cervix,
slistinguieT - it from malignant adenoma by characters

which I shall describe. It may begin in almost any part of
the cervix, and we will begin with an account of it as it is
met with in the lower part of this structure.

Cask 13.—For notes of the first case I am indebted to Dr.
George Bird, with whom I saw the patient. Previously to her
marriage, at twenty-two, she had enjoyed good health. The
cervix was divided bilaterally in 1876. She went to India.'
In 1877 menstruation recurred every three weeks. In 1886
menstruation was excessive, lasting seven days. The cervix
was ulcerated, with stringy discharge issuing from the oe.
She had no bearing down, but much aching pain in the
vagina. The os bled on being touched. She first noticed
excessive menstruation in 1883. She had a discharge which
was slightly tinged with blood escaping during micturition. A
sojourn at Malvern improved her condition, and in February,
1886, it was noted that the periods lasted five days, the inter-
menstrual interval being twenty-one days. She was losing
flesh. When I saw her there was an erosion on the cervix,
and the canal was filled with a soft dark-red growth, which -
bled freely on examination with the finger.

The oervix was amputated at the inner orifice. On cutting
open the part removed, it was seen to be covered with villi
almost three-fourths of an inch long and of a dark-red
colour. They were in the main simple, and not branched—
in fact, not unlike the simple tentacles of an actinia. The
squamous epithelium of the portio was intact, but there was
an erosion at the os with numerous large glands. Just
within the external orifice were some superficial glands
undergoing cancerous degeneration. The upper ana more
superficial part of the gland was lined by healthy columnar
epithelium. In the deeper part it was many-layered, and
filled the lumen so that the fundus of the gland appeared
like the end of a club. This little mass was nodular, and
short processes of fibrous tissue projected into its interior like
imperfect septa, the alveoli formed by them being filled by
cancer cells. It seemed as if a gland, in the fundus of which
were many papillee, had become cancerous. The transition
from the columnar epithelium into cancer was well seen. The
cells became many-layered and, losing their columnar form,
became many-shaped. In many places there were vacuoles
containing several small cells or nuclei, generally closely
aggregated together; in others more loosely. The cancer in
this instance began in the superficial glands or in the deep
recesses between the vilii, and not on the villi themselves.
The cervix was removed because the villous growth was
suspected to be malignant. The villi were not cancerous,
however, although cancer was present at their bases, and it
was present at such an early stage that it would have been
impossible to discover it except by the aid of the microscope,
for it gave rise to no physical signs which would lead to a
suspicion of its presence. It is, I think, certain that in this
case the growth of villi preceded the growth of the cancer;
but this does not prove the tendency of villous growths of
the cervix to become carcinomatous, for the cancer attacked
structures which are present in every healthy cervix—
namely, the glands, not the villi.

Case 14.—In the next case cancer had attacked the lower
two-thirds of the cervical wall and formed a kind of nodnle
in it. The patient was admitted into University College
Hospital on Jan. 23rd, 1884. She was forty-two years of
agd and married. She had always been a strong healthy
woman previously to her present illness. About Christmas,
1882, she noticed that she was growing stouter and fancied

strength slowly. She nursed her children for about ejgtrt-4-that she was pregnant; at the same time there was milk in

her breasts. At the beginning of her illness she had a
discharge of blood from the vagina during micturition; this
discharge would last for a week or a fortnight, and then
cease for a time ; it only appeared during micturition.
For a long time—she does not remember how long—she has
been subject to bleeding after coitus, but in August, 1883,
connexion was followed by a large flooding; since that
time the hasmorrhage has been almost continuous and liable
to be greatly aggravated by exertion of any kind. Previously
to August the discharge was almost pure blood, hut during
the last four or five months a yellow discharge appears
whenever the bleeding ceases. The discharge has been
offensive throughout. She has had a dull aching across the
loins, but no pain in the stomach. There has been no
difficulty in micturition or defecation. She has lost flesh
lately. Menstruation began at fifteen, and has always been
regular, and never painful. It returned at intervals varying
between three and four weeks, and lasted three days each
time until four years ago; but from that time on, the flow
lasted for not more than a day. The loss was not excessive.

G

Thb Lancet,! DR. J. L. DOWN: MENTAL AEPEOTION8 OF CHILDHOOD AND YOUTH. [Jan. 22,1887. 163

The patient was married at thirty-four, and has bad one
ohiid; her labour was easy and natural; she has had no mis¬
carriages. Her father died of cancer of the stomach, and
her mother (at fifty) of "effusion on the brain”; brothers
aad sisters healthy.

The whole uterus was extirpated. The following descrip¬
tion is by Mr. Victor Horsley, M.S.:—The parts removed con¬
sist of tne uterus and parts of the vaginal wall. The body
of the uterus was healthy. The cervical wall is occupied for
its lower two thirds by a whitish mass of new growth
which apparently ceases above by a well-defined margin.
The rest of the cervical wall is pale almost as far as the
internal os. The new growth has infiltrated the lips of the
external os, so as to form a large bulbous swelling around
that orifice, especially anteriorly, where the growth is about
one-fourth of an inch in thickness. At the upper part,
where this growth appears to finish, the musculur wull is
pressed upon so as to form a sort of capsule. The under
surface of the lips is exteriorly ulcerated, and this condition
extends upwards along the right side of the cervix as far as
the middle. On the front wall are still present remains of
the arbor vitse. The surface of the vagina posteriorly is
encroached upon for a distance of half on inch. The
margins of the ulcer are thin, but raised.

This was a typical case of cancer growing from the cer¬
vical glands. The patient died, and the lymphatic glands
along the iliac vessels and one gland at the bifurcation of
the aorta were considerably enlarged and infiltrated by
creamy white new growths.

(To bo concluded.)

ABSTRACT OF THE

frttsomian lectures

OS SOME or TUB

MENTAL AFFECTIONS OF CHILDHOOD
AND YOUTH.

Delivered before the Medical Society of London,
January, 1887,

By J. LANGDON DOWN, M.D. Lond., F.R.O.P.,

PKY31CIAW TO THE LOS DOS HOSPITAL.

LECTURE II.

Causer of Idiocy: Causation of Accidental Cases. —The
history of the “accidental” cases usually elucidates the
cause. Necessary instrumental interference at birth was
the cause of a few cases only. During the later years of
Dr. Ramsbotham’s life the lecturer took great pains to
investigate the subject, and he found among the great
number of feeble-minded children about whom he could get
thoroughly reliable accounts that in only 3 per cent., in¬
cluding members of the three great classes, bad the forceps
or any other instruments been employed. It is probable
that in 9 per cent, of purely “ accidental” cases instrumental
interference might have been the principal factor. Prolonged
labour was far more important in the production of acci¬
dental cases. In the paper read before the Obstetrical
8ociety of London, Dr. Down found that in as large a pro¬
portion as 20 per oent. of all idiots there was an undoubted
history of suspended animation at birth requiring active
efforts to bring about resuscitation. He believed that many
surgeons could testify to the frequency of association of
contractures and other lesions with suspended animation at
birth. First labours being longer than later ones, first-born
children more often owe tbeir idiocy to prolonged parturi¬
tion. It was “ not proven ” that ergot of rye given during
labour was a cause of accidental idiocy. Insolation in
infancy is certainly a cause. Opium was regarded as
an infrequent cause. “ Much more tangible as a cause is
morbid sexual erethism, too often induced by nurses, who
procure the quietness of their charge by means which, even
u mental health is not sacrificed, lead eventually to grave
moral delinquencies.” Traumatic injury to the cranium
from falls is a cause, though not a frequent one, of accidental

idiocy. Meningitis very frequently leads to it. So also do
epileptiform convulsions, whether eclamptic or not. Hydro¬
cephalus and paralysis from cerebral haemorrhage are
occasional causes.

Causation of Developmental Variety. —Deterioration of
mother’s health, especially during the sixth or seventh month
of pregnancy, is a potent cause. Causes of congenital idiocy
operating during the later part of pregnancy produce the
“developmental” variety. Vomiting, uterine htemorrhage,
great emotional disturbance, and grave febrile disease, were
the most important causes of deterioration of the maternal
health.

Causation of Congenital Variety, —In a large number of
cases Dr. Down is convinced that several factors have been
in operation. Heredity was an important factor. In the
investigation of 2000 casep, 3G per cent, of the fathers and
38 per cent, of the mothers showed no history of neurotic
disease. But only in 10 per cent, did Dr. Down fail to
obtain a grave history of physical or psychical decadence
from either progenitor. It might be necessary to examine
the physical conformation of parents and grandparents.
Disparity in the age of the parents might be & cauee in some
cases. Dr. Down has found, that seven is the average
number of living children born to those who have had an
idiot child; prolific child-bearing appears to be a charac¬
teristic of people begetting feeblt-minded children. Twin-
births do not act as appreciable factors in the causation of
idiocy. Dr. Down attaches immense importance to the
emotional life of the mother during the period of gestation.
The physical health of the mother also nas an appreciable
influence. One cannot fail to be struck with the nature of
the stock from which idiots have sprung. “With fathers
phthisical and irascible, with mothers feeble in judgment
and so emotional that everything is a cause of fright, one is
astonished that, they should have procreated aoy sane child
at all.” Dr. Down has found it very difficult to get at
reliable statements with regard to the influence of alcoholic
intemperance. In the members of the upper ranks of the
social scale it was an insignificant factor, but in the lower
social classes a factor of great importance. Some cases are
the result of deterioration of the father’s mental and
physical powers, others of procreation having taken place
during a debauch. As to malignant disease, 3 per cent,
of the fathers and 5 per ceut. of the motherp, in all
8 per cent, of the progenitors, died from cancer. Goitre
occurred ia 2 per cent, of the mothers, but not once in a
father. Syphilis is not an important factor in the produc¬
tion of idiocy. Dr. Down met with a history of epilepsy
in 3 per cent., of the fathers and in 6 per cent, of the
mothers. Phthisis, amongst progenitors, also exercises an
important influence. This was most evident in the Mon¬
golian type. In 23 per cent, of the cases there was a
history oi idiocy, mental feebleness, insanity, or other
grave neurosis, in one or several of the brothers and
sisters. The lecturer bad known several instances of the
father begetting healthy children except when suffering
from recurrent mania, idiocy resulting to the children con¬
ceived at that time. In like manner Dr. Down knew of
examples of healthy children being produced except when
the merchant’s business speculations have been hazardous,
when the clergyman’s parish has been disturbed, or the
dissenting minister’s church meetings have been stormy.

Although Dr. Down’s patients came from every variety of
social rank, he could not draw any safe deductions as to the
influence of various occupations of the parents on the
causation of idiocy. He had collected 400 cases with fair
social antecedents, and had found that 76 per cent, were the
children of merchants, county gentlemen, officers in the
army and navy, gentlemen of independent means and liberal
education, and members of the titled aristocracy. No less a
proportion than 25 per cent, were the children of members
of one or other of the three learned professions. Of these.
18 per cent, were the children of members of the clerical
profession. Mr. G&lton finds that the legal profession!
(which procreates fewest idiots) gives birth to 11 percent,
of the foremost men of eminence; that the medical profes¬
sion (which procreates 1 per cent, more of idiots than the
legal) gives origin to 9 per cent, of scientific men ; while the
clerical profession, which procreates the maximum amount
of idiocy, gives birth to only 6 per cent, of men of science.
These statistics illustrated the process of natural selection.

Dr. Down discussed at great length the subject of con¬
sanguinity in relation to idiocy. He is convinced that
frequently the other possible factors have been npglected,
d 2

Digitized by ^.ooQle

164 The Lancet,] MR. T. WHARTON JONES: THE WHITE CORPUSCLE OF THE BLOOD. [Jan. J2,1887.

and this has led to very contradictory opinions. “Although,
looked at superficially, my statistics are rather less favour¬
able to the marriage of first cousins than are those of many
other observers, I am strongly of opinion that, having regard
to the remarkable antecedent neurotic history of the first
cousins who have married and procreated feeble-minded
children, the evil apparently resulting is, that where there
is hereditary predisposition, the intermarriage of relations
determines the concurrence of two morbid factors, and this
may account for the undoubted greater frequency of feeble¬
minded children among the progeny of cousins than among
those of mixed marriages/’

Illegitimacy might be a potent factor in the causation if
it entailed emotional disturbance in the mother during
pregnancy. Attempted abortion might also have an influ¬
ence. Idiocy is occasionally induced by deprivation of the
senses. The case of a boy who was born only with the sense
of smell and that of touch was narrated. The boy could
“ smell out” his friends, and manifested by a smile his con¬
sciousness of their proximity.

Cretinism might be caused by malarial poison. Some
-cases under Dr. Down’s care were procreated during the
intemperance of the father.' Three of Dr. Down’s cases of
.cretinism were maler, and nine were females. He gave a
/bsumi of the work of Billarger (1857), Dr. Hilton Fagge,
Sir William Gull, Dr. Ord, Professor Kocher, and Victor
Horsley on thje relationship of cretinism to myxcedema and
the thyroid g and.

Dr. Down e ntertains positive opinions as to the higher
culture of worn en. He says: “ If there is onq thiDg more
.certain than another about the production of idiocy, it is
the danger which arises from the culture of only one side

of woman’s nature. There can be no reason why the

faculties which they possess should not be cultivated so as
to make them not only fit to be * mothers of men,’ but also
companions and helpers. My statistics point to the im¬
portance of training our eons to be temperate, and our
daughters to be self-possessed.”

THE WHITE CORPUSCLE OF THE BLOOD.

>A SUPPLEMENT TO MV REMONSTRANCE ADDRESSED TO
PROFESSORS OF rHYStOLOGY AND PATHOLOGY AGAINST
TEACHING, IN THEIR WRITINOS, LECTURES, OR OCCASIONAL
ORATIONS, THAT WHITE CORPUSCLES OF THE DLOOD
EMIGRATE FROM THE INTERIOR OF 8MALL VESSELS,
UNTIL THEY HAVE VERIFIED IT BY ACTUAL OBSERVA¬
TION OF THEIR OWN AS A FACT IN NATURE.

By T. WHARTON JONES, F.R.C.S., F.R.S.

Though he still held that white corpuscles do emigrate
through the walls of small vessels from the blood therein
•contained, Cohnheim latterly came to the conclusion that
the escape depends on a passive filtration merely, and not,
as he first supposed, on an active boring by means of
■processes which he alleged the white corpuscles shoot out
•even while the blood is still within the living vessels, in the
amoeboid manner they are seen to do in blood displayed
under the microscope immediately that it is drawn.

Dr. Bin* of Bonn, 1 however, maintains the validity of
'Cohnheim’s first teaching, and, in support of it, adduces an
experiment by which he thinks the white corpuscles of the
blood within the vessel! of the living part under observation
can be rendered incapable of undergoing amoeboid change
of shape, and incapable therefore, according to him, of
boring a passage through the vascular walls, so that emigra¬
tion is prevented. This seems to be an inconclusive
experiment, seeing that a reagent which could extinguish
the irritability of white corpuscles is not likely to leave
unscathed the other constituents of the blood and the
integrity of the vascular walls. Suspension of the alleged
capacity of white corpuscles to shoot out processes in an
amoeboid manner while the blood is still within the vessels
might thus be owing to a change in the condition of their
surroundings, as much as to change in that of the white
corpuscles themselves. But, let it be asked, did Dr. Binz
ever really see white corpuscles of blood, while still within
the living vessels, shoot out processes in an amoeboid

’ Virchow's Archly, vol. lxxiii.

manner under any circumstances, and by a teredinous
action therewith make their way through the vascular
walls?

Even if white corpuscles of the blood while still within
the living vessels did undergo amoeboid change of shape,
what grounds are there for the supposition that the
diverticular processes they shoot out do or could exert
any boring action? The idea of a boring action, in fact,
betrays an imperfect study of the nature of the amoeboid
phenomenon exhibited by the white corpuscles in blood
newly drawn. The amoeboid change of shape which the
white corpuscles commence to undergo in blood immediately
on being drawn seems to be really the result of partial con¬
traction or collapse <>f the cell wall around the nucleus and
contained protoplasm on one side, whilst on another side
the wall is protruded here and there in diverticula. This
takes place with a more or less evident jerk, and has been
mistaken for an actual bursting of the corpuscle with
evacuation of its contained protoplasm. There is, however,
no such bursting of the corpuscle nor evacuation of the
protoplasm. 3 Continuing to watch the corpuscle in its
supposed burst state, we may see a diverticular process
become more or less retracted in concurrence with a super¬
vening diverticular protrusion of some other part of the
cell wall which had been previously collapsed around the
nucleus and protoplasm. Of the nucleus any defined view
is prevented by the protoplasm.

The protrusion of a diverticular process is thus certainly
not an active movement with force, like that of a proboscis
fitted for a boring operation, as supposed. The phenomenon
appears to be a last manifestation of the vital irritability
inherent in the substance of the white corpuscles, excited
by the altered condition in which the blood comes to be
placed by abstraction from the living body. After the
fibrin of the blood under examination is seen to have become
deposited on the slide by coagulation from the plasma,
the serum that is left seems to be received into the interior
of the collapsed white corpuscles by endosmotic imbibition
through their wall into the more consistent protoplasm,and
distends them so far that they recover in some degree their
round form.

In the course of our observations of the flow of blood in
the vessels of a frog’s web displayed under the microscope,
a white corpuscle may often be seen to become adherent by
a point of its surface to the wall of a vessel, and to be pressed
into a pear shape,in consequence of the bearing of the passing
stream on it while thus anchored. When the adhesion
gives way, the white corpuscle, on becoming free, recovers
its previous round form, and is carried along in the stream.
This phenomenon, which is of well-known occurrence and
obviously passive, has actually been described -as a mani¬
festation of an active ni/tbKng on the part of the corpuscle-
by means of a process which it shoots out as a feeler for the
purpose of finding a pore in the wall of the vessel through
which to commence a boring operation in order to emigrate.

It is well known that when the white corpuscles of the
blood are acted on by much diluted acetic acid, the proto¬
plasm is dissolved out, and an object like several small
nuclei adhering together brought into view. This object
is commonly accepted as the vera effigies of what actually
exists in nature before the abstraction of the protoplasm
permits it to be seen. In my paper on the “ Blood-
corpuscle,” in the Philosophical Transactions for 1846, it was,
however, shown that the white corpuscle possesses in
reality only one large nucleus, and that the appearance of
several small ones aggregated together is owing to a corru¬
gation of the cell wall of this single large nucleus by the
action of the acetic acid of the dilution commonly employed.
To prove that such is the fact, let water acidulated in the
slightest degree only be used. Under the action of this,
solution of the protoplasm will go on, though very slowly;
but if we patiently watch its progress, a nucleus—single
and large—will at last come into view. 3

3 The protoplum evacuated, u alleged, from the bunt oorpuacle wma
supposed to act as a ferment whereby coagulation of the blood was
Inducted. but in disproof of this opinion there stands the fact that in the
course of our observation fibrin is deposited by coagulation on the g'as*
slide, though no such bunting of the corpuscle* or evacnatlon of their
contents is seen to take place.

* In histological research, reagents applied to the object under micro¬
scopical examination are often of great assistance by bringing Into view
detail* of structure and indicating chemical composition. As above
shown, however, noetic acid oorrugates the single large nucleus of the
white corpuscle to as to make it appear as an aggregation of several
small ones. From this example, a cautlou must be interposed against
accepting the appearances disclosed by the action of reagent* on tissues

Digitized by Google

Tub Lancet,]

ME. C. J. BOND ON A CASE 0? EMPYEMA.

[Jan. 22,1887. 165

In the course of my researches, 1 observed that the
single nucleus of the white corpuscle of horse’s and
'iephant's blood in particular was less susceptible of be¬
aming corrugated under the action of acetic acid. Here I
woald particularly remark that the single nucleus of the
white corpuscle of the blood of man and the mammifera
‘orreaponda in size and structure with the red corpuscle of
•,te same blood; being, for example, very large in the
elephant, in the blood of which the red corpuscles are very
irge; and, on the other hand, very small in the goat, in
he blood of which the red corpuscles are very small;
furthermore, inclining to an oval form in the alpaca,
•he red corpuscles m the blood of which are oval. It was
: >r this reason, among others, that in my papers on the

Blood-corpuscle,” in the Philosophical Transactions for
l'*4d, I enunciated the view that the red corpuscles of the
rlood of the mammifera are homologous with the single
nucleus of their white corpuscles. 4

To return to the question of “emigratio.” Although
tohnbeim latterly abandoned the idea that emigration of
white corpuscles from the blood is an active process, I do
not know whether he continued to hold that white corpuscles,
having passively escaped by filtration, do then commence to
undergo amoeboid movements, and thereby wander in the
interstices of the tissues. If a minute section of the cornea
•*> displayed under a microscope with a one-eighth of an
och object-glass, and attentively examined, no corneal
nrposcles are at first seen at the cut edge. After a brief
interval of time, however, corpuscles are observed to protrude
a- if filtering through interstices. Are these corneal cor¬
puscles the objects which Cohnheim considered to be white
'orposclea of t[ie blood which had emigrated through the
Tails of vessels in the adjacent part of the conjunctiva and
•eierotica, and which had, as he supposed, made their way
by mear 8 of amoeboid movements into the interstices of the
cornea ?

The gist of Cohnbeim’s doctrine, we have above seen, is
•bat “ emigratio” of white blood-corpuscles constitutes the
rirst real characteristic step of the inflammatory process. The
•. ication, therefore, latterly agitated between Cohnheim and
rinz as to whether emigration be a passive filtration
or an active boring would be so far of secondary import in
■ae pathology of inflammation, even if emigration pure and
•imple could be demonstrated. We have seen that “emi-
zratio” baa been accepted and taught as a fact by professors
who seem never to have made any observation of their own
relating to the subject. In the Hunterian oration at the
Royal College of Surgeons some two years ago, the orator,
m referring to John Hunter’s sketch of the phenomena of
.r lamination, observed that if his hero had flourished in
'■os present day he woald have dwelt in a particular manner
on the emigration of white blood-corpuscles, by virtue of
•heir amoebiform endowments, through the softened walls

the small vessels and their further action on the tissues.
Hunter, I am sure, would have done no such thing, but
would have first said: ** Let us see whether it be a fact
•oit white corpuscles do emigrate at all, as alleged.”
iiid the orator himself ever done this? Pity that some
cuirdian angel had not roused him from the musings
bv which he was led to make such a suggestion, and
whispered into his ear: nilfingendum, nil excogitandum,
**•/ inr miendum quod natura faciat—quod natura fernt.
71 at the walls ot the vessels through which emigration
;< alleged to take place first become softened by inflarn-
aitior, so that the white corpuscles are enabled readily
bore their way through, is an assertion in which
■be sequence of the steps formulated by Cohnberm is
averted, so that the gist of his doctrine of the inflam-

■» an exact representation of the detail* of strnoture actunlly existing
nature. Prepared structures mounted on *II(les— such as sections,
■vilar Injections, Ac.—are for the most part mere toys. It must
t fAvt be borne In mind that the dissection of minute objects by
- .updating under the simple microscope, whether for further
• -notation with a higher power under the compound microscope or
i" . can never be superseded by the examination of ready-made specimens
n noted on slides.

* It is to l*e remembered that the large nucleated red corpuscles of the
•>rlr mammiferous embryo are homologous with the nucleated red
~ w«rles of the oviparous vert-brata. Sec my papers referred to for
vis in regard to this and my discovery of large nucleated corpuscles
'■ t 'i-blood of grown mammif-sra, especially the horse and elephant, some
the cell well slightly tinge-l red. and sime with the cell wall wholly
..loured, and as pile nearly as the almost, invisible cell wail of
-.lain oval nucleated corpuscles (the uuc'ei very strongly marked).
*j*enr*bte in the Wood of the froe. which I described and delineated
'orty years ago In the philosophical Transactions, but which h ive of
U‘.e yean been *• rediscove r ed "—to adopt t euphemism.

matory process is misrepresented; whilst his relinquish-
ment of the idea of an active boring operation which he
originally entertained is not mentioned.

“ Softening by inflammation,” whioh Mr. Marshall, in his
Hunterian Oration under notice, alleged to be a state of the
walls of the vessels which permits or a boring of the white
corpuscles therethrough, is a mere gratuitous assumption,
ana, as we see, inconsistent with Cohnbeim’s teaching. The
expression “ softened by inflammation ” might, however, be
admitted as applicable to the Boftening and disintegration
of structure to actual disappearance of tbe vascular walls,
as originally observed and described by myself in cases of
intense inflammation of the frog’s web, whereby white
corpuscles were left free and unenclosed in any wall, but
forming, by their aggregation, succedaneous walls of a
venous channel, through which the blood was seen still
flowing. This observation was quoted in my “Remon¬
strance” from my essay in Guy’s Hospital Reports for
October, 1850. Had Mr. Marsball read this?

The characteristic which especially distinguished John
Hunter as a scientific man was his subjecting tbe physio¬
logical and pathological questions that came before him to
the test of observation and experiment. The suggestion,
therefore, that he would have dwelt on “emigratio” in
elucidation of the question of tbe pathology of inflammation
on the mere assumption that it was a tact, made by Mr.
Marshall in his oration, was like putting in a plea for Cobn-
heim’s doctrine (though at the same time misrepresenting it )
under tbe sanction ot John Hunter’s name. Such a sugges¬
tion, however, was disparaging rather than eulogistic of the
hero of the day, and may be compared, conversely, to the
divided eulogy of Harvey on the occasion of the unveiling of
his statue at Folkestone in 1880, when Mr. (now Sir Richard)
Owen, taking advantage of hie position as inaugural orator,
virtually claimed a place on Harvey’s pedestal for the glori¬
fication of John Hunter also - a proceeding something like
the cunning manoeuvre of Richie Moniplies (subsequently
dubbed “Sir Richard”) in Sir Walter Scott’s novel of the
“ Fortunes of Nigel," who enclosed in his master’s petition
to King James I., which he had been sent to deliver, a
“sifllication” of his own.

Tbe scepticism as to “emigratio” being a fact in tature
evinced in my “Remonstrance” on tbe question has been
called “ comical ”; perhaps tbe strictures now made may be
accounted “pragmatical,” though (to adopt Bishop Bedell’s
aspiration) I hope good men will not so account them.
Hereto may be added, now I think of it. that my volume
containing two lectures against the Darwinian hypothesis
of evolution, 5 which had been delivered in the botanical
theatre of University College to large audiences of ladies
and gentlemen, was noticed in the Saturday Be view at the
time of publication in the following words, and no more:
“ The author is angry, and it is not very scientific to be
angry.” This short and easy criticism—this shirking the
question under review and levelling a flippant personality
against the author—was an ignoratio elenehi, aggravated in.
its meanness and dishonesty by being anonymous.

Ventnor, Isle of Wight.

ON A CASE OF EMPYEMA,

WITH REMARKS ON THE MANX Kit IN WHICH PH H FOE ATI O V
OP A BRONCHUS IS BROUGHT ABOUT.

By C. J. BOND, I’.Tf.C.S.,

HONORARY SUROKON* To THK LEICESTER INFIRMARY.

lx making a post-mortem examination some time ago in
the case of a young man who hail died suddenly with
symptoms of empyema discharging through the lung, the
ebullition found was sufficiently interesting to suggest the
following remarks.

A. B-, a.previously healthy lad, aged fourteen, was

admitted into the hospital with a history of an attack of
pleurisy, with effusion, of sudden onset, and of a month’s
duration. Some ounces of clear fluid were drawn off bv
aspiration. A week later, however, the path-lit was seized
with dyspneeu, during which lie coughed up a quantity of
thin, purulent fluid. The pleural effusion had, in fact,

* Evolution of the Human Race from Apes, and of Apes from Lower
Animals—a Doctrine un*anctloned by Science. London. ts7tt.

166 Tub Lancet,]

ME. C. J. BOND ON A CASE OP EMPYEMA.

[Jan. 22,188V.

become purulent, and had perforated a bronchus. The
patient died shortly afterwards.

Necropty. — The right pleural cavity contained some ounces
of thin offensive pus. The lung was collapsed—in fact, com¬
pressed from apex to base against the spine, the heart, and
opposite mediastinum. Below the level of its root, j ust at the
rounded and compressed posterior border, and close to the
spine, was a depressed area the size of a penny, which con¬
tained numerous depressed openings. A section of the lung
at right angles to the surface over a part of this area (Fig. 1)
showed that several wedge-shaped portions of lung tissue
had necrosed, partially and irregularly filling corresponding
cavities (d) in the lung parenchyma. These necrosed portions
of tissue (c) were still in continuity with the pleura (b)
covering them, but in several places that membrane had
plan given way, thus leaving the depressed openings men¬
tioned above; in other places the lung tissue had sloughed
under the pleura, so that this latter alone remained,
forming a thin septum between the pus of the empyema
and the cavities in the lung. Finally, the cavities commu¬
nicated at their central or narrower ends with several small
bronchi (b).

Something more than mere perforation of an air vesicle and
Fig. 1

Section of lung at area of perforation (from|photograph).
x, Compressed lung. B, Pleura, c, Necrosed lung.

D, Cavity, e, Piece of string through bronchus, com¬
municating with cavity.

bronchus by the fluid had evidently occurred. A portion of
lung tissue, owing to the pressure upon it, or to plugging of
its vessels and arrest of its vascular supply, or possibly to
inflammatory changes, had sloughed. Further, the fact that
the pleura remained intact in several places, although the
lung tissue beneath it had necrosed so thoroughly as to leave
a cavity, suggested that the necrotic change preceded the
perforation or the serous membrane, and the entrance of the

S us; in fact, it seemed as though the necrotic change itself
etermined the site of the perforation. If, on the other
hand, the perforation of the air vesicle occurred first, subse¬
quent inflammatory and destructive changes in the lung,
might be caused by the filling of the alveoli with pus; but
it has alwaysseemed difficult to understand why a collection
of fluid pressing equally on the luDg surface should cause
perforation, unless there be also some primary change in the
lung tissue itself, which would allow of its more easy
destruction and so determine the site of the opening. It
appears to me that the condition here described strongly
suggests such a preliminary change in the lung tissue.
Microscopical examination of the lung tissue immediately
around this area showed a marked pneumonic change, while

at a distance of a quarter of an inch the lung appeared
healthy, though compressed.

A further very important point for consideration is the
situation of the perforation in the lung. Mr. Marshall has
shown that when an empyema perforates the chest wall,
the tendency is for it to ao so in front—namely, between
the fifth and sixth costal cartilages, where the muscular
interspaces are thinnest and weakest. Now in cases of
empyema which I have observed, in which perforation of a
bronchus has occurred, the collection of pus has been chiefly
at the posterior part of the chest, and often limited to that
area by pleural adhesions—being shut off, of course, from
the anterior part of the thorax, where the chest wall is thin.
In fact, it would appear that the seat of election for per¬
foration is, in front, in the case of the chest wall, and in the
case of the lung, at the back, somewhere near the posterior
border and below the level of the root. The following
observation may suggest an explanation of this fact. If
a vertical antero-posterior section be made of a lung
compressed by pleural effusion (Fig. 2), it will be seen
that the larger tubes, both bronchi and pulmonary
vessels, are arranged in a closely packed semicircle, with
its convexity towards the spine; further, that this line

Fig. 2.

Vertical section, from before back, of lung compressed by
pleural effusion (from photograph). Section passes at
right angles to entrance of bronchus, and shows openings
of bronchi and vessels arranged in a semicircle, with its
convexity backwards towards spine.

of the openings of the tubes, is considerably nearer the
posterior than the anterior border of the lung, and also
that the tubes are more closely packed below than above.
Any pressure therefore exerted on the lung tissue from
without, as in the case of an empyema, would act most
powerfully on this portion of the lung, compressing it
against the rigid bronchi, which lie at this spot just beneath
the surface, while, in addition, the thickness of the elastic
cushion is less, and the distance between the surface of the
lung and an air-tube of any size is shorter here than in
other parts of the lung. In confirmation of this belief, 1
would observe that if, on the contrary, pressure be exerted
on the lung tissue from within, as by the forcible injection

Google

DR. K. FRANKS: CHLORIDE OF AMMONIUM IN THROAT DISEASES. [Jan,2$ 1887. 167

oration or rapture generally |
oner margin, probably owing .
in moet adult lungs, there is ,
consequent weakening of the
generally, then, an empyema
i, the front of the chest, will,
rforation of the chest wall;
ack part of the pleura will
>ns perforate the lung,
onnezion with these cases to
Mention. In many or most of
i an opportunity has occurred
v jinning to end, the affection

evidently' commences in pleurisy with serous effusion, the
Raid gradually becoming more and more turbid, until in a
<*w wreeks perhaps the purulent stage, or true empyema,
■waits. The cause of this change would appear to be
«a follows, at any rate in some cases. The thick de¬
posit of exudation composed of leucocytes and fibrin
which occurs on the surface of the lung becomes partially
-or wholly detached owing to the shrinking and movements
■of the long, and remains as shreds or sheets of loose mem¬
brane in the serous fluid in the pleural cavity, as may be
found if the contents of the cavity be evacuated by an
«»rly incision and the interior explored with the Anger.
It seems probable, then, that these flakes act. as foreign
bodies, and by constant irritation bring about the conversion
of a serous "into a purulent effusion. Moreover, as these
membranes take a long time to break up and disintegrate,
they constitute one ot the difficulties in the after-treatment
of the case, often lying as they do below the level of the
incision. In children, on the other hand, it is far more
common to find the effusion purulent at an early stage
in the history of the illness; it is thicker, more like the
pua of an ordinary abscess, and is generally present soon
After the onset of the inflammatory symptoms.

ON THE USE OF CHLORIDE OF AMMONIUM
AS AN INHALATION IN DISEASES OF
THE RESPIRATORY TRACT.

Br KENDAL FRANKS, M.D., F.R.C.S.T.,

■SCmOEOX TO THEAPKLAinKAWD THBTHBOAT AND EAR HOSPITALS, Dl'HLIX.

Chaoridb of ammonium has been extensively used as a
therapeutic agent, and its value in many affections of the
mucous membrana. Mf the. throat has been very widely
recognised. That such is the case is amply proved by the
many forms of lozenges or So-Called compressed “ tablets ’’
containing the salt which are more or less in vogue. In
this form it has been found most useful in catarrhal con¬
ditions of the fauces and pharynx; but its use in pos¬
terior nasal catarrh, rhinitis, and catarrh of the Eustachian
tubes and of the middle ear, as also in affections of the
larynx, trachea, and bronchial tubes, has not been so en¬
couraging, and the reason of this no doubt is that in
the form of the powder, dry or in solution, or made
into lozenges and given by the mouth, the salt cannot
net locally on these regions, but only through the general
system, and under such circumstances the benefit to be
•derived from its administration is more than doubtful. In
order to overcome these difficulties and to extend the local
one of the chloride to these less favoured regions, advantage
has been taken of the fact, long since recognised, that the
combination of the fumes of hydrochloric acid with ammonia
gas at once forms a white smoke, which consists of chloride
of ammonium in a finely divided state. This forms the basis
upon which all chloride of ammonium inhalers are framed.
The great therapeutical advantages to be derived from the
-chloride in this state has been long known and valued by
throat and aural specialists; but general practitioners, as a
rule, do not seem to have appreciated the good results
which may be looked for by the judicious and regular use
-of the inhalation of chloride of ammonium. The cause of
this probably has been the complicated nature of the
apparatus often nsed to develop the vapour, the liability of
its getting out of order or of its breaking, and the uncertainty
as to the vapo hr containing the neutral salt alone, or perhaps
also containing free hydrochloric fames or free ammonia.

The vapour (I employ this term here to express the white
clouds formed by the junction of the fumes sod the gas)
when neutral is almost tasteless and perfectly unirrituting,
and it is in this form that it is of greatest-use. Free acid
I consider is always bad; a little free ampiouia is not of
much consequence, and -is often of use. The method of
detecting either the acid or the ammonia in. the vapour I
shall allude to again. Add to these objections the trouble
of charging the inhaler with fresh acid and. ammonia each
time it is used, and we shall have a sufficient explanation
of the reason why the inhalation of chloride of ammonium
is not more popular among the members of the profession
generally. For many years • I have used this salt in this
form extensively both in hospital and private practice, and
have {it different times tried most of tne inhalere designed
for developing it. 1 therefore venture to call attention to
that form of inhaler which I believe will be found most,
simple and the most easily and satisfactorily managed, and
also to point out the various classes of cates in which its
use is moet indicated.

I have found the best results to follow the inhalation of
chloride of ammonium in chronic catarrhal conditions. In
acute catarrh it does little good—at least, when the disease
is once fully established; but in the beginning of an acute
catarrh I believe it will be found often to cheok its farther
progress. I have known it to be so in my own case, and
have been greatly gratified to find the symptoms of a cold
in the head disappear after an hoar’s intermittent use of the
inhaler. In chronic catarrh of the post-nasal region, so
frequently associated with deafness, due either to chronic
otitis media or to obstruction of the Eustachian tubes—a
condition sometimes very intractable to ordinary means—
I have found the regular use of the inhaler for weeks or
even months give the most satisfactory results. The best
method of using it in nasal catarrh, or in chronic inflam¬
mation of the mucous membrane lining the nasal or post¬
nasal regions, is to inhale freely by the mouth and to exhale
by the nose. In this way the chloride of ammonium comes
directly in contact with the affected parts. In catarrhal
conditions of the middle ear or of the Eustachian tube the
salt can be brought directly to bear upon these parts
by having recourse to Valsalva’s method of inflating
the ear. A deep inhalation is made by the mouth; then
exhalation through the nose is begun, and as soon as the
white cloud is observed to emerge from the noetrils they
are closed by suddenly compressing them between the
thumb and forefinger. The month is firmly closed, and the
patient makes an effort, as it were, to force the air through
the nostrils. The apertures being closed, the distending
power of the exhaled air forces open the Eustachian tubes,
and the vapour enters through them into the tympana.
This may be done two or three times at a sitting without
any evil effect. I have met with many cases where this
plan of treatment has alone sufficed to effect a cure where
other methods had failed. When the Eustachian tubes are
obstructed, so that air cannot be forced through them by
Valsalva’s method, the occasional use of Politzer’s bag
during the earlier part of the treatment will usually suffice.
In chronic laryngitis, especially of the catarrhal form,
chloride of ammonium inhaled is .of great value. In the
early stages of that form of laryngitis which so often
accompanies phthisis, when there is erosion of the mucous
membrane covering theinter-arytenoid fold, or when there
is chronic inflammation of the vocal cords themselves, I
have seen good results follow from this vapour, more
especially when combined with some volatile oil, such as oil
of eucalyptus or pine oil, in a manner I shall immediately
describe.

Again, much benefit may be derived from its use in affec¬
tions of the trachea and bronchial tubes. Some years ago I
prescribed it for an elderly gentlemen who waa confined to
his room in the beginning of winter for a chronic oougb.
He had been liable to chronic bronohitis every winter,
which kept him in-doors for several months. Most of the
usual remedies had failed with him, so at last 1 determined
to try the effect of chloride of ammonium as an inhalation.
He was directed to nse it three times a day for fifteen
minutes at a time. In a fortnight he was sufficiently well
to go out, and the. use of the inhalation during the winter
prevented the return of his bronchial trouble.

The beat method of inhaling in laryngeal nr bronchial
cases is much the same as is used by smokers in inhaling
from cigarettes. A mouthful of the vapour is first taken,
followed at onoe by a deep inspiration or ordinary air; thi*

byGoOgll

168 Tkr Lancet,] MB. F. W. LOWNDES: VENEREAL DISEASES IN GIRLS OP TENDER AGE. [Jan. 22,188?.

carries the chloride well down into the bronchial tabes. If
this is not done, the vapour tnay perhaps not travel beyond
the pharynx.

The apparatus for developing the chloride of ammonium
which I prefer to all others re the Burroughs Improved
Chloride of Ammonium Inhaler (Vereker’s patent), a
drawing of Which is annexed. As it is comparatively of
recent date, I may be excused for shortly describing its
modus operandi. It is essentially composed of three bottles
connected together by tubing. The two smaller bottles (b
and c)' contain respectively solutions of ammonia and of
fuming hydrochloric acid. 1 have found that the pure com¬
mercial acid acts the best. Tbe pure acid of the British
Pharmacopoeia is scarcely fuming enough, and is much more
expensive. Each of these bottles is provided with an india-
rubber cork, with two perforations each. Through one of
these holes passes down in each case a glass tube (b and c),
open at each end. This should dip down well into the fluid
in the bottle. Two short tubes pass through the other holes.
These should only reach to just below the cork. The outer
end of each of these short tubes is connected by means of
indiarubber tubing (e and f) with a glass tube (a). This
glass tube reaches down nearly to the bottom of the bottle
a, and its upper extremity terminates in a cross tube
open at both ends, to which are attached the ends of the
tubee e and f. The bottle a contains Water, which should

beyond it into the bottle. To the outer end of it is attached
a long rubber tube (d), with a mouthpiece (x) attached to
its free end. This tube (d) is usually made too short for
convenience, and I generally advise patients to procure a
long piece of tubing. When the tube is short the patient
has to hold up the inhaler, and is incapable of doing any¬
thing else during the time of inhalation; but with a long
tube the inhaler can be placed on a table beside him, and the
patient can read or write all the time, and thus a more re¬
gular use of the inhaler is probable. From the foregoing
description it will be seen that when the patient inhales
through the tube D, a vacuum is formed in the bottle a, and tbe
air in the bottles B and c rushes in to take its place through
the tubes f e, and a. These bottles are again replenished
with air through the tubes b and c. As the air passes down
through the tubes b and c, it bubbles up through the ammonia
and acid in B and c respectively, and consequently becomes
charged with their vapours. These vapours meet in tbe tube a,
and at once form chloride of ammonium. The air charged with
this salt bubbles up through the waterin A,and is thus washed
before it is inhaled through D. When exhaled it is seen to
emerge as a dense white smoke. How, in order that this
should be neutral—that is, that the vapour should contain
no free acid or ammonia—it is essential that the bottles
b and c should contain the proper proportions of their

respective fluids in eqftal volumes. Suppose c contains half
an ounce of pufe commercial hydrochloric acid, B should
contain half an ounce of equad proportions of the ordinary
solution of ammonia and water. Should this be found too
Strong, a little of it may be poured out and the same quan¬
tity of water added. If it be too weak, less water and more
ammonia should be used. A little practice will make the
patient expert in regulating the proportions. The acid
bottle should not be interfered with unless tbe acid hae
become so weak as to require to be changed for a fresh
charge. 1 have generally found that the acid will not
require to be changed oftener than once in two months. On
the other hand, the ammonia is so volatile that it will require
strengthening, perhaps once a week, sometimes more fre¬
quently. Theplanladoptmyselfis simple. When I have found
chat the charge of ammonia has become disproportionately
weak, l add two or three or five drops of strong solution of
ammonia to it, until I find the vapour has become quite neutral.
I have already said that the vapour inhaled should be perfectly
unirritating. I have found from experience that when the
ammonia is too strong it canses a smarting sensation at the
back of the pharynx. When, however, the acid is in excess—
that is, when the ammonia is too weak—the vapour chiefly
affects the larynx, when a burning feeling accompanied by
couxjhiTw and sometimes a sensation of choking is experienced.
Thu affords, then, a good guide as'to whether the ammonia
should be strengthened or weakened. Another point deserves
attention, and that is that the ammonia, being so much more
volatile than the acid, has a tendency to pass over through the
tube B into the waterin the bottle A, and thus the vapour when
passing through the water may take up an excess of ammonia
gas. This is easily obviated by changing the water in A every
second or third day. When it is considered desirable to add
any other substance, such as oil of eucalyptus, to the vapourto
l>e inhaled, the simplest and best plan is to add every day,
say, five drops of the oil to the water in the bottle A. As-
the vapour bubbles up tlirough this water, the oil globules
become agitated and broken up, and the vapour carries with
it a very sensible amount of the volatile oil. I have found
this extremely useful. A great advantage which this form
of inhaling these oils possesses is that they are inhaled cold,
und therefore the patient is not exposed to the risk of
catching cold, if obliged to leave the house shortly after
inhaling.

I believe that if this inhaler be more largely tried in ;
general practice, it will lie found that all I have "said in its
favour, more particularly as to the results of its use, will
be found to be borne out by individual experience.

Dublin.

VENEREAL DISEASES IN GIRLS OF
TENDER AGE.

By FREDERICK W. LOWNDES, M.R.C.S. Eng *

8UR9E0X TO THE LIVERPOOL LOCK HOSPITAL AXD LIVERPOOL POLICE.

Of all the cases in which medical evidence is required,
few, if any, are less inviting than those in which men are-
charged with criminal assaults on females of tender age.
To a conscientious medical witness who has carefully
pemsed the chapters on rape in the various medico-legal’
works of Casper, Taylor, Ogston, Guy, and Tidy, the responsi¬
bility appears to be very great; for any remissness on his
part to state every circumstance which may be favourable
to the accused on the one hand, or to strengthen the case
for the Crown on the other, may be productive of the most
serious consequences. In the former case it may lead to the
conviction of a man who is perfectly innocent of tbe crime
with which he is charged, and his sentence to penal servi¬
tude for a considerable portion of his future life; while in
the latter case it may assist in the acquittal of a guilty man—
guilty of as vile an offence as a man can be guilty of. In
addition to this grave responsibility, the details and
surroundings of these cases are of so gross a nature that, as
a learned judge (Justice Wills) recently remarked in his
address to a grand jury, “men of mature life could hardly
wade through the mass of iniquity which be had to struggle
through in these matters without feeling himself degraded
and poisoned by their perusal.”

If any apology were needed for this paper, I trust that its
heading will be sufficient.' The subject was brought to my

Digitized by Google

Tax Lancbt,]

D8. W. ALEXANDER ON PURULENT ENCEPHALITIS.

[Jan. 22,1887. 169

notice In a very prominent manner immediately after my
election (more than eleven years ago) as surgeon to the
Lock HoepitaL The very first female patient admitted
under my care was a diminutive girl whose age was stated
to be twelve years, who looked even younger, but who was
really just over thirteen. Since then other cases of infected
children have been hrought to the hospital, making up to
the present date a total of twelve cases. There are two
points to which 1 would wish to direct special attention.
The first is that under existing circumstances we can
hardly expect a reduction in the number of these offences.
For as the recently passed Criminal Law Amendment Act now
makes carnal knowledge of a female under thirteen years of
age a felony, and under sixteen years a misdemeanor, even
with her consent, it naturally follows that this Act has
created a new class of felonies and misdemeanors. The
other point is that in all these cases there was some evidence
of infection with gonorrhoea or syphilis, and in at least
three of them it was clearly proved that the accused persons
who were suffering from a similar disease hoped to effect a
cure by having sexual intercourse with their victims. This
horrible superstition still prevails largely in Lancashire as
in other parts of England, and as it must from the very first
have proved to be as false as it is filthy, it is lamentable to
obeerve how long it has prevailed. So far back as 1827 the
iate Dr. Gordon Smith alluded to it in his Principles of
Forensic Medicine (3rd edition, page 413), and most writers
on forensic medicine allude to this superstition more or less
briefly. Thus Casper says: “ It is well known that among
the lower classes there prevails an- absurd and horrible
opinion, that a venereal complaint is most certainly and
.quickly cured by coitus with a pure virgin, and most
indubitably with a child, and this explains the very
-numerous cases observed by us.” 1 Taylor says: “ There is
a vulgar error prevalent that gonorrhoea in the male is
cured by 6exual intercourse with a female virgin; and
this error is said to be the cause of the frequency of
the crime of rape on children in England.” 4 Tidy says:
“In a very large proportion of the cases sent for
trial the victims are young children. There are several
reasons for this. One is the popular superstition that if a
man suffering from gonorrhoea have intercourse with a
virgin he will be cured. Disgusting as it may seem, it is
no Teas a fact that old women doctresses not unfrequently
prescribe this criminal attempt to young men who consult
them for urethral dischargee. Many cases recorded show
this to be the fact.”*

The following is a summary of the cases which have been
seen in the Lock Hospital within the last eleven years:—

No.

| Date. 1

Name. • i

Age.

I

May 90th. 1875

M. MoD-

Years.

13

3

August Uth. 1378 |

M. K. S-

11

■3

August 31th, 1681

8. A-

13

4

August 24th. 1881 i

O. 8-

9

S

December ltth. 1881 !

B. 8-

13

■e

March 30th, 1884 i

A. O-

14

7

July 34th. 1881 .

E. R-

11

s

September 11th. 1881

M. B. M-

7

* ,

September 18th. 1881 >

B. A. Y-

13

10 |

September 14th. 1886 |

M. H-

. **

n t

February 18th. 1888

J. A. O- ,

9

12

March 30th. 1888 '

A. H-

Hi

At the present date (Oct. 18th) we have in the female wards
a girl aged thirteen suffering from ulcers of the labia under
Dr. Bernard’s care. Then are also two imbecile females in
my ward, one suffering from syphilis, the other from vsginal
discharge. In none of these cases can the offenders be
p r o se c uted.

Besides these, 1 have seen other cases in private practice.
In one which was brought to me by the late Mr. Higginson,
a girl was infected with syphilis by, as was stated, a lad
whom she met in the street one Saturday afternoon. Mr.
Higginson had informed a police-inspector of the case, but
thelad was wholly unknown to the girl, and she could give
no satisfactory description of him.

In all the cases of syphilitic infection the disease was
moot amenable to treatment, a mild mercurial course, and
soothing applications to the primary ulcers producing a
most marked improvement in a very short time. For

1 Handbook of the Practice of Torenalc Medicine. Balfour'* translation,
toI. HI- |>. SOI. * Medical Jurisprudence. 3rd ed., vol. H., p. 437.

• Legal Medicine, parf H., p. 161.

eondylomata yellow wash acted extremely well after a
previous application of lead and opium lotion. The vaginal
discharges readily yielded to cleanliness and alum injections
earefully applied by the nurse.

There remains to be noticed a very important matter upon
which much difference of opinion still exists. 1 refer to the
right of a medical practitioner to examine an accused person
at the request of a magistrate or police official. 1 have
never done this without the permission of the person
charged, given in the presence of at least one witness.
Moreover, 1 have always, in addition to obtaining his consent,
fully explained that the result might be in his favour or
against him, but that whatever it might be I was bound to
state it. If after this full explanation he consents, I have
no hesitation in examining him. Although the consent of
the accused is mentioned as requisite in both Taylor’s 4 and
Tidy’s" works, there are members of our profession, barristers,
and police officials, who appear to hold a contrary opinion,
la view of the almost epidemio form of actions against
medical practitioners, which we are still experiencing, it
appears to me to be of paramount importance not only to
decline to make any compulsory examination, but to be
absolutely certain that consent is given, not in ignorance,
but in full knowledge of all the consequences.

In conclusion, 1 would wish to say that, while the
experience of all the foregoing cases shows how little
reliance could be plaoed upon the statements of at least some
of these girls, it is perfectly clear that what is now con¬
sidered a misdemeanour was committed upon all of them,
while in nine cases they were under the age of thirteen,
which makes it a felony under the existing law. I fear
that there are many other cases (where fortunately for
the females there has been no infection with disease)
which do not come to light. In this city all such cases
are most severely scrutinised before they are 6ent to
trial. Then the grand jury, acting under the direction of
the judge, are quite prepared to throw out the bill in any
case which appears to them to be a weak one. Lastly comes
the trial itself. The judge, the counsel on both sides, and the
men who compose the common jury are all fully aware how
easy these charges are to make and how difficult to disprove.
A calm dispassionate review of our judicial system as regards
these cases will, I think, convince most medical observers
that it is admirably adapted to fulfil its purpose: to
prevent, on the one hand, any man from being put upon his
trial for a groundless or weakly supported charge: and,
on the other hand, to punish severely those men who commit
such cruel outrages on children of tender age.

Liverpool.

PURULENT ENCEPHALITIS WITH OBSCURE
- SYMPTOMS OCCURRING IN A PREG¬
NANT WOMAN AT PULL TERM;

CHILD SAVED BY ABDOMINAL SECTION (PORHO’S
OPERATION).

By W. ALEXANDER, M.D., F.R.C.S.,
vurrnro srHOKOPr, irvxRPooL workhouse hospital.

Elizabeth W-, aged twenty, wss admitted to the

division for pregnant women of the Liverpool Workhouse
on Oct. 14tb, 1886. She did not complain of anything on
admission, but was regarded by the other women in the
division ss “distant and snappish,” and when spoken to
would tell the speaker to “mind her own business” and “not
to bother her.” She complained to the doctor on duty on
the 16th of headache, but she said it was not much, and
probably owing, she thought, to the onset of labour. On
Oct. 18th she was taken to the lying-in wards on the sus¬
picion of labour having commenced, but it was found to be a
“ false alarm.” Next morning she went again, but no signs of
labour presented themselves. She then seemed to the
midwife to be quite well. On the evening of the 19th she
looked restless before retiring to bed, but did not complain,
and during the night she got up several times to drink water.
Towards the morning, on returning from the water-bottle, she
fell three times across the beds that intervened. The nurses
from the lying-in wards were then sent for, and found the
patient in a “ hysterical” convulsion, confused in her manner,
but quite conscious except when “ working” in her fits.

* Op. eit- rol. li- p. 461. » Op. oit., p. 11., footnote on page 306.

Digitized by Google

1*70 Thi* LAncet,]

MR. J. Ti HUBI60N ON TRAUMATIC TBTANUS.

[Jan. 22,1887.

On Oct. 20th, as 1 was going through the lying-ward* of
the hospital oa my usual rounds, my attention was called to
this patient, who was still in the pregnant women’s division.
Her face was somewhat congested, she was slightly un¬
conscious, and was suffering from irregular convulsive move¬
ments that teemed partly voluntary and partly involuntary.
No signs of labour were to be found, but she seemed to be
at full term and the foetal movements were very distinct.
The substance of the history just given was then told to me.
The case was diagnosed as one of puerperal convulsions
occurring during pregnancy, and probably caused by a
debauch. As her bowels had been already moved, ana as
she could not swallow, a rectal injection of thirty grains
each of chloral and bromide of potassium was prescribed, to
be repeated according to necessity.

I visited the hospital again in the afternoon, at 6.30 p.h.,
and found that the coma had deepened very much during
the last half-hour; the convulsions nad become moredecidea
and epileptiform, affecting chiefly and primarily the faoe
and arm centres for the left side, bat extending often into a
storm that involved the whole body. The eyes gave the
faintest response to pressure, and the pulse was scaroely
perceptible. Mustard to the legs, frictions, &c., had been tried
without effect, and Dr. McMurray, who had watched the case
carefully during the day, had already come to the conclusion
that the patient was dying. A short examination convinced
me that he was right, and that the “ status epilepticus ” into
which the patient had fallen was one from which she was
not likely to reoover. The child was still moving, but less
vigorously than at midday, and it was evident that whatever
was to be done would have to be done quickly. An examina¬
tion per vaginam showed that the os uteri was still firmly
closed, that the vagina was dry and undilated, and that there j
was an entire absence of any signs of labour. The removal of
the child per vias naturales would, it seemed to me, be too
slow to save the child and relieve the mother. Abdominal
section offered the best chance, especially as 1 am quite
familiar with and very successful in the performance of this
operation for various diseases. Nurses were immediately
detailed to wash the woman with warm soap-and-water and
with corrosive sublimate solution; the spray was got in
readiness, and the sponges that are always kept at hand
for an “emergency” abdominal section were brought to
the lying-in ward, as this ward is very clean and was then
fortunately empty of any case in labour.

The uterus was exposed by an incision four inches long.
Through the uterine walls the plaoentacould be seen adherent
to the part just beneath, Mid over the placenta some large
veins were distinctly visible. Dr. McMurray kept the
abdominal wall closely applied to the uterus, ana sur¬
rounded the opening 1 was about to make into the uterus
with sponges. This opening I made in a longitudinal
direction for two inches in a Bpot free from large veins. A
gush of venous blood was the result of the incision. This
was immediately stopped by the insertion of two fingers
into the uterine wound. By means of these two fingers the'
placenta was stripped off the uterus, and on their with¬
drawal the haemorrhage had oeaaed. The opening was now
enlarged upwards and downwards until a sufficient opening
was made to enable the placenta and afterwards the child
to be removed. As the child was removed Dr. McMurray
expressed the womb outside the abdomen, thus closing the
abdominal walls around the organ, so as to completely shut
the abdominal cavity and protect the intestine. All this had
been done without chloroform and without a movement of
the patient. The midwife now took charge of the child and
placenta, and the question was what was to be done for the
mother. The screaming of the child that we now heard
showed that one life was saved. I was disappointed that,
the operation had not roused the patient, which I’had hoped
it would, and Dr. Blackwood had been standing by ready
with chloroform and watching for any sign of consciousness.
As the woman was young, and all the internal organs healthy,
I would have liked to have stitched the womb up and
left her undeprived of any organ ; but this operation
would have taken time, and would have allowed some risk
from haemorrhage, which might have destroyed any re¬
maining Chance Of life, and the chance seemed already a
very desperate one. I therefore quickly performed a “Porro,”
and, covering the abdominal wound with antiseptic sponges,
endeavoured to resuscitate the patient. Stimulants per rectum,
subcutafle&u# injections of ammonia and ether, artificial
respiration, galvanism, &c., were tried for abottt an hour, but'
the failing pulse gradually disappeared and death ensued.

Next morning a aster of the deceased told us that the
latter had led an intemperate and profligate life, and had
been beaten just before admission.

An examination of the body showed slight contusion*,
bat none greater than she might have obtained during the
convulsions. On opening the sknll, a thin layer of pus
was found beneath the dura mater, covering the whole
of the encephalon, and extending down to the base of the
sknll. There were no signs of any injury to the brain or
skull; the lungs were congested, and all the organs showed
signs of excessive indulgence in drink, but otherwise they
were healthy.

The baby ‘is a plump healthy girl, who takes to her bottle
with avidity, and seems to enjoy the life into which she was
so tragically ushered.

When 1 was house-surgeon at the Workhouse Hospital in
1873, a woman was brought in suffering from convulsion8.
Just as my colleague, the late Dr. A. M. ti. Hamilton, saw
her, for the purpose of locating her, she had a sharp con¬
vulsion, and died in the cab. We immediately took her
into the nearest room and performed Ccesarean section. A
fine, well-formed, well-matured infant was removed, but
quite dead. In my last case the result has been better,
although I was disappointed that the coma did not yield to
the stimulation of the operation. Had the coma depended
merely upon essential puerperal eclampsia, the operation,
the gush of blood, and the emptying of the uterus might
have done good, and saved mother as well as child. The
imperfect history of the case obtained before death, and the
latency of the symptoms before convalesoenee set in, did not
prepare ns for the startling lesion found at the necropsy.
Altogether, I do not think any improvement could have
been made either in the time of the operation or the kind of
operation, and a fuller knowledge of the case would not have
secured any better results.

ox a cask or

TRAUMATIC TETANUS SUCCESSFULLY
TREATED BY THE SUBCUTANEOUS
INJECTION OF MORPHIA.

BY J. FALCONER MURISON, M.B., C.M.Abkro.

One of the most appalling and fatal maladies to Which
man is liable is traumatic tetanus. The following case,
which came under my care nearly twelve months ago, will,
I think, be of some interest to the profession.

On Jan. 29tb, 1886, I was sent for to visit a young man
whose “jaws were stiff and would not open.” I found him in
bed, complaining of great stiffness in his jaws, and a peculiar
feeling when he attempted to swallow food or drink. He was
twenty-six years of age, over six feet in height, and power¬
fully built. On questioning his parents I elicited the follow¬
ing facts: On Jan. 15th he was engaged, along with a servant
lad, carting manure from the farmyard to the fields. He asked
the lad to hand him a spade, which he (the lad) at once
took up and threw towards the patient. The distance
between them was only six yards, and the spade struck the
patient severely on the inside of the left knee-joint, causing
at the time excruciating pain. The part was badly bruised,
but although in severe pain the patient continued at his
work all that day. In the evening the pain increased and
the knee-joint became swollen ana stiff. For the following
ten days he was confined to bed, during which time he
constantly applied fomentations and poultices to the knee.
The swelling and pain disappeared, and he resumed his
ordinary duties, feeling nothing whatever the matter with
him, until the 29th, when the first symptoms of tetanus made
their appearance.

When [ first saw this young man he was suffering intensely.
The jaws were firmly clenohed, and he experienced some
difficulty in swallowing. The muscles of the temples, jaws,
and neck were stiff and rigid, the features were fixed, and
the countenance expressive of acute pain. Risus sardonicus
was well marked, giving a comical expression to the face.
I. saw at once that I had to deal with a very serious case,
and, as the patient was lying on a bed in the farm kitchen,
1 had him removed at once to a cool, quiet, and airy bed¬
room, a screen being drawn round his bed and perfect
quietness enjoined. His temperature was 104°, his pulse 90,
and his body covered with free perspiration.

Di.

O

Thb Lancjct,]

HOSPITAL MEDICINE AND SURGERY.

[Jan. 22,1887. 171

The treatment confuted of thirty grains of hydrate of
chloral, with twenty grains of bromide of potassium, given
every four hours. This was continued for three days, at
the end of which time the patient was in no way benefited;
he did not even sleep. The symptoms increased; the musoles
of the back and legs became involved; and during the
paroxysms opisthotonos was well marked and excruciating
pain felt at the pit of the stomach. Tincture of cannabis
indie* was then tried, the does being fifteen minims at first,
gradually increased to half a drachm, with inhalation of
nitrite of amyl. This was also given every four hours and
continued for three days, at the end of which time there
was still no improvement visible to the patient. Ice
was applied to the spine, and he whs put under the
i?i finance of chloroform twice a day for an hour at a time.
Scill the paroxysms oontinued as bad as ever, if not
wane, and as the patient had got little or no sleep
for the previous week, I determined to,try the effects
• 4 morphia. I therefore injected subcutaneously one grain
and a half into the muscles of the right thigh, and awaited
the result. In about half an hour he was dosing, and con-
tinned so for about two hours. On awaking he felt him-
-tfif greatly relieved, and begged hard to have the injection
repeated, as he was unable to suffer such severe pain.
The medicines were now all discontinued and the subcuta¬
neous injections of morphia thereafter solely relied on. For
four days one grain was injected every four hours, for the
next two days every six hours, and the next two days every
eight hours. Then, as the symptoms gradually disappeared,
the injections were used less frequently, until at the end of
the third week only one grain was injected at night, with
an occas ion al half-grain through the day. During the fourth
weak only half a grain was injected at night, ana during the
fifth week only every alternate night. At the end of the
sixth week the patient wae convalescent, and was able to be
out of bed ana to do without the morphia. During the
whole time of his illness, which extended over a period of
six weeks, his nourishment consisted of beef-tea in a con¬
centrated form, milk, switched eggs, soups, wine, and brandy,
all being given freely.

I think this case will interest not a few, owing to the
marked benefit the patient derived from the subcutaneous
injections of morphia, after the usual remedies -chloral
hydrate, bromide of potassium, cannabis Indies, ice, See .—
had been thoroughly tried and completely failed to relieve
him of a single symptom of this terrible disease. So much
am I convinced of the benefit accruing from the use of
morphia in this particular case that, were I called upon again
to treat another case of a similar nature, I should have no hesi¬
tation whatever in beginning the treatment at once with a
fall dose of the solution of morphia injected hypodermically.

Glasgow. ^

% Utiranr

or

HOSPITAL PBACTICE,

BRITISH AND FOREIGN.

Valla aotoaa eat all* pro oerto noaoeodi via, qUI qaamplurtaiM et mor-
Viruaa «t dlMOOtlonura hlatoriM. tarn allorutn turn propria* ootleota*
iaabers, et inter m oomparare.—Uoasaen Da Had. at Gama. ifarA,
Ub. It. Procamiuxn. ————

MIDDLESEX HOSPITAL.

PYLORECTOMY FOR CARCINOMA; DEATH; NECROPSY.

(Under the care of Mr. Henry Morris.)

Thv following instance of operation for carcinoma of the
<toniach. In which the growth was situated at the pylorus,
*1-pears to have been performed in one of those cases which
are especially adapted for the operation of pylorectomy. The
growth was limited in extent, free from adhesions to the
surrounding parts, there was no affection of the glands in
secondary deposits, and the patient was comparatively
young, being only thirty-nine years of age. The progress
after operation was for a time satisfactory, and although the
patient died, few surgeons of experience would hesitate to
adopt the same line of treatment in a similar cose in pre¬
ference to the alternative operations of gastro-enterostomy,
duodenoetomy or ’ejunostomy, which are only palliative,

For the report of the case we are indebted to Mr. W. Roger
Williams, surgical registrar.

The patient, a very emaciated woman of dark complexion,
aged thirty-nine, was admitted under the care of Dr. F inla y
on July 9th, 1885, with the following history:—She has
suffered from dyspepsia since youth. Symptoms of the
present disease began nine weeks ago with an attack of
jaundice, which lasted for a month. During this illness
constipation, nausea, and vomiting were marked symptoms,
and have continued so ever since. A month ago she first
noticed a “ lump ” in the upper part of the abdomen, which
was mifeh the same size then as now. During the last five
weeks she has lost much flesh. She has never had good
health. In addition to dyspepsia, she has frequently been
subject to a hacking cough, with much expectoration, and
shortness of breath. Twenty years ago she had rheumatic
fever. She married at twenty-six, and has had seven
children, four of whom died in infancy, and of the others
one has & ‘‘weak chest.”

On admission she complained of a sinking feeling at the
pit of the stomach, constipation, and flatulence, with nausea
and vomiting after taking food. The bowels had not acted
for a week. The conjunctivas were slightly yellow, but
there were no other signs of jaundice. On examination of
the abdomen, a freely movable, hard, nodulated mass, the
size of a hen’s egg, was felt a little above and to the left of
the umbilicus; sometimes its position shifted to the right,
of the umbilicus. There was dulness on percussion over the
tumour, to which all her pain was referred. The tumour was
not affected by movements of the chest. The liver dulness
extended from the sixth rib to the costal margin; the
splenic area was normal. The urine was free from albumen,
and its specific gravity 1016. A loud blowing bruit, which
replaced the first sound of the heart, was heard at the apex
and at the angle of the scapula. A loud systolic bruit was
also heard over the second right costal cartilage. After
admission the vomiting continued, and on July 20th she
ceased to retain nutrient enemata. Death from starvation
eeemed imminent.

At a consultation on July 24th it was decided to make an
exploratory abdominal section, with a view to pylorectomy,
in the event of the tumour being free from important
adhesions, and the adjacent glands &c. uninvolved- other¬
wise gastro-enterostomy or jejunostomy was to be done.

On July 26th and 27th the stomach was washed out with
a warm weak solution of horacic acid. This was repeated
on the morning of the 28th, shortly before commencing the
operation. At 9.30 a.m., Assisted by Mr. Gould and Mr. Paul
(the house-surgeon), Mr. Morris proceeded to open the
abdomen by & longitudinal incision, four inches long, made
a little to the right of the umbilicus Mid having its centre
over the tumour. On opening the peritoneal cavity, the
enlarged and hard pylorus was at once reached. It was
quite free from adhesions, and was readily withdrawn
through the wound. No enlarged glands could be felt, and
the adjacent parts seemed normal. The omentum above and
below the diseased part was ligatured with two rows of
catgut sutures, and then divided between the rows.
The pylorus and the adjacent parts of the stomach
and duodenum being thus completely freed from their
omental connexions, a flat sponge was placed beneath the
diseased area, and the division of the stomach was then
commenced at the small curvature and carried obliquely
downwards and to the right, just along the anterior and
then along the posterior surface for about half the distance
between the great and small curvatures. All bleeding points
on the cut surface being stopped by pressure forceps, the
incisions were extended by a succession of short snips. As
r soon as the stomach was sufficiently laid open, its contents
were removed by the introduction of sponges on long
forceps; thus extravasation of its contents into the peritoneal
cavity was avoided. Before completing the section of the
stomach some occlusion sutures were introduced. As soon
as the separation of the stomach from the diseased mass
had been completed, a couple of silk loops were passed
through its sero-musc'ular coats, and the cut edges
were retained outside the abdomen whilst the separa¬
tion from the duodenum was being effected. Finally, the
divided duodenum was united to the stomach by numerous
sutures, the posterior ones being introduced first. Part.
of the duodenum, through which the section passed, was
devoid of peritoneal investment; so that in effecting
the union of the divided viscera, for a certain extent, the ,
apposition of serous surfaces was interfered with. This

Digitized by GoOgle

172 The Lax cet,

HOSPITAL MEDICINE AND SURGERY

[Jan. 22,1887.

wm a circumstance of importance, because it was in this
situation that the sutures subsequently ulcerated through
and allowed extravasation into the peritoneal cavity.
Lembert’s method was alone employed for the first ring
sutures, and Lembert’s alternating every three or four with
Gussenbauer’s suture for the occlusion suturing. The opera¬
tion lasted nearly two hours and a half.

The patient was a little sick after returning to bed.
Enemata of port wine (three ounces) and peptonised beef-
tea (three ounces) were given alternately, the first port-
wine enema being administered two hours after the.opera-
tion. During the afternoon and evening she complained of
intense thirst, and a teaspoonful of iced water was allowed
by the mouth at intervale. There was a slight motion of
the bowels at 6.30 a.m., one hour after a port-wine enema,
and again slightly at 8 p.m , when she passed eight ounces of
urine. Evening temperature 100-4°; pulse 120. During the
night she slept tor about six hours and a half.

On the morning of July 29th she still complained of in¬
tense thirst, for which a teaspoonful of iced barley-water W&s
given from time to time. This she retained. The enemata
were continued every four hours, and five minims of liquid
extract of opium were added to the beef-tea injections to
assist their retention. There was a slight motion of the
bowels; no sickness. Morning temperature 98*6°. She passed
another fairly good night.

July 30th.—She still complained of great thirst. Tempera¬
ture 99°. Six ounces and a half of urine passed during the
last twenty-four hours. Enemata retained; no vomiting.
At 9 p.m. the bowels acted freely, the motion being of a
dark-grey colour. Rectum irritable, and the enemata but
partially retained. During the day she slept for about six
hours, At 10.30 p.m. she vomited about half a pint of dark-
brown odourless fluid, and again at 1 a.m. She slept for
about six hours and a half during the night.

31st.—Morning temperature 98-6°. She has passed seven
ounces of urine during the last twenty-four hours. Most of
the enemata are retained. At 11.30 a.m. she complained of a
sharp pain in the epigastric region, screamed loudly, and then
vomited several times. At 1.30 p.m. the wound was dressed
for the first time; it looked normal; the sutures were not
disturbed. During tbe afternoon the patient continued to
complain of pain in tbe abdomen; she was sick at intervals,
and the enemata were not retained. At 9.30 p.m. she was
very weak and much changed for the worst. 8he still
vomited occasionally. Temperature 101°. During the night
she had no sleep, was very restless, and died in a state of
collapse at 4 a.m. on August 1st.

. Necropsy, ten hours after death .—Body exceedingly ema¬
ciated. The peritoneal cavity contained about eight ounces
of eero-purulent fluid. There was recent acute general
peritonitis, the intestines being injected and glued together
by recent lymph. The left lobe of the liver was adherent
to the anterior surface of the stomach. The stomach occu¬
pied a position that was almost vertical; it was small and
contained some fluid. On close examination of the opera¬
tion lesion, it was found that all the occlusion sutures and
all the ring sutures that were on the peritoneal aspect were
quite secure and well embedded in lymph. It was at the
posterior and upper part of the wound, near where tbe
oeclusion sutures joined tbe ring sutures, that some of tbe
latter had ulcerated through and allowed the gastric con¬
tents to escape. These were found occupying a small pouch
immediately behind the gap. There were no cancerous
glands adjacent, and no secondary deposits in other parts of
the body. The lungs were small and emphysematous. There
were oid pericardial adhesions. Both auriculo-ventricular
valves were competent, but they presented much old
thickening. The aortic valves were thickened, calcareous,
and incompetent. The heart was rather large. Both kidneys
were small and granular.

WEST LONDON HOSPITAL.

CASE OP PARTIAL PARAPLEGIA, PROBABLY DUE TO
SYPHILITIC MENINGITIS; RECOVERY; REMARKS.

(Under the care of Dr. Donald W. C. Hood.)

C. H-—, aged twenty-eight, a stonemason, was admitted
on Jan. 18th, 1886. He complained only of great weakness in
both legs. He was unable to walk more than a few yards.
He dated his illness from the evening of the 24th ult., when
he had felt much fatigue after a short walk, and had stiff¬
ness and cramps in the calves of both legs. During the

preceding week be had had seminal emissions every night,
and irritability of the bladder night, and day. From/
the morning of the 25th up to tbe day of admission the-
weakness in his legs rapidly became more and more marked.
He was unable to retain his urine longer than an hour at &
time. The patient was a strong, muscular, healthy-looking
man. 'He had had no previous illness of moment, but had-
suffered from a chancre some seven years before. The-
chancre was not followed by sore-throat or by any consti¬
tutional trouble. There was great loss of power, equal ly
distribnted in both lower extremities. He could barely
move his legs as he lay in bed, and could only stand or
struggle along a few yards with the greatest effort and
fatigue. There was complete loss of all reflexes below
tbe abdominal ; if anything, these were in excess.
The cremasteric were entirely absent. The limbs were-
muscnlar, and there was no wasting. Sensation appeared
perfectly normal, and the patient made no complaint of
pain. The spine was carefully ' examined, but no trace
of bone disease could be discovered. The muscular power
of the upper limbs and trunk appeared/ natural. On the
supposition that tbe patient was suffering from syphilitic
inflammatory mischief he was at once placed on iodide of
potassium and percliloride of mercury. Under this treat¬
ment the patient made rapid progress towards recovery,,
recovery being, however, impeded by a sharp attack of
tonsillitis, which at that time was almost endemic in the
hospital. The first indication of improvement was the
lessened irritability of the bladder; then muscular power
returned bv degrees, the patient being able to move and turn
in bed without effort. A month after admission there ff&s
some return of plantar reflex, the patellar and cremasteric
being still absent. The patient could now stand without
difficulty, and could walk acroes tbe ward. A month later-
the muscle power was noted as being fairly normal, and
within a few days the patient was discharged as well.

Bix weeks subsequently the patient reported himself as-
well as he bad ever been, and able to walk any reasonable
distance without fatigue. At this time there was still no¬
patellar reflex.

Remarks by Dr. Hood.— There can be but little doubt that
tbe lesion in the above interesting case was a circumscribed in¬
flammation of the spinal meninges,lying somewhat above the
lumbar enlargement of theoord. The inflammatory mischief
was probably gummatous in character, and must have been
limited to the anterior portion of the cord, the substance of
which could scarcely nave been affected, looking at the
rapid and perfect restoration of muscular power. I con¬
clude that the inflammatory products involving the internal-
surface of the dura mater compressed the anterior surface of
the cord and implicated the motor roots.

BURTON-ON-TRENT INFIRMARY.

CRUSHED PELVIS; RUPTURE OF THE BLADDER; NKCROP8Y
REMARKS.

(Under the care of Mr. Mason.)

For the following notes we are indebted to Mr. A. P.
Trinder, house-surgeon. *

Thos. P-, aged thirty-six, was admitted on Nov. 1st,.

1886, at 6.30 p.m. The patient, a powerful man, a shunter in
one of the yards, was riding on the spring of a waggon, when-
passing some points, on which he had himself placed some-
trucks without allowing proper space between them and
the main line, he was caught by the buffer of the nearest
one on the left hip, twisted round by it, and so crushed that
his hips passed transversely through a ten-inch space.
Having passed the obstacle he fell, and was immediately
brought to tbe infirmary by his mate, who, being behind,
him on the same waggon, saw what occurred and saved
himself. The patient was never unconscious.

On admission, the hands and feet were slightly cold; body
warm; pulse regular, and of fair volume; temperature-
98 4°. The man complained of great pain in the hypo-
gastrium. The perineum and left hip were slightly bruised
and painful, but not much swollen. He could not lift his-
thighs without assistance, especially the left. He asserted,
positively that he had passed urine within an hour of the
accident. Mr. Mason saw him, and on account of tbe pain
passed a No. 8 silver catheter, which entered the bladder-
easily, but, to his surprise, drew off bright-red blood. The
catheter was kept in. An ice-bag was applied over th»

The Lancet,]

PATHOLOGICAL SOCIETY OF LONDON. [Jan. 22,1887. 173

pubes, and beef-tea and ice were given by the mouth. He
was also ordered twenty minims of liquor morphias, which
was repeated later on.

Nov. 2nd.—Very little sleep last night; body warm; pulse
quiet, of fair volume; temperature 9'.*°. Taking iced milk
and beef-tea pretty well. Pain diminished; no pain in
the abdomen on pressure, except over the pubes ; no dulness
on percussion anywheie except over the bladder, which
reached two inches up. The catheter has drawn off a con¬
siderable quantity of bright blood and urine. A consulta¬
tion was held as to operating, but delay was advised, as the
haemorrhage had abated and his condition was good.

3rd.—Slept well; temperature last night 101°; to-day 100°.
“Catheter blocked with clot, and exchanged for a soft red
rubber instrument; very little blood, and of a blacker colour.
Bowels cleared out by enema.

6th.—Doing well; sleeps and eats fairly. Catheter draw¬
ing nearly clear urine, but has been often blocked by clots.
Bladder repeatedly washed out with 1 in 300 carbolic solu¬
tion, as the urine smells very foul. Temperature 101-2°;
.pulse 120.

8th.—Doing well, except that he had another smart
hemorrhage from tbe bladder to-day. Perineum rather
more swollen and discoloured, but not prominent as in
ruptured urethra. Temperature 100°; pulse 120, steady. At
3 p.m. another consultation was held, but the tuemorrbage
having again ceased, it was considered advisable to leave
him alone, as it would probably be impossible to control the
bleeding vessel, which was supposed to be the internal pudic
artery ruptured by a fracture of the pelvic ramus. Very
foul gas escapes along the catheter.

9th.—Slept all night. Takes food better. Catheter drains
well; no more haemorrhage. Temperature last night 101°;
to-day 99°. On pressure over tbe right side of the pubes
emphysematous crackling can be plainly felt, and foul gas
is expelled from the urethra. For fear of infecting the
ward, he was carried, mattress and al 1 , into a small special
ward, without experiencing any pain or producing any
hmmorrhage. At 9 p.m. he had a rigor, and the temperature
was 102-5°. Mr. Mason made two small incisions—one in
the perineum, which Jed nowhere, the other over the
crepitating region to the right of the pubes, the latter
incision giving vent to horribly offensive gas and urine,
which dribbled slowly on syringing through the catheter.
At 3 a.m. the temperature was 103*6°, ana the pulse 160,
weaker, slightly irregular. Two ounces of brandy ordered.

From this time tbe patient lost ground in spite of a large
amount of fluid food and from two to four ounces of brandy
daily. The temperature ranged from 101° to 103-8°, and the
pulse from 120 to 150, and becoming smaller and weaker. Two
small haemorrhages occurred, and diarrhoea ensued, followed
by death on Nov. 17th. The smell during the last week was
overpowering, in spite of sanitas and carbolic sprays.

No regular post-mortem examination was made, but the
pubic wound was enlarged to admit two fingers, when it
was discovered that the pelvis was fractured in three places—
viz, the symphysis pubis and the right and left body and
descending rami of the pubes. The triangular fragment on
the right side was found pushed backwards and downwards
into a rent in the bladder wall as large as an egg. The
silver catheter could be felt lying against the bare none of
the pubic arch, the soft parts. ot the neck of the bladder
being destroyed. The right triangular fragment was easily
removed through the wound and carefully examined. The
fracture through the body of the pubes ran right through the
obtnratoT notch, so that in all probability it was the obturator
artery which was ruptured and caused the haemorrhage, and
not the internal pudic, the more so that the fracture of the
descending ramus ran in a slanting direction through it,
coming out at the arch of tbe pubes, and leaving the lower
or perineal border attached to the ischium.

Remarks by Mr. Trindkr. —The points of interest in this
case seem to be that the patient should with such a severe
injury (1) show so little sign of shock, (2) live seventeen
days, (3) have his bladder ruptured in an empty condition,
and (4) bear carrying from one room to another without
pain or haemorrhage. A median or right lateral cystotomy
(which was several times proposed and postponed) would
have allowed freer drainage and cleansing, but at the same
time would have tended to increase the haemorrhage by
removing the beneficial pressure exercised, in all probability,
on the ruptured vessel by the large body of clot which was
•known to be present. The operation could not have enabled
us to control the haemorrhage effectually.

Utehical Societies.

PATHOLOGICAL SOCIETY OF LONDON.

Hypertrophy of Bladder.—Lipoma of Heart.—Spontaneous
Disintegration of Vesical Calculi.—Infantile Palsy.

Ax the ordinary meeting of this Society held on Tuesday
last*' Sir Jaxnes Paget, F.R.S., President, delivered his
presidential address on taking the chair. This will be found
in extenso at page 159. The meeting was a very large one.
Sir Joseph Lister proposed, and Dr. Samuel Wilka seconded,
the vote of thanks for the address.

Mr. E. Hurry Fenwick showed a frozen Bection of a
Hypertrophied Bladder, removed from a patient suffering
from stricture of the urethra, who died of intercurrent disease.
The specimen demonstrated the greater thickness of the
anterior wall as compared with the posterior. In this case
tbe anterior wall was twice the thickness of the posterior.
He believed this condition,which obtained in hypertrophied
bladders, had been overlooked, and the reason for its want of
recognition was due to wasting of the muscular wall after the
stricture had been relieved, and cases of unrelieved strictnre
were rarely found on the post-mortem table. He adduced
anatomical proofs to support the theory that it is the
anterior wall which possesses the greater power of byper-
tropbying, and he submitted that the comparatively greater
strength, elasticity, and resistance to pressure of the anterior
wall was one of tbe reasons for its acknowledged greater
immunity in ruptures of the urinary bladder.—Sir James
Paget said that, so far as he knew, the communication
supplied a new fact. -Mr. James Black suggested that the
anterior wall became hypertrophied because it offered more
resistance to muscular contraction than the posterior.

Dr. Handford showed a specimen of Fatty Tumour of
the Heart, and said there was no satisfactory example of a
true lipoma of the heart in any of the nineteen principal
museums in the kingdom. There are, however,, three
doubtful specimens, two of which are probably examples of
fatty overloading, and the third is classed among “ tumours
of uncertain ongin.” They are in the museums of the
College of Surgeons of England, St. Bartholomew’s Hospital,
and Queen’s College, Birmingham. So far os he could
ascertain no such specimen has been shown at tbe Patho¬
logical Society of London. The recorded cases only number
three, one of which (Gemet's) is doubtful. The three cases
are: 1. By Albers, In Yirchow’s Archio, Bd. 10, p. 215. (1856.)

2. By Gernet, in Virchow’s Archie, Bd. 42, p. 554. (1867.)

3. By Banti, in Lo Sperimentali, tom. lviii. (Sept. 1886.) Be
was indebted to Mr. Evan Powell, medical superintendent of
the Nottingham Borough Asylum, for the specimen, as also for
tbe notes of the case and of tbe necropsy. Unfortunately,
only the tumour and the inter-auricular septum in which
it was embedded have been preserved. The patient was a
woman aged seventy-six, who died during sleep. At the
necropsy there Was found a fair, but not excessive, amount
of subcutaneous fat. There was no fatty tumour or excess
of fat anywhere, except around the heart, which weighed
14 oz. The muscular substance of the heart was very pale,
and of a yellowish colour; it felt greasy and looked streaky
to the naked eye. In the inter-auricular septum was a hard
round substance about the size of a small pigeon’s egg.
It was distinctly limited, but had no definite capsule.
When cut it had all the appearance of an ordinary fatty
tumour. The liver was fatty, but the other organs were
apparently healthy. There could be no doubt of the dis¬
tinctness of the growth, or of its fatty nature. From tne
appearance of the tumour, from its position in the septum
between the auricles, and from the observations of Mr. Power
at the necropsy, he entertained no doubt that it was not an
instance of the burrowing inwards of tbe subpericardial fat.
A microscopic examination showed that the tumour consists
of fat cells with a few degenerating muscular fibres scat¬
tered here and there. The probable origin of the tumour
was in the inter-muscular connective tissue.

Dr. W. Ord showed fragments of Vesical Calculus, which
had resulted from spontaneous disintegration, and had been
passed tbe last few months by a gentleman, aged seventy-
five, who for six years had had sugar in varying quantity
in his urine, and albumen also. Free uric acid in large
crystals were also passed. Six months ago the left
femoral artery became blocked, and sloughing or the skin of

Digitized by GoOgle

174 The Lancet,]

CLINICAL SOCIETf OF LONDON.

[Jan. 22,1887.

the left leg waa observed. And three months ago he began
to pass calculous fragments 'without pain and with but little
bleeding. A soft catheter had to be introduced as much for
enlargement of prostate as for calculous obstruction. The
detached fragments evidently came from an ovoid calculus
one inch in length. Some fragments had rounded margins,
having been chipped off some time before being ejected.
Dr. Ord had shown five specimens of spontaneous disinte¬
gration of calculi, so it was doubtful whether this process
was of rare occurrence. There were two ways in which
disintegration could occur: either from within or from
without, as in the present specimen. The chemical com¬
position was uric acid and urate of ammonia, and the parts
were probably not originally firmly put together; the
remarkable alterations in specific gravity of urine might be
compared in their effects to alternations of comparative
drying and moistening. This was the best explanation he
could offer.—Sir Jakes Paget had seen similar specimens.

Dr. Seymour 8habkky read a paper on Infantile Palsy,
dealing chiefly with the final stage. The specimens were
removed from an old man aged sixty, who died of epithe¬
lioma of the oesophagus. The legs had been paralysed for
fifty-eight years. All the muscles of both legs were repre¬
sented by masses of fat showing numerous pinkish streaks
running longitudinally. The lumbar part of the spinal cord
was much wasted. The microscope showed innumerable
corpora amylacea. The large nerve cells were reduced in
size and number; there were a great many nuclei, and the
groundwork of the anterior horns had a finely fibrillar
texture. The walls of the vessels had a hyaline appearance,
with abnormally large perivascular spaces. All the white
columns were shrunken, but the antero-lateral strands
seemed to have undergone greater diminution than the
others. The larger nerves, shown in transverse sections,
presented a great number of healthy nerves intermixed with
islands of atrophied axis cylinders surrounded by the sheath.
The muscles consisted chiefly of fat, but here and there a
few perfectly healthy fibres, well striated, were seen. Other
sections were shown from an earlier stage of infantile palsy;
in some of these there were to be seen parallel wavy rows
of sarcolemma nuclei.—Dr. Samuel Wilks said that tne case
corroborated the views be had always held.—Mr. W. Adams
spoke of the value of the communication.—In reply to
Mr. E. W. Parker, Dr. Sharkey said there were no obvious
secondary changes in the cortical motor centres.

The following card specimens were exhibited :—Dr. Hand-
ford : (Esophageal Malformations, Fistulse, and Carcinoma.
Dr. Sharkey : Syphilitic Arteritis. Dr. H. Maudsley: Ulcera¬
tion of Trachea, with Perforation of Aorta. Dr. B. O’Connor:
Mediastinal Tumour. Mr. F. Treves: Melanotic Sarcoma.

CLINICAL SOCIETY OF LONDON.

Athetosis and Aphasia in a Child—Treatment of Cysts of
Thyroid—Treatment of Imperforate Anus.

The annual general meeting of this Society was held on
the 14th inst., Mr. Thomas Bryant, F.R.C.S., president, in
the chair. The list of officers for the ensuing year is'
appended to this report. The scrutineers of the ballot were
Dr. 8. Phillips and Mr. G. E. Turner. The votes of thanks
to the retiring president (Mr. Bryant) and surgical secretary
(Mr. E. J. Godlee) were warmly accorded. Mr. .Christopher
Heath, the treasurer, read the report of the finances of the
8ociety.

Dr. Samuel West read notes of a case of Eight-sided
Hemiplegia with Aphasia, occurring in a female child. The
hemiplegia came on suddenly during a paroxysm of whoop¬
ing-cough. 81ight rigidity developed in the weakened
limbs, which had recovered some power, but of late
athetosis as described by Dr. Gowers had developed.
Haemorrhage was the probable cause of the hemiplegia,
but the locality of the lesion could only be surmised.—
Dr. Eadcliffe Cbockek related the case of a girl, Aged ten,
in whom there was a condition of athetosis and spasm of
the right hand. There was a history of right-sided fits,
three in number, and lasting over twelve hours. Hemiplegia
followed, and about six weeks later the athetosis developed.
The child had mitral disease, and the hemiplegia was
probably of embolic origin.—Dr. Broadbent thought that
the fact that athetosis had been associated with lesions
about the great ganglia should not outweigh certain con¬

siderations pointing to a cortical lesion. The remarkable
difference in the limbs at rest during sleep and during
waking without permanent contractures seemed to point to
functional activity of the cerebral cortex. If paralysis had
had more the type of a monoplegia, the cortical origin
would be still more probable.—Dr. 8. West had preferred
not to suggest the pathology, but thought that the seat of
the lesion would rather be in the internal capsule than
cortex, considering the sudden onset of hemiplegia and
subsequent spasm.

Mr. Mayo Hobson (Leeds) read a paper on a Method of
Treating Thyroid Cysts, in which he advocated antiseptic
incision and stitching the edge of the cyst to the skin,,
draining for a short time under an antiseptic dressing, and
then packing with zinc lotion and lint. He read notes of two
cases thus treated, the first in a young woman, aged twenty-
two, who had a cyst the size of a Tangerine orange over
the trachea, which occasionally produced dyspncea; the
second in a woman, aged twenty-four, in whom the right lobe
of the thyroid was iorming one large cyst. In both the
above treatment was perfectly successful, and produced no
constitutional or local disturbance. When seen some time
afterwards there was very little trace of scar, and no
tumour in either case. He quoted from several standard
surgical works to prove that the usual operations for thyroid
cysts, such as injection, seton, &c., are either dangerous-
or unsatisfactory, and thought that the advantages of
this method were its simplicity, safety, and certainty.—
Mr. Chei8topher Hbath said that the contributor had said
nothing about haemorrhage, which he knew from personal
experience could be pretty severe from the interior of the
sac. He did not know the reason for this; but the injection
of perchloride of iron and plugging with strips of lint soaked
in the perchloride succeeded very well in arresting the
haemorrhage. Perhaps in Mr. Robson’s cases the cysts were
so small that no haemorrhage occurred.—Mr. Gant said that
under no circumstances would he interfere with the interior
of the cyst. Tearing or scraping of the same should be
considered dangerous.—Dr. S. Mackenzie had examined
many microscopical preparations of these cysts, and the
thin-walled vessels were remarkably numerous. Doubtless
this anatomical fact accounted for the haemorrhage, and
perhaps for the beneficial effect of the perchloride, as tes¬
tified by Mr. C. Heath. Iron was better than iodine to
stanch bleeding. — Mr. H. H. Clutton corroborated Mr.
Heath’s remarks as to the liability to abundant haemorrhage.
He never thought it necessary to suture the skin to the cyst
wall. In some cases of plugging the opened cyst high
fever developed; the use of iodoform gauze obviated trns
tendency. The suture to the skin had an objection, in that
it might cause the sinus to remain open, as in one case
which continued three years. He would prefer complete
excision of the cyst to scraping its walls.—Mr. T. Bryant-
supposed that Mr. Robson did not claim that free incision
was a new treatment, but that stitching the capsule of &
cyst to the skin was. If this were not adequately done,
septic matters might escape into the subcutaneous tissues.
The fear of hemorrhage would be an argument in favour
of laying the cyst open, and making a sinus. In a case
of puncture of a cyst, free incision and plugging were
required to control the bleeding. In another case, in which
Mr. Bryant injected a mixture of tincture of iodine, iron,
and alcohol four times without untoward results, the fifth
injection was followed by the development of a tumour
that pulsated like an aneurysm. Fortunately, however,
the application of an ice-bag reduced the swelling without
further trouble; but a large artery had probably been
tapped. With regard to Mr. Robson’s operation, he
considered that scraping the interior of such cysts was
a bold form of practice.—Mr. Mayo Robson advised the
suture to the skin as shutting off all the surrounding
cellular tissue and preventing inflammatory extension. He
would not practise complete excision again; in one case
asphyxia, and in another haemorrhage caused great anxiety.
Furtner, the surgeon could not know how much of the
gland would have to be removed, and in view of the func¬
tions of the thyroid, as expounded by Horsley, its removal
was not advisable. He practised sufficient scraping to
separate all colloid material, but not to extend deeply into
the wall of the cyst. ,

Mr. Mayo Robson also read a paper on a Suggested
Method of Operating on a Uniform Principle in the Treat¬
ment of Imperforate Anus, with example, and gave extracts,
from several authors to prove that the recognised treatment-

Gc

o

Thk Lancet,]

HAKVBIAK SOCIETY.

[Jan. 22,1887. 175

of cues where the bowel is not soon reached is to perform
either Littr£’s operation or colotomy, although the mortality
of the operation, judging by published statistics, is extremely
hoary—e.g., M. Gueraant haring operated in this manner
twelve times without saving a patient. He advocated an
i ncision from the central point of the perineum to the
coccyx, and then a careful dissection, until either the bowel
is reached or the peritoneum is opened, when the upper end
of the rectum or the sigmoid flexure of the colon can be
brought down and sutured to the skin in the anal region.
He described a case in a child one day old, on whom, in
Hatch, 1806. he bad performed this operation with a very
good result, the child recovering without a bad symptom,
either local or general, and when seen last the infant
had what appeared to be a normal anus, through which
a motion was passed about once a day. He considered
the operation ought not to be very difficult if a catheter
were introduced into the bladder and a good horizontal
light were available ; that it should not be very dangerous
either from shock, peritonitis, inflammation, or htemor-
rhage; and that the result, if successful, was infinitely
preferable to that of LittTd or a colotomy. — Mr. R. J.
Godlbb related a cate of imperforate anus which seemed
to show that the meconium was by no means so irri¬
tating to the peritoneum as ordinary fasces were. The
trocar in this case, it was found, had passed through
the peritoneal cavity before puncturing tlm rectal cul-
de-sac. Colotomy was successfully performed. The
child died some time later from disease unconnected
with the surgical operations.—Mr. Harrison Cripps
remarked that he had listened with much interest to Mr.
Robson’s paper, for he himself bad collected and published
in the St. Bartholomew’s Hospital Reports the results of
operation in over a hundred cases of imperforate anus.
With regard to the statement quoted by Mr. Robson, on the
authority of a foreign author, that there was only one case
on record of recovery after Littr^’s operation for imperforate
anna, the statement was entirely erroneous, Mr. Cripps
mentio n i n g that in his own paper five cases of recovery
were described. He remarked that there were two chief
varieties of imperforate bowel—the one in which there
was no sign of an anus, the skin stretching unbroken
from the perineum to the coccyx; the other in which the
anus existed, but terminated in the cul-de-sac. In the
roraer the rectum was generally near the skin, and much
more likely to be found than in the latter class of cases.
By making the dissection well backwards, and even, if
necessary, following Vemeuil’a practice of resecting the
oooeyx, the bowel could generally be found and opened
without catting through the peritoneum. Mr. Cripps con¬
sidered the dragging down of the rectum and stitching it to
the skin a great mistake, for it hardly ever united, while
the pas and discharge became pent up behind the stitches,
tod then set up the cellulitis and peritonitis which wore
the chief causes of death in these cases.

The following living specimens were shownDr. Rad-
cliffe Crocker: Athetosis after Hemiplegia in a Child. Dr.
Stephen Mackenzie: A case of Chyluria with Filarise
Sanguinis. Dr. Angel Money: Hemiplegia with Spasm in a
Syphilitic Idiot.

The following is a list of officers for the ensuing year:—
President: W. H. Broadbent, M.D. Vice-Presidents: Sir
fryoe Duckworth, J. Hughlings Jackson, Samuel Wilks,
Sydney Jones, Howard Marsh, and Sir Henry Thompson.
Treaeorer: Christopher Heatb. Council: R. E. CarringtoD,
S. Cropland, F. G. D. Drewitt, J. K. Fowler, W. B. Hadden,
?. d© Havilland Hall, Felix Semon, F. C. Turner, W. J.Tyson,
S. West, H. H. Clutton, W. H. Cripps, H. T. Butlin, A. Pearco
froald. R. J. Godlee, C. H. Golding-Bird, W. A. Meredith,
W. Rirington, and John Wood, F.RJ3. Honorary Secretaries:
Stephen Mackenzie and R. W, Parker.

HARVEIAN SOCIETY.

A meeting of this Society was held on Thursday, Jan. 6th,
Dr. J. Hughlings Jackson, F.E.S., President, in the chair.

The Analogy between Croup and Asthma. —Dr. Morton
mad a paper on this subject, the object of which was to
compare stridulooe laryngitis—to which be gave reasons for
t hinking the name of croup should be confined—and " spas¬
modic’’ asthma, with a view to their mutual elucidation.
Be called attention to the resemblance in the sudden
nocturnal invasion; the diurnal remissions and recurrences

for two, three, or more nights; the liability to repeated
attacks; the greater prevalence in the male sex; the dry,
early, and moist later stages; the cessation of the liability to
croup, as well as to asthma, beginning at about six years of
age; the frequent origin of both in slight catarrhal or peptic
disorder; the common occurrence of both in summer as well
as winter. All these peculiarities showed that croup could
not be a real laryngitis with paralysis according to the
commonly accepted pathology, but a paroxysmal dyspnoea
from disturbed innervation of the larynx, as asthma was of
the bronchi. This left it open whether the disturbance was
motor or trophic. Sir Andrew Clark’s hypothesis of fugitive
quasi-erectile swellings of the mucous membrane afforded as
complete and adequate an explanation of croup as it did
of asthma. It was further suggested for inquiry whether hay
fever, croup, and asthma might not be different expressions
of the same state forming really one and the same disease.—
Dr. Charles West observed that children who had been
the subjects of croup or stridulous laryngitis in their earlier
years were more prone to suffer from true asthma in later
life. The child asthma, as a rule, ceased almost entirely
before puberty, and this point should be especially borne in
mind by practitioners, since it was possible that the rule
might not hold good in cases where the general health of
the child was not carefully maintained. Croup was essen¬
tially spasmodic in its nature, but was frequently caused by
sudden variations of temperature, by attacks of slight
catarrh, and by errors in diet. In croup the phenomena
were those of spasm and something else; in laryngismus
stridulus the spasm was the principal feature, a distinctive
difference being formed by the catarrhal signs in the former.
He thought that for the present it would be advisable to
retain the term “stridulous laryngitis” as he could not alto¬
gether renounce the view that some form of congestion or
inflammation of the larynx was generally associated with
it.—Dr. Gooduart referred to the replacement of croup and
stridulous laryngitis by asthma in later life, and inquired
whether any corresponding replacement occurred in the case
of child asthma after its subsidence at the period of puberty.—
Dr. Hughlings Jackson, after remarking on the great
value of Dr. Morton’s paper, spoke of laryngismus stridulus
and also of convulsions in cases of spasmodic laryngitis. He
believed that these fits, and probably those occurring in
pneumonia and other acute diseases of children, were owing
to discharges beginning in parts of tho medulla oblongata or
pons Varolii; in other words, they were dependent on dis¬
charges beginning in parts on the lowest level of evolution,
wbicn was pretty much the “true spinal system” of
Marshall Hall. He thought it a matter of great importance
to note the mode of onset, the march of the convulsions, in
these cases, as carefully as most people now do in cases of
epileptiform seizures originating from the middle level of
evolutiou (the so-called motor regions), and as we ought to
do in cases of epilepsy proper, dependent, as Dr. Jackso^x
believes, upon discharges from the highest level of evolu¬
tion. Bearing in mind Victor Horsley’s researches, we should,
among other things, carefully note the nature, tonic or
clonic, of the spasm in the different regions convulsed in
the convulsions of children. He stated again a hypothesis
he had put forward regarding the convulsions of laryngismus
stridulus. 1 He thought they were owing to discharges
beginning in the respiratory centres determined by super-
veuosity of the blood by an excess of their natural stimulus.
That convulsions could be produced in some lower animals
by inducing superveuosity and by rapid bleeding was well
kaown; in these cases the convulsion is respiratory, and
is probably owing to absence of oxygen. According to
Kuspmaul and Tenner, convulsions in rabbits are produced
by rapid bleeding when the cerebrum proper is taken away.
Laryngismus stridulus occurs in children at an age when
the respiratory apparatus is imperfectly developed, and
most often in those who, from rickets, have soft riba;
moreover, the attacks usually come on during sleep, when
respiration is less active; these are conditions favouring
supervenosity. The good t fleets of fresh air, country air,
and cold sponging are in favour of this hypothesis; more¬
over, some authorities highly praise musk and belladonna,
which drugs are respiratory stimulants ; spasmodic asthma
in the child and adult was, he supposed, a respiratory con¬
vulsion owing to the discharge of imperfect. (? small) respi¬
ratory centres from supervenosity.— Dr., West added that
both asthma and croup appeared to affect males more fre-

1 Brain, April. 1888.

176 The Lancet,]

OBSTETRICAL SOCIETY OF LONDON

[Jan. 22,1887.

quently than females, while in other nervous affections, such
as chorea, the frequency was exactly reversed. He did not
recollect any instance of neurosis in after-life succeeding to
child asthma. Nor could he remember any case in which
general convulsions occurred during stridulous laryngitis.
In laryngismus stridulus the convulsive movements were
almost always confined to the limbs.

Suppurative Peritonitis.—Dr. Goodhabt read a paper on
this subject, of which the following is an abstract. The
author related several cases illustrative of the resemblance
of the symptoms of suppurative peritonitis to those of
intestinal obstruction, in each of which, however, there had
been subsequent diarrbcea. A remarkable feature of these
cases was the absence of high temperature, and much stress
was laid upon the uncertainty of this symptom, as in a con¬
siderable proportion of such cases the temperature was not
raised at all. The degree and position of pain were also shown
to be indefinite in their indications. Diarrhoea, in the presence
of other symptoms of peritonitis, must be regarded as a
most serious symptom; the bowel in ordinary peritonitis was
more or less paralysed, and constipation resulted as a very
general rule, but this rule did not hold good for the suppu¬
rative form of the disease. The fact that peritonitis, and
especially suppurative peritonitis, frequently spread to the
pleura by direct extension was insisted upon, and the neces¬
sity for closer observation of this point was maintained,
apart from the ordinary treatment of peritonitis by opium,
belladonna, and the administration of food by nutrient
enemata or suppositories. No positive rules of treatment
could be laid down. Surgical interference in some cases
might save life, but its use could only be determined by close
study of the particulars of each individual case; the eases,
however, most generally suitable for such interference are
those in which the disease shows a tendency to localise
itself, or, at any rate, has given some indication of having
originated in an accessible situation.—Dr. Walter Pearse
mentioned a case in which, after resection of the knee, exces¬
sive vomiting with diarrhoea, but no rise of temperature,
had supervened with fatal result. Suppurative peritonitis
had been diagnosed, but none was discovered after death.
Enormous dilatation of the stomach was the only abnormal
condition.

Cancer and its Treatment. —Dr. Blenkinsop made a pass¬
ing reference to the pathology and causation of cancer, and
then dealt with the purely medical aspect of the question,
both in regard to internal forms of the disease and its
general constitutional treatment. He leaned to the belief
of a cancerous diathesis, and argued in favour of preventive
measures in suspected constitutions. He thought that effort
should be made to test the value of all remedies which pre¬
sented a reasonable prospect of success, and related details
of four cases in which lime salts appeared to have had a
beneficial effect. He assumed that the deposit of lime salts
in the vessels gave rise to atheromatous and calcareous
degeneration, and so lessened the supply of blood to the
caucerous tissues. Cretaceous preparations derived from
the animal kingdom—e.g., from oyster-Bhells—appeared to
derange the stomach less, and to be more readily absorbed.

OBSTETRICAL SOCIETY OF LONDON.

A MEETING of this Society was held on Jan. 12th, Dr. J. B.
Potter, President, in the chair.

Dr. Amand Routh showed a Uterus, with what appeared
to be a fibro-myoma attached to the left cornu of a “ uterus
bicorauate." Early in 1885 there was a history of extra-
uterine foetation.—Dr. W. Gbiffith and Mr. Doran re¬
marked on the case, and the specimen was referred to a com¬
mittee for report.

Midwifery among the Burmese. —Dr. T. F. Pbdley of
Rangoon read a paper which described the occupation, dress,
and physique of Burman women. The knowledge of tbe
native doctors is handed down by tradition, and takes
origin from fable, horology, astrology', &c, and dieting is
followed according to a certain letter, date, name, good or
evil spirit. The midwives are of the poorest and lowest
class, their chief qualification being ago and being the
mothers of large families. The more decrepit, the more
they are respected. All new methods are resisted. Nature
is kind as a rule to the mother, and carries her safely
through. In lower Burmah there is little real poverty,
and the women lay by for the event from 6 to 50 rupees.
A large store of firewood is laid in. If she cannot buy it.

she collects it before her delivery. A room is set apart, where
the mother remains till convalescent. Regardless of all
sanitary laws, every effort is made to keep out air, and
especially tbe smell of cooking, which is supposed to be
particularly injurious. A fire is made of wood, no chimney
being provided, and the smoke renders the air stifling. The
patient, when in labour, is surrounded by female mends,
and a crowd of men and women squat behind the curtain
which divides the apartment, and smoke or chew betel.
When the pains become severe the patient squats on tbe
floor, supported by a woman sitting behind her. The mid¬
wife assists in front by pushing with her hands on the
abdomen, using more and more violence as the pains in¬
crease. A silk scarf or cloth is tied tightly round the body-
above the umbilicus, which is drawn tighter as the case
proceeds, not with any idea of restraining hasmorrhage or
supporting the uterus, but to prevent its rising into
tbe chest. As tbe head progresses the woman is laid
on her back on the floor with her knees drawn up.
Her attendants press on the abdomen with all their might.
When the head of the child presses on the perineum the
midwife leaves the pushing to others, and in all first cases
tears the perineum, either with her thumb-nail, which is
grown sharp and long for the purpose, or with her great
toe-nail. In other cases tbe perineum is retracted, and, as
soon as the head is born, the child is rapidly extracted. If
the placenta does not follow quickly the cord is dragged on,
and this failing, it is removed by tbe hand or tom away
piece by piece. The mother is washed, and the whole body
rubbed with turmeric, and saffron is plastered over the vulva.
The fire is kept up, and hot bricks wrapped in rags, or bags
of hot sand, are placed on tbe abdomen, and twice a day tbe
patient has to squat over smouldering embers upon which
tumeric bas been thrown, or over steam arising from hot
bricks. The skin is often blistered by the application of
heat, but heat is supposed to permeate the parts and heal
them. The food is hot water, hot broth, with fish and rice.
Thepoor get upon the fourth or fifth day, but the better classes
scarcely move for a fortnight, except for the daily steaming
process and the calls of nature. On the seventh day a hot
“pack”is used for some hours, which produces free perspi¬
ration. When the blankets are removed the patient is bathed
freely in cold water. The constant sweating during the
first week brings out a miliary rash, which is considered a
good sign. Shampooing or massage is used for hours
together, often so excessive over the abdomen that displace¬
ments of the uterus are produced. Though Barman women
are clean when in health, washing is avoided during sickness,
and their habits are dirty. When delivery is not rapid, various
barbarous methods are followed, such as standing on tbe
patient’s abdomen and pressing or kneading it with
the feet, or a bamboo or plank is placed across the
abdomen, while the attendants endeavour to expel the
child by using all their force at tbe two ends. This
method is very usually fatal to mother and child, and
often causes rupture of the liver or bladder. Cases of
tetanus often follow lacerations of the perineum, cervix, or
rectum; one case of recovery was recorded under the use of
chloral. In cross births the part presented is tom or cut
off, and the child removed piece by piece, the head being
extracted by means of a large fish-hook. In all cases the
object, is to remove the child as quickly as possible and
regardless of risk to the mother, owing to the superstition
that if a woman dies undelivered the spirit of the mother
and child haunt and bring misfortune to the relatives ever
after. Burman women really need little assistance if nature
is left to herself. Their pelves are roomy and expulsive
efforts strong. The native system leaves little for perverted
ingenuity to devise towards preventing recovery, and is
about the most severe and fatal in the world. The
only remedy is a supply of properly trained Burmese
midwives, which the Burman branch of the “Countess
of Dufferin’8 Fund” has determined to undertake. The
paper was illustrated with coloured drawings by native
artists of tbe most characteristic points mentioned.—Dr.
Boxall mentioned many points of similarity between the
Burmese and Chinese as regards sophistry and superstition in
the practice of all the branches of medicine, and the descrip¬
tion of the practice of Dr.Hua during the Han Dynastyabout
a thousand years ago taken from the Story of the three
States” puts modem abdominal surgery back several hundreds
of years.—Mr. Doran asked Dr. Boxall if he knew whether
women in the East suffered from disorders incidental to
menstruation and pregnancy in consequence of the habit of

5y Google

D

The Lancet,]

ACADEMY OP MEDICINE IN IRELAND.

I Jan. 22, 1887. 177

tobacco-smoking, to which it is said they are addicted from
an early age?—Dr. Box all was not aware of any.—Dr. W.
Griffith thought the paper of great interest as a record of
moot barbarous midwifery in the nineteenth century, which
would be still more interesting at some future time. There
wraa a field open for gentlemen who had the opportunity of
studying midwifery amongst various races to investigate
the modifications of the process due to different conditions
present which are peculiar and normal to these races. Sir
w. Turner and others are investigating their crania and
pelvis, and b&ve shown such differences in them as to indi¬
cate the probability that the mechanism of labour, includ¬
ing the position of the head at the brim, must be altered
accordingly.

On Stricture of the Female Urethra, by Dr. Herman.—
The author had measured the female urethra In fifty-five
cases in which no urinary trouble was complained of, lie
found that in the majority No. 17 catheter would pass, and
in all bat two No. 14. He related six cases of stricture of
the female urethra under his own care. He had collected
and arranged in tabular form twenty-three others, which
were all that he had been able to find reported. lie drew
a parallel between the two sexes as to the etiology of
urethral stricture, and showed that while it was much
commoner in males, its causes were much the same in the
two sexes. In both it might be the result of injury (these
case* being proportionately commoner in females on account
of child-bearing), or of the cicatrisation of chancres. In the
female it was sometimes due to growths of so-called lupus
of the vulva. In both sexes the chief cause in young and
middle-aged subjects was gonorrhoea. In the aged of the
male aex enlargement of the prostate was the common form
of stricture. In old women there was found stricture due
to general fibrous thickening and induration of the urethra,
occurring without any history of gonorrhoea or other dis¬
coverable local cause. The author suggested that, as in
women the homologue of the prostate gland was the urethro¬
vaginal cellular tissue, these cases were possibly analogous to
enlarged prostate in the male. As to treatment, he found that
rapid dilatation was so simple and successful that it was
preferable to any other method.—Dr. Horrocks related two
caees under bis own care, both of which he considered were
congenital. He approved of the treatment by dilatation.—
Dr. A cut Lawrence (Clifton) considered stricture of the
female urethra rare. He had only met with two cases in
the laat fifteen years. _ One was in an old woman, and
appeared to be due to cicatricial bands; the other was in a
young woman, probably the resalt of specific urethritis.
Both were cured by dilatation.—Dr. Amand IIocth men¬
tioned a case of inflammatory urethritis which appeared to
have commenced with anterior parametritis and spread
downwards aloDg the cellular tissues of the vagina, a double
urethral stricture eventually resulting.—Dr. W. Griffith
bad that day seen a case at the Samaritan Hospital in a
married multipara aged thirty. She had probably suffered
from gonorrhoea. The stricture was an inch and a quarter
from the meatus, and only just admitted a uterine probe.
It was dilated in a few minutes with bougies to No. 13.—
Dr. Galabin related a case, and Dr. Hrrman replied.

ACADEMY OF MEDICINE IN IRELAND.

Parotitic Disease of Lungs of Sheep. — Stricture of the
(Esophagus.—Adenoma from the Mammary Gland of a
Rat.—Simultaneous Fracture of both Clavicles.— Cerebral
Meningitis and Abscess.

A meeting of the Pathological Section was held on
Dec. 3rd, I860.

Dr. Henry Bbwbby said that in the lungs of several
•heep which were examined lately in the Physiological
Laboratory of Trinity College, Dublin, a number of whitish
or greyish nodules were found scattered through them,
varying in sire from ^in. to |in. in diameter. On micro¬
scopic examination these nodules proved to be caused by a
email nematode worm, from 15 mm. to 17 mm. long, and
extremely slender. The worm lay coiled up in the interior
of a mass of apparently dried purulent matter. This mass
wu surrounded by a rone of elongated epithelioid cells,
arranged in a radiating manner round the central mass. The
epithelioid cells were embedded in a delicate fibrous reti¬
culum; and here and there large giant cells were seen.
Around these radiating cells was a rone of small lymphoid

calls, embedded in fibrous tissue, and arranged in concen¬
tric layers. Outside these cells, iu some of the specimens,
was healthy lung tissue. In others the nodules were sur¬
rounded by catarrhal pneumonia. The worms in these
nodules have no reproductive organs, and are apparently
immature forms of strongylus filaria—a nematode worm
that inhabits the bronchi and trachea of sheep and goats.
Leuckart (“Die menschlicheu Parasiten,” 1807, Bd.ii., p. 107)
and Baillet, in a Dictionary of Veterinary Medicine, mention
the existence of nodules in the lungs of sheep similar to
those in the cases described above, caused by the embryos
of strongylus lilaria; but they give no account of the
histological changes in the lung produced by these parasites.
—Dr. MacSwinky asked if Dr. Bewley looked for thi6 para¬
site in any other part of the tissue of the sheep. It would
be interesting to know whether its habitat was confined to
the pulmonary organs, or the parasite was ubiquitous.—
Dr. Bewley, in reply, said he did not examine any other
part of the sheep’s body for parasites. He would have liked
to examine its trachea, and he hoped to be able to do to at
some future time.

Mr. Edgaii Flinn exhibited the (Esophagus and Stomach
of a man who died in St. Michael's Hospital, Kingstown,
from stricture of the oesophagus, due to malignant disease.
The history of the stricture dated back four years, the act
of deglutition becoming more and more difficult during the
last three months of the patient’s life. The stricture became
very much contracted during the last three weeks of his
existence—so much so that he became unable even to
swallow fluid, and had to be fed by nutrient enem&ta. A
post-mortem examination was made, and it was found that
the left lung was very much atrophied and collapsed. The
walls of the oesophagus were greatly thickened and sur¬
rounded by a hardened mass matted together, which
implicated the neighbouring structures. The oesophagus
was very much narrowed at its lower fourth, and tbe most
contracted part of the stricture was found to be about
three-quarters of an inch from the cardiac orifice of the
stomach, and would hardly admit of a small-sized pen-
handle being passed through it. The stomach was enor¬
mously dilated, so much so that when the abdomen was
opened it appeared to fill up the entire cavity, and was full
of a brownish fluid, very offensive in odour. A large fruit-
stone was found immediately contiguous, and somewhat
beneath the pyloric orifice, embedded in a diverticulum.
This fruit-stone must have lain in this diverticulum for a
long time, the post-mortem appearances showing that its
passage through the oesophagus would have been well-
nigh impossible during the last two years of tbe
patient’s life ; from its position near the pylorus,
it exercised a considerable deal of pressure on tbe
pyloric orifice, and thus, in great measure, the great dilata¬
tion of the stomach was to be accounted for. The liver
was likewise very much enlarged. Dr. M‘Kee, the curator
of the Royal College of Surgeons in Ireland, had made a
microscopic examination of the parts, and had reported that
the disease implicating the oesophagus was epithelioma.-
Mr.DoYLB asked if the patient showed any symptoms of old
pleuritis. — Dr. Ball said one of the most interesting
features in the case was the presence of tbe diverticulum in
the pylorus. True diverticula were exceedingly rare. Mr.
Moore, one or two years ago, brought before the Pathological
Society of London a case of several true diverticula in the
neighbourhood of the pylorus; and he suggested that they
might be analogues of tbe multiple diverticula which were
present in fishes.--Dr. Purser said tbe most interesting
point in the case was tbe dilatation of the stomach. In
stricture of the (esophagus the stomach was usually con¬
tracted. There must have been some disease in this patient
long before the carcinoma of the (esophagus, which pro¬
duced tbe dilatation of tbe stomach. It appeared to him
that the pylorus Was extraordinarily small. The stricture
of the pylorus must have been either produced by disease
or congenital. The pouch in the stomach was, he thought,
not an abnormality, but the product of the fruit-stone in its
ineffectual efforts to get through the narrow pylorus.—Mr.
Flinn, in reply, said he was not aware that the patient had
bad pleuritis or any affection of the chest at a previous date.
He did not think there were any diverticula except the one
where tbe fruit-stone was.

Mr. J. A. 8cott exhibited a specimen of Adenoma from
the Mammary Gland of a Rat. At the Carmichael College
of Medicine a number of rats were kept. The animals were
in the habit of gnawing through their cage* and escaping.

178 Thk Lanckt,]

REVIEWS AND NOTICES OF BOOKS.

[Jan. 22, 1887.

and others had to be got in their places; and the result was
that from 100 to 200 rats had passed through their bands
during the last two or three years. The rat from which the
specimen was taken was brought to him by the porter. It
had a big tumour in its abdomen, into which its legs seemed
to be drawn up, very much in the way in which a penis
sometimes was into a large hydrocele. Nevertheless, the
animal had been several times pregnant, and was able to
suckle its young. The rat was killed, and on opening it he
found the large tumour that was before them. A section of
the tumour showed it to be an ordinary adenoma. A part
of the specimen showed the ordinary excretory mammary
gland, with a quantity of fat; in other parts there was the
gland tissue, and elsewhere a large quantity of tibrous
tissue. Dr. Scott said he had invariably opened the dead
rats, particularly the females, in order to secure the embryos,
but he had never before met with a tumour of the mammary
gland in any of them. He did meet with an ovarian tumour,
and he hoped to bring it before the Section.

Dr. E. II. Bbnnktt submitted a cast exhibiting Simul¬
taneous Fracture of both Clavicles, taken from a man who
was treated in Sir P. Dun’s Hospital, and also the clavicles
of a little girl, aged six, who bad sustained a complete
fracture of one clavicle, and an incomplete fracture of the
opposite, by beiDgrun over by a tram-car. Having detailed
the history and mechanism of the injuries, Dr. Bennett
directed attention to the fact that in the first case perfect
union bad been obtained in both fractures, with but little
deformity—a fact of importance, seeing that out of eighteen
cases collected by Ourlt, no less than eight had resulted in
non-union of the fractures, which was clearly attributable
to the difficulty of maintaining the parts at rest in such
an injury without the most careful nursing. Dr. Bennett
exhibited at the same time a series of injuries’ of the costal
cartilages taken from the body of the child who had had
the collar-bone broken. On the right side, the second, third,
and fourth cartilages were broken transversely, while tbe first
was d isl ocated f rora i ts ri b. On the opposite side one of the lower
cartilages had also been dislocated from its rib, and one had
sustained a partial fracture. Dr.-Bennett directed particular
attention to the dislocation of the cartilages from the ribs, as
tbe occurrence of such dislocation had been denied by
Malgaigne. lie also directed special attention to the in¬
complete fracture of one of the cartilages, not ou account
of any great practical importance attaching to the injury,
but as serving to complete the analogy between these
injuries and fractures of bone.—Dr. MacSwinby asked, Did
Malgaigne, in bis criticism, or rather dogmatic statement,
that dislocation of the cartilage never occurred, refer to
adults or children ? —Mr. Flinn mentioned that about oight
years ago a case came under his notice of a coal-miner in
Staffordshire. While engaged in a lying position ia what
was called “ holing,” a very large piece of coal fell upon him
and fractured both his clavicles—tbe one at the-sternal end
and the other at the aoromial end. The lower third of his
femur was also fractured.—Dr. MacSwinby: Did the frac¬
tures of the clavicle unite?—Mr. Flinn : Yes.—Dr. Bennbtt,
in reply, Raid that Malgaigne gave four cases of this frac¬
ture at tbe ag« of seventeen, which was the earliest age
that he recorded. It was an eminently difficult thing to
keep it reduced, for, although after tbe individual had made
a full breath thfe parte would slip into their places, when
the chest collapsed they would slip out again.

Dr. Quinlan exhibited a case of Cerebral Meningitis and
Abscess. He said it was taken from the body of a scrofulous,
starred-looking young man. aged twenty-three, who was
admitted into St.* Vincent’s Hospital on Nov. 2.3rd. He had
for many mouths had an offensive purulent discharge from
his right ear, and was on admission suffering from the most
agonising pain, radiating from tbe ear to the frontal, parietal,
and occipital regions. -His pulse and temperature were above
normal, but he was quite clear in hie mind, and had no con¬
vulsions or muscular Bt'ffuess. On the morning of Nov. 25th,
about 8 3D a m:., be became suddenly stupid and heavy 4 and
the right pupil became dilated and insensible to light, the
left pupil remaining normal. He gradually got comatose,
and died at 2 p m. A post-mor’ean examination was made
twenty hours after death by Mr. Coen, tbe house-surgeon.
The dura mater was firmly attached to (be upper part of
the brain, the general surface of which was rather congested.
On removing the brain, a dark discolouration was perceived
on the side of the right middle lobe, and on the back part of
the cerebellum and on the mededU Oblongata a-large patch
of recent meningitis with suV-’-' :ioid effusion. On open¬

ing the right ventricle, it was found full of aero-purulent
fluid; and ou making a section of the right middle lobe, a
large abscess, full of offensive pus, was discovered, corre¬
sponding to the dark spot already mentioned. The petrous
portion of the temporal bone was extensively diseased ; and
the cause of the sudden coma on the day of death was, no
doubt, tbe bursting of the cerebral abscess into tbe right
ventricle.—Dr. MacSwinby said tbe pathological symptoms
in the case were those of chronic purulent inflammation of
the middle ear. He wished to ask, What was the condition
of the temporal bone and the bones of the ear on the side
affected? Was the disease obviously extended from in¬
flammation of the middle ear ? —The Pbbsidbnt : Was an
examination made of tbe petrous bone? — Dr. Quinlan, in
reply, said there was an opening into the petrous bone, from
which matter was flowing. He probed it and found the bone
quite diseased and disorganised, but he did not cut the bone
out. There was the same smell from the pus that came out
of the ear as from the pus that came out of the abscess.

anb Notices of ^ooks.

The Lfc of Sir Robert Christison, Bart., M.D., D.C.L. Oxon.,

LL.D. Edin., Professor of Materia Medica in the Univer¬
sity of Edinburgh, Physician to the Queen in Scotland.

Edited by his Sons. In two volumes. Vol. II.: Memoirs.

Edinburgh and London: William Blackwood and Sons.

1886.

In the first volume, already noticed, of this remarkable
book Sir Robert Cbristison is allowed to tell the story of
his own life. In the second, which is now before us, the
story is largely told by others, though free insertion is given
to Sir Robert’s own letters. There is, of course, some over¬
lapping and some repetition of subjects; but when the
length of Sir Robert’s life is considered, ond the fruitfulness
of it in work and honour and influence and example, this is
not only forgiven, bat becomes a cause of gratitude to
the editors. Chapters 7 and 8 in this volume deserve
very special notice. The first is written by Professor
Gairdner, and treats of Cbristison as a physician ; the second
gives an account of his other scientific work. Christison
followed Bright powerfully in his researches in renal
disease before the true significance of Bright’s discoveries
were generally accepted, and he gained from Rayer,
the greatest of continental authorities, high praise. His
accounts of Fevers and Inflammations will remain very
valuable parts of medical literature for their vigour and
accuracy. True, he did not accept the modern doctrinee of
fever, and ho persisted in believing that inflammation fifty
years ago was of a different type and required a different
treatment from that of later years. This is only an interest¬
ing proof of the fact that there is a conservative element in
the most intelligent minds. And who does not know that
Sir Robert was a Conservative?—broad enough to vote for
his friend Sir Lyon Playfair so long as he thought him a
representative of science and learning rather than of mere
political shibboleths, but capable at eighty of making a
political speech of an hour’s length against bis friend when
he thought he had exchanged tbe academic mind for the
political one. But, his conservative views notwithstanding,
his account of the fevers which he saw and the six or eeveu
fevers which he passed through—of which most interesting
notes are to be found in this volume, one describing
eloquently a personal experience of hyperpyrexia (tempera¬
ture 107°)— are of permanent interest. Professor Fraser’s
account of what Christison did in dietetics, toxicology, and
materia medica, and still more of what was in his mind to
do in the matter of therapeutics by studying first the action
of medicines in the healthy body, shows that Christison was
on the true scent of the recent great advances in the
medical art. His investigations into the action of oxalic
acid, of Calabar bean, and of digitaline were original.

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D

Ths Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Jan. 22; 1887. 179

Christison's knowledge of poisons and his sound common
nnie made his evidence in all the ohief medico-legal oases
of hia time indispensable. As with Sir Benjamin Brodie
in England, the Government sought his opinion on all
subjects of medical interest — not only those affecting
Scotland and the Scottish Universities, but having wider
relations, such as that of vivisection. Of all such subjects,
and a hundred more, this volume contains notices that are
extremely readable and instructive. Por what the volume
shows is the many-sidedness and manliness of this Professor,
who ruled the University of Edinburgh probably more than
any other man for more than half a century, who was
absolutely without cant, whom many thought cold and
haughty, and yet who was so loved as to be nursed in one
of his illnesses, at the age of eighty, by fonr old pupils, and
who was followed to his grave by all that was worthy and
reputable in Edinburgh. If the fame he achieved has no
charm for some of our readers, perhaps the feats he per¬
formed—his rapid ascent of mountains, his walking tours,
his captaincy of the Volunteers when over sixty, and his
indomitable pluck and hopefulness under illness—may secure
their admiration. The study of these volumes, however,
cannot but leave the impression of a tree leader of men.

Handbook qf Diseases of the Ear. By Urban Pritchard,
M.D. Edin., F.R.C.S. Eng., Professor of Acral Surgery at
King’s College, London, Aural Surgeon to King’s College
Hospital, 8enior Surgeon to the Royal Ear Hospital,
London: II. K. Lewis. 1886.

This manual of Diseases of the Ear, intended “ for the use
of students and practitioners,” commences with a descrip¬
tion of the anatomy of the three divisions of the ear, that of
the Inner ear being especially good. The account of the
examination of the ear and the diseases to which it is liable,
is given in a short and methodical manner, and, for the most
pact, is in accordance with wh&t maybe found in other
text-books on the subject. Some points, however, call for
remark.

In making mention of the force-pump (which we believed
is now seldom if ever used) as a means of inflation of the
mulille ear, Dr. Pritchard says that “it requires to be used
with the utmost caution, and although it may in certain
eases be applied with advantage, there is some risk in doing
so 0 ; but the reader is left in doubt as to the selection'of
there cases. In speaking of an operation for imperforate
irpfrtnt in cases when some hearing power is present, ho
recommends the use of a tube to prevent the surfaces
nnirifig, but he does not say whether by this means he has
ever succeeded in establishing a lasting meatus. The
re mov a l of foreign bodies is carefully considered, and useful
eaationn, as well as advice, are given. The author regards
nnltapla and rounded exostoses of the meatus as “ the result

table of the skull, while there must be considerable danger
in attempting to do so, for the bone in this position varies
much in thickness, and the lateral sinus may be very close.”
The words “little Or no advantage ” so applied appear very
inadequately to express the results to be expected if the
inner table of the skull were perforated. Dr. Pritchard thinks
the late Dr. Harvey was correct when he considered that gout
and rheumatism affected the middle ear through their aetion
on the joints of the ossicles, and the treatment to be relied
hpon for this condition is mainly constitutionoL The illustra¬
tions are well executed and there is a very complete index.

Lehrbuch der Vergleichenden Anatomic dcr Wirbelthicre.

Boarbeitet von Prof. Dr. Robert W ibdbrshbim. Z weite

Auflage. Jena: Verlag von Gustav Fischer. 1886.

No better evidence of the excellence of this handbook can
be adduced than the fact that the first edition, has been
rapidly exhausted and that a second edition has been called
for. Considerable additions have been made to the old
materia], especially in regard to palaeontological discoveries,
the development and morphology of the mammalian
skull and of the hard parts of the extremities, the brain
and the cerebral nerves, the . suprarenal bodies, the cutaneous
sense organs, and the thymus and thyroid bodies; and
the introductory sections on the development of the
urino-genital apparatus have been extended. The account
of the respiratory apparatus of birds has received
large additions, and the author expresses his obligations
to his colleague Dr. Sclater (who is recognised as (me of
the first authorities) for assistance in this section. In
passing, we would call the attention of Prof. Wieileraheim
to the indifferent way in which the index has been compiled,
for, desiring to read that Section, we naturally turned to
“ Vogel,” but that word does not occur. Disappointed in this*
we turned to “ Respirations organe,” and found we were
referred to “Athmungs organe,” when again no. referenoe to
those of birds is made. The word we should have looked fotj
is “ Luftwege but why not save tlie time of the reader by
: giving under the head of “ Respirations organe” the reference
to those of birds at once, without the annoying' pro¬
ceeding Of referring to something else? Surely it would
have been easier to have put it after “ Respirations organe
der Vogel”, (p. 735) than “v. Athmungs organe.” The
bibliography, on the other hand, is drawn up in first-rate
style, and occupies sixty pages. The page is larger than in
the former edition, and the lines are longer, so that, although'
the volume isl not increased in thickness, it contains con¬
siderably more matter. A few additional woodcuts have
been introduced._^_ . ■

Our Temper amenta; their Study and Teaching. A Popular

Outline. By Albxandbb Stbwart, F.R.C.S. Edin;

London: Crosby Lockwood and Co. 1887.,

of gouty, or, in some cases, perhaps rheumatic, irritation of
the periosteum”; and he is careful to. explain why the
removal of any exostosis, except to allow a freer outlet for
iiadkarge, is rarely advisable, and should never be under¬
take* lightly.

It ie much to be hoped that in another edition of this
the author will be more definite in his directions in
ooe. or two particulars, For instance, in recommending
puncture of the membrane tympani in cases of acute
afhanmedotk, he Says “the operation ought to be per-
fanoedfif possible, by a practised hand.” Sorely if this

were not possible it were better left unperformed. Again,
ate* enflffretinir that In rmnnn irhnrn an opening into
the qtmdtc&L process is required the perforator that was
figuredton’s article in Holmes! Surgery be used, so
that it Cemeot,penetrate fuxtner tfyau a quarter of an inch,
and ihat' IpSfoto, 1 by the htfp tidf * dentist's elevator and
pus; is not reached, he continues, “ and
thec#e*H^ioMd ek no advantage In perforating the inner

Thb author very justly draws attention to the import¬
ance of temperament throughout life, more especially
during the educational period and illness, and to the
general neglect of the subject, and the frequent misuse
of the word. He makes suggestions for classifying* the
triple and quadruple combinations of temperaments so com¬
mon in our mixture of races, the extreme complication,of
which must often invalidate any sweeping judgments
passed on first appearances. From his own observations the
author has added the possession of a long neck to the
other signs of the nervous, formerly the bilious, tempera¬
ment. Altogether the book is suggestive, and not lew so
because, owing to the absence of authorities on the subject,
it is rather a collection from every quarter of such materials
as have, any passing relation to the theory than,a, treatise of
final authority. The volume leaves no luxury bf type or
paper to be desired, and in addition to other illustration^
some thirty faces from Lodge's Historical Collection of

Portraits are reproduced as an Appendix.

fizzed by CjOOglC

] 80 The Lancet,] THE TOLL OF THE FELLOWS OF THE ROYAL COLLEGE OF SURGEONS. [JAR. 22,1887.

THE LANCET.

LONDON: SATURDAY , JANUARY S3, 1887.

At the quarterly meeting of the Council of the Royal
College of Surgeons, held on the 13th inst., the result of
polling the Fellows on the question of extending the
franchise to the Members of the College was duly announced.
As will have been seen in our last issue, the Fellows have
replied in the negative to both the questions put before
them—viz., (1) whether Members should be allowed to vote
for Fellows as members of the Council ? and (2) whether
Members should be eligible for seats on the Council ? An
answer other than negative to these questions was hardly
to be expected—could, indeed, hardly have been expected
even if the qualification of a certain standing at the
College, which is insisted on by the Association of
Members acting for the body at large as a sine quA non,
had been prominently put forward, instead of having
been ignored, by the Council when framing the
questions. There is, however, much to encourage the
Members in the result of the poll, if this be carefully
analysed. In the first place, the total number of available
Fellows is 987, and not 1140, as recently estimated by a
past President of the College—a fact which still further
emphasises the impropriety of so small a part of the body
corporate having the exclusive management of a scientific
College numbering not less than 17,000 Members. More¬
over, from the 987 Fellows to whom circulars were posted
only 706. answers wqre received, and of these six gave no
decision one way or another; thus the number of Fellows
who. have voted on this occasion is, actually 700, Of the
balanoe, 21 Fellows failed to get their circular, which was
accordingly returned to the College through the dead letter
office^ leaving! 260 circulars unanswered, Of these 280
Fellows Wy* certs&ily he said that they are neutral in,
their views; it would not be unfair even to claim them aa
favourable to the views of the Members. Had they been
Strongly opposed to the proposed changes, they would
certainly have voted against them. On this line of argu¬
ment, if we oount the 260 unanswered circulars as favour¬
able, and deduct them from the majority of “ noes* to the
first question, we convert these “ noes* into a solid majority
of *ayes”j while the 354 “noes” to the second question
would be reduced to 94.

But even aa the figures actually stand the majorities of
“•noes* are decidedly small, and cannot therefore in any
aerie* be oentidOred final or binding. • To the first question,
as to whether Methbers shall be allowed to rote, the Fellows
have responded ip the negative. Allowing these * noes” and
“ ayes” to equaUss tbempelves as far as they will, we have a
majority of only 143 Fellows to dsal with. It cannot for a
moment be supposed that the constituency of the College,
numbering 17,000 educated men, willbonsider the question
settled by such a rote. We tbfiik that under

tbepe, mrcnmstancee tbe of Surgeons

should regard themselves As cu" ^ upon-rat once to take

steps to give effect to the desires of the constituency at large.
As regards the second question, whether Members shall be
eligible to sit on the Council, there is a larger majority voting
“no”—the “noes” to the “ayes” being as three to one.
Even this, however, on such a question, is not the overwhelm¬
ing majority which might have been expected. To ask the
Fellows to give up their cherished privilege of alone being
eligible to sit on the Council of the College is to test them
very severely, and they hesitate to relinquish their present
position. It would be most interesting to know something
more about the votes. We incline to think that the “noes”
will be found chiefly among the older London Fellows, who
are either enjoying a seat on the Council or other offloe at
the College, or are looking forward shortly to do so; and
among the younger men, recently admitted Fellows, who
have little else to rely upon, and would keep themselves, at
any cost, as select as possible. Those who regard the
Fellowship as an academic distinction, instituted and kept
up for the purpose of promoting a high surgioal standard
among teachers and hospital surgeons, will rely upon some¬
thing more than mere title, and will seek to distinguish
themselves by their attainments, rather than hy the mere
exercise of a voting franchise which is denied to the majority
of their-fellow Members.

If we now look at these figures from the standpoint of the
“ noes,” the Council must themselves see how small and un¬
satisfactory the majorities are. Fellows voting “ no” to the
first question number only 419—a minority as judged by the
number of circulars sent out; Fellows voting “no” to the
second question number only 526—that is to say, a majority
of 65 as judged by the circulars issued. Finally, the Council
must not lose sight of the fact that 260 FeUowB have de¬
clined to vote at all. Of course we cannot pretend to fore¬
cast what Will he the action of the Council under these
circumstances. They have never before, we believe, appealed
to the Fellows at large for assistance in the settlement of
an admittedly difficult problem, and we have therefore no
precedents to guide us in forming conclusions as to what
their action is likely to be at the present juncture. This we
may say in all truth, that the Council of a body corporate
have rarely had such an admirable opportunity placed in
their hands for gracefully putting an end to an unwise and
unconstitutional rule by which about sixteen-seventeenths
of the entire body are excluded from all participation in its
affairs, and for the introduction of a much needed and
greatly desired reform, which cannot but consolidate the
College, improve the status of its Members, and ruse the
profession in the esteem of the public.

Tho Council of the College of Surgeons hav6t however,
consistently opposed ail reforms, and will'doubtless in this
as in other matters only move when some higher authority
absolutely Compels them to do so. We must refuse to' find
any sign of concession even in tbs, resolution proposed by
Sir Spenceb Wells, which was only passed by eleven votes
to eight, and still requires confirmation at the next Council
meeting—viz., “ That although the Council arc not prepared
to give effect to the recommendation c ont a ine d in the first
resolution carried at the meeting of Fellows' and
Members held at the College on the 4th of November,.1886,
the Council are prepared to act qpqqthe second resolution,
so far as to appoint a small committee to confenon the

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Diqiti2

J&fciwj

TREATMENT OF “DIFFICULT” TAT1ENT?.

[Jan. 22,1887. 181

first resolution with representatives appointed
i#W’-akoci ation of Fellows and the Association of
IMnMMtr The terms of this resolution are peculiar. If
W6g4Ul are not prepared to give the Members the
tjjlfWy few they seek, what purpose will a conference with
A ssociations serve? This determination on their
just as well be conveyed in a letter. The
have been so long, so persistently, and so tem-
' pnt befoTe the Council, that a conference on the

down in the above resolution seems unneces-
Hf fft the interests of the Members such a conference is
t^^tifidesirable, for it simply means delay and procrasti-
n fl Wffi ' 1 Meanwhile the Members must notice that the
flljliMtttee of Cliarters and Bye-laws are “requested to
W08tk farther report as soon as possible in reference to the
iSKpflied changes in the Charter and Bye-laws.” Members,
flMBntte, should lose no time in making known their
jjwtittces. The official analysis of the recent polling of the
WBwm shonld be placed in the hands of an actuary, and its
Wfcfes and indications be thoroughly worked out and for-
to Her Majesty’s advisers along with the formal
now in course of signature. We can only hope that
a* new signatures have been added during the present
yHit. If the officials of the Association of Members still
iriBft others, we would recommend a house-to-house visita-
tft*, with a view to expedite matters, and in order that the.
petition may be presented with the least possible delay.

1 < ■■■■'■ " ■ ♦

Hb practitioner Who has had a lengthened experience
MfUny department of the medical profession can question
ttf? existence of a class of difficult patients. We do not
W* of difficult cases, nor are we alluding to difficulty
«Mbe sort which arises out of the necessity of adapting
end methods of treatment to the idiosyncrasies of.
etfirtftutlon and susceptibility. The perplexities caused
t^&is particular need are often more than sufficiently
sHitemssing; but it is not of these we are now thinking,
<*»gee which are made gradually, whether in the
eMMsm or in the habits of life, do not commonly challenge
dUifcition, but are not the less, on that account, effective in
tMbconsequences. We are apt to forget that a really great
e&imge has come over the spirit of the popular dream of the
paMkian and surgeon and their respective arts during the/
etMtaxy which is now hastening towards its close; and one-
ef*ate most notable and potential features of this change
hMAtten the complete breaking down of the fence of mystery.
*4* once surrounded the practice of medicine, and which,,
intangible and groundless in itself, did most cer-
confer this mutual advantage on doctor and patient, that
wMb the former gave Ms advice with an authority, perhaps
fidlijipofw or exaggerated, which has now disappeared, the latter
xNiiited more or less unquestioning obedience, and reaped
hisltwird by having both mind and body brought under;
tfcfeftwmy Of the physician who essayed to relieve him. A,
deal of very short-sighted nonsense is spoken and;
w|kte> by well-meaning but narrow-minded people on the
mNmi of mental influence. In the realistic honesty of this
oilibMIied age, it is too commonly held to be a measure of
tsMbfhljkSM that the effects of treatment shall be counted
«ifeja:9fa$r*ttoa as they ax# physically apparent. In a
lA|^ia|£^tid be material, 4ther as chemical or directly 1

realistic, in some immediately appreciable manner and
degree. All else is disregarded or declared to be worthless
and useless, because “ imaginary.” It is forgotten that the
brain is not only the organ of the mind, but in a very potent
way the centre of the nervous system, and consequently
what may be imaginary in its inception may so react on
the nervous system as to be fully as real as any other
agent in producing material changes and effects, pro¬
ductive of good or evil results, as regards first, the function,
and, second, the structure of the organism. Physiology
compels us to give Weight to what may be termed
dynamic, as well as to directly chemical powers and pro¬
cesses. Moreover, it teaches us that the one class of
phenomena are as real as the other. It is a strangely
perverse “ materialism” that seeks to exclude the large class
of mental, or, in other words, cerebral, influences from the
category of forces operating within the area of the organic
life. The bearing of this general proposition on the subject
immediately before us may be briefly stated thus: It is not
less unscientific than it is practically inexpedient to treat
patients as though they were simply apparatus for the
carrying out of chemico-physical processes. It is not with
masses of solid and fluid materials we have to deal, but with
living beings like ourselves, with moods and tempers, and
susceptibilities and caprices, mental as well as bodily, every
one of which must count for something in the totality of
disease. It is not with bodily maladies only, but also with
mental states, we are required to cope in the endeavour to
arrest, or limit, or remedy the effects of morbid action.

The most troublesome class of difficult patients is, we
are convinced, composed of individuals who are not
treated, as it were, personally. The exigencies of a
professional life Compel the majority of busy practitioners
to form a habit of work which does not readily admit
of their bestowing sufficient attention on the question
of mental idiosyncrasy; The condition rathei* than the
men are to blame for this defect, but It is a fault of
clinical method, and we believe a very serious one. Thus
there are difficult patients who would cease to be difficult
if it were only perceived that their mental, add col¬
laterally their nervous, conformation and habit of life,
require that the processes which are to be wrought out in
their organisms in the medication of disease, shall be brought
directly under the domain of the consciousness. To take a
familiar example of this; cases are not uncommonly met
with in which a moderate dose of sedative will not pro¬
duce quietness, still less induce sleep, or even exert a
soothing influence on the nervous system, unless the effedt
which it is desired to cause by the drug is explained. It is
easy to turn this into a jest, and to recall that hack¬
neyed story of the bread pill; but such a line of remark
is notable only for its stupidity and ignorance. The
true explanation of the effect produced is not that
“ imagination ” puts the patient to sleep, but that the
fretful state of unrest which prevents natural sleep is
quieted by the perfectly physiological process of removing a
source of worry about expected wakefulness, and substituting
for it an expectancy of sleep. Even if it were that much-
abused agent “imagination” which sent the patient to
sleep, without any or with only a minimum of some
stupefying poison such as bromide or chloral, it would he

•

182 The Lancet,]

SMALL-POX IN AUSTRALASIA.

[Jan. 22,1887.

better to get the result by simply removing the mental
or cerebral obstacles to repose, than by setting up a
state of drug-induced stupor. The explanation given to
the patient is as much part of the physical process of
medication as the administration of an opiate. We merely
mention this matter as illustrative of the principle.
Precisely the same mental method applies to the relaxation
of muscular spasm in the case of a dislocated joint or a
troublesome case of fracture, and to the induction of
vermicular movement of the intestines in a stubborn case
of constipation, and in many other forms of disease. There
are patients whose consciousness must be made party, so to
say, to the treatment. On the other hand, there are patients
who cannot possibly be thus treated, and who must be
helped on the way back to health by authority and
mystery. To explain processes to patients of this last-
mentioned class is to jeopardise success in every respect.
In short, the confidence and co-operation of the patient
should be secured as aids to cure; and these can only be
enlisted on the side of the practitioner by a skilful manage¬
ment of the patient not less than of the disease.

The point on which we are anxious to insist is that
patient s ought to be studied not less than diseases, and that,
to ensure the largest measure of success in his work, the
physician or surgeon needs to be not only versed in
the loro of the schools, but to be a man of the world
and a close student of men and manners. The class of
difficult patients might be more correctly described as a class
of persons whom it may be difficult to understand. Diffi¬
culty in managing cases generally means difficulty in
dealing on the best terms with the individuals who
form the subjects of disease. Practitioners too commonly
form habits of manner and method. We venture to suggest
that the medical advisor should approach each patient with
an entirely open mind, and study the person as closely and
promptly as he studies the disease. The treatment should
be adapted equally to the patient and to the disease. Plans of
treatment, even particular drugs, may be contra-indicated or
Tendered specially desirable by the idiosyncrasies of a patient.
Difficult patients are nearly always simply misunderstood.

The occurrence of small-pox on board the North German
Lloyd steamer Preussen, and the resulting importation of
the disease into several of the Australasian provinces, is a
matter of grave importance, and it gives interest to the
attitude of the Australian Governments towards this disease.
The possibility of serious results ensuing from such im¬
portation was evidently one of the grounds which led to the
assembling at Sydney in New South Wales of the Australasian
Sanitary Conference of 1884, when it was unanimously held
to be necessary to endeavour to cope with small-pox
introductions by means of quarantine; the several adjoining
territories which go to make up the mainland and the
adjacent islands to be regarded as one state for this purpose,
with one Federal Quarantine Act to control the importation
of infectious diseases.

The report, of that Conference deals in the most candid
maonor with the quarantine question. It admits that such

measure must deal with individuals in an opposite way
to that in which the criminal law affijcls them—that is to
say, every person, however free from infection, must be

assumed capable of spreading disease until his incapacity
to do so has been proved, the period of proof extending at
least as long as the period of incubation of the disease. At
the same time it is frankly admitted that there is a limit
to the period for which a quarantine system will be possible,
and it is stated that as the Australasian commerce increases,
the possibility of continuing the system will beoome less
and less, and hence that internal sanitation must be pro¬
ceeded with, because it is such sanitation that is, after all,
the true defence of all nations against disease, and the real
guarantee of national prosperity. The application of the
system as heretofore in force is admittedly accompanied by
great hardships. Nothing worthy of the name of quarantine
could be done until the terminal port was reached, and
then, even if all sickness had ceased on board for even as
long as a fortnight, all the passengers and crew were sup¬
posed to spend three weeks in seclusion in the quarantine
ground, besides restrictions as to the vessel, the cargo, and
the process of unlading. These processes, apart from lose to
individual passengers, may be estimated in the case of a
steam-vessel to cost from £120 to £300 per diem. Without
relaxing the stringency of the process, in so far as detention
is necessary to prevent importation of small-pox, it was
proposed that two quarantine stations should be established,
one at King George’s Sound for vessels approaching Austral¬
asia from the westward, and another at Lizard Point for those
coming from the north. The sick and their immediate atten¬
dants would be disembarked at once, and, if need be, all pas¬
sengers would be landed so as to ensure proper disinfection
of the vessel. It is also stated that “ those persons most
likely” to be incubating the disease would also be detained
at the first quarantine ground touched at; but what this
means it is difficult to say. Indeed, herein lies the main
weakness of the system, for although, after the elimination
of these sick and suspected ones, whoever the latter may be,
the vessel would resume her journey, and the length of that
journey would be deducted from the total quarantine deten¬
tion which would otherwise have become necessary at the
port of arrival, yet success would, we imagine, be almost
entirely dependent on the complete elimination of persons
“ apparently well ” but who nevertheless had already con¬
tracted the infection.

In many cases the process would be facilitated by the
vaccination or revaccination, whichever it may be, of all
persons on board. Indeed, for all practical purposes a
compulsory system of vaccination would be brought to
bear upon the passengers and crew. Thus, one of the
conclusions of the Conference is to the effect that &H
persons arriving in an infected ship, and not being them¬
selves affected, “shall be revaccinated,” unless they can
afford proof of having recently undergone the opera¬
tion, If the vaccination succeeds, a fifteen days’ deten¬
tion at the quarantine grounds will be required, or its
equivalent on board ship; but if any persons refuse to be
vaccinated, then the health officer is to have the -wide
power of detaining them until “he is satisfied of their
inability to spread small-pox,” and in no case is the detention
to be of less duration than twenty-one days. To what
extent such a measure could succeed it is impossible to fore¬
tell. Its justification appears to lie in the belief that in
Australasia the population are not protected by vaccination

Digitized by v^»ooQLe

Thb Lakcbt,]

TJHE USB OP THB WORD “ SPAYING.’

[Jan. 22,1887. 183

When contrasting the system with that obtaining in England,
the Conference is under the belief that in this country
the performance of vaccination is so efficient that small¬
pox “very properly is not feared.” We wish it were so;
bat so long as years like 1881 give us 2371 small-pox
deaths in London alone, we cannot claim the position
which efficient vaccination would afford us. In short, it is
not the fact of the existence of a compulsory power to
vaccinate every child once in its life, and this as imperfectly
as the operator may choose, that leads us to deal with
small-pox otherwise than by quarantine; but because, as
the Australasian Conference very properly puts it, “ quaran¬
tine against small-pox is at this date an anachronism.”
The Absence of a system of compulsory vaccination must
place Australasia at an immense disadvantage in dealing
with small-pox, and hence the Conference demands that
vaccination shall be enforced. There, as here, a principal
trust must be placed on the enlightenment of the population,
and it is possible that only in so for as the quarantine
system fails will the Australian people as a whole see the
necessity for universal vaccination. How far quarantine
protections are likely to postpone adequate national pro¬
tection by means of vaccination remains to be seen, but the
Australian Governments are admittedly in a difficulty with
regard to the subject.

In the meantime the Preusaen affair has led to twenty-
two attacks amongst tiie passengers in quarantine at
Melbourne; thirty passengers were landed at Sydney, and,
the disease spreading, seventy-one cases resulted; and
several attacks are reported at Adelaide. We sincerely
trust that the disease will be held in chock, and we shall
look with interest for a report of the actual proceedings
adopted with a view to this, and of the results attained.
--

Thb English language is rich In words descriptive of the
operation for the removal of procreative organs, such os to
spay, geld, cut, and castrate. One of these words only is,
however, applicable to the operation in the female alone.
The male appendages have been removed in the young of
a nim a ls , for economic reasons, from time immemorial, and
the operation is then called gelding, castrating, or cutting.
They have been removed in the human subject, also, for
domestic reasons, and the operation is called “castrating”
or “gelding.” They have, again, been removed in man for
disease, and here also the operation has been called
castrating by surgeons at all times—castrating for cancer,
sarcoma, &c., as the case may be. Within the last twenty
years removal of the uterine appendages has been practised
for disease of those organs, for epilepsy, nervous disorders,
&c.; and the operation has been called “spaying,” Battey’s
operation, odphorectomy, removal of the uterine appendages,
&c.; but objection his been taken to the word “ spaying"
in this connexion for more than one reason. It is said that
spaying means the removal of the uterine appendages in
young animals for economic reasons, and that the removal
of these organs for disease is not spaying, if this be the
case, it follows that removal of the testicles for disease is
not castration, and it must be concluded that all the learned
men who have written on surgery have been wrong in their
use of the word. In the next place, it is said that a kind of
reproach or opprobriun) is attached to the word spaying.

If this be the case, greater is the reproach attached to
castration, for the operation has been practised upon the
human subject for the purpose of maiming simply—the
making of eunuchs. No analogous use of spaying can be
proved. It follows clearly from this that if the present use
of the term castration in surgery be correct, it is also correct
to designate the operation for removal of the uterine
appendages in women as “ spaying.” These reasons for the
use of the word, however, hardly deserve mention bat for
the objections taken to the word, and mentioned above.
The real reasons for the use of the word are two—
namely, that it is the only English word for the opera¬
tion, and that it alone, and no other word or words,
conveys to English people the meaning of an opera¬
tion which has been lately not unfrequently performed.
It is true that there are other words by which the
operation can be explained to persons conversant with
anatomy, physiology, and surgery; but all the women who
are subjected to the operation of spaying are not versed
in these branches of science, and it is not possible to make
the operation intelligible to them, and to place them in a
position to give consent or refusal to undergo it, except by
the use of the word “ spaying.” But after this word has been
given in explanation, there will remain a certain number of
young girls under twenty—for it should be borne in mind that
such have been made the subjects of removal of the uterine
appendages—who do not understand the meaning of the
operation. Under such circumstances—if the operation be
necessary—the parents and friends should be made to
understand what the operation proposed really is, and we
know of no other way of doing this, as a rule, than by the
use of the expression “spaying.” That a certain reproach
is attached to barrenness in women is well known, and this
reproach is all the greater when all hope of becoming a
mother is destroyed by the removal of the uterine appen¬
dages ; but the reproach is not in the word, but in the con*
dition secured beyond hope by the operation. Wo - would be
the last to use the term “spaying” or “castration” in any
way offensively or as a term of reproach, but Wo advise its
use in justice to those who are about to be subjected to
the operation, and to their friends.

^rnwtetiima.

"Be quid nimto."

THE ERASMUS WILSON BEQUEST.

A vxnY influentially signed memorial (see page 193) has
recently been addressed to the President, Vice-Presidents, and
Council of the Royal College of Surgeons of England referring
to the disposal of the Sir Erasmus Wilson bequest, and direct¬
ing their special attention to the need of support of certain
collateral branches of medicine, “ which can only flourish
by liberal pecuniary aid.” The memorialists suggest to the
Council the great desirability of founding an institution
under the direction of tho College, having for its object
“ Physiological and Pathological Research.” They deplore
the absonce of any such institution in England, and that
English studonts should have to look to continental schools
for the elucidation of such questions, for instance, as
tubercle or hydrophobia. They draw attention to the
splendid laboratories which exist not only in the other
capital cities of Europe, but in comparatively small towns,

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THE VENTILATION OP CHURCHES,

[JAN. 22,1987.

such ns Leipzig or Bonn ; ancl while pointing out that there
is little or no prospect of such an institution being founded
by the Government, they urge its national importance, and
the value of the scientific work and training which could
be carried on under the auspices of such a body as the
College of Surgeons. This memorial was at the last Council
meeting referred to the committee appointed to consider as
to the disposal of the Erasmus Wilson legacy. We can only
hope that such an evident hiatus in onr higher educational
establishments will appeal to their judgment and good
sense, the more so as the memorial is signed by some of the
foremost scientific men of the day. Rumours have been
published that extensive pulling-down and rebuilding schemes
are contemplated, and that enlargement of existing depart¬
ments rather than the foundation of new ones finds most
favour with those whose voices command the greatest
attention at the Council table. Scientific men will
await the deliberations of this committee with consider¬
able interest; should they decide to devote Borne of the
funds at their disposal to the above purpose, it is not
unreasonable to hope that other funds in process of time
may be placed at the disposal of the College to enlarge,
amplify, and further endow this kind of work. It is not a
little curious that, of all European capitals, London alone
should be entirely without a physiological and pathological
institution, open to its scientific men, for the elucidation of
such questions of public health as those just mentioned,
among many others. The Council of the College of Surgeons
have now a magnificent opportunity to make good this
great want. We sincerely hope that they will not fail to
.avail themselves of it, and of the occasion it affords of con¬
sulting the opinions of the great body of Fellows and Mem¬
bers, whose voice should unquestionably be heard in a
matter of such public no less than professional importance.

THE VENTILATION OF CHURCHES.

A provincial contemporary relates a serious accident
which occurred at Staplegrove Church, near Taunton.
About the middle of the service it is said, many of the
congregation felt a peculiar faintness, which by the
time the sermon was drawing to a dose caused several
to fall “ like ninepins about the church.” The lady
organist is reported to have fallen on her face in the
aisle, while several others followed her example, the rest
of the congregation escaping through the doors, faint
and overcome. Probably it will be found that the dis¬
aster was caused by the accidental introduction of carbonic
acid gas from a eoke furnace into the interior of the
church; but, however this may be, we hope it will lead
to a thorough investigation into the ventilation of churches.
It is often pleaded, we cannot help feeling unjustly, that
other influences than those of ventilation are sometimes the
occasion of the drowsiness of congregations. The clergy are
therefore'perhaps interested in the subject not less than
those who attend their churches; but we Would beg to
remind medical officers of health that their duties include
the recommendation of proper ventilation Of places where
large assemblies sire held, and that this is so far reco¬
gnised by the Legislature that metropolitan medical officers
are required by . the Metropolis Local Management Act
,l to point out the most efficient modes for the ventilation
of chorohes, chapels, &c.” It would be an instructive piece
of Work for any health officer to give an account of the
various methods Of warming and ventilating the churches
and chapels in his district, and by comparing one with
another to show the reasons of their failure to keep
the congregation warm without contributing to the
drowsiness which is not infrequent in these buildings. He
would undoubtedly find that in many instances no serious
attempt is made to warm the ohuroh until very shortly

before the service commences; the walls are necessarily
cold, and thus a higher temperature is required for the air
which is admitted to compensate for this disadvantage.
The hot air is almost invariably admitted from the floor
alone; and as insufficient ventilation is provided in the roof,
the hot column of air, which rises as high as possible, presses
down until all the colder air beneath is excluded. At this
period the congregation are warm, but the air they breathe
has become more or less polluted, and the effects of carbonic
acid become in corresponding degree evident. The use of flues
or shafts fpr carrying off the heated air would not accord with
the notions of ecclesiastical architecture, and thus it cannot
be expected that the atmosphere of a church can be exchanged
as rapidly as that of a dwelling-room, although proportion¬
ately it may contain ten or twenty times the number of
occupants. There are probably no badly ventilated churches
which could be satisfactorily improved without material
alteration in the existing arrangements, but certainly much
could be done by thoroughly warming the structure before
it is used, instead of leaving it for days together at a tem¬
perature which must approximate somewhat closely to
that of the outside air. _

A CALCULUS IN THE BRONCHUS.

La Encyclopedia publishes an account, by Dr. Don Luis
Montana, of a case communicated by him to the Havana
Academy of Sciences. The patient was a young lady
from the United States, who up to 1884, when she
was first seen, had enjoyed good health. In that year
she had an attack of pleurisy on the right side, for which
parathoracentesis was performed, which removed 090
grammes of fluid. After this she completely recovered.
In the early part of 1886 she was again seen for a persistent
dry cough, which was considered to be due to pharyngitis,
but which did not yield to the remedies prescribed. A
painful spot was complained of at the base of the neck a
little above the left stemo-clavicular articulation. Up to
May 13th there had been no elevation of temperature; for
some days after this, however, there was a slight degree of
fever, which was quite unaffected by quinine. The cough
afterwards became more spasmodic—somewhat resembling
whooping-cough; some streaks of blood also appeared in
the sputum. On auscultation occasional dry rhenchi were
heard over the left apex, and a slight roughness in the
breath sounds; there was, moreover, a want of per¬
cussion resonance in the left infra-clavicular region.
An active counter-irritant was applied, and digitalis ordered,
but no good effect was produced. On the morning of
May 26th it was noticed that the respiratory sounds over
the left apex had become weaker, and in the afternoon the
whole of the left lung was almost impermeable to dir. Only
some very slight rhonchi being peroeptible at the apex; the
percussion resonance was also highly exaggerated, allowing
the existence of an emphysematous condition of the entire
lung. A consultation was now held with Dr. Jover, who
suggested that there might be pneumonia of the apex, and
that a pseudo-membranous plug, due to the inflammation,
was obstructing the left bronchus. He proposed to order
an emetic in the hope of dislodging this plug. After
ipecacuanha had been given, the oough became less violent,
the fever diminished, and the air entered more freely into
the obstructed lung. Tire next morning, however, all the
previous symptoms returned with as much severity as
before, and this condition continued till May 24th, when
the patient, during a violent fit of coughing, expec¬
torated a hard substance, which proved to be a calculus.
It measured one centimetre by seven millimetres, and was
irregular, ovoid, and hollow, with a rough surface. Its
weight was twenty centigrammes. On analysis it was
found to be composed of carbonate and phosphate of
calcium. Immediately after the expulsion of this body the

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TUB LONDON UNIVER8ITT.—VACCINATION IN PERU.

[J AH. 22,1887, 185

air penetrated freely into every part of the loft lung, the
cough disappeared as if by magic, and the fever gradually
diminished, till in three days’time the patient was perfectly
well The author states that this is tho first case of the
kind which haa been reported in Cuba. Indeed, such a case
as this is of extreme rarity everywhere,

THE LONDON UNIVERSITY.

The House of Convocation of the University of London
met on the 18th inst., the chairman of the body, Mr. Frederic
John Wood, LL.D., presiding. After the report of the annual
committee had been presented and adopted, a long and
animated dismission took place respecting the selection of
an appropriate motto for use in connexion with the Univer¬
sity arms. Several mottoes and proverbs were submitted,
but ultimately it was resolved, on the motion of Sir Albert
Kaye Rollit, LLJX, that the whole subject be referred back
to the annual committee, with power in conjunction with
tha Senate to select a motto, and that the members of Con¬
vocation be invited to send in appropriate mottoes. Sir
Philip Magnus presented the report of the special committee
on the constitution of the University. He referred to the
oonferenoe that had taken place between the committee and i
the Banstn, and the deaire of tha Senate to meet the wishes
of Convocation as to the reoonstitution of the University.
He noted the scheme proposed by the Association and that
of the Royal Colleges of Physicians and Surgeons, and con¬
cluded by expressing his conviction that the grievance of the
m ed i cal schools was a real one, which he hoped the Senate
would find some way of removing. The questions of the estab¬
lishment of a Doctorate either of Literature or Philosophy
and the regulation of expenses were referred to the Annual
Committee, and the meeting was adjourned.

VACCINATION IN PERU.

It is satisfactory to learn, from a recent number of
J2 1 Monitor Medico (Lima), that some steps are being taken
to persuade the Government of Peru to establish compulsory
vaccination in the Republic. At present the only place
where the compulsory system is in force is in Lima itself,
where it has been established as a local enactment by the
municipality. Provincial vaccinators find the greatest
difficulty in keeping up supplies of lymph, and are fre¬
quently obliged to apply to the Lima authorities, who, at
the desire of the Government, assist them as far as possible.
The Free Academy of Medicine has recently caused the whole
matter to be looked into, and a report to be drawn up by a
committee of its members. They say that the frequent
cpsdemioa of small-pox and the numerous cases that are
constantly occurring in most of the towns of Peru are
aoeoontable for a large part of the present high rate of
mortality; that the experience of all other countries shows
that the only way to make vaccination really effective is to
reader it universal by compulsion, which cannot be carried
out without arrangements for supplying lymph to all
requiring it; and that the best way of doing this is to oonfide
the charge of a central establishment to a scientific body—
that is to say, to the Academy of Medicine. It is remarked
that the neighbouring republic. Chili, established com¬
pulsory vaccination in 1884, and has an institute of animal
vaccination in Santiago which is subsidised by the Govern¬
ment to the extent of 3500 dollars a year. Iu the case of
Lima, the municipality seems disposed to take the burden of
establishing a national animal vacoine institute upon itself.
The Academy suggests that all parents should be compelled
to hare their children vaccinated before they are three
months old, and that all persons should be revacoin&ted
every ten years. The authorities of all penal and charitable
institutions should be obliged to see to the carrying out of

the vaccination law, which of course would be rigidly
enforced in the army. It is also suggested that the local
boards of health should be authorised to give two prizes
annually to the most successful vaccinators in the district.
The distribution of lymph and the instructions for vacci¬
nators the Academy would wish to have left in its own
hands. _

PATHOLOGICAL SOCIETY.

The crowded benches on Tuesday last testified strongly
to the popularity of the movement that caused Sir James
Paget to accept the presidential chair of the Pathological
Society. The acceptance of this office will prove of great
value not only to the Society, but to the cause of pathology
at large. It is well known that Sir James Paget is
disposed to sympathise with every extension of pathological
science likely to conduce to the advancement of this
important branch of medicine. We were particularly
gratified with that portion of his address pointing ont
that there need be no inconsistency between practice
and science. The scientific mind may place all things
in a scientific light. The illustrations from clinical
medicine by the new President were full of significance and
meaning to those who look below the surface of things.
Excellent indeed was the recommendation to examine all
morbid tissues whilst they are yet living. That there is
no exaggeration in the notion that tissues just removed
from the body might be regarded as still vital will be con¬
ceded all the more when the facts of skin, tendon, and
nerve grafting are borne in mind. The occasion was, indeed,
an exceptional one for the Pathological Sooiety. The
actual combination of the faculties of the pathologist and
the orator is necessarily rare, and the audience of lost
Tuesday signified their appreciation of the presidential
appointment by according to Sir James the warmest possible
reception of his address. Sir Joseph Lister proposed the
vote of thanks for the “ beautiful and instructive ” address;
and Dr. Samuel Wilks, in seconding the vote, echoed the
conviction of everyone in his allusion to the youthful
vigour of the President’s intelleot.

THE ETIOLOGY OF PULMONARY GANGRENE.

Db. Bonome of Turin contributes ( Deutsek. Med. Woeh .,
1886, No. 62) some new facts upon the intimate pathology
of gangrene of the lung, a condition which supervenes tinder
most varied circumstances, being sometimes the outcome
of acute lobar pneumonia in cachectic subjects, or the result
of inhalation of putrid matters, or of the embolic impaction
of thrombi from infective centres. The gangrene may be
limited and circumscribed, or diffuse and widespread; it may
be confined to a single area or disseminated in multiple foci—
variations depending largely upon the antecedent condition.
Dr. Bonome’s investigation refers to circumscribed gangrene,
and would apparently include the metastatic pulmonary
abscesses of pysendo infection. He describes the focus as
divisible into four zones, which, mutatis mutandis, could
stand also for those of a pysemic abscess. Thus in
the centre, be says, is a necrotic zone made up of
the debris of dead leucocytes and of micro-organisms,
to which the necrosis is due, -this necrotic change including
a fibrinous metamorphosis of the protoplasm of the alveolar
epithelium (coagulative necrosis) and d eat ruction of the
inter-alveolar septa. Then comes a zone of a granular appear¬
ance, composed of broken-up leucocytes, which ztain deeply
with carmine. Around this is a zone of haemorrhage, whilst
outside all is a zone of catarrhal inflammation. Examina¬
tion of the necrotic focus in fresh specimens revealed, in
addition to putrefactive bacteria, masses of micrococci; and
cultures hi agar-agar and peptone-gelatine enabled the
determination of the variety of micro-organism. This

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186 The Lancet,] THE DARENTH HOSPITAL DISPUTE.—MORPHINE IN DIABETES.

[JA*r. 22,1887.

proved to be the staphylococcus pyogenes aureus and albus,
and its special necrotising power was proved by inoculation
of pure cultures both directly into the lung and indirectly
through embolism. In this way pulmonary gangrene can
be artificially induced in rabbits, control experiments with
other microbes—as the pneumococcus and microsporon
septicum—failing to produce the same effect. The staphylo¬
coccus is the micro-organism which has been proved to excite
infective osteomyelitis, furuncle, paranitium, inflammation
of subcutaneous tissue, and ulcerative endocarditis,—so that
its action upon lung-tissue is not singular. It may be intro¬
duced into the lung either directly through the air-passages
or metastatically conveyed by the blood-stream (embolic
gangrene). Wounds of the .lung by instruments infected by
the staphylococcus pyogenes rapidly produce necrosis and
inflammation. The putrefactive prooess is caused by tho
free entrance of saprophytes by the bronohi; the peculiar
odour of gangrenous foci being due to this secondary change
induced by contact of the necrotic patch with atmospheric
air. __

DEATH OF A CADET AT WOOLWICH.

The recent death of one of the cadets of the Royal
Military Academy, Woolwich, from a fall while sliding on
an extemporised slide, is the first that has occurred in
the hospital since it was attached to the Academy some
forty years ago. The case from a medical point of view is
instructive, as showing what serious results may follow a
blow on the head which at first is thought but little of. In
this case the patient was able to walk about and take his
meals after his fall, and it was not till the middle of the
night that the surgeon was called to him on account of
severe pain referred to the zygoma, which was the part
struck. He was then removed to the hospital, which is
distant two or three hundred yards, and walked there
without difficulty. The patient slept and took his break¬
fast. In a few hours, however, coma came on, preceded by
sudden accession’ of acute agonising pain in the head,
death occurring in the afternoon. At the necropsy an
immense clot was found between the base of the skull and
the dura mater, the blood having come from a small
puncture in the middle meningeal artery, caused by a
minute spicula of bone which had been detached from the
suture between the orbital plate of the frontal and the left
wing of the sphenoid. _

THE DARENTH HOSPITAL DISPUTE.

The question whether the hospital at Darenth should be
constructed with wood or brick—that is to say, whether it
should be temporary or permanent—came again before the
Metropolitan Asylums Board at their meeting on Saturday.
The occasion for the further consideration of this subject
was the receipt of a letter from the Local Government Board
agreeing to the proposal of the managers that the material
to be used should be brick, but that the managers should
modify their former proposals as to the manner in which
the institution should be constructed so as materially to
reduce the cost. The opposition to a brick building which,
has been shown by various district authorities is evidently
due to the belief that, inasmuch as wood is a less expensive
material than brick, it is more economical to use the former.
The determination of the managers to persist in their inten¬
tions is based upon the fact that in the course of time
wooden structures cost more money than those which are of
a more.permanent nature. The objection of the Local
Government. Board is founded upon the uncertainty of
medical knowledge as to the proper method of construction
of small-pox hospitals. .It is matter for regret that the
Central Board have not freely placed before the managers the
whole of the information available with regard to this point;

they would undoubtedly have carried the managers with them.
But, as we have already pointed out, the use of wood or bride
is merely incidental to the real question which underlies
the whole—viz., the means which must be taken to prevent
the sm&ll-pox hospital being a source of danger to the
neighbourhood in which it is placed. There is much reason
for believing that the aggregation of persons convalescent
from small-pox is in its effects very different from that of
persons in the acute stage of the disease. But although the
Darenth Hospital is intended for convalescents, it may be
accepted that it will, in the course of epidemic pressure,
eventually receive a much larger number of acute cases
than Mr. W. H. Power found to be necessary for the dissemi¬
nation of the disease. There is no economy in building even
a temporary hospital upon principles which do not include
a full recognition of this fact; and the authorities who fail
to bo guided by the experience of past epidemics or to take
measures for adding to the knowledge which already exists
are incurring a serious responsibility, and will find eventually
it will be no easy matter to j ustify their procedure when the
influence of small-pox hospitals is more fully known.

“ON SOUL AND CONSCIENCE!”

The medical certificate constitutes one very useful safety-
valve for educational over-pressure. Were its just influence
ignored, the effect on the public health would be far from
satisfactory. Were the same influence pushed into abuse or
indiscriminately applied, it would certainly come into con- .
tempt, with a like result. According to the School Board of
St. Cyrus, the medical profession in that parish is not guilt¬
less in this particular; but the remedy suggested at a recent
meeting is certainly a novel one. A member proposed with
all gravity, as a possible solution of the difficulty, that
absentees must be excused on the ground of illness, which
would not in future be admitted on the mere assertion of a
medical practitioner, but must be certified by him “ on soul
and conscience.” This proposal, it seems, was not intendedfor
burlesque. Whatever it means, it is not likely, we fear, to
improve materially the school attendance at St. Cyras.
Probably the most practical means of correcting the truant
tendency, if it? is really to be so described, would be to issue'
a form requiring certifying practitioners to state precisely
the fact of a personal examination and the nature of the
illness for which a certificate is granted. We need hardly
again impress on our medical brethren the need of due care
in examination, as malingering is by no means unknown
among children. _

MORPHINE IN DIABETES.

The good effect in oertain eases of diabetes of administer¬
ing morphia has seldom received better illustration than is
afforded by a case recorded by Dr. Mitchell Brace (Prac¬
titioner, .Tan. 1887). The patient was a printer, aged
twenty-six, and was under observation for ten months.
During this time a series of observations were made as
follows. For two days he was placed on ordinary mixed
diet without medicine, and the average daily excretion of
sugar was estimated at 1360 grains. In the second place, for
about three weeks he was kept on “ strict Pavy diet,” but
without any notable diminution in the amount of sugar
excreted. This was followed by a third series of observations,
when, with continuance of the rigid diet, acetate of morphine
was given by the mouth in increasing doses, commencing
with fifteen minims, every four hours. The amount of sugar
began to diminish notably. Oft the fifteenth day, when three
grains of acetate of morphine were being ingested daily,
the sugar had fallen to 912 grains; on the forty-eighth day
(4£ grains of acetate of morphiqe) to 360 grains; and from
the fifty-sixth to the sixty-first days of this treatment
I (4g grains of acetate of morphine) sugar was entirely absent

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HEALTH OF MAURITIUS.—DENTAL CARIES I>' BAKERS.

[Jan. 22,1887. 187

from the urine. It was only towards the end of this series
of observations that any narcotic effect, and that Incon¬
siderable, was produced. On discontinuing the drug, but
trill maintaining the rigid diet, there was a rapid reappear¬
ance and daily increase in sugar—viz., from 600 to 2400
grains. Still continuing the diet, observations Tvere now
made of the effect of morphine administered hypodermically,
with gradual increase from about £ grain up to 3 grains
per diem. The amount of sugar excreted never fell belOw
768 grains, whilst the drowsiness of the patient required a
reduction in the drug, with an increase in the sugar excreted,
until the latter reached 3000 gr. Recourse was now again had
to the administration by the mouth, and by the seventeenth
»lay of such administration the sugar had fallen from 4000 to
1000 grains; by the forty-fourth day it reached 882grains; but
it was not until the ninety-ninth day, when seven grains of
the acetate were being given daily, that the sugar was
reduced to a mere trace. The patient’s general condition
correspondingly improved. Dr. Bruce, in his concluding
remarks, considers that the glycosuria in this case was
proved by the foregoing results to be due to an increased
income of sugar in the blood, and not to its diminished
destruction in the system; for the morphine bad. less in¬
ti amice on the glycosuria when introduced into the general
circalation than into the portal circulation. It alsb showed
that glycogenosis was still active, and that this was
going on mainly in the liver; and that, if of nervous origin,
the disorder was in the liver itself, and not in the central
nervous system. For whilst the hypodermic administration
produced marked depression of the central nervous system,
the drug given by the mouth had much less effect,
operating mainly on the glycosuria.

THE GREAT NORTHERN CENTRAL HOSPITAL.

Thje men of the north of London have an object well
worth their consideration and sympathy in the Great
Northern Central Hospital. This subject divides itself into
two parts—tho maintenance of patients in the existing hos¬
pital in the Caledonian-road, and the provision of funds for
building the new hospital in the Holloway-ro&d. We regret
to see that on both heads the financial report at the annual
meeting (Mr. Marshall Lang in the chair) is unsatisfactory.
The maintenance fund is £657 short of last year, and the
funds in band for the new hospital are so small that the
promoters have determined to proceed with only one block
of buildings, at a cost of £2000. This is highly judicious on
the part of the committee, but we trust that in this Jubilee
year we shall see them supplied with the £24,000 required
to make the new hospital com piste and worthy of the
populous district by which it is surrounded

HEALTH OF MAURITIUS.

Tux annual report of the medical department of Mauritius
for the year 1885 is remarkable chiefly for the very small
amount of information which it famishes on the subject of
the health of the population. It states that the health of
the colony was by no means satisfactory. “ Some localities
in Mauritius are as healthy as England, and others again
are little lese than pestiferous.” But it does not give a-
single figure to show what was the death-rate of the island
generally, or of any of the districts, with the .exception
of Riviere da Rempart, in which it amounted only to 21‘82
per 1000 of the population. This total absence of detailed
information as to the death-rate is the result, apparently, of
the returns which were furnished not being printed—an
instance of extravagant economy, for without them the
report is of scarcely any value. We would suggest to
the Chief Medical Officer that in future, instead of merely
referring, as in the present report; to tables wMch may not.

be printed, he should state in the text of the report the
numerical results which are shown by them. As illustrating
the very unhealthy condition of the island, and at the same
time the prevailing distress, the Chief Medical Officer states
that about 44,000 cases of disease were treated in the medical
institutions of the colony in 1885, bat he does not state the
population. Assuming it to be 370,766, as given in Whitaker’s
Almanack, this would show that one in eight had thus
obtained medical relief. The report shows that 15,488 cases
were received into the public hospitals, and of these 1366
died, being in the ratio of 88 24 per 1000 treated. This high
death-rate was, doubtless, to a considerable extent due to
the condition of the patients on admission, for in the Civil
Hospital, for which alone the details are given, of 598 deaths
213 took place within forty-eight hours after admission.
Malarial fevers, including under that term also cases returned
as “ malarial cachexia,” were the most prevalent and fatal
diseases admitted Into the public hospitals; there were 5749
cases returned with 240 deaths; of dysentery there were
693 cases and 216 deaths; and of pneumonia and pleurisy
there were 264 cases and 156 deaths. Pneumonia appears
to be a very fatal disease in the island; at Powder Mills
Hospital 21 cases were admitted, and all died—“a fact
sufficiently remarkable to deserve explanation,” but of which
no explanation is givsn. We cannot but regret that the
Information repecting the health of the island is so very
kneagre, but we trust that before the next annual report is
due the Chief Medical Officer may be able to satisfy the
Governor of the necessity for publishing the usual statistical
tables, if the report is to have any practical value.

DENTAL CARIES IN BAKERS.

Dr. Fr. Hkssk has given a detailed description in a recent
number of the Deutsche Monatschrift fiir ZahuheiPcunde of
a peculiar form of oaries especially affecting the’ outer
surfaces of the teeth. The oaries is soft, rapid in its pro¬
gress, and penetrates deeply. It commences at the neck
where the tooth is in contact with the gum, and extends more
towards the free cutting edge than towards the fang. The
discolouration produced is of a brownish tint. It commences
early, usually attacking patients bo tween tbe ages of
seventeen and twenty-three. He refers it to the inhalation
of meal dust, and thinks it also occurs in millers.' It most
commonly first attacks the upper front teeth, eating away
the enamel, the eroded edge of which is sharply defined,
and exposing the dentine, which assumes a brownish or
even black colour.. The same conditions are found in sugar-
bakers and In confectioners, both of whom remain long in
rooms the air of which is loaded with sugar dust, and who
have often to taste hot saccharine substances. Hesse there¬
fore considers this condition to be caries induced by sugar. A
similar defect is found in the front teeth of children who
are fed with certain kinds of sacoharine farinaceous food,
such food being often in a state of acid fermentation.

DIPHTHERIA AT BASSINGBOURN.

A srriqcs epidemic of diphtheria, which attacked sixty
children in thirty-seven families in the adjoining parishes
of Bassmgboum and Xneesworth in the Roysfcou rural
district, has just been reported on by Dr. Anniugoon. The
epidemic commenced on June 18th last, and continued for
fifteen weeks until Sept. 2oth, and the peculiar feature
attaching tp it was its apparent connexion with a polluted
water-supply at the elementary sohool. The incidence of
the disease was oertaialy very marked on the girl’s aide, where.
this polluted water was available, but at the same time
it is difficult, in the face of the'existence of other means of
diffusion, such aa are in operation in an elementary School, to
eliminate all tbe usu&l conditions favoariog personal com-

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188 The Lancet,] METROPOLITAN SEWAGE DISPOSAL.—THRIFT IN COOKERY. [J an. 22,1837.

munication, and to assign the disease to a water-supply.
The Bassingbourn outbreak is regarded as having, in the
first instance, been brought about by the recrudescence of a
previous epidemic, and school assemblage is admitted to
have been a main cause of its introduction. Hitherto,
although there have been similar cases in which polluted
water has appeared to have been associated with the spread
of diphtheria, this circumstance has, as a rule, been over¬
shadowed by some more potent factor, such as personal
communication during school attendance. The influence of
such attendance in causing diphtheria is well known; that
of a polluted water-supply is as yet not definitely made out.
But all such cases as that under consideration are well
worthy of study in this connexion.

METROPOLITAN SEWAGE DISPOSAL.

We observe with regret that the Metropolitan Board of
Works have accepted an estimate to provide, at an enormous
cost to the metropolis, the tanks and jetty which are neces¬
sary for treating London sewage in the manner upon which
the Board had previously decided. We have recently so
fully discussed this matter, that we fear it will serve little
purpose to reiterate the arguments we adduced against this
method; it will be sufficient for most of the ratepayers to
know that the Metropolitan Board is acting in defiance of
the recommendations of a recent Royal Commission which
carefully studied this subject in all its bearings. The Metro¬
politan Board only indirectly represents those who will
have to bear the cost of this unwise undertaking; they
represent the vestries and district boards, and upon them
must devolve the chief duty of opposing the scheme against
which we have felt it necessary to protest. But we observe
with much satisfaction that an influential meeting of rate¬
payers was held on Wednesday to consider the question of
London sewage disposal, and that at this meeting a resolu¬
tion was adopted strongly protesting against the action of
the Board. A committee has moreover been appointed,
which will, we trust, urge this view upon those who are
responsible for the wasteful expenditure contemplated. We
are not, however, sanguine of the result. It will be very
difficult for the Metropolitan Board at this period to with¬
draw from a position which has already been taken up, but
we gladly see the effort made to induce them to adopt this
course, if only to demonstrate that the metropolis as a whole
is not wanting in wisdom._

as to ready methods in cookery, which bear the mark of
experimental training. Some of the dishes enumerated,
seem to us rather too rich for an invalid. This defect, if it
prove such in practice, a little judgment might easily remedy.
In another pamphlet the same lady treats of “Tinned Meats
&c., and how to use them.” It is an unfortunate thing that
the wholesomeness of food preserved in this way is not yet
so far above suspicion as to render all care in its selec¬
tion unnecessary. This fact does not, however, suffice to-
forbid the discriminating use of such food, and it does
not in any way impair the general excellence of the advice
contained in the pamphlet just mentioned. Whilst on this
subject, we may direct attention to a device introduced by
Mr. H. T. Tallack, of Hatton-garden, in the shape of stout
steel skewers, each headed with a hollow iron sphere, and
which being thrust deeply into the substance of the joint
prepared for roasting, serves to conduct the heat more
readily into the centre of the meat, thus ensuring more
rapid and complete cooking.

MEDICAL FEES IN CROWN CASES.

Wk have often in our columns directed attention to the-
inadequate fees paid to medical witneses in Crown cases..
In a manslaughter case at Wigan, last week. Dr. Brady, one
of the medical witnesses, refused, when before the magis¬
trates, to be bound over to appear at the Liverpool Assizes-
alleging as a reason that he would not undertake to leave
his patients and practice from day to day to attend tho
Assize Courts at Liverpool for the remuneration offered by
the Crown. He was willing to give evidence and render
what assistance he could when called upon, but he would
not from day to day wait about the Assize Courts till
called upon for £1 la. per diem. The magistrates on
the bench threatened him with all the pains and penalties
possible if he refused to be bound over, and the assistant
magistrate's clerk stated that, with an experience of thirty-
five years, it was the first time he had known a professional
witness refuse to be bound over. Dr. Brady assured the clerk
it was not too late to begin, and he was eventually allowed
to leave the court without being bound over. We agree
with Dr. Brady as to the inadequate remuneration, and
think it ought to be two or three guineas at least. A
medical practitioner’s time is usually too valuable, not only
to himself, but to his patients, to be wasted in waiting
about law courts day after day.

THRIFT IN COOKERY.

Economy in the kitchen has long been recognised as a
domestic virtue; and in these days, when cooking has
become more than ever a fine art, it is satisfactory to note
that old-fashioned household thrift can well keep pace with
the advance of custom. Important as this fact is on general
grounds, it is no less important in the treatment of the sick.
In the various forms of fever, as is now generally admitted,
the value of suitable nourishment can hardly be exaggerated.
The case is not different in instances where the failing
powers of age rather than the nature of disease form the
chief obstacle to reoovery. Here time gained may be life
saved, and a diet at once palatable and digestible therefore
becomes a primary consideration. For the wealthy invalid
such a diet is not difficult to obtain; the resources of
cookery are at his command. The poor in illness are less
fortunate, though much may be accomplished in the same
direction by the introduction among them of simple but
efficient means of cooking, which appear in careful hands to
answer many of the purposes of a more elaborate system.
Of this we are reminded by the excellent teaching conveyed
in a small and practical manual by Miss E. de V. Mathew,
entitled “Cookery for our Sink and Invalid Poor.” This
little work contains a large number of reci™=. with hints

SIMPLE METHOD OF ESTIMATING THE EFFECTS
OF RESPIRATION.

MM. IIanbiot and Cb. Rlchet have described a method of
measuring the oxygen inhaled and absorbed, also the car¬
bonic acid formed, during respiration, which is much more
simple than the usual method by weighing, and is adapted
for carrying out at the bedside. A gas-meter measures the
volume of air inhaled, and a second that of the air expired ;
this air is then passed through potash and subsequently
through a third gas-meter. The difference between the
second and third meters of course gives the carbonic acid
formed, and the difference between the first and third the
oxygen absorbed. _

POLICE EMERGENCY CASES IN EDINBURGH.

The Public Health Committee of Edinburgh have had
before them the arrangements for securing medical attention
for emergency cases. The question of appointing police
surgeons in different districts was raised, but was not
favourably received. The present system was approved, by
which the nearest practitioner is to be summoned by the
police, who are to give remuneration according to the time
at which the service is required.

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Thb Lan6*t,] ELECTRIC LIGHT IN MINES—ENDEMIC GOITRE IN CENTRAL ASIA. [Jan. 22,1887. 189

THE ELASTIC LIGATURE FOR UTERINE FIBROIDS.

Thb removal of uterine fibroids by menus of tbe elastic
ligature having been recently adopted by Prof. Slavyanski
in four cases, a paper has been published by one of his
pupils, Dr. Zhabotinski, dealing mainly with the history of
tMft method of operating. He has collected accounts of 216
eases, of which 151 are British f44 being Dr. Robert Lee’s),
•27 French, 20 Germun, 10 Russian, 5 American, and 3
Italian. Of these 18, or 8'3 per cent., proved fatal—8 from
peritonitis, 3 from septicaemia, 3 from exhaustion, 1 from
pleurisy and peritonitis, 1 from meningitis, 1 from tetanus,
and 1 from an accidental disease. In 12 of these death
occurred before the tumour came away, and in the remain¬
ing 6 after separation had taken place. The author thinks
■that the opinions of West and M'Clintock on the dangerous
character of this method of procedure were formed on the
results of too 6mall a number of cases, and that as most of
ths published cases occurred in pre-antiseptic times the
danger with modern methods may be looked upon as very
alight The mode of procedure which Prof. Slavyanski
.adopted, and which in Dr. Zhabotinski’s opinion is the best,
is to cat away the tumour after the elastic ligature 1ms
been applied to the peduncle. This seems to have given the
bent results, even before the days of antiseptics. The main
indications for the elastic ligature operation are a pedun¬
culated condition of the tumour, an accessible situation,
Mid a disposition to haemorrhage.

THE GENERAL MEDICAL COUNCIL.

Pursuant to the-provisions of the Medical Act of 1886,
the following appointments have been made:—Dr. John
Gtruthers, to represent the University of Aberdeen; Dr.
William Leisbman, the University of Glasgow; Sir William
Timer, M.B., the University of Edinburgh; Dr. William
Moore for Ireland; and, as announced last week, Professor
Rail Pettigrew, the University of St. Andrews.

THE ELECTRIC LIGHT IN MINES.

Among the future possibilities of the electric light, there
is probably none which possesses more interest than its
-adaptation to the lighting of mine9. The advantages which
must follow its use in this way are at once obvious. Dark-
weee and fire-damp between them will account for the
Majority of the more serious as well as for many lesser
O ccidents to miners, and they are dangers which cannot
better be avoided than by tbe general adoption of & mode of
lighting which ensures at once brilliant illumination and
the perfect exclusion of gas currents from the lamp dime.
Now that the one disqualification which can be urged against
the electric light—namely, that it does not serve as a test for
jjeeenns impurity in the air of tbe mine—has been removed
fay attaching indicators to the lamps used underground, we
may indulge a hope that the coat of introducing new lights
■mad electric machinery will not long be allowed to oppose
tUl much-needed reform._

ENDEMIC GOITRE IN CENTRAL ASIA.

Bgsobon G. M. Giles, M.D. Lond., surgeon to the I.G.S.
Jkveetigator, who was sent on special duty with Colonel
Lockhart's Mission to the Gilghit and the Paman Plateau,
faxniflbee an interesting paper to the Indian Medical Journal
-utt the Prevalence of Goitre among the Denizens of the
of Central Asia. Dr. Giles is inclined to attribute
ifce ifiaeaee to the habheof the people who live in dark mud
hate with no entrance for light bat the door, and to the
ubemwevpf trees on the surrounding hills. He speaks very
Vtreatment by injections of iodine into the
dl * week or. ee, and Jay a gnat stress on

Vl

the use of a watery, not an alcoholic, solution of the drug.
His highly favourable opinion of the efficiency and harm-
leeeness of iodine is founded on the result of some three
hundred injections. __

DENTAL SURGERY ON THE CONTINENT.

According to the Independent Practitioner, in Austria
and Hungary there were until lately no dentists, medical
men alone being allowed to practise dentistry. Before the
year 1876, in order to practise dentistry in Holland, it
was necessary to hold the diploma of medicine, surgery, and
midwifery. The law has now been amended, a special
course of study and special examinations having been pro¬
vided for, os in Germany, Russia, and Switzerland. Is
not this non-insistance on medical qualification rather a
retrograde step ? _

THE “JACOB” TESTIMONIAL.

The subscriptions to the Jacob testimonial fund which
have been handed in or promised up to the present amount
to about £210. The lengthy list of subscribers shows how
general and widespread is the desire of the profession to
mark in an appreciable way its esteem for Dr. Jacob.

THE DISCUSSION ON RABIES AT THE FRENCH
ACADEMY.

This debate, says our Paris correspondent, whose letter
we are obliged, from want of space, to hold over, was con¬
cluded on Tuesday last. M. Peter read particulars of two
new cases in which death had occurred from rabies after
the intensive inoculations. M. Vulpian praised Pasteur’s
work, and criticised the statements and conclusions of
M. Peter; after which M. Brouardel spoke, and the dis¬
cussion terminated. _

FILARIA SANGUINIS HOMINIS.

Du. Stephen Mackenzie gave, at the Clinical.Society on
the 14th inst., a most successful demonstration of the living
filatire from the blood of a gentleman—a member of the
medical profession—suffering from chyluria. The micro¬
scopical preparations were seen by u lurge number of
members of the Society. _

M. BLONDIN.

Viewed from a physiological point, the performance of
M. Blondin at the Agricultural H&ll must be regarded as one
of the marvels of the age, which grows more wonderful
every year. Such feats as his are remarkable when done by
men of twenty, but done at the “grand climateric" they
are trebly so. Though on close inspection it is seen that
M. Blondin bears marks of age, his step on tbe rope, and his
self-oommand in a “ poke ” or on his bicycle, are as perfect
as ever. _ .

FOREIGN UNIVERSITY INTELLIGENCE.

Dorpat .—The Heimburger prize, amounting to about £50,
has been awarded to a former Dorpat student, Dr. Erich
Ham ack. Professor of Physiological Chemistry and Phar¬
macology in Halle, for his treatise on Materia Medica and
Prescribing,

Gratz.—YoT the vacant Professorship of the Diseases of
Children the names of Drs. Soltmann of Breslau, Epstein of
Prague, Von lliittenbrenner of Vienna, and Tschumer of
Gratz have been brought before the Medical Faculty. For
the Professorship of Ophthalmology, vacated by Prof.
Blodig, the claims of Drs. Becker of Heidelberg, Eversbusch
of Erlangen, Sattler of Prague, and Schnabel of Innsbruck
having been considered, the last was invited to accept the
chair.

Groningen— The death is announced, at the age of thirty-
eight, of Dr. Johann R. Ranke, Professor o< Surgery. The

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190 The Lanckt,]

PHARMACOLOGY AND THERAPEUTICS.

[Jaw. 22,1887.

deceased professor was a German by birth, and was formerly
assistant to Prof. Volkmann.

Kieff. —Dr. D. V. Chirkoff of Moscow has been appointed
Professor of Special Therapeutics.

Madrid .—The death is announced of Dr. Gonzalez Encinns,
Frofessor of Clinical Surgery, and one of the most dis¬
tinguished operators in Spain.

Naples .—A Professorship of Orthopaedic Surgery has been
established.

Paris. —M. Pajot has resigned the chair of Midwifery
owing to his advanced age. M. Farabeuf has been appointed
Professor of Anatomy, in succession to M. Sappey. M. Gabriel
has been appointed Professor of Physics, in succession to
M. Gavarret. M. Dieulafoy has been elected to the chair of
Internal Pathology, in succession to M. Hardy. M.Moisson
has been appointed Professor of Toxicology in the £cole
Sup<5rieure de Pharmacie. M. Chatin has been chosen
Assistant Professor of Zoology in the Faculty of Sciences.

Dr. William Perry, of Exeter, N*. H., the oldest living
graduate of Harvard, celebrated the ninety-eighth anniver¬
sary of his birthday on the 22ad ult. Dr. Perry is the sole
survivor of the passengers on Robert Fulton’s steamboat on
its trial trip down the Hudson 9eventy-nine years ago, and
he was a member of the class of 1811 at Harvard College, of
the members of which there is only one other survivor.

In connexion with the outbreak of small-pox on board
the German steamer Preussen from Southampton to Ade¬
laide, we are requested to point out that although foreign
steamers call at British ports to embark passengers, they do
not necessarily come under the sanitary supervision which
the Board of Trade exercises over British steamers under the
Passengers Act. _

Cholera is now prevalent on both sides of the continent
of South America. It has increased in Chili, where it is
fatally spreading in the province of Valparaiso ; and it has
since been reported to have broken out at Monte Video, in
Uruguay. Situated as Monte Video is at the mouth of the
river La Plata, considerable commercial interests are likely
to be involved. _

A new bi-monthly publication, devoted to the Diseases
of Children, the Centralblatt fiir Kinderheil/cunde, will be
published in Vienna on the 1st of March next. The editor
is Dr. R. W. Raudnitz, and the English collaborator, Dr. H.
Ashby of Manchester. _

By the death of Colonel Bolton, which we announced last
week, the office of Water Examiner under the Metropolis
Water Act has become vacant. This is really an important
public health appointment, and should be held by a medical
man having special knowledge and experience in sanitation.

At the next meeting of the Hunterian Society, on Wednes¬
day, January 26th, Mr. Croft will contribute a paper on the
Immediate Treatment of Fractures, and give a demonstra¬
tion of his mode of applying plaster-of-Paris splints.

It is satisfactory to have to announce that the Naval
Medical Good Service Pension of £100 a year has been
awarded to Sir William Smart, K.C.B., the senior officer on
the retired list of Inspectors-General.

The Berlin police department is doing its best to dis¬
courage the sale of quack medicines by issuing warning
notices to the public.

An International Health Exhibition, referring especially
to foods and cooking, under the presidency of M. Chevreuil,
is to be held next month at Lyons. It will be open from
the 20th to the 28th proximo.

The annual general meeting of the Neurological Society
will be held at the National Hospital, Queen-square, at
8.30 p.m. on Thursday, January 27th. The President-elect ia
Dr. Samuel Wilks, F.R.S. _

In many parts of Bavaria diphtheria lias been very rife.
It is thought that fully 10,000 children have been affected,
there being 3000 in Bamberg alone. In several localities the
schools have been closed._

A successful meeting of the Association of General
Practitioners was held in Exeter Hall on the 19th inst. We
hope to publish in our next issue a detailed account of the
proceedings. _

In the Eghri-Capon quarter of Constantinople there is at
present a great deal of small-pox, 9ome forcy-flve deaths¬
having already occurred. _

We are glad to hear that a matter which has excited much
painful interest in one of our northern universities has been
satisfactorily settled by apology and retractation.

Pmrmacobgj aitb ®(terapentics.

BROMIDIA.

Bhomida, a sample of which has been forwarded to u»
by Messrs. Roberts of New Bond-street, is a combination of
bromide, chloral, hyoscyamine, and cannabis indica, and i»
acknowledged to be a valuable hypnotic. The combination
seems to be peculiarly efficient, for cases of insomnia have
been relieved by it when each of the drugs mentioned had
individually failed.

DIFFERENT METHODS OF TREATING CERVICAL CATARRH.

Dr. L’voff of Kazan has reported in the Meditsinskoe
Obozrenie a number of observations made on the compara¬
tive value of different methods of treating catarrh of the
cervix uteri. The total number of oases was eighty-two.
Of these thirty-six were treated by mechanical scraping of
the mucous membrane, eighteen by means of powerful
caustic applications, and twenty-eight with weak caustics.
The method of applying the weak caustics was, after washing
out the vagina with warm water or a solution of boracic
acid, to swab the cervical canal with tincture of iodine or
with a 10 per cent, solution of chromic acid. This was
done once a week, plugs soaked in glycerine of tannin
being also used every other day. The strong caustic appli¬
cation consisted of a bougie made of sulphate of zinc
and alum fused together. This was allowed to remain in
the canal till it had all dissolved, which took place usually
in one or two hours. Afterwards the mucous membrane
presented a white appearance, due to the eschar. This fell
off in five or six days, during which time warm vaginal
douches were administered and plugs of glycerine and iodo¬
form inserted every alternate day. In the cases treated by
scarification an iodoform and glycerine plug was left in for
twenty-four hours, and the patient was then sent home.
The results of these different methods of treatment were
that the mild caustics ultimately effected a cure, but required
at least two months to do so ; while the severer methods—
that is to say, the fused zinc and alum and the scarification—
produced a permanent cure in about a fortnight. The
author adds that no unpleasant symptoms were caused
by either the caustics or the scarification in any of the
eighty-two cases,

RUSSIAN PEPSINE

The comparative value of different preparations of pepsine
and papaine as peptonising agents has recently been inves¬
tigated by Dr. Lipski of St. Petersburg. He finds that the

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INOCULATION FOR BOVINE CONTAGIOUS PLEURO-PNEUMONIA. [Jan. 22,1887. 191

best of all the dry preparations he tried was the pepsinum
Mccharatum siccum of the Russian Pharmacopoeia, 2 grmB.
of which, when freshly prepared, digested 9 53 grms. of
albumen. From his results it appears that the Russian
pepsines are far more active preparations than most of those
m use in western continental Europe. Dr. Lipeki did not
apparently make any determinations of the value of any
English or American preparations.

ANTTFEBRINE IN TYPHOID.

Antifebrine has been used a great deal in Professor
Kotovahcheaki’s clinic in Kazan in typhoid fever cases with
good results. After a single four-grain dose, the tempera¬
ture sank in the course of an hour 0*9° to 2° C., the reduced
temperature persisting for from an hour and a half to three
hoars. It was found that by repeating these four-grain
doeea every two hours the temperature could be kept at the
normal point all day. The frequency of the pulse was at
the same time diminished and its tension increased. The
excretion of urea was also augmented. The patients liked
the drag, and no ill effects were ever observed from its use.

8ALICYI.IC ACID IN FOOD.

M. Vallin has presented a report to the French Govern¬
ment on the employment of salicylic acid in articles of food,
in which he states that medical observation has established
that even small quantities of salicylic acid, or its deriva¬
tives, if taken constantly, are capable of affecting the health
of certain subjects who are peculiarly susceptible to the
influence of this drug, as also the health of aged persons
and those whose renal and digestive organs are not per¬
fectly sowid. He consequently advises that the addition
of salicylic acid and the salicylates, even in small quantities,
to solid and liquid articles of food should be prohibited.

° ICHTHYOL IN ERYSIPELAS.

Dr. Nussbaum of Munich has recently obtained strikingly
successful results in traumatic erysipelas by the use of an
ointment composed of vaseline with 10 per cent, of ichthyol,
a chemical substance rich in sulphur, obtained from mineral
oil, which was introduced by Dr. Unna a few months ago,
and which was found useful by Dr. Dubelir of Moscow in
acute and chronic rheumatism' (see The Lancet, Oct. 2nd,
1886) both as a medicine and as an external application.
Dr. Nussbaum found, as indeed Dr. Dubelir also remarked,
that the ichthyol had an irritating effect on the skin, so that
it could not well be borne for more than three days, but ns
this was long enough to effect a cure in all the cases no
difficulty on this head arose.

PULVERISED SPLEEN IN CHLOROSIS.

The German medical papers quote some observations made
by Dr. Predazzi at Prof. Maragliano's request, on the value
of treating chlorotic patients with an emulsion of pulverised
spleen, bitter almonds, and brandy. In the five coses in
which this was adopted, rapid improvement took place both
in the general condition of the patients and in the physical
signs; that is to say, the number of red blood-corpuscles was
increased, as also the arterial tension and the body weight.
The author does not attempt any explanation of the action
of this singular remedy. The quantity of “ polp. splenic.”
given daily was about five ounces, and it was ordered at
meal-tomes.

PROTECTIVE INOCULATION FOR BOVINE CON¬
TAGIOUS PLEURO-PNEUMONIA.

The a n ima l plagues which have for so many years com¬
mitted such havoc among our flocks and herds are gradually
becoming amenable to the measures of sanitary police
devised for their limitation and ultimate suppression.
Indeed, one of the most troublesome and costly of these
maladies—that popularly known as the foot-and-mouth
disease—seems to be entirely eradicated from our soil after
harassing cattle-owners since 1839, ae no cases have been
reported in the three kingdoms for several months. But its
companion diaease, the so-called lung-plague, or “plenro,”
as the dairymen and butchers designate it, which appeared
in Great Britain in 1842!, yet lingers in some parts of the
country, and particularly in Scotland, in spite of the
efforts of local authorities. This disorder has been a
most serious scourge, not only in the United Kingdom,
but also on the European continent, notably in Holland

(which has now, however, stamped it out), from which
country it was originally introduced into our own. Within
the last thirty years it has been carried into nearly every
part of the world, and its desolating effects are now being
experienced in South Africa, Australia, and the United
States of America. The difficulty in suppressing it is mainly
due to its insidiousness—the invasive stage being most
difficult to detect—the uncertain duration of incubation;
and the fact that an animal which has been imperceptibly
affected, or which has apparently recovered, may for a long
time afterwards infect healthy cattle, owing to a necrosed
piece of lung, more or lees encapsuled, continuing to give
off infective elements during expiration.

The disease, unlike rinderpest and foot-and-mouth
disease, appears to be exclusively confined to the bovine
tribe, all attempts to transmit it to other species having
failed; and no authentic instances of accidental trans¬
mission to other animals or mankind, even by the ingestion
of the milk or flesh of diseased cattle, are recorded.

In order to diminish the ravages of this lung-plague,
protective inoculation, first introduced by Dr. Willems of
Hasselt (Belgium) some thirty years ago, has been resorted
to in this country, on the Continent, and in South Africa
and Australia. The value of this procedure has been
thoroughly established, the protection afforded by the
inoculations having been demonstrated in the most marked
manner during outbreaks of the disorder, and also by the
experiments instituted by commissions appointed by the
Governments of Franco and other countries. The virus for
inoculating purposes is obtained from the diseased lung at
a certain stage, and, as may be surmised, great care is
necessary not only in collecting and keeping it, but also in
introducing it into the body of the ox which is to be pro¬
tected. Indeed, success or failure depends upon the skill of
the inoculator, as he must not only be cognisant of how to
obtain the material in its purest and most active condition
but also when and Where to introduce it, and how to
control its action when inoculated. The infectiyeness of the
virus is extraordinary. If a drop of the serous fluid from
a diseased lung is inserted beneath the skin of a part where
the connective tissue is loose and abundant—as in the
dewlap of the ox—the effect is most serious, death being
the result in almost every case from rapid extension of the
morbid process set up to vital organs. To obviate such
unfortunate accidents, the extremity of the tail is now
selected, as there the connective tissue is scantier and denser
than elsewhere; and when the morbid action threatens
to extend to the body, timely amputation of a portion of
the organ—necessitated by certain indications manifesting
themselves beyond the seat of inoculation—at once checks it.

Protective inoculation can be resorted to with great
advantage when a district or country is invaded by the-
disease, and slaughter of all the cattle therein would prove
a serious calamity. Even in the case of valuable herds,
when the disease has only attacked one or two animals, and
it is of great importance that its extension should be checked
and the remainder of the cattle saved, there is good reason
for the adoption of the measure; though the " stamping-out
method, entailing the slaughter of all, has its advocates.
These urge the danger of allowing cattle to live which may,
through contact with the sick, have only a small portion of
lung involved, present no symptoms, are inoculated, and so-
are supposed to be safe to place among others, while all the
time they are capable of infecting. This is really the danger
attending the practice of inoculation, a danger not easily
avoided, because of the difficulty of thoroughly exploring
the thoracic cavity of the ox, owing to the thick skin and
parietes, and the unfavourable position of the animal for
examination.

There seems to be no danger of infection from cows-
during the inoculation period, no reliable evidence having
been adduced that this operation tends to spread the disease,
or to maintain it in districts where it is prevalent. On the-
contrary, there are numerous instances recorded in wbiob
the extension of the scourge in a cowshed has been
stopped in a few weeks after inoculation has been
practised, and the inoculated cattle have resisted sub¬
sequent infection under the most favourable conditions
for receiving it. Holland has been freed from lung-plague-
by energetically slaughtering the diseased and inoculating
the unaffected, and France has adopted the same course. In
| this country no experiments of a public kind have been
j instituted to set at rest the value of protective inoculation
I for this malady, and notwithstanding strong evidence in

'3

192 TheLancbt]

PHTHISIS IN THE ARMY.

[Jan. 22,1887-

its favour, its adoption is strongly opposed by those who
favour the expensive, but thoroughly effective, plan of
wholesale slaughter of the sick and suspected, the latter
including all the cattle which have been directly or indirectly
in contact with the former.

PHTHISIS IN THE ARMY.

At the Statistical Society on Tuesday evening a paper
was read by Robert Lawson, Esq., LL.D., Inspector-General
of Hospitals, on the Mortality among Troops serving in the
United Kingdom from Consumption. After stating the
sources from which the rates of mortality from phthisis in
the army and in civil life respectively were obtained, the
author showed in a tabular form the ratio of deaths in civil
life from this disease at five periods of life between seven¬
teen and forty-five in the five years 1838-42 and the seven
quinquenniads 1850-84. The decrease in the mortality from
phthisis in the later periods he considers to be mainly
attributable to hygienic measures, and perhaps to some
extent also to more successful medical treatment. In
making a comparison of the death-rates in the army with
those in civil life, the author pointed out the necessity of
adding to the military deaths a certain proportion, which he
shows reason to estimate at one-half, of the men discharged
the service in each year on account of consumption. Calcu¬
lating the ratio of deaths upon the numbers living, and
bringing it into comparison with theproportion which would
have occurred in civil life in a population with the same
age distribution as the army, the following results were
obtained:—

Phthisis observed.

Period*.

Phthisis
in army at
civil rates. 1

Deaths.

| Half of |

| discharges, j

Total

deaths.

1837-18 .

609

8-63

1 !
0-85 |

938

1860-34 .

3-63

307

2-70

6-77

1865-69 ••• ...

3-81

2-57

’ 2-26 .

• 4-83

•1870-74 .

. 339

2-43

2-21

4-64

1875—79 ... •••

321

. 246

1 2-22 |

4-67

1880-84 .

2-70

1-92

1 ™ |

363

The actual reduction in the deaths among the troops in
the latter as compared with the first period is to some
extent due to increased facility of invaliding phthisical
cases; but with the correction made by Dr. Lawson there is
still a marked progressive diminution to the extent of about
three-fifths. The table, however, shows clearly that “at
■every period mentioned service in the army was attended
•by greater mortality from phthisis than would have been met
with among men of the same age exposed to the ordinary
•causes of that disease in civil life.” Dr. Lawson questions the
opinion held by many of the medical officers that this de¬
crease was to any great extent attributable to improved
ventilation in barracks. He believes it to have been much
more in consequence of removing a considerable number of the
■troops from tbe towns in which they were quartered to camps
at Aldershot,Shorncliffe, Colchester, and the Curragh, and to
«n improvement in their clothing by the adoption of woollen
shirts for linen or calico. He also considers the abolition of
white trousers and the substitution of woollen material for
■them to have exercised a beneficial influence. Dr. Lawson
pointed out that the mortality from consumption has de¬
creased also among the troops in the colonies, with the excep¬
tion of Mauritius aod Ceylon. In a subsequent table it
was shown that while so marked a decrease occurred in
the general death-rate among troops at home, it was greater
in deaths from phthisis than from other diseases. Instead
-of the former—as in 1837-46—constituting 62'3 per cent, of
the whole, in 1880-4 they only amounted to 43 8 per cent.

In the discussion that followed,' Dr. LongstafF, Captain
Douglas Galton, Dr. Marston, Dr. Dickson, Dr. Lloyd, R.N.,
<and others took part.

Dr. Longstaffs criticism mainly bore upon the differences
between the military and civil portions of the community,
rendering comparisons between them difficult, and, as affect¬
ing the statistical deductions, unreliable.

Captain Galton spoke of what had been done in effect-
-ing sanitary improvements in barracks since the time of

Lord Herbert, and dwelt upon the fact that there was a
great diversity in regard to these in different barracks, and
even in different portions of the same barrack, rendering it
difficult to gauge exactly their effect on the soldier’s health.

Dr. Marston adverted to the large prevalence of ophthalmia
in the army twenty-five or thirty years ago; the amount^ of
inefficiency and invaliding it caused then as compared with
the practically insignificant amount of the same disease
now; and he urged that this could only have been due to the
removal of a main factor in its production—vix., the effects
of overcrowding and imperfect ventilation. Clothing migh t
fairly be estimated as a cause of disease. He likewise
called attention to the prevalence of pulmonary disease
among the crews of ironclads years ago, and to the prejudicial
effect of crowded and badly ventilated buildings in causing
these diseases, as proved by his experience in India and
Afghanistan. He traced the operation of the same factor
in affecting tbe incidence and prevalence of epidemic disease
generally, and cited some illustrations.

Dr. Dickson and Dr. Lloyd, R.N., followed, and Dr. Lawson
in his reply, after meeting Dr. Longstaff’s criticism, ex¬
plained, in effect, tbat owing, no doubt, to the difficulty of
grasping the points in a statistical paper of this kind some
misapprehension had arisen. He did not at all depreciate
the effect of sanitary improvements, but he bad endeavoured,
to point out some of the directions in which these had
operated that had not hitherto received due attention.

BRITISH MEDICAL BENEVOLENT FUND.

Thb annual general meeting of subscribers to this Fund
was held on Monday, Jan. 10th* at 34, Seymour-street,
Portman-square, the residence of the treasurer, at 4 p.m.,
when the chair was taken by Dr. Jonson, chairman of the
committee, in the unavoidable absence of the President,
Sir George Burrows, Bart.

The financial statement was submitted and the annual
report of tbe committee read, from which it appeared tbat
the donations during 1886 had amounted to .£869 5s. Or/.,
subscriptions to £1228 9s. 5 d., exclusive of £226 8s. Id. con¬
tributed from the Jubilee Fund—a total of £2324 3s., which
shows an increase over tbe receipts of 1885 of nearly £300.
The disbursements during tbe year bad been, in grants to
183 applicants, £2128; in annuities distributed amongst
61 old people, all over sixty years of age, £1074. The
cost of collection and distribution of this large bum
(over £5500), minimised though it is by the fact that tbe
officers are all honorary (with the exception of the
collector), amounted to £130, including stationery, col¬
lector’s commission, the printing and postage of the
report (6f which a copy is sent to each subscriber), the
postage and other expenses of the secretaries for financs and
cases, and the postal and incidental expenses connected
with the distribution of over £3200 in weekly or monthly
instalments, which is a peculiar characteristic of this Fund,
carried out by means of the Cheque Bank, and by Dr. Jonson
as regards the annuities. The distribution of grants
is entrusted to the various honorary local secretaries, when
it can be done without imposing too irksome a burden upon
those gentlemen who so kindly undertake that duty. The
numberof applicants for grantB was209, of whoml83 (an excess
of two over the number relieved in any previous year) re¬
ceived sums varying from £5 to £20, and many of those
inadequately relieved would have been given larger grants,
had the sum in the hands of the committee been larger.
Personal inquiry proved dire and distressing want in many in¬
stances amongst tnose wb o had been brought up in comparative
ease and comfort, and who, by the death of the breadwinner,
found themselves dependent upon charity for the common
necessaries of life. If this applies to the case of those in
receipt of grants, how much more must it occur in the cases
of those who, in addition to want of money, are suffering
from the weight of years. Of such, the list of an¬
nuitants efforts many an example, and well shows the
infinite good wrought by this charity. The celebration of
the Jubilee Year by a banquet in July, under the presidency,
and aided by the distinguished advocacy, of Sir James
Paget, including a donation of £100 from Her Majesty the
Queen, resulted in the addition of £3000 to the funded
property from which the annuity payments are derived.
This splendid addition will allow of the creation of new

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TKbLaxckt,]

TdE ERASMUS, WILSON BEQUEST.

[Jan. 22,1887. 193

MmAtiea ud a consequent relief to the donation or grant
dMAOMt.

b- Brett of Watford joined the Committee of Management,
place of the late Dr. Harvey Kowen, a liberal con-
' during hie lifetime, and the generous donor of a
of £500. The names of Dr.. Coates of Bath, Dr.
nva Duncan, and Dr. R. Quain were added to the list
-Presidents of the Fund, in recognition of their
BkinBty. __

THE ERASMUS WILSON BEQUEST.

(.following memorial, to which we alluded last week,
addressed to the President, Vice-Presidents, and
of the Royal College of Surgeons of England:—
in,—W e, the undersigned, being informed that
of a considerable amount has been bequeathed to
tfie late Sir Erasmus Wilson for the benefit of the
p, and presumably for the advancement of science,
ipectfully to direct your attention to the need of
t of those collateral branches of medicine which can
>njish by liberal pecuniary aid. We would, therefore,
r t to you the desirability of founding an institution
r the direction of the College which shall have for its
‘physiological and pathological research.” The want
an institution in England has long been felt, and
:ially of late, when we have had to look to Berlin for
don respecting tubercle and to Paris for experiments
(prevention of hydrophobia. It is a national discredit
have nothing in London like the splendid labora-
i which exist not only in the capital cities of Europe,
i, comparatively small towns, such as Bonn, Strasburg,
Hpsic. There is little prospect of the Govern mentestab-
; such an institution, or of its being founded by public
>tion; the only hope of its foundation lies in the
» bequest of a large sum of money to be devoted to
io uses. An opportunity has now occurred which
it it in the power of the College to carry this into
an opportunity which if now lost may never recur,
mdation of an institution of this nature would tend
England to the scientific position held by France
many, would create a body of men anxious to
themselves to scientific work, would be in accord
best wishes of the donor, and would place the
i College of Surgeons of England amongst the foremost
ttions of Europe. The President and Council would
.Ung much to their honour if, when an endeavour is
[jmade to strengthen the Empire by a consolidation of
" mies, they founded an institute in the mother
which should draw to it students from all parts of
ajesty’s dominions,
remain, gentlemen, yours obediently,

John Eric Erichscm. F.R C.S.; J. Hughlings Jackson,
8ir Henry Thompson, F.R.C.S.; Sir J. Fayrer,
ifL n X.aS.U M.D. ; David Ferrier, M.D.; Sir William W.
jgfr Gall, Bart., M.D.; W. Watson Cheyne, F.R.C.S.;
- Francis Gal ton, M.A.; Geo. H. Savage, M.D.; George
Pollock, F.R.C.8.; Sir Jas. Risdon Bennett, M.D.;
H. Pye-Smitb, M.D.; John Simon, C.B., F.R.C.S.;
* X. Klein, M.D.; Sir Henry W. Acland, K.C.B, M.D.;
£ George J. Romanes, F.R S.; F. W. Pavy, M.D.; W. H.
Flower, F.R.S.; Sir Andrew Clark, Bart., M.D..; Sir
.X. Bowman, Bart., FES.; Richard Quain, M.D.;
Gerald F. Yeo. M.D.; George Fleming. LL.D.; W. H.

. t- Broad bent, M.D. • Thos. Stevenson, M.D.; Victor
Horsley, F.R C.S.; Sir Edward H. Sieveking, M.D.;
dA.T. Lauder Brunton, M.D.: E. A. Schafer, M.R.C.S.;
W. Withe* Mcore, H.D.; Robt. Cory, M.D.; H. N.
t'Jfoeeley, F.R.S.; E. Ray Lank ester, F.R.S.; R.
>fiK<denell Carter, F.R.G.8. ; Charles E. Groves, F.R.8.;
fiae H. Huxley, F.R.C.S.; Arthur Gamgee, M.D.;
iTyndall. F.R.8.; 8ir John Lubbock, Bart.; Jos.
>. Booker, F.R.8.; W. T. Thiselton Dyer, F.R.S ;
P 8hMey F. Morphy, M.R.C.8.; M. Foster, M.D. ; J.
• BMf Dorf on Sanderson, M.D.; Charles S. Rov, M.D.;

Darrin, M B.; Hugo Muller, F.R.S.; J. N.
‘ It. R.8.: W. H. Corfield, M.D.; W. H. Gaskell,
MacAIister, M.D.; Samuel Wilks, M.D.
rMat^friribed gentleman acted as secretary.)

IjjM announced last week, referred
Lt&e wue^on as to the disposal of the
i tfc -wait pi fife Erasmus Wilson.

HD.

HEALTH OF THE METROPOLITAN POLICE.

Sib Chahles Wariien states the “authorised strength
on Dec. 31st, 1885,” to have been 13,319, but nowhere in the
report is the average strength throughout the year given.
Of this strength, 12,586 were employed in the metropolitan
divisions, and 783 in the dockyards and military stations of
Woolwich, Portsmouth, Devonport, Chatham, and Pembroke.
The Chief Surgeon reports that “ the total number of separate
individuals who were on the sick list during the year 1885’'
was 6328, but he does not state how many cases occurred,
nor does he give any information respecting the diseases
.from which the men suffered or .the number constantly
off duty on account of sickness. There were 204 men
admitted into general or special hospitals, and 20 into naval
hospitals during theyear, but thereis nothing toshowwhether
these were included in the number stated above. The deaths
amounted to 66, of which 16 occurred in hospitals; 1 man shot-
himself, 1 was drowned, 1 was killed by accidentally falling,
downstairs, and 3 died from fractures, in one case complicated,
with delirium tremens. The proportion of deaths to strength
for the whole force was 4 96 per 1000; only one of the deaths
occurred among the men employed in tbedockyards. Th e death -
rate in the metropolitan divisions was 516 per lOOOof strength,
a ratio which compares favourably with previoueperioda. In
the five years 1852-6, it amounted to 7'6, or excluding deaths,
from cholera, which was epidemic in 185S-4, to 7'4 per 1000,
and in 1880 it was 6‘4 per 1000. Of the 65 deaths in the
metropolitan divisions, 31 were caused by pulmonary diseases,,
being in the ratio of 2 46 per 1000 of the strength, and-
lower than in either of the two previous periods. The men
removed from the force on account of being “ incapacitated
by sickness or long service” amounted to 222, or 16 67 per
1000. This is very much below the proportion returned as
“ invalided” in previous reports, having been 35 in 1852-6'
and 25 in 1880; but there may probably be 6ome difference
in the mode of recording the discharges at these different
periods. In the present return the cause of invaliding is
stated in only 163 cases; 44, or upwards of one-fourth,
were assigned to rheumatism, rheumatic gout, and sciatica ;•
22 to long service, age and debility; and 16 to pulmonary
diseases. 8o far as we can ludge from the information-
afforded by the returns, the health of the force has been very-
satisfactory. _

THE PARKES MUSEUM.

Thb annual report of this institution, which was presented 1
at the general meeting in December, shows conclusively that
the work which is being done by the museum is of a kind
calculated to be of great utility to the public. Since its-
inception, now nearly eleven years ago, the annual records
of the work done have none of them, we think, equalled-
the record of 1886 for real solidity in its accomplished facts.
Early in the year 1886 it was suggested that a course of
lectures should be given intended to meet the require¬
ments of persona desirous of qualifying for such offices
as that of inspector of nuisances, &c. No difficulty was-
found in arranging these lectures. Professors de Chaumont,
Corfield, Robinson, Messrs. Easaie, Percy, Boulnois, Shirley
Murphy, Wynter Blytb, Sykes, and Cassal each expressed
their readiness to help by delivering one or two lectures
intended to form part of a coherent course, and it is
no bonder that with such a well-qualified staff the
lectures became popular. A fee of 5s. was charged,
with the result that some sixty persons attended the
course; and when, as was necessary, the course was re¬
peated in the autumn, Beventy-five persons were found who
•were eager to pay the small fee and listen steadily to the-
instruction offered. This is work of the right kind, and
work which, as we have said above, must benefit the public.
The lectures are admirably calculated for' the audiences to
which they are delivered, and the museum affords abundance-
of material with which to illustrate them. In lectures such
as these the museum finds its true, mission. The collection
is not one calculated to attract the public at large, and it is
obvious that the person who is ignorant in sanitary matters
would fail to appreciate the exhihite, many of which are of
a very technical character. When, however, the lecturer

194 Tub Lancet,]

ADULTERATION OP FOOD AND DRUG8 ACT.

L Jan. 22,1887.

and the museum collection become mutually complementary
to each other the value of each is enormously increased.

The ordinary lectures to the members were well attended.

Most of the recognised teachers of hygiene brought their
classes to the Museum for practical instruction.

The library, we are told, has been enriched during the
past year by 450 books and pamphlets, and the card catalogue
is completed, so that the work of reference is easily carried
on. Those of our readers who issue annual reports on
sanitary subjects would do well to remember the import¬
ance of sending such reports to this central library devoted
to sanitation, which is yearly becoming of more and more
importance.

The lectures for the ensuing year are to be given, not as
heretofore in the evening, but at five in the afternoon—an
hour which it is hoped may prove convenient to the
majority of members and their friends. The first lecture
is arranged for Thursday next, .Tan. 27th. The lecturer
is Mr. Ogle Tarbotton, M.Inst.C.E., and the subject is
“ Engineering and Architecture in relation to Sanitary
Science.” Captain Douglas Galton, F.R.S., will occupy the
chair.

ADULTERATION OF FOOD AND DRUGS ACT.

A spbciax general meeting was held on Jan. 12th at the
Lecture-room of the Sheffield Pharmaceutical and Chemical
Society, Norfolk-row. The meeting was called “ to consider
the recent ruling at Sheffield Town Hall under the ‘ adultera¬
tion of Food and Drugs Act.’ ” The chair was occupied by
the President, Mr. Newsholme, and there was a large attend¬
ance, the room being almost filled.

The Chairman proposed the first resolution, which was as
follows: “That this meeting, specially convened, views
with alarm the recent decision of the Sheffield stipendiary
magistrate * that a preparation containing any opium and
any alcohol whatever may be legally sold as tincture of
opium’; and this meeting is of opinion that if this be upheld
*s legal, and is acted upon, it is likely to interfere dangerously
with uniformity and with the public safety. It would
further affirm that the only tincture of opium acknowledged
generally by the trade is that of the British Pharma¬
copoeia.

The resolution was carried unanimously, as was also the
following:—

Moved by Mr. Ward, F.C.8.: “ That this meeting expresses
also its astonishment at the judgment recently given with
respect to paregoric, that any preparation of a soothing
nature may be sold under that name. It holds that the fact
of two or more dissimilar prepartions having the same name
is so dangerous to public health that it is desirable the
Pharmacopoeia Committee should adopt, as a synonym of
the oompound tincture of camphor of the Pharmacopoeia,
that which is commonly known as paregoric, paregoric
elixir, and elixir paregoric.”

Moved by Mr. Preston: “That this meeting desires to
point out its determination strictly to conform to the
British Pharmacopoeia as binding upon it, in accordance
with the Order in Her Majesty’s Privy Council made respect¬
ing thereto.”

■ This resolution was carried almost unanimously, and a
vote of thanks to the Chairman concluded the meeting.

practise their profession. Dr. B. W. Richardson, President
of the Association, Sir J. Crichton Browne, Surgeon-General
Gordon, and Dr. Hicks, F.R.8., spoke in support of the
memorial. Mr. Balfour and the Lord Advocate, in reply to
the deputation, assured them that the ancient University of
St. Andrews was secure of the good-will of Her Majesty’s
Government, and that the memorial itself and the arguments
in support of it would receive due attention. They also inti¬
mated to the deputation that evidence upon the matter set
forth in the memorial would be received by the Commission
about to be appointed to inquire into the constitution and
endowments of the Scottish Universities, and the deputation
agreed to furnish this evidence to the Commission. A cordial
vote of thanks to Mr. Balfour and to the Lord Advocate for
their courtesy and attention was then proposed and carried
unanimously.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5866 births
and 4263 deaths were registered during the week ending
Jan. 15th. The annual death-rate in these towns, which had
increased in the preceding four weeks from 20 - 7, to 26 5 per
1000, declined again last week to 241. During the thirteen
weeks of last quarter the death-rate in these towns
averaged 20 3 per 1000, and was 21 below the mean rate in the
corresponding periods of the ten years 1876-86. The lowest
rates in these towns last week were 17‘4 in Portsmouth,
193 in Bradford, 19 3 in Sunderland, and 19 8 in Oldham.
The rates in the other towns ranged upwards to 80 - 4 in
Cardiff, 308 in Blackburn, 31*0 in Manchester, and 316 in
Wolverhampton. The deaths referred to the principal
zymotic diseases in the twenty-eight towns, which had
been 537 and 475 in the preceding two weeks, were last
week 485; they included 195 from measles, 95 from
whooping-cough, 82 from scarlet fever, 48 from “fever"
(principally enteric), 34 from diarrhoea, 31 from diph¬
theria, and not one from small-pox. These rymotie
diseases caused the lowest death-rates last week in
Brighton, Portsmouth, Nottingham, and Bolton; and
the highest rates in Leeds, Sunderland, and Hudders¬
field. The greatest mortality from measles occurred in
Liverpool, Wolverhampton, Newcastle-upon-Tyne, Halifax,
Leicester, and Leeds; from whooping-cough in Bristol,
Plymouth, Preston, Sunderland, and Huddersfield; from
scarlet fever in Norwich, Bristol, Manchester, Blackburn,
Sheffield, and Sunderland; and from “ fever” in Birkenhead
and Plymouth. The 31 deaths from diphtheria in the twenty-
eight towns included 18 in London and 5 in Birmingham.
Small-pox caused no death in London and its outer ring,
or in any of the twenty-seven large provincial towns. Only
2 cases of small-pox were under treatment on Saturday last
in the metropolitan hospitals receiving cases of this disease.
The deaths referred to diseases of the respiratory organs in
London, which had increased in the pre<*ding four weeks
from 416 to 731, declined again last week to 591, but ex¬
ceeded the corrected average by 89. The causes of 107, or
2-5 per cent., of the deaths in the twenty-eight towns last
week were not certified either by a registered medical prac¬
titioner or by a coroner. All the causes of death were duly
certified in Cardiff, Birkenhead, Derby, and Plymouth. The
largest proportions of uncertified deaths were registered in
Sheffield, Halifax, and Huddersfield.

ST. ANDREWS GRADUATES’ ASSOCIATION.

On Friday afternoon last, Mr. Balfour, Secretary for
Scotland, and his colleague, the Lord Advocate, received a
deputation of the St. Andrews Graduates’ Association at
Dover House, Whitehall. The memorial, signed by 789
graduates of the University, urged that an endowment be
found for two additional professors—viz., a Professor of
Anatomy and a Professor of Botany, so that the University
may be enabled to give two anni m-edici to medical students
attending the University. After completing their two years’
course of preliminary and theoretical study, they could go
for practical and clinical work to any of the great hospitals
of the United Kingdom most convenient to them; they
could then return to the University and submit themselves
to examination, and thus obtain graduation and a licence to

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 25 - l and 29’9 per 1000 in the preceding
two weeks, declined again to 261 in the week ending
Jan. 16th; this rate exceeded, however, by 2-0 the mean rate
during the same week in the twenty-eight large E nglish
towns. The rates in the 8cotcb towns last week ranged from
16'4 and 180 in Greenock and Leith, to 30 9 in Glasgow and
333 in Paisley. The 652 deaths in the eight towns last week
showed a deciine of 94 from the number in the previous week,
and included 26 which were referred to whooping-cough, 13
to scarlet fever, 10 to measles, 10 to diarrhoea, 7 to “ fever”
(typhus, enteric, or simple), 5 to diphtheria, and one to small¬
pox ; in all 72 deaths resulted from these principal rymotie
diseases, against 63, 73, and 94 in the preceding three
weeks. These 72 deaths were equal to an annual rate of

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PPEVEE CASES 1N‘GENERAL HOSPITALS.”

[Jan. 22,1887. 195

2*9 per MOO, which wm 02 above the mean rate from
the eame diseases in the twenty-eight English towns.
The fatal cases of whooping-cough, which had been
Id, 21, and 27 in the previous three weeks, were last week
26, of which 18 occurred in Glasgow, 4 in Edinburgh, 2 in
Aberdaetuuid 2 in Paisley. The 18 deaths from scarlet fever
corresponded with the number in the previous week, and
included 8 in Glasgow and 5 in Edinburgh. The 10 deaths
attributed to diarrhoea showed a decline of 8 from the number
in the previous week; 5 were retained in Glasgow and 2 in
Edinburgh. AH the 10 fatal cases of measles occurred in
Glasgow. The seven deaths-referred to “fever” corre¬
sponded with the number in the previous week; and in¬
cluded 2 in Glasgow, 2 in Greenock, and 2 in Paisley. The 5
fatal cases of diphtheria showed a decline of 12 from the num¬
bers in the previous week; 4 were returned in Glasgow. The
death referred to small-pox was a fatal case of chicken-pox
in Gla sgow. The deaths from acute diseases of the
respiratory organs in the eight towns* which had been
179 and 213 in the preceding two weeks, declined again
last week to 181, but exceeded the number in the corre¬
sponding week of last year by 36. The causes of 86, or
more than 13 percent^ of the deaths in the eight towns last
week were sot certified. _

• HHALTH car DUBLIN.

The rate of mortality In Dublin, which had been 38 0 and
31 - 3 per 1000 in the preceding two weeks* rose again to 36-2
in tne week ending Jan. 15Lh. During the thirteen weeks
of last quarter the death-rate in the city averaged
26*7; the mean rate during the same period dia not exceed
18*8 in London and 19 5 in Edinburgh. The 245 deaths in
Dublin last week showed an increase of 33 upon the number
retained in the previous week, and included 8 which were re¬
ferred to scarlet fever, 7 to diarrhoea, 4 to “fever” {typhus,
enteric, or simple), 2 to whooping-cough, and not one either
to small-pox, measles, or diphtheria. Thus the deaths from
these principal rymotic diseases, which had declined in the
preceding five weeks from 23 to 13, rose again last week 1
to 21; they were equal to an annual rate of 31 per 1000,
the rates from the same diseases being 2*3 in London and
2*4 in Edinburgh. The fatal cases of scarlet fever, which
had been 11 and 6 in the preceding two weeks, rose again
last week to 8; the deaths from diarrhoea and diphtheria
also showed an increase upon the numbers in the preceding
week; while those from “fever* showed no variation.
The deaths both of infants and of elderly persons showed
a considerable increase upon the numbers In the previous
week. Five inquest cases and 5 deaths from violence were
registered; and 82, or more than a third, of the deaths
occurred in public institutions. The causes of 41, or more
than 16 pet cent., of the deaths registered during the
week were not certified.

the Services.

India Officb. —The Queen has approved of the following
pro mo tio n s made by the Governments in India:—Surgeon-
Major James Hunt Condon, M.D., of the Bengal Medical
Establishment, and Surgeon-Major Edward Seaton, M.D., of
the Bombay Medieal Establishment, to be Brigade Surgeons.

▲mcraAX.iT. —The following appointment has been made:
Surgeon Ernest Apthorpe, to the Bullfrog.

Rlflb V oluNtkrrs.— 1 st Dumbartonshire: Acting Sur¬
geon William Mackie resigns his appointment.—1st Elgin:
Acting Surgeon D. Hardie resigns his appointment.

The Croydon Sewage Farm.—T he Beckenham
Local Board have given instructions for an injunction to be
applied for to restrain the Croydon corporation from con-
tinning to use their sewage farm at South Norwood. It is
aHegea that the farm causes an intolerable nuisance, and is
prejudicial to the health of the locality. The Beckenham
board will, it is stated, probably be joined in the application
by other adjacent local authorities.

Perils of Juvenile Parties,—I t is stated that
after a juvenile ball given. by a well-known Spanish noble¬
man, seventeen, of the children who had been present were
found to be differing from measles, one of the little guests ;
having only just been convalescent from that affection.

(fomaponime.

" Audi alteram partem.’*

“ FEVER CASES IN GENERAL HOSPITALS.”

To the Editors qf The Lancbt.

Sirs,— In your short article, on page 83 of your issue
dated 8th inst., approving the decision of the governors of
the Sussex County Hospital, situated in the borough of
Brighton, to exclude in future cases of typhus, scarlatina,
and measles (small-pox is already proscribed) from the
hospital, you do not appear to have been fully informed as
to the ample provision which has been made by the Corpora¬
tion for the isolation and treatment of these and other in¬
fectious diseases. Will you, therefore, allow me to supple¬
ment this deficiency, and to put your readers in possession
of the cardinal facts relating to the question.

About six years ago the Town Council—which is the
sanitary authority of the borough—purchased ten acres of
ground to the north of the town or on the Downs, well
removed from' all human habitations, and in due course
proceeded to erect thereon a commodious sanatorium at a
Cost of about .£13,853, so arranged and divided as to enable
the sanitary committee, assisted by the health officer, to
cope not. only with the ordinary, but also with any extra¬
ordinary, demands that might be made upon its re¬
sources. The administration block provides accommoda¬
tion-for the physician, matron and steward, nurses, and
fetnale servants. The numerous wards and the conva¬
lescent rooms can be separately heated at any moment,
and maintained at any temperature required. The ventila¬
tion is unimpeachable. The arrangements are such
that each form of contagious disease oan be effectually
quarantined from ail other types* The sexes are also
separated. So that there are two wards assigned for each
variety or type of fever, each being equipped with its own
nursing establishment and other necessary appointments.
Any of thes*compartments can be fumigated and disinfected
with ease -, aad, as a matter of precaution, this is repeatedly
done to make assurance doubly sure. The disinfecting
apparatus is open for the use of the public as well as for
that of the inmates of the sanatorium. There is an efficient
laundry. Telephonic communication exists with the porter's
lodge, the Town Hall, and one of the police stations. For
the extinctionqr limitation of fire, hydrant? have been fixed,
and are periodically inspected and reported upon, like
others in the town, to the Watch Committee. A Lewis
band fire-extinguisher is suspended in every ward.

From the foregoing summary, it will be gathered that, as
regards the town of Brighton, the quarantine afforded is all
that can be desired. The public are still further protected
by the employment of an ambulance for the transport of
atients and their infected clothing See., and by its thorough
isinfection after being used. The risks involved in con¬
veying in cabs persons suffering from infectious disease are
thus avoided. As regards the different kinds of fever, the
segregation on the spot, and the periodical purifications
of the wards Sec., are about as perfect as they can be made.

Luring the meeting of the British Medical Association
here in August last, the hospital wqs visited by a large
number of medical practitioners and health officers, who,
without exception, accorded to its management and organisa¬
tion their full and unqualified approbation. Then there
were only four patients. The numbers have seldom exceeded,
at any time, a very minute tithe of those for whom pro¬
vision can be inade at the shortest notice. But, seeing that
Brighton has occasionally suffered from want of a refuge of
this description, the Corporation, in the exercise of the
feanitary powers vested m them, have doubtless acted
wisely ana well, in providing, on a large and liberal scale,
readily admitting of much elasticity either in the direction
of expansion or contraction, for every emergency.

The commissioners of the adjoining town of Hove have
lately opened their splendid Sanatorium which, with the
ground, it is believed, cost about £10,000. It is placed at a
safe distance, and convenient enough to Aldrington and
Portslade—both rising and growing communities; and it
may probably be eventually utilised by the inhabitants of
these places as well as by those of Hove.—Yours truly,

Joseph Ewart, M.D.,

Chairman of the Sanitary Committee,
Brighton, Jan. 14th, 1887 ■ Brighton Town Council.

196 The Lancet,]

THE MEDICAL REGISTER *—* SCHOOL-MADE CHOREA.’

[Jaw. 22,1887.

THE PROVIDENT PRINCIPLE AND THE MEDICAL
PROFESSION.

To the Editors of Thb Lancbt.

Sirs,— In condensing into a single paragraph in your
'leading article in The Lancet of to-day the proposals for
united action between hospitals, general and special, and
-dispensaries, provident or otherwise, in each district of
London, contained in my Sturge Prize Essay, you do, I
think, some injustice (quite unintentionally, I am sure) to
nn idea for which 1 lay no claim of originality, it having
been expressed in both the other successful essays, and
.possibly in many others of the seventy or eighty which were
not successful. The following passage will place the
matter before your readers in its true light:—

“ If the managers of hospitals desire, as no doubt they do,
■to have their incomes increased in proportion to the needs
of an enormously increased and still increasing London, they
-must be prepared to abandon the policy of isolation which
leads eacn institution to appeal for itself alone, and to act
as if unconscious of the presence of other medical charities
in its neighbourhood. The union, for certain purposes, of a
.group of general and special hospitals and dispensaries in
each district of London is to be advocated on many grounds,
not the least of which is that it would greatly facilitate the
making of effective appeals for funds in a systematic
manner. It would also render it easier for the public to
■distinguish between useful and useless charities, and for
hospital managers to compare the different modes of
keeping hospital accounts, and of making appeals to the
public, with the object of securing the general adoption of
what seemed to be the best. It would be almost a necessary
preliminary to the systematic workshop collections advocated
-above, as it would render it possible to offer subscribers the
-option of going to any of the united medical institutions in
their district. A further step in advance would be the union
of these various groups under one council with a central
office.”

I must not trespass on your space so far as to explain
what are the “ systematic workshop collections” mentioned
in this passage, but I shall be happy to send a copy of the
•essay to any of your readers interested in the subject.

I am, Sirs, yours faithfully,

Southville Park Villa*. Jan. 18th, 1887. H. NELSON HARDY.

THE MEDICAL REGISTER.

To the Editors qf The Lancet.

Sirs,— With reference to my communication as to the
registration of the diploma of Member of the King and
■Queen’s College of Physicians in Ireland, and the degree of
Master in Obstetrics of the Universities, which appeared in
The Lancet of Dec. 25th, I have since that time been
engaged in correspondence with the English and Irish Offices
•of the Medical Council as to the refusal of the Registrar of
the Branch Medical Council for Ireland to carry out Clause 20
•of the Medical Act, 1886. The result is that these qualifica¬
tions are now registrable in England, Ireland, and Scotland,
and I understand that those already on the Register can
"have these additional qualifications appended to their names
in the Register for 1887 by making application to the
Registrar for Ireland during the next week or ten days.

I am, Sirs, yours &c.,

Dublin, Jan. 15th, 1887. C. FREDK. KNIGHT, M.D.

“SCHOOL-MADE CHOREA.”

To the Editors of The Lancet.

Sirs, —Having a year or two ago acted for twelve months
«s honorary correspondent to one of thelargest Board schools
in London, I have read with much interest in The Lancet
of last week Dr. Sturges’ contribution and the leading article
•upon the subject of school-made chores.

Dr. Sturges clearly makes out two points. First, that by
neglect of the temperament of children chorea is sometimes
caused by the mere distress of uncongenial work. Secondly,
that when chorea has just begun in a child it often remains
unnoticed, and so becomes much exaggerated by school work.
The remedy for the first grievance will, I am afraid, remain
far distant so long as the present system of forcing children
through certain standards, irrespective of their inclination

and capabilities, prevails. The second complaint, that of the
neglect of commencing chorea, is only a small part of a very
wide evil. The commencement not only of chorea, but
of all diseases, is neglected in Board schools. Noplace affords
so good an opportunity of studying the different stages in
the development of permanent squint than a large infants’
Board school. Here, also, children may be seen “ growing
out of" rickets, and so on. Most of us will also remember
the sad case of the child who died of meningitis a few days
after he had received a blow on the head for being stupid.
The remedy for this state of things is obvious. What is re¬
quired is a drilled medical inspection of Board schools. It
is useless to trust, as at present, to the unskilled and pre¬
occupied observations of the teachers. The Board at present
has an expensive organisation for driving children into the
schools, but no provision is made to ensure that the children
so driven in are fit to go to school. It seems incredible that
an institution such as the School Board, whose very
existence depends on the value of training, should trust
their pupils’ health to unskilled hands. I trust that all this
will soon be changed; but the change will be brought about
only by the calm display of facts, such as appears in Dr.
Sturges’ article.—I am, Sirs, your obedient servant,

London, Jan. 1887. _ ThO S. GLOVER LVON.

RELATION OF PHTHISIS TO OVARIAN
CYSTIC DISEASE.

To the Editors of The Lancet.

Sirs, —In reference to Dr. Bailey’s case narrated in your
Clinical Notes of last week's issue, I would, firstly, venture
to congratulate him on his accurate diagnosis and success¬
ful treatment of a most difficult case, and, secondly, I would
thank him for the information he kindly gives me on the
oint of the relation between phthisis ana ovarian cystic
isease, for which I am the more grateful because it is not
confirmatory of the common family history of consumption.
But he mentioRs a fact which strongly supports the theory
I ventured to propound, that ovarian cysts were caused by
a family tendency to early tissue degeneration. Dr. Bailey
says “the patient’s parents were first cousins,” and how
marriages of consanguinity tend to the enfeeblement of the
offspring in a great majority of cases is well known. But I
feel still more grateful to Dr. Bailey because many pro¬
fessional brethren have most kindly and courteously sent
me family charts or particulars of cases in which ovarian
cysts and phthisis were existent markedly in the same
family, but hitherto no one has favoured me with notes of
a case occurring in a member of a healthy family. 8ucb, of
course, we know do happen, and I have tried to show the
importance of knowing why .—Yours faithfully,

West-street, Flnsbury-clrcus, BEDFORD FENWICK.

Jan. 17th. _

A “NEW” METHOD OF EXCISING THE
KNEE-JOINT.

To the Editors of The Lancet.

Sirs, —I at the earliest opportunity most frankly acknow¬
ledge that the operation I thought to be my own has pre¬
viously been suggested and performed by Professor Ollier. I
also tender my sincere thanks to Mr. Keetl ey for referring me
to Professor Ollier’s paper in the Revue de Chiruryie , which
I had never seen before this day. The merits of the opera¬
tion I submit should in fairness be left to future clinical
experience. I am, Sirs, yours truly,

Jan. 19th, 1887. HERBERT AlLINGHAM.

DEGREES FOR LONDON MEDICAL STUDENTS.

To the Editors of The Lancet.

Sirs,— With regard to your paragraph in The Lancet of
Jan. 15th, stating that the students of St. Mary’s Hospital
were the first to express a collective opinion on the scheme
of the conjoint Colleges for granting an M.D. degree, I
think it is only right to say that on Nov. 25tb, 1885, at a
meeting of the University College Medical Society, attended
by over one hundred students. Dr. Thomas Barlow being in
the chair, an almost identical resolution to that approved
by the students of St. Mary’s Hospital was passed, after a
long and animated discussion.—Yours truly,

J. Walter Carr, M.B., B.8.,

President, Univ. Col. Medical Society.

University College Hospital, Jon. 18 th, 1887.

Digitized by GoOglc

The Lancet,]

NORTHERN COUNTIES NOTES.—LIVERPOOL.

[Jan. 23,1887. 1§7'

KORTHERN COUNTIES NOTES.

(From our own Correspondent.).

THE NEWCASTLE INFIRMARY.

The fecial committee appointed by the governors of the
Newcastle Infirmary two months ago have completed their
tboors and have adopted their report for presentation to
the gover no r s . The report is a very voluminous one, and
it the same time critical as regards the financial position
iad past management of the institution. The ground it
eovers may be inferred from the fact that it fills nearly five
miasms of our daily papers here, so that I can only give
joa a condensation of it in this letter. The committee, in
Idling with the question of admission of patients, recommend
institution of award for thoee who can pay a whole or
?*rt of the expense incurred by their keep. They point out
that at present there is much overlapping of the medical
Parities of the city, and, for instance, recommend the
vaoval of children, except in some surgical oases, to the
; isw children’s hospitals at Newcastle and Gateshead
! *b*n these institutions are ready to receive them.

I i* regards expense, under the head of stimulants they point
*jt that it is in excess Of all other institutions with which
mnparison has been made, with one exception, and they
lunk that it ought to be capable of a reduction of at least
i'W. per bed per annum, which would effect a saving of £117
a this bead. In reference to the very large expense of one
trade of diet for the sick—vix, £747 last year for beef-tea
tiooe,—they suggest that a better and cheaper beef-tea could
* made by proper cooking. The use of rabbits in place of
| ‘twt to some extent is also recommended; and skimmed
! zilk, they think, might be more generally used at the
c6i issry; also the more general nse of oatmeal porridge,
ft* weeamendations of the committee as regard8 beef-
v* am to a very great extent borne out by the special
taalyrioof Mr. T. Hatfield Walker, analyst for the city of
1 irtiris, who states that when beef-tea is intended for
wamata it should not be heated above 100° F. Some ang-
ietioss are made as to the nursing department, and also
** ragudo saving under the head of antiseptic dressings, an
ireooOto be kept of the expense to each bed and to each
«rgMft,as at Edinburgh. A table is given, showing the
Baabor of out-patients and casnals treated in the various
si ilirol charities of Newcastle and Gateshead daring the
year 188ft, the total amounting to 75,603. The committee are
’f opWoB that the time has come for abandoning the letter
*yt sm, and making the infirmary a free institution, and in
-ftuthey have the unanimous support of the medical board.
They farther say that the infirmary has long been a school
4 practical medicine and surgery, and is not the least im¬
portant factor in the success of the College of Medicine here.
TV? number of pupils entered for the hospital practice
a the pres e nt time is 115. Of these 38 are full students
atered for the complete course of the College, and about 40
«e from the metropolitan hospitals. At present the fees
m about £1000 per annum, and are at the disposal of the
temcKmrj physicians and surgeons,with some small deductions
far the infirmary library, &c. - The committee think that,
vcboift Interfering with the fees charged for pure clinical
■trodioB^ charge of £55 s. per annum should be made for i
ueh stu de n t using the infirmary, to be paid to and received i
by the tree surer for the benefit of the infirmary, and they
refer to the custom at Edinburgh in this respect. My own
opinion is that Newcastle cannot be compared with Edin¬
burgh for wiany obvious reasons, and that the charge will
be regasted, on the one hand, as a fine on the students, and,
<w the Other, an attempt, and not & generous one, to lighten
eh peshote of the teachers. Barely £5 6s. per annum is
ho hisies fine for a student’s attendance at our infirmary,
TptA sell is I predict that this suggestion will require
nuudemhle modification before it is adopted. The com-
afetewaasocd an investigation of cases which is of con-
■hnkle hrtsrest. Of 161 oases, 41, or one-third, were
vp o rto d nwveoereaL Of 33 cases investigated, 6 were in
w*ipt -oAdtfpm -week, 2 had given false addresses, 5 were
■ ERsmC'w pel loll relief, arid the remaining 21 were per¬
se* nTurn misnmst u nr mT may be said to have justified
bar teehfcg risstHral relief ah,the infirmary, though some
wld a0mnp> make some small payment to a olub or

provident dispensary. As to venereal cases*, the committee
recommend that, although only a few mule patient* had been
admitted since 1885, when the lock ward was dosed, for the
futureastringentrule should bemadeexcluding til suchcases,
as it is an abuse of the charity to use its funds for this pur¬
pose, and they further advise all the other medical chanties
not to receive them. Here the committee go rather astray,
and forget, or are ignorant of, the 1 multitude of cases which
spring from this origin, and crowd out eye, throat, ear,
and skin hospitals. Besides, ii this Is strictly oarried out at
the infirmary, their pupils will pass from its wards very
imperfectly equipped with practical knowledge of a very
valuable nature. Not very long ago I told yen that the
question of making the infirmary a free hospital was looming
in the not very far distance. This met with an official
contradiction. Well, after all, your correspondent was only
very slightly in advance of the fact, which is now in a fair
way of being accomplished. The committee also recom¬
mend the abolition of the casual and out-patients’ depart¬
ment, which would effect a saving of £1000 per annum.

Newciutle-on-Tyne, Jan. 17th.

LIVERPOOL.

(From our own Correspondent.)

THE SEVENTEENTH ANNIVERSARY OF HOSPITAL SUNDAY
IN LIVERPOOL.

When Hospital Sunday first became an institution here
we were favoured with good weather. This continued for
years, and it is only recently that the weather has been so
inclement. A more unfavourable day than that which
marked the seventeenth anniversary could not have been
imagined. The result was a great falling off in the attend¬
ance at church and chapel, and in most instances a con¬
siderable reduction in the sums collected. So strongly has
it been felt that many parsons were deprived by the weather
of the opportunity or showing their interest in the medical
charities, that additional appeals were made and offerings
collected on the following Sunday, the 16th inst. The-
total amount of the Sunday collections, as advised to the
treasurer up to the 18th inst., amounts to £4074. Many
more collections have yet to be returned.

THE HOSPITAL FOB WOMEN.

A meeting of the governors of this charity was held on
the 17th to elect a successor to the late Dr. Lupton. On the
recommendation of the Committee, Dr. Henry Briggs,
M.B. Edin., F.R.C.S. Eng., honorary medical officer to the
Ladies’ Charity and Lying-in Hospital, was unanimously
elected. Dr. Briggs has resided in Liverpool for nearly ten
years, during which he has held the offices of senior house-
surgeon at the Stanley Hospital, and of resident medical
officer to the Royal Inflrmanr. He has also been demon¬
strator of anatomy at the Liverpool University College,
surgical pathologist, tutor in clinical' surgery, and chloro-
formist at the Royal Infirmary. In all these he has won
golden opinions both from patients and colleagues, and the
governors of the Hospital for Women are to be congratulated
on the choice they have made.

THE STANLEY HOSPITAL.

Drs. CoBtine and Sheldon, the founders of the Stanley
Hospital, who have just retired from the poeitions of
honorary physician and surgeon respectively after twenty
years’ Bervice, were on the loth inst. presented with their
portraits painted in oil, as a mark of the appreciation in
which they are held by the medical staff of the hospital.
The presentation was made at a dinner given at the Adelphi
Hotel, at which Dr. Kellett Smith presided, among the
guests being Mr; Edward Whitley, M.P. For the vacancies
thus created Dr. Whitfoid has been elected physician, and
Mr. Robert Jones surgeon.

ADULTERATION OF PEPPER.

Dr. Campbell Brown, the city analyst, and Professor of
Chemistry in University College, has done a great public
service in detecting and exposing the manner in which
pepper is largely adulterated, not only in Liverpool, but
elsewhere. It would appear that the adulteration consists
of the admixture of 15 per cent, of a hard ligneous tissue.

198 The Lancet,]

EDINBURGH.—GLA8G0W.

[/AN. 22, 1887.

consisting of ground fruit stones, resembling olive stones.
It would also appear that a worthless material resembling
ground olive stones is imported from Italy, under the name
of “pepperette"or “poivrette,” for the express purpose of
being fraudulently mixed with pepper.

NOBTHEBN HOSPITAL.

Dr. James Barr was on the 18th inst. elected, without
opposition, physician to the Northern Hospital, in the
place of Dr. Seaton, recently elected physician to the
Infirmary. Dr. Barr is well known for his many con¬
tributions to medical literature.

Liverpool, Jan, 20th._

EDINBURGH.

(From our own Correspondent.)

THE LATE LOBD IDDE8LBIGH.

On Tuesday last the lectures in the University were en¬
tirely omitted, as a mark of respect for the late Lord Rector,
while in the afternoon a University memorial service was
held in St. Giles’ Cathedral, synchronously with that in
Westminster Abbey, and with the funeral obsequies in
Devonshire. In the Cathedral, which was very crowded,
there was a large assemblage of the students, amongst
whom the late Lord Rector was. an especial favourite, and
who were eager to pay this last tribute of respect t.o their
twice-elected representative. The general public filled all
the remaining space, with the exception of a portion of the
ohanoel, which was occupied by University officials in their
robes and insignia of office. The memorial sermon, preached
by Dr. Cameron Lees, one of Her Majesty’s chaplains,
referred to the great loss to the University and to the
cause of culture throughout the country occasioned by Lord
lddesleigh’s death. A large part of the sermon dealt with
the manly and noble character of the late Earl, as evidenced
alike in public and in private life. A special service had
been prepared for the occasion, containing appropriate
selections for the choir, and the whole ceremony was of a
strikingly impressive nature.

HEALTH LBCTUBK FOB THE PEOPLE.

A popular lecture under the auspices Of the Health Society
was delivered by Professor Stirling of Manchester last Satur¬
day, and was largely attended. The lecturer chose the
subject of “Wear and Tear,” illustrating the transforma¬
tion of energy and of material in the animal mechanism by a
series of most demonstrative experiments. In an admirable
way the physiological facts connected with nutrition and
excretion were enumerated, illustrated bjr conclusive experi¬
ments, and correlated with rules for daily living of great
practical importance. The demonstration was heartily
appreciated by the audience, who could hardly fail to profit
by the lucid exposition of the subject supplied by the
lecturer.

THE BOYAL INFIBMABY.

A meeting of the contributors was held last Monday, to
consider the report of their committee upon the manage¬
ment of the institution during 1886. The report was of a
very satisfactory nature, and was: unanimously adopted.
It shows that m the twelve months 8088 in-patients and
26,600 out-patients'- have received treatment at the insti¬
tution; 67 per cent, of the cases were treated in the surgical
hospital, 43 per cent, in the medical house. The success of
the new special departments for dermatology and throat and
ear diseases is also alluded to. During the year a new observa¬
tion hospital for infectious cases has been added, situated in
an isolated part of the infirmary grounds; and, including this
addition, the institution can now accommodate 660 inmates.
The ordinary expenditure shows a distinct decrease, while
the daily average of patients has been larger than in pre¬
vious years. The committee report in favour of a modifica¬
tion of the bye-laws giving a deliberative as well as a cast¬
ing vote to the chairman of the Board of Managers, which
is not at present the case, an alteration in which all the
parties interested .concur. Comment is also made upon
the thorough and efficient performance of their duties by
the present staff, and the yeoman service during so many
years rendered by Dr. Joseph Bell, who recently retired from
the acting surgical staff of tbe hospital.

Edinburgh, Jsn. 10th. '

GLASGOW.

(From our own Correspondent.)

BOUTHEBN INFIBMABY.

The proposal to erect a third infirmary in Glasgow, to
be placed on the Bouth side of the river, where there is at
present no such institution, has taken very definite shape,
and may now be said to be fairly before the public. A few
years ago the future of the scheme seemed to be absolutely
assured by a large legacy left by a wealthy local manufac¬
turer ; it turned out, however, when the donor’s estate was
wound up, that there was no available balance for the pro¬
posed infirmary, so that the provisional committee are again
appealing to the public for funds. It is proposed to erect
only a portion of the buildings in the meantime. Plans for
this have been prepared and estimates accepted provision¬
ally. The sum which the promoters aim at raising is £20,000,
and of this £8000 have already been secured. Acting in the
spirit of “Bart. Rous,” whose lines'appear in last week’s
Lancet, the executive committee haveapproached the Town
Council of Glasgow, urging the adoption of the Southern
infirmary scheme by the city as at least one of its methods
of commemorating the Jubilee of Her Majesty the Queen.
If this rather appropriate suggestion be adopted, and Her
Majesty’s consent be obtained to name the institution the
“ Queen’s Infirmary,” or the “ Victoria Infirmary of Glasgow,”
the project will become fashionable and popular, and will
soon have plenty of funds. Certainly no Jubilee memorial
could, be more fitting than this, or more in accordance with
Her Majesty’s well-known sympathies. The great need for
such an institution has been amply demonstrated. The
south aide of the Clyde, with a population of about a
quarter of a million, mostly of the working class, has not
a single infirmary bed, the two existing infirmaries being
situated one at the extreme northern and the other at the
extreme western end of the city. That theee two infirmaries
are unable to cope with all the work expected of them is seen
in the fact that, after filling every available bod, the average
weekly number of suitable applicants waiting for admis¬
sion was in 1886 no less than forty-eight, and in 1886 it
was fifty-two. While that was the average number, the
maximum was reached each year in February, being 120 in
1885 and 144 in 1886. Further statistics show that, while
Dublin provides one bed for every 167 of her population,
and Edinburgh one for every 400, Glasgow has only one for
every 700, and even that is obtained here by considerably
curtailing the number of cubic feet of air space which it is
desirable each patient should have. When these facts have
been fairly digested by the wealthy and generous of Glasgow
the future of the scheme will be no longer doubtful. Mean¬
time, it is to be hoped that the request to be made to Her
Majesty for official recognition of the infirmary may meet
with a favourable response.

HEALTH OF THE CITY.

The last annual report on the health of the city shows
that in the year 1886 there were 13,099 deaths registered, as
compared with 13,486 in the previous year, a decrease ol
387, representing an average death-rate of 25 in place of 2f
per 1000 livjng. Since the Public Registration Act tool
effect there has not been so low a death-rate, except in 1879
when it was 24*5 per 1000. The slow but steady improve¬
ment which is taking place in the health of Glasgow ii
indicated in the following table

Mean death-rate. 1866-75 . 30 4 per 1000.

„ » „ . 1876-80 . 26-7

„ „ „ . 1881-85 . 26 3

For the fortnight ending 1st January, 1887. the deaths wer
631, giving a death-rate of 31 - 5 per 1000. Fevers, especial!
scarlatina and measles, still prevail to a great extent ii
Glasgow; but it is satisfactory to note that in the vehol
city there are only 3 cases of typhus, and they are all i
hospital. One of the typhus patients is a medical practi
tioner. It is many years since a Glasgow medical man wa
attacked by typhus, yet in times not very remote, sa
twenty years ago, this was a common occurrence, and man
valuable lives were thus lost. The value of these fever hos
pitals, both to the profession and to the community at larg<
could not be more clearly demonstrated than by these fact;

Olaagow, J*u. IStta.

Digitized by v^.OOQLe

Thb Laxcjct,]

DUBLIN.—MEDICAL NEWS.

[Jan. 22,1887. 199

DUBLIN.

(From our own Oorretpondont.)

THB GENERAL HKDICAL COUNCIL.

I ah in a position to Btato that Dr. William Moore,
Physician in Ordinary to Her Majesty in Ireland, has been
offered and has accepted the post of Crown nominee for
Ireland on the General Medical Council. Dr. Moore has
tilled numerous offices with distinction, including that of
president of the College of Physicians; and deservedly ranks
high in the estimation of the public and his professional
brethren.

BRITISH MEDICAL ASSOCIATION.

The tenth annual general meeting of the Dublin Branch
of the Association will be held on the 27th inst. in the College
of Physicians; when the officers and council for the ensuing
year will be elected by ballot, and any other necessary
business transacted. The President elect (Dr. Grimshaw),
will give the annual address.

BONE-SETTERS! A WARNING.

At a recent meeting of the Drogheda guardians, an
application was received from Dr. Adrien for a fee for
the performance of an operation under the following cir¬
cumstances. The patient was a fine young man, aged
twenty, who had got his arm broken above the elbow by a
fall off a cart. He went to a bone-setter, and as a result of
his treatment Drs. Kelly and Byrne were called in, and
found the man’s arm gangrenous from the tight manner in
which the bandages had been applied. On taking off the
bandages the bones were found to overlap. The only
chance was amputation close to the shoulder, which was
done by Drs. Adrien and Kelly. The man is not expected
to recover.

BARBINGTON’8 hospital, limerick.

This institution seems financially to be in a very low con¬
dition, for at a meeting of the governors last week it was
stated that the hospital was £748 in debt, £300 being due
to the bank, which had refused to honour any further
cheques. It appears also that the resident medical officer
and other officers and servants have not been paid their
salaries for the past two months. Another meeting of the
governors will shortly be held, and in the meantime a com¬
mittee has been appointed to open a subscription list, and so
{dace the institution in a more satisfactory position than at
preemit.

RICHMOND HOSPITAL, DUBLIN.

There were five candidates for the post of physician to
this hospital, which had become vacant by tne death of
Dr. Lyons. The board appointed Dr. O’Carroll, the assistant-
physscion. There is no salary attached to the appointment.

ASSISTANT HBDICAL OFFICER TO THB DUBLIN METRO¬
POLITAN POLICE.

By the death of Dr. Long, J.P., a vacancy for an assistant
medical officer to the Dublin Police arose; and although the
emolument of the post was only £75 a year, yet the com¬
petition was most keen, and the candidates were, it is said,
over fifty in number, and were from all grades of the pro¬
fession, from the examiner of a university or corporation
down to the simple apothecary. I believe Dr. Long had to
compo u nd the medicines ordered, bat I understand his
successor will not be required to do so. The vacancy has
now been filled up by the appointment of Dr. Oulton,
formerly resident surgeon to the Meath Hospital.

Dublin, Jan. 18th.

Manchester Medical Society. —The annual meet¬
ing of the members of this Society was held on the 12th inst..
Dr. J. Uardie, president, in the chair. The secretary, Mr. F. A.
8<mtiiatn, read the annual report of the committee, in which
the members were congratulated on the continued prosperity
of the Society. Daring the past year, it was stated, twenty-
four new members had been elected, whilst seventeen had,
through death and other causes, severed their connexion.
The number of members now on the roll is 249.

On the 10th inst. an Eye Hospital was formally
opened at Cardiff by Mr, Alfred Thomas, M P.

Hhirial fUins.

Royal College of Surgeons of England.— The

following gentlemen, having undergone the necessary exami¬
nations for the diploma, were admitted Members of the
College at a meeting of the Court of Examiners on Jan. 17th :

Granstoun. George. M.B. Durham, Ludlow. 8alop.

Middleton, Alfred Hancock. M.D. Dublin, Sh&nkill, co. Dublin.

Moxham, Marcus Camplin, L.S.A.. Swansea.

Murray. John. M.B. Dublin, Norfolk-atreet.

Tattcrsall, C. Herman, L.R.C.P. Lond., Patrlcroft, Manchester.

Wild, Charles Henry, L.K.Q.O.P.I., Bedford-road, Bootle.

Admitted on the 18th inst.:—

Adams, Percy Targett, L.8.A., Ashford-road. Maidstone.

Browne, Henry. L.S.A., Corn wall-road, W est bourne-park.

Foxton, Edward, M.D. Kingston. Brockvllle, Ontario.

Green, Arthur, M.B. Durham. Walker-terraoe. Gateshead.

Harrington. Samuel Henry Nazeby, L.K.Q.C.P.I., Parliament-
street. Liverpool.

Howitt, John FltzWilllam. M.B. Toronto, Gullford-stroet.

Johnson. John G., L.B.C.P. Lend.. Campbell House, Aldershot.

McLeam, Isaac Crawford, M.D.Q.U.I., High gate.

Sparrow. John Blllotson Pennington. L.S.A., Clarendon-road.
Soutbsea.

Sumpter, Berners George. M.B. Durham, Cley-next-sea, Norfolk.

Thornton, Fred Whitlield, L.K.Q.C.P.I.. Trinity-street,
Huddersfield.

Yeoman, William Metoalfe, M.B. Durham, Northallerton.

Admitted on the 19th inst.:—

Blake, William Henry, L.S A„ Brondesbury Villas, KUbum.

Brown, Henry Herbert, The Park, Harrow.

Crook, Herbert Evelyn. L.R.C.P. Load., Northfleet, Kent.

Duncan, H.. L.R.C.P. Lond.. Henrietta-street, Co vent-garden.

Spencer, George Herbert. L.K.Q.C.P.I., Turton. Bolton.

Williams, John T. Creswick, L.S.A., Dolgelly, North Wales.

College Lectures.— The annual course of lectures will
be commenced on Monday, January 31st, at 4 o’clock,
by Professor Francis Warner, M.D., who will deliver three
lectures on the “Anatomy of Movement.” Professor W. H.
Hylson Jessop will deliver three lectures on the “Intraocular
Muscles,” commencing on Wednesday, February 16th. Pro¬
fessor C. Barrett Lockwood will deliver three lectures on the
“ Development and Transition of the Testicle, Normal and
Abnormal,” commencing on Wednesday, February 23rd.
Professor A. Alfred Bowlby will deliver three lectures, com¬
mencing on Wednesday, March 2nd (subject will be duly
announced). Professor Charles Stewart will deliver nine
lectures on the “ Auditory Organs of the Vertebrata,” and on
some recent Additions to tne Museum, commencing on
Wednesday, March 9th. The eourse will be concluded in
June by Dr. Leonard C. Wooldridge, Professor Henry
Power, and Professor Christopher Heath. The subjects of
the several lectures will he hereafter published? The lectures
will be delivered in the theatre of the College on Mondays,
Wednesdays, and Fridays, at 4 o’clock punctually each day.

University of Cambridge. —At a congregation held
on the 13th inst., the degree of M.B. was conferred on —
Walsham, Hugo, Caius.

College of Physicians in Ireland. —At the

January examinations the following obtained the licences
in Medicine and Midwifery of the College:—

Mkdicixk,—T homas Spread Campion, William H. Haslop. Hugh
Griffith Hughes. Henry John Mathews, Frederick William Monsell,
Denis Joseph O'Loghlin, Thomas Fox Parry, John Sclesfleld, Thomas
Henry Wilson.

MiDwiFBKr.—Thomas Spread Campion. Thomas Augustus Connellan,
Timothy Corkery, Hugh Griffith Hughes, Win. Edward MacFeeters,
Henry John Mathews, Frederick William Monsell, Denis O'Loghlin,
Thornes Fox Parry, Thomas Henry Wilson.

The following have been admitted Members of the College:

J. Armstrong Hanrmhan. I William Frazer (Dublin).

William Frazer. | Guy P. L’E. Nugent.

Royal College of Surgeons in Ireland.— The
following have been admitted FoIIowb of the College:—

Alfred Asbury, A.M.D. | James McMullen, A.M.D.

Society of Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to pract's) on the 13th inst.

Bacot, William Hickward, The College, Sudbury, Middlesex.

Ford, Theodore Albert Vores, B-saufort-road .Clifton, Bristol.

Johnson, Reginald Bdward, Wtnter-street, Sheffield.

Wilde. Leonard. Ardwlck House. Watford.

• Underground Wires.— The Postmaster-General,
in reply to a correspondent, states that the question of ex¬
tending the Aystem of laying telegraph wires underground
Shall receive nis careful consideration.

Digitized by

200 Thk Lancet,!

Medical NEWS.

[Jaw. 22, 1887.

Medical Magistrate. — Dr. Charles B. Plowright
has been placed on the Commission of the Peace for the
borough of King’s Lynn.

A new monthly medical journal, entitled Thera-
peutieche MonataMefte, edited by Drs. Langgaard and Rabow,
is being published by O. Liebreich of Berlin.

The Marquis of Bute has decided to present to the
corporation of Cardiff a site for the proposed hospital for
infectious diseases, which it is proposed to provide for that
town.

At the annual meeting of the governoi-s of the !
Lincoln County Hospital on the 13th inst., it was reported
that during the past year tbe expenditure of the hospital
had exceeded its income by £101.

Naval Medical Supplemental Fund. —At the
quarterly meeting of the directors of the fund, held on the
11th instant. Sir W. R. E. Smart, K.C.B., M.D., Inspector-
General, in the chair, the sum of £01 was distributed among
the several applicants.

The large number of applications for admission to
the Normal School of Science and Royal School of Mines at
South Kensington at the beginning of tbe present session
has necessitated the adoption of a process of selection for
the future.

Society of Public Analysts. —At the annual
meeting of this Society held in the rooms of the Chemical
Society. Burlington House, on the 12th inst., Mr. A. H. Allen,
of Sheffield, analyst for the West Riding of Yorkshire, &c.,
and author of “Commercial Organic Analysis," wa9 elected
President of the Society for the ensuing year.

Cardiff Medical Society.—T he following members
have been elected office-1 Kjarers for the year 1887: Pre¬
sident: Mr- T. Garrett llorder. Committee: Dr. M. G.
Evans, Dr. Herbert Yueher, Mr. J. L. Treliarne, and Mr.
P. Rhys Griffiths, M.B. Treasurer: Dr. C. E. Hardyman.
Hon. Secretary: Dr. W. Campbell.

The Countess of Dufferin has issued an appeal for
subscriptions in aid of tbe funds of the National Association
for supplying Female Medical Aid to the Women of India.
Tbe Jubilee year seems, as the Countess of Dufferin remarks,
a fitting occasion to make & very special effort to help those
Indian women in whose sufferings the Queen has shown so
great and personal an interest.

Epidemics of Measles. —Up to the 17th inst., 130
cases of measles, 14 of which proved fatal, were reported
by the medical officer to have occurred at Sebastopol,
Monmouthshire. In accordance with a notice of the sani¬
tary authority the schools have been closed for three weeks.
At Ashford in Kent several deaths have occurred, and the
disease is pronounced to be of a very bad type. All the
schools in the town have been closed for a fortnight.

Presentations. —On the 29th ult. the members of
the recent class in connexion with the St. John Ambulance
Association at Worsbro’ Dale presented Mr. Blackburn of
Barnsley, who had acted as their instructor, with a Tantalus
spirit stand and a silver jug, in recognition of Mr services.—
On the 13th inst. Mr. E. J. Foulston was presented with an
illuminated address and a purse of gold, on the occasion of
his departure for Earlestown.

Liverpool Medical Institution. —At the annual
meeting held on Thursday, Jan. 13cb, the following list of
officers, council, and microscopical committee was adopted.
President: J. B. Nevins, M.D. Vice-Presidents: William
Alexander, F.R C.S.; James Barr, M.D.; Robert Robertson,

M. D.; W. Williams, M.D. Treasurer: F. J. Bailey, L.R.C.P,
General Secretary: A. Bernard, M.B. Secretary of ordinary
meetings: Damer Ilarrisson, M.R.C.S. Librarian: Richard
Williams, M.R.CS. Council: Alexander Davidson, M.D.;

E. T. Davies, M.B.; C. G. Lee. M.ILC.S.; Robert Gee, M.D.;

N. K. Marsh, M.R.C S.; T. G. Wollaston, M.D.; J. D. Craw¬
ford, M.D.; Karl Grossmann, L.R.C.P. Edin.; W. Irvine,
M.D.; W. P. Rowe, L.R.C.P. Edin.; G. E. Walker, F.R.C.S.;
W. Whitford, M.D. Microscopical Committee: W. Alexander,

F. R.C.S.; A. Barron, M.B.; P. M. Braidwood, M.D.; Henry
Briggs, F.R.C.8. ; G. Hamilton, M.R.C.S. ; J. S. Hicks,

L. R.C.P.; J. R. Logan. M.B.; Rushton Parker, F.R.C.S,;
F. T. Paul, F.R.C.S.; W. Williams, M.D.; J. Wiglesworth,

M. D. Auditors: William Fleetwood, M.K QC.P.I.; T. G.
Wollaston.M.D.

The third annual ball for the benefit of the Italian
Hospital in London wa9 held on the ISth inst., and was
largely attended.

Mortality of Medical Men at Matanzas.—T he
Havana journal, La Enoiclopedia, states that during the
last three years no less than eight medical practitioners
have died at Matanzas, which is a port in the northern p&rt-
of the island of Cuba, the populatiou of which is only about
33,000.

Ayr County Hospital. —The Committee of the
County Hospital ball, which was held last week, have been
able to hand over to the treasurer of the hospital the handsome
sum of £408 17s 6 d, whilst the funds of the charity hare
been still furthur enriched to the extent of £40 as the
proceeds of the concert given in the Town Hall a few days
since

Measles in a London Workhousf, Infirmary.— A
serious epidemic of measles is prevalent in the Homerton
district. At the meeting of the Hackney Board of Guardians
on the 19th inst., twenty-four cases, four of them proving
fatal, were reported to have occurred in the workhouse
infirmary. A Board school in the district has been closed
to check if possible the spread of the disease.

North-Western Association of Medical Officers
of Health. -At the monthly meeting of the members of
this Association, on the 6th inst., a paper was read by Dr-
Niven (Oldham) on tbe Infectiousneae of Pneumonia. The
author stated that the whole bearing of tbe inquiry into
the question was that the new view that pneumonia was
conveyed by germs might lead to the preparation of a-
vaccine having the power to protect anyone inoculated with
it against a subsequent attack of the disease.

Morison Prizes for Meritorious Attendance on
the Insane.— On the nomination of Dr. Alex. Keiller, LL.D.,
F.R.C.P.E., the Morison Lecturer on Insanity, the treasurer
of the Royal College of Physiciana, Edinburgh, has awarded
the two annual prizes endowed by the late Sir Alex. Morison
for meritorious attendance on the insane to Miss Agnes
Sbankland, of the Crichton Royal Institution, Dumfries,,
and Mr. Edward M‘Mahon, head attendant, Saughton Hall,
Murrayfield. _

EXAMINING BOARD IN ENGLAND BY THE ROYAL*
COLLEGE OF PHYSICIANS OF LONDON AND THE
ROYAL COLLEGE OF SURGEONS OF ENGLAND.

FIRST EXAMINATION.

Part I.-CHBMISTRY, INCLUDING CHEMICAL PHYSICS.
Tuesday. January 4th, 1887, from 1 to 4 p.m. (Candidates must answer
at least four questions, and not more than six.)

Section 1. Explain what is meant by the diffusion of gases. • Ac¬
cording to what law do gases diffuse ? The relative densities of marmiv
gas and carbonic acid gas being 8 and 22, what are their respective
diffusibilities? 2. What is understood by tbe ternj latent heat? A.

pound of ice at 0° C. is placed in a pound of boilina water, aod the mean
temperature of the water is found to be 10 s O. What is the latent heat
of water?

.Section 11. —3. Write a brief sketch of the properties of sulphur. How
is sulphuretted hydrogen prepared, and what are its distinguishing
chemical characters ? Ten grammes of sulphuretted hydrogen are burnt,
in air. What products, and how much of each by weight, are formed ?
(8=32; 0=16; H=l.) 4. What are the chief properties of iodine?

How it it prepared from kelp ? State carefully what occurs when
Iodide of potassium is added to solutions, respectively, of (a) mercuric
chloride, (by mercurous nitrate, (c) lead nitrate, (<0 silver nitrate, an<t
(«) ohloride water. Give equations. 5. Describe the oxide*, chloride*,
and iodides of mercury, and give their formula. How are the oxldea
prepared, and how are they acted on by dilute hydrochloric acid ?

Section Ilf. —6. What is the composition of cyanogen, and what are its
properties? How can the following bodies be obtained from potaasiutn.
ferrocyanide: carbon monoxide, cyanide of potassium, prussic acid?
7. What are t lie relations between marsh gas (methane), chloroform,
methylic alcohol, and formic acid ? Describe nowyou would obtain marsti
gas from acetate of sodium. Give equations. 8. Describe the constitu¬
tion of the fats and oils. 8ome beef fat is boiled with a dilute solution of
caustic potash: describe in detail what happens, and the properties of
the bodies formed.

[Note. —Th's paper also applies to candidates for the licenoe of the
Royal College of Physicians of London.]

Part II.-MATfcStA MEDICA AND PHARMACY.
Wednesday, Jan. 5th, 1887, from 1 to'4 p.m. (Candidates must answer
at least four questions.) .

1. Give an account of nux vomioa, stating its origin, its most im¬
portant active principles, its medicinal action on. the various organs of
the body, ite official preparations, and their doses. 2. Enumerate the
[ various'forms of alcohol oontalned in the Pbarmaeopccla. State the.,
[strength of each,‘and give a brief account of their medicinal action.'

vjOOglC

Tht? Lancet,] APPOINTMENTS.—VACANCIES.—BIRTH8, MARRIAGES, AND DEATHS. [Jan. 22,1887. 201

3. What are the official salts of (l) bismuth, (2) zinc ? In what doses are
they employed, and what are their motions? 4 . Give an account of the
medicinal action of hyoacyamua. To what drugs ia it most closely
allied, and to what ia it antagonistic ? What are its preparations, and
what are theirdoaea for internal administration? 5. Give the composi¬
tion of the following Pharmacopudal preparations: —Mistura ferri
compoaita, pul via cretie aromatlcuarum oplo, pulvis catechu compositus,
)ot<ohydrargvrifl*va, puivlsopti compoatt.ua, liquorarsenll ethydrargyri
iodidi. 6. What forma of sulphur are mentioned In the Phsrmacopc-ta ?
What are its preparations and doaea and how it it eliminated ?

[.Vote.—This paper also applies to candidates for the licence of the
Koyal College of Physicians of London.]

Part III.-BLKMBNTARY PHYSIOLOGY.

Tuesday, January 4th, 1887. From 10 a.m. to 13 noon. (Csnditate*
must answer at least four of the aix questions.)

1. Name the tissues shown under mioroacopes A, B. C. By what cha¬
racteristics do you recognise them ? 2. Olve the position and action of
the valres of the heart. 3. Milk is a complete food for infants. Explain
this statement. 4. Describe and explain a simple reflex act. ft. Enumerate
the chief constituents of bile. 6. What changes does a striped muscle
undergo in contraction and in death.

SECOND EXAMINA TION.

PHYSIOLOGY.

Thursday, January 6th, 1887, from 3 to 5 P.M. (Candidates must Answer
at least four questions.)

1. Explain and illustrate tne action of the nervous system on the
arteries. 2. Describe the minute structure of the spinal cord. 3. What
is the structure of a capillary bloodvessel and a venule? Contrast the
character of the blood-flow in these with that inan arteriole. 4. Describe
the structure and functions of the skin. ft. Mention the fats which are
usually taken at food. How are they digested ? What Is their probable
destination ? 6. State the composition and properties of glyoogen ?

Where does it occur i How may it be prepared ?

ANATOMY.

Friday, January 7th, 1897, from 3 to ft P.M. (Candidates must answer
at least four questions.)

1. Describe the sensory nerve-supply to the skin of the f*ce and scalp.
2. Describe the dissect lou required to expose the deep epigastric artery.

Give the origin, course, insertion, actions, relations, and nerve-supply
r. 1 the pyriformis muscle 4. Describe the (esophagus, and give Its
^situation, relations, arterial and nervous supply, ft. Enumerate the
muscles acting on the shoulder-joint. Give tbeir actions and nerve-
supply. 8. Give the course, relations, and tribuUrits of the superficial
.-aid common femoral veins.

Sjpitttmtnts.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
ethers possessing information suitable for this column are invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
th-tn y o'clock on (As Thursday morning of each week for publication ui
the next number. _

Bovvbrik, F. P. McDonald. M.D.. C.M., Ac., has been appointed
Medical Officer and Public Vaccinator for the North District of
Wallasey of the Birkenhead Union.

Briggs. Henry. M.B.. F.K.O.8., has been appointed Honorary Medical
Officer to the Hospital for Women, Sbaw-street, Liverpool, vice
Lapton, deceased.

Bubkitt, John C. S.. M.D.. L.Ch. Roy. Uufv. Trel., has been appointed
Medical Officer to the Whitwlek Local Board.

Cattle. Hutton. M.B. Lond., M.K.C.8., has been appointed Medical
Officer for the Shorwell North District of the Isle of Wight Union.

Colrtikr, Raymond, M.B.Dor.. M.R.C.8., late Senior House-Physician
at the Westminster Hospital, has been appointed Assistant Metrical
Officer to the St. Marylebone Infirmary. Notting-hill. W.

Dr Jong. Howard M-, B.A.. L.S.A., has been appointed Resident Junior
Visiting Surgeon to the Anooats Hospital, vice Alfred Mackay, M.B.,
C.M.. resigned.

Drake. Thomas, M.R.C.8., L.S.A., has been appointed Medical Officer
of Health for the West Ham Urban Sanitary District.

<>rsknlkss, T. Duncan, M.B.Hdin.. Second Assistant Medical Officer
to the Counties Asylum, Carlisle, has been appointed Assistant
Medical Officer to the City of London Asylum. Stone. Dartford.

Hordes. T. 'G. Fosdrokk kick. L.F.P.S.. L.M.. L.S.A.. lies been
appointed Medical Officer and Public Vaccinator to the Sutton
District of the Aston Union, vice C. Barlow, M.R.O.S., L.S.A.,
deceased.

Itglxby-MacKbszie, K. W., M.R.O.S.. L.R.C.P. Lond., hsa l>een
appointed House-Surgeon to the Koyal Isle of Wight Inttrmsry,
Ryde, vice A. G. R. Foulerton, M.R.C.S., L.R.C.P., resigned.

Jollifff:. Walter J-, M.R.C.8., L.R.C.P.Bd,, has been appointed
Medical Officer for the Shorwell South District of the Isle of Wight
Union.

Lixrick, W. Somerville. L.R.C.S., L.ILC.P.Bd.. has been reappointed
Medical Officer of Health by the Waterloo Local Board,

Parry-Joxe*. W. B.. L.K.C.S.. L.E.C.P.Bd., L.8.A., has been appointed
Medical Officer to the Rhosddu Lodge, N. U. Order of Oddfellows,
tbe Bridge House. Golden Lion. Bowling-green, and Wrexham and
District Colliers Tontine Societies.

Rtoatf:. John R.. L K.Q.C.P.I., L.R.C.S.Bd., has been anpolcted
Medical Officer for the Seventh District of the Bridgwater Union.

Weston, George H.. M.B.OH., L.8.A., has been appointed Medical
Officer for the Polesworth District of the Atherstone Union.

Whitfokd. William, M.D., Honorary Assistant Physician, baa been
appointed Physician to tbe Stanley Hospital, Liverpool, vice D. D.
Costlne, M.D., J.P., appointed Consulting Physician.

Young. R. R., M.B.. C.M.GIm., haa been appointed to the Medictl Staff
of the Midland Railway Company, Leicester Centre.

llanuidcs.

In coinpli.tnre icii/i the desire of numerous subscribers, it has hern decided to
resume the publication under this head of brief particulars of the various
Vacancies which nre announced in oar advertising columns. For farther
information regarding each vacancy reference should be made to the
advertisement.

Carlisle Countt Asylum.—J unior Medical Assistant. Age under
twenty-six. Salary £80, with board; no wine or beer.

Great Northern- Central Hospital, Caledonian-road. N. — Two
ClinloAl Assistants.

Hospital for Consumption and Diseases of the Chest, Brompton.—
Resident Cliulcal Assistants.

Hospital for Epilepsy and Paralysis, Regent'e-park. — Assistant
Physician.

Hull axd Sculcoati.s Dispf.nsary.— House-Surgeon. Salary £150 per
annum, with house (unfurnished), coals, and gas.

Lancashire County Asylum, Rainhill. near Liverpool.—Assistant
Medical Officer. Salary commences at £l0o a vear, with apartments
and board.

National Orthop-kdiu Hospital for the Deformed, Great Portland-
street.—Snrgical Kegist rarnnd Anesthetist. An annual honorarium
of £20 is attached to the office.

North Biding Infirmary, Middlesborough-on-Tee*.—Honse-8urgeon.
Sa'ai-v £100 a year, with bed, board, wasbiog, and £5 per annum In
lieu of beer.

Koyal Berks Hospital, Reading.—Assistant House-Surgeon. Qualili
cation not essential. Board and lodging, but no salary.

Sanitary Asm. ham i. Association.— Chief Medioal Officer.

Births, Hferrraps, anb gcattjs.

BIRTHS.

Herman. —On the 19th Inst., the wife of G. Ernest Heiman, M.B.,
F.K.C.P., of Harley-street. Cavendish-square, W., of a son.
Hu.ti.ky.— On the 17ih Inst-.. at Higher-terrace, Torquay, the wife of
J. Usher Huxley, M.D., of a daughter.

JoNF.s.—On the 13th Inst., at Llanfyliln, Montgomeryshire, the wife of
F. Feli* Jones, M.K.C.S. Ac., of a daughter.

MacQufikn.— On the 18th Inst., at Eastbourne, tbe wife of Thomas
MacQueen, M.B., C.M., of a son.

Mavricf;.—O n the 15th inst.. at Terrace House, Marlborough, the wife of
J. Blake Maurice, M.D., F.K.C.S., of a son.

MARRIAGES.

Griffith* — Collino. — On the 15th inst., at 8t. Michael's. Great
Torriugton, Surgeon Gilbert Saunders Griffiths, 33nd Punjab
Pioneers, to Katherine Celestina. seoond daughter of the late H. II.
Colling. Esq., of Oakehampton, Devon.

HoDiih—G kdyk.— On the 14th inst., at the Wesleyan Chapel. Gotham,
Bristol, the Rev. Sydney Ruper. Hodge. M.K.C.8., L.R.C.P.. to Ann
Elizabeth, eldest daughter of Pitmois W. Gedve, of Ashley Granee.
Bristol.

Lef.ds—Edwards.— On the 15th Inst... at St. Andrew's, llolborn. Thos.
Leeds. M.K.C.8., to Fannie, daughter of Joseph Edwards, of Burton*
on-Trent.

Rlid—Hornk. —On the ftth last., at the Parish Church, Kirkcudbright.
Wiliam Swauston Spence Reid, M.B., C.M., to Agnes Darling,
daughter of the late James Darliog Horne.

Bisk — Langston-Faddy. — On the 13th ult., at St. Luke's Church,
Jullandur, Punjab. Surgeon B. J. Hrsklne Risk, A.M. 8taff. to
Bllle Mary, youogest daughter of Major Langston-Faddy, Ret. List.
Bengal Army.

Si anwell — Sharpe. — On the 12th Inst., at St. Mary’s, Rochdale.
William Stamvell, M.R.C.S.. to Mabel Frances, eldest daughter
of the late Alex. Barclay Sharpe, M.D., F.R.C.S., of Norwood,
Surrey.

Warner—Grovk.— On Wednesday, the 19th lost., at St. Peter's, Baton-
square. bv the Rev. R. E. Warner, M.A., cousin of the bridegroom,
assisted by the Rev. A. Boyd, M A., Frederick Ashton Warner,

L.R.C.P., M.R.C.S.. L.8.A.Lond., only surviving son of Frederick
Warner, Barrister-at-law, of Woodford House. Trinidad, W.I., to
Sydney Anne Grove, 'laughter of the late Christopher Grove, of
Hertfordshire House, Bucks.

DEATHS.

Angikk.—O n the 16th lost., at his reaidenoe. The Highlands, College-
road. Upper Norwood, James Hague Angler, M.R.G.S., L.S.A., In
his 81th year.

Andrrw.—O n the loth Inst., at his residence, St. John's Hill. Shrews¬
bury. Edwyn Andrew, M.D., aged 55.

Hollis. -On the 17th Inst., at Deacons, Yarmouth, Isle of Wight,
Charles Wise Hollis, M.D. Univ. Bdin.. in his 71st year.

Won.—On the 17th Inst., at Russell-road. Kensington, Hamlin Nott,

M.R.C.S., L.R.C.P.Bd., Surgeon-Major, Ketirea List, II.M.’s Indian
Forces.

Snaps. — On the 13th Inst., at Chorley New-road, Bolton-le-Moors,
Rtchizxl Forth Suape, F.R.C.S.Eog., aged 65.

N.B .—A fee of St. is charged far the Insertion of Notices of Births
Uurriagss, and Deaths.

Digitized by Google

202 The Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jan. 22,1887.

Utebiral $jiarjr for % ttisuing

Monday, January 224.

Royal London Ophthalmic Hospital, Moorfields.—O perations,

10.30 A.M.. and each day at the same hoar.

Royal Westminster Ophthalmic Hospital.— Operations, 1.30 p.m..
and each day at the same hour.

8t. Mark’s Hospital.— Operations, 2 p.m, ; Tuesdays, same hour.
Ohklska Hospital pob Wombn.— Operations, 3.30 p.m. ; Thursday, 9.30.
Hospital pob Wombs, 8oho-squabb. — Operations, a p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.— Operations, 2 p.m.

Royal Orthopedic Hospital.— Operations, 2 p.m.

Okhtral Loudon Ophthalmic Hospitals.— Operations, 2 p.m., and
each day In the week at the same hour.

Society op Arts.—3 p.m. Dr. J. L. W. Thudlchum: The Diseases of
Plants, with special regard to Agriculture and Forestry (Cantor
Lecture).

Medical Society op London.— 8.30 p.m. Clinical Bvenlng. Mr. Davles-
Colley : Case of Plastic Operation for Rotropinm.—Mr. Walter Pye:
Case of Plastic Operation on the Face.—Dr. Maguire: Analgesia
after Injury to the Head.—Dr. I asm bard Owen : Case of Tumour of
Abdomen, and others.

Tuesday, January 25.

Out's Hospital. —Operations, 1.30 p.m., and on Friday at the same hour
Ophthalmic Operations on Mondays at 1.30 and Thursdays at 2 p jt.
St. Thomas’s Hospital.— Ophthalmic Operations, 4 p.m. ; Friday, 3 p.m.
Gancbb Hospital, Brompton.— Operations, 3.30 p.m.; Saturday, 3.30 P.m
Westminster Hospital.— Operations, 3 p.m.

West London Hospital.— Operations. 3.30 p.m.

St. Mart's Hospital. —Operations. 1.30 p.m. Consultations, Monday,

1.30 p M. Skin Department. Mondavi and Thursdays, 9.80 a.m.
Society of Arts.—8 p.m. Mr. J. H. Kerry Nicholls: The Voloanlc

Bruption In New Zealand.

Royal Medical and Cjiiruroical Society. — 8.30 p.m. Mr. Barwell:
On Widely Inciting by a Two-Stage Method Hydatids of the Liver.—
Mr.W. B. Cant: Clinical Observations on “ Induration "in the Primary
Lesion of Syphilis In Women (communicated by Mr. Holmes).

Wednesday, January 26.

National Orthopaedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital.—O perations, 1.30 p.m. ; Saturday, same
hour. Ophtbalmio Operations. Tuesdays and Thursdays, 1.30 P.M.
St. Thomas’s Hospital.—O perations. 1.30 pm.; Saturday, same hour.
London Hospital.—O perations, 3 p.m.; Thursday ft Saturday, same hour.
Great Northern Central Hospital.—O perations, 3 p.m.

8amaritan Frrb Hospital FOR Women and Children.—O perations,
3.30 P.M.

University College Hospital.—O perations, 3 p.m. ; Saturday, 2 p.m
S kin Department, 1.45 p.m. ; Saturday, 9.15 a.m.

Royal Free Hospital.—O perations. 3 p.m., and on Saturday.

King’s College Hospital.—O perations. 3 to 4 p.m.; and on Friday,
3 p.m. ; and Saturday, 1 p.m.

Children’s Hospital, Great Ormond-Street.—O perations, 9 a.m.;
Saturday, same hour.

Hunterian Society.—8 p.m. Mr. Croft will explain and demonstrate
the Method of Treating Fractures by the Immediate Application of
Plaster-of • Paris.

Society of Arts.—8 p.m. Mr. J. Traill Taylor: Photographic Lenses.
British Gynecological Society.—8.30 p.m. Specimens will be shown.
Address on Llsterism, by Dr. Granville Bantock. Council at 8 p.m.

Thunday, January 27.

8t. George's Hospital.—O perations, 1 p.m.

8t. Bartholomew’s Hospital.—S urgical Consultations, 1.30 p.m.

Charing-crom Hospital.—O perations. 3 p.m.

North-West London Hospital.— Operations. 3.30 p.m.

Ophthalmological Society of the United Kingdom. — 8.30 p.m.
Living and Card Specimens at 8 P.M.:—Mr. Nettleshlp: (1) Atrophy
of Optic Nerves with Multiple Congenital Bxostoses of Skull;
(2) Three cases of Night Blindness with Peculiar Retinal Changes.—
Mr. George Cowell: Three cases showing the result of Operation for
Conical Cornea.—Mr. Marcus Gunn : Case of Transverse Calcareous
Film of Cornerr. Papers :—Mr. P. H. Mules : A short record of Some
Unusual Clinical Cases.—Mr. G. A. Berry : On three cases of Acute
Cerebral Disease with Ocular Symptoms —Mr. W. H. Jessop: Sudden
and Lasting Lateral Nystagmus.—Mr. W. Lang: Case of Meningitis
after Excision.

Friday, January 28.

Sr. George's Hospital.— Ophthalmic Operations, 1.30 p.m.

Royal Booth London Ophthalmic Hospital.—O perations. 3 p.m.

Olcocal Society of London.—9.30 p.m. Address by the President.
Mr. Henry Morris : (1) A case of Calculous Disease of both Kidneys,
with Remarks on the 8urgical Treatment of Calculous Kidneys;
(2) A case of Nephro-lithotomy.—Mr. Howard Marsh : A case in
which very Severe Symptoms were due to Fpur Small Stones in an
Atrophied and Movable Kidney; Failure to Detect the Kidney by
Lumbar Inolsion ; Discovery by Laparotomy ; Successful Removal
of the Organ.—Mr.W. H.Bennett: A case of Supposed Nephrotomy
for Scrofulous Disease. Living Sjiecimena :—Mr. J. R. Luun : (1) A
Boy with Ichthyosis; (2) Peculiar Deformity of the Feet In an
Ataxic Patient; (3) A Man with Raynaud's Disease of the Feet;
(4) A case of Myxcedema with want of Development of the Genital
Organs.

•atarday, January £9.

Hawn Hobpdaju—O perations, 9 rat.

METEOROLOGICAL READINGS.

(Taken daily at 8 JO a.m. by Steward’! Instruments.)

The LANCET Offloe, January 90th, 1887.

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ftiites, Sjjcrri Comments, ^.nsfers to
Comsponttents.

It is especially requested that early intelligence of local events
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent dtrect to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors .”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intendedfor insertion or for private informa¬
tion, must be authenticated by the names and addresses of
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of Thb Lancbt to be addressed “ to the
Publisher.”

We cannot undertake to return MSS. not used.

TnF. Riddell Fund.

Amount already acknow- | C. J. Kleland, Bsq.

ledged .£54 I 0 I J. Gould, Bsq. ...

F. Le Gro* Clark, Bsq. ... 1 1 0 W. Pearte, Bsq. ...

W. B. 0. Nourse, Bsq. ... 110; Miss B. Lunn

Sympathy. 0 5 0 W. Easton, Bsq. ...

'Collected by Dr. Wood- Mrs. Nicholson ...

man. Exeter:— I J. E. James, &q....

B. A. Brash, Bsq. 110; Sympathy.

£110
1 1 O

1 1 (>

1 0 i>

0 5 0

0 5 0

0 5 0

0 3 6

Captain Petrie .—The disclosures made by our Analytical Sanitary Com'
mission resulted, we are happy to say, In such legislative measure*
being adopted as have rendered Impossible in this oountry grosa
adulterations of the kind specified in the extract from the Pittsburgh
paper. The article, as a whole, is probably Intended to be amusing,
rather than dosorlptlve of an actual condition of things.

A Subscriber will find the reply In our Issue of the 8th Inst., p. 109.

COCAINE IN WHOOPING-COUGH.

To the Editort of The Lancet.

Sirs,—I n a letter which appeared in The Lancet of Feb. 37th, 18SG.
on the treatment of pertussis by local applications, I suggested that
cocaine be tried with the view of lessening the severity of the paroxysms.
In the Journal of the American Medical Association of October 9th, there
appears an original article by Dr. A. V. P. Garnett of Washington. In
which he states that in January of last year he determined to try the use
of hydroohlorate of cocaine by inhalation and used a six per oent. solution
of muriate of cocaine in chloroform, of which ten minims poured Into a
wineglass made warm by tepid water were placed under the patient 's
mouth. No difficulty was experienced after a few trials In getting the
patient to inhale the vapour. This practice was repeated every four
hours, and, whenever possible to do so, immediately preceding or at the
outset of a paroxysm of coughing, in the latter instance nsing double
the dose of the solution. He found that by thla means many of ths
paroxysms were arrested entirely or materially cut short. In very young
children Dr. Garnett has found it more convenient to pour ton or
twelve drops on a handkerchief, instead of using an Inhaler. Should
farther experience confirm these conalaslons, we have in cocaine »
remedy that will do much to rob this disease of Its most distressing
symptoms, besides greatly facilitating the application of germicide* for
its radical cure. I am. Sirs, yours truly,

Bournemouth, Jan. 17th, 1887. A. Woodman Dowdincj, M.D.

M.D. If F.B.C.S.E. and O.P.Q. have not enolosed their eards.

Mr. GiUibrand .—Next week.

Digitized by G00gle

Thk Lancet,}

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Jan. 251,1887. 203

Should Norfolk Hospital aw Fue t
Mr. James C. Barnham, in a letter to the Eastern Daily Press, argues
against the p wpo w l of wiring admission to the hospital independent
of lettere of subscriber* and dependent on the mere comparative
tine— of caaee aa determined by medical offloers and other*. He
tM«E« raeh a role vronld tell hardly upon patient* coming from a
distance, who might find themaelvea refnaed, and that it would hot
ronolllate the support of distant parishes.

A Tosasg Practitioner.— The attention of the bodies whose qualifications
'.he advertiser holds should be directed to the matter.

Srwrr Fontana! (Lerida).—We cannot exchange.

Ifr. J. W. Mason's (Hull) letter arrived too late lor publication this week.

PBB 8 ISTBNT DIAEBHCEA.

To the Editors of Thk Lanckt.

Sirs,—I n reply to the request of " L.B.C.P.” for information from
tw readers concerning the treatment of persistent diarrhoea, I beg to
tend you the following abstracts of two cues.

Caw 1.—A coachman, aged forty-two, consulted me in 1879 for per¬
sistent diarrhoea. He bad been exposed to great hardships and privations
during the Franco-German War, and bad had Intermittent fever.
Whenever he took anything to drink it was sure to 11 run through him”
immediately, and he had been obliged to give up his place because he
foand that he was unable to sit for any length of time on the box
without being disturbed by his Infirmity. On the theory that the
trouble might be of malarial origin, 1 gave him quinine (all the more
areal remedies having been tried by my pre d eces s ors), and this was the
hat I saw of him as a patient. A few months later, however, I met him
ta the street, and in reply to my Inquiry as to his health, he informed
cm that he arms perfectly well. I was just congratulating myself on the
aeoeeee of the treatment when he added that It was not due to any
physic of min*, or, indeed, of any professional brother, but that one of
Us colleagues who bad suffered In a similar way had cured himself by
waring a flannel binder round the body, and, following his friend's
advice, he had found it equally efficacious.

Cask 3.—A lady of uncertain age, from Central America, gave me
tome particulars about a similar condition. I was attending her husband,
sad the ailment was mentioned as a chronic Infirmity, for wnlch she did
aet e xpect to And any relief. She was saturated with malaria, and had
(ried every kind of treatment, the only medicine in which she had
-*- 1 —^ aay faith being hamamelis. I do not think I offered any
tirim: but In any case she would not have followed it. The following
year she again visited Paris, and I was mueh struck with the change for
the better in her appearance, and learnt that she was then quite well.
Afire trying without effect a grape cure and a whey cure in Switzerland,
fist had been recommended to go to Wiesbaden, where she had by the
<se of the waters been restored to health, and witnessed a like success in
the case of a fellow bather.

I presume that your correspondent has eliminated from his diagnosis
the possibility of organic disease of the liver. Assuming, then, that
there Is only habitual hypersemia of liver and intestine, associated with
malarial poisoning. I would recommend him to abstain from fluids
-tar ing meals and the period of digestion, and take, even if It bas failed
under other circumstances, small doses of arsenic.

I am. Sirs, yours faithfully,

Rue Marbeof, Paris, Jan. 17th, 1887. Oscar Jennings, M.D.

To the Editors of Thk Lancet.

Sirs, —Tour correspondent, “ L.B.C.P.,” seems to me to be suffering
from the result of abnormal fermentative changes in the bowels, due
(rofaabty to the original obstruction. In all ordinary diarrhma cases I
tad carbolic add with ammonia sufficient to check these changes and
the resulting flatulence. When, however, an element of chronlcity is
iiK re d a ced, the bacillary oonsequenoes have to be combated with germi-
rital remedies having a more remote action, and of these the blnlodtde
of mercury Is the one I depend upon. I would prescribe as follows :—
ft. gptritus unmoa aromat., 5*s.; sol. morph; hydrochlor. (P.B.), 3 I.;
vj. aekl. carbolic. (1 fn 30), jvi.; ether, chloric., Jil.; sol. hydrarg.
'odder. (B.P.), 51; potass, iodld., jss.; aquam ad |vill. M. ft. Mist.
Oae tablespoon!nl every four hoars.

I am, Sir*, your obedient servant,

Jan. 17th, 1887. 0. B. Illingworth, M.D.

To the Editors of Thk Lax err.

Sir*. —I have little doubt In my own mind that" L.B.C.P.” Is suffering
from malarial poisoning, and I would suggest a trial of large doses of
qabriae. I have myself suffered from such diarrhoea on my return from
the tropics, and at first oould not account for it, and treated It wrongly
with astringents; but experience has proved to me that, as far as my
east Kent. Its cause was tropical malaria lying latent In my system and
breaking oat periodically In troublesome diarrhoea, and at other time* in
iii iiiiiitallng muscular pains. As 8 lr J. Fayrer said In his lectures at the
Cottage of Physicians In 1883, Its symptoms are multifarious. Among
otftar peculiar pains it gives rise to is unendurable pain in the violnity
of UMkMasftad along the coarse of the nreter mod into the testis. This
in my ease is always relieved by a large does of quinine. I remember in
sjy young and ioexperlenoed days, in the hot weather fn India, treating
tine latter expr e s sion of, its tristeooe in soldier* as acid urine passing

down the nreter, and giving bicarbonate of potash and anodynes. Since
I have become the subject of such symptoms I am forcibly reminded of
my malpraxls, and in those cases a large dose of quinine would have
given rapid, if not instant, relief.—I am, Sirs, yours faithfully,

Jan. 17th, 1887. A Surgeon.

To the Editors of Thk Lancet.

Sirs,—W ill anyone kindly give me some suggestions as to the treat¬
ment of the following case of obstinate diarrhoea ?

Mrs. L-, after suckling her first child for two months, was attacked

for the first time In her life with diarrhoea, which has continued, more
or less, for the last five years. Milk, vegetables, fruit, or coffee always
bring it on. Worry, anxiety, and excitement also have the same effect.
The diarrhoea came on worse after the birth of the eeoond child and the
third, so that she had to give up suckling. She Is rather weak, and not
well nourished. Appetite good. A mixture of catechu, opium, and
chloric ether seems to have given more re'ief than any other medicine.
She is the wife of a medical man, and has undergone a variety of treat¬
ment without any permanent good effect.

1 am, 81rt, your obedient servant,

Jan. 17th, 1887. Nemo.

Dr. W. II. Murray.—Vie fear the employer is not liable, unless onr cor¬
respondent can prove that he was called fn on the employer's authority.
Mr. Eoersked (Arundel).—We shall be glad to receive the particulars.

B. 8. W. —It Is customary to waive all considerations of fee in such
cases.

HOMfEOPATHY.

To the Editors of Thk Lancet.

Sirs,—I have just received a pamphlet on “ The Medical Treatment of
onr Time,” which proves to be a prize essay on homoeopathy addressed
apparently more to the public than to the profession. In the appendix
there Is an urgent appeal to young practitioners to “visit the homoeo¬
pathic hospital in Great Orraond-strect, watch Its treatment, examine
into Its cases, and test its results with an open and candid mind and a
sincere desire to arrive at truth.” Now, this is exactly what I did. or
rather attempted to do, soon after I was qualified. I was treated with
great courtesy by the medlaal offloers, and allowed to accompany the
physicians on their somewluit rapid rounds; but upon my repeated
requests to be permitted to attend in the morning and assist in
taking notes and examining the patients, I was told that that
could not possibly be allowed. I was, I remember, shown a patient who
was being cured of Impetigo by taking a solution (!) of carbon, and was
assured that some drug—I forget what—had caused several ovarian
tumours to disappear. I was also taken to a meeting of the British
Homecopathio Society, where I heard it gravely stated that natrium
muriatlcum (chloride of sodium) iu minute doses was the best treatment
for relapsing fever. I was also shown the book by which, as I was told,
all homreopaths studied their treatment, referring to it as to a dictionary.
This was “ Jahr’s Materia Medics.” The absurdities I found in It when
I looked at it in the British Museum convinced me that homoeopaths
must be satisfied with very little evidence, and has since made me scep¬
tical when I am told of the wonderful cures they effect.

I am. Sirs, yours faithfully,

Jan. 18th, 1887. A Baffled Inquirer.

%* We have also received a letter on this subject from Mr. A. G. Bateman,
M.B., In which he says that Dre. Binger and Brunton have done an
immense deal to break down the barrier between homoeopathy and
allopathy, asks for a oalmerand juster examination of both systems and.
with a generosity which does him no discredit, argues fora discon¬
tinuance of what he calls “ boycotting" the homcnopatb. The prize essay
which calls forth these letters Is prefaced by a communication from Dr.
Bichard Hughes, in which, in a somewhat menacing tone, he says,
and he reiterates, that “this [the prize essay] may be the last appeal
to the profession of this country for justice to homoeopathy." We re.
gret to say that the “ last appeal to the profession” looks much more
like an appeal to the public, or rather ta the less informed among the
public. The medicine of to 1 day, excepting homoeopathy, is held up
to ridicule and disparagement, and is in very material respects mis"
represented whilst its real achievements are not stated. The whole idea
underlying, the prize emay Is that there is a conspiracy in the minds
of the men of medical science to shut their eyes to the discovery of
Hahnemann. This is an admission of despair and almost of failure.
Is there any other instance of all the scientific men in Burope resist¬
ing a true discovery for nearly a hundred years ? The idea is altogether
absurd. The sooner homoeopaths see that they boyoot themselves the
better for them. All they have to do is to drop their distinctive
appellation, cease to believe that there is something In the human
mind specially inimical to.them, liberate thdr own minds from the
fetters of a fantastic notion which they are pleased to call a" law,”
and recognise the general drift of medical science and art, and they
will find no unfriendly feeling to them.—E d. L.

Alois.—Such a person is not likely to suffer prosecution. But he is not
justified In acting in the way suggested.

Prater. —It is (Dffioult to answer the question without knowing tire
nature and amount of the insurance for which the fee la paid.

Mr. E.'J. Fisher—The duty is by law made imperative and gratuitous*

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204 Thk Uancht.1

.KOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jan. 22,1887.

Oitt and Guilds or London Institute. j

Professor Armstrong's lectures at this institution, on the Chemistry !
ot the Alkaloids and Albuminoids, commence on Monday next,
Jan. 21th, and not on the 27th, as by an error was stated in an
advertisement in ouroolutnns.

M.D., F.R.C.S .—Our correspondent acted with much humanity and
reasonableness. The journey home might have been followed with ,
fatal consequences. He has the satisfaction of having done right—the i
pnlse of Boards of Guardians doe# mt always follow that line of
couduct. The exUtrnoe of measles already in the infirmary nullifies
the only conceivable argument against his action.

Constant Reader—l. Moot-fields orally of the principal general hospitals.— j

2. This is more a question of taste than of professional etiquette.— j

3. We cannot give an opinion without seeing the circular.—4. As
we understand the question, the reply must be in the affirmative. I

Honorarium. —Unless any circumstance* exist of an exceptional nature, |
such as length of attendance, Ac., the charges mentioned appear highly ,
reasonable.

EMASCULATION OF FOWLS.

To the Editort of The Lancet.

Sirs.—Y oor correspondent, ** B. L. T.," will find all he want* relative
to caponislog and poutardislng of fowls if he refers to the large edition
of Tegetmeier’s Poultry Book. p. 138 (published by Koutledge).

As I am writiog, I should like to take the opportunity of asking
whether any of your readers have found any special treatment succeed
in split or fissured lip. A little girl, aged ten, always suffers from this
la cold weather, especially the lower lip, which gets rather a deep crack
in the centre. Even If It slightly heals, laughing will make it bad
again. I have tried several of the usnal applications—oleates, salves, Ac. 1

I am. Sirs, yours faithfully.

Jan. 19th, 1887. Fidklis.

To the Editors of Tu Lancet.

Sirs,—I n reply to your correspondent. “ B. L. T.,” we beg to say we i
have been making sets of Instruments for oaponlng ohickens for ]
upwards of eight years: Directions os to the mode of operation accom- |
pany each set. We are. Sirs, yours obediently,

Jan. lath, 1887. Krohxk axd Sksemaxx. 1

Hr. Brown (Oban).—We liave not given an exhaustive opinion on the ;
nutritive value of the esculent. One of the Handbooks published by j
Clowes in connexion with the late Health Exhibition, entitled •* Health
in Diet,” Part I., contains a chapter on the subject, which may possibly j
answer the purpose of our correspondent.

THK LICENCE OF THE LONDON COLLEGE OP PHYSICIANS I
A 8UBGI0AL QUALIFICATION. I

To the Editors of The Lancet.

Sirs.—C an a L.B.C.P. Lond. call himself "Surgeon," having no other
diploma? Or is a L.K.C.P. Lond. having only that diploma a surgeon? |
Can he give surgical evidence in court ? Can he sue in a county court |
for surgical treatment ? I am. Sirs, yours truly,

January, 1887. L.B.C.P.Lond.

».* The answer to all the above questions Is in the affirmative. The
licence of the London College is a double qualification, complete in :
itself.— Ed. L.

Erratum.—A n obvious printer’s error occurred in ottr issue of Dec. 25th,
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Washington.

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THE LANCET, January 29, 1887.

Harfehm fktos

CANCER OF THE UTERUS.

By J. WILLIAMS, M.D. Lond., F.RC.P.,

OBSTKTRIC PHTSICIAX TO UBIVMSITY COLLEGE HOSPITAL, LOXDOIT.

LECTURE II.
CANOBB OF THE CERVIX.

(Concluded from page 1$3.)

Cabs 15.—A married woman, thirty-one years of age, was
admitted into University College Hospital in December, 1884
and gave the following history. She first noticed a yellow
discharge three years ago, which has greatly increased in
quantity daring the last three months. It was preceded by
bearing-down pain. Daring the last three months she has
had hemorrhage about a fortnight after each menstrual
epoch, lasting for about two hours. This was first noticed
after a fall. She began to menstruate in her fifteenth year,
has always been regular, with bearing-down pain for two or
three hours. She has been losing flesh for twelve months,
but more rapidly during the last five months, and during
this time she has suffered from indigestion, swelling of the
feet, and faintnese at times, once causing her to fall and
hurt her back. She has had rheumatic fever three times.
She has been twice married, the first time at eighteen; she
became a widow at twenty, and was married again at
twenty-nine. She has had one child by the first husband,
and no miscarriages. She was fairly nourished, somewhat
sallow; she weighed 7 st. 7 lb.

The uterus was moderately low down, slightly rctroverted,
and freely movable; the cervix had been lacerated on the
right and left sides. The anterior lip was rough, and there
was a rough edge apparently at the Junction of the vaginal
surface with that of the canal. The posterior lip was thick¬
ened, soft, everted, and bled readily on examination. The
surface of the growth was of a pale pink colour, and some¬
what like brain-substance in appearance. The growth in
the posterior lip extended backwards, but did not involve
the vagina.

The cervix was amputated above the vaginal insertion.
After removal the nodule on the posterior lip was found to
be three-fourths of an inch in diameter. On the anterior
was a papillary superficial growth about three-fourths of an
inch in diameter and one-fourth of an inch in depth. The
surface appeared rough, and the stratified epithelium was
retained to the border of the disease on both lips, and at that
paint was a slight depression as if it ceased abruptly. On the
vaginal surface of the nodule on the posterior lip the strati¬
fied epithelium was intact. The squamous epithelium on
the vaginal portion was preserved. The whole thickness of
the posterior lip was cancerous; the cancer extended down¬
wards so as to abut on the squamous epithelium. It was of
the columnar type, and developed in the glands. It appeared
to have begun m the deeper parts of the glands.

8be returned twelve months afterwards with recurrence,
and I ask your particular attention to what I have to say
about this, for its importance from a clinical and therapeu¬
tical point of view cannot be exaggerated. A portion of the
vagina and of the stump of the uterus remaining after the
first operation was removed, and when the part removed was
submit tod to examination a very curious and interesting
condition was found. The surface of the vagina as well as
of its walls was healthy. The epithelium was somewhat
thickened, but it showed no sign of malignancy. The surface
of the stump was healthy. There were numerous glands in
the mucous lining of the portion of the canal left, and these
were healthy; none of them showed signs of cancer. Deep
m the cervical wall, however, on its outer aspect, was found
well-developed cancer. Between the glands on the inner
surface of the canal and the diseased tissue was a layer of
perfectly healthy cervical tissue, containing neither glands
nor cancer. There was no connexion between the glands
preaentizLthe cervix and the malignant new growth. The

cancer wan of a typically glandular character, and every

■

stage of transition from almost healthy glands to cancerous
masses could be distinctly traced. Whence came the disease ?
The recurrent disease presents the same glandular character
as the primary disease in the cervix, and yet it does not
grow from the cervical glands. On examining the whole
section, we find the cancer grows from the outer end of the
cicatrix upwards and inwards into the wall of the cervix;
and it is clear that before the first operation the disease
had extended through the whole thickness of the cervix
and invaded the cellular tissue around, though in so flight
a degree as not to have affected the mobility of the uterus,
and to have escaped notice during the operation. As far as
the uterine stump was concerned the cancer had been ex¬
tirpated, but the cellular tissue around proved traitorous and
the disease recurred on the outer and non-glandulous aide
of the organ. I must illustrate this further by another case
of no less interest.

Case 16.—A married woman, very sallow and cachectic-
lookiug, was admitted on May 9th, 1885. She weighed
8 st. 3 lb. For the last six months she has been getting
thinner; she has noticed a slight discharge, and has lost a
great deal of blood : during the whole time she has hardly
been free from haemorrhage. She has had slight pain in the
stomach and between the shoulders. She haB freqrkJnt.
frontal headache, and lately has frequently vomited after
taking food. She has no pain or flatulence after food.
Temper bad. She was married when nineteen years of age,
and has had five children, at twenty, twenty-one, twenty-
three, twenty-five, and twenty-seven years of age. Her
labours were good. The catamenia appeared at thirteen,
and have always been regular until a few months ago,
lasting six days without pain. The cervix was low down,
freely movable, and of the diameter of half a crown. It was
flattened and granular, some of the granules being hard,
others soft. Tne cervix was greatly thickened. The body
was not large for a woman wno had had five children ; it
was freely movable.

Supra-vaginal amputation of the cervix was done, and id
the course of the operation the disease was found to extend
up higher than was expected, the whole of the cervix being
thickened. The cervix and the greater part of the body
was removed, and the mucous membrane of the fundus,
together with that at the orifices of the Fallopian tubes,
were shaved off. The cancer in this instance proved to be
histologically of the same character as that already de¬
scribed-glandular. The patient was lost sight of un®
August last, when she came back complaining of a return
of the bleeding. On examination it vas found that recur¬
rence of the disease had taken place, and the manner of it
and the lines of its growth were very clear, and have an
important bearing upon the operative treatment of cancer
of the cervix.

"The patient was readmitted into the hospital on Ang. 31st,
1886, sixteen months after the operation. She said that she
had been well until lately, when bleeding returned, and
recurred occasionally, lasting four or five days. She had a
varying amount of offensive discharge, but always small m
quantity. The mucous membrane of the vagina was healthy
up to the old wound. A finger was passed through the opening
at the top of the vagina into a cavity large enough to hold a
small walnut. The sides of this cavity were formed by the
cellular tissue around the cervix, and tne bases of the broad
ligaments, the bladder and peritoneum, and the roof, by the
remains of the body and fundus of the uterus left after the
operation. The sides of this cavity were cancerous. The
walls of the vagina were fixed and rigid—the anterior in
almost its whole length, the posterior for about an inch
from the top; the sides were also similarly affected. On
microscopic examination of a portion of the vagina at the
edge of the wound, the superficial epithelium was found
intact, and the papilltc were not enlarged; beneath the
epithelium was a layer of healthy vaginal wall, and deepet
still was cancerous tissue. The recurrence was of a cylin¬
drical shape, but the cells composing it might have been
taken for those arising from squamous epithelium rather
than from columnar. While in the hospital she had several
attacks of severe haemorrhage, and died on September 20th.

On examination after death the peritoneum of the pelvic
was in the main healthy. The fnndus of the uterus was
normal. It was freely movable within certain limits, the
limits being determined by the indurated tissues below the
stump at tne upper end of the vagina. There was a chain
of cancerous glands running up along the iliac vessels on
n s —

y Google

206 Thu Lancet,]

&R. J.,#tLUAMS ON CANCER OF THE UTHBHS.

[Jam. 29,1887.

tfie loft side; on the right side were a few enlarged glands
at the brim of the pelvis, at the sacro-iliac synchondrosis,
-awl-ftlong each side of the spine. There were three yellowish
white spots, each of the sue of a hemp-seed, on the posterior
,affsct of the fundus. They were covered by peritoneum,
.and ..the vessels running into them were injected. The
ovudes were healthy. The right Fallopian tube was closed
atj,fche outer extremity, but not dilated; the left was
healthy,'but a little more bent than usual owing to an old
adoesipn. The rectum and sacro-uterine ligaments were
^etynthy, 'There was a large opening between the bladder
ajnd iiM> vagina. The new growth had spread for the most
part ,in the cellular tissue around the vagina, breaking
through the mucous membrane in a few places only. The
jgMuo .between the vagina and the bladder was involved
as/ar. down as the opening of the urethra;. posteriorly the
disease extended for a much shorter distance. The growth
.was sloughing. The mucous membrane of the vagina was
healthy, except at a few points whore a few whitish spots
aalfig as carra way-seeds were seen, caused by the encroach¬
ment' of the new growth from the surrounding tissues. The
kidneys showed extreme interstitial nephritis; the pelves
>fer»ddated; the right contained pus; there was commencing
apnpurativo nephritis in the right kidney.

. .In this instance the recurrence took place, not in the
Htonne atump or in the vagina, but in the peri-cervical
fefijul^r tissue. It grew into the bladder, forming a large
bttenipg into it, and into the cellular tissue at the base of
the broad ligaments and around the vagina, and at the time
of death had only just begun to invade the uterine 6tump
fcud the vaginal mucous membrane by extension.

, Three other cases 1 have observed in which the cervix was
amputated for cancer and in which recurrence took place.
In two of these the disease did not return in the stump, but
ia-the cellular tissue around, and it did not appear in the
Stump until the close; in one I cannot tell whether the re¬
currence appeared in the stump or cellular tissue. In one
qf those in which recurrence snowed itself in the cellular
tissue, Ido not know the nature of the cancer; in the two
ofhers it began in the glands.

.’But cancer may also begin not only in the lower section
Off the cervix, but also just below the inner orifice in the
substance of the cervical wall. This happens perhaps
ofjtener than is generally supposed, and the fact has not
been taken into consideration m theorising about the cause
of cancer. I have seen two instances of this which were
observed from an early period.

, Cask? 17.—The first was that of a lady, aged about forty
years, of a very fair complexion, who had had two children
lAdeome miscarriages. I saw her first in July, 1878. She said
that she bad not been poorly for six weeks, and that she
felt sick and had very frequent micturition. On examina¬
tion, the os was found laqge and patulous; and high up, close
to, the inner orifice in the wall of the cervix, was a small
hsird mass the size of a pea. This was thought to be a small
fibroid. I saw her again in 1879. She said that she had had
a, miscarriage at Christmas-time. Her husband had been
away.for six months, and returned a fortnight ago, and she
hadobserved a slight loss of blood after coitus since, but at
another time. She had no pain and no discharge. The
Uterus was a little enlarged and freely movable. The
posterior wall was thickened, and on its inner surface was a
small ulcer about the size of a shilling, which extended
ajjjghtly on the vaginal surface of the lip; it was depressed
hard edges, and it bled on the slightest touch. The
qfcextu .was extirpated. It was throe inches and a half in
l*W«th. The walls of the body were somewhat thickened,
tmt otherwise appeared to be healthy. The cervix was con¬
siderably enlarged, the enlargement affecting chiefly the
pqrterior wall, which had a small ulcer situated ou its anterior
s|jpta<» ,jiut within the .os. The anterior lip was papillary
oa ,the surface. Section showed the posterior wall to be
occupied by a mass of the size of the kernel of a walnut.
T^is reached upwards to a little above the level of the
internal orifice, and occupied the whole thickness of the
W#U,-an4 it reached downwards to the portio vaginalis; but
ibpod nowhere penetrated through the mucous membrane
o£vbha portio, which remained intact. The mueous mem-
bjQape oi the lower half of the cervical hid broken
dgprn, and there was found the ulcer I have already men¬
tioned* The growth appeared to the naked eye almost as if
ibflwe inoapsuled; but this appearance seamed to be due to
pressure exercised bythe growth uponthe, parts imme¬
diately surrounding it. The growth was a glattmilS'- cancer.

"But cancer may have more than one point of origin. It
may begin in the substance of the wall of the cervix, near
the inner orifice, and also at or near the os externum. It
may begin in the cervical glands and in the squamous
epithelium of the portio at the same time. This happened
in the following case

Case 1^.— The patient was thirty-nine years of age; she
had had three children, and was admitted into University
College Hospital in July, 1885. She said that menstruation
had always been regular until July, 1884, when she had a
“tremendous haemorrhage.” She had been bleeding for
three weeks. She bad hhd no pain until a few months before
admission, and then it was only slight, situated in the um¬
bilical regioD, and of a sharp shooting character, lasting a
few seconds. Micturition was normal. She had wasted
a little. Menstruation began between the age of fourteen,
and fifteen; it was regular, lasting two or three days, in
large quantity, accompanied by a little backache. Her
labours were good; the last was “rather hard.” She made
good recoveries. The father died of cancer of the stomach ;
five brothers and sisters died of consumption. The patient
was well nourished, fat, but looked very ill, sallow, and
anaemic. She was of dark complexion. There was a slight
watery discharge from the vagina. There was a growth on.
the anterior lip of the uterus and inner surfaoe of the canal,
extending to the vaginal portion; the mucous membrane
over the portio appeared healthy. The posterior lip was
healthy. The body of the uterus was somewhat enlarged
and freely movable. The cervix was amputated at the inner
orifice. She died of septicaemia.

After death no enlarged glands or secondary deposits were
discovered. The body of the uterus was healthy. Examina¬
tion with the microscope showed the squamous epithelium
of the vaginal portion to be intact and unchanged up to a
point close to the external orifice. Beneath the part of it
close to that orifice were many glands, clearly glands of an
erosion. Before it terminated at the external orifice it
became suddenly much thickened, and beyond this point it
was cancerous, and this cancerous part overlapped the
glandular cancer which I shall presently describe. This
cancerous portion was in part separated from the glandular
cancer by glands which were not cancerous. Then we came
upon the cancer of the cervix, which appeared to have been
developed from the lower cancerous centre. This was
developed from the glands in the substance of the cervix, and
had not involved the whole of the superficial glands, so that
the inner surface of the cervical canal was in the main
intact. Higher up towards the inner orifice was the cancer
developed from the upper centre near the internal orifice,
and this also had grown from the deeper glands, and
had left some superficial glands unaffected in the canal.
The growth of the cancer from the glands is clearly
shown by the transition from columnar epithelium of the
glands into cancer. Here we have cancer developing from
two points of origin, if not from three—that is, from the
glands just below the inner orifice, from glands near the
external orifice, and from the squamous surface of the
portio vaginalis. It may be asked, What is the relation of
the growth of cancer in the squamous epithelium to that

? rowing from the glands? I cannot answer this question.

do not know whether it was an independent growth, or
whether it was due to irritation caused by the presence of
the glandular cancer in its immediate neighbourhood.

A form of cancer which has not been described before is
the squamous epithelioma, which attacks the mucous polypus
of the cervix. I have met with only one instance of the
kind. It was the following:—

Case 19.—A patient aged forty-two, was taken into the
hospital for a few days to have a small mucous polypus
removed. She said that she had been losing a good deal of
blood with her periods. The uterus was low down, and a
small polypus was found projecting from the os externum.
It wa3 seized with forceps and twisted off. The polypus
was about three-quarters of an inch in length, and naif an
inch in diameter at its widest part. Its pedicle was quite
thin. A section was made of the growth in its whole
length, and this was examined microscopically, and a very
curious and not less important state of things was discovered.
The lower and larger end of the tumour was capped by a
layer of cancerous squamous epithelium, which sent pro¬
cesses into the substance of the growth and into some of the
glands. Above the point where the cancer ceased and along
the surface of the pedicle many glands opened, and the
I surface was covered by columnar-epithelium. The pedlfcle

Tn Lancs*,]

DR. C. F. KNIGHT OK ACUTE GRUUI’OUS PNEUMONIA.

[Jan. 29,1887, 2fl7

was quite healthy, Thia.waa amuooua polypus, and evidently
had grown from the surface of the cervical canal. The
lower portion of it, outside the os externum, appeared to
have acquired a squamous epithelial covering, while that
covering the base retained its original columnar form.
Jteriae polypi in advanced age are ape to be malignant, and
whenever removed they should be examined by the micro¬
scope with a view to ascertain their true character.

The changes in the glands in cancer are various. The
glands increase in number, and develop in places where
glands are not present in health. They assume forms which
are not seen in health,, but which are often seen in erosions.
The chief and the characteristic changes, however, are those
observed in the epithelial lining of the glands. The cells,
which are in a single layer in health, become stratified or
multiple-layered, and frequently fill the gland, obliterating
its lumen. The cells, instead of having a single nucleus,
acquire two or more, and they become many-shaped. Not
infrequently they form long branching tubes, or stringB of
cells, and clusters and nests, which sometimes contain horny
cells, just like those found in squamous epithelioma; and
frequently the true character of the growth can only be made
out by tracing it to its origin, or by tracing its mode of
growth. The latter method fails, however, in some cases,
as in the recurrence in Case 16. Sometimes the cells pre¬
serve their original columnar character, but become thinner
and larger, and stratified as in Case 17. In other cases the
user product oonrists of small round or oval oells, as in
Qasa 18; and here it would have been impossible to have
arrived at certainty with regard to the origin of the growth,
but for the discovery of the actual transition of the columnar
to the round cells. The cells in the recurrences may
maintain the character of those met with in the original
growth, retaining more or lees their columnar shape, as in
Case 15; or they may lose every trace of it, and present
characters which are indistinguishable from those of
growths from squamous epithelium, as in the recurrence in

<Wl7.

The starting-point of cancer of the cervix, so far as 1
have seen, is in the cervical glands. I have seen no case
originate in the epithelium of the surface, but it may begin
in the glands close to the surface or in the deeper portions
of the glands. Of twenty-four cases, the whole cervix was
involved in nine when first seen, and it was not possible to
discover the starting-point of the growth. It is not im¬
possible, indeed I think it is probable, that in some of these
•-he growth had begun near the inner orifice, and among other
reasons for this opinion is the fact that the portio vaginalis
was not ulcerated in any one of them, although the whole of
the cervix was involved. In eleven the cancer had clearly
begun in the lower part of the oervix; in two it began near
the inner orifice; in one it appears to have begun in two
separate centres, one being near the outer and one near the
inner orifice; and in one it had commenced on the surface
of a mucous polypus. So that although the upper part of
the oervix is by no means uncommon as the starting-point
of casoer, yet the lower half appears to be a far more
favoured site. Of the eleven in which the disease had begun
in the lower part of the oervix, the posterior lip was alone--
or chiefly affected in. six, the anterior in two, and the right ’
commissure and lipe in two, leaving the left commissure
free. So that cancer appears to show a preference for the-
posterior rather than the anterior lip of the uterus, the
growths retaining more orlessthe columnar character, as in
Case 15, or they may lose all trace of it, and present appear¬
ances which are not distinguishable from those of growths.
from squamous epithelium, as in the recurrence in Case 16.

Qc forma assumed, by cancer of ; the cervix are various.
It may form a polypus hanging from one of the lips; in
this oaaa its surface carries for a considerable time a thin
layscotnormal squamous epithelium, which has nothing to
do with tile disease. In others it)forms a papillary growth
on the surface* which- penetrates deeply into the wall of the
cervix, and then it looks much like the head of a cauli¬
flower; or the growth may begin as-a small nodule in the
wall of the oervix, as in Cases 14, 15, 16, and others; or,
again, it may begin as a nodule-dose to the inner orifice and
gradually extend and involve the whole cer run 1 have met
with no dear instance .-in which the disease began on the
smiaee.

The lines of its growth appear simple, and unfortunately
thayhavaa direction which is calculated to baffle treatment.
If we talas fimt of aU the polypoid form, we find here the
tsmiaMferiiltfcft dissaas ia- tq, grow ,downwards into the

vagina and to form a sort of excrescence on the lip. The
growth appears to invade the lip for a short distance, appa¬
rently for a depth of not more than about three-quarters of an
inch; but it involves the whole thickness of it. If we take
three or four cases in succession, beginning with Case 14, we
shall find the disease commencing as a small nodule near
the surface and gradually extending downwards and out¬
wards, and upwards in a lees marked degree, invading the

degree, invading the

wall of the cervix deeper and deeper until it has passed
through its whole thickness and has reached the cellular
tissue around it, where it luxuriates. At the same time it.
grows downwards, causing elongation of the lip aa well as
thickening. In the course of this process of growth the
squamoas epithelium is retained, but it becomes thinner
and thinner, apparently by the tension placed upon it. As
the disease progresses, it extends upwards and reaches the
internal orifice, and sometimes, but rarely, passes it. This
tendency to grow downwards and in a lateral or horizontal
direction towards the peri-uterine tissues is very clearly
shoWn by the instances of recurrence which I have related..

Again, when it begins high up, just below the internal
orifice, its lines of growth are similar. It has no tendency
towards, or preference for, the body. It does not, however,
invariably respect the internal orifice, for sometimes, it
passes beyond it and invades the body, it grows downwards
towards the vaginal portion and outwards towards the
cellular tissue around, and ultimately involves the .whole fi
the wall in its length and thiokness. This was well seenin>
Case 17 and-in another, the only two cases in which this fern),
was observed from an early stage. Thus the lines of growth
are mainly outward and downward so as to involve the portio;
vaginalis and the vesico-vaginal and recto-vaginal septa,
but respecting the mucous membrane of the vagina. , ,

ftrinre

ON

ACUTE CEOUPOU8 PNEUMONIA.

Delivered at Mercer's Hospital , Dublin,

By CHARLES FREDERICK KNIGHT, M.'IX^

I'OXStTLTING PHYSICIAN; MASTER IN SURGERY, OUSTKTBICS. AN!>

< t YN.ECOLOGY i LKCTURKR ON PRACTICE OF MZIUCING AN1> ■

PATHOLOer, LSDWiaH SCHOOL; PHYSICIAN It)

THE HOSPITAL.

Ghntusmrn, —Towards the end of last session you-wens'
afforded an opportunity of hearing a paper read on “ Certain
Peculiarities attending the type of Pneumonia prevalent
during the session in Dublin and its immediate neighbour¬
hood,” and of subsequently listening to a discussion on. the
b object, which by special request was chiefly directed to the
treatment of the affection. The peculiarities to Which
attention was directed were complications—viz., pericarditis,
pleuritis, peritonitis, congestion of the brain, lungs,, and
kidneys, and in one case dyspepsia. It was stated;that
morphia, had been administered-in some of these case*sub¬
cutaneously to allay pain and diminish the number of respira¬
tions, also that in onp case aconite was administered with
benefit, and in another where the right hbart was loaded
cupping afforded speedy and lasting relief. Tou heard that
some years ago the late Professor Stokes treated cases ot this
form of pneumonia with large doses of tartars ted antimony
—six-or eight-grain,doses; that some years after this the
disease was treated: in Edinburgh with diaphoretics, whiah
practice was about the same time followed by Professor
Stokes, who stated that the .constitutions of the people had
changed so much that they were unable to beac the more
depressing mode of treatment. Cases were cited where, the
affection had been preceded- by exposure to emanations
from sewers, and also cases where it was associated wjth
enteric fever. A close observer of climatic influenaaaon the
causation of disease bad noticed that the affection was must
frequently met with in the months of April, May, and .hip*—
that is, during the transition period from wet to dry cold-r¬
and suggested that this atmospheric condition may sot ,ft»
aa excitant. Opium was advocated to allay pain, umUdpo-
ergoty though, mid to be a oardiae sedative, like aqouite*

208 Thk Lancet,]

DR. S. TAYLOR ON A CASE OF RAYNAUD’S DISEASE.

[Jan. 20, 1887.

itill, good effects have been obtained by carefully watch¬
ing the action of these drugs. Quinine was little noticed
except by one speaker, who objected to its adminis¬
tration in the disease because it “ dries up the secretions.”
Large blisters were advocated, but attention was drawn to
the fact that they caused localised pleuritis. Lymph had
in one case been found on the cerebral arachnoid. Mercury
had also been administered with advantage. Attention was
directed to a valuable physical sign, obtainable in a large
number of cases, which occurred during the session—viz., in¬
creased resonance, sometimes amounting to tympany, above
the affected portion of lung, which was not subsequently
attacked.

The CO803 that have come under your notice during the
session have not presented any unusual features, and though
.some might be classed as bad cases, in no instance have we
had a fatal termination. You have been taught for years
to avoid opium in all forms of pulmonary disease. I admit
that in cases of pneumonia where opium or its preparations
have been given, the objects aimed at—namely, allajHng
pain and reducing the frequency of the respiratory acts-
have been obtained. But is this advisable ? Can we not by
other means relieve the pain, and is not the increased
frequency of the respiratory acts a conservative process,
compensating for the lung tissue, which is inactive ? Again,
in oases related to me, ana also in those recorded, in which
opium has been given, complications, especially cerebral,
have arisen. Is this due to the cerebral congestion caused
by the narcotic ? With regard to ergot, does it act as a
cardiac sedative in medicinal doses ? Doubtless it does so
in toxic cases, like digitalis, and in medicinnl doses it
diminishes the frequency of the cardiac beats; but does it
not act primarily by contracting the arterioles, thus raising
arterial tension, and causing the heart to contract less
frequently, but with more regularity and force ? I regard
ergot as a most valuable therapeutic agent in this affection,
particularly if given in the earlier stages, causing contraction
of the vessels, acceleration of the blood current, and limit¬
ing the amount of exudation. Quinine is of value as an
antipyretic. The term “ drying up secretion ” is rather in¬
definite, but if it has the power of limiting the amount
of exudation, its administration will be beneficial even
in the earlier stages. It is probable that the delirium
may in many cases be due to the presence of exudation
substance on the arachnoid, and not to the action of
narcotics. The hyper-resonance noticeable above the affected
portion of lung was, I believe, pointed out by Dr. Hudson,
who was of opinion that this preceded extension of the dis¬
ease to' the area which was hyper-resonant; this, however,
did not occur in the cases previously referred to, no exten¬
sion of the disease having taken place. Is not the increased
resonance due to distension of the air vesicles which are
adjacent to the consolidated portion of lung? The more
marked the distension, the greater will be the tenuity of the
membrane which forms the walls of the alveoli; conse¬
quently there will be stasis of the capillary circulation in
that part, thus placing it in a condition most favourable for
the manifestation of the disease in question.

It has been remarked—and very properly—that this dis¬
ease is not suitable for “ speculative medicine,” and also that
drugs have little effect on its progress. Pathologists of the
present day nearly unanimously regard acute croupous
pneumonia as a specific disease, the exudation substance in
the pulmonary alveoli being its local manifestation. The
views which I hqld are not only in accord with this, but I
go further and say that the affection tends to throw out
exudation substance on all serous membranes, these being
especially “ selected" on account of the tenuity of the mem¬
branes and transudation from the bloodvessels taking place
with facility. The “ selective power ” of disease is readily
seen in many other affections—rheumatism, &c.; and this
view with regard to croupous pneumonia explains the
phenomena seen in the pericardium, pi euro, peritoneum,
arachnoid, kidneys, &c., and shows us how occasionally these
membranes are implicated as well as the pulmonary alveoli.
The predilection for the lung tissue appears to me to be due
to the fact that its tenuity is greater than other serous
membranes; the walls of the vessels are more permeable;
the membrane is the most extensive of its class in the body,
and its vascularity is far in excess of any other. The exuda¬
tion in the alveoli obtains its peculiar characters from the
presence of so many bloodvessels, and is most likely to
become puriform from its constant exposure to the air,
whereas the same exudation substance on other membranes

does not so frequently undergo the same degenerative
changes from the absence of this exciting cause. I would
direct attention to the pathological significance of the
“raspberry” congestion of the posterior thick margin of
the lungs, to the attenuation and fatty condition of the
right heart, and finally to the elongated and attenuated
condition of the papillary muscles in the right ventricle.
At a recent necropsy I found two papillary muscles with
a clot projecting into the pulmonary artery, which accounted
for the sudden termination of the case.

The following is the treatment which you have seen
adopted in the cases occurring in my clinique:—A patient
in the first stage is placed on camphor and ergot, with counter-
irritation over the affected area by sinapisms or turpentine
stupes; if the temperature runs up, quinine is added to the
camphorand ergot. Embarrassed respiration from congestion
of the right heart is relieved by depletion; but if from exten¬
sion of the disease, the physical signs point to its advent and
call for energetic treatment—viz., larger doses of ergot, using
turpentine in th e form of inh alation, stupes, and by the mouth.
Finally, in the third stage, if the exudation is not being ab¬
sorbed, stimulants are given, as brandy; if the cardiac action
is weak, digitalis is prescribed, carefully watching effects to
guard against these drugs embarrassing respiration. In cases
associated with “prune juice” expectoration turpentine is
especially useful. I regard it as the only remedy on which
we may rely with confidence in apparently hopeless cases.
It is a stimulant to the pulmonary capillary circulation,
stimulating their absorbent functions. It is also a powerful
“antiseptic” and haemostatic, and a therapeutic agent which.
I believe, exerts a powerful and beneficial influence on the
progrees of this affection; and by its free uee you have had
numerous opportunities of seeing many cases of croupous
pneumonia guided to a happy termination in the wards of
this hospital.

A CASE OF RAYNAUD’S DISEASE.

By SEYMOUR TAYLOR, M.D.Abebd., M.R.C.P., &c.,

ASSISTANT PHYSICIAN TO THK WKST LONDON HOSPITAL ; DKMON3THATOK
OF ANATOMY, ST. THOMAS'S HOSPITAL.

On February 8tb, 1886,1 was called by my friend. Dr. C.
F. Wilkinson of Caledonian-road, to see a patient of his. £
made the following notes of the case:—

L. D-, aged fifty-six, widow, who keeps a butcher’s

shop, had been in failing health since her husband died,
some years ago. Formerly a very active and energetic
woman, she had, during the last four years, been somewhat
lethargic; she had increased rapidly in bulk, owing to over¬
feeding, and, as a consequence, her exercise had been much
restricted. She had hitherto enjoyed only tolerably good
health, having suffered from occasional bronchitis and
rheumatism. She was also subject to quinsy and frequent
‘nettle-rash.” In addition, she had periodic attacks of
“ stomach-ache” and looseness of the bowels for many years,
the diarrhoea being easily increased by hurry or excitement.
Her friends asserted that she was always emotional, being
“easily upset,” tremulous, and would always cry at the least
distressing occurrence; and they constantly noticed her
habit of sighing and gaping. The patient herself was always
complaining of catching cold, and of always feeling cold
except in the middle of summer. There was no history of
exposure to malaria.

When I examined the patient—a very large, fat woman—
she was complaining of excruciating pain in her hands and
fingers and in her toes and feet. The digits in both ex¬
tremities were affected by the condition known as Raynaud’s
disease. In the right hand the pulp of the index and little
fingers was of a dusky, livid, or bluish tint, whilst the whole
of the skin, back and front, on the terminal phalanges of the
ring and middle fingers was of the same dusky and livid
colour, but apparently in a more intense condition. In the
left hand the same fingers—viz., the index, the middle, and th e
ring—were affected in a precisely similar way, except that
the discolouration was on the skin over the dorsum of the
little finger instead of on the pulp. (See engraving.) There
were symmetrical blackpatches about, the size of half-crown3
on the dorsal metacarpal surfaces of both hands. Over these
patches of discolouration the skin was of a dark bluish tint
at first, not at all unlike the discolouration resulting from a

Thx LancktJ

DE. S. TAYLOR ON A CASK OF pfYNMJD’8' DISEASE. ,[Jan. 29,1387. 4209

the aortic valve and in the course of the aorta. The
lungs presented a slightly impaired percussion note
at both bases, with small crepitation both with inspira¬
tion and expiration. Elsewhere there was dry rhonchus,
with a slightly prolonged expiratory murmur, which condi¬
tion, togethei with great expansion and hyper-resonance of
the thorax, is generally held to be characteristic of chronic
bronchitis with emphysema. The respirations were 30;
temperature 99° F. The hepatic dulness was slightly
incr eased, and there was some slight resistance over the
hepatic region, probably showing just such an enlarged
liver as one would expect in a patient of her build, occupa¬
tion, and habits. The urine was of sp. gr. 1025. and con¬
tained mucus and an excess of urea, but no albumen or
tugar. I could detect no oxalates with the microscope,
but amorphous urates were abundant, and there was un
occasional crystal of uric acid. There was nothing in tl o
appearance of the urine or in its chemical reaction indi¬
cating the presence of blood. The skin over the general
surface of the body, but especially on the chest and back,
was damp and sodden, and, in addition, was covered with a
dense papular exanthem somewhat resembling an irregular
eruption of small-^ox. This condition was perhaps
best marked round the loins and abdomen at the line of cinc¬
ture of her garments. Indeed, beneath the band of an old

blow or crash. The cutaneous sensibility was so much
increased over the discoloured arete, that the slightest touch
caused exquisite pain; the patient even complained of pain
from exposure to the atmosphere. The toes were affected in
a similar way ; that is to say, in the right foot the terminal
phalanges or the middle, ring, and little toes were dis¬
coloured, tense, and painfal, the pulp being the part appa¬
rently most involved, although ti e lividity extended to the
dorsal surfaces of the digits. There was, in addition, a patch
of discolouration about two inches equ&re on the dorsum of
the foot over the bases of the second, third, and fourth meta¬
tarsal bones. In the left foot the ring and little toes only were
seized, but exactly in the same way and degree as in the
right foot. There was, however, no patch on the dorsum of
the foot. At night there were paroxysms of excruciating
pain in the discoloured fingers and toes, causing her, although
a woman of some fortitude, to cry out with distress. The
pulse was 100, but regular and free from intermission.
There were no signs of degeneration in the vessels, nor any
obstruction in the main arterial trunks of the limbs, and, in
addition, pulsation could be distinctly felt in the digits of
both npper and lower extremities. The heart’s apex beat
was in its normal position; there was no increase of area
of cardiac dulness. The only abnormal sign which she had
in reference to her heart Was a faint systolic murmur over

flannel petticoat which she habitually wore, night and day
the skin eruption was so pronounced as to suggest the
presence of some local irritant, .rather than a constitutional
disorder. The eruption was intensely irritating, especially
at night, and her skin was in places lacerated by her con¬
stant scratching. There was notliing approaching a
gangrenous condition in any port of the body except in the
hands and feet, as described. The joints of the body
appeared quite healthy. Her eyesight was, and always has
been, good. I did not, however, examine her optic discs.
She had no indications of affections of any of the columns
of the cord; the “reflexes,” both superficial and deep, were
normal. The surface temperature of the trunk and limbs
was not, I regret, observed. It may be interesting to note
that the weather at the time was very raw, cold, and damp.

The treatment we resolved upon was complete' rest in
bed; the hands and feet to be thoroughly protected from
the atmosphere by being swathed in cotton-wool, ller bed¬
room, winch hitherto had been stir.iy, as the windows wqre
always closed to shut out the noise of the street, was
thoroughly ventilated. The windows were ordered to be
kept open night and day, whilst the temperatuie of the
room was maintained by a brisk fire. We attended to the
state of her stomach and digestive organs, and wo pre¬
scribed mild aperients with a view to ensuring a regular
action cf the bowels, and thus help to lessen vuacular irre¬
gularities or disturbance. In addition, wo prescribed ether
and digitalis, with iodide of potassium. Her diet consisted
of milk und broths and other eusily digested foods, together
with four ounces of brandy daily.

She apparently improved so much under this regimen,
that three days afterwards, when I was again asked to see
her, the lividity of her toes and fingers had almcst dis¬
appeared. There wan no discolouration ou tlie dorsum of
the hands, and, with the exception of some still aoute
pain in the phalanges of botti hands and feet, there
was very little trace or appearance of What so recently
had seemed such a dangerous malady. But the “local
asphyxia” reasserted itself in a few days more, with
all the old intolerant pain, which was worse at night,
all the symptoms of restlessness, and oho of alternate
fits of irritability and depression. The skin outlie trunk
during the remissions was again very active, and the papular
eruption, which had somewhat faded during the intervals,
becumo again lit up, and added, by its irritation, to & truly
pitiable condition of mental depression and bodily help¬
lessness. The same toes which only a few days since were
threatened with death, and which subsequently recovered,
were again swollen, with an integument which was tense,
shiny, and livid. There was a recurrence of the intolerable
pain, and, in addition, the mental agony, as a result of her
pain and sleeplessness, was apparent. Such exacerbations,
with subsequent remissions, continued, but with decreased
length of intervals, for about three or four weeks, till
eventually they were replaced by constant pain and dis¬
colouration of the toes, and at length death of tho parts.
This occurred in spite of treatment, which we varied. Gentle
shampooing of the limbs above the seat of injury was tried,
and this, together with hot anodyne fomentations, appeared
to afford more relief than anything, galvanism was not
attempted on account of difficulties m its regular applica¬
tion. Collodioh, however,' appeared to afford transient
reprieve from pain.

On seeing the patient about three months after my first
visit, I found that the following destruction had occurred:—

Right hand

Left band
Bight foot

Left foot King . Lou of pulp.

There can be no doubt that this case is an
example of Raynaud’s disease, but with this peculiarity:
the patient is not only an adult, but is beyond life’s prime.
The great majority or cases have occurred, so far as I have
been able to gather from the literature on the subject in
this country, in children. Dr. Barlow, however, has pub¬
lished a case in an adult.and Dr. Oolcott Fox has published
two. But my case occurred in a woman who had no obvious
sign of heart disease, the only exception being a fainr
systolic murmur at the aortic orifice. She had no sign of

Litfle Unger . Slough of pulp.

King .. Terminal plwlanx exposed.

Middle. Terminal pludaux had been .xposed,

an^ was removed by Dr.Wilkinson.

Index . Slough of pulp.

I Little . Slough of pulp.

\ Middle ,, ...... Terminal phalanx exposed.

Middle toe . Loss of pulp and nail.

Little „ ...... Do- Do.

Thb Lancbt,]

MR. R. W'. PARKER ON CLUB-POOT.

[Jan. 29,1887.

vascular degeneration; there was no history of syphilis.
Besides all thesei the pulse both at the wrists and on the
dorsal surfaces of the feet was good. One could distinctly
feel, in addition, pulsation in the digital arteries of both
hands and both feet. Another point in the diagnosis is the
almost perfect symmetry of the affection, the fingers affected
of the left hand being the same as those of the right,
although varying in amount. Again, we must note the
almost precise parity of conditions in the feet. It is of
interest, however, to observe that the toes have been in¬
volved to a less extent than the fingers, a condition one
would expect to be reversed were Raynaud's disease a true
dry gangrene. On the other hand, it canno", fail to be noticed
that the pollex and the hallux, both of which are extra
well supplied with blood, show no signs of the disease. The
darkened condition of the finger ends is not due to ecchymosis.
There is no true ecchymosis. The discolouration is transient.
It may be present to-day with intolerable pain, but it
vanishes perhaps to-morrow, to reappear, it may be, in two
or three days.

In criticising the suggestion that the disease is a peri¬
pheral neuritis, I must content myself with clinical evidence
at present. For until I have had demonstration that such
lesion does exist, the clinical aspect of the case must be
regarded as against such theory. One of the characteristic
features of the disease is its transient nature. To-day the
patient is suffering intense agony, and to-morrow, or it may
be the next day, there is little or no pain, and perhaps less
naked-eye evidence of the disease. This characteristic is,
so far as I can understand, opposed to the theory of an
inflammatory condition of nerve-endings—a condition which
would suggest chronicity in duration, regularity in its
painful course, and eventually the production of some
.atrophic lesion of the part, whether of skin or of joint.

On the other hand, we must recognise the main clinical
,points which present themselves—viz., that cases of Ray-
.naud’s disease occur most frequently in feeble, ill-
nourished children, or in adults, in whom, by some cause or
other, be it inactive habits, be it defective systolic stroke,
or be it some functional disorder of the sympathetic
system, the peripheral circulation is diminished. For
although the typical lesion occurs in the fingers or toes,
patches of “asphyxia” may be occasionally seen in the
.external ears, the nose. See .; in other words, those distant
parts which are exposed to any disordering influence from
without, such ns changes of temperature or the like, are
the sites in which the disease manifests itself. This looks
as though the extremities, or the external ears, or the face,
are the seats of local vascular storms—storms which are not
.of a very wide range, but which are very severe in those
localities in which they occur; and that the “ chief centres
of depression 0 of such vascular storms occur in the finger
or toe ends, or in the tip of an ear or nose, producing, it
may be, damage which is easily repaired, or, on the other
hand, a destruction which, as in tne case above related,
amounts to gangrene and the loss of some digits bath in
the hands and feet.

Taviton-Jtreet, Gordon-square,

ON CLUB-FOOT.

Bv R. W. PARKER,

8URGEOS TO THE JUST LOXDOX CHILD HEX'S HOSPITAL, ETC.

Thr interest of the subject, and the diversity of the views
held by competent observers as to the mode in which this
well-known deformity is brought about, lead me to offer
some further observations thereon, and to add some fresh
proofs in favour of a mechanical mode of causation. 1
cannot do better than make the observations a sort of
criticism on a paper published two years ago by Dr. H. W.
Berg, of the New York Orthopaedic Hospital, in 8eguin’s
Archives of Medicine (voL viii., No. 3, pp. 226-48), now
defunct, in which this author raises most of the points in
dispute.

fn the International- Journal of the Medical Sciences for
July, 1886, there iff a brief but friendly notice of some views
on the pathology and etiology of dub-foot, whieh I recently
communicated to the Pathological Society Of London con¬
jointly with my friend Mr. Shattdck. 1 cannot sufficiently

thank the author of that notice for calling my attention
to Dr. Berg’s excellent paper, and can only regret that I
did not become aware of its publication until the end
of last October, the more So as I might then have embodied
in the monograph just alluded to, the few criticisms on
his paper I now desire to make. As regards the question
of priority, delicately hinted at in the above-mentioned
journal, I need only say that both Dr. Berg and I have
been anticipated, more or less, by so many previous writers
that we can both afford to say nothing about priority.
Moreover, our interpretation of club-foot rests not so much
ou individual work, as may be well seen from the rich
bibliographical references contained in Dr. Berg’s paper,
as on the application of that of many workers in the various
branches which constitute scientific medicine. I must thank
Dr. Berg, however, for his mention of my first paper, which
appeared some two years before his own, and again express
my regret that 1 could not (for the reason given) reciprocate
this kind attention by a reference to nis views in my
later, more detailed, and illustrated monograph. As regards
one other remark in the International Journal, “that the
American contributor has carried his observations a stejp
in advance of the authors’, and followed them to their
legitimate logical conclusions, which for some reason
Messrs. Parker and Shattock have avoided,” I will only ask
for a suspension of judgment until the present paper is
concluded.

Premising that the purport of Dr. Berg’s paper is to
attribute congenital talipes equino-varus to non-rotation of
the limb during development (without attempting, how¬
ever, to explain the reason of this non-rotation), I will pass
on to discuss how far his criticism of “ those who consider
the deformity as the result of a mechanical force acting
upon the feetus in utero” is just. He eays: “By these
authorities it is assumed that for various reasons the foot, in
certain cases, is maintained in one fixed position by the
■pressure of the walls of the uterus [the italics are my own].
This theory would thus account for all the forms of club-foor,
and this general applicability is its only merit. For, apart from
the fact that the feetus in utero is not an inert mass, but a
living being, which moves about in its surrounding fluid
and does not maintain its feet in any fixed position, the
theory lias this objection, that other parts of the body,
which under similar circumstances should be subjected to
a similar pressure, are not found with equal frequency to
have acquired this false position. Permanently flexed knee-
joints, for instance, should be according to this view a very
frequent, instead of the rarest possible, deformity.” It is
on this part of Dr. Berg’s paper that 1 Chiefly join issue
with him; and yet the difference between his own views
and mine is not so radical as his criticism of them—“ that
their only merit lies in their general applicability”—is
intended to imply. I will examine his points seriatim.

In the first place, the general applicability of a law or a
doctrine is. for the majority of persons, usually a merit, and
primA facie entitles that law or doctrine to credence ; on
the other hand, a theory that only accounts for one kind of
club-foot must obviously be received with caution. Now,
although Dr. Berg applies his views to congenital equino-
varus only, and not to calcaneus, these two—the common- -
forms of congenital club-foot are so clearly due to some
common mode of cansation that, mutatis mutandis , only
such mode of causation can be acceptable as will apply to
each. Non-rotation of the limb, however, will not explain
calcaneus, and for this reason, therefore, I regard Dr. Berg’s
explanation not as wrong, but rather as insufficient, due to
the fact that Dr. Berg has not followed his observations to
their legitimate logical conclusion.

In the next place I must object to the idea that when the
foot is “ maintained in one fixed position " this is always
due to “ pressure of the walls of the uterus.” This latter is
only one of several mechanical forces acting on the festal
foot. Direct pressure of the uterine wall undoubtedly occurs
in certain cases, but I doubt very mufch whether it comes
into play in any large proportion of the cAsep of club-foot
which come under the surgeon’s observation.' A more
frequent force, only to mention one of Beveral, is inter¬
locking of parts of the foetus, one in another, This con¬
dition, described by various authors, leads to deformity
without the direct action of the uterine walls, and cases
have been figured which undoubtedly originate in this
manner. According to Dr. Berg, the “mechanical theory”
has also this objection: the foetus in utero not being an
inert mass, but a living being moving about in its surround-

Tub Lancet,]

MR. R. W. PARKER OX CLUB-FOOT.

[Jan. 2}>, 1837. 211

ing fluid. And not maintaining its feet in any fixed position,
other parts of the body ought to show sigus of similar
pressure with equal frequency [the italics are my own].
Here again I find myself at variance with Dr. B<-rg. It
teems to me that a very sufficient reason why other
parta suffer less frequently than the feet may be found
m their being less anatomically disposed to a defor¬
mity so consistent with healthy development elsewhere.
Is it not highly probable that when direct pressure affects
the head or the abdomen, the life of the foetus is endangered
and that abortion takes place? But that both hip- and knee-
joints do frequently suffer analogous deformity is known to
every orthopaedic surgeon, certainly to every surgeon who
sees much of children’s diseases, la the severer forms only
are these deformities rare; in their lesser degrees they are
matters of every-day experience. But the surgeon must look
for them not among his orthopedic cases, but among new¬
born infants; there he wilt find that probably not lees tliun
30 per cent, are quite unable to fully extend the thigh or the
lag for a variable number of days or weeks after birth. As
regards the hands, it will be remembered that Cruveilhier
explained their comparative exemption by the protected
position they occupy during foetal life.

Dr. Berg further says (op. cit., p. 228;“ There are no
adhesions to overcome. On the contrary, motion, as far as
is possible in the deformed position of the joint, is good;
and as soon as we rectify the deformity by tenotomy, the
motion of the joint becomes unrestricted.” I am quite
unable to follow Dr. Berg in this opinion also. Mr. Shattock
and 1 both found fibrous adhesions within the ankle-joint
in several cases, one of which (Case 6) is figured in our
monograph. It will be within the knowledge of all ortho¬
pedic surgeons that many cases of club-foot, especially of
equino-varus, cannot be rectified after tenotomy. 1 have
elsewhere shown what an important part is played by the
tarsal ligaments in maintaining the deformity. Even after
section of both ligaments and tendons there are cases
which resist rectification. It is quite probable that this
resistance is due to the presence of such adhesions between
the astragalus and the tibio-fibular articular surfaces.

If additional evidence be required to show the insufficiency
of the “non-rotation” causation of congenital varus, I will
draw attention to the condition known as “crus varum”—a
deformity involving the foot and the whole limb up to the
hip-joint. In such cases the talipes proper is generally very
marked, but is further aggravated by the inward rotation—

I would say hyper-inverted position—of the limb. Such cases
are described by Dr. Berg's distinguished countryman. Prof.
8ayre, by Mr. Adams, ana some other authorities, and I have
myself also seen several. The chief difficulty in treating
these cases depends on the abiding tendency of the limb to
tom inwards. In one of my own cases, a little girl, the
feet could be completely inverted, so that the heels looked
forwards; and this was the position the feet assumed when
she first attempted to walk, even after the talipes proper
had been quite overcome, until suitable instruments were
applied.

As showing conditions analogous to club-foot, I may cite
the following cases from my own practice, and while
admitting that they are rare, I would carefully point out
that their rarity depends on the degree rather than on the
nature of the deformity. As 1 have already said, the hip- and
knee-joints do not lend themselves, anatomically, to severe
deformity; nor does the ankle-joint, and it is for this reason
a talipes calcaneus is far less severe as a deformity than
tquino-varus. The former concerns a hinge-joint, and
involves movements of flexion and extension only; the
latter, besides these movements, involves others (chiefly of
rotation) between the calcaueum and astragalus, and between
these bones and the fore part of the foot, at the transverse
j >int. It is this multiplicity of joints and of possible
movements which renders the foot so much more liable
than the hip or kuee to be influenced by alight causes, while
the complicated nature of the deformity ensures its coming !
under the care of a surgeon, and of being reported. i

Fig. 1 represents a child with genu recurvatum—a con¬
dition of the knee-joint in every way analogous to talipes;
oaring to malposition in utero, the limb has not been able to
pass through that series of positions which is necessary to
the development of muscles and ligaments (chiefly) of suffi¬
cient length to ensure healthy movements in independent
life, aod thus certain movements of the knee- and hip-joints
were faulty. The deformity, like talipes, yields, to suitable
manipulations. This infant was only seventeen hours old

when first seen. There had been a normal presentation, and
labour was quickly accomplished. The deformity affected
the left side only.

Fig. 2 represents a still severer form of the fame deformity,
associated with talipes calcaneo-valgus. The infant was
fourteen days old when first seen. The right limb was mop*
affected than the left. The right knee could not be flexed at
all; it appeared quite fixed, and resisted all attempts at
flexion. The thigh could be extended a few degrees only.
The left limb differed ia having a few additional degrees of
movement. The child was born in, and when naked and
left to itself it for some weeks resumed, the position indi¬
cated in the drawing. During intra-uterine life the limbs
had remained extended on the trunk, with the feet pressed
against the cbes*. Ia this case there can be no doubt that
talipes was caused by uterine environment; the muscles and
ligaments were, as a consequence, so short that the joints

Fia. 1. Fig. 2.

could not be extended until the shortened structure) had*
been stretched.

These cases and the whole subject of talipe3 will be dealt
with more fully in a work I have nearly completed, and am
about to send to press. More especially I hope to point out
the part played by certain of the tarsal ligaments in main¬
taining the deformity of club-foot, and the importance of
dividing them in view of a speedy and radical cure of the
deformity;.

These observations dispose, I think, of the chief objections
urged by Dr. Berg against the “ mechanical the< ry.” After
discussing other alleged causes and demonstrating their
insufficiency, he proceeds to enunciate his own views. Hi 1
says:—“1 shall endeavour to present in a new light a
view which, although feebly advanced by some authorities
from, time to time, has never been supported by well-
observed facts, and has therefore gained no adherents. This
theory supposes that the deformity of pes equino-varus is
due to an obstruction in the normal development of the feet
during some period of intra-uterine Ife" I am quite pre¬
pared to endorse this italicised sentence, and am quibe
sure Mr. Shattock would do the same. For reasons to be
presently given, I cannot endorse the earlier part of. the
above quotation from Dr. Berg’s paper. He next proceed &
to epitomise the development of the lower limbs, more
especially as to the rotation they undergo during the earlier
weeks of intra-uterine life. He then says that the deformity
“is not due to pressure,” but to “non-rotation inwards, or
a retarded rotation inwards of the lower extremities.” He
thus very materially limits the method of carnation, and
rather goes back on himself and his opinion previously
expressed in the italicised sentence just quoted above. In
this I think he is wrong, and that Mr. Shattock and
I have the advantage over him, since we point out the
direct mechanical agencies, which are the active cause:
it being hardly possible to conceive non-rotstion or retarded
rotation of the limbs as spontaneous: this non-rotatiou itself
must have some active cause. It would seem not improbable
that the vitality of a foetus may be low and insufficient to
carry through those developmental processes on which the

Digitized by GoOgle

212 The Lancet,] DR. T. BARR: NECROSIS OP OSSEOLS LABYRINTH OF RIGHT EAR. [Jan. 29,1887.

integrity of the limbs and other organs depend. Should
this be very marked, death of the fcetus and abortion
take place. When the want of vitality is more localised,
perhaps it results in deformity or deficiency in the organ
chiefly affected; but these are mere speculations, difficult
to test, and obviously inapplicable to the majority of cases
of congenital club-foot, siuce, as Dr. Berg himself admits,
the limbs are fat and well-nourished, of normal surface
temperature, showing no signs of the atrophy which would
follow on deficiency of vital power. What, then, are these
active causes? Without pretending to have explained all
the methods in which a mechanical force may act, I think
good evidence may be found in our monograph in favour of
the mechanical mode of causation as the most reliable and
most satisfactory for the majority of cases met with in
practice.

If Dr. Berg still entertains the view that the developmental
processes to which he alludes in his paper have not been
sufficiently taken into consideration when attempting to
explain the production of club-foot, and have fdund no adhe¬
rents, I would refer him to an ad mirable exposition of the whole
subject entitled, “Ueber die Fdtalkriimmungen, namentlich
in Bezug auf die Bedeutung der angeborenen Yerdrehungen
der Baucbglieder,” by the late Professor Escbricht of Copen¬
hagen, and to other writings by this distinguished physio¬
logist. I think he will find that Professor Escbricht has
anticipated him in most of his conclusions. By consulting
the literature of club-foot Dr. Berg will also find that
Eschricht’s doctrine has many adherents; it has been fully ap-
reciated by writers of emioence, such as Billroth, Volkmann,
iicke, and many others of lesser note, including myself. The
great merit of Escbricht is that he was original in his enuncia¬
tion of thisdoctrine and farahead of his compeers. Hefounded
it on researches, both human and comparative, carefully and
laboriously carried ou for years. Among other interesting
points he showed that one particular form of monstrosity—
the 6iren — depends on a total absence of this rotation of the
limbs, and he thus explained how it was, in such cases, that
fusion takes place along the outer border of the limbs, and not
along the inner border, as many have erroneously supposed.
If Eschricht’s views appear to be neglected, it is due to the
fact that they are unconsciously included in the larger
“mechanical theory” which is at last gaining ground, and
to one probable factor in which Dr. Berg has contributed
the weight of his authority. , ,

In conclusion, I hope that Dr. Berg.' as Well as the writer in
the International Journal of the Medical Sciences, will accept
the assurance of my regret that I did not sooner meet with
Dr. Berg’s paper, and that they will bestow careful con¬
sideration on the points on which the^y and I seem to differ.

Old Cavendish street, W. i

CASE OP .. ' " '

SEPARATION BY NECROSIS OF THE OSSEOUS
LABYRINTH OF THE RIGHT EAR, AND ITS
REMOVAL AS A SEQUESTRUM FROM THE
EXTERNAL AUDITORY CANAL . 1

Br THOMAS BARR, M.D.,

SURGEON TO TITE GLASGOW EAR HOSPITAL; LECTURER OS AURAL
SURGERY, ANDERSON'S COLLEGE.

Thr specimen shown in the accompanyirg figures was
removed on June 1st from the right ear of a boy aged
eleven years. It consists of an osseous labyrinth with
its three divisions—the vestibule, semi circular cattails, and
cochlea—clearly marked. In examining the specimen from
the outer aspect (Fig. 1)—that is, from the direction of
the cavity of the tympanum—we see the opening of the
fenestra ovalis (Fig. 1, ») leading into the vestibule con¬
siderably enlarged by carious erosion; below this, and
separated from it by a part of the outer wall of the
first turn of the cochlea, there is the fenestra rotunda
(Fig. 1, d) leading into the scala tympani of the cochlea.
Behind and abovo the fenestra ovalis the external or horizontal
semicircular oanal (Fig. 1, b), with its .ampullary enlarge¬
ment, is seen in its whole extent. Springing from the upper

- -.- -- -V -■ r- 1 -i——

1 Th|t tpeelmea waa to the Q'aaxow iPAthotogta&l ABd GCnittil

Society on Nov. 8th, 18SS., . | • 5 •

part of the vestibule, the superior semicircular canal (Fig.ljO)
is seen to about half of its extent. The Fallopian canal, with
its contained facial nerve, is absent at that part of its course
where it lies above and behind the fenestra ovalis. The
outer wall of the cochlea, considerably thickened, is seen in
front (Fig. l,el. On the inner aspect of the specimen (Fig. 2),
or that corresponding with the interior of the cranium,
there is a cavity of considerable size (Fig. 2, c) leadipg into
the vestibule and the scala vestibuji of the cochlea; this

Fir,. 1. Fig. 2.

a a

Outer aspect of sequestrum. Inner aspect of aequmtrum. _

opening is evidently a carious extension of the apertures of
the lamina cribrosa. In its interior can be traced part of
the osseous spiral lamina of the cochlea. On this side of
the specimen are two other smaller apertures in the vesti¬
bule ; one is that common to the two united extremities of
the superior and posterior semicircular canals (Fig. 2, d), and
the other is the ampullary end of the posterior semicircular
canal—the only part of this canal represented in the specimen.
The superior semicircular canal (a) and the horizontal
canal (b) are also seen on this side of the specimen.

The boy from whom this sequestrum was removed had
been affected for ten years with profuse purulent discharge
from his right ear, which had originated in an attack of
scarlet fever when a year old. Facial paralysis of the cor¬
responding side appeared shortly after the commencement
of the discharge, and has continued ever since. He was
brought to the Glasgow Ear Hospital on June 1st, mainly in
consequence of severe pain in the affected ear. A polypoid
growth was seen to occupy the orifice of the ear, ana on
examining with a probe a large loose sequestrum was felt
in the external auditory canal. After the polypus was
removed by means of a snare the sequestrum was with some
difficulty extracted with a pair of forceps. The external
auditory canal was considerably dilated and its lining much
excoriated, but after the removal of the necrosed bone the
discharge quickly subsided,and within two weeksithadcom¬
pletely ceased, while the interiorof the ear had become healed.
There was apparently at no time any mastoid complication.
It has also to be mentioned that the boy suffered a few years
ago from hip-joint disease, which went on to suppuration, and
baa left behind considerable shortening of the left leg. There
is, as might be expected, total loss or the hearing power in
the right ear, as tested both by air conduction and by bone
conduction. A vibrating tuning-fork or a londly ticking
Watch, applied to any part of the head, is heard only in the
left ear, while neither a watch, tuning-fork, nor PolitzeFs
Hormesser is perceived by air-conduction, if the opposite ex¬
ternal auditory canal is efficiently closed. The voice spoken
into a hearing tube inserted into the ear is heard—evidently,
however, by the other ear through osseous conduction. In
view of the loss of the semicircular canals on one side, it is
interesting to note that this boy .his at no time suffered from
giddiness or staggering. This seems to support the theory
that disturbance of the equilibrium, which has its origin in
the semicircular canals, is due to irritation from disease or
injury of these canals, while, on the other hand, absence or
destruction of the semicircular canals has no effect upon the
equilibrium. The facial paralysis is almost complete. As
thd trunk of the facial nerve was without doubt destroyed
at that part of its course where it ordinarily lies on the inn^r
wall of the tympanum, it was important to determine accu¬
rately the condition of the muscles supplied by that nerve;
and in order to insure this accuracy I asked the President of
the Glasgow Pathological and Clinical Society to examine
the area of supply, both electrically and otherwise. The
following is his report of the condition as tested on the 5th
and 7th of June:—

“ There is almost complete paralysis of All the muscles of
expression on the right side, and the Mce is drawn to the left;
the right eye seems lower than the other, probably from the
relaxed state of the occipito-frontalis. The right eye can
be closed to a much more considerable extent than is usual
in bad facial paralysis, but the'part of the sclerotic below
the cornea can be seen He con ddse both eyes Bltaul-

Thb Lancet,]

MR.R. H. FIRTH: POISONOUS PTOMAINE IN MILK.

[Jan. 29,1887. 213.

taneously pretty well, but he cannot wink with the right
alone. The right side of the lips has also some slight power
of movement, and the right buccinator contracts feebly on the
finger introduced between it and the gums. There is also some
movement of the ala nasi on the right in sniffing; otherwise
the whole right side of the face seems flabby and expression -
less. The cornea is clear; the eye waters only slightly on
exposure on a cold day; the movements of the eyeball are
good, and the sensation of the paralysed side of the face is
perfect. There is a pretty distinct deviation of the uvula
to the left; no deviation of the tongue. On testing with the
faradaic battery no response could be obtained in the para¬
lysed muscles, even when using strong currents. Ordinary
strengths of the galvanic battery likewise failed to secure
contractions. On getting up to twenty-seven or thirty
elements, and using an interrupting handle Well soaked
in salt water, the slightest recognisable quivering was
produced in some fibres of the orbicularis in the lower lid,
and in the orbicularis at the angle of the mouth. During
this testing marked contractions of the muscles of masti¬
cation sometimes occurred.” Dr. Finlayson again reports
-on November 8th: “No distinct change since above note.
The s?.nse of taste was not tried last time, and the boy does
not seem very ready to give assistance in this testing.”

It is somewhat surprising that in such a case as this
there was not extension of the disease to the brain or its
membranes. In cases where sequestra have been found
after death in the inner wall of the mastoid process, in
contact with the dura mater, but without injuring the intra¬
cranial contents, there has usually been found localised
thickening of the dura mater. Probably thickening of the
dura mater also exists in this boy in the region of the
posterior surface of the petrous bone—a conservative process
of nature, by which a barrier is erected against the propaga¬
tion inwards of the purulent disease. It is very curious to
see how the inflammatory process has caused death and
separation of only the hard ivory-like osseous tissue which
forms the encapsuling walls of the labyripthine cavities, as
if these walls were separate and distinct, which they are
not, from the adjoining more cancellated bone. The disease
has really provided us with a preparation which the
anatomist finds it difficult and tedious to prepare by dissec¬
tion.

It only remains for me to say that while a number of
cases are on record of individual sections of the osseous
labyrinth, especially the cochlea, being exfoliated, there are
comparatively few cases recorded of an exfoliated labyrinth
having its various parts so well represented as in this
specimen. A pretty complete specimen which was placed
in the museum of the London College of Surgeons, but has
since disappeared, is mentioned in Toynbee’s book, and is
fully described in the eighth volume of the Pathological
Society’s Transactions. Wilde also describes one in his “ Aural
Surgery” (p. 377), and refers to it as “ one of the most extra¬
ordinary pathological specimens of diseased bone perhaps in
existence. In the British Medical Journal of June 13th,
1885, Dr. Pye of London describes a specimen removed from
the mastoid process somewhat similar to the one I have
■described. Another case is related in the same journal by
Dr. Phillips of Bolton on July 4th, 1885. In his paper
Dr. Pye gives an interesting account of the more important
recorded cases of necrosis of the labyrinth, both partial and
-complete. _

-ON THE OCCURRENCE OF A POISONOUS
PTOMAINE IN MILK.

Br R. H. FIRTH, F.R.C.S.Eng.,

SUKOEOX, IBM" MEDICAL STAFF.

From time to time one reads or hears of people who
!laving partaken of certain milks or ices, and even cheeses,
are afterwards the subjects of symptoms indicative of an
irritant poison. I am at the time of writing unable to
quote instances of such with any accuracy, but readers of
The Lancet will doubtless be able to recall several such
casea. During the past few months my attention has been
devoted to an inquiry into the circumstances of a case of
the kind.

On August 3rd, lS8fi, certain men in the British
Infantry section of the Station Hospital, Meean Meer, were

seized with nausea, vomiting, dryness of the fauces, with a
sense of constriction, colic, purging, and in some few a
tendency to collapse, while in others there was a dis¬
position towards stupor. On the some day nine out of
ten men in the military prison were affected with
similar symptoms in greater or less severity. Under
simple treatment all the cases recovered. The circumstance
naturally attracted the attention of the medical officers, and
on inquiry it was found that the only men affected in hos¬
pital were those upon “milk” or "low milk" diets. Also
it was noted that the one prisoner who had been free of
the symptoms was a man who, not liking the taste of his
milk At breakfast, had refused to drink, it. Curiously
enough, the others remarked nothing to be wrong with the
taste or smell. This common factor in the dieting of the
two groups of men directed suspicion towards the millc,
supplied. Further, it was noticed that the milk supplied to
the British Infantry section of the hospital and to the mili¬
tary prison were from one and the same contractor, while
the*milk sent to the Artillery section of the hospital came
from another contractor, ana amongst the Artillery sick no
similar symptoms had followed the drinking of the milk.
Unfortunately, none of the suspected milk remained from
the hospital, but tho unconsumed pint remained at.the
prison. As officiating staff surgeon at the time, I inquired
into the matter, and secured the residue of the milk. The
contractor was reported to the commissariat officer, and fined
on the strength of the circumstantial evidence. Analysis
of the sample of milk left gave the following result:
Sp. gr. 1025; solids net fat, 9 6; caseine, 4‘1; fat, 3’3; milk
sugar, 5 04. It was pronounced therefore to be a fairly good
milk. I inspected the premises of the contractor (a native),
and examined all his utensils and his cows. His premises,
while not being all one could wish, were yet good for a
Dative of his class. However, I unhesitatingly condemned
the condition of two of his pans, which were markedly
unclean, emitting a repulsive odour, and evidently had been
unwashed for some days. Though unable to extract in so
many words the fact that these vessels had been used to
store the milk in on tho morning in-question, the presump¬
tion was that they had been. The weather at the time was
very hot, and specially favourable to organic decomposition,
fermentative or otherwise. Tt^e cows appeared healthy, well
nourished, and the udders quite free froni fissures, sores, &c.
Reflection on this case led pie to try to isolate, if possible,
and if such existed, any organic poisonous product from
the milk under suspicion. Further consideration favoured
the belief that any such product must be a ptomaine.

As the quantity of milk for disposal was small after the
ordinary analysis had been finished, I adopted the follow¬
ing method. The milk, being coagulated, was filtered. The
filtrate was nearly odourless and acid. This was neutralised
and made feebly alkaline by potassium hydrate, and after¬
wards well shaken up with ether. This was now allowed
to stand for awhile, and the. ethereal stratum removed by
a pipette, and then allowed to evaporate spontaneously.
After the completion of this process a moist serai-crystal¬
lised residue was left. This appeared to be aqueous,
probably the result of a certain amount qt Water which the
ether had taken up. This concentrated residue had a
mawkish sickly odour, and a strongly pungent taste when
put on the tongue. Trying some carefully myself, I was
soon after conscious of marked nausea and dryness of the
fauces, followed by headache. Though without the
prominent symptoms obtained from the original milk, I
suspected I had more or less reached the/bn* et urigo
mali. Following the idea up, I gave all the remaining
residue after evaporation to a small pariah dog belonging to
one of my servants. Tho effects were pronounced : the dog
was within fifteen minutes purged, vomiting, and obviously
ill. He gradually recovered] and six hours later I had him
killed. The stomach and intestines, though containing a
serous and frothy fluid, were quite free of congestion or
inflammatory action.

Deeming this result so satisfactory, I decided to follow up
the inquiry and see whether this product was always pre-.
sent in milk, and,if so, under what circumstances. Taking
six samples of fresh milk, I tested them all in the above
manner, and in each case failed to procure any toxic residue.
To see whether time or degeneration of its constituents wan
the essential factor for its formation from milk, I obtained,
a gallon of fresh milk, and by analysis assured myself of its
goodness. This I. placed.in eight clean glass stoppered,
bottles, and put the same .in a room having a mean tem-,

[Jan. 29, 1887.

214 The Lancet,] MR. R. W. LEEMING ON UNUNITED FRACTURE OF THE FEMUR.

perature of 80° F. From time to time, usually every twenty
days, a bottle was opened and the milk examined for the
ptomaine, as before explained. Negative results were
always obtained until Oct. 19th, ■When bottle No. 6 was
examined and yielded a white acicular crystalline substance
having the same odour and taste as that found in the
originally suspected milk. Its action on myself and on four
dogs and a cat was identical—namely, nausea, vomiting,
purging, thirst, frontal headache, and collapse. Bottles 7
and 8 yielded the same product. My means at command
are too imperfect to enter into any precise analysis as to the
exact nature of this product. I tJelieve it to be a ptomaine,
and to which 1 offer the name “ lactotoxine.” How and
why it is formed seem obscure. It is evidently an effect of
decomposition. Microscopical examination of the milk
showed no specific organisms on which to father it beyond
some common forms of oidium and penicillium. The milk
was not unpleasant to taste or smell.

The literature on this topic at my command is so limited
that I am unable to refer to the writings of others; but that
ptomaines, or similar bodies, do exist in organic fluids under
certain circumstances is probable, and it is only by patient
and careful investigation as to their causation and composi¬
tion that we may hope to unravel some frequent but obscure
forms of dietetic poisoning. As but an indifferent contribu¬
tion to this subject, and with a keen sense of its imperfec¬
tions, I somewhat hesitatingly furnish this paper; but, in
conclusion, would remark how well this case illustrates one
of the many difficulties we in India have in guarding
the soldier from the dirty habits and carelessness of the
native food contractors. Notwithstanding the care taken
in hospitals to see the milk drawn from the cows on the
premises, and under supervision, yet on this occasion some
evasion of the precautions must have occurred either by
mixture of stale milk with fresh, or by employment of
unclean vessels. That the cows themselves were not to
blame is supported by the fact that on the next day the
very same animals gave milk unproductive of toxic effects.

Meean Meer, Punjab._

NOTES ON A CASE OF UNUNITED FRACTURE
OF THE FEMUR.

By ROBT. W. LEEMING, B.A., M.B. Cantab., M.R.C.S.

The following notes may prove of interest as showing
the success attending the use of ivory pegs in ununited
fracture of a large bone like the femur, and the power of
recovery in youth after severe injury. '

On Sept. 27th, 1884, J. B-, aged twelve years, an errand

boy, was admitted into the Kendal Hospital suffering from
injuries received on the railway. From a subsequent
account by himself, he was standing on the metals, when a
waggon coming up behind him knocked him down, and
“he thinks ran over him.”

On admission, there was a large open wound over the
lumbo-sacral region, about four inches and a half in
diameter; just below the left trochanter was a second
wound, two inches and a half in diameter, showing the
tendons &c. perfect and uninjured, and having a long
subcutaneous connexion with a similar opening on the outer
side of the thigh a short distance above the knee. The right
thigh had sustained a compound comminuted fracture at
the junction of the upper and middle thirds of the femur.
All the wounds, especially that at the seat of fracture, were
thoroughly washed out with carbolic acid (1 in 40) and
dressed with iodoform wool. The fractured limb was ex¬
tended to its original length, and placed on a bracketed
Liston’s splint. The temperature was 96-6°; the pulse 136,
small and feeble. The patient was ordered brandy, and a
mixture containing carbonate of ammonia and digitalis every
two hours.

The temperature gradually rose to 104° on Oct. 1st, after
which date both that and the rapidity of the pulse subsided,
till on the 10th both became normal, and remained so. On
the third day a gangrenous slough had formed over the seat
of fracture, and the veins showed great congestion around.
Hot fomentations were applied, and the slough separated on
Oct. 3rd, when all the wounds assumed a healthy appearance.
Owing to the frequent dressings required by the wound on
the back it was quite impossible to keep the limb in perfect
position, more especially as there was a fragment over an

inch in length lying between the ends of the broken bone.
It was therefore decided to keep the parts in as good position
as possible until the wound on the back was healed. Thi»
proved a very tedious process, and was not completed tilL
the beginning of March, and then only by the aid of skin-
grafting.

At 12 noon on March 10th the patient was placed under
chloroform, when examination showed the end of the lower
fragment to be drawn backwards and upwards towards
the ischial tuberosity, and firmly fixed in that position*
while the upper fragment was tilted forwards. An incision,
was made the full length of the cicatrix, and a second one
at right angles to the first meeting it in the middle, when &
fragment of dead bone an inch and a half in length was
removed. The upper end of the lower fragment was so
firmly embedded in connective tissue that the greatest diffi¬
culty was experienced in reaching it. This was done by
means of the finger-nail and a blunt-pointed instrument to
avoid risk of haemorrhage, the whole circumference of tho
bone from the wound upwards having to be stripped before
any reduction could be effected. When this was done
the end was sawn off, and the upper fragment was treated
in the same manner, its end also having to be stripped
for some considerable length before it could be brought into
apposition. Having been under chloroform for more than
an hour, it was found necessary to proceed no further for
the present; the limb was therefore placed on a back splint
and firmly bandaged, with the ends of the bone in contact.
The lad stood the operation remarkably well, the temperature
being highest (100 4°) on the 13th and 14th; but as tho
position was not maintained, it was determined to try ivory-
pegs as a dernier restart before amputation. On the morn¬
ing of the 16th the boy was placed on a fracture board and
encased in plaster-of-Paris, strengthened with bell wire*
from the shoulders downwards, with the exception of the
anterior parts of the chest and abdomen, the second limb,
and an opening eight by six inches in extent over the
wound. By these means the body and limb were completely

fixed, and he could be moved when required without
injury. In the afternoon of the same day, under chloro¬
form, several strands of strong silk were passed beneath
the lower fragment, which was then drawn forwards and
held in position by an assistant, while the upper frag¬
ment was depressed till accurate contact was secured.
Holes were then drilled through both ends of the bone in
opposite directions, as is shown in the above diagram.
Into these holes two ivory pegs, each two inches in length,
were driven, their crossed direction preventing any dis¬
placement; the wound was then closed and dressed with
iodoform wool as before. On the 26th the temperature rose
for the first time to 102 6°, and as it remained high a large
portion of the plaster in the neighbourhood of the wound
was removed, as it bad become saturated with discharge*
and a fall of temperature followed; this was on April 2nd.
A large amount of callus had by this time been formed, the
diameter of the bone at this part being nearly four inches;
and a few days later all the plaster was removed and the
bracketed splint again brought into use. On May 9th the
temperature suddenly rose to 104'4° without any apparent
cause; the exhibition of quinine caused a fall, which was
again followed by a rise on successive days. On the 16th a.
small red swelling, not unlike a boil, was observed near the
cicatrix; while examining this, half of one of the ivory pegs
was expelled spontaneously, falling some distance from the
limb. After this the temperature remained normal, and in
about a fortnight the second half of the peg came away
through the same opening. The ivory shows deep marks of
absorption over the whole surface, and as more than twelve
months have now elapsed since the operation, it seems very-
probable that the other peg has by this time been absorbed.
On July 16th he was discharged cured, being able to walk
easily with a thick sole to his boot, and even to ride on
horseback.

The two points which seem of most importance in this
case are the difficulty in keeping the broken limb in position
and the absorption of the pegs. From experience the splint

Digitized

Th* Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Jan. 29,1887. 215

vu evidently powerless to keep the limb so firmly in
position as to prevent the two thin pieces of ivory from
being broken, but by encasing the body and limb in plaster
almost complete immobility was maintained. With regard
to the second paint, the marked absorption of the material
used, as shown by the appearance of the portions which
came away, affords an argument in favour of using ivory
where possible instead of wire, presenting as it does the
chance of a wound healing by first intention, and no further
operation being required. Of course this plan could not be
adopted in the ease of a slender bone, since the drilling of so
many holes would render the ends too weak to bear any strain.

KcndaL

OVARIOTOMY FOR THE REMOVAL OF A
DERMOID CYST.

By E. SINCLAIR STEVENSON, M.R.C.S., L.R.C.P. Ed.

Thb following case illustrates the rapid growth of
dermoid cysts.

Mrs. B-, aged thirty (second pregnancy, last eighteen

months ago), a spare and healthy person, sent for me
in September, 1885, suffering from symptoms suggestive of
pelvic haemorrhage occurring during menstruation. The
locality of the effusion could be easily felt anteriorly in the
left inguinal, and per vaginam filling the posterior cul-de-
sac and left fornix. The patient being thin, a thorough
examination of the pelvic cavity could be made. The right
side was free from any ruspicioua enlargement. The pelvic
hsematocele gradually disappeared under careful treatment.
On Nov. 26th of the same year I saw her again, and found a
lump the size of a turkey’s egg projecting in the hypo-
gastrium, inclining to the right, freely movable, hard, not
fluctuating, with little pain and no inconvenience. She bad
menstruated since I had last seen her, and there had been
no increase in the flow. The case was carefully watched at
frequent intervals. At the end of three months, during which
she had menstruated regularly,the growth had reached a level
two inches above the umbilicus, fill ing the abdomen anteriorly,
leaving the flanks clear. Fluctuation was now distinct,
percussion at any point of the circumference producing an
equal wave in all directions, pointing to the existence of a
large unilocular cyst. The patient felt very little pain or in¬
convenience besides that of weight; but a few days before she
had been seized with a sharp pain in the right side, sugges¬
tive of a twist in the pedicle. For this and other reasons,
especially that of the rapidity of the growth, it was decided
to interfere.

The operation on Feb. 21st, 1883, was done with strict
antiseptic precautions. The room was carbolised with spray
for half an hour previously to the operation, other details
being strictly carried out on Listenan principles. There
were no adhesions, and no haemorrhage whatever. The cyst
contained about two pints of sero-albumen, with lymph
flakes and oil and fat floating in it. While tying the
pedicle a small secondary cyst burst and discharged its
sebaceous contents into the peritoneal cavity, necessitating
a careful toilet. The growth woe a cyst of the right ovary,
containing bunches of long bail in th6 cavity, short hair
growing on the lining membrane, and between the walls
anteriorly a flat bone half an inch long with two teeth.
Besides which there were five smaller cysts, containing
sebaceous matter and hair. Carbolised silk was used for
tying the pedicle and for the sutures, and a dressing of
salicylared cotton wadding externally. The temperature
immediately after the operation was 99°. She was kept on
ice for two days, with the _ addition of injections of
peptonised beef-tea. On the third day she had milk added
to her diet. Menstruation occurred on the second day
after the operation, and lasted four days. On the twelfth
day the wound was healed, and on the twenty-first day she
got up.

Remarks .—The interest of this case lies in the clear data
which I bad, enabling me to calculate almost to a certainty
the duration of the growth. Thus in three months the cyst
grew to the size or an adult’s head. The success of the
operation I attribute to its having been done early, and
to the skilful assistance rendered me by my friends and
colleagues, Drs. Murray, Parson, and Evans.

Cepe Town.

%, Utirm

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nulla au tern eat alia pro eerto noeoondl via, nlal quamplurlmaa et mor-
bo rum et dineotlonam hUtorlas, turn allorura turn propriaa colleoraa
habere, et later se oomparare.— Moksaqsi Dt Std . ft Cam . Mori.,
lib. lv. Proamlum. -

LONDON HOSPITAL.

HKPATIC ABSCESS.

(Under the care of Dr. Ralph.)

Thb surgical treatment of tropical abscess of the liver has
excited considerable discussion in the past, and it was at
ne time advised that such abscesses should be left to
reak sppntaneously. Since the introduction of improved
methods of drainage and the employment of antiseptics, of
wbioh the following case is an'example, the opinion of the
majority will be found to coincide with that expressed by
Dr. Ralfe in his remarks. This mode of treatment, however,
cannot in all cases supersede the use of the aspirator or trocar,
the employment of which is still required where the die
gnosis is obscure, or the abscess deeply seated and possibly of
small size. That the use of the aspirator may be beneficial
where no abscess exists is proved by a case published by
Dr. Ralfe in The Lancet of 1876. For the notes of the
case we are indebted to Mr. J. F. Johns.

John A-, a sailor, unmarried, a strong, muscular man,

came to the hospital on Nov. 15th last, complaining of a
feeling of uneasiness in his abdomen, and of “ a lump there.”
The patient was pale and tremulous, and looked exceedingly
unwell. On examination a fluctuating tumour was felt about
an inch and a half below and a little to the right of the xiphoid
cartilage. The tumour was very soft, ana the fluctuation
well marked. No pain was experienced by the patient in
the region either on palpation or percussion, nor indeed had
he ever noticed any pain in the part, but, as he was evidently
very unwell, he was taken into the hospital forthwith. The
patient had contracted syphilis in India twelve years ago,
had suffered from cholera in India three yeara ago, and had
also suffered from dysentery whilst in China recently.
During several recent voyages the patient, together with
others of the crew, partook frequently of partially cooked
meat, especially the so-called frozen mutton. His illness
commenced about three weeks ago, after a considerable
debauch, by general pains all over the abdomen, which on
subsiding left a feeling of uneasiness at the upper part of
the abdomen. Then it was that the tumour was first noticed.
He stated that the tumour got larger for about a fortnight,
and then seemed to cease enlarging. The temperature ou
the evening of the 15th was 100°, being down to normal the
next morning, and running up to 101° in the evening again.

The patient was seen by Dr. Ralfe on the 17th. The
tumour waa larger and more doughy to the touch, and the
fluctuation less distinct than ou the previous Monday.
Mr. MacCarthy was called in consultation, and it was
decided to make an exploratory puncture. The patient being
anaesthetised with ether, Mr. MacCarthy proceeded to puDC-
ture the tumour at about its centre with a trocar and
cannula, with the result of pus being found. Then, without
the use of the carbolic spray, a tree opening was made
into the abscess and enlarged with the finger, allowing about
a pint and a half or two pints of laudable pus tinged with
blood to escape. On inserting the finger, an extensive cavity
was found extending deeply downwards, excavating the
whole left lobe of the liver. The cavity was then washed
out with a weak carbolic solution and a large drainage-tube
inserted. The orifice was dressed with iodoform, with a
wood-wool pad and antiseptic gauze.

Nov. 18th.—Temperature last night 101°. The patient
felt no ill effects from the operation beyond a slight head¬
ache. • Wound dressed this morning, and the cavity syringed
out with carbolic solution. A considerable amount of dis¬
charge had taken place. Temperature 99°; pulse 80.
Patient quite comfortable; no pain.

20th.—Discharge still plentiful, but diminishing. The
drainage-tube, which was level with the surface of the

Digitized by CjOO^Ic

-2M> The Lancet,

HOSPITAL MBDIOINE AND 8URGERT.

[Jan. 29, 1887.

abdomen, now protrudes half an inch from the wound.
Temperature normal; pulse 78.

26th.—The temperature went up to 100° last night, but is
normal this morning; pulse 82. The tube in the cavity is
now about an inch and a half long. Discharge much less.
General health much improved. Diet increased. No pain.

27th.—Large drainage-tube came out in the night, and so
this morning a smaller one was substituted. Very little
pus washed out. Temperature 97°; pulse 80.

Dec. 4th.—There has been no pus washed out for two or
three days, and so syringing is discontinued. A very small
piece of drainage-tube is now left in the cavity. The open¬
ing of the cavity is too small to admit even the tip of the i
little finger, but the probe goes in about an incn and a
quarter. Wound dressed as usual. Temperature 97'5°; ,
pulse 80. Patient gets up.

7th.—Tube removed entirely; no discharge. Probe goes !
in about an inch. No pain, only a tickling, itching sensa¬
tion round lips of wound.

13th.—Wound dressed with small piece of padding an4
iodoform; is healing rapidly. Patient eats well and is up
all day. Has no pain whatever.

17th.—Patient discharged. Wound quite healed up. He
was looking much better than when ne came in, and had
gained several pounds in weight.

The only drug treatment the patient had was a quinine
mixture until the operation and slight laxatives regularly
afterwards.

Remarks. —The clinical interest in this case was the painless
character of the swelling, and the very slight degree of
pyrexia attending this large and rapidly formed collection of
pus. The patient declared that he had never experienced a
rigor and did not sweat, and it was not till his admission to the
hospital that a slight rise of temperature at night was noticed.
This, taken with the history of the patient having eaten for
some time raw meat, led to a suspicion that the swelling
might prove to be a hydatid cyst undergoing suppuration,
but the peculiar doughy infiltration of the integuments over
the tumour was considered decisive of the abscess being
hepatic. The case also illustrates the advantage of a large
opening and drainage-tube, the patient being discharged
cured within a month of the operation. In a previous case,
where the incision was made between the eighth and ninth
ribs, owing to narrowness of the intercostal space only a
small drainage-tube could be introduced. Considerable dif¬
ficulty was experienced in keeping the tube free, and pus
was constantly re-collecting in the abscess, so that the
patient was in the hospital some months before the abscess
closed up. As regards the comparative results obtained by
aspiration and free drainage respectively, Dr. Ralfe has had
seven cases of hepatic abscess under observation. In the
first three aspiration was relied on, and of these all have
died. Of four cases treated by incision and drainage three
have made a complete recovery; the fourth case recovered
from the operation, but as soon as the abscess closed tuber¬
cular phthisis developed, which rapidly proved fatal.

NORTH-EASTERN HOSPITAL FOR CHILDREN.

TWO CASES ILLUSTRATING THE TREATMENT OP THE
DEFORMITY FOLLOWING TUBERCULAR DI8EA8E
OF 1HR HNEB-JOINT.

(Under the care of Mr. Bilton Pollard.)

For the notes of the following cases we are indebted to
Mr. H. Downes, house-surgeon.

Case 1. Tibia flexed and displaced backwards; joint
opened by division of the patella; anterior crucial ligament
divided and limb straightened; joint healed under one

dressing— Eliza P-, aged seven years, was admitted on

Sept. 27th, 1886. Her father and two of her brothers had
died from consumption. The disease of her knee began
when she was two years of age. Plaster-of-Paris bandages
were applied for a few months, and then for a period of
eighteen months nothing more was done. The leg became
drawn up and shortened. Two years ago an operation was
performed on the knee, and the child returned home with
discharging' aiAMsee.' For the last seven months the knee
had been quite sound, but the deformity had been Readily
increasing. On admission the child was well nourished, and
presented no signs of disease. There were scars of old
sinuses on the front and- inner side of the right knee. The
joint was flexed almost to a right angle, and so firmly fixed
that no extension or flexion movements could be made.

The tibia was displaced backwards considerably, and the leg
was much wasted.

On Oct. 8th an incision was made across the front of the
knee, and the joint opened by sawing across the patella. It
was found impossible to straighten the limb owing to the
tibia being held backwards by means of a mass of fibrous
bands taking the direction of the anterior crucial ligaments.
These bands were divided, and then it was possible to bring
the tibia forwards; but the limb could not be quite
straightened owing to the interval between the condyles
being so filled up as to prevent the somewhat enlarged
spine of the tibia riding forwards into it. This interval was
deepened sufficiently to accommodate the spine, and then the
leg was brought forwards into a line with the femur.
There were no visible signs of recent disease in the joint.
A few vascular points were seen and ligatured, but the
tourniquet was not removed until the dressing had been
applied. The two halves of the patella were united by a
silver wire suture. The middle portion of the skin wound
was sutured, but both ends of the wound were left open for
drainage. No tube was employed. The wound was dusted
with iodoform, and a dressing of salicylic wool was applied!
and firmly bandaged on. A piece of galvanised iron was
placed behind the knee in the middle of the wool as
a support to the joint. The limb was raised to a
right angle with the body for a few hours. The spray
was used during the operation, and the strictest atten¬
tion was paid to antiseptic details. The temperature-
reached 100'6° F. on the second day after the operation ; it
then fell to the normal and remained so. No blood or dis¬
charge showed through the dressing, and there was no need
to change it, but on the twenty-second day after the opera¬
tion this was done to remove the stitches. The wound was-
healed except at a small spot opposite the wire in the-
patella. Three weeks later the wire was removed from the
patella, and a week after that the limb was put up in plaster-
of-Paris and the patient was discharged. She was seen six
weeks later. The limb was straight and slight movement
at tbe knee was possible. The patella was soundly united
and freely movable at the condyles of the femur.

Case 2. Left leg flexed and abducted at the knee and
ankylosed; joint excised and bones wired; joint healed
under one dressing. —Annie P—-, aged eight years, was
admitted on Aug. 31st, 1886. Her father and grandfather
died of consumption. The disease of the knee commenced
after a fall when the patient was fifteen months old. The
knee had never suppurated, but it got much deformed and
almost prevented the patient from walking. The child had
been twice in the hospital during the year. Weight exten¬
sion and forcible movement under chloroform failed to
reduce the deformity.

On admission, the patient could only hobble about a
little; the knee was flexed to an angle of 45° from the
extended position; the leg was abducted and rotated
outwards at the knee; the joint was firmly ankylosed, and
the patella was fixed to the external condyle.

On Oct. 2nd the joint was opened by a transverse cut
across the patella; the patella was firmly ankylosed to the
external condyle, from which it was freed by a vertical
saw-cut. Tbe greater part of the external condyle had been
destroyed, and as it was found impossible after the division
of fibrous bands to bring the leg straight, a slice of bone
was removed from the lower end of the femur, and a very
thin layer was removed from the tibia; a few vascular
points were tied. Tbe limb was put straight, and the
patella was united by a, wire to the front of the femur, the
femur and tibia being united by a second wire. The rest of
the treatment was identical with that described in the first
case. The temperature remained normal throughout. On
the second day after the operation a spot of blood appeared
through the wool, sea layer of the latter was removed and
a fresh layer applied, but the wound was not exposed.
Four weeks after the operation the dressing was removed
and the wound was found healed in its entire length. The
dressing was stained with blood only, and was perfectly
dry. Three weeks later the limb was put up in plaster-of-
Paris and the patient was discharged. The patient was
seen a month later; the limb was soundly healed, but there
was a small sore opposite the wire suture which united the
tibia to the femur. • This was removed, and after a week tbe
wound was healed.

Remarks by Mi. Pollard.— The first case appears to me
of much interest and importance. It is well known that
after strumous disease of the knee, when the tibia is dis-

The Lancet,]

ROYAL MKDICAL AND CHIRUBGICAL SOCIETY.

[Jan. 29,1887. 217

(drifted baekwuds, it is useless to attempt to straighten the
joist until the tibia has been carried forwards, for unless
this precaution be taken, either the backward displacement
will be increased or the. tibia will give way at the upper
eaiphyei&l line. To Mr. Beck’s teaching at University Col-
l%ei owe the knowledge that the cause of the difficulty in
straightening the limb in such cases is the shortened anterior
cneial ligament combined with other adventitious bands,
in this case 1 was able to demonstrate the correctness
it teaching, and to show that the deformity might
jTnmedied after dividing these bands without removing
' ie, and subsequently without impairing the growth
„ • limb. In the second case the external condyle of the
it was so destroyed that it. was impossible to straighten
limb without performing an excision. This 1 regret
ly, and I would not have d<me it if any other means
i have succeeded, for the growth, of the bone will be
tired thereby. The cases are good examples of what
be achieved by aseptic surgery-primary union—
afjler a single dreesiug without tubes. 1 do not know that
tfedomplete method of dressing detailed in the hist case
h^bas yet been published, butl claim no credit for it;, I
ofm it likewise to Mr. Beck, and my cases are only instances
<4tk# success which has attended it equally in his hands as
uftjTas those.of other surgeons. For such operations as
described I prefer Volkmann's method of dividing the
patella, for 1 should anticipate firmer union of a wired
patella tb » n of a sutured ligament.

itiuii -—•— -

*. "Vincents hospital, Dublin.

CASKS OF ABSCESS EVACUATED WITHOUT ANT
RESULTING DISFIGUREMENT ; REMARKS.

JOK-i (Under the care of Dr. Quinlan).
rill&’f'eport of these cases we are indebted to Mr. M. C.
O'Gorman, resident pupil. .

Care 1. — C. B-, aged seventeen, a messenger, was ad¬

mitted on Oct. 12th, suffering from a large swelling occupying
ths^ybole right submaxillary space, and in which deep-seated
linfaiilion could be detected. On the loth, the purulent
matter being apparently half an inch from the surface, a
siktr wire was introduced in a horizontal direction, be-
gi^ritog in the healthy tissue to the right of the abscess,
paging throngh it, and coming out about half an inch on
th*riaoer side of it. Lint wetted in spirit lotion was applied
tabjbe external surface. On the next day purulent matter
-wapcoming out at both openings; but after a few days it
wap evident that the lower part of the abscess was working
towards the surface. This arose from the circumstance that
»wer part of the abscess extended down the neck much
foggier than was at first supposed, and in consequence a
* jacket” of purulent matter pressed upon the tissues and
Mlved absorption of them. As the akin was actually
ba ginni ng to thin, another wire was on the 20th intro¬
duced through the external opening of the original wire,
capped through the “pocket” above described, and
(■ought out well below it. In a few hours the pus
tnn to discharge through the lower opening, and the
t^dency to “ point ” at once ceased. The discharge became
lly thinner, the abscess being carefully evacuated
assure with a tampon, of soft cloth in the morning,
ly, and evening. On the 26th the discharge from the
igs of the original wire having entirely ceased, it was
red, and the evacuation process through the secondary
carefully continued. On Nov. 22nd all discharge
crimed, the swelling was much reduced, and the redness of
tlippkin greatly lessened. On Nov. 7th the secondary wire
wpp removed, and on the 10th the openings had healed up.
QwKov. 16th the patient was discharged.. There was slight
swelling and induration on the site 6f the abscess, and very
' i redness of the skin on the spot where ib had threatened
_ ‘ it. Three red points showed the sites of the entrance
[ exit of the wire*. On Nov. 22nd the boy was Been, and-
of the abscess were rapidly disappearing, there
no disfigurement whatever.

in 2.—1a. H——, aged thirty-nine, a healthy, well-
npwrisbed womans the mother of eight children, had been
oasriaed of her last child, a girl, on June 2nd. A moath
«jkr,a swelling aippeared in the left iliac fossa Over PovtpatfS 1
tinmsnty aosompsnied with gztest pain, gathering up of the
Mt thigh, nod Mooping of tha body. She became gradually
uaabletnnaahn th* slightest exertion, and was at last obliged
tp Ukstatftbsi jflhe was admitted on. Aug. lfltb. She was

treated with hot poppy fomentations and linseed poultices,
together with hypodermic injections of morphia, to keepdown
the pain, which was extreme; quinine and nourishing diet
were given to, support her strength, which was very much
reduced. Suppuration took place, so that on Aug. 26th the
purulent matter was within half an inch of the surface.
Two silver wires were introduced through the abscess—one
in a direction parallel to Pool part’s ligament, and the other
at right angles thereto. The matter gradually discharged
itself along these wire setons, a dressing of calico steeped
in spirit lotion being kept continuously applied. The pain
apd swelling steadily subsided, and the discharge, which was
profuse, became lees of a purulent and more of a sanious
character. On Sept, 10th it had oeased for some days, and
one of the wires was, withdrawn. After an interval of three
days the second wire was withdrawn, and the openings
closed. On the 20th she was able to walk without stooping,
contraction of the leg, or pain; and on the 28th she 1 was
discharged, cured, and without any mark oyer the site of
the abscess, except four red pinhole openings corresponding
to the entries and exits of the wires.

Remarks by Dr. Quinlan. —In both these cases large
abscesses were evacuated without the production of any
external mark or diefigurement. In the second case the
situation of the abscess in the groin rendered: this a point
of little consequence, although this case clearly shows hew
disfigurement can be avoided in abscesses of the neck and
face, where the avoidance of marking or deformity is most
desirable, especial ly in the case of f em ales. The treatment is
dependent upon the early introduction of the wire, upon
the avoidance of poultices (which tend to relax the capil¬
laries of the skin) during the wire process, and upon the
application of spirit lotion, which cools the surface, keeps
down inflammation, and hardens the skin. This method is
superior to aspiration, which causes too many punctures,
and has not the same power of keeping the sac of the
abscess empty by the drainage of the matter, whether
purulent or sanious, as fast as it is secreted. This constant
drainage, which is greatly aided by the use of the flat
tampon of old soft calico, causes the sac of the abscess to
collapse, and removes all pressure and consequent chance of
absorption from the akin. The red wire openings left after
the operation are small cicatrices, not larger than the head
of a full-sized pin. These undergo cicatricial contraction

and disappear. In the case of Miss O. D-, recorded in

The Lancet some years ago, they cannot now be detected,
even by the aid of a lens.

IBei rinxl jSoci etttB,

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Surgical Treatment of Hydatids of the Liver.

An ordinary meeting of this Society was held on Tuesday
last, Mr. G. D. Pollock, F.R.C.S., President, in the chair. The
whole of the evening was occupied by the discussion of
Mr. Barwell’s paper.

Mr. Richard Barwell read a papor on widely incising,
by a two-stage method. Hydatids of the Liver. Hydatids of
the liver .may be treated surgically by (1) puncture with a
small trocar, (2) evacuation with a large persistent opening,
and (3) electrolysis. This last has not commended itself to the
judgment of the profession. . The author recommends that
the first method should always be primarily resorted to,
chiefly beoause it sometimes is curative—via, in cases of
single barren cyst; but in alarge proportion of cases there are
numerous daughter or secondary oysts, and then the tumours
frequently recur. Under such circumstances the most
efficacious treatment is by keeping a large opening patent
for some time. The object of the paper was to point out the
safest way of making such an opening. After discussing
certain other methods, it was shown that incising the abdo¬
minal parietes first, then stitching to them the cyst or its
surroundings, and finally cutting into the tumour after a few
days, was regarded as a very safe and efficacious procedure.
The author recommended certain precautions to be taken
when the cyst wall appeared so thin that a needle puncture
might cause effusion of hydatid fluid into the peritoneum.
Some modifications introduced with a view to meet special;
circumstances were discussed. The, oase of . a young. :

Di.

d

218 Thk Lancet,]

MEDICAL SOCIETY OP LONDON.

[Jan. 29,1887.

woman who had a hydatid of the liver which had been
punctnred eight times, and on whom the author performed
the above mentioned operation, was related. After a time
eighteen hydatids and the wall of a large mother cyst were
passed from the wound. There was an absence of peritoneal
symptoms, ana the patient made an easy recovery.

Mr. W. Haward considered that the character of the
contents of the hydatid cysts should determine the nature
of the operation. Doubtless a free opening would be re¬
quired if the contents were thick and compounded of
daughter cysts. He criticised Mr. Barwell’s method, and
thought that the potassa fusa caustic was to be selected,
rather than the one which Mr. Barwell advised. His re¬
marks were illustrated by cases. In one instance a second
eyst was found bulging into the first, which had been
emptied. The second one was also opened through the
first, but still the patient did not recover, and finally died
with lardaceous disease. Hydatids were found in the omen¬
tum and spleen, and a suppurating cyst in the back of the
liver, which was doubtless the cause of the continued ill- i
ness and lardaceous disease. Altogether the method of
gradual perforation of the abdominal wall, so as to secure
proper peritoneal adhesions, was to be preferred to other I
methods.

Mr. Howard Marsh had successfully practised the opera¬
tion recommended by Mr. Barwell in one case recently.
The sutures had to be passed into the substance of the liver
because the hepatic peritoneum was so thin. The suppurat¬
ing hydatid cyst was incised four days afterwards. In a case
of suppurating hydatid cysts of the liver in a little child,
an abdominal section was made without attempting to
secure adhesion between the liver and abdominal wall. The
result was satisfactory, and the case not complicated by
the extravasation of the contents of the cysts into the
peritoneal cavity.

Mr. Harrison Cripps considered that the free incision
enabled the surgeon to deal with multiple cysts, which, in
his experience, were frequent complications of hydatids of
the liver. A case illustrating the advantage of a free incision
was mentioned. In this instance special precautions with
a' view to obtaining adhesions were not used. A second
cyst was completely emptied through the wall of the first
cyst, which had also been completely evacuated. The
results were perfectly satisfactory.

Sir Dycb Duckworth had seen good results after all the
methods of treatment for hepatic hydatids. He was doubtful
of the excellency of the advice that all the contents of the
cyst should be evacuated at the surgical operation. It was
still a point for the surgeons to decide whether the cysts
should be completely cleared out. and whether antiseptic
injections should be practised.

Mr. Walsham remarked that surgical treatment of
hydatid cysts was not always of a harmless nature. A few
cases of sudden death, even from aspiration, had been
recorded. Perhaps this was due sometimes to hydatid
fluid escaping into the venous circulation. He could not but
think that an incision four inches long would be attended
with some danger. In several cases of the kind he had
made the incision from an inch to an inch and a half in
length, and found this size ample for all purposes. There
was but little fear of pus or hydatid fluid escaping into the
peritoneal cavity, and he thought that excellent results could
be obtained without the surgeon first endeavouring to
secure adhesions of the cyst to the abdominal wall. After
evacuation of the contents the cysts should be well syringed
with carbolic acid solution, and then powdered with iodo¬
form. In his own practice the wounds healed under this
treatment with the best possible results.—Dr. Angel Money
said that a continental surgeon was operating by abdominal
section on a case of hydatid of the liver when the patient
suddenly fainted and died. A daughter cyst must have
escaped from the liver and entered into the hepatic vein, for
one was found free in the right auricle of the heart.

Mr. A. Pearce Gould thought that aspiration should be
tried first in all oases. It was still an open question as to
what was the best means to be adopted even in aspiration.
Should the surgeon remove all the hydatid fluid obtainable, or
only a small quantity ? Perhaps the latter method was the
safer. In one case that had been under the care of Dr.C. Y. Biss,
in a woman aged forty, Mr. Gould made an incision through
the right linea semilunaris, when peritoneal adhesions were
found and four quarts of pus and'hydatid cysts evacuated.
The patient began retching, and the omentum protruded
at the lower part of the wound. In the omentum

abortive hydatid cysts were seen, but the omentum wae-
easily returned and the sinus eventually closed. In a second
case there was a very large hepatic tumour, from which
reddish serous fluid, without hooklete, was drawn off. After¬
incision two pints of fluid flowed out, and a large quantity
of solid material was discovered. Some days later much of
this material was scraped away, and some bleeding resulted.
The case had now almost completely recovered. He was
strongly in favour of the knife as against canstics. He did
not think it was necessary to stitch the wall of the cyst to-
the abdominal wall before opening the tumour.

Mr. Henry Morris supposed that the chief point for dis¬
cussion in the paper was the necessity or not of a double¬
operation. In a work of Dr. W. Thompson, published in 1841,
on diseases of the liver and biliary passages, four methods of
treatment were fairly stated Some quotations were made by
Mr. Morris from an article published in the Madras Quarterly’
Medical Journal for 1839 by an Indian surgeon, in which the-
opinion was expressed that there was not much danger of
effusion into the peritoneal cavity in opening abscesses of
the liver. The plan of attaching the cyst to the abdominal
wall was perhaps associated with that of gastrostomy and'
colotomy, but the procedures in the three cases were
altogether different; for in the two latter operations a>
mobile and contracting organ had to be dealt with. In-
hydatids of the liver it was necessary to obtain a sufficiently
large opening to allow of the escape of bulky oontents. It
was not difficult to secure coaptation of the cyst to the abdo¬
minal wall, and thus to prevent the escape of fluid into
the peritoneum. Manipulations were also possible by
which this coaptation could be secured at the time of
operation. He thought that there was no necessity for a.
division of the operation into two stages. He could not-
think the procedure of Mr. Harrison Cripps—of removing
the entire mother sac—an advisable one. Once, whea-
tempted to perform this, he had in his recollection the case,
recorded by Dr. Bright, in which the stripping of the parent
membrane from the adventitious coat was followed by
haemorrhage that nothing succeeded in stopping. Once--
also a boy was run over and died. It was found at the
necropsy that a hydatid cyst of the liver had become-
detached from its adventitious capsule, with consequent-
fatal extravasation of blood between the true and the
false sac of the hydatid. The surgeon should, in his opinion,,
empty as much of the fluid and daughter cysts as would
come away without using force, but he should not attempt
to remove the parent sac at the time of operation. He had-
never resorted to irrigation, but aseptic drainage-tubes should'
be used. The indiscriminate use of iodoform in the cyst
might be followed by disagreeable delirium and perhaps even
death.—Mr. Barwell said that he could supply the sequel to-
the case narrated in the paper. A small but long sinus

S srsisted for some time, but had recently completely healed.

[e had a dread of filling a large cavity with iodoform
symptoms of blood-poisoning had been known to occur
after such free dressings with this powerful antiseptic.

MEDICAL SOCIETY OF LONDON.

Hunterian Chancre of Lower Lip.—Plastic Operations for-
Ectropion and Contraction of Face.—Excision of Elbow .—
N<evus of Hand. -Early Colotomy.—Floating Abdominal?
Tumour. — Pharyngo- laryngeal Stenosis.

A clinical MEETING of tli is Society was held on Monday
lost, Mr. R. Brudenell Carter, F.R.C.S., President, in the chair.

Mr. G. R. Turner showed a living specimen of Hunterian
chancre on the lower lip complicated by a mushroom-like
growth on the chin. The man bad injured bis lip five months
ago, and two months and a half ago the site of injury took
on morbid action. Thera had probaoly been simultaneous-
inoculation at two places, and this was perhaps the chief
interest of the case. Syphilitic sores were found on the
penis, and a suppurating bubo in the left groin, also at*
eruption on the arms.—The President thought thetaiglr
probabilitv was that the inoculation bad been accidentalPy-
effected with the man’sown fingers.—Mr. Bloxam remarked on
the occurrence of two chancres on the lip in close proximity.
He had several times seen three and four hard chancres in.
one individual at the Lock Hospital. They affected any
position, such as the upper and lower eyelids, side of the nose,,
armpit, nipple, abdomen, umbilicus, arms, and back.—Mr.
Harrison Cripps had observed fourteea case® of Huntemt»

Digitized byLjOOgle

The Lancet,]

WEST LONDON MEDICO-CHIBCRG1UAL SOCIETY.

[Jaw. 29,1887. 219

chancres of unusual situation during the past year. In one
case of chancre of the eyelid, in a woman aged seventy
jeara, it seems that the grandchild wae Buttering from
secondary syphilis, and the woman averred that she had
obtained her sore from the child. These unusual sores
might not show any induration when occurring in the
akin; but those attacking the lips sometimes caused the
aubmazillary glands to enlarge so much as to suggest
mumps.

Mr. Daviks-Colley exhibited a case of Ectropion follow¬
ing necrosis of the superior maxilla in a boy aged six. He
showed the case as an example of a new form of operative
procedure for the relief of a severe case of ectropion. The
lower eyelid exhibited a granulating surface of the palpebral
conjunctiva, and was expoeed over au extent of three-eighths
of an inch at least, from above downwards. The bone
beneath the sinus was bare, but not loose. The edges of
ihe tarsal cartilage were pared over the outer two-thirds of
their extent, and after freeing the lower eyelid by an
incision three-quarters of an inch long, made parallel to it
and a quarter of an inch below its free border, the eyelids
were sutured together. Three-fifths of the palpebral aper¬
ture were closed. Niue months after this operation the
anus had healed up, but the contraction of the parts had
considerably drawn down the upper eyelid. The union was
divided, and the eversion of the eyelid was seen to be
as bad as ever. A year after the first a further plastio
operation was performed: a triangular flap of akin two
inches long was taken from the left temple just behind the
external angular process, and fixed on the gaping incision
which had been again made below the lower eyelid. This
flap healed fairly well, but the upper eyelid was still drawn
down, and the palpebral aperture was very small. To over¬
come this defect, Mr. Davies Colley divided the upper eyelid
and converted that portion of it which had for some time
occupied the position of tbe lower eyelid into a substitute
for it. The result was very satisfactory. The boy had
good sight and could close the eye. The hairs of the upper
eyelid still remained in what was now the lower border of
the lower eyelid.—Mr. Bbudbnkll Cart.br congratulated
Mr. Davies Colley on the success of the treatment.

Mr. Walter Pyb showed a Ntevus of the Left Hand in a
aged seven years, in whom there was a clear and definite
ory of a maternal impression.

Mr. Abtley Bloxam exhibited a case of plastic operation
for Contraction following Ulceration of the Face. In 1879
tbe patient had ulceration of tbe entire face as high as a line
drawn transversely across the face at the level of the infra¬
orbital ridges. The nose was completely eaten away in
process of time. The ulceration was probably due to
lupus, though some contended that syphilis was tbe
cause. In December, 1886, the mouth was represented by
on opening half an inch in transverse and a quarter of an
inch in vertical diameter. On Jan. 13tli Mr. Bloxam operated
as follows: A tube wk placed into the orifices repre¬
senting the nostrils, and the tODgue was secured by a piece
of string passed through tbe lip. An inoision was then
made through the cheek on either side, and the mucous
membrane turned down over the lower lip and fastened to
the incision in the skin by horsehair sutures close together.
The akin of tbe upper lip was then stitched to the mucous
membrane with horsehair. The result was very satisfac¬
tory.—Mr. Brudenell Carter had operated on a somewhat
similar case with a good result.

Mr. Walter Pyb showed a case of Excision of the Elbow
in a boy aged six, in whom he tried to perform a partial
-exdrioo, leaving the lesser sigmoid cavity of tbe ulna; but
that bad to be removed after five months had passed. The
part left seemed to be typically healthy. The case went
to show that complete excision was most necessary in order
to obtain a perfect result.

Mr. Harrison Cripps showed a case of Colotomy for
Carcinoma of the Sigmoid Flexure in a woman aged forty.
The opening of the artificial anus was of a valvular nature,
and tne patient had considerable power over defecation.
The operation bad relieved distress and diarrhoea, and
probably retarded tbe growth of tbe disease, it was im¬
portant to obtain primary union between tbe skin and
uuaeotui membrane. The operation was in this case very
beoafleial to the patient.—Tbe President, Mr. J. H.
MonoAW, and. Mr. Bloxam joined in the discussion. Mr.
1L CBEPPfc replv. thought it woe most important to get
the bowel thoroughly emptied before opening it, if primary
unltm tm omnfi.

Mr. Isambard Owen described a case of Floating Abdo¬
minal Tumour in a woman aged seventy-six. It was situate
in the epigastric and umbilical regions, and reached beyond
these bounds, but was not apparently connected with
either the liver or spleen.—Dr. W. H. Dickinson thought
it was a floating kidney.—Dr. C. T. Williams considered
that the splenic relations of the tumour were not abso¬
lutely negatived; tbe tumour might be omental and
benignant.

Dr. Gilbart Smith showed a case of Pharyngeal Stenosis
of peculiar funnel shape; the epiglottis was much contracted
and the cricoid cartilage thickened. The larynx seemed to
have received a sort of twist. There was no doubt that the
man had had syphilis, though he attributed the laryngeal
state to accident.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.

At a meeting of this Society on Jan. 7th, Dr. Alderson,
President, in the chair, the following communications were
made:—

Dr. Blenkinsop read a paper upon Phthisis and its
Treatment.

7he Etiology of Phthisis and its Treatment from a
Hygienic Standpoint. ---Dr. Seymour Taylor read a paper
under this title. Phthisis he considered a condition or
symptom having several causations—inflammatory, fibrous,
tubercular, or otherwise. The tubercular form might be
described as bacillus phthisis, or, owing to Koch’s connexion
with the tubercule bacillus, tbe disease might be culled
Koch’s phthisis. In his experience the bacillus tuberculosis
was id ways present in tubercular phthisis. Tuberculosis,
like cancer, may vary in its virulence. In some it may be
general in its distribution; in others it may be quite a local
process. It is not singular in its behaviour. It seems to attack
some localities from choice. It selects certain families or
constitutions, apparently by preference, and not by accident.
The author then discussed tne arguments which had been
advanced against the infective theory of tuberculosis, and
said tbat other factors were necessary for a man to contract
tbe disease than the mere contact of the bacillus; while,
whatever the gate of infection might be (mucous or
otherwise), an abnormal condition of the points of contact
was a certain factor in the production of the disease. The
blood contained bacilli after inoculation, and, as in enteric
fever, a relapse may be occasioned by re-inoculation from an
infected, patch of ulceration; so it may be tbe case with tbe
extension of tubercular ulcer on the tonsil, or buccal cavity, or
from strumous glands containing bacilli; indeed, it is possible
by inhalation to account for the multiple tubercular lesions
which are met with in the lungs. The author then eketched
briefly the life history of a tubercular patch, and discussed
the origin of the giant cells. He concluded by epitomising
the causes which in his opinion rendered phthisis so virulent
amongst us, and said that our cold damp climate, by favour¬
ing the prevalence of catarrh of the respiratory apparatus,
was directly responsible for a condition which allowed the
tubercular parasite to flourish.

The Operative Treatment of Intercurrent Disease in
Tubercular Patients.—lit. Bruch Clabkb read a paper on
this subject. After briefly dismissing the nature of tuber¬
culosis and its dependence on a specific bacillus, the author
proceeded to show that it was almost impossible to remove
by a surgical operation the whole of the bacilli that had
found their way into tbe body. The local manifestation
was all that could be got at. It was dear, therefore, that
an operation could only aim at removing a growth which
was causing so much constitutional disturbance as to pre¬
vent the recuperative powers of the patient and the phy¬
sician’s remedies from exercising a dne influence on the
conrae of the intercurrent disease. After relating several
eases of bis own and of other surgeons in which such
operative treatment had been practised with more dr
less favourable results, and after showing tbat such cases
healed with success and ease, the author concluded by
asserttncr tbat surgical interference was only justifiable
when all attempts at cure without the knife had been
tried and found wanting.—Dr. Thorowoood, in the course
of some remarks, said that a depressed state of tbe nervous
system was an especial factor in the causation of
phthisis.—Tbe President said that a dry soil was an im¬
portant preventive of phthisis. In the second decade men

220 The Lancet,]

EPIDEMIOLOGICAL SOCIETY OP LONDON

[Jan. 29,1887.

were much more prone to the disease than women.—Dr.
Thudichum observed tliat there was no climate in the
world which was. free from phthisis. He thought the
Koumiss cure advocated by the .Russians was of no real use.
It was remarkable that .since Koch’s discovery of the bacillus
phthisis had increased all over the world.—Messrs. H. H.
-Taylor, Lloyd, Benham, and Dunn continued the discussion;
and Drs.i Blenkinsop, Seymour Taylor, and Mr. Bruce
Clarke respectively replied.

Dr. P. S. Abbakam showed a selection of sections of
Tubercular Organa in man and the lower animals, and
specimens of the Tubercle Bacillus.

Messrs. Whisht and Co., of New Bond-street, exhibited a
large collection of Instruments, Sprays, and Inhalers.

EPIDEMIOLOGICAL SOCIETY OF LONDON.

Preventive Inoculations.

' A meeting of this Society was held on Jan. 12th, at which
a paper on the above subject was read by Edwabd F.
Willoughby, M.B.

In opening this paper, which was, he said, in some sense
a continuation of one he. read last May on the Variolas of
Man and Beast, the author called attention to two characters
by which a large class of diseases were distinguished from
all others—via., the spontaneous extinction of the morbid
process within a limited, often definite, time, and the im¬
munity against subsequent infection, more or less lasting
and complete, which followed one attack. The two pheno-i
mena were doubtless closely counected, but till lately no
rational explanation had been even proposed. On the latter,
ihowever, rested the whole idea: of protective inoculations,
and it was of the utmost importance that clear and correct
conceptions of their naturie and relations should take the
.place of the confused notions that at present prevailed, not
only out of, but even within, the profession. The first con¬
dition of a preventive inoculation was that the virus used,

, should be derived directly or indirectly from the disease it
. was intended to avert: “ Diseases distinct but antagonistic,"
to use Mr. Fleming’s expression, were unknown to patho¬
logists. Cow-pox protected against small-pox only, because
it.was small-pox modified by having passed through the cow.
The second condition wasthat the disease must be one that does
not recur. All non-recurring diseases were, or were presum¬
ably, baoterial; but the converse did not hold good, for some
bacterial diseases ran oniadetinitely, as tuberculosis and septi-
t csemia; and others, as diphtheria, typhoid, and cholera, con-
. ferred no immunity. Consequently, there could in such be
no such thing.as preventive inoculation, while inoculations
of one disease in the hope of averting another were worse
than useless. Preventive inoculations might be divided
into four or five orders—viz., methods of (I) Inoculation,
(2) .Vaccination, (3) Attenuation, and (4) what for want
,of'A better term he would, call Neutralisation. The first
c«ad seoond had as yet been applied only in the case of the
varioloid diseases, and he would repeat from his former
. paper the principles on which they were based. They were:
1, One attack of variola, of the kind proper to any animal,
.protects the individual against infection by, or inoculation
o£, the same., 2.. Inoculation, of any animal with the virus
of its. own variola, produces a milder form of the same
.disease, but affords a protection similar to that conferred by
an attack contracted by ordinary infection. (This is the
, method of inoculation, properly so called.) 3. Any variola
, inqcplated in an animal other than, that whose proper
.variola it is gives rise to. a peculiarly modified form
. of [he diuease^ attended by little constitutional disturb¬
ance* , merely local eruption, and no danger to life, such
modified disease .being no longer communicable to any other
animal, of . the .same or of different species, except by direct
inoculation (cow-pox. is such a modified form of small-pox).
.4. This, modified disease affords a, considerable degree of
immunity against infection by any means whatever with
the variola whence it was deriyed, either to the animals
whpse varied* [was the original source of it, or to others
. capable of being infected m any . way thereby. (This is
vaocinntion, properly so colled.) The first method, or that
of inoculation, is open to the grave objection that, however
-great the immunity conferred and small the risk incurred by
the individual, the .disease, is unchanged nr«’ : nfectious.

Jenner’s operation is as yet the only instance of the
application of the second method, though there is no reason
why some animal should not be found to play for the
sheep the part that the cow does for man, and it seems
probable from Dr. Klein’s experiments that the disease
at the farm at Hendon, which he would call Cameron’s
disease, stood in precisely the same relation to scarlatina as
cow-pox did to small-pox, and might possibly be employed
in the same way. If so, it would be a vaccination in every
Bense. The third class comprised the so-called attenuations
of M. Pasteur, in which it was alleged that the cultivation
of the bacilli in artificial media under certain conditions
lessened their virulence, so that inoculation with them pro¬
duced, as in the first method, a milder form of the disease.
To minimise the risk, M. Pasteur generally used attenua¬
tions of two degrees of virulence, the weaker affording pro¬
tection against the stronger, and this against the disease
itself. This method was open to the same objections as the-
first, and also- to the more serious one, that, it being im¬
possible to standardise the attenuations, they sometimes
failed to confer any protection, and at others caused
the death of the animal. For this reason they could
never be used in the case of man, and except under-
special circumstances could not be recommended even for
domestic animals. The fifth class was represented by
Pasteur’s practice as regards rabies and hydrophobia, on.
which he did Mot yet feel in a position to express a decided
opinion. But it was to the fourth method that he wished to
to call the attention of the meeting. It consisted in the
inoculation of the products of the development of the bacilli
without the bacilli themselves. It was well known that
all low forme of life, such as those concerned in fermentation,

f iutrefaction, &c., as well as bacilli secreted or caused to be
ormed in and from the fluids in which they grow, contain
chemical products, and that in some cases, as alcoholic
fermentation, when these accumulated to a certain point
the further development of the organisms was arrested,
and doubtless something analogous to this occurred, and to
some extent explained the spontaneous extinction of the
febrile process, in the so-called zymotic diseases, though it
would not of itself explain the subsequent immunity, since
such products could not but be eliminated in the course of
a few weeks at the longest. However, Dr. Salmon, of the
Bureau of Animal Industry in connexion with the Agri¬
cultural Department of the United States, had found that,,
while pigeons were peculiarly susceptible to the poison
of swine plague, he could by employing inoculations of
sterilised cultivations of the bacilli in artificial media
render them perfectly insusceptible. After some more or
less successful experiments he performed a series which
gave the most decisive results. Culture fluids heated to
140° F. for several hours were bo far sterilised that they
failed to develop in fresh gelatine solutions. And four
pigeons inoculated two or three times at intervals of a fort¬
night or more with such sterilised fluids were but slightly
indisposed after each operation. Finally these birds,,
together with one that had received a much smaller dose
seven weeks previously, and a control bird inoculated with
the gelatine only, were each inoculated with ’76 cc. of a
virulent culture of swine plague, a dose that had invariably
proved fatal to others. The results were most remarkable r
the control bird died in twenty-four hours; that which
bad received the insufficient, dose fifty days previously died
in forty-eight hours; while the other four birds were
absolutely unaffected. Cultivations from the blood of the
twotbat'died developed the specific bacilli in abundance.
Dr. Salmon, therefore, inferred that the products of the
development of the bacilli of any snch disease so modified
the constitution of the bioplasm of the tissues as to render
it incapable of affording a pabulum for the bacilli, and, if
they did not cause the death of the animal, led to the-
cessation of the morbid process; and, secondly, that since cells
to which a special character had once been imparted tend, as
in the case ef carcinomata and other neoplasms, to transmit
it to those to which they gave rise in the aofcof proliferation,
this inability to support the growth of the particular
bacUlus might persist for many years ; but that, since they
might tend to revert to their original character, the individual
might sooner or later become again susceptible. That euch
Wad the case was well known, as also that in dome persona
the insusceptibility was so soon lost as to be practically
unattained, and that very mild attacks, like that of the
pigeon that had received the smallest dose, failed to afford*
appreciable protection. This method, Dr. Willoughby thought.

S'hb Lancet,]

THE NEW SEWBR3 QF TUB PALACE OF-WESTMINSTER.

(Jan. 1887. tffil

promised ■ results of incalculable importance, and to be of
the widest application to the diseases of man and beast. It
was merely necessary to identify the specific bacillus to find
a suitable medium for their cultivation and to determine
their thermal death-point, or to remove them by the
Pftsteur-Chamberland filter. It was entirely free from the
objections to which inoculations and -attenuations were
open, the phenomena induced being those of a poison,
whatever it be, actually antagonistic tp that of the disease.
Mr. Willoughby urged that investigations op. these lines
should be at once undertaken in respect of all infectious
diseases of cattle, and that there was one human disease-
yellow fever—the fatality of which would fully justify, or
rather demand, such an experiment, which might under
circumstances of special exposure.

Tr\-»n ——— _____

•-HIT,
td
.(ho

■ator-BEW FLEXIBLE GLYCERINE RING PESSARY.
-ICB88BS. Arnold & Sons, of West Smith field, have patented
anew form of annular pessary, which is precisely similar
to the ordinary indiarubber ring pessaries. Like these it
contains a watch-spring, and is therefore of the same
resistance; but instead of being covered with a piece of

fUfa lufentiras.

I ILi-k

thick indiarubber, it bas first a coating of rubber around
the watch-spring, and then a thin rubber cash filled with
glycerine. By this means the pessary is rendered beautifully
soft; the glycerine,unlike air,never esoapee; and the peatery
is rendered much softer and easier of introduction.

HUTCHINGS’S FILTERING-PAPER.

Jj i/rit:

-i»JasN

■Jm this paper (manufactured by G. J. Hutchings, Howard-
street, Baltimore, U.S.) a coarse trellis-like gauze is embedded
.in the pulp, so that filters of quite exceptional strength can
be made from it; Paper filtration is so exoellent, and the
material so cheap and clean, that we have no donbt this-
.new article will be largely used. The inventor has already
applied it to the household filtration of water, wine, and
the like, and bas made a coffeepot, which we hive not seen,
but which ought to be perfect. We think it was Jerrold!
who described English coffee as “perfectly palatial, standing
in its own grounds,” and the description is but too often!
true enough. Paper filtration is at once sufficiently accurate
and quick to. give a perfect infusion, as every chemist
knows, while by successive additions of water all waste!
may be avoided* , . v ,
i • n '->n-

ffEiW SEWfeRS OF THE PALACE OF

■ ' Westminster.,

lohrtnl -edJ ni l t « -m • ,/ *

'rewh-neode^ fedMeMtioti of the main sewers 6f
*the Houses of Parliament has been carried out during the
.recess by Mr. Isaac Shone,, the engineer in efiorge' of the
,,works, and on Tuesday last a select party, including repre¬
sentatives of some of the daily and Weekly journal^, Were
-Fereoenlly conducted by the engineer to view thebltera-
1 three which have been made. Mf. Shone has issued ad
'explanatory pamphlet,-Which to a certain extent is historical,
ff- T/ %fo.-ftfew■ Wkat an,4f4>*olutely modern science ii

sanitation as cunied outat present, audLow ciude were the
attempts in this direction fifty.years ago, eveu in the hands
of men of genius with command of unlimited funds. The
original sewer of the House, as laid by Sir Charles Barry in
18311, was a huge brick structure with a fiat bottom, and
haviug a fall of 1 in 923 towards Abingdon-street, wlieie it.
emptied itself. It is needless to say that such a sewer as
this, with no moans of flutliing,soon became little more than
a nuisance. In consequence of the complaints of smells in
the house a new sewer was constructed in 184(1, with a
narrow deeply curved invert, and with a fall of 1 in 215
towards Speakers-green, close to which it emptied into
& sewer in Bridge-street. This sewer, it will b$ observed,
sloped in a direction opposite to the original One, and, being
of better form and possessing ample means of flushing, served
its purpose well till 1873. In this year the metropolitan low-
leyel sewer was made, and the Palace sewer was connected
with it, its bottom being 21 in. above the bottom of the
metropolitan sswer, which was 7 ft. 9in. in diameter.
The average depth of sewage in the metropolitan sewer
in dry weather has been about 42 in., 21 in. aboye
the bottom of the Palace sewer. Thus there was always
a head of sewage against the Palace outlet, and in wet
weather, when the metropolitan sewer was full, the Palace
sewage could, not escape, and its sewer became a sort of
storage reservoir for the metropolitan sewage, the pressure
of .which forced the sewer air -back into the Palace. Thus
the Palace of Westminster, especially: of a night,,when the
gas was lighted, served the purpose of a’partially exhausted
chamber for sucking poison from thp metropolitan sewers.
Who can complain if the legislation of late years has not
been all that could be desired? To remedy this state of
things a committee was appointed in' i8.8(1, with : Sir II.
Roscoe, FJLS,aa chairman,-and the recent improvements
are owing to the labours of this committed It is due
to Mr. L. II. Isaacs, the Conservative member for Newing¬
ton and Walworth, who is by profession an architect, to
6tate that this gflntlemafl twice performed the unpleasant
and almost herpic task qf traversing and inspecting the
Palace sewer, and it. was largely to his evidence and
practical knowledge that the works just completed were
undertaken. The plan of the new arrangement was
supplied by Mr. John Phillips, and received the approval of
Major Hector Tulloch, R.E., the Local Government Board
inspector. There were originally about 122 subsidiary drain
connexions with the main sewer, and these were formed at
yario.us levels on the to p, bottom, and sides. The original
main sewer was 10 ft. high and 3 ft. Wide. The improve¬
ments which have been.made are many of,them in the
direction of simplification, and will be easily understood. In
the first place, the old brick sewers have been replaced by iron
.pipes. Tbe chief tributary id 9in. in diameter (in place of one
.24 in* by 15 in.), and the main sewer is jL2 in. instead of the
dimensions above given. Tbe outlet is into a manhole in
Speaker s-green, and thisisat a lower level than the bottom
of the old sewer. Thus the gradients have been everywhere
increased, and tbe rate of flow has been increased in the
sewers from P11 lest jte.rsfcCQD-d (the rate ih the main sewer
of 1839) to a rate of 2 8 feet per second. This rate of flow
is-claimed to be wflat ji called, a sulf-clearniug velocity.
Ample means for tbe automatic flushing of thfse-qew sewers
has been provided ih the shape of two Shone’s automatic
hydraulic flushing ejectors, which at regular intervals dis¬
charge a' large volume of water through tbe tewer pipes.
One of there flushing ejectors is at the bead Of the sewer
near the Victoria Tower-, the other .is somewhere near the
centre, of the Palape. The sewage, falling to a lower level
than formerly, is nnally lifted some twelve "feet, and is dis¬
charged into the metropolitan sewer at a level several feet
above itabottorii, so that the outlet 'of the-' Paldce sewer is,
except in times of flood 1 , always above tbe level of tbe fluid
in tbe metropolitan sewer, and bas no head of sewage Co
oppose its outflow* The-lifting of-the;'Palace sewage into
the metropolitan $e wer * 8 effected by means of Shone’s
pneumatic sfiyage' elector?; These machines are placed
m ft cbamBW beneath Speaker’s-green. They consist bf
strong iron vessels/into which the Sewage flows bygravifft-
tioin. When they are filled ft series of valkes act auto¬
matically (1) to close the-inlet, and (2) to admit a stream of
.'conpressed air, by which the sewage is, driven through
.(3) the outlet. These electors have only to lift the sewage
some twelve feet; : bnt ft Is well knriwnlhat hi otper places
where they are ln nse (s»,fotexatnple,ftt Warrington in Lari-
cft&hixe) this force js;sufficient to drive the sewage more than

5d by

oogle

222 The Lancet,]

CAMBRIDGE MEDICAL GRADUATES’ CLUB.

[Jan. 29,1887.

a mile. These ejectors have to be supplied with compressed
air, which is provided by means or gas-engine air-com¬
pressors, which are in a chamber beneath tne Palace, at
some little distance from the chamber containing the
ejectors. Between the metropolitan sewer and the Palace
sewer a strong dam has been erected, which is perforated to
admit the outlet pipe. The ejectors are fitted with auto¬
matic counters, so that every emptying of them is registered,
and thus they will serve as sewage meters. These ejectors
take, when Parliament is not sitting, about fifteen minutes
to fill, but they discharge themselves always at about the
same velocity of half a minute. Observations made while
the machinery has been at work lead to the supposition
that one gas-compressing engine and one pneumatic
ejector will always be sufficient for the needs of the Palace.
In order, however, to guard against all possible mishaps,
there are four compressing engines and three ejectors. The
Palace sewers take the rainfall which falls on the Palace
area as well as the sewage, and therefore it is necessary to
be ready for times of flood. If in times of flood sewage
water accumulates in the outlet manhole, this will act
on a float, which in its turn acts on Julius Sax’s auto¬
matic electrical tidal water gauges, one of which is placed
in the ejector chamber and another in the gas-engine room.
These machines show the exact level of the water in the
manhole, and tell of the necessity of putting a second or
third ejector, or a second, third, or fourth gas-engine into
operation. Again, if the whole of the new machinery
should by some unforeseen accident become inoperative, a
valve may be raised in the manhole, and the sewage will
fall by gravitation into the metropolitan sewer, as was
formerly the case. The new iron pipes are laid in the bed of
the old sewers, which serve as convenient subways for
workmen. The sewers are ventilated by means of the
furnaces which exist in the basements of'the Victoria and
Clock Towers, and 'fchich are made by a very simple con¬
trivance to draw fresh air through the pipes. The works
have cost £11,000.

We must congratulate the members of both Houses
upon the very important sanitary reform which has been
effected by means of these works. There can be no doubt
that the condition of the House will be immensely improved,
and we think that much credit is due both to Sir H.
Roscoe’s committee and to Mr. Shone, who has so efficiently
carried out the recommendations of that committee. The
machinery for keeping the Palace sewers empty will, of
course, be constantly supervised by skilled persons, who, it
is evident, must always be present night and day, both in
and out of session, in order that the proper supply of com¬
pressed air may be maintained, and the possible accident of
sudden flood be grappled with. However, there is little
likelihood of sewage accumulating in the Palace of West¬
minster in the future. Our legislators have shown them¬
selves alive to the importance of “passing it on.” Let us
hope they will next turn their attention to the recipients
of it, and take unhappy Barking and poor Father Thames
into their kindly consideration.

THE CAMBRIDGE MEDICAL GRADUATES’ CLUB
AND LONDON MEDICAL DEGREES.

A special meeting of the Cambridge Medical Graduates’
Club was held in the rooms of the Med-cal Society of
London on Thursday’, Jan. 20th, “for the consideration of
the pending questions with regard to degrees in medi¬
cine.” The chair was taken by’ Dr. Dickinson of St. George’s
Hospital, one of the Vice-Presidents of the club. There
was a poor attendance of members, only twenty-eight
being present.

Sir Geo. Paget, K.C.B., moved the following resolution:—
“That to establish a second university in London for the
purpose of granting medical degrees is either unnecessary
or unadvisable. That it is unnecessary, if the degrees are
to be granted on a standard of acquirements equivalent to
those of the existing University of London. That it is
unadvisable, if they are to be granted on an inferior standard.
Because, to lower the distinction would be unjust towards
those who by extended study and diligence have already
obtained these titles from the University of London or other

universities which maintain a high standard. Because it
would be injurious to the interests of the public and to the
advancement of medical science to lessen the inducements
to men of ability to attain the superior knowledge required
for the highest distinctions. That to establish a second
university in London with the purpose of granting the
same or similar titles for a lower standard of acquirements,
would be a competition downwards, and be utterly
unworthy of such bodies as the Royal Colleges of Physicians
and Surgeons. That the injurious consequences would be
intensified if a medical degree were given on the existing
standard of the professional examination of the Con¬
joint Board. That this would in its first effect be unfair
towards those who have already passed the same or
like examinations without receiving such degree; and in
its ultimate result, by making medical degrees nearly
universal in the profession and no longer a distinction,
would be utterly destructive to the purpose they have
served as inducements to superior attainments in medical
science.”

The resolution was seconded by Dr. Sturges. Sir Henry
Pitman, Professor Latham, and others opposed the resolu¬
tion.

The discussion occupied nearly two hours, and ultimately
the resolution was lost, six voting in its favour and fourteen
against. Eight members of the Club who were present did
not vote.

Professor Latham then proposed the following resolution,
of which he had given notice:—“That it is expedient
that a committee be appointed whose duty it shall be
to consider from time to time the regulations relating
to degrees in medicine in the University, to receive and
consider suggestions for the improvement of medical
education there, and to take such action as they deem
necessary.”

The resolution was seconded by Dr. Abercrombie, and after
a brief discussion it was resolved to adjourn its considera¬
tion to the next general meeting of the Club.

The meeting ended with the usual vote of thanks to the
Chairman.

MEDICAL APPOINTMENTS IN TI1E COLONIES.

A short account of the medical appointments which are
from time to time filled up by the Colonial Office has been
recently forwarded to the medical schools. The medical
officers are chiefly required for the West Indies and the
West African colonies, and very occasionally for the Eastern
colonies (Ceylon, Straits Settlements, and Hong-Kong),
Cyprus, Gibraltar, St. Helena, and the Falkland Islands. On
the opposite page we have tabulated the Chief points in
respect of the separate colonies, for easy reference.

In addition to the ordinary medical appointments in these
colonies, vacancies also occasionally, though very rarely,
occur for which specialists are required—as, e.g., to take
charge of a lunatic asylum ; and the particulars connected
with the post of chief medical officer in some of the larger
colonies have not been given, as the headship of the medical
department in such colonies, requiring administrative as
well as professional qualifications, is not reserved to the
ordinary medical staff, but is often filled up directly from
the outside.

All applicants for medical employment in the colonies
must be between the ages of twenty-three and thirty, and
must be doubly qualified ; preference will be given to those
who have held hospital appointments as house-physicians*
and house-surgeons; certificates of moral charaoter and of
sobriety will be required, and every officer before being
ointed will be medically examined,
pplications for medical employment in the tropical
colonies from persons in the United Kingdom must be ad¬
dressed to the Private Secretary, Colonial Office, Downing-
street, S.W., during the month of April in each year, and
notices to that effect will be posted up early in the vear in
the leading hospitals and medical schools of Great Britain
and Ireland. Out of the total number so applying a list of
thirty selected candidates will be made, who will be eligible
to fill any vacancies which may occur during the year, and
no application at any other time for ordinary medical ap¬
pointments will be entertained.

From twelve to sixteen vacancies usually occur annually.

Th* Laxcrt,]

MEDICAL APPOINTMENTS IN THE COLONIES. [Jan. 29,1887. 223

Three superintending officer*. 7 district medical officer*, end 8 «fdit»Dti, with the pay and privilege* above noted, are appointed to take care of the labourers on ooffee and other estates.

t About £28 each a* public vaccinator*.

224 Thu; LANCirtv]

THE ASSOCHTIO.VOP GENERAL PRACTITIONER*

[Jaw. 29,1887.

THE ASSOCIATION OF GENERAL PRAC¬
TITIONERS.

A meeting of the Council of this Association was held at
Exeter llall on Wednesday, Jan. 19th. The following
members of Council were present:— C. G. Wheelhouse, Esq.,
F.R.C.S. (Leeds), in the chair; Sir W. Foster (Birmingham)
Mr. Ernest Hart, Dr. Alfred Carpenter (Croydon), Dr. Danford
Thomas, Dr. Crowe (Worcester), Dr. Mickle (Bow), Mr. Steele,
Mr. Wickham Barnes, Dr. Alderson, Dr. Gubb, Mr. Walter
Pocock, Dr. J. B. Brierley (Manchester), Mr. Walter Marsh
Dr. Maurice Davies, Mr. Major Greenwood, Dr. R. l’aramore
Mr. A. D. Roe. and Dr. W. Piercy Fox, and the hon. secs.,
Messrs. Bott and Verdon.

Letters of apology and assent were read from absent
members of Council, including Mr. Jolland (York), Dr.
Holman (Reigate), Mr. Hallowes, and others. Fifty new
members were elected, and the following were added to the
Council: — Mr. E. Galton. Dr. C. Royston, Dr. K. Lord,
Mr. F. B. Hallowes, Dr. H. C. Pope, Mr. J. W. Workman,
Dr. H. J. Capon. Dr. M. Coates, Mr. T. E. Watford. Mr. J.
Manley, Mr. W. Eddowes, Mr. Hugh Aker, Mr. W. Winter-
botham, Mr. De Vere Hunt, Mr. T. S. Ellis, Mr. Priestley Smith,
Mr. J. S. Bartrum, Mr. J. S. Turner, and Mr. F. Wallace.

Mr. Whef.lhogse said: “I must thank you very cordially
for placing me in this 1 chair, and assure you that, so far as it
is in my power to aid tha objects of this Association as they
have been put before me, they shall have my heartiest and
most cordial support in every way. We cannot conceal
from ourselves the fact that we are living in critical times,
when everything, so far as the profession is concerned,
appears to be on the point of turning, and it is just
at that point of turning when it behoves us as general
practitioners to see that our rights are not swept away
as the tide flows rounds The question was raised during
the late election for the General Medical Council as to
whether I was a consulting surgeon, a general practi¬
tioner, or what ? I have been a general practitioner all my
life. I am a general practitioner still in a somewhat
restricted sense, for when I accepted a seat in the Council
of the Royal College of Surgeohs, it became necessary that
I should forego the practice of midwifery and the dispensing
of medicines. I still have a large family practice, and although
those amongst whom I live choose every now and then to
ask my opinion in consultation, I do not think that that
should redound to my discredit, at all events. Now, there
seems to be a very general feeling throughout the profession
that the rights of the general practitioner were likely
to go by unheard unless the general practitioners them¬
selves looked after those rights in all the changes which
seemed about to come upon the profession. For a very
long period—certainly for twenty-five years—1 have been
working with the Medical Reform Committee of the British
Medical Association in the hope that by patient plodding
and by patient working we should after a time, at all events,
secure for the profession certain definite rights, and these
rights appear now to be within reach of our hand. It seems
to ni9 that with this very general desire upon general prac¬
titioners to look after our own rights, some such Associa¬
tion a9 this has become a necessity. In the first place, it
has seemed to me perfectly monstrous that so far as
liondon schools and London-educated men are concerned
they have no means of taking an ordinary M.D. degree; and
whilst you are about it I think you are perfectly right in
putting that as one of the points upon the programme for
which you contend, and I hope the upshot will be in the
end we shall obtain a right to that qualification, or some
means by which those educated in London may obtain it
without having to go beyond the limits of London itself.
Amongst other things we have been striving for, and one to
which I bave.looked all my life with very great hope, is that
we should live—at least , some of us—to see one portal, and one
portal only, by which those who enter our profession may
■>e admitted to it. With twenty competing bodies there
must be a Competition which must be unfavourable to
the general mass of the profession in the way in which
•heir examinations are conducted. If we cannot have,
one portal fpr the whole profession, I should like, as'

* fie nearest approach to it, one portal for England, one
f ir Ireland, c*nd oqg for Scotland, and I would have
those under the guidance of the one examining body

which will be instituted, I hope, in the near future;
and each of these kingdoms should make it an absolute
necessity that every man who enters' the profession
should pass through that portal, and should be tnade to
show that he is efficient in the arts of medicine and surgery.
I hope that there will be some means by which the general
practitioner, if he says *1 don’t care to stand upon this
same dead level in which I entered,’ may be able to pass
into a higher status. If lie be a surgeon, he may desire to
obtain his Mastership or Fellowship in Surgery. In the same
way I would have a medical degree within reach, so that
everyone who takes medicine in hand can be able to obtain
a London M.D. degree which shall place him upon an equality
with the M.D. obtained either in Dublin, Edinburgh, or any
other large European centre. In order to do that, I think we
should need a very considerable modification in the way in
which examinations are conducted. I am one of those who
look upon the examinations of the present day as unsatis¬
factory in more ways than one. 1 consider they are broken
up into many minor matterp. A man is called upon to pass
too many examinations, and to pass them in such a way
that he thinks when he has passed any one subject he-may
forget it as quickly as he likes, i would therefore diminish
the number in which he is called upon to pass examinations.
I believe that, examination? are conducted too hastily, too
cursorily; that they are conducted in a way which is not
strictly'fair to the student [or to examiner, and I think
there are changes in the method of examination which, now
that new examination halls are to be erected, may be forced
upon the attention of those who constitute the examining
I bodies. 1 have been very much grieved at wljat has
taken place with respect to both the College of Surgeons
and the College of Physicians in the action they have taken
with respect to the Apothecaries’Society. My-feeling is
that if we could see those three bodies so united as to
form the examining body of the kingdom, the one-portal
system would be within our reach. But when I saw, with
all the desire on the part of the Apothecaries’ Society to join
heartily in any scheme which may be propounded, that
that offer was rejected, I felt that pressure ought to be
brought to bear upon the Councils of the College of Surgeons
and the College of Physicians, and, if need be, on tbe Privy
Council itself, to pray if possible that this arrangement may
not be completed if it is not heartily accepted. I hope that
this Association will be able to put such pressure upon the
examining bodies, upon tbe governing bodies, and upon
all the bodies concerned with medical education, that we
shall eventually succeed in obtaining that for which every
general practitioner has been fighting for a long time.”

Dr. Alderson moved the following resolutionThat
this Association urgently appeals to the general prac¬
titioner of England to give their adhesion and support to ■
the Association, by becoming members, in furtheranise of
its important objects, which are briefly as follows: That
this Association regards with satisfaction the proposal for
securing to the general practitioners of England in the future
means of obtaining the M.D. degree in London by reasonable
and adequate examination tests.” Dr. Alderson thought the
success of tbe Association was assured. They were most
fortunate in having as their president the most representa¬
tive medical man in the kingdom. He (Dr. Alderson) felt a
particular interest in proposing this resolution, inasmuch as
ne had not only met with some little difficulty in getting
his own degree; but he bad been compelled to send a son
of his away to Durham. Why, he asked, should London
have only given her diploma to thirty-six men during the
past year? Could'it be that there were only thirty-six
students in the whole of London worthy of that degree ?
The student’s career should be progressive.

Mr. Major Greenwood said he had great pleasure in
seconding the resolution, and expressed the hope that some
alteration would take place in London 1 with regard to the
granting of degrees. The London University could not in
any sense be said to fulfil the requirements of a London
University. There were many students who desired to
complete their curriculum after having engaged in practice
who found it impossible now, compelled as they were to
return to the hospital, and go through the whole curriculum
again. He hoped when a new University was instituted
that it would help those who failed to carry out the fuU
curriculum at the present Lcnlon University.

The resolution was carried unanimously.

Mr. Wickham Barnes moved the following:—“That,
this Association protests against the eXclusioh of the

The Lancet,]

THE ASSOCIATION OP GENERAL PRACTITIONERS.

[Jan. 29,1887. 223

Apothecaries’ Society from the Conjoint Examining Board of to give to the general practitioners, who compose upwards
England as tending to create a division of medical interests of 95 per cent, of the profession, a just voice in the
to the public and to the profession.” He stated that he had governing councils of such corporation or university.”
inserted two notices in the Medical Press asking the mem- Dr. Brierley said he quite agreed with them. They should
bersof the Poor-law Medical Officers’Association to express never forget what infinite good the Apothecaries’ Hall
their opinion upon the question. As the result he had had done for medicine in the past, and lie thought it was
received 200 replies, only one being opposed to the admission perhaps t he most ungraceful act that could possibly
of the Apothecaries’ Society to the conjoint examination. have been done towards that corporation to exclude it

Mr. Steele i said’he had much pleasure in seconding the from any new arrangement which might he made.
sboTe resolution. The action of the College of Surgeons in He would have had nothing to do with the resolution if it
ignoring the resolution passed at one of its meetings was had been to suggest a new power for the Apothecaries’ Hall
conduct which could not be approved. The position of the to confer a further degree. They had, as had been remarked,
Chairman on the General Medical Council was a protest by the more than enough already. It was not new powers, but a
general practitioners throughout England that henceforth reconstruction of the old that was required, and the merging
u general practitioners they intended to have some voice into one scheme. With regard to the College of Physicians,
in matters affecting their interests. The fact that the he must say he held that qualification in very high esteem,
Apothecaries’ Hall had been omitted from the conjoint scheme He possessed that qualification. On the other hand, he had
ibowed the necessity for vigorous action on their part. the profoundest respect for the licentiateship of the Apothe-
Thia resolution was passed unanimously. caries’ Society.

Dr. Daneord Thomas, in moving the following resolution Dr. Gunn, in seconding the resolution, said they had
-vi*., “ That this Association claims for the general practi- passed several resolutions, and after passing them the next
'toners of England, Members of the College of Surgeons, thing for them to do was to give them effect, it was a very
ud Members and Licentiates of the College of Physicians grave measure asking for a Royal Commission, but if they
» representative voice in the governing bodies of the obtained it he thought it was extremely probable that it
respective Colleges, of which they are the main support,"— would fulfil their wishes,
aid this was a matter in which he was specially interested. The resolution was carried unanimously,

and from his connexion with a kindred Society—viz., the Dr. Mickle suggested that the two questions, that of

Association of Members of the College of Surgeons, which had obtaining the London M.D. degree for medical students and
been working for some two or three years now in endeavouring the incorporation of the Colleges, should be kept distinct,
to obtain the right of the representation of members on the The burning question was the one of degrees. Everyone
Council of the College. The success which had recently who had watched the London schools during the last twenty
dtended their efforts to secure representation on the General years knew that the students laid under enormous dia—
Medical Council, and the honour they had in seeing two of advantages. This Association had already committed itself
;bo*e gentlemen who had been elected present, should in a former resolution to support the obtaining of the
encourage them to commence work with the view of obtain- M.D. degree, and it seemed to him very undesirable for the
mg the reforms set out in the resolution. What Parliament Association to do anything which would form an opposition
bad realised they should be successful in carrying out in a to it. He thought the resolution might be so modified as to
minor degree. They had now their representatives on the imply that no opposition would he given to the granting of
General Medical Council, and they intended to fight—he the M.D. degree.

hoped successfully—for representation on the Council of Mr. Hart said he hoped no one would consent to this
their College. _ They had, he thought, met with consider- proposal, which practically meant selling their birthright
able success with regard to the work they had done in the lor a mess of pottage. Now, when the Colleges were
Aaociation, to which he had referred, and he believed the asking for new Charters, was the time to move for an
Council would now be willing in some way to meet them, inquiry into their constitution. The only ground on which
The steps they had taken had, he thought, been to some they would go to the Privy Council would be to ask to be
extent more favourably received than hitherto; and if allowed to constitute a new University, and the only
®*eeesary they were determined to take the course to be ttatus they, had was to go and say, “ Yes, they were in favour
pursued by this Association, and petition the Privy CounciL of that, but the Colleges must remodel their constitution.” If
They bad received a similar reply from the Privy Council, they were allowed to establish their new constitution on the
bating that nomew Charter would be granted to the College present basis, they would be givingthem somuch added power,
until they bad bad an opportunity of being heard. This Dr. Mickle suggested that the two questions should he
Association went further, and said that the licentiates of the I fought out on separate lines.

College of Physicians should also have a representative j Mr. Hart said the answer to that was that once the
Toice in the governing body. That, he thought, was only Colleges wore allowed to obtain their new powers, they
lair and just. (the Association) had no further locus xtandi in the matter.

Mr. A. D. Roe seconded the resolution, which was carried Dr. Brierley said that he apprehended the very object of
nm.con. this resolution was to prevent any action being taken

Sir Walter B. Foster said as regards the principle of without its beiBg carefully watched by a Royal Commission
the resolution it had had his support from the beginning, which would consider the whole question.

He believed he was the first member of the profession who Dr. Steele said everyone seemed to be very imperfectly
publicly announced that that principle was tne only one on informed as to what the Colleges were asking for. He
which Hie College of Surgeons could hope to flourish. He understood that the Colleges of Surgeons and Physicians
published a pamphlet, entitled “The Political Powerless- jointly asked for one thing. The College of Surgeons were
®W8 of the Medical Profession," and in that he pointed asking for a new Charter which should give larger powers,
out that the Council of the College would never speak and this his Association was opposing. The Colleges unitedly
with the fuU force of authority with which it ought asked for power to give an M.D. degree. That they as an
to speak until it rested on the full 16,000 members of Association would support. The present Association had in-
*hieh it consists. He believed that was the only principle timated its intention of supporting the Members, who were
on which the two Colleges ought to be constituted. Every- opposed to the College of Surgeons acquiring further powers
oe who held a diploma from the Colleges had a right to which would exclude them from a voice in its affairs,
some voice in the body with which he was connected. It Mr. Major Greenwood said they opposed any Charter
was, he contended, wrong for one portion of that body to for whatever purpose it might be asked which excluded
exclude another. He (Sir W. Foster) believed that Members Members of the College of Surgeons and Members or
md Licentiates were equally interested in the College to Licentiates of the College of Physicians from their Councils,
which they belonged as Fellows, and he wanted them all Dr. Mickle withdrew his suggestion, and the resolution
to be interested. He was heartily with them. was carried unanimously.

Dr. Brierley (Manchester) said he had been asked to pro- Dr. Pocock moved, and Dr. Par amobe seconded, the next
pose what was, perhaps, the most important resolution on resolution, which was “ That copies of the forepoiDg
the paper. He aid so with very great satisfaction. It was: resolutions be forwarded to the Privy Council, with a
“That this Association asks for a Royal Commission of request for an audience on the above matters, and that dun
inquiry into the constitution of the said Colleges as a pre- steps be taken to bring them under the notice of medical
liminary to the granting of any Charter for the extension of corporations, the profession, and the public." This havirig
the powers and privileges of these two corporations sspa- been passed without opposition, the meeting closed by Dr.
ratdy or in conjunction, unless such Charter be framed so as Mickle proposing a vote of thanks to the chairman.

* digitized by GoOgle

226 Thr Lancet,]

MANAGEMENT OP THE SICK ROOM.

[Jan. 29,1887.

THE LANCET.

LONDON: SATURDAY , JANUARY 29, 1SS7.

It is so generally the custom of medical men to leave the
management of the sick room to the friends of a patient or
to nurses, that it seems to be almost forgotten that this is f
in a remarkable degree, a professional duty. “ Treat¬
ment” does not consist wholly, or indeed ohiefly, in the
administration of drugs. The surroundings of the sick are
not less important os agents of cure than the medicines
given to them. Indeed, we will go so far as to say that in
the best and most physiological methods of therapy drugs
are only admissible as aids to the arrest of disease and the
recovery of health, which Nature will accomplish if only
the case be so conditioned as to remove obstacles out of her
way, and facilitate the processes whereby she is working.
The scientific therapeutist regards the placing of his patient
in circumstances favourable to convalescence as the first
and most urgent step he has to take, and it is therefore
impossible for him to look upon the management of the sick
room as of trivial or even subordinate importance. We have
no thought of attempting to determine the particular
conditions required for the recovery of the sick. Obviously
these can only be indicated by the needs of each patient. We
believe one and all systems of management must be open to
the fatal objection that they do not deal directly with the
lesser needs of the individual; and these lesser needs are in
practice the most important. The point on which we are
especially anxious to insist is that the practitioner
ought to make the management of the sick room his
most solioitous care. To relegate this part of his duty as a
minister of health to a nurse, however skilled, or friends,
however intelligent and solicitous for the welfare of the
patient, is to surrender to others a power which may be
ither wasted or applied bbstructively, with tho best of
Intentions; and simply because, being dissociated from the
exhibition of drugs, the management of the sick is no longer
felt to be what it really is—namely, an integral and
elementary part of treatment.

To manage the siok room wisely and efficiently, the prac-
itioner must be so thoroughly versed in all the details of
uning as to be able himself to do, if necessity arises, all
that he expects of others. The best illustration of what
we precisely mean may be formed from the position of a
captain commanding his ship in a storm. He not only
possesses a general notion of what ought to be done, but be
is practically acquainted with every rope and spar and sail
in the vessel, and he oould, if it were physically possible,
perform the whole duty himself. He can supervise, because
he has himself passed through every grade of seamanship,
possesses the knowledge of how things are to be done, as
well as what to do in the circumstances. Now we greatly
fear that anything approaching to this practical familiarity
with the details of the duty devolving upon a medical
practitioner as a minister of health is rare, and daily be¬
coming increasingly difficult to find amongtbe most advanced

and theoretically competent workers in our profession.
Division of labour is no doubt a necessity of progress, but
we cannot regard without uneasiness the erection of nursing
into a specialty, separate from, and in large measure inde¬
pendent of, treatment. The profession is not, we think,
aware of the magnitude of the sacrifice it is making in
allowing this provinoe of the art of healing to pass out of
its grasp. The development of nursing as a craft has grown
out of the neglect with whioh that function has been too
long treated by those who ought to be its principal pro¬
moters and directors. The condition of matters exposed by
Chables Dickens in connexion with his personification of
the old-fashioned nurse as “ Sairey Gamp” did permanent
service; and the nurses of to-day are confessedly as superior
to their predecessors of forty years ago as the medical men
of the present time are better provided with instruments of
precision, and more skilled in the knowledge of both health
and disease than were those of the last or a previous gene¬
ration. Nevertheless, we cannot but feel that against this
gain to the interests of good management in the sick room
must be reckoned the very grave fact that the most erudite
and expert of our cloth to-day are incomparably, and almost
of necessity, less able to direct and control the conditions of
the sick than the practitioners of a time when the
average attainments of the scientific physician or surgeon
were immeasurably less considerable than those of the
least advanced and accomplished of our contemporary
doctors. There is no marvel in this fact, because
nowadays the details, and much more than the details, of
the art of nursing are left to a class of persons who,
whatever their devotion and intelligence may be, are cer¬
tainly not qualified to take the 'position of medical prac¬
titioners. It is not with any disrespect to the class of
skilled nurses that we protest against the growing evil of
surrendering a large and most potent part of the art of
healing to those who are not in a position to master it. No
lasting success can possibly attend the separation of nursing
from medicine. The doctor who does not himself direct the
nursing of his patient in all its details cannot be held to have
control of even half of the appliances of cure, and, for any¬
thing he can tell, the manner in which his patient is treated
during the intervals between his visits may be such as,
though admirable in themselves, must prove antagonistic to
his own method and policy. We are not now thinking of
the disastrous effects of bad or even careless nursing, but of
the very best that can be procured. Nursing ought to play
a leading role in treatment, and therefore it should be one of
the first considerations of the practitioner. His should be the
guiding hand in everything that conoerns the sick, and to
this end his authority and influenoe should be paramount
A great point is gained when it can be said of a practitioner
that when he appears on the scene he takes not only general
but specific control of the whole management of the case,
and personally directs every detail. In no other way can
perfect unity of aim and policy be secured. It may be argued
that the busy practitioner has no time to spare for thus
entering into matters; or that he descends from a high
professional position when, for example, instead of content¬
ing himself with simply ordering a poultice, he takes pains
to ensure that it shall be properly made. How strangely
erroneous such notions as these really are will appear when
Digitized by UOoQle

The Lancet,]

THE NEW MEDICAL COUNCIL.

[Jan. 29,1887. 227

we reflect that the most sacceesful practitioners have been,
ind still are, those who possess, and do not scruple to apply,
the most minute acquaintance with the art of nursing—a
knowledge for the most part either aoquired by painful
experience in their own families or obtained by years of
observation and practice in the wards of hospitals where
homely rather than ornate systems of nursing were in opera¬
tion. It must be frankly confessed that we do not see how
the itodents of to-day are to learn the art of nursing in suoh
i way as to reader them really able and useful practitioners
in private families, seeing that the management of the sick
ud of the sick chamber is an art and mystery studied and
practised by a separate class of non-medical persons, who
cannot share the practitioner’s responsibility.

--

Is view of an early meeting of the General Medical
Council, it is worth while to consider the composition of
that body as affected by recent legislation. The Medical
Council of 1887 will be in its representative character and
in its personnel different from any Medical Council that has
(rer sat. For one thing, and a very important thing, it will
be larger. It will consist of no less than thirty-two persons,
instead of twenty-four. The President, Sir Henry Acland,
will continue to be a member of the Council and its Pre¬
sident in virtue of the provision in Section 9 of the Medical
Act of 1886, that “ nothing in this section shall affect the
dotation of the term of office of the person who at the time
of passing of this Act is President of the General Medical
Council.” At the expiration of Sir Henry’s term of office
in 1889, the Council will be required by the Act to choose its
President from one of its own members, instead of being
•flowed as heretofore to go outside. Similarly the number
of Crown representatives is unaffected—that is, continues at
four for England till the first expiration of the term of office
of one of them, when the number will be reduced to three
for England. It is satisfactory that Sir Henry Acland
*ill initiate the change from the old Council to the new.
He has been a member of the Council ever since its formation.
Only he and Dr. Aquilla Smith have this distinction.
Whether Sir Henry Acland has ardently longed for the
changes which have taken place in the Council or not is a
utter of doubt, but be is quick to see the good in actual and
woomplished facts, and generous enough to regard without
fur a direct representation of the registered practitioners,
ud even an enlarged representation of the individual bodies.

The new Council will contain several persona who have
never eat in it before—viz., Dr. Bruce of Dingwall, Mr.
H. B. Carter of London, Sir Walter Foster of Birming-
hun. Dr. Glover of London, Dr. Kidd of Dublin, Dr.
William Moore of Dublin, Dr. Leishman of Glasgow, and
Mr.WHBKLHocsE of Leeds. Sir William Turner will enter
the Council, not indeed for the first time, but for the first
time in his new capacity as representative of the University
of Edinburgh alone. He has repeatedly sat, and that with
much effect, as the representative of the two Universities of
Edinburgh and Aberdeen. The latter University will be
henceforth represented by Dr.STRUTHEits.and Sir W. Turner
Till have his hands free to vindicate the ways and interests
°f the great University of Scotland. Few bodies have
gained rent than the Scottish Universities by the recent
Act, Hire*admitted on all hands that the Act of 1838 was

indefensible when it gave only half a representative to such
a body as the University of Edinburgh, while giving a whole
one to the Apothecaries’ Society of Dublin mid to the Faculty
of Glasgow. Now the Scottish Universities will be repre¬
sented by four members in the Council; the representatives of
Scottish Corporations will bo three in number; the Crown in
Scotland will have one representative as heretofore ; and there
will be the new direct representative—from all accounts a
good typical specimen of a medical Scot, contending credit¬
ably with disease and climate in the extreme north, and yet
so interested in problems of medical education and registra¬
tion as to be willing to take a journey of four or five
hundred miles for their promotion. Fully a third of the
new Council, about to sit, enter it for the first time,
or in a new capacity. Of the thirty of which the
Council will ultimately consist, nine will represent
Sootland, as againet seven representatives for Ireland and
fourteen for England. It will be curious to see how the
different elements of the new Council will comport them¬
selves—how they will oombine and how contend; whether
Corporations will combine against Universities, or “nation
rise against nation,” or the Direct Itepresentatives preserve
their happy independence of “ Bodies.” They will constitute
only one-sixth of the whole Council—too small a proportion
to greatly affect the issues, though large enough, let us
hope, to be of some use. Numerically the Universities will
be the most represented interest in the new Medical Council,
having eleven representatives, against nine of the Corpora¬
tions, five of the Crown, and five of the registered prac¬
titioners. The extension of the principle of individual repre¬
sentation of bodies in the Council is a very serious feature and
fault of the late Act. But our simple object at present is to
indicate the elements in the composition of the Counoil.

■ - —

The two past numbers of the Journal of Anatomy and
Physiology contain an article on “ Intra-peritoneal Blood
Transfusion and the fate of Absorbed Blood,” by Dr. William
Hunter of Edinburgh, which has an important bearing at
the present time, and demands the most serious considera¬
tion from those who advocate intra-peritoneal operations
for the removal of effused blood. The observations form
part of an Edinburgh graduation thesis, and, although not
yet published in their entirety, are of much importance,
and will necessitate a reconsideration of some of the
principles which are often urged for immediate operative
treatment in cases of intra-peritoneal haemorrhage. The
experiments and observations are Tory striking, obviously
moat trustworthy, and deal most fully with the absorp¬
tion of blood introduced experimentally into the peri¬
toneal sac. They were undertaken with the view of
observing what effect extravasation per st had on the
life-duration of the absorbed ooipuscles, and of deter¬
mining the seats and methods of blood destruction within
the body; but incidentally they happen to be of especial
interest in regard to the absorption of the blood from the
peritoneal cavity and the dangers of its presence therein.
From 30 to 90 per cent, of the quantity of blood calculated
to be present in the body was transfused within the peri¬
toneum of rabbits, and occasionally of dogs. In certain
cases deiibrinated blood was used; in other cases entire

blood was transfused directly from the carotid of the one

Diqitized by vjjVJOV LL.
a i c>

228 The Lancet,]

MEDICAL PEERAGES,

[Jan. 29,1887.

animal into the peritoneal cavity of the other, and this
latter class of investigation forms the special set of experi¬
ments to which we would partictilarly draw attention.

In the cases in which dofibrinated blood was employed no
special immediate effects were noticed, and the question of
the fate of the corpuscles under such circumstances, though
very interesting and valuable from a physiological stand¬
point, are comparatively beside the more important issue—
viz., what happens locally and generally to the animal
experimented on when such a large quantity of normal
blood is introduced into this great serous sac. In only two
instances out of twenty-five experiments did death follow,
and this result was directly traceable to a septic condition
of the syringe used for injection. In other words, blood
within the peritoneum, unaccompanied with sepsis, led
to no danger whatever. In some instances the transfusion
was repeated several times in the same animal—notably in
one in which blood to the amount of 200 per cent, was
introduced four times in the course of three months, and in

medical peerages in this country. Why should England alone
of all nationalities refuse to admit members of the profession
of medicine to the higher social ranks? It is the more
inexplicable that this refusal should be maintained because
there would seem to be no scruple as to the elevation of
successful tradesmen of all classes. Sorely the professors
of an art which, being really an applied science, directly
concerns the physical and mental capacities of the people
for prosperity and happiness, are not less worthy of
admission to the most - exclusive order than men who have
amassed wealth by the manufacture and sale of beer, or by
trading in any one or more of the necessaries wherewith the
body is nourished or clothed or warmed, or its comfort
promoted ! Taking the lowest view of the question, and
conceding that, possibly, medicine and surgery are among the
most degraded of arts, it can scarcely be contended that those
who study and practise them are of viler clay than the suc-
i cessful purveyors of coal, iron, wood, beer, and other vulgar
| commodities, who have achieved “ greatness.” It is difficult

another in which transfusion was performed three times
within two months. The most striking feature in the
experiments was the slight amount of harm due to the trans¬
fusion. In cases in which defibrinated blood was used the
animals were almost entirely unaffected; and even when
blood not deprived of fibrin was employed, the opera¬
tion was accompanied by only slight loss of appetite and
fall of body weight for the first three or four days,
doubtless due, as the author suggests, to some localised
peritonitis. The rapidity with which coagulation takes
place—for in the interim the blood practically behaves
as a fluid,—and its distribution previously to coagulation,
are the two main factors which determine the amount
of absorption. The conditions on which rapid or slow
coagulation depends cannot be defined beforehand in an
individual case, but the distribution of the extravaeated
blood gives rise to this most important consideration: “ If the
blood remains en masse at or near the seat of extravasation,
coagulation, when it occurs, will be likely to involve the
greater part of it, with the result that a clot of some size will
be formed which will serve to entangle the great majority of
the extravaeated corpuscles. Under such circumstances the
amount of absorption which takes place may be extremely
slight.” If, on the other hand, the blood, on being effused,
escapes amidst the neighbouring organs before coagulation
takes place, not only will coagulation be longer delayed,
but even when it does occur the clots which form will be
much smaller in size, although perhaps more numerous, and
larger numbers of the corpuscles remain free to be absorbed.”
The post-mortem examinations and experiments fully bear
out the writer’s conclusions: under the former conditions a
large caseous mass, thirty grammes in weight, was found in
the abdomen; under the latter only a small caseous nodule
hot larger than a marble remained.

It is very manifest that, however much effusions of blood

to suppose that any sensible man of culture who knows
the hollowness of conventional dignities as the practitioner
of medicine knows it can hanker greatly after a peerage;
but this does not in the least degree affect the fact that those
who persistently refuse peerages to medical men are neither
very politic nor very consistent. We are glad that Professor
Billroth has achieved the distinction he so well deserves,
and we commend the subject of peerages for medical men to
the renewed consideration of those who advise the
Sovereign in this year of jubilee 1887. It would be a timely
moment for the ending of a senseless policy and the wiping
away of a needless reproach—namely, that members of the
profession of medicine are the only persons systematically
excluded from the peerage of the United Kingdom.

“N« quid nimla."

A NEW CHOLERA FUNGUS.

A report of t lie Commission upon Cholera which w as
despatched to Spain last year by the conjoined action of
the Royal Society, the University of Cambridge, and the
Association for the Promotion of Scientific Research, has
appeared in the proceedings of the first-named body.
The commission consisted of Drs. Roy, Graham Brown, and
Sherrington, and the report, although “ preliminary,” con¬
tains matter of much importance and interest. Twenty-
five typical cases of cholera were examined, either imme¬
diately or at a short interval after death, with the result
that Koch’s comma bacillus wus not discovered in the
intestinal canal in all the caees^ In 6ome this microbe
was present in great abundance; in others it was far
less conspicuous; whilst in many undoubted cases, where
death occurred before the reaction stage set in, it could
not be detected at all. These observations were confirmed by
the results of plate cultivations in gelatine and agar-agar.

under pathological conditions may differ in their behaviour
from those Which take place into the healthy abdomen, these
experiments and observations suggest an expectant treat¬
ment, rather than immediate orhurried operative procedures*

-o--

The elevation of Professor Billroth, the eminent surgeon,
to the peerage of Austria revives the vexed question of

Moreover, it was found that when present the comma
bacilli were collected either on the surface of the mucosa or
so close to it as to suggest a penetration of the epithelium
after death, but in the majority the organism could not be
found in the mucous membrane or in any of the tissues or
organs. These results, which are directly opposed to Koch’s,
are considered to be conclusive against the bacillus having
a pathogenic relation to the disease; but it is suggested to
Digitized by Lv_

Thi Lancet,]

THE ISOLATION OP FEVER NEAR BRADFORD.

[Jan. 29,1887. 229

be the cause of the premonitory diarrhoea, which is held not
to be a mild attack of Asiatic cholera, but only a predispos¬
ing condition. Having thus satisfied themselves that the
comma bacillus is not the cause of cholera, these investigators
similarly dismiss the claims of Emmerich’s straight bacillus
to that distinct ion, and also state that they were unable to re¬
cognise Klein’s straight bacillus in any of their preparations.
An interesting fact is their examination of specimens of
Fenin’8 inoculation fluids and cultivations. These were
found to contain several forms of bacilli and micrococi, but
no comma bacilli and none of the peronospora bodies
which Ferran describes as developed from the commas. The
inference ifi that not only can the inoculations practised by j
Ferran have no protective power, but they are dangerous |
from the risk of inducing septicaemia. The pathological j
characters of the choleraic intestine as described by Strauss I
and others are confirmed, and some valuable remarks !
are made upon the nature of the intestinal flux. This
hyper-secretion has none of the characters of catarrh,
nor does the bowel present any lesions suggestive of !
its being due to the presence of an irritant. On the
other hand, Moreau’s observation is confirmed, which '
demonstrates the close similarity of this excessive secre- j
tion to that induced by section of the intestinal nerves. It
is suggested, therefore, that the choleraic flux may be
owing to some causes acting on the glands or mesenteric
nerves or ganglia. The search for & pathogenic parasite
w»s continued by the commission after their return from
Spain, and many months were occupied in the task. At
length the discovery was made of a fungus, present in the
intestinal mucosa of every case, at varying depths from
the surface, and also in the kidney and liver. This fungus,
consisting of granular masses and a delicate mycelium,
which could not be stained without difficulty, was pro¬
nounced by Messrs. Vine and Gardiner to belong to the
Chytridiacese, a class which includes many rapidly-growing
ud virulent parasites of vegetables. The difficulties of its
detection may have led to its being overlooked by former
observers; whilst the objection of possible after-contami¬
nation is met and refuted. At the same time, it is stated
that further investigation is needed, especially in the
cultivation of the fungus, before the discovery can be held
to be conclusive. .

THE ISOLATION OF FEVER NEAR BRADFORD.

Thk Local Board of Health for North Bierley have very
wisely come to the conclusion that it is their duty to provide
their district with a hospital for the isolation of cases of
infectious fever; the need for such a hospital being the
®ore pressing because the Bradford Fever Hospital, hitherto
»public institution open to the districts around Bradford,
ia to be for the future handed over to the Bradford Corpora¬
tion, and to be retained for the purposes of the borough
only. Both decisions are wise ones. The Bradford Fever
Hospital is certainly not, in point of accommodation, in
ocens of the requirements of the borough, and North
Bierley stands in need of a place near at hand to which first
attacks can be promptly despatched for isolation as well as
for treatment. From the discussion which took place, it is
evident that the subject had been carefully thought out in
advance. Mr. Whitteron, the medical officer of health, very
Properly explained that the needed building could not be
r *gMfled as sufficing to deal with an epidemic; its object
wm to provide such a number of beds as would prevent an
epidemic. At the same time it is important, in the case
of a new hospital, that the authority should take sufficient
'and to enable them to pnt up temporary additions if
Me ded. Then came the question of single action, or joint
•ctfanrlA other authorities near by. This must almost
wasjtrflyt* • matter to be decided by local feeling. If
that one hospital will serve for several

localities, it is obviously cheaper to combine, instead of
going to the cost of providing several sites, several admi¬
nistrative buildings, and several groups of pavilions; the
cost of maintenance is also borne by a larger number of con¬
tributors. But the only satisfactory method of uniting is by
means of a Joint Board formed under a Provisional Order, and
this means delay and an additional local organisation. Under
these circumstances North Bierley has decided to act alone.
With regard to the cost, it is hoped that it may be publicly
subscribed, and that the building may thus come to form a
memorial of Her Majesty’s Jubilee. A more appropriate
method of commemorating /a reign, which has been more
marked than any that has ever preceded it by the success of
efforts to control the spread and mortality from infectious
diseases, could not well be conceived. But there is just one
aspect of this method of raising the needed funds, as opposed
to the system of building the hospital out of a loan raised
on the security of the rates, that is worth notice. If the
former practice were adopted, the Bierley Local Board
were informed they would be free from interference on the
part of the Local Government Board. Now we have no
reason for suggesting that the authority should in any way
that they do not desire place themselves under the instruc¬
tions of the central body; but at the same time we know of
similar hospitals that have been constructed without the
guidance of official advisers, that have come far short of that
which it had been hoped to attain; and we would hence
remind the Local Board of North Bierley that, even in cases
over which they neither have nor seek to have any control,
the Local Government Board have been most willing to
make suggestions, on plans submitted to them, and that these
suggestions, coming from those who are constantly engaged
in dealing with the question of infectious hospital construc¬
tion, have been found most valuable. North Bierley had in
1881 a population of about 21,000, and a considerable pro¬
portion of these live in houses which cannot retain the
infectious sick without risk of spread. Whether, therefore,
all the necessary accommodation is provided at once or not,
the authority should not, in the long run, contemplate less
than some twenty beds. Perhaps the best plan would be to
begin with one of the composite pavilions recently designed
by the Local Government Board, and so contrived that under
the same roof two diseases in both sexes can bo received
without practical risk of spread. Such a pavilion will
always be needed, and under ordinary circumstances it will
be the one which will be mostly in use.

MUSCULAR ATROPHY CAUSED BY u HYDRO¬
MYELITIS.”

Da. C. Wallis of Stockholm reports an interesting case
occurring under his care in the Sabbatsbarg Hospital, where
a peculiar affection of the spinal cord, which he calls bydro-
myelitis, had produced progressive atrophy of the muscles.
The patient, a peasant aged thirty-eight, was admitted for
empyema on the right side, of which he died in a week’s
time. He had noticed for some eighteen years a gradual
impairment of the power of bis right hand, and for seven or
eight years of that of the left. The right hand was flexed
{in Kr aliens tellung), with atrophy of the interosseous, flexor
brevis, and opponens pollicis. A similar condition existed
in the left hand, but to a less marked degree. The muscles
of the right arm and shoulder were also slightly atrophied.
At the necropsy, besides the empyema, atrophy of the
muscles of the hands and forearms was found, and the same
condition was also present in a marked degree in the deltoid
and serratus maguus on the right side. Microscopical
examination showed that in most of the localities where
atrophy existed the muscular fibres had lost their transverse
striated appearance, and that they were undergoing fatty
degeneration. A centimetre below the medulla oblongata

230’$ The Lancet,]

SUICIDE WITH A DARNING-NEEDLE.

[Jan. 29,1887.

the central canal of the spinal cord began to be dilated,
attaining opposite the roots of the second and third cervical
nerves a diameter of half a centimetre. The anterior cornua
were greatly atrophied; the posterior cornua were of an
abnormal shape, and displaced by the increased size of the
canal, but were not atrophied. The distended condition of
the canal continued without alteration along the whole of
the cervical portion; below this it began to diminish, and
at the same time the atrophy of the anterior cornua became
less marked, but it was only in the lumbar portion that the
cord presented its normal characters. The canal contained
a transparent and very fluid liquid, and its wall consisted of
a Arm white membrane a millimetre in thickness.

CONSULTATIONS BY TELEGRAPH.

The phrase “medical advice” is one which has assumed
at different, times very different meanings in accordance
with the varying custom of practitioners. It usually does,
as it should, imply that the recipient has been seen and
examined by a medical man, so as to leave no reasonable
doubt as to his illness, constitutional state, and appropriate
mode of treatment. In order to arrive at this degree of
security—the least that is required for any serious effort to
overcome disease—it is commonly necessary' and always
advisable that a practitioner should he at the time in
attendance on his patient. It does not necessarily' follow
that every prescription which is granted without regard to
this rule is mischievous or ineffective. The arrow shot at a
venture may hit the mark. The risk implied in such hap¬
hazard practice, however, may be very great. It is of two
kinds. There is, lirstly, the danger that remedies may do no
good and no direct harm, yet cover and disguise the progress of
disease; and, secondly, that actual injury may be caused to
persons who are thus treated without respect to signs of
illness other than reported symptoms. We do not deny that
past experience of some patients will enable a medical man
to sanction the continuance of a course of treatment, or even
a change of minor importance, without a fresh attendance.
Cases of this kind, however, are in reality such that the
invalid understands his own management without the
guidance of more skilled opinion. If any such plea can be
urged in defence of the prolonged series of consultations for
which the Atlantic cable is said to have been utilised, it has
probably been strained to the utmost. Practice conducted
on these principles is no better than a Dame. If it concern
itself with graver matters it becomes unjustillable, while its
systematic exerciso even in trifles is at best the harmless
shadow of a dangerous custom, and does not accord with
the true ideal of professional duty.

TYPHUS IN THE STOURBRIDGE UNION AND
NEIGHBOURHOOD.

It seems pretty clear from the local newspaper reports
that typhus is prevalent in the Stourbridge Union, and that
it has made its way into the workhouse. Of all places in
which typhus constitutes a real danger, a workhouse is
perhaps the worst; for it is the centre towards which destitu¬
tion tends to congregate, and, as is well known, destitution,
overcrowding, and that special form of filth which is
attendant on those conditions, are precisely the circum-
1 stances which are favourable to the spread of typhus. It is
true that a workhouse which i3 well ventilated, free from
overcrowding, and provided with real means of isolation,
may uid materially in checking ty phus. But it is evident,
from the interview which Dr. Mouat of the Local Govern¬
ment Board has had with the Stourbridge guardians, that
these favourable conditions do not obtain in their work-
house ; and Dr. Mouat found it necessary to warn them in
grave terms as to what they might have in prospect. Already

one nurse has sickened and died, and, as Dr. Mouat says, no
true isolation is provided. And whilst this report reaches
us, we find that Mr. Spear, another medical inspector of the
Local Government Board, has interviewed the Quarry Bank
Local Board, whose district lies in the same neighbourhood,
and one mile from Dudley. From twenty-five to thirty cases
of fever were found there, of which five have already termi¬
nated fatally. According to Mr. Spear, this disease was
connected with filth, overcrowded houses, and destitution.
This, too, looks suspiciously like typhus; and at this period
of want of labour, and its attendant destitution and tendency
to overcrowding, the significance of such events is all-
important. The Local Government Board show that they
hold this opinion by the despatch of two skilled medieal
officers into what is practically the same district.

ST. JOHN AMBULANCE ASSOCIATION.

When the Colonial and Indian Exhibition was opened in
May last, an ambulance station was, by permission, established
in “Old London,” under the direction of Mr. John Furley,
with Mr. II. Percy Potter as honorary surgeon, for the use
of the staff and employes, and of the visitors to the
Exhibition, and was continued till the dismantling was
completed at the end of November. During that time aid
was afforded to 701 persons, of whom 41 were removed to
their homes or to hospital on litters. Of the total number,
.‘>99 were coses of injuries and 302 of diseases, chiefly fainting,
diarrhoea, epilepsy, and hysteria, and included two cases of
drunkenness. An ambulance station was also established
at Liverpool, in the grounds of the Exhibition there, of which
Mr. F. T. Paul was the honorary surgeon, and Mr. Furley
the honorary director. Between March 26th and Nov. 18th
248 persons received “first aid,” and 11 were removed by
horse ambulance or hand litter; 211 were cases of accident,
wounds, &c., and 37 of disease, 18 of the latter being returned
as fainting. In London one case and in Liverpool two cases
of apoplexy are stated to have died subsequently to removal.
These reports afford good evidence of the valuable work
done by the Association under the superintendence of its
able honorary Director of Stores.

SUICIDE WITH A DARNING-NEEDLE.

On the 16th inst. Dr. Danford Thomas held an inquest at
Clerkenwell on the body of Charles Nutter, aged seventy-
seven, who was found dead in bed with a common darning-
needle flxed in the epigastrium. Through the eye of the
needle a cross-bar of tin had been threaded, and this had
been flxed firmly in position by binding with worsted. The
object of the deceased man (the jury returned a verdict of
“ Suicide whilst of unsound mind”) was, no doubt, to make
an instrument wherewith he could effectually encompass his
end. Over the epigastrium and lower part of the chest
were nine punctures: the one already mentioned as contain¬
ing the needle, which had caused a superficial laceration of
the liver; another had passed through the fourth right
intercostal space and had penetrated the right ventricle and
entered one of the posterior set of musculi p&pillares.
Through the small puncture blood to the amount of nearly a
pint had escaped into the pericardium, where it was found
in part liquid and in part firmly coagulated. The remain¬
ing punctures had only extended into the abdomino¬
thoracic walls. There are several points of interest
suggested for examination. In the first place, as
regards the suicidal or homicidal origin of the wounds.
The fact of a needle being used to inflict a mortal
injury on an exposed part and being left in situ was
of itself practically sufficient to negative the theory of
murder; but there was further circumstantial evidence
tending to show that deceased committed suicide. The heart

Thx Lancbt.]

THE SPECTATOR ” AND THE ERASMUS WILSON BEQUEST.

[Jan. 29,1887. 231

wm greatly hypertrophied and dilated. This is important
as furnishing presumptive evidence that the epigastric
pulsation led the deceased to make the punctures where they
were found, instead of, as is usual, more immediately over
the cardiac region. The case shows that penetration of the
cardiac cavities by means of a small instrument is not
necessarily suddenly fatal, for it is clear tliat deceased must
have lived for a considerable time—probably for an hour or
more—after the fatal puncture was made, considering the
rise of the opening into the ventricle and the large quantity
of blood found in the pericardium. No injury of the
coronary vein or of either coronary artery could be detected.

THE MOXON MEMORIAL.

At the meeting of the friends of the late Dr. Moxon,
to be held on Tuesday next, Feb. 1st, at 5 p.m., at the
Royal College of Physicians, it will have to be deter¬
mined what form the proposed memorial should take.
The first resolution will be moved by Sir James Paget,
and seconded by Sir Andrew Clark, ft would seem right
that Dr. Moxon’s name should be associated with Huy’s Hos¬
pital, where he was physician and lecturer on medicine;
but as many outside the Huy’s clientele have expressed a
desire to assist in raising a monument to his exceptional
talents, it is probable that the fund raised will be divided
between Huy’s Hospital and the Royal College of Physicians.
It has been suggested that, after placing a tablet to his
memory in Huy’s Hospital, the remainder of the funds
collected should be used to found a clinical medal, to be
swarded, like the Baly Medal in Physiology, every alternate
year, to the physician or surgeon most distinguished for
clinical research. __

‘‘THE SPECTATOR” AND THE ERASMU8 WILSON
BEQUEST.

Thk Spectator ridicules the idea of an Institution for
Physiological and Pathological Research being needed, and
founded in London, especially in the present year, lest it may
one day be said that in the jubilee of the Queen’s accession
"one of those monstrous bastilles for the incarceration of
creatures destined to the question of physiological inquisi¬
tors was founded in the capital of the most tender-hearted
and truly humane of English sovereigns.” It would be futile
to enter into a discussion with onr contemporary on each a
subject, and we do not propose to do so. The foundation ef
a pathological institution will not in any sense “ neutralise
the Act of 1876”; it will not reconcile students “ to horrors
such as those which have hitherto been confined to con¬
tinental capitals”; and it will not tend to obliterate in the
minds of students "that scruple in subordinating the art of
inflicting pain to the art of relieving it which has hitherto
dignified the characters of our surgeons and physicians.”
There is little fear of such changes coming over the profession
as are foreshadowed by the Spectator. "Sentiment and
law* will continue, as heretofore, to actuate doctors in all
their professional work. Our contemporary evidently
misunderstands the uses of such an institution as the
one proposed. If vivisection be carried on, it will be in
strict accordance with the law, under the direct supervision
of the Council of the College of Surgeons, and would thus
be under more complete control than it is even at present.
We imagine, however, that vivisection will form but a very
subordinate part of the work to be done. There are physio¬
logical and pathological researches of the greatest value,
which can only he studied in the dead subject ; it is more
than probable that the study of the intimate causes of
disease'mad of the intimate effects of these causes may
largely svferiede other methods .of research. The artificial
cultivation of micro-organisms—"disease germs;*— their I

variation under varying conditions, in different cultivation-
media, their analogies, antagonisms, and possible combina¬
tions, are the subjects which now attract professional atten¬
tion, and it is chiefly for the study and elucidation of such
questions that London demands a suitably equipped physio¬
logical and pathological research institution.

UNUSUAL SITE OF AN HYDATID CYST.

A case of hydatid of the scrotum came under the care of
Mr. Philip E. Muekett in the Sydney Hospital during the
course of last summer, and as this is an example of a
very rare condition a brief note will be of interest. The
patient, aged twenty-live, had been in Australia since he
was three years old, and in a sheep distriot where the water
was very bad for four years before the swelling appeared;
this was first noticed eight years before he came under
treatment. During that time it had been tapped twice,
and on the Becond occasion also injected with iodine.
When admitted to the hospital “ there was an intra-scrotal
tumour, about the size of a large emu egg, on the right side.
It was smooth in outline and its general contour nearly
oval. The tumour was tense and dull on percussion, but
gave to the fingers on palpation the sensation of fluid
within. There was no impulse on coughing, and it was
irreducible. The position of the testicle at its posterior
part was made out by the presence of testicular sensation.
The cord could not be clearly defined at the upper portion of
the swelling. Light was transmitted by the ordinary
manner of procedure, and, finally, the history had been that
of an eight years’ growth: painless except from its mere
weight.” The cyst was tapped on the day following admis¬
sion, and about an ounce of “ serous-looking fluid ” of pale
yellowish tinge evacuated. Suppuration followed this
tapping, and thirteen days later about six ounces of
purulent fluid were drawn off. After this pus drained
away from the puncture for eleven days, then a hydatid
sac partly forced its way out and was partly extracted
through this opening. The sac was greyish in colour,
translucent, and elastic, and in its sunken condition would
about fill an egg-cup. The swelling gradually subsided,
the sinus closed, and the patient left cured.

EMIN PACHA.

On the 21st inst. Mr. H. M. Stanley left England on his
new expedition, the object of which is to effect the relief of
Emin Pacha and to secure the withdrawal of the women,
children, and non-combatants who are with him in a position
of great danger in his province of Equatorial Africa. The
fact that Emin Pacha is a member of the medical profession
may not be known to all our readers. Dr. Hermann
Schnitzler, better known as Emin Bey and subsequently as
Emin Pacha, is an Austrian doctor, who was educated at
Vienna, Paris, and Berlin, and is a man of great attainments,
both linguistic and scientific. He has the reputation of
being able to speak all the principal European languages,
together with various African ones; and he has also an
intimate acquaintance with geology, botany, meteorology,
anthropology, geography, &c., on which subjects he has
supplied valuable papers to many learned societies. Twelve
years ago Gordon Pacha, who was then Governor of the
Equatorial Provinces, appointed him Surgeon-General, and
he held that post for four years, when he succeeded
Gordon in the governorship. Since then he has been
engaged in bringing a barbarous region into a state of
civilisation, and, owing to the attacks of rebels from the
north, has been for three years completely cat off from the
outer world. During the first five years, at least, of his
governorship he devoted any little leisure which his varied

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232 Thu Lancet,]

LONDON POOR-LAW INFIRMARIES.

[Jan. 29,1887.

duties left him td the healing of the sick. At sunrise every
morning he was to be found in his hospital, and at night he
used to write reports for scientific papers by the light of
candles of his own manufacture. The preservation of such
a man, and the rescue from the terrible dangers by which
they are threatened of those he has for three years guarded
with such magnificent and such heroic devotion, will be a
feat which will add fresh glory to the already illustrious name
of Stanley, and it is earnest ly to be hoped that success, speedy
and complete, may attend him in his errand of mercy.

LONDON POOR-LAW INFIRMARIES.

The paper of Colonel Montefiore on Metropolitan Poor-law
Infirmaries, and the importance of throwing them open to
medical science, which was read at a meeting of the
Hospitals’ Association, Mr. Timothy Holmes in the chair,
recalls attention to a subject of much importance, alike
to the poor, the profession, and the public. The metro¬
politan infirmaries number fourteen, with 6803 certified
beds; besides which there are eleven irregularly built
institutions, with 6392 beds. In other words, they
contain roughly double the number of sick beds of the
great hospitals of London. The rate of expenditure was
lightly touched on by Colonel Montefiore. He showed that
different Boards pay very different prices for the same
things, ne pointed out that the medical officers had an
enormous amount of work to do, and that for very modest
salaries. In some cases two medical men had to attend
600 cases, besides having other duties to perform. He
advised that these infirmaries should be brought into
relation with the great hospitals, that the hospitals should
supply their best men to fill the posts of the infirmaries,
and that the medical superintendent of the infirmaries
should be instructed to hold consultations with members of
the consulting staff of the hospitals of the district in cases
of unusual interest. We believe the Poor-law infirmaries
are well officered, and their inmates now as a rule tolerably
well cared for. But it does seem reasonable, and indeed has
long seemed urgent, that provision for consultations should
be made. It requires little imagination to conclude that 600
or 600 cases of sickness must involve much misery, and
some difficult questions of duty and treatment, for winch
it is but reasonable to provide the opinion and help of more
than one man. Indeed, it is scarcely fair to one man to
make him responsible for all that 600 or GOO poor people
may need, and we trust that, both for his sake and theirs,
an arrangement for consultation will be conceded by the
Local Government Board._

TO CURE LONDON OF ITS FOGS.

Sib H. W. Tyler has hit on the idea of doubling, or if
need be, trebling, the duties on coal, with the proviso that
these duties should be levied only on bituminous or smoke-
producing coal, and that the smokeless sorts should be free
of duty. From this legislative “ protection ” of the cause of
colour and body in fogs he anticipates a very considerable
diminution of the nuisance and injury inflicted by them. We
heartily wish Sir H. W. Tyler success. It is an experiment
worth trying. Meanwhile, it must be remembered that
mists and fogs—properly so-called—we shall necessarily
continue to have with us, at least until the pre¬
diction of another savant is fulfilled, and, some twenty
millions of years hence, the sun gTows cold, and, as the
need for fuel increases, the mode as well as the means of pro¬
viding heat utterly fails. We are fully alive to the fact that
much would be gained by ridding the fogs of their car¬
bonaceous impurities, but they would be none the less chill
and raw, and nerve-depressing, for all that gain involves
and implies.

CAMBRIDGE GRADUATES AND LONDON DEGREES.

We are pleased to see that the medical graduates of Cam¬
bridge University were sufficiently liberal-minded to reject
by a substantial majority Sir (1. Paget’s resolutionThat
to establish a second university in London for the purpose
of granting medical degrees is either unnecessary or un¬
desirable.” Opposition from the existing universities
may doubtless be expected, but it is gratifying to find that
many of the members of the most important medical
university in England are firm supporters of the schema.
If Sir G. Paget were more in touch with the London medical
student, he would hear the most cogent reasons for the
establishment of a second university in the metropolis, and
he need not apprehend that it will lead to a competition
downwards. Everyone connected with medical teaching
agrees that the University of London insists on an absurdly
high standard of acquirements, and that another university
must be formed sooner or later in the metropolis.

THE GENERAL MEDICAL COUNCIL.

Dr. William Moorb, A.B. and M.D. Dub., was officially
appointed on Tuesday last by the Queen as Crown Nominee
for Ireland in the Medical Council. Dr. Moore is Physician
in Ordinary to the Queen in Ireland, is physician to several
hospitals in Dublin, and author of works on various medical
subjects. Professor Rawdon Macnamara has been again
chosen unanimously to represent the Royal College of
Surgeons of Ireland in the Council. Mr. Macnamara has been
in the Council for twelve years, and, while redoubtably
defending his “ Body” against all attacks, does so with
unfailing good temper and 44 honest courtesy,” of the good
Irish type. _

RED AND WHITE MUSCLES IN RODENTS.

M. Ranvier has again directed attention to the interest¬
ing difference of colour in the muscles of rodents. We refer
to it because we believe that a careful study of the histology
and experimental pathology of the corresponding nerves and
spinal centres will bring fresh knowledge into a region
where it is much wanted. There are great differences of
organisation between guinea-pigs and rats on the one hand,
and rabbits and hares on the other. In the hare all musclee
are red, doubtless in relation to its greater agility; in
guinea-pigs and rabbits some muscles are red and others
white. The nuclei of the sarcolemma of red muscles are
numerous and form longitudinal series. The semi-tendinosus
and soleus of the rabbit are red, whilst the great adductor
and gemelli are white. Although all the muscles of the
hare appear red, yet the great adductor and gemelli have
the same histology as the white muscles of the rabbit, whilst
the semi-tendinosus and soleus have the constitution of the
red. _

TORSION OF AN INCISOR TOOTH.

Mr. Smalk mentions in the British Journal of Dental
Science the case of a boy aged eight who had the right upper
central incisor twisted so that the mesial surface presented
towards the lip. The tooth was grasped firmly by a pair of
straight-bladed forceps and twisted into a good position,
care being taken to press the tooth firmly into the socket
during the operation. It was tied to the surrounding teeth
with silk twist in order that it might not return to its old
j position. A week afterwards it was quite firm, the tooth
; could be tapped, and he could distinguish between bot and
| cold applications. There was no discolouration, and the
i gum was quite healthy. Torsion may be used freely before
the patient arrives at the age of twelve years, and should
be always done at one operation, It is only applicable to
the incisors.

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TJIftfcAKaicI , REAL AND APPARBhT ©EATlf* • 1 [Jaw. 1687. 2$3

THE.^MWTORW 86ADWG OIRDLE”

1>\ as Carlyle maintained* the diffusion of printed
literature removed ia great measure the necessity for
universities the establishment of puhlia libraries must
hare still further reduced the need of those institutions.
As if to impress this fact. we. have had presented to us the j
syllabus of a newly-established “ Victoria Reading Circle,” i
the aim of which is to secure “ at home some .of the !
advantages of a college, so far as reading and study are i
concerned, without interference with other duties.” This :
new society affords to adults whose early education '-has' I
been defective and to young people who have recently left
school* a course of systematic reading id general literature.
The whole course, like that of ^university, extends over four
years, each of which is divided into two periods or sessions.
Certain readings are exacted as necessary, while others axe
optional. There; -areno examinations, bat a guarantee ia
required to show that the works prescribed hate been care¬
fully read. Annual certificates, and finally a diploma, are
granted te-thoee candidates who have fulfilled their course
and have satisfied the conditions laid down by the society.
The admission fee* the cost of books, and the amount of
reading tp be done daily are each of them very moderate
indeed, and the system as a whole, .though yet untried,
appears well calculated to foster a habit of self-culture, and
at least in some degree to work out the Carlylean theory.
The home of this , new enterprise in education is at 56; Old
Bailey, London. . •

REAL AND APPARENT DEATH.

It was only last year that we commented in our columns
upon the “ signs of death,” drawing attention to the more
important criteria by which a skilled observer may avoid
mistaking cases of so-called suspended animation from
actual decease. Quite recently two instances have been
recorded in which, if report be true, it would, seem there is
still room for maturing the judgment upon the question
herein raised. At Saumur a young man afflicted with a
contagious disease apparently died suddenly. His body was
enshrouded and coffined, hut as the undertaker’s men were
carrying “the remains” to their last resting-place they heard
what they believed to be a knocking against, the coffin-lid,
and the sound was repeated in the grave. Instead of testing
at once the evidence of their senses, they, in accordance with
judicial custom, sent for the Mayor, In whose presence the
lid wan removed from the coffin. Whereupon, to .the horror
of the spectators, it was observed that the dead man had
only just suocumbedto asphyxia. The abofe narrative
seems on the face of it too ghastly bo be true, especially as
che occupant of the coffin must have been shat up in a space
containing oxygen in quantity totally inadequate to Sustain
an approximation to ordinary breathing. Sot in cat&leptio
and similar states the organic functions are reduced to
the lowest ebb, and history records several instances
in which, for a time at least, the determination of the living
state was a matter of. uncertainty. In our issue of the
15th inst., p. 129, the reader will find an account of “Post¬
mortem Irritability of Muscle,” in which the phenomenon
was manifested in a marked degree, two. hpurs after death,
from & chronic wasting disorder —a condition which
favours early extinction of vital action in muscle. It may
be signed, then, with some show of reasonableness, that it
is quite possible for the heart to stand still, as it were, and
yet retain the power of action, although experience tells
us but little on the question as regards the human subject.
Experiments on the lower animals, however, show that
ow-dastenaioa of the tight cavities of the. heart causes
cessation Of cardiac contraction, and that-relief from the
diqljiilnrimay be followed by resumption- of the function
nf jiwilmdBTiilitijT If most not- be- forgotten that-an

analogous condition ia-witnessed at times in patients suffer¬
ing from capillary bronchitis or other physical states under¬
lying acute distension of the right heart; for, in these cases,
venesection:is not uncommonly instrumental in arresting
the rapidly failing cardiac contractions. The second case
of apparent death alluded to above happened in “ the land
of big things.” Aa inhabitant of Mount Joy, Paramatta,
waa believed to be dead, and. hi* supposed remains were
about to .be committed to the earth, when a mourning
relative startled the bystanders by exclaiming, “I must
see my father once more; something tells me he is not
dead.” The coffin ivaa taken from the grave to the sexton’s
tool-house, and, there opened, and was found, to contain a
living inmate, who justified the presentiment of hisson by
V slowly recovering.” As no mention is made in either case
Of the . period that elapsed, between the occurrence of
apparent death and the body being placed in the enffin,
or of the time during which the enoaeement lasted, special
and minute criticism is uncalled for. Enough has been
said on the subject to emphasise the exhortation: “Get
knowledge, and with all thy getting get understanding.”

THE SPHYGMOGRAPH IN ASYLUM PATIENTS.

Dci»ing recent years the junior medical Officers of our
large aaylumB have recorded, perhaps more than in the past,
observations an clinical pathology and morbid anatomy.
We have repeatedly urged that these are profitable fields
for investigation. Dr. Duncan Greenlees has an interesting
paper m the current number of the Journal of Mental Science
on observations with the sphygmogrnphon asylum patients.
In netrly every case the sphygmogram was found to be
abnormal.^. Acute mania is characterised by dicrotism, due
to laxarteries, during the stage of great agitation. Mental de¬
pression enfeebles the cardiac action, and thus leads to dimi¬
nished arterial tension. Epileptics generally have relaxed
arteries and low-arterial tension. During the status epilepticus
and during the unconscious stage of the fit, the sphygmogram
becomes monocrotic or dicrotic, and the pulse “ soft, frequent.
Small, and running,” as that of coma or collapse from acute
disease. In general paralysis the pulse varies with the
stage of the disease. The pulsc-tracing of dementia indicates
a fee hie cardiac action and a slow circulation from imperfect
fulness of vessels. Io cases of arrested-development of
brain, the arteries were found to be tense, with strong
Cardiac systole, calling to mind renal disease and aortic
obstruction. • _

SUICIDE OF A MEDICAL MAN SUFFERING FROM
TYPHOID FEVER.

The Exeter Evening Post of Saturday last gives the sad
particulars, elicited at an inquest, touching the death of
.Dr. Morris Ilannigan Curtin, one of the medical staff of the
Exeter Medical Aid Association. On the Saturday preceding
hefiret complained of being ill. On the Tuesday following he
felt better and performed his nsnal duties. On the Wednes¬
day he was worse, and had a high temperature. Mr. Baretow,
one of the non-resident officers, suspected typhoid, and
called in Dr. Davy, who seems to have confirmed the
diagnosis,' though other particulars are not given in the
report. Mr. Barstow kindly had Dr. Curtin removed from his
lpdgings to his oWn residence, thinking that he would have
better attention. Dr. Davy saw him on the Thursday and
i Friday, and on-both days found him in good spirits and
comfortable, only regretting his distance from home. On
the Friday he saw Father Hobson, who found him wander¬
ing in mind. Shortly after his visit Mrs. Barstow heard and
gaw him making for the surgery, where he shut himself in,
and was shortly after found with a bottle containing liquid
near him, gasping, bleeding at the nose, - and the heart

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234 Thb Lancet,]

SALICYLIC ACID USED FOR ADULTERATION.

[Jan. 29,1887.

scarcely beating. The breath had the odour of prussic acid,
lo spite of the injection of ether, artificial respiration,
and the use of the stomach pump by Dr. Roper, he died in
about twenty minutes, and the jury properly returned a
verdict of “Suicide while in a state of unsound mind.”
Dr. Roper said it was not unusual for persons with typhoid
to suddenly develop a suicidal mania. It is not, perhaps,
quite so common, however, to see so much method in
suicide in typhoid as was shown in this very sad case.

SALICYLIC ACID USED FOR ADULTERATION.

A commission appointed by the French Academy of
Medicine to inquire into the employment of salicylic acid
as an antiputrefactive agent in the manufacture of beers
and wines has recently issued its report. Though this
addition to beers and other eatables to ensure their keeping
has not at present been the subject of legal proceedings in
England, yet-, as the report remarks, there is no evidence to
show whether this is due to the tacit tolerance of the
analysts or the fact that the acid is not used in English
beers, which are more capable of preservation owing to
their greater alcoholic strength. The inquiry divides itself
into two parts. First-, Has salicylic acid, in moderate doses
continued for a long time, any deleterious effect on the
body ? Secondly, Is there a point in the percentage of the
acid in beers and wines beyond which it is unsafe to go,
and below which there is no danger to the consumer ? The
first question is answered in the negative. Despite the
fact that Kolbe took for thirteen months one gramme every
day in beer or wine, and that Lehmann gave fifty centi¬
grammes a day to two individuals in sound health, without
effect, there is reason to believe that the acid would be
injurious in those predisposed to its action, and in persons
not in sound health, especially those suffering from renal
disease, in whom, as has been known for some time, owing
to defective elimination, the drug quickly produoes toxic
symptoms. The answer to the second question is also
unfavourable to the supporters of salicylage. Owing to the
difficulty of ensuring an exact percentage and the ease with
which a maximal dose can be passed without detection, it is
unadvisable to sanction by law any addition of this nature.
Moreover, as has been well said, Let each put salicylic acid
in his beer if he likes, but not in that of others without
their knowledge.

MEDICO-LEGAL REFORM IN PORTUGAL.

The Society of the Medical Sciences of Lisbon is very
anxious to obtain a radical reform in medico-legal matters,
and at its last meeting, under the presidency of Professor
O. Feijtio, discussed the best mode of drawing up a satis¬
factory scheme. The Minister of Justice, who was present,
thanked the Society for the steps it was taking, and pro¬
mised to be present at future meetings for the discussion of
the subject. The Society appointed a small committee,
consisting of Sehhores Bettencourt Raposo, Sousa Martins,
and Silva Amado, to consider the subject and to draw up a
report. _

ENTOZOA AND PERNICIOUS AN/EMIA.

Db. G. Reyher, writing on the etiology of pernicious
anmmia, points out that, as in a large number of these cases
a Bothriocephalus latus has been diagnosed and expelled by
means of male fern, the patients subsequently recover¬
ing, and as the ansemia of miners is now known to be due to
the Anchylostomum duodenale, it is possible that all cases
are due to entozoa of one kind or another, and that therefore
diligent search should always be made in the faces for the
ova of ttenue, Sec. The treatment will in cases of successful
search be obvious.

THE GUY’S H08PITAL FUND.

Though the sum contributed to the Guy’s Fund (over
.£30,000) is still far short of what is needed, enough i»
already secured to raise hopes that the whole will be forth¬
coming. The letter of Mr. Money Coutts, forwarding th®
generous subscription of £1000, is in the right spirit and
strikes the right note. “ Hospitals are a permanent boon to-
the poor.” So they are; and what a gain they are to the rict»
in the skilled surgeons and physicians they educate! We hope-
to hear of many more gifts like that of Mr. Money Ooutte.
But is it past hoping for that we may see in this annuo-
mirabilu another Guy, whose generosity will build and
endow an institution like that in the Borough, where-
poverty and sickness for generations to come may find »
bed and all the amenities of medicine and surgery? The
wealth of the nineteenth century is greater beyond all com¬
parison than that of its predecessor? Shall it be used leee
magnanimously ? _

THE PREVALENCE OF HYDROPHOBIA.

A contemporary comments on a case of alleged hydro¬
phobia in a man named Mullett, at Bolton, who had beet*
bitten three months before by a terrier, which is stated to have
remained healthy until destroyed three months after biting*
the man. The wound was sucked and cauterised at the
time. This case and another recent case at Putney am-
thought to be inconsistent with the axiom that rabies in
always fatal to animals, and, according to Pasteur, fatak
within ten days. An inquest was also held on a case of
hdrophobia at Hindley in a woman bitten ten weeks before
her death by her fox terrier; and another mad dog is reported
to have been killed at Bolton after biting several children.
Our contemporaries do good service in recording minutely all
alleged cases. We may hope to see the provinces take a
serious view of this question and help those who are seeking
some protection to the public from a terrible risk.

MARGARET-STREET INFIRMARY FOR
CONSUMPTION.

Some difference of opinion appears to exist amongst the-
governors of the Margaret-Btreet Dispensary for Consump¬
tion and Diseases of the Chest. A large majority of the
medical men attached to the hospital object to a small
minority of their colleagues practising what is called
homoeopathy. At present a breach exists, and this cannot
be rectified until the special general meeting has decided
what course is to be pursued. The Executive Committee-
have already given effect to their opinion. They considered
that the minority should give way to the majority, and
resign their poets or desi9t from the practice of homoeo¬
pathy. Amongst the governors there are certainly two
camps. It seems that the constitution gives the executive
committee no legal powers in the circumstances. It is per¬
fectly certain that the majority of the medical staff will
resign unless the special general meeting endorses the
action of the executive committee.

DEATHS OF EMINENT MEDICAL MEN ABROAD.

The deaths of the following eminent continental medical
men have recently been announcedDr. Fedele Margary,
chief surgeon of the Hospital of San Giovanni Battista in
Turin, and editor of the Archivo di Ortopaedia. Professor
Dr. Halla, the well-known clinical teacher of Prague, in hie
seventy-fourth year; he had been editor of the Proper
Vierteljahrachrift since the year 1843. Dr. J. Halt-, one of
the most esteemed members of the profession in Bonn; he
was a “ Sanitatsrath.” M. le Dr. Charles Sar&xin, formerly
agr6g<5 of the old French Faculty of Medicine of Straabuzg*

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TUB PROPOSED MATERNITY HOSPITAL FOR BRISTOL.

[Jan. 29,1887. 235

Dr. Jo »6 Pereira Reis, Emeritus Professor in the Medical
School of Oporto, and author of several medical and scien¬
tific works in Portuguese especially dealing with materia
medica and prescriptions; he left a considerable legacy for
the foundation of a children’s hospital.

widely in their opinions as to how, should such a hospital
be established, the best result may be obtained; so that
it is doubtful whether, after all, the opponents of the scheme
may not, for the present at least, prove successful.

TRANSPORT AND TREATMENT OF INFECTIOUS
PATIENTS IN THE METROPOLIS.

Sna Viwcbnt Rennett-Barrington has addressed to
The Times a letter pleading for the free admission of all
classes of patients into the hospitals of the Metropolitan
Asylums Board, and for the general use of the Board's
Ambulances to the exclusion of all other vehicles. These
proposals meet with our cordial approval. From an
administrative point of view, we believe it is the only
system which will ensure the perfection of the metropolitan
machinery for the isolation of cases of infectious disease.
But when the writer quotes statistics to show that hospital
treatment has conferred upon London the benefit of reducing
the amount of prevalence of these disorders, he exposes
himself to some criticism. The diminution of the death-
rate from scarlatina, which has undoubtedly been taking
place for some years, is not confined to London, and other
'circumstances besides those of hospital provision are
probably concerned in the redaction of this malady. As to
small-pox, the less said about hospital treatment of the
disease by thoso who are in favour of the Londou practice,
the better. London, which treats the vast majority of its
•cases in hospital, has suffered out of all proportion to the
rest of the country. _

HOW LONQ SHOULO A NERVOUS PATIENT BE
TREATED?

The question of how long treatment should be continued
in a neurotic case when no evident benefit is produced has
recently been raised in a Hamburg law court. A medical
mao, having as a patient a merchant suffering from “ner¬
vousness," treated him by galvanism. Altogether he
galvanised him 445 times, but the nervousness did
-not disappear. Then came the matter of fees. The
cum claimed was Jill 5s.. The merchant disputed this
<m the ground that the treatment ought not to have
been continued so long, as it was not producing any benefit.
The court referred the matter to the medical board, which
gave as its opinion that the doctor ought to have asked the
patient after some fifty sittings whether he would like to
continue them, as it was doubtful whether the treatment
was doing any good. The court, however, declined to accept
this view, holding that it was for the patient to say when
he had tried the treatment as long as he was disposed to
pay for, and so gave Judgment for the full amount claimed.

THE PROPOSED MATERNITY HOSPITAL FOR
BRISTOL.

The scheme for the establishment in Bristol of a
maternity hospital is exciting sharp local controversy. The
erection and endowment of such an institntiou as a jubilee
memorial is being earnestly advocated, and equally as
•earnestly opposed. A memorandum, expressing the opinion
that a maternity hospital is much needed for the poor of
Bristol, and would supply a long-felt want in the city, has
been signed by all the members, with 0119 exception, of tbe
medical staffs of the three great Bristol medical charities
and by other local medioal men, and in the face of such a
statement it will be well-nigh impossible to maintain that
there is no need for such an institution. Many, however,
of thoes who signed the memorandum referred to do not
eupfori Ahe scheme as a Jubilee celebration, and differ

METROPOLITAN HOSPITAL SUNDAY FUND.

An important meeting of the Council was held at the
Mansion House on Thursday, under the presidency of the
Lord Mayor. A letter from the Bishop of London was con¬
sidered, suggesting an alteration in the Sunday for the
collection; but as all churches have now made their
arrangements for the year, it was thought impossible
to change the day. A special committee was appointed, on
the lines of that proposed last year by the late Dr. Wakley,
to consider the best means of promoting the success of the
Hospital Sunday Fund, with special reference to the Jubilee
of Her Majesty’s reign. Incidentally Mr. Carr-Go mm made
a statement showing that the London Hospital, of which
he is treasurer, has not lost a single private subscrip¬
tion since the establishment of tbe Hospital Sunday Fond.
Mr. Burdett adduced facts to the same effect.

THE SICK POOR OF ALL ENGLAND AND THE •
HOSPITALS.

Mr. Hbnrv C. Bdrdbtt in the daily press propounds a
buge scheme for bringing the sick poor in every hamlet in
the land into practical touch with every hospital, and the
highest medical and surgical skill, through the Hospitals’
Association. Every parish, congregation, village, or hamlet
is invited, through its clergyman, minister, or other repre¬
sentative, to affiliate itself to this Association by the
formation of a hospital society. The Hospitals’ Associa¬
tion would thus be au immediate aid society, and its office a
bureau of information and centre of reference. The scheme
is to be discussed at a congress in May next, to b9 presided
over by Sir Andrew Clark. The only question is, Is it not
too big—too central? Have we got so well in hand the
problem of the maintenance and management of metro¬
politan hospitals that London men should assume a kind of
providence over the provincial sick and invite them up to
fill our Loadon hospitals? This is a practical and argent
question. Mr. Burdett is a wonderful organiser, but we
think he would do well to leave the provinces to look after
their own sick poor and hospital administration, and devote
his great energies to the metropolitan institutions.

EMMENAQOGUE ACTION OF OXALIC ACID.

Dr. Poux.bt ( Gazette Hebiom'idaire , 1830, No. 20) extols
oxalic acid as the best of all emmenagogues. It does not,
however, he admits, abolish the pain experienced by many
women in the discharge of the menstrual function, and it is
of course, inoperative in amenorrheas consequent upon
organic disease. The dose in which he prescribes it is one
teaspooninl every hour, of a mixture containing thirty
grains of oxalic acid, about six ounces of water, aud two
ounces of syrup of orange-peel.

INFLUENCE OF TIME ON COLOURATION OF WINE.

According to the observations of M. Cszeneuve, the
aniline dyes—fuchsine, Bordeaux red, purple red, &c.—
employed in.colouring wines may persist for many years in
certain wines, and be obtained intact therefrom by analyse.
The chemical changes that wines undergo, especially in the
dtpovilleinmt (stripping) of new wines, lead to the precipita¬
tion of a greater or less amount of the artificial colouring
agent. The diseases produced by microphytes (e.g., myoo-
dermi vim and aceti) also cause a disappearance of colour.

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236 Th£ Lancet,]

HEALTH.OF ENGLISH 'AND SOOTNJ»TOWH& :: V

mt.

PY/EMIA AET£R EXTRACTION OF A TOOTH.

Du. Zawadski mentions in a Polish journal a case where
the extraction of a lower wisdom tooth in a man, aged forty-
six, by a “ feldsher,” was followed by a fatal result. The day
after the operation the soft parts in the neighbourhood
began to swell, then foLkrtved sevtere headache, a rigor, and
fever, death occurring on the nineteenth day. At the
necropsy, purulent inflammation of the dura mater of the
base on the left side was found, and purulent thrombi in the
cavernous and superior petrosal sinuses. The soft parts
near the angle of the lower jaw were infiltrated with pus,
and there were broken-down thrombi in the neighbouring
veins, also metastatic abscesses in the lungs and spleen.

ANOTHER POST-GRADUATE COURSE.

Following in the wake of America, Edinburgh, and
.Manchester, where the movement has been attended with
remarkable success, an arrangement has been made by the
staff of the Leeds General Infirmary, under which a course
of lectures and demonstrations will be given weekly to
qualified practitioners. The first lecture of the course was
delivered by Dr. Clifford Allbutt on the 21st inst. on “ Coma
and its causes.”

Several of the local boards in the Halifax district have
recently decided to have medical officers of their own,
instead of joining in the payment of one medical man for
the whole district. The Local Government Board have,
however, decided that the combination shall continue, and
this decision is meeting with considerable opposition
throughout the district affected.

For an alleged libel published in Life on Juxle 6tb,
Mr. Tom Bird has, through his solicitor, obtained from the
magistrate sitting at Bow-street Police Court summonses
against the proprietor and publisher of that newspaper.

A Professorship of Hygiene has recently been created at
Breslau, to which Professor Fliigge of Gottingen has been
appointed, where he is Director Of the Institute of Chemistry
and Hygiene. _

We hear that Dr. Ralph Leslie, who accompanied Sir
F. W. de Win ton up the Congo, has started with Mr. Stanley
on the Emin Pacha Expedition.

VITAL STATISTICS.

BHALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6040 births
. and 4043 deaths were registered during the week ending
, Jan. 22nd. The annual death-rate in these towns, which
had been equal to 265 and 2-PI per 1000, further declined
last week to 22 8. During the first three weeks of the
' current quarter the death-rate in these towns averaged
24-5 per 1000, and exceeded by 0‘4 the mean rate in the
corresponding periods of the ten years 1877-86. The lowest
rates in these towns last week were 15‘0 in Derby, 15 2
•-Mi Norwich, 16"6 in Brighton, and 18 - 2 in Birkenhead.
The rates in the other towns ranged upwards to 28*4 in
Leeds, 301 in .Manchester, 32 7 in Preston, and 33 - 8 in
Plymouth. The deaths referred to the principal zymotic
diseases in the twenty-eight towns, which had been
475 and 485 in the preceding two weeks* declined last
Week to 392; they included 146 from measles, 92 from
. whooping-cough, 62 from scarlet fever, 36 from diarrhoea,
, $3 from “fever” (princimlly enteric), 23 from diphtheria,
And not one from small-pox. No death from any of
' these tymotic diseases was recorded, during the week
in Birkenhead, Bolton, or Halifax; whereas they caused

the highest rates in Preston, Leeds, and Hudders¬
field. The greatest mortality froni measles occurred in
Newcastle-upon-Tyne, Wolverhampton, Liverpool, Leeds,
and Huddersfield; from whooping-oough in Leeds, Man¬
chester, Norwich, and Huddersfield; from scarlet fever in
Norwich, Sheffield, and Plymouth; and from “fever” in
Cardiff. The 23 deaths from diphtheria in the twenty-eight
towns included 13 in London, 2 in Portsmouth, 2 in Liver¬
pool, 2 in Manchester; and 2 in Preston. Small-pox caused
no death in London. apd its outer ring, or in any of the
twenty-seven large provincial towns. Only 4 cases of
small-pox were under treatment on Saturday last in the
metropolitan hospitals receiving cases of this disease. The
deaths referred to diseases of the respiratory organs in
London, which had been 731 and 591 in the preceding two
weeks, further declined last week to 631, and were 5-below
the corrected average. The causes of 93, or 2*3 per cent, of
the deaths in the twenty-eight towns last week wore not
certified either by a registered medical practitioner or by a
coioner. All the causes of death were duly certified in
Nottingham, Portsmouth, Brighton, and in four other Bmaller
towns. The largest proportions of uncertified deaths were
registered in Oldnam, Salford, and Hull.

HEALTH OF SCOTCH TOWN8.

The annual rate of mortality in the eight Scotch towns,
which had been 29 - 9 and 26-1 per 1000 in the preceding
two weeks, further declined to 237 in the week ending
Jan. 22nd; this'rate exceeded, however, by 0‘9 the mean rate
during the same week in the twenty-eight large English
towns. The rates in the Scotch towns last week ranged from
97 and 15'8 in Perth and Leith, to 27*7 in Glasgow and 30 S
in Paisley. The 691 dedths in the eight towns last week
showed a further declineof 61 from the numbers in the pre¬
vious two weeks, and. included 20 which were referred to
whooping-cough, 16 to scarlet fever, 8 to measles, 8 to
diphtheria, 7 to diarrhoea, 5 to “ fever” (typhus, enteric, or
simple), and 1 to small-pox; in all 65 deaths resulted
from these principal zymotic diseases, against 94 and 72 in
the preceding two weeks. These 66 deaths were equal
to an annual rate of 2*6 per 1000, which was 0'4 above
the mean rate from the same diseases in the twenty-
eight English towns. The fatal cases of whooping-cough,
which had been 27 and 26 in the previous two weeks,
further declined last week to 20, of which 14 occurred in
Glasgow, 3 in Edinburgh, and 2 in Aberdeen. The deaths
from scarlet fever, which had been 13 in each of the pre¬
ceding two weeks, rose last week to 16, and included 9 in
Glasgow, 3 in Aberdeen, 2 in Edinburgh, and 2 in Paisley.
The 7 deaths attributed to diarrhoea showed a further con¬
siderable decline from the numbers in recent weeks, as did
the 8 fatal cases of measles, of which 7 occurred in Glasgow.
The deaths from diphtheria, which hod been 12 and 5 in
the previous two weeks, rose again last week to 8, all of
which occurred in Glasgow. The deaths referred to “ fever,”
which had been 7 in each of the previous two weeks,
declined last week to 5, of which 2 occurred in Edinburgh.
2 in Dundee, and 1 in Glasgow. The death classed to
small-pox was said to be a fatal case of chicken-pca in
Leith. The deaths referred to acute dieeaaes of the respira¬
tory organa in the eight towns, which had been 213 and
181 in the preceding two weeks, further declined last week
to 165, but exceeded the number in the corresponding week
of last year by 5. .The causes of 70, or. nearly 12 .per
cent., of the deaths in the eight towns last week were
not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 31‘3 and
38‘2 per 1000 in the preceding two weeks, .declined again to
32 2 in the week ending J’ul 22ad. 1 During the first three-
weeks of the current quarter the dsath-rate in the city
averaged. 33'2; the mean rate during the same period did not
exceed 237 in London and 23-5 in Edinburgh. The 218 deaths
in Dublin last week showed a decline of 27 from the number
returned in the previous week, and included 4 which were re¬
ferred to scarlet fever, 6 to diarrhoea, one each to diphtheria,
whooping-cough, and:“fever” (typhus, enteric, or simple),
and. not one either to small-pox or measles. Thus the deaths
from these principal zymotic diseases, which had been 13 and
21 in the previous two weeks, declined again last week to
13; they were equal to an annual rate of 1-9 per 1000.
the rates from the same diseases being 1-9 in LoadoS and

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THE UNIVERSITY OP LONDON AND ITS NEW REGULATIONS. [Jan. 29,1887. 237

1"4 in Edinburgh. The fatal cases of scarlet fever, which
had been 6 and 8 in the preceding two weeks, declined
last week to 4; and the deaths from diarrhoea, fever, and
whooping-cough also showed a decline from the numbers in
the preceding week. The deaths both of infants and of
ektorly persons were fewer than those in the previous
week. Six inquest cases and 11 deaths from violence were
registered ; and 56* or more than a quarter, of the deaths
occurred in public institutions. The causes of 45, or nearly
20 per cent., of the deaths registered during the week
were not certified.

THE SERVICES.

On the 20th inst. Surgeon-General J. Handley, C.B., the
principal medical officer at Aldershot, made the official half-
yearly inspection of the Depot (lGth Division) Medical Staff
Corps, which paraded under the command of Surgeon-Major
Staples.

Admiralty.— Staff Surgeon Eugene Victor de Meric has
been promoted to the rank of Fleet Surgeon in Her Majesty’s
Fleet.

The following appointments have been made;—Fleet Sur¬
geon Thomas H. Atkinson, to the Vernon; Fleet Surgeon
Fleetwood Buckle to the Brilliant; Staff Surgeon Solomon
Kellett, to the Cordelia; Staff Surgeon Herbert M. Ellis, to
.the Valorous; Staff Surgeon Valentine Duke, to the Calliope;
Surgeon Alexander W. M'Leod, to the Invincible; Surgeon
Alfred Copley, to the Calliope; Surgeon A. M. Page, to the
Monarch; and Surgeon G. Smith, to the Hercules.

Artillery Volunteers.— 3rd Durham: Surgeon and
Honorary Surgeon-Major Joseph Frain resigns his com¬
mission ; also is permitted to retain his rank, and to con¬
tinue to wear the uniform of the corps on his retirement.—
1st Kent: Acting Surgeon G. H. Harvey, M.B., resigns his
appointment.—1st Worcestershire: Acting Surgeon Henry
Horton resigns his appointment.

Rifle Volunteers.— 3rd Surrey: Surgeon G. R. Barnes
is granted the honorary rank of Surgeon-Major.

“ Audi alteram partem.”

THE UNIVERSITY OF LONDON AND ITS NEW
REGULATIONS.

To the Editors of Thh Lancet.

Sirs, —A recent regulation affecting the Intermediate
Examination for the degree of Bachelor of Medicine has been
Issued by the University of London. As it is reasonably
considered a h ardshi p by many students who are preparing
for the July examination, I desire to draw attention to it.
Hie regulation (dated August 1st, 1886) is to come into force
hi July, 1887, and is as follows:—

“ Candidates at the July examination shall be examined
for a Pass or for Honours' in each of the following subjects:
(1) Anatomy, (2) Physiology and Histology, (3) Organic
Chemistry ; (4) Materia Medica and Pharmaceutical
Chemistry. Every candidate for the July examination, oq
sanding in his name for the examination, must state whether
he intends to compete for Honours in any subject or subjects;
No candidate shall be> allowed to take both th» Pass and
the Honours .papers in the same subject; but eyerv candi-i
date must take the Pass papers iu those subjects in which
he dees not offer himself .tor Honours. A candidate who
miters for but fails to obtain Honours in any subject may be
recommended by the examiners for a Pass in that subject.

.."in' gather, will be-altogether to cut out many men

deserving.of Honour! from the Competition for Honours.
Why 7 Because few. medical Students can afford to risk
rriect ro c f lnany one subject which entails rejection on the
whole exiumnstion. A« it is, the curriculum is quite long
enough; then: have not thfe jjTqie, money, or inclination to
Mfaj .pt fhom} therefor®, who might have com-
pma for Honours under the old regulations will now rest

content with taking the Pass papers only, and, having so
decided, will lower their standard of work accordingly.
They will be supported in this course by a note appended to
the above-quoted regulation, which reads thus:—“Candi¬
dates must bear in mind that the standard of attainment for
the Honours Examination is much higher than that for the
Pass Examination; and they should therefore exercise due
caution in making their choice, to which they will be required
to adhere” (the italics are mine). There appear to be two
possible objects only to be attained by the new regulations.
The first, that the,examiners may be saved a little trouble,
which is, I fancy, scarcely a valid one; and the second,
that those students who present themselves for the
Intermediate M.B. Examination “in due course”—that
is to Bay, in two years after having passed the Prelimi¬
nary Scientific Examination—may be practically excluded
from the competition for Honours. It is only reasonable to
ask, if the University of London aims at restricting the
competition for Honours in any subject to specialists in that
subject, that such should be definitely stated in the regu¬
lations. Specialists in even one of the four subjects of
the Intermediate M.B. Examination are scarcely to be pro¬
duced, under ordinary circumstances, in two years at a
medical school.

I may mention, in passing, that a very general opinion
appears to prevail that the vmole system of competition for
Honours at the University of London needs revision. At
present there is nothing to indicate the relative standing in
point of seniority of the competing candidates, and a man
on his first attempt at an examination may be pitted in the
Honours competition against, and beaten by, another several
years his senior, who has tried the examination one or more
times previously without success. Of the unfairness of the
Competition there will be no record: the result only will
remain.

As regards the new regulations at the Intermediate M.B.
Examination, however, I think you will agree with me that
they are scarcely likeljr to satisfy the prevailing wish for
revision. They tend either to encourage men to postpone
the examination and prolong their ante-clinical studies, or
to lower their standard of work. They are not likely to add
popularity to the University of London examinations,whicl>
are already not too popular among students or teachers.

I am. Sirs, yours truly,

Vincent D. Harris, M.D. Lond., F.R.C.P.,

Demomtrtitor of Phyaiolotry afc 8t. Bartholomew'* Hospital.

Wimpolfr street, Cavendish-square, W., Jan. 1887.

THE PROPOSED JUBILEE HOSPITAL.

To the Editors o/Thb Lancet.

SrR9,—The proposal to found another special hospital for
the treatment of diseases of the throat, ear, akin, eye,
rectum, &c. f is not likely to meet with general approval.
There already exists in London a number of special hospitals
devoted to the treatment of these diseases, in addition to
the facilities afforded by all the general hospitals. As a
consequence, it is a notorious fact that many of the patients
seeking relief at these special hospitals do not belong to the
class of the indigent poor, for whose relief alone money is
subscribed by the public* Lf* however, it is thought advisable
to commemorate the Queen’s Jubilee Year by the foundation
of a Queen’s Jubilee Hospital, there is a class of cases for
which, it seems to me, hospital accommodation Is required.
I refer to cases of chronic but curable diseases, such as
spinal abscess, diseases of joints, suppuration of joints, &c.
Although cases of spinal abscess, especially in adults, were
formerly practically incurable, we have now ample evidence
that, if the cases are treated strictly aseptically from first
to last, a very large proportion will recover completely.
Unfortunately the time required for cure is long, on an
average eight to ten months, and sometimes much longer,
and this lengthy treatment can only be carried out
irv exceptional cases and with great inconvenience in
a general hospital. The aim qf. these hpspitala is to-do the
greatest good to the greatest number, and if a considerable
proportion of the beds is. occupied for months by these
chronic, cases the efficiency of > the institution is seriously
impaired, and cases requiring urgent treatment have to be
rejected for want of room. Hence one of two things usually
happens. Either the cases are mot admitted at all, the
abscess is allowed to burst, and fchq patient ultimately loses
his life from prolonged suppuration and its consequences

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a y ^

I

238 The Lancet,] ARTERIAL PRESSURE.—TREATMENT OP THYROID CYSTS. [Jan. 29,1887.

or, if the patieQts are admitted, they are only kept in and
treated sceptically till the discharge becomes slight, and
then they are dismissed and relegated to the out-patient
department. In most of these cases the -whole benefit of
the stay in hospital is undone, and the patient goes steadily
down-hill. For, however efficient the apparatus employed
to give support and fixation to the diseased part, the home
surroundings and hygienic conditions are as a rule wretched,
and the food unsuitable in quality and deficient in quantity,
while the patient as soon as he is discharged irom the
hospital may have to earn hia living. And more serious
than these are the risks to the continuance of strict
aseptic treatment: the patient finds it inconvenient to come
to the hospital on the day he is told, and the dressings are
left on too long, or he finds the wound uneasy or itchy, and
takes off the dressings with the view of giving relief; or
when he comes to the hospital, especially if it be a large
hospital, his wound is not dressed by the surgeon or the
house-surgeon, but, it may he, by some dresser who has hud
insufficient experience of antiseptic work. For one or
other of these reasons, when a patient is dismissed from
hospital before his wound is completely and thoroughly
heale 1, fermentation, as a rule, ultimately occurs, and he is
very little better off than if he had never been taken in at all.
1 ai'ii constantly meeting with such cases, more especially in
the case of children, where patients present themselves
with septic and suppurating wounds who have been in
other hospitals for some weeks, and have then been sent
out to be treated as out-patients. I do not at all mean to
imply that this is any fault of the surgeon in charge of the
case, or of the hospital at which it was treated ; it results
entirely from the fact that in a general hospital one cannot
allow any large number of beds to be occupied for an
indefinite time by the same cases. It is no exaggeration to
say that there is a pressing necessity for an institution
where patients, provided their diseases are curable, can be
kept as long as is necessary and treated strictly aseptically,
and that if such an institution existed many lives would
be saved which are now lost.

In speaking of spinal abscess it must not be supposed
that I mean that that is the only or, indeed, the chief class
of cases for which this sort of accommodation is necessary.
It is Equally required for other chronic but curable cases—
as, for example, diseases of joints. The same remarks
apply to advanced joint disease as to spinal abscess; and it
may be added further that excision, which is not always
good practice, would not be so often resorted to were it not
that it is necessary to shorten the stay of these cases in
hospital.

A great deal more might be said in support of this
suggestion, but 1 think I nave said enough to show why I
hope tha.t the energies of those who wish to promote a
Queen’s Jubilee Hospital may be expended in the direc¬
tion which I have indicated, rather than on the foundation
of a special hospital for which there is no public necessity.

I remain, Sirs, yours faithfully,

Welbeok-street, W.. Jan. 22nd, 1887. W. WATSON C/HJRYNE.

THE TERM “ SPAYING.”

To the Editors qf Thb Lancet.

8ibs,—I cannot say much in respect of your critical re¬
search on this subject if you believe, as certainly is asserted
in your article in The Lancet of to-day, that the word
“ castration” is the analogue in the male for “ spaying” in
the female. It is not so; the proper word so to use is
'“gelding.” Both these terms mean the removal of the
■essential sexual organs of immature animals to prevent the
access of sexual maturity, and they both mean the double
operation. “ Castration ” has no such meaning, and it may
be either single or double. To apply this term to removal
of the uterine appendages, as is done by the Germans, is an
■error in classics, but otherwise not very objectionable. The
word “ spaying” is, however, eminently objectionable, for it
is entirely misleading. Whenever used, it at onoe conjures
op the idea of masculine voice, the growth of a beard and
other male peculiarities, as well as the loss of sexual appetite,
not one of which is an incident in the complete after-history
of a case of removal of the diseased uterine appendages
from a mature woman. It is a term, therefore, which ought
not to be used, as well for the other reason, which you so

trenchantly point out, that it is one of reproach to the poor
sufferers who have had to submit to it. There are many
other and very strong objections to this unnecessary term
which I have already urged and need not repeat here.

1 am, Sirs, yours truly,

Birmingham, Jan. 22nd. 1887. LAWSON TaIT.

THE PETITION OF MEMBERS OF THE ROYAL
COLLEGE OF SURGEONS TO THE PRIVY
COUNCIL.

To the Editors qf The Lancet.

Sirs,— Without attempting at present to give a detailed I
analysis or a final summing up of the signatures to this 1
memorial received by us, we may state that up to date we !
have over 4000 names of Members of the Royal College of i
Surgeons appended to it, and that each post still brings in
numbers of signatures in reply to our issue of copies of this
petition. Already, therefore, you will see that our demand '
is most strongly backed up by Members of the College, and '
should have enormous weight with the Privy Council. Of
course, however, we are still desirous of receiving additional I
names to add to the petition, though its success appears to I
us now assured. As our time is just now so much occupied l
in the reception and arrangement of these forms, perhaps 1
you will excuse any further details for the present. \

We are, Sirs, your obedient servants,

Warwick Steele, ] h 0 d. Sec«. Aj»oc.

Jan. 28th, 1887. Wm. AsHTON ELLIS, J of M.B.C.S. I

ARTERIAL PRESSURE.

To the Editors of The Lancet.

Sms,—Dr. George Johnson’s letter is satisfactory so far as
it explains one possible form of blood pressure—that produced
in the large elastic arteries from constriction of the minute
arterioles. But this does not cover the whole ground. In
the first place, I do not understand Dr. Brunton to refer
exclusively to the large elastic arteries when he states that
tension and pressure are synonymous terms. On the con¬
trary, I understand this expression as a universal one,
applicable to all areas. Indeed, there are many passages
where he distinctly implies so; as, for example, dilatation
of the renal arterioles increasing the pressure in them. Are
we to suppose, when constrictive impulses travel along the
vaso-motor nerves, that the peripheral ends of the arterial
system are contracted, and the pressure in them lowered,
while the more central parts are dilated, and have their
pressure increased ? If this is the correct reading, how are
we to understand the following statement at page 231:—
“ If the arterioles are made to contract, the pressure rises,
but the increased pressure stimulates the vagus roots in the
medulla.” Surely the vagus roots would be affected by the
arterioles, whose lumen is contracted and whose pressure is
lowered; certainly not by any large elastic artery, where
only is the pressure increased.

I remain, Sirs, your obedient servant.

Bast Greenwich, Jan. 25th, 1887. W. NICHOLSON.

TREATMENT OF THYROID CYSTS.

To the Editors of Tbs Lancet.

Sibs,—A fter reading a paper on the above subject at the
Clinical Society on Jan. 14th, Dr. Felix Semon, who was
present but did not take part in the discussion, mentioned
to me that he thought someone had previously adopted the
method of stitching the cyst wall to the skin; but as he
could not give me more exact information without reference,
he would write and tell me if it were so. The following
information, to me quite new, which he was kind enough to
communicate by letter, is so important that I feel I ought
to ask you to give it publicityI find on reference that
the proposal was made, and acted upon, not less than thirty
years ago by the younger Chelius (vide Chelius’ ‘ Handbuch
der Chirurgie,’ voi ii., p. 463, 1857), and that it has been
referred to since with approbation by Bardeleben and
Liicke (in Pittra Billroth’s ‘Chirurgie,’ Band iii., Abth. i.,
Liefernng 6, p. 83), and mentioned by myself in Heath’s
‘ Dictionary of Surgery,’ vol. ii., p. 619).”

1 am, Sirs, yours truly,

Leedi, Jan. 2oth, 1887. A. W. MAYO ROBSON.

Digitized by G00gle

The Lancet,]

MANCHESTER.—BIRMINGHAM.

[Jan. 29,1887. 239

MANCHESTER.

(from our own Correspondent.)

OWENS COLLECTS.

Fob the third time within a comparatively short period
the College has lost by a sadden and unexpected death one
of the members of its teaching staff. On Friday night last
Mr. W. H. Waters, M.A., the senior demonstrator with Pro¬
fessor Stirling in the physiological laboratory, died in bed
from what appears to have been an epileptic seizure. He
htd been at work as usual at the College in the afternoon,
ind his death has come as a great shock to all connected
therewith. During the interregnum between Dr. Gamgee
and the appointment of Professor Stirling, Mr. Waters had
entire charge of the physiological department, delivering
the lectures and superintending the work of the laboratories.
Holme Hall (the new hall of residence for students) was
opened this month, where at present thirty students can be
accommodated. The sanitary arrangements of the building
have received special care and attention, and the comfort of
the students, booh in their studies and their amusements,
has been well cared for. Under the will of the late Mr. A.
Heywood, the College receives £10,000, which the donor
desires shall be used, so far as the rules and regulations of
the College will allow, for “ the instruction of women and
girls in the said College.” As years roll on, it may be fairly
expected that the different colleges of the Victoria Univer¬
sity will become possessed of ample funds for carrying on
the various branches of their work ; it has but recently been
announced that Mr. Harrison of Liverpool has given £10,000
to the Liverpool College to found a chair of Engineering
there. The proposed application to the Government for a
grantout of the Imperial exchequer on behalf of the Victoria
University is receiving the support of most of the municipal
bodies of this and adjoining counties.

HOSPITALS.

Amongst the hospitals, &c., benefited under Mr. Hey wood’s
Nill St. Mary’s comes in for £200. This time the Royal
Infirmary receives nothing. From a return published for
the six months ending Dec. 31st, it appears that the number
of patients under treatment at the lufirmary and its allied
branches, the Convalescent and Fever Hospitals, has been in
considerable excess of those of the corresponding six months
of the previous year. The largest increase has been at the
Fever Hospital, where 914 patients have been admitted,
against 569 in the foregoing year, owing to the great
prevalence of scarlet fever during the past lew months. At
the three hospitals there has been a total increase of 713
in-patients and 2790 out-patients. At the Infirmary no
special festivities were held at either Christmas or New
iear tide, the authorities having apparently set their faces
against anything of the sort during the last few years,
though formerly some very pleasant entertainments were
got np at these seasons. At tne Children’s Hospital, Pendle¬
ton/. at the Ancoata, the Clinical, and the Royal Eye
Hospitals, entertainments were much enjoyed; the inmates
of the latter hospital were mainly indebted to its inde¬
fatigable chairman, Mr. Alderman Goldschmidt, for their
evaain^’s feast and amusement. It is worthy of note how
the various boards of guardians differ as to the supply of
hear to the inmates of the workhouses at Christinas time;
in Salford and Manchester no beer was allowed, whilst at
"ithiagton and Prestwich the adults were supplied with a
pint each.

SOCIETIES.

The annual meeting of the Medical Society disclosed a
*Wiefactory condition of the Society’s affairs. Both financially
**d numerically it is flourishing. A proposal was alluded
to of attempting to raise funds for the erection of a building
of its own for the purposes of library and of meetings, but
Present this project is deferred, and, indeed, seeing how
’"wet present the Society is housed at the College, it would
***celyappearto be necessary. Itseemstohave almost passed
tototaunwritten rule now that the president should hold
oSoe for two years, and in accordance therewith Mr. Hardie
re-elected for the ensuing year. The Pathological
k°qety cctttinnes to increase and flourish, and a very plea*
**** wa ters is the exchange of courtesies between this
Md-that of Liverpool by the attendance (as has been

the case recently) of members from the two cities at each
other’s meetings. The Medical Society might also well take
a leaf out of its younger rival’s book in the provision at its
meetings of tea and coffee prior to the commencement of
business.

Many of your readers will hear with regret of the ill-
health of Mr. Scott, the genial and obliging secretary of the
Manchester and Salford Association and its allied societies.
A testimonial from a number of his friends who appreciate
his services in connexion with the above was recently-
presented to him, in the shape of a puree of £100.

Manchester, Jan. 35th.

BIRMINGHAM.

{From our own Correspondent.)

POST-GRADUATE LECTURES.

Yet another series of advanced lectures is advertised; this
time under the auspices of the Medical Institute, on the
subject of Bright’s Disease. No one can have any excuse
for not becoming acquainted with the modern views
embraced in these courses of lectures—that is, if he can And
time to attend them. What with work and worry the busy
practitioner generally has his hands pretty full, and however
he may be disposed towards the attainment of knowledge,
he may reasonably ask, “Which of the learned, with all
his love, hath leisure to be wise ? ”

A SUGGESTION FOR TEMPERANCE REFORMERS.

A novel suggestion has been made by an enthusiastic
advocate of the temperance cause, the practical application
of which,could itbecarriedout.mightprobably be productive
of some good. He says: let a certain number of barmaids
from various public-houses attend the casualty rooms of the
hospitals', on Saturday nights particularly; when they wilt
see for themselves the effects of drink and degradation in
some of its worst phases. They will doubtless be stirred to
higher motives in refusing to supply more drink to those
who have evidently already had enough, and they will
observe for themselves how misapplied in a given sense are
the philanthropy and benevolence of those whose charitable
aid supports these institutions and provides the best educated
professional men and intelligent nurses to administer aid,
not to tbe poor and deserving, but mainly to the debauched
and debased through drink. Such is charity in its widest
sense, and as such it knows no distinction between the
thrifty and steady and the worst forms of social evils.
Polioe-courts, on the other hand, take more note of human
nature than charity. The contrast is worthy of attention.

DILAPIDATED DWELLINGS.

The so-called rookeries have ever been a subject of active
condemnation on the part of the coroner, and a recent
experience of his where the jury narrowly escaped tumbling
through a rotten floor evoked a strong expression of regret,
that such tenements should be allowed to exist in crowded
towns, where risks to life and limb, to say nothing of com¬
fort, were so often conspicuous. Another oft-repeated and
wise admonition on the part of the coroner will bear
repetition—the treatment or

FAINTING AND 8YNCOPB.

The common practice of raising fainting persons to a
sitting or upright position is often sufficient to destroy the
•park of life which remains. The death of an eminent
statesman a short time ago gave opportunity to the coroner
for emphasising this fact, and of pointing out how much,
more reasonable ami sound it is to keep such persons in the-
prone position while restoratives aDd local means are adopted
to enable them, if possible, to regain consciousness. Though
inquiring, into the cause of the appearance of the “shadow-
feared by man,” the coroner is not unmindful that its
advent is often preventable, and a due regard to the welfare
of tbe living prompts him to give sage admonition as the re¬
sult of his own experience of some frequent causes of death.

Birmingham, Jan. 37th.

The annual meeting in connexion with the Newton
Cottage Hospital and Dispensary was held on the 20th inst,
when favourable reporta were presented.

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240 The Lancet,]

NORTHERN COUNTIES N0TE3.—EDINBURGH,

[Jan. 29,1887.

NORTHERN COUNTIES NOTES.

(From our ovm Correspondent.)

CURIOUS CASE: ACCIDENT INSURANCE.

A curious case, bearing on accident insurance and the
legal and medical definition of an accident, has just been
tried before before Mr. Justice Cave at the Newcastle Assizes.
The widow of a late hotel proprietor brought an action
against the Northern Accident Insurance Company to recover
.£1000 due upon an ordinary policy in the company. The
deceased, it was shown, was a healthy man, but two or
three years ago he bod suffered from diabetes, from
which he had recovered, and it had nothing to do with
his death. He was not, as far as was known, suffer¬
ing from any disease at the time of his death. It appears
that in May, 188G, he was in his bedroom alone,
and while cutting his com the knife slipped and cut
his foot. The wound was painful, but the deceased did
not consider it serious, and after five days of domestic
treatment the foot got into such a state that medical
assistance was called in, blood-poisoning set in, and
death ensued. Evidence was called to show that death was
caused by the accident named. His widow was not aware
that at the time of his death he was insured in the company,
and when the policy was found the claim was sent in. The
defence was that death arose fronj mortification caused by
diabetes, and that no notice of claim was sent in within
the time specified in the policy; but the judge overruled I
this, saying that “this was a ground for a counterclaim
only.” Mr. Justice Cave, in giving judgment, said “ he had !
come to the conclusion that the cut on the foot which was j
spoken of did lead to the production of the sore, which I
degenerated into gangrene and produced blood-poisoning,
and so death. Deceased’s actual health was not so robust as
that of some men; it seemed to him impossible to say
that the diabetes alone could be said to have so contributed
to his death, but that the injury alone could not have so
contributed within the meaning of the policy it. was also
impossible to say. No doubt he was a man of irregular
habits, but to go so far as to pay he was intemperate was
another matter. If insurance companies did not intend to
bp liable in these cases, they must at once introduce some
conditions to strike at them.” His lordship gave a verdict
for the plaintiff for £1000, but as the case was one fairly
admitting of argument and discussion, he consented to stay
execution on £1150 being paid into court.

SOUTH SHIELD® VOLUNTEER LIFE BRIGADE.

The Volunteer Life Brigade of South Shields is well
known for its deeds of mercy and of daring in connexion
with shipwrecks at the mouth of the Tyne. The Newcastle
Daily Chronicle, in an appreciative article, mentions that
since the formation of the brigade 180 persons have been
rescued by means of the rocket apparatus, and adds that
during its existence the brigade has been honoured with
the services of an honorary surgeon. The first gentleman
who held the appointment was the late Dr. Stokoe, and he
has been succeeded by Dr. J. R. Crease, who has since been
unanimously elected annually. It may be mentioned that the
appointment of surgeons to the brigade entails services of
the most arduous nature and exposure to the very worst
weather, for it is only at such times that medical services
are needed.

BOROUGH OF TTNKMOUTH INFIRMARY.

It is now stated that the foundation-stone of the new
building is fixed to be laid on the Jubilee day in June next,
on land presented by the Duke of Northumberland. The
building fund was opened only a month ago by & donation
of 200 guineas from Mr. R. S. Donkin, the borough member,
and it was much augmented by an Art and Industrial
Exhibition held at Tynemouth about the same time.

NEWCASTLE INFIRMARY.

Owing to the longth of my letter last week, I was unable
to give yo i the recommendations of the special committee as
to the future election of the honorary medical staff, and which
will be duly appreciated by candidates“ They desire to
call attention to the very unsatisfactory method under
which the election of the honorary medical staff is con¬
ducted. On the skill of these gentlemen the reputation and
efficiency of the infirmary depend, yet their election is

dependent on their skill as canvassers or the number of
personal friends who canvass for them. This must always
be the case when success depends upon securing a majority
of the votes of a large body of subscribers who know little
of the fitness of the applicants. The committee therefore
recommend that in future all elections to vacant posts at
the infirmary be placed in the hands of a committee of
selection. Such committee might be the house committee
or a special committee appointed fo*- that purpose.”

Ne^cMtley-on-Tytte, Jan. 24th.

EDINBURGH.

(From our ovm Correspondent.)

DR. CLOU8TON ON SELF-CONTROL.

Last week Dr. T. S. Clouston, Lecturer on Mental Diseases
in the University, delivered an address on Science and
Self-Control, under the auspices cf the University White
Cross Society, Viewing the subject from a purely scientific
standpoint, and in the light of his large experience, the
lecturer traced the relation of the reproductive functions to
the general activities of the human economy in the various
stages of life. The developmental phases of the question
occupied the greater part ot the address, and it was demon¬
strated in a most interesting way, from the evolutionary
point of view, that the premature expenditure of energy
in that direction results in racial deterioration, if not
extinction. Numerous illustrations from the history of
human and animal races were cited to show the wise
checks and penalties ordained by Nature's laws for the.
preservation and elevation of her types. Dr. Clouston also
stated a physiological law of the transformation of vital
energy, accurately corresponding to that of the physicist,
showing that the various physiological activities of man
are correlative to, and to a great extent substitutional
f.>r, one another; the substitution of one form for any other
less adapted to normal existence in its several phases being
carried out by the will of the individual appropriately
directed, or by the exigencies of his environment. This law
of the conservation and transformation of vital energy was
illustrated by reference to the very specialised manifesta¬
tions of human activity produced by particular combina¬
tions of natural or fortuitous surroundings. The lecturer
shortly and aptly pointed the moral to be derived from the
scientific principle thus established. In addressing an
audience of undergraduates, who in their torn must become
the teachers and exemplifies of healthy living, wherever
their lives may be spent, he laid stress upon the importance
of a due balance between the various forms of vital activity
in human life, and showed how the possession of self-control
supplied the only key to its attainment. Professor Chiene,
who occupied tbo chair, warmly coincided in Dr. (Houston's
views, ana hoped that the able expression of them to which
he had listened would be rendered permanently and widely
useful by the publication of the address; a hope also ex¬
pressed by Professor Calderwood, who supported the pro¬
posal of a vote of thanks to the lecturer.

. EDINBURGH UNIVERSITY COURT.

At a recent meeting the Court adopted a minute express¬
ing the deep sorrow and the great loss occasioned to the
University by the death of Lord Iddesleigb, and directed
that a copy of the minute should he sent to the family of
the deceased earl. Lord Balfour of Burleigh was appointed
one of the curators of patronage of the University for a term
of three years. A number of appointments to examiner-
ships in the Medical Faculty were then made. In Materia
Medica, Dr. C. D. F. Phillips of London was appointed, in the
room of Dr. Murrell; in Physiology, Dr. Noel-Paten takes the
place of Dr. Caton; in Pathology, Dr. Sims Woodhead suc¬
ceeds Dr. Sidney Coupland; in Surgery,Dr.James D.Gillespie
has been succeeded by Mr. Watson Chevne ; and in Clinical
Medicine, Dr. Byrom Bramwell by Dr. J. D. Affieok. These
appointments are for a period of one year, but their occupants
are eligible for re-election annually till a term of five years
has been completed ; and it is customary for them to retain
office for that length of time. The University Court also
recognised the courses on Pathology and Practical Pathology
held by Dr. Alexander Bruce as qualifying courses in the
University medical curriculum; and a Similar recognition

Tim Lancet/]

DUBLIN.—PARIS.

[Jaw. 29,1887. 241

was continued in the case of Dr. Peter Young's lectures on
Midwifery, on his removal to new class-rooms.

PROPOSED CONVALESCENT HOME FOR FEVER PATIENTS.

A proposition is at present under consideration by the
city authorities as to whether they cannot establish a
convalescent home for patients treated in the city fever
hospital. At present there are frequent cosee of patients
leaving the fever hospital recovered only so far as an early
stage of convalescence, and it is felt that could care and
good nursing be extended to these for a somewhat longer
period, away from tLe fever wards, it would greatly
whence the usefulness of the institution. The City
Assessor is to be consulted on the question.

Edinburgh, Jan. 28th.

DUBLIN.

{From our own Correrpondont.)

DEATHS OF EMINENT MEDICAL MEN IN DUBLIN.

Within the last few days two well-known practitioners
have been taken away. One of these, Dr. Denham, an
ex-president of the Royal College of Surgeons in. Ireland,
had for some years retired from practice; but Dr. Henry
Kennedy, who succumbed on Monday last, was in active
practice until his last illness. I trust next week to be able
to refer at greater length to the last-named gentleman,
whose loss is deeply regretted by a large circle of friends.

ACADEMY OP MEDICINE IS IRELAND.

At the last meeting of the Surgical Seotion of the
Academy, Mr. Henry Fitzgibbon read a very interesting
paper on a ca9o of Trephining for Mastoid Disease, with
Paralysis and Aphasia. The patient recovered, perfectly,
although before the operation death was imminent. In tne
discussion which ensued. Mi. Wheeler, who recommended
the procedure in 1SS3, stated that by this operation the
tympanum, mastoid cells, dura mater, and the temporo-
xpbenoidal lobe were successively exposed.

13MTISH MEDICAL ASSOCIATION.

The annual meeting of the Dublin branch will take place
on Thursday', the 27th inst., when the following motions
will be brought forward: u That the Council be requested
to take such steps as may be necessary to bring before the
various teaching bodies in Dublin the necessity of providing
lystematic instruction in pathology." “That quarterly
meetings of the branch are essential for carrying on the
work of the Association.” A paper will also be read on
“ Medical and Hospital Reform in Dublin."

INQUIRY AT MERCERS HOSPITAL, DUBLIN.

The Corporation inquiry into the alleged ill-treatment of
the patient Farrell, in Mercer’s Hospital, closed on Saturday.
The committee came to the unanimous conclusion that
Farrell had received proper care; that he had been supplied
with proper food during his illness. They considered that the
conduct of the matron was justified throughout, and that
Mr. Newcomen’s Conduct to her was unjustifiable; that
Farrell had not beeO ill-treated, and that he received the
most anxious care and attention from Dr. Kennedy. The
committees further report that on Aug. 4th Farrell’s con¬
dition made it probable that he might at any moment be
Mixed with paroxysms of homicidal or suicidal mania, and
that he should therefore be pat under proper restraint. With
reference to the conduct of the matron, toe committee were
of opinion that there was absolutely no evidence that she
had neglected her duties, but, on the contrary, abundant
proof that she had discharged them efficiently. The com*-
mittee finally report that in their belief the allegations
made against the institution originated in a concurrence
of trivial circumstances, and that the management of the
hospital was effective and humane.

DUBLIN HOSPITAL SUNDAY FUND.

I regret to state that the collections made in aid of this
excellent charity on the 14th of last November show a
decided falling off as compared with the previous year.
In 1885 the amount obtained came to £4468 6t. 8 d., and
last year to .£4168 Os. 3d., or a decrease of £310 5s. 5 d It

must, however, be stated that the collection in 1885 was the
highest obtained since the fund was organised. It may be
interesting to add that the total amount collected since 1874
amounts to £50,058 (is. 2d.

BITE FROM A MAD FOX.

Lord Doneraile, of Doneraile Court, county Cork, and his
coachman were recently bitten by a tame fox, which was
affected with rabies. Although his lordship had on his
gloves at the time, yet it has been thought better to take
every precaution, and he and the coachman have proceeded
to Paris, to be placed under the care of Prof. Pasteur.

The death is reported at an advanced age of Dr. O'Connell,
of Kilmallock. The deceased at one time was u surgeon in
the British army.

John Bryan, M.D.,of Pettigo, has been plaoed on the Com¬
mission of the Peaoe for the County of Donegal.

Dublin, Jan. 25th.

PARIS.

{From our own Cbmtpondent.)

THE DISCUSSION ON RABIES.

. The discussion on rabies was resumed on the ISth inst.,
the interest in the question being so great that it was diffi¬
cult to obtain standing-room even in the passages. M. Peter
read particulars of two new cases, communicated to him
since the last meeting, in which death had taken place
from the paralytic form of rabies after the intensive
inoculations. A stonemason and his son were bitten on
Nov. 8rd by a mad dog, and were treated in Paris from the
7th to the 21st of the same month. On Dec. 2nd the father
was seized with violent pains at the seats of the inoculations
in the head, the loins, and the limbs, and with general
prostration. On Dec. 7th he had complete paraplegia with
anaesthesia, or rather painful analgesia, as the pains vere
still felt in the limbs. There was no difficulty of degluti¬
tion, delirium, or convulsion, but slight hallucinations of
healing the day before his death, which took place on the
8th. These cases of paralytic rabies continue to occur, said
M. Peter, and yet the partisans of the intensive method
still ignore its dangers. The cases are explained away either
by the doctrine of limitation or by attributing the death to
some pathological condition, such as urtemia. The child,
who was said to hove died from uraemia, had not even had
his play interfered with by the headache that always pre¬
cedes a fatal termination. He had had neither eclampsia,
coma, nor delirium. He had had dyspnoea and difficulty of
deglutition, symptoms referable to the pneumogastric and
glosso-pharyngeal nerves; and these, it must be recollected,
hove their origin in the parts of the nervous centres affected
in rabies^ The death of the man at Constantine had not
been put down to uraemia, but no one knew exactly what
he had died of. In the six cases brought forward the
inoubation had been from thirty-six to thirty-nine days,
and death had occurred from paralysis, whereas ordinary
rabies occurs after forty days, and is convulsive. M. Brouardel
bod quoted M. Von Frisch. It should be known that the
Viennese Professor of Bacteriology had been sent to Paris
on behalf of a committee of ladies interested in Pasteur’s
experiments, and that his sympathies were all in favour of
the method ; but when asked on h» return what was his
impression, he replied diplomatically, “ I think that it is
well to continue the investigation. The first ten con¬
clusions of his report of his subsequent experiments were
favourable to M. Pasteur’s method, and were quoted by
M. Brouardel in his last communication to the Academy;
but the other six conclusions were absolutely condemnatory
of it (see The Lancet, p. 50). Consequently, both clinical ij
and experimentally, the intensive method was dangerous—
unlike the first method, which, if inefficacious, was at least
harmless. As long as Pasteur’s experiments remained
purely physiological, they deserved the greatest praise and
admiration; but the line must be drawn at the point where
they are applied to human medicine. The anti-rabic
inoculations originated in the following conception : Was
it not possible to prevent the ulterior appearance of rabies
by inoculation during its incubation with an attenuated
virus, similar to those whioh had already been obtained for

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242 The Lancet,]

PARIS.

[Jan. 29,1887.

other diseases ? For his previous attenuated viruses
M. Pasteur had made microbic cultures in bouillon, the
Attenuation being obtained by the action of oxygen through
time. But this method was not applicable to rabies, the
microbe of which was unknown. The ingenious idea oc¬
curred to him of passing the virus through a succession of
living organisms, and it was found that the virulence of
the monkey vaccine, so obtained, was attenuated, whereas
that of the rabbit was intensified. This intensified virus was
found to be attenuable by exposure to air, and M. Pasteur was
able to obtain a series of decreasingly virulent viruses, the
progressive inoculation of which, beginningwith the weakest,
prevented the appearance of rabies after infection with the
most virulent. Thanks to this “MithridatisatioD," a dog
■could be made refractory to rabies, and, what was even more
extraordinary, a dog already bitten could also be rendered
incapable of developing the disease. At this juncture a
young man who had been badly bitten by a mad dog
(J. Meister) offered to make a trial of the method. The case
was delicate, but, after consultation with MM. Vulpian and
■Orancher, the treatment was applied, and four months later
the result was made known to the scientific world, and it
was proclaimed by M. Vulpian that a certain remedy had
been found for hydrophobia. What had been the results
of the method during the last year? In his article upon
“ Rabies” in the Encyclopaedic Dictionary, M. Brouardel
gave thirty as the average annual mortality for twenty-
seven yearsin France. This was exactly thenumber of deaths
for the last year—sixteen not inoculated, fourteen inoculated.
After a fresh protest against the intensive method, M. Peter
said: “I must be moved by a profound conviction to
come here to discuss a treatment that has been adopted by
the most eminent representatives of French medicine, and
■so risk my popularity and the sympathy of the Academy,
which I prize above all. If I do so, it is because the new
method seems to me not only dangerous, but rash, and
I cannot help saying to M. Vulpian, a propot of his enthu¬
siastic speech at the Academy of Sciences, ‘ What! you, an
experienced physician, and a member of the Academy, did
not understand that a single case proves nothing in thera¬
peutics! You could not see that the patient had the same
hve chances out of six that we all have of escaping rabies
after a bite from a mad dog! Why proclaim with enthusiasm
what should have been made the subject of sober examina¬
tion? Why conclude so hastily from the laboratory to
clinical application ? An eminent physician like you
should have dissuaded rather than encouraged M. Pas¬
teur, and I do not hesitate to declare that the words
pronounced by M. Vulpian might compromise the Academy
of Sciences, M. Pasteur, and M. Vulpian himself.’ ”

M. Vulpian, who was received with applause, said that he
was proud of what he had done on the day he pronounced
the words alluded to by M. Peter, and that he was pre¬
pared to repeat them to-day. Nothing could be grander
from a humanitarian point of view than M. Pasteur’s work,
And it was a pity that M. Peter had chosen the hour when
he was absent through illness to make his attack. “What
can be M. Peter’s object? Surely not to prove that the
method had sometimes been unsuccessful. That has been
admitted by M. Pasteur himself. M. Peter has accused
Af. Pasteur of concealing facts. This is untrue. In each of
his statistics the rare failures have always been mentioned.
M . Peter relies upon the statistics to show that the method
is inefficacious ; but all those who have examined them
without bias have recognised that they afford a striking
proof of the preservative value of the method. He endea¬
vours also to show that the intensive method is dangerous.
Stripping bis language of all artifice, M. Peter in reality
accuses M. Pasteur and all his assistants not only of a grave
error, but even of involuntary homicide. His propositions
may be formulated as follows: (1) M. Pasteur’s anti-rabic
method is dangerous, as it may communicate rabies to those
who are so treated. (2) The method is inefficacious. To
prove that the anti-rabic method is dangerous, M. Peter hue
brought forward a small number of cases where death,
according to tyim, is,attributable to what he terms the
'collaboration of the two viruses forming, to use his own
_ j>erimen£al virus. As regards the
optiiLoate of death of Wilde sent
: pulmonary disease as the
oase ot Sriuth: 4e more
i rep wfrla published it should
k>®» i In fcob observations that
t.Peter has noted the

■expression
■cases sees
to Fasten
erase.- nCbe,

occurrence of general fatigue ( courbature ) in the patient as a
proof that the materiea morbi was derived from the rabbit.
But where did M. Peter recognise this fatigue in rabbits ?
and by what feat of imagination can he see in the fatigue of
the patient the proof of rabbit-derived infection ? The pains
at the seat of the inoculations have no diagnostic value.
All sorts of sensations may occur after inoculation, and it is
possible that, with the development of rabies, any existing
wound may become painful. If we knew more.about this
disease— if, for instance, we knew for certain that rabies
never occurred in a paralytic form in man—the paralytic
symptoms adduced by M. Peter would have more import¬
ance. But this is not the case. Not only is it probable that
the paralytic form of rabies will soon become a recognised
variety, but it has even been described in a Paris thesis
published before the application of M. Pasteur’s intensive
method, and consequently written without partiality. Van
Swieten also quotes a case which occurred in 1684, and
which is reported in the Philosophical Transactions by Dr.
Roger Bowman.” M. Vulpian read several observations of
the kind, and added that “we cannot, without committing a
grave mistake, attribute the paralytic symptoms of rabies
occurring in those who have been submitted to the inten¬
sive treatment to the effect of the rabbit virus. The rabbit-
derived virus, indeed, does not always give rise to paralytic
symptoms; in the dog so infected the rabies is of the
furious kind. To return now to M. Peter’s assertion that
the method is inefficacious and irrational, having failed
‘lamentably.’ How can we lay down the law in such
matters? This is not a question of theory, but of fact.
M. Peter knows as well as anyone that the over¬
whelming proofs he speaks of do not exist. He
bases his examination of the results upon an old statis¬
tical return of the number of deaths occurring annually
in France from rabies, from which it would appear
that, notwithstanding the preventive inoculations, the
mortality remains the same. But these statistics are
perfectly unreliable, and when quoted by M. Brouardel,
the remark was added that the mortality was no doubt
much greater than appeared. It has been pointed out
repeatedly that fourteen cases have died after inoculation,
and that sixteen deaths have occurred in individuals who
have not undergone the preventive treatment. Adding the
two together the mortality has been the same as the average
—that is to say, thirty deaths in all, and it has been concluded
by a comparison of the numbers of deaths that the chances
were only as sixteen to fourteen in favour of the inoculated.
But the truth is, the vast majority of those bitten have
submitted to inoculation, and the fourteen deaths have
occurred in 1726 cases, giving a mortality of less than
1 per cent., whereas the sirteen fatal terminations have
occurred in a small minority, probably not more than a
hundred cases, and give a mortality of 16 per cent.,
which is about the average mortality from rabies after dog-
bite. Taking this figure, 16 per cent., as the basin of our
calculation, of the 1726 persons treated, by M. Pasteur
276 would have died. Subtracting those who were not
saved by his method, there remains 262 persons who owe
their lives to M. Pasteur. And this is the lamentable
failure of which M. Peter speaks! M. Peter’s objections
stand upon no solid foundation, and they are without
value. The method of M. Pasteur is entirely free from
danger, and nearly always preserves from rabies. It Is
successful even in an unhoped-for degree.” M. Vulpian,
whose speech was received with enthusiastic applause, was
followed by M. Brouardel, who went over much the same
ground. He read passages from the observations of Van
Swieten, and quoted from the thesis of Dr. Roux to show
that there was a paralytic form of rabies in man. He
maintained also that there could be no question as to the
value of inoculation as a criterion of rabies in obscure cases.
M. Peter’s attempt to discredit its certitude w&s useless, the
results obtained by this means of investigation having been
uniformly constant..

The iStcmaine Medicate of the 19th inst. publishes the
account of a conversation on M. Peter’s communication
between M. von Frisch and its Vienna correspondent.
Professor von Frisch says M. Peter is wrong in concluding
that the cases he has brought forward died of rabbit-derived
disease. The laboratory virus does not always give rise to
a paralytic rabies, and the only proof that death had been
caused by the inoculations would be the production of the
dog, for whose bite the treatment had been undertaken, in
a state of health. Since the publication of the results of his

Thx Lancet,]

rABIS.—FLORENCE.

[Jan 29,1887. 24 3

lint experiment M. von Frisch finds that “ dogs which have
beta treated by the intensive method without previous in¬
fection with street-rabies have invariably succumbed.”

The Pasteur Institute has lost nothing by M. Peter’s con¬

tentions. The last three subscription lists have brought in
129,000 francs.

The following statistical account was distributed to the
members of the Academy

General Statistical Account of french and Foreign Patients treated at the Pasteur Institute up to December 31st, 1S8G,

Pmo m bitten and treated . 8682

Doth] . 31

Mortality. l'U%

f Persona bitten by animals known to have been rabid, either by experi¬
mental proof or veterinary observation:

Bitten ...

Deaths .

Mortality... .1. .

Persons hi tten by animals suspected of rabies:

Bitten .

Deaths .

Mortality.

3164

29

i-3i%

513

2

0-38"

Statistics of French and Algerian Patients treated up to December 31st, 1886.

f Persons bitten by animals known to have been rabid either by experi¬
mental proof or veterinary observation :

! Bitten . 1583

Pwsona bitten and treated .

eee

...

...

1929

Deaths .

... 19

Doth* .

...

...

...

18 ■

Mortality.

... 1-04%

Mortality.

0-93%

1 Persons bitten by animals suspected of rabies:

Bitten .

Deaths .

1 Mortality.

391

2

0-57%

Statistics of Bites about the Head and Face.

French and foreigners bitten and treated ... 214

Deaths . 10

Mortality. 4-66%

Pawns bitten bv animals known to have been rabid either by experi¬
mental proof or veterinary observation :

Bitten . 186

Deaths . 9

Mortality. 4’88%

Persons bitten by animals suspected of rabies :

Bitten . 28

Desth . 1

Mortality. 3-57%

Comparison of the Simple and Intensive Treatments.
Bites about Head and Face.

Persons bitten bv animals known to have been rabid either by experi¬
mental proof or veterinary observation :

French and foreigners bitten and treated

Simple treatment .

Deaths .

Mortality.

186

136

10

6 - 66 %

Intensive treatment

Deaths .

Mortality.

50

0

0

Statistics of Persons Bitten by Rabid Wolves.

Persons bitten . 43

Deaths . 7

Mortality . 14%

Three of these deaths oocurre<l during the treatment. They are, however, comprised in the return, and count in the percentage.

Persons who have Died after Treatment.

French.

Metier, Videau, Lagnt, Bouvier, 016didre. Peytel, Leduo, Magneron,
Artier, Moolis, Moermann, Clergeot, Jansen, Grand, Sodlni, Leteng,
See. Gerard.

Vrtr.—Pelletier and Moermann came for treatment thirty-ft ve days after
Ufcbite.

Persons treated %cho ha»• died of different Diseases.

Christin, meningitis (Dr. Genoud); Durasset, pulmonary disease
ibr.Yot); Rouyer, uremia(report of Dr.Brouardel); B 6 veillac. unknown.

-Yefc.—Go riot’s esse (a recent one) will figure in the 1887 statistics,
'fctlh having occurred on January 16th.

Foreigners.

Ivanowa, Bossian ; Gagou. Houmanian; Zotoff, Russian; Nyasnikoff.
Russian; Glutza, Roumanian; Lecudet, Dutch ; Nlldforoff, Russian;
Guardla Ribes, Spaniard ; Pita, Spaniard; Kequego, Spaniard; Berqui,
Italian ; Collinge, English ; Smith, English.

Note .—Ivanowa was seized with symptoms six days after treatment 7
Gagou the day after the end of the treatment; Nikiforoff came a month
after the bite; Requego thirty-four days after the bite. These count in
the percentage.

Person treated dying of other Disease.

Wilde, Arthur, pulmonary disease (Dr. Foote).

FLORENCE.

{From our own Correspondent.)

For the present in Italy Florence is the centre of sanitary
iaterett, owing to the charges brought against her salubrity
bj non-medical correspondents in influential journals. In
the first quarter of 1886 there were, it seems, fifty-one
d«*th» from typhoid and five from diphtheria; whereupon
the foreign visitor was loudly warned to keep outside her
Wee until her municipality had purged her of the disease-
producing causes. The SocietA d’lgiene, however, has just
iwwl a report which proves Florence to have a lower
kwh-rate than any other Italian town of approximate
and that, as to typhoid, she ranks ninth among the
’hiiteen great Italian cities in mortality from that disease.
The document is a carefully compiled one, and is signed by
President of the Society, Dr. Paoli, by the two Vice-
Presidents, Drs. Faralli and Fenzi, and by six other office-
hwers, well known in the medico-statistical world. A few
extracts may be useful to those of your readers who are 1
Mked (as is usual at this season) how far this or that Italian !
tawn is safe for the English sojourner.

In the quinquennium 1881-85 Florence had 811 deaths I
from typhoid, thus distributed: 202 deaths in 1881; 166 I
a 1882; USfcln 1883; 112in 1884; and 179 in 1885. Except I

in 1885 there was thus in the preceding four years a pro¬
gressive diminution. For the same quinquennium the
mortality from every cause was 23-292, which (the typhoid
deaths being 811) gives 34 - 8 victims to this disease per 1000.
The population of Florence according to the census of 1881
being 169,001, there were in every 10,000 inhabitantsO 6 deaths
from typhoid—i.e., lees than one per 1000 yearly. In fact, the
annual mean of deaths from this cause was 162—that is to say,
13 5 per month. It is therefore manifest that the mortality
of the first quarter of 1886 ought to have been 40 5, but that
it was 51 by one of those accidental variations common to
every fact in nature, to be compensated by an opposite
variation, as indeed happened in the quarter immcKhately
following, when the mortality from the same cause was.
only 32.

Another point. That the importance attached to th&
deaths from typhoid is exaggerated is shown by the fact
that in the necrological tables typhoid appears among the
other causes of death as occupying only the eleventh place,
the order of sequence being this:—1, pulmonary phtnisis;
2, inflammation of the respiratory organs; 3, organic affec¬
tions of the heart and great vessels; 4, marasmus and the
varieties of tabes; 5, determinate causes and others; 6,
cerebral apoplexy ; 7, cancerous cachexia ; 8, pulmonary
catarrh ; 9, enteritis and peritonitis ; 10, meningitis and
encephalitis; 11, typhoid fever. Moreover.it is necessary
to distinguish, in the total number of deaths, those victim?

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244. The Lancet,]

NEW TORE.—ROYAL COLLEGE OF PHYSICIANS.

[Jan. 29,1887.

■who, having come to be cured in Florentine hospitals of
diseases contracted in the outlying communes, have died in
these hospitals. In the fif tv-three months from July 1st, 1882,
to Nov. 30th, 188G, out of 711 deaths from typhoid, 566 were
of persons belonging to the commune of Florence, and 145
(rather, more than one-fourth) were of the other category.
With this legitimate deduction the deaths would be reduced
to the much smaller mean of 128 per annum, and the mortality
among the resident citizens would descend to 7'57 per 10,OOOof
the population yearly. Without this deduction* Florence still
ranks only as ninth in mortality fronwyphoid, after Bari,
Catania, Brescia, Leghorn, Palermo, Messina, Turin, and
Milan; her death-rate from this cause being almost equalled
by that of Naples, and slightly higher than that of Rome,
Genoa, and Venice.

Yet another point. The observations on the mortality
from typhoid made during the last six years have proved
that there is no true centre of typhoid infection in Florence,
the deaths having occurred in quarters of the city quite
distinct and wide apart. With very few exceptions the
malady has numbered its victims by preference, and almost
exclusively among the very lowest in the social scale, who
herd or huddle together in wretched 'habitations, whose
life is h struggle with bad or insufficient food, foul
air, scanty clothing, and neglect of every sanitary law.
The Florence in which the English-speaking visitors con¬
gregate—the new Florence extending from the feet of the
Coliine di Majano, di San Domenico e del Pelegrino, up to
the grand Viali, which separate it from the old city—offers
hardly a case of typhoid to the statistician.

Finally, from the quite recent official publication of the
Minister of Agriculture and Commerce it appears that at
the end of 1885 the.population df the Italian kingdom was
29,699,786, out of which in that year there were 737,217
deaths, which gives the proportion of 265-06 deaths per
10,000 of the inhabitants, or 26 50 per 1000. In Florence
in the same year there were 4625 deaths, from which,
deducting 720 as not belonging to the commune, there
remain 3905. The population of the city up to that date
being 173,063, the proportion of deaths that year was
225-64 per 10,000 inhabitants, or 22-36 per 1000—notably,
therefore, lower than the general mean of the kingdom.
To improve this state of things (relatively satisfactory as it
is), the municipality will shortly put in practice new and
extensive sanitary measures, chief among which is the
daily flushing of the city drains, while the Societa d’lgiene
has appointed a commission, in concert with the great body
of the practitioners, to examine the causes of typhoid at
their source, and to aid the municipality in removing them.

Diphtheria, it is added, since the epidemic of fifteen years
ago, has hardly been known in Florence.

Florence, Jan. 16tb.

NEW YORK.

(From our own Correspondent.)

JOHN P. GUAY, H.D., LL.D.

The death of Dr. Gray, superintendent of the New York
State Lunatic Asylum, creates a vacancy among the alienists
of; this country which ’will not soon be filled. For over
thirty years he stood in the front rank in hie specialty. He
made the asylum at Utica famous as a school in which were
trained many of the more prominent asylum superintendents
of this State. His own fame culminated in the trial of
Guiteau, the assassin of President Garfield, when he appeared
as the Government expert, and by his testimony as to the
prisoner’s sanity exercised so powerful an influence that
prompt conviction followed. Dr. Gray was a man of massive
physical as well as mental form and force, and while an
autocrat in his field of labour, be was a most genial
Christian gentleman, overflowing with Sympathy for human
suffering. Dr. G. Alder Blumer, the first assistant physician
of the asylum, has been appointed Dr. Gray’s successor.
Dr. Blumer is of English birth, but was educated in this
country, and has been on the staff of the asylum seven
years.

quarantine at new yobk.

The quarantine of New York, always the most efficient in
this country, has undergone marked improvements during
tl}e. year. Detention as a quarantine measure has yielded

to sanitary cleanliness and freedom from contagious diseases.
So thoroughly has the health- officer impressed upon the
masters of vessels that cleanliness of their ships and healthi¬
ness of crew and passengers will be his test of their right
to pass quarantine, that during the past year net a pound of
cargo has been discharged in quarantine, nor has there been
longer detention than was needful to make the necessary
examinations. This is an entirely new experience in the
management of quarantine with us, and is undoubtedly the
beginning of a new era in the history of this old, cumber¬
some, ana ineffectual method of preventing the introduction
of foreign pestilences into our ports.

ABDOMINAL AND PELVIC 6CBGEBY.

These new fields of operative surgery are being cultivated
with an ardour among our surgeons quite astonishing. I
have before me the cards of several hospitals announcing the
operations in each on operating days. Abdominal section
has the precedence. In one hospital four such operations
are announced for one session. Cancer of the stomach, gall¬
stones, peritonitis, and uterine and ovarian affectionsare given
as the objective points in the operations. Extirpation of the
ovary for alleged hydro-, pyp-, of hsetHato-salpinx is becoming
alarmingly frequent. The question has been raised in the
Academy, and none too scon Is this operation required so
frequently? One prominent gynaecologist stated in con¬
versation that he had seen healthy ovaries that had been
removed as in diseased conditions. The successful
removal of a table-knife from the stomach by Dr.
Bemays, of St. Louis, is one of the most recent achieve¬
ments in abdominal surgery. The knife was nine inches and a
quarter long, and lay transversely, the handle at the pylorus.
The operator on exposing the stomach seized the handle,
cut on it, and withdrew the knife; the patient did well.
This is the second recorded operation for the remhval of
a table-knife from the stomach. The first was performed in
1791 by Scbwabe, who extracted a knife six inches and a
quarter long by the.point; his patient recovered.

INTEBNATIONAL MEDICAL CONG BESS: SECTION OF
PSYCHOLOGY.

By the death of Dr. Gray this section was deprived of an
energetic chairman, whose force and prestige would have
ensured a successful session. Hie successor is Dr. J. B.
Andrews, superintendent of the Buffalo Insane Asylum,
New York State—a gentleman little less known as an
alienist than his predecessor, and of equal force of character.
He has begun the work of organisation with great energy,
and will without doubt make the section one of the moat
interesting of the Congress. From present appearances the
Congress will prove a great success. Every eection is now-
well advanced in its preparation, and the profession of the
States has become heartily and coidially enlisted in the
work of organisation.

LABORATORY OF PRACTICAL HYGIENE.

Laboratories are increasing in this country. Several
medical colleges have recently received endowments for
departments for laboratory work. Recently the State Board
of Health of Michigan petitioned the Regents of the Uni¬
versity of that State to establish a Laboratory of Practical
Hygiene, and the Regents have approved the suggestion,
and will ask for the requisite appropriation.

January, 1867.

ROYAL COLLEGE OF PHYSICIANS.

At the Comitia on the 27th inst., Sir W. Jenner, Bart.,
President, in the chair, the following gentlemen were
admitted Members of the College: —Dr. G. A. Maoonachie,
Dr. J. A. Marston, Dr. Jas. Reid, and Dr. F. J. Smith.

A communication was read from the Royal College of ’
Surgeons, with reference to the celebration of Her Majesty’s
Jubilee by the Colleges; and a Conjoint Committee was [
formed to consider the proposal.

Dr. Eristowe was nominated to the Committee of Delegates, !
in the place of Dr. Pye-Smith, resigned. Dr. Habershon,
Sir Ed. Sieveking, Dr. Blandford, Dr. Sturgee, and Df. J. E. j
Morgan were elected to serve on the Council of the College. ,
The annual report of the Examiners was read, ana a 11
tabulated return showing the results of the several exami- r
nations was presented. .

A report from the Committee of Management recoin- J

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The Lancet,]

OBITUARY.—MEDICAL NEWS.

[Jax. 29,1887. 2 45

mending the appointments of Mr. F. G. Haltett as secretary,
and Measra. W. Fleming and C. E. Scragg as senior clerks to
the Examination Hall, was adopted.

On the recommendation of the Council, the title of the
Certificate in Hygiene was altered to that of "Diploma in
Hygiene,” and it was resolved that the College of Surgeons
be invited to join in the examinations for this diploma.

On Dr. Qu&in’s motion, the resolution adopted on June 29th
with respect to the Crooni&n Trust was referred to the
Special Committee, to ascertain what further steps were
necessary to carry it into effect.

A report was read from the delegates appointed by the
two Colleges to deliberate on the best use to which the
unoccupied ground on the Thames Embankment, belonging
to the two Colleges, can be applied. The recommendation
of the delegates, that the ground be utilised for the prose¬
cution of research in, and the exposition of, subjects connected
with medical science, was adopted by the Colleges.

(fbituarj.

JOHN DENHAM, M.D., F.JLGS.I.

Ox Friday, the 2let- inet., Dr. Denham died at his residence
at Kingstown, near Dublin, at the advanced age of eighty-
one years. Dr. Denham was well known in Dublin, where
he practised for many years as an obstetric surgeon, filling
for seven years the important post of Master of the Rotundo
Lying-in Hospital in that city. The deceased was born.at
Killsahandra in 1800, and was the son of a Presbyterian
clergyman. He was apprenticed to Dr. Ephraim McDowel,
one of the founders of the Richmond Hospital, where he
commenced his studies. He graduated in medicine at
the University of Edinburgh in 1801, and the following
year obtained the licence of the Royal College of Surgeons
in Ireland. He was elected a Fellow of the College in 1803,
some time afterwards a. member of the Council, and pre¬
sident in 1873-4. He was also an ex-president of the Dublin
Obstetrical Society. Dr. Denham’s health became impaired
a few years since, and he retired from practice; the occasion
being taken advantage of by his friends, both lay and pro¬
fessional, to present him with a substantial testimonial in
1886. His contributions to obstetric medicine included
"Case of Inversion of Uterus after Delivery,” "Puerperal
Tetanus,” "Case of Labour with Unruptured Hymen,*
"Operations for Ruptured Perineum,” &c. He was married
twiee, his second wife surviving him, and leaves a son, who
is a member of the profession and practises in Dublin. His
remains were interred in Mount Jerome Cemetery on the
26th inet., the funeral torthge being a very large one.

HENRY MUNROE, M.D.

Db. Henry Munrok, whose death recently occurred at
his residence in Hull, was born in Kingston-upon-Hull in
1818. He received his professional education at Gay’s
Hospital, and became a Licentiate of the Apothecaries’
Society in 1839, a Member of the Royal College of Surgeons
of Englamd in 1840, and in 1859 obtained the degree of M.D.
at King's College, Aberdeen. In 1840 be settled in his native
town, where he for many years enjoyed a large practice.
Dr. Monroe was a Fellow of the Linnfean Society, and for a
quarter of a century was lecturer on Medical Jurisprudence
tad Histology at the Bull and East-Riding School of
Medicine. For some years he was an active member of the
Hull Corporation, and rendered essential service to the town
oa the sanitary and other committees of that body. Dr.
Monroe contributed several papers to the various medical
aad microscopical journals, and since 1800 he had been an
active and ardent supporter of the temperance movement.

SURGEON JAMES PEDLOW, M.D.Q.U.I.,

SUR<; Alt MY MEDICAL STAFF.

SOBOSOXPnbi.o 'a died of cholera on board the a&Itangoon
on Oct. RlaVand was buried at Menbo. He was proceeding
up the Irrawaddy to Bhamo in charge of C and D Sections,
No. 16 fMM Hospital. After leaving Tbayetmyo he was
attackedhy egtqjfa*; all that could bedonafor him by careful

attendance was afforded by Surgeon S. F. Freyer, A.M.S.,
who was with him till his death. Dr. Pedlow had seen
much active service in Afghanistan and Egypt; for the
former he was awnrded a medal, and for the latter a medal
and two clasps and bronze star, as mentioned in the de¬
spatches. He formerly served in the Turkish army and saw
much fighting. He received a commission in the Turkish
army, which was dated Feb. 3rd, 1878.

Hhbual $hfos.

Royal College of Surgeons of England.—T he
following gentlemen, having undergone the necessary exami¬
nations for the diploma, were admitted Members of' the
College at a meeting of the Court of Examiners on Jan. 20th :

Balgamle, Wilfred. Scarborough. '■

Beadle, Joseph. Middieton-ln-Tijfsdiile. Durham.

Brown, Lewis Henry, Cuienove-road, Stamford-hill. .

Charles, Henty Evans. 8wansea.

Farr, Joseph James William, Enrls-oourt-road.

Frost, Francis Taruer, College-road, Bromley.

Green, Robert Walter. Leeds.

Grose, John Soboy, Wadobridge, Cornwall.

Hebblothwaite. Harold, Bradford.

Hitchings. Robert, South Hackney.

Nicholson, Charles, York.

Powell, Lewis, Orouah Bnd.

Hymcr, James Francis, Pevensey, Croydon.

Simpson. Charles Shackletqn, West Kensington.

Taylor, Frederick Howard, Pyrland-road.

Turtle, Frederick Wean an. Woodford. Essex.

YuugeyBateman, Marcus George, Folkestone.

Admitted on the 21st inst.

Bidwell, Leonard Arthur, L.S.A.. Lce-terrace, Blackheath.
Blenkinsop, Alfred Percy, L.RC.P. Lend., Hijldrop-crescent.
Brook. W. H. BreflHt. Lincoln.

Bueno de Mosquito, Solomon, Goodmans-flelds.

Corbin, Eustace Rhodes St. Clair. M.B. Lond., Stanhope-street.
Crouch. Charles Perolval, Hampstead.

Garrould, Walter Robert, L.R.C.P. Lond., Willcsden-park.
Gravely, Harry, L.S.A., Lewes. Swssex.

Hamilton, Robert Jcssop, Brinces-road. Liverpool.

Harris, Edward Bernard, L.5.A.. Stoke Newington.

Helsbam. HugUPaijl. L-R.C.P- Lond., Klrkdale, Sydenham. ,
Marshall, Arthur Lurasden. L.S.A., Leicester.

Staple, James Dibble, L.S.A„ Basswater.

Walsh, Robert William. L.S.A., 6h*dwell.

Walla, James. L.S.A., Handey, Wigan.

. Williams. Arthur Henry, New Cross.

Admitted on the 24th inst.

Anderson. W. Maurice Abbot. M.B. Durh., Endslelgh-ganlens.
Browne, Edward Granville, LJt.O.P. Lond., Bernard-street.
Brownfield, Harry Munyard, Rotberhithe.

Bullock. Roger. L.R.C.F. Load., Warwick.

Cook. Edward Thomas, L.S.A.. Southsea.

Dinoker, William Remhold,L.R.O.P. Lond., Finsbury-park-road.
Evans, Howell Thomas, Tredegar.

Bvelyn. William Arthur, L.R.U.P. lond., Vincent-square.
Fitzgerald, Gtrald Crowfoot, M.B. Camb., West Dulwich.

Fjra, Tbeordore Albert Veres, L.S-A.. Clifton, Bristol.

Greene. Henry Bertram Bladwell, Cheltenham.

Griffiths. William, L.8A, Htghgato.

Hamel, Julius, Clapham.

Hicks, Edward Harman, L.S.A.. Folkestone.

Kitaon, Francis Parsons, UR.O.P. Lond., Martland-park-villas.

., Loxton. William Arthur, L.B.O.P. Lond., Birmingham.

Taylor, John Francis, L.S.A.. Blackheath.

’ - MoShane, George, L.R.G.P.Lond., 8outhsea.

The lectures for the present year will be commenced on
Monday, the 31st inst, by John Bland Sutton, F.R.C.9. Eng.
(Erasmus Wilson Lecturer), who will deliver on that day
and on Wednesday and Friday three lectures on “ Evolu¬
tion in Pathology.” The lectures will be commenced at
4 p jc. each day.

Society of Apothecaries.—T he following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on the 20th inst.

Arnold. Francis Sorell, M.R.C.S.. Bradmore-road, Oxford.

Blaker, Edward Spencer, M.R.C.S.. Mamiora-road, Honor Oak.
Braddou, William Leonard, M.R.C.S.. Upton-upon-Severn.
Laker, Richard, L.R.C.P., M.R.C.S., Smith-square, Westminster.

German Hospital.—T he annual general court of
governors of this institution was held on the 26th inst.,
when the report showed that the number of in-patients
treated during the year was 1663, and of out-patients 23,219.
The number of parents in the Convalescent Home was 449.
The annual expenditure amounts to about £9200, while the
reliable income is only £5800. The Duke of Cambridge,
President of the hospital, has promised to preside at the
42nd anniversary festival, which will take place on April 27th,

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246 Tins Lancet,1

MEDICAL NEWS.

[Jan. 29,1887.

The Shrewsbury Hospital Sunday collection is to be
held on the ISthprox. The last collection realised £'238, an
increase of .£12 on the previous year.

At the second annual meeting of the subscribers to
the Sidmouth Cottage Hospital, which was recently held, a
highly satisfactory financial report was presented.

The first annual ball in aid of the funds of the
Royal National Hospital for Consumption, which was
recently held at Ventnor, proved highly successful.

Medical Magistrate. —The Lord Chancellor has,
on the recommendation of the Lord-Lieutenant, placed the
name of Dr. Langdon Down on the Commission of the Peace
for the County of Middlesex.

On the 19 th inst. a cowkeeper at Leicester was
sentenced to a month’s imprisonment, without the option
of a fine, for being the owner of meat intended for the food
of man, but which was unfit for that purpose.

Vaccination Grant. —Mr, T. H. B. Bodwell, of the
No. 2 district of the Loddon and Clavering Union, has
received the Government grant for efficient vaccination
(sixth time).

Deaths of Centenarians. —The deaths are reported
of a widow in Wetzlau, aged 108, and of the well-known
sheikh of the howling dervishes in Constantinople, Alif Baba,
aged 110.

A Grateful Patient. —M. Ramon Fernandez, the
Mexican Minister in Paris, has informed the Prefect of the
Seine that a native of Zacatecas, a State of Mexico, has
bequeathed £1060 to a Paris hospital where he was nursed
in 1841.

At the fortnightly meeting of the managers for the
Central London School district on the 24th inst., it was
reported that there had of late been an appreciable decrease
of ophthalmia amongst the pauper children at the Hanwell
schools.

The report of the Charite Hospital in Berlin shows
that 17,010 patients were admitted during the year 1886, to
which number must be added 1253 infants bora alive, also
79 stillborn. The total deaths amounted to 1904. The cases
cured numbered 14,892.

Presentation. —Mr. D. H. Thomas, Swansea, has
been presented with an illuminated address and a purse of
160 guineas, in recognition of his services to the town and
its inhabitants. The money has been given by the recipient
to several local charitable institutions.

Food Exhibitions. —An International Exhibition of
Popular Food and Cookery will be opened at the end of the
present month at Leipsic. The capital of 100,000 florins
required for the organisation of an International Food
Exhibition at Amsterdam has been subscribed.

Finsbury Dispensary. —The annual general meeting
of the governors of this institution was held on the 26th inst.,
when the committee’s report showed that during the past
year 15,912 new cases had been treated at the dispensary,
with a total attendance of 35,366 ; 3151 patients had also
been attended at their own homes.

West Cornwall Dispensary and Infirmary.—
The fourteenth annual meeting of the supporters of this
institution was held at Penzance on the 19th inst, when it
wos reported that the number of in-patients during the past
year was 104, and of out-patients 1525. The income amounted
to £635, and the expenditure to £624.

Lincoln General Dispensary. —The annual general
meeting of the governors of this institution was held on
the 18th inst., when it was stated that the number of home
patients treated during the year was 1513, and of out¬
patients 1744, making a total of 3257. The total income
amounted to £886, ana the expenditure to £833.

Adulteration of Food in Spain. —The Spanish
Ministry of the Interior has issued a circular to the governors
of the different provinces, calling their attention to the im¬
portance of fool being sold in a pure and wholesome con¬
dition, and directing them to see that the various municipal
authorities enforce the laws against all persons, of whatever
position they may be, who adulterate food, and that their
names and the nature of their offences are published in the
Bole tin Oficial.

Leeds Hospital for Women and Children.—
The report which was read on the 24th inst. at the thirty-
fourth annual meeting of the supporters of this hospital
stated that the patients during 1886 had numbered 1339.
1140 being out-patients, and 199 in-patients. The total
income was £2265, being £789 more than in 1885, and the
expenditure amounted to £1382.

At the meeting on the 26th inst. of the committee-
appointed to consider the proposal to found a medical
school in connexion with the Dundee University College,
the receipt of a donation of £6000 towards the foundation
of the school was announced. This sum is in addition to
the gift of £12,000 for the endowment of a chair of anatomy
which had previously been announced.

Steps are being taken by the officers and men of
the Coldstream Guards to raise a monument to the memory
of Sister Crump, one of the staff of nursing sisters doing
duty at the regimental hospital, who recently died while in
the actual discharge of her duty. Miss Crump joined the
service four years ago, and after serving in Egypt since
October, 1884, was invalided home last April.

Volunteer Medical Staff Corps. —Sir J. Harr-
bury, K.C.B., the principal medical officer of the home
district, distributed on the 22nd inst. prizes to the Woolwich
division of the Volunteer Medical Staff Corps, and took the
opportunity of speaking strongly of the importance of a
more extended system in connexion with the Volunteer
force for tending the sick and wounded. An appeal wm
made to the medical profession to take up the matter.

Norwich Jenny Lind Hospital for Children.—
The annual meeting of the governors of this institution was
held on the 19th inst. The number of patients during 188ft
was 1642, being 438 in excess of the number received inr
1884, when the highest total since the establishment of the
hospital was reached, and 50 in excess of 1885. The total
receipts amounted to £2272, and the expenditure to about
£ 1100 .

City Dispensary. — The ninety-eighth annual
meeting of the governors of this institution was held on the
20th inst. During the past year there has been a great
increase in the number of personal attendances, the aggre¬
gate exceeding 30,000. The total number of patients treated
was 15,124. The accounts showed that with a balance of
£366 brought forward from last year the receipts had been
£1744 and the expenditure £1443, leaving a balance or £301.
but the liabilities at the present moment will absorb this.
The annual festival in aid of the charity is to be held on th*
24th prox.

Harrogate Bato Hospital. — At the general
annual meeting of the governors of this institution on the-
20th inst., it was reported that the number of patients treated
during the past year was 664. This was a decrease on the
previous year, but many cases recommended were of a con¬
valescent nature, and consequently inadmissible; this diffi¬
culty will be removed when the convalescent wing is opened.
The receipts amounted to £1535, as against £1636 in the pre¬
ceding year. The number of baths administered was 5580.
being 17 more than in the previous year.

Birmingham Children’s Hospital. —-The annual
meeting of the governors of this institution was held on the-
24th inst., when the secretary reported that the finances of
the hospital were in a much sounder condition at the end
than at the beginning of 1886, as the debt had been reduced
to £301, whereas twelve months ago it was £910. The total
expenditure during the year was £4306, being £142 less than
in the preceding year. The number of in-patients was 794.
out-patients 18,035, and 143 children were received at the-
Convalescent Home.

Society for the Prevention of Hydrophobia
and Reform of the Dog Laws. — A most important
meeting of this Society was held at the offices, 50, Leicester-
square, London, W.G.,-on Monday. The Duke of North¬
umberland, the Duke of Westminster, the Earl of Egmont,
Lord Stanley of Alderiey, and Professor Huxley were elected
vice-presidents, and several members were added to the
eneral committee, among them being some well-known,
readers and exhibitors of dogs. Proposals for future legis¬
lative action had been circulated among members* and these
were considered and adopted formally as a basis for subse¬
quent discussion. The Society aims at such amendment of

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Ties Lancet,] APPOINTMENTS—VACANCIES -BIRTHS, MARRIAGES, AND DEATHS. [Jan.29,1887. 247

the Dog Act as will ensure, permanently, the better control
ot all dogs throughout the kingdom, and the removal of the
large number of stray dogs, which are a constant source of
danger and trouble; but, in consequence of the continued
-spread of rabies in the country, it is hoped that a short
Act may be carried by Parliament for the extension to
the provinces generally, for six months, of those regulations
which have recently proved so effectual in London.

Football Fatality. —A boy aged nine years,
residing with his parents at Irvine, died on the 20th inst.
from injuries received while playing football at school.
During a scrimmage he received a kick on the loinp, which
resulted in inflammation of the bowels. Deceased remained
in an unconscious condition for several days after the
occurrence.

National Hospital for the Paralysed and
Epileptic. —A festival will be held at the Holborn
Restaurant on Wednesday, Feb. 9th, the Right Hon. Lord
Halobury (Lord High Chancellor) in the chair, to com¬
memorate the opening of the National Hospital for the
Paralysed and Epileptic, and with the especial object in
view of assisting to raise a jubilee fund to enable the whole
of the accommodation to be taken into use, wards containing
fifty-five beds (of a total of 180) not having been as yet
in occupation.

Dorset County Hospital. —At the annual meeting
•f the friends and supporters of this institution, held on
Thursday the 27th inst., an attempt was made by resolution
to render members of the medical staff ineligible to sit on
the general committee of the hospital. So great and
effective, however, was the opposition to the motion, that it
had to be withdrawn. The committee was enlarged from
twelve elected members to eighteen, and a resolution pro¬
posed by Dr. Lusb, that at least four days’ notice be
given of any notice of dismissal, was carried by a large
majority.

Society for Relief of Widows and Orphans
of Medical Men.—A quarterly court of this Society was
held on Jan. 12th, at the rooms of the Society, 63, Berners-
street. In the unavoidable absence of the President, Sir J.
Paget, the chair was taken by the Senior Vice-President pre¬
sent, Mr. Tegart. A sum of £1364 was voted for distribution
among the 63 widows and 9 orphans on the funds. The
expenses of the quarter amounted to £56 &*. 6ei. One new
member was elected, the resignations of 4 read, and the
deaths of 5 reported. The secretary stated that during the
last year there had been 16 deaths among the members,
and 19 resignations, and only 5 elected. Astonishment was
expressed by many of the directors that so few new mem-
ken joined, the advantages being so great; some thought if
it could be made more generally known that young men
could join on completing their studies and when still living
within the twenty-mile radius, and that, when once a mem¬
ber, the membership was not forfeited by removal beyond
the radius or even out of the country, many young men
would avail themselves of the opportunity of ensuring a
-slight provision for their widows and orphans.

l^ointments.

Successful applicants for Vacanciss, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to Thb Lancet Office, directed to the Sub-Editor, not later
than 'J o'clock on the Thursday morning of each week for publication in
the next number. _

Arnold. William, M.R.C.S., L.S.A., has been appointed Medical Officer
for the Blisworth District of the Towcester Union.

Bkaley. Adam, M.A., M.D.Cantab., F.B.C.P.Lond., has been re-elected
Honorary Consulting Offioer to the Harrogate Bath Hospital.

Bkitton, Thomas. M.D. St. And., M.R.C.S.. has been re-elected
Honorary Medical Officer to the Harrogate Bath Hospital.

Coombe. Hubert Gorton, iun., M.B.C B.. L.H.C.P.Bd., L.S.A., has
been appointed Medical Officer. Public Vaccinator, and Registrar of
Births and Deaths to the Southminster District of the Maktan
Union, vice Arthur iattey. L.R.O.P.Lond., M.R.C.S., resigned.

Deane, Edwaki>, L.B.C.P., M.R.C.8 .. late Assistant House 8urgeon,
has been appointed House-Surgeon to the Royal Berks Hospital,
vice G. A. Shackel. resigned.

Dotne. R. W., M.R.C.S., L.SA., has been appointed Surgeon to the
Oaford Bye Hospital.

Gave, H. 8 ., M.D. St. And.. M.B.C.8.. has been elected Consulting-
Burgeon to the Newton Cottage Hospital and Dispensary.

Greene, Guorok Bn ward Joseph, L.R.C.S.I.. L.K.Q.C.P 1., Admiralty
Surgeon, KUraore, has been appointed Medical Officer for Ferns
Dispensary, Bnnisoortbv Union, vice Smyth, resigned.

Harston, Lionel dk Couitcv Eagles, L.R.C.P.. M.K.C.S., has been
appointed Medical Officer to the Perth Hospital, West Australia.

HayhuN. Eimjar, M.B., C.M.GIas., lias been elected Medical Director
of the Newton Cottage Hospital and Dispeusary.

Honsox, M.D.. B.S.Lono., P.R.0.8.Bng., has been re-elected Honorary
Medical Officer to the Harrogate Bath Hospital.

Little, A. N.. M.R.C.S., L.S.A., has been appointed Third Assistant
Medical Officer to the Worcester County and City Lunatic Asvlum.

Macaulay, Thomas, M.R.C.8 ., L.S.A.. has been reappointed Medical
Officer of Health for thft Market Harboro’ Rural District.

Mitchell. John, M.D.. C.M.Qias., has been re-elected Medical Officer
to the Barnard Castle Dispensary.

Morris. Biiward, M.H.C.S., L.8.A., has been appointed Medical Officer
for the Fernbum District of the Midburst Union.

Patrick, Roukrt. M.D.Dur., M.K.C.S , has been appointed Certifying
Surgeon (under the Factories Act) to the Bolton District.

Scott. W. Gifford. M.B., C.M.Ed., has been elected Medical Director
of the Newfon Cottage Hospital and Dispensary.

Silaw, Laueintox £.. M.D., M.K.C.P.. has been appointed Medical
Registrar and Demonstrator of Practical Medicine to Guy's
Hospital.

Southern, John, M.R.C.S., L.S.A., has been appointed Medical Officer
for the Ludlow District of the Ludlow Union.

Trkdixxick. Brxest, M.R.C.S., L.R.C.P. F.d.. has been appointed
Medical Officer for the 8tofci'say District of the Ludlow Union.

Watsox. Harry O., L.K.C.P.Hd., L.F.P.8.G!as., has been appointed
Medical Offioer for the Clee Hill District of the Ludlow Uniou.

il act ticks.

Ill compliance u-ith the desire of numerous subscribers, it has been decided to
resume the publication tender this haul of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement, _

Great Northern Central Hospital, Caledonian-road, N. — Aural
Surgeon.

Hull and Sculcoatks Dispensary.— House-Surgeon. Salary £150 per
annum, with house (unfurnished), coals, and gas.

Liverpool Infirmary for Children. — Assistant House-Surgeon.
Board and lodging In lieu of salary.

Liverpool Northern Hospital.— Assistant House-Surgeon. Salary
£70 per annum, with residence and maintenance in the house.

Norfolk and Norwich Hospital. Norwich. — Assistant to House-
Surgeon. Board, lodging, and washing provided, but no salary.

St. Bartholomew's HosprrAL. Smithfleld. K.C.— Asshtant-Physician.

Shrewsbury Bte, Ear, and Throat Hospital. — Surgeon. An
honorarium of £150 per annum will be given for three years.

Hirijrs, Utarriagcs, ttik $)ratfis.

BIRTHS.

Adams.—O n the 30th lust., at Glifton-gardens, W., the wife of G. D’Arey
Adams, M.D., of a son.

Baldino.—O n the 34th inst.. at Dane House, St. Albans, the widow of
Mortimer Balding, M.D.Cantab, (who died on Nov. 23rd, 1830). of a
son.

Com yn.—O n the 18th inst., at Dawson-place, W., the wife of J. Sarsfleld
Comvn. Deputy Surgeon-General (prematurely), of a eon.

Hunt.—O n the 19th inst.. at Crouch-street. Colchester, the wife of
Edgar A. Hunt, M.H.C.S., L.R.C.P., L.8.A.. of a daughter.

Oman.—O n the 13th inst., at Strnda Mer.zodl, Valetta, Malta, the wife
of Nell Oman, M.D.Ed., of a daughter.

Payne.— On the 33nd inst., at Wimpole-street, the wife of Joseph Frank
Payne, M.D., of a daughter.

Struunkll.—O n the 24th inst.. at lligbgate-road, N.W., the wife of
F. W. Strugnell, L.R.C.P., M.R.O.8., oi a daughter.

MARRIAGES.

Praix— Thomson.— On the24th inst., at Calcutta. David Prain, Surgeon,
I.M.8.. to Margaret, second daughter of the Rev. W. Thomson, M.A.,
Minister of Belbelvle, E.B.

Belton—Bkll. —On the 25th inst., at the Parish Church, Baling. W,,
Bernard Belton, M.K.C.S.. L.8.A.. to Georgina Kate, yonnger
daughter of the late A. D. M. Bell, Esq., of Quebec.

Simon—W iL lans.— On the 36th inst., at Christ Church, Lancaster-
gate, by the Rev. Canon Fleming. B.D., assisted by the Rev. F. O.
Cun-ham, M.A.. Vicar of Cropwell Butler, Notte, Robert M. Simon,

M. B., M.R.C.P., of 26. Clarendon-road. Bdgbaston, Birmingham,

to Bmily Maud, younger daughter of William Henry Willans. of
23. HolUnd-park, Kensington, and KlghCIyfte, Seaton, Devon, Bsq.
(no cards). _

DEATHS.

Brown.—O n the 20th Inst., at hit residence, 25, Dublln-street, Edin¬
burgh, William Brown, F.H.C.S.Ed., aged 90.

Chkssall. —On the 19th inst., at his residence, Horley, Surrey, William
Chessall, M.D., aged 56. _____

N. B .—A fee of be. is charged for the Insertion of Notices of Births,

Marriages, and Deaths.

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248 This Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

{Jan. 29,1887-

HLbiral Jjrarjr for % muing Milk.

Monday, January 31.

Royal London Ophthalmic Hospital, Moorfixlds. —Operations,
10.80 A.M., and each day at the same boor.

Botax Westminster Ophthaluio Hospital.— Operation*, l JO P.M.,
and eaoh day at the tame hour.

St. Mask’s Hospital.—O peration*, a p.m.; Tnesdaya, same hour.
Chelsea Hospital nor Women.—O perations, 3.30 p.m.; Thursday, a JO.
Hospital fob Women, Soho-square. — Operation*, a P.M., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O peration*, a p.m.

Botal Orthopedic Hospital.—O peration*, a p.m.

Central London Ophthalmic Hospitals.— Operations, a p.m., and
eaoh day in the week at the same hour.

Society of Arts.— 8 p.m. Dr. J. L. W. Thudlchum: The Disease* of
Plant*, with special regard to Agriculture and Forestry (Cantor
Lecture).

Medical Society of London.—8.30 p.m. Dr. J. Langdon Down.- On
some of the Mental Affection* of Childhood and Youth (Lettsomian
Lecture).

Tuesday, February 1.

Huy's Hospital.— Operation*, 1.30 p.m., and on Friday at the same hoar.

Ophthalmio Operation* on Monday* at 1.30 and Thursday* at 2 p.m.
St. Thomas’s Hospital.—O phthalmic Operations, 4 p.m.; Friday, 3 p.m.
Cancbb Hospital, Brompton.—O perations, 3.30 p.m.; Saturday, 3.30 p.m .
Westminster Hospital.—O perations, 3 p.m.

West London Hospital.—O peration*. 3 JO p.m.

St. Mary's Hospital.—O peration*. 1.30 p.m. Consultations, Monday,

1.30 P M. Skin Department.. Mondays and Thursdays, 9.30 a.m.
Royal Institution op Great Britain.—3 p.m. Prof. Arthur Gamgee:

The Function of Respiration.

Society of Arts.—8 p.m. Mr. T. Armstrong: The Condition of Applied
Art in England, and the Education of the Art Workman.
Pathological Society of London. — 8.30 p.m. Mr. Bland Sutton :
Genito-urlnary Diseases of Animals.—Mr. D’Arcy Power: A Neglected
Point In the Pathology of Colles’ Fracture.—Dr. Griffith: Extra-
uterine Fcotation. — Mr. Bruce Clarke: Subperltoneal Rupture of
Bladder.—Dr. Barling: Tubercular Tumour of Brain.—Mr. Btlton
Pollard: MultlplePerforativeNecroslsofSknllof Tubercular Origin.—
Dr. W. Edmund*: Horny Growth on the Hand.

Wednesday, February 2.

National Orthopaedic Hospital.—O peration*, 10 a.m.

Middlesex Hospital.—O peration*, 1 p.m.

St. Bartholomew’s Hospital.—O peration*. 1.30 p.m.; Saturday, same
hour. Ophthalmic Operations, Tuesdays and Thursdays, 1.30 p.m.

St. Thomas’s Hospital.—O perations, 1 JO p.m. ; Saturday, same hour.
London Hospital.—O peration*, 2 p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital for Women and Children.—O peration*,

2.30 p.m.

University College Hospital.—O perations, 3 p.m. ; Saturday, 2 p.m.

Skin Department, 1.^5 p.m. ; Saturday, 9.16 a.m.

Boyal Free Hospital.—O peration*. 2 P.M., and on Saturday.

King’s College Hospital.—O peration*. 3 to 4 p.m.; and on Friday, j
2 p.m. ; and Saturday. 1 p.m.

Children's Hospital, Great Ohkohd-Strket.—O perations, 9 a.m.;
Saturday, same hour.

Obstetrical Society of London.—8 p.m. Specimens will bo shown.
Dr. Gibbons : Case of Unilateral Galactorrhcea. Annual Meeting—
Election of Officers and Council. The President (Dr. Potter) will
deliver the Annual Address.

Society of Arts.—8 p.m. Dr. Alfred Carpenter-. Sewage Irrigation.

Tbum.ay, February 3.

St. George’s Hospital.—O perations, l p.m,

St. Bartholomew's Hospital.—S urgical Consultation*, 1.30 p.m.
Oharing-cross Hospital.—O perations, 2 p.m.

North-West London Hospital.—O perations, 2.30 p.m.

Royal Institution oy Great Britain.—3 p.m. Prof. A. W. Rucker:
Molecular Forces.

Hakveian Society of London.—8.30 p.m. Mr. G. Bucks ton Browne: The
Position r r 1 the Value of the Operation of Internal Urethrotomy.—
Sir W. Mac Cormac : The Supra-Pubic Operation In its application
to Stone In Children.

Friday, February 4.

f r. Gkobgns Hospital.—O phthalmic Operation*, 1.30 p.m.

oyal 8outh London Ophthalmic Hospital.—O peration*. 2 f.m.
W MT London Mkdico-Chirubgical Society.—8 p.m. Living Speci-
•. men*:—Mr. Keetley:• (1) A case of Arterio-venon* Aneurysm of
Cavernous Sinu* (?) after Treatment by Compression; (2) A case of
Cholecystotomy. Card Specimens: -Mr. H. Percy Dunn: (1) A
Large Intussusception from a Child; (2) Tuberculosis of the Spleen
from k Child of three months; (3) Extensive Kaptnre of the
Duodenum followinga Kick from a Horse. Papers c—Dr. Thudlchum:
On the Nature and Operative Treatment of Hypertrophies and
. Tumour* of the Nasal aud Pharyngeal Cavity.—Dr. Campbell Pope
(for Dr. Suckling): A case of Acute Multiple Neuritis following
Diphtheria, and one of Unilateral Progressive Facial h trophy.

Royal Institution of Great Britain.—9 p.m. Mr. Edwin Preahfleld:
Some Unpublished Records of tlie City of London.

Saturday, February 5.

Middles** Hobpoal.— Operabnci, a p.m.

Royal Insthttion of Great Britain.—3 p.m. Mr. Carl Armbmster:
Modern Co japosers of Classical Song— Johannes Brahms (with Vocal
Illustrations).

METEOROLOGICAL READINGS.

(Take a daily at 8JO a.m. by Steward’s Instrument*.)

The Lancet Office, January 37th, 1887.

Oats.

Barometer
reduced to
Sea Level
and S*“F.

Dire*-

tlon

of

Wind.

Wet

Balb.

Solar

RadU

in

Vaano.

Max.

Tents.

Shade.

Min.

Temp

fcU.

Remarks at
8JDAJA

Jan. 21

3039

W.

37

36

45

34

rt H*xy,

„ 23

30-68

N.W.

43

41

40

37

Overcast

.. 23

30-60

W.

43

41

44

36

Overcast

.. 34

30-50

H.

37

30

40

86

Overosat

.. 25

30-24

H.W.

40

39

50

30

Overcast

,. 36

30-32

S.W.

43

41

53

40

Hazy

27

30-40

S.W.

37

37

...

36

Foggy

flute, J&|ort Cmmiunts, # ^nsfaers to
Coraspimknts.

It is especially requested that early intelligence of local events
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressedTo the Editors."

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intendedfor insertion or for private informa¬
tion, must be authenticated by the names and addresses of
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-varagraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of Thb Lancbt to be addressed “ to the
Publisher.” '

We cannot undertake to return MSS. not used.

A Fact in French Country Practice.

A French doctor being asked by a man one day to go to a distance to
see his sick child, replied that It was too far to walk, and that he had
no carriage. "Oh,” said the man, “that doesn't matter; I am a
livery stable keeper, and will drive you.” Some time afterwards the
doctor’s bill was asked for. It was five francs. The livery stable keeper
then presented his bill for the hire of the carriage. It was six francs ;

Sptro .—The Apothecaries’ Society does labour under the disability
described by it* clerk, and this can only be remedied by an Act of
Parliament, which we fear could not be obtained.

A Non-subscriber .—We regret that our correspondent *honld think it
necessary to punish himself in the manner he proposes.

FISSURED LIP.

To the Editors of The Lancet.

Sirs,—Y our correspondent, “ Fidelis,” may be Interested In a case of
fissured lip under my care some three years ago.

I painted the adjacent surfaces with a 5 per cent, solution of oooaine.
Incised the base of the ftMure freely, inserted a harelip pin and silk
binding, covering the Whole with collodion. The pin was removed
about the fourth day, and the crack has never recurred. The patient
was a woman of about twenty, much exposed to wind and weather, and
the fissure had been in existence for three or four years. Ointmento.
strapping, collodion, simple incision, Ac. had previously been tried In
vain. I am, Sirs, yours truly.

Jan. 24th, 1887. Fissure.

To the Editors of The Lancet.

Sirs,—I f your correspondent, “ Fidelis,” will apply a piece of court.
plaster (which has been made thoroughly pliant by dipping It In hot
water) over the fissure, the sides of it being pressed together, lie will find
that it will quickly heal. Salvos or ointmeuts would be of more avail
as preventive than as curative treatment.

I am. Sirs, yours faithfully,

Jan. 24th, 1887. G. H. S.

To the Editors of The Lancet.

Sirs,—I would recommend your correspondent, "Fidelis,” to try the
application of nitrate of silve' in stick. £ have seen a troublesome
central fissure of the lower Up cured by its use after other applications
had been tried wP hout success. I am. Sir*, y-ur* faithfully,

j Jan. 25tb, 1887 B. H.

Digitized by ^.ooQle

TtlH Lantkt,]

MOTE8, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jan. 29,1887. 249

Thk Valds or the Bupke.

The subject of the depreciated value of the rupee as affecting the
pay of medical officers la India Is a largo financial question scarcely
witsble for discussion la our pages. There caa be no doubt that a
jrest injustice Is inflicted not only upon medical but upon all officers —
,l»il and military—In India, by their pay being issued to them In rupees
calculated at the value of 2s., while In the ordinary transactions of trade
the real value is something under Is. Qd. In fact, officers receive only
;} per oent. of the pay which Is professedly secured to them by regu¬
lation. We cannot doubt that some new arrangement will have to be
tdopted ultimately to remove these complaints ; but we are bound to
my that It is a large and very difficult subject.

There is no doubt the lice may be contracted from clothing,
linen, bedding. 4c. The crab louse lays from ten to fifteen eggs, and
the young are hatched in six or seven days, and become capable of
reproduction In two weeks.

d. W. .V.—With few exceptions the surgeon has all his meals In the
nloonwlth the passengers, even where the officers dine by themselves;
bat he does not have a cabin in the saloon, nor does he sleep there.

id. /TuoAet.—Yes.

“ HOMOEOPATHY."

To the Editor* of The Lancet.

Mrs,— I know not who the “ Baffled Inquirer ” is, nor am I at present
-oanectedwith the London Homccopathlo Hospital; but I know that
aov, is ever, the medical officers of that Institution are always happy to
vtlcorae and assist any inquirer who presents himself at the hospital
iwl conforms to Its established customs. Your correspondent says he
aade" repeated requests to be permitted to attend In the morning and
urfst In taking notes and examining the patients,” but that he was not
itossd to do so. I imagine he would not be allowed to do this In any
4her hospital In London In his character of an Inquiring visitor. The
aw might be different if he were a regular pupil. Of oourse, all your
raalen will see the unraaaoaabteness of his request to visit and examine
the patients at his own convenience ; tor If he were allowed to do this,
*tf not others? And how would it fare with the patients suffering
toro serious acute diseases to be examined and disturbed several times
» by by sceptical, or even by unprejudiced, Inquirers? Nothing of the
. •* would be permitted In other hospitals. Why, then, should your
'irmpondent think that It would be allowed In the Homccopathlo
Kotpttal ? I imagine that his memory Is not very good as regards the
print* of therapeutics be Incidentally mentions. As he forgets the drug
ihtf he was told had cured some cases of ovarian tumour, probably be Is
•nsg In supposing that he was told that Impetigo was cured by a
•Nation of cartoon, and that relapsing fever was best treated by natrium
wrtstlcum. He could hardly have been Informed at the British
Homrrop*&bio Society that all hommopaths studied their treatment in
Ishr’s Materia Medic*. ” If the “Baffled Inquirer” really wishes to
inquire into homoeopathy, I would recommend him to stndy it In such
wkj as Dr. R. Hughes's “ Pharmacodynamics ” and “ Therapeutics,”
•here he will And something better than the " absurdities ” which I
believe he found in “ Jahr."

A* regards your own question, “ Is there any other lnstanoe of all the
•cimtiCc men In Europe resisting a true discovery for nearly a hundred
Pa-i?" I would only remark that homoeopathy Is acknowledged as the
in therapeutics, and Is practised at the present moment, by upwards
d i'.OOO regularly educated and qualified medical men, some of whom
tut no doubt be considered to be “ scientific men” ; that It has hospitals
ia suay Boropean countries, and upwards of forty hospitals and lunatic
wyhjtns in the United States; that though there is only one chair of
bxowotiathy in European Universities—viz., that at Pesth — it has
'riiegrs and universities in the less tradition-bound United States. On
t** whole, though we regret the attitude of the authorities of established
medicine in this and other countries towards homccopathy, we make no
vhalsdon of despair and almost of failure” as regards the progress of
Hitn“mann's discovery. I am, Sirs, your obedient servant,
kwidon. January 22nd, 1886. R. E. Dudgeon.

To the Editors of The Lancet.

pats - Many thanks tor your kindly-expressed notice of my letter ia re
•Irnicpaihy. Your readers might perhaps imagine that I was a
^crou-opsth," bat such is not the case. I am only a “ puzzled inquirer,”
**1 ay puzzle Is not solved Nvhen I study Dr. L. Brunton's work—a text-
’'** in almost general use; as In it I find drugs such as pulsatilla,
tlr 70 Bla, rut*, thuja, cantharls, and dulcamara—all recommended In
*®»ll doses for various diseases I All these drugs I was brought up to
""re strictly homccopathlo, but when I find them in suoh a work
a the one mentioned I begin to wonder If there be not some mistake.

I am, 81rs, yours faithfully,

I>*gridgc-road, S.W., January, 1887. A. G. Batsman.

• 1*. Brunton and Mr. Bateman are, of course, free to use any drug
***? please. It Is not the use of any particular drags that oonstltnte*
fl0 ®®cpaUjy, and that has caused it to be oontemned by the medical
L.

Parke*’ Hygiene, Ganot’s Physics, Baldwin Latham's Sanitary
Kxctnearfng. and the Public Health Acte.

The Cost ok a Hospital Bed.

The following statement of the comparative cost per occupied bed in the
year 1863 in thirteen large general hospitals in industrial centres has
been drawn up at Newoastle-on-Tyne :—Birmingham General, 237 bet Is,
£36 6s.; Bradford, 113.6beds, £53; Edinburgh Royal, 393 beds, £56 f *.9d .;
Glasgow Western, 368 bedj, £50 18*.; Hull, 96 beds £65 16*. 4<1.; Leeds.
253 beds, £56 7«. 9rf.; Liverpool Southern, 161 beds, £10 •>#. 6 d .; London
Hospital, 620 beds, £63 5*. 10<i.; Manchester Royal, 253 beds, £60 li. ;
Nottingham, 133 beds, £53 3*. M .; Sunderland, 128 beds, £12 3s. 9<1.;
Wolverliampton, 200 beds, £32 5s. 2d. ; Newcastle Infirmary, 233 beds.
£50 14*. 9 d. Such comparisons arc, however, fallacious and unreliable
without a full knowledge of the dietary of the patients of each hospital,
and other matters which contribute directly to Increase or diminish
the average cost per bed. For instance, In some hospitals the patients
must provide at their own cost tea, sugar, and batter. This la the
case, we believe, at Newcastle and the Birmingham General Infirmary ;
whereas at the Leeds Infirmary the patients are provided with every¬
thing. In this institution the average cost per occupied bed, In 1883.
for these three articles of diet was £3 10*. 3}tf., which reduces tho cost-
of the bed* to £52 17*. 5|rf. if calculated on the same basis of the
other two hospitals named. At Leeds, agnln. the repairs of bnttdlngs
and fittings are charged to the cost of in-patients; some other hos¬
pitals do not adopt this plan.

X. y. Z.— Our correspondent should have been communicated with;
but he does not allege that the gentleman who certified!* unregistered.
He would have real grouud for complaint if an unregistered member
of the staff had officiated.

Young Practitioner is referred to The Lancet of Aug. 8th, 1883. p. 278,
for an answer to his question.

W. G.— No.

THE GREAT NORTHERN CENTRAL HOSPITAL.

To Vie Edilore of The Lancet.

Sirs,—W hilst tendering to you the beat thanks of all those who have tli«-
welfare of this hospital at heart for so kindly calling the attention of
your readers to its pressing wants, you will allow me to point out two
Important mistakes in your statement concerning the financial report
submitted to the half-yearly meeting of the general council on the 14th
Inst., which. If not corrected, may prove detrimental to the success of
tbe appeal for the required funds.

The cost of the block of buildings which the commit tee have determined
to proceed with in the first place, and which will oontain sixty beds, and
part of the administration block, Is £20,000, not £2000; and the amount
required to complete the new hospital of 160 beds with a large out-patient,
department, is £tdi,000, and not £24,300 as stated In your paragraph.

1 am. Sirs, your obedient servant,

Jan. 24th, 1837. William T. Grant, Secretary.

Are Mrowrvn Arotkecabur ?

The following may raise a question In the minds of the Apothecaries’
Societ y, as It certainly will in the minds of their licentiatesMrs. O. H.
Botham, midwife, 69, Langdon-road. Mixture: One tableapoonful
three times a day." Though a midwife may attend a midwifery case,
does it follow that she may attend and supply medicines to patients ?
May she even do so in a case of puerperal fever or puerperal con¬
vulsions, and be within tbe bounds of her duty ? We trow not.

Stairs. Krohne and Sesemann.—Tho name was given simply at that of the
apparatus which was preferred by the writer of the article. There
was no question of priority raised.

G. P.— We must refer our correspondent to our advertising columns for
the Information he desires.

OBSTINATE CONSTIPATION IN AN INFANT.

To Vie Editors of The Lancet.

Sirs,—I shall bo glad to have some suggestions from your readers
regarding the management of a case of most obstinate and persistent
oonstlpatlon In a child of twelve months.

For a long time the bowels have not been moved without aperients of
rather strong charaotsr, or the use of one mats of various kinds. The
tsscal mass Is often so hard and lumpy as to require being scooped out of
the rectum. There Is bleeding on almost every occasion of defecation.
The child Is artificially fed, and every kind of food suitable for a child of
such a tender age has been tried without avail, and various constitutional
remedies likely to be of service have also failed. There Is no abnormal
distension of the stomach or large intestine, and the child is well
nourished. Indeed, it Is rather above the average size, and is a fine,
bealtby-looktng child. I am, Sin. youn truly,

Jan. 18th, 1887. O. P. Q.

F. — 1 and 2. These questions must obviously be answered In tbe
affirmative.—3. Dr. Hack Tuke’s work on the Influence of the Mind
on the Body la Health and Disease,
i C.—Ye*, shortly.

Digitized by Cj00^1.0

250 The Lancet,]

NOTES, COMMENTS; AND ANSWERS TO CORRESPONDENTS,

[Jan. 29,1887.

Tire VAXES'of Neva Watkh as Medicine.

A certain baron in St. Petersburg haa been for a long time selling a
specific for a number of diseases at a high price. This has lately been
analysed by order of the Medical Council, with the result that It has
been declared to be nothing more or less than simple Neva water!
It might have been expected that the publication of this fact would
have seriously interfered with the baron's trade ; but the Neva water
remedy seems to have taken such a hold on the imaginations of the
St. Petersburg public that they still flock to purchase it at from one to
four shillings a bottle.

Mr. K. Taylor.—Tcmpora mutantur. Circumstance* are now very dif¬
ferent from those which obtained years ago, when the words quoted
were written.

W. W. W, should consult a surgeon. We do not give advice.

.V. has not enclosed his card.

THH BINIODIDK OP MERCURY A 8 AN EMMBNAGOGUE.

To the Editors of The Lancet.

Sirs,—I find the red iodide of mercury is a certain and safe emmena-
gogue. My attention was directed to its virtues quite accidentally some
three or four years ago, since which time I have used it successfully in a
large number of cases. I prescribe it in the form of mixture as follows ;
but I should think it would act quite as effectually in pills of a quarter
of a grain twice a day, or an eighth four times a day:—R. Sol. hydrarg.
blchlor., gi.; potass, iodid., 5 * 3 .; ferri ammon. citrat., 31 .; ether,
chlorid, 3 ij.; aquam ad gvlli. One tablespoonful three times a day
after meals. I am, Sirs, your obedient servant.

Jan. 24th, 1867. C. B. Illingworth, M.D.

The Climate of Plymouth.

Or. Hampton sends us word that he lias seen primroses in bloom growing
in the open at Plymouth during the last week. Under the circum¬
stances, a primrose is a primrose and something more. It is a floral
record of the current atmospheric conditions, and sums up or registers
all the past meteorological and geological conditjpns to which it has
been exposed. In short, it indicates the mildness and geniality of the
climate during the late winter months. It is to be borne in mind that
the people in towns farther north are exposed to more than the
equivalent of South Devon rain, in the form of hail, snow, and sleet.

Alfred Robinson, M.B., MJd.C.S. —A chapter in Powell's Diseases of the
Lnngt.

M.D.—Yfe fear little can be done in the matter.

Or. Percy Boulton is thanked.

Ekrati'M. —In a paragraph headed " Presentations,” which appeared in
our last issue, page 200, Mr. FouUton was spoken of as taking his
departure for Barlstown, whereas, in fact, he is leaving that town tor
Liverpool.

Communications not noticed in our present number will receive atten¬
tion in our next.

Communications, Letters, &o.. have been reoeived from—Sir J. FayreT;
Dr. J. Williams, London; Mr. J. B. Godlee, London; Mr. Lawson
Tait, Birmingham; Mr. C. Lucas. London; Dr. W. B. Steavenson,
London ; Dr. Juler, London; Dr. B. Martel, Paris ; Mr. J. N. Bredln ;
Mr. Hodgskin, London ; Dr. Wolf Smith, Montreal; Mr. C. Hewett,
London; Mr. Tallacli, London; Mr. Blackett, London; Mr. Watson

Cheyne, London ; Mr. Balls-Headley, Melbourne; Mr. W. F. Moon-.
London; Dr. Dudgeon, London; Dr. Galton, Norwood; Mr. Morton
Smale, London ; Mr. Evans, Wolvexhamptoa; Messrs. Brinsmead and
Co., London; Mr. A. G. Bateman, London; Messrs. Maclachlan and
Co., Edinburgh ; Mr. F. H. M. Burton, Birmingham; Messrs. Smith
and Son, London ; Mr. E. C. Beale, London; Messrs. Hopkinson and
Co., Notts; Dr. C. Magheria, Naples ; Mr. Millar, London; Mr. J. G.
Marshall, Dover ; Mr. H. H. Ashdown, Edinburgh; Messrs. Squire
and Sons, London ; Dr. Hawkes, Northampton; Messrs. Deighton
and Co., Cambridge; Mr. J. L. Wright. Derby; Dr. Jacoby, New
York; Mr. J. D. Wateon, Glasgow; Mr. Lavis, Naples; Mr. Poole
Shrewsbury ; Mr. Greenwood, Liverpool; Mr. Palish; Messrs. Boulton
and Paul, Norwich; Mr. Barker, Hull; Mrs. Storgea ; Messrs. Woolley
and Co., Manchester; Mr. Williams, Oswestry; Messrs. Isaacs and
Co., London ; Mr. Plummer, Thame ; Dr. O'Flynn ; Messrs. Blake
and Co., Leeds ; Mr. Brown, Westgate-on-Sea ; Messrs. Longman and
Co., London j Miss Moorhouse, London; Dr. Fulton ; Mr. Lowndes,
Liverpool; Dr. Dale. Scarboro'; Messrs. Morley, London ; Mr. Baker.
Newport; Mr. Larder, London; Dr. Dowse, London; Messrs. Bromley
and Co., Llnooln; Dr. Biordan, Plumsteod; Messrs. Sharrow and
Co., London; Mr. Moore, Callingtoa; Dr. Hare; Messrs. Bates and
Co., London ; Dr. Mallna, Birmingham; Messrs. Marlborough and
Co., London; Dr. W. Sumpter. Cley-next-the-Sea; Mr. Klchard
Prale, Rochester; Mr. Kershaw, London; Dr. Fitzgerald, Folke¬
stone; Mr. Robson, Leeds; Mr. Bond, Leicester; Messrs. Harris
and Co.. Birmingham ; Dr. Itobinson, Dublin; Messrs. Burroughs and
Wellcome, London; Dr. V. D. Harris, London; Messrs. Wright and
Son, Bristol; Mr. Lupton, Bradford; Dr. Nicholson ; Messrs. Fletcher
and Co., Manchester; Mr. B. B. Rawlings, Leicester; Mr. Latimci,
Swansea; Mr. Pycroft. Kenton; Mr. Grant, Edinburgh; Mr. W. T.
Grant, London; Dr. Illingworth, Clayton; Mr. Sutherland, Fence
Houses; Dr. C. J. Power, London ; Mr. Abbs, Dewsbury; Mrs. Wood,
Kington; Mr. Unsworth, Liverpool; Mr. Harris, Aberbillary ; Mr. F.
Bird; Mrs. Armstrong, Byde; Dr. Tennant, Matlock; Mr. Oldham.
Manchester; H. W. S.; O. P. Q.; B. H.; A O.; M.; Junior
‘Consultant; K. K., Buoksted; Editor Brutal Observer : Verbena
sat. Sapienti; Advertiser; Fissure; G. B. 8.; Oeltau; Speeo;

. Subscriber.

Letters, each u-ith enclosure, are also acknowledged from — Dr. Day.
London; Mr. Lilley, Leicester ; Mr. Hamilton, Birmingham ; Dr. B.
Meadows, London; Mr. Flower, Melksbam ; Messrs. Willmott and
Co., Shepherd’s-buah; Mr. Hardman, Birmingham ; Mr. Hoffmeistcr.
Gosport; Dr. Eve lyn, Arrnoy ; Mr. Wylde, Crawley; Dr. Thomson.
Brailes ; Mr. Clark. Edinburgh ; Mr. Shute, Greenwich; Ur. King.
Lurton; Mr. Jennings, Coleford ; Miss Hunter; Messrs. Wright and
Co., Romford; Mr. Draper, Huddersfield; Dr. McKeith, Wickham
Market; Mr. Parry, Bagillt; Mr. Ride&l, London; Messrs. Blake and
Co., Leads; Mr. Davies, Worcester; Dr. Trevor, Angleaea; Mr. H. H.
Bigg, London; Mr. Armstrong, Manchester; Messrs. Roberts and
Co., London; Miss Bourne. Coventry; Mr. Cow land, Launceston;
Dr. Griggs, Parkstone ; Mr. Rowley. Barnsley; Medieus; Dispenser,
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THE LANCET. 7 F^ruary 5, 1887. ’ •• •

S|it ^irbre ss

OX

DEFECTIVE SANITATION AS A CAUSE
OF PUERPERAL DISEASE.

Delivered at the East London and South Essex District of
the Metropolitan Counties Branch of the British
Medical Association.

By W. S. PLAYFAIB, M!D., LL.D., RR.C.P.,

nonaoi or obotiteic medicine at king's college, and physician
rOK THE DISEASES OF WOMEN AND CHILDREN TO KINO’S
COLLEGE HOSPITAL.

Qkstlkmkn,—VT hen your Secretary, Dr. Hunt, did me
the honour of suggesting that I should deliver an address at
your opening meeting, the difficulty 1 experienced in acced¬
ing to his request was not the want of a subject, but rather
the selection of one amoDgst the many topics connected
with obstetrics and gynaecology which might be of sufficient
interest to claim your attention for a short period. My
first idea was to offer you a comment on some of the topics
that hare .of late boon especially discussed by gynaecologists,
such ah-Hihe moflr- rtfceut developments of abdominal
snrgery^tparticularly the removal of the uterine append¬
ages and ovaries, which mooted point certainly calls for
much riaore thorough discussion than it has yet received.

I soon fej&nd that to enter on topics such as these in the
brief pttiod which I could occupy without unduly tres¬
passing on your patienoe and courtesy involved an effort
at com antration of which I was incapable. Dr. Hunt’s
invitati in told me that a short paper of half an hour’s
doratio i or thereabouts would suffice, provided it was
of a na Are to elicit discussion; and I therefore resolved to
direct i lor attention to a hardly appreciated ^purce of Septic
disease Ao which I have myaeli traced many otherwise
inexpli Able cases of septicaemia in childbirth, and to
which Mby attention has been store particularly drawn
withinffine last few months from the fact that I have
had thdfcisfortune to meet with what I believe to be a well-
marked’instance of it in the person of the wife of an
esteemM professional. friend, whose terrible illness was
traced M this source. 1 refer to the poisoning of lying-in
womeitf$rom sewer gas, conveyed tothe house in consequence
of defective sanitary arrangements. Here at least is a topic
which lipst interest you all, for if there is one thing more
than HNlXter wMjk the practitioner has to dread it is
the development of this insidious and terrible illness after
delivery, defying as it so often does the most strenuous
and best-directed treatment, desolating happy homes, and
too often leading to most undeserved blame and Injury
to the medical man who has the misfortune to meet with a
case to his practice. This source of puerperal disease has
scarcely received any attention at aD, and it is hardly
alluded to m our text-books, and yet I believe it to be very
far from uncommon, and I trust I may elicit from your
experience some corroboration of my views on this topic. I j
thus spdak bf it in mv work On Midwifery: “ Exposure to
sewer gas may, I feel sure, produce t^e disease. In two'
cases oF'fhe kind I had the opportunity of closely WatOHing,
an untrapped drain opened directly into the bedroom, in
one instance into a bath, in the other into a watercloset.
Both cases were indistinguishable from the ordinary form
of the disease, and in both improvement commenced
as soon ss the patient was removed into another room,
In a case I Saw some years ago at dotting-hill, the
patient, who hod been confined' a week, had all the'
symptoms of a most intense kttack of septicaemia, but
none of a diphtheritic character, while her husband lay
in an ad louring room suffering from a diphtheritic sore-
threat. Here the waste-pipe of the bath W'ke found to com¬
municate directly with tne eewet. In spite of her intense
Alness I had the patient Removed to another house, and from
that moment she began to Improve. In two other cases in
which ttyfe Same source of disatte was detected, the removal
of the p a te n t froth the hxftM^d Atmosphere was immediately
foUowed by k 1 marked ameflwatfori in the symptoms. 1

No. 3310,

know of three similar cases which ended fatally, in which T
have every reason to believe that the cause of the disease
was poisoning by sewer gas. Prankenhauser has related a'
curious case of the poisoning of four puerperal women by
sewer gas. In fact, the whole question of defective sanitary
conditions on the puerperal state deserves much more serious
study than it has ever yet received, and I have long been
satisfied that they have often much td do with certain grave
forms of illness in the lying-in'State the origin of which
cannot otherwise be traced.”

Now this quotation, which is only to be found in the later 1
editions of my book, contains, I believe, a summary of
nearly all that is known on this important topic, and you
will see how little it is. It is surely high time that it
should be more thoroughly worked out and studied, and
although I have no pretension to-night to do inore than to
direct your attention to it, I trust that the endeavour tnav
be of some practical use. i I purpose therefore to describe
more particularly some few illustrative caseB of the kind,,
and to show you by rough diagrams how the sewer gab'
came to be brought closely into contact with the patient. 1
shall select four only out of the large number of cases I'
have seen and noted, in which no othersource of disease 1

Fig. 1.

coujd be traced, and in which its dependence on this cause
may, I think, be ■ taken* aft 1 mtoVad' to dfemoistratiOn. As l
am now dealing with causation only, I shall not desoribe at
all the symptoms of the patients-, merely saying that all
these cases were typical examples of the ordinary puerperal
fever or septicaemia, not differing in any marked way from
the dsttel types of that disease.

• Let me first direct your attention to the case I have
alluded to. I myself attended my friend’s wife early to
June last, and very shortly she developed a severe
illness, acObmpanied by marked hyperpyrexia, the tem¬
perature constantly ranging over i04°, and continuing at
this high level for over six weeks. It was only kept down
by the use of Thornton’s ice-cap and constant sponging
with iced''water. Two months after delivery large py pernio
abscestes formed; and I wish it could be said that even
□ow, after the lapse of three months, convalescence was
established. Now, in searching out the causes of this
terrible' illness the hygienic condition of the house waa
naturally investigated, with the results I shall show you.
My friend entered his hense on his marriage a year
1 since, and believed that the sanitary arrangements bod
Men thoroughly seen to. Unfortunately, the engineer to
Whom they nad been entrusted had relied on the state¬
ment of the former owner that the main drain was in good

Digitized by GoOgle

252 The Lancet,] DB. PLATPAIB: DEFECTIVE SANITATION AND PUERPERAL DISEASE. [Feb. 5,1887.

condition. Moreover, there existed the radical defect of
having the closets and soil-pipe in the centre of the house,
an arrangement quite incompatible with perfect sanitation.
Now let me point out what was discovered. First, as to the
basement (Fig. 1):— At A in the passage the new soil-
pipe placed when the house was taken was joined to
the old one, and at the junction there was a consider¬
able leakage, and when uncovered the stench was intoler¬
able. At b was found an old brick drain surrounded
by sodden sewer earth, very foul. A large cartloadful was
removed from the spot indicated below the floor of the
kitchen. At c were two defective joints with considerable
soaking through of sewage, and over these drains there
was nothing but earth and kitchen boards. Dr. Dawson
Williams, who conducted the investigation, very naturally
says that he considered the above a very serious condition.
Dr. Williams also points out that on the second floor not
only was the sewer gas from the basement drawn up (Fig. 2),
but the bedroom (a) where the confinements took place,
the boudoir (b) where the patient chiefly lived, and the
w.c. (c) “were practically in one.” Besides the above,
other but less important defects were found, such as a
housemaid’s closet, the waste-pipe of which opened directly
into the soil-pipe (d).

Now, can it be reasonably doubted that this illness

Fig. 2.

originated in this horrid state of things, since no other
possible cause could be detected ? Moreover, is not this a
striking example of the way in which we are all placed
absolutely at tbe mercy of workmen and plumbers ? Here
is the case of a member of the profession fully alive to the
risks of defective sanitation, who in going into a new
house spares no expense to have it properly drained,
who employs a sanitary engineer for the purpose, with
the results I have described above. It is a curious
fact in connexion with this case, and I think, it must be
something more than a coincidence, that in the favourite
professional street in which my friend lives I have myself
seen four cases of puerperal septicaemia within the last five
years, one of whioh proved fatal, and 1 have heard of three
more, one of which proved fatal. Possibly there may have
been more of which I am not cognisant. Now, in a street
of 152 houses there can only have been a small number of
confinements in five years, and if out of this small number
seven were attacked with puerperal septicaemia, surely there
is fair ground for suspecting that there exists some morbific
cause localised in tbe street; for to suppose that there were
sdven cases of conveyed septicfemiain one street in five years
is an assumption that is incredible* Now, all these houses
are old, probably all were original!ydefective in their sanitary

arrangements, and many may yet remain so. I do not wish
to attach too much importance to the fact I have stated, but
it is certainly striking and suspicions. I have often won¬
dered whether in the good old days, when there was no such
thing as a watercloset in existence, when foul smells were
at least localised to the place of their origin, and when
sewer gas was not ingeniously carried by a complex
series of pipes to our very sleeping-places, true sanitation
was not really better than it is now, when it is so much
studied and so little practised.

Now let me show you a second example. This diagram
(Fig. 3) represents the bedroom floor oil a new house of
considerable pretensions in Notting-hill, in which l saw a
lady some years since, with her medical adviser, Mr. Hewer,
in a very dangerous state from septic disease. The origin
of her illness was discovered from the curious fact tnat
her husband was lying ill at the same time in the bed in the
dressing-room (c) with a severe diphtheritic sore-throat.
This could hardly be a mere coincidence, and it pointed
very strongly to some common cause of illness to which
both bad been subjected. The fact that his wife’s illness
showed no diphtheritic symptoms went for nothing in my
judgment, for 1 have been long satisfied that septicsmia may
be produced in lying-in women from zymotic prison—as, for
example, the scarlatinal poison—without any of the specific

Fig 3.

symptoms of the qpecial poison producing it. Here the cause
wasnot far to seek, for, amazing as it may seem, the waste-pipe
of the bath (a), cloee to the bed (b) occupied until a few days
before by both, went straight down the outside of the houee
to the main drain, into which it opened, so that the sewer
was ventilated right into the dressing-room. As soon as
this was detected, seeing that the patient must have been
constantly inhaling fresh doses of poison, I had her removed,
in spite of her critical condition, to her mother’s house in &
neighbouring street. The result most fully proved the
correctness of the assumption as to tbe cause of her illness,
for a marked change for the better at once occurred, and
the patient was soon convalescent.

The next diagram (Fig. 4) represents a bedroom in a large
house in the most fashionable part of the West-end, which
bad been recently taken and done up in the most costly
way. I attended the lady of the house in her second con¬
finement, and she lay in her bed at a. Shortly she developed
well-marked septic symptoms, and I naturally investigated
the sanitary state of the house to see if it threw any light
on their origin. I could find nothing amiss. There was no
bath or fixed washhand stand near the room, and the closets
were at a distance, with the soil-pipe running down the
outside wall, as it should do. It was not until some days
afterwards that I discovered the extraordinary arrange¬
ment depicted in tbe diagram, which no one could possibly
have suspected, and the Knowledge of which the patient
had given special directions should be withheld from me.
At b is represented a very handsome and innocent-looking

Digitized by

Google

Thb Lancbt,] DR. PLAYFAIR: DEFECTIVE SANITATION AND PUERPERAL DISEASE. |Fjsb. 6,1887. 253

piece of furniture which seemed to be & fixed wardrobe, to
which purpose its ends were in fact devoted. The centre
door, however, formed by a large mirror, opened on a con¬
cealed waterdoeet (c), which luxury no one could have
looked for in such a situation. I subsequently discovered
that this was a brilliant idea of her husband’s, who actually
had had a special soil-pipe carried through the centre of the
house, which communicated directly with the main drain,
with no ventilation, and who had thus contrived, at an
enormous cost, to have a stream of sewer gas laid on close
to his bedside. And be it remarked that builders and
plumbers had carried out this ingeniously dangerous arrange¬
ment without giving him the slightest hint that it was
either unusual or perilous. Of course as soon as I made this
discovery I had the patient removed to another room, when
her symptoms soon abated.

I could easily go on multiplying examples of this kind,
but I shall content myself with one more case, which was
thoroughly worked out, with very instructive results. It
was that of a lady who was confined in the country of her
first child, in a large and expensive house, newly built, and
supposed to be supplied with all the most perfected sanitary
arrangements. There was nothing particular about the
labour, and for the first ten days the convalescence left
nothing to be desired. On the eleventh day sue got up aud

Fig. 4.

lay on the sofa (Fig. 5, d) opposite the fire (f), which, as it
was in January, was burning day and night. The day after,
although she had a headache and felt poorly, she again got
up and lay on the sofa. The subsequent day, although
feeling very ill, she again insisted on getting up and lay on
the sofa at B, in her husband's dressing-room. On the
following day she was very ill indeed, with a temperature
of 104° and a pulse of 130, and I was summoned to see
her. It is needless to say more of her illness, which
rapidly increased, except that, feeling satisfied it was
caused by defective sanitation, I advised her removal
to a house in the neighbourhood, in spite of the very
gave symptoms that existed, with the most satisfac¬
tory result, for within twenty-four hours her temperature
had fallen, and she rapidly became convalescent. Of course
at this time nothing was known of what actually existed,
bat I was led to form this conclusion from the fact that a
number of the servants and residents were suffering from
•ore-throats, and from being told that almost everyone who
aas to atay felt ill and out of sorts. Subsequently the
sanitary .state of the house was thoroughly investigated
by one of the most distinguished sanitary engineers in
London, from whose reports the accompanying diagram
is copied. It is useless to enter into a description
of aR thy, abominations which were found to exist, which,
in a hones of the kind, in the building of which no ex¬

pense wa9 spared, were almost past belief. For the purpose
of my story it will suffice to.say that the smoke test showed
that there was a very abundant escape of sewer gas into
both the bedroom and dressing-room, which, from the fact
that there were large fires burning constantly in both rooms,
passed in a continuous current in the direction of the arrows.
In addition, the plumbing work in the closet in the dressing-
room had been so imperfectly done that its contents found
their way out under the floor. Now, mark how thoroughly
and curiously these facts prove the cause of the disease.
The patient lay in the bed at c, whiclx, from the accident of
its being winter, and the current of sewer gas being drawn
therefore to the chimneys, was quite out of its reach,
aud for the first ten days after her confinement, while
she remained in bed, she was perfectly well. On the
eleventh day, when she got up, she was placed directly
in the current of sewer gas at d, and instantly got
poisoned. On the twelfth and thirteenth days she was
again exposed to the absorption of further and more intense
poisoning; while immediately on her removal to fresh and
uncontaminated air all her threatening symptoms dis¬
appeared. Remark also that there was nothing peculiar in
the symptomatology, nothing different from an ordinary
and rapidly progressing case of puerperal septicaemia. It
seems to me that this instructive history is about as com-

Fig. 6.

plete a demonstration of the origin of puerperal disease ftom
defective sanitation as anyone could possibly desire, and I
can see no flaw in the chain of evidence.

It may probably be objected that most of these cases had
been exposed for a length of time to tbe very influences
which are supposed to have caused disease after labour, and
that therefore the illnessshould haveappeared antecedently.
This is undoubtedly a fact difficult to understand, and of
which I profess to offer no explanation. It is to be re¬
membered that there are many things fn connexion with
puerperal fever “ not dreamt of in our philosophy,” and foa
which we are as yet quite unable to account. Doubtless
future investigations will throw fresh light on this and
other obscure points. It may be that delivery, and the ex¬
posure of large absorptive surfaces resulting from it, makes
women susceptible to influences they previously resisted.
It may be also—and I have seen many cases that
lend weight to the assumption—that absorbed poisons
may remain latent in tbe system, and only sbow their
malefic influence after delivery. 1 well remember a terrible
case which could not, so far as 1 can see, be explained ex¬
cept on this theory. It was that of a lady wbo bad been
residing in a hired cottage in tbe coun.ry, close to London,
up to tne time of her confinement. If I remember rightly,

254 The Lancet,]

MR. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY.

[Feb. 5,1887.

she was confined before her medical man could reach her.
Within twenty-four hours she was terribly ill. and waB dead
in a few days. The virulence of the septic influence may be
judged of by the fact that one of the nurses in attendance
pricked her finger, got rapid gangrenous poisoning, and had
•to have her arm amputated at the Bhoulder-joint. Is the
conclusion not inevitable that the patient, who felt perfectly
•well on leaving the country, brought with her in some latent
way the poison that developed with such deadly results ?
Some light is thrown on its origin by its being discovered
that the cottage in which she had been living was in a most
insanitary state, the details of which, however, 1 never
learnt.

Now, of course, the question arises: If these risks are
really so serious to lying-in women, as I contend they are,
how ate they to be avoided? Increased attention on the
part of the profession maydo something,but not much,for the
demon plumber is abroad, and one may rest in fancied security
tbit proper care has been taken, while the carelessness of a
single workman may render all our precautions useless. The
Buuding Act authorises the district surveyor to inspect
•every new building, and any fault of construction promising
to he dangerous he has the power to have remedied; but in
the very house the beams and floors of which he inspects,
every bath and cistern may open into the sewers, and the con¬
tents of the soil-pipes may freely percolate under the floors;
he may even be aware of these facts, and yet he has no
power to interfere. Now, if a beam breaks or a floor gives
way, it is possible, but not very likely, that one person,
possibly two, may be injured, although accidents of this
kind are of the rarest possible occurrence. But an escape
of sewer gas spreads its deadly poison insidiously 'day
and night, and it may destroy the lives or sap the
health of whole households, ana, so < far from being un¬
common, it is of daily and constant occurrence. Would it
be asking too much—would it be an undue interference
with public liberty, an excess of grandmotherly legislation
—to insist that careless workmanship and errors of construc¬
tion, such as I have pointed out, should be prevented? It
is no use shutting the stable door when the steed is stolen,
but it seems to me that it would bo a'Simple thing to ex¬
tend the provisions of the Building Apt in such a way that
no new building should be inhabited, or old building re-let,
until its sanitary arrangements have-been inspected by a
properly constituted authority and passed as safe. The
whole system of closet ahd water arrangements in modern
towns la£ds itself so easily to faulty construction that
defpcte ate not astonishing, and 1 believe that nothing but
such a provision will teach builders and plumbers the
importance of their work. . -*i x

il ABSTRACTS OP THE

fesmrts ®ilsdf^ctur£s

EVOLUTION IN PATHOLOGY.

delivered at the Royal College of Surgeons of England, ■

•'"‘’ By J, BLAND SUTTON,

Jhlf ASMSTAira-SU'BGBOM TO THE MIDDLESEX H08MXAL.J

oeOoai'!!n: •/'i •>i v -;!j <-f om i J to i u i-d iivmI

bon ,‘Toednl :!;• Mi-Oii 'LECTURE Ii oi h-.-.o-MUfc yin (Viiiiv/

v/'n^hyi iJi'K !'viT&UPPBESSION OF PASTS. 1 ' \ \

i’liEaiDHNT and Gentlemen,— Last year I endeavoured
to show that the three laws formulated by Professor Huxley
ts expressions of the principles concerned in evolution, id
So far as they relate to anatomical details, are equally
applicable to pathological anatomy,' The ; first law— Therq
has been an excess of development qf some parts in relation
to others— was abundantly illustrated under the term
“(hypertrophy.” In the present course full attention will
be devoted to the second law— Certain parts have undergone
complete or partial suppression. A careful consideration of
this law leads to important conclusions, and renders
intelligible some very obscure conditions, which have excited
Snore or less curiosity in the minds of pathologists.- uup>i---:
./i';!• ii ir'Ki-'ii- ■ ! »• j i>,xl 1; jrnij'Mft ol <im

The first example is merely chosen to serve as a clear
instance of the process termed “ suppression.” Recent
researches indicate, beyond all doubt, that an oasidle has
been suppressed in the human carpus. In the manna of a
very large number of vertebrates,- beginning with tailed
amphibians and passing onwards to primates, wedged in
between the proximal and distal row of the catpal bones,
we find an ossicle known as the “oentrale.” A typic
carpus, taken from a baboon, is represented in Fig. 1.

Fig. 1.

Fig. 2.

Carpus of a baboon, showing
the os centrale.

This bone became very

KevhefSSS -unite ™a.m.»u, y

Key her, Kosenberg, KOI- centrale, e (after Laboucq).

liker, and others drew

attention to the occurrence of a temporary nodule of
cartilage representing this element in the carpus of the
human foetus. The interest was quickened when Gruber
and Turner reported cases with a fully developed os
centrale in the adult human carpus, taking rank with,
and being coequal with its fellows. The illustration
chosen (Fig. 2) is of course one purely anatomical, and
the existence or absence of the ob centrale, in so far as
the function of the carpus is concerned, is of little moment.
In most of the cases now to be considered the matter is very
different, for I shall endeavour to show that in many cases
where a suppressed organ reasserts itself, in some it gives
rise to serious malformations, and in others is a source of
danger, inasmuch as the parts are not infrequently the
starting-points of abnormal growths. To trace the ancestral
history of these structures and to decipher their meaning is,
in many instances, exceedingly difficult, but the quest is
surrounded with fascination, and is one of the most enjoy¬
able occupations which fall to the lot of the scientific
pathologist. It is rendered more delightful from the fact
that the investigator is obliged to carry his inquiries into
the remotest realms of biological science, and gather evidence
in support of his case from animals which have long since
passed away, now only known to us by their bony frame¬
work. All mammals possess in their brain a striking illustra¬
tion of the truth of this remark, for the pineal body,
imagined by the older anatomists to be the seat of the soul,
lias now been shown by Mr. Baldwin Spencer to be the
remnant of a median eye, which still poraistein a rudimentary
form in lizards, it was most highly developed in extinct,
amphibians, being probably a functional sense organ of pre-
tertian' periods. The fact of the pineal body originating' as
a tubular diverticulum from the thalamencephalon is very
suggestive, and that it should be the seat of aberrant
formations may be anticipated. Weigert, "Vircbow, Wilks,
and Drs. Chsriewood Turner and Siloookihave described
specimens of a cystic condition of the pineal body in the
human subject,

1 One of the dearest instances of suppression, and at the
same time one capable of indisputable demonstration, is
connected with the disappearance and occasional reappear¬
ance of a third incisor tooth in man. The matter was first
worked out and announced by Professor Albrecht (now of
Hamburg) in quite a number of papers, that normally man
inherits three incisors on each side in tbe upper malillte,
but during development the middle (second) one of the three
is suppressed. In many cases at cleft palate, however, more
room is afforded, and the usually suppressed tooth attains
a functional condition. The question was one of importance,
and I was able in a paper read before the Odontologio&l
Society of Great Britain in December, 1884, to confirm this
part of Albrecht’6 observation. Professor Sir W. Turner, a
month later, adduced also confirmatory testimony in the
• oil 'j< :■! . • \ ii:- ’ *• : ii .J-nia v:ll lo *■ m

Thk Laaobt,]

ME. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY.

[Fkb. 6, 1887. 255

Joumtd if Anatomy and Physiology, vol. xix.; aud the last
contribution in this direction is by VVindle and Humphry in
the same journal. A careful analysis of the facts shows,
beyond all doubt, that in the usual course of events an
incisor tooth is suppressed in the upper maxilla of man; the
only point admitting of any latitude of opinion is whether
die missing tooth is tbe second or third incisor. -Vs tbe case
stands at present tbe balance of opinion is m favour of it
being the second, i j i

We must not fofget, however, that supernumerary teeth
are found in other situations than in the incisor series;
indeed, they may occur in almost any part of the dental
arch, and may vary in character from a perfectly formed
enamel-covered tooth to a tiny conical mass of dentine. In
determining whether an extra tooth is a supernumerary
one or not, we must also take into consideration the fact
that an excess in the number of teeth is occasionally due to
the retention of one or more milk teeth. In order to com¬
prehend the trne significance of supernumerary teeth, it is
necessary to bear in mind the morphology of these organs.
In their essential features the teeth of a shark agree with
those of a mammal, and in their development as calcified
papillae of the involuted epiblast in the buccal region the
stomodgeum—the two forms are in perfect harmony. In the
case of the shark almost the whole of the mouth is beset
with teeth, whereas in mamnmls they are normally restricted
cocertain very definite tracts. An.unprejudiced survey of the
[acts ought to convince us that though t he teeth of mammals
are thus kept within narrow limitp, yet the papillse in the
immediate vicinity of these teeth territories are potentially
teeth, and it is perfectly consonant with what we know
of the principles of atavism that these papillre should
occasionally declare their ancestry by developing as rudi¬
mentary, or even perfect, teeth. Nor is this form of atavism
limited to this particular region : for, inasmuch as teeth are
modified papillas of the skin or integumental covering (and
this may be absolutely demonstrated in the case of the young
">f the dog-fish, in whom the various stages may be clearly
raced from placoid scales to teeth), so in those remarkable 1
ceratomata arising in obsolete canals lined with epiblastic ,
tissues, calcified papillro (teeth) make their appearance.
Dentine and enamel are tissues which exist in scanty propor- ;
ions in man, yet they formerly occurred in great abundance
in the remarkable mailed-ganoids which are encased in an
elaborate armour of these very extraordinary tissues.

If we admit the above opinions, then a rational explanation
u» forthcoming of certain interesting pathological conditions
which occur in the mouth. For instance, some forms of
adontomata may be considered as aberrant involutions of
buccal epiblast and pnpill®; the view is supported by the
fact that this variety of neoplasm occurs in many mammals.
There is also good evidence to support the view that the milk
lentition is to be regarded as a set of teeth appearing in
bedience to the law of inheritance. In many mammals
.hey are, like the lanugo of the human foetus, shed before
;he embryo quits the uterus. If supernumerary teeth can
be regarded as atavistic, then we must, consider certain
pre-calcific stages of teeth in the same light; for instance, in
■lie early stage a tooth consists of an up-growing papilla
capped by a down-growth of epithelium. Suppose the de¬
velopment to advance no further, but growth to continue,
the result is an aberrant formation—a neoplasm. Involu¬
tions of this kind have been detected by Malaseez, and
Jr. Ere has discussed their relation in connexion with mul-
'ilocular cystic tumours of the jaws. The upshot of the
argument is this: supernumerary teeth, odontomata (ex¬
cluding the cementomata of herbivora), and multilocular
cystic tumours of the jaws may be regarded as originating
n the germs of teeth suppressed in the process of evolution
of our species. The incisor tooth, to the consideration of
which the early part of the argument was dedicated, may be
considered, in all probability, as the last tooth in the order
of suppression.

In addition to neoplasms originating in undeveloped
>aamel germs, we have to take into consideration a class of
tumour usually described somewhat vaguely os adenomata,
growing from the palate. Our knowledge of these cases is
much advanced by the work of Mr. Stephen I’aget on this
subject. It appears that neoplasms, perfectly Innocent in
*heir nature, but full of epithelial nests, occur in the palate,
and there are good grounds for believing that many of the
growths variously described as glandular, alveolar sarcoma,
alveolar carcinoma (!) &c., have their origin in little
rounded masses of epiblast, which become enclosed between

the two horizontal plates/which fuse together in tbe median
line in order to separate the nasal and buccal cavities. The
existence of such isolated epithelial islets has been affirmed
by more than one observer, and a good account of them,
with references to the literature of the subject, will be
found in Leboucq's papers on “ Le Canal Naso-palatine chez
rilomme,” and Note sur les Perles Epithdliales de la Youte
Palatine.” 1

In the museum of the Middlesex Hospital, standing side
by side in the section devoted to injuries aud diseases of the
kidney, are two specimens; each in the words of the
catalogue is thus described :—“ A kiduey, which is enlarged
to three times its natural size, and is almost entirely made
up of a congeries of cysts, varying in size from a walnut to a
pin’s head, separated from one another by a narrow band oi
reual tissue. The pelvis and ureter were not diluted. The
normal shape of the organ i3 retained, but uo distinction is
visible between the cortex aud medulla." The kidney, 1
have since been able to determine, was removed from a
feetus at term, and its general appearance may be gathered
from Fig. 3. Few can have conducted many pathological
examinations of foetuses without encountering such a case
I have examined ten such kidneys. A goodly uumber are
recorded in the Transactions of the Pathological Society,
and many of the pathological collections in London possess
examples of the condition. This cystic state is not confined
to human kidneys, for l have studied them in calves, sheep,
asses, and horse?. Such kidneys are usually found in still-

Fig. 3. Fig. 4.

General cystic disease of the testicle.

Innocent form.

bom foetuses, aud olten co¬
exist with such malforma¬
tions as cleft-palate, hare-lip,
talipes, hydrocephalus, &c.;
but they may occur without
associated mai formations, and in a milder form are not
incompatible with life. The first to draw attention to
this remarkable condition was Virchow,* although cases
had been reported by ltayer and Forster. Virchow con¬
sidered the cysts to arise by ectasia of the uriuiferous
tubules, in consequence of obstruction to the tubules,
the result of diseuse during intra-uteriue life; in the
majority of specimens the pelvis of the kiduey is
absent. The cysts contain fluid which numbers among
its constituents* urates. The ureter is excessively thin,
but always pervious, and the renal artery excessively
attenuated. Often the kidneys are of the horseshoe
pattern. In rare cases a tract or a few patches of nor¬
mal renal tissue is presen\ The researchts of my friend,
Mr. S. G. Shattock, put the matter on a totally different
footing. By great good fortune a fce'al kidney in a less
advanced stage and with a perfect p-lvis came under his
observation, and microscopic examination showed that the
walls of the cysts were lined with tessellated epithelium.
Comparison of sections from this kidney were carefully made
with sections of the mesonephros (Wolffian body) of a human
feetus, arid their identity established. Whilst Mr. Shattock
was working in this way, I adopted an independent method,
and compared sections of congenital cystic kidneys with

1 Archive# des Biologie, vol. il.. Issi.

2 Ueber Congenital® Nierenwassersucht. Geaainnidto Abiiandlungeii.
pp. 8.‘i9, 801. Consult also Pre-Smith, Trans. Path. Soc.. vol. xxxii.,

p.112.

A congeuital cystic kidno.v.

256 The Lancet,] DB. J. L. DOWN: MENTAL AFFECTIONS OF CHILDHOOD AND YOLTH. [Feb 5,18S7.

specimens prepared from an abnormally large paroophoron
in a fcetus, beside numerous smaller ones. The conclusion
derived from the study was irresistible —vis., that in these
enormous cystic kidneys, whether they occur in the fcetus
or adult, are to be regarded as persistent mesonephritic
(Wolffian) tubules which have become cystic (retention
cysts). The amount of mesonephritic tissue varies in dif¬
ferent cases, and in most a certain proportion of meta-
nephritic tissue is present. Mr. Shattock’s observations on
congenital cystic kidneys are not only directly confirmed by
what we know of mesonephritic remains composing the
paroophoron, and the great tendency they exhibit to form
cysts, but they shed much light on the innocent variety of
cystic disease of the testis. In this case the cystic spaces are
lined with tessellated epithelium, and arise from the dila¬
tation of the collection of mesonephritic remains familiar as
the organ of Giraldes, situated between the testis and
the epididymis. The general appearance of this affection
recalls that of the congenital cystic kidney. (Fig. 4 ) Thus
developmentally, structurally, and in pathological tendency,
congenital cystic kidney, the innocent form of cystic testicle,
and paroophoron cysts are identical.

Among suppressed organs of pathological import must be
mentioned the pedicle of the allantois—familiar as the
urachus. Although normally persistent as a shrunken,
impervious cord, passing from the summit of the bladder to
the umbilicus, it may occasionally retain its patency for
a long period after birth. In some instances it may grow
equally with the bladder, retain a communication with
that viscus, and give rise to a so-called bifid bladder. It
may dilate unequally and form a chaplet of small cysts, and
in some rare instances may serve as the starting-points of a
cystic tumour (outside the peritoneum 1 ) of enormous dimen¬
sions. In one case I had an opportunity of examining and
reporting upon with Dr. Aveling for the Gynaecological
Society, the tumour weighed nearly five pounds. A careful
account of some examples of this kind of cyst has been
furnished by Mr. Lawson Tait in the Gynecological Journal ,
toI. ii., in a remarkable paper on “Extra-peritoneal Cysts.”

Among the most extraordinary instances of suppression
of parts, with retention of an original function, known to
me, is exhibited by the prostate. Morphologically, this organ,
with its utriculus, glands, and muscle fibre, i8 to be regarded
as a diminutive uterus. Careful analysis of its mode of deve¬
lopment shows very conclusively that it is the homologue
of the uterine cervix and upper segment of the vagina.
These portions of the female reproductive organs are formed
from that part of the Mullerian ducts which, in the oviparous
vertebrates, constitutes the shell-forming segment. All
surgeons and pathologists must be familiar with the small
concretions so constant in the recesses of this organ in
adults, and which have been so well described by Sir Henry
Thompson in the Medico-Chirurgical Transactions (vol. xl.,
p. 78, 1857). In constitution and composition they agree
with egg-shell, and they are formed in parts strictly homo¬
logous in reptiles, birds, and mammals. Thus man has in
his prostate, morphologically, structurally, and functionally,
an unimpeachable witness testifying to an ancestry with
the feathered tribe, low down among the oviparous reptiles.

Manchester Medico-Ethical Association.— The
annual meeting of this Association was held on the 28th ult.
The report of the committee showed continuous prosperity,
With a steady increase of funds. The following resolution
was passed: —“ That the Manchester Medico-Ethical Asso¬
ciation expresses its approval of the action taken by the
Apothecaries’ Society of London, to obtain admission to the
Conjoint Examining Board for England, together with the
Royal Colleges of Physicians and Surgeons of London.”
The following gentlemen were elected office-bearers and
members of committee for the year:—President: Dr. H.
Simpson. Vice-Presidents: Drs. H. Ashby, W. H. Barlow,
S. Buckley, and F. M. Pierce. Treasurer: Dr. D. Lloyd
Roberts, F.R.S. Ed. Secretaries: Mr. J. Broad bent and Dr.
A. Wahltuch. Committtee: Drs. F. H. Collins, A. Emrys-
Jones, 8. H. Owen, T. C.Railton, W. J. Sinclair, and W. Walter,
and Messrs, fl. A. G. Brooke, J.C. Clarke, J. Hewett, J. Foster,
H. P. llderton, and G. H. Pinder.

Ta4 Tkrarnamouth Improvement Commissioners
contemplate spending .£9000 in a scheme for supplying the
town with sea water tor street-washing and sewer-flushing.
The gas and water company have objected, and it is necessary
that their consent to the scheme beobtained. ' .....

ABSTRACT OF THE

^ttfsomian futures

OX SOM* OF THE

MENTAL AFFECTIONS OF CHILDHOOD
AND YOUTH.

Delivered before the Medical Society of London,
January, 1887,

By J. LANGDON DOWN, M.D. Lond., F.R.C.P.,

PHYSICIAN TO THE LON DO* HOSPITAL.

LECTURE III.

Infantile Insanity. —Infantile mania is not of frequent-
occurrence, and has not been the subject of much comment.
Dr. Down has observed recurrent attacks of acute mania in
young children. Cases having well-marked delusions of
suspicion have also been met with. The ordinary trust¬
fulness of childhood has been replaced by painful mis¬
trust. The lecturer had seen some cases of melancholia
associated with manifest delusions, one boy believing that
he resembled an animal. In one case of homicidal mania in
a little girl who subsequently became epileptic Dr. Down
thought that the maniacal paroxysm was really masked
epilepsy. As puberty approaches attacks of mental aberra¬
tion assume a special character; there is frequently un¬
natural introspection, and a critical hyper-conscientiousness
lecomes prominent. Sometimes such patients avoid making
any positive assertion lest the exact truth should not be¬
spoken. These cases cause great anxiety at the time, and
occasionally end in a permanent break-down. Many, how¬
ever, by careful management may be tided over the climac¬
teric period of puberty, and then all may go well. It is
important to be on guard against concealed suicidal impulse
and to note its slightest indication, as the tendency in sucb
cases is to melancholia, and in some cases to self-inflicted
injury. Care should be taken that there is no sexual devia¬
tion. If present it should be treated as a physical evil, and
to be corrected far the good of the body. Sexual deviations
are readily recognised by the supra-orbital headache, dilated
pupils, brown umber areola: surrounding the eyes, averted
look, and statuesque bearing. Occasionally the latter is so
marked as to resemble a minor cataleptic state.

Moral insanity is met with in childhood and youth. Sncb
are cases of purposeless theft, lying, or mischievousness.
The subjects of this condition are sometimes intellectually
bright, and have an amount of address which makes them
extremely troublesome to their friends. More frequently
moral insanity is associated in childhood and youth with
some amount of mental backwardness. The backwardness
may be very alight, but the manifestations of moral insanity
may be multiform. A dangerous form of moral insanity is
incendiarism. Many forms of low cunning are developed
in backward boys by associating them with others of more
wit.. Under such circumstances the backward boy calls to
his aid lying, theft, and deceit to compensate for his intel¬
lectual weakness. The moral sense in these cases may be
regained or developed when removed from their injurious
surroundings and submitted to appropriate training. Idiot
savants are feeble-minded children who exhibit soma
faculties developed to excess. Some such could carve and
draw with great skill. Extraordinary memory is often met
with associated with very great defect of reasoning. Ono
boy, in reading Gibbon’s “Rise and Fall of the Roman
Empire,” skipped a line on the third page at his first perusal.
Ever after, when reciting from memory the stately periods
of Gibbon, he would, on coming to the third page, skip the
line and retrace his steps just as when he first re-committed
the passage to memory. Often the memory takes the form
of remembering dates and past events. One boy never
failed to tell correctly the name and address of every
confectioner’s shop he had visited in London, and could
as.readily tell the date of every visit. The faculty
of number is usually slightly developed in feeble¬
minded children, while memory is farriy well deve¬
loped ; yet occasionally the power of mental arithmetic
has been well developed. Improvisation is an occasional

The Lancet,] DR. J. L. DOWN: MENTAL AFFECTIONS OF CHILDHOOD AND YOUTH. [Feb. 5,1887. 257

faculty. Memory of tune is a very common faculty among
he feeble-minded; they readily acquire simple airs and
rarely forget them. In none of the cases of idiot savant
had there been any history of the possession of a similar
faculty by the parents or sisters or brothers. In one case a
necropsy had been made. The boy had a remarkable, indeed
perfect, appreciation of past or passing time. There was
no difference from an ordinary brain, with the exception
that there were two well-marked and distinct soft com¬
missures. Dr. Down’s explanation of the phenomenon was
that, as every movement of the house was absolutely
punctual, he bad data from which he could estimate the
time by accurate appreciation of its flux. All these cases of
idiots were males. Every form of mental deviation may be
met with in the congenital feeble-minded. They may become
the subjects of acute and chronic mania, of acute and chronic
melancholia, and of dementia. Occasionally under the in¬
fluence of acute mania, the feeble intellect or the youth be¬
comes fanned into a brighter flame. The taciturn may become
loquacious; the timid and respectful, proud and defiant; the
amiable and tractable, abusive and destructive. Three
remarkable instances have occurred to Dr. Down of boys
who had never been able to speak making use of well-
formed sentences during the high febrile state of acute
pneumonia or scarlatina. There are two ailments from
which the congenital feeble-minded are remarkably free —
chorea and hysteria. Chronic and persistent incoordinate
movements may be seen, but not the acute attacks so
common in a general hospital. Perhaps it is partly owing
to the lessened emotional life of the patients. The same
reason may account for the rare occurrence of hysteria.
This defective emotional element in the feeble-minded spares
them much grief. Epilepsy i9 a common complication of
feeble-mindedness. Of the whole number of Dr. Down’s
patients 24 per cent, have been at some period or other
epileptic. Dr. Kerlin of Pennsylvania gives nearly the
same percentage. Epilepsy often appears for the first time
at puberty, ana subsequently disappears. Occasionally the
status epilepticus supervenes with tne worst, possible results.
Catalepsy is met with among the feeble-minded, but always
associated with impure habits.

The physical deviations of the feeble mind are important.
They are very prone to eczematous eruptions in the flexures
of the joints and behind the ears. The skin gives evidence
of degeneration in its tendency to unnatural unions, just as
the petals of the corollifloral exogen indicate a lower grade
than the distinct petals of the thalamifloral. So do webbing
of the toes and fingers and adhesions of the lobules of the
ears suggest marked inferiority. Abnormalities of the ear
were frequent in people of a degenerate type: lobules absent,
lobules adherent, helices defective, and. the entire pinnte
misshapen or shrunken, are very common. The develop¬
ment of the hair offers some anomalies; some of the feeble¬
minded are hirsute over the whole body, and 11 percent,
have the eyebrows continuous over the nose. The tongue
is very badly coordinated; at the usual time for commencing
to speak, 36 per cent, were found to be speechless, and 30
per cent, could speak but little, whilst not more than 28 per
cent, could speak fluently. Mastication is often defective;
deglutition is often hurried. Rumination occasionally occurs.
The appetite may be perverted, pebbles and otlrer things
being swallowed without ill effect. The organs of repro¬
duction are ill developed—small ovaries ana undeveloped
nr undescended testes. The reflex functions are defective.
Constipation is common. Emesis difficult to excite. Absence
of cough and expectoration when the subjects of phthisis
was also to be explained in the same way. The vaso-motor
system is very sensitive. Sudden change of weather easily
excites gi>tro-intestinal trouble. Bolting food, or over¬
eating, or taking too much meat, or electrical disturbances
are other common causes of catarrh of the bowels. Dis¬
seminated sclerosis, shown in the characteristic gait and
scanning speech, may be observed; but more frequently
pseudo-hypertrophic paralysis is manifested in the feeble¬
minded. Diseases of the liver and kidneys are extremely
rare, owing to the discreet and temperate habits which such
patients are accustomed to lead nnder medical guidance.
Rheumatism is very exceptional. Diseases of brain and
lungs are the chief causes of death, putting aside the
diseases of childhood. Dr. Fletcher Beach found that about
2] per cent, of the average daily number of inmates of
the schools at Darenth die from epilepsy, or more than
the mortality of London from all causes. The preva¬
lence of phthisis as a cause of death depends very much

on the nature of the soil on which they reside. In the
year 1867 Dr. Down wrote a paper in The Lancet “ On the
Relation of Idiocy to Tuberculosis,” in which he showed how
prevalent phthisis was among idiots, amounting to 39 per
cent, of the general mortality. Nothing is more remarkable
than the readiness with which feeble-minded children
succumb to acute disease of any kind, or the way in which
they are affected by climatic changes. The onset of illness
should be narrowly looked for ana promptly treated. The
thermometer is or great value in detecting the early signs
of disease and the need for early precautionary measures.
Loss of appetite was the indication most relied on of illness
before the introduction of the clinical thermometer. As to
height and weight of idiots, Dr. Down’s observations agreed
with those of Dr. Shuttleworth and Dr. Tarbell of America.
They are shorter and lighter, but the relative rate of growth
of tbe two sexes of idiot children follows the same rule as
that of normal children, and is subject to the same variations
at puberty.

Diagnosis —The diagnosis is important both for training
and forensically. The profound cases are easily diagnosed,
especially if associated with marked asymmetry of cranium
or microcephalism. The congenital class is that which has
to be considered in early life. The instinctive process of
feeding is often acquired with difficulty, and indicates that
there is no predominance of instinct in infancy. The young
animal is on a higher platform than an idiot baby so far as
inUinct is concerned. There is a marked indisposition to
make muscular effort. There is no responsive leap when
the feet are allowed to touch the ground. No disposition
to crawl. The power of standing is long deferred, and
walking may never be attained. There may be much
difficulty in diagnosing the accidental cases. They are, as
a rule, fleet and mobile and mischievous to a degree.
Irritated by constraint and intolerant of cephalic exami¬
nation, they alternate their mischievous pranks with
shrill shrieks and unmeaning cries. They rarely speak, are
fond of feeling things with their tongue, and run about
in search of fresh objects for indulging this freak. They
live entirely in a world of their own. Slavering is a very
common sign among the members of the three classes,
arising sometimes from inattention, or from the hypersemic
condition of the salivary glands, from prognathous form and
inadequate size of jaw, from want of muscular power of
lip, from incoordinate movements of the tongue, and some¬
times from a combination of two or more of these con¬
ditions. Automatic movements are also common. These
may consist of rotatory movements of the head on its axis,
from side to side, and rhythmical movements of the Angers
before the eyes.

Backwardness .—There are a large number of boys and

r ls who are dull and backward, who develop tardily, but
eventually attain to a fair amount of intellectual power.
These are tne en/ants arribres of French writers. For
diagnosis the question to be answered is, Can we in imagi¬
nation put back the age two or more years, and arrive thus at
a time perfectly consistent with the mental condition of
our patient ? This would be possible with a backward but
not with an idiotic child.

Absence of speech may be ascribed to deafness or congenital
defect of hearing; to defective formation of tbe tongue,
palate, or lips; to defective mental power, the child having
no idea, or being incapable of converting ideas into words.

•Anatomy —The weight of the brain may be very considerably
diminished in the microcepbalic or Aztec types. The brain
is not always simply retarded in growth. Too early
synostosis could not be the cause of microcephalism. There
is defect of development as well as of growth. The develop¬
ment of convolutions was not arrested equally at all parts
of the brain. In one case—the brother of the patient whose
brain was described by Mr. Marshall—the occipital lobe had
developed but slightly. Tbe convolutions were less complex,
smoother, and with fewer secondary sulci than those of the
orang or chimpanzee. The supra-marginal lobule, and the
second connecting convolution were almost absent. The
first convolution was very simple. There was a calcarine
lobule, hut not any accessory fold uniting the second ascend¬
ing fold to the 6upra-marginal lobule. In these features
the brain resembled the quadrumanous cerebrum. The
want, of symmetry, of an operculum, of the two in¬
ternal connecting convolutions: the position of the
bent fold in regard to the Assure of Sylvius; the
complete junction of the calloso-marginal and the
middle temporal or uncinate convolution—were character*

258 ' TriA'lA cet,'] MrT fcbiii‘D! WOUND

essentially human. Asymmetry of the brain is common.
The occipital lobe is often undeveloped. Hypertrophy of
the brain is not unfrequent. A hiwe cranium with com¬
pletely ossified sut ures may coexist with a hypertrophied brain.
The cranium may be greatly thickened. More or less com¬
plete absence of commissures may be met with. The corpus
callosum has been absent in 2 per cent., and the soft com¬
missure in 8 per cent., of Dr. Down’s post-mortem examina¬
tions. Pallor of the grey matter is ot very frequent occur¬
rence. Indeed, nothing is more striking than the frequent
mention of whiteness of this part. Dr. Down could not
but think that this phenomenon afforded indications for
treatment and hopeful prognosis—as to the possibility of
functional improvement of the brain.

Treatment resolves itself into physical and medical, and
moral and intellectual training. Treatment should be begun
betimes. Early training is of importance in preventing
the growth of bad habits. Dr. Down avers that he knows
nothing of cataclysmal improvements at seven and fourteen
years of age. These ages are developmental crises full of
danger. The most successful training is effected by placing
the child with its peers, and not with its superiors. Intelligent
children will not take part in the amusements and games of
feeble-minded ones. It is important to rescue the feeble one
from a solitary life, to give him companionship with his
equals, and to place him in a condition where all the
machinery moves for his benefit, where he is surrounded by
influences of art and nature calculated to make life joyous, ]
to arouse his observation, and to quicken his power of
thought. In the families of the wealthy feeble-minded
children do not receive the needful education and the
necessary attention. It must always be kept in mind
that the basis of all treatment should be medical in
the large sense of the word. Success can only be attained
by keeping the patient in the highest possible health. This
is demonstrated by the increased intellectual torpor that
accompanies deterioration of bodily health, and also by the
diminished intellectuil vigour observed in cold weather.
A verjr liberal dietary is of great importance. It should
contain a fair quantity of nitrogenous elements, and be rich
also in phosphates and oleaginous constituents. Green
vegetables are very essential os a valuable antiscorbutic.
Too much farinaceous food should be avoided. Semolina,
entire wheat flour, or macaroni are the best. The food must
be easy to masticate. The bed- and sitting-rooms should be
spacious, well warmed, and ventilated. The akin should be
frequently sponged; the exhalation from it in the feeble¬
minded is something mi generis. A gravel soil, with well-
made walks and plenty of out-door exercise and warm
clothing, are most necessary. Summer brings with it a
remarkable immunity from disease. Gymnastics, massage,
and galvanism are employed to improve the condition
of the muscles. Volitional movements should take the
place of automatic ones. Simple ones are first practised.
Finger lessons should precede tongue lessons. Dr. Down
always remembers the pinioned Frenchman who entreated
that his arms might be freed because he wanted to speak.
The physical quality of the brain and other nervous centres
must be improved, and this will bring the patient into prac¬
tical relation with the external world and initiate reasoning.
The moral training is of great importance. The patient's
will must be brought into subjection to that of another. lie
has to learn obedience, that right-doing brings pleasure, and
wrong-doing deprivation of pleasure. The affective faculties
should be so cultivated that loss of the teacher’s love should
be felt as the greatest punishment, and vice versa.
In this way indications of untruthfulness, selfishness,
obstinacy, sensuality, theft, and unkindness are checked.
Corporal punishment should be strictly forbidden. Nothing
is worse than deprivation of food as a punishment for
an offence. Moral delinquency may be the result of
mental excitement, the outcome of defective nutrition.
The intellectual training must be based on a cultivation
of the senses. They should be taught the qualities of form
and the relation of objects by the sense of touch; the
colour, size, shape, and relation by sight; the understanding
of the various sounds; the qualities of objects presented to
t aste or smell. The concrete, not the abstract, should be
taught. Dressing and undressing should be taught. Habits
of order and neatness, of dexterity in the use of the knife,
spoon, or fork, of precision in walking and handling, should
be inculcated. Defective speech is best overcome by a well-
arranged plan of tongue gymnastics, followed by a cultivation
of the purely ind*stive powers. Monosyllabic sounds having

OF THE COMMON' foafrOKAt YEIN.' 1 [F*b. 5,188?/

concrete representatives should be first taught. Th6tran-‘
suctions of buying and selling may be easily arranged for,
amongst the patients themselves. House and school instruc¬
tion should be supplemented by gardening and farming
operations. The lathe, the fretwork machine, carpenter’s
bench, and printer’s shop are useful appliances and means.
For girls kindergarten occupations and the various elegancies
of needlework may be the outcome of persevering effort..
Music and dancing may, for all, alternate with dramatic
entertainments, which appeal to eye and ear.

A CASE OF WOUND OF THE COMMON
FEMORAL VEIN; SECONDARY HAEMOR¬
RHAGE FROM THE COMMON FEMORAL*
ARTERY; SEPTICaEMIA; DEATH . 1
By A. PEAECE GOULD, M.8.,

ASSIST AMT-SUHGEO-X TO THE MIDDLESEX HOSPITAL.

The wound of a vein is, as a rule, less serious and more
easily dealt with than a wound of the corresponding artery*
and for this among other reasons wounds of veins hav&
received but scant notice at the hands of most surgical
writers. Wounds of very large veins, however, are very
grave injuries, and there are several interesting questions
connected with their treatment which may be considered as-
still open to discussion. Having recently had to treat a.
case of wound of the common femoral vein attended with
grave complications, I have thought an account of it might
be considered worthy of attention.

On the evening of Oct. 11th, 1886, M. M-, an Italian

ice-cream seller, was stooping down in. the street, when on
rising he came in contact with the knife of a cat’s-meat
woman who was standing by his side, the knife entering his-
left groin. Blood flowed very freely, and he went to a,
neighbouring chemist, who applied a pad and bandage and
sent him to Middlesex Hospital. On his arrival at the-
hospital the haemorrhage had ceased, but while the house-
surgeon (Mr. Livermore) was preparing to readjust the pad
the man vomited, and at once a full stream of venous blood-
spurted from the wound. A compress was firmly baudaged
on and I was sent for.

1 found the man pale, cold, and rather faint from
loss of blood, and as the haemorrhage bad been so
abundant I determined to secure the wounded vessel.
An anesthetic was administered by Mr. Fardon, and
a Petit’s tourniquet was applied t6 the thigh below the
wound. The wound was a clean cut half an inch long,
immediately below and parallel to Poupart’a ligament and
exactly over the common femoral artery; a probe passed,
into it slipped downwards and inwards. There was no
Alteration in the femoral or tibial pulse. I enlarged the
wound by a vertical incision about three inches long, and
turned out a considerable quantity of clotted blood which
was lying beneath the fascia lata; upon this very free-
venous bicmorrhage ensued, which was with difficulty held 1
in check by digital pressure above the wound. 1 then
passed my finger into the bottom of the wound, and found
that it passed quite into the common femoral vein through
a wound which severed the whole anterior segment of tne
vesseL A ligature was passed around the vein above and.
below the wound and tied. This did not arrest the bleed¬
ing, which was then seen to come from the internal
saphena vein, which entered the femoral just opposite the-
wound; a ligature was passed around this vein and tied.
But blood still welled up from the wounded vessel, and a
further search showed that another vein entered the femoral
trunk just opposite the wound in the segment between the
two ligatures. This vein was tied, and then all haemorrhage
was found to be arrested. The ligatures were of carbolised silk.
The femoral vein was divided between the two ligatures.
The man lost a good deal of blood during the operation,
which was attended with considerable difficulty owing to
the impossibility of completely arresting the haemorrhage
by pressure above and below. The femoral artery was clearly
seen during the operation, but was apparently uninjured.
The wound was very thoroughly irrigated with solution of

1 A paper read at a recent meeting of the MedlcAl Society ot London.

The Lancet,] MR. A. PEARCE GOULD: WOUND OF THE COMMON FEMORAL VEIN. [Fun. 5,1887. 259

Cases of Wound of the Femoral Vein.

Surgeon.

Reference.

Injury.

Treatment.

Result.

Langenbeck

Langenbeok’s Archil- , 1

Wound of femoral vein during removal of |
sarcoma of groin i

Ligature of femoral artery

Recovery

•Oettingen

“ International Kncyolop.
of Surgery.'’ vol. iii.

(Dr. LTcletTs article)

Wound of femoral vein during removal of |
tumour of groin j

Double ligat ure of vein :
ligature or femoral artery

Recovery

McClellan

Ditto

Wound of the Internal saphena vein at the j
entrance to the femoral vein, during ’

excision of tumour In the groin l

Lateral ligature of the
femoral vein

.

Recovery

Itour

Gazette da Hapitivx, 1853
(quohxl by Nicursv)

Wound of femoral tein abore anphena during 1
removal of tuitiour fli the groin j

Double ligature of the
femoral vein

Recovery

■McClellan

Dr. Lldcll. op. eit.

Wound of femoral vein and exposure of the 1
femoral artery by * blunt hook

Ligature of femoral arterv;
compression of wounded
vein

1

Gangrene
of leg:
aniputatiim ;
recovery

•Ollier

( Quoted by HlcaUe

| Wound of femoral vein in groin

Suture of skin wound ;
light compression

Recovery

tDelore

Ditto

)

Wound pf femoral vein

Compression above tho
wound.

Death from
ha-morrliage

Eoux

1 Ditto

Compound fracture of the middle third of the
femur; wound of the femoral vein

Wonttd enlarged ; hrrmot-
1 rhage arrested by plugging

Recovery

Larrey

1 Quoted by Nicairc

| (Clin. C'hir., t. iii.)

Sabre-wound of groin div iding saphena
vein at the cutrauce to the femoral vein

Ligature of femoral and
saphena veins

Recovery

Garret son

"Medical nnd Surgical
History of the War of the
Rebellion,” second Surgical
volume

Wound of femoral vtln

1

1

i Double ligature of femoral
vein: single ligature of
femoral artery

Death

Leale

1 Ditto

1

•

1 Gunshot-wound of femoral vein and

j prustatc

Compr.j&TS

; Death on
j lire 13th day

Pcgue

Ditto

■ Gunshot-wound of femoral vein

—

Dtath on
] the 17th day

—

Ditto

j Gunshot-wound of femoral vein

| •

1 Death on
j the 18th day

-

Ditto

i Wound of femoral vein

-

j Death

—

Dr. Lldcll, op. cit.

Wound of femoral vein and crural nerve

Con.presses and stypfrc 3

Dent h

Agnew

Quoted by Li.lell

1 Wound of femoral vein during ligature of
< artery for aneurysm

Ligature of artery

| Recovery

Travers

J " Surgical Beanys,” by
; Cooper and Travers

■ Wound of femoral vein during ligature of 1
artery for aneurysm •

-

<3en60ul

Quoted by Nieaise

Gunshot-wound of middle of th'gh.
fracturing femur; s> o.-mlnry h.vmorrhage
from femoral vein

Ligature of common femoral
ar'ory

Death OU the
7th dar; no
gangrene

■Desprte

Quoted bv Kicaisc

1 iSoc. de C'hir., Oct. loth, .
[ 1871) ' 1

1 Wound of upper part of thigh ; secondary
hiumon hag •

Ligature of femoral vein

Recovery

’’

.■Nelson

1 “ Medical and Surgical
| History of the War of tluj '
Rebellion," Part 3rd ^

Gunshot-wound of groin; sloughing; ,

pyicmia ; secondary h.-vniorrlwge from a
wound of femoral vein by a needle

Ligature cf femoral artery ^

1

Death

1 " International Eneyelop. i
I of Surgery " (Dr. Lidell), 1
yoC iii. . j

Wound of fern oral artery and vein

—

Death in a few
moments

Ditto ’ i

' Wound of femoral artary and vein i

—

Death In a few

’ ■ 1

»

moments

it 0*0 j

i

Ditto :

Punctured worm I of femoral artery and i

vean

Double ligature of femoral
artery and rein

Recovery

Dr. Lidell’s artiole, op. at. j

1

Gunshot-wound of femoral artery and
vein

Ligature of femoral artery
and vein

Gangrene;
death

JDongherty

" Medical and 8nrg1c*l |
1 History of the War of t he
Rebellion,” second Surgical

volume

Gunshot-wound of femoral artery and

vein 1

i

Doulvlc ligature of femoral
artery and vein ; ampu¬
tation

Death

—

Ditto }

i

Wound of femoral art*, ry and vein

Amputation 1

Pytemla;
death

—

Ditto

Wound of femoral artery and vein 1

Amputation on ninth day

Death

"Thomson

Ditto

Wound of thigh ; secondary hemorrhage 1

Ligature of f •moral artery
nnd vein

Gangrene;
death

Thomson

Ditto

Wound of femoral artery and vein

1

Double ligature of femoral
artery and v-iu ,

Death

Gayet

Quoted by Nlcalse

Wound of femoral vein and profunda artery j

Ltg. of external iliac arterv ’

■ * 1

Dtath

Digitized by

Google

[Fbb. 6,1887.

260 The Lancet,] MR. A. PEARCE GOULD: WOUND OF THE COMMON FEMORAL VEIN.

bichloride of mercury (1 in 2000), and was closed with
catgut sutures, a drainage-tube being inserted at the lower
angle, and dressed with sal alembroth wool. A flannel
bandage was rolled around the limbs, and the man was re¬
turned to bed with the knee slightly flexed. A quarter of a
grain of morphia was given hypodermically.

Oct. 12th. — Next morning he appeared comfortable;
pulse 96; temperature 98*4°; sweating freely. The leg and
foot were nearly as warm as the other side, and there was no
oedema. The temperature rose in the evening to 101*2°; and
the urine was drawn off by catheter, as none had been passed.

13th.—Temperature 103*6°; pulse 100; profuse sweating;
patient restless at times. One grain of opium was ordered
every six hours. The wound was dressed; there was no
redness of the edges, swelling, or bagging. The drainage-
tube was removed. At 9 p.m. the temperature was 104°, and,
as the bowels had not acted, an ounce and a half of com¬
pound senna mixture was given.

14th— Temperature 101. Bowels acted five times during
the night, and this diarrhoea continued through the day, in
spite of the opium which was taken. There was slight
oedema of the left foot and lower part of the leg.

15th.—Temperature 101°; pulse 108. Diarrhoea has ceased.
The wound was dressed, and a considerable quantity of turbid
serum oozed from it. The highest two stitches were removed,
the edges separated, and the cavity was well washed out
with corrosive sublimate solution (1 in 2000).

16th.—Temperature 100° ; pulse 96; no sweating. On
removing the dressing the edges were found sloughy, so the
remaining stitches were removed, the edges separated, and
the part well irrigated with corrosive sublimate.

17th.—Delirium set in; at 12 noon he had a fit, being
seized with tremors and cough, followed by dyspnoea, the
patient with wide-open mouth gasping for breath for four
or five minutes. The wound was dressed and well irrigated.
One-sixth of a grain of morphia was injected, but he slept
only a very short time after it, and at night a mixture con¬
taining half a drachm of bromide of potassium, one scruple
of chloral hydrate, and fifteen minims of tincture of byos-
cyamus was ordered to be given every hour until sleep was
obtained. The delirium was closely like delirium tremens.
Four doses of this mixture produced no effect, and the man
had a very restless night. At 4 a.m. one-sixth of a grain
of morphia was again injected under the skin.

18th.—The patient has had two hours’ sleep, and is much
more sensible. The wound looks healthier. During the day
he had three injections of one-sixth of a grain of morphia.

19th.—He bad had a fairly good night and was better;
the edges of the wound were granulating. He was quiet
all through the day, and took nourishment well.

20th.—The improvement continued; in the evening he
passed urine voluntarily for the first time.

At 12.30 a.m. on the morning of Oct. 21st, after a violent
fit of coughing, profuse haemorrhage came on, and a good
deal of blood was lost before aid arrived. The artery was
controlled above Poupart’s ligament, and Mr. Livermore
seized the bleeding point with pressure-forceps. I was sent
for, and had the patient placed under the influence of
chloroform. I found that the bleeding came from the
common femoral artery ; without difficulty I placed a silk
ligature upon the vessel close below Poupart’s ligament.
The vessel was softened, and obviously unfit for a ligature
as far down as the origin of the profunda, so a ligature was
placed around both the superficial and the deep femoral
arteries; this entirely arrested the haemorrhage. The wound
was again irrigated with the mercury solution, and dressed os
before with alembroth wool. The limb was wrapped in a thick
layer of cotton-wool, and hot bottles were placed in the bed.

The patient never recovered from the effects of the loss of
blood, and he died in the evening of Oct. 22nd. During the
last five days of his life the foot and leg became more
oedematous, and especially was this so after the second
operation. The foot and leg did not regain their warmth
after the ligature of the artery.

The necropsy was made nineteen hours after death by Mr.
Roger Williams. Rigor mortis was present, and the body was
jaundiced in appearance. The two ends of the femoral
artery were separated by about two inches, each secured by a
ligature; in the upper end was found a rather firm reddish
clot, which extended up to and obliterated the origin of the
deep epigastric artery ; the distal end was filled by a much
smaller and softer clot, about three inches long. The tied
end of the profunda femoris artery was found between the
ends of the femoral artery. The upper end of the femoral vein

was found with its ligature lying loose by it; there was no liga¬
ture over or near the distal end. A ligature was found around
the internal saphena vein, and another around the external
circumflex vein. The profunda vein entered the lower end of
the femoral vein. There was a broken-down clot filling the
external iliac vein from the entrance of the circumflex iliac
vein and extending almost up to the vena cava. The left
lower limb was deeply congested, and swollen from oedema and
gas generated by decomposition. Liver and kidneys fatty.
The spleen weighed 14± oz., and was deeply congested. The*
endocardium on the right side of the heart was stained red.

Remarks— I would submit the following interpretation*
of this caseThe wound of the vein was made with an
infected knife. Antiseptic irrigation failed to remove all the-
infective material, which, remaining behind, set up inflam¬
mation in the wound and led to the breaking down of the
thrombus in the vein. The femoral artery may have been
bruised at the time of the original injury, although it
showed no signs of it at the time, and the treatment pursued
—plugging the wound. &c.—may have injured it, and so its
walls quickly yielded to the septic processes in the wound,,
and secondary haemorrhage ensued, necessitating ligature of
arteries. Meanwhile the septic thrombus had been spread¬
ing up the iliac vein until all the direct channels for the
venous blood returning from the lower limb were blocked,,
and with this moist gangrene occurred, its full development

a prevented by the death of the patient from general’
•poisoning, accelerated by loss of blood.

The consideration of this case naturally divides itself into-
two heads—the occurrence of the septicaemia and the proper
treatment of a wound of the common femoral vein.

1. The septiceemia. —Of the fact of septic infection of the
wound, with the formation of a spreading, softening throm¬
bus in the iliac vein, there can be no doubt; but exactly to
determine how this infection was occasioned is a more-
difficult matter. My own impression is that the cat’s-meat
knife was the carrier of the infection, and that my anti¬
septic irrigation, although carried out with a special view
to this contingency, failed to remove all the infective-
material. All the usual precautions in wound treatment
were adopted: the ligatures were of silk, which had been
boiled in carbolic acid solution (5 per cent.), and kept in the-
same liquid. To the occurrence of this septic infection or
the wound the fatal result is due. for it prevented the heal¬
ing of the wound by first intention, was an important
factor in the production of the secondary hemorrhage, led
to the complete closure of the channels for the venous-
return from the limb, and induced the constitutional change
which was manifested by fever, sweating, diarrhoea, deli¬
rium, and jaundice. .

2. The treatment of the wounded vein. — From the
“ Medical and Surgical History of the War of the Rebellion,
Dr. Lidell’s article in Ashhurst’s “International Ency¬
clopaedia of Surgery,” and Nicaise’s “ Thesis,” I have col¬
lected the following cases of wounds of the femoral vein.
The cases in the accompanying table (page 259) illustrate
several varieties of wound of the femoral vein: (a) wound
of the vein during the removal of tumours, four cases,
all ending in recovery; (6) accidental wound of the
vein by bullet, sabre, hook, or fragment of bone, eleven
cases—only three of these patients escaped with their
life; (c) wound of the femoral vein during ligature of
the artery for aneurysm, two cases; (d) secondary hemor¬
rhage from the femoral vein, three cases, one of which
recovered ; (e) simultaneous wound of the femoral vein and
the femoral or profunda artery, ten cases, with only one-
recovery. As in so many other statistical inquiries the
cases have varied so much in their nature, and in some in¬
stances the reports are so scanty, that this table cannot be
relied upon as a safe and sufficient guide to the treatment
of a wounded femoral vein. But at the same time it showe
certain facts, the most striking of which is the variety of
treatment that has been adopted, and the success that has-
attended almost every means used. ,

Ligature of the wounded vein. — The table shows fou^*
cases, in one of which the ligature was applied laterally; air
these patients recovered, and no mention is made of sub¬
sequent oedema or congestion, still loss of gangrene. On
the other hand, Verneuil is quoted by Nicaise as having had
three cases of lateral ligature of the femoral vein, all-
fatal. During the removal of cancerous glands from the
groin on one occasion I had to tie the saphena vein at its
juncture with the femoral vein. The man recovered, with¬
out any symptom referable to venous obstruction, in

Thk Lancet,] DR. A. J. WALL: CONSIDERATIONS IN REGARD TO CAUSATION OF SEX. [Feb. 5,1887. 261

M‘delIan’s case of lateral ligature of the vein, he speaks of
tfae wound as a large one. The relative value of the lateral
and circular ligature is the same in the femoral vein as in
tber situations, and although many cases of successful
lateral ligature of large veins are recorded, the fatalities are
coo numerous to warrant its repetition, except in the case
of punctures and small wounds.

Ligature of the femoral artery. —The table shows in all six
oases, three ending in recovery, and three in the death of the
patient. The best known case is that of Langenbeck, who
failed to secure the vein, and then, on ligating the artery,
found the venous haemorrhage stop. In one of the cuses the
ligature "was placed upon the external iliac artery.

Liqature of the femoral artery and vein. —This was done
in three cases for wound of the femoral vein only (including
one case of wound of the ending of the saphena vein), with
two recoveries; and in four cases for simultaneous wound
of the two vessels, with one recovery and three deaths.
The ligature of an artery for wound of the corresponding
vein was first done by Gensoul in 1831; but Langenbeck's
name is specially associated with this form of treatment,
which has been advocated also by Tillmanns and others.
Langenbeck urged that the danger of ligating the main
vein of a limb was the occurrence of gangrene from venous
obstruction, and that by tying the main artery the supply
of blood to the limb was so reduced that this danger was
obviated. There are two sufficient answers to this argu¬
ment : in the first place, it has been Bhown that ligature of
iSie main vein of a limb does not produce gangrene so long
as the various accessory channels of venous return are
patent; in the second place, ligature of an artery lessens
very materially for a time the msatergo of the blood in the
capillaries and veins, and therefore reduces the force which
is opposed to the venous obstruction. 1 have three times
ligatured the axillary vein while removing malignant
growths from the axilla, and have not observed any
erious effects upon the circulation, and many cases
might be quoted to show that Langenbeck over-estimated
'.he injurious effects of ligature of the main vein of a limb.

The treatment of a wound of such a large vein by com¬
pression is not to be recommended, especially in view of the
fact that the haemorrhage, when apparently stayed, is liable
o burst out during any expiratory effort, as was the case in
lay patient. Ollier's case, in which the only treatment
idopted was 6uture of the skin wound and light compression,
19 a very striking one, and may serve as a good example in
ike instances.

The best treatment, therefore, appears to be the ligature
of the wounded vein, and should I meet with another
«imilar case this is the practice I am prepared to follow,
'^hen the secondary hsemorrhage occurred, the question
of amputation suggested itself, but such a course would
.iave been quite unjustifiable in view of the success which
las sometimes attended ligature of the femoral artery
and vein. In my case it would have been doubly wrong,
far it would have inflicted a most serious injury upon a
patient already doomed to death from the septic thrombus
in his iliac veins. In a table of cases of bremorrbage from
veins in the “ Surgical History of the American War,” fifteen
cases of wound of the femoral vein are mentioned, of which
only two recovered.

SOME CONSIDERATIONS IN REGARD TO
THE CAUSATION OF SEX.

By A. J. WALL, M.D. Lond.,

H.M. INDIAN ABM V.

So many theories have been put forward as to the
•aus&tion of sex that it would require much time even to
rtate them. The object, however, in view at present is to
propound no theory whatever, but simply to examine facts
i&t may have a bearing on the subject, and, if possible, to
ring out any relation that may be found to exist between
T he occurrence of sex and any well-ascertained circum-
’-ances in regard to the parents, and to draw therefrom any
1 'inclusions that may seem just.

In the lower animals there are so many different arrange¬
ments of the procreative process that it is not easy to
determine what is the exact relation they bear to sex us
*en in the higher members < f the animal series. Of course.

the essential point in all reproduction is the same— namely,
the separation of a portion of the tissue of an organism, and
its development after more or less change—a change some¬
times so great as to surpass the creations of a lairy tale—
into an organism like that from which it took its origin;
and though in by far the greater number of animals the
process has become modified, so that portions of tissue of
two organisms unite before development proceeds, yet that
it took its origin in the simpler method is evident trom the
fact that even so high up in the animal scale as birds the
first step in the development of the ovum—cleavage—may
occur without any interference of the male element what¬
ever, though the process continues no further: a survival of
great importance as evidence of an earlier and simpler
method of reproduction. But, judging from the facts that
intermediate between the simplest forms of reproduction
and the complex ones, in which two individuals are required,
there is a large class in which both sexual elements are
placed in one individual, though not necessarily for self-
impregnation, and also that even in the highest animals
there is an occasional natural effort to revert more or less
completely to this arrangement, it would seem that sex is
merely an abortion of one class of sexual organ in each indi¬
vidual, and we must therefore look upon the sexual form which
accompanies this as purely secondary. And widely different
in appearance as the sexes in the higher animals often are,
yet but remove the sexual organs and you have in each case
a being with characteristics between the two. Moreover, if
there is any imperfection in the development of the sexual
organs, there is generally an approach in outward charac¬
teristics to the appearance of the other sex, showing that it
requires the presence in perfection of one class of organ to
exclude entirely the approximation to the opposite sex.

But the mode in which this suppression of one class of
sexual organ has been brought about is exceedingly obscure,
though a very cursory glance at the animal world would
suggest that it is not always produced in the same way. In
the class Insecta, for instance, we have in the well-known
case of the honey-bee perfect females and sterile females
produced from eggs impregnated by the male, but the larvae
of which are fed in different ways; whereas males are pro¬
duced from eggs that have never received any of the male
element at all—a position proved by the fact that if the
communication with the spermatheca in the queen be
interrupted, the ova then produced only bring forth males,
and also that when the common bee is crossed with the
Ligurian, only the queens and workers have any trace of
the cross-breeding, the males being purely of the race of
the queen from whom they proceed. In ants also it
occasionally happens that the workers, who of course take
no part in the nuptial flight, bring forth eggs, and as far as
observation goes-certainly in Lasius niger and Formica
fusca—these eggs invariably produce males. Now, what¬
ever views may be held as to the cause of sex in man —and
many of them are sufficiently eccentric,—no one has ven¬
tured to suggest that it is due to the absence or presence
of impregnation by the male element. But even in the
same group of animals sex is not always arrived at in the
same way, for in this very class Insecta—in Chermes abietis
for example—no male individuals have ever been detected,
and perfect females lay eggs from which only females are
produced. In aphides, again, after several generations of
sexless forms, perfect males and perfect females are pro¬
duced for normal sexual reproduction. In looking, there¬
fore, for the cause of sex, we should be even more careful
than usual in not generalising too hastily, and any evidence
obtained should be applied in reasoning strictly to the
group from which it comes till other observations show that
it may be safely extended.

As in man differentiation of sex occurs by no means late in
foetal life, attention is naturally directed to the condition of
the parents, and though we cannot with any prospect of
success investigate all the circumstances relating to them,
yet there is one fact often ascertainable with precision, and
that is the age, which is necessarily correlated with some
of the most important conditions of life. It will be, then,
the present object to examine all the evidence accessible on
this subject, and to see what light is thrown on the occurrence
of sex: but it may be well to state at the outset that age
of itself cannot be the cause, for both sexes appear to be
produced at nearly all possible ages of the parents.

In regard to man, the examination of this question has
not attracted the attention it deserves. Sadler, in his “ Law
of Population ” (vol. ii., page 343), gives a table by which

Digitized by G00Qle

a y ^

262 The Lancet.] DR. A. J. WALL: CONSIDERATIONS IN REGARD TO CAUSATION OF SEX. [Fbb. 5, 1887.

he believes he proves that the older the male the greater is
the proportion of male births; but as he admits that in only
3S1 families were the ages of both parents known to him,
and as he classes together all offspring at whatsoever ages of
the parents they may have been produced—a proceeding
that will be seen in the sequel to be well adapted for
defeating the purpose of the examination,—his conclusions
are not worthy of serious consideration.

As this inquiry must be necessarily statistical, the first
point to be aimed at in the statistics is their accuracy.
Therefore, the Royal Houses of Europe were first included.
They contributed in all 120 families, our own Royal Family
giving 15 of them. The authority chiefly used was the well-
known “Almanach de Gotha,” and from the same source
were taken 27 other families of princely rank. No family
was utilised except those in which the dates of the births
of both father and mother were exactly given. Next follow
890 noble English families from the “Peerages” — the
volumes used being twenty-five years apart in date, so as,
if possible, to include two geneVations. In addition, 163
families are taken from the “Gothnisches Genealogisches
Taschenbueh der GriiHiehen Hiluser.” These families had
each of them several children, and the mother's house was
given in the volume as well as the father’s, ensuring, as far
as possible, the accuracy of the date of her birth. Thus in j
all there are 1200 families with 6529 children, being 5-1
children to a family. Of these 6529 children 3381 were
males and 3148 were females, or a birth-rate of I07 - 4 males
to 109 females. This is something higher than the usual

Chart 1.

dividing line. From the twenty-eighth to the thirty-sixth
year inclusive 2823 children were born, giving 1189 males
and 1334 females, or a proportion of 1116 males to 100
females. Here the males again asserted their predominance
considerably beyond the mean proportion.

The last period will be from the thirty-seventh year to
the termination of sexual life at forty-nine years. Here
812 births occurred, of which 119 were males and 393
females, being 114'2 males to 100 females—a very great
excess of male births, being only a fractional pare below
the excess noted in the period of immaturity.

There is, therefore, evidence that the proportion between
the male and female births is constantly changing, and that,
the varying proportion bears a distinct relation to the saxua
condition of the mother. Chart 1 will show more clearly
than any words this relation between the age of the mother
and the sex of the offspring.

We must now turn to the influence of the age of the
father. But we have here a difficulty to contend with, which
is due to the much greater length of the sexual life of the
male. In the tables containing these statistics the age of
the youngest father is nineteen, and the oldest eighty.,
giving a sexual life of sixty-two years. To investigate
thoroughly an extended period like this would require a
far larger number of families than is at present available.

In the period of immaturity in the male, which may be
taken, as in the female, up to the end of the twenty-first
year, there were but 21 births, of which 10 w«=re male
and 14 female, or a.proportion of only 71 males to 10C

Chart 2,

Apes of

A act of Fathers.

Showing the number of male and female births at different
periods of the ages of the mothers.

rate, which is generally given as 106 males to 100 females,
but variations occur, ard a much higher male birth-rate than
tbiB has been observed.

As the sexual life of the female is so much shorter than
that of the ihale—being in these statistics thirty-four
years, the earliest age of a mother being sixteen and the
latest forty-nine,—it will be advantageous to consider first
the influence of the age of the mother. Does, then, this
proportion of 107 4 males to 100 females obtain equally in
all periods of the mothers’ lives? To ascertain this it will
be convenient to divide the whole time of fertility in the
female into periods corresponding to the natural stages of
life. The earliest period, that of immaturity, may be taken
as commencing from the date of the first birth at sixteen
years of age till the completion of the twenty-first year.
Within this period there were 589 births, of which 315 were
males and 274 females, or a birth-rate of 114‘9 males to 100
females—a grent excess of male births over the average of
1074, which occurs at all ages.

The next naturnl period is that, of complete womanhood,
when the sexual powers are at their height, which may be
taken as from twenty-two to twenty-seven years, both
years being included. During these years 2275 births took
place, of which 1128 were males nnd 1147 females. This is
equivalent to a birth-rate of only 98‘3 males to 100 females—
a very complete reversal Of the usual frequency of the
occurrence of the sexes.

Uter this the sexual powers undergo a decline, but it will
be convenient to divide the remaining sexual life into tWo
periods using the end of the thirty-sixth year as the

Showing the number of male and femate births at different
periods of the ages of the fathers.

N.U.—In this chart the dotted line begins too far above the plain
straight line. The two ought to begin very close together, the dotted
line being only slightly above the other.

females. This, taken together with the evidence we have
obtained from the mother in the time of immaturity, when
no less than 114-9 males were born to 100 females, shows
how little capable the immature parent is of impressing its
own sex on the offspring. But it shows, moreover, that
the immature has even lets power of doing this than
the iminature female.

After the twenty-second year a difference is perceptible
in the influence exercised by the male and female parent.
In the female from twenty-two to twenty-eight years a
considerable excess of female births takes place; but after
that there is a decided decrease ; whereas in the male there
appears to be no great difference in the proportion of male
to female offspring till considerably after thirty years.
Thus from twenty-two to thirty-six years of age, both
inclusive, of the lathers, there were 3820 births, of which
1997 were males and 1823 females, or 109 5 males to 10O
females—an excess of males beyond the mean proportion.

In the period from thirty-seven to forty-eight years there
were were 2281 births, with 1180 males and 1101 females,
or a proportion of 107'1 males to 100 females, or a slight
decline of males from the previous rate, and very close
indeed to the mean proportion.

In the last period, that of decadence of sexual power,
from forty-nine years to the limit of sexual life, here given
at eighty, there'were 404 births, with 194 males and 210

The Lancht,] MB. A. HBTB' DRAINAGE OP THE LUNG FOE PHTHISICAL XUBVBMES. [Feb, M88T; 28 &

females, or a proportion of only 92*4 males to 100 females*
That is to say, in the period of declining sexual power in
the male the proportion of females bom is greater even
than at the period of the greatest energy of the female, from
twenty-two to twenty-seven years. At the same time, the
proportion of males produced by male parents in their declin¬
ing years is considerably greater than at the age of their
immaturity. Chart 2 illustrated these varying proportions.

(To be concluded.)

ON A CASE OF

INCISION AND FREE DRAINAGE OF THE
LUNG FOR PHTHISICAL CAVITIES.

By ARTHUR NEVE, F.R.C.S. Bdin., &c.

In the very dawn of aorgery it-is probable that the cbOst
was opened from time to time when, abscesses pointed out¬
ride it. fai this sense H puLmonotomy ” is no new proceeding.
But incisions through the thoracic wall for gangrene, deep-
seated abscess, and bronchiectasis hr tubercular cavity, are
truly modem operations, differing from the former as widely
as the counter-puncture and thorough drainage of an abscess
differs from the rude gash made by some Polynesian savage..
The advance of visceral surgery has, indeed, only been ren¬
dered possible by the increased precision of diagnosis; and
there is little cause for boasting of surgical advance, when
in such a large proportion of cases the increased accuracy of
diagnosis only, makes ua feel the more keenly our remedial
poweriesaness. It is only within quite recent years' that:
notices of attempts to. drain purulent collections in the lung
itself base appeared in the journals. As far as I can make
out, from reference! to Hr, Neele’s valuable Digest land the
medical journals, the cases as yet are confined to one or two
for abscess, several for gangrene, and more recently one
or two for bronchiectasis. But that the operation has not
taken a recognised position is shown by the fact that in
Busin’s “ Dictionary of Medicine ” it is, only mentioned in
connexion with gangrene, and then but oasually as an alter¬
native of tapping. The case which I have to record is as
follows:— i .;

- A young man, .hsggafd and wasted to a degree, was
admitted, into the CALS. Mission Hospital onApril 10th, 1886.
For a year he had been suffering room violent.oongliaad
profuse expectoration. His appearance was that.of a. man in
the last stage of phthiris. His lingers were much dubbed.
The expectoration amounted.to a pint and a hall or two
pints in the twenty-four hours, it. was .tough,! and. in
large flocculent, purulent -masses. Microscopic exami¬
nation showed a very considerable proportion of pus
cells, with elastic fibres, Ac* and swarming with bacilli.
Examination of the chest revealed the presence of cavities
in the.upper and anterior part of the right lung, while the
right base and most part of the left lung was fairly healthy.
The left apex appeared condensed, with possibly commencing
softening. For nearly three Weeks the patient whs treated
with ood-iiver oil, tonics, eucalyptus and creasote spray,
and counter-irritation. During this time there was no im¬
provement, and the patient (a troublesome one) wueclamor¬
ous for something to be done. Accordingly on April 29th,
having administered chloroform, I made an. incision two
inches long close to the right nipple, through which a
corresponding portion of the fourth rib was rqaacted./wUh
the periosteum attached. The pleural: surface was, as I
expected, firmly adherent. I then forced my finger inwards
and upwards in the direction of tne cavities. There was no
such large cavity close to the wound as I had hoped to
find; but Upwards it entered two nhalj cavities, t The
tissues were card, but friable. I did uot attempt to open
the cavities on the axillpy aide, deeming that they would
drain by the bronchi into the wound, A large-sized
drainage-tube, six inches long, was passed into the lung,
and the wound closed by a pad of gauze and & sawdust
bagC 'Haemorrhage• was quite inconsiderable, and the air
wbistHng through the wound gave promise of good
drainage. Within twd flavs the expectoration by the
mouth was diminished to three or four ounces, and was
no longer accompanied by the distressing cough which the
man had complained of. There was, however, much pain
about the wound. It was daily washed out with corrosive

sublimate solution, and pure oil of eucalyptus was poured
into the tube. At first this gave rise to cough, but tolstott-
tron Was established. Inhalations of creasote and eucalyptus
were continuously maintained by keeping the' pad on-the
wound moist with them. The discharge from the tube was
chiefly muco-purulent; at first bloody, later’ thick and
tenacious, but progressively less so. About the fourth
week the patient began again-to complain of the drainage-
tube (which he had himself removed several times during
the first two days); a little blood also appeared bn the
dressings; so, fearing ulceration into.the vessels of tfaeliteg,
I removed it altogether. In- the early part ol June the
sputum continued healthier, and he went home. On the
24th he returned! The improvement was then striking,'
especially in the local signs. The chest around and above
the wound was considerably contracted, and sucked In.
The sinus was freely open, and upon- coughing some
mucus was expelled from it. The healthy area of'
the lung seemed increased. - The apex of the left hang,'
however, showed' more signs of breaking down. .' Hv
remained under observation in hospital for two days; and:
was photographed. The expectoration was about ten
ounces in twenty-dour hours, but was- chiefly clear and
watery, with a lew nummular masses similar to those of
which it formerly eotirfely consisted. His cough troubled
him only in the morning; he slept and ate well, almost
ravenously, and gained Strength,-though but fitile flesh.
He was then sent to a mountain sanatorium 8600 feet above
the sea. Up to this point the improvement effected was
entirely by means of' the operation. Since that time l have
not seen the patient, but occasionally receive reports from,
his friends. After September he became weaker. He is
said to wander over the country, is seldom at homp, knd
does not work. 1 There still remained a smAll-Opening to tho
chest. • < ■ ' ; • - 11 f

Remarks.— In resorting to phlmonotomy for a case ofi
advanaed phthisis, I was performing an irregular proceed¬
ing, though it was fully justified by the amount of the
expectoration) by the limitation of gross lesions to one lung,'
and to a' not very extensive area therein, arid, thertfdrC, by
the possibility of effective drainage. An operation, moreover,
offered, the means of directly medicating the affected parts,
and of delaying or arresting the advance of disease ip the t
othe dung, which would have rapidly determined £ fatal,
issu For these reasons I did not hesitate to avail myself
of the Willingness of the patient to undergo an operation
which be was givep to understand w;oula alleviate his.
distress. The result was as satisfactory as I had antici¬
pated. The cavities which were opened, and also those
higher up in the apex, ceased to secrete such a large amount
of sputum, and apparently cicatrised. In this they weto
assisted not only by the drainage and topical dedication,
but by the removal of a considerable portion of' rib, with
the consequent possibility of retraction of the thoracic wall.
The slight amount of respiratory movement of the uppef
part of the chest and lung Is probably the chief cause of
the special liability of tne apex to the formation of
tubercle and its resulting cavities; but' even this
slight movement is 1 probably Unfavourable to the
healing Of ' such cavities , when . the pleural surfaces
are adherent. I therefore think that in many Cases of
phthisis with tipidal vomicoe it might be beneficial to remove
portions Of the upper ribs, as in Estlander's operation for
empyCmtf. If a similar case presented itself, but with ICsk
abundant sputum, I should, be disposed to try the resection of
portions of the second and third ribs, with intra-pulmonary
rejections. As the preliminary to all operative methodsL
the usual antiseptic inhalations and other remedies should
be fully tried. Having decided td operate, the aspirator
should be used to confirm the diagnosis as to the position of
the cavity. The first risk met with in operating is that
arising from non-adhesion of the pleura. Circumstances
may point towards adhesions, but the diagnosis must always
be attended by uncertainty. Puncture and drainage of *
cavity, where the pleural cavity is not shut off from thh
puralent secretion, would lead almost necessarily to a
pyogenic pleuritis. If after resection of the rib the pleura
is found non-adherent, it would probably bft best to unite
the luffg by catgut stitches to the thoracic wall, and post¬
pone incision into the lung for a few days. When the exuded
lymph will occlude the pleural cavity ; this might not bd
practicable on account: of collapse of the lung, but
at least it might be attempted by seizing the hrog
with a sharp hook, and effecting the sntnre promptly.'

[Fbb. 5,1887.

ME. R. CANNON ON 8TRONGYLOS GIG AS.—CLINICAL NOTES.

264 Thb Lxnckt.]

In making the incision it is not necessary to une a sharp
instrument. The Inability of the lung often permits of the
Anger being used, in which case dangers are avoided and
information procured which no other instrument could give.
In my case bleeding was insignificant, and most surgeons
have found that if it occurs it is easily arrested. Drainage
takes place less by gravitation than by the expiratory
efforts; but position can do much towards helping these.
Similarly, position, aided by inspiratory efforts, will effec¬
tually distribute antiseptic applications, such as iodoform
dust, eucalyptus oil, &c., to subjacent parts of the lung,
and their effect may be kept up by the use of volatile anti-
septics^n the dressing used. As in all my surgical cases for
the last four years, I use large pads of cedar sawdust, to
which I add creasote &c.; these act as respirators, filtering
and warming the air. I may add that the operation cannot
be taxed with failure because a permanent cure is scarcely
to be achieved, inasmuch as legitimate operative interference
is necessarily delayed nntil the disease has made great head¬
way, and the local symptoms, grave as they may be, are but
the manifestations of a graver constitutional disease.

KMhmir Mission Hospital.

CASE OF STRONGYLUS GIGAS.

By R. CANNON, L.K.Q.C.P„ L.R.C.S.I., M.D. Chili.,

LAT* 8UKOKOS, ROYAL MAY Y.

On August 20th I was called to see a boy of twelve years
of ago suffering from febrile symptoms of three days’ dura¬
tion. He complained of headache, aching in the limbs, and
general malaise. He had had epistaxis, his tongue was foul,
and his bowels costive; temperature 39-50°C.; pulse 90.
The night before! saw him he could not micturate, and on
the morning of my visit he had done so without difficulty.
In the chamber-vessel, which he had used in the upright
position, a worm had been seen. The “patio,” or court of
the house, was asphalted and dry, and it was quite impossible
that any earth-worm could have been introduced by chance
into this vessel. 1 take this to be a case of strongylus
gigas, of which only seven cases at all trustworthy have,
according to Davaine, been reported. The worm was in
three parts, and was of a reddish colour, as if blood-stained.
It measured about ten inches. Around the head could be
seen prominences, as if tubercles or rudimentary eyes; some
fine membranous fllin», as if of a delicate cyst, were adherent
to the broken parts. The urine contained po blood or any
deposits; it was of a darkish colour, but not more so than
one sees in febrile states. I at once put the specimen into
spirit and have not since extracted it, contenting myself
with examining it with a lens. It does not appear to me to
be an intestinal lumbricus, and I have not the slightest
doubt that it issued from the boy’s urethra. He was not
aware of having passed anything unusual until .he vessel
was brought to him by his mother. There could be no object
in deception of any kind. The boy was treated with sali¬
cylate of soda and with nightly doses of antipyrine, and
after copious bleeding had taken place from the nostrils
the headache and febrile symptoms were in a few days
quite relieved, and the boy had no other troubles in con¬
nexion with the urinary organs.

We know that this parasite is found in the kidneys and
urinary passages of such animals as the weasel, hare, ox,
dog, wolf, &c.; but in the present case the only animal that
could have interfered would be the dog. I saw no dogs
about t'ue “patio,” and, besides, it would have been ridiculous
to suppose that a dog would have had the sagacity to
deposit his strongylus gigas in a chamber-vessel; moreover,
on the previous night the boy had been unable to pass hi^
urine, and the parasite must have occupied the urethra or
blocked its entrance into the bladder.

Cases have been recorded in which intestinal worms have
found their way into the bladder. This, of course, might
easily occur in the female, but in the male the difficulty
would be great. The boy, in this instance, was a quiet
sensible lad, not by any means hysterical or a trickster, and
1 think the case from its rarity is very interesting and
worthy of the fullest investigation. Of course the interest
turns on this worm being a specimen of strongylus gigas
or not, and this fact I have no means of deciding. I showed

the specimen to my friend Dr. von Scbroeders, of this city,
but he had no plates depicting the parasite. I also showed,
it to an American colleague, but, curiously enough, he had
never heard of such a thing as strongylus gigas.

Vilpaiaiio, Chili. _

Clinical Itotcs:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

A CASE OF EXOPHTHALMIC GOITRE TREATED BY
THE CONTINUOUS CDRRENT.

By W. B. Hadden, M.D., M.R.C.P.

Drugs are uncertain, and unfortunately often useless, in
exophthalmic goitre. I therefore determined to try gal¬
vanism in this case, and the result, as will be seen, was very
satisfactory.

The patient was a single young lady, aged twenty-eight,
a professional nurse. She consulted me on Jan. 15th, 1886.
For nine months previously she had found difficulty in
distinguishing the names of streets, and for three months
her friends had notiTed that her eyes were prominent. She
had remarked some fulness of the throat for two months.
When I first saw her the eyes were markedly prominent
and somewhat injected. The thyroid was large, mainly on
the right side, but not pulsating. The pulse was 140. There
was no cardiac bruit. She had frequent and excessive
perspiration. There were constant efforts at deglutition,
and she suffered from borborygmi. The bowels were
regular. There was no derangement of the catamenia. She
expressed herself as feeling pretty well in herself; bnt on
being questioned said she had seme dyspnoea and dysphagia.
She had never suffered from any illness except measles. I
ordered a constant battery of ten cells to be used night and
morning. The negative pole was placed on the nape of the
neck, and the positive over the thyroid gland and also over
the eyeballs, the eyelids being closed. Each application did
notextend beyond ten minutes. There was a marked improve¬
ment in a month.

On June 22nd she was practically well. The right eye¬
ball and the right side of the thyroid were still slightly full.
There was no palpitation, from which previously she bad
suffered, and the pulse was reduced to 96. The perspiration
and sensations of excessive heat had quite disappeared. I
have seen her frequently since, and the improvement is
maintained. She tells me that when her illness first began
she used to sleep in cold weather with only a sheet over
her. During the time she was under treatment her weight
increased by more than one atone. No medicine was
given except belladonna for two or three weeks ; bnt
this drug, which was prescribed at the very onset, was dis¬
continued, as no beneficial result ensued. The battery was
not used at this time.

Remarks .—The treatment of exophthalmic goitre by this
method deserves a trial. I do not wish to dogmatise from
one case; but I may mention that I have had quite reoeutly
the opportunity of seeing the beneficial effects of the
continuous current in another patient.

Welbeck-atreet, W. _

ON A CASE OF TETANUS SUCCESSFULLY TREATED
WITH CHLORAL HYDRATE.

By J. Hawkss, M.D.

I think the following notes on a case of idiopathic
tetanus treated with chloral hydrate throughout the greater
part of its duration may prove interesting, as indicating the
almost specific effect of the drug and the large doses
tolerated in this often intractable complaint.

A healthy country-lad, aged thirteen, employed in out¬
door work, was taken ill with symptoms of tetanus about a
week before my attendance was requested on Nov. 16th.
When I saw him he was lying on his back in rigid
opisthotonos; dorsal region and tnorax'prominently arched,
and stretched towards the right side; head drawn back;
eyelids partly closed : lips retracted, exhibiting marked

Digitized by GoOglC

The Lancet,]

CLINICAL NOTES.—H08PITAL MEDICINE AND SURGERY.

[Feb. 6,1887. 265

Titos sardomcus; muscles of neck and trank hard and
hoard-like; lower extremities extended ; breathing hurried
and shallow. The boy had been unable to sleep. The jaws
were firmly clenched to within about a quarter of an inch. I
ordered belladonna libimeut to the spine, powdered jalap
with calomel, and a sudorific mixture three times a day. As
he resided at some distance from my house, two davs elapsed
before I saw him again, when his condition had undergone no
change. The bowels had freely acted. Linseed-meal poultices
sprinkled with turpentine were applied to the dorsal region,
and ten grains of chloral hydrate, with twenty grains of
bromide of potassium, were given every four hours.—
Nor. 21st: Has had two hours’ sleep, the first he has
had since the beginning of his illness. Decubitus natural;
opisthotonos much relieved, but not disappeared. Coun¬
tenance natural; lips no longer retracted, but the jaws
are clenched as before. To continue treatment, and apply
a mustard-and-linseed poultice to the nape of the neck.—
22nd: Slight improvement. — 24th: The chloral to be
increased to twenty grains and the bromide of potas¬
sium to thirty, ami taken every four hours. — 27th: Can
open his mouth more freely, and speak distinctly, but the
rigidity persists in the abdominal and thoracic muscles;
the neck is easier. To apply linseed poultice with tur¬
pentine to the neck as before. To continue the treatment.—
Dec. 2nd: Lies placidly in bed; answers questions distinctly;
sleeps for two or three hours, but never more than three;
bowels act regularly; takes semi-solid food. To continue
the treatment—6th: Is going on fairly well, but some
rigidity continues, especially in the trunk; can move the
feet freely. The chloral treatment was now suspended for
four days, and henbane with foetid spirit of ammonia sub¬
stituted, but no improvement followed. — 10th: Ordered
fifteen grains of chloral hydrate, twenty minims of tincture
of lobelia, and twenty minims of compound tincture of
cinchona, thrice daily.—13th: Belladonna plaster applied to
the whole dorsal region. To continue the treatment.—17th:
Has obtained further relief, the rigidity becoming less. To
continue the mixture. Is wearing the plaster, which he
feels to be beneficial.—22nd: Is altogether better. To con¬
tinue the mixture and repeat the belladonna plaster.—24th :
Is very comfortable, and almost convalescent.—29lh : Was
aWe to enjoy his Christinas dinner downstairs with the rest
of his family. Appears to be fairly well. To discontinue the
treatment.

Remark*.— This was a case of idiopathic tetanus brought
on by exposure to wet and cold. It presented the symptoms
of -trismus very markedly, and there was absence of sleep
for a long time. It appears to me that chloral alone or
combined with bromide of potassium controlled the severity
of the disease, and if it did not actually cure the malady it
afforded time for nature to exert its recuperative power.

■ocUnmpton. _

SURGICAL MISHAPS.

By E. L. Hussey, F.R.C.S.E.

One of the cases mentioned by Mr. Teale reminds me of a
ease formerly under my care.

In 1861 a young lady applied to me with a small tumour
behind the angle of the jaw on the right side. It was
tough and almost cartilaginous under examination, and the
akin was generally adherent over the surface. The case had
been seen by the late Mr. Hester and Mr. Owen of Oxford,
■ad by Sir H. Acland. Lt was thought to be of a cystic
nature, and the swelling had been injected with tincture of
inrfinff I cnt through the substanee in its whole thickness,
and endeavoured to dear away the contents from each half;
this ooold only be done to a very slight extent. The wound
healed favourably. A second operation was undertaken
aomn months afterwards. The skin was divided, and
separated without difficulty from the tumour. This now
appeared to be about the sue of a large walnut and of a
fibre-cellular structure. 1 cut off the exposed part, so as to
dear the wound for a deeper dissection. Then, fixing a
hook in the remaining part, I endeavoured to draw it
forwards. This I was unable to do. The attachment was
evidently very, deep; the skull itself moved with the
motions of the hook. I Cnt off. as deeply as I could, the
MTt of the. tumour which was transfixed by the hook, and
ckaee*l the wound. This heafed as favourably as after the
farmer operation. The lady afterwards married, and she
db* fnir'pfcttiris mote than twenty years after the

operation. There was not any fresh growth of the tumour.
Being in communication with Mr. Ctesar Hawkins at the
time of the operation, I mentioned the case as a disagreeable
piece of active surgery. He told me that Mr. Liston, in a
similar case, found, upon the death of the patient, that the
tumour had its origin in the base of the skull.

Oxford.

HYDATID OF LIVER TREATED BY PUNCTURE;

COMPLETE RECOVERY.

By Febdk. A. A. Smith, M.D.

Mbs. K -, aged forty-eight, struck her right side against

the kitchen table about five months ago. She did not think
anything about the accident, but soon afterwards felt a pain
in the right side, which gradually enlarged and extreme
emaciation set in. Cancer was diagnosed by several medical
men, and one thought the ribs were fractured. When I saw
the patient, she was extremely weak and emaciated, and
looked like a woman dying of cancer. On examination the
ribs of the right side were found very prominent, with
bulging of the intercostal spaces. Percussion dulness ex¬
tended over the median line and downwards to nearly three
inches below the ribs. The tumour felt firm and smooth, and
gave one the impression of an enlarged liver. At a spot, the
size of a florin, an inch below the margin of the lower ribs
and two inches to the right of the median line, slight
fluctuation was felt. Diagnosing the oase as one of either
abscess or hydatid cyst, 1 plunged a No. 1 trocar and cannula
into the centre of the fluctuating spot, in a direction
upwards and backwards, and drew off about six ounces of
limpid, straw-coloured fluid. A small piece of plaster was
placed over the puncture and a towel tied tightly rouAd
the abdomen. Nothing more was done, and the patient got
rapidly well and is still alive. The only precautions I took
were to stretch the skin, so as to make the opening valvular
and arrest the flow of liquid before the cyst was entirely
emptied; thus no air was allowed to enter.

The interesting part of this case was the distinct history
of a blow, and the rapid enlargement of the tumour and
extreme emaciation. The fluid was examined carefully under
the microscope, but no booklets were detected.

Cheltenham.

% Pirar

or

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nails aatem e*t alls pro oerto noaoendl via, ni*t qoamplurtmaa ofc mor-
borura et dissect!emum histories, tom aliorum torn propria* oolleotaa
habere, et inter se oompararo.—Moxoaen D* Htd. *t Cbm*. Jtf*r4.,
Ub.lv. Proos mlnm . 1 1 ■

ST. THOMAS’S H08PITAL.

8UPBA-PUBIC LITHOTOMY IN A MAN AGED SEVENTY-TWO;

CUBE; SUBSEQUENT DEATH FBOM APOPLEXY;

BE MARKS.

(Under the care of Mr. John Cboft.)

The following case is one of those in which the operation
which was performed is specially advantageous. There were
two large stones, an enlarged prostate, and a patient who
was in a very poor state of general health. He was not in a
condition to bear the prolonged administration of an anaes¬
thetic, or the manipulation which would have been called
for had the size of the stones permitted of lithotrity; there¬
fore no very accurate measurement was taken of the stones
before operation, the supra-pubic method being so clearly
indicated.

J. T-, aged seventy-two, a labourer, was admitted into

Edward ward on July 12th. About twelve years ago he
noticed pain at the end of the penis on micturating;
during the last two or three years the pain has increased.
Micturition is and has hem very frequent, he not being able
to hold his urine for morj than two hours. Has on several
occasion had catheters passed, but has not suffared from
retention of urine. On examination per rectum tfis prostate

Digitized by GoOgle

,2C6 Thb Lancet,]

HOSPITAL MHDKJUfB AND SURGERY.

[Feb. 5> 1887.

was felt considerably enlarged laterally. On passing a
sound the sensation of striking a stone was elicited, and
appeared to be produced by the presence of a very large one
or by a collection of calculi, stone being struck on either side
as the sound was rotated. The urine was very offensive,
alkaline, and contained pus. The patient was much en¬
feebled by suffering and age, by degenerated arteries, and a
great tendency to bronchitis. !

On July 17th Mr. Croft operated. Chloroform was
administered. A catheter was with some difficulty pissed
into the bladder, and this was washed out three times with
a solution of. boro-glyceride, eight to ten ounces of this
solution being left in the bladder, and the rectal bag injected
with twelve ounces of fluid. An incision three or four
inches in length was made in the middle line above the
pubes. There was a fair amount of abdominal fat. The,
tissues in front of the bladder were unusually friable and 1
vascular, the Veins being somewhat varicose in appearance. ;
A puncture was made in the bladder with the point of a
scalpel; through this the foreflnger of the left hand was
inserted and the wound dilated. Two large calculi of lithate
of ammonia&c. were extracted, together weighing over four
ounces, one weighing 969 grains and the other 945 grains.
-No other stone was felt, but the middle lobe of the prostate
formed a well-marked projection into the bladder. The
•pening in the bladder was not dosed, but two stitches
were placed in the upper part of the abdominal wound.
The bag was removed from the rectum. A large drainage-
tube was inserted,, and the wound plugged with lint soaked
in carboliaed oil; over tliis was placed lint spread with
iodoform and vaseline ointment and. Andy drawn carbonised
jtow and absorbent wool. Two hours before the operation
the patient had had a rigor, and the temperature rose to
101 - 4°; in the evening it was normal,
i*For three days the patient was kept on his baok, and a:
flexible indiorubber catheter retained in the urethra. The
Wound was dressed every two hours in a similar manner to
ithat employed after the operation. For a long time the old
man was very feeble and apathetic, requiring great attention
and careful feeding and nursing. The catheter was of no
service, and therefore removed.

!,• On the 18th he had slept well after a subcutaneous injec¬
tion .of morphia, but complained of pain in the abdomen
due to flatulence; warm milk instead of cold was given,
and he was much easier in the afternoon. There was slight
cough, and his breath was veryoffenstva.

19th.—Wound washed out morning and evening with a.
carbolic solution. He perspires very much over the face
and hands.

20th.—Restless, requiring the subcutaneous administration
of morphia. Complaining of flatulence and cough, he was
ordered an effervescing mixture* of citrate of potash and
carbonate of ammonia, and allowed three ounces ;Of rum.

21st.—Allowed to lie o‘n his side. Had an attack of con¬
vulsive character in the early morning, which lasted about
fifteen minutes, during which he appeared to be only semi¬
conscious. 1

On the 23rd the bowels acted after medicine. The 1 drain¬
age-tube was removed on the 28th. and a sponge, which had
bepn soaked in a warm solution of Condy, was applied over
tab wound, Wine was ordered, and a tonic of quinine and
iron.

There was a gradual bat slow improvement until Aug. 1st;
during that day he oomplained several times of faintness
and shortness of breath, but could move more easily .in bed
in the intervals. The urine was very offensive, and most of
it came by the wound. Next day a broad strip of strapping
v^as placed across the wound from hip to hip; and in the
■evening he was taken out of bed, and safe in an arm-chair
for a time. The wound was kept open for more than a
month after thiB date, and the bladder washed out daily.
£he-temperature rose on the third day after the operation
to lOW*; This was the highest record, the reading after
tUe fourth day varying from 96° to 98 6°. He was taught to
pads a catheter for himself. When he left the hospital, the
wound was firmly closed, there was no evidence of cystitis,
and the man was apparently quite welL
.-.It appears from a letter written to Mr. Croft by Dr. Thom¬
son of Luton, who attended the patient, that the latter died
.suddenly on the 19|th of October from apoplexy.

Remark* by Mr. Cuoft.—T his case is of special interest,
lasitie the fleet aupra-pubic operation for stone performed at
Bu.Thomas’s since Cheeeklec gave up tbehigh operation about
a century jand a (quarter, ago,, He himself < says that J‘ he

would not have left the high way but for the hopes he had
of a better, being well assured that it might hereafter be
practised with greater success." His prediction has come true.
The incision into the bladder was a puncture not more than
half an inch in extent; this was dilated with the Anger until
large enough to allow of the extraction of the stones. This
lesion healed, when permitted to do so, very soundly and
readily, although the exit of urine from the bladder was
materially obstructed by the enlarged mi4dle lobe of the
prostate, which projected greatly into the bladder. It was
only his age and debilitated condition that prevented the
removal of thiB at the time of operation.

BULLET WOUND OP CHEST; WOUND OP LUN6 ; BKMOVAX. OF
BULLET ; BECOVERV,

(Under the care Of Mr. Cboft)

Bullet wounds of the chest are not common in oivil
practice, and it is important that such should be recorded
if only to increase our knowledge of the prognosis when
they are treated under the most favourable conditions. That
there was a penetration of the lung in this patient was
proved by the amount of shock which immediately followed
the injury, the haemoptysis, the emphysema which was
manifest around the point of entrance and about the
swelling behind, which correspohded to this point, by the
subsequent slight heemopneumothorax, and the later de¬
velopment of localised pneumonia. No attempt was made
to remove the bullet at first; the amount of shock was con¬
siderable, and it was not considered advisable to add to this
or increase the risk of septic inflammation of the parte
damaged by the passage of the bullet. For the following
notes we are indebted to Mr. G. R. Anderson, dreeser.

F. de C. C—, aged thirty-three, was admitted on Oct. 13th
ih a rather collapsed condition, suffering from a gunshot
wound of the chest, of his own infliction. He used a Awe-
chambered revolver, carrying a ’820 bullet. Before using
it he threw back his coat and vest.

On admission the patient was pale; surface df body and
extremities cold; beads of perspiration on the forehead;
hands clammy. The pulse felt at wrist was rapid* thready,
and small; respiration shallow. He spoke rationally And
answered questions; seemed in a desponding condition, End
expressed a wish to die. On examination, in front 1 was
found a small wound in the second intercostal space, on the
left side, just internal to the nipple line. The shirt covering
this region wad blood-stained, blackened, and singed rouiid
a small bole corresponding to the wound. The patient
wore no under-vest. On probing the superficial part
of the wound the direction was found to be from before
backwards and outwards. No rib was exposed. The tissues
round the wound were emphysematous. On forced respira¬
tion this emphysema was increased, but air did not
definitely escape by the Wound. Oil examining the back,
a small hard body was found over the vertebral border of
the scapula about an inch and a half from the root of the
spine, freely movable under the skip ; some tenderness on
moving it. There was emphysema about this also. The
wound was dressed with carbolic solution (1 in 20), and a pad
of iodoform game strapped firmly on. Mr. Croft saw the
patient at 10.30 p.if. He had rallied from the shock. Tbert
had been very little external hemorrhage, but there were
signs of internal bleeding. Bright-red sputa. Dulness over
•left base behind ‘ hypar-resonance in front. Emphysema was
now detected as low as the pubes, extending backwards dver
the left loin; it also extended some little distance. up the
neck. It was not largely increased over the scapular region.
Mr. Croft decided not to remove the bullet at once; The
patient was given ice to suck, and the frost and left side bf
the chest were covered with ice-bags. ■

Oct. 13th.—Retention came on; bladder emptied by
catheter at 9 B.w. Some COugh; bright-red sputa. Tempe¬
rature 100 - 4°; pulse 82; respiration 36.

16th.^Some dyspnoea early this morning. Sputa merely
blood-stained. Bullet wound has healed without Buppura 1 -
tion.

17th.—Patient deeps badly. No recurrence'of dyspnoea.
Catheter passed every eight hours. Temperature 98 - 8°.

18th.—Cough better. Sputa streaked with blood. Ice-
bags discontinued. Temperature 98°; pulse 72; respira¬
tion 36. .., .

20tiL—Has control.ql, bladder. Emphysema remains. .A,t

Digitized by GoOgle

The Lancet,]

HOSPITAL MEDICINE AND SUBGEBY.

[Feb. 5,1887. 267

the right base poeteriorly, dulnees, tubular breathing; and
crepitations; above the left base also there ia a small patch of
pneumonia. Pulse 90; respiration 28; temperature 100-4°.

22nd.—Patient feels comfortable. Cough better. Tempe¬
rature 98°; pulse 85.

28tb.—Sleeplessness returned. Pulse 80; respiration 24.

29th.—Cough almost gone; no blood in sputa since the 15th.

Nov. 1st.—Mr. Croft removed the bullet; subcutaneous
injection of cocaine (1 in 20) was given ten minutes before
extraction. An incision of an inch and a quarter was made
over the bullet; it was found to be beneath the muscular
fascia; this was incised and the bullet withdrawn without
difficulty; wound dressed antiseptically. The bullet was
grooved on one side in screw-like fashion, flattened at the
apex; on comparison with an unused bullet it was six
grains short.

3rd.—Wound dressed; looking well. Temperature 97 4°;
pulse 60.

10th.—Patient got up to-day; feels much better. Wound
dressed with chlorinated soda solution three times daily.

20th.—Emphysema over abdomen, chest, and neck quite
gone. Wound nearly healed; some swelling and hardness
to left of incision still remains.

22nd.—A little suppuration in the wound; a drainage-
tube put in.

25th.—Discharge decreasing; wound syringed out with
weak solution of chlorinated soda solution.

Dec. 2nd.—Patient went out, there being still a little dis¬
charge from the wound. His mental condition has im¬
proved since admission, though he is still very despoudiug
at times.

Jan. 31st.—Continues quite well.

LEICESTER INFIRMARY.

SUPBA-PUBIC LITHOTOMY IN THE ADULT; SUTURE OP
BLADDER ; PRIMARY UNION ; REMARKS.

(Under the care of Mr. C. J. Bond.)

W. C-, aged forty-nine, blacksmith, very stout. Has

had symptoms of stone for three years, also some enlarge¬
ment of the prostate, the bladder being very irritable. At
the time of operation the bladder was emptied and injected
with sixteen ounces of boradc fluid, and the rectal bag
then introduced and distended. On division of the abdo¬
minal wall, the bladder did not seem fully distended, so four
ounces more were injected, and it was then opened in the
usual way. A uric acid calculus, measuring 1£ in. in one and
l£ in. in the other diameter, was removed by lithotomy
forceps. Catgut sutures were used, the upper being passed
first through the bladder muscular wall, slightly invert-
inn the edges of the wound; the organ was then
hold np by this suture, and the others introduced.
A drainage-tube was placed deeply in the abdominal
incision, and the bladder again injected with boracic fluid,
which came out clear. No catheter was left in, but a soft
catheter was passed every three hours for the first two days,
the patient passing urine naturally on the third day. On
passing the catheter, however, on the evening of the day of
operation, the bladder contracted violently, forcing the
catheter out and driving some urine between the sutures
through the wound. This, however, did not occur again,
and apparently- did not retard the primary union of the
bladder wound at all. The drainage-tube was removed on
the fourth day, the wound having healed. The temperature
was normal throughout.

The supra-pubic opening was chosen in this case, on
account oi the enlargement of the prostate, the great depth
of the perineum, and the irritability of the bladder.

Remarks by Mr. Bond.— This is, I think, a good example
of primary union of the bladder wound after supra-pubic
lithotomy in the adult, and the result is the more encourag¬
ing, because it shows that an escape of urine between the
stitches within a few hours after the operation need not
necessarily prevent union, provided that the urine be healthy
and there be no cystitis with its accompanying urinary
decomposition. I think it might be useful in the present
probation stage of this operation to draw attention to
the following pointsFirst, the difficulties pf suturing
the bladder in a fat adult, with large pelvis and stout
abdominal muscles, are considerable, but can be best over¬
come by inserting the upper suture first, pulling the
bladder upwards by this, and so drawing the edges into

apposition; the bladder wall being thick, it does not eeem
necessary to produce much incision of the edges, but chiefly
to avoid transfixion of the mucous membrane. Secondly,
after considerable or even moderate distension of the
bladder when the tendon is relieved by the incision and
rapid escape of fluid, the organ does not contract at all
forcibly for some little time, but rather collapses; the
posterior wall is driven downwards and forwards by the
weight of the abdominal viscera on to the anterior, thus
flattening the empty vise us; and unless the Anger is intro¬
duced immediately after the incision, this bulging
forwards of the posterior wall may render manipulation
inside the bladder more difficult, and might possibly
lead to injury if the point of the knife be held directly
backwards. A slight difficulty was also caused in the
case related by the rectal bag being introduced after
injection of the bladder; it thus slipped up the bowel
and, passing above the sharp peritoneal fold (which can
always be seen like a broad ligament on looking into the
pelvis), turned forwards and increased the bulging of the
posterior wall mentioned above. In the distended bladder
m the living and in the dead subject, as the peritoneum is
pushed or rather drawn upwards it leaves an empty fold in
the angle between the abdominal wall and the receding
upper part of the anterior surface or summit of the bladder;
this upper portion of the anterior surface is never wholly
uncovered by peritoneum by distension, and the fold men¬
tioned above is generally pulled upwards out of the way
at the operation. The uncovered space in a distended
bladder has, in fact, the shape of a triangle with apex cut
off, with the base downwards on the pubes, its width here
corresponding to the interval between the two Foupart’s
ligaments. Finally, in settling the important question whether
after supra-pubic lithotomy the bladder wound should be
left open and a tube placed in the bladder, or whether
it should be sutured ana primary union attempted, 1 think
the condition of the urine may be a guide; if that be healthy,
other things being equal, primary union will probably
result after carefm suturing; it seems better to pass a
catheter frequently than to leave one in the bladder.

ST. VINCENT'S HOSPITAX, DUBLIN.

A CASE OF PERFORATING ULCER OF THE 8 TO MACH.

(Under the care of Dr. Quinlan.)

B. O’C-, aged thirty-eight, cook, was admitted on

Oct. 11th, in great agony. She bad for several years been
suffering from dyspeptic symptoms, with occasional gastric
irritation and habitual oonstipation, for the relief of which
she constantly took purgatives. On the previous Wednesday
night she had taken pills and a large dose of compound
senna mixture, which had a powerful effect. Immediately
after she was attacked by severe pain, which kept increasing.
Early on Saturday morning the pain became intolerable,
and her employer humanely called in Dr. Kendal Franks,
who saw her immediately, and to whom I am indebted for
the notes of the case while it was under his care. Dr.
Franks found her in acute agony and resting upon her
elbows and knees. With difficulty getting her to lie upon
her back, be found slight distension of the abdomen, but no
pain on pressure worth recording. The pulse was 110, the
temperature normal, and the expression of the face pinched.
She became worse and worse, with increasing temperature, and
was removed to St. Vincent’s Hospital on the Monday. The
abdomen was then greatly distended, but there was no ptun
on pressure; in fact, pressure seemed rather to give relief.
There was much vomiting, and nothing would remain in
the stomach except a little iced brandy-and-water. _ Her
bowels had not moved since the previous Thursday; the'pulse
was 120, weak and compressible. The temperature 101-2°.
The facial expression was almost like that of cholera. As
the end was evidently approaching rapidly, treatment was
directed solely to relieve her great agony, this being accom¬
plished by large hypodermic injections of morphia, along
with hot poultices and poppy fomentations to the abdomen.
Relief was thus obtained. At about 11 p.m. the patient said
that all her pains were gone, and spoke quite rationally to
the house-surgeon, Mr. Coen, who was looking after the
hypodermic morphia. About a quarter of an nour after¬
wards she suddenly collapsed, and died immediately.

The post-mortem examination was made ten hours and a
half after death, in the presence of Pf. Quinlan and Dr. Kendal
F 2

PATHOLOGICAL SOCIETY OF LONDON.

IFkb.6,1887.

268 The Lancet,]

Franks. The deceased was a fairly nourished woman, and
upon opening the abdomen the intestines were found
distended with gas, and the contents of the stomach
effused into the peritoneal cavity. There was much peri¬
tonitis in the upper -and left portions of the abdomen.
On examining the stomach, a perforating ulcer about the
size of a bronze penny was found in the middle of the lesser
curvature, and equally divided between the anterior and
posterior aspects of the stomach. The ulcer was divided
into two portions by a cord of gastric substance which
stretched across it. Beside the ulcer there was a thickening
of the gastric parieteS about the extent of a crown-piece,
and evidently the result of old gastric disease. On the
inside of the lower curvature were three bright-red patches
of congestion of the mucous capillaries, each about the size
of a sixpence. The etomaoh contained a small quantity of
dark grumous fluid, which was tested in the medical
laboratory for mineral irritants, but With negative results.

The case was evidently one of chronic ulceration of the
stomach, which had greatly thinned the parietes of the organ
when the perforation occurred, probably as the result of the
straining incidental upon the strong purgative dose already
described. The remarkable feature, however, is the fact
that, with extensive acute peritonitis accompanied by very
severe agony, there was a complete absence of pain when
the hand was pressed upon the abdominal surface,

U toial Sem ites,

PATHOLOGICAL SOCIETY OF LONDON.

Genito-urinary Disease in Animals. — Pathology of Colies’
Fracture.—Extra-uterine Fcetation.—Rupture of Bladder.

• Cerebral Tumour. — Multiple Perforative Necrosis of
Skull of Tubercular Origin .— Homy Growth on the Hand.
An ordinary meeting of this Society was held on Tuesday
last, Sir James Paget, Bart., F.R.S., President, in the chair.

Mr. Bland Sutton related some cases illustrating Diseases
of the Genito-uriaary Organs in Animals. The first speci¬
men consisted -of the kidney of a Sloth-Which had lived in
the Zoological Gardens twelve years. Occupying the pelvis
of the kidney were two calculi; one was small and weighed
2 grains, the other’ 12’83 grains. Chemically they were
found'••to be composed principally of oxalate ot lime.
Although renal calculi are not uncommon.in domesticated
animals, they seem to be excessively rare in wild ones. A
remarkable case of distension of the vaginal, cervical, and

f iterine cavity of a hog deer was described, and a uterus
rom an agouti was shown, in which some pieces of placenta
and fcctal membranes had been retained. Inflammation
and suppuration of the mucous membrane (suppurative
endometritis) resulted; the pus made its way along the
left cortm and' Fallopian tube, and an abscess formed
in the ovary, which ruptured into the peritoneal cavity
and brought about the agouti's death by acute peritonitis.
Details of a case of inflammation of the oviduct of a fowl
were related. The bird during life laid eggs of very Small
size, and without yelk. When the bird was killed the
infundibulum of the oviduct was found adherent to the
Ovary, so that the ova could not fall into the duct; the
intestines were matted together by inflammation. A pelvis
of a baboon was shown with the viscera in situ. The uterus
exhibited a severe retroflexion. During life the animal pre¬
sented well-marked symptoms, which were attributed to
the condition of the uterus. Some remarks were made
regarding the existence of ripe ova and follicles in the
ovaries of the human feetus, and in those of the embryos of
various and diverse species of mammalB.—Sir Jambs Paget
thought it would be difficult to over-estimate the value of
Mr. Sutton’s work, for it illustrated the influence of con- 1
ditions of human life on newly imported animals and the !
influence of close! confinement on animals not submitted to :
the ordinary accidents, of their life. It seemed that they .
became subject to varieties of the same diseases that affected
human beings. He asked whether the diseases in animals .
just after importation differed much from those found in j
animals long resident in the Gardens. The diseases of |
animals in their native state might be thus differentiated.—
Mr. Bland Sutton said that it was the first twelve months !
that settled the question whether tho animal would be very

diseased, or whether it would go oa an indefinite time mad
become acclimatised.

Mr. DArcy Power read a paper cm the Pathology of (Mies’s
Fracture, -and drew attention to the large proportion of
fractures of the lower end of the radius in winch the lower*
fragment was comminuted into the joint. He believed that,
from a pathological standpoint, this variety of fracture is
more common than the simple form ordinarily described. ;
and he held that, without dissection of the in j area part,it was
often impossible to distinguish the simple from'the com¬
minuted fractures, since the deformity might be identical.-
He related the case of a man, aged thirty-nine, who frac¬
tured his wriBt, and sustained such other injuries that he
died. During life, and even after death, when a more careful
examination could be made, the wrist presented the sym —

1 ptoms of an ordinary Colles’ fracture, and it was only upon
disssotion that the true nature of the injury was apparent.
The lower end of the radius was 6een to have undergone a
very complete crushing, the wrist-joiiit being implicated in
more than one place. Since the occurrence of this fracture,
Mr. Power had examined several other cases which appeared
to be of the ordinary type, but which, upon dissection,
proved to be in reality comminuted. He exhibited the six
specimens before the Society. He had also collected details
of cases in which, after almost identical injuries, a fairly
useful joint had resulted. He concluded his paper by-
observing that, although the pathological interest attaching
to these cases was great, he believed that the clinical im¬
portance Was but small, since it was difficult to distinguish*
between the two classes in the first place, and when that
was done the final result appeared to be almost equally
good. In examining the specimens preserved in the various
pathological museums in London, Mr. Power had only found
twenty-five cases of simple fracture, as against thirty-two,
in which, the lower fragment of the radius being com¬
minuted, the fracture had extended into the joint, th&s
bearing out the observation of Mr. Clement Lucas that
pathological specimens , showed a very large proportion of
comminuted fractures.—Sir James Paobt asked if the
history of the manner in Which the patients fell was
known.—Mr. Gilbert Barling had seen cases of simple,
impacted, and comminuted fracture into the joint, but this
anatomical knowledge would not be of therapeutical value.

—In 'reply, Mr. Power agreed with , the last speaker,'and
said that indirect violence was the cause of all the fractures,
but the exact method of its application was very difficult
to discover.

Dr. Griffith showed a specimen of early Pregnancy in the
fimbriated extremity of a Fallopian tube, with large extra-
uterine hsematocele; also specimens of Decidual Casts from
the Uterus, discharged in cases of tubal pregnancy. The
patient, who had been under the care of Dr. Matthews
Duncan, was a nullipara, aged thirty-two. The catamenia
had been absent four months; she suffered from morning
sickness, severe right iliac paia, and metrostasis. The usual
signs of early pregnancy were present, and a small, rounded,
not tender, swelling was found on the right side of Douglas’s
pouch. Eight days before death she passed a decidual cast ;
and three days later, after a severe attack of pain, she
became collapsed, and remained so until her death. A large
hsematocele bad formed, filling the pelvis and extending
into the hypogastrium, in which the blood was coagulated
and shut off from the general peritoneal cavity by recent
adhesions between the omentum and small intestines, illus¬
trating the usual anatomy of haematoceles, if tho patient
survive the effusion of blood for a few days. Dr. Griffith
stated that, in spite of what had recently been written to
the contrary, the large majority of effusions of blood of con¬
siderable size in this region are intra-peritoneal and true
hsematoceles, whilst the large subpentoneal effusions or
hfematomata, described by Mr. Lawson Tait and others,
were, for the most part, a new disease produced in
abdominal operations involving the - broad ligaments, and
were due to a vessel being left insecure in the broad ligament,
leading to a sudden or gradual distension of it with blood. The
decidual casts are probably diagnostic of extra-uterine fceta¬
tion, and are easily distinguished by their size and thickness
from tlie menstrual casts of so-called membranous dysmenor-
rheea. Both tubes present similar appearances of past disease,
the outer third of each being dilated, and the mucous mem¬
brane partially destroyed; the inner two-thirds of each tube
appeared healthy, but on microscopical examination the
mucous membrane was found to be nearly destroyed, only a
thin layer of the deeper part remaining, and the columnar

The Lancet,]

CLINICAL SOCIETY OF LONDON.

[Feb. 5,1887. 269

epithelium had disappeared from all parts. These condi¬
tions were probably the result of past destructive inflam¬
mation, and were sufficient to account for the arrest of the
ovum in the entrance of the tube. The muscular wall of the
tubes was thickened, as were the walls of the vessels.

Mr. Bbucr Clarke showed a specimen and drawing of
Bladder Ruptured at its Apex. All the coats were ruptured
except the peritoneal coat, and the blood was extravasated
in the subperitoneal tissue. The man, aged seventy-five,
had a stricture of the urethra, and had been run over. The
bladder was columnar in shape.—Sir James Paget said the
muscular coat was much thinned.—Mr. W. Rivington asked
whether there was any sign of tunicary hernias, which
ware most numerous about the ureters and urachus, and
might be the cause of the rupture.—In reply, Mr. Bruce
Clark* said he took it to be some sudden Rupture
without extravasation of urine, of which there was not
as much as a teaspoonful between the ruptured coats.—
Mr, fi. Hurry Fenwick quoted Mr. Rivington’s statistics to
show the position of the rupture in one hundred cases.
Eighty-eight times the rupture was situated on the posterior
surface. A case of litholapaxy was mentioned iu which
there was vertical rupture of the bladder between the inter-
uretal bar. The entire thickness of the muscular wall of the
bladder was torn, but not the peritoneum; pelvic cellulitis
resulted in death. The rupture had evidently been made by
the evacuator having been used too violently in a small
bladder. He referred to the case because of its illustrating
aa entirely new class of violence acting on the posterior
wall—a uniform fluid pressure acting from within and tear¬
ing the viscus posteriorly and vertically. He contended that
the occurrence of fatty degeneration and inflammatory
softening were insufficiently recognised as causative elements
in the production of rupture. These pathological changes
affected certain parts more than others, and the posterior
wall was a common seat of both changes. This was interest¬
ing in relation to the frequency of posterior rupture.—Mr.
R. J. Godlke inquired whether in the operation of Iitho-
lapoxy it was possible that the lithotrite or catheter had
caused the rupture.

Mr. Gilbert Barling showed a Tubercular Tumour of
the Brain, which occurred in the practice of the late Dr.
W. Bussell of Birmingham. It came from a boy aged
twelve years, who died in 1859 from ascites and anasarca of
renal origin. Epileptiform fits on the right side without loss
of consciousness, subsequent partial paralysis of the right
limb* and right side of the face, and jerky movements in the
paralysed limbs were noticed. The tumour was situate at
th* junction of the anterior and middle lobes of the brain in
the upper part of the left “ motor ” area. The surrounding
tissue was not softened. A few bacilli were found in the
caseous part of the tubercular mass. The tumour was very
circumscribed, and gave rise to symptoms only five weeks
before the patient’s death.—Dr. Owlf.s asked whether there
was any scrofulous disease of the kidney.—Dr. Norman
Moon thought there might have been tubercles in the
pericardium. He had found tubercles in the adherent peri¬
cardium in children who bad tubercle in other parts of the
tody.—Mr. Barling, in reply, said there was no record of
icrofulous or tuberculous disease in the kidney.

Mr. Hilton Pollard showed the Vault of a Skull, in
which there were four perforations, which had resulted from
tubsmalar disease of the bone. The specimen had been
taken, from a female child aged ten months, when she first
came under. Mr. Pollard’s care at the North-Eastern Hospital
lot 4ran- At that time there were four chronic

ibencweofl on the skull, for which no cause could be assigned.
They.were opened, and found. to be, situated immediately
ora the bone. They were all scraped out. The smallest
ibeoess hqoled in a few weeks, witboqt. causing perforation
of the bane, hut the others remained fistulous, and a fifth
ifrsrnen iornped over the occipital protuberance; this was
created .like the others, and ran a similar course. Four
aoaths later sequestra, involving the whole thickness of the
■kail* w ere removed. Three of Hie abscesses then healed
■oan&gt bat.tbgt over the occipital protuberance never
quite heeled After the.removal of the sequestra the child
rapidly wasted, and two months afterwards she died. There
were a few po^fkes of caseous tubercle in the lungs, and
the toonofaud glands warp caseousj the mesenteric glands
ware enlarged-, The skull presented four perforations, the
boedeas yqfi three*, of which ware smooth and healthy, but
these*v ye ygpa of disease still present along the upper
bordeem wai pjporation in the occipital bone, Mr. Pollard

had exa mi ned some of the granulation tissue, and one of
the pieces of bone which had been removed, but though
they showed the microscopical structure of tubercle, he had
failed to detect any tubercle bacilli in them. There were
no signs of syphilis of the skull. Volkmann ( Central-
blatt f. Chirurgie, 1880, p. 8) had described similar cases,
which he considered to be of tubercular origin. — Mr.
G. Barling had seen a similar specimen in a child less
than twelve months of age. This child had a cyst in the
back. Excision of the cyst was practised and two small
sequestra of the laminae of the vertebrae removed. Menin¬
gitis followed, and death supervened. At the necropsy
circular sequestra of the bones of the skull were discovered.
These were not due to syphilis, but a protracted search
would probably be required before tubercular bacilli could
be discovered, if at all.—Mr. W. G. Spencer referred to a
case of tuberculosis of the skin in a woman aged forty, in
whom necrosis of the skull was present. Tubercle bacilli
were found in the cutaneous lesion, which had some
resemblance to syphilitic disease. — Mr. A. E. Barker
showed a specimen of tubercular disease on the inner
aspect of the skull. It was removed from a child who
had suffered from very extensive caries of the spine ;
there was no evidence of intra-cranial disease during life.
After death a whitish patch over the greater wing of the
sphenoid was found between the dura mater and bone; the
disease had penetrated the bone and produced a rarefying
osteitis of tubercular nature.—Dr. T. D. Acland testified
from considerable experience to the difficulty or impossi¬
bility of finding tubercle bacilli in chronic scrofulous
lesions.—Dr. Dawson Williams said that inoculations in
guinea-pigs with material from tubercular joints gave
ris9 to generalised tubercle, the lesions of which showed
typical bacilli, though they were not found in the inoculated
material.—Mr. A. A. Bowlby testified to the rarity of the
affection of the cranial vault by tuberculous processes. He
accepted Mr. Pollard's views of the specimen. He agreed
that the presence of bacilli was not necessary to the diagnosis
of tubercle. The bacilli might be there in very small
numbers. The same paucity of numbers existed in lupus.—
Mr. Bilton Pollard, in reply, said that Vclkmann had
collected eleven cases, in some of which caries rather
necrosis was ' the chief feature. In his own specimens the
necrosed bone appeared to have been previously infiltrated
by tubercular material.

Dr. Edmunds showed a specimen of Horny Papilloma of
Hand from a woman aged seventy-five. It occupied a great
part of tba surface of the back of the hand. There was
about an inch in thickness of horn. The papilla) of the
skin were hypertrophied. The hand had been burnt seventy
years previously.—Mr. B. Sutton asked whether it was to
be regarded as a homy epithelioma.—Sir James Paget
thought the ulcerated surface resembled that of an epithe¬
lioma.—Mr. Edmunds said that the growth did not extend
in depth below the cutis.

The following card specimens were shown:—Mr. E. II.
Fenwick: Carcinoma of Prostate. Mr. Targett: Extra-
peritoneal Rupture of Bladder.

CLINICAL SOCIETY OF LONDON.

President's Address. — Nephro-lithotomy.—Renal Surgery.

An ordinary meeting of this Society was held on the
28th ult., Dr. W. Hi Broadbent, F.R.C.P., President, in the
chair. Owing to the lateness of the hour, the discussion on
the surgical papers was postponed till the next meeting.

. Dr. Broadbent gave his inaugural address as President
of the Society, and expressed his high sense of the honour
and responsibility attaching to the post. If he had had an
ambition outside and beyond the performance of his duty, it
was certainly that of figuring as President on the honoured
rules of one or other of the Societies. Allud ing to the progress
Which had been made in the study of morbid anatomy,
pathology, qnd therapeutics, he congratulated the profession
on the fact that every day tended to render practice more
scientific, and that pathology and therapeutics now went
band in hand. Diagnosis w&s one of the most important
elements of success in the career of medical men. A well-
known barrister of his acquaintance, in his post-prandial
chat, was wont to say that, to paraphrase an aphorism of
Demosthenes, the first element 6f success at the Bar was
good animal spirits; the second,good animal spirits; and the

O

270 The Lancet,]

CLINICAL SOCIETY OF LONDON.

[Fab. 6,1887.

third, good animal spirits. In the same way, he would be
disposed to say that the groat element of success in medi¬
cine was diagnosis. By diagnosis he meant careful and
exact localisation of lesions. It was not diagnosis to say
that a patient had paraplegia unless the nature and site of
the lesion was ascertained. As to the mere fact of some
cases proving exceptional, he recalled the saying of Sir
James Paget, that “an exception to one rule was in reality
the first indication of another and possibly unknown rule,”
and might therefore be the means of enabling the careful
and attentive observer to carry out useful observation on a
new line. He observed that in the Transactions of the Society
the surgeons appeared to better advantage than the phy¬
sicians—a state of things probably attributable to the fact
that physicians’ cases did not lendthemselves to exhibition as
did the surgeons’ cases. The physician could, and often did,
point to the arrest of phthisis in individuals and communi¬
ties ; the progress of Bright’s disease might be staved off
indefinitely if the patient only carried out the treatment
laid down for him; but such cases scarcely admitted of
being shown, and in any case did not appeal to the attention
in the same way as the more palpable results of the surgeon’s
intervention. He deprecated anything in the nature of
scepticism in regard to the uss of drugs, and declared
that when physicians used drugs they did so in good faith.
Alluding to the class of drugs known as antipyretics, he
said that, while very useful in a certain category of cases,
the mere knowledge that they lowered the temperature
was not a sufficient justification for their use. It was
necessary for the physician to know how the temperature
was lowered before he ventured to lower it. The mere
existence of fever was not a sufficient reason, and there
were many cases in which it was doubtful whether a reduc¬
tion in temperature was desirable or beneficial to the
patient. The physician was not in a position to say that a
high temperature was per se a symptom to be combated,
since it might be a necessary item in the evolution of the
morbid phenomena. Referring to the employment of the
salicylates in the treatment of acute rheumatism, he
acknowledged that many of the inconveniences and sequel®
of that disease were abridged or prevented by its use. At
the same time he enjoined a certain caution, especially in
prolonged courses of the drug. He said that, since its use
had become general, he had certainly seen deaths from rheu¬
matic fever of a kind he had not met with before. In con¬
clusion, he thanked the Society for the honour they had
conferred upon him.

Mr. Henry Morris read a case of Calculous Disease of
both Kidneys, with remarks on the Surgical Treatment of
Calculous Kidney generally. A woman, aged forty, was
sent to Mr. Moms at the Middlesex Hospital on June 15th,
1886, by Mr. Nunn, for the purpose of undergoing an
operation for calculous disease of the right kidney, asso¬
ciated with a purulent fistula of long standing in the right
loin. The patient was very ill at the time, had passed
several small calculi, and complained of severe pain in the
right loin and frequency of micturition. Within a few
days some pain had also been felt in the left loin. There
was a history of albuminuria of long standing. On
June 18th the right kidney was explored through an
incision in the loin. The tissues round the kidney
were condensed, indurated, and tenaciously adherent to
the renal capsule; the kidney was small and hard. On
cutting into the kidney several small calculi and some
fragments of pyogenic membrane, but no pus, were re¬
moved. The operation was followed by no relief, and more
intense pain was experienced on the left side. Partial and
then complete suppression of urine followed, and the patient
died comatose on June 23rd. At the post-mortem examina¬
tion the left kidney was found very large and white, and
with a great increase of cortical substance. It contained
two cysts filled with pus, in one of which there was about
two hundred small calculi. Numerous other calculi were
scattered through the kidney. The right kidney was small,
hard, and contracted, and one or two minute calculi were
found scattered in its substance. There was no calculus in
either ureter, and no other cause of ureteral obstruction
present. It is argued from such a case as this that the
surgeon may be easily misled by clinical symptoms, and also
by abdominal exploration, to operate upon'the wrong kidney
—viz., one which, though the seat of a calculus, is not the
organ which is exciting the present symptoms, these
symptoms being caused by the second kidney having become
calculous after it had undergone hypertrophy, owing to

previous long-standing calculous disease in the first. 8uch
cases are not favourable for operation, and differ vastly from
the more numerous cases which are cured or relieved respec¬
tively by nephro-lithotomy and nephrectomy.

Mr. Henry Morris read a case of Successful Nephro¬
lithotomy. A man aged forty-two, who for ten years had
been suffering from symptoms pointing to renal calculus,
was sent to Mr. Morris by Dr. George Johneon on May 4tb,
1886. He was admitted into the Middlesex Hospital on
May 12th, and operated upon on May 15tb. A rough
rounded calculus, weighing 23£gr., was removed through au
incision in the loin from the right kidney. There was no
pus in the kidney. After the operation no urine whatever
escaped by the wound, but blood in decreasing quantity was
passed in the urine for some days. The wound healed by
direct union. The patient sat up on the sixteenth day, and
was discharged perfectly well at the end of the third week
after the operation. For a long time prior to coming under
notice he had taken very largo quantities of brandy and
laudanum to relieve pain; these were entirely discontinued
from the time of the operation, as all pain ceased from
that time. He has been several times seen since he left
the hospital, and is in good health and passing natural
urine.

Mr. Howard Marsh read a case in which very severe
symptoms were due to two small Stones in an Atrophied
and Movable Kidney; failure to detect the organ by an
anterior lumbar incision; discovery by laparotomy; success¬
ful removal of the kidney. The patient, aged twenty-
five, unmarried, was admitted into St. Bartholomew’s Hos¬
pital on June 29th, 1886, with well-marked symptoms of
stone in the left kidney, constant pain, severe exacerba¬
tions, frequent micturition, and pus and blood in the urine.
As no improvement followed rest and medical treatment, it
was determined to explore the kidney. For this purpose an
incision, suggested by Mr. Willett, and which had several
times been found highly advantageous for the removal of
large kidneys, situated exactly half way between the spine
and the middle line in front, and vertical in direction,
was mode through the abdominal wall and fascia trans¬
versal is. The kidney, however, could nowhere be found
though a wide search was made. On a subsequent
occasion the abdomen was opened in the middle line, and
the hand passed in. The kidney was now easily detected,
but found to be movable and atrophied. No stone, however,
could be felt. The kidney was then removed by the ordinary
lumbar incision. The patient made a bad recovery. Or
opening the kidney after removal two small stones were
found m one of the calyces. The author drew attentior
to the important fact that-, though the symptoms were verj
urgent, the stones on which they depended were of verj
small size. He pointed out that, though the incision in the
axillary line is ordinarily adopted for the removal of a larg<
kidney, the posterior lumbar incision is preferable for the
purpose either of mere exploration or the removal of a etone
from the kidney; and he discussed the means that may be
adopted for the detection and removal of small renal calculi
He also raised the question how far the symptoms in thi
present case may have been due to the fact that the kidney
was freely movable.

Mr. William H. Bennett read a case of supposed Nophro
tomy for 8crofulous Disease. The patient, a marrie<
woman, aged thirty-seven, was admitted into St. George’
Hospital under the care of Dr. Champneys on Dec. 25th
1885, on account of abdominal tenderness, painful micturi
tion, and a reniform swelling on the left of the umbilicu/
which rapidly increased, and by Jan. 8th extended into th
left loin. On the 14th there was a sharp rigor, fiuctuotioi
became manifest in the mass, and a considerable amount c
pus appeared in the urine, which was neutral in reactioi
and up to this time had only been slightly turbid. Exhaust
ing vomiting set in, and the case was transferred to Mi
Bennett’s care, who, on Feb. 3rd, laid open the tumour freel
through the left loin, whereupon a large quantity of curd;
partly caseating discharge poured out, with a foul urinoO
odour. On the finger being introduced into the cavity i
entered what was apparently a disorganised scrofulous kic
ney, there being a large sac with irregular imperfect sept
formed, so far as could be judged, by the undestroyed oelyc<
running in the usual direction. At the inner aspect was
pouch-like offshoot, which was thought to be the dilate
ureter. Great relief followed the operation; the patiei
was progressing favourably in every respect; the abscc
contracting rapidly until Feb. 18th, When lung conap]

Thb Lancet,]

OPHTHALMOLOGICAL SOCIETY.

[Feb. 5 , 1887 . 271

cations set in, of which she died on the 28th. Post¬
mortem examination: There was a small wound in the
left loin leading into a sacculated abscess of small size,
at the inner and anterior part of which lay the kidney abso¬
lutely intact , not having been involved in the operation at
all. The organ, on being out open, was found in a condition
of scrofulous disease, but had not broken down to any
extent. Difficult as may be the differential diagnosis of
renal and peri-renal abscess, Mr. Bennett was unacquainted
with any case in which doubt had arisen, after free incision,
as to the situation of the disease. In his case, so exactly in
every way did the cavity resemble the interior of the kidney
at the time of operation, that no surgeon could have doubted
that the kidney bad been laid open. Had the patient sur¬
vived, as she might have done but for the occurrence of lung
disease, the abscess would certainly have healed, and the
case probably have been recorded as a successful instance of
nephrotomy for scrofulous disease. As it seemed not impos¬
sible that similar sacculated abscesses may have been opened
by other surgeons under the impression that the kidney had
been incised, Mr. Bennett thought the case not without
interest in connexion with the statistics of the result of
treatment of scrofulous kidney by incision.

The following living specimens were shown:—Mr. R. J.
Godlee: Removal of both Upper Jaws for Epithelioma of
Hard Palate. Mr. R. W. Parker: An Unusual Form of Hare¬
lip. Mr. J. R. Lunn: (1) A boy with Ichthyosis; (2) Pecu¬
liar Deformity of Feet in an Ataxic Patient; (3) A man with
Raynaud’s Disease of the Feet; (4) A case of Myxcedema
with want of Development of the Genital Organs.

Mr. Hbnry Mourns exhibited four Renal Calculi and
case* illustrative of successful Nephro-lithotomy.

OPHTHALMOLOGICAL SOCIETY.

Treatment of Cortical Cornea.—Calcareous Film of Cornea.
— Choroidal Hamorrhage. — Exostoses of Skull , with
Atrophy of Optic Nerves.—Unusual Clinical Cases .—
Acute Cerebral Disease, with Ocular symptoms.

An ordinary meeting of this Society was held on the 27th
ult, Mr. E. Nettleship, F.R.C.S., Vice-President, in the chair.

Mr. Cowell showed three patients with Conical Cornea
treated by transverse incision, which he preferred to
vertical incision. Text-books averred that conical cornea
was commonest in women; but his experience was different.
Two of his patients had asked that the second eye might be
operated upon, they were so gratified with the results.—
Dr. Brailey thought women were more commonly affected.
He preferred a vertical section, but hod of late simply made
a vertical groove in the cornea and then stitched the edges
of the groove together.—Mr. Higgkns said that women
were most frequently affected, and hypermetropic eyes were
more prone to it than others. After operation a convex
glass greatly improved the eight.—Mr. Me Hardy hod seen
rt only in very young men. He preferred trephining to
removing an elliptical flap; but the latter was attended
with less pain and retention of aqueous fluid. The
horizontal was better than tbe vertical section. — Mr.
Anderson CniTCHBTT observed that anterior synechia was
noted in 50 per cent, of the cases operated on, and iridectomy
was necessitated. He began with a minute vertical iridec¬
tomy, and ten days later another iridectomy outwards, and
afterwards an elliptical portion of the cornea was removed.—
Mr. Lano thought the incision should be wider than the size
of the pupil, and so adhesion of cornea and iris could be
avoided. He cut out a short, nearly circular ellipse.—Mr.
Hartley concurred with Mr. Lang, and was struck with
the apparent length of the scar in the cases exhibited.—
Mr. COwbll claimed no originality for the vertical method,
but thought it had fewer inconveniences than others. He
would not employ a suture, for it set up irritation. The two
ratface* of the cut cornea adapted themselves better if the
incision were long.

Mr. Marcus Gunn showed a living specimen of Trans¬
verse Calcareous Film of both Cornea). The left eye bad
defective vision, and originally squinted. The chief features
of interest were the causation and treatment. The man
wss * blacksmith, and had been exposed to blasts of cold
air-as well as to great heat. The vision in the right eye
wm atm fairly good. Mr. Gunn proposed to scrape away
th* calcareous matter. There had been no keratitis or iritis.

There was no family history of gout or rheumatism. Tbe
film reached to the extreme inner edge of the cornea, but
did not slope. In these two features it differed from those
shown by Mr. Nettleship.

Mr. W. H. Jessop read the sequel to the case of Large
Semicircular Hmmorrhage. The eye has recovered with
perfect vision, and without a scotoma. He concluded that
the extravasation had probably occurred into tbe nerve-
fibre layer.—Mr. Quarry Silcock said that the case of
large haemorrhage shown by him at the last meeting had
resulted in a white patch of choroidal atrophy, which there¬
fore justified his calling the case choroidal rather than
retinal haemorrhage.

Mr. W. Lang showed a case of Central Detachment of
Retina of obscure origin in a widow aged sixty-three, a
semptress.

Mr. E. Nettleship showed a living specimen of Con¬
genital Multiple Symmetrical Exostoses of Skull, with
Post-papillitic Partial Atrophy of Optic Nerves. The boy,
aged twelve, was much undergrown, but fairly healthy and
intelligent. There were very large and perfectly symme¬
trical smooth exostoses in the temporal and mastoid regions
and on the outer wall of each orbit, laterally, and at or near
the situation of the anterior and posterior fontanelles in the
middle line. The coronal Buture could be felt as a groove
on the temporal and anterior median exostoses. At the
sided of the root of the nose there is a gap between the
nasal process of the frontal and of the superior maxillary
bones, but the central ridge formed by the nasal bones is
normal. Numerous large veins emerge from or pass into
the gap on each side of the root of the nose; and others are
seen in the temporal regions. The eyes are too wide apart,
the orbits being separated apparently by expansion of the
median bones. When the mouth was opened the lower jaw
was dislocated forwards, but without causing inconveni¬
ence ; probably the shape of tbe glenoid cavity is much
altered. The roof of the palate is very high and narrow
anteriorly; with this exception, the facial bones seem to be
quite natural. The smell and hearing were good. There
was no other deformity. Both the optic discs were pale, with
clear evidence of former inflammation. The left showed
more change than the right. Vision is defective: right,
14 J.; left, 1G J.; less than with either. The refraction
was hypermetropic, 3’5 D. He could read better with the
aid of + 3 D. The head was of its present shape at birth,
but the bosses have become less conspicuous as he lias
grown. The sight has been in its present state all his life,
so far as could be ascertained. There were no other cases
in the family.

Mr. P. H. Mules read a paper on some Unusual Clinical
Cases. 1. Pseudo-sarcoma of iris. A case of solitary
gummous tumour of the iris simulating sarcoma, in a child
aged thirteen months. There was no iritis or other appear¬
ance of syphilis. The growth was dispersed by mercurial
inunction in seven weeks, leaving the eye normal. 2. A
deep and extensive crescentic ulcer of the cornea (Wecker’s
malignant ulcer), with splitting of the corneal layers to the
apex, permitting passage of probe (a very rare condition),
occurring in a man aged fifty-four, arrested by scraping and
iodoform. The case was a crucial one, and Dr. Mules pointed
to it as proof of the efficacy of scraping and antiseptics. 3. A
second case of corneal ulcer in a man aged fifty-six suffer¬
ing from Graves’s disease. Tbe ulcer was painful, and was
complicated by posterior synechia. All minor treatment
failed, and the cornea being in eminent danger of destruction,
the lids were united over four-fifths of their length. The
pain was at once relieved, and the ulcer healed rapidly with¬
out further treatment. The interest of this case was
accentuated by the record of corneal losses from Graves’s
disease recently published. 4. A case of double auto¬
extraction, the result of accident, in a man aged sixty-
seven, with retention of useful vision in both eyes. 6. Ex¬
traordinary foreign body retained in globe: a dart from puff
and dart encapsuled for eleven days. 6. Scleral hernia from
direct violence on the front of the eye; media transparent.
Papilla with an irregular margin of sclera, forced out and
destroyed; central artery reduced to white lines; vein re¬
taining its normal patency. It was believed that this was
the only case in which this accident had been observed.—
Mr. Critchett related the case of a lady who had been shot
in the eye with a dart nine months before. During the
enucleation of the eye for sympathetic ophthalmitis the
dart was found to have penetrated the optic nerve, and lay
outside the eye in the orbit.—Mr.G. A Berry had examined the

272 The Lancet,]

case of exophthalmic goitre, and the result seemed to be most
satisfactory. Was it requisite to pare the edge before bringing
the lids together? He had recently seen a similar case in
which good results were obtained without paring the edges.
—Mt\ Higgkns referred to the crescentic ulcers; they were
more amenable to treatment by eserine and bandaging than
by any other method of treatment.—Dr. Brailey thought
that cases where there was no infiltration of the base of the
ulcer did best with eserine; where there was infiltration,
the galvano-cautery was very useful.—Mr. Marcus Gunn
said that in one case of fairly clear, greyish, serpiginous
ulceration, extending half round the entire cornea, he had
employed the galvano-cautery with great success.—Mr.
Simeon Snell alluded to the value of quinine in two-grain
doses three or four times a day.

Mr. G. A. Berry read three cases of Acute Cerebral
Disease with Ocular Symptoms. His first case was one of
acute ophthalmoplegia externa in a little girl, aged two
years and a half. There was a history of gastro-enteric
catarrh five months before admission. The present illness
began three weeks ago with cough and headache; Ten days
before something wrong was noticed with the sight. There
was almost complete ptosis of both eyes, with absolute
divergence of eyeballs—in fact, a condition of almost com¬
plete ophthalmoplegia externa. The child was mentally
very apathetic; once she had a severe screaming fit; the
knee-jerks were absent. After treatment by iodide of
potassium for two weeks, distinct improvement in the
general condition began, and the ophthalmoplegia 'Was less
marked. There was a scrofulous condition of one finger.
The pathology of ophthalmoplegia was reviewed. Perhaps
the condition was dependent on tubercular disease about the
ocular nuclei. The second case was one of megrim associated
witli spasm of convergence, in a girl aged eighteen. The
possibility of hysteria being the cause was considered. On
one occasion the patient had an attack of apparently insur¬
mountable conjugate deviation of the eyes to the left.
Extraordinary abnormalities of temperature of the body were
observed. The corpora quadrigeminn or the cortex might
he the seat of the nervous lesion. The third case was one
of recurrent attacks of bitemporal hemianopia. The patient
was a man aged fifty-three, who had suffered from headache
and drowsiness. Both temporal halves of the fields of vision
were extremely defective up to about 6° from the points
of fixation. On six occasions, at intervals of about one
week, and for three or four days, vision became affected
and the temporal fields of vision dimmed or obliterated,
whilst at the same time the heart’s action was markedly
slower than during the periods of intermission of the
ocular symptoms. Pressure on the chiasma in an antero¬
posterior direction might be the cause of the hemianopia.—
Or. Gowers said the cases were difficult. He agreed with
Dr. Berry that it was highly probable that different cases
of external ophthalmoplegia had different pathological
lesions, especially judging from what was known of
ophthalmoplegia interna. The loss of light-reflex, usually
attributed to degeneration, might pass away even in tabes.
"Where recovery took place, the lesion could not be a
destructive one, though there might be some nutritional
change. With regard to the first case, he doubted whether
it could be due to distension of the aqueduct or to a simple
tubercular lesion. Distension of the aqueduct was fre¬
quently met with without paralysis of ocular muscles.
Sudden lesions were generally vascular. Thrombosis was
common in children; in this case it was probable that a
thrombus had occurred in the artery leading to the ocular
Centre. In the Becond case, he agreed that the case was
not one of hysteria. Divergent strabismus was conclusive
against hysteria. As to the third case, no doubt internal
hydrocephalus was an occasional cause of pressure on the
chiasma, ahd blindness. He referred to a case where first
the decussating arid ■afterwfifds the non-decUsfenting fibres
were affected by tbe distension of the third ventricle.—
Mr, Warkn Tay referred to a case of Mr. Hutchinson’s,
which recovered.—iDr. SEYsrom Sharkey did not accept
the. tubercular theory of the first case. Many acute cases
resembled tubercular disease and got well, but there was not
Any reliable evidence of recovery after tubercular disease of
tile braid. He had discovered diffuse inflammation of the
basal ganglia when the cerebral symptoms had hegun
suddenly. lie would regard the present case as one of
this kind rather than as of thrombotifc origin.—Mr. Berry,
In reply, considered that some VAsculat lesion was most |
probable in the first case. He bad observed one case of ;

[Feb. 6, 1887.

external ophthalmoplegia, evidently of inflammatory origin.
Spasm of convergence, so far as he knew, was rare; paralysis
more common.

LEEDS ANI) WEST RIDING MEDIOO-
CHIRURGICAL SOCIETY.

At the ordinary meeting held on Jan. 14th, Mr. Wheelhouse
in the chair, the following pathological specimens were
shown:—Mr. Lawford Knaggs: Carcinomatous Ulcer of
Pylorus. Mr. C. J. Wright: Pedunculated Fibroma of
Labium—a large mushroom-shaped tumour ulcerated on the
surface. Mr. Mayo Robson: Diseased Uterine Appendages—
vis., tube occluded by caseous matter; distended tube with
parovarian and small ovarian cyst.

A drawing of Lichen Circnmscriptus was shown by Dr.
Barrs of a case in which the eruption was produced by
wearing flannel.

Mr. McGill exhibited a specimen of a large Cyst near the
larynx, removed post mortem.

The following communications were made:—

On the persistence of Palsy in limited groups of Muscles,
Dr. Clifford Allbutt pointed out the frequency with
which this occurred both in cerebral and spinal paralyses,
and he held that the theory that it depended On the parti¬
cular group of cells affected by the lesion Was untenable,
at all events in cerebral cases. Considering the muscular
actions to be carried on by groups of mechanisms, he thought
the will acted with diminished power and therefore im¬
perfect control, resulting in the overaction of stronger
muscles and consequent spasm through want of their
proper antagonisers. This local disorder was to be treated
by local means, and he recommended the use of elastic bands
to assist in counteracting the spasm of stronger muscles,
and spoke highly of the use of tenotomy, which should
be done early, before any dislocation &c. could take place.
—Mr. Wheelhouse said that he and his surgical colleagues
had been led to make a very extensive use of tenotomy in
the treatment of infantile palsies through the representa¬
tions of a very skilful surgical mechanician, and had been
much surprised at the results obtained.—Dr. Major thought
that in polio-myelitis anterior there could be no doubt, from
the wasting and altered electric relations of the muscles,
that the lesion did pick out certain groups of cells and
leave others.—Dr. Eddison agreed with previous speakers
in the benefit to be obtained from surgical treat¬
ment. -Dr. Chadwick thought that atretchiug the un¬
opposed muscles by means of a splint was more reason¬
able than cutting their tendons—Dr. ChurtoN thought
that in the gradual evolution of the nervous system the
later formed parts might be more delicate than the older,
and therefore lesions produced different effects; but tenotomy
relieved the muscle by removing the irritation of its oppo¬
nents.—Dr. Griffith thought the same theory could not
account for cential and peripheral palsies. In lead-palsy
there was very little spasm, and he thought deformity arose
from the long continuance of the parts in a position like
that seen in the cadaver.—Dr. Allan had seen excellent
results-from the U9e of elastic bands in the practice of Air.
Chauncy Puzey of Liverpool.

Pernicious Ancemia.— Mr. Bates described a fatal case in
a patient aged forty-nine. Tbe principal symptoms were
shortness of breath, attacks of vomiting, and diarrhcea; there
wos also an attack of jaundice. At the necropsy the liver
was slightly fatty, and the stomach walls were very thin,
but had not yet been microscopically examined. Death took
place after twenty-four hours’ unconsciousness. Another
case of the same kind was described, in which also there
had been jaundice before death. The stomach was very
thin.—Dr. Black recommended the use of alteratives in the
treatment of anrerhia. -Dr. Alldutt referred to the definite
appearance of pernicious anosmia, as accompanied by extrava¬
sations into the retina, and in tbe curAWe cases remedied by
arsenic rather than iron.- Mr. Jessop spoke of three patients
he had seen, all of Whom lived in houses much exposed to
sewer hir—Dr. Eddison doubted the advantage of the
term “ pernicious.” • He thought many cases so galled were
due to ague or syphilis. In all cases he had seen the blood-
cells were distorted.

Primary Serve Suture.— Air. RowEdescribeda case where
j the ulnar nerve and artery were both divided. After securing
the artery he joined the out end of the nerve (the prmtimal

LEEDS AND WEST RIDING MEDlCO-CHIRURGlCAL SOCIETY.

Tint Lancet,]

SHEFFIELD MED1C0-CHIRURGICAL SOCIETY.—REVIEW8.

[Fbb. 6,1887% 27S

bring much retracted) with a carbolised catgut-suture passed
through the nerve. Two days after the operation the
numbness waB lees. In five days and a half the sensa¬
tion was the same, but there was some slight movement in
the muscle. In thirty days sensation was slightly-impaired,
and motion was definite, but not perfect. Shortly after¬
wards the man pursued his occupation. Mr. Rowe referred to
cases by Favel, Nfiaton, and others; in some sensation partly
returned at the end of the second day, recovery taldng place
at the end of a week. In a ease of primary nerve suture
reported by Laugier, recovery began on the day of operation.
In Page's cases it occurred in nine days; in Pye’s cases, in
eight days; but there were some errors of localisation in the
former. Mr. Rowe compared the rapid restitution of function
in primary suture with the later development noticed in
cases of secondary suture, referring specially to a case where
the sciatic nerve was sutured by Mr. Wheelhouee, perfect
function being only restored after several months. —
Mr. Whebleio use said that nerve suture was now estab¬
lished as a satisfactory operation, whether primary or
secondary; but in one case by the latter he had known the
effect delayed for three months. Referring to a case men¬
tioned by Mr. Hartley where a painful tumour formed over
the seat of suture of the median nerve, he said that pro¬
bably some part of the nerve had failed to unite and had
beeome bulbous, and he recommended a fresh operation to
remove this.—Mr. Jessop thought we should in future, in
large wounds, fix more divided parts in apposition by sutures
than has been the custom. One of the first cases of nerve
suture on record was one where he had sutured the ulnar
twelve years after division, first removing a bulbous end.
On the seventh day the patient could localise a touch.

SHEFFIELD MEDICO-OHLRUHGICAL SOCIETY.

At the meeting on Dec. 23rd, 1886, the following com¬
munications were made:—

Malignant Disease <j f Pancreas . and Liver .—Dr. Dyson
related this case. The patient, aged forty-nine, was pre¬
viously under his care for left pleural effusion, for which he
was tapped, and he made a good recovery. His colour was
suggestive of Addison’s disease, and there was a history of
alcoholism. The patient applied at the Sheffield Infirmary
for relief because the tumour, which was situated in the
epigastrium and which was somewhat movable, interfered
with his work. The most noteworthy fact in the case was
Use complete absence of pain fend digestive troubles until
within a month of his death. During the last month, pain,
vomiting, obstruction of bowel, haemorrhage, and pyrexia
supervened, and the patient died of exhaustion. At the
necropsy the pancreas was found almost entirely invaded by
srinhus ; the neighbouring glands were affected, and there
vers numerous secondary deposits in the liver, one especially
large one in the left lobe. No other deposits. Left pleura
adherent.

Tremor and Incipient Graves ’ Disease. —Dr. Dyson intro¬
duced this patient, an iron-turner, aged thirty-six. The
tremors were fine and generally distributed, and probably
doe to chronic alcoholism. CaTdio-vascular symptoms were
the first to appear, and slight exophthalmos and Graefe’s lid
symptom came on quite recently. Pulse 150. He had also
a slight internal squint and dilatation of the pupil of the
left eye ; no glycosuria. Many drugs had been tried for his
rtttrf, but none so far was obtained. •

Some Clinical Featttres of Graved Diseasc.—^blr. Swell
read this paper, based on cases coming under his observation.
Referring to those in which the eye symptoms were the first
to appear, he mentioned the case of a young woman, in
wham the other cardinal symptoms had recently developed,
and the patient was introduced by Dr. Dyson, under
wheat) care she was now; also that of a woman, aged
forty-five (introduced), with Graefa’s and Stellwag’a sym¬
ptoms'in right eye; no marked (if any) exophthalmos;
slightly enlarged thyroid, and unobserved by patient;
absence of other Bymptoms; left eye normal. Two
mooodulAf cases in females were related, besides the one
above; as were also two instances of suppuration of both
corn—; -the eases coming under observation first when tbe
seriously affected in one (aged twenty-three),
aadgkgttam&inthe other (aged forty). The question of Stell-
wiifg gS mMBnii of eyelids) and Graefe’s (loss of coordinated
tMftififci tf Upper eyelid and globe on looking down) signs

occurring independently of the usual train of symptoms of
Graves’ disease was discussed, Sad the following two cases in

P articular were related;—A .young lady, with Graefe’s and
tell wag’s symptoms in one eye (right); no other apparent
symptoms of exophthalmic goitre; greatly improved under
treatment. A miner, aged thirty-six (introduced), the sub¬
ject of miner’s nystagmus. In both eVes Stall wag’s and
Graefe’s signs Were present; no ■ exophthalmos,-. enlarged
thyroid, or other symptoms of Graves’ disease. The man
seemed to possess some control over the lid phenomena.
Among other points, the pathology was briefly touched
npon, and support given by the cases related to a central
disease theory (Sattler, Fitzgerald).

WIGAN MEDICAL SOCIETY.

Attendance of Medical Witnesses at Assize Courts .—A
special meeting of the Society was held on Jan. 27th,
Dr. Berry, J.P., President, in the chair, for the purpbSe of
considering the present procedure in binding over medical
witnesses to attend at assize and sessions courts, and the
inadequate fees paid fer the great loss of time involved.
After some discussion upon tbe hardships entailed upon
medioal men by being compelled to attend as witnesses
for a number of days at these courts, held in Liverpool, before
their particular case is disposed of, and attention having been
palled to the fact that the scale of fees (namely, one guinea per
day) was fixed thirty years ago by the then Lord Chancellor,
when that sum was of much more value than at present,
and there was not the same, facilities for the saying of
public time, the following resolutions were unanimously
adopted:—!. “That it is most desirable that some alte¬
ration be made in the present procedure of detaining
medical men as witnesses for a number of days at assize
and sessions courts, and that adequate remuneration be
.allowed them for the loss of their time.” 2. “That a sub¬
committee, comprising the president, vice-president, secre¬
tary, Messrs. Baxnish and Brady, be appointed to consult
counsel, and take the necessary steps towards calling the
attention of the Crown to this grievance.” 3. “That a
report of the proceedings of this meeting be sent to the
medical journals for publication.”

JLebitfos atth fjtotiaa of look

The Healing of Arteries after Ligature in Man and Animals.
By J; Coins Warren, M.D., Assistant Professor of
Surgery, Harvard University; Surgeon to. the Massa¬
chusetts General Hospital, &c. New York: William
Wood and Co. 1886.

There is probably no theme in Surgery which has com¬
manded a greater amount of interest and attention than the
arrest of arterial hremorrhage. The importance of the
process is its just claim to attention, and this is for us
greatly strengthened by the history of its gradual develop¬
ment, and the great names that are inseparably connected
with the chief steps in the advance of our knowledge and
in the improvement in our practice upon arteries. In spite
of all that has been done there are many points yet open to
discussion. It is still debated whether a ligature should be
flat or round, large or small, permanent or temporary, single
or double; and whether it should be applied tightly so as to
partially sever the vessel, or more loosely so as only to com¬
press it more or less firmly. For some years past Dr. Collis
Warren of Boston has been studying with much care the
minute processes occurring in the healing of ligatured
arteries, and he has embodied his results in a valuable
treatise. Dr. Warren has, of course, availed himself of the
aid afforded by direct experiment on animals, and the series
of vessels thus obtained, together with several human
arteries removed at varying times after ligature, have formed
materials from Which he has been able to trace the entire
process of healing. In removing the artery experimented
upon, he has been careful not to dissect it away from the

Digitized byVLiOOQfe

274 The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Feb. 6,1887.

body of lymph or “ callus ” in which it lay, but to remove
the mass entire. By examining sections of specimens thus
preserved the entire process can be followed far better than
when the vessel is dissected out and examined alone.

In many points Dr. Warren confirms the statements of
other observers, but several of his facts are so striking that
they are certain to excite fresh inquiry. The relative rules
of the internal coagulum of Petit and of the various coats
of the arteries have afforded much matter for discussion.
Dr. Warren attributes to the internal clot a very subsidiary
share in the cicatrisation of the vessel. Like others, he
finds that the size of this clot is much affected by efficient
antiseptic treatment; he does not believe that it plays any
active part in the closure of the vessels, but that it forms a
very suitable soil for the development of granulation tissue
sprouting into it from the neighbourhood of the ligature.
The part played by the tunica intima has been variously
estimated. Dr. Warren finds that both in animals and
in man the endothelium of an artery takes but a small
share in the work of cicatrisation. Iu some specimens it
was seen to be undergoing proliferation, and by this means
to affix the internal clot to the vessel wall; this may not be
seen at the seat of the ligature, but at the otber extremity
of the clot. The endothelium also proliferates to form a
lining for the vascular spaces in the arterial cicatrix; beyond
this it does not take any active share in the closure of the
vessel, if Dr. Warren’s experiments and statements are to be
relied on. The tunica media appears to play a very impor¬
tant part, for it is found that a main and essential part of
the cicatrix in an artery is composed of long oval cells with
rod-shaped nuclei, which are derived from the middle coat,
and are to be regarded as involuntary muscular-fibre cells.
These cells shoot into the organising tissue wherever the
elastic lamina of the intima is broken through, whether at
the seat of ligature or at some distance from it. Outside
this muscular layer of the cicatrix is a fibrous layer
by which it is continuous with the tunica adventitia
and the scar tissue in the sheath of the vessel. The
fully developed scar of a ligatured artery is therefore
seen to be formed of three distinct layers: an inner¬
most, derived from the intima, and consisting of endo¬
thelial cells with and without newly formed elastic
lamina; a thick central mass consisting of delicate mucous
tissue and capillaries, with muscle-fibre cells; and an
outer layer of dense fibrillated tissue. Among the many
interesting facts observed in this inquiry is the opening out
of the artery a short time after its ligature. At first the
inner and middle coats are severed and the outer coat is
strangled and the lumen of the vessel is completely
obliterated. This is quickly followed by the formation of j
a callus of exudation material around the vessel; the outer j
coat is then disintegrated at the seat of ligature; this
allows of its opening out and of its retraction, and through
the aperture thus formed granulation tissue sprouts into
the interior of the vessel from the surrounding callus.
This process is very clearly seen in several of the diagrams
which illustrate Dr. Warren’s book, and which have all the
appearances of faithful representations of facts. This growth
of granulation tissue invades the internal coagulum, and
within it blood spaces are formed which communicate with
the lumen of the vessel. The muscular-fibre cells sprout
out into the granulation tissue, and may sometimes be
specially traced around the anastomosing blood channels.
The time required for the formation of a complete cicatrix
in a large artery is at least from three to Bix months.
Dr. Warren has investigated the changes occurring in
arteries in stumps, and the processes leading to the
obliteration of the ductus arteriosus and the hypogastric
artery. In these he finds corroboration of the above facts.
Altogether this book is the record of a very valuable piece
Of work, and deserves to be carefully studied;

Translation. Edited by W. P. Turnbull. London
Simpkin, Marshall, and Co.; and the Midland Educations.
Company, Limited!.

This is a much-needed work, and one that should be ixi
the hands, not only of every surgeon, but of all those whc
have the care of children—schoolmasters and mistresses
and tutors of all grades and classes, from the heads of om
great public schools and colleges to the humblest National
school teachers. The work is founded on an article ixi
Eulenberg’s Real-Encyclopedie, but the author has added e
short and popular introductory chapter on the Anatomy oi
the Eye, as well as a few remarks on its physiology and
pathology. The chapter is of course correctly and simply
written, but a doubt may be expressed whether any ordinary
layman could, in the absence of special education and
dissection, follow the account of the eye and its defects
here given. Something, however, will be done if Prof. Cohn
can explode some antiquated notions which are very
generally accepted—as, for example, the erroneous idea that
a short-sighted eye is a good eye, and improves with age.
Prof. Cohn very properly maintains without hesitation that
a short-sighted eye is a diseased eye, and still more that
progressive short sight is in every case ominous of evil
for the future, so that not uofrequently at the age
of fifty or sixty, if not much earlier, the power of
sight, either from detachment of the retina, or from
htemorrhage, or, lastly, from atrophy and degeneration of
the yellow spot, is irrecoverably lost. All ophthalmic
surgeons will, ws are convinced, agree with Professor Cohn
in thinking that one of the main causes, if not the only
one, is the continual looking at near objects, especially with
insufficient illumination. The influence of this unfavourable
condition is of course greatly intensified by insufficient food
and other lowering causes. Professor Cohn is well known
to have been amongst the first to publish statistics in regard
to the development of myopia in schools; and his table of
results obtained from the examination of 10,060 children has
been often quoted. They show that in every school the
number of short-sighted children increases from class to class,
and that the average degree of myopia rises constantly from
the village schools to the gymnasia The eleventh chapter
is devoted to School Desks, and opens with a graphic account
by Fahmer of the position and movements of children under
ordinary circumstances in writing, and shows clearly the
effect of the form and height of the desk, and the poeition of
the slate or copy-book in producing “ round” or M skewed”
backs; and careful descriptions are given of the proper form,
height, slope, and back-rest of model school desks and school
seats, in regard to which many points are noted that wia
venture to say have never crossed the minds of nine-tenths
of the teachers in English schools. Prof. Cohn quotes wittaj
approval the remarks which have been drawn up by Prof;
Esmarch of Kiel, and distributed to parents whose children
were crooked. This report says: “ School children become
crooked and short-sighted by crooked sitting on bad school
forms. They sit crooked when the form is too far off the desk^
is too low for the desk, and has no back-rest.” The propel
form is then described, and it is noted that a readjustment o|
the seat and the desk should be made every six months to meej
the requirements of growing children. Another very imi
portant chapter is devoted to the Day-ligbting of school¬
rooms. How many schoolrooms in the country are dark an«
dingy, dirty in their interior, with small windows, with ba<
ventilation, and with the desks all placed in a faulty post
tion in regard to the little light that enters. Von Hoffmani
of Wiesbaden has recently made the excellent suggestion
that in every class-room Snellen’s test-types should hi
hung up, and lessons ended as soon as the day-light is ndl
strong enough to allow a healthy eye to read type No. 1

Dig t zed byU00gTe ]

The Lancet.]

REVIEWS.—THE MOXON MEMORIAL.

[Feb. 5,1887. 27 5

at a distance of six inches. The author expresses himself
in the strongest terms in regard to the amount of light
admitted into a school-room: “ There can never be too much
light in a school.” Javal says, “ The school must be flooded
with light, eo that the darkest place in the class may have
light enough on a dark day.” Prof. Cohn maintains thpt for
every square foot of floor there should be at least thirty
sqaare inches of glass. The light should be admitted from
the left of the scholars, and of course there should be
no high buildings in close proximity to the school to
intercept the light. The distance of the opposite buildings
should be twice their height. From natural illumination
the transition is easy to artificial illumination of schools.
The author prefers gas, then petroleum, then oil; the relative
illuminating power of these substances being—gas 100,
petroleum 87, oil 63. The work concludes with admirable
chapters on handwriting, drawing, print, and paper. We
have said enough to show that this is a valuable book,
and one that should be widely read. The present arrange¬
ments in the schools of England are simply disgraceful.
We have only praise to accord to Mr. Turnbull for his
very well executed translation.

Minutes of the General Medical Council, of its Executive
and Dental Committees, and of its Branch Councils,
for the Year 1886. ' With four Appendices. Vol. 23.
London: Spottiawoode and Co.

This volume has now been issued, and includes a full
report of the transactions of the Council and its committees,
together with four valuable appendices. The first contains
the Standing Orders of the General Council; the second,
Visitation Reports on the Universities of Oxford, Cambridge,
Darbam, London, Edinburgh, Glasgow, Aberdeen, St.
Andrews, Dublin, and the Royal University of Ireland. The
tLird and fourth appendices contain respectively the second
and third reports by the Statistical Committee of the General
Medical Council regarding medical students registered as
beginning the study of the profession in the quinquennium
1871-1875.

THE MOXON MEMORIAL.

A meeting of the friends of the late Dr. Walter Moxon
was held ia the Royal College of Physicians on the 1st inst.,
to consider the question of perpetuating his memory by
some suitable memorial. Sir William Jenner took the chair
at 5 o’clock, and was supported by the treasurer and registrar
(Sir Dyce Duckworth and Sir Henry Pitman). Letters were
received from Sir A. Clark, Sir J. Lister, and Dr. Wilson
Fox, expressing their regret at being ubable to attend.

Sir William Jbnnxb opened the proceedings by explain¬
ing, in a few remarks, that the object of the meeting was to
raise some visible sign which should be a lasting memorial
of one now passed away, who was honoured for his scientific
and professional work, esteemed for his zeal, and universally
respected for his high and unsullied character as a man.

Dr. Wilks moved the first resolution, as follows: “ That
ia the opinion of this meeting it is desirable to express, by
public memorial, the widespread appreciation which exists
of the high character and remarkable personal qualities of
the late Dr. Moxon, and especially of tbe services he rendered
in advancing medical science, and in otherwise promoting
the highest interests of the profession.” He said that as he
grew older lie was conscious of the ranks of the profession
growing thinner around, and it remained for the few to
hand down tbe names of thope who had gone before. It was
difficult for him to speak of Dr. Moxon, whom he had known
as a pupil; but all who had met him were ready to admit
thit Moxon was no ordinary man. He was a burning
and shining light that dazzled men by his brilliancy, so
that his companions often ceased to converse and preferred
tntlatsa. He threw a halo wound every subject he touched.
Succeed!eg the speaker in the chair of Pathology, he soon
mastered every detail in that science. Then passing to the

chair of Materia Medica, he at once threw a new interest
around a very unattractive subject. He was able to
strike sparks out of rhubarb and senna leaves. In
practice, he endeared himself both by his manner and
acumen, and in treating patients his wit was constantly
seen. Only the other day he heard of a story of a hypo¬
chondriac clergyman Who had consulted Moxon. When the
atient returned home his wife wanted to know what the
octor called his complaint. On this point the patient was
a little doubtful, so it was determined to send his son down
to inquire. When the son arrived Dr. Moxon said he could
not remember the particular case, but if the son chose to
look in his note-book he might there see for himself Moxdn’s
candid opinion. The son looked, and found “ a lanky parson
with nothing the matter.” The diagnosis was taken home
and cured the patient. Moxon took pains in everything he
did. At the College of Physicians his influence was soon
felt, and he made strong friends. How gratifying it was to
the friends and relatives to see the esteemed President at
hla grave, as a mark of respect to his memory, the speaker
well knew. T wo things they had to commemorato-s-Moxon’s
great genius and high scientific contributions to medicine,
and his great personal worth, his pure heart, upright
conduet, and general integrity. Many illustrious men died
without evoking this feeling.

Sir James Paget, in seconding the resolution, said that
Dr. Wilks had left little for him to say, who knew person¬
ally so much less of Dr. Moxon, for be had never seen
Dr. Moxon at his work at Guy’s Hospital; but this slighter
acquaintance made the impression he had formed or him
perhaps the more remarkable. He knew him only by
repute, by his work, and by occasionally meeting him at
societies or in consultation ; but it was impossible to know
him in that way without being impressed by his mental and
moral worth. His mind was of a kind which gave free play
to imagination, yet went on progressing towards the truth.
To him it seemed at first strange and difficult to understand
how this should be so, till be learnt that there was always
present a most perfect appreciation of facts. At a consulta-
| tion the beginning was illuminated, but tbe end was full of
the most practical decisions for the patient’s good. In
society the charm of his wit was most fascinating. In the
profession there never was a question but that what he
intended to do was always the best according to what he
conceived to be right. It was right that such good work
should be recorded, and that a memorial should be raised
which generations after would respect.

Dr. Pavy moved the second resolution, to the effect that
subscriptions should be invited, and that an influential sub¬
committee be appointed to decide on the most suitable form
of memorial. He spoke of the satisfaction it was to him to
pay respect to one ne had known as a pupil, colleague, and
Friend, and expressed a hope that part of tbe memorial fund
should be devoted to perpetuating Dr. Moxon’s memory at
Guy’s Hospital.

Sir Dycb Duckworth seconded the resolution, and said
that ho had known the late Dr. Moxon for twenty-five
years, and had often visited him when at work at Guy’s.
He had the highest appreciation of his character and work.
He thought the memorial might be divided between Guy’s
and the College of Physicians, and hoped that it would be
something worthy both of Dr. Moxon, of Guy’s, and of the
College.

Dr. Braxton Hicks and Mr. Sidney Turner proposed
that Mr. R. C. Lucas be treasurer, and Dr. G. N. Pitt and
Mr. W. A. Lane secretaries to the fund.

The Treasurer of Guy’s Hospilal proposed a vote of thanks
to the President for presiding, and to the Council for the use
of the College, which Mr. Durham seconded, and to which
Sir William Jbnnrr briefly replied.

Hunterian Society. —The annual meeting of tliis
Society will bo held on Wednesday, the 9th inst., at 8 p.m.,
when tbe oration will be delivered by Dr. Galabin in the
theatre of the London Institution, Finsbury-circus. The
following is. a list of office-bearers for the ensuing year:—
President: Dr. Gerviu. Vice-Presidents: Dr. Talbot King,
Mr. T. R.* Fendick, Mr. G. E. Herman, and Mr. G. J. B.
Stevens. Treasurer: Dr. Fotberby. Orator: Mr. Clement
Lucas. Secretaries: Dr. Charlewood Turner and Mr. John
Poland. Council: Messrs. T. E. Bowkett, F. M. Corner,
J. S. E. Cotman, G. B. Hicks, T. Mark flovell, W. Rivington,
u. G. Tatbam, C. J. Symonds; and Dre. E. G. Gilbert,
1*. Horrocks, Pye-Smitb, and Stephen Mackenzie.

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276 Tm? Lancet,]

THE UNIVERSITY OP LONDON.

[Feb. 5,1887.

THE LANCET.

LONDON: SATURDAY, FEBRUARY 5, 1887 .

We understand that the promoters of a Teaching Uni¬
versity in London are waiting on the Senate of the
University of London for an official answer to their
representations an the necessity for, and the functions
of, a real University in London. In all past discussions
on the threefold subject of the University of London in
relation to medical degrees, the formation of a Teaching
University in London, and degrees for average London
medical students, we have not had the advantage of any
definite statement from the authorities of the existing
University of the policy which they were inclined to pursue,
but have been obliged to be content with such side-lights as
the present Vice-Chancellor lias thrown thereon in his
speeches at the last presentation of degrees and honours
and at Manchester in November. Prom these speeches we
have learned that the “pass” degrees are considered by the
Senate to constitute “distinct honours,” and that every
successful candidate has an evidence “that he has passed
no ordinary standard.” We can now go a step further,
for we are practically informed, in an article in the
current number of the Quarterly Review, that the Univer-.
sity relies on its past history. For instance, in medicine
it is prominently put forward that "the University
has probably influenced the profession profoundly and
beneficially by confining its distinctions to the Hite of
medical students, and by setting up a high ideal of profes¬
sional qualification.” The author of the article writes as if
he were in full knowledge of the views of the Senate, and he
has perceptibly striven to justify its present position in—
we will not say a complete rum poteurmu, but in admit¬
ting only minor internal alterations in the character,
management, and functions of the University. He also
believes that it is in medicine that the University influence
has been most powerfully felt and conspicuously successful,
so that we must point out a few considerations on the other
side of the question. We shall more particularly refer to
the medical aspect of the question in our next issue, and
will now confine our remarks more especially to the general
question of degrees in all faculties.

The fundamental objection to the University of London
is in its title. As the author truly says, “ In the sense ih
which Oxford, Glasgow, or Bonn possesses a University—
an organised body of teachers confederated for the purpose
of attracting scholars, guidingtheir studies, and encouraging
learning by appropriate rewards—London still remains
without a local university worthy of its metropolitan
position, it8 population, and its intellectual repute.” The
chief reason for the continuance of this reproach in the nine¬
teenth century is the usurpation of the title “ University of
London” by a huge examining board in the metropolis of
the empire, From its existence and from its having the
power of conferring degrees Of Bachelor and Doctor (Land,),
the public has been induced to believe that a bod v which

has something to do with teaching as in other univer¬
sities, and with definite collegiate attachments, really
exists in this metropolis as in other centres of learning.
This delusion hast been strengthened and confirmed by
the requirement of certificates of attendance on systematic
lectures and hospital practice from medical graduates,
although in the other faculties all such restrictions have
long been cast aside. Its success as a medical univer¬
sity, even if this were to be admitted, only , the more
completely proves its failure in regard to the other, faculties.
Certificates of collegiate education are either valuable or
useless. But the University requires them in one faculty
tod will have nothing to do with them in the others. So
we are not any nearer noW to a real University than in 1615,
and we have to thank the University authorities for not
assisting in bringing us any nearer to the ideal placed
before us in t)ie Appendix to Stowe’s “Annales” of that
date.

The present University from its commencement has
thrown cold water on the amalgamation of London colleges
uid schools, and in 1858 deliberately affirmed that, except
in. medical training, a collegiate education was -unim¬
portant to it, and availed nothing. Therefore it is not to
be wondered at that the institutions which have since
replaced "the divinity schools at St. Paul’s, at West¬
minster, and at St. Feter’s in Comhill, the King's College
in Chelsea, the Inns of Court and of Chancery, Doctors’
Commons, the College of Physicians, St. Katherine’s Col¬
lege, the College of Heralds, and St. Paul’s School,” are
now no closer in affiliation and corporate union than were
these places of learning in 1615. King’s College and
University College, the Science and Art schools, the
Technical Institute of the City and Guilds of London, the
Medical Schools, the Colleges of Physicians and Surgeons,
the Incorporated Law Society, and the Inns of Court and
the large public schools of London are as isolated, so far
as the University of London is concerned, in this the jubilee
year of its existence as were the bodies above mentioned,
when a University of London only existed in the imagi¬
nation of a few worthy scholars and teachers. The only
reasons for this failure in duty on the part of the London
University are that this work was not ambitious enough
for its early promoters, and that it was pledged by
its Charter to encourage many persons who pursue a
“regular and liberal course of education both in the United
Kingdom and elsewhere.” Its first proof of encouraging
a regular and liberal course of education was to admit,
under pressure of Lord Brougham (teste p. 45), unworthy
certificates of studentship, and so, instead of rigorously
demanding sufficient proofs of regular courses of study,
it gradually drifted into the acceptance of more and more
loosely given certificates, until they became no guarantees
even of an honest, much less of a regular, curriculum
of study. It is impossible to believe that the then
Senate, had it been so minded, could not have overcome
this difficulty. From such a passive position towards the
affiliated colleges an open examination allowed a speedy
retreat, but even then the authorities shrank from the
logical carrying oat of their views, and insisted on certdft-
' cates from candidates in medicine being still forthcoming.
The medical schools were in quite as eager competition for
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Th a Laxcrt’] THE SURGICAL TREATMENT OP HYDATID TUMOURS OP THE LIVER. : [Phb. 6,188?. 27T

students as the affiliated schools and colleges in the Arts
Faculty.

The writer of the article above referred to fnost
clearly indicates that he has no sympathy with any
modifications which would change the cosmopolitan cha¬
racter (examining only) of the present institution into
a metropolitan institution, having relations exclusively
to London students, to London academical organisation,
and to London teachers, and whilst gravely suggesting
that the title of “ university ” now only means a “ ttudium
generate, a echola, a gymnasium, a corporate body and
buildings dedicated to the pursuit of the highet learning,”
still uses it throughout in its older sense as perfectly
applicable to the Imperial Examining Board in Burlington-
gardens. What has this body to do with the pursuit of the
higher learning? We should say, less than many of our
first-grade schools, medical and scientific colleges, and yet
the most perfect satisfaction is expressed with things as they
are, and the whole article is as optimistic as even an
official explanation could be expected to be. We have
thought it expedient to comment on this past history in
order that our readers may be fully aware that since 1858
the University of .London has deliberately placed itself in
the anomalous position of being only an “ examining board”
for the empire, and that as a result of such action it is only
right and proper in the interests of local London that a
true University should, if possible, be founded.

Ti ir discussion which was raised at the Medical and
Chirurgical Society on Tuesday week by Mr. Bahwki.l
dealt with a matter of considerable surgical interest—the
best method of dealing with hydatid tumours of the liver.
The opinions elicited showed that the line of practice is not
settled, and it may be well to consider some of the points
involved.

One point to which only scant reference was made in the
discussion, but which has important surgical bearings, is the
great diversity met with in hydatid tumours of the liver.
They may be single or multiple, superficial or deep, barren
or fruitful; and if multiple, they may be closely grouped
together or distinctly separated. These differences have
great practical importance. A single superficial cyst may
be readily dealt with by simple means, such as tapping.
When a number of cysts are present, they may be so grouped
together that when the most superficial are opened the others
may be opened from their interior; but, on the other hand,
they may be so situated that this is impossible, and a deeply
seated inaccessible cyst may thus set up mischief, and cause
the death of the patient, as in a case alluded to by Mr. War¬
rington IIaward, Fortunately these complicated cases are
not common; in the majority of instances the tumours are
favourably placed for operative interference. The simplest
surgical means is tapping the tumour and removing some
or all of its fluid contents. But it was pointed out at the
meeting that this operation, simple and apparently safe as
it is, is not absolutely tree from danger, for sudden death
has more than once occurred, which in one case at least was
found to be due to the entrance of a small cyst into a
hepatic vein, through which it passed to the heart. There
is, further, the possibility of the leaking of some of the
contents into the peritoneal cavity, and a fact incidentally

, mentioned by Mr. P*a&ch Goth,© is of interest from this
j point of view. 1 He stated that while operating upon a case
! of very large suppurating hydatid, a quantity of omentnmf
was suddenly forced out of the Wound, and it was seen to
be thickly studded with abortedhydatid Cytfta. This patient
had been previously tapped on two occasions, and the
question naturally arisen whether the condition of the
omentum was caused by an escape of hydatids from the
parent cyst. On the other hand, howeVbr, it must be borne
in mind that these accidents have occurred in a osty small
minority of caeeB, that tapping has frequently wrought a
cure, and that sometimes it is used for diagnostic as well
as for therapeutic purposes. If tapping is employed, bow
much fluid should be removed? Should the sac be emptied,
or should only a email proportion of the fluid be with¬
drawn? On this point two opposite opinions are held 1 , arid
clear and definite views are needed. The question turns
upon the modus operandi of the Operation. U it that it
causes the ectocyst to collapse away from the adventitious
capsule, or is it that the withdrawal of fluid kills the
hydatid and prevents the re-secretion of the fluid ? Curiously
different results of tapping are obtained. In some cas^s the
cyst that has been emptied collapses altogether, and never
refills; in other cases it refills with, hydatid' fluid indis¬
tinguishable from that obtained at first; in others, again, the
fluid becomes increasingly albuminous after each tapping;
in yet others the cyst suppurates. Surely we need more
light on this question. We believe that some physicians
think that where the nature of the tumour is obvious, ft is
better at once to proceed to a more radical mode of - dealing
with it than to trust to tapping, and they base this opinion'
upon the fact that the cases which are oapable of core by
tapping cannot be recognised with certainty beforehand, 1
but that they are* just those in which a free incision and
drainage is easiest and safest—so safe, indeed,' as net to
expose the patient to any appreciable risk. They Would
state the matter somewhat thus: Tapping is dangerous'josh
in those cases in which incision and drainage ore necessary
for the cure; incision and drainage are free from danger in
those cases in which tapping succeeds; therefore, to incise
and drain all cases at once, in place of trying the effects of
tapping first, is not to expose the patients to any addi¬
tional risk, but to preserve them from the special risk/
Occasionally attending tapping. Without asserting that
this is the correct line of reasoning and practice, we must
admit that there is reason in the view, although the
perfectly just conservatism of surgeons will probably
dispose them still to resort to tapping in apparently
suitable cases.

The particular point, however, which Mr. Barwrix dealt
with in his paper was the best mode of executing the
operation of incision and drainage in superficial accessible
cysts. He advocates an application to this case of a
well-known surgical manoeuvre—operation in two stages -
which has had brilliant results in gastrostomy, and has
been applied to the operation of enterostomy also. The
object aimed at is a laudable one—the exclusion of the
contents of the cyst from the peritoneal cavity; but the
argument was' defective in two essential points. Mt.
Barwkll did not show that this escape of contents has
been a serious sequela of the operation as more usually per*

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2 78 The Lanobt,]

METROPOLITAN WATER-SUPPLIES.

[Pub. 6,1887.

formed, nor did he show that other means which have been
adopted have failed to prevent it» We by no means assert
the impossibility of supplying these gaps, but their exist¬
ence is very evident as the case at present stands. Other
means have been employed to attain the adhesion of the
cyst to the abdominal wall before incising it, such as the
introduction of acupressure pins, the use of caustics, and
staffing the wound made through the abdominal parietes
with lint or gauze. Of all methods, we should certainly give
the preference to Mr. Babwell’s suture; it is less painful
and more precise than any other; but it is doubtful whether
the disadvantage of dividing the operation into two stages
is not too heavy a price to pay for the supposed advantages.
After the cyst has been freely opened, we have little doubt
that the wisest plan is to allow the contents to escape com¬
pletely, except the mother ectocyst; and not only so, but, os
far as possible, the wall of the cyst should be explored for
any bulging swellings formed by neighbouring cysts: all such
swellings should be tapped and drained through the first.
The vessels in the adventitious cyst wall are large and
varicose, and the separation of the ectocyst may be fol¬
lowed by seriouB haemorrhage. The question of irriga¬
tion is one of less moment; where the cyst has sup¬
purated it is probably wiser to at once remove all the pus
by irrigation.

One other point worth mentioning incidentally turned
up in the discussion. Mr. Hawabd mentioned a case
in which an unopened suppurating cyst caused the death
of the patient, setting up fever and albuminoid degene¬
ration of viscera. Mr. Pkabce Gould mentioned a
case of a large suppurating cyst which was unattended by
any fever, and gave no sign of the purulent nature of its
contents. There must be some explanation of the opposite
results of an apparently similar condition. Is it that in one
case the pus had wandered out of the cyst proper into the
pleura or some other tissue, while in the other it was
securely lodged within the parasite ? But this is only one
of many very interesting problems suggested by hydatid
disease, the chief and most unexplained of all being the mode
in which the parasite gains entrance to the human body.

The President of the Local Government Board has filled the
vacancy created by the death of Sir Francis Bolton, and
has appointed an engineer to occupy this important office.
It is convenient therefore at this moment to review the
safeguards which London possesses against injury from
so fertile a source of disease as contamination of water-
supplies. Under the Metropolis Water Act of 1852, Section 4,
every water company is required to “effectually filter all
water supplied by them within the metropolis for domestic
U9e before the same shall pass into the pipes for its
distribution, excepting any water which may bo pumped
from wells into a covered reservoir or aqueduct, without
exposure to the atmosphere, and which shall not be after¬
wards mixed with unfiltered water.” In order to ensure '
the enforcement of this provision, the Metropolis Water
Act of 1871 requires that “ there shall be a water examiner,
being a competent and impartial person from time to time
appointed by the Local Government Board, who shall from
time to time, in such manner as the Local Government Board
direct,examine the water supplied by any company in order to

ascertain whether or not the company have complied with
the requirements of Section 4 of the Metropolis Water Act,
1852, and shall from time to time report the results of his
several examinations to the Local Government Board ; and
that Board shall send a copy of every such report to the
company to which the same relates; and the company may,
if they think fit, on each occasion of such examination, be
represented thereat by some officer, but such officer shall not
interfere in the examination.” The metropolis is therefore
largely dependent upon filtration and chemical analysis
for its preservation against water-carried diseases. Dr.
Buchanan, in his Annual Report for 1881, summed up the
position of chemical analysis as a safeguard against injury
to health by stating that the chemist can tell us of im¬
purity and hazard, but not of purity and safety, and
this conclusion will undoubtedly be supported by those
who are aware of the minute quantity of specific matter
which is competent to produce injury to man. The evi¬
dence of mischief is, indeed, less readily found by the chemist
than by the health officer, whose duty it is to discover
the cause of outbreaks of sickness amongst those who
are resident in his district. In London the machinery
which would bring such illness to light is of so unsatis¬
factory a character that no substantial reliance can be
placed upon it. The absence of any system of registration
of disease is itself a noteworthy disadvantage; the division
of London into some thirty-nine districts is again a serious
obstacle to the investigation of any diseases which might
be produced by the contamination of water-supplies. 11 is
for this reason that wo had hoped that the late Sir Fbaxoi.h
Bolton’s office might be filled by the appointment of a
medical man competent to perform such duties as we have
indicated.

We are fully cognisant of the importance of engineer¬
ing and chemical skill being brought to bear upon
the control of water-supplies, but these touch but one
side of the question, and nothing short of the exercise of
watchfulness over the health of water consumers can give
any guarantee of safety to those who in these matters arc
practically powerless to help themselves. The legislation
of 1852 and 1871 could not have regard to this con¬
sideration; medical knowledge has grown since those
times, and would itself bo largely developed by con¬
tinuous investigation into the effects upon health of
water under different conditions. It has been too readily
assumed that sewage when introduced into running water
becomes oxydised in its passage down stream; doubtless
there is much dilution of the impurity by the addition of
other water, but it is difficult to say at what point below
the intake of impurity the water regains its whole¬
someness.

The drinkers of water supplied by the Thames have much
ground for anxiety at the present time; the published
reports of Sir Francis Bolton raise serious question as
to the propriety of continuing those supplies which are
derived from the Thames at a suspicious proximity to the
localities of the discharge of sewage. Certainly, no health
officer would be willing to accept as a sufficient basis for
confidence the fact that water lias been filtered, or that
chemical analysis fails to detect impurity. The issues
involved are of vital importance to Londoners, and cer-

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Thb Lancet,]

SHORTER HOURS IN THE HOUSE OF COMMONS.

[Feb. 5,1887. 2 79

tainly those who can exercise control in this matter
ought not to leave the metropolis unprotected.

Among the proposals for reform in regard to the rules of
procedure and customs of business in the lower House of
Parliament, is one which must elicit the sympathy of the
medical profession without respect to the party feeling or
political principles of its members. We refer to the contem¬
plated new rule that, “ unless previously adjourned," the
House shall “ sit till half-past twelve of the clock at night,
when the Speaker shall adjourn the House without question
put.” The phraseology in which this proposal is embodied
is not remarkable either for English or elegance, but the
idea is an excellent one. Half an hour after midnight is
surely late enough for the making of laws. If we may not
fall back on the old adage that “ it is time for all good people
to be in bed,” it is an hour at which those who are engaged
in work supposed to require fairly clear and energetic
brain-functioning may, without any fear of being thought
idle, avow themselves weary, and seek reliefand recupera¬
tion in repose, flow very heavy is the fine imposed by
Nature upon the class of public men who not merely turn
night into day, but burn the candle at both ends by rising
early and late taking rest, is too well known to those upon
whom devolves the task of combating the advances of mind
and body weakness and of fighting off death on behalf of the
victims of this inexplicably mistaken policy. In the old days
when the House first formed the evil habit which has come
to be one of its cherished usages, early rising was not a prac¬
tice to which the class of society from which members of
Parliament were then commonly taken was much addicted.
The legislators of the last century, and the early part of this,
acted very much on the prudential principle enunciated by
the late Lord Bybon and did not get up until the sun had
warmed the world. We have changed all this, but with
wondrous awkwardness and fatuity. We rise betimes, but
do not go to bed any—or only a very little—earlier than did
our great-grandfathers. This is bad enough when the mus¬
cular and general systems only are worked excessively, and
the brain is practically allowed to lie fallow, as in the case of
the man about town; but it is incomparably worse when the
particular organ which most needs rest in sleep, and can
only get it therein, is worked at the time when it ought to be
slumbering.

It has been repeatedly urged that the work done by
jaded law-makers at two or three o’clock in the morning
connot but be less than the best of which the same
minds are physically or intellectually capable. This appeal
to the self-critical consciousness of our legislators in the
first instance, and to the public, their constituents, in the
second place, ought to be regarded as forcible; but, as a
matter of history, it has not proved in a practical sense
effective. The argumentian ad hominem may, perhaps, have
greater success. Let it, then, be distinctly understood that
recent Parliaments have shown a very serious percentage of
brain-mortality—or, which is much worse, mind-ruin—as
the result of late sittings which have to be endured after bcdy
and brain have been already wearied, if not exhausted, by
a fair day’s work in a Government office, in court, or with
some tiresome occupation, it may be thought that such toil
as members of the House of Commons have to face is not in

itself very exhausting. That is a misconception, and it may
readily be accounted for, because no one who has not per¬
sonally experienced the weariness of habitually sitting out
long debates can ever guess how the strength of body
and mind is tried by the process. The time has passed,
perhaps for ever, when the business of legislation in the
Lower House was mostly left to the enterprise of
younger sons of noble families and squires—in short, to
njen who could afford to be idle except in Parliament.
The Commons of to-day are for the most part busy men,
wholly apart from politics; and it is, therefore, more than
ever desirable—we would say necessary—that a reasonable
limit shall be put on the duration of sittings of the House.
The Lords do not indulge in late hours, and seldom sit after
dinner, except when questions of great moment or urgency
are engaging their attention. It is with the Lower House
we are chiefly concerned in connexion with the subject of
“ overwork,” and we sincerely hope the very late hour
(12.30 p.m.) selected by the promoters of this reform may be
accepted as the limit at which measures for the enforce¬
ment of rest become publicly and personally indispensable.

i-intofatums.

“ Ns Quid nlmU."

THE MEETING OF THE ASSOCIATION OF GENERAL
PRACTITIONERS.

At the meeting lately convened by the Council of the
Association of General Practitioners debated questions
with which the profession is now familiar were once more
considered, and the resolutions passed respecting these may,
alike in tone and matter, stand as guiding precedents in
future discussions of the same character. The advantage
of instituting a degree obtainable by London students on
terms more reasonable than those required by the University
of London was well brought out in a speech by Mr. Wheel-
house, the chairman on this oocasion. Another question of
considerable moment was not forgotten. In supporting the
claims of the Apothecaries’ Society, Mr. Wheelhouse and
Mr. Wickham Barnes advocated no greater concession than
the conjoint Colleges might conveniently grant, or, indeed,
than it is incumbent upon them in respect to the expresed
wish of the great body of their constituents to allow. The
sendees rendered to the medical profession by the Society
in the past call for some return, while to ignore its claims
and the recognition afforded them by the last Medical Act can
only tend to weaken the influence of the yet unborn conjoiut
qualification, which embodies the fairest promise which we
now have of a common adequate professional status for
London-trained practitioners in the future. The importance
of the motion which was entrusted to Dr. Danford Thomas
must be generally acknowledged. In asking for a repre¬
sentative voice in the government of the College of
Surgeons the Members are seeking no more than their
due, and it would be a graceful no less than a politic
act on the part of the College of Physicians to afford
recognition in a similar way to their Members and
Licentiates. Personal representation as the counterpart
of personal duty is the most characteristic feature of
our national life. It is a principle than which none ean
be fairer. It is native and inevitable to every constitu¬
tion composed of intelligent men, and, whatever its pos¬
sible disadvantages, its history in the past has been marked
by progress and prosperity. If the Councils of the Colleges
have misgivings lest a deterioration of their professional

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280 Thb Lancet,] DEATH FROM CHRONIC LEAD POISONING. {Pro. 5,1887.

spirit, or their qualifications might follow the application of
this principle In their own case, we would bid them take
confidence. Among their less prominent alumni are many
men well able to appreciate the value of a high standard of
professional education and practice, and it is not likely that
their number will diminish. The Privy Council, it is satis¬
factory to learn, has interested itself in these proceedings.
It engages to weigh the opinions of the Members, and we
presume of the Licentiates also, before it ratifies any material
Change in the Charters of the Colleges. If, however, it
should happen that ordinary measures fail to attain the
desired object, the Practitioners’ Association proposes to
avail itself «f othpr and mqre effectual help. The motion by
Dr, Brierleyasks for the appointment of a Royal Commission
to inquire into the subject, and unless a request so reason¬
able can be turned aside by party influence, it is difficult to
see how the claim for representation can fail to be conceded.

alterations in the examinations at the..

UNIVERSITY OF LONDON.

’ Wfl are pleased to see, in the interest of the candidates,
that the number of hours at the Matriculation Examination
will be reduced from twenty-eight to twenty-five. They
will now only be required to-show a competent knowledge
of one instead of two languages—vis., Greek, French,
German, Sanskrit, or Arabic, in addition to Latin, and
English language and English history, with the geography
relating thereto. Mathematics; mechanics; and one branch
ot experimental science—viz^ chemistry, or heat and light,
or magnetism and electricity—are the science subjects care¬
fully laid down to 'balance the classics. Experience has
apparently proved to the authorities that chemistry can be
taught at only few schools, and we venture to say that the
Otlter 'branches of experimental science will not be better
taught. Moreover, if -science has to be taught.to school¬
boys, why might not some choose one of the various
branches of biology, which we^ at any rate, believe to be
taore interesting and important? The only answer is
that, however much boys may-wish to prosecute such
studies, teachers are wanting. But adequate teaching
and instruments for -experimental science exist in but
few large schools and in the science college*, and the
preparation of the rest is pure cram. By'cram we mean
laying stress on a normbe* of isolated facts without insisting
on a knowledge of the principles which underlie them, or
of the instruments by which they are demonstrated to
exist.- If the University Of London were to insist' mi a
sound knowledge of any one branch of learning—classics,
mathematics, English, or an experimental science,—some
advantage to real learning might result; Now it presents to
the candidate merely an olla podrida, and cannot ‘make up
ite mind whether its matriculation examination is the
terminate a quo for its degrees, or the terminus ad quern , when
the learning of the pupil is to oometo a stop.

• A practical examination with patients will be held in the
Examination in Surgery at the M,B. Pass Examination. The
recent visitation by the General Medical Council has led to
the removal of one blot whieh was most forcibly insisted
on by the official visiterd. “There was no Clinical Exami¬
nation;'no-operations were required on the dead subjects;
no testing as to- bandaging was employed; no recognition
was requited of surgical instruments or apparatus.” Such
shortcomings are simply and solely the. outcome of the
University regulations, and for them the examiners are by
no means responsible. We think that other alterations on
the lines suggested, by the Visitors will have to be carried
out, for the M.B. Lond. is a registrable qualification, and
this must always include a sufficient examination in surgery
4s well as in medicine knd midwifery,- and aa there are

still a few Btudents who do not present themselves to the
corporations for examination, but are registered merely on
their University degrees. __

„ DEATH FROM CHRONIC LEAD POISONING

An inquest was held recently at Islington touching the
death of a woman aged about thirty-eight. Deceased had
worked for many years at a white lead manufactory, and
had from time to time suffered from “ a touch of the lead,’
or in other words had had “painter’s eolic.” Sheis reported
also to have indulged in alcohol, although the post-mortem
examination failed to furnish evidence in support of the
assertion. For some time before her death there had been
weakness of the extensor muscles, yet this could not have
been greatly developed, seeing that deceased had continued
her occupation until within about ten days of her death.
On the last occasion of leaving her employment she showed,
in addition to her previous symptoms, signs of cerebral dis¬
turbance. As the latter became alarming she Was removed
from her home to the workhouse, where upon her admission
she was found to be delirious. The delirium passed into
insensibility, and this into death. She had no saturnine
convulsions. At the necropsy the gums were seen to be
bordered by a deep blue line, more deeply coloured on the
dental than on the labial surface. The muscular coat of
the intestines was greatly hypertrophied, though the bowel
was not at all contracted. The colon was filled with solid
faeces. The liver, spleen, kidneys, heart, and lungs were
fairly healthy. The dura mater and arachnoid appeared
normal. The meshes of the pia mater were filled with
cloudy serosity, but there was no coagulated plasma, and
none of that sulphur-like layer found in pronounced
meningitis. The oerebral veins were full, but presented no
evidence of ante-mortem blocking. In short, there was no
intra- cranial disorder other than is found incases of cerebral
irritation from many other causes .than lead-poisoning;
nor, indeed, could the condition be better described than as
what is commonly called “ serous apoplexy.” It is instruc¬
tive to note that there had been no known disturbance of
brain function attributable to deceased’s occupation ante¬
cedent-to her fatal illness. The surgeon engaged to attend
the factory hands stated that 95 per cent, of the operatives
had the blue line, and a man who gave evidence at the
inquest, and who had only worked in lead for about three
months over a period of three years, showed a decided dis¬
colouration of the gums. There was ample testimony to
show that every precaution had been takes by the employers
to protect their workpeople, both as regards legal imposition
and voluntary action. We understand that tliere is the
greatest difficulty to compel the operatives to habitually
avail themselves of preventive treatment; but even allowing
for this, we cannot help thinking that “ white lead ” making
is still a dangerous occupation, and one alike calling for
scientific aid and legislative enactment requiring regular
medical inspection. The mere weekly attendance of a
medical man is delusive in its supposed benefit to the
workers in lead, for the existence of the blue line is not
considered of sufficient moment to discharge operatives, and
obviously inany of them will rather conceal any Blight sub¬
jective symptoms than run the risk of being invalided and
so lose their source of income. We cannot subscribe to the
opinion giyen by the medical man to the firm “ that the
blue line was not evidence of constitutional affection.” It
is true it may not be accompanied by other manifest signB or
symptoms, but, for all that, it proves that the metal has been
absorbed into the circulation, and that thus it may be slowly
and silently working irretrievable mischief in the tissues—
mischief-which at any time may show itself in colic, palsy, or
even in fatal activity in the brain. An analysis of portions
of the liver, made by Mr. A, 1* Luff, showed traces of lead.

rifftiiafewr,]

TEH ELECTION AT ST. BARTHOLOMEW’S.

[Fbb. 6,1887. 281’

ZSh ?" tfa 6 mwca^;society.; s [ ,; u .

ft^lditeM given by the hew President) to titer-Clinical
Cti * % on Mb taking the chair for. the first tune, was, as
Mtitaatidteraoeare likely to be, eminently characteristic.:
liM^Hwa showed a good many traits of Dr.-fitoadbent’a
■Ml Mt it Showed nose better than this—hia appreciation
»f» *& interest in, all tier branches of the great tree of !
metfidne. He is not one of those who cry. ‘(Diagnosis. !
diagnosis, diagnosis,” and then neglect the treatment. |
Neither does be'sympathise with- the anatomical to the
of' the clinical» or experimental .pathologist. I
'^TtlV true practical physician, he believes that- all the
fca nfjttfl ge of a medical raanshould be utilised' to the full
for Ifcoibenefit of the patient. His remarks on. reducing
Urn gpaperature by special antipyretic drugs struck us as
PMlfsglfflJ philosophical and practical. Who knows,
iudnwi.what other actions antipyretics may possess? The
othfOr Stations may be deleterious, innocuous, or harmless.
ItiHMnpting, but Useless, to speculate, as to the probable
t-fleflbni .antipyrin on other titan thermogenetic functions.
WAtjsguire more actual knowledge of Che action <of these
dngRrPB the nervous centres and heart. The value of
PM***’ addressee consists in their, being historical, as
vaifeMl ornamental, useful,.and introductory. The medical
kfatfBfexi of the future will find in these addresses a repre-
ii itigtlun of the feeliugasmd thoughts of eminent physicians
tademgeons; he will also find in them indications of the
myinrilfiiin of the times at whioh they were delivered, and
ot special tendencies of knowledge. ■ • ■ r
.U** - ■ - --- '

! 3^|| ELECTION AT 8*. BABTHPLOMeW’S.

li|* vacancy in the staff of St. Bartholomew’s Hospital,
ofliilby the resignation of Dr. Wickham Legg, is likely to
prai^ba occaskm cd a severe ceotest. From the list which
we4q*mi4 below it will be seeh that the number of can-
dkfai*as exceptionally large, for. the system that prevails
UtMM»«P>tal of encouraging junior members to hold the
temgMvy *taff . appointment of “casualty physician’’
aaatftftfly lays, open the office of assistant-physician
to .ttjaCcitiderable number of claimants. Many of the
eaaflSbtes, too, are well known fdr their scientific
■tfafiMNWsts and, important contributions to medicine. Dr.
SeafMl .West, Who has. been medical registrar to the
IxMhjlft' far several years, and medical tutor in the
sebij^bas very great claims, which we should like to see
dal*h**cfarledged. Amongst the many earnest and able
raft* in the ranks of young physicians, few have done so
moqfj^Btil in clinical and pathological research as Dr.

E nother candidate, is also favourably
itions to pathology, especially in
Ormerod is equally wall known as
neurological science. Dr, Vincent
rk as a physiologist. Besides these
hers named more or less .known
their school, and the governors
■ulty in making a judicious selec-
tioally protest against the reten-
f the ancient method of election
ovemora. It involves great hard-
j*and.places them in ^humiliating
> means follows that the candidate
1 be elected. Surely it is time-that
i altered, and the election placed by
uod# of tt select committee, which
’ Atombers of the medical staff, who
AgA'ceWSct opinion of the merits of
nOfahdbpted at many hospitals, and
KHM done Away with the degrading
oF a learned profession |

have to stoop to solicit the votes of individuals who have
no interest in or knowledge of what constitutes the real claim
to a position on a hospital staff. Another suggestion has
been made Which is worthy of consideration—viz., that the
staff- on the medieal side of St. Bartholomew’s Hospital
should be increased by the addition of a physician and an
assietant-physiciail. There is ample room for such enlarge¬
ment, and it would harmonise with the number of members on’
the surgical Stiff. If carried into effect, such a change would
create two more medical vacancies, and there would be no
difficulty in filling them from among the following names of
gentlemen who are candidates for the post of Assistant-Phy¬
sician, now vacant:—Oswald A. Browne, M.A., M.B. Cantab.,
M.R.O.P. Lond; Arthur Temple Davies, B.A., M.B. Cantab.,
M.R.C.P.; Archibald Edward Garrod, M.A.,' M.B. Oxon.,
M.R.C.P. Lond.; Samuel Herbert Habershon, M.A., M.B/
Cantab., M.R.C.P. Lond.; Vincent D. Harris, M.D. Lond.,
F.R.C.P. Lond.; Wilmot Parker Herringham, B.A., M.B. :
Oxon., M.R.C.P. Lond.; Henry Lewis Jones, M.A., M.B.
Cantab., M.R.C.P. Lond.; Percy Kidd, M.A., M.D. Oxon.,
F.R.C.P. Lond.; Joseph Arderne Ormerod, M.A., M.D. Oxon.,
F.R.C.P. Lond.; William. Edward Steavenson, M.D. Cantab.,
M.R.C.P. Lond.; Howard Henry Tooth, M.A., M.D. Cantab.,
M.R.C.P. Lond.; Samuel West, M.A., M.D. Oxon., F.R.C.P.
Lond. _

DIPHTHERIA AT EALINQ.

A sebious outbreak of diphtheria has occurred at Ealing
The disease appeared at the close of the week ending
January 22nd, and - continued to increase until Thursday,
January 27th, when fresh cases ceased to occur. In all up
to the time named twenty-tliree cases were discovered, and
three cases terminated fatally, one of them in the person of
Mr. Charles James Fox Ken worthy, of Kerrison Lodge,
The Park, Ealing, a gentleman thirty-four years of age, and
very much esteemed. One of the remarkable features of the
outbreak was that not a single instance of an attack was
met with amongst the poorer classes—a fact which pre¬
supposes that neither water-supply nor drainage is account¬
able for the outbreak. The idea that milk is the source of
the contagion seems pretty goneral, and Dr. Corfield has, we
understand, been called in to inquire into the matter. He
is reported tO have inspected the principal dairy farm at
Ealing in company with the medical officer of health, and
after inspecting the ninety-six head of cattle on - the farm,
together with the cisterns, the drainage, and the. sheds, has
come to the conclusion that everything is unexceptionably
good. The suggestion, therefore, is that if milk be the cause'
of the evil, it has been imported into the locality—a sugges¬
tion the more probable because such importation is rather
extensively carried on. The whole subject is still under
investigation, and as the elements of the problem are nar¬
rowed down to a few we should hope the solution of the
mystery will be definitely eolved.

UNIVERSITY OF EDINBURGH.

Ws have hitherto studiously declined to enter into the
painful details of the scandal now agitating the: University
of Edinburgh and, through- it, the public. Everyone must
regret to see a man in the position of Professor Rutherford
bringing charges of a gross character against his assistant,
and having to acknowledge them groundless and to retract
them. We have no right to speak judicially, even if We had
the means of investigating all the facts of the case; but we
are all interested in the welfare and the fame and reputation
of the University of Edinburgh; and we think it not only
a discredit, but a misfortune, that no notice has besn
taken of this matter in its earlier stages by either
the Benatus or the University Court. The Senatus fa aa
exclusively professorial body. And it is a fault of the

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282 The Lancet,]

AVIAN TUBERCULOSIS.—THE SHOP HOURS BILL.

[Feb. 5,1887.

University that all arrangements seem to regard too ex¬
clusively the interest of the professors. Scarcely from
such a body oould effective intervention have been
expected. But the University Court is mare responsible. It
has powers of censure. In it the public, the graduates, the
students, as well as the professors, are represented. And yet
it has allowed this matter to grow to a height that is
damaging to the reputation of the University and of the
professor more immediately affected, to say nothing of his
assistant. We shall want fresh guarantees in the new legisla¬
tion for the Scotch universities against the recurrence of
such scandals as this, and in favour of those assistants whose
work is only second in importance to that of the professors,
but whose emoluments are so small and so liable to discon¬
tinuance with the cessation of dignified relations with the
professor. Even now, and with its present powers, the
University Court ought to intervene, and it would satisfy
the public that the University of Edinburgh is a school
where scandal may not be raised with impunity.

AVIAN TUBERCULOSIS.

The October number of the Journal of Comparative
Medicine and Surgery (Philadelphia) contains an interesting
article upon Avian Tuberculosis by Mr. Bland Sutton. The
bibliography of this subject is comparatively small, and Mr.
Sutton’s contribution is therefore all the more welcome. The
disease affects mainly, if not entirely, graminivorous birds,
and its occurrence in birds of prey may often be attributed to
tbeir feeding on tubercular smaller birds. As an illustration
of this in another class of animals Mr. Sutton cites the case of a
python which died with tuberculosis of the liver, having been
fed on fowls, pigeons, and ducks, " which are exceptionally
liable to tuberculosis.” The marked characteristic of avian
tuberculosis is the selection of the alimentary canal and
associated organs for the seat of the disease. Large
nodular masses form in the intestinal walls, and may
give rise to actual obstruction, or eventuate in perito¬
nitis. The lymphatic vessels in connexion with the
bowel are often dilated and plugged with caseous material;
whilst the liver and spleen show abundance of miliary
deposits, resembling in their early stages those produced by
such parasites as gregarinid®. The portal circulation in birds
is peculiarly suitable for the secondary infection of liver
and spleen. Microscopically, the tubercular nodules consist
in early stages of a central focus of round and giant cells,
with bacilli in and around the cells; in older nodules the
caseous centre is surrounded by an epithelioid zone, and that
by a “ bacilliferous zone” in which large giant cells occur,
and that finally by a zone of inflammatory cells. The bacilli,
which are perfectly homologous with the bacillus tuberculosis
of Koch, occur in vast numbers; and careful observation
shows that in the liver they are arranged in masses corre¬
sponding with minute vessels, whose lumina they completely
plug. Mr. Sutton finds here an illustration of “amoebic
warfare,” to which attention was first drawn by Metschni-
koff, and subsequently by Mr. Sutton himself in his lectures
at the College of Surgeons. The bacilli gaining entrance by
the food invade the walls of the intestine, and thence enter
bloodvessels, where they encounter leuoocytes, which by
fusion constitute “ giant cells,” and take up numbers of the
bacilli. He compares the tubercular nodule to a battle¬
field, the older masses containing most giant cells and indi¬
cating the traces of the past struggle in the caseous debris
of dead cells and the extending zones of contending cells
and bacilli. The disease is probably propagated by con¬
tamination of grain with the excreta of affected birds; yet
hitherto attempts to detect bacilli in the excreta have
failed. Mr. Sutton, however, adduces collateral evidence in
support of this, and gives some striking facts upon the
propagation of disease among parrots and other birds from

neglect and overcrowding. In conclusion, he points out
that the high body-temperature of birds doubtless favours
the luxuriant growth of bacilli within their tissues, and
suggests the possibility that the tubercular baoillus may
have been evolved from some harmless form, “ and that its
peculiar character of thriving best at a temperature equal at
least to that of the human body was first acquired by being
transplanted to a medium, the chief constituents being
animal excreta.” _

THE SHOP HOURS BILL.

The Shop Hours Act, 1886, came into operation at the
beginning of the present year. The limitation expressed in
this measure, though it does not err on the side of stringency,
has achieved a definite good. Something has been done to
restrict the almost incessant work which from week to
week was telling with unquestionably serious effect against
the health of many young men and women. It cannot be
said that the allotted period, seventy-four hours per week,
is unduly Bhort. It might, we imagine, be still farther
curtailed in the case of a good many shops without serious
injury to trade. We do not pretend that shop labour is at
all times arduous. Both as regards muscular and mental
activity it is often, no doubt, sufficiently exacting; but,
apart from such considerations, the atmosphere of even
large establishments is frequently by no means well adapted
to the preservation of health. On this subject we have
before spoken at some length, and need not therefore now
discuss it further. One evident advantage possessed by this
Act is the elasticity conferred upon it by granting power to
local authorities to modify its provisions to a reasonable
extent in conformity with the local fluctuations of trade;
and since in any calling two-thirds of the voting strength
must support a proposed alteration, there is reason to expect
that this liberty will not often, if ever, be abused. The
right of keeping open shop on Sunday is denied to all callings,
except those of publicans, keepers of restaurants, tobacco¬
nists, and news-agents. E ven these, perhaps, migfa t without
much public inconvenience be included within the terms of
the Bill, provision being made if required, as in the case of
chemists, for occasions of real emergency. It has been
found impossible so far to apply in the working of the Shop
Hours Act the costly machinery of inspection. We sincerely
hope that no such system may be required, and that public
opinion may act as somewhat of a substitute. Where
business premises consist of shop and factory combined the
inspectors appointed under the Factory Act are available,
and the need of their services in such cases has unfortunately
been proved by experience. There is a tendency on the part
of some employers to use their workshop employes after the
allotted work period to reinforce the staff of ordinary shop-
servers. Such an abuse, it is obvious, can only be remedied
by oaref ul and frequent inspection. Having thus considered
some of the leading features of the new Bill, it is hardly
necessary for us now to speak at greater length upon it.
Even in its present somewhat imperfect form it must relax
considerably the too great strain of business life, and we are
convinced that employers will find themselves repaid in the
quality and amount of service rendered in the shorter
period for the working time which they appear to have lost.

HEROIC DOSE OF TURPENTINE IN CROUP. 1

In an obstinate and dangerous case of diphtheritic
croup, which had extended into the larynx, after painty
ing with boracic acid, and subsequently with a chloril
acid application, without benefit, the child’s conditiof
becoming worse and worse, Dr. Lewentaner of Constantly
nople, before resorting to tracheotomy, remembering j
paper by Demlow in which turpentine was recommended
in these cases, determined to give it a trial, and sjj

i

I

Die

The Laxcbt,]

THE REGISTRAR-GENERAL’S ANNUAL REPOET.

[Fkb.5,1887. 28 3

administered with his own hands a teaspoonful of the pure
olenm terebinth®, giving after it some warm milk. In a
quarter of an hour the laboured laryngeal breathing had
given way to normal respiration sounds. That night the
•child slept well and was quite free from the brassy cough
which had previously been present. The next morning he
waa quite lively and was found playing with his toys. All
trace of false membrane had disappeared from the pharynx,
which merely presented a reddened surface. Convalescence
was rapid and uninterrupted. The. turpentine, however,
caused an eruption on the face, trunk, and extremities, having
much the same appearance as the rash of measles hut of a
brighter red. The spats completely faded in two days, end
woe followed by no sign of desquamation.

THE REGISTRAR-GENERAL’S ANNUAL REPORT.

Tint forty-eighth annual report of the Registrar-General
has just been issued, and contains the detailed vital
statistics of England arid Wales for the year 1885. It is
satisfactory to note that the usual delay in the appearance
of these annual reports his been abridged by more than
three months, Which "encourages the reasonable hope 'that
the increasing portion of the public which is interested in
the national health statistics may in the near future antici¬
pate the publication of the Registrar-General’s detailed
annual report, at any rate before the close of the year
following that to which its statistics relate. The Registrar-
General of Ireladd has set a good example t6 the Registrars-
Genaral of tiho.priaer, gort^aas of the United Kingdom in this
matter, for his report for 1885 was issued early in July last.
On the other hand, the detailed report of the Registrar-
General for Scotland for the year 1881 has not yet been
issued. It is true that an approximate annual summary of
the vital statistics of each part of the United Kingdom is
published in various forms within a few Weeks of the close
of each year, but this does not lessen the force of the nn-*
questionable fact that the value of all vital statistics depends
in great measure upon the promptness with which they can
be issued after the occurrence of the facts With which they
deal Great as is the interest attaching to the exhaustive
wies of tables' contained in the Registrar-General’s Annual
8ep<jrt for 1885, it is impossible to ignore the fact that at
tie present moment that interest is considerably discounted
by the fresh,er interest felt in the summary of the figures for
1886, which is now dnei The year 1885 completed the first
quinquennium of the entreat intercensnl decade 1871-80,
and was, as the Registrar-General reports, “ the fifth con-
wcutiveyenuiu which the- dqqtfrfnjtp dpbd no^emoeed 19 6,
the lowest death->rate in any year previous to this quin-
quamium having been 20 3.” The mean rate in these five
jean fell to 19 3,,from rates that had steadily declined in
tbs four preceding quinquennia from 22'6 in 1861-C5
to 20-8 in 1876-80.' It' is impossible to doubt the sub¬
stantial improvement of the public health implied by
these figures. The gfeat saving of life in recent years
has been mainly due to decrease of child mortality, and of
®c?tality from £hej)riixcipaS zymotic diseases. At the same
time it is eminently satisfactory to note, from the report
tow to hand, that while, the decline of mortality in the five
y«a*s 1881-85, <£>mpartd with the mean for the whole
’agiatratipn period 1838-85, was most marked under thirty-
& velars of age, among males,.and under' forty-five among
femmes, the death-rate iq the quinquennium at each of
the twelve age .periods,was "below this general average.
Thja awut be.especially satisfactory to those who have
wfnped fnlly to recognise the advantage of the decreased
pjfter middle life the death-
/ the decline in the rate of
tfre grorii depth-rates at all eges had
cqnfainssome, special and

interesting statistics upon the marriage ages of bachelors
in different classes and occupations; on the mortality from
hydrophobia in England and Wales in the thirty-eight
years, 1848-85 ; and upon the local age arid sex distribution
of mortality from diabetes in the thirty years, 185G-85. We
shall have occasion to refer to these subjects in a further
notice of the report just issued.

ACUTE SPREADING GANGRENE,
hr is'not often that examples of this terrible and fatal
disease are met with, improved methods of treating wounds
and the wounded having almost effectually banished it
from the list of surgioal accidents daring treatment. A
short account of a case, which was admitted under the
care of Mr. Sydney Jones at. St. Thomas’s Hospital, will
therefore he of interest. The patient, a fairly healtby-
looking man, aged forty-three, a gardener, who said he
had previously enjoyed good health, fell, on Tuesday,
Jan. 26th, and ran a rusty spike into his left leg, about four
inches below the knee, , making a long punctured wound
upwards and backwards, wounding a vessel in the position
of the anterior tibial artery. The haemorrhage appears to have
been easily arrested, and the man was 6ent home and put to
bed by his medical attendant. He suffered severe pain in
the leg until the Thursday morning, when it began to swell
and the pain ceased ; the swelling rapidly extended and the
leg became discoloured. On Friday midday he was sent to
the hospital, and was then very ill, but apparently unaware
of his serious condition. The leg was swollen from the
foot almost up to the groin, and emphysematous crackling
extended, chiefly on the outer aide of the thigh, to the hip,
and downwards over the foot, which was cold and without
sensation. The leg was gangrenous, the region of the
wound very tense, cold, and purplish-black, with vesica¬
tion. Above the knee there was brownish pigmentation
of the skin, and. this, like the cedematous swelling
of the thigh, was most marked on the lateral aspects.
His tongue was dry, pulse rapid and compressible, and
examination- of the arine showed the. presence of much
albumen. Amputation above the middle of the thigh was
performed coon after admission,, but the patient, who did
well for a time, died somewhat suddenly on the following
afternoon, four ,daye after the receipt of the injury. There
was slight emphysematous crackling in the subcutaneous
tissue of the stump, and tenderness ulong the femoral vein
on the morning after the operation. .

WARMING RAILWAY CARRIAGES.

It is very strange that the repeatedly urged proposal to
warm railway carriages by a complete system of pipes
heated with the waste steam and the hotair from the engine
has not been carried into effect. There Would be no serious
difficulty and comparatively little expense in putting this
plan in operation. At the moment we write it is warm
enough for spring weather; a day or two ago the weather
was wintry. The cold may return, and, if it should, we
shall be shivering under burdensome rugs, even in first-class
compartments, while those who travel by the more genial
appliances of locomotion across the Channel are taking
matters more easily, and, if not actually enjoying themselves
—by reason of the intolerable slowness of even fast trains on
the Continent—will he, at least, free from perils by chill;
not, indeed, because railway companies across the silver
streak are one whit more considerate of the comfort and
well-being of their passengers, but because the weather
being less severe, the ills and grievances of a railway
traveller’s life are less difficult to bear. It will be well
if the companies begin to warm their carriages at once ; if
not, they must be compelled to do this small service to the

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284 The Lancet,]

ANTIPYRIN IN PHTHISIS.—A FATAL CASE OF SCURVY.

[Feb. 5,1887.

public. Meanwhile, let those who travel in cold weather
insist on securing as many foot-warmers as possible in the
compartment, and have them frequently renewed, so that
the atmosphere of their carriage may have the keen edge
taken off its icyness. _

ANTIPYRIN IN PHTHISIS.

Antipybin has been shown to have various uses, but if
the success which has been reported by Dr. Zakrzhevski in
a paper contributed to the Russian Military Medical Journal
attends the practice of other medical men, this drug will
hereafter be looked upon as almost a specific. While under
ordinary methods of treatment the mortality of phthisical
patients in the Helsingfors Hospital was 50 per cent,
during the eight months in which the antipyrin treat¬
ment has been carried out not a Bingle case has proved
fatal, many of the patients having, on the contrary, improved
so decidedly as to be able to return to their homes. The
author much prefers the hypodermic method of administer¬
ing antipyrin, as the effect is produced in less than an hour,
whereas when the drug is given by the mouth no effect is
produced for from one to three hours. The action of anti¬
pyrin is to increase the force of the cardiac contractions,
and so to raise the blood-pressure. In phthisical patients it
slows the pulse, but never quite to the normal rate. It also
slows and deepens the respirations, and the digestive
functions are improved. No albuminuria or other sign of
renal disturbance was observed. With regard to the dose
Dr. Zakrzhevski finds that it should be regulated by the
strength of the patients. In a man with phthisis, who was |
still fairly robust, a full dose of ninety grains was required
in order to produce the best effect; whereas in greatly de¬
bilitated typhus patients ten or fifteen grains were quite
sufficient, and in cases where there was decided exhaustion
it was found that a dose of sixteen or seventeen grains was
the largest that it was advisable to give.

A FATAL CASE OF SCURVY.

An inquest held recently at Greenwich shows how
narrow is the margin of protection afforded by lime-juice
against outbreaks of scurvy when ships are ill-found or the
crews unhealthy. In this case the patient, who died just on
entering the Seamen’s Hospital at Greenwich from syncope,
embarked at Calcutta in the ship Aladdin on August 12th
last. After nine days he showed symptoms of disease, which
the captain thought was due to syphilis, and treated him
accordingly, but it ultimately proved to be scurvy. Another
member of the crew was also affected, but more slightly/
Evidence was given which showed that the diet was con¬
fined to salt meat, bread, peas, rice, tea and coffee, and water,
which was very bad. Such a diet would eventually lead to
scurvy, and the date of the occurrence of the outbreak
would depend upon the powers of the resistance of each
individual member of the crew. The two men who were
attacked probably had the seeds of the disease in them
when they left Calcutta. We have repeatedly drawn atten¬
tion to tlie fact that a very large proportion of crewB are
recruited direct from hospital. So long as they can pass
muster btfore the agent, they are content to engage for the
voyage. As Mr. Harry Leech used to say, more ships are lost
through the unseaworthiness of the crews shipped than of the
vessels themselves. It is certainly a strange anomaly, that
while tha captains of ships can have emigrants medically
examined the crews are not inspected. The Board of
Trade, too, is also responsible for the maintenance of the
defective dietary still in vogue in the mercantile marine.
In these days of cold storage fresh provisions could
easily be served out during the whole voyage; but then
the rules and regulations of the Board of Trade stand

in the way, and fresh meat may not be substituted for
salt, unless the weight of fresh meat is equivalent to the
regulation allowance of salt, which is absurd; and it is
quite unreasonable to expect owners, if they have already
gone to the expense of putting up a cold storage-house, to
pay the difference between one pound of fresh meat and one
pound of salt—a difference of about 2J d., which would repre¬
sent a considerable sum on a long voyage and with a large
crew. Some time since a large shipping company proposed
to introduce a fresh meat supply throughout their vessels,
and at their request a well-known authority drew up a
diet scale, in which he proposed to substitute twelve ounces
of fresh mutton for every sixteen ounces of salt pork and
beef allowed by the mercantile marine scale. This very
reasonable proposition was not, however, accepted, and for
a time the matter was allowed to drop. We hope, however,
the Board of Trade will become alive to the importance of
improving the dietary of the mercantile marine ; with the
improved methods of preserving and storing fresh provisions,
there can be no excuse for adhering to the antiquated
method of provisioning ships still adhered to. There
is no reason whatever why the sailor should now be pre¬
disposed to scurvy any more than an agricultural labourer.
Lime-juice, no doubt, is an excellent preventive, but it is an
artificial resource, for if ships were provisioned in accordance
with the opportunities now afforded by cold storage and
hermetically sealed tins of vegetables, it would become
unnecessary and useless. _ ,

THE GEORGE THOMPSON FELLOWSHIP IN
MEDICINE.

The conditions and regulations regarding this Fellow¬
ship of £100 yearly, foiinded by G. Thompson,'Esq., of
Pitmedden, have just been issued by the Medical Faculty of
Aberdeen University. The object of the founder was ta
enable a Graduate i,n Medicine of the University to pursue
further studies and researches at a foreign or some other
British school of medicine or hospital. The Fellowship will
be tenable for two years, will be awarded after the last
term of graduation for the year, and will be open for com¬
petition to all who in that or the preceding year have passed
all the examinations for graduation in the University. The
examination for the Fellowship will be held early in July,
will be conducted partly in writing, partly viva voce, and
partly practically, and will be confined to three of the
subjects of the medical curriculum.

MERCURIAL PERIPHERAL (?) NEURITIS.

Clinical, histological, and pathological facts grow apace
in the subject of diseases of peripheral nerves. The number
is great of morbid processes known to the clinical physician in
which peripheral neuritis has been found. Alcoholism, tabes
dorsalis, diphtheria, endemic neuritis (bdri-bdri), leprous
neuritis, saturnism, mercurialism, typhoid fever, rheumatic
fever, and probably other continuous fevers, including
tubercle and phthisis, are all accredited causes of lesions of
peripheral nerves. Many of these causes do not act equally
on the whole length of a nerve. Curiously enough, the
changes may occur at intervals in the length of a single
nerve. This variety has been badly named “ segmental.” Ifc
contrasts strongly with the Wallerian degeneration of the
whole length of the nerve, though in this degeneration the
first part to undergo change is that next the point of
section, not the terminal plate, which would be furthest
away from the source of nutrition. M. Letulle communicated
recently to the Acadetnie des Sciences the results of some
histological investigations into the conditions of the nerves
in mercurial paralysis as experimentally induced in animals.
The results are remarkable, and require further investiga¬
tion. The alterations were segmental, as above explained,

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CHOLERA AND QUARANTINE IN SOUTH AMERICA.

[Fbb.8, 1887. 28 5

utd peri-axial, but not in the least inflammatory. The special
character consists in the progressive destruction of the
myeline sheath, with preservation of the axis cylinder, but
without increase in the number of nuclei of the neurilemma.
Let die speaks of them as trophic changes. Clinically,
aarcurial paralysis differs from saturnine forms in the
preservation of normal electrical reactions, absence of
amyotrophy, and persistence of deep retlexes. But further
min ate study of these paralyses is certainly desirable in the
light of most recent knowledge.

THE HOME SECRETARY AND THE CONVIOT
TH0MP80N.

Wn are glad to see that the Home Secretary has promised
Sr. James that a careful inquiry shall be made into the facts
of the case of Thomas Thompson, now under sentence of
death in Durham gaol for the murder of his child at Gates¬
head. We have reason to believe that there are unmistakable
proofs of melancholia in Thompson's family. If there are
any eases of murder, more than others, in which it is proper,
and indeed imperative, to investigate and give doe weight
to facts proving an element of insanity in the murderer, it
ii is such a case as Thompson's, where the murderer kills
his own child. It would be painful indeed to see such a
man executed without thefullest proofs that be had escaped
its evil inheritance of his family.

CHOLERA XND QUARANTINE IN SOUTH AMERICA.

Is is quite evident that cholera is on the increase in South
America. On the east coast Uruguay and the Argentine
Eepablic are affected, the disease having commenced at the
important ports of Monte Video and Buenos Ayres. Inland
there has been a somewhat wide diffusion into the centre of
the Argentine Republic and also as far north as Paraguay.
At Monte Video the increase which is taking place is con¬
siderable. On the western ooast of the continent the disease
xppears so far to be limited to Santiago. The first spread
of cholera to South America is believed ter have taken place
m connexion with a very considerable emigration of
faliaoe to the district of the River Plate; but it is not easy
to determine which locality became first, affected. The
tttitude of the several Governments concerned is thoroughly
characteristic of nations wedded to the quarantine system.
K»eh one begins by denying or minimising the news as to
cholera, and theft'When all are alike infected they set up a
rigid system of quarantine between themselves.

TREATMENT OF TYPHOID FEVER BY INHALATION
OF COLD AIR.

M. A. SoEOiiOKF, of the Military Hospital.of Kresnooenky,
published some time ago interesting researches on a new
nethod of treatment «f typhoid fever. The author had
naarked that the patients suffering from this disease who
bob placed in tents could without inconvenience respire air
d a temperature of zero, aud that coincidently the tempera-
tm of the body fell from 40° C. to normaL He was thus
led to conjecture that inhalations of cold air might be em¬
ployed with a therapeutic object in view. He experimented
•o twenty-three cases, and found that inhalation of air
uariy at zero caused a more or lees pronounced defervescence,
though the action is, as might have been expected, less lively
than with cold-air or cold-water baths, and is at the same
fine more transitory. He found that the action varied under
diflermt conditions, the defervescence being least from mid-
<lsy to (S v M-, and g r e a te st between the hours of 7 and
10 in the evening. The effects were less during the first
bxtaight, the defervescence effected being less than 1° C.,
snd lasting for only an hour and, * half or two hours, whilst

they were greater after the first fortnight, the deferves¬
cence amounting to more than 1° C. aud lasting for several
hours. The duration of the inhalation was found to be of
little importance, a stance of ten minutes’ duration being
equal to one of twenty minutes. The best time was from
twelve to fifteen minutes. The defervescence was not
in direct ratio to the temperature of the air inspired, and
air at very low temperatures did not act auy better than air
at somewhat higher temperatures, because exposure to the
former had to be curtailed. Depression or excitation of the
patient diminished or suppressed the antipyretic action of
the inhalations. The general effects of inhaling cold air
were that the respiration was diminished in frequency by
about four times in the minute, and became deeper; the
poise was lowered on the average six beats, and became more
full. On the other hand, the skin and mucous membrane
became less dry. _

THE APOTHECARIES’ SOCIETY AND PRESCRIBING
CHEMIST8.

Readbbs of The Lancet of Jan. 8th may remember the
case of a chemist at Bedwortb, named Homer, visiting and
attending a child till it died. The facts were inves¬
tigated by the coroner, and the jury found that the
chemist had been guilty of a breach of the law .in attend¬
ing, prescribing, and giving a certificate of death; A corre-
Bpsndence has been sent to us by Mr. Upton, clerk of tbe
Society, showing that the Society was ready to prose¬
cute the chemist, and gave him notice of their intention to
commence proceedings. Thereupon Mr. Homer pleaded to
have the proceedings stayed, and promised that the Society
should have no more occasion to complain. The Society
then drew out a form of undertaking to be signed by the
chemist, and agreed, on these conditions, to abandon pro¬
ceedings. The Society deserves praise for action in this
matter, and not least for its readiness to forbear on a
promise of good behaviour, which we anticipated in qut
notice of the case. There are many culprits who have not
given any such promise, who should not be so leniently
dealt with. _

SALICYLIO ERUPTION.

Bubnino sensations in the skin, cedema of eyelids, and
patches of bluish-red erythema were noticed by S. Rosenberg
to follow the administration of four grammes of salicylate
to a sempstress. A bullous eruption appeared on the site of
the erythema as the result of continued use of the drug.
Three days after the discontinuance of the drug the vesicles
dried up. A fresh experimental observation was made, with
a similar result. The urine gave a distinct ferric chloride
reaction. The inunction of salicyl ointment was followed
by burning and red patches on the skin with blueness of
face, and the urine showed the salicyl reaction.

THE CRICHTON ROYAL INSTITUTION, DUMFRIES.

It will doubtless be remembered that about the middle of
last year Dr. Lennox, assistant medical officer at the Crichton
Royal Institution, Dumfries, charged Dr. Rutherford, the
medical superintendent of that institution, with subversion
of order in the house, and also complained of the inferior
quality and deficient quantity of the food supplies.
The General Board of Lunacy held an inquiry into these
charges, and the result of their investigation has been pub¬
lished. The conclusions which were arrived at are as
follows:—(1) The charge of want of discipline is unfounded;
(2) the statements made by Dr. Lennox respecting the food
are undeserving of confidence, the supplies being satisfac¬
tory, although on a considerable number of occasions the
cooking of the food appears to have been unsatisfactory

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286 The La'nc*;]

• f' ' UNlVEftSitf EXTENSION IN ’SCOTLAND’. 111 ■' ■»

[wb^-UkT’

(3) that the estimate of the cost of the food is unsupported
by facts, and shows an ignorance of the cost 6f the food of
patients in other asylums; and (4) that the charges
against • the management were prepared and brought for¬
ward in a way which deserves strong censure. Two medical
commissioners who visited the asylum at the request of the
Board of Lunacy also reported most favourably-of the
discipline and food-supply of the establishment. The case
has eicited much local interest, and Dr. Rutherford is to be
congratulated upon the result of the inquiry and the ter¬
mination of an episode which must for some months have
been a cause of considerable mental annoyance.

IMPENDING RUIN , OF SPANISH PHARMACISTS.

: La Vara de Esadapio states that since the beginning of
July—that is to say during the last six months—nine phar¬
macies in Madrid have been closed, and that forty more will
cfertainly follow their example before July, 1887; also that
unless the present arrangements aboat military pharmacies
are entirely changed an additional seventy will probably
close at eome subsequent date. If this prophecy comes to
pass, the,Madrid pharmacies will in a short time have been
diminished by 109! In this country chemists have to com¬
pete with the stores and seem to have good, reason to
complain, but we never hear of such wholesale closures as
are being carried out in Madrid, where, though the military
pharmacies may to an unjustifiable extent supply civilians
at something like cost price, as is alleged, no medical man
thinks of such a thing as dispensing his own medicines.
La lambada Espahola, referring to the subject, suggests
that the dootors and pharmacists should combine together
and demand the consideration of their rights from the
Government. _

UNIVERSITY EXTENSION IN SCOTLAND.

A movement is at present in progress among the Scottish
Universities for the organisation of systematic courses of
extension lectures upon all departments of science and
literature, similar in range and aim to those which were
initiated in England upwards of twelve years ago by one of
our best known educationists^Professor Stuart, M.P., and
which have been so successfully carried on by the University
of Cambridge, particularly in the mining and manufacturing
districts of the north of England and the midlands. It is
hoped in Scotland to overcome the difficulty of supplying
regulnr and complete instruction, so far as the Universities
lire concerned, by uniting their available lecturing power;
so that while any town would naturally in the first place
be supplied, as far as possible, from the nearest University,
any desired course might be drawn from a more distant one.
The project of establishing “ extension colleges i.e., centres
of regular teaching—is already under consideration in
several of the most important county towns and mnnufac-
factnring centres throughout Scotland, especially in con¬
nexion with the local jubilee movements.

TUBERCLE INOCULATION DURING CIRCUMCISION.

Dn. ELSfiNBKRO, writing in a Polish medical journal,
gives an account of a case where tubercular infection was
cbtivoyed to a child during circumcision through the filthy
practice of sucking the Wound. Several cases of this kind'
have been previously recorded by Lindniann and by Lesmann,'
who recorded ten instances of Infection by one operator. The
interest of this case lies chiefly In the doubt Which at first
existed as to the nature of the ulceration, which had very
much the appearance of a chancre, but which on micro¬
scopical examination showed the existence of tubercle
bacilli. The Operator was apparently iii pretty good health,
having only a trifling cough, but tubercle bacilli were found

in hi6 sputum, and in the inter-arytetfOid space eome distinct
,tuberoles were seen by means of the laryngoscope on an
infiltrated base. _____

EPIDEMIC DIARRHCEA.

: It is unusual to hear 6f any epidemic prevalence of
diarrhoea during the winter months, yet there is little
reason to doubt that a large number of persons in London
have during the last few weeks suffered from this malady,
and this in a manner which raises a strong suspicion of
community of cause. The subject is one that would likely
enoqgh escape attention, for the ailtaent is nqt qf a character
to influence death returnsj neweriJ^jess, diarrhoea is some¬
times associated in its etiology with other diseases of. a
serious nature, and we cannot regard the appearance of
groups of cases of this affection without some anxiety as to
its meaning. Health officers would render valuable service
by placing themselves in communication with medical
practitioners in their district, for the subject is well worthy
of investigation. _

THE COSTS OF THE ELECTION OF DIRECT
REPRESENTATIVES.

We are asked to remind our readers that the costs of the
election of Mr. Wheelhouse and Sir Walter Poster are still
'undefrayed by the contributions that have been received,
■and that subscriptions will be gladly received by Dr.
■Robert Saundby, Edmund-street, Birmingham. 0

DISPENSING BY MEDICAL MEN IN FRANCE. '

In the Freedi Medical Bill, Which.baa been draws up>
and published,'the old law whioh permitted practitioners
residing in towns, villages, or communes where there wad
no chemist's shop to supply medicines to their oWn patients
is now proposed to be altered, ao that dispensing may be d6n&
' only in cases where there is no chemist withinfaurhilotnetres.
iUpon this Lt Practicien. remarks that it is to: he hoped that
all rural practitioners. Who would simply be Unable
to exist under such conditions, will protest most ener¬
getically against this alteration, drawn. up> «s of course
it is, by persons who have no knowledge of/the conditions
of medical practice in the country.. ■

THE JACOB TESTIMONIAL.

It is gratifying ts observe that the Jacob Testimonial is
j likely to be a great success. The subscription-list includes
;tbe names of many eminent p^yaipiamj-aniLaurgeons in tho
United Kingdom, whilst the popularity of the movement
! is shown by the support it receives from the rank and fils
lot.tlhe-profession. '•••■ *' v ; !••.• •<>.«• - • .• ..

THE BLOOD IN LEUKuCMML -

Dli. Putts, a Polish' observer, havihg studied the com¬
position of the blood in five cases of' leukaemia, writes
(Afedycynd, No. 39,1886) that crystals of 13ucih are only
found in the form of leukaemia which; is accompanied with
swelling of the glands. In general the number of Bifczozero’e
plates is very Considerable, while the crystals of OharCot and
Neumann are but seldom found. The movements of tbs
white corpuscles are greatly increased. ■ •

DEATHS OF EMINENT FOREIGNERS. .

Trnf following deaths are recorded i^Prof. Aug. Nonat,
formerly a well-known and highly esteemed Parisian jjynw-
cologist, in his eighty-third'year; Dr. Antonio Garbiglietti,
Dean df the Royal Academy of Medicine of Turin; and
Dr. Pieter Hendrik Suringar of Amsterdam.

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TKsUxcaff,]

FOREIGN UNIVERSITY INTELLIGENCE.—8BWAGE SLUDGE. £Fkb. 5,1887. 287

SMALL-POX IN AUSTRALIA

Skits from Melbourne is to the effect that, there having
no increase in the cases of small-pox amongst the
passengers landed there and at Adelaide from the Nord-
- aracher Lloyd steamer Preu&aen, those who were detained
!i qauantine have been released.

FOREIGN UNIVERSITY INTELLIGENCE.

Halle.— Dr. Oberst has been nominated Extraordinary
■jlemca of Surgery.

Prague.—Dr. Emil Kaufmann has been recognised as
Print Docent in Otology in the Bohemian Faculty.

Vienna .—The Ministry of Education has addressed an
Ejiiry to the Professorial Senate as to the necessity of
rCAtJiohing a third ophthalmic clinic—that is, one in addition
j those under the charge of Professors von Stellwag and
:adu. A committee has been appointed to report on the
mar. _

Lktprm will be delivered in Gresham College, Basing-
iil-street, E.C., on the Glands, on the -8th, 9th, 10th, and
iith iast., at 6 p.m., by Dr. E. Symes Thompson. The
abject* of the respective lectures, which are 1 illustrated by
utgrtms and free to the -public, are the Structure and
'ration of the Absorbents; the Glands in Health and
-j«ue; Diseases of the Glands; and the Surgical Treat-
:«t of Glandular Disease._

Sr vim at. practitioners residing in and on the borders of
4* hamlet of Mile-end having consented to notify the
’t’orence of cases of infectious disease coming under their
idee, the guardians have resolved to allow a fee of
C£ for each case so notified. :

1*reference to the honour conferred on Prof. Billroth, to
*uch we alluded last week, we may remark that the Vienna
wgeoa is the third medical professor who has in recent
r*n attained the dignity of the Austrian peerage, the
ia two being Rokitansky and von Briicke.

SEWAGE SLUDGE.

case of the metropolis the conveyance of the sludge to sea
was the only available remedy, but where local conditions
were favourable, he refrained from saying other methods
of disposal were undesirable.

Another papet by Mr. William Santo Crimp on Filter-
presses for the Treatment of Sewage Sludge was also read
at the 8ame time, the author pleading for the filter-press as
a ready means of disposing of the sloppy mass of putrescent
mud produced daily in' sewage precipitation works. He
argued that the offensive and useless mass might be quickly
converted into a practically inodorous manure, which was
superior to ordinary farm-yard manure.

A very ingenious method of separating the liquid from
the solid portion of the sludge was exhibited last week at
Walthamstow, in Essex, where arrangements have been
made for the application of Mr. Astrop’s system of convert¬
ing sewage Bludgeinto dry powdered manure. At Waltham¬
stow the sewage is run into a'tank, where it is subjected to
precipitation by lime, and, after the supernatant water is
run off, the sludge is pumped into an adjoining building
which contains Mr. Astrop’s water-extracting machine. It
is received' flret into a large sludge-vat, in which are two
hollow perforated metal cylinders covered with fine wire
gauze, andwhioh are kept constantly revolving against brushes
which keep the gaUze clean; a partial vacuum ie created in
these cylinders by pumping, and about 60 per oent. of the
moisture is extracted. The sludge then passes by a sluice
valve on to an endless travelling web of wire gauze,
having the same sized mesh as the cylinders, and occupy¬
ing xhe whole width of the machine. The web is sup¬
ported by rollers, and also passes under rollers, as well
as over one of Korting’s exhaustors, by which 10 per cent,
of the moisture is removed. The sludge then passes between
a series of rollers provided with scrapers, whence it falls
into a hopper, and thus reaches a disintegrating cage on the
lower floor; here it is exposed to a blast of warm air, and
at the end of this process it contains but 5 per cent, of
moisture. By this time it is in the form of a powder, which
falls through the meshes of, the disintegrator on to an
Archimedean screw, and by this means is conveyed to a
distance, where it is packed into bags. There is but little
doubt Mr. ABtrop’s system will Supersede other, methods of
fluid deprivation, and,it can evidently be worked at a very
small cost. The v^lue of the product for manure is said to
be considerable, but this must be determined more fully by
future experience. The method is, however, a very con¬
venient one ; the machinery occupies but a very limited
space,and isin every way inexpensive.

^ —-i ’-

THE MEDICAL ATTENDANCE ORGANISATION
' COMMITTEE.

Tet beet method of dealing with sewage sludge is one of
aost pressing questions of the day. The importation of
iortign guano has tended materially to reduce the expecta-
of any reasonable pecuniary return by the sale of sludge
^ the cost incurred by its separation from the fluid-which
•ttoop&niee it. Nevertheless, this removal Is necessary in
interest of the purification of the effluents which now
^durge into our rivers, and it may be hoped that the
way experiments which are being carried on for this
Purpose may at last end in success. Mr. William J. DLbdin
la interesting paper last week an this subject, in which

* pointed out that the solubility of a portion of the sue-
;wied matter in solutions of lime seemed to have been'

overlooked; that the use of an excessive quantity
<line, while affording a rapid settlement of the sludge And
1 note or less dear effluent, dissolved a by no means
® e «riderable quantity of the offensive matters previously
x wjpengion. Chemical precipitation was incapable of
waning mote than a limited quantity of the oxydisable
*g»aic matters in solution in London sewage. Of the various
Moieal agents, sulphate of iron was superior to alumina
*wage purification, the latter being valuable chiefly for
54 affect ia removing some of the colour from the efflueffjt,
wt leaving the matters actually in solution. He regarded-
**<ge sludge presses as a convenient mode for converting •
■*ae sludge into a semi-dry portable form, but doubted the'
wcceeefui use of the material thus prepared, and said that,
® Pjace of the farm, in many cases, the furnace appeared to

* the ultimata destination of the offensive matter.. In the:

This Committee consists-of the following gentlemen:—
Chairman: Sir T. Spencer Wells, Bart. Medical: Dr. J. Ford
Anderson, Dr. F. H. Alderson, Mr. E. C. Barnes, Mr. M. G.
Biggs, Sir AndrowClark, Bart, Dr. Alfred Carpenter, Dr. M.
Corner, Dr. A 1 . D. Ducat, Mr. W. G. Dickenson, Dr. J. Grey
!Glover, Dr. Alex. G r a nt , Br.- Julm Chwlun, Mr. Ernest Hart,
Mr. H. Nelson Hardy, Mr. Timothy Holmes, Mr. G. T. Keele,
■Dr. Alfred Meadows, Dr>. W. M. Ord, Dr. H. Campbell Pope,

, Dr. Gilbert Smith, Dr. J. C. Steele, Dr. Walter Smith, Dr. G.
Stoker, Mr. W. E. Steavenson, Dr. Dunbar Walker. Lay: Sir
T. Foweil Buxton, Bart, Mr. W. Bousfield, Mr„ W-G. Bunn,
Rev. Canon Erskine Clark,. Mr. II, N, Ilamilton-Hoare,
Lieut.-Col. Monteflore, Mr; F. D. Mocatta, Mr. Claude G.
Monteflore, Rev. Geo. S. Reaney, Mr. C. J. Kadley. Secre¬
tary t Mf.. W. G. Bunn, fi, Lbmb’s Conduit-fctreet, London,
;W.C. -

The. meetings of tha committee, which are well attended,
take place on alternate Tuesdays, from 4 to frSOi So far
hot much has been done rave to pass tlie following resolu¬
tion “ That any future plan for the medical treatment of
tha: working -classes should be conducted upon the principle
of assurance, with a. small fee at each attendance, or upon
each prescription made up. Special terms should; however,
be arranged for: the admission of persons requiring imme¬
diate treatment, who shonld be compelled fo join, and be
expected, within oUe month of recovery, to continue as
ordinary members, with the sanction of the medical officer
under, whom they wish to be registered.” Such a resolution,
of course, o&rriea us but a little way in this difficult

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288 The Lancet,]

THE VICTORIAN JUBILEE AND SANITARY IMPROVEMENT.

[Fra. 5,1887.1

question. All will agree that it is desirable that the
payments of the working classes should be on the prin¬
ciple of assurance—i.e., that they should be periodical,
in sickness and in health, in order that they may
be of moderate amount, and most would agree to a little
extra payment at each attendance or on the dispensing
of medicines as a check upon the tendency to make frivolous
demands on the medical men. The difficulty begins when
we come to details and to formulate schemes and rates of
payment which will really satisfy good general practitioners.
All the recent attempts to organise medical attendance on
the working classes have been more or less unsatisfactory,
including those of the Metropolitan Provident Association.
They have not improved on the demoralising notion pre¬
valent among the working-classes that medical attendance
is to be had for next to nothing. It could not be expected
that medical men should identify themselves wit h an Asso¬
ciation which at low terms took patients of all classes
without respect to fitness. It remains to be seen whether
any modification of the provident dispensary system can be
got to work satisfactorily in London, where the conditions
of life are exceptional. It is not proved yet that any new
discovery works better than the old club system, supple¬
mented by those accommodating terms on which medical
men have always been ready to attend the humbler classes
in the emergencies of sickness and disease.

THE 'VICTORIAN JUBILEE AND SANITARY
IMPROVEMENT.

A public conference was held at the Paddington Vestry
Hall on Jan. 25th to consider proposals for commemorating
the Jubilee. The following proposals were made:—(1) A
recreation ground; (2) a public library and museum; (3) a
town hall; (4) the Imperial Institute; (5) and the purchase
of the canal basin and wharves, and the removal of the dust¬
collecting business from the parish. This last proposal had
reference to the following motion, which Mr. Mark H. Judge
intends to propose in the Jubilee Committee if sufficient
support should be forthcoming from the inhabitants:—
“That in the opinion of this Committee, the dust-collect¬
ing and other trades which are carried on in connexion with
the canal basin between Warwick-crescent and Praed-street,
besides being a continual menace to the health of the parish,
are, during the summer months, a serious danger to the
inmates or St. Mary's Hospital, and a source of annoyance
to the Great Western Railway Terminus, which is so often
visited by Her Majesty the Queen and the Ministers of the
Crown; that the Committee, therefore, considers that no
better memorial of the Victorian Jubilee could be devised in
Paddington than for the Vestry to purchase the canal basin
and adjacent property in order that this long-standing
nuisance may be abolished and the site suitably utilised for
residential and other purposes.”

this scheme was supported at length by Mr. Mark Judge,
and by Mr. Edmund Owen on behalf of St. Mary’s Hospital.

NATIONAL HEALTH SOCIETY.

On Friday evening, Jan. 28th, a meeting was held at the
Paddington Baths to inaugurate a course of health lectures
to be given by Dr. A. T. Schofield, under the auspioes of the
above Society. The meeting was largely attended and the
audience representative of every grade of society, showing
how general is the interest in the all-important subject of
health. In the absence of Lord Randolph Churchill, who
was detained in the House of Commons, the chair was taken
by the Rev. J. C. Ridgway. Among the gentlemen on the

E latform were Sir Crichton Browne, Sir Spencer Wells,
>r. Priestley, Dr. Thorne Thorne, Mr. F. Trews, Rev. Dr.
Clifford, and Mr. Shirley Murphy. After some introductory
remarks by the chairman. Sir Crichton Browne addressed
the meeting, dwelling on the importance of the work of
the National Health Society in its efforts to prevent the
■origin and spread of disease by imparting knowledge through
such lectures as Dr. Schofield’s to all Claeses; SirC. Browne
also remarked that a special feature of these lectures would
be the avoidance of technical terms and complicated ex¬

pressions, and he went on to draw a favourable comparise
between the physical condition of Englishmen and &fl(
other nation in tbe world. i

Sir Sfsnceb Wells pointed out that the average lengfi
of life was twenty years longer now than it was fifty yeai
ago; this he attributed to efforts at sanitary reform, such 2
those of the National Health Society.

Mr. F. Treves said tbe National Health Society wa
strictly a missionary society, inasmuch as it appealed ti
individuals; in this he was supported by

Dr. Thornr Thobne, who said it was essentially tb
work of ladies to go among tbe poor, and to impress upa
them both personal and general sanitary principles.

The Rev. Marshall Trbddlb and Rev. Dr. CliffobI
spoke warmly in favour of the scheme of the propose*
Paddington Park.

Dr. Schofield then announced that the lectures wool*
take place at the Baths, at 8 o’clock on the following even¬
ings:—I eb. 1st: Prevention of Disease. Feb. 4th: Batin;
and Drinking. Feb. 8th: Use and Abuse of Stimulant!
Feb. lOtb: Mind and its Culture. Each lecture will b
followed at 9 o’clock by an ambulance lecture and demon¬
stration ; either course may be attended separately a
together.

After a vote of thanks to the Chairman the meetinj
separated. _

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5933 birth:
and 3734 deaths were registered during the week ending
Jan. 29th. The annual death-rate in these towns, whicl
had been eqoal to 26-5, 24T, and 22-8 per 1000 in thi
preceding three weeks, further declined last week t<
21*1. During the first four weeks of the current quarte
the death-rate in these towns averaged 23-6 per 100C
and was 07 below the mean rate in the correspond
ing periods of the ten years 1877-86. The lowes
rates in these towns last week were 11T in Derby, 14-1
in Birkenhead, 16 2 in Salford, and 17 4 in Wolverhampton
The rates in the other towns ranged upwards to 26 1 ii
Liverpool, 264 in Blackburn, 27'9 in Manchester, and 30*6 ir
Bristol. The deaths referred to the principal zymotii
diseases in the twenty-eight towns, which had beer
485 and 392 in the preceding two weeks, further declinec
last week to 371; they included 130 from measles, 76 fron
whooping-cough, 54 from scarlet fever, 41 from diarrhoea
37 from “fever” (principally enteric), 33 from diphtheria
and not one from small-pox. No death from any of thes<
zymotic diseases was registered daring the week in Derby
whereas they caused the highest death-rates in Bristol
Preston, Leeds, and Huddersfield. The greatest mortality
from measles occurred in Hull, Bristol, Leeds, and Hud¬
dersfield ; from whooping-cough in Halifax and Hudders¬
field; and from scarlet fever in Sheffield, Bristol, am
Salford. The 33 deaths from diphtheria in the twenty-eigh-
towns included 22 in London and 3 in Manchester. Small¬
pox caused no death in London and its outer ring, or ir
any of the twenty-seven large provincial towns. Onlj
1 base of small-pox was under treatment on Saturday Iasi
in the metropolitan hospitals receiving cases of this disease
The deaths referred to diseases of tbe respiratory organ:
in London, which had been 731, 691, and 531 In the preceding
three week#, farther declined last week to 432, and wen
128 below the corrected average. Tbe causes of 90, or 2 '4
per oentt, of the deaths in the twenty-eight towns last
week were not certified either by a registered medical
practitioner or by a coroner. All the causes of death wert
duly certified in Bristol, Portsmouth, Norwich, and Wolver¬
hampton. The largest proportion of uncertified deaths -were
registered in Blackburn, Plymouth, Halifax, and Sheffield.

HEALTH OF SCOTCH TOWNS.

Tbe annual rate of mortality in the eight Scotch towns,
which had been 29-9,26*1, and 237 per 1000 in the preceding
three weeks, rose again to 247 in the week ending
Jan. 29th; this rate exceeded by 3*6 the mean rate during
the same week in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from
14-6 and 187 in Perth and Edinburgh, to 297 in Glasgow and

y Google

Thk Lancet,]

THE UNIVERSITY OF LONDON AND ITS NEW REGULATIONS.

[Fbb.5, 1887. 289

30-8 in Paisley. The GIG deaths in the eight towns last week
showed an increase of 26 upon the numbers in the pre¬
vious week, and included 19 which were referred to
whooping-cough, 18 to measles, 15 to scarlet fever, 10 to
diarrhoea, 7 to diphtheria, 6 to “ fever” (typhus, enteric, or
simple), and not one to small-pox; in all 76 deaths resulted
from these principal zymotic diseases, against 72 and 66 in
the preceding two weeks. These 75 deaths were ©qua)
to an annual rate of 30 per 1000, which exceeded by
09 the mean rate from the same diseases in the twenty-
eight English towns. The fatal cases of whooping-
cough, which had been 27, 26, and 20 in the pre¬
vious three weeks, further declined last week to 19,
of which 16 occurred in Glasgow. The 18 deaths from
measles, of which 15 were returned in Glasgow, showed
a marked increase upon the numbers in the previous
two weeks. The fatal cases of scarlet fever, which had been
13 and 16 in the preceding two weeks, were 15 last week,
snd included 12 in Glasgow and 3 in Dundee. The 10
deaths attributed to diarrhoea, of which 6 occurred in Glas-

? ow, exceeded those returned in the previous week by 3.

he deaths referred to diphtheria and “fever” scarcely
differed from the numbers in the previous week; diphtheria
caused 5 in Glasgow and 2 in Edinburgh, and 8 of the 6
deaths from “fever” were returned in Glasgow. The
deaths referred to acute diseases of the respiratory organs in
the eight towns, which had been 213, 181, and 165 in the
preceding three weeks, further declined last week to 156,
snd were fewer by one than the number returned in the
corresponding week of last year. The causes of 80, or
■early 13 per cent., of the deaths in the eight towns last
week were not certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had beeD 86'2 and
33U per 1000 in the preceding two weeks, farther declined to
S3 in the week ending J*\n. 29th. During the first four
weeks of the current quarter the death-rate in the city
averaged 32 0 per 1000; the mean rate during the same
period did not exceed 227 in London and 22 4 in Edin¬
burgh. The 191 deaths in Dublin last week showed a
farmer decline of 27 from the numbers returned in
the two preceding weeks, and included 6 which were
referred to scarlet fever, 4 to “fever” (typhus, enteric,
or simple), 4 to whooping-cougb, and not one to measles,
diphtheria, diarrhoea, or small-pox. Thus the deaths from
these principal zymotic diseases, which had been 21 and
13 in the preceding two weeks, were 14 last week; they
wne equal to an annual rate of 21 per 1000, the rates
from the same diseases being 1'9 in London and 1-2 in
Edinburgh. Tbe fatal cases of scarlet fever, which had
been 8 and 4 in the previous two weeks, rose again
last week to 6 ; and tbe deaths due to fever and to
w h oo pin g-cough showed a considerable increase upon tbe low
numbers In the preceding week. The deaths both of infants
sad of elderly persons showed a further decline from the
Bombers in recent weeks. Five inquest cases and 5 deaths
from violence were registered; and 47, or nearly a quarter,
of the deaths occurred in public institutions. Tbe causes
cf 35, or more than 18 per cent., of the deaths registered
dwriwg the week were not certified.

THE SERVICES.

8orgeon-Major John Godfrey Rogers, M.B, Medical Staff,
has been appomted a member of the Distinguished Service
Order for operations in tbe Soudan.

Sorgeon General R. Lewer left England on the 27th ult.
for Hong-Kong, to take over the appointment of Principal
Medical Officer to tbe British troops stationed in the China
command.

Staff Surgeon Parke left Alexandria on the 3rd inst., to
join Mr. Stanley's expedition for the relief of Emin Pasha.

AmnaALTT.-Deputy Inspector-General of Hospitals and
Fiesta Dogald McEwao, M.D., has been promoted to the
mak of Inspector-General of Hospitals and Fleets in Her
MajastVs Fleet, and has been sppointed Honorary Physician
to Hot majesty, vice — Salmon, deceased.

The following appointments have been made:—Fleet Snr-
geott Henry C. Woods, to the Victoria and Albert; Staff
Surgeon Alfred E. Delmege, to the Osborne; Staff Surgeon

Richard J. Barry, to Portsmouth Dockyard, and Staff Sur¬
geon Henry T. Cox, to the Duke of Wellington, additional.

Artillery Volunteers. —5th (Isle of Wight, Princess
Beatrice's) Volunteer Battalion, the Hampshire Regiment:
Acting Surgeon T. Q. Wiley resigns his appointment.—5th
Surrey : Acting Surgeon W. A. F. Bateman to be Surgeon.

Comspnkitte.

“ Audi alteram partem.**

THE UNIVERSITY OF LONDON AND ITS
NEW REGULATIONS.

To the Editors of The Lanckt.

Sirs,— Dr. Harris, in his letter in The Lancet of Jan. 29th,
has opened up a question of great import to those pro¬
ceeding to graduate in medicine at the University of London.
From the first appearance of the new regulations, in August
of last year, we have anxiously awaited some higher power
than ourselves to take up the cudgels on our behalf, it has-
been stated that the regulations in regard to the competi¬
tion for honours at the Preliminary Scientific Examination
(which are practically the same as those recently issued for
the Intermediate E x am in ation in Medicine) have worked
satisfactorily, and from this it has been argued—upon very
scanty data—that there will be a successful result from the
new rules for the Intermediate Examination. But the differ¬
ence between the two examinations seems to us most
apparent. At the former the candidate usually presents
himself before he has entered a medical school, and, the
subjects being not strictly medical, be has no very strong
wisB to gain honours, and therefore does not run the risk of
a failure. But, in the latter examination, there are subjects
—anatomy and physiology—in which he will greatly covet
honours; and yet, if he essays to secure them, he has to
imperil his pass in the whole examination, and perhaps in
the end will be only “ recommended for a pass,” in which
case no record of bis proficiency in the other subjects of the
examination will be made. No student, after two years*
work, will now be able to compete for honours without the
misgiving that he may lose six months of his most precious
time on account of his desire to acquit himself well at this-
very important examination. Is this the manner in which
to encourage a high standard of work ? If one paper only
must be given, let it comprise a certain number of “ honour**
questions, which could be apswered or not at the discretion
of the candidates; or let there be a return to the old regu¬
lations. This letter, we believe, bears out the feelings of the
majority of those who are now studying for their degree.

We are, Sirs, your obedient servants.

Six Undebgkadcates of the University
F eb. Ut. 1887. OF LONDON.

TREATMENT OF HYDROPHOBIA WITH THE
POISON OF THE VIPER.

To the Editors of The Lancet.

Sirs,— In my studies of hydrophobia I have been interested
to observe how frequently of late curious methods of treat¬
ment have been proposed which have been considered
original by those who advocated them, but which are simply
resuscitations of old and discarded methods. I have not
thought it important before to criticise any of these because
they seemed to receive but little attention; but I have very
recently seen in so many medical journals in America and
in Europe recommendations of the employment of the sting
of the viper as a preventive of hydrophobia, that it seems
worth wnile to point out two facts: first, that the sug¬
gestion is by no means new; and second, that it has been
tried and found wanting, and has been very properly
abandoned.

More than a hundred years ago, in 1784, M. de Mattheis,
surgeon to the King of Naples, seeing A dog said to be mad,
and which went into a convulsion when water was offered
it, bethought him of a viper which he had with hint, and let
it bite the dog’s throat. The dog’s head swelled imme¬
diately, the dread of water ceased, and tbe dog recovered. 1

> See London Medical Journal, val. p. 830,1786.

Digitized by CjOO^Ic

290 The Lancet,]

RECENT PASTEUEIAN DEATHS.

[Feb. 5, 1887.

In 1788, Fabbroni 3 reported the case of a man supposed to
have hydrophobia, who was treated by the application of a
viper to each of his legs. The patient seemed to be relieved
for a moment, but died in half an hour.

These are the only cases I can now 'recall in which this
astounding method of treating hydrophobia has been carried
out, and it cannot be considered strange that it is not at
present generally adopted. Other curious methods of treat¬
ment may be found described in many books on hydrophobia
and rabies, and not a few are included in a paper on “The
Treatmen of Hydrophobia Historically and Practically Con¬
sidered,” which I read before the American Medical Associa¬
tion in 1834, and which was published in the journal of
this Association on Aug. 10th of that year. A reference to
some of the books referred to, or to the paper just men¬
tioned, would save some writers from error as to the origi¬
nality or practicability of the methods which they propose
for the treatment of this disorder.

I am, Sirs, yours respectfully,

Philadelphia, Dec. 26th, 1B86. CHARLBS W. DULI.BS, M.D.

RECENT PASTEURIAN DEATHS.

To the Editors ^The Lancet.

Sirs,— In the tables appended by your Paris Correspon¬
dent to his most interesting letter in your last issue, 1 find
that Arthur Wilde who died at Rotherham after being
treated at Paris is stated to have died of pulmonary disease.
This is not correct. According to the account given in the
Rotherham Advertiser the man was mortally ill before any
symptoms of lung affection showed themselves, which
occurred only a few hours before his death. It was stated
that the Temains of an old lung affection were found after
■death, but this could not have been the cause of death.
His mother, who nursed him, who is a woman of great
intelligence and the matron of an orphanage, assured me that
he had nothing wrong with his lungs since he had an attack
of pneumonia in his childhood, and that he had enjoyed
■excellent health afterwards. Her description of his case
agreed with that given in the Rotherham Advertiser, and
also with the description of the cases related by Professor
Peter, especially In the commencement of the symptoms at
the seat, of inoculation—the intense prostration and some
frothing at the mouth. These are not the usual symptoms
of “ congestion of the lungs,” of which he is said to have
_ died—indeed, the term is too vague for scientific use; there
■could have been no pneumonic consolidation, or that
would have been mentioned. I observe by the table that
M. Pasteur acknowledges the death of Smith, or Goffl, who
died at St. Thomas’s Hospital to have been due to hydro¬
phobia, though at the inquest the question was left in doubt.
It is reported that the rabbits inoculated from GoffL’s spinal
marrow died of rabies in seven days.' According to the
statement of M. Pasteur, made after the death of Louise
Pelletier, this would prove that the inoculations were the
cause of death, and would greatly strengthen Prof. Peter’s
case. At any rate the facts should be made known without
delay, in order, on the one hand, to remove suspicion from
M. Pasteur’s treatment, or,' on the other hand, to warn
possible applicants against the risk it involves.

HKbu isv.m! •••/«•; I am Sirs, yours truly, y

■ >- .fw-.Ms , John H. Clarke, M.D.

St. CrtorgeVteriiice. Cflortcerter-road, S.W., Jan. 31*t, lsrifT'

i-. "i ■ ..___ - ■ -„Ji ,;f

v ^‘' 5 fi ?J^; , QtEEN , 9'iu6lLTEE HOSPITAL; 0 '

the Editors of The Lancet. ■ ^ ^' i

! you permit me to say a few words in reply
; tb Mr. Cheyne’s letter, inasmuch as I wish -to correct a most
important error which I am sure he has inadvertently made
. —viz., that the proposed hospital is only for the treatment of
diseases of the “ throat, ear, skin, eye, rectum, &c.,” whereas
he has omitted to mention “ orthopaedic surgery” in all its
branches, which will, of course, include diseases of the “ spine
and joints.” Thera is also connected with this institution a
surgical appliance department, for the purpose of supplying
various mechanical Instruments to distressed persons on
their obtaining the requisite number of letters from the
subscribers to this department, and I venture to think that
this branch (sureical appliance department) is moet im¬
portant and of absolute necessity to the poor, who abound

1 Ibid., vol. lx„ p. (

in thousands in the immediate neighbourhoods, such 1
Chelsea, Fulham, &c., who cannot afford the time to obtal
such articles from more distant institutions. It w<
this branch that induced the promoters to add to the
programme most of the special organs for treatment, sue
as the throat, ear, skin, and eye, and to these they ha^
since added a department for the treatment of disease <
the nasal and pharyngeal cavities by the most advance
methods, as beyond the cost of a few inexpensive drugs, tl
same establishment and employes can be utilised for carrj
ing out the latter, and the medical staff is, of course, hone
rary. With regard to the in-patients, though the numb*
of beds is somewhat limited, there is every prospect <
success of adding more, as a great many influential persor
have already promised their support, but who do not and wi
not contribute to other charitable institutions, for the reaso
that they are not allowed any privilege with regard to tl
internal administration of such beyond a few patient
letters of recommendation. Another all-important item !
that, by the establishment of this institution, it will affoi
opportunities to many medical men to become attached t
a hospital, and so develop “latent talent which wouli
otherwise lie dormant.”

In conclusion, 1 beg to state that this hospital will 1
governed by a committee consisting of an equal number c
lay and medical members, and that by strictly adhering t
all matters of professional etiquette and economy th
Queen's Jubilee Hospital will, I hope, be an omameqt to th
profession.—I am, Sire, your obedient servant.

The Secrbtabv.

The Queen's Jubilee Hospital, Gloucester-tcrrace,

Qucen's-gate, S.W.. Jan. Isa?.

*#* We are still decidedly ot opinion that such a hospits
is not needed.—E d. L._

HOSPITALS, THE SICK POOR, AND ALL
ENGLAND.

To the Editors of The Lancet.

Sirs,— In a kindly notice of Sir Andrew Clark’s origins
proposal, formulated in a scheme over my signature in 77,
Time8, for affiliating every parish, congregation, village, c
hamlet through its clergyman, minister, local doctor, c
other representative, with the Hospitals Association, by th
formation of a Hospital Society, you have misunderstood
the proposal in one important particular. It is not desired
nor will it be attempted, to assume a kind of Providence ove
the provincial sick, and to invite themuptofillourLondoi
hospitals. On the contrary, the provinces will be left to lool
after their own sick poor and hospital administration, and al
that we propose to do is to bring our intimate connexioi
with metropolitan and provincial hospitals to the aid o
those who come in contact with the sick poor in all parti
of England, with the object of locating difficult cases o
disease or infirmity in the most suitable institution tha
may be available, always giviDg the preference to the on
which is easiest of access to the particular case which need
such assistance. The scheme has excited very general inte¬
rest; the conference in May, under the presidency of Si
Andrew Clark, promises to be a genuine success; and, a
the proposal aime at aiding all the hospitals by excitin;
a wider interest in their work among all classes of thi
people, Sir Andrew Clark or myself will be very gla<
to hear, or to receive offers of co-operation, from an’
member of the profession who may wish to know more o
our proposals and intentions.

I am, Sirs, yours truly, u

The Lodge, Porchester-iquare, W. IlENRY C. BcRDRTT.

THE MERE PRESENCE OF BLOOD IN THE PERI¬
TONEUM NOT A REASON FOR ABDOMINAL
SECTION.

To the Editors of The Lancet.

Sirs,—T he novelty and importance of such a question as
that dealt with in your leading article or pp. 227-228 induces
me to trespass again on your extreme goodness to me in the
matter of space in your columns.

I shall pass over the strong objections to the conclusions
of Dr. Hunter’s thesis as afforded by what we see in the
human peritoneum, which proves conclusively that its

Du

TYPHOID AND HYDIiAN’I'S.—RELIEVING THE DUKES.

[Feb. 5 , 1887 .

inactions anvils pathology differ most materially from those
of the peritonea of rabbit* and dogs. I wish only to point
oat that there is a vast difference between the mere presence
oi blood in the peritoneum artificially injected and the
presence there of a bleeding point. It is the latter and not
the former which demands prompt surgical interference,
and in the presence of which the expectant treatment is
absolutely criminal. No experiments on the lower animals
can help ns in deciding how to stop the bleeding from a
raptured tnbnl pregnancy, for po animal except the human
is known ever to be the subject of such an accident.
t • . 1 am, Sirs, yours truly,

■fcnfefhain, Jan. 29th, 1887. LAW80N TAIT.

TYPHOID AND HYDRANTS.

^ To the Editors o/The Lancet.
jEEsJ— 111 your issue of Jan. 8th there appears a para-
of a letter by Dr. H. Ward on Water Hydrants.
I beg to point out that in publishing this Dr. Ward exceeds
the bound* of professional etiquette. I, as medical officer
4 health for the Cowpen District, should have received some
ntunatkm of such “ inquiry ” and letter. 1 have refuted the
awntiono brought forward in this letter, which wee pub-
iufeed in several of the local papers, and written in a very
tansim style. The Local Government Board requested a
special report from me on the prevalence of typhoid daring
which I forwarded to them with the suggestion about
the hydrants, They have taken no notice of the latter, and
tare asked me to report to them upon the carrying out of
ay recommendations. I attributed the epidemic of lost
war to wind- pressure upon the open outfalls of the sewers
lacing the drain-traps. The epidemic of 1884 1 proved
esuclnaively to be caused by sewage pollution of one of the
tads of the water-supply, which I condemned. I made
area quantitative analyses of the water And sent them to the
taal Government Board, and they confirmed my decision.
i I am, Sirs, yours truly,

:ai^i*d i-•- R. Laing, M.R.C.S., L.R.C.P.,

JisInaiJo •»!' Medial Offloer of Health, Cowpen District,
jjgjgffifriffnirUlrniTnl-n-lTn-li Feb. let, 1887.

5Hfe»HBIEVING THE DUKES.

■jnta--; 7*0 the Editors of The Lancet.

Jtttit,—The year before last 148 cases of typhoid fever
waw treated at St. Bartholomew’s Hospital, and 118 at
St Thomas’s; and it seems probable that at all the London
hospitals 1000 cases of typhoid are treated annually, at a

g of about £16 each. Now, since the Metropolitan Asylums
d is required by law to take charge of all cases of
r arising among the London poor, it follows that by
tting these cases the hospitals are relieving, not the
poor, but the fates; and, further, since it does not
matter to a man how much of his total for rent and taxes
brent and how much taxes, the only effect of reducing rates
■ to increase rents, and the hospitals are really benefiting the
^landlords to the extent of £16,000 a year. A better course
would be for the hospitals to contract with the Asylums
iloard for the care of their typhoid cases; they could do the
mork cheaper and better than the Board can do it for them-
^ves, and the cases would be available for clinical in-

I direction. Especially is this course advisable at the present
flaw, when so many beds are standing vacant for want of
tan 300,1 am told, at Guy’s and St. Thomas’s
I am, Sira, your obedient servant,

Wu^TIES NOTES,
wn our oton Correspondent.)

d3lLDRKN% fcdSFITAL AT GATESHEAD.

3 have a Children’s Hospital at Gateshead
time before the public, and we all thought
ratter mu ueen settled as far as the project was con-
.. led ; Indeed, a considerable sum has been collected, and
Ha’site tor the building granted free by Lady North bourne,
When all of a sudden a letter appears in our local papers
j condemnatory of the whole thing, and from a strong but
wry unlocked for quarter—namely, the Rector of Gates¬

head, Who contends that there is no need for a Children’s
Hospital, and that the proposal is both wasteful and
eitravagant. This, I think, will not accord with the
experience of Newcastle hospital surgeons, for they know
that Gateshead children and adults crowd the waiting-
rooms of the various hospitals on this side of the water.
The Rector’s contention fs perhaps true, but true only in
one aspect—namely, that the Gateshead poor obtain medi¬
cal aid in Newcastle which ought to be provided in
their own town, and that the subscriptions received
by the Newcastle hospitals from Gateshead are in no
way commensurate, so tliat it could hardly ba con¬
sidered a commendable economy to ask the towns¬
people to continue to send us their aick poor, to the
saving of pockets at their side of the river. Dr. William
Mearns of Gateshead has put the matter very forcibly
in a capital letter in answer to objections, and which
has appeared in our local papers. He says: “The popu¬
lation of Gutesheud is over 70,000, that 90 per cant, belong
to tbe working classes, and at least 26 to 30 per cent,
live constantly from hand to mouth, and are in consequence
obliged to apply to some charity for medical relief when
overtaken by illness. The only medical charity in Gates-
I head is the Dispensary, which has no accommodation for
in-door patients. As a medical man residing and practising
in Gateshead for some considerable time, and as one of th<-
honerrary staff of the Dispensary, 1 give nsy emphatic testi¬
mony t* the absolute need of a great many of the children
treated by the staff of that institution being removed
from the miserable, and wrenched conditions under which
they hre sad their polluted surroundings, so as to be treated
with any chance of a safe and speedy recovery.” Dr. Mearns
adduces many other reasons in hie forcible' letter why
Gateshead should have a hospital of its own.

THE LATE ME. G. M'COULL, SURGEON OF OVINGTON.

The late Mr. M'Coull of .Gvington, Northumberland, died
very suddenly of heart disease! when in active practice last
April, and his many patients and friends have erected a
monument to his memory in the cemetery. Tbe design is of
obelisk’ form, with massive plinth, and its height is sixteen
feet. The inscription is in bold Egyptian oharaoters, record¬
ing hie agei, and that “the monument .was erected by a
large number of patients and friends aa a tribute of respect
ana in remembrance of many kind servioes rendered by
him.”

TRIPLETS IN NEWCASTLE,

A few days ago a poor woman was delivered of two girls
and a boy by Dr; Farquharson; of Westgate-road. Ft may
be mentioned that this is the third case of triple birth
taking place in the Westgate district of Newcastle within
the last eighteen months—Mr. John Foggin, a young surgeon
here, if 1 mistake not, having 1 attended two of these cases,
which followed each other very closely.

NowcMtle-upon-fyiM, Feb. And.

EDINBURGH.

{From our own Correspondent.)

PROFESSOR HAMILTON AT THE ROYAL SOCIETY.

At the last meeting of the Royal Society Professor
Hamilton of the University of Aberdeen read a paper
entitled “The Conducting Paths between the Cortex of
the Cerebrum and the Lower Centres in relation to their
Function,” and exhibited a large number of sections and
drawings illustrating his views on the subject. lie defined
in the first place the generally received view of the corpus
callositm as a commissural structure. In contrast with
this he stated the opinion that such is not the case, but
that it is constituted by strands of decussating fibres
derived from the cortex of either side and passing to the
basal ganglia of the opposite half of the cerebrum. The
apparent tendency to turn upwards at the lateral
extremities of the corpus callosum depends on the neces¬
sity for the fibres to pass over the roof of the lateral
ventricle before turning downwards to divide into the inner
and outer capsules, which Dr. Hamilton describes as their
real destination. Having referred to Foville s views on this
point, which closely coincided with bis own. Dr. Hamilton

e

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EDINBURGH .—GLASGOW.

[Feb. 5,1837.

laid down three postulates which must be fulfilled before his
view could be proved beyond dispute. They are, first, a
naked-eye demonstration by means of the scalpel, showing
the course of fibres that he indicates; second, the same
shown by transverse vertical sections of the brain; third, a
microscopical demonstration that the fibres of the inner
capsule and those of the corpus callosum are coterminous.
All these, he claimed, were established by the specimens
displayed, the third point being most difficult of demonstra¬
tion, since the fibres do not run transversely, but obliquely,
either from behind forwards or from before backwards, in
their passage across the corpus callosum from the cortex of
«ne side to the basal ganglia of the side of the cerebrum.

A NEW CENTRE WITH A CORRELATING FUNCTION.

In referring to the formation known as the branching
neuroglia, Professor Hamilton stated bis opinion that it is a
delicate plexus of nerve fibrils. It is present in the grey
•cortical matter, also in the white matter of the centrum
ovale; and a specially dense collection of these fibrils is
found internal to the upper part of the inner capsule in the
vicinity of the lenticular nucleus. This Professor Hamilton
proposes to call the “ plexiform nucleus.” He assigns to it
« function of great importance as a correlating centre.

THE FUNCTION OF THE THALAMUS OPTICUS.

Many of the fibres passing across the corpus callosum
•end in the thalamus opticus, and form a large part of that
body, placing it in direct communication with the cortex of
the opposite hemisphere. It has, however, little or no direct
connexion with parte below, none whatever through the
peduncles, as has been thought. Its main relations in other
directions are those which it bears to the optic tracts, with
which it is continuous. From these facts Professor Hamilton
draws the inference that the optic thalamus is a com¬
municating centre of association, relating other functions
to that ot sight; {hrough it nearly all the special sense
centres receive their education, their functions being
here correlated with visual impressions. In support
of this view, and of the anatomical details upon which
it is based, reference was made to cases of destruction
of the corpus callosum, in which it is found that
education of the higher centres does not take place,
since they are cut off from the influence of the optic thalamus.
Where, however, the corpus callosum is congenitally absent,
not having been destroyed, decussation takes place lower
down than its normal site, and education of the higher
centres is possible, and in fact takes place. When education
is complete, the function of the corpus callosum as n channel
for transmitting educating impulses falls into abeyance;
this explains why injury to the corpus c&Uoeum late in life
■does not result in idiocy, as it does when occurring during
childhood.

THE RELATION OF NERVE CELLS AND NERVE FIBRES.

As the result of continuous observations upon this point.
Dr. Hamilton has come to doubt whether nerve fibres ever
enter nerve cells, unless perhaps in the motor areas. He
thinks the fibres form a kind of capsule around nerve cells,
but do not become actually continuous with them. In regard
to this point, it was stated bv Dr. Brain well, in the discussion
which followed the paper, that in the anterior horn of the
•spinal cord there is direct continuity between the nerve
cells and the delicate fibrils of that region, the latter being
in turn aggregated into fibres. The same probably holds
true of motor areas of the cortex; and if there,
presumably also in sensory areas. Some such arrange¬
ment is demanded by what is known of the conduction
-and insulation of nerve impulses, and although, as stated
by Professor Hamilton, there seems to be conduction apart
from continuity in the ear in the relation of the sensitive to
the conducting structures, yet in the eye it is found that
Actual continuity exists between the rods and cones and the
nerve fibrils which convey visual impressions. Dr. Bram-
well also criticised Professor Hamilton’s paper in regard to
the views put forth relative to the corpus callosum, and the
plexus of nerve fibrils supposed to have a correlating
function. Since the object of a nervous mechanism is to
conduct as directly as possible nerve impulses to tbe
eeat of their realisation, such a plexus interpolated in
the path could only complicate the matter very seriously. On
the morning following tbe discussion Professor Hamilton
gave a demonstration of his large collection of specimens in
the hall of the Royal Institution, at which a large audience
was present.

THE EDINBURGH PATHOLOGICAL CLUB.

This new medical society, formed for the informal dis¬
cussion of medical and pathological topics, has already
attained to vigorous vitality. At its second meeting, held
in January, there was a plethora of interesting communica¬
tions, and the limited number of members who form the club
speak highly in praise of its efficiency as an arena where
new ideas may reoeive such treatment as fits them for a
wider field of battle, or devitalises them once for all.

Edinburgh, Feb. 2 nd._

GLASGOW.

(From our own Correspondent.)

ANNUAL MEETINGS.

The time for the annual meetings of most of the charitable
institutions of the city has again come round. One of the
most important was that of the

ROYAL INFIRMARY.

The meeting was held a few days ago, when it was reported
that the number of patients treated in its wards during the
past year was 4884, as against 4943 in tbe year preceding,
and 6300 in 1886; taking the average of five years, the
number of patients availing themselves of in-door treatment
had fallen off to the extent of about 10 per cent. This seems
to indicate a lees amount of ill-health or serious accident in
Glasgow during the past twelve months than for several
years before. As to d^ath-rate, excluding deaths occurring
within forty-eight hours of admission, it was found to be
6 6 per cent., as against 7 6 per cent, in 1886. Those treated in
the dispensary numbered 39,260, a decided increase on previous
years. This, ho wever, is understood to represent tb e number of
consultations, and not that of new patients. The infirmary
paid its way throughout the year, and put £265 to capital
account. The meeting was rendered particularly interesting
and lively by an account given by an infirmary champion
of the manner in which its medical school had been
founded. Prominence was also given at this meeting to the
infirmary’s proposal that the school should be erected into
a college of Glasgow University—a plan which, if carried
out, would probably relieve the directors of a very burden¬
some white elephant.

GLASGOW EYE INFIRMARY.

At the annual meeting of this very deserving charity it
was reported that the number of cases treated during 1886
was 13,701; of these, 983 were in-door patients. This in¬
firmary has recently been enlarged by tne erection of new
buildings and alterations made in the old one; it has now
104 beds, with air space of 1430 cubic feet for each. The
income for the year nearly balanced the expenditure.

SICK CHILDREN’S H08PITAL.

During 1886 the cases admitted to this hospital numbered
458, the highest total since the hospital was opened four
years ago. None of the wards had been closed on account
of infectious disease during the year. The mortality, after
deducting deaths within twenty-four hours of admission,
was 6 8 per cent. The directors intend very shortly to pro¬
ceed to tbe erection of a dispensary. The income for 1886
fell short of the sum expended by £140.

THE LUNACY LAWS.

A somewhat unusual case was before Sheriff Ratherfurd
of Edinburgh a few days ago, a gentleman who had been
detained in Morningside Asylum on tbe certificates of
Drs. Littlejohn and Clouston having lodged a caveat to stay
proceedings. After the case had been certified, the Sheriff
said he thought it was certainly a matter of great regret that
the Legislature bad devolved upon a single judge, sitting
alone, whose judgment was by statute to be final and con¬
clusive, without the intervention of a jury, to state what
the mental condition of a party was. The question before
him now was the present state of mind of the gentleman
in question and whether he was in such a state as to
threaten danger to himself or others. The judge did not
think iu was a bad case, but as a man of common sense,
and one accustomed to weigh evidence, he could come
to no other conclusion than that the unfortunate gentle¬
man was at present in a state of unsound mind, and
that while these delusions continued, he might at any
moment become excited and dangerous to himself or

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DUBLIN.—BELFAST.

[Feb 5,1887. 293

others. He (th;? Sheriff) must, therefore, act upon that,
ind grant the prayer of the petition. The patient was
iceordingly conveyed back to Moiningside Asylum, it
being understood that he might at any time obtain
:he intervention of the Inspectors of Lunacy to in-
ijaire as to his state of mind.

DUBLIN.

{From our own Correspondent.)

SIMPSON’S HOSPITAL.

Bt the death of Dr. Henry Kennedy, a vacancy for a
phjBcian to this institution has arisen, and it will probably
bt filled up by the trustees at their quarterly meeting this
sonth. For the appointment, the emoluments of which are
£5 per annum, Drs. C. H. Robinson, J. W. Moore, and H. C.
Tveedy are candidates.

BBmSH MEDICAL ASSOCIATION (DUBLIN BRANCH).

At the annual meeting of the Branch held last week, the
=Mgural address was delivered by Dr. Grimshaw, Registrar-
r meral for Ireland. In the course of his address, he said
At we had high political authority for stating that the
*lth of the people should be the first care of a government,
ill if this was so, and if sanitas sanitation omnia sanitas
’Merer to become a reality, and not merely the motto for
-«professors of a “ policy of sewage,” it was manifest that
>lr profession must take a highly important position in

> fabric of the State. Did their profession occupy such a
'/ation? lie was afraid the answer must be that it did

either in this or in any other country that he was
mre of. Many of those who had not given sufficient
cation to the question thought that these faults in their
;~lt«ion were owing to defects inherent in the profession
'<lf. This was by no means the case. The fault mainly
Ay with the State. The medical profession had two prin¬
ce relations to the public—viz., those comprised under

> heads of the prevention of disease and the cure of disease.
*hile the duties under the former head have to be mainly '
formed towards the public in its collective capacity, those \
‘Altr the latter have to be mainly rendered by individual i
•sabers of the profession to individual members of the
jabbc. While the relative scope of preventive and of cura¬
te medicine might thus be respectively defined in general
ffla^it was clear that preventive medicine must oiten be
1-nriied individually—as, for instance, when they, advised
M to family hygiene and healthy homes. Curative medicine

also be practised collectively where the Poor-law
Tidied officer or the medical officer of a hospital or public
station treats large numbers of sick on an organised
-7 **b of medical attendance. When viewed from a State
K ®dpoint, this crossing of the functions of the profession
private and public capacities presented difficulties
P* most necessarily complicate the relations between the
and the profession. These difficulties were not insur-
-*®t&ble, though their existence must be admitted by all
And, indeed, a considerable number of them had
remounted slowly and by a sort of quiet progressive
^sbpment through the public medical system of Ireland.
T *umual dinner of the Branch took place in the evening,
“^College of Physicians.

mehcer’s hospital.

Utils Southern Divisional Police-court, Dublin, last week,
£ Aamedy, resident surgeon to Mercer’s Hospital, was
by Mrs. Farrell with having accelerated the death
J® bnaband, Joseph Farrell, by assaulting him while a
jtfwrt in that hospital in August last. Evidence of a
P* contradictory kind was given, and after several ad-
] ©amenta it was ultimately decided to have the matter
before a jury. Dr. Kennedy has therefore been
for trial at the Quarter Sessions, which will be
-« «U month, his own security in £100 being taken for
ktjpearance.

Monaghan, has been elected medical officer to
/**8**®dispensary district, in the vacancy caused by the

William Woods.

1.SV? 1a fanc y and full-dress ball on the 9th inst.,
funds of 8t. Michael’s Hospital, Kingstown.

BELFAST.

{From our oxen Correspondent.)

BELFAST HOSPITAL FOB SICK CHILDREN.

Prom the medical report presented at the annual meeting
of this charity (Mr. Dunville, D.L., High Sheriff of co. Down,
in the chair) I learn that there were-829 in-patients and
8694 out-patients during the year 1886. During the present
session there are the usual cliniques, which are attended by
the senior students of the medical school. In accordance
with one of the rules, a meeting was held on Jan. 19th, when
Dr. M‘Caw, one of the physicians, was re-elected for a
period of four years. A letter was read from the Hon. R. J.
O’Neill, M.P., the president of the hospital, urging strongly
the claims of the Convalescent Fund, by which children are
sent to the country and seaside for change of air after having
been in the hospital. The financial statement showed that the
income was slightly in excess of the expenditure.

ULSTER BYE, EAR, AND THROAT HOSPITAL,

At the annual meeting of this hospital it was reported
that during the past year 1789 patients had attended, and of
these 180 were intern. The total receipts for the past veai
were £560 6s. 5d., and the expenditure £641 14s. Dr. W. A.
McKeown (honorary surgeon of the hospital) mentioned
in his report that upwards of 600 cataract operations
had been performed since the opening of the hospital, the
patients being from all parts of the province. He alluded
to the absurd superstitions that still exist in regard to
diseases of the eye, and said that every year a number of
eyes were lost through ignorance ana so called “ popular
remedies.” Dr. McKeown referred with just satisfaction
to the fact that it was in this hospital first that the magnet
was employed to remove pieces of metal from the eye in
1873. Three years afterwards the practice waa adopted by
Prof. Hirschberg (Berlin), and now it is a settled practice all
over the world. In May, 1884, Dr. McKeown originated his
new operation for cataract, by which patients are prevented
waiting, as it matters little whether a cataract is “ ripe” or
not for this method to be used. This institution is becoming
more and more self-supporting, as for the last five years the
contributions of patients (.£2070 2s. 6d.) are in excess of those
for the previous eleven years by .£238 1U. 8 d.

SAMARITAN HOSPITAL.

The report read at the annual meeting of this hospital
showed that there were 148 intern and 974 extern patient*
during the year. The committee expressed the hope that
some benevolent person will see his way to build a wing to
the present building suitable for a lying-in department.

BELFAST MAIN-DRAINAGE SCHEME.

A report has been prepared by the Lagan Pollution Com¬
mittee in which they point out what they deem defective in
the drainage scheme of our Town Council. They object that
as to the high-level main sewer proposed to be constructed no
special system of ventilation is provided, and they believe
the ordinary street ventilation gratings would constantly be
giving off poisonous gases. Further, the fall in this sewer
(1 inch in 120 feet) is so slight that the committee allege it
will become a sewer of deposit. Again, no provision is made
by this scheme to drain tne Falls district, one of the most
densely populated parts of the town, and all the sewage of
this must continue to find its way into the Lagan. After
stating other objections, the committee say they urged upon
the Town Council the adoption of the scheme proposed by a
gentleman named Gilliland. Suchaschemeoould be carried out
for £18,000. It is not an alternative but & necessary adjunct
to the main-drainage scheme, and as absolutely necessary
to secure the purification of the Lagan. The works, the
committee think, could be carried out simultaneously with
the erection of the new Albert Bridge, and would entirely
abate the Lagan nuisance, and convert the river above this
bridge into a highly ornamental sheet of water. In con¬
clusion, the committee think that the main-drainage scheme
would entail an enormous expenditure without any corre¬
sponding advantage. At some of the reoent meetings of
tne Ulster Medical Society papers were read on the proposed
drainage schemes, and a very interesting discussion took
place. There can be no doubt that Belfast, from its peculiar
situation and from the great rapidity of its growth, is a
town for which it is extremely difficult to construct a

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PARIS.

[Fbb. 5, 1887.

thorough system of drainage, but it is to be hoped the
problem in time will be solved to the satisfaction of all
parties.

BELFAST ROYAL HOSPITAL.

I am glad to say that the treasurer has received over
X'1000 in aid of a special fund to pay off the debt incurred
during the year ending Aug. 31st, 1886.

Belfast, Peb. 1st. _'_ '

PAMS.

: {From our own Correspondent.)

8ANTTABY STATISTICS.

The last number of the Bulletin Hebdomadaire de
Statistique Municipale gives , a retrospect of the sanitary
condition of Paris daring the past year, from which it
appears that the principal epidemic diseases have been less
frequent. Typhoid fever has caused 1009 deaths, or 45 per
100,000 inhabitants, which is one of the lowest percentages
of the last twenty-five years. In 1885 there were 59 deaths
per 100,000 of the population. The deaths for the tint and
second quarters of 1886 numbered 212 and 171 respectively.
In August the mortality increased to 148 for the month.
Since then it has diminished, although it remains higher
than during the first half of the year. Small-pox, as usual,
capricious m its evolutions, has caused in all 213 deaths, or
0 per 100,000 inhabitants, being 97, 73, 24, and 19 for the
respective quarters. Measles shows a tendency to increase
in frequency year by year, but the mortality for 1886 is
less than that of the preceding two periods. From
1865 to 1869 the average was 32 deaths per 100,000 inhabi¬
tants. From 1872 to 1876 it was 36; from 1877 to 1881,
30. In 1880 it was . 44 per 100,000 of the population;
in 1888, 49; in 1884, 67; and in 1885, 68. During
the year 1886 there have- been 1238 deaths; giving a
mortality of 56 per 100,000. Scarlatina has been three
times as fatal as in 1882 and 1883, when there were 6 deaths
per 100,000 of the popnlation; twice as fatal as in 1885,
when the death-rate for the same number of people was
nine. In 1886 there were altogether 410 deaths, being
18 per 100,000 inhabitants, the maximum (67) being in
June. Diphtheria has increased in frequency in Paris,
during the last twenty years in the same way as measles.
For 100,000 inhabitants the mortality from 1865 to 1869
was 43 deaths. From 1877 to 1883 it increased progressively
to nearly 100. In 1884 it was 93; in 1885, 79; in 1886
there were altogether 1628 deaths, representing 72 per
100,000 of the population.

TYPHOID POSSIBILITIES.

In connexion with the above statistics, it must be remarked
that if the health of Paris has appeared more satisfactory
during the past twelve months, the improvement is dne
to providential causes rather than to any attention on the
part of the authorities to sanitary matters. All Parisian
residents are more or less protected against typhoid by
acclimatisation in an attenuated typhoid atmosphere, and
the chief victims to the disease are generally visitors or
new-com6rs. When, on account of some unusual influx of
strangers, or for some less evident atmospheric or telluric
reason, the typhoid nieus increases in virulence and the
“ directing classes" suffer, there is always a talk of sanitary
improvements, which are forgotten as soon as the alarm is
over. In inspect to typhoid, the health of Paris has pro¬
bably benefited by the general commercial stagnation, which
has made the past year a bad one for hotel-keepers.
The mortality has been no doubt restricted in a great,
measure by the absence of the potential victims. The laws
of supply and demand must also hold good in bacteriology,
and the poorer classes, having been more or less decimated
in previous years, have necessarily contained a smaller
number of individuals in a state of receptivity. To predict
the sanitary possibilities for the coining year would be
somewhat hazardous; but there are immediate indications
of epidemic and portents, if not in the air, in the
water, not without their meaning. Parts is supplied
with drinking water from the Vanne, the Dhuys, the
Seine, and the Ourcq. That of the first two is of
good quality, whereas the water of the Seine and the
Ourcq, to qBote the opinion of M. Ldori Collin, is “ hot in the
summer, cdld in the Winter,’ disturbed tend muddy stall

times, and contaminated by waste product and humai
excreta.” At the present moment the supply from thi
Vanne is temporarily suppressed on account of repairs t>
the aqueduet which conveys it to Paris, and the districts ii
which it is usually supplied are now furnished with typho
genic water from the Seine. It is a matter of genera
observation that enteric fever has been on the increas
during the last few week 87 ”the mortality from this caus
having been higher last week than during the precediDj
one. The distribution of bad water to those unaccustomet
to it is not likely to check the morbidity; and visitors t
Paris, to whom the risk is greatest, will do well to adop
simple precautions against infection. Boiled filtered wate
is not easily procurable in hotels, and the best plan is
perhaps, to usd genuine mineral waters. The ramilia
syphon is not to be trusted, being often filled from ai
impure source.

THE TREATMENT OF TYPHOID.

Professor Grancher, following in the steps of Professo
Bouchard, gives the following directions for the treatmen
of enterica: Four principal indications result from thi
pathogeny of the disease—general antisepsis, intestine
antisepsis, antipyretics, and nourishment. As soon as thi
disease is suspected, M. Bouchard commences by the admin is
tration of a purgative which is renewed every thre
days. For the first four days, calomel is given ii
doses of one-third of a grain every hour as a genera
antiseptic. Intestinal antisepsis is secured by the adminis
tration of vegetable charcoal in powder (100 grammes;
iodoform (1 gramme), and naphthaline (5 grammes). Thi
is mixed with 50 grammes of peptone and 200 gramme
of glycerine, which constitute the basis of ^he alimenta
tion, and the black magma so formed is taken by table
spoonfuls every two hours. The bowels are washed ou
night and morning with carbolic acid and water (1 in 1000)
each enema measuring one pint. From the beginning o
the disease the patient takes eight baths a day unti
recovery, but instead of using water at a much lowe
temperature than that of the body, the difference is only o:
two degrees Centigrade, 38°, for instance, of the temperatur
is 40°. The bath is then cooled by a tenth of a degree pe
minute to 30°, but never below, so avoiding all shock am
spasm. When the temperature remains high, notwith¬
standing the baths, quinine is recommended, 30 grains bein
given in four doses, in the course of two hours, am
repeated after an interval of three days. Besides th
glycerine and peptone associated with the antiseptics th
only other food allowed is bouillon, boiled with barley
and as a drink lemonade with a little wine. Should com
plications occur, they should also meet with a vigorou
reception. Extreme or prolonged delirium is to be treate
by opium, and peritonitic symptoms by ice or mercuris
ointment. Of 266 patients so treated by M. Bouchar
31 died, giving a mortality of 11*7 per cent. The averag
duration of the disease was nineteen days, and relapses too

f tlace on the whole number in 20 per cent., and during th
atter period in 10 per cent, of the cases. These figure
speak for themselves, and there is one point abou
M. Bouchard’s method beyond contestation. It is certain!
thorough. But if, as it would seem, the patient spend
thirteen hours in the bath and undergoes fifty or sixty othe
visitations of different kinds in the course of the twenty-
four I ours, it is difficult to see what time remains for repost

PASTE URIAH A,

The Tempi of Tuesday evening gives the following par
ticulars of another death after the preventive treatment
M. BergS, living at Bordeaux, was bitten five or six month
ago by a mad dog, and went to Paris, where he was sub
mitted to M. Pasteur’s treatment. On his return to Bordeau
he appeared to be quite cured, but two days ago symptom
of rabies set in, and it became necessary to’ send the patien
to the St. Andrd Hospital, where he died yesterday. Th

? o8t-mortem examination was made this morning by 11
eter, dean of the Faculty of Medicine, who dedined t
give any opinion, but who has made with the medull
inoculations on rabbits. The results of these inoculation
will show whether M. Berg6 did or did not die of rabiei
M. Peter, in a recent clinical lecture, stated that a chi!
had died of rabies at Sceaux after the intensive' treatment
Per contra, at the Academy of Sciences, thb statistics
account, published in your last issue, was received wit!
enthusiasm, and it was decided, on the proposition o
M. Bertrand, that a reprint of M. Vulpian-e note- sboul

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OBITUARY.—MEDICAL NEWS.

[Feb. 5,1887.

be made by authority of the Academy (tons iestampille
de la campagnie ),. and distributed to all the Frtiich
-and foreign committees now collecting subscriptions) for
the Pasteur Institute. This has already been done* and
the note forms a small pamphlet in quarto, with the seal
of the Academy engraved on the title page—a broad hint
to future candidates for the honour of membership.
At the Academy of Medicine a note was read from M. Can-
tini, of Naples, giving details of his experience of the
method, which are entirely favourable, none of the patients
having as yet died. At the Socidtd de Biojogie, M.
Gameleva related sixteen cases of rabies in which paralytic
symptoms had occurred, although no preventive inoculations
had been performed, thus showing that the paralytic form
of the disease is not necessarily camno-erperimental. A
similar case was mentioned by M. Laborde.

TILE LATE DR. GALLARD.

The death id announced of Dr. Gallard, physician to the
Paris hospitals and member of the Academy of Medicine.
Dr. Gallard was a practitioner of great merit, and although
not officially connected with the School of Medicine, he was
the teacher of gynaecology, whose wards were the most fre¬
quented by students. His loss will be the more felt in this
respect in that there is no ohair of women’s diseases at the
Faculty. Dr. Gallard was also senior physician to the
Orleans Rail way, and in this capacity rendered great services
in medical organisation during the siege, for which he was
made an officer of the Legion of Honour. The death is also
announced of another gynaecologist. Dr. Nonat, who, having
far exceeded the usual span of life, had dropped in a certain
measure out of the memory of the present generation.
Middle-aged men still remember him at the Charity, where
tiis practioe chiefly consisted in leeching the uterus. Nonat
■was a nephew of the great chemist, Thdnard.

A NEW DENTIFRICE.

The Gazette Hebdomadaire contains an article by M. Paul
Vigier on the Use of Steatite as a Tooth Powder. Many years
back M. Vigier discovered, that the addition of powdered
talc to water prevented the deposit of calcareous salts in
boilers. Applying this fact to dental therapeutics, M. Vigier
has devised a new dentifrice, which, he says, prevents the
formation of tartar. The formula is as follows:—Powdered
steatite, 60 grammes; desiccated alum or cream of tartar,
5 grammes; powdered cochineal, 10 grammes; essence of
peppermint, 20 drops. • Any other perfume may Of course
oe substituted. ■ . .

HENRY KENNEDY, M.B., M.E.I.A.

With regret we record the death of a well-known
Dublin physidan, who died on Jan. 24th at his resi¬
dence in Rutland-square. Although in his seventy-sixth
year. Dr. Kennedy was of very active habits, and was
possessed of a wonderful amount of vitality considering his
advanced age. He obtained his degree in Arts and Medicine
at the University of Dublin in 1839, and was elected a
Fellow of the College of Physicians ten years afterwards.
Connected for some years as visiting physician to Cork-
street Fever Hospital, he made great use of the valuable
material at his command; and a good deal of the experience
in fever and diseases of children, for which he was so justly
celebrated, was obtained at this institution. He was also
physician to Simpson’s and the Whitworth Hospitals. The
deceased was a constant attendant at the various medical
societies, and; proved himself an apt and fluent speaker in
the discussions which ensued on the various papers read
before the members. He was a prolific writer, the following
being only a few of the numerous papers he contributed to
medical literature:—“ Essay on Fatty Heart," “ On Slow
Pulse in Fever,” “On Scarlatina,” “On gome of the Forms
of Paralysis which occur in Early Life," “ On the Coexist¬
ence of Functional and Organic Disease of the. Kidney,"
“ On Hydrocephalus and its Treatment,” &c.

RICHARD FORTH SNAPE, F.R.C.S. Eng.

We regtet to record the death of Mr. Richard Forth Snape,
which occurred at his residence, Chorley New-road, Bolton,
on January 13th. Mr. Snape took up his abode in the town
about forty years ago, and some years afterwipds became

for a time one of the honorary surgeons to the infirmary and
dispensary. He early took an interest in the question of the
health and long hours of employment of children and young
persons in cotton mills, and was instrumental, along with
several other gentlemen, in promoting a demonstration of the
inhabitants ot the town in favour ot petitioning the Legis¬
lature to pass an efficient Bill for shortening the hours of
labour in factories. At the meeting at which this resolution
was adopted, and which was held on Jan. 25th, 1847, Lord
Ashley (afterwards Earl of Shaftesbury) was present. Mr.
Snape had for many years up to his decease held the post
of certifying factory surgeon. He was a staunch Conserva¬
tive and an ardent member of the Church of England, but
abstained from any active share in public affairs, his pro¬
fessional duties requiring most of Ins time and attention,
being consulted by many of the influential families in the
town and neighbourhood. As a practitioner he was judicious
and philosophical in bis views, ever cautious to keep him¬
self informed of the most recent discoveries. Few men have
possessed to so marked an extent as he did the instincts of
a doctor, or have loved t-beir profession more; hia kindliness
of heart and unaffected simplicity of character had won for
liim the love and esteem of a large circle of friends, many
of whom will continue to think of him with affection and
tedder regret. Ho leaves a widow and three sons.

Utebica! jfetos,

Royal College of Physicians of London.—T h
list of new Members was given in our last issue, page 244.
The following were admitted Licentiates on Jan. 27th

Andrews, Archibald George, Poplar Hospital, East India-road.
Ballanoe, John Des Carribres, Harley-street.

Barlow. Charles. Asplnall-street, Prescot.

Barr, George Arthur, Newport, Isle of Wight.

Barton, Edwin Alfred, University HospitiU.

Belson. George de Veulle, Albion-street, Hyde-park.

Blenkinsop, Alfred Percy. Hilldrop-cresceut, Holloway.

Bostock. Robert Ashton. South Camp, Aldershot,
lioxall, Frank. Oak ley-square.

Bradbury. Harvey Klmineraley, Hlll's-place, Regent-circus.
Brodle, Frederick Carden, Middlesex Hospital.

Browne, Edward Granville, Bernard-street, Bussell square.
Bulstrode, Herbert Tlrabrell. St. Thomas’s Hospital.

' Butler, Heury John, New Wortley, Leeds.

Calthrop, Lionel Claude, Cheal. Hornsey-lane.

Calvert, John Telfer, Osborne-terraoe, Clapham-road.

Calvert. William Dobree. Seward stone-road. Victoria-park.

Clark, Brown, London Hospital:

Connolly. Frank Glynn. London Hospital.

Cosens, William Bur-rough, Philpot-street, Mile-end. -.

Cox, Alfred Harold LIssant, Millman-atreet, Bedford-row.

Crook, Herbert Evelyn, NortbAeet.

Cross, Robert George, Compton-terrace, Highbury,

Dalgleish, John William, West-parade, Newcastle-on Tyne.
Debetiham. Horace Allan, Stepney.

Downing. William, Varna-road, Birmingham.

Uownman, Charles Frederick, Newmarket.

Drinkwater. Charles, King's College Hospital.

Duncan, Horace, Henrietta-street, Co vent-garden.,

Duncker. William Helnhotd, Finsbury-pork-road.

Bilye, John Simpson, Army Medical Staff. Colchester.

Evelyn, William Arthur, vlnoent-square, Westminster.
FitzGerald, Gerald Eustace, Shrewsbury-road. Westbourpe-park. ’
Fraser, Paul Wilkes, Gainsford-etreet. Kentlsh-town.

‘Furrlivall, Bryan, St. Bartholomew’s Hospital.

Garrould, Walter Robert, WIlle»den-park.

Hall, Herbert Strange. Bradshawgate, Leigh. Lancashire.

Haslip, George Ernest. Whitehall-place, Gravesend.

Helsbam, Hugh Paul. Cbarlwood-st.reet, Pimlico.

Holloway, Samuel Frederick. Osman-road.

Husbands. Harold Wessen, Wellington-park, Clifton, Bristol.
Iredale, Thomas, Midland-road, Headingley, Leeds.

Jarvis, William Charles, Southampton-street, Camberwell.
Jeaffreson, John Leslie, Park-creaoent, Stoke Newington.
Johnson, John George. Lan*do wire-road, Clapham.

Joly, Joseph Antoine Maurice, Ofipidans-road, Primrose-hill.
Jones, John Qwen, Cnrnbridge-ternioe, Islington.

, Kltson, Francis Parsons. Maiiland-park-villas. Haverstook-hlll.
Knaggs. Francis Henry, Dlsraell-road, Putney.

Lansdale. William, Chelsham-road. Clapham.

Loxton, William Arthur, Bath-row. Birmingham. ' . ■

McKague, William Henry, Burton-crescent.

McShane, George, Shaftesbury-road, Southsea.

Mann, Harold Kdward. West Cromwell-road, Kensington.

Martin. Frederick George Sturridgc Goodall. Haverstock-hill.
Maxwell. Matthew. Hunter-street, Brunswick-square.

Miller, Frederick Richard, Frederick-street, Gray’s-inn-road.
Moore. James, Gotha-street. Victoria-park-road.

Morgan, George Froderic Elliot, Soutbwark-bridge-road. :<’)

. Morgan, William Vaughan, Glen Marteg, Streatham-park. ,

Mould, William Thomas, Faimolme-roaa, Kensington..

, Moxham. Marcus Oampltn, Cresoent-etreet, ThorahiN-tqaftHk •
Nlhill, John Edward, Newcastle-on-Tyo«< . - -ui— /i , /jilmu \f.
Ord, George William. Strp^thain-ldll, , • ,Vo 4 in * 1 (

296 Thk Lancet,]

MEDICAL NEWS.

[Feb. 5,1887.

Pod ley, George Alton. Terrace, Camberwell.

Peeke. Harold Samuel, Sinclalr-road, Kensington.

Pepler, William Herbert. Kedbarn-street, Chelsea.

Plnniger, Charles Lever, Bleislngton-road, Lee.

Powell. Bdgar Bikins, Stoke road. Guildford.

Quiller, Charles Turner, Orlando-road. Clapbam.

Roalfe-Oox. Walter John. Hermitage. Sireatham.

Rosenau, Albert. Bath. Kissingen. Germany.

Sbarman, John Scbiitze William Bdward. Oak Villas, Norwood.
Stott, Hugh. Carlton Villas. Colney Hatch.

Strickland, Percy Charles Hutchison, Montague-itreet, Russell-
square.

Thane, E Igar Herbert. Montagae-street.. Rnasell-aquare.
Thompson, Stephen Robert, Glenmore House, Dulwich.

Trow, Charles, Kndslelgh-street, Tavlstock-square.

Tweed, Edward Reginald. Upper Brook-street, Grosvenor-square.
Vldler, Albert Bdward. Clapton-squar*.

Wale, George, West Kent Hospital. Maidstone.

Walker, Alfred William Hinsley. Hampden Club, St. Pancr&s.
Wheeler, Humphry John. Abingdon Villas, Kensington.

Wllbe, Richard Haydock Wlflln. Flnchley-road.

Wilson, William, HolUee, Cleveland-road. Wanstead.

Wreford, John, Clapbam-road.

Royal College of Surgeons of England.— The
following gentlemen, having undergone the necessary exami¬
nations for the diploma, were admitted Members of the
College at a meeting of the Court of Examiners on Jan. 25th :

Belson, George de Veulle, L.R.O.P. Lond., Alblon-street.

Brodie, Frederick Carden, L.S.A., Wootton Bridge, Isle of Wight.
Calvert, John Telfer, L.R.C.P. Load., King's-road, Rochdale.
Calvert, W. Dobree, L.R.C.P. Lond., Bast Bergholt, Colchester.
Holloway. 8amuel F., L.R.O.P. Lond., West Kfnslngton-park.
July, Antoine Maurice. L.R.C.P. Lond.. Oppldans-road.

Jones, John Arnsllt, L.R.C.P. Lond.. Port Talbot, Glamorgan.
Key, David Thomas, L.S.A., Trinity-square, Borough.

Usnn. Harold Bilward, L.R.C.P. Lond., West Cromwell-road,
Kensington.

Parry, ThomaaFox, L.K.Q.C.P.I., Ling-street. Liverpool.
Sldebottom. Ralph Bennett, L.R.C.P. Lond., Manor Houro,

Mo tram.

81ater, William Arnlton, L.S.A., Green-lane.

Vidler, Albert Edward. L.S.A., Magdale House, Rye, Sussex.
Wheeler, Humphry John, L.R.C.P. Lond., Abingdon Villas.

Admitted on the 26th ult.: —

Barr, George Arthur, L.R.C.P. Lond., MUner-street.

Barton, Bdwin Alfred. L.R.C.P. Lond., Lexham-gardens.
Bindley, Robert Alfred. Hlgbbury-hlll.

Carvalho, Alberto Pedro de, L.S.A., Lldllngton-place, Ampthlll-
square.

Copeman. Sydney Arthur MoncVton, M B. Cantab., York-road.
Debenham, Horace Allan, L.R.C.P. Lond., Heath Hoose,
Stepney.

Hasllp, George B., L.R.O.P. Lond.. Whltehall-place, Gravesend.
Husliands, Harold Wessens, L.R.C.P. Lond., Welllngton-park,
Clifton.

Jarrii, William Charles. L.S.A., Southampton-street.

Jeaffreson, John Leslie. L.R.C.P. Lond., Park-crescent, Stoke
Newington.

Lylr, Charles Conway Vaeey, L.R.C.P. Lond., Maryland-road.
Mai pas, James. L.R.C.P. Lond., H.M. Dockyard. Pembroke.
Martin. Frederick George Sturrldge Good&ll, L.R.C.P. Lond.,
Haveratock-hlll.

Morgan. William Vaughan. L.R.C.P. Lond., Streatham-park.
Norton. Henry Harvey, Beddenden, Kent.

Smith, Perciral, L.S.A., Harley-atreet.

Admitted on the 27th ulf.:—

Carey, Baall de Beauvoir, L.S.A., Guernsey.

Cosens, Wm. Burrough, L.R.C.P. Lond., The Vicarage. Dudley.
Cox, W. J. Roalfe, L.R.C.P. Lond., The Hermitage. Streatham.
Davey, Thomas George, L.S.A.. Helsham, Cornwall.

England, George Fuller Ashbrldge, L.S.A., Winchester, Hants.
Gilpin, William John, L.8.A., The Grove. Bedford.

Going, Joseph Andrew, L.8.A., Wanstead.

Hawkins. Herbert Pennell, L.S. A., Vincent-aquare, Westminster.
Iredale, Thomas, L.R.C.P. Lond., Leeds.

Lewis, John Nicholls, L.S.A.. Primrose Cottage. Swansea.
Macnab, Allan James. L.R.C.P. Lond., Phllbwch-gardens.
Oldbam, Montague Williams. L 8.A., Southam, Warwickshire.
Ord, George William, L.R.O.P. Lond.. Streatham-blll.

Phillips, Thomas, L.S.A., Newcastle Emlyn South Woles.
Prldham, William Frederick. L S.A., Cromwell-crescent.

Quiller, Chiu. Turner, L.R.C.P. Lond., Orlando-road, Clapham-
eommon.

Rusher, John Golby. L.S.A., Finsbury-park.

Sanaom. Harry Arthur, L R.C.P. Lond., Harley-atreet.

Sen. Chandl Charan, L.R.C.P. Lond., Hanwell.

Walker, Alfred William Hensley, L.R.O.P. Lond., Hampden Club.
Wilson. A. Harvey. M.D. Dartmouth. Sooth Boston, Maas., U.SA.
Wreford, John, L.R.C.P. Lond., Clapham-road.

Admitted ou the 28th ult.

Hill, Charles Marshall, L.R.C.P. Lond., Halifax.

Oliver, Charles Pve. L.S.A., Maidstone.

Ormerod, Bdward Booth. L.S.A., Robe Town, South Australia.
Peeke. Harold Samuel, L.R.C.P. Lond., Kensington.

Powell. E lgar Elkins. L.R.C.P. Lond., Guildford.

Wilde, Leonard, L.S.A., Watford.

College Lectures. —Professor Francis Warner, M.D.,
F.R.C.S, will deliver a course of three lectures on “The
Anatomy of Movement.” The lectures will be delivered on
Monday, Wednesday, and Friday, the 7th, 9th, and 11th
insL, at 4 o'clock precisely each day.

University of Cambridge.—A t a congregation held
on the 27th ult, the degree of M.B. was conferred on the
following gentlemen

George Gavin Morrloe, Trinity; William Perdval Gore Graham.

Gonvllle and Caiua.

Society of Apothecaries.—T he following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, aod Midwifery, and received certificates
to practise on the 27th ult.: —

Gilpin, William John, The Grove, Bedford.

Hawkins. Herliert Pennell. VIneent-snnare, Westminster.

Lewis, John Nicholls, Granby-street. Hsmpstiad-road.

Ormerod. Bdwsrd Booth. Lawo-terraoe. Blaakheath.

Prowse, John dkardon. Burl-street, Cambridge.

The Hospital Sunday collection was held at Rother¬
ham ou the 80th ult.

The eighth annual dinner of the Leeds medical
students (past and present) was held on the 28th ult.

The recent Hospital Sunday Collection at Reading
realised £237.

The Queen has been pleased to sanction the Hull
Children’s Hospital being called in future “ The Victoria
Hospital for Sick Children, Hull.”

The seventy-first annual general meeting of the
supporters of the Weymouth Royal Hospital was held on
the 20th inst.

The financial report of the Tiverton Infirmary and
Dispensary, which was read at the annual meeting on the
26th ult, was unsatisfactory.

At the annual meeting of the governors of and
subscribers to the Hertford General Infirmary, on the 20ch
ult., an unsatisfactory financial report was presented. The
deficit amounted to £1118.

Bills to amend and consolidate the Acts relating
to lunatics have been laid on the table of the House ot‘
Peers by the Lord Chancellor, who proposes to move the
second reading of the measures on Monday next.

At a large meeting of the inhabitants of Dart¬
mouth on the 18th ult., it was decided to erect a cottage
hospital, with a dispensary, for the town and surrounding
district, in celebration of the J ubilee. «

Rabies.—A n Order in Council, entitled “The
Rabies Order of 1887,” has been officially published. It lays
down certain fresh regulations in regard to animals found to
be affected with rabies, more especially dogs. The order,
which will take effect from and after the 28th inst., will
not interfere with the operation of the DogB Act, 1871.

Royal Maternity Charity.—T he annual meeting
of the governors of this charity was held on the 25th ult., Sir
John Lubboek, M.P., presiding. The report of the managing
committee, which was read, snowed that 4000 poor married
women had been administered to daring the past year. * The
expenditure amounted to £3371, and the income to £3740.

Sheffield Hospital Sunday Collection.—A total
of £2278 has already been received as the result of the appeals
made in the churches and chapels of'Sheffield.on the 30th ult.,
in aid of the looal medical charities. This is an increase of
£156 over the amount received last year, and there are several
sums yet to come in, which it is estimated will bring the
total amount received this year to about £2300.

Medico-Psychological Association. —At the next
quarterly meeting to be held at Bethlem Hospital, 8t.
Gteorge’s-road, on Feb. 23rd, it is proposed to discuss the
question “ Whether there is ever sufficient reason for the use
of strong clothing and side-arm dresses.” Dr. Percy 8mith
will read a communication on “The results of an Epidemic
of Typhoid Fever in the Insane.”

London Hospital Saturday Fund.—S eventy-five
metropolitan hospitals and fifty-seven dispensaries have
participated in the awards of the above fund. The follow¬
ing are among the chief items: Charing-cross, £162; King's
College, £175; London. £586; Middlesex, £276; St. George’s
£267; St. Mary’s, £224; University College, £204; West¬
minster, £208; Royal Free, 168; Seamen’s, £111; West
London, £131; firompton Consumption, £589 ; North Lon¬
don, £176; Victoria-park, £288 ; Royal National, £108 ;
Ormond-8treet Children’s, £120; Temperance, £73; City-
road, £96; Cancer, £115; German, £115.

Digitized by ^jOOQle

The Lancbt,] APP0INTMBNT8.—VACANCIES -BIRTHS, MARRIAGES, AND DEATHS. [Fkb. 5,1887. 297

The annual collections in aid of the local medical
charities were held in Nottingham on the 29th and 80th ult.

The fifty-fourth annual meeting of the subscribers
to the Sussex Eye Hospital was held at Brighton on the
27th ult The receipts exceeded those of previous years, but
additional subscriptions were appealed lor, the numbers of
patients being year by year on the increase.

Windsor Royal Dispensary and Infirmary.—
The report which was read on the 27th nit. at the annual
meeting of the supporters of this institution showed that
daring 1886 the total revenue amounted to £1989 and the
expenditure to £2036. The number of in-patients was 269,
a against 176 in 1885, and of out-patients 3661, as against
«23.

The annual general meeting of the National
Association for Supplying Female Medical Aid to the Women
of India was held on the 26th ult., under the presidency of
the Viceroy, who congratulated the Association upon the
firm hold it had obtained upon the affections and conviction
of the people of India. The funds amount to over three
and a half lakhs of rupees, bat an appeal was made for
farther assistance.

Sanitary Registration of Buildings Bill.— A
special meeting of the Council of the Sanitary Assurance
Association was held on Monday last, for the final revision
of the above Bill before presentation to the House of
Commons, Sir Joseph Fayrer, K.C.S.I., F.R.S., in the chair.
The new measure was adopted by the Council, and in the
absence of Dr. Farquharson, M.P., from England, it was
decided to aek Mr. C. C. Lacaita, M.P., to take charge of the
Bill in the House of Commons.

In his annual report to the Commissioners of
Sewem of the City of London, Dr. Saunders reports that
daring 1886 he has analysed 61 samples of milk, 22 of
whisky, 9 of gin, 16 of mustard, 27 of drugs, 10 of dis¬
infectants, 6 of water, 4 of butter and butterine, 2 of pepper,
2 of mineral waters, 2 of oil, 6 of pickles, 12 of preserved
herrings, 3 of bread, and 6 of arrowroot. Dr. Saunders
states that the apathy of the public in the working of the
Food and Drugs Acts, which he has previously commented
on, still continues.

Dorset County .Hospital. —The annual meeting of
the subscribers to this institution was held on the 27th ult„
when the report, which was read and adopted, showed that
the total receipts were £2454, and the expenditure £2387.
Charges of extravagance in the salaries of the paid staff,
and in the amount spent on surgical instruments and lint,
were made by several subscribers; and it was eventually
resolved that all future reports should be published at least
one week before the meeting, in order that the various items
may be carefully considered before their adoption by the
mbecribers.

appointments.

Successful applicantt far Vacancies, Secretariat of Public Tmtitutiona, and
•then pottesting information tut table for tbit column an invited to
forward it to The IA «cbt Office, directed to the Sub-Editor, not later
than 9 o'clock on the ihurtday morning of each week for publication in
Vie next number. _____

Ajums. James, M.D.Aber., M.R.C.3., ha* been re-elected Surgeon to the
Ashbunon and Buckfastleigb Cottage Hospital.

Baihon. Houter. M.B., C.M., M.R.C.S., L.R.C.P., has been appointed
Medical Officer to Chiiat’a College, Finchley, N., vice W. Phelps,
M.R.C.8.. resigned; also Medical Officer to the Convent of the
Good Shepherd, Finchley, N.. rloe W. Pbelpa, M.R.C.S., resigned.

Bukuton. T. H., L.R.C.P.Bd., M.B.C.8., baa been appointed Oculist
U> the Liverpool Royal Infirmary.

Bats. A. H.. L.R.C.P.Bd.. M.R.C.S., haa been appointed Medical
Officer for the 8econd District of the 8t. Alban’s Union.

I -War. J„ L.R.C.P.Bd., L.B.C.S.. baa been appointed by the Home
Office Certifying Factory Surgeon for Blmly, Sbeppey.

Hutchinson, A. 0.. M.B., C.M. Aber., haa been appointed Honorary
Medical Officer to the Brighton, Hove, and Preston Dispensary.

AswBit, Arthur C.. L.K.C.P., L.B.C.8., L.M.Ed., has been appointed
Surgeon to the Roman Gravels and Wotberton Lead Mines; also
Medical Officer and Public Vaccinator tothe Wort hen Diatrlotof the
Forden Union, Shropshire, vice T. L. Macartney, L.R.C.P., L.B.C.3.,
L-M.Brito., resi g ned.

Pollard, Charles. M.R.C.S., L.R.C.P., has been appointed Assistant
Medical Officer to the St. George’s Union Infirmary, Fulham road.

”*TC HF7rr ’ Merry, M.R.C.8., L.8.A., has been appointed Medical
Officer for the Workbonse and the Second District of the Bedminster
union.

Bodehtr. Jar. black. M B.. C.M.Bdln,. haa been appointed Medical
Bumhter to tba Nottingham School Board. -

Stark, Arthur C., M.B., C.M.Bd,. has been appointed Medical Offloer
for the Third District of the Romsej Union.

Stephenson, William. M.K.CB., L.S.A., has been appointed Honorary
Surgeon to the Beverley Cottage Hospital.

Stuart, Chas., M.B.. C.M.Bd., has been appointed Medical Offloer for
the Great Ay ton District of the Stokesley Union.

Ubsiiell, Henry, M.R.C.S., L.S.A., has been re-elected Surgeon to the
Ashburton and Buckfastlelgh Cottage Hospital.

Vo©AN, James N., L.H.O.P. Lond.. F.B.0.8 B.. has been appointed
Medical Officer for the St. Matthew’a District of the Ipswich
Union.

ilacmifs.

In compliance with the detire of numerous tubseriben, it hat been decided to
resume the publication under thil head of brief particulars of the variout
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should bs made to the
advertisement. _

Doncaster General Infirm art.— House Surgeon. Salary £100 per
annum, with board and residence in the houaa.

Royal Albert Hospital, Devonport.—Honorary 8nrgeon.

Tunbridge Wells General Hospital.— House-Surgeon and Secretary.
Salary £100 per annum, together with board, famished apartment*
in the hospital, gaa, firing, and attendaace.

|5irt{rs, ||Tarriagts, attit Jtatfrs.

BIRTHS.

Bell.—O n Dec. 30tb. at Meean Meer, Punjab, the wife of Surgeon
W. Howard Bell. Medical Staff, of a daughter.

Jobson.—O n the 36th ult., at Keillour House, Perthshire, the wife of
Brigade-Surgeon Jobson, M.D., of a son.

Murphy.—O n the 36th ult., the wife of Harry A. Murphy, L.R.C.S..

L.R.C.P.Bd., of Bolton, Lancashire, of a daughter.

Stride.—O n the 33rd ult., the wife of Anton Hugh Syrde, M.R.C.S., of
Northallerton, Yorkshire, of a son.

Taunton.—O n the 35th ult., at West Norwood. 8.E., the wife of W. M.

Taunton, M.B.C.P.Bd., M.R.O.8., of a daughter.

Wooldridge. — On the 29th ult., at Prlory-vlllaa, Barnes, 8.W.,
the wife of Leonard C. Wooldrldga, M.D., D.So., of a daughter.

MARRIAGES.

Branfoot—Cabter.— On Dec. 18th. at St. George's Cathedral, Madras,
Arthur Mudge Branfoot, Surgeon-Major, ITM.D., to Lucy Inues,
seooad daughter of H. R. P. Carter, Btq., of Madras.

Browne — Whitaker. — On the 27th ult.. at the Parish Church,
Leytonstone, Essex, William Browne, L.R.C.S., L.R.C.P.Bd., of
Stirling, to Agnes Mary, fourth daughter of the late Jaa. Whitaker,
of Elm field, Huddersfield.

Cheyne—Servant^. —On the 29th ult.. at Christ Church. Gipsy-tail',
by the Rev. B. Allen, Vicar, assisted by the Rev. C. W. Servants,
brother of the bride, W. Wat»on Cbeyne, M.B., P.R.C.8., of 59,
Welbeok-street, W„ to Maty q„... a, only daughter of the late Rev.
Wm. Servants. _ ,

Irvine—Hogg.— On the 27th ult., ** Hilton, near Perth, B. W. Irvine,
M.B.. C.M.Bd.. of Pitlochry, to Minnie, youngest daughter of the
late Jamea Hogg, of Lowvalleyfleld, Culroas.

Jessop—Rogers. — On the 27th ult., at St. Pancras Parish Church,
Edward Jessop, M.R.O.S.. L.R.C.P., of Retford, to Ada, youngest
daughter of Thomas Arnold Rogers, of Bndslelgh-street, Tavistock-
•quire.

Poland—Denham.— On the 31st ult.. at St. George’s Churcb, Edin¬
burgh, by the Rev. Archibald Scott, D.D., Minister of the Parish.
John Poland. F.R.C.S , of St. Thomaa’s-street, S.B.. third son of
K. H. Poland. Biq., Eliot Vsle, Blackheath, to Mary Roberta,
youngest daughter of Jamea Glover Denham, Esq., of Castle-terrace,
Edinburgh.

Potter— Du Bois.-On the 29th ult., at St. Marys, Biyanston-square,
by the Rev. C. H. Bowden. M.A., assisted by the Hon. Rev. Canon
Leigh. Henry POrcy Potter. F.R.C.S.Eng.. Kensington Infirmary,
W.. to Annie Blanche, third daughter of the late Douglas Du Bo is,
ot Thurloe square. _____

DEATHS.

Alexander.— Od the 27th ult., at Trinity-square, S.B., on hit 67th
birthday, Charles Linton Alexander, F.R.C.S., L.S.A.

Daubkny.— On the 26th ult., at Sau Remo. Italy, Henry Daubeny,
M.D., In the bilh vear of his age.

Liston.—O n the 28tb'ult., at her residence. 10, Glengyle-terrsce, Edin¬
burgh, Christina, widow of Robert Liston, F.R.8., F.R.C.S., Ao. t In
her 88th year.

Massey.— On the 29th ult., at Greek-street, Stockport, Thomas Massey,
M.R.O.S., aged 66.

Myrtle.— On the 2nd inst., at 348, Oxford-road, Manchester, Andrew
Scott Myrtle, juo., M.D., aged 24.

Prosser.—O n the 30th ult., at Bromsgrove, Worcestershire, Roger
Prosser, L.R.C.P.Bd.. M.R.C.3.. aged M.

Hawks.—O n the 29th ult., at Bath. William Wilson Rawea. Deputy
Inspector-General of Hospitals. Madras Army, In his 71st year.

Startin.— On the 26th ult., at Surbiton-hlll, the wife of Jamea Startin.
of 17, Sackville-street, Piccadilly, aged 37. ,

17 JL —A fee ofSt.it charged fbr the Insertion of Notices of Births,
Marriages, and Deaths.

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NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Ebb. 6,1867.

298 The Lancet,]

literal $)iarjj for % ensuing Eitk.

Monday, February 7.

Boyal London Ophthalmic Hospital, Moorfields.— Operations,
10J)0 A.M., and each day at the same hoar.

Boyal Westminster Ophthalmic Hospital.—O perations, 1.30 pji.,
and each day at the tame hour.

St. Mark’s Hospital.—O perations, a p.m. ; Tuesdays, same hoar.
Ohklska Hospital fob Women.—O perations! 2.30 p.m. j Thursday, 2.30.
Hospital fob Women, Soho-sqdahb.—O perations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Fbbb Hospital.—O perations, 2 p.m.

Boyal Orthopaedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 2 p.m., and
each day In the week at the same hour.

BOyal Institution of Great Britain. — 5 p.m. General Monthly
Meeting.

Odontological SocreTr op Grbat Britain. —8 p.m. Casual com¬
munications by Messrs. A. S. Underwood, B. G. Bette, Storer
Bennett, C. D. Davis, J. Ackery, W. H. Coffin, L. Matheaon,
C. Hollins, and Willoughby Weiss.—President’s Inaugural Address.
Society op Arts .—8 p.m. Dr. J. L. W. Thudichum: The Diseases of
Plants, with special regard to Agriculture and Forestry (Cantor
Lecture).

Medical Society of London.—8.30 p.m. Mr. Lennox Browne: Excision
of Half the Larynx,—Mr. S teph en Paget: Cases of Parotitis after
Abdominal Operation.—Mr. Hugh Smith : Bupture of Aneurysm
into Pericardial Cavity.

Tueftday, February 8.

Guy's Hospital.—O perations, 1.30 p.m., and on Friday at the same hour'
Ophthalmio Operations on Mondays at 1.30 and Thursdays at 2 P.M'
Sr. Thomas’s Hospital.—O phthalmio Operations, 4 p.m. ; Friday. 2 p.m.
Cancer Hospital, Brompton.—O perations. 2.30 p.m.; Saturday,2.30 p.m .
Westminster Hospital.—O perations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

St. Mary’s Hospital. —Operations. 1.30 p.m. Consultations, Monday,

1.30 p m. Skin Department. Mondays and Thursdays, 9.30 a.m.
Boyal Institution of Great Britain.—3 p.m. Prof. Arthur Gamgee:

The Function of Beapiration.

Boyal Medical and Chtruegical Society. — 8.30 p.m. Mr. Cant:
Clinioal Observations on Induration in the Primary Lesion of Syphilis
iu Women (communicated by Mr. Holmes).—Dr. Hebb: A case of
Actinomycosis Homlnis (communicated by Dr. Sturges).
Anthropological Institute of Great Britain and Irkland.—8.30 p.m.
Lieut.-Ool. Sir Charles Wilson: Notes on the Tribes of the Nile
Valley North of Khartoum.

Wednesday, February 9.

National Orthopedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew’s Hospital.—O perations, 1.30 p.m.; Saturday, same
hour. Ophthalmic Operations. Tuesdays and Thursdays, 1.80 p.m.
St. Thomas q Hospital.—O perations, 1.30 P.M.; Saturday, same hoar.
London Hospital. ^-Operations, 2 p.m.; Thursday* Saturday,samehour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital fob Women and Children.—O perations,

2.30 p.m.

University College Hospital.—O peration*, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.43 p.m. ; Saturday, 9.15 a.m.

Boyal Free Hospital.—O perations. 2 p.m., and on Saturday.

King’s College Hospital.—O perations, 3 to 4 p.m.; and on Friday,
2 P.M.; and Saturday, 1 p.m.

Cht£drkn's Hospital, Great Obmond-STreet.—O perations, 9 a.m.;
Saturday, same hour.

Epidemiological Society of London. — 8 p.m. Mr. John Moiri
Statistics of Small-pox Cases in the West Ham Hospitals during the
Epidemic of 1884 and 1885.—Dr. John Macpherson: A Memorandum
on Notices of Cholera in India before 1817.

Boyal Microscopical Society.— 8 p.m. Presidential Address by the
Rev. Dr. Dalllnger, F.B.S., on Recent Optical Improvements in the
Microscope, and the operation of the Darwinian Law amongst the
Minutest Organisms.

80CIETY op Arts .—8 p.M. Mr. A. Gordon Salamon : Purity of Beer.
British Gynecological Society.—8.30 p.m. Specimens will be shown
. by Mr. Bland Sutton. Dr. Pancourt Barnes, and others. Dr. Charles
' B. Fitzgerald : The Use and Abuse of Pessaries.

Thursday, February 10.

St. George’s Hospital.—O perations, l p.m.

St. Bartholomew’s Hospital,—S urgical Consultations, 1.30 p.m.
Charing-cross Hospital.—O perations, 2 P.m.

NflRTH-W est London Hospital.—O perations, 2.30 p.m,

Boyal Institution of Great Britain.—3 p.m. Prof. A. W. Rfloker :

, Molecular Forces.

Friday, February 11.

St. 8 x 0 roe's Hospital.—O phthalmia Operations, 1.30 p.m.

BoraxB ohth London Ophthalmic Hospital.— Operations. 2 p.m.
Society of Arts.— 8 p.m. Dr. George Watt. C.I.E. : The Economical
Condition of India.

Clinical Society of London.—8.30 p.m. Nephro-lithotomy—discussion
on papers read at the last meeting by Mr. Henry Morris, Mr. Marsh,
and Mr. Bennett.—Dr. Hughlings Jackson: A case of Crural
Monoplegia from Snhoortioal Disease.—Dr, Carrington: A case of
Bheumatlc Hyperpyrexia- Living SpecimensDr. A. H. Rpbinton :
A case of Ohkroot’s Joint Disease.

Boyal Institution of Great Britain.—9p.m. Mr. EdwardB.Poulton:

. Gilded OhrysaUdes.

Saturday, February 12.

Middlesex Hospital.—'O perations. 2 p.m.

Boyal,Ierottction of Great Britain.—3p.m. Mr. Carl Armbrnster:
Modern Composers of Classical Song—Rubenstein, Raff, and 'Grieg
(with Vocal Illustrations).

METEOROLOGICAL READINGS.

(Taken daily at 8M a.m. by StewartTi Instruments.)

The Lanowi Offloe, February 3rd, 1887.

Barometer Dlreo- j Solar I

rit , reduced to Uon Dry Wat Radix T _ D mg. Rain Beoafkaas
Rea Level ol Bulk Bulk, in Temp lalL 8J0 ajl

and 8J° F. Wind. I Vacuo.

and 8J* F. Wind. Vacuo. |

Jan. 28 30 39 W. 43 42 ... 51 37

„ 29 30-51 W. 50 48 ‘ .., 60 42

„ 30 30-36 8.W. 40 39 ... 47 87

„ 30 90-36 8.W. 40 39

,. 31 30-14 S.W. 47 46

Feb. 1 29-82 S.W. 60 48

,. 2 30-10 S.W. 87 35

„ 8 30*08 W. 60 47

51 37 ... Overcast

60 42 ... Overcast

47 87 ... Okmdy

53 39 ... Overcast

52 44 ... Clondy

60 38 *10 -Cloudy

62' 36 ‘09 Cloudy

Ituies, SJjenrt Cermmtitig, # to
Cmrrtsjnmbtnts.

It is especially requested that ear lyinteWpence of local event»
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office. ■■■ ■

All communications relating to the editorial business of the
journal must be addressed “ To the Editors .”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or forprivate informa¬
tion, must be authenticated by the names and addresses qf
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “ to the
Publisher.”

We cannot under take to return MSS. not used.

An Italian Daily Medical Journal.

An Italian correspondent informs us, with reference to a letter appearing
in our issue of Jau. 1st, that a dally medical journal is published in
Naples, called La Tt’Jorma Mtdiea, which enjoys a considerable circu¬
lation. The editor has recently issued a notice that prizes consisting
of gold medals will be awarded to the students who shall contribute
the best original articles on various branches of medical science. Tho
awards are to be adjudicated by a commission of professors of the
different universities.

Med. Stnfl .—Our correspondent has completely misapprehended our
views. We believe also that his opinions on the subject of rewards am
not those held by a large majority of'the officers.

Mr. Brinsley is referred to a general notice at the head of this oolnmn.

TO ALL WHOM IT MAY CONCERN.

To the Editors of The LiNCET.

Sirs,—A s an advertiser and answerer of advertisements in your journal
I will ask you to be so good as to give a place to the few remarks I make
on the above subject.

I have answered several advertisements ip your journal, in each case
sending an enclosed stamp for reply, along with a copy of my testimonials.
I have asked the persons to whom I wrote to be so good as to return my
testimonials and favour me with an early reply. I think if persons who
Insert any advertisement were for a moment to seriously consider that
such an act entails a certain amount of responsibility, and to look on tho
matter as a business transaction, they would at once see that it is neither-
business-like nor courteous to leave a reply unanswered, especially when a.
stamp is enclosed for a reply, and a request made to have one's testimonials
returned. Those who advertise should also bear in mind that they are*
not the only persons who do so; and that the person who answers their
announcements may very probably be in communication with other*,
who also desire to come to a settlement). When, therefore, an early
reply is asked for it ought as far as possible to be given, especially
when it is particularly requested, and a stamp enclosed to defray postage.
Surely It would be no hardship-—and very little trouble in such cases— to
return testimonials, and enclose a slip of paper with " declined with
thanks "when one Is hot disposed t*> have kay more to do in the matter. It
is alike to the interest of the advertiser and those who reply to adopt
such a course. I feel sure the subject ouly requires to be mentioned to
draw the attention of your clientele to the matter.

I uk Sirs, yours truly,

• Jan. 20th, 1887. Advertiser.

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Tuk Lancet,]

NOTES, COMMENTS, AND AN8WEHS TO CORRESPONDENTS.

[Fjsu.5, 1887. 299

FUBNEAUX JORDAN TESTIMONIAL FUND.

SEC03D LIST.

Coleman, T. M.. Bsq. ... £5 5
Browne. H. Langley, Esq. 3 3
Foster. B. H.. Bsq. ... 3 3

Johnson, O. J.. Bsq. ... 3 3
Pemberton, Oliver, J.P.,

K.K.OS.3 3

Pemberton. C. L. 11., Brq. 3 3
Bnulburr. J. P.. Esq. ... 3 3
Lewis. Christopher, M.D. 3 3
Willlngton. Dr. Wm. ... 3 3
Owen, D. C. Llojd,

F.R.CAI. 3 3

VTllson. Wright, Bsq. ... 2 2

Bond, Dr Francis.3 3

Kills, H. D’Aroy, Bsq. ... 1 1
Kvane, A. P., Bsq. ... 1 1

Fox well. Dr. A.1 1

Giant. J. P.. Bsq. 1 1

Gettings, John 3., Brq. ... I 1

Gibb. E., Keq. . 1 1

Grinling, J. C., Bsq. ... I 1
Banner. J. B., Bsq. ... 1 1
Hxrmjir. J., Bsq. _. ... 1 1

0 | Johnston, A. K.. Bsq. ... £110

0 HAycraft, Prol, B. 110

0 Martin, J.. Bsq. 110

0 1 Moore. O.W. B.. Bsq. ...110
I Neal. J. Hreward. Bsq. ... 1 1 0

0 j Price. B. Bsq. 110

0 I Robinson. Dr. Edmund ... 110
0 ' Sanders, Chat.. Esq. ... 1 1 0

0 I SAundby. Dr. Robert ... 1 1 0

0 i Simon. Dr. Robert ... 1 1 0

i Standiah, Thomas, Esq.... 1 1 0

0 Underhill, Frank, Esq. ... I 1 0

0 Van Vestrant, Esq. ... 1 1 0

0 Windle, Prof. B. C. A. ... I 1 0

0 Whltehouse, J., F.H.G.S. I 1 0

0 Whltehouse, John. Ksq. ...110
0 Wood, Horatio, Esq. ... 1 1 0

0 Weston, 9. L. Darby, Esq. 110
0 Young. T. B., Esq. ... 110
0 Fowler, Walter, P.R.G.3. 0 10 d

0 Lawrence. S. C.. Bsq. ... 0 10 rt

0 Westwood, H. O., Bsq. ... 0 10 rt

0 Sunderland, Wm., Bsq. ... 0 10 0

Subscriptions may be forwarded to the treasurer, Mr. T. H. Bartleet,
27, New hall-street, Birmingham, or to the secretaries. Messrs. Benn<^t
81, Bdmond-street. and Jordan Lloyd, 23, Broad-street.

*fr. J. He!knotty .—Our correspondent does not supply all the material
which would enable a precise opinion to be given. When oold air Is
heated it requires increased moisture to prevent it from becoming dry
and Irritating. The amount of moisture required must necessarily
depend upon the amount of increase of temperature resulting from
the heating. The proper amount of moisture in air for breathing
thould be from 66 to 75 per cent, of saturation, and the absolute
amount which should be added to each cubic foot of air thus warmed
can be calculated from the following table, which gives In grains troy
the moisture contained In each cubic foot of air when saturated at
different degrees of temperature:—

30 1-3 -I 70 8-0

30 ...... 3-0 80 . 10-0

40 3-9 I 90 160

60 10 1 100 19-0

.4 Sufer.-Wf may perhaps take an early opportunity of going fully
into the subject.

i/r. W. H. Bull .—Miss Warden's Institution at Brookiey-hlll, 8 tanmore.

•• OBSTINATE CONSTIPATION IN AN INFANT."

To the Editort of The LaXCKT.

Sots.—If your correspondent. •• O. P. Q.,” will read Dr. Chenille's
L-otore on the Pathology and Treatment of Chronic Constipation In
Children, contained In The Laxckt of Dec. 4th (pp. 1063-1061) and 11th
■ pp. 1116-1118), 1886, he may find some hints for treatment that may be
useful, i have acted as locum tenens for a doctor who used to treat
constipation In Infants, generally with success, with a mixture as
follows:—Q. Res. podophyllln, gr.l.; sp. rect., 3 I.; syrup, aurant., 3 U. j
aqua ad Jiss. One toaapoonful to be taken every night. I saw a child of
ux years old that received much benefit from taking two-minim doses of
Unctore of nux vomica in water dally, as recommended by Dr. Ringer.
Dr. Goodhart, in his Manual on Diseases of Children, first edition, p. 41 v
draws attention to the association of small fissures about the anus with
obstinate cons t ipa t ion, and recommend# " the lower inch of the bowel
end anus to be well greased with an ointment composed of equal parts of
lead, zinc, and mercurial ointments, or the Assure may be dusted with
rqual parts of calomel and oxide of zinc."

I am. Sirs, yours faithfully,

Jan. 29th. 1887. W. P. P.

Mr. George Pyeroft (Kenton). — We certainly cannot commend the
practice referred to. If unwelcome, the book might be returned.

LATERAL CURVATURE.

7b the Editors of Tkz Lascxt.

Situ,—A patient of mine, a girl aged fourteen yean. Is suffering from
lateral curvature of the spine. The deformity la not very much at
present—in fact, it waa only about a month ago that her parents Ant
noticed anything the matter. There is, however, a distinct bulging of the
ribs, with projection of the lower end of the scapula on one side. Could
you kindly Inform me of any form of strap or other apparatus which
would be of use In such a case ? I am, 8 irs, yours faithfully,

Jaa. 20 th, 1887. Graduatr.

V We would not advise any strap or other appliance of the kind, but
regular and .proper exe r cise of the spinal muscles, together with the
correction of hod habits In standing and sitting, and general tonic
treatment.—Bx>. L.

Medical Appulttwbjits trr thk Coloxiks.

Mr. J. Goodhidok Axdkrsox writes“ It will be very necessary for
those who think of taking appointments in the colonies to be qnite
sure of what they are going to before they go to it and find themselves
in a strange country, among strange people, under circumstances
very different from what they had been led to expect, and without the
means of getting home again. I see in the table published in your
last issue that the salaries In the Windward Islands are stated to
range from £200 to £100. This if not correct. The salaries In Tobago
are £100 a year. They were £200 ; but some year or so bark, money
being scarce, and It being discovered that the Act under which the
medical officers were appointed set forth that they should be paid
salaries not exoeedhig £300 a year. It neaded only a stroke of the
governor's pen to make those salaries £100 a year. I need hardly say
timt the stroke was made. I know little, beyond hearsay, of the
medical services of the other West Indian colonies ; but they are
mostly, if not all. Crown colonies. In which the Crown—i.e., the
governor for file time being—is paramount. In the larger of these
colonies the salaries offer a certain compensation for what the holders
of medical appointments have to pat ap with In connexion with
them ; In the smaller colonies there Is no compensation whatever, and
they should be avoided by every man with even the smallest modicum
of self-respect."

G. H. /’. — The question Is a difficult one to discuss, though many
attempts at Its elucidation have been made.

Doubtful — No; there are many reasons why the question shonld be
decided In the negative.

M.B .—The L.S. A. cannot a 4 - present be counted as a double qualification.

Viator.—Mr. L. Brack, 36, Castlerengh-street, 8ydney.

THE GENERAL MEDICAL COUNCIL AND UNQUALIFIED
ASSISTANTS.

To the Editors of The Laxcet.

Sirs,—C an you lend your powerful aid In behalf of a body of men who,
through the proposed action of the General Medical Council, are about
to become the victims of a, to them, sweeping and cruel law abolishing
their vocation? Are scores of hard-working and valuable men to their
employers to be thrown on the world, many of them married and with
families depending on them; some, if not the greater number, too old
to embark in any other walk of life; few, alas 1 with the means? If it is
made illegal for a medical man to employ an unqualified assistant,
although many general practitioners prefer to do so, and these men are
deprived of their livelihood with their wives and families, what Is there
before them ? The workhouse ? Are we all to be ruined by the profession
many of us have served so long and faithfully ? Many of us are working
our way slowly Into the legitimate ranks of the profession, perishing
onrselves, depriving ourselves of small luxuries, saving what we can of
our not too liberal salaries, so that wo can pay for lectures and hospital,
and still maintain the appearanoe of gentlemen. Others, who have
unfortunately married and hare families, have no such hope, bub
manage to live decently and respectably. Some of the very men who
are now our moat bitter enemies have been unqualified assistants them¬
selves. They used the same atepplng-stones; but now they have
arrived safely on the other bank, they would kick away the stones, so
that no one else may croas, except by the new bridge. Is there no way
by which, at all events, the man who are now holding the unenviable
position of unqualified assistants may be protected ? Could not these
men, as has been suggested by a writer In your columns, be allowed to
register as assistants, and no fresh admissions be allowed after a certain
date, confining them to holding appointments as general assistants, nob
allowing them to practise "under cover,” and striking them off the
Register if found doing so. The race would soon die out. Many In
course of time would qualify, and the others would gradually
disappear. Such an act was allowed In 1815—the same almost—by the
pharmaceutical and dental professions, and last year by the Canadian
authorities. These men are to be registered as medical practitioners on
passing a practical examination before three medical men and payment
of a fee. If yon would lend year powerful voice In.the settlement of
this, to many men, vital question, their deep gratitude would be due to
you. It has been suggested that a representa t ive meeting of bond-fide
unqualified assistants be held in London, and resolutions forwarded to
the General Medical Council. This would, I think, be a wise proceeding.
Entreating your advocacy for a deserving body of men,

I am. Sirs, yours faithfully,

Jan. 18th, 1887. UxqtJALmnn Asshtaxt.

Medical Nkighbourlixiss.

T. B. B .—When a medical man is called upon in an emergency to see
the patient of a medical neighbour who chances to be out of the way,
it Is his duty to act for his neighbour, and to transfer the oase to the
ordinary attendant. Every medical man occasionally needs neigh¬
bourly kindness of this sort, and there Is something wrong In any
neighbourhood In which it cannot be relied on.

Dr. Blncknum (Portsmouth).—The paper baa been received.

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300 Thu Lancet,]

NQTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Feb. 5, 1887.

The University of Berlut.

The number of student* at the University of Berlin increases yearly.
It is stated that during this winter more student* have matriculated
than in any term since the foundation of the University in 1810. |
In the theological, medical, law, and philosophical faculties there
are Wo? regularly matriculated students, and, adding the other schools
which are also part* of the Uni versity, the number rises to the aggregate
ofd680. E very country ef Europe, except a few minor Turkish provinces,
is represented, and also are Asia, Africa, Australia, and America.
Tha United State. Is represented by 149 students, Russia by 98,
Switzerland by 80, Orest Britain by 18, Japan by 31, and Turkey by 7.

Mr. Thai. Edwards.— If such diseases as those mentioned were cured by
medical measures, the power of legal recovery would be good.

Mr.'D. Jones (Bicester).—The West-end Hospital, Welbeck-street, would
probab’y receive the case.

Mr. H. E. Facet/. — We do not copy letters from the pages of our
contemporaries.

M. H. C. P. — The proposition appears to us to be impracticable.

THB CLIMATE OF THB SOITH-WBST OF ENGLAND.

To the Editors of The Ljlxcet.

Sibs,—I n your issue of Jan. 29th you have an interesting reference to
the blossoming ,of the primrose in the .open air during the present
month, and you interpret the true value which flowers furnish of the
meteorological and geological conditions in which they have been
placed. It is a subject In which so many of your readers are Interested,
that I trust you will find room to record the fact that at the present
date the subjoined plants are In blossom In the sheltered valleys of this
district. In addition to the veronica. In variety, there are the primrose,
violet, snowdrop, and the following herbaceous plants and shrubs now
in bloom—viz., Bscallonia macrantha, Gentiana veraa. Genista fragrans,
Coronilla lberica, Brici codonodes, Anemone fulgens. Primula purpurea,
Godetla Albemarle, Cherlautbuschriri, Berberis DsrwinH, Rhododendron
dauricum, the old “ monthly’’ rdse, and red carnation.

I am. Sirs, your faithful servant,

• Edwv.v Slade-Kin'O,

Ilfracombe, Jan. 29th, 1897. Medieal Officer- of Health.

SCIENCE IN THfe NURSERY.

To the Editors of The Lamcet.

SlR«,—I learn from the St. James’s Budget that an Incnbatfng experi¬
ment is now proceeding at Glasgow upon three children who made their
appearance in the world rather earlier than was good for them. What a
grand opportunity It is'for testing General Pleasanton’s (of Philadelphia)
plan, and of the alleged efficacy of the mazarine blue glass being inserted
alternately with the usual pl vin white in the nursery windows of the
olive branches, as explained in his very Interesting little book published 1
by Messrs. Tritbner and Co., Ludgate-hill.

I am, Sirs, yours faithfully.

Saltbnrn-by-the-Sea, Jan. 26th, 1887. H. G. J. be S.

AN APPEAL.

To the Editors of Tub Laxcbt.

Sirs.—M ay 1 venture to appeal through yoor columns to the generosity i
of our profession on behalf of the aged widow (82) of a surgeon, long
sinoe dead. She is in urgent need of asslstanoe to enable her to pay
debts contracted daring a long illness. The smallest sum will be thank¬
fully received and acknowledged by

Yours faithfully, I

Thomas Brookes, M.R.O.S., L.S.A. I
Whitchurch. Tavistock, Devon, Jan. 27th, 1887. I

Communications, Letters, Ac., have been received from — Mr. Bryant.
London; Dr. Mapother, London; Mr. 8 . Shell,' Sheffield; Mr. Dawson
Talt, Birmingham ; Mr. Bennett May. Birmingham ; Dr. Sedgwick
Saunders ; Dr. Fothergtll, London ; Dr. Linde, Boss; Mr. Bull, Stony
Stratford; Mr. C. J. Bond. Leicester; Mr. Upton, London ; Sir John
Lubbock. Beckenham; Dr. P. A. A. Smith. Cheltenham; Mr. Mark
Judge. London; Mr. Blake. Dublin; Mr. Lankester, London; Mr. L.
Humphry, Cambridge ; Mr. Whitsed, Hurstplerpoiut; Mr. Frank
Smith ; Dr. Has lam. Birmingham ; Dr. Hawkes. Northampton ;
Mr. Brooks, Whitchurch ; Dr. Dunlop, Jersey; Messrs. Boulton and
Paul. Norwioh ; Dr. Hurry, Beading; Dr. Dudgeon, London; Dr. Joy
Jeffries, Boston, L'.S.A.; Mr. K. Bonham,-London ; Messrs. Blake and
Co., Leeds i Dr. Sinolair, Dundee; Dr. Rosenau, London; Mr. H. B.
Dow; London; Mr. W. T. Kyle, London; Mr. Curtis, Liverpool;
Dr. Davies, Denbigh; Mr. Reid. Canterbury; Messrs. Shanks and
Co.. London; Mr. Gibson,Bromley; Mr. Kershaw. London; Mr. Bland
Button. London ; Mr. 8 porgln, Maryport; Mr. Glendlnning; Mr. W.
VVelss, London; Dr. Wahltnch. Manchester; Dr. Anderson, MWdle-
thorpe ; Mr. Welpton. Bavensthorpe ; Mr. H. V. Knaggs. London;
Messrs. Thorn. London; Dr. J. Rutherford, Dumfries; Dr. Carriok
Murray; Dr. J. H. Clarko, London ; Mr. Monks. Wigan; Mr. Laing.
Biyth; Mr. C. J. Symonds, London; i)r. Goaeett, Canterbury, New
Zealand ; Mr. Barff, London ; Mr. Allen, Chicago ; Messrs. Lee and
Martin.Birmingham; Dr.Dawson,Southbonrn-on-SSa; Dr.Main,Bast
Ilslgy; Mr. K. Thornton, London; Dr. F. Warner, London; Mr.B. J.
Kitts. London; Mr. C. D. Green. Loudon; Dr. Steal, Abergavenny;
Messrs. Waltham Bros., Stockwell; Dr. Crooke, Portsmouth ; Mr. J.
Anderson, London; Mr. Green, London; Mr. Page, Taunton ; Mr. W.
Jones; Miss Glelbzmann, Clifton; Mr. Gurnet-, London ; Dr. Langley.
London ; Messrs. Street and Sons. Gottdfosd; Messr s . Macmillan and
Co., London; Messrs. Read and Donald, Perth; Messrs. Whitfield
^nd Co„ Birmingham; Mr. Calderwood, Battersea> Meters. B*tU*>
and Co., Paris; Mrs. Adams, Hollington ; Mr. Blliott, Carlisle ; Mr. T.
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Harbmtt lottos

QH

CANCER OF THE UTERUS.

By J. WILLIAMS, M.D. Lom, F.R.C.P.,

OMTJTTBIC PHTSXCtlX TO UJIITBIUUTT COLLKGIi HOSPITAL, LONDOS.

LECTURE III.

Gkntlbsikn,—M ost of the cases given were perhaps too
little advanced to manifest secondary growths discoverable
by clinical investigation, aad in only three of them was the
disease watched to the end and a post-mortem examination
made. In these the glands along the internal iliac vessels,
and in one those along the spine, were cancerous. The
amro -uterine ligaments were not affected in any of them,
bat tbe cellular tissue around the cervix and in the broad
ligaments was diseased in two.

Small cancerous masses are sometimes seen on the interior
of the body of tbe uterus in cases of primary cancer of the
oervix. These are sometimes spoken of as secondary de¬
posits. It is, however, difficult to see how secondary deposit*
can be produced in the body of the uterus from a primary
cancer of the oervix. Neither the arrangement of the blood¬
vessels nor .that of the lymphatics can explain it, and it
appears more reasonable to regard such formations as new
growths from independent een tree—such as I have described
m occurring in tbe oervix itself. They are not often met
with.

Age seems to have a considerable influence on this form of
cancer, though no age above twenty-eight years excludes it.
The oldest patient was eighty-one, the youngest twenty-
nine. There was only one under thirty; there were six
between thirty and forty, aad fifteen between forty and
fifty; there was one between fifty and sixty, and one over
eighty. So that during the ten years In which the menopause
generally occurs this disease is far more rife than at any
other period of life; it is next most frequent between thirty
and forty; and it is comparatively rare before thirty and after
fifty. The history of the menstrual function throws no more
light on this form of cancer than it does on that of the portio
vaginalis. The age at the time of marriage and the duration
of married life throws iust as little.

With regard to childbearing, it is to be noted that two, or
a twelfth of the whole number, had never been pregnant;
four had had one child; two had had one child ana one mis¬
carriage ; two had had two children; one had had two children
and abortions; one had had three children; one, three and
one abortion; one had had four children ; one, five and five
abortions; one, seven; one, eight; one, eight and five abor¬
tions ; one, eleven and one miscarriage; and one, thirteen
aad two miscarriages. So that fourteen out of the twenty-
four had been pregnant fewer than five times.

The characters of the labours, again, appear to have no
influence on the production of cancer. Of sixteen cases in
which this point was investigated, eleven had had good, one
had had lingering, and five had had difficult labours. Only
two of these required the use of the forceps: one five times,
the cervix being probably cancerous on the last occasion;
and one once, the cervix being probably cancerous at the
time. So that we have two cases only among the whole
number in which labour had been instrumental.

The chief symptoms of cancer are haemorrhage, pain,
discharges, and wasting. Haemorrhage was present in
greater or less amount in all the cases. Its quantity, how¬
ever, varied greatly, and the time of its appearance with
respect to the onset of the disease not less. In some it
began at a very early stage, while in others It set in only
when the growth had attained a large size. For instance,
in one case haemorrhage had been present for three years
when first seen; the disease affected the whole of tbe
cervix, but the surface of the portio was still intact. In
this instance the haemorrhage began probably soon after tbe
growth commenced. In another case, again, where there
was a large growth in oae lip, haemorrhage had been present
for three weeks only. Pain may be absent throughout: it

No. 3311.

was absent, or present in a very slight degree, in six of
these cases. When present it is often relieved by the onset
of bleeding and by lying down. Discharges are commonly

E resent; four of those with advanced disease had none, six
ad an offensive discharge, five a watery, two a greenish,
four a yellow, and one a white discharge. Wasting was
present in varying degrees. Eight of the patients had lost
much flesh, six very little, and all these presented a sonw-
what advanced stage of cancer, except the one who was
eighty-one years of age. In some cases extreme emaciation
was present, while in others, even at the time of death,
there was an abundance Of subcutaneous fat. Micturition
was frequent in only five of all the cases: in the two eaoea
in which the disease began near the internal oriftefc, in
two in which the whole of the cervix was diseased, and in
the old woman. As a rule, when the disease attacks the
lower part of the cervix the bladder is not disturbed until a
very advanced stage of it. •

There is a view of the etiology of cancer of the cervix
and portio vaginalis which has been recently brought into
prominence, chiefly because it has been made the ground
for procedures of an operative kind: I mean tbe view that
lacerations of the cervix are a cause of cancer. If this view
be correct, it has a very important bearing on treatment of a
prophylactic character; on the other hand, if it be vntrae,
it has a no less important bearing in an opposite direction.
It has been said again and again that lacerations of the
cervix are the cause of cancer of the lower part of the a tern*,
and that the cure of the lacerations by Emmett’s operation
is a means of preventing the development of the disease.
Now, what is tne evidence with regard to this view? Are
there any known facts which favour or oppose it ? One
fact which favours this view, or which is supposed to fhvoor
it, is that cancer is frequent in women who have bad many
children. Laceration of the cervix occurs so frequently m
first labours—and probably far more frequently than in
subsequent ones—that we cannot regard multipanty as tba
cause of lacerations as against uni parity. Indeed; it may
fairly be said that when laoerStion is present, tbe time when
it was produced was during the first labour; and if this be
true, and if it be also true that laceration of tbe dervix is a
cause of cancer, uniparity should be as frequent a cause of
cancer as multiparity; and if multiparity is really a cans*
of cancer as against uniparity, then we most explain
the fact in some other way than by the kicermtion present.
In the next place, cancer is often present in association with
laceration. But association does not necessarily involve the
relation of cause and effeot--a fact too frequently lost sight
of in the study of uterine disease. It is said, moreovefr, that
lacerations occasion the development of cancer by reasen of
the irritation to which they give rise. Now, if tibia be true,
we should expect to find the starting-point* of cancer-to lie
at the place of greatest irritation—that is, in or dose to the
tear, or in the surface of the irritated part. But what are
the facts? I have described to you cases of cancer of the
portio vaginalis and of cancer of the cervix proper in asso¬
ciation with lacerations, but in no instance have I seen it
attack the lacerated part primarily. Indeed, it app ears t o
avoid it, and to invade it only after the rest of the cervix
has become involved in the disease. The tear is the last
part to be attacked. Bnt it may be said that although earner
does not commence in lacerations, yet it beguie in the
everted or irritated surfaces of the lips. I have beat ahle to
trace cancer primarily to the surface in no single instance,
except in tbe variety of Bquamoua epithelioma, whan it
necessarily begins on the surface. But in cases of squamous
epithelioma the disease beg his on any part of the d nrfn os of
the vaginal portion, except perhaps the edges of the tear*—
a fact wbica does not favour the view f am discussing.
When cancer attacks the cervix proper, it begins, in so far
as r have been able to discover, in the glands in the sahstance
of tbe cervix, and a layer of non-cancerous glands is often,
though not always, seen between the disease and the surface.
Thisis the condition preeent whether laceration exists ear
not, and the fact that the disease begins in the same situation
in the lacerated and the non-Iacerated cervix militates
against tbe view that lacerations are an important) factor in
the development of cancer. Moreover, if irritation be stieh
a very frequent cause of cancer of the nterns as is some¬
times maintained, the disease should be frequently met with
in the procident uterus; but this, again, is not the case.
In some hundreds of eases of canoer of tbe uterus Whfcfc l
have seen there was but one in wHeh the organ won pree*-

G

O

302 Thb Lancet,]

DE. J. WILLIAMS ON CANCER OF THE UTERUS*

[Feb. 12,1887.

•lent. It appears to me that the facts at present known
tend to show that lacerations play no important, if any, part
in the causation of cancer.

CANOBR OF THB BODY OF THB UTBRU8.

The next part of our subject is cancer of the body of the
uterus. This is a form of cancer which is much less common
than that of the cervix, and indeed it was at one time
thought that cancer never attacked this part of the organ
primarily. It is certain that the disease occurs much more
frequently than is generally supposed. Pichot has collected
forty-four cases of what he terms cancer of the body of the
uterus. They are all apparently cases of malignant disease,
but there is no sufficient evidence that they are all cases of
cancer. In saying this I wish it to be understood that no
case can be scientifically admitted to be a case of cancer
unless sections of the growth have been submitted to
examination with the microscope. Tbis brings us down to
very recent times—past the time when microscopic examina¬
tion of tissues meant the examination of scrapings and the
search for characteristic cells; down to the time when the
arrangement of the various elements of a growth were
examined into and their relations observed m their un¬
disturbed position in sections. Ruge and Veit have described
more or less fully twenty-one cases in which the nature of
the disease was established by microscopic evidence. I have
seen twelve cases which were believed to be malignant
disease of the body of the uterus, but in only three of them
was the growth ascertained to be cancer by microscopical
examination, and consequently these three only are of
sufficient value to serve my purpose in these lectures. It
would only lead to confusion were I to introduce cases as
basis for description around the nature of which—that is,
whether they were sarcoma or carcinoma—any doubt rests.
These cases, together with those recorded by Ruge and Veit,
will mainly form the material for the description of cancer
of the body which I shall give you.

Garb 20.—The patient was a widow aged fifty-two. She
was admitted into University College Hospital complaining
of a profuse and offensive vaginal discharge, which excoriated
and caused swelling of the external parts. She was a nurse, ■
and eight years previously she received a shock through the
sudden death of a patient. This brought on a sanguineous
discharge, which has continued more or less ever since. She
has been losing flesh for some time, but more especially
during the last three months. She was married at twenty-
two. Her husband lived eight years. She had one child
twelve months after her marriage, and no miscarriages. She
said that during the lifetime of her husband she had sore-
throat, lost her hair, and took medicine which made her
gums sore and teeth to ache. She had a polypus removed
from the womb five years ago. She began to menstruate in
hear twelfth year, was pooriy every three weeks, losing a
good deal, with bearing-down pain in the abdomen. After
the birth of her child the flow returned regularly, but
in far greater quantity, and with much more pain than
before her marriage. She has suffered from leucorrhoea
since she was fifteen. There was no history of cancer in
her family.

On admission in January, 1881, she was pale, amende, and
emaciated; the pulse was 100, and temperature 99° F. The
uterus appeared to be of the normal size, but less movable
than natural. The cervix was normal, except that a small
villous growth could be felt in the os. The outline of the
body could not be made out, and the sound was not used.
Examination by the rectum revealed several nodules
apparently growing from the posterior wall of the uterus.
There was little or no tenderness.

The villous growth projecting in the os was removed. On
Feb. 6th she had several rigors, and her temperature went
up to 105°, and remained above 100° until Feb. 10th. This
attack of fever was accompanied by severe pain in, and
exquisite tenderness over, the whole of the abdomen. A
month afterwards Bhe had a similar attack, but without
rigors. With these exceptions her temperature remained
between 99° and 100°, and her pulse was over 100 a minute.
She complained also of globus and other symptoms usually
called hysterical. In March there was oedema of the vulva,
aud a hard growth about the size of a hazel-nut projected
slightly through the os. There was copious greenish-yellow
discharge with some blood. She gradually became weaker,
and died on March 20th. At the necropsy the small intestines
were adherent to the fundus of the uterus and the posterior
wall of the bladder. There was a small cyst at the end of

the Fallopian tube. At the posterior part of the uterus
there were several nodules, two of the size of cherries, others
smaller, projecting into the peritoneal cavity. These were
of a whitish colour, with injection around them. The upper
half of the posterior surface in the middle and the fundus
were white and bloodless. The rest, especially the sides,
were of a purplish colour, with the veins injected. There
was a big nodule on the anterior surface where the
intestines were attached, and a communication which
admitted the thumb was found between the adherent intes¬
tine and the cavity of the uterus. The ovaries were white
and atrophied. The uterine wall varied from one-half to
one inch in thickness. The cavity of the uterus was a fetid
abscess; its surface was irregularly nodular and of a
greyish-green colour; beneath this was & layer of highly
vascular tissue, and still deeper the altered uterine tissue.
The cancer was glandular.

Casb 21. —This patient was fifty-two years of age, and
was admitted into the hospital in January, 1884. She had
enjoyed good health until fifteen months before, and was a
strong woman. “Menstruation,” which had ceased about
nine years previous to this date, recommenced, and recurred
about every three weeks. At this time the flow was of the
ordinary colour and not profuse. It lasted at first for two or
three weeks, but latterly only for one day. For the last
five months bleeding had ceased entirely, but a yellow-
offensive discharge had been continuously present. Some
time after the bleeding commenced labour-like pain was felt
at the bottom of the stomach and back, but since January,
1883, the pain had been seated principally in the right side
of the pelvis and down the right leg, shooting at times to
the left side. For some years before her illness* the patient
suffered from pain in passing urine, and micturition be¬
came frequent in June, 1883, for which she had a growth
removed from the “ entrance to the bladder.” Micturition,
continued to be frequent after the operation. There had
been no difficulty or pain in defecation. She had lost touch
flesh during the previous fifteen months. Menstruation began
at fifteen, was regular and painful, and ceased at forty-three.
She had been twice married ; first at twenty-three. Daring
her first marriage she had four children; one child and one
miscarriage during the second. All her labours were natural.
One sister died of cancer of the womb in an asylum.

On admission the patient was thin, but not greatly
emaciated. The perineum was excoriated. There was a
small superficial ulcer on the inside of the right labium. On
the vaginal wall were about a dozen small greenish patches,
which felt slightly raised to the finger; there was no loss of
tissue. The anterior lip of the uterus was thickened by a
growth which projected into the cervical canal, which bled
on examination. The uterus was freely movable; the
body was a little enlarged, thick, and roundish, eo that the
whole of the uterus—body and cervix—approached a
globular form. There was no thickening anywhere in the
pelvis. The sound passed in three inches. The chief thicken¬
ing was in the anterior wall. The cavity of the body was
considerably enlarged; the sound conld be moved about
freely in it. A good deal of bleeding followed.

The uterus *as extirpated. The parts removed consisted
of the whole utems, with the exception of a small irregular
rounded portion situated on the left side of the middle line,
and reaching almost to the origin of the Fallopian tube.
The margin of the opening when this piece was absent
was lacerated and nodular. The absent portion was about
one centimetre in diameter. The whole organ was increased
in size—laterally and antero-posteriorly. The external os
and cervix for the lower two-thirds were normal in appear¬
ance, but soft and pale. The cavity of the uterus contained
some dirty muco-pus. The surface was occupied by a
nodular new growth, which on section was seeD to extend
into the muscular wall as pinkish-white granular-looking
growths, the tissue which ft invaded appearing gelatinous.
The nodules of new growth were irregularly scattered over
the inner surface, but were thickest on the right ride of the
posterior wall. Outside the new growth everywhere exoept
at the point mentioned was a layer of muscle and perito¬
neum, which varied from one to three millimetres in thick¬
ness. A month after the operation the patient died. The
wound had almost entirely healed, but there was a small
abscess in the remains of the right broad ligament. In the
small intestine were several small fistulous openings, which
were connected with the scar of the operation. The kidneys
and ureters were normal; but the bladder was in a state of
chronic inflammation.

Tins Lancet,]

DB. J. WILLIAMS ON CANCER OF THE UTERUS.

[Fbb. 12,1887., 303

Cask 22.—The patient, n single woman, aged sixty-three,
was admitted into University College.Hospital in January,
1833. She said that she had been losing blood from the vagina
occasionally for two years, but not much until March, 1882,
when she lost a great quantity, and since then she had been
continually losing more than sh e had from the commencement
of her illness until that date. She bad fainted several times
from the loss of blood. She suffered no pain until the previous
March, but since that date she had suffered pain on and off
in the bottom of the back and stomach ; it was twitching
in character, an^ never lasted more than a minute; it was
never severe enough to lay her up, and was not made worse
by walking. After the bleedings there was a slight yellow
offensive discharge. Micturition had been at times frequent,
and sometimes scalding. The patient had suffered for
two months from acute eczema of both arras. She had
lost much flesh since her illness; her appetite was good.
Menstruation began in her thirteenth year; usually regular
and profuse, but vithout pain. It ceased in her fifty-fourth
year. She saw nothing afterwards for six years; then she
bad & slight bleeding twice; after chat it ceased for one
year, and since that time she had bled frequently. There
was no history of cancer in her family.

On admission, she was well nourished and fat. The hymen
was intact and the vagina senile. The body of the uterus
was large and nodular, and filled the pelvis ; it could be felt
above the pelvic brim, and it appeared to extend further
to the left than to the right. The cervix was far back, very
short; the lips were softish. There was no tenderness. The
vagina contained a dark-brownish very offensive discharge.
Temperature 98‘4° to 99 6° F. ■,

The cavity of the uterus was scraped, after which the
bleeding and discharge ceased for sortie time. She ulti¬
mately died in the cancer ward of the Middlesex Hospital,
under the care of Mr. Henry Morris, through whose courtesy,
together with that of Dr. Kingston Fowler, I am enabled to
give an account of the appearances found at the necropsy,
and a drawing of the uterusThe body was well nourished.
There were several firm adhesions between the omentum
and the parietal peritoneum. A large swelling having the
appearance of a uterine fibroid was seen at the lower part
or the abdominal cavity. The intestines in the middle line
of the abdomen were matted together, forming a sac, which
on being tom open was found to communicate with the
bowel, and appeared to be the seat of a slight faecal
accumulation. The lungs contained several secondary
cancerous nodules scattered over the pleural surfaces.
Numerous minute secondary deposits were round on the sur¬
face and in the substance of the liver. There were three
cancerous deposits of the size of peas on the surface of the
right kidney. In other respects the kidneys were fairly
healthy. The uterus was large and its walls contained three
fibroid tfimoure, two of which were calcified and of the size of
walnuts, and one was as large as a man's fist. The walls were
much thickened. The inner surface of the body was every¬
where cancerous, irregular, and ulcerating. The cervix was
healthy. The cancer bad cot invaded the fibroid growths,
but had penetrated through the part of the wall free from
fibroids into the broad ligament on the left side, and.formed
a large mass in that situation, apparently involving the
ovary and Fallopian tube. The Fallopian tubes on each
side were inflamed and contained pus. The cancer was
glandular, and the glands presented a very remarkable
appearance. JIany of them were coiled up in spaces so
that the spaces appeared in section to be filled by circles of
columnar epithelium without any connective tissue frame¬
work. In many places the epithelial cells appeared normal,
while in others they were altered, many-shaped, and more ;
or less broken down. The nodules in the liver presented a
glandular structure similar to that of the glands in the |
HUM

Outcer of the body may be diffuse or circumscribed. The
diffuse form is much the more common; indeed, I have not
met with an. instance of the circumscribed. Several cases of
tbe latter, however, have been described. They assume a
polypoidal shape, and the uterine trail at their base may be
healthy, or they may form sessile tumours and grow in the
substance of the uterine wall, projecting into the uterine
cavity like a submucous fibroid. In the former case the
disease may have originated in a poly pus already formed, as
in Case 19, in which a raucous polypus of the cervix was
removed while undi Tgoingthe process of incoming a cancer;
or it may develop from the first in the form of a polyp. In
th® second ease, when the cancer dips deeply into the

uterine wall, it is not improbable that it begins in the deeper
portions of the gland, as it so often does, in the cervix, and
then as it grows it becomes more and more superficial and
prominent in the uterine cavity ; at the same time it pene¬
trates deeper and deeper into the uterine wall. The further
growth of the polypoid form is said to be, not superficial,
but in a radial direction towards the peritone um. The
polyp may break down and disappear and leave, a mass of
cancer in the uterine wall, but; connected with the surface.
In this way Huge and Veit explain tlieorigin of circumscribed
masses in the uterine wall described as primary, and it is
in many cases probably a correct explanation; but there is
no impossibility, and indeed no improbability, that cancer
may begin in the deeper portions of the uterine glands and
there form nodules iu the wall just as we found to occur in
the cervix, for the uterine glands are known to enter deeply
into the muscular wall of the body of the uterus. The
diffuse form affects usually the whole of the inner surface
of the body. Whether this is the case from the beginning, cr
whether it is the result of its mode of growth, is not known,
and is difficult to determine. In some cases, however, a
part of the surface escapes. The cervix is generally
respected until a late period. The surface is villous, rough,
and ulcerated, or covered with warty nodules, sessile
masses, or polypi. The uterus is usually much enlarged;
sometimes, however, the enlargement is not great, and. even
very slight; the wall becomes thickened and hypertrophied
by a process, it is said, similar to that which takes place .
during early pregnancy. As the cancer grows, the suc¬
cessive deeper layers of the wall become involved, and
the muscular part becomes thinner and thinner. The
cavity of the uterus is iu some cases considerably elongated
and deformed, in others but little; in some, after the
disease breaks down the cavity increases in capacity. In
some cases, or in some pert of the uterine surface, the
disease is quite superficial, the decidua not being much
thickened, although diseased throughout, as in Cose 22. ‘
The disease grows from the glands; it may perhaps begin
also in the epithelium of the surface. This has not
been actually observed, but the fact that the whole of
the surface is generally involved—at least in the specimens
which have been examined—is in favour of this mode of
origin.

Several cases have been recorded in which fibroid tumours
were present with cancer; one of my cases was such. In
this case the cancer clearly grew from the uterine glands,
and had not invaded the fibroid. Klob, however, has re¬
corded a case in which a fibroid was present and cancerous.
He was of opinion that the cancer had commenced, in the
fibroid. His case is imperfectly recorded, ami the growth
had begun to break down and to slough, so that the
tissues over it had been destroyed, and were in a con¬
dition which precluded the possibility of establishing
the view of the case adopted by Klob. Moreover, all the
histological evidence collected goes to show that cancer
of the body begins nowhere except in the epithelium
of the surface or of the glandB. It has further been
shown by the observations of Buhl and Buge that cancer
may extend from the mucosa covering a fibroid and involve
the fibroid itself.

The direction or lines of growth of cancer of the body
appears to be in two directions—rt hat is, such os to involve
the surface and to spread into the deeper structures: The
spread of the disease superficially is often stopped at the
inner orifice of the uteruB and the openings of the Fallopian
tubes; and this, although not invariable, appears to be the
rule. In some of my cases the cancer had posted the os
internum and invaded the cervix; and in a specimen in the
museum of St. Bartholomew’s Hospital, already referred to,
the disease had invaded the Fallopian tubes.

(7b be concluded:)

Staffordshire General . Infirmary. —At th©
annual meeting of the governors of this institution, on th©
28th ult., it was reported that the ordinary income for th©
ast year was £2142, and the expenditure £2953. The books
aving been neglected, it was impossible to ascertain the
number of patients who bad been treated. A letter vfas
read from Dr. C. H. Crawford resigning his appointment as
physician to the hospital, and a resolution thanking him for
his thirteen years’ services, and expressing the regret of
the board of governors at his retirement, was unanimously-
agreed to. e

304 The Lancet,]

ME. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY.

[Feb. 12, 1887.

ABSTRACTS OF THE

Erasmus fcctrarts

OK

EVOLUTION IN PATHOLOGY.

Delivered at the Royal College of Surgeons of England ,

By J. BLAND SUTTON, F.R.C.S.,

ASSISTAXT-SUBQKOX TO THB MIDDLK3KX HOSPITAL.

LECTURE II.

SUPPBBSSION OP PARTS.—( Continued.)

Mb. Pbesident and Gentlemen,—To the student of
mammalian anatomy it has always been a somewhat
remarkable fact that, whatever the length and flexibility of
the neck, the number of cervical vertebrae remains almost
constant; whereas in birds the reverse of this obtains, for
the cervical vertebra are extremely variable in number—
a pigeon may possess thirteen or fourteen, but the swan has
twenty-five, whilst in the extinct plesiosauria as many as
forty cervicals existed in some species. Parker, in his
valuable memoir, “ The Development of the Green Turtle,”
has found that at one stage in the embryology of this form
fifty-one somatomes are visible externally, but in the adult
only forty-one vertebra are developed, and an examination
of the embryos in various stages clearly shows that seven
somatomes in the neck and three in the caudal series abort.
This suggests an ancestry from forms having a longer neck
■and tail than existing turtles, and the free suppression of
parts indicates a modification by shortening of a form not
unlike a plesiosaur. There is abundant evidence to support
the view, which at first seems somewhat strange, that there
exists an undoubted correlation between the hand and the
number of the cervical vertebra. In such vertebrates as
birds the number of the cervical vertebra and the saddle-
shaped articular facets on their centra confer great mobility,
and enables the beak to perform actions which rival in
delicacy those of the hand and fingers. It is beyond all
dispute that as the functions of the hand increase in pre¬
cision so the number and size of the cervical elements of the
spinal column diminish.

In the green turtle we saw that in the embryo several
somatomes were suppressed, and now I shall enter upon a
discussion to show that it is exceedingly probable that a
similar suppression of somites occurs in man. In the first

{ dace, the disposition of the cervioal nerves suggests that at
east one vertebra has disappeared, for in order to har¬
monise the arrangement of spinal nerves in the cervical
region with what pertains in other parts of the column an
extra vertebra is requisite. Apart from these anatomical
speculations, the observations of teratologists go to show
that in the various regions of the column suppression of
somites occurs. Professor Humphry 1 has drawn attention
to Otto’s observation of a spine in which there was deficiency
of one-half of the eleventh dorsal vertebra; also a case
described by Bandifort in which one-half of the seventh
cervical and of the ninth and eleventh dorsal vertebra is
absent, the remaining half being wedge-shaped. Dr. Good-
hart a has described a foetal vertebral column preserved in
the mnseum of the Royal College of Surgeons in which only
four and a half cervical vertebra can be made out. The
malformation was associated with spina bifida. In the
report of the Spina Bifida Committee oi the Clinical Society
a sacrum is figured in which the left halves of the first and
third segments are absent. Willett and Walsham have
published a detailed account of a remarkable suppression of
vertebra in a woman aged thirty-one dissected by them,
and have referred to the specimens mentioned above. There
is in the museum of the Middlesex Hospital a well-prepared
skeleton of a presumably full-grown female, in whom there
is lateral curvature of the spine caused by absence of one-
half of a dorsal vertebra, apparently the third. (Fig. 5.)
Now, all these cases illustrate suppression of halves of

i The Human Skeleton, p. 133.

* Journal of Anatomy and Physiology, voL lx., p. 9.

the vertebra belonging to spines presenting less than the
normal number. It bccasionnlly happens, however, that
the half vertebra is in excess of the proper number. Thus
in a case Rokitanski records in his “Pathological Anatomy”
(vol. iii., p. 230) there were four half vertebra, with their
half arches and processes, too many. They were so placed
on the two sides as to compensate one another, and cause
four curves in the spine, two in the dorsal, one in the
dorso-lumbar region, and the fourth involved the sacrum.
This case, in conjunction with examples of supernumerary
vertebra occurring in the lumbar and sacral'series, can only
be explained satisfactorily by the hypothesis that during
development mesoblastic somites become suppressed, which
in the ancestors of man assumed a functional condition.
Every human anatomist of moderate experience knows full
well that the coccyx may consist of three, four, or five
segments. That among mammals the caudal vertebra may
vary from three in the tailless monkey Inuus to as many as
forty-six in Manis longicauda. If it is true that meso¬
blastic somites are suppressed in other parts of the column,
but occasionally attain complete development, we ought to
have them reappearing in the caudal series.

When we remember that some sharks and serpents may
possess the prodigious number of three hundred vertebra
whilst man has only thirty-one, it necessarily follows that
a great many segments of the spinal column have under¬
gone suppression. This is still more marked when we

Fio. 5.

A half vertebra, from the spine of man. (After Reid.)

compare the vertebral column of a frog with that of a fish,
for the frog’s spine is normally composed of only nine
vertebra, this being an unusually small number when com¬
pared with vertebrata in general. This fact alone would
suggest that supernumerary vertebra ought to occur in
frogs. Bourne* has recorded a case in which a spine of
Rana temporaria was composed of ten vertebra, and
Howes 4 has also described a similar specimen, which agreed
in its main details with Bourne’s case; in each the super¬
numerary vertebra was in the sacral region.

The notion of tailed men is usually treated with ridicule
because on careful examination the supposed cases have
turned out to be lipomata, spina bifida, or coccygeal
tumours. But human foetuses with tails are certainly met
with. A careful examination and description of such a case
is given by Gerlach ;* in this case the tail not only contained
striated muscle fibre, but notochord.

To return to the question of half vertebra. Professor
Albrecht* has reported an anomaly of this character which
occurred in a python (Python sebse). The skeleton consisted
of 333 vertebra, but interpolated between the 195th and

* Quarterly Journal of Microscopical Salence, vol. xxii\, 1884: On
certain Abnormalities of the Common Frog.

4 Anatomlacher Anzelger, Nu. 11. 1886: On some Abnormalities of
the Frog’s Vertebral Column.

5 Bln Fall von Sohwantbildnng bei eiaem menscbliohen Embryo.
Morp. Jahr., Bd. vi.. s. 106. 1880.

* Bulletin du Musie Royal d'Histolre Naturelle de Belgique, tom. xl.,
1888.

Digitized by G00gle

Thx Lxncbt,]

ME. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY.

[Feb. 12 1887. 305

196th segment on the left side was an additional half vertebra.
That in the normal course of events the vertebral centra
are developed from a single nucleus is beyond all doubt; the

C have been carefully investigated by many observers:

e spent many hours in vainly hunting for two nuclei.
It is equally certain that under exceptional circumstances
two centres may be deposited and remain independent, os is
the ordinary method in the ossification of the odontoid
process of the axis. We must also remember that Muller
detected two nuclei in the sacral vertebras of birds. 7 Cope*
bos recorded the following interesting observation, that in
on extinct batrachian found in the Permian formation of
Texas the vertebral bodies are composed of two lateral
pieces. The skeleton belonged to the order Ganocephala,
and was named Eryops megalocephala. Between each
vertebra a large intercentrum was developed, and the
centrum of each vertebra consisted of two lateral pieces or
pleurocentra. A similar condition of things existed in other
strange forms belonging to this order. Thus there is good
reason to believe that in the bilateral nuclei for the odontoid
bone we have an instance of the retention of a primitive
character, whilst in the occasional existence of a half
vertebra, either in excess or diminution, or accompanied
by disturbance in the normal ossification of the column,
we have to deal with atavistic phenomena.

The conclusions which may be legitimately drawn from
the foregoing facts may be summed up in a few brief state¬
ments:—1. During development the human embryo possesses
more mesoblastic somites than are utilised in the formation of
the permanent vertebral column. 2. At least one undergoes
suppression in the cervical and lumbar region respectively,
and probably many in the caudal segment of the column.
3. Occasionally one, or half of one 6omite, usually suppressed,
may persist, and give rise to a supernumerary vertebra or
half vertebra; or the suppression may extend beyond its
usual limits, and the total number of segments in the
column be fewer than usual. The diminution may affect
only one half of a vertebra. 4. Under exceptional circum¬
stances a vertebral centrum may arise from two distinct
centres of ossification; this must be regarded as indicating
the reappearance of on ancestral character. The study of
the evolution of the spinal column teems with illustrations of
the two laws—namely, those of suppression and coalescence.

Parasitic Foetuses .—These may vary from a shapeless
moss of varying proportions to a more or less fully formed
individual attached to a perfect child. They ore most
common in the sacral region, and they may occur on any
vertebrate from fish to man. A careful consideration of
preserved specimens, as well as actual observations on the
eggs of fish and amphibia tend to show that from a single
ovum two embryos may be produced. This conclusion is
supported by the following facts: 1. Thero is a continuous
series of forms from one extreme of duplicity to the other.
2. Each embryo in a double monstrosity is smaller as a rule,
but never larger than a normal single foetus. If the
duplicity were the result of the fusion of two ova, this
condition would not be so constant. 3. Double monsters
ore invariably of the same sex. These facts render it pro¬
bable that when twins occur of the same sex they are the
products of a single ovum. Parasitic foetuses and super¬
numerary limbs in the sacral region may be regarded as
suppressed embryos, the autosite and parasite originating
from one ovum.

We must now.consider some points in the history of
the mammalian ovary of considerable importance. The
fecundity of fish is proverbial; it has been estimated that the
roe of a cod-fish contains 9,344,000 ova. From various
obvious intrinsic and extrinsic causes only a fraction of this
number attain an adult condition, and in the same way only
a small fraction of those actually hatched come to maturity.
Of the very large number of eggs deposited by frogs only a
small proportion of the tadpoles resulting therefrom attain
an adult condition. The same is equally true of birds.
Thus a bird which produces ten pairs of young during its
lifetime (and this is far below the fertility of many birds)
will, if we take its life at five years, increase to a hundred
millions in about forty years. (Wallace.) Yet only a small
proportion of the ova become mature. What is true of fish,
batrachians. and birds is equally true of mammals, including
man. _ Waldever has computed that the ovaries of a fcetus
contain at birth no fewer than 300,000 ova. This is an

T Johannes Mailer.

1 Pros. American Philoeoph. Soc., vol. xlx., p. 61, 1880-83.

exceedingly high estimate, and a very large margin must
be allowed for portions of the same ovum appearing in two
or more sections. Be this as it may, it is certain that
if a section of the ovary of a fcetus be compared with
one taken from a girl at puberty, diminution in the
number of the ova is a most striking feature. This
can only be accounted for in two ways: either many
of them are suppressed without advancing beyond the
foetal stage, or they ripen and undergo retrogressive
changes. As a matter of fact, the ripening of ova, the
formation of Graafian follicles and corpora lutea, commences
very early, even at the seventh month of fce'al life. It
appears that this fact was known to Volisneri in 1733; but
attention was turned to this question in consequence of
the writings of Carus (1837) and Ritchie (1842).' Several
investigators have turned their attention to the subject,
among whom may be mentioned Waldeyer, Beigel, De Sindty,
and Balfour. The researches of Beigel are especially interest¬
ing ; for he shows most conclusively that the ova not only
ripen in foetal ovaries, but the follicles undergo retrogressive
changes and form corpora lutea. I have examined sys¬
tematically a very large number of fcetal ovaries, and am
able to confirm the statement that the follicles enlarge,
the ova ripen, and then undergo suppression. It must
be borne in mind that few of these early ova are really
shed into the peritoneal cavity, as occurs at and after
puberty. The various changes are represented in Fig. 6.
This ripening and suppression of ova is not confined to
fcetal life or the period immediately succeeding birth; it
goes on continuously, but at a diminished rate, from its
commencement to puberly, as I have assured myself by
examining ovaries of children at all ages between these two
extremes. Ova shed in the interval between birth and

Fro. 6.

mmm-'

• I*.? . 'V-

Section of on ovanr of a lumen foetus at the ninth month.
b f, Ovum In iu follicle, o n, Corpus lateum. Cyst.

puberty are not to be regarded as abortive, for there ore
instances, fortunately rare, in which girls have been
impregnated at the age of ten.

Having satisfied my mind beyond all doubt that this
remarkable suppression of ova occurs in the human foetus
as a normal process and not an occasional event, I secured
the ovary from the foetuses of mammals as widely different
as a monkey and a kangaroo, a lemur and a sloth, a
Japanese deer and a cat. The species selected were the
bonnet monkey (Macacos sinicus), the great kangaroo
(Macropus major), the ring-tailed lemur (Lemur catta^
and a deer (Cervus sika), besides other immature forms. In
all these cases the ovaries exhibited follicles in every stage of
development, growth, and suppression. If this process goes on
in the ovaries of mammals as widely different as the species
named in the above list, there can be little doubt that
it is general throughout the mammalian series, and there
are good reasons to believe that the process occurs in
animals outside the mammalian circle. The only explana¬
tion to be offered concerning this phenomenon seems to be
this: Mammals are to be regarded as derivatives from
amphibian forms, which in their turn had a piscine ancestry.
In order to maintain themselves in due proportion they
must bring forth a large number of offspring, so as to
guard against the wholesale destruction of their young by
their natural enemies. The higher mammals are in a very
large measure exempt from this danger, and the necessity
for such extraordinary fecundity as the Ichthyopsida mani¬
fest is averted. Nevertheless, by virtue of the law of
inheritance the ovary possesses an enormous number of
ova. Although mammals are thus spared the trouble
of bringing such large numbers of young into the world,
the suppression of ova acts as an intrinsic source of danger.

* Talt: Dlieatea of the Ovary.

306 Thk Lanckt,]

SIR JOSEPH FAYRER ON DISEASE IN THE PUNJAB.

[Fbb. 12,1887.

for these unused follicles become in some instances the
source of ovarian cysts, not in the human female only,
but in the individual species throughout the subkingdom
mammalia. It serves as an excellent instance of the appli¬
cation of evolution to pathology. Further evidence regarding
the fecundity of the progenitors of the human species is
furnished by organs other than the ovaries.

If I were asked by a student to furnish him with a single
character, selected from the arterial system of mammals,
which could be relied upon as a distinguishing feature in
their anatomy, 1 should certainly choose the internal tnam-
mary and deep epigastric arteries. These remarkable vessels
form, a double line of communication situated on each side
of the median line of the abdomen, and serve to connect the
subclavian and iliac systems. The parallel offered by two
main arterial stems coursing along the ventral aspect of the
trunk seems to correspond so closely with the two main
stems of the primitive sort® that a morphological explana¬
tion of this character seemed irresistible. Prolonged medi¬
cation and continued observation directed to this question
have at length served to convince me that these arteries
have some relation with the original disposition of the
mammary glands. In man and many quadrumana among
the higher Eutheria, and in Sirenia (manatee and dugong)
among the lower, the mammas are situated on the thorax.
In the cow, mare, ass, and the like the mammae occupy an
inguinal position. The insectivorous Eutheria, as in so many
other characters, hold an intermediate place in this respect, for
the teats extend from the pectoral to the abdominal region,
lu the bats the mammas may occupy, as in Pteropus, the
ttx'illaj; this is also the case in Guleopithecus; whilst m some
l-nrirs these glands are placed on the arms. These last-
im-iirioned situations are altogether exceptional; the most

common regions are the
Fig. 7. pectoral, abdominal, and

, , inguinal. These facts are

, J ft w suggestive of a primitive

. r disposition of the mammary
•- i glands aloDg the whole
/ : 1 length of the ventral aspect

of the trunk. If it be pro¬
bable that this remarkable
disposition of arteries is in
any way related to the
primitive arrangement of
these glands, it would ne¬
cessarily follow that in
cases where the suppressed
mamma; reappeared assuper-
numerary organs they ought
most frequently to occur in
relation with these vessels.
This is exactly what happens.
Supernumerary nipples and
mammre are by no means
rare, for one observer, Dr. J. Mitchell Bruce, in a careful and
valuable paper, 10 has considered sixty-five cases which came
under his observation in three years. This observer informs
U3 that out of 207 men examined in succession O il percent,
presented a supernumerary nipple, and of 104 women
•P807 per cent, la the majority of coses the additional
nipple was single, and without exception situated on
the front of the trunk below and within the ordinary
nipple, and more frequently on the left than on the
right side. In more than one iustance the anterior abdo¬
minal wall was the seat of the abnormality (Fig. 7). Until the
appearance of Professor Leichtenstern’s oft-quoted paper 11
supernumerary mamma; were believed to be extremely rare,
and it is to this writer that the credit is due of exposing the
fallacy. I am unaware of any observer who has personally
examined sixty-five and eleveu additional cases, except Dr.
Mitchell Bruce; Leichtenstem’s total was made up of thirteen
cases noticed by himself and ninety-two recorded by others.
These records clearly show that supernumerary nipples in
nearly all cases follow closely the line of the internal
mammary aud deep epigastric arteries. The occurrence of
nipples in male mammals is capable of easy explanation.
Darwin was of this opinion: “ If we suppose that during a
former prolonged period male animals aided the females
in nursing their offspring, aud that afterwards from
some cause (as from the production of a smaller number

nernumprary nipple situated on
abdominal wall of a boy.

Journal of Anatomy and Pliysiologv, vol. xiP., p. 425.

i> Virchow’s Archiv, Bl.dxxiii.

of young) the males ceased to give this aid, disuee of
the organs during maturity would lead to their becoming
inactive.” 1 * This view is very plausible and possible, but it is
equally probable that, as every mammal at one period of
embryonic life is hermaphroditic, the mammas persist as
remnants of that condition; in the same way the functional
parovarian in the female represents the efferent ducts of the
male gland. The fact that supernumerary mammae occur
twice as frequently in the male as in the female is to be
accounted for on tbe principle of correlation. The female
mammte are functional, and require more blood-supply; this
leads to dwarfing of the adjoining glands. The contrary of
this pertains in the male. Our knowledge of accessory
nipples and glands lias been considerably increased since
Darwin considered the matter, for, hiving regard to the very
rare and in some instances questionable cases of supernumerary
mamma; on the thigh and back, he thought that they
weakened the probability of reversion. This did not prevent
him ending the discussion in this way; “ On the whole,
we may well doubt if additional mammae would ever have
been developed in both sexes of mankind had not his early
progenitors been provided with more than a single pair.’”
No one can examine the evidence since accumulated without
agreeing with this view; hence accessory mamma; must be
regarded as atavistic structures in a true sense, and their
occurrence in not confined to men, for they are not
infrequently seen in other mammals, especially cows.
The very valuable inquiry conducted by Dr. Champneys, 1 *
“On the Development of Mammary Functions by the Skin
of Lying-in Women,” adds a new interest to the matter,
for it seems to prove that supernumerary mammas without
nipples may lie hidden under the skin of tbe axilla, and
become active when stimulated by the increased function
of the normal mamma; at the termination of pregnahey.
Thus, the only conclusion one can arrive at from these faets
is that the suppression of ova in foetal ovaries and the very
frequent occurrence of supernumerary mamma and nipples
are indicative of an ancestry from forms which not only
produced a greater number of offspring, but in whom the
males assisted in giving suck to the young.

It is impossible to reflect upon tbe preceding facts without
feeling convinced of the truth of Bacon’s remark: “No
natural phenomenon can be studied in itself alone, bnt to
be understood must be considered as it stands connected
with all nature.”

DISEASE IN THE PUNJAB.

By SIR JOSEPH FAYRER, M.D., F.R.&, K.C.S.I.

In the annual report on tbe sanitary 7 administration of
that part of Northern India included in the Government of
the Punjab for 1835, there are facts recorded which it may
be interesting to notice.

The population, according to the last census, is 17,514,978 _
Tbe deaths from all causes among these were as follows:—

Per 1000.

Cholera . 1,936 O10

Small-pox . 7,575 040

Fevers . 340,763 18 - 40

Bowel complaints... 17,711 0’94

Injuries. 127,606 677

All causes . 507,140 26iX)

This return shows how relatively small a part cholera plays
during some years in the mortality of the population, but how

very grave and important a death cause is found in climatic
fevers —a subject which stands much in need of further
investigation.

There are two items among the death causes which are of
special interest, and therefore worthy of attention. Under
the head of injuries, which gives 127,606 deaths, there are
recorded 852 from snake-bite, 146 from hydrophobia, and 17
from wild beasts—the latter item being small indeed com-

f ared with the same returns from other parts of India.

he deaths from snake-bite are doubtlesss due to Naja
tripudians, or the cobra; Bungarus cceruleus, or krait; and
Echis carinata, or small (carpet) viper; and must, one
supposes, be considered as inevitable, albeit it is difficult not
to consider them as among those deaths which should be
regarded as preventable. The hydrophobia cases, which

l * Descent of Man. i* Med.-Gblr. Irani., vol, lxtx., p. 419

Thu Lanckt,J DR. A. J. WALL: CONSIDERATIONS IN

seem to be on the increase, certainly suggest a similar idea ;
and. also that here would be an excellent opportunity ot
tasting Pasteur’s method of treatment—a suggestion which
may perchance be deemed not unworthy of adoption by some
of our medical officers in the Punjab.

The following details are taken from the report cited; one
of the lost, it is to be feared, which will be drawn up by
Brigade-Surgeon Bellew, C.S.I., whose retirement deprives
India of one of her most distinguished sanitary officers:—

“The total deaths registered under the head of ‘snake¬
bite’ were 852, against 900 in the previous year. In the
following districts the number of deaths due to snake¬
bite was larger than in the rest of the districts in the pro¬
vince: Lahore, 67; Mooltan, 61; Gujranwula, 58; Jhelum,
51; Muzaffargarb, 49; Knngra,48; Thaug, 45; Montgomery,
‘2; Karnul, 41. It appears from the returns for the pre¬
vious years that in these districts deaths from snnke-bite
are always more numerous than in the other parts of the
province.

“Tho deaths from * hydrophobia’ have of late years very
considerably increased, as will be seen from the subjoined

table:—

1886 .

. 146 1 1881 .

. ... 139

1884 .

. 158 | 1880 .

. ... 107

1883 .

.. ... 117 1 1879 .

. ... 69

1882 .

... 128

Of the 146 deaths registered duriug the year under review.
20 occurred in Hoshiarpur, 19 in Lahore, 18 in Amritsar,
o in Mooltan, 7 in each of the districts of Ilissar, Ludhiana,
Gurdaspur, Montgomery, and Sialkot.

"Five deaths were caused by scorpion sting—viz, 4 in
Peshawar and 1 in Mooltan.

“The number of persons killed by wild beasts was as
follows: Carried away by wolves, 3; by jackals, 7; torn by
a leopard, 1; by boar, 1; by bears, 3; killed by crocodiles, 2. |
There are comparatively few tigers in this part of India.

“ The deaths j-egistered under the head of 4 other causes ’
were 127,604. Of this number 27,390 were due to chest
diseases.”

The above shows what an ample field exists for the study
of disease in India, and what large opportunities our young
medical officers may enjoy of prosecuting their studies in
pitbology, epidemiology, and hygiene in all its branches,
fbe subject of fevers especially needs elucidation, and
■hoold be studied in a spirit of independence as regards
preconceived notions of fever etiology.

Wlmpole-*twet, W._

SOME CONSIDERATIONS IN REGARD TO
THE CAUSATION OF SEX.

By A. J. WALL, M.D.Lond.,

K.M. IXDIAR ARMY.

(Concluded fro* jnuje t>i.}.)

In* the cases of the fathers and mothers that have been
■ aken it will be observed that each has been treated
without reference to the other. The inlluence of the age of
:he mother has been considered without regarding the age
of the father, and vice versa. But though this is so, yet,

- these were families whose parents married under the
rdinarv conditions and rules of society, it is clear that a
Ttry large proportion of the fathers were a few years older
1 ian the mother, and therefore these families must have a
preponderating influence. In fuct, in these statistics tbe
age of the father was on the average 6 6 years greater than
that of tbe mother in the whole 1200 families. But if we
take the proportions obtained from all these families and
contrast them with those we shall obtain by selecting
families in which wide differences existed between the ageB
of the fathers and mothers, we shall then be iu a position to
•*-** what results are due to these great differences of age.

There are in these tables 111 families in which the father
was considerably younger than the mother, the differences
wing n j ne months to ton years. Iu these families
t ere w.^re 546 children, 297 males and 249 females, or 119*2
■nal. ? to 100 females, being a groat excess of males over tbe
mt-au proportion of 107 - 4 to 100. If we divide these births
,nt ° periods according to the age of the mothers we obtain

REGARD TO CAUSATION OF S BX. [Feb. 12,1887. 307

the following results:—In the period of immaturity only two
children were born, one of eucii sex, showing rbst when the
father is younger than the mother, the mother as a rule
marries somewhat late in life. In the period from twenty-
two to twenty-eight years there were 86 births, 39 males
and 47 females, or only 82 9 males to 10U females, against
98 3 males to 100 females, which was the proportion for the
whole of the families, showing again how incapable the
immature male is of imprinting bis sex on tbe offspring
when the female is at her prime. From the twenty-eighth
to the thirty-eixth year inclusive of the mother, 179 males

Chart 3.
Ages of Mothers.

6ho»mg iIib number m mule ami female lurUis al diil-runt
(period* of the hj{ i>s of the mothers In families In w licli
the father was younger than the mother.

were born to 156 females, or 114 7 males to 100 females, or
on excess of male births over the 1116 males to 100 females
occurring in all families taken together; whereas in tbe
last period of decline of I lie power of the mother there were
78 males to only 45 females, or 173 3 males to 100 females,
an enormous excess of males over the proportion obtained
for this period at all ages of 114*2 males to 100 females.
Chart 3 shows those varying propor'ion.-.

Now let us contrast this with a series of families as widely
different, as possible—that is, where the father is much older
than the mother. In 111 fertile families in tlie<e tables the

( HART 4.

At, es of Mothers.

Showing the number of mala and female birth* at different
period* of the age* of the mother* in famiiie* in which
the father waa more than fifteen year* older than the
mother.

father was older than the mother by more than fifteen years,
rlie excess varying from fifteen years to forty-nine years.
In these families there were 519 children, 255* being males
and 264 being females, or only 965 males to 100 females,
being actually an excess of females at all tbe ages of tbe
mother taken together. During the period of immaturity of
the mother there were 34 males born to 39 females, or 87
males to 100 females, or au excess,of females. In the period
from twenty-two to twenty-seven years 100 males were
born to 91 females, or 109*8 males to 100 female*, or au

Digitized by CjOO^Ic

308 The Lancet,] DR. A. J. WALL: CONSIDERATIONS IN REGARD TO CAUSATION OP BEX. [Peb. 12,1887.

excess of males. From twenty-eight to thirty-six years
inclusive, 97 males were born to 103 females, or only 94 males
to 100 females; whereas in the last, or declining period of
life 24 males were born to 81 females, or only 77'4 males to
100 females, contrasting markedly with the proportion of
114-2 males to 100 females obtained for this period from
families at all ages of the fathers, and still more strongly with
the proportion of 173-3 males to 100 females obtained for the
eame period in families where the father was younger than
the mother. Chart 4 shows the results obtained from these
families, and, as it is drawn on the same scale as Chart 3,
it illustrates also the relative fertility of these families,
differing only in the age of the father, and shows how com¬
paratively infertile families are when the father is aged.

A table of these varying results will enable us better to
study the relation between these differences.

Number of Maxes born to 100 Females under

VARYING CIRCUM8TANCES AS TO THE

Age of the Parents.

A. At all ages of the mothers.

All births . 107 4

Where the father is younger than the mother. 119 2

Where the father is much older than the mother ... 96 5

B. Mothers below twenty- tico years of age.

All births in this period. 1149

Where the father is younger than the mother. 100 0

Where the father is much older than the mother ... 87 0

C. Mothers from tioenty-tioo to twenty-seven years.

All births at this period. 98 3

Where the father is younger than the mother. 82 9

Where the father is much older than the mother ... 109-8

D. Mothers from twenty-eight to thirty-six years.

All births at this period. 111*6

Where the father is younger than tho mother. 114 - 7

Where the father is much older than the mother ... 94-0

E. Mothers above thirty-six years.

All births at this period. 114-2

Where the father is younger than the mother. 173 3

Where the father is much older than the mother ... 77"4

P. At varying ages of the fathers.

Where the fathers are below twenty-two years of age 71’0
Fathers between twenty-two and thirty-six years ... 109 6
Fathers from thirty-seven to forty-eight years ... 1071
Fathers above forty-eight years . 92-4

These figures speak forHhe most part sufficiently clearly
for themselves. Thus the highest rate of male births (173 3
to 100) occurs when the mother is above thirty-six years
and the father'*' younger than th*- mother. The fewest
rate of nude JritSfas (Yi to 100) is seen when the father is
below twen£y-ti»jl yearn of age, and the next lowest (77-4 to
100) when toe mother is above thirty-six years of age and
the father la taore than fifteen years older than the mother.
A great eioess of females (82-9 males to 100 females) also
occurs-When the mother is between twenty-two and twenty-
sevdn years and the father is younger. It has long been
known that in illegitimate births the females are more
numerous than In legitimate births, and Darwin, whose
notice nothing seemed to escape, in his “ Descent of Man,”
suggests that the excess may be due to the want of care
that these mothers experience during parturition, leading to
ggflgiye deaths amongst the males from their greater size.

i renders it probable that the excess may be partly
' for by the mother being frequently at the age in
“"i of females is to be expected, and partly to the
a male is very often indeed at the age of
immaturity, an explanation to a certain extent to the credit
of humanity.

But there is one portion of this table that requires notice.
In all the births between twenty-two and twenty-seven
years of age of the mother, the male birth-rate is 98-8 to
100 females. But when the father is younger than the
mother, the male birth-rate sinks to 82-9 males to 100 females;
whereas when at the same age Of the mother the father is
more than fifteen years older than the mother, the male
birth*-rate, instead of sinking further, rises tol09-8 males, con¬
trary to all expectation* We mtftt therefore submit the 2275
births taking place at this period of the mothers age to a
more minute analysis, to which they are well entitled, as they
represent nearly one-third of the entire number of births.

In the first place, the greatest proportion of female births
obtains in the twenty-second ana twenty-third years of the
mother’s age, when the proportion is 87*9 males to 100
females. In regard to the age of the father, the greatest
proportion of male births for this period of the mother’s
age is when the father is between twenty-two and twenty-
eeven years. When at this period of twenty-two and
twenty-seven years of the mother’s age the father is younger
than the mother, but only by a few months, there are only
78 3 males born to 100 females; but when the father and
mother are as nearly as possible equal in age, the difference
not exceeding six months either way, the proportion of
males rises to 1457 to 100 females. But when the father is
older than the mother, but neither of them exceeding
twenty-seven years, the male birth-rats drops to 96-2 to 105
-females. Thus, we see that when the father and mother
are both at their prime, the influence of the male parent in
imprinting sex on the offspring is stronger than that of the
mother; but let the father be even a little beyond the prime,
or a little below it, and the mother is far more powerful.
When the father is between twenty-eight and thirty-six
years, the mother’s age still being between twenty-two and
twenty-seven, the birth-rate is 987 males to 100 females;
and when the father’s age rises to between thirty-seven and
forty-eight years, the male birth-rate drops to 95-4 to 100
females. But after this a great change occurs, for when
the father is older than forty-eight, the male birth-rate,
instead of dropping further, rises to 133 - 3 to 100 females.
Is this totally unexpected rise due merely to smallness of

Chart 5.

Ages of Fathers.

Showing the number of male and female birth* taking place
when the mother* are between twenty-two and twenty-
leven year* at different age* of the father*.

numbers, or to a real preponderance of male births under-
the8e circumstances? If we increase the number by
taking all births after the father has reached forty-
five years, the age of the mother remaining between
twenty-two and twenty-seven, we get an increased
proportion of males—-viz., 1387 males to 100 females.
So also when the mother is below twenty-two and the
father is above forty-five the proportion is 175 males
to 100 females. It seems, therefore, in the highest
degree probable that when the mother is under twenty-
eight and the father is very much older a considerable excess
of male births occurs. This agrees with what I have
observed in private families, and Historical evidence points
the same way: the cases of Louis XIII., our Edward VI..
the offspring of both the Napoleons, and many others will
occur to every reader. The explanation may be too obvious
to require mention here; but I do not think this. It
certainly cannot be due to the father having increased
sexual power in his declining years, for when the father is
above forty-eight, but the mother is between twenty-eicht
and thirty-six years, only 88 8 males are born to 100 females.
It will be far more reasonable to attribute it to the very
modified sexual feeling elicited in the female when the male
is “out of all reasonable match,” as Touchstone says, which
may produce an actual inhibitory effect on the nerves of the
generative system. If this be so, it would throw an addi¬
tional light on the reason why in illegitimate births there
should be an increased number of females, as these con¬
ditions are there reversed. Chart 5 shows the number of

Thx Lancxt,]

MINIMA VISIBILIA AND SENSORY CIRCLES.

[Fxb. 12,1887i, 3f)£

male and female births taking place when the mothers are
between twenty-two and twenty-seven years at the differ¬
ent ages of the fathers.

The results obtained may be briefly summed up by saying
that each parent while in his or her prime has the greatest
power of imprinting his or her sex on the offspring. That
probably the male is the most potent when the age is
-exactly equal. That the immature parent has very little
power of doing so, the immature male being peculiarly
powerless, for of all births when the fathers were below
twenty-two, the proportion of male births was only 71 to
100 females. That when there is a difference in the age of
the parents the sex of the offspring is most frequently that
of the parent who is nearest the prime of life; but that if
the male should be much older than the female, the female
being in her prime, a considerable excess of male births may
be expected. Thus, males are obtained with the greatest
amount of certainty with females above thirty-six years of
age and males distinctly younger, and the same result is
obtained with old males ana disproportionately young
females, and also with immature females. Whereas females
are greatly in excess if we take males under twenty-two
years of age and females above that age, or else males above
Ifty-six years of age with females about fifteen years or
twenty years younger.

It may be stated in addition, as a by-product of these
inquiries, that in England the peers, of whom a fair pro¬
portion marry in their prime have a considerable excess of
male children. The average age at marriage of fifty peers,
or eldest sons of peers, that had offspring was thirty years;
not one was below twenty-one years, and thirty-two were
above twenty-five years. The lowest classes in England,
who exercise about as much forethought in their domestic
arrangements as dogs, have also apparently an excess of
males. Of fifty fertile marriages of this class taken
indiscriminately, the dates being verified as far as possiblo,
twenty-three husbands were below twenty-one years of
age, and only six were above twenty-five, the average age
on marriage being twenty-two; the whole of the families, it
is scarcely necessary to add, were in receipt of charitable
relief. In the midole classes there appears to be an increased
proportion of female births through the later marriage of
the males. In England, with the exception of 1884, the

S tion of male births, as might be expected, has been
for many years. The cause of the rise in that year,
may not be continued, is far too obscure a subject to
be speculated on here.

In regard to the exact cause of sex, the evidence here
adduced is very unfavourable to the view that it depends
merely upon the number of spermatozoa that penetrate the
ovum. For we see that men at advanced age are even more
capable than very young men of producing males. And, again,
females in their prime give an excess of females with ma'es
somewhat older, but males are more common when tbe
father is greatly older. Not to discuss the question minutely,
it would seem that the vigour of the embryo-forming tissue
is a more important agent than its quantity, and (bat this
may be modified in various ways, tbe female element being
■especially liable to modification. There are not wanting,
for instance, cases in the tables that seem to imply that
anything that debilitates a parent renders it far less capable
of imprinting its sex on the offspring. These, however, are
points quite beside the present question, which iB the influence
of tbe age of the parents. But enough has been said in this
relation to prove how important a factor this is, for it can
change a mean proportional birth-rate of 107‘4 males to
100 females, on the one baud, to 71 males to 100 females,
and, on the other, to uo less than 173'3.

French Hospital and Dispensary.—T he nine¬
teenth annual dinner in aid of the funds of this charity
took place on the 6th Inst., Comte d’Aubigny in the chair.
Opened in 1867 and enlarged in 1878, it has afforded relief
to 4388 in-patients and to 100,176 out-patients, drawn from
24 nationalities, so that, although French in name, the
charity is cosmopolitan in character. During the evening
subscriptions amounting to about .£2000 were announced.

The governors of the Bedford Infirmary having
determined to purchase the fields contiguous to the build¬
ing from the Duke of Bedford’s trustees for £3360, an
intimation has been received from his Grace of his intention
to contribute £1000 towards tbe purchase-money, and a
■ike donation has been promised by Mr. Whitbread, M.P.

MINIMA VISIBILIA AND SENSORY CIRCLES.

By the lath BRIGADE SURGEON T. OUGHTON,

ARMY MEDICAL DEPARTMENT.

Harris found that a black square on a white card, the
side measuring T V in., is distinguishable as a mere speck at
the distance of 40 ft. from an emmetropic eye, whilst the
square is not perfectly defined in colour at a further distance
than 7 ft.; he found also that these distances corresponded
to visual angles of 44" and 4'6" respectively. Ernst
Weber’s experiments on the skin elaborate a result that
a circular metallic tube, the diameter measuring £ in., is felt
as a single point when pressed against the palm of the hand,
whilst its shape may be perceived with its diameter exceed¬
ing £ in. (sensory circle of the palm). Hence two varieties
of minimal perception may be recognised—viz., points and
areas (minimum visibiie vel tactile et punctorum et exten-
sionum vel formarum). Our present subject will deal with
the proposition that all minima are of a secondary nature,
defining and being defined by a limitation in the acuity of
muscle-perception. That there is such a limitation in the
apperception of visual angles is exemplified in the judgment
of apparent distance being liable to error in the retina of
actual objective distance, as well as in apparent relievo
being leBS marked in a like ratio (minimum motorium).
One strong argument consists in bracketing together the
non-existence of minima auditoria vel objectoria with tbe
absence of suitable motorial appendages to these senses; so by
analogy physiology would probably supply no basis for
dogmas on tbe present subject were there wanting the
groundwork of a visual or tactile muscular diagnosis. Then,
again, the phenomena of minima visibilia and sensory circles
are so harmonious in two very diverse sensations that
nothing short of a common causation can adequately solve
the harmony; neither are discrepancies in these phenomena,
where any exist, explicable on terms other than those of
the proposition under consideration. Finally, by coupling
the facts that visual angles are of muscular origin, whilst the
minima of vision have been resolved into such angles by
Harris (“Treatise on Vision”), the proposition as regards
vision seems to be adequately verified.

Let us examine a series of ascertained data so as to insti¬
tute a comparison between their solution by the hitherto
prevalent and the present doctrine, simply premising that
the former tenet has been constructed on tbe view that all
sentient points exercise their directional and positional
powers by an inheient faculty of primary sense—thus: “ The

skin is toe criterion of locality” (Todd and Bowman).

“ The simple sense-impressions of the optic nerve are colour,
intensity, and direction ” (LeConte). As regards the skin,
there is no cutaneous point that we can prick without pro¬
ducing pain; as regards the retina, a star is distinctly visible
and without apparent magnitude, even though it be magni¬
fied 6000 diameters. From these data we are committed, by
the former dogma, to a conclusion that each minimum
punctorum corresponds with the brain by a distinct and
duly insulated nerve-fibiil. Dr. Young has calculated that
10 ,000,000 of nerve-flbrillte pass through the contracted
orifice of the sclerotio tissue, and as many are possibly trans¬
mitted by each sensory nerve. Now, such a minute sub¬
division into nervelets is entirely superfluous, according to
our proposition. To all intents and purposes, both skin and
retina may be regarded as sentient expansions or, super¬
ficies, whose every minimal point is subject to a muscular
surveillance. This conclusion seems to be warranted by any
limit to the minuteness of visibility, with sufficient luminous
intensity, having been disputed by some metaphysicians;
and, additionally, by stars of the smallest magnitude being
seen under the comparatively greater visual angle of 44",
whilst the smallest tactile impression is referred to tbe
entire area of its correspondent sensory circle, equalling in
apparent size the impact of numerous sentient impressions
on the same area. It has been surmised, with a view of
covering these peculiarities, that each visual minimum of
44" corresponds to a single cone of the bacillar layer, so
that an identical excitation is effected by tbe incidence of
purer or more luminous raylets; but a serious objection
consists in the surmise being inapplicable to tbe case of
sensory circles—namely, that their numerous ultimate
fibrils coalesce into a single sensory fibre. For, granting

TfiB Liitcw/j ! MR. W. A. MACKIa? i X^tt6SriNAli , SBlcfl ! dSf #Oft PWLVltffeUPPURATION. [FuC.

this to be so, two cutaneous points in adjacent sensory
circles of .} in. diameter would be apparently duplicate with
an interval between them of only £ m., which is not the
case. Sensory circles, therefore, are mere metaphysical
abstractions in the above respect, and the inextricable blend¬
ing or interlacement of their impressions points only to a
common muscular influence.

Then, each retinal cone must be subdivided into at lenst
three terminal fibrils in order to explain intelligibly the
perception of colours (Young, Helmholtz, &c.); there must
be a blue, yellow, and red, or u red, green, and violet fibril
(primary colours), whilst the function of the entire cone
naturally combines these minimal colours for a sensation of
minimal whiteness. I must protest against the coinage of
a minute anatomy in this perfunctory manner; both matter
and organisation are pliable commodities, but I think
hypothesis must be stretched here. Quite sufficient differ¬
ence exists in the intrinsic nature of coloured lights to
explain adequately a variety of correspondent coloured
perceptions without resorting to variations in nervous
mechanism; neither should it be forgotten that, the pro¬
vince of nerve organisation is to interpret rather than to
modify nature, for 1 of a truth (others notwithstanding)
there is 4 latency in the cerebral constitution of every
natural imponderable that may be transmitted' thereto by
natural channels! Far be it from me, nevertheless, to deny
that the minimu m visibile of 44" is much concerned in the
several phenomena of colouratioh, colour-blindness, &c.
And, apart from colouration, transparencies teach us thus
much about their construction—that their molecular particles
fall extremely short ofthe minimum visibile, '

Based on the evidence of apparent extension (minimum
formarum) is the doctrine of the cerebral realisation of
sensational points, indicating a similar mechanical deport¬
ment of nervous structures. Impressions on two adjoining
minimal areas, retinal or cutaneous, give rise to the mental
impression of contact, and the excitation of several con¬
tiguous' areas effects an idea of coherence or extension; such
experiences could not obtain, according to the above
dogma, excepting on ,the inference that the termination of
afferent fibrul® m the brain is a precise facsimile of their
origin. Bernstein ^ays. “The representation of the surface
of theliody is imprinted upon 6ur brain,” so that by experi¬
ence of practice (which may signify a constant repetition of
primary perceptions) the brain is capable of determining
any points oi the skin's surface that may be touched. 1
Ptofessor R. S. Wyld writes: “ In vision there is mapped
out in the sensoniim n true representation, though on a
different scale, of the forms, motions, and relative sizes of
external objects as they exist on the retina”; a and he
has submitted a diagram, explanatory of single and
double vision, in which each retinal image is actually
reproduced in the corpus quadrigeminum. 3 But, on the con¬
trary, the idea, (perception) of space or extension is as
different from that of body (the sense of contact) as it is ■
from that of a scarlet colour; it is true that a scarlet colour,
like body, must have extension, but the two ideas are
distinct 1 (Locke). Moreover, since the idea of solid form
(relievo) is contained by surfaces, and has been proved to
be a secondary perception elsewhere, the idea of superficial
extension must also be of a secondary nature. Where¬
fore the present proposition renders the anatomical identity
of relation between the proximal and distal extremities
of an afferent nerve another redundaht additameutum to
minute anatomy.

■Nevertheless, in farther elucidation of the subject, the
contiguity of sentient impressions on peripheral nervous
expansions is clearly a sine guA non in the constitution of
an idea of extension; retinal images or sensory impressions
must be arranged in ordine for the generation of the mental
idea of coherence, although we deny tlieir reception in ordine
by the brain through the channels of primary perception.
This will be obvious on'reflection that toe directional influ¬
ence of a voluntary muscle upon neighbouring itnpressional
areas varies by a regulated increment, according to their
regular positional relation to the dynamic centre of secondary
perception. It Is maintained that all ideas of extension,
whether definite or infinite, may be ultimately resolved into
thfe appreciated movements occurring in exarthrodial and
diarthrodial articulations in the tactile sense, Or into un¬
fettered ocular rotations in the case of vision ■ and,' farther,

O-tJJrc' - •( 1 Fi*« Sense* of Man. p. 37; 1SJ6-

* Physic* and Pbilo*ophy o{ the Sense*, p. 185. 187S. .

•“ - * Ibid., fig. 40. p. 221.

the coherence of extension is comprehended ultimately fiy
a duly perceived aggregation of what We may designates &
minima motoria. (Tobecencludtdj

ABDOMINAL SECTION BOR PELVIC
SUPPURATION.

By WM. ALEX. MACKAY, M.B., C.M.

Inks D—-, aged twenty-four years, gives the following
history. She has been married for four years and a half,,
and has given birth to three children. Two days after the-
birth of her last child she felt a severe pain in the region of
the left oVary. Since then—that is, during the last six
months—she has never been free from pain and feverishness.
The menses have been completely suppressed throughout
her illness; no treatment has given any relief; she has been
losing flesh rapidly, and feels weaker every day.

When seen the patient presented a most emaciated appear*
ance. On examination, a hard tumour fixed and painful to-
the touch, could be felt in the left iliac region, filling it up-
and extending nearly to the middle line forward, ana up to-
the umbilicus. Per vaginam, a rounded mass, painful to
the toucb, was felt to the left of the uterus, and extending
round behind it. Womb fixed; cervix hard. Bim&nually,
indistinct fluctuation was felt in the tumour, but there was
no indication of its pointing anywhere. The patient bore
this examination very badly, and was very hopeless of her
condition. She was put on extract of malt and allowed to
rest for a week, as she had come a long diligence journey.
Daring the week her temperature was always above normal,,
ana her pulse between 110 and 120. Urine free from
albumen and normal in quantity. Heart and other organs
healthy, Motions fairly regular, and presenting nothing of
note.

A second examination of the tumour revealed Nothing
new, and on April 29th, 1884, the following operation was
erformed. I opened the abdomen in the middle line,
eginning about midway between the umbilicus and the
pubes; the incision was carried down two inches. On
opening the peritoneum, the index-finger came immediately
upon the uterus and roof of the pelvis, which was raised up
so as to lie against the anterior abdominal wall, but was
not adherent. The uterus was quite immovable, and fixed
to a large swelling, which lay behind it and surrounded its
left side. Deep fluctuation could be felt at a point about
ah" inch behind and half an inch to the left of the left-
cornu of the uterus. The incision was enlarged upwards to-
get at this'point, which with the whole pelvic root was
raised to vritnin an ihch of the umbilicus. With consider¬
able difficulty a Wells’ trocar was here pushed into the
tumour, a sponge having been first placed immediately
behind the intended opening. About fourteen ounces of
pale-yelldw pus immediately ran out through the tube. 0»
withdrawing the trocar, a little blood and pus followed, and
was caught Up by the sponge. On introducing the index
finger into the abscess cavity, it became apparent that tho
trocar had traversed quite one inch and a half of indurated
tissue before it entered the cavity. After clearing away the-
blood and cleansing the abdomen with warm sponges, the
opening into the abscess was secured by a continuous suture
to the abdominal wall at_ the upper part of the incision.
This was the most difficult part of the operation. It was a
belaying down of the abdominal wall to the-wall of the ab¬
scess, the latter being immovable. The rest of the abdomi¬
nal incision being dosed with silk sutures, a drainage-tube
was passed into the abscess cavity and an iodoform dressing
applied, with strips of plaster and a flannel binder. The
anaesthetic employed was a mixture of chloroform and ether..
A good deal of vomiting followed the operation, lasting till
the evening of'the next} day. ;

April 30th: Temperature normal; pulse 104. Wound-
dressed. Ordered a little-brandy in warm water for vomiting.
—May 1st: Temperature normal; pulse 88. Had a good
motion. Complains 6f slight pain throughout the abdomen.
Wottnd dressed.—2nd: Temperature normal; pulse 90.
Wound dressed. Discharge passes freely into the dressings
arbund the tube.—3rd': Temperature normal; pulse 114.
Patient fefels Very Well, and has a good appetite. Wound,
dressed. Pus of a dark-red colour.—4tn: Temperature

The Lancet,]

DR. J. C. GOODING: CYST OF THE GREAT OMENTUM.

[Fbb. 12,1887. 311

normal; poise 100. Wound dressed. Pus smelling pecu¬
liarly.—5th: Temperature normal; pulse 100. Wound
dressed. It is now.evident that there is a communication
between the intestine, and the abscess cavity, as the dis¬
charge is mixed with faeces.—6th : Temperature normal;
pulse 112. Patient excited and frightened, because she
has felt while straining at stool that a good deal of
fiscal matter comes by a tube and none by the anus. Wound
dressed.—7th: Temperature 99-5°; pulse 114. The patient
feels very well, and is not alarmed, as she has passed three
motions by the anus and very little by the wound. Since
the first passage of the faecal matter by the tube the abdo¬
minal wound is carefully protected by an arrangement
of mackintosh and adhesive plaster, and the attendant
constantly renews the dressing around the. mouth of the
tube; also the abscess cavity is frequently syringed
out with carbolic lotion.—'12th: Temperature and pulse
normal. Wound dressed; almost no discharge. Con¬
tinuous suture removed. The abdominal incision is firmly
healed. The patient eats and sleeps well.—21et: Drainage-
tube removed. Cavity quite contracted. Patient sitting up
in bed.

The woman went home restored to health oh May 31st.
Menstruation, returned at the end of July and continued
regular. A year after the operation I was told that the
patient continued to enjoy perfect health.

Remarks .—That this caee is an example of suppurating
fa»matoma I think there can be little doubt; but a special
interest is added by the communication, which occurred on
4he fourth day after operation, between the bowel and
the abscess cavity. It is probable that we have here an
illustration of the course of such abscesses as described by
Dr. West, who says: “ When suppuration takes place, the
nutter makes its way. outwardly through .the vagina, or
through the intestinal canal in almost all cases in which the
inflammation is limited to the parts contained within the
bread ligament.” From the length of the illness, which
lasted six months, it seems probable that the pus had begun
to seek an outlet towards the boweL On evacuating the
abscess, the weakened part of the intestinal wall would yield
towards the cavity, and finally give way when the patient
•strained at stool. No pus was at any time observed in the
motions. The rapid progress toward complete recovery did
not appear to be delayed by th^complication which.occurred.

Haetra, Spain.

•CYST OF THE GREAT OMENTUM.

REMOVAL, RECOYRRYv

By J. C. GOODING, M.D.

Miss-,in 1878, when aged eighteen years,, first noticed

a lump the size of a hen’s egg low down in the right iliac
region, which, at the monthly periods chiefly, was painful.
Jt gradually enlarged upwards till, at the time of my first,
visit in August, 1879, it had attained the size of a cocoa-nut
and reached two inches above and to the left of the
umbilicus, and three inches below, extending back into
the lumbar region. It was elastic, could be completely !
pushed across the abdomen:to toe left; of the umbilicus,
■and pressed down to Peru part’s ligament; there was most
limitation to upward movement, and between it and the :
liver there was resonance. My first impression was that
it was a renal growth, but the tumour could be moved i
away from the kidney without le >ving any sense of void :
in the loin; it was freely movable in all directions, but
lets so from the ovarian site. The urine was healthy,
and there was no constitutional disturbance. I' diagnosed
■ovarian cyst with long pedicle. In March, 1880, the patient
at my request saw 8ir $. Wells, who wrote me that his
impression was it was renal, but, having doubt, wished
Sir W. Jenner to see the case with him, which be did
a few days afterwards.' The result of the, consultation
was that they both, “while doubting,, inclined rather to
the view of an ovarian tumour with a long pedicle
than a renal cyator tumour,” and both agreed in advising.
■“in the absence of aqy>.pjgent symptoms, no surgical
interference.” . ; •.

M Da rta^.tfre summer bfdSgl the patient began to suffer
noth astiy m and oc cas ion! ) vomiting after meals, and a
Shotting! aohiqgjppn. in.,§n4 abpqt tfce

tumour. These symptoms much impaired her health; and
interference, for which the patient was anxious, was deter¬
mined on. The growth had now attained the size of a
child’s head of four years old, had equally enlarged without
altering its relation to other parts, was as mobile as ever,
and obviously contained fluid.

On April 27th, 1882, Mr. C&rdew gave ether and Mr. C. J.
Newton assisted me. When the patient was amestheti6ed
the tumour retreated so much under the hypochondrium
that it was obviously not ovarian (a confirmation of the value
of anaesthetic^ for abdominal diagnosis—so well known, but
so seldom employed)! a short incision into the peritoneal
cavity, confirming this, was extended to the umbilicus, and
disclosed a white cyst covered by peritoneum; this was
scratched through so as to admit tne finger, which was
swept round, breaking down strong areolar tissue. Ob
seizing the tumour with a vulsellum a clear fluid gushed
out; then a most tedious process of separation, facilitated
by holding the thin-walled cyst up against the light,
was effected by scratching through den to cellular tissue,
its closely fitting envelope. There was no pedicle, the
tumour was embedded in folds of the omentum, having
the transverse colon immediately below it. There was
no haemorrhage. The entire operation was conducted under
carbolic acid spray—a practice, however, which I no longer
follow.

The patient, very pallid and cold, but with fair pulse (60),
was removed to bed, and after a couple of hours the ex¬
tremities became warm. During the first night there was
much pain referred to the left shoulder and back. For
thirty-six hours there was continuous sickness. On the
second day the temperature was 100° and the pulse 98-104.
Barley-water and milk in small quantity were relished and
retained. On the third day the temperature was natural,
and the pulse 92. On the seventh day three sutures were
removed, and the remainder on the tenth day'; firm union
had taken place.' The progress to recovery continued
uninterrupted, and the patient when last seen (September,
1883) was enjoying good health.

The tumour much resembled an hydatid cyst, but it was
not-of thisnature. Its origin (obscure) might have been due to
a severer blow in the abdomen sustained some months before.

Cheltenlram. '

% Httrror

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

. i

NttUaaabem mt alia provorto nmoendi via, nisi qnamplurimaa et mor.
borum el dUtectionum hUtoriaa, turn aliorum turn propriaa colUct&a
habere, et Inter se oomparare.— Moroagwi De Sect, ft Caul. Morb.,
Hb. lv. Prooemlum. ■ ■ ■■■

ST. MARY’S HOSPITAL.-

PARTIAL RNYEROCRLR; OANORXKK J RROOVEBY; REMARKS.

(Under the care of Mr. Edmcxd Owen.)

The term here used to .describe the hernia which was
the ciuae of the symptoms- in the. following case is
one which will probably find general acceptance. If our
tenders Will refer to the report of the meetings at Which
the papers referred to ( vide infra and page 314) were
discussed, they will gain much information on the subject
of this form of protrusion.

On November 30tb, 1886, a spare man, aged fifty-seven
years, was admitted with a strangulated femoral'hernia* on
the left side, of the size of n large walnut. He vomited a
good deal; bnt the ejecta bad no stercoilaceous odour; there
was no tympanites and no hiccough, but the man was
somewhAt collapsed. Hs Said that the hernia had been
down- generally during the past three winters, when hie
conch wn«. bad, but that nearly the whole of it went away
wh«v the'mi Id weather arrived; that there was, however,
at the beW of timbs, always a very small piece which did not
go back. He said further that the hernia, in thelarger mesa,
had been down for nearly a. week, that for five days his
bowels had not acted, and during that time he had been
frequently sick, and in pain across the umbilicus. , Without
any difficulty Mr. Lloyd, the house-surgeon, returned the

Digitized by GoOgle

312 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Feb. 12 r 1887.

chief part of the protrusion, and then applied an ice-bag to
the small piece which resisted his efforts.

Mr. Owen saw the patient some hours after his admission,
and finding him free of pain and nausea, and learning that
the general improvement, which set in directly after the
partial reduction of the hernia, was as real as it was
apparent, he decided not to cut down upon the irreducible
piece, which he took to be a nodule of omentum. That
decision was justified; all went well; the bowels acted
nearly every day; but still the small piece remained irre¬
ducible. On the tenth day in hospital the hernia began to
pain, and the ice was entirely left off; and a week later
an abscess was incised over the seat of the hernia, pus and
faeces escaping. After this the local pain entirely passed
away, but for some weeks a ftecal fistula kept on discharging.
The opening eventually closed; the remnant of the hernia
has disappeared, and the man is quite well, at any rate so
far as his groin is concerned.

Littre gave various important indications for recognising
strangulation of a diverticulum, or of a piece of the side of
the intestine, all of which are illustrated in the case just
recorded. Thus: The bowels continued to act during the
progress of the attack, because the channel itself was not
obstructed. The bowels were confined whilst the supple¬
mental hernia was strangulated, but they began again to
act directly that part was released, although the diverti-
eulum, or the small piece of the side of the bowel, remained
so tightly strangulated that it sloughed. The man had no
hiccough or abdominal distension, nor did he vomit except
on one occasion—that was before the chief mass was reduced.
The permanent prolapse was particularly small, and, though
it was persistently and tightly pinched, the general and
local symptoms ran an unusually mild course.

The small irreducible part of this strangulated hernia
was, without doubt, intestinal, for on the occurrence of
gangrene and abscess faeces escaped when the tumour was
incised. That the strangulation did not implicate the
entire circumference of the intestine is evidenced by the
fact that from the very day that the chief part of the
strangulated mass was returned the bowels began again,
and continued, to act naturally. Possibly the piece of bowel
which sloughed was Meckel’s diverticulum, or an adventi¬
tious diverticulum; possibly it was a piece of the side of
the bowe^ But that this particular feature in the case
remained obscure is probably much to the advantage of the
man himself. Mr. O wen said he was not of opinion that a
clinical history is complete only when a necropsy is de¬
tailed.

On April 19th, 1886, Mr. Morgan read a paper on a case of
strangulated hernia without complete obstruction of the
bowel before the Medical Society of London, 1 and on
December 14th last Mr. Treves chose the same subject for a
communication to the Medico-Chirurgical Society, 3 and on
each occasion reference was made to an essay which was
read by Littre in 1700 at the Acaddmie Royale des Sciences,
in which the author described a fatal case of hernia
which was probably strangulation of Meckel’s diver¬
ticulum. By Littre’s hernia, however, one now generally
understands a partial hernia of the circumference of
the bowel rather than of a diverticulum. But on this
matter opinions differ; and with some surgeo- s the name
of Richter is usually associated with that condition, Littre’s
name being connected with diverticular protrusions. Thus
what should be a tolerably simple subject has become over¬
burdened with proper names, and terminology has become
indefinite. Mr. Owen ventured to express the opinion, there¬
fore that in the interest of surgical literature in general, and
of the student in particular, it is expedient that individual
names be not associated with special kinds of hernia. The
surgical archaeologist may dissent from this proposition, but
specialism in any branch of knowledge should tend always
to simplification. Indeed, in the discussion of one of the
excellent papers just referred to, Mr. Hulke is reported 3 as
saying that he rather thought that Richter himself did not
fully comprehend the matter with which his name is so
honourably mentioned. Every surgical reader, however,
can understand what is meant by a “ lateral hernia of the
bowel,” and by a “ hernia of a diverticulum.” The former
term, therefore, or the still more comprehensive one, "partial
enterocele,” is preferred by Mr. O wen as the heading to this
report.

1 Th* Lajjckt, vol. i. 1886, p. 786. * Ibid., vol. 11.1686, p. 1170.

* Ibid., vol. 11.1880, p. 1177.

NEWCASTLE-ON-TYNE INFIRM Ail Y.

HERNIA OF OVARY.

(Under the care of Dr. Oliver.)

A well-developed young girl, aged sixteen, a house¬
maid, was brought to the infirmary complaining of a painful
swelling in the right groin. Ten days previously to this,
when lifting a heavy pan, she felt something crack in th©
lower part of her abdomen. This was followed by a
feeling of sickness, but she did not vomit. The bowel©
bad been opened daily since the commencement of
the illness. On examination, a tender, roundish swelling
was found in the neighbourhood of Poupart’s ligament
on the right side, which was easily reduced. Three day©
after this, as the swelling had reappeared, she returned
to the infirmary, having vomited a good deal. Walking was
to her now a matter of great pain. She said that she
suffered most pain when she lay on her left side, less when
she lay on her right, but least of all when on her back. Th©
swelling, which was about the size of a walnut, lay imme¬
diately under Poupart’s ligament (right); it was soft, elastic,
of firm consistence, and did not give one altogether th©
feeling of being intestine. It had been easily reduced in
the first instance, but on now handling the swelling special
notice was taken of the amount of pain which it caused, the
sense of sickness complained of, the extreme pallor of the face,
and the tendency to faintness. No impulse was detected in the
swelling on coughing, nor in its reduction was there fel*
anything like a slip or a gurgle. It was regarded as &
hernia of the ovary. On examination under chloroform, an
ill-defined mass could be felt behind Poupart’s ligamenb
(right), which, on being displaced, fell into the pelvis to
the right of the uterus. The uterus itself felt healthy, bufc
to the right of it lay a round smooth mass about the size of
a walnut freely movable, easily displaced in front of the
uterus, and easily tilted upwards by and beyond the reach
of the finger. A coil-like structure could be felt lying
external to this smooth round ma«s as it lay in the pelvis,
but whether it was a distended Fallopian tube or a portion
of small intestine, it was impossible to say. The round mas©
was doubtless the right ovary. On the left side th©
ovary was felt to be about a quarter of the size of that on
the right, while its Fallopian tube could be felt about the
size of a quill. On one occasion after this, when the
swelling reappeared in the groin, the ovary had evi¬
dently dragged down with it a portion of intestine, for
in the reduction a gurgle was distinctly felt. The dia¬
gnostic signs of hernia of the ovary relied upon were—the
dragging and pain felt by the patient when she lay on
her left side, the side opposite the swelling; pain on
movement of the limbs; pain of a sickening character
on manipulation of the swelling; pallor of the countenance
and tendency to faintness; the consistence of the swelling - r
and, in its reduction, absence of slip and gurgle. The house-
physician, Mr. Waldy, had a proper truss made for the
patient, since wearing which the displaced right ovary, still
in all probability enlarged and prolapsed, has ceased to
trouble her._

DUNDEE ROYAL INFIRMARY.

ACUTE 8PORADIC CBREBBO- SPINAL MENINGITIS; DEATH
ON THE FOURTH DAY; NECROPSY; REMARKS.

(Under the care of Dr. Sinclair.)

For the clinical record of the following case we are
indebted to Mr. H. Hampden Pridie, house-surgeon; and
for the notes of the necropsy to Mr. A M. Stalker, patho¬
logist to the infirmary.

Jessie P-, aged twenty-one, mill-worker, was admitted

on the afternoon of August 14tb, 1886, having been certified
as suffering from typhus. There had been no typhus, how¬
ever, in her neighbourhood for a long time, and there was
no evidence obtained either on admission or subsequently
of contact with typhus. Three days before admission,
without any apparent cause in the shape of injury, over¬
fatigue, or exposure to excessive heat, she had a rigor,
followed soon after by great heat, loss of appetite, exoessive
vomiting, severe headache, and noisy delirium.

On admission the patient was very drowsy, and had a
dnsky aspect and flashed forehead. Pulse 124, bounding;
respiration 28; temperature 101-4°. Tongue furred and

DgtzedbyGOQQle

THBlANoirr,} ROYAL MEDICAL AND CHIBT7RGI0AL SOCIETY.

beginning to dry. Spleen distinct! y enlarged. No abnormal
physical signs in heart or lungs.

Next day, at Dr. Sinclair’s visit at noon, she was in¬
sensible, and bad been having convulsions since 6 a.m. The
pupils were dilated and slnggisb, the pulse' was 120 and
bounding, and the temperature lu2°. The tongue was pro¬
truded, and bore marks of biting by the teeth. She was
then ordered to have half a drachm of hydrate of chloral by
enema, which was to be repeated in two hours if necessary,
and, if still unable to swallow in the afternoon, she was to
be fed by pancreatiaed enemata. At ten minutes past 3 p.h.
she died.

Necropsy. —On, opening the dura mater, a thin layer of
yellow lymph was found to be uniformly distributed all
over the pia mater. No evidence of extension from the
middle ear or from any part of the temporal bones. The
spinal canal was opened, and lymph, continuous with that
on the brain, was found all down the cord, most markedly
about the middle of the dorsal vertebrae. The cranial and
vertebral bones were healthy. The lungs were congested.
Abdomen: Intestines congested and moderately full of
semi-fluid fasces. Careful examination showed no lesions
of Peyer’a patches. The spleen was enlarged and pulpy.

Remarks by Dr. Sinclair. —There can, I think, be no
doubt that tbis caso was an example of the more severe
type of cerebro-spinal meningitis. The initial and subse¬
quent symptoms were sudden and overwhelming; the
patient was evidently beyond hope when she was admitted
on the third day; and the post-mortem examination showed
that both the cerebral and spinal meninges had been acutely
inflamed. And there can be as little doubt that the case
was isolated and unassociated with any epidemic ontbreak,
because there had been no similar case in the neighbourhood
far a long time before, and I have not been able to find any
trace of a similar case np till now (Jan. 27tb, 1887). No
traumatic cause could be ascertained after a very careful
and exhaustive inquiry. The clinical history is singularly
complete except in the one respect of the absence of the
eruption, which is so often associated with this interesting
and fatal malady. Isolated as it is, I think it worthy of being
placed on record, as a contribution to our knowledge of
a very rare disease._

UUitiral Snrittirs. '

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

41 Induration” of Hunterian Chancres in the Female .—
Actinomycosis Hominis.

As ordinary meeting of this Society took place on Tuesday
last, Mr. G. D. Pollock, F.R.C.8., President, in the chair.

Mr. W. E. Cant contributed a paper on some Clinical
Observations on M Induration” in the Primary Lesion of
Syphilis in Women. (Communicated by Mr. Holmes.) The
following results were founded on about 3800 cases examined
in the Royal Albert Hospital, Devonport, during a period of
ox and a half years. In contradistinction to the generally
accepted fact that in men induration is as a rule well
marked, it is so in women far less generally. The induration,
which is described as being circumscribed, limited to the
base of the sore, and clearly marked off from the surround¬
ing tissue in men, in women is, about as often as not,
diffused a considerable distance into the tissues around,
often very widely, not sharply defined from the surrounding
tissues, nor circumscribed in the base of the sore itself. The
moat typical form of primary sore with its induration, resem¬
bling a disc of cartilage set in surrounding soft structures, de¬
scribed as being frequent in men,is seldom met with in women.
Every variety as to the degree of development of the indu¬
ration is met with in women; but there is a large propor¬
tion in which it is very slight (about one-third). In some
of these slight cases it is impossible to affirm that there is
MJy thickening at all present, and there is a small number
in which none exists throughout the whole course of the
sore. Induration is piesent in the early stage of the sore
only in a small proportion of case#. The time of its occur¬
rence in the course of the sore varies greatly; it may occur
at almost say period of its course. It becomes most marked
snd developed towards the middle and latter part in many
OMts. Tables of cases of primary sores, grouped according

[ftra. 12,18OT.T 333

to their clinical character, and showing “ when first appa¬
rent,” “characters at earliest period,” &c., and also of
five cases of infecting primary sore in which there was
no induration, were appended to the paper. — Dr. C. R.
Dbysdaxb said the subject of iuduratiou at the commence¬
ment of syphilis bad at times become much confused. He
bad gathered much the same impression as Mr. Cant, in his
observations mode at a small lock hospital. The initial
chancre might be but little indurated in women. The tissues
in the female genital organs were rather different from those
of the male, and tbis condition probably influenced the
occurrence of induration. In a bard chancre of the lip in a
woman the induration might be quite “ wooden.” A large
number of cases in the male might exhibit but slight
induration. In his own experience, of 241 coses four-
fifths occurred on the labia majora and minora. The
initial hard sore might occur on the os uteri, lie bad
not seen one on the vagma.—Mr. Habbison Cbipps
bardly agreed with Mr. Cant that the locality made no
difference in the occurrence of induration. He thought
position was everything. On the lip induration could easily
develop. In chancre on the finger there might be absence of
induration, even from beginning to end. Hunterian sores on
the faceandflngeraindeed were generally free frominduration.
—Mr. T. Hoc mbs said the paper differed from most records of
observations in being a record simply of facts. No mere
opinion was expressed in the paper. Works of eyphilo-
graphers gave a record of general impressions, not of actual
facts of which notes were made at the time. He believed
that the situations of the sores were given in the tables
appended to the paper. The conclusions of the author were
in accord with his own experience. He considered it a
matter of regret that the Contagious Diseases Act had been
repealed.—Mr. R. W. Parkbb asked, if induration was
not the test of a chancre, wbat was the test f What is the
characteristic feature of a chancre? How much of the
features was due to mere irritation, and how much to the
action of the true syphilitic virus?—Dr. C. R. Drysdalb
said that it was not to be supposed that absenoe of indura¬
tion meant identity of the Hunterian sore with a soft one.—
Mr. Cant, in reply, said the situations of the sores were
given in the paper; two occurred on the os uteri, and one
oo the vaginal wall. Some of the sores on the buttock were
indurated—this in opposition to Mr. Cripps. Induration
was the beet character of a syphilitic chancre when present.
Bto paper did not, however, deal with the characters of
syphilitic sores.

Dr. R. G. Hkbb contributed a case of Actinomycosis
Hominis, (Communicated by Dr. Sturgee.) A boy, aged
eleven, was admitted into the Westminster Hospital on
Maroh 18tb, 1886. He had suffered for a month previously
from pains in the limbs, diarrhoea, vomiting, and " feverish¬
ness.” On admission the most prominent symptoms were
those of lung consolidation and pleural effusion, for which
he was tapped twice. Soon afterwards pysemic symptoms
developed, and tbs patient died on June 2nd. The post¬
mortem examination disclosed abscesses of the brain and
meningitis, pneumonia, excavation of the lungs, and suppu¬
rative pleumis. A large vegetation was found on the wall
of the right auricle of the heart, and in the liver an abscess
and many areas of caseation. On microscopical examination
of the liver, there were found numerous pigmented cells,
many of which formed the centre for the departure of
radiating filaments. The conjunction of these two factors
gave rise to the appearance of a definite organism,
for which the name of actinomycocee was adopted. In
the brain and lungs collections of cocci only were found.—
Dr. Stubgbs testified that Dr. Hebb had taken an immense
deal of pains about the pathological preparations. The
paper read by Dr. John Harley tried to show that the morbid
appearances were due to tubercle, but he could not agree
with tbis view. The boy came in with pneumonia, and
developed hectic fever and an empyema. Three things were
clear: first the pneumonia, then the wasting fever, and
there were also signs in the liver, which was explored two
or three times with the aspirator. There were now at least
three cases of this disease starting in the lung. The clinical
aspect was alike in the three cases—Israel’s, Markham
Skeritt’a, and the present one ; and a diagnosis ought to be
possible from the clinical characters. The present case was
shorter and acuter than the other two; the duration was two
or three months. The onset was gradual, the symptoms being
those of diarrhoea and loss of appetite preceding the signs
of pneumonia.—Dr. T. D. Act and said the disease was not

O

314' XSB lUNcan)

MEDItlALSQGIETY OF LOUDON.

[FHB.1SU887.

nearly so rare as Dr. Sturgefl thought it to be. He had seen
no Jec-s than fourcases himself. The disease was very common
in cattle, and thirty casae of disease of tho long in human
being* had been reported in Europe. In Dr. Hebo’s specimen
the organism did not seem to be the central point of the
morbid process. It seemed as though the organisms were
lying in holes bounded by tibrous tissue. He had cut
sections of Dr. Hebb’s specimen without being able to find
anyi organism. Whether the disease was caused by the
organism be could not say. Naked-eje appearances were
not sufficient to diaguose the disease if it were called actino¬
mycosis.—Dr. Hebb said a similar case was reported by
VaocheVta in the Veterinary Journal of Milan for 1882; it
occurred in a dog, and was toougbt to be a sarcoma of the
lower jaw. He thought that Dr. Acland supposed that the
sections were only three in number on which the diagnosis
had been made. . _

MEDICAL SOCIETY OF LONDON.

Partial Enterocele.—Parotitis after Abdominal Operation .—
Rupture of Aneurysm into Pericardium.

An ordinary meeting of this Sooiety was held on Monday
last, Mr. R.Brudenell Carter, F.R.C.S., President, in t-heehidr.

Mr. Edmond Owen read a paper on Littre’s hernia, which
appears in full on page 311.—Mr. Brudbnrll Carter said
the French were not alone in varying the spelling of their
proper names. He objected to the use of proper names tp
designate diseases—a method serving to confuse students.—
Dr.C. J.Harh said the nomenclature of disease as issued by the
College of Physicians went far in the direction of not using
proper names for designating diseases, bat no doubt would
go further if representation were made on the matter to the
Registrar.— Mr. F. Trkyes referred to the diagnosis, which
was not perfectly clear from the symptoms. The extreme
rarity of hernial diverticula on the left side of the body was
against the diagnosis. The influence of the ice-bag in pro¬
ducing the abscess was of interest. He believed that the
prolonged use of the ice-bag might cause abscess and gan¬
grene. As to Littre s hernia this much might be said, that
it was doubtful whether Littie had ever seen a case of
partial enterocele. Richter’s hernia was the beet name to
designate the hernia by, since be was the first actually to
describe it.—Mr. Stephen Paget referred to a case of in¬
carcerated hernia in a lady which was treated with an ice-
bag and followed by an .abscess.—Mr. Walter iPir con¬
sidered that the phrase “ lateral enterocele ” wa* barren o£
meaning.—Mr. Davihs-Coxiu-iv asked what evidence there
W 48 that this was not an ordinary femoral bernla. injured by
GitnbemaFs ligament; the abscess had slowly come to the
surface through the crural canal.—Mr. J. H. Morgan, in¬
quired whether there was any indication of the portion of.
tj»e bowel that bad; been the seat of strangulation.—Mr. J.
Black suggested that iced applications -in peritonitis might
increase the shock.—Mr. E. Owen, in reply, maintained
that was a. partial, not complete, obstruction of the bowel.
Yhe ileum on the side away from the mesentery Was -the
part of the bowel affected. : •.«

cMr, & PAGOT read a paper on. 101 cases of Parotitis after
Injury or Disease of the Abdomen or Pelvis. He referred to
Olives’- 30th. Clinical Lecture, on the Connexion between
J&easeaof Different Organa- He also referred to the fact that
ajwews of the kidneys and.of the muscular, Substance of the
btfSrtis muck mare common in pysamia after adate 1 necrosis
than in pycemia after amputation. In 18 ousts of pyntnia
after acute, necrosis, 10 had aibsflass of the heart, and 11 hadi
ab**e?8. or i infarction of the kidney. - But in 140 cases of,
Hjaemia after amputation, only 1 hediabsceea of the heart,
aidnpti ope had abscess of. the kidney.' Another morbid
Sftquept^of a aimilarikindds shown In the fact Chut abscess
oft the liver nr of the spleen is much/more common in.
pyaemia after injury involving tt^e medulla of, bone, thanin
pyaemia after injury involving only the soft parr*, via 67
caeea otf pysemia-after injury involving only the soft parts,4
hM abacsw of-tl»e: liter, and 3 bad abeceSj; of.-,the spleen.;
But in, 217 cases; of pysBmia after injury involving ,the
medulla' of, bone, 66 bad :%b*oes»,iof ,t|ie,liter* abd 28
had abscess of. the spleen.- . 'These vtortud (sequences are
of very great inter eat; ?a revealing relations- between remote
pagans which are never shown in health. Physiology knows
c&HQio connexion, between the* periosteum* the.heart, -and
t|*e kidneys; or between the modulla of bone*rthe spiepiv

and the liver. Another morbid sequence is parotitis after
in j ury or disease of the abdomen or pelvis. Out of 101 cases,
19 followed injury or disease of the urinary tract; 18 followed
injury or disease of the alimentary canal; 23 followed injury
or disease of the abdominal wall, subperitoneal or pelvic
cellular tissue, or peritoneum; and 60 followed injury or
disease or temporary derangement of the generative organs.
Under “temporary derangement” Mr. Paget included such
causes as alight injuries, menstruation, See . Parotitis, after
injury of the extremities, is always part and parcel of a true
general pyaemia, with other secondary inflammations else¬
where. But this parotitis after abdominal or pelvic lemons
was, in 93 cases oat of 101, an isolated event, unaccompanied
by any other inflammation like itself. In only 16 of the
101 recorded cases was there distinct mention of “ septic
symptoms," “ septicaemiaor “ pywmia.” Of the 101 cases,
37 died. But of these 37, 3 were over eighty, 3 had cancer, 2
had perforation,2 had strangulated henna; others had acute
peritonitis, severe injuries, septicaemia, or pyaemia. Thus
the danger is not in the parotitis itself, bnt in the
primary lesion which causes it. This form of paro¬
titis hts no period of incubation; it has been observed-
on the first day after the primary lesion, and on the
nineteenth, and on the intermediate days also; to say
nothing of a case where it came on the morning of the
day fixed for operation. It seems to come later when it is
due to delivery or abortion than when it is due to operationson
the generative organs. The onset of this form of parotitis
is rarely attended by much disturbance of the general con¬
dition of tbe patient. Rigors are mentioned only in 4 coses ;.
delirium or puerperal mania in 6 cases, in the great
majority of cases there is only slight rise of temperature, no
rigors, no high fever. Such cases have been well described
by Dr. Macdonald of Edinburgh, Dr. Goodell of Philadel¬
phia, and tnany others. As regards the termination of this
parotitis, by resolution or by suppuration, tli tre are only IS
cases which give information uu this point. Of these, 46-
went on to suppuration and 24 died ; whereas of the 33 that
were resolved without suppuration only 1 died, and she died
of cancer a month after colotomy. Death in the fatal caseswas
due not to the suppuration of the parotid but to old age,

; cancer, perforation of tbe bowel, &c., or to septicaemia or
pyaemia. They did not die because the parotitis went on
.' to suppuration, but it went on to suppuration because they
were going tt> die. Mr. Paget suggested that this suppura¬
tion of the parotid in cases of pyaemia might be allied to-
ithose cases of pyaemia after compound fracture where
. suppuration occars round simple fractures indicted at
the fume time as the compound fracture, and to the-
: experiments of Cliauveau, Loeffler, and others, who pro¬
duced simple fractures in animals, then injected septic fluids
;into their veins, and thus produced suppuration round the
' simple fractures. Mr. Paget spoke of the surgical features
| in some canon of this form of parotitis, and of the treat-
j ment by belladonna and by incision, according to the old
I rule, “ Patotitides omnes ante maturitatem aperiendre.” He
! had lately, by the kindness of Mr. Knowsley Thornton, mad^
a post-mortem in the case of a woman who died ten days
after tbe removal of a very large sarcoma from the mesen-
Iterv. Swelling of the left parotid gland set in three days
I before death. The operation had been one of great severity,
land she never thoroughly rallied from it. Necropsy (seven
hours after death): No rigidity of limbs or of neck r
i jaws tightly clenched, and could not be opened. Abdomen
-fiat-and' collapsed; operation wound healed. Firm non-
! fluctuating swelling of left parotid. Pus wells freely into
jthe mouth, when pressure is made over the gland. The
maeous membrane of the month is soft, clean, and
Iwhollv-firee from sordes or ulceration. Tbe month of the-
duct is just marked by one or two tiny points of bfemor-
rhagB under the mucous membrane. A bristle passes
freely up the duct. The skin and loose cellular tissue over-
tue parotid and in the anterior triangle of tbe neck are
cedematpus and fall of serum; the lymphatic glands at the
|a»gle ol tbe jaw and in the neck ore much enlarged and
'soft. Oh section, the parotid is found everywhere evenly
infiltrated, not with pus, bnt with reddish, slightly turbid
serous fluid, looking like the cut surface of a spleen. There
-is no pus’in the gland itself, bnt just at the proximal end of
the duct,'where it leaves the gland, are two or three drops
of healthy pus and a minute calculus no bigger than
millet-seCd. There is no general peritonitis, but a small-
circumscribed abscess at the seat of the operation. Spleen-
large and diffluent. No marked lesions elsewhere. The

Tub Lancet,]

SOCIETY OP .MEDICAL OFFICERS OF HEALTH.

[Fku. 12, 1887.; 3d 6 ;

microscope showed the acini and lymph spaces of the gland
invaded by masses of small round cells (ly mph cells), which
here and there could be seen inside the acini and ducts. The
gland tissue was broken up and confused by these masses of
cells; but the interlobular Bepta of fibrous tissue were for
the most part hardly changed at all. It was a true inflam¬
mation of the gland tissue itself. As to any micro-organism,
Rosenbach has grown colonies of staphylococcus pyogenes
aureus from the purulent infiltration of the parotid,
in. a man who died with “ acute septic peritonitis,”
after operation for strangulated hernia. But this micro¬
organism has no specific value. In conclusion, Mr.
Paget observed that this form of parotitis, which fol¬
lows abdominal or pelvic injury or disease, is, in many
ways, of great interest. In 93 cases out of 101 it was
an isolated event. It has no period of incubation, and no
regular course. It may subside and recur and subside again,
or may attend each pregnancy or each menstruation. It is
rarely marked by much fever or disturbance of the system
indeed, in many cases it is “critical ” rather than “sympto¬
matic”; and out of 33 cases where it was resolved without
suppuration, only I died, and she died of cancer. In only 15
cases is mention made of “septicaemia” or “pyaemia.”
Neither is it due to the spreading of inflammation from a
parched and sordid mouth up the duct into the gland. In
only one or two cases was thesocia parotidis involved at all;
nor are the mouths of patients with abdominal or pelvic
lesions more parched than those of other patients. It is a
pure theory, not supported by any evidence. Nor is it due
to inflammation of the lymphatic tissue in the substance of
the parotid. The characters and histories of the case render
such a view impossible. Even although some of the cases
are best explained in one or other of these ways, there are
others which cannot thus be explained. But there are many
reasons for believing that the reflex nervous system may, at
lfeast in part, be a cause of this parotitis. The influence of
the nervous system on the salivary glands, both reflex and
direct, is familiar to all. Experimentally, Paulow has found
that if a loop of intestine be kept drawn out from the abdo¬
men of a dog, the action of the gustatory nerve is inhibited,
and the secretion of saliva is checked or arrested, until
the loop of intestine is put back. The observations
of Pastematski on the changes of the pupils during
various diseases are also of interest in this connexion. Now,
if the same lesion produces salivation in one patient,
arrest of salivary secretion in another, and swelling of the
salivary glands in a third, must we not conclude that all
three are different workings of the same agent? Thus,
gastritis may cause salivation, or arrest of saliva, or paro¬
titis. 8o, too,parotitis may follow gastric ulcer, gastrostomy
(2 cases), duodenal ulcer, enterostomy (2 cases), herniotomy
(6 cases), hepatic abscess, abdominal cancer (2 cases), typh¬
litis, colotomy, the removal of abdominal or umbilical
iumours (3 cases), penetrating wound of the abdominal
wall, and peritonitis (8 cases). It has also followed division
of stricture of rectum, and operation for haemorrhoids; and
with these lost two cases may be compared the fact that
salivation has been observed as an early symptom of cancer
of the rectum. Again, derangement of the generative organs,
like derangement of the alimentary cnnal, may be followed
either by salivation, or by arrest of saliva, or by swelling of l
the salivary glands. The salivation of pregnant women, .
and their longings for sapid food, are well known; and the
same thing may occur during menstruation. Dr. Goodell !
rives two cases: one, of excessive salivation just be¬
fore and during menstruation; the other, of a lady
with a congested and tender left ovary, in whom the
left parotid gland did not secrete during menstruation, so
that the month and fauces on that siile remained dry and
painful. So, too, parotitis has been known to accompany
each pregnancy, and to accompany or replace the menstrual
flows (two cases). It has followed various trivial derange¬
ments of the generative organs (4 cases), pelvic abscess or
hematocele (4 cases), operation for lacerated cervix (4 cases),
other operations on vagina or uterus (4 cases), delivery or
abortion (8 cases), the menopause (2 cases), and ovariotomy
or oophorectomy (27 cases). So, too, after lesions of the
urinary passages, parotitis has followed the use of the
catheter. (3 cases), the use of the sound, renal abscess, and
cystitis (5 cases). Ifc is certain that, though some of these
cases were due to septicaemia or pyaemia, others were not.
Sorely they are analogous to the retention or suppression of
wine, which so often follow* abdominal and pelvic lesions.
They are not doe to a mere reflex spasm of the

mouth of the duct, such as Verneuil describes; for this, as
shown by many cases collected by M. Terrier, causes a mere
passive dilatation of the gland, which alters with every
meal, never disturbs the general health, never suppurates, 1
and disappears when a probe or catheter is passed up the
duct. Bather, while admitting the influence of the con¬
stitutional condition of the patient, we must believe that
in many of these cases of parotitis there is a reflex vaso¬
motor constriction of the arteries of the gland itself,
which, as Mr. Kuaggs of Huddersfield has suggested,
may be followed by a reaction going on to parotitis.—
Mr. Alban Dob an discussed the question of the mode of
origin of the parotitis. It could not be said thafi it was
always a question of some oonnexion between the generative
organs and the parotid gland, because injury of other porta
of the abdomen was followed by parotitis, fie examined the
theories of simple reflex action, local septic inf action,, and
mere constitutional debility, with attendant local conditions
about the opening of the duct of the parotid into the mouth.
—Mr. W. A. Mebedith raised the question whether in
parotitis after ovariotomy the parotitis occurred on the
same side of the body as that whence the ovarian tumour
was removed. In one case of his own the relationship was
crossed—the right ovary and the left parotid.

Mr. Hugh Smith read & case of Rupture of Aortic Aneu¬
rysm into the Pericardium. It occurred in a washerwoman
aged forty-two, who died whilst working at the washtub.,
Tne specimen was exhibited, and showed dilatation of the
first two parts of the aortic arch ; the third part of the arch
showed a saccular aneurysm, which opened into the peri¬
cardium by a rent three-quarters of an inch in length; as
much as fifteen ounces of fluid and clotted blood were found
in the pericardium. There was collapse of the left lung.
During life signs of consolidation were noted at. the apex of
the left lung, but there were no laryngeal or pupillary
signs.—Mr. Mabmaduxk Shbild related cases of aneurysm
of the aorta in which the patients continued to go about
doing their work till death occurred.—Mr. J. Black con¬
sidered it of interest that the aneurysm should have
originated in the third part of the aorta and yet have burst
into the pericardium.__

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

At a meeting held on January 21st, Dr. Septimus Gibbon
in the chair,

Dr. C. E. Saunpebs read a paper on “ Legislation for the
Purification of Rivers, and its failure.” Dr. Saunders traced
the abortive attempts at legislation up to the time of the
passing of the Rivers Pollution Prevention Act of 1876. He
showed that this Act bad been scarcely better than a dead
letter; that in eight years legal action to enforce its pro¬
visions had been taken only in fifty-six cases; in these,
twenty-six orders had been made to restrain pollution, but
a great number of such orders had never been actively-
enforced. Of the twenty-six orders, twelve had been obtained
at the instance of two authorities. Out of the fifty-nine
County Court circuits in England and Wales, in only twenty-
Beven had proceedings been taken; in fourteen of them there
had only been one case each. No lees than nineteen
out of the ttfty-six cases were prosecutions against
the sanitary authority, the very persons to whom the
exclusive carrying out of the Act is entrusted. As to
any spontaneous action to prevent pollution, the rivers
bear testimony of failure in that direction. Dr. Saunders
considered that trade interests militated against any effec¬
tive legislation, and deprecated making manufacturing
pollutions the chief object of prevention, these being, in
his opinion, of far lees consequence from a health point of
view than sewage pollutions. He, however, quoted the'
opinions of the Rivers Pollution Com mission ars, which,
show that “ there is not one trade pollution which cannot
be kept out of the streams altogether, or so purified
before admission as to deprive it ot its noxioue character,
and thia without unduly interfering with manufacturing
operations, but even in some instances with a dietinot
profit to the manufacturers.” Some streams are so filthy
that they are even unfit for manufacturing purposes, and
the value of clean river water in such cases is estimated by
manufacturers at from £L0 to X'1000 a year. The author
urged the importance of attacking the very tilth-beginnings
of rivers— sewage ditches; and pointed out. the good effects

316 The Lancet,]

MIDLAND MEDICAL SOCIETY.

[Feb 12,1887.

this would have on general sanitation, as well as on river I
purity, especially adhering to the old view, that diphtheria 1
is largely, if not entirely, a filth disease. He next gave the l
heads of a Bill which had been drafted by Mr. Willis Bund,
which it was intended to introduce into Parliament at the
earliest opportunity. This Bill makes it obligatory, instead
of permissive, on the sanitary authority to prosecute
offenders against its provisions, and if they (the sanitary
authority) fail to institute, or, having instituted, fail to prose¬
cute with due diligence, then any person having a legal right
to make complaint may apply to the judge of the County Court
for leave to prosecute in the name and at the cost of the
sanitary authority. Dr. Saunders then sketchedthe machinery
by which any future Act should be carried out, and advo¬
cated the establishment of a central authority, having
no other function whatever than that of attending to river
purification, looking to the medical officers of health of the
various districts for detailed and periodical information.
Dr. Saunders concluded his paper with the following re¬
marks: “The policy of ‘pass-it-on’ is too great a temptation
to put in the way of local sanitary authorities, for although
they suffer in their turn, still it is convenient to get rid of
their sewage, and the river is a costless and convenient
vehicle. If 1 might venture to paraphrase averse of Horace
I should say—

• Sanlta* exspectat dum amnia defaecat.'

And unless more effective legislation is provided in the
future than there has been in the past, one may find an
application to the completion of the line and couplet—

.• at llle

Labltur et labetur, In omne volubiils oevum.’ ”

In the discussion which followed, Drs. Gibbon, Swete, and
Woodford took part._

MIDLAND MEDICAL SOCIETY.

A meeting of the Society was held on Jan. 19tb, Mr
Lloyd Owen, F.R.C.S.I., President, in the chair.

fracture of Spine. —Dr. Suckling showed a youth, aged
eighteen, who at the end of last September had fallen twice
upon his back. When seen four days after the second fall
he was unable to stand, but could move his legs when in
the recumbent position; he was unable to turn over in bed ;
had girdle pains in the upper lumbar region and shooting
pains over the iliac bones. There was no anaesthesia, no
actual paralysis, no bladder trouble; but the first and
second lumbar spines were prominent, and great pain was
elicited on light percussion over them. The right cremasteric
reflex was loet, and the temperature varied from 99° to 102°
for a week after admission. Under treatment by a plaster
jacket these symptoms have now almost entirely dis¬
appeared. Dr. Suckling considered that there had been a
fracture through the arches of one or more of the lumbar
vertebr© with irritation of the last dorsal and first lumbar
nerves.

Meckel's Diverticulum..—Mr. A. F. Clay showed a speci¬
men of Meckel’s diverticulum from a girl aged thirteen.
She had swallowed a number of plum-stones, and for the
removal of these had taken strong purgatives. When first
seen by Mr. Clay, ten days after swallowing the stones, she
was suffering from peritonitis and obstruction. He opened
the abdomen in the middle line and found a quantity of puru¬
lent fluid in the peritoneum, the intestines being matted
together. The peritoneum was washed out, and a distended
piece of intestine opened and stitched to the wound. The
patient died from exhaustion thirty-six hours after the
operation. At the post-mortem examination a Meckel’s
diverticulum was found with its ligament attached to the
mesentery; a piece of the ileum below this had got under
the loop, and was firmly strangulated, ulceration and
perforation having taken place.

Dermoid Cyst of Ovary—Dr. Mali ns showed an ovarian
cyst containing a quantity of oily material that solidified
on its removal from the body, and a mass of hair.

Enlarged Ovary.—Dr. Malinb also showed an enlarged
and cystic ovary from a patient aged twenty-five. Both
these cases had been subjected to operation, and both had
recovered without a bad symptom.

Vtsteal Calculi.—Mr. Haslam showed twelve uric arid
Calculi, weighing altogether one ounce and three-quarters,
tbat bad been removed from the bladder of a female subject
in the Queen’s College dissecting-room. The bladder was

much hypertrophied, but nothing was known of the previous

history of the case. .

Dr. Foxwell read a paper on Acute Peritonitis in its
Medical Aspect. __

GLASGOW OBSTETRICAL AND GYNAECOLOGICAL,
SOCIETY.

The fourth meeting of the session was held in the Faculty
Hall on Jan. 26tb, Dr. Samuel Sloan, President, in the chair.

The President exhibited a model of the Incubator in use
at the Maternity, and made some remarks upon the current
experiment with Triplets.

Dr. Murdoch Cameron showed a Fcetus at the sixth
week with Membranes, &c.; and also a Fcetus at the fourth
week, with Amnion, Chorion, and remains of Umbilical
Vesicle.

A Review of Thirteen Years Private (Obstetric) Practice .—
The adjourned discussion of Dr. J. K. Kelly’s paper was then
taken up by Mr. J. S. Nairn e, who said Dr. Kelly was for¬
tunate in having had no cases wherein delivery had not been
possible by means of forceps. He could not imagine such
an amount of distensibility as that contended for compatible
with a healthy pelvis. He had never observed any “erection
of the hip” during labour. Nevertheless, the pelvis was
normally capable of a slight amount of distensibility; but
he thought the joint most capable of it was the lumbo¬
sacral, which allowed, certainly not a dilatation , but an
adjustment of fcetus to the pelvis. He objected to, and
repelled. Dr. Kelly’s views as to the occurrence of ruptured
perineum to such an extent as to require perineorrhaphy.—
Dr. Park objected to “ bad nursing ,T being accepted as an
efficient cause of death post partum, and to Dr. Kelly’s
wholesale condemnation of ergot, especially for hemorrhage,
and thought he had been extremely lucky in never having
had either a case requiring craniotomy or a case of death
from post-partum hemorrhage.—Dr. W. L. Reid thought
Dr. Kelly’s practice wrong in respect of rupture of the
perineum, and that it was dangerous practice to apply
the straight forceps at the pelvic brim. He also believed
first labours to be more dangerous than subsequent ones.—
Dr. Abraham Wallace said that the luxation of the
lumbo-sacral articulation during labour had been drawn
attention to before. He thought such an amount of general
pelvic distensibility as Dr. Kelly contended for was not
according to fact.—Dr. Oliphant thought moderate rup¬
tures healed very well without stitching.—Dr. Sloan
thought straight forceps inadequate for use at the pelvic
brim, and that a double-curved instrument should always
be used. He places his pad somewhat higher than “over”
the uterus, and administers ergot as a routine, as it kept
the uterus retracted. He had observed distensibility of &
marked kind only in one case, and in it a firm binder had-
to be adjusted post partum, in order to enable the patient to
walk comfortably. He did notreck on rupture of the four-
chette as rupture of the perineum, as tbat occurred in almost
every case. He considered there were three degrees of
perineal rupture—viz, 1. Where a few fibres only were
tom. 2. Where it went within a quarter to half an inch of the
anus; this should be stitched at once thoroughly. 3. Where
it passes through the anus, when, as a matter of course,
stitching is necefsary—Dr. Kelly, in reply, adhered
generally to the positions contended for in his paper.

Dr. Geo. Halket then read a paper on the Obstetrical
and Gynaecological Cliniques of Berlin and V ienna, which
was listened to with great attention, and frequently elicited
the applause of the Fellows. He also exhibited the obstetrical
and gyntecological instruments in common use at Vienna.

Rotherham Hospital. —The annual general meet¬
ing of the subscribers to this institution was held on the
27th ult., when the committee reported tbat the total
number of patients during 1886 was 4092, of whom 189 were
in-patients and 3903 out-patients. The receipts amounted
to £1571, and the expenditure to 1493. The new ward now
in course of erection is almost completed, and as when it
is occupied a larger income will be necessary, the com¬
mittee appeal for increased support.

At the annual meeting of the subscribers to the
Tavistock Dispensary on the 26th ult., it was resolved to
erect a cottage hospital in connexion with the institution.

Digitized by GoOgle

The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Pbb. 12,1887. 317

aab ftotkes of $ook

The Surgeon's Pocket-book. An Essay on the best Treat¬
ment of Wounded in War. Especially adapted for the
Public Medical Services. By Surgeon-Major J. H.
Porter, late Assistant Professor of Military Surgery,
Army Medical School, Netley. Third Edition. Revised
and edited by Brigade Surgeon C. H. Y. Godwin, Medical
8taff, Assistant Professor of Military 8urgery, Army
Medical School, Netley, late Medical Officer of the Royal
Arsenal, Woolwich. London : Griffin and Co. 1887.

Thr basis of this work was originally an essay selected
for the prize offered by Her Majesty the Queen of Prussia
and Empress of Germany on the “ Practical Treatment of
the Wounded in War.” The adjudicators were Professors
Billroth of Vienna, Baron von Langenbeck of Berlin, and
Socin of Basle. The first edition was published in 1875, the
second in 1879, with a preface by its author dated Cabul, in
September of that year, where, to the great loss and grief of
the army in Afghanistan, Surgeon-Major Porter soon after¬
wards perished of pneumonia. The present, or third edition,
is in many respects another book altogether. It possesses some
historical sort of interest in this respect, that it enables one
to trace the progress and changes that military surgery has
undergone in the interval. The first edition received the
stamp of official recognition in the “ Precis of Medical
Arrangements,” published for the guidance of medical
officers in the Afghan campaign. The present editor—
Brigade Surgeon Godwin—has introduced so much that is
new, practical, and in our opinion sound, that we can
without affectation recommend this “Surgeon’s Pocket-
book " as an invaluable guide to all engaged, or likely to be
engaged, in field medical service ; in fact, we do not know
of any other book of the kind that contains the same
amount of pertinent information in the same compass.
The key to the changes he has effected is to be found in
the substitution of antiseptic for “antiphlogistic” in the
treatment of wounds and injuries. The amount of revision
that the book has undergone and the new matter that has
been added will be more easily appreciated by examining
tbeae a little in detail. The following may be taken as samples
At page 2 a stretcher section is described. At page 17, et eeg.,
a clear and correct precis is given of the present arrange¬
ments in the army for service in the field (illustrated by the
frontispiece), which is likely to prove really useful. At page 22
there are a few new remarks on “ shock.” At page 41 there is
a short paragraph on “fat-embolism.” Then follows a brief
account of the theory of Listerism, with details for wound
treatment in general and remarks on the chief antiseptics.
At page 49 the treatment of special wounds, or those which
have already taken on unhealthy action, is given, followed
by Beyher’s experiences and rules for treatment of gunshot
injuries. At page 57 Surgeon-General Cammerer’s experience
in Roumania during the last Russo-Turkish war is given.
The lesson to be learnt from that experience is that his
mccess should impress the importance of surgeons at
different hospitals on a long line of communications not
losing heart because wounds come to them septic from
exposure and inattention. There is some new matter under
the head of wounds of the abdomen: for instance, at
page 102, in the way of suggestion of free incision in
diffuse peritonitis; and at page 103, regarding the question of
laparotomy in injuries of the abdomen where viscera are
injured, and where foreign bodies have penetrated and
have to be removed. At page 120 some rules are offered for
guidance respecting gunshot fractures of the femur, where
the situation, and especially the factor of rest afterwards
greatly influence the treatment. It is pointed out how
•Marly hopeless it is to try to save the limb if the patient
has to he carried day after day, &c. At page 232 there is a
useful table of water rations required for man and animals;
*«1 a typical war ration as a guide for medical offioera,

followed by excellent and precise information regarding air¬
space and ventilation. Considerations of space compel us to
omit by far the larger number of revisions of and additions to
the text. The four appendices are new, and contain some
excellent formulas and useful information. The third con¬
tains a translation of the orders reoently issued to the
Medical Department of the German Army, which is calculated
to afford medical officers—serving in India for instanoe—
useful hints of what to do when suddenly ordered to prepare
for a flying column, and so forth.

Sanitary Examinations of Water, Air, and Food. A Vade-
mecum for the Medical Offloer of Health. With 110
illustrations. By Cornelius B. Fox, M.D., F.R.C.P. Lond.,
formerly Medical Officer of Health of East, Central,
and South Essex. Second Edition. London: J. and A.
Churchill. 1886.

During the eight years that have passed since the pub¬
lication of the first edition of Dr. Cornelius Fox’s book much
valuable labour has been devoted to sanitary science and
many new methods have been described. Dr. Fox has in¬
dustriously studied these modem methods, and in the present
edition gives us the benefit of his work. A considerable
portion of this book is new, and all the leading authorities
have evidently been consulted. In the section devoted to
water, the most important addition is a clear and well-
illustrated description of the biological methods, chiefly
founded on the researches of Koch, which have attracted so
much attention of late years. The field is promising,
and already a crop of useful results has been gathered
by Dr. Percy Frankland, Dr. Tidy, and others; but
as yet no certain inferences can be founded upon the
experiments, for bacteriology is still in its infancy. The
influence of bacteria in nitrification and denitrification
might with advantage have received more notice. To the
latter process, a very important factor in the destruction of
sewage matters in river water. Dr. Fox hardly alludes, and
we gather from some words on page 100 that he has not
read or has misunderstood the interesting results arrived at
by Dr. Angus Smith in one of the latest, if not the latest,
researches of his useful life. In the presence of excess of
sewage, nitrates are rapidly reduced, the nitrogen escap¬
ing as gas. As in so many other cases in chemistry,
oxidation and reduction seem to go on simultaneously.
A section is given to the very important question of dis¬
solved oxygen, about which, as yet, we have by no means
heard the last word. Schiitzenbergen’s process, based on
the use of sodium hyposulphite (the true hyposulphite
Na SO„ and not the thiosulphate NajSjOj commonly known
by the name), is described with sufficient clearness. In
skilful hands it is simple and satisfactory, but Dr. Fox does
not sufficiently insist on the absolute necessity of working
quickly and excluding even momentary exposure of the
sample to the air. The velocity with which water takes
oxygen from the air is marvellous, and the neglect of proper
precautions for the exclusion of air has rendered mere deter¬
minations of dissolved oxygen worthless. With regard to
the determination of organic carbon and nitrogen, we are
inclined to think that Dr. Fox underrates the importance and
overrates the difficulty of the method of Frankland and
Armstrong. It is, with certain well-known restrictions,
accurate as well as valuable when properly carried out. It
was, however, wiser to exclude it from a manual intended
for medical officers of health, who have seldom had the
training of professional chemists.

The section dealing with air is about equal in length to
that devoted to water. There is a great deal of valuable
matter in it, particularly in regard to microscopic examina¬
tion, which is constantly becoming more efficient, and
therefore more important. There are some useful directions
in regard to meteorology, and a chapter on ozone, in which,
however, we And some serious defects. The simultaneous
formation of ozone and peroxide of hydrogen is now well

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JU# Tun L.VN'dBf,]

R RV IEWR—NEW INVENT! ON*?.

[Fbb, 12,1887.

known, and should have been noticed, and to say that
“peroxide of hydrogen is produced by a combination of the
oxygen of the air with water” is a very loose way of stating
the facts.

In the last section, which treats of the sanitary examina¬
tion of food, the beat chapters ore those which describe the
inspection of meat, poultry, and fish. In this and in the
simpler methods for food analyses, the author is at home;
but he would have been wise, considering his limits of space,
to have omitted the complete quantitative analysis of food,
for which his directions are entirely insufficient, and in
somei'cases- misleading. On the whole, however, in spite of
some defects, Dr. Fox's manual is a good sound piece of
work, And will be of great value, not only to medical officers
of health, but to all who are interested in sanitation—thaf
•is, to the whole medical profession.

Outlines of Quantitative Analysis. By A. Hum bolt Sexton,
' ProfessoT of Chemistry in the College of Science and Arts,
Glasgow. London: C. Griffin and Co. 1887.

‘The writer of an elementary text-book is nearly sure to
say in his preface that he thinks his work will supply a
'Want. Too often he is alone in his belief; and we have of
Tate years been flooded with Buch books or booklets, many
'of them absolutely- unnecessary, and many worse than
“useless. Professor < Sexton tells us the usual story, but in
hiis case we are btand to admit that the story is perfectly
true. A compact laboratory guide for beginners in quanti-
.tative chemical analysis was wanted, and the want has on
kite whole been well supplied. Even among students who
jlo not intend to make chemistry a profession there are many
,rwho can afford the time and would gladly devote the labour
necessary for the study of elementary quantitative analysis.
,Apart from its practical utility, the mental and mechanical
.training gained in exact scientific work is of infinitely
jhigher value than the careless and slovenly test-tube messing
which is so often mistaken for practical science. At some
i’ew schools, notably at Epsom College, elementary quanti¬
tative analysis has been introduced among the more advanced
students with signal success. To those teachers and students
who are willing to devote the time necessary for real scien¬
tific work in chemistry Professor Sexton’s little book will
be useful. It is not quite free from faults, but as far as we
have seen it is accurate; the descriptions are clear and
sufficiently full, and the examples chosen are for the most
part well selected. The few faults which we have to find
,are of a secondary character. Now and then we regret the
absence of some well-known simple and useful method—
.such, for example, as the estimation of copper by electro¬
lytic deposition on platinum; but more frequently we are
iaqlined to complain of the somewhat too wide scope which
•wb author has permitted himself. Ultimate organic analysis,
£or example, including combustion in oxygen and Dumas’ 1
,.prooess for the estimation of nitrogen, cannot be sufficiently
■ explained in so short a space, and no student would attempt
Jt without, fuller directions. Then the apparatus described
is often more elaborate than is really necessary; and alto¬
gether the book, good and. useful as it is, will be apt to
;i l ighten students who have neither much money nor much
jtime at their disposal.. _,

■ |Eehr ^nhcntwms.

” *'i - .. i' / . [

,. f . POC^E^T SURGICAL INSTRUMENT CASE.

Messrs. Ap^OLD ANDSoN8,of West Southfield, have made
-PH a smal 1 pocket surgical instr u meutcase. which will, I think,
;-.Wfound afroonto general practitioners. The average eurgical
.drying qafpj*fa* too large and cumbersome to be habitually
,**frwd abqtfhip. the pocket, consequently it frequently
• happens that it ys not at baud when most wanted. A case
K>E7Tt*p4red flogtwohpg a few , t ^ .peftweaigr emergency

instruments, yet so small that it may habitually be carried
about without causing inconvenience <by its bulk. The
annexed woodcut depicts such a case, containing scissors,
dressing forceps, artery forceps, probe and director, abscess
knife, and gum lancet, with pockets for sutures and needles.
The dimensions are as follows: length, 3in., width, 2in.,
thickness, £in. Pocket cases intended to answer this

purpose are sold by several makers, but the instruments
being placed in two roros the case is rendered so thick as
to entirely defeat the object for which it is made. In the
above cases the few absolutely necessary instruments are
laid as fiat as possible in one roue, and thus the outside thick¬
ness of -£ in. is obtained. The case fits easily into the watch
or waistcoat pocket. WxU.iam D. Stbbl, ALD.

~ m

BASDON’S CHLORIDE OF AMMONIUM INHALER.

The catarrh-producing winter through which we are pasa-
inghasgiven unusual interest to all devices for removing aural
catarrh, of which the various inhalers for the nse of chloride
of ammonium are amongst the most valuable. We have tried
the above inhaler, and can express our approval of it. It
is well made and easily used. Tbe materials of it are good;
the cork of the bottle as well as the tubes and the stopper
of the sponge tube are made of flue indiarubber. It has
the great advantage of cheapness, is simple in con¬
struction, and works well; one feature of it being that a
prolongation of the tube holding the pumice-stone, beyond
tbe point of exit of the tube carrying tbe fumes into the
water, serves to receive any excess of acid and thus prevent
its escaping into the water. The directions should state the
strength of tbe ammonia and acid preparations. The agents
are Messrs. J. Carr and Co., PhannaCentical Chemists, 17A,
High Holbom, London, W.C.

THE “UNBREAKABLE” CLINICAL THERMOMETER IN
PATENT “ SAFETY ” CASE.

We consider the patent “safety” case introduced by Messrs.
J.C.Fell and Co.(l,Queen Victoria-street, Lpudon) a very use¬
ful invention. The insertion of the thermometer in its case
must be performed by a screwing motion in .the direction of
the arrow marked on the case. If the attempt be made to
insert the glass by direct pressure, considerable resistance
will be offered by tbe indiarubber flanges, and it is difficult
then to asoertain when the thermometer is “driven home.'’
Would it not be an advantage to have some means of knowing
how “far and no further” the instrument should be inserted?

IMMISCH’S IMPROVED CLINICAL THERMOMETER.

To Mr. Immisch’s a vitreous thermometer an addition has
been made which will be appreciated by clinicians as a
distinct improvement. It consists of the introduction of a
stop, by means of which the reading can be fixed after the
temperature is takeD. This object is secured by simply
pu lling out a.knob inside the bow, the reverse action serving
again,to liberate tj}e pointer.. . ( /

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Ths Lancet,]

THE INFLUENCE OF SMALL-POX HOSPITALS.

[Feb. 12,1887. 819

THE LANCET.

LONDON: SATURDAY, FEBRUARY IS, 1887.

Ob. Buchanan has submitted a second official report to
the Local Government Board as to the proceedings of his
department daring the year 1885. His first one related
solely to cholera; the present one may be taken as his
ordinary annual volume, and it deals with many matters
of great interest. There is, however, one subject which
may be regarded as taking precedence of all others, and
that is the question of the influence of small-pox hospitals
is London. Ever since the Medical Department of the
Local Government Board found themselves confronted by
the facts reported by Mr. Power as to the influence of the
Falham Small-pox Hospital on the area around it, this
mbject has received a considerable amount of attention
both on the part of experts and of the public. Former
unbelievers in the influence for evil which the metropolitan
mall-pox hospitals have exerted have very generally come
to see their error, and Mr. Power’s contention of the
miaehief produced has been supported and endorsed by
some of the ablest of metropolitan medical officers of
health. Even those who do not agree as to the method by
which the ovil is brought about have been unable to deny
the facts, but many have sought to reduce to a minimum
the inference which it is natural to draw from Mr. Power’s
labours, and to point to side issues which, after all, do not
materially affect the principal question under discussion.
All the information at present available on the subject is
sow brought down to current date, and it is impossible to
read the carefully considered document which Dr. Buchanan
has submitted to his Board without being convinced that
some radical change in the matter of isolating small-pox
patients in urban districts is called for. London has always
been liable to an exoess of small-pox when compared with
the provinces, but, as the report points out, “ of recent
yean a new factor has come into operation.” Indeed, it is
ihown, both by statistics and by diagrams, that, whereas
in the provinces there has been a remarkable and almost
steady diminution of small-pox mortality during the
past ten years, no such reduction has taken place in
the metropolis. It is true that improved vaccination in
London has succeeded in effecting a great reduction in the
(mall-pox deaths amongst children, but, notwithstanding
this, the general small-pox rate remains so high that it is
in effect sevenfold that which obtains in other p^rts of
England. What is this new factor ? None other than the
establishment in London of permanent hospital centres for
the aggregation of small-pox cases.

Quite recently a correspondence has been going on in the
general preea as to this matter, and an attempt haa been
made to show that even those who now condemn the London
•mall-pox hospitals have expressed opinions to the effect
that such hospitals operated for good in urban as well as
iu rural districts. But the principal opinion quoted was
twelve years old, and the writer who quotes it has

apparently forgotten that the science of preventive medicine
is progressive. The fact that Mr. Power and others, who
first ascertained the serious evils resulting from the Fulham
Hospital, originally entered on their inquiries under a
distinct conviction that the mischief complained of would
admit of a totally different interpretation, gives special
foroe to the altered views which they now And themselves
compelled to express. These views were of such importance
that they were investigated at great length by a Boy ad
Commission, which came to the conclusion that by some
means or other the London small-pox hospitals all shared
the disastrous ability to spread small-pox over the neighbour¬
hoods around them. Since then the investigation has been
continued, and, instead of any discovery tending to vitiate
this conclusion, the evil has become more and more evident*
and it is clear that even the diminished number of acute
oases which the Metropolitan Asylums Board decided to
retain in London hospitals is capable of spreading small¬
pox, and this at a distance of a mile over inhabited urban
areas. This circumstance is the more important because the
misohief is maintained, notwithstanding every effort to
control it. Improvements have been effected in the ambulance
service, the staff of the hospitals have submitted to
restrictions which were not deemed necessary before, and
all the incomings and outgoings of the hospital have been
placed under a rigid supervision. Indeed, those responsible
for these hospitals could, in so far as administration is
concerned, hardly have done more. But no effect has
resulted; the hospitals, when used for small-pox, still remain
centres of infection to the districts around.

We shall recur to this subject of the influence of small¬
pox hospitals in London when we review Dr. Buchanan's
report more in detail. But iu the meantime we would note
the curious fact that, at the request of the President of the
Local Government Board, Dr. Buchanan has inserted in his
report certain observations made by Dr. Bridges, of the
Poor-law Department, on the same subject. Indeed, the
insertion of Dr. Bridges’ contribution is apparently intended
to minimise the effect ot that emanating from the Board's
principal medical officer, but, as a matter of fact, it does
nothing of the kind. It takes up two points. Tbe first is,
Do small-pox hospitals spread disease around them ? As to
this. Dr. Brzdgbs accepts Mr. Power’s facts, and admits
that they "show clearly that a small-pox hospital in a
populated neighbourhood has been, with all the precautions
as yet devised, an appreciable source of danger to that
neighbourhood.” Bat he then proceeds, with the aid of tbe
Begistrar-General, to point out that a district which
contains a small-pox hospital may possibly have the
“ benefit conferred upon it counterbalanced by some small
disadvantage.” As to this, we expect such districts as
Hampstead and Fulham would far sooner have faced tbo
“ disadvantage” of having no small-pox hospital than have
run the risk of suoh “benefit” as is here referred to.
Dr. Bridges’ next point relates to the question of tbe
conveyance of the small-pox infection atmospherically for
long distances. But this is on the present occasion entirely
beside the mark, for Dr. Buchanan's report does not deal
with this subject at all. His contention is simply that,
notwithstanding every effort to the contrary, these hospitals
are in some way or other centres of jnfectum, and that.

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820 The Lancet,!

THE UNIVERSITY OF LONDON.

[Feb. 12,1887.

their establishment has coincided in point of time with the
maintenance in the metropolis of an excessive small-pox
death-rate.

We sincerely trust that the atmospheric theory as
set oat by Mr. Powbb may be found to be the true
explanation of the evil, for it will then still be open to
the Metropolitan Asylums Board to devise means such
as were brought under the notice of the Royal Commis¬
sion'for so constructing snall-pox hospitals . that no
infected air shall pass out of them. But if the anti-aerial
theorists are correct, then we are in an utterly hopeless
state, for “ with all the precautions as yet devised ”—
and Dr. Bridges has apparently no others to suggest—
the danger stall continues. Surely the time has come when,
as Dr. Bochanan points out, the other moans recommended
by the Royal Commission for reducing the chance of
spreading'this infection ought to be triod. The Asylums
Board are wanting to spend large sums on small-pox
hospital construction at the present moment; we hope .that
they will be urged to carry out the views of the Commission
'by the erection of at least one experimental hospital which
shall destroy its own infected atmosphere on its own premises.
'When this has failed, but not until theta, they will have
done all that the public can at present expect of them.

lx our last number we. pointed nut that the optimist
conclusions with regard to the past and future of the Uni¬
versity of London set forth in the current number of the
Quarterly Review required very considerable modifications
when examined from the point of view of the other
Faculties, and we shall now show that even from a medical
standpoint the results are not so wholly favourable as the
writer would have ns believe. No one conversant with
medical studies and medical examinations during the past
ten or twenty years will endorse the following opinions
of the writer of the article: “ It is probably in Medicine
that the influende of the University of London has been
most powerfully felt, and that its most conspicuous

successes have been achieved.It is generally

admitted that the requirements of the University have
done much to encourage those higher studies and re¬
searches on which the advancement of pathological and
therapeutical science • most depends.” Criticism, of such
dogmatic assertions as these iB difficult, as they are
obviously written without due appreciation of tire means
and'Methods by which medical science has been making
such rapid strides in late years. When the University
of London instituted degrees in Medicine, and raised
the standard of professional and general examination,
all the ambitions alumni of the London and 'provincial
schools naturally endeavoured to obtain the newly made
and coveted degree of M.D.LOnd., and this movement
went on for some thirty years, because degrees elsewhere
wert Only to be obtained by Compliance with onerous
restrictions as to residence which London students oould
ill afford to yield. The examinations and regulations Of the
University of London, although stringent, were then really
much -less severe than those which are insisted on at the
present time/ahd the required period of study was not
nearly so protracted or attended with such great expense.
’the Senate, being practically a body into which only

the least possible change can be introduced, looks but little
at other educational institutions, and clings to the belief
that all modern improvements in medical education and
examination are due to tihe example and influence of
Burlington Gardens. But in the last twenty years a
great alteration has come over the spirit of medical work
and responsibility throughout the kingdom, whilst the
authorities of the University of London have done little or
nothing. to assist therein, one guiding consideration alone
influencing their conduct—that to increase the stringency of
its examinations was the raison d'etre of its existence
the proof of its utility. Other Universities have enormously
developed from a teaching standpoint, and have increased the
number of their students; biological and physical sciences
have, been fostered and encouraged by them; their degrees
have acquired a greater prestige in the eyes of medical
students, and candidates from all schools outside the metro¬
politan range have been attracted to Cambridge and Man¬
chester, until now a very insignificant number of the total
body, of students are bo be found amongst London medical
graduates; and yet the University of London is satisfied. It
does not see that under its present arrangements it is fast
losing its pre-eminence. “The University has probably
influenced the profession profoundly and beneficially by
confining its distinctions to the Hite of medical students,
and by setting up a high ideal of professional qualification.
It may be doubted whether an equally useful object would
have been attained if it had admitted ten times the number
on easier conditions.” We very much question whether it
is now attracting the Hite of the profession, and we are
quite sure that it could have been much more influential
by not ignoring the teachers and without any real lowering
of its standard. Out of 800 students in the London medical
schools only 36 obtained the qualification of M.B. last year,
and 42 is the average number for the past eight years. Is
this a satisfactory result after fifty years of existence? We
venture to say that the result is most unsatisfactory,
and that many men equal in intellectual calibre, and in
many respects superior in professional acquirements, to
those who have obtained a London degree, have been
stopped at the threshold by the undue severity of its first
two - examinations, whilst the prohibitive regulations of
its later ones and the length of time and cost involved in
carrying out the curriculum, have deterred many others. The
Senate must not conclude that it collects within its net
even all the abler London men; it is well known that for
many years past this has not been the Case, and onr columns
last week afford a striking example. One candidate only
out of II who are competing for the vacant assistant-
physioiancy at St. Bartholomew’s Hospital is a graduate of
the University of London. In 1863 the degree of M.S. was
instituted, and we have, after twenty-three years, just 16
graduates who have passed the examination for its attain¬
ment. Most of these are also Fellows of the College of
Surgeons, and have passed as stringent a professional
examination for this honour as for the University degree.
The - institution of this degree in Surgery is therefore
evidently not a success. Out of 14 examiners-in medical
subjects in the University itself, only one^half are gra¬
duates qf the University, and of 12 external examiners
appointed at the Victoria Urd verity only 3 ire London

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Thj; Lancet,]

THE LORD CHANCELLOR’S LUNACY BILL,

^Feb. 12,1887. 321

graduates, clearly showing that in medical science
experts are largely found among graduates of other
Universities. We believe that in a few years we shall
?e 0 a further displacement of London graduates in the
London teaching schools by those who, having been
clinically educated in London, havo sought degrees
elsewhere. The Quarterly reviewer, whilst pointing out
the desirability of a federation of the medical schools in
London, says that this could not be enforced by any
external authority, and could be adopted at once without
waiting for a reorganised University to suggest it. This
is undoubtedly quite true, but he overlooks the considera¬
tion of the assistance which an external authority like a
University would be able to afford to such a movement,
and we hope we may yet see a real University in
London with a medical faculty under the care and guid¬
ance of the Royal Colleges of Physicians and Surgeons. The
constitution of the Senate of the University of London,
composed of “ men of eminence in literature, in science, and
in academic and public life,” must be completely altered
before it will pay any heed to the needs of teachers
or students. It has quite lost touch with these, and
its foremost considerations are given to shaping the
"conditions of its examinations.” For these only it exists,
and to these its satisfaction is limited.

It would seem to be possible, if not probable, that the
session of Parliament now in progress will be distinguished
by the passing of a Bill to consolidate and amend the Lunacy
Acts. At present the Lord Chancellor’s scheme has been
embodied in two Bills, for the convenience of discussing the
new proposals apart from the technical business of consoli¬
dating those provisions of the existing Acts concerning
which there is no question. Hereafter the two Bills are to be
combined ; but meanwhile it must not be assumed that the
Consolidating Bill .contains no new and important amend¬
ments. For example, it makes the appointment of a resident
medical officer essential in the case of every asylum having
■ifty patients. This enactment does nob affect existing in¬
stitutions, as the practice has outrun the law; Jmt the sub¬
stitution of fifty patients for one hundred as t,he limit is a
notable amendment; and other changes not less significant,
though more effective, will be found on close scrutiny. The
Consolidating Bill will need to be carefully studied and
witched.

The provisions embodied in the amending Bill are ex¬
plained in a memorandum accompanying the measure as
presented to the House of Lords, and are generally described
M carrying out “ in the main the recommendations made by
the Report of the Select Committee on Lunacy Law in the
year 1873," which committee, it will ■ be remembered, the
community owes to the persistent enterprise of the member
for 8wansea, Mr. DipBwxN.. We are not able to say that
tho Bill as it stands is all that could be desired; but it cer¬
tainly gets forth changes to be made in the law wh$h will
h&ve the threefold effect (1) of rendering the tieatmepf of
8ine penons as lunatics increasingly difficult and therefore
probable—it would be well if we could say impossible,;
('-) prelecting from vexatious proceedings those who have
^ '“•SPW^I^MibiUty ip the placing of alleged lunatics
Un ^(?JOtrol r althougli in (bis reppeqt the provision relates

rather to the arrest of proceedings than to their prevention^
and (3) of preventing the multiplication of private asylums,
albeit those which exist are to be allowed to cany on their
business, and any number which may be in process of estab¬
lishment at the time of the passing of this Act are also to be
tolerated. It is to be regretted that the rights of property,
however admirable in their way, should be deemed an in-
superableobstacle to the summary sweeping away of a system
which is bad in principle, and admits of no defence. The
change to be immediately accomplished consists mainly in thq
elaboration of measures whereby the now facile process Qf
placing an alleged lunatic in confinement is to be complicated
and brought under official cognisance. The main defects of
the method by which this is to be done lie in details whicty
can be modified in committee.

Speaking broadly, it may be eaid that the chief pointg
gained by the reformers at whose instigation this passably
liberal measure has been wrung from the Government
that henceforth the hole-in-corner proceeding by which,it
is now easy to put away any weak-minded or eccentria
person in an asylum as a lunatic will be, in a perfunctory
I and permissory fashion, brought under the cognisance of a
I County Court judge or a justice of the peace, who, may, tfhe
| see /i£, or if the victim of the proceeding has the wit and is aWa
to get at the magistrate, bring about a personal interview
. between the alleged lunatic and the functionary appointed,
to protect him. What would be thought of a provision .tOj
the effect that if the judge thought fit, or a prisoner
demanded it, the accused might be present at his owa trial .
Nothing probably will convince those who look upon t^a.
j victims of mental disease as wild beasts from whom the s&ne
| are to be protected at all costs and risks that even a repute^
madman has his rights. After the passing of this Act, also*
j it will be possible for persons to be placed under treatment^
, of their own volition. This is,a most important and useful
provision. • Moreover, there will be a system of visiting end (
eportiug upon the cases of persons who are confined, a^
lunatics, which, if only what is now permisaory can be made,
obligatory, and some way can be devised of compelling thfy
authorities to discharge their duty quickly as well,

\ efficiently, will be advantageous. ...

We . are not greatly interested to discuss the detajj?
of the Bill at this stage—first, because they have been,
again and again discussed, usque ad nauseam, in. both
the professional and the lay press; and second, because)
unless or until the measure reaches the House of

i

Commons it cannot be hold to be actually on its trial,
as a practical proposal. There has been so much trilling,
with , this question of Lunacy Law amendment, that eyen
those who regard the proposal as a threat of “wolf”
have ceased to tremble at the cry too often raised if),
vain; while for the majority—who earnestly desire
sweeping away of a vicious system—the truckling to vested,
interests, and the blighting influence of officialism inter-*,
fering, with the effect of taking the heart out of ev^ry,
measure of reform and reducing what yrere once spirited
proposals to mere, puny changes of name and fom^, the,
vexatious delay and trilling which have characterised thiq
matter throughout its progress have proved so disappointing
as to, give rise to a feeling of disgust with the whoja
business. Hereafter it may happen that interest, may be re-

Digitized by Google

522 The Lancet,]

ANATOMY AND PHYSIOLOGY OF THE BRAIN.

[Feb. 12,1887.

awakened by the development of a measure which at the
first blush appears to be a curious crowding of elaborate
detail into a crude and confined outline. Precisely that
■which might be expected to result from the meddling and
muddling of many interested persons working together
under the anxious supervision of a timid Minister, morbidly
solicitous to please the majority and give serious offence to
no one, this Bill certainly is. It is not possible that it
should ever be a thoroughly satisfactory measure; but, on
the principle that half a loaf is better than no bread, we
may yet learn to take it and be thankful. Some of its
provisions, if not ridiculous, are grotesque. Thus those who
are wont to be thankful for the very smallest of mercies
may find consolation in the proposed enactment by Sub-
section 2, Section 8, that a lunatic shall not be sent to an
asylum upon the medical certificate of his mother-in-law;
but it does seem strange that, as Lord Halsbury mani¬
festly contemplates the rapid rise and extensive practice of
feminine physicians, he has not, while protecting a lunatic
from his mother and mother-in-law, also provided for his
safety against the machinations of his grandmother!
--

As we reported in our columns last week, Professor
Hamilton of Edinburgh has recently propounded his views
on some poiuts in the anatomy of the brain, which he has
studied by means of enlarged sections of the organ pre¬
pared by a special method of his own. And first, with
regard to the corpus callosum, be still adheres to the view
which he put forward at the Royal Society of London in
the year 1881. This theory is a modification of that
originally advanced by Foville. It argues that the fibres
which compose the corpus callosum are really derived from
the basal ganglia, and pass upwards towards the cerebral
cortex along the fibres of the internal and external
oapsules to the opposite side of the brain. We tbiok this
notion is inherently improbable. Further, it is based on a
method of examination which, to say the least, cannot be
regarded as altogether satisfactory. The method is that of
naked-eye examination, or aided by the use of a lens, of the
enlarged and prepared sections. The more careful method
adopted by Dr. Bkevor and the experiments of Mr.
Victor Horsley are apparently directly opposed to the
conclusions of Dr. Hamilton. In the October number of
Brain for 1835, Dr. Bkevor gives the results of his inves- ;
tigations of sections stained by Weioert's method, so j
prepared as to exhibit the medullary fibres. This method |
demonstrated that the fibres of the corpus callosum
and those of the internal capsule interweaved with one
another in their passage to the cerebral cortex. He could
not discover any direct communication between the fibres
of the capsule and those of the corpus callosum. Mr.
Victor Horsley, in the last series of the Brown Lectures,
explained that when the whole motor area of the cerebral
Cortex of one side in the monkey was extirpated, stimula¬
tion of the remaining motor area was not able to evoke cor¬
tical epilepsy of the limbs of the same side of the body as the
cortex stimulated, showing, with other experiments appa¬
rently conclusively, that the fibres of the corpus callosum
conveyed stimuli to the opposite cortical motor centres. The
•ame experimenter’s observations on the division of the corpus

to Dr. Hamilton's plexiform nucleus having a correlatin
function situated internal to the upper part of the interzu
capsule near the lenticular nucleus, we can only say tha
it is altogether at variance with our present notions, for i
would appear to be an axiom of cerebral physiology tha
a creating or a correlating function cannot take plac
in the absence of nerve cells; and, if our information, b
correct, Dr. Hamilton assigns such a function to a mer
aggregation of fine nerve fibrils. The optic thalamus is an<
has been a crux to experimental and clinical pathologist
for all past time. We are much indebted to him fo:
attempting to throw light on this most obscure subject
He believes that this body is a communicating centre o
association bringing the functions of sight into relatior
with those of other cerebral functions. It may be so; bul
such a view rests on scarcely any other basis than that ol
mere opinion. We cannot but think that his theories as tc
the relation of nerve cells and fibres are also diametri¬
cally opposed to the doctrine of continuity of structure and
function. We have only the report, necessarily brief, of the
meeting of the Edinburgh Royal Society to guide us. But we
cannot think he is right in doubting that nerve fibres enter
nerve cells, unless in the motor areas. Must we suppose that
Dr. Hamilton believes that the capsular network of fibrils
which surrounds the nerve dell, but does not come into
actual structural relationship with it, acts after the fashion
of induction of one current on another, as in faradisation ?
Although we are unable to concur with Dr. Hamilton in all
the conclusions at which he has arrived, we must allow
that he has displayed considerable ingenuity in his views,
and has contributed largely to our practical methods of
investigating the anatomy of the brain.

-4,-

We have already pointed out that the Medical Council
that is to sit on Tuesday next will be largely a new body.
Fully a third of its members are either new or sit for the
first time in new capacities. The profession at large will
have its representatives, and several Universities which have
hitherto had but half a representative, or one representative
between two Universities, will each have a member of the
Council all to iteelf to defend the individual interests of his
own institution in that subtlest and most pleasing of all ways
—by showing that the harmony and general welfare of the
universe are only to be maintained by preserving intact all
its emoluments and privileges. We cannot of course say
what the exact nature of the duties of this reformed Council
will be at its approaching sitting, but we may be sure that it
will have some new duties to discharge, arising under the
very imperfect Act of 1886, as well as various duties of the
old type. The clauses of the Act which create fresh duties
for the Council are chiefly two. Clause 2, Section 8, declares
that it shall be the duty of the General Council to secure
the maintenance of such a standard of proficiency at the
qualifying examinations as shall guarantee the possession of
the knowledge and skill requisite for the efficient practice
of medicine, surgery, and midwifery. Not only so; it
specifies a new and special means by which this duty of the
Council is to be discharged

“ For that purpose (securing the maintenance of such
1 standard of proficiency as aforesaid) such number of Inspec-

caBosum in animals pointed ? similar conclusion.

As tors as may be determined by the General Council shall be

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THE NEW DUTIES OP THE MEDICAL COUNCIL.

[Peb. 12,1887. 323

ippointed by the General Council, and shall attend, as the
General Council may direct, at all or any of the qualifying
eliminations held by any of the bodies.”

In a subsequent paragraph, Section 3, the duties of these
inspectors are defined. They are to report their opinions on
the sufficiency or otherwise of examinations. Moreover, they
ire to report as to any other matters In relation to such exa¬
minations on which the General Council may require them
to report. This is a large sentence, and may be used to make
‘.be reports of inspectors cover much. The bodies reported
on ore to receive copies of such reports, and so also is the
Priry Council, which is further to be supplied with the
uuwers of the said bodies. Clearly, then, the appointment
of Inspectors nnder the recent Act is a most important
-perhaps the most important—duty that can engage the
ittention of the Council. The duty of considering and
reporting on this question in a preliminary way was en¬
trusted to the Executive Committee, from which a report
my be expected. It is of great moment that efHcient men 1
should be chosen for this duty of inspection. The words of j
the Act show that its framers look to inspection as the chief j
mans of securing the general efficiency of examinations.
And it is to be fondly hoped that no narrow fields or terri¬
torial restrictions will limit the purview of inspectors. We
vuit, above all things, fair play and sound work in every
division of the kingdom. We want a cessation of inter¬
zonal suspicions and disparagements. We want the Cor¬
porations to respect the examinations of the Universities,
ud the Universities not to deepise the examinations of the
Corporations. The inspectors are expected to achieve theee
remits, and they should be men to whom the profession and
;ie examining authorities will look up.

Other new duties will arise under the second part of the
Act, referring to the registration of Foreign and Colonial
qualifications, and a report of the Executive Committee on
the subject may also be expected. Further new work has
been made by the recent Act not only for the Medical
Council, but for all the examining authorities, in Clause 21
c " Put III., which provides for the registration of diplomas
■o Sanitary Scionco. The examining bodies may all be
expected to respond and to ask recognition of their
laminations in Preventive Medicine. Besides these sub-
i*t«, there will doubtless be a score of others to exercise
the new Council and to tempt the eloquence of its members.

bespeak, for the sake of our reporters and of our
; *ders, speeches short and to the point. It is hard to hope
that a Council of thirty or more will work better than
t®* of twenty-four. The scheme of The Lancet for
a Council of twelve is still unrealised, as is the one-
P 01 **! system of all medical reformers and even of the
' iiincil itself. Lot ns, however, whilst hoping against
hope, give the Act of 188G a fair trial.

Ox the 3rd inst. Mr. Ritchie, in reply to a deputation
rom the National Society for the Prevention of River Pollu-
j°n. stated that the Government intended to give to the
‘-ounty Boards, which they hoped to establish, the power of
sealing with the question of river pollution, and it was
loped that this would meet the requirements of the case;
lt rate, the Government would not be inclined to go
farther uatil the County Boards Bill had been passed
“tfitMpaatfoMaated.

^mutations.

“Ho quid nlml*."

THE PUBLIC HEALTH IN 1886.'

Following closely upon the Detailed Annual Report for
1886, the Registrar-General has just issued, in his quarterly
return for the three months ending with December last, a
summary of the national vital statistics for 1886. The
birth-rate of England and WaleB was last year equal to 324
per 1000 of the estimated population, and no less than 20
below the mean annual rate in the preceding ten years; it wos
lower than in any year since 1848, when the registration of
births is known to have been very incomplete. The death-
rate of the year, notwithstanding the exceptionally trying
weather in the first quarter, and a more than average warm
summer that caused excessive mortality from infantile
diarrhoea, was so low as 19 - 3 per 1000, corresponding with
the mean annual rate in the preceding five years. Thus the
mean death-rate in the first Bix years of the current
decennium (1881-90) was equal to 19-3, and was 2*1
below the mean-rate in the preceding ten years 1871-80.
The Registrar-General points out that this remarkable
decline in the death-rate “ implies that more than 339,000
persons in England and Wales were alive at the
end of the six years (1881-86) whose deaths would have
been recorded had the mean rate of mortality equalled that
which had prevailed throughout the preceding ten years.”
Nearly half this reduction in the death-rate in recent year*
was due to decreased zymotic mortality, for it appears
that the death-rate from the principal zymotic diseases,
which was equal to4'16 and 340 per 1000 respectively in the
two decennial periods 1861-70 and 1871-80, further fell to
243 in the six years 1881-6. Compared with those recorded
in 1886, the deaths from diarrhoBa lest year showed a con¬
siderable increase, and those from “ fever ” were rather more
numerous, whereas those referred to each of the other
zymotic diseases showed a decline. The death-rate from
scarlet fever was considerably lower in 1886 than in
any previous year on record, and has fallen year by
year since 1878. Fever (typhus, enteric, or simple) mor¬
tality has been equal to an annual rate of 0 26 per 1000
in the past six years, whereas the rates in the preceding
three decennial periods were 0*91,0 - 89, and O’SO respectively.
Only 284 fatal cases of small-pox were reported in England
and Wales in 188G; the nearest approach to so low a number,
recorded in any previous year since civil registration com¬
menced, was 630 in 1879. On the whole, this brief summary
of the vital statistics of 1886 supplies a measure of the
public health during last year which is full of the strongest
encouragement to sanitary effort, of which the present
satisfactory bulletin is undoubtedly the result.

THE DARENTH HOSPITAL DISPUTE.

Tee Metropolitan, in discussing a recent article in ThH
Lancet on the reasons for the opposition which has been
raised to the construction of brick hospitals at Darentb,
states, as one of these reasons, that medical knowledge
increases with every epidemic, and with the help of
advanced sanitation is reducing the virulence of small-pox.
Certainly, as the value of vaccination and revaccination is
better understood, it may be anticipated that small-pox will
be less prevalent in the metropolis; but, apart from this, we
fear that London will continue to be visited by epidemics,
which will make the existence of a hospital at Darenth or
elsewhere a necessity for very many years to come. We fail,
indeed, to understand the position either of the Metropolitan
Asylums Board or the Local Government Board in the course
they have adopted as the result of the controversy. The

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THEUN'IVERSITY OP EDINBURGH.

[Fkb. 12,1887.

324 Thh Lancet,]

managers, in seeking to erect a permanent brick structure,
were doubtless acting in accordance with the dictates of
their experience of the great cost incurred in the main¬
tenance of temporary erections. The Local Government
Board, in their turd, had but too muqh reason for ob¬
jecting to the construction of such a hospital on similar
lines to those which have proved so disastrous to the
jiietropolis. But the bargain which has been struck
betweep the two authorities is distinctly ludicrous. The
managers adhere to the use of brick, and the Board assent
pn the understanding that the hospital is not permanent ;
Jhat is to say, the managers can now assert that the hospital
is to be temporarily permanent, while the Board can plead
that it is to be permanently temporary, or, in other words,
they agree that the brick hospital is to be so badly built that
it is warranted to fall into decay within a short period. It
is clear that the speculative builder can urge that high
authorities have justified his existence. The greatest hope
for the reduction of small-pox in London is thd present
arrangement, which removes to a distance from occupied
houses the majority of all persons suffering from this disease,
and the aggregation of the few cases which must remain
in London, under the conditions indicated by Dr. Buchanan
In the report which the Local Government Board have
just issued. _ _

’ ‘ THE UNIVERSITY OF EDINBURGH.

Thr prosperity of the University of Edinburgh continues
and increases, especially in its Medical Faculty. Last year
its matriculated. students numbered 3635—11U more than
the previous year. Of tbese, 1915 were in the Faculty of
Medicine. In this faculty 51 candidates took the degree of
MkD. and 229 the combined degrees of Bachelor of Medicine
and Master in Surgery. This prosperity is attributed largely
to tbe excellent appliances of the nevr University build¬
ings. Private benefactions are always testifying to the
gratitude and affection of wealthy or willing 9cots, who are
proud of their Universities, which have done so much for
them and,their countrymen. Several .have been received
in;the last year; and one large donation is expected, to
the amount of £50,000, from a public-spirited citizen
of Edinburgh, whioh is to take the shape of a grand
Aoademic Hall. The Fancy Fair in December, initiated
by the students, proved a great success, and something
like £11,000 were raised. When will London feel the
true fire of this academic pride? W'ben she does, with I
her superior resources and her splendid clinique , Edin- !
burgh may begin to fear; but she . must be in earnest, ]
and have a real University that can win the admiration of
all sorts of intellect and the gratitude of all claves.

PNEUMOTOMY IN PULMONARY ABSCESS

Dr. Runsosbq, Professor of Mejlieine at Helsingfors, in
a clinical lecture which has been published in a Swedish
journal published in Finland, gives an account of a case of
pulmonary abscess consequent on acute pneumonia, where
he had performed pneumotomy with succeed. In addition
to this he had collected nbtes of ten other cases. Leaving
a'sidd three of the eleven on account of uncertainty in the
diagnosis, five of the remaining eight recovered, or at all
events improved very* decidedly, and in the rest, which were
fatal, death could not in any way be attributed to the
operation, so that Dr. Runeberg considers that when the
diagnosis of pulmonary abscess is clear, and it is in an
accessible situation, the best practice is certainly to open it.
He then refers to the question of operating for gangrene
of the lung. He hirqself bad had a case of this, together with
bronchitis and bronchiectasis; after the operation secondary
gangrene and septicaemia occurred, which proved fatal. In

seventeen other cases of gangrene be quotes from medi¬
cal literature where pneumotomy was performed, • seven
recovered more or less completely, and the fatal termination
of the remaining ten did not appear to have been attri¬
butable to the surgical interference. As to tbe method of
opening the lung, Dr. Runeberg is in favour of resecting a
rib, and then using the thermo-cautery. He does not
approve of washing out the cavity with antiseptic lotions,
thinking them dangerous, and believing that ample drain¬
age is sufficient. In conclusion, he mentions several pneumo¬
tomy cases he had collected: two were for ecchinoccocue,
both terminating favourably; six were for bronchiectasic
cavities with gangrene; and six for tubercular cavities, ^n
the latter two classes of cases he does not think operative
procedures are advisable. _

THE METROPOLITAN HOSPITAL SUNDAY FUND.

A special conference between the Council of Hospital
Sunday Fund and tbe managers of the various hospitals was
held on the 9bh inst. at the Mansion House, the Lord Mayor
presiding. Thefollowingresolutionwascarried unanimously:
“ That with the view of largely increasing the Fund to be
contributed on Hospital Sunday (June 19th) for the support
of the hospitals and dispensaries of the metropolis, a series
of public meetings be held during the two weeks preceding
Hospital Sunday, and that the members of the oommitteee
of the several hospitals and dispensaries be requested to co¬
operate with the Mansion House Committee in organising
these Jubilee Year meetings in their respective localities.'’
The Lord Mayor will preside at a meeting arranged to be
held in the Egyptian Hall, Guildhall, on behalf of the Metro¬
politan Hospital Sunday Fund, on June 14th, at 2.30. p.m.
The meeting was originally fixed to take place on Wednesday,
June 15th, but has been altered as above for the con venience
of Lord Salisbury, who wishes to move the first resolution.
It is expected that Lord Granville, Cardinal Manning, Canon
Fleming, and many others will be present and take part in
the proceedings. The London bankers and leading mer¬
chants will be specially invited to attend by the Lord
Mayor. This meeting, taking place within five days of
the Sunday |(June 19th) on which the collection is made,
should have a most favourable effect upon the amount
received. We may here mention that Ernest A. Honkey, Esq.,
has recently contributed the sum of £495 to the Fund for
this year. _

DEATH BY FIRE ON RAILWAYS.

There can be no question as to the inexpediency of
lighting railway carriages with swinging lamps burning
petroleum. The risk is manifestly so great that it is inex¬
plicable tli at a nation so advanced and enterprising as the
American should tolerate it. The only hypothesis, which,
indeed, is supported by other anomalies in the social life of
that great nation, would seem to be that, however ingenious
and go-a-head the Americans have shown themselves,
they' must be at heart a young people with the reck¬
lessness as to life which distinguishes tbe youth of com¬
munities, just as heedless daring is a characteristic of the
young individual. Just outside the boundaries of strictly
city life the American carries his revolver and uses it without
scruple, as the juvenile employs his fists or a stick. So it
is with the enterprise of this rapidly-growing people;
everything must be very 41 big,” and very ‘'tall," and
very “ grand,” and all risks, rational and irrational, must
be dared in making it. We of England may be perverse and
fatnous in the imbecility of our second childhood, but we
are not quite such fools as to heat our railway carriages with
swinging lamps of petroleum or by stoves. Our stupidity
comes out in not heating them at all. It is quite useless try¬
ing to point the moral of the recent terrible catastrophe

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THE DIPHTHERIA EPIDEMIC AT EALING.

[Peb. 12,1887. 325

which has caused & deplorable loss of life on the Ver¬
mont Central Railway. There is nothing to be said on the
subject, except that it is not less a senseless than a deplor¬
able occurrence. Death by Are on railways can but very
rarely be classed as “ accidental.”

TUBERCULOSIS OF THE OESOPHAGUS.

At a recent meeting of the Medical Society of Vienna
(Progrit Mid., 1887, No. 6, Vienna Correspondence), Dr.
Zeraann, assistant to Professor Kundrat, read a paper on
tuberculosis of the oesophagus, of which he distinguished
four different forms. In the first the affection is propagated
‘ by direct extension from the bronchial glands or the lungs.
In these cases the gullet may be perforated by direct
ulceration, and frequently the contiguous portion of the
trachea or bronchia is subsequently perforated; or the
ulceration of the oesophagus may arise from tubercular
deposit in its anterior wall. In the second variety the
mucous membrane of the oesophagus is invaded by extension
ef tubercular disease of the pharynx; or larynx, producing
luperfidal ulcers which are .limited to the .upper third.
Instances were given of a still further propagation
of the disease in the oesophagus in two patients who
were snffering from strictures of the tube from cor¬
rosive poisoning. They were also the subjects of
tubercular phthisis, and although the larynx and bronchial
glands were frbe, yet caseous and yellow tubercles
were found in the dcatrioial tissue in the oesophagus.
Bacilli were detected in these'tubercles. The explanation
evidently lies in the fact that ordinarily, from its thick
epithelial lining, the cBsophageal mucous membrane is
protected from bacillary infection, and a protection which
is destroyed by the action of corrosives. In both the cases,
it should be added, intestinal tubercle was present. The
third variety is acute miliary tuberculosis, of which, how¬
ever, only one case is on record—viz., by Marotti. The fourth
variety, also of great rarity, is infection of the oesophagus
by sputum; a condition probably only produoed when the
epithelium is more or less detached.

THE NON-REGISTRATION OF STILLBORN INFANTS.

Acorrespondent has sent us the “return” required by
the Brooklyn Board of Health in the case of every stillborn
infant bom within the district. How complete this return
is may be inferred from the fact that there are no fewer than
sixteen items to be filled up. In addition to the more ob¬
vious ones of sex, parentage, place and date of birth, name
and address of medical attendant, and cause of stillbirth, we
ebserve that the “ nativity of father and mother” is required,
also the nameand residence of the person making the ret urn,
those of the undertaker, and the place of burial. The
mportance of all these details, which, more or legs modified,
are required in almost every civilised country except Great
BriUhi, will be appreciated by all who have had much
ohetetrio practice or have interested themselves in forensic
medicine. • Obstetric practitioners know that while a
certain proportion of stillbirths are inevitable from causes
both known and unknown, a very large number are pre¬
ventable, being caused by want of proper attendance
before and after birth, syphilis in one or both parents,
neglected or inefficiently treated, and other causes. The
n*ct determination and classification of these would be
Mfflcient to justify the notification, if not the registration, of
ell stillborn infants in this country. But there are other
resioQs equally strong from the medico-legal point of view.
It,ia well known that most burial authorities adopt a sliding
Nile of charges for the burial of newly-born infants, the
between those for a stillbirth and those for a de-
CMaed Infant being from Is. 6 d, to 7s. 6<f.—a great con- I

sideratlon to poor people, and a strong inducement to them
to make false declarations. If this sliding scale could be
abolished and one uniform charge made for all infante still¬
born or deceased within twenty-four hours after birth, this
inducement would be lessened, if not removed altogether.
But, besides this, it is imperative that there should be a
register kept and returns made periodically of all bodies
interred as stillbirths in every public burial-ground. A
printed form of certificate should be issued by the Home
Office or the Local Government Board, which should be dis¬
tributed to all medical praotitioners, and these as they are
presented at the burial should be carefully preserved. It
Is, to say the least, an anomaly that, while the birth and
death of a premature infant born at the seventh month of
utero-gestation are each registered as solemnly as the death
of the “ oldest inhabitant,” the State takes no heed 1 of the
many infants born dead at full time.

THE LESSON OF THE “KAPUNDA* DISASTER.

After the sad teaching of experience in the case of the
Kapunda, we may perhaps expect that the safety of
passengers on board ship will be moA carefully provided
for than it was in this instance. As usual, after aa event
of the kind, suggestions are numerous as to the best means
of guarding against a sacrifice of life by such a disaster ia
the future., Boats, folding-boats* floating seats, life-belts
and. buoys have figured prominently in the newspaper
correspondence on the subject during the last few days.
There is no want of possible appliances apparently, and
there are no doubt shipping companies willing to spend
freely upon them in order to .’assure as far as may be the
safety of their crews and passengers. Still the uncomfort¬
able fact remains that such assurance cannot always be
relied od, nor is it likely to be otherwise while the law upon
this subject remains as at present—notably inefficient. It
is not enough to entrust a matter so serious to the private
judgment .of individuals. The Board of. Trade already
exercises a jurisdiction.in such cases, and it ought, in order
to justify its action, to afford to every passenger, and not
only to a limited number, the means of self-preservation in
case of shipwreck. __

THE DIPHTHERIA EPIDEMIC AT EALING.

The outbreak of diphtheria: at Ealing, to Which we called
attention in our last impression, ha 3 unfortunately proved
more severely fatal than was at first hoped. We.referaed to
three deaths which occurred in the first five days of the
outbreak, but we now learn, the faUHty wanton until the
record has reached eleven. * The attack Was singularly
sudden in its appearance, and stems to have been .as. sudden
in its cessation. Its actual coarse has. been apparently
confined within the limited period of seven days, but, aa
Mr. Patten, the medical officer of health fbr the district,
reported to his board, the fatal cases were in every instance
Confined exclusively to persons who were the first to exhibit
symptoms of the disorder, and upon whom the virulence of
the poison appears to have been expended. We are: glad
to learn that Mr. W. H. Power has received instructions to
make an investigation into the circumstances connected with
the outbreak of diphtheria at Ealing. There are oertain
Characteristics of the outbreak which are etiologically of
considerable interest, and a Government inspector has special
facilities for extending his inquiry beyond any defined sani¬
tary areas if he finds reason to suspect that the cause of a
disease lies ontside those limits. An unanswerable exposition
of the cause of the catastrophe at Ealing may be Of lasting
value to the whole codntry, and’ for the matter of that to
the whole world. It was &'deliverance of an authority nob
less illustrious than Sir Isaac Newton himself that bo more

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SOME CHOLERA STATISTICS —CASUAL WARDS.

[Feb. 12,1887.

causes of a phenomenon ought to be admitted than such as
are true and sufficient to explain the phenomenon, and the
problem in this case is how to get at the true and sufficient
cause of the outbreak. Under present circumstances the cause
cannot be very deeply concealed; whatever it may be, it is a
cause which has operated chiefly among the well-to-do
classes. It has been introduced suddenly ; it has departed
speedily. Taking the incubation period of diphtheria at
three or four days, we may almost determine the day when
the cause entered Ealing—namely, about Jan. 17th or 18th.
If it had come in by water-supply, we must assume it would
have affected large numbers of people irrespectively of class.
If it had come in from drainage, it would most likely have
affected the poorer classes rather than the richer. If it had
been an atmospheric cause, it would surely have been equally
distributed. If it had spread from one case to another
simply by contagion or infection, it would have been trace¬
able from one centre in definite lines. The evidence there¬
fore points to the causa as entering through some particular
article of food or drink, of which a limited number of
susceptible persons partook within a very few days, perhaps
hours, of each other. _

SOME CHOLERA STATISTICS.

Thb municipality of Marseilles has issued statistics con¬
cerning the second and last cholera epidemic which are not
without interest. The number of deaths from cholera in
1884 amounted to 1781, or 4-94 per 1000 of the population.
In 1885 the epidemic was not so severe; there were 1256
deaths, or 3'49 per 1000 inhabitants. During the course
of the latter year the municipality organised twelve
ambulances in different parts of the town, where assistance
coaid be obtained at all times of the day and night. In
this the authorities were supported by a staff of 102
doctors, 28 medical students, and 87 dispensing chemists.
The total number of patients treated by the members of
this service amounted to 2017, of whom 1513 were suffering
from cholera. Of the remaining 604, the greater number
were suffering from typhoid fever; then came, in order
of frequency, cases of htetnorrhage, nervous complaints,
pulmonary affections, wounds from accidents, and, above
all, derangements of the digestive organs and a few cases
of manifest drunkenness. Taking the cholera cases only,
the males numbered 871 and the females 607. In 35
instances the sex was not indicated. This proportion is
analogous to that noticed in 1884. The ages are given in
all excepting 169 cases, and we find the division to be as
follows: From the period of birth to the age of twenty
there were 223 cases of cholera; from the ages of twenty
to fifty there were 813 cases, and only 129 from fifty
upwards; under the age of ten there were only 53 cases.
It appears, therefore, that cholera proves most fatal in the
prime of life. The nationality of 1438 patients was as¬
certained. There were 1081 French subjects, 272 Italians,
and 85 persons belonging to various other nationalities. This
shows a very great increase in the foreign elements, and
helps to confirm the theory that the crowding together of
the poor Italian labourers who flock to Marseilles is one of
the most evident causes of insalubrity. D a ring the epidemic
of 1884, in the single district of the Bourse, out of 694
cholera patients no less than 242 were Italians. The
statistics with regard to the professions of the sufferers
unfortunately only refer to 798 patients. By far the greater
proportion were unskilled dock labourers or navvies; these
numbered 376. After this 94 cases are entered as without
profession, 67 as domestic servants, 44 as charwomen, 28
sailors, 25 clerks or shop assistants, and smaller numbers as
belonging to various other callings. From these statis¬
tics, though referring to only 798 out of the 1513 cases
treated, it seems fairly demonstrated that those who came
specially in contact with the cholera did not suffer con¬

spicuously more than the rest of the population. But the
men who were employed to bury the dead, to disinfect the
houses, and to clean the sewers, and the whole of the
medical and nursing staff, enjoyed remarkable immunity.
It may be added, in conclusion, that the entire cost of the
twelve ambulances and hospitals which supplied medical
assistance to the 1513 cases amounted to £1641. For medi¬
cine and medical advice the actual outlay did not surpass
the average sum of 12 ». 6 d. each case; but much gratuitous
advice was given to the poor.

HOSPITAL SATURDAY AND THE CONTRIBUTIONS

OF WORKING MEN.

Wb have always felt, and candidly expressed a feeling
of, regret at the inadequate collection for the hospitals of
London made by its workmen on Hospital Saturday. With
equal candour we have insisted that the only way to secure
a fit contribution from workmen was to organise a weekly
subscription. Something less than the price of a glass of
beer would do it. An actual case in point if reported in the
Sunderland Daily Echo of Jan. 24th, in a notice of the death
of a local man of great worth, the late Mr. John Armstrong,
of the firm of Armstrong, Addison, and Co., who is credited,
amongst other good and sound work, with being the first
to carry out the workmen’s weekly subscriptions to the
Sunderland Infirmary, which have become one of the chief
sources of revenue. In the report for 1861 such subscrip¬
tions are mentioned as amounting to £45. In the following
year they amounted to £200. In 1885-6 they had reached
the creditable sum—in this town, whose whole population
does not equal that of a large London parish, and in a time
of great local distress—of £2000. All honour to such men
as Mr. Armstrong, and to the working classes of Sunder¬
land for following his lead and supporting the very best of
their local institutions. _

CASUAL WARDS.

Thb condition of casual paupers requires serious attention,
since it is possible that no more wretched set of creatures
exist anywhere. Dragging out miserable existences during
the day, at night they are housed in lonely dens hardly better
than dog kennels, if fate keeps them in London ; or if they
take refuge in the country workhouse, in outhouses pro¬
vided with a few sloping boards for beds. For food, a piece of
bread and a basin of skilly serve for supper and breakfast.
For this entertainment, however, the guest has to pay a some¬
what high price, even calculated at the present low rate of
wages, by having to perform a considerable amount of
manual labour before he is allowed to proceed on his way
and find work to support himself. Occasionally he finds
that, having entered the casual ward with a light heart,
he is not permitted to leave it, even supposing his daily
task to have been performed, and he is constrained
to remain, against his will, over the coming Sunday.
Such an excess of hospitality is not, however, always
well received; and the other day a “casual,” much to
the surprise of the workhouse authorities, refused to
return to his “cell,” preferring, as he said, the prison
to the casual cells on Sunday. It appears that the
prisoner had applied for admission on a Friday night
at St. George’s Workhouse, Westminster. Ou Saturday
morning he was called out and set to work in the yard.
The task given him he accomplished quietly and well, and
expected the usual discharge. Instead of this, however, he
was told to return at once to his cell, as no “ casual” was
allowed to be out on a Sunday, and as he had come in on
Friday he must remain till Monday. In answer to an
inquiry by the magistrate, the master informed him that
according to the rules of the New Model Workhouse, the

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THE COLRSE OP THE POSTERIOR ROOTS OF THE SPINAL CORD. [Feb. 12,1887. 327

Titj| ti.NCKTj]

"ewnil" is locked up and kept in solitary confinement all
Sunday, without exercise, but with the option of attending
& short mission eervice of an hour’s duration. In this case
the prisoner had not been informed of the rule when
sdmitted, and refused to return to his cell when requested.
Inconsequence he was removed to the police station, where
he spent his Sunday, let us hope more cheerfully than in
the workhouse cells, and was discharged by Mr. D'Eyncourt
on the Monday morning. Comment on such a case is
hirJIy needed. Nothing was said against the prisoner’s
chsracter or conduct; he was aimply an artisan out of
work. Whilst in the workhouse he behaved properly, and
the authorities admit he fulfilled his tasks "very quietly
»nd well,” and yet this man is arbitrarily seized and
‘hreatened with solitary confinement and imprisonment
for twenty-four hours for no offence whatever except that
he came to the workhouse on a Friday instead of any other
night of the week. Severe measures no doubt are required
to prevent imposition and idleness, but to act in this out¬
rageous manner to every casual who seeks shelter for a
night is certainly, to put it mildly, unnecessary.

THE COURSE OF THE POSTERIOR ROOTS OF
THE SPINAL CORD.

Db. Andrkas Takacs gives the following summary of
the results of his investigations in regard to the course of
the posterior roots of the spinal nerves and the composition
of the white matter in the posterior columns of the cord.
1. The fibres of the posterior roots on their entry into the
spinal cord divide into two groups; one part penetrates the
grey substance, whilst another group run externally and
internally into the white substance bounding the grey
horns. 2. The fibres which penetrate the grey horn appear
to traverse the substantia gelatinosa, and may be followed
to the ganglionic column of Clarke, in the cells of which
they terminate. 8. The fibres of the posterior roots, which
fnter Burdach’s column internally and the posterior part of
the lateral column externally, immediately bend upwards
ad run at least as for as the third root above, where they
l*netnte the substance of the posterior horn. 4. Part of
the fibres arising from the cells of Clarke’s column dip into
2'irdach's column, and, after assuming here a wing-like
ispect in section, go to form the column of Goli.
’■ Another portion of the fibres arising from the cells of
thrke’s column leaves the grey substance externally,
*“4 dips into the posterior segment of the lateral
column, where, bending backwards and upwards, it arches
rcuad the lateral pyramidal column, and thus forms the
^eral cerebellar columns. 6. Goll’s column and the lateral
ctiebell&r columns aro composed of similar fibres, which
present a continuation of the posterior root-fibres, effected
thraugh the cells of the posterior grey cornua; these fibres
nn without any further connexion upwards in the spinal
[tfd, and their number therefore progressively increases,
i. Bardach’a column, as well as the posterior segment
of the lateral column, are chiefly formed of the imme-
prolongation of the fibres of the posterior roots,
I* these fibres enter into the posterior horns at variable
lutancea above their point of entry. The increase in size
°f these columns is effected also by the fibres proceeding
fom CUrke’a column and passing through them to Goll’s
column on the one hand and to the cerebellar columns on
the other, and Takacs thinks that with these may be asso¬
rted the fibres which connect the different parts of the
romn with each other. From these anatomical and his¬
tological facts he draws the conclusion that the column of
Wl and the-Cerebellar columns are the continuation of the
interior rodWHrrts after these hare been interrupted by
lhe of the grefr cornua. They constitute the

most AtwrS fcr tHe conduction of sensory impressions.

j

- VLt» : . * .•*

The cuneate fasciculus of Burdack and the posterior part of
the lateral column are chiefly transference-points, and
are only mediately paths for sensory conduction. It
thus becomes intelligible why in the primary stage of
tabes and in the lower parts of the cord the fasciculi of
Burdach are affected, whilst in the later stages and in the
upper part of the cord the columns of Goll are affected.
His pathological investigations show that the affection of
the fibres of the posterior white columns in tabes stands in
direct relation to the disease of the posterior grey cornua,
and in these again essentially in relation to its changes in
the cells of Clarke’s column. The disease of the posterior
segment of the lateral column and of the cerebellar columns
is relatively less than that of the posterior white columns.
He distinguishes lastly two form9 of tabes.

EARLY CL08ING.

According to the report which has just been issued by
the Early Closing Association, the voluntary reduction of
shop hours by various employers has been found to exercise
a most beneficial effect on the character and abilities of
shop assistants. Such an observation is in no way remark¬
able. It is impossible that work done over time can be of
the best quality, or that its ultimate injurious effects can
long be postponed. Trade also must suffer somewhat by
the failure of energy in those who carry it on; and what¬
ever may be said for securing custom by keeping late hours,
we doubt very much whether, if a shorter working day
were once inaugurated, its manifest advantages, alike
for shopmen and the public, would not secure for it a
wide and increasing popularity. Such an introduction
has been effected by the Shop Hours Act of 1886. It is
hoped that this valuable Act may be administered without
any regular system of inspection. In that hope we cortainly
share, though not without some misgiving. In the circum¬
stances, it is, at all events, satisfactory to learn that the
majority of shopkeepers are in favour of the change which
the Act is intended to bring about. They appreciate this
measure in itself, but are unwilling to assume an individual
responsibility in connexion with it unless assisted by a
greater consensus of opinion on the subject among them¬
selves than exists at present, and they look for more definite
assurances of public support. We would recommend them
not to depend quite se much upon prevailing habit. Popular
custom in such matters is greatly guided by the methods of
trade, and if these be determinately altered as provided by
the Act we have little doubt that custom will follow suit
Certainly an effort in this direction would now be well timed.

THE GORDON BOYS' HOME.

Dippicolt as it may seem, the reclamation of the waste
land of human nature by intelligent and moral culture has
alway proved a success in careful hands. The history of
the Gordon Boys’ Home, we are please I to note, affords no
exception to thi9 rule. Since its institution fifteen months
ago, the afTairs of the Homs and its occupants have made
material progress. The number of boys has increased from
nine to eighty-seven; health has decidedly benefited by the
influence of fresh air and wholesome food; schoolwork has
been methodised and carried out in an efficient manner;
while conduct, fair at first, has markedly improved, in spite
of considerable difficulties, and without the exercise of any
undue severity. The administration is conducted on the
military system, and one former pupil has already taken
service as a soldier. As is now generally known, however,
the Home is not designed to act merely as a feeder for the
army or navy; any of the ordinary trades are open to the
boys, though it can hardly be doubted that the mode of their
training will incline many to pursue a military life. We

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328 The Lancet,] THE POWERS OP THE METROPOLITAN BOARD OF WORKS.

[Feb. 12,1887.

note with satisfaction that some provision is made in the
school arrangements for technical education. Smiths’ and
carpenters’ work, tailoring, shoemaking, and telegraph
work are 'taught with more or less success, and it is signi¬
ficant of the proficiency attained that all the boys’ clothes,
with the exception of caps and socks, are now made in
the establishment. It need hardly be stated that out-door
recreations are not forgotten, while two rooms have been
fitted up within the Home for amusement during bad
weather. There is a library of general literature, and
music is represented by a pianette. Friends of the institu¬
tion have been commendably forward with subscriptions
and with gifts, and these we sincerely hope will suffer no
decrease in the future. At the same time, it is at least
doubtful if, in consideration of the antecedents, age, and
undecided future career of'most of the boys, such a present
as a barrel of beer is a wise seleotion. It would be well,
perhaps, if some rule were ma«de excluding the use of
stimulants from the Home except under medical restrictions.
So far the memorial project has evidently succeeded. With
due care it should yet attain ite brightest expectations, and
become, in a much greater degree than at present, a trainer
in strong, intelligent, and moral manliness.

IS IODOFORM ANTISEPTIC?

The widespread employment of iodoform as an antiseptic
dressing may receive a check should the conclusions
arrived at by MM. Heyn and Rovsing of Copenhagen be
confirmed. These observers have (Fortschritte tier Medicin,
1887, No. 2) been making experiments with iodoform to test
its value as an antiseptic, which they point out is so gener¬
ally accepted that the surgeon does not hesitate to employ
a non-sterilised spatula or to insufflate ordinary air with
the powder, procedures which he would shrink from employ¬
ing were it not for the belief that the iodoform can destroy
the germs adhering to the one or suspended in the
other. Yet as iodoform is rarely used to the exclusion of
other antiseptics (as Carbolic acid or mercuric chloride),
there is never much opportunity, clinically, of testing
Its germicidal properties. Mikulicz, in 1881, tested the
action of iodoform upon putrefaction, but with no definite
result; and Rummo’s experiments in 1883 were complicated
by his use of oil of turpentine as a solvent for the iodoform.
Meyer fbund in one case of abscess that iodoform had no
effect in reducing the virulence of the pus, and in another
that it had a slight action. The results of the research
pursued by MM. Heyn and Rovsing surprised themselves.
Acting on the theory that it is through liberation of free
iodine that iodoform enjoys its germicidal reputation,
they prepared solfttidns of iodoform in olive oil and in
serum, and, having sterilised them, mixed them with culture
media, and studied the effect of cultures of various bacterial
organisms in these mixtures, as well as under iodoform
powder alone. They also , experimented'on rabbits by
nuxing inoculation fluids with iodoform. The details of the
experiments need not be reproduced here; suffice it to
say that in no case did the presence of the substance
interfere with the development of npcro - organisms.
So- that thoy conclude that as an antiseptio its em¬
ployment in surgery is valueless. But, more than this,
its use is dangerous, for, as two of their experiments
proved, iodoform itself may contain pathogenic micro¬
organisms ; and even if all care be taken tQ purify it, yet
it may become the medium of the conveyance pf patho¬
genic germs introduced into it through the spray or spatula.
Yfe trust that thefts experiments, which have received such
prominence, wilL be repeated, for, if confirmed, -we can
Imagine that the use of iodoform (apart.,from any other
Antiseptic) would in certain' circumstancea be serious. It
wbuld be deplorable if in "any such case the material upon

which the Burgeon relies to protect his patient from bacterial
invasic)n should prove to be the means whereby such invasion
occurred. The writers of the article themselves advise that
before using iodoform (which is valuable as a dressing on
other grounds than as an antiseptic only), it should be
disinfected in sublimate solution.

THE POWERS OF THE METROPOLITAN BOARD
OF WORKS.

The position occupied by the Metropolitan Board of
Works has long been one of a very peculiar nature, and the
services rendered to the population of London and its
environs by that body have been also peculiar. As a matter
of history it will hereafter probably be shown that the
Metropolitan Board of Works has bridged over—so tu
say—the gulf between an obsolete (because exhausted)
system of local government and the more perfect organisation
by which it is to be replaced. Just now the Board is anxious
for more power. It wants to take the public buildings ol
the metropolis underita protection, not only as regards their
construction, but as regards their management. It would
like to manage everything, and do all the licensing as
well. These things could scarcely be done less efficient!}
than at present, so that we are not prepared to check tht
omnivorous propensity of the Board. By all means let Sii
James M'Garel Hogg and his colleagues take over the entm
business, and if there be something so soporific in the police
officialism of the metropolis that a Chief Commissionei
must needs forget to protect the streets in the neighbour¬
hood of a mass meeting of roughs, as Sir Edmund Hender¬
son forgot Fall Mall and Piccadilly, and as Sir Charlei
Warren has since, whilst otherwise taking admirable anc
most necessary precautions, forgotten Goswell-road, it ma;
become desirable that the Board should add to its othe
cares that of the police control of the metropolis, vice th
authorities of Scotland-yard, resigned.

A NEW METHOD OF SEWER VENTILATION.

A new proposal has just been brought forward for th
ventilation of sewers. It has the merit of originality an
ingenuity. Mr. R. S. Ash has patented a system of ventila
tion by the force of concussions resulting from explosion
automatically produced. In the man-hole of a sewer, or i
the ventilating-shaft of a coal-mine, &c„ he places a ema
cylinder where coal gas accumulates till it reaches a littl
hole, and there comes in contact with a jet burning outsid
An explosion results and the lid of the cylinder is blown ol
but counter-weights make it fall back in its place, so th»
all is ready again for the next explosion. Of course tl
air is blown out of the man-hole, and a vacuum created an
filled by the air rushing up from the sewer, but this displac*
ment is not the principal merit of the process. A ventilatir
fan or revolving wheel and a furnace will equally produ<
a current of air; but such current generally travels dow
the central and main sewers, and leaves almost untouched tl
accumulations of foul gas in the branch sewers, in the angle
and in other inaccessible places. A shock, however, do
not travel in a straight line, but spreads out in a circl
A stone thrown into a pool of water affords the readie
illustration of this fact. Let the edges of the pond be jaggt
and angular, the ripple will travel up every little crevice
opening in the banks. A current, on the other hand, ev<
the current of a rapid stream, leaves quiet nooks ma<
by the recesses of the embankment, where a boat may 1
safely moored without risk of its being borne away. Tin
an explosion in a sewer will with more certainty move tl
air in the branch sewers and out-of-the-way passages thj
will a strong current down the ma i n channel. Also
should be noted that it is precisely these branch pipes ai

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The Lancet,] GASTRIC AFFECTIONS AMONGST SWEDISH PEASANTS. [Feb. 12,1887. 329

sewers which are nearest to the inside of the dwelling, and
therefore most urgently need ventilation. Consequently,
if ventilation by concussion or explosion can be made to act
without involving too great an inconvenience and expense,
it is likely to prove as valuable a progress in practice as it is
an advance in theory. _

GASTRIC AFFECTIONS AMONGST SWEDISH
PEASANTS.

Db. Wiesf.neb. mentions in the Medicinisk Revue that in
part of Sweden gastric affections are very common. These
he comprises under the general term “ cardialgia.” They
include, however, chronic gastritis, dyspepsia, ulcer of the
stomach, dilatation of the stomach, nervous cardialgia, and
carcinoma. The first two of these are less common than
tho others. The main causes are to be found in over¬
work anil injudicious diet—the usual lot of the poorer
inhabitants. It is not that their food is actually insufficient,
tail it contains too little nitrogenous matter and'too much
carbo-hydrate, vegetable albumen taking the place of animal
albumen, and quantity being substituted for quality, which
impedes the mechanical and chemical processes of the
stomach. Again, such meat and fish as the peasants do eat
in usually salt, and their milk is soyr; indeed, the fish is often
in a partly decomposed condition, containing ptomaines. The
porridge too, which in many places forms the staple of the
peasant’s dietary, is frequently insufficiently cooked, so that
the starch is unchanged in the alimentary canal. These dis¬
eases are seldom met with until after the age at which young
people take part in heavy out-door work. As to treatment,
both of a prophylactic and curative character, Dr. Wiesener
recommends more rest, attention to cleanliness (which is
sadly wanting in the culinary operations), more freBh meat
and vegetables, and an improved method of preserving
milk &c. As to drags, alkalies, hydrochloric acid, bismuth,
magnesia, and carbolic acid may be found useful according
to circumstances. _

. SUICIDES OF CHILDREN.

Wh have no means of knowing whether suicides among
children are proportionally more numerous withiu the last
few years than they were previously. Attention has been
specially directed to these most lamentable occurrences
recently, and this may account for the fact that an increased
number of cases are from time to time under notice. There
is something especially distressing in the fact that con-
feiouaaess may be, and often is, so painfully influenced by
circumstances in the early stages of life that death is
sought as a relief from misery. We do not think that
a man or woman must needs be insane to seek death as an
-scape from trouble. It seems to us that well within the
limits of sanity a perverse, or morally cowardly, or very
much worried consciousness may reason out-the proposition
that life is not worth living, and conclude to die. Precisely
the same processes which go on in the mind of an adult
may be in operation in the mind of a child. There is, in
*hort, no reason why the young should not commit suicide
M well as the old, if only hope—which in a very practical
*ay may be said to be an essential of life—is crushed out of
existence. The mind in which hope dies may court death,
mid yet he in no sense morbid. It is difficult, but it is
possible, to slay hope in the life of a child, ,and when this is
tccompHsbed it is not unreasonable to suppose that despair
may end in eelf-slaughter.' The intense haste of life and
enterprise is doubtleM one of the causes of suicide, and
there can be no question, that oor system of forced education,
sod the premature imposition of hideous brain-tasks on the
jmmjj, press heavily on the consciousness. We venture to
thfidrtbUxnbject of suicides among children is one which
lie tideen Into very serious consideration by those

who are responsible for the operation of laws which may
ultimately render the population more erudite, but which
will not, unless greatly modified, make them happier, or in
a social sense more prosperous, than heretofore.

SUDDEN DEATH IN PLEURISY.

Some years ago the occurrence of a aeries of cases where
death suddenly took place during or after the operation of
paracentesis thoracis led to much discussion, especially in
the Paris Socidtd Mtfdicale des Hopitaux, without, in many
instances, clearing up the cause of the fatal event. Post¬
mortem examination often failed to reveal lesions, although
the fatal attack was in most cases ushered in by convul¬
sions. Oflate we have heard less of such accidents; but
the subject of sudden death in pleurisy is one which
deserves study. Dr. Weill of Lyons contributes to the
current number of the Revue de Midecine an essay con¬
cerning it, which hardly includes the class above alluded
to where the seizure supervenes upon operative- inter¬
ference. He speaks rather of cases of pleural effusion
that are unrelieved by art, and arrives at the follow¬
ing conclusions: That sudden death in pleurisy
is allied to certain lesions—such as cardiac or pulmonary
thrombosis or embolism, cedetna of the opposite lung, and
changes in the myocardium. Such derangements as grave
syncope, mechanical impediment to the circulation from dis¬
placement of the heart and torsion of the great vessels, and
hypothetical lesions, as multiple cerebral embolism, may be
provisionally accepted, but require further investigation
before being accepted as adequate explanations of the event.
Sudden death may occur in various forms of pleurisy—in
right pleurisies more often than in left, in acute or in
chronic cases, and in cases of progressing, stationary, or ab¬
sorbing effusion. The effusion is generally serous. The cases
may or may not be accompanied by special symptoms, such
as attacks of dyspnoea, syncope, and irregularity of pulse;
but often death will occur quite unexpectedly without any
premonition, and following upon some movement hr effort
on the patient’s part. Paracentesis is the only prophylactic
measure, and would be indicated by the onset of threat ening
symptoms, or evidence of heightened intra-pleural pressure.

PETITION OF THE BELGIAN MEDICAL FEDERATION.

The Belgian Medical Federation, after a good deal of dis¬
cussion, has agreed upon a petition, which it has addressed
to the members of the legislative chambers on the subject
of medical legislation. Discussing the question of examin¬
ing bodies, the Federation expresses a distinct preference
for the plan of a central jury, believing that it secures a
fairer but more stringent and satisfactory examination than
that of juries composed exclusively or mainly of the pro¬
fessors under whom the candidate has studied, and whose
questions he can probably answer if he lias merely a reten¬
tive memory. An opinion is also expressed that professors
alone should not be allowed to form & jury, but that a certain
number of prectifciOAets Bhbuld be associated with them.
A State examination for all would, in the opinion of the
Federation, exert an influence of the best kind on the
instruction given in the four universities by setting up a
noble emulation between them—“ each of them labouring,
not, as heretofore, to send into practice the greatest pos¬
sible number of its alumni, With diplomas of questionable
value, but to surpass its rivals by obtaining a greater
amount of success at the State examinations.” ,Of course,
the Federation hopes that all foreign practitioners will,
before being allowed to practise in Belgium, be obliged to
go before the central jury, and, as the holders of Belgian
University degrees will have to be examined, there can¬
not be any hardship in obliging the holders of foreign

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330 The Lancet,]

ARTIFICIALLY PRODUCED RELAPSE OF ERYSIPELAS.

[Feb. 12,1887.

degrees to undergo the same test. The Federation wishes
dentists to be obliged to take medical diplomas. An im¬
portant recommendation is contained in the portion of the
petition upon “ It stage medical" This stage is represented
by the time of hospital clinical stud}, but according to
the Federation it is much too short. No regulation insist¬
ing on a further time for clinical work appearing to be
practicable at present, the Federation suggests that in
view of the ever-increasing overcrowded state of the
profession and the unwisdom of encouraging more young
men without private means to enter it, it would be
well to desist from offering scholarships to first-year’s
students and to employ the funds thus set at liberty in
giving travelling exhibitions to those who have finished
their course for the purpose of enabling them to prolong the
stage medical with profit to themselves and their future
patients. The Federation concludes by suggestions for a
special education and diploma for experts in forensic
medicine. _

ARTIFICIALLY PRODUCED RELAPSE OF
ERYSIPELAS.

Db. Bohn of Cdthen contributes to the Allgemeine
Medicinische Central-Zeitung an account of a case of ery¬
sipelas in an elderly woman, which was apparently brought
on by eating some insufficiently cooked fish, which also
disagreed with other people who partook of it. After the
erysipelas (which had been extensive and accompanied by a
good deal of fever) had disappeared, the patient remained
in good health for six days, being only inconvenienced by
the presence of a dried film of carbolic oil which had been
used to anoint the affected surface. At the end of this time
she received permission to wash herself, which she did
pretty thoroughly with soap and flannel. The same evening
her temperature rose again, and she suffered from rigors,
heat, and headache, erysipelas reappearing the next morning,
which arrived at its crisis on the tenth day and shortly
afterwards disappeared. There seemed to be no doubt as
to the connexion between the washing and the relapse.
Dr. Bom suggests that the infecting micrococci may have
been lying dormant in the skin or subcutaneous tissue, the
rubbing sending them into the circulation; or else that
infective matter may have been external, and reintroduced
by minute scratches or abrasions produced by the scrubbing.
The public are, he says, known to have a great fear of
washing in erysipelas, and this case would seem to show
that there may be some ground for it. Dr. Bom goes on to
remark that medical men are told of individuals who have
repeated and regular attacks of erysipelas more frequently
than they see such cases for themselves, and he suggests
that here it is more probable that dormant centres of
infection exist in the body, which at times are brought into
the circulation, and so rendered capable of causing an attack
of the disease, than that the persons in whom these repeated
attacks occur are again and again infected from outside.

AN EXPERIMENT ON HUMAN LIVES.

" It behoves such populations as Ripon and York, which
derive their drinking-water from a river seriously contami¬
nated by agencies beyond their own control, to be aware
that they are having an experiment performed upon their
lives, an experiment contrary to the provisions of the
English law.” Such are the sufficiently striking terms in
■which Dr. Buchanan refers in the fifteenth Annual Report of
the Local Government Board, which has just appeared, to
the pollution by sewage of the river Ure. Strong as this
language is, it is undeniably justified by the facts of the
case. Briefly they are these: The Ure rises in the hilly
country which lies upon the north-western border of the

North Riding; it runs through Wensleydale, passing in its
route through numerous villages and hamlets, and the little
town of Masham. Winding on in a southerly direction, it
eventually joins the Ouse, about fourteen miles above the
city of York. All along its course it is used alternately as &
sewer and a source of water-supply. At Masham, which lies
about twenty-two miles from the source of the river, it re¬
ceives the drainage of a town of 1000 inhabitants; and at
Ripon, some fifteen miles further down, it supplies drinking-
water to a population of nearly 8000, and receives drainage
in exchange from the same town. Pursuing its course, it
passes through several other villages which contribute still
more sewage to the stream; and after joining the Ouse at
Boroughbridge, a place situated some eight miles below
Ripon, it flows on through the city of York. Mr. Sweeting,
who made the inspection of the river, sums up the facts
relating to York as follows: "The Ouse has, by the time it
gets to York, received not only a considerable amount of
impurity that has been brought into it by the Ure above
Ripon and by the Swale, but also the drainage of the city of

Ripon, of five small villages, and of Boroughbridge.The

sum total of contamination contributed by the Ure to the
Ouse is therefore great.” It is reassuring to learn that
analysis seems to show that the Ouse water is not ordinarily
affected to any serious extent by this abundant pollution,
but it is certainly no unwarrantable use of language to
describe it as on experiment upon human life.

THE ASYLUMS BOARD AND THEIR MEDICAL
SUPERINTENDENTS.

A new discovery has been made of the extravagance and
mismanagement of the Metropolitan Asylums Board. The
City of London Board of Guardians have found the "painful
fact” that at present there are no fewer than three medical
superintendents in the employ of the Metropolitan Asylums
Board for whom there is really no occupation whatever, and
whose salaries range from £400 to £500 each, with
rations and other privileges. The guardians can have no
desire that medical knowledge shall increase, for they fail
to see that the ratepayers would be distinctly benefited by
the employment of medical men in investigations which
vould add to our means of treating disease successfully.
It has been too much the custom of the managers at the
close of every epidemic to dismiss a staff, some members of
whom could render important service in the direction we
have indicated; in times of epidemic pressure there is but
little opportunity for work of this nature, but in the
intervals it should be seriously undertaken, and it is &
standing reproach that so little attempt has been made to
turn to good account the material for study which is at the
disposal of the medical officers of the managers.

ANTI-PYRETIC ACTION OF NITROGENISED AIR.

Db. Fbancisco Valenzuela of Madrid has made some
observations (published in El Siglo Midico, Jan. 30th, 1887)
on the effect of inhalations of nitrogen, or rather of air con¬
taining an abnormally large proportion of nitrogen, upon
febrile diseases. He compared its action in reducing tem¬
perature with that of cold applications, quinine, antipyrin,
digitalis, and arsenic, and concludes that the inhalation of
nitrogen is the only method of treatment the cessation of
which for a day is not followed by a rise of temperature to
its former height. It has also, he believes, a beneficial
effect on the diseased process itself. The plan adopted was
to administer the nitrogen in two daily sittings of from
half an hour to an hour in duration, beginning with air
containing 17 - 7G per cent, of oxygen, and gradually decreas¬
ing this proportion till at the close of the sitting it was
reduced to 12 per cent. Some few details are given of a

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Thn Lancet,]

PHYSICIAN AND PHILANTHROPIST.

[Feb. 12,1887. 331

phthisical case in which it was tried. At first some
dyspnoea was produced, bat the evening temperature at
once sank to normal, in addition to which the cough
decreased, the blood almost entirely disappeared from the
tpatom, the sweats became less frequent, and the appetite
improved. This patient had been previously treated by
quinine, with bat little good result. No other cases are
reported, though several other patients were treated in
this manner, most of whom are stated to have been benefited
by it. _

PHYSKXAN AND PHILANTHROPIST.

Taa profession in Italy has been gratified by the royal
recognition of a well-known “ companion in arms.” King
Humbert, proprio motu, has made Commendatore of the
Order of the Crown of Italy Dr. G. B. Trombini of Milan, in
consideration of his judiciously applied and munificently
untamed philanthropy. Charity unless wisely bestowed
has long appeared to Dr. Trombini as worse than useless, and
accordingly he makes himself personally cognisant of every
esse that appeals to him for help. Bat such help should be
tome thing more than mere almsgiving, and as he has his
proUgi* under his eye, so he sees to their being usefully
employed with a view to their self-rehabilitation. He has
thus become the patron of an establishment at Melegnano,
where 800 recipients of his bounty are kept usefully at
work—an institution from which society is periodically re¬
inforced by skilled and able hands who would otherwise have
been lost to it. Furthermore, by the rule of principiia obsta,
he baa just established at Melegnano an infant asylum on a
magnificent scale, where every physical and mental want of
the waifs and strays of fortune will be judiciously met by a
wall-appointed organisation. This institution, suggested to
Dr. Trombini in an hour of anguish after the loss of two
•oas on whom he doted, has already cost him 300,000 francs,
tod will form the most fitting and enduring monument of
idtizenwhom adversity has not soured, and who values
wealth only as a means of raising and reinforcing his
fellow-man. _

DEATHS OF EMINENT FOREIGN MEDICAL MEN.

On the 7th inst. there died at Berlin, at the early age of
forty-nine, after a fortnight’s illness with brain fever,
brought on by overwork. Professor Carl Schroder, one of the
beat-known gynaecologists in Europe. Ills Hospital for
Women at Berlin, with which his name will always remain
uaodated, attracted crowds of students and patients from
»11 parts of the world. Professor Schroder was a volumi¬
nous writer, some of his works—notably, his Manual of
Midwifery, including the Pathology of Pregnancy and the
Puerperal 8tate B —having been translated into English. The
following deaths are also announcedM. Ie Dr. Snyers, one
of the beet known and most highly respected practitioners of
Liip,

Senor Dr. Don Francisco J. de Castroy Perez, Pro-
fa** of Therapeutics in the University of Madrid.

THE TREATMENT OF FRACTURED PATELLA.

1* the report of the Sabbateberg Hospital, Stockholm,
nosnily Maned, Dr. Soderbeig has collected a number of
owe of fracture of the olecranon and patella, in which a
cuttiag operation has been performed—that is to say, where
mi Hwiri c o has been made and the fractured surfaces (after
tmtaipaied if necessary) sutured. A large proportion of
tbs eesae are from English souroea, but there are some re¬
ported by American and continental and a few by Swedish
moiMaah Altogether Dr. Soderberg has analysed 81 cases.
A *ort wale wae obtained in 51; in 9 there was ankylosis,
* * ■VBrenttso with impaired mobility, in 9 impaired
suppuration, and in 3 fibrous union, while

death occurred in 3. To separate the recent from the long¬
standing cases: Of the 43 recent cases a good result was
obtained in 37, ankylosis occurring in 1, suppuration in 1,
partial mobility in 3, and fibrous union in 1. The 38 cases
of long-standing showed, as might be expected, a much
worse series of results, there being only 14 which could be
classed as good, while 3 were fatal and 8 ended in ankylosis.
The author speaks with considerable reserve about the
operation. In recent cases it is naturally less dangerous,
but here it is, as a rule, quite unnecessary. In such cases
of long-standing as present facilities for the operation, the
statistics of the future may be expected to show better
results than those of the past. Where, however, there is
adhesion between the posterior surfaces of the fragments
and the posterior walls of the capsule, as there was in a
case occurring in the Sabbateberg Hospital, of which the
details are given, little or no good effect is usually produced
by the operation. Dr. Soderberg seems to have missed a
good many cases published by English and French surgeons
—notably some forty collected by a French surgeon, details
of which appeared in The Lancet a few years ago.
Altogether the cases published up to the present time must
amount to more than 120, and there are besides several
successful cases known to us which have not as yet appeared
in print. It may be remarked, too, that in the cases
published by Mr. G. R. Turner, and referred to by Dr. Siider-
berg, fibrous union was obtained rather more often than is
stated by the latter writer._

THE COUNTESS OF DUFFERIN’S FUND.

We are glad to learn that the Countess of Dufferin’s Fund
is being well supported and likely to prove a success. The
statistics of Indio, though far from perfect, afford evidence
of a very high rate of mortality among children under five
years of age, and in the female population at the child¬
bearing age. It is to these two classes especially that the
fund will prove beneficial by providing skilled medical
assistance through the medium of qualified female doctors.
The rules of caste and the customs of the country deprive
them of the aid of the male members of the profession.
There can be no doubt that by the introduction of educated
female medical practitioners a great saving of life and
redaction of sufferiog will be effected, especially in these
two groups. _

THE SIGNIFICANCE OF URIC ACID DEPOSITS IN
URINE.

Da. Johannes Mvoge, while chief of Professor Trier’s
clinic in Copenhagen, having repeatedly remarked abundant
and persistent deposits of uric acid coinciding or alternating
with albuminuria, carried out a series of examinations on
the urine of the 272 male patients under his supervision.
Of 3287 urines examined, 2786 from 127 patients were
entirely free from uric acid deposits, while they were found
in 601 specimens from 105 patients, but only in any con¬
siderable quantity in 262 specimens from 59 patients.
In 43 of these last patients the deposits were of a transitory
character—that ie, they were only observed once or twice;
while in the remaining 16 they were found to persist
for a week or more. Deposits both of a transient and of &
permanent character were found, especially in rheumatic
affections, whether of an acute or chronic form. Transient
deposits were found also In pneumonia in 11 cases oat of
25. In 27 oat of the 59 patients in which uric acid deposits
were observed albuminuria was also present in appreciable
quantity, and in many of the rest there was a doubtful
trace noted. Dr. Mygge’s observations oonftrm Dr. Dickinson’s
statement that deposits of uric acid of a transitory character
frequently coincide with the suppression of acute albu¬
minuria. In the majority of cases where the deposit was

Diqi

332 The. Lancet,] ALLEGED TOXIC EFFECTS OF COCAINE IN THE BLADDER._[Fed, 12,1887.

examined microscopically, casts or tubal epithelium cells
were found, indicating that some connexion probably exists
between uric acid deposits and functional renal disorder. In
some instances, it may be supposed that a peculiar condition
of urine, especially its supersaturation by uric acid or an
increase in its acidity, has irritated the epithelium of the
tubes, and has thus set up a renal lesion. In others, the
latter condition doubtless precedes the precipitation of
uric acid, and here Esbach’s theory of the precipitation of
uric acid being due to the existence of morphological
elements in the urine may afford an explanation.

THE MOXON MEMORIAL.

A meeting of the sub-committee appointed to determine
the form of memorial best adapted to perpetuate the memory
of the late Dr. Moxon was held at the Royal College of Phy¬
sicians on Feb. 8th, and was very fully attended. Sir Joseph
Lister proposed, and Sir Andrew Clark seconded, the follow¬
ing rosolutioD, which was carried unanimously“That
the fund raised by subscription be devoted to the foundation
of a scholarship or medal, to be awarded by the Royal
College of Physicians, and to the erection of a memorial of
him at Guy’s Hospital.”_

* I

ALLEGED TOXIC EFFECTS OF COCAINE IN THE
BLADDER.

In the'surgical section of the Madrid Medico-Chirurgical
Academy, Dr. Call read a paper on the Effect of Cocaine on
the Bladder. He found that fifty centigrammes of a 1 per
cent, solution of the hydrochlorate injected into the bladder
produce convulsive movements, upon which Dr. Osio
remarked that this toxic action might very probably be due
to the development of microbes in the solution.

“THE GRAPHIC AND GUY’S HOSPITAL.”

THb issue of the Graphic for the 5th inst. contains a
well-executed illustration of the Accident Ward of Guy’s
Hospital on Visiting Day, when the patients receive the
members of their families from whom misfortune has
separated them. The picture may, as we hope it will, enable
those who are not personally acquainted with the inner life
of the institution to understand a part at least of its useful- 1
ness, and stimulate the response to the appeal which has
recently been issued on behalf of its funds.

THE HUNTERIAN ORATION.

The President of the Royal College of Surgeons, Mr. W.
Scovell Savory, F.R.S., will deliver the Hunterian Oration
in the theatre of the College, on Monday, the 14th inst., at
3 p.m. precisely. _

Medical Appointments in India.

De. Vandyke Carter, we learn* has been appointed to be
Principal ,of the Grant Medical College at Bombay, and
Physician to the Jamsetjee Hospital there, in the room of
Dr. Cook, F.R.CJ’., retired. Mr. D. N. Parakh, M.R.C.S.,
L.R.C.P., has been appointed to.be surgeon to the Goculdns
Hospital in Bombay, in the room of Dr. Carter. Mr. J. B,
Eaton, M.B., will, we believe, succeed Mr. Parakh as assistant-
surgeon to the Sassoon Hospital in Poonah.

THE INTERNATIONAL MEDICAL CONGRESS.

We understand that the owner of the steam yacht Ceylon is
anxious to place his vessel at the disposal of members of the
medical profession and their families who intend to visit
America during the Congress. The cost per head (inclusive

FOREIGN UNIVERSITY. INTELLIGENCE. ,

Basle.— Dr. BisChoff, Professor of Midwifery and Gynaeco¬
logy, has been obliged by ill-health to resign his post.

Brussels. —M. le Dr. Marique has been nominated chief of
the post-mortem examination department. Some new
courses have been recently opened on advanced toxico¬
logical chemistry, elementary biological chemistry, chemical
and micrographical study of alimentary 8ubstances,.and the
detection of their alterations and adulterations.

Greifswald.— Dr. Grawitz, Extraordinary' Professor of
General Pathology and Pathological Anatomy has been
appointed Ordinary Professor;

Leipzig. — Professors Olshausen of Halle, Zweifel of
Erlangen, and Fritsch of Breslau, having been selected for
the vacant chair of Midwifery, the offer "was made to
Professor Olshausen, whose name stood first on the list, lift
has, however, signified his intention of remaining at Halle.,
Dr. R. Altmann, Prosector of the Anatomical Institute, has
been appointed Extraordinary Professor.

Leyden— Dr. H. Treub has been nominated to the Pro¬
fessorship of Midwifery aud Gynaecology, vacant by tho
death of Dr. S. Thomas.

Lyons .—For the chair of Experimental and Comparative
Medicine, vacant by the death of M. Cbaqyeau, M. Arloing
has been selected by the Faculty of Medicine, the second
name mentioned being that of M. Rodet.

Madrid .—The Minister of Education has just published
a regulation applying to all Spanish faculties of medicine
and pharmacy, obliging all students on their first matricula¬
tion to show that they have passed successfully through a
year’s course of instruction in French, but permitting tho
certificate of a similar amount of knowledge of German to
be deferred till the end of the first year. This delay, how¬
ever, will only be permitted for a short time, after which
the original regulation insisting on both French and German
certificates on matriculation will be enforced.

We learn with great regret that Professor de Chaumont
of Netley is seriously ill. Dr. de Chaumont is a singularly
able and accomplished man, whose scientific work' iras
secured him a deservedly great reputation, and we heartily
trust to be able to announce next week his favourable
progress towards recovery._

A course of post-graduate lectures on Bright’s Disease is
now being delivered by Dr. Robert Saundby in the library
of the Birmingham Medical Institute. The lectures com¬
menced on the 9th inet., and will be continued on the next
three Wednesdays, commenciug each day at 4 p.m.

In accordance with the resolution of the Epidemiological
Society, the Council are about to consider the various Act 3
of Parliament having relation to sanitary administration,
and propose in the first instance to consider the Public
Health Act, 1875. _

The citizens of Nairn are about to perpetuate by a bronze
statue the memory of the late Dr. John Grigor, in gratitude
for his services as a medical practitioner, and foe bis
munificence as a public benefactor.

An outbreak of diphtheria, which has assumed formidable
proportions, is reported as having occurred at Whitatable-
on-Sea._ 1 _|_

Mbs. Bancroft Will give ; a recital on the 18th and
19th inst., 1 .at the Novelty Theatre, for the benefit of. tht
Belgrave Hospital for Children.

Digitized by C^jOO^LC

ef everything) would be, we believe, £Q0, but at least sixty
passengers would be required.

The Lancet,]

THE HIGH ALTITUDE TREATMENT OP PHTHISIS.

tPED.12,1887. 338

THE HIGH ALTITUDE TREATMENT OF PHTHISIS.

(Faoic a Spboiax Cobebspondbn t.)

No. II.

Davos; , the Indications and Contra-indications for and
against the High Altitude Treatment of Phthisis; the
recent Results of Treatment at Davos ; Precautions
regarding the Journey.

Thb high altitude treatment is still sufficiently novel to
leave considerable room for doubt regarding the classes of
patients which can be confidently recommended to have
recourse to the Alpine health-resorts. Nevertheless, every
year now adds abundant data towards the formation of a
correct conclusion on this important topic, and it is much
to be desired that the profession should be made acquainted
with the rich results of clinical experience now being
gathered at Davos and elsewhere.

In approaching this question one preliminary error must
be pointed out. Some writers fail entirely to distinguish
between cases which do badly at Davos and those which do
badly anywhere and everywhere. It adds nothing to our
knowledge to inform us that cases of phthisis complicated
with albuminuria do badly at Davos, for we know that
such cases are beyond the reach of all climatic treatment.
As little does it help towards a clear understanding of the
special function of the Alpine sanatoria to say that easels of
laryngeal phthisis fare badly there, as we may pertinently
ask, Where do they fare otherwise than badly? On the
other hand, it is of little value to inform us that the cases for
Davos are those of chronic phthisis without hereditary pre¬
disposition, where there is immunity from visceral complica¬
tions and the retention of digestive and circulatory vigour,
because such cases as a rule respond fairly well to any
climate where the meteorological conditions are more
favourable to health than those amidst which the disease
was contracted. We must come to closer quarters with the
problem and avoid those generalities which are part of the
general prognosis of phthisis. What we .want to determine
is this—In what classes of case may Davos be expected to
prove decidedly more efficacious than Cannes, Madeira,
Algiers, or Egypt? Secondly, What types of phthisis are
likely to he injuriously affected by the peculiar features of
the climate of high altitudes ? Let us look first at the latter
question, 03 ; admitting of a readier and more definite
answer.

All authorities are agreed fhat patients with'weak circu¬
lation should on no account be sent ,to the mountains.
Circulatory weakness is the first and most conclusive
contra-indication against the high altitude, and the reasons
for this rule are too obvious to need amplification. Organic
heart disease, such aa valvulitis, is not an absolute contra¬
indication. The main.point is the" integrity of the cardiac
muscle and the degree of efficiency with which the circula¬
tion is maintained. A patient with valvular disease, but in
whom compensation is well maintained,, may. be freely
recommended to try Davos; but, on the other hand, a case
in which. ’ there is no actual cardiac disease, but marked
functional weakness of the circulatory apparatus, shbuld be
prohibited,from resorting to the mountains.

The-next most important contra-indication is the presence
of senile change. No doubt this point should hd viewed in
close ,.«oiy unction, with the former one, since arterial
degeneration , is probably the main reason, why elderly
patients fare ill among the Alps, ,

Qqut end rheumatism are contra-indications which need
only.be mentioned in order‘that their importance ipay be
appreciated. Organic nerve disease and hysteria ar6 also
prohibitive to the adoption ot the mountain treatment,- no
doubt because of the highly stimulating properties of the
climate of Jiigh altitudes.

Cases of phthisis in which dyspepsia is a prominent
symptom cannot be sent to Davos without some misgivings,
although the facts do not warrant the presence of dyspepsia
being regarded as an absolute contra-indicatidn. Almost
every case of phthisis is Sooner or later complicated with
digestive troubles, but it is only where these are very obsti¬
nate that the high altitude treatment' is definitely contra¬
indicated. It has been remarked that some patients with
whom diarrhoea has been a troublesome symptom obtain
speedy relief from this annoyance at Davos. It need hardly

be said that no relief may be expected if there is any reason
to suspect that the diarrhoea depends upon, intestinal
ulceration.

The last contra-indication to which we will draw atten¬
tion is that peculiar condition known to German authorities
as the eretische constitution, or the erethic diathesis. It is
impossible to define exactly what is meant by this term, but
every physician has a fairly definite conception of what is
included under it. I'robably the main feature in a con¬
stitution of this type is some species of nervouB and circu?
latory instability. But whatever be the erethic constitution
—and each observer must form his own conception of it—r
its presence is an absolute contra-indication to the adoption
of the high altitude treatment.

Let us now look at the converse side of the question, and
inquire to what classes of the malady the mountain treatment
is specially applicable. Iu the first place, there can no longer
be much doubt that in a considerable proportion of cases
of early phthisis, where there is freedom irom severe pyrexia,
marked emaciation, and renal complication, the high altitude
treatment is not merely palliative, but actually curative.
The Davos doctors claim from 10 to 15 per cent, of cures,
and anyone who visits the valley will find numerous
individuals who arrived there with fully-developed phthisis,
but who are now either restored to complete vigour, or, at
least, are succeeding in keeping the destroyer indefinitely at
bay. Some of these convalescents return to the lowlands
and resume their avocations with safety, but many others
find themselves compelled to settle permanently at Davos.
It is a point worthy of the most careful study what pro¬
portion of the alleged recoverieaare absolute cures, and what
proportion are contingent upon the convalescent remaining
in the climatic and hygienic conditions in which the cure
was effected. The latter will undoubtedly be found to con¬
stitute a considerable percentage.

Cases of phthisia which exhibit a “ torpid reaction ” are
those most suitable for the mountains. In other words,
patients should not be sent to Davos unless they are capable
of supporting and responding to the high stimulating
climatic conditions which there prevail. This is a very
obvious 1 consideration, but, next to indications afforded by
the circulation, it is the most important clue tp the prdper
selection of cases. >

Dr. Ruedi has remarked that cares of hemorrhagic
phthisis, where the haimorrhages are profuse and the phy¬
sical signs slight, are very favourable for treatment at Davos'.

Apsrt from phthisis, there are many morbid oondttionl
which respond readily to tho high altitude treatment. > Old
pleurisies and unresolved pneumonias often undergo mwr
velloualy rapid improvement)—a fact which is easily ex¬
plicable when we-. remember that the aerial rarefaefioq
promotesImig expansion, and the general climatic condition^
stimulate'nutrition and tissue changes. 1

Asthma Often, does well at Davos, but every praotitso&e*
is aware that no precise rules can be laid down regarding
this erratic malady. . s»n,»

Cases of nervous exhaustion from excessive brain wprk
often benefit decidedly by a resort to the high altitudOS.” rn
these patients the mountain air often acts as an excellent
hypnotic, and With the return of sleep the'other syMptoori
are rapidly relieved. It is, however,! a sine qud tion in sndh
cases that the patient shall give, dp?all intellectual, effort
and take absolute rest. '-•< • l1 Vi vna ia

As a general rule, a certain amount, of. cpn^itutumal
Vigour ip necessary to enable a patient to.^thstautf xhe
cold or the high altitude climate ftnd to Te‘spon4 to ,it8
stimulating 'actlpn. QU thi& subject, however, afiy hard-
and-fast rule would be fallacious, as undoubtedly some
patients who arrive in a'State qf marked prostration subsep
quently rally and benefit by a residence at Davos. Never¬
theless, therd call be ho' more perfaifcious error than to
suppose ^hat the air of the higher Ajp^s is any specific foir
advanced phthisis. . ! ' .

Do hopeless cares of phthisis pass the repmubt 'bf tnei*
days more easily at DaVos than elsewhere ? 1 Can Cnly
answer— cela depend. There is no rule. Some patients,'who
have tried all resorts, deliberately go to Davos in order to
die as comfortably as possible, but probably a still larger
number of Moribund cases experience some relief on removal
to the softer air of Mentone or Madeira. It seems natural
that the dying should seek sooth ing and sedative climatic
conditions, rather than those that are pre-eminently stimu¬
lant. , '

An important question arises, whether iuvallds shqula gp

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334 Thb Lancet,]

COCAINE IN DENTISTRY - .

[Feb. 12,1887.

direct to Davos or break the journey at some intermediate
stations. Probably, if the circulation is vigorous and the
nervous system fairly sound, a journey direct is the less of
two evils; but if there is any reason to dread cardiac failure
or severe nervous disturbance, the need for a halt at some
intermediate points is imperative. The best places at which
to break the journey are Ragatz and Klosters. Coire may
be selected if the Landwasser route is chosen. The invalid
should not stop either at Landquart or Kiiblis. Some
German authorities urge that, whatever practice be adopted
on the upward journey, there should be no exception to She
rule of making the descent to the plains by several stages.

Patients begin to arrive at Davos early in October, and by
the end of November the winter colony is assembled. It is
one of the moot points when the patient should arrive. It
used to be taught that it was a mistake to arrive before the
valley was fully invested with its winter robe of snow—a
rule which would delay arrival until the third or fourth
week of November or later. The Davos doctors now teach
that the earlier the patient arrives the better—September
being a good month,—and that the more serious the case
the greater is the need for a timely arrival. This seems
reasonable, and English practitioners should note this point
carefully, inasmuch as the neglect of it may lead to the
disappointment of even well-founded hopes.

REPLANTATION, TRANSPLANTATION, AND
IMPLANTATION OF TEETH.

Replantation consists in the return of a tooth to the
same cavity from which it has been extracted. Transplanta¬
tion is the extraction of a tooth of one person and trans¬
ferring it to the socket left in the mouth of another by the
extraction of a tooth. Implantation is the ingrafting of a
natural tooth into an artificial socket.

Replantation is performed when teeth have been knocked
out, extracted accidentally or in error, sometimes to rectify
malposition, and occasionally for disease. In the first three
cases the tooth is simply cleansed in some antiseptic solution,
forced into place, and kept fixed by means of ligatures. These
cases do extremely well; even if the tooth has been out of
the mouth some hours, union certainly takes place between
the periosteum of the tooth and that of the socket; but
whether the circulation in the pulp ever becomes re¬
established is not absolutely known. It has been inferred,
because these teeth often lose none of their natural trans-
lucency, which is always the case when a pulp is dead;
but there is no authenticated proof of this; it is therefore
the practice of many to remove the pulp and fill the nerve
canals before replacing. When there has been for a long
time a chronic alveolar abscess, the offending tooth has been
extracted; the diseased portion, which is invariably the apex,
being cut off, it is put back into its socket, a hole being left
through the fang to allow for drainage. This operation has
not been very successful, and is almost entirely abandoned,
at any rate in this country.

Transplantation is a very old operation. John Hunter,
one hundred years ago, spoke of it as being in his time a
habitual practice, ana gave a very practical and detailed
description of the procedure. When he was about to per¬
form the operation he had half a dozen persons ready, so
that if one “scion” tooth, as he called the one to be trans¬
planted, did not fit the socket, another was at hand if
required. He believed that the circulation in the pulp was
restored, both from the translucency of the pulp and from
the results of his oft-quoted experiment of transplanting a
tooth into a cock’s comb, whicn, by the way, he says in a
foot-note, succeeded but once in a great number of trials.
The objections are numerous: first, there is the difficulty
in obtaining healthy fresh teeth which will fit the socket,
the liability of the transmission of disease, the uncer¬
tainty of the result, and the comparatively short time
the teeth last, three years being a good average. Not¬
withstanding, every decade the operation is reintroduced
'with Some modifications in detail, only to fall into desuetude.

Quite recently, Dr. Younger of San Francisco brought
before several dental societies, and published a monograph

on, a method which he calls implantation. It is appli¬
cable to cases where teeth have been extracted ana the
alveolar crypt filled up with cancellous bone. An arti¬
ficial socket is made with a trephine or large drills; a
dead tooth, no matter how old so long as its periosteum
remains intact, rendered aseptic and its pulp canal filled,
is then inserted into the socket and ligatured in places.
It ia maintained that the great difference of this opera¬
tion is that the tooth is placed in a healthy, not a dis¬
eased, socket. In his early attempts he used fresh teeth,
which he obtained from other dentists, and which he en¬
deavoured to keep alive by implanting them in cocks’ combs,
so that one had virions of a farmyard of cocks armed
with teeth as well as spurs; but he soon abandoned this,
presumably because he failed. He has performed fifty
operations since June, 1886, two of which were failures.
There is unimpeachable evidence that a large number of
these teeth have retained their positions, but the question is
how long will they continue to do so. We certainly should
not expect this to be any more successful than transplanta¬
tion with fresh teeth, and those that are not thrown off at
once either by absolute failure to unite, or subsequently from
alveolar abscess, will in time, as past experience has shown,
become absorbed just as ivory pegs are in bone.

COCAINE IN DENTISTRY.

Mb. Mobton Smalb, at the last meeting of the Odonto-
logic&l Society, made a communication on the use of Cocaine.
He advocated the formation of a subcommittee of investiga¬
tion to experiment with the drug in order that an authori¬
tative utterance might go forth to the members of the
Society and the profession at large as to its value; for at
present, with regard to dentistry, the profession and the
public are in a state of suspended judgment in relation to
it. He said: “ I began using cocaine early in 1884, and have
used it more or less ever since. In the Westminster Hospital
Report for 1885,1 thus speak of it: * In extraction, if the
drug is applied to the gums surrounding the tooth (the part
having been first dried and protected from saliva, or the
cocaine will be washed away) the pain attending the adjust¬
ment of the forceps is obviated, but the wrench attend¬
ing the fracture of the alveolus and rupture of vessels
and nerve at the apical foramen is much the same. A small
loose stump may be removed painlessly. In cases of frac¬
tured teeth, where it is necessary to remove the pulp,
cocaine is useful. Applied to the surface of the exposed
pulp it will deaden sensibility, and if applied several limes
at short intervals the nerve extractor can be inserted and
the pulp extracted with very little pain. This drug is of
distinct value in practice, and should be in every dentist’s
consulting-room.’ The experience of injecting it into the
gum tissues has caused me to enlarge very materially my
views about it. I have been using 6,10,16, 20, and 25 per
cent, solutions of hydrochlorate of cocaine; the weaker ones
I have discarded in favour of the four stronger ones. Of the
cocaine faintness I have seen and heard very little, except in
the journals; the only case was in a man who felt faint at the
insertion of the needle, and who, when he was vaccinated a
year or two before, nearly fainted. I can hardly quote cases
in a short casual communication, but I have used it success¬
fully for the following purposes: extractions, torsion,
removal of live pulp, inserting hickory wedge between teeth
for stopping purposes. These operations, all very painful
ones, have been done almost without pain, so mncn so that
they were easily endurable. In cases of removal of pulp, I
have, in addition to injection, always applied the drug to the
surface of the pulp. A few days since 1 applied it both by
injection and to the cavity in a patient who had some exqui¬
sitely sensitive cavities on the buccal surface of some molars
and premolars, but the result did not come np to my anticipa¬
tion. The patient said the pain was lessened, but it was still
painful. I was anxious to be able to speak from personal expe¬
rience, and, as I could not afford to lose a tooth, thought I
would try the next most painful operation in dentistry. Th is, I
consider, is the rapid separation of two front teeth. 1 there¬
fore inserted five minims of a 20 per cent, solution into my
gum over my front teeth, and placed a wedge of hickory
wood between them, and drove it in with a dentist’s hand-
mallet, at the same time driving the wedge against the gum
between the teeth. I left the wedge there for twenty

The; Lancet,]

THE SUAW-STREET HOSPITAL FOR WOMEN, LIVERPOOL.

[Feb. 12,1887. 335

minute?, and then slowly dragged it down between the teeth.
The whole of this was done with very little discomfort, and
had I a tooth that wanted removing I should be content to
hate it removed after the injection of cocaine.”

THE SHAW-STREET HOSPITAL FOR WOMEN,
LIVERPOOL,

Thb annual meeting of the governors and supporters
of the Hospital for Women, Liverpool, was held on the
3rd inst., the attendance of subscribers being very large.
Hr. T. A. Bushby presided, and after a few preliminary
remarks, in which he referred to the inquiry into the prac¬
tice of the institution which has taken place since the last
annual meeting, called upon the secretary, Mr. M. Guthrie,
to read the report of the past twelve months’ work. From
this it appeared that, in spite of the disturbed state of affairs
which has recently prevailed in the hospital, its general use¬
fulness has been proved. The number of in-patients was
239 and of dispensary patients 3505. The expenditure during
rhe year was £1759, beiDg £47 less than in the previous
y pot; but as there was in 1885 a deficiency of £88, the total
expenditure came to £lft47. Against this there was received
the sum of £1074, showing a deficiency of upwards of
£770. The medical board, in their fourth annual report,

• nnounce a decrease in the work done in the hospital and
dispensary in the past year as against 1885, the number of
in-patients showing a decrease of 108 and the out-patients a
decrease of 6. To this report tables were appended which
showed that of the 239 in-patients 104 were submitted to
operation. Of this number 64 weTe minor operations, with
do mortality; the remainder were major operations or
abdominal sections, and resulted in a taortality of 10. This
report and the balance-sheet were then adopted, and votes
of thanks to the various visitors to, and officials of, the
hospital proposed and carried. ■ The appointment of the
honorary medical staff was then proceeded with, and Dr.
Briggs was, upon the motion of Mr. Tinne, unanimously
reappointed.

Mr. Lancaster proposed the re-election of Dr. Burton,
who, be stated, haa been connected with the hospital ever
since its foundation; his practice as a surgeon had never
been called into question; be bad maintained a moderate
course; he bad invariably consulted according to the rules
of the hospital; and he had not in a single instance brought
upon himself the condemnation or the criticism of the
members of the medical profession in Liverpool and else¬
where who had thought fit to criticise the operations of the
other members of the medical staff.

Mr. Bip kkt t seconded the proposition.

Mr. Titsnb opposed Dr. Burton's re-election. He had no
objection to Dr. Barton as an individual, but he considered
that it would be for the interests of the hospital that the
whole of the old staff should not be re-elected at that
meeting.

Mr. 8. 6. Bacon opposed, and Mr. W. Oulton supported, 1
the proposition, and ultimately, after a few remarks from
the chairman respecting the reasons which bad led to the
proposal of names separately, and not, as in former years, cn
we, a vote was taken, and Dr. Burton was deolared re-elected
by thirteen votes to nine.

Mr. C. Jones moved that Dr. Tmlach be re-appointed as
honorary medical officer of the institution. After having
briefly reviewed Dr. Imlach’s connexion with the charity
from its foundation down to the close of the inquiry which
was held last year, Mr. Jones contended that, on the strength
of the report of the investigation committee, they could not
dismiss Dr. Imlach—a contention which he supported by
several quotations from the report. He hoped that they
would not permit the greht injustice of turning away one
man f vho had done so much for the success of the hospital.

Mr. W. B. Uaxhbd seconded the motion, and contended
that in the special report of the Medical Institute there
was no implication that Dr. Imlach should be turned out
ot IbAkdgpiul. If thery had. wished that course adopted, he
ires me that they would have said so.

Mr. Guthrie having apposed the motion, Mr. Lancaster
defended 4ll* Inquiry Cqmmittee, and maintained that in its
c -W re retire iB no hostility vm shown to Dr-Imlach or to any
. rertiXoftkemedical elafl offchohospital* .. .

Thevotingthen took place,whensixteen handswere heldup
in favour of the reappointment of Dr. Imlach and seventeen
against.

Mr. C. Jones demanded a poll on account of the proxies.
This was granted, and resulted in the rejection of Dr. Imlach
by 272 votes to 137.

Some formal business was then transacted, and an adjourn¬
ment of fhe meeting for the consideration of several altera¬
tions in the rules was carried. Previously, however, to the
termination Of the proceedings the Rev. D. Mountfield
proposed a vote of thanks to Dr. Imlach, who had, he con¬
sidered, been very badly treated. Mrs. Alfred Booth also
spoke in favour of Dr. tmlach, but the proposal was not put
to the meeting.

ARMV MEDICAL SCHOOL, NETLEY.

The fifty-third session of the Army Medical School at
Netley was brought to a close on the 7th inst., when General
Sir Donald M. Stewart, Bart., G.C.B., G.C.S.I., &c., late Com¬
mander-in-Chief of the Forces in India, presented the prizes
gained during the term by the surgeons on probation. Sit
Donald, in some remarks to the students, criticised the
system at present in force in the British service, which in
his opinion has one main defect-viz., the absence of any
direct connexion between the medical service and regiments.

Sir Joseph Father then announced the gift of about 350
separate works, comprising between 600 and 700 volumes,
to the library at Netley School, by Dr. Waring, late of thd
Madras Medical Service. The collection, he stated, was
specially rich in works on Materia Medica, and others deal¬
ing with foreign countries, besides several rare books of
medical bibliography.

Sir Thomas Crawford thanked Sir Donald Stewart for
having consented to present the prizes, and congratulated
the students who had gained their commissions on the
way in which they had worked through the past session,
concluding by most heartily wishing them every success in
the future.

Sir Thomas Longmore expressed similar good wishes for
the prosperity of the medical officers on behalf of the pro¬
fessors under whom they had studied, and the proceedings
then terminated.

$aMic aitir '$nnx fafo.

LOCAL GOVERNMENT DEPARTMENT.

reports of medical officers of health.

West Susses Combination, —Dr. Charles Kelly’s report
for 1885 reached us somewhat late. Of the eleven districts
which compose it, the lowest rate of mortality was in the
small district of West Worthing, where it stood at 7‘8 per
1000, the highest being 16‘6 in the Westfcourne rural district
These rates have, however, varied much during a series of
years. Viewing the whole combined districts the death-
rate has diminished from a mean rate of 15'4 per 1000 in
the five years 1876-80, to 14'4 in the subsequent period of
five years. There has been a rise in the diphtheria death-
rate'in this district. Taking the whole of England that
rate stands at 121 per 1,000,000; in West Sussex it now
reaches 170 per 1 .Oft),000, and it is, as elsewhere, more in¬
clined to be fatal in rural and semi-rural places than in
towns. Thus, in Brighton the rate is 81 per 1,000,000,
whereas in Petworth it is more than live times, and in
Horsham more than three times, higher. But there are differ¬
ences even in the same district, and Dr. Kelly has made it a
special care to examine the influence of soil as regards this
and other mortalities. The result is that he has found
that the death-rate per 1,000,000 from diphtheria, 1 eing 246
on his entire area for a period of ten vears, was no leap
than 454 on the retentive soils such as the Weald clay, the
clayey beds of the lower green sand, and the gault; and
only 127 on such pervious soils as the upper and lower
green sands, the cnalk, and the lower Tunbridge Wells
sands. The influence of soil in the production of this
mortality is the more striking because it appears so entirely
to outweigh that which is brought about by personal intef-

Digitized by Google

336 The Lancet,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[Feb. 12,1887.

communication, which, one would have imagined, would in
towns have so greatly exceeded that which obtains in rural
areas. These and similar contributions to our knowledge of
the etiology of disease come most appropriately from
medical officers of health acting for wide areas, and they
add special interest to their reports.

Huddersfield.—Dr. Spottiswoode Cameron in his report
on the fourth quarter of 1886 points out that although,
speaking generally, Huddersfield compares well as regards
infectious diseases with the twenty-eight large towns and
cities quoted by the Registrar-Genera), yet the rate of
mortality in the borough from diphtheria has been half as
much again as in the towns referred to, and that the rate
from whooping-cough was three times that with which it
is compared. Diphtheria is essentially a disease to be dealt
with by early isolation of first attacks, and though some
cases are received into the Birkby hospital, yet this sanitary
institution is, notwithstanding excellent additions to it,
not sufficiently complete to deal with this disease. Whoop¬
ing-cough is, unfortunately, a disease which is at present
almost beyond the scope of sanitary measures.

Salford. —Dr. Tatham, in reporting for the last quarter of
1886, finds it necessary to issue a warning as to the spread
of scarlet fever in his district; this spread being largely due to
deplorable carelessness. Of 603 cases reported to the Health
Department during the quarter, 307, or 61 per cent., were
removed to the infectious hospital. This is very satisfactory,
but unless those responsible for the remaining 49 per cent,
take note of the warning issued, especially as regards chil¬
dren during the school age, scarlet fever will continue to
spread. The numbers of those attacked during the past
four quarters have been 177, 230, 650, and 603 respectively.
It is certainly time for the inhabitants to aid the health
officers in controlling this scourge.

VITAL STATISTICS.

HEALTH OP ENGLISH TOWNS.

In twenty-eight of the largest English towns 6846 births
and 3470 deaths were registered during the week ending
Feb. 6th. The annual death-rate in these towns, which
had declined in the preceding four weeks from 26 6 to
211 per 1000, further fell last week to 19'6. During the
first five weeks of the current quarter the death-rate in these
towns averaged 228 per 1000, and was T9 below the
mean rate in the corresponding periods of the ten years
1877-86. The lowest rates in these towns last week were
13-5 in Nottingham, 137 in Brighton, 16 3 in Norwich, and
171 in Birkenhead. The rates in the other towns ranged
upwards to 25 0 in Preston, 25 3 in Bradford, 26 3 in Man¬
chester, and 28’4 in Plymouth. The deaths referred to the
principal zymotic diseases in the twenty-eight towns, which
nad been 486, 392, and 371 in the preceding three weeks,
further declined last week to 367; they included 111 from
whooping-cough, 104 from measles, 54 from scarlet fever,
40 from “fever” (principally enteric), 29 from diphtheria,
27 from diarrhoea, and 2 from small-pox. These principal
zymotic diseases caused the lowest death-rates last week
in Nottingham, Cardiff, and Wolverhampton; and tbe
highest rates in Bristol, Plymouth, and Blackburn. The
greatest mortality from whooping-cough occurred in
Bradford, Sunderland, and Plymouth; from measles in
Bristol and Newcastle-upon-Tyne; from scarlet fever
in Salford, Sheffield, Blackburn, and Birkenhead; and
from “fever” in Plymouth. The 29 deaths from diphtheria
in the twenty-eight towns included 16 in London, 3 m Ports¬
mouth, 3 in Liverpool, and 2 in Preston. Small-pox caused
1 death in Manchester and 1 in Blackburn, but not one in
London and its outer ring, or in any of the twenty-five
other large provincial towns. Only 1 small-pox patient
was under treatment on Saturday last in the metropolitan
hospitals receiving cases of this disease. The deaths referred
to diseases of the respiratory organs in London, which had
declined in the preceding four weeks from 731 to 432, further
declined last week to 364, and were 279 below the corrected
average. The causes of 76, or 2-2 per cent., of the deaths
in the twenty-eight towns last week were not certified
either by a registered medical practitioner or by a coroner.
All the causes of death were duly certified in Manchester,
Nottingham, Leicester, and in six other smaller towns. The
largest proportions of uncertified deaths were registered in
Halifax, Oldham, and fiulL

HEALTH OP SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 23 7 and 24 7 per 1000 in the preceding two
weeks, declined to 198 in the week ending Feb. 5th; thia
rate exceeded by 0'2 the mean rate during the same week
in the twenty-eight large English towns. The rates in the
Scotch towns last week ranged from 12 2 and 14'6 in Leith
and Perth, to 21 -3 in Aberdeen and 23 7 in Glasgow. The
495 deaths in the eight towns last week showed a decline
of no fewer than 121 from the numbers in the previous
week, and included 23 which were referred to whooping-
cough, 12 to measles, 10 to “fever" (typhus, enteric, or
simple), 8 to scarlet fever, 7 to diphtheria, 6 to diarrhoea, and
not one to small-pox ; in all 66 deaths resulted from these
principal zymotic diseases, against 65 and 75 in the pre¬
ceding two weeks. These 66 deaths were equal to an annual
rate of 2 6 per 1000, which exceeded by 0 5 the mean rate
from the same diseases in the twenty-eight English towns.
The fatal cases of whooping-cough, which had declined in
the preceding five weeks from 27 to 19, rose again last week to
23, of which 17 occurred in Glasgow, 3 in Edinburgh, and 2
in Paisley. The 12 deaths from measles showed a decline
of 6 from the number in the previous week, and included
9 in Glasgow and 2 in Aberdeen. The deaths referred to
“ fever,” which had been 5 and 6 in the preceding two weeks,
further rose last week to 10, of which 5 occurred in Glasgow,
2 in Edinburgh, and 2 in Greenock. The 8 fatal cases of
scarlet fever, on the other hand, showed a considerable
further decline from recent weekly numbers, and included
4 in Edinburgh and 3 in Glasgow. The 7 deaths from
diphtheria, of which 4 occurred in Glasgow, corresponded
with the number in the previous week. The 6 deaths
attributed to diarrhoea, showed a decline of 4 from the
number in the previous week. The deaths referred to acute
diseases of the respiratory organs in the eight towns, which
had Bteadily declined in the first four weeks of the year'
from 213 to 155, further fell last week to 126, and were
9 below the number returned in the corresponding week of
last year. The causes of 76, or more than 15 per cent-, ol
the deaths in the eight towns last week were not certified.

HEALTH OP DUBLIN.

The rate of mortality in Dublin, which had been 36 2, 32 2,
and 28 2 per 1000 in the preceding three weeks, rose again to
297 in the week ending Feb. 5th. During the first five
weeks of the current quarter the death-rate in the city
averaged 31*5; the mean rate during the same period
being but 218 in London and 21’4 in Edinburgh. The 201
deaths in Dublin last week showed an increase of ID
upon the number returned in the previous week, and
included 4 which were referred to scarlet fever, 3 to
whooping-cough, 3 to diarrhoea, 2 to “fever” (typhus,
enteric, or simple), 1 to diphtheria, and not one either
to small-pox or measles. Thus the deaths from these
principal zymotic diseases, which bad been 21,13, and 14
in the preceding three weeks, were last week 13; they
were equal to an annual rate of 1-9 per 1000, the rates
from the same diseases being 18 in London and 2D in
Edinburgh. The fatal cases of scarlet fever, whooping-
cough, and “fever” showed a decline from the numbers m
the previous week, while those attributed to diarrhcBa were
more numerous. The deaths of infants exceeded tbe number
returned in any previous week of this year, while those of
elderly persons showed a further decline. Seven inquest
cases and 8 deaths from violence were registered; and 64,
or more than a quarter, of the deaths occurred in public insti¬
tutions. The causes of 32, or nearly 16 per cent., of the deaths
registered during the week were not certified.

THE SERVICES.

Surgeon-General E. G. M'Dowell, of tbe Army Medical
Staff, has been appointed Principal Medical Officer at Halifax,
Nova Scotia.

Messrs. Wilkins, Patterson, Venour, North, and Dr. Ogilvie
(all Surgeons-Major) have been appointed Senior Medical
Officers to Brigades in Upper Burman.

Mr. C. W. Owen, C.I.E, M.R C.S., L.R.C.P., who was with
the Afghan Boundary Commission, was recently presented
by the Amir with an autograph letter thanking him fior

,GoogIe

Thi Lancet,]

GENERAL H08PITAL8 AND PARISH INFIRMARIES.

[Fbb. 12,1887. 337

the good work which he had done in the medical treatment
of Afghan officials and other subjects of the Amir.

Admiralty. — The following appointments have been
made:—Surgeon James J. Walsh, to the Vernon, additional;
Mr. John V. Laverick, to be 8urgeon and Agent at Skinnin-
grove, Staitho, Runswick, Kettleness, and Hammereen.

Rifle Volunteers.— 2nd Volunteer Battalion, the Loyal
North Lancashire Regiment: Surgeon and Honorary Sur¬
geon Major R. Settle, M.D., resigns bis commission; also is
permitted to retain his rank and to continue to wear the
uniform of the battalion on his retirement.

Volunteer Medical Staff Corps. — The Woolwich
Diriaon: William Collingridge, M.D., to be Surgeon (Super¬
numerary). _

&nrmpott!bmr.

“ And! alteram partem.’*

GENERAL HOSPITALS AND PARISH
INFIRMARIES.

To the Editors of The Lancet.

Sirs, —I agree entirely with the letter of your corre¬
spondent “ X.,” published last week, but 1 would go much
further than he. It has always seemed to me, more par¬
ticularly so in these days of hospitals partially closed for
want of funds, that it is an injustice to the ratepayer to
Hare built, and to compel him to keep up, the magnificent
pariah infirmaries which one may see now in the north,
noth, and west of London. It would surely have been no
difficult matter in the case of many parishes to have sub¬
sidised the nearest general hospital, and thus to have com¬
manded beds sufficient, at any rate, for all urgent cases of
disease. And if it be objected that none of the existing hoe-
pitalscould have provided sufficient accommodation, I should
reply that it would have been better far to extend the
already existing general hospitals, and, if need be, to build
others in quarters where they were needed, than that each
parish should have launched out into bricks and mortar to
the extent that has been done with completely equipped
establishments. It used to be the custom at Guy’s, 1
know, to receive parish cases at so much per week,
but few such are, f think, admitted now; and I am told,
that in some of the large continental towns a small
sum per diem is paid for each patient admitted, unless he be
selected and consent to occupy a bed in the wards devoted
to special clinical cases. It is difficult to see what insuper¬
able difficulty there could have been, or would be now, with
an ever-growing population, in adopting some general plan
«f this kind. But I venture to maintain that these large
parish infirmaries are not only an injustice to the rate¬
payers—I do not think I should take up a pen on that score;
they also do harm to the general hospitals; and, in a
reuse, I think it may be fairly' said that they may do in¬
justice to the patients that are admitted within their own
doors. 1 have been told by more than one surgeon at the
metropolitan hospitals that a great number of surgical cases
sre bow diverted by the parish infirmaries. It is evident
that it must be so. First- class men seek and obtain the
resident appointments at these institutions, and they are
»ot content—why should they be?—to treat only the very
uhroiuc sad incurable cases; they operate on hernias, ampu-
tste limbs and breasts—in fact, do anything within the range
uf trodden or untrodden medicine or surgery; and as a
result the practice in general hospitals is curtailed, the
Undents surfer to a very definite Extent, and again, since it
is a very clinching argument, the rates are necessarily
increased. Surgical skill and appliances, the latest novelty
in drugs, cannot be had for nothing; and the advanced
medicine and surgery (particularly the latter) of the present
d*y are admittedly very expensive. I submit that the rate-
P*yera are not called upon to undertake this expense until the
general hospitals are unable to meet the demand, and it is
■nfe to assume that in the present impecunious state of these,
und with their many vacant beds, it could be done cheaper
*nd more helpfully by them than the parishes can do it in
their own infirmaries, when the cost oi building, staff, &c. t
w taken into account. It may also be said that to turn
the parish infirmary into a general hospital, as is done in the
Fwaert da|r, is unjust to many of the patients.

This might seem at first a delicate matter to touch upon,
but it is no more than common sense after all. Everyone
will probably allow that the advanced surgery of the present
day—I speak as a physician might be expected to speak!—
should always, in the interest of the patient, be a matter of
free consultation. Success is happily otten the crown of what
at the outset is but a desperate venture to the patient, and
even to the surgeon hardly more than a forlorn hope, with
forlorn writ very small and hope unusually big. But it
is the desperate venture that requires the more considera¬
tion, and the fastest express requires the most perfect
possible of brakes. Again, it is quite impossible in the
present day that the one or two (able men as they are)
resident medical men can work a large general hospital
—such as, in fact, these institutions are becoming,—and
this has of late been recognised in the proposition
which has been made, that they should have a con¬
sulting staff attached to them. But I do cot think that this
meets the requirement. Honorary consulting physicians
and surgeons are for the most part illusions, and to my mind
a largely increased acting staff is what is necessary. By
this means alone can any free consultation, the discussion
of opinions and of proposed measures of treatment in critical
cases, be guaranteed as a matter of routine. I live in hope
that somehow or other, at some not far distant day, the
present parish infirmaries may be linked each to its nearest
general hospital, and that both will be in some measure
aided by the rates. I feel sure that economy and efficiency
would gain thereby, and that thus the real want of hospitals
and infirmaries would be mutually supplied.

I am Sirs, yours obediently,

Weymcuth-»tr«et, W., Feb. 5th, 1887. JAMES F. GOODHART.

THE CAMBRIDGE CHOLERA FUNGUS.

To the Editors of The Lancet.

Sirs,— In a recent issue (Jan. 20th) of your contemporary
Nature, Mr. Gardiner, who had previously suggested that
the so-called Cambridge cholera fungus might be a Chy-
tridium, has withdrawn that opinion, and now believes it
to be the involution form of some bacterium. He further
adds that this organism very' vividly recalls to his mind the
involution form assumed by' Bacterium cyanogenum. I
should like at once to point out that this later opinion bears
out to a certain extent the conclusion which I arrived at
last year. This I have expressed in the new edition of my
Manual of Bacteriology, which will be issued, I hope, in a
few days, as follows:—“At a meeting of the Physiological
Society, May 15th, 1886, at Cambridge, a preliminary com¬
munication was made upon the investigations in Spain,
referred to in the first edition of this work. The observa¬
tions madeby Roy, Brown, and Sherrington, rather tend in the
opinion of the author, to confirm Koch’s views. Comma bacilli
were found to be present in some cases in enormous numbers,
and the frequency of their occurrence led these observoTS to
believe that they must bear some relation to the disease. At
the same time, as they failed to find them in all cases,
they regarded the existence of a causal relation as
not proveL. They failed to find the Naples bacterium
or the small straight bacillus noted by Klein, but
they drew attention to certain peculiar mycelium-like
threads in the mucous membrane of tbe intestines. This
organism, however, judging from a preparation stained
with methylene blue, which was exhibited at tbe meeting,
appeared to the author to much more closely resemble some
of tbe involution forms of the comma bacillus, filaments d
masses globuleuses, figured by Van Ermengen than any¬
thing else he had seen. Yet, assuming that these peculiar
structures do belong, as described, to some species of
Cbytridiacese, it is very doubtful whether they can be con¬
sidered to be of any significance. Methylene blue bas been
employed by Koch and others, including the author, for
staining sections of the intestine from cholera cases, and had
these structures been constantly present it is hardly possible
that such striking objects could have been overlooked.
Again, we must bear in mind that hyphomycetous fungi
occasionally have been found to occur saprophytically in
tbe intestinal canal, tbe lungs, the external auditory meatus,
and elsewhere. We must, however, wait before expressing
a more decided opinion nntil tbe report of these observers is
published in full.”

I have now before me the proceedings of the Royal

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338 Thb Lancet,]

THE FUTURE UNIVERSITY OF LONDON.

[Feb. 12 1867.

Society (No. 247), an abstract of which was given in your
issue of Jan. 29th, and I most confess that I am much
puzzled by the illustrations which accompany the pre-
liminary report on this subject. These figures, as Dr. Klein
has pointed out, certainly appear to represent a branched
mycelium, but they do not in the least recall to my mind
the actual preparation which I had an opportunity of ex¬
amining, and upon which I founded my opinion in May
last. It has occurred to me that possibly Mr. Gardiner was
shown the very same preparation, and hence his recent
opinion that this organism is some involution form.

With regard to methylene blue having been used by
Koch, 1 would refer those interested in this discussion to
“ Bacteriology,” p. 141, where the method is given, as re¬
ported in the Berliner Klinische Woch., No. 31 (Conferenz
zur Erbrterung der Cholerafrage, Juli 26,1884). In their
preliminary report, Messrs. Roy, Brown, and Sherrington
state that the particular method they employed was almost
identical with that of Loffler, and they add, “ So far as we
know, Ldffler’s method has not been employed to stain
sections of tissues taken from fatal cholera cases,” but here
1 must add that Loffler’s method was precisely the one
which 1 used in staining a great number of sections in
July, 1885, as it had been especially recommended for that
purpose by Dr. Workman in the British Medical Journal,
No. 1280. I am Sirs, yours faithfully,

Edgab M. Cbookshank, M.B.

Munch ester-square, W., Feb. 3rd, 1887.

THE FUTURE UNIVERSITY OF LONDON.

To the Editors of Thb Lancbt.

Sirs,— In your excellent article replying to the writer in
the Quarterly Review, you enumerate University College,
King’s College, the Science and Art Schools at Kensing¬
ton, the Technical Institute of the City'Guilds, the Royal
Colleges of Physicians and Surgeons, and the Inns of Court
as bodies which are not, but might be, incorporated in a
true University of London. Will you allow me to ask for
a reconsideration of this position ? It is of immense im¬
portance that the wrong ingredients should not be mixed
to form the new University. As nearly as circumstances
will allow, we want one body of professors actually united
and organised as a single corporation of teaching exa¬
miners or exemining teachers to constitute the new Uni¬
versity. The attempt which has been made by Sir George
Young and one or two members of an Association which
has never itself assented to such a scheme—to bring in¬
dividuals from diverse and very many teaching insti¬
tutions together as the basis of a new University—is,
1 venture to assert, a fatal error. A certain small amount
of popular support may be obtained for the new Uni¬
versity movement by thus widely throwing the net, but
it is at the sacrifice of all that is worth obtaining in the
foundation of a new University. The Normal School of
Science has no locus standi in the matter. Its business is
to train school teachers and to grant its own certificates.
Its lecturers are paid by the taxpayers. The Technical
College similarly must stand on its own bottom and grant
its pwn diplomas, and has no claim whatever to take part
fn the. University. Leaving aside for the moment the
question of professional degrees in law and medicine,
it results that for the general purposes of University
training and the granting of degrees in Arts and in Science
there are only two bodies in London which can claim the
concession to their professors of the special favour and
privilege in question. These two bodies are University
and King’s Colleges. The mere fact that there are only two
such bodies is immensely important; it results in an
absolute certainty that were these two bodies endowed by
the Crown with the style and authority of a university,
they would gradually fuse with one another and become a
single corporation identical with the University. Thus we
should at last see in London one powerful and authoritative
body of teachers able to claim and to attract endowments
whilst teaching and carrying on research on a scale worthy
of the richest city in the world. The professional degrees
in Law and in Medicine must, I admit, bo placed on a some¬
what different footing; and in thenewUniversitytheFaculty
6t Law and the Faculty of Medicine should oonsist not of

the professors of these subjects in the University and King’s
College, but of representatives of the professions of law and
of medicine generally. This distinction is necessary for
several reasons, but chiefly because in the case of medicine
the degree has a special professional significance, and because
the teaching of medicine and surgery, strictly so called, is
splendidly provided for by the great London hospitals
and tested by the great medical corporations. There
may be a reluctance on the part of the Crown to grant
the power of conferring what would purport to be an
academical degree to a purely professional corporation.
If so, the objection might be removed by making the
new body—whatever its internal constitution may be—
which is to confer the degree of M.D. on London students
occupy the position of the Medical Faculty of the new
University whose Faculties of Arts and of Science are
formed by the professors of University and King’s Colleges.
It will be objected to these proposals that special privilege
and favour are to be accorded to University and King’s
Colleges. But why should such favour not be granted to
them ? The essence of university foundations is the grant
of a privilege of dignity And authority to a selected body.
No one can maintain for a moment that University and
King’s Colleges are not worthy to receive this privilege, or
that there is any other body in London which has any claim,
except in regard to medicine and law, strictly so called, to
share it.—I am. Sirs, your obedient servant,

E. Ray Lankebtkb, M.A., LL.D., F.R.S.

Savtle Club, Piccadilly, W., Feb. 7th, 1887.

%* We did not instance these institutions as constituent
bodies in a new university, but merely to show that the
existing University bad done nothing to bring them into
any closer union than was the case with corresponding
institutions in the time of Stowe.—E d. L.

ON THE CAUSE OF MARKED HYPERTROPHY OF
THE ANTERIOR WALL OF THE BLADDER.

To the Editors of Thb Lancet.

Sirs,— At the meeting of the Pathological Society on the
18th ult., Mr. Fenwick drew attention for the first time to
the fact that the anterior wall of the bladder hypertrophies
much more than the remainder, especially in cases of un¬
relieved stricture of the urethra. The position of the
bladder in the anterior part of the pelvis enables it, when
dilated, to expand posteriorly in the direction of the rectum
and upwards into the abdominal cavity, but the pubic wall
fiatten8 the anterior snrface. This affords the true explana¬
tion of the phenomenon. If membranes in the shape of
spheres of varying sizes enclose fluid, so that the tension ia
uniformly distributed along each fibre, the thickness of the
membrane must by the principles of hydrostatics bS exactly
proportional to the radius of the corresponding sphere.
Similarly it follows that the greater the flattening of the
anterior wall of the bladder as compared with the curvature
of the posterior and upper walls, the greater must be its
thickness, in order that the pressure of toe urine in the
bladder may be balanced by the same tension of each
muscular fibre. Hence the diminished curvature of the
anterior wall of the bladder throws a proportionate increase
of work ou that part of the wall, and a greater thickening
ensues. This is, in fact, an illustration of the general law in
physics—that every limitation to the free movemeut of a
body throws an increased strain upon the body: the p'ubic
wall -impedes the projection of the bladder forwards, and
therefore throws an increased strain upon its impeded por¬
tion, the anterior wall, and this completely explains the
localised thickening to which Mr. Fenwick has drawn
attention. I am, Sirs, yours truly,

Jan. 19th. 1S.37. G. N. PlTT.

TIIE LAW RELATING TO CORONERS.

To the Editors of The Lancet.

Sirs, —As I have made a public promise, of which you
have been kind enough to take notice, that I should bring
in a Bill to amend the law relating to the election of
coroners in English counties, I wish, if you can give me
space in your valuable columns, to explain why I have nob

Digitized by GoOgk

TSekLancr,!

LISTERIAN ANDNON-LlflTBfllAN OVARIOTOMY.

[Feb. 12,1887. 33&

been able to fulfil that promise. I did draw up such a Bill,
in which I proposed ttiat the freeholders oa the Parlia¬
mentary Register for the time being should be the electors.
On consultation with several of my Radical M.P. friends,
with whom 1 generally act, I find there is an objection on
then part to conferring any special benefits on the free¬
holders, and they prefer that the whole of the voters on the
Parliamentary Register should be the electors. This I find
impossible, as the numbers which would have to be dealt with
would be bo large as to be practically unworkable. Another
objection taken is that the freehold portion of the present
Padiamentary Register will within a few years be done away
with, on the principle of “(me man one vote," and that it
would not be likely to be kept on for the election of coroners
only, it is abo objected that the election of coroners for
counties should be put in the same category as that for towns,
which is vested in the town councils, and should in tbe
former oase be delegated to the county local boards, which
ire likely to be established during tbe present session of
Parliament. Failing the support of the gentlemen with
whom I usually act, I have given up the subject in despair,
tad written to one of the Middlesex magistrates for the
information of the Bench, stating these reasons for not
bringing in the promised Bill. I have always been of
opinion that every coroner should be in the first place a
medical man, and that an examination in tbe law of evidence,
similar to that in State medicine, should be set on foot, in
aider that every medical man who aspires to be a coroner
should be able to shew by passing, it that he is.doubly
tnd folly qualified to discharge the duties of such a respon¬
sible poet. Your powerful advocacy of such a proposition
would soon bring it within the range of practical politics,
md confer a great boon on the medical profession. Barristers
or solicitors who bold a doable medical qualification would
in this case also be eligible for the port.

I am, Sire, yonrs truly,

Peb. 8th, 1887. R. MACDONALD, M.D., M.P.

LISTERIAN AND NON-LISTERIAN
OVARIOTOMY.

To the Editors of The Lancet.

Sas,—In The Lancet of May 27th, 1882, there appeared
•n editorial nt>te on the results of ovariotomy at the
Sunritan Free Hospital in the year 1881, contrasting the
units under the Listerian and non-Listerian methods of
operating, and I shall be obliged by your allowing me to
recall attention to the subject. In the note referred to you
pointed out that the mortality under the Listerian method
very much leas than that under the non-Listerian in my
bods, but, unlike your contemporaries, you were careful not
toihaw any conclusions from the data. In tbe following
lumber (June 3rd) yon were good enough to publish a note o!
®i*e, in which I asked you to suspend your judgment, on
tbe ground that it was “ a very unsafe proceeding to lay too
much stresq on any particular series of cases, and especially
® those of one year only.” The reasonableness of that request
»ill be apparent when I bring to your notice the results of
tbe same operation during the year just past (1886), for they
NBpletely upset the fanciful Conclusions derived from the
remits of 1881. Thns, in the year 1886 there were forty-
bx ovariotomies performed in the Samaritan Free Hospital
by three operators, with a careful observance of all the
^riails of the Listerian method, and of those cases seven
'had; Irtifle the twenty-five cases done by me Without any
antiseptic precautions, beyond the strictest atten¬
tion to cleanliness, qll recovered.

I offer, no comment, and have only to request that yon
*111 give the same prominence to this statement as you gave
to that to which I here recall your attention. As the results
the work done in the Samaritan Free Hospital will not
pubHabed in tbe form in which they appeared in 1882,
u there Will be no meafis of judging between the merits
°* the two systems in. future reports, I beg to enclose the
P^ose data.ft# jrbur own flse.

I am. Sits, yohrs faithfully, .

0th. i8df. ;Q$g. Gbanvjixe Sanuocs.

THE FELLOWS AND MEMBERS OF THE ROYAL
COLLEGE OF SURGEONS.

To the Editors of The Lancet.

. Sirs,—As the Association of Members of the Royal
College of Surgeons is now taking the preparatory steps for
the immediate presentation to the Privy Council of the
petition which yon kindly noticed in your journal about a
month ago, it may interest your readers to know that we
have obtained the large number of 4590 signatures of Mem¬
bers of the College to the same. The old taunt of the
Counoil of the College that “some Members” only were
desirous of this change in the election of the Council is
thereby set at rest once and for all, for this is a very large
proportion indeed of the whole number of the Members
of the Royal College of Surgeons, and much larger thnn it
seems at first sight, the calculation of the officials of the
College as to the number of its own Members being hope¬
lessly at fault. We find, and till the other day we had
accepted this as correct, that the College Calendar gives a “list
of Members” totalling 17,040, and most men would have
thought that that was very nearly accurate. But upon
reading three weeks age that the College authorities had
only sent out 987 polling papers to its Fellows, whoee-
numbers appear on the Calendar as 1124, it occurred to us
that a similar discrepancy between the actual and the
official numbers of the Members might also exist. Nay, we
expected, as we have found, a still greater difference; for
whereas the Fellows are honoured by what calls itself an
“Alphabetical Register,” the poor Members are put off with
only a “list.” The distinction is most subtle. However, if
may be presumed that the word “ list ” was chosen as not
committing its promulgators to an endorsement of th»
accuracy of its contents. Now, we have gone most
carefully through the Medical Register for 1886, pub¬
lished only four months beforo the last College Calendar,,
and find that the number of Members of the College
upon it is only 11,821, which, to allow for errors in
casting, we will call 12,000—that is to say, that five-
seventeenths, or nearly a third, of the Members exist
only upon that li6t, or in the imagination of its com¬
pilers. They have existed, it is true; but the College
clings fondly to their memory, and mutters still, as Words¬
worth’s peasant child, “We are seven’’-teen thousand f
That our calculation is, in the main, correct is proved by an
analysis of a sample of this “list.” On page 89 we find 98
names of Members; of these, only 61 are on the Medical
Register, to which we must add 2 who qualified in the
interval between its publication and that of the Calendar,
thus leaving 37 names of Members whose ghosts still linger
round the College -walliy awaiting -the burial of their
' diplomas. We trust you will pardon tbis digression, but it
is of importance with regard to the weight that the sum of
! these signatured should carry. That out of 12,000 Members
of tbe Royal College of Surgeons, of whom a good 2000
are inaccessible, 4600 abonld have actively identified
themselves with this movement by their signature should
have great influence with the profession and with the Privy
Council. We may/in conclusion, add that every signature
is by a bond file M.R.C.S., for we have checked each in the-
Medical Directory for 1887, and thus eliminated not only,
men who had signed before, but those few who signed in
error, not holding the College qualification. We .hope later
to be able to give you a few local and other details of the
signatures. We*are. Sirs, your obedient servants,

Warwick C. Steele, 1 Hon. Secs.. Amoo.

, • Wh. Ashton Ellis, . / ofM.R.o.s.

■Western Dispensaty, Westminster, S.W.. Feb. Ptb, 1887.

' A CURIOUS LACRYMAL CASE.

To the Editors of Tuts Lancet.

Sirs, —Tbe following case, which in. my experience I am,
glad to say is unique,, deserves a passing record.

On Saturday, Jan. 29tb, a young man came to my clinic,'
The wholb of the right side of his face was Considerably
swollen, puffy,, and covered with scabs in places. About
half an inch below the lower lid in the angle formed by the,
Cheek and the nose, but' far removed from, the position of

zed by

Googl

340 The Lancet ]

EPIDEMIC DIARRIKEA.

[Feb. 12,1887.

the lacrymal sac, these crusts become unusually thick, and
projecting from their centre was visible the upper ex¬
tremity of a hollow silver lacrymal style. Struck by its
unusual position, 1 began to seek for the distal extremity.
This was found in the mouth bstween the gums and
cheek, just above the socket of the right canine tooth.
It had not perforated the mucous membrane owing to the
discharge produced by its irritation having found exit
through the cheek, but it could easily have been pushed
through had it been of sufficient length. Any movement
communicated to the cheek moved the whole tube in situ,
and it had obviously never been in the proximity of the
lacrymal apparatus or nasal duct. The way the operation
must have been performed was no doubt as follows: The
supposed position of the lacrymal sac having been
determined, an incision through the skin was made over it.
The subcutaneous structures having been reached, the style
was pushed downwards, passing in front of the superior
maxilla below the whole thickness of the cheek, and was
there left. The tube had been in its present position for
fourteen months, and it is needless to say the slight lacrymal
obstruction which it was intended to have cured bad derived
no benefit. The case was seen by Dr. Davies, Mr. Wicks,
Mr. Brewis, and other gentlemen who kindly assist at my
clinic. I am. Sirs, yours truly,

C. S. Jeaffrbson,

Sen. Surg. Northumb. and Durh. Eye Infirm.

.Newcaatle-on-Tyne, Jan. 29th, 1837.

EPIDEMIC DIARRHCEA.

To the Editors of The Lancet.

Sirs,— In reference to your article in The Lancet of last
•week, concerning our London water-supply as a possible
source of distributing disease the following particulars may
be of interest.

During the last four weeks the casualty and out-patient
departments of the West London Hospital have been called
upon to attend to an extensive outbreak of a severe form of
diarrhoea. The cases have been very numerous, far exceed¬
ing those met with daring the summer months, and also
exceeding those in the severity of the attack. The
symptoms in nearly all the cases have been sudden pain in
the epigastrium, vomiting, incessant diarrhoea witn (in a
few cases) bloody stools, a rise of temperature (100'5° to
lt)l'5°), followed by extreme prostration, and in two cases
collapse. The duration of the attack has been from three to
eight days. The districts affected were thoee of Fulham,
Chiswick, and Hammersmith—an area too large for any
common cause save those of atmosphere and water-supply.

I am, Sirs, yours truly,

Chas. H. Taylob,

Wfst London Hospital, W., Feb. 7th, 1887. House-Physician.

FRIENDLY SOCIETIES’ MEDICAL ASSOCIATIONS:
VIEWS AND EXPERIENCE OF A MEDICAL
OFFICER.

To the Editors of The Lancet.

Sirs,— Before entering a Friendly Societies’ Medical
Association, in which I stayed several years, 1 had no
knowledge of such institutions, hut thought they partook
of the character of dispensaries and adapted for the neces¬
sities of the working classes of limited means. In this I
was soon undeceived, and found it to be composed of an
amalgamation of friendly societies’ clubs within a radius of
three miles, who sent delegates, one for each hundred or part
of a hundred of its members, to form a general committee,
who again appointed from their numbers annually a com¬
mittee of management, consisting of president, vice-president,
secretary, treasurer, trustees, three auditors, and nine mem¬
bers, the secretary and auditors being paid fdr their
-services. The managing committee, seven of whom formed
a quorum, sat once a month, the general committee once a
quarter, except under special circumstances. The medical
officers were appointed by the general, after being selected
by the managing, committee, the senior medical officer
living on the society’s premises, having to sign an agree¬
ment, stringent in its particulars, such as to finding all
surgical instruments, not to absent himself from work
either through illness or otherwise, Up less supplying his
fflace by a duly qualified practitioner as substitute, not to

practise within four miles of the town, under a penalty of
.£100, except he has served the society five years, there
being no equivalent if be is given, with or without cause,
three months’ notice as by agreement. The objects of the
Society were to supply certificates, examine candidates for
the various societies, give advice and medicines, and to visit
within a radius of three miles members at their own homes.

The hours of the dispensary were from 9 to 10 morning,

1 to 2 afternoon, and 6 to 8 evening, the rest of the day
being consumed by visiting the sick and attending mid- 1
wifery if forthcoming. For visiting, except in cases of
emergencies, notice had to be left at the dispensary
before 10 a.m. This rule was never strictly carried out.
Sunday, although supposed to be a day of rest, the visit¬
ing, &c., only being in cases of sudden illness, yet members
would worry on that day more than any other, and that from 1

morning till night. The only holidays in the year were i
Christmas Day and Good Friday, if nothing happened. The ,
medical staff of the Society, which numbered about 4000
members, consisted of one resident, and one non-resident, ■
there being no dispenser. The members, their wives and
children, also lodgers and relatives over eighteen, and living ‘
under the same roof, paid Is., and children and others under 1
eighteen years of age paid del. per quarter, accouchements
10a 6 d., vaccination free. Juvenile members of the various
societies could include in the benefits of the Association ■
their parents, grandfathers, &c. Members were composed
of tradespeople (some in good circumstances), clerks,
artisans, and labourers, also, retired individuals of various
callings. Often the attendance at the surgery came to 100,
sometimes 180 in the day, not counting the visits at the 1
patients’ homes. Calls for visits were frequently required
for most trivial complaints. Abuses on the members’ part 1
are taken no cognisance of, in fact, no rule applied to any
such charge against a member, but two rules applied to 1
complaints made by a member or his family against the
medical or other officers.

The salaries of the medical officers were the following: !

Resident, £180; noo-reeident, £120. Extras, midwifery '

fees paid to the officer attending, at first, 8s. 6d., after¬
wards 10a 6d., the 2s. being allowed for out-pocket ex¬
penses to drivers when going loDg distances, cabs being <
on contract terms. An allowance at first of £10, then i
£15, per annum to resident medical officer for coals, gas,
cleaning, &c., this applying to waiting-room, used also for
auditors, managing committee meetings, and others ; also i
supplying gas to surgery, consul ting-room, lamp to gate, &c.
Formerly, what the club doctor lost through the members i
he gained by the families. Now, under the Association i
plan, not only the families of the poorer, but those of the i
well-to-do portion of the'members belong to it, thus seri- i
ously affecting the medical interests, as instead of about. i
£700 being the annual receipts, as in the Society to which I i
belonged, and then not all paid to the medical staff under i
the old system, at the lowest estimate three times as much
would accrue from the same numbers, and would all go to i
the medical profession. I am, Sira, yours faithfully,

Feb. 8th, 1887. ___ SURGEON.

SURGICAL TREATMENT OF HYDATID CYSTS !

OF THE LIVER.

To the Editors qf The Lancet.

Sirs,— Permit me to make a short comment upon your (
leading article (Feb. 5th, 1887) on the Surgical Treat- ,
ment of Hydatid Tumours of the Liver, which is founded
on my paper and the ensuing discussion at the Medico- ,
Chirurgical Society. You say that I “did not show that j
this escape of contents [hydatid fluid] has been a serious i
sequela of the operation as more usually performed.” I even <

went further, stating that the escape of a small quantity of 1

saline and usually non-albuminous fluid would not in the
majority of cases set up septic peritonitis, that with this
fluid, however, a certain number of scolices might be carried ‘
into the peritoneum, and give rise secondarily to hydatids '
more or less diffused in that cavity. I would, therefore, 1
in view of both these possibilities, avoid any effusion of
hydatid fluid into the abdominal cavity. The question
appears to me to be not whether a certain number oi opera- ’
tions, otherwise performed, have terminated favourably,
but whether the procedure I have advocated avoids, as I
contend it does, the dangers alluded to more surely and

Thk Lancet,]

DR. BRUNTON AND HOMCEOPATUY.

[Feb. 12,1887. 341

completely than any other method. As for the supposed
besvy price to be paid for this extra degree of safety by
dividing the operation into two stages, I must point out that
this price is nil, for the second stage consists merely of an
incinoQ not into the patient, but into an hydatid cyst. It
presents itself as a detail of dressing; the parasite may per¬
haps feel the cut—the patient most certainly does not.

I am, Sirs, your obedient servant,

Fet, 1887. _ _ Richard Bab well.

DR. BRUNTON AND HOM(EOPATHY.

To the Editors of The Lancet.

Sras,—You are quite right in your remark on Mr. Bate¬
man’s note that “ it is not the use of any particular drugs
that constitutes homoeopathy”; but that is not all that we
allege against Dr. Lauder Brunton in reference to his work
on Pharmacology, &c. Dr. Brunton not only takes a large
number of his drugs from the homoeopathic materia medica,
but be likewise takes his indications for the use of these
drugs from homoeopathic works. Where else could he
derive his knowledge that pulsatilla is a remedy for acidity,
diarrhoea, earache, and epididymitis; that bryonia is useful
in pleurisy, pneumonia, meningitis, peritonitis, and rheu¬
matism ; that thuja is good for condylomata; viola tricolor
udrhus toxicodendron for eczema; gold for ozaana ; achillsea
for uterine haemorrhage; ignatia for hysteria, melancholia,
infantile convulsions, and nervousness; and fifty other
remedies and their indications strange to old physic ? Dr.
Brunton gives in his book a bibliographical index with
lavish references about the medicines commonly used in
jonr school, but not a single reference about the medicines
which homoeopathy has introduced into medical practice.
Why is this ? Did Dr. Brunton rediscoverall these remedies
tnd their indications for himself ? I know Dr. Brunton
ii a very clever man who has made many experiments with
drugsonmany frogs, but if bis researches iu this field had
taught him the above uses of these drugs, he would certainly
have told us. So we are driven to the conclusion that Dr.
Brunton has borrowed extensively from homoeopathy, but
has studiously withheld from his readers the source of these
borrowings, and, for anything that appears to the contrary
in bis book, be assumes to himself all the credit of all these
remedies and their indications, so strange to the practice of
jour school. Is this the right thing for a medical author to
do? We may be a contemptible sect in the eyes of an
orthodox author, but it is surely carrying cynical contempt
for the rival school a little too far to “ convey ” a large
number of their chief remedies into his book, and to conceal
carefully the source whence he has taken them. Does not
Dr. Brunton owe the profession some explanation of his
atnordinary conduct.

I am, Sirs, your obedient servant,
tendon. Jan. 39th, 1887._ E. E. DODGEON.

INEQUALITY OF THE PUPILS IN VARIOUS
DISEASES.—-CAUTION IN THE ADMINIS¬
TRATION OF SALICYLIC ACID.

To the Editors of The Lancet.

Sras,—In your impression of last week I noticed amongst
joar annotations some remarks published by Dr. Paster-
naUki on the inequality of the pupil in certain diseases,
and on careful reading I am surprised to note, although
Kvtnl diseases are mentioned where this phenomenon is
observed, no allusion is made to its occurrence in tuber-
cukr meningitis. Now, as far as my experience goes,
it it in this disease (especially in young children) that this
•jmptom is frequently to be noticed, and is of great patho¬
gnomonic value, indeed pre-eminently so as regards
diagnostic importance, where the signs of this disease are
or obscure. I have never had a case where death
ms followed the diagnosis of tubercular meningitis with-
the inequality of the pupils having been a prominent
*®dwrty symptom, so much so that 1 have been induced to
axdnde the diagnosis of this disease if this symptom is
ussntjand in every case that has resulted in recovery from,
u 1 here thought, tubercular meningitis, this symptom was
“ot pnesnt,and consequently I believed I had been mis¬
taken in my diagnosis; and perhaps this is why I am very
“eptm aa to the recovery from genuine tubercular diseases
<4themembttM»of the brain.

If it will not make my letter too long, I would wish to
add 1 have seen no notice taken of the case you publish in
your Clinical Notes of The Lancet of Dec. 18th os to the
need of caution in the administration of salicylic acid. The
fatal result there mentioned, in my opinion and probably of
others, was in no way due (unless the drug was impure)
to the medicinal dose given (15 grs.) of that remedy. Truev
the symptoms did not appear to call for its administration,
for there was no fever or history of malaria; and even if
symptoms were due to latent rheumatism as was supposed,
other remedies might have been preferable. It would be
regrettable if, in the case published, the post hoc and not the
propter hoc should cause needless fear and prevent the
proper use of this very valuable medicine.

I am, Sire, your obedient servant,

Jan. 15th, 1887. FREDK. H. ALDBRSON, M.D.

DIPHTHERIA AND MILK.

To the Editors of The Lancet.

Sirs,—T he prevalence of diphtheria renders it incumbent?
on all who have opportunities of studying its causation or
propagation to ventilate their views. I wish to offer a
small but important contribution to the subject of propaga¬
tion of diphtheria and other diseases by milk-supply, and
also to make a suggestion with regard to preventive
measures. It has frequently happened to me to see the
household milk-can, supplied by the dairy, in the patient’s
room and in close proximity to him, and even used by him
to drink from. Some residue of milk, in all probability
highly infectious, is returned in the can to the dairy, whero
it may or may not (often, I fear, the latter), be subjected to
the action of boiling water or steam. If, as must often
happeD, it is simply rinsed in hot water with many others,
these are in turn infected, and will affect the milk supplied
to various households. Medical men would be doing a great
public service in the cause of disease prevention by giving
orders in every household where infectious disease exists
that no milk-cans be taken into such houses at all.

I am, Sirs, your obedient servant,

H. Campbell Pope, M.D. Lond., F.R.C.S.

Goldhawk-road, W., Feb. 1887.

UNIVERSITY OF EDINBURGH.

To the Editors of The Lancet.

Sire,—W ith reference to your annotation in last week’s
issue, permit me to inform you that no “gross charges”
were brought against my late assistant by me, nor were
illegal charges of any kind intentionally made against him,
even by imputation.—I am, Sirs, yours obediently,

Feb. 8th, 1887. __ W. RUTHERFORD.

THE SANATORIUM BUILDINGS OF KINGSTON-
UPON-HULL.

To the Editors of The Lancet.

Sirs, — In reference to your criticism upon the annual
report of the health of the borough of Kingston-upon-HuD,
which appeared in your issue of Jan. 1st, attention is
directed to the new Sanatorium buildings, which are stated
to be defective. The washhouse mentioned in your criticism
is twenty-three feet from the road, and it is intended that
all articles before being removed from the fever blocks will
be disinfected by being placed in a solution of some reliable
disinfectant and conveyed away in proper receptacles pro¬
vided for the purpose, and its situation was so planned
that persons engaged could in nowise be in communication
with the hospital buildings. The wards for probationers are
distant some thirty feet from the administrative departs
ment, being connected only by a covered way. The greatest
care has been exercised in the construction of the building,
and the plans have t^en submitted to various eminent
authorities, also to Her Majesty’s Local Government Board
inspectors, during their sanitary surveys.

I am, Sirs, yours truly,

John W. Mason,

Medical Offloer of Health for the Town and Port of.

King* ton-upon-Hull.

Town Hall, Hull, Jan. 19th, 1887.

*,* The publication of the above letter has been un¬
avoidably delayed.— Ed. L.

Digitized by GoOgle

342 The Lancet,]

LIVERPOOL.—NORTHERN COUNTIES NOTES.

[Feb. 12,1887.

THE PRESENCE OF BLOOD IN THE PERITONEAL
CAVITY.

To the Editors of The Lancet.

Sirs,— I can unfortunately claim no credit for the conclu¬
sions as to the necessity for reconsidering the advisability
of operation in cases of extravasation into the peritoneal
cavity which Mr. Lawson Tait ascribes to me in your issue
■of last week, and to which, by implication, he raises such
strong objections. These conclusions are not to be found in
my thesis, but are those of the writer of the article referred
to, who has viewed my experiments and observations chiefly
in their bearing on this importaut practical question. On
the question of the advisability or non-advisability of opera¬
tion in such cases, I am not qualified, nor have I ventured,
to speak. My experiments, so far as they bear on this
question, deal almost exclusively with the fate of theextra va¬
cated blood—the conditions influencing its absorption, and
the extent to which its red corpuscles are at once absorbed
back into the circulation. Any conclusions, however, which
have been arrived at will be found to differ very materially
from those of Mr. Lawson Tait, when he allows himself to
state, without bringing forward any facts to support his
assertion, that the function of the peritoneum in man
differs “ most materially ” from that of the peritonea in
dogs and rabbits.

1 am, Sirs, your obedient servant,

Edinburgh, Feb. 7th, IS*;. WILLIAM HUNTER, M.D.

LIVERPOOL.

(From our otm Correspondent.)

THE .ASSIZES.

The South-west Lancashire assizes, which are held in
Liverpool four times a year, include all local and county
cases within a certain radius. Occasionally caSes which
should have been tried in Manchester are tried here. The
present assizes commenced on the 4th inst., before Mr. Justice
Hawkins, and comprise a very large number of cases, some
of a very serious character. One, which is known as the
Oldham poisoning case, will for several reasons assume
most of the characters of a cause c6lebre. The prisoner, who
was at the time of the occurrence a nurse in the workhouse
at Oldham, is charged with having murdered her daughter,
a girl eleven years of age, by administering a corrosive
poison. One remarkable circumstance in connexion with
the case is that though the prisoner has been committed on
the coroner’s warrant, the magistrates dismissed the case.

FATAL ACCIDENT TO A FIREMAN AND REMARKABLE
ESCAPES.

Liverpool is justly proud of its fire brigade, and, con¬
sidering the very dangerous character of their calling, it is
Iremarkable how few fatal accidents oocur either to the fire¬
men or to the police-officers who assist them. At a recent
warehouse fire a wall fell down, killing a constable instan¬
taneously, and injuring, though only slightly, a number of
others. It was not known that the deceased constable was
at the fire, he not having reported himself, but as he was
missing search was made, and his remains were found in
the ruins. The escape of all those firemen on whom the
wall fell is little short of miraculous.

APPOINTMENT OF OCULIST TO THE ROYAL
INFIRMARY.

It having been resolved by the Committee of the Royal
Infirmary to create an additional medical officer as oculist,
Mr. Thomas Bickerton has been selected as the first holder
of the office. Mr. Bickerton, who is the son of a former
oculist in this city, is known by his painstaking inquiries
into the subject of colour-blindness.

SWING-BOAT FATALITY.

An inquest was recently held at Bootle on the body of
a young woman who was thrown out of & swing-boat
on the 6th inst., and died soon afterwards from the effects
of the fall. The police sergeant stated, that five accidents
from swing-boats had occurred to his knowledge within
the last three months, and he had hetifi of numerous others.

The proprietor of the swing-boat admitted that they were
allowed to go level high, and it appeared that half an
hour after the accident the swings were going as high as
before. A verdict of “Accidental death” was returned, and
the proprietor of the swing-boat was severely censured for
the manner in which he gave his evidence.

THE INFECTIOUS DISEASES HOSPITAL.

The Hospitals Committee of the Corporation are adver¬
tising the office of visiting physician to the Netherfield-
road Hospital, at a salary of .£100 per annum. The office,
which is a newly created one under the Corporation, will
be of great importance, and much interest is felt as to
who will be first appointed.

Liverpool, Feb. 9th.

NORTHERN COUNTIES NOTES.

(From out own Correspondent.)

NEWCASTLE INFIRMARY.

The annual meeting of the governors of the Newcastle
Infirmary was held on Thursday, the 3rd.inst., and in view
of the proposed changes so strongly recommended by the
Special Committee, and which were the subject of a previous
letter from me, the meeting was looked forward to with
considerable interest, especially by the medical staff and
students, whom, as I have told you, the committee handled
in rather an ungracious manner. The annual report
Bhowed that daring the year 3175 in-patients bad been
admitted, being 329 more than during the previous
year. The average stay of each patient in the hospital had
been 29 G days. In the four years immediately preceding
it was 301, 31*2, 86, and 39. so that in this respect there
has been a gradual improvement. The death-rate for the
year had been 6 - 55 per cent. The average cost of each
patient had been £3 17 s. ll^rf. This was much smaller than
in some previous years. The cost of each occupied bed during
the year had been £48 Is. 2d.; in 188-5 it had been £6016s. 6a.
The number of out-patients received during the year had been
4641. The result of treatment of the in- and out-doorpatients
during the year has been: in- and out-patients cured,
5490; relieved, 1697; in- and out-patients still under treat¬
ment, 421. The number of casuals that have been treated
during the year is 19,624, against 27,811 in the previous year.
The reason of this large diminution is that at the quarterly
meeting of governors on July 8th it was resolved to charge
casualty patients 3d. on eacli visit from Aug. 1st. The
effect of this resolution is seen in the following figures:—
From Jan. 1st to July 31st 14,178 patients were relieved,
but from Aug. 1st to Dec. 31st only 5446 applied for relief.
Of these,-4385 paid the amount charged, and 1061 were
relieved without payment on account of their poverty. The
report states that it is the opinion of the resident medical
officers, to.whom the care of casuals is committed, that after
the charge of 3d. had been made a superior class of patients
presented themselves, persons who would not accept of chari¬
table assistance, but had no objection to be cured cheaply, while
the very necessitous diminished in numbers. The resolution
of the governors expressly provided for the destitute, but
at present the report states “ they appear to be scared away
The famished and ill-clad children of destitute or drunken
parents, it is pointed out. are subject to a variety of diseases,
for the relief of which they had hitherto resorted to the
infirmary. These, the report states, are a class deserving of
sympathy, and it says that the resolution imposing a charge
of 3d. on each casual will be again taken into consideration
after the plan has l>een in operation a year. The statistics
as to the various classes of operations are interesting, but
would take up too much space to record here. The report
states, in speaking of the major operations, “that probably
few hospitals, if any, could give so favourable a report of
this serious class of operations,” and that therefore “the
situation of the Newcastle Inflrmsry cannot be so insanitary
as it is supposed sometimes to be.” The report then alludes
to the grave pecuniary position of the infirmary. The whole
expenditure of the year had amounted to £13,’695, showing
a diminished outlay, notwithstanding an increase of patients,
of £262 10#., but yet exceeding the ordinary income by
£5326 6#1 The report went on to say “we began the
year with an overdraft due to the treasurer of £6403 4*. 4*1.
The whole of the ordinary income of the year has been used

EDINfl&fcGiL-iDUfiLlN.

[Feb. 12,1887. 34&

opr t«8#er with <£141 revived in subscriptions for the
completion of the Ravensworth ward, in addition to this
X8000 consols, part of the capital of the institution, has been
m Notwithstanding all this, the institution finds itself
'dose of the year in debt to the treasurer in the sum
11s. lOd. To meet this deficit corporation bonds to
lotmt of £4000, also forming part of the capital, had been
sAfl, still leaving a debt due to the treasurer of £245011s. 10 d.
Array animated discussion took place on the reading of the
report, w also on the report of the Special Committee, but this
last was referred to the Medical Board and two other coin-
. to report to a special meeting of governors to be
on the first Thursday of next March. It is apparent
that the infirmary cannot go on in its present condition,
and the whole dritt of its affairs is in the direction df a free
hospital, and the giving none of the responsibility of its
support to the artisans of the district, who more directly
bene fi t from it than any other class.

WA UrBM BOROUGH HOSPITAL.

’Croat Bis 1 been of late years remarkably free from
epidemics of typhus, although in past times the resources
of the Fever, Hospital were frequently strained on this
account. Within the past few months, however, there has
been a serious amount of this disease, and about sixty cases
tare been received in the Borough Hospital. No less than
seven of fcbe nurses have been infected, fortunately with
so fatal result, and the general mortality has not been
high. The Borough Hospital, lately under the manage¬
ment of a committee as a public charity, has been acquired
by the sanitary authority, and modernised from thb old
“corridor 7 ’ type into a building more in accordance with
modem requirements. Some further improvements, how¬
ever, as to warming and ventilation, are, I believe, to
be considered, at the suggestion of the medical advisers
4 the Local Government Board, .

•Tyne, Feb. 7th.; ,j*•
etl k Miifa »■■■*> i -*»»-

Ulin ii- •-‘■i. I .]•' .>'i r.

-1 ^EDINBURGH.

our ovm Correspondent.)

rtoi 'ii -;n . i/si

non TO SIB DOUGLAS MAC LAG AN.
bnday afternoon a large assembly of ladies and
gentlemen gathered in the Freemasons’ Hall on the occasion
presentation of his bust aud portrait to Sir Douglas
Npoagan by his friends and admirers. The platform, which
wu tastefully decorated with palms, was occupied by a
■amber of leading men in the city and the University,
aaaimgar them the Lord Justice-General (Chancellor of the
Oaivanaty), Lord Balfour of Burleigh, Lord Moncreiff, the
bird Provost of Edinburgh, Principal Sir W. Muir, Pro-
■mrs Crum Brown and T. B. Fraser, and many others. On
the motion of Sir Alexander Christison, the Lord Justice-
General (Lord lag Us) took the chair. Apologies for absence
were intimated from Mr. Eriohsen, Sir Joseph F&yrsr, Sir
Noel Faton, Lord Trayner, and others. To the right and
kit of the chair were the bust and. picture of Sir Douglas
XaeUgan, both veiled; ,Sir Douglas himself and Miss
Hadagan occupied seats to the right of the chair. Lord
tag!* * making the presentation, referred to his ow*n
enriy ‘ ttomradeshlp #itb Sir DoUglas when they entered
thb High 8chool together, and to the long years of close
frtfnddhtp that have followed. He did not venture to
atfn wp bis professional attainments and achievements
h tha prese n ce of so many of Sir Douglas’s professional
rOapmnr. but referred to some of the special honours which.
» Merits have won him; making mention of the fact
Sr Dobglas has held the office of President of both of
Boyfel Colleges, and of the honour recently received at
hamle of Her Majesty the Queen in recognition of his
j ii bi s J public services. Lord Inglis then spoke of the
jvateraft Se r vice rendered to the University by Sir Douglas
Wiling Ii is tenure of the Chair of Medical Jurisprudence for
piafHKw W quarter of a century, and 6Y the great expansion
ftp* us tskea pises in the practical and theoretic instruc¬
ts ridbUcbOalth under Us personal supervision. Tum-
ttt otbersiJje °* bis character, the speaker described
* ' a# *hinan of highly cultivated mind, well versed
HftSsical andmodern, apoCt, a sweet singef,
talk u Ibyal VoMnteer, and a great officer in
H£r Ha P*lrtd#gbArd f<* Scotland. He has been, and

is all this, Just because his habits hare been bo active and
sprightly, because he has such a happy and lovable dispo¬
sition, without the slightest trace of cynicism or gall, and
because of his inclination at all times to look on the best
and brightest side both of men aud things.” The bust and
the picture were then unveiled amidst great applause, and
were formally presented by Lord Inglis. Sir Douglas
Maclagan, in accepting the bust, spoke of the peculiarly
delicate nature of the circumstances in which he found
himself, and of the difficulty of expressing adequately his
sense of the kindness showered upon lum m so overwhelm¬
ing a manner. Referring to the proverb of the empty vessel
making the loudest sound, he attributed any incomplete¬
ness of his utterance to his being replete with gratitude.
On behalf of himself and Miss Maclagan, for whom the
portrait was .destined. Sir Douglas accepted also the
remarkably faithful likeness painted by Mr. George Reid,
R.S.A,, to whose talent, as to that of Mr. Hutchison, the
sculptor, he paid a warm tribute. Votes of thanks were
accorded to these gentlemen for the admirable way in which,
they had carried out the wishes of those concerned in the
presentation; also to Dr. Gibson, tbe treasurer, and Mr.
Lyell and Dr. Ashdown, the secretaries, whose efforts have
so efficiently realised the object in view. A similar com¬
pliment to the chairman terminated the proceedings.

THE STUDRNTS - UNION.

The final adjustment of the acoounts of the recent monster
baxaar shows that between £10,000 and £11,000 are available
fox the purposes of erecting the University Union. A site
in close proximity to the new medical buildings has been
selected, ahd plans of the proposed edifice are now in course
of preparation.

THB LORD BBCTOB8HIP.

The Lord Reotorship, vacant through the lamented death
of Lord Iddesleigh, presents a question of some difficulty.
It is thought very undesirable that another contested elec¬
tion should be fought out so soon after the last struggle. A
proposal that his Royal Highness the Prince of Wales
should be requested to fill the office has been very graciously
negatived on his behalf. It is hoped, however, that a can¬
didate may still be forthcoming in regard to whom there
will be no clashing of party sentiment, and whose unani¬
mous election may be secured.

ASYLUM APPOINTMENT.

The Colonial Secretary has appointed Mr. J. B. Spence,
M.A., M.B., assistant-physician at the Royal Edinburgh
Asylum, to be Medical Superintendent of the Ceylon Aeyluth.

Bdinbutgh, Feb. 8th. •

DUBLIN.

{From our ovm Correspondent)

ROYAL COLLEGE OF SURGEONS IN IRELAND.

The question of the College forming dual combinations
with the Collpgo of Physicians and the Apothecaries’ Hall
of Ireland was under discussion at a meeting Of the Council
bf this College last week. Although there is no doubt that
the combination would be a legal one, yet under present
cittumstfaades it has been thought advisable not to move in
the matter; bat there is a strong probability of a dual
scheme being formed at no distant date. The College (tea ante,
page 102) have resolved to constitute a diploma in public
health, and have matured a scheme of examination. Details
will shortly be published, but it may be mentioned that all
candidates who possess a registrable qualification will be
eligible for the diploma. The Council have adopted a vote
of condolence with the family of the lato Mr. Denham, an
ex-president of the College., . i

DUBLIN SANITARY ASSOCIATION.

The annual meeting was held last week, the inaugural
address being given by the President, Dr. Grimshaw. He
showed that Dublin alone of all the great towns of the
United Kingdom had an increased death-rate, after having for
ten years enjoyed in common with other cities the advan¬
tages of improved sanitary laws and the opportunities for im¬
proved administration. From the annual report of the Asso¬
ciation it would appear to be doing good work, but the
results of its operations, it must be confessed, are not very

Die

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344 The Lancet,]

DUBLIN.-—PARIS.

[Feb. 12,1887.

tangible. It will surprise many to learn that for the ten
years ending 1884 about 3500 more lives were lost than in
the previous decade, while in other cities the gain has been
relatively greater than our loss. It must not, however, be
•forgotten, as Dr. Grimshaw points out, that it takes a long
■time for sanitary measures to make a marked impression on
a previously delicate population, and a still longer time to
produce a permanent improvement.

THE LATE G. E. BRUNEBR, M.D., F.B.C.B.I,

At the advanced age of eighty-three years, Mr. Brunker
-died at his residence near Dublin, on the 2nd inst. He
graduated in medicine at Edinburgh in 1826, and obtained
the Fellowship of the Royal College of Surgeons in Ireland
in 1844. He held the post of surgeon to the Louth County
Infirmary for a considerable period, and on his retirement
from practice settled in Dublin. He took a very active
part in getting an alteration made in the Charter of the
College of Surgeons, so as to allow provincial and other
Fellows to vote for the election of President, Vice-President,
and Council by voting papers. A resolution was proposed by
Mr. Brunker to this effect in June, 1883, and was adopted at
a meeting of the Fellows. He was for a short time a member
of the Council of the College.

SIB P. dun’s hospital.

At a special meeting of the governors, held recently, a
cheque for £1000 was received, being the amount of a
legacy left by a Mrs. Hughes to the hospital. The executors
requested that the money should be expended towards the
construction of separate wards for the treatment of fever
patients, in accordance with the wish of the deceased lady.
The amount has been lodged to the credit of the Fever
Wing Fund. The available funds, in consequence of the
■difficulty of obtaining rents from the estate of the hospital,
ihave been seriously diminished, and the governors during
the past six years have been obliged to sell out stock to the
amount of £3500, to meet the expenses of the institution.

HEALTH OP DUBLIN.

The deaths from zymotic diseases during the past quarter
cumbered 818, being 14 above those recorded for the pre¬
vious quarter. Over 32 per cent, of the mortality from
zymotic affections was due to scarlatina, which caused 103
deaths, or 60 in excess of the preceding three months. Six
<leaths were attributed to cerebro-spinal fever, a disease
which may be said to have existed as an epidemic in Dublin
for the past eighteen months.

THE LATE DR. O’CONNELL.

The remains of the late Dr. O’Connell of KUmallock were
interred in the family burial-ground at B&llingaddy on
Saturday, the 29th ult. The deceased served as a surgeon in
the British army, and took part in various engagements in
Spain in 1830 to 1835. For his services he was presented
with a gold medal of the Legion of Honour by Queen
Isabella, and the honour of knighthood was conferred upon
him (Knight of the Order of St. Ferdinand) for attending
the Queen in her accouchement.

FOOTBALL.

One of the players at the International Football Match
{Ireland v. England), which was held on Saturday last in
Dublin, received a severe injury to the head, and is now
suffering from concussion of the brain.

Sir George H. Porter, surgeon to the Queen in Ireland,
was last week sworn in as High Sheriff of co. Wexford, in
the Court of Exchequer, before the Lord Chief Baron.

Dublin, Feb. 8th.

The Subsoil of London Streets.—T he Chairman
erf the Board of Works, Sir J. M'Garel-Hogg, M.P., has
introduced a Bill for conferring further powers on the
Board with respect to the subsoil of streets and the laying
of mains or pipes. It proposes that without the consent of
the vestry or the district board no road is to be made over
land where the sand, gravel, or subsoil has been taken
away. And without this consent none of this subsoil under
a road already made is to be removed. In cases where this
consent is given, any conditions may be imposed. But in
euch cases and in case of the consent being refused, an
appeal is permitted to the Board itself. Similar restrictions
as to obtaining the approval of the vestry or board as to depth,
position, and course are imposed by the Bill with respect to
laying mains or pipes under any new street.

PAMS.

(From our own Correspondent.)

THE HEALTH OP PARI8.

Hitherto the supply of putrid Seine water in the place
of that of the Yanne has not had any appreciable effect
upon the mortality. Indeed, the number of deaths from
typhoid recorded in the last Bulletin de Statietique Munici¬
pal was much smaller than usual. It is a matter, however,
of common observation that typhoid has increased in fre¬
quency, and in the Montparnasse quarter more particularly
bowel complaints of an unusual kind are exceedingly pre¬
valent. According to Dr. Roussel, who is well known in
England in connexion with transfusion, there is an epidemic
of haemorrhagic convulsive enteritis in this district. Whilst
passing along the street a few days since he saw a child fall
down m a fit and void blood. A summary inquire elicited
the fact that attacks of this kind were quite com¬
mon amongst the children of the poorer classes, and further
investigation showed that they only occurred in the families
of those who are supplied with offensively-smelling water.
1 may mention, as one instance out of many, that several
employes of a large administration are now absent on account
of bowel troubles, and those who are not actually ill are
suffering from intestinal irritation.

PASTE UBIANA.

With the exception of the appearanoe of the first number
of the “ Annales de l’lnstitut Pasteur,” the past week has
been comparatively uneventful. The official delegate of the
Portuguese Government has, it is true, made known, in a
letter to the Gazette dee Hdpitaux, his impressions upon the
subject, but they are too vague to amount to an opinion.
Unless I am mistaken, the writer has not yet made up his
mind as to the value of the method; although be is inspired
with respectful veneration forM. Pasteur himself. In my
last letter the name of the physician who made the post¬
mortem examination in the caee of Berg6 was written
“ Peter.” To M. Peter I referred a few lines further on, but
the Dean of the Faculty of Bordeaux mentioned in the pre¬
ceding paragraph is M. Pitres, an eminent pathologist, and
one whose opinion upon the case in question will be
authoritative.

CHLORAL ERUPTION.

Dr. Barbillion contributes a paper to the Archives de
Physiologic upon a variety of eryt hema appearing in patients
under the intluenoe of chloral, upon the administration of
alcohol. The chloral eruption was ftrat recognised by
Jastrowitz in 1869, and has since been met with by nume¬
rous observers. The point to which Dr. Barbillion calls
attention is the almost mathematical regularity with which
the exanthem appears under certain circumstances. Given
a child of from four to eight years of age, who is taking
from two to four grammes of chloral daily in repeated small
doses, the administration of alcohol in the form of wine or
spirit mixture will cause the appearance of the rash in from
fifteen to thirty minutes.

ALCOHOLISM.

That the best remedy for alcoholism lies in the restriction
of the use of alcohol seems almost a foregone conclusion.
But in the present condition of public exchequers there are
few ministers of finance who would venture to adopt such
a measure, and hence intemperance in the use of spirituous
liquors is almost universally tolerated, if not encouraged,
in the interest of the revenue. And yet it is admitted in
France that 40 per cent, of the cases of mental alienation,
and one-half of the murders committed, to say nothing of
minor consequences in disease and crime, are due to alconol.
This great question of intemperance, its causes and results,
has been the subject of a number of independent studies
lately by economists, humanitarians, and scientific men, and
there is a growing opinion that the evil is not wholly
incurable, and that there is even a possibility of dealing
with it to the satisfaction of all legitimate interests.
Alcoholism does not necessarily result from the abuse of
alcohol. At the recent discussion on the adulteration of
wine at the Academy of Medicine the speakers were agreed
on this point. Excess in the use of alcoholic drinks of good
quality causes simple inebriation, which has its train of
morbid symptoms, but these are quite different from those

Digitiz

Thu Lancet,]

PARI3.—MEDICAL NOTES IN PARLIAMENT.

[Feb. 12. 1887. 345

of alcoholism. The classical drunkard, merry and expansive
in his cups, the true “ knight of the burning lamp,” common
enough in Burgundy, where the good wine Is evidently kept
for home consumption, is seldom met with in Paris. The
ouvrier, who drinks in the capital, is pale and wasted,
and when excited becomes aggressive. If his existence
is not cut prematurely short by accident or disease —
and under the former heading must be included suicide
and the scaffold,—it generally ends in the hospital or
the asylum, and his children, if there are any, have
the same prospeot tea their sole inheritance. Notwith¬
standing the increasing prevalenoe of diseases due to
alcoholism, it is stated by M. Aglade, who delivered a lecture
on the subject a few days ago at the Sorbonne, that drunken¬
ness is not on the increase. It is the toxic property of the
alcohol consumed that has become greater, and the remedy
exists in the prevention of adulteration. Formerly intoxi¬
cation was induced with ethylic alcohol distilled from wine,
but at the present day. of 1,872,000 hectolitres of alcohol
consumed annually in France, scarcely 25,000 are extracted
from wine. The remainder is derived from potato, beetroot,
rice, maize, &c. Some of these so-called “higher” alco¬
hols are extremely dangerous ones. Amylic alcohol, for
instance, is seven times more toxic than the ethvlic,
l’l gramme per kilogramme of body-weight being a fatal
dose. The statements of the lecturer were illustrated by
experiments upon docs and guinea-pigs, which were
watched by tne public with interest, and not dis¬
turbed by any hostile manifestations. A small quantity
of ethylic alcohol being injected under the skin of a
guinea-pig, the animal became lively, but was not other¬
wise disturbed. The same quantity of amylic alcohol
administered in the same way to another guinea-pig
was followed by paralysis of the legs, and it died, as if
stunned, in a few minutes. The experiment being repeated
upon dogs, gave similar results. With ethylic alcohol there
was merely increased liveliness; with amylic alcohol,
stupor and inertia. But when absinthe was used, the injec¬
tion of less than a cubic centimetre caused death in a fit of
furious delirium. The remedy for alcoholism proposed by
31. Aglade is the supply of unadulterated alcohol, which
should be a State monopoly, and this would not only reduce
the evils of drink to a minimum, but, according to M.
Aglade, the revenue would gain more than £40,000,000 a
year. _

MEDICAL NOTES IN PARLIAMENT.

The Lunacy Laws.

In the Home of Lords, on the 7th inst., the Lord Chancellor
moved the second reading of the Lunacy Bill. He stated
that with the exception of one controversial matter the
measure was substantially the same as that which on two
previous occasions had been agreed to in that House. He
believed that no alteration of the law would be satisfactory
if it did not make further provision for the liberty of the
subject. The Bill made it a condition of the power of
restraint that upon every person alleged to be a lunatic there
should be served a notice, giving him information that if he
pleased be could be taken before a magistrate.—Lord Her-
schell, in supporting the second reading, said he sympathised
with the desire of nis noble and learned friend to safeguard
the liberty of the subject as much as possible, so far as it
could be done with safety to the lunatic.—The Earl of Mill-
town hoped their lordships would take steps to prevent an
abuse ot the Lunacy Laws, and to increase the visiting
power of the Lunacy Commissioners.—The Bill was read a
second time.

The Lord Chancellor then moved the second reading of
the Lunacy Bill, the object of which, he explained, was to
codify the Acts of Parliament, numbering something like
30, dealing with the subject of lunacy.—The Bill was read
a second time.

The discussion of the Lunacy Acts Amendment Bill in
Committee in the House of Lords has been fixed for the
21st inst., instead of the 15th inst., the date to which the
Committee was originally postponed.

The Military Colleges.

In the House of Commons on the 3rd inst., in reply to
Sir H. Tyler, Mr. Stanhope stated that, as regards the Royal
Military Academy, the provision of increased sleeping

accommodation and of hot water for the bath-rooms will
be proceeded with when funds are available after the com¬
pletion of more urgent services. No room in Herbert’s
Hospital can at present be made available as an infectious
ward for cadets. As regards Sandhurst, steps have been
taken to carry out the recommendations that the riding
school be lit with gas, that better furniture be provided for
the cadets’ ante-rooms, that windows be addwi in certain
rooms, and that a dressing-room be added to the gymnasium;
but funds are not as yet available for building accommodation
for the servants on the college estate.

Mad Dogs and Hydrophobia. ■

On the 8th inst., Lord John Manners, in reply to Mr. H. Si
Wright, stated that the enforcing of the regulations respect¬
ing the muzzling of dogs lay in the hands of the local
authorities, and tnat the Government did not intend to take
further steps in the matter of regulations.

In reply to Mr. Coghill, who asked whether the Govern¬
ment intend taking any steps to found an institution in
London similar to M. Pasteur’s in Paris for the gratuitous
treatment of persons who have been bitten by mad dogs,
Mr. Ritchie said that the report of the committee now
investigating the Pasteur system would, when presented,,
receive careful consideration.

Dover Barracks.

Mr. Stanhope, in reply to Mr. Norris, said that since the
death of Lieutenant Jarrett, in December last, a thorough
inspection had been made of Dover Barracks, but no insani¬
tary conditions had been discovered. Every precaution
against an outbreak of typhoid fever had been adopted.
Tne medical officer of the district was responsible for the
sanitary condition of the barracks.

The Condition of the Thames.

Mr. Bigwood gave notice of his intention on an early day
to move the appointment of a Select Committee to inquire
into and report on the state of the River Thames in the
neighbourhood of Richmond, Twickenham, and Brentford,
and to consider what remedies might be applied.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At an ordinary meeting of the Council of the above
College, held on Thursday, the 10th inst., the following
motion was passed :—“ That, as recommended by the Court
of Examiners, it be referred to the Committee of Manage¬
ment to consider and report to the two Colleges on the
advisability of extending the rule by which, under the old
regulations, candidates obtaining fourteen out of the fifteen
marks required to pass the examination in Surgery are
admissible to re-examination after a period of three, instead
of six, months’ additional study, to those candidates exa¬
mined in Surgery under the regulations of the Examining
Board in England by the Royal College of Physicians or
London, and the Royal College of Surgeons of England.”

The report of the committee on the extension of the Col¬
lege premises was received, approved, and adopted. The
report included the following recommendations :—

“ 1. That the College premises be extended in the manner
proposed in tbe first report; but that the alterations thereby
occasioned be carried out gradually, and be subject to such
modifications in matters of detail as the Council, on the
recommendation of the Committee, may hereafter approve.
2. And that the Committee be authorised to make arrange¬
ments for tbe erection, with as little delay as possible, of an
additional Museum, as shown in the plans, on the ground
occupied by the back premises of Nos. 43 and 44, Lincoln’a-
inn-fielde, abutting on Portugal-street, and for the con¬
struction of an additional storey to the main building of
the College to accommodate the new work-rooms, at an
approximate cost of £10,000 for the new museum, and £5000
for the new work-rooms.”

To carry out Sir T. Spencer Wells’ resolution the Council
elected a committee, consisting of Sir James Paget, Sir T.
Spencer Wells, and Mr. John Marshall, with the President
and Vice-President, to confer with a deputation from the
Association of Fellows and from the Association of Members
on the subject of the first resolution, passed at the meeting
of Fellows and Members on Nov. 4th of last year.

Mr. H. G. nowee was elected a member of the Court of

346 Thm Lancet,]

OBITUARY.—MEDICAL NEWS.

[Feb. 12; 1897.

Examiners in Sorcery, in the vacancy caused by the resigna¬
tion of Professor Humphry.

A communication was read from the Registrar of the
Royal College of Physicians, informing the Council of the
appointment of a deputation consisting of the President,
Treasurer, and Registrar, to confer on the question how the
two Colleges may duly celebrate conjointly the Jubilee
Year of Her Majesty’s reign- The Council appointed the
President and two Vice-Presidents to meet these delegates.

Another communication was read from the Registrar of
the Royal College of Physicians, inviting the College tn
associate itself with the former College in granting the
diploma in public health. -The invitation was accepted by
the Council, and it wrs referred to the Committee of Manage¬
ment to devise a scheme for carrying out the neoessary
arrangements for the purpose, and report them to the two
Colleges.

A communication was read from Mr. Handheld Jones,
forwarding the resolutions passed at the Sts Mary’s Medical
Society concerning the title of Doctor.

Dirituarj.

FRANCESCO MAOX1.

The greatest Italian ophthalmologist, since Vaeca died at
Sun Remo on the 2nd inst.

Francesco Magoi was bora at Speduletto, in the Province
of Pistoia, Tuscany, in July, 1828. Having completed his
secondary curriculum in the Pistoiese Lieeo Forteguerri, he
devoted himself to the study of medicine in the University
of Pisa, where he won the respect of his teachers and the
affection of his fellow-students by his sedulous applieation
and his genial vivacity. Like most of the generous Italian
youth of his time, the upheaval of 1848-49 drew him into
the vortex of the revolution, and he abandoned the bedside
and the laboratory to assist in the patriotic campaign. He
was no less ardent and effective as a soldier than as a
student, and, in particular, at the stubborn fight of Curta-
tone, where he was wounded, be earned the honourable
mention of his commanding officer. The war over, he pro¬
ceeded to -Florence, and at the Hospital of Santa Maria
Nuova he steadily and rapidly made up the arrears of study
and observation incurred by bis service in the field; From
Florence he started on a professional tour, and visited
in succession, each time for a considerable period, the
principal cliniques of Germany, France, and England-
Ophthalmic surgery was his favourite branch of medicine,
and the opportunities lie enjoyed, particularly under vou
Graefe, were not thrown away upon him. On his return to
Florence, where he graduated, he filled the post of director
of the Anatomical School until 1859, and in the following
year he was transferred to Bologna to occupy the chair of
Oftalmoiatria, and to conduct the clinique attached to it.
Having acquired a sound and solid reputation iu the oph¬
thalmic specialty, he proceeded to America, and in the chief
cities of the northern States he enhanced his already dis¬
tinguished name for the centripetal exactness of bis dia¬
gnoses and the brilliant success of his operations.. Fortune
as well as fame attended him in his subsequent career, hie
increasing lucrative clientele necessitating periodical visits
to the chief cities of the Italian peninsula,. With all this
occupation he found time to enrich thn literature of his sub¬
ject witli contributions to the.leading medical journals, in
which the student will find it worth while to refer to the
following papers :—“ Lezioni di Oftalmoiatria” (JRivuta
Clinica, 1861-67); “ Sarcoma sulla Cornea” {Mtdomadario
Clinico, 1861); “ Lezioni teoricbe di Oftalmoiatria” (Bologna,
1867); “ Descrizione della Cassula di Tenone” (1868); Coutri-
buzione alia Anatomia Patologica dello Strabismo” (1868);
“ Sopra alcune Auomalie. di forma nella Lente dell’ Occhio’
umano" (1868); “ Contribuzione alio Studio del Glaucoma”
(1371); “Sugli Effotti del Processo flogistico della Coroide”
(1872) “ 11 Processo flogistico considerato in alcuni Tessuti
dell' Organo visivo” (1877); and an able treatise on University
Reform addressed to.Coppiqp, Minister of Public Instrqctiou
(1878). _ _ .

Besides being an effective clinical prelector and brilliant
operator, Dr. Magni took an energetic part in politic*. He
>ya.s eleyated to the digP'ty of Senator of the Kingdom in

1876, and proved of the greatest service to successive
Ministries, particularly in the field of public health and State
medicine. He was a consistent but independent adherent of
the Italian Left, and (what in Italy means devotion to the
same school of politics) an ardent Freemason. His death,
which was sudden, was due to asystole, of which he had
lately had many premonitory symptoms.

VINCENT AMBLER, F.F.P.S.G.

This gentleman, who for many years past has been known
as a West-end London practitioner, died suddenly in his bed
on Sunday last, Feb. 6th, at his residence, No. 14, Colville-
square. He commenced his medical career in the Crimea
during the war, being then a student of medicine, and
reoeived the Order of Medjidie, 2nd class, as well as English
and Turkish war medals. He qualified for medicine in 1866,
and became F.F.P.S., L.S.A., and L.M. He had considerable
practice amongst spme of the foteign legations resident
in London, was appointed Physician in Ordinary to the
Japanese Legation and to the Persian Embassy, and was
decorated with the G.K.C. of the Ancient Order of Lion and
Sun, conferred on him by the Shah of Persia. A man of
artistic tastes and accomplishments, of energetic nature, and
of kind, hospitable disposition, he enjoyed the society of a
wide circle of friends and acquaintances. His fatal ulness
commenced bet ween two and three years ago, and was marked
by severe attacks of spasmodic apnoea, for which he consulted
Dr. B. W. Richardson, who diagnosed thoracic aneurysm, and
who obtained a ephygmographic aneurysmal tracing at a
pulsating point to the right of the stefnuih on the level of
the nipple. Quite aware of hie danger, Mh Ambler neverthe¬
less persisted in following out his professional work, and for
many months past seemed to improve, the pulsation having
ceased, and being succeeded by dulness and other signs of
filling of the aneurysmal sac by fibrinous deposition. He
remained at work, attending regularly to his duties, public
and private, until Jan. 21st, when there was a return of
the spasmodic apnoea, which passed away under rest and
suitable remedies. He recommenced work in two or three
days, did a fair amount on Saturday, and awoke on Sunday
morning in his usual state, partook of a light breakfast in
bed, and, lying down again to sleep, expired while still sleep¬
ing. His remains were interrod in Kensal Green Cemetery
on Wednesday lash_

Ifh&ical lUfos.

British and Indian Medical Services. — The
following Surgeons on probation in the Medical Depart¬
ments of the British and Indian Armies were success¬
ful at both the London and Netley examinations held
on Feb. 7th. The prizes are awarded for marks gained
in the special subjects taught at the Army Medical School.
The final positions of these gentlemen are determined by
the marks gained in London added to those gained at Netley,
and the combined numbers are accordingly shown ih the
lists which follow: —

BRITISH MEDICAL SERVICE.

Morgan, F. J.

Combine*:
Marks.
.."*85

Salmon, L. B. A.

Combined

Marks
... .- 4552

*Hom>cks. W H.

.5783

Wade. G. A.

.45151

HaleJ C. H.

.5557

Mlnhieoe, J.

. 4489

Thurston, H, C....

. 5478

Peuton. R H. ...

... 44T5

Scott, B. H.

.5318

Holt. M. 1*.

.*442

Poola, W. C. ...

.5281

Gray, W. L.

... .... 4390

Julian, O. R. A...

.5058

Browne, B. G. ...

. 4341

Raymond, G.

... ... 60M

Morgan, J. C. ...

. 4282

Burnside, E. A....

.-5032

Pocock* H. J. ...

.4247

McCulloch. T. C..

. 5020

Hilliard. G.

... ... 4230

tHInde, A. B. ...

.4851

BUiott, 0. R. ...

... ... 4193

Kelly, A. Y.

.4«88

Young, C. A.

... ’... 4179

Oockerill. i, "W....

i.. 4351

Bullen. I. W. ...

.4150

Ritchie., j....
Hore. H. St. G....

.4706

Weir. C. J.

... ... 4140

... ...'4705

Innlss, B. J.

.4123

Macdonald; S. ...

.V.. '... 4741

Thacker, R. O. ...

.4112

Corcoran. B.

.;*679

Murphy, W. N....
Clark. 8. F.

... ... 4109

Watson. A. C. ...

. 4628

. 4073

Grav. E. W. ...

... ... 4621

Hassard.B.M. ...

. 4039

Stlell, D. .

... 4605

* Gained the Herbert Prise of £20, the Monteflore Medal and Prise
of 20 guineas, and also the Martin Memorial Gold Medal,
t Gained the Parks* Memorial Bronze Medal.

Digitized by ^.ooQle

Tki Lancet,]

MEDICAL NEWS.

[Fbb. 12,1887. 347

INDIAN MEDICAL SERVICE.

‘Msctunura, H. J. ...

Combined

Mark*.

.;. 5S9S 1 Dyson. T. E.

Combined
Marks.
... 4814

f Pilgrim, H. W.

... 6711

Hare. B.O.

... 4833

French. G. B.

... 5449

Clarkson. F. O.

... 4673

Ttuwson. F. W.

... 6372

Jordan, J. G.

... 4647

Brown, B. H.

... 6313

Swinburne, J. D. M...

... 4383

Hensley. C. K.

... 6114

Morris, H. M.

... 4437

Henderson, S. H. ...

... 5073

Russell, A. K. P. ...

... 4441

Hill. G. C.

... .6053

Morwood. J.

... 4359

Gray foot, B. B.

... 4043

Maidment, F. U. ...

... 4315

StotUnd.D. W.._ ...

... 403d

Hall, B. A. W.

... 4108

Green, C. B. M..

... 4033

Blancanl, J. T.

... 4033

Cut or, H. H.

... 4833

Doyle, J. P.

... 3947

Setltek, J. H.

... 4819

• Gained the Prize in Pathology, presented by Professor
Wm. Altken, F.H.S.
t Gained the MonteJiore Second Prize.

TnE annual ball in aid of the funds of the Newark
Hospital took place on the 3rd inst.

The death of Mr. Arthur "Woolnough of Carlisle,
from an overdoe© of chloral, occurred on the 31st alt.

The twenty-seventh annual dinner of the old

Ka-ieots of King’d College was held on the 4th’instant.

Donation.—A. W. Shaw, J.P., has given £50 to
Birrington’s Hospital, Limerick.

H.R.H. tile Duke of Cambridge will preside at
»public dinner on April 19th in aid of the funds of the
Veatnor Consumption Hospital.

A death from hydrophobia occurred on the 4th inst.
in the Nottingham General Hospital. Muzzling regulations
lor dogs are in force in Nottingham.

Lord Wolvertox has contributed £1000 to Morley
House (Hospital Saturday Convalescent Home) upon con-
'Stion that a four-bedded room, to be called the “ Wolverton
Boom,” shall be set apart for London postmen.

The second annual general meeting in connexion
vith the Newbury District Hospital was held on Jan. 25th,
vhea satisfactory financial and medical reports were pre¬
wired.

Guy’s Hospital. —A sum of £5730 has been
(oilected among the members of the Stock Exchange in aid
of Guy's Hospital, and has been sent towards the special
fund of the hospital started at the Mansion House.

At the annual meeting of the subscribers to the
AAburton and Buckfastleigh Cottage Hospital, on Jan. 28th,
ii was resolved that the work of erecting a new building be
proceeded with forthwith.

At the recent annual meeting of the collectors and
Rbseribers of the Metropolitan Hospital Saturday Fund, it
was reported that the committee hod divided among the
potiaipating institutions £9750, or £250 more than in any
former year.

Presentation. —Mr. Isidore Prager, on his resigna¬
tion of the post of house-surgeon to the National Dental
Hospital, has recently been presented with a silver hot-water
Hpintns for surgery use by the staff and students of that
uidtution.

At a farm at Chignn.1, Essex, thirty-nine animals
fare, within the past few days, died of anthrax, and eeven-
•Ma have been slaughtered; in all, fifty-nine out of sixty-
r *obead of cattle have been lost. Every precaution has
ten taken to prevent the spread of the disease.

Medical Magistrates. —Edward England Phillips,
hltCJML, M.R.C.8., L.8.A., medical officer of health to the
Sccthend Urban and Rochfoid Rural Sanitary Authorities,
George Davidson Deeping, L.R.C.P. Lond., M.R.C.8.,
hSA, have been placed on the Commission of the Peace for
te couaty of Essex.

Royal United Hospital, Bath. — The annual
**tiagof the supporters of this institution was held on
tjje 24th ult. The report, which was read by the secretary,
®°wred the receipts lor the past year to have been £5&7v,
•a increase of £132S as compared with 1885; while the
wgacies showed a decrease of £218, being only £649. The
«P«oditure, amounting to £6996, exhibited an increase of

The fourth annual dinner of the members of the
Association of Public Sanitary Inspectors was held on the
5th inst., Mr. Edwin Chadwick, C.B., the president of the
Association, occupying the chair.

A prize of fifty thousand francs is offered by the
French Minister of Education for a discovery rendering
electricity economically' applicable in the shape of heat,
light, chemical action, mechanical power, transmission
of messages, or treatment of disease. A committee, with
M. Bertrand, of the Academy of Sciences, as chairman,
will adjudicate.

Bradford Children's Hospital.—A t the annual
general meeting of subscribers to this institution on the
28th ult., the secretary reported that the receipts amounted
during the year to £652, and the expenditure to £526. The
fund which was raised for the extension of the hospital
amounts to over £4600, and the committee are in search of
a building suitable for the purpose.

Royal University of Ireland.—A t a recent meet¬
ing of the Senate, the following additional Examiners in
the Faculty of Medicine for 1887 were appointed
Medicine : Stephen M‘8winey. Midwifery: John A.
Byrne and II. M. Jones. Medical Jurisprudence: E. W.
Davy and M. M'Hugh; Materia Medica : F. J. Quinlan
and J. S. Reid.

Hospitals Association. — At the third general
meeting of this Association, to be held at the Outer Temple
(Room 44), 225, Strand, on Wednesday, Feb. 16th, at 8 p.ar.,
a paper will be read by Miss E. G. Mansion, entitled “ Is
it desirable for Metropolitan Hospitals to possess Nursing
Institutions, and to supply Nurses for Private Cases out¬
side the Hospital walls ?”

Royal College of Surgeons of England.—T he
library of the College will be closed on Saturday, Monday,
and Tuesday, the 12th, 14th, and 15th inst. for the purposes
of the Hunterian Oration and Festival.—Professor W. II. H.
Jessop, F.R.C.S., will deliver a course of three lectures on
“The Intra-ocular Muscles,” on Wednesday, Friday, and
Monday, February 10th, 18th, and 21st, at 4 p.m. precisely
each day.

Serious Epidemic of Measles.—N ews has been
received in Paris of an outbreak of a peculiarly virulent
form of measles among the inhabitants oi Saint Pierre and
Miquelon, a couple of islands about ninety square miles
in extent, situated off the Newfoundland coast. One thou¬
sand children out of a total population of 5700 are affected,
and several deaths occur daily, either from the immediate
effects of the disease or from secondary complications.

Durham County Hospital.—T he annual meeting
of the governors and subscribers to this institution was held
on the 1st inst., when it was reported that during the past
year there had been 419 in- and 1513 out-patients, a decrease
of 52 in-patients and an increase of 270 out-patients as com¬
pared with the preceding year. The income for the year
was £2286, and the expenditure amounted to £3590, the
latter amount including a balance of £1220 brought forward
from the year before.

Royal Fbee Hospital.—-T he fifty-ninth annual
meeting of the governors of this institution was held on the
3rd inst., under the presidency of Mr. James Hopgood. The
receipts from all Bources have, the secretary reported,
amounted to £20,083, and the total ordinary expenditure
to £11,121, as compared with £11,085 in 1885. The number
of in-patients admitted was 1813, the daily average in
the wards being 138, as against l?o in 1885. The number
of out-patients who received advice and medicine was
22,191.

Medical Attendance Organisation Committee.—
At the fourth meeting of the above committee on Feb. 8th,
Sir T. Spencer Wells in the chair, the following resolution
was passed: “ That local committees are recommended to
pbtain from applicants for membership a declaration that,
in the case of a single pcrsoji or man and wife, their average
earnings do not exceed 30s. per week; or of a family, 40s.
per week; or of domestic servants, £15 per annum: those
whose earnings are over this amount being, as a rule,
ineligible for membership * The next meeting of the com¬
mittee will be held on the 22nd inst., when they wifi
proceed to consider the rates of contribution and benefits.

Digitized by Google

348 The Lancet,] APPOINTMENTS.—VACANCIES— BIRTHS, MAEEIAGES, AND DEATHS. [Feb. 12,1887.

City of London Truss Society.—U nder the pre¬
sidency of Mr. J. Norbury, the seventy-ninth annual meeting
of the governors of this charity, the object of which is
indicated by its name, was held on the 2nd inst. From the
annual report, which was read and adopted, it appears that
the gross income during the past year amounted to £4189, aa
against £4062 in 1685. The total expenditure was £4926.
During 1886, 9394 patients of all ages and both sexes were
relieved, being the largest number ever relieved in one year
since the foundation of the charity. The total number
relieved to the end of last December since 1807 amounts to
422,710 patients. The number of instruments supplied
during the year was 9436. Permission was afterwards
obtained to sell out the funded property of the charity to
the amount of £1250, in order to pay off a loan and to meet
its growing requirements.

The Jubilee.—A t a meeting of the Blackpool
Town Council on the 1st inst., it was resolved that a public
hospital and dispensary should be erected in commemoration
of Her Majestye Jubilee. A sum of £9000 is, it is stated,
already available for endowment purposes.—On the 3rd inst.,
at Folkestone, it was decided to erect a large hospital in
celebration of the same event, and several large contribu¬
tions have been promised.—At a public meeting at Mex-
borough, on the 1st inst., it was resolved that a J ubilee
Cottage Hospital be erected in the town.—The inhabitants of
Skipton, Yorkshire, have decided to celebrate the Queen’s
Jubilee by erecting a Hospital for Infectious Diseases,at a cost
of £3000.—In view of the Queen’s Jubilee a commemorative
dinner of the friends and supporters of the Dental Hospital
of London will be held at the Hotel M6tropole on Thursday,
March 10th, under the presidency of Sir James Paget, Bart.,
F.R.S.—At the annual meeting of the friends and sup¬
porters of the Queen’s Hospital, Birmingham, on the 7th
met., it was resolved that an effort be made to raise a Jubilee
fund of £10,000, one half to be spent in improving the
building, and the other half to he kept in hand so as to avoid
financial embarrassments in the future.

Ilpointments.

Successful applicants for Vacancies. Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to THE LANCET Office, directed to the Sub-Editor, not later
than 9 o’clock on the Thursday morning of each week for publication in
the next number. . _

Briggs. Henry. M.B., C.M.Ed., F.R.C.S.B , has been reappointed
Honorary Medical OBluer to the Hospital for Women, 8haw-»treet,
Liverpool.

Brodik. v . Cardbw, M.R.C.S., L.R.C.P., L.S.A., ha* been appointed
Home-Physician to the Middlesex Hospital.

Burton. John Barp. L.R.C.P.Lond., M.K.C.8., ha* been reappointed
Surgeon to the Hospital for Women, Sliaw-street, Liverpool.

Oartkr, T. H., M.B.Lond., M.R.C.S., ha* been appointed Surgeon to
the Stamford and Rutl.nd Infirmary.

Cham pn are, Francis Hknhy, M.A., M.B.Oxon.. F.R.C.P.Lond., ha*
been appointed Consulting Physician to the General Lying in
Hospital. York-road. Lambeth.

C08GRAVK, B MacDowkl, M.D.. M.K.Q.C.P.I., has been appointed
Physician to the Hevte*bury Industrial School, Dublin, vice Walter
Smith. M.D., resigned.

Ed IB. J. Butler, L.B.O.P. Bd., M.R.C.S., ha* been reappointed
Honorary Assistant Medical Officer to the Hospital for Women,
8baw-strcet, Liverpool.

Jordan. Furxkaux, F.R.C.S.B., has been appointed Consulting Surgeon
to the Queen's Hospital, Birmingham.

Phillips, Edward England, L.B.O.P.Bd., M.B.C.S., L.S.A., has been
re-elected Medical Officer of Health for the Southend-on-Sea Urban
Sanitary Authority. Essex.

Pollard, Reginald, M.B.Dur., M.R.C.8., has been elected Physician
to the Western Hospital, Torquay, vice Nanldvill, resigned.

Ramsay, R. Hamilton, M.D., C.M.GIaa.. has been elected Physician to
the Western Hospital, Torquay, vice Hounsell, deceased.

Roberts, Thomas A.. L.D.S., has been appointed Honorary Dental
Surgeon to the Plmllco-road Free Dispensary, vice G. W. Payne,

L.D.S., retired.

Short, Thomas Sydney. M.B., M.R.O.S., L.S.A. Cert. San. 8c!. Oambi,
has been appointed Resident Medical Offioer to the Jaffray Hospital,
near Birmingham.

Spence, J. B., M.A., M.B.. Assistant-Physician, Royal Edinburgh
Asylum, ha* been appointed Medical Superintendent of the Ceylon
Asylum.

Sterlk. Charles B., M.R.C.S., L.S.A., his been reappointed
Honorary Assistant Surgeon to the Hospital for Women, Shaw-
street, Liverpool.

Stewart, James. L.F.P. A S.Glas., Ac., has been appointed Poor-law
Medical Officer for the District of Rotherham, and also Public
Vaccinator, vice D’Oyley Foote, M.D., M.R.O.S., L.M., deceased.

Wharry. H. G. O., M.R.O.S., L.8.A., has been elected House-Surgeon
and Secretary to the Scarborough Hospital and Dispensary, vice
Kenne th Frazer, BX, M.D. Dub. Univ.

toanties,

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
informition regarding each vacancy reference should be made to the
advertisement. _

Birmingham General Hospital. —Two Assistant House-Surgeons.
No salary, but residence, bon'd and washing, will be provided.

Chelsea Hospital nor Women, Fulham-road, London, 8.W. —
Three Olinica! Assistants. Salary £5 6s. for a period of three
months.

Glamorganshire and Monmouth Inftrmaht and Dispensary,
Csrdiff.—Ophthalmic 8urgeon.

Preston and Coonty of Lancaster Royal Infirmary. — Senior
House-Surgeon. Salary £100 per annum, with lodging, washing,
and board.

Royal Hospital for Diseases of the Chest, City-road, London.—
Junior House-Physician. Salary £25 for six months, with board and
lodging.

8t. Asaph Union.—M edical Officer. Salary £83 per annum.

Staffordshire General Infirmary, Stafford. — Honorary Visiting
Physician.

West Herts Infirmary, Hemel Hempstead. — House-Surgeon and
Dispenser, to also act as Assistant-Secretary. Salary £100 per
annum, with board, furnished rooms, fire, lights, and attendance.

$irt{rs, Uferriagcs, anil Deaths.

BIRTHS.

Coward.— On the 29th ult., at Burdett-road. Llmehouse, the wife of
Christopher T. Coward, L.F.P.S.Glaa., L.S.A.. of a daughter.

Orossfikld. —On the 1st inst., at Broadstone House, Dartmouth, the
wife of A. Kyffln Crossfield, L.R.G.P.Bd., L.R.C.S., of a ton.

Sherwood.— On the 2nd inst., at Eastbourne, the wife of Arthur P.
Sherwood, L.R.C.P., of twins (daughter and son).

Skinner, —On the 16th ult., at Dagshsi. Punjab, the wife of Surgeon
Bruce M. Skinner, L.R.G.P.Bd., M.R.C.S., Army Medical Staff, of
a son.

Smith.—O n the 6th inst.. at Kensington-gardens-square, the wife of
B. Stanley Smith, L.R.C.P.Bd., M.R.C.S., of a daughter.

Wylie.—O n the 30th ult., at Dyneley House, Skipton, the wife of
William Wylie, M.D., of a son.

MARRIAGES.

Caudle—Barton.— On the 3rd inst., at St.John’s Ohnrch, Calcutta.
Charles B. Caudle. M.D., to Agnes, second daughter of ths
late Rev. R. G. Barton, late Rector of Etching ham, ana of Urmston,
Bast bourne.

Douty—Cazalet.— On the 29th ult., at the Parish Church, Leigh, near
Worcester, by the Right Rev. the Lord Bishop of Worcester, uncle
of the bride, asslstea by the Rev. B. H. Sheppard, Rector, and by
the Rev. W. G. Cazalet, brother of the bride. J. Harrington Doutr,

M.H.C.S.Eng., Ac.. Medical Superintendent (elect) of the Berks
County Asylnm, Moultford, to Madeline, only daughter of Major
G. H. Cazalet, of Brantford Court, Worcestershire, late of the 1st
Royal Surrey Militia.

Doyle—Steele. — On the 3rd inst., at 8t. Luke’s Chapel, Norwich
Cathedral, Charles William Doyle, M.B., to Baum, daughter of ths
late Adam Rivers Steele, Barrister-at-law.

Halford—Hose. —On the 2nd inst., at the Parish Church, Baling,
Edward Halford, M.D., to Latitia Thomaslne, third daughter of the
late Rev. Fredk. Hose, M.A., Rector of Dunstable, Beds.

O’Connor—Richardson. — On the 5th inst.. at the Parish Church.
Chatteris, Camb*., Martin O’Connor, L.K.Q.C.P.I., L.R.C.S.I., to
Julia Temperance, only surviving daughter of the late Fryer
Richardson, Esq., of Fortrey House. Chatteris.

Rowley — Fordk. — On Dec. 21st, 1889, at 8t. Peter’s-ln-the-Foreet,
Bombay Settlement, Great South-road, Auckland, New Zealand,
bv the Rev. B. J. Macfarland, B.A.. Charles Rowley, M.R.O.S.Bng.,
of Bombay, eldest son of Charles Octavius Rowlev, M.R.O.S.Bng.,
of Barnsley, to Lilian Louisa, second daughter of the late Frederick
Forde, J.P., of Bombay Settlement.

DEATHS.

Foote. — On the 3rd lost., at Croft's House, Rotherham. Yorlca.
Harry D’Oyley Foote, M.D., M.R.C.S.B., L.M., in the fifty-third

- year of his age. Friend* will please accept this the only intima¬
tion.

Gankoin. —On the 0th inst., at The Priory, Caerleon, Mon., George
Gaskoln, M.R.C.8., late of Westbourne-park, London, aged 70.

Howard. — On the 6th inst., at New Buckenham, Norfolk (of
diphtheria); Herbert Howard, M.R.C.S., L.R.C.P.Lond., in his 26th
year.

Matheson. —On the 5th inst., at his residence, Granville-plaoe, Port-
man-square, Duncan Matheson. L.B.O.P.Bd., L.F.P.S.Gias.

8mith.— On the 27th ult., at Portland House, Cheltenham, Thomas
Smith. M.D.. M.R.C.P.L., aged 74.

Underbill.— On the 1st inst., Bmlly Margaretta, the beloved wile of
William Lee* Underhill, 6urgeon, of Tipton.

N.B .—A fes of St. it charged for the Insertion of Notices of Births,
Marriages, and Deaths.

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l*H3t LANCET,]

BOOKS ETC. RECEIVED.—MEDICAL DIARY.

[Feb. 12,1887. 34$

BOOKS ETC. RECEIVED.

Allen. E. W., Paternoster-row. London.

Electricity in the Treatment of Disease. By Jas. B. Tumner,
M.H.O.S. pp. 108.

CittXLL A Co., London. Paris, New York, A Melbourne.

Tbe Year-book of Treatment for 1880. pp. 304.

ClUKinx, J. A A., New Burllngton-straet, London.

On Aphasia; being a Contribution to the Subject of the
Dissolution of Speech from Cerebral Disease. By James Boss,
M.D.. LL.D.Aber. pp. 128. Illustrated.

Yearbook of Pharmacy, 1881. With the Transactions of the
British Pharmaceutical Conference held in Birmingham, pp.
672.

Prelectlones Anatomle Universalis. By William Harvey.

. Edited, with an autotype reproduction of the Original, by

a Committee of the Boyal College of Physicians, pp. 98,
quarto. 52s. 6d.

Dexshton, Bell ft Co.. Cambridge; Q. Bell ft Sows, London.

The Croonlan Lectures on Some Points in the Pathology of
Rheumatism, Gout, and Diabetes. By P. W. Latham, M.A.,
M.D. ftc. pp. 133.

Dulau A Co., London. Braumuller, Vienna. Vail ft Co., Hew
York.

Anatomy, Descriptive and Topographical. By Carl Heitzmsnn,
M.D. English Edition by Louis Heitzmann, M.D. pp. 3o6,
with 623 Illustrations.

Clirra. C.. ft Co.. Bxeter-street, Strand, London.

The Surgeon's Pocket-book. By Surgeon-Major J. H. Porter.
Third Edition. Bevised and Edited by Brigade-Surgeon
C. H. Y. Godwin, pp. 257, with Illustrations.

RiJtscHWAi.D, A., Berlin.

Studien liber Stoffwecbsel im TblerkOrper. Gesammelte
AbhandluDgen von. Prof. Dr. J. Seegen. S. 660, mit 2 lltho.
Tafeln.

Die Chh nrglsohes Behandlnng des Kropfes. Von Anton WOIfler.
S. 90.

Lewis, H. K., Oower-etreet, London.

A Text-book of Medicine. By Dr. Adolf Striimpell. Translated by
permission from the Second and Third German Editions by
Dr. H. F. Vickery and Dr. P. C. Knapp. With Editorial
Notes by Dr. F. 0. Shattuck. pp. 981, with 111 Illustrations.

Outlines of the Pathology and Treatment of Syphilis, ftc. By
H. v. Zeiss], M.D. Second Bdition, Revised by M. v. Zeissl,
M.D. Authorised Edition, Translated with Notes, by H.
Raphael. M.D. pp. 403.

What to do in casesof Poisoning. By Wm. Murrell, M.D.. F.B.G.P.
Fifth Edition, pp. 330.

Massage as a Mode of Treatment. By Wm. Murrell, M.D., F.B.C.P.
Second Bdition. pp. 100.

Loren am, Greer, ft Co.. Paternoster-row, London.

Anatomy, Descriptive and Surgical. By Henry Gray, F.B.S.
Eleventh Edition. Edited by T. Pickering Pick. pp. 978,
profusely Illustrated. 36s.

Risbst, J. ft Co.. Berners-street. London.

Forbidden Fruit for Young Men. By Major Seton Churchill, pp.
269. 2s. 6d.

Outer ft Boyd. Edinburgh.

Sputum: Its Microscopy and Diagnostic and Prognostic Significa¬
tions. By Francis Troup, M.D. St. And., ftc. pp. 263, with 36
Plates.

Pentland, Young J., Edinburgh.

The 8cience and Art of Obstetrics. By Theopbllus Parvin, M.D.,
LL.D. pp. 701, with 314 Woodcuts, and a Coloured Plate.

Practical Medicine and Medical Diagnosis. By Byrom Bramwell,
M.D., F.B.S.B. pp. 149, with 41 Illustrations.

Sjutk. Elder ft Co.. Waterloo-place, London.

St. Bartholomew's Hospital Beports. Edited bv W. S. Church,
M.D., and John Langton, F.B.G.S. Vol. XXII. pp. 455—
106.

Smithsonian Institution, Washington, U.S.A.

Researches upon the Venoms of Poisonous Serpents. By 8. Weir
Mitchell. M.D., and B. T. Belchert, M.D. pp. 186, with five
Coloured Plates.

Thorp A Godfrey, Lansing, Michigan.

Thirteenth Annual Report of the Secretary of the 8tate Board
of Health of the State of Michigan for 1885. pp. 294.

Williams ft Norgatk. Henrietta-street. Corent-garden, London.

Tbe Factors of Organic Evolution. By Herbert Spencer, pp. 76.

On Antiseptic Snrgery; by Surgeon-Major J. Martin (Churchills).—
Journal Aknsherstva 1 zhenskikh Boleznel, Tom. 1, No. 1 (Russian
Journal of Obstetrics and Gynsoology).—Index Modious, Vol. VIII.,
No. 12.—Lists of Publications and of Foreign Correspondents in
connexion with tbe Smithsonian Institution, Washington, U.S.A.—
La Circulation des Forces dans les Btres Anlrnes; par le Dr. L. Natan-
ton.—Par le Dr. Jules F61lx: Etude sur lee HOpltaux et lee Materaltes;
De 1'Ajesdnissemeot dee Vlllea et dee Habitations; La Question des
HOpltam; Etude Clinique la Fistule ft l’Anus; Tumenr Care Inornate use
•du Sein; Des A vantages dn Pansement MdtalUqne.—Causation and
Treatment of Congenital Club-foot; by Frederick OhurchllL M.B.,
F.B.C.8.—A Balva; por Eduardo Abreu (Lisboa).—Magazines for
February -.—Good Words, Snnday Magazine, Leisure Hour, Sunday at
Home. Beys’ Own. Paper, Girls’ Own Paper.

Hfcbical Diarj for % mixing Meek.

Monday, February 14.

Boyal London Ophthalmic Hospital, Moorfixlds.—O perations,

10.30 am., and each day at the same hour.

Boyal Westminster Ophthalmic Hospital.—O perations, 1.30 PM.,
and each day at the same hour.

St. Mare's Hospital.—O perations, S pm. ; Tuesdays, same boor.
Okxlsea Hospital for Woher.—O perations, 2.80 P.M.; Thursday, 2.30.
Hospital for Women, Soho-squab*. — Operations, 2 pm., and on
Thursday at the same hour.

Metropolitan Fbxb Hospital.—O perations, 2 pm.

Royal Orthopaedic Hospital.—O perations, 9 pm.

Central London Ophthalmic Hospitals.—O perations, 2 pm., and
each day in the week at the same hour.

Society of Arts.— 8 p.m. Mr. W. Y. Dent : Building Materials (Cantor
Lecture!.

Medical Society op London.—8.30 p.m. Dr. Leopold Servais of
Antwerp will read a report on Two cases of Enormous Tumours of
the Faoe, treated by Removal.of both Superior Maxilla.

Tuesday, February 16.

Guy’s Hospital.—O perations. 1.30 p.m.. and on Friday at the same hoar.

Ophtbalmlo Operations on Mondays at 1.80 and Thursdays at 2 pm .
8t. Thomas’s Hospital.—O phthalmic Operations, 4 pm. ; Friday, 2 pm.
Oaboeb Hospital, Bbompton.—O perations, 3.30 pm.; Saturday. SJ0 pm .
Westminster Hospital.—O perations, 2 pm.

West London Hospital.—O perations, 2.30 pm.

St. Mart’s Hospital.—O perations. 1.30 pm. Consultations, Monday,

1.30 P M. 8kin Department. Mondays and Thursdays, 9.30 a.m.
Royal Iimrnrnox of Great Britain.—3 pm. Prof. Arthur Gam gee i

The Function of Respiration.

Society of Arts.—8 pm. Mr. Allan Bansome i Some of Oar Colonial
Woods.

Pathological Society of London. —8.30pm. Dr. Hale White: On
the falling ont of Teeth In Tabes Dorsalis.—Mr. D’Arcy Power:
Intermuscular Synovial Cysts.—Dr. Hyla Greves: Endothelioma of
Dura Mater.—Dr. Semon ’(for Dr. Jacob) : Syphilitic Hyperplastic
Laryngitis. — Dr. Hadden i Mitral Aneurysm la a Child. — Mr.
Shattock : Ectopia Vesica:. — Mr. Clutton : Retro - pharyngeal
Abscess.—Mr. Gould: Horny Growth on Penis.—Mr. Godleet Adeno-
sarooma of Tongue with Calcifying Nodule in Centra. Card
SpecimensDr. Hadden : Perforation of Large Intestine in Bnterio
Fever.—Mr. Fenwick : Renal Carcinoma.—Dr. Mott: Myxo-flbroma
compressing the Spinal Cord.—Mr. Clutton t Congenital Abnor¬
mality of Lower Lip witn Cleft Palate.

Wednesday, February 16.

National Orthopedic Hospital.—O perations, 10 am.

Middlesex Hospital.—O perations, 1 pm.

St. Bartholomew's Hospital.—O perations, 1.30 pm.; Saturday, same
hour. Ophtbalmlo Operations, Tuesdays and Thursdays, 1.30 pm.
St. Thomas’s Hospital.—O perations. 1.30 pm. ; Saturday, same hour.
London Hospital.—O perations, 2 p.m.; Thursday ft Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital fob Women and Children.—O perations,

2.30 P.M.

Uniynrsitt College Hospital.—O perations, 2 p.m.; Saturday, 3 pm.

Skin Department, 1.46 pm. ; Saturday, 9.16 am.

Boyal Free Hospital.—O perations, 3 p.m., and on Saturday.

King’s Oollbge Hospital.—O perations. 8 to 4 pm.; and on Friday,

3 pm. ; and Saturday, 1 pm.

Childrex'9 Hospital, Great Obmond-Strext.—O perations, 9 am.;
Saturday, same hour.

Society of Arts.—* p.m. Mr. Henry H. Cunynghame: Uses. Objects,
and Methods of Technloal Bdueation in Elementary Schools.

Thunday, February 17.

St. George’s Hospital.—O perations, 1 p.m.

St. Bartholomew’s Hospital.—S urgical Consultations. I JO p.m.

Okarxng-cboos Hospital.—O perations, 3 pm.

North-West London Hospital.—O perations, 3.30 pm.

Royal I n st itu t i on of Great Britain.—8 pm. Prof. A. W. Riloker i
Molecular Forces.

Pabees Museum op Hygiene. —5 pm. Mr. Charles E. Cassalt
Food Adulteration and Analysis.

Habvelan Society op London.—8.30 pm. Mr. Sedgwick: Notes on the
Collapse of Cholera.—Dr. Sidney Phillips : Some points In the Treat¬
ment of Fever.—Dr. A. H. N. Lewers: The best means of Dilating
the Cervix Uteri.

Friday, February 18.

St. Georges Hospital.—O pbthalmlo Operations, 1 JO pm.

Boyal South London Ophthalmic Hospital.—O perations. 3 pm.

Society op Medical Officers of Health.—7.30 p.m. Mr. 0. B. Paget i
A Practical Illustration of the Protective Influence of Vaccination.

Royal Institution of Great Britain.—9 pm. Mr. William Crookes:
Genesis of Elements.

Saturday, February 19.

Middlesnx Hospital.—O perations, 3 pm.

Royal Institution of Great Britain.—3 pm. Mr. Carl Armbruster:
Modern Composers of Classical Song—Jensen, Lassen, Holstein,
Berlioz, and Wagner (with Vocal Illustrations).

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350 the "Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Fbb. 12,1837,

METEOROLOGICAL READINGS.

(TaJun daily at 8 JO a.m.by Steward's Instruments.)

ThX Lancet Offloe, February 10th, 1887.

Date.

Barometer
reduced to
BeaLeval
aadtt°F.

Direo-

tioo

of

Wind.

Wet

Bulb.

8oUr

Padla

in

Vacno.

Max.

Temp.

Shade.

al

XaLL

Remarks at

8 JO AM.

Feb.

4

30-84

w.

63

61

64

60

Overcast

5

3039

w.

47

45

t „

66

46

Fine

6

80-71

B.

40

38

46

37

Hazy

7

30-75

B.B.

36

35

43

34

Foggy

8

30-74

B.

32

32

42

30

Hazy

9

30-71

E.

35

32

38

81

Overcast

*•

10

30-66

N.B.

31

Froz.

...

37

80

Cloudy

ItaUs, S|ort Comments, # §,nskrs to
Corrospoii&ents.

It is especially requested that early intelligence of local events
having a medical interest , or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office..

AU communications relating to the editorial business of the
journal must be addressed “ To the Editors."

Lectures , original articles, and reports should be written on
one side only of the paver.

Letters, whether intended for insertion or for private informa¬
tion, must be authenticated by the names and addresses of
their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of Thb Lancet to be addressed “ to the
Publisher.”

We cannot undertake to return MSS. not used.

Should Medical Aid Friendly Societies not be Surebtiskd
by the Medical Council?

Philalethes, In a letter boo long for insertion, draws a terrible picture of
the evils likely to result If no legal check is put to the tendency of
friendly societies to combine and exact heavy and responsible duties
from medical men on grievously low terms. He thinks the Medical
Council might supervise such societies in regard to their medical
affairs, and see that they select proper officers and pay them properly.
We lament with him the evils of the existing system, and we urge all
medical men to decline those appointments; but we are of opinion
that the profession must In this matter protect Itself. The Legislature
IS too helpless just now, even If it had the wish, to do any such useful
work as regulating the medical service of the friendly societies.
Ambulance .—Probably Fur ley's horse ambulance carriage would be found
suitable. Our correspondent would do well to communicate with
Mr. Furley on tha subject.

Mr. SkdlsuftU .—The paper is marked for early Insertion.

WARMING OF RAILWAY CARRIAGES.

7o the Editors of The Lancet.

Sirs,— On reading last week’s issue -of The Lancet I noticed an
article on the above important subject, both as regards the health and
comfort of railway passengers. It may not j be. known to very many, if
to any, of the readers of The Lancet that an apparatus for the warming
of railway carriages has been Invented and patented by Mr. Fonlls, the
engineer to the Glasgow Corporation Gasworks, and that experiments
hav.e taken place with it on the Glasgow ami South-Western Railway
Which have proved ft to be a great siiccess. The following is an account
of the apparatus which I have taken from the Railway Renew of Jan. 21st.

‘•The heat is obtained from the gas-lamp la the roof of the carriage. At
the top of each lamp there is a small water-heater, and from this the hot
water descends by means of two small pipe* about a quarter of an inch in
diameter, encised in the panelling of each compartment. The pipes
pass into heaters placed beneath the seats in the carriage, and these are
so arranged th*t the air entering at the bottom or the heater, where It
is coldest, passes up and leaves the heater at the top, where It Is hottest,
discharging a constant glow of hot air into the carriage. The heatere
have fan-shaped months, so that there is no intcfmlt tency In the supply.
Only one carralge has been fitted with the apparatus, but this has proved
successful beyond anticipation. If this apparatus becomes general,
railway passengers will have to thank Mr. Foulls for one of the greatest
boons conferred upon them.” I am, Sirs, yours truly,

Wednesbury, Feb. 8th, 1887. HeNRyK. BLACKWOOD.

Drunkenness in Belgium

According to statistics, Belgium Is the most drunken country in Europe
Where in 1850 there were 53,000 public-houses, there are now 195,000 —
that is to say, one for every 41 of the population. The Government!!,
however, taking steps, to repress and prevent drunkenness. Should
the Bills be carried, publicans who supply drink to persons obviously
drank, or to anyone under sixteen years of age, will be liable to a fine
not exceeding £1 for the first offenoe, while if they cause a minor to
drink to Intoxication they may be fined £4. Whoever is responsible
for serious illness resulting from Intoxication may ba fined from £3
to £80, with from a week to two years’ imprisonment, according to
the gravity of the case. Should death ensue, a fine varying from £10
to £200, and from five to ten years’ Imprisonment, may be lmpoeed,
Publio-house debts are no longer to be recoverable.

Mr. Wm. Luts.—' We have no knowledge of the “remedy” or of tb»
person who advertises it.

K. K. might write to the bankers of the Fund, Messrs. Coutts, Strand.

8BA-SICKNES8.

To the Editors of The Lancet.

Sirs,—H aving had occasion last week to escort a patient to the Con¬
tinent. I had two rongh journeys across the Channel to encounter. Most
of my Mllow-paasengers paid a tribute to the power of Father Neptune.
I escaped by a method which I should like to discuss, if you think it
worth your space, which is so valuable.

I take It that all are agreed that in some way the nervous system i»
the primary cause of sea-sickness. I have heard it argued that this
distressing malady is the consequence of variations In the pressure at
different parts of the cerebro-spiual fluid, consequent on the varying
position of the ship. My own notion is that a sort of vacuum is created
In the abdominal cavity. Suppose, for instance, the ship is descending
Into the trough of a sea, the lower limbs feel the effect of the deecent
before the upper. The contents of the abdominal cavity are likewise
drawn downwards, the uppermost contents being the last to feel the
effect. Suppose.at the same moment an expiration takes place, the
diaphragm is at its highest. Under ordinary circumstances the viscera,
would be steadily pressed by the abdominal mosaics, but in this case the
diaphragm rises at the moment that the intestines tend to fall. The
result is a momentary removal of pressure from the solar plexus and
splanchnic nerves, followed by an unusual pressure. The result must be
excessive action, followed by.complete arrest of action. AU rhythm must
be lost before long under snob dreumstanoea. The result must be. It
seems to. me, that wild, inhibitory messages are sent to the heart,
amongst other organs, resulting in the pallor which precedes each,
access of sickness. The directions to the various organs are equally
excessive or equally wanting. At one moment saliva, blls, and other
secretions are set flowing with extraordinary vigour; at the next
arrested. The peristaltic action of the intestines becomes confused, and
at times reversed, and the bile finds its way into the stomach. The
action of the diaphragm becomes spasmodic, and sickness ensues.
Assuming this theory to be correct, how does it throw light on the-
treatment ? The method I adopted was this: Whenever the cockleshell
in which I was travelling gave an extra roll I held my breath and con¬
tracted my abdominal muscles as mnch as I conld. In this way I kept
up a steady pressure on my solar plexus. When the boat travelled
comparatively steadily for a moment or two, I breathed again. If for a.
moment I was off my guard and relaxed my abdominal muscles, that
moment I felt that singular sinking sensation at the pit of the*
stomach which heralds rnal de mtr. Of course, this method is only
applicable to short trips, such as that across the Channel. If the-
methods in vogue for treating sea-sickness be considered, it will be seen
that many of them are explicable on my theory. When I was a ship’*
surgeon the plan* most recommended by travellers were to administer
bottled stout or champagne. In either case the gas evolved distends the
stomach, and so keeps the pressure uniform. Another plan I have
heard recommended ig to eat pickled onions freely before going on
board. Probably, in that case, too. indigestion produoe* evolution of
gas, and so steady pressure. Could not an elastic belt be tried to belpi
to keep up even pressure ?

I am, Sirs, your obedient servant,

Bouthboroogh. February. 1817. E. Paget Ihurstan, M.D.

' ’’OBSTINATE CONSTIPATION IN AN INFANT.”

To the Editors of The Lancet.

Sirs,—I n answer to your correspondent, “ 0. P. Q..” who sought ft*
your issue of Jan. 99th suggestions on the treatment of the above, 1
wonld advise him to eschew The administration ef purgative medicine©,
and enemata. He should try massage—gentle kneading of the abdomen,
and friction over the region and In the dlreotion of the colon, by which
meeds muscular action Is stimulated and the desired result produoed.
The process should be repeated once or twice, at fixed times, dally, until
regular action of the bowels results. Of course, the diet baa to be
attended to, and the feeding regulated as to time and quantity. The
child should be given passive exercise in the freeh air dally. Other
readers might also, I venture to hope, try, and prononnee their opinions
upon, this pl&n of treating obstinate constipation.

I am, Sirs, yours very truly,

Ramsgate, Feb. 3rd, 1887. John Lucas, M.D.

, Google

The Lancet,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Feb. 12,1887. 351

nOVIDBXT DISPENSARIES SUICIDAL TO THE PBOFBS8TON.

To the Editor! of Tub Lancet.

Sjkj,— l'our correspondent, Dr. DIokinson, not long ago stated that
the Vaods worth Medical Aid Society—and I take this one simply as a
type of all the others—provides medicines and medical attendance,
either at the patient’s house or the doctor's surgery, for 5000
people for one year for £350. In my district they do the same.
Baida*, a heat of letter* are given away, so that almost anyone can
■ttend a local hospital for nothing. Again, the London hospitals are
vfthlnaeheap ride. And I quite agree with your correspondent that
it is anal for half a dozen of the oldest practitioners In the district to
sDsw their names to be placed on such a list. They really ought to be
■darned of it. Why do they do this? Because they want to keep all
the patients on their own books; and they would attend the whole lot
for nothing rather than let them go to a fresh man. These old prac-
U toners have seoared the best class of patients, and to prevent oppo-
utkra they will attend the ragged lot for next to nothing. Under the
tosk of charity It is a lever to try to starve a new man and give vent
to their profene tonal jealousy. Ho w Is a doctor to start a practice, and who
are likely to be his first patients ? These are the very people upon whom
be depends ; yet they are to be gathered into the old practitioner's net,
sad treated for an ignominious fee to prevent any other doctor having
thra on better terms. The people who pay these pence regularly are
ihose who can very well afford to pay a shilling or two each time the
dsstor attends them. The other class will not subscribe. Then, the
mis gives leas than 4s. a year for each patient. Now, if a patient bat
rezt to the doctor, say. for a couple of bottles of physic, he would pay
tfcat amount. If It be necessary to have this sort of oharlty, let the
psklie bear the burden of it, and not medical men. For every member
sbo pays 4s. let the public add 6s., so as to offer something like a fee to
shieh a doctor is entitled. On what grounds is a doctor always to be a
tool of charity ? The poverty of the profession flourishes on the jealous
—policy of its member*. They endeavour to grasp each other’*
patient* by offering skill at a lower fee. Even then, not content,
they play the rile of cat’* paw to the parson'* monkey. Who gets
the chestnuts ? The public. Who gets the honour ? The parson.
Who does the work? The doctor. What other professional man
vrrto seven days and two nights a week ? What other professional
nan has so poor an in6ome and such ill-proportioned expenses ?
At tUa rate a doctor’s income should be double a lawyer’s. But
it is not. There la talk of Increasing the student's period of study
tr» a year or so. What Is he to have afterwards ? The dignity attached
to attending and supplying patients with physic for it. a year.
Happy man I Your correspondents are usually well-to-do men, of
p os iti o n and ability, and who have sufficient from practice or other¬
wise to keep them. Therefore yon rarely hear from my class, and rarely
hear bow the benefloent system take* the butter from the struggling
doctor's bread. There Is very little etprit de corps in general practice,
tod we wage a war of extermination against each other with kid gloves
on. Tboae who rapport and encourage these clubs and charitable asso-
eiationa are working against the mass of doctors for the good of a few.
As yon undoubtedly rapport all forms of charity, I trust you will bestow
«tittle of It, by inserting this in your journal, on

Yours faithfully.

Dee. 13th, 1396. t A Grumbler.

8. P. J .—General Maxwell’s treatise, entitled “The Beaufort Artificial
Arms and Legs for the Crippled Poor,” is printed for private dis¬
tribution, and will be freely sent to all applicants who are Interested In
the charity. Bequests for oopie* should be addressed to General H. H.
Maxwell. C.B.. E.A., Villa Gamberini, Via Palestro, Boms.

Eaqwtrer .—The best inhaler for the administration of the A.C.B. mixture
is the perforated leather cone, containing a sponge and lined with
flannel. Several layers of lint may be used, and even Junker'* apparatus
In operations of the face and mouth.

I'. V. fa referred to announcements in our advertising columns.

AN IMPROVED TRICYCLE.

To the Editor! of Thk Lancet.

Sow,—May I call your attention to a tricycle which I saw at the
Stanley Show last Saturday, and which seems to me to be a great
improvement on the ordinary kind of machine. Certainly it is so from
a medical point of view. We have all noticed how the ordinary tricycle—
and, for the matter of that, the bicycle as well—tends to round the
fl w s Mwi and contract the chest. In the machine to which I wish to
esB your a t ten ti on this evil Is entirely removed. The action which pro¬
pels this m ac hine la precisely that of rowing. The rider sits upright,
md literally rows himself along, and that at a first-rate speed. Instead
of only a few groups of mosclee being brought into play, all the muscles
of tbs body are, as In rowing, at work. The advantages of the sliding
Mat are obtained by means of a moving stretcher, this movement itself
tiding tn the propulsion of the machine. Dr. Richardson has often
wr i tt en about the advantages of tricycle exerolse. I wish he would try
tMa new m a ch i ne , as I feel sore he would endorse my views. The
machine has bean Invented by Mr. J. Inglls Mitchell, O.B., and Is being
eshWIed by Mr. A. Do man. It ja.eallcd the “ Jubilee” tricycle.

I remain, Sira, yours faithfully,

HoBoway^road, H., Fab. 1st, 1887. W. Hmntr Rmtxvct.

Thk Vac.vncv at St. Bartholomew's.

The namo of Dr. W. E. Sbeavonson wss placed amongst the list of candi¬
dates for the pjst of assistant-pliysiclan to this hospital In oar last
issue. This was a mistake, as Dr. Steevenson is In charge of the electrical
department, and did not apply for the appointment.

Dr. R. W. Pots.— The paper was published In the tenth report of the
Medical Officer of the Privy Council. We do not know whether tlu

volume Is out of print.

*

Ur. C. S. Jeaffreson. —As early as possible.

“THE GENERAL MEDICAL COUNCIL AND UNQUALIFIED
ASSISTANTS.”

To the Editors of Thk Lancet.

Sirs,—Y our correspondent, “Unqualified Assistant,” asks, In your
last issue, if “ soores of hard-working and valuable unqualified assistants
are to go to the workhouse " because the General Medical Council Is pro¬
posing to abollth their further use, and mentions their “ long and
faithful ” services to the profession, and concludes by suggesting that a
special Register should be made for their peculiar benefit. This Is simply
the wildest nonsense that could be penned in support of an abuse that
ought never to have been allowed. No snoh unqualified man can engage
In practice without palming himself off as a “ doctor,” and as such he is,
in plain words, deceiving the public, with the sanction of the greater
offender, who knowingly employs him. Would the public receive an
unqualified man If he went to them In his true colour ? Certainly not.
And why should they ? The law has a test whioh the public generally
expect medical men to comply with. So long as this abuse Is tolerated
by the General Medical Counail It will only put a premium upon
ignorance, and encourage the idle and lazy among chronic students who
have neither the brains nor the perseverance to work for a qualification
to become what Is erroneously railed an “ unqualified assistant.” It is
not fair or just to the young qualified man, who has after hard work
reached the required standard and gained his legal status, to be check
mated by a hybrid who is neither student nor qualified. At the present time,
as matters stand, a man may graduate in the best university and beoome
duly registered, and the only return he gets from the Medioal Council is
simply a copy of the Register containing his name and degree, Ac., with
no protection whatever against any poacher, no matter how unqualified
he may be. There are in the kingdom very many entrances into the
medical profession, and the highest standard required in the best of
them Is not too severe for an ordinary student who shows a desire to
obtain the distinction. Ordinary men have obtained these distinctions,
and ran still obtain them If they only try In the proper way.

I am. Sirs, yours faithfully,

Feb. 7th, 1887. Nuda Veritas.

An Old Astittant, In a communication on the above subject, writes :—
“There are men on the Medical Register who have no diploma*
and possess no legal qualification, but are registered for service.
On the Medical Register for 1884 are about twenty such men.
They are registered for services variously obtained—the army,
navy, public service, and as surgeons, under the 48th Section of
' the Medical Act, 1868. If the 46th Section admitted these unqualified
men on the Medical Register, why not make the same use of that
Section and admit all old assistants of approved education and ante¬
cedents, and allow them to met as assistants, or, if jpossible, if their

f irivate means allow, to gradually Improve their positions and become
egally qualified? I am an old assistant myself, am now running on
fast to the age of threescore years, have liked my vocation, and oould
have legally qualified n early thirty years sinoe; but forty years and more
have gone since I became a probationer, previously to apprentices hip
under the Act of 1815. In due time I completed ray apprenticeship, ana
gained In the seven years and a half an Insight Into practice which has
stood me In good stead. I was thenafairall-round practitioner. I tried
to gain employment, bat was told that If I 'legally qualified’ 1 most
' be gone.’ I was left a parentless youth with only a small patrimony.
Still, I am a man of full ourriculum, and of a university to boot. I
considered, and made a resolution, upon whioh I have acted for forty
years, that It was better to be a rich assistant than a poor principal;
and In my rase it has paid. I only held two as*latencies in thirty-six
years, was employed In first-class situations, loved my work and all Ite
surroundings, obtained good salaries, worked hard, and merited my
masters’ approbation, keeping my bonds never to Injure my masters or
their families by proceeding to qualify and register. Such has suc¬
ceeded well with me. In mv sere time of life a place on the Register
win avail nothing. I have lived a life free from disputes and tergiver¬
sation ; but I have been spared the bitterness of non-snccess. I am in
comfortable circumstances. My masters are both dead. I have stood
a guardian's part to the last master's widow and family. I married at
thirty years of age, or a little nnder that age. and have brought up a
family of three daughters and one son. My son is a university under¬
graduate, who will soon obtain his degrees in medicine and surgery.
The experience I have gained has been of great value In knowing bow
to handle the reins. I have given my children good education, and
do not regret in one particle the plan I have followed. Had I my
time over again I should follow out the same plan. I am fully aware
that a man cannot do now as a medical assistant what was done
twenty, thirty, or forty years ago. A more advanced ourriculum is
demanded, and an extended compulsory classical and mathematical
examination is required. Bat are the medioos of the present day
better men? I think not. If all circumstances are fairly balanced,!
think the same standard of perfection would have been reaohed. The
Medical Council ought to take a fair percentage of those who matricu¬
late, and take an estimate of cause* of failure to pass the finals, and in
all fit and proper rases allow a man to work as an assistant under**
legally qualified practitioner, sr, if experienced and above a certain age,
to be registered under the 49th Section of August 1st, 1858."

352 This Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Pub. 12,1887.

DROWSINESS ACOOMPANYING DYSPEPSIA.

To the Editors of The Lancet.

8ibs,—I shall feel obliged if some of your numerous correspondents
will give me their views as to the actual cause of the extreme drowsiness
and torpor that one meets with in some oases of dyspepsia. Is it due to
anosmia, or congestion of the brain, or to some poisonous product in the
blood, the result of mal-assimilation ? I am not speaking of that lesser :
degree of drowsiness which most people experience after a heavy meal,
hut a state of what one may call almost constant sleep, not confined to
gross eaters or to those who lead sedentary lives. Some of these people
will sleep all day, even after breakfast the desire for sleep being almost
irresistible. Treatment in the way of drugs seems to be of little avail.
Any information on the subject, as well as any treatment that has been
found successful, will be very acceptable.

I am, Sirs, yours faithfully,

Jan. 29th, 1887. L.R.C.P.Lond., M.R.C.S.

Atclepiad.— The latest contribution to the literature of malaria in its
nature and Its etiology is the paper read at the Roman Academy of j
Medicine on Jan. 23rd, 1887, and published in the Transactions of that 1
body.

Mr. H. Sergeant.—The alterations in the matriculation to which we
referred were adopted at a meeting of the Senate on Dec. 22nd, 1886,
but we oannot say how soon they will be embodied in the official regu¬
lations, or take effect.

Circocele. —All forms of medical treatment aim at securing obliteration
of the affected veins, and we know of none which succeed without
this.

Mr. H. Fenwick. —Yes.

C. P.— The question has been repeatedly answered.

Communications not noticed in our present number will receive atten¬
tion In our next.

ColorurriCATloJm, Letters, Ac., have been received from—Mr. Bland
Batten, London; Dr. Oulllngworth, Manchester; Mr. M. Handfleld
Jones, London; Dr. C. West, London; Dr. Dowdlng; Mr. Fftzroy
Ben ham, London; Dr. Cos grave. Dublin ; Dr. Good hart; Dr. Murray
Kaeksnrie ; Dr. J. Williams, London; Dr. Macdonald, M.P., London;
Dr. Steavenson, London; Dr. Ray Lankester, London; Dr. Percy
Boulton, London ; Mr. 8 . Snell, Sheffield; Mr. Noble Smith, London;
Mr. J. Marshall, Dover; Mr. J. Clerk, Glasgow ; Dr. Campbell Pope,
London ; Dr. C. H. Taylor, Hammeromith; Mr. Pink, London; Mr. H.
Sergeant, London ; Dr. E. P. Thurstan, Southborougb ; Mr. Barwell,
London-; "Dr. J. B. Potter, London ; Dr. Park, Glasgow ; Mr. Clement
Lncas, London ; Mr. R. W. Murray, Manchester; Dr. A. G. Williams,
Brixton; Mr. F. J. Smith, London; Mr. W. Lulu, London; Mr. H.
Simmons, London; Mr. E. M. Orooluhank, London; Mr. A. Drysdale.
Cannes; Dr. Foss, Stockton-on-Tees ; Dr. Lucas, Ramsgate ; Mr. S. W.
North, York ; Dr. Oliver, Newcastle-on-Tyne; Surgeon-Major Dobie,
Kamptu; Mr. H. 0. Arnold, Vienna; Dr. Lindsay, Belfast; Mr. E. E.
PMTttps, Southend; Mr. Leemlng, Kendal; Mr. Finley; Dr. Beavnn
Babe, Trinidad; Mr. Whyte, London; Mr. Woodd; Messrs. Knbner
and Co., London; Mr. Storey, Stroud; Mr. Yeatman, Auburn, South
Australia; Mr. Williams, Oxford ; Mr. Glatz, Ohampel; Messrs. Lee
and Nightingale, Liverpool; Dr. Sanctuary, Salisbury ; Messrs. Blake
and Co., Leeds ; Dr. W. J. Collins, London; Dr. Braathwaite, High
Shot Hoase; Mr. Hi ton, Clifton; Mr. Erast, London; Dr. Jamieson,
Shanghai; Dr. Burn, Stafford; Mrs. Gray, Banff; Messrs. Dawson
Bros., Montreal; Mr. Barnes, West Hartlepool; Messrs. Summer and
Co., Castleford; Mr. Patterson, Butterknowle; Messrs. Whitfield and
Co., Birmingham ; Messrs. Bradshaw, Notts; Messrs. Oliver and
Bwpd, Edinburgh ; Mr. Boyd, Wandsworth; Mr. Tanmer; Mr. Van

Voorst, London; Mr. Manwaring, Kensington; Messrs. Condy ans|
Co., London; Mr. Moring, London; Mrs. Pratt; Dr. Walton. Hbdea
Bridge; Mr. Groves, Dorchester; Mr. Daws, Wandsworth; Mr. Lace, 1
Hemel Hempsted; Mr. McNonn, Islington; Messrs. Maythom and
Son, Biggleswade; Dr. Leichman, Bnchin ; Mr. Jacob; Mes sr s. Bold
and Cross, London; Mr. Sturmfels, London; Messrs. Peebles an(0
Co., London; Mr. H. G. Phillips, Biggleswade; Messrs. Wyley and!
Co., Coventry ; Dr. Thos. Reid, Lochmaben ; Messrs. Wright anil
Co., Bristol; Mr. Owthwaite, London ; Mr. Gibson, Bromley ; Dr. W,
Hunter, Edinburgh ; Mr. Annandale, Edinburgh ; Messrs. Billing'
and Son, Bristol; Mr. E. A. Thompson, Ripley; Messrs. Hunter and
Co., Aberdeen; Mons. C. Eloy, Paris ; Dr. Squire, London; Mr. J. S,
Wood, London; Mr. Hornibrook, London; Mr. MacDonald, New,
Abbey; Mr. Cooke, Lowestoft; Mr. Oolman. Cardiff; Mr. Smith;:
Evesham; Dr. Ridge, Enfield; Mr. Moss, London; Mr. Poole, Shrews*
bury; Dr. Needham, Gloucester; Mr. Blackwood, Wednesburvjl
Mr. Haslam, Birmingham; Mr. Haokett, Manchester; C. J. E. jj
Oircocele; Ambulance; A Victim ; Enquirer; Traveller; Unqualified^
Assistant; K. K. ; M.D.; B.,D*wlish; B.O.; Medicos, Monte; Nuda
Veritas; B., Bournemouth; A. G.; Matron, Bristol; Secretary,
Milton Chemical Oo.

Letters, each with enclosure, are also acknowledged from—Dr. Powell,
London ; Sir J. Sawyer, London; Mr. Logan, Glasgow; Mr. Smith,
Manchester; Mrs. Wontner, St. Leonards-on-8ea; Messrs. Symes and
Oo., Liverpool; Mr. W. Thompson, London ; Meson. Zlmmermaira
and Co., London; Messn. Black, Edinburgh; Means. Richardson
and Co., Leioester; Mrs. Bellamy, Grantham; Messrs. Sllnger and
Co., York; Mr. Boyvean, Paris; Mr. Warman; Mr. Purneanx, Forest
Hill; Mr. Finlay, Germany; Mr. Geddes, London; Messrs. B u rgoynO
and Co., London ; Mr. Morris, Swansea; Mr. Brockelbank, London ;
Mr. Cowan, Bridgwater; Dr. Russell, Wickham ; Messrs. Kilner and
Co., London; Mr. Bean, Plymouth; Mr. Maycock, Staffs ; Mr. Reid.
Canterbury; Mr. Bruce, Dingwall; Mr. Bell, Dover ; Messrs. Hooper
and Co., London; Dr. Hudnott, Brooklyn; Messrs. Benjamin and
Sons, London; Mr. Shlrtliff, Kingston-on-Tliames; Messrs. Bullock
and Co., London ; Mr. Unsworth, Liverpool; Dr. Adye, Bradford-on-
Avon ; Mr. Fuge, Taunton ; Mr. MacMordie, Belfast; Dr. Williams.
London; Dr. Fulton, Toronto; Mr. Smith, Finsbury; Mr. White.
Bayswater; Mr. Webb, Bury ; Mr. Baker, Dawliah ; Mr. B. Carpenter,
London; Miss Chreiman; Dr. Taylor, Nottingham; Messrs. S he rwood
and Co., Manchester; Mr. Little, Cymmer; Mr. Rowley, Araik land. New
York; Dr. Pope, Bardisiey; Mr. Davis, Worcester; Messn. Goddard
and Massey, Nottingham ; Mr. MaaLehose. Glasgow; Messrs. Smith
and 8on, Liverpool; Dr. Arnison, Newcastle-on-Tyne • Messrs. Webb
and Go., Klngsbridge; Mr. Chamberlain, Harlston ; Messn. Loeflnnd
and Co.; Dr. Ritchie, Otley; Dr. Aldenon, Hammersmith ; Mr. Van
Prnagb; Mr. Rhydl, London ; Mr. Galloway; Messn. Mackey and
Son. Morpeth ; Dr. Smith, Leamington ; Mrs. Stirling, Portsmouth ;
Dr. Fletcher, Hlghgate; Mr. Hltchin, Nottingham ; Messrs. Giles and
Co., Clifton ; Mr. Furness, WIgton ; Mr. Brown, Hull; Mr. Please,
London ; Mr. Crossdale, Colne; Mr. Gilyard, Bradford ; Mr. Stewart,
Rotherham; Mr. Robertson, Edinburgh; Miss Proctor, Middlesbrough;
Larynx; M. A.; Medicos, Chesterton; Salopian, London; Medicos,
Banbury ; Nucleus ; Vicar, Ilfracombe ; M.D., Leeds ; Secretary,
Marylebone; Dr. M., Accrington; H. P. H., Sydenham; Imogene.
Folkestone; Coca; B. A.; A. X. L., Lambeth; Z. Y. X.; Medtcns.
Brookley; Epsilon, Nerwcaatle-on-Tyne ; Alpha, 6tamford ; W. H. L..
Darby; Alpha, Brighton ; Surgeon, Pontypridd; X. Y.; Medicos,
Buntingford; M. I.; Surgeon, Redosr; X., Carlisle.

Birmingham Daily Gazette, Liverpool Courier, Western Morning News,
Middlesex Chronicle, Liverpool Mercury, Liverpool Daily Post, Pendleton
Reporter, The Methodist Times, Sfc., have been received.

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THfi LANCET, Febhsdaby> 10,i 168&

®fte Hunterian ©ration

DELIVERED AT THE

KOTAL COLLEGE OF SURGEONS OF
ENGLAND,

Monday , February 14 th, 1887 ,

Bt WILLIAM S. SAVORY, F.R.S.,

FHarBjDrr or the ho tax. college or sumosoira or ekglaitd, sumoBtar
TO «X. BARTHOLOMEW'S HOSPITAL.

Gwilbius x,—N 0 word of defence can be needful for the
faun in which English surgeons hare chosen to celebrate
tbs memory of Hunter; but an apology may be offered by
one who now attempts the task of speaking of him. The
duty of reviewing in this place the life and work of Hunter
has been so often and so ably performed that it seems to me
I can do bat little else than incur failure by any effort , to
tread in such familiar footsteps. But although tempted, as
I may have been, by this and other reasons to torn aside
into some less known path, yet a natural sense of loyalty to
th» great surgeon and of responsibility to the trust I have
accepted has constrained me, and so Hunter in his work
mast be again the subject of what is called with oppressive
gnndeur the ** Hunterian Oration.”

8urgeons with one voice have proclaimed the supremacy
of Hunter above all who have ever studied surgery. Students
oi science.have acknowledged him to be among the chief
of those who have in any age advanced human knowledge.
1st although his claims have been often examined, and
many students and surgeons have been engaged in the task,
his greatest to the high place he holds is not always reco¬
gnised, perhaps not even always understood. May I stand
excused, then, for asking once more, and attempting to
answer the question. What has Hunter done ?

It bos been well said that when we attempt to estimate
the achievements of the foremost men of past ages too often
we see them only in eclipse. A large part—it may be muoh
the larger part—of what they did is too often hidden from
ua The proportion of sudden, or what may now appear as
sudden, discoveries may be seen, though from afar; they may
still strike us even from a distance. But we can now no
longer adequately appreciate the conditions under which the
pioneers of knowledge laboured. In the light of the present
day it is difficult to realise the darkness of past times, or to
measure fairly the part they played in dispelling it. We
may diligently trace the course they took, and become
familiar with every step of it, and yet fail to understand
that they not only trod, but actually made the way.

But was Hunter a great discoverer —I mean in the
ordinary sense of the word ? For we speak of discoveries
in science, sometimes forgetting that all real progress
involves discovery. What are the particular discoveries,
then, or i m provements in the art of surgery, wbieh
sre now recalled by the mention of his name? We
quote at once, as an instance, the operation for aneurysm,
known to all as the Hunterian, and then — we pause.
What else shall be declared upon which his fame particu¬
larly rests? Anyone, indeed, who has but a passing
acquaintance with the works of Hunter can speedily furnish
a long list of important papers in which many new and
valuable facts are revealed, and knowledge largely increased,
not only in anatomy and physiology, but in pathology and
aurgery. Mere than one or two of these would alone suffioe
t o esta blish the anther’s claim-to'ability and industry of no
cemunon order; but in none of them can be pointed out, I
think, any particular discovery in surgery from the loss of
■wb*eh Hunter’s fame as a surgeon would materially Buffer.

But 1st us go further. As a surgeon was Hunter pre¬
emine ntly skilful in practice? Whs he, beyond all other
auigeons of Ms time, sagacious in diagnosis or successful in
treatment? Was he even dexterous in operation? I do
not know where to ftndthe evidence upon which these I
quMttate Mf-ljte ahJrWeiM'M the affirmative; indeed, '.on

H&. 3B1S •

the latter point there is evidence to the contrary. Or, once'
more, was he a learned man in his profession, as the phrase
is commonly understood? Was he, as we say, a “well-
read" man? Was he fully informed of the labours of
others ? I fear it must be admitted that the testimony id
favour of this belief is very slender too. The introduction
of the operation for aneurysm which bears his name whs
indeed a great step onward. In taking it he gave ample
proof of rare foresight, which could proceed only from
sound apprehension of some important facts in pathology
and surgery, and a masterly grasp of some of the leading' 1
truths of physiology. Yet we bear witness to Hunters 1
fame when we acknowledge that even this grand discovery,
among the chief in surgery, adds comparatively little to it.

What more, then, did Hunter achieve ? What waq he,
therefore ? Wherein consists his greatness ? He was, add'
is, beyond and above all surgeons, a philosopher in surgery.
Ms idea of the subject of his thoughts was far more '
adequate than that of other men. He was supreme in the
scope and method of his work. He understood muck better
than those around him how to engage in the interpretation
of Nature; he knew best how to approach ana to- dis¬
close truth; for he Dot only understood that the problems
which lay immediately before him were of all the most
complex and difficult to solve, but he could see also that 1
they were not isolated, but dependent ones. He saw in the 1
necessary relation in which they stood to others the drty
means by which they could be worked out, and on this
understanding he resolved to investigate the questions he
desired to answer. But consider for a moment What, with the
light in which Hunter then stood, that resolution involved.
Remember how often, in more recent times, have able men' 1
doubted the doctrine, hesitated to accept the idea of that inti- --
mate relationship between the various forms of life—of their
continuity, of that harmony of plan, of that unity of design, ’
which Hunter not only clearly conceived, but so accepted
as a vital truth that he made it the foundation of all his
labours; and, after all, the only sure test of genuine and
thorough belief iB the work which comes out of it. This
was the principle on which Hunter never wavered ; it was
the star that guided him—without haste, without rest-
through all the work of his life.

But observe, I pray you, further, how Hunter pro- '
ceeded in his work, for this is eminently characteristic '
of the man. He is not fond of starting propositions,
which are then supported by arguments and made plain ’
by illustrations; but his practice is to demonstrate in '
their order, without comment or dissertation, the facts
which reveal knowledge. His habit appears to be, not
to say to us, “ I am convinced of this, and I will tell “you
why there can be no doubt about it,” but rather to place ’
the premisses before us—sometimes, it may be, with indiffer¬
ence, certainly without regard to effect, or any attempt at
direction. His purpose appears to have been uniformly not
to support a conclusion, but rather to make way for otie.
This, I think, is inscribed on the proudest monument of his
genius—his Museum. May I ask you, only for a few momehts,
to look once more at it ?

The passion of Hunter fer collecting is well known; it
has often been the subject of comment. His Museum In¬
cluded not only, to use the words of Professor Flower,
“illustrations of life in all its aspects, in health and in
disease; specimens of botany, zoology, paleontology, ana¬
tomy, physiology, and every branch of pathology; prepara¬
tions mads according to all the methods then known;
stuffed birds, mammals and reptiles, fossils, dried'shells,
corals, insects, and plants; bones and articulated skeletons;
injected, dried and varnished vascular preparations; dried
preparations of hollow viscera; mercurial injections, dried
and in Bpirit; vermilion injections; dissected preparations
in spirit of both vegetable and animal struotures, natural
and morbid; undissected animals in spirit, showing external -
form or waiting leisure for examination; calculi and various
animal concretions; even a collection of microscopic objects;
but it extended to minerals, ooins, pictures, ancient eclats
of mail, weapons of various dates and nations, and other
so-called ‘articles of vertu.’” Yet I do not doubt that,
notwithstanding the apparently miscellaneous character of
a great part or his museum, this vast collection was very
far from being what oould be called an empirical one. Sate
in material, it had nothing in common, as some would suggest,
with an old curiosity shop. For myself, I believe thah even
the objects-found there, which appear most foreign' to the

354 Thh Lancbt,]

MB, WILLIAM RSAVORY: THE HUNTERIAN ORATION

[Pbb. 19,1887.

subject of his thoughts and work, were not introduced from
mere idle fancy, but for the purpose, either at once clearly or
dimly seen, or, if otherwise, at least conceived possible, of
throwing light in some way upon the great questions of which
his mind was full. I submit that this view is worthier than
the prevailing one of the character of Hunter; and it is
fortified by evidence of the strongest kind. Look at that
section of his Museum which, as Professor Flower truly
says, is most characteristic of the man—that which is
called, and I venture still to think well called, the
physiological. Had it been somewhat more fragmentary
than it was when he left it, had not a fuller light been
thrown on the truth it illustrates by the masterly labours
of von Baer, the brilliant exposition of Milne Edwards, and
the thoughtful volumes of Carpenter, how much longer
would the great idea, that governs this unrivalled senes,
have remained concealed ? Nay, even still, how often in
the comments made on it, is this idea unheeded or over¬
looked? It is a magnificent collection of comparative
anatomy, or, as we may speak now, of morphology. It sets
forth the variations in form which the different organs
undergo in different species, or in the same species under
different conditions. But, above all, it introduces us, in
the happiest way, to the study of comparative physiology.
It demonstrates the great law of progress from the general
to the special; the law of evolution from-the simple to the
complex; the principle of elaboration, and advancement
of function by division of labour. Or, again, as Pro¬
fessor Flower admirably puts it—and need I apologise
for quoting him here in reference to the Museum?

- -it throws “light upon one of the great biological
problems, classification ; which, when rightly interpreted,
means nothing more or less than a statement of the order
in which living beings have been evolved from one another.”
I know not, indeed, whether Hunter ever formulated this
idea. He has not laid down the law in explicit terms. I
can find no distinct expression of it in any sentence he has
written which has reached us. But, then, hasty generalisa¬
tion was no habit of his mind. 1 do not doubt that, in some
large degree, he grasped it, and had he lived on, as the truth
became established, ne would have made it plain to all.
When his labour ceased, be was working out the great idea.
But by such glimpses as we thus obtain of the character of
his mind and the method of his inquiry, of the way of his
genius to begin the search for the truths he sought at the
furthest outposts, and thence, so to speak, to work in¬
ward and upward, I cannot regard the possession of any
facts or illustrations which he was enabled to collect, but had
not time to place, as wanton or purposeless, or even merely
curious. To me they are wonderful, but withal most sug¬
gestive, that the great mind of Hunter was not only far in
advance of his own age,but is hardly overtaken by this.

The same method of work is plain in Hunter’s labours in
surgery. He was ever searching for principles, but strove
to reach them only through facts. Facts always first; but
never facts only. From facts to principles. He understood
that all progress mainly depends on the power of grouping
and uniting for some new purpose facts that have been
discovered independently, and that are daily being revealed,
yet with little or no reference to the principles they are
found to support. And here, again, after a careful examina¬
tion of Hunter's work in surgery, it is necessary to pause
and review it in relation to the knowledge of his time. Then
I think we are impressed, not so much by the actual advance
he made in the art, as by the degree in which, through the
character of his work, he raised surgery to the level of a
science. I would almost venture to say that he effected
more by the nature of the questions which he set than by
the answers which he worked out. Surely his conception
of surgery, of its possibilities in the future, of its relation
to the sciences, of the plan —the only sure one—upon
which it could be advanced, went very far beyond that
of any surgeon before him—shall I say has gone far
beyond, that of most surgeons after him? But if he
could (has estimate the task before him, what shall we
say or think of Hunter as we watch him, with unex¬
ampled diligence and patience, pondering over the preface?
Never turning a page of the great book of Nature, which be
had set himself to lead, until each sebtenoe before him had
been duly weighed, and all thathe could jeam from it had
been secured. Bat this was not enough. He not only saw
that g nr gery, to he soundly established, must rest upon
pathelggy,hut that the language of*>athol*gy,, required an
inter p re te r f that its problems eould be solved only by the

light of physiology. Where in any work before his—nay,
where in any since—shall we find such a union of physio¬
logy and surgery? In the pages of Hunter, but there I
think only, are they found, as they should be, literally
woven into one. We study his chapters on the Blood, on
Inflammation, and on Gunshot Wounds, and acknowledge
that nowhere else are the principles of pathology so sup-

? sited and illustrated by the facts and truths of physiology.

68, as no one before him has given proof of so dear and
ample a conception of the relation of surgery to natural
science, so in no one since has it borne such fruit. Hunter
not only saw more fully than anyone who preceded him the
way in which the art of surgery, through a knowledge of
physiology, could be advanced, bat he possessed the happy
power of working to far better purpose upon this under¬
standing than any of his successors. Nay more, the same
power of mind which gave him & larger grasp of surgery-
raised him to a loftier view of the science on which it u
founded. He knew better than other men in what direction
to look, and when he turned his eyes thither he could see
further.

So now, as we stand upon higher ground on this side of
it, we can discern, I think, the idea which pervaded Hunter's
work. He saw that surgery in his time was but a rude
empirical art, consisting of little else than a knowledge of
many facts which stood in no visible relation to each other,
and of many more opinions which, for the most part, had no
relation, or but a very distant one, to any facts whatever;
that surgery should be raised from a collection of such
creeds to the rank of a science; but this could be only by
founding its practice upon sound principles. The discovery
of some at least of these principles was Hunter’s final aim.
But these principles could not be reached by guessing; they
could be approached only through the orderly investiga¬
tion of facts. But then an explanation of these facts
themselves could be only through the truths of physio¬
logy. The signs of disease could be understood only by
him who had studied the laws of life and health. An
intelligent interpretation of the one could only be in
proportion to a previous knowledge of the other. But
the problems of life and health are presented to ns in man in
their most complex form—in a form so difficult that even
Hunter could not solve it. They must be reduoed to simpler
terms through a study of the lower forms of life. Thus,
with the ultimate aim of relieving human suffering, Hunter
studied the phenomena of motion in plants. Nay, he went
further—to crystals and other forms of inorganic matter,—
and he says: “ The better to understand animal matter, it is
necessary to understand the properties of common matter,
in order to see how far these properties are introduced into
the vegetable and animal operations.” Note the character¬
istic thought at the end of the sentence. He does not start
with a denial or an assumption, but he is anxious to “ see
how far.” And if it must be said that in his attempt to
grapple with the crucial problem of life Hunter failed, it
must be acknowledged that he failed only in the task where
none have hitherto succeeded. And the weakness he exhibits
here appears chiefly in the fact that he encountered this, the
greatest of all questions before him, not always according to
his wont, by careful, patient, and impartial investigation of
the facts which lead up to it; but it must be confessed
that the dominant idea of a living or vital principle
was too ready to do duty for causes that were to hun
then, as they are to us now, obscure. Yet, even here where
Hunter is tried by the severest of all tests, one cannot
but observe in what favourable contrast he stands
to others who have attempted to solve the problem; how
determined he is, for instance, to depend for the most part
on experiment, and how comparatively trivial has been the
advance in actual knowledge of the subject since his time.
Recently we have learnt, indeed, to recognise more fully the
play in the living body of the common forces or forms of
force of nature; and hence we have been led to suppose that
the forces peculiarly vital may hold the same relation to
them as they do to each other; that all the distinctive
phenomena of vital action may depend on the transforma¬
tion of force with which elsewhere we have become in effect
more or less familiar. But beyond this attempt to see, as
Hunter put it, how far the common forces of nature are
concerned in the phenomena of life, and the reasonable con¬
jecture that has hence arisen of the relation of the vital
within us, and the forces around ns, how much further have
we gone? Yes, Hunter stood before the crowning mystery
of life, and could not raise the veil, But, then, to whom

The Lxs cet,]

[Fkb. 19,1887. 3&5

MR. WILLIAM S. SAVORY: THE HUNTERIAN ORATION.

amongst the sons of men has it been yet given to draw it
aside? Let the darkness which, after another century of
thought and work, still enshrouds the subject be the com¬
ment on Hunter's reflections on the nature of life.

Now, perhaps the question may be worth asking, IIow far
is it practicable in the present day to turn to good account
the priceless legacy which Hunter has left us in the record
of the plan on which he studied surgery? How far is it
possible to follow now, at however great a distance, the
example which he set? Or to put it thusSupposing
Hunter to have lived in our day, could the range of ms work
have been still as ample? How much of what he did
depended for its scope on himself?—how much on the
scanty state of knowledge of his time ? If Hunter lived
amongst us now, his grasp of natural science and of surgery
would, of coiirae. be very different from what it was in the
lastoentury. It is common to remark that knowledge in
this, aa in other directions, has increased so largely that
the relation in which any man can stand to the whole of
it most be very different now from what it was a hundred
years ago.

As knowledge advances, and the sum of it accumulates,
the share which any one man can appropriate must of neces¬
sity gradually grow less, and become a smaller fraction of
the whole. There can be no help for this or remedy, save in a
corresponding advance in the development of the human
mind. What reflection is more familiar to us than that on
theprogressof knowledge? But is the power of apprehending
it greater now than it was in the days of Plato or Aristotle ?
Thu must mean that, as the world goes on, the attainments
of even the foremost in intellectual power must become
more partial. Who now would dare to talk of taking all
knowledge for his province ? It involves the fact of greater
individual incompleteness. In the old days, the best men
could be more on a level with the knowledge of their time.
Thence every year onward places even these further below
it, and the great law of division of labour prevails. Yet for
this there is a gracious law of compensation. For while, on
the one hand, there is now so much more to be seen; on the
other, the master minds of previous ages have made it much
easier for us to see. For by the establishment of prin¬
ciples, the outcome of their labours, we are raised, as it
were, upon the Bhonlders of our ancestors, and the horizon
of our vision is more comprehensive than theirs. Foe as
facts accumulate and principles become moulded out
of them, not only does the apprehension of these principles
enable us, except for special purposes, to dispense with
many facts, but such expansions of knowledge have a value
far beyond this. Principles are the means by which
important facts are fixed and registered. They are means
by which our knowledge of the facts they embrace are
neared and made available for the future. Disconnected,
isolated facts —facts which are not orderly arranged and
assimilated into principles—are in constant danger of dying
out. Very grevioueiy, I imagine, has the practice of medicine
and surgery suffered from this loss. It is painful to think
of the multitude of facts which must have been known to
the older physicians and surgeons that either have been, or
sre being, from time to time mislaid by us. Many of these
no doubt, in the course of knowledge, have become worthless,
being superseded by others, but many, too, had probably a
value that now we can neither appreciate nor understand.

Let us look at this matter more closely in its relation to
forgery. What place should physiology, for instance, occupy
in the study of surgery? 1 am not speaking now of physio¬
logy as a chief instrument of education (a very different
matter), but I ask what share it should receive of the time
and attention of the student of surgery ? Some knowledge
of physiology is essential to the surgeon. This statement,
1 suppose, will be generally accepted. At all events, those
who may think otherwise will hardly care to say so in good
company. But then how mnch of physiology i£ needful for
the surgeon ?, What parts of it may safely be left alone? I
would answer shortly, that tbe principles of physiology
Bhould be thoroughly understood by tbe surgeon, and with
these, perhaps, what may be called the leading facts.

For instance, with reference to the circulation, it sterns to
me that every surgeon should understand the function and
mode of action of the heart, arteries, veins, and capillaries;
but I do not think that every surgeon need be able through¬
out his lifft to State the facts and observations upon which
the ooael U SMty are,b»I think he should understand
the mesafea^oCjthe, capillary circulation and its relation to
1116 ajKPititSajyjnrctem.. and the conditions

by which the pressure of the bipod is regulated; but I should
not think it necessary for him to be able always to follow the’
impressive series of facts through the vegetable and animal
kingdom upon which these conclusions are founded. Thus
he takes advantage of great principles which have been
established on a multitude of facts; and, by intelligent
study of a few weeks, he may be spared many months of
what might, perchance, prove to him tedious detail.

So with respiration. He should understand, I think, not
only the mechanism of the process in man, but the principle
on which a respiratory organ is constructed; which are the’
essential and which the accessory parts. But he need not
be called upon to remember always the various forms of the
respiratory apparatus in the animal kingdom.

So with digestion. He should, I think, understand what
is known of the function of dirferent portions of the ali¬
mentary canal, and of the organs accessory to it; but he
need not be able to recognise at a glance through the micro¬
scope a particular section of every part of it.

Now, assuming, as we have done, that some knowledge of
physiology is necessary to the surgeon in ordinary, have
his labours in this science, if properly directed, been ex¬
tended, do you imagine, by its advance ? I should say, on
the contrary, that they have not only been reduced and
shorn of many difficulties, but that, if only his studies be
conducted with moderate judgment, he can now acquire
much more than formerly upon far easier terms. If any
doubt exists in the mind of anyone of what has thus come
of the enunciation of principles, or of what I would call
leading facts in physiology, let him look over the history
of our knowledge of the great subject of development. Of
what a mass of hard, dry, almost unintelligible statements
it formerly consisted. Now, I do not mean to say that
our preseut knowledge of this subject is free from all
intricacy; but as much that was mysterious and doubtful
has become clear and plain, I appeal to all who have studied
it whether the task has not only been made far more
agreeable and profitable, but whether it is not now easier to
get it all “ up, as the phrase is, in a shorter period of time.
And, further, this applies not only to the surgeon properly
so called, not alone to one who studies physiology only as a
means to an end, but it applies also to those who would
study physiology, as Hunter did, with the pure view of its
advance. TlisA which occupied Hunter years to unravel
may now be gathered up in a few days, and from the point
so readily reached the work may still be carried on. The
field of labour, the ground which has to be upturned, is
happily now no longer the same; but what change is called
for in the method of work, what improvement can be
suggested of the plan which Hunter pursued?

Now, while for the scientific surgeon a knowledge of the
principles and leading facts of physiology will suffice, for
the practice of surgery a knowledge is required not only of
the priuciples of surgery, but of as many facts as possible
and of detail of every kind. But although in the practice
of surgery acquaintance with every fact and familiarity
with every detail is of importance, inasmuch as it may be
useful in some degree in promoting recovery or alleviating
distress, yet in surgery, os in physiology and other sciences,
and for the same reason, a knowledge of principles must be
always paramount, and it is only by their discovery and
establishment that its advance will be secured. Principles
are in tbe practice of surgery what grammar is to language.
Men may talk without grammar, speak even good English
without knowledge of grammar, and men may practise
surgery with little or no knowledge of its principles, just as
a mariner may sail in familiar waters without compass or
quadrant. But what if strange difficulties should arise?—
and is it unusual in surgery to encounter them? What
when we pass, as often we are driven, from the well-wqrn
track of every-day experience!

Surely, the great lesson which Hunter taught and teaches,
the example he set in the study of surgery, was never more
needful than it is now, when every year the strain in this
direction becomes more urgent. I think from the time of
Hunter to the present we can trace his influence upon the
scientific study of surgery through a long line of dis¬
tinguished men. -But the improvement of surgery as an art
is not altogether favourable to the progress of surgery as a
science. For as the art of surgery advances, and skilful
management of detail involves more and inore of every sur¬
geon’s care and time, the study of principles is in, danger of
being neglected. There may be less of science because there
is more of art. And then the art of surgery is—apparently,'

82 qtzed bv Google

356 The Lancet,]

MR. WILLIAM S. SAVORY: THE HUNTERIAN ORATION.

[Feb. 19,1887.

at least—the more immediately important. Its application
to practice is more obvious and, to the general view, more
useful. Above all, it leads to an end by a shorter path and
easier steps. To study surgery as a science, and to master
its principles, makes a far larger demand on the intellect,
and involves higher and rarer qualities than to acquire
technical skill in the form, not only of mere manual
dexterity, but also in that of familiarity with routine. In
a word, the knowledge of the art of surgery means far less
expenditure of that which most men are most loth to yield
than a study of the science, and secures always a more
immediate, and usually’, in one sense, a more substantial
return. Hence it is popular, and is likely to become still
more so. This may be from a certain point of view—which
is not the finest—of temporary advantage to particular
surgeons, but in the highest sense it is bad for surgery.
Moreover, the truth is, that science is never able to accom¬
plish much when held in bondage by the immediate wants
of life. Its investigations are successful only when they are
pursued with indifference to the uses to which they may be
applied.

This suggests, then, a question for the future, the
answer to which seems to be hardly an encouraging one.
As in each successive year facts and details in every direc¬
tion—all of more or less immediate importance in the
practice of surgery—accumulate, less and less time and
attention are likely to be spared for the study and apprehen¬
sion of its principles, to say nothing of the neglect of the
sciences upon which these principles are founded. Is not
surgery itself, then, as a science, it may be asked once
more, in danger from the extension of surgery as an art ? I
can imagine there are some who will admit that this is so
with very sinister complacency. But what would Hunter
have said to it ? And, unfortunately, in the present ten¬
dency of affairs, what he does say and teach is likely to
become unheeded, for it can hardly be expected that the
study of his works will suivive the decline of scientific
education.

The law of division of labour is oftentimes appealed to in
this matter, but I venture to think this is not, or at least
ought not to be, a case in point. It is often said that as
surgery advances, and the art grows more extensive, it
becomes more impracticable for anyone to entertain the
whole of it. Thus then, first of all, the study of surgery as
a science must be set aside by practical men, and then the
art must in turn be broken up, the several portions of it
being assigned to different practitionere. Now with regard
to what is called specialism, let me say at once that I have
no word to utter in disparagement of that form of it which
consists in a man, first of all, studying and duly qualifying
himself in the principles and practice of surgery as a whole,
nnd then at length devoting his attention more especially
to the cultivation of some particular department of it. This
is not the form of specialism against which I would protest.
In my humble opinion, it is in no way an unworthy one,
and, if it were, it is by no means frequent. It is no illustra¬
tion of the law of division of labour as commonly under¬
stood, for excellence is not here obtained solely by exclusive¬
ness. But the kind of specialism which should be denounced,
and which it is to be feared is not very rare, is that which
consists in the practice of somfe particular portion of sur¬
gery without adequate attainment in, or continued study of,
surgery as a whole. This is a form of exclusiveness detri¬
mental, I think, to the progress of surgery, and therefore to
our profession, both from a scientific and social point of
view, and to the public. This I take to be a false applica¬
tion of the law of division of labour, which in manufacture
and in many branches of skilled labour is so advantageous,
and even inevitable, for ease, rapidity, and cheapness of
production, and by which every day human hands are being
superseded by machinery. The law of division of labour is,
indeed, generally recognised and very useful here, but it is
nob known, and has no place, in the noblest science or in the
highest art.

While, then, we contemplate the genius of Hunter in his
works, he has left us an example which is not altogether
out of our reach, in his conception of the subject and his
idea of the plan of studying it. His view of surgery was
more comprehensive, far worthier than that of others. Had
he lived with us, would his views, do you suppose, have
become narrower? would they have been less remote from
specialism? Is it now no longer practicable to study
surgery as Hunter studied it? Ay, but to study surgery
As Hunter studied it means more than this. For he was

great, not only in his understanding, in his apprehension of
the nature of the task which lay before him, or in his
appreciation of the difficulties of research, but he was great
in the spirit with which he encountered them. His patience
in ascertaining facts, in investigating questions of every
kind, seems to have been wellmgh inexhaustible. It was
certainly no habit of his mind to take anything for granted,
or, when he could help it, to accept any statement at second¬
hand. And this was the more remarkable in a man whose
mind was ever on the alert for the larger truths beyond, to
which facts are but the stepping-stones; for the titles of his
various papers very often convey no inadequate notion of
their contents. He writes on somefactinnatural history which
is carefully and accurately described. But very soon it is
used in illustration of some principle which is forthwith ex¬
pounded, or in evidence of some original view which is then
set forth, or in suggestion of some further research. Thus
the fact, of which only the title speaks, becomes the text of
a very valuable discourse. Yet Hunter was also remarkable
in this, that the ideas which constantly occupied bis mind,
and on which he was always at work, still left him with the
keenest eye for every novelty which his labours incidentally
disclosed, although it lay altogether outside the current of
his thoughts. Thus, in addition to the progress he made in
the main subject of his labours, he was always accumulating
a multitude of what, for the time being, were isolated facts.
In this way he must have added largely to his wealth of
knowledge.

If there iB any point clear in’tbe character of Hunters
work, it is that it was real, genuine, thorough. It may be
said,indeed, that this must be true of all good work; but not,
I think, in the degree in which it is obvious in his. He is
never content with a cursory glance or a superficial
view. Even when questions arise in the course of some
inquiry, which, so far as that end is concerned, may be
lightly disposed of, Hunter almost invariably dwells on
them, sometimes at such length and so exclusively as to
suggest that he has forgotten the purpose on which he set
out. But it is evident that he could not bear to go on his
way passing by so much that was undone. This gives a
singular character to many of his papers. Much of the
apparent want of skill in arrangement and exposition, and
the seemingly purposeless way in which oftentimes state¬
ment of facts are scattered through his writings, is, I think,
due to embarrassment from the riches he had gathered. And
the singleness of purpose with which he worked is made
evident, not only in the actual result of his labours, for no
human being with divided interests could rival such
achievements; but in the record, as we have it, of the life
he led. He gave not only the whole of his time—yes, the
whole of it in no mere conventional sense—and all his great
powers, his mind and body alike, to the one object of his
life; but to this he sacrificed all that he possessed, all that
he could gain. To this he devoted, without stint or scruple,
his money, his friendships, all his other interests. What any
other man would have consideted impossible he made
practicable. And this to no personal end. Careless of all
reward eave that which was to him paramount—the dis¬
covery of truth.

A noteworthy point in the character of Hunter appears to
me to be found in the relation which in him thought bore
to action. He combined in himself, in a very eminent, I
had almost said in a singular, degree, the power of con¬
ception and of execution. He not only saw much further,
but he was able to do muoh more than most others. He
saw, as Bacon saw, and the idea was probably as original
with him as with Bacon, that the systematic and thorough
examination of facts was the first thing to be done in
science, “and that till this had been done faithfully and
impartially, with all the appliances and ail the safeguards
that experience and forethought could suggest, all generali¬
sations, all anticipations from mere reasoning, must be
adjourned and postponed; and further, that, sought on
these conditions, knowledge, certain and fruitful beyond
all that men then imagined, could be obtained.” But he
went immeasurably further than the great prophet of
science in putting his conceptions to the proof in imperish¬
able work on the lines he had laid down. “I only sound
the clarion,” said Bacon proudly, “ but I enter not into the
battle.” Hunter Bounded a clarion the echoes of which are
reverberating still, but he entered into the battle also, was
always found where the blows fell thickest, and we are in
possession of the spoils. In his Museum there is at once
the clearest evidence of the ideh end- the richest fruits of

>ogle

THB bANCET,]

MR. WILLIAM S. SAVORY f THE'HUNTERIAN ORATION.

[Peb. 19,1887. 357

execution. Bacon, we know, has been compared to Moses
on Pisgah surveying the promised land, and Newton to
Joshua, who began to take possession of it. But Hunter
saw the Canaan of surgery, and took possession of it too.

The mode in which Hunter conducted his investigations
m physiology and surgery reminds one of the scientific
work of an engineer in laying siege to some fortress. He
begins by examining in every way he can the character of
the defences; he studies, by every means in his power, its
strength of resistance; he measures, to the best of his
ability, the difficulties before him. Then, when all this is
done, and in nowise previously, he draws out deliberately
the plan of attack, arranges the whole scheme of action,
and works steadily, patiently, and persistently upon the
lines so laid down, it may seem to those who look on in
ignorance that time and force are wasted in such elaborate
care and toil. Bnt all this means that each step forward
shall be well assured, and that there shall be no risk of
having to fall back. Ever ready to take advantage of sur¬
prises or of dashing assaults, he does not reckon upon these,
or allow any part of his design to be made dependent on
their success. He goes in to win, not by chance, but by
method, and the flag of his country at length floats upon
the battlements, not as the trophy of the courage of a forlorn
hope, but in triumph of scientific forethought and calcu¬
lation.

The study of Hunter in his work is instructive, in view
not only of what he was, but also of what be was not. What.
Hunters acquirements were when he commenced the study
of anatomy is not quite clear, and cannot be determined
with precision now; but this, at least, may be considered
eertain—that he could not, at that time, have been called a
man of good general education; and it appears certain also
that never, at any subsequent period of his career, could he
have devoted any care or time to attainments in literature.
One result of this defect in him is evident, not only in the
absence, in all be wrote, of that which is termed style, but
even in the want of power of lucid expression. He cannot
always say clearly what he means. His thoughts are too
frequently involved in obscurity and confusion.

Very much has been said and written on the rival claims
and opposing merits of science and literature; but surely to
very little purpose. To compare or contrast the advantages
of literature and science—to discuss their relative value
even as instruments of education—appears to me to be as
futOa as to consider the relative advantages or propor¬
tionate value of the forces of Nature. Each has its place,
its power, and its claims. Each by itself is incomplete,
defective. But they are in their purpose correlative, each
supplying that which the other lacks, and together, but
together only, making the circle of knowledge and educa¬
tion complete. When the champion of science thinks
lightly of attainments in literature, or the master of
letters speaks with disdain of scientific knowledge, each,
I take it, shows only that he cannot appreciate what
he does not understand. It is, perhaps, the most con¬
spicuous instance of the evil of that one-sidedness which
springs from the inevitable division of labour; of the
want of sympathy which is too common in distinguished
men with any kind of work outside their own. It is, indeed,
natural and necessary that men should become chiefly inter¬
ested in that which is the daily occupation of their life, that
they should prefer, before every other, their own pursuit.
But it is unfortunate that we should grow so indifferent, as
wo commonly do, to the claims of branches of knowledge that
we do not possess; and it is still worse if, instead of devoting
any spare time at our command to their study, we employ it
in denouncing the effort or in expressing contempt for them.
In tbB example of Hunter, one passes over with impatience
the numerous disquisitions in which attempts have been
made to prove the enormous advantage that Hunter derived
from -want of education; how much less a man he would
have been had he learnt more in his boyhood. No doubt
very much depends on the nature of the subjects taught,
and stiLl more on the method of instruction. But I confess
that to me it seems the education, of whatever kind, must
indeed be a very bad one which isnot better than none at all.
My conviction is that ifHnffter had received a good general
etfoeatiori in early years, he wonld have been all the better
forifc. He would nave lost nothing; his mental powers could
have been in ho way impaired -on tbe contrary, enhanced.
He qrtjruld hive'' recorded the result of his labours in better
jigfc t and greater effect; and we should
have hadthe sovittftage Oft dearer revelation of his thoughts.

But all this is very far from saying that Hunter was not,
in tbe strictest sense, an educated man. He was not, indeed, a
echolar. If the subtle rendering of a Greek poet or the
skilful turning of Latin verse be tbe sole test of culture, he
gave no sign of it. Of ancient lore he was sadly destitute.
In literia humanioribiu he coaid have had no place. But if a
transcendent knowledge of Nature and her ways, if a firm
and ample grasp of her noblest truths, be accounted educa¬
tion, if the devotion through a lifetime of gigantic in-
tellectualpowers and of a truly loving heart to the reverent
study of God’s works be culture, then Hunter, though not a
man of letters, was surely a highly educated man.

I do not think that we can now obtain a closer view of
the character of Hunter and of his habit of work than that
which is afforded by his letters to Jenner. How entirely
destitute they are ot any trace of literary skill. Even after
some correction, howclumsilyandawkwardlytbeyarefor the
most part expressed; evidently not a passing thought
bestowed on their composition. But how they always
struggle, often how straight they go, to tbe point. Always
full of the subject of his work, they must thoroughly reflect
the disposition of his mind at the time he wrote them.
Careless of all form, and of everything else, save to get out
of Jenner some information he wanted; now seeking directly
for some knowledge which he believed Jenner to possess;
now suggesting some inquiry that Jenner might make for
him; sometimes plainly dictating the method of it; then
begging boldly for some animal or other specimen which he
coveted; occasionally only a word of persuasion or an-
couragement, or even an attempt at bribery, lest Jenner
should grow weary of well-doing. All outside matters,
whether public or private or domestic, ignored ; except at
rare intervals, when it is comical to see, as anyone may
easily, that a sense of unbecoming neglect of these small
ceremonies strikes him, and then we are surprised by some
polite sentence in conclusion. Once, indeed, there is an
attempt to console Jenner for some disappointment in love
by the assurance “ I shall employ you with hedgehogs.”
But the whole correspondence tells a simple tale of indefatig¬
able industry, of unquenchable energy, of singleness of?/
purpose and unbounded sacrifice; of determination, heedless-,
of cost and difficulty and all else, to seize every possible,
opportunity of accumulating knowledge.

The fame of Hnnter, after all, falls far short of him. It .
may, without exaggeration, be said that he is really greater--
than to most men, even to most surgeons, he appears to be. _
And the reason of this is not far to seek. Neither the genius
nor the labour of Hunter is of a kind that at once strikes
the inquirer, or can be readily understood by the student..
He made no startling discovery, in the popular acceptation
of the term, which can be discerned at a glance and appre¬
ciated by everyone. As we follow, one after another, tbe .
successive, or oftentimes, as they really were, the timnl- .
taneous works of Hunter, we may remark the absence of
any apparently great intellectual feats; we are never
dazzled by the brilliancy of particular achievements. We .
may, indeed, say of very much of what he did that it migbb
have been produced by any very intelligent, thoughtful, and
industrious man devoted to his subject. With regard to .,
separate portions of it, we can very rarely go beyond this,
and exclaim, as a famous author tells us that be did, as he
threw down his pen over one of his own passages, “By Jove,.,,
that is a stroke of real genius.” In this respect, Hunter
will not compare favourably with some far below him in
scientific rank. His work, in order to be fully appreciated,
must be studied throughout. It is not, of course, of uniform ’
excellence. But Hunter’s fame does not rest altogether on any
particular part; indeed, it may be said that any particular pait-
might he withdrawn without any material loss to our esti¬
mate of his power. We might select examples of it to illus¬
trate his ability in this or that direction—as, for instance, hie
skill in inquiry, to hisresearcheson theincreaseof temperature
in inflammation, and his experiments on the transplantation
of the cockspur, and on the growth of bones; his sagacity,
to his inference, from the character of their contractility,
that the arteries are muscular; the soundness of his judg¬
ment, to his reflections on the coagulation of tbe blood. Buti
I venture to think that no separate fraction of his work will
enable us to grasp his conception of the plan on which
surgery should be studied, or the progress which, in a few-
short years, he actually made in its execution. It is only-
after a review of the whole of his vast labours in their
mutual relation—not merely after a study of the merits of
his numerous papers, each taken by itself, but in an attempt

358 Tkk Lakcxt,} DR. J. WILLIAMS ON CANCER OF TEE UTE&U£. [Fra. 19,, 1887.

to apprehend the scheme to which,as it appears to me, all his
labours were subservient—that we are, in any measure, able
to realise the strength of Hunter’s genius.

, Then, as the chief merit of his work is not of a character
to Catch at once the eye, even of one who searches for it,
sp his subject is not one of widespread or popular interest.
I can well imagine that, of all men who have achieved
greatness. Hunter requires to be studied with most dili-

K j. The more so because of the absence of all literary
And there can be no doubt that he shared the fate of
all those who have been, like him, in advance of their time.
He was so far beyond his contemporaries as to be, for the
most part, out of their reach, and therefore they left him
alone. And even his successors have not always found him
out. It may, indeed, be said to have been almost by an
accident that in association with the possession of his Museum
we have periodically a festival in honour of his memory.
Yet, even with all this, how much time is devoted at the

f iresent day to the study of his works? Nay, dare I ask the
urtheer question here. Can every one of us who call our¬
selves surgeons say that he has read them?

Such then, at least in the eyes of one who, though from
afar, has long and earnestly looked up to him, was John
Hunter. Beyond all cavil, if the word have any meaning
for us, a man of genius; a man supremely endowed with
power and faculties for the discovery of truth. With little
education at the outset of life, without the advantage of
the schools, be found himself face to face with tho deepest
and most mysterious problems of Nature. And he was
forthwith able to take full measure of the magnitude of
the task. It seems never to have occurred to him that
he could snatch an answer by surprise; that a solution
could be reached by any short or sudden means. But
his survey assured him that upon one plan only, but
by that abundantly, could success be made certain. So
with patience, which uf itself has been called genius, he
went back to the beginning. It was genius* too, and that of
the highest order, to discern at so vast a distance where that
beginning lay. But there he placed himself, and from that
point went forward only when he had made each footstep
sure. Who shall say that bis imagination was not fertile
or that he faltered in the use of it ? Yet no seductive theory
tempted him into undue haste; and though sometimes
drawn aside by a specious speculation, he seems hardly ever
to have been lost in an unsound conclusion. And when he
fell, the treasures he had won were found not only in the
multitude of facts he had garnered, or even in the principles,
which by virtue of the facts he had discovered were made
plain; but also in the very plan and purpose of his work.
For from the height on which at length be stood, not only
can the path he trod be clearly traced, but the highway
thenceforward is disclosed. So is the greatness of John
Hunter to be estimated, not only by what he discovered,
but rather by the lesson and example of his work.
Truly it may be said of him that he did much. Truly it
may be said of him that he showed how much more is to
be done.

“ He, being dead, yet speaketh ’’—still speaks to us as no
other man before or since has spoken. But when and where
can his voice be heard most plainly ? Are the spirits of
those who have shaken off “ this muddy vesture of decay "

i iermitted to revisit the scenes of their earthly labours?
Jan they still be with us on our way ? If the soul of this
mighty son of science is ever in our midst, surely his
favourite haunt must be now within these walls—in the
Museum which will soon almost surround us—at once his
most graphic and glorious monument. The memory of
Hunter, like the memory of the greatest men of every
age, is imperishably enshriued. Art, in her noblest
efforts, has striven- to make his form familiar to us. His
name is stamped in indelible characters on the records of
human progress. But, before all, he lives in and draws the
breath of life from his own immortal works; and of these,
none can be so truly a memorial of the very man as this; no
other can so resemble him, can possess so much of him, can
tell so fully of what he was; can so perpetuate him in the
vast store of facts, in the purpose for which they are set
forth, in the illustration of principles, in the suggestion of
truths beyond those it can show, above those it can reach ; in
all this, I say, no memorial, however majestic, can rival our
Museum. The foundation of this with his own hand and
his whole heart he laid; it has grown, and still is growing,
from his strength, and it must oe made for ever worthy of
his name, .

f)arlrran factors

os , '

CANCER OF THE UTERUS.

Br J. WILLIAMS, M.D. Lora., F.R.C.P.,

0B3TKTKIC PHYSICIAN TO UXIVKOSITV CQLLEOK HOSPITAL, LOHDOir.

LECTURE III.

(Concluded from page 903.) ■

Micboscopically, thore are two forms of oanoerous disease
of the body as of the cervix—adenoma and true cancer. The
changes in the glands in adenoma are of two kinds: the
cells may retain pretty much the character of the epithelium
of the glands in health, or they may be somewhat smaller,
but regularly formed, or they maybe larger. Dr. Matthews
Duncan first described a case of adenoma of tho body of the
uterus; the disease was polypoid, and Was remove 1. In true
cancer, the cells lose their shape, becoming angular, many-
nucleated, and fill the lumen of the glands. The changes
often call to mind scirrhus; and Mr. Stanley Boyd, after
examining such a case for me, and finding In the growing
part that the disease grew from the glands, suggested that
all cancers of the body were columnar epithelioma. This
has been shown to be so; for of all the cases examined
by Huge and Veit and myself there was no instance in which
the disease grew from anything but the epithelium of the
glands or of the surface. The direction which the growth
takes is similar in some respects to that taken when it
attacks the cervix primarily. It involves the whole surface
of the body, but tends to respect the cervix. In the later
stages, however, it passes beyond the inner orifice and
attacks the cervix, and extends down as far as the
os externum. It spreads deeply, involves the muscular
wall, and may pass through it, giving rise to inflammatory
exudation on the peritoneal surface and adhesions to neigh¬
bouring organs, and then it invades the adherent parts. In
one of my cases it had opened the intestine; in another it
had all but caused a fistula between the siqpll intestine and
uterus ; and in one it had passed through the uterine wall
into the broad ligament, where it had formed a considerable
tumour. The glands affected are those in the broad liga¬
ment and those along the spinal column. Secondary
deposits may be present in many organs—as the lungs, liver,
and kidneys. Its structure is always glandular.

In all my cases the disease began after the menopause.
One patient was fifty-three years of age, one fifty-four, and
one sixty-three. Of Ruge and Veit’s cases two were under
forty, the youngest being thirty-two. One was between
forty and fifty, six were between fifty and sixty, and seven
were bet ween sixty and seventy. So that the disease is rare
under fifty and before the menopause, and about as frequent
between fifty and sixty as between sixty and seventy.

With regard to childhearing, five women had never been
pregnant, four had had one child, and nine had been
pregnant twice or oftener. So that we find thirteen out of
eighteen had been pregnant and five had not, showing a
much larger proportion of sterile women suffering from
cancer of the body than from cancer of the cervix.

Hiemorrhage is the symptom which usually attracts the
patient’s attention and points to the existence of the disease.
After the menopause bleeding sets in, and frequently returns
at tolerably regular intervals, and women think that men -
struation has returned. It is often profuse, but sometimes
only slight. It is said to increase as the disease progresses.
It is, however, not characteristic, for it is present in the
endometritis of old age, and in certain forms of ulceration
of the cavity of the body called lupus. There is generally
present an offensive discharge.

Pain is a common symptom; and in some cases it comes
on at stated hours and lasts for a longer or shorter time, and
is of great severity, as was pointed out by Simpson. It is
believed to be due to contraction of the uterus. In all my
cases cachexia was present in a marked degree.

I regret to have to pass over these matters so briefly, but
it appeared to me that the questions I have discussed in
I the previous lectures are of far greater importance in their
i bearing upon the great aim of practitioners than the

Txb IU-nc**,]

MLJ. WILLIAMS ON CANCER OF THE UTERUS.

[Fbb. 19,1887. 369

enumeration or; the ilisoaaaion of symptomsto be found in
oil works on the diseases of worsen, and I therefore felt it
necessary todevote most of the time at my disposal to them,
i most now point out the bearing of what I have already said
«ipnw treatment.

1 do not propose to. discuss the palliative treatment
of cance r of. the uterus. - With this you are all well
acquainted from^exparienee ia>your own'pmctioes. It is
the common property of all practitioners, and is in the
miiin fully giyen in all works on medicine, and the part of
it which is specially applicable to cancer of the uterus is
giren in all works on 1 the' diseases of women. It consists
mainly in the relief of pain and .the praotice of cleanli-
oees, while in soaespecial cases particular means may
he Called for to arreet hiBmorrhage and other dischargee.
These I pass by, and proceed to discuss the radical methods
of treatment which have been practised during the last ten
years. These, methods are two-—the supra-vaginal-amputa¬
tion of the eeCvix and the total extirpation of the uterus.
Freund of Stnsbnig introduced or reintroduced total extir¬
pation into praotioB/same dozenyesrsi ago. He practised it
by abdominal seed on, and the results of this method proved
disastrous, the mortality from it amounting to 72 per cant,
at least. This method was modified by Czerny and others,
who amputated the cervix by the vagina first, and then per¬
formed abdominal section to remove the 'remainder of the
uterus, i Sohroeder subsequently described what is known
as the vaginal method; in which the whole ;of the organ is
removed through the vaginal oanal; and by this method
much greater sucoeae has been obtained, so far as the imme¬
diate mortality after the operation is concerned, than by
the abdominal, for about 72 per omit, of the cases operated
upon recover from the operation.

Amputation of the cervix has been practised for many
years, bat only recently in the way . it is done now. I am
not going to describe these operations further than I am
obliged to, but I want to show the bearing of what I have
told you in these lectures upon the application of the two
methods—total extirpation and partial extirpation of the
uterus. That you may follow me, I must remind you of
what I said about the sites of origin of cancer and the lines
of its growth. And, in the first place, cancer of the vaginal
portion begins in the ; squamous epithelium; it i9 superficial,
and remains superficial for a long time; it spreads towards
the vaginal vault and along the vaginal walls superficially.
In these eases the whole of the disease, provided it is
limited to the uterus, can easily be removed; indeed, in
most cases, if the lower half of the cervix be removed, the
disease will be extirpated from the uterus. The difficulty
arises after the disease has spread beyond the limits of the
portio vaginalis into the vaginal vault, and lies in the
obstacles to the removal of a large superficial area, owing
to the conformation of the parts—the near proximity of the
'bladder and ureters especially. Many cases nave been cured
by amputation of the cervix, or of a portion of it, with
the ficraseur. Recurrence takes place superficially at the
edge of the cicatrix, and not in the deeper structures, and
consequently no advantage would be gained by total extir¬
pation of the uterus.

In the next place, we have to discuss the applicability of
total and partial extirpation to cases of cancer of the cervix
proper, first of all, in the light of pathology. In the last
lecture I pointed out that cancer may begin in the cervix in
two situations—in the lower part near the external orifice,
or in the upper part near the internal orifice. 1 showed
that the tendency of the disease was to grow downwards
towards the portio vaginalis, and outwards towards the
parametric connective tissue. It does not spread upwards
into the body of the uterus except in rare instances and
in the late stages of the disease, when no operation can
be undertaken with any hope of effecting a radical cure.
Before it has involved the whole of the cervix, it has
probably in some places invaded the parametric tissues,
and this is the- case long before the body is attacked.
Under these circumstances, what are the advantages, if any,
of -total over partial extirpation ? The lines of incision
in the vaginal walls can be made in the same situation
in amputation of the cervix OS in the operation for
total extirpation, so -‘that in this respect total extirpa¬
tion has no "advantage over the minor procedure. Then,
in botfc hpmwtiois the i. dissection itt front is made in
tha eethdarttame. between to# tttJerue and the bladder. It
is gttmalUyi tfi 'teat 7 twrpugh this tissue after the

vsgiaol W*a*J»T*P beeft"cut- 'though. The dissection cab

be made in both operations as far as the reflexion of the
peritoneum from the uterus on to the bladder. On the
sides, again, the dissection can be made at the same distance
from the uterus in amputation of the cervix as in total
extirpation. With regard to the dissection posteriorly the
proceeding is usually somewhat different in the two opera¬
tions. In the minor operation the. vaginal wall is divided
as far as the peritoneum, but the peritoneum is not opened;
it is peeled on up to the point where it is firmly adherent
to the wall of the uterus. In the major operation the peri¬
toneum is opened over the place where the incision is made
in the vagina. This in many cases—cases in which the
disease has involved ths posterior wall of the cervix deeply,
and invaded the parametric tissue—is a distinct advantage.
It is, however, an advantage which can be made available
in the minor operation; for in amputation of the cervix the
peritoneum is often deliberately opened, and this does not
appear to add greatly to the risk incurred. As far as we
have gone, then, total amputation presents no advantage
over supra-vaginal amputation.

But what are the facts with regard to the entire removal
of the disease from the uterus itself, and the prevention of
recurrence. How much of the uterus can be removed by the
minor or less severe operation? Can enough be removed to
ensure prevention of recurrence? In reply to the first
question, I say the whole of the cervix can be easily removed,
and a great part of the body can also be removed. When
the reflexion of the peritoneum has been reached, the dis¬
section can be carried up in the uterine wall near the peri¬
toneal surface, and a cone-shaped piece of the body
reaching up to the fundus can be cut out. This was done in
Case 16. Iq that instance the mucous membrane of the
fundus was removed, together with that at the internal
orifices of the Fallopian tubes. This was done without
injury to the peritoneum; so that the entire uterus can be
removed, except a shell of the upper part of the body. But
is this suffloient to prevent recurrence? Is the risk of re¬
currence greater or not when a part of the uterus is left
behind? I believe it is not any greater, and on-grounds
which appear to me to be sufficient; for in six cases in which
recurrence took place, in four the stump remained healthy,
and in one it was superficially and clearly secondarily
affected. In all recurrence took place in the parametrie
tissue, and in four in that only. This evidence points
clearly to the possibility of extirpating cancer entirely
from the uterus by supra-vaginal amputation, and shows
that, in so far as the prevention of recurrence in the uteru9
is concerned, total extirpation of the uterus presents no
advantages over partial amputation. But how about recur¬
rence in the parametrium? Will total extirpation help us
to prevent this mode of recurrence more than amputation
of the cervix? 1 think not, l have shown that the line of
dissection around the cervix up to the level of the inner
orifice or the reflexion of the peritoneum is the same in
both operations; that the peritoneum can he and often is
opened at the same level frequently In amputation of the
cervix, as in the operation for removal of the Whole uterus;
that, in fact, the tissues in the area of recurrence are cut
through in the same planes'in both operations, and there¬
fore that one presents no advantage over the other. It has
been suggested, however, apd I believe practised, to remove
a portion of the bladder when the cancer has invaded the
connective tissue between that organ and the uterus. This
could be d°no in the minor operation without increased
risk; but I imagine that it would greatly enhance the
danger of the operation for total removal of the uterus. So
that, if anything is to be gained by such a procedure, this
gain would he in favour of the minor operation. I doubt,
however, whether such a proceeding would be likely to
possess any advantage over the ordinary method.

In so far, thfen, as the natural history of cancer of the
portio vaginalis and of the cervix throws light upon the value
of operations for its cure, it appears that supra-vaginal
amputation of the cervix is quite as satisfactory an opera¬
tion as the removal of the entire uterus. But what does the
experience of operators tell us on this point ? Does it accord
with the conclusions we have arrived at upon pathological
grounds ? A large number of patients have been operated
upon for Cancer as well as for other conditions, and the
results of the operation have been recorded in societies or
published in journals soon afterwards, and long before the
cases were completed tyy observation of .the permanent results.
All these cases are absolutely of no value' for our purpose, t
cannot conceive any good object in operating upon a patient

360 The Lancet,]

DB. J. WILLIAMS ON CANCER OP THE UTELOS.

[Feb. 19,1887.

on a Monday and reporting the case on a Thursday and then
burying it out of eight few ever. The cases which have been
watched for years after operations for cancer are com¬
paratively few. I do not profess to know them all, and I
shall therefore take the results obtained in the Vienna
Hospital published by Pawlik and those of Schroeder
published by Hofmeier. They are the largest and most
complete. Those of Martin or Berlin and those of Fritsch
of Breslau are for my purpose and for purely scientific pur¬
poses valueless, because the cases had not been watched for
a sufficient length of time to determine whether recurrence
took place or not. They are useful for the purpose of
estimating the mortality of total extirpation only.

Recurrence may take place early or late, but if a consider¬
able time has elapsed before its appearance it may be inferred
that the reappearance is not a recurrence, but a new develop¬
ment ; for just as a new development of cancer may take
place in a part of the body quite independently of cancer in
another part, so may a new growth appear in the stump of
a uterus whose cervix had been amputated for cancer
independently of the cancer which was removed. I con¬
sider, and I believe justly, that if recurrence does not take
place in the course of two years a cure has been effected,
and that should the disease break out after the lapse of that
time the new growth is not a real recurrence, but a new
development. Bearing this in mind, we find that Pawlik
reports thirty-one cases of cancer of the portio and cervix
which were cured by amputation of the cervix. One hundred
and thirty-Bix cases were operated upon. Of these thirty-three
remained in goodhealthatperiodsvaryingfrom one to twenty
y oars af ter t he operation. Pawlik operated by means of the gal-
vanic Scraseur, and opened the peritoneum thirty-nine times.
Of 105 partial operations performed by Schroeder ten died;
the fate of seven is doubtful; recurrence took place in forty-
three during the first year, and forty-five remained well;
thirty-one remained well at the end of two years; twenty-
three remained well at the end of three years; one had died
of cancer of the bones, one of cancer of the ovary, and
three had recurrence, the state of one was doubtful, and
two were lost sight of. If we now compare this result with
that of total extirpation in Schroeder’s hands, we find the
uterus extirpated during the same period in forty cases, with
ten deaths. Recurrence took place in fifteen during the first
year, and one was lost sight of, leaving fourteen healthy at
the beginning of the second year. Recurrence took place
in seven during the second year, and in one case the point
was doubtful. Four were known to be healthy. We have
therefore about 30 per cent, in good health after partial
operation, and only ten after total operation—that is, of
those operated upon; and nearly 35 per cent, of those who
recovered after partial operation, and 13 per cent, after total
extirpation. It should not be forgotten that these cases of
total extirpation were cases of more advanced disease than
those in which partial extirpation was performed; or, at
least, that they were cases in which the disease had involved
the uterus to such an extent that partial amputation was
thought to be insufficient.

Hofmeier, who reports Schroeder’s cases, divides cancer of
the lower segment of the uterus into cancer of the portio,
cancer of the mucous membrane of the cervix, and cancer of
the cervical tissue. For cancer of the portio he advocates
amputation of the cervix; for the other forms, total extir¬
pation of the uterus. All the cases in which he had observed
a long and lasting recovery after total extirpation were cancer
of the mucous membrane. The results obtained in cases of
cancer of the cervical tissues are much more unfavourable.
He states that “ this form of cancer is not discovered until
it has existed for a long time, until ulceration has taken
place, total extirpation is indicated for the disease may have
extended into the body. The prognosis is very unfavourable,
and recurrence is most frequent in them.” I cannot accept
HofmeieFs classification of cancer of the lower segment;
but it should be said that his paper is purely clinical, and
not in any sense pathological, so that I lay but little stress
upon his division. He does not describe the seat of the
recurrence, but as the whole uterus was removed it must
have taken place in the parametrium, and in so far his
observations are in accord with mine; and as the recurrence
takes place not in uterine but in connective tissue, it
cannot be said that total extirpation is indicated in these
' cases. Moreover, he shows that of the forty-three cases
in which recurrence took place during the first year after
partial amputation, in only two did the recurrence take
place in the uterine stump. In all the others its seat was

the cellular tissue, and therefore, as a rule, total extirpation
is not indicated. Clinical experience appears, therefore, to
point to the same conclusion as pathological investigation—
that is, that in cancer of the portio vaginalis and cervix total
extirpation of the uterus possesses no advantages over
supra-vaginal amputation of the cervix, because the tend eucy
of the disease is, not to invade the body of the uterus, bat
the parametric tissues. In cancer of the uterine body there
is but one operative procedure whioh holds out any hope
of a radical cure, and that is total extirpation.

There is one other question in connexion with the opera¬
tive treatment of oancer of the uterus ujfcn which I wish
to make a few observations, and that is the indication for
operating. All cases of cancer should be operated upon
provided they are met with at a period sufficiently early to
justify the hope of effecting a radical cure. But what
are the physical signs whieh justify this hope ? The patho¬
logical condition which justifies it—be the cancer in
the portio vaginalis, the cervix, or the body — is that
the disease has not passed beyond the uterine tissues.
This, however, is not easily discovered either before
or during the operation. Frequently, indeed, the after-
results prove that it was too late, even in cases which
appeared to be favourable. The physical signs generally
relied upon are mobility of the uterus, absence of induration
around it, and absence of affection of the glands, in
endeavouring to establish these points, the examination
should be made under an anaesthetic, and the whole pelvic
should be explored by the vagina and by the rectum. In
spite of every care, however, clinical investigation may
mislead, because the disease may have passed beyond the
limits of the uterus and yet give rise to none of the physical
signs mentioned. The pathological condition present is
most easily established by clinical examination in cancer
of tbe portio, for when the disease has reached the vaginal
vault it gives rise to superficial induration at the place
invaded, and this is more easily discovered than when
induration of a slight degree is present in deeper tissues. In
such cases, and indeed in all cases, the rule should be to
make the incision in the vaginal wall wide of the indurated
part. In this means alone lies any hope of preventing
recurrence.

In cancer of the cervix proper the investigation is muds
more difficult, for the uterus may be freely movable, th»
mobility of the organ may be unimpaired, no indurated tissue
may be discovered, and no enlarged glands may be found,
and yet the disease may have passed into the cellular tissue
around the cervix. I have seen several such cases, and in
them the tissues through which the incisions were made
appeared to be healthy. I know of no way in which the
difficulty can be overcome. Coarse induration can be
readily discovered—that points to an advanced stage of
cancer; but the commencement of infection of the para¬
metric connective tissue will escape the most sensitive and
cultivated touch. If the parametrium is free, no anxiety
need be felt about the degree of extension of cancer upwards
towards the body. It can be entirely extirpated m that
direction. The difficulty is to extirpate it in a lateral
direction, according to both pathological and clinical
research. The difficulty is sometimes just as great in cases
of cancer of the body. The tendency in these cases is t»
invade the broad ligaments and peritoneum or adherent
intestines. I have seen one case in which the uterus was
movable without surrounding induration or large glands,
and yet tbe fundus was adherent to a coil of small intestines,
and the disease had invaded the wall of the intestine and
almost formed a utero-intestinal fistula. This patient was
examined under ether, and vet the condition escaped
detection. In spite of these difficulties, and in spite of
recurrence, the operative treatment of cancer gives in many
respects satisfactory results, and this is especially true of
cancer of the portio vaginalis and cervix. Sometimes
permanent cures are effected, while in a large number a
respite for one or more years is given. In Schroeder’s
cases the respites were as follows: Of 105 partial opera¬
tions, 10 died, the fate of 7 was doubtful, and recurrence took
place in 43 during the first year; so that 45 had a respite of
one year, 41 of eighteen months, 31 of two years, 27 of two

ears and a half, 23 of three years, 17 of three years and a

alf, 10 of four years, 7 of four years and a half, 7 of five
years, 3 of six years, and 1 of seven years. Besides these cases,
which remained under observation, many were lost sight
of and their fate was not known. Of 40 total extirpations
10 died, 14 had a respite of one year, 8 of eighteen months.

Digitized by G00Qle

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DR. J. S. BRISTOWE: CASES OF GALL-STONES.

[Feb. 19,1887. 3M

4 of two yean, 2 of three yean, 1 of three yean and a half,
tad 1 of four yean and died of apoplexy.

1 thought at one time that recurrence caused more and
earlier suffering than the primary disease, because it
affected the deeper tissues sooner than the primary disease
would have done, but a larger experience of such cases has
convinced me that 1 was in error, and that the pain depends
on some peculiarity in the patient or in the disease, for many
recurrences are painless. 1 cannot speak of the duration of
the disease after recurrence. I have not a sufficient number
of cases, but I have seen it last from four to eighteen months.
It is not impossible that a more careful study of the patho¬
logy and natural history of cancer of the uterus will help us
much further in its diagnosis and treatment, and the earlier
we are enabled to make the diagnosis the more successful
will our treatment prove. No haphazard and blind pro¬
cedures of treatment will prove of any avail; the only
method which can give us a sound and firm basis upon which
to build is patient study in the laboratory as well as at the
bedside; and although I would in no way depreciate clinical
research, yet I cannot help thinking that the investigations
conducted in the laboratory, in the present state of our
knowledge, are the more likely means to give us light upon
cancer of the uterus—to elucidate the laws which govern its
development and growth, as well as those which should guide
ns in our treatment.

CASES OF GALL-STONES, WITH REMARKS . 1

By J. S. BRISTOWE, M.D., LL.D., FJLS.

Thjb subject of gall-stones is always one of great practical
interest, but it is much too large to be dealt with exhaus¬
tively in a short paper. I prefer on this occasion only to
bring under notice two cases of special interest which
have come under my care during the last year or two—cases
which illustrate in different ways the phenomena which
attend the escape of gall-stones by ulceration from the
cavities or channels in which they are formed. The first
case is one in which jaundice (due to partial obstruction to
the flow of bile from the liver) of twenty years’ duration
was followed by the formation of an abscess in the lower
part of the right side of the abdomen, and the escape,
together with pus, of large quantities, not of trae gall¬
stones, but of biliary gravel. The second case is one of the
escape through an ulcerated opening of a large gall-stone
from the gall-bladder into the duodenum, and of death
from consequent obstruction of the small intestine.

Case 1. Gall-stones and gravel causing suppuration, and
discharged through the abdominal walls below the level of

the umbilicus .—Ann A-, unmarried, a governess, aged

thirty-eight, came under my care on May 16th, 1884. Had
always had weak health. Had rheumatic fever when six
yean old, and when twenty if second attack followed by
typhoid fever. As long as she could recollect she had been
liable to “ spasms” commencing in the left hypochondriac
region, and extending thence obliquely into the right lumbar
region. Had been jaundiced for twenty years, the jaundice
varying in intensity, but never disappearing. Her illness
dated from the previous October, when she bad an attack
of “ spasms ” lasting for ten days, which left her very weak.
After this she first discovered a small lump on the right
side of the abdomen. This tumour had been enlarging
ever since. Owing to constant pain in the situation
of the tumour and to debility, she took to bed, and only left
it in order to come from the country to the hospital. The
journey caused great aggravation of pain.

The patient was spare, but not markedly emaciated; pale,
and quite obviously, though not deeply, jaundiced. The
conjunctive were yellow. The abdomen was not generally
distended or hard; but on the right side, extending vertically
from a little above the level of the umbilicus above to the
groin below, transversely from the left of the mesial line to
the anterior superior spine of the right ilium, and having a
superficial extent about equal to that of the palm of the
band, was a hard mass, the edges of which were not very
well defined, sad which appeared to be incorporated with

i Paper rmi at the meeting of the Hertfordshire District of the
MSwp o BtM Oonntlee Branch of the British Medical Association,

Isr.Mk 188 CJ

the deeper parts of the anterior abdominal walls. It did
not move with respiration or under the skin; but it moved
with the movements of the abdominal walls. It was
slightly nodulated, the more prominent parts seeming to
infiltrate the parietos as if coming to the surface. It was
dull on percussion, and no resonance could be obtained
between it and the liver. She complained that it was
tender, and after it had been handled she suffered from
much lancinating pain in it. Tongue clean, appetite poor;
thoracic organs all healthy. Catamenia regular; urine of
specific gravity 1030, and containing neither sugar, albumen,
nor bile. No enlargement or disease of any organ within the
abdomen could be detected; and at this time it was
uncertain whether we had to do with a malignant tumour
invading the abdominal walls or a suppurating inflammatory
mass. Against the latter view were the facts that the
tumour had been growing for six months, that it was uni¬
formly hard and tree from all sense of fluctuation, and that
the temperature was scarcely above the normal.

During the ensuing twelve days the patient’s general
health improved; and, indeed, on the whole she seemed
fairly well, excepting that she suffered at times from severe
pain in the tumour, which had to be allayed by morphia
injections. During this time, however, the tumour got
more tender, and therefore more difficult to examine; it
enlarged somewhat; it became more definitely adherent to
the skin at two or three points, and the akin in these
situations presented a blush of redness. At length one of
the prominences became somewhat yielding, and, although
it did not fluctuate, it was thought well, on consultation (on
March 27th) with Mr. 8ydney Jones, to make an exploratory
puncture. A email incision was made, and a few drops of
thick pus oozed away. A probe was then inserted for a
couple of inches or so. It passed pretty easily in two or
three directions, not into any definite cavity, but apparently
through tissues infiltrated with pus. A deep incision about
two inches long was then made; and thence a considerable
quantity of thick pus escaped.

Up to this time the temperature, though generally normal,
had been in the habit of rising occasionally to 100° or 101°;
but after the operation all traces of fever disappeared; the
health and appetite improved; she lost the abdominal pain;
a slight discharge of pus continued; and the tumour
diminished markedly.

On the morning of June 3rd, on removing the poultice,
several rounded black bodies, varying from the size of a
coriander-seed downwards, were for the first time found in
the discharge. These were rough on the surface, and readily
crumbled between the finger and thumb into a coarse
powder. They were insoluble iu ether and in chloroform,
and gave the reaction of bile when treated with nitric acid;
they were obviously biliary concretions. From this time
scarcely a day passed in which a greater or smaller number
of biliary concretions failed to be discharged. They varied
from mere dust to friable masses as large as a small
pea, and, like those first observed, were always black and
structureless, and formed essentially of biliary colouring
matter.

As (although the patient’s health continued to improve,
and the abdominal pain, tenderness, and lump had all much
diminished) the discharge of pus and of biliary concretions
continued, it was determined at a second consultation with
Mr. Jones to enlarge the incision (now partly healed) in the
upward direction towards the gall-bladder, in order, if
possible, to remove the accumulation of concretions which
were obviously retarding the patient’s recovery.

On June 24th the patient was put under the influence of
ether, and Mr. Janes passed a probe through the wound
upwards and to the left to a point two inches to the right
of the umbilicus and half an inch below it. He then slit up
the sinus, and from its upper point passed his finger into
a prolongation of it, whicn extended upwards in the pre¬
sumed direction of the gall-bladder. The tissues around
were dense and cicatricial in character; and in the sinuses
themselves, and mainly in the upper one, were found large
numbers of friable calculi and much biliary gravel of tne
same kind as those that had been previously discharged.
The wound and its diverticula were washed out freely
with a weak solution of carbolic acrid, and a drainage-tube
was then inserted. The patient took the ether badly,
became very blue during the operation, and at the end of
it almost ceased breathing, and had to be revived by arti¬
ficial respiration. She fainted several times during the
evening, and afterwards suffered from sickness. A good deal

882 Thb Lancet,]

DR. J. S. 0RISTOWE: CASES OF GALL-STONES.

[Fed. 19,186T.

of biliary fluid woe discharged from the wound in the course
of the afternoon and evening.

For about a fortnight after the operation she continued
very weak, suffered a good deal from pain in the wound, and
in the abdomen in its neighbourhood, and often fainted
two or three times a day. Then she began to improve in
health manifestly, and to gain flesh and strength, and on
August 10th sat up for the first time. After this her progress
towards health was rapid, and almost uninterrupted.

Notwithstanding the great amount of calculous matter
removed at the operation, large quantities of calculi, vary¬
ing from rounded aggregates a quarter or one-third of an
inch in diameter to grains like those of ground pepper,
escaped daily from the wound with the fluid discharge. From
twenty-five to fifty were not unfrequently discovered daily.
The abdominal hardness gradually decreased, and the wound
healed excepting at its upper point, where a drainage-tube
was retained, and the fluid discharge escaped. The yield
of stones diminished latterly, and none were observed after
Sept. 19th. The sinus remained open, however, and dis¬
charged a good deal of thin colourless fluid as long as the
patient remained in the hospital.

On Sept. 10th she had an attack of severe lancinating

K in the left hypochondrium, which lasted for about an
1 and a half, and was followed bv diarrhoea, and it was
thought some increase of jaundice. She said the attack was
exactly like those to which she had been liable.

The patient left the hospital on Sept. 30th, still with a
small weeping sinus, but in good flesh, much improved in j
strength, and able to walk about, healthy in appetite, free
from abdominal pain, and cheerful. But she was still
jaundiced, as she had been all along. The skin had a pale
brown tint, and the conjunctivas were distinctly yellow. But
there was not, and there never had been, any bile in the
urine. The concretions discharged from the wound on several
occasions were very carefully examined, both chemically and
microscopically, and proved to consist almost exclusively
of biliary colouring matter. I have not seen, but have several
timeB beard of, the patient since she left the hospital, and
believe that she remains well.

It is, of course, not uncommon for ulceration to take place
in the gall-bladder, in consequence of the presence of stones
in it, and for these to be discharged from an ulcerated
opening over the site of the inflamed cyst. But the case just
narrated is not an ordinary one of this class, because: first,
there was a history of biliary obstruction of twenty years’
duration, which was not removed by the treatment which
relieved the patient in other respects; second, the local
evidences of inflammatory thickening and suppuration ap¬
peared at a considerable distance from the situation in which
they might have been expected to show themselves; and
third, tne concretions which escaped were not ordinary
gall-stones, but amorphous granules of biliary colouring
matter.

Abscesses arising in the abdomen not unfrequently present
in situations which are remote from their seat of origin,
and especially have a tendency to gravitate into the
venter ilei or pelvis. And more than once I have seen an
abscess of the liver which had communicated with the
cavity of the lesser omentum, or had opened into its sub¬
stance, lead to considerable inflammatory thickening of the
implicated tissues and their permeation with sinuses, to
adhesion between them and the abdominal walls, and Anally
to perforation of the latter at or near the umbilicus. In
this case the inflammatory phenomena corresponded in the
main with those just described; and I am inclined to
think the abscess had been conducted downwards by the
tissue of the great omentum, and that the peculiarities
which were observed were largely determined by this cir¬
cumstance.

The concretions were amorphous, and presented a vitreous
fracture; and, if cholesterine was present in them at all, it
was present in exceedingly minute quantities. 1 never saw
such concretions in the gall-bladder, and am inclined to think
they are never found there. They were such concretions,
however, as not unfrequently form in the gall-ducts, and
tend to coalesce or grow into calculi, which become moulded
to the channels in which they lie, and usually present a
more or less tuberculated surface. I am consequently in¬
clined to think that in this case the gravel came, not from
the bladder, but from ■ the ducts j and. that the abdominal
abscess originated in ulceration of one of the ducts, probably
the hepatic or common duct.

: ' The long* duration of jaundice in this cue cannot, 1 think,

be directly explained by the passage of gall-stones, unless,
indeed, as sometimes happens, the irritation caused by
them determined the formation of a stricture at the point at
which the common duct opens into the bowel. But if such
a stricture had been an early result of the passage of a gall¬
stone from the gall-bladder, one might have expected that
the passage of subsequent stones from the gall-bladder into the
bowel would have been prevented, and that their accumula¬
tion in the common duct would long ago have led to absolute
obstruction, and to a fatal issue. But 1 could not satisfy
myself that the spasms to which the patient was liable
were typical attacks of gall-stones, or that there was any
clear evidence that the jaundice commenced with such an
attack. I am inclined, on the whole, to think that her •illness
began with a seizure of catarrhal jaundice, which induced
permanent thickening and stricture, but not complete
obstruction of the lower end of the common duct, and that,
following upon that, permanent yet variable jaundice super¬
vened, associated with general dilatation of the hepatic ducts,
and tendency for the retention of bile in them, and for the
deposition of its solid constituents in a granular form. If
this view be correct, the spasms might be referred to the
occasional passage of gravel.

I recollect a patient of mine, a middle-aged man, who
was suffering from jaundice of some years’ duration, but
who still passed bile in variable quantities into the bowel,
and died ultimately from profuse haamorrhage (I think
from the nose), whose jaundice we found after death to
have been caused by such a stricture as I have assumed to
exist in the present case, a stricture barely admitting the
passage of a very fine probe.

I may here add a remark with regard to the abundant
presence of cholesterine in gall-stones formed in the bladder.
The general belief, 1 think, is that this substance is pre¬
cipitated from the bile around solid nuclei, the origin of
which I need not now consider. But cholesterine forms a
very minute proportion of the solid constituents of the
bile; and it is odd, therefore, that the great bulk of these
calculi should consist of cholesterine with only a trace of
other bile constituents, and sometimes even of pure choles¬
terine ; and it becomes especially odd when we bear in mind
that biliary concretions formed in the ducts generally
consist of the solid constituents of the bile, and present
little or no cholesterine. Many years ago I examined a
patient in whom there was a contracted gall-bladder with
extremely thick walls. Embedded in these walls wefe a
considerable number of cavities varying between the size
of a pea and that of a bean, which were evidently dilated
mucous crypts. And within each one of these were large
crystals of pure cholesterine. These were colourless, rhom¬
boids!, varied from |t.h to Jth of an inch in breadth, and
were about the ^th of an inch thick. I was led from the
facts of this case to assume, and 1 am inclined to think,
that the bulk of the cholesterine in gall-stones formed in the
gall-bladder is derived, not from the bile, but from the
secretions discharged from the mucous surfaee.

Cask 2. Obstruction of ileum by a gall-stone: death?

necropsy .—Ann 8-, a marfied woman sixty-five years of

age, was admitted under my care on March 24th, 1885. Her
history revealed nothing of any importance, excepting that
she had had no symptoms at any time pointing to affection
of the liver or its excretory apparatus. Her illness began
on March 20th with retching and vomiting, which continued,
with varying, but on the whole increasing, severity up to-
the time I saw her. The vomit during the last two days
had been offensive. The bowels had not been relieved for
two or three days previously to the onset of her illness, and
they had not been relieved since. 1 She bad passed little
urine, and passed it only on one occasion since the 22nd. It
was then small in quantity, high-coloured, and turbid. She
is said to have had three fits on the morning of the 23rd,
in which she became cold and unconscious, but was not
convulsed. She did not seem to have had any pain.

' On admission she appeared to be well nourished, but her
face was pinched and anxious-locking, and her eyes were
sunkeh; her tongue was thickly furred; her abdomen was
full, but flaccid, and free from tumour, tenderness, and pun;
she had no hernia; the heart and lungs and her temperature
were normal. She was admitted in the evening, and the
next morning (March 25th) the following notes were
taken:—“ The patient slept well till 4 a.m., after which she
was restless; a as vomited much black grumous- looking
fluid, and had some hlcbough; had ah enema last night,
which did not act; has not rambled. She is now very

Thb Langbt,]

MB. C. B. KEBTLEY: TRANSPLANTATION BY EXCHANGE.

[Fra. 19,1887. 363

weak; still suffers from sickness, and complains of pain
•cross the upper part of the abdomen; she looks vacant, and
is fretful. Pulse 88; temperature 96’4°.” Later in the day
(thirty hours after admission) she passed for the first time
a few ounces of urine; it was high-coloured, presented a
trace of albumen and a deep indigo reaction, and its specific
gravity was 1030. Her temperature at this time was normal,
•her pulse 90, feeble and regular, her tongue dry and thickly
coated. The sickness continued.

March 26th.—Vomiting ceased at 10 p.m. yesterday; she
slept till 8 a.m., after which she rambled a good deal. Now
she seems feeble-minded and incapable of concentrating her
thoughts or of recollecting. Bhe complains of feeling sick,
and of pain in the epigastrium on breathing deeply, and is
extremely feeble. Pulse 88, weak; temperature 96'4°. A
catheter was passed yesterday evening, and twenty ounces
of urine were withdrawn. She died in the course of the
morning. She was treated mainly with opium.

Necropsy .—On opening the abdomen, the stomach and
small intestine in the greater part of its length were found
moderately distended, but the last few feet of the ileum
were contracted to the thickness of the little finger.
The duodenum was adherent to the gall-bladder and liver
in the neighbourhood. The gall-bladder itself was much
•contracted and difficult to make out. Its cavity eom-
municated by an irregular orifice with the duodenum. The
stomach and upper part of the bowel contained thin
stereoraceoua fluid. In the duodenum were two small faceted
gall-stones, and one or two other similar ones were dis¬
covered lower down. Between six inches and a foot above
the spot at which the contraction of the ileum commenced
was a rounded gall-stone about as large as a walnut.
It filled the bowel in this situation, but was not impacted
in it. The intestines above the obstruction presented small
areas of inflammation, as if the stone had been impacted from
time to time in its course downwards, and had thus irritated
the mucous membrane. The contracted portion of bowel
and the large intestine contained mucus only. All the other
abdominal viscera and the peritoneum were healthy. The
lungs were deeply congested and cedematcrus. The heart
was soft, and there was a good deal of atheroma of the
mitral and aortic valves (which, however, were competent),
and of the aorta.

The case just narrated is, I take it, a typical example of
obstruction of the bowel by a large gall-stone. It is note¬
worthy, that (as I think usually happens in such cases)
there was nothing in the previous history pointing to the
passage of gall-stones ; that the Btone, although it had
dearly caused obstruction of the bowel, was scarcely so
e, one might have thought, as to forbid its ready transit
ultimate escape from the anus; that there was never
any evidence —such as pain, tenderness, or distension—of the
presence of abdominal inflammation; and that not only was
there absence of fever, but the temperature was generally
subnormal. The patient died apparently partly of asthenia
and partly of collapse, determined by the concurrence of j
inflammation of the mucous membrane of the upper part:
of the small intestine, with obstruction of bowel, vomiting,;
and incapacity to take nourishment.

BnrUngton-atrcet, W.

TRANSPLANTATION BY EXCHANGE.

By C. B. KEETLEY, F.R.C.S.,

8XXIOR straoaoK to the west lowdoh hospital.

The title of this paper is the name I would apply to an
operation by which two portions of living tissue are made
to exchange places. The following case will illustrate the
procedure and the kind of circumstance in which it may be
advantageously employed.

In March, 1886, a female infant, aged two or three weeks,
was brought by a neighbour of its mother’s to the West
London Hospital with a request that a hairy mole covering
nearly the whpte of the left cheek might be removed. I
•explained that the result would be a contracting scar worse
than the mole, ehd seat the child away. Next .week the
neighbour returned, and Said that the mother could not
endure the'sight the large inole, and wotfld prefer a scar.
I placed fhfant’s arm agkihat its face, and was rather

dismayed to see that all the skin of the outer side of the
upper arm, from the shoulder down to the elbow, would be
required to replace the mole should I cut away the latter
and then fill in the flap by transplantation. Upon reflection,
I resolved to exchange the hairy mole of the face and the
smooth white skin of the arm. The advantages of this plan
are obvious, and especially the consideration that the mole
would give useful skin for the upper arm; but it will be
better to defer enumeration of them till the operation and
its results have been described.

On April 2nd, the little patient being anaesthetised, I first
thoroughly cleansed and disinfected the cheek and arm with
liquid potash soap (Duncan’s) and solution of parchloride
of mercury, successively. Next I marked out the flaps in
the following manner. A straight ink-line was drawn from
A to b (see illustration)^ The arm was then placed in com¬
fortable position, arching upwards over the face and head.
The wet ink on the line A b printed a second line on the
arm at c d. A paper pattern of the flap to be removed from
the face was cut, and with its aid an exactly similar flap
was marked out on the arm, so that c d h g on the arm corre¬
sponded to bab r on the face, each letter to each respectively.
Though this is a very simple matter, some care is required
in practice to avoid confusion. The knives, Bcissors, sutures,
needles, forceps, &c. f to be used lay in a tray of carbolic
lotion, but were dipped in boiled (not boiling) water imme¬
diately before use and replaced in the carbolic tray when not
actually in use. The object of this was to take care that no
erysipelas or other specific infection should be carried by the
instruments, and yet to prevent the flap and raw surfaces
from being irritated by the carbolic. The sponges had all

been thoroughly disinfected, although they were now placed
in water only. The faoe flap was reflected first. It included
the subcutaneous fat proper, which had to be carefully
separated from the cushion of fat which swells out into the
middle of the cheek from beneath the r&mus of the jaw;
and it was necessary also to cut very carefully and see
everything which was divided near the parotid and
some of the branches of the facial nerve. The struc¬
tures iu an infant’s face are, of course, comparatively
small and near to each other, and the amount of fat is,
comparatively, very considerable. Almost all the cutting
throughout the operation was done with scissors, and
not very sharp ones either. The main object of this was
that bleeding might stop rapidly, and thus dry surfaces be
obtained speedily—a very important matter in a plastic
operation. This object was entirely attained in the case 1
Sm describing. The arm flap also included the fat down to
the deep fascia. As I thought it would he somewhat diffi¬
cult to put in the sutures when the arm was up against the
face, I applied entirely distinct, but corresponding, sutures
to the arm flaps and edges of the arm wound on the one
band, and to the face flap and edges of the facial wound
on the other, and afterwards lifted the arm to the head,
placed the arm flap in the facial wound and the face flap
(containing the mole) in the arm wound, finally using the
ready-placed sutures as “tags,” which, twisted together
each to each, fixed everything with absolute security and
accuracy. But this plan, though excellent in suitable
cases, was scarcely necessary in this, and was, indeed, a
little too elaborate. The angles between the arm and face,
near the flaps, were now packed with iodoform gauze,

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364 The Lancet,] MR. T. OUGHTON: MINIMA VISIBILIA AND SENSORY CIRCLES.

[Fbb. 19, 1887.

and the whole arm was most carefully fixed to the head
and neck with good strapping. Finally, over sufficient
flannel and wadding, the head and thorax and both arms
were rigidly secured in piaster-of-Paris. The whole had
somewhat the appearance of a large egg with an infant’s
face peering out of a hole near one ena and its hips pro¬
jecting and legs kicking freely out of the other end. The
child’s conduct showed that it was free not only from pain,
but even from discomfort.

The following notes of the after-treatment were made by
the house-surgeon, Mr. Harold Des Vceux:—April 9th
(seven days after operation): Part of case removed; dress¬
ings found to be very offensive. Both flaps looking well,
though the face flap is red and the stitches along its
anterior border have given way. Dressed as before.—
13th: Whole case removed and bases of flaps cut and
sutured respectively to face and arm. This, of course,
liberated the arm from the head and severed each of the
two transplanted flaps from its original connexions, com¬
pleting the exchange of places. At the lower and outer
boideT the flap upon the face was found to be not adherent
and partially redundant, owing to cicatricial contraction of
the face wound; it was therefore pared to fit, and re-sutured
to the face. Wounds dusted with iodoform; both arms
strapped to body to prevent child from scratching the
wounds.—20th: The face flap not fitting perfectly in one or
two places, it was there refreshed, adjusted, and fixed with
fine horse-hair sutures.

The result bids fair to be excellent, though not perfect,
owing to the fact that a certain amount of cicatricial con¬
traction had taken place in each wound. I feared this
would pull the mouth to one side eventually; but it appears
now, nine months afterwards, that this has not occurred.
The following account of the present state of the case is
written by Mr. C. H. Taylor, house-physician to the West
London Hospital, who has just visited the little patient to
report on it:—“The child is much fatter and healthier in
appearance; the transplanted skin on the face is of the same
colour and appearance as the rest of the face; all that is
noticed is an incomplete irregular ring of depressions or
dimples and linear scars, these being slightly paler in colour
than the surrounding skin. At the outer and lower edge
nearest the ear are two small patches of mole, one about the
size of a pea and the other smaller; 1 they are pale brown in
colour, and have a few silky hairs growing from them. The
arm is much fatter, and the mole upon it is more raised and
movable than it was upon the face, but it remains the same
in size.”

There can therefore be no doubt about the satisfactory
results attained by this mode of operating, which is, to the
best of my belief, new. It is obviously a very great advan¬
tage to be able to anchor, so to speak, the arm to the head
by the strong sutures which unite the former to the trans¬
planted mole. It is thus rendered needless to put any
except fine sutures into the face. Secondly, the bases or
necks of the two flaps, lying with their raw sufaces in
mutual contact, help to keep up each other’s warmth and
nutrition. Thirdly, not only is the risk of sloughing dimi¬
nished, but should the part removed from the arm slough, the
mole saved from the face is there covering the arm wound
with healthy and supple, though discoloured and abnormal,
skin. I cannot help thinking that this plan of preserving
what might be termed “healthy disfigurements”of the face,
such as hairy moles, and exchanging them for skin taken
from parts usually hidden by the clothes, to be a great
improvement on the practice of excising such moles and
wasting them._

1 Thete small patches lay near the border of the large mole when it
was transplanted, and were left behind.

Sanitation at Shbswsbury.— The Shrewsbury
Corporation at the quarterly meeting on the 14th inst.,
considered reports of the borough surveyor for a new water-
supply and a new drainage system which would carry the
whole of the town drainage into the Severn at a point
below the town. The water scheme proposed to take the
water out of the river above the town, and after filtering it
to pump it into a service reservoir, from which the whole of
the town could be supplied by gravitation. The estimated
cost was £26,000. The 6ewage scheme would entail, when
complete, an expenditure of £16,000, but at present only
£*7800 of this was to be laid out. Both plans were agreed to.

MINIMA VISIBILIA AND SENSORY CIRCLES.

By the late BRIGADE SURGEON T. OUGHTON,

ARM V MEDICAL DEPARTMENT.

{Concluded from p. 310.)

There is an idea of motion when an image traverses the
retinal disc of a motionless eye, or when the finger is passed
over the surface of the skin; the prevalent doctrine accords
the resultant perception toaoonaecutiveexcitation of impres¬
sion al areas. Advantage may be taken of the present oppor¬
tunity to instance a few arguments justifying the classifi¬
cation of apparent motion with the secondary perceptions.

1. No progressive motion is experienced in a train passing
along a dark tunnel, or in a ship’s cabin, because the muscular
system is quiescent. But our progression when walking io
the dark is quite perceptible. How is this? It cannot bo
due to the tactile impressions made on the feet, even grant¬
ing them to be unlike, since no idea of motion is presented
by a succession of dissimilar sounds, or by the ^different
thoughts of ideation. Neither can it be explained by noting
the time that it occupied in each step, since time and motion
are not to be confounded (Locke). This philosopher imagines
the sun to be a fire lighted in the same meridian every
twenty-four hours, and asks whether such a regular ap¬
pearance would not serve to measure duration as well
without motion as with it. No solution is available saving
that of muscle-perception.

2. Apparent motion is realised by the aid of the thauma-
trope or zoetrope; but it is inconceivable (as with different
sounds or thoughts) that the retinal representations of a
number of successive attitudes—the consecutive phases of a
horse leaping a gate, say—should generate the mental notion
of a motion, inasmuch os there can be no possible relation
primarily between any two such mechanical representations .
Contrariwise, however, as the hand perceives an object in
two positions by movement of the arm through a certain
angle, so the secondary perception of the horse in one

option is amalgamated with a similar perception of the

orse in another position. It is the linking of these like
perceptions that is essential to the idea of a perceived
motion.

3. Objects are perceived to gyrate round the individuality
after rapid rotation of the body, notwithstanding their
retinal images are fixed. The general rotatory muscles, in
this case, cause the centre of perception to spin round in
one direction, whilst (by sympathetic secondary abeyance^
the straight muscles of the eyeball give rise to objective
gyration in the opposite direction; when walking rapidly
along a road, in like manner, the adjacent hedge-rows seem
to move oppositely. Here is evidence that the secondary
perceptions of vision are persistent after absolute cessation
of the antecedent bodily movements, and we have already
employed this principle of persistence in the formation of
visual angles.

4. Let a traveller by train fix his optical axes on an object
some 300 yards distant, he will observe that the near hedges
move rapidly in one direction, whilst the more distant trees
move slowly in an opposite direction; this effect may be
likened to tiie arms of a balance swaying horizontally about
the binocular centre. It is true that the nearer objects are
depicted on the upper and those more remote on the lower
retinae, but the main incident resides in the images of both
sets of objects floating over the fundus in the same course;
how, it may be asked, are such contradictory results to be
reconciled excepting by some process of secondary per¬
ception? Whilst confessing that the paradox awaits a
definite solution, I cannot omit to note its striking analogy
to the twofold forma of monocular relievo, wherein a super¬
ficial extension is seen to face towards the right under on#
form and towards the left under the other form (conversion
of phase).

Resuming our data, when the points of a pair of compasses
are applied to the skin of a blindfold person, they require to
be separated by a certain interval—the diameter of a sensory
circle (Ernst Weber)—before they can be identified as being
duplicate. Apparent number, conseqdeutlv, has been
viewed as resulting from the intervention of one or more
sensory circles or retinal cones; but our proposition makes
it to consist in the appreciation of two or more distinct
directions, and the phenomena of single and double vision or

TKb Lancet,] ME. T. OUGHTON: MINIMA VISIBILIA AND SENSORY CIRCLES. [Fbb. 19,1887. 36^

teuch (already cited) are a sufficient illustration. Number,
indeed, is related to two classes of perceptions entirely dis¬
tinct; it is a secondary perception in connexion with
extension and form, and primary in its relation to time—so
many sounds striking the tympanum per minute. This
distinction between the mental ideas of number is impor¬
tant, furnishing a satisfying clue to the paradoxical im¬
possibility of squaring a circle; thus, a ring of thread is
readily convertible into the square formation (secondary),
whilst the feat is impracticable by mathematics (primary);
a straight line, again, is unity in a secondary aspect, but
it may be abstracted into any number of primary measures
(and the same for a superficies). Take another example of
number: a printed word appears per ae to be a unite
(secondary), although its several letters may be counted;
the mental idea of number, in this instance, is primd facie
so many distinct volitional impacts, but it is really a ques¬
tion of time together with a succession of primary per¬
ceptions.

Sensory circles vary in size in different parts of the
body. The adjoining table gives their apparent diameters
according to different authorities:—

Weber. Le Conte. Bernstein.

Tip of tongue ... i a line . In. *039 In.

„ fingers ... 1 to 2 lines . to In. *079 in.

Palm of band ... 6 line* . 1 hi. . —

Back „ ... 14 . * to fin. *157 to *196In.

Arm . 30 „ . f to j In. —

Back ... ... 30 „ . 3 in. 1*97 to 3*86 in.

Fineness of tact conjoined with correspondent mobility in
various parts has long been recognised, as in the elephant’s
trunk, the beaver’s tail, &c.; such a constant ratio between
sensory and muscular acuity (well shown by the table) has
been viewed in the light of a mere coincidence; but it is
offered as verifying a motor causation. The dimensions of
sensory circles have been attributed to textural fineness of
nervous organisation; thus, if we suppose one hundred
tactile i>apill» to exist in a circle of the back (3 in. diameter),
there will be a like number in a circle of the palm of the
hand (£in. diameter), whereby the hand’s sensibility is so
many times greater than that of the back. But, by the
proposition, the cutaneous nerve-expansion may be univer¬
sally equisensitive in so far as the present phenomena are
concerned ; and what are the practical facts concerning
increments of sensibility? I consider that sensibility is
best measured directly by passing the forefinger lightly
over different surfaces of the skin. If we adopt this method,
a tolerable equality of sensation will be felt between the
palmar aspect of the forearm and hand; these surfaces
appear to be more sensitive than that of the forefinger,
whilst the back and flanks are highly sensitive. Then,
touching another point, it has been assumed that one
hundred cutaneous corpuscles in a sensory circle really
■guides a corresponding number of fibrillary terminations
in the brain; how is the single impression disposed of ?
Mental essence, according to the adkuo highly mechanical
but rather speculative neurologists, now steps in with its
stately faculty to charm away every dilemma; the mind, it
is said, whilst it can readily identify each fibrillary stimula¬
tion, is limited in its differentiation of an aggregation of
impressions unless more than a certain number (a hundred
say) of fibrillary insertions are excited. I am not aware
that it has been decided whether or not the fibrillary in¬
sertions are more compressed in some cerebral areas than
ethers; but here, in the absence of an explanatory modus,
1 contend that the foregoing hypothesis is foundered.
Truly says Locke, “ In bare nakea perception the mind is
passive, and wbat it perceives it cannot avoid perceiving.”
la troth, physiology points everywhere to conscious mind
as being an lmpressional resultant rather than an impres¬
sions! generator or modifier.

Proceeding next to examine a few data which seem to be
intelligible only on the terms of the proposition, the first
remark is that the minimal visual angle of 44" is an in¬
variable value in every part, lateral or direct, of the retina.
On the terms of Le Conte, however, (1) that the size of the
cones determines the minimum visibUe, and (2) that the
room of the macula lutea are far smaller and more numerous
than elsewhere, it will malt that minimal angles are more
seats in the axis, rather than that a hypersesthesia ensues.
S e nsory drains are of variable, and visual anglesVf uniform,
vabse; in the latter case, because ocular rotations affect
equally the entire retinal expansion.

The following facte, lastly, refer especially to the tactile

faculty, and possess a marked significance: — (a) Sensory
circles differ in size in different individuals, well shown in the
above table. Does a more close disposition of nervelets in
some persons offer a satisfactory reason for the difference ?
(6) They differ in size in the same person at different times.
Has the mind an influence to contract or dilate cerebi al
impressional areas, and irrespectively of volition? (c) They
are developed by assiduous exercise—e.g., the blind man
reading with his fingers, or the armless woman sewing with
her toes; the sensibility in these cases is increased in an
equal ratio with the mobility. Is this a mere coincidence?
Let us draw a simple parallelism in reply to these queries.
Thus: Some persons play billiards better than otheis; they
are in a better cue for play at some times than others; they
profit by practice. Well, then, has primary sensation any
causative bearing on either parallel?

Addendum .—At the close of a protracted investigation
concerning the nature and various phases of the secondary
perceptions, comprising several memoirs which have been
honoured by insertion in these columns, I may be permitted
to add a few general remarks. My hypotheses on erect and
single vision, visual reliefs, &c., have been present to my
mind in a more or less imperfect shape for upwards of a
score of years. These several subjects tend to elucidate, and
have been elucidated by, what a strict inductive system
seems to justify me iu styling a theory of secondary or
acquired perception. The main feature of the theory con¬
sists in a biainward transmission of the via insit a of
voluntary muscular tension, to enter into a combination
therein with relational centripetal currents of primary per¬
ception for the evolution of appropriate forms of secondary
perception—that is, for the mental declaration of the primary
qualities existing in natural bodies. I am happy to say that
the theory does not seem to be invalidated by, but rather
harmonises with, the experimental researches of Professor
Ferrier on the motor areas of the cortex. Professor Wyld states
for instance, in reference to the faradisation of the anterior
lobes giving rise to contractions of the head and limbs of
animals, that he is not disposed to surrender his admiration
of the forehead as the seat of intelligence; I cannot sub¬
scribe to his position, however, seeing that by far the major
part of intellectualsm is a motor process. The following
remarks of Dr. James Davey bear directly on the context,
and I cordially endorse them. He writes: “ The application
of stimuli to portions of the cerebral surface beget, as a
matter of necessity, certain and defined muscular move¬
ments*, but such are no kind of proof that a centre or source
of mere motive power has been reached or excited to action.
The movements observed are, to all intents and purposes,
due to another cause, and that a psychical or mental one.” 1
Then he points out that this must be so, since the stimuli
may produce like motor results indirectly through the
instrumentality of one or more of the external senses—the
seDse of sight, or touch, or sound, and so ofi.

One or two words more. The muscle sense of Sir Charles
Bell has especial reference to a recognition of the position
of the limbs and other movable parts of the body, together
with sensations of solidity or impenetrability (not solid
form), the weight and other resisting properties of essences;
hence it is a line of research having only a remote connexion
with the various doctrines enunciated in these columns. It
might repay investigation to trace the reason that a Chinese
or Japanese painting exhibits such vivid colouration, whUst
their crude notions of perspective clearly evince a defective
or modified secondary perception; their statuettes, too, are
such grotesque contortions. Is it dependent on their seden¬
tary habits co-operating with a perfunctory exercise of
secondary attention, or are their muscular dispositions
irregular? Not the least claim of the above theory is that
it establishes a sound substantive basis for positive or
realistic metaphysios; its obvious tendency is to deal a
heavy blow to every ideational and intuitional form of
philosophy as touching initial conscious states.

1 Journal of Piychologic*! Medicine, vol. II., p. 253.

The Sanitary Assurance Association. — The
sixth annual meeting of the members of this Association was
held on the 14th inst., Sir Joseph Fayrer in the chair. Mr.
Joseph Hadley, secretary, read the annual report, from which
it appeared that the business of the Association during 1886
had been much greater than in any previous year, the
income having been £804, as against £462 in 1886.

Digitized by GoOgle

366 : Thb Lancbt,!

CLINICAL NOTES.

[Fra. 19, 1387.

Clinical ftoks:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

SUBMAXILLARY CALCULUS.

By Collis Barky, L.K.Q.C.P.I., M.R.C.S.

Thr following case is worthy of record on account of the
unusual sire of the calculus and the gravity of the symptoms
resulting from its presence.

R. W-, aged sixty-six, consulted me early in September

last concerning a swelling beneath the lower jaw on the
right side, which caused him extreme difficulty in swallow-
Flashing pains came on at intervals, and extended
ally from the swelling upwards into the face and head,
inwards towards the tongue, and downwards as far as the
right shoulder and arm. These symptoms had existed for
about eight months, becoming gradually more severe;
latterly the patient had begun to lose flesh, and his friends
became alarmed at bis condition.

Upon examination I found a hard substance corresponding
in position with the submaxillary gland placed just below
the ramus of the inferior maxilla, rounded in form, and
more easily distinguishable from the outer side than from
the interior of the mouth, and about the size of a small
Walnut. By pressure from the outside a few drops of
undent discharge appeared at the orifice of Wharton’s
uct. There was no hardness or concretion at the mouth of
the duct, as usually met with in cases of salivary calculus,
and there was no induration of the cervical glands. Taking
into consideration the gravity of the symptoms and the
increasing loss of strength, I suggested early removal, but
requested a consultation. Dr. Ainsley of Hartlepool saw
the case with me and confirmed my suggestion. On Oct. 12th,
chloroform being administered by Dr. Ainsley, I proceeded
to cut down upon the submaxillary gland by a vertical
incision about a quarter of an inch anterior to the facial
artery as it crosses the inferior maxilla, extending down¬
wards about two inches; a second cross incision was
made to make room. There was considerable htemorrhage
from the submaxillary and other small branches of the
f&cial. The whole of the gland superficial to the mylo¬
hyoid was removed, and the calculus could then be distinctly
felt at the commencement of the duct, and apparently em¬
bedded in the gland. A few of the posterior fibres of the
mvlo-hyoid were divided, and the calculus seized with vul-
sellum forceps and removed. Upon examination after
removal, the calculus proved to be phosphatic, and measured
one inch by half an inch approximately (the exact measure¬
ment in length being uncertain, owing to the crumbling of
a portion of the calculus beneath the vulsellum forceps).
The wound was plugged with lint soaked in turpentine,
eucalyptus ointment and iodoform being substituted upon
the following day. The subsequent history of the case was
cine of uninterrupted recovery, the wound granulating freely
and becoming entirely healed in three weeks from the date
of operation, all the symptoms previously complained of
having entirely disappeared.

Remarks .—The ordinary method of removal by incision of
the mucous membrane was impracticable in this case owing
to the depth of the calculus from the surface of the mucous
membrane. Erichsen mentions, as the largest calculus
removed, one of the size of a small damson-stone; but, so
far as 1 can ascertain, no mention has been made of a
calculus of this size occupying so deep a position.

Castle Bden, Parham. _

ERUPTIVE ECCENTRICITIES.

By J. G. Marshall, M.B. Cantab.

Mbs. Q-, aged forty-eight, married, living alone, had

been a sufferer from chronic rheumatism for several years.
She had ah attack of facial erysipelas some time back, but
could not fix the date. She was subject to occasional severe
attacks of neuralgia, for whioh I could find no visible cause.
About two months agd she presented the symptoms of
erythema nodosum, and went through the illness in a severe
ahd typical form, the patches being very large and painful,

leaving the shins, back of forearms, and inside of thigh &
covered with livid marks, as if she had undergone a beating.
At the end of a fortnight this eruption seemed to have run
its course; but the patient still seemed very unwell, and
complained of stiffness about the neck and jaws, with con¬
tinual pain in the head. She maintained that she had been
suffering from erysipelas, though she acknowledged that
she had not been like it before. Two days after the last
crop of erythematous lumps had disappeared she was seized
witn erysipelas of the head and face, and had it very severely,.*
with high fever and extensive swelling of the face and neck.

She was for two or three days in a very critical condition,
the features being almost obliterated, and the infiltration of
the tissues of the neck deep and extensive. One morning
when she was getting better she complained of intense
itching of the back of the forearms and hands, which on
examination presented the unmistakable white “ wheals ”
of urticaria. There was little or no redness of the slrin ; the
eruption was confined to the extensor surface, did not reach
above the elbow, and died away in forty-eight hours. There
had not been a trace of erysipelatous rash on the body
during the attack of that disorder. A short time ago I
congratulated her on getting on so well, when she said that
she had another attack of erysipelas at the bend of the
elbow. On examination of each elbow-joint, on the flexor
side, and nowhere else, I found a patch of typical eczema, the
vesicles being perfectly unmistakable, with watery exudation
and 6hiny redness. She had been scratching with her nails,
which she had not done before. Fresh patches of eruption
appeared at the wrist. Both yielded readily to treatment,
and now nothing is left but a little branny desquamation.

The case is such a remarkable one that I think it deserves
publication. I have not the smallest doubt as to the several-
characters of the eruptions, which I observed most, carefully.
Unfortunately 1 am at a disadvantage in being at a distance
from any of my own profession, or I should have exhibited*
the case. I am quite prepared to see this lady shortly with
a fine development of herpes zoster, or exhibiting patches of
psoriasis to complete the series. Sheisof a highly nervous tem¬
perament, and occasionally subject to fits of great excitability ►
St. Margaret'* Bay, Dover.

THE TREATMENT OF MALARIAL DISEASES BY
PICRATE OF AMMONIA.

By H. Martyn Clark, M.B., C.M. Edin.,

IX CHARGE OF TUB AMRITSAR MEDICAL MISSIOX.

Picratb op ammonia possesses valuable therapeutical'
properties, though it does not seem to have received the
attention which it deserves. The characters, properties, and
uses of this substance were carefully investigated by Dr.
Dujardin-Beaumetz, and the results were communicated by
him to the Therapeutical Society of Paris in 1872. 1 The salt
had previously been successfully used in the treatment of
intermittent fever by Drs. Braconnot, Calvert, Aspland,
Bell, and others. Dr. Beaumetz’a investigations confirmed
the results at which these observers had arrived, and
showed that in this substance we have a valuable, and
efficient substitute for quinine in the treatment of mala**
rial diseases. It appears to have passed oat of mind,
and, aa far as I can gather, has never been used in
India. My attention was directed to it accidentally in
the following way.. I had a patient under my care at a-
hill sanatorium who had suffered for seven months from
severe intermittent fever of the quotidian type. Quinine,
arsenic, and other antiperiodics had been, and were, freely
used, but failed to give relief. After ten days’ treatment
the fever still recurred daily with its accustomed severity.
At this juncture the local chemist told me of a remedy for
fever, which he had received some years previously, but bed
never tried. This l found to be picrate of ammonia. I gave-
it to my patient, with very gratifying results. The fever
did not recur next day, nor did it do so at any time during
the three subsequent months in wjiich she remained under
my observation. 1 have since then constantly used the
icrate of ammonia in the treatment, of malarial diseases,
here has been ample opportunity to test it'fully, for
Amritsar is notorious in the Punjab lor its unhealthiness,
and diseases of this'kind, are severe and frequent. During
a period, of four years and a half, I have treated over

r J The Lancet, Oat. 12th. 1872.

Digitized by G00gle

Tin Lax cit,]

HOSPITAL MEDICINE AND SUftGERYv'

[Fja. W,.188TU' 3fiT.

10 , 000 .cases of these diseases with tins agent, svith tbe
hippiest results. So uniformly successful baa it been that
I hare in our very extensive practice here, given up the uee
of quinine and tbe cinchona alkaloids for the treatment of
intermittent fever, and have substituted picrate of ammonia
for them. A record was kept of 5000 cases of intermittent
fever treated with this agent. Of this number, in nine cases
only did it fail to cure, and in these quiniue succeeded
at once. 1 usually give it iu doses of from one-eighth
of a grain to ft grain and a half four or five times a day
in pill. Half a grain is a fair average dose. Thus given
the result is soon visible, in the great majority 61 the
eases treated, half-grain doses in the interval prevented the
recurrence of the next attack of the fever, while in about
10 per cent, of the patients two or three attacks followed
before the fever ceased. In one case of quartan ague,
despite large doses of the salt, the fever recurred for six
periods, graddally diminishing in intensity, and then
yielded to it. It is equally successful in all the forms of
ague, but it is a curious fact that the cases iu which it failed
to cure were all of the tertian variety. I have also employed
this agent iu the treatment of twenty-five cases of malarial
neuralgia of various nerves, six cases of malarial headache,
and one of malarial colic. Iu all these instances it cured
completely and speedily. In remittent fever it does not
appear to be of use; Six cases of a severe type were treated
with it without any effect. Neither is the enlarged spleen of
ague benefited by it. I have given it in numbers of such
cases in conjunction with ergotioo with good results, but
‘och results are secured equally by the use of the ergatine
alone.

My experience leads me to the conclusion that in all
mieties of intermittent fever, and in malarial neuralgias,
picrate of ammonia is a valuable antiperiodic, and it is an
efficient and perfect substitute for quinia. It has the
following advantages over quinine:—1. It is much less
expensive. This is an important consideration where, as in
Indian practice, hundreds of cases of mularial diseases have
to be treated annually. 2. The dose given is very much
ffludler. 3. It does not produce the unpleasant effects that
quinine does—headache, deafness, tinnitus, &c.; nor does it
<fisorder the digestion or cause nausea, os quinine is apt to
do, in tbe doses in which it has to be given in India.

AmrtUar, Punjab, Northern India.

CASE OF TRAUMATIC TETANUS; RECOVERY.

By John Welpton, L.R.C.F.L., M.R.C.S.

Is Tim Lanobt for 1886 two cases of recovery from
tetanus (traumatic) are referred to. I had myself a short
time ago a successful case.

On Sunday evening, Nov. 7th, I was called to B. B-, a

toll powerful man about the age of thirty, and found him
wffering from pronounced tetanus, with eyes fixed and
storing, nands clasped behind the neck and quite rigid, and
opisthotonus so strong that four people could with difficulty
keep him down when the spasms were violent, those of the
diaphragm being agonising. I placed him under the
influence of chloroform, and administered within a short
bme two drachms of bromide of potassium, together with
one drachm of chloral hydrate. I remained with him nearly
dtres hours, when he became quieter and had no more
*P««ns. He was quite well in two or three days. His friends
did nbt know of any wound, but the man explained that in
catting a corn under the right great toe he had cut painfully
t»to the quick three o* four days ago. He was a night
watchman at that time and much exposed to the weather.
Bawarthorpe, Yorks._

CASE OF MELANOTIC SARCOMA.

Bt J. N. Bkbdiw, L.K.Q.C.P.I., &c. •'

Tbk patient, a lady, aged fifty-four, first noticed a little
fix* oa tbe right heel about the last week in October, 1886,
thinking it was merely a chilblain or occasioned by a tight
it gradually, however, became troublesome, though
®tinly face from pain, And the then consulted my pre-
Hr, gplt, who advised a consultation. Accordingly,
Mr. Rmagton was called-jfc, and advised an operation
which was performed on Npv, 29th, and seemed effectually

to remove the mass, I saw the patient on . Dec; 2ed>:
The growth had none of the characters whatever afo
melanosis—in fact, up to this time nothing showed itdelfo
from October to leud one to . be certain. • Meanwhile,
Mr. Holt and Mr. ILivington suspected melanotic sarcoma.*
About eight days after the operation several spots of unr [
mistakable melanosis appeared, first on the outside and
subsequently on the inside of the thigh, and afterwards on
the heel, and was now covering the cicatrix of the wound,
which healed without intermission. All these places on tke
thigh and heel are now becoming oonfiuent and extending,
and growing rapidly on the skin, without pain. One spot,
identical in character appeared on the head, and a single one.
on the back. Neither of these has increased in sire, nor
have any fresh ones appeared. This is, I presume, a most
interesting and remarkable case, and may be seen by any
medical man who may appoint an hour with me, as the
patient is most willing to be seen by anyone.

Norton Folgate, E.C. ,

HOSPITAL * PRACTICE,

BRITISH AND FOREIGN.

Nnn&autem eat alia pro certo noecendl via, nlil quamplurlmas et raor-
borura eb dlaseottonum hfatoriaa, turn allorum turn propria* oolleorat
habere, et Inter *e oompsmte.—MossAesi D* S*d. it Oatu, Mtrb.,
Ub. Iv. Frocemium. - - ...

GUY’S HOSPITAL.

SEVEN CONSECUTIVE CA8E8 OF CHARBON TREATED
SUCCESSFULLY BY EXCISION.

(Under the care of Mr. Bryant.)

Wb are able to publish a series of cases of malignant
pustule which have occurred in the wards of Guy’s Hospital
during the course of the last few months, all of them under
the care of one surgepn, and successfully treated in a similar
manner, by excision, followed in some instances by the
application of caustic. This disease is one of which during
the last few years several examples have presented them¬
selves in London, chiefly at Guy’s and the London Hospitals,
and much has been done by the surgeons of these institutions
to advance our knowledge of it. The cases, two of which
we give this week, will be read with interest, and the
difference in the local and constitutional symptoms carefully
noted.

Case 1 .—Charbon of right temporal region, jvith lymphatic
enlargement; excision; skin-grafting; cure. (From notes

by Messrs. Du Boulay and F. P. Sarjant.)—Chas. A-,

aged twenty-nine, a labourer at a hide warehouse, was
admitted on Jan. 21st, 1885. The patient’s father died of
aneurysm of the heart.; his mother is living and well. He
has been a hard worker, and 6 teady in his habits. Had
measles, when a baby, and rheumatic fever when he was a
boy (this lasted six weeks). About four years ago he was
ruptured, and ever since has been wearing a truss. He has
of late had some palpitation and nervousness. The patient,
who works at a hide factory, was sent to the hospital by
the manager (who, he thinks, had the disease himself some
years ago). About Christmas last he came as an out-patient
with a swelling like a boil on his left cheek. This was
opened, and be got well. He was in his usual health up to
Monday, the 19th ult., and was at his ordinary occupation,
which consisted in handling hides of all kinds, which had
come from all parts of the world; they were cow, ox, buffalo
hides, and rabbit and opossum skins. While he was at work
he felt an itching on his left temple, and putting up his
hand felt & small pimple about the size of the head of a pin.
He felt dull, depressed, and cold that day. On the Tuesday,
1 he still felt poorly, the pimple had increased to about the
size of a pea, and tbe surface was black. On the Wednesday
it was blacker and larger. During the whole time he had
felt cold and unwell, but had kept at work until he was;
admitted into hospital.

Condition on admission.—Vac patient is a well-built,
healthy-looking. young man. When placed in bed be
shivered and complained of bad headache. . Temperature

Digitized by ooQie

368 The Lancet,]

HOSPITAL MEDICINE AND SUBGEBY.

[Feb. 19 , 1887 .

OS'S 0 ; respiration 20; pulse 88. The pustule was situated
on the letc temple, about an inch behind the outside of the
eyebrow and above-, the zygoma. The central slough
measured one-eighth of an inch in diameter, and was
circular. It was surrounded by a rim of vesicles whose
long diameter—namely, in the horizontal direction—was
three-eighths of an inch; in their short diameter—the
vertical—a quarter of an inch. The vesioles were more
marked above, and at the back there was redness of the
skin for about two inches and a half from above down¬
wards, which faded away gradually; the pustule was not
raised above the skin more than one-sixth of an inch. The
glands at the angles of the jaw were enlarged on both sides,
particularly on the left. His teeth were bad. There was a
swelling on the left side of the face just below the angle of
the mouth. There was also a pimple on the left side of the
back of the neck, about the size of a pea, red like a boil,
without perceptible black centre. The patient was unable to
open his mouth very widely.

At about 7 p.m. on the day of the man’s admission,
Mr. Du Boulay, by Mr. Bryant’s instructions, removed the
pustule. Chloroform was administered in the ward. A
skin incision, elliptical in shape, was made behind the
eyebrow to about half an inch in front of the ear, extending
in depth to the deep fascia over the zygoma. The skin
and tissues beneath, between the incisions, having been
dissected away, the raw surface was thoroughly cauterised
all over with Paquelin’s thermo-cautery; the wound was
then dressed with terebene oil and a pad of lint bandaged
over it. The patient took chloroform very well, and was
not sick after it. He was ordered five grains of sulphate of
quinine every four hours, four ounces of brandy, and full
diet.

Jan. 22nd.—The patient was restless during the night,
as he said, from headache and the effects of chloroform.
Temperature 97 - 2°. He seemed fairly comfortable. His
bowels were open twice yesterday before his admission.
Urine limpid, clear, and of a light straw colour, much
lighter than normal. Sp. gr. 1017; slightly alkaline reaction;
no albumen, mucus, blood, or pus; on boiling there was a
slight whitish precipitate, which disappeared on the addition
of nitric acid. At 2 p.m. the patient was much the same;
his face was red and puffy, and he had headache, and a
singing or buzzing noire in his head. Wound painful.
Evening temperature 98 8°. Wound dressed. No bacilli
could be detected in the urine.

23rd.—The patient passed a good night and feels com¬
fortable. He is better than yesterday. The pimple on the
back of the nock is not a cbarbon. There has been no rise
of temperature.

24th.—The patient feels only a little soreness about the
wound; slight headache. His bowels have not been open
since his admission. Urine of normal colour; sp. gr. 1024;
no albumen, but some phosphates; slight acid reaction ; no
bacilli could be detected, although the examination was
carefully made.

25th.—The patient passed a fair night. Complains of
increased soreness in the wound and shooting pains across
the back. In the evening he seemed worse. Temperature
102-5°. The quinine was omitted, and ten grains of calomel
and colocyntb given at night; also twenty grains of salicylate
of soda in orange flower water every three hours.

26th.—Passed a restless night; has great pain in the head
and across the back and chest; temperature 992°; bowels
open. Pulse 84; respiration 20. Urine: sp. gr. 1025; normal
colour; no albumen ; could find no bacilli.

27th.—Bowels open this morning. Not much alteration
in patient’s condition.

1 28th.—Passed a good night. Great soreness in the wound.
Patient says he feels better. Pulse 72. Wound dressed in
the evening.

80th.—Patient doing fairly well; bowels open daily. The
wound itches and smarts very much.

31st.—The salicylate of soda ordered three times a day.
Patient much the same; takes his food well. Urine straw-
coloured ; acid; no albumen; sp. gr. 1021; reaction of salicine.

Feb. 9th.—Has been getting up daily since the 4th, and is
making good progress; there is still a quantity of discharge
from the wound. Patient feels fairly well in himself.
Ordered fifteen minims of tincture of perchloride of iron
three times a day, with glycerine and chloroform water.

• J 01 h.—Five pieces of akin were grafted.

12th.—Three of the above have taken; the skin looks
healthy. and less flabby than it was some'days ago.

15th.—Three more pieces of skin were grafted to-day and
the wound dressed; the skin is beginning to spread over the
upper edge of the wound. Ordered a mixture, with cinchona
as a tonic.

24th.—Patient progresses but slowly. The sore is not
much smaller than it was on the 15tb; it looks rather pale
and flabby.

March 14th—The patient was discharged to-day; wound
not quite healed.

Case 2. Charbon of face, with enlargement of lymphatic
glands; excision and cautery; recovery. (From notes by

Messrs. Beard and D. T. Jones.)—J. N -, aged thirty, living

at Walthamstow, was admitted on Sept. 5ch. On the previous
Wednesday a small lump appeired on the left cheek; it
gradually increased in size. On the Friday following she
called in a medical man, who told her she was suffering from
blood poisoning. She bad bad nothing to do with cattle,
and she bad a baby vaccinated recently.

Condition on admission. —The pustule is half an' inch in
diameter, with a black depressed centre, surrounded by a
ring of vesicles containing red serum. There is a brawny
hardness in the surface aronnd for the radius of one inch ;
there is great swelling in the submaxillary region, where the
glands are enlarged and tender.

Sept. 5th.—Urine nearly colourless; no mucus ; add ;
sp. gr. 1005; no sugar, blood, or albumen.

6 tn.—Mr. Clement Lucas examined the patient, and recom¬
mended excision, which was performed this morning by
Mr. Beard. Two incisions were made, one on each side of
the pustule from a point about a quarter of an inch above
the side of the nose down to a point at the lower margin of
the inferior maxilla about an inch and a half from the
median line ; then, holding the skin at the upper end with a
tenaculum forceps, the skin within the margins of the
incisions and a quantity of muscular substance were cut
away. Two vessels were twisted. The deepest indsion
was near the angle of the mouth, extending at this
point nearly to the mucous membrane. The wound was
oval in shape, three inches long by an inch and a half
broad; it was cauterised by Paquelin’s thermo-cautery, and
lefr, open.

7th.—The wound appears fairly healthy; the swelling
in the submaxillary region has decreased in size. Patient
has been ordered a mixture containing iodide of potassium.
Urine of a bright yellow transparent colour, containing a
small quantity of flaky mucus; reaction decidedly acid;
sp. gr 1033; no albumen or blood; five grains of sugar to
tbe ounce.

9th.—It should have been remarked that lymph was
running from the arm before the lamp appeared. . Patient’s
baby is eight months old, and is still suckling. Fresh
serum was examined for anthrax bacilli, but none were
found. One of the patient’s breasts was beginning to get
tender, and a lotion of belladonna and glycerine was applied.
Tbe urine is of a dirty yellow opaque colour, containing a
large quantity of mucus, which is of a buff colour;
sp. gr. 1031; acid; sugar still present.

13tb.—The wound was dressed this morning. When the
dressings were taken off one of the vessels began to bleed;
this was at once twisted by the dresser. She is allowed to
get up an hour every evening after tea.

16th.—Ordered a ten-grain aperient pill at night; middle
diet.

22nd.—Patient is taking perchloride of iron and cinchona
mixture. She left this afternoon. Wound smaller, and
looking healthy. __

NORTH-EASTERN HOSPITAL FOR CHILDREN.

A CASE OF ACUTE MENINGITIS IN WHICH COMPLETE
RECOVERY TOOK PLACE.

. (Under the care of Dr. O. E. Armand Semple.)

For the following account we are indebted to Mr. C. D.
Green, late house-surgeon.

William C-, aged seven years, was admitted, under

Dr. Semple, on May 13tb, 1886. The child was said to have
been quite well until May 10th (three days before admission),
when, on returning from school, he vomited and complained
of headache. The following day he was drowsy, and at
night became delirious. The next day (May 12th) he was
brought to the out-patient department; he was then some¬
what drowsy and moved with difficulty; pulse 108°; tem¬
perature 10i°; tongue coated and rather brown. Whilst

Digitized by GoOglc

Thk Lancbt,]

HOSPITAL MEDICINE AND SURGERY.

[Fbb. 19,1887. 369

wilting he appeared to become unconscious for a few
minutes once or twice. As there seemed some probability
of the patient being in the early stage of an acute specific
fever, he was not admitted. The next day (May 13in) the
mother came to sajr he was much worse, and, she thought,
dying. He was visited, and found to be in a condition of
active delirium, throwing his. arms about wildly, and
screaming loudly “ Mother, mother,” although his mother
was standing close to his bedside at the time. The skin was
hot and dry; there was no eruption save that produced by
insects, and no inflammation of throat. His removal to the
hospital was directed. Both parents living and healthy;
no history of phthisis in their relatives. There were three
other children, two of whom are living and healthy; the
third was taken ill some two weeks before the patient, and
died during his (patient’s) illness. The symptoms were
pain in the head, vomiting, and rapid wasting. Optic
neuritis was observed; the diagnosis was tubercular
meningitis, but we were, unfortunately, unable to obtain a
necropsy.

State on admission .—A fairly well nourished child, com¬
plaining of headache. He was in a semi-conscious condition,
not could be roused when spoken to loudly. The muscles
at the back of the neck were contracted and rigid; the head
wis retracted, and could only with difficulty be moved.
Abdomen somewhat retracted; tache ctribrale well marked.
Pupils equal and aoting to light; no oculo-motor para¬
lysis; no nystagmus. No paralysis of limbs, and no
evident loss of sensation. No abnormal physical signs in
chest or abdomen. Tongue covered with a brown fur and
rather dry. Temperature 101°; pulse 112, regular. Urine
clear; acid; no albumen. The right optic disc appeared a
little blurred.

Daring the night the patient was wandering and noisy,
frequenuy screaming loudly. The following day (May 14th)
he complained much of headache. There had been no
vomiting since admission; he answered questions and
obeyed directions. The urine and faeces were passed into
the bed. During the next few days the more acute sym¬
ptoms subsided somewhat; the patient became conscious,
ind, though he still complained of headache, slept fairly
veil at night. (He had teen kept in a dark room.) The
temperature chart showed evening exacerbations, with morn-
in? remissions, but rising slightly higher on successive nights
(maximum 103°). On the morning of May 20th the tem¬
perature fell to 99°, and remained below that until the
evening of May 21st, when it rose suddenly to 103 u . The
patient was rather drowsy, and still complained of headache.
He lost flesh rapidly; his weight, which on admission was
381b., mi May 22nd had fallen to 341b.

Doling the next month the symptoms were drowsiness
ud indifference to what took place around him, disinclina¬
tion to take food, and progressive emaciation; there were
frequent complaints of headache, and occasional screams
and cries of “ mother,” once or twice repeated; seemed only
semi-conscious, and would not answer questions. Super¬
ficial reflexes exaggerated; knee reflex and ankle-clonus not
obtained. Poise variable in frequency, and at times
irregular. Bowels confined. With the exception of a slight
convergent squint, which was noticed the day after admis¬
sion and only lasted a few days, no local paralyses were
observed. Temperature below 100° from May 27th to
Jane 16th. On June 16th the weight was 29^ lb., the
patient having thus lost lb. in thirty-four days.
On the morning of June 22nd the patient, for the
bit time since admission, had a fit, in which there wai
{eoeral rigidity with complete unconsciousness ; he had
vomited twice during the morning. On the 26th he had
tbree similar fits, the fits lasting each about fifteen minutes.
So fits occurred after this date. He was at this time very
wide and extremely emaciated; was usually in a drowsy,
apathetic condition, but was occasionally noisy, constantly
repeating the cry “ mother.” He could, however, be roused
» some extent when sharply spoken to. There were
**aeioaal evening rises of temperature from June 14th to
lltb, after which the temperature remained below
10(P until August 9th. The patient remained in a
sutler eondition for about a fortnight; he waB markedly
o aa ri at efl, and so feeble that his death was daily
“Pocted. Hie malar and jaw bones were extremely
Broviaeiit, and the outlines of the limb bones plainly visible.

bedoorea had formed at any time (he had been kept on a
**ta w bed). .there was a purulent discharge from the right
noticed for the first time a few days after

admission, and no history of its presence previous to the
onset of the illness could ue obtained.

July 17th.— His weight was again 29} lb. He had not
been weighed for a month, appearing too ill to be moved,
but had evidently still further lost flesh during the firtt
part of the interval. Began to take his food better.

20th.—Would answer questions, but not intelligently;
vomited twice on the 21st.

27th.—No complaint of headache; no vomiting.

29th. — Vomited three times; answers questions in¬
telligently ; takes food well; does nor complain of pain.

Aug. 6th.—Now considerably improved; plays with toys,
and takes much more notice or his surroundings; does not
complain of headache; still vomits occasionally; bowels
regular; gaining flesh.

On the evening of Aug. 8th the temperature rose to 101°,
and the patient again complained of headache; the dis¬
charge from the nghc eur, which had persisted to a slight
extent since it was first noticed, increased somewhat (the
ear had been syringed out twice daily with boracic acid
lotion, and iodoform powder had been blown in, but no other
local treatment had been adopted. On the following day
the temperature fell to 99'2°,and the patient ceased to com¬
plain of headache. From this date convalescence was un¬
interrupted, and the patient left the hospital on Sept. 23rd.
His weight was then 42} lb.; there was no mental defi¬
ciency, and the general health was good. He was seen again
at the end of a month, and appeared to have no ailment;
the discharge from the ear had quite ceased; the membrans
tympani was not destroyed, nor was the hearing very much
impaired in that ear. There was no defect of vision.

Remarks by Dr. Semplb. -Cases of recovery from a severe
attack of meningitis, however caused, are, I think, suffi¬
ciently uncommon to make the above case worthy of record.
When the patient was first admitted, the diagnosis made was
tubercular meningitis (the more so as the brother was at
that time under observation, who, as mentioned in the
history, died of what was believed to be tubercular menin¬
gitis), and the extreme and rapid wasting which took place
was certainly in favour of tubercle; the appearance of the
diarrhoea, however, suggested another explanation of the
case, and the slight relapse which took place associated
with an increase in the discharge from the ear, and also the
fact that the patient recovered, were more compatible with
its being a meningitis caused by extension from the
tympanum rather than due to tubercle; it must be borne in
mind, however, that there was never any swelling or tender¬
ness over the mastoid process, that the otorrhoea completely
ceased without any treatment beyond syringing ont the ear
and dusting in iodoform powder, and that the discharge
never became offensive; moreover, it appeared after the com¬
mencement of the patient’s illness, so that, although tuber¬
cular meningitis could not with certainty be diagnosed, there
were some points in favour of that explanation. In Thk
Lancbt of Jan. 8th, 1887, there is an account of a case
brought by Dr. Carrington before the Pathological Society
in which recovery from tubercular meningitis was inferred
from post-mortem evidence. In Jaccoud’s “ Dictionnaire
de M6aecine et de Chirurgie,” article M6ninges, are quoted
two remarkable cases of complete apparent recovery after
tubercular meningitis, in which a second attack of menin¬
gitis occurred after a long intewal—in one case five years,
and in the other one year— nfter the first attack; in both
cases the diagnosis was confirmed by a necropsy, but, un¬
like Dr. CarriDgton’s case, the exact appearances are not
described, the reference to the post-mortem examinations

being as follows:-In the first case,.“Les meninges

offr&ient des Idaions t5videmment graves et fort anciennes
que remontaient certainement a la premi&re attaque ”; and

in the second case.“ et mourut.d’une tuberculosa

m<3ning6e avec un fort dpanchement hydroc6{)halique fait
dont nous pfimes nous convaincre fit l’autopsie.” In the
same article is quoted another case more exactly bear¬
ing on Dr. Carrington’s case, in which a girl aged
thirteen was observed to recover from an attack of
meningitis “ caract6ris6e par les symptfimes les pins
classiques et survenue graduellement,” and who died some
years afterwards of pulmonary phthisis; no reference, how¬
ever, is given to any post-mortem evidence, and the writer
of the article remarks that the inference that the meningitis
was of tubercular origin did not appear to him to be legiti¬
mate. I have thought the case worth quoting, however, on
account of its resemblance to that brought forward by Dr.
Carrington,

Digitized byCiOOgl

370 The Lancet,]

CLINICAL SOCIETY OF LONDON.

[Feb. 19,1887.

UteMcal Societies.

CLINICAL SOCIETY OF LONDON.

Discussion on Nephro-lithotomy.

An ordinary meeting of this Society was held on the 11th
inst., Dr. W. H. Broadbent, F.R.C.P., President, in the chair.
The whole of the evening was occupied with an interesting
discussion on Nephro-lithotomy, of which the following is
a full report.

Dr. George Johnson said nothing could be more satis¬
factory than the case read at the last meeting by Mr. H.
Morris. The patient had suffered for nineteen years, had
had to take enormous quantities of alcohol and morphia,
and yet was relieved in a short time by a simple and safe
surgical procedure. He had altogether given over to
surgery five cases of renal calculus, and with complete
success in all the cases. Three were operated on by Mr.
Knowsley Thornton, one by Mr. T. Smith, and one by Mr.
Morris. One of the cases was thought by a medical man to
be chronic Bright’s disease, but for this opinion there was
not the slightest ground; yet even after the removal of a
calculus the medical practitioner remained incredulous, and
hinted that the stone shown him by the patient was of
fraudulent origin. The case of a little girl, eleven years of
age, who suffered from pyuria and hiematuria with renal
colic in the left side was narrated. Mr. Thornton operated i
by the combined abdominal and lumbar method, and, strange
to say, removed five stones, not from the left, but from the
right kidney. Had the lumbar operation been performed
this case would have been set down as a failure of renal
surgery. Dr. Johnson remarked that now the physician
could have recourse to other measures than lithotripsy,
passage of stones per via* naturales, and encystment before
or after suppuration, with destruction of kidney, and, look¬
ing to the serious effects and dubious prospects of success of
such methods, he thought the profession and the public were
to be congratulated on the new aid that was afforded by
surgical interference.

Mr. Knowsley Thornton gave the history of his own
practice in renal nephro-lithotomy. In 1879 or 1880 he
made his first attempt at lumbar nephro-lithotomy. After
making the lumbar incision a large tubercular kidney was
discovered. This was drained in the loin; some relief of
symptoms was obtained by the patient for a time, but sup¬
pression of urine supervened, and the patient died. The
necropsy showed that both kidneys were diseased. This
operation suggested the necessity for a thoroughly exact
diagnosis. In future Mr. Thornton resolved to secure greater
accuraoy of diagnosis by an exploratory abdominal section,
and if a stone were found, to make a separate clean incision
in the loin for its extraction. By employing Langenbeck’s
incision for abdominal section, he thought it would be pos¬
sible to explore the kidneys and the ureters, and thus make
certain of the state of both organs as well as of the position
of the stone, should one be present. It was not until
the year 1883 that Mr. Thornton had the opportunity
of putting these principles into practice. In December, 1883,
the combined method was successfully employed upon a
woman aged twenty-three, with right renal calculus. She
was in a bad state of health. Her father had died of renal
calculus. The combined method was practised; the
abdominal incision allowed of the examination of the other
kidney. The left hand was used to fix the stone in the
pelvis of the kidney, whilst the right hand made a clean
incision in the loin straight down on to the stone. The patient
did remarkably well. The overlooking a stone was illus¬
trated by the third case, which was performed in February,
1884. This was a lumbar operation. A second smaller stone,
situated higher up in one of the calyces, was overlooked.
Drainage was practised, .and gave some relief for a time,
but suppression of urine followed. The other kidney
was of considerable size. In April and in June, 1884,
Mr. Thornton had two successful cases of nephro-litho-
tpmy by the lumbar incision. In the first case the in¬
cision healed rapidly; in the second the healing was
slow, and the sinus frequently reopened, but eventually
♦he case got well. The fourth case was that of a French
woman, aged fifty-nine, who was in a bad state of health.
Mr. Thornton returned to the combined method in this
case. But death occurred with suppression Of Urinfe' hi

less than twenty-four hours. The fatal result was largely
to be attributed to the exhausted state of the patient. She
had taken a considerable quantity of morphia; the opera¬
tion was prolonged; the stone was but a small one; the
urine fairly healthy. The fifth case was a second operation
on Case 1, reported in the Medical Times and Gazette. The
sixth case was begun as an abdominal nephrectomy, bat the
kidney was found n'ot to be removable; ft contained a large
stone; a counter-opening was made in the loin; the case
eventually did well, though the sinus remained discharging
for some time. The seventh case was that of a military
officer, seen in consultation with Mr. Morrant Baker; the
combined method was practised with perfect success. The
other two cases were also completely successful. In
discussing the general question, Mr. Thornton said that
surgery should be exact. The more exact it was, the
more successful would be the results. The lumbar nephro¬
lithotomy never will or can be exact. Surgeons have even
failed by it to reach the kidney. For example, both he
himself and Mr. Morris had missed the stone by this method.
Though the kidney tolerated the knife, still we should all
agree that it should not be needlessly incised. It was
doubtful what the effect of puncturing the kidney was;
punctures and incisions might lead to deleterious changes 1
in the organ; the ultimate history of cases that had been 1
submitted to the punctures would prove of value and
interest. The more common the operation of nephro¬
lithotomy became, the more kidneys would be unsuccess- i
fully explored, the greater would be the mortality, and renal
surgery would lose in reputation. Mr. Thornton referred
to his previous position with regard to the two operations i
as expressed at the Eoyal Medical and Chirurgical Society
last session, and said he now felt disposed to go further,
and to assert that the combined operation was the
correct one, for we should never fail to find the kidney, never
cut into a healthy one, and leave the one with the stone;
never damage the peritoneum, as by puncture, without
knowing it, and we could examine the other kidney and
both ureters. The stone would be removed through a small
clean cut in the loin, which was farpreferable to the method
of dissection, since this latter allowed of infiltration of
tissues and favoured the chances of eevere inflammation and
septicity; and, finally, the combined method allowed of a
thorough examination of the kidney, so thatadecision could
be come to which was the best operation—nephrotomy or
nephrectomy— for the individual case. He said thatMr. Morris
had objected to the abdominal exploration as being inefficient
for perfect palpation, but his own experience did not bear
out this belief. The whole investigation could be carried out
with much less doubt and with greater safety for the patient, j

for a fairly accurate knowledge of the state of the other ,
kidney Would be ascertained. The only possible objection
to the combined method was that it made two wounds; but
counter openings were made everywhere in surgery, and why
not in renal surgery also ? The real objection was doubtless ,
a dread of the peritoneum, but this was unfounded, and his
own experience was that with strict asepticity the peri- ,
toneum tolerated operations as well as, if not better than,
any other tissue of the body. Finally, Mr. Thornton mads
some remarks on the subject of referred pain, and said that ,
in some of his cases the pain was referred to the other
kidney, and might have led to the wrong kidney being
operated on, with possible disastrous results. Ovarian pain
was sometimes referred to the side opposite to that of the
diseased ovary. . '

Mr. Bernard Pitts briefly referred to three cases of
loration of kidney by the lumbar incision that had recently
een under his care. The first was that of a woman with
large suppurative scrofulous kidney; here no stone was
found, but great relief was given by the drainage, and but
little discomfort was occasioned from the resulting urinary
fistula. In the second a stone was discovered and re¬
moved, but there was also a suppurative condition of the
kidney. For one month the patient did well, but there was a
constant discharge of pus from the lumbar wound, though
no urine was ever detected with this discharge. Thiis
patient then suddenly developed inflammatory symptoms,
and died after several weeks of continued fever; and it was
found that there was a diffused suppuration behind the
kidney, which extended along the aorta into the thorax. A
second small stone was found embedded in the upper part
of the organ. In the third case, whieh had been explored
through the loin six weeks ago, a calculus was removed, and
again a suppurative pyelitis was present. Great relief was

Gc

Thb Lancet.]

CLINICAL SOCIETY OP LONDON.

[Pbb. 19,1887. 371

given by the operation in thin case, but suppuration still that whilst a number of stones might be cleared out
continued, and no urine had been detected with the dis- of a kidney which were causing no symptoms, a small
charge from the loin. Mr. Pitts. would like to ask those one might escape the detection even of the experi-
who had had experience in these cases whether one might enced hand in the opposite kidney, which, after all, had
assume that a kidney was no longer active if, after incision been the cause of the colic ; and, lastly, it was surely
into its suppurating pelvis, no urine escaped at any time possible, if a stone can escape detection through a lumbar
with the discharges. He regretted that in the second case incision, when the organ can be felt above and below, and
he hid not removed the organ, and so possibly saved the behind as well as in front, it might fail to be detected when
patient, and stated that in tne last case he had felt it right the finger can only reach the anterior aspect. A case to
to sdrise the man to have the kidney excised, since he illustrate this position was then detailed, in which a patient
believed it to be useless, and likely to continue to suppurate, had for years suffered from symptoms referred to the bladder.
Owing to the enlargement of the kidney, and to the narrow- which at last gave way to those of marked right renal colic.
ss6s of the interval in this case between the ribs and the Mr. Godlee cut down on the right kidney, which was quite
crest of the ilium, it would be difficult to remove the kidney imperceptible on abdominal palpation, and found it lving
from the loin; and if the abdominal cavity was opened, it very high np under the ribs. A stone of the size and shape
would be difficult, with the suppurating sinus present, to of a tiger’s claw was found quite at the back of the gland,
ensure perfect antisepsis. and it was held that this would in all probability have been

Mr. Mobrant Bakkr referred to a case, which be showed quite imperceptible on feeling the organ through an abdo-
u a living specimen, of a young man aged twenty-three minal incision. He maintained that it was almost certain
who had suffered from hydro-nepbrosis for some years that the abdominal method would occasionally fail when the
before 1881, when the large cyst was opened and drained, fact was borne in mind that the most urgent renal symptoms
The patient was subsequently shown at the International may be caused by stones of very minute size.

Medical Congress, at which tame he was wearing, slung to Mr. Bruck Clarke related a case bearing on the diagnosis
his side, a leathern bottle, into which several ounces of urine of renal calculus. For one year the man had suffered from
were discharged daily. Subsequently his health began to fail, occasional attacks of left renal colic, and just before ad-
ind in Deo. 1882 the Kidney was removed; the large cyst, the mission to the hospital had a typical attack, in wliich pains
boundaries of which were, beyond the reach, not only of the radiated along all the branches of the left lumbar plexus,
finger, but of a long metal sound, was left, Mr. Morrant Fortunately, before thinking of an operation, the tortuous
Baker thinking that any attempt at its removal in its sup- state of the arteries was observed, and a considerable pulsa-
porating and probably adherent condition might involve tion was noticed in the abdomen. Abdominal aneurysm was
wide exposure of the peritoneal cavity, and be very perilous, diagnosed, and at the necropsy it was found that the aneu-
He thought, also, that the removal of the secreting organ rvsm had burst into the left psoas muscle and dissected out
might lead in time to withering of what would become a ail the branches of the lumbar plexus of nerves. Death had
useless receptacle. The patient recovered well from the resulted from rupture of the dilated aorta into the pleura,
operation of nephrectomy, and the ultimate result justified A second case was related as tending to show the value of an
the plan adopted, for in about two years after the nephrec- abdominal incision with preliminary exploration. The patient
to my the cyst had contracted to about the size of an orange, had passed several stones. A lumbar incision was made,
ind was found filled by a quantity of offensive putty-like but an hour elapsed before the kidney could be found. The
material, the removal of which with free drainage was patient was greatly wasted and cachectic. It would have
followed by complete reoovery. been wiser to perform the abdominal operation. A small

Mr. Qodlrb said that although he was not much amount of calculous matter escaped from the lumbar
enamoured of the so-called combined operation, and not incision. Death followed in three days from anuria. At
eager to perform it, he thought it only right to mention two the necropsy fatty and amyloid degeneration of all the
cues, which might be adduced as favouring the position viscera was observed, and many disseminated stones were
field by Mr. Thornton. The first of these cases was that of found in tbe kidney, but no distinct calculous mass. It
a young man, who had come from South Africa for the relief would have been more satisfactory if the whole kidney had
of most urgent symptoms pointing to stone in tbe right been removed at an earlier period.

kidney, and was under the care of Mr. Marcus Beck at Dr. Burney Yeo asked the surgeons to answer the
Cniveraty College Hospital. Mr. Beck exposed the kidney question, what were the precise indications for physicians
folly nod punctured it freely with needles, but detected no to give up their own “ imprecise” method and take to tbe
•tone. The wound closed readily and rapidly, but the precise method of surgery. He was not so fond of precision
Pstient was unrelieved. Afterwards he came under Mr. as to be enamoured of it. At Contrexdville patients were
ftxilee’s care, and tbe kidney was again exposed, incised, known to pass large numbers of calculi under the treatment
ud carefully explored with the finger, but no stone was pursued there. This treatment consisted largely of free
found. A few days later this patient passed a small stone, drinking of the waters, some patients taking as much as six
ft was conceivable, though not certain by any means, that, quarts of water a day.

through an abdominal incision this stone might have been Mr. Pkabce Gould mentioned the case of a woman, forty
detected in the opposite kidney, supposing it possible, as years of age, from whom he removed a renal calculus last
Mr- Thornton suggested, that a stone in one kidney November. The history was that fifteen years before she
■sy cause colic on the opposite side. He observed, in had struck the right loin, tbe blow being followed by
pujaiag, that considerable fibrous thickening around the haematuria lasting a week. Ever since that she had had
odney had resulted from the first operation. The recurring attacks Of renal pain, and for five years had been
Kama ease was that of a young man who had a stone conscious of a swelling in the loin. When admitted to
tupsoted in the right ureter, which led to disorganisation Middlesex Hospital she presented a fluctuating renal tumour
the kidney. An absoess formed around this kidney, in the right loin, with pyuria. The kidney was opened by
*fiich was opened; but at the operation it was impossible the lumbar incision, and in the distended pelvis of the kidney
tothfloorer the kidney itself. Borne months afterwards the an oval uric acid stone was found and removed. After three
PUieot died of suppression of urine, coming on during one days urine ceased to flow through the loin, and within a
« his frequent attacks of colic, and no doubt partly caused month the wound was all firmly healed. The patient was
fiy the opium taken to relieve the pain. Even at the shown before the pieeting. Mr. Gould referred to the
Port-amtem the kidney oould hardly be detected, as it was statistics given by Dr. Brodeur in his work on the Surgery
tedoced to a flabby bag of pus. The other kidney was en- of the Kidney. He had found 25 cases of nephro-lithotomy
‘•'gsd and fairly healthy. Here, again, it was possible for simple renal calculus, with 2 deaths—the coses of Durham
m abdominal incision might have resulted in the dis- and of Bennett May : 66 cases of calculous pyelitis had been
?"«yaf the stone in tbe ureter, and thus have led to an submitted to operation; in 44 of these nephrectomy had been
“wristt being made into the suppurating kidney, and the performed, 34 by the lumbar incision, with 19 recoveries, 10
rocattiMt of the pus might conceivably have again started by the abdominal incision, with 5 recoveries ; 16 had been
worsting action of tbe sound organ. On the other treated by nephro-lithotomy, 13 by tbe lumbar incision, with
ti * fl d,th*re appeared to be objections to tbe abdominal in- 6 recoveries, 3 by the abdominal incisioD, all fatal; 6 had
oww-lwideft the one on which Mr. Thornton had specially been treated by nephrotomy, only 4 of which had recovered.
d *e»k lb begin with,* danger to which he had alluded These statistics, like others, were not complete, as many
JWf. distinct onwyyfc, that of causing a ventral | cases had not been recorded; but they were tbe most recent-.

Jacking tbe tight, muscular abdominal wall and the most important that had been compiled. He referred
0{ t streag -aaaa. But, besides this, it was possible to the fact that many cases had occurred where the

h 3

372 Thu Lancet,]

MEDICAL SOCIETY OF LONDON.

[Fbb. 19 , 1887.

diagnosis of renal calculus had been made by competent
observer^ and on exploring the kidney no stone. was
detected, but the operation was followed by complete relief
of the symptoms. Two such cases had occurred in his own
practice. On the other hand, all must have met with cases
of renal calculus which had not given rise to any symptoms
during life. In reference to the abdominal operation, he
thought Mr. Thornton was disposed to regard too lightly the
importance of opening the peritoneal cavity, and his asser¬
tion of the tolerance of the peritoneum to operation, pro¬
vided the wound was kept aseptic, applied equally to all
other tissues.

Db. S. Coupjland thought that the method of treatment
known as lithontripsy might halve to be practised for months
and yeara before any appreciable effect would be made on
the size of the stones, and during all this period the patient
might have to suffer from severe symptoms, whilst the
kidney would be injured by the presence of the foreign body
or bodies. Post-mortem experience showed how injurious
the effect of stones in the kidney could be. He considered
that the remarkable success of surgery of the kidney ought
to encourage physicians and patients alike to resort to the
simple surgical method of removal as infinitely preferable to
the slow, uncertain, and possibly perilous methods of
medicine.

Mr. T. Smith thought it was easy to generalise too
positively, and to regard certain methods of operation as
infallible in ascertaining whether there was a stone. If itwere
Mr. Thornton’s contention that by the combined method it
would be impossible to overlook a stone, he could not concur;
for he knew of cases in which most careful palpation of the
kidney, and even pressing it against a solid table, was unable
to diagnose the presence of a stone in the removed organ.
It was possible, also, that the peritoneum would not behave
with equal benignity to all surgeons as it did to Mr. Thornton.
He thought that Dr. Coupland took too gloomy a view of
the patient’s condition in cases of renal calculus. At Con-
trex6ville, as Dr. Yeo had related, patients passed stones and
led comfortable lives—nay, even lived to form other atones.
A kidney that had once formed a stone was very likely to
form another, thus requiring repeated operation. A
three weeks’ course at ContrexSville might effect won¬
ders for the patient. He had no objection to per¬
form the operation of nephro-lithotony; in fact, was
yearning to do it. But having three near relatives Buffering
iroan renal calculi, and knowing that they had passed
several stones and yet lived a fairly happy life—one rela¬
tive was so little injured in general health as to be able to
ride forty miles on a tricycle,—he should hesitate to resort
to surgery when such simple means as abundant drinking
of water would effect so much relief. One of his relatives
drank six pints of warm water every day, and) described
the effect of drinking it as refreshing and exhilarating.
This patient had had plugging of the common iliac vein,
and an abscess had burst into the intestine. Yet he now
led a comfortable existence. As to the water, the only pre¬
caution to observe with regard to it was that it should be
drank whilst it was very hot, and on an empty stomach.

Mr. K. Thornton believed that it would be easier to detect
a stone in a living kidney than in one that was removed
from the body, and in which the circulation had ceased.

' Mr. Henry Morris said that in the five minutes at his
disposal it would be impossible to reply adequately to all
the observations that had been made, so he should confine
his remarks to the question .of the relative merits of the
lumbar and abdominal methods and to the point raised by
Dr. BurnCy Yeo. As to Mr. Thornton’s objections! to. the
lumbar nephrotomy, he admitted that tome of the objec¬
tions might hold, good, but contended that even by the
combined mbthofl the stbhe. could pot be located with
certainty, and that, indeed, there ■vkas nothing very advan¬
tageous that could be claimed for the abdominal incision.
The lumbar wound might heal ,as rapidly as possible,
so that lie. could not concur in Mr; Thbmtoa’s (remirks
about the necessarily alow hdalihg -of this wound; <-He
illustrated the rapid healing of the hnnba*.wound: by
reference to: cases that, had been under his care* The
freedom from fatality and .misfortune, the absence of
any difficulty in finding the kidney, and the ease with
which the various surfaces of the kidney could*be- pal¬
pated were some of the advantages of the lumbar opera¬
tion. What was wanted was greater precision in diagnosis,
and he suspected that some cases of failure to find the stone
might be attributed to this want. When the kidney was

thought to be the seat of mischief; in cases of pain resembling
renal colic, he thought that the directing of the attention, to
the prostate in the male, and to the ovary and Fallopian
tubes in the female, would lessen the chances of making an
erroneous diagnosis. The more accurate the diagnosis, the
fewer would be the failures to find the stone. In answer to
Dr. Yeo, he would say that when the Contrex6ville and water-
drinking treatment had been tried and the patient itill pos¬
sessed the symptoms of stone, then the physician might
reasonably, and without fear or trembling, call in the surgeon,
who would in a short space of time effect far more for the
benefit of the patient than would any amount of water.

Mr. Bennett remarked that the direct sounding of the
kidney by freely puncturing the organ was a frequent
practice at St. George’s Hospital, and the results of this
practice were most encouraging.

Mr. Howard Marsh did not reply owing to the lateness
of the hour.

The following living specimens were shown:—Dr. A. IL
Robinson : Case of (?) Congenital Cretinism and Myxoedema
in'a man aged twenty-three. Mr. H. H. Clarion showed a
case of Lupus with Ulceration of Palate and Phthisis, and a
second case of Tubercular Ulceration of Palate. Mr. H.
Morris: A successful case of.Nephro-lithotomy. Mr.Battle,
for Mr. Sydney Jones: A case of Rheumatoid Arthritis in a
girl aged six. Sir Dyce Duckworth: A case of Heart
Disease with Rheumatic Nodules.

MEDICAL SOCIETY OF LONDON.

Removal of both Superior Maxilla.

An ordinary meeting of this Society was held on Monday
last, Mr. R. Brudenell Carter, F.R.C.S., President, in the chair.

Dr. Leopold Servais (of Antwerp) read a paper on
Removal of both Superior Maxillaa for large tumours of the
face. The first case was that of a boy aged nine years,
living at Wduroo, Holland. The operation was performed
on Oct. 10th, 1883. The tumour had developed at the
expense chiefly of the right superior maxilla. Fergusson’s
method of operation was adopted. The cautery was used
to stanch the bleeding. The roof of the orbit, the orbital
plate, the nasal process of the right, superior maxillary
bone, and the larger part of the malar, bone were preserved.
Recovery was rapid. There has been no recurrence. The
second case was that of a woman. The tumour had been
slowly growing for eleven years; it was of enormous Bize
and extremely painful. It had been treated by caustics.
The tumour was successfully removed, and the patient was
now completely well. The operation took five hours.

Mr. F. Bowrxman Jessbtt read a case of Sarcoma in¬
volving both superior maxillary bones and hard palate, with
removal of the tumour, together with great part of both
bones, ending in recovery. The patient was a woman, aged
thirty-five. She first noticed a lump in the hard palate
twenty-one months ago; it grew rapidly, and projected
considerably into the mouth and interfered with eating
and speaking. At the end of six months she went to Gnyjs
Hospital, wider the care of Mr. Lucas, when the tumow
—a myeloid sarcoma—was excised, and its base.jseiaped
and cauterised. In June, 1886, she was in St. Thomas’s,
under |the care of Sir W. Mac Cormac, with an extensive
recurrent growth, which proved td be a very vascular
sarcoma. In Ootober, 1886, she came finder Mr. Jessetfe
care. The whole of the hard palate and moat^of.the soft
palate were implicated. Respiration could not :take place
through the nose. On Nov. '9th the operation i was per¬
formed, Two inoisioBs were mad*-extending firom either
angle of the mouth upwards and outwards toward* the outer
angle ol the orbits. Thfe whble flap, which included the-nose,
-was reflected upwards over the forehead,’ and the whole of the
tumour was thua freely exposed to view; With- a fin* narrow
saw both superior maxillary bones were divided about half
an inch • above and parallel to the &lv4ote> process. With a
raspatory used as a lever this portion of the bones was
separated from the upper and remaining ports. The
separated bone was than seized with a lion forceps and the
whole growth was gradually removed, with the exoeption of
that portion which had grown into- the left antrum. This
was afterwards easily removed by the use of a Volk man n’s
spoon. There was scarcely any hemorrhage. The skin
flaps were brought together with bare-lip pins and the
wound dressed with iodoform. She was fed with nutrient

Digitized by GoOgle

Till IiANCJtB,}

OBSTETRICAL SOCIETY OP LONDON.

(Feb. 19,1887* 373

aneroafa for the first twenty-four hours. The patient, who
was shown, made an excellent recovery, and was still quite
well three months after the operation. The growth was a
mired-celled sarcoma.

Mr. Bbudbnell Carter spoke of the value of the revolv¬
ing circular saw in the division of bone.

Dr. Angel Money said the tumour was a mixed-celled
sarcoma, having a plexiform or columnar arrangement, and
with some distinct myeloid cells.

Mr. Harm adukb Sheild said the tumour had an alveolar
structure, and was composed of mixed cells, some of which
had something of the appearance of myeloid cells, though
they did not appear to have many, nuclei.

Mr. J. H. Morgan spoke of the historical value of Dr.
Servais’ paper, and congratulated him on the success of his
courageous surgery.

Mr. H. Alli noham referred to a case of removal of a
tumour from the superior maxilla by Mr. Pick.

OBSTETRICAL SOCIETY OF LONDON.

The annual meeting was held ou Feb. 2nd, J. B. Potter,
M.D, F.R.C.P., President, in the chair.

The following specimens were shown : — Dr. Am and
Booth’s specimen, which was exhibited at the last meeting
of the Society, was reported by Mr. Alban Doran and Dr.
ff. S.A. Griffith to be. a fibroid growing from the unde¬
veloped horn of a uterus unicornis. Mr. F. A. T. O’Meara
showed a Foetus with the bladder so dilated and thickened
that it nearly filled the abdominal cavity; the urethra was
impermeable. Dr. John Phillips showed a dissection of a
Foetal Heart with .two auricles and one ventricle, taken
fnm a dicephalous monster. Dr. Horrocks exhibited an
infant a week old suffering from Spina Bifida; the cyst had
contained 50 ox. of fluid. Dr. M. H. Jones read remarks on
the oase.

Unilateral Qalactorrhaa.-— Dr. Gibbons described this
bmc. A lady, aged twenty-three, who had ceased nursing
for six weeks, complained Of constant running of milk from
tbs left breast. After her first confinement she had nursed
for five months with .both breasts, when she had to giveup
aa account of weakness, and an abscess formed m each
heastaad discharged for eleven months. After this, her
•stood confinement, she at first nursed with both breasts,
hat the milk disappeared from the right one, and she con¬
tinued with the left breast only for four months, and then
discontinued, ae it was thought that her milk disagreed with
the child. Menstruation had not reappeared. There was no
reason to suspect pregnancy, and there was no uterine dis¬
ease.. Although she was anaemic, the milk was of good
ehwacter, and the amount that flowed was twenty ounces
in twenty*four hours. Dr. Gibbons then enumerated the
various remedies which he had nied to arrest the secretion
of milk, without remit. These included arsenic, iron, strych¬
nine, iodide of potassium, belladonna, bromide of potassium,
quinine in large doses, coinpressioh of the nipple, opium, gal-
TOiii, faradigin, rest and a dry diet. Menstruation appeared
«kvea months after the birth of the child, being preceded by
i gradual diminution ef the flow of milk, whioh continued
over theeecond period and then ceased altogether, and the
pataca?* condition became one of natural health. The
“tbor drew attention to the following facts(1) That the
gaketozrhcea was unilateral; (2) that the milk was of
•ocnal quality and quantity; (8) that there was no stimulus
ofaamug or of the genital organs; (4) while resisting all
this treatment, it ceased spontaneously on the occurrence of
Badhutiam Authors were quoted as to the value of
certain drags in galactorrhcea, and cases were given illus-
tatfre of treatment by galvanism and faradism. Reference
wjfc.JbftdA to tba experiments of/Roehrig to. determine
*hsther the nervous or vascular element has the greater
influence over the secretion of milk, and resulting in favour
°f ^wd-pressuro as the chief factor. . Sinety was also
1 tofed, ind, in conclusion, the speaker remarked that ho had
tiifadtoftnd my ease similar to the one brought forward.
It vras proposed and seconded that the discussion of this
>H0«dd be postponed till the next meeting of the

Tha treamcu’s report was., adopted on the motion of Mr.
Dm* Mtonfed by Dr.:Ospham/as were also the report
• WS- hSm. (librarian, on. the. motion of Dr. Herman,
BtiNid fcTftte JAele, and:that of the Midwifery Board,
* mvwbm ihk Playfafr* seconded by Dr. Malin*.

It was proposed by Dr. J. Williams, seconded by Dr. W.
Black, and carried, that an alteration in the law regarding
the meetings of the Society in January and October be made
so that these meetings shall be held on the first Wednesday
in each month, unless for some reason the Council should
alter it—e.g., on account of the first day of the new year
falling on a Wednesday.

The scrutineers (Drs. M. H. Jones and E. S. Tait) declared
that the list of officers and Council as proposed had been
adopted.

The President then delivered the annual addross, which
will be published in a future number.

A vote of thanks to the President for his address, and to
the retiring officers and members of the Council, concluded
the proceedings. ____

ACADEMY OF MEDICINE IN IRELAND.

Conservative Surgery in Diseases of Foot and Ankle.

At a mooting of the Surgical Section held on Doc. 10th,
1886, Mr. W he klee read a paper on Conservative Surgery
in Disease of the Foot and Ankle-joint, in which he recorded
several successful operations, including excision of the
os colds, of the astragalus, scaphoid, cuboid, middle, cunei¬
form, and metatarsal bones; also resection of the first
pbalango- metatarsal articulation. He described in detail
the diseases requiring excision of the os calcis, the form of
incision, and after-treatment. He condemned the sab-
periosteal operation in such cases. All his excisions of the
os calcis were successful, and the locomotion, of the patients
was but little impaired. One of the cases he operated on
died seven years after the operation from phthisis. The
case of excision of the astragalus had been seen within a
very recent period. The lady had a movable joint between
the os calcis and malleoli, and possessed nearly equal powers
in the foot operated on and in that unoperated on. In the oase
in which he removed the astragalus, os calcis, and the malleoli,
with articular surface of the tibia, for disease of the bones, the
patient had left for India last October, at which time be wUs
able to wear a well-adapteff boot and walk with the aid of a
stick. Mr. Whefelte emphasised the necessity for carefulness
in diagnosing the seat and cause of disease in the foot, like¬
wise tne stage the disease was in before undertaking partial
operations.—The President bad not found cases in which
the disease was sufficiently limited to ensure satisfactory
and permanent results by partial excision, and the want of
such limitation was the chief reason'why Pirogoff’s opera¬
tion was abandoned. Indeed, he was himself one of the
first, if not the first, in this country to perform excision of
the ankle-joint for caries, and be obtained what seemed to
be a successful result—the wound healed and the'patient
had the use of his foot for two years; but at the end of that
period the disease manifested itself again, and contempo¬
raneously with it there was also evidence of tubercular
disease of the lungs, which prevented further operative
measures.- Mr. Wheeler seemed inclined to disparage the
subperiosteal method, without giving definite reasons.
While the advantage of some excisions by that method were
exaggerated, as in excisions of the elbow-joint, yet in others
there was no doubt that it was useful, especially in the
shoulder-joint, and the excision of shafts of bone, as the
fibula, radius, and ulna; for in the young the preserva¬
tion of the periosteum was of great importanoe. In
excision of tne elbow he did not think that better
results were obtained by this than the older method.—
Mr. Croly had performed a great number of operations
for disease of the ankle-joint, and be did not like the opera¬
tion for excision of the os calcis. He had not had success
in saving the foot where the disease seemed to be confined
to the os calcis. He removed the os calcis by a horse-shoe
incision where the rest of the bones seemed sound, bnt it
turned out that they were infiltrated. He had' had, how¬
ever, a most successful case in. private practice of excision of
the os calcis for gunshot injury where tne bone was shattered
and shot had lodged in it, and the gentleman now had a
useful foot, He had met with another case of great interest.
A man fell off a horse injuring his ankle-joint, jrhich
exhibited all the evidence of compound fracture. Amputa¬
tion was proposed, but the man refused to allow it. Months
afterwards, when under his care, he cut down under the
ankltv-joint and found the astragalus was detached, and that
the tibia bad come down and accommodated itself on the
os calcis. The njan was now engaged as a coachman and

Googl<

374 Thb Lancet,]

MIDLAND MEDICAL SOCIETY.

[Feb. 19,1887.

groom with a useful foot. The advantage of saving the
' periosteum of the os calciS bore no comparison to that of
saving the periosteum of the shaft of the bones. —
Mr. Barton distinguished between caries from disease of
the bone and that from accident, which was approached by
the surgeon on different lines. The experience of the prac¬
tical surgeon was unfavourable to gouging or partial opera¬
tions where there was extensive caries or the disease was
diffused. Hutton, who had operated as Mr. Wheeler did,
discountenanced the then new procedure as leading to au
unsatisfactory result, and yet Mr. Wheeler, by removing a
similar amount of bone without following the same line of
incision, had obtained success. He himself had attempted
to save a foot of which the disease was only partial, and
his experience was that while he had been successful in
some cases, yet in a great many he had been unsuc¬
cessful, and it would have been better for the patients
had he performed Syme’s operation at first.—Mr. Franks
said the unsatisfactory results of partial excision were
due in the first instance to foci of disease being left
untouched, and, secondly, to operating on patients who had
sunk so low in health that they had no recuperative power
in them. At the same time, the condition of the patient
was often made too much of in these days of antiseptic
surgery, and therefore conservative surgery might be
adopted with more hope than before. In tubercular disease,
however, health was a great factor: everything depended
on the constitution of the patient, and caries sometimes
got well without operation at all. The tendency of surgery
was to the partial excisions, especially in view of the success
achieved by Ollier of Lyons, who was a great advocate for
subperiosteal operations. It was obviously better to leave
a periosteum that could develop bone rather than excise
it with the bone, and hope for a pad of cicatricial tissue to
walk upon.—Mr. Henry FitzGibbon remarked that, in con¬
sidering the question of excision, the main point was what
was the primary cause of disease in the bones. The great
distinction was between disease of bones resulting from
accident and disease arising from constitutional cachexia.—
Mr. Wheeler replied. _

Addison's Disease.—Select Clinical Reports.

At the meeting of the Medical Section held on Dec. I7th,
1886, Dr. Doyle read a paper on a supposed case of Addison’s
Disease occurring in a dark-complexioned female somewhere
between twenty-two and twenty-five years of age, having
brownish and bronze-looking pigmentation of the temples,
cheeks, backs of hands, ana front of legs. Constitutional
symptoms preceded the pigmentation by nearly three
months. 111-health first commenced with an unhealthy
ulcerated condition of one of her fingers. This patient was
said by her friends to have recovered, but that slight dis¬
colouration remained along attachment of the hair to the
temples. The chief interest connected with the case was to
discover the primary disease that gave rise to weakness,
lassitude, vomiting, cough, fever, and discolouration.

Dr. A. W. Foot read a communication styled “ Notes of
some Unusual Cases observed in Hospital Practice.” One
was a case of obstinate vomiting from “land-sickness,”
which continued for nine days after the man had come
ashore. Another was a case of mistaken identity on the
part of four persons. The man was living, but comatose
from alcohol. A husband, wife, and two of their daughters
claimed him as their son and brother—wrongfully as it
turned out. There was a case of well-marked articular
gout in a hospital patient, very corpulent, and long addicted
to porter-drinking. The series concluded with an account
of a man who was firmly convinced that he was the source
of an offensive effluvium which made his presence unbear¬
able and even injurious to others—animals as well as men.
Dr. Foot called this, and some similar cases which he
alluded to, by the provisional name of “ subjective
osmidrosis.” The question was discussed of an hallucina¬
tion of smell or organic irritation of the sensory centre.—
Dr. Cox said he had himself a tendency to sea-sickness
which lasted for some hours after he came on shore. He had
had two cases of acute articular gout. One was that of a
butler, who was considerably improved under a treatment of
colcbicum and lithia, and subsequently iodide of potassium.
The other was that of a policeman ; bromide of lithia gave
him considerable relief, and the administration of salicylic
acid seemed decidedly beneficial. Other patients he had
seen relieved by ointment of belladonna and iodine, with
powder of opium or the extract of opium. With reference

to the curious case of delusion, he might state that at present
he had under treatment a man who was sensitive of emitting
a disagreeable smell, which might be the result of disease of
the bones of the nose or of mischief at the back of the pharynx.
—The President had himself been consulted three years ago
by a gentleman on account of a bad smell which, he said,
emanated from his body and made him offensive to every¬
one around him. He saw that the gentleman was under a
delusion, and endeavoured to convince him of the fact. Once
afterwards he again saw this gentleman, who had, he believed,
given up the idea. As to remedies against hallucination,
even specialists seemed to have forgotten the great results
published many years ago by Seymour of London as to the
value of opium in cases of hallucination and melancholia.—
Dr. Foot replied. _

MIDLAND MEDICAL SOCIETY.

A meeting of this Society was held on February 2nd,
Mr. Lloyd 0 wen, F.R.C.S.I., President, in the chair.

Gunshot Wound of Vertebra. —Mr. J. T. J. Morrison showed
a man aged twenty-five who nine weeks ago, in a fit of
depression, shot himself in the mouth, discharging a No. 7
conical Eley bullet from an ordinary revolver. On admission
there was some shock, but no loss of consciousness. The
tongue and palate were blackened with powder; the soft
palate presented a round perforation, through which the tip
of a finger could feel an opening in the bony wall of the
pharynx; a probe passed through this aperture, traversed a
canal about an inch in length in the bone, and impinged on
a hard substance at the bottom. There were no signs of
spinal concussion or haemorrhage. No operative treatment
was adopted for the extraction of the bullet. The patient
is now in excellent health, the hole in the vertebral column
being filled up and its place indicated by a slight elevation.

Fractured First Rib. — Mr. A. F. Mbssiter exhibited a
specimen of fracture of the first rib from a man aged
seventy, who had been run over by a cart, and died shortly
after admission from collapse. At the post-mortem exam¬
ination the sternal end of the right clavicle was found to be
dislocated forwards; the first rib was broken at the spot
where the subclavian artery passed over it; the second was
fractured at its middle, and the third and fourth behind
tbeir angles, the latter wounding the lung; there was no
other injury. Mr. Messiter considered that the clavicle after
dislocation was pressed down on the first rib, thus fracturing
it by direct violence. The periosteum was tom on the
under surface of the bone, but was intact on its upper
surface.

Mr. J. W. Taylor showed some Female Catheters made of
Glass. He uses them for operation cases whenever a catheter
is required, and finds them very clean and inexpensive. He
also exhibited his “Artificial Amnion,”a simple formof uterine
dilator and tampon. Both instruments may be obtained
from Messrs. Mappin of Birmingham.

Rupture of Abdominal Aorta. —Mr. L. Taylor showed fori
Dr. Oliver Field a specimen of Rapture of the Abdomina g
Aorta, taken from a boy aged eight. Half an hour before hi
admission to the hospital he was run over by a brewer’s cart.
On admission he was suffering from great shock and was
much blanched, the abdomen being moderately distended;
he died in an hour. On post-mortem examination a con¬
siderable quantity of blood was found extravasated behind
the peritoneum, and there was a large rent in the abdo¬
minal aorta, where it divided into the two common iliacs,
the abdominal viscera being uninjured.

Mr. Donovan read a paper on “ Some points in Thera¬
peutics.” __

WOLVERHAMPTON AND DISTRICT MEDICAL
SOCIETY.

A meeting of this Society was held on Jan. 4th, Dr. S. A.
Smith, President, in the chair, when the following speci¬
mens were exhibited:—

Mr. Vincent Jackson showed a girl aged fourteen, sent
to him on account of alarming symptoms occasioned by the
presence of a large adenoid bronchocele. To relieve her
symptoms of asphyxia Mr. Jackson completely divided the
very broad isthmus, and removed a small portion. The
operation was followed by complete departure of the dis¬
tressing symptoms, and by a visible diminution of the size

D

O

The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

of the tumour, amounting, as ascertained on measuring the
circumference of the neck, to one inch. The wound healed
quickly.

Dr. Evans showed a case of Splenic Leucocythsemia in a
child aged twelve. The spleen extended down to the pubes,
and occupied the greater part of the left side of the abdo¬
men; it had grown rapidly during the last two months
whilst under observation.

Mr. Yincent Jackson exhibited (1) a large loose cartilage
removed from the right knee of a gentleman aged thirty-
two. Its removal was accompanied by a free incision of the
skin and capsule of the joint. A rapid recovery followed
in fourteen days. The operation was done with anti¬
septic precautions. A drainage-tube was kept in the
joint for two days. Also (2) a large multilocular ovarian
tumour of almost solid character successfully removed
from a woman of fifty-two years of age. It was con¬
nected by tough adhesions to the walls and contents of
the abdomen, and an innumerable quantity of bleeding
points required deligation, including some on the intestinal
walls. Rapid recovery followed the operation. A glass
drainage-tube, withdrawn at the fourth day, was used.

Intestinal Obstruction and the Difficulties in the Way of
Diagnosis.— Dr.ToTHBRiCKread a paper on this subject, and
remarked that in this respect age had an important bearing,
for in children the cause was generally either intussuscep¬
tion or peritonitis, and in aged persons either impaction of
faeces or malignant diseases. He advocated the use of
repeated enemata of water or oil in those cases due to im¬
paction of faeces. In acute cases, where the diagnosis is
uncertain but the fatal termination sure, exploration by
abdominal section was advised. Of all. drugs opium was
most generally useful, and in cases of impaction saline
aperients might do good. In simple inertia of the bowels due
to repeated constipation and over-distension he had found
faradaism very useful.__

PLYMOUTH AND DEVONPORT MEDICAL
SOCIETY.

Thk monthly meeting of this Society was held at Ply¬
mouth on Wednesday, Feb. 2nd, Dr. C. Aldridge presiding.

Mr. W. J. Square read an interesting paper on Cystic
Tumours of the Breast, and related a recent case of Lym¬
phatic Cyst treated by Evacuation, followed by the con¬
tinued application of a liniment after Sir B. Brodie’s formula,
with excellent result.

Dr. Bampton opened a discussion on the Treatment of
Typhoid Fever, advocating the use of quinine in large doses
and cold applications to combat hyperpyrexia, where the cold
bath treatment was not practicable, orwhere tepid sponging
was insufficient. The administration of antipyrin had in his
bands been followed by marked lowering of temperature,
accompanied by profuse sweating, and succeeded by refreshing
sleep. No untoward symptoms were manifest. Maltine was
suggested n9 a valuable dietetic adjuvant. 8tress was laid
upon the cautious return to farinaceous food or fish at a
considerable interval after the normal temperature bad been
reached. The routine treatment of cardiac exhaustion in
the later stages of the fever with brandy was pointed out to
be a mistake, and a more scientific and rational discrimina¬
tion, based upon a knowledge of the different qualities and
properties of the various alcoholic liquors, in the selection
of so potent a remedy, was pleaded for. The more highly
etherised wine, as old sherry, was indicated in cases of
cerebral or cardiac exhaustion. 8urgeon Russell, A.M.D,
bore testimony to the efficacy of the cold bath treatment,
not only in controlling and lowering hyperpyrexia, but also
its ability to prevent its access. An interesting discussion
followed, to which a large number of members and visitors
contributed.

National Hospital fob the Paralysed and
Epileptic.— The annual festival in aid of the funds of this
institution was held on the 9th inst., the Right Hon. the
Lord.Chancellor (Lord Halsbury) occupying the chair.
Daring the evening, the secretary, Mr. Burford Rawlings,
announced that the subscriptions received towards the
Jubilee Fund amounted to £1183. The object of this fund
is to enable the whole of the hospital accommodation to be
taken into use, wards containing mty-flve beds out of a total
of 180 not having been as yet in occupation.

[Fit. 19, 1887.

THE GENERAL COUNCIL OF MED ICAL
EDUCATION & REGISTRATION.

Tuesday, February 15th.

Sir Henry Acland, President, in the chair.

As soon as the Council was formed,

Dr. McVail, on a point of order, said be desired to raise a
question with reference to the appointments of several of
the members, which he said had been made by the Senatus
Academicus of the Scotch Universities.

The President interposed, and stated that the question
about to be raised by Dr. McVail could not be brought
forward without notice of motion.

Dr. McYail said he would give the requisite notice.

The President then delivered his address to the Council.
He said:—“The difficulty of condensing within reasonable
space the topics which demand the attention of the Council
has never been as great as on this occasion. The Council
now meets, for the forty-first time, enlarged, under the
Medical Act of 1886, by seven members, with the addition,
since the Act passed, of a representative from the Victoria
University. These eight members, with a newly-appointed
Crown Nominee for Ireland, and a new member for the
Apothecaries’ Society of England, form almost a third of the
entire Council. It would seem, therefore, culpable not to
endeavour to place before you a short statement of the
work that lies before us. This is the less easy, because,
although every member of the Council is acquainted with
our duties, yet most would admit that we do not all look
at them from the same point of view. Of this, however, I
am sure, that you will believe in my earnest desire to place
before you, as briefly as possible, such facts only as have a
practical bearing on the important work that brings us
together to-day. We meet in the present year under
conditions which have no precedent, and which ‘can never
recur. The year of the Queen’s Jubilee, with all that this
implies, suggests to every body of Englishmen who have
been charged with national duties thoughts of change from
the known to the unknown, even though they are, in tbe
main, thoughts of thankfulness and hope, of progress and
peace. In no public body can these thoughts, and tbe
questions which attach to them, be more important and
more deep than in one which fixes its attention on the
changes which medicine has undergone in the last fifty years.”
The President then touched upon what he termed the pro¬
gress of health notions during the Queen’s reign, in regard
both to curative and preventive medicine, and passed on to
consider the progress of legislation in respect of medical
education during the same period. “As regards the history of
the duties assigned to the Medical Council,” he said, “ there
is little need to concern ourselves. We have the power and
duty to see (1) that no one legally enters the medical pro¬
fession who is not fit for it; (2) that no one remains in tbe
profession whose conduct has been professionally infamous;
(3) that all necessary medicines may be officially sanctioned
and scientifically prepared; (4) that due rights and privi¬
leges are accorded to all properly educated Colonial and
foreign practitioners who are legally qualified in their own
countries. It has taken seventy years of discassion to come
thus far. Au opportunity was lost in 1815. Tbe agitation
for comprehensive medical legislation began in earnest after
1830. A Bill was laid before Parliament in 1840. Principles
of union were agreed upon by the great London authorities
in 1848. In this same year a Bill was brought forward in
vain by a powerful Minister, Sir James Graham, in concert
with Sir Benjamin Brodie. Sir Benjamin’s correspondence,
consisting of hundreds of letters, about that date, is still
in existence. All these and many other movements resulted,
in 1868, in the Act which, constructed on broad principles,
empowered, and therefore required, all the bodies connected
with tbe legal authorisation of practitioners in medicine
throughout Great Britain to place their education on
adequate and uniform grounds. Twenty-nine years have
passed, and now only last year has this been effected. Over
the melancholy history of this delay a veil had best be
drawn. Of the Act of 1858 we cannot, on the whole, speak
too highly. Where it failed, it has failed through and by

376 Thb Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Fbb. 19,1887.

season of one canker of our nation —amor sui, non patria.
Two expressions have been rife in this regard—and they
have. given rise to comment, and have caused offence on
opposite grounds—the one, ‘moral suasion’; the other,
‘ the battle of the shops.’ These terms represent great
forces in nowise peculiar to medicine. The former appeals
to individual and to corporate conscience. The latter asserts
the claim of supposed corporate interests. Seeing that
neither of these forces rectified acknowledged evils, in 1870
the Government made an attempt to institute national
licensing boards. The principles of the Government pro¬
posals were accepted by the Medical Council. These were
to enforce uniform and adequate examination for entranoe
into the medical profession. Much fruitless labour has been
expended in the sixteen years that followed, involving loss
of time to the Council and to Parliament, and some
loss of character to our profession. It is a sad chapter
in the history of Parliamentary government and of
free institutions. But this chapter is now closed, and
closed in a remarkable way. There were two principles on
which most persons with knowledge and of calm judgment
seemed in 1870 to be thoroughly agreed—viz., (1) that the
present Council was too numerous for the best form of
executive, though perhaps this was an unavoidable evil in
our day, pre-eminently a time of ‘representation’; and
(2) that the examining and licensing institutions were too
numerous for uniformity of action. The Act of 188G, to
which all who did not oppose it are practically parties, in¬
creased by a full fourth the number of this Council; and the
institutions, with power to license separately, are more
numerous by one than they were before. This is surely a
strange result. It teaches a profound lesson for the
future of medicine and of science. It is the lesson
that it is an evil thing for a free country when its
people and its institutions depend on Parliaments,
and not on themselves, for matters which they them¬
selves can, without compulsion, adjust and rectify.
There are now, therefore, tioenty independent bodies with
power and duty to certify the fitness of the medical practi¬
tioners of Groat Britain to practise every part of their pro¬
fession ; to grant higher titles to those who possess know¬
ledge, general or scientific, or practical, higher than is
essential for the generality; and to combine together for
this national end in whatsoever manner they may severally
determine. Once again the institutions are free, and, being
free, are once more on their trial. It is almost needless to
state here that while eleven universities still remain
separate, the licensing corporations have combined, or are
combining, into one in Scotland; they aim at becoming
either two or one in Ireland; and they are two in England.
"When this is done there will be in all sixteen separate
examining boards. A movement is in action in England to
make a sixth degree-giving body, to be designated a uni¬
versity. Should this be accomplished, there will then be in
England only one medical corporation. Whether these
arrangements will hold, whether they are the best, whether
some Government will arise to constitute three divisional
licensing boards, as recommended by the Royal Com¬
mission on the Medical Acts, are matters on which it were
idle now to speculate, and which do not concern this Council
as a State-appointed Council of Education. We here lament
the time that has been occupied, though necessarily occupied,
in doubtful questions, administrative and political. These
belong to another arena, and to voluntary associations. The
work of regulating education by calm consultation of repre¬
sentative teachers from every part of the country has
become great enough when we consider the vastly increased
mass alike of medical knowledge and of opportunity. But
it cannot be said that the principles of medical education
are altered. That education must always be, as it always has
been, though in varying proportions and of various quality,
threefold—general, scientific, and practical. As regards the
bourse of discussion and action which led up to the Act of
1886, it would improperly waste the time of the Council to say
touch. Notthatthe Governments of this period are justly to be
blamed. The two great political parties have faithfully
striven to do their best for us. Four Government Bills have
passed the House of Lord& each, of a more or less complete
character. Discussions within the profession have prac¬
tically checked the full proportion which these BUIb pro¬
posed. to give to a national system of-.medical education and
examination. Voluntary boards^ more, or less complete, in
England, in Scotland, and in Xre^nnj, have been formed,
dissolved, and in other guise fbrned again. And at length

the Act which brings us together with our present numbers
is law. As 1 have already said, eleven universities and nine
licensing corporations are free to act as they will, within
certain conditions. These conditions are practically defined by
this Council, or by the Privy Council, or by both. They are
chiefly to enable and require every body to examine and to
license in every department of medicine: Universities in all
subjects; 8urgeons in medicine and midwifery, m well as
surgery; Physicians in surgery and midwifery, as well as
medicine; Apothecaries in all. As heretofore, any combinor
tions may be made among the bodies with the view of com¬
bining and nationalising institutions still separate and
numerous. And so ends the system of double and treble
qualification, which has been the result of accident and
the imperfect knowledge of former days, and the. source of
heartburning and confusion in our own. It remains now
for this enlarged Council to bring clear and harmonious
effort to a national task of interest and importance, interest
and importance which are ever growing as biological science
extends, as conceptions of national life and national con¬
science rise, and as the relations of the human family
throughout the globe, and especially of the English-speaking
race, are drawn more close, and are better understood.
The President then referred to the educational inquiries of
the Council from its commencement, and to the business to
come before the present Council, pointing out that the
Council could delegate whatever it pleased of its multi?
farious business, except its judicial functions and con¬
demnatory representations to the Privy Council, to the
branch councils or special committees. He concluded thus:
“ 1 am painfully aware of the hopeless task which I under¬
took in making the abstract of medical progress in England
which I have presented to you to-day. Of foreign countries
I have not attempted to speak. Still, it seemed to be a
clear duty, at this stage of the Council’s history, to attempt
a rough catalogue of the chief points which this Council
has had before it during the last twenty-nine years, in its
endeavour to establish the basis of a sound and uniform
training for the medical student of the future. It has had
much support, from Government, and whatever aid can be
derived from abnndant criticism. This last would have Bad
more real value had it fully appreciated the difficulties of a
period of progress never equalled, and of changes in
institutions naturally tenacious of their past. In dealing
with the education of the medical student, we now are
dealing with a subject which depends on some of
the most difficult departments of science. For the
science of medicine is in touch, on the one hand,
with the science of many of the inorganic con¬
stituents of our earth, on whose nature there have of
late been made fresh revelations from day to day; on the
other, with the world of mind wherever manifested in
living things. It is daily face to face with the tyranny of
everlasting all-pervading Law, and yet is open to every ray
of light by which from time to time is darkly shown the
Cause of all. It cannot overlook the actions and reactions
of matter and mind. It is entangled among the mysteries
of Evolution and the effects of Heredity, it must note the
decay as well as the growth of the individual and of the
races of men. It revises with unsparing band the data on
which have rested the juvantia it- kedentia of life which
had the blind faith of our fathers before experiment altered
some foundations of accepted clinical fact. It has to reco¬
gnise as a stern reality that in some manner the laws of all
other living things are the laws by which, free-will not¬
withstanding, we also have our being. It explores what
connexion may be found in the origin and development of
all living things. It has to struggle for the alleviation,
though it does not trouble itself to solve the mystery, of
pain. It seeks to appreciate what are the principles of the
universal pathology which underlie the life history of the
vegetable world, and the bodily sufferings and the mental
agonies of man and brute alike. It is the function of this
Council to represent interests intimately connected with all
these topios through the seats of universal research and
universal learning. It considers the long experience of the
institutions which watch over the practical and beneficent
exercise of the healing art, and which are in sympathy with
the whole body of faithful workers among practitioners.
The Council has to contract the impossible and unnecessary
in education into that which is possible and necessary; it
most so limit purely scientific studies that they may be
directly subservient to the health and the wants of the
public as distinguished from the profession of medicine—

J

ftcs Lancet,} MEETING OP THE GENERAL MEDICAL COUNCIL. [Feb. 19,1887. 377

thatpublic whose welfare is here expressly represented by
the (Sown. We live, in short, in a constant endeavour to
advance the study of an art which ultimately will rest on
science, and to ensure such progress and knowledge as will give
us scientific practice not divorced from rational empiricism.
It is no alight happiness to those who have long watched the
changes of our time to know that there are now in our
medical schools many who, judged by the tests of love for
truth, desire for knowledge, and benevolence of purpose and
personal character, may stand comparison with any youths
of any place or any profession. To them belongs the task
of Temping the harvest of knowledge which this age has
sown, .and which cannot yet be fully gathered in. Many
have the temper of reverent and earnest inquirers into the
order of things under which, for a little span, we have all
been, placed, and in which they, being in constant contact
with the sufferings of other men, have deep concern. In
th^r progress and in their lives will be the great reward of
the Court of Education.”

It was moved by Mr. Marshall, seconded by Dr.
HctjCfhby, and agreed to—“That the President’s address be
entered in the Minutes, and that the thanks of the Council
be Accorded to the President for this address.”

!Rie Finance Committee having been appointed, a table
Showing results of professional examinations held in 1886
for. qualifications granted under the Medical Act by the
bodies named- in Schedule A of the Act, also a table
showing results of preliminary examination in 1886, com¬
piled by the registrar from such returns as have been
supplied by the examining bodies, pursuant to the Council’s
request, were presented.

With reference to the latter table,

Dr. A. Smith called attention to the fact that the
Apothecaries’ Society of London had passed 214 candidates
and rejected 447, and that the Faculty of Physicians and
Surgeons of Glasgow had passed 65 and rejected 159.
These results, he said, showed either that the examinations
of the bodies in question had become much more stringent,
or that the education of the candidates was very defective.

Mr. Macnamara called attention to the circumstance
that in regard to the highest percentage of marks obtained
by the candidates, several oi the universities had stated
that information could not be supplied, and he urged the
desirability of returns being made as to the lowest amount
of information considered satisfactory by the examining
bodies ih preliminary education.

A table was then received showing the number of excep¬
tional cases that occurred during the year 1886 in regard to
the length of the course of professional study, together with
a statement of the action. taken thereon by the several
licensing bodies; and another table showing results of pro¬
fessional examinations held in 1886 for qualifications granted
under the Dentists Act.

With regard to the former table,

Dr, 8TBCTHRRS said it would be observed that the number
of exceptional cases had greatly decreased since lost year.
The only bodies in which they had occurred were the Royal
College of Physicians of London and the Royal College of
Sargeohs of England, in which the number of’ cases was 39
and 22 respectively. That number seemed to he large, and
to require some explanation.

8irDvcK Duckworth said that the cases that had occurred
in file College of Physicians related chiefly to Colonial gra¬
duate*. Only three or four had come from foreign uni¬
versities, and in those cases the diplomas had been closely
scrutinised, not only to ascertain that they were themselves
genuine, but that tne education was satisfactory.

It Was resolved that the registrar should be directed to
inquire in future into the details of such exceptional cases.

The usual communications were received from the Army
and. Navy Medical Departments, in answer to the applica¬
tions of the Council.

A preliminary report by a subcommittee of the Executive
Committee on the. Visitation and Inspection of Examina¬
tions wae presented, together with certain suggestions by
Me. jBunoh on. the subjwst, and recommendations by the
Executive Committee.

Hr.M arshall, in bringing up the report, suggested that
the aublectr W|« so ufgdftt ana important that it ought to be
dealt With bv A.Iarger .body than the. Executive Committee;
tadljdOW&Ofad tr lat the subject should be referred to a
the CounctLior. consideration and report
fat session.. ,
ritTSON seconded the proposal.

Dr. Struthebs said that the report proceeded on the
assumption that the inspectors should be apppointed only
with reference to medicine, surgery, and midwifery in their
limited sense at the final examination. He thought that the
words of the Act had a more extended sense, and should be
regarded as referring to all that led up to those subjects.
It was as important to inquire into the earlier examinations
as it was into the final. They were m reality the founda¬
tions on which the later subjects were built. He quite
agreed with the suggestion of the committee that there
should be inspectors for the three divisions of the kingdom,
and that they should not be limited to one division. An
international arrangement would certainly be the most
satisfactory. As to the nature of the inspection, it should
not be of so detailed a character aa some former inspections.

Dr. Haughton thought that the inspections should be
confined to the final examinations. In the case of the uni¬
versities, at any rate, the preliminary examinations might
be left to take care of themselves.

Dr. (iuAiN, in supporting the motion, said that the
inspectors were not to be mere visitors, but were required
to examine into the question whether the standard of pro¬
ficiency was such as “sufficiently to guarantee the possession
of the knowledge and skill requisite for the efficient practice
of medicine, surgery, and midwifery.”

Sit William Gull moved as an amendment that the
Council should on the following day take into consideration
Section 2, Subsection 3, of the new Act with reference to
inspection. If that course were adopted, the report of the
committee could of course be considered.

Dr. Matthews Duncan said that the old visitations might
still continue with regard to preliminary subjects, and that
the inspection required under the new Acts should have
reference to medicine, surgery, and midwifery.

Sir William Turner said he concurred in the suggestion
of Sir William Gull that the Council should take the special
clause of the Act into consideration. If Mr. Marshall would
embody in his resolution a reference of that clause to the
proposed committee, it would bo more satisfactory.

Mr. Tkale supported the same view.

Mr. Simon thought that the Council ought at an early
period to decide the question of the narrow or the en¬
larged meaning of the words “ medicine, surgery, and mid¬
wifery,” and not refer it to a committee for solution.
That, he thought, would save time, and facilitate the
labours of the committee. He should like at the proper
time to move as a rider to Mr. Marshall’s resolution, “ That
it be an instruction to the committee that the Council desires
its inspection of examinations to cove! the entire range of
those branches of knowledge which it has declared in its
Recommendations to be essential constituents of the qualifi¬
cation of a candidate for licence.”

Dr. Humphry said he would propose as a substitute for
Mr. Simon’s proposed rider the first recommendation of the
Executive Committee- namely, “ That, reserving for future
action the visitation and inspection of the examinations in
the earlier subjects of professional education, the Executive
Committee recommends to the Council that the first year's
appointment of inspectors provide for tho inspection of
examinations in medicine. Surgery, and midwifery.”

Sir William Gull said he was willing to withdraw his
amendment if it were understood that under Mr. Marshall’s
motion the whole bearing of the subsection of the Act
would come before the Council.

Mr. Marshall said he was willing to include the con¬
sideration of Sections 2 and 3 in his resolution.

The motion was then put and agreed to in the following
form:—“That Sections 2 and 3 of the Medical Act of 1886,
together with the foregoing preliminary report by
Dr. Humphry and Dr. Quain, on the Visitation and Inspec¬
tion of Examinations under the Medical Acts of 1858 and
1886, with certain suggestions by Mr. Simon for the Council’s
future Inspection or Examinations, and the recommenda¬
tions by the Executive Committee, be referred by the
Council to a committee, to report on the subject to the.
Council at its present session.”

' The committee was then appointed, and Mr. Marshall
was requested to act as chairman.

Mr. Marshall brought up various communications on
the subject of diplomas in Sanitary Science for entry on the
Minutes. . He stated that the schemes and curricula all
Coincided in requiring that the candidates presenting them¬
selves should be registered practitioners, and in some
instances the candidates were required to be graduates in

378 The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Feb. 19,1887.

medicine of the university giving the diploma, or of some
other body.

A communication was received from the University of
New Zealand, applying for the recognition of its diplomas.
It was ordered to be entered on the Minutes.

Communications were also received from the Apothecaries’
Hall of Ireland, and the King and Queen’s College of
Physicians in Ireland, with reference to a conjoint scheme
of education and examination, and ordered to be entered on
the Minutes.

The remainder of the sitting was held in the absence of
strangers. _

Wednesday, Feb. 16th.

Sra Hbnby Acland, President, in the chaib.

The Apothecaries' Hall of Ireland and the Conjoint Scheme.

Dr. Struthebs brought forward the following motion :—
" With reference to the ‘ scheme for constituting an Exa¬
mining Board in Ireland by the King and Queen’s College of
Pliysicians and the Royal College of Surgeons in Ireland,’
received and entered in the Minutes of Nov. 20th, 1886,
page 154; and to the communications to the Council from
the King and Queen’s College of Physicians in Ireland of
Nov. 10th, 1886, and the Apothecaries’ Hall of Ireland of
Nov. 9th, 1886, received and entered in the Minutes of
Nov. 19th, 1886, page 145; and to the * Remarks,’ with
Appendix, by the King and Queen’s College of Physicians,
of date Dec. 31st, 1886, transmitted to the President by the
College on Jan. 5th, 1887, and the ‘Comments’ thereon by
the Governors and Court of the Apothecaries’ Hall of
Ireland, transmitted to the Registrar of the Council on
Feb. 3rd, 1887, and received and entered in the Minutes
of Feb. 15th, 1837: that the Council request the King
and Queen’s College of Physicians and the Royal Col¬
lege of Surgeons in Ireland to reconsider the scheme,
in the strong hope that they may be able to arrange
with the Apothecaries’ Hall of Ireland a scheme which
shall include the Apothecaries’ Hall with the two Colleges.”
lie said he did not appear in any way as a special pleader
for the Apothecaries’ Society, but as performing what he
considered a public duty. It was somewhat difficult to
frame the motion because there was not now before the
Council any motion for the approval of the scheme; but
they had the scheme on their Minutes, and therefore could
deal with it. The motion was simply that the Council
should advise the two Dublin Colleges to reconsider the
scheme with a view of admitting the Apothecaries’ Hall
into a triple scheme. If the apothecaries were left out of
the scheme what was to happen? By the Act of 1886 it
was provided that a medical corporation might apply to
the Council to have examiners appointed, and if the Council
declined to do so the body might go to the Privy Council,
and if it appeared to the Privy Council that the General
Council had failed to secure the maintenance of sufficient
examinations, or that occasion had arisen for the General
Council to appoint assistant examiners, then the Privy
Council might notify their opinion to the General Council,
and if the General Council failed to comply with such
directions of the Privy Council, the Privy Council might
themselves appoint assistant examiners, and the Apothe¬
caries’ Hall of Dublin might be started as a new and
independent licensing body for medicine, surgery, and
midwifery. That was the prospect before them, and if that
were the case they might have the profession in Ireland and
England Hooded with practitioners, whatever their pro¬
fessional knowledge might be, under the name of
“apothecaries.” This question had been discussed very
elaborately on former occasions by the Council; and in 1863,
in answer to an application from the War Office, the follow¬
ing resolution was agreed to: “That this Council is of
opinion that the registered licentiates of the Apothecaries’
Company of Dublin are as apothecaries entitled to practise
medicine in Great Britain and Ireland.” The result was that
the army and other boards received the apothecaries’
diploma on the same footing as any other medical
licence. After tracing the history of the establish¬
ment of conjoint examinations, he said that the other
Colleges of Physicians and Surgeons must make up their
mmds to part with a few of their privileges and fees, and
that the examinations must be made, though upon “reaonable
terms. He made the motion on three grounds: first as a
measure of justice due to the apothecaries; secondly, as a
matter of expediency to the other bodies; and thirdly, as a

public duty. It was not for the interests of the public that
these bodies should be tolerated as independent licensing
bodies, flooding the country with practitioners with their
name and qualification. He moved this as a measure of
peace. If they had the three corporations united into a
conjoint board, they would have an end to contention; if
not, it would be every man for himself.

Dr. Bruce seconded the resolution.

Mr. Simon, in supporting the motion on the ground of the
demands of public duty, said: Could any reasonable person
say that it was for the public interest that a separate and
competing examining board should be set up in Dublin? No
one would contend that it was. In proportion as the
College of Physicians felt itself stronger and higher tii&n
the Company of Apothecaries, it was bound to adopt the
course which was urged upon it. Noblesse oblige. They
ought not to allow any narrow personal feeling to stand,
between them and the completion of a scheme that would,
be for the general good of the country. It could never be
for the public benefit that the two corporations should force
the Company of Apothecaries into a position in which they
would have to take refuge in the power of the Privy Council
or the Medical Council to appoint assistant examiners. The
Apothecaries’ Company had been legally recognised, whether
wisely or not, as a medical authority, and the question was
whether they were prepared to assent to a course which
would make that body a competing authority against the
two Colleges in Dublin.

Mr. Whbelhousb maintained that the Company of Apothe¬
caries in Ireland did not give a really full qualification. If,
therefore, the Council advised the Colleges in any other sense
than that of Dr. Struthers’ resolution, it would be favouring
the establishment of a new corporation very ill equipped for
its purpose. He accordingly supported heartily the proposal
of Dr. Struthers, believing that if the Apothecaries’ Company’
were not admitted to the conjoint examination infinite harm
and mischief would be done.

Mr. Tealb said he desired emphatically to endorse the
motion, believing that its rejection would be a public
calamity.

Dr. Banes also supported the motion, and said that it
would be discreditable to the Council if it favoured the crea¬
tion of a new body in Ireland.

Sir William Gull, in supporting the motion, said that
the same principle would equally apply to this side of
St. George’s Channel. The Apothecaries’ Company had a
distinct function to perform, and on public grounds there¬
fore it ought to be maintained. The Council, he thought,
would stultify itself if it did not adopt the motion of Dr.
Struthers.

Dr. Glover said that recent legislation did not contem¬
plate the destruction of existing bodies, but rather their
continuation. As therefore the number of bodies could not
be diminished, the only hope they had was in their fusion.
With that view, and believing that, after all, the pharma¬
ceutical side of medicine was very important, perhaps more
important than ever, he was quite prepared to give a hearty
vote in favour of the motion of Dr. Struthers.

Dr. Kidd said that the feeling of the profession in Ireland
was that the three bodies ought to be fused, and that it
would be a very serious injury to the community if a body
were established to compete with the two Colleges in their
conjoint scheme. Such a rivalry would be a competition
downwards, and not upwards. As to the legal position of the
Apothecaries’ Company, he would remind the Council that
the College of Physicians accepted the first examination of
that body as equivalent to their own first examination. He
did not see how the dignity of the College of Physicians
was affected. The intention of the Act or 1886 was to in¬
clude the Apothecaries’ Hall in any conjoint scheme, and it
was the duty of the Council to encourage such inclusion.

Sir Wm. Turner said Dr. Struthers’ statement was so
convincing that he felt there was nothing left for him but
to support the motion. There was one aspect of the ci6o
which was of very great importance—vir., what was in the
mind of the legislature as regards this question when they
framed the Act of 1886? They necessarily put into the
front rank that which they considered to be the most im¬
portant, and that was “combination.” The mind of the
Legislature was that combination should take place where-
ever it was possible, but that if through any difficulty com¬
bination did not take place, then that a body which could
show that it was doing its duty efficiently should not be
extinguished. Wha\ therefore, they should urge upon the

The Lanckti]

MEETING OF THE GENERAL MEDICAL COUNCIL*

[Fbb. 19, 1887. 379

bodies was that they should strive to carry out what he
believed to be the prime meaning of the Act, and that the
alternative proposition should not be required to come into
operation if combination could be performed.

Mr. Collins hoped that the Council, if it passed this
reeolation, would also pass a resolution of which he had
given notice—that they should nominate one examiner
m surgery for the Apothecaries’ Hall of Dublin, which he
represented. If this was not done, and the recommendation
of the Council was not adopted, the effect would be that that
body would be disfranchised, at any rate till the nekt meeting
of the Council in June. The Apothecaries’ Hall were most
anxious and willing to form a tripartite scheme, or if not
a tripartite scheme a dual scheme, with the College of
Surgeons.

Sir Dyck Duckworth said he could not follow Sir
William Gull in regarding this question ae having brought
before the consideration of the Council the other ques¬
tion which had to do with London. The question of the
Apothecaries’ Hall in Dublin, and its relation to the Royal
College of Surgeons, was not at all on all fours with
the question of the relations of the English bodies. The
action taken by the London Colleges was perfectly well
known. It had bee a taken after very full and careful
deliberation. He entirely disagreed with the bugbear that
had been held out as to the terrible consequences that they
were to expect. They were told that a great injustice
would be committed, that the country would be flooded with
an inferior order of practitioners, and the public would
suffer. He denied that the public would suffer from any¬
thing of the kind, because by the Act of Parliament it
would be the duty of the Council to see that any other
examination which might be adopted was one worthy the
confidence of the public, and, therefore, if the Council did
its duty the public would not suffer.

Mr. Macnamara said, as representative of the College of
Surgeons in Ireiand, it could not be expected that he should
give a silent vote. The Council of the College of Surgeons
had on several occasions gone to the College of Physicians to
represent the justice of admitting the Apothecaries’ Society
into the conjoint scheme. He thought the resolution pro¬
posed by Professor Struthers, and for which he would vote
most heartily, that the scheme should be sent back for the
consideration of the College of Physicians, was a most
desirable one, and it would be a sad thing if the College of
Physicians would not listen to the voice of the Council on
ibis point. A competing body would then be established in
Ireland. He did not want to say that it would be au
unworthy competing body, but it would become the duty
of the Council to see that it was not so, and that would
throw a great expense upon the Council.

The Council then rose for its customary ten minutes’ ad¬
journment, and on resuming held a private sitting, at which
Mr. Mair Mackenzie attended for the purpose of giving legal
advice. On the admission of “ strangers,”

Dr. A. Smith resumed the discussion on the motion of
Dr. Struthers. After quoting from evidence given by Mr.
Macnamara in 1374 to the effect that he considered that the
present system of licensing in Ireland had been attended
wrth a paralysing effect on the promotion of pharmacy, and
that the Apothecaries’Company had abnegated their functions
in becoming examiners in medicine, he proceeded to give an
accoant of the proceedings taken by the two Colleges in
reference to the application of the Apothecaries’ Company
to be admitted to the joint examination. When that appli¬
cation was received the Council of the College of Physicians
held a special meeting, at which it was decided, nem. con.,
that the Council of the College regretted its inability to
accede to the proposal, because it believed that the inten¬
tions of tbe Medical Act were best carried out by the
arrangement that had been made in accordance with
that in force in Eagland. In consequence, however, of
a letter received from the College of Surgeons suggesting
a modification of the scheme with a view of including the
Apothecaries’ Hall, another special meeting of the Council
was held, and a resolution was carried by 17 to 4 declining
to reopen the question of the constitution of the joint ex¬
amining board. Under these circumstances he (Dr. A. Smith)
rhoaght it was hopeless to send the matter back to the
College of Physicians for reconsideration.

Mr. B»Ot*w*ll Carter said he had for some time been
familiar with the matter that had been brought before
the Council byJf r. Muir Mackenzie, and he was quite pre¬
pared to bear that the Council could in no way control or

influence the combinations of corporations. It would, he
thought, be unworthy of the dignity of the Council to
address a petition to the College of Physicians the prayer of
which it had no power to enforce; he was therefore unable
to vote for the motion of Dr. Struthers.

Dr. Struthers briefly replied. He said that the opinion
of Mr. Muir Mackenzie had nothing to do with the matter.
The Council was only offering a piece of advice, and not
seeking to exercise control.

The motion was then put and carried by 19 against 4,
five members not voting.

The Council then adjourned.

Thursday, Feb. 17th.

After a short sitting in private, Mr. Collins proposed a
resolution for the appointment by the Medical Council of an
examination in surgery for tbe Apothecaries’ Hall in Ireland;
but after discussion he ultimately assented to an amend¬
ment by Dr. Struthers deferring the consideration of the
question until the result of the previous motion on the
subject had been ascertained.

The Council then considered the subject of a memorial
sent to the Privy Council, and thence transmitted to the
Medical Council, complaining of the inefficiency of the
clinical teaching of the Royal University of Ireland and of
the inaction of the Medical Council. Alter some discussion
the question wa3 referred to a committee to report to the
Council. On the motion of Dr. Heron Watson, a resolution
was passed expressing the desirability of obtaining an
opinion from the legal advisers of the Government in regard
to the position of tbe Council in relation to medical authori¬
ties combining for examinations. Some discussion then
took place ia regard to the subject of dental finance, and
the Council adjourned.

[A fuller report of this day’s sitting will appear in our
next issue.] _

ON THE CAUSE OF MARKED HYPERTROPHY
OF THE ANTERIOR WALL OF THE
URINARY BLADDER.

To the Editors of Thh Lancet.

Sins,—On Jan. 18th I brought before the Pathological
Society for criticism a novel and, I believe, an important
fact which I had noticed whilst cutting frozen sections of
pathological urinary bladders—namely, the increased mus¬
cularity of the anterior wall as compared with the posterior
iu certain cases of obstructive hypertrophy. In The Lancet
of the 12th inst. Dr. G. N. Pitt has given a very clear and
certainly a very plausible explanation of that phenomenon.
At the same time that I would acknowledge its partial value
and partial truth, I would give my reason for having
rejected the hydrostatic law that explanation is based upon,
as being the eole cause for the production of the localised
hypertrophy. Dr. Pitt says, “ If membranes in the shape of
spheres of varying size3 enclose fluid, so that the tension is
uniformly distributed along each fibre, tbe thickness of tbe
membrane must, by the principles of hydrostatics, be
exactly proportional to the radius of the corresponding
sphere”; and thus it is that the anterior wall, having a
greater curvature than the posterior, must be thicker than
the posterior in order that “the pressure of urine in the
bladder may be balanced by the same tension of each
muscular fibre.” If, however, we carefully inspect the
hypertrophied anterior wall more closely, we shall see that
its composition does not conform with the law just
enunciated. There are two main muscular strata—the
circular and the longitudinal. Which has tbe greater curva¬
ture? The longitudinal. According to Dr. Pitt’s explana¬
tion the longitudinal layer should be the thicker. But this
is not so. If we examine any frozen section, we shall see
that it is the circular stratum which has so greatly hyper¬
trophied, and that it is often twice as thick as the longi¬
tudinal. 1 remain, Sirs, yours truly,

George-street, Hanover-square, Feb. 12th. E. IlURRY FENWICK.

Sir Henry Thompson has just been elected “ un Membre
Associo’ of the Soci6t6 de Cbirurgie de Paris, having for
some years been a corresponding member 1

Googli

380 The Lancet,] THE MEDICAL COUNCIL AND THE CONJOINT EXAMINATION SCHEME. [Feb. 19,1887.

THE LANCET.

LONDON: SATURDAY, FEBRUARY 19, 1887.

The General Medical Council has again returned to its
labours, and this time strengthened by those of its members
who represent the great body of the profession throughout
the three kingdoms. Its President (Sir Henry Acland)
inaugurated the session by the delivery of an address
on the work of the Council, past and present. His dis¬
course, not unnaturally, included a brief summary of
the progress in medical and surgical knowledge since
Queen Victoria came to the throne, and here he was
able to show that a notable advance had been made.
In his account of the progress of legislation in respect of
medical education and examination, he had no alternative
but to tell the story of numberless failures, of prolonged
delays, and finally of but partial success. The blame cannot
rest upon Parliament, for, as Sir Henry Acland stated,
the two great political parties have faithfully striven to do
their best. The troubles have been created by the profession
itself, or, rather, by those corporate bodies which have for
years been held to represent its views. In the rivalry and
the jealousy which they have shown towards each other is to
be found the cause of the difficulties which have prevented
medicine taking her proper place in this country.

We would gladly have seen Sir Henry Acland lay greater
stress on that great political change which enables the pro¬
fession to be directly represented on the General Medical
Council, and which recognises that there are rights and
privileges to be guarded which are greater than those which
have been held in view by the bodies whose representatives
have heretofore determined all questions relating to the
welfare of the profession and of the public. No doubt, as
the President pointed out, the Council was already too
large for the performance of effectual work ; but so long as
the system of representation is maintained this obstacle is
insuperable. We believe, however, that the additions which
have lately been made to its number will be found of
value, if not in accelerating the work it has before it, at
any rate in bringing it into more immediate relation with
the majority of those who are actively engaged in curing
disease.

The first important decision at which the Council has
arrived will undoubtedly give almost universal satisfaction,
and will raise the hope that the corporate bodies will not
be deterred by a mistaken vanity from adopting a course
which is urgently needed in the public interest. The de¬
cision was taken, upon a motion by Dr. Strothers, that

Council. The unfortunate results which would follow from
the existence of separate licensing bodies if the Colleges
persisted in their refusal to allow the Apothecaries’ HaU to
unite with them were amply dwelt upon by the speaker,
and he further showed that the Council had itself, in a
communication addressed to the military authorities, ex¬
pressed their opinion that the licentiates of the Apothe¬
caries Society in Dublin are, as apothecaries, entitled to
practise medicine in Great Britain and Ireland. Of the
twelve speakers who followed Dr. Strothers, not one
could be said to adduce any substantial argument
against his proposal. The College of Surgeons them¬
selves were in favour of the amalgamation; it was only
the College of Physicians that held aloof, and Dr.
Aqdilla Smith appears to have contented himself with
statements to the effect that the College he represented
disapproved of the proposed union. The only pertinent
objection to the adoption of the resolution came from Mr.
Brudenell Carter, who, while fuHy sympathising with
Dr. Strut-herb’ views, was unwilling to see the Council
exceed its statutory powers, and recommend the adoption
of a course which it was unable to enforce. Eventually
the motion was adopted by a large majority, and it remains
for the Irish Colleges to determine the final issue.

It is sincerely to be hoped the Colleges will take advan¬
tage of this further opportunity for the reconsideration of
the question, and that they will learn from the decision
of the Council that the Apothecaries’ Hall are not likely
to apply in vain for the appointment of assistant
examiners should it be necessary for them to make
such application to the Council. We would hope,
further, that the English Colleges will learn, from the
events of this week, that it would be well for them to
regard as assured the appointment of the London Society of
Apothecaries as an independent examining body should they
continue to refuse to allow its union with themselves. Sir
Dycb Duckworth announced his ability to show that the
controversy in England was not altogether comparable with
that in Ireland. That there are some differences in detail we
are prepared to admit; but the broad principles are the
same, and will afford sufficient reason for the Council to
arrive at a similar conclusion when the subject comes under
their consideration. The only hope that can be entertained
is that a golden bridge may yet be found by which oppor¬
tunity may be given for the Colleges to retrace their steps.
Dr. Glover forcibly showed that the desire to preserve the
existence of the Apothecaries’ Societies &s examining bodies
did not emanate from the Council, but was given by law,
and that the duty which devolved upon the Council was to
carry that law into effect. Of the intention of the Legis¬
lature on this point there can, indeed, be no doubt; and we
wd'uld protest against “the battle of the shops,” to which
i Sir Henry Acland referred in his address, being further

the Council should request the King and Queen’s College
of Physicians and the Royal College of Surgeons in Ireland
to reconsider their scheme of amalgamation, in the strong
hope that they may be able to arrange with the Apothecaries’
Hall of Ireland a scheme which shall include the Apothe¬
caries’ Hall with the two Colleges. The admirable argument
of Dr. Strothers Was practically unanswerable, and was
obviously accepted in this light by the great body of the

continued to tbe detriment of the profession.

The many reasons which exist for the adoption of the
principle of unity have been so fully discussed in these
columns that it is needless now to consider them farther.
If the corporations had been less desirous of their own
welfare than that of the profession, there would be less
urgency for the demand for a reconstitutiota of their govern¬

ing bodies. But this demand has now been made, and will

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Ths LaucktJ

THE DIFFUSION OF SMALL-POX BY MEANS OF HOSPITALS. fFra. 19,1887. 38l

receive fresh impetus if, in the face of the recent de¬
cision of the General Medical Council, the English and
Irish Colleges refuse to modify their policy.

Last week we referred in general terms to the subject of
the influence of small-pox hospitals in London, to which
so prominent a place is given in Dr. Buchanan's last
report to the Local Government Board on the proceedings
of his department. It is sincerely to be hoped that this
report will lead to some final decision as to the attitude of
the Government towards metropolitan small-pox hospitals,
and since the material which is so ably put together in it
on the subject cannot fail to exert an important influence
on medical and public opinion, we now recur to the matter
in some detail.

The immediate cause of this report was the receipt from
Mr. W. II. Powkb of a further account of the influence of
Fulham Hospital down to the end of 1884-8-3, that account
showing once more that the use of that hospital for the
reception of small-pox cases at times when that disease
vu about to assume epidemic proportions led to an
excess of small-pox around the hospital, that excess being
graduated according to the proximity of the houses to the
institution. And this repeated experience is the more
important because it has taken place in' the face of every
effort to remove the conditions by which infection might
L spread along lines of communication between those
inside and those outside the hospital. In spite of every
possible restriction, the fact remains that houses within
half a mile of the hospital have been attacked at three
times the rate of those between half a mile and a mile of
it, and at nearly four times the rate of the parts beyond. If
Fulham stood alone, it might be possible, even in the face
of the overwhelming statistical evidence which has been
repeated year after year, to express some doubt as to
whether this fatal influence was a necessary result of these
London amall-pox aggregations; but similar evidence as to
the effect of the other metropolitan small-pox hospitals
has, during recent years, been flowing in apace, whether
it come from Deptford, Stockwell, Homerton, or Hamp-
st^d, or, again, from Ilighgate or 'West Ham. As Dr.
Bvchanan points out, metropolitan and registration
districts exhibit a change of rank, qua small-pox, when a
®»ll-pox hospital is established in them, this change of rank
Tu 7 ing, again, according as the hospital is used or not.
Tha* Hackney and Camberwell, which for twenty years stood
in rank in regard to the freedom of their inhabitants
from amall-pox deaths, needed but a small-pox hospital in
Aieir midst to be relegated to a place among the worst
districts. The Registrar-General, in his annual summaries
for 1881 and 1884, basing his argument on registration
districts, tries to console the sufferers from small-pox in
these special areas by telling them that though “that
di*tnct which contains the small-pox hospital may be the
one which, derives on the whole the least benefit from it, or
rather which has the benefit conferred by it counterbalanced
hy some small disadvantage,” yet the absence of a hospital
evil by leading to a disinclination to use
using for .this purpose groups of registra-
Jay® it down as “probable” that those
4 **fe*«e worst off which neither have hospitals of their |

own nor make use of the hospitals outside, whereas those
districts are best off which have no hospitals within their
own areas, but make use of hospitals outside their borders.
So, after all, those who suffer do so for the public benefit.
This seems the only crumb of comfort which Dr. Bridges
can provide in the report to which we referred last week.
But unfortunately Dr. Buchanan’s inferences are based on
the experience of definite circular areas round the hospitals
themselves, whereas the Registrar-General’s "probable”
inferences are based on districts which, as Dr. Buchanan
shows, have no fixed relation to hospital areas, and as such
should not for a moment be compared with Mr. Power's
areas. * '

But, leaving these special areas, Dr. Buchanan next
considers the small-pox death-rate all over the metro¬
polis,' and he compares this with that prevailing in
the provinces. Both In London and in the provinces
generally there have been improvements in vaccination,
and in both the small-pox mortality amongst children
has in consequence been reduced below any former
experience. But in the provinces the general small¬
pox death-rate has also been greatly reduced since the
European epidemic of 1871, whereas in the metropolis
there has been no such reduction. In fact, although before
1871 the London small-pox death-rate “only once reached
the double of the provinces, it has in the last two five-year
periods been maintained at a point sixfold and sevenfold
that which has affected other parts of England.” Taking a
long group of years, from 18.30 to 1874, the mean annual
small-pox rate per million would be some 380 in the metro¬
polis and 225 for the provinces; for the period 1875-84 it
has been 268 in the metropolis and only 41 in the provinces.
Some “ new factor has plainly come into operation.” Indeed,
this changed attitude of London towards the provinces
dates from the time when London, and not the country,
became plentifully supplied with hospitals for small-pox,
which, when in use, have again and again caused an excess
of disease about them, this excess having amounted to a
threefold incidence of small-pox upon the three nearest
square miles as compared with its incidence on the
remainder of the circumjacent districts.

The Royal Commission on Small-pox and Fever Hospitals
believed that thirty or forty acute cases of small-poi might
safely be treated in each of the metropolitan small-pox
hospitals. Mr. Power has shown conclusively that the evil
influence of these hospitals can be, and has been, exerted
with a much smaller number of oases, and it is obviously
this influence which, is largely contributing to maintain
small-pox as an endemic disease in our midst, whilst it is
disappearing elsewhere.

Th'e closing paragraph of that portion of the report which
deals with this subject of the diffusion of small-pox urges
action on the part of the Metropolitan Asylums Board
towards reducing the chance of spreading infection, such as
was indicated by the Royal Commission. That Commission
had taken into consideration Dr. Burdon Sanderson’s
scheme of a hospital so contrived that it should be artificially
ventilated, and that its air should, after passing through the’
hospital, be subjected to a high temperature for the purpose
of destroying its dangerous qualities before it was discharged
and they distinctly place amongst their “ practical recom-

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382 The Lancet,]

CREMATION IN NEW SOUTH WALES.

[Feb. 19,1887.

mendations” one which advocates the adoption of this
system, which they “ fully believe ” might be devised. But
as yet nothing has been done in this direction. Surely here
is a line of action which is plainly indicated, and we trust
that all who have influence with the Asylums Board
will press its adoption on them, for the only other
alternative seems to be the entire abandonment of small¬
pox hospitals, at least in populous districts.

Cremation is rapidly making its way in some civilised
communities. Sensational objection to it is subsiding,
and the gentler part of the creation, to whom not
long since it was most objectionable, has, eo to speak,
come round to it with such effect that at a meeting
of the Ladies Somerville Club, held a year or two ago,
with one of the representatives of medicine in the chair,
a resolution in favour of cremation was carried by a large
majority. For many and sufficiently valid reasons we have
been most careful in these columns not to favour cremation
nntil we could see how it might be carried out, cito, tuto,
and like the Latin poet, have felt our anxiety, “ tuta timens, ’
to the extent of fearing safety. For this there was abundant
cause in one danger alone—namely, that men inclined to
commit murder might And in the crematorium the easiest
concealment of their guilt. At the same time we never
doubted the value of cremation as a sanitary measure, and
now that some of the more serious difficulties surrounding
it are passing away, we are open to all fair discussion of its
progress. In New South Wales the practice is gaining
favour so freely that a Public Bill authorising cremation
passed through the Legislative Chamber on August 6th for
presentation to the Legislative Assembly, and has probably
by this time become the law of the laud. This Act is called
the Cremation Act, 1886, and in its construction the word
“ crematorium” means a place furnished with apparatus in
accordance with the provisions of the Act for the purpose
of reducing the human body after death to its mineral
constituents. Subject to the provisions of the Act, any
person may establish a crematorium provided the site and
place be approved by the Board of Health constituted under
the authority of the Infectious Diseases Superintendent
Act of 1881; but a licence must be obtained by the con¬
structor, and be signed by the Governor with the advice of
the Executive Council, and the burning of the doad body of
any human being in a place that is not licensed is declared
illegal. It is further rendered illegal to burn a dead body
except under one of the following three conditions: (a) The
receipt by the registrar of a certificate from some legally
qualified medical practitioner, stating that such practitioner
has been in professional attendance on the deceased for at
least four days immediately prior to the day of death, and
that the deceased died from natural causes; (6) a certificate
of a legally qualified practitioner, after a post-mortem
examination, that the deceased died from natural causes; and
(c) a certificate from a coroner or justice of the peace who has
held an inquest or inquiry as to the cause of death, conveying
to the registrar that such cause has been inquired into and that
no further examination is necessary. Some further rules of
a more stringent kind are added relating to the responsibility
of all who are concerned in carrying out a cremation.
The registrar who improperly issues a "cremation permit”

may be subjected to a fine not exceeding £600, or im¬
prisonment for any term not exceeding two years. The
relatives of a deceased person, such as a widow or next
of kin, may prevent a cremation, unless the deceased has
left an attested memorandum directing that his body shall
be cremated, when it is the duty of the executor or adminis¬
trator to see that the direction is duly carried out if there
be a licensed crematorium within twenty miles of the place
where the death occurred. As a protection against crime,
there is a clause to prevent persons from giving, or joining
in giving, certificates for cremation after the death of anyone
in whom the said porson has an interest or expectancy.
There is also a clause by which the Governor, acting on the
advice of his Council, may suspend cremation for sanitary
reasons in the event of a great epidemic if the suspension
be considered advisable; and there is another clause
enabling the Minister of Justice to forbid cremation
under certain circumstances. There are some other
minor provisions in this Act which are important for
local reasons, but which may be passed over here. We have
presented the leading principles of the measure, and we are
bound to admit that they are as sound as they are vigorous
and effective. The provision which makes it impossible for
anyone who has an interest or expectancy in a deceased
person to obtain a “cremation permit” removes the one
great objection, which we have always enforced, more
efficiently than any other plan that has hitherto been pro¬
posed, and seeing that cremation is apparently already reco-
gaised by the law of England, we should be glad to see an
Act passed in this country on the same lines; for it
seems to be proved by recent cremations that there is
no real obstacle to cremation in England in the present
state of the law, and there was no real obstacle in
New South Wales. But, with much common sense, our
colonial brethren have preferred to proceed in this matter
by virtue of an affirmative rather than a negative law,
and they are unquestionably in accord with the spirit of
the times in carrying out this principle. They have, in short
made the law on a great sanitary question intelligible and
fresh, so that everyone can understand it and act upon if.
We must not conclude this article without claiming for the
profession of medicine in the Antipodes considerable credit
for the part it has played in the matter of cremation legis¬
lation. To one of our medical confrhret in Sydney, the
Honourable John Mildred Creed, who, in a speech
exceedingly able and exhaustive, moved the second
reading of the Bill in the Legislative Council of New
South Wales, a tribute is due for the success which so
far has been achieved towards bringing cremation into a
legal and safe practice on the other side of the globe.

The Presidential Address of the Rev. Dr. Dali.ingf.r,
F.R.S, who has had the distinguished honour paid to him
of being for the fourth time elected President of the Royal
Microscopical Society, possesses more than usual interest,
for it treats of a series of experiments which he has
conducted for nearly seven years without intermission,
having for their object the determination of the extent of
change of temperature to which the lower forms of organisms
can be adapted by slow modifications. The problem which
Dr. Dallinof.r set himself to solve was first investigated

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THb LancetJ

DR. DALLINGER'S EXPERIMENTS.

[Fbb. 19,1887. 383

ia placing various species of monads in a medium, the
temperature of which, by an ingenious arrangement devised
by Professor Schafeb, could be gradually altered at the
will of the operator. The mechanism worked so well that
the variations in temperature in the course of twenty-four
boon were lees than one-sixth of a degree Fahrenheit. Com¬
mencing at the normal temperature of 60° F., the first four
months were occupied in raising the temperature 10° without
altering the life history. When the temperature of 73° was
reached, an adverse influence appeared to be exerted on the
utility and productiveness of the organisms. The heat
being left constant for two months, they regained their
full rigour, and, by very gradual stages of increase, 78°
wu reached in five months more. Again a long pause was
necessary, and during the period of adaptation a marked
development of vacuoles was noticed, which again dis-
ippeared when it was possible to raise the temperature still
higher. The further history of the experiments presented
pnctically the same features—long pauses, vaouolation,
alow advance,—until at last the high temperature of 168°
was reached, when the research was accidentally ter¬
minated.

It need hardly be said that great care, skill, and patience
us required to conduct experiments extending over so long
a period, but the interest attached to them is fully propor¬
tionate to the time and labour expended upon them. The
capability of organisms to adapt themselves to their
environment has hitherto been a postulate rather than
a proved fact on the part of Hbbbbbt Spences and
Diawiw, and much still remains to be shown in regard
to the influence such changes effect in the structure and
composition of the body; but it must be acknowledged to
ie a striking fact that organisms which normally live
and multiply at 63° F. and are killed at 140° F. should by
gndotl adaptation become capable of living at 168°, whilst
®their return to their original temperature they die.
Tbe slowness with which cosmicel changes of temperature
occnr, and the possibility that living organisms are capable
of gradually adapting themselves to such changes, was
oot overlooked by Dabwin, but the difficulty that con¬
fronted him, with other naturalists, was the number of
guentions required to be investigated before any con-
dtriona could be drawn in regard to the effects of
change of temperature on the race under observation.
Dr. Dalunokb has overcome this difficulty. The monads
be examined incessantly multiply by division, the longest
■nterval being four minutes. Ue must, therefore, have
observed something appr oaching h^ if a million generations
of the organisms under consideration. This is not far
short of the "countless generations” required, and it is
a matter of great interest to find that at the close
of the aeries the organisms are found to have undergone
each modification either in their composition, structure, or
functions, as to enable them to flourish under circum-
st * ac * that at first proved fatal.

hi* proposed to form an Anatomical Society, which shall
O0et *bout four times a year for reading papers, and
'iiacumng subjects bearing directly, on Human Anatomy,
Kmbryoiogy, *c. The first meeting will probably take
PtasMpa,.. .

^molatitras.

"Ho quid nlmU."

DEGREES FOR LONDON STUDENTS.

The various methods which have been suggested for
procuring degrees for London students have practically
resolved themselves into two—viz., the professional as ad¬
vanced by the Royal Colleges, and the academical as put
forward in the programme of the promoters of a Teaching
University. The authorities of the existing University are
too much bound to the examination-groove and standard
which they have inherited from its founders to be expected
to make any but minor changes in their regulations, and
Convocation (which must be consulted in respect of a new
Charter) is too jealous of the teaching influence to allow any
new step of importance to be taken, even if the Senate were
inclined to take such an initiative. The Colleges are steadily
pressing forward their movement, and will soon be in a
position to make application to the Crown for permission to
grant degrees under their joint authority and regulation.
We are sorry, however, to have to again urge the Association
for Promoting a Teaching University in London to put for¬
ward its views quickly and in some authoritative manner.
It is evidently at the crisis of its existence. The small
attendance of members at its general meeting shows that its
protracted deliberations, conferences, and waitings on other
bodies have wearied many of its members, and a large seces¬
sion of others may be expected if something earnest be not
soon undertaken. The teachers in the Arts and Science
Faculties of University and King’s Colleges, who constitute
the largest proportion by far of the Association and its
executive committee, must agree at once on some combined
lino of action, if they wish to be credited with any real
desire to form the academic side of a new university, and to
shape the movement in that direction. The Colleges will
apply to govern the professional faculty, and it will be
entirely due to the supineness of the teachers in the literary
and scientific chairs of London if the basis of the movement
is not made sufficiently wide to embrace them also. The
Colleges have a well-defined claim and a definite aim in view;
the Association seems at present merely a collection of well-
intentioned gentlemen with a far-reaching ideal of some great
university before it; but the ideal does not yet appear to pre¬
sent itself to all the members in the same light. This want
of agreement will merely lead to obstruction towards the
Colleges, and be no gain in any other line. It is imperative,
therefore, that the Association should take some tangible
step at once or quietly dissolve. The teachers at the Bristol
School pf Medicine are alive to the necesaity of prompt
action, and will either oppose or assist the Colleges, according
to whether residence in London be made imperative in the
schemes, or whother the provincial schools, not affiliated to
a university, be included in the application. At present,
the report of the delegates leaves this to the discretion of
the future managing body._

MILK EPIDEMIC OF TYPHOID AT YORK.

The epidemic of typhoid fever in York, the prevalence of
which we recorded a short time since, has been made the
subject of a very elaborate report by Mr. S. W. North,
medical officer of health to the city. York has & system of
compulsory notification of infectious diseases, and under it
243 cases of typhoid fever were reported during 1886, 29
terminating fatally. Of these 243 cases, 210 came under
notice during the last four months of the year, and the
great incidence of the disease was in the Micklegate
district, where, subsequently to Oct. 16th, no less than 119
cases occurred. In this district there are three dairies, each
of which was, before the outbreak, in the habit of receiving

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384 The Lancet,]

INDICATIONS POE THE USE OF NITRO-GLYCERINE.

[Pm. 19,1887.

milk from a dairy-farm at Oabaldwick. One of these dairies
had used no other milk than the Osbald wick supply; another
mixed the supplies; and a third, the Cleveland Dairy Company,
kept their several sources, as a rule, distinct. Considerable
suspicion attached to this Oabaldwick milk, and hence
Mr. North visited it. He found that the owner had been ill
with some fever, and that his wife was then in bed with a
similar disease; and he gives it as his opinion that the whole
family had suffered from typhoid fever. The symptoms
described are not sufficiently detailed to convey a decided
opinion on the subject, but Mr. North’s conclusion was
doubtless founded on sufficient data. The dairy pump was
found to have a privy on one side, and an open ashpit on
the other, together with other conditions that ought never
to prevail at a dairy-farm. The analysis of the well water
did not prove much, but since typhoid excreta can be pur¬
posely mingled with water without causing special suspicion
on the part of the chemist, this goes for little. But the
slops and excrement from the house had gone into the ash¬
pit or privy, or on to a slop stone near the pump, and it is
added that “the arrangements of the premises and the
habit3 of the people are such as to render any mode of con¬
tamination possible.” The whole course of this milk through
the tradesmen taking it and on to the public is discussed at
length, and, by way of additional danger, it was found that)
as a result doubtless of the use of the infected milk,
there were on the Cleveland Dairy Company’s pre¬
mises two unreported cases of typhoid fever, and this
whilst the manager was passing from the sick room of
his children to distribute the milk to his men and to the
shops. Between October 18th and December 18th a total of
188 cases were reported, and of these 111 are proved to have
lised the suspected milk. An inspector having secured a
sample of this Oabaldwick milk, it was stated to contain
10 per cent, at least of added water. And taking the three
dairies distributing this milk, whether alone or mingled
with other milk, it was found that 42 4, 38 5, and 217 per
Cetat. respectively' of their customers were ill with typhoid
fever. In confirmation of this view as to milk infection,
cases are cited showing how the disease picked out of
families, not otherwise exposed to the infection through the
h8e of milk, single individuals who had used it; and in one
charitable institution, where only one out of forty-seven
took the fever, the single case was that of the only child
who had milk in an uncooked form. But all the typhoid
feve* in Ydrk has not been due to infected milk. It
Will be remembered how serious an epidemic took
place in the autumn of 1884, and from what Mr.
North says it is clear that, notwithstanding the
Severe lessons which the City has had, it still remains
a town specially adapted to favour the spread of such
an infection when once received into it. It is essen¬
tially a midden town, several hundreds of these structures
having more than one privy in connexion with them, and
their cleansing is greatly neglected, such work being mainly
done at the discretion of the inhabitants. Then, again, the
sewers are largely liable to deposit, and only under special
circumstances and in limited areas are they either flushed
qr ventilated; they are also blocked by back-water in flood
times. The street gullies and old sewers also admit of
leakage of contents. Such an array of conditions favourable
to enteric fever may well account for the fact that the
disease is endemic in the city. But it is unfortunately sup¬
plemented by the suspicious circumstances attaching to its
yater-supply. Mr. North does not credit it with any share
ill spreading this epidemic, but its use involves, as we
pointed out last week, a dangerous experiment on human
lives. We hope that we may soon be able to report some
substantial progress towards removing the dangerous con¬
ditions to which we have adverted, and whfch'Mr. North has
faore than once brought prominentlybefore the Town Council.

THE VOLUNTEER MEDICAL SERVICE IN PEACE
AND WAR.

Dr. W. P. Mears has just been lecturing at Newcastle-
on-Tyne on the Volunteer Medical Service, and his lectures
have created much interest there. He shows that the
Medical Dep&rtnient is almost in the same condition, as it
was in 1859. One surgeon only is carried on the establish¬
ment of each corps, however large it may be, even where,
as in Edinburgh and Cardiff, there is an administrative
battalion of 2000 men. The surgeon,'.Dr. Mears points out,
has no duties laid down for him beyond attendance at
ranges and in camp. He is not responsible in any way for
the physical fitness of recruits, the sanitation of drill-
sheds or corps buildings, for the sites and surroundings, the
food, water-supply, or drainage of camps. His inter¬
ference in such matters, unless asked for courtesy sake,
might not improperly be considered impertinence, and his
presence (personal considerations of course aside), except in
an ornamental capacity, is apt to be thought of as a
necessary inconvenience. He has nothing to do, dees
not know where to go, gets in everybody’s way, and, as
Dr. Mears points out very forcibly, is thus more likely to
prefer the social to the military duties of volunteering.
He is not even required to pass an examination, and his
optional examination is more or less a form. Until last
year he ooutd not, like other officers, go to a school of
instruction where alone he could learn anything Of military
medical work, and permission was granted him last year
only on condition of paying his own expenses. That con¬
dition, we are glad to say, has just been removed.
Dr. Mears, in his excellent lectures, fully points out the
anomalous and indifferent state of the present Volunteer
Regimental Medioal Service, of Which he is himself an
active and enthusiastic member, and ha makes some
valuable and practical suggestions for its reform, which
should have more than a local effect. We are pleased to
see that he believes that the present unsatisfactory state
of things is due to want of knowledge of medical require¬
ments on the part of combatant officers, and not to want of
good-will. In this view we entirely concur with Dr. Hears,
and that much good might be done if the subject could
I be similarly brought forward in other Volunteer centres.

INDICATIONS FOR THE USE OF NITROGLYCERINE.

Dr. Trussewitsch, in an instructive paper on the uSe of
nitro-glycerine published in the St. Petersburger MedunmseJie
Woahemchrift, points out that the value of this drug in
various affections—angina pectoris, migraine, and neuralgia
(which he describes as angioneuroses), as also in sea-sickness,
some forms of anaemia, faintness, palpitation, and other
diseases—depehds upon the existence of an irregular distri¬
bution of blood, which condition may be inferred from a
certain degree of pallor of the skin, especially of the face,
often coexistent with a Weak pulse and a small rigid radial
artery, which frequently is situated at some depth., When,
on the other h^nd, headache and neuralgia occur in patients
with chronic congestion of the subcutaneous veins of the
face, nitro-glycerine is to be avoided; and similarly it is of
no use in asthma, When the face is reddened in consequence
of emphysema. If, however, a pale face exists with angina
pectoris, migraine, giddiness, shock, toothache, or sea¬
sickness, the best results may be looked for by giving nitro¬
glycerine. The regulating effect of the drug exercises an
influence over the congestion of internal organs similar to
that brought about by bloodletting; and in these congestions,
whether of lung, brain, or kidney, when they are of & tempo¬
rary character, the pulse is generally found to be slow and of
low tension—af act which,as theauthorremarks, is sufficiently
well known in reference to the fever-free periods of acute

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Diqiti:

THE BIRKENHEAD AMPUTATION • CASE,

[Fkb. 19, l&Sfr

hTpMM^i of the lung and kidney. Dr. Trussewitsch lays
down as a'rule that the'condition of the pulse is the best
iBdlMtknh for -the employment of ‘nitro-glycerine, and the
nootariftalworthy guide as to the dose with which to com-
meafc&the treatment. The smaller the radial artery is, the more
it dilates under the action of the drug, and the less
ttw«ia»dary effects proceed; on the other hand, the fuller
tb«* pulse with a distended radial ttrtery, the less it is
affected ; and finally, the softer the artery, with a weak
pnlMfthe greater the secondary, and the less the general,
effect* Single-drop doees of the 1 per cent, solution are
s nflt ui gn t in cases of small pulse, but with a full pulse it will
be fbbmd tt at the full effects cannot be produced with less
thmi two-drop doses. When there is a soft artery with a
weak pulse, subnormal doees only should be giren—a quarter
to half a drop. After the trial dose is given, the patient’s
sensations of pulsation and pain in- the head, as well as the
distension of the radial artery under the finger of the
phyMdan, will be the guides for increasing the dose. The
author finds that the best modes of administering nitro¬
glycerine are the Biinpie dropping of the solution on the
tongue, and by means of tablets; much less satisfactory
restdlft were obtained When given mixed with water.

; ; THE BIRKENHEAD AMPUTATION CASE.

On Jan. 28th an inquest was held at Birkenhead by Mr.
Cktoton, coroner, touching the death of Mary Murray, fifty-
four years of age. The facts of the Case were very simple.
The deceas e d was subject to fits. On J an. 5th she wasfound
lying, on the floor, with a shawl which site had round her
aeok oo fire. Whilst she was an in-patient at the Borough
Hospital gangrene of the foot and leg set in. The mortifl-
cataon spread, so rapidly that it became necessary, in> order
to save the woman’s life, to amputate the limb without
delay. A messenger was sent to the husband to seek his
consent -to the operation, but on its being found that an
answer could not be obtained for three hoars, the staff of
the-kospiCaL decided not to Wait but to amputate at onee.
This was accordingly done; - At the inquest the husband of
fl scenes ! complained that he received no intimation that an
opomtiirm would have to be performed, and one of the jurors
considered “ that great laxity existed oq the part of the
doctors in not consulting the deceased’s relatives with
regard to the operation to be performed.” It might possibly
be contended that legally an assault had been committed upon
the deceased in that her leg had been amputated without the
huabandTs consent) but such a charge would fall to the
gnaMd inasmuch as the woman was taken to the hospital
to in treated (or her injuries, mid that, too, without any
IrnriteHoa or definition of the kind and extent of such treat¬
ment; Had iti not been for the burns we doubt if the
gangrene would have set in; and as, therefore, on this
•sumption the burns constituted the cawsa causans of the
deaffct we maintain that the authorities were - within their
rights in doing whatever they deemed necessary to re¬
lieve suffering and to save life. Yet there is a general
understanding that where any serious operation, as one
perilous to life or involving mutilation of the body, becomes
neessbary or advisable, the immediate relatives of the
patient shall, H possible, be made aware of its intended per¬
formance. Now, considering the extremely rapid course of
the g t hgro he in this case, we are of opinion that had the
ButaHttad surgeons waited for three hours they would
have Vasa guilty of dereliction of duty; for their first duty
wsaM’ikaxd off impending death, and how could they be
isiAIABe doing so if they allowed the disease to progress
for kotos mainly because they-had not obtained the husband’s
uatfll&fot aaputation to be performed? It is just to
nlpfSSS thlt sanations an opemtion was not anticipated by
llmb#U>nIl j* otiai jiii. ni hi) srimlil have got provisional per¬

mission for its performance. In a still more recent case
within our knowledge the husband refused to altow the
gangrenous limb of his wife to be removed. Such refusal,
we imagine, would make one answerable for being a party
to acceleration of the death, in the same way that the
“Peculiar People” are amenable to the law for neglect-
ing to call in medical aid where it is by professional
and common oonsent avowedly necessary. The coroner
complained of the house-surgeon not giving notice of
the death, but the latter gentleman replied that, believing
death to have been due to natural causes, he did not
think such notice necessary. We cannot help thinking,
however, that where any kind of violence has been
Sustained shortly before death, it is well to give the coroner
an opportunity of holding an inquisition if he deems it
advisable, even if the medical man who attended deceased
believes that the injury had nothing to do with causing the
death. Where a patient, fifty-four years of age, sustains
bums and is subsequently attacked by gangrene of the leg,
it may be very difficult to say with certainty that the gan¬
grene arose independently of the burns.

CATHETERISM OF THE AIR PASSAGES.

The introduction of a Catheter into the larger air
passages, for the purpose of local medication or mechanical
dilatation, or to obviate recourse to tracheotomy, lias beon
much facilitated since the introduction of cocaine into
laryngeal surgery. A paper recently read before the
Medical Society of the Charitu Hospital at Berlin by Dr.
Landgraf, clinical assistant (Bcrl. Klin, Woch., 1687, No. 5.),
illustrates the ease with which the procedure is effected.
He described a case preseating symptoms of stenosis of the
left bronchus; the symptoms, which had gradually increased
in severity, dating over two years. When admitted into
the hospital last July, the patient was liable to dyspneeal
attacks; and physical examination led to the above dia¬
gnosis. The constriction was at first thought to be due
to compression, a view which was borne out by the pre¬
sence of a small area of dulness over the manubrium
sterni and to its right. There was no evidence that this was
due to a tumour arising in the bronchial glands. The long
duration of symptoms negatived the existence of a malignant
tumour, and the absence of bacilli in the sputum, set aside
the notion of tubercular disease. Aortic apeurysm was
more probable; but this diagnosis lucked confirmation,
the only positive sign being tho area of dulness. It was
therefore thought to lie between syphilitic stricture (the
patient had contracted syphilis twelve years previously) and
aneurysm; and, since the former gave a more hopeful pro¬
gnosis, the patient was placed under anti-syphilitic treat¬
ment. But the dyspnoe&l attacks increased in frequency, And
measurement of the chest showed a diminishing capacity of
the lungs. Further, au examination made at the beginning
of October revealed what was thought to be a membrane
deep down in the trachea. This appearance supporting the
endo-brouchial character of the steno3i£, it was resolved to
resort to catheterism. The larynx was anaesthetised by a
20 per cent, solution of cocaine, and a 10 per cent, solution
was injected into the trachea. The catheter was easily passed
to a distance of 28 - 5 centimetres from the teeth (found sub¬
sequently to correspond to the tracheal bifurcation) with¬
out meeting any constriction. Tho catheterism was
repeated at intervals, and on several occasions to a depth of
35 centimetres, with a view to traverse the left bronchus.
The measure produced so much relief that at the end of the
month the patient was well enough to leave the hospital.
Unfortunately the diagnosis of stricture, which had been
apparently confirmed by the relief of the symptoms, proved
incorrect; for in a few weeks he returned, having had
a severe asphyxial seizure, and shortly after died. The

d by Google

386 The Lancet,]

“ VENT—NOT VENTILATION.'

[Fed. 19, 1887.

cause of the stenosis proved to be—what is by far the
most common cause of such a condition—an aneurysm
of the aorta, which compressed the left bronchus. The
condition which was mistaken during life for a mem¬
brane was an anaemic part of the right wall of the trachea.
Although during life some irregularities in the mobility of
the vocal cords were observed—on one occasion the right
cord moving less on respiration and phonation, and on
another the left cord appearing immobile in middle line,—
yet the dyspnceal attacks could not be referred to involv-
ment of the vagus. They must have been due to the com¬
pression of the bronchus, for they disappeared directly the
narrowing produced by that compression was mechanically
relieved. Dr. Landgraf fully recognised the danger of
resorting to such mechanical dilatation in aneurysmal cases,
and he would hesitate to catheterise in any case in which
aneurysm could be suspected. Nor is it quite easy to account
for the great relief temporarily afforded by the measure in
this case. The valuable point learnt from it is the ease with
which the air passages oan be catheterised with the aid of
cocaine, thus affording means to relieve strictures, as well
as to apply remedies locally to ulcerated surfaces on the
respiratory tract.

“ VENT - NOT VENTILATION.”

It is encouraging to find that the particular, if not
peculiar, views of the sewer-air and drain-ventilation
question, which have for many years past been put forth in
these columns, are at length becoming popular—at least, so
far popular that a leading sanitarian is pleased to adopt
and enforce them. In his lecture on “ The Laws of Nature
in relation to Health,” recently delivered before the Hert¬
fordshire Natural History Society, Professor Attfield, F.R.S.,
denounces the absurdity of ventilating at a low level close
drains, and shows clearly enough what ought to be evident
to every common-sense observer—namely, that (1) directly
in proportion as we make “openings” at a low level for the
escape of air from sewers do we return to the open ditch
system; and (2) that there is really no need for the ventila¬
tion of drains—it is only a vent to avoid back-pressure in the
drain that is required. These two propositions should not
need even to be formally stated. It goes without saying
that to make in any pipe which is designed to carry away a
noxious material such an opening as will admit of the
escape of its contents, whether solid, fluid, or gaseous, must
needs be to destroy its character as an apparatus for the
removal of offensive matter. As well put an air-tube in the
cover of a close-stool as ventilate a drain. Who first evolved
the absurd notion that drains should, or could with impunity ,
bo ventilated by openings at a low level we do not know.
That there must be some sort of safety-valve for the escape
of small quantities of air or gas when over-pressure occurs
from back-flow or the sudden influx of storm-water cannot be
doubted. If no such provision were made, the foul gas in the
sewers must be forced back through the water-traps into
our houses. The obvious mode of supplying the air-ventB
necessary is to erect pipes at suitable points reaching to
high levels, and there affording a way of escape for air or
gas in the drain at a safe distance from windows and
chimneys. The notion of ventilating drains for the sako of
ventilating them is so absurd that it can be compared to
nothing but a special provision for the dissemination of
pestilent gases and vapours in the atmosphere, and only
the most perverse ingenuity could be supposed to in¬
tentionally and consciously propose the construction of
openings into drains on the level of streets, and in the
proximity of houses and thoroughfares. Professor Attfield’s
perspicuous and attractive mode of presenting the facts in
his recent lecture is much to be commended, and we gladly
welcome him as an advocate in a cause in which we are
much interested.

AN OBJECTIONABLE “PLEBISCITE.”

It is greatly to be regretted that an enterprising
contemporary could not, in the fertile ingenuity of its
resources, discover some less objectionable subject for a
prize than that which it recently proposed as a “ timely
plebiscite to its readers "—namely, the mention of names
under the following extraordinary headings: (I) “The best
doctor of all,” (2) “the best ladies’ doctor,” (3) “the best
surgeon,” (4) “the best dentist,” (5) “the best-managed
hospital,” (6) “ the best watering-place for convalescence,’’
and (7) “the best nursing establishment.” “The usual
prizes of £2 and £1 will be given to the two competitors
whose coupons agree most nearly with the opinion of the
majority.” A plebiscite such as this can but be most
repulsive to the feelings of the medical -body as a whole, as
well as of those selected. It is a grievous annoyance that
practitioners should be subjected to freaks like this. The
vagary to which we now direct attention is probably with¬
out its equal. “ The winter,” says the evening paper referred

to, “is the doctor’s harvest time . During the bitter

winter months few of us escape the doctor’s dutches, and
there are few households in the metropolis to which he is
not called.” Upon this ground the plebiscite is regarded as
“timely.” Whether our contemporary thinks the “bitter
winter months” are past and this is the time to re¬
turn thanks for the blessing of a good doctor, or if
he looks forward with dread to a wintry March and April,
so that the opinions he proposes to elicit are likely to be
presently applicable, we do not know; but it matters little
to our immediate concern whether the gratitude which is to
find this strange expression be for favours past or to come.
Under any conditions, the scheme is a bad and offensive
one, and we can only regret the adoption of a device so
obviously objectionable. _

THE GERMAN MEDICAL CONGRESS.

The sixth annual German Medical Congress is announced
to be held at Wiesbaden from the 13th to the 16th of April,
under the presidency of Prof. Leyden, of Berlin. The follow¬
ing are subjects already notified: The Treatment of Phthisis,
to be opened by Dr. Dettweiler (Falkenstein) and Dr. Pen-
zoldt (Erlangen); Localisation in Cerebral Disease, by Pro¬
fessor Nothnagel (Vienna) and Dr. Naunyn (Konigsberg);
the Pathology and Treatment of Whooping-cough, by Dr.
Vogel (Munich) and Dr. Hagenbach (Basle). Besides the
foregoing set discussions, papers are promised on Pernicious
Anaemia, by Dr. Lichtheim (Berne); on the Pathological
Anatomy of Tabes Dorsalis, by Professor Rindfleisch
(Wurzburg); on Experimental Epilepsy, by Dr. Unverricht
(Jena); on the Physiological Import of Migrating Leuco¬
cytes from the Tonsils and Lingual Glands, and on
Chyluria, by Dr. Rossbach (Jena), who will also describe a
chair he has devieed for aiding respiration ( Athmungutuhl)
in cases of emphysema and asthma. The secretary of the
Congress is Dr. Emil Pfeiffer, of Wiesbaden.

ON THE ETIOLOGY OF THE UTERINE SOUFFLE.

Wbhmeb contributes to the Centralbl.f. Gym, March 13th,
1886, an interesting oase in which the seat of origin of the
ordinary form of uterine souffle could be clearly and

experimentally demonstrated. A.Z-, multipara, pregnant

nine months; abdomen very pendulous. The recti muscles
were so widely separated as to leave below the umbilicus an
interval of twenty centimetres (eight inches) between one
another. In this interval the abdominal walls were extremely
thin and translucent, so much so that through them a large
pulsating bloodvessel could be seen on the left side running
in the uterine wall and followed for a distance of ten centi¬
metres (four inches). On auscultating this vessel, a distinct

Digitized by GoOgle

Thb Lancet,]

INFANT MORTALITY AT WORKINGTON.

[Feb. 10,1887. 887

whining bruit was audible synchronous with the maternal
poise, and the moTemeute of the arterial wall could be
readily felt with the huger. Pressure with the stethoscope
or the finger completely silenced the bruit. Anaesthesia
also brought it to a standstill, owing probably to the
coexisting fall of intra-abdominal pressure; the bruit
returned when the woman regained) consciousness. During
the labour-pains the note of the souffle reached a higher
pitch and became, musical. After delivery it continued
audible for two days with diminishing distinctness. Wehmer
believes tb»« to be the first ease in which the seat of origin
and the various circumstances affecting the souffle have
been so capable of demonstration, and here thsy were so
owing to the existence of an unusually large branch of the
uterine artery. _

INFANT MORTALITY AT WORKINGTON.

The Time* comments on the "remarkable report "of the
medical officer of health, of Workington, in Cumberland, and
quotes the comments it contains on the extraordinary
infantile death-rate, whieh is stated to have amounted in
1886 to 136-2 children under one year of age per 1060 regis¬
tered births. This mortality is regarded by Mr. Lowe as due
to a series of causes, and notably to tea-drinking, patent medi¬
cines of a “ soothing" type, and to the neglect of children
whilst their mothers are engaged at meetings of the Salvation
and the Church Armies. The statements which the report
contains as to scarlet fever, and the threat of resignation
which Mr. Lowe commits himself to because he will not be a
party to “ wilful murder" if hie advice as to school-closing
should be disregarded, probably have reference to a fatality
amongst children at the school age and not to young
infants. The School Board, he alleges, “prefer to save money
at the expense of human life,” a statement which we assume,
relates to the frequently, experienced desire of School
Boards to look with disfavour on anything which lessens
the school attendance, and so interferes with the Govern¬
ment grant. But as to children under one year of age, we
think Mr. Lowe bases his scathing condemnation of Work¬
ington on insufficient data, for at Workington the infantile
death-rate under one year—that is, 136 per 1000—fell short
of that far England and Wales during the same period, and
indeed during any recent period. For the whole country
the oorresponding rate was 150 in 1886,147 during 1885, and
148 for the ten years 1871-80. Whilst we have no wish to
detract from efforts to reduce the deaths amongst infants in
Workington, we feel bonnd to point oat that the rate there
experienced is by no means extraordinary. If Mr. Lowe had
turned his attention to the 178 per 1000 rate in the twenty-
seven provincial towns quoted by the Registrar-General, or
to the 200 to 250 rate in some selected towns, we could
have better understood the terms of his report.

BORACIC ACID AS A. PRESERVATIVE OF FISH.

The preservation of fish, and especially herrings, by
boracic acid is a matter of considerable economic importance,
and one which cannot fail to have an interest from a medical
and hygienic point of view. The subject naturally divides
itself into two distinct departments—the influence of the
preserving agent on the fish, and the effect of flsh so pre¬
served on the human economy. As often happens in ques¬
tions of the kind, accurate scientific data are not available
for the discussion; so that we have to trust to a priori
reasoning to common sense. That boracic acid cannot
improve the quality of the tisBnes of the herring as a food
goes without'saying, and we have the actual evidence of the
m** to prp^e that its saVonr and appetising qualities are
deteriorated.by fhia method of preservation. That the acid
old jjSjr.'.nnd in aul^cieht quantities /will prevent

septic decomposition may be granted, but this is hardly all
that is required of a preservative of fish. From long experi¬
ence we have learnt that preservation by common salt and
by wood smoking is not deleterious, but we have yet to
learn. whether fish can with impunity be kept in boracic
acid for a long period of time. ITowever, in the absence of
accurate experimental data, it is impossible to assert posi¬
tively that minute doses of boracic acid can prove dele¬
terious to the healthy action of any or all of the organs of
the body, though the inference may fairly be drawn that
the use of the drug can neither be truly preservative of all
the qualities of frbsh fish nor altogether innocuous to the
physical welfare of man.

SCIENTIFIC TERMS,

It has sometimes been questioned whether the use of
Latin or Latinised Greek as the language of scientific
nomenclature is not open to the accusation of pedantry.
Some would prefer a system like the German, which to a
large extent employs, besides the usual classical expressions,
a set of names belonging to the native tongne. This plan
has no doubt some value with a view to popular instruction;
apart from this consideration it is needless and cumbersome.
On the other hand, the revival of the dead languages for the
same purpose has distinct advantages. Possessing a voca¬
bulary copious, definite, and familiar to educated persons,
they afford to all such the easiest means of arriving at a
common understanding as to scientific facts. It cannot be
denied, however, that the wish for precision-does sometimes
lead to wordiness. Natural history, botany, medicine even,
but above all organic chemistry, can show instances in
which a term has so excelled in lengthy conciseness of
learned description that its fitness for general use is abso¬
lutely gone. Such terms in combination would almost
constitute a new language in themselves. It is needless to
say that their proper place is in purely technical records.
Thus placed, they actually assist the expressions and under¬
standing of the erudite. They have no convenient place in
every-day life, and we find accordingly that as soon as they
have to travel beyond the precincts of the laboratory they
are superseded by terms which, if less fully descriptive,
convey some definite idea in a simpler form.

THE MOSCOW MEOICAL CONGRESS.

The second congress of Russian practitioners has just
been held in Moscow (the first having taken place at
St. Petersburg last year), and seems to have been a great
success, the great hall of the University being crowded at
the two general meetings by hundreds of medical men from
all parts of Russia. It had been previously announced that
the sections to which most prominence would be given
would be those of Publio Medicine, Pharmacology, Balneo¬
logy, and Electro-therapeutios, and the Pharmacy and
Pharmacognosis of Ophthalmic and Children’s Diseasee.
General subjects were, however, by no means excluded,
many burning questions connected with both medical
science and medical politics being discussed. At the final
general gathering, Professor V. V. Pashutin congratulated
bis audience on the increased number of members whom
this congress had succeeded in attracting, there being no
leas than 1300, whereas last year there were only about 500.
The number of papers, too, was double that which was com¬
municated to the St. Petersburg meeting, being 200 against
100 last year. Remarking on the general interest of these
papers, he mentioned as particularly valuable those on the
treatment of phthisis, the various operations for stone,
Ctesarean section and abdominal section, Pasteur’s inocula¬
tions, the need of raising the level of pharmacists’ education,
the possibility of admitting properly educated women to

Digitized by VJJ

388 Thb Lancet,] MORTALITY IN POBLIC LYING-IN HOSPITALS OP GERMANY.

LPbb. 19,1887.

the examination for dispensers, over-pressure in schools, the
want of revision of medical legislation, the definition of the
position of medical experts in legal practice, &c.

MORTALITY IN PUBLIC LYING-IN HOSPITALS OF
GERMANY.

Dohrn, in Zeitach /. Geb. und Qyn ., p. 121, 1886, draws
attention to the great diminution in the mortality of
lying-in women which has taken place in the above-
mentioned establishments since the introduction of anti¬
septics. He selected the period of 1874-83, since in 1874
antiseptics were scarcely used anywhere, while in 1883 they
had become very general. The total number of cases of
labour was 104,287, and 1429 women, or 1*37 per cent., died.
The vast improvement indicated by this percentage will be
clear on comparison with the statistics of previous years.
Thus, in 1866, Lefort found the average mortality in the
lying-in hospitals to be 3 4 per cent., while Winckel in 1869
calculated the mortality on 500,000 births to be 3 per cent.
Even this great improvement, however, in lying-in institu¬
tions leaves their mortality far behind that of women
attended in private practice; in the latter the percentage of
deaths is only - 6 to '7 per cent. Various influences con¬
tribute in bringing about this result: 1. The large propor¬
tion of primiparae in public lying-in hospitals, puerperal
fever being, as is well known, unusually common after a
first confinement. 2. The cliuical instruction given in
public hospitals, which is invariably accompanied by special
dangers in spite of every precaution. 3. The numerous
complicated cases that are sent to such establishments.
4. The fact that many women are admitted who have been
examined and exposed to septic infection before admission.
Dohrn further investigated the question as to how the
mortality was affected by the clinical use made of various
lying-in hospitals, and he found that the mortality in
those in which no instruction was given was ‘56 per cent.;
in those where midwives were trained, 1*13 per cent.; in
those where midwives and students were trained, T42
per cent.; in those where students were trained, 1-90 per cent.
This shows, as Ssmmelweiss pointed out long ago, that
students, who are much in contact with septic matters, are
a great source of danger to lying-in women, even more
so than midwives. Dohrn is of opinion that the recent
decreased mortality in public maternities is solely due to
the introduction of antiseptics, and that the mortality will
be low in proportion to the conscientiousness with which
the antiseptic system is carried out.

TREATMENT OF H/EMATOMA OF THE EAR.

Db. A. Lebrun, in a clinical lecture published in the new
Brussels journal, La Clinique, says that after having tried
various plans for the treatment of haematomas of the ear,
including free opening as well as Follin’s method of making
a number of punctures, and having found them all very
unsatisfactory, he has latterly injected iodoformed ether
with complete success. For this two needles are inserted
into the tumour at opposite points; through the larger one,
No. 3 of Dieulafoy’s aspirator, the contents are drawn off,
the puncture being closed by means of iodoformed collodion.
Then through the remaining needle, which is that of an
ordinary hypodermic syringe, from fifteen to sixty minims
of a solution of iodoform in ether, of a strength varying from
2 to 10 per cent., is introduced into the cavity of the tumour.
This injection cauees some pain, which, however, soon
passes off. No dressing is required, and a complete cure
results. In one case M. Lebrun twice injected a saturated
solution of iodoform in ether without evacuating the con¬
tents of the tumour. This occasioned severe and prolonged
pain, an eschar of the Bize of a half-franc piece formed, and

although this healed, the process required more than threo
weeks. The comparatively unsatisfactory result in this,
case is considered by M. Lebrun to have been due to th»
escape of a large part of the first injection, and to over¬
distension of the tumour.

ANIMAL LYMPH.

A paragraph which emanates from the Central Press
has appeared in many newspapers, to the effect that tho-
Local Government Board have issued, or are about to issue,
a circular letter enjoining precautions to be taken with
regard to vaccination, and recommending a more general use-
of calf lymph. We disbelieve the latter part of this story. Th»
Local Government Board have recently published the report
of their medical officer, Dr. Buchanan, in which he state»
that as Dr. Cory “has previously established an identity
between calf lymph and humanised lymph in the degree of
their ‘insertion success’ when both are used in a fresh
condition, so now he shows (at all events for English
practice) that there is much lees difference than at one time-
was believed to exist between the two kinds of lymph, in
respect of the degree of success obtainable from them after
keeping during ordinary periods of time.” Thus, calf lymph
may be relied upon to produce results similar to those of
humanised lymph, but it would be disastrous if the use of
stored calf lymph were to replace direct arm-to-arm vaccina¬
tion. The reports of the Local Government Board have amply
shown that direct vaccination arm-to-arm or calf-to-arm.
should be performed wherever this is possible, and if direct
vaccination is replaced by the use of stored lymph, as would be
the case if calf lymph were “ generally ” used, the protection
of the population against small-pox would be greatly
diminished, for the results obtained by the latter prooeee
would give an insertion success of come 20 or 30 per
cent. lees than direct vaccination.

THE JUBILEE YEAR AND THE HOSPITAL
SATURDAY FUND.

A daily contemporary reports a public meeting in
Bethnal-green to promote the collecting of voluntary con¬
tributions in aid of the metropolitan hospitals, dispensaries,
and convalescent homes. The collection is to be by boxes
in all conceivable places, to be spread over fifty days, and
is to take the place of the annual demonstration and collec¬
tion of the East-end of London in aid of the Hospital
Saturday Fund. Two-thirds of the sum raised are to be
given to the Hospital Saturday Fund, and the remaining
third to the Working Men’s Morley Convalescent Home near
Dover. This is a Jubilee movement, but is scarcely to be dis¬
tinguished from the ordinary Hospital Saturday methods. We
repeat what we said last week and often before, that sys¬
tematic weekly payments by the working classes should be
organised by the Hospital Saturday Fund.

UNQUALIFIED ASSISTANTS.

On the subject of unqualified assistants we continue to
receive communications, urging two very sharply differen t
views. According to one set of writers, unqualified assistants
are an unmitigated evil and almost an imposition on the
public. According to another, they are an old institution to
be retained, if not defended. We have not further space for
this controversy. The general conclusion in our mind is
that the day of unqualified assistants is weltnigh over. A
few old members of the class are to be pitied, and some of
them are even to be respected for their abilities and
character. Such men will still find employment—perhaps
should find employment under the immediate eye of good
practitioners. But their prospects and position will bo
increasingly unsatisfactory. Public opinion demands tbat

Digitized by GoOgle

Thb Lahcbt.]

HERPES ASSOCIATED WITH LOCOMOTOR ATAXY.

[Fsb. 19, 1887. 389

■11 men who practise medicine should he qualified, and
the profession feels that it is injured by the competition
of uaqualifled assistants. All young men who are shirking
their examinations and threatening to drift into the position
of unqualified assistants should take warning in time. If
they cannot see their way clear to gain medical qualifica¬
tions, they should abandon all thoughts of medical assistant-
ship and take to other callings.

NEURASTHENIA - NOT HYSTERIA.

Mb. Hovkll returns with unabated ardour in a pamphlet
before us, published by Churchill, to his favourite occupation,
that of defining the conditions of neurasthenia, and com¬
bating the theory that it is represented in the term hysteria,
which he woold like to see abolished from medical language,
lie has no patience with material views of the causation of
such states, whether tending to locate the material injury
it the nervous or the uterine system. He complains that
the effect of shock, especially moral shock, has been much
overlooked in this connexion, and would have us regard
neurasthenia as essentially ,a psychological condition in
which no lesion can be detected. He claims for such patients
more patience and sympathy than he thinks they receive
under the old theories of their disease. He admits the cures
wrought by Dr. Weir Mitchell and Dr. Playfair, though he
thinks the cases of the latter physician savour more of
ooerdon than is desirable, considering that he is dealing
with patients of the feminine gender. His guiding prin¬
ciples of treatment are to remove all causes of irritation
sad to build up the strength. The one point on which all
seem agreed nowadays is the existence of a veritable
weakness in such cases. This should be considered and
treated. It is equally undeniable that some degree of firm¬
ness in the physician is beneficial, though this should never
be allowed to exceed proper limits. A third point is that the
aterus has no such special culpability in these cases as has
been assumed, and that the use of the term “hysteria” as
involving an exploded notion should be discontinued. Pos¬
sibly finer researches in pathology than have yet been
realised, or are even now practicable, may show positive
physical lesions in many of these cases.

OEATHS OF EMINENT FOREIGN MEDICAL MEN.

The following deaths are announced M. Bechard, Pro-
fe*sor of Physiology and Dean of the Faculty of Medicine
of Paris; he was also permanent secretary of the Academy of
Medicine. Dr. Jos. Zit, Privat-docent of Children’s Diseases
® the Bohemian Faculty of Prague. Dr. F. von Jiiger,
former Chief of the Medical Senate, aged seventy-three. Dr.
P. Sutkovski, Professor of Surgery in Kazan. Dr. Miltiader
Weligelo8, Professor of Midwifery at the University of Athens.

DAMP BEDS.

A corjlkspondknt, “ Traveller,” in despair of finding any
*ssna which will prevent the use of damp beds, asks us to
name an antidote which will protect the sleeper so un¬
fortunate as to occupy one. A reply in the terms he suggests
is for us, we fear, impossible. His question will be better
•wwwsd if we follow the gaidance of common sense than
by an appeal to any purely professional dictum. In so far
ws differ from our correspondent, that we still believe in the
Preventive power of care on the part of travellers and hotel¬
keepers. Without this, indeed, no other remedy can have
reach efficacy. Neglect in this particular has been followed
by the most serious consequences, and there is no detail in
hotel management which more deserves the attention of the
directing authority, or which, if its due execution were
®*®red, would better repay the pains expended on it.
«e dampness of beds is usually in their sheets. Blankets

and mattresses are not changed with every occupant, and are
therefore less liable to this defect. Whenever, therefore,
a traveller has reason to donbt if his bed has been duly aired,
he should insist that the sheets bs thoroughly warmed
forthwith by hot bottles or some other mode of applying dry
heat.

HERPES ASSOCIATED WITH LOCOMOTOR ATAXY.

It is stated in O Correio Medico, of Lisbon, that there is
now in the wards of the hospital of St. Sebastian of that
city a patient suffering from locomotor ataxy, who in addi¬
tion to joint affections as described by Charcot, and loosening
of the teeth while quite sound, has developed herpes zoster,
extending from the cervical to the lumbar region, the erup¬
tion spreading outwards in the directions of the intercostal
spaces, and being accompanied by severe neuralgia and
hyper»sthesia of the skin over all the region affected. A
few previous cases of herpes associated with locomotor ataxy
have been mentioned by Fournier, Charcot, and Buzzard, and
by Portalier in his thesis (Paris, 1884). In all these, how¬
ever, the herpes seems to have been developed in the pre-
ataxic period. Similarly as to the falling out of the teeth
which is also rare, Fournier only mentions one instance,
and in this it occurred before the manifestation of ataxic
symptoms. O Correio Medico refers to a thesis by Dr. H.
Bonnieux (Paris, 1883) on this subject.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

At the last meeting of the Society a resolution was adopted
expressing approval of a scheme for amalgamation with the
provincial Societies of Health Officers, as proposed by the
President, Dr. Alfred Hill. A committee consisting of the
president, ex-president, the treasurer, and the two honorary
secretaries, was appointed to consider the details. The
Council is about to report to the Society on the amendments
which experience has shown to be necessary in the Public
Health Act, 1875. Health officers who have found the Acts
faulty in any particular should communicate at once with
Dr. C. E. Saunders. This duty, it should be observed, is
being undertaken by the Society of Medical Officers of Health,
and not by the Epidemiological Society, as inadvertently
stated in last week’s issue._

BRIGADE-SURGEONS IN INDIA.

Wb understand that the case of the Brigade Surgeons
in India will shortly be brought before Parliament by
Colonel Hughes-Hallett. We have repeatedly noticed the
injustice done to officers of this grade by the denial to
them of the advantages of pay and allowances which
ought to attach to the rank. We trust that their claims
may be so strongly pressed home upon the Government as
to lead to an early redress of their grievances. Copies of
the statement of these claims may be obtained by any person
interested in the subject on application to Messrs. Holt,
Lawrie, and Co., the Army Agents, in Whitehall-place.

THE CONTAGIOUS DISEASES ACTS.

Thk Woolwich Board of Guardians was specially sum¬
moned last week to consider a letter received from the
Portsea Island Union with respect to the spread of contagious
disease since the suspension of the Contagious Diseases
Acts, asking the Woolwich Board to appoint a deputation to
co-operate with them in waiting upon the Local Government
Board with a view to restoring the operation of the Acts.
The chairman (the Rev. S. G. Scott, Rector of Woolwich) read
a letter from the principal medical officer of the Woolwich
district, in answer to a request for information which he
had addressed to him. This letter gave ample evidence of the

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HON0UB3 TO MEDICAL MEN,—EXCISION OF CHANCBES.

[Kjw- KU887.

lamentable results of the suspension of the Acts. The Board
then questioned the relieving officers of the union, and they
all, with a single exception, bore testimony of a similar
character, as did likewise Mr. Boulter, the medical super¬
intendent of the infirmary. One of the guardians, a local
chemist, said that his “business experience” since the
suspension of the Acts had furnished him with such over¬
powering evidence of the resulting evils, that h6 was now
as strong an advocate for the restoration of the Acts as he
had formerly been for their repeal. The Board unanimously
resolved to give the co-operation asked for by the Portsea
Island guardians. _

HONOURS TO MEDICAL MEN.

The Queen has been pleased to make the following,
among other appointments, to the Most Eminent Order of
the Indian Empire:—Sir George Christopher Molesworth
Birdwood, M.D., C.S.I., Special Assistant in the Statistics
and Commerce Department of the India Office, and Surgeon-
General Benjamin Simpson, M.D., Sanitary Commissioner
and Surgeon-General with the Government of India, to be
Knights Commanders; and Thomas Beatson Christie, Esq ,
M.D., Medical Superintendent of the East India Asylum at
Ealing, to be a Companion of the said Order. The Queen
has also been graciously pleased to give directions for the
following appointment to the Most Distinguished Order of
St. Michael and St. GeorgeSurgeon Charles William Owen,
C.I.E., to be an Ordinary Member of the Third Class, or Com¬
panion of the said Most Distinguished Order for services
rendered on the Afghan frontier.

EXCISION OF CHANCRES.

Dn. Andbonico claims to have entirely eradicated the
syphilitic virus in four cases by excising the primary
chancre. He believes that if the sore is situated in a locality
such as the nymphso or the prepuce, where excision is
possible, and if the operation is performed within forty-
eight hours, or at the very latest three days, from the first
appearance of the chancre, success may be hoped for. The
operation is, he says, contra-indicated if a longer time than
this has elapsed or if the glands are enlarged.

RESPITE OF THE CONVICT THOMAS
THOMPSON.

We are glad to find that the representations we made as
to the doubtful sanity of Thomas Thompson, sentenced to
death at Durham for the murder of his child, have been so
far confirmed by the experts to whom the question was
referred that the Home Secretary has felt warranted in
advising Her Majesty to respite the prisoner.

FOREIGN UNIVERSITY INTELLIGENCE.

Breslau .—The students have arranged a public presenta¬
tion of thanks to Prof. Fritsch for declining an invitation to
the chair of Midwifery at Leipsig.

Cracow'.— Dr. Mikulicz, Professor of Surgery, who received
recently an invitation to Konigsberg, at first accepted it, but
subsequently withdrew his acceptance, preferring to remain
in Cracow.

Dutch Universities .—The total number'of medical students
during the present session is 1264, Amsterdam having 462,
Leyden 346, Utrecht 247. and Groningen 198.

. Giessen.—Dr. H. Steinbriigge has been nominated Extra¬
ordinary Professor of Otology.

•l Dalle.The .14th inst. being Professor Krukenberger’s
100th birthday, a grand assembly of his old pupils was held
in his honour.

Italian Universities .—The total-number of medioalstudente
at present is 5195. Of these, 2073 belong to Naples.

Nancy.— M. Spillmann has been selected for the chair of
Clinical Medicine, and M. Alphonse Herrgott for that of
Clinical Surgery.

Paris. —M. Guignard, Professor of Botany in Lyons has
been appointed to replace M. Chatin in the &cole Sup&rieure
de Pharmacie. __

Sib Henry Thompson has requested us to call attention to
the unauthorised use of his name in widely circulated adver¬
tisements respecting Friedrichshall Water. He feels aggrieved,
first, because be invariably refuses the use of his name to all
applicants for recommendations in any form; and, secondly,
because in this case he does not hold the opinion attributed
to him. Nearly twenty years ago he named with approval,
in a lecture at University College, the water in question-—a
period at which not more than two or three natural aperient
waters were used in this country. Since that time several
others have been imported, and be no longer endorses the
original statement. The advertisers disregard this fact.
There is never any clue to them in the announcements, or
he would have sent an earnest protest against the practice.
He has no other resource than to make one in public, and
this we willingly afford him an opportunity of doing.

La Province M6dicale (Lyons), referring to an American
paper which had expressed an opinion that practitioners in
France are less handicapped by public charities than in
England or America, remarks that if the author fancies that
French medical men are less put upon (exploits) than their
American confreres he is quite mistaken. It is true that
there are fewer dispensaries, but the multiplication of
specialists and the opening of departments for patients to
be visited at home fully make up for their absence. Then
too, there are the mutual aid societies, whose system is to
obtain advice, not gratis, but for very little.

On Monday last the examinations for admission into the
Army, Navy, and Indian Medical Services were commenced
at the London University. Seventy-three candidates pre¬
sented themselves for twenty-five commissions in the army,
the same rtumbef for twenty-eight in the Indian sendee,
and twenty-five for eight in the navy.

It has been determined that the testimonial Subscribed
by past and present King's College students on the occasion
of Dr. George Johnson’s resignation of the Chair of Clinical
Medicine shall take the form of a portrait, and Mr. Frank
Holl, R.A., has accepted the commission.

In our announcement in our last issue respecting the
forthcoming meeting on behalf of the Hospital Sunday
Fund on June 14tb, it was stated ihadvertently that the
meeting would be held in the Guildhall instead of at the
Mansion House. _

The Sanitary Eegistration of Buildings Bill to be intro¬
duced by Mr. C. C. Lacaita, M.P., will, we understand, be
backed by Dr. Farquharson, M.P., Sir W. Guyer Hunter,
M.D., M.P., and Dr. Cameron, M.P.

The Queen has intimated her intention to become a
patron of the National Hospital for the Paralysed and
Epileptic (Albany Memorial), Queen-square.

The 150th anniversary of the founding ot the University
of Gottingen is to be celebrated next year.

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HEALTH OF THE NAVY.

[Feb. 391

IjjanuacDlogn’ aift l^mpeutics.

KBGOIINE IN INTEBMITTENT FEVEB.

Du. S. L. SA.VIT8K3, writing in the Vrach on the value of
jrgotine in the treatment of intermittent fever, remark?
that the drug has been usad with success in the treatment
of many affections—s.g., by Vidal in prolapsus recti, by
Hunt and Pepper in diabetes, by Saunders, Murrell, and
Xo&kes in diabetes insipidus, by Allan for the cough in some
lung affections, by Granzio in obstinate constipation, by
Gauldmel in the night sweats of phthisis, by de Martini iu
spermatorrhoea, by Demange in some forms of typhoid fever,
and by Girma in general paralysis. It has been also em¬
ployed in chorea and in dysentery. The theory of its action
in these diseases he does not pretend to expound, but he
calls attention to the similarity of the action of quinine and
ergotine. Both, he says, undoubtedly cause contraction of
the uterus and the spleen, the effect of quinine on the
uterus having been scientifically worked out in a disserta¬
tion published by T. T. Smolski in 1876, and that of ergotine
on the spleen having been shown by Dobodchiki ( Vrach,
1880) and bv Semchenko ( Vrach, 1883). This similarity led
him to think that one of these drugs might serve as a sub¬
stitute for the other, and he therefore made a large number
of observations on the effect of ergotine upon the cases of
intermittent fever occurring in the Lubinski regiment with
excellent results, especially where an enlarged and tender
spleen was present. He finds that a combination of
ergotine with quinine acts very satisfactorily, and that in
this way considerable quantities of quinine can be saved, as
half tbe dose of quinine which would be required if given
alone will suffice it combined with ergotine. The prepara¬
tion of ergotine used was Bonjean’s, the dose in chronic
cases being about a grain three times a day.

" 8PABTEIN.

Dr. Gluziniski, in a preliminary note published in the
Przeglad Lekarski, gives the results of some observations,
both physiological and clinical, on the action of sulphate of
spartein. Its main action is to slow the heart; besides this,
it raises the blood-pressure. On cold-blooded animals it acts
with a greater degree of intensity than on mammalia. Tbe
action on mammalia may be divided into three periods or
stages, during the first and last of which the effects are
more marked than during the second. Indeed, in some cases
the heart <8 even quickened during the second period. This
may be explained by the existence of some abnormality or
pathological change in the irritability of the vagus or of the
heart muscle. Tbe reflexes are at first increased, afterwards
diminished. Death occurs from nsphyxia, and is due not
only to the effect on the medulla, but to that experienced by
the respiratory muscles. The therapeutic use of sparteia is
limited to the first stage of its action. Its value consists in
the rapidity with which it acts. In some cases, within an
hour after the first dose the pulse begins to improve, as well
as the subjective sensations of the patient, and no irregu¬
larity is produced. Spartein ha* not so powerful an action
as digitalis. It may, however, be useful in cases where the
condition of the patient renders it unadvisable to wait for
the more tardy effect of digitalis, and it may therefore be
used as an adjunct to the latter drug, besides which it may
be prescribed where circumstances exist which contra¬
indicate the use of digitalis.

BUCAJC.YPTOL IN PHTHISIS..

Bouveret has employed hypodermic injections of eucalyptol
in the treatment of phthisis. The daily dose of tbe anti¬
septic has varied from one gramme and a half to two grammes
and a half. The duration of the treatment has been from
fourteen to sixteen days. Sixteen cases of phthisis were
treated by this method; six of the number had fever, and
the remaniing ten were without fever. There was rarely
any local disturbance at tbe site of injection. It was
certain that the antiseptic was absorbed; it could be detected
in the breath,, but not in the urine. Albuminuria wae not
observed as the result of the treatment. It is very doubtful
whether the number of bacilli was altered in any way by
the method of treatment. Sweating, as a rule, was dimi¬
nished. Its chief effect is as a balsamic preparation on
the bronchial secretion, which it influeuces favourably.
MM.Perret and Chabbannes have made experiments with the

5 per cent, solution of eucalyptol, injecting a mixture of it
with tuberculous matter under the skin of guinea-pigs.
The general conclusion at which they have arrived is to the
effect that the antiseptic is utterly insufficient to prevent
the activity of the microorganism that causes artificial
tuberculosis.

HYDBA.8TIS IN UTERINE H.EMORRHAGE.

Dr. L. Goth has employed the tincture aud fluid extract
of hydrastis canadensis in various forms of uterine bremor-
rhage, especially in disordered menstruation, metrorrhagia,
hretnorrhage following abortion, and that occurring at the
change of life. The best results were obtained where no
organic disease existed, and in the climacteric luemorrbages.
Less satisfactory effects were observed in the menorrhagia
of chronic metritis, and no effect at all was produced on
haemorrhage due to erosion of the os uteri or on the
secondary haemorrhage following abortions. The dose of
the fluid extract used was twenty drops, and this amount
was given several times a day.

HYPNONE.

MM. Mairet and Combemale have published a full account
of their investigation into the physiological and thera¬
peutical action of aceto-pbenol or hypnone in the current
number of the Archives de Neurologic. They are forced
to conclude that it has no hypnotic action whatever; in
this they differ from Dujardin-Beaumetz.

BISMUTH 8UBIODIDB.

This is intended to replace iodoform. Iodine fused with
bismuth forma bismuth iodide; Boiling the latter with water
leads to the precipitation of the subiodide as a fine powder.
It, like iodol, is said to be inodorous, and yet to be equally
os effective as iodoform as an antiseptic.

HEALTH OF THE NAVY.

The statistical report on the health of the Xavy for the
year 1885, which has just been presented to Parliament,
shows, on the whole, a very favourable state of the saiiitary
condition of the force. The average strength afloat during
the year was 46,670; the cases of disease or injury amounted
to 1103 per 1000 of the strength, the deaths to TDl, the
invalided to 35 65, and the daily sick to 4628 per 1000.
These ratios are all considerably under those of the preceding
year, and are also under the average of tbe last ten years.
The marked reduction in the invalided, however, is probably
duo to an alteration in tbe returns under that headj for, if
we understand rightly the remark on page xvii.,“ invalided ”
has hitherto included men sent home from foreign stations
for change,as well as those discharged the service on account
of disability; but on the present occasion only the latter are
shown in the tables. We would suggest that the heading
“discharged as invalids” would more accurately define th.e
nature of the proceeding. Compared with 1884, the reduc¬
tion iu the admissions has taken place chiefly in paroxysmal
fevers, rheumatism,syphilis, and injuries; in the deaths, in
those from fevers and injuries; and in the invaliding, from
fevers, debility, and injuries. The reduction in the death-
rate has been well marked on the Home, Pacific, African,
and East Indian stations. On nil tbe others there has been
an increase, though in none of them to any very marked
extent.

The strength of the force afloat on the home station was
23,100; the cases amounted to 880, the deathe to 4 76, the
invalided to 26 , 53, and tbe mean daily sick to 45-09 per
1000 of strength. These axe all lower than the correspond¬
ing ratios in 1884. The reduction in the deaths, amounting
to 3 47 per 1000, occurred chiefly in those from injuries,
which -were raised to an abnormal amount in 1884 by the
loss of the Wasp on the Irish, coast; in the present report
only 10 deaths axe returned in this class, as against 65 in
tbe preceding year. Fifty-two cases of scarlet fever were
reported, of which 35 occurred in the Britannia training-
ship. The disease appears to have been brought by one of
the cadets on his return from leave; he was attacked on
Feb. 6tb; on the I9fch 10 cases were sent to hospital, on the
20th there were 8, and the others' betwean that date and
March 7th; they were all sent to the Cadets’ Hospital on
shore and recovered. Tbe ship was cleared out and diain-

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392 Thb Lancbt,]

HEALTH OF THE NAVY.

[Fbb. 19,188T.

fected, and there was no recurrence of the disease. In June
and July 10 cases of rotheln occurred on board the same
ship. Twenty-two cases of enteric fever are returned on
the home station, but 6 of them were contracted at Malta.
Most of the cases occurred singly in ships; 4 only terminated
fatally. Mumps prevailed to a considerable extent, 166 cases
having been treated; of these 129 were on board the boys’
training-ships. One of these, the Lion, also furnished a
high proportion of cases of diseases of the respiratory sys¬
tem, including 38 of pneumonia, and the medical officer
remarks that “damp decks, from too frequent wettings,
with defective ventilation and overcrowding at times,
have been, to a great extent, factors in the excess of
this disease." A death from pyaemia occurred in the
person of the junior medical officer of the Ganges, the
result of an accidental puncture in the forehead by a suture
needle while engaged in a post-mortem examination.
On the Mediterranean station an average force of 5360
furnished 1342 cases, 8'02 deaths, 79 66 invalids, and 53 94
daily sick per 1000. The cases were considerably under, and
the deaths 2 03 above, the ratios in 1884. The reduction in
the cases was chiefly in those of rheumatism, syphilis, and
diseases of the respiratory and digestive systems; and the
increase in the deaths in those from continued fevers,
diseases of the nervous system, and injuries received in
action, the latter being from spear wounds in tbe attack by
the Soudanese near Suakim on the 22nd March. There were
65 cases of enteric fever, with 12 deaths, in the squadron;
of these 45 cases occurred at Malta during the last quarter—
3 in October, 3 in November, and 37 in December. This out¬
break was believed to have been the result of a contaminated
water-supply, and it is stated that “one of the naval tanks—
that, in fact, from which the water was at the time being
taken for the ships—had not been cleaned out for a number
of years, and the water, on being examined by tbe Govern¬
ment analyst, was found to contain a large quantity of
albuminoid ammonia, and pronounced unfit for drinking.”
There seems good reason, however, to think that the water
contamination was much more widespread, and that the
disease was contracted, “ not on board the ships, not by the
drinking-water brought on board, and not by the stagnant
air of the Grand Harbour, but by the impure water that the
men drink when on shore on leave.” The quality of the
water from wells and the scoring tanks is said to be most
unsatisfactory, and enteric fever to have been prevailing as
an epidemic among the troops and civil population at the
end of the year. When it broke out in the fleet an order
was issued by the commander-in-chief “that only condensed
water was to be used in Her Majesty’s ships until further
orders.” Works are in progress for an improved water-
supply, and a new system of drainage is being carried out,
which it is hoped will prove successful in reducing the
prevalence of fever in the island. There were only 3
deaths from injuries, omitting those received in action
already noted; one was by drowning, and 2 were from
fractured skull by falls from aloft.

The force on the North American and West India stations
averaged 2400; the cases were in the ratio of 993, the
deaths of 5 - 0, the invaliding of 2375, and the daily sick of
35-47 per 1000. These very closely correspond with the
results of the preceding year, but contrast favourably with
the average of the last ten years. The only disease requir¬
ing special notice was yellow fever, wbioh appeared in
Jamaica about the end of September. One case occurred
in an engine-room artificer of the Tyne, and 9 cases with
S deaths among the crew of the Urgent in Port Royal
Harbour, contracted apparently on shore. No information
is given as to any sanitary measures being adopted, nor
does the Tyne appear to have been sent to sea—the usual
course followed on such occasions. Of the 12 deaths which
occurred on the station, 4 were from accidental drowning,
and one from fracture of the skull by an accidental blow.

On the South-east Coast of America station, in a force of
510 the cases amounted to 1208, tbe deaths to 6*88, tbe
invalids to 25 - 49, and the daily sick to 37'18 per 1000. The
eases and mean sick were higher than in 1884, bnt all
the ratios were under the average of the last ten years.
Seven cases of enteric fever, with 2 deaths, occurred in the
Heady, at Monte Video, between Feb. 4th and March 6th,
evidently the result of a contaminated water-supply. The
description given by the medical officer of the sources of
aupply and the condition of the storing reservoir is such as
would warrant a prohibition to water ships there until some
efficient steps have been taken to prevent contamination.

The Pacific station, from a force of 1710, had 1140 cases*
2 33 deathp, 32-16 invalided, and 46 07 daily sick per 1000 of
strength. The cases and daily sick were higher, but the
deaths and invaliding lower than in the preceding years, and
the cases and deaths under the average. There was nothing
in the returns which calls for special notice.

The African station, including the West Coast and Cape of
Good Hope, had an average force of 1750. The cases were
1084, the deaths 4 57, the invalided 34‘85, and the daily
sick 36-13 per 1000 of the strength—all lower than in 1884,
and under tbe decennial average. The cases of paroxysmal
fever were less numerous than in the preceding year, but
above the average; none of them terminated fatally. The
disease was contracted chiefly on tbe West Coast. Quinine
was given as a prophylactic, but does not appear to have
been successful. Of the 8 deaths, 3 were tbe result of
accidents.

On the East Indies station the average strength was
1900; the cases were in the ratio of 15 66, the deaths of
16 31, tbe invalided of 60 - 52, and the daily sick of 61-24 per
1000. These ratios are all much under those of 1884, and,
except the deaths, are under the decennial average. Of the
31 deaths, 8 were by cholera, 4 from the Briton in Bombay
Harbour, and 4 with the Field Force expedition in Burmah ;
and there were 7 deaths by drowning. The death-rate by
disease, exclusive of cholera, was only 8 42 per 1000; diseases
of the digestive system were the most fatal, giving a ratio
of 3-68 per 1000.

In an average force of 3670 on the China station, there
were 1556 cases, 9 26 deaths, 22 34 invalided, and 4619 daily
sick per 1000 of strength. There were 12. cases, with
2 deaths, returned as enteric fever, and 7, with 3 deaths,
as typho-malarial fever, but the latter appeared to have
been enteric. Eight of the cases, 4 of which terminated
fatally, occurred in the Audacious, and 6 cases, with 1 death,
in the Cleopatra. All but two occurred in officers, and were
believed to have originated at Nagasaki. The exact source
of the disease is doubtful, but it is suggested that it may
“ be accounted for by the fact that the officers made use of
tbe hotels situated "in tbe heart of the native town, and
often dined there, these hotels being in a sickly state at tbe
time.” There were 10 cases of cholera, with 4 deaths, all
of which appeared to have been contracted on shore at
Hong Kong, Shanghai, and Nagasaki. “ Cholera seems to be
deeply rooted in all the Chinese ports, and must be expected
to remain there until the value of sanitation comes to be
appreciated in China.” Diseases of the digestive system,
especially diarrhoea, were unusually prevalent in the
Japanese ports and at Hong Kong, the cases having amounted
to 323 per 1000 of the strength.

On the Australian station the strength was 1420; the
cases amounted to 1195, the deaths to 774, the invalided to
30-28, and the daily sick to 39 02 per 1000—all, except the
daily sick, higher than in 1884, but under the average.
Two-thirds of the deaths and upwards of one-fourth of the
cases were returned under the class of injuries. Fourteen
cases and 2 deaths of enteric fever occurred, of which 13
were contracted at Sydney and one at Brisbane. The disease
at Sydney was believed to have been caused by defective
sewerage and scanty water-supply. “ Sydney still holds its

position . as the chief source of enteric fever

in the squadron on the Australian station.”

The Irregular Force, in which were included the Nile
Expedition for eight months, and the Marines serving in
Egypt and the Soudan for a little over six months, averaged
4850 strong. The cases furnished by it were 1385, the
deaths 15-05, the invalided 40'82, and the daily
sick 63-74 per 1000; one-third of the deaths were
of men killed in action; of the 26 reported under this
head, 17 occurred in the Nile expedition, consisting of 90
officers and men, and 9 at the zereba near Suakun, the
former mostly by spear and sword wounds, and the latter by
gunshot. Twenty-six cases and 12 deaths of enteric fever
were returned; 5 of these, all fatal, were in tbe Nile expedi¬
tion, and the greater part of the rest at Suakim and Alex¬
andria. Twenty-one cases of heatstroke were recorded, of
which 19 occurred among tbe men employed in Egypt add
in the Nile expedition; only one terminated fatally. In
addition to the 26 deaths in action, there were 13 by injuries,
of which 6 were from fracture, 6 by drowning, and 2 by
suicide.

The strength of the Royal Marine Divisions at head¬
quarters, not included in the returns of men afloat, was
4880; the cases among them were 1293, the deaths 6*6?,. the

The Lancet,]

THE INFIRMARY FOR CONSUMPTION, MARGARET STREET.

[Feb. 19,1887. 393

invalided 55 5, and the daily sick 62'42 per 1000 of strength,
all in excess of the proportion in the preceding year. The
admissions were much higher than amoDg the troops serving
in the United Kingdom, but the deaths and daily sick corres¬
pond very closely in the two branches of the service.

THE INFIRMARY FOR CONSUMPTION,
MARGARET STREET.

We regret to learn that through the apathy of the main
body of the governors of the above institution, the homoeo¬
pathic party were enabled at the special general meeting on
Wednesday, to outvote by three the old body of governors,
including the majority of the executive committee and
medical staff.

After the notice convening the meeting had been read,
the Rev. W. R. Mowll, M.A., moved a resolution to the
effect that Drs. Jagielski and Marsh should cease from

f ractising homoeopathy at the Margaret-street Infirmary;
urther, that Dr. Jagielski should take his name from the
llomceopathic Directory, and that Dr. Marsh should resign
his appointment at the Homceopathic Hospital, or resign
their appointments at this infirmary. This was seconded
by Captain Hunter Baillie, and spoken to by Dr. Cholmeley,
one of the consulting physicians, who in an able speech
pointed otu the incongruity of the present state of things,
and said that nowhere in the United Kingdom was there an
institution officered by a mixed staff of allopaths (so called)
and homoeopaths. He also stated that, should the resolu¬
tion be lost, he and the six members of the staff who
thought with him could no longer conscientiously retain
their appointments, and read a letter from Dr. T. Hawksley,
the senior consulting physician (who was too ill to be pre¬
sent) in favour of the resolution.

An amendment was moved by Dr. Dudgeon (a governor
of only six months’standing), and seconded by Mr. D. Bryant
(a governor of about three months’ standing), which was
spoken to by Drs. Jagielski and Marsh, and carried by
twenty against seventeen.

Of the twenty who voted for the amendment in support
of homoeopathy, we understand that several have only re¬
cently become governors of the institution—that is, between
three and six months, and since the question in dispute
haabeen on the tapis. Of the seventeen who voted in the
minority, all are old governors, and have for years given
their time and services to the institution, and one of them,
Mr. W. IL Baillie, for about forty years.

Lord Grimthorpe was in the chair, but voted with the
homoeopathic party, as did also Dr. Cooper Torry.

The seven gentlemen of the staff who have decided to
resign are Dr. T. Hawksley and Dr. W. Cholmeley, the con¬
sulting physicians; Mr. F. Carr Beard, F.R.C.S., the sur¬
geon; and Dr. Featherstone Phibbs, Dr. Julian Willis, Dr.
Robert Wolford, and Dr. Scudamore Powell, the visiting
physicians. The majority of the executive committee also
intend to resign—viz., the Rev. J. J. Coxhead, M.A., Rev. W.
R. Mowll, M. A., Lieut.-Colonel Ilollway, treasurer; Joseph
Lott,Esq., solicitor; Captain W. Hunter Baillie, J. A. Pepys,
Esq., and St. Leger Bunnett, Esq.

In again expressing our regret, we would warn other
institutions by the fate of this one (an infirmary which has
been of immense value to the suffering poor), so that they
may be on their guard against this thin end of the homoeo¬
pathic wedge.

• - - " 1 1 ■ ■- 1 ■ ■-

THE SEAMEN’S HOSPITAL, GREENWICH.

The annual meeting of the governors of and subscribers
to this institution, which takes up the work carried on by
the late Dreadnought, was held on the 16th inst, under the
presidency of Sir Andrew Clark, Bart., M.D. The sixty-sixth
animal report, which was read by the secretary, stated that
though the institution had suffered severely during the
great commercial depression, the committee had not been
compelled to draw upon their reserve funds in order to
make the income meet the expenditure. The number of
Patients treated last year was 2267, and of these 1452 were
jgreharged cured and convalescent, 477 had been relieved,
of died, and 194 remained tinder treatment at the close of

the year. There were also 5359 out-patients during 1886,
making a total of 269,782 patients treated at the institution
since its foundation. Sir Andrew Clark gave an account of
a visit of inspection he had paid to the hospital, and, com¬
mending its management, he urged its claims to the support
of the charitable public. The report was adopted, and the
customary votes of thanks brought the proceedings to a close.

PROSECUTION OF ORIGINAL RESEARCH IN
EDINBURGH.

The committee appointed to consider and report on the
Prosecution of Original Research in connexion with the
Royal College of Physicians, Edinburgh, have issued their
Report to the President and Fellows of the College. The
committee recommend (1) that the College establish and
maintain in the neighbourhood of the infirmary a laboratory
for tbe prosecution of original research; (2) that the College
vote £1000 for the establishment of this laboratory, and,
year by yesr, a sum not exceeding the third of the clear
surplus of annual income over annual expenditure for its-
maintenance, including the payment of salaries. It is
suggested that tbe laboratory be placed under the care of &
curator and committee, with a scientific man as superin¬
tendent, at a salary' of not less than £200 per annum, and
an assistant, to reside on tbe premises, at a salary of £80;
(8) that the laboratory be open without fee to Fellows and
Members of the College, and to any investigator, on certain
conditions; and (4) that the committee should be empowered,
if sufficient funds be at its disposal, to offer yearly a medal
and money prize (not exceeding £21) for original work con¬
ducted within the laboratory or elsewhere, the results to be
embodied in essays to be submitted to tbe oommittee, and
to be specially connected with medicine, therapeutics*
gynaecology, and psychiatric medicine.

VITAL STATISTICS.

HEALTH OF KNGLI8H TOWNS.

In twenty-eight of the largest English towns 6788 births
and 3453 deaths were registered during the week ending
Feb. 12th. The annual death-rate in these towns, which had
steadily declined in the preceding five weeks from 26 5 to
19 6 per 1000, further fell last week to 19'6. During the
first six weeks of the current quarter the death-rate In these
towns averaged 2t3 per 1000, and was 2-2 below the
mean rate in the corresponding periods of the ten years
1877-86. The lowest rates in these towns last week were
14-9 in Nottingham, 15 3 in Leicester, 161 in Derby, and 16 9
in Leeds. The rates in the other towns ranged upwards
to 25 8 in Manchester, 26 9 in Liverpool, 271 in Wolver¬
hampton, and 301 in Huddersfield. The deaths referred to
the principal zymotic diseases in the twenty-eight towns,
which had declined in the preceding four weeks from
485 to 367, further fell last week to 340; they included 95 from
whooping-cough, 77 from measles, 61 from scarlet fever, 43
from diphtheria, 32 from diarrhoea, 31 from “fever” (princi¬
pally enteric), and only 1 from small-pox. No death from
any of these zymotic diseases was registered last week in
Derby, whereas they caused the highest rates in Norwich,
Liverpool, and Huddersfield. The greatest mortality from
whooping-cough occurred in Oldham, Sunderland, Hudders¬
field, aod Norwich; from measles in Halifax, Bristol, and
Huddersfield; and from scarlet fever in Birkenhead, Liver¬
pool, and Sheffield. The 43 deaths fiom diphtheria in the
twenty-eight towns included 17 in London, 4 in Liverpool',
3 in Birmingham, 3 in Manchester, 3 in Huddersfield, 2 in
Portsmouth, 2 in Norwich, 2 in Oldham, and 2 in Hull.
Small-pox caused 1 death in Manchester and 1 among tbe
residents of London and its outer riDg, but not one in any
of the twenty-six other large provincial towns. Only 3
small-pox patients were under treatment on Saturday las ft
in the metropolitan hospitals receiving cases of this disease.
The deaths referred to diseases of the respiratory organs in
London, which had declined in the preceding five weeks
from 731 to 364, rose again last week to 373, but were so
many as 244 below the corrected average. The causes of 89*
or 2 : 6 per cent., of tbe deaths in the twenty-eight towns
last week were not certified either by a registered medical

Google

394 Thb Lan'crt,] MEDICAL TREATMENT AT HOSPITALS AND DISPENSARIES.

[F*b. 19,1887.

practitioner or by a coroner. All the causes of death were
duly certified in Leioester, Nottingham, and in four other
smaller towns. The largest proportions of uncertified deaths
were registered in Oldham, Bradford, Sheffield, and Liver¬
pool. _

HEALTH OF 8C0TCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 247 and 19 - 8 per 1000 in the preceding two
weeks, rose again to 22*0 in the week ending Peb. 12th; this
rate exceeded by 2*5 the mean rate during the same week
in the twenty-eight large English towns. The rates in the
Scotch towns last week ranged from 130 in Perth and 14'4 in
Greenock and Leith, to 247 in Glasgow and 27’4 in Paisley.
The 550 deaths in the eight towns last week showed an
increase of 56 upon the low number in the previous week,
and included 28 which were referred to whooping-cough,
1G to measles, 14 to diarrhoea, 13 to scarlet fever, 3 to diph¬
theria, 2 to "fever” (typhus, enteric, or simple), and not
one to small-pox; in all 76 deaths resulted from these
principal zymotic diseases, against 75 and 66 in the pre¬
ceding two weeks. These 76 deaths were equal to an annual
rate of 30 per 1000, which exceeded by l'l the mean rate
from the same diseases in the twenty-eight English towns.
The fatal cases of whooping-cough, which had been 19 and
23 in the preceding two weeks, further rose last week to
28, of which 19 occurred in Glasgow, 3 in Aberdeen, and 3
in Paisley. The 16 deaths from measles showed an in¬
crease of 4 upon the number in the previous week, and
included 12 in Glasgow and 4 in Aberdeen. The deaths
from scarlet fever, which had been 16,16, and 8 in the pre¬
vious three weeks, rose again last week to 13, of which 7
occurred in Edinburgh ana 4 in Glasgow. The 14 deaths
attributed to diarrhoea showed a considerable increase
upon recent weekly numbers, and included 5 in Glasgow
and 3 in Dundee. The doatbs referred to diphtheria and
"fever,” on the other hand, had considerably declined;
2 fatal coses of diphtheria were returned in Edinburgh.
The deaths referred to acute diseases of the respiratory organs
in the eight towns, which had steadily declined in the first
five weeks of the year from 213 to 126, were last week
133, and were 11 below the number returned in the corre¬
sponding week of last year. The causes of 71, or nearly
13 per cent., of the deaths in the eight towns last week
were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 28 - 2 and
297 per 1000 in the preceding two weeks, declined again to
27‘3 in the week ending Feb. 12th. During the first six
weeks of the current quarter the death-rate in the city
averaged 308, the mean rate during the same period
being but 21*1 in London and 21 - 4 in Edinburgh. The 185
deaths in Dublin last week showed a decline of 16
from the number returned in the previous week, and
included 5 which were referred to scarlet fever, 4 to
"fever” (typhus, enteric, or simple), 4 to diarrhoea, 3 to
whooping-cougb, 1 to diphtheria, and not one either
to small-pox or measles. Thus the deaths from these
principal zymotic diseases, which had been 14 and 13
in the preceding two weeks, rose last week to 17; they
were equal to an annual rate of 2*5 per 1000, the rates
from the same diseases being 1'5 in London and 2 8 in
Edinburgh. The fatal cases of scarlet fever, which had been 6
and 4 in the previous two weeks, were 5 last week, and the
deaths from both " fever ” and diarrhoea also showed an in¬
crease upon the numbers in the previous week. The fatal
cases of whooping- cough and dipntheria corresponded with
the numbers in the preceding week. The deaths both of
infants and of elderly persons showed a decline from the
numbers in the previous week. Six inquest cases and 5
deaths from violence wore registered; and 51, or more than
a quarter, of the deaths occurred in public institutions. The
causes of 23, or more than 12 per cent., of the deaths regis¬
tered during the week were not certified.

Ventnor Hospital for Consumption. —On Monday
last, at the annual general meeting of the governors of this
hospital, it was announced that the Duke of Cambridge
would preside at a festival dinner at the Hotel Mlitropole
on April 19th, and that in the summer Princess Beatrice
would, on behalf of the Queen, open a new block of houses
for twenty additional patients. '•

ConEsjDttitnu.

“ Audi alteram partem.”

MEDICAL TREATMENT AT HOSPITALS AND
DISPENSARIES.

To the Editors 6f Thi? Lancet.

Sirs, —I observe in the report of the proceedings of the
Medical Attendance Organisation Committee that a resolu¬
tion was passed calling "the attention of the governing
bodies of hospitals and other public authorities to the
necessity of some check on the indiscriminate provision of
medical treatment at hospitals and dispensaries.” Some
years since this question forced itself on the notice of the
managers of the Children’s Hospital in Great Ormond-street,
where the number of out-patients had become so large as
to be entirely unmanageable. I have described in my book
on Hospital Organisation 1 the manner in which this diffi¬
culty was dealt with, and so successfully that the number
of out-patients, which had been 13,000 in 1874, was reduced
to 9000 in 1876, and might, I believe, have been reduced still
further, without inflicting real hardship on any deserving
applicant. As the book is now out of print, I ask permission
to state the details of the plan, which might, I think, with
some possible alterations, be advantageously adopted in
London.

The regulations were as follows:—All applicants were
entered by the house-surgeon in attendance into two classes
—viz., those of slighter ailments to be treated as casualties,
and graver ailments to be entered on the register, and to
be supplied with letters entitling the bearers to attend for
a period of two months. The register and also the letters
bore a record of the name and residence of the patient, as
also of the occupation and weekly earnings of the parent;
and no child whose parent was in receipt of more than 30*.
per week was considered eligible for permanent treatment.
These letters had to be submitted to the secretary or other
officers of the Charity Organisation Society of the districts
in which the patient lived, and to have the stamp of the
Society in verification of the facts stated in the letters,
before the patients were considered eligible for permanent
treatment. Persons in the receipt of parish relief, and those
whose income exceeded 30*. per week, were considered in¬
eligible, but the medical officers were authorised on purely
medical grounds to dispense with these regulations; they
entering the reasons for so doing in a book provided for the
purpose. A further regulation provided for the contirraance
of a patient for a longer period than two months, at the
discretion of the medical officer.

It will be observed that in the first attendance eveiy
applicant was admitted without any question, and it
happened very rarely that mothers came saying that they
had no wish to attend permanently, but desired an opinion
on some points concerning which they felt doubts or
anxiety. Further, to provide against, the exclusion of any
on purely social grounds, the medical officers had a dispensing
power wherever a case was of special medical interest, or
where the treatment it required would be either costly or
protracted. The regulations then applied, in reality, to those
only who sought for permanent relief in ordinary ailments,
and the aim was to deal with them as wieely, and at the
same time as gently, as possible. The wife in almost every
instance gave an answer, though often not an exact one, as
to her husband’s earnings, and it was at first attempted, to
control this statement by requiring that before presenting
themselves a second time each letter should be counter¬
signed by some householder, clergyman, city missionary, or
other minister of religion. The regulation turned out a
farce; the clergy of no persuasion cared to be guilty of the
apparent unkindness of refusing their signature to a person
asking for it merely to obtain hospital relief, and the small
shopkeepers in a poor district did not dare to disoblige their
customers. Theoretically, this test of fitness seemed to
conciliate kindness and discrimination; practically, it was
worthless. .

At the time that the help of the Chanty Organisation
Society was sought for, though no longer on the medical
staff of the hospital, I took an active part in its man&ge-

> On Hospital Organisation, with special reference to the Organisation
of Hospitals for Children. London, W77.

oogle

fen Lanckt,]

‘•GENERAL HOSPITALS AND PARISH INFIRMARIES.'’

[Feb. ID, 1887. 395

ment. Soon after my connexion with the institution ceased,
the old system was once more resorted to; and the lost
report of the hospital shows a total of 14,281 new out¬
patients in the year 18S5. This total represents an annual
attendance of 85,686, on the assumption that each child
attends six times, or a daily attendance of 279; of whom 46
would be new cases, deduction being of course made for
fifty-two Sundays, Christmas Day, Good Friday, and four
Bank Holidays. If we reckon that properly to investigate
each case, new and old, three minutes is a reasonable time
to allow, it appears that fourteen hours would be required ;
on dividing tne labour among four, we find that three hours
and a halt must be dbvoted by each medical officer. It is
needless to dwell on the time required to supply these
patients with the necessary medicines, even though the
dispensing arrangements were very good. The failure of the
plan was at once assured when the original scheme was
departed from, and in deference to the representations of the
house-surgeons (who objected to be called on to put
questions to the mother concerning their husbands’ earn¬
ings or concerning any matter not purely medical) the
preliminary inquiry at the hospital was given up. The
officer of the Society was at once placed in an
entirely different position when called on not merely
to verify a statement, but to institute an entirely new
inquiry for the conduct of which he had no data. He at
once was placed in the offensive position of the relieving
officer of the parish, who is supposed popularly to derive
his name from its being his duty to refuse relief. The
failure of the plan was secured by this apparently insignifi¬
cant change, just as surely as the upset of a carriage by the
removal of the lynch-pin. It would probably not have been
difficult to entrust the preliminary' inquiries at the hospital
toothers than the house-surgeons; but unfortunately the
diminution of the number of out-patients was not seen with
friendly eyes by many. The medical officers for in-patients
did not lie a scheme by which the field whence cases of
medical interest were gleaned was diminished in extent;
the subscribers sometimes objected to their letter of recom¬
mendation being submitted to inquiry; while the committee
fancied that the larger the number of out-patients, the
greater the claim of the charity to public support. A few
complaints, too, were made by the patients themselves of
the inquisitorial nature of the questions put by the agents
of the Charity Organisation Society. Very few indeed of
these complaints were well substantiated: while, to the
best of my recollection, none were made during the time
when the preliminary inquiries were made in the first
instance at the hospital, and were referred for verification
only to the Charity Organisation Society. The difficulty
is one felt in France as well as in this country. My excuse
for occupying so much of your valuable space is that I have
seen no other plan proposed for dealing with it, and that,
while it no donbt may be altered for the better, it at least
attained the object for which it was started.

I am. Sirs, yours faithfully,

Charles West, M.D.,

Founder of the Hospital for Sick Children.

HufcjMtreeC. W-. Feb. 7th. 1987.

“GENERAL HOSPITALS AND PARISH
INFIRMARIES."

To the Editors of The Lancet.

Sim,—A llow me to make a few remarks in criticism of
Dr. Goodhart’s letter in yonr last issue respecting general
hospitals and parish infirmaries. As the medical super¬
intendent for nearly ten years of the largest of these infir¬
maries, I may perhaps be considered to have some slight
■pedal knowledge on the subject.

Dr. Goodhart’s objections range themselves under the
following heads:—1. It is an injustice to the ratepayer to
nave bnUt, and to compel him to keep up, magnificent
P*ri*h infirmaries. 2. That they do harm to the general
3. That they do injustice to the patients that are
knitted within their doors; and he instances this result
**podaUy in surgical cases.

Take the first objection—that of injustice to tbe rate-
P*y*r (although, further on. Dr. Goodhart naively confesses
n® does not dam much about him if his own hospital is not
“woted injuriously). I maintain the present system is not
no. h is net expenri+e for the work dona The ratepayer
lor Mm much cheaper and quite as

efficiently as at the general hospitals. I believe that the
public has not much idea, after all, of how little is the actual
cost for the maintenance of the sick poor. I have before me
now the Local Government Board’s “Return of Expenditure
at the various Metropolitan Infirmaries,* and I find that the
total actual cost per head per week, including salaries, drugs,
stimulants, and, in fact, every expense, is at St. Saviour’s
Infirmary 8s., at St. George’s, Hanover-equare, l.'to., Lam¬
beth 14s. 2d., Kensington 14». 2d., and at St. Marylebone,
which is admittedly, if I may use the expression, an ex¬
travagant infirmary, 15s. 10tf. ’ I have no means at hand of
knowing myself the cost per head in the general hospitals,
but I should imagine in most cases it much exceeds this.
The reasou why St. Saviour’s i9 so low is that most of the
labour is done by pauper help, and that there are many
inmates who by rights should not be in the infirmary
proper, but rather in tbe infirm wards of the workhouses.

Tne second objection of Dr. Goodhart I would reserve for
the moment, simply remarking that from the point of view
of the rutepayer, or of the sick actually in the infirmary,
“ doing harm to the hospitals ” does not ‘concern them.

Thirdly, that they necessarily do injustice to the patients,
especially in surgical cases, I emphatically deny. If there
is one branch of practice in which we have had the most
satisfactory results, it is in surgery. I have not had leisure,
for various reasons, daring the last few year*, nor have I
time just at present, to publish my surgical statistics; but I
hope to be able to do so at no distant date, and the results
will be found to bear very favourable comparison with
those of any general hospital. One would imagine that all
surgical Bkill and knowledge is monopolised by hospital
staffs! 1 don’t believe it. I could tell more strange

stories from personal experience of patients who
have come under my care from general hospitals. One
perhaps I may be permitted to quote. An old man
who had fallen heavily on his side was carried to a certain
hospital, complaining principally of pain in the left knee.
For this the knee was carefully strapped and bandaged, and
tbe patient sent home. The next day he was admitted here,
when I found the knee absolutely uninjured, but there was
a comminuted fracture of the left hip, with extensive
bruising of the soft parts. On his death, a few days after¬
wards, from the effects of chronic bronchitis and severe fog,
the diagnosis was fully verified at a necropsy, and the head
and neck of the femur were found broken into four pieces!
To anyone who has a bent foreurgery, with a fair surgical
education, it is absurd to suppose that he is not quite
capable of undertaking any ordinary surgical operation.
As for very rare or special cases, we seldom see them; these
are too readily snatched up at hospitals; but, when we do
come across such a one, some of us are quite able to under¬
take it, with, perhaps, some little extra assistancein the form
of advice and opinion, which I have never found any difficulty
in obtaining, even from some of the most eminent surgeons.

Surgical appliances are admittedly very expensive. Some
certainly are, but I will not admit that they are always
necessary, certainly not as a rule in parish infirmaries. I
am often astonished, on visiting hospitals, to see the amount
and quality of the dressings and appliances used. No wonder
that under such conditions surgery is expensive and hos¬
pitals poor. Gauze dressings, gauze bandages, strapping,
complicated splints, expensive drugs and appliances, are
used with a reckless disregard to cost which is appalling to
an onlooker. I can get quite as good results with some
marine lint, a little Gamgee tissue, a very few layers of
gauze, an ordinary calico bandage, and such cheap drugs as
terebene, carbolic acid, iodine water, corrosive sublimate,
and such-like. I have been answered by hospital surgeons:
“Oh, yes, it is all very well for you, with healthy wards not.
crowded with surgical oases, to use simple appliances and
dressings; but wo cannot, with our surroundings.” Well, this
may be so, but I doubt it.

Dr. Goodhart says that the advanced surgery of the pre¬
sent day should always be a matter of free consultation. I
entirely agree with him. I have always maintained that a
patient has an absolute claim to it. I should like to ask
him, however, how often amongst his surgical colleagues
does this free consultation ever take place. When I was
at the hospital I should say almost never, or "hardly ever.”
Look, on the other hand, at St. Bartholomew’s, where there
is a regular consultation of the staff once a week openly in
the theatre. Could one find a proceeding more conducive
to the welfare of patients and to the interest of the students ?
—not only to the benefit of the students from hearing the

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396 The Lancet]

MEDICAL CORONERSHIPS.—“EPIDEMIC DIARRHtEA.”

[Feb. 19,1887.

various opinions expressed, but also in acquiring a notion of
the forms and etiquette of consultation, a knowledge which
cannot but be of great advantage in after-life. Again, on
operation days at Guy’s some jears ago, one always saw
two or three at least of the surgeons in the operating-room,
assisting, at any rate, by their presence. Students liked to
see them; it showed an interest in the hospital, it helped to
develop an esprit de corps in one’s alma mater. I
remember how glad and proud one used to feel to be able to
point out to strangers coming to operations, That is Mr. A.,
who wrote such-and-such a book, a great man on so-and-so;
or, That is Mr. B., a very clever man—splendid fellow; why,
he actually removed a kidney ! And one felt a glow of
pride in thinking what wonderful men our hospital
possessed! Now, I regret to see that much of this has
changed. The surgeon who is operating is generally without
a colleague present; one may occasionally drop in apparently
accidentally, look over the operator's shoulder, and walk
out. Or operations are going on in three or four wards at
once, and one never knows where any operation on the list
ds likely to be performed. This, I urge, is not just to the
students, all of whom have a sort of pre-emptive right to
an opportunity of seeing every operation, except of
course those in which the patient might suffer from his
presence, and it is, I am sure, a real grievance. As a matter
of fact, the patients here have the advantage always of two '
opinions, and in very critical or doubtful cases one fre¬
quently calls for other advice in the persons of various con¬
sultants, whom I have always found most kind and willing
with advice, and to many of whom I am much indebted.
The proposition of having a consultant staff is more par¬
ticularly because, as far as the medical officers are con¬
cerned, we feel we should not be dependent on the courteous
kindness and gratuitous services of eminent medical
men. It is only just and right that they Bhould receive
some fee, and that the pernicious system of continually
enlarging the sphere of unpaid medical services should be
avoided. Undoubtedly, there is a great deal of work in
these infirmaries, and an increase in the medical staff is de¬
sirable. It must be remembered, however, that although
we have a great number of cases, many of a serious nature,
involving much time and attention, there is a large propor¬
tion of trivial ones, trivial at least as far as actual work in
treatment goes, although perhaps not so in respect of patho¬
logical interest. A large proportion of our cases consists of
chronic ulcers, chronic bronchitis, chronic gout, chronic
rheumatoid arthritis, forms of paralysis in old people, and
bedridden cases from senile decay. All these do not entail
a large expenditure of time, so that to say that we have
large general hospitals is not exactly correct. Two resident
medical officers (and in every infirmary there are now two),
not engaged in other practice and devoting their whole time
to the duties, can get through a great deal of work.

I am afraid that I have already trespassed too much on
your space, and will leave the questions as to the utilisation
of these infirmaries for clinical studies, as to their proposed
affiliation to the general hospitals, and as to the merits and
•demerits of the present system, to another letter, should you
be willing to accord me space at a future opportunity.

I am Sirs, your obedient servant,

Charles Gross, M.D. Lond., F.R.C.S. Eng.

St. Saviour 1 * Union Infirmary, Walworth, Feb. 15th, 1887.

*** We have received several other letters on the above
eubject, for which, however, we cannot find room, this
week.— Ed. L. ___

MEDICAL CORONERSHIPS.

To the Editors of The Lancet.

Sirs,—W ill yon allow me to make a few remarks in refer¬
ence to this subject, as suggested by Dr. Macdonald’s letter
which appeared in your issueof last week. Having been acan-
didate for the last appointment, until promised the deputy-
ebip by Mr. R. Collier should be have proved successful, he
having held that post for ten years, and having on that
promise withdrawn my name from the contest, and now
being a candidate and having issued my addroes in your
columns, my remarks may be pardoned on the eubject. I
quite agree with Dr. Macdonald that the medical and not
the legal profession are the proper persons to act as coroners.
Dr. Macdonald may not be aware of one clause which now
stands in the new Coroners Act, and which I believe has
passed the second reading, to the effect that the appointment

of coroner should be only eligible to barristers or solicitors.
Surely this clause has crept in unchallenged. I have seen no
allusion to it at all, and therefore draw attention to it. The
legal profession are so inundated with appointments that
they can well give up their absolute claim to such a post.
1 quite agree with Dr. Macdonald, that the coroner should,
if possible, combine a medical and legal knowledge. Having
graduated both in law and medicine, I felt that 1 had
pnusual demands for such an appointment. As to the elec¬
tion, I think that it should rest with the Middlesex magis¬
trates, and not with, as has proved to be the case, members
of the Odd Fellows, Foresters, and Druids, because they
were members of these respective halls, which were in the
eastern division of Middlesex; and also with boatmen,
who, mooring their boats on the foreshore of the Thames,
claimed a privilege to vote. Such farcical nonsense ought
surely to be put a stop to, and Borne Act of Parliament passed
to legislate in these matters.

I am, Sirs, your obedient servant,

Feb. 15th, 18S7. L. FORBES WIN8LOW, D.C.L. Oxon.

“EPIDEMIC D1ARRHCEA."

To the Editors of The Lancet.

Sirs, —We also have been visited- in this neighbourhood
(St. James’s) with an epidemic of diarrhoea—“winter
cholera,” as the people call it. The attacks come on with
great suddenness, often after the evening meal, and, in
most of the cases I see, the symptoms become aggravated
at night after the patient goes to bed. Severe pain is, as a
rule, a prominent symptom, but 1 have seen more than one
case in which, whilst the intestinal catarrh has been profuse,
there has been no pain from first to last. I am disposed to
attribute the outbreak to atmospheric influences solely.

I am, Sirs, your obedient servant,

Piccadilly, Feb. 15th, 1887. _ T. BROWNE 0’CONNOB.

To the Editors of The Lancet.

Sirs, —Within the past fortnight several cases of diar¬
rhoea have occurred in my practice in this neighbourhood
(Bayswater, W.). Some of the cases have been of extreme
severity. The symptoms in all were: pain of a griping
character, referred to the region of the umbilicus; frequent
diarrhoea of, at first, bilious matter, subsequently becoming
of a watery nature ; vomiting, thirst, loss of appetite, and
general prostration. In one case the symptoms were much
aggravated, having, in addition to those above, cramps iu
the muscles of the abdomen and lower extremities, pulse
small, weak, and frequent, almost complete suppression of
urine, sunken eyes, and general depression of strength. The
attacks lasted from three to six or seven days, and recovered
ander appropriate treatment. As other districts were
affected in a similar manner, perhaps atmospheric influences
and water-supply have had a good deal to do with this (at
this season of the year) unexpected visitation.

I am. Sirs, yours faithfully,

Pembrldge-garden*, W., Feb. 15th, 1887. JOHN WHEELER, M.D.

* # * On the above subject Dr. Shirtliff of Kingston-on-
Thames also sends a communication, in which he mentions
cases that have occurred in his district exhibiting symptoms
similar to those described above, and expresses the opinion
that the disease is attributable to cold.—E d. L.

THE UNIVERSITY OF EDINBURGH.

To the Editors of The Lancet.

Sirs, — I have read in The Lancet of the 12th inst. Pro¬
fessor Rutherford’s letter of the 9th inst. I am exceedingly
reluctant to enter upon any correspondence in reference to
the attack made upon me by Professor Rutherford, more
especially after the remarks made by him to his class on
the 28th ult-. In the course of these he is reported to have
said that the time would come when all the facts of the
case would be known, and until that time he asked his
students to suspend their judgment. I looked upon this
statement as an intimation by Professor Rutherford that
an inquiry will be made by the Senatus Academicus, or by
the University Court, into the whole matter. I can only
say that I shall hail such an inquiry with much satis¬
faction, more especially after what Professor Rutherford

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y y ^

Thb Lancet, - ]

NORTHERN COUNTIES NOTES.—EDINBURGH.

[Fbb. 19, 1887. 397

has said and written since his letter of apology was
given to me. As regards Professor Rutherford's letter of
the 9th inst. to Thb Lancbt, I think it only necessary for
me to send yon, as 1 do, a copy of his letter of apology to
me of the 17th ult, which speaks for itself. I shall merely
farther add that immediately after the incident of the 11th
of December last, I put the matter into the hands of my soli¬
citors in order that they might take what proceedings they
thought necessary for my complete vindication, and that
the conclusion of the correspondence with Professor Ruther¬
ford’s solicitors was that, after consultation by him with
his solicitors and counsel, this letter of apology, written
by Professor Rutherford’s own hand, was received by me.

I am. Sirs, your obedient servant,

Edinburgh, Feb. 16th. 1887. HERBERT H. ASHDOWN.

THE PRESENCE OF BLOOD IN THE PERI¬
TONEUM.

To the Editors of Thb Lancet.

Sirs, —1 am amazed that Dr. Hunter should be so ignorant
of the facts of the surgery and pathology of the human
peritoneum—he a graduate of the University in the city
where Keith lives. He seems to have squirted blood of
various kinds and from various sources, foreign and domestic,
into the peritoneal cavities of dogs and guinea-pigs without
ill results. We, on the contrary, cannot even allow a small
quantity of a woman’s own blood to remain in her abdomen!
without fear of trouble; so, following Keith, we clear it out
by sponging, washing, and the drainage-tube, with every
possible care we can exercise. Then we get good results;
and Dr. Hunter ventures to say I have not adduced facts in
support of these views. 1 have been doing as much as I
can in this direction for the last twelve years. It is in the
human subject, and in that only, that we must look for
guiding facts for human surgery. We have been led astray
too far and too long by experiments on dogs and guinea-
pigs. I am, Sirs, yours &c.,

Birmingham, Feb. 12 th. 1887. Lawson Tait.

“DR. BRUNTON AND HOMCEOPATHY”

To the Editors of The Lancet.

Sms,—In the preface to the third edition of my Pharma¬
cology I have discussed various criticisms of earlier editions,
and nave also expressed my opinions regarding homoeopathy.
As the book will be out in a few days, I think it unnecessary
to occupy your columns with extracts from the preface.

I am, Sirs, your obedient servant,

Welbeck-ctreet, W., Feb. 14th, 1887. T. LAUDER BrTTNTON.

NORTHERN COUNTIES NOTES.

{From our ovm Correspondent.)

1HB NEWCASTLE DISPENSARY.

Thb annual meeting of this old institution has been held,
and it has presented its 109th annual report, which shows
that the number of letter patients showed a decrease of 826
as compared with the previous year. There was, however,
an incmaee of 2722 in the number of casual patients, and
this was the largest namber of patients of this class admitted
in any one year. The medical report showed that 6201
patients had been admitted by letter, while the total number
treated had been 22,936. The medical officer (Dr. Beatley)
suggested a closer inquiry into the circumstances of patients
by donors of letters of recommendation. The increase of
patients was in a great measure due to the adoption
of a charge in these cases at the Newcastle Infirmary, which
had caused an unusual influx at the Dispensary. This gave
rise to some remarks from the chairman, Mr. R. H. Holmes,
who suggested that it would perhaps become necessary to
appoint an officer to make inquiries into these cases. The
financial statement was satisfactory. A vo'e of thanks was
given to the medical staff, and the chairman especially
referred to the loss the institution was about to sustain in
the services of Dr. Beatley, who is retiring to commence
practice in this city.

thb chest hospital.

The annual meeting of the Chest Hospital has also been
held here. The r eport showed that 596 patients in all had

been treated during the year. An increase over the previous
year. This institution is doing as much good as possible
within its limited means, but if it is to move with the times
and keep pace with the other charities of the city it must
throw itself on the public, and at once abolish the “ letter ”
system with which it has been hampered sinoe its birth.

GATESHEAD DI8PEN8ARY.

At the annual meeting of the Gateshead Dispensary just
held the medical report showed that the number of patients
treated during the year by letter had been 2733; of this
number 995 were treated at the hospital and 1738 at their
own homes. The total number of patients treated daring
the year was 13,265, against 12,974 in 1865. The town,
it was mentioned, had been wonderfully free from infectious
diseases during the past year. The financial statement was
satisfactory; there had been an excess of income over
expenditure of £166. The chairman, the Rev. Moore Ede,
said he believed the time was come when the provident
system should be tried side by side with the obaritable
elements in dispensary management. This brought up Dr.
Green, a practitioner in the town, who pointed oat that at
least one-half of the medical men in Gateshead took patients
already on the provident system, a system under WDich, in
the form of a club they paid 3d. per week. He (Dr. Green)
protested against what was called “ the provident system ”
becoming introduced in connexion with charities, which he
ooutended had their endowments for charity alone. At the
suggestion of Dr. Newcombe a committee was appointed in
connexion with the dispensary to consider the question of
having nurses on its staff in order to attend on patients
requiring their aid.

ins match poisoning craze.

Dr. Philipson, in submitting the last annual report of the
infirmary, referred to “a remarkable feature in the social
history of Newcastle”—namely, the so-called “match-poison¬
ing craze” which has characterised the past year, nine cases
of poisoning by phosphorus from a solution of match heads
having been admitted into the infirmary, all of which reco¬
vered, but after suffering intensely. I may state, in con¬
nexion with this “ craze,” that many cases ended fatally in
this city, and in its vicinity the mania had a very rapid
“run,” so to speak, cases lor some time being reported
weekly. Happily it now seems to have died out.

Newca*tle-on-Tyne, Feb. 14th.

EDINBURGH.

{From our ovm Correspondent .)

the new university buildings.

Last Monday the Chancellor of the Exchequer had an
interview with a deputation from the University, consisting
of the Principal, the Chairman of the Buildings Committee,
and several noblemen and gentlemen, in reference to a
proposed grant of £12,000 from Government for the com¬
pletion of the new medical buildings. Owing to the
munificence of a private donor, the University has already
at its disposal a sum of money considered adeqnate to
complete the graduation hall and the tower, but as yet no
provision has been made for the purchase of the site on which
these parts of the original plan of the building are to be
erected. In addressing Mr. Goschen, 8ir W. Muir and Sir W.
Turner laid stress upon the fact that but for lack of means
to purchase the site the buildings themselves would already
be in course of erection, and urged the desirableness of a
Government gTant to aid in the completion of works of such
national importance. It is feared that the reply of the
right honourable gentleman does not indicate any immediate
intention on the part of the Treasury to accede to this
request, for, while expressing his regard for the interests
of the University, Mr. Goschen hinted that there were
difficulties of a serious nsture in the way of making the
grant, chiefly in regard to other claims likely to be strongly
represented should the present action give a precedent for
such demands. At the same time, he promised that the
subject should receive his best consideration; and with this
ray of consolation the deputation withdrew. There seems
to be a possibility that a much smaller grant than that
asked for may be given, on the condition that the remainder
of the sum required shall be forthcoming from other sources.

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398 The Lancet,]

DUBLIN.—ROME.

[Feb. 19,1887.

In any case, the University -authorities deserve high com¬
mendation for their energetic efforts. The building, which
is a remarkably beautiful piece of architecture, still lacks
the balanoe which a whole additional wing would give it,
and in the internal economy of the University the absence
of any hall for academic ceremonials is constantly felt to be
a pressing want. Now that. interest is so thoroughly
awakened in the matter, one may fairly hope that at an
early date this want will be satisfied.

SC ABLET FEVEB IN EDINBURGH.

For some weeks scarlet fever has been present in Edin¬
burgh in an epidemic form. All parts of the city and all
classes of the community seem equally affected, and the
City Fever Hospital is crowded with patients of all ages
and conditions, for since it lias ceased to be a purely charit¬
able institution, but has been supported by borough rates,
it has been much more largely made use of by patients of
the upper classes, greatly to the benefit of the public health.
At present there are 202 patients in hospital, of whom 160
are suffering from scarlet fever. Thera is considerable dis¬
cussion as to the cause of the outbreak. The city medical
authorities have not ah yet published any special recom¬
mendations on the avoidance of infection beyond the direc¬
tions as to procedure in cases of infeotious disease, of which
a most useful code has been in the hands of the public for
some years. They are, however, very alert in the visitation
and isolation of snspeoted cases, having a most complete
stem for carrying this out. Failing any special order on
e subject from the authorities, Dr. Foulis has written to
the local papers recommending that jdl milk received for
domestic consumption should be boiled for five minutes
before it is used, and that the vessels containing it should
be scalded thoroughly, with the view of destroying the
specific virus of the disease. He points out that such a
process in no way detracts from the character of the milk as
an article oE diet, while it is calculated to destroy the
germs of most infective diseases. At the meeting of the
Town Council, held on Tuesday, Bailie Russell, M.D., con¬
vener of the Public Health Committee, announced that the
Fever Hospital was filled with patients beyond the limits
of its intended accommodation, and that the Council must
at once undertaxe to furnish additional wards. This was
agreed to, and relegated to the Public Health Committee,
with full powers to act. A large addition has also been
rendered necessary in the nursiDg staff. Up to the present
there has been a daily increase in the extent of the epidemic.

Edinburgh, Feb. 15th._

DUBLIN.

(From our own Correspondent.)

ALLEGED ILL-TREATMENT OF A PATIENT IN MBBCEIt's
HOSPITAL.

In the Green-street Court-house last week, before Mr.
Justice Murphy, Dr. B. Kennedy, resident surgeon of
Mercer’s Hospital, was indicted for having assaulted a
patient named Farrell, in August last. Dr. Kennedy had
been indicted for manslaughter, but the bill had been
thrown out by the grand jury; after some evidence had
been given; the jury were of opinion that the case should
not go on, to which his lordship agreed. He said that
Dr. Kennedy would not have been warranted in leaving a
delirious man among the other patients, for if anything had
happened in consequence he would have been censured.
He could not say from the evidence that he had used
unnecessary violence. The case had been got up against
Dr. Keimedy by witnesses obtained here and there, and
suggestions made by a man who was expelled from the
hospital, but who did not now appear. However, it was
best for the accused that an open investigation in that court
should be held. The jury acquitted Dr. Kennedy, and
appended the following rider to their verdict :—“ We con¬
sider that, according to the evidence. Dr. Ke nnedy should
not have been subjected to the hardship of, a prosecution.”
All must sympathise with Dr. Kennedy in the anxiety,
annoyance, and expense to which he has been so unjustly
subjected.

THOMPSON MEMORIAL HOME, LISBURN.

This institution, founded in 1885 in memory of a dis¬
tinguished surgeon, was established for the admission 'of

patients suffering from incurable diseases. The Home was
founded by the widow, daughter, and son-in-law of the late
Dr. Thompson. 1 may state that the site, grounds, furniture,
and fittings cost .£23,767. The second annual meeting was
held last week, when it was shown that at the close ot 1886
there were thirty-six patients in the Home, while the income
exceeded the expenditure by about £300. To the sum of
£60,000, set apart by the promoters of the charity, Mrs.
Bruce has added £10,000 in memory of her mother (Mrs.
Thompson), and also a sum of £6000 in memory of her
brothers, it is contemplated to admit deserving cases until
the inmates number fifty-five. The memorial is a magnificent
one, considered as the outcome of generosity on the part of
a single family.

CITY OF DUBLIN HOSPITAL.

This morning I had an opportunity of seeing some very
interesting cases at this hospital. A tumour of (he occi¬
pital region with marked head, symptoms, which probably
will require Mr. Wheeler to trephine; and a patient of
the same surgeon with aneurysm, foT which he may be
obliged to ligature the subclavian or arteria innominata. An
obscure tumour (probably malignant disease of the pan¬
creas), under Mr. Henry Fitzgibhon; also under the latter
gentleman’s care a case of a child who some time since
fractured his thigh, and though union has taken place, there
exists a piece of bone the size of a walnut, which freely
moves about, aud yet there is no shortening. There is also
under Mr. H. Gray Croly a case of lumbar colotomy, with
interesting details, this being his ninth successful case. The
same morning Mr. Fitzgibbon operated for external piles,
with Smith’s clamp, knife, and thermo-cautery.

NATIONAL EYE AND BAB INFIRMARY,

The performance of the “Sleeping Beauty,” held last
mouth in aid of the funds of this hospital, ha9 realised a
sum of £62 13*. lid.

KILKENNY TOWN COUNCIL AND ANALYST’S FEES.

At the quarterly meeting of the Town Council last week
a notice of motion that the services of Sir Charles Cameron
be dispensed with was under consideration. The majority
of the Council appeared not to value the services of the
eminent medical officer of health and city analyst for
Dublin; they considered that the local medical practi¬
tioners were sufficiently skilled to uudertake analytical
duties, probably forgetting that a special course of study is
absolutely necessary, and that the salary attached to the
post (£6 per annum) would not defray the interest on the
cost of the necessary instruments. The resolution, how¬
ever, was adopted by eleven votes against three.

Dr. C. Nixon has been appointed a member of the Senate
of the Royal University of Ireland, vice Dr. Lyons, deceased.

Dublin, Feb. 15th. __

HOME.

(From our ovm Correspondent.)

Oite Lady of Snow paid a memorable visit to Rome on
August 6th, a.d. 352, and the miracle—a snow-heap on the
Esquiline, near the market of Livia—caused the reigning
Pope Liberius to erect in her honour the Basilica of Santa
Maria Maggiore, which, says Freeman, “remains to show
what a Christian Church looked like in the days of the first
triumph of the faith.” Hardly less of a miracle m modern
Roman eyes—though certain to have no such august com¬
memoration—has been the two days’ snowfall which has
just given the Eternal City the aspect of a Swiss town in
midwinter and converted the surrounding hills into a bijou
Bernese Oberland. Nonagenarian survivals from last century
can recall no similar portent in the Urbs Septicollis, while
the latest accessions to the English-speaking garrison flock
to every elevated point within or without the walls to enjoy
a panorama as magnificent as it is unique. “Ave Maria ”
tolls from a hundred belfries, but groups of spectators yet
linger on the Loggia of the Pincio, or the esplanade of San
Pietro in Mbntorio, to revel in the solemn sunset, or to draw
from its “mighty missal-page” a lesson or homily not
unbefitting the devotional hour.

Another pbenometion much more familiar, though scarcely
less picturesque, is apt to follow from heavy snowfall on
the Umbro-Sabellian uplands. The Tiber, swollen by the

Go

Tee Lancet,]

MEDICAL NOTES IN PARLIAMENT.—OBITUARY.

LFeb. 19,1887. 399

melted snow, has only to be impeded at its outlet by a
steady west wind, and its regurgitant waters flood the city
and reduce it lor a time to something like Venice. For such
an invasion—the only one that King and Consul, Bmperor
and Pope, have alike failed to repel—experience has pro¬
vided palliatives, if not remedies; and the pontoon service,
patrolling the nooturnal streets with flambeaux, and, in the
Jewa’ quartet* filling with bread the baskets lowered from
second and third storeys for the refection of the isolated
inmates, will add another to the picturesque situations
which somehow never fail the visitor in Rome. Meanwhile,
the health of the city is admirable; hardly a case of fever
has been known for weeks; and if the magnificent weather,
with its skies of azure and its lovely spring sunshine, have
tempted enthusiastic arcbrcologists or artists to outstay
their strength in damp ruins or gusty basilicas, the result
has been oftener seen in catarrhs or mild bronchitic attacks
than in any more serious ailment of the respiratory or
circulatory systems.

Not Rome, but Florence, has this season been the centre
of sanitary interest; and now that the City of Flowers has
been able to clear herself of the imputations directed at her
by non-professional censors, it is again the turn, not of
Rome, but of Umbria and Upper Italy, to attract thq
attention of the hygienist. A trichina scare has just been
averted from Camerino and that populous agricultural
neighbourhood by the prompt intervention of the munici¬
pality. A man suffering from aggravated trichinosis died
in spite of skilled medical treatment, and immediately the
Town Council forwarded an arm of the deceased to Professor
Perroncito, the distinguished helminthologist of Turin, for
examination. The Professor’s report declared that micro¬
scopic inspection revealed extensive inter-fibrillary trichi¬
nosis in the limb; and, acting on this indication, the health
officers of Camerino and district microscopically examined
the wares of the pork-butchers’ shops, and, as a result, re¬
doubled their vigilance at the slaughter-houses for the
supply of such meat. It was proved that, in the fatal case
just mentioned, the pork consumed had been of foreign
importation; and so, in this direction likewise, a strict
surveillance is re imposed on all Bwme-fleah of non-Italian
origin.

A yet severer scourge, for the most part confined to
Northern Italy, has also been the subject of preventive
legislation. The Chamber of Deputies has now below it
the Bill of Signors Grimaldi and Magliani (the Ministers of
Commerce and Finance) for excluding from the alimentation
of the peasant unsound wheat, or rather maize, the nearest
equivalent for the Italian “gran turco.” Such food, the
chief canse of pellagra, will be put out of reach of the poorer
population of the agricultural districts by the establishment
of “ essiccatoi,” or desiccating apparatus, by which the
maize is presented for food only when by evaporation it has
been deprived of all pellagra-causing elements. . Where
communes are unable to provide such “essiccatoi” for
themselves, they are to be aided towards that end by 8tata
subsidies, the aggregate of which shall not exceed 50,000
lire (£2000> annually. This seems a small sum for such an
object when wd consider that the pellagra-stricken com¬
munes in Italy amount to 2453, according to the last reborns
in 1881. .But Signora Grimaldi and Magliani set forth in
their Bill that in some of these communes desiccation of
the maize is effected without special apparatus, and that in
others private enterprise or, benevolence provides such
apparatus gratuitously. There remain of the communes
that require Stale help for the supply of “ essiccatoi" not
more than the subvention will amply cover, an “ essicca-
toio” costing on an average some 2000lire (£80).

Italy, more than any other European country, is lavish of
honours to her great physicians and surgeons. Francesco
Puccinotti, the classic historian of medicine, the translator
of Aretseua, the acuteet intellect ever applied in Italy to
medical jurisprudence, author of memorable treatises on
epidemics peculiar to the nineteenth century, and in all
respects exemplary as a citizen, is about to receive iu the
8anta Grooe of Florence (the Walballa of distinguished
Italians) the tribute of a monument iu bronzed Urbino, his
native town, heads the subecription-li^t with 1000lire (£40),
and the Universities of Pisa and Macerata, with the Institute
of Higher Studies in Florence, are combining to augment
it bjr their own contributions and those of other seats of
learning.,

An impgtfam.additio? WJust been made to sanitary
literature By W. Gidfeppe Pilita . .“J Ripui di Roma, con¬

sidered dal Lato Igienico” (The Regions of Rome considered
in their Hygienic Aspect). l)r. Pinto’s work will be found to
warrant the high expectations formed from his previous con¬
tributions to the same interesting discussion.

Rome, Feb. 12th. __

THE 8ERVIOES.

War Office. — Army Medical Staff: Surgeon-Major
Gough Ashton, M.B., is granted retired pay; Surgeon-Major
Sandford Moore, M.B., is granted retired pay, 'with the
honorary rank of Brigade Surgeon.

Admiralty. — The following appointments have been
madeSurgeon P. E. Maitland, to the Acorn; Surgeon
S. T. O’GrSdy, to the Zion; Surgeon J. J. Walsh, M.B, to
the Vernon, additional; and Patrick J. Sheridan to be Sur¬
geon and Agent at Kilmore.

Yeomanry Cavalry. — Royal East Kent: Honorary
Brigade Surgeon Owen William George, M.IX (late 1st Life
Guards) to be Surgeon.

Artillery Volunteers. —2nd Volunteer (Devonshire)
Brigade, Western Division, Royal Artillery: Frederick Adams
Davaon, M.p., to be Acting Surgeon.

MEDICAL NOTES IN PARLIAMENT.

Army Medical Officers.

In the House of Commons, on the 15th inst., Sir G.
Hunter asked the Secretary for War whether, in the recent
Army Warraut, any alteration had been made in the relative
rank, position, or titles of medical officers to those hereto-*
fore held by them. Mr. E. Stanhope replied that relative
rank has been abolished for all departments; but medical
officers retain all the privileges heretofore attaching to it,
and that in other respects their status is unchanged.

Police and Sanitary Regulations.

Qn the 16th iust,, ou the motion of Mr. Stuart-Wortley,
it was resolved that the Committee of Selection should
appoint a committee, not exceeding nine members, bo whom
should be referred all private Bills promoted by municipal
and other local authorities, by which it was proposed to
create powers relating to police and sanitary regulations
which deviated from, or were in extension of, or were
repugnant to, tlie general law.

Open Spaces.

Leave was given to Sir J. Lubbock to bring in a Bill for
extending certain provisions of the Metropolitan Open
Spaces Act, 1881, with amendments, to urban sanitary
districts throughout England and Wales. The Bill was read
a first time, b

PROFESSOR B&CLARD.

M. Jui.es B£clard, who died somewhat suddenly last
Wednesday, was the son of the celebrated anatomist Pierre
Augustin B6clard. He was bom in 1818. After passing
through his madicai curriculum in Paris, he became house-
physician to the Asylum of Cbarenton, where be remained
tor three years. In 1842 he took the degree of Doctor of
Medicine. His first scientific publication was “ Les Elements
d’Anatomic GtSndrale,” which had been left in manuscript by
his father. Pursuing the same line of study, he published in
1804 the results or his researches on the Cartilaginous
System. These were followed by memoirs on “Muscular
Contraction in its relation to Animal' Temperature,” “On
the Influence of the Temperature upon the Comparative
Development of Organic Systems,” “On the Functions of
the Spleen,” “On the Influence of Light,” and “On the
Development of Animals.” Besides these, M. Bdolard
furnished numerous contributions to the “ Dictionnaire
Encyclopgdique dee Sciences Mddicalea,” and at one
time was a frequent writer in the Gazette Hebdoma¬
dal re. But his principal work was his “ Traits de Physio-
logie Humaine,” which has reached its seventh edition,
having now been for more than thirty years the standard

490 The Lancet,]

OBITUARY.—MEDICAL NEWS.

[Feb. 19,1887.

text-book for French students. At the Uuiversity,
BtSclard obtained his first success in the competition
for the Assistant Professorship ( Agrigation ) of Anatomy
and Physiology, the unsuccessful candidate being the
illustrious Claude Bernard. Two years later, in 1840, being
at the time’ only twenty-eight years of age, he competed
for the chair of Anatomy unsuccessfully, and in 18o2 he
again failed to secure the lectureship on Hygiene. The
concours, or public competition, being afterwards abolished,
B6clard was obliged to wait until the death of Lon get,
whom he succeeded as Professor of Physiology in 1871.
Elected to the Academy of Medicine in 1862, he was at once
named annual secretary, and the remarkable panegyrics
which be pronounced in this capacity designated him in
advance for the functions of perpetual secretary, to which
post he succeeded on the death of M. Dubois. In 1881 he
became Dean of the Faculty of Medicine, after the death of
Professor Vulpian, a dignity which he held at the time of
his death.

Bdclard had studiously abstained from practice, and
devoted all his energies to his duties ns a professor and to
his functions as perpetual secretary of the Academy of
Medicine. When he was nominated Dean of the Faculty
his talents as an administrator became evident, and upon
the expiration of his first term of office its renewal was
claimed by the unanimous vote of all the members of the
Faculty, both professors and agrtgh. His extreme affability,
his impartiality, and his well-known kindness made him
a favourite with all classes, and no Dean was ever more
regretted, both by his colleagues in the professoriate and
the students placed under their tuition. In fact, it may
be said that B6clard had none but friends—a happy fate for
a man of perfect integrity, and who never failed to defend
what he thought to be the right.

Utelriral Ihfos.

Society of Apothecaries.—T he following gentle¬
man passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received a certificate
to practise on the 3rd inst.

Chapman, Robert Hugh, M.B.C.S., Halford-road, Richmond.

Passed on the 10th inst.

Skeldlng, Henry, M.R.C S., M.B., B.C. Camb., Eiuton-sqnare.

Bartholomew, Alfred Adam, Crowle, Doncaster.

A ball was held at the Bristol Lunatic Asylum
on the 9th inst.

The annual ball in aid of the funds of the Liver¬
pool Stanley Hospital was held on the 9th inst.

Dr. W. Sedgwick Saunders, medical officer of
health and public analyst for the City of London, last week
celebrated his silver wedding.

The annual meeting in connexion with the South
Devon and East Cornwall Hospital was held on the 8th inst.,
Sir Massey Lopes presiding.

The Right Hon. G. Sclater-Booth, M.P., has
accepted the Presidentship of the Congress of the Sanitary
Institute of Great Britain, to be held at Bolton in Septem¬
ber next.

Under the will of the late Mrs. Elizabeth Hughes,
the City of Dublin Hospital has received a sum of £997 2». 5 d.
Mr. Alexander Finlay has given £50 to the Belfast Royal
Hospital.

The annual Hospital Sunday collections in aid of
the medical charities of Manchester and Salford were made
on the 14th inst. The Hospital Saturday collection is to be
held on the 19th inst.

Arrangements have been made for holding this
year a Hygienic Exhibition at Warsaw. The exhibition will
be divided into five groups, comprising respectively the
hygiene of food, of dress, of dwellings, of schools, work¬
shops, and hospitals, and, finally, statistics and meteorology.
The opening is fixed for May 15th, the dosing for July 1st.

At the annual general meeting of the governors
of and subscribers to the Nottingham Coppice Hospital on
the 10th inst., satisfactory medical and ftnandal reports were
presented and adopted.

The annual meeting in connexion with the Essex
and Colchester Hospital was held on the 10th inst.

Bradford Infirmary and Dispensary.—T he
sixty-second annual meeting of the governors of this institu¬
tion was held on the 8th inst. The total number of in¬
patients during the past year was 1611, and of out-patients
5330, as compared with 1386 and 6137 respectively in 1886.
The income amounted to £8110, and the expenditure to
about £7842.

Royal General Dispensary.—T he annual meet¬
ing of the governors of this institution was held on the
14th inst, when the report showed that during the past
year 11,050 cases had came under the notice of the medical
officers, 3684 being new cases, and 2178 visits had been made
to 546 patients at their own homes. The statement of
receipts and expenditure was satisfactory, there being a
balance at the bankers of £62.

The thirty-fourth annual meeting of the Man¬
chester and Salford Sanitary Association was held on the
4th inst.

Hospitals Association.—T he third general meet¬
ing of the members of this Association was held on the 16tb
inst., when a paper written by Miss Manson, Matron of St.
Bartholomew's Hospital, entitled “ Is it Desirable for Metro¬
politan Hospitals to possess Nursing Institutions, and to
supply Nurses for Private Cases outside the Hospital
Walls?” was read by Dr. Bedford Fenwick.

Brompton Cancer Hospital.—T he annual meet-
of the governors of this charity was held on the 16th inst.
From the report of the committee, it appears that during
the past year 1028 new patients were received, 652 being
in-patients, and 976 out-patients. The total number of
visits of new and old out-patients was 6276, against 5360
in 1885.

Royal College of Surgeons of England.—
Professor Charles Barrett Lockwood, F.R.C.S., will deliver a
course of three lectures on “ The Development and Transi¬
tion of the Testicle, Normal and Abnormal,” on Wednesday,
Friday, and Monday, Feb. 23rd, 25th, and 28tb, at 4 p.m.
precisely each day. Students desirous of attending these
lectures are admitted on the introduction by a Fellow or
Member of the College.

The Jubilee.—A t a meeting at Chipping Norton
on the 8th inst., it was decided to erect a cottage hospital to
commemorate the Queen's Jubilee. A site of land has been
presented and several subscriptions are already promised. A
suggestion has been made that the Children’s Hospital in
Great Ormond-street be completed by means of a subscrip¬
tion raised among the children of England in celebration of
the Jubilee.

* Guy’s Hospital. —Mr. J. S. Morgan has promised
£10,000 in aid of the funds of this hospital, on condition
that the amount required to put the institution into a state
of thorough efficiency—viz., £100,000—be secured on or
before the 1st day of May next. A grand afternoon concert
in aid of the Special Fund will be given at Willis's Rooms
on the 22ud inst., when Mdlle. Antoinette Trebelli, Madame
Patey, Mr. Edward Lloyd, Mr. Santley, and other distin¬
guished artists will appear.

The Trained Nurses’ Annuity Fund.—T he Com¬
mittee of the Trained Nurses’ Annuity Fund desire to call
the attention of lady superintendents and matrons of
hospitals, infirmaries, &c., to the existence of this fund,
which was founded in 1874, and has been steadily increasing
ever since. At this moment twelve annuities of £15 per
annum have been permanently founded, and above £4000 is
invested in the bands of trustees, the interest of which pays
the annuitants, so that there is no danger of an annuity
failing through lack of funds; but the number of appli¬
cants is daily increasing. It is calculated that there are
now about 10,000 nurses in the United Kingdom. If each
would give Id. a month or Is. a year towards the fund, its
powers of usefulness would rapidly increase. Lady super¬
intendents and ma'rjns would therefore do well to
bring this matter before the nurses on their staff, and to-
lead on behalf of their sisters whose health has broken
own under the fatigue and anxiety of their arduous pro¬
fession. Communications may be addressed to R. Gofton
Salmund, Esq., hon. secretary, 73, Cheapside, London, E.C.;
or to Lady Bloomfield, Shrivenham, Berks.

y Google

The Lancet,] APPOINTMENTS.—VACANCIES.—BIRTHS, MARRIAGES, AND DEATHS. [Feb 19,1887. 401

Deaths from Chloroform.— On the 10th inst. an
inqaefet was held at Sheffield on the body of a woman who
had died from the effects of chloroform, which had been
administered for the performance of an operation. A verdict
of death from syncope was returned. On the 14th inst. an
inquest was held at the Ipswich and East Suffolk Hospital
on the body of a man who bad died at that institution ^hile
under the influence of chloroform. The jury returned a
verdict in accordance with the evidence, and exonerated the
medical man from all blame in the matter.

City of London Lyikg-in Hospital.— The 136th
anm.nl meeting of the governors of this well-known and
deserving charity was held on the 9th inst., when the Com¬
mittee of Management submitted a report statiDg that the
year I860 had in many respects been a satisfactory one.
There had been an increase in the number of both in- and
out-patients, an increase which had been accompanied
by a reduced mortality. The number of in-patients de¬
livered during the year bad been 283 ; 287 children had been
born—viz., 131 boys and 15G girls; 15 children were still¬
born ; 3 women and 5 children bad died. In the out-patient
department 1249 women had been delivered, as against 1118
in 1883. The income for the year from all sources, together
with the balance left over at the end of 1885, was £3166,
while the expenditure amounted to £2925.

Waldo, F. J.. M .A.. M.D Cantab., M.R.C.S., b»s been appointed
Assistant Physician to the Chelsea Hospital for Women.

Whkatly, A. W.. M.B., S. Sc.O. Dur.. M.R.O.S., lia* been appointed
Surgical Registrar and Anaesthetist to the National Orthopedic
Hospital.

Wheaton, S. W.. L.R.C.P.. M.R.C.S.. has been reappointed Resident
House-Physielau to St. Thomas’s Hospital.

Willoughby, Edward F., M.D.Load., M.R.C.S , has been appointed
Chief Medical Officer to the Sanitary Assurance Association, vice
Stevenson, resigned.

Winfield-Roll. G., M.B., B.C. Cantab., L.R.C.P., M.R.C.S., has
lwen appointed Second Ophthalmic Clinical Assistant to St. Thomas's
Hospital.

Daranries.-

In compliance with the desire of numerous subscribers, it has been decided, to
resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. _

Dumfries and Galloway Royal Infirmary. — Assistant House-
Surgeon (qualified or unqualified). Board and washing, but no
salary.

Ecclks and Fatricroft Hospital, near Manchester.— House-Surgeon.
Salary £'10 per annum, with board and rooms.

Royal Pimlico Dispensary. —Medical Officer.

8alford and Pendleton Royal Hospital.— District Surgeon. Salary
£80 per annum, with board and lodging.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. _

Brook. W. F., M.R.O.8., L.8.A.. has been appointed Clinical Assistant
In the Bar Department of St. Thomas’s Hospital.

Brown. C., L.R.O.P., M.R.C.S.. lias been appointed Clinical Assistant in

the Throat Department of St Thomas's Hospital.

Bulrtrode. H. T., L.H.O.P., M.R.O.8.. has been appointed Clinical
Assistant In the Ear Department of St. Tbomaa's Hospital.

Calvert. J. T., L.R.C.P., M.R.C.S., has been appointed Clinical
Assistant in the Skin Department of 8t. Thomas's Hospital.

Clarke, Frsdk. H., M.B., C.M.Hd., has been appointed House-Surgeon
to the Great Yarmouth Hospital.

Davies, E. T.. M.D., C.M.Ed., has been reappointed Assistant 8urgeon
to the Hospital for Women, 8haw-street. Liverpool.

Evans, C. S., M.B.CanUb., M.R.C.S., L.S.A.. has been reappointed
Resident House-Pbvslciao to 8t. Thomas’s Hospital.

FitzGerald. G. G. B.A.. M.B.. B.C.Camb., M.R.C.S., has been
appointed Junior Assistant Medical Officer to Cane-hill Asylum,
Surrey, vice H. Gardiner Hill, promoted.

Hawkins. H. P.. M.R.C.S.. L.S.A., has been appointed Assistant
House-Physician to 8t. Thomas’s Hospital.

Hxnshxlwood, James. M.A.. M.B., C.M., has been appointed House-
Surgeon to the North Riding Infirmary, Middlesbrough-on-Tecs,
rice Fraser, resigned.

Hutton. J. S.. M.B. Lond., L.R.C.P.. M.R.C.S., has been appointed
House-Surgeon to St. Thomas’s Hospital.

Mackvoy. H. J., L.H.C.P., M.R.C.S., has been appointed Resident
Acooocheur to St. Thomas's Hospital.

Montague. A. J. H.. M.B.Dur., L.R.C.P.. M.R.C.S., L.S.A., has been
reappointed Non-resident House-Physician to St. Thomas’s
Hot pital .

O'Brien, P. M., M.R.C.S., has been appointed Resident Medical
Officer to the North London Hospital for Consumption, Hamp-
il^ad.

Pm rTT. Alfred Freeman. M.R.C.S., L.8.A., has been appointed
Medical Officer of Health for the Leyton Urban District, and
8orgeon to the Master Bakers’ Almshouses, vice A. Peskett, M.D.,
doxtMd.

■Phillips, H. Heygate. M.D., L.R.C.S.I., bns been appointed an
Honorary Consulting Surgeon to the Reading Dispensary.

Sannom. H. A.. L.R.C.P.. M.R.C.S., haa been appointed Clinical
Assistant In the Throat Department of St. Thomas’s Hospital.

8KKLDING. H., M.B.. B.A.Camb.. M.R.C.S.. L.8.A.. St. Bartholomew’s
Hospital, has been elected Resident Surgeon to the Bedford
General Infirmary, rice Pynsent 0. Smith, whose term of office
hai expired.

Solly, B.. M.R.C.S., L.S.A.. has been appointed Clinical Assistant in
the Skin Department of St. Thomas’s Hospital.

Sr ABB. B. C.. L.R.C.P.. M.R.C.S., L.8.A., has been appointed Assistant
House-Surgeon to St. Thomas's Hospital.

Exact. J. H. t L.R.C.P., L.B.C.S.Bd.. has been appointed Medical
Officer and Public Vaccinator to the First District of the Henstead
Union. NorfolE. vioe T. W. Richardson, M.R.C.S., L.8.A.. resigned;
■Iso Medical Officer to the Sixth District of the Norwich Union, vice
C. W. Doyle. M.B., resigned.

Statelet, W. H. C., L.B.C.P., M.R.C.S., has been appointed House-
Surgeon to St. Thomas's Hospital.

Stmks. B. West, M.D.Bdin., M R.C.S., has been appointed Medical
Officer to the Halifax Poat Office, vice Solomon 8mtth, M.R.C.S., Ac.,

STMEafcLDlCKiNsoN, M.B.G.8., late Clinical Resident. Bethlem Royal
Hospital, has been appointed Assistant Medical Officer to the
Lanoasbire County Asylum, Bsinhill.

Tohkesg. J. H>, L.R.O.P.. M.B.C.S., has been appointed Assistant
linn— Wrgnnn to St. Thomas’s Hospital.

§irt!js, lltarrraps, anfr $M{is.

BIRTHS.

Bushk. — On the 10th Inst., at Beaufort Lodge. Hounslow, the
wife of Surgeon-Major Cecil Bushe, M.B., Medical Staff, of a son.

Chapman.- On the 11th lost., at Denham House. Goldhawk-rosd, W.,
the wife of C. W. Chapman, L.R.O.P.Lond., M.R.C.S., of a son.

Gairdner.— On the 10th inst., at Gibson-square, N., the wife of John
Galrdner, M.R.C.S.. L.S.A., of a son. _ _

Hbntsch.— On the 11th inst., at l*ortland-place. Camberwell, S.B.,
the wife of John Page Heutscb. M.R.C.S., of a daughter.

Ogilvy. — On the 9th inst., at Bournemouth, the wife of Surgeon-
General Ogilvy. of a son.

Tripp.— On the 6th ult., at Herat, Institution-hill, Singapore, the
wife of C. LI. H. Tripp, M.R.C.S., L.R.O.P.Lond., L.S.A., of a
daughter. _

MARRIAGES.

Berry—Baldwin.— On the 8th inst., at St. Savionr's, Paddington,
F. O. Berry. M.D.. to Charlotte Meers, daughter of the late G. T.
Baldwin. Esq., of Fakenham, Norfolk.

Blancard—Taylor.— On the 9th Inst., at St. George’s Church, Rams¬
gate, by the Rev. O. E. Shirley Woolmer. Vicar of Ramagate.
Surgeon J. T. Blancard, Indian Medical 8taff. to Edith Emma
Mary, younger daughter of Charles Taylor, Bsq., late of Ealing

Bradbchn— OHiLCOT.-^On the 14th inst., at Christ Church, Ealing, W.,
by the Rev. J. 8. Hilliard. M.A.. James Denham Bradbum.
F.R.C.S.Bdln.. eldest son of James Bradbum. Bsq , of Monks’ Hall,
Bccles. Lancashire, to Bmlly Victoria, widow of the late Jas. Chllcot,
M.R.C.S., of Mere. Wilts. . ...

Dyson—Wall. — On the 10th inst., at Stoke Prior Church, by the
Rev. Harcourt Aldham. B.A., Thomas Edward Dyson, M.B.,
to Annie, eldest daughter of the late Wm. Wall, Bsq., of Stoke Prior,
Worcestershire. .

Gostling — Parkinson. — On the 10th inst., at 8t. Marks. West
Hackney, bv the Rev. J. G. Pilkington, M.A., Vicar, William
Avton Gostling. M.D., of Worthing, Sussex, to France* Marion,
only daughter of Mr. G. H. Parkinson, of the Royal Oourta of
Justice, London. ,

Holt— BusTKF.D.-On the 9th inst., at Isleworth, Percy Holt, Army
Medical Staff, to 8arah, only daughter of T. M. Busteed, Bsq.,
B&rrister-at-Law. Indian Judge, retired. _ , _ , .

Stedman—Buckley.— On the 10th Inst., at St. James s, Norlands.
John Buck Stedman. F.R.C.S , to Emma Buckley, widow of the late
John Buckley, Bsq., of Manchester.

DEATHS.

AMDLKR.-On the 6th inst., at Colvlile-square. Bayswater. Vinoent

Brad don. —On the 5th inst.. suddenly, at his residence. Ham Honse.
Upton-on-Sevem, Charles Braddon, M.R.C.S.. aged 71.

Butt.— On Dec. 20th, 1886, at Blenheim, New Zealand, the Venerable
Archdeacon Henry Francis Butt. M.R.C.S., in the 71st year of his

Gibson!— On the 16th inst., at Kirkland. Campbeltown, Argyllshire,
Gregory Gibson, Medical Student, aged 23.

Prentis.—O n the 14th ult.. at Calcutta (on his way to England), Surgeon-
Major Chas. Prentis, Bengal Medical Service, M.B.O.S., F.L.S., Ac.,
late of Gorakhpur, in his 52nd year.

Rider.— On the 10th inst.. John Rider, of Wellington, Shropshire,
M.R.C.S., L.S.A., aged 64. _

H.B.— A fee of Os. is charged for the Insertion of Notices of Births,
Marriages, and Death*.

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402 Tftf, Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Feb. 19,18S7.

HJtirial gtartr for % tnsuing

Monday, February 21,

Royal London Ophthalmic Hospital, MooRfields. — Operation*,

10.30 a.m., and each day at the game hour.

Royal Westminster Ophthalmic Hospital.—O peration*, 1.30 p.m.,
and each day at the same hour.

St. Mark's Hospital —Operation*. 2 p.m. ; Tuesday, 2.30 p.m.
Ohklsra Hospital for Women.—O peration*, 2.30 p.m ; Thursday,2.30.
Hospital for Women, Soho-squakk. — Operations, 2 p.m., and on
Thursday at the lame hour. .

Metropolitan Free Hospital.—O peration*, 2 p.m.

Royal Ortkop.edic Hospital.—O peration*, 2 p.m.

Central London Ophthalmic Hospitals.—O peration*, 2 p.m., and
each day in the week at the same hour.

Medical Society on London.— 3.30 p.m. Mr. E. Milner: On the
Different Modes of Administering Mercury in Syphilis, and the
Indication* for their Application.

Society of Arts.—8 p.m. Mr. W. Y. Dent: Building Material* (Cantor
Lecture).

Tuesday, February 22.

Gut’s Hospital.—O peration*. 1.30 p.m. and on Friday at the same hour.

Ophthalmic Operation* cn Monday at 1.30 and Thursday at 2 p.m.
St. Thomas’s Hospital.—O phthalmic Operations, 4 p.m. ; Friday, 2 p.m.
Cancer Hospital, Brompton.—O perations,2.30 p.m.; Saturday,2.30 p.m.
Westminster Hospital.—O perations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

St. Mart’s Hospital.—O perations, 1.30 p.m. Consultations, Monday,

1.30 p.m. Skiu Department, Monday and Thursday, 9.30 a.m.
Royal Institution of Great Britain.—3 p.m. Prof. Arthur Garagee:

The Function of Respiration.

Society of Arts.—8 p.m. Mr. J. Starkle Gardner : Wrought Ironwork.
Anthropological I vstitute of Great Britain and I reland.—8 JO p.m.
Prof. Ferrier: The Functional Topography of the Brain.—Mr. H. D.
Rolleston: Description of the Cerebral Hemispheres of an Adult
Australian Male.—Mr. Suren Hansen: On a Fossil Human Skull
from Lagoa Santa, Brazil.

Royal Medical and Ciiirurgioal Society.— 8.30 p.m. Mr. Henry
Morris: A case in which the Urinary Bladder was twice Ruptured,
the first time by an Injury, the second time—seven year* after the
first—by the giving way of the Cicatrix.—Mr. W. H. Bennett: A case
of Extra-peritoneal Rupture of the Urinary Bladder, the Direct
Result of Aspiration above the Pubee, with Remark* on Some
Objections to the Use of the Aspirator as a Mean* of Evacuating the
Bladder, and Suggestion* for tho Treatment of certain case* of
Retention of Urine.

Wednesday, February 23.

National Orthop.edic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O peration*, 1 p.m.

St. Bartholomew's Hospital —Operations, 1.30 p.m. ; Saturday, same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgical Consultations,. Thursday. 1.30 p.m.

St. Thomas’s Hospital.—O perations, 1.30 p.m.; Saturday, same hour.
London Hospital.—O perations, 2 p.m.; Thursday* Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital for Women and Children.—O peration*.

2.30 p.m.

University College Hospital.—O peration*. 2 p.m. ; Saturday, a p.m.

Skin Department, 1.45 p.m. ; Saturday. 9.16 a.m.

Royal Free Hospital.—O perations, 2 p.m., and on Saturday.

Kino’s College Hospital.—O perations, 3 to 4 p.m. ; Friday. 2 p.m. ;
Saturday. 1 p.m.

Children's Hospital. Great Ormond-ntrbkt. —Operation*, 9 a.m.;
Saturday, same hour.

Society of Art9.—8 p.m. Mr. JohnW. Urquhart: Rooent Advance*
in Sewing Machinery.

Hunterian Society.—8 p.m. Dr. Searth i A Review of Forty Cases of
Diphtheria, illustrating its Manner of Spreading, and it* 'Relations
to other Fevers, to Diathesis, and to Neurotic and Paralytic Con¬
ditions.

British Gynecological Society.—8.30 p.m. Specimen* will be shown.
Adjourned Discussion on Dr. Fitzgerald's paper on the Use and Abuse
of Pessaries. Council at 8 P.M.

Neurological Society of London.—8.30 p.m. Exhibition of Clinical
Case*.

Thursday, February 24.

8t. George’s Hospital.—O perations, 1 p.m. Ophthalmic Operations,
Friday. 1.30 p.m.

Charlnihcross Hospital.—O perations. 2 p.m.

North-West London Hospital.—O perations, 2.30 p.m.

Royal Institution op Great Britain.—3 p.m. Mr. Edmund Goese :
The Critics of the Age of Anne.

Friday, February 25.

Royal South London Ophthalmic Hospital.—O perations, 2 p.m.
Society of Arts.—8 p.m. Mr. Holt S. Hallett: New Market* aDd
Extension of Railway* in India and Burmah.

Qubkktt Microscopical Club.—8 p.m. Annual General Meeting
for Election of Officers. President's Address.

Clinical Society of London.-8.39 p.m. Dr. Hughlings .Tack»on: A case
of Paralysis of Left Leg from Subcortical Disease.—Dr. Carrington :
A case of Rheumatic Hyperpyrexia treated by the Cold Bath.—
Dr. Hadden: Acaseof Epilepsy following an Injury to the Leg.—Mr.
Bowlby: Cases of Profuse Hematuria in connexion with Granular
, Kidney. Living Specimens: Dr. Arthur Davies: Two cases of
Myxtcdoma (male and female).

Royal Institution of Great Britain.—9 p.m. Captain W. de W.
Abney: Sunlight Colours.

Saturday, February 28.

Middlesex Hospital.—O perations, 2 p.m.

Royal Institution or Great Britain _3 p.jf. The Bight Ron.

Lord Rayleigh: Sound.

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.m. by Steward's Instruments)

The Lancet Office, February 17th, 1887.

DaM.

Barometer
red new to
Sea Level
and ST’F.

Direc¬

tion

of

Wind.

Bulb.

Wet

Bulb.

Solar

Radio

In

Voruo.

Max.

Temp.

Shade.

Min.

Tamp

Rain

tall.

Rmurta at

8J0aj«.

Feb. 11

30-38

B.

35

33

41

31

Overcast

.. 12

30-47

N.B.

36

36

45

35

Cloudy

.. 13

3048

N.E.

33

36

42

34

Cloudy

.. 14

30-25

N.K.

35

34

41

33

Overcast

III

303 i

E.

39

39

41

35

Overcast

16

30-46

B.

30

42

27

.. IT

30-44

S.W.

26

21

foggy

ftoics, jl|rort Comments, # ^nsfars to
Corasjjoit&rnts.

It is especially requested that early intelligence of local events
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
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Lectures, original articles, and reports should be written on
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Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
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We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
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We cannot undertake to return MSS. not used.

Thk Effects of Alcohol.

A. G .—It is not possible to state with arithmetical precision the pro¬
portion of disease* due to alcohol. It is certainly very large. Medical
opinion on the diseases dne to aloohol is to be gathered from variona
quarter*, rather than from any one book. The views of many eminent
medical man may be found in the evidence taken on the subject by
the Committee of the Home of Lord* in 1878-9. There 1* a pre¬
ponderating amount of medical opinion to the effect that all but a
very moderate amount of alcohol to the majority of people i» injurious.
Will Medina (Salford) kindly forward hi* card, a* the one sent haa
been mislaid.

NIGHTMARE.

To the Editors of The Lancet.

Sirs,—I should bo much obliged to any confrere who would kindly
advise mo what to do for nightmare, greatly affecting sleep and
proper rest. I hare no sensation of fright, bat wake up after distressing
dream*, with disturbed heart'* action, flushed face, &c. The amount of
nightly disturbance varies; but the shortest interval between falling
asleep, dreaming a long dream, and waking baa been as little as five
minute*. No particular symptom* referable to any apodal organ its
fault. Proximate cause probably due to liver disturbance. I am fifty
years of age, and have some lung tronble of five or six years' standing,
now quite chronic, and limited to slight expectoration and occasional
slight hemoptysis. I am, Sir*, your* faithfully,

February 16th, 1867. M.D.

One Reason for an Urgent Call into the Country.

A French practitioner received a call one afternoon, about fire o’clock,
from one of hi* country patients, a farmer who had been in town at
market all day, who requested him to drive over at once to see a
member of hi* family. The aase not appearing to be urgent, the
doctor replied he would go in the morning. “ Oh, that will not do at
all," said the farmer. “ I ask you to go now because I want a lift
home, and to hire a trap will cost more than your visit.”

Dr. Reihlen (Stuttgart).—We cannot exchange.

COLORADO.

To the Editors of The Lancet.

8irs,— 1 would feel thankful if some of your numerou* correspondents
would give me their experience of the climate of Colorado for con¬
sumptive*, and also their opinion of it* relative advantages a* compared
with other climate*. I am, Sire, yours truly,

Feb. 14tb, 1887. ▲ Physigxak.

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NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Fra. 19,1887. 403

Hut Holidays.

Wl extract the following paragraph from the A'ei o York Medical Record
of Feb. 5th:—“ In Switzerland and tome parts of Germany the law
provide* that all schools, public or private, must give the scholars a
holiday whenever the temperature reaches a certain height. The
regulations in Basle are that when the temperature reaches 77° F. in
the shade by 10 A.Jf. the school most be dosed until the late afternoon.
These beat holidays are very popular among the scholars."

Dr. That. Reid. —The R.C.P.Bdln. does not pretend that its licence is
s qualification in surgery as well as physio, as the London College has
always maintained Is the case with its licenoe, and as the public
bodies have recognised. This statement virtually answers all our cor¬
respondent's other questions.

MM.—Tbo statements contained in the extract from the “chatty letter”
in so completely at variance with the results of our own inquiries
that we cannot undertake to publish It without more precise and
detailed Information.

We hare received from Messrs. Ellis and Steele, hon. secretaries of the
Association of Members of the Boyal College of Surgeons, a communi¬
cation for which we regret we are unable to find space this week.

••DROWSINESS ACCOMPANYING DYSPEPSIA.” .

To the Editors of The Lancet.

Sus,—Drowsiness accompanying digestive troubles Is very common;
tx* I think yoor correspondent, “ L.B.G.P.Lond., M.R.C. 8 .,” will find
it most extreme in cases resembling the following-.—The patient is
mxuic and irritable, troubled with palpitation, and sensation of fatness
after meals caused by flatus. Bowels may be constipated or not. Used
a sedentary life. The principal points, however, to be looked to are
the teeth and urine; the former are bad, and the Utter scarcely add,
or else alkaline, and often phosphatlc. Alkalinity or deficient aoldity is 1
probably present in the stomach, and germs from the teeth swallowed
to Uu* saliva. In the stomach, as a rule, the trouble oommenoes; hence
the distension and, from pneumogastrio irritation, the palpitation.
Pcpnneean only act In an add medium, and so the food undergoes some
s t eonaa l decomposition, with the production of gas, instead of normal
digetiion. It is not difficult to imagine that the products of such
chaages. taken up and passing through the liver into the general circu¬
lation, would produce toxic symptoms. The brain, already badly
nourished and amende, cannot work with blood deficient In oxygen-
carrying corpuscles and loaded with morbid products as well. It there¬
fore ** sleeps,” distorted, however, by fitful dreams as more or less
irritating matter is (applied to it.

What should be the treatment of such a condition ? Simply supply
what is deficient. If there be oonstipatlon, a mild aperient—say, ext.
ctscar. sag., gr.lii., o. m. ante cib. Attend to the teeth. For the
alkalinity and palpitation the following.—Q. Acldi hydroch. dll., m. xv.;
tr. nuds vom., m.x.; tr. calumbae, m.xv.; aquam ad Jl; ter die post
dbos, with or without anocus taraxaci, 3 !., or vin. pepsin., 3 I., as required.
Limit smoking. 8 top all tea, coffee, oocoa, and hot fluids. Let the
patient drink oold water for breakfast, light ale, claret, or water at
dinner—say, at 2.30—and a light sapper at 8 p.m„ with the same drink,
and no fluid between meals. Nearly finish every meal before drinking.
Advise friction with a towel over the abdomen, snfflcient ent-door
n ue ks, and early bed. I am, Sirs, yours faithfully,

Feb. 14th, 1887. F. T. S.

•' Passing Rich on £40 a Year.”

Tax guardians of a Norfolk union advertise for a district medical officer
for ten parishes at a stipend of £40 a year, with extras, he to supply all
medicines.— Local paper.]

The country parson who, in olden days.

Formed the choloe subject of a poet’s praise
Spent a calm life of usefulness and cheer.

And thought him “passing rich on £40 a year."

Now Poor-law surgeons, rich In physio's lore.

Per arduous work in places half a score,

All drugs supply, the slek poor's Ills allay.

And £40 a year's the bounteous pay.

The parson lived In frugal days of old ;

His wants were few, hence scant wss then his gold.

Not so the doctor of the present day :

His wants are many, small howe'er his pay.

Eastern Daily Press.

A QUERY.

To Vie Editors of The Lancet.

Sirs.—I have had twenty year* of grilling In India, and am now on
ay way borne, with the intention of spending a year or two there. I
tear the cold of the borne winter unlees I can get some sheltered spot by
the sea, wherein to peas the oold season under favourable circumstances.

I do not care whether the time be pessed in England or Ireland, if I can
only be sore of a mild and tolerably equable temperature by the tea.

I shell feel much obliged if some of your readers will favour me with advioe
as to tin beet plaoe to go to which shall fulfil the foregoing conditions
sad be tolerably cheap. I am, Sirs, yours faithfully,

Febr uar y, 1887. ].

A Roman Skeleton sound at Plumstead.

A short time since a most interesting discovery was made by some
workmen In a field at Plumstead of a leaden coffin containing a
skeleton. Various persons, more or less learned in antiquarian
matters, all coincided In placing the date of the leaden coffin about
lfiOO years ago, and as being probably of Roman workmanship. The
owner of the ground promised to give the remains to a medical man
for a museum, but was unable to carry out his intention, as the Vicar
of Plumstead had the relies buried privately In the parochial ohurch-
yard. and now refuses to reveal their present position. This action of
the vicar was discussed at first in a tone of banter, and afterward*
with more seriousness, at the last meeting of the Society of Antiquaries.
The remains had fortunately been sketched by Dr. Gaw, assistant
medical officer of the Plumstead Infirmary. It is, however, to be
feared that unless the vicar should see fit to relent, or the Home
Secretary to order exhumation, these Interesting relics will be entirely
lost to science.

H .—A note on Saccharine appeared in onr Issue of Deo. 18th last,
page 1193 ; one on Antlfebrlne In The Lancet for Sept. 4th, page 462.
and another on Oct. 2 nd, page 645.

SHA-SIOKNBSS.

To the Editors of The Lancet.

Sirs,— Dr. Paget Thnrstan, while offering an explanation of the cause
of sea-sickness, has certainly hit upon a very old and usual mode of
treatment. That it is the abdomen, rather than the brain or spinal cord,
which requires treatment 1 feel convinced. On short voyages the best
preliminary is, no donbt, a good meal of oold meat, and then In a
couple of hours or so the application of a broad belt of webbing or rubber.
It appears to me rather the up-and-down pitching movement of the
vessel than the side-to-side rolling action whloh invokes the sensation.
The supine position is a distinct advantage, and serves to keep off the
sickness more permanently than anything else. Dr. Gowers says that
“ tea-sickness is not improbably due to the oscillations of the endo-
lympb in the semicircular canals ”; but, surely, this oscillates freely
enough in ordinary looomotlon. The puzzle is, why do some people
always suffer and others never ? And who are most exempt, the stoat oc
thin, the tight-laced or the rationally dressed ?

I am. Sirs, yours faithfully,

Feb. 12 tb, 1887. J. Russell Harris, M.D.

To the Editors of The Lancet.

Sms,—Dr. Paget Thurstan's letter to The Lancet last week Is one of
great practical value. I have always thought a great deal might be done
in the way of alleviating sea-sickness by mechanical means. It may
Interest yonr readers to hear bow I prevented myself from being HI last
time I crossed from Boulogne to Folkestone. I am a very bad sailor.
My method was as follows:—i stood up ereot in the cabin, near the door,
where I was at the same time protected from the weather and had
plenty of fresh air to breathe. I kept tight bold of one of the pillar*
supporting the deck overhead with one hand, and as the boat heaved
upwards and down again as it went over a wave I took a few rapid
paces, between a walk and a run, uphill aa It were. In thla manner I de¬
ceived my stomach. That organ imagined the motion was doe to my own
exertions, which it did not object to submit to, and never found out
zbaT. at the same time that I walked or ran uphill the boat was playing
all sorts of trloks with me. I stood with my face In the direction the
boat was going. The passage was an unusually bad one, nearly everyone
on board being affected; but I escaped. The method I have endeavoured
to describe is rather fatiguing, as it involves standing dating the whole
passage. It Is therefore only suitable for a short tea passage. I have
tried other mechanical meant to prevent sea-sickness, but have never
found one equal to this In efficiency for a short passage.

I am, Sira, yoor obedient servant,

Rlohmond-terraoe, S.W., Feb. 15th, 1887. Henry Sutherland, M.D.

To the Editors of The Lancet.

Sirs,—A t page 350 of yoor lest Issue Is an Interesting note upon the
above affllotion by Dr. Thnrstan, who suggests whether a belt that keeps
up pressure on the stomach might not be useful. A reference to Section 862
of the “ Medical Digest ” will show that this plan has many advocates.
One gent leman advises collodion applied to the abdomen. Singing has
been affirmed to prevent an attack, evidently acting by fixing the
abdominal muscles. Lying on the right side Is also stated to be a
specific. 1 am, Sirs, yours truly,

Boundary-road, N.W., Feb. 14th, 1887. Bichd. Neale, M.D. Lond.

•• FISSURED LIP.”

To the Editors of The Lancet.

Sirs, — If those gentlemen who advocate the heroic treatment of
paring the edges and patting in harelip pins for fissure of the Up would
try keeping the part moist with vaseline or other greasy application,
and forbid aU sources of irritation, smoking especially, they would find
the fissure rapidly heal.—I am. Sirs, yours truly,

T. Grant Langhorne, M.B.C.S., *o.
St. James's-squlre, W., Feb. 15th, 1887.

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NOTES, COMMENTS. ,4W) AJSflftHSBS.IQ, CQRRBaWPKNTS,

[F*908. mz*

The Jacob Testimonial. ,

The sum subscribed to this fund now amounts to about £431. We are
asked by the honorary treasurer to remind gentlemen of their sub¬
scriptions promised, in the hope that they will forward them immedi¬
ately, so that their names may appear in the address about to be
presented.

Afr- J£. H. JHackett .—The literature of the subject is scattered about In
pamphlets and publications. Our own oolnmns have contained a large
amount of information on Pasteur’s method.

Hr. G. W. Parker.— 1. We think not.—2. Sooresby Jackson's work on
Medical Climatology might be consulted.

TREATMENT OF DIPHTHERIA.

To the Editors of The Lancet.

Sirs,—H aving regard to the present prevalence of diphtheria, I hope
you will nllow me to call the attention of the profession to the very
valuable and, I believe, specific effects of sulphite of magnesia upon this
disease. I was first indebted to Dr. Lewis of Dalbeattie, N.B., for my
introduction to the drug, and have used it during the past eight years
with unfailing success. I first drew attention to the remedy in a paper
I read some few years ago before the Bradford Medlco-Chirurgioal Society.

I use the sulphite in the proportion of 1 ounce to sixteen ounces of water
as a gargle every hour (directing the bottle to be well shaken before use,
as the substance is but sparingly soluble), a little to be swallowed after
each gargling. In children ahd bad cases I likewise apply the powder
direct to the diseeeed fauces by immersing a damp throat brush in some
of tbe powder, thus being able to get a considerable portion clinging to the
brush, which I then apply direct to the fauces, where I leave as mnch of
tha powder as possible. I unhesitatingly state that this drug in my hands
has been the means of saving several lives. An arrest of the disease may
be looked for within a few hours of its use and the commencing dls-
appcaranceof the membrane within from twenty-four to forty-eight hours.
Without at present entering into the theory of the care, I should like to
state that I am of opinion that the comparatively speaking insolubility
of tbe powder is an important factor in its action, and that the object to
be chiefly aimed at in its application is to leave as much of ft as possible
clinging uboat the throat.

I remale, Sits, yours faithfully,

Bradford!'Ffeb. MUr, 1887'. W. Gilchrist Bt'Hfttfc, MVR.O.&

Communications not notlccd,in our present number will receive atten¬
tion in our next.

Communications, Letters, to., have been received from—Dr. Lauder
Brunton, London; Dr. F. Warner, London; Prof. Attfleld; Dr. John
Williams, London; Mr. Ericbsen, London; Mr. St. Clair Buxton,
London,; Dr. Jacob, Leeds; Dr. Saundby, Birmingham ; Mr. Lawson
Tait, Birmingham ; Dr. Hughes-Bennett, London; Dr. J. B. Harris,
London; Dr. Quinlan, Dublin; Sir Dyce Duckworth; Mr. Bland.
Sutton, London; Dr. Forbes Winslow, London; Mr. Roger Williams,
Loudon; Dr. Dowdlag, Bournemouth; Dr. Illingworth, Clayton;
Dr. W. B, Fargusaon, Newtown ; Dr. J. Lucas, Ramsgate ;
Mr. W. H. Bennett, London; Mr. A. M. Shelld, London; Mr.
T. Bi O'Connor, London; Dr. J. F. W. Silk, London; Mr. F. C.
Turner, London -1 Mr. Longhorns, London; Dr. J. K. A>wler; Hr. W.
Gem, London; Mr. Keetley, London; Dr. Linde; Dr. Davies-Colley,
London; Dr. Btverley, Norwich ; Mr. Karkeek, Torquay; Mr. T. W.
Beid, Canterbury; Mr. Bi H. Fetrwtck, London; Mr. Ltonington
Ash. Hohworthy; Dr. Ballton. Manchester; Dr. Scilla; Mr. John
Marshall, Dover; Dr. Neale, Hampstead; Dr. Solomons; Dr. Ward
Cousins, Southsca; Mr. W. H. Ellis, Shipley; Messrs. Wright and
Co., Bristol; Mr. G. W. Parker, Christchurch; Messrs. Mawson and
Swan, Newcastle; Dr. Fraser, Salford ; Mrs. De Vere Mathew.; Mr. T,

Smith, London ; Mr. T. F. Raven, Broads‘airs ; Messrs. Willing and
Co., London; Mr. W. R. H. Stewart, London; Lady J. Manners,
London; Mr. Basterbrook, London; Dr. Rayner; Messrs. Harris and
Son ; Mrs. Rees, Pimlioo; Mr. Bunting, Notts; Messrs. Kuhner and
Co.,London; Dr.Wise,Walthamstow; Mr.Oasella,London; Mr. J.W.
North, York; Dr. Wilks, London; Mr. Poole, Malden ; Messrs. Beale
and Sons, Brighton; Mr. Burgess, Manchester; Messrs. Boulton and
Paul, Norwich; Dr. Tomkins. Lelo c e to r; Mr. Somerville. Edinburgh ;
Mr. Fa veil, SheMeld; Dr. Mitchell, Manchester; Messrs. Ferris and
Co., Bristol; Mr. Jennings, Lambeth; Mr. Aroher, Marseilles ; Mr. C.
Boyce. Maidstone; Mrs. Thompson, Oldham ; Messrs. Hopklnson and
Oo., Nottingham; Mr. Armstrong, Manchester ; Messrs. Brown and
Oo., London; Mr. Bvans, Oswestry; Mr. Pitman, Biarritz ; Dr. J. P.
Glover, Brlxbon; Mr. Wright. Derby ; Mr. T. D. Oook; Dr. Fleming,
Glasgow; Mr. 8 tokes, London ; Mr. W. G. Dickinson; Dr. Shlrtliff.
Kingston; Dr. Wheeler, London; Mr. Lister, Burnley; Mr. Gourlay.
Glasgow ; Dr. A. Blomfield, Exeter; Mr. Biiiott, Carlisle; Mr. W. H.
Hughes, London; Mr. Denman, Beaconsfield; Mr. Carless, Liver¬
pool ; Mr. Homibrook, London; Dr. Phillips, Kgham; Mr. Bilton
Pollard, London ; Dr. H. H. Ashdown, Edinburgh ; Mr. A. GressweR,
Louth ; Dr. Nicholas, Wandsworth ; Mr. R. Harrison ; Dr. Thurtfield,
Bridg no rth; Dr. G. Stoker. London; Mr. A. W. Burrell, London;
A. J. L.; Ha R. L. K.; M.B.C.S., L. 8 .A.; Vloar, London ; Glasgow
Apothecaries' Company; A Physician; Assistant, L.K.Q.C.P.; Pro
Bono PubMce; M.B.O.S.; Z.; H.; M.D.; M. O. F. S. M. Assoc.;
M.D. (Hastings).

Letters, each with enclosure . are also acknowledged, from — Dr. Hope.
London; Mr. Dennis, Limebouse; Mr. Maopherson; Messrs. Smith
and Son, Birmingham ; Dr. Seaton, 8nnbury; Messrs. MaefarUn and
Co., Leeds ; Mr. Hendry, Eastbourne ; Dr. Beaman; Messrs. Simpson
and Co., Leeds; Mr. GolHns, Sax mun dh a m ; Dr. McNaugfaton, New
Ohunoh j Mr. Miller, London; Mr. Fetter, Yeovil; Messrs. Wyley
and Oo., Coventry; Mr. Aiderwood, Battersea; Messrs. Oliver and
Boyd, Bthnburgh • Mr. Johnston, Glasgow; Dr. McLintock, Church
Stretton; Dr.' Hicks, Hendon; Mr. Lloyd, London; Messrs. Gale and
Oo., London; Mr. Macpherton, Middlesbrough ; Messrs. Davies and

. Oo., Warrington; Mr. Phillips, Kidderminster; Messrs. Woolley and
Sons, Manchester; Mr. Crisp, Keynsh&m ; Mrs. Hitch, Hoilington :
Mr. Tweed, London; Mr- Horton, Exeter; Mr. Birtwhistle, Barton -
on-Humber; Dr. Rayner, Ealing ; Dr. Eberle, Thirsk; Messrs. Bell and
Bradfute, Edinburgh; Mr. Maclaren, Stickney; Mr. Bentley, New
Wortley; .Dr. Harris, Pembroke; Mr. Ay torn Farebam; Mr. Praetor,
Shifnal; Mjr. Smith, Evesham; Dr. More, Kettering; Mr. Cherry.
Worcester; Mr. Sargeant. London; Mrs. Brust, London; Mr. Conyers,
Leeds; Mr. Mason, London; Mr. Deacon, Leloester; Messrs. Mortens
and Co., London ; Mr. Gilbert, Hammersmith; Dr. Hilliard, Ayles¬
bury; Mr. Alton. Aberdeen; Dr. Lindsay, Belfast; Dr. McLennan.
Nairn; Mr. Haywood, Manchester; MissHeall,Matlock; Mr. Rhydlal,
London; Mrs. Hills, Grimsby ; Mr. Kneebone, Bedford ; Mr. Fraser,
Otttheroe; Mr. Emminson, Haxey; Mrs. Maitland, London; L. O.;

. Miss B;, Birmingham ; M. G., Whitechapel ; Secretary, Wrexham
Infirmary; Epsilon, Newcastle-on-Tyne; Median, Newport; Lady
Superintendent, London; M. M.; J. H., Reading; Horace; M~D.,
London; A., Kingsbridge; Medicus,Poniler's-end; Median. Birmiag
ham; J. A. W.; O. K., Peterborough; Surgeon. Eastbourne; Lady
Superintendent, St. John's Wood ; G. N. G., Uxbridge; Alb; Surgeon,
Kirton Lindsey; Matron, Eastbourne; Practitioner; Alpha, Reading;
M.D., Swanage; E. L., Manningham.

Western Morning A’«n vs, South/nrt Visitor, Bath Chronicle, Bristol
Heronry, Hampshire Independent, Oldham Daily Standard, Maiton
Messengers Dumfries and Galloway Courier, Drtmfries and Galloway
Standard, Devon Evening Express, Kent and Sussex Post, Ilfracombe
Estates Gazette, Bovmemouth Visitors’ Directory, «5'c., have been received.

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• THB LANGET; February • M, 1887,

ABSTRACTS OP THE

Erasmus Milsmt f trtms

ox

EVOLUTION IN PATHOLOGY.

Delivered at the Royal College of Surgeons of England,

By J. BLAND SUTTON, F.R.C.S.,

A3SI3TAXT-8UKOKOX TO THE MIDDLESEX HOSPITAL.

LECTURE III.

REVBqffOK OB ATAV18K (GEB. BftCKSCBLLAG).

Mb. Pbexidbnt AND Gkntlkmen, — By reversion or
atavism is usually understood a tendency in the offspring
to resemble its grandparents or more remote ancestors
instead of its immediate parents. To the consideration of
this interesting and important subject the present lecture
will be devoted, bat attention will be more particularly
directed to reversion as it affects structural aberrations.

Pew persons competent to form an opinion on the matter
will deny that in the embryological history of a given
animal we read a brief epitome of its ancestry—in fact, its
evolution. Nothing represents this so forcibly as the fol¬
lowing quotation from Von Baer: “In my possession are
two little embryos in spirit, whose names I have omitted
to attach, and at present I am quite unable to say to what
class they belong. They may be lizards or small birds, or
very young mammalia, so complete is the similarity in the
mode of formation of the head and trunk in these animals.
The extremities are still absent in these embryos; but even
if they had existed in the early stage of their development,
We should learn nothing, for the feet of lizards and mam¬
mals, the wings of birds, no less than the hands and feet of
man, all arise from the same fundamental form.” This
Striking passage from the writings of the great father of
embryology has been rendered more forcible by the efforts
of modem investigators in this the most difficult of all
departments of biology.

Structural aberrations of congenital origin must be divided
into three main classes: 1. Persistent foetal conditions.
2. The attainment of a functional or more or less full deve¬
lopment of structures which for a given animal are nor¬
mally suppressed during embryonic life. 3. Malformations:
spurious atavism. Earn of the three classes will be con¬
sidered in detail.

1. Persistent foetal conditions .—To this class belong the
various forms of deft palate, whether it vary from a bifid
uvula to a cleft extending the whole length of the roof of
the mouth. In fish the buccal and nasal cavities are a com¬
mon chamber; in lizards and most birds the hard and soft
palates are normally cleft, whilst in the young kangaroo
the uvala is bifid. The funicular pouch of the peritoneum
is a case in point. Normally it becomes closed in its abdo¬
minal segment, leaving the tunica vaginalis testis as an
isolated sac. Frequently it fails to obliterate in any of its
Course. In this respect it conforms to the condition of the
pouch found in the majority of mammalia. Up to the pre¬
sent time, although I have examined all the more important
mammals specially in regard to this point, I have never yet
found the pouch dosed. Sometimes it will only admit a
thin probe, but in others the index-finger could be easily
accommodated in the peritoneal recess. Numerous examples
suggest themselves of arrest in development—e.g., malfor¬
mations of heart, uterus, intestinal canal, &c

2. The attainment of a functional or more or less full
development of structures which for a given animal are
suppressed during embryonic life .—In my first lecture—that
on suppression of parts—a nnmber of examples were given
of organs or parts of organs which became arrested during
embryonic lire, Which later on may serve as germs of various
pathological growths. In this place/we shall have to deal
with certain of these structures in a functional condition.

developed.” The facts relating to the os centrale of the
Carpus, as described In the first lecture, is a good example
of what is to be understood by the preceding sentence. It
is also essential to bear in mind that in the majority of
cases of reversion the atavistic parts do not belong to forms
paleontologically remote or systematically far distant.
(Hensel, Gegenbaur.) In the case of the os centrale we
know that it occurs among the higher apes, for the Ofang
and gibbon present this bone well pronounced in the carpus.
The clearest instance, and one which is also interesting, is
that furnished by the manus of the horse. It is a well-¬
established fact that Hlpparion, the immediate ancestor of
the modern horse, possessed three functional toes of the
character represented in Pig. 8. Hensel’s investigations
appear to show that the inner toe was the last to abort
when the equine manus assumed the condition Shown in
Fig. 9. Theoretical reasons would le&d us to suppose that
if any of these toes reappeared as abnormalities, the one
which was the last to disappear would be that most
frequently represented atavistically. This is precisely what
occurs, and numerous specimens preserved in museums and
reported in periodical literature attest the fact'. By fat the
most remarkable of these cases is that reported by Marsh 1
in an important paper on “ Horses recent and extinct.” Here
he gives an excellent account of a case exhibited as the
Cuban pony, in which this inner digit had reappeared in a
functional form on both hind and fore limbs. The skeleton
of a manus of this nature is given in Fig. 9. In such cases
as these there seems to be little difficulty in clearly assigning
the deformity to atavism; but that the difficulty may not
he under-estimated, let the student carefully consider the

Fig. 8.

Fig. 9.

Fig. 10.

No. 3313.

. 7afart><W>. Bd. ri., 8. 684. [8M
’, vol. ivi., p. 816.

Pro. 8.—The maim* of Hfpparion, with three functional
toe».

Pie. 9. —The murai of A Item wlLh an extra digit func¬
tional. (After Manh.)

Fig. 10.— The manua of the modern horse, One too
functional.

remarks made further on regarding another, mode by which
the horse may acquire an additional functional digit*
In the spider monkeys the thumb is usually represented
by a mixture of fibrous and cartilaginous tissue, yet a
perfectly developed thumb is occasionally developed in
these quadrumana.

3. Spurious atavism .—Twenty years ago, anyone writing
upon this subject and regarding abnormalities such as We
have been considering as reversions bo lower forms would
have been looked upon in a very unfavourable light. Fortu¬
nately the aspect of things has changed, and the discussion
of such matters is admissible even in polite conversation.
It is exceedingly necessary to guard against running into
the opposite extreme, for there is a decided tendency at the
present time, when anything unusual occurs in the con¬
formation of the parts of an animal, to find out some corre¬
sponding condition in lower animals, and at once to pro¬
nounce it as a reversion. This is, of course, erroneous, and
an attempt will be made to briDg under notice soipe examples
of this false and unsatisfactory form of reasoning. One of
the clearest instances known to me is that abnormality of
the stomach called congenital contraction. Wby it should
be termed congenital is not very evident, since no anatomist
or pathologist who has studied this matter or described
specimens of this nature makes any mention of such a
condition being found in the foetus or young child. A
typical form of the malformation is represented in Fig. 11.
We see midway between the pylorus and oerdiac ex¬
tremity of the stomach a contraction which divides the
viscus in two distinct parts, causing it to resemble some¬
what a rudimentary condition of the oomplex stomach of

* American Journal <ji Bcience and Art, 187*.

| ■ -.1

oogle

4<'6 Tub Lancet.]

MR. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY*

[Feb. 28,1887.

tb* ruuuuaut, ur uu approach rattier to that ot the geiiuo
Cervulus. Carefully bearing in our minds that a reversion
consists in a reappearance of a lost character, we shall have to
show phylogenetically that man’s immediate ancestors pos¬
sess such a stomach; but we know full well that a complex
Tiscus of the character exhibited by the ruminant stomach
is an exceedingly specialised arrangement, reaching its
maximum among this division of the Ungulata, and in its
most complex form confined to it. Certainly on phylo¬
genetic grounds the argument cannot be upheld. Again, in
by far the greater number of cases, atavism consists in
retention of foetal characters, and the atavistic type is, as
I have been so careful to point out, due to the retention of
foetal characters which attain a functional condition. If
during its embryonic stages the human stomach presented
such a shape as that represented in Fig. 11, it could easily be
understood that in some cases it would be permanent; but
this we know full well is not the case.

Phylogeny and embryology are both eloquent in furnish¬
ing denial on this subject; therefore it is illogical, and as
unreasonable as it is unscientific, to regard this malformation
of the stomach as a reversion. We must also be careful not
to confound physiological types with reversions. For
example: an erectile tumour is structurally similar to the
comb of a cock, yet no one would venture to suggest that
the neevi which occur so frequently in infants, immediately
over the anterior fontanelle, are to be regarded as reversion
to a cock’s comb.

A like instance is furnished by the submaxillary gland
of the armadillo. In this edentate, the duct, soon after it
leaves the gland, dilates into a salivary bladder, serving as a
reservoir of soma capacity. How easy it would be to say that
in cysts of the mouth produced by obstruction and subse¬
quent dilatation of the salivary ducts we have a good
instance of reversion to the armadillo type. The thing at

So-called congenital contraction of the human stomach.

once strikes us as absurd. Take the case of those remark¬
able bodies found in some of the ganglia or cysts occasionally
connected with the tendons of the flexors and extensors of
the hand. Now bodies exactly resembling these occur con¬
stantly in connexion with the jaws of sharks. Professor
Charles Stewart has shown that immediately above the
mandibular articulation in the skate there is a recess where
concretions exactly resembling the melon-seed bodies arc
formed and passed down into the joint through a narrow
opening. In this instance we may use these as physiological
types of the melon-seed bodies found in ganglia, but the
latter must not be regarded as reversions. It must not be
concluded from this that I object to descend to fish to find
reversions; on the contrary, the human body abounds in struc
tures decidedly piscine—e.g., the enamel and dentine of teeth
and odontomata, and our primitive cartilaginous skele¬
ton ; in the possession of membrane, bones, branchial clefts,
and the like. In these cases, however, we can trace them
in mammals, thence to reptiles, downwards to amphibians,
and so on to fish; but if a character appears in man which,
so far as we know, occurs not in the intermediate formR, and
especially those closely allied, then objection must be taken
to it as being atavistic.

Let me now select an example which will serve to show
how much care is requisite in determining reversions. The
possession of lanugo by the foetus, which is as a rule shed
tn utero, is a clear indication of a lost adult character merely
persisting in the embryo in obedience to heredity. Occa¬
sionally, however, the lanugo, instead of being shed, attains
full development. This excessive growth may perhaps
only affect a patch half an inch square, but it may extend
over half the body, as in Fig. 12. Such overgrowths are
known as moles. This is trn© atavism, for we have only to
descend to man’s nearest neighbours, the anthropomorphic,
and the truth is evident. But every abnormal hairy natch
is not due to overgrowth of lanugo. It has long been known,
and Hunter was well aware of it, that when parts have long

been irritated, us by the prolonged use of poultices <fcc., an
abundant crop of hair has been produced around the part.
But there is a more subtle form of hairiness which leads to
some very remarkable speculations.

There is a variety of spina bifida known as “occulta," the
chief peculiarity of which consists in the non-existence of

Fia. 12.

A hairy mole on a man. It hod become the seat of an
epithelioma. (From a drawing presented by Mr. George
Law»on to the Middlesex Hospital Museum.)

any external tumour, but a membranous spot may be
detected in the vertebral column, as described in the first
lecture. Associated with this is some thickening of the
membranes, an accumulation of fat, or mixture of fat and
striped muscle fibre in relation with the spinal cord. The
irritation leads to the development of an abundant crop of

Abnormal hafrinfsa of the loins, due to the initatihn of a spina bifida
occulta. (After Becklinghauten.)

baire, as shown roughly in Fig. 13, the hirsutes being most
abundant in the vicinity of the delect. The case in question
was reported by Recklinghausen, 3 but it is not the most
perfect one that could have been selected, for a tumour bad
been removed in early c hildho od .from ^he patient. Hoiy;
ever, it serves well to illustrate the point.

* Virchow’* Arohiv, 1886,

Thk Lancet,]

ME. J. BLAND SUTTON ON EVOLUTION IN PATHOLOGY.

[Feb. 26,1887. 407

Darwin 4 draws attention to the curious variety of fowls
which possess a topknot of feathers, as shown in Fig. 14,
familiar to poultry breeders as the Polish fowl. The skull
nndemeath this tuft exhibits a remarkable deviation from
the ordinary form seen in fowls. The deformity ^ill be
best understood by a glance at the skull of a Polish fowl,
shown in longitudinal section in Fig. 15. The summit of
the protuberance in the Polish fowl often presents irregular
membranous spaces. Virchow 3 regards the cranial deformity
as of the nature of a hereditary encephalocele, and the
luxurious overgrowth of feathers is associated with it, in the

Fig. 14.

S c ct1«S i of sk^lKt the Pollah fowl, showing the protuberance.

metacarpal or ffietatarsal bone. D&rwin was of opinion that
supernumerary digits are..atavistic in the sense that they
are to be regarded as a process of budding similar to that
found in the limbs of amphibians. This view, however, has
not found favour. In order to find a vertebrate ancestor
with more thfmtbe typical number of five digits in manus
and pes, we tahould be obliged to descend to fish or snch
fossil reptiles as the ichthyosauri for types. From such
forms to man the gap is too enormous, and the modi¬
fications of... the limbs so extensive that misinterpreta¬
tion is unavoidable. It has already been indicated that
when atavism occurs, although it may occasionally repro-

iBts under Domestication, vol. 1., p. 262.

S. 274; and Archiv, Bd. dll., 8. 11, 1886,
gie.

duce a remote ancestral character, it with far greater
frequency represents those of. its more recent ancestors.
If all cases of supernumerary digits are reversions, where
are we to go for types with double hands, double feet, and
so forth ? A broad survey shows that there is a tendency to
reduplication in many parts of the body. Thus; in lizard?,
reptiles, or amphibia double tails are not unknown; even
reduplication of the vertebral column occurs, not only in
man, but in many vertebrates. Interesting examples of the
bifurcation of the axis of a limb have been described by
Albrecht in the mud-fish, Protopterus annectans, and in
Ceratodus by Howes. A good example of the tendency
exhibited by digits to bifurcate is represented in Fig. 16. It
is the manus of a horse preserved in L’Ecole Vdtdrinaire de
Lyons. In this case the phalanges attached to the .main
(third) metacarpal have bifurcated. If these are to 'be
regarded as examples of atavism, we shall be obliged to find
animals with two tails, any number of spare digits, or even
limbs. To insist that such examples are to be regarded as
reversions is certainly inconsistent with sound reasoning. -
The following example will serve to show to what extent
care is necessary in deciding whether a given abnormality
is atavistic or otherwise. In the Teratologioal Collection of
the Museum of the College of Surgeons is the .interesting
specimen shown in Fig. 17. It consists of the skeleton of
the right manus of a horse, with an additional largely

shod on both toes. A superficial glance at once suggests
that we have here one of the horse’s lost digits reappearing.
A critical examination reveals, however, that, if this is a Case
of atavism, the splint bone on the inner side must represent

Head of a Polish lowl wiUx feathery tuft. (Alter Darwin.)

same way that excessive growth of hair is a concomitant of’
spina bifida occulta in man, and even ordinary spina bifida.

Polydactyly .—Supernumerary lingers and toes constitute
a class of malformations whicli give rise to great difficulty
to those who have devoted attention to reversionary
phenomena. A very large number of cases of increase in
the number of digits has been recorded and carefully
described by tfr gists, anatomists, and surgeons; the
extra digits va-ying from one or two phalanges, encased in
ti-^ues, and hanging by a pedicle from a complete finger, or
as a complete linger articulating with, or ankylosed to, a

Fig. 16.

at j m

Fig. 17.

D' ;

Bifurcation of the third digit of a A •imilar specimen. (Museum of
horse. (After Ch&uveau.) Royal College of Surgeons.) ‘

the thumb. This is contrary to what has been already
expreseed—viz., the parts laat suppressed are those most
prone to reappear by reversion. If we take the pains
to compere this specimen with Ghanveau’s case represented
beside it, there remains very little doubt that it is not
atavistic, but a reduplication of the middle digit—in fact,
a malformation.

In concluding these lectures, permit me to make the fol¬
lowing remarksHow many have felt, as the yearly total
of facta make their appearance in the volumes known as
the Transactions of the Pathological Society and Virchow’s
Archiv , that many wearisome details of the minute
structure of tumours and other morbid changes are recorded
•again and again, until it seems that the description of. the
histology of a diseased strncture marks the finality .of
pathological science. Pathology is sufficiently hampered
with isolated facts already, and it is time that those who
have the energy and leisure should employ them in searching
for some laws whereby to regulate this accumulation, which
bids fair to bring discredit on the pathologist. Comparative
pathology, studied from the standpoint of evolution, offers
every, inducement in this respect, and will yield a fruitful
harvest to those willing to toil in this fertile field.

Note .—That part of the lecture devoted to “ Branchial
Fissures and Supernumerary Auricles” appears in full in the
January number of the Journal of Anatomy and Physiology.
The theory advanced to explain the transmission of male or
female characters, and a full discussion of the morphology
of ■ the prostate, will appear in the Proceedings of- the
Zoological Society for December, 1886. The discussion
regarding parasitic fostuses in the sacral region, with full
illustrations, will appear in the Gynaecological Journal ,
vol. ii. The explanation of “ meningocele” in the occipital
region was published in Brain (October, 1P86).

I 2

)°gk

408 The Lancet,]

DR. T. F. CIIAVASSE ON RENAL SURGERY.

[Feb. 26,1887.

% Clinical fcctcm

ON

RENAL SURGERY.

Delivered at the General Hospital , Birmingham ,
on Nov. 25th, 18SG,

By T. F. CHAVASSE, M.D., C.M., F.E.C.S. Ed.,

SURGEON TO THE HOSPITAL.

Gentlemen,— The surgery of the kidney his made of
late years many and great advances, but there are still
practical points open to discussion and to improvement.
Some of these I propose to consider -with you. As a basis,
and in order that the examination may be made more
complete, I have selected fatal cases in which post-mortem
examinations have afforded opportunities of verifying our
diagnosis and discovering sources of error.

Case 1. — A warehouseman, aged twenty-seven, was
admitted to the General Hospital on July 6th, 1886, under
the care of my colleague. Dr. Saundby. For three years, on
and off, pain had been experienced in the left side, but
latterly tne pains had been centred in the back.

On admission, there was a slight swelling, more or less
lobulated to the feel, and dull on percussion, to be detected
in the left flank, extending forward to a point below the
umbilicus. An examination of the urine showed that the
average daily quantity passed was thirty-five ounces, that
the reaction was acid, the specific gravity 1014, and that it
• contained albumen, blood, and pus. With regard to the
pus. Dr. Saundby noted that the quantity was about one-
fifth of the deposit in a conical glass—viz., two ounces out
of ten. At this stage of the proceedings the patient declined
to submit to any operative treatment, and left the hospital
on July 12th.

He was readmitted on August 4tb, as the tumour had
increased in size, and a few days later came under my care.
After consultation, as a renal calculus was suspected to be
the cause of the swelling, it was decided to explore the
kidney through a lumbar incision. This was accordingly
done on Aug. 10th. Oa exposing a portion of the viscus,
it appeared firm, but somewhat tense. The organ was
•incised, and more than eighteen ounces of purulent fluid
were evacuated. The forefinger introduced into the wound,
after a little search, detected this rough tuberculated
calculus, somewhat triangular shaped, weighing 30 gr.
It was removed, and careful examination, made by my
own finger and that of my oolleague assisting, failed
to detect anything further. I was then warned by the
anas3thetiser that the patient was much collapsed, and
that the operation had better be concluded as rapidly
as possible. The kidney was therefore irrigated by
means of a tube introduced into the wound with a weak
warm solution of boracic acid, and a large drainage-
tube inserted. The whole operation only lasted half
an hour, but the patient when removed to bed was in a
state of extreme collapse. After tbe application of restora¬
tives his pulse improved somewhat, but life was with
difficulty maintained. Great pain was complained of in the
legion of the wound two hours after the operation, and
One-eighth of a grain of morphia was administered sub¬
cutaneously. The discharge was profuse, and necessitated
* change of the dressings eleven hours after the operation.
After this the cold perspirations and other symptoms of
•hook seemed to be improving, but sixteen hours after the

a eration he suddenly but quietly died. A few ounces of
oody urine were passed per urethram between the time
. of death and the completion of the operation. Unfor¬
tunately the friends declined to permit any regular examina¬
tion ot the body. The left kidney had therefore to be
removed by merely enlarging the lumbar wound. The
condition of the other organ could not be ascertained.

. -"The kidney here presented shows total disorganisation; it is
enlarged and divided by septa into numerous abscess cavities.
..Practically no cortical substance exists. From the recesses
jfi. the pouches numerous small calculi (about fifty) were
,, (washed out. Here are some of them, varying in size from a
millet-seed to a pea. The organ itself was hardened in
•pirit for a month and then laid open. Another and a larger

calculus than the one removed was disclosed firmly im¬
pacted in the top of the ureter, and virtually obliterating
this tube. Its weight was 38 gr.

In this case surgical treatment was too long delayed. To
obtain the greatest possible benefits from operative measures,
renal calculi must be sought for and removed before de¬
struction and consequent abecess have resulted. Doubtless,
reference to cases within one’s own knowledge, and to the
literature of the subject, shows that a suppurating kidney
may contract and heal marvellously well after efficient
drainage has been established and all irritants removed, but
then it can only work as a very much damaged organ, while
an earlier operation may be the means of restoring its
powers to nearly normal. Surgically speaking, the signs
and symptoms most to be relied upon for the diagnosis of
renal calculus where no tumour exists, the patient being
otherwise healthy, are the following:—1. The presence of
blood in the urine, especially after exertion. 2. Unilateral
pain passing down the ureter towards the testis. 3. Pain
elicited by deep-seated pressure in the lumbar region,
between the last rib and the iliac crest, just external to
the erector spinas muscle. 4. The presence of uric and
oxalate crystals in the urine as revealed by the microscope.
With such symptoms the surgeon is fully justified in making
a lumbar exploration of the kidney, as he is also, I think,
in those cases of chronic nephralgia depending on uncertain
causes which milder means and medicines have failed to
remedy. Even if no stone be detected, instances are on
record in which the patient has obtained prolonged relief.
The explanation may be that the division of the lumbar
tissues and of the renal capsule lessens the existing tension.

The shock following a surgical examination of the kidneys
varies very much. In some instances I have seen it marked;
but in an individual otherwise healthy and free from any
renal suppuration it is generally slight. The death of this
patient was somewhat of a surprise, and it is a matter of
regret that a complete post-mortem examination was not
permitted, in order that the conditions of the opposite
viscus might have been ascertained. According to the
statistics of Professor Gross, based upon seventy-two cases
of incision and drainage, thirteen fatalities occurred. In
32 20 per cent, of the remainder a renal fistula resulted.

In suppurative lesion9 of the kidney permitting operative
interference it is, I think, better th^^oepl tf olu t y and
drainage should first be undertakery-. , sfioavrm of o'vents
watched. The surgeon is then afforded a* opportunity of
seeing the effects produced upon tJfce opposi'-e kidney. If the
pus soon diminishes and disappears from tin urine, the organ
is probably sound. The lumbaw incision, at the time of the
operation, throws no light upcA the important question as
to whether the patient has another kidney. The abdominal
does not assist much more ; Jit certainly reveals the fact of
bare existence, but it can give no information with regard
to the working condition/bf the organ. A permanent sinus
of a troublesome nature,'may remain after the drainage, but
if nephrectomy has ultimately to be resorted to, the kidney
is more or less shrivelled and easily shells out. Statistics
show that such a removal through a lumbar wound gives
the lowest mortality rate—viz., 9 33 pm cent.

Reference must be made to the dSfficulfssencountered in
an examination of a kidney for ealeu]
marked disorganisation is present. The •
exposed by means of a lumbar inc
not be satisfied by exploring merely
punctures. If these fail to detect,
must be divided, and either a bent silve-.Aptobe or a small¬
sized child’s sound introduced into the. ivis of the organ,
and the whole of its interior inveetig. >d. This incision
need not be large, and may be made either i* the outer
border, or, as suggested by my friend Mr. Lloyd, at the
lower edge of the organ. This little wound, it is true,
causes a slight haemorrhage, but it can be easily restrained
by sponge pressure. In a case reported Dr, Tiffany 1 the
hot blade of the thermo-cautery was sunof ully substituted
for the knife in order to avoid this bleeding.

Case 2.— On May 12th, 1885,1 exposed the right kidney
of a woman, aged twenty-two, who had Buffered from
pyuria for nearly three years, and at times from pain
referred to the regions of the right kidney and ureter. The
pus in a conical urine glass formed a deposit of one inch and
a half, and the patient was much e ma /ite d . I “needled”
the kidney in nearly a dozen place^lAMMlMLtlther to find

-- ^

1 Transaction* ot the American Surg'c*!

in which no
having been
snrgeon must
series of needle
cal structure

Dia

G°ogl

1HB UA.N CKT, 1

DlU

JAMES P. GOODHART ON PERITONITIS.

[Fra. 2*, 1887. 4 09

a stone or to tap an abscess. 'B'he patient suffered a good .
leal from shock, but recovered from this to sink later on
it -m exhaustion.

it the necropsy, on section of the right kidney, au abscess
carity the size of a walnut was found at the head of the
rgan, occupying the portion of three pyramids and their
tpanded medullary substance. This abscess cavity com¬
municated with the ureter. To the top of one of the pyra¬
mids a amall phosphatic stone was found adhering. The
-wsule of the organ could be readily removed, and its sur-
» was smooth and pale. Numerous small abscesses could
'■* seen in the cortex. The lower portion of the kidney
ted fairly healthy, and, although pale, the cortical sub-
ace was of good thickness and consistence. The ureter was
■'-atly thickened and adherent to surrounding structures;

ling membrane was thickened and studded with minute
ft oodles the size of a millet-seed, intimately adherent to,
ud apparently in the substance of, the mucous coat. The
ling into the bladder was unobstructed. The left kidney
weighed 6oz., and was deeply congested, but the pyramids
appeared normal. The bladder was much contracted.

At the time of this operation I did not fully appreciate
« necessity of incising the cortex and sounding the pelvis
^ those cases where the exploring needle failed to detect
my abnormality, and, as a consequence, a fair-sized abscess
iad a small piece of stone remained undetected. For the
ant of a sufficiently thorough examination of the pelvis of
xplored kidney by means of an incision and a sound I have
no doubt that other operators have met with the same ill
"ccess that I did in this instance. The ultimate result
uld probably have been the same; but the condition of
urinary tract, as revealed by the sectio cadaveris, proves
i uselessness of resorting to nephrectomy in cases of
died tubercular kidney. The affected organ may be
-moved; but the disease is present in other parts of the
iry apparatus, and the whole disease is not removable,
nm thorough examination of the kidney pelvis by incision
ne cortex is a decided advance, but may sometimes prove
Idlacious.

Cask 8. —The enlarged kidney here shown is the right
ucus of a man, aged thirty-one, who had suffered with
-:ked symptoms of renal calculus for ten years. Through
i oblique lumbar incision I failed with needling to detect
ay stone. The ct. . .Huis therefore incised for three-
aartera of an inch c liO«*4 °j?*} outer border of the organ, and !
ith a large bent probe 1 explored the pelvis, as was thought
the time, most thoroughly ’id effectually, yet no calculus
■■w detected. Unfortunately ^e man died some days after
* operation with sympt >m.s ,';f septic poisoning. Plenty
inne was pawed after the exploration, and at the end of
•s second day moet or it, o th’ naked eye, was free from

iuo following is the •'pofo r *uf our pathologist. Dr.
TOke:—'“On ml i nducing the l, v nd into the incision
the right loin, tho ki' 1 - y could he Felt, and an incision into
isubstance, tbirou'.i. which the foretinger could be pushed
r about an inch. On removing the abdominal viscera, the
jkt kidney was *wju w position, lying somewhat loosely
a its renal cushion, and greatly enlarged. Coloured water
r.jectod through tb*' wound distended the peri-renal cellular
•wand oozed si ply by force of pressure through the
■eritoneum into th**. peritoneal cavity, but there were no
■idences whatever of any opening into the peritoneum,
jht kidney enorn ouaiv enlarged, weighing 1 lb. 3 oz.,and
curing in. by H in. The pelvis was extensively dilated
A sacculated, ite e considerably hypertrophied, and its
dng membrane sm shining; with it communicated

considerably dila_ d and hypertrophied ureter. Lying
he bottom of the lowest aacculus, into which opened the
>ter, was a lenm “ uttened convex stone, measuring ljin.
v 1} in., and weighing 28* gr. Besides t he large stone,
Zht smaller mts, brownish in colour and all facetted, were
md; these weig^ d together oO gr. The kidney substance,
•uich was uniforifv » hypertrophied, looked fairly healthy
“dnomwl. All tha* remained of the left kidney was a small
okened and dilated sac filled with a turbid secretion;
J he upper part there were a thin crust of atrophied
au. tissue and several small cysts. Intestines: Walls
ickened, and somewhat sodden with cedema. The coils
'ere much distended with g;ss and liquid yellow fteces; the
-ntom.il coaJ iw^ ld bere and there the linesof hypenemia
adicative of easy ■.. nftia. Thu parietal peritoneum was
lls ? hypenemici* ; i -ci.illy over the region of the

Zht loin tad vlgfe— odominal wall. The bladder and

i rectum were normal. The heart weighed 15 oz. The left
ventricular wall was much thicker than normal, and generally
hypertrophied. The valves aud cavities were normal. The
bases of the lungs were somewhat congested and (edematous,
the upper lobes were quite normal.’’

Now, at the time of the operation the tip of my own fore¬
finger and that of my colleague assisting passed into a
cavity which was considered by us both to be the pelvis of
the kidney, and a probe travelled freely upwards and down¬
wards in this space. As a matter of fact, os you now see,
the finger and the probe never reached the pelvis, but were
separated from it by its lax hypertrophied lining membrane,
and the instrument in its course separated tins thickened
tissue from the cortex without entering the interior of the
organ. If in this particular instance the exploration had
taken place through an abdominal incision made at the edge
of the rectus muscle, there is little doubt that the stone
would have been readily detected aud removed; as it was,
owing to the great enlargement of the viscus, the sulcus
containing the calculi lay sheltered in the upper part of the
pelvic cavity, and the incision into the renal substance was
more than six inches away from the object of the search.
The features of interest in the whole case are so numerous
and abnormal that in the present imperfect state of renal
j surgery they appear worthy of special note.

A few words on those cases in which nephrectomy may
be performed. Professor Gross, in an able paper J showing a
wide range of research on this subject, says: “From an
extensive acquaintance with the literature of the subject, I
have been loDg convinced that the kidney has been too
frequently removed.” This is very probable; and in our
zeal to test the efficacy of a new operation for the relief of
very painful disorders perhaps a few kidneys have been
sacrificed. But now that Professor Gross can present a
list of 233 cases, and tabulate the diseases, the operation
performed, the number and causes of death, together
with, in many instances, the results of post-mortem
examinations, I think surgeons are in a position to judge
more or less accurately what cases are fitted for the
operation and what are unsuitable. The statistics show
that the lumbar operation is safer than the abdominal.
I would not say that on this account it is always
to have the preference, as due allowance must be made
for the nature of the case and the dexterity of the
particular operator; but in the majority of instances it is
the best operation. It may bo resorted to, after nephrotomy
and drainage have failed to relieve, (a) in suppurative
lesions depending upon a local irritant, (b) in hydro¬
nephrosis, and (c) in traumatic rupture of the kidney. The
operation is also justifiable (d) in cases of painful floating
kidney', when the attempt to lix the organ has failed and
the sy'mptoms are still urgent (the abdominal method to be
preferred); and (e) for any very troublesome fistula, either
renal or ureteral. Nephrectomy is a very doubtful
expedient—in fact, I believe it to bo contra-indicated in
(1) tubercular disease, (2) carcinoma of adults, and (3)
sarcoma of children.

CASES OF PERITONITIS.

By JAMES F. GOODHART, M.D., F.R.C.P.,

PHYSICIAN TO OUT’S HOSPITAL AND THE EVELINA HOSPITAL KOR
CHILDREN.

Tub subject of peritonitis is not one upou which there is
anything new to be said, nor one into which any novelty of
handling can be well introduced; but it is one which presents
points of difficulty in practice which are weighty if thejr are
but few; aud some of these will bear reiteration, even allow¬
ing that we are not all agreed upon their importance or
their bearing. I do not. of course, propose to deal with the
subject of peritonitis in all its aspects, but only to touch
upon som9 few of the more salient and, to my mind, dis¬
turbing elements in the matter of diagnosis and treatment.
I shall probably best carry ray readers with me if I say that
the points to be insisted upon mostly concern suppurative
peritonitis, and if I let cases as far as possible tell their
own tale.

Some short while ago 1 saw a young married lady with
what, at first seemed to be like intestinal obstruction. She

* American Journal of Medical Sciences, July, 1885.

“-"^vTTooglc

4 it) Thb Lancet,]

DR. JAMES F. GOODHART ON PERITONITIS.

[Feb. 26, 1887.

was six months pregnant, and her bowels were by habit
much confined. The constipation had been worse than
usual, and she had taken some pills to overcome this
without medical advice. These had caused a great deal of
pain, but had produced an evacuation at first scybalous and
then loose. Sue vomited soon after the aperient had acted,
and continued to do so, and for five days after she passed
nothing, not excepting flatus. The abdomen had become
much distended and the vomit had assumed a sterooraceous
appearance. But there was another element in the history
ot the case which is important to the formation of a dia¬
gnosis. She had had during two or three years repeated
attacks of pain in the right iliac region, with considerable
thickening there at times; and for this she had been obliged
more than once to take to her bed and couch for two or
three weeks at a time. 8he had had an attack of this kind
two or three months before her last illness, but was supposed
to be now well of this. She had a most pinched and
collapsed appearance, her eyes being sunken, her voice low
and hollow; pulse 120 to 130, of good volume; the tongue
foul. There had been no vomiting since the morning, but a
constant tendency to retch. The bowels had acted fully
that morning. The temperature was normal. The abdomen
was distended with flatus, but it was quite soft and easily
palpated. There was, perhaps, slight induration in
the right groin, not much, and some tenderness in that
region. She vomited while I was in the house, the
vomit being a dirty-brown thick fluid, but having no
offensive smell. Now, this case much resembled a case
of intestinal obstruction, and all the more closely from
the fact of the existence of pregnancy. The diagnosis
rested upon the constipation, the vomiting, the distension
of the abdomen, and partly, I think, upon the normal tem¬
perature. But none of these things are reliable means of
distinction between the paralysis of peritonitis and mecha¬
nical obstruction; and the old history that existed of ctecal
inflammation, or rather of inflammation in that region,
made the peritonitic hypothesis far more probable. I heard of
her from time to time during the next few days, the account
always being that her temperature was normal; there was
a yeast-like diarrhoea, which was difficult to control, but
that, on the whole, she was doing well. The diarrhoea went
on, and caused considerable anxiety. Then it was con¬
trolled, and again she was doing well, with a “ but “ the
pulse kept up so quick,” and on the ninth day it became
unsteady, and the patient sank. The necropsy revealed
what was expected: some old disease in the right broad
ligament and in the csecal region, with a local abscess and
general suppurative peritonitis.

With this care let me tell of another. A girl of thirteen,
of healthy but neurotic parentage, was quite well till a
certain day, and she then complained of pains in the stomach,
but nothing much, and no notice was taken of it. Next day
she was at a children’s party, and the same evening she was
decidedly unwell and had much more pain. The next day
she was sick several times, but it was supposed to be a
mere bilious attack, and no medical man was called in until
the fifth day. During all this time she had been vomiting
—a decidedly illegitimate extension of the meaning of
“ bilious,”—and she had also marked tenderness in the
right iliac region. In two or three days after her medical
man first saw her she still continued to vomit, and the
bowels were confined. She toen had two or three doses
of castor oil, after which she had what was described as
“not diarrhoea, but a continuous oozing from the rectum.”
This had been considered to be the result of nervous exhaus¬
tion, it being argued that the absence of pyrexia, which had
been a notable feature throughout, negatived the existence
of inflammation. I did not see her until the twenty-sixth
day of her illness. I had heard the whole history, and the
special object of my visit from the parents’ point of viow
was to suggest something to control the diarrhoea. They
rested on the idea that if only the food would lodge
somewhere and become digested, instead of running
out at one end as fast, as it was put ia at the other,
the child would quickly rally. But the history I
have given seems to mo all too plain, except in
one respect to be mentioned directly. I could not doubt
that the case was one of typhlitis and peritonitis, and the
latter all the more ominous in that its symptoms had been
somewhat masked, and that it was now associated with
diarrheea. The child was not pinched and hollow-eyed like
a bad case of peritonitis, I must admit, but she had a tense
moderately distended abdomen, lay with her legs drawn up,

and the muscles of the abddminal wall were exceedingly
irritable. In this case 1 was uncertain whether there was
any thickening in the csecal region, but I thought I could
detect something. No complaint of pain in the abdomen
was made now, but there was much in the che6t. The tem¬
perature was 103 - 4°, and the pulse 140; the lower two-
thirds of the left side of the chest were dull, and there was
a dry rub round the diaphragmatic edge in front. The
heart sounds were excessively muddled and murmurous, but
there was no decided murmur, pericardial or other. The
view I took of the case was that there had been peri¬
typhlitis, general peritonitis, quite possibly suppurative,
and extension of the inflammation to the left pleura, and
possibly to the pericardium also—a condition obviously of
the gravest possible danger. 1 must candidly admit that
the medical gentleman in attendance—of great ability,
and, as years go, of larger experience than my own—was
not very ready to concur in this opinion ; but I cannot even
now see any other alternative which gives nearly so
adequate an explanation of the later complications as the
diagnosis above stated.

Great stress was laid upon the absence of fever in this
case, as in the last, but it is untrustworthy as an indication
if taken by itself. In the first case I have narrated, a post¬
mortem examination demonstrated the existence of diffuse
suppurative peritonitis, and the temperature was never above
normal; and the second case appears to have been like it. I
have repeatedly seen the same thing in hospital practice; and
whether from acute plastic peritonitis—as is well known—
or suppuration in the peritoneum, the temperature may give
no sign. I do not say that it never does; I will not even
say that in the majority of cases it never does. I think it
is the other way; but the temperature of peritonitis is an
uncertain one, and in a good number of cases it is not raised.
But this question of temperature is worth consideration in
another way. These cases simulate intestinal obstruction—
nay, to speak more truly, they often are casee of intestinal
obstruction, but it is the obstruction of paralysed peristalsis,
not the mechanical obstruction of volvulus, band, and so
forth. But what we have to determine—and it is most
important to determine—is, which of these conditions exists.
If a volvulus or internal hernia be present^ the sooner the
condition be relieved by the surgeon, the better. Well, now,
I believe the temperature will son > times help us. A few
weeks ago I saw a case with Dr. f airer James where this
point, rightly or wrongly, greatl^f determined our decision.
A healthy youth of seventerf was suddenly taken with
vomiting and abdominal paiff after his tea. He had had
nothing of a notably indigesvble nature to eat. He con¬
tinued to vomit, and next piy walked to eee Dr. Culver
James at his own house. Th^Oowels were confined; an enema
on the third day produced C opious ordinary lumpy stool;
after that the rectum remviuod empty, and no flatus passed
for more than twenty-fov£noura s The tampierature was 101'5°.
Here, then, was a case ot acute vomiting, and con¬

stipation. So far it might well hav^ been either some
internal hernia or a case of local peritonitis. There was no
decided local thickening, although Dr. Jam— had at one
time felt a something ia the cseoal region, bo which spot all
the pain was referred. We, however./ agreed that the
malady was probably inflammatory a*uL‘ typhlitic, because
6f the pyrexia and because of the comparatively moderate
urgency of the symptoms. The subseqde*'‘«5W>f? re88 of the
case, I think, confirmed this view. H* fatinued to vomit
occasionally, but the rectum slowly filled with fsBcal
material, showing that there was par ' ad action, and not
obstruction. The temperature t -II. rnfbowi te then acted
daily, and he seemed almost out* of the wood. Suddenly,
although he had been most carefully tended and treated,
in the disappointing way these cases sometimes ter¬
minate, at the end of ten days the temperature, ran up
again to 103°; sickness again came on; there was more
increase of pain in the abdomen.-aor/mpamed by dis¬
tension ; the pulse became peritonitic, 4Tid be died within
a few hours of acute peritonitis, wy no powers of
persuasion could we get a post-mo—hni. j *

(To be concltuMJ j

At the annual meeting in cwrihexion with the
Bideford Infirmary and Dispensary bn/ the 17th inst-. it was
reported that the total cost of the' new hospital will be
£2135, and of this a sum of £1711 haa already been collected.
The new buildings will be opened on the SLst pros.

Thh Lancht,]

DR. C. H. RALFE ON PHQSPHATIC DIABETES.

[Fbb. 26,1887. 411

>

ON

DISPLACEMENT OF THE INTER-ARTICULAR
CARTILAGE OF THE LOWER JAW, AND
ITS TREATMENT BY OPERATION.

By THOMA8 ANNANDALE, F.R.8.E.,

axaics PB0FE980B or cubical scbskbt, ubivkbsitt or bdikbcboh

Thai the proper movements of the temporo-maxillary
joint may be interfered with by conditions inside the
articolAtion is a fact recognised by all surgical authorities.
Thatadisplacementof theinter-articularcartilage—the “sub¬
luxation " of 8ir Astley Cooper—may be one of these con¬
ditions is also recognised. But most modern works on
-euzgery describe this affection as being generally due either
to relaxation of the ligaments of the joint allowing a too
free movement, or to inflammatory changes of a simple,
gouty, or rheumatic nature. Heath 1 writes upon the subject
thus: “ It is an affection occurring principally in delicate
women, and has been thought to depend upon relaxation of
the ligaments of the joint permitting a too free movement
of the bone, and possibly (though this is conjecture) a slip-

C of the inter-articular cartilage.” Believing with Mr.

,h and other authors that inflammatory results may
cause interference with the movements of this joint, I feel
further convinced that, as in the cAse of the semilunar
cartilages of the knee, the inter-articular cartilages of the
temporo-maxillary joint may become displaced either from
a sudden tearing of their connexions or from a gradual
stretching of them.

But the chief object of this short paper is to advocate
a new method of treating by operation cases of this con¬
dition which resist counter-irritation and the other means
usually advised, and in which there are symptoms of a
too free movement of one or both of these cartilages. The
operation is upon the same principle as that which I have
described and successfully carried oat in connexion with
the displacement of the semilunar cartilages of the knee-
joint. The method is as follows: — An incision slightly
curved, about three-quarters of an inch in length, is made
-ever the posterior margin of the external lateral ligament
of this joint, and is carried down to its capsale. Any small
bleeding vessels having been secured, the capsule is divided,
and the inter - articular cartilage is seized, drawn into
position, and secured to the periosteum and other tissues at
the outer margin of the articulation by a catgut sutnre.
The following two cases illustrate the condition, and also
the good result obtained by the operation suggested.

Case 1.—Mary M‘C-, aged thirty-eight, was admitted

into my wards on March 2nd, 1886. Nine years before her
admission she injnred her temporo-maxillary joints during
<an attack of vomiting. The joints remained “ locked” for a
few minutes, but after a little manipulation she herself put
the condition right. Ever since this time she has suffered
great discomfort in the joint upon the left side, for when¬
ever any extra movement of the jaws was made this joint
became fixed, and remained so until she had practised some
manipulations, when movement returned. Frequently also,
when she tried to open her mouth, she found that she could
only do so to a limited extent, but by using the manipula¬
tions the proper separation of the jaws was completed. On
March 12th an indsibn was made over the left temporo-
maxillary joint, and, its capsule having been divided, the
inter-articular cartilage was found to he loosened from its
attachments, and much more movable than usual. The car¬
tilage, having been seized with artery forceps, was drawn into
position, and a catgut suture passed through it and the peri¬
osteum and other tissues at the outer margin of the joint.
The wound healed rapidly, and she left the infirmary on
March 25tb. At this time the movements of the joint were
natural, and she could close and separate the jaws perfectly,
without any locking or catch:

Case 2. - Ann M——, aged eighteen, admitted on Jan. 20th,
1886. Two years. before admission, the patient when
yawning found her jaws fixed. After a little manipulation
she was able to close the iaws, but with a “ click ” on the
right side. Since then she has suffered from pain and stiff¬
ness upon the left side, and the tiiovements of the joint
were constantly interfered with by something' “slipping”

1 Injuria* and DIMM of the Jaws, third edition, p. 416.

in it. She had been treated by blistering and other remedies
without obtaining any relief. On July 23rd the usual'
operation was performed, and the left inter-articular .car-.
tuage, being found loosened, was stitched in position with a
catgut suture, as in the former case. The wound was
headed at the end of a week, and she left the Infirmary on
July 31st, with perfect and proper movement of the jaws.

PHOSPHATIC DIABETES. 1

By CHARLES HENRY RALFE, M.D. Cantab., F.R.C.P. L.,

ASSIST ABT-PimrOIAll, LOJTOOH HOSPITAL.

Among the numerous investigations that have engaged
the attention of physiologists during the last fifteen years,
few yield in interest and importance to the study of the
part played by the inorganic constituents of the body in
histogenesis, and their influence in producing the daily and
hourly variations which occur in the chemical composition
of the secretions. Although this branch of animal physio¬
logy is only partially developed, yet our knowledge in this
direction is steadily and constantly advancing, and the
advance will be more rapid when it becomes clearly per¬
ceived how greatly minute variations of the inorganic
constituents conveyed by the blood plasma to the cells
influence for good or evil the processes of nutrition going
on in the tissues. I can here only glance at some of the
more important facts that have been established in this
direction, and touch only on those points which are most
closely related to the subject matter of the present paper.

. Twenty years ago it was stated in most text-books that
inorganic substances passed unaltered through the body, and
that the same weight of saline constituents was recoverable
from the urine and feces as was introduced during the
same period with the food and drink. The first advance on
this simple view was made when it was discovered that
chloride of sodium was retained in the body, and conse¬
quently disappeared from the urine, in certain diseases
attended with increased cell-formation; and that even
under normal conditions only four-fifths of the common
salt ingested left the body as such, the renvtining fifth being
decomposed and altered in constitution within the system.
Further researches led to the important discovery that whilst
inorganic salts pass with immense and usually uniform
rapidity into the circulation, and thence to the tissues,
their discharge is by no means so regular, and they are
detained for very unequal periods, which apparently depends
on the need of the tissue to which they are supplied. Thus both
Hoffmann and Lascar have shown that, however great the
tendency of the alkaline bases is to combine with acids and
acid salts, these cannot be withdrawn from the alkaline
blood, but are powerfully withheld to maintain its alka¬
linity. And this fact is illustrated by what qecura in scurvy,
for, as I pointed out in 1877, 2 and it has since been corro¬
borated by Zuelzer, 3 as soon as the alkaline carbonates cease
to be supplied by means of vegetables, the alkaline phos¬
phates begin at once to disappear from the urine, evidently
to maintain the alkalescence of the blood diminished by the
withdrawal of the alkaline carbonates. In connexion with
this it is interesting to notice that Dr. Gee J has likewise
called attention to tbe remarkable fact that in ague, on the
days of the paroxysms, the phosphates almost entirely
disappear from the urine; and although Dr. Gee has not
attempted an explanation of the phenomenon, still it is not
unlikely that this is again an instance of a salt being with¬
held to supply a special requirement, whilst another is being
discharged in excess; for it is important to notice in con¬
nexion with this withdrawal of phosphoric acid during the
ague fit that the chlorides are at that time eliminated in
considerable excess. It would be easy to multiply examples,
but enough has been said to emphasise the importance of
the rv/e played by the inorganic substances in the economy.

Of all inorganic constituents phosphorus has always been
regarded as holding tbe prominent position. When first
Separated from the urine by Brandt (1669) it was at once
hailed by the physiologists of the day as tbe “blood of

1 Head before the Medical 8ociet.v of London, Jan. 10th. 1887.

* General Pathology of 8curvy (Lewi*. London. 18771.

* Hhteranchnngen liber die 8emitogie dee Hum; Berlin, 1881.

4 St. Bartholomew'* Hoepital Be port*, vol. viii.

Google

4l2 The Lancet,]

DR.C.H.RALTE ON PHOSPHATIC DIABETES.

[Feb. 20,1887.

nature,” and quacks held forth that their “wonderful
shining pills ” contained the true elixir of life. The dis¬
covery, at the commencement of this century, by Wool as ton
that certain calculi were composed, some wholly, othere in
part, of phosphate of lime and ammonio-magnesium phos¬
phate, led to further inquiries as to the conditions that
cause the deposition of these substances in the urinary
passages; and to Dr. Prout and Dr. Golding Bird we
are indebted for the discovery of many important facts
connected with phosphaturia. Unfortunately at first suffi¬
cient care was not taken to discriminate between the
conditions which, led to the deposition of phosphate of
lime, and that which caused the precipitation of ammonio-
magnesium phosphate; and as the latter was often asso¬
ciated with paraplegia, or followed after spinal injury, the
idea that phosphaturia was caused by irritation or disease
of the nervous system became dominant, and it was taught
that the phosphates in the urine were derived chiefly, if not
entirely, from the phosphorus of the disintegrated nervous
matter. Dr. Owen Rees was the first to combat the view
that phosphaturia was caused in all cases by excessive
elimination; and pointed out that so far as deposition of
triple phosphate was concerned, it might be accounted for
by the secretion of abnormal mucus, which, owing its
alkalinity to fixed alkali when mixed with urine, united
with the acids of the amujoniacal salts and set free ammonia,
with consequent deposition of ammonio-magnesium phos-
hate. Dr. Bence Jones went further than this: he showed,
rst, that causes of the deposition of the triple phosphate
were due entirely to local conditions, which brought about
an ammoniacal state of the urine from decomposition
of the urea; and the admixture of calcium phosphate
with the triple phosphate (mixed phosphates) was caused
simply by precipitation from alkaline urine, and not* due
to the presence in excess of the phosphates themselves.
Moreover, in that form, of phosphaturia in which calcium
phosphate Was deposited alone from the urine, he declared
the deposition was caused solely by precipitation from urine
whose alkalinity was due to the presence of fixed alkali.
Besides this, he stated that no increase of quantity in the
amount of phosphates in the urine takes place in spinal
diseases; nor in chronic diseases of the nervous system
generally; nor in chronic cases of general paralysis, mania.
Or melancholia; nor in chronic diseases in which the
nervous system is not specially affected; nor in fevers, or
acute inflammations of fibrous, muscular, or cartilaginous
tissues; and that the only decided increase of the phos¬
phates noticed occurred in acute inflammation of the
brain substance, not of the -membranes unless the brain
was likewise affected. He also stated that there was
not the least reason to believe that there was any con¬
stitutional state specially characterised by an excessive
excretion of phosphates, and that the so-called phos-
phatic diathesis was simply alkaline urine.

These views have been generally accepted in England, and
the teaching as laid down in leading modern text-books
is that the phosphaturia in which calcium phosphate is
solely deposited depends on urine alkaline from fixed
alkali, and denotes nothing more than some disturbance
of digestion in which the alkaline tide of the urine
becomes exaggerated; that the phosphaturia in which
both kinds of phosphates are deposited depends on urine
alkaline from volatile alkali which arises from decompo¬
sition of urea in the urinary passages, and which is mainly
brought about by local conditions; and, lastly, that the
excretion of phosphates, even if in excess, has no special
pathological significance. In Germany, however, the im¬
portance of the excretion of phosphoric acid has attracted
more attention; for whilst observers there admit the facts
connected with the deposition of phosphates from alkaline
urine both fixed and volatile, they maintain that the study
of the daily variations of the amount of phosphoric acid,
especially as regards its relationship to the excretion of urea,
has an important bearing on various questions connected with
tissue metabolism, both normal and abnormal. They have
shown, further, that Dr. Bence Jones was mistaken when he
stated that no excessive elimination took place in oh tonic
nervous disorders, since it iB exactly in this class that the
greatest increase has been found, especially in “ depressoil
states.” Besides this, they maintain that the fact or there
being no absolute increase in the excretion of phosphoric
acid does not disprove the view of an increased elimina¬
tion of phosphorous bodies, since they, have very conclu¬
sively shown that in many nervous affections phosphorus

appears in the urine, not in its fully oxidised state
as phosphoric acid, but as lecithin, or as glycerine phos¬
phoric acid. In France Professor Teissier of Lyons, who has.
paid considerable attention to the physiological conditions
which regulate the elimination of phosphoric acid from the
body, has described a 'condition to which he has applied the
term, “ phosphoric diabetes,” and which consists in the con¬
tinuous and excessive discharge of phosphates by the urine,,
attended with symptoms not unlike those of saccharine
diabetes. This condition, Professor Teissier states, may be
observed (1) in certain functional derangements of the
nervous system; (2) it may precede or accompany certain-
affections of the lungs; <3) it may coexist with glycosuria,
or alternate with it; or (4) it may run a course distinct
by itself. As I have seen a few cases like those described
by Professor Teissier, I have ventured co bring them before
tne consideration of the Society to-night, in the hope that
by attention being drawn to the subject it may be more
closely investigated than has hitherto been the case. In
relating the cases, 1 intend to keep to Professor Teissier’e
classification; not because I altogether agree with him,,
but for convenience of reference and discussion. And
again, in order to obviate the necessity of constantly
reading figures of analysis and referring to the amounts oF
phosphoric acid passed, I may say that no case has been
admitted to this series in which the daily average excretion
has fallen below two-thirds more than the ordinary normal-
secretion.

Group 1. Increased excretion of phosphoric acid asso¬
ciated with disturbance of the nervous system. —The first
case is that of a lad, aged sixteen, who was under my care
at the Seamen’s Hospital in 1876. When admitted he was
in a stupid, semi-comatose condition, much emaciated and'
very feeble. He was passing considerable quantities of
slightly acid urine of medium specific gravity containing &
slight trace of albumen, but no sugar. In this case the-
excretion of phosphoric acid was for some time more than
double what a lad of his age and weight (9 at.) should pass
under ordinary circumstances. No other morbid conditions
could be detected ; and, after remaining in bed several days,,
he gradually brightened and began to gain in weight, whilst
the excessive excretion of phosphoric acid fell at first to
two-thirds and then to one-half more than the normal, at
which point it remained till the patient’s discharge.

The next case is the lad whom I have brought before
the Society to-night. I first saw him in September of
last year, in consultation with my friend Dr. Allt of
Clapham. The symptoms were considerable and progressive
emaciation and a dull lethargic condition, sitting for houre-
by himself doing nothing, and being roused to speak only
with great difficulty. He also obstinately refused at times
to take food, which had to be forced on him. No other
special morbid condition could be detected. The urine was
highly acid, normal in quantity, about forty ounces, with &
specific gravity of 1036. The urea was in excess, whilst the.
amount of phosphoric acid was in considerable excess.
Complete rest (either in bed or on a sofa), country air, and
massage were advised, and for treatment bromide of
potassium, nux vomica, and cod-liver oil. The patient-
then went to Melton Mowbray, where be has been under
the care of Dr. Powell, who has kindly from time to time
kept me informed with regard to the case, and sent mo-
samples of the twenty-four hours’ urine to analyse. The
treatment has been varied from time to time, mineral acids-
with strychnine and small doses of opium being that
generally persisted in. Till just before Christmas no¬
improvement was manifested, though the patient was-
certainly less dull; still the high specific gravity was
maintained, and the emaciation was very marked. But
about three weeks since the patient began to take his cod-
liver oil more regularly, and Dr. Powell soon after noted an
increase of weight, whilst the excretion of phosphoric acid
fell to 3 - 9 grammes daily, which for the boy’s age and weight
still represent very nearly two-thirds more than what the
formal excretion should be. I may mention that the
patient has been at times troubled with boils.

In another case, in which the patient was passing on an
average six grammes of phosphoric acid in the twenty-four
hours, a small syphilitic growth was found post-mortem at
the base of the brain, with some softening of the brain,
substance round. As, however, there was an intense polyuria
amounting to thirteen pints a day, with a specific gravity
of 1002 to 1004,1 think some of the increase in this case was
due to tdie washing out of phosphoric acid from the tissue®

Tics Lancet,]

MR. W. H. BATTLE ON PARTIAL BNT&ROCiJLE.

[Peb. 26,1887. ‘413

liy the drainage going on through the body, and is not an
instance of increased tissue metabolism.

Gboup 2. Increased excretion of phosphoric acid associated
with pulmonary disease. —I have met with three cases. The
first, a young gentleman, aged nineteen, who was living in
London engaged in mercantile pursuits. When I first saw
him there was nothing definite to be made out, except that
he complained greatly of lassitude and aching pains round
bis loins. A careful examination of the chest revealed no
■disease. The urine was normal in quantity, of high specific
gravity, very acid, but occasionally becoming alkaline,
when it deposited dense masses - of calcium phosphate. The
urea was in excess and the daily elimination of phosphoric
add considerably above the normal. This patient was
frequently troubled with boils. As he became weaker, and
it was evident that London life did not suit him, I advised a
sea voyage, which I believe he took. Three years later I j
heard through a friend that the patient was dead, that two
years after I had last seen him symptoms of pulmonary
disease manifested themselves, which ran a rapid course and.
terminated fatally.

The second case was sent me by 8urgeon-General Balfour.
A gentleman, aged forty-nine, who had spent the greater
part of his life abroad, was in 1881 troubled with polyuria,
passing about eighty ounces of urine a day. This urine was
acid, and had an average specific gravity of 1015; there was
some excess of urea, and a considerable increase in the daily
excretion of phosphoric acid, fle suffered from thirst, loss;
of flesh, and complained of severe rheumatic pains in the
loins and pelvic regions; he also was troubled with boils.
On my advice he left London and went to reside at Brighton,
and shortly after the urinary flux fell from eighty to sixty
ounces, whilst the excessive elimination of phosphoric acid
was also reduced. After he had resided at Brighton about a
year he began to suffer from cough, and again to iose flesh.
Before this he had exhibited no signs of lung mischief, but
now on examination I found a patch of consolidation in the
apex of the right lung. As it was then autumn I advised
him to winter either in the south of France, Algiers, or Sicily.
He chose the latter, and 1 heard nothing more of him till the
other day, when Dr. Balfour told me he died the next year
at Naples of typhoid fever, contracted at the same time as
the fatal seizure of Professor Munro of Cambridge.

A third case was observed in a tubercular lad who was
under my care at the Seamen's Hospital in 1877. He was
admitted suffering from severe debility and prostration,
complaining of pam in all his limbs, and especially across
the loins, and some coarse rales were heard in the bronchial i
tubes. The urine was clear, acid, and abundant, averaging
■about six pints daily, with an average specific gravity of
1016, urea was in excess, and the phosphoric acid excreted
amounted on more than one occasion to over nine grammes
in the twenty-four hours; whilst the average of several
observations gave nearly seven grammes. Previously to the
commencement of the illness, about three weeks before
admission, he had always enjoyed good health. Daring the
attack he had lost 181b. in weight. After being kept a
week in bed the rales in the chest cleared up, and he was
not so prostrate, but several boils made their appearance.
He regained a greater portion of his lost weight whilst in
hospital, and the urinary secretion was diminished from an j
average of six pints to barely four, and the phosphoric acid
from 9-6 to 4*8 grm. (r# u

A CASH OF

PARTIAL ENTEROUELE (IRREDUCIBLE)
ASSOCIATED WITH DOUBLE HERNIAL
SAC; OPERATION.

By WILLIAM HENRY BATTLE, F.R.C.S.,,

HXSIDKKT ASSIST A3TT-S17BQKOX TO 9T. THOMAS’S HOSPITAL.

It is now nearly two yean since the patient whose case
is related below came under observation, and during that
time I have been unable to find any record of a similar
condition. A good deal of attention has been drawn to the
rarer forms of femoral hernia by the discussions which have
ttfcan place at the various Medical Societies during the last
few months, and I hope that the publication of this case
^ill elicit information With regard ttfothers resembling it

Mrs. D-, aged forty-five, manned, and the mother -of

several children, was sent to me from the country on Monday,
March 17th, 1884, for irreducible hernia. She had had a hernia
in the right groin for five or six years, and had worn a truss,
the hernia being always reducible until lateiy; she could not
state the exact time that it had been irreducible. Pain was
first felt in the swelling on March lOtb, but as this was slight
she did not Bend for her medical attendant until the 14th,
when there was much more pain, the swelling was larger.
And she felt anxious about it. There had been no vomiting,
and the bowels had acted naturally. Ice was applied and
the diet restricted, but there was no improvement.

"When she came under my care there was a femoral hernia
on the right side the size of a large duck’s egg, fluctuating,
but without any particular pain or tenderness. T here was
impulse on coughing, which was probably conveyed from- the
abdominal wall. Ifc was dull on percussion, and extended out¬
wards to within two inches from the anterior superior spine.
There was no abdominal distension, and no vomiting. The
bowels had acted three days before. The tongue was slightly
furred. The pulse was quiet and the temperature normal.
There was no albuminuria, and the internal organs appeared
healthy. - Ice was applied and the legs flexed over a pillow,
milk only being given.

On the 21st there had been no improvement, the swelling
had notdiminished.and the patient was anxious to have some-

Vertic*l mtero-posterior Motion.

1, Aponeurosis of the external oblique. 2, Poupart's liga¬
ment. 3. Falciform process. 4, Fascia lata of thigh.

6, Intestine with lateral projection fnto the canal.

S, 6a, Peritoneum. 7, Larger sac. 8, Firm fibrous mem¬
brane separated from the adherent intestine by the fluid
contained in the smaller sac, 9.

thing done for her relief. Accordingly, with the assistance of
Mr. Edmunds-and Mr. Tyrrell (who administered ether), an
incision was made, about two inches long, over the sac and
rather to its inner side, the dissection carried down to the
sac and then opened on a director, when there was an escape
of from three to four ounces of yellowish fluid, which soon
coagulated after removal from the body. A small projection
about the size of a filbert was then seen occupying the
position of the femoral ring, the surface of which was dull-
purplish in colour, smooth, but slightly irregular, and quite
adherent all round. It did not appear to be intestine.
Careful incision proved this to be a thin, tougb, fibrous mem¬
brane, which was separated by a layer of fluid from a small
projection of the intestinal wall; which was firmly adherent
to the crural canal all round and irreducible, purplish in
colour, in a good state of vitality, but with less than the
usual,clearness of polish. As this was evidently not strangu¬
lated, and there appeared considerable danger of tearing it
by any attempt to separate the strong adhesions, it was left
in situ. The membrane was removed with scissors, the sac
wall dissected up, excess cut off, and the remainder closed
over the adherent intestine by means of catgut sutures.
Two split drainage-tubes were employed, one being placed
under the new sac and the other in the space left after the
dissection of the old one; these were brought out below and
the wound dosed with catgut and silk sutures. No vessel
required ligature. The carbolic spray was used when the
sac Was opened, and full antiseptic dressing employed. The
patient was rather faint towards the close of the operation,
but soon recovered.

The after-progress of the case was satisfactory and

Di

Google

414 The Lancet,]

DR. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA.

[Feb. 28,1887.

recovery uninterrupted. The wound was dressed twice,
the inner tube being removed at the first dressing on the
evening of the following day, and the outer with the sutures
at the second dressing a few days later. A pad and bandage
were then applied for a time. The patient was not advised
to wear a truss, and left my care on April 6th.

The rough diagram on the preceding page will probably
assist in understanding the condition of the parts as found
at the operation.

We have here three conditions which in my opinion
deserve special comment, and are each of great rarity:
(1) The partial enterocele; (2) the membrane which by its
position divided the sac of the hernia into two parts; and
(3) the distension of these sacs by fluid.

Before the operation my diagnosis was, distension of the
hernial sac by fluid, secondary to the blocking of the canal
by a piece of omentum. The complete absence of symptoms
in connexion with the intestinal tract made it unlikely
that there was intestine present, and the absence of resonance
on percussion pointed in the same direction. At the opera¬
tion the condition described above was revealed, and from
the small amount of the intestinal protrusion, and its firm
adhesion without the causation of any symptom, there can
be no doubt but that it was a partial or lateral enterocele,
or, as some have preferred to call it, Richter’s hernia.

It is difficult to account for the presence of a membrane
of such perfect formation in the interior of the sac of a
hernia; tough, fibrous, and inelastic, it did not give the
impression that it was of recent date, and this makes the
explanation of the pathology of the case lees easy. It
has appeared to me that possibly its origin was due, in
the first place, to a limited but complete inflammatory
adhesion of the neck of the sac just external to the canal,
following irritation produced by the pressure of a truss,
subsequent stretching of this adhesion by internal and
external pressure, the former caused by the frequent
attempts of the gut to descend the canal, and that from
without by the pressure of the truss aided by the presence
of fluid in the old hernial sac. There was, however, no
evidence of this, and the membrane, which was of the
thickness of writing-paper, did not appear to slope away at
its insertion, but was as distinct as the attachment of the
parchment of a drum, and was smoothly lined on both
surfaces. By the presence of this membrane, whatever
may be the explanation of its origin, and by the adhesion
of the intestine to the crural canal, two sacs were formed,
each of them being in a condition for the production of
what is known as hydrocele of the hernial sac—a condition
so rare that Mr. Langton, in his remarks on a case, 1 stated
that he had only found a record of the one case which he
was describing out of almost 7000 cases of femoral hernia
recorded by the Truss Society during a period of eighteen
years. The fluid in these sacs was probably much of it the
result of recent irritation, but thebe -was no evidenoe of
actual inflammation at the time of operation.

PYKJEXIA AND ItYEEJlPYREXIA.

By T. J. MACLAGAN, M.D., M.R.C.P.,

PHYSICIAN IS ORDINARY TO THEIR ROYAL HIGHNESSES PRINCE AND
PRINCESS CHRISTIAN OF SCHLBSWIS HOLSTEIN.

The physiological facts which have to be kept before us
in considering the theory of fever are as follows1, Two
main processes are constantly going on in the system-
tissue formation and tissue disintegration; 2. During tissue
disintegration there are formed -various products destined
for elimination; the chief of these are urea, carbonic acid,
and heat. _ 3. ;Urea is eliminated by the kidneys, carbonic
acid by the lungs, and heat by the skin. 4. lathe ease of
each, production and elimination are to .tpell balanced that
' no oci)uiJridlrtionta3rm place in the s y st em. 6. In the case
‘ iHHance is so well maintained that the normal

always the same ,(98 4° F.). , !

1 - In £e*er .the. whole process is disturbed; there is incroaied
-formation;.of urea and carbonic acid, and the temperature
rises, abovte, 98-4°., This rise of,i temperature is regarded as
. :the .pathognomonic feature Df fcheietarite state* and it^exfceat

ilHaporU^wir,*.*;

| as the index to the amount of febrile disturbance. All theories
of fever essentially consist in an attempt to account for this
rise. The readiest and most natural way of doing so is to
attribute it to increased activity of the processes which
keep up the normal temperature. We accordingly And that
the most generally accepted of the modem theories of
fever—the 60 -called combustion theory—is that which
attributes it to such increase. “Fever,” says Virchow,.
“ essentially consists in elevation of temperature, which must
arise from an increased consumption of tissue.” Lieber-
meister defines it “ as a symptom-group, at the foundation
of which is an elevation of the temperature of the body
produced by a morbid general increase of metamorphosis.”

The evidence of increased tissue metamorphosis in fever
is the wasting of the tissues, and the increased elimination
of urea and other excretory compounds. This distinct
evidence of increased tissue metamorphosis, and the un¬
doubted competence of this to cause a rise of temperature,
are the foundations on which this theory of fever rests. If
this expressed the whole truth, and if fever simply consisted
in increased heat due to increased tissue metamorphosis,,
the amount of febrile disturbance ought to bear a direct
relation to the extent of the tissue disintegration, and the
quantity of excreta eliminated would be directly as the
amount of fever. The fact that such is not always the case,,
and that the amount of urea excreted does not always rise
and fall with the rise and fall of the temperature, has cast
doubts on the accuracy of this theory, and led observers to-
seek for some other explanation of the rise of temperature.
The combustion theory is not discarded, but it is regarded
as inadequate to explain all the phenomena which present
themselves in fever; and the more one studies these phe¬
nomena at the bedside, the more apparent does it become-
that increased tissue metabolism is not enough to explain,
them all.

In 1863 Traube advanced the hypothesis that the rise of
temperature was due to retention of heat consequent on
contraction of the minute arteries. Liebermeister and
Leyden demonstrated the inaccuracy of Traube’s hypothesis,
and by a series of careful observations showed that the
febrile body does give ofF more heat than the non-febrile—a
fact already made familiar to every clinical observer by the-
greater sense of heat felt by the hand placed under the bed¬
clothes o£ a patient suffering from fever, as compared with
that felt in the case of the non-febrile. Ten years later
Senator revived Traube’s hypothesis in a modified form. He
supposed that there are periodic diminutions of loss of heat,
together with a constant, though not great, increase of
heat production. But this is mere hypothesis, and is
opposed to the facts observed by Liebermeister and Leyden.

ft seems to me that there is really no valid reason for
supposing that during fever the mutual relation of heat-
. production and heat-eJimination is materially altered. That
there is increased production of heat is undoubted; but a
careful consideration of the facts with which we have to
deal shows that increased production is met by increased
elimination. The range of the temperature in fever lias its
limits, just as that of health has; the range is wider and
more variable, it is true, but still it has its recognised limits.
It could not be so limited were the increased production of
heat which causes the rise not met by increased elimination.
In. health an adult produces in half an hour heat enough to
raise the temperature of his body 1 C C. Were heat to go on
being formed uninterruptedly at this rate, without any
elimination, the body woHld rapidly become verv hot, and
would reach the boiling point in thirty-six hours. As it is,
the heat does not exceed 98*4°. > IA fever the amount of heat
produced is much greater. Were this increased production
to go qu with only the normal elimination of health, the range
of febrile temperature would have no limits—the temperature-
wouid go on rising^ day by day till ib reached a point which
was incompatible with the. continuance of life. As it is, the
temperature in fever rarely reaches 106® F., and the immense
majority of fever patients recover. In typhus fever the
maximum temperature is reached by the fifth or sixth day,
but the fever goes on for a week or ten days more, all the
symptoms increasing in severity: but in very few cases is a
higher temperature noted during the second week than was
observed before the completion of the first, and yet all that
time:there re marked wasting of the nitrogenous tissues and
increased SUAgnation of urea. The fever process, with its
increased nietataprphGSiiand increased heat production, con-

I i.,.i i-Xondoii’ Physiology, p. 446. . , - , .'•«

THE Laiccbt,] DR. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA. [Feb. 26,1887. 415

tin use in fall swing, but the temperature does not rise—
clearly showing that there is no accumulation of heat, and
that increased production is met by increased elimination.
In typhoid fever the same thing is observed. By the tenth
day, or even earlier, the temperature generally reaches a
height which is not exceeded during the remaining course
of the fever, and an attack of typhoid may go on for three,
four, or five weeks without having a higher temperature
than was noted at the end of the first: clear evidence
that the increased formation of heat, which keeps the tem-
ratore np, is counterbalanced by increased elimination,
hy is this? Why should the temperature rise rapidly
during the first few days and not go on rising ? The same
cause which made it rise daring these days continuing in
full operation, why should there not be the same result ?
The stagfc of invasion of a febrile attack is that at which
the tot symptoms of the action of the poison on the system
are felt. The earliest indication of this action is a feeling
of cold and misery—a desire to hug the fire. The cause of
this is contraction of the minute arteries of the skin. The
feeling of cold to which this contraction gives rise is a
mere subjective sensation; at the time at which it is felt
the temperature is really above the normal—may be, several
■degrees. Besides this subjective sensation, another result
of this spasm of the minute arteries of the skin, that which
concerns us at present, is decreased elimination of heat. It
is by the skin that heat is normally eliminated; contrac¬
tion of the cuticalar arteries, by diminishing the flow of \
Wood to the surface, produces a corresponding and con- i
sequent decrease in heat elimination. While the condition
of the cuticular vessels thus interferes with the free
elimination of heat, Wie fever-producing cause is at work
in the system, causing heat to be produced there in more
than normal amount. The inevitable result is the undue
accumulation of best in the system and a rise of temperature.

This is what takes place during the early days of a febrile
attack. In the course of a few days the spasm of the
minute arteries passes off, the blood again flows freely
through them, the heat-eliminating function of the skin is
thus restored, and keeping pace with heat production,
prevents a further rise of temperature. Thus is to be
eiplained the fact that in typhus fever the temperature
reaches its maximum by the fifth or sixth day, rising little,
if at all, after that time. It rises up to that point because
there is increased formation of heat, and because the con¬
dition of the skin renders impossible a corresponding
increase in elimination; it ceases to rise after that time,
when the blood again circulates freely through the skin—
not because the fever-producing cause has ceased _ to
act, but because the mutual and normally counter balancing
relations of production and elimination are reetored, and
increased production Is met by increased elimination.
When the fever comes to an end, and heat production
returns to the standard of health, there is still in the system
» more than natural amount of. the excretory products ;
formed daring the last days of its oontinuance—the chief of ,
these are urea and heat; we consequently find that the |
phenomena of defervescence essentially consist in increased j
action of the kidneys and skin, the former evidenoed by the j
loaded condition of the urine, the latter by the perspiring
aria sad rapidly falling temperature. Taking this view of j
the nature of heat—regarding it as an excretory product
requiring to be eliminated,—it is evident that increased
formation of heat must give rise to increased elimination so
long as the skin can perform its functions. Increased
formation of any excretory product leads to stimulation and
increased activity of the organ by which it is eliminated.
Tresis the natural stimulant to the kidneys, and its injection
iato the circulation gives rise to increased activity of theee
organs and an increased flow of unne. Carbonic acid excites
J-he respiratory centre, and ite increase in the blood causes i
increased activity of respiration. In the same way increased
formation of heat gives rise to increased activity of the
'ieat-«Hminating function of the skin; hence it.is that
before an attack of -fever has lasted many days increased
formation of heat is balanced by increased elimination, and
no further rise takes place, though the -fever process
continues unabated.

Such ere the facte. Daring the continuance of the febrile
process there ie increased tissue disintegration and oonee-
quenf increased formation and elimination of the prodoet«
of such disintegration. The chief of these are urea, carbonic ,
ecid, sod heat. The so-called combustion theory is simply -
s& exposition of theee facts. It is not a theory of fever in |

the sense of being an explanation of the mode of production
of the febrile state; it is merely an attempt to explain one
of the phenomena of that state—increased body heat. But
a theory of fever to be satisfactory must not only tell os
what are the essential phenomena of the febrile process; it
must tell us also how the process is originated. If the first
step in the production of fever be increased tissue-change,
the first requisite to a satisfactory theory of fever is that it
should account for this change; this the combustion theory
as hitherto expounded fails to do; it gives a reasonable
explanation of the leading phenomenon of fever—rise of
temperature; but offers no explanation of what, according
to this theory, is the cause of this rise, and therefore a prior
step in the production of fever—increased tissue change.
We accept the combustion as a fact, but in accepting it we
ask for an explanation of its occurrence. We see that the ■
fire is burning, and we recognise the results of the com¬
bustion ; but we want to know how it originated, and who
applied the match that set it a-going? This manifest short¬
coming of the combustion theory did not escape the obser¬
vation of oven those who are its chief exponents. To; his
definition of fever, that it “ consists essentially in elevation
of temperature, which most arise from an increased con¬
sumption of tissue,” Virohow adds the rider that this in¬
creased consumption “appears to have its immediate cause
in alterations of the nervous system.” But whence these
alterations, and what are they ?

It has been suggested by Dr. Ord* that the rise of
temperature in fever may be partly due “ to the persistence
in the form of heat of energy which should have taken
another form.” In fever, tissue-formation is practically in
abeyance, and his suggestion is that, as in health the process.
of tissue building uses up heat, its oessation leads to the
liberation of heat enough to raise the- temperature of the
body. But does the process of tissue-building use upbeat
and itB oessation liberate it? In support of bis-assumption
that it does so Dr. Ord adduces no evidence, and frankly
admits that there is none. That a small amount of heat may
be absorbed dining the formation of some of the inter¬
mediary products of tissue metabolism is generally admitted,
but the question raised by Dr. Ord is not whether or not
heat may be absorbed during the formation of these
products, but whether or not it is absorbed during tissue
formation—a totally different question. It is contrary to all
physiological law to assume that a product of retrograde
tissue metamorphosis, an excretory product, as heat un¬
doubtedly is, should be freely used in tissue formation. The

E osition is essentially and physiologically unsound; and
>r. Ord’s suggestion that by the cessation of the processes
of tissue formation heat is “ left to run wild” cannot but be
regarded as an exaggerated and inaccurate estimate of any¬
thing that can possibly take plaoe m the way of heat
liberation. His observations on the relative temperatures
of growing and ripe cucumbers are beside the mark. We
are dealing with animal heat, and even in this the question
for consideration is hot so much whether heat may be
ab8orbedj but whether during tissue formation it is absorbed
in quantity sufficient to lower the temperature of the whole
body several degrees. If there is not absorbed daring tissue
formation enough heat to lower the temperature several
degrees, there cannot, when tissue formation ceases, be
liberated enough to raise it several degrees. But even the
acceptance of Dr. Ord's hypothesis would not materially
better our position so far as our knowledge of the causation
of fever is conoemed. “Rise of temperature,” says Dr. Ord,

“ results partly from the cessation of tissue formation.”
But why does tissue formation cease? Dr. Ord’s hypo¬
thesis is based on an unsound physiological -assumption.
There is no good reason to regard heat as other than
essentially excretory in nature; and the more we keep this
physiological fact before ue in investigating the phenomena
of the febrile state, the less liable shall we be to fall into 1 '
error, and the more likely to interpret aright the'complex
and varied phenomena which go to constitute that state.

. Dr. Ord’s hypothesis, though it cannot be accepted as
. tenable, or as affording any relief to the difficulties by which
we are beset, is an expression of the existence of these
difficulties, and of the fact that there is much in the
phenomena of the febrile state which the combustion
theory does not euffioe to explain. It is a call for move
light.

It is since the combustion theory of fever was pro-
* Brit. Med. Journal, vol. 11.. 1886.

4L6 The Lancet,]

HOSPITAL MEDICINE AND SURGERY,

[Fkb. 26,1887.

pounded tb&t the thermometer has come into general use as
a means of clinical research. By its aid we have not only
acquired a more accurate knowledge of the range of tem¬
perature in ordinary febrile and inflammatory ailments, but
have also gained much information regarding the clinical
history of other morbid conditions. Among the most
important of the results which have accrued from its use is
the recognition of the condition to which the term hyper¬
pyrexia has been applied. In ordinary fevers and inflamma¬
tions the temperature rarely reaches lu6° f and 105° is
looked upon as very high. Hyperpyrexia essentially con¬
sists (1) in a temperature which runs .up, generally very
quickly, to 107°, 108°, 109°, 110°, or even higher; and (2) in
the coincident development of alarming nervous symptoms,
usually resulting in death by coma. Hyperpyrexia is not a
disease oer se, but an incident occurring in the course of
other ailments. The recognition of this condition, of the
circumstances under which it arises, and of the phenomena
which go to constitute it, has probably done more than any¬
thing else to shake confidence in the combustion theory of
fever; and no wonder, for it is apparent that, while
that theory of fever may afford a fairly adequate explana¬
tion of the rise of temperature which occurs in ordinary
pyrexia, it is quite incapable of explaining the condition
which has to be dealt with in hyperpyrexia. The rapidity
with which the temperature attains such a height, the
absence of the other evidences of such increased tissue dis¬
integration as should from this view accompany so great a
rise, and the fact that hyperpyrexia rarely occura in those
fevers in which the evidence of increased tissue disintegra¬
tion is most pronpunoed, show that the combustion theory
of pyrexia does not suffice to explain the phenomena of
hyperpyrexia. Tyrexia and hyperpyrexia have been linked
together clinically and pathologically, and looked upon as
different degrees oi the same condition, allied both in nature
and causation. The inadequacy of the combustion theory
to explain the occurrence of hyperpyrexia has thus materially
weakened its foundations as a theory of pyrexia, and the
necessity for finding some other explanation of the very
high temperature of the former has led to the enunciation of
new views as to the causation of the more ordinary tempe¬
rature of the latter.

But it is.by no means certain that we are right in thus
linking these two conditions so closely together, and in
looking for one common explanation of both. Their clinical
histories are so dist inct, and the circumstances under which
each occura so different, that we are scarcely warranted,
without some very special reason for doing so, in assuming
similarity of causation. No such special reason exists. The
only bond between them is the occurrence in each of a
higher than normal temperature ; but our knowledge of the
mode of production of febrile temperatures is not such as to
warrant us in saying that there is only one way in which a
rise can be produced, that all rises of temperature are due to
one cause, and that pyrexia and hyperpyrexia are due to the
operation of this cause acting in different degrees. Were
thi/3 the case—were hyperpyrexia merely an exaggeration of
pyrexia, and produced by the same agency,—we should find
pyrexia running into hyperpyrexia much more frequently
than it does, and hyperpyrexia would be most common in
ailments in which pyrexia is most pronounced and most a
source of danger.. Typhus, typhoid fever, relapsing fever,
cerebro-spinal fever, scarlet fever, measles, pneumonia, peri¬
tonitis—those diseases, in ehort, in which pyrexia is most
pronounced, prominent, and prolonged—are the ones in which
hyperpyrexia would most commonly occur were this view
of its nature, the correct one. But it is rarely met with in
these maladies, and when it does occur is regarded as not only
a rare but an accidental complication. The physician finds
hyperpyrexia occur,notin connexion with the continued fevers
or severe inflammations, but in cerebral haemorrhage, in heat
apoplexy, and in those cases of acute rheumatism which
are accompanied by cerebral symptoms—what used to be
called cerebral rheumatism. The surgeon finds it not in
long-continued or severe inflammations of wounds, bones,
veins, _&c., but in certain injuries of the cervical cord
involving little or no inflammatory disturbance. One point
in the clinical history of hyperpyrexia is specially pro¬
minent-the association with the very high temperature
of prominent nervous symptoms. This association is all
but invariable, and such symptoms are as essential a part of
the morbid condition to whioh we apply the term
hyperpyrexia as is the very high temperature to which it
owes its name.

The question at once arises. What is the mutual relation of
the higb temperature.and the cerebral disturbance? There
are two views on this point: one, that the high temperature
is primary and the nervous symptoms secondary; the other,,
that the nervous disturbance is primary, and the high
temperature a consequence of it. According to the former,,
the high temperature of the blood causes disturbance and
ultimately paralysis of the nervous centres. 3 But were this
the sequence of events, the prominence of the nervous sym¬
ptoms would be directly as the height of the temperature,
and such symptoms would be most marked in ailments in
which the temperature runs highest; but such is not the
case. Isolated cases of disease are on record in which very
high temperatures have been noted without coincident
nervous symptoms; but, leaving out of account these rare
and exceptional cases, we need only turn to the clinical,
history of relapsing fever for decided evidence that high
temperatures do not necessarily produce serious disturbance,
of the nervous centres. In that fever it is not an uncommon
thing for the temperature to run up to 100°, 107°, or even 108°,
without the occurrence of any symptom other than this
high temperature to distinguish cases in which it occurs from
cases in which the temperature never exceeds 103° or 104°_
“ A circumstance of some importance in the pathology of
pyrexia is the fact conclusively established by many inde¬
pendent observers that these high temperatures in relapsing,
fever entail little or no danger to the patient, and do not
roduoe serious cerebral symptoms” (Murchison). Did a.
igh temperature of the blood have on the nervous centres
the disturbing influence attributed to it by Liebermeiater
and others, head symptoms would be a prominent feature
in these cases of relapsing fever with nigh temperature.
But such is not the case; for head symptoms are much less-
prominent in them than in typhus and typhoid fevers, in
whioh the body heat is several degrees lower.

(To bo continued.)

% lltirar

HOSPITAL ^PRACTICE,

BRITISH AND FOREIGN.

Nollaautera eat alia pro oerto noscendl via, nisi quamplurimas et mor-
borum at dlsieotlonum hlstorlas, turn aliorum turn proprlas collect**'
habere, et Inter (a oomparare.—MoHaaosi Do Sod. tt Cam. Mori.,
Ub.lv. Procaoalnm. - - -

GUY’S HOSPITAL.

8EVEN CONSECUTIVE CASES OF, CHARBON TREATED

successfully by excision ( continued ).

(Under the care of Mr. Bryant.)

In the last issue of Tiik Lancet (pp. 367-8) we published 5
cases which form the commencement of the series which is
here continued. The period which had elapsed from the
apparent beginning of the disease until the patient came-
under care varied from one to six days, and the efficacy of
the treatment by excision is again confirmed by the marked'
improvement which immediately followed its adoption, and'
the ultimate good result iu each case.

Case 3. Charbon of neck with great oedema and lymphatic,
enlargement: excision, follmotd by severe pyrexia; cure.

(From notes by Messrs. Beard and J. W. Roberts.)—J. M-,

aged fifty, a waterside labourer (and he occasionally has to-
handle foreign hides), was admitted on Oct 31st. Family
history good. On the previous Tuesday (Oct. 27th) the
patient felt a pimple situated about the angle of the jaw on
the left side. The swelling increased very much in size on.
the Friday and Saturday following. He does not remember
having scratched or out himself. He had the same clothes
on the day that he noticed the pimple as he was wearing a
month previously, and then he had been handling some-
hides from foreign parts.

On admission the patient looked a strong healthy man.
There was a swelling on the left side of his face about
the angle of the jaw; it presented a dark central spot
surrounded by a circle of vesieles, and beyond this the

3 Liebermeiiter: Deutecb. Arcfa- fur Klin. Med., vol. I., 1858.

o

Di.

The Lancet,]

HOSPITAL MEDICINE AND SHKjGEKY.

[Feb. 26,1887. 4l£

swelling was red and (edematous. Mr. Targett found
abundant bacilli anthracis in the discharge.

Oot. 31st.—Mr. Bryant at 8 o’clock, this afternoon removed '
the pustule and a good deal of the surrounding structures;
one artery bad to be twisted. The wound was after¬
wards washed with carbolic acid, 1 in 1, dressed with dry
gauze, and a sponge placed over it. Evening temperature
104°.

Nov. 1st.—Ordered five grains of sulphate of quinine
every four hours until the temperature falls; to have milk
and ice, and four ounces of brandy. The patient to be
sponged if his temperature goes up to 104°. Ten grains of
colocynth and hyoecyamus'to be given at once, also fifteen
grains of antipyrin, to be repeated in four hours if neces¬
sary.

2nd.—1230: Ordered eight minims of kinate of quinine
(solution of kinate of quinine, one grain in four minims).

3 M: Injection of eight minims of kinate of quinine. The
patient has had ice applied to bis head; his bowels are open.

8th.—Ordered compound acid mixture.

9th.—Patient got up in the evening for the first time; he
felt rather weak. Temperature normal. There is a slough
at the bottom part of the wound; the- upper part looks
very well. There is still oedema below the wound.

Dec. 3rd.—The skin below the wound became undermined,
and a large slough formed. This has been coming away in.
small pieces with the discharge for the last three weeks; it
has now nearly all gone, and the wound looks quite
healthy.

6th.—The slough has now gone, and there is only a slight
discharge from the wound. The inflammation around the
■wound has subsided.

Case 4. Charbon on right cheek, with oedema of neck;
■excision: application of pure carbolic acid; cun. (Prom

-notes by Messrs. Elliott and H. P. Ainsworth.)—W. H-,

aged fifty-one, a skin porter, was admitted on Jan. 21st.
The patient carries hides; these are from China, Australia,
Bombay, the Cape, &c. On January 16th he noticed a
-stiffness and tightness of the skin on his right cheek; on the
17th this was more apparent, and on the 18th a vesicle
formed. On the 19th this burst and some watery fluid
-came away. There was bat little pain in the cheek. The
patient kept at work until the 20th. Poultices had been
applied to bis cheek.

On admission the temperature was 99°. The patient
has not been sick. On his right cheek, about one inch in
front of the lobule of the ear, is a circular patch three-
quarters of an inch in diameter. There is a small black
eschar in the centre of the patch about the size of a pea
around this, especially at the anterior and lower parts, is a
cone of vesicles, becoming confluent; around this, again, is
a zone of redness, which gradually fades off into the sur¬
rounding parts, which are oedematous. The oedema extends
forwards to the angle of the mouth and backwards and
-downwards into the neck. An enlarged gland can be felt
below the body of the jaw.

Jan. 21st. —Chloroform was administered; Mr. Bryant cut
out the skin and subcutaneous tissue around, including the
-eschar, by an incision about one inch in diameter and
three quarters of an inch in front of the lobule of the ear;
there was very little bleeding and only one vessel was
twisted. Pure carbolic acid was applied to the raw surface,
and the wound was then dressed with iodoform strips and
gauze. Several attempts were made to find bacilli in the
s er um exuding from the vesicles, but none could be found;
at last, however, three were found in one slide, but they were
-not certainly anthrax.

22nd.— 1 There was but little bleeding; the wound was
-dressed to-day and looks clean and well. Patient is not in
orach pain. He was ordered quinine and iron mixture with
infusion of calumba three times a day.

28th.—The small gland near the angle of the jaw has in¬
creased in size and become very hard; the skin over it is
tens e . Evening temperature 100°, the highest recorded.

81«b—The discharge from- the wonnd is very slight; the
-enlarged gland is slowly decreasing in size.

Pe&i 8tn.—The wound is circular, about the size of a
penny and the granulations are small, healthy, and level
with t b fr iarfa oe. The enlarged gland ie still firm and hard,
asms tskbe decreasing.

-• E2th;—Ttottwmfi is-now about the size of: a. halfpenny,
the r W h tssS around the wound is fading away, and the ea-
SMit'fci SMrtfc&maller arid softer. • ■ '

went ttx-a . convalescent-’hometo-day.

The wound is about the size of a sixpence, and covered with
healthy granulations; the gland behind the jaw is smaller,
and soft.

Case 6 . Charbon on the left side of the neck; excision;
application of carbolic acid; cure. (From notes by Messrs.
Taylor and Coombe.)—J. B—-, aged thirty-two, a skin-
dresser, was admitted on April 14tb, 1886. On April 5th the
patient felt a pain on the left side of his neck. This pain
seemed to pass down his neck. He thought it was only a stiff
neck. On the 8th he noticed a small pimple in the region of

in size, and became more painful. On the 12th he saw a
doctor, who treated him for carbuncle, and ordered poultices
to be applied. He got no relief from the poultices. On the
13th he went to work, but was obliged to leave off.' When
he woke on the 14th he was unable to raise his head, and
had great pain in his-neck.

The patient is a strong, healthy-looking man. On the
left side of the neck, at the posterior margin of the stemo-
mastoid, and about two aud a half inches below and behind
the lobule of the ear there is a swelling about the size of a
florin, slightly raised above the surrounding skin. There
is a black spot in the centre surrounded by a zone of red¬
ness, outside of which, entirely surrounding it, is a complete
circle of vesicles containing clear serum ; the tissues around
are all swollen, and have a red brawny appearance; the
swelling extends some three or four inches around. Shortly
after admission chloroform was administered, and a circular
incision was made round the swelling, and the whole
removed. There was not much bleeding. Pure carbolic
acid was applied.

April 15th.—The patient seems much relieved since the
operation. Ordered sulphate of quinine (three grains), with
dilute sulphuric acid and infusion of gentian, three times
a day.

16th.—The patient slept better last night, and says he
feels better.

27th.—The patient now gets up every day, and has gone
out of doors for a short time. Wound looking well; granu¬
lation healthy.

May 8th.—The patient is not so well this morning; com¬
plains of headache, and has occasional shivers; he is
thirsty. Temperature 100°. There is a little redness to
be seen round the wound, but its extent is very small. To
keep in bed.

Case 6. Charbon on the right cheek, with lympathic enlarge¬
ment ; excision, and actual cautery. (From notes by Mesere.
Metzgar and Meares.)—W. D—aged fifty-four, a labourer
in a hid« warehouse, was admitted on June 10th. On the
9th he noticed a small lump on the right cheek, about an
inch above, and external to, the corner of the mouth ; it was
hard, aud had- a bright-red spot at the apex; it was not
painful, but irritating. On examination of the cheek, there
was seen a small elevated papule; it consisted of a small,
dark-coloured central spot, surrounded by a ring of vesicles
secreting a clear serous fluid, outside which was an area
gradually running down to the surrounding skin levels, and
outside this again a third circle, which showed a reddish,
bluish colour, gradually fading out into the surrounding
tissues. The patient was put under chloroform at once, ana
the papule dissected out, and removed between two circular
incisions, There was slight bleeding from a small artery.
The actual cautery was applied to the wounds.

June 12th.—The patient feels weak and sick; his sub¬
maxillary glands, especially on the right side, are enlarged.
Temperature 99 6°. Urine clear, and light in colour; reaction
acid; sp. gr. 1008; no albumen, sugar, blood, or pus.

13th.—Temperature 99°. Patient is sick and weak,
glandular swelling less. A sixth of a grain of morphia, was
given subcutaneously, and aperients ordered.

14th—Temperature 996°. Patients Bays he feels weaker
and not so comfortable. Bowels very confined; no action
since admission.. • ...

15th.—Bowels opened last night and again this morning.
Temperature 100 . Glands smaller. Patient’s appetite
poor. He is in pain it he moves his jaw.. There is a
strong' history of gout. He has gout in the right knee
and foot; ankle- a little swollen and inflamed;, knee is not
swollen. A mixture containing vinum colqhici and alkalies
ordered. , *

17th.—Knee painful. Temperature 99 - 6°. •

25tli.—Wound healthy; granulating freely. -

July lat.T*-Patient got up for an hour or two yesterday.

DiaitizedbvGoOoIe

418 The Lancet,]

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

[Fbb. 26, MW.

Case 7. Charbon of face, with surrounding oedema;
excision; cure. (From notes by Messrs. W. F. Clarke and

W. C. Swayne.)—F. T-, aged twenty-three, a worker in

a dye-house of a leather merchant, was admitted on
Dec. 23rd, 1886. On Dec. 20th a small pimple came at the
root of the nose. On the 21st, whilBt at work among
leather, he picked the top off the pimple, and he says a
hard morsel like a crystal of brown sugar came away
(possibly hardened serous effusion); after this bis eyes
began to ache, and were swollen under the lower lids.
On the 22nd the pimple became more painful, and the
swelling under the eyelids increased.

There is a small sore at the root of the nose in the median
line, about the size of an ordinary shirt-button in circum¬
ference, and for a small area around the part affected it is
indurated and swollen. Underneath the eyes it is much
puffed, and the parts are very painful. No enlarged glands.
No vesicles to be seen around the sore. Some of the fluid
from the sore was examined, but no bacteria could be
found. Urine acid; sp. gr. 1016; no albumen or blood.
Temperature 99’4°.

After admission, chloroform having been administered, a
circular incision three-fourths of an inch in diameter was
made round the sore, and the whole of the tissues excised
down to the bone. Very little bleeding occurred. The
wound was washed with iodine lotion, and iodine dressings
applied.

Dec. 26th.—Wound looking well; no pain. The swelling
under the eyelids is almost gone. Temperature normal.

29th.—The patient gets up and remains about the ward
all day. No sign of inflammation around the part. The
cedema of the face bas entirely disappeared.

Jan. 4th, 1887.—The patient has been going on very well.
Wound looking healthy and filling up; but at 7 o’clock this
morning he had a rigor, and was put to bed, with hot-water
bottles to his feet. 11 a.m. : Still has a fit of shivering come
over him now and then. Temperature 99^; skin feels hot
and moist.

7th. —Patient discharged well.

DEVON AND EXETER HOSPITAL.

tJNILOCULAR OVARIAN CYST IN A GIRL AGED THIRTEEN;

OVARIOTOMY; REMARKS.

(Under the care of Mr. Bell.)

Fob thb notes of the following case we are indebted to
Dr. A. Blomfleld.

Edith G- was admitted on Aug. 19th, 1886, with a

fluctuating abdominal tumour. The girl was very small and
undeveloped for her age, and had never menstruated. About
four months before her admission she complained of pain in
the left iliac fossa, which she describes as “like stomach¬
ache.” The pain was afterwards felt higher up and on the
opposite side of the abdomen. She is certain that there was
no enlargement at this time, but that shortly afterwards the
abdomen began to enlarge and increased somewhat rapidly
to its present sire. There has been no jaundice, vomiting,
or oedema of the legs.

State_ on admission. —The abdomen is much enlarged,
presenting a somewhat barrel-shape appearance. The
superficial veins are not prominent, nor is there any oedema
of the walls. The circumference of the abdomen, one inch
above the umbilicus, is thirty-two inches; the lelt side
measuring three-quarters of an inch more than the right,
«W»d the measurement from the left anterior superior iliac
spinetotbe ldwer border of the sternum is half an inch
more than from the opposite spine. There is complete
aoittess over the part of the abdomen to the level of the
fewer border of the sternum; the left flank is quite
resonant, the right somewhat less so. There is resonance
bvtsr the left Iliac region, but the right fossa is abso-
Hrtaiy dull. There is a distinct free wave of fluid from
side to side through the sweping. On placing the hand
oh 'the abdomen, a sensation df erepitna dan' sometimes
be felt: - . •" '• : ;f " ’

The case wat'senr inter fh0’4oipital as probably ascites,
but from the examih«ttoa!t ww etfdent that the fluid was
en cysted , an^ ti to d p irf blk ^ reh W a s mat the ease was one

On Aug. 28t^m^9rcddcris f o rin > Mj. Bell, through a small
incision (three • jmffleij,- rfifBblWMUa umlocular ovarian cyst.
Thenyst and contained eight pints

broad,.arid <g*ang

from the right side; it was tied in two parts with thick silk,
and returned. There was one long thm omental adhesion,
which was easily separated. The intestines did not come
into view. The left ovary appeared healthy. The abdominal*
wound was brought together by silk sutures, whieh were
removed at the end of the week, when the wound was found
healed. Gam gee tissue was used as a dressing. The girl
made an uninterruptedly good recovery.

Remarks by Mr. Bell. —The points of interest in the case
seem to be the age of the girl, her small size for her age, the
size of the cyst, and itB somewhat rapid growth.

Aral Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Rupture of the Urinary Bladder.

An ordinary meeting of this Society took place on
Tuesday last, Dr. J. W. Ogle, F.R.C.P., Vice-President, in.
the chair.

Mr. Henry Morris read a case in which the Urinary
Bladder was twice Ruptured, the first time by an injury,,
the second time—seven years after the first—by the giving
way of the cicatrix. A man aged thirty-six, had been
drinking at a public-house on the evening of June 4th,
1879, when a struggle ensued, and his opponent threw
him and knelt with violence upon his abdomen. All the
symptoms of peritonitis and rupture of the bladder were
excited, and the patient was admitted into the Middlesex.
Hospital on June 6th, 1879. The treatment consisted of
hot fomentations to the abdomen, half a grain of opium in.
a pill every six hours, and the retention just within the
neck of the bladder of a gum-elastic catheter. He recovered
perfectly, and left the hospital on July 10th, 1879. He
applied at the hospital again on August 4th, 1886, and gave-
the following account:—On August 2nd he had been at a.
“beanfeast.” On the following morning his bowels acted
and he passed some urine, but the latter act was attended
with some pain. From this time pain increased, and in the
evening he was unable to micturate. He vomited frequently.,
and had had hiccough since the onset of pain, until the
afternoon of August 4th, 1886, when a catheter was passed
and nearly three ounces of bloody urine were with¬
drawn. He was then admitted as a case of peritonitis
and suppression of urine. On the 6th about one pint
of thick, purulent, and slightly blood-stained urine was
drawn off. At 7 a.m. on August 6th he passed a little
flatus and a large quantity of urine, and suddenly became
very sick. Soon afterwards he was quite collapsed; his-
abdomen became very distended; he never rallied, and
died at 11.6 a.m. on the same day. At the necropsy recent
general peritonitis was found, and in the pelvis there were
fifteen ounces of purulent urine and a quantity of lymph_
A band an inch and a quarter long united the fundus of the
bladder with the rectum. The vesical end of this band was
hollowed out into a slender funnel, and through a rupture in
it dose to the bladder a string of mucus was projecting-
Slight pressure caused purulent urine to ooze from the
bladder through the rent into the peritoneal cavity.. Tire
rectum, bladder, and penis were removed ex masse, and
were submitted to a committee consisting of Mr. Savory,
Mr. Bryant, and Drs. Good hart and Kingston Fowler,
who reported that in their opinion “ the specimen ^-ex¬
hibits all the features which might be expected at A
remote period after a rupture of the bladder.” This
case, in the first instance, was reported in 1879 as <are
of recovery from rupture of the bladder. It is now brought
before the Royal Medical and Cbirurgical Society because
in its completed form it affords conclusive proof that
aft intra-peritoneal rupture of the bladder is not neces¬
sarily fatal, but may be recovered from under the simple
treatment employed in this case, provided the urine at
the time of the rupture is of normal composition. The
case is believed to be unique in that it furnishes us with
the post-mortem appearances of /the bladder some years
after reoovery from an intra-perithneal rupture of theooate
of that organ. \

Mr. W. H. Bennett read a case of\ Extra-peritoneal Rup¬
ture Of. the Urinary Bladder, the direst result of aspiration

Thb Lancet,]

ROYAL MEDICAL AND CHIRURGICAL SOCIETT

Fbb. 26, 1887. 410

above the pubes, with remarks on some objections to the
use of the aspirator as a means of evacuating the bladder,
and suggestions for the treatment of certain cases of reten¬
tion ot urine. The author stated that he bad always
objected to the aspirator as a means of relieving a distended
bladder, excepting in a very limited number ot cases, as he
believes that its use directly tends, in a large number
of instances, to rupture of the prgan, or oozing of urine
by the side of the needle, in consequence of the imme¬
diate relief to the vesical tension being insufficiently
afforded by the small instrument commonly employed. The
question of vesical tension was discussed as having an import-
sat bearing on the subject. The case was then described
of a man, aged thirty-eight, who came under the authors
care on Sept. 19th, 1886, with retention of urine of three days’
duration consequent upon a stricture which had existed lor
fifteen years. .The house-surgeon, having failed to pass
a catheter, aspirated the bladder above the pubes. Rupture
of the organ immediately followed. The abdomen was laid
open by the author, and a large quantity of urine escaped
from a cavity in the pelvis and hypogastric region. The
bladder was subsequently drained through a perineal
incision. The patient progressed satisfactorily till Novem¬
ber 6th, when an opening formed between the bowel
and the peri-vesioal cavity, after which he sank. The
preparation and a drawing of the parts were shown.
Three other instances in which complications happened were
referred to. In conclusion, the following propositions were
submitted:—1. Aspiration of the bladder ior the temporary
relief of retention of urine can only be resorted to with
absolute safety for cases in which the bladder walls are
presumably healthy. 2. The operation is inadmissible in
cases of retention consequent on long-standing stricture,
the bladder walls being diseased and often rotten; the
appropriate treatment in such cases, if the stricture be
impassable, being drainage of the bladder through a perineal
incision. 3. The aspirator can be used only with some
risk in cases of distended bladder where there is reason
to suppose that the urine is foul, unless the organ is
wiAed out with an antiseptic solution before the with¬
drawal of the needle, and even then aspiration is only
applicable to oertain cases of retention from prostatic
obstruction not associated with long-continued previous
cystitis or irritable bladder, such cases being properly
treated by proetatotomy and perineal drainage. 4. In any
case of bladder-distension where there is reason to suspect
disease of the coats of the organ, if tapping be performed
at all, a large trocar and cannula should oe used, and not a
email aspirating needle. 5. In the event of aspiration
being followed Dy pain, supra-pubic dulness, and rigidity
of more than a temporary character, incision above the
pubes should be practised, the bladder being drained
through the perineum if the urethral obstruction be still
impassable.

Mr. T. Bryant thought there could be no doubt that Mr.
Morris’s was a case of repaired rupture of the bladder, in
which in the course of seven years an acquired hernia or
sacculus had developed. The case also showed the impor¬
tance of not interfering with an opening that was in process
of repair, and thus suggested a practical hint to the surgeon
to be careful in dealing with the bladder so as not to reopen a
wound that was already healing. Mr. Bennett’s paper gave
clear evidence to show that there was some danger in aspira¬
ting the distended bladder. He did not remember to nave
written lightly in his text-book of aspirating the bladder for
retention of urine. His own experience had taught him that
such a method of treatment might be of a serious character.
He alluded to two cases: —1. A man, aged thirty, was seen in
1888, with retention from urethral stricture relieved by supra¬
pubic puncture; afterwards it was found necessary to perform
perineal section, but death followed. Evidences of suppura¬
tive peritonitis, with a diffuse sloughing abscess, the result
of extravasation of urine, were found at the post-mortem
examination. 2. This was the case of a man aged seventy-
eight; there was retention from an enlarged prostate, which
wm relieved seven or eight times by supra-pubic puncture.
At the necropey made by Dr. Goodbart six distinct punc-
tsrea were visible from the bladder surface, and each
opening would allow of the escape of urine into the peri¬
toneum* Even with & healthy bladder there was risk in
tapping if the vinos were over-distended. There was an
analogy between the aspiration of a tight hydatid tumour
an$ thsfcnf a full bidder.

\said that Mr. Morris’s case showed

that healthy urine could enter the peritoneum without
necessarily leading to lethal effects. He considered that the
specimens showed that a sinus rather than a sacculus had
formed as the result of the original accident. He related
the case of an elderly man who had retention of urine from
enlarged prostate. Aspiration was performed, with the
result of extravasation of urine and fatal consequences.
Hod the surgeon who aspirated been aware of the possible
dangers of aspiration, perhaps tbe patient’s life might not
have been sacrificed. He endorsed the importance of the
facts brought forward by Mr. Bennett.

Mr. Richard Babwbll said that in his experience
ruptures of the bladder were usually very large, and that
any attempt to treat such cases by the expectant method
would not usually be attended with satisfactory results. The
diagnosis of a case of extensive from a small rupture of the
bladder was very difficult, for the signs of peritonitis might
be as marked in the latter as in the former. In order to aid
in the diagnosis, the catheter need not be pressed so far as
to reopen a rupture. The rate of flow of the urine through
the catheter might help in the diagnosis; if the flow increased
during inspiration and decreased with expiration, the sur¬
geon should not wait, but perform abdominal section, for if
such a flow of urine be obtained, a large rupture might
reasonably be concluded to exist. He concurred in the
views expressed by the previous speakers on Mr. Bennett’s
paper.

Mr. J. W. Hulks said it was very difficult to obtain clear
and decisive evidence of a large vesical rupture. Mr.
Morris’s case was valuable, as showing that even advorse
circumstances were not absolutely hopeless. He had long
been convinced of the dangerous practice of aspirating a
distended bladder. The mechanism of escape of urine from
the bladder be did not feel convinced about; but that was
hardly the practical matter. Aspiration was only to be
retarded as safe where the bladder and urine were healthy.

Mr. W. Rivxngton had examined the specimen shown by
Mr. Morris, and he considered that a rupture of the bladder
had occurred, though he did not agree with the conclusions
of the committee who had reported on the specimen. There
was no evidence that the bladder had been ruptured by a
vertical rent, which would be intra-peritoneal, though tnis
term was not used in the report. Again, there was no
evidence of any cicatrix on the mucous or. peritoneal sur¬
faces of the viecus, and he did not believe that such evidence
would be obliterated in the course of seven years. He
would be prepared to admit that there had been a local
peritonitis, which would be well explained by a tubperitoneal
rent. He did not think that a true intraperitoneal rupture
had occurred. He also considered that there was not much
urine in the bladder at the time the original injury was
received. Commenting on Sir W.MacCormac’s cases, he con¬
tended that the amount of fluid passed through tbe abdo¬
minal drain was so large that it could not be ascribed to
the flow of urine, and must be set down to serum exuded
from an irritated peritoneum. Experimental research also
showed that normal urine was not innocuous to the peri¬
toneum.

Mr. Christopher Heath said that in the fresh state the
bladder showed an undoubted cicatrix, and he fully con¬
curred in the view of Mr. Morris.

Mr. J. K. Fowler thought there was no doubt whatever
of the bladder having been ruptured, and the presence of
a distinct though distended and atrophied cicatrix was the
evidence of this at the time he made the necropsy.

Mr. Henry Morris, in reply, said that he had merely
placed the facts before the members of the Society th^t
they might form their own opinion. He submitted tie
specimen to a committee of Fellows of the Royal College
of Surgeons, so that there should be an unbiased opinion.
His case showed at least this—that the continued use of the
catheter could be followed by a favourable result, even
when there was no doubt clinically of the occurrence of
vesical rupture. The infundibuliform adhesion he took to
be the actual cicatrix, altered by circumstances in the course
of time. The early history of the case, he contended,
justified the conclusion that the bladder was distended at
the time of rupture.

Mr. W. H. Bennett, in reply to Mr. Hujke's objections to
his explanation of the mechanism of production of the
extravasation, said that he believed that a circular opening
in the bladder was formed by tbe aspirator at the timeof
puncture, but that later on a slough separated from tne
l bladder wall at the site of the vesical puncture.

420 The Lancet,]

PATHOLOGICAL 80C1ETY OP LONDON.

[Pub. 26,1887.

PATHOLOGICAL SOCIETY OF LONDON.

Shedding of Teeth in Tabes Dorsalis.—Intermuscular Synovial
Cysts.—Bn dothelioma of Dura Mater.—Syphilitic Hyper¬
plastic Laryngitis.—Mitral Aneurysm in a Child. —Ectopia
Vesicce—Retro-pharyngeal Abscess.—Homy Growth on
Penis.

An ordinary meeting of this 8ociety was held on Tuesday,
Feb. 15th, Sir James Paget, Bart., President, in the chair.

Dr. Hale White read a paper on the Falling of Teeth in
Locomotor Ataxy, and related the case of a man, aged forty
who had had the first symptoms of locomotor ataxy eight years
earlier; ataxy had been present for one year, and the light¬
ning pains for nine months. When admitted taste was
impaired, there was anaesthesia in various parts of the body,
and girdle pain; all the reflexes were absent, there was loss
of sexual power, and some diarrhoea. A wisdom tooth was
exhibited which had fallen out two years ago without any
previous signs of decay; it was quite healthy. The other
teeth were ground down, but otherwise quite healthy. He
was treated with iodide of potassium, and went out of the
hospital after showing some improvement. Dr. Hale White
mentioned some references to this subject. Thus, Richardiere
(Rev. de M6d., No. 2, 1886, p. 170) related how in a patient
suffering from tabes the mouth and face swelled; all the teeth
of the upper jaw fell out one by one without any previous
caries; after this a few pieces of bone came away from the
palate. Hoffman (Berlin. Klin. Woe hen.. No. 12, 1885)
mentioned a case in whom all the teeth fell out of the upper
jaw without any apparent cause, and two years after tabes
dorsalis showed itself. Dr. Lewis (Amer. Joum. Nerv. and
Mental Dis , No. 2, 1885) also gave cases. Dr. Hale White
considered that before allowing that this was a definite sym¬
ptom of tabes dorsalis we should notice many more cases,
for the teeth were liable to fall out from so many causes.—
Dr. F. Semom said there were two varieties of shedding
of the teeth—one in which the tooth simply drops out, and
in the other where part of the alveolus breaks off as well.
In cases of gastric and laryngeal crisis such teeth and bone
changes, should be specially looked for, in view of Dr.
Buzzard’s theory of the association of the trophic bone
centre with the pneumogastric centre.—Mr. Bennett spoke
of an affection of middle life in which from the socket of
the teeth a discharge of serum or pus took place, and in
some of which cases nodules of tartar developed on the
periosteum, and fragments of dead bone came away. It
was an absolutely painless affection, the pathology of which
was much disputed. Gout and imperfect nutrition were
ascribed as causes.—Dr. G. N. Pitt referred to two cases of
tabes in which a larger number of teeth had been lost than
was usual at the age at which the patient had arrived.—
Dr. Ormerod alluded to a case of well-marked tabes in which
a pare of the alveolus with three teeth had spontaneously
broker, off. The man had had syphilis. The neurologists con¬
sidered the fracture due to tabes, but some others - syphilo-
graphers—thought the case was due to the syphilis.—Mr.
Bland Sutton referred to four cases of disease of the spinal
cord in animals which had perforating ulcers and nerve
troubles. They were carnivora, and all had softening of the
alveolus with shedding of teeth, though they were animals
who should have had a full supply of teeth.—Sir James
Paoet thought it was a subject of much imoortance, and
required further investigation.

Mr. D’Arcy Power showed some more specimens of Inter¬
muscular Synovial Cysts. After alluding to the examples
already brought before the Society in 1885, he said that the
present series confirmed in all respects the theories he then
advanced. He showed a preparation of a knee-joint from a
patient who died of phthisis in St. Bartholomew’s Ho-pital.
The joint presented an irregular hourglass-shaped cyst
Situated over the inner side of the knee, and communicating
by a contracted channel with a second enlargement situated
in the loose connective tissue of the popliteal space. The
bursa beneath theBgpteeuB was also greatly dilated, though
not conoeoWelSfMfTBB^other swelling. Neither of the
^the knee-joint. Mr. Power
fenced in an almost
trsse in the neighbour-
..■baps on some form of
"then opened one into
resistance. He further
1 ^as the first case he had dissected in

which there was absolutely no communication between the
cysts and the synovial cavity of the articulation near
which they had formed. In a second specimen in which
the joint was extensively diseased, there was a cyst
in the same situation as in the first case, but it opened
directly into the knee-joint. An especial point of interest
consisted in the fact that there was a partially pervious
cord connected with the cyst; it represented the remains of
a pre-existing cyst, which had been aspirated with anti¬
septic precautions sixteen months before amputation of the
joint. In the third specimen exhibited by Mr. Power the
cystic enlargement was due to a hernia of the synovial
membrane ot the elbow, and not to the distension of any
bursa. It was a significant fact that in two of the three
cases the cyets occurred in cases associated with tubercular
disease of the neighbouring articulation.—Mr. R. J. Godlxx
asked for the experience of members of the Society as to
the relationship of ganglia on the back of the wrist to
tubercular disease of that joint.—Mr. Charters Symonds
mentioned a case of swelling of solid nature, part of which
was composed of caseous material, and referred to a second
case of solid growth on the inner surface of the sheath of
the tendon of one finger, which proved to be of tubercular
structure. He asked Mr. Godlee whether his cases were
true ganglia or solid tubercular mewses, to which the reply
was that reference was made to the sequence of apparent
ganglia on the back of the wrist and tubercular disease of
that joint.

Dr. Hyla Grevrs showed a specimen of Endothelioma
of the Dura Mater, removed from a lady aged sixty, who
had had attacks of headache localised by tenderness to the
right parietal bone. Spasms of epileptiform kind occurred in
the left face and band, sometimes with loss of consciousness,
and followed by paresis, but not complete paralysis. Giddi¬
ness, vomiting, and double optic neuritis had been noticed.
The case lasted fifteen months. The memory was deteriorated.
Operative interference was not accepted by the patient or
her friends. The tumour was found to have the dura mater
adherent over an area the size of a shilling. The external
surface of the dura was rough and thickened, and the bone
thinned. A branch of the middle meningeal crossed the
tumour, which was deeply embedded in, but displaced and
depreesed, the convolutions about the fissure of Rolando.
The tumour had a crenate margin, and was an inch and a
half thick. It had a fibrous and greyish aspect, and
was blood-stained. A delicate membrane, probably the
pia mater, separated it from the brain substance.
Cell neste with reticulated strings or bands of cells
and a fibrous margin formed the histological structure.
The strings or bands were composed of flattened cells
arranged in reticulated layers. Many distended blood¬
vessels were seen, whose walls were composed of flattened
cells circularly arranged, and in some places having an
ampulla-like appearance, but no separated portions, as de¬
scribed by Cornil and Rsnvier in angeiolithic sarcoma. The
specimen shown resembled those described by Ziegler as
endotheliomata—Mr. F. 8 . Eve asked for the precise rela¬
tions of the tumour to the dura mater, for Dr. Goodhart had
presented to the museum of the Royal College of Surgeons
a large intracranial tumour growing from and into the
bone; the dura mater covered, but was not attached to the
growth. He had been surprised to find that the growth
was an angeiolithic sarcoma; it consisted of small connec¬
tive tissue cells, which in places formed whorls, which
he thought originated in abortive vascular bands.—Mr.
Jonathan Hutchinson thought there was much to be
gained by dropping the term “psammoma,” and using in
its place the term “ calcifying endothelioma.” The growths
differed from sarcoma in their tendency to remain isolated.
He recalled a case which he had reported to the Society of
calcifying endothelioma, arising in connexion with the
vertebral column, which had entirely compressed without
invading the cord.—Dr. Hyla Ghevhs said the dura mater
lay external to the growth, and was only attached over a
small area.

Dr. F. Semon showed, for Dr. Jacob of Leeds, photographs
and microscopic specimens of Hyperplastic Syphilitic Laryn¬
gitis. The patient was a child five months old, who had,
from a fortnight after birth, suffered from manifestations
of congenital syphilis, and who was admitted into the Leeds
Infirmary in November last with cough and huskiness of
voice. Laryngeal obstruction soon supervened, tracheo¬
tomy had to be performed, and thei patient died the same
day. At the necropsy no marked change was observed in

Thb Lancet,]

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

[Feb. 28,1887. 421

the upper compartment of the larynx, but below the cords
the lumen was reduced to a mere chink by swelling and
thickening of the mucous membrane, whicli extended about
three-quarters of an ineh downwards, and terminated rather
abruptly. The thickening, on section, was of a deep-red
colour. Microscopically it was seen to consist of a mucous
membrane greatly thickened by interstitial deposit of con¬
nective tissue, as well as by hypertrophy of the gland tissue.
Tbe vessels were greatly distended. The lungs Bhowed a
few patches of lobular pneumonia; the liver an increase of
connective tissue, and some email aggregations of leucocytes.
Dr. Jacob drew attention to the differences which this case
presented from the somewhat similar ones reported by Dr.
r. Semon in vol. xxxi. of the Society’s Transactions, in that
the localisation of the tumefaction was different, and that
there was entire absence of ulceration.

Dr. Hadden showed an Aneurysm of the Mitral Valve
removed from a female child, aged two years and three
months. There was no history of syphilis or rheu¬
matism. The child became occasionally blue, but no murmur
existed. 8he was taken ill with bronchitis, and suddenly 1
became worse and died. Some blood-stained mucus was
found in the larynx, and a caseous mass in the upper part of
the right lower lobe. The posterior flap of the mitral valve
was the seat of an aneurysm the size of a nut; it measured
half an inch in diameter, and bulged into the ventricle.
At its auricular orifice there were a few pale firm vege¬
tations ; the anterior flap and chordae tendinere were
healthy. The chief interest was the rarity of the case
and its unexplained etiology.—Dr. S. CouplanD remarked
on ths rarity, and said, the aortic valves being quite
healthy, it was impossible to ascribe tbe formation of
the aneurysm to secondary infection of the mitral valve
from the aortic.

Mr. S. G. Shattocx showed a specimen of Ectopia Vesicaa
from a male child. He said that no adequate explanation
had been offered of the occurrence of ectopia vesicse, which
was looked upon as of the same order as ectopia cordis—a
deficiency of growth of the mesobl&stic basis of the abdo¬
minal wall. The explanation submitted by him was that
the primitive cloactu invagination of the surface, which
normally lays open the lower end of the rectum and the
lower end of the urogenital sinne, in these cases, by an undue
extension forwards and upwards, lays open the anterior
wall of the urogenital sinus and the anterior wall of the
bladder. There would thus result a complete Assure of all
the parts in the middle line as high as the umbilicus, and
the rudimentary penis or clitoris would be on its first, appear¬
ance completely cleft.—Sir James Paget remarked on the
ingeniousness of the explanation, which he conaidered to
be a highly probable and correct interpretation of the defor¬
mity or malformation.

Mr. H. H. Clutton read a case of Retro-pharyngeal
Abscess that occurred in a man aged twenty-four, who was
subject to epileptic fits, during one of which, he asserted,
tbe t bee ess in the neck formed, or rather, the pain and
swelling in the neck were first noticed. But the patient
could not give an intelligent account of himself. He had
been spitting up a quantity of muco-purulent fluid mixed
with blood, which clearly came from the abscess opening
into the pharynx. When first seeD, the bead was retracted,
and there was dysphagia, apparently from inability of the
larynx to move m the act or deglutition. The larynx ap¬
peared to be fixed. There was a rapid subsidence of
symptoms. Over the right carotid artery a soft and
paoeid area was felt, but it was not thought advisable to
indae it. On Oetober 6th, two days after dismissal from the
hospital, a sensation of crackling or crepitation could be
felt, and the tumour disappeared oh pressure. Mr. Semon
said the larynx was normal, but there was a small red
swelling below the larynx, which was probably a communi¬
cation with the abscess cavity and the trachea. Nine days
after leaving the hospital the patient seemed quite well.
On October 23rd he was readmitted with broncho¬
pneumonia, and died on November 3rd. Some retinal
hemorrhages were discovered by Dr. Mackenzie. The
patient had albuminuria, but there' were no casts in the
Mine. l%e left tonsil was m a chronic state of hypertrophy;
the right bad an abscess which ;did not communicate with
the tun-walled cavity, which reached downwards to the
level of the clavicles. The origin of this chronic abscess
wia uncertain. It opened by three rounded smooth
orinre*. into the pharynx, and by one into the trachea,
widen, with the IarytUr, was acutely inflamed. One lung

had gangrenous pneumonia. There was no trace of
glandular enlargement. He did not know whether the
abscess could have originated from a pouch of the oeso¬
phagus, but there was no trace of an epithelial lining
to the abscess cavity. Reference was. made to retro¬
pharyngeal abscesses of children. — Dr. Ernest Oulbkb
remarked on the chronicity of the case. He had had
to perform tracheotomy on a child eight months old,
who died. The necropsy showed a large post-oesopha¬
geal abscess, which, on careful examination, proved to be
connected with the third cervical vertebra by a sinus that
led into the intervertebral disc.—Mr. M. Shbild asked
whether the abscess could have had its origin in a haemor¬
rhage in the neck, resulting from straining in an epileptic
fit. This Wood clot might have become septic and sup¬
purated. Some cases in children might be due to scarlet
fever, which had been overlooked.—Dr. Angel Monet re¬
marked that a large majority of the cases occurred in
infants a few months olu.—Mr. H. H. Clotton, in reply,
thought the fits were not sufficiently severe to have caused
a haemorrhage into the neck.

Mr. Pbaecb Gooli) read a case of Epithelioma of the
Penis with a horn growing from the glans. The patient,
aged fifty-two, had had congenital phimosis, for which he
was oircumcised only four years ago. The wound healed,
except in one place in the middle line, where a small granu¬
lation remained. Here a Email wart developed, and was
followed by a second by its side. The first wart began to dis¬
charge, and continued to do so eversinoe. On the middle of
the upper surface of the glans was a sessile truncated born,
hard in consistence, of yellowish colour and translucent,
the size of a small marble. The penis was amputated, and
large inguinal glands were removed, the patient rapidly
recovering. Sections prepared by Mr. L. Hudson showed
the usual epidermic structure, the cells being flattened,
nucleated, and arranged in regular superposed layers. There
were no enlarged papillae entering the base of the structure.
The ulcer was a typical globular epithelioma. The glands
showed no secondary deposit. Ninety cases of horns were
collected by Erasmus Wilson, of which five were penile.
Lebert collected 109 cases, of which six occurred on the
penis. A committee of the Royal Academy of Medicine
collected seventy-one cases of horns, three penile. This
was the fourteenth case. Some of the horns have reached
a great size. In Jewett’s case the horn was 3J in. long and
Jin. in diameter. In Pick’s case the horn was 2£in. long.
In Gould’s case the corn was regularly pared down. Horns
have been shown to start in three different ways : some
grow from the interior of sebaceous cysts—the most frequent
mode of origin; some develop from the matrix of tbe nails;
and others Dy some change occurring in warts. Those on
the glans penis belong to tbe last group. Histologically,
they may be divided into papillary and flat. The present
specimen was of tbe latter kind.

The following card specimens were shown:—Dr. Hadden;
Perforation of Large Intestine in Enteric Fever. Mr. E. H.
Fenwick: Renal Carcinoma. Dr. Mott: Mvxo-fibroma com¬
pressing the Spinal Cord. Mr. Clutton : Congenital Abnor-;
mality of Lower Lip associated with Cleft Palate. Dr. Pitt
(1) Ulcer of Vagina, possibly tubercular; (2) Two cases of
Hydro-salpinx, __

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

Small-pox Hospital Influence.

At a meeting of this Society, held on Friday, Feb. 18th
(the President, Dr. Alfred Hill, medical officer of health for
Birmingham, in the chair), Dr. 8kptimus Gibbon proposed
the following resolution:—“That this Society, having heard
that a proposal will be made to the Metropolitan Asylums
Board at their next meeting to close the hospital ships and
to admit cases of small-pox into tbe London hospitals,
desire to express theix hope that the Board will not adopt
the proposed motion, which, in their opinion, is not con¬
ceived in the interests of the public health.”—The motion
was seconded by Dr. Woodforde, medical officer of health
for Berkshire, who said that, as a provincial officer, he was
much interested in small-pox, as, whenever an epidemic
occurred in the metropolis, it invariably affected nis and
other districts in the oountry.—The resolution was adopted,
and a copy was ordered to be communicated to the Metro¬
politan Asylums Board.

422 The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Feb. 28,1887.

ait& Uoiix.es of looks.

The Sealing Art; or. Chapters upon Medicine, Diseases ,
Remedies, and Physicians—Historical, Biographical, and
Descriptive. TwoYols. London: Ward & Downey. 1887.

The history of medicine is a subject which has been
strangely neglected in this country, and yet it is one which
Well repays profound study and investigation. No English
anthor has yet appeared to give us works like those of
Haeser and of Hirsch; but such works are the product of a
lifetime devoted to literary research, and we have no pro¬
vision for that in England. There is no University endow¬
ment here for the prosecution of these higher studies; but
we would fain hope that the day is not far distant when
such a defect will be remedied. To trace the evolution of
medical knowledge, the rise and fall of doctrines and theories,
the growth of pathological science, the development of
rational therapeutics, and the remarkable advances in
surgery, would-be an arduous but grateful task to one who
had the ability, as well as the opportunity, to undertake it.
There is much to be learnt from the study of such a fruitful
topic, whilst in interest it can have few equals. Pending,
however, the appearance of a work of this wide scope, we
must be content to reoerve such minor contributions as
the present volumes typify. The author does not lay
claim to have written an exhaustive treatise, whilst he
deserves credit for having compiled a most interest¬
ing, intelligent, and entertaining book. The main basis
of it is biographical, the story of the origin and progress
of medicine being told in the lives of its more notable pro¬
fessors, from Hippocrates to the present day. In spite of
the diligence exhibited in the collection of materials to fill
these volumes, we regret that the names of the leaders of
the great continental schools, which signalised the early
decades of the present century, should only receive the
barest mention, attention being almost exclusively bestowed
upon the English leaders in medicine and surgery. In respect
of earlier times, however, the writer is more cosmopolitan, so
that we have accounts of Vesalius, Fallopius, and Eustachius,
but Ambrose Par 6 is dealt with in too cursory a manner to
be satisfactory. On the Alchemists and the birth of che¬
mistry there is an entertaining chapter, which contains
admirable accounts of the history of Paracelsus, who, in
spite of his empiricism, did medicine some service in the
introduction of chemical compounds into therapeutics; and
also of Jerome-Cardan, mathematician and physician, some of
whose precepts are reproduced in these pages. In the chapter
dealing with English physicians of the sixteenth century, it is
rather surprising to And Sir Kenelm Digby, the advocate of
the virtues of the sympathetic powder, dealt with in company
with such illustrious men as William Harvey and Thomas
Sydenham. S urely-amore suitable place for him would have
been in the previous chapter, which treats of Animal Magnet¬
ism, Mesmerism, and Faith Healing. A graphic account is given
of Mesmer and his following; but why did not the author
punue the subjeot to our own day, and tell us how Elliotaon
was duped, and how at length hypnotism came to be studied
scientifically by physiologists and neurologists? The bio¬
graphical record is. very rich in the second volume, and no
exception can be taken to the way in which the lives of
fl &dc H f fe and Mead; of the Hunters and Edward Jenner, of
Bedllie, and many others nearer to our own time, are given;
but we Can imagine that there is room for cavil at the
biographical notes of “ eminent contemporary practi¬
tioners” which conclude the work, for such selection
requires more discrimination than the writer has evinced.
One very interesting chapter is devoted to the lives
of members of- tbe; medical profession who have made
their mark in literature; such as Sir Thomas Browne,
John Locke, Garth, Akenside, Crabbe, John BroWn, and

Oliver Wendell Holmes. From the goodly list, of which
we have only cited a few, we miss one notable name—that
of John Keats. Other chapters interpolated in the chrono¬
logical sequence are those on great Epidemics and on Mes¬
merism in the Arst volume, and that on Herbs and Simples
in the second. The book contains some inaccuracies of state¬
ment, one of the most striking being that the duct which bears
the name of Eustachius connects the ear with the thoraeio
duct, and a few in the matter of dates, and the spelling of
names; whilst it will be news to Dr. Matthews Duncan to
bear that he has taken up his residence in Bath. Still these
are comparatively triAing errors, and the book cm the whole
is one which will repay the reading, for it is well written
and full of spirit, with a very just appreciation of the
mingled truth and error that characterise the development
of the art of medicine. If, as we infer, the author does not
himself practise the “ healing art,” he is all the more to be
congratulated upon the fairness and impartiality, as well as
upon the technical knowledge, which he evinces in his lively
and interesting pag es. ___

A Commentary on the Diseases of India. By Nob MAN
Chbvbbs, C.I.E., M.D., F.R.C.S. Eng., Deputy Surgeon-
General H.M.’s Indian Army, &c. Loudon,: J. and A.
ChurchilL 1886. ' "

This large and handsome volume of 816 pages is an out¬
come of a study of Indian disease maintained for thirty-
eight years, upwards of twenty-four of which were mainly
devoted to clinical observation in. Bengal. In publishing
this volume, its author has told us in his preface that ho
brings “to an end a course of observation, thought, and
study which has occupied the whole of a professional life¬
time”; and his lamented death followed its publication so
quickly that a mournful sadness attaches to his words.
It is a voluminous book, dealing with a vast number of
subjects, aud all from the clinical point of view. There is,
no doubt, a great deal of information that is not clinical in
character—statistical, topographical, and anecdotal to wit;
still, it all has a bearing that way, and is indicative of the
bent of the author’s mind. Dr. Norman Chevers must have
resembled, we imagine, a lately deceased statesman in that
he was eminently fair-minded and truthful, gentle and
erudite. The perusal of this book leaves that kind of
impression on the mind. It is the record of a worthy
professional life, and contains a large amount of informa¬
tion based upon the results of his own experience and
observation, which, by his extensive reading, he was enabled
to compare with those of other labourers in the same Aeld.

The Asclepiad. No. IS, VoL IV.

The most interesting contribution to this number appears
to us to be the biographical one on John Mayow, a neglected
genius, of whom a portrait is given. We cannot assent to
theclassiAcationof purpura hsemorrhagica and the scorbutic
diathesis, for the reasons that we are unable to recognise
properly the differences between aqueous, saline, and vascular
purpura. This division does not commend itself to ns on
account of its clinical value or its pathological significance.
As doubtless the author and editor of the Asclepiad attaches
Borne importance to the article which occupies the place of-,
honour in the current number, we may examine his positkar
a-little. He states that “ the pathological character of thie
[aqueous] type is special. The blood of the patients who are
subject to it is in a state of extreme Aridity, the Aridity
boing due to an excess of water, so that the colloidal parts
of the blood are diluted to an unnatural degree.” Of saline -
purpura we read that there is in this type no deficiency of
fibrin, but as a colloidal substance it is held in a fluid state >
by an excess of soluble saline material. 1 The vascular variety
of purpura is said to be characterised by the perfectly
natural state of the blood, which coagulates firmly and

by Google

Tab Lancet,]

MEETING OF TEE GENERAL MEDICAL COUNCIL.

[Feb. 26,1887. 423

quickly. There is much to be said for the ingenuity of
these views, but when we come to inquire on what scientific
data the clinical distinctions are based, the ground on which
Dr. Richardson’s classification is made appears to us to be
of an unsafe and theoretical kind. The Opuscula Practice
are of the customary useful kind, and the article on Prac¬
tical Biometry, or the Measurement of Life in Health and
Disease, is of a high intellectual order.

Ifcfo Jnfontim

THE “MATCHLESS” SELF-LIGHTING GAS-BURNER.
This contrivance was originally brought out in America,

Manufacturing Company, 73,

and is now in general use
there in all places where an
immediate light is wanted for
a short time. The lighting is
accomplished by means of a
small concealed flame con¬
stantly alight, but so small
that the amount of gas it
consumes is imperceptible*
Medical men who are liable
to be called up in the night
will find this appliance most
useful, and as its price is
moderate and it is easily
adjusted, there can be no
doubt that it will be exten¬
sively used. The patentees
and manufacturers in this
country are the G. K. Cooke
Cowcross-street, E.C.

A NEW PATENT “ BROUGHAM HANSOM.”

Messrs. W. and F. Thorn, of 19, Great Portland-street,
have under the above name introduced what is practically a
angle brougham on two wheels. The term “ Hansom ” is,
we think, inappropriate, as this carriage in no way resembles
in appearance the familiar two-wheeled cab, over which it
has the distinct advantage of being a really comfortable
closed vehicle—a desideratum which the Hansom, useful
enoogh in many ways, entirely fails to supply. The driver,
instead of being behind, has his box in front, and the pas¬
senger enters the cab from the back, the door opening out¬
wards in the middle, and the corresponding portion of the
teat being kept raised when unoccupied by a spring. "When
the passenger is seated, a simple but effectual arrangement
ensures that the door cannot become unfastened by accident
ot from the outside. We have had an opportunity of
personally trying Messrs. Thorn’s new “ Brougham Hansom,”
Md can speak to its comfort and to the remarkable absence
of “knee motion.” The weight is only C.} cwt., at least
- cwt. less than that of an ordinary Hansom, and the cab is
very roomy. A little recess between the front windows
would afford a convenient place for stethoscope, &c.;
mdeed, taken altogether, we think that this two-wheeled
brougham is likely to prove a very convenient and com¬
fortable carriage for country practitioners.

Fatal Attack on a Doctor in Roumanla.—
A Roumanian general, thinking that his wife's doctor was
to blame far her death, attacked the unfortunate practi¬
tioner at a railway station and cut off his nose, a wound
which subsequently proved fatal. The irascible general, on
being arraigned before a court-martial, explained that he
had not i ntended to murder the doctor! The deceased was
an rntrira by birth, and it is probable that some diplomatic
comepoodaace is taking place on the subject. The result
of toe trial baa not yet been published.

THE GENERAL COUNCIL OF MEDICAL
EDUCATION & REGISTRATION.

Thursday, February 17th.

Sir Henry Acland, President, in the chair.

The Council sat for some time in private to consider a
communication from Mr. M‘Vail.

Mr. Collins moved the following resolution:—“That, in
conformity with the request of the Governor and Court of
the Apothecaries’ Hall of Ireland of November 9th, 1880,
already entered on the Minutes of the Council, this Council
will proceed to appoint an Examiner in Surgery to entitle
the Apothecaries’ Hall to issue registrable qualifications in
conformity with Clause 5 of the Medical Act, 1880.” He
asked the Council not to allow the Apothecaries’ Hall in
Ireland to be without a registrable qualification until the
Council met again. The Apothecaries’ Hall was quite willing
to co-operate with the other bodies, and that desire would
still remain even if it continued an independent body. He
hoped the Council would nominate an examiner to complete
the educational examination of the Apothecaries' Hall.

Dr. Haughton seconded the motion.

Sir Wm. Gull pointed out that the Corporation itself
ought to have made the application. The motion of Mr.
Collins was only a personal request from that gentleman.

Mr. Collins said he proposed the motion as the repre¬
sentative of the Apothecaries’ Hall.

Sir William Turner said the motion could be put in
order by a reference to the letter of the Apothecaries’ Hall
on the subject.

Dr. Leishman called attention to the peculiar construc¬
tion of the motion, which was, he said, really a request of
of the Examiners and Coart of the Apothecaries’ Hall, and
not in the form of a resolution of the Council itself.

Sir W. Foster thought the resolution was premature. It
related to a great question which would have to be decided
by the Council. The intention of the Act of 1880 was to
force combinations on all the corporations of the United
Kingdom, and he hoped that that result would be obtained.
It was important that the contention between the parties
concerned should be settled in a friendly manner. If the
motion were passed, Mr. Collins would be in the position of
a Bismarck, and would be able to take up an antagonistic
position at onca. If the negotiations failed, the Council
could take the matter into consideration, but at present the
granting of the request would not be likely to promote the
friendly spirit to which they desired to appeal.

DA Struthbrs moved, as an amendment, “That the
Council defer giving a decision on the motion of Mr. Collins,
in order to give the King and Queen’s College of Physicians,
the Royal College of Surgeons in Ireland, and the Apothe¬
caries’ Hall in Ireland time to consider the resolution passed
by the Council yesterday on the motion of Dr. 8truthers.”

After some further discussion the motion of Mr. Collins
was altered in the following form: “ That in conformity
with the request of the Governor and Court of Apothecaries
Hall, Ireland, of the 9th of November, already entered upon
the Minutes of the Council, this Council will proceed to
appoint an examiner in surgery, to entitle the Apothecaries’
Hall to issue registrable qualifications in conformity with
Clause 5 of the Medical Act of 1886.”

Mr. Tbalb, in seconding the amendment, said that if the
question were not settled in a friendly way, the Council
would no doubt have to meet again lor the purpose of
appointing an examiner.

Sir William Turnbr said that in passing the proposed
motion the Council would be stultifying itself. The motion
was altogether premature, and the amendment was the only
logical sequence to the resolution passed on Wednesday.

Dr. William Moork thought that the Irish bodies should
have time given them to consider the question.

Dr. Glover asked if there were any ohance of the Council
receiving an answer from the College of Physicians in
Ireland during the preeent session of the Council. The
necessity of another meeting of the Council in June to eottle
the question would be simply deplorable. .

Dr. A. Smith said there was no possibility of getting an
answer from the College of Phyaicians during the present
session.

M t. Collins and Dr, Haughton stated that they would

"Digitized by GoOgle

424 The Lancet,]

MEETING OF THE GENERAL MEDICAL COUNCIL.

[Feb. 26,1887.

accept the amendment, in the hope that the Council would, Dr. Kidd read a description by the Visitors of the Dublin
if necessary, meet in June to settle the question. Hospital, stating that the patients were mostly old and

Mr. Macnamara said that the College of Surgeons was worn-out persons, too stupid or deaf to hear and answer
most anxious to bring in the Apothecaries’ Hall. Dr. Kidd questions, and might almost be regarded as specimens in a
could bear him out in that statement. pathological museum.

Dr. Heron Watson supported the proposal of Dr. The proposal to refer the subject to a committee was then

Struthers. The Council could not aot in the direction agreed to, Sir William Gull being the chairman,
required without knowing something of the terms that had Dr. Heron Watson moved: “ That, considering the
been discussed between the bodies themselves. It might, somewhat anomalous position in which the General Medical
after all, turn out that the Apothecaries’ Hall had been Council is placed by the opinion given by Mr. Muir
unreasonable in its demands. ' Mackenzie on the clauses of the Medical Act referring to

Dr. Quain protested against the further discussion of the' the qualifying examinations held by a combination of
matter (Mr. Collins having accepted the amendment), and medical authorities, and the relation of the General Medical
stated that the Council was sitting at the enormous Council to such contracting bodies as may agree to hold
expense of £1 a minute. qualifying examinations under such scheme, it is desirable

The amendment was then put and carried, and it was that a further opinion from the responsible legal ad-
also unanimously agreed to as an original motion. visers of the Government be obtained Before - the Council

A communication waS received from the Lord President proceeds to take any steps arising out of the interpreta-
of the Privy Coiincil, forwarding a memorial presented to tion of Sections 15, 18 and 19 of the Medical Act, 1858,
the Lords of the Council by Mr. Laffan of Cashel with construed along with Sections 1, 2, 8, 4, 5, and 6 of
respect to the efficiency of the qualifying examinations the Medical Act, 1880, together with the consideration
under the Medical Acts, and requesting the Medical Council of any other points which may arise within this reference,
to favour his lordship with their observations on the and that it be referred to the Executive Committee
memorial. The memorial called attention to the Report of to take the requisite steps to give effect to this."
the Visitors on the Examinations of the Royal University He said that the opinion of Mr. Muir Mackenzie as to the
of Ireland, with a view of showing that the candidates for duties of the Council in reference to combination had placed
the degrees of the University were shamefully, deficient the Council in a very distressing position. The Council
in clinical training. Complaint was also made that the ought to be quite certain as to what constituted a qualifying
University had declined to recognise the unidn hospitals for examination and what it might be required to do with
clinical purposes. reference to any body excluded from combination; and

Dr. Ranks explained the action of the Royal University although not wishing to doubt the ability and acumen of
in the matter, and read the following regulations of that Mr. Muir Mackenzie, he thought that the matter should be
body: “ In the case of a hospital seeking recognition as a referred to the legal advisers of the Government in order
school for clinical teaching, the Senate will require evidence that the Council might know the exact position in which it
that it contains at least Bixty beds in constant occupation; stood and what was the true interpfetation of the Medical
that at least ten beds are provided for the treatment of Aots.

oases of fever; that it possesses a suitable lecture theatre Dr. Struthers seconded the motion,
and other appliances necessary for clinical teaching; that a Dr. A. Smith thought that the Council should be satisfied
roll of attendance is strictly kept, which shall be open to with the opinion expressed by Mr. Muir Mackenzie. He
the inspection of any person delegated by the Senate. He moved as an amendment, “That the Council, in accordance
moved that the following resolution be transmitted to the with the opinion of it® law adviser respecting a Conjoint
Lord President: “That this Council, having before it the Board for.Ireland, do proceed tq the next order of .the day."
regulations of the Royal University with respect to the This amendment was put and negatived,

attendance of students of hospitals, is of opinion that it is Dr. McVajl said if it should turn out that Mr. Muir

not expedient to take any action on the subject.” Mackenzie was right, be thought it would be desirable that

Dr. Kidd, in seconding the motion, said it was the opinion the Council should memorialise the Government to intro-
of the Royal University and the College of Surgeons in duce a Bill to give it the power which it had lost. A short
Ireland that the union hospitals were quite inadequate for Bill with one clause would be sufficient,
the due teaching of clinical medidhe or surgery. They Dr. Quain brought up the Finance Committee’s report,
were receptacles of the aged, the poor, and worn-out subjects which showed that the income of the General and Branch
not presenting features of active disease. Councils for the part year was £9741 6 $. 4 <L, an amount

Dr. Haughton suggested that the matter should be which was less by £1372 2s. 5d. than in 1885. Theexpendi-
referred to a committee acquainted with hospital teaching, ture during 1886 was £8991 3s. StL, which was less by
with a view, not Of controlling any university or corpora- £3092 13», Id. than in 1885. With reference to future
tion, but of laying down some such principle as that, if the expenditure, it was estimated that the enlargement of the
teaching of any hospital school in the country were efficient Council would necessitate hereafter an increased annual
and the field of practice good, it should be partially outlay, on account of fees and other expenses, of about
recognised. £1200.

Sir William Gulu concurred in the suggestion that the Sir Wm. Turner said he wished to draw attention to the
matter should be referred to a committee to report to the subject of Dental finance. In January, 1881, the Dentists’
Council. Fund amounted to £9824, in 1883 to £9220, in 1885 to

Mr. Simon, in supporting the proposal, expressed a hope £9017, in 1886 to £8445, and in 1887 to £7465. Therefore
that the committee should not be an exclusively Irish one. during the six years it had sustained a diminution of £2359.
Dr. Heron Watson also supported the proposal. If that process went on in anything like the same proportion.

Sir Walter Foster hoped that the committee would the vanishing point of the fund was almost within measur-
oonsider not only the memorial, but all the documents able distance. This was an especially Berious matter, as the
entered on the Minutes in connexion with it. dentists had no representative on the Council. The method

Mr. Macnamara referred to a visit made by him and Dr. of administration was imposed upon Hie Council by Act of
Banks to the Galway Infirmary, with the admirable, appear- Parliament, and he thought something ought to be done in
once of which they were both greatly pleased; He pro- the way of ■diminishing the ratio of expenses, so that a balance
tested against the allegations made by Mr. Laffan against might he obtained between income and expenditure,
the honour of the medical men an the Senate of the Royal Dr. Quain said .that if the Council wished to diminish the
University, who were men of the higheetrank, and wholly dental expenditure it must be done at the expense of the
above any sordid considerations such as those: charged medical profession. He quite agreed that some means must
against them. be adopted; if possible, to prevent a final catastrophe in

Dr. Bruoe called attention to the fact.that the Act of 1886 connexion with the Dental Fond, but he could not see how
had only just come into operation, end said it was hardly mb expenditure was to be lessened. The proportion of ex¬
time to consider the action of -the Council under that Act. peases paid by the dentists had been fixed atohetsixth, but as
: Dr. Banes -expressed his willingness to accept the amend- theji weae6000 as against 24,000 it ought to be one-fifth. The
ment referring the subject te a committee; and said that the dentists were advised originally to allow the Council to
University had aeted on the knowledge of the fact that the appoint a board composed of eminent dentists and of some
workhouse hospitals did nob prbvide proper materials for members of the Council, but the dentjstsexpressed themselves
clinical teaching. There was no intention, however,, to east as having so much confldenoe in thp Gouhafl that, they were
the slightest slur upon the medical officers of those bodies. perfectly willing to put Hie whole! matter into their hands.

Te* Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Fwb. 20,1887'; 435

If thsy had accepted the principle of the Duke of Richmond’s
Bill and appointed a Dental Board, they could have worked
with one-tenth part of the expensive machinery.

Dr. A Smith said that he believed there had only been
one special meeting of the Dental Committee. On all other
occasions the business had been transacted as supplemental
to that of tho Executive Committee.

Mr. Marshall thought that the dentists should be en¬
couraged to sever themselves financially from the Medical
Consol. At present their registration was at a very low
ebb, twenty-live or twenty-six a year, but students were
coming on to the Register at the rate of from seventy-five
to a hundred a year, and therefore in a few years the
dentists would have increased resources, and that ought to
encourage them to feel that by and by they might be able
to ran alone.

The Council then adjourned.

Friday, Feb. 18th.

Sib Henry Acland, President, in the chair.

Mr. Marshall said he had thought it his duty on the
previous day, as chairman of the Business Committee, to
uk the Council to suspend the printing of a communication
received from Dr. McVail, wishing to see whether any
irregularities had been committed. He had now unreservedly
to say that there had been no irregularity, and he therefore
moved that the letter be now entered in the Minutes.

Dr. Heron Watson seconded the motion, which was
igreed to.

The following is the letter: —

Diar Sir,—T he point of order that I rote to speak to yesterday con¬
cerned the commissions of the representatives of the Scottish univer-
irties, u read by the Registrar.

These commissions in all four instances are from the Senates of the
nniTenitiee; hi three of them this is formally expressed; and in the
cue of Glasgow, although not delinitely stated in the document, yet
the Senate alone made the appointment.

1 desired to call your attention to the circumstances—ftrst. that the
Medical Act of 1880 does not, in the case of any one of these universities,
restrict the power of election to the Senate; and second, that the
Scottish Universities’Act of 185S is likewise without anysuah limiting
pro viilon.

1 bold that in the Scottish universities the duty of electing the repre¬
sentatives to the General Medical Council falls on the same constituencies
that return the representatives to the Imperial Parliament.

I therefore regard tho returns read before the General Couneii yester¬
day as being quite invalid.

I am, dear Sir, yours faithfully.

To BIr Henry W. Acland, President of the * O. C. McVail.

General MediealOonnail.

Dr. Humphry moved, “ That a committee be appointed to
consider the past and prospective income and expenditure of
tin Council, and to report to the Council whether any, and,
if so, what, diminution'can be made in the future expendi¬
ture of the Council.” In doing so, he said when the Council
*m first constituted they had to settle the fees and expenses
to be paid to the members j therefore one of the first actions
of the newly "Constituted Council should be to take the same |
"object into consideration. The expenses of the sittings of
the Council amounted to about .£2000 a year, and any op¬
probrium cast on the old Council should not be fixed on the
new one. The excess of inoome over expenditure during the
post seven years averaged .£1400 annually, and the estimated
increase of expenditure in the years to come would be £1200.
That would bring expenditure and income within close rela¬
tion to one another. Additional expenses must, however, be
expected. It would be an unusual thing for & large number
of men to dp Business in a shorter time than-a. email number.
He therefore'thought the Council bhould seriously consider
whether' imY dimmutidd bonld'Be effected In the various
«*MM*»frL:-e:!r l: : : " . n., Dj...

Ir. WH£BhHocsE seconded the motion, believing that the
tttio* of such a committee would be some guarantee to the
Pie f e wMn that anmye was kept on (the expenses, and that
the Oonncil was not ipclinisd-tot spend its funds recklessly.

Dr, Me Vail thought that th* committee should atepeoap
side* the question whetfier(thdm#Stlngs:of.thle Council could
not beheld in rotation in London; Edinburgh, and Dubliri.
-Noorie eouki doubt thaft thereopust be some rearrangement
with ragatd to{ fees^iadiit'rizonkdlhe absurd to propose that
tfceynbflnldrhe reduced bblow the present sdalei for gentle^
®*aJ«ving Mt of j the eountry in width the meetings were
hehWoiH nwptddthereforenfacrfraaan amendment that the
cotipphteeifettieakad to txmaider ’jdsd whether the meetings
ccel&bafelii hddvac^rionalltr *vBfata;ln : Edinburgh
WdWipfeubMMJ-dJ. -:v - -...id - i. ..Jji;

i

The President ruled that Dre Me Veil's proposal -Was not
an amendment to the motion. *

Dr. Quain strongly opposed the suggestion. ' There were
sixteen English members, and if they had to travel to-Scot¬
land and Ireland the expenses would be doubled, and- the
fands would be utterly inadequate. ' - • °

Dr. Haughton said be might add the Additional reaeon
that the Irish members were so hospitable'that if the
Council catoe to Dublin they would be broke ifi entertaining
it. (Laughter.) ■ ■ :

Mr. MaonamarA suggested that the following words
should be added to the motion: “ And also whether and ih
what manner iti income may be increased.”’ He had very
strong views upon the subject as to a method arid way ift’
which the income of the Council might be substantially
increased, and he should be prepared to state them when the,
time arrived.' ’ ' ’ '

Dr. Humphry said he would accept Mr, Macnamara’s
suggestion, and add those words to the motion. • .

Sir. Simon said"the financial position' Of the COudcil WAS'
only one part of a large subject. Tbe primary question was
the organisation of their work, because if their work Was
well orgahised he believed that great economies would
result. The Council was not nearly strict enough in distin¬
guishing fancy work from statutory work. The Council-met
for definite duties—happily now much more definite than
they formerly were. He had handed in & notice of motion
expressing what he thought the better view to take -f<W the
present of this finance question—namely, that it be referred’
to a committee to be appointed to consider under what nriea
of meeting and procedure and with what appointment nnd
authorisation of standing committees and sub-committeeS
the Council might best provide for tbe regular, effective, and
economical discharge of its statutory duties, the committee
to report to the Council at its next meeting and to bring up
a draft of any standing orders which it might deem desir¬
able. If a reference of that sort were made, then on the
report of the committee the Council would be in a position
to reoonsider their finances; but at present he thought they
were not in a position to do so.

Dr. Pettigrew agreed with Mr. Simon that the present
motion was premature. • . " ■ t

Dr. Aquicla Smith supported that view.

Dr. Bruce thought that until they knew what their
expenditure was to be they could not deal with ways arid

means. ■. — ' . ' " ■“

The motion, with the addition of tbe words suggested by
Mr. MAcnamara, was then carried and the- committee- -tras
nominated. " ' 1

Mr, Marshall, in furnishing information m regard To
some exceptional cases which the Council had directed'to be
nquired into, said it appeared that twenty-two such cases
had occurred at tbe College of Surgeons and thirty-nine At
thd College of Physicians, but he wished to point out that a
certain number of those were duplicate representations m
the same persons. In every instance the men were graduates
of Indian, colonial, or foreign universities, and he was
prepared to state that they had all studied medicine for the
required period of forty-five months.

Sir Dyce Duckworth corroborated ^Mr. Marshall’s State¬
ment, and said that all the cases bad been carefully
scrutinised by the Registrar of the College of Physicians.

Dr. Heron Watson asked if in the case of graduates of
an Indian university English was regarded as a good sub-

stituteior a classical'language/^. " . j

, f Mr, MarbHALl Said ^hat StwA4. r ' ' ' •• '/

The next subject on the agenda Was 1 tbe ffnifl report froth
itft' VteUatkm of Ex'aroinatioae'Committee.'y ''' ’ J
Mr. Marshall, in moving thAt it be received and printed;
Arid appended'td the Minutes, expressed hra deep regret'that
Dr. Haldane- was prevented ^rom being' present at’ this
thedtingof tbe Oonndl, : and his Extreme sorrow at the un¬
expected deativ-ot Dr. LyOnS. -In addition to d 1 historical
summary of ftCdtf, the report contained'A Commentary'iq
which oare hfid-beSn taken'riot to express decided opinions
that worild create Ariy advensebritieism, but gather to bnlancp
and weigh arid see Where bfnts eoaki be bbttfihed for future
examinations. 'THe*report tertriiWated with 1 yherfes of“toh-
clnsiorip,” not “reifommendatiCris.’* : ' 1 1 •'

-• Mr. TeAlE seconded the motion. .' 1 ' If .' i! °'- A

Dr, Haughton- bore testimony to the extreme accuracy
and carewith Which Mi*. Marshall :bAd prlepar^d Hie report;
BO thought Hhh committee might perbaris Seh' fhWr Way to
add a statement ae to the eufBmCricy of thb examinations, 1 '

Digitized by GoOgle

426 The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Frb. 26,1887.

Dr. Stbuthbrs thought it would very much detract from
the value of the report if any such addition were made.

Mr. Macnamara, while expressing his admiration of the
report, said it was very remarkable that the alumni of
Trinity College were not thoroughly grounded in Latin.

Dr. Glover heartily joined in thanking Mr. Marshall and
his colleagues for their enormous labours in regard to the
report. At the same time he thought the conclusion of the
whole matter was rather impotent and disappointing.
Considering the great cost of these visitations, he thought
the committee might have given a more definite deliverance,
and ventured a little bold criticism in the way of either
endorsing the complaints of the Visitors or acquitting the
universities. The Privy Council had sent some very serious
observations for the consideration of the Council, and unless
some reply was given the Lords of the Council would think
that the General Medical Council had rather evaded the
expression of a definite opinion upon the truth or untruth,
the justice or otherwise, of the charges which had been
made. It was also a serious thing for it to go forth to the
world as presumably the expression of the Council’s opinion
that prescriptions might be written either in Latin or in
English at the option of the candidate, yet Oxford University
appeared to be indifferent on this point.

Dr. McVail dealt at considerable length with the details
of the report, and quoted the papers contained therein with
a view of showing the character of the teaching in the
schools, and insisting upon the urgent necessity of the
Council going into the matter much more fully than was
proposed. He was proceeding to refer to the character of
the examinations in operative surgery in the University of
Glasgow, when

Dr. Lkishman interposed, and said the University of
Glasgow was the only body which for the M.D. required
examinations in operative surgery. There was no law
which obliged them to give any such examination whatever,
and he could not submit to the very elaborate attack which
was being made upon certain portions of their examinations,
which were in excess of what the law required of them.
He could conceive of nothing tbat would be a stronger i
illustration of a reckless waste of time, but if Dr. McVail I
was allowed to make his statement, he might have to ask !
the indulgence of the Council to say a word in defence of j
his university.

. The President said the Council must clearly see that
if Dr. Me Vail’s course was pursued it meant an elaborate
discussion upon the whole merits of the report.

Dr. McVail said the document required much more con*
sideration than could result from the adoption of
Mr. Marshall’s motion with regard to the insinuation that
he was attacking any university. He said he was speaking
of facts alone, and was giving figures that could be got by
all the members.

The President having ruled that Dr. McVail could not
be heard unless he moved an amendment,

Dr. McVail said he would conolude with the amendment,
“ Tbat the Council proceed to consider the conclusions of the
report seriatim.”

Dr. Qoain protested against this expenditure of the time
of the Council, and with that of the funds of the profession.
£Hear, hear.) The report would be sent to the various
institutions for consideration, and that would do infinitely
more good than all the discussion that could take place at j
that Council. He therefore pressed the Council to follow 1
the advice given by the committee to send the papers to
those bodies who would be influenced and guided by them,
ymd then to wait the result.

Dr. Stecthehs said the whole matter had been threshed
out at the November meeting.

Dr. Matthews Doncan said he entirely disagreed with
the general tenour of Dr. Glover’s remarks, as well as
with those of Dr. McVail, Dr. McVail seemed to think
tbat the opinions of the Visitors carried authority. The
Council had never given them any authority; its responsi¬
bility ended with sending the Visitors and receiving and
printing their reports. This subject had been very carefully
dealt with by the Council, and he considered it was a very
good resolution that was arrived at that the reports of the
Visitors, beyond being responded to by the bodies visited,
should not be farther dealt with. The Council by the repre¬
sentations which it published had done and was doing an
infinite amount of good, and anybody who could give a good
picture of the examinations oi the Faculty of Physicians
and Surgeons a few years ago and contrast them with the

present examinations would find the enormous improve¬
ment that had been effected in consequence of the repre¬
sentations of the Council.

Mr. Maeshall protested against the irrelevant discussion
raised by Dr. McVail, and said the Council was altogether
out of order in going into details till the report had been
ordered to be an appendix to the Minutes.

Dr. Hehon Watson said he intended to give notice of
motion that the Council should resolve itself into committee
on the following Tuesday for the purpose of considering the
conclusions of the report in detail.

Mr. Simon hoped that in that case Dr. Humphry would
move the suspension of standing orders with reference to
fees received by members of the Council, if that subject
was to be gone into.

The motion proposed by Mr. Marshall was then put to the
Council and agreed to.

On the motion of Dr. Steothers, seconded by Sir W illiam
Turner, the best thanks of the Council were accorded to the
Visitation of Examinations Committee, and also to Mr.
Marshall for the great labour and care he had bestowed in
preparing the report.

The report by tbe Sub-committee on the Registration of
Colonial and Foreign Titles and Foreign Degrees, as adopted
by the Executive Committee, was then, on the motion of
Mr. Marshall, seconded by Mr. Simon, received and
adopted.

Mr. Marshall then proposed the following new Standing
Orders suggested by the Solicitor, by direction of the Execu¬
tive Committee, as arising out of the recommendations of
the above report

(a) When an application is made, under the provisions of Section 10
of the Medical Act, ltiSd, by a medical practitioner—already on the
Medical Register by virtue of an English, Scotch.or Irish qualification—
to have tlie description of a foreign degree in medicine possessed by him
to be added to hi* name as an additional title in the Register, tbe Regis¬
trar shall require from the applicant satisfactory proof of the date of the
grant of the said degree, aud also such further information as may be
necessary, In order that the General Connell shall be satisfied before the
title Is registered that the degree was obtained after •• proper examina¬
tion." (6) Any application by a registered medical practitioner for
removal of his name from the Medical Register shall. In the first instance,
be referred by the Branoh Registrar to the medical authorities who
granted the applicant bis qualification or qualifications, to asoertain
whether there is any valid objection to suoh removal. The General
Registrar shall bring such application before the next meeting of tbe
General Counoil, who will consider the application and any objections
thereto, and the President may put from the chair to the General
Council the quer ion—Whether the Registrar shall erase the applicant's
name from the Medical Register. The General Registrar shall, upon tbe
removal of tbe applicant's name from the Register, send notice of such
removal to the applicant by a letter addressed to his registered address.

Mr. Simon seconded the motion.

Sir Walter Foster said, as the first of these Standing
Orders was rendered necessary by a section included in the
Medical Act of 1886 on his motion in the House, he should
like to have some little understanding of how it would
work. In introducing that section, he was anxious that
nothing but good sound foreign degrees should obtain access
to the Register, and would therefore like to know what
steps the Council proposed to take nnder the new Standing
Orders to secure that end.

Mr. Marshall said the Registrar would have to be
satisfied tbat the applicant had obtained such degree after
proper examination, and prior to the passing of the Act.

The motion was then agreed to, and the Council adjourned.

Saturday, Frb. 19th.

Sir Henry Acland, President, in the chair.

The Society of Apothecaries and the Conjoint Scheme.

Mr. Bbudenbll Carter moved:—“ That inasmuch as the
Master, Wardens, and Society of the Art and Mystery of
Apothecaries of the City of London, having used their best
endeavours to enter into a combination with some other
corporation or university for the purpose of holding &
qualifying examination in accordance with the provisions
of the Medical Act of 1886, and having reported to the
Council that they have been unable to enter into any each
combination, have in consequence, and in further compliance
with the Medical Act aforesaid, made application to the
Council for the appointment of assistant examiners in
surgery, the Council do now appoint such examiners
accordingly.” He said he should have thought the motion
would have been nothing more than a formal one, were
it not that he had received an intimation that in the
judgment of some of the members tfhe precedent which had

Digitized byLjOOglC

Th* UncW.J

MEETING OF THE GENERAL MEDICAL COUNCIL.

[Feb. 26,188?. 4*2

been set in the case of Dublin ought to be applied equally in
the cue of London, and that expression of opinion had
uken definite shape in the two amendments that had been
placed on the programme. It was a very significant matter
that the amendments were to be moved by gentlemen who
were not resident in the metropolis, and who might therefore
be supposed to be not so familiar as some of them with the
precise tendencies of the currents of forces which there
existed with regard to this matter. The Apothecaries were
now, u they always had been, perfectly willing to enter
into combination with the Royal Colleges. The difficulty
which had arisen had not arisen from them, but on the
part of the Royal Colleges. If it was the pleasure of
the Council to defer the matter, the Society would not
protest against its being so deferred,and if the bodies which
had refused to enter into combination with the Society
were to come forward and say that in deference to the
new of the Council they would reconsider the position,
no possible difficulty would be placed in the way of such
combination on the part of the Society. It was also due to
the Society to say that as a self-respecting body they could
not be expected by that Council to approach again those
universities or corporations which bad already in so decided
a manner refused to combine with them. If in deference
to the opinion of the Council the question was postponed,
then be thought it would be for those other bodies to.
approach the Apothecaries’ Society, and not for the Society,
having fulfilled its statutory and moral obligations, to go
round to the different corporations once more to receive the
same answer. As a member of the Council, be protested
*«ry strongly against what seemed to him a waste of time—
namely, the proposition to adopt in the case of the London
Society the same course as had been done in the case of the
Dublin Society, and refer the subject back to the Colleges for
their reconsideration. Thedifferencosbetween thetwocasesof
Dublin and of London were very great. The London Society
stood in a somewhat strongerpositionthan the Dublin Society,
in the fact that its privileges rested upon the wide basis of
parliamentary enactment and long usage, and that during
the seventy years of its licensing and examination career it
had given its licence to no less than 22,000 general prac¬
titioners. Then, again, the two Royal Colleges having
received the consent of the Council to their present amalga-
madon, how could the Council go back from the sanction
which it had already given to a particular combination and
that that combination was to be altered ? He thought it
would be useless for the Council to endeavour to put pres¬
sure upon constitutional bodies with a union already
anctioaed in order to induce them to take into that
ouioo a third body which they had already refused. The
Council _had no locus standi whatever, and no power of
uduenoing the results. Another point of difference
wm that in Dublin the College of Surgeons was willing to
admit the Irish Apothecaries’ Hall into combination, and the
■Dfflculty arose only with the King and Queen’s College of
“JJMeiaiis. In London precisely tbe contrary was the case,
ibe matter had been under consideration for eleven years,
wd when the con joint scheme was agreed upon the two
R°y*l Colleges joined hands and excluded the Society of
Apothecaries from their combination, and did so in tbe
®°*t deliberate way. Both Colleges were governed by men
°f profound sagacity and sound judgment, and they must be
f *ken to have considered the matter in all its bearings,
looking at all the facts, he thought it would be utterly
aeelees to refer the question back to them for reconsidera-
tiou. Referring to the history of the Apothecaries’ Company,
claimed that it had fulfilled all the conditions laid down
totheAct of 1886. During the seventy years of its exist-
«ee it had continually raised the standard of medical
wacatioc. Daring the first fifty of those seventy years
"wj general practitioner held its licence. During the last
years it had licensed annually 250 persons ou au average,
wd had recently, in compliance with the recommendations
of tile Council in 1884, added to its examining body
examinot in surgery and midwifery. Their examining
tow d wf » composed of gentlemen of the very highest
Rending. -He hoped that his application would be a merely
formaLohet in fact, if it was carried he should ask the
nominate as examiners in surgery tbe gentle-

1i*.*p*. filled the port. with such distinguished

wMP&pftMeoqBded the motion. The proposition was
statutory duty, and be thought
without delay. It would be

useless to refer the matter back to the Colleges. It was not
possible, knowing the deliberate action of those Colleges,
to suppose that they would reconsider the question; they
had considered it for so many years that they would be
wrong in reconsidering it. The proposals, therefore, put
forward in the amendments on the programme were simply
to defer the question until it was too late to be of use.

Mr. Mitchell Banks had given notice of the following
amendment: “That the Council postpone coming to a
decision on the motion of Mr. Brudenell Carter, and earnestly
request the Royal College of Physicians of London and the
Royal College of Surgeons of England to reconsider their
action with reference to the admission of the Apothecaries’
Society of England to a joint examining board.”

Dr. Strothers had also given notice of an amendment,
seconded by Mr. Teaeb: “ That the Council, being of
opinion that it would be contrary to the interest of the
public to have two competing examining boards Bitting in
London, and that it is desirable that the Royal College of
Physicians of London, the Royal College of Surgeons of
England, and the Apothecaries’ Society of London should
arrange to hold a qualifying examination conjointly, strongly
recommend to these medical authorities to reconsider their
position with a view to such an arrangement; and mean¬
time defer coming to a decision on the application from the
Apothecaries’ Society of London of 12th February.”

Mr. Mitchkll Banks said the two amendments had
practically the same tendency, and he would be glad to
merge his with Dr. Struthers’, or to abandon it in favour of
the latter. He admitted the services which the Apothe¬
caries’ Society had rendered to the cause of medical educa¬
tion, but the only reason for its continuance was tbe
memory of its past deeds. It had been suggested that the
existence of another examining body would mean a whole¬
some rivalry, but he thought it would be a competition
downwards.

Mr. Whbblhousb was prepared to second the amendment.
There was among the profession generally a most earnest
desire for the suggested combination.

Sir Dscb Duckworth said that in one important particu¬
lar the College of Physicians had never recognised the
Apothecaries’ Society as qualifying for its licence. When the
two Colleges agreed to combine for tbe purpose of holding a
qualifying examination the Apothecaries’ Society was left
out of the combination. The Apothecaries admitted that the
Conjoint Board of the two Colleges was complete and wanted
no adding to, and he was quite sure from the character of
the examiners of tbe two Royal Colleges in the subject in
which the Apothecaries claimed to take part, that the exami¬
nation was second to none, not even to that of any of the
universities in the United Kingdom. What, did the
Society want? They offered to examine in botany,
chemistry, and pharmacy. It would naturally he asked,
Who were the men whom the Apothecaries’ Society
would be likely to appoint to those important functions.
Far from being able to find amongst its own members
persons qualified to examine, they had to go outside and fake
six or seven of the Fellows of the College of Physicians
to do the work for them. In preliminary and scientific
subjects tbe two Colleges took the greatest pains to secure
examiners of the first eminence, and he did not see what
particular benefit would result from granting the claim of
the Apothecaries’ Society. It would bo a great disaster to
have another competing licensing body. A good deal had
been said about the dignity of the College of Physicians.
It was a body which respected itself, and therefore respected
all other bodies. He was authorised to say that it was
absolutely useless to refer the matter back to the College,
because be was perfectly certain that its deliberate action
would be sustained.

Dr. Struthers said he had very serious objection to
sending a body of men out into the profession with the title
simply of Licentiates of the Apothecaries’ Society. It might
be that the Privy Council would yield to the request, but he
himself could never be a party to lending crutches to the
Apothecaries’ Society.

8ir W. Foster, as a direct representative of tbe profession,
apposed the multiplication of portals to the profession.

Dr. Haughton thought the Apothecaries had made out a
fair case for considering wbat examiners should be appointed,
and should therefore vote for the resolution.

Mr. Simon hoped that the two amendments would be
amalgamated.

Mr. Teals speoudod Dr, Struthers’ amendment, and after

428 The Lancet, - )

MEETING OF THE GENERAL MEDICAL COUNCIL.

[Feb. 26, 1887.

a short discussion Mr. Mitchbll Banes withdrew his
amendment in favour of that by Dr. Strothers.

Dr. Glover, regretted exceedingly th&t at the advanced
stage of the proceedings of Council they were spending
three hours in discussing a question which ought not to
have presented any difficulty. Ho should be no party to
asking the Apothecaries’ Company to put itself into the
attitude of knocking at the doors of all the corporations and
universities of England again. It had gone through a pro¬
cess very painful to those who held its licence, and certainly
they could not ask it to continue that attitude. The profession
had never been in such a complicated state as at present, when
they had universities competing with corporations, and
corporations desiring to assume university functions, while
the united Colleges were repeating the action of the College
of Physicians in 1815—that of disregarding a very extensive
feeling in the profession that the body which had had so much
to do with the general practitioners ought not to be treated
coldly, nor, at present at any rate, to have its existence dis¬
continued. The situation was still further, complicated by
the Act of 183(3, which did hot appear to give the Council
the power which it had hitherto possessed of expressing its
opinion upon conjoint arrangements. They might assume,
however, that the Royal Colleges would not disregard the
strong expression of opinion of the Council, and he therefore
hoped that Dr. Strothers! amendment would be adopted. The
Council might only get another proof that it had lost its
power, but the sooner they got that proof the better.

Sir Dycj$ Duckworth asked Mr. Carter what was the
significance of a rather minatory clause in the letter
addressed to the Royal Colleges of Physicians and Surgeons,
which did not appear in any of the letters addressed to.the
universities—viz.: “ Nor should it be forgotten that,.if the
Colleges be unwilling to combine with the Society, there is
still open and possible to the latter a very formidable com¬
bination, which in this alternative would equally cause a
very serious competition to arise, to the prejudice of the
Colleges.”

Mr. Carter said that the letter was written before he was
the representative of the Society, and he had no knowledge
of what was in the mind of the writer. The applications
made to the Ufiiversities of Oxford and Cambridge were
regarded as merely pro formd , but it was thought possible
that those addressed to the Victoria and Durham Univer¬
sities might lead to combination, and a deputation was sent
to Durham to discuss the matter with the authorities.

Mr. Marshall said that he felt a difficulty, owing to the
position which he occupied in relation to the College of
Surgeons, in voting for the amendment, and at the same
time he could not oppose it. As. a member of the Council,
his sympathies were in favour of the amendment. The
argument now brought forward was, not that it was neces¬
sary for the purposes of examination thnt the Society of
Apothecaries should be taken into the Conjoint Scheme, but
that it was necessary for the public good t and that was an
argument that, as an honest member of the Council, he
conld not oppose. Under those circumstances he thought it
best to give no vote on the subject.

Dr. Duncan said that, while intending to vote Cor the
amendment, he entirely disapproved of the tone of many of
the remarks that had been made. He saw no reason for the
mock humility displayed by Mr. Carter in reference to the
Society of Apothecaries, which might hold up its head as an
equal with the Colleges of Physicians and Surgeons, and not
as an inferior. Though he proposed to vote for the amend¬
ment, he was no advocate for the one-portal system, which
he thought was the worst of all systems. Competing bodies
he considered to be of great advantage. But there would be
a benefit, in the present crisis of affairs, in the union, not
the absorption, of the Society of Apothecaries with the two
Colleges. It had been said that if the Medical Council did
not do it the, Privy Council would. He did not take that
view. He.bad no doubt that the Privy Council would treat
the decision of the Medical Council with profound respect.
If he thought that the exclusion of the Society of Apothe¬
caries would tend to a competition downwards, and to a
lowering of the qualification, he could not vote for its con¬
tinuation. But its past history had shown that it had
generally kept pace with improvements in teaching. and
examination. One of his reasons for voting for the amend¬
ment was that if the Council now appointed examiners for
thf Society of Apothecaries in England the Colleges in
Dublin would hardly listen to the advice which had been
given to them, and to which be hr-pM they would listen.

Dr. Humphry agreed With Dr. Duncan that in rejecting
the amendment the Council would be acting inconsistently
with the vote it had passed in reference to the Apothecaries'
Hall in Dublin. But he had no great hope as to the result.

Dr. Banks supported the amendment.

Mr. B. Carter, in replying, eaid he believed that the
power to compel combinations was designedly withheld
from the Medical Council. The power of appeal to the
Privy Council was inserted at tha rtqdest of the Society of
Apothecaries. He wished to ask what security the Sooiety
had that the Council would meet in May, because unless
there was some assurance to that effect it might be their
duty to appeal before that date. They had acquired a
vested interest in English' medical education and examina¬
tion, and no Government or Parliament would ever dream
of extinguishing it without compensation.

The amendment proposed by Dr- Strothers was then put
to the Council and carried, 24 voting in its favour and 4
against.

Mr. Brudenell Carter asked what coarse would be
taken with regard to the resolution just agreed to.

Sir Wm. Turner said he was just about to ask the same
question, not only with regard to this matter, but also as to
communication with the Irish bodies.

The President said after consultation with the Chairman
of Business he should be prepared to suggest the course
that should be taken at tbelr next sitting.

On the motion of Mr. Simon, seconded by Mr. Marshall,
it was resolved: “That it be referred to the Business
Committee, with six additional members to be appointed by
the Council for the purpose of the reference, to consider
under what roles of meeting arid procedure, and with
what appointment and authorisation of standing com¬
mittees and sub-committees, the Council may best provide
for the regular, effective, and economical discharge of its
statutory duties; the committee to report to the Council
at its next meeting, and to propose for consideration of the
Council the draft of any new Standing Orders which it may
deem desirable.”

i Dr. Heron Watson then moved: “ That, having received
the final report of the Visitation of Examinations Com¬
mittee, the Council determine that it resolve itself into a
committee to consider the report of the Visitors appointed
by the General Medical Council, together with the answers
oi' the several universities, in the light of the report, and
that it do so resolve itself into committee upon Tuesday
next.” He said he moved the resolution simply with the
viewof putting the Council in line with the mode of procedure
adopted in connexion with previous reports of visitations.
The report in question was of a most admirable character,
and it would be a pity for it to he banded over to a remote
shelf of the office without any further expression of opinion
on the part of the Council with regard to it.

Dr. Banks seconded the motion.

Dr. Aquilla Smith thought the motion a very un¬
desirable one, because if the Council resolved itself into
committee it was impossible to say how long the discussion
would last. There was no necessity at all for it, as all good
that could possibly be derived from it would arise from its
study by- the various bodies.

Dr. Humphry also opposed the motion.

Dr. Bruce moved as an amendment: “ That, in receiving
the final report from the Visitation of Examinations Com¬
mittee, the General Medical Council is happy to find that all
the universities do provide a sufficient guarantee that their
graduates possess the requisite knowledge and skill for the
efficient practice of their profession."

Dr. Haughton seconded the amendment, and moved the
adjournment of the debate.

Dr. Struthkes gave notice that at the next sitting he
would move the previous question.

The Council then adjourned.

Monday, February 21st.

Sir Henry Acland, President, in the’ chahl
The Apothecaries' Societies and the Conjoint Scheme.
-The President said that, in accordance with the wish of the
Council, he had consulted with the Chairman of Business and
also some other members of the Council as to the mode to be
adopted in bringing the resolutions of the Council before the
Royal Colleges, and, with the permission of the Chairman of
Business, a resolution would be moved on the subject.

The Lancet,]

MEETING OP TEE GENERAL .MEDICAL COUNCIL.

[Feb. 26,1887. 429

Dr. Stbuthbbs proposed: “That the President be requested
to communicate to the King and Queen’s College of. Phy¬
sicians and the Royal College of Surgeons of Ireland, and the
Apotheoariee’ Hall of Ireland, the resolution of the Council
of Feb. 16th, and to oommunicate to the Royal College of
Physicians of London, the Royal College of Surgeons of
England, and the Society of Apothecaries of London, the
resolution of the Council of Feb. 19th, and to take such
further action as he may see tit towards the attainment of
the object of those resolutions, to which the Council
attaches great importance, in the interest of the public.”'

Mr. Whbeluousb seconded the motion.

Dr. Aotilu Smith could not agree with,the motion. He
objected to the idea of personal influence being brought to
bear, which seemed to be the object of the resolution, and
at the same time thought it would be very unfair and very
unreasonable to impose upon the President the duty of
entering into oral communication with these Colleges.

Mr. Brudbnell Cabikb said he should move an amend¬
ment—vis. : “ That the letters, if any, to the Royal College of
Physicians,; London, and the Royal College of Surgeons,
England, be addressed to the Presidents of .those Colleges
respectively, with the request for immediate reply, and that
those replies be considered by the Council during its present
session.”

Mr. Mabshall said, if an amendment was to be moved, it
could not be be discussed without being on the programme.

Tbe motion and amendment were therefore adjourned to
the following day.

Dr. Bruce then moved the amendment (of which he had
given notice) to the motion of Dr. Heron Watson with re¬
gard to the rejport of the Visitation of Examinations Com-
atye*. '.He said they bad had a Valuable report from the i
committee, and it was quite unnecessary to go over again I
sllthepoint8 raised in .that document. Indeed, rit would
not be/ courteous to the committee to do eo;iand no one
«ro«ld eare to sit upon a committee if every point discussed
by itirraa taken up again, by the Council.. Unless Dr. Watson
was prepared to move an amendment to some of the rules
add regulations Of the Council, which would be .the logical
sequence of his proposal to go into committee, the course he
had suggested would be a mere waste of time; It had often
been said to the direct representatives on the Council during
the progress of their election that they ought to take Care
that.no man who was not a gentleman and had-not the
making-of a good doctor in him should be admitted to the
profession. But that was not the function, of the Council.
So resolution of the Council and no Act of Parliament would
make a man a gentleman. The .Council was not a patent
machine for turning out irreproachable doetors.: All that it
coultido was to See that candidates came up to a certain
minimum in their e&Uawations.

Dd.'H auohtoh, in seconding the amendment, said, it had
net;been provedito the,satisfaction of the Council that any
ob«l corporation or University in tbe three kingdoms was
letting loose upon the world men Who Were not safe practi¬
tioners, That was their business, and that alone. On
reading over tbe reports, he did not see that any case had
been made out to satisfy any individual member, much less
the Council as a whole, that in any instance these bodies had
pawed men whiS were incompetent to practise.

Mr. Simon said he couhl vote neither for the motion nor
the amendment. The amendment stated that the amenders
were “ happy to find.” He rejoiced in their happiness.
(Laughter.) They were happy to find what, in point of fact,
was not to be found in the report. On the contrary, he
was correct in saying that in the Visitors’ report there were
passages se strongly as possible in an opposite direction, and
in three cases it was stated that the degrees' ought not to
admit to the Register. He did. not think it would be right
to meet this with the “ previous question.” Here were three
courses proposed, and he thought the. Council could not take
anyone of them. There was a fourth-course, although that
was going beyond the usual quantity of option, and perhaps
it would not be irregular if: he read what he thought that
p 0 ®*® abould be: “That the Council/intending shortly to
D^pnits inspections unde* th^ Medical Act of 1886, will,
when it enters on tbat duty, particularly direct thh attention
tditsinspectors to all points kt ! Which the late Visitors of
Soal examinations of the universities take exception
®**eorlee8 to the sufficiency of cortain of those examina-
«*M*l:lrai?on the same occasion take a like course in
*^o!.tte reports which it last received on the examina-
“Wtktl to snsd W corporations.”..

Dr. Matthews Duncan said he should be prepared to
second that amendment.

Sir Wu. TuiiNEtt agreed that the two amendments before
the Council hardly met the motiou, and was quite prepared
to support Mr. Simon's amendment. He could not acoept
what be understood to be the proposition laid down by
Dr. Heron Watson—viz., that these various documents had
not been properly discussed in tLo Council, because on
page 3 of the revised reports he found that the documents
which the committee had before it consisted of certain
instructions prepared by order of the Medical Council for
the instruction of their Visitors; secondly, of the reports of
the Visitors; and, thirdly, of the discussions held on J une 7th,
8th, 9th and 10th, in committee of the whole Council. He
could not see any reason at all why Dr. Heron Watson
should now ask them to go into committee on documents
on which the Council had sat in.committee on four full
days in tbe month of J une. He submitted that the Council
ought not to take up such a position os to render it neces¬
sary for members to remain away from their home duties
any longer than was absolutely necessary.

Dr. Bbucb said he was willing, with the permission of
the Council, to withdraw his amendment in favour of that
proposed by Mr. Simon. ; .

Dr. Stbuthebs said he had intended to move the previous
question, but he would refrain from doing. sp.in>favour of
Mr. Simon’s amendment, if it could be disposed of without
waste of time. ' ■ •

Sir W. Foster said he would .himself mpye the previous
question in the interests, of, eqpnoiny of time,, which, had
been for days past neglected by the Council. . , ; . . . .

.Dr-M oore said he would second the previous question..

The Pkesjdent ruled that thap.revjqusquestion could not
be moved until Mr. Simon’s amendment, (.which had^ been
substituted for Dr. Brape’s) hgd been djspoted of. : .

Dr. Glover contended that the e.uhjeec;had not. been fully
disposed of at the last meeting of the-,Council, but had been
distinctly postponed. If there was one party in the Council
more than another that should have favoured the fullest
discussion of the reports of ; the university examinations, it
should, he thought, be the representatives of t}ie univer¬
sities themselves. The amendment of Dr. Bruce (which
damned the universities with faint praise) was a very in¬
adequate, outcome of the visitations which had takep place
by men pf. the highest eminence. In one of, the reports it
had been distinctly stated that, the examiners had erred on
the aide of leniency, and in three cases, as Mr. Simon had
pointed out* the examinations were not considered sufficient
to guarantee the requisite knowledge on the part of the
persons passed. Under those circumstances time was not
being Wasted in properly disposing of the,reports. .He should,
however* vote for ,Mr. Simon’s amendment, seeing (hat the
Council was about to turn over anew leaf and to gnilottake
very critical inspections with a view of securing, a. more
severe standard than formerly-existed, ■

Dr. McYail said that the-majority, of the Council had
evidently made up their minds not to deal with the reports,
because if any opinion were given by the Council a number
of institutions would be severely censured before the pro¬
fession and the public. (“No, no.”) If there was any
waste of time, it would be in not considering the reports,
the drawing up of which had involved so much trouble and
expense. .. .

Mr. Macnamara said be accepted the principle of Mr,
Simon’s amendment and should vote in its favour.

Dx. Leishman said that Mr, Simon’s amendment had
relieved him from a great difficulty. He sympathised with
a good deal of Dr. Heron Watson’s statement, but if the
subject were to be fully discussed, he did not know when it
would be ended. With regard to the University which he
himself represented, nothing would give him greater
pleasure than to .hear anything that could be said against
it, provided he had the right to reply. He repudiated the
idea of being influenced by any such motive as had been
attributed to: the representatives of universities.

Dr. Banks; stated that one of the three cases cited by
Mr. Simon had reference to tl)e University of Dublin, aud
that in that case the examination was for physicians, and
not for general practitioners. The visitors stated that they
were favourably impressed with some portions of the
examinations, ' and could conscientiously commend the
specially medical portions.

- Six Walter. Foster said that the statement made by
Dr, Banks was & good illustration of the fatal course on

430 tfHE Lancet,]

Meeting of the general medical council.

[Feb. 26,1887.

which the Council was entering in discussing the reports.
If ail the points were to be taken up in the same way
there would be no end to the discussion. They were,
in reality, doing nothing more than discussing an entire
Blue-book.

Dr. Duncan said that some members of the Council had
entertained the false impression that the reports had not
been already discussed. In truth, they had been considered
for a period of four days at the June sitting of the
Council.

Dr. Struthers said that the whole subject had been
thoroughly threshed out, and he repudiated the insinuation
that he was afraid of further discussion.

Dr. Heron Watson having briefly replied, Mr. Simon’s
amendment was put and carried, and it was also carried
nem. con. as a substantive motion.

The next business was the following motion, of which
notice had been given by Mr. Teale: “That in the opinion
of the General Medical Council it is desirable— (a) That, in
the interest of students whose place of medical education is
at a distance from the seat of examination, the written
portion of the examination should be conducted at the place
of education; (6) that a sufficient time should intervene
between the written and the oral portions of an examination
to allow the examiners to read over and judge the written
answers of every candidate, and to confer upon doubtful
cases before the commencement of the oral examination;
and (c) that candidates who in the written examination
have failed so completely as to have forfeited all chance of
passing by the aid of the oral shall be ‘stopped’ from passing
on to the remaining portion of the examination. This step
ought to be granted as a matter of economy of money in the
coses of students, and as a matter of economy of time in the
case of examiners.”

Mr. Simon rose to order. He said it was the duty of the
Council to mind its own business, and this was not its
business. It was a question in contest between parties
independent of them, and over whom they had no control.
It was merely as to questions of internal economy between
independent examining boards and their students.

The President ruled that the motion was in order. It
was merely another form of recommendation, and that was
a matter quite within the province of the Council.

Mr. Teals, in moving his resolution, said that in order to
shorten the proceedings he would reduce it to the first
paragraph. This was a subject clearly within the cognisance
of the Council, inasmuch as there were remarks of the
Visitors of corporations in which it was referred to very
distinctly as an opinion which they had arrived at during
their visitations. He urged that a step such as he proposed
would be of great value in certain portions of the kingdom,
but it would be of most conspicuous value in England,
because a great number of students were licensed every

{ tear by the two great corporations in London, and a very
arge proportion of students were educated at a great dis¬
tance from London, which involved on each occasion of
examination a necessity for coming up from their proper
work and remaining in London for some days till the oral exa¬
mination took place. Students were now brought up for
their first or semi-flrstexamination eariy in the course of their
first year, when their examinations might possibly be divided
into seven different portions, so that students might have
to come up seven different times. A memorial had been
made on this subject to the examining bodies initiated by
the medical department of the Yorkshire College, and signed
by other teaching bodies. If there was one thing that
struck the Visitors more than another, it was that examin¬
ing was becoming more laborious, and if done well would
require much longer time, and therefore if time could
be gained from the paper examination and given to
the oral it would be a great advantage to the students;
he therefore hoped that the Council would accept the
resolution.

Mr. Mitchell Banks seconded the motion. He thought
that in justice to the provincial students in England some
means should be adopted by which their examinations might
be lightened. Examination papers could be easily and
safely sent through the Post Office, and the heads of the
colleges and schools might be thoroughly trusted to see that
the examinations were fairly conducted.

Dr. Moore said that there were practical difficulties in
carrying out Mr. Teale’s proposal. Students sometimes,
while writing their papers, would ask for some explana¬
tion respecting a question, and if the examiner wore

not present the explanation might not be satisfactorily
given.

Dr. Haughton said that in Dublin it was always con¬
sidered necessary to have the examiner present at an exami¬
nation for honours; but that was hardly necessary in the
case of a pass examination.

Dr. Duncan said he had never known a student unde¬
servedly rejected, but he had known some students unde¬
servedly passed. The plan recommended by Mr. Teale had
been adopted by the University of London and other bodies,
including the Obstetrical Society of London, and had been
found to work satisfactorily.

Dr. Banks referred to the dangers attending the trans¬
mission of the papers. In order to obtain absolute security
in this regard, the authorities at Trinity College, Dublin,
had decided to have a printing press on the premises.

Mr. Wheelhouse Baid there was a very strong feeling
amongst provincial students that injustice was done them in
regard to their written examinations. Even when there was
no chance whatever of their passing in their written papers
they were detained in London for days to go through the
oral examination, which could only be a farce. The present
method, he considered, added at least .£10 to the cost of a
diploma for a provincial student.

Dr. Heron Watson moved the previous question, and
said he considered it a waste of time to discuss the subject.
Application should be first made to the Colleges, and distinct
evidence should be given of any injustice done to the
students. When that was done, the Council might be in a
position to take steps in the matter.

Mr. Simon seconded the motion for the previous question.
Dr. Humphry pointed out certain practical difficulties
which, he said, would arise in carrying out Mr. Teale’s pro¬
position. He considered that it would be very undesir¬
able to prevent a student from coming up to the oral
examination in consequence of his failure at the written
examination. Nothing could give a Btudent more per¬
manent information than that which he obtained at an oral
examination.

Sir Dyce Duckworth said this question had already
come under the consideration of the Colleges in London.
There was little doubt that after due deliberation some
course of action would be decided upon. He did not agree
with Mr. Teale’s motion. He believed it was a very good
thing for the students to come up to the Colleges and to see
London. He was somewhat surprised to learn for the first
time that there was a want of confidence as to the manner
in which the proper work in the examinations was conducted
by the examiners on the Conjoint Board. As one of those
examiners, he could only say that an amount of time was
given by examiners to their work which perhaps would
surprise some members of the Council. The papers were
most religiously and caref ully read, at a very great expenditure
of time, and no candidates were rejected on any one paper.
Practically it came to this, that in each subject every man
had a vivd voce examination.

Mr. Simon, while sympathising with Mr. Teale’s motion,
thought the Council had no authority with the licensing
bodies in this matter.

The vote was then taken on the previous question, which
was carried by 11 votes against 9.

On the motion of Mr. Marshall, seconded by Dr. Heron
Watson, the report of the Executive Committee in regard
to Dr. Day was adoptod. The committee recommended
that “ before proceeding further in the matter, it would be
desirable to refer the papers on Dr. Day’s case, with the
Report on the Uses ana Abuses of Unqualified Assistants
resented by the committee appointed by the General
ouncil on July 3rd, 1882, and the resolution passed by the
Council on April 21st, 1883, to the Privy Council, and to
communicate the result of such reference to a future meeting
of the General Council.”

Mr. Marshall then moved: “That the diplomas in
Sanitary Science, Public Health, and State Medicine, granted
after examination (see pp. 46-71 of the Minutes for Feb. 16th,
1886) be recognised by the Council for purposes of Registra¬
tion in the Medical Register, under Section 21 of the Medical
Act, 1886.”

Dr. Haughton seconded the motion.

Dr. Glover asked if anything could be done to introduce
something like uniformity in the titles.

Mr. Marshall said they had taken a legal opinion on the
subject, and were distinctly instructed by their solicitor, and
also by Mr. Muir Mackenzie, that they lied no power in the

Thb Lancet,]

MEETING OF THE GENERAL MEDICAL COUNCIL.

matter. They were compelled to use the title that the
body itself used, if it was an evil, it was not an evil of
the Council’s creation, and it was not for them to exercise
any influence on the matter

Ur. Heron Watson read a letter from a graduate of
science with reference to the subject under discussion. It
pointed out that in one of the bodies granting diplomas in
public health—viz., the University of Edinburgh—residence
was required, and a special course of study in laboratory
work; while in many others that was not required, so that
any registered practitioner could present himself for exami¬
nation when he felt competent to do so. If a man were put
to the trouble and expense of residence for a degree, the
writer considered that the degree should not rank with
certificates not so obtained. He would call each degree or
certificate by the title given it by the authorities.
Dr. Watson thought it would be a misfortune to depart
from the plan hitherto followed in the registration of other
qualifications.

The motion was agreed to.

Presentation to the President.

Dr. Humphry said the very agreeable duty had been
deputed to him of offering a marble bust to the President
lor his acceptance. That bust, executed by M. Boehm, was
presented by the members of the late Council and others
who bad at various times sat under Sir Henry Acland pre-
tidiug at that table; of those, alas, some were unable to be
with them in their bodily presence, of whom he might name
Dr. Scott Orr, Dr. Apjohn, and Dr. Storrar. The mention of
those names recalled the names of others who also had at
Mill earlier periods sat at that table—Dr. Embleton, Dr.
Allan Thomson, Sir Dominic Corrigan, Dr. Kolleston, Dr.
Sharpey, and Dr. Andrew Wood,—and there could be no
doubt that every one of those would have rejoiced in any
opportunity of doing honour to their President. There
was no person who hud been so identified with the work of
the Council up to the present, and it was scarcely probable
that any other person ever could be. Ever since its first
institution in the year 1858 he had been a member of it, and
for more tlian twelve years he had been its president. The
presentation was made as a mark of their high regard for
their President os such, and their no less hign esteem for
him as a man. It was also a token of the general wisdom
of hi* administration in that chair, and of the untiring, con¬
tinuous, unselfish devotion which he had given to the work
the Council. Dr. Humphry also referred to the work
named on by their President in the University of Oxford,
where it was lie who first opened the springs of natural
vienee, which afterwards flowed to Cambridge, while from
' lose two universities fountains had been opened in various
P»rts of England, which had done much to promote a higher
Md more extended education. He concluded by assuring
the President that whenever he should cease to bear that
honoured name he would he remembered with affection and
rejrret

The President, in acknowledging the gift, referred to
his long connexion with the Council, and said it was rather
remarkable that, considering the uncertainty of things here,
he had never been absent from any sitting of the Council
eicept on one day when he was obliged to be at Oxford.
Referring to the origin of the Council and the strange feel¬
ing with which they met for the first time in the history of
‘heir profession to endeavour to heal its feuds and foster
the good of future generations, and remembering the men
*ho sat on those earlier councils, Brodie and Green, and
Ciristison, Watson, and Corrigan, and those who suc¬
ceeded them, Parkes and Begbie and BoUeaton, they
might well understand that it was with truth that he said
the greatest gratification of his life had been the
deling that he.was a member of that body. He intimated
that from considerations of health he should be obliged to
wtire from his presidency, but was likely to retain office
“Mil the next meeting if necessary, in order, if possible, to
bring about some settlement of the difficulty in connexion
*>th the Conjoint Scheme. In conclusion, he asked the
tavoar of the Council to accept the bust, and allow it to
remain in the Council room.

Dr. Humphry, on behalf of the Council, accepted the
7 V)* 1 they hoped shortly to add to it the bust

ot Sr Henry’s predecessor. Dr. Paget, so that both univer-
Mtw# might be. fitly represented,

. 1 A T^ 0 *#**^ having been passed to Dr. Humphry and
also to Mr. Boston, the proceedings terminated,

Tuesday, Fbbr
Sir Henry Acland, Prep

On motion put from the che
to remove the qualifications
Edward Robson from the M
tions having already been
Physicians and Surgeons in

The Apothecaries' Societies u„.

Dr. Struther8 moved: “ That the Preau.
communicate to the King and Queen’s College v.
in Ireland, the Royal College of Surgeons in Irelanw,
the Apothecaries’ Hall of Ireland, the resolution of the
Council of February 16th ; and to communicate to the Royal
College of Physicians of London, the Royal College of
Surgeons of England, and the Society of Apothecaries of
London, the resolution of the Council of Feb. 19ib; and to
take such further action as he may see fit towards the
attainment of the object of these resolutions, to which the
Council attaches great importance in the interest of the
public.” He said it was not to be supposed that the
President should exercise any undue influence or pressure,
but if he would kindly undertake these good offices it might
be of very material service to the bringing about of a har¬
monious solution of this very important point. In looking
over the letters that had passed, he thought, he saw a ray ot
hope, notwithstanding all that had heon said.

Mr. Whkelhouse seconded the motion. The matter was
one of very great importance to the profession at large, and
in trying to carry it to a successful issue the Council should
leave no stone unturned.

Mr. Macnamara, while sympathising with the desire
that had been expressed, was afraid that hope had told a
flattering tale. From letters which he had received from
Dublin, he feared that the two Colleges would not listen to
the charmer, “ charm he never so wisely.”

Dr. A. Sihth asked whether the letters were from Fellows
of the College of Pbyaicians or of the College of Surgeons.

Mr. Macanmara said tli9y were from well-informed
people (laughter).

Mr. B. Carter proposed an amendment omitting all
reference to the English bodies. He contended that any
efforts iu relation to those bodies would be a waste of time
on the part of the Council, and might inflict serious injury
on the Society of Apothecaries. It was necessary that that
Society should have ready by Juno 1st an examination which
might with confidence be submitted to tbe Council, and
examiners would have to be appointed either by the Medical
Council or the Privy Council. The time, therefore, would
have to bo fixed—a time beyond which the inaction of the
Council would be interpreted as a refusal, aud when appli¬
cation would have to be made to the Privy Council. It was
not right to hang up the Society of Apothecaries between
heaven and earth, like Mahomet’s coffin, between the pre¬
sent time and the next meeting of the Council, whenever it
might happen to be. The Society did not object to com¬
petition, but it claimed to be treated with simple justice.
The proposed delay would be a profligate waste of time, and
the efforts made would be absolutely futile.

Dr. Hauohton, in seconding the amendment, said he had
hopes with regard to Dablin; but from all he had heard in
England he thought that the proposed action would be a
mere waste of time.

Sir W. Foster opposed the amendment on the ground
that the Council haa no right to look outside its own body
in the matter. They were custodians and guardians of the
interest of the public, and must leave aside narrow vieWB
as to the advantages likely to accrue to any individual body
by their action. He could quite understand that the
Apothecaries’ Society would be delighted to be put in an
independent position, but he thought the Council ought if
possible to prevent it.

Sir William Turner said tbe Council had already
seriously considered all that was involved in Mr. Brudenell
Carter’s amendment, and therefore his impression was that
the whole of this was out of order. The Council had come
to a deliberate resolution to go to these various bodies both
in England and in Ireland. Having done so, they ought not
to pass this amendment, which would practically reopen the
whole question, because if it were accepted the next step
that Mr. Carter would take would be to bring forward a
resolution asking the Council to appoint examiners, when it
had already decided that it oould not do so this session.

*087. 483

Lord

cjver-

°S ; pg

MEETING OP THE GENERAL MEDICAL COUNCIL.

LFkb. 26,1887.

Lancet,]

which

lf h. Simon thought the Apothecaries’ Company would be
the lle equal to making a provisional arrangement on
j one 1st in the event of an adverse decision from the other
• bodies.

Mr. Mitchell Banks hoped that the amendment would
not be carried, because it was simply an undoing of all that
had been done.

Dr. Heron Watson said the Council would only be stul¬
tifying itself if it did not do something to carry out the
resolution which it had passed. As to the question of delay,
there was no likelihood of the PHvy Council aoting in the
matter without consulting the Medical Council. After such
consultation he thought there would be no difficulty in
making the necessary arrangements for the examinations.

Dr. Struthers, in replying, said he had no reason to
suppose that the efforts of the Council and the President
would be useless. He Could not believe that a resolution
of the Council passed by a majority of 20 against 4 would
be disregarded by the Colleges. The object of the motion
was Bimply to carryout the resolution.

Mr. Brudbnell Carter thought it would best harmonise
With the general feelings of the Council if he withdrew the
amendment.

The amendment having by leave been withdrawn, the
motion as proposed by Dr. Struthers was agreed to.

Inspection of Examinations.

The next business was to consider the report by the
Inspection of Examinations Committee.

It being resolved to deal with the resolutions in the report
seriatim,

Mr. Marshall moved the adoption of the first resolu¬
tion : “That the principle on which the Council’s visitation
and inspection of examinations ought to be founded is,
that the visitations and inspections shall systematically
cover, within stated periods of time, the pass examinations
in all branches of knowledge which the Council deems
essential as qualifications for licence.”

Dr. Heron Watson seconded the motion.

Dr. Duncan said the Act of 1886 distinctly confined their
inspections to the three branches of “ medicine, surgery and
midwifery,” and therefore to state that they should cover
“ all branches of knowledge” introduced confusion.

Dr. Kidd said it was not possible to secure the requisite
knowledge of surgery if they did not ascertain that the
student was taught anatomy, or that he had the requisite
knowledge to practise as a physician without ascertaining
whether he had been taught physiology and pathology.

Dr. Duncan said that might be true, but it was not an
answer to the words of the Act, which did not include many
branches of knowledge which the Council rightly deemed
essential. The meaning of the Act was plainly that inspec¬
tions should be confined to examinations of medicine, sur¬
gery, and midwifery, and he would therefore move as an
amendment that, instead of the resolution reading “past
examinations in all branches of knowledge,” it should be
“ past examinations in medicine, surgery, and midwifery.”

Dr. Quain hoped that such a small matter would not be
discussed by the Council on that which they hoped would
be the last day of their sitting. It was sheer waste of time.

Mr. Simon said that the power of visiting courses of study
and attending at examinations under the Act of 1858 still
Continued, but in regard to examination it was merged in
the new power of inspection. The phrase " visitation of
etaminations” was therefore misleading. The reference to
the committee was in relation only to the new power of
inspection.

Dr. Humphry said that the new Act commanded the
Council to appoint inspectors to ascertain the sufficiency of
the standard of proficiency required of the candidates at the
Said qualifying examinations, which were examinations in
tnedibine, surgery, and midwifery; and it was not certain
that the inspectors were at liberty to attend any other ex¬
aminations than those in the three subjects named. It was
not oertain that Mr. Simon’s view was correct, that the old
power was merged in the new. Under all the circumstances,
it would be better to use the powers of the two Acts.

Dr. Duncan’s amendment being withdrawn,

Sir William Gull proposed as an amendment—“ That
the Council’s visitations and inspections, imposed by
Section 19 of the Act of 1858 and Section 20 of this Act of
1885, shall be systematically Performed within stated
periods.”

Dr. Humph&Y seconded the amendment.

Dr. Bruob thought it would be better to omit the first
resolution altogether. He proposed to move to that effect.

Dr. Struthers supported that suggestion.

Dr. Heron Watson said the resolution before them was
dependent upon the interpretation which was to be placed
upon the two Acte of Parliament on which they aoted, and
he believed the wording of that first resolution was adopted
in committee for no other reason than to keep that as an
open question, it was the expression of a general principle,
and the subsequent resolutions worked out the details. It
was therefore important to press the resolution.

The amendment was then put to the Council and lost.

Dr. Bruce then moved the previous question, which was
seconded by Dr. Struthers.

The previous question was put and lost.

The motion for the adoption of the first resolution was then
agreed to.

Mr. Marshall moved the adoption of Clause 2: “ That,
reserving for future action the visitation and inspection of
the examinations in the earlier subjects of professional
education, the first year’s appointment of inspectors provide
for the inspection of examinations in medicine, surgery, and
midwifery.”

Dr. Heron Watson seconded the resolution, which was
adopted.

Mr. Marshall moved the adoption of Clause 3: “That
each inspector to be appointed for any purpose of the pre¬
ceding resolution (2) be appointed for all three divisions
of the United Kingdom.”

Dr. Struthers seconded the motion, which was agreed to.

Mr. Marshall then moved the adoption of Clause 4:
“That the Council appoint one inspector representing medi¬
cine, one representing surgery, and one representing mid¬
wifery—three inspectors in all.”

Dr. McVail asked whether, looking to the number of
bodies to be inspected, it was considered that three inspectors
would be sufficient.

Mr. Marshall said the committee had taken that impor¬
tant subject into consideration. It was felt that they could
not afford to pay more than three inspectors during the first
year, and hence the inspection was limited to those three
subjects. With regard to the work they had to do, there
were fifteen bodies only to be examined in the three
divisions of the kingdom, and those fifteen bodies surely
could be inspected in the course of the twelve months.

The resolution was agreed to, as were also the subsequent
resolutions: “ That, previously to making appointments, the
Council invite suggestions concerning them from each
Branch Council. That each inspector make, from time to
time, such inspections of the examinations in his special
subject, held by the several licensing bodies in the United
Kingdom, as may enable him to form an opinion upon, and
report to the Couucil as to the sufficiency or insufficiency of,
those examinations; and, further, that he enter in a diary
the date of and the time occupied in each inspection, and
any observations that he may think fit, and present this
diary, with & report as to the sufficiency or insufficiency of
the examinations of each body so inspected by him, to the
General Council annually or at such times as may be re¬
quired ; and that the remuneration for these inspections be
by annual payments.”

Mr. Marshall then moved the last resolution contained
in the report: “That the inspector in medicine and the
inspector in surgery, appointed as above recommended, re¬
ceive for the yew’s services £300 and certified travelling and
hotel expenses, and the inspector in midwifery £200 and
certified travelling and hotel expenses.”

Dr. Watson seconded the motion.

Dr. Duncan asked why a difference had been made
between the payment to the inspectors of medicine and
surgery and the inspector of midwifery.

Mr. Marshall explained that the inspectors in medicine
and surgery would have more work to do and more exami¬
nations to inspect than the inspector in midwifery, who
would have nothing to do with clinical examinations
proper.

Dr. Duncan said that ever since the establishment of the
Council midwifery had been oombined with gymecologv,
and therefore involved clinical w<frk. He moved “that the
emoluments of the inspector in midwifery be the same a*
those of the inspectors in medicine and surgery.”

Dr. Haughton seconded the amendment on the ground
that .the Act of Parliament placed the three subjects of sur¬
gery, medicine, and midwifery on an equality.

Thb LAnobt,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Pbb. 2d, 1887. 483

Dr. Steuthebs said it was estimated that the inspector instruction. In conclusion, they begged to assure the Lord
in midwifery would not employ more than half the time President that they had full confidence in the Royal Univer-
that the others would. sity of Ireland maintaining the efficiency of its qualifying

The amendment was then negatived, and the motion was examinations under the Medical Acts, and in their adopt-
tgreed to, • ing so far as a non-teaching university could, every

Dr. Quain moved, and Sir Walter Foster seconded: possible means for promoting the practical training of
“That it be referred to the Executive Committee to students.

make arrangements for carrying out the resolution just Dr. Moons seconded the motion.

adopted, and to report to the next meeting of the Council Mr. Macnamara said Mr. Laffau’s grievance was really
thereon.” not much more than a sentimental one. Ever since he

Mr. Simon objected to this work being thrown on the (Mr. Macnamara) had been connected with the governing
Executive Committee, and moved as an amendment “ that body of the College of Surgeons, Ireland, there had been a
the Inspections of Examinations Committee be continued rule that six summer months’ attendance in a provincial
during the pleasure of the Council, and that thiB committee hospital should count as equivalent to three summer
(subject to the future directions of the Council) be charged months’ attendance in a hospital in Dublin, Cork, Galway,
with the duty of giving to the inspectors such instructions or Belfast; but the registrar of the College could not
as may be requisite, and of superintending the progress of recollect one instance for years past in which a student had
their work.” • availed himself of the privilege. A somewhat simUer rale

After some discussion the amendment was negAtived and prevailed in the University of Dublin, and yet Dr. Haughtxm
the motion agreed to. ’ hftd told him that during the thirty years when he con-

It was then, on the motion of Mr. Marshall, seconded by ducted the medical examinations there he only remembered
Sir William Ghll, resolved that a record should be placed three cases in which students sought to'take advantage of
cm the Minutes of the Council of the presentation' to the it, and all those students happened to be tlie sons of
President that took place on the previous evening, and of surgeons attached to hospitals.

the acceptance of the bnst by the Council. Dr. Banks said that the Royal University of Ireland

The President having made a statement to the Council accepted certificates of attendance at the county in-
in reference to the communication which the Council had flrmaries. ’■

directed to be) made to the Royal College of Physicians of Dr. Leishman said that the Royal University of Ireland
London and the Royal College of Surgeons of England, and was not a teaching, but simply and strictly an examining
to the communication which the Council had directed to be body, but the strictures which Mr. L&ffan had passed with-
made to the King and Queen’s College of Physicians in out exception pointed to deficiencies in teaching with which
Ireland and the Royal College of Surgeons in Ireland, and the University had nothing to do.

having expressed his intention to resign his office at the The report was then adopted, and on the suggestion of
close of the present meeting, it was unanimously resolved: Mr. Marshall it was decided to forward it to the ljord
“ That the President be invited to continue in office until President, together with the first and final reports of the
the next meeting of the Council.” Visitation of Examinations Committee.

The President having consented to adopt this course, the The next subject Was the visitation of medical schools
Council adjourned. and hospitals.

Dr. Hauohton proposed the motion of which he had
Wednesday, February 23rd. given notice: “That the visitation of medical schools and

c „ . ’ „ hospitals is a pressing question, more especially as regards

Sir Henry Acland,. President, in the chair. their requirements and facilities for the practical study of
Dr. Heron Watson drew attention to a report in the fever and midwifery cases.” He said he thought he might
morning papers of an application before a divisional court have been spared the agony of having his motion blocked,
for a rule tor a writ of mandamus directed to the Council The position of the motion, and of that to be moved by
ordering them to restore the name of Mr. Partridge to the Dr. Glover on the eighth day of the session of the Council,
Register under the provisions of the Dentists Aot of 1878. indicated what their fate was destined to be. He asserted.
He wished to ask whether the Royal College of Surgeons of from personal knowledge of the great centres of medical
Ireland had any explanation to afford in regard to the education, that the regulations with regard to the practical
statement that they had withdrawn Mr. Partridge’s diploma atudy of fever and midwifery cases were simply disgraceful,
on the ground that he had advertised in the course of When he himself was a student, he found that, with very
bis business as a dentist; whether the College required few exceptions, the students never entered the fever wards,
of each licentiate in dental surgery that he should sign There were great centres of education where, fever cases
a declaration before receiving his diploma that he would ■were not admitted, and, as a rule, he could prove, when
not advertise or employ unworthy means of attracting the time came, that the regulations for compelling the
public notice; and, thirdly, whether the Royal College reluctant students practically to study fever were a
of Surgeons of England had any similar provisions against disgrace to the licensing bodies. The new Act com-
advertiang. pelied the Council to see that the men sent out to prac-

The Registrar announced that he had received a letter tise were competent to deal with fever and midwifery
from the solicitor bearing upon the subject. cases. It was, nowever, impossible to discuss the question

Strangers Were then requested to withdraw, and during at this meeting, and he was quite sure the Council would
their absence the subject was referred to the Exeentive consider that his proposal, taken in connexion with the
Committee. motion to he breught forward by Dr. Glover, which was

On the public being readmitted, somewhat wider, would be worthy of the most earnest and

8ir W.Gull moved the adoption of the report by the anxious consideration at a future period. He asked Dr.
Lard President’s Letter Committee. Leishman to allow him to ask the Council to postpone the

The committee was appointed to consider a memorial question, and not to let the Council disgrace itself by block-
sddreeeed to the Lords of the Council by Mr. Thomas ing the motion.

Lallan, of Cashel, with respect to the efficiency of qualifying Mr. Macnamara seconded the motion,

examinations under the Medical Acts. Mr. Laffan charged Dr. Leishman objected very much to Dr. Haughtons Use
the General Medical Council with inaction, arid stated that of the word “ block,” and especially to the interpretation
the candidates for the degrees of the Royal University of attached to it. His reason for giving notice of the previous
Ireland " are shamefully deficient in clinical training ”; and qaestion was that at the present time not one or- the
that the University imposed restrictions in the way of subjects was ripe for discussion, still less for decision. Am
adequate clinical training. The committee c onsidered the far as he knew, the attendance on fever was compulsory in
charge of inaction devoid of foundation, With regard to the Royal University of Ireland, and in no other licensing
<h« second charge, theK’ considered that the large proportion body. It could not, therefore, be said, at that stage of the
ot rejections proved tne imperfect training of the candi- meeting Of Council, to he a “ pressing” question, seeing that
dates no lees than the impartiality and disc rimination of so many years had elapsed, and the Council had never
the examiners. In reply to the third charge, t he committee thought it necessary to introduce any regulations on. that
ifltetht'strongest sympathy with the utilisation of the subject; and, further, he objected to the consideration of
miteml In union hospitals, but it 'was a matter these subjects at this moment, because they would un-
,r W* required inquiry into thecharacter of each hospital, doubtedly give rise to a considerable degree of discussion,
udtheauftttial tt offered-for affording useful clinical He should be the last member at that table to block any

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484 The Lamce*,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

|Feb. 26,1887.

qaestion which had for its object the improvement of mid¬
wifery. He moved the previous question.

Dr. Humphry seconded the amendment.

Mr. Simon thought the whole subject involved in the
motions brought forward by Dr. H&ughton and Dr. Glover
should be referred to a committee to b9 called the “ Curricu¬
lum Committee.” In that way very great service would be
done to the medical profession.

Dr. Banks supported Dr. Haughton’s motion. As physician
to a fever hospital, he knew the extreme difficulty of getting
students to attend fever cases. The Royal University was
not the only body that required attendance on fever cases;
the University of Dublin many years ago required such
attendance, and the younger university had followed in its
footsteps.

Dr. Moore thought the final examinations as to fever
were not sufficient.

Sir William Gull strongly repudiated the idea that
there could be any doubt that students were required to
study disease, whether fever or any other form. He ex¬
pressed his surprise that on the other side of St. George’s
Channel there should be gentlemen who thought that their
lives were in danger because they were called to see a case
of fever.

Sir Dycb Duckwobth pointed out that it was not possible
for a etudent in one of the great London hospitals to see a
case of typhus or scarlet fever, and it was only with very
great effort that a few diligent and illustrious students could
be got to go to the fever hospitals to see them. The fact
remained that the great mass of London students were
grossly ignorant of these fevers.

Dr. Duncan said it was only within the last two or three
years that the fever cases had been removed by order of the
Government to separate hospitals. These arrangements
were new and required new arrangements on the part
of the Council, and he hoped that Dr. Haughton would
be able to bring forward an adequate scheme at a future
meeting.

Dr. IIeron Watson was glad the matter had been taken
up by the Council, and hoped that the vote that day
would show that the Council considered it their duty to
take in hand and carry out their regulations as to oourses
of study.

Mr. Cabtbr thought a great deal would be done in
the way of supplementing any deficiencies of medical
examination by the inspection of examinations which the
Council was about to undertake. The only thing to make
students desirous of learning any particular subject was
the knowledge that questions would lie asked upon that
subject. With regard to his own special brand) of surgery,
he found that the very large proportion of students
never came near his wards at all; the reason given was
that they thought they were practically wasting time in
learning something which did not promise to be immedi¬
ately useful.

Dr. Bhuce thought the Council would be going beyond
its province by passing Dr. Haughton’s resolution.

After some further discussion the amendment was with¬
drawn.

Dr. Haughton expressed his pleasure at this course being
adopted, aa he had felt that the "block” was an offence,
though of course it had not been so intended.

Mr. Simon then moved : “That a standing committee, to
be called the Curriculum Committee, be appointed to report
from time to time to the Council on questions arising under
Section 18 of the Medical Act of 1858, with regard to
oourses of study; and, secondly, that the motions of
Dr. Haughton and Dr. Glover be referred to the committee
for early consideration.”

Dr. Humphry, in seconding the amendment, said that in
his opinion study and teaching would always conform them¬
selves to the examinations, aqd therefore, if the Council
looked well after the latter, the former would be consider¬
ably improved.

Dr. Dunoan thought the proposed committee superero¬
gatory ; it would merely be a department of a committee
already in existence.

Dr. Stbuthehs also considered the committee unneces¬
sary.

Dr. Pettigrew was opposed to the amendment. The
question of the visitation of BcboolB had been referred to
the Branch Councils, and it would not be treating them
fairly if a general committee were appointed to supersede
them.

Dr. Heron Watson considered that if the committee
were appointed, their only duty would be to constantly
harrass the medical schools.

Mr. Simon said he did not propose a visitation of schools,
but only that the committee should have under their cogni¬
zance a particular class of questions.

The amendment was put and lost.

Another amendment, moved by Dr. Struthbrs, to post¬
pone the question until the next meeting of the Council,
was carried.

Dr. Glover then proposed the following resolution, of
which he had given notice: “ That a committee be
appointed to consider the best methods of increasing the
practical element in medical education—as by a system of
limited pupilage with a registered practitioner, and insist¬
ence on more clinical, therapeutical, and pathological
teaching and work in medical schools.” He said there were
two or three facts which went far to justify him in bringing
forward this resolution. The first was a very prevalent
impression in the minds of the profession that, whatever
might be the accomplishments of the men now leaving the
schools, they were not well up in practical subjects,
because they had not had opportunities of becoming
familiar with the common diseases which made up the
bulk of medical practice. He was afraid that the pecu¬
niary difficulties of the hospitals would accentuate
this state of things, and that the hospitals might more
and more become receptacles for exceptional cases. This
showed the necessity of supplementing the general hospitals
with other means of instruction. The tables of results of
Final examinations pointed in the same direction. The
Royal College of Physicians of London in 1885 rejected 152 and
paseed 243; the Royal College of Surgeons rejected 443 and
passed 5G1; the Apothecaries’Society rejected 131 and passed
235. In Scotland matters were still worse. The Royal
Colleges of Physicians and Surgeons of Edinburgh rejected
116 and passed only 91; at the Conjoint Examination of the
three corporations there were 74 rejections and 84 passes.
In Ireland the Royal College of Surgeons rejected 54 and

g assed 81; the Royal University rejected 77 and passed 76.

!e could not help thinking that these figures showed a
terrible deficiency in the means of practical teaching.
Many of the men so rejected were men of some character,
as they had passed the earlier examinations, and some of
them were known to be very good men. The favourite
explanation of the failures was that, the students were to
blame, that they had been idle or slow to learn; but such
wholesale rejections seemed to require a far deeper and
more thoughtful explanation. Probably it would not be
far wrong to divide the blame between the candidates, the
teachers, the schools, and the Medical Council, which had
not made stronger recommendations as to the need of
practical teaching. It was notoriously true of many
of the best schools that there was a great dispropor¬
tion between the clinical field provided and the number
of students. There were some great opportunities for
practical teaching which were not utilised. First, there
was private practice. Many practitioners who had had
good masters, as he had, believed in some modification of
the old system of pupilage, where common diseases and
common remedies became familiar to the students, and
he believed that great good might b8 done by bring¬
ing private practitioners into co-operation with medical
schools. Then there were the workhouse infirmaries,
which would supply a field of enormous value, containing,
as in London they did, numbers of common diseases and
somo which were uncommon. Some of, the medical officers
there were developing branches of pathology in a surpris¬
ing way. There was also a great deal of midwifery in the
workhouses, and the number of surgical cases was very
considerable. Dr. Glover dwelt at length on the necessity
for more practical teaching in midwifery. He said that
many of the examining bodies contented themeelves with
requiring attendance on only six cases. He hoped that if
the committee were appointed they would see their way
to recommend the examining bodies to require such an
education in midwifery as would guarantee the actual
observation of the operations and complications of mid¬
wifery.

Dr. Chambers seconded the motion. He said he could con¬
firm what had been stated by Dr. Glover about the general
feeling in the profession as to the incompetence of recently
passed candidates. A few years ago statements were made by
those who employed them that they were compelled to do

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THE MARGAKET-8TREET CONSUMPTION INFIRMARY.

[Fub. 26,1887. 433

to because qualified men were not competent. He considered
that the blame rested with the Medical Council in consequence
of the arrangement of their curriculum. In the final exami¬
nation a man was called upon to pass in subjects which he
had learned in the lecture-room some time before, the inter¬
vening period being supposed to have been spent in clinical
study. The consequence was that if he did study clinical
medicine he got plucked in his proper work. A remedy
might be found in the multiplication of examinations. A man
might be allowed to pass in the principles of medicine,
surgery, and midwifery, and after a certain time he might
be examined in art.

Mr. Wheblhouse supported the motion, regarding the
subject as one of extreme importance. If a committee were
appointed to consider it, and bring up a report, the Council
might afterwards be able to arrive at a just decision
upon it.

Sir W. Gull supported the motion. Hospitals taught
morbid anatomy, and pathology founded upon it; but there
was & very wide area of pathology which bad no morbid
anatomy, and which could only be studied in private
practice.

Dr. Heron Watson explained that the number of rejec¬
tions at the final examination of the Royal Colleges in
Edinburgh was due to the fact that many of the men
were inefficient, remaining over from the old state of
affairs. Some of them had come up os often as six times,
but they could never do so again. In the University
of London there was a still higher percentage of rejec¬
tions.

Dr. Struthrrs suggested that the students might be
connected with practitioners after they had passed.

Dr. Humphry said the real difficulty in connexion with
the clinical teaching was the enormous amount of pre¬
liminary work which was laid upon them.

Tne motion was carried unanimously, and a com¬
mittee was appointed consisting of Mr. Wheelbouse, Dr.
Chambers, Mr. Mitchell Banks, Dr. Haughton, Mr. B. Carter,
Mr. Teale, Dr. Fergus, Dr. McVail, Sir W. Foster, and
Dr. Glover.

On the motion of Dr. Hbbon Watson, seconded by
Mr. Mabshall, the thanks of the Council were voted
to the Directore-General of the Army and Navy Medical
Departments, with a request that they would continue
to supply the Council with the number of candidates
referred to in their respective lists who bad two or more
qualifications, and the number of those who were passed or
rejected.

A Uble prepared by the Registrar, showing the number of
candidates and the rejections per cent, at final examinations
in the jeara 1883 to 1886, was received, and entered on the
Minutes.

This concluded the business of the session.

“GENESIS OF THE ELEMENTS”

The wonderful hypothesis in regard to the evolution of
chemical elements which Mr. Crookes produced at Birming¬
ham last August, in his address as president of the Chemical
Section of the British Association, was again unfolded by
him the other day, in a Friday evening lecture at the Royal
Institution. Some slight variations were introduced, and a
number of magnificent experiments aided the audience, but
substantially the hypothesis stands as it did when we pre¬
rented a sketch of it in the autumn. It starts, it will be
remembered, from the diagramatic, and, so to speak, symbolic
expression which Professor Emerson Reynolds devised for
the illustration of the periodic law of Newlands. A pendulum,
*ith a pencil attached to its weight, is supposed to be falling
•lowly to rest, and at the same time to be sinking bodily
downwards. The pencil would mark on a vertical sheet of
paper a zigzag line of decreasing amplitude. If a perpendicular
line were drawn down the middle of the paper, the zigzag line
would cross it repeatedly, sometimes approaching and some-
times receding from it. This swing and simultaneous fall
of the pendulum denote two opposite forces, which may he
•upposed to have co-operated in the genesis of elements.
Imaging a uniform elementary matter, which Mr. Crookes,

for convenience, calls protyle. This is at an enormous and
unknown temperature, but at some period inconceivably
remote, and before the birth, not only of suns, but of all
known kinds of matter, cooling began, typified in the
diagram by the gradual perpendicular fall of the pendulum.
Simultaneously there comes into play some other force—
perhaps electricity—which is denoted by the horizontal and
gradually diminishing swing of the pendulum. Now, if the
symbols of the elements are marked at regular intervals
on the zigzag in the order of their atomic weights,
it is seen that they fall into octaves, or series of
seven. On all parts of the line receding from the perpen¬
dicular electro-positive elements occur, and their valency
increases steadily. Thus, starting from hydrogen, we find
lithium, glucinum, boron, and carbon as the first four. Aa
the pendulum swings bockand approaches the perpendicular,
we find nitrogen, oxygen, and fluorine, and then, on the
receding half, sodium, magnesium, aluminium, and silicon,
the eighth from carbon. The whole diagram exhibits the
periodic law with remarkable distinctness, and, apart from the
use co which Mr. Crookes puts it, will have great value to
teachers. Mr. Crookes suggests that by the operation of
forces typified by the great cosmic pendulum the atoms have
been developed from protyle at successive stages of time.
Occasionally several very similar elements have been gene¬
rated instead of one, so that we have the groups nickel and
cobalt and the platinum metals nearly of the same atomic
weight, and very similarin properties. Space precludes us from
giving any adequate account of the mass of ingenious reason¬
ing and experimental illustration which Mr. Crookes has
brought to bear upon his hypothesis. Of the experimental
portion, the most important and the mo6t original is that
which deal8 with the separation of the very similar and
very scarce metals of the yttrium group. By a system of
fractionation, which is a marvel of ingenuity and industry,
and by the use of the amazingly delicate radiant matter
test, Sir. Crookes appears to have found that seven, or
perhaps nine, kinds of atoms are present in what we have
always called yttrium. He has, in fact, sorted the atoms.
Are these so similar, yet not identical, atoms to be taken os
separate elements? or, as has before been suggested, is
what we call the atomic weight only the average atomic
weight—and, if we could weigh all atoms, should we find
them to be only very nearly but not quite the same ? Science
does not as yet afford a positive answer.

THE MARGARET-STREET CONSUMPTION
INFIRMARY.

The following letter has been addressed by the under¬
signed members of the medical staff to the Executive Com¬
mittee and governors of the infirmary:—

Lords, Ladies, and Gentlemen,—A fter the vote of the
governors at the special general meeting on Wednesday last,
which enables professed homoeopaths to hold office on the
medical staff, it has become necessary for the undersigned
members of that Btaff to resign into your hands the appoint¬
ment s which have been held by many of them for a long series
of years, under the belief that their services were appreciated
and that they wee doing good and useful work for the sick
poor; it is therefore with great regret that they take this
step, but the action of the governors has left them no alter¬
native. The undersigned took office in the belief that they
were connecting themselves with an institution belonging
to and governed by the doctrine and practice of established
medical science sanctioned by the most learned professors
and schools of medicine throughout ths world, and which
alone is held and taught by our own governing bodies,
and they feel that this new departure is equivalent to an
abandonment of the same, and that its acceptance would
be a betrayal of honour unworthy the members of the noble
profession to which they belong.

Thanking you for the confidence hitherto accorded,

We remain your obedient servants,

Thob. Hawksley, M.D.

Wm. Cholmrlhy, M.D. i

F. Carr Beard, F.R.C.S.

R. Featherstonh Phtbbs, M.R.C.P.
Julian Willis, M.RC.P.

Robert Walford, M.B.

Pet. 23r<l, 1887. SCUDAMORE K. POWELL, M.D.

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438 TUb Lancet 1 ,] 1 THE MEDICAL COUNCIL AND THE CONJOINT EXAMINATION SCHEME. [Fra. 26,1887*

THE LANCET.

LONDON: SATURDAY, FEBRUARY 26, 1887.

' The General Medical Council will this week finish their
sitting, and they may congratulate themselves on the
quantity as well as on the excellence of the work they have
accomplished. The subjects they have had under their con¬
sideration are. of much moment to the profession, and they
have wisely construed in a liberal sense their duties in
relation to them, and have not limited themselves merely to
carrying into effect their statutory powers.

The demand of the Apothecaries’ Society of Dublin for the
appointment of assistant examiners, which we discussed in
our last number, was followed by a similar application from
the London Society, and with the same result. The state¬
ment of the Society’s case by Mr. Brcdhnbll Carter
made it a matter of difficulty to refuse their immediate
request fqr the appointment of assistant examiners, and
effectually disposed of any probability that it would not
be eventually complied with. He drew attention to the
services the Society had in the past rendered to medical
education, and to the rights' conferred upon them by the
Medical Act of last year. His plea was in no sense one ad
muericordiam, but was a demand for justice, with whioh the
Society is certain to meet. An amendment by Dr. Strothers
and Mr. Tkalk was, we are glad to say, carried by a
large majority, and theCouneil have urged upon the three
London Corporations, “in the interests of the public,” the
desirability of combining for the purposes of holding one
licencing examination., The ^Uingness of the Apothecaries’
Society to join with the other bodies was amply vindicated;
the refusal has come from the Colleges alone; and the
Society would still combine, although they would not be
prepared again to take the initiative. Nevertheless, tjhe
effort is worth making, and the opinion the Council h^ve
formed Will, we trust, meet with the respect it deserves. /

What will be the result of this further opportunity for
the avoidance of competing examining bodies, which, is
thus afforded by the action of the General Medical Council,
time alone will show. But the profession will regard with
satisfaction the fact that the Council have shown themselves
alive to ltd best interests, and that, whatever the outcome of
this proceeding, they have been willing to utilise every
power they possess to prevent the existence of conditions
Which will militate against the prosperity of the profession,
and which the legislation of last year was mainly enacted
t6 prevent. In these endeavours they have been warmly
seconded by their President, Sir Henry Acland, who has
not hesitated to place his great personal influence < at
their disposal, and who has freely undertaken to be
the means of communicating the Council’s views to the
corporations in London and id' Dublin, whom it is hoped
to persuade. Until the final decision is known, the hope
will still be entertained that the bodies may take the
higher view of their duty, and may be willing to make some
sacrifice in a matter which so closely concerns the welfare

of the profession and the interesteof the public. A journey
to Ireland and the labour these communications will involve
are no light undertakings for Sir Henry Acland, and the
profession will recollect with gratitude the efforts he has
made to give effect to the resolution of theCouneil. His
action must undoubtedly impress the corporations with the
importance which the Council attach to the principle of
unity, and will, we think, remind the Colleges both of
London and Dublin that Mr. Simon is not exceptional in bis
opinion that “ in proportion as they feel themselves higher
and stronger than the Society of. Apothecaries they are
bound to adopt the course which is recommended to them—
nobleue oblige.”

It is oonduct such as this that has won for Sir Henry
Acland the esteem both of those who have shared his work
and those who have been but the witnesses of his labours,
It will therefore be a cause of general regret that he has felt
the necessity of curtailing the demands upon his strength
which the business of the Council incessantly makes.
During the many years he has, as a member of that body,
and subsequently as its President, influenced its proceedings,
he has unswervingly kept before his mind the advancement
of the profession with which he is associated. For this
reason we fully sympathise with his colleagues in their
desire to do honour to him at the close of a long and useful
career. The admirable bust which they have presented to
him, and which will serve in the future to remind the
Council of their former President, is a marked expression of
the estimation in which his services have been held by those
who are best able to appraise them at their true value.
Placed, through Sir Henry Aclanr’s courtesy, in the
Council chamber, it will be a permanent reoord of their
appreciation of his worth, to which Professor Humphry
born eloquent testimony.. It is a source of satisfaction that
Sir Henry Acland has not yet absolutely severed his
connexion with the Council, and that be has consented to
remain for a short while in offloe until the important busi¬
ness he has undertaken is accomplished. There could be no
more fitting termination to his tenure of office than this
present effort to unite the corporations in a duty in which
competition should be unable to find a place.

Of other important work before the Council, we mqst
mention the presentation of the final report by the Visitation
of Examinations Committee. This report is of so much con¬
sequence to the profession that we propose to discuss it at
length in a future number. Some other business occupied
their attention, but that of greatest interest was un¬
doubtedly the proposals of Dr. Haughton, which related to
the provision of better facilities for the study of fever and
midwifery cases, and of Dr. Glover, that a committee
should be appointed to consider the best methods of increas¬
ing the practical element in medical education. Mr. Simon
made the happy suggestion that a special “curriculum”
committee should be appointed to consider these resolutions,
as well as the whole subject of the course of study which it
was advisable should be pursued by candidates for the pro¬
fession. Although the Council did not accept Mr. Simon's
proposal in the form in which it was placed before them,
they adjourned the further consideration of Dr. Haughton's
motion to a future meeting, and Dr. Glover’s to a special
committee. It is certainly true that medical students

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THE TEEATMENT OF PLACENTA PRJ5VIA.

CFbb.26,1887. 427

ue not required to, and do not, avail themselves of the
opportunities which are afforded by special institutions for
the (tody of infectious disease. Sat this is not the only
subject neglected. Dr. Glover’s desire to amend medical
education is based upon the fact that young medical men
tie often found wanting in knowledge of practical details
when they are called upon to engage in active practice. It
is not at once easy to see how this difficulty is to be over¬
come. The period formerly passed in a lengthened pupilage
being now devoted to studies which obviously lit men
eventually for undertaking higher duties, the question
to be considered is whether on the whole the gain com¬
pensates the loss. There will, however, be general agree¬
ment that some effort should be made to supply de¬
ficiencies; but whether it should, as Dr. Strcthebs and
Dr. Me Vail proposed, take the form of improved clinical
teaching, or whether, as was suggested, the material
in workhouse infirmaries might be utilised, or arrangements
could be made with gentlemen engaged in active practice
(or this purpose, the Committee must consider.

Or all the complications of labour, none is more urgent
and more serious than btetnorrhage; and of the causes
of haemorrhage none is more important than placenta
previa. The earliest mention of the condition is to be
found in the works of Guillemeau, in a.d. 4609; and
next in those of Mauricbau, a.d. 1668. Their view was
that the after-birth was originally situated higher up, hut
became displaced as pregnancy proceeded, a view which
is still extant in the phrase popular among the lower
elasses and midwives — “ the after-birth slipped.” The
eorrect view, that the after-birth is firmly planted in its
dangerous position, was first illustrated by the necropsy of
a woman who died of placenta prsevia, and was dissected
by 8challbr in a.d. 1700; and this' view was first
introduced into the text-books by JoMaNn van Hoorn,
ad. 1715, a pupil of Portal. VAi» Hoorn plainly says
that the eauSe of the dangerous condition is the after¬
birth, which at the beginning of pregnancy takes its place
on or above "the oe uteri. After Lbvbet’s time the main
facts with regard to placenta prsevia are found generally
current.

To write a historical review of the subject from that
time to this would consume too much of our space; more¬
over, it would show occasional retrogressions in know¬
ledge and understanding. At the present time our know¬
ledge, which not many years ago was thought to be pretty
complete, has been somewhat disturbed by the study of the
“lower uterine segment,” to which a great impulse was
given by the sugjgefetive studies of Ludwig Bandl on
uterine rupture, 1 pursued by him in search of the explana¬
tion of many other problems. BanDl’s Views, which need
not here be given at length, were many times modified
by their author, hat the result of the discussion and
observations which they have excited has been to shcr#
that during labour the uterine body becomes differentiated
into a refracting and ever-thickemiig fundus, a stretching
tad vrflr»-ihfaming ^ lower uterine segment,” and the
Cerv hc' it liHwfc yet, hoWtrVer, finally settled' what is
^lower Utfeihe : segment. ,,;,I The loWest
partw < fl*e ( ^4ri(eted fundus is felt after labour as the

bottom of the hard uterine cricket-ball; below it come the
cervix and “lower uterine segment,” hanging loose, appa¬
rently unretracted and passive; like a piece of . flabby hose.
The question is not yet settled why, if this lower uterine
segment is the site of placenta prmvia, any woman escapes
flooding to death after this complication. Meanwhile it is
possible that, thongh it feels flabby, it may be physio¬
logically retracted to an extent sufficient to control
hemorrhage. Having said thus much, we will proceed to
be more dogmatic.

And first we would say that the utterances of the text¬
books on this great subject are most unsatisfactory, being
overloaded .with detail both as to pathology and treatment,
and generally * hedging” each statement with a timidity
and uncertainty which appears in the answers of students
in examination, and in the treatment of practitioners. It
would be worth all the writing which ocoupies so many
pages, and leaves us at the end as uncertain as to the
author’s views as we were, at the beginning, to enunciate
a few great propositions, and to get them well absorbed by
those whom we have to teach. We will give some of them.

1. The bleeding comes from the placental site, f

2. The cause of the bleeding is the detachment of tbe
placenta.

S. The cause of the detachment- of tbe placenta is tbs
expansion of the lower uterine segment, which the placenta
is unable to follow.

This will be seen to be eqmvalent to saying that
before labour there is no bleeding. This is generally,
but not always, true. We are obliged,, therefore, to
remark that the beginning of labour is not always
synchronous with the beginning.’9? the “first stage "of
labour, but begins with the dilatation of the os interpvun*
which may precede tfip “fljoet stage” by days or ey$q
weeks. Also that the bleeding in placenta pnpvia u i*>
often due to the same: causes as operate in “aeoiden&al
haemorrhage,” acting, indeed, with additional advantage
on account of the low.si,te of the plapenta apd the conse¬
quently heavier column of blood which the utsro-plaoaatal
vessels have to support under these conditions.

- Having plainly stated the main great Jfacfce, which are
worth all the rest put together, aqd which should be
always taught dogmatically and almost likB aphorism^ we
now proceed to the question of treatment, for a". plain,
statement of which the student looks in vain in even the
most, recent text-books, and which seems to us capable
of at least an attempt at formulation. We would first
remark that a certain number of cares of placenta pnaria
progress favourably to a safe termination, and require no
interference. This is of course more likely when only part
qf the placenta is situated on the area of necessary detach¬
ment, but it is not unknown where the placenta is central—
that is, implanted across the os internum. In such esses
the child has been known to be born by strong contraction!;
wearing the placenta like A.cap on its bead. On this the
well-known treatment of Simpson— tha complete detach¬
ment of the placenta by the hand,—and its modifiestion by
Babers— partial detachment,—were founded. It is to. be
remarked that Simpson’s treatment wta 1 founded on hit’
interpretation Of the phenomena which Implied that the
Woman was delivered safely "because tihe plaoemta ires
detached, whereas in our opinion such owes only shcrW

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438 The Lancet,]

THE MEDICAL PROFESSION IN EXCELSIS .

[Feb. 26,1887.

that Hie uterus acted with unusual vigour, shortening the
dangerous period and producing good retraction, which,
as is well known, is the only safeguard against bleeding.
Detachment of the placenta apart from vigorous uterine
action is only an increased element of danger. But moat
oases of placenta provia do require prompt and wise inter¬
ference, and to wait for their spontaneous termination
would be as wrong as to wait for some form of spontaneous
expulsion or evolution in a cross-birth. Treatment, to be
rational, must be founded on the pathology and natural
history of diseases; in other words, it must take cognisance
of the causes of death with a view to avoiding them, and
of the manner in which Nature deals with them when she
does so successfully. We come, therefore, to enunciate two ;
more great principles.

4. The great dangers of placenta praevia are: (a) bleeding
before and during labour; ( b ) bleeding after delivery;
(c) septic processes.

5. The great safeguard against bleeding before, during, and
after delivery is uterine retraction.

We come, therefore, to consider how the dangers arise,
how they may be avoided, and how retraction may be
secured.

The cause of bleeding before and during delivery has
already been touched on. It is detachment of the placenta
by dilatation of the placental site. The causes of bleeding
after delivery are mainly two—imperfect retraction, and
laceration of the cervix and lower uterine segment, which
is of course unusually vascular. This also predisposes to
sepsis. The causes of sepsis are three—the low situation of
the placental site, bringing it nearer to the outer world and
nearer to the accoucheur’s fingers, lacerations, and perhaps
also imperfect retraction of the lower uterine segment.
The great object, therefore, with a view to avoiding and
controlling haemorrhage, has been to produce uterine con¬
traction and retraction; and to do this directions have been
given to empty the uterus as soon as possible. The condition
of the cervix, which, though soft, is often loth to dilate
(probably in connexion with the abnormal position of the
placenta, whieh disorders the polarity), has rendered it im¬
possible in many cases to affect this without forced delivery
(accouchement ford), which' consists in thrusting in the
hand and dragging out the foetus by the feet. This is a
most dangerous proceeding, and generally takes tbe prac¬
titioner out of the frying-pan of ante-partum haemorrhage
into the fire Of laceration, post-partum haemorrhage, and
blood-poisoning.

Delivery by Hie head is not suitable for cases of dangerous
placenta praevia. No aid can be given till tbe labour is so
far advanced as to be practically over so far as the danger
of bleeding is concerned. A sixth proposition may now be
enunciated:—

6. The great treatment for placenta praevia is turning by
the feet.

Our readers will perhaps say, “ and extraction.” But here
we must make another statement—namely, that this is
usually unnecessary.

7. It is found practically that as soon as turning has been
effected and the leg brought down the bleeding ceases.

The explanation usually given for this is that the pre¬
senting part plugs the bleeding site; but it is not ™rtj> in
Whether this explanation is correct, or whether the arrest of

bleeding is not rather due to the retraction which partial
emptying of the uterus effects. It follows, therefore, that—

8. After the leg is brought down, the case may gene¬
rally be left to nature.

Tiie Saturday Revieio has favoured the medical pro¬
fession with some very flattering remarks h propot of
Sir Henry Acland’s address at the Medical Council. We
are rising in knowledge and capacity, both socially and
politically. Our social advancement is evidenced by the
surprising increase that has taken place in the number of
medical men who have been commissioned as county
magistrates, and even sent to Parliament, that Valhalla of
respectability, during recent years. Our political enlarge¬
ment and ennoblement is partly indicated by, and partly
due to, the fact that while the landlord and his agent acd
the county parson are losing ground, “ the county franchise
has placed ‘the doctor 1 in more immediate contact with
the great mass of voters, and brought them more'imme¬
diately within the sphere of his daily influence.” We
confess that it is not easy to realise the force of this
reasoning; but let that pass. It is at least something to
our credit that we did not coaspire with the proletariat
when both ourselves and the people were out in the cold
together. It is perhaps a little humiliating to find that one of
the best grounds of hope in our political future is, according
to our contemporary, to be found in the fact that, while we
are as benevolent as the squire and the parson, we have no
land, and are not involved in questions of property which
would place us at a disadvantage or breed ill-feeling between
us and tbe voters. This is a left-handed kind of compliment,
but we may endure it patiently — the more patiently,
perhaps, because it is coupled with the avowal that the
classes we are supposed to have displaced are a little
afraid of us. “The country doctor has come into the
possession of a power—what will he do with it?” is the
burden of the Saturday Review's lament. “ The profession
as a whole is strongly conservative, although, as is usual
with all other professions, some of its most active and con¬
spicuous members have strong tendencies the other way.
In political matters,” continues our contemporary, “it ia
not necessary that medical men should act in one body,
as there is some fear of their doing, but each man should
identify himself with the local organisations, and thus exert
bis individual influence for the general good of the country
and of his own locality.” The terror of “ the classes ” is, then,
that the medical profession will constitute a political organi¬
sation of itself. We hasten to assure the Saturday Review that
there is not the least peril of such a calamity. Medical men
are quite as individual in their opinions and tastes, privately
and politically, as the persons engaged in other callings.
We fail to perceive the slightest fear of any abuse of power
arising out of the fact that a few members of our profession
have been placed on the Commission of the Peace, and hero
and there a medical man has secured a eeat in the House of
Commons. We do not admit that it would be a very
terrible evil, in a social sense, if even a larger number
of practitioners of medicine had achieved socio-political
greatness, but looking to the extreme paucity of the list
of medical, men who write M.P. or J.P. after their names,
nothing but needless timidity can give rise to the fear of

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TasLANCBT,]

THE FELLOWS AND MEMBERS OF THE COLLEGE OF SURGEONS. [Feb. £G, 18S7. 43$

a medical confederacy exerting influences injurious to the
beat interests of the community. Our contemporary may
dismiss this cause of anxiety in so far as it can be
rationally held to have any real existence. That some¬
thing may have beam gained in politico-social prestige
by the medical profession as a body during the last fifty
yean is indeed possible, but the reflection can scarcely
have been suggested by Sir Henbt Acland’s address,
for the President of the Medical Council is of opinion that
the internal struggles, not to say wranglings, of medical
men in connexion with the development of the work of
education have not tended to advance the interests of that
body either socially or politically, but, on the contrary, that
there has been “ some loss of character to our profession.”
We fear the President is nearer the truth than the Saturday
Review. In fact, we are in nowise puffed np with pride at
our present position, and we do not think the profession is
in excelsis. There is much—very much—to be accomplished
before a body bf men so well qualified to play an important
part in the business of government and to advance the best
interests of the nation, as the medical profession undoubtedly
is, can properly assert and make good its really strong claims
to public recognition. Had there not been extraordinary, and,
ai it would appear, inexplicable blundering in our policy, we
should long ago have writ the maxim Solus populi supremo
lex, which the Saturday "Review adopts as the text of the
remarkable article to which we are alluding, so large on the
aanxla 0 f our country that no question could possibly be
held to exist as to the adequate recognition of the profession
by which solus populi is chiefly promoted. There is, in
troth, something astounding in the neglect and contumacy
with which medical opinion is treated by statesmen in this
country. The affectation of superiority on the part of the
commercial sections of the community, tolerated by the
common sense of the people, is one of the most convincing
proofs that we, of England, have as yet no solid ground for
the pretension to a front place in the intelligence of nations.
In no other of the more enlightened nationalities are medical
men so lightly esteemed or so grudgingly recognised as a
power in the State as in our own country, the felicitations
of the Saturday Review notwithstanding.

"He quid nlml*.’

THE FELLOWS AND MEMBERS OF THE COLLEGE
OF SURGEONS.

dr will be remembered that at the general meeting of the
Fellows and Members of the Royal College of Snrgeons in
November last, the following resolutions were carried by
overwhelming majorities-L That in the opinion of this
meetiftg it would conduce to the welfare of the Royal
College of Surgeons, and would tend to promote the
interests «£ medical polity and education—(i.) if Members
of the College were empowered to take part (separately or
can jointly with the> Fellows) in the election of members of
the. CmwriU (ii) if Members of the College were eligible to
nit in theCouncil, provided (e) that no Member of the
UoHegoahs]} be entitled to vote till he have been such Mem-
k*** P period of ten yetam>s-{b) that no Member of the
rn fl<HK d|fcH,ha eligible to gift in the Council till he
have been each Member tot a period of twenty years;

and (c) that not inore than one-fourth of the Council shall
consist of Members of the College who are not also Fellows.
2. That, with a view to give effect to the recommendations
in the foregoing resolution, the Council is hereby respect¬
fully requested to empower certain members of its body to
meet and confer with representatives of the Association of
Fellows and of the Association of Members, together with,
if necessary, an equal number of Fellows and Members who
may not belong to either of the associations, to be selected
in any manner satisfactory to the Council. The Council of
the College, at a meeting in January of this year, appears
to have taken these two resolutions into consideration with
the result that the following motion was carried: “That,
although the Council is not prepared to give effect to the
recommendation contained in the first resolution carried at
the meeting of the Fellows and Members held at the College
on Nov. 4th, 1886, the Council is prepared to act upon the
second resolution, so far as to appoint a small committee to
confer on the subjects of the first resolution with represen¬
tatives appointed by the Association of Fellows and the Asso¬
ciation of Members.” We now hear that a Joint meeting of'
delegates from the two Associations has been held to con¬
sider this resolution of the Council, and that they have
unanimously passed the following resolution:—

“That considering that the Council has laid.down as a
condition of a conference that it is not prepared to give
effect to the recommendation contained in the first resolu¬
tion carried at the meeting of Fellows and Members held at
the College on Nov. 4th, 1886, no useful purpose is likely to
be served by a conference on these subjects with repre¬
sentatives of the Associations of Fellows and of Members;
but if the Council will withdraw this condition, both Associa¬
tions will be happy to appoint delegates to meet a committee
of the Council.”

This resolution was forwarded to the College of Surgeons,
and will, we understand, be brought before the Council
at its next meeting on March 10th. The Council of the
College must have strangely misunderstood the signi¬
ficance of the resolutions of the Fellows and Members,
or it would scarcely have passed the resolution we have
just referred to. For, on the face of it, a conference with
delegates from the two Associations could be of no use,
seeing that the Council has already agreed not to accept the
recommendations made to it. After having beard the ques¬
tions fully discussed in public meeting, a few delegates from
the two Associations could hardly have added anything
new or weighty to the arguments already advanced,
and hence no good could possibly have resulted from
a conference after the Council had decided not to move
in the direction asked for by the general meeting. The
Associations have very properly declined such a meeting,
and matters, we presume, must now take their course.- The
petition of the Members now contains nearly 6000 signa¬
tures; the sooner it is presented the better its chance
of being favourably considered.

PAROXYSMAL HEMOGLOBINURIA IN SWEDEN.

Da. R. Bauznuus, writing in the Nordiskt edicinekt
Arkiv on paroxysmal hsemogiobinuria, gives an account of
the only three cases he has seen in the course of a long
period of practice. These ore the pnly ones which have been
published by a Swedish practitioner, and in Norway only
two cases have been reported. Of all countries, England,
he remarks, appears to have produced the greatest number of
instances of this affection. The first case is that of a woman
who, at the age of twenty-seven, after exposure to cold, ex¬
perienced slight rigors, pain in the sacral region, pruritus, and
urticaria. These attacks returned the next four years, and
then there oocurred a very marked attack, with a rigor,
hrticaria, jaundice, and hsemogiobinuria. Subsequently

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440 The Lancet,] UNIVERSITY COLLEGE AND A TEACHING UNIVERSITY FOR LONDON [Feb. 28 1887.

similar attacks were noted, the severity of which appeared
to be directly proportional to the amount of exposure to
old which caused them. The patient was peculiarly sen¬
sitive to cold—8.g., the contact of the hand with the
cold window for a few minutes brought out urticaria,
with pricking and itching sensations. During the attacks
there were marked crises, with rigors, pyrexia (39'5° C.),
sweats, pain in the sacral region, urticaria, jaundice, and
highly coloured urine containing hmmoglobin, casts, and
albumen, but no red corpuscles. At the end of from
three to eight hours the fever disappeared, the urine
regaining gradually its normal characters. There were also
other attacks of a milder nature. The microscopic examina¬
tion of the blood during the attacks failed to discover any
evidence of the destruction of the red blood-corpuscles,
while the spectroscope revealed the presence of haemoglobin
in the plasma. Twelve years after the first attack the
author saw the patient again. She had not had any
marked attack during the previous three years, having
carefully avoided all exposure to cold. The second case
was that of a man aged fifty-two, who five years previously
had been seized with an attack of hmmoglobinuria after
exposure to cold air, and who subsequently always suffered
from similar attacks on any exposure. No treatment proved
of any avail. The man died ultimately of disease of the heart.
No signs of syphilis could be detected. The third case was
that of a man aged seventy-one, who had had this disease
for two years. He died of acute pneumonia. Dr. Bruzelius
considers paroxysmal hemoglobinuria to be a blood disease,
the destruction of the corpuscles taking place in the organs
of circulation, and not only in the kidneys, as was supposed
by Rosenbach. In each case the immediate cause of the
hmmoglobinuria was refrigeration of the body. Other
observers have, however, reported fatigue as the cause.
Murri and Schumacher look upon syphilis as the real cause
of the disease, but in only one of the present cases was
there any sign of syphilis._

UNIVERSITY COLLEGE AND A TEACHING
UNIVERSITY FOR LONDON,

The annual general meeting of the members of Univer¬
sity College, held on the 23rd inst., was rendered especially
important by the adoption of the resolution passed by the
Council, or governing body, of University College in favour
of “ the organisation of a Teaching University in and for
London, with Faculties of Arts, Sciences, Medicine, and
Laws,” apd the defeat of the recent resolution of the Sepate,
or professorial staff, in approval of an “ application for
the grant of a Charter to an academical body, of which
University College should be the first constituent, such
Charter to give the light of conferring degrees in Arts
and Science only.” Professor Lankester has strongly ,
urged the adoption of the latter course, by common
agreement with King’s College, if the authorities of
that institution so desire, and the precedent of Victoria
University is in its favour, but his colleagues are obviously
more desirous of obtaining the wider opportunities afforded
on the basis originally laid down by Sir George Young’s
organisation. We fear lest the scheme may lose in intensity
and cohesion whatever it may gain in other respects, by
throwing the net so wide. It seems to us that a conjunction
of the Arts and Science Faculties of King’s and Univer¬
sity Colleges (reserving power for the after-admission of
other bodies and colleges) might have formed a combination
with the Royal Colleges of Physicians and Surgeons as a
Medical Faculty, which would have served as an admir¬
able basis for a true academical university. For some
such plan very strong support from without as well as
from within the profession would have been forthcom¬
ing, and legal difficulties which might ^hinder the ob¬

taining of a Charter for the two Royal Colleges only for
granting medical degrees would easily have been overcome.
A greater difficulty will probably be experienced in a com-
bioation between the Royal Colleges and the Executive-
Committee of a Teaching University, which has no real
existence except in the Faculties of King’s and University
Colleges, than by the more direct and simple plan. The
Royal Colleges are not likely to yield the control of
medical teaching and medical examinations to a third body,
over which they will only be able to exercise an indirect
and a limited authority, and this will be the great obstacle
to Sir G. Young’s scheme, and far outweigh the considera¬
tions involved in the hostility of the University of London
towards the more definite proposition. The Council of Legal
Education has shown no desire to be approached by a body
desirous of giving degrees in Laws; and we can scarcely
expect the Colleges of Physicians and Surgeons to look more
kindly on it when proposing to control the conditions for the
conferring of degrees in Medicine. Some compromise must
be arrived at by the executives of the two organisations,
and the Crown will look more favourably on a united appli¬
cation for power to confer degrees in all Faculties than on
two separate, and to some extent antagonistic, proposals—
one in all Faculties, and the other only in Medicine.

PROFESSOR VIRCHOW ON MYXCEDEMA.

It is a curious and interesting fact that the condition
with which we have been familiar in this country for the
past ten years under the name “myxcedema” is almost
unknown in Germany, the home of scientific medicine.
The clinical characters of the condition are so obvious
that it was a matter of some surprise when Dr. Ord
first formulated them (following, it will be remembered.
Sir W. Gull’s observations on the “ Cretinoid State ia
Women”) that the cases should have been overlooked.
To German physicians the present state of ignorance
is the more significant, as it indicates a lack of know¬
ledge of English literature, which is hardly recipro¬
cated. In France the subject has been more studied,,
and M. Charcot some years ago suggested the alterna¬
tive title of “ cachexie pachydermique as descriptive
of it. Professor Virchow has, therefore, done a real service-
in introducing the subject of myxcedema to the Medical.
Society of Berlin, of which he is President (see Berl. Klin.
Woch ., 1887, No. 8). He said that although the London
Clinical Society had collected details of 110 cases, and many
had been published in France, there were records in Ger¬
many of but two or three cases, and these of quite recent
date. In his visit to London last October he enjoyed
opportunities, especially at St. Thomas’s Hospital and the
Brown Institution, of becoming familiar with the disease ;
and his address was largely taken up with the interesting
subject of its pathology as investigated by Professor
Horsley. He had been convinced from inspection of Pro¬
fessor Horsley’s preparations of the truth of his statement
that lymphoid tissue occurs in the thyroid body; but,
although accepting the fact that the blood in the thyroid
veins is 7 per cent, richer in leucocytes than that in the
corresponding arteries, he hinted that this difference may
be explained by the slower current in the veins, and did
not consider the lymphoid tissue to be adequate to
entitle the organ to be considered of haamopoietic nature.
As to the nature of a myxcedema, he pointed out that
adipose tissue, when atrophying, undergoes mucoid change
—a reversion to the foetal state; but that myxcedema.
is not a mere atrophic change. On the other hand, it
is the outcome of an active process of cell growth in
the cutaneous and subcutaneous connective tiesue, with
increased bulk, whilst the superficial layers of the outis

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THE ASYLUM-BUILDING MANIA IN SCOTLAND.

[Feb. 26 1887. 441

are not involved. It resembles an inflammatory rather
than an active process, and he was reminded of the
similarity to the condition of phlegmasia alba dolens, or
pachydermia. The experimental and chemical researches
of Horsley and Haliburton, which prove that extirpa¬
tion of the thyroid is followed by an increase of
mucin in the blood, tissues, and secretions—a condition
of “ myxoemia ”—form a distinct advance in the know¬
ledge of the subject; but Professor Virchow expressed
himself with caution upon the theory of the function
of the thyroid propounded by Horsley upon these
results. Nor does the histology of myxoedema bear.out
the notion of its being mainly a condition due to
retention of mucin; on the contrary, it points to an
active irritative process. Professor Virchow next passed to
consider the relations between myxoedema and cretinism,
and again cited Professor Horsley’s experiments on
monkeys, which in a few weeks after thyroidectomy
passed through a series of stages — neurotic, mucinoid
and atrophic—to death; and where, after exclusion of any
nerve lesion, the phenomena were attributed to perverted
nutritional changes. He called to mind the ill effects,
noted long ago, of the too rapid wasting of the thyroid
under treatment of goitre by iodine—effects attributed by
some to iodism, but considered by Virchow himself {Oesch-
aiiUte, L, 114) to be due to the “ goitrous cachexia.” He
discussed the association between goitre and cretinism, and
between so-called “congenital rickets” and cretinism, with
especial reference to myxoedema, adducing s)me interesting
facts, such as that of two infants, subjects of “ congenital
rickets”: one presented the characters of myxoedema, and
had an abnormally large thyroid; the other was small and
atrophied, having no myxoedematous characters, but having
extreme atrophy of the thyroid, such as described by Ord in
myxcedema. He also referred to Kiister'a observation upon
“cachexia strumipriva,” and glanced at the subject of
exophthalmic goitre, more by way of contrast than an
illustrating any relationship between Graves’ disease and
myxcedema; and he concluded by admitting that although
the part played by the thyroid body in myxcedema was not
yet proved, it was a subject worthy of careful study.
Professor Ewald, who spoke on the conclusion of Professor
Virchow’s paper, preferred “cachexia pachydermica” to
the term “myxoedema,” and suggested that in Horsley’s
experiments the increase of mucus in the salivary secre¬
tion was attributable to injury to the sympathetic
during the operation of extirpation of the thyroid. He
mentioned that recently Schiff and Herzen had observed
spasmodic affections suggestive of cortical irritation to
follow extirpation of the thyroid, whilst Albertoni and
Tizzoni had noticed a great diminution in the blood-
capacity for oxygen; and he considered that such varied
results proved how far we are from a knowledge of the
functions of the thyroid. Drs. Wolff and Bergmann also
spoke, their remarks being mainly directed to the effect of
piutial thyroidectomy in producing atrophy of the remainder
of the body—a result which does not obtain in experiments
<m the healthy organ._

THE ASYLUM-BUILDINQ MANIA IN SCOTLAND.

It is said of the Scotch that they have a keen eye to
economy. No one would think so to observe the growing
passion for huge asylums north of the Tweed, if it were not
a recognised fact that asylum-building is distinctly a mania.
If it mere not so, a clear-headed and far-sighted people
would never be So infatuated as to squander many hundreds
of thousands of pounds every year, as we do, in seeking
refuges for the insane, instead of providing hospitals of
moderate else for their rapid cure. It is not too much to
•ay that fully one-half of the Htnecy in the United Kingdom
s tsilly fottMous. Our lAws and our asylum system

directly tend to the cultivation of mental disease in its
chronic forms. The obstacles which the law—in its bene¬
volent imbecility—throws in the way of prompt treatment,
and the practice of herding the insane in vast caravanserai,
and treating them in classes instead of individually, combine
to render rapid recovery improbable. There can be no radical
change in these respects until fine lesions of the brain are,
like coarse lesions, held to constitute ordinary disease. It
is the separation of physical disease with mind (i.e., brain)
symptoms from physical disease without what are arbi¬
trarily called mental phenomena—albeit there may be
delirium, and impulsive or even delusional excitement—
that creates the anomaly and entails all the mischief
and failure. We heartily sympathise with ratepayers groan¬
ing under the influence of “ further lunatic asylum accom¬
modation,” and only wish they had the courage to put a stop
to it. _

EXTIRPATION OF THE SPLEEN.

At the recent congress of Russian medical practitioners.
Dr. A. G. Podrez, privat-docent in Kharkoff, read a paper on
extirpation of the spleen, including the notes of a case in
which he. himself had recently performed this operation.
The patient was a woman with ague-cake, associated with
ascites and extreme cachexia. The operation was performed
ou the 22nd of November last; the patient subsequently
went on well, being able to get up on Dec. 10th. The
weight increased and the ascites disappeared. On the 16th,
however, she had a rigor, aad the urine contained a large
quantity of albumen and hyaline casts. Death occurred on
the 27th, and was due, as shown by the necropsy, to diffuse
parenchymatous nephritis. The total number of cases of
extirpation of the spleen collected by Dr. Podrez (including
his own) is forty-two. Of these one was performed in 1549
by Soceharelli, and one in 1711. The rest all belong to the
present century. H his own c&9e is reckoned as a recovery,
the mortality is 73 per cent.; if otherwise, the mortality is
76; the recoveries being twelve or eleven out of the forty-
two cases, according as this is or is not reckoned as belong¬
ing to that category. The cause of the eleven deaths was
septicaemia in one case, peritonitis in one case, and haemor¬
rhage either during or shortly after the operation in all the
others. Dr. Podrez thinks that an improved method of per¬
forming the operation is required in order to obviate the
tendency to haemorrhage. It is also to be desired that, by
means of further observations, the indications for the opera¬
tion in cases of enlarged spleen associated with both ague
and leukaemia may be defined.

SANITARY SCIENCE.

In a lecture on Sanitary Science with which Dr. Edward
Seaton recently inaugurated his lectures on Public Health
at St. Thomas’s Hospital, the point was insisted on that the
advocacy of cleanliness was not the sole object of sanitary
workers. The enforcement of cleanliness has undoubtedly
done much to improve the public health, but there is too
much tendency at the present time to forget that for the
prevention of disease much more is necessary. Our know¬
ledge of its causes is still in its infancy, and until these
causes are fully understood it is impossible to define the
means by which it shall be prevented. To rely upon
cleanliness alone is, therefore, to neglect other conditions
which are often far more potent for evil. Dr. Seaton’s
protest is certainly timely. We freely join with him in the
desire to see the dcctrine of cleanliness generally accepted,
but we none the less accept his view that this is not a
panacea for sill hutnan ills. Every year emphasises this
opinion, and teaches ns that many maladies, and especially
some of those which are of a communicable character, have
less to do with filth as a cause than was formerly supposed.

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442 The Lancet,]

THE HOYAL ASYLUM OF ST. ANNE’S, SOCIETY.

[Fbb.26, 1887.

The recent investigations of Mr. W. II. Power have shown
-this forcibly, and lead us to hope that sanitary science
has before it much greater triumphs than those which have
already been attained. It is not many years ago that the
public were taught that all that could be known was already
discovered, and that the use of a two-foot rule was now all
that was required for the purposes of sanitary adminis¬
tration. It is this view which the public is but too willing
to accept; its teachers are not always those who are
workers, and it is well that it should bo reminded from
time to time that sanitary science must necessarily be
progressive. We trust Dr. Seaton’s protest will be heard
outside his class. _

THE ROYAL ASYLUM OF ST. ANNE'S SOCIETY.

In the year 1702, the first year of the reign of Queen
Anne, a few benevolent persons, amongst whom were the
excellent and pious Dr. Bray and Mr. R. Nelson, formed
themselves into a society for clothing and educating twelve
<boys, the sons of parents reduced to a necessitous condition.
In 1790 the St. Anne’s Society established a girl’s school in
connexion with the town establishment. The good work
has prospered, and the Society has enlarged its sphere of
usefulness and benevolence, so that now the establishment
Cdnsi9ts of a governess and master, thirty boys, and thirty
girls. Besides thie town School, which is open to children
living within two miles of its building, there is a country
esylum, and lately some new schools have been erected at
Redhill for the accommodation of 400 children. The insti¬
tution has special claims on the medical profession, for
many of the benefited are the children of medical men.
The same kind and generous friend who has already founded
three perpetual presentations to this institution for the orphan
daughters of distressed medical practitioners has this year
added a fourth, and this presentation, like the others, is in
the hands of the Royal Medical Benevolent College. The
annual festival was held on Tuesday last, and the report of
the Committee showed that excellent management prevails,
for the institution pays its way, though it is unendowed
and without any permanent income. The secretary is Mr.
R. H. Evans, and the offices are situated at 68, Graceehurch-
street, where donations may be sent. 1

THE CONTAGIOUS DISEASES ACTS IN
QUEENSLAND.

On Oct. 1st, 1886, a motion for the repeal of the Contagious
Diseases Acts in Queensland, which was one of the first of the
British dependencies to follow England’s example in passing
them, was moved in the Parliament held in Brisbane. It
was only carried by the casting vote of the Speaker, in a
thinly-attended House, there being but thirty-one members
present. In consequence of this the Premier of Queensland
has wisely, as we think, decided not to act on it, especially
as many members were absent who would have opposed the
. motion. The next session will commence in June, when the
subject will again be brought forward. From the report of the
.proceedings in the official “ Parliamentary Debates” it would
appear that the opponents raised all the old stale objections,
but fortunately those who supported the Acts were fortified
with replies to them in the series of articles which were
recently published in The Lancet, enabling the Premier
. and those who agreed with him to refute completely every
. one of these objections. It would indeed be unwise were
Queensland to repeat the mistake of the mother country,
■ more especially in view of the experience of other colonies.
Only last week it was noticed in our columns that the
authorities of two of the districts in the southern oounties
■formerly protected by the Acts were about to appoint
.la deputation to wait upon the Local Government Board

with the view of urging upon the President the
restoration of the Acts. Reports from all the other dis¬
tricts show that the repeal of the Acts has proved
disastrous in the extreme. It has been found necessary to
reinforoe them in and around the vicinity of Gape Town, in
consequence of the fearful spread of venereal diseases, and
notably of severe forms of syphilid among both the native
and European population. A like result followed - the
repeal of similar Acts in Malta, Bombay, and other colonial
places, and judging from what has been effected by the
Acts in Queensland, it is very clear that their repeal would
be a retrograde step to be much regretted subsequently.
All the arguments were as usual in favonr of the Acts ;
the case of the .opposite side was not argument, but
sentiment of the weakest character. The queetiob* after
all, is—Are common prostitutes in Queensland or else¬
where to be permitted to spread these diseases broadcast
without let or hindrance? Those who would answer in
the affirmative cannot justify themselves as humanitarians,
either to the unfortunate women themselves or to their
victims, who, as has been repeatedly shown, are not only
vicious men, but inuosent wives and children. Those who,
on the other hand, would wish to prevent the spread of these
loathsome diseases will find no better means of doing eo than
the Acts of 18(39 and 1869, which, so far from being specimens
of hasty legislation, as has been so recklessly asserted, give
evidence of aueh care in their framing as to be scarcely
capable of improvement. _

THE INTERNATIONAL MEDICAL CONGRESS.

We hear on the best authority that several of the
Transatlantic steamboat companies are prepared to make
considerable reductions in their fares to medical men
attending the International Medical Congress to -be held at
Washington in September next. The Hamburg American
Steamship Company offers a first-class return ticket for
£18, whilst the Royal Netherland will provide similar
accommodation for il6. The Red Star line will give a
return ticket from Antwerp to New York for £20. The
Inman line, whose steamers are among the largest and
fastest on the Atlantic, will also afford every acoommodatdon
to passengers at reduced fares; but the Canard have
declined to entertain the overtures which have been made to
them. Ladies accompanied by members will also be taken
on favourable terms. The hotel expenses, everything In¬
cluded, need not exceed from twelve to sixteen shillings a
day: so that it will be possible for members of the Congress
to attend the meeting for about twenty-five guineas a head.
Messrs. Thos. Cook and Son, of Ludgate-circus, and 261,
Broadway, New York, have issued a circular of round tours
through the United States, at fares which are extremely
moderate. _ •

WOMEN DENTISTS.

The Committee of the National Dental Hospital have
resolved to admit registered female medical students to the
practice of the hospital; moreover, we find upon looking
through the Dental Register which is issued by the Medical
Council the names of twenty-two women, sixteen of whom
are practising in England, two in Scotland, and four in the
colonies.. All these are registered on the ground of being
in practice before the passing of the Dentists Act. Tho
College of Surgeons of Edinburgh have also decided to
admit women to the examination for the licence in Dental
Surgery, but we believe so far none have applied. The
question arises—are women fit to be dentists? A great deal
has been written and said recently about the ill effects of
those occupations for women which necessitate long-con¬
tinued standing, and how much worse must it be wheu to
the standing is added the strained apd cramped position

Digitized by Google

Thji Lancet,]

WEST DERBY INFECTIONS HOSPITAL.

[Feb. 20,188?. 443

necessitated in stopping, which takes up the greatest part
of tbs time of the dentist of the present day. That the
long-continued confined position is a severe strain is shown
by the occasional occurrence of neuralgia of the anterior
crural or external cutaneous nerves of the leg, which is
known by the name of “ the dentist’s leg.” We think that
women most often fail in extracting teeth from sheer want
of muscular power. Again, in mechanical ideas women are
particularly wanting, a fact perhaps due to their training,
bat nevertheless a fact; and in what department of den¬
tistry does not mechanics play a large part ?

WEST DERBY INFECTIOUS HOSPITAL.

The West Derby Local Board of Health find themselves
confronted with a good deal of opposition in their efforts to
provide their district with a hospital for the isolation of
first attacks from infectious diseases. The difficulty as to
site is one that has to be faced nearly everywhere, for such
hospitals and similar institutions an never regarded as
desirable neighbours. The last phase of the proceedings in
West Derby is, however, an unfortunate one, for a body of
the ratepayers demand that, instead of having a hospital in
their own district, they should send all their cases to the
Bootle Hospital. Such a plan is by no means a good one.
The principal object which a sanitary authority should hold
in view is to secure the earliest possible isolation, and since
many people who would willingly enter a hospital in their
own district naturally object to be sent off into another
for the protection of their neighbours, it is as a rule to
be desired that urban districts should possess their own
hospitals. This view seems to have been enforced by
Dr. Glazebrook at a recent meeting, but some of his remarks
were not received with the attention they deserved.

ON RENAL SECRETION IN THE F(ETUS AND THE
FORMATION OF LIQUOR AMNIL
K&ukbnbbbo {Arch, f Oyn., xxvl., p. 268) reviews the
rweat contributions to this subject, and defends his own
opinion that no constant or considerable activity of the
kidneys exists daring fcetal life. Wiener, who takes an
°PP°«t* view, bases his opinion on experiments made by
injecting various substances. In one case he injected
mlphlndigotato of soda under the skin of a foetus, and found
thanriniferous tubules of an intensely blue colour, blue urine
present in the foetal bladder. Cohnstein and Zuntz, on
the other hand, have shown that in foetal sheep the arterial
Pf^sore is scarcely half of what it is post partum, so that
the conditions of the circulation are unfavourable to renal
^vity. Krqkenberg replies to Wiener’s arguments by
Pointing oat that ho conclusion as to physiological processes
«*n be drawn from any experiments by which the feet ns is
Pi*«d under abnormal conditions, as it is when substances
*onh M snlphindigotate of soda are injected. Krnkenberg
“on proceeds to discuss the question how potassium iodide
w soluble substances pass into the liquor amnii. His

'rie w Was that at the end of pregnancy iodide of
j***tomn passed through the fcetal membranes' into the
Inmii, and this view was in harmony with the fact
»lt was absent from all the organs of the feetua
As stomach, into which it could have passed by
w allowed. In his recent'experiments, however,
the contents of the stomach might give the
fracti on even when the liquor amnii did not-** result
T~**2Pjsred oppbeed to hie former belief, and suggested
Ijyto^tynf its passing from the fcetaa (through the
into tfce liqnor amnii. But on making
s*p«iiaBBt6 ^ tUriU his original view the most
'/r’W^^toodifyfcsg lt lBKthe extent of believing that
^■^•reedi toe end of gestation that the iodide passes

into the liqueur amnii—i.e^ at a time whqp the membranes
become permeable. This view is greatly strengthened by
comparative experiments made on guinea-pigs and rabbits.
He chose these animals owing to the great difference in the
thickness of their fcetal membranes, and found that when
thick the iodide did not pass into the liquor amnii, while it
did so when the membranes were thin. Similar results were
obtained from experiments on dogs and cats. Krukenberg was
further led to the discovery that amongst the foetal mem¬
branes the ectodermic layers are those that offer most
obstruction to iodide of potassium transuding into the
liquor amnii, and that it is only towards the end of gesta¬
tion, when those ectodermic layers become thin, that the salt
can pass. His former view—that it passes through the
foetal membranes— is therefore confirmed. The experiments
above referred to were made on lower animals, but there is
every ground, for believing the results to be applioable to
man.

THE ETIOLOGY OF FOGS.

Mb. John A it ken’s theory of fogs is gaining credence, and
it is certainly one that has much to recommend it. There
can be no question that ic covers the ground better than
any other. As our readers are aware, Mr. Aitken attributes
the production of mists, fogs, and rain to toe presence of
particles of solid matter in the atmosphere. Professor
Tyndall was the first to demonstrate how the atmosphere
could be filtered, and to show it in a comparatively pure
state. Mr. Aitken is of opinion that water vapour clings to
and condenses on these particles, either bringing them down
as rain, or remaining suspended with them as mist or fog.
Chloride of sodium derived from the sea is the most extensive
fog producer, but sulphur is the common base of town fogs ;
and he suggests that it is well that it should be so, because
the sulphur has an antiseptic effect on the stagnant air, and
saves us from worse evils than fog. This is good news
to the sufferers from an annoyance which, if the theory
broached be true, cannot possibly be got rid of. There
is no special cause of uneasiness as to the sulphur fogs, and,
on the whole, they are blessings in thick disguise. We may
therefore go on throwing our three hundred and forty-seven
tons of sulphur in the air every winter’s day in London,
not only with impunity, but with something of a sanitary
pride in the achievement, because if we did not thus dis¬
infect the stagnant atmosphere matters might be worse
with us than they are at present. All the same, if we
strained our smoke a little so as to get rid of the dirty
carbon, it would be more cleanly, and altogether better
for us. .

MEDICAL ADVICE THROUGH NEWSPAPERS.

Thebe is a growing tendency to the use of. newspapers
—not religious newspapers only—as media for giving
prescriptions and medical advice to the public. Thus,
in a letter in the Weekly Times and Echo, Mr. T. R.
Allinson, L.R.C.P. Edin., “Medical {sic) Editor of the
Weekly Times and Echo” thanks those who have written
words of cheer, See, He is glad to know that he
has been of great service in bringing before his readers
means whereby they have attained good health. Many
have desired to see the worthy licentiate, because they have
tried the ordinary drug doctor and have often been worse
for their pains. He only asks his readers to help him by
circulating the Weekly Times and Echo, He tells his readers
his hours for consultation. But this is only benevolently
to save his time and theirs. In a similar spirit, no doubt,
he proposes to educate the people, and the doctors will
either have to follow or—lose their incomes! We see
indications of the same tendency even in quarters, where
we should have expected better things. For instance.

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444 Thb Lancet] THE DANGERS OP CHILD LIFE.—CHOLERA IN AUSTRIA-HUNGARY. [Feb. 26, 1887.

just now in the case of Ealing, where the public has been
agitated with a severe outbreak of diphtheria, not only are
•the local papers flooded with speculations as to the scientific
explanation of outbreaks of diphtheria, but some medical
practitioners describe their treatment in detail. It may be
well to discuss in the newspapers the sanitation of dairies
and of cows, but the attempt to describe the niceties of
medical treatment is to be deprecated.

THE DANGERS OF CHILD LIFE.

On the 2lst inst. Dr. Tatham, medical officer of health for
the borough, delivered an address at Salford on this subject.
Of all the children bom in the neighbourhood, Dr. Tatham
state! that one-fifth die before attaining the age of one
year. The proportion of infant deaths per 1000 births for
the whole of England and Wales is about 130; in the Green-
gate district of Silford it exceeds 200. In Salford alone
1200 children die annually from the following causes :
measles, 30-40 ; whooping-cough, 50-70; diarrhoea, 100-200,
or more; consumption, 180-200; premature birth, 80-120 ;
■convulsions 150-200, lung diseases 100-300; whilst about
100 are found dead in bed, suffocated or overlain. Such a
state of things was unnatural, and he desired to secure the
co-operation of his hearers in reducing this excessive mor¬
tality. Dr. Tatham then discussed the causes of some of the
diseases which are particularly fatal to children, and
remarked that human life is of more value than that of sheep
cr pigs, and legislators ought to recognise this, and to see
that means are adopted for the protection of human life, not
•less stringent than those already in force for the protection
cf cattle. _

THE USE OF TOWN REFUSE IN ROAD-MAKING.

A decision has been come to by the corporation of
■Cardiff which is of considerable importance. It relates to
the employment of the town refuse in making roadways.
It appears that two years ago similar refuse was used in
the construction of newly formed roadways in a low-lying
district, where it was necessary that the roads should be con¬
siderably raised, and, according to the information before us,
this is stated to have received the assent of the medical officer
-of health, subject to the surface and the sides of the road¬
ways being constructed of marine clay, an arrangement
intended hermetically to seal in any possible harm that might
arise. We have not the full reports to refer to, but, so far
■as we can judge, the intention to extend this practice was
recently preceded by an inquiry by the borough analyst, who
emphatically condemns it. He has found that the roads in
question, when opened up for the purpose, were wet, full of
bacilli, and likely to cause serious evils, and so far from
•emanations being prevented from passing to adjoining
houses, it has to be remembered that the lateral clay band,
which rises to the height of the pavements, has to be
intersected along its course by drain and other pipes.
In short, any such hermetically sealing as was ■ intended
is practically impossible. Notwithstanding this, and appa¬
rently with the concurrence of the borough surveyor, it
is announced in the South Walct Daily News that the
Council have voted in favour of continuing a similar
practice. On the subject generally, we may call to mind
the report which was prepared for the borough of Liver¬
pool in 1871 by Dr. Burdon Sanderson and the late
Dr. Parkes. They sought to ascertain what was the
■effect of time on the animal and-vegetable matters which in
each a town necessarily becomes mingled with- so-called
•dry house refuse, and their object was to advise the cor¬
poration how far- such refuse might without risk be utilised
tfor the purpose of filling up inequalities in the ground.: The
results of that inquiry are set forth in adetaskd report;

but for our present purposes it will suffice to point oat ths
it was ascertained that “ the process of decay for aU th
most easily destructible matters,” including vegetabl
ref use, “ is completed in three years,” and the conclusion i
drawn that “ the vegetable and animal matter contained i
the cinder refuse decays and disappears in about thre
years, and is virtually innocuous before that time.” Faec<
matter is not referred to in this connexion, and there was, c
course, no attempt to hinder the process of decompoeitioi
by any clay seal, hermetical or otherwise. Possibly, thi
conclusion may aid the Cardiff corporation in arriving at
decision which will still enable them to utilise the materit
referred to, and yet to do so without risk of causing injur
to health. If such refuse could be properly stored at som
depot for a period bordering on three years, it is probabl
that at the end of that time the borough analyst would n
longer object to its being used for the purposes indicated.

CHOLERA IN AUSTRIA-HUNGARY.

So far, there is no further report on the recent recurrenc
of cholera in Austria-Hungary. On Feb. 26th as many a
twenty-five cases were stated to have occurred at Essegg, it
Slavonia, seven of the attacks terminating fatally. Thii
news was confirmed by further information on the lllb, t<
the effect that eleven out of eighteen patients had died then
on the 10th. Essegg lies on the southern bank of the rivei
Drau, just to the west of its junction with the Danube, and
al. a point where the river forms the boundary between
Hungary and Slavonia. A large number of villages in
Hungary were the seat of cholera in 1886, and it has all
along been feared that, if any recurrence of the disease
were to take place this year, its first appearance would be
in this direction.

THE CUSTODY OF PERSONS ALLEGED TO BE
LUNATICS.

The law ought to define the conditions under which
a person alleged to be a lunatic and giving trouble to those
around, and say where, and how, he is to be protected during
the delay so unwisely necessitated by legal enactment before
such a person can be placed in an asylum. Meanwhile, we
are not disposed to urge medical practitioners to go out of
their way to help magistrates out of their difficulty in dealing
with such cases. It would be far better policy, and conduce
to the best interests of both the sane and insane, if matters
were left to take their course, so that the defects of the
law as it stands might, just now, be seen in their true
aspect. _'

EXPERIMENTAL ALBUMINURIA.

Schbbibbb finds (Arch. f. Exp. Path. v. Pharm., 1886-6;
abstr. by Sabli in Fortschrittc dcr Medicin, 1887, No. 2) that
albuminuria may be artificially induced by compression of
the thorax, the duration of the compression in young sub¬
jects needing to be only one minute and a half to produce the
effect. The quantity of albumen is variable, but the time
during which the albuminuria lasts varies directly with the
duration of the compression. In one case hyaline casts, and in
another blood-corpuscles were found in the urine. Schreiber
refers the albuminuria under such conditions to stasis of the
pulmonary circulation from diminution of the negative
thoracic pressure, diminution of the normal difference in
pressure between the pulmonary capillaries and left auricle,
diminution of the vascular area in the longs, and correspond¬
ing diminution of respiratory changes. In a second paper
Schreiber describes the chemical characters of the albumen
excreted in these cases, and gives cardiographic and sphyg-
mograpbie tracings taken before and during the compression
of the chest, which show a slight dimiuution in the fulness

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GOLD AND THE TYPHOID BACILLUS.

[Feb. 26,1887. 445

of the peripheral arteries daring the practice. Ophtbalmp-
scopiaal examination did not show any variation in the size
of the retinal vessels. These facts rather tend to throw
doubt on the explanation of the albuminuria first offered,
especially as no dyspnoea, such as would be expected from
pulmonary stasis, is produced by the degree of compression
sufficient to induce albuminuria.

FRENCH SURGICAL CONGRESS.

Thb third meeting of the French Surgical Congress will
be held in Paris in April of next year, the precise date
of which has not been fixed, under the presidency of Pro¬
fessor Yemeuil. The following questions, amongst others,
are set down for discussion:—The treatment of gunshot
wounds of the viscera; the value of the radical cure of
hernia; and chronic suppuration of the pleura, and its
treatment. _

COLD AND THE TYPHOID BACILLUS.

Dr. John S. Billings sends a note to the Sanitary
Engineer of Jan. 29th (New York) respecting the influence
of cold upon the typhoid bacillus. He found that cultures
could be obtained from water which, after inoculation with
the bacillus, had been frozen for some hours. Evidently,
Dr. Billings adds, the vitality of the typhoid bacillus is
not destroyed by freezing._

DEATHS OF EMINENT FOREIGN MEDICAL MEN.

Thb following deaths are announced:—Dr. Alois Geigel,
Professor of Hygiene in the University of Wurzburg, at the
age of forty-five. Dr. Richara, founder of the Bonn Lunatic
Asylum, one of the most famous alienists in Germany, at
the age of seventy-five. _

PORTUGUESE WORK ON RABIES.

Dr. Eduardo ABnEtr, of the Royal Academy of Sciences
of Lisbon, who was appointed by the Portuguese Government
to examin e into M. Pasteur's treatment of hydrophobia lias
published & work upon rabies (a Jtaiva), in which, after
describing the disease and referring copiously to the writings
of observers in different countries, he gives the notes of the
cases of Portuguese subjects who were seht to Paris, and also
an account of some experiments made on rabbits (obtained
from M, Pasteur) by himself. The work is, however, a rela¬
tion of facts, rather than a critique upon them.

“ ERYTHROMELALGY.”

The possibility of what has been spoken of as erytbro-
melalgy being related in some way to a local aapbxyia is
certainly deserving of consideration. A case of the kind is
recorded in La France Midicale, No. 14. It is that of a female
*ged twenty-six, a patient in the Salpetriere. For eight
jean the had been snbject to hysterical attacks of a classical
description. The attacks bad diminished in frequency the
last two or three years. She had not suffered from an
attack for more than three months, when she fatigued herself
for several days in succession, after wljich she commenced
to safer with headache and bypertesthesia of the skin, and
^ent to bed in an agitated state. The next day her face was
ofsoriethue, her eyes were injected, and she had beatings in
the totttples and violent palpitations, with severe occipital
headache. At the same time she experienced smarting
sensations on the back of the hands, and on the inner aspect
°f the thighs and arms. In a few moments there appeared
red patebse in the before-mentioned parts of the skin; they
*8**discrete, and looked like erysipelas or scarlatina. The
ifan irregular, and not raised at the edges. 1 The
hotWr lpr 1° C. than the unaffected

. *

areas. The erythematous areas were not painful, but were
the seats of an insupportable Smarting. Their duration waB
about two hours. Their disappearance was followed by
sweating and the passage of a large quantity of urine.

RECTAL GASEOUS MEDICATION FOR
EMPHYSEMA.

Pursuing the plan of M. Bergeon, MM. Renault and-
Thierry have employed lavements of carbonic acid gas in
the treatment of emphysema complicated with catarrh.
The number of observations has been but small. The general
method of treatment was the same as that employed for the.
treatment of phthisis, but the sulphurous water was omitted.
The results were remarkably satisfactory, especially as
regards the relief of cough and shortness of breath, a daily
lavement for a week or a fortnight being the usual course.

FOREIGN UNIVERSITY INTELLIGENCE.

'Bordeau-t.^-The chair of Chemistry is advertised as open
to competition.

Berlin .—The temporary charge of the University Clinic for
Women in Artillerie-strasse, vacant by Professor Scbroeder’s
death, has been feiven to Dr. Hofmeier, the chief assistant
physician. '

; Leipsic .—After having met with two refusals, the invita¬
tion of the University to fill the chair of Midwifery has been,
accepted by Professor Zweifel of Erlangen.

Moscow .—The new Clinic for Mental Diseases founded by
Mdme. Morosofl has been formally opened.

Zurich— The number of medical students here is larger
than at any other Swiss University, being 241. Berne has,,
however, the largest number of female students—viz., 42.

The following are the names of the gentlemen who form,
the medical staff of the London Throat Hospital recently
founded in Great Portland-street, W.: ~W.-McNeil Whistler,
M.D..M.R.C.P.; Edward Woakes, M.D. Lond.; George Stoker,
M.K.Q.C.P.t. ; W. H. Fenton-Jones, ' M.D., M.A. Oxon.;
W. R. H. Stewart, F.R.C.S.; C. Coleman Jewell, M.B. Lond.;
Edward Law, M.D. Aural Surgeon, Dr. Woakes; Patho¬
logist, Dr. Jewell. _

We have been requested to call attention to the fact that-
the meeting of the Pathological Society next week will be¬
held on Thursday, March 3rd, instead of Tuesday, when the
annual meeting of ‘the Royal Medical and Chirurgical
Society takes place. ( _____

A volume of. papers by the late Dr. Moxon, bearing the
title of “ Pilocereus Senilis,” [a announced as ready for
publication by Messrs. Sampson Low and Co.

Dr. E. Drummond of Rome will, we understand, con¬
tribute to an early dumber of the Fortnightly Review a
paper on the health of that city.

Metropolitan Hospital Saturday Fundl— The
first meeting for the present year of the delegatee of this
fund was held on the 19th inst., when the certificates of
126 delegates were verified. It was resolved that the
ladies’ collection should take place on June 26th, and that
a series of meetings be organised with a view to securing
for the Jubilee year such an amount as shall be Worthy or
the working classes of London, and testify to their apprecia¬
tion of the hospitals and dispensaries of the metropolis.
Invitations have been issued m the officers of the Hospital'
Saturday movement in the provinces tb attend a conference,,
to be held either in Loudon or Birmingham during the'
ensuing slimmer. , v - ' " ■

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446 The Lancet',]

health op English and scotch towns.

[Pm. 26,1887.

VITAL STATISTICS.

HEALTH OP ENGLISH TOWNS.

In twenty-eight of the largest English towns 6772 births
and 3736 deaths were registered during the week ending
Feb. 19th. The annual death-rate in theee towns, whioh had
steadily declined in the preceding six weeks from 26'5 to
I9'5 per 1000, rose again last week to 21*1. During the first
seven weeks of the current quarter the death-rate in these
towns averaged 22 - l per 1000, and was 2-3 below the
mean rate in the corresponding periods of the ten years
1877-86. The lowest rates in these towns last week were
17'2 in Derby, 17‘9 in Salford, 17'9 in Leicester, and 18*1 in
Brighton. The rates in the other towns ranged upwards
to. 26*7 in Plymouth, 26'8 in Liverpool, 28'6 in Manchester,
and 296 in Preston. The deaths referred to the principal
zymotic diseases in the twenty-eight towns, which had
declined in the preceding fire weeks from 485 to 340,
roseagain last week to371; theyincluded 125 from whooping-
cough,107 from measlea,47 from scarlet fever, 36 from diarrhoea,
32 from diphtheria, 23 from “fever” (principally enteric),
and only 1 from small-pox. The lowest death-rates from these
principal zymotic diseases were recorded last week in Brighton,
Derby and Leicester; and the highest rates in Bristol,
Huddersfield, and Liverpool. The greatest mortality from
whooping-cough occurred in Sunderland, Huddersfield, and
Plymouth; from measles in Hull,.Huddersfield, and Liver¬
pool ; from scarlet fever in Salford, Blackburn, and Bristol;
and from “fever” in Preston. The 32 deaths from diph¬
theria in the twenty-eight towns included 15 in London,
3 in Portsmouth, 2 in Birkenhead, 2 in Liverpool, and 2 in
Preston. Small-pox caused 1 death in Newcastle-upon-
Tyne, but not one in London and its outer ring, or in any
of - the twenty-six other large provincial towns. Only 4
amall-pox patients were under treatment on Saturday last
in the metropolitan hospitals receiving cases of this disease.
The deaths referred to diseases of the respiratory organs in
London, which had been 364 and 373 in the preceding two
weeks, further rose list week to 892, but were 149 below
the corrected average. The causes of 95, or 2-5 per cent., of
the deaths in the twenty-eight towns last week were not
certified either by a registered medical practitioner or by a
coroner. All the causes of death were duly certified in
Bristol, Blackburn, Norwich, and in four other smaller
towns. The largest proportions of uncertified deaths were
registered in Brighton, Leicester, Salford, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 19'8 and 22 - 0 per 1000 in the preceding two
weeks, further rose in the week ending Feb. 19th to 24*3;
this rate exceeded by 8*2 the mean rate during the same
week in the twenty-eight large English towns. The rates
in the 8cotcb towns last week ranged from 13 - 7 in Greenock
and 14‘6 in Perth, to 26-6 in Aberdeen, 27 0 in Glasgow, and
28-2 in Paisley. The 607 deaths in the eight towns last
week showed a further increase of 67 upon the numbers
returned in the preceding two weeks, and included 32
which were referred to whooping-cough, 25 to scarlet fever,
23 to measles, 14 to diarrhoea, 5 to diphtheria, 4 to ** fever”
(typhus, enteric,, or simple), and not one to small-pox;
in all 103 deaths resulted from these principal zymotic
diseases, showing a further increase upon the 66 and 76
returned in the previous two weeks. These 103 deaths
were equal to an annual rate of 4-1 per 1000, which
exceeded by 2'0 the mean rate from the same diseases
in the twenty-eight English towns. The fatal cases
of : whooping-cough, which had been 19, 23, and 28 in the
preceding three weeks, further rose last week to 32. of
which 22 occurred in Glasgow, 4 in Aberdeen, and 3 in
Edinburgh. The deaths from scarlet fever and from measles
also showed a considerable further increase upon recent
weekly numbers; the 25 fatal cases of scarlet fever included
16 in Edinburgh, 5 in Glasgow, and 3 in Dundee; of the
23 deaths, from measles, 12 occurred in Glasgow and 9 in
Aberdeen. The 14 deaths attributed to diarrhoea included
7 in Glasgow, 8 in Dundee f and 3 in Aberdeen. Three of
the 5 fatal cases of diphtheria and 2 of the 4 deaths from
“fever,” were returned in Glasgow. The deaths referred
to’acute diseases of the respiratory organs in the eight towns,
which had been 126 and 133 in the preceding two weeks,
further rose last week to 146, but were 7 below the number

returned in the corresponding week of last year. The
causes of 69, or more than 11 per cent^ of the deaths
registered during the week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 29*7 and
27'3 per 1000 in the preceding two weeks, rose to 35'3 in
the week ending Feb. 19th. During the first seven weeks
of the current quarter the death-rate in the city averaged
31*5, the mean rate during the same period being but
20'9 in London and 21*8 in Edinburgh. The 239 deaths in
Dublin last week showed an increase of 54 upon the
number in the previous week, and included 4 which were
referred to “fever” (typhus, enteric, or simple), 3 to
scarlet fever, 3 to diarrhoea, 2 to whooping-cough, 1 to
measles, 1 to diphtheria, and not ohe to small-pox. Thus
the deaths from these principal zymotic diseases, which
had been 13 and 17 in the preceding two weeks, de¬
clined again last week to 14; they were equal to an
annual rate of 2‘1 per 1000, the rates from the same
diseases being 1*5 in London and 4-0 in Edinburgh. The
deaths referred to “ fever,” corresponded with the number in
the previous week, while the fatal cases of scarlet fever,
diarrhoea, and whooping-cough each showed a decline. The
deaths of infants exceeded the number returned in any
previous week of this year, and those of elderly persons
also showed an increase upon recent weekly numbers.
Five inquest cases and 2 deaths from violence were
registered; and 81, or more than a third, of the deaths
occurred in public institutions. The causes of 33, or nearly
14 per cent., of the deaths registered daring the week were
not certified.

THE SERVICES.

The following is added after paragraph 1244 of the Regula¬
tions for the Army Medical Department, 1885 Whenever a
medical officer is required to report, in the cate of individuals
injured in the Service, upon their capability, or otherwise,
to contribute to their own support, the greatest care wiU be
observed by him in forming and recording an opinion, as it
is mainly upon such opinion that the important question, of
granting compassionate allowances or gratuities has to be
considered.

Deputy Surgeon-General J. B. C. Reade, C.B., has handed
over his charge at Umballa and proceeded on leave of
absence, and has been replaced at Umballa by Deputy Sur¬
geon-General J. Landale, M.D.

Surgeon-Major F. A. Turton has been brought in from the
temporary half-pay list, and has joined the Northern District
for duty at Birmingham in charge of the detachment there
stationed.

Wab Office. —Army Medical Staff: The undermentioned
Surgeons have been seconded for service with the Egyptian
Army: William Henry Phillips Lewis, Aylmer Ellis Hayes,
Arthur Maher Kavanagh, and Richard Edward Ricketts
Morse.

India Office.— The Qileen has approved of the retire¬
ment from the Service of the undermentioned officer of the
Indian Military Forces: Surgeon-Major John Proudfoot
Stratton, M.D., of the Bombay Medical Establishment. The
Queen has also approved of the undermentioned officers
being granted a step of honorary rank on retirement: Deputy
Surgeon-General Charles Planck, Deputy Surgeon-General
Alfred James Dale, and Deputy Surgeon-General John Brake,
all of the Bengal Medical Establishment, and Deputy Sur¬
geon-General Henry Cook, M.D., of the Bombay Medical
Establishment, to be Surgeons-General; Brigade Surgeon
James Fairwaather, M.D., Brigade Surgeon James Browne,
M.D., and Brigade Surgeon Robert Sander Bateson, all of the
Bengal Medical Establishment, to be Deputy SurgebEs-
General; and Surgeon-Major John Protrifoot Stratton,
M.D., of the Bombay Medical Establishment, to be Brigade
Surgeon.

Admiralty. — The following appointments have been
madeSurgeon John N. Corbetr, to the Orwell; Mr.
Patrick J. Sheridan to be Surgeon and Agent at Kilmore;
and Mr. George C. Dickson to be Burgeon and Agent at
Whitehaven.

An.TTT. ijm Y Volunteers.— 1st Banff: Acting Surgeon
James Hitchcock, M.B., resigns his appointment. — 1st
Volunteer (Hampshire) Brigade, Southern Division, Royal

Digitized by GOGQlC

Th* Lancet,]

THU MEMBERS OF THE COLLEGE OF SURGEONS.

[Feb. 26,1887. 447

Artillery: Surgeon Burford Norman is granted the honorary
rank of 8urgeon-Major.—1st North Riding of Yorkshire:
Friend Edward Streelen, Gent., to be Acting Surgeon.

Engineer Volunteers. — The Volunteer Submarine
Miners (the Humber Division): Edward Furniss Potter,
Gent., to be Acting Surgeon.

Rifle Volunteers.— 1st Volunteer Battalion, Princess
Charlotte of Wales's (Royal Berkshire Regiment): James
Hopkins Walters, Gent., to be Acting Surgeon; Frederick
Wlniam Dyce Fraser, M.D., to be Acting Surgeon.—2nd
Cambridgeshire (Cambridge University): James Hayward
Hough, Gent., to be Acting Surgeon.—4tn Cheshire : Kenneth
Maclean, Robert Alexander Murray, M.B., and John Keay,
to be Acting Surgeons.—1st Midlothian (Leith): James Mill,
M.B, to be Acting Surgeon.—2nd Shropshire: Surgeon and
Honorary Surgeon-Major F. J. Sandford, M.D., resigns his
commission; also is permitted to retain his rank and to
continue to wear the uniform of the corps on his retirement.

Comsponhnrt

" Audi alteram partem.”

ASPIRATION OF THE URINARY BLADDER.

To the Editors of The Lancet.

Sins,—At the meeting of the Medico-Chirurgical Society
last luesday, Mr. William H. Bennett read a paper on a case
of aspiration of the bladder which ended fatally, and in the
coarse of hie remarks said that the text-books taught that
aspiration of the bladder was a harmless operation. Owing
to the discussion on Mr. Morris’s important paper, there was
no opportunity of replying to Mr. Bennett, and I therefore,
with your permission, beg leave to state that in my article
on Retention of Urine, in Mr. Christopher Heath’s “ Dictionary
of Practical Surgery” (vol. ii., p. 336), I am careful to say
that “fatal extravasation and abscess have been known to
follow a second aspiration,” and I based this remark upon
a case published some years ago by Dr. Macfie Campbell of
Liverpool. Other fatal cases of aspiration have been pub-i
lished (e.g., by Mr. Treves, Thf. Lancet, August, 1880), in
all of which 1 find that over-distension of the bladder was
allowed to recur after the relief obtained by aspiration. If,
after aspiration, the bladder is kept free from over-distension
by the introduction of a catheter—often easy enough when
the urgent symptoms have been relieved—or by a second or a
third aspiration, the operation is a safe one. I am well
aware that a bladder has been aspirated twenty times in
immediate succession safely; still, I do not consider such a
proceeding good practice, and, in the article above referred
to, I advise that in the event of more than two or three
aspirations being required, supra-pubic puncture with trocar
ami cannula should be performed. Mr. Bennett’s case fur¬
nishes valuable additional evidence that aspiration must not
be inconsiderately resorted to, but the operation is such a safe
and useful one in certain rare cases of Retention where an
instrument cannot at the moment be introduced by the
urethra, that it is a pity it should in any way be discredited.
1 make no reference to the treatment of a rotten bladder
(the expression used by Jlr. Bennett), because I am not
aware of the existence of such a condition in acute retention
of urine. By the time a bladder deserves to bo called rotten
Saturn has anticipated the surgeon and has relieved herself
by rupture, requiring appropriate treatment, which is cer¬
tainly not aspiration. I am, Sirs, yours truly,

Wlmpole-ttreet, W., Feb. 33rd, 1887. G. BCCKSTON BROWNE.

the MEMBERS OF THE COLLEGE OF SURGEONS.

To the Editors of The Lancet.

Sirs,—W e trust that you will forgive u* for offering a
few farther details as to the signatures (now over 4600)
received to the petition of the Members of the College of
8urgeona to the Privy Council. By the end of last year the
number was 1430, chiefly obtained by personal solicitation;
hut we felt then that we might expect a very much larger
total than this, and consequently issued about 9000 forms
?*the petition to Members of the Royal College of Surgeons
in the United. Kingdom who had not already signed, this
number covering all those whose addresses appear in the

Medical Directory. It has been most satisfactory, seeing
the usual fate of a circular, that over one-third of this
number have been returned to us, and that we have what
may fairly be called almost half of the Members resident in
the United Kingdom, whose present addresses are discover¬
able, as signatories to the petition. We make no manner of
doubt that by a “house-to-house visitation," as you sug¬
gested a few weeks ago, the overwhelming majority would
be iu our favour. But we do not think the expenditure of
energy and money at all necessary, the more especially as the

f >robable result of such a measure isclearly shown by the fol-
owing statisticsOut of 603 Members of the Royal College
of Surgeons placed on the local list of the Medical Directory
for 1887 as resident in the following eighteen pro¬
vincial towns—viz., Bath, Bolton, Bradford, Bristol (and
Clifton), Cardiff, Chichester, Great Malvern, Middlesborough,
Ramsgate, Scarborough, Shrewsbury, Southampton, Swan¬
sea, Wigan, Windsor, Worthing; Yarmouth, and York—359
have signed, which, allowing for about 23 of the 503 being
either marked as “retired." or with an asterisk, as of
uncertain address, gives a proportion of three-fourths who
have signed—75 per cent. We instance these places, as in
them our local Bon. secretaries have been very active in
getting the question ventilated; and it is far more just to
argue from such localities than from very large, unwieldy
cities or country districts, where onr circular is the only
intimation Membeis have had that such a movement was on
foot, and where, consequently, their interest has not yet
been aroused in it. Of the towns mentioned above, we
would especially lay stress on Bristol, from which and from
Clifton our local hon. secretary, Mr. Samuel Smith, sent ns
the petition, signed by sixty Members—i.e., by half of the
Members residing there,—twenty-four of the remaining half
sending their signatures later on our circular forms. The
Council of the College are really responsible for this wide¬
spread expression of opinion; for, had they moved forward
more quickly with cheir application for a new Charter, we
should not have had the time to get our aim9 so widely
known. Shall we call this generosity on their part ? As
to any feeling contrary to our proposals existing among
the Members, we may inform you that we have bad only
fourteen expressions of objection to the memorial—fourteen
against 4600.—We are, Sirs, your obedient servants,

WabwiUk C. Steele, j Hon. Secs.. Assoc.
Wm. Ashton Ellis, | of m.h.o.S.

Western Dispensary, Westminster, S.W., Feb. 16th, 1887.

LUNACY ACTS AMENDMENT BILL, 1887.

To the Editors of The Lancet.

Sirs,— Permit me to draw the attention of workhouse
medical officers to the injustice which it is proposed
in the Lord ChanceUor’s Lunacy Act Amendment Bill
to perpetrate on them by the provisions contained in
Clause 14, Sections 5,6,7, 8, page 13, whereby it is arranged
that they shall be debarred by statute from receiving any
remuneration whatever for the examination and certification
of a lunatic received into the workhouse of which they are
the medical officers, and that they shall be subjected to a
fine of £10 for any day or part of a day they neglect to
supply a certificate for nothing. Some forty-five to fifty
years ago a similar proviso was made, but, the great injustice
implied therein having been made manifest, the restriction
was removed, and guardians were permitted—nay, encou¬
raged—by the Commissioners in Lunacy to allow the
Workhouse medical officer to perform this duty and to
pay him. a. fee. varying from 10*. 6 d. to 21*. The
reason given for the prohibition in the first instance
and for its repetition now is the feeling entertained
by certain persons in the medical and legal professions that
the workhouse medical officer would abuse ( his position for
the sake of the fees above named in certifying that all and
sundry of the inmates of the house were of unsound mind,
wholly oblivious of the fact that when certified to they at
once pass under the skilled superintendence of the principal
medical offioer of the asylum to which they may be sent,
who would speedily report, upon any abuse of authority by
the workhouse medical officer or by his substitute. Before
concluding, I should like your readers to understand that,
with the rare exception where an inmate become* insane,
all persons admitted to a workhouse alleged to be of unsound
mind go there with a certificate from the district medical
offioer, the divisional surgeon of police, or by the. order of a

/Google

448 Tin? Lancet,]

“INFANT MORTALITY AT WORKINGTON.’

[Feb. 26,1887.

police magistrate or justice of tlie peace. It should be
remembered that it not unfrequently happens that the
workhouse medical officer is specially sent for on the admis¬
sion of a lunatic, and perhaps may have to travel four or
five miles, and that he is liable to be assaulted, as I have
been in years gone by, by an excited lunatic. Yet all this
is to count as part of his duty, for which he is to receive no
consideration of any kind—nay, many workhouse medical
officers will lose much of their emoluments when the Bill
becomes law. It is probably hopeless to expect that the
law lords will modify these sections, but it is to be hoped
that some medical members of the Lower House will enter
en opposition to them; at any rate, I feel that I am only
doing my duty to my former colleagues in raising this
objection.—I am, Sirs, yours obediently,

Joseph Rogehs,

Chairman of the Poor-law Medical Officer*" Association.

Montague-plaoe, W.O., Feb. 21st, 1887.

“ INFANT MORTALITY AT WORKINGTON.”

To the Editors of The Lancet.

Sirs,—K indly allow me to state that the annotation
beaded “ Infant Mortality at Workington,” in the last issue
of The Lancet, was written without adequate knowledge.
I am not responsible for the comments of The Timet, and the
Teport in that journal was not accurate.

As to my remarks on scarlet fever, I was alluding to a few
cases in the district during the latter half of the year, and I
wrote: “ Should the disease appear to spread to a dangerous
extent, I shall advise you to have the schools closed.” I pre¬
sume that you will agree with this. During 1885 a malignant
form of measles broke out here. I argued the question of
school-closing first with the Local Board, and then with the
School Board. Time and lives were lost in consequence.
Indeed, from Oct. 4th, 1885, to the end of March, 1886, there
were sixty-three deaths from measles. I did not wish for
this delay over a probable scarlet fever epidemic, as to be fore¬
warned is to be forearmed; hence my remarks. You mention
** fatality amongst children at the school age, and not among
young infants. My opinion is, that so long as there is
scarlet fever in a house all the children in such nouse should
remain away from school. 1 have not stated that 136 per
1000 is a high infantile death-rate, and, moreover, I turned
my attention to the Registrar-General’s reports. I stated
that the infantile mortality in Workington might be less,
and gave reasons which are defensible. You would appear
to argue that because infantile mortality is low in Working-
ton, when compared with the same mortality in all England
and Wales, I should be silent on the subject. But if I know
from personal observation that the infantile mortality in
Workington can be reduced, surely you will agree that it is
my duty to show how this may be effected.

1 submit, therefore, that my “ scathing condemnation ”
was not based on “ insufficient data.” My report is being

f rinted, and you shall have a copy of it at an early date.

u the meantime, I am convinced that a report should be
couched in the terms best suited to the people for whom it
is written. I might show this from the improvements
effected in Workington during my term of office, but I avoid
egotism. My object is not to wnte useless disquisitions on
Tital statistics, but to point the way to sanitary reform and
thereby ameliorate the conditions of the public health.

I am, Sirs, your obedient servant,

John Love

Workington, Feb. 21st, 1887. Medical Officer of Health.

DOES LACERATION OF THE CERVIX UTERI
MORE COMMONLY OCCUR IN FIRST LABOURS
OR IN SUBSEQUENT ONES ?

To the Editors of The Lancet.

Sirs,— In Dr. John Williams’ third Lecture on Cancer of
the Uterus, published in your issue of February 12tb, at
page 301, the following sentence occurs: “ Indeed, it may
fairly be said that when laceration is present the time when
it was produced was during the first labour.” I have seen a
large number of cases of laceration of the cervix, and have
ood notes of sixteen cases, in thirteen of which I have
one Emmet’s operation. In eleven of these cases it was
possible to tell with tolerable certainty during which con¬
finement the accident had occurred, and in one only bad it
• 'iken place during the first, and this patient has dot sub¬

sequently borne children. The labour at which the laceration
' had probably occurred was usually the last, or the last but one
or two, the average being 5‘24, the total average of confine ments
of these eleven being 6 63 for each patient. Of course these
numbers are small, and my conclusion or inference that the
laceration occurred at a certain labour, and not at a pre¬
ceding or subsequent one, may not have been invariably
correct, but there was usually very good ground for the
conclusion. So far as they go, however, these cases show
that laceration is uncommon at the first labour. The
explanation probably is that although at the first confine¬
ment the os dilates more slowly, it is in a healthy condition,
and it is not so likely to tear as after the parts have lost to
some extent, their power of resistance from inflammatory
action, the result of previous hard labours.

I am, Sirs, your obedient servant,

James Braithwaite, M.D.,

Feb. 22nd, 1887. Obstetric Physician to the Leeds General Infirmary.

THE PREVENTIVE TREATMENT OF SYPHILIS
AND OF HYDROPHOBIA.

To the Editors of The Lancet.

Sibs,—R eferring to the annotation in your issue of the
19th inst., which states that Dr. Andronico claims to have
eradicated the syphilitic virus in four cases by excising the
primary growths, permit me to point out the superiority of
destroying chancres by means of the thermo-cautery as
obviating the risk of reinfection of the system during the
actual performance of the operation. I can now inform
your readers with regard to the case of Mr. A B. C.
(published in The Lancet, July 17th, 1886;, in which I
destroyed a Hunterian chancre on Nov. 11th, 1885, with
Pacquelin’s cautery, and upon the suggestion of Sir William
Jenner, carried out a course of mercurial treatment, that
when I last saw the patient in September, 1886, there had up
till that date been no secondary manifestations of syphilis.

On Oct. 18th, 1886,1 saw a patient in consultation with
Mr. Abbott of Braintree. A typical hard chancre existed on
the left side of the corona penis, and its development had
been noticed to have commenced since Oct. 13th. This was
destroyed with Pacquelin’s cautery, the pert having been
previously painted with a solution of cocaine to mitigate
the pain, as in the case of Mr. A. B. C. A mercurial course
was also suggested, and 1 have no doubt Mr. Abbott will be
happy to report in due time the effect of the treatment.
Here five days had elapsed since the first suspicion of infec¬
tion before the destruction of the chancre, and such a delay
is no bar to attempting the eradication of the virus—not
even if the nearest lymphatic glands be enlarged, since this
enlargement is probably at first of a simple and only later
of a specific character. Owing to the very strong analogy
which exists between the natural histories of syphilis and
hydrophobia, a fortiori to the longer period of latency of
the latter disease, there is ground for recommending that in
all suspected cases of hydrophobia the earliest attempt to
destroy the virus at the seat of inoculation should never be
omitted. Add to these considerations the fact that only
from 5 to 50 per cent, of those bitten by dogs and other
animal?, rabid or otherwise, really receive the vims of
hydrophobia, and the argument in favour of treating these
patients in the first instance by applying the thermo-cautery
thoroughly to the cocainised part becomes insuperable.
The method is simple, and any practitioner in England can
carry it out readily.

I am, Sira, your faithful servant,

Chas. E. Jennings, F.R.C.S. Eng.

Upper Brook-rtreet, Gro«venor-*quare, W., Feb. ISth, 1887.

The Jubilee. —The committee of the proposed
Victoria Hospital at Bournemouth have received promises
of subscriptions amounting to £2800 towards the hospital
which is to be erected in commemoration of the Queen’s
Jubilee. The committee of the existing Cottage Hos¬
pital and Dispensary have £2000 in hand towards the
erection of a building (which has been contemplated
for several years past), and they have agreed to hand
over this sum, together with their interest in the present
building See., to the public committee, in order that there
shall be one large and central institution.—At a meeting
of working men, at Mansfield, on the 16th inst,, resolutions
in favour of the proposed establishment of a hospital to
celebrate the Jubilee were adopted.

aitized by Google

Tot Lancet,] MANCRESTBR.-^EDINBURGH. [Feb. 26,1887. 449

MANCHESTER.

(irons our own Correspondent.)

H08PITAL SUNDAY.

On Sunday, the 13tb, the annual collections were made on
behalf of the hospital funds. A special appeal bad been
issued by the hon. sec. (the Rev. J. Henn), who, through the
medium of the press, gave a brief account of the work
carried on by our various medical charities. He gives some
interesting figures respecting the consumption of alcohol at
the Royal Infirmary, which showed that whilst in 1876 the
cost per patient for alcoholic stimulants averaged be. Ojd.
per head, it had steadily diminished to only Is. 2\<1. per
bead in 18S6. It is too soon to say with certainty what the
amount of the collections will probably be, but the returns,
so far, do not show much increase upon last year, notwith¬
standing that the weather on Sunday was favourable.

CHILDREN'S HOSPITALS.

A mongst the many projects put forward here in the name
of the “ J ubilea Year,” one of the most deserving is perhaps
the suggestion to build a children’s ward to the Ardwick
and Ancoats Hospital. Situate as this is in the midst of a
densely populated district, its usefulness cannot bp gain¬
said, for, notwithstanding the work being done on the
opposite aide of the city by the Pendlebury Children’s
Hospital, there is more than sufficient sickness and acci¬
dent to keep a children’s ward here always full. Some
mention is at present being directed to the fact that
at the Childrens Hospital, Pendlebury, cases of infec¬
tious disease are received, and it is alleged that it is by no
means an unknown thing for children who have been
under treatment in the general wards to have to be trans¬
ferred to the “fever” ward, and it is insinuated that
children admitted for one disease have contracted another
after admission. If this be so, and it has not been denied,
the serious attention of the management should be directed
thereto, for nothing can be more damaging to the reputation
of a hospital than that the idea of the possibility of such a
thing happening should get abroad in the public mind. It
is true that the “fever ward” is isolated so far as a ward
can be isolated that opens out of the main corridor, and it is
known that the late Dr. Borchardt (to whom the hospital
owed very much) had very strong opinions that with due
precaution no harm was to be feared. It is for the autho¬
rities to show from past experience that there is no ground
for alarm, for if otherwise, seeing that we are well provided
with hospital accommodation for infectious diseases else¬
where, the practice of treating fever patients at a general
hospital ought not to be followed.

LIMITATION OF INFECTION.

The Manchester guardians have lately been again urged by
the Government inspector to provide some means of isola¬
tion for doubtful and infectious cases of disease occurring
among the children at their schools at Swinton, but they
appear to be loth to comply with the recommendation.
The ophthalmia which for a long time was so prevalent
there is now very much diminished. It is satisfactory to
note the co-operation of the Poor-law authorities with the
health authority in endeavouring to cope with the spread
of infection in large communities like this. The medical !
officer of health of Salford met the guardians last week, i
recommending certain precautions in dealing with tramps,
&c., with a view to arresting the threatened spread of
small-pox in their district. His suggestions were received
with favour by them. The infant mortality in Salford still
continues alarmingly high from suffocation, the Salford
coroner recently stated that within two months be had held
inquests on the bodies of thirty infants, in all of which
the verdict had been “accidental suffocation.” Probably
a few committals on a charge of manslaughter would tend to
diminish these “ accidents.

SANITATION.

At the annual meeting of the Sanitary Association a good
report was given of the year’s work in endeavouring to
remedy sanitary shortcomings and promoting a spread of
sanitary knowledge among tne people. The balance-sheet
showed an adverse balance of £36, and an appeal is
made to the public for a little more support in aid of the
voluntary work undertaken by the Society. Considering

the smallness of the sum annually at their disposal, much
credit is due to the committee for the results obtained.
Amongst one of the, latest matters to which they have
directed attention is a memorial to tlis corporation urging
the desirability of publishing their health report annually
as in other towns, instead of biennially, as is now the case*
and suggesting that it should contain some more detailed
statement of the work and operations of the Health Com¬
mittee, which hitherto the reports have not contained.
Seeing that at the present time this department of the
corporation is about to undergo a strict inquiry into all ita
operations and various works, the suggestion is a timely one.

The election Of Dr. Morgan, Professor of Medicine at Owens
College, as a member of the Council of the London College of
Physicians, has given much satisfaction here, it being some¬
time since Manchester was represented upon that august body.

Feb. 15th, 1887. _

EDINBURGH.

(JProm our own Correspondent )

ROYAL SOCIETY OF EDINBURGH.

Amongst the papers read at the last meeting of this-
Society was one by Professor Tait upon the effects of dyna¬
mite explosions. In a recent explosion of dynamite on the
London Underground Railway it was noticed that many of
those injured suffered from rupture of one membrans
tympani, the other being unaffected. Professor Tait
explains this by a reference to the physical nature of a
dynamite explosion. At the centre of explosive violence a
state of physical conditions is present different entirely
from that which obtains at a very slight distance from the
centre. The explosion is so instantaneous throughout the
whole of the explosive material, that the projected gases
travel from the centre of explosion at first more rapidly
than the rate of transmission of sound. Light is produced
at the immediate seat of explosion, from tne compression
of atmospheric air by the liberated gases, the air becoming
self-luminous by the instantaneous compression. It is
only at an appreciable distance from the centre of explo¬
sion that the velocity is reduced to that of sound transmis¬
sion ; up to that point there would be an excessively intense
impulsive pressure, which would be likely to produce very
considerable damage. In this respect dynamite differs
totally from gunpowder, in which a much slower combus¬
tion takes place, so that the effects of increased pressure
with graduated speed are produced; whereas in dynamite
the maximum impulse is of instantaneous production.

EDINBURGH MEDICO-CHIBUBGICAL SOCIETY.

The last two sessions have witnessed a considerable
increase of activity in the work of this Society. Under the
able presidency of Professor Grainger Stewart the number
of meetings held and the amount of work produced at them
have been largely augmented, and a number of special interim
meetings have been held for the discussion of special topics.
Last week the Society met at the College of Physicians,
when the subject of Empyema was fully discussed in all its
aspects. The discussion was opened by Dr. William Russell,
who read a paper detailing his own experience in the matter.
He advocated early and complete drainage, with strict anti¬
septic precautions, citing a successful case of his own in a
child of six weeks old, and exhibiting patients to illustrate
his results in other cases. Dr. Caverhill expressed himself in
favourof asystem of expanding thelung by pneumaticexhaus-
tion. Mr. Duncan referred at length to aspiration, drainage,
and removal of a segment of the chest wall as the three
types of surgical interference, each of which had its appro¬
priate uses, the first and the last in relatively few cases, free
drainage, with the removal of a piece < of a single rib,
being the treatment usually most satisfactory. In this
operation he dispenses with the carbolic spray. Dr.
Affieck referred to the value of the hypodermic needle
as a diagnostic agent. He also gave dbme interesting facts
in regard to the treatment of empyema carried on by
Hippocrates and his disciples, showing on how philo¬
sophic a basis, and how near to modern practice, was the
procedure of the Father of Medicine. Dr. James illus¬
trated the action of the pleura in respiration, showing how
morbid processes spread from part to part of the membrane;

EDINBURGH.—DUBLIN.

[Pub. 28,1887.

450 The Lancet,]

Dr. Byrom Bramwell deprecated active exhaustion of the
pleural cavity, as liable to produce further complications by
the bursting outwards of morbid accumulations near the
surface of the lung. Dr. William Hunter spoke of absorption
from serous membranes, showing that a partial removal of
serous effusion is best calculated to result in the absorption
of the remainder and a return to the normal condition. Dr.
Brakenridge, Mr. A. G. Miller, Dr. John Thomson, Mr. Hare,
and Dr. Leith Napier also took part in the discussion. It is
probable that other similar discussions will be arranged for
during the remainder of the session.

THE BCABLET FBVEB EPIDEMIC.

The serious epidemic of scarlet fever that has prevailed
in the west ana north districts of the city for some days
has apparently reached its apogee, and is beginning to wane.
On Monday only fourteen fresh cases were intimated, a
great diminution as oompared with last week, when the
number was between fifty and sixty daily. It is satisfactory
also to learn that there is a corresponding diminution in the
intensity of the disease in the cases now occurring. A great
deal of public interest is evidenced in a discussion now
carried on in the local papers as to the supposed connexion
of the disease with a bovine disorder. It does not appear,
however, that there is any proved connexion in this case
between the epidemic and the milk-supply.

THE STUDENTS’ UNION.

A site has now been purchased for the Union buildings,
adjacent to the new medical buildings of the University, at
a cost of £2000. The building is to be designed by Mr.
Sydney Mitchell, architect, who has done much to beautify
Edinburgh by buildings planned by him. It will cost
£8000. That and the cost of the site take up £10,000 of
the £13,500 in the hands of the acting committee. £1500
are still required to complete the £15,000 necessary to carry
out the whole scheme. The building will contain a hall
seating 500 persons, reading, writing, luncheon, and com¬
mittee rooms, and a well-equipped gymnasium.

Edinburgh, Feb. 22 nd. _

DUBLIN.

(From our own Correspondent.)

THE CONJOINT SCHEME BETWEEN THE TWO COLLEGES.

As was generally expected, the proposed conjoint scheme
between the Royal College of Surgeons and the College of
Physicians has been referred back to those colleges for
reconsideration by a large majority of the General Medical
Council. The exclusion of the Apothecaries’ Hall is mainly
due to the Fellbws of the College of Physicians, who appear
to consider it derogatory to be associated with the Apothe¬
caries’ Hall in any conjoint scheme. To use an expressive
word, the College of Physicians is an “ uppish " corporation,
and by 17 to 4 has recently declined to reopen the question
of the constitution of the jbint examining board. I
recently alluded to the suggestion made by some of the
Council of the 'Royal College of Surgeons that a dual com¬
bination might be formed between that institution and the
College of Physicians on the one hand, and also with the
Apothecaries Hall and the College of Surgeons on the other.
Should the College of Physicians refuse to admit the
Apothecaries’ Hall mto the scheme, they will commit a fatal
error by lowerifag the tone of medioal education in this
country. Besides this, sooner or later the Apothecaries’
Hall will be joined in the scheme with the College of Sur¬
geons, and, should the College of Physicians withdraw, the
latter body will, in my opinion, not have a very long tenure
of existence.

DUBLIN H08MTAL 8UNDAY FUND.

The thirteenth annual meeting of the supporters of this
fund was held last week. The total amount or contributions
for 1886 was £4158 0s. 3d. t being a decrease of £310 5s. 5d.,
as compared with th^ previous year. Last year the Com¬
mittee of Distribution were requested to form a committee
to inquire into the dietaries of the participating hospitals,
and report to the council. This committee now reported
that considerable, differences existed in quantity between
some of the principal items of diet among soine of the
general hospitals. For example, in the Whitworth Hospital
toe dally allowance of bread amounts to 18 oz., and potatoes

20 oz., while at Sir Patrick Dun’s the daily allowance to the
patients is only 12oz. and 4 oz. respectively, a discrepancy
which appears inexplicable. As the committee remark,
these returns point either to waste in the former or short
allowance in the latte? institution.

THE TOXICITY OF SILICON FLUORIDE.

Sir Charles Cameron has recently published some remarks
on the toxicity of this gaseous substance, consequent on
two fatal cases which occurred in Dublin. The manure
factory where these deaths took place is for the manu¬
facture of superphosphates, and the phosphatic material
used contains an unusually large amount of fluoride of
calcium. On treatment with acid, this would evolve very-
large quantities of carbon dioxide and fluorine compounds.
The symptoms in the last case and the condition of the
lungs and heart, as shown by a post-mortem examination,
indicated death by asphyxia. An analysis of a portion of
one of the longs showed that the whole organ contained at
least 075 gramme of silica (SiO,). When silioon fluoride
comes into contact with the moist surface of the respiratory
passages, it deposits thereon gelatinous silica and fluosilicic
acid. The silica being in the colloidal state opposes great
resistance to the passage of gases, and it forms a glaze or
varnish on the walls of the bronchi and their ramifications.
As it is not absorbable into the circulation, it can only be
got rid of by expectoration. Sir Charles Cameron is of
opinion that it probably acts as an irritant to the nerves of
the smaller bronchi, causing their muscles to contract spas¬
modically, thereby diminishing the area of the passages
between the trachea and the air-vesicles. The fluosilicic
acid, being readily soluble, passes into the circulation, and
acts as a nerve poison. It may act directly upon the filaments
of the pneamogastric nerve, and paralyse their action.

THE JACOB TESTIMONIAL.

Up to lost Saturday the total promised or paid towards
this testimonial amounted to £450, and as the subscription
list will close in a few days it is absolutely necessary that
those intending to subscribe should do so without delay. If
the Poor-law medical officers of Ireland have any gratitude,
they most {certainly should contribute towards this testi¬
monial to Dr. Jacob, who for so many years has be¬
friended them in various ways. They may not be in a
position to give large sums, but surely none would miss half
a guinea, or even less, in showing their appreciation of his
services.

ALLEGED AS8AULT ON A LUNATIC BY AN ATTENDANT.

Last week an attendant of the Limerick District Lunatic
Asylum, named Fitzgerald, was prosecuted at the Petty
Sessions for having violently assaulted an inmate named
Cooney on the 27th ult. The latter gave his evidence in a very
coherent manner, and stated that without any provocation
whatever the prisoner had brutally assaulted him by kicking
him in the abdomen. He reported the matter to the resi¬
dent medioal officer the following morning, and identified
Fitzgerald from among several other attendants as hi$
assailant. Dr. Gelston, the visiting physician, deposed to
'thein j urita inflicted on the lunatic, and the case was returned
for trial to the assizes, bail being accepted.

SINGULAR CASE OF SUICIDE.

. A man named Martin Doyle, aged thirty-three, committed
suicide last week in Dublin while apparently labouring
under mental derangement. The deceased lived -with hii
brother, and on the latter coming home after work he found
Martin lying on his bed bleeding profusely from a number
of self-inflicted wounds. He was removed to hospital,
where he died two hours afterwards from haemorrhage. The
number of wounds on his body was very considerable, oved
twenty being on the head alone, while above the heart were
two deep gashes, which penetrated to the lungs; the bracbiij
artery also was cut across. The instruments of destruction
which the unfortunate man used consisted of some common
2 in. nails and pieces of window-glass. Pins -were alsd
found sticking in various parts of the body of tbe deceased;
The deceased was of a morose temperament, and, it is stated,
about two years ago suffered from some head affection.

Zymotic diseases in Dublin during 1886.

The deaths from zymotic diseases numbered 1100, being
217 under the number for tbe preceding year, and 442 undtSf
tbe average for the ten years 1876-85. Measles only caused
9 deaths, against 296 in the previous year; scarlatina l£l
deaths, showing a trifling increase; whooping-cough, 246, <d

The Lancet,]

BELFA8T.—MONTREAL.

[Fkb. 26,1887. 451 .

68 in excess. There were also 23 deaths from cerebro-spinal
fever. The mortality from fever was much below the
average, the deaths numbering 193, or 108 below the average
for the past ten years. It is satisfactory to note that there
has been a great decrease in the number of cases of typhus
treated in the Dublin hospitals during the past few years;
thus, in the year 1883 the cases admitted numbered 829; in
1884 the number was 469; in 1886 they fell to 247 ; and last
year there was a further decline to 123.

Robert Browne, F.R.C.S.I., of Largo House, Rathmines, has
been placed on the Commission of the Peace for co. Dublin.

Dr. Falkiner has been appointed Physician to the Whit¬
worth Hospital. There is no salary attached to the post.

Dublin, Feb. 32nd. _

BELFAST.

(-From our own Correspondent.)

THE ULSTER HOSPITAL FOR WOMEN AND CHILDREN.

From the report read at the annual meeting of this
charity, 1 learn that a large cheerful women’s ward has been
added to the hospital, and a new dispensary and waiting-
room; and further, the whole house has been cleaned and
painted. The number of students attending has been larger
than in any former year. There have been some changes in
the medical staff, owing to the death of Dr. Malcomsou and
the resignation of Dr. Poole, and Dr. Barron and Dr. Straf¬
ford Smith have been appointed in their place. The
President of Queen’s College, who was present at the meet¬
ing, referred in terms of the highest praise to the late
Dr.Malcom8on. He said that he was now greatly pleased to
know that the hospital had as many beds as would satisfy
even the exacting Senate of the Royal University. He
regretted to have to make that statement concerning the
Royal University, but one could never tell what changes
might be effected in the demands of that university in the
curriculum laid down for students. Financially the hospital
is in a good condition, there being a balance in hand of over
£44. Lady Johnston has given £260 in aid of the expenses
incurred in the alterations in the hospital.

THE MEDICAL STUDENTS’ ASSOCIATION.

A conversazione, under the patronage of the President and
Professors of Queen’s College and the medical staff, will be
held in the Queen’s College on Thursday, March 10th. The
students and their friends are exerting all their efforts to
make the entertainment a success. It will be held in the
same rooms as those in whioh the brilliant conversazione
took place at the meeting of the British Medical Association.

THE ULSTER MEDICAL SOCIETY.

The annual dinner of this Society was recently held in
the Royal Avenue Hotel. The President (Dr. Whitla)
occupied the chair. Upwards of forty members of the
medical profession were present, and the evening was
a decided success. The Society is in a very flourishing
condition, and the plan adopted this year of taking up
special subjects at the meetings has tended to increase the
attendance and interest of the members. Already we have
had a sanitary night, and at the last meeting the treatment
of phthisis formed the subject. Very good papers were read
by Dr. Cuming, Dr. Lindsay, and Dr. Sinclair, the discussion
being adjourned until the next meeting.

BeUut, Feb. 15th.

MONTREAL.

(From a Correspondent.)

Matters medical remain very quiet in this part of the
country. Before Christmas both medical schools— McGill
and Bishop’s—held their annual undergraduates’ dinners,
which were well attended by present students, with a fair
proportion of graduates. These annual dinners, which were
evolved from the old “footing dinner” some three or,four
years ago, may be taken as evidence of the change which
has come over the medical student during the past decade.
Whereas the “footing dinner" was simply nothing but
dnmken revelry, the present annual dinner is a gathering
of gentlemen* ' j

The Faculty of Arts students at McGill, who have long
worn the gown in and about the College, have recently
decided to wear the trencher also. The science students have
likewise decided in favour of the trencher.

A very unusual case recently presented itself at the
Montreal General Hospital—viz., a case of true scurvy ia a
farm labourer from the eastern townships. Although work¬
ing on a farm, the man’s diet for the past twelve months
had consisted of bread-and-butter, milk, tea, and sugar exclu¬
sively ; no vegetables except potatoes, and no meat, either
salt or fresh. Although put upon suitable diet and given
appropriate treatment, the patient died on the fifth day
after admission. At the necropsy haemorrhagic infarcts
were found to be present in both lungs, and a large blood
clot in the light temporo-sphenoidal lobe of the brain.
Although scurvy is not a rare disease in this country, being
frequently seen among navvies, especially amoug the
Italians, it is rare to meet with a case coming from the
part of the country where this patient worked, and in the
class to which he belonged.

The proposed amendments to the Medical Act in this
province are not meeting with the unanimous approval of
the profession.

The addition of philosophy, intellectual and moral, to the
list of subjects to be passed at the preliminary examination,
was secured by the French representatives on the Council
of the College of Physicians and Surgeons ; and as
philosophy is taught in most French schools and colleges,
while it is not in English schools (I refer, of course,
to schools in the province of Quebec), the result will bo
that an English student going into medicine will have to
secure the services of a private tutor to prepare him for the
preliminary examination. The general feeling seems to be
that the matriculation or preliminary examinations were
already as stringent as there wa9 any necessity for, while
the final or professional examinations could with advantage
be rendered more severe.

It is announced, and the announcement gives a great deal
of satisfaction, that the Governor-General and Lady Lans-
downe will spend a considerable part of this winter in Mon¬
treal. Although the commercial metropolis of the Dominion,
Montreal has hitherto 6een very little of our eeveral vice¬
regal governors, and the approaching visit of the Marquis of
Lansdowne is taken as a happy angury for the future.

The recent death of Dr. J. M. Drake has deprived the
community of a successful practitioner and the medical
faculty of McGill College of an earnest coadjutor. Dr. Drake
came to this country from London, Eng., thirty years ago,
and after obtaining his medical education at McGill College,
became house-surgeon to the Montreal General Hospital,
and subsequently Professor of Physiology in McGill College,
which post he held till succeeded by I)r. Osier some years
ago. Although his career has terminated at the early age
of fifty-nine, he bad a large practice nntil the death of bis
wife, which occurred a few years ago, and which was such
a blow to him that he gave up active work and retired to
his country residence at Abbotsford, where he ended his
days, regretted by all who knew him.

it is expected that at the next meeting of the governors
of the Montreal General Hospital to be held in February, the
plans for the new and much-needed hospital buildings
will be submitted, and the work probably commenced next
spring. The Civic Small-pox Hospital is nearly completed,
and will be ready for use about April next should there be
occasion for it. At present the city is free from small-pox,
though typhoid fever and diphtheria are rather prevalent.

The annual flooding of the lower-lying parts of the town
(caused by the blocking of the river below the city by the
ice-bridge), with the sickness and pecuniary loss attendant,
has again occurred, and though efforts are made to keep the
sewers empty by means of pumps, they are only partially
successful, and one may look for sickness due to this cause
until the Dominion Government takes it in hand.

Montreal, Jon. 12 th.

Royal College of Surgeons of England.—P ro¬
fessor Anthony Alfred Bowlby, F.R.C.S. Eng., will deliver a
course of three lectures on “ Injuries of Nerves, their Patho¬
logy, Symptoms, and Treatment,” on Wednesday, Friday,
and Monday, March 2nd, 4th, and 7th. Students are admitted
to these lectures on the introduction of a Fellow or Mem¬
ber of the College., The lectures -mil commence at 4 o’cock
each day.

Digitized by G00gle

452 The Laxckt,]

OBITUARY.—MEDICAL NEWS.

[Feu. 26,1837.

MEDICAL NOTES IN PARLIAMENT.

Lunacy Acts Amendment Bill.

On the 21st inet. the House of Lords went into Com*
mittee on this Bill. In Clause 3 Lord Grimthorpe proposed
an amendment to modify the preliminaries prescribed in the
clause as necessary to be carried out before the friends of
a lunatic could obtain a magisterial order for placing him
under restraint. Lord Selborne was of opinion that the pre¬
liminaries would cause such delay as either to lead to lunatics
being left at large until their lunacy was no longer curable,
or to drive tbe friends of lunatics to resort in all cases io
urgency orders for placing tbe lunatics under restraint.
Lord Herschell was of the same opinion. The Lord Chan¬
cellor, admitting the force of the objections to the clause,
promised to modify its machinery if its principle—the
right of every alleged lunatic to have a judicial examination
of his case before his liberty was taken away—were
agreed to by their lordships. The amendment was ultimately
withdrawn, and tbe clause was postponed. The remaining
clauses were agreed to, with some slight alterations, and the
Bill passed through Committee.

The Sanitary Registration of Buildings.

In the House of Commons on the 21st inst., a Bill brought
in by Mr. Lacaita, to provide for the sanitary registration of
buildings, was read a first time.

The Vaccination Act.

Mr. Picton gave notice of his intention to move, on the
21st prox., a resolution in favour of the repeal of the com¬
pulsory clauses of the Vaccination Act.

THOMAS FRASER, M.A., M.B., C.M. Ed.

With regret we have to announce the untimely death of
this young and promising physician, at the early age of
twenty-six. Recent graduates of the Edinburgh School will
remember his genial manner and the conscientious thorough¬
ness of his work as a resident physician in the Royal
Infirmary, and latterly as assistant to Profeasor Chiene. He
left Edinburgh for a voyage in the East twelve months ago
on account of failing health, but returned to Scotland
recently and obtained the appointment of assistant-physician
at the Crichton Institute, Dumfries. There his sudden death,
which took place on the 15th inst. from diabetic coma, has
occasioned deep regret; and it is pleasant to learn that bis
friends in and around Dumfries have decided to raise a
memorial stone that may keep fresh the memory of his
bright and useful life in that town. The remains were
removed to Edinburgh, where the final tribute of affection and
respect was paid by his sorrowing friends on Saturday last.

Hle&iad ftebs.

Society of Apothecaries.—T he following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on the 17th inst.

Bindley, Robert Alfred, M.R.C.S., Highbury-hill.

Dane, Robert, Flnchley-road, Hampetead.

Danaan, William, M.D. Toronto, Horwood-aveime, Toronto.

Jamieson, Archibald, M.D. Kingston, Ontario, Spark-street,
Ontario, Canada.

Owen, John Vaughan, M.R.C.S., Machynlleth.

Ozzard, Alberht Trornon. M.R.O.8., Southeea.

Wolfe, Robert Inglewood, Ardsley, near Wake&eld.

The annual meeting of subscribers to the Maccles¬
field Infirmary was held on the 17th inst. In the report the
financial condition of the charity was described as
satisfactory.

London Hospital.—T he annual dinner of the
students of the London Hospital is, we learn, to take place
on Tuesday next, at 7.30 P.M., at the London Tavern. Tickets
can be obtained from C. L. S. James or L. Wainwright, the
hon. secs, to the Dinner Committee.

H.R.H. the Duke of Cambridge has consented to
preside at a festival on May 6th to commemorate the
twentieth anniversary of the Victoria Hospital for Children.

The annual banquet of the Newcastle-on-Tyne
Clinical Society was held on the 17th inst., Dr. Oliver, the
president, in the chair.

Dr. Ct. A. Mayer of Binghampton, New York,
while setting a fractured arm, suddenly paused while pulling
vigorously at the injured member and fell back deatk
Apoplexy is believed to have been the cause of hie
death.

The twenty-third annual collections in aid of the-
funds of the Sunderland Infirmary were made in the various
places of worship in that town on the 20th inst.

Vaccination Grant.— Samuel Evans, L R.C.P.
(Lond.) M.R.C.S., &c., of Harwich, Essex, has obtained a
Government grant for the efficient performance of public
vaccination in the first and second districts of the Tendring
Union.

The first annual ball in aid of the funds of tbe
Nottingham Samaritan Hospital for Women was held on
tbe 17th inst., and, being largely attended, proved a decided
success.

An inquiry was opened on the 23rd inst. by Mr.
S. J. Smith, Local Government Board inspector at West.
Cowes, relative to an application from the Local Board of
Health to borrow £18,021 for sewerage works and £700 for
increasing the water-supply. The inquiry was ultimately
adjourned to the 19th prox.

The third annual general meeting of the subscribers
to the Blackheath and Charlton Cottage Hospital was held
on the 5th inst., when satisfactory financial and general
reports were presented and adopted.

The English Conjoint Board.—O n and after
Monday, March 14th text, all applications relating to the
diplomas of the Royal College of Physicians of London and
the Royal College of Surgeons of England, under the old
regulations, as well as under those of the Examining Board,
must be addressed to Mr. Frederic G. Hallett, Examination,
Hall, Victoria Embankment, London, W.C.

At a meeting of the Court of Governors of the
University College of South Wales and Monmouthshire,
Cardiff, on the 16th inst, a further appeal to the treasury
for funds for the establishment of schools of medicine and
engineering was advocated.

Exeter Dispensary.—T he annual meeting of the
supporters of this institution, which was founded in 1818,
was held on the 12th inst. The report stated that 5513
persons were treated during last year, as against 5206 during
1885. Since the opening of the institution 202,456 patients
have been treated. The treasurer’s account showed that
there was a balance in the bank of £391.

Sussex County Hospital.—T he annual general
Court of Governors of this institution was held on the
16th inst., when it was reported that during the past year
the number of in-patients had been 171; of out-patients,
6143; and of casuals, 1553. The receipts during the year,
including legacies, were £9943, as against £12,019 in 1885.
The expenditure was £10,426, as against £10,790. It was
resolved that a new mortuary be erected, at a cost not
exceeding £500.

Greenock Infirmary.—A t the annual meeting in
connexion with this institution, on the 17tb inst., it was
reported that the ordinary income for the past year was
£4082, as against £4297 in the previous twelve months.
The ordinary expenditure amounted to £4944, as against
£4719. The total number of patients admitted to the
infirmary during the year was 868, as against 879. Earnest
appeals for increased support were made.

Pirils of Rural Practice. — A French rural

[ nractitioner, Dr. Pierre Seguin, driving home one evening
ately, was thrown out of the carriage and killed instan¬
taneously by tbe shying of his bone. In tbe address of
condolence drawn up by the Association of Medioal Prac¬
titioners in the Gironde, attention is called to the dangers
to which country doctors are exposed, just as sailors who
have to brave the perils of the ocean.

Digitized by GoOgIc

The Lancet,] APPOINTMENTS.—VACANCIES —BIRTHS, MARRIAGES, AND DEATH8. [Feb. 26,1887. 453

Owing to the recent prosecutions of tradespeople for
selling pepper adulterated with pepperette it is announced
that the manufacture of this substance at Leghorn has been
discontinued, and that its importation in England has ceased.

At the recent annual meeting of the governors of
the Blackburn and East Lancashire Infirmary it was decided
not to alter the rule which prohibits the election of a junior
house-surgeon to the institution.

The Anthrax Epidemic. — Mr. Whisken, the
■veterinary surgeon who made the post-mortem examination
of the diseased cattle at Chignal, lies in a dangerous con¬
dition in Chelmsford Hospital. Two butchers also are
reported to be suffering, and the horse which drew the
carcases has died.

University College Hospital.—L ady Jessel has
recently paid into the bankers of this hospital a donation of
X‘2000 'for the permanent endowment of a bed in the
institution to be called the “George Jessel” bed. The
Eight Hon. G. J. Goschen, M.P., has consented to preside at
the festival dinner in aid of the funds of the charity to be
held on April 27tb.

The British Medical Temperance Association.—
This Association held a meeting in the rooms of the Medical
Society of London on the 18th inst. Dr. Walter Pearce,
B.Sc., read a paper on the Absolute and Differential
Diagnosis of Alcoholic Paralysis. In the discussion which
followed. Dr. Bich&rdaon called attention to the fact that
in past times cases of alcoholic paralysis had often been
regarded as lead poisoning. He considered that the change
which took place in the nervous system, as the cause of the
symptoms must be of the nature of pectous change of
tne fluid nerve substance or of the membranous expanses
leading to imperfect dialysis. Dr. Norman Kerr then called
attention to the very great decrease of the amount of
alcohol consumed in workhouses. He considered that there
was still room for a greeter reduction. In the discussion
which followed Drs. Hall, Drysdale, Gray, Ridge, and other*
took part. _

i,p]}<riutnmits.

Successful applicants far Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 5 o'clock on the Thun lay morning of each week for publication in
the next number. _

Bolton, B. C. B., U.B., B.Oh.Dub., ho* been appointed Medical Offlccr
for the Sixth District of the Lincoln Union.

Coombk, Robert G., hue been appointed Medical Offloer for the South-
minster District of the Maldon Union.

Empson, John. L.K.Q.C.P.I.. L.R.C.S.I., has been appointed

Medical Officer for the Milborne Port District of the Wincanton
Union.

Pox. B. L., M.A.. M.B., B C.Cantab., M.R.C.S.. has been appointed
Assistant House-Surgeon to the Liverpool Children's Infirmary.

Orenfbll, Henry Osborne, M.R.O.S.,L.R.O.P.Lond., L.S.A., has been
appointed Assistant Medical Officer to the Wandsworth Union
Infirmary, vice H. T. Corbouid, resigned.

Hordes, Thomas G. P. R., L.F.P.S.GIas.. L.S.A.. has been appointed
Medical Officer for the Sutton Coldfield District of the Aston
Union.

Hownsbll. P. C. W., C.M. Cantab., M.R.C.S., L.S.A.. has been
appointed Resident Clinical Assistant to St. Marylebone Infirmary,
Notting-hill. W.

Larder, Herbert, M.R.C.S., L.S.A.. has been appointed Medical
Officer for the Infirmary and the Workhouse of the Whitechapel
Union.

Lock. John G., M.R.C.S.. L.R.C.P.Bd., has been appointed Medical
Officer for the Third District of the Pembroke Union.

Pearce, John P.. M B.C.S., L.8.A.. has been appointed Medical Officer
for the 8econd Division of the Third District of the Newbaven
Union.

■Robertson, Robert, M.D.Bd., L.R.C.S.. has been appointed Visiting
Medical Officer to the Netherfield-road Hospital for Infectious
Diseases. Liverpool.

Sters, W. Henry, M.D., M.R.C.P.Lond., has been appointed Assistant
Physician and Registrar to the Hospital for Bpilepsy and Paralysis.
Regent,'*-park.

Tatlor, Alfred Ernest. M.R.C.S.. has been appointed House-
Surgeon to the Bast Suffolk and Ipswich Hospital, vice Hitching,
resigned.

Taox, G., M.B.C.S., L.8.A., has been elected a Surgeon to the Royal
Albert Hospital, Devonport.

Tyrrell, Bdward Muxro. M.B.Bdin.. has been appointed Assistant
Medical Officer to the Counties Asylum, Carlisle, vice T. D. Green-
lees. M.B., resigned.

T arrow, G. R„ M.D., L.R.G.P.Lond.. Ac., has been elected Snrgeon-
Accoucheur to the City of London Lylng-'.n Hospital, vice P. L.
fiorchell, M.B., resigned.

iUanutcics.

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particular* of ths various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. _

Ashton-under-Lyne District Infirmary. — House-Surgeon. 8alary
£i0, with board and residence.

Birmingham and Midland Bye Hospital. — House-Surgeon.
Salary £100 per annum, with apartments, board, and attend-
ancc.

Boscn.MiiE Provident InfirmarT, Bournemouth.—Resident Medical
Officer. Salary £80 per annum, with board, lodging, fio.

Chelsea Hospital for Women, Fulham-road, S.W. — Resident
MHIcal Officer. Salary £80 per annum, with board and residence.

Citt of London Hospital roH Diseases of the Chest, Vtctoria-
park. B.—Pathologist.

General Hospital, Nottingham.—Junior Resident Medical Officer.
Salary £100 for first year, with an addition of £10 a year up to £120,
with board, residence, imd washing.

Glamorganshire and Monmouth Infirmary and Dispensary.
Cardiff.—Ophthalmic Surgeon.

Hospital for Women, Soho-square, W.—Clinical Assistants. Fee for
course of three months, £5 5s.

Infirmary for Consumption, Margaret-street. Cavendish-square, W.—
A Physlcian-in-Ordlnary; three Visiting Physicians; and a
Surgeon. _ _

National Hospital for the Paralysed and Epileptic, Queen-

square, Bloomsbury.—Laryngologist.

North-West London Hospital, Kentlsh-town-road. — Assistant
Physician.

Owens College, Manchester.—Senior Demonstrator In Physiology.
Stipend £150 per annum. „ , _ .

Paddington Workhouse Infirmary. — Assistant Medical Superin¬
tendent and Dispenser. Salary £100 per annum, with board, lodging,
and washing.

University of Glasgow.—E xaminers in Medicine.

West Herts Infirmary, Hemei Hempstead. — House-Surgeon and
Diipenser; to a'so act as Assistant Secretary. Salary £100 per
annum, with board, fumlsbea rooms, fire, lights, and attend-

|5irt{js, Carriages, anil $M{is.

BIRTHS.

Elliott.—O n the 17th Inst., at Monson-place, Tunbridge Wells, the
wife of Thomas Blltott. M.D., of a son.

Gardner.—O n the 19th inst., at Clifton, the widow of Bdward Barton
Gardner, Surgeon-Major, I.M.8., lat* Civil 8urgeon, Bareilly.
N.W.P., of a daughter.

MaoCombie.—O n the 17th Inst., at the South-Eastern Hospital, New
Cross, the wife of John MacComble. M.D., of a daughter.

Plktts.- On the 19th inst., at Wyndham House, Byde, Isle of Wight,
the wife of J. Menham Pletts, M.D., of a daughter.

Smith.—O n the 15th inst., at The Acacias, Upper Clapton, the wife of
Gerard Smith, M.R.O.8., of a son.

Yko.—O n the 18th Inst., at 8taines. tie wife of Gerard P. Yeo, M.D.
(prematurely), of twin boys, one stii.born.

MARRIAGES.

Hadawat— Mooblry.—O n the 22nd Inst., at St. James's, Westgate-on-
Sea, bv the Rev. Geo. Collls, Vicar, Dr. James Hadawmy, of Dent-de-
Llou Villa, Westgate-on-Sea, to Eliza, widow of the late O. Moorley.
No cards.

James—Driffield.— On the 17th inst., at the Parish Church, Prescot,
David James, M.D.Bd., to Letitia Kemball, youngest daughter of
the late Walter Wren Driffield, Solicitor, of Liverpool and
Prescot.

Myles—Whitson— On the 33rd Inst., at 15. York-place, Edinburgh,
by the Rev. Armstrong Black, of Edinburgh, assisted by the Rev.
John Kemp Bruce, of Peterhead, brother-in-law of the bride,
Thomas Patrick Myles, of Brechin. N.B., M.B., C.M.Bdln., to
Buphemla Grace, youngest daughter of the late Jas. Whitson, Esq.,
of lila-park, Coupar Angus, N.B. At home March 3rd. No

Walker—Browne.— On the 17th inst., at St. Luke's. Shire Oaks, by
the Rev. H. T. 81odden. Vicar of Worksop, Hunter Urquhart
Walker, L.M.. L.R.C.P.Bd., L.R.O.S.Hd., eldest son of the Rev.
Alexander Walker, of Rescobie, Forfar, N.B., late Senior Chaplain on
H.M.'s Indian Establishment, to Ethel Mary, eldest daughter of
the Rev. G. Osborne Browne, Vicar, of 8hlre Oaks.

DEATH8.

Forsyth. —On the 18th inst., at 12, Park-place, Maze-hill, Greenwich.

Katherine, wife of Alexander Forsyth, M.D.

Hackney.— On the 19th inst., at Twickenham, John Hackney, M.R.C.8.,

Lindsay^—O n^tbe^jlst inst., at Mlckleover, Derby, J. Wallace Lindsay,
eldest son of J. Murray Lindsay, M.D., aged 33.

Mocklbb. — On the 17th inst., at Oxford-terrace, Hyde-park,
Bdward Mockler, formerly Surgeon, Queen's Bays and 17th Lancer*.

Ritchie.— On the 15th inst., suddenly, at Liverpool, William Barry
Ritchie, M.D., J.P., of Belfast, in his 71st year.

fee of Si. ie charged for the Insertion of Notices of Birth*.
Marriage*, and Deathi.

Digitized by Google

454 The Lancet,]

N0TE8, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

. [Feb. 26,1887.

Uteirital |!iarg for % Ensuing Week.

Monday, February 28.

Hotal London Ophthalmic Hospital Moorfceldb. — Operation*,
10.80 A.M., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.— Operations, 1.30 p.m.,
and each day at the same hour.

Chelsea Hospital for Women.— Operations, 2.30 p.m ; Thursday. 2.30.
Hospital for Women, 8oho-squark. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Botal Orthopedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 2 p.m., and
each day In the week at the same hour.

Soctett of Arts.—8 p.m. Mr. W. Y. Dent: Building Materials (Cantor
Lecture).

Medical Society of London. —8.30 p.m. Clinical Evening. Dr.
Bobinson: Excision of Hip in Adult.—Mr. Lennox Browne: (l)Oate
of Bxolslon of half the Larynx ; (2) Faucial and Pharyngeal Tubercu¬
losis.—Mr. Pick: Displacement of Head of Femur after Fever.—Mr.
Bourne: Ichthyosis Hystrix.—Mr. Black : Trephining for Supposed
Abecees of Brain. March j

Guy's Hospital.— Operations. 1.30p.m. and on Friday at the same hour-
Ophtbalmio Operations on Monday at 1.30 and Thursday at 2 p.m-
St. Thomas’s Hospital.— Ophthalmio Operations, 4 p.m. ; Friday, 2 p.m-
Cancer Hospital, Brompton.— Operations, 2.30p.m.; Saturday, 2.30p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital —Operations, 2.30 p.m.

St. Mart’s Hospital.— Operations, 1.30 p.m. Consultations, Monday,

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.m.
Botal Institution of Great Britain.— 3 p.m. Prof. Arthur Gamgee i

The Function of Besplratlon.

Society of Arts.— 8 p.m. Mr. Edward Cunliffe-Owen: The Colonial
and Indian Exhibition.

Botal Medical and Chirurgical Soctett. — 8.30 p.m. Annual
Meeting. Address by the President. Election of Officers and Council.

Wednesday, March .

Middlesex Hospital.— Operations, 1 p.m.

St. Bartholomew's Hospital —Operations, 1.30 p.m.; Saturday, same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgical Consultations, Thursday, 1.30 P.M.

St. Thomas's Hospital.— Operations, 1.30 p.m.; Saturday, same hour.
London Hospital.— Operations, 2 p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital.— Operations, 2 p.m.

Samaritan Free Hospital for Women axd Children.—O perations,

2.30 P.M.

University College Hospital,— Operations. 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 p.m. ; Saturday, 9.15 a.m.

Botal Free Hospital.—O perations, 2 p.m.. and on Saturday.

King’s College Hospitai— Operations, 3 to 4 p.m. ; Friday, 2 p.m. ;
Saturday. 1 p.m.

Children's Hospital, Great Ormond-street. — Operations, 9 a.m. j
Saturday, same hour.

Obstetrical Society of London.—8 p.m. Specimens will be shown.
Inaugural Address by the President (Dr. John Williams). Adjourned
Discussion on Dr, Gibbons’ paper on Unilateral Gaiaotorrboea.—Dr.
Champneys: On the Separation of the Placenta.

Society of Arts. — 8 p.m. Mr. H. J. Beale : The Cultivation of Tobacoo
In England. Thnrfday, March 3.

St. George’s Hospital.—O perations, 1 p.m. Ophthalmic Operations,
Friday, 1.30 p.m.

Charino-cross Hospital.— Operations, 2 p.m.

North-West London Hospital.—O perations, 2.30 p.m.

Pathological 8ociett or London.—8.30p.m. Mr. Godlee: Adeno-
sarcoma of Tongue with Calcifying Nodule in Ceutre.—Mr. G. E.
Turner: Alveolar Sarcoma growing from the Lumbar Spine.—Dr. N.
Moore: Malarial Diseases of Liver and 8pleen.—Mr. Lawson Taiti
On the Pathology of Extra-uterine Pregnancy.—Mr. Barweli: Cirsoid
Aneurysm of the wholeof Left Upper Extremity.—Dr. Price: Chole¬
steatoma at Base of Brain.—Mr. Fenwick : Metastatic Carcinoma of
Prostate.—Mr. A. Doran : Fibroma of the Ovarian Ligament. Card
Specimens:—Mr. Gould: (1) Portion of Cervical Vertebra; ex¬
pectorated from a case of Hetro-pbaiyuger.l Abscess; (2) Old Excision
of Knee-joint.—Mr. D’Arcy Power: A lihlnolith.—Mr. Shattock:
Colles' Fracture with Forward Displacement of Lower Fragment.—
Mr. A. Doran : Hornv Growth from the Neck.

Botal Inotitution op Great Britain.—3 p.m. Mr. Bdmund Gosse :
The Critics of the Age of Anne.

Harvkian Society of London. — 8.30 p.m. Mr. Mitchell Banks
(Liverpool) t Extirpation of the Axillary Glands a Necessary Accom-

S niment of Removal of the Breast for Cancer.—Dr. W. If. Day
ibitual Constipation in Children, and the Methods of Treatment 1

Friday, March 4

Botal 8outh London Ophthalmic Hospital.— Operations. 2 p.m.
Society of Arts.—8 p.m. Major-General Sir F. J. Goldsmld: Our
Trade Routes to the East.

West London Mkdico-Chiruhgical Society.—8 p.m. Card SpecL
mens-.—Mr. H. Percy Dunn: (J) An Aneurysm of the Thoracic-
extending Into the Abdominal—Aorta ; (2) Epithelioma of the
CEsophagus.—Dr. P. S. Abraham : Microscopical Sections of the
Cervical Cord and Sympathetic Ganglia in a case of Exophthalmic
Goitre. Living Specimens:—Dr. Scanes Spicer: A series of cases of
Diseases rtf the Naso-pharynx. Papers : —Dr. J. B. Ball:' Nocturnal
Incontinence of Urine.—Mr. R.Fitzroy Benham: Impacted Urethral
Calculus, Perineal Section. Recovery.

Botal Institution of Great Britain.— 9 p.m. Mr. Victor Horsley:
Brain Surgery in the Stone Ages.

Saturday, March 5.

Middlesex Hospital.—O perations, 2 p.m.

Botal Institution of Great Britain.—8 p.m. The Right Hon.
Lord Rayleigh: On Sound.

METEOROLOGICAL READINGS.

(Taken daily at 8.S0 a.m. by Steward't Instruments )

The Lancet Office. February 24th, 1887.

30 05 S.W. 37 87

30 22 N.B. 41 39

3023 N.W. 42 40

30 04 N.B. 43 41

30-15 W. 35 35

30-18 W. 48 47

80-13 W. 47 46

46 24 -07 Raining
45 37 12 Cloudy

45 38

48 40

49 34

62 36

I

Overcast

Overeat*

Foggy

Cloudy

Cloudy

ftotes, JSIrort Comments, # §mstes to
Corresptknts.

It is especially requested that early intelligence of loetd events
having a medical interest, or which it. is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors."

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed u to the
Publisher.”

We cannot undertake to return MSS. not used.

The Cold Affusion nr Headache.

W. F. P .—Sir Robert Christison, in his “ Autobiography,’’ bears emphatic
witness to the efficacy of this treatment, oltlng in particular the ease
of his own mother, who suffered from headache of a peculiarly per¬
sistent character, and who cured herself effectually by the cold douche.
It was the favourite remedy of the Romans, as may be Inferred from
more than one passage in the judicious compilation of Celsus: “ Caplti
nihil aequo prodest atque aqua frigida ” (Nothing is so beneficial to the
head as cold water), Lib. i., o. 4. Again (Lib. 1., C. 5), when touching
on the various inflammatory affections of the head and its cavities.die
says: " Usus aquae frigidae prodest 11s etlam quosassidoe lippitudlnes
gravedo, destillatlones, tonslllaque male habent ’’ (The cold affusion is
of benefit to those also who suffer from chronic ophthalmia, from cold
in the head, from catarrh, and from inflamed tonsils). Again, the
lassitude and headache Induced by the scirooco (auster), to which the
British resident on the Mediterranean is so subject, and which no
amount of acclimatisation seems to lessen, has its appropriate remedy
In cold water: “ Praecipue omnibus eo anxllis u tend urn eat ubi gravios
caelum austri reddlderunt ” (This remedy Is of especial advantage to
all when tho atmosphere has become heavy by the acirooco). Lib. 1., c. 5.

U. O. H.— We do not think that the medical officer of health should
make inquiries In all cases through the medical attendant. Such
limitation would make his work Impossible, If always enforced ; but
undoubtedly he would be more likely to aooomplish bis object if he
were to adopt a conciliatory conduct both towards the patient and the
medical attendant.

Stand Nurs.—Be true to your synonym, and assume that everyone knows
that yon are nob the discredited practitioner.

W.McC.—l. Yes.—2. No.—3. They are bound to provide an applicant
with some sort of accommodation.

SIR JAMES HANNBN’S COURT AND THE NEWSPAPER PHBSS.

To the Editors of The Lancet.

Sirs,—M ay I venture to suggest that the members of the medical
profession memorialise the Lord Chancellor, or whoever may be the
proper authority, to adopt measures whereby the wives and daughters
of all decent citizens may be able to read the newspapers without having
presented such shameful evidence as has recently outraged public decency
by being reported at some length and in some detail In the columns of
our dally and other journals.

I am, Sirs, your obedient servant.

Grove-road, N.W., Feb. 22nd, 1887. Norman Kerb, M.D.

itized by G00gle

Tim Laitcbt,]

NOnB, COMMENTS, AND ANSWEfifiT TO CORRESPONDENTS.

[Fbb. 26,1887. 455

A Oohdul Olduti for Anglo-Indians.

In reply to a query Inserted in our last number on the above subject,
“A Brigade-Surgeon write*: — “ I will venture the statement that
“ J." will not have much to complain of on tho score of the cold of
Bullish winter*. I have myself been twenty years in India, and have
now been home several winters; but I have seldom to put on a great
coat, and am almost surprised to hear so many complain of the oold.
Further, I feel the heat of a hot summer’s day a great deal more than I
did before I went to India, and more than a native of these isles
who baa never been in the tropios. My own theory is that the malaria
which anoomnlatee in a person in India and remains in his system
render* him Insensitive to oold and very sensitive to heat ."—"An Old
Indian ” recommends Southport, Lancashire, as a spot possessing a
mild and equable temperature, and where living is cheap. Another
correspondent, who has spent three winters at Tenby, Pembrokeshire,
thinks “that Is just the place for people who have lived In India.”
A fourth recommends Flushing on the shore of Falmouth harbour. A
fifth writer speaks of Bournemouth as possessing ati the qualities
likely to meet the wants of an Anglo-Indian. A sixth has no doubt of
the superior advantages of Bonchurob, Isle of Wight, for the same
purposes Whilst a seventh correspondent give* glowing aooouut* of the
climate of Queenstown.

n. X. (Colchester).—The “ Acque Catulllane.” They were discovered in
1794 by the well-known naturalist, Giovanni Catullo, on the Monte
OvBlina, in the Venetian territory. On analysis they were found to
be ferro-areenical, and are in high repute among Italian physicians for
tbelr tonic and alterative virtues. Italy abounds in such mineral
resources; but, unlike France, Germany, Austria, and Switzerland,
the has hitherto been lacking in the enterprise which establishes well-
appointed hotels in their neighbourhood under oompetent medical
mrrelllaaoe.

Or. C. BeU Taylor (Nottingham).—Yes, in as early a number as possible.

DAMP BBDS.

To the Editors of The Lancet.

Sres,—Your note on this grievance, and the desire for a remedy on the
pirtof your correspondent, “Traveller," reminds me of an anecdote I
heard come time since of a commercial nomad, who, having retired to
rest, became unpleasantly conscious that his bedclothing was anything
but properly aired. He jumped up in a rage, stuffed the offending
■beets up the chimney, and rolled himself In the blankets. Some
twelve months afterwards his travels brongbt him to the same hotel.
When shown up to his room, the chamber-maid examined him rather
closely, and then said: “ Dear me, sir, yon are the same gentleman. Do
you know, a most curious. thing happened when you were here last.”
“ What was that f ” he e x cla im ed. “ Why,” she saM, “ the sheets dis¬
appeared, and we oonld not think what became of them.”. “ Ob, indeed,”
be replied. " Then get me my bill directly; you’ve not bad a fire In
this room since, or you would have found your sheets—where all damp
linen ought to be—stuck up the chimney 1 ” Possibly, if fellow-sufferers
revenged themselves in similar fashion, hotel-keepers would take better
precautionary measures for insuring their guests’ health and safety.

I am, Sirs, yours truly, .

Walton-on-the-Nsre, Feb. 31st, 1887. Hjknbt Gramshaw.

To the Editors of Tkb Lanoe*.

8rns,—Yoorcorrespondent “Traveller” seeks a plan of safety when
compelled to occupy a bed which may be damp. Let him always be
provided with a waterproof sheet (a nloely made one witl not take up
much room in a portmanteau), place this on the bed with two blanket*
over it, discard the sheets, and use two or three blankets over him,
■wording to weather, and fie will be safe. I have repeatedly been
thanked for this information by patients who are constantly on travel.

I am, Sirs, yours faithfully,

Kidderminster, Feb. tilth, 1887. S. STRBTtoif, M.R.C.S.

The Margaret-street Consumption Infirmaby.

Or. R. R. Dudgeon, In a tomowhat lengthy communication, writes that
the terms of his amendment to the Bav. M. B. Mowll's resolution were
as follow*: “That any attempt to limit the liberty of opinion or
practice of the medical officers is not sanctioned by the laws of the
infirmary. Is prejudicial to the interests of the infirmary and it*
patients, and is opposed to the spirit of the Medical Act of 1858.”
Dr. Dudgeon remarks: “ The medical men who voted in the minority,
and. Indeed, the whole medical profession, should be much obliged to
me for this effort to uphold the freedom and dignity of the profession,
and to prevent the right of private judgment in therapeutics of the
medical officer* of apablle infirmary being interfered with by a set of
non-medical members of an executive oommlttee, who know nothing
st a8 about medical theories or practice. ”

Mr. Friend (Brighton). —We are not aware. But the work could no
doahtbs ob ta in e d by,order of any m a rt i n s I bOPkrellsr.

Sba-8iCkn»8.

Mr. WTuttingdale states that while acting as surgeon to the Peninsular
and Oriental Steam Navigation Company, be tried at different times
most of the remedies reoommended for sea-tiokness, such as bromide
of sodium, oooains, nitrite of amyl, Ac., with very unsatisfactory
results. The following method, based on the treatment of chloroform
sickness, however, proved most successful. A tumbler of tepid water
la first administered to the patient. This, of coarse, is generally
quiokly returned, but soothes the stomach. Then a warm mustard and
linseed poultioe, in the proportion of one part of mustard to two of
linseed. It applied to the epigastric region, and the following draught
given a quarter of an hour after the tepid water: —Chloral hydrate,
twenty grains; simple syrup, one drachm ; water, to an ounce. If
this be rejected, our correspondent begins de novo with the tepid water
and repeats the draught. After the draught has been taken and
retained, the patient is ordered to lie In his berth, and sleep usually
follows. On waking the swimming In the head and nausea have dis¬
appeared. and he is able to go on deck.— Ur. H. Wakefield consider*
that anyone who has seen much of this malady can hardly doubt that
its origin is mental, and in a large majority of case* the imagination
Is the source of trouble—for lnstanoe. he has seen on several occasions
ladles suffering from seasickness before the ship has left its moorings
in the dock, where there is not the least sign of motion. Iced
stimulants and the recumbent posture are remedies which be now
employ* after a careful trial of alt the so-called specifics extending over
a period of six years.—Jfr. J. R. Stocker, of Liverpool, refers to a paper
of his In Titk Lancet of Deo. 17th, 1881, in which he suggested a some¬
what similar cause of sea-sickness to that suggested by Dr. Thurstan.
“ I may take this opportunity of stating,” says Mr. Stocker, “that in
describing the physiological conditions concerned in its production,

-1 unfortunately omitted to mention a very important matter—vlx., the
spasmodic closure of the glottis, which occur* when the vesael fall*;
this fs a matter of common experience, and is popularly expressed
as * catching the breath.’ ”

Doubtful .—The dietetic treatment of goat is a matter in which pro¬
fessional opinion is still at variance. There are two extreme schools to
discriminate between, those who may be termed the “aseetlos” and
those who advocate the tonic treatment of the disease; whilst a few
hold to the golden mean, and adhere to roles originally laid down by
Sydenham. Some teachers prohibit meat, others allow it; some pro¬
hibit sugar, others say it is not injurious; some forbid fat, other* say
it is the only constituent that may be freely used.

Climate. — Spencer Thomson’s “ Health Beeorte of Britain " would
probably answer the purpose.

G. M. P .—The case is not a very unoommon one.

TRANSPORT OF INFBCTIOUS PATIBNTS.

To the Editors of The Lancet.

Sirs,— I was much surprised to find in The Lancet of Jan. 39th,
page 835, a paragraph proposing the nse of particular vehicles—to the
exclusion of all others—for the transport of infectious patients. I thought
that this custom had long been prevalent in London, as it is in many
other towns—c.g.. In Berlin, and will soon also be adopted In Dresden. To
prove the urgency of adopting this measure, allow me to mention a
cate which took place in Dresden some time ago. A gentleman
happened to drive in a Cab, which had been used a short time previously
for the transport of a patient attacked by small-pox. The gentleman
soon after took the same disease, and could only have caught the Infection
through using the cab. as his was the only case of small-pox In the town
stthstiisM. A similar oaae is mentioned by Dr. OUtvler In Paris with
regard to diphtheria. It is my firm belief that cabs, trams, railway-
carriages, Ac., are among the chief means of spreading infection, and It
Is high time that the sanitary authorities should take the matter Into
serious consideration, and prevent further mischief by providing ambu¬
lances for the transport of infectious patients, to the exclusion of all
othsr vehicle*. I am. Sirs, yours truly,

Dresden, Feb. 15th, 1887. Da. MED. Arthur BebthoLd.

I The Astrop Process.

We are asked to add to oar recent statement concerning the Astrop
process of fluid depuration which Is now carried on at Walthamstow
that Mr. Astrop does not recommend the use of Urns, upon which the
sanitary authority of that place Insist for the precipitation of sewage.
The intention of the anthority is to retain in the effluent, for
use on their land, all matter of manorial value. The desire of
Mr. Astrop is to retain this matter In the sindge, whence It would
remain in the poudrette which is manufactured by his prooess.

Mr. A. F. Mickle, M.B. — The result of previous attempts to found
medical dabs is not of a kind to afford much hope of suoaess for fresh
efforts In the same direction. %

, n. (Brighton).—The letter* too l»eg foe InaarUkn.

Digitized by LjOOQle

466 The Lanobt,]

NOTB8, OOMMIJNBSi ,AB* AtfSWEBS TO COBRBSPONDWnBB.

ITW.36, 1887.

Myopia is Schools.

Ah examination of the condition of the eye* Amongst the young people
frequenting some of the more important schools in S took holm, carried
out fay Dr. Widmark, showed that at the age of from six to eight there
was no myopia; at nine, however, though the girls were still nearly
free froa it, 14 per cent, of the boys were slightly, though distinctly,
myopio. This difference is said to be accounted for by the examination
. which boys have to pass on admission to a secondary school, which
obligee them to work more in the preparatory school. After this age
myopia in the two sexes goes on Increasing, until at sixteen, when
girls usually leave school, the percentage amongst them is thirty-
three, the mean degree of myopia being 2 5 dioptrics. At this age the
percentage of myopia amongst the boys Is 39, and tlic mean amount
two dioptrics. Later on, amongst advanced pupils the myopia was
much more oommon and more marked amongst the girls, which
Dr. Widmark thinks Is to be accounted for partly by the delicacy of
the sex, but mainly by the great Inferiority of physical education and
opportunities for out-door games in girls' schools, and by the needle¬
work and music whloh are there so frequently the employment of
out-of-school hours.

Mr. Bobottom is referred to an article on the subject in our last kune,
page 387.

AN APPEAL.

To th* Editort of Thb Lancet.

Sue,—Although appeals for professional help are unfortunately but
loo common, the sympathy of some members of the profession may, I
am sure, be solicited on behalf of an elderly medical man—Mr. C. H.
Huxley—who Wa* Injured In a railway accident nearly three years ago,
and has since Men unable to support hts wife and children. He sustained
an injury to the hip-joint, and chronic arthritic changes resulted, so
that Ms powers of walking are very limited, and he is unable to attend
40 ordinary p r o fes sional work. Very small damages—only £50—whre
given at the railway trial, and he Is now in a destitute condition. Pro¬
feasor Brichsen fully concurred with me as to the nature and extent of
the articular changes. Subscriptions will be received by me at the
address given Mlow. I am, Sirs, your obedient servant,

5, Henrletta-st., Cavendish-eq., W., Feb. 21st, 1887, Wii. Adams.

OPHTHALMIC AND AURAL PRACTICE ABROAD.

To the Editor* of Tax Lancet.

Sins,— Will you kindly allow me to ask your readers for Information as
to openings for ophthalmic and aural snrgeon* abroad, especially in the
•olonies? I am. Sirs, yours faithfully,

Feb. 18th, 1887. J.

Dr. ThursJieWe communication is unavoidably held over till next week.
Mr. J. Rand.—The lines are rather too political for our columns.

Communications not noticed In our present number will receive atten*
tlon In our next.

Communications, Letters, Ao., have Men received from—Dr. Norman
Kerr, London; Mr. Cavendish Bentinck, London; Dr. Coloott Pox,
London; Dr. F. Warner, London; Mona. Masson, Paris; Dr. Bdrney
Yeo, London; Dr. Lambert, Liverpool; Dr. Glanvillo; Mr. Simeon
Snell, Sheffield ; Dr. W. Hunter, Edinburgh; Dr. R. Macdonald, M.P.,
London; Mr. Barwell, London; Mr. Seaton-Cockell; Mr. Buclcston
Browne, London ; Dr. Jos. Rogers, London ; Mr. J. A. Jones; Dr. A.
Berthold, Dresden; Dr. Jas. Bralthwalte, Leeds ; Mr. Lawson Talt,
Birmingham; Mr. B. H. Fenwick, London; Mr. Handheld Jones;
Dr. Jacob, Leeds; Dr. Lowe, Workington ; Mr. F. Proud, Bishop
Auckland; Mr. J. Whittlngdale, Maidstone,; Mr. C. Barry, Castle
Bden; Mr. Stretton, Kidderminster; Mr. Freer, Birmingham; Mr.8.
Mil -1-L'J-ll l I 1' - l !!l! =8* 111 feM = SSL

Lawrence. Oban; Mr. F.A. Davis, Philadelphia; MM. Bigaud and
Chapoteaut, Paris; Dr. B. O. Alexander, Halifax; Messrs. B. Smith
and Co., London; Mr. Wakefield, London; Mr. T. W. N. Greene.
Consultas; Mr. Sibbald, Richmond ; Dr. Illingworth ; Mr. Bara&rdo,
London ; Dr, Coburn, Fredericton; Mr. Pink, London; Dr. A. J.
Mickle, London ; Dr. Thompson, Stapleton ; Mr. G. F. Blake, Dublin ;
Mr. J. B. Stocker, Liverpool; Mr. W. Crookes, London; Mr. Ash,
Monaco; Mr. Gramshaw, Walton ; Mr. Scopes, Dartford ; Mr. Thomas
Christy, London; Mr. A. F. Hawkins, Birmingham; Messrs. Fhrwig
and Co., London; Mr. W. S. Barrett, Hinoktey; Mean. Bromley and
Oo., Lincoln; Mr. Robottom, London ; Mr. Ch A. Harris; Dr. R. B.
Dudgeon, London; Mr. J. T. Wilmott, Brisbane ; Mr. MoNanght, Sew
Church; Dr. Heelas, Bonohurch; Dr. J. Wheeler, London j Mr. C. B.
Jennings, London; Mr. W. Sedgwiek, London-, Messrs. Duncan and
Co., Edinburgh ; Mr. A. V. Dyer; Mr. F. O. Combe ; Messrs. Griffin
and Co., London; Mr. Hicks, Hendon; Mr. Jesset, London; Dr. Lucas,
Ramsgate; Mr. Walker, Glasgow ; Mr. Berthier, Paris; Mr. Bostock.
Mansfield; Mr. Ashcroft, Birmingham ; Mr. Hodgklnson, St. John's
Wood ; Mr. Mason, Highbury ; Mr. Beales, Yarmouth ; Mr. Craake,
London ; Mr. Heron, London ; Dr. Saul, Lancaster ; Messrs. Newbery
and Co., London ; Mr. Armstrong, Manoheater; Messrs. Reynolds and
Go., Leeds; Mr. Oldham, Monsall; Mr. Hanks, Malmesbury; Mr. H.
Marsh, London; Dr. Adye, Bradford-on-Avon ; Messrs. Butterfield
and Son, Northampton; Dr. Daviee, Manchester} Mass is . Famln and
Co., Dublin; Dr. Tennant, Matlock; Mr. Porter, Levon ; Mr. Friend,
Brighton; Mr. Bottomley, Ashton-under-Lyne; Messrs. Hopklnson
and Co., Nottingham; Messrs. Thorne, London; Messrs. Beale and
Son, Brighton; Mr. Lacey, Wandsworth; Messrs. Burroughs and
Co., London; Mr.Mouliln, London; Mr.Gumer, London; Mr. Myers,
Edinburgh ; Mr. Hornibrook, London; Mrs. Stamilng, Newark-on-
Trent; Mr. Hawkins, London; Mr. Knlgfatley, London; Memrs. Wyley
and Go., Coventry; Messrs. Wright and Oo., Birmingham ; Mr. W. J.
Penny, Bristol; Stand Sure; B. W. W.; A. B„ Bow; G. M. P.;
T. 0.; Doubtful; T. B.; J.; M.D.; A Brigade-Surgeon; Lady
Superintendent, Belgravia.

Letters, each with encloturt , are also acknowledged from—Dr. Saundby,
Birmingham; Mr. Higgins, Malvern; Mr. Gale, TeUworth; Mr. Gray,
Burnley; Mr. Hopkins, Bath ; Mr. Phillips; Messrs. Burgoyne and
Co., London ; Mr. Bemner, Dublin; Mr. Butler; Hearn. Bennett and
Co., Salisbury; Dr.Rayner, Malvern; Mr.Whitehead,Wellington,New
Zealand; Mr. Oarmont, Dumfries; Mr. Osborne, Worksop; Mr. Nfvin,
Oldham; Mr. Snell, Ketton; Mr. Pead, Dulwich; Messrs. Roberts and
Co., London ; Miss Carson, Burton-on-Trent; Miss Spreat, St. John’s
Wood; Miss Napper, Eastbourne; Mr. Derry, Leeds; Mr. Ligertwood.
West Mailing; Miss Hargreaves, Stoke-on-Trent; Messrs. Csssell and
Co., London; Dr. Lindsey, Mickleover; Mr. Hemery, Nottingham;
Mr. Harrison, Liverpool; Miss Chreiman, Kensington; Mr. Hague,
London; Dr. Cock, Peckham ; Mr. Powne, Chard; Measa. Bc h wel ta er
and Oo., London; Mrs. Billing, Birmingham; Mr. Haywood, Man¬
chester ; Mr. Coleman, Cardiff; Mrs. TarrU, Hertford; Mr. Brown.
Weetgste-on-Sea; Mr. Browning, Manchester; Messrs. Bennett and
Co., London; Mr. Thompson, London; Dr. Hadaway, Garilnge;
Mr. Archer, Marseilles; Mr. Green, Middlesbrongh; Mr. Sarsfield,
Limerick; Mr. Griffiths, Chester; Mr. Yonng, Slough; A. J. L.;
Matron, Bedford ; J. M., Keith ; Medicos, Chesterton; A., Finsbury-
park; Beta, Carnarvon ; Hakim, M.D. ; Medious, Llskeard ; Box.
Hull; Iodine; Theta; Medicus, Ponder’s-end; M.D.; O.X.; Medians,
Rhyl; Tropar; H. W.; X. Y. Z. ; Z. Y. X.; A.; Max; Medicus;
B. S.; T.C.D.; Galen; B. S.; Ajax; W. H. B., Risca; Medloua,
Hove; Cymro; Delta, London; Berks; Superintendent, Newcaatle-
on-Tyne; T. M„ Chelsea.

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Digitized by LjOOQle

THE LANCET, Makch: 5, 1887.

SURGICAL TREATMENT OF PULMONARY
CAVITIES.

Delivered at the Consumption Hospital, Brompton,

By RICKMAN J. GODLEE, M.S., F.R.C.S.,

glTROKOH TO THK HOSPITAL AXD TO UJfTYKllSITY COLLEGE HOSPITAL.

LECTURE I.

r

Gsntlkicbn,—I t may be hoped'that the subject of the
surgical treatment of pulmonary cavities is still in its
infancy, and it may fairly be anticipated that whilst that of
certain classes of cases will advance in efficiency, the treat¬
ment of others will again be handed over altogether to the
physicians, although it is not yet obvious in what direction
their efforts, if pursued, are likely to be more successful
than heretofore. In some forms of pulmonary abscess
surgical interference is obviously inadmissible; nothing,
for instance, can be hoped from it in treating a lung which
is riddled by numerous tubercular cavities or the multi¬
plied gangrenous foci which occur in the course of embolic
pyaemia. Those in which surgery has been, or may be,
-attempted, may be thus classified :-^l. Tubercular cavities.
2. Cavities resulting from gangrene of the lung. 3. Cavities
resulting from the bursting into the lung of abscesses
or other collections of irritating matter from without.
4. Bronchiectases, from whatever cause arising, and including
thoee which depend upon the presence of a foreign body in
the air passages. - Before giving an account of such cases
as have come under my own observation, I propose to give
a short rStumS, not a complete history, of what ha3 been
done by others in this branch of surgery.

As long ago as 1726 Dr. (afterwards Sir) Edward Barry 1
of Dublin hints at the advisability of opening phthisical
cavities in the following quaint way: “ But when from the
violence of the distemper, or the neglect of a proper method,
tho Symptoms are so far increased as to carry a fatal aspect
and dude the force of the most effectual medicines, instead
of amusing the unhappy patient with false hope and the
repeated nee of palliative remedies, or denouncing certain
death, R would be of the greatest use if a method could be
proposed which, tho’ dubious and painful in the opera¬
tion, may give the afflicted some chance for their life:
Prttmtet anceps quam nullum experiri remedium. Such
a probable relief can only be expected by opening the
breast where the most frequent pain and oppression
direct the situation of the ulcer,” &c. He then proceeds
to say that the operation may be performed without
danger because adhesions are sure to exist, And fortifies his
argument by the account of a case which may or may not
beer upon the subject. It was that of a man who received
a sword-wound in the chest, which was allowed to heal
rapidly externally. The cough, hectic fever, and purulent
expectoration which followed were relieved by a timely
opening Up of the original wound. Bat this may of course
have been merely a case of empyema. He concludes: “’Tia
that this method has not been frequently
, since it is founded on such plain and easie
_ from anatomical observations, tho’ I’m sensible
that them are several obstacles that will always oppose

it, ftA . But ’tis most certain that many phthisical

perad hO m ay by this means be preserved that will other¬
wise unavoidably perish. If the operation be rightly per¬
formed there is great reason to expect success; neither if
it flfif Ma it be attended with any great danger or mach
contribute to hasten their fate.” Whether -Barry ever
actually Operated upon a genuine pulmonary abscess must,
I think, remain doubtful; numerous coses am reported
both hem and in another work of his, 3 but I am sure that
at all events a large number of these must have been cases
of empyema. I cannot leave Edward Barry without quoting
a foar-waWa

•IrtfeV a popular belief at that time in the

in. 1738. p. 317.
and Discharges of. the

parasitic nature of phthisis, which at the present day of
the bacillary rule sounds strangely prophetic. He says:
“It has been observed that ulcers in the lungs and in
other parts, when narrowly viewed with microscopes, are
covered with several insects; from whence it has been
concluded that they owed their origin to them, and by being
inspired with the air, fixed their situation on the lungs,
eroded and ulcerated them. From the same irregular way
of reasoning, these animalcules have been by others sup¬
posed the cause of several distempers, and particularly such
as are contagious.” The whole quotation is quaint and
interesting; but Barry’s own opinion on the subject is
difficult to gather, and, indeed, it is pretty clear that this
was as indefinite as his knowledge was vague. He con¬
cludes his work on the three digestions with the following
words: “ This infinite number of animalcules which swarm
in the air and on the surface of the earth seem to me to be
of much greater use and importance than is generally
imagined, as all stagnating animal and vegetable humours
are quickly taken up by them, and receive a new life and
regular circulation; and perhaps we owe our safety in some
measure to this scarcely visible part of the creation, without
which the atmosphere would in a short time become highly
corrupted, and unfit to continue the life of other animals.”

Before Barry’s time it is said that Baglivi, in 1714, recom¬
mended the incision of pulmonary cavities, but I have not
been able to find any reference to the subject in glancing
through his long and discursive work. 3 And still older men
than these had made incision into the chest in desperate
cases, and with good result. Paschal, Pard, and Harvey
have cases in point; and upon looking back into the dawn
of medical history we must not forget the classical case re¬
corded by Pliny,* when a soldier, given up by bis doctors
and sick of his heavy burden, sought death in the front of
battle. Great must have been his wonder when the enemy’s
spear relieved bis sufferings in a quite unexpected manner
by opening his empyema. “Atque feliciter hoc vulnere
sanatus est.”

About the same time as Barry, two or three surgeons
seem to have written on the subject. In Gottingen, in 1793,
Gumprecht 5 devoted his doc tori al thesis to a dissertation on
abscess of the lung, in which he advocates the incision of
pulmonary cavities ; but the diagnosis at that time between
pulmonary cavities and empyemata was so uncertain that
we do not gain anything beyond the historical interest in
perusing his work. At the end of it, however, is an interest¬
ing series of cases of wound of the lung, which well repays
study. In Scotland, Benjamin Bell 0 in 1778 refers to the
free incision of abscesses in the lungs and the drainage of
them by means of lead tubes, making special reference to
the importance of some arrangement for preventing the
tube from slipping into the chest; but he' seems to be
referring altogether to absceses which have resulted from
the infliction of wounds, and not to those occurring spon¬
taneously.

After this but little attention seems to have been directed
to the matter until the middle of the present century; we
then find that Dr. John Hastings, 7 fired by Barry’s example,
procured the help of his friend, Mr. Storke, to Open two
apparently genuine cases of tubercular apex cavities, one
of which improved under the treatment, but the other, a
woman of twenty-five years, in whom phthisis was far
advanced at the time of the operation, died fourteen days
afterwards. The account is to be found as an appendix to
his work on the Treatment of Phthisis by Naphtha, and it
includes a letter from Sir Henry Marsh detailing two cases
supposed to be of tubercular cavities treated by him by
incision about 1830; but as in both cases the matter was
pointing, s certain amount of doubt must hang over the
diagnosis. One recovered and the other died. Hastings
says that a Welsh doctor named Thomas performed a similar
operation about the same time. He recommends the use of
a full-sized: gum catheter with a perforated ivory eap, to
which straps could be attached, and over which a piece of
warm 6ponge was to be placed.

A few years later there appeared an interesting paper by
Dr. Horace Green, 3 written in a somewhat combative spirit,

3 Georgli Baglivi, op. om. Luffd., 1714. * Lib. vll., cap. 60.

* De Pulmonum Abeoeeeu ope CWnirgioa Aperfendo. Gottingen, 1703.

* A System of Surgery, third edition, iT9t, vol. ▼., chap. 36. sect. 11.

T Pulmonary Consumption successfully treated by Naphtha. London,
1846.

* On Injection of the Bronchial Tube* and Tubercular Cavities of f
Lungs. American Medical Monthlv. 1859.

)C>

o

458 Thb Lancrt,] ME. E. J. GODLEE: SURGICAL TREATMENT OF PULMONARY CAVITIES. [Mabch 5,1887.

because the possibility of passing tubes through the glottis
from the mouth had been denied by Erichsen and others.
His treatment for both bronohiectatic and tubercular
cavities consisted in passing a soft tube not only into the
trachea, but, so he asserts, into one bronchus or the other as
the case demanded, and injecting a drachm or more of an
aqueous solution of nitrate of silver (thirty or forty grains
to the ounce) into the dilated bronchi or the pulmonary,
cavity. The patients whose cases he recites appear generally
to have been distinctly benefited, and, as is very remarkable,
seem not to have suffered from a fit of coughing or other
unpleasant symptom at the time the injection was made.
Notwithstanding its apparent success, however, the treat¬
ment does not seem to have met with much favour, Dor are
his extremely categorical statements, it must be owned,
quite convincing that the dose was not sometimes received
into the stomach.

Quite another method of introducing fluids into phthisical
cavities is suggested by Dr. F. Hosier of Greifswald. 0 He
passed a fine trocar and cannula through the chest wall into
the cavity, and then injected through the cannula a weak
solution of permanganate of potash. Then in a later case he
called in the help of lliiter, who made an incision into a
large apical cavity. The incision was made at the upper
border of the third rib, 5k cm. from the sternum, and passed
through Arm pleural adhesions. The operation offered no
'difficulty, and caused no trouble from haemorrhage. He
-subsequently injected weak perchloride of iron when some
little bleeding had occurred, and at other times solutions of
carbolic acid and permanganate of potash and tincture of
iodine. The patient lived from July 2nd to Oct. 5th, and
for a time seems to have markedly improved; the cough
was much relieved, and the great albuminuria from which
he suffered diminished. The albuminuria relumed, however,
and emaciation became great, and it is perhaps questionable
how far life was prolonged, though comfort was, no doubt,
given by means of the operation.

An almost precisely similar method of treating pul¬
monary cavities has been advocated in America by Pepper
of Pennsylvania and Beverley Robinson of New York, 9 10
and in our own country this or some modification of
it has been put in practice by Dr. Shingleton Smith and
others.

Dr. Shingleton Smith 11 records five cases, two of which
were of tubercular phthisis, one was of gangrene of the
lung, one of chronic pneumonia, and one of chronic
tubercular pleurisy. The phthisical patients seem to
have improved somewhat under treatment, though one
developed some pleurisy, which was possibly the result
of the injection; the tubercular pleurisy case remained
in statu quo; the other two cases died—not, however,
apparently as a result of the injection. The method of
proceeding is to introduce with a hypodermic syringe five
minims ot ether in which one grain of iodoform has been
dissolved; the iodoform was at first dissolved in oil, but a
fear of fat embolism led to the adoption of ether as a solvent.
The injections were sometimes continued daily, sometimes
less often. I do not think that these cases show much, except,
-as is stated by the authors, that the process does not appear
to be a dangerous one. I can conceive that the introduction
of iodoform might be useful in cases of bronchiectatic or
gangrenous abscesses, though I think that a free incision
into the latter, at all events, would be better treatment. As
to the phthisical cavities, it seems most improbable that, even
if iodoform be fatal to the tubercle bacillus, it could be
made to diffuse itself sufficiently to reach further than the
immediate vicinity of the cavity or the spot of solid lung
into which the injection is introduced; if, therefore, it be
of anv Service at all, it can, I conceive, only be in the
direction of stopping the fetor of the expectoration from
a vomica. This, then, does not appear a very promising
line of treatment to pursue. If ever we do discover a drug
which is a specific for destroying the active principle of
tubercle, it is more likely that it will be efficient if
administered internally than if any attempt be made to
attack locally a mischief which is usually, at the period
when each an attack would be thought advisable, very
widely diffused throughout the organ.

An interesting summary of what has been done in the
direction of pulmonary surgery will be found in a paper by

9 Seporatabdruck aus dar Berliner KliniacUen Woohenschrlft, 1873,

No. 43. 10 New York Medical Record, Jan. 10th. 1885.

11 Bristol Medlco-Oh'rurglcal Journal. Sept. 1885.

Dr. de Cdrenville of Lausanne. 12 He has himself treated
surgically four cases of phthisical apex cavities with a
different object from that pursued by others—viz., following
Estlander’s treatment for chronic empyema, to allow the
chest walls to collapse on the cavity by removing portions

of the ribs. These are his cases:— ---• ,

\\ 1. F-, aged forty years, advanced phthisis with large V

Cavity at left apex. Resection of the third rib to allow the
chest wall to fall in. The patient lived little more than a
fortnight. Some retraction is said to have occurred.

2. F-, aged fifteen. Advanced phthisis, with consoli¬

dation and excavation of the upper lobe of the left lung.
Parts of the second and the third ribs were excised, and
threads were passed through the pleura into the lung in
order to ensure adhesions if these were not present. Four
days later, an attempt to reach a large cavity resulted only
in the discovery of a small one. The operation appears to
have had but little influence on the progress of the disease.
The patient died three weeks after the first operation.

3. F-, aged twenty-five. Advanced phthisis; cavities

in the left upper lobe. Parts of the second and third ribs
were removed, and a large cavity was opened. The cough
and expectoration were very much relieved, and the cavity
decidedly contracted; the patient living five weeks after }

.the operation. N

He has also operated on another case of which he does
not give the notes. The results of these are interesting,
but not very encouraging. The cases were obviously hope¬
less, however, and some temporary relief seems to have
been gained in the third. At the Congress at Wiesbaden,
1883, the consensus of opinion (Mosler, Fenger, Hollister,
&c.) seems to have been strongly against the opening of
tubercular cavities, at least until a specific tubercular
bacillicide can be found. De C6renville agrees with this
conclusion in the main, making, however, a possible
exception in favour of cases where the cavity is single,
the cough troublesome, and the mischief apparently
localised. He allows, however, as is notorious, that the
amount of mischief is likely to be greater than the
physical signs indicate. As far as I can form an opinion
without practical experience I am inclined to agree with
de C^renville, though I cannot help thinking that in a
certain number of cases of single apex cavities with
troublesome cough, not only might the symptoms be
relieved, but the danger of transplanting the mischief into
the other lung might be to some extent lessened. - v.

A far more heroic method of dealing with tubercular luDg J J
has been in recent years suggested by certain Italian
surgeons who have made this subject a specialty, though it
has been followed up by some observers in Germany. Dr.
Domenico Biondi showed first the possibility of an animal
surviving the complete extirpation of a healthy lung, 13 and
then proceeded to demonstrate that the same might be done
in an animal the lung of which had previously been
inoculated with some of the sputum of a tubercular patient,
and had actually become the seat of tubercular changes. 1 *

A very considerable proportion of the animals (rabbits, cats,
and dogs, twenty-one in all) died as the result of the
first or the second operation, but some survived and lived
for a very considerable time afterwards. The dogs and cats
were not favourable subjects for the development of tuber¬
culosis, but it is remarkable and interesting that in some of
tbe rabbits tubercle was actually developed in the lung,
which was removed, and after the removal the animal
remained free from further development of the disease.
Tbe conclusion that the author wishes to draw is obvious,
but he hardly ventures to hint at the application of the
treatment to the human subject, and it can scarcely be
suspected that it will ever be placed amongst the recognised
surgical procedures. It could only be applied in tbe early stages
of phthisis, when tbe disease may be considered within the
possibility of a practically permanent cure by other and
simpler means. And indeed the same may be said of another
possible deduction—namely, the removal of tumours of tbe
lung. Diagnosis must clearly reach a much greater pitch of
refinement before the physician could counsel or the surgeon
attempt the removal of a primary tumour of the lung, rare
as it is, and difficult as it must always be to discover in its

IJ De l’lntervention Opdratolre dans les Maladies du Bauman.
Revue de la Suisse Romande, 1885, p. 411.

15 Estirpaz'one del I’ulmone. Cnntribuzione sperimentale peril Dr.

D. Biondi. Ciior. Interuaz. d. Sc. Med. N. S. lv.

w Loc. cit., N. S. rt., 1881, pp. 730-711; or Med. Jahrb. Wien.. 1S3I.
pp. 207-216.

Digitize'

Thb Labcbt.]

#R. J. B. POTTER: ADDRESS AT THE OBSTETRICAL SOCIETY. [ILuich 5,1887. 459

earlier stages, when, alone it could conceivably be extir¬
pated. 18 It must, however, be stated that in two cases of
phthisis parts of the lung have been actually removed by
Roggi, one of the patients dying in a few hours, and the
other on the ninth day. And not only so, but tumours of
the lung also have been removed, though it must be owned
that the experience of the surgeons who undertook the
operation is not very encouraging. Weinleicher, in 1882,
removed a round tumour as large as a man's head from the
thoracic wall of a man aged thirty-seven, leaving a huge
■gaping opening into the chest and taking away a part of tne
lung to which it was adherent; the patient died twenty-
four hours afterwards. And Kroenleim also removed a
recurrent sarcoma in the same situation from a girl, aged
eighteen, taking away part of the sixth rib and some
adherent lung. The end of this case is not reported in the
interesting article of Albert’s from which I take the refer-'
V ence. 14 —'J

Lastly, to complete this branch of the subject, must be
mentioned a method of treating tubular lung, whether con¬
taining cavities or not, introduced by Gudrin in 1830, and
more recently modified and extensively practised by Vidal—
viz^ the puncture by means of the actual cautery. Vidal
reports forty-four cases, thirty-seven of whom improved
under treatment; and I believe that this method has also
been employed in Australia.

Gangrenous cavities .—It must be remembered that gan¬
grene of the lung may follow wounds of the chest, and in
the old days of duelling empyemata and pulmonary abscesses
from such a cause seem to nave been common. Now, how¬
ever, this is not the case in civil practice. Gangrene of the
lung is said also to be caused by the presence of a foreign
body in the air passages; but as from the present point of
view the dilatation of the bronchi, which I believe invariably
follows, is the more important lesion, I shall discuss this
question under the head of Bronchiectasis; and will pass on
to gangrenous cavities resulting from some form of pneu-
moniai^These oavities are perhaps the most promising >
~ Wlibwhich the surgeon is called upon to deal, especially if p
operation be not too long delayed. In the course of time,
it the patient survive, the surrounding lung becomes con¬
densed and inelastic; but in the earlier stages of the disease
it retains more or less its normal characters, and the walls
of the cavity are able to fall together like those of an abscess
in the soft parts elsewhere. But delay is often almost un¬
avoidable on account of the great difficulty of localising the
position of the cavity with precision, and the still greater
difficulty of ascertaining the absence or the presence of
adhesions. I do not think that the second point should
be allowed to influence the surgeon in the direction
of delay, and certainly should not interfere with an
exploratory puncture, because, in the first place, experience
shows that even adhesions which have been accurately
diagnosed by the most competent observers may, after all,
be found to have no existence, and, in the second place, it
seems clear that exploration with an aspirator needle may
be safely made through a patent pleura, even if the instru¬
ment pass into a collection of putrid pus. I do not say
that mischief will never follow this procedure, and I am
sore that it is wise to ascertain for certain the condition of
the pleura before making a. free incision into a lung
containing septic pus, for if the non-adherent pleura be
opened, and through it a drainage-tube be passed into a
putrid cavity, very serious symptoms may result. This
was well illustrated in a case of bronchiectasis (which
will be referred to again), where we had ascertained a
week or two previously that there was some clear fluid
in what was thought to be merely a remnant of the
pleural oavity. On cutting through the intercostal space,
it was found that the two layers of the pleura had
become adherent since the preliminary puncture, but only
by very weak adhesions, which easily broke down undt r the
pressure of the Anger and the expiratory efforts of the
patient whilst the opening was being made into the
bronchiectatic cavity. This led to the opening up of a large
remnant of the pleural sac, the walls of which were non-
adherent, and the consequence was that the pus from the
bronchiectasis escaping into the pleura set up a septic
pleurisy, from which the patient nearly died.

KI

h

u Them* rapRrhnenU have also been carried out In Germ any. by
Th. Gluck, In 1881 (twenty cate*, some successful removals of the entire
hmjT). Dr. Han* Schmidt (three oat of eight survived), and Dr. Block,
hi 1883 (fifty to sixty cases done without removal of rib).

. *• Defeat Lungea Ohlnugte. Wien. Ued. Press*, 1884, p. 887.

It will be well, therefore, to consider at the outset what
should be done when these adhesions, so commonly but yet
not invariably found, are wanting. One plan would be that
mentioned above as recommended by De Cerenville as a
precautionary measure—namely, to pass needles armed with
silk through the pleura into the lung; but as in almost all
cases the lung is solidified, and will therefore not fall
away to any extent from the thoracic wall, even if no
adhesions at all be present, I do not think that this,
though quite unobjectionable, can be considered to be
a necessary precaution.\J The right method of procedure,
though I confees it is not a very easy one, is carefully to
stitch the lung up to the opening which has been made in the
chest walls. It is a difficult proceeding, because the parts
are in a constant state of movement from the act of respira¬
tion, and because the lung itself is but ill suited to retain
the stitches tb&t are placed in it, and also because the hole
in which the manoeuvres have to be carried on is a rather
deep one, and mostly obscured by the presence of blood. I
bkve only once had to put thus plan into practice, and
though here it was only partially successful, it was suffi¬
ciently so to show that, with a little more care, the closure
of the pleura might have been effected. We found, in this
case, at the end of a few days, that a part of the stitching
had given way, but as no cavity was reached, no evil conse¬
quences as regards the pleura resulted, the wound remaining
aseptic. Of course, after the stitches have been placed, the
attempt to open the cavity must be postponed for at least a
week, and at the end of that time the instruments used must
be sharp, and their employment gentle, lest the accident
which it is intended to avoid may, after all, happen.

(TobtcondwUd).

§,it |,Hrcs s

DBLIVKRBD AT TH*

OBSTETEICAL SOCIETY OF LONDON.

On February 2nd, 1887,

By J. B. POUER, M.D., F.R.C.P.,

PRESIDENT OF THE SOCIETY.

Gbntlbmbi*,—I have again to congratulate the Sociefr
on its prosperous and healthy condition. Our numbers at
the close of the year were 73G. We have lost by death,
resignation, and erasure 40 Fellows, but during the year we
elected the large number of 72. Including the 25 new
members that have been already elected thui year, the
Society at the present time stands with a total of 761, the
highest number that ha* been reached since its foundation.
Our financial position is good. As you have heard from the
report of our excellent treasurer, another £100 has been
added to our invested funds, making the amount of our
capital £1600, and we commence the year with a good
balance at our bankers. Oar library has been increased by
the addition of 156 volumes, bringing up the total to 3690..
These are all proofs of our popularity and prosperity; but
the success of the Society depends more upon the work
done, and we can show continued good results in this. Oar
midwifery board reports good and still increasing work.
The number of women examined reached the large number
of 102, of whom 80 were found qualified to receive tbe
Society’s diploma; 395 women are now on our register.
This gratuitous and honourab'e work, as was stated last
year, causes considerable strain on the Society and its
unpaid examiners, and, as the numbers are continually in¬
creasing, some scheme will have to be devised to meet the
difficulty. It is curious to notice how the value of the
S'K-iety’s diploma has increased when we obstrve that,
whereas in the first eight years only 47 names appear,
during last year 102 women presented themselves for exa¬
mination. The unsettled 6tate of politics still prevents this
burning question from coming to the front, br sooner or
later it must do; but the Society, if it bad no other work to
show, may well be proud of baviDg taken in hand this duty,
so long neglected by the 8tate. The attendance at <■ -
meetings has been good, and the work of the session •-

460 The Lancet,] DR. J. B. POTTER: ADDRESS AT THE OBSTETRICAL SOCIETY.

[Makch 6 , 1837.

maintained. The publication of the Transactions in portions
has been undertaken for the first time, and, although the
circulation has not been large, it has been a boon to those
■who have availed themselves of it, and an advantage to the
Society in bringing its work more rapidly before the notice
of the profession.

[Dr. Potter then entered into an enumeration of the more
remarkable of the specimens shown and of the chief papers
read at the meetings of the Society during the past session.]

I have attempted no more than a slight summary of the
work of the Society during the year, and the quality of the
papers is an evidence that its scientific standard has been
well maintained, and that it has fulfilled its function as
established for the promotion of knowledge in all that
relates to obstetrics and tbe diseases of women and
children. It may be contended by some that we have not
the records to show of great improvements in the practice
of our art during the past year—no striking novelties in
treatment; but it is the function of the Society to maintain
a judicial attitude, and, while assisting progress when the
progress is real, to check or arrest this when it tends to
danger. In other words, it welcomes improvement, but
avoids destruction. One of the highest points that we
should aim at is the prevention of disease, and this, though
well worked out in the practice of obstetrics, has nor, received
the same attention in the diseases of women. Much has
been done at different times to solve the important question,.
Should any death occur in or after natural labour?. And the
answer to this question has been each year more favour¬
able, as evidenced by the improved record of our lying-in
hospitals. Even in difficult labour mortality has been
much reduced, and though the wish expressed by Dr. Tyler
Smith in his paper in the first volume of our Transactions
for the abolition of craniotomy from obstetric practice in
all cases where the foetus is living and viable has not yet
been fully realised, the more frequent induction of premature
labour and more timely use of the forceps have conduced
much in this direction. In our present state of knowledge
we are not yet prepared to accept abdominal section as its
-alternative in all cases, still holding to the English axiom—
the safety of the mother before that of the child. Again,
by the use of chloroform and the more frequent application
of the forceps we have means of preventing laceration and
sloughihg of the soft carts, thus rendering far less common
the miserable after-effects of a lingering labour. But the
prevention of diseases of women has not received tbe same
attention: the effects of cold, damp, climate, occupation,
imprudence and want of care at tbe menstrual periods, the
effect of excessive child-bearing, abortions, the prevention
of impregnation, and many other causes of disease, deserve
and require our careful consideration; and he who can
prevent the occurrence of the diseases of women will be a
greater benefactor to his race than the operator, however
skilful he may be, who treats them.

The whole question of uterine pathology is far too large
a one to enter into here, even had we the requisite time at
our disposal. To attempt to enter into the various theories
that have from time to time given rise to different modes of
treatment would be a perplexing and unprofitable task;
each seems to reign for a short time only to be cast aside
and replaced by some other, and now the tendency seems to
grow more and more surgical, until at last to some minds
abdominal section and the removal of internal organs seem
the panacea for all the evils that woman is heir to. To the
‘Indiscriminate use of these procedures we cannot give our
adhesion, and especially do we object to the heroic surgical
.,treatment of hysteria—that chameleon disease which still
, claims so much sympathy and treatment at our handa
J£ven statistics on these matters, however carefully tabu¬
lated, have to be received with caution; the distinction
between cases that have recovered or become well and those
that can be truly said to have only just escaped death or
..have lived too frequently with their suffering unrelieved
, ; nas not always been clearly shown. In estimating these
'.matters much must depend On character. A reputation for
i if 6f more permanent value here
M»i. results that will not bear

■ truth and logical p;

' than the statement
the test of inv
.this matter, it is 6
forget the sac rednesi','
' Ang, and this must *• *
One task yet ref*
j Always to deplore
'This year fortunately

T baVe spoken strongly on

K some may be apt to
heir zeal for operat-

tfbe. We have
irs by death,
so great as

on many occasions. Eight have passed away: two of our
honorary Fellows—viz., Dr. Simon Thomas erf Leyden, and
Dr. Courty of Montpellier; and six of our ordinary Fellows.
Of the former, Dr. A. E. Simon Thomas of Leyden, whose
death was announced so recently as December last, we have
not yet been able to find any obituary notice. He was
elected an honorary Fellow of the Society in 1868. Many of
his works are in our library, one of the most important being
his great work on the Oblique Pelvis. For the following
notice of M. Courty I am indebted to tbe memoir published
in the Annalcs de Gynecologic, of which journal he was one
of the original founders:—

Professor Am6dde Courty was born at Montpellier on
Nov. 2nd, 1819, his father and grandfather having also
followed the profession of medicine. After receiving tbe
usual classical education he threw hhnself with zeal into
the study of medicine, and at the same time devoted himself
to the pursuit of science. After taking a licence in Scienoe
he became Doctor of Medicine in 1846, the subject of his
graduation thesis being “Sur le Ddveloppement de I'flBuf datts
l’ispece Humaine.” He now gave himself up to the study of
physiology, and published several memoirs on this subject,
also teaching the subjects of anatomy and enreery until his
appointment as a professor in the Faculty of Medicine in
Montpellier in 1849, when he wrote a thesis on tbe use of
Anaesthetics in Surgery. In 1854 he wrote a memoir on
Cauterisation of the Cervix Uteri with the Actual Cautery
during pregnancy. From this time he devoted himself to
the special study of the diseases of the genital apparatus in
women, and, dissatisfied with the knowledge that he found
in the text-books of his time, began to collect materials for
the great work on which rests his title to fame, named 44 Traits
Pratique des Maladies de I'Utdros et de see Annexes,” the
first edition appearing in 1866, followed by asecond and third
in 1873 and 1879. This work was translated into English in
1882, with a preface by Dr. Matthews Duncan. Though no
doubt largely indebted to the works of German and English
authors, still throughout we find the impress of his own
mind and the result of his long and patient researches. The
great secret of Courty’s success in his department of practice
was that he became a specialist only after long study and
a familiarity with medical and surgical work of many
years. On this foundation he grafted bis special studies,
-this being the way in which he understood the term
specialty, not following, as is too often the case in the
present day, the plan of calling himself'» specialist and
therefore considering himself one—such a specialist as
might be defined as one knowing a very little of one subject
and nothing at all of the science and art of medicine. He
obtained a large practice in Montpellier, and was largely
consulted throughout the south of France. His professorial
duties obliged him during hie later years to pay frequent
visits to Paris, and advantage was taken of his presence by
many to avail themselves of his matured knowledge and
skill. He took great interest in the French Association for
the Advancement of Science, and also in the International
Medical Congress. Ha was a regular attendant and frequent
speaker at, these meetings. He died on March 2nd at Mont¬
pellier. His loss is felt by all the medical world, and
especially that part of it devoted to tbe study of the
diseases of women. He was elected an honorary Fellow of
this Society in 1875.

Of our ordinary Fellows, John Archer, F.R.C.S., practised
in Birmingham, his native town, upwards of fifty years, and
was one of the early Fellows of this Society, having been
elected in 1859. He was senior surgeon to the Lying-in
Hospital, and was an able obstetrician. He was a good type
of the general practitioner—honourable, hard-working, and
successful. A past president of the Birmingham Medical
Institution, be held a most resoected professional position in
the town. He died on March 8th, at the age of seventy-
seven, of angina pectoris.

In speaking of the lamented death of Dr. Alfred Wiltshire,
which occurred on the 4th of December, at a comparatively

early age, 1 refer to a loss which is specially feit in our
Society; a regular attendant at our meetings, and one who
had taken an important part in its management.

[Dr. Potter gave a sketch of the career of the deceased
physician, particulars of which were published in our issae
of Jan. 1st of tbe present year.]

Dr,’ J. Macgrigor Croft, of Abbey-road, practised fpr
many y&ars .in St. John’s Wood, and died on Jan. 1st. He
was elected.a Fellow of the Society in 1859» » * - v:><i, i.

John M. Burton, F.B.O.S., of Lee, died on Feb. 10th. He

TBB IiAWCigr,]_PB. JAMBS F.GOODHART ON PERITONITIS._ [Mabch5,1887. 461

was a well-known and respected practitioner in that
neighbourhood, where he had passed the whole of hie long
and industrious life. He became a Fellow of the Society
in 1862.

Henry Albert Lovett, M.R.OS., of Tasmania, died in July,
1885, but hie death was only reported to us in 1886. lie
-entered the Society in 1876. •

John Gittina, L.R.C.P., of Horselydown, was elected in
1867, and died on July 27th, aged forty-five.

Whilst closing these brief and imperfect records of our
'departed friends, I cannot bpt feel how often it has been
scanty and insufficient, but this has been due, not to a want
-of respect and appreciation on our part, but to the absence
of knowledge and details at oar disposal. It may perhaps
be said of them as of many other silent workers—

" The nobJert eervloe comes from tiaroeless heads.

And the beet servant doe* his work unseen."

It remains to me before leaving this chair, to which I was
-elected by your kindness two years ago, while apologising
to you for my many shortcomings, to thank you for your
.patient consideration and courtesy to me on all occasions;
and especially must I thank our secretaries for the help and
assistance'they have' accorded to me at all times. The work
-of oar secretaries, often laborious and self-denying, is known
to few; and I can only say that, as long: as the Society js
served by such officers as Drs. Herman and Champneys, we
-need have no fear either for its future prosperity or the pro¬
motion of obstetric science. Of my successor whom you
have elected unanimously to-night, Dr. John Williams, I
need say bat little; his name is a household word in the
-Society. Beyond his other and many qualifications, I know
•of no one who has its interests more, thoroughly at heart,
and 1 can only congratulate the Society on the wisdom of
its choice.

CASES OF PERITONITIS.

By JAMBS F. GOODHART, M.D., F.R.C.P.,

WHTSICUX TO OUT'S HOSPET AZ JJTD THK HOSPITAL FOB

CHILDKKW.

(Concluded from page 4 JO.)

Now another point. In some cases suppurative peri¬
tonitis is marked by all the severity of symptoms found in
acute plastic peritonitis, and in such there will necessarily
be the small, thready, wiry pulse, the collapse, and the
depressed temperature seen in the more rapid form of the
■disease. But I am now concerned with the cases of more
insidious onset, and in these another negative symptom, in
addition to the absence of fever, is quite likely to deceive—
•vis., the absence or comparative absence of pain. Mauy
years ago I remember examining a man, the other details of
whose malady have now escaped me, bilt as regards wham
this has remained firmly fixed in my memory, that he
allowed the freest possible manipulation of his abdomen
without evincing any pain, and yet within a few hours he
was dead, and I found the peritoneum to be full of pus.
That was an extreme case, but many times since then 1
have seen this: that the abdomen has been soft, not
markedly distended, ' and the tenderness, although not
absent, has been of.the slightest; conditions, in fact, which
would of themselves seem to negative rather than to suggest
the existence of peritonitis. 1

Next, a word as regards diarrhoea. Constipation is the
-symptom of peritonitis, not diarrhoea. So constantly is this
the case that, as I-h&te just said, one of the great difficulties of
practice is to say whether we are dealing with mechanical
•obstruction or the obstruction wrought by paralysed peri¬
stalsis. I am sure it is quite impossible in some instances
to be certain of the nature of the case without having
surgically a finger in the pie. Peritonitis is far the more
■common. But what about diarrhoea ? That may well seem
to negative peritonitis. It by no means negatives tuppura-
tive peritonitis. But more than this, I wish to insist that
when it exists with any symptoms of peritonitis it is, in my
experience, an omen of the gravest, I would almost say
fatal, import.

Some have laid stress upon the position of the pain in
peritonitis associated with cmcal inflammation. Some
have said that It is very liable to be referred to the

left groin, others to the umbilieus ; 1 would venture to
assert, on the other hand, that the peritoneum is very
treacherous in this indication. I remember some years ago
making a post-mortem for Sir William Gull and Mr. Bryant
upon a lady who had died with an illness of much obscurity;
and Sir William Gull said to me before commencing: " I
want the liver examined very carefully., 1 am sure there is
some disease in that neighbourhood; there was always so
much pain in the right shoulder.” This opinion was so far
correct that there was a considerable collection, of pus
between the liver and the diaphragm; but the real disease,
of which I believe there had not been a suspicion, was a
sloughing cascal appendix and suppurative peritonitis.

This case leads me to remark upon the very insidious
nature of some of these cases. In the two cases I first
narrated there were pains in the abdomen, which, had they
been more carefully attended to, might possibly have enabled
one to avert the disastrous result. But I remember two
other cases, which occurred to me some time ago, which
well illustrate this point. I was asked by Mr. Alexander to
see a policeman, not far from the hospital, because be was
having nearly daily repeated rigors of severity associated
with a temperature of 103°, and during the attacks his con¬
dition seemed to be a very alarming one. He bad had a
severe attaek of epigastric pain and jaundice five months
before, but had been well in the meantime.' When I saw
him lie was apparently pretty well, his temperature normal,
and all that 1 could detect was a little tenderness of the
abdomen near the gall-bladder. He remained thus without
any severe symptoms till the Monday, when he was suddenly
seized with intense epigastric pain, Collapse, and feeling
of impending death, and he died within two and a half
hours of his attack. We made a post-mortem examination
the next day, and found the caecal appendix twisted and
adherent to the caecum, dilated into a sac of considerable
size near its termination, with smooth abscess-like walls, an
ulcer into the peritoneal cavity, and a small concretion
escaping. There were extensive adhesions hetween the
liver and the diaphragm, and a large abscess between them
and in the right lobe of the liver.. Another very similar
case, I believe, for there was no post-mortem, I saw with
Dr. Bootbroyd of New Crosa, only a month or two ago, in
the person Qf a bealthy-looking man, aged twenty-five. He
had had a severe attack of abdominal pain and frequent
vomiting four months before) had been very ill at the time,
but got quite well. He had been ill nine days when I saw
him with remittent attacks of fever, sweating, and rigors.
He had a normal temperature, was sweating profusely, his
tongue a beefy red, and a rather full abdomen, but nothing
Capable of localisation. Remembering my former experiences,
I could not but fear that there was some deep-seated sup¬
puration about the mid-rib, but in the absence of any indica¬
tion of its exact seat, and having a dislike to bootless
prodding, we decided to wait for further knowledge. I did
not see the case again, but Dr. Bootbroyd told me that the
temperature continued to rise almost daily; the sweating
continued, a little more fulness appeared in the epigastrium,
and the lower lobe of the left lung became consolidated.
Dr. Bootbroyd still felt sure that there was an abscess high
up in the abdomen between the liver and diaphragm, or in
the liver itself, and I have not yet recovered from my disgust
at the stupidity of the poor man’s friends in refusing any
further aid, and in subsequently refusing to let us make an
inspection of the body.

One other word about these cases, which always seems to
me worth While to insist upon—viz, the frequency with
which pleurisy spreads from peritonitis, and peritonitis
from pleurisy. I was once in frequent attendance upon a
case of empyema with another medical man. It was in an
only boy, and anything the matter with him, or rather, in
his then condition, any variations in bis progress, were the
causes of repeated panics. I had left the house one morn¬
ing, the child doing perfectly well, for the rest of the day,
and returning at night found the whole place in a turmoil—
another doctor calm down from London, whispers of some
serious fresh complications, and so on. The child had suddenly
been seized with fresh pain in the upper part of the abdo¬
men, and was consequently in great distress for the time;
but f believe it was nothing more than the extension of
inflammation through the diaphragm, calling for the exhibi¬
tion of opium. At aU events, that treatment was adopted; all
the pain subsided, and no further evil happened.

I do not think the freedom of communication between the
serous sacs of peritoneum and pleura is sufficiently well z^co-

Digitized by GoOgle

462 Thb Lancet,]

DR. C. H. RALPE ON PHOSPHATIC DIABETES.

[March 5,1867.

gnised. We are all familiar with the jaundice, which is a not
uncommon feature of right-sided pneumouia, and we attribute
it, perhaps, vaguely to the proximity of the diseased lung
to the liver; but it is not so generally known that in a
great many cases there is a well-marked inflammation
of the peritoneum, in these cases limited to the surface of
the liver—a condition, in fact, of direct extension. This
extension occurred in three of the cases I have quoted, and
I might give several others. Not long ago I saw a boy of
fifteen with Mr. Withers Green of Serjeants’-inn, who had
been ill five days, and who was then dying of acute peri¬
tonitis, but he had, in addition, acute pleurisy spreading
up the left side. The point is clearly of much importance
both as regards prognosis and treatment. Indeed, as regards
diagnosis also it may not be unimportant, as one of the cases
I have mentioned shows. Surely, with abdominal pain and
vomiting, tenderness in the csecal region, followed by
diarrhoea, and then by an acute form of pleurisy, it is flying
in the face of probabilities to suggest anything else thau
a primary peritonitis followed by the pleurisy. As regards
prognosis, too, a daily examination with the stethoscope of
the lateral regions of the thorax will help us, sometimes by
the discovery of pleuritic inflammation, more correctly to
forecast the issue of the case.

I have not much to say dogmatically on the subject of
treatment. What I purpose is rather to say a word upon
the difficulty that besets us in this matter in these cases in
the present day. Take all the cases we have seen, and 1
suppose this to be the summary — they have all been
regularly and properly treated by opium, and perhaps bella¬
donna, local applications, and so on; they have all been
properly subjected to a rigorous limitation of food, both as
regards quantity and material; some,perhaps, have been fed
for a time exclusively on enemata, Nevertheless, some—I
will not go into proportions—a good many have got well;
but others—others, which at least promised equally well, or
better—have rapidly gone to the bad. That is where I stand
at present, and I only make the statement personal because
I am sure it is the experience of all. We have all seen
patients whose condition looked exceedingly grave pull
through by skilful medical treatment; we have all of us
seen cases that looked well die. See how difficult this
experience makes practice in the present day. How can we
tell in any given case whether to trust to medical treatment
alone, or to commit the fortunes of the patient to the chance
of relief by exploring the abdominal cavity. The peritoneum
is now dealt with by the surgeon under conditions of anti¬
septic surgery with the greatest freedom. We hear of
ovarian tumours with general peritonitis being removed
successfully—nay, more,of patients thus rescued from what
seemed the jaws of the grave. We hear of the peritoneum
being drained, washed out, sponged out, and so on, with
the immediate subsidence of alarming symptoms ; and this
question must occur to all of us when these cases
die without operation, “Could life have been saved by
opening the abdomen ? ” Now I am not writing to
advocate any general rule of treatment; my purpose is
rather to bring myself as near as may be face to face with
the difficulties of anyone called upon to decide this matter,
believing that by so doing anyone of us will be more master
of the situation in the next case of the kind that comes
before him, ev»>n if we decide nothing at the moment. I
have already stated the main difficulty, medically speaking.
The deaths make us think, “ I wish we had done something”;
the recoveries, “ I am very glad we waited.” Who can help
being undecided. But there are other difficulties. I have
alluded to the insidious nature and the obscurity of some of
these cases. See wbat this implies: firstly, the inertia
resulting from our fear of doing actual harm to the patient,
of submitting him to an operation the necessity of which is
not quite certain, and which if not necessary is harmful;
Secondly, the inertia supplied by the fear that the operation
may prove fruitless and the patient die soon after; thirdly,
the inertia resulting from a certain regard for our own
reputation, for in such a case it is very likely indeed to be
said that, the operation has killed the patient; and, lastly,
the inertia which results from the very natural antipathy
in everyone to the resort to painful treatment which
is the very breath of the atmosphere of “ home.”
Some may think such things trifles compared with the main-
say they the only-question, What is the best thing for the
patient ?—a stoical maxim of medical ethics which completely
demolishes indecision. 1 Venture to think, however, that a
paper argument of that kind is overweening, and that it is

through such ins-aud-outs as have been mentioned that on»
ultimately has to act. I shall not attempt to decide in any
detail what cases should be operated upon, what cases not.
I do not think it is possible to decide for more than one
case at a time, but I firmly believe that thinking the matter-
out in this informal way will enable us, sometimes at
any rate, to recommend an operation and to save a life.
There is no doubt this may be done much less fearlessly
thau in times gone by; and in any case where th»
symptoms are severe, and there is any tendency toward*
localisation of the mischief, this is par excellence the on©
most suitable for operation. Obviously so. But I ana
further inclined to think that others also, where the inflam¬
mation is more generalised, may sometimes be rescued, could
we in any given case appraise with sufficient skill the right;
value of the symptoms, nit off with balanoed judgment tho
proper point—the nick of time—on the inclined plane of
deterioration, and courageously make as little as possible,
instead of as much as possible, of the inertia remaining.

PHOSPHATIC DIABETES.

By CHARLES HENRY RALFE, M.D. Cantab., F.R.C.P. L.„

ASSISTAHT-PHrSICIAJT, LOXDOIT HOSPITAL.

(Concluded from p. US.)

Group 3. Increased excretion qf phosphoric acid alternating
or coexisting with saccharine diabetes. — I am indebted to
Mr. Meredith for a unique example, as far as my experience-
goes, of phosphatic, replacing saccharine, diabetes. The case
was that of a young American gentleman, aged twenty-one.
and a student of Harvard University. About two years
previously to my seeing him he was training for a college
boat-race, and one day, whilst practising, he was much
exposed to the sun's rays, which fell on the upper part of
his back and neck, which were not protected by his rowing-
jersey. So strong was the action of the sun that he felt
very faint, and the next day the skin of his neck was
blistered, and for some time afterwards his neck felt stiff.
About six months after this it was noticed that he was
looking pale and thin, and had lost weight, and he himself
complained of weakness and of sciatic pains. Dr. Sabine,
bis medical attendant, then discovered sugar in his urine,
and a sample being sent to the laboratory at Harvard, it
was found to contain as much as 5 per cent, of sugar,
whilst a decided increase of urea and phosphoric acid was
also noted. A strictly regulated diet controlled the amount
of sugar, but it always asserted itself again on the slightest
breach of discipline or attempt to study, or after more
than ordinary exercise. It was then determined that he
should come to Europe, and see if anything fresh couldr
be suggested. On his arrival Mr. Meredith kindly gave him
my name; the reports of the American physicians were
handed me, and the urine of the twenty-four hours was sent
to me for analysis. It was extremely acid, normal in
amount, but with a specific gravity of 1040; it contained
2£ per cent, of sugar, the patient being on partly restricted
diet; there was also considerable excess of urea and phos¬
phoric acid. The patient had loet altogether more than a
stone in weight, was much depressed, suffered greatly from
headache, pains in the pelvis and thighs, and was also-
troubled with boils. I ordered the patient to continue hie
diet, put him on liquor arsenical is bromidi, and told
him to take two Russian vapour baths a week. Thia
treatment was continued three weeks, and the patient wae
better in every way. There was only a trace of sugar in tho
urine, the pains had diminished, and there was less headache.
The treatment was continued for another month, during
which period the patient, instead of residing in London,
spent the time chiefly at the seaside. The urine now becamo
free from sugar, except every now and then, when a trace
appeared; but, to my astonishment, there was no great fall in
the specific gravity, which, with a normal secretion of urine
(from forty to fifty ounces daily), ranged from 1030 to 1083;
and it was then I found that he was passing daily an enor¬
mous quantity of phosphate of lime. I now placed him
upon mineral acids with nux vomica, and told him to take a
tablespoonful of cod-liver oil once a day in lime-juice, and
to spend the summer among the high Alps. A slight relaxa-

Th* Lancbt,]

DR. 0. H. RALFE ON PHOSPHATIC DIABETES.

[March 6,1887. 463

tion wu permitted in his diet, & small quantity of wheat
bread and some of the least injurious vegetables, such as
tomatoes, French beans, cauliflowers, See., being allowed.
He was away the greater part of three months, and on his
return looked much improved, had gained six pounds in
weight, lost all his pains and headache, and was able to take
long walks without fatigue. The urine still continued at
from forty to fifty ounces, but the range of specific gravity
was now 1024 to 1027, and the amount of phosphoric
acid daily excreted, though far from being within normal
limits, was still much reduced; no sugar had been seen for
several weeks. He now returned to America, with instruc¬
tions to follow a moderately restricted diet for at least two
years, not to study more than three hours daily, to be
careful not to engage in athletic pursuits, and only to take
moderate exercise. A year after bis return 1 received a letter
to say that he had completely regained his health—that he
was completing his course at the university, and that
for the summer be intended to camp out west on one of the
prairies. His urine, which, according to mjr advice, is i
examined once a week, is still normal in quantity, and the
specific gravity is nearly so; the sugar only occasionally i
reappears in minute quantities.

■In a second case the phosphaturia coexisted with a mild
form of diabetes. This patient first came under notice in
1880; he had suffered some time before from saccharine
urine, which, however, had not much affected his general
health, when he began almost suddenly to experience
constant aching pains in the loins and pelvic region; he
also became dispirited and hypochondriacal, and began to
lope flesh. The amount of sugar had always been controlled
by diet, and at the onset of these symptoms he certainly
was not passing more sugar than he had done before. Nor
could any correspondence be observed between the amounts
of sugar and the amount of phosphoric acid, for the mean
of three observations made when no sugar was present in
the urine gave a daily excretion of C‘7 grms., and b'8 grins,
(also the mean of three observations) when the sugar was j
considerable. After treatment the daily average excretion i
was reduced to 3'8grm&, but the sugar still remained i
persistent, always returning when the dietetic regulations
were at all relaxed. The patient, who is still living, says i
that the tendency to excessive pboephatic excretion recurs j
from time to time, and that he can always tell when to
send his urine for examination by the recurrence of the I
boring and aching pains in the loins and pelvis.

In a case for which I am indebted to Mr. Pearce Gould, I
sbgar had been found repeatedly in the urine by the medical
attendant, and the patient’s diet regulated accordingly.
Owing to some mistake, the patient’s visit to me was
delayed some weeks, during which he was under dietetic
restriction. When I saw him, the urine contained no sugar,
but had a specific gravity of 1030, was highly acid, and
contained a very considerable excess of phosphoric acid.
This patient, Mr. Gould tells me, is now quite well.

Uboup 4. Increased elimination of phosphoric acid, without
cwy special connexion, apparently'running an independent
pmrse.— I have notes of five such cases. In all, the elimina-
fibn of phosphoric acid was considerable; the patients
•offered from boring, aching, rheumatic pains in the loins
sad in the pelvis, together with hypochondriasis and some
degree of emaciation. The urines varied; in some the i
secretion was normal, but in others increased. The urea
was always in excess, and with the excessive excretion of
phosphoric acid a deposit of calcium oxalate was nearly
invariably noted. All complained more or less of constipa¬
tion alternating with a yeasty-looking diarrhoea, and in¬
digestion and flatulence were always more or less prominent.
A* these cases correipond in most particulars with those
described some years ago by Beneke in his work oh the
pat hology of Phosphate and Oxalate of Lime,” I have not
wfonght it necessary to quote them separately. None, of
resemble those described by Professor Teissier, as
Amdatfe g saccharine diabetes only without the sngar. As
» have add; they seem very much like ordinary cases of
so-called oialoria.

. Of th e thirteen cases thus briefly recorded all with the
exception of two occurred in young male adults. The
syap totng eommoti to all, though varying greatly in donee,
* * m Boms cm to the extent of consider-

affacting
dry harsh
ravondus,
ssaer says

•M® ettaristton; aching +k*umtkic- pains, ohiefly
“elowerpajidf the book trad pel¥tc regiaue; a
j td boQf; appetite generally
raoTidd 'raftHMd bf food. jTbj

that in some cases under his observation cataract has
developed, just as in saccharine diabetes; this 1 have never
noticed. In the majority of cases there was polyuria, but
this in no way approached, either in amount or character,
the polyuria of diabetes insipidus. The increase of urinary
water rarely ever exceeded four pints and a half; the
highest observed, with the exception of the doubtful
case of tumour of the brain, was eix pints, as compared
with the enormous diuresis of diabetes insipidus; whilst
instead of the specific gravity falling to an extremely
low limit, as in insipid diabetes; it was well maintained,
showing that, unlike the insipid form, there was in these cases
a very considerable drain of solid matter from the body. In
some of the cases, however, the amount of urine passed was
normal, but in these the specific gravity was greatly in¬
creased, all pointing to the same fact—viz., the increased
elimination of solid matters by the urine. In all my cases
the urea was in excess—in some to a considerable extent; in
others it was not so marked. Teissier, however, has pub¬
lished cases in which no increase of urea was observed, and
he contends that it is not atari necessary that there should
be any when there is an increased elimination of phos¬
phoric acid. On this point an observation of Sir William
Roberts throws some light. Speaking of the cases originally
described by Prout under the term “ azoturia"—cases ex¬
hibiting a dense urine and a train of nervous symptoms,—
he says that these tubed out, on more exact investigation,
to want the special feature indicated by. Prout as the
essential one—namely, an absolute increase in the daily dis¬
charge of urea. It does not appear that in these cases Sir
William Roberts determined the amount of phosphates pre¬
sent in the urine; had he done so, he most probably would
have found them in considerable excess. Indeed, it is difficult
to account for the. increased density of the urine otherwise;
for if there was no excess of urea, and there was no sugar
present, what else could increase the density of the urine
but the inorganic constituents ? Now an excess of chlorides
does not increase the density of urine, because, unless water
is withheld, they always increase the flow of aqueous excre¬
tion, so, if anything, the specific gravity falls. Whilst the
sulphates when in excess in the urine are always accompanied
by excess of urea, which Sir William Roberts tells us in
these cases was not observed. There remains therefore
only the phosphates as likely to cause the increased density
of-urine; and as Professor Teissier has shown, and as also
the observations of Zuelzer, Edlessen, and others have shown,
the excretion of phosphoric acid may be very greatly in¬
creased without any corresponding increase in the amount
of urea. The great feature, therefore, of these cases is the
increased elimination of phosphoric acid, with or without a
corresponding, increase if the other constituents of the urine-
a feature which distinguishes ic from insipid diabetes, with
which it has been improperly confounded, and in which
there is only an increase of water and no other morbid
change; and from azoturia , in which urea is decidedly
increased.

With regard to the pathology of the condition, many
views have been brought forward, which are too numerous
for discussion here. 1 will only therefore mention those
that occur to me as being most probable. In the first place
I would reduce the four groups to two—placing Groups 1
and 2 together, and likewise combining Groups 3 and 4. I
do not believe that phthisis is ever necessarily attended or
preceded by an exaggerated excretion of phosphoric acid.

I have examined the urine of a good many tubercular and
phthisical patients in all stages, and failed to establish any¬
thing of the sort. It is true that Marcet has found a great
diminution of phosphoric acid in the ash of diseased lung
as compared with healthy lung, but the removal of the
phosphoric acid would be so gradual as scarcely to affect
the urinary secretion. I believe, therefore, that the cases
of increased excretion of phosphoric acid associated with
lung disease are accidental. Naturally one would expect
abnormal tissue metabolism in weak and delicate subjects,
and certainly phthisical tendencies would be likely to be
developed iu persons suffering from a long-continued drain
of such an important vital constituent as phosphorus. . u

Then, again, with regard to the cases in which nervous
symptoms are prominent, are these due to disintegration of
nervous tissue ? is there Increased oxidation going on ? and
are the phosphates an expression of the destruction of tissue b ■
I think not, and I think the fact that the other urinary con¬
stituents are not always increased pari passu strongly against •
this view; .whilst the fact established by recent German

464 The Lancet,] MR. MAYO ROBSON: TREPHINING POR PARALYSIS OF RIGHT ARM. [Mab/ih 6,1887.

observers, that increased elimination of phosphoric acid
occurs chiefly in depressed conditions of the nervous system,
and that there is evidence of lowered vitality generally,
paints, to my mind, rather to defective than to increased
metabolism, that the tissues are unable to utilise the
phosphorus brought to them for nutrition, and that conse¬
quently a greater amount has to pass through the system
daily. I am therefore inclined to classify the first two
groups as cases of excessive elimination of phosphoric acid
dependent upon defective nutrition.

With regard to the last two groups, the one relating to
the connexion between sugar and phosphoric acid in diabetes
mellitus is the more interesting. Many explanations have
also here been suggested. One, that phosphoric acid replaces
the sugar in consequence of some occult change in the
nervous system, may be dismissed as visionary and vague.
The others that occur to me as being most likely are (a) that
instead of the sugar passing into the urine, it becomes
partially oxidised in the system into a series of acids—oxy-
butyric, crotonic, glyoollic, lactic, &c.,—which, circulating
through the tissues, dissolves out the phosphates, especially
the earthy salts. This explanation receives support from
reoently ascertained facts respecting the nature of the “acid
intoxication ” that so frequently marks the course of diabetes.
The other explanation is that in diabetes mellitus, as is now
a well-recognised fact, there is a considerable elimination of
phosphorus in an unoxidised form, as lecithin, or glyoerine
phosphoric acid. Now, should improved oxidation take
place in the body, this unoxidised phosphorus would probably
undergo oxidation and appear as phosphoric acid. This
view is supported by the fact that in the two cases in which
sugar had been observed, but had disappeared and been
replaced by an excessive excretion of phosphoric acid, the
tendency was towards recovery. At first, with defective
oxidation there was sugar and probably unoxidised phos¬
phorus; with improved oxidation the sugar disappeared,
and the lecithin or glycerine phosphoric acid was oxidised
into phosphoric acid; and a further improvement led to the
disappearance of the excessive excretion of phosphoric acid
and ultimate restoration of health. No doubt both con¬
ditions—namely, the imperfect oxidation of sugar into
intermediate acids and the oxidation of unoxidised
phosphorus into phosphoric acid—are at work in these
cases. With regard to Group 4, which ran a distinct
course without association with any special form of dis¬
ease, as I have already said they seem to correspond,
as far as I have been able to judge, with those cases
of oxaluria attended with increased excretion of phosphoric
acid described by Beneke, who considered them to be due
to the excessive formation of lactic acid in the intestines
and its absorption into the body and dissolution of the
phosphates out of the tissues. These cases, then, pro¬
bably depend on a similar condition, such as that which
causes the appearance in excess of phosphates in saccharine
diabetes. I think, therefore, we may classify these two
groups as cases of excessive elimination of phosphoric acid
dependent on abnormal formation of acid within the body.

With regard to the prognosis in these cases, those arising
from defective nutrition are the most unsatisfactory. With
rest—or, better still, the employment of massage—they
regain weight, and the excessive elimination of phosphoric
acid is somewhat diminished, never completely; then when
allowed to get about they fall back again, till, owing to the
general exhaustion, they become victims to some acute
disease, or else drift on into phthisis, or, as Teissier says,
sometimes into saccharine diabetes.

With respect to the second division, the prognosis is
more favourable. Of the three cases of saccharine diabetes
associated with considerable excretion of phosphoric acid,
two got quite well; the first, step being the replacement of
the sugar by phosphoric acid in excess. The second case
has remained a mild case of diabetes mellitus for over seven

years.

Concerning the cases resembling oxaluria with increased
phosphoric add excretion, they Usually get much better
under appropriate treatment, but are troublesome from their
frequent relapses.

Lastly, in respect to the term “phosphatic diabetes,” as
will have been gathered from the preceding remarks, exces¬
sive elimination of phosphoric acid is symptomatic rather
than a disease per se. It would be wrong, therefore, to use
such a distinctive appellation without strictly limiting the
conditions of its use. And this would be to employ it as
a ^distinguishing term from “ phoaphaturia." This latter

admirably describes that condition in which phosphates are-
precipitated from alkaline urine, whether fixed or volatile
but as it would be awkward to speak of phosphaturia.
due to deposition, and of phosphaturia due to excessive-
elimination, I would propose to use the term “ phosphatic
diabetes ” to distinguish the latter, and retain phosphaturia
to designate the former, condition.

Queen Anne-itroet, W.

CASH OF

TREPHINING OVER THE LEFT BRACHIAL.
CENTRE FOR PARALYSIS OF THE RIGHT
ARM DUE TO A BLOW A WEEK PRE¬
VIOUSLY; CURE OF PATIENT.

By A. W. MAYO ROBSON, F.R.C.S.,

HONORARY BURGEON TO THK LEEDS GENERAL INFIRMARY, AND
LECTURER ON OPERATIVE SURGERY AT THK
YORKSHIRE COLLEGE.

The following case, the notes of which have been furnish e<J
by my house-surgeon, Mr. Ashton Street, presents so many
points of interest that I venture to think a somewhat
detailed description may interest the readers of Thr Lancet,.
especially at a time when cerebral localisation, as applied
to brain surgery, is engaging the attention of the pro¬
fession.

' J. S-, aged thirty-eight, was admitted into the General

Infirmary, Leeds, on August 9th, uuder the care of Mr.
Mayo Robson. He gave the following account. Whilst
walking along the street six days previously he was struck
from behind over the head by a buckhom-hondled stick.
He does not remember the blow, and was totally unconscious
for ten hours. Just before recovering consciousness there
was some vomiting. He noticed as soon as he regained bis
senses that he had lost the use of his right hand. He was
dizzy and confused for some days, and had impairment of
memory, as he remembered some events in the police-
court, but not all. He was so far bright and intelligent,,
however, as to give evidence in court the day after the
accident. He was apparently so little injured that a surgeon
who saw him thought his arm was powerless from simple
braising due to the fall, and his head so little damaged as
not to require dressing. He noticed that his right fingers
and hand began to twitch twenty-four hours before
admission.

On admission there was a lacerated wound about l in-
long, too small even to admit the tip of the little finger,
situated over the left side of the skull, 5J in. from the root
of the nose, 5 in. from the left external angular process of
the frontal bone, 4^ in. from the root of the zygoma, 6£ in.
from the external occipital protuberance, and II in. to the
left of the middle line. On digital examination through the
integuments very little could be made out, as there was
some inflamma tory swelling; but on probing the wound
bare bone could be plainly felt, and at the posterior part
the probe could be felt to drop suddenly for about I in. The
whole of the right forearm and hand were markedly
paralysed, the extensors and supinators being entirely power¬
less, whilst with the flexors he could barely make his grasp
felt. The muscles of the upper arm were only half as
strong as those of the opposite side, but the shoulder
muscles were equally powerful. Sensation was much im¬
paired, considerable pressure being needed to make him
feel; but when he did he recognised the kind of touch and
noticed the temperature. There were constant rhythmic
twitchings of the fingers, and occasionally of the band and
arm, those of the fingers being about 40 per minute. The-
hands were of the same temperature, but he had a peculiar
numbness in the right. He was able to walk, the right leg
seeming to be as powerful as the left; but the cremasteric
and knee reflexes were both exaggerated on the right side.
He was able to whistle, hot not nearly so loud as before the
accident, and could only screw his eyes up with difficulty.
His pupils were of medium size and reacted quickly to light.
There was well-marked oedema of the left optic disc; his
sight, however, was good. Hearing was slightly deficient.
He complained of pain at the seat of the wound and all over
the frontal region, but more on the left side. He was per¬
fectly conscious and answered questions with rapidity. Ris

ed by GoO^lC

The Lancet,]

DR. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA.

[Mabch 5, 1887. 465

breathing was easy and tranquil; his pulse 86, full and
soft; his temperature in the axilla 98*4°. He could swallow
well, and passed urine normally.

Mr. Mayo Robson at once decided to operate. The patient
having been put under ether, the head was shaved and
cleaned, first with turpentine and afterwards with per-
chloride of mercury solution. Under the spray, and with
-full antiseptic precautions, a crucial incision was made, the
arms being 1£ in. long. The flaps so formed were reflected,
exposing the wound in the bone, which was found to be a
trifle over f in. in diameter. The whole piece of bone was
depressed, the posterior part being more so than the anterior.
The margins of the surrounding bone were remarkably
dean cut and circular, almost as if a piece had been punched
out. The periosteum from the neighbouring bone was not
stripped. A trephine fin. in diameter was applied, but as
the centre pin could not be used rather mere bone was taken
from the posterior edge than in front. The outer table and
diploe were then raistxl in one piece by the elevator, but the
inner table was found to be splintered in all directions, one
piece of the size of a finger-nail depressing the membranes
very considerably, just over the ascending frontal convolution.
These fragments were carefully picked out, but without using
much force, as the dura mater was stripped from them.
The dura mater, which bulged slightly into the wound after
the bone had been raised, was markedly pulsating; it was
not perforated, and the surface seemed perfectly healthy.
The wound was syringed out with perchloride lotion (1 in
600), and the bleeding vessels in the flaps, which had been
temporarily stopped by clips, were ligatured. The flaps
were then stitcned with catgut, and a small drainage-tube
put in the centre, so that the bottom of it was just free of
the dura mater. The wound was again syringed and dressed
with a layer of wet carbolic gauze, iodoform, and salicylic
silk. The patient took ether very well, but bis pupils
dilated and remained so during the operation. After the
elevation, and whilst the patient was still under ether, it
was noticed that the twitcbings had oeased, but whether
this was due to the anaesthetic or to the operation is not
known, as, unfortunately, the condition of the hand was
not noticed before the elevation. The whole operation only
lasted twenty-flve minutes. He soon recovered from the
anasthetic, and for the first hour had great pain in his head,
but the twitchings in the hand had ceased; they returned,
however, in the second hour with greater severity. At
fi p.jc.— i.e., four hours after the operation—he was much
easier. Temperature 98’6°; pulse 80. At 12 p.m. the patient
slept, but was restless; he had no pain except slight frontal
headache. The hand was much stiller. Pulse 72. The
twitchings did not stop during sleep.

Aug. 10th.—Patient felt much better and had no pain;
pulse 72.—11th; Slept well in the night, and during sleep
the movements of the hand Btopped. Wound was dressed
for the ft rat time, the spray being used. The tube was
Temoved, as the wound looked well and there was no pus.
Movements of Angers were much less frequent.—12th
Patient was so well that he wanted to get up. Tetnperature
and pulse normal. His diet having been confined to fluids
since admission, he felt hungry, and asked for and was
ordered solid food. Power in the hand had very slightly re¬
turned. Twitchings were rather less frequent. Had slight
soreness in the concatinate glands. Temperature normal.—
15th: Patient dressed, as the glands were rather swollen
and painful. There was a little oedema of the scalp,
hut no suppuration. The centre of the wound where
the blow was given gaped a little, as the tissues had
been bruised and lacerated. Pulse 70.— 17th: Swell-
ioR of glands was subsiding. Pressed under the spray,
and the wound found healed, except the centre of the
otom, which was still open. Twitchings had completely
gone, and since the 16th he had only had one or two, when
he attempted to raise the arm. Patient could hold his hand
straight up without the fingers falling. Slight increase of
power when the band was held horizontally.—19th : Grasp
of right hand could be plainly felt in any position, equal to
the grasp of thumb and forefinger of the left hand. The
oedema of the optic disc had disappeared, the outline being
clear and normal.—21st; Grasp of dynomometer with right
36 lb., with left 95 lb.—25th: Grasp of right hand 60 lb.,
“■ft 95 lb,—28th: Patient got up, but felt a little dizzy.—
Sg. : Wound quite healed. Grasp of right hand 70 lb.—
*hd; Patient discharged cured. Both hands and arms
**^*“7. Strong, ■ N 6 headache or dizziness. Sensation
temperature throughout had been normal.

Remarks. — The man had evidently only been seen
casually by a surgeon on account of the arm, which the ,
patient thought had been bruised by the fall, the head
injury appearing trivial; but the case illustrates well the
great importance of a very careful examination in all, even
trifling, head injuries, as out of this misapprehension arose
a medico-legal difficulty, the assailant having been sent for
a week to prison foT ordinary assault, when it might have
been a case of manslaughter. Further points of interest in
the case are—(a) The recovery of consciousness and intel¬
ligence within a few hours of the aecident, although the
local paralysis continued; concussion apparently accounting
for the former and bruising and pressure for the latter.
(6) The exact correspondence as proved by measurement of
the brachial centre and the wound, (c) The threatened
extension of paralysis to the facial, which adjoins the
brachial centre. ( d ) The congestion of the optic disc on
the injured side, which congestion disappeared within a few
days of the operation. ( e) The exaggerated cremasteric
and knee reflexes on the right side. (/) The localised
rhythmic epileptiform movements of the paralysed hand
and arm, which began on the fifth day after the accident,
were forty to the minute at the time of operation, ceased
for an hour afterwards, then retained as frequently as ever,
to gradually lessen in violenoe and number until they dis¬
appeared on the sixth day after operation, (g) In the
success of the measures taken to render the wound aseptic,
although it was thoroughly septic at the time of admission,
and had been exposed for six days previously. (A) Lastly,
in the oomplete and perfect recovery of the patient.

Leedt.

PYREXIA AND HYPERPYREXIA.

By T. J. MACLAGAN, M.D., M.R.CJP.,

PHYSICIAN IN OSDINi.Br TO THEIR BOTAL HIGHNESSES PBINCB AND
PRINCESS CHRISTIAN OF SCHLESWIG HOLSTEIN.

(Continued from page H6.)

It is evident that the view that the nervous symptoms of
hyperpyrexia are caused by the high temperature lacks the
clinical support which would commend it to our reason.
Experimental evidence seems to afford to it more support.
The chief evidence of this kind is that adduced by Wood. 1
He placed rabbits, cats, and dogs in a box, and raised the
temperature of this 120° to 180°, and found that in animals
so exposed the temperature rapidly rose, and that by the
time it reached eight or ten degrees above the normal the
animals died. The experiments were evidently performed
with great care, and the results very accurately noted. From
these Dr. Wood draws the conclusion that it may be regarded
as proven that “external heat applied to the body of
normal animals, including man, so as to elevate the internal
temperature, produces derangements of the functions of
innervation, of respiration, of circulation, &c., precisely
similar to those seen in natural fever, the intensity of the
disturbance being directly proportionate to the rise in tempe¬
rature.” He further adds, no doubt in explanation of Ms
including man in this generalisation, that “ the brain of
a man is much more highly organised, and no doubt corre¬
spondingly more sensitive, than that of a cat; and if a tempe¬
rature of 113° F. be fatal to the brain of a cat, whose normal
temperature is 102-5°, it seems very certain that the tempe¬
rature of some cases of insolation (113°) is sufficient in itself
to cause death in man, whose normal temperature is 99°.
Much as one admires the patience and skill with which
Dr. Wood made his observations, one cannot fail to see that
they do not warrant these inferences, and that Dr. Wood
has failed to grasp the correct interpretation and bearing of
his own faqts.

In the first place, there are no grounds for “including
man” in the general inference which he draws. No obser¬
vations were made on man, and in this matter the results
of experiments made on cats and dogs cannot be accepted
as applicable to him. Man naturally eliminates through
his sum an enormous amount of heat, and possesses a power
of accommodating himself to high temperatures, whioh is
not possessed by the animals experimented on by Dr. Wood.

1 Fever: a Study In Morbid And Normal Physiology. By B. C. Wood
M.A., M.D. Philadelphia, 1880 . Digitizea by VJil/OV IA.

466 Thb Lancet,]

DF. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA.

[March 6,1887.

The temperature which he found proved fatal to cats and
dogs is one to which man may be and constantly is exposed,
without serious results. Every time we take a Turkish bath
we are exposed for a length of time to a much higher tem¬
perature than that to which Dr. Wood’s animals were
exposed.

In the second place, it is not an accurate statement of the
physiological position to say that because a man's brain is
more highly organised than a cat’s it is correspondingly
more sensitive to heat; and that because the normal tem¬
perature of man is 98 5°, a temperature of 113° must be a
more serious thing to him than it is to a cat whose normal
temperature is 102'5°. What Dr. Wood really found was that
when the bodily temperature of rabbits, cats, and dogs rose
8° or 10° above the normal the animals died. But a rise of
8° or 10° above the normal produces per se no serious
symptoms in man, as is evidenced by tbe frequency with
which such a temperature occurs in relapsing fever without
the occurence of any other symptom to distinguish the
cases in which it occurs from those in which the tempera¬
ture is several degrees lower. That is the proper way to
put Dr. Wood’s facts. The reason why the temperature
which he found to be fatal to cats and dogs does not pro¬
duce serious results in man is that he can naturally bear a
much higher temperature than they, and that the surface of
his body possesses a heat-eliminating function which is not
possessed by that of cats and dogs.

Then, again, I do not think that Dr. Wood has correctly
interpreted the mode in which death was produced in his
animals. He says that the derangements produced were
“ precisely similar to those seen in natural fever, the
intensity of the disturbance being directly proportionate to
the rise in temperature.” Of course, this disturbance was
most pronounced in the animals which died. But when we
come to inquire into their mode of death, we find it stated
that in these fatal cases the heart continued to beat for
some time after respiration had ceased. Now, there is no
form of fever in which death is ever brought about in that
way. In fever death results either from asthenia or coma—
cessation of cardiac or cessation of cerebral function; but,
in Dr. Wood's animals it was brought about by arrest of
pulmonary function. His animals died neither of pyrexia
nor of hyperpyrexia, but from cessation of pulmonary
function ; and it is not difficult to say why this should have
been their mcde of death. Man eliminates heat by the skin ;
the animals experimented on by Dr. Wood eliminate it by
the lungs. Breathing as they did in the hot box an atmo¬
sphere with a temperature many degrees above that of their
blood, it was impossible for them to throw off heat; in such
an atmosphere they could not eliminate heat any more than
they could eliminate carbonic acid in an atmosphere charged
with that gas; heat therefore accumulated in the system.
The result of the accumulation in the system of any excretory
compound is first stimulation, and ultimately arrest, of the
functional activity of the organ by which it is normally
eliminated. Accumulation of heat, in the blood of Dr.
Wood’s animals thus led to arrest of pulmonary function,
much in the same way that accumulation of carbonic acid
in their blood would have done. It was not the heat they
took in, but the heat which they failed to give off, that
killed them. That was how and why his animals died. But
that is a result which could not be produced in man by a
like agency, simply because he eliminates heat through his
skin. He might die from too great heat, but death would
not be brought about by arrest of pulmonary function.

Moreover, there is another point in connexion with Dr.
Wood’s investigation which, though a side issue, is not
altogether to be lost sight of. In his animals heat was
applied artificially; by this they were heated up, and the
sole question for consideration is the action of this heat on
their economy; but in fever and hyperpyrexia there is no
artificial heat, and the question at issue is not only the
action of the high temperature, but also its mode of pro¬
duction—not only what does the heat do, but how does it
come to be there. On this, the main question which has to
be considered in dealing with this subject of the hyper-
pyretic state as it occurs in man, the experiments referred to
throw no light. Reasons will hereafter he given for the
belief that the high temperature is a result rather than a
cause of disturbance of the nervous centres. Meantime, l
wish only to point out that, so far as concerns the action
of high temperatures on his organi-m, man is not in
the same position as the animals experimented on by
Dr. Wood—that he possesses a power of accommodating

himself to extremes of temperature which is not possessed
by them, and that, for the reasons given, Dr. Wood’s experi¬
ments cannot be regarded as supporting the view thatiu
the hyperpyrexia of man the high temperature is the cause
of the nervous symptoms. It is incumbent upon us to
explain the occurrence of the high temperature, ns well as
the nervous symptoms; and no view of the mode of produc¬
tion of the condition to which we apply the term hyper¬
pyrexia can be regarded as satisfactory which does not ex¬
plain one of its most prominent and striking features—that
from which it takes its name. But on the view that
the high temperature is primary, how arc we to do so ?
It is evident that neither the clinical nor the experimental
evidence favours the view that the high temperature is the
cause of the nervous symptoms. The alternative view, that
the high temperature is secondary to disturbance of the
nervous centres, has much more to commend it. The
constancy with which, under the most diverse external con¬
ditions—in the Arctic cold as in the heat of the tropics,
the temperature of the human body remains at 98 4°, liH'
led physiologists to look beyond the crude physical con¬
ditions of tissue change and surface transpiration, and to
regard a special centre controlling and regulating the
formation and elimination of heat as essential to the expla¬
nation of the phenomena which have to be considered.
Without some such regulating centre it is difficult to see
how the temperature equilibrium could fail to be frequent)'
disturbed by agencies which, as it is, have no effect upon it.

The tendency of modern physiology and modern research
is more and more towards the recognition of the doctrine of
localisation of cerebral function, according to which circum¬
scribed aud limited portions of the nervous centres preside
over, control, and regulate particular actions and functions
We recognise the existence of centres for the specia'.
senses of sight, hearing, taste, &c., as well as for speech,
mastication, deglutition, &c., aud the position of these in
the nervous centres can be defined with more or less exact¬
ness. We recognise, too, and define the position of a
respiratory centre, a cardiac centre, and a vaso-motor
centre. But we go even further than this, for the experi¬
mental investigations of Fritsch and Ilitzig, of Ferrier, Yeo,
Munk, and others, have enabled these observers to map out
on the surface of the brain a series of circumscribed areas,
stimulation of which by means of electricity causes con¬
traction of certain muscles of the opposite side of the body.
Thus they have been enabled to demonstrate that particular
groups of muscles are presided over by a special portion
of brain. The muscles of the forearm have their special
area; the muscles of the face have another; a third presides
over the muscles of the tail; and so on, each particular group
of muscles being apparently presided over by a specia'
central motor area. With the localisation of cerebral func¬
tion thus demonstrated in so many casee, and with even the
position of various controlling centres thus more or less
accurately defined, we have good a priori grounds for regard
ing the existence of a thermic centre as at least not im¬
possible. But there exist other than a priori reasons. There
is not a little evidence, both physiological and pathological,
that such a centre does exist.

In 1837 Sir Benjamin Brodie drew attention to the fact
that injury to the upper part of the cord was, under certain
circumstances, followed by a great rise in the temperature
of the body. Since then the accuracy of Brodie’s state¬
ment has been amply confirmed. The subject has recently
been experimentally investigated by Dr. Wood, and much
valuable information has been got from his researches. He
made sections high up in the cords of a large number of
dogs, the general result of which was to show “that after
section of the cord there are two distinct antagonistic forces
at work, the one depressing, the other increasing, the pro¬
duction of heat.” The nature of these forces was deter¬
mined by carefully conducted experiments. It had already
been shown by tbe researches of Dittmar, Owsjannikow,
and Heidenhaim, conducted independently of each other
that the chief vaso-motor centre has its seat in
the medulla oblongata. Owsjannikow defined its seat
as being in a region “whose upper boundary is one or two
millimetres below the corpora quadrigemina, and whose
lower boundary is four or five millimetres above the point of
the calamus scriptorius.” Wood made a number of experi¬
ments with the object of satisfying himself on this point, and
came to the conclusion that Owsjannikow’s statement
was accurate. “The evidence,” he says, “seems to me con¬
clusive that the chief governing vaso-motor centre is placed!

Thb Lancbt,]

DR. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA.

[March 5,1887. 467

iu toe dower port of the floor of the fourth ventricle near
the point of the calamus”—almost exactly the seat assigned
to it by Qwsjaunikow. Stimulation of this centre causes
contraction of all the arteries, and consequent great increase
of arterial blood-pressure. Paralysis ot this centre causes
•dilatation of the arteries, and fall of blood-pressure. Such
changes in the circulation could not fail to have a modifying
influence on the temperature of the body; for it is obvious
that contraction of the arteries would lead to diminished
iljw of blood to the surface of the body and consequent
diminution in loss of heat, while their dilatation would have
the reverse effect. In investigating the effects of section of
the cord on the temperature of the body it was therefore
essential to determine how far the results obtained were or
were not due to injury of the vaso-motor centre and con¬
sequent disturbance of the circulation.

Having satisfied himself of the exact situation of this
•centre. Wood proceeded to make sections above and below
it, and to contrast the results. Section of the cord belo w the
vaso-motor centre paralysed the vaso-motor nerves. The
immediate result of this is dilatation of the bloodvessels.
This flushing of the superficial vessels necessarily leads to
great loss of heat. The blood being spread out, as it were,
over the surface of the body, is more freely exposed to tbe
cooling influence of the atmosphere, and more readily parts
with its heat. The results of his carefully conducted ex¬
periments satisfied Wood that “injuries of the medulla
below the calamus cause a fall of the animal temperature
nud of arterial pressure, and confirm the belief that the fall
of temperature is due to vaso-motor paralysis.”

The next point was to determine the effects of wounds of
the medulla made high enough up to avoid injury of the
vaso-motor centre; with this object a number of experiments
were made. The matter is thus summed up: “The results
of our whole study as to the effects of separation of the
medulla from the pons upon thermogenesis may be formulated
as follows : Section of the medulla at its junction with the
pons is followed by increased heat-dissipation and increased
heat-production, the increased dissipation usually not keep¬
ing pace with the increased production, so that the bodily
temperature rises.” The increased dissipation is, of course,
merely a result of the greater heat of the body—a result
which necessarily follows increased production when the
vaso-motor system is intact. “ Increased heat-production
being the cause of the increased heat-dissipation, the
problem presents itself—What is the cause of the increased
heat-production ?”

It waa suggested by Heidenhaim that the rise of tempe¬
rature might result from irritation of the vaso-motor
centres; but, as Wood remarks, “it is a general guiding
principle in making deductions that section of a nerve
■induces abolition of function, and that the symptoms which
follow such section are paralytic unless clearly proved to be
of other nature and the arguments which he adduces seem
•quite to warrant the conclusion at which he arrives, “ that
t be rise of bodily temperature and of heat-production follow¬
ing separation of the pons from the medulla is paralytic and
due to the removal of some active force.” The general result
of all the observations is thus summed up by Wood : “The
theory that teaches the existence of a nerve centre in tbe
pons or in the brain above it, which by a direct action in¬
hibits the production of animal heat, seems to be most in
accord with all the evidence bearing upon it, and I am dis¬
posed to adopt it as at least probable.”

Reference has already been made to Sir Benjamin Brodie’s
observation as to the effect of injuries of the upper part of
the cord on the temperature of the body. Since he wrote
other surgeons have made similar observations, and sudden
and great rise of body heat has come to be regarded as not
an uncommon symptom in injnries affecting the cervical
column. Weber, 3 for instance, has recorded cases in which
the temperature rose to 110° and 111 0 before death.
<Jlmrchill 3 records one in which it rose to 110°. Other cases,
too, have been recorded in which injuries involving this
region have been followed by the opposite condition—a
great fall of temperature. Mr. Hutchinson 4 has related a
case of crashing of the cord at the fifth cervical vertebra, in
which -within twenty-four hours after the injury the tem¬
perature in the urethra was 93°, and in the rectum, 95-8°.

Much difficulty bas been experienced in offering an
explanation of these facts, the difficulty arising, as Mr.

* Clin. Soo. Tans., vol. 1.. r. 168.

* St. Thomas's Hospital Heporta, vol. t. 4 The Laxckt, vol. 1., 1875.
- "

Jacobson 5 observes, from “ the uncertainty as to the existence
of any centre which presides over the production of heat,
and the connexion betweeu the production of excessive
temperature and vaso-motor paralysis.” Wood’s experi¬
ments throw considerable light on this subject, and tend to
remove much of the difficulty referred to by Mr. Jacobson.
If the injury paralyses only the vaso-motor nerves, there
will be distension of the vessels on the surface of the body
and rapid loss of heat, such as Wood found follow section of
the cord below the medulla. If the thermal inhibitory
nerves are paralysed, there will be a rapid rise of tempera¬
ture. The injury which results from crushing the cord is
much rougher and coarser than that made by cutting it, and
the same nicety of result is not to be expected. Crushing of
the cord at a given point does not mean exactly the same
damage in each case ; for the injury is a rough one, and one
portion of the cord may be more seriously damaged than
another—the right side more than the left, the anterior
more than the posterior surface, and vice versa. It is not
the thermal or vaso-motor centre that is injured in these
accidents, but the nerves proceeding from these; and it is
an accident, whether in a given case the thermal or vaso¬
motor nerves suffer most. According as one or the other is
more affected the temperature rises or falls.

injuries of the cervical cord are not the only lesions of the
nervous centres in which alterations of temperature are
noted. One of the many important results which have
accrued from the use of the clinical thermometer is the dis¬
covery of the fact that hemorrhagic and other non-iuflam-
matory lesions of the brain are frequently followed by a rise
in the temperature of the body. The subject is one which
has come into existence only since the thermometer came
into general use; its literature is, therefore, not extensive ;
but a sufficient number of observations have been made to
demonstrate that lesions of the brain frequently cause a
rise of temperature such as does not result from similar
lesions in any other organ.

Charcot 8 divides the apoplectic state resulting from
haamorrhage or from cerebral softening into three periods,
according to the modifications of temperature: in the first,
comprising the first few hours immediately following the
attack, the temperature falls below the normal; in the second,
which lasts a variable number of days, it varies from 99° to
100°; in the third, which terminates necessarily and speedily
in death, it runs up to 102°, 104°, and even 10G°. Bourneville 7
dividesit into four: (1) the initial loweringof the temperature,
(2) the stationary period, (3) the ascending period, and (4)
the terminal temperature. The first three are the same as
Charcot’s. The fourth, which is really the maximum point
of the third, is added to indicate that the ascending period
does not always stop short at the point noted by Charcot;
but that at the instant of death or some minutes after ,
there takes place in some cases a very remarkable rise.
M. Bourneville gives a table of seventeen cases, eight
of which were observed by himself, in which the
average temperature a short time before or after death
was nearly 107°, while in eight of the seventeen it
exceeded 108°. The initial lowering of the temperature
is no doubt the result of shock. The second or stationary

f ieriod is sometimes altogether absent, and after the initial
owering has passed off there may be noted only the rapid
rise of temperature of the third and fourth. This stationary
period is met with chiefly in cases in which the clot is com¬
paratively small, and in which the ventricles are not injured.
Should recovery take place, the stationary period is suc¬
ceeded by a return of the temperature to the normal
standard. Should the case tend to a fatal result, the second
period runs into the third, and the temperature rapidly
rises. A rising temperature, therefore, indicates a speedily
fatal termination.

Since Bourneville’s cases were published similar ones have
been recorded by other observers; the accuracy of his state¬
ments has been amply confirmed, and a rise of temperature
has come to be regarded as a common result of cerebral
haemorrhage. But haemorrhage is not the only form of
cerebral lesion in which such alteration of the body heat is
noted. The same change has been found to take place in
tumours and various other non-inflammatory lesions of the
nervous centres. (To u amtinU4Sd .)

5 Holme*' System of Surgery, 3rd ed., vol. 1., p. 654.

* Lemons Clinique* *ur le» Maladies des VleiUards. 1869.

1 Ktudes Clinique* et ThermomiStrlque* sur le» Maladies du Systime
Nerveux. 1872.

468 Ths Lanxtbt,]

CLINICAL NOTES.

[Mabch 5,1887.

Clinical ftotes:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

A CASE of choleraic diarrhcea with collapse.

By G. Childs-Macdonald, M.D.

On Sunday, Feb. 20th, I was called to W. D-, a grocer’s

assistant, who was engaged on Saturday the 19th in packing
up goods in hay taken from a case of wine recently received
from Italy. On returning home that evening he felt unwell,
and early on Sunday morning was suddenly seized with
cramps, purging, and vomiting, the evacuations passing
from him like water. At the commencement he was able to
walk to the lavatory, but he rapidly became so weak that
this was impossible. The vomited matters were composed
of almost pure water. When seen by me at 11 a.m. on
Sunday he had had Sixteen evacuations, all of which unfortu¬
nately had been carefully emptied before my arrival. The
sheets, however, at the upper part were soaked with
apparently water, but which afterwards proved to be vomit.
The man was lying on bis left side, and in the semi-flexed
position; the eyes were deeply sunken; the nose, chin, fore¬
arms, hands, and legs and'feet cold and cyanoeod; the
tongue cold and dry. There was complete absence of the
pulse at the wrist, the heart was beating feebly and almost
inaudibly. The respiration was sighing. He would at times
throw the arms over the head with an almost spasmodic
catch flu the breath- ih fact he showed all the symptoms of

3 n hunger. Mentalisation was slow; there wa9 also
dimness of sight and deafness. The pupils were equal
and slightly dilated, the eyelids closed. Every minute or so
he Would rouse slightly with a cry of pain caused by cramp
in the abdominal muscles and calves, to relapse again into
a semi-conscious condition. No urine had been passed
sinfce the previous - evening, and the bladder was quite
empty. He was given immediately thirty minims of ether
hypodermically over the right pectoral region, ordered hot-
water bottles to the sides and extremities, sinapisms to the
calves and over the cardiac region, hot coffee with brandy,
and to be rubbed with the latter spirit; also a mixture com¬
posed of acidi siilpb. atomat., sp. sotb. co., tinct. opii; oi,
cajaputi, and ol. menth. pip., aq.; an ounce to be taken every
three hours. At 12.80 there was a little improvement. The
pulse was just perceptible at the wrist. No further motion 1
or urine. Cramps the same. At 7.30 he had made a sudden
attempt to get out of bed, and in so doing he had fallen acid
injured his forehead. The extremities are warmer. Pulse 80
(very feeble); temperature subnormal. Cramps less. Says
he reeiB better, but complains Of great thirst. No stool
or urine.—Feb. 21st: Passed a very restless night. Cramps
at intervals. Vomited several times. No nrine or motion;
Pulse 84 (weak); temperature P8°. Skin dry, but tongue
moist; bladder empty. Ordered sinapisms to epigaetrio
region, milk sand lime water, and a little ice to suck if
nausea continues. Linseed poultices to be applied over loins
and diuretic mixture to be taken. Evening: Pulse fuller (84);
temperature 1 97'4P. Vomited only once. No cramp, motion, or
urine. Ordered eggs and milk, and meat juice.—22nd: Had a
better bight. • Two stools, but Bmall in amount, mainly
codfpb&ea of Slimy material; no blood in them; no urine.
Oofiplkhi* of flStus and great prostration. Has Votaited
once a. little bilious fluid. Keeps eyes .still closed. No
crrfflp. Ordered a little ride pudfling.-‘-28M: Has had a
godfl^night andvWSSfed fjfty ounces of nrine. Has had a
Sn. Vbmited bilious matter and mticus
t-df cramp. 'Is much brighter Mid Cheerful,
-fjfwadaebe.' 'Temperature 97’5° ; pulse 60,
fny^lhffae.' Ordered one ounce Of bismuth,
Sr mixture','three times a day. Since the
i note he has dteadiiy improved np to to-day (fcbe 28th)*
when he con sit up and read the paper. His appetite bos
mueh -Improved, and he had a little fish. lor dinn er.
Although, up-he.i8.ttnablerto leave the bedroom, and-shows
great, muscular weakness and emaciation. . .! i

ffiOife are several points trf Interest in the case, especially 1
is there is so much of the so-called winter diarrhoea about.

It would be interesting to know how much the Italian hay
had to do with it. The long time the kidneys remained
inactive, nearly three days, without uraemic symptoms, ie
specially noteworthy; .also the rapid and evidently complete
evacuation, followed by such extreme odllapse. 1 have never
seen anyone so near death and recover as this man; pro¬
bably the ether saved his life. I have called this choleraic
diarrhoea with collapse. Some of my readers might give it-
another name. It is unfortunate that the stools were not seen.

Daches»-strect, Cavendish-square.

A CASE OF LACERATED WOUND TREATED WITH.
IODOFORM.

By A. Mitba, L.R.C.P., L.R.C.S.,

CHIEF MEDICAL OFFICER, KASHMIR.

Rajaul, a prisoner at the Kashmir Gaol, aged thirty-five*
received a wound in the hand and forearm on April 12th.
Be, together with other prisoners, were engaged in breaking
stones on a hill close to the city of Sreemugur. A large
block of stone came rolling down, and Rajaul foolishly
attempted to stop it. Sopn after the injury, as he was-
being carried from the spot to the gaol, it was fortunate
that Dr. Neve, of the Mission Hospital, happened to be
passing, who took him to his hospital close by, stopped the
bleeding, and rendered such help as he thought was neces¬
sary. 1 saw the patient next morning at the gaol, where

I had deputed an assistant to watch him. I examined the-
wound, and found a large lacerated flap, including skin,
muscles, tendons, arteries, and nerves, had been separated *
the flap commenced four inches above the wrist, extended
along the middle of the hand, and curved round the web-
of the fingers’ ends over the head of the metacarpal bone of
the ring finger on its dorsal side. The second flap on the-
dpraum was more lacerated; it commenced at the second
phalanx of the thumb, and curved round the ends near the-
pisiform bone. All the metacarpals except the first were frac¬
tured ; the third metacarpal was divided into four pieces. J>
happened to meet Dr. Neve that morning, who remarked n
“ The wound is one of the serverest I have ever seen.” Con¬
servative surgery in such a case of lacerated wound with
extensive injury of all the tissues can hardly be justified *
but as twenty-four hours had already elapsed, I was deter-
nrined to give it a trial, without, however, entertaining any
hope to preserve the hand. I kept the injured parts soaked
with corrosive sublimate lotion (seven grams to a pint). On
tHe third day I opened the wound; there was very little
discharge. Dusting the wound thoroughly with iodoform,

I I covered it with oiled silk, and bandaged with corrosive
BUblimate gauze. The wound was opened the next day, as the-
temperature of the patient rose to 100 6° F. in the previous-
evening. There was slight discolouration in the tips of the
little and ring fingers. I decided on amputation, not of the
fdrearm but of the fingers. I made an incision, commencing
fitom between the web of the index and middle fingers*
carrying it straight down to the pisiform bone and curving,
round along the dorsum of the hand to meet the point or
commencement, Iodoform was used all along. The wound
healed in twenty days. The rise of temperature for the-
first five days ranged from 100° to 101°. The man has now
perfect use Of tie thumb and index fingers. There is no
resulting contraction.

Remarks ,—This case shows wbat repairing powers the
tissues sometimes possess. It also establishes the great
value- of iodoform in the treatment of wounds. In my
surgical wards, iodoform is used aa the chief dressing, and
it always secures for me rapid and aseptic healing. Iodoform
dusting has been found more efficacious than ointment even
with vaseline; My experience has, however, proved to a
certainty that disagreeable symptoms often result from
iodoform dressing. They are chiefly gastro-intestinal
and nervous irritation. But I have never observed iodo¬
form io fever; these internal manifestations do not come
to my notice, because I strictly follow the plan of
Washing the wound before fresh iodoform is used. With
this precaution, there is no fear of poisoning. The forty-
eight cases given by Kdnig. 1 where symptoms of poisoning
sup erv e ne d during the use of iodoform as surgical dressings*
were probably treated without this necessary precaution.

i Centrmtbl. fdr Ohlr., No*. 7, 8, 17, and 23.

vjOOglC

Tub Lancet,} HOSPITAL MEDICINE: AND 1 SURGERY. [Mauqh ,188*, lT 46# f

HEMORRHAGE DURING PREGNANCY, PROBABLY
DUE TO SEPARATION OP PLACENTA.

By M. G. Biqgs, M.R.C.S., L.S.A.

Mbs. M-, aged thirty-eight, mother of seven children,

was confined of a healthy boy on Sept. 30th, 1880. There
was no hsemorrhage of any unusual kind during the labour.
Forceps were used after the membranes had been ruptured,
owing to uterine inertia. She has always had tedious labours.
Early in January, 1886, she was regular; she then saw
nothing until about the middle of February, when it cams'
on rather suddenly and freely whilst she was standing in the
shop, her husband being a dyer. From that time up to about
a Week before the confinement she used to bleed every fort¬
night or month, and even between these times there was
often a blood-stained discharge. In July she sent for me ;
but rest in bed and the use of gallic acid and digitalis inter¬
nally set things right for the time, and I heard nothing more
of her until the day of labour. She had never been at all
like this on any previous occasion. On removal of the
placenta one part of the zone was of a much lighter colour
than the other, with partly decolourised clots, and these same
partially decolourised clots were clinging to the correspond¬
ing outer surface of the membranes. The appearance was
moet characteristic. The sudden onset looks suspicious, but
then it was so early in the case when it commenced,
before the formation of the placenta.

Northoote-road, 8.W.

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nulla aatem e*t alia pro oerto noaoendl via, old qoamplurimaa et mor-
borura et dissectlonum hlstorlos, turn allorirm turn propria* collects*
habere, et Inter *e oomparar*.— MoBoaein Da Sad. at Cans. 1tfb.,
lb. lv. Pftxamlum. -. - •

UNIVERSITY COLLEGE HOSPITAL.

THBHB CASKS OP BADLY UNITED FBACTUHB OF THE
FBMUB.

(Under the care of Mr. Christopher Heath.}

The three cases which follow are interesting, as showing
the different plans of treatment carried out in badly united
fractures, according to the period which has elapsed since
the receipt of the primary damage. We would refer our.
readers to the remarks appended. We are indebted for
the notes of these cases to Mr. Bilton Pollard, surgical
registrar.

Cask 1.—E. G-, a boy aged seven years, was admitted

into the hospital on August 27tb, 1886. His left femur |
bad been broken about its middle by direct violence
Bhortly before admission. There was only half an inch
shortening. The fracture was treated with Liston’s long
splint for two days, and then with Hamilton’s splint for
three weeks. There was then only a quarter of an inch
shortening. The limb was fixed with piaster-of-Paris
bandages, and the patient was discharged. Seventeen days
later he was readmitted, as the plaster case had slipped and
the femur was bent at the seat of the fracture and shortened
to the extent of an inch and a quarter. The fragments
occupied the positions usually met with in fracture of the
shaft of the femur. The-patient was placed under the
influence of ether, and Mr. Heath bent the bone over the
knee to a good position and reduced the shortening to a
quarter of an inch by forcible traction. A Liston’s long
splint with a perineal baud was applied. The bone united
TOll in good position, and about a month after it was reset
a pi aster-of-Paris case was applied and the patient was
discharged.

Case a.—H. O——, a boy aged twelve years, was admitted
into the hospital On Sept. SOtb, 1886. He stated that between
three ‘and four months ago he fell whilst getting over a.
stHe and broke bis left thigh. The< fracture was treated ,
"Hh a Liston’s long splint lor a month, and afterwards
with starched bandages for sight Weeks. In the last seven ,

weeks of this time the. bqy went about on crutches. A
simple bandage was then applied. On admission the boy
could only walk with difficulty, owing to the left leg
being two inches and a quarter shorter than the right.
The fragments were firmly united, with their ends over¬
lapping, in the manner characteristic of a fracture of the
shaft of the femur. At the junction of the upper and ^
middle thirds of the thigh there was a large swelling on
the outer surface of the limb due to the projection of the
lower end of the upper fragment. On Oct. 11th the patient
was anaesthetised, and Mr. Heath with considerable diffi¬
culty succeeded in breaking down the uniting callus. This
he did by placing his foot on the swelling above mentioned,
and using the extended limb as a lever, by means of wb,ich ^
great force was brought to bear on the uniting callus.
Forcible traction was then made on the limb, and some of -
the shortening was by that means overcome. Weight
extension was applied to tbe limb-. Two days later, the
shortening being reduced to half an inch, the limb was
fixed in a Thomas’s knee-splint. Five weeks after the bone
was reset, the position of the fragments was good, and the
shortening was less than half an inch. The limb was
immovably fixed in plaster-of-Paris, and the patient was
discharged. A month later the plaster-of-Paris apparatus
was removed, and the knee, which was very stiff, was moved
whilst the patient was under the influence of gas*

Cask 3.—D. P-, a boy aged seventeen, was admitted

into the hospital on Nov. 1st, 1886. In 1882 he had suffered

from a fracture of bis left thigh, which had united in good
position. In November, 1884, he broke bis right thigh. It
was treated with a Liston’s splint for four weeks, and a
Week later the patient left his bed and began to walk
about. His thigh appears to have kept sound till April,
1886, when he occasionally fell down, owing to weakness in
it; but he gives no account of any severe injury, though
he states that he noticed an increasing deformity of
bis thigh. On admission bis right thigh presented the
marked deformity shown in the accompanying woodcut.
There appeared to have been a double fracture of the
femur, for, in addition to the prominent angle on the
outer surface of the thigh, there was another prominence,)
also on the outer surface of tbe thigh at a point about.,,
four inches below tbe tip of the great trochanter. At
this spot the upper fragments appeared to overlap the lower.
on its outer surface. At the point .of greatest deformity
the fragments did not overlap one another. The limb was,!
two inches and three-quarters shorter than its fellow. .On
Nov. 10th Mr. Heath first tried to break the femur in tbe.
manner described in tbe last case, but failed. He then made
a small incision on to the most prominent part of the
deformed bone, and with the aid of a chisel partially divided ,
it. The remainder of the bone was then broken. The carbolic.
spray was used during the operation, and tbe wound was
dressed with carbolised gauze. The limb was pat up in a

Digitized by Google

470 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[March 5,1887.

Thomas's knee-splint. After the bone was broken the frag¬
ments overlapped, and it was found impossible to overcome
the displacement entirely, but by increasing the amount of
extension force from day to day the deformity was largely
reduced. The dressing was changed on the second day after
the operation, and weekly afterwards. The temperature
remained normal till the eleventh day, when it rose in con¬
junction with a slight pleuritic attack. Six weeks after the
operation the wound was soundly healed, the fragments
were united by a large mass of callus, and the limb was in
good position, but it was still three-quarters of an inch
shorter than its fellow. A plaster-of-Pans splint was applied,
and the patient was discharged to the Convalescent Home at
Eastbourne.

Remarks.— The three cases now recorded were under
Mr. Heath’s care at the same time, and they form an in¬
teresting group illustrative of the treatment of badly-united
fractures. In the first case the fracture was only five weeks
old, and the callus was soft enough to allow of its being
bent and the bone being brought into good position. In the
second case the bone had been broken between three and four
months before the patient was admitted, and it was found
necessary to employ considerable force to rebreak it. The
result was very good, for the shortening of two inches and a
quarter, which had entirely crippled the patient, was reduced
to less than half an inch. With regard to the third case, it
is doubtful whether the deformity which the femur pre¬
sented was due to the fracture two years previously, or
whether it depended on an injury sixteen months later, for
it was only about eight months before admission that the
great deformity was noticed. In this case it was necessary
to divide the femur partially with a chisel before the bone
could be straightened; and, though the improvement in
this case was the most striking of the three, there still
remained about three-quarters of an inch shortening. It is
probable that this was dependent on the second fracture,
which had united, with slight overlapping of the fragments.
The Thomas’s knee-splint, which was used for the last two
cases, was very efficient, as it secured perfect fixation, facili¬
tated extension, and in the last case allowed of the antiseptic
dressing being changed without disturbing the fracture.

LONDON HOSPITAL.

FOREIGN BODS’ IN THS UBETHBA ; REMOVAL; REMARKS.

(Under the care of Mr. Rivington.)

For the following account we are indebted to Mr. A. W.
Burrell, house-surgeon.

On January 1st a big, strong, healthy-looking labouring
man cime to the hospital complaining that a pin bad slipped
into his urethra, and that he could not get it out. He had
had a stricture for some time, which caused periodical
retention, to relieve which he had been in the habit of
passing the beaded head of a large shawl-pin through the
stricture. On this occasion, however, the point had slipped
ast the meatus, and, catching in the mucous membrane, he
ad been unable to extract it, and during the walk of a
mile to the hospital it had worked some distance up the
urethra.

On examination, the point of the pin could be felt stick¬
ing through the urethra into the cellular tissue of the
scrotum, in the middle line, just in front of the perineum ;
while with the finger in the rectum the shaft could be
followed through the membranous and prostatic portions
into the bladder, into which, however, the head penetrated
too far to be felt. As after a little rest and a bath he passed
his urine pretty freely by the side of the foreign body, he
was left till the morning.

Jan. 2nd.—The point of the pin could now be felt just
under the loose skin of the scrotum, with an inch and
a qaarter of the shaft protruding through the urethra.
Mr. Bureell passed down a long pair of urethral forceps,
and seised the pin in the urethra; at the same time
passing his finger up the rectum, he pressed it up
under the arch of the pubis, thus fixing it. Mr. T. N.
Thomas then, under Mr. Burrell's direction, stretched the
skin over the point, making a nick with a knife on it. He
seized the point with forceps, and drew it out until the
head stopped at the aperture in the urethra; then he
depressed the point, and, reversing the mode of entrance of
the pin, easily pushed the head out of the meatus, followed
of course by tne shaft. A catheter was passed, and some
collodion placed on the puncture. The man refused to have

his stricture treated, and went out the next day. The pin
proved to be a blue steel shawl one, five inches and three-
quarters long, with a black glass bead for a head, a quarter
of an inch in diameter.

The case is interesting, as showing the position taken up
by a long, straight foreign body slipping into the urethra.
Thus it lay across the fixed curves of the urethra, the point
perforating the penile urethra about one inch in front of
the membranous portion.

ST. VINCENT'S HOSPITAL, DUBLIN.

A FATAL CABB OF PARAPLEGIA ; NECROPSY; REMARKS.

(Under the care of Dr. Quinlan.)

P. S-, aged fifty, a stout well-built man, a cabdriver,

was admitted on Jan. 6th. He had for the last t wo years
been of very intemperate habits, and on New Year’s Day
was driving his cab in a state of partial intoxication, when
he fell off the box upon the road, which was then hardened by
severe frost. He was assisted up to his driving seat, and
was able to guide the vehicle home at a walking pace.
Arriving home, his trap was put up for him, and he went to
bed, as it was thought, to sleep off his potations. Next
morning he felt chilly .and numbed, and was unable to
stand; he got daily worse, and began to speak thickly.

On admission upon the 6tb, Dr. Quinlan found the man
unable to move hand or foot; the surface of his body was
livid, and very cold; and he was unable to distinguish the
double points of the sensation compass at all in the lower
parts of the body, and in the upper only when they were
divaricated over an inch and a half. He had no control over
his fasces, and the urioe had to be drawn off by the catheter
several times a day. His pulse was only 44, and his month
temperature the clinical thermometer would not register, it
being under 95°, its lowest marked degree. Priapism was
present. He did not suffer any pain; but all over his sacral
region a large bedsore was threatening to form. He got
steadily lower and weaker; effusion into the bronchial tubes
set in; and he died on the afternoon of Jan. 9th.

The post-mortem examination was made twenty hours
after -death by Mr. Coen, resident medical officer, who
removed the calvaria, the occipital bone, and the whole
covering of the back of the spinal canal, thus allowing the
brain and spinal cord to be removed in their entirety. There
was no injury of the vertebral column, but intense and
general congestion of the vascular covering of the brain and
of the spinal cord, which were pinky-red over the whole
extent. There was no softening; but on making sections of
the spinal cord, spots of congestion, almost resembling small
haemorrhages, were to be found ecattered throughout ite
whole substance. On the sacral region was a circular,
yellowish discolouration, nearly the size of a dinner-plate,
and surrounded by a well-marked commencing line of
separation, and which before many hours would have become
a slough.

Remarks by Dr. Quinlan. —In this case the oerebro-
spin&l inflammation was evidently caused by the patient
falling on his back upon tbe hard road. He apparently fell
in this way, for his head was not injured, and, from his
inebriated condition, he does not seem to have put out his
arms to save himself. The severe cold of the weather and
his chronic alcoholism no doubt contributed to tbe fatal
result. The case was from the beginning hopeless, from tbe
general involvement of his nervous system, both cerebro¬
spinal and sympathetic, as evidenced by the symptoms
above described.

The Countess of Dufferin’s Fund. —The second
annual report of tbe central committee of the National
Association for Supplying Female Medical Aid to the Women
of India has just reached England, and contains the follow¬
ing information as to the financial state of the fund;—The
central fund at the beginning of last year brought forward
a balance of 146,188 rupees. Since that date 76,109 rupees
have been received. The annual income of tbe central fund
is estimated at 19,450 rupees, which is partly made up of
9760 rupees interest on investments, of 2700 rupees irom
annual subscribers, and of contributions from the branches,
which in 1886 amounted to 2700 rupees. This income, Lady
Dufferin states,'is very far below the exigencies of the
situation; and she earnestly appeals for support from the
people of England in this the Jubilee year.

Thb Lancet,}

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

[March 5, 1887. 471

Hfe hical Soci eties.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Annual General Meeting.—Presidents Address.

Thx annual general meeting of this Society was held on
Tuesday last, Mr. G. D. Pollock, P.R.C.S., President, in the
chair. Mr. R. W. Parker and Dr. Angel Money were
appointed scrutineers of the ballot.

Dr. Cheadle read the report of the President and Council.
It showed that the financial position and general prosperity
of the Society were in a favourable state.

The report of the honorary librarians states that the
additions to the library during the year 1886 consist of 879
works, including pamphlets, but not including Transactions,
journals, and other periodical publications; 638 of these
additions have been obtained by purchase and 241 by
donation. These latter include 25 works in 100 vole, pre¬
sented by Dr. Lauder Brunton, and 32 old books given by
Mr. Charles Ilawkine. In the 638 works added by purchase
is included a bound collection of 420 “ Theses de Mddecine,”
put together by the late Dr. C. Parrot. The total number of
works in the library, Dec. 1886, was 30,282. During the past
year 3587 books have been borrowed from the library. The
number of visits of Fellows has been 4574. The collection of
portraits of members of the medical profession has been
enriched by the addition of 63 new portraits.

The President read his address. It consisted, as is
customary, of the obituary memoirs of all those Fellows of
the Society, deceased during the past year, and occupied an
hour and a half in the reading, thus proving the numerous
losses the Society had sustained by death since the last
annual meeting.

Dr. Charles West proposed and Mr. J. IT. Mono an
seconded the adoption of the report of the Council.

Sir Joseph Faybeb proposed and Mr. Cowell seconded
the vote of thanks to the President for his address.

Mr. R. Barwell proposed and Dr. Payne seconded the
vote of thanks to the retiring vice-presidents and members
of the Council: Dr. J. W. Ogle, Mr. Berkeley Hill, Dr.
Buzzard, and Dr. Church.

Dr. O. Stubglbs proposed and Mr. Hawabd seconded the
vote of thanks to the retiring treasurer. Dr. Raddifle.

The following is the list of officers unanimously elected
for the ensuing year:—President: Mr. G. D. Pollock, F.R.C.S.
Vice-Presidents: W. H. Dickinson, M.D.; W. Ogle, M.D.;
A. E. Durham; T. Smith. Treasurers: C. J. Hare, M.D.;
Timothy Holmes. Secretaries: W. B. Cheadle, M.D.; Howard
Marsh. Librarians: Wilson Fox, M.D., F.R.S.; J. W. Hulke,
F.R.S. Members of Council: J. Cavafy, M.D.; Sir T. Crawford,
K.C.B., M.D.; J. F. Payne, M.D ; R. D. Powell, M.D.: A. E.
8ansom, M.D.; H. C. Rose, M.D.; Marcus Beck; H. T. Butlin;
J. McCarthy; C. S. Tomes, F.R.S.

CLINICAL SOCIETY OP LONDON.

Paralysis of Left Leg from Subcortical Disease.—Rheu¬
matic Hyperpyrexia successfully treated by the Cold Bath.
Epilepsy following an Injury to the Leg—Profuse Ileema-
turia in connexion with Granular Kidneys.

An ordinary meeting of this Society was held on the 25th
ult., Dr. W. H. Broadbent, F.R.C.P., President, in the chair.

Dr. Hughlings Jackson read a paper on a case of
Paralysis of the Left Leg from Subcortical Disease, with
Cancer and Fracture of the Left Femur. A woman aged
fifty-two was admitted on Dec.28tb, 1885, under Dr. Hugh¬
lings Jackson’s care, for paralysis of the left leg, which had
come on suddenly on Dec. 7th, whilst she was standing at
her work. The knee-jerk on the paralysed side was greatly
®*aggerated, and there was foot-clonus; there was no defect
of sensation; no morbid changes in the fundi. On Dec. 30tb,
whilst she was being lifted from the bed-pan, the left femur
broke just below the great trochanter. Death occurred on
Jan. 19tb. At the necropsy there was found cancer of
the left femur, of the ovary, and of the brain. The
brain was examined by Dr. James Anderson, who found
several growths in it, one, accounting for the paralysis
of the left leg, being in the region of Fender's leg centre.—

Dr. Broadbent said the case was interesting from more
than one point of view. The nodule to which the paralysis
corresponded might have been described from other points
of view than the internal aspect. The early occurrence of
ankle-clonus and exaggerated knee-jerk was hardly in
accord with the sclerotic theory of these phenomena.—
Dr. Beevor said that Messrs. Scbftfer and Horsley first dis¬
covered that the posterior part of the marginal convolution
was a part of the leg centre. The absence of fits might be
explained by the nodule not having implicated the cortex.
He Was working with Mr. V. Horsley at the minute arrange¬
ment of the leg centre, and found that the toes were
represented in the parietal lobule, which was not involved
in Dr. Jackson’s case. With regard to the fibres of the
internal capsule, those from the leg descended in the hinder
part of the internal capsule, as bad been ascertained by
experimental stimulation of the exposed fibres in the
monkey.

Dr. Carrington read a ca3e of Successful Treatment of
Hyperpyrexia in Acute Rheumatism by the Cold Bath. He
said that although there was nothing new in the case he
brought forward, still fie thought it was well to put such
cases on record in order to accumulate a body of evidence
such as would enable medical men to combat the prejudice
existing amongst the friends of patients against the employ¬
ment of a remedy which afforded the only chance of safety
in this desperate complication. The patient was a medical
student, aged twenty-three, strong and muscular, and
hitherto in perfect health. He had been ill with what was
apparently a mild attack of rheumatism, for which he had
been treated by salicylic acid. He was so far recovered that
he had left his bed, and on the evening of Oct. 31st bad re¬
ceived the visits of his friends. He passed a good night, and
there was nothing to excite attention next day, but on taking
his temperature next morniDg about 12 noon, quite as a
matter of routine, it was found to be 107°. Dr. Carrington
saw him soon afterwards, and then found the temperature
to be 106°. no was, as soon as practicable, removed to
the private ward of Guy’s Hospital, but in the journey had
become noisy and delirious, and by the time he had been
placed in bea he was quite livid, unconscious, and generally
convulsed. Bis temperature was then found to be 109 8",
The necessary arrangements had been previously made, and
he was at once placed in a bafli at a temperature of 70°,
which was as rapidly as possible cooled down by ice ; large
quantities were used, but the body heat was so great that
there was great difficulty in lowering the temperature of the
bath. Pouring ice-cold water on the patient’s head had a
beneficial effect. A rectal injection of fifteen grains of
antipyrin was exhibited. He was kept in the bath for a full
hour, and when the rectal temperature was 102-4°, he was
removed add placed on a blanket and lightly covered by a
sheet. Then marked tetanic convulsions supervened, and he
gradually became quiet, and at 7 p.m. hie temperature fell to
97 2°. At 8 p.m. consciousness returned, and be took a pint
of milk, and at 10 p.m. he was quite rational. During the
next day he remained comfortable, and took twenty grains of
salicylate of soda every two hours, but his temperature again
arose, and at 12 P.M. it was 103 - 8°. He was given fifteen
grains of antipyrin by the moutb, but at2A.M. the temperature
was lOS^ 0 , and the ice-bath was again employed for fifteen
minutes. Ue was taken out when his temperature had
falLn to 101°, but at 6 a.m. it had again risen to 105 4°,
and the bath was again had recourse to for a similar period.
After this he slept well, but at 2 p.m. the temperature had
reached 105°, and he was bathed again for for^y minutes.
From this time the temperature never again rose to any
extent; it was for the most part normal, but on one occasion
with a return of the articular pain it reached 101°. After
the third bath salicine was substituted for sodic salicylate,
in twenty-five grain doses every two hours. After two days
he took it every three hours, and the dose was gradually re¬
duced. With an interruption due to the slight relapse, the

f iatient made an uninterrupted recovery from this time, and
eft the hospital quite well. Theexperienceofthe case seemed
to be that within the limit of collapse, prolonged immersion
was more effectual than shorter and more frequent baths.—
Dr. Hale White remarked on the uselessness of the anti¬
pyretics in this case, and he thought that the way in which
the drugs act must be different in different cases. The
class of pyrexias influenced by antipyrin and other anti¬
pyretics were, perhaps, of a different nature. Referring to
a case of inexplicable pyrexia that ultimately got perfectly
well, he said that neither antipyrin, salicylate of soda, nor

472 Thf, Lancet.]

CLINICAL SOCIETY OF LONDON.

[March 5, 1887.

quinine had auy iniluence over the course of the fever.—
Dr. Broadbknt remarked on the occurrence of convulsions
in connexion with this case ; he had not observed con¬
vulsions during the rise of temperature; perhaps the
removal of the patient to the hospital might have had some
share in their causation. In cases of hyperpyrexia in
typhoid fever, he had witnessed the development of remark¬
able opisthotonos, which had no relation with the general
convulsions. He inquired whether shivering was taken a6
an indication for removal of the patient from the bath. He
had known hyperpyrexia to supervene during the adminis¬
tration of large doses of salicylates, but in one case pericar¬
ditis developed. He supposed that the prmcordial murmur
in Dr. Carrington’s case was of hasmic origin, and
partly due to myocardial dilatation, not to pericarditis.—
Dr. Hcghlings Jackson said it was important to note
whether convulsions were tonic first and clonic afterwards,
or whether they occurred in confused alternation. — Dr.
Stephen Mackenzie had seen four cases of hyperpyrexia
in private practice. In one of rheumatic fever he employed
ice and water till the temperature became normal, when the
patient was seized with complete tetanic rigidity, in which
he was only partially conscious, and became of deathly
pallor, reminding one of the picture at Brussels of the man
risen from his coffin after being interred as dead from
cholera. It was found necessary to employ stimulants, but
the man died ten hours later. In private practice he had
had no case of complete recovery, thus showing the im¬
portance of careful nursing and proper appliances For such
cases. In Dr. Wilson Fox's first case the balance between
hyperpyrexia and subpyrexia was very marked, cold and
stimulants being alternately and concurrently required. No
clonic convulsion was observed with the tetanic state.—
Dr. Broadbent said that the convulsions observed by him
were of an irregular clonic character, in which there was no
recognised phase of rigidity. No clonic convulsion occurred
in association with the tetanic opisthotonos to which he had
referred.—Dr. Carrington said that it was only on removal
trom the bath that the tetanic state without clonic spasms |
developed. The first bath lasted one hour. Drugs, so far as
one could tell, had no beneficial effect.

Dr. Hadden brought forward a case of Epilepsy after
Gunshot Wound in a man aged thirty-two, who was under
Mr. Croft’s care at St. Thomas’s Hospital. There was no
family history of epilepsy. In 1872 he was wounded in the
left calf, and several shots were extracted. In six or seven
weeks the wound was quite healed. Four months after the
injury he began to have fits. For nine months they were
occasional, but afterwards he had as many as twelve daily.
The sciatic nerve was then stretched, and the fits ceased for
thirteen years. They recommenced seven weeks before
admission into St. Thomas’s, when he fell to the ground from
a ladder unconscious. During the week preceding admission
he had eight or ten daily. The fits began with a sharp
twitching pain in the scar in the left calf; then there was a
creeping, heating sensation passing up the leg and left side
of the body to the head. The left side then became con¬
vulsed. The pupils were immobile, and the conjunctive
insensitive. Finally, there were some general convulsive
movements, and then rapid return to consciousness. The
tongue was not bitten, nor were the evacuations
passed. The scar was somewhat tender, and when
pressed he would at times have the sensation passing up
the body, and sometimes a convulsion. Occasionally in the
seizures lie would roll about in bed, and sometimes there
was opisthotonos. An attempt was made to stretch the
sciatic nerve by extreme flexion of the hip, but the result
was a violent convulsion. A few days later the nerve was
exposed and freely stretched. The fits stopped for nine
days. He then had occasional seizures—sometimes one a
day, sometimes one every other day. Two occurred whilst
the splint was being bandaged to the leg, and one during
removal of the splint. The man wrote four months later to
say that ho had had no convulsion since he left the hos¬
pital, but he suffered from severe paroxysmal pain in the
left calf, followed by the “fitty” sensations. There was
no doubt that the attacks were genuine, the condition of
the pupils and conjunctiva® and other points proving this.
The interest of the case has reference to Brown-SSquard’s
and Victor Horsloy’s experiments on guinea-pigs. Epilepsy
was induced by these observers after injury to the sciatic
nerve. There is usually a latent period of from two to six
weeks. In the man the incubation was four months. Opistho¬
tonos occurred in the patient, as in the case of grnnea-pigs.-^-

Mr. Bowlby related the case of a man who had received
a charge of shot in the leg about eighteen months before he
was first seen. The fits had been increasing in frequency
and force, and were always characterised by pains beginning
in the wounded leg in the area supplied by the musculo¬
cutaneous nerve, of which an inch and a half was excised,
and after two or three days the fits ceased, and the wound
healed soundly after having suppurated. The man remained
five years without recurrence of the fits. Some shot under
the skin were then found and removed, with the result of
temporary stoppage of the fits. After a time Mr. Willett
practised stretching of the sciatic nerve; the fits thereafter
continued for awhile, hut then ceased, and there had been no
further occurrence.—Dr. H. Jackson referred to the case of
a boy brought before the Society last November, who had
fits whenever his head or face was touched—a case like that
of a guinea-pig rendered epileptic by injury of the sciatic
nerve or spinal cord. — Dr. Carrington alluded to cases
of trephining for epilepsy, and said that recovery some¬
times followed the mere operation. — Dr. Angel Money
considered, t with Dr. Hughlings Jackson, that in most
cases of epilepsy there was an epileptogenous zone in
some part of the periphery of the nervous system.
Probably there were various kinds and modes of excita¬
tion of this area, and these were the exciting causes of
the attacks of epilepsy. Reference was made to a case of
genuine idiopathic epilepsy in which the ingestion of a
stick of chocolate was sufficient to excite a genuine attack,
which began with a sensation of frightful hunger at the
pit of the stomach a few minutes after eating the choco¬
late, was soon followed by a rushing sensation to the
head, and this was succeeded by loss of consciousness, in
which convulsions of tonic, clonic sequence might be observed.
—Dr. Broadbent referred to his own experience of like cases.
In one, that of a girl with a whitlow, violent epileptiform
convulsions were of frequent occurrence, but on the removal
of dead bone they entirely ceased. Another case of reflex
epilepsy was that in which there existed a piece of glass in
the ulnar nerve, palpation of which was invariably followed
by the occurrence of a fit. These cases differed from ordi¬
nary epilepsy in that they might occur at any age. Cases
of idiopathic epilepsy in which fits occurred several times a
day were of rare occurrence. The extreme frequency of the
fits was another feature of the cases under discussion. He
concurred with Dr. Hadden in thinking that removal of the
scar rather than stretching of the nerve was the better treat¬
ment to adopt.—Dr. Hadden, in reply, thought the class of
cases of epilepsy under discussion partook of the nature of
tetanus resulting from a wound. He was much struck by
the resemblance between Mr. Bowlby’s and his own case.

Mr. Anthony Bowlby read a paper containing the records
of three cases of Hsematuria in connexion with Granular
Kidney. The first was that of a man aged seventy-three,
who was admitted into St. Bartholomew’s Hospital suffering
from enlargement of the prostate and hrematuria. His death,
which occurred within twenty-four hours, appeared to be
chiefly due to the exhaustion caused by the loss of blood.
A post-mortem examination showed an enlarged prostate
and dilated bladder, containing several ounces of almost
pure blood. The kidneys were small and granular. Their
pelves and the ureters contained blood, and in the renal
substance there was much blood extravasated. Micro¬
scopical examination showed that the haemorrhage had
occurred both into the renal tubes and into the cellular
tissue of the gland. The second case was that of a man aged
forty-nine, who had long suffered from stricture of the
urethra and difficult micturition, and who for three months
previously to admission into St. Bartholomew’s Hospital had
passed considerable quantities of blood with his urine. He
had many of the ordinary signs of interstitial nephritis, and,
in addition, passed a great deal of blood. On his death, from
uraamia, no cause of haemorrhage was found, except in the
kidneys. These were small and granular, and contained a
little bloody urine. The third case, a man aged sixty-four,
was admitted on Feb. 3rd, 1886, with profuse heematuria
and pain in the loins. After losing much blood for several
weeks the hiematuria ceased. The urine when clear
contained albumen. There was some albuminuric retinitis
and some opacity of one lens. Attention was drawn to the
fact that the subject of hiematuria in connexion with
granular kidney has received little attention, that no
cases of profuse hiematuria of this nature have been pre¬
viously recorded, and that no post-mortem examinations
have been described. It was pointed out that lit ofie of the

Thb Lancet,]

MEDICAL SOCIETY OF LONDON.

[March 5,1887. 473

patients who was the subject of this paper the haemorrhage
was so profuse as to be mistaken for vesical bleeding,
and in the others the diagnosis had to be made from other
of the more recognised causes of renal haemorrhage, espe¬
cially calculus. It is in connexion with this question of
diagnosis that these cases are of importance. Lastly, it
was stated that simple interstitial nephritis, independently of
dilatation or absorption of the renal substance was often
found as the result of obstruction to the outflow of urine.—
Dr. Carrington considered the cases to be of great rarity,
and remarked on the existence of obstruction in the urinary
passages.—Mr. R. J. Godlbe referred to the fact that in some
of the cases instrumentation had been practised for the
relief of retention of urine. Such instrumentation of
the urinary passages would be likely to be followed by
acute attacks of haematuria and renal congestion.—
Dr. Hadden referred to two cases of profuse htcmaturio,
in which the diagnosis had been overlooked and in which
the kidneys were found after death to be the seat of large
haemorrhages.—Dr. Maguire considered that cases of
haematuria in association with granular kidney were not of
great rarity, and the haematuria seemed to be followed by
improvement in the patient’s general condition.—Dr. Bboad-
bbnt thought that profuse haematuria was rare in cases of
granular kidney. In one case the patient had had uraemic
convulsions, from which recovery took place, and death
occurred some years later from haematuria, the cause of
which was bleeding from an artery running in the wall of
the pelvis of one kidney.—Mr. Bowlby, in reply, said that
catheters had been passed in one case but not in the others,
and the circumstance that all the cases occurred in the
surgical wards showed the prof use ness of the haemorrhage
and the overlooking of the nature of the cases.

The following living specimens were shown Dr. Arthur
Davies: A case of Myxcedema in the male, aged thirty-eight,
of seven years’ duration, and a case of the same disease in
the female. Mr. A. E. Barker: A case of Fracture of the
Upper Cervical Vertebrae, causing Right Hemiplegia, from
which the patient had completely recovered.

MEDICAL SOCIETY OF LONDON.

The Treatment of Syphilis by Mercury.

Air ordinary meeting of this Society was held on Monday,
Feb. 2lst, Mr. R. Brudenell Carter, F.R.C.S., President, in the
chair.

Mr. E. Milner read & paper on the different modes of
administering Mercury in Syphilis, and the indications for
their application. He gave some of the results of his
experience of twelve years’ out-patient practice at the
Lock Hospital, with a view of arriving at some definite
conclusion as to what preparation of mercury should be
employed in order as rapidly as.possible to get rid of
the visible signs of syphilis. In the majority of cases
blue pill is as good as blue ointment and green iodide as
Donovan’s solution; but even in these cases he thought
that more accurate and more careful observation in prac¬
tice would render such an admiesion unjustifiable. He
dealt with three of the most common methods of adminis¬
tration: 1. Some of the cases in which green iodide should
be used. 2. Some of the cases in which inunction should
be practised. 3. Some of the cases in which the vapour of
calomel should be employed. Of all the syphilitic rashes,
the most evident, most persistent, and perhaps the most
difficult to combat, is the vesicular syphihde. It moBt fre¬
quently occurred in light-haired women who drank large
quantities of wine as distinguished from spirits. The vesi¬
cular may be associated with an early tubercular syphilide,
and this usually in dark-haired people during cold weather,
and in the underfed and underclothed patients of anxious
temperament. In the first of these two classes green iodide
with Donovan’s solution, in large doses, was most valuable ;
in the second class the inunction of the German preparation
of blue ointment has excelled all other methods of treatment.
In billiard-markers, some actors, barmaids, actresses, and
commercial travellers, who drink freely and sit up late, the
syphilitic rash is apt to become angry, excessively red, and
marked. In spite of the diarrhoea, give green iodide in large
doses. Donovan’s solution, with soda and iodide of sodium
will assist, the latter salt being better than the potassic salt.
The keeping of late hours materially influences the character
of syphilitic eruptions. These people often have a thick

oily perspiration which interferes with the nutrition of the
akin and initiates the manifestations of syphilis; it was per¬
haps one of the causes of the so-called gouty character of
the syphilide. Barmaids present the reddest and most
angry syphilitic rashes, and the lesions are most difficult to
treat. Such might be named “ barmaid’s syphilis.” For these
cases green iodide of mercury was the best preparation.
In those who drink and never take care of themselves green
iodide was next best to inunction, and would probably, under
all the circumstances of the case, prove most efficacious.
Green iodide of mercury is the most available remedy with
patients who sit up late, who have light hair, and drink
freely. The typical case for the green iodide would probably
be the light-haired degenerated lady who sits up all night
playing the piano at suburban parties, who eats but little,
but refreshes herself frequently and takes a little brandy
before retiring to rest. The German ointment is less strong,
contains more suet, and is harder and preferable to that of
the British Pharmacopoeia. It salivates severely lees fre¬
quently, and produces a more permanent effect. Many cases
of primary syphilis in healthy, abstemious, light-haired men
will be benefited by mercurial inunction. Patients with dark
hair treated in this country with inunction, though they
may almost avoid syphilides, may suffer severely from a
form of sloughing sore-throat. Inunction in the late stages
is a refuge for the destitute, but rarely it may give gratify¬
ing results. Largo syphilitic testicles, secondary gummata,
and syphilitic nervous disease may yield like magic
to inunction. Inunction is most useful in the early
stages with healthy, light-haired, abstemious patients
with a primary sore, and the German ointment will almost
certainly cure the distracted married man who has had
syphilitic lumps for many years. To rapidly get rid of
sores the local administration of mercury in the form of the
vapour of calomel is of material assistance, whether the sore
be the smooth, flat, indolent button, or accompanied by
destructive ulceration of the glans penis. The vapour is also
valuable in ulceration of the extremities, especially the legs,
syphilitic in their origin, but frequently associated with a
weak state of constitution, or, more frequently still, asso¬
ciated with a too rapid or indiscriminate administration
of mercury. In certain cases, where mercury cannot be
administered internally, the vapour of calomel locally
applied is of great assistance, as also in the red, angry,
tubercular eruption on the forehead along the line of the
hat leather, and in the destructive ulceration of the fauces
in late secondary syphilis.

Mr. Brudenell Carter referred to the syphilitic lesions
of the eye, especially of the retina, which were met with in
the tertiary stages, and especially in those individuals in
whom the mercurial treatment had been inadequately
carried out.

Dr. Drtsdale could not agree that mercury was the only
treatment of syphilis, and spoke of the probable germicide
effect of mercury and iodine.

Dr. Lauder Brunton said that it was very difficult to
explain the modus operandi of mercury and iodides in
syphilis, for the pathology of this disease was still imper¬
fectly known. Perhaps tney acted as germicides.

Mr. de M£bic considered inunction was an uncleanly
method. He had seen many cases of tertiary syphilis which
were benefited by mercury.

Dr. Althaus alluded to other methods of introducing
mercury than those given in the paper. He spoke of hypo¬
dermic injections, lanoline inunction, and the oleates, all of
which methods he had employed with success.

Dr. T. K. Salter had nad a syphilitic chancre on the
finger, treated for nine months by calomel baths, and
without any secondary symptoms having appeared.

Mr. Milner, in reply, alluded to the baneful influence of
large dotes of iodide of potassium. Mercury was prac¬
tically indispensable.

Tbe following is a list of the names of Fellows nominated
for office by the Council for the ensuing year:—President:
J. Hughlings Jackson, M.D., F.R.8. Vice-President: T. L.
Brunton, M.D., F.RS.; Sir W. Mac Cormac, D.Sc.; T. H.
Green, M.D.; J. Knowsley Thornton, M.C. Treasurer: A. E.
Durham. Librarian: W. II. AllchiD.M.B., F.R.S.E. Honorary
Secretaries: Samuel West,M.A., M.D.; Bernard Pitts, F.R.C.S.
Secretary for Foreign Correspondence: Felix Setnon, M.D.
Council: R. Brudenell Carter; H. II. Clutton; W. Harrison
G'ripps; J. N. C. Davios-Colley ; S. H. Daveon, M.D.; D. W.
Finlay. M.D.; Francis Fox; J. Langton; J. Lowe, M.D.; R.
Macguire M D.; R. P. Middlemiat; J. n. Morgan; W. M.
s 2

4^4 'ThB l/ANCWt,]

EPIDBMIOliOGICiL SOCIETYOF LONDON.

Ord, M.D.; R. Douglas Powell, M.D.; W. Pye; J. P.Richards;
A. J. MfeeConhel Routh, M.D.; T. Gilbart Smith, M.D.: C.
Theodore Williams, M.D.; S. W. Wyman, M.D. - 1

Excision of Half of Larynx. — Tuberculosis of Fauces.-^-

Dislocation of both Hips.—Excision of Hip .— Trephining

for Cerebral Abscess.

’ A clinical meeting of tills Society was held on Monday .
last, Mr. R. Brudenell Carter, F.R.C.S., President, in the chair.

Mr. Lennox Browne exhibited a patient from whom
he had ten weeks previously excised the left half of the
Thyroid and Cricoid Cartilage with the corresponding
arytenoid, vocal cord and internal soft parts, on account
of unilateral epithelioma in a male patient aged 61. The
following points were emphasised :—l..Use of the raspatory
for removing the tissues external to the cartilage as the
surest safeguard against hromorrhage, as lessening the
chance of septicemia, and ensuring speedy recovery of the
power of swallowing, &c. 2. The use ot Hahn’s tampon
cannula. 3. The use of perchloride of mercury in solution,
and of corrosive sublimate gauze in preference to iodoform,
as dressings for the wound. 4. The not too quick closing
of the external wound, with the view of prolonging
functional rest of tho larynx without the irritation of
a tracheotomy tube. The patient spoke with a fair gruff
■voice, and was able to resume his occupation, but Mr.
Browne considered that it was too early a period yet to
speak as to the freedom from recurrence.

Mr. Lennox Bhownk also showed a young woman, aged
twenty, married, and the mother of three children who was
the subject of Tuberculosis of the Fauces and Pharynx,
extending to the posterior wall of the larynx and slightly
involving the right arytenoid cartilage. The lung condition
showed only incipient phthisis, but bacilli of tubercle were
plentiful at the seat of ulceration. The patient had suffered
on admission into the hospital on December 4th from
dysphagia in such an extreme degree that she preferred not
to take food. According to the method advised by Krause,
of Berlin, the diseased surface, previously anaesthetised by
cocaine, was scraped, and solutions of lactic acid, 20, 40, and
GO per cent., were applied daily for twenty-one days. At
the end of that period acute inflammation took place, on
recovery from which the dysphagia was found to be
absolutely relieved. In reply to Dr. Angel Money, he said
that the case was regarded as tubercular by all who had seen
it, and the typical bacilli were discovered.

Mr. T. Pickering Pick showed a boy aged eleven with
Dislocation of both Hips, as the result of softening of both
capsular ligaments. The legs were distorted and deformed,
and he was unable to stand; the right thigh was apparently
lengthened, Hexed, abducted,and rotated outwards; the left
thigh seemed to be shortened, flexed, adducted, and rotated
Internally. The boy had suffered from acute necrosis of the
tibia, and the resulting illness had led to the adoption of an
abnormal position of the legs so as to relieve pain; from this
dislocation had resulted. He had performed osteotomyon both
femora with a view to obtaining better positions. Reference

osteotomy was the best operation that could have been done
for the boy. He spoke also of Rawdon’s operation of ex¬
cision of the head of the femur. lie was not certain of the
mechanism of the dislocation that occurred in continued
fevers. Was the capsule torn or merely distended ?—Mr. J. IL
Morgan thought that infantile arthritis might lead to dis¬
location a9 well as rheumatic fever. In one case of upward
and backward dislocation, the head of the bone was found
to be perfectly healthy and jnovable, the acetabulum was
filled With granulation tissue, the capsule tense and stretched
over the displaced head, and the teres was destroyed.—
Mr. Walter Pyb thought that spontaneous dislocation
might occur as the result of pyrnmic arthritis.

Dr. A. Robinson showed a case of Excision of the Hip in
a woman aged forty-five. She had been suffering previously
from pyrnmic joint affections. The right leg was shortened
and everted; there was a sinus discharging freply on the
outer side. There was a dislocation on to the dorsum ilii,
where the head, denuded of its cartilage, was embedded in
indurated tissue. The head and surgical neck were excised,
and the final result was good, the patient having a movable
limb And being able to walk,—Mr. Wm. Adams thought the
case a very successful one.

Dr. Whitelaw Bourns showed two caA^s^f
sis Hystrix, in one of which the affection of the right
only began four years ago in a woman aged seventy-one.

Mr. J. Black read a case of Trephining for supposed
Abscess of the Temporo-sphenoidai ‘LObe. The patient was
a man aged twenty-two, whose illness began with vomiting
and shivering, and continued with rigors and high fever,
lie had suffered from otorrhcea for many years. There was
a perforation of the membrana tympani and there had been
a sinus leading into the mastoid cells. The cells Were
perforated and free drainage established, without much
relief. A few days later the trephining Was performed, the
dura mater was laid open, and the brain pierced, without
result. A day later fresh piercings in different directions
were made, but no abscess was detected and the rigors con¬
tinued. Quinine in large doses, stimulants, and nourishing
food were given, and in the course of two weeks the patient
had improved considerably, when the rigors returned. Optic
neuritis was not detected. The patient ultimately com¬
pletely recovered. He inquired whether the ($enrt$jfw«a
justifiable under the circumstances. Referenw wife mSn
to papers by Mr. Barker, Mr. Ilulke, and Dr. Greenfield, _J

Mr. H. Allixgham, iun., showed a case of Fracture of
the Lower End of the Right Humerus, with involvement Of
the median nerve in the callus, and consequent neuritis
with paralysis. It was that of a boy aged twelve> and he
proposed to cat down by the nerve and liberate it.

~ ■ ■ . • ’ kt etl t

EPIDEMIOLOGICAL SOCIETY OF LQHDiOJMis'.

- i\> -.’ i) be*

A mbkting of this Society was held on WedttMday«
Feb. 9th, Inspector-General Lawson in the chair.

A paper by Inspector-General John MACi’iiE'RSbNwas
read, entitled a Memorandum on Notices of Cholera in
India before 1817, of which the following is an abstract.
Th« object of this paper is to show that Dr. SenSmelinch in
his recent history of cholera before 1816-17, and still more
Colonel Yule, in his admirable Anglo-Indian Glossary, have
made some additions to tmr knowledge of the diffusion of
cholera in the East in early times. Dr. Semmeliuch points
out that bort was the name applied by the Dutch in the
east to choleraic attacks, although he doea not helieve that
malignant cholera existed in the East before 1816-17, as all
accounts of the disease before that date are unsatisfactory
to bis mind, owing to their being incomplete in the enumera¬
tion of the symptoms of the disease. However, we have
positive evidence through him, and still more through
Colonel Yule, that cholera of the worst type occurred in
Anaca in the Bay of Bengal, in 1602, that bort occurred in
Ceylon in 1679, and cholera in the Isle of Bourbon in 1716,
and further quite possibly cholera in China in 1517. In
almost all cases where captains of ships, or travellers, or
doctors have mentioned the diseases of the East, they have,'
in addition to the usual ones of the country, mentioned a
certain disease called mordexin or mart do c/iien of the
French, noted for its sudden onset and rapid coarse. This
was doubtless Indian cholera—sometimes sporadic, some-.
timeB epidemic. . - ,

A paper was read by Mr. John Moir on the Statistics of
the Wt»9t Ham Small-pox Hospitals during the Epidemic
of 1884 and 1885. He stated tnat during that, pmod he
attended 1211 cases in the Guardians’ Hospital and 303
cases in the Local Board Hospital, with a total mortality of
280 (18-4 per cent.); and the tables compiled by him
showed that the mortality after revaccination, with the
exception of one case of pneumonia, from which the
patient was suffering on admission, was nil „• after
primary vaccination with three or more good marks. 4 per
cent.; with from one to two marks, 15 per cent.: in the
imperfectly vaccinated, 29 per cent.; in those said to be
vaccinated, but without evidence, 44'6 per cent.,; and in the
admittedly nnvaccinated, 52-66 percent. As to the question
of protection by vaccination, it was in exact ratio to. the
efficiency of the vaccination, and revaccination afforded
practical immunity from confluent small-pox and death from
small-pox. The deaths from small-pox’in West" Ham were
259 in 1884 and 563 in 1885, whereas in 1886 there were
only 3. A house-to-house visitation carried on by Dr. A.
E. Kennedy led to a great increase in vaccinatioh and re¬
vaccination, as during the period in question, from March
.'10th to May 14th, 1885, the public vaccinators in West H&iq.
revaccinated 2978 persons, besides vaccinating 615 over the
age prescribed by the Vaccination Act, with a large inorease

Dij

ThsLanSW,]' ’ MANCHESTER PATHOLOGICAL SOCIETY—REVIEWS. [March 5,1887’ 475’

iathennmber of primary vaccinations. It appeared from the neighbourhood of the Joint, and secondarily involving
Dr. Kennedys report to the West Hem Board of Guardians the synovial membrane. He did not think that in the
in May, 1886, that, in a population of close on 130,000,98 6 hip-joint the simple removal of sequestra was sufficient,
per cent, were found to be vaccinated. But the chief benefit but believed rather that, since the mischief so frequently,
■was the increased impetus given to vaccination, and the fact began in the head of the bone, the proper treatment
that there were only 8 deaths from small-pox in 1886 was was to excise the head and neck only at an early stage—
greatly owing to this house-to-house visitation. Another an operation which was frequently followed by'primary
feature brought out by this epidemic was the increase in the union and a movable joint. In the later stages excision was'
number of cases round the hospiuls area. The report of very unsuccessful, and he preferred expectant treatment.—
Mr. Power to the Local Government Board, printed by the Mr. A. W. Stocks thought that the characteristic position of,
West Ham Board of Guardians, shows that in the three- the limb in incipient hip-joint disease, and the favourable
quarters of a mile radius (used for the reason that it result of early and judicious treatment without operation,
iacludes the whole of the built-upon area of Plaistow, in combined with the fact that forcible distension of the joint'
which the hospitals were situated, and leaving a zone com- in the dead subject produced a similar distortion, threw a
paratively sparsely populated), in the six months, Dec. 1883 good deal of doubt upon the theory that hip-joint disease,
to June 21st, 1881, this hospital area suffered a rate of small- commenced, as a rule, in the substance of the bone.—Dr.;
pox mortality ten times greater than that of the remainder Wm. Tiiorburn said that Mr. Wright had proved the osseous
of the district; in the two months and a half, June 22nd to lesions to exist in such cases as he thought required excision,
August 80tb, 1881, a period corresponding to the normal but he would ask what was the proportion of cases' excised’
seasonal decline of epidemic small-pox, West Ham.suffered to those treated without operation, and whether Mr. Wright
about the sapie amount of fatal small-pox ;isin the preceding held that the lesions were similar in the large number of
six months, but the small-pox mortality iu the hospital area oases whioh it is possible to cure by rest, &c.?—Mr. Wright,
was smaller, butstill nearly twice as great us in the remainder in reply, said that the fixed position of tho limb in abduction
of the district; in the next six months it increased again and flexion occurred as soon as the mischief reached the
to over three times that of the rest of the district. There joint, but so long as the interior of the bone alone was in-
was a large number of hemorrhagic cases in hospital (fifty- volved it did not occur; this corresponded with the “latent
•even), mostly coming from the insanitary and over- period” so often seen, and was confirmatory of the view that
crowded districts. The tables showed that the largest the bone lesion is primary.. The proportion of cases excised,
number of cases occurred between the ages of fifteen and to those seen was about one in six. There was no reason to
thirty years, proving the necessity for successful revaccina- suppose that the excised cases differed in pathology, but
tion. Of the 1514 cases, 55 were under two years of age, 18 only in the stage , at which they were seen and iu the
being vaccinated, with 2 deaths ; 4 had small-pox and possibility of carrying out efficient treatment,
vaccination concurrently, with 3 deaths; and 88 were un-

vaccinated, of whom 27 died-: , ". ■ =

In the discussion which followed, the President, Dr.

$tbitfos aiftr lottos of looks.

Thome and Willoughby, and Mr. Shirley Murphy took part -

'■‘MANCHESTER PATHOLOGICAL SOCIETY.

•ilf lo pvHj.. L:i .v -- '

BttffcfliwrtoE Is a brief record of the proceedings of the
■eating on Jan. 19th, Dr. J. Draschfeld, President, in the
daj£ v .j exu I . i •. .. * i.

BMk mim mi DiieaM of the Hip-joint in Children .—
Mr. G. A Wright opened the discussion, and after reference
to a few points in the anatomy of the joffit, he proposed
five headings as the subjects for debate, premising that be
took for granted the tubercular nature of the complaint.
L The seat of the primary lesion was held to be nearly always
lathe bone, as an articular ostitis or affection of some part
of the epiphysis, the epiphysial line, or the calcar femoris'.
The relation between the anatomy of the joint and the seat
of the lesion was discussed, and the question of the effects
of injury alluded to. A case of synovitis was mentioned as
being the only instance in over a hundred cases examined,
fe It was almost impossible to determine the frequency of
pHmary acetabular disease, though the existence of pelvic
Mischief could usually be ascertained. 3. Necrosis of the
femur was said to be present in about 17 per cent., of the
toetabulum in about 22 per cent., of cases that had’reached
the stage of abscess. Total epiphysial necrosis and the
Question of diastasis were discussal. The mere removal of
nquestra was held to be insufficient on the ground that the
specimen* showed tubercular ostitis round the sequestrum
eavity, and this would be left behind. The difficulty
of finding the presence of sequestra without section of
bone was also pointed out,. 4. The probability of
ricovery of the bone in the specimens shown was de¬
emed against, on the ground that no specimen showed
toy sign of repair except one in which the whole epiphysis
tod been removed by natural processes, since it was observed
that until this occurs relapses are probable even if tempo-'
tory quiescence is procured. On pathological grourids
tra conclusion was that excision is the proper treatment.
Between fifty and sixty preparations were shown to illus¬
trate the Various features of hip disease and the points
indicated in the address—Mr. F.T. Path. (Liverpool) agreed
ylth Mr. Wright’ hi placing the Origin of the disease most
fte( l a totl* : ifc the bone* 1 end;-from repeated microscopical
•toMiaatum typical oases, mmuAteed'thet pulpy disease

w ta* joint! WM, aiw*ys tubefcplar. ,He regarded it a»a
rarefying or tubercular ostitis, commencing in

A New Departure in Science. Being a Second Edition of a
New Chapter in the Story of Nature. By Charlks
Bland Kadcliyfe, M.D. 8vo. London; Mac mill anf
and Co. 1886. ■ ■

Not the least important aid to one branch of scieneeis
often furnished by those professionally engaged in another 1
department, for the wider the sphere of a man’s knowledge
So much the more philosophic will be his treatment of
special subjects. Thus geology owes much to the labours
of surgeons and physicians, among whom may be mentioned
Fittoh, Mantel!, Dixon, Holl, Lycefcfc, Duncan, and others;
and during the past seventy years no less than six medical
men have occupied the presidential chair of the Geological
Society of London. Of these, Mr. J. Whitaker Hulks
(formerly president) has just been awarded the Wollaston
Gdld Medal, the highest honour the Society ean bestow, for
his researches on Fossil ReptHia. Now and' again; how¬
ever, a feeling of scepticism in •' scientific teachings is
developed in the minds of those who pin their faith on the
literal interpretation of the Bible; and this is especially
prominent if they have some acquaintance' with geological
, literature, but have failed to thoroughly grasp the principles
of the science. The results when put in print are generally
lamentable, and unfortunately we cannot make the volume
under notice an exception.

The author’s first “ departure* is founded on his belief
that there is a tidal wave in the land, dependent upori
tidal fluctuations in subterranean heat. His conclusions
are based on barometrical observations taken at high and'
low water, afloat and on shore, although he previously
“saw that the atmospheric pressure must increase if thef
land or water went down, and decrease in the contrary 1
case.” His observations show a slightly diminished atmo J
spheric pressure ashore at low water, but no material
difference between the pressure afloat and on shore at high
water. The records, however, are somewhat conflicting,
nor is any statement ■ made of the temperature at tW
: different places. It is well known that there a$e areas of
high and low pressure distributed side by side, and meteoric

Digitized by G00g[e

476 The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[March 5,1887.

influences would be amply sufficient to account for the
slight differences recorded by the author, while in any case
the records are too meagre for the establishment of general
conclusions on the subject. It is true he admits that “ no
doubt additional evidence is wanted before it is possible to
lay down the law positively,” but further on he adds,
“ and to return, it may not be wrong to conclude that the
evidence in favour of a tidal wave in the land is even more
conclusive than the evidence of a tidal wave in the water.”
Throughout his volume the author, after introducing his new
departures and pointing out that it may be so and so, has
a tendency to argue as if it is so, and as if his statements
and conclusions might be accepted as facts. He seldom
presents any real arguments against these “departures,”
and appears to read too much in the light of his preconceived
opinions. In the case of the tides, no doubt, it is difficult
to define the exact influences that affect them, through the
revolution of the earth, the configuration of the coast lines
and of the ocean beds, and from astronomical causes. The
author, however, says little about the action of the tides on
rivers, nor does he point out how they would be affected by
upheaval of the land. It is well known that minute earth
tremors affect the land—vibrations (almost microscopic in
character) that are produced both naturally and artificially,
and in the former case sometimes by variations in barometric
pressure. Nevertheless, in the case of violent earthquakes
the vertical movement of the land is seldom more than one
millimetre, and yet from the observations of the author at
Eastbourne he found, to his great delight, “ that the land
went down at high water and up at low water, and that
this movement amounted fully to nine feet ” 1

That rocks may expand under the influence of heat will
not be denied, but we cannot follow the author further
when, for example, he remarks “ that some rocks expand
and shrink more than others under the action of tidal fluc¬
tuations in subterranean heat, and that a day may come in
which the rising and falling of the tidal wave may give the
key to the geological construction of the sea-board—when,
e.g., an exceptionally high tide may be looked upon as
pointing possibly to the presence of coal at no great distance
from the sea in that locality.”

Dr. Radcliffe’s second “ departure” is one “ in which sub¬
terranean and other forms of natural heat are found to be
dependent upon electrical incandescence, &c. v ’ He observes :
“ The simple fact is that the earth is traversed instanta¬
neously by electrical currents from the sun and moon ; that
these currents in certain parts of their course across the
earth are, as instantaneously, frittered down into heat by
resistance.” In this way he would account for the tempera¬
ture of the Bath waters; but we must pass over the laboured
arguments which are put forth to interpret facts that are
capable of simple and intelligible explanation on the theory
of the earth’s internal heat. Although the author is appa¬
rently acquainted with the fact that the daily changes of
temperature do not affect our soil beyond a depth of about
three feet, and that the annual variation below twenty-five
feet is very small, yet he does not realise that the subject
of the gradual increase of temperature at greater depths is
incapable of explanation in the way he supposes. The tem¬
perature of the earth’s surface varies according to the heat
of the sun, whereas in descending below the surface to a
depth of upwards of fifty feet, we reach a point where the
oscillations of temperature due to surface causes cease; we
come, in iact, to what is termed “ the stratum of invariable
temperature”; 1 and below this, wherever observations have
been made, the temperature gradually increases.

Turning to the concluding “ departures” of the author, we
are not surprised to learn that he is incapable of accepting
the doctrine erf evolution. lie states, as one departure, that

‘ i SeeGreen’* Phyrtoai Geology, 3rd eiUt-.p. M3. 1 ‘

Oh'v '*Hn *./i■' -y ■ tnif,

“ in which the age of the earth is not found to reach very
far back into immemorial times.” Sir William Thomson
has pointed out that the period during which life can have
existed on the earth’s surface should perhaps be restricted
to about 100,000,000 years, and Dr. Croll has inferred that
the glacial period probably commenced about 200,000 years
ago. These figures may be fairly approximate, but they do
not profess to be precise, and we should not find So much
fault with the present author if his conclusions rested upon
facts. He says: “A chief reason for believing in the
extreme antiquity of the fos9iliferou9 rocks is that which
is supplied by the doctrine of evolution. Set aside this
doctrine, and the reasons for entertaining a view altogether
different to it retain all their force. So it may be—nay, so
it must be. And if so, then there is so far nothing in the
history of the fossiliferous rocks to make it absolutely
certain that immemorial ages have been spent in the
formation of these rocks.” The antiquity of the earth is
proved by the succession of sedimentary deposits and the
succession of more or lew distinct faunas and floras in
different areas, as well a9 by the evidence of breaks or
intervals that were accompanied by upheaval of the strata
and extensive denudation. Continuous deposition was no
doubt going on when we take in consideration the entire
area of the earth’s surface, but many physical changes have
interrupted this continuity locally. In the same way the
chain of organised beings was no doubt continuous^ when
we consider the life history of the earth’s surface as a
whole; and one of the charms of geology is to be able
to discern in the strata of a small area like England
evidences of physical conditions that are repeated in
various climes and conditions over the globe at the present
day.

The final “departure” of the author consists in the
assertion that “the actual and Scriptural history of the
earth are found to be not wholly irreconcilable,” and that
“the elder stratified rocks were formed in the compara¬
tively short interval between the creation and the deluge.”
He speaks as if the series of stratified rocks was formed
continuously, observing “how in the space of a year the
great revolution in which the bed of the ancient sea was
converted into the present land may have been brought
about.” The “universal deluge” in his opinion preceded
the glacial period, and was due to the refrigeration, because
“ with water everywhere the earth would be insupportably
cold.” We have at present no positive evidence of human
remains in pre-glacial times, but man no doubt occupied
portions of the British area during the glacial period, for
the old flint implements found in the Thames valley deposits
and in certain caverns are associated with a fauna that is
older than some of the latest glacial deposits of the north of
England. The idea, however, of a universal deluge is so
entirely opposed by the present geographical distribution
of animals that no one can hold it without at the same
time believing in numerous special creations of different
forms of life on the isolated continental areas and islands ;
while, as regards the antiquity of man, it has been remarked
that if all the leading varieties of the human family
sprang originally from a’ single pair a much greater
lapse of time was required for the slow and gradual
formation of such races as the Caucasian, Mongolian, and
Negro than was embraced in any of the popular systems of
chronology. -

In noticing these “ departures” of the author, we have
quoted his own words in order to express his views as fairly
as possible; but we cannot escape the conviction that in
most cases he has gone out of the way to seek a new expla¬
nation of well-known phenomena, and his work is in reality
a departure from science. No one believing in an all-
powerful Creator would deny that anything might have
been produced in any way; but the object of scientific in*

. ... '■•■v *?:,/•

by Google

The Lancet,]

REVIEWS.—NEW INVENTIONS.

[Maech 5,1837. 477

vestigation is rather to ascertain m what way Nature has
worked. In the one case observation and reason are the
chief guides, and in the other we seek to interpret blind¬
folded. To many of ns the geological record reveals a won¬
derful and beautiful story of the creation, and if so we may
believe that our ability to decipher some portions of the
history was likewise intended. Be this as it may, any
attempt to reconcile literally the Biblical account of the
creation with the geological record is about as scientific as
as it would be to reintroduce the systems of surgery aud
medicine that were in vogue at the time the “Mosaic"
account was written. __

.4a Bleuientarg Text-book of British Fungi. Illustrated by

64 Plates. By Wm. Dblislb Hat, F.R.G.S. Pp. 238.

London: Swann Sonnenschein, Lowrey, and Co. 1887.

A8 the poet says of vioe, that we “first endure, then pity,
then embrace,” so it would appear from the writings of all
professed fungologists, that we first suspect, then collect,
then enjoy these singular half-animal, half-vegetable bodies.
It i3 certain that by neglecting them and their culture a
very considerable quantity of wholesome and eminently
nutritious food is annually wasted; and it is not a little
curious that, while most of even the smaller and less con¬
spicuous flowering plants have received common names and
are easily distinguished by field labourers, the very large
group of fungi are only differentiated by the majority of
even well-educated people into two groups—“ mushrooms,”
or edible fungi, and “toadstools,” or poisonous fungi,
the latter including all but the three or four species
of agarics that are found in open pastures. Mr. Hay
remarks that no other nation is so ignorant, but that,
oq the contrary, the various peoples of the continent of
Europe bestow a great deal of attention on fungi. He
follows the classification of Fries, and refers for illustrations
to the admirable work of Mr. Cooke which is now approach¬
ing completion.. The neglect of fungi, of which Mr. Hay!
complains, is doubtless due to the difficulty of discriminating
wholesome from unwholesome species, and he very rightly
devotes successive chapters to their structural anatomy
and the characters of the more common edible species. We
give an extract which will show the lively style in which 1
Hr. Hay writes, and the delicate food that is provided
for us without cost were we only sure of true selection.
Speaking of the Chanterelles, he observes; “Few mushrooms
can be so readily recognised as this, and once known it i&
impossible to mistake any other for it. The chanterelle
grows in woodlands and parks, and its distinguishing
features are these: an irregular shape; gills like wrinkled
folds or plaits; a uniform bright golden-yellow colour; 6
scent like that of plums or apricots. It is a supremely ex¬
cellent viand, in high estimation among mushroom epicures.
In continental. markets it fetches a high price, though
plentiful there as here. Finding it often in quantities near
London, the author has sometimes presented basketfuls to
his French and German friends in the metropolis to their
gre&t gratification. But when he has proffered it to his
own countrymen be has usually encountered contemptuous
*coru; bo deep is the fungophobio superstition.” .Other
excellent but entirely neglected mushrooms are the oreads—
Marasmius oreades, which is the chief former of “ fairy-
rings”; the Blewit, Lepista personate, which the author
declares is as good as veal cutlet; the Puffballs (Bovistnj),
which, however, must be eaten When young, white through¬
out* and solid; the Helvels, the Mousseron (Agarictrapru-
nalue), the Oyster (Agaricus ostreatus), and many besides.
Mr. Hay is not content with describing the British fungi,
and with indicating their economic value and digestibility,
hat he devotes a chapter to culinary receipts, which give
the remits of his experience in dressing them in a palatable
®«ner forth* table. :• 1 '

MODIFICATION OF MIDWIFERY FORCEPS.

I believe it is a recognised fact that the chief difficulty,
if it can be oounted as such, in the nse of the forceps lies in
the introduction of the upper blade, for these reasons: When
the lower blade is introduced first, it is an obstacle to the
application of the upper one, from its presence in the vagina
and by the uterine contractions which are sot up dyna¬
mically by it. It is easier to introduce the lower blade
chiefly on account of the relative positions of the patient
and the operator; for on whichever side the patient may
lie, it will be found to be more oonvenient for the hand,
to trace out the under surface of the fcetal head than,
the upper. However, a great authority says : “If we
use the curved forceps — i.e., with the second pelvic or'
sacral curve, — then the upper blade is generally the
best to introduce first.” After this I take it for granted
that, whether the upper blade be introduced first or last, it
is always the more difficult to apply. In order to obviate
this difficulty, Mr. Coxeter has constructed for me a pair of
forceps having the lock adjustment reversed to those in
ordinary use. It is obvious that if the
upper blade of the latter kind be first
introduced and held in situ, it will lie
well against the perineum, and between
them there will not be room to pass the
lower blade without first displacing the
handle of the other forwards, which is not
good for the uterus; whereas with my
forceps, when the upper blade is in posi¬
tion (having its lock forwards), there will
be plenty of freedom for the passage of the
lower blade. 1 have often noticed that it

is not so much the actual use of the forceps, that alarms
the patients as the preparation for the simple opera¬
tion. “Drawing the patient to the edge of the bed
and baring the buttocks” is not a pleasant procedure, but
hitherto a necessary one on account of the rigid blade. In
these instruments I have endeavoured to obviate this also;
for in the handle of the upper blade adjoining the lock there
is a lateral hinge which flexes backwards, but which is rigid
to forward pressure; when dosed, it moves on two plates,
with a concealed pivot constructed in such a way as not to
impair'the strength of the blade for leverage or traction’
neither is it conspicuous when the handles and locks are in'
apposition. The shanks are made sufficiently open to admit
the Index-finger comfortably for traction, and the handles
aife full long. When the handle is flexed, the upper blade is,
shortened, and can be introduced without altering the posi¬
tion of the patient, supposing she is in the usual obstetric
position. The upper blade being passed, the lower easily
follows. The forceps have also been fitted with Dr.
Avefing’s handles, the curve of which greatly aids the design
of the instrument.

Wm. D. Haslam, M.D., M.R.C.S.,

Late Obstetric Assistant to University College Hospital.

Meoklentrorgb-square.

Digitized by

478 The, Lancet,]. , _SANITARY GONDI^ION OF WINDSOR. OUpca5,1887.

THE LANCET.

• LONDON: SATURDAY, MARCH 5, 1887. ;

The Local Government Board have published the report
upon the Sanitary Condition of New Windsor, which, has
been presented to them by their Inspectors, Dr. Hubert
Airy and Mr. Arnold Taylor. We trust the lessons it
teaches will be taken to heart by the local authority,
^hose members have until now denied the existence of
conditions which have been the subject of special reports
by our Sanitary Commissioner.

Windsor, the Inspectors state, is in most respects no
worse, and in some respects is distinctly better, than many
other old towns With which they are acquainted, and they
think some allowance should be made for the difficulties
that beset a sanitary authority in its endeavours to amend
the faulty state of things which it has inherited from
bygone centuries. With these viewB we entirely concur;
there are towns which are worse than Windsor, and it has
been our duty recently to 1 adduce evidence in this respect,
but the existence of faults elsewhere is no excuse for the
neglect to reniedy those in Windsor, and we have held that
the Tqwn Council would have been acting more wisely in
admitting the necessity for the exercise: of their powers,
and claiming such consideration as is due to thb Sanitary
Authority which-has inherited the evils of 1 bygone centuries,
rather than in denying that their district required aotive
improvement.

The report dwells upon the injuries inflicted by the
floods which from time to time inundate the lower parts of
Windsor, the water reaching to the top of the kitchen grates,
and leaving behind it a layer of mud on floors and furniture,
and causing “the destruction of wall paper and plaster, the
saturation of walls andfflobrs, which it takes months to get
rid of.” The Inspectors point out that the Town Council
have no power to require dwellings already built in low-lying
situations to be altered in each a way as to raise their
ground floor above the flood level, but the^r omit to dlscUss
how far they might be expected to prevent the overflow of
the river by Work such as that which has been successf ully
carried out at Strood, on the banks of the Medway.

Apart from this, the Inspectors describe, in words of
condemnation, the .condition of the older courts and all eye
of the town, where they And that, “though in many
<Jase8 the houses stand on fairly' sound ground, their
condition in respect of outBide air space, back-yard
space, internal ventilation, closet accommodation, surface
formation, and pavement-—in some or ail of these particu¬
lars-—is still pitiably bad.” A tuple details are givdrim the
body of the report from the Inspectors’ own observation of
the grounds upon Which this general Statement is based.
Thus, in Garden-court, hack yards, or rather closet-wells, are
only from four to six feet across, and contain each & pan¬
closet to be flushed by hand; water has to be fetched from
a stand-pipe near the entrance to thb court. ^ The absence of
back windows in different parts is c n orally,commented On.

In Distil House Row it is $oted, among other defects, that
the bouses have no back yards, while , cavities'in the. ground
receive Ashes and hbuse refuse, and “ at the edge of thn bade
lane which bounds these courts stand four pai-dosete for
thirteen houses, pahs dirty for want of flush-water, wood¬
work giving way.” Again, in South-place, “ of thirteen
houses on the south side, ten have no opening whatever at
the back, no scullery, no closet, and no water, but a tap at the
end of the row.” For closet purposes, the sixty-five dwellers
in the ten houses have to go Into hn open yard ait the bade
of the opposite houses on the north 'side. "Some houses
in South-place wanting in ventilation, the Inspectors
believe, can be remedied by: putting in a window at the
head of each stair; bat as for the houses On the south side,
they “Bee no way of rendering them tolerably habitable
but by demolishing every third house and converting its
site into a yafd for its neighbours, With a proper water-
closet to each.” Keppel-row is referred to as “another
insanitary locality,” and a description of its condition is
given; and the Inspectors state, they might add details con¬
cerning Keppel-street, Love-lane, and Others, but that the
examples they have cited will suffice to Show the general
condition 6f the older and poorer dwellings in these parts
of Windsor.

Concerning the sewerage, the report observes that “ the
flushing is not sufficient to keep the long and almost level
outfall sewer (with a fall of three feet in a mile) free bom
deposit, which thus i6 left in the sewer long enough to de¬
compose and cause offensive effluvia from the gratings.”
House-drains are further condemned, the report asserting
that “there is reason to believe that in many cases the
house-drains are ill-laid and on ventilated,, and ready to
oonvey poisonous gases direct from Ihe hewer to
the house through an untrapped sink-pipe or an ill-
constructed watercloset.” The Inspectors lament; the
insufficiency of the general law to do more than hinder the
recurrence of those conditions which have actually shown
themselves to be nuisances; the fact remains, however, and
we have urged this with regard to Windsor, that the
poor cannot he trusted "to make complaints, And that
nuisances, if they are to he remedied, must be Sought for
by the Sanitary Authority. The report also wisely points
out that although the work of nuisance inspector is
enough to demand a man’s whole time, and the sanitary
authority ought not to content themselves with less,
this work has entirely devolved upon an officer who is
the borough surveyor, the inspector of common lodging-
houses, the inspector of weights and measures, of petro¬
leum, and of canal boats. As the report states, without a
proper staff no local authority can fully enforoe the pro¬
visions of the Sanitary Acts, and Windsor is quoted as a
borough which needs amendment in this particular. The
fact is dwelt upon that most, if not all; of the courts and
streets whose defective sanitary condition has been de¬
tailed might have been dealt with, externally at least,
under the 150th and following sections of the Publia Health
Act, 1875, but no attempt appears to have been made to use
these sections.

We note with pleasure that Dr. Casey, the medioal officer
of health, is regarded by the inspectors as an able and con¬
scientious officer, and that they And in his annual reports

Digitized by viOOQlC

ThbLancbt,}

THE TREATMENT OF PLACENTA PREVIA..

[March 5, J887. 470

ari^woe pf, much good work in his distriot, and sound
advice offered to hie Sanitary Authority. They state, how-
6Taf r tbat ,Dr. Cabby hap under-estimated the importance
of such sanitary defects as have been described in connexion
vita South-place, or else has over-estimated the difficulty
of legally dealing with those defects.

As the result of their inquiry, the Inspectors reco mm end,
where thq Publio Health Act, 1875, is insufficient,. that
resort should be had to tbe,A?tisans and Labourers’ Dwellings
Improvement Acts, 1875 and 1882, for the improvement pf
unhealthy areas; that these should be more constant and
thorough nuisance inspection, and that a separate inspector
of nuisances should be appointed for this purpose; and,
finally, that the Sanitary Authority should make the much-
needed provision for the isolation of infectious disease for
the disinfection of infected articles, and for the destruction
of house refuse. f! -

If these recommendations be faithfully carried out by
the looal authority, we shall certainly feel we have not
laboured in vain. Already, as the result of publicity given in
Ths Lanckt to sanitary neglect in Windsor, great improve¬
ments have been effected. We have no hesitation in saying
that, notwithstanding the still unsatisfactory condition of
many parts of the town, the Windsor which is the subject
of the report of the Local Government Board is very
different from the Windsor to which we first directed public
attention in August, 1885. The extraordinary efforts made
by the Sanitary Authority after the publication of our
articles are .well .known to us through, subsequent inspec¬
tions . of tfieir town by our Commissioners. There is,
indeed, no more instructive, passage in the whole ,of
the report of . the Local Government Board which is no w
mads public,than the statement that, “in looking through
the Nuisance Report Book, we ooujd not fail to notice that
in the single month of September, 1886” (the month before
the Inspectors’ visit), “ there are about as many cases of
premises inspected, and nuipapoes reported as in the two
yean from September, 1884, to August, 1886.”

1b resuming our discussion of the subject of placenta
pnewa, we come to some points in the history of that con¬
dition. Internal version requires dilatation of the cervix
to an extant implying that labour has advanced to a con¬
siderable degree of progress. To wait for this is often
impossible, and accouchement foraS (forced delivery) was
formerly the only alternative.

The first great advance was made in 1860 by Dr. Braxton
Hicks who showed the possibility of turning by the bipolar
inethodj when the cervix would admit two fingers, or even
Me.. Mu.expressly pointed out the advantages of early,
version by this method in placenta prcevia, and published a
leriee of'caeee to illustrate his point. Our Teutonic brethren
•eem to havei read his publications (which are plain enough)
without understanding, for the greatest German accoucheurs,
Yon Bbckka and Spjlegklbkbq, opposed and decried bipolar
vertfou, but showed ti^at they.failed to comprehend it. In.
the meanwhile various methods of treatment were proposed
and partly adopted, aud Hicks's method seems to have been
^m&ifAUy unknown in France and America. Twenty-two
yean after its, publication a serious trial of early bipolar,
jHaFMBiRm.f year, later b/ BaHM,and

a year later by Lombh, all in Berlin. It was then found
that the method which aq English accouoheur had described,
and practised in 1860 required' twenty-two years and a
foreigner to bring it into vogue.

■ These accoucheurs treated 236 cases with eight maternal
deaths, a mortality of 33 per cent., Bbhji delivered fifty-
eight cases consecutively, without a single maternal death.
It must he remarked that Hofmeibb and Berk treated all
their patients themselves, whereas Lomhr’s cases were
treated by nine different assistants. The presence of a
sculled operator must of course .be discounted in comparing
ancient with modern methods, and so must the use of anti¬
septics. Still, it may be safely said that, after all due
allowance is made, the above results have never been nearly
reaohed. The reduction of mortality may be stated as from
24 per cent, to 3 per cent. The method may be described ae—
a. Bipolar podalio version as early as possible, b. Extraction
by natural forces, or after complete spontaneous dilatation.

. It is found, as said above, that the bleeding practically
oaaaas after version and before extraction. As regards the
life of the child, delay does not* according, to statistics,
much impair its Qhauces» which are always bad; and, on the
other hand, the great danger of laceration and fatal hemor¬
rhage from.it is set aside, while a fertile source of sepsis is
also avoided. Other methods are still mentioned in text¬
books: complete' or partial separation of the placenta,
rupture of the membranes, and plugging. Rupture of the
membranes and evacuation. q£ the liquor, amui is often
impossible when the plaqenta is completely praavia; .the
other methods have no .such brilliant results, and must
predispose to sepsis by : the fingering 1 of the plaaental site,
aod the, retentipu of oloto near it which they entaiL

In France the use of the plug still holds its own, and the
statistics have certainly improved since the introduction of
antiseptics. Still, it can show no results like the above, arid
should not, in our.opufiop, he the routine ipractice among
medical men,. It must* however, be remembered that
placenta preevia is one of the conditions which midwives
often have to treat, at least temporarily in the absence of the
doctor, and that unless these cases axe treated property they
die. It is Obviously impossible to entrust midwivefl, on the
other hand, with so delicate: an operation as bipolar version,
For midwives the.best treatment will certainly be to plug
tightly with antiseptic precautions, washing out the vagina,
and plugging, if possible, through a speculum, with cotton¬
wool or gauze rendered aseptic. There, is nothing better for
plugging than a band age of ooocrosive sublimate gauze. The.
plug excites contractions, controls, hemorrhage to a con¬
siderable extent (for conceal ad haemorrhage in placenta
prtevia is almost unknown), and preserves the membranes
for turning: by the accoucheur.

In .summing up the question, of. treatment, it must bet
remembered, that capes divide themselves into two principal'
desses: The fiat, in. which the uterus, so tossy, takes matters
into its own hands and acts.powerfully; in these oases, to
temporise aftd assist labour, as by foroeps of rupture of the
membranes if they present, will often be sufficient. The
second, in which the labour is disordered, the utertis
demoralised, and, unless prompt and skilful help is at hand,
thp tendency is to rapid death. It is these oases, about 1
which there should be do two minds with regard to treats

.oogle

Digitize

480 The Lancet,]

LEGAL CHARGES AGAINST MEDICAL MEN.

[March 5,1887.

merit, and it seems to be proved that it may be summed up
as (a) bipolar version as early as possible, (b) extraction
aetually or practically left to nature.

There is yet a third class of cases—namely, that in which
the patient is either moribund or in extreme and urgent
peril from flooding, and in which forced delivery by manual
dilatation affords the only chance. These cases are ex¬
ceptional, and it is hardly necessary to add that the
operation should be performed with Rll possible skill and
gentleness.

There are several morals to be deduced from the history
of plaoenta praevia. Firstly, the new is not always the
true, nor the truth new. The latest improvement may be a
retrograde movement, and the “ greatest modern triumph ”
a thing of which the not remote future will be ashamed.
We need not illustrate this maxim here; it is a text
on which we have preached and shall preach again. To
the reader we need only say, in the language of Sir
Christopher Wren’s epitaph (slightly altered) “Si docu-
mentum requiris, circumspice.” The verdict of the day is
often wrong; each must make up his mind as to what is
bad and false and what is good and true. To follow fashion
may entail forty (or twenty-two) years’ wandering in the
wilderness, till it takes a foreigner to oonduct us into the
promised land. Secondly, it seems possible that even
the most intelligent foreigners may fail to understand
plain Eaglish and decry a practice whioh they fail to com¬
prehend. In this instance it took twenty-two years for
them to oomprehend it. Thirdly, English practice is not
always the worst, even if unacceptable on the Continent.

It will be seen that the best modern practice agrees with
Dr. Braxton Hicks’8 recommendations in 1860, and that
though some of the facts in the pathology of placenta
praevia (such as the arrest of haemorrhage after turning
and before extraction) were unknown to him at that time,
as well as to bis contemporaries, his name deserves a
prominent place in the history of the affection.

- ♦ -

It is important to study the charges made against
members of our profession. They are bound in the very
nature of their calling to place themselves often in difficult
potions which can easily be misrepresented by little or
unfriendly minds. Sometimes unreasonable duties are
required of them and unfounded charges are brought
against them. It is true that as soon as they get into an
open Court and can challenge the judgment of a trained
judge or an intelligent jury, their adversaries ore generally
discomfited and the case against them melts into very thin
air; bat, nevertheless, great injury is done to them, and
no redress that law can give can repay them for the injury
which law permits, and whioh perhaps it is not in the
power of law to prevent. We have reports of two or three
cases which painfully illustrate the injury which the law
allows to be done to medical men even in cases where it
vindicates their conduct and their honour.

In one cose reported the doctor’s name is not given, and he
is very deeply involved. A working man, described as “re¬
spectable-looking,” appeared before the Southwark police
magistrate, Mr. Hosack, to ask advice and assistance in
the following circumstances. Three of his children were ill.
One was affected in the thigh, another ir> ' ' oulder, and

a third in the eye. He could not afford to pay for a
medical man, aid he sought Mr. Hosack’s assistance to
compel “the doctor to attend.” The man was very much
disappointed when told by Mr. Hosack that he could not
in any way help him. Probably the least respectable
quality about this poor man was his intelligence. He
seems to have mixed up very doubtful theories of his
children’s illness with equally absurd theories of the power
of magistrates to compel medieal attendance for nothing.
His idea was that the children were suffering from
small-pox brought through the doctor from children in an
adjoining room. This individual’s views of diagnosis are
probably on a par with his legal views of medical dnty, and
need not detain us.

A more serious illustration of our complaint is to be
found in tbe report of a case in the newspapers of Saturday
last, in which a respected medical man, Mr. John Brown,
of Battersea, appears as one of two co-respondents in a
divorce case, the petitioner being Mr. Joseph Cecil Len-
nard, a provision merchant. Mr. Brown had an easy task in
repelling the charges brought against him. He had been
in frequent attendance on Mrs. Lennard, whose father and
mother he had known from the time of her childhood. He
produced his books and a specimen of the very few letters
he used to reoeive from her, which was of the most ordinary
character, requesting him to call and see the little girl.
He positively swore that he never had been guilty of any
misconduct or familiarity with the lady. The accusation was
made after Mr. Brown’s account was sent in. Mrs. Brown
gave evidence for her husband, and said there never had been
any secrecy about Mrs. Lennard’s visits or notes to her
husband. Sir Jambs Hannbn’s remarks were very good,
lie said he did not know anything more important or
serious than the question whether or not a doctor had been
goilty of misconduct with one of his patients. Though
such misconduct is a serious offence, it was for the welfare
of society and of the medical profession that the freedom
which was allowed the profession should not be made the
basis of accusations unless established by the clearest evi¬
dence. In this case there was no evidence of the slightest
familiarity between Mr. Brown and Mrs. Lbnnard, and tbe
jury, without retiring, negatived the allegation against Mr.
Brown, and the petition against him was dismissed with
costs. This is the sort of case which harasses a medical man
grievously, and to which every practitioner is daily liable
at the hands of unprincipled or ungrateful people. It may
be said the judgment is all right; costs are allowed, and no
harm is done. But what costs—even if they are forth¬
coming-can repay a practitioner for the annoyance extend¬
ing over months, of an unfounded charge like this ? And if
they are not forthcoming, what grievous pecuniary injury
is added to mental torture. We admit cheerfully the dis¬
position of judges and juries to protect the fair fame of
medical meD, and to recognise the delicacy of their position
and their reputation. But something is still wanting for
their protection against wanton and unreasonable patients.
It is not enough that they should be acquitted of such
, charges. They should not be placed upon their trial without
some prima facte case against them other than appears in a
case like the one on which we ore commenting.

Yet another instance. Last week an action was brought

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Th* Lancet,]

THE NATURE OK COMA.

[March 5,1887. 481

by & young lady against Mr. William Bbdbll Benison,
surgeon, of Moseley and King’s Heath, near Birmingham,
for alleged slander, the damages being laid at iSOO.
The slander consisted in attributing some symptoms in the
young lady to having contracted contagious disease from
her betrothed, who for some time had laboured under a
suspicious sore of the lip. Mr. Benison had warned the
young lady on this subject, and did not charge her with
anything more culpabla or . criminal than having possibly
been a party to a kiss, which the most severe young
ladies, under such circumstance?, might too readily allow.
No fault was found with the opinion or treatment of
Mr. Bbnison for six months, and not then till his account
was sent in, which included not only charges for attendance,
but for kindly loans which he had granted in circum¬
stances of exigency to the plaintiffs family. The jury,
without much deliberation, gave a verdict for the defendant.
Medicine is a profession so difficult and its services are so
valuable, that gratitude should cover even occasional
errors or shortcomings of treatment. This is so with many
patients. But how different here, where ordinary charges
are disputed and become the occasion of litigation, which is
expected at least to injure the medical man, even if he
gains a verdict. We are not without hope that the very
frequency of these cases will bring about some legal
protection to medical men. Meantime the sympathy of
the profession and of the public will be with those
practitioners who in the very discharge of their duty and
vindication of their rights incur the displeasure of un¬
reasonable or unscrupulous patients;

The subject of coma—a condition which is induced by so
many and varied circumstances—has always been open to
much speculation and discussion; but it has seldom received
more apt and adequate treatment than Dr. Mbrcibr
supplies in the January number of Brain. His paper is a
thoroughly scientific exposition, and the conclusions at
which he arrives are valuable both for their suggestiveness
and for the light they throw upon the higher cerebral
functions. He accepts, with one slight modification,
Mr. Savor v ’8 definition of coma, as a “ state of insensibility
from which the patient cannot be completely aroused,
together with a tendency to death, chiefly by asphyxia”; the
modification being the substitution of the phrase “ evidence
of defect of consciousness” for the term “insensibility,”
as being more correctly descriptive of a state in which it is
impossible to determine whether or not consciousness is
absolutely lost. He points out that the failure of respiratory
power is due to the same condition of powerlessness and
loss of muscular tone that pervade the whole organism in
the comatose state. The skin is relaxed and flaccid, the
pulse is full and soft, the bladder contracts sluggishly, the
pupils may have lost all power of contraction, and all the
limbs are paralysed, the muscles being quite flaccid. The
comatose patient is not inert because he is unconscious, but
because he is actually paralysed. Indeed the cardiac muscle
fclone does not share in this universal paresis. From this
condition of complete coma to that pre-comatose period
marked by the slightest mental confusion and bodily weak-*
ness there are all gradations—as may be' seen, for example,
in alcbhoHc poisoning, of which an excellent sketch is given.

The phenomena of drunkenness in all its stages exhibit an
unbroken chain of gradually deepening lesion of the higher
oerebral functions, which enable us to trace-the relations of
the condition we call coma to the slight perturbations and
deviations from the normal condition that mark the earliest
changes due to the action of the poison on the brain. As
Dr. Hughlings Jackson has pointed out, the paralysis is
first that of a loss of movements rather than of motion; the
more elaborate actions go before the coarser; the breathing
fails before the heart, and the accessory parts of the
breathing apparatus fail before the fundamental. It con¬
sists in “ a long process of degradation, the last point of
attack being the heart, and the penultimate the breathing.”
Incidentally Dr. Mercier indicates a pathognomonic sign of
true coma, which depends on this loss of muscular control,
and that is the movement of the eyes independently of one
another.

As with the bodily so with the mental functions. The
progress of coma is marked in the one as in the other by a
gradually increasing enfeeblement. At first there is difficulty
in performing delicate mental operations, and then inability
for any coherent thought, and, lastly, evidence of loss of
consciousness; no response to impressions from without, no
evidence of response to impressions from within. And this
coincides with the relaxation of muscular tone, the ataxia
passing into paralysis; so that the power to execute
voluntary movement fails pari passu with the failing in¬
telligence, and suggests overwhelmingly the inference that
both mental and bodily defect are due to the same lesion.
And, it is pointed out, the whole organism is affected—
evidence again, that in the highest centres of the brain we
have to do not with any specialised and circumscribed areas
of “localisation,” but with a region where the various parts
of the body are all represented in some degree, the region of
consciousness and of the organism as a whole. Dr. Mbrcibr
implies that in the modem doctrine of “ nerve centres ” we
ran a risk of losing sight of this fact or principle, that the
whole organism is represented, and therefore to a certain
extent controlled and knit together through the highest nerve
centres—a principle which is so clearly manifested in the
phenomena of coma, and just as dearly in the phenomena of
insanity. For insanity is linked with defects in the nutrition
of the body; it runs its course, both as regards mental
faculties and bodily functions, in the same direction and
with the same pathological sequence as does coma, in which
it often finally terminates. But if coma be a form of insanity
it is a “fulminant” form; and if insanity be expressed in
the terms of coma it would be that it is coma long drawn
out. We are not aware that this ingenious parallel has ever
been advanced before, but we cannot help being struck
with its feasibility, and commend it to the attention of the
alienist. The underlying principle in Dr. Mercier’s argu¬
ment is that the higher brain centres, where consciousness
is aroused by impressions from within and without, and
where the will is bom of intelligence, mid action expresses
the response of the conscious will to the environment,—that
there, where all the bodily functions must be represented, is
the seat of the lesion that suddenly or gradually breaks the
chain between the individual organism and its surround¬
ings, and may profoundly affect those functions which,

< under the control of the nervous system, are essential to the

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482 The U-NCbt,] THE REAL INTERPRETATION OP THE NEW ARMY WARRANT.

[Mabch 5, 1887.

life of the organism. Possibly—nay, we might say probably—
this region is. conterminous only with the whole of .the
Cerebral Cortez; bat this does not detract from the sug¬
gestiveness or truth of the. proposition that “ whether in
origin, or in cause, or in termination, coma and insanity are
pathologically and symptomatically identical, and the only
important difference between them is the difference in
duration,” They each illustrate the law of Dissolution,

Annotations.

“Ke quid nimls.”

THE REAL INTERPRETATION OF THE NEW ARMY
WARRANT.

When the Royal Warrant of January 1st was promulgated
we took a considerable amount of trouble to ascertain
whpthar it would affect the Medical Officers, and we came
to the conclusion that, except as regards a step of honorary
rank on retirement, it would not affect them in any way
whatever. It would appear, however, that some other
persons have arrived at a different opinion, and last week
a medical contemporary published a leader denouncing
the military authorities, and advising the professors and
teaqhers in .the medical schools to reoommend their pupils
to hold back from entering the Service. And upon what
has this advice been founded? On the abolition of the
word “ relative ” in describing the position of ths medical
officers in relation to the so-called combatant officers. But a
eareful examination of the Warrant satisfies us that nothing
either injurious to the prospects or derogatory to the
position of the officers of the medical staff is inteqded
or effected by this change; for in paragraph 125a it
is distinctly laid down that “officers of departments of
our army,not having honorary rank, shall rank as follows for
purposes of precedence, pensions for wounds, pensions to
widows, and compassionate allowances to children: With
Major-General,- Director-General Army Medical Depart¬
ment, and surgedn-general; with colonel, deputy
surgeon-general; with lieutenant-colonel, brigado-surgeon,
surgeon-major after twenty-years’ service, or under
twenty years’ service if promoted for distinguished ser¬
vice in the field'; with major, surgeon-major under twenty
years’ service, if not. promoted for distinguished service in
the field; with captain, surgeon; with lieutenant, surgeon
on probation.” If to rank with certain grades of officers be
not relative rank, though the adjective is not employed, we
confess that we do not know what is; they are, in fact,
synonymous. The term “ relative rank ” Was dropped, we
believe, because it was found to operate unjustly in
certain cases among the combatant officers, but it can have
no effect upon the medical staff,whose position will in no way
be altered by the change of terms. The status of medical
officers is assured to them by their respective commissions
and the Royal Warrants. They have never had commissions
conferring on them military rank, but their title to
take rank with the different military grades is conferred on
and secured to them by the Warrants. We cannot but
regret that such a recommendation as the one we have
alluded to should be made, when careful inquiry and a
study of the Warrant itself would have shown that the
grounds on which it is based were wholly misoonceived.
We trust the professors and teachers of the medical schools
will investigate this matter for themselves. We claim to
have fought the battle of the medical department when it
was unjustly treated, and we are quite prepared to do so
again should ocoasion arise. But we are satisfied that there
is nothing in this Warrant detrimental to the best, interests
6f the medical officers.

TEACHING UNIVERSITY FOR LONDON.

The report of Lord Justice Fry’s Committee will be pre¬
sented to the Senate of the University of London at an early
date, and will then be referred td Convocation at the
annual meet ing in May, unless a special meeting be sum¬
moned. The reforms which will be recommended will
probably include the direct representation of University
and King’s Colleges on the Senate, boards of studies com¬
posed of teachers and former examiners, and an increased
representation of Convocation. None of these changes
have a direct bearing on the organisation of teaching
in London for London students only; for the present Uni¬
versity must consider its candidates throughout the
country, indeed throughout the empire. It can hardly
be expected to meet the demands of those who are pro¬
moting a teaching university for London. We understand
that the Councils of University and King’s Colleges will
have brought before them for consideration a proposal that
they should unite to form Arts and Science Facilities, and
should take means to approach the Royal Colleges as the
Faculty of Medicine, so that they may apply to the Crown
conjointly for a Charter. If power be reserved for the
admission of further suitable institutions, the views of those
who prefer an academical to a professional degree will be
carried out. _

METSCHNIKOFF ON PHAGOCYTES.

The suggestive doctrine that cells and bacteria are opposed
to one another in a struggle for existence within the body
based upon the remarkable property possessed by leucocytes
of devouring foreign material in contact with them, and
employed to explain the phenomena of inflammation, the
formation of giant cells, and of specific neoplasms, as well
as to account for immunity after inoculation, has been
criticised on the one hand and staunchly supported on the
other. Professor Metschnikoff—whose beautiful researches
upon the behaviour of the cells of Daphnia to the spore
disease that attacks this entomostracous organism formed
the basis of this doctrine—returns to the subject in the last
issue of Virchdw’a Archiv (Band 107, Heft 2). in an article
upon the “strife between cells and the ooooi qf erysipelas.”
He declares that Fehleisen’s observations upon the minute
anatomy of cutaneous erysipelas harmonise with the theory
of phagocytes. The spreading margin of an erysipelatous
patch can be differentiated into three zones: a peripheral, in
which the lymphatic spaces are filled with ! the streptococcus
in a State of active growth; a middle, exhibiting inflammatory
reaction in abundance of leucooytee between the masses of
cocci i and an internal, in which cocci are. conspicuous by
their absence. Metschnikoff examined several cases: some
fatal; others, which recovered, with the view of testing the
truth of his surmise that recovery from erysipelas is due to
the destruction of the microbe by the phagocyte. In the
one case, of fatal gangrenous erysipelas, he found a few dis¬
integrating leucocytes, and an abundance of,oocoi; in: the
other, where recovery took place, leucocytes were seen
filled with cocci or their debris; and transitional states could
be traced between these extremes in specimens derived from
other cases. The inference he gathers is that in the fatal cases
the streptococci gain the mastery from defective inflammatory
reaction. Besides the small free leucocyte, he assign* similar
properties to larger oelIs, derived.from.th* fixed connective
tissue elements in the subcutaneous tissue. Ths former he
terms micropkagi, the latter macrophagi, mid he notes an im¬
portant difference in the function of these two elements. In
the subcutaneous tissue in erysipelas he finds macrophagi
which do not consume the micrococri. That office is confined
to the microphagi, whereas it appears to be the duty of the
larger elements to oonsnme the ddbris of tbs dead and dying
leucocytes. The macrophagi therefore perform the useful

ThbLaxcxt,]

THE PORT OF LONDON.—INHERITED PHTHISIS.

[March 5,1887. 483

{unction of clearing the battle-field of the slain leucocytes;
and they therefore increase in sue and number in proportion
as tho strife between the microphagi and streptococci
diminishes. It reads almost like a romance, this account of
the mimic warfare carried on to the death between
the invading microbe and the defending leucocyte; and
yet the phenomena of local infection, inflammatory reaction,
resolution, and absorption of the inflammatory, products,
can all be expressed in the terms of streptococcus, micro-
phage, and macrophage. Other factors, it is admitted, may
be at work—such as. pyrexia—but professor Metechnikoff
holds to the foregoing as a most probable explanation of the
local phenomena. In asserting this, he has to meet the
arguments adduced by Baumgarten and others, especially
with reference to the fact that in many infective diseases
bacteria are found within leucocytes without any variation
from the fatality exhibited, and also the fact that experi¬
mental injections into the blood of bacteria do not lead to
the consumption of the latter by phagocytes. However, he
meets these and other objections, and declares that Cohn-
heim’s dictum “no inflammation without bloodvessels”
must be changed into “no inflammation without phagocytes.”
The doctrine is attractive, and is deserving of further study;
bat it cannot be said to be established, or as yet far removed
from the stage of probability.

THE PORT OF LONDON.

In his report for the second half of 1886 Dr. Collingridge
is able to show an exceptionally clean bill of health as
regards shipping entering the port of London, and also an
excellent amount of work, often involving structural altera¬
tions, which tends to a steady improvement in the sanitary
state of the vessels. The metropolitan sewage question
still causes much difficulty, for though the precipitation
process now being experimented with appears to answer
fairly well in cold weather, when the nuisance i* always
at a minimum, yet when hot weather supervenes the stench
and inconvenience are as great as ever. The regulations
now in force as to the disinfection of the clothing of seamen
who have died abroad of infections diseases axe, fully
answering their purpose, and in this way another source of
danger to the country has been successfully dealt with.
Only one cholera-infected vessel entered the port during the
year. This was the BiaUo , which arrived at Gravesend on
November 4th, having had three deaths from cholera and
one from dysentery on board, the cholera deaths occurring
from four to eight days after leaving Galoutta. All the
crew being found on examination to be healthy, the vessel,
after certain precautionary measures, was given free pratique.
Inspection of canal boats is carefully carried out, and
already these boats are found to carry fewer persons on
board than they are certified for. The port sanitary
hospital was successfully used during the half-year for the
isolation of cases of infectious disease found in the port.

INHERITED PHTHISIS.

Professor Firket ( Revue de Med., Jan. 1887), writing
upon the subject of heredity in tuberculosis, points out
certain difficulties in the acceptance of the doctrine of
direct transmission from parent to offspring. Such trans¬
mission may conceivably take place before conception, the
tubercular bacilli being associated with the sperm or germ—
a purely hypothetical idea—or through the medium of the
placenta, and therefore solely by the maternal blood. He
contends that there is not such positive proof of infection of
the maternal blood, and thereby of transmission of disease to
the feetus in the case of tuberculosis, as there is in anthrax
or syphilis, or vaxfpla and otfaer affections. Moreover, he
•hows that ixi dnkh^y phthlsf? fully one-half of the cases

do not exhibit, in the presence of remote secondary lesions,
evidence of blood infection. It is for the most part a local
disease of the lung, and such secondary lesious as do occur
may be explained in many cases apart from general
blood contamination. How different, it may be said, from
the old notion of phthisis ! But the fact of the lung being
the primary seat of tubercular disease in inherited cases is
almost conclusive against the congenital theory; for if the
foetus were infected through the blood, the chances are
that the lungs would not suffer more than any other organ.

THE METROPOLITAN ASYLUMS BOARD.

The managers of the Asylums Board bad under their
consideration on Saturday a proposal of the General Pur¬
poses Committee to make the services of their principal
officers available at any infectious establishment under the
managers’ control. This is obviously required in the
interests of the public service, for the experience of past
years has amply shown the necessity for the managers
to possess the power of utilising the services of their
officers in such manner as the requirements of the
moment may dictate. . It was, resolved that the Local
Government Board should be requested to make an
amending order for this purpose. The change will
doubtless cause expense and inconvenience to some
of the older officers, but this point will, we trust, meet
with consideration at the hands of the Metropolitan
Asylums Board, and we shall gladly see the officers
manifest a readiness to comply with a change which is
needed to enable the Board more efficiently to perform their
duties. A second and more important point is embodied in
the report of the same committee, who recommend that
application be made to the Local Government Board
to obtain authority for the managers to remove, at
the request of duly qualified registered medical prac¬
titioners, all persons, whether paupers or not, who suffer
from fever ,or small-pox who desire such removal. Sir
Edmund Currie moved the adoption of this recommendation,
which was agreed to unanimously, and which we trust will
meet with the approval of the Local Government Board.
There is no reason why the admirable ambulance service
of the Metropolitan Asylums Board should not be made
available for the use of the general public.

THE MEDICAL PROFESSION AND THE GENTENARY
OF THE UNITED STATES.

The Journal of the American Medical Association points
out an interesting coincidence—viz., that the International
Medical Congress at Washington will be held in the very
month which will mark the centenary of the present con¬
stitution of the government of the United States. The
journal suggests for answer the following question—What
progress has medicine and medical organisation made under
such a form of government ? It suggests part of the reply.
When the century began there was but one organised medi¬
cal college in actual operation in the entire country, having
much less than a hundred students and granting less than a
dozen diplomas annually. State medical societies existed
only in New Jersey and Massachusetts, and there was not a
single medical periodical. Such was the state of matters in
1777. But in the present year there are more than 100
organised medical colleges, educating over 10,000 students,
and granting 3000 or 4000 medical diplomas annually.
There are active State medical societies in every State and
inhabited territory, all represented in one National Associa¬
tion, and 100 medical periodicals. This is a great growth,
and one on the whole greatly creditable to the States. No
doubt, according to our standard, the growth seems excessive
and uncontrolled. There are too many colleges, and they give

Digitized by GoOglC

484 The Lancet,]

HEALTH-SEEKERS ABROAD.—THE RIVER LEA.

[March 5,1887.

too many diplomas—that is, the colleges give the diplomas
too easily. But in a young democracy one man is apt to con¬
sider himself as good as another, and it is at any rate some¬
thing to have it recognised that men must undergo sys¬
tematic education and have their education tested. Law
and public intelligence will still further define the tests to
be applied in the interest of the health of the people, which
is only another word for the good of the Republic.

HEALTH-SEEKERS ABROAD.

If it be the fact, as many—Professor Huxley among other
philosophic scientists—think, that earthquakes are caused
rather by the shrinking of the earth’s crust upon the cooling
mass within, than by special convulsions set up by the sudden
inrush of water through fissures into the midst of subter¬
ranean fires, it is inevitable that these phenomena should
recur with certain intervals, and, which is more to the point,
it is at least probable that the first crack will be followed
by others, while it can be by no means certain that sub¬
sidence will not follow either suddenly or gradually upon
any contraction so considerable as to cause an extensive
disturbance of the surface. If the shaking, and perhaps
rupture, of the outer crust were simply due to an accidental
outburst of steam among the lower strata, there would be
nothing to say except that what has occurred once may of
course occur again; but if progressive shrinking is taking
place, it can scarcely happen that a crust which is anything
but homogeneous should not break away and fall in as it con¬
tracts. We know that the whole of the Riviera consists of a
thin crust resting almost loosely on an irregular bed of rocks;
and it is reasonable to anticipate that, while from time to
time there will be earthquakes in that region, sooner or
later great and widespread settlings will be effected, with
more or less damage to the structures on the surface. These
are the probabilities, and it is desirable that they should be
recognised by those who frequent the health-resorts of the
district, and particularly by those who build houses for
their own occupation or the use of visitors. We are by no
means sure that the very solid edifices extolled and desired
in the districts recently disturbed are really the most
suitable. It is quite true that the stronger buildings
have escaped serious damage in certain localities, but
this is perhaps more directly due to their position than
to the resisting power of the structures themselves, or
of the materials employed. It is not probable that any
erection could offer greater resistance than the rocks, which
have in some places been disturbed. Prudence would
point to the expediency of constructing houses in the
Riviera so that they shall rest upon the ground, rather
than form part of it, and be self-contained in their stability.
We fear it must be assumed that this district will hence¬
forward need to be regarded as one in which movements
of the earth’s crust, and probably subsidences, are likely
to occur. The fate of those who have visited the Riviera
in search of health and had their nerves tried by the shock
of these recent earthquakes is greatly to be commiserated.
As regards the danger to life and limb actually involved,
calculated on the bases of accident all the world over, the
risk has not been much greater than that which would have
been incurred elsewhere, whether on land or by sea; but there
can be no question that the nervous shock has been consider¬
able, and, although the Riviera cannot be correctly classed as
a distinctly “volcanic” district it is a question whether
it ought not to be considered an unsuitable place of
residence or prolonged sojourn for those who are easily
impressed or excitable. If the immediate effect of the ex¬
perience of the last few weeks should be to make health-
seekers and their advisers think more of the almost in¬
exhaustible varieties of climate, atmosphere, ar><! surround¬
ings generally, which are obtainable within th ■ vies of

the United Kingdom, good may come out of evil. It is
much to be regretted, we think, that the resources of Ire¬
land, Scotland, and Wales, with the various well-known,
and less well-known, parts of England itself, should be so
persistently neglected as they are for health-resorts
abroad, which are neither so salubrious, nor, but for the
false glamour thrown over them, so attractive. It must be
confessed that the medical profession has much to answer
for on this score. To the recommendation of English
physicians these continental resorts mainly owe their repu¬
tation. Let us turn our attention to the development of
home resources, and our patients will he not less benefited,
and decidedly exposed to fewer perils.

THE RIVER LEA.

Last week an important conference was held at the
Hackney Town Hall to consider the steps which should
be taken to secure the future preservation of the purity
of the river Lea. It will be recollected that the Act of
Parliament which was procured as a temporary measure
will shortly expire, and we may anticipate that the Lea will
revert to its former condition, unless means be taken to
prevent sewage effluents draining into it. The adoption of
a scheme for the drainage of the whole valley of the Lea is
the only effectual method of disposing of this question, but
the co3t will no doubt be considerable. Sir Quyer Hunter
pointed out that it was necessary that delegates from each
authority concerned should meet together, and determine
the best method of dealing with the subject, and finally a
resolution was passed calling upon the local authorities to
appoint a joint committee with a view to preparing evidence
to submit to a Committee of the House of Commons.

MORE MIND, MORE MADNESS.

It is in no way surprising that insanity should seem to in¬
crease in races or classes which are being intellectually
stimulated by education. There is always in every com¬
munity a proportion of brains which, being brought into
action, will break down. This proportion doubtless dimi¬
nishes as the community is elevated, and in a very few
generations the result of culture may—probably will—be to
develop a better stock, looking upon the people as a
whole; but at the outset of the educationary process, and in
the generation first taught, the immediate result must be a
considerable number of wreckings. This general principle is
applicable to all races, peoples, and classes, and it explains
why the first effect of trying to elevate the negroes has been
to produce an apparent increase of insanity among them.

THE PREVENTION OF ANTHRAX.

The recognition of the danger of contagion in anthrax
has at length been officially made by the Agricultural Depart¬
ment of the Privy Council Office, in a notice just issued upon
the danger of handling carcases of animals dead of anthrax.
The notice is brief and to the point. It cites the fact that
“ several cases of serious and sometimes of fatal infection
have occurred in persons who have been employed in cutting
up carcases of animals dead of anthrax, and it is important
that the public should bs made aware of this source
of danger to human life.” The notice goes on to warn
any person having abrasions, however slight, on their
hands or arms from handling any carcases of animals which
have been the subjects of this disease, or of “dealing with
fodder, litt6r, manure, or other things which may be con¬
taminated with the blood of diseased animals and it con¬
cludes with the recommendation that Buch carcases “should
be buried entire, without being Bkinned or Cut, and be well
covered with quicklime and not less than six feet of earth.

Tin Lancet,] THE LATE PROFESSOR SOHEOEDER.—CHOLERA INTELLIGENCE. [March 5,1887, 483

We trust that this advice will be widely followed, and that,
as a result, we may hear less of cases of this highly malig¬
nant disease among the members of the community who
have to do with animals liable to infection. There is no
reason why, with suitable precautions, a disease the nature
of which is so fully known should ever be allowed to be
transmitted to human beings.

THE LATE PROFESSOR SOHROEDER.

At the opening of the sitting of the Berlin Medical Society
on the 9th February, the President, Professor Virchow,
alluded to the loss sustained by the University and the
Medical and Gynecological Societies. In compliance with
the wish of members, he gave details of the post-mortem
examination, which showed that death had been caused by
the rupture into the lateral ventricle of an abscess situated
in the white substance of the brain near the posterior part
of the fornix. The abscess was old and encapsuled, and the
pus within the ventricle was enclosed within a fibrinous
layer, which formed a membrane at first sight resembling
a hydatid. The right thalamus was completely flattened
by this. Between the root of the right lung and its
base there was a mass of tough fibrous tissue enclosing a
smallpus-containingcavity which communicated by anarrow
channel with the oesophagus. There were also scattered foci
within the fibrous mass, one of which contained much pig¬
ment and cholesterine—a kind of focus, Professor Virchow
observed, which he had never before met with in similar
conditions. The lungs were perfectly normal and free from
adhesions. There was no trace of tubercle. The cause
of the cerebral abscess was difficult to solve. Five years ago
Schroeder had a severe illness, which he attributed to septic
infection leading to conjunctivitis and pneumonia, lie
himself thought the conjunctivitis was diphtheritic, but
Professor Schweigger did not take that view, and it is
scarcely conceivable that any connexion existed between
the conjunctivitis and the abscess. It is possible that the
old lesion in the mediastinum might have been the starting-
point of the cerebral abscess, the contents of which indicated
that it could hardly have existed for more than a year.

NEW TREATMENT FOR PHTHISIS.

A new method of treating phthisis has been proposed, but
apparently as yet but slightly tried, by Professor Kremianski,
who read a paper on the subject at the recent Moscow Medical
Congress, which provoked a good deal of discussion. The
idea is based, firstly, on the fatal effect of the mo9t dilute
solution of aniline on Koch’s bacillus, and, secondly, on tbe
fact that aniline seems to be bnt slightly, if at all, poisonous
to the human body. Professor Kremianski proposes to in¬
troduce aniline into the lunge, and, indeed, tbe circal&tion
generally, by inhalation, so that the phthisis bacilli should
be bathed in a very dilate solution of aniline, wherever they
may be. This, he thinks, would kill them, and render even
pulmonary cavities free from bacilli, so bringing them into
the condition of healthy granulating ulcers, which may
be expected to cicatrise. A committee has been ap¬
pointed, including Professors Subbotin and Ostroumoff,
who expressed themselves at tbe meeting as strongly
opposed to the plan, for the purpose of observing Professor
Kremianeki’a proposed experiments in one of the Moscow
hospitals. Two cases in which the aniline treatment
h*d been successfully tried were detailed. A lad of
eighteen, who had undoubted phthisis, was ordered
a four-drop dose of aniline (bat took by mistake three
tuneethe proper quantity) combined With nux vomica, mint
water, and Sntifebrin, his diet being good, including dried
meat^kva^ and oranges. He was also given inhalations of
etoafieed aailine. A remarkable change took place almost

immediately, all the rales disappearing; his temperature,
respiration, and pulse becoming normal. His skin, how¬
ever, assumed a slightly blue tinge, but whether this was as
permanent as the cure is represented to have been is
not stated. The second case was a complicated one, there
being tubercular peritonitis and meningitis, together with
typhoid fever, present at the same time as pulmonary phthisis.
Aniline inhalations, washing out the pulmonary cavities
with corrosive sublimate and antifebrin, were employed,
together with a special acid diet, as in the other case. Here,
too, the results are said to have been remarkably good, the
bacilli disappearing from the sputum, and the patient regain¬
ing his health entirely. No mention is made in the abstract
published by the Vrach of any change of colour in this
patient’s skin. Amongst the various replies that were made
to Professor Kremianski, Dr. Zakrzhevski, of Helsingfors,
remarked that, admitting the facts as stated, still there was
nothing to show that the aniline had been the cause of the
cures. He himself had had surprisingly good results in
phthisical cases, the disease becoming completely arrested
by simply giving increased nourishment and prescribing
antipyrin. _____

CHOLERA INTELLIGENCE.

The announcement which has been received through the
Colonial Office, to the effect that vessels are not admitted
into Malta from Sicily on account of the occurrence of
cholera at Catania, reminds as again that the seeds of this
disease still lie scattered about in different parts of Europe.
Catania is a very ancient town on the east coast of Sicily at
the foot of the mo3t southern offsets of Etna, and has
a population of some GO,000. A9 a port its trade is not what
it formerly was, owing to the obstruction offered to the
entrance of vessels by remains of lava floods; but it ranks
as one of the foremost cities in the island, and the possibility
of extension of cholera in it must be viewed with consider¬
able apprehension. No further news has been received as to
cholera in Hungary, but the absence of news, for even long
periods, has been shown on former occasions not to indicate
absence of the disease. The news from South America is
also very intermitting, but the disease is still prevalent
from the neighbourhood of the River Plate on the east to
the coast of Chili on the west.

THE HOME FOR LOST DOGS AND HYDROPHOBIA.

The annual meeting of the Temporary Home for Lost and
Starving Dogs, Battersea, was held on Feb. 38th at Jermyn-
street, the Earl of Onslow in the chair. In the course of his
remarks, when moving the adoption of the report, the chair¬
man said:—

“The effect of the restrictions had been to sweep away
from the streets of London a very large number of homeless
curs, but how had it affected the terrible disease of rabies
and hydrophobia? He ventured to say that, although the
returns showed that in London rabies hod been almost
annihilated, the mere precaution of ordering that dogs within
a certain given area should be muzzled was not in itself
sufficient to stamp out the disease. The only way would be
to treat rabies somewhat in the same manner as the Privy
Council treated other infectious diseases affecting animals
and to proscribe certain circles in which the infection
existed, forbidding that migration in or out of such circles
should take place without the permission of a properly con¬
stituted authority.”

These remarks were received with cheers and, coming
from one who is well known to be personally interested
in many ways in dogs, will, we trust, calm the hyper¬
sensitive feelings of some dog-owners, who seem to regard
hydrophobia as, if not a myth, a muzzle-created and arti¬
ficially induced disease. We give every credit to them fox

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486 'The Lancex,]

CATALEPSY IN A MOTHER AND CHILD.

[Mines 5,1887. :

their affection for our four-footed companions, of which
we cannot, however, allow them the monopoly; but when
a most terrible disease can be stamped out by restrictive
measures, sentiment must not be permitted to run riot. We
trust the Dog’s Home will meet with the support it unde¬
niably deserves. J_

CATALEPSY IN A MOTHER AND CHILD.

Dn. van Schoox discusses in a Dutch medical journal a
case of convulsive seizures of a peculiar kind in a woman in
the seventh month of pregnancy. When he first saw her
she was motionless, her face being cyanotic, but her tem¬
perature, respiration, and pulse normal. She was quite
unconscious, and the slightly dilated pupils did not react
to light. The arms were flexed at right angles, requiring
some force to move the forearms. By means of chloroform
all the contracted muscles relaxed, and some hours’ sleep
was obtained. Afterwards she remembered nothing of the
fit, but she stated that all movements of the feetus seemed
to have ceased, and no heart sounds could be detected.
These attacks were repeated frequently for a fortnight, the
urine being quite normal all the time. Large doses of
bromide were given without effect, but some amelioration
was produced by sulphate of atropine. Latterly the attacks
were associated with considerable movements of the abdo¬
minal muscles. Some temporary benefit was obtained by sub¬
cutaneous injections of pilocarpine. At the conclusion of a
fortnight from the first attack labour came on, a female
child being born alive, which, however, died in a week’s
time, after repeated convulsions Rimilar to those affecting the
mother. The mother had no attack till the fifth day (the
same day that the child’s first attack occurred). After this
there was only one more attack two days later, complete
recovery ultimately taking place. The author, referring to
the diagnosis, is disposed to exclude eclampsia, because,
although there were clonic contractions of the abdominal
muscles, the main spasm—indeed, at first the only kind of
spasm—was tonic. The entire absence of albuminuria, too,
tends to exclude eclampsia. Again, epilepsy may be ex¬
cluded, as after the tonic no clonic spasms occurred, and as
the limbs remained fixed in a certain position for one or two
hours. He therefore considers that the attacks were of a
cataleptic nature, both in the mother and child.

POISONOUS CHEESE.

In this country cases of cheese-poisoning are rare, and in
France, where cheese is largely consumed, they are all but
unknown. But, according to Dr. Victor C. Vaughan, of the
Michagan State Board of Health, the annual number of such
instances in the United States must be several hundred, if.it
does not reach a thousand. In Germany cheese-poisoning
is also frequent. The symptoms generally include dryness
of the throat, nausea, vomiting, diarrhoea, nervous prostra¬
tion, headache, and sometimes double vision. As a rule,
recovery takes place. Recently Dr. Vaughan has given a
good deal of attention to discovering the cause of cheese¬
poisoning, and he has received help from the manufacturers
whose produce hao brought about symptoms of poisoning.
Amongst the manufacturers there would appear to be
entire ignorance as to the cause, and such suggestions as
they have been able to make, including the consumption by
the cows of poisonous plants, are not borne out on investi¬
gation. From the freshly cut surface of 1 poisonous cheeses
there exude; as a rule, drops of a watery, slightly opalescent
fluid, which have been found to redden blue litmus paper
instantly and intensely; and Dr. Vaughanis of opinion that
this should always bo regarded as an element of suspicion
in a cheese. Micrococci are also found in the fluid in
question; but, according to Dr. Sternberg. »' ns yet

no evidence that these micrococci are directly related to the
poisonous properties of the Cheese. There are, however, sub¬
stantial grounds for believing that the poison isa chemical one,
and it is by no means impossible that it mAy be generated by
bacterial growth. Dr. Vaughan, in making and dryidg an
alcoholic extract of poisonous cheese, procured a residue
consisting of a fatty mass, which, on being eaten by him¬
self, produced symptoms -closely allied to those above
described; but the poison itself was not sufflciently elimi¬
nated. The best results were obtained by rendering cm
aqueous extract of the cheese alkaline with potassium
hydrate, then extracting with ether; needle-shaped crystals
being ultimately separated. On placing a small piece
of one of these on the end of the tongue, a sharp burning
sensation, together with a sense of sickening, was soon
followed by dryness and constriction. A drop of the fluid ’
from which the crystals were ultimately extracted pro¬
duced, in addition, griping pains in the bowels, followed by
one or more diarrhoeal discharges. Ultimate analysis of the’
poison has not yet been practicable, owing to the difficulty
of procuring it in sufficient amount. But Dr. Vaughan
places it, for the moment, amongst the ptomaines which
originate in organic substances undergoing putrefactive
changes. As the putrefactive changes in the milk are due
to the growth of minute organisms, the introduction of’
these organisms into the milk may lead to the formation of
the ptomaine. The practical suggestions which, so far, are
the outcome of Dr. Vaughan’s investigation are, firstly, more
care in the inspection and cleansing of the milk-oans used
in the manufacture of cheese; and, secondly, increased care
as to the cows themselves, and this because where cows are
kept in filthy stalls their milk is the more likely to undergo
speedy putrefaction. _

MEDICAL ATTENDANCE ORGANISATION
COMMITTEE.

The fortnightly meetings of this committee continue, and
the reports sent us show that the committee has a good
grasp of the principal questions involved in any settlement
of this complicated question. Sir Spencer Wells has pre¬
sided at every meeting but the last, anti shown as much
interest in the matter as if his future prospects were bound
up with the movement. The committee have decided on
a wage limit, and at the following rates of charge:
single persons, male or female, are to pay 6 d. a month; man
and wife without children, Is. per mouth; man and wife
and one child. Is. per month ; other children, 3d. per month,
each, not charging for more than four children in one family,
making the maximum rate Is. 10<i. per month, it is clear,
as the committee perceives, that the rates must be such as
to secure reasonable payment for thp medical men. The
charges for children are important, for attendance on children
will be a large part of the work of such a scheme. At the
next meeting the question to be considered will be entrance
fees, midwifery, and special rates for sick persons .joining.

JEQUIRITY.

MM. Hhckkl and Schlagdenhauffen arrive, at the.
following conclusions as to the nature of true and false
jequirity (a full account of their researches is published
in Der Fortschritt, Nos. 3 and 4)That false jequirity
(Adenanthera pavonina) does not contain the phlogogenio
principle; that the latter exists neither in the peeled seed,
nor in the alkaloid, nor in the glucoside; that the testa con¬
tains a yellow colouring matter; soluble in water, but which
can only be discovered niter maceration of the previously
bruised seeds; that true jfequirity contains—besides the
jequiritine discovered by Bruylants and' Vennemann—a
neutral principle, a brine, distinct fromgallie acid and ibe

Digitized by GoOgle

The Lancet,] THE TYNE PORT.—TEMPERANCE IN THE NAVY. [March 6,18#. 48?

two colouring rhatters; that the Chemical composition of the
true and the false is completely dissimilar, although the
two seeds are closely allied botanically; that the bacillary
elements furnished by the maceration of either Beed are
absolutely identical; that the true jequirity only possesses
the power of inducing inflammation, which must be depen¬
dent on the chemical composition ; that the seed of false
jequirity, being clearly distinguishable both by its external
configuration and internal structure, ought not to be sub¬
stituted for the true jequirity!

THE TYNE PORT.

In the Tyne port nine infectious cases were received into
the floating hospital during 1886, and the regulations as to
the compulsory notification by ship-masters of all such cases
is working well. Nq less than 596 vessels were boarded in
the port on account of coming from cholera-iufeoted or
suspected ports, and 119 vessels. reached the Tyne direct
from Bilbao. In the current work of the port we find that
14,030 inspections of vessels were made, and in 651 cases
notices as to nuisances were served, structural alterations
l>eing required in 61 cases. This work is effecting great
good, and Mr. Eenry Armstrong is already ; able to report
that great improvement is noticeable both in the cleanliness
and in the crew spaces of the vessels examined. With the
increasing work of port 'administration, the old floating
hospital was found to be iasufflcieRt, and it ia satisfactory
to report that an expellent and typical floating establish¬
ment, consisting of three separate ward pavilions built on
cylindrical iron pontoons, was launched during the year.
The administrative arrangements are separate, and these
are now undergoing improvement. The Tyne port authority
has long been carrying out excellent work, and this year’s
record affords another proof of the maintained interest in
the healthiness of shipping and seamen.

. TEMPERANCE IN THE NAVY.

At a meeting presided over by Archdeacon Farrar, a satis-'
factory account of the progress of temperance In the Navy,
especially under the auspices of Miss Weston, was given.
Miss Weston said therewere over 10,000 abstainers in the
including 200 officers, and that? half the boys in the'
training service were teetotalers. Mr. Caine said that, when
Civil Lord of the Admiralty,Jie was helped and complimented
hy the admirals for his attempts to favour substitutes for
sailors’ grog. It must be admitted that poor Jack needs all
the help he can from bifch Officials add kindly people like
Miss Weston. Too Often hie case is, as the poet has it,

■* Saved from the sea,

And shipwrecked on the land.” . . .

THE BRADFORD FEVER HOSPITAL.

The Bradford Corporation have at last decided to purchase.
°r a sum of .£10,000 the Bradford Fever Hospital, which it
origuniiy cost £30,000 to erect. One point which seems to
have led to the final decision-waa the necessity of providing
a small-pox hospital, and it will-certainly he easier for the
Corporation to isolate that disease on a site which has often
"drived small-pox ca9es before than to establish a new
»mall-pox hospital elsewhere. The Bradford Fever Hospital
w, m the hands of its Board of Management, done admir¬
able workup to the present time, and those who have been
responsible for its working deserve a tribute of praise for
labours in preventing the spread of infection in and
at Bradford. Last year alone no less than 726 cases were
Emitted, 625 of these being cases of scarlatina. The death-
Th 0 ^ ear wa * ^7 pfer cent., or the lowest on record.

® premises lie on the outskirts of the borough,

, occupy an area of nearly eight acres in extend

PREGNANCY IN AN IMPERFECTLY CANALISED
UTERINE CORNU.

Dr. Nf.tzbl mentions, in a Scandinavian journal, a rare
Case of pregnancy occurring in the imperfectly canalised
half of a bieoamate uterus. The movements of the child had
ceased in the thirty-third week of conception, and from that
time the woman became thin and felt HI. Five months
later Dr. Netzel was called in; the diagnosis was Uncertain.
He could not find anything corresponding to an extfa4
uterine pregnancy, and it was clearly not a normal intra¬
uterine one. He performed laparotomy, and thus discovered
that’ conception had taken place in the right half of a
bicorhate uterus. An elastic ligature was applied round the
base of the tumour. The uterus was opened and a macerated
foetus extracted. The half sf the Uterus was amputated
with the tube and orhry. All went well until' a month after
the operation, when an abscoss formed in the cicatrix of the
abdominal wound, which was followed by a fistula. A
quantity of silk and elastic ligatures came away a month
later, and the woman ultimately recovered completely,
Dr. Netzel thinks the rarity of such caSes causes them to be
confounded with extra-uterine pregnancies, and with the
“ missed labours ” of English obstetricians. He is of opiniot*
that a more frequent resort to laparotomy would be of much
service in throwing light cm the subject. He mentions
eight more or less doubtful cases as occurring in literature,
including one reported by Dr. Keith of Edinburgh.

QUEEN’S COLLEGE (BIRMINGHAM) MEDICAL
SOCIETY.

This' Society celebrated its hundredth general meeting
on Wednesday, Feb. 28rd. Sir Walter Foster is almost ubi¬
quitous, for the records of the Medical Council show that on
that day he was preserit at its discussions. Nevertheless, he
was the orator of the hundredth meetihg at Birmingham,
and spoke well on the advantages of the Society as tending
to cause improvements in their Way of thinking, in their
power of speaking, and in their power of action. He referred
with pride to the eloquence associated with Birmingham;
and made allusion, fit and graceful, to this quality in two
much-respected, and, alas, now much-missed, Birmingham
men, Dr. Hefelop End Mr. Sampson Gamgee. He described to
the Society the position of the medical bodies in England
and Ireland, and the efforts of the Medical Council towards
inducing the Colleges to combine with the Apothecaries in
Ireland and England, and so realise to some extent the one-t
portal for which the profession has long wished. j

E. W. ALABONE.

Wb observed with much regret in the columns of the
Illustrated London News of last week an announcement
respecting Mr. ; Edwin William Alabone, whose name was
removed from the Medical Register in November, 1880. We;
are, however, authorised by our respected contemporary tot
state that • the announcement ‘'was inserted inadvertently
as an advertisement, and came through an advertisement
agent.” An intimation to this effect will, we are informed,;
appear in. the Illustrated London News of this day.

THE PERILS OF FOOTBALL.

The great winter game of football continues to manifest
its claims upon the services of medical men, and also, alas, of
coroners. It is most regrettable that a pastime good and useful
in many ways, and popular beyond all cavil, should be appa¬
rently incapable of reasonable reform. Yet another death
is recorded. An inquest was held at Manchester last week
on a young man named Makin, who met with fatal injuries
in a football match. Deceased was playing in a Rugby’

oogle

Digitize

488 Tub Lancet,]

THE VOLUNTEER MEDICAL STAFF CORPS.

[March 6,1887. ^

game, when he ran against another player and was acci¬
dentally struck in the abdomen. He fell unconscious, and
died two days later. The coroner commented on the rough
character of the game, and warned players that they ran
great risk of being charged with manslaughter. A verdict
of accidental death was returned. The coroner is to be
commended for his outspoken and very necessary comments,
which should be taken to heart and acted upon, not only by
individual players, but also by the authorities of the Rugby
Union and the Football Association.

THE VOLUNTEER MEDICAL STAFF CORPS.

Thb first presentation of prizes in connexion with the
London Division of this important corps, which is largely
composed of medical students, was held at the St. James’s
Restaurant on Friday, February 25th. The prizes were
given by Lady Crawford. Sir Thomas Crawford, E.C.B,
Director-General of the Army Medical Department, General
Freemantle, and other distinguished visitors, were pre¬
sent. In the evening Sir Thomas Crawford presided over
the dinner given by the officers of the corp3, at which
several well-known members of the profession were present,
the civil element being well represented. After the staff
had dined, a visit was paid by them to the non-commissioned
officers’ mess in another part of the building, and the
manner in which they were received was evidence of the
excellent feeling which exists in the corps. Much credit is
due to Surgeon-Commandant Cantlie and Surgeon Lees
Hall, A.M.D., for their excellent arrangements.

TESTIMONIAL TO PROFESSOR AITKEN.

It is proposed in recognition of the great service ren¬
dered by Professor Aitken, F.R.S., to his profession generally,
and to the medical officers of the Army, Navy, and .Her
Majesty’s Indian Army, by his writings on medicine and
his teaching in the Army Medical School, and in admira¬
tion of his high personal character in public and private
life, to invite him to sit for his portrait, to be plaoed at
Netley, the scene of his labours, and the home of the school
with which his name has been honourably associated from
its foundation. An influential committee has been formed
to carry out this scheme, and numerous subscriptions,
which are limited to one guinea, have already been pro¬
mised. The honorary secretary and treasurer of the fund
is Surgeon-General W. Campbell,Maclean, M.D., C.B., 28,
Carlton-erescent, Southampton, to whom subscriptions and
promises of support may be sent.

INTRA-OCULAR CYSTICERCUS.

Da. Van dbr Laan, writing in a Lisbon journal, gives
an account of an ophthalmic case which puzzled him for
some time. A man had been suffering from inflammation
in the left eye for about a year. On examination there were
found Berous irido-choroiditis, almost entire loss of vision,
opacity of cornea, and increased intra-ocular tension. Several
times paracentesis was performed with some benefit. Iridec¬
tomy being refused, mercurials and purgatives were given
for twelve months, during which time considerable improve¬
ment had taken place, ultimately permitting an ophthalmo-
scopical examination to be made. The retina was seen to
bulge forward in one spot, where it was of a yellowish white,
the prominence increasing as time went on. It was observed
that its form varied, being oblong and round by turns; the
patient also said that he sometimes felt something moving in
his eye. He then remembered that, when two years previously
he hod consulted a country practitioner, be had stated that he
could “detect an organism, possibly the ovum of a ttenia,” a
diagnosis which now proved to be correct. Dr. Van der Lean

has published descriptions of the only two other oases of
intra-ocular cysticerci he has seen in Portugal, which in
many points differed from this case. He does not propose
to operate until the cysticercus has succeeded in perforating
the retina and thrusting its head and neok into the vitreous,
when he hopes by means of a sclero-choroidal incision to
free the patient from his parasite and to preserve the sight
of the eye. _

DEGREES FOR LONDON MEDIOAL STUDENTS.

On Friday, Feb. 18th, the London Hospital students held
a mass meeting in the Anatomical Theatre to discuss the
M.D. scheme for London students. Dr. Langdon Down took
the chair, and was supported by Mr. F. Treves, Dr. Francis
Warner, Mr. Munro Scott (Warden), and Mr. H. G. Lys. Mr. F.
Treves proposed, and Mr. J. Moore seconded, a motion, “ That
a committee of students be formed to draw up a petition
to the two Royal Colleges, praying them to use their best
endeavours to obtain the power of granting a degree in
Medicine; and that this committee take such other steps as
they may think fit to support this petition.” Dr. F. Warner
spoke in support of the proposition, which was carried
nem. con. Messrs. J. Moore, F. H. Taylor, Hugh Smith,
H. Watts, and J. Rayner were elected on the committee, the
latter to act as secretary. The meeting was very enthusiastic
throughout. _

DEATHS OF EMINENT FOREIGN SCIENTIFIC AND
MEDIOAL MEN.

Thb following deaths are announced: —Dr. Leopold von
Pebal, Professor of Chemistry in Gratz, was attacked in the
Chemical Institute on Feb. 17th by a discharged Servant,
and wounded so seriously that, though he managed to drag
himself into the caretaker's apartments, he died soon after¬
wards. Dr. Beschiitz, Sanitatsrath of Salzwedel, has died
suddenly in his eightieth year, having continued to practise
till the last. Dr. T. R. von niittem, Director of the Lainzer
Lunatic Asylum in Vienna. Dr. Franz Gunther, Emeritus
Professor of Forensic Medicine in Prague, at the age of
seventy-four. Dr. Bonnamy, Professor of Anatomy in
Toulouse, joint author with MM. Broca and Beau of a well-
known anatomical atlas. Professor Ludwig B&ndl, the
eminent gynaecologist, who had only recently been ap¬
pointed to the obstetric chair at Prague, at the age of forty-
four. _

CALCULUS AS THE CAUSE OF PERITYPHLITIS.

A Swedish surgeon. Dr. Sigurd Lovdo, has published the
notes of a case of perityphlitis, followed by a tumour in the
ileo-caecal region, and abscesses opening over the coccyx
through the abdominal walls and rectal walls. Ultimately a
calculus was passed through the abdominal wound weighing
79 centigrammes, and measuring 2-5 centim. by 1*3 centim.
It was composed of alkaline phosphate of lime. Dr. Lov«5n
believes this hod existed for a considerable period, and that
its situation had been in the vermiform appendix.

THE REVOLVER.

It is indeed time that Parliament should recognise the
appalling results of the indiscriminate and reckless way
in which revolvers are allowed to be sold —and used!
On one page of an evening paper this week were recorded
two distinct cases of suicide, and also a case of suicide and
attempted murder, all by means of the revolver. Cannot
the Legislative Assembly find time to restrict the awful
facilities of destruction now afforded to the burglar, the
suicide, and the murderer? Every revolver should be
numbered, licensed, and specially and heavily taxed. Those
who really require them in this country for purposes of

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The LanCet,]

REPORT ON THE SANITARY CONDITION OF NEW WINDSOR. [March 6, 1887. 489

defence—and they must or should be few—can well afford to
pay. Many a life has been sacrificed owing to “ the sight
of means to do ill deeds,” as represented by the fatal revolver.

ST. BARTHOLOMEW’S HOSPITAL.

The Assistant-Physiciancy at the above hospital, rendered
vacant by the resignation of Dr. Wickham Legg, has been
filled by the election of Dr. Samuel West, who obtained
a very large majority of votes.

BORATED FISH.

We have received from Mr. T. Christy some samples of
" kippers” cured by the boracic Mid process, and some Scotch
“ kippers” that have not been so treated. We have examined
the specimens, and they support the truth of our assertions
on this subject—viz., that boracic acid is not truly preserva¬
tive of all the qualities of the fresh herrings. The borated
specimens are black down their central parts, but the Scotch
specimens are clear and fresh-looking. In the process of
cooking the black colour of the borated fish becomes en¬
hanced. _

FOREIGN UNIVERSITY INTELLIGENCE.

Breslau. —Drs. Wiener and Lesser have been promoted to
extraordinary professorships.

Bucharest .—The Professorship of Histology and Bacterio¬
logy has been filled by the appointment of Professor von
Babes, of Buda-Pesth.

Erlangen. —Dr. Richard Frommel, of Munich, has been
invited to acoept the chair of Midwifery.

Halle .—The University is about to build an Institute for
Mental Diseases, to accommodate 160 patients.

Innsbruck .—There are here four chairs vacant—viz., those
of General Pathology,Medical Jurisprudence,Midwifery,and
Ophthalmology.

Prague (German University).— Professor Heubner, of
Leipsig, has accepted the invitation to the chair of
Therapeutics. Professor Schauta, of Innsbruck, has been
appointed to the chair of Midwifery, vacant by the death
of Professor Band!. _

At a meeting of the Committee recently appointed to
collect subscriptions in aid of the Dundee Medical 8chool
Jubilee scheme, on the 24th ult., it was reported that the
Senatus Academicus of St. Andrews University desired to
co-operato with the Committee, reserving the claim of St.
Andrews to a share of the medical teaching. The two
Principals of the University have indicated their willing¬
ness to join the Committee, and it is stated that other
members of the Senatus will also join. Subscriptions
amounting to £19,000 have now been received in further¬
ance of the scheme. , _

Correspondence has been in progress for some months
between the Admiralty and influential committees at Ply¬
mouth, Portsmouth, and elsewhere, with reference to the
increase of disease among sailors and soldiers. As a result,
official information has been received that the Lock Hos¬
pitals for the accommodation of. voluntary patients will be
W|Opened from April 1st, and that at Devonport the Ad¬
miralty will contribute £36 per bed for each of the beds.
Similar grants will be made at Portsmouth and other naval
porta.

Dn. G. Y. Heath, President 6f the Newcastle-on-Tyne
College of Medicine, has been elected representative of the
College op the.Senate of the University of Durham; the
Profeaor cd.Medicine having been made an official member
of the'Senate, kad an elective member having been con-

thwrtttftleieaoaJJ » - : *.• *ii:. .* iw

A case of myxeedema was exhibited at the Berlin Medical
Society by Professor Senator on Feb. 9th. He remarked
that this was only the second case observed in Berlin, the
other having been reported by Dr. Riess at the end of last
year. Together with two cases described by Professor Erb of
Heidelberg, this case made the fourth reported in Germany.

M. Co CRB arikh, intern of the maternity department of
La Charity, Paris, died recently from typhoid fever, at the
early age of twenty-eight years. He was a man. of much
promise, and was highly esteemed, as evidenced by the testi¬
mony given by Dr. Budin, in his speech on the occasion of
the funeral. (Le Progres Medical, No. 9.)

The condition of Professor von Arlt, which for a time
has been satisfactory, has suddenly changed for the worse,
so much so, indeed, that the death of the renowned
Ophthalmologist is almost daily expected.

We are glad to learn that the health of Dr. De Chaumont
has improved, the more urgent symptoms of his late attack
of illness having passed away.

Sbnor Don Dr. Rodolfo del Castillo and several other
practitioners in Cordova, are forming a local Spanish
Society of Hygiene.

ABSTRACT OF REPORT

ON THB

SANITARY CONDITION OF NEW WINDSOR.

By DR. HUBERT AIRY and MR. ARNOLD TAYLOR.

The following is an abstract of the Report on the Sanitary
Condition of New Windsor which tbe Local Government
Board have just published. After stating the circumstances
which were the occasion for holding the inquiry, the
inspectors (Dr. Hubert Airy and Mr. Arnold Taylor)
describe the situation of the town and discuss its popu¬
lation, which is estimated to be 12,600, Urn number including
the Household Troops, which at the last census numbered
1047.

Under the heading dwellings, account is given of the situa¬
tion of the houses, the greater part of which are on the
alluvial plain that stretches at the foot of the western slopes
of Windsor. “ Certain rows are built on such low ground
that when tbe river overflows its banks and floods the
meadows, their ground-floors are two or three feet under
water. One quarter also in the older part of the town suffers
from the same cause; this is the lower part of Bier-lane
and its side courts.” In 1852 “ the water was in the houses
for seventeen days, during which time the inhabitants had
to live in the upper rooms; the last serious flood was about

five years ago.Besides the temporary inconvenience,

there is the layer of mud which is left behind on floors
and furniture as the water subsides, tbe destruction of
wall-paper and plaster, and the saturation of walls aad
floors, which it takes months to get rid of; and there is
the still more permanently injurious Condition of damp sub¬
soil affecting these dwellings at all times.There cannot

be a doubt that this is an unwholesome state of things ; to it
is probably due a rather high mortality from phthisis in
Windsor.” Although the Town Council have no power to
require dwellings already built in low-lying situations to be
altered in such a way as to raise their ground floor above
flood level, this has been voluntarily done in one row by
tbe owner. The newer rows of houses have advantage of
greater air space about them and have the requisite f aoiUties
for through ventilation.

Old Courts.— ' But when we come to examine the older
courts and alleys of the town, we find that, though in mjujy
cases the houses storid on fairly sound ground, their eqp-

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490 Thb Lancet,] REPORT ON THE SANITARY CONDITION OF NEW WINDSOR.

[Mabch 5> 1887.

dition in respect of outside air space, back yard space,
internal ventilation, closet accommodation, surface forma¬
tion, and pavement—in some and all of these particulars—is
still pitiably bad. We, however, willingly recognise that
there is evidence of structural improvements having been
made in the older courts and alleys in recent years.”

The following are some of the details givenBier-lane:
170 yards long, 5 yards wide at the top, widening to 12
ards. On the east side is a butcher’s shop, with slaughter-
ouse at back; “ might be more cleanly kept. Next is a
shoemakers shop, with narrow back yard, widening from
3 ft. to 8 ft. across, ashpit recently emptied, gully out of
repair, w.c. in the dwelling without ventilation, walls damp.”
Next come five capital houses, with workmen’s club room
and a brewhouse. On west side are two common lodging-
houses; then comes entry to Garden-court, which contains
twenty-one cottages, ten of which on left side lie close under
high retaining wall; their back yards, or rather closet-wells,
are only from 4 ft. to 6 ft. across, and contain each a pan¬
closet, to be flushed by hand. “Water has to be fetched
from a standpipe near the entry to the court. Ashes
are deposited at the head of a back lane beyond the
entry of the court. Each cottage has three rooms, one
above another, cubic space from 700 ft. to 800 ft., from
which should be deducted the space occupied by bedding
&c.; they have no back windows; the front windows are
from 3 ft. to 3 ft. 6 in. square. The cottages in opposite row
are similar, but, if anything, their back space is still smaller;
this space is half roofed over, and made to serve as pantry,
or netted over to keep the cats out.” Many cf the houses
are damp. No serious overcrowding discovered. “ Lower
down in Bier-lane are some old cottages, partly dilapidated,
which, the inspector understand, are going to be pulled down.
On the left side formerly stood Red-lion-row; seven new
houses are being built here. “ On the right side space is less
closely occupied: there is, first, a detached house with
central stair and a room on each side, top and bottom ; no
back window, except at the top of the stair. Next are two
cottages under one roof, with small gardens in front. The
pan-closet belonging to one of them is in a dark recess in
a narrow covered yard off the scullery. The inhabitants
are laundresses, who flush their closets with their suds.
Next come two six-roomed houses of better class, but
with ill-paved yard. A pump by the pathway supplies
this court with water.” Again returning to Bier-lane,
the inspectors noted some fairly decent cottages, and
came to a passage leading to Distil-Hou<e-row, consist¬
ing of eleven cottages on the right band and two more
at the further end facing the entry. “ In front of the row
is a space of bare earth bounded by a blank wall, against
which Btands the pump, which serves foe the common
supply of these thirteen houses. Near by, at the foot of the
wall, are cavities in the ground, which receive ashes and

house refuse.Some of the interiors showed neatness and

cleanliness and comfort, others the reverse; one, containing
five children besides the parents, was found to be very dirty.
Each cottage in the row has front, kitchen (cubic space
about 770 ft.) and scullery (540 cubic feet) at back, with
bedrooms above, the back bedroom having a lean-to roof,
which much diminishes its cubic space. Front windows
3 ft. by 3ft. 6 in., back windows 3 ft. by 1 ft.; but the two
cottages that look up the yard have only two rooms each,
and have no back windowp. All but three have slop sinks
in the sculleries; there are also gullies in the front yard
where slops tire poured; this row has no back yards. At the
farther end, at the edge of the back lane, stand four pan¬
closets for thirteen houses; pans dirty for want of flush-
water; woodwork giving way. The palings, which should
part these closets from the back lane, are almost all pulled
down.”

South-place contains forty-two houses, on either side of
an asphalted passage. “Of thirteen houses on the south
side, ten have no opening whatever at the back, no
scullery, no closet, and no water but a tap at the end of the
row. For closet purposes the sixty-five dwellers in the
ten houses have to go into an open yard at the back of the
opposite houses on tbe north side.” Some of them are four,
others two-roomed; their stairs have no ventilation, and
no light except in one instance, where there is a front,
window on tbe landing. “ On the north side, Nos. 1 to 4
have sculleries, opening into back, gardens, and back lean-
to bedrooms over the sculleries, with back windows 18in.
square. Bach of these bousee has its own pan-closet. No. 5
mlmn hat a closet. Nos. 26 to 28 in like manner, have scul¬

leries and back bedrooms. They open into a common yard,
with an old pan-closet and a new cistern-closet. Nos. 6 to
24, with a population of fifty-six, are two-roomed houses,
without any back openings; the bedroom, reached by a stair
against the inside of the back wall, contains about 800 cubic
feet; a certain small degree of ventilation could be obtained
by the stair if all doors and windows were kept open
together, but practically this is not done. Behind these
houses are three open, unpaved yards, common to five or six
dwellings, each with the entries from the asphalted passage.
One of tbe houses adjoining each entry has the advantage of
a larger bedroom extending over the entry. These yards
together contain eight old pan-closets without water and
five new cistern-closets, thirteen in all, for a population of
121, reckoning those who come over from the south side.
They have taps of town water; one of them has an iron
dustbin, the others have merely cavities in the ground at
the foot of the house wall.” There is plenty of open space at
the back; ventilation could be easily obtained by putting in
a window at the head of each stair. “ As for the houses on
the south side, we see no way of rendering them tolerably
habitable but by demolishing every third house and con¬
verting its site into a yard for its neighbours with a proper
w.c. to each. The death-rate of South-place is calculated to
be about 24 per 1000.”

In Charles-place and Charles-street cottages there are-
houses without through bedroom ventilation. Keppel-row
is another insanitary locality of fourteen houses, fronting a
9 ft. high brick wall with an asphalted passage 8 ft. across
between, with no ram spouting in front, only partial at
rear. The first six dwellings have each only one bedroom,
not 7 ft. high, with no back window; each has a back
room or scullery measuring 7 ft. by 7£ ft., with a lean-to
roof on the ground floor. Instances are given of the con.-
ditions to which this sort of accommodation gives rise. The
next eight dwellings have each a small back bedroom, some
not occupied on account of the damp. At the back are
two unpaved yards; each has three closets, which serve for
eighteen houses. There are three taps of town water in the
yards; an ashpit near the washhouse door the inspectors
found duly emptied, but it is said to be often offen-ive.
Keppel-court has no back openings to its back ground-floor
rooms, except where the tenants have removed a brick or
two, admitting air from an inn yard.

Special reference is made to the neglected and dangerous
state of some Crown property in St. Alban’s-street, and of
certain houses belonging to the Corporation.

Water-supplu.—Taa town water-supply is said to be good,
being derived from a well in the chalk. There are still a
number of wells in tbe town, some like those in Red-lion-
row and Distil-nouse-row supplying several houses in
common. These waters are analysed by the medical officer
of health, and when found impure the wells are closed ; in
the case of private wells, it has been thought sufficient for
the present to warn the tenants of the probable impurity of
the water.

Sewerage .—This is described, and the statement is made
that ventilation was originally provided for by means of
surface gratings, but complaints were made from time to
time of the smell from these gratingp, and many of them
have been closed in consequence. It would seem that the
flushing is not sufficient to keep the long and almost level
out.fall sewer (with a fall of 3 ft. in a mile) free from deposit,
which is thus left in the sewer long enough to decompose
and cause offensive effluvia from the gratings. The necessity
of diverting certain storm-water is pointed out.

House-drains .—There is reason to believe that in many
cases the house-drains are ill-laid and unventilated, and
ready to convey poisonous gases direct from the sewer to
the house through an untrapped sink-pipe or an ill-con¬
structed w&tercloset.. The means at the disposal of the
Sanitary Authority for dealing with this difficulty have been
not so much by way of prevention as by removal of such ef
the defective conditions as bad demonstrated themselves to
be nuisances injurious to health. The oode of bye-laws in
course of preparation will not avail to prevent bad drainage
arrangements and ill-constructed closets except in the case
of new and rebuilt houses. It is requisite that public
opinion should come to the aid of the Sanitary Authority in
this matter.

Closets —Windsor is decidedly in advance of those towns
which have vault-privies; the worst thing in Windsor is a
an-closet, constructed to be flushed by nand, which has
ecome coated with dirt or temporarily choked for want of

3

Thb Lancet,]

THE PEABODY IMPROVED DWELLINGS TEC ST.

[Mabch 5,1887. 491

water. Now and then it was found the pan was broken by
tome rough usage, and it was evident there waa untrapped
air communication with the sewer. While not to be com¬
pared to the foul privies that still disgrace so many towns,
jetthese Windsor pan-closets ought to be kept in better
order, and there ought to be such a system of inspection as
should ensure this being done. For the credit of the town,
it is to be hoped that this improvement will be generally
mode. The existing accommodation is in places not sufficient.

Ashes and House Ref use .—There is a weekly collection of
bou«e refuse, the inhabitants bringing out their dust in
boxes and pails; those who will not take thia trouble are
requested to give notice at the surveyor’s office when they
desire the refuse to be removed from their premises. It is
caned to a field one mile and a half from the centre of
the town, where it is used for filling up hollows in the
ground.

Isolation of Infectious Disease .—A hospital for this pur¬
pose is urgently needed, and in connexion therewith it is
very desirable there should be a suitable disinfecting
chamber. The authority offer a fee of 2s. 6 d. for every case
of infectious disease notified by a private practitioner to
the medical officer of health.

Bye-laws .—The need for their revision has long been
recognised, new bye-laws are on the point of receiving the
sanction of the Board.

Sanitary Staff .—The medical officer of health is an able and
conscientious officer, and the inspectors find in his annual
reports evidence of much good work in his district, and
sound advice offered to his authority. Evidence is given of
the scientific spirit in which he approaches bis work. It must
be objected, however, that he has under-estimated the im¬
portance of such sanitary defects as have been described in
connexion with South-place, or else has over-estimated the
difficulty of dealing with its defects The inspector of
nuisances has done very useful work in organising the pre¬
sent system of refuBe-removal, and in bringing about
countless improvements; but it is evident that his duties
are too multifarious to allow him to give the time that is
required for continuous detailed sanitary inspection. The
work of nuisance inspector is enough to demand a man’s
whole time, and the Sanitary Authority ought not to con¬
tent themselves with less. The inspector ot nuisances has
also to act as borough surveyor, inspector of common
lodging-houses, of weights and measures, of petroleum,
and of canal boats. Most, if not all, of the courts and
streets might have been dealt with—externally, at least—
under the 150th and following sections of the Public Health
Ac'.; but, as far as the inspectors could learn, no attempt
appears ever to have been made to use these sections, nor
is it possible to do so as long as the inspector has so many
other duties to discharge in addition to those that properly
pertain to the office of borough surveyor. In looking through
the Nuisance Report Book, the inspectors could not fail to
notice that in the single month of September, 1886, there
ore as many cases of premises inspected and nuisances
reported as in the two years from September, 1884, to
August 1886.

Mortality .—The average death-rate is 16'3 per 1000, but
this low rate is certainly in part accounted for by the ex¬
cessive proportion of inhabitants of the ages between ten
tad thirty, and the low birth-rate. The zymotic death-rate
is also low.

Conclusion. —The sanitary condition of Windsor is in most
respects no worse, and in some respects is distinctly better,
than that of many other old towns with which the inspect ore
are acquainted. Provided the Town Council have a sufficient
staff of officers acting nndar their orders, the sanitary
defects which have been pointed out will in the main be
satisfactorily remedied.

Recommendations. —With regard to the sanitary defects
in the areas referred to, especially in point of through ven¬
tilation and outside air space, the sanitary authority should
inquire whether the requisite improvements can be obtained
under the powers of the Public Health Act, 1875, and, if not,
they should resort to the powers given by the Artisans and
labourers’ Dwellings Improvement Acte, 1875 to 1882. In
oider to secure more constant and thorough nuisance in¬
spection the sanitary authority should appoint a separate
inspector of nuisances. They should also make provision
■or the isolation of infectious disease and for the disinfection
of infested articles, and should take into consideration the
queotiotv of providing & furnace for the destruction of house

refuse.

THE PEABODY IMPROVED DWELLINGS TRUST.

Tim twenty-second annual report of the trustees of the
Peabody Donation Fund is satisfactory, whether viewed
from a financial, social, or sanitary point of view. The half¬
million of money given and bequeathed by Mr. Peabody
between the years 1862 and 1873 has by the accumulation
of rentand interest very nearly doubled itself, for on Dec. 31st
last it am mated to .£910,668. That the object of the donor
has been faithfully carried out is evident from the fact that
by the end of last year the trustees had “provided for the
artisan and labouring poor of London" 11,150 rooms, without
counting bath-rooms, laundries, and washhoases, and that
these rooms were occupied by a population of 20,228 persons ;
this shows an increase of 12,431 upon the number in resi¬
dence at the end of 1876, ten years before. The various
buildings contained 5014 separate tenements, including 74 of
four rooms, 1782 of three rooms, 2360 of two rooms, and 808 of
single rooms; the average rent of each tenement being rather
more than 4s. 9<i.,aud of each room rather less than 2 s.2d. It is
stated that the average weekly earnings of the head of each
family in residence at the close of the year was rather less than
23s. 10 d. If this information, which is presumably supplied
by the tenants themselves, is trustworthy, it furnishes a
complete answer to the charges that have been made from
time to time that the Peabody Buildings are not inhabited
by the class for which they were intended—namely, the
“ artisan and labouring poor.” The report contains the usual
figures bearing upon the vital statistics for last year of the
population of more than twenty thousand persons inhabit¬
ing those buildings. The birth-rate was equal to 42 4 per
1000, exceeding by 10 the mean rate for the whole of Lon¬
don. This high birth-rate is evidence of the abnormal age
constitution of the population, which contains an excep¬
tionally large proportion of young adults, and consequently
of children, and necessarily a very small proportion of elderly
persons. The death-rate among this population, including, as
is stated in the report, the deaths of those residents who were
removed to hospitals, was equal to 19 3 per 1000, which is 0 6
below the mean rate for the whole of London. Bearing in
mind that this population belongs exclusively to the work¬
ing dlasses, and further that its exceptionally large pro¬
portion of young children more than counterbalances the
effect of its small proportion of elderly persons, this death-
rate may be taken to afford evidence of the sanitary
condition of the residential population of these buildings.
It should at the same time be remembered that to the
reported death-rate of this population should undoubtedly
be added a proportion of the deaths recorded in workhouses,
to which institutions certain numbers of these classes
when out of health or work inevitably drift. It may be
stated that nearly 12 per cent, of the deaths registered in
the whole of London last year werei recorded in workhouses
and their infirmaries. It seems certain that such a working-
class population as that residing in the Peabody Buildings
must actually contribute a still larger proportion of its
deaths to the number that occur in workhouse establish¬
ments. This disturbing element of the Peabody mortality
statistics does not, however, affect the rate of mfant mor¬
tality, and it is especially satisfactory to learn tbat'in this
working class population housed in improved dwellings the
rate of itofant mortality in 1886 did not record 149 per 1000
registered births against 958, the mean rate in the whole of
London.

THE MOXON MEMORIAL.

At a meeting of the friends of the late Dr. Moxon, held at
the Royal College of Physicians on Feb. 1st, Sir William
Jenner, Bart., in the chair, the following resolution waspro-
posed by Dr. Wilks and seconded by Sir James Paget*
“That in the opinion of this meeting it is desirable to
express by public memorial the widespread appreciation
that exists of the high character and remarkable personal
qualities of the late Dr. Moxon. and especially of the services
he rendered in advancing medical science and in otherwise
promoting the highest interests of the profession.” It was
proposed by Dr. Pavy and seconded by Sir Dyce Duck-

oogle

492 Tiik Lancet,]

TUE MOXON MEMORIAL.—WILLS OP MEDICAL MBS.

[March 5 , 1887 .

worth: “That subscriptions be invited, and that a sub¬
committee be appointed to decide upon the most suitable
form of memorial.” These resolutions were unanimously
carried.

At a meeting of the subcommittee, held at the Royal
College of Physicians on Feb. 8th, the following resolution
was proposed by Sir Joseph Lister, seconded by Sir Andrew
Clark, and unanimously carried: “That the fund raised by
subscription be devoted to the foundation of a scholarship
or medal to be awarded by the Royal College of Physicians,
and to the erection of a memorial of the late Dr. Moxon at
Guy’s Hospital.”

SUBSCRIPTIONS RECEIVED (FIRST LI8T).

Sir W. Jenner, Bart.£21 0 0

F. W. Pavy. M.D., F.B.S. 21 0 0

R. Clement Lucu, 21 0 0

8lr W. Gull. Bart. ... 10 10 0

R. Quain, M.D. 10 10 0

8. Wilki, M.D.. F.R.S. 10 10 0

Ed. Rawlings, E*q. ... 10 10 0

T. Bryant, Esq. 10 10 0

J. Sydney Turner, Baq... 10 10 0

Mra.Blphinetone. 10 10 0

Sir J. Lister, Bart. ... 10 0 0

8ir James Paget, Bart.... 5 6 0
Sir Dyce Duckworth ... 6 6 0

Sir H. Pitman . 6 6 0

P. H. Pye-Smith. M.D.,

F.ILS. 5 6 0

Pembroke Minne, M.D... 6 5 0

A. B. Durham, F.R.C.S. 5 6 0

G. H. Savage, M.D. ... 6 6 0

W. H. Broailbent, M.D. 6 5 0
Dr. and Mrs. Alkman ... 5 5 0

F. Orton. M.D.. J. P. ... 6 6 0

Wilaon Pox. M.D. ... 6 6 0

B. Clifford Beale. M.D.... 3 3 0

R. N. Wallace. M.B. ... 3 3 0

F. Newland Pedley,

F.R.C.S. 3 3 0

A. T. Gillings, M.D. ... 2 2 0

8tephen Mackenzie.M.D. 2 2 0
W. A. Brailey. M.D. ... 2 2 0

J. Hand. F.K.0.8. ... 3 2 0

C. Bader. Esq. . 2 2 0

C. A. Aikin, Eaq. 2 2 0

H. L. Adney. M.D. ... 2 2 0

J. F. Table, Esq. 2 2 0

W., T. Parker Douglas,

M.D. ... 2 2 0

Charles Lewis, Esq. ... 2 2 0

W.F.R. Burgess. M.D... 2 2 0

Charles Higgens, F.R.C.S. 2 2 0

H. Horsley, Esq. 2 2 0

J. Batteson, Esq. 2 2 0

John Gill, Esq. 2 2 0

John Mao kern. M.D. ... 2 2 0

Th. Bastes, M.D. 2 2 0

H. C. Burton, B«q. ... 2 2 0

MUs.Elphlnstone. 2 2 0

Ben. Rix. Bsq. 2 2 0

L. B. Shaw. M.D. 2 2 0

T. A. Spalding. Bsq. ... 2 2 0

R. J. Kerby, M.D. Ill fl

8ir W. Bowman, Bart. ... 110

W. John. Em. . 110

D. U. Forty, Esq. 110

J. Farrant Frv. Eeq. ... £110
J. Montague Day, Esq. ... 1 1 0
W. A. E. Waller. Esq. ...110

A. Roper, Esq.110

Arthur Davies, M.D. ... 1 1 0
C. O. A. Price. Bsq. ... 1 1 0

W. Lockhart. F.R.C.S. ... 1 1 0
J. Lauder Brunton, M.D.,

F.R.S.110

F. Turtle. M.D.110

J. Kingston Fowler. M.D. 110

R. Hicks. Esq.110

H. J. Wolsteuholme, Esq. 1 1 0

F. J. Burgess. F.R.C.S. ... 1 1 0

J. A. Fraser. Esq. 110

B. F. Gaitekell, Esq. ...110

W. A. Aiken, E*q. 110

H. H. Dixon. Ksq. 110

A. H. Baines, Esq. 110

Challoner Clay, Esq. ... 1 1 0
James Blsshopp, Esq. ... 1 1 0

G. W. Shipman, Bsq. ... 1 1 0

W. P. Reynolds. Baq. ... 1 1 0
J. B. B. Burroughs, Bsq.... 110
W. A. Lane. M.8. 110

B. Marshall, Esq. 110

S. Knaggs, Esq.110

J. E.Viney, M.D. 110

B. T. Phillips. Esq. ...110
Prof.W.K. Parker, F.R.S. 110
Robert Harris. M.B. ...110
Edgar Crookshank, M.B. 110

F. Manser, Esq.110

Ii. Manser, Esq. 110

W. Fioyer, M.l). 110

J. R. Boswortb, Esq. ... 1 1 0

It. Psrry, M.D.110

S. Tilley, F.R.C.S. 110

Surgeon-Major J. Ince,

M.D.110

G. W. Daniell, Baq. ... 1 1 0

A. G. Medwln. M.D. ... 1 1 0

J. G. Hall. Esq., J.P. ... 1 1 0

O. P. Creed. Esq.0 10 «

F. P. Weaver, M.D. ... 0 10 6

Bransby Brooks. Esq. ... 0 10 6

H. Hawksworth, Bsq. ... 0 10 6

John Crew, Esq. ... ... 0 10 6

R. 8. Mutch, Ksq. 0 10 «

J. C. Clarke. Esq.0 10 6

P. W. Humphreys,

F.R.C.S.0 10 6

S. Bingham, Esq.... ... 0 10 6

H. N. Smith, Esq. 0 10 6

WILLS OF MEDICAL MEN.

Tub will of Mr. Samuel Harrison Evans, M.R.C.S., formerly
of Derby, afterwards of Normanton, but late of Landour,
Weston-super-Mare, wtio died on Oct. 30th at Southsea, has
been proved at the Wells District Registry by the Rev. John
David Evans and Mr. Thomas David Fabian Evans, the
nephews, the executors, the value of the personal estate
amounting to over £22,000. The testator bequeaths £200
each to the Church Pastoral Aid Society, the Church
Missionary Society, the British and Foreign Bible Society,
and the Society for Promoting Christianity among the Jews;
£50 to the Derbyshire General Infirmary; bis household
furniture and effects to his wife, Mrs. Chloe Evans ; £5000
upon trust for her for life; and numerous and considerable
legftciesto'hisown and his late wife’s relatives, servants, and
others. The ultimate residue of his property he leaves to
the person or persons who would, have been entitled thereto
under the statute for the distribution of intestates’ effects if
he had died without a will.

The will of James Dickson Steele, M.D., lato of 18, Blom-
fleld-road, Mftida-vale, who died on April 23rd last, has been
proved by Major George de Winton and Mr. Richard Eve, the
executors, the value. of the personal estate amounting to

over £15,000. The testator bequeaths £2000 to the said
Major de Winton; £1000 each to his brother Robert
Moore Steele, his sisters Mary Stuart Steele and Esther
Steele, and to the said Richard Eve; and legacies
to friends and others. All his real estate and the residue
of his personal estate he gives to his housekeeper, Mrs.
Anne Penny, in consideration of her long and faithful
services.

The will of Charles Sanders, M.D., late of the Haylands,
Chigwell, Essex, who died on Oct. 17th last, has been proved
by Mrs. Laura Ann Sanders, the widow and sole executrix,
the value of the personal estate exceeding £9000. The
testator gives certain plate, the portrait of his grandfather,
and also his real estate in the county of Norfolk to his wife
for life, and then to his son Charles Edward Brad field
Sanders. The residue of his real and personal estate he
leaves to his wile.

The will of Mortimer Balding, M.D., late of St. Albans,
Herts, who died on Nov. 23rd last, has been proved by Mr.
Albert BaldiDg, the brother, and Mrs. Thomas Gowland Page,
the executors, the value of the personal estate amounting to
over £3000. The testator bequeaths £50 and his household
furniture and effects to his wife, Mrs. Kate Greaves Garling
Balding, and he confirms the settlement made on their
marriage; he also bequeaths legacies to his sister and to a
nephew. The residue of his real and personal estate he leaves
upon trust for his wife for life or widowhood, then for
all his children in equal shares, and in default of children to
his sister Octavia.

The will of John Findlay Lindsay, M.D., late of Great
George-square, Liverpool, who died on Oct. 11th last, has
been proved at the Liverpool District Registry by Miss Janet
Lindsay, the sister and sole executrix. With the excep¬
tion of two or three bequests of jewellery, the testator
leaves all his property, including his interest in certain
property in Glasgow, to his daughter Florence Bosquet
Lindsay.

The will of Arthur Wynn Williams, M.D., formerly of
Montagu-square, but late of Brooklyn, West Drayton, who
died on Nov. 15tb, has been proved by Mr. Arthur Lough¬
borough and Mr. Freke DalgleiBh Williams, the executors.
The testator gives certain family pictures to his wife for life,
then to his son Trevor Wynn Williams, and then to his son ;
£50 and all articles of personal, domestic, or household use
to his wife; the residue of his real and personal estate upon
trust to pay the income to his wife for life, and at her death
for all his children in equal shares.

The following legacies have recently been left to hospitals
and other medical institutions:—Mr. George Fielder, of
Doctors’ Commons and West Horsley-place, Leatherbead,
Surrey, Proctor, on the death of the survivor of hia
wife and sister, £500 consols each to Charing-croee
Hospital, Middlesex Hospital, Surrey County Hospital,
the Seamen’s Hospital (late Dreadnought), and the London
Homoeopathic Hospital.—Mr. Thomas Lockerby, of Derwent
Villa, Addiscombe, Surrey, £100 to the Royal Infirmary,
Glasgow.— Miss Fanny Halsey, of Little Gaddesden, Herts,
£100 to the West Herts Infirmary.—Mr. Octavius Edward
Coope, J.P., D.L., M.P., of Rochetts, near Brentwood, Essex,
and 41, Upper Brook-street, £100 to Middlesex Hospital.—
Mrs. Alicia Mary Gaselee, of 2, Cambridge-sq uare, Hyde-park,
and Tytherley, Bournemouth, £100 to St. Mary's Hospital.—
Miss Emily Barry, of 8, Cleveland-square, llyde-park, £500
to tbe Royal Hospital for Incurables, Putney Heath ; £300
each to St. Mary’s Hospital, Royal Orthopaedic Hospital, and
the Hospital for Sick Children; £100 to St. Mary’s Conva¬
lescent Home, Broadstairs, in connexion with tbe Orphanage
of Mercy, Kilburn-park-road; and £100 to tbe Metropolitan
Convaloscent Hospital, Walton-on-Thames.—Mrs. Charlotte
Broadwood, formerly of Tunbridge Welle, but late of 4, Tbe
Mount, St. Leonards-on-Sea, £2500 consols in aid of the
Cottage Hospital built by her atCapel, Surrey.—Mr. Stephen
Peter Schilizzi, of Park Point, Higher Broughton, Manchester,
£400 to tbe Athens Hospital, Evagelismos, and £300 to the
Scio Hospital.- Mrs. Harriett Beckford, of West Hill, Cowes,
Isle of Wight, £1500 to the Isle of Wight Infirmary, Hyde ;
£1000 to the Hospital for Incurables, West Hill, Putney •„
and £600 to tbe Metropolitan Convalescent Institu¬
tion, Walton-on-Thames.—Captain Thomas Ruddiman, of
I, Cavendish-place, Cavendish-square, £100 to tbe Middlesex
Hospital.

Digitized by

Google

Thb Lancet,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[M Afion 5,1887. 498

VITAL STATISTICS.

HEALTH OF BNOLI8H TOWNS.

IH twenty-eight of the largest English towns 6882 births
and 3767 deaths v^pre registered during the week ending
Feb. 26th. The annual death-rate in these towns, which had
been equal to 19 - 5 and 21'1 per 1000 in the two preceding
weeks, further rose last week to 21-3. During the first
eight weeks of the current quarter the death-rate in these
towns averaged 22*0 per 1000, and was 2‘3 below the
mean rate in the corresponding periods of the ten years
1877-86. The lowest rates in these towns last week were
13-5 in Nottingham, 137 in Brighton, 144 in Derby, and 16-1
in Sunderland. The rates in the other towns ranged upwards
to 27^2 in Newcastle-upon-Tyne, 29'8 in Plymouth, 30'1 in
Manchester, and 33 0 in Huddersfield. The deaths referred
to the principal zymotic diseases in the twenty-eight towns,
which had been 340 and 371 in the preceding two weeks,
was last week 372; they included 140 from measles, 94 from
whooping-cough, 47 from scarlet fever, 39 from diarrhcea
and dysentery, 31 from diphtheria, 21 from “fever"
(principally enteric), and not one from small-pox. No
death from any of these rymotic diseases was registered last
week in Birkenhead, while they caused the highest death-
rates in Leicester, Liverpool, Manchester, and Huddersfield.
The greatest mortality from measles occurred in Leeds,
Manchester, Liverpool, Sunderland, Leicester, and Hudders¬
field ; from whooping-cough in Birmingham and Norwich ;
and from scarlet fever in Bristol and Blackburn. The 31
deaths from diphtheria in the twenty-eight towns included
14 in London, 4 in Liverpool, 2 in Portsmouth, 2 in Man¬
chester, 2 in Leeds, and 2 in Cardiff. Small-pox caused no
death in London and its outer ring, or in any of the
twenty-seven other largo provincial towns. Only 6 small¬
pox patients were under treatment on Saturday last in
the metropolitan hospitals receiving coses of this disease.
The deaths referred to diseases of the respiratory organs in
London, which had been 364, 373, and 392 in the preceding
three weeks, further rose last week to 466, but were 18
below the corrected average. The causes of 114, or 3 - 0 per
cent^ of the deaths in the twenty-eight towns last week
were not certified either by a registered medieal practitioner
or by a coroner. All the causes of death were duly
certified in Portsmouth, Bolton, Blackburn, and in fpur
other smaller towns. The largest proportions of uncertified
deaths were registered in Salford, Oldham, and Sheffield.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 19*8, 22 0 and 24 3 per 1000 in the preceding
three weeks, declined again to 22*5 in the week ending
Feb. 26th; this rate exceeded by 1*2 the mean rate during
.the seme period in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from ll'O in
Greettock and 16 8 in Dundee, to 24-8 in Glasgow and 837
in Aberdeen. The 662 deaths in the eight towns last week
showed a decline of 46 from the number returned in the
preceding week, and included 33 which were referred to
whooping-cough, 30 to measles, 17 to scarlet fever, 11 to
diartncea, 6 to “fever” (typhus, enteric, or simple), 3 to
diphtheria, and not one to small-pox; in all 99 deaths,
resulted from these principal zymotic diseases, against
76 and 103 in. the previous two weeks. These 99 deaths
wefT. equal tb an annual rate of 40 per 1000, which
exceeded'by 1U the mean rate from the same diseases
in' the. twenty-eight English towns. The fatal cases
<rf‘VhtKffiihg-cough, which had increased in the pre-

■ cedgUt four weeks from 19 to 32., further rose ; last week
to SVof frhich 17 Occurred in Glasgow and 7 in, Edinburgh.

easles also showed a further cqnsider-.
he numbhrs in recent weeks, and in-
a and 12.in Glasgow.. The 17deaths
the other harid, were fewer by 8 than
vious Week; 11 were returned in Edin-
r, apfi 2 in Dundee. The 11 deaths
is, bf Wbgch. 4 occurred in Aberdeen
freely djflfered from the average- nnm-
le fi fleatftefrom “ fever ” included 3 m
increase upon recent Weekly numbers,
ass pf diphtheria occurred in Glasgow.

td acuw diseases of the respiratory

owiis, wmcb had been 126; 138, and

146 in the preceding three weeks, declined last week to 121,
and were 38 below the number returned in the correspond¬
ing week of last year. The causes of 78, or nearly 14
per cent., of the deaths registered during the week were
not certified. -

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 27*3 and
35’3 in the preceding two weeks, declined again to 30 7 in
the week ending Feb. 26th. During the first eight weeks
of the current quarter the death-rate in the city averaged
31'4, the mean rate during the same period being but
20 9 in London and 217 in Edinburgh. Tne 208 deaths in
Dublin last week showed a decline of 31 from the
number in the previous week, and included 8 which were
referred to “fever" (typhus, enteric, or simple), 2 to
scarlet fever, 2 to whooping-cough, 2 to diarrhcea, and not
one either to small-pox, measles, or diphtheria. Thus
the deaths from these principal zymotic diseases, which
had been 17 and 14 in the preceding two weeks, were
again 14 last week; they were eqaal to an annual rate
of 21 per 1000, the rates from the same diseases being
1'8 in London and 4 2 in Edinburgh. The deaths referred
to “fever,” which had been 4 in each of the previous two weeks,
rose last week to 8, and exceeded the number returned in any
previous week of this year. The fatal cases of scarlet fever,
whooping-cough, and diarrhcea were almost identical with
those in the previous week." The deaths both of infants and
of elderly persons showed a decline from the numbers in
the previous week. Six inquest cases and 4 deaths from
violence were registered; and 50, or nearly a quarter, of
the deaths occurred in public institutions. The causes of
40, or more than 19 per cent., of the deaths registered during
the week were not certified.

Comspnbm*.

“ Audi alteram pattern."

A NOTE OF WARNING REGARDING THE CON¬
DITION OF ARTICLES OF FOOD SOLD FOR
THE USE OF THE DIABETIC.

To the Editors of The Lancet.

; Sies,—I n the interests of patients and for the sake of the
credit of the profession, 1 think attention requires to be
drawn to the unsatisfactory character of some of the articles
of food that are being sold for the special use of those suffer¬
ing from diabetes. The principle at the foundation of the
preparation of these articles is to furnish a food as free
from starchy and saccharine matter as can be practi¬
cally done, and whilst this object is attained it is desirable,
in order to render it acceptable for consumption, that the
article produced should present as close an approximation to
the food in ordinary use as possible. The chief difficulty, it
may be said, lies with a representative of bread. Various
substitutes for ordinary bread are manufactured and placed
at the command of the diabetic. Some of them are carefully
prepared and fairly represent what they Should be. Others,
on the other hand, although placed- before the consumer as
of a proper character and charged for Upon about the same
scale of prices, are but little removed in constitution from
the representative product in its ordinary state. Thus, the
patient may he-deluded into taking that which is positively
obstructive to satisfactory progress; and with this, discredit
will be thrown upon the profession by the efforts of treat¬
ment proving abortive. Gluten flour and gluten bread
always contain a certain amount of starch, and it may be
considered that the article is in a good state if the amount
does not exceed from 26 to 30 (or about this) per cent. 8oine
gluten bread and gluten ftOur being 6old at tne present time
cbntain no less than from About 75 to 80 per cent, of starch.
The actual Agates before me are for a sample of gluten
bread 74 and another from the same source 76 per cent, of
starch, and for two samples of gluten flout derived from
the same establishment 80 and 82 per cent, of staroh. 1 -
These figures, as with thore belonging to all my analyses,
refer to the - article in the dried or- WatOr-free state. \ For

__ AlA ... -,h*.

J It is only right to «Ute that theee mtapleAiRM mat obtaine* from -
-either of the London venddn of diabetic food.- 1 ,

Digitized by G00gle

494 Thb Lancet,]

LUNACY ACT3 AMENDMENT BILL, 1887.’

[March 6,1887.

comparison, 1 may state that the figures yielded for a sample
of ordinary wheaten flour were 90 per cent, and ordinary
household bread 89 per cent. A biscuit sent to me for exami¬
nation by the wife of a patient as a gluten biscuit obtained
from France contained 84 per cent., and another kind 89 per
cent., of starch.

Bran biscuits vary. The figures before me, yielded by the
analysis of some that are sold, give about 38 per cent, of
carbohydrate expressed as starch; whilst the figures for
others amount to from 60 to 60 and upwards of this. Besides
starch, bran contains cellulose and lignose. These, under
the boiling with sulphuric acid in the process of analysis, are,
like the starch, transformed into glucose, and thus comprised
in the result obtained. Presumably, however, cellulose and
lignose in a great measure, if not entirely, resist the solvent
influence of the digestive secretions, and thereby, although
carbohydrates, escape passing on to sugar in the system of
the diabetic. But the starch of course is in the same posi¬
tion as starch from other sources. The starch removable by
foiling water from some ordinary bran, or bran as it came
from the mill, amounted to 23 per cent.; with prepared bran
sold for the use of the diabetic the amount of starch obtained
was practically the same, justifying the conclusion that
6imply grinding without previous washing constituted the
process of preparation adopted.

Macaroni, vermicelli, and semola are also articles announced
to be specially prepared for the use of the diabetic. I have
never yet come across a sample that could be regarded as
euitable. Indeed, they have either resembled the ordinary
article in use, or only differed to a slight extent. For instance,
taking recent analyses, one sample of macaroni gave
85 per cent, of starch, another 71, and another 78; a sample
of vermicelli 70, and a sample of semola 74, per cent. The
figures yielded by a sample of ordinary macaroni were 86,
and vermicelli 87, per cent.

I am. Sirs, yours obediently,

Gro«venor-»treet, Feb., 1887. F. W. PAVY.

“LUNACY ACTS AMENDMENT BILL, 1887”

To the Editors of The Lancet.

Sirs,— In your last issue is a letter from Dr. Rogers
drawing attention to an alleged injustice to workhouse
medical officers in being prohibited from receiving a fee for
certifying lunatics as fit to be removed to asylums. I sub¬
mit he is entirely wrong in his conclusions and in his
interpretation of the proposed statute. The Bill does not
prevent the workhouse medical officer from being paid a
fee when the patient is removed to an asylum, but only in
the case when the lunatic is of such a harmless nature that
he can with safety remain in the workhouse. Even under
the present law no fee is payable to the medical officer under
these circumstances.

Clause 14, which Dr. Rogers quotes, enacts: “ No person
being a lunatic shall be allowed to remain in a workhouse
unless the medical officer of the workhouse certifies in
writing—(a) that such person is a lunatic, with the grounds
for the opinion ; ( b) that he is a proper person to be detained
under care and treatment in a workhouse as a lunatic; (c) that
the accommodation in the workhouse is sufficient for his
proper care and treatment (2) A certificate under this sec¬
tion shall be in the Form 8.(3) A certificate under this

section shall be sufficient authority for detaining the lunatic
therein named against his will in the workhouse for fourteen
days from its date. (4) No lunatic shall be detained against
his will or allowed to remain in a workhouse for more than
fourteen days from the date of a certificate under this
section without an order under the hand of a justice of the
peace having jurisdiction in the place where the workhouse
is situate. (5) The order in the last preceding subsection
mentioned may be made upon the application of a relieving
officer of the union to which the workhouse belongs, sup¬
ported by a medical certificate in the Form 6 under the
band of a duly qualified medical practitioner, not being an
officer of the workhouse, and by the certificate under the
hand of the medical officer of the workhouse in the

Form 8.(6) The guardians of the union to which the

workhouse belongs shall pay such reasonable remuneration
as they think fit to the medical practitioner who, not being
an officer of the workhouse, examines a person fot the
purpose of a certificate under this section. The whole
of the above-quoted part of the clause simply refers

to harmless lunatics detained, and suitable for detention,
in the workhouse. On the other hand, if not suitable,
the 7th subsection goes on to say: “If in the case of any
alleged lunatic being in a workhouse, the medical officer
thereof shall not sign such certificate—i.e., not feel justified
in signing—as in this section mentioned, or if at or before
the expiration of fourteen days from the date of the certifi¬
cate an order is not made under the hand of a justice for the
detention of the lunatic in the workhouse the medical officer
of the workhouse shall forthwith give notice in writing
to the relieving officer of the union to which the workhouse
belongs, that a pauper in the workhouse is deemed to be a
lunatic, and a proper person to be sent to an asylum, and
thereupon the like proceedings shall be taken by the reliev¬
ing officer and all other persons for the purpose of removing
the lunatic to an asylum, and within the same time, as by
the Lunatic Asylums Act, 1853, provided in the case of a
pauper deemed to be a lunatic and a proper person to be
sent to an asylum. (8) If the medical officer of a workhouse
omits to give such notice to a relieving officer, as by the last
preceding subsection provided, he shall for each day or part
of a day after the nrst, and before the notice is given,
during which the alleged lunatic remains in the workhouse,
be liable to a penalty, not exceeding ten pounds.” The
italics throughout are mine.

In short, the meaning is this. Harmless lunatics may be
detained for fourteen days on the certificate of the medical
officer of the workhouse alone, provided he considers them
suitable cases and the accommodation sufficient; but not
longer, except with a magistrates’ order given on the certifi¬
cate of an independent medical practitioner in addition to
that of the medical officer of the workhouse. On the other
hand, if the medical officer of the workhouse believes that
the alleged lunatic is not a proper person, or that the work-
house accommodation is not sufficient, then he must go
through the same procedure as is enjoined by the old Act,
16 and 17 Viet., c. 97, and he will be paid according to the
provisions of that Act.

I am, Sirs, your obedient servant,

Charles Gross, M.D. Lond., F.R.C.S.Eng.,
Barrbter-at*law.

Elm-court, Temple, B.O., Feb. 28th, 1887.

To the Editors of The Lancet.

Sirs,— The Lunacy Acts Amendment Bill has passed
through the third reading of the House of Lords, and will
shortly be submitted to the House of Commons. 1 there¬
fore venture through your journal a few suggestions for the
consideration of the medical profession. The treatment of
lunatics is considered a specialty. It would benefit the
profession and the public at large if the study of lunacy
were more generally encouraged by appropriating certain
wards in all general hospitals for the treatment of lunatics.
According to a report in The Times on the second reading
of this Bill, the Lord Chancellor stated that “there are
4400 licensed houses in this country.” These numbers do
not tally with the Fortieth Report of the Commissioners in
Lunacy, Appendix N, which only shows ninety-six
licensed houses, provincial and metropolitan, including
private asylums. One of the objects of this Amendment
Bill is to get rid of the private licensed houses, and force
all patients into asylums. Putting entirely aside the
interest of the medical profession, I submit that it would
be detrimental to the community at large. In asylums,
the attendants number about one to ten patients. Bad
cases are consigned to padded rooms, a practice which too
much resembles solitary confinement—a punishment for
criminals. From a natural disinclination of charitably dis¬
posed persons to visit lunatics, the patients have no society
beyond other lunatics like themselves, and attendants, who
do not belong to a sufficiently educated class, therefore not
companions likely to benefit those of a higher degree.
Sufficient precautions are not adopted to prevent self-abuse,
though such practice is admitted by the profession to be
highly detrimental; and females are much neglected at
certain times. In private licensed houses each patient has
a separate attendant, and the combined aid of all the
establishment, if necessary. Padded rooms are not known;
recautions are taken to prevent self-abuse and dirty
abits, and the patients have the advantage of the society
and the constant supervision of the family. I would there¬
fore recommend that the number of private licensed houses.

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Tech Lancet,]

MEDICAL ASPECT OP THE EARTHQUAKE AT CANNES.

[MABQK6, 1867. ,485

to receive from three to six patients, should be considerably
increased.

It was lately published in The Times that there are over
30,000 female luuatic patients in the asylums. It is well
known how eaoly they are excited by the presence of the
opposite sex. Why not appoint lady visitors for the female
wards and private female patients in licensed houses, in
place of, as at present, the commissioners and magistrates,
all gentlemen, whose visits generally upset such patients.
Lady visitors would also better understand tbe habits and
requirements of their own sex. The power which the Com¬
missioners in Lunacy and Lord Chancellor’s visitors hare
for summarily removing patients from one house to another,
or from a house to an asylum, without a thorough investi¬
gation of the case, and against the will of the iriends and
relatives, should be abolished. The practice is much too
arbitrary for a free country in the present century.

I am, Sirs, your obedient servant,

Surbiton, March 1 st. 1 887. _R. CoLLUM, M.D.

winter station, in order to escape the frosts and fogs of
England and of Northern Europe.

But, as I write, everything has returned to its normal
state; the earthquake, although still the topic of the day, is
no longer dreaded by the still large number of remaining
visitors and residents of the place; a bright sun, a balmy
atmosphere, a blue sky, a calm sea, one and all now reward
those—and they are by far the majority—who did not give
way to unreasonable fears. The total absence of any damage
to property or of injury to individuals justifies our belief
that this lovely spot is indeed charmed. When sickness
hovered around us, as it did a year ago, Cannes escaped.
She has done so again, and, with neighbouring cities almost
in ruins, at the best severely shaken, Cannes still offers a
safe retreat to those who wish to avoid the bleak Mareh
winds of the north.

I am, Sirs, yours faithfully,

H. Blanc, M.D., F.R.C.P.,

Clone*, Feb. 23th, 1887._Physician at Cannes.

MEDICAL ASPECT OF THE EARTHQUAKE AT
CANNES.

To the Editors of The Lancet.

Sirs, —At a few minutes to 6 A.M. on the 23rd of February
I was startled in my sleep by a marked oscillatory move¬
ment having a S.E. to N.W. direction; a noise, faintly
comparable to a couple of trains passing under my house,
and the tremor with which my little villa was seized, told
my half-awakened senses that an earthquake had most
unexpectedly visited this peaceful land. 1 got downstairs
with some difficulty, the staircase rocking so much as to
bring to my mind the rolling of a vessel at sea, and I had
reached the garden before the" vibrations had ceased. The
first shock lasted forty seconds; it was followed by two
more, less intense and of shorter duration. The following
night three somewhat similar vibrations took place, the last
one only, Which occurred at about twenty minutes past five,
being of any intensity and duration. Since then there have
been a few mild movements, but so slight that they have
scarcely been felt by all. Fortunately for Cannes, these earth¬
quakes have done no material damage; apart from a few
superficial cracks in the ceilings here and there, a looking-
glass or two broken, and a few clocks which have stopped,
we have nothing to lament; no one was injured, and not a
single building has been damaged. 1 was, I must say, some¬
what surprised at this result, as the shock on tbe morning
of the 23rd was certainly a severe one, and much injury
was caused by it in the neighbouring towns of Nice and
Mentone. Cannes has come out unscathed from this ordeal,
owing mainly to tbe hotels, villas, &c., being well built,
solid constructions, able, as they have proved themselves,
to resist even a severe shaking; moreover, with but few
exceptions, the foundations of the buildings at Cannes rest
on rock, whilst at Nice and Mentone many have been
erected on alluvial soil or on reclaimed land; hence, probably,
the reason why tbe earthquake did us so little, if any, harm.

So much for the physical side of the question. As for the
moral one, it was simply disastrous. A regular panic seized
upon a very large number of tbe visitors, and at several of
the hotels, for forty-eight hours at least, scenes of the most
terrible dismay, especially during tbe night, occurred—not
to much among the sick and invalids, many of whom
teemed to have learned patience and resignation from
physical suffering, and did not give way to the morbid con¬
dition which prevailed extensively among their more
healthy and stronger companions. Many cases which 1
was ealled upon to see were, after tbe second night, in
tech a state of nervous depression or excitation, so dulled
w to irritable, so unable to think but of the terrible earth-

a not of the one they had felt, but of something more
still to come, unable to sleep, to eat, in fact men¬
tally and physically so ill, that no remedy, no persuasion
proved of any avail, and they were advised to leave the
place at once if they wished to avoid some more tangible
dtoaaa. Next to these, terror-stricken individuals, in some
oases the earthquake proved the occasional cause of sick-
*ws; age, lUeman. just recovering from an attack of gout,
^ha d-frtm his warm rook into tbe cold outside, and con-
JtaCtad e aavere attack of bronchitis; a lady, convalescent.
P okart iculayirilecmatisaa. from exposure suffered a sharp]
tatapsejLsad: neuralgia, colds,' sleeplessness, &C;, have been
™IF imifimii ... the defeats people who resort to this

TRANSPORT AND TREATMENT OF INFECTIOUS-
PATIENTS IN THE METROPOLIS.

To the Editors of The Lancet.

Sirs,— A letter from Sir Vincent Kennett-Barrington in>
The Times of Jan. 21st, under the above title, hardly met
with the support it deserved either there or in the medical
press. Coining from a member of the Metropolitan Asylume
Board, it seemed to me an invitation to the public in general
to apply for aid to that body in case of need. Acting on.
this view, I bod an opportunity last week of advising direct
application to Norfolk House for the removal of a servant
ill with scarlet fever from a house of business in a fashion¬
able part of the parish of St. George, Hanover-square. A
telegraphic request for ambulance and hospital accommoda¬
tion was seut off at 4 o’clock km., and a certificate by
messenger followed; by G o’clock the ambulance with a-
nurse arrived, and the patient was removed, with no further
delay than was needed to procure another certificate from
our dispensary resident medical officer. Dr. Percy Rendall.
Another time the certificate, very properly required by the
nurse, could be left in readiness with the patient. Very-
little time was lost in this case, as doctor and patient wore
only separated by the length of one street.. The occurrence
was notified to the medical officer of health. Dr. Cor field,,
and in a very short time tbe room the patient had occupied
was sulphured, the bedding being taken away to be stoved
and thoroughly disinfected, all without cost to the house¬
hold concerned.

I wish to contrast with this what happened a few days-
before near the dispensary, but in an opposite direction. A
young girl, living at home with her parents, was engaged to
assist by day in a large house near where a servant was
laid up, as was said, with cold and sore-throat; at the end
of a week the servant reappeared among the others for a
day or two until she left for the country as convalescent,
then this girl suddenly sickened, and was seen by me on the
second or third day, in consultation with Dr. Rendall, to
confirm his diagnosis of scarlet fever.

In the one case, a source of infection is not only at once
retaoved from among us, but its course in any other direc¬
tion prevented; in tbe other, we trust that the vigilance and
tact of our sanitary authorities may eventually, after much
care and trouble, succeed in averting further mischief, as
far ns our district is concerned. But what as to the neigh¬
bourhood where the convalescent goes, without any pre¬
caution taken, or even a word of warning given? This,
however uncertain, is indicative of one way in whibh
country epidemics follow any extension of scarlet fever in
London. Want of encouragement delays tbe Asylums
Board in providing for us the accommodation of a con¬
valescent home at Winchmore Hill, in addition to that of
perfectly appointed ambulances. The Times, in its faint
support of tbe letter above referred to, commends the
Board ambulance to anyone “ who is able to pay for these
conveniences.” Now.it is precisely to those who can pay
but little, or who cannot pay at all, that they are to be
commended. The charge is small; if the expense is not.
recovered at once, it is saved in the long run, or else all will
feel a little as ratepayers, what we know too Well as doctor*-,
that “ good is often done at a loss.” ■ '

I am, Sirs, your obedient servant.

OKJhak-it., W, Feb. Kth, 1887. WILLIAM SQUIBS, M.D.

Di

Googli

4#6 THB Lancbt,]

CANCER OP THE BODY OP THE UTERUS.

[March 6,18*7.

THE PRESENCE OF BLOOD IN THE
PERITONEUM.

To the Editors of Thb Lancbt.

Sibs,—M y sole object in replying to Mr. Lawson Tait’s
first letter was to remove a misapprehension under which
he seemed to labour as to the aim and object of my
experiments, and as to the conclusions which I had deduced
from them. It was neither my wish nor my intention
to enter upon any discussion with him on the subject
of peritoneal surgery. I am therefore somewhat at a loss
to conceive with what object Mr. Lawson Tait has again
recurred to the subject in your issue of Peb 19th. If it
was to expose my ignorance of the surgery and pathology
of the human peritoneum, his letter must be regarded as
somewhat premature, as 1 have not as yet expressed any
views on either subject, and the extent of my knowledge
must therefore be quite unknown to him.

A simple statement that the function of the heart in man
and in the dog is probably the same does not of necessity
imply absolute ignorance on one’s part of the pathology of
that organ in the case of man; and yet it is on precisely
similar grounds that Mr. Lawson Tait bases his charges of
ignorance against me in regard to the surgery and pathology
of the human peritoneum. If, on the other hand, his letter
was intended as a criticism of my paper on “Intraperi-
toneal Transfusion,” now in course of publication^ I can
only conclude that Mr. Lawson Tait has not even done me
the honour of reading the paper which he now proceeds to
criticise so adversely. If he bas done so, then I must venture
to protest, both on my own behalf and in the interests of all
fair discussion, against the misrepresentation to which he
has subjected the nature of my experiments—a misrepresen¬
tation whose completeness can only be fully appreciated by
those already acquainted with the subject of transfusion.
For, so far from having injected “ blood of various kinds
and from various sources, foreign and domestic,” into the
peritoneal cavity, I have expressly stated in my paper that
blood of only one kind, and from only one source, was used—
viz, that obtained from an animal of the same species as the
one operated upon, the behaviour of which, as is well
known, is in all respects similar to that of the animal’s own
blood; and, so far from “dogs and guinea-pigs” having
been employed for my purpose, no mention is even made
of guinea-pigs throughout the whole course of my paper,
and all my experiments, with some two exceptions, were
performed on rabbits.

I must confess my inability to see what useful object it
can possibly serve to continue a correspondence apparently
made up for the most part of explanations on the one side,
and personal charges of ignorance and misrepresentation of
facts on the other. I trust, therefore, I may be excused if
I decline to take any further part in it.

I am, Sirs, your obedient servant,
BdlnbQrgh, Peb. 33rd, 1887. WlLUAM HUNTER.

* # * This correspondence must now cease.— Ed. L.

CANCER OF THE BODY OF THE UTERUS.

To the Editors of Thb Lancbt.

Sirs, —l shall be glad to be allowed to make a few friendly
©omihents on Dr. John Williams’ interesting Harveian Lecture
on Cancer of the Uterus, reported in your issue of Feb. 12th.

Of cancer of the body of the uterus Dr. Williams says :

** This is a form of cancer which is much less common than
that of the cervix, and, indeed, it was at one time thought
that Cancer never attacked this part of the organ primarily.
It it certain that the disease occurs much more frequently
than it generally supposed." (The italics are my own.) We
have at the Middlesex Hospital unusual opportunities for
the stody of the pathological anatomy of cancer pf the
uterus, as there are on an average more than twenty
necropsies madd •annually on the subjects of this disease. I
have been in charge of the pathological department for the
last six yean, and have paid especial attention to the incir-
•dence of cancer on. the Ykriohe f«4taig*M,(tltfi.Jiterus. My
, -expeirisaceDlnadnwe fcnth* chaser

of the body of the utertuxdnst <^a& liSMmiety sffAo- '
tion, as I have mot met?vrithita>ripgMrexfimfpl p, of it in moite'
Add cabea. ■ My* 6 61 lea gu e # jfcr. Bid- < upland* wh£4

preceded me in office, and had an almost equally long expedi¬
ence, tells me that he can only recall one undoubted case of
primary cancer of the body or the uterus.

I have met with several cases of malignant disease infil¬
trating the fundus uteri, but in all it originated in some
neighbouring organ or growth, and affected the uterus
secondarily. In three such cases the site of the primary
growth was a fibro-myoma of the uterus, and in one of these
the new growth was a myxo-sarcoma. Dr. Williams de¬
scribes three out of twelve cases which he bas met with,
which were believed to be examples of malignant disease of
the body of the uterus; in the other nine no microscopical
examination of the growth was made. I confess that these
cases do not appear to me to be beyond doubt. 'With regard,
to Case 22, that of a patient who died in the Middlesex
Hospital under the care of Mr. Henry Morris, and on whom
I made a post-mortem examination, my recollection (and
description in the Pathological Report of the hospital) does
not quite agree with the account given by Dr. Williams, as
I believe the disease originated in the fibroid tumour and
spread thence to the body of the uterus.

I have met with a case very similar to the one described
as Case 20, in which there was a communication between
the uterus and intestine sufficiently large to admit the
thumb. In that case it seemed clear that the disease had
spread from the intestine to the uterus, and not vice vertd.
May it have been so in Dr. Williams’ case? Whilst, then,
I think that they are wrong who hold that cancer never
affects the body of the uterus, yet I believe that view to be
nearer to the truth than that “ it occurs there much more
frequently than is generally supposed.”

I am, Sirs, yours faithfully,

Clarges-street, Feb. 15th. 1887. J. KlNG8TON FOWLER, M.D.

THE CHILDREN’S HOSPITAL, MANCHESTER.

To the Editors of Thb Lancbt.

Sirs, —Your Manchester correspondent, in a letter pub¬
lished in your issue of Feb. 26th, refers to some allegations
which have been made in reference to the reception of
infectious cases into the fever ward of the Children’s- Hos¬
pital in this city, it being insinuated that outbreaks of fever
frequently occur in the general wards; and, moreover, that
children admitted for one infectious disease contract another
during their Btay. He further says that this has not been
denied. As these statements as they stand are hardly fair
to the authorities of the-Children’s Hospital, may I ask
you for space for a few lines in order to pat the facts
before your readers ? The allegations to which yonr cor¬
respondent refers appeared in some letter to the public pre68,
written in anything but a friendly spirit towards the hos-

f ital by a critic who had not the courage to sign his name,
t can hardly be surprising if under these circumstances the
hospital authorities declined to discuss the subject with
him in the public press. But I must confess that I ex¬
pected better things of your correspondent, who, if he had
consulted the yearly volume of abstracts of medical and
surgical cases, & 0 ., published annually by the hospital, for
the last five years, which gives all details of the cases, post¬
mortems, infectious disease arising in the hospital, &c^ he
would have seen many of the allegations referred to had no
foundation in fact, at any rate at the present time. We
have undoubtedly a fever ward, which is used solely for the
admission of scarlet fever cases, no other cases of infections
disease having been admitted to the ward for at least five
years, though during this period there have been several
outbreaks of measles and chicken-pox, which have been due
to the admission of cases admitted with scarlet fever who
were inenbating measles or chicken-pox at the time of
their admission. I need hardly Say that no amount of
care on the part of the medical officers can obviate this.
With regard to the general wards we have had csMs of
Scarlet fever arising from time to time in - them, but the
number of these, taking the five years 1881-5 (<oide abstrahts),
amounts to less than 1 per cent, of the admissions to the

K er&l wards during this period, and in many of these oases
infection was clearly traced to cases admitted incubating
scarlet fever; while in the others no definiteBonrcfe^infec¬
tion could be ascertained. J would aakvCan other Afldran’s
hospitals where no scarlet fever is admitted shin? shatter
record? Or can fever hospitals where eeartetievwv^ery¬
sipelas, typhus, small-pox, &c,, are rhCetredahowsbettsfOMe?

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ThhLaiccbt,]

BIRMINGHAM.—LIVERPOOL.

[March 5,1887. 497

Your correspondent very properly asks “ that the serious
attention of the management should be directed,” &c., to this
important question, f am happy to be able to assure him
that for many years past the most serious attention of both
the medical officers and board of governors of the hospital
has been given to this question, that all cases of infectious
disease arising in the general wards have been reported to
the medical board, and by them to the general board, with
the object of tracing the source of all such cases of infec¬
tion, and of adopting the most stringent means to prevent the
introduction of each disease from without or its transference
from within.

I have no reason whatever to complain of the tone of
your correspondent’s letter as regards this question, but
surely he can hardly expect the authorities of the Children’s
Hospital to waste their time over anonymous critics in the
Manchester papers who take no pains to make themselves
acquainted with the facts of the case.

1 am, Sirs, yours truly,

Maaohwter, March l»fc, 1887. LLeNRY ASHBY.

“GENERAL HOSPITALS AND PARISH
INFIRMARIES.”

To the Editors of The Lanobt.

Bibs,—I was pleased to see in your issue of Feb. 12th the
boldness with which Dr. Goodhart has advocated a closer
connexion between general hospitals and parochial in¬
firmaries, as I believe that it is in this direction we must
look for a satisfactory and permanent solution of the diffi¬
cult problems connected with hospital finance and manage¬
ment. Within less than a mile of the house in which I am
writing are three large parochial infirmaries, with an aggre¬
gate accommodation for not less than 1200 patients, and
probably many more; the professional staff is represented by
a total of three chief and three assistant resident medical
officers. Compare with this the three nearest general hos¬
pitals, with an aggregate accommodation for 144, and a total
staff of seventeen, of whom five are resident and twelve
honorary. In neither case have I included officers whose
duties are connected with out-patient work, and to none of
the general hospitals mentioned is a school attached. It
is obvious, therefore, that in the case of the infirmaries
there must be an immense waste of clinical and patho¬
logical material. Even admitting the chronic nature of the
majority of tbe cases treated in the infirmaries, I believe
that Dr. Goodhart will agree that many valuable lessons
V® to be learnt from the study of even these, while
there can be no doubt that many cases whose ending
it would be of much interest to note, after going the
round of the general hospitals, sink into oblivion within
the walls of one or other parish infirmary. Curiously
enough, an instance of this has just come under my own
observation in the case of a man to whom I was called some
few days back; he was suffering from some obscure cerebral
mischief, and I urgently advised his friends to take him to
the hospital, of which he was an inmate some two years
*8°. He Was taken, instead, to tbe parish infirmary, and I
have just been informed is now in artieulo mortis.

I trust that the ventilation of this subject in your columns
lead to the promulgation of some definite scheme for
bringing into touch the parochial infirmaries, the general
hospitals, and the medical schools throughout the metropolis.
I am, Sirs, yours obediently,

?eb. 1887. J. Frbdk. W. Silk.

BIRMINGHAM.

(From our own Correspondent.)

PROPOSED MIDLAND UNIVERSITY.

A papbr read by the Rev. Dr. Crosskey on this subject at
a recent meeting of the Philosophical Society elicited an
animated and useful discussion. As the medical element is
largely involved in all university teaching in the present
a claim was put forward by Professor Haycroft, of
Mason College, for an extension of facilities for obtaining
degrees in a midland centre. It w*a shown, however, that
it would be impracticable and undesirable to establish a

midland university for a long time to come, and the’argu-
ments against it from a financial point of view were thought
to be insuperable in the existing state of difficulty in ob¬
taining the necessary funds. The arrangements for medical
teaching at tbe Birmingham School were pointed out as
having been vastly improved, and the association with
Mason College established a federation which afforded ex¬
cellent ground for preparation to any of the examining
bodies.

THE JAFFRAY SUBURBAN HOSPITAL.

Tbe inmates of this admirable branch of the general
hospital were lately gratified by a visit from Madame Marie
Roze, whose kindness and sympathy won golden opinions.
With characteristic geniality, she charmed them by singing
some well-known songs. She left an impression which
will long be remembered, as much by the rare vocal powers
of the gifted artiste as by the graceful and kindly manner
in which she exhibited her attention-to the suffering patients
in the various wards she visited on the occasion.

INSTITUTION FOR TRAINING NURSB8.

Birmingham possesses an exceptionally well-managed and
thriving institution for this purpose. The report shows that
there are ninety-four nurses, and that the transactions of
the year had been carried out with efficiency and success.
The statement of accounts at the annual meeting showed
that the total income for, the year bad been £3223 17*., and
the total expenditure £2981 5s. 5d., giving a balance of
income over expenditure of £244 11*. Id. From this sum
bad to be deducted a transfer to the sinking-fund for the
provision for new premises of £100, a condition of tliing3
which must be regarded as satisfactory and promising well
for the future.

BIRMINGHAM AND MIDLAND COUNTIES SANATORIUM.

Another useful institution, of which the twenty-first
annual meeting was held on Feb. 24th, also showed that its
place was well maintained in the estimation of the public.
In the year 1886 as many as 1016 patients were admitted,
the woekly cost of each bed being as low as G«. 4 \d. The
absence of complaints and the gratitude of the patients were
marked features in the report, while the financial position
was shown to be sound. As a valuable aid to convalescence
this institution is well worthy of support.

Birmingham, March 2nd.

LIVERPOOL.

(From our own Correspondent.)

THE ASSIZES.

The winter assizes for the south-west division of Lanca-
shirefconcluded on the 24th ult., having lasted all but three
weeks. Among other cases of medico-legal interest was
one from Southport, in which a youth of sixteen was
charged with shooting a girl. The bullet entered tho
girl’s heart, and she died soon afterwards. The charge of
murder was withdrawn, and the prisoner found guilty
of manslaughter. Tbe Oldham poisoning case, Which
lasted four days, is the third case of the kind which
has been tried in this county within the last three
years. The case of the women Flannigan and Higgins, which
was the first, was a series of wholesale poisdnings, the
first-named prisoner acknowledging that she had assisted
in poisoning eleven persons. The second case, fbat of the
woman Britland, tried in Manchester last summer, showed
that three victims bad succumbed to poison administered
by her. And in this most recent case, since tbe prisoner was
sentenced to death for the murder of her child, a coroner’s
iury has returned a verdict of wilful murder against her,
her mother having died more than a year ago with symptoms
of poisoning by atropia. These repeated murders have
been much commented on by the daily press, and are Calcu¬
lated to create a very uneasy feeling among the public. It
is to be hoped-that as time advances it will be found easier
to detect the very first symptoms of poisoning, to save the
intended victims, and to bring their would-be murderers to
justice. This will impress the public more fayourably
than the conviction of prisoners only after, a series of
murders.

Digitized by CjOOgIc

498 The Lancet,]

•EDINBURGH.—DUBLIN'.

[March 6,1887.

THB NETHBRFIRLD-ROAD FEVER HOSPITAL.

Dr. Robertson, visiting physician to the Liverpool pariah
infirmary, has been selected by the Hospitals Committee for
the office of visitiDg physician to the Hospital for Infec¬
tious Diseases recently acquired by the city corporation.
Dr. Robertson has had considerable experience in the treat¬
ment of these cases, and the selection is a wise one.

Liverpool, March 2nd.

EDINBURGH.

(From our aum Correspondent)

THB 8CABLBT FEVER EPIDEMIC.

Dobing the past week the epidemic has steadily declined
in its intensity, and the state of extraordinary pressure at
the City Fever Hospital has greatly abated. Although all
parts of the city have been affected, the outbreak has been
much more severe in the northern and western districts
than elsewhere; the epidemic has thus avoided the most
crowded districts, and has been worst in the more open and
the more opulent quarter. During February 41 deaths have
occurred from the disease out of the 697 cases intimated to
the city authorities during that time.

THE ARCHITECT AND HEALTH.

Dr. J. A. Russell, F.R.C.S.E., one of the bailies of the city,
lectured on this subject last week before the Edinburgh
Architectural Association. In describing the status of the
architects in the community, he pointed out that theirs
was the only profession for which no academic or official
form of training was demanded beyond a mere system of
apprenticeship. He advocated a system by which they
should become thoroughly acquainted with the most recent
advances of natural philosophy and with the laws of health
in relation to light, heat, ventilation, and drainage. So
qualified, he would be ready to see extended to them a
monopoly comparable to that enjoyed by Law and Medicine,
and with similar powers to suppress irregular practice.
Referring to the improved death-rate in children of school
age, he nad little doubt that it was largely due to the
efforts of Board school architects who have provided for
the children surroundings better than those of their own
homes. In discussing tne ventilation of Board schools,
he spoke of a mechanical system as that likely to be ulti¬
mately adopted, since with the cubic space authorised by
the Education Department it was all but impossible to
obtain complete ventilation by natural methods. In con¬
nexion with this question, Bailie Russell is at present en¬
gaged in a research into the atmospheric condition of public
buildings of various descriptions throughout the city. The
Town Council have authorised a special grant for the pur¬
pose, and the experiments are to be carried out in the
Public Health Laboratory at the University by Dr. Hunter
■Stewart and Dr. Cosmo Burton.

8ANITABY PROTECTION ASSOCIATION.

The annual meeting of the Association was held last week
under the presidency of Professor Sir Douglas Maclagan.
The annual report shows that the work of the Association
has been largely augmented, and that an increased number
of the citizens have availed themselves of its services. The
officers of the Association are to furnish plans for buildings
arranged to ensure perfect sanitation; to inspect dwelling-
houses, and report on their sanitary state; to supply recom¬
mendations and estimates for remedial measures, and to
carry out alterations. Transactions to the extent of between
.£2000 and .£3000 have been carried on by the Association in
the last twelve months. The chairman, in moving the adop¬
tion of the report, commented on its favourable nature, and
stated that they were not a body striving to obtain di vidends,
but that their sole object was to carry on an important public
sanitary work.

SCIENTIFIC RESEARCH IN EDINBURGH.

The Royal College of Physicians has now perfected the
scheme for instituting a research laboratory in Edinburgh.
There is a general consensus of opinion that this arrange¬
ment will be fraught with great good to the Edinburgh
school. The new laboratory, which will be amply fitted
with apparatus and all requirements for original work, is to

be placed under the care of a well-qualified scientific man
and an assistant, and is to be open on an easy arrangement
to all would-be workers. This arrangement will bring the
opportunity of doing useful work within the reach of many
ot our younger practitioners who have time to engage in it,
but who have till now been debarred from research by the
exorbitant tariffs of the University laboratories. The
College could not have found a better means of employing
usefully a portion of its great wealth.

Edinburgh, March l«t.

DUBLIN.

(From our own Correspondent.)

ROYAL COLLEGE OF SURGEONS.

The Council have agreed upon a scheme for the granting
of a diploma in Public Health, and have submitted the same
to the Medical Council for approval. The fee is fixed at
seven guineas, and the examination will be a very strict
one. The conjoint scheme will be discussed by the Council
this week on a motion by Dr. Kidd. Sir Charles Cameron’s
suggestion for a dual scheme will also be under consideration.

ROYAL MEDICAL BENEVOLENT FUND SOCIETY OF
IRELAND.

At a quarterly meeting of the Central Committee held
last week, the following resolution was adopted: “That
the Central Committee of the Royal Medical Benevolent
Fund Society of Ireland have learned with much regret of
the lamented deaths of Dr. Purdon of Belfast, late local
honorary secretary, and of Dr. John Denham, Dr. H. Kennedy,
and Dr. E. G. Brunker, members of the Central Committee ;
and at this their first meeting since their deaths, desire to
express their sense of the loss they have sustained, and
their sympathy with the respective families in their bereave¬
ment.”

CITY OF DUBLIN HOSPITAL.

Last week Mr. H. Gray Croly operated for varicose veins,
and removed several inches of the internal saphenous vein
in the right thigh and leg. The patient, a female, three
weeks since had been operated upon by him in a similar
manner on the left lower extremity, and the wounds
had quite healed. Mr. Croly uses a drainage-tube, but
removes it after a couple of days, as he considers it has a
teudency after that to act as a foreign body. He afterwards
fired an enlarged knee-joint by the thermo-cautery in the
case of a boy with a strumous history. This was followed
by an operation for eequestrotomy by Mr. Henry Fitzgibbon
for necrosis of the left ulna, occurring as the result of acute

e eriostitis. A couple of weeks previously Mr. Fitzgibbon
ad removed several inches of the humerus of the right side
in this patient, arising from the same cause. A large seques¬
trum, fully four inches long, was removed. Esmarch's
bandage was used, and very much facilitated the operatior.

FBVEB IN CORK.

The medical officers of the Cork Fever Hospital for the
past year state that the increase in the number of admissions,
as compared with the previous year,was due to an epidemic of
typhoid fever which prevailed in the city during the autumn
and winter months. They are glad, however, to be able to note
a sensible diminution in the recordsof the fevers of the present
day, as compared with those of years gone by. They hope
that there will be a compulsory system of legislation enacted,
to be enforced in those places where the sick are lying in
their homes of dangerous infectious disease, and that the
inmates will not be allowed to walk abroad, sell their mer¬
chandise, or associate with their fellow-beings, until such
time as they are free from the danger of propagating
disease. A good deal has been done, but a great deal more
requires to be done before Cork can be called the “ Modern
Hygeia,” which they consider it is j ustly entitled to by reason
of its situation. Better swimming-baths are required for
the public; a better system of drainage, and a water-supply
so arranged as to effect a simultaneous flushing of all the
drains of the city when the tide ie out. In order to ensure
a better water-supply for the city, the medical staff strongly
urge on the corporation, as the urban sanitary authority, tne
necessity of keeping strict supervision over the river Lee
and its tributaries, so as to prevent the possibility of the
water-supply being polluted along its course.

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The Lancet,]

BURMAH.—MEDICAL NOTES IN PARLIAMENT.

[March 5,1887. 499

MUSCULAR ANOMALY.

I bad an opportunity of examining last week, in the dis¬
secting room of the Ladwich School of Medicine, an example
of the biceps flexor cruris arising by three heads. The extra
head came off below, and outside the insertion of the coraco-
brachialis, that muscle, slightly overlapping it at its inser¬
tion. The third head passed down and was inserted into
the tendon of the biceps at its posterior aspect. I described
a somewhat similar biceps a couple of weeks since, with this
difference that the third head was inserted about the middle
of the muscle posteriorly. Both these specimens were in
females, and on the left side.

DROGHEDA UNION.

Drs. O'Keeffe, Delahoyde, and Callan are proceeding against
the guardians of this union for fees due to them under the
Labourers Act. The guardians have refused their medical
officers a fair remuneration, but last week, without hesita¬
tion, gave a cheque for £120 to their solicitor in order to
defend the action against the board.

It is intended to present Dr. B. Kennedy, resident surgeon
to Mercer’s Hospital, with an address and testimonial, as a
mark of sympathy with him in the recent prosecution at
the police-court, in which he was honourably acquitted.

Dublin, Mtw; h 1st.

BU11MAU.

A correspondent at Burmah favours us with the follow¬
ing notes

DEATHS OP 8URG. E. W. KELSALL AND DR J. PEDLOW.

The Official Bulletin of Dec. 7th, 1886, Burmah Field Force,
published at Mandalay, says:—“Yemethin, Dec. 6th, 1886.
8urgeon Kelsall, Medical Staff, died of cholera this morning.”
Mr. Kelsall’s commission dated March 31st, 1875. He was
bom on August 9th, 1851. . He served in the Afghan war,
1879 to 1880: defence of Candahar. Mentioned in despatches,
London Gazette of Dec. 3rd, 1880; medal. Also in the
Egyptian Expedition of 1882: action at Kassassin; battle of
Tel-el-Kebir. Mentioned in despatches; medal, with clasp
and bronze star. Mr. Kelsall leaves a wife and family to
mourn their loss. He is the second member of the Army
Medical Staff who has recently died of cholera in the
Burmah Field Force.

Dr. James Pedlow, surgeon. Army Medical Staff, bom
Oct 16tb, 1851, died of cholera on Oct. 21st, 1886, on the
ss. Rangoon, while on his way up the Irrawaddy in charge
of two sections of a field hospital ordered to Bhamo.

PERILS OP “NON-COMBATANTS” ON THE FIELD.

8urgeon John MacGregor, M.D., of the Bombay Medical
Service, has again had a pony killed in action ; this time in
the Shan Hills (Nov. 1886). In April last, when in medical
charge of the expedition against the Ponkan Rachin Saubwa,
his pony was shot dead while he was dismounted and
dressing a severe gunshot wound of the knee-joint. Dr.
MacGregor was for many months senior medical officer of
Bhamo, and the first civil surgeon at that place. He was
very successful in the operations he performed after the
engagement with the Rachins and other marauders.

The following medical officers are in charge of British
field hospitals:—No. 4 Field Hospital: Surgeon-Major A.
Minto, M.B., AM.S. No. 5: Surgeon-Major R. de la Cour
Corbett, A.M.S. No. 16: Surgeon-Major William Venour,
AM.S. No. 17: Surgeon-Major T. W. Patterson, A.M.S.
Surgeon-Major R. Vacy Ash, M.B., has been appointed
Assistant to the Principal Medical Officer, Burman Field
Force. Surgeon W. A. Morris, A.M.S., has been appointed
to the charge of the Ambulance Corps followers. Surgeon
M. Q’C. Drury has been appointed to the Charge of the C
*od D Sections, No. 16 Field Hospital at Katha. Surgeon F.
H. M. Burton has been transferred from the Charge of the
B Section, No. 6 Field Hospital at Bhamo, to that of the
B Section, No. 17 Field Hospital at Bhamo.

Bormth, Jan. 1887.

T&e Humber of in-patients admitted to the Sussex
County Hospital during last year was 1247, which added
to 147 remaining on the books at the end of 1885, makes
the total number treated 1394.

THB SERVICES.

Deputy Surgeon-General R. A. Chappie, recently Principal
Medical Officer of the Northern District, has arrived in India
for duty in the Bombay Presidency.

On the 26th ult. the remains of Brigade Surgeon John
Henry Hunt, Medical Staff, were interred in the Aldershot
Military Cemetery, with the full military honours to the-
rank of a lieutenant-colonel, which relative rank the deceased
held.

War Office. —Army Medical Staff: Surgeon-Major Jamea
Hector, M.B., is granted retired pay, with the honorary rank
of Brigade Surgeon.

Artillery Volunteers. — ^rd Middlesex: Robert S.
Fancourt Barnes, M.D., to be Acting Surgeon.

Rifle Volunteers.— 1st Fifeshire; Lieutenant Charles
Edward Douglas, M.D., to be Acting Surgeon.—5th (Isle of
Wight, Princess Beatrice’s) Volunteer Battalion, the Hamp¬
shire Regiment: George Arthur Barr, Gent., to be Acting
Surgeon.—5th Lancashire (the Liverpool Rifle Volunteer
Brigade): Charles John Macalister, M.B., to be Acting Sur-
eon.—2nd Oxfordshire: Acting Surgeon G. 0. Willis resigns
is appointment.

Volunteer Medical Staff Corps.— William Colling-
ridge, M.D., Medical Officer of Health for the Port of London,
has been gazetted Surgeon to the Volunteer Medical Staff
Corps, and appointed Acting Adjutant to the 3rd (Woolwich)
division.

MEDICAL NOTES IN PARLIAMENT.

Alleged, Insanitary Barracks.

In the House of Lords, on the 25th ult., in reply to Lord
Ormonde, who was supported by Lord Ellenborough, Lord
Harris said that he had himself examined the half-yearly
reports of the principal medical officer of the Home District
made in October and February last, from which it appeared
that the drainage at the barracks at Hyde Park was in good
sanitary condition. He had also examined the quarterly
regimental reports of the regimental officer in charge, and
the weekly reports of the same officer for the last seven
weeks, and all those reports agreed that the sanitary condi¬
tion of the drainage in the officers’ quarters was good. In
June last a very important improvement was carried out in
the officers’ quarters, when the soil-pipes were put on to
the exterior of the wall.

Sandhurst and Woolwich Academies.

On the 28th ult., in reply to the Earl of Strafford, Lord
Harris stated that the recommendations of the Board of
which the noble lord was chairman were considered so im¬
portant by the First Lord of the Treasury, the War Office,
and by the Secretary of State, that they had endeavoured
as largely and rapidly as possible to carry out the changes
recommended in their report; but he was sorry to say they
had not been able to carry out the changes in such a way as
the report suggested. The difficulty of finding sufficient
sleeping accommodation for the number of cadets at Wool¬
wich was one of funds. An arrangement was in con¬
templation for reducing the length or the course, by which
the number of cidets at one time would be reduced, thereby
increasing the accommodation for those who were there.
The room at the Herbert Hoppital which the Board sug¬
gested should be fitted up for the reception of cases of
infectious diseases was, he regretted to say, not available at
present, but as soon as possible the matter would be dealt
with. With regard to Sandhurst, nearly all the recom¬
mendations had been carried out. The recommendations
•with regard to Woolwich would be carried out by the War
Department as rapidly as circumstances permitted.

Lunacy Acts Amendment Bill.

On the 1st inst. the House resumed the consideration in
committee of the Lunacy Acts Amendment Bill. In
Clause 3—which as it. stood when the Bill was first in com¬
mittee met with strong objection by Lord Selborne and
Lord HerMhell—the Lord Chancellor introduced an amend-

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500 • Thk Lakoht,]

MEDICAL NOTES IN PARLIAMENT.—MEDICAL NEWS.

[March 6,1887.

merit, having for its object to simplify and render more
speedy magisterial investigation in lunacy cases. The
amendment was agreed to, and the Bill passed through
committee.

The Pollution of the Upper Thame*.

In the House of Commons, on the 24th ult., Mr. Ritchie, in
reply to Colonel Dawnay, stated that the Thames Con*
eervttncy Board had prepared a series of bye-laws in regard
to the pollution of the waters of the Upper Thames by
means of sewage from house-boat* and steamers with a view
to their being submitted to Her Majesty in Council.

The Status of Army Medical Officers.

On the 28th ult., Major R&sch asked the Secretary of
State for War what would regulate the status of army
medical officers on boaftl ship or for choice of quarters,
their relative rank having been abolished.—Mr. Stanhope,
in reply, reminded Major Rasch that relative rank was
neither actual nor titular rank, but only a classification for
precedence, allowances, and widows’ pensions. As relative
rank servfed no useful purpose, it had, he stated, been
abolished; but the classification which it represented re¬
mains and still regulates all such matters as those referred
to in the question.

On Thursday, Sir Guyer Hunter asked the Secretary df
State for War whether, since relative' rank of the medical
officers of the army had been abolished, what rank, if any,
tbev now have in the army?—The Secretary for War, in
reply, said: A medical officer holds the rank in the army
which his commission confers upon him, and under Article
125« of the Royal Warrant it is provided that for purposes
of precedence, allowances, and widows’ pension, medical
officers shall rank with combatant officers as there laid
down. As a matter of fact, the abolition of the term
“ relat ve rank ” has not altered the position of medical
officers in any respect whatever.

Small-pox Statistics.

In reply to Mr. Barran, Mr. Ritchie said that he had com¬
municated with the Registrar-General, and had been in¬
formed that practically there has been no epidemic small¬
pox worth mentioning in any of the 19 great provincial
towns dealt with in the Registrar-General’s reports in the !
last ten years. Only one small-pox death was registered in 1
that period in Leicester itself, but ten more were regis-
tered in the Leicester Borough Hospital outside the town.
This gives an annual rate of 9 in 1,000,000 living—a rate,
however, which, small as it is, was nevertheless higher than
the rates at Portsmouth, Norwich, Plymouth, Bristol, and
Bradford. The last calculated rate for the registration
district of Keighley is for the ten years 1871-80, as given in
the last decennial supplement. The annual rate in the
district in that decennium was 270 per 1,000,000 living, and
‘higher than in 25 out of the 32 remaining districts in the
West Riding; higher also than in either Hull, Bristol,
Manchester, Leeds, Oldham, Bradford, or Brighton.

Alleged Wrongful Confinement in a Lunatic Asylum.

In reply to Mr. W. Corbet, who asked the Home Secretary
the result of the inquiries promised into the confinement in
a lunatic asylum for seven years of a female alleged to be
of sound mind, and whose case was recently under the
notice of the Board of Guardians of Paddington Union,
Mr. Stuart-Wortley said that he had made inquiry and
ascertained that the woman referred to in the question was
not an inmate of a county asylum, but of the asylum at
Darenth belonging to the managers of the Metropolitan
Asylums Board. The President of the Local Government
Board has accordingly taken up the matter, and is making
inquiries as to the case.

Brampton Cemetery.

In reply to Air. Baggallay, Mr. Plunket stated that
Brompton Cemetery contains in all 38 acres and 20 perches.
There now remain available for future graves 4 acres and
34 perches. Since the first burial in Brompton Cemetery in
1840 up to Feb. 26th last there have talcen place 135,617
burials. The average number of burials in the last three
years was in round numbers 5000. The graves are of different
depths, and the coffins are placed in the ground subject to
restrictions laid down by the Home Office. No limit can,
unless by Act of Parliament, be fixed to the number of in¬
terments, except that each year there is less space available

for the purpose. The Government does derive a profit
(which was last year £7070) from the cemetery.

Supplementary Civil Service Estimate*.

The House having gone into Committee of Supply, on the
supplementary vote of £1800 for the Local Government
Board, Colonel Nolan desired further information on the
subject of the inspections of local sanitary areas, which had
been undertaken by the Local Government Board.—Mr.
Ritchie said that in 1885, it having become apparent that
there was considerable danger of an outbreak of cholera in
this country, it had been proposed by the Local Government
Board that inspections which had been made in the pre¬
vious year at seaports should be extended to inland towns.
The Treasury had assented to the employment of five extra
inspectors for the purpose of inspecting the sanitary areas
throughout the country. The result had been in every' way
satisfactory, and fraught with advantages of a permanently
beneficial character.—Mr.T.IIealy complained thatin Ireland
all such expenses came out of their own pockets.—Mr.
Esslemont urged the claims of those Scotch ports which had
taken precautions to prevent disease coming in.—After a
lengthy discussion, Sir M. Hicks-Beach undertook to
inquire into the matter, and if it were found that Irish
boards of guardians had incurred extra expenses of the
nature covered by this vote, he would urge on the Treasury
that a similar vote should be brought forward to recoup
the Irish boards of guardians.—Mr. E. Russell asked for a
similar assurance in regard to Scotland.—Mr. A. J. Balfour
said he would give an undertaking that he would do his
best to secure that such expenses be thrown on Imperial
funds.—The vote was then agreed to.

Vaccination.

On the 1st inst., in reply to Air. T. Robinson, Mr. Ritchie
said that the Government could not consent to having the
subject of vaccination inquired into, either by a Royal
Commission or a Committee of the House. With regard to
repeated prosecutions for evasion of the Vaccination Act,
the views of the Local Government Board were, he remarked,
well known. They were set forth in a letter to the Board
of Guardians of the Evesham Union, which was presented to
Parliament. He could not hold out any hope of legislation
with the view of preventing the imposition of cumulative
penalties. _

HUbiral lUtos.

University of Cambridge.— At a congregation held
on Feb. 24th, the following degrees were conferred:—
BiCHBLOR of Mkdicixb.—R oger Alan Bird wood. Petsrhooae; William
Heaton Hamer, Christ's ; Eaward Lawrence Fox. Cavendish Hostel.
Bachelor of Sl'RGKRT.—G dward Lawrence Fox, Cavendish HosteL

College or Physicians in Ireland.— At the
February examinations the following obtained licence* in
Medicine and Midwifery of the College:—

Mbdicittk.—J ames Butler, James Davis Egan. Thomas McCraith
Foley, James 8. Freeborn. Thomas Morton Frood, William Richard
George Hamilton, Vincent Naah.

Midwifkht.—J ames Davis Egan, Vincent Nash, Edward Franch
, O'Snllivan.

The undernamed have been admitted Members:—

Patrick Thomas Lyster. | Ralph Stone.

Barnsn Medical Service.—T he following is a list
of candidates who were successful for appointments as
Surgeons in the Medical Staff of H.M. Army at the competi¬
tive examination in London on Feb. 14th and following days:

Marks. Marks.

Smith, H. E. H.

3190

Alexander, G. F.

3290

Gore-Graham, W. P.

3210

Woods, B. M.

3185

8pong, C. 8.

3140

Leishman, W. B.

3125

Bawusley, G. T.

3060

Thomson, J.

3010

Reilly, C. W.

2990

Crofton, W. J.

2895

Wright, A.

2880

Luther, A. J.

23M)

Girvin, J .

2820

Indian Medical Servi

Paterson, J.

... 2815

Trask. J. B.

... 2800

Forbee, N. H.

... 2785

Freeman, B. O....

... 2755

Davoren, V. H. W_

... 2730

Copeland. B. J.

... 2720

Blenklnsop, A. P. ...

... 2870

Borrodalle, A, L. ...

... 36*0

Halloran, W. ... ...

... 2640

Btrt, T. ...

... 2*30

Peeke. H. S.

... 3630

Smyth, B. H..

... 2630

—The following is a list

of candidates for appointments in this Service who were
successful at the competitive examination recently held at

Digits

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¥hb Lancet,]

MEDICAL NEWS.

[March 5,1887. 501

Burlington House. Of the 73 candidates who competed
for 23 appointments, 70 were reported qualified:—

Mark*. Marks.

Merer, C. H. T, . 8435 Fisher, L. 0 . 2996

Billot, W. H. W. auo Buchanan. A. 2970

Childa, L. F. 3330 Manifold, C. C. ... 290*

Clark. W. K.. ... 3290 Jacob. A. H . 2900

Bralde, ». F. W. . 3270 Garvle. .1. 2890

Murray, J . 3230 Jollifl*. A. K. ... 2880

Hallev. P. O. W. 31«0 j Crawford, F. J.. M.D. ... 2770

Marks, If- J. ... . 3150 j McKvoy, W. G. 2760 V

Ker, M. A.... J ... ..'. '311)6 • ’ Maclead; H W. G. 2760 f

Barry, T. D. C.._ . 3010) Robertson, R. 2750

Gilbert. C. B. L. 3010 V Irvine, G. B. 27301

Vost. W. . 30*0j I Moore. T. C. 2730 f

Herbert, H. 8030 ( Karney, W. H. 2720 \

Sander, O.E. 3000 ! Simpson, D. ... 27201

Society or Apothecaries.—T he following gentle^
men passed the examination'in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificate^
to practise on the 24th ult.

Carver, Arthur Richard; Wenallb, Carmarthenshire.

Obllng, Arnold Bbeoezer, Lancaster Villas, Brighton.

The jbalds, Owen Le Marc, Bast Looe, Cornwall.

A donation of £5000 has boon received, by the
commutee.of the Worcester Infirmary from an anonymous
donor.

A concert, which proved highly Successful, was
given on the 28r.h ult. by the Children’s Orchestra on behalf
of the Victoria Hospital for Sick Children.

A public meeting in aid of the funds of the East
London Hospital for Children, Shadwell, is to be held in
the Egyptian Hall of the Mansion House to-day (Friday),
the Lord Mayor presiding. •

A dramatic performance, under distinguished

S itronage, in furtherance of the- appeal on behalf of Guy>
ospital, will be given at the Novelty Theatre on the
21st prox.

The first annual meeting of the members of the
Medical Defence Union was 'held on the 23rd ult., when the
report for the past twelve months was read. Mr. Lawson
Tait waa elected president for the current, year. _ ,

City Dispensary. —The Lord Mayor presided at
the ninety-eighth annual festival in connexion with this
institution on the 24th ult. Daring the evening subscrip¬
tions amounting to nearly £400 were annoubced by the
treasurer.

At a recent meeting of the Buildings Committee
of the Tynemouth Infirmary it was decided to erbct a new
building at a cost not exceeding £3000. The Duke of
Northumberland has signified his intention of giving a site
for the new hospital.

Suburban Sewerage.—A t'a special meeting on
the 28th ult., the Richmond vestry adopted a petition to
the Local Government Board, asking that body to issue a
provisional order forming a joint main sewerage board for
the parishes of Richmond, Mortlake, Barnes, Kew, and
Petersham.

The annual banquet of the Newcastle Clinical
Society took place recently, under the genial presidency of
Dr. Oliver, while Mr. W. G. Black acted as a most efficient
Mcretarv. The entertainment left nothing to be desired,
and will be long remembered by the Society and its
numerous guests.

Epidemic of Measles at Stonyhurot College.—
Stonyhurst College is at present visited by an epidemic of
measles of a very virulent type from which several deaths
have occurred. The disease was introduced from Germany,
»nd all possible precautions are being taken to confine the
disease to its present limits.

St. Pancras and Northern Dispensary. — The
annual meeting of the governor^ of this institution, which
was instituted in the year ,1810, was held on the let inst..
ihfl repott stated that $568 $asea vere treated during' the
past year, as against 2076 daring 1885. The treasurer's
account showed there Was a balance at the end of the year
. -W 18s. 2d only. From a letter read during the meet?- ■
it appeared that the present is the fiftieth year.
Mtjesty has. bestowed her patronage on the institu-

tiom -f 1

I • Bequest.—T he governors of the East Suffolk and
Ipswich Hospital have been informed by the executors
under the will of the late Alderman Booth that a legacy of
1 £600, free of dnty, is to be paid for the perpetual endow¬
ment of the Pembridge Cot in the children’s wing of the
hospital, with a request that the name be altered to the
Booth Cot.

Patients for M. Pasteur. — Dr. Thursfield,
medical officer of health for Shrewsbury, left London for
Paris on the 2nd inst., accompanied by six patients who are
suffering from the bites of a rabid dog. The inhabitants
of the neighbourhood have liberally subscribed towards the
necessary expenses of placing the sufferers under the treat¬
ment of M, Pasteur.

Stanley Hospital, Liverpool.—A t the annual
meeting of the supporters of this institution on the 28th
ult., it was reported that the total number of out-door
patients who had been treated during the past year was
12,475, and of in-patients, 661. From the financial state¬
ment it appeared that the receipts amounted to £1730 and
the expenditure to £2975, leaving a balance of £2767 now
due to the bank.

The Kensington Yestry Bill.—T his Bill, the
object of which is to enable the vestry to acquire land for
the purpose of erecting thereon a dust destructor, has been
approved by a select committee of the House of Commons.
Two conditions have, however, been imposed—vir., first,
that the dust should be destroyed immediately and not
stored; and second, that a portion of the land to be acquired
should be set apart as a public recreation-ground.

Death of an Aged Spanish Practitioner.—D on
Rosendo Moreno y Valesco.a venerable Spanish practitioner
residing in Logronn, who would have completed his
hundredth year on Feb. 25th, has just died. Considerable
preparations were bring made for a pablic celebration of the
day, no misgivings having been expressed as to the proba¬
bility of Don Moreno living to see it, as up till quite recently
he had been in good health and in actual practice.

New. Hospital for Madrid.— El Siglo Medico
states that the plans of the new Hospital of San Juan de
Dios, which is about to be erected by the corporation of
Madrid, are most complete. The number of beds provided
for is 644. The building is to be in ten pavilions constructed
of brick and iron on the Toilet system, and separated from
one another. It is expected that the building will not be
completed for four years.

The Colonial and International Congress on
Inebriety, organised by the council of the Society
for the Study and Care of Inebriety, and unavoidably post¬
poned from 1886, will be held on Wednesday, July 6tb, 1887,
in the Westminster Town Hall, London, S.W. At the day
sittings, after the president’s opening address, papers on
various phases of inebriety as a disease, and on legislation
for inebnates, will he read. The hon. secretary ib Mr. C. H.
Bishop, 42, Grove-road, Regent’s-park, N.W.

Provident Surgical Appliance Society. —During
the past year this Society has helped with instruments
4.'143 patients, making a total since its establishment of
40,611 who have been relieved. The receipts for the year
amounted to £2273, and the expenditure to £2236. This is
the first occasion since the formation of the Society, fifteen
years ago, that the accounts have showed a balance in hand.
The anniversary festival is to be held at Willis’s Rooms on
the 27th prox.

TnE Jubilee.—I n connexion with the Queen’s
Jubilee in Belfast, it was stated at a meeting of the General
Committee of the Belfast Royal Hospital, on the 28th ult.,
that one of the most pressing necessities in the town waa
the want of a hospital for consumptive patients, of whom
there is a very large number, in consequence of the nature of
the employment ih which the operatives are engaged in the
linen mills and factories. Mr. Foster Green offered to
build a new wing to one of the local hospitals, and fit it up
for consumptive patients, provided the town supplied a
permanent endowment, which would be secured by a con¬
tribution of £15,000. Mr. Green will further provide £1600
of the latter amount,—At a meeting at Glasgow on the
28th'ult, it Was agreed erect a hospital for the southern
,! district of the dtyji^ af memorial of Her Majesty’s Jubilee.

602 Tub Lancet,]

MEDI AL NEWS.—BIRTH8, MARRIAGES, AND DEATHS.

[March 5,1887.

At a public meeting held at Romford on the 21st nit. it
was resolved to erect a cottage hospital in commemoration
of the Jubilee. The Duke of Grafton has consented to pre¬
side at the festival dinner early in June next on behalf of
the extension fund towards the completion of the new
wing of the City Orthopaedic Hospital, in commemoration of
Her Majesty’s Jubilee year.—Mr. Tharia Tapan, a well-
known British Indian subject at Zanzibar, has announced
his intention of celebrating the Queen’s Jubilee in that town
by giving a suitable building for a general hospital, open to
all nationalities, and to endow it with £16,000, subject to
the single condition that the building and endowment fund
be placed under the protection of the British Government.

Liddell Provident Dispensary, J arrow. —At the
annual meeting of this dispensary (erected in memory
of Canon Liddell, and successfully conducted on the
provident system), the medical officer reported that he had
paid 4G88 visits, and had 7468 consultations at the dispen¬
sary, where he had also dispensed 11,195 prescriptions. The
financial statement was satisfactory, the institution being
self-supporting; but these figures lead one to think that
the success of the dispensary must be due to the untiring
energy of the medical officer.

Newcastle Children’s Hospital. — The annual
meeting of the Newcastle Children’s Hospital has just been
held, under the presidency of Sir Wm. G. Armstrong.
The number of in-patients treated had been 161, as com¬
pared with 156 in 1885, and the number of out-patients
had been 2660, as compared with 2483 in 1885, showing
that the useful work of the institution had been steadily
maintained. The total cost per head per letter for
four weeks had been—for in-patients, £2 0*. 2d., as com¬
pared with £2 12 a. 11 d. in 1885.

Scarborough Sea-bathing Infirmary. —The annual
meeting of supporters of this institution was held on the
28th ult., when, in their annual report, the committee con¬
gratulated the subscribers on the continued usefulness and
success of the institution. During the past year 594
patients have been received, this number exceeding that of
any previous year by 32. The expenditure for the year was
£1619, showing an increase of £20, and the receipts,
including a balance of £92 brought forward from 1885,
amounted to £1737.

Sheffield Children’s Hospital. — The annual
meeting of the governors and friends of this institution was
held on the 25tn ult., when it was reported that the number
of individual out-patients during 1886 had been 3626, and
that the number of in-patients had increased from 126 in
1885 to 142. The total receipts were £859, and the expendi¬
ture was £99 less than the income. It is proposed to erect
a new wing in connexion with the hospital, the present
accommodation for in-patients being inadequate to the
demands made upon the charity.

St. John Ambulance Association. —The Streat-
ham division of the Metropolitan police having undergone
a course of instruction in “ first aid to the inj ured,” under
Deputy Inspector-General M. Coates, R.N., have been
examined by Mr. Steet, F.R.C.S., chief medical officer.
General Post Office, with the result that the whole of the
candidates (twenty-three in number) have been awarded
certificates.—Lord Lyttelton presided last Monday at a meet¬
ing of the Great Western Railway employes at Paddington,
when an address was given by 8ir Vincent Barrington,
deputy chairman of the above Association.

London Sanitary Protection Association. —The
sixth annual meeting of the members of this Association
was held on the 26tn ult., under the presidency of Lord
Chelmsford. The report for the year showed that the number
of members was 1144. The number of houses inspected for
the first time last year was 398, and the percentage classified
as in a bad condition was 59, as against 65 for the
previous five years. Suggestions were made for enlarging
the operations of the Association by undertaking the inspec¬
tion of a smaller olass of house at a reduced fee, and also
the supervision of new building estates on special terms.

The Medico-Psychological Association. —The
quarterly meeting of this Association was held at Bethlem
Hospital on Wednesday, Feb. 23rd. The chair was taken by
Dr. Savage. Dr. Baker exhibited a 1 of a crib bed¬

stead, with a close top, as recently in use at Utica Asylum.
Dr. Savage then introduced for discussion the question,
“Whether there is ever sufficient reason for the use of
strong clothing and side-arm dressings,” which was followed
by an interesting debate, in which Drs. Brushfield, Hayes,
Newington, S. R. Philipps, Fox, Moody, and Hack Tuke took
art. The proceedings concluded with a paper by Dr. Percy
mith, on the “Results of an Epidemic of Typhoid Fever
in the Insane.”

Rabies. —By an Order in Council, which came
into operation on the 1st inst., and is to extend throughout
England, Wales, and Scotland, the Privy Council have given
special and enlarged powers to local authorities to make
regulations for the muzzling of dogs; for the keeping of
dogs under control; for the seizure and detention of stray
dogs; and for the slaughter of dogs being at large and
affected with or suspected of rabies, or having been exposed
to the infection thereof. The new order extends not only to
dogs, but also to cattle, sheep, and goats, and all other
ruminating animals and swine, as well as to horses, asses,
and mules.

Royal Hospital for Children and Women.—
The annual general court of governors of this institution
was held in the hospital, Waterloo-bridge-road, on the
28th ult., the Lord Mayor presiding. The number of in¬
patients treated during last year was 483, against 479
in 1885; out-p&tients 7195, against 6015; and suffering
children visited at their homes, 417. The annual subscrip¬
tions were fully maintained, and the donations showed a
slight increase. Still, the total income of the year fell short
of that of the previous year by nearly £400, and the total
deficit amounted to nearly £800. It was resolved to endeavoar
to raise a J ubilee fund of £1000 to free the hospital from debt.

§irt{is, Carriages, anil $jeat|rs.

BIRTHS.

Bottrkk.—O n the 23rd ult., at York-oreaoeot, Woolwich, the wife of
Surgeon Ulick J. Bourke, Army Medical Staff, of a ton.

Burn. —On the 23rd ult., at Richmond, Surrey, the wife of Staoey S.
Burn, M.A.. M.B.Oxon., of a eon.

Clark*.—O n the 22nd ult., at Twickenham House, Middlesex, the
wife of Richard Ashmore Clarke, L.R.C.S.I., of a daughter (still¬
born).

Godson.— On the 2tth ult., the wife of Clement Godson, M.D., of a
daughter.

Hajblam.—O n the 2lth ult., at Meoklenburgh square, the wife of
W. D. Haslam. M.D., M.R.O.S., of a daughter.

Hopk.—O n the 28th ult., at Curzon-street, Mayfair, the wife of William
Hope, M.D., of a son.

Simmons.— On the 20th ult., at Bertram Lodge, Sandown, Isle et
Wight, the wife of B. Walpole Simmons, M.B., M.R.O.S.. of a
daughter.

Whitcombs. — On the 26th ult,, at Weeterbam, Kent, the wife of
C. H. Whitoombe, L.F.P.S. Glas., L.S.A. (prematurely), of a
daughter. _

MARRIAGES.

Battkrsby—Btrne.—O n the 22nd ult., at St. Peter’s Church, Dublin.
J. Carter Battersby, M.B., Surgeon, Army Medical Staff, to Pmnees
BUza, eldest daughter of John Alexander Byrne, Esq., Q.C., of
Lower Leeson-street, Dublin. ,

George — Doward.— On the 17th Inst., at the Parish Churoh, Tiden-
ham, Gloucestershire, Hugh George, M.D., to Ellen Maud, third
daughter of the late Alfred Doward, of Day House.

Lumpkin—Lewis. —On the 26th nit., at 8t. George’s Cathedral, Free¬
town, Sierra Leone, West Africa, C. Jenkins Lumpkin, M.D..
youngest son of the Hon. H. Lumpkin, deceased, to Carrie, only
daughter of Wm. Lewis, Esq., sen., and sister of the Hon. 8amuel
Lewis, of the Middle Temple, Barrister-at-Law. ,

Moore— Baker. —On the 21st ult., at St. James’ Churoh. Hereford,
Henry Cecil Moore, M.R.C.S., L.8.A., to Henrietta Elizabeth,
widow of Thomas Baker, of St- Albans. m

Shadwkll— Bourne.—O n the 26th ult., at St. Stephens Church,
Shepherd's Bush, by the Rev. G. Collett, M.A., assisted by the
Rev. A. Matthey, D.D., Harry Winstaniey Shadwell. M.R.C.8.,
L.R.O.P.Lond.. of Acton, to Mabel Oonstanoe Harriette, youngest
daughter of the late Captain G. Lealy Bourne, B.N.

DEATHS.

Drummond.— On the 28th ult., at his residence, Great Cumberlnnd-
place, very suddenly, James Hnlthtnond, M.D., late of Niee, aged

Prichard. — On the 26fch nit., at Norton Court. Gloucestershire,
William G. Prichard, late Inspector-General of Hospitals, Madras,
aged 73. '

N.B .—A fee of it. it charged for the Tntertio* of Ifotims ef Birtki ,
Marriagu, and Death*.

Digitized by GOOgle

Thb Lancet,]

APPOINTMENTS.—VACANCIES—MEDICAL DIARY.

[March 5,1887. 503

appointments.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 'J o'clock on the Thursday morning of each week for publication in
the next number. _

Barky. Bdward Joseph. M.D.Hd., M.R.C.S., has been appointed
Honorary Medical Offloer to the London Skin Hospital, Oranbourue-
street, Leicester-square. _

Bras son. John, L.K.C.S., M.B.C.P. Ed., has been appointed
Medical Officer for the Rotherham Dlatrict of the Rotherham

Claw^.^Doxoah McCallum, L.F.P.S. Olaa., L.R.C.P. Hd , has been
appointed Medical Officer for the Auaton District of the Worksop

Colk. William R. N.. M.D.. M.CJh. Queen's Unlv.Irel., has been
appointed Medical Officer for the 8eventh District of the Bodmin

CooEK.'a 1 . T. B. B.. F.lt C.S.Bd., L.R.C.P.Ed., haa been re-elected
Honorary Medical Officer to the Scarborough Sea-Bathing Inflr-

Oriftb.'Albert Watson. M.R.C.8., L.B.C.P.Bd., haa been appointed
Parochial Medical Officer for the Rotherfleld Dlatrict of the Uckfleld
Union, vice Matthew Mackintosh, M.R.C.S., L.S.A., deceased.

Hackett. H. Bugrne, M.R.C.S., L.B.O.P.Lond., haa been appointed
Medical Officer for the Sixth District of the Chorlton Union.

Joints. John T., M.K.O.S., L.8.A., haa been appointed Medical
Officer for the Lauglitou District of the Rotherham Union.

0. Gilroy, M.I3., C.M.Gla*.. ha* been appointed Sanitary
' Medical Officer for tne Pariah of Baatwood. Glasgow, vice Walker,

Llewellyn, Ernest G. T., L.F.P.S. Glas.. M.B.C.S., haa been
appointed Medical Officer for the Sixth District of the South

Lytii J. B., M.R.C.S.. L.B.C.P.Bd., haa been elected Honorary
Surgeon to the Rotherham Hospital and Dispensary, rloe Foote,

PennivF^ancis, M.R.C.S., L.8.A.. haa been appointed House-Surgeon
to the Doncaster Infirmary, vice Gelston, resigned.

Poco- k. Walter. M.R.C.S., L.S.A., haa been appointed Honorary
Medical Officer to the London Skin Hospital, C ran bourne-street,
Leiceater-aquare. _. „„„„ . ...

Putter. E. Fursiss, L.R.C.P.Lond., M.R.C.S., haa been appointed
Medical Officer to the Victoria Hospital for Sick Children, Hull,
vice J. Soutther. L.R.C.P.Lond., M.B.C.S., resigned.

Smith, J. Anderson, M.B. Lond., M.B.C.S., has been appointed
Resident Clinical Assistant at the Brompton Hospital for Consump¬
tion and Diseases of the Chest. . , . „ .... , __

fiTUtTiN James. M R.C.S., has been elected Honorary Medical Offloer
to. and Lecturer at, the London Skin Houpital, Cranboume-atreet,
Leice*ter-*quare.

Iaylor. John W.. M.D., M.R.C.S., haa been reelected Honorary
Medical Officer to the Scarborough Sea-Bathing Infirmary.

©araitcits.

In compliance with the desire of numerous subecribers, it has been decided to
resume the publication under Me head of brief particulars of Vie various
Vacancies which are announced in our advertising columns. For further
inform ition regarding each vacancy reference should be made to the
advertisement. __

Ashton cnper-Lyne District Infirmary.— Honae-Sorgeon. Salary
£3U, with board alii! residence. .

Bosgombk Provident Infirmary, Bournemouth.—Resident Medical
Offi ;er. Salary £*J i>er annum, with board, lodging, Ac.

City of London Hospital for Diseases of thr Chrst, Vlctorla-parK,
E. —Pathologist. „ .

Dehuyshike General Infirmary, Derby. — House-Surgeon, (salary
£100 for the first year. Increasing £l0 a year np to £ 160 , won apart¬
ments, bosrd, and washing. _ .. ,

Bast London Hospital for Children, Sbadwell, H.—Resident Clinical
Assistant. Board and lodging, but no salary.

Glamorganshire and Monmouth Infirmary and Dispensary,
CardifT.-Opht halmic Surgeon. _ „ __

Hastings. St. Leonards, and Hast Sussex Hospital. — House-
Surgion. Salary £70 per annum, with board, lodging, and laundry
expenses. . ~

Infirmary fob Consumption. Margaret-straet. Cavendish-square, W.—
A Physician in-Ordlnary; three Visiting Physicians ( and a

Vale Lock Hospital, Dean-street, Soho.—House-Surgeon. Salary £50

per annum, with board and lodging. _

HI iTon am Workhouse, Ilolbom Union.—Medical Offloer. Salary £100
p**r annum. __

Mational Hospital for thr Paralysed and Bpileptic, «ueen-
aquare. Bloomsbury.—Laryngologlat. , .

Kohtu-Wkst London Hospital, Kentiah-town-road. — Assistant

Nottingham General Hospital.— One Resident Surgical, and one
Resident Medical, Assistant. Board, lodging, and watting, but no

Parish ^>p Putney.— Medical Officer of Health. Salary £76 per
annum, rising (subject to the order of the Board of Works for the
Waudaworth District! by annual Incremental of £6 each to a
maximum of £110 per annum.

University of Glasgow. —Examiners In Medicine. .. ,

Western Dispensary. Rochester-row. West ml ns ter.—Resident Medical
Officer. Salary loo guineas per annum, with furnished rooms,
Cials, gas, and attendance.

Petontl giarj for% tnstting

Monday, March 7.

Royal London Ophthalmic Hospital, Moorfiklds. — Operations,
10.30 a m., and each day at the same hour. . w „

Royal Westminster Ophthalmic Hospital.— Operations, 1.30 p.m.,
and each day at the same hour. .

St. Mark’s Hospital.— Operations. 2 p.m. ; Tuesday, 2.30 p.m.

Hospital for Women. Soho-squark. — Operations, 2 p.m.. and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Royal Obthop.edic Hospital.- Operations, 2 **•*•. . ,

Central London Ophthalmic Hospitals.— Operations, 2 p.m., and
each dav in the week at the same hour.

Royal Institution.—6 p.m. General Monthly Meeting.

Odontological Society or Great !;T^oke^’

muuications by Messrs. A. WInterbottom. F. Henri WMss. T.Aoke^.
A. 8. Underwood, C. Vlnoent Cotterell. and W. Harrison (Brighton).
Dr Dudley Buxton : Physiological Action of Nitrous Oxide ws-
Boci^tt ofK-Tp h. rfr. W.Y Dent: Budding Material. (Oantor

Mkd^l Society on London. — 8 JO p.m. General Meeting for Election
““f ouled Council.—Mr. Marmaduke ShelldI: 5n a nee o
Perforation of Femoral Artery and Vein by Ulceration; Ligature of
both Vessels. Tueaday, March 8.

Guy’s Hospital.—O perations. 1.30 p.m. and on Fridayat the same hour.

Ophthalmic Operations cn Monday at 1.30 end
St. Thomas’s Hospital.— Ophthalmic Operations, 4 p.m. , Friday, 2 p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital —Operations. 2.30 p m.

Kt Mary’s Hospital. — Operations. 1.30 p.m. Consultations, Monday,

1 £11 SldnDepxrtment, Monday and'Thursday. Jix
Royal Institution.-3 p.m. Prof. Gamgoe: Fusion ^ .

Royal College of Physicians of London.—6 p.m. Dr. Mao Allster.

The Nature of Fever (Gulstonian Lecture). T)r

RnvAi Medical and Chirurgical 8ocikty. — 8.90 P.M. Dr. Debout
B d’Ritrl^ • On Gouty Parotitis and Gouty Orchitis (communicated
bv D^arrod).-Dr W. Bwart and Mr. B. F. Bonham> Case of
^noy ema with Pulmonary Gangrene following Enteric Fever, treated

by Perflation. Wednesday, March 9,

National Orthop.edic Hospital.— Operations, 10 a.m.

Sr^BAWraoLOMrsPs^Hospir^'^Operattons. 1.30 p.m. ; Saturday, same
8T ' ho\ur^ H0 OphSairnio°0^> e ratl 0 ns, Tuesday and Thursday, 1.30 P.M.

Suraical Consultations, Thursday. 1.30 p.m. .

8t Thomas's Hospital. -^Operations, 1.30 p m. ; Saturday, same hour.

?LL H NXsp 9 iTA°L.-Operatlo^.2P.M, T^y^urday.^ehour.

Great Northern Central Hospital.—O perations, 2 p.m.
BamaritanFrek Hospital fob Women and Children. Operations,

UniIemit^'COLLEGE Hospital.— Operations, 2 P.M.; Saturday, 2 p.m.

Skin Department. 1.46 P.M.; Saturday, 9.15 fl

Rnr*L Free Hospital. —Operations, 2 p.m., and on Saturday.

K25 Kkge HosPiTAL.^8peratlons, 3 to 4 P.M.; Friday, 2 P.M.;

CHiLDMw'^HoeprrAL, Great Ormond-street.— Operations, 9 a.m.j

8ociCTY^F y AJS?^ 0 p r M. Mr. William P. Marshall: Railway Brakes.
Epidemiological 8<M7Ihty "

HUNTER^ ^TT ^M »r. Hurrock.: ewe. Of Uterine Tumour

UOT ^anled%Pyr«^r.T H r r r: AcMnomyc^

B ° T Dlfferentlatlon * of ^TtMues^Tn ""fo iIkL "— Dr^ H?' jf*JohnstoipLavia
■nd Dr G 0 J Vosmaer: On Section-cutting of 8ponges, Ac.
BRIT^HGYN^liG^L SOCIETY -8^ P-N

Dr. Poroell: On Three oasea of Vaginal Hysterectomy.

Thun day, March 10.

St. George’s HospiTAL.-Operatlons, V p.m. Ophthalmic Operations,

CharinchCROSS HOSPITAL—Operatlon« 2 P.M.

KCritics of the

RortTcoLLEaK OF Physicians of London.- 6 p.m. Dr. Mao Allster:

The Nature of Fever (Gulst onian Lec^re)- „ _ 8-30 P M.

Ophthalmological Society or the u «itkd Kihgdok.

Lisins and Card Specimens at 8 p.m .—Dr. G. s. neev JJ,

Retinal Changes, priday, March 11.
HOYAL Socth OPHTHALMIC

°“^SKE occurring in

Royal Institution
Century a.d.

(Saturday, March 18.

a». Krt o» sw.

Die

, y Google

&04 The Lancet,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[March 5,1887.

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.vt. by Steward') Instrument * )

The Lancet Office, March 3rd, 1887.

Date.

Barometer
reduced to
Sea Level
and Stop.

Direc¬

tion

of

Wind.

Ball.

Wet

Bulb.

Solar

Radla

In

Vacno.

Max.

Temp.

Shade.

Min.

Temp

Bain

fall.

Remarks at

8J0a.il.

Peb. 25
28
27

.. 28
Mar. 1
>. 2
.. 3

30-06

30-62

30-59

30-58

30-57

30-85

30-60

W.

8.B.

S.E.

S.E.

W.

w.

w.

49

38

44

35

36
32

37

47

36

40

34

36

32

85

63

53

60

63

39

46

43

47

34

35

31

34

30

31

Fine

Foggy

Hazy

Foggy

Foggy

Foggy

Foggy

Itotes, JSjmrt Comments, ft H-nsfoers to
Corwspttrents.

Cremation.

This method of disposing of the dead finds no favour from the Roman
Catholic Church, which has recently denounced it In prose and verse.
Montlgnor Giovannlni, theological canon of the arch-dioceae of Bologna,
has published a special treatise against It, and the treatise, In turn,
forms the subject of the following epigram from the pen of Prof. D.
Vincenzo Tavozzi

" Quam sclte ustrlnum damnas, et sacra sepulcrl,

Digna vel humano pec tore, jura tones.

Ut tua soripta amet indoctus doctusque, Leonls
Jussaque Pontiflcls firmius usque probet."

(" So wisely 'gainst cremation you defend

Man’s sacred right to sepulture, that all—

Learn'd and unlearn’d alike—your work extol.

And keep Pope Leo’s mandates to the end.’’)

Professor Tavozzi has more than metrical reasons for using the word
ustrimem, instead of the modem and needless coinage crematorium.
On the other hand, his tuil tcripta (the short vowel before sc) is a col¬
location which “ought never to be introduced into modem Latin
poetry " (Ramsay’s Latin Prosody, p. 280).

It is especially requested that early intelligence of local events
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed u To the Editors.”

Lectures , original articles, and reports should be written on
■ one side only of the paper.

Letters, whether intended for insertion or for private in-
formation^ must be. authenticated by the names and
addresses of their writers, not necessarily for publication .

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

The School of Salerno.

E. C. (Glasgow).—The important place held by this seat of learning in
the annals of the healing art could not be better stated than in the
words of Dr. Salvatore De Benzi, the distinguished physician and
scholar of Naples, whose “ Colleotlo Saleraitana" (Naples, five vols. 8vo,
1862-69) Is a monument of industry and judgment. “The School of
Salerno,” be says in his introduction, “has laid the whole world of
medicine under heavy obligations. First and greatest among its
services, it has preserved the tradition of the Graeco-Latin medicine in
disorganised and calamitous times, during which the antiquo civi¬
lisation had fallen under the brutal sway of nomadio invaders, and
science and literature had sunk into oblivion. Secondly, it reared the
first Christian institution in the West when the sciences, having
become Mahometan, were constrained to seek shelter under the aegis of
the enemies most fatal to them. Thirdly, it laid deep the foundations
of modem universities, reconstituting medicine as a part of the whole
civil order, and establishing public hygiene on new and solid bases.
Fourthly, it enriched by special contributions the scientific heritage
bequeathed by our forefathers. Fifthly, it was the source and centre
^whence Instruction in the healing art was diffused over all Europe, so
contributing to evoke the scientific renaissance. Sixthly and dually,
it fulfilled a noble mission of the Italian people—that of making them-
eeives the custodians of the Intellectual palladium, and preserving for
them the glory of endowing the world a second time with civilisation.”
Dr. De Henri's argument, it will be seen, is pitched high ; but we have
only to peruse faithfully the documents he has put together, with the
Rid of the German Henscliel and the French Daremberg, to justify,
and even to share, his enthusiasm.

CountryAuisUtuttoV) If .omeonewlllsuggestthemicrosoopicalspecimens
necessary for the Triple Edinburgh, alto where they can be procured.

RAYNAUD’S DISEASE IN ADULT LIFE.

’• TV> the Editors of The Lancet.

nt aT ,MU ? ° f Jan ’ 29111 Dr ’ 8e J mour Taylor describes a case

h. f!*? “ n * dult female - whioh 116 Is exceptional.
Sl^oi fifty-six. She is still under my

thf^fl ‘ f CJ,n, J our Taylor wish for any particulars of

1 ,haI1 be ver ? filswad to giye tw if he will communicate

W. rot. a*. 1 r nfm 2t* ni .

Mr. Reginald Pollard .—The announcement appeared in our issue of the

12 th ult.

THE VOLUNTEER MEDICAL SERVICE IN PEACE AND WAS.

To the Editors of The Lancet.

Sirs,—I quite agree with the snbstance of the remarks in your issue
of February 19th by Dr. W. P. Mears on this subject. I must state,
however, that in connexion with the 1st Volunteer Bittalion Royal
Warwickshire Regiment the physical fitness of recruits is insisted upon
before enrolment, the medical offloera attending every week, when
recruits present themselves, who are subjected to a rigid medical exami¬
nation on army lines, to the number of about 300 each year. This
system has now been in vogue about three years, and has resulted
in a marked improvement in the physique of the men. I may
also mention that we are invariably consulted on sanitary and;
other medico-military matters, although, as Dr. Mears states, these
matters are not insisted on by the War Office authorities, and are simply
the result of good feeling between the combatant and medical officers.
We have also a well-drilled department of regimental bearers (two pep
company), and, our own ambulance-waggon (Mark 3), and stores—as
stretchers, water-bottles, haversacks, Ac. This work Is, I am glad to
say, being taken up by many other battalions in the Midlands, mainly
owing to the Midland Volunteer Medio*! Association, which has been
formed for that purpose, and in connexion with which an annual field-
day is held at one of the regimental camps. I think that such an
association In other centres would have a very good effect In developing
an Interest in ambulance work. In conclusion, I quite endorse the
opinion of Dr. Mean that many of us are deterred from attending
schools of instruction, and passing the necessary examinations, by the
fact that we do not receive pay. The expenses, which are already much
heavier than those of combatant offioers attending schools, are rendered
deterrent In oonsequenoe of the additional strain involved.

I remain, Sirs, your obedient servant,

Edward L. Freer,

Acting Surgeon, 1st Vol. Batt. Royal Warwickshire Regt. r
Hon. Sec., Midland Vol. Medical Association.

Birmingham, Feb. 21st, 1887.

SPONTANEOUS DISAPPEARANCE OF A TUMOUR IN THB
PAROTID REGION.

To the Editors of The Lancet.

Sirs,— In an article on “ Surgical Mishaps" by Mr. T. Pridgin Teal©,
in your issue of January 1st. mention is made of the disappearance of »
tumour In the parotid region after ineffectual attempts to remove it.
In November, 1885, I operated with the intention of removing a tumour
the size of a waltmt from the parotid region, on a ehild three years of
age. It had been growing a year, and latterly very fast, was elastic and
quite movable. On cutting down I found it had no capsule, and was
very adherent to the muscles and fascia. I made a second incision back¬
ward towards tha mastoid, and attempted to enucleate it, but the deep
attachments were so firm and the bleeding so free, that I was forced to
desist, after ligating a number of vessels on both posterior and anterior
sides of tumour. The wound healed promptly, and I saw no more of the
cose until October, 1888, when I was called to see another member of the
family. On asking for the child, the mother Informed me that about
two months after the operation she noticed that the lump was smaller,
that It continued to decrease, until at that date no traoe of it remained
except the operation soars. I attributed its disappearance to the cutting
off of the blood-supply.—I am. Sirs, your faithfully,

Frederioton, N.B., Canada. G. H. Coburn, M.D.

Paraldehyde.

To the Editors of The Lancet.

Sirs,—W ill any of your many readers who may have prescribed
paraldehyde kindly give their experiences of its effects ?

I am, Sirs, yours truly,

March 2nd, 1887. Subscribe* 1

Digitized by V^OOQLe

Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [March 5,1887. 505

The Medical Profession and Life Assurance Offices.

Dr. Thursfield present* his compliment* to the Editors of The Lancet,
and asks for the insertion in that journal of the enclosed circular and
the correspondence in connexion therewith, as it is of Importance to
li/e assurance office* as well as to the profession.

“National Life Assurance 8ociety,

“ 2. King William-st.. B.O., Feb. 14th, 1887.

“Dear Sir,—My directors have found it necessary to reconsider the
scale of fees for medical examination of lives proposed for insurance, as
many oases, after examination, are not completed, and the fee of 21s. is
a very heavy charge upon the small assurances, even when they are com¬
pleted; and the following scale has been adopted: —For assurances
under £500, a fee of 10*. Od. ; of £500 and upwards, 21*.; when the
premiums are payable monthly, a fee of 10*. In each case, except when
the monthly premium is under 10*., when the fee will be 0*. My directors
believe that these are the fees usually paid In such cases, and I shall be
glad to hear whether you are willing to accept them.

“ I am, dear Sir, yonrs faithfully,

“ Dr. W. Thursfield." “ H. J. Pucklx. Manager and Secretary.

“39, High-street, Bridgnorth, Feb. 16th, 1887.

“Dear Sir,—Tour directors may have good reasons for reconsidering
the soale of fees for medical examinations; but when they ask the pro¬
fession to adopt their scheme, I would ask. Are they prepared to reduce
the number of questions at each examination in proportion to the
reduction in fees ; or do they expect us to answer for 6*. what formerly
they were willing to pay a guinea for? And will they issue a sliding
soale in the ascendant, and pay a guinea for each £1000 insured for T
When they deal thus with the profession they may expect us to acquiesce
la the arrangement; not otherwise. To my mind, the amount insured
for has, and should have, nothing to do with the medical referee. He
has simply to do his duty by examining the person to be Insured, and it
fakes him as long, and gives as much trouble (and very often offence), to
do it for £100 as for £8000. As this matter is of importance to tha pro¬
fession, I am sending ypur circular and my reply to The Lancet for
insertion. “ I am, dear Sir, sincerely yours,

“ H. J. Puckle, Beq.” •'W. Thursfield, M.D.

“ National Life Assurance Society,

“2, King Wllliam-st., B.O., Feb. 17tb, 1887.

“ Dear Sir,—I have received your letter of the 18th lost., and have had
an opportunity of submitting it to the President of this Society, who
expresses hie surprise that you should think of sending our circular and
vonr reply to The Lancet without consulting U6. m answer to your
inquiry, 1 beg leave to state that we do not expect you to answer for 5*.
what formerly we were willing to pay a guinea for. My directors have
reran tfy decided to grant aasnranoea at monthly premiums, with a view
to making t he payments easier for those to whom the payment of yearly
premiums would be inconvenient. The average amount of these assur¬
ances will'ptuttably be considerably smaller than In the case of assurances
atiMaual pretaimn*,and/or them a simplified form of medioai examiner's
repor t hae been .specially drawn, up. Of this I enclose yon a copy. I
think it is ybyiou* on very slight oouslderaton that an office cannot
possibly afford to pay guinea fees for business of that description. With
regard to the farther question as to a sliding scale, I do not think that
there will be any objection to paying a guinea for each £1000 assured—
that is to say, taking the large and small cases together, we should, I
think, be prepared to pay at the rate of a guinea per £1000 at quarterly
or half-yearly Intervals, as may be arranged, if vou have sent our
circular and your reply to Tire Lancet, yon will probably see the
p r opr i e ty of sending this letter also for publication.

“ 1 am, dear Sir, yours faithfully, . .

“ H. J. Puckle, Manager and Secretary.

" W. Thursfield, Esq., M.D."

“39, High-street, Bridgnorth, Feb. 18th, 1887.

“ Dear Sir,—Unsolicited yon sent me on the 16th lust, a printed circular,
which your directors had authorised you to do. It was, I suppose, sent
to others as well as me. It was not marked “ private and confidential ”;
and as it was important to the profession, I deemed it worthy of dis¬
cussion in the medioai press. Hence my action. I oannot see what
cause of complaint yon have against me for doing so. Puhlioity in snoh
matters is good for all. It is a pity you did not enclose with your
eifpnUr what yonoali the “ simplified form of medioai examiner’s
report ” (for, 5*.). Why when sending it yesterday did you omit to send
the gnlfiea report for comparison ? The one yon sent Is pretty exhaustive
far the money. Including, as it does, urine testing and personal exami¬
nation inside and out. I do not think you will find medioai examiners
enamoured with Tour plan of paying ascending fees In dribblets, quarterly
or half-yearly. I contend- for a guinea in all cases, the amount of assur-
anoe having nothing to do with the duties of the examiner. I will, at
yon wish, forward this oorrespondenae to The Lancet.

... “ I am,dear Sir, sincerely yonre,

“ H. J. Puckle, Esq.” W. Tkur&fuld, M.D.

‘•The Stability of the Barth.”

The repent frightful convulsion in the South of Europe renders ah
article with the above title, by Professor N. S. Sbaler. published in
Scribner's Magazine tor March, peculiarly Interesting and opportune.
The writer describes the causes, distribution, and effects of earthquakes
and oognato phenomena, and offers suggestions as to the best methods
of proparihg for them and avoiding the perils they occasion. The
article is illustrated by several excellent engravings.

NIGHTMARE.

'To Ms Editors of The Lancet.

Sirs,—I would suggest to “KJ).” that he have his heart and aorta
teerihUysxaiMiiMbysotneaxpecianoed friend; and, if he be a smoker
him to give tip tohaooo altogether.

_ _ I am, SUs, yours faithfully,

fhhruary, 1887. .tb/ r : .ciJva'i; r.„ ... < r'

Vivisection.

Physiologus. — Whether, or to what extent, vivisection is justifiable
forms a theme of discussion as old as modlcal history. Oeisus drew the
line st the anatomy of tho living (human) subject, and condemned as
“ crudele et supervacuum ” the dissections performed by Herophllns
and Braslstratiu on live criminals who were handed over to them by
reigning monarchi for the purposes of soienoe. The wounds inflicted
on gladiators in the arena, on soldiers in the Held of battle, on travellers
at the hands of highwaymen, sometimes exposed the Internal parts,
and the anatomist (he held) was quite warranted In making the most
of such opportunities. On the other hand, the “ Father of Inductive
Research" says. In Book iv. of the “Do Augmentds”: “It is no less
true (as was antiently noted) that many of the more subtle passages,
pores, and pertusions appear not in anatomical dissections, because
they are shut and latent in dead bodies, tbengh they be open and
manifest in live. Wherefore, that utility may be considered as well as
humanity, the anatomy of the living subject is not to be relinquished
altogether, nor referred (as it was by Celsns) to the casual practices of
surgery; since it may b9 well discharged by the dissection of beasta
alive, which, notwithstanding the dissimilitude of their parts to
human, may, with the help of a little judgment, sufficiently satisfy
this Inquiry." Baoon’s latest and best editor, Mr. Robert Leslie Ellis,
in giving a guarded opinion on this passage, omits to notice that It
was written before the discovery and application of an*sthetlcs.

Mr. W. K. Gould .—The specimen of the valuable powdered root might
be submitted for experimentation, say, to Prof. Fraser, or Dr. Ringer,
or Mr. Victor Horsley, if it is desired to have its efficacy tested in
hydrophobia.

Mr. G. Steel Scott, M.B. — Our correspondent must be guided by tba
sdvlce of his solicitor.

FRACTURE OF THE THIGH DURING PARTURITION.

To the Editors of The Lancet.

Sirs,—T hree weeks ago I attended J. O-in her fifth confinement.

It was a natural vertex labour in first position. After the birth of the
head I had only just time to tell her to take it easy till another pain
came, when the shoulders and body followed. As they were coming I
heard a snap, which, had she been a prim!para, I should have put down
to rapture of the perineum. The true cause was at onoe evident in the
fracture of the left thigh. I was naturally rather dismayed at the
probable difficulties of treatment, fearing that I should soon have a
broken skin in addition to the broken thigh, and not knowing at all how
to s«t about keeping the latter quiet. However, after a little consideration.
It struck me that the most natural position would be that which had
been In utero—doubled up on the abdomen. I therefore put a turn of
Gamgee tissue round the thigh, and two or three turns of soft bandage
round that; then, after dressing the stump of the cord and confining
that in a belly-band as usual, I procured another belly-band broad enough
to reach from the lower part of the abdomen to the middle of the thorax,
cut a hole in the centre of it large enough to slip the foot and lower leg
through, and by this means bound the thigh pretty securely against tha
abdominal wall, the foot and leg below the knee hanging out of the middle
of this second belly-band. Besides this, I further controlled the movement
of the lower leg by telling the nurse always to confine It entirely inside
the ordinary napkin. The dressing has been entirely changed every
other day only, and there is now considerable firmness of the broken
bone, with very good position, though, of course, a good deal of
thickening. The skin has been kept sound, whloh I think would hardly
have been the case had any stiff material been used as a splint.

I should be obliged if any of your readers would comment on the case
as to the probable cause of the fracture. The only thing that struck me
about the birth was the very marked and very qulok rotation of the. face
to the mother's right thigh after the escape of the head. The child
thrives, and seems quite healthy. I am, Sirs, yours faithfully,

Feb. 23th, 1887. &■

Mr. T. Laffan .—The correspondence is printed in the Minutes of the
General Medical Council. We regret oor Inability to reproduce It In
our column*.

M.D. ( Erlangen ) is referred to our advertising columns.

MB. ASH’S METHOD OF SBWHR VENTILATION.

To the Editors of The Lancet.

Sirs,— Accept my slnoere thanks for the article In your valuable and
highly esteemed journal on my Invention for sewer ventilation. At the
same time I beg to point out to your notice a slight mistake In the
wording that may give to the general public a very wrong oonoeptlrm, as
you will readily perceive. In my specification I claim (1) the method op
system of ventilating by means of the ignition and explosion of gas or
other suitable substance or compound producing an explosion at certain
intervals and at determined points or situations In the structures to be
ventilated, and (2) the construction of an apparatus where ooalrga* can
be applied to produce explosions. The man-holes are generally placed
. where it would bq impossible to have explosions.

Iam, 81rs, yo -- hedlent servant, A

^MaMtosJFsbastb, im. , Rohhht S. Ash.

506 The Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[March 5,1887.

The Ancoats Hospital.

Mr. E. Stanmore Bishop, F.R.C.S., referring to a note in our last issue
by our Manchester correspondent on the Ancoats Hospital, states that
there has never been the slightest wish on the part of the governors
of that institution to trespass upon the domain of the Children's
Hospital, or interfere with the work so well done by it. What it is
desired and intended to do is to develop its resources as a general
hospital ina district which, perhaps more than any other, requires one ;
and this object will be effected by obtaining a women’s ward for
medical cases, so that they need no longer be treated with the surgical
ones, and the constant demand for women’s beds may be fairly met.

“ OBSTINATE CONSTIPATION IN AN INFANT.”

To the Editors oj The Lancet.

Sirs.—I can fnlly bear out the statements of Dr. Lucas as to the
efficacy of massage in the treatment of constipation in infants. It is a
most potent and reliable remedy. I have at present an infant under
my care that has suffered from constipation since its birth, seven weeks
ago. During that time there had not been a single natural motion, and
enemata had to be resorted to, sometimes twice daily. The usual
medicines were tried as well, but with very indifferent results. About a
fortnight ago these remedies were altogether discarded, and massage
•resorted to. In less than a week the Infant was quite cured of the con¬
stipation, and, in fact, erred in the opposite way. The motions also lost
their very offensive character, and became quite natural. I lay particular
stress on the mode in which the *' rubbing ” should be done, and am
•inclined to think that it may prove a source of danger in untrained
hands. I am, Sirs, yours faithfully,

Ben Khydding, March 1st, 1887. T. Gerald Garrt, M.D., M.Ch.

To the Editors of The Lancet.

Sirs,—I n reply to your correspondent, “ O. P. Q.," in your Issue of
Jan. 39th, I would advise him to try simple wheat bran for the con¬
stipation. This is a very simple remedy, but in my hands it has done
more than any drug or combination of drugs that I have ever tried. It
is becoming quite a popular remedy for habitual oonstlpatlon in the
United States. I am afraid your readers may treat it as one of old
> (owated the instructions to wash seven times in the river Jordan ; bub I
can assure them that if they try it they will be well repaid in the results.
For an adult I usually direct a tablespoonful to be taken in milk or
.water at bedtime. If necessary, it may be taken twice or three times
•during the day. I would recommend your correspondent to give a
teaspoonful twice or three times a day, in any way possible to gat the
child to take it. I am, Sirs, your* faithfully,

Lincoln, Neb., D.S.A., Feb. 14th, 1887. G. H. Simmons, M.D.

Communications not noticed in our present number will receive atten¬
tion in our next.

Communications, Letters, Ao., have been received from —Dr. Jnliu*
Pollock, London; Dr. W. O. Maclean, Southampton ; Dr. Donald
Mac Alister, Cambridge; Mr. J. Hutchinson, London ; Mr. Lawson
Tait, Birmingham ; Dr. Churton, Leeds ; Mr. Godlee, London; Dr. H.
Blanc, Cannes; Dr. Mansell-Moullln, London; Mr. Clement Lucas,
London; Mr. Wainwright, London ; Dr. Jos. Rogers, London; Mr. D.
Miller, London; Dr. Hambleton, London ; Mr. G: S. Scott, Halifax;
Mr. C. L. Peel, London; Dr. J. Murphy, Sunderland; Mr. Harrison
Cripps, London; Dr. Ohilds-Maodonald, London ; Messrs. Hertz and
Collingwood, London ; Mr. J. G. Brown, Sunderland; Dr. Higham
Hill, London; Dr.G.H.Simmons, Lincoln,Neb.; Dr. Jos. Jones,New
Orlsans; Mr. Bideal, London; Mr. W. Weiss, London; Mr. Charles
Gross, London; Mr. W. K. Gould, Manchester; Messrs. Burroughs and
Welloome, London; Mr. Brad don, Upton-on-Severn; Messrs. Oliver

and Boyd, London ; Dr. Cochrane, Skye ; Mr. Cook ; Messrs. Christy
and Co., London; Mr. G. Geddes, Glasgow; Messrs. Bradshaw and
Son, London; Dr. W. Squire, London ; Mr. T. Laftan ; Messrs. Ingram
and Royle, London; Mrs. Spillman, Melbourne; Messrs. Street and
Co., London ; Mr. J. P. Maynard, Neweastle-on-Tyne; Dr. Woodman,
Exeter; Mr. H. E. Armstrong, Newoastle-on-Tyne; Mr. Benthall,
Souths ea; Mr. Jessett, London; Mr. Hooper, London; Mr. Griffiths,
Chester; Mr. Maguire, London; Dr. H. Barnes, Carlisle; Dr. Ralph,
London; Dr. Rayner, Hanwell; Mr. Martin, Purton; Miss Ghtwfeman,
West Kensington; Mr. Hlnde, Wolverhampton ; Messrs. Cassell and
Co., London; Mr. Fumeaux, Forest Hill; Messrs. Wright and
Co., Birmingham; Mr. Smith, Westgate-on-Sea ; Messrs. Robertson
and Soott, Edinburgh; Mr. Milne, Ladywell; Mrs. Belton, Hyde-
park; Mr. Gib9on,' Bromley; Mr. Porter, Leven; Mr. Lace, Hemel
Hempstead ; Mrs. Maitland, London ; Mr. Gumer, London ; Mr. Poet,
London ; Mr. Birchall, Liverpool; Dr. Fulton, Toronto; Mr. Belson,
London; Mr. Bast, London ; Mr. Wad ham, Farnham ; Mr. Bridgman
Smith, Weatgate; Mr. T. Birkett, Weston-super-Mare; Mr. Harley
Gough, Wolverhampton ; Dr. F. W. Bennett, Leicester; Dr. Henry
Ashby, Manchester; Mr. E. S. Bishop, Manchester; Dr. Garry, Ben
Khydding; Mr. Fuge, Taunton; Mr. Clifford, London; Mr. Tendy,
Haverhill; Mr. F. O. Turner, London ; Dr. Rorie, Dundee; Surgeon-
Major Alcock, Dublin ; Mr. Nelson; Mr. Scrimshaw, Holt; Mr. Gant,
Hastings; Mr. Lawrie, London; Mr. Davies, London; Messrs. Brown
and Co., London; Mr. Arrowsmlth, Bristol; Mr. Shaw, Wiliington-
on-Tyne; Mr. Armstrong, Manchester; Mr. Kallrahl, Bonn ; Mr. S.
Smith, London; Dr. Tetley, Keighley ; Dr. Fitzgerald, Folkestone;
Mr. Townsend, Exeter; Mr. Bond, Nottingham ; Mr. James, Forest
Gate; Mr. Thornton; Mr. B. B. Joll. Liverpool; M.D., Erlangen;
M.D. (Newport, Mon.) ; F.B.C.S., Bushey; A. B. Brookley ; Country
Assistant; Theta; B.0., Bayswater; X. Y., Newoastle-on-Tyne; Lady
Superintendent; Justitia ; Medicus, Highbury; Subscriber.

Letters, each with enclosure, are also acknowledged from—Dr. Woakea,
London; Mr. Monk, London; Mr. Mylee, Forfar; Dr. Morgan, Bbbw
Vale; Mr. Alldea, Southampton; Mr. Porter; Messrs. Butterfield and
Son, Northampton ; Mr. Bloomfield, Manchester ; Messrs. Hooper
and Batty, London; Mr. Cornish, Manchester; Dr. B rams haw, West
Appledore; ‘Mr. Wooler, He&nor; Dr. Lumpkin, Lagos; Messrs. Beale
and Son, Brighton; Mr. Phillips, Stourbridge; Mr. James, Forest
Gate; Mr. Mawson, Bradford; Mr. Moring, London; Messrs. Ford
and Co., London ; Mr. Wier, Manchester; Mr. Hughes, Birkenhead ;
Mr. Guest, Darlington; Mr. Nickel, Bromyard ; Messrs. Wright and
Co., Bristol; Dr. Stanley, Graham’s Town; Mr. Haigh, Chipping
Norton ; Mr. Austin, Glasgow; Mr. Richards, London; Mr. Stock,
Bristol; Mr. Williams, Truro; Mr. Affleck, Manchester; Mr. Marsh,
Hindley; Mr. Whittaker, Derby ; Mr. Blakeley, Preston; Mr. Jones,
Hull; Mr. Davies, Manchester; Miss Ruffey, Kettering; Mr. Mason,
Highbury; Mr. Loverock, Osvan ; Dr. Purcell, London; Mr. Flower,
Melksham; Mr. Davis, Bewdley; Dr. Bberle, Think; Messrs. Blake
and Co., Leeds ; Dr. Roberts, London ; Mr. Rhydial; Mr. Armstrong,
Ryde; Mr. Jenkins, Newport; Mrs. Nelson, Bayswater; Mr. Dickson,
Whitehaven; Dr. Days, Llandrindod; Mr. Sidebottom, Stockport;
G.; Graduate, Ventnor; Surgeon X.; Matron, Windsor; Catholic
Prectioe; Sigma; W. H. V.; H. B.; M.D., Bournemouth; Medicus,
Street; A. B.O., St. John's; Epsilon; Yorkshire; Epsilon, Newcustie-
on-Tyne; Sarsfleld, Limerick ; J. W., Blackburn ; X. Y. Z.; Medleus,
Chesterton; P. A. M., Grimsby; S. P.; Medicus, Belgravia; Alpha,
Stamford; X., Preston; Aqua; Cymro; Medicos, Brighton; Box,
Hythe; T. M. G., Birmingham ; T. 0.; Junius; Surgeon, Bootle.

Leeds Keening Express, Zoophilist, Doctor, Islt of Wight County Press,
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THE LANCET, March 12, 1887.

M . T

(Mstmruw lectures

OK THK

NATURE OF FEVER.

Delivered at the Royal College of Physicians,

By D. MACALISTER, M.A., M.D., F.R.C.P.,

PHTHICIAH TO AHDHNBKOOKK 9 HOSPITAL, LECTURER IK MEDICINE AT
THE UXITKBSITY OF CAMBR1DGK.

LECTDRE I.

Mr. President and Gentlemen,— I have at the
outset to acknowledge the goodwill of our much-esteemed
President, which led him to invite me, one of the four
junior. Fellows of the College, to assume the exacting office
of Gulstonian lecturer. The distinction of the audience to
be addressed, and the high standard of excellence upheld
by previous lecturers, make the office exacting indeed.
Had I not understood that the invitation to undertake it
had in it something Royal, and was almost a command, I
would have shrunk from inflicting my crude reflections and
my profound inexperience on your practised ears. But
when I considered that you would probably not look for
maturity or experience from one who is literally a junior
Fellow in every sense, when I was assured that your
tolerance of youthful effort was large and kindly, I took
heart and ventured to announce this course of lectures.
Fortunately for me, a wide latitude in the choice of a
subject and in the manner of treating it has hitherto been
permitted. My term of practice has been far too short to
enable me to offer you any generalisation based on extensive
clinical work or on ripe knowledge of human nature, such
as has in late years delighted and instructed you. My
aim must perforce be humbler. I must be content with
attempting to coordinate certain recent advances in our
knowledge concerning a department of pure pathology, and
with suggesting to you certain lines along which it is
possible that further advances may be made.

My subject is the Nature of Fever, and though I did not
choose it light-heartedly, it was only when I came to set
down my ideas upon it that I fully appreciated all its
difficulty. Still, inasmuch as for the last five or six years
it has never been long absent from my thoughts, and as
its problems, physical and physiological, have constantly
exercised me, 1 may be pardoned if I venture to discourse
on a subject in one aspect so familiar and fundamental, in
another aspect so little understood. Our knowledge of
the clinical aspect of fever is now singularly full. I can
add little or nothing on this side. But that the intimate
nature of the febrile process—its morbid physiology, so to
speak—is not understood, we have sufficient evidence in
tne diverse and contradictory explanations offered in our
medical text-books. From time to time, and chiefly at
present from the Continent, we are receiving fragmentary
solutions of some of the outstanding questions that present
themselves to the investigator of fever. These often come
from workers who have no thought of the pathological
problem they are unwittingly helping to solve. They
appear under various guises and in many journals. The
busy physician cannot hope to notice them all, or to
recognise their bearing on his needs. He may therefore
welcome an attempt to bring together their results, which
are apt ,to be buried under a mass of experimental detail,
and to Appraise their value as contributions to the general
subject. My literary work for some years has obliged me
to survey much of recent pathological literature, and it is
on that ground only that I can hope to offer you some
matters for consideration that are perhaps not known to
all. That inuch of what I have to say is already familiar
to some of my audience is certain. . if I say it notwith-
— 'j, it is because I wish tp be clear and complete

iit. is necesauyto'state what I mean by
iy say that! whOt refer to the specific
grouped, together as "the “eruptive” or
of feverish-
diseases and to

many others—the disordered inward condition of the body
heat, whose frequent and most manifest outward sign is
high temperature. It is of course true that the term
“ fever” conveys to our mind a more complex notion—it
implies, in general, disorder of the circulation and tbe
respiration, of secretion and digestion, of the nervous
system and the muscular system, as well as of the body
heat. But without saying, as some have said, that all the
other disorders of function whicli we describe as febrile
are merely consequences of the disorder of temperature, T
shall not be going too far if I state at tbe outset that the
essential fact in fever—the condition which is always
present whether other of its symptoms are present
or absent—is disorder of the body heat. In using the
word “essential” rather than “primary,” I wish to avoid
the pre-judgment suggested by the latter. Other condition#
may precede in time or in causation the essential symptom
of disordered heat, and according to the confidence or the
refinement of our analysis we may term one or another of
them primary, but not until the essential- symptom is
present have we to do with fever. We have a like state of
things in the case of inflammation. The single word covers
a whole series of processes; each process is a complex of
many elements. It implies changes textnral and changes
vascular, changes nervous and changes mechanical. And
in the gradual development of pathological knowledge now-
one and now another of these has been regarded as primary.
But to-day we are justified in holding, for the reasons so
admirably set forth by your Lumleian lecturer in 1882, that
alteration or damage of the minuter bloodvessels is the
essential condition, without which there is no inflammation.

Disorder of the body heat, then, is the essential condition
of fever. To understand the nature of fever we must
examine the nature of this disorder. But first it is neces¬
sary to consider the natural ordering of the body heat, the
healthy function of which pyrexia is a disturbance. The
constancy of the temperature of the body in health, under
widely varying internal and external conditions, is a fact so
familiar that we have ceased to wonder at it. Yet it rests
on a perpetual balance of opposing tendencies which is as
mysterious and as*beautiful as anything in our frame. As a
mere question of physics, the maintenance of a constant,
temperature by a body plunged in a cooler and variable
medium like the air involves three cooperant factors. There
must be a source whence heat is produced, whether at a
uniform or at a variable rate. There must be processes by
which heat is discharged from the body or transformed
within it. There must be a mechanism by which the heat,
production and the heat loss are balanced at the normal
height. This mechanism must be in relation on t^ie one
hand with the processes of heat production, and on the
other hand with those of heat loss. ^ And its relations with
these must be so intimate that within limits the balance it
maintains shall be not only steady, bnt stable. In other
words, small deviations from the normal temperature in
either direction must call into play thermal tendencies whose
resultant is back towards the normal. Increased loss must
be promptly compensated by increased production, and in¬
creased production met by increased loss. This stability is
to be distinguished from the property of mere steadiness or
constancy, though, of course, the tWo are-connected. In
health, as we all know, there are daily fluctuations of a
regular kind, and these must be borne in mind when we
speak of the temperature of the body as constant. The
constancy, so far, is imperfect. But in health the stability
of the temperature is nearly perfect. A very short time
suffices to overcome the disturbance produced by change in
the external thermal conditions. And in like manner tbe
‘consumption of a large amount of physiological fuel
(i.e., food), and the internal production of heat thereby
originated, has only a transient influence on the surface
temperature. If we may use Greek terms, we might say
that man, with other “ warm-blooded" animals, is not only
homrrothermic, but thermostatic. We shall have occasion to
refer to this distinction when wd come to consider a theory
of fever which has found eome acceptance among ns.

The mechanism which regulates the body temperature and
gives it stability, as the governor of a steam- engine regulates
the speed, we speak of briefly as the thermOtAxic mechanism.
When we reflect on the promptness of its action* on its sensi¬
tiveness, on the amount and variety of the substance whosei
thermal Variations it has to control and adjust, we cannot-,
resist the conviction that the mechanism is nervous. '

Google

~»-r i

508 Thb Lancet,]

DR. D. MAU ALISTER ON THE NATURE OP FEVER.

[Mabch 12,1887.

as we go on we shall And numerous reasons in support of this
conviction. It*is when we come to consider the exact
nature of this thermot&xic nervous mechanism that diffi¬
culties arise. Where is the seat of the coordinating power?
Is its action direct or indirect ? Does it control temperature
chiefly by varying heat production, as when we raise or
lower the flame of a gas stove or the damper of a furnace
flue ? or by varying the heat loss, as when we open or close
the window of a heated room? These are questions of
physiology, but their solution is in a sense the solution of
the problems of fever; and no fruitful discussion of its patho¬
logy can take place if they are not carefully dealt with, and
their scope at least understood.

It is clear that, given a steady and fairly uniform pro¬
duction of heat, regulation might to some extent be effected
by a mechanism controlling only the loss of heat from
the body. It is as clear that, given a steady rate of heat
loss, a mechanism controlling the production of heat would
also suffice to regulate the temperature. But we have
abundant reason for believing that neither the production
of heat nor the loss of it is even approximately steady in
healthy active life, and therefore for believing that both
these controlling mechanisms are necessary and in fact exist.
The thermotaxic mechanism is, in Dr. Hughlings Jackson’s
■sense, “ higher” than either of them. It governs them both;
it adjusts their mutual relations. It is later in attaining its
full development, and it is more liable to fail under injury
or disease. We shall see that the mechanism controlling
heat production comes next in functional order, while that
controlling heat loss is lowest of the three. Now, it happens
not unnaturally that our knowledge of those mechanisms is
least as regards the highest and greatest as regards the
lowest; and as each has its special bearings on the process
of fever, 1 shall subdivide my discourse into three parts
having reference (1) to heat loss, (2) to heat production,
and (3) to the thermotaxic nervous mechanism. I shall thus
proceed from the better known to the less, in the hope that
in passing from the certain to the probable and thence to
the possible I may not wholly fail in carrying you with me.

First, then, as to heat loss and its relations to the process
of fever. The main channels by which heat passes out of
the body to its environment are of course the skin and the
lungs. Through the skin in health by evaporation, conduc¬
tion, and radiation there escapes more than 80 per cent, of
all the heat discharged. In warming and moistening the
breath less (perhaps much less) than 20 per cent, escapes.
The rate of loss is varied, as we know, by alterations in the
vascularity of the skin and in the period and amplitude of
the respirations. A face flushed with wine feels warm, for
it is rapidly discharging heat; a dog, whose skin lets little
beat pafls through, pants to cool itself. Experiment and ob¬
servation have established the existence in the brain and
spinal cord of vaso-motor “centres” that control the blood-
supply of the integuments by varying the calibre of the
arteries. The efferent nerves that pass from these centres
to the vessel walls are of two kinds: the one vaso-constrictor,
or, as we may say, motor; the other vaso-dilator, or inhibi¬
tory. The “centres,” whatever meaning be given to the
"term, must themselves have something corresponding to this
twofold differentiation. In like manner the rate of respira¬
tion is governed by a nervous mechanism, consisting of
centres in the medulla- and cord, with a twofold com¬
plement of nerves proceeding to the respiratory muscles.
There are strong grounds for regarding these nerves also
as respectively motor and inhibitory, and the respiratory
centre as consisting of two correlated parts, one subserving
inspiration, the other checking inspiratory movement and
subserving expiration. The channels of heat dissipation are
thus admittedly under the control of nervous mechanisms,
twofold or double-acting mechanisms we mighc say, each
having a motor and an inhibitory aspect. Moreover, theee
mechanisms are known to be susceptible to rise of tempera¬
ture, reacting thereto in such a way that the resulting
vascular and respiratory changes increase the discharge of
heat from the body. Attracted by the apparent simplicity
of these arrangements, for the governance of heat loss, it is
not wonderful that TraubeahQuld have sought to base on
them a theory of thenoaotaxfa and. of that derangement of
thermotaxlg : whose, manifestation is pyrexia. “ In health,”
lie w<wldr^, r “4h« to^ttp^gr9 bf-the;Vody;is maiB^ained
by the, .«M9. that

TtfPP. and

heat is thus pent up within the tissues, and their tempera¬
ture rises by ‘retention.’ This general rise of temperature
then reacts on the organs to their hurt, and the disorders
of secretion and nutrition, which we know as febrile,
naturally follow.” No explanation could well have been
more simple, and it was applied with much skill to account
in a natural way for many of the clinical features of pyrexia.
Irritation of the vaso-motor centres by injury or poison led
to prompt and abiding spasm of the arterioles of the skin.
When the centres were very irritable or the irritant intense,
the resulting rise of temperature was rapid. The sudden
difference thus caused between the temperature of the peri¬
pheral ischiemic parts and that of the central parts acted as a
powerful sensory stimulus, and this by a reflex action set up
a powerful motor disturbance—the initial rigor. When
the spasm of the arterioles suddenly relaxed, a gush of heat
took place from the fevered body, and its temperature fell
by crisis; when the spasm yielded gradually and with inter¬
missions, we had a lysis. It is not wonderful, I say, that
observers like Traube and Marey, whose labours on the
mechanism of circulation and respiration had been so great
and so fruitful, should favour this “retention theory? It
rested on their own work, it involved only mechanisms with
which they were intimately acquainted, it was apparently
capable of wide application to clinical facts, and it was
partially true. And so long as certain other facts were un¬
known or ignored, the theory certainly satisfied many acute
observers, and even now appears in some of our medical
text-books as the last word of physiological pathology.

Let us consider, then, the retention theory of Traube, and
examine wherein it fails. “ Pyrexia is due to a diminished
discharge of heat from the surface of the body, and this to
a powerful contraction of the arterioles of the skin.” It is
plain that the structure rests on the one fundamental
assumption—namely, that the escape of heat from the body
is unduly small. If that assumption is itself unfounded, we
have no choice but to conclude that, though retention may
be a vera causa of fever, it is not the essential cause. Twenty
years ago experiments were made to test the assumption.
Inasmuch as the question is one of quantities of heat and
not of temperature only, it was clear from the outset that
the test must be calorimetrical, not thermometrical.
In other words, the heat passing from the fevered
body must be measured by the moss of water (say) it
is capable of warming to a measured extent. This quan¬
tity of heat must then be compared with that given
out by the normal body under like conditions. The first
attempts, made by Liebermeister and others, were open to
objections of many kinds, physical as well as physiological.
Professor Burdon Sanderson has subjected some of them to
criticism, sometimes more severe than they quite deserve, in
his excellent memoir on the “ Process of Fever,” published
as a Government paper in 1875. Thus Liebermeister placed
a fevered patient in a tepid bath, and noted the amount
by which the water was heated in a given time. But the
experiment was vitiated as a quantitative teat by the
changed physiological conditions the contact of the water
might cause in the patient’s body, and by the fact that the
powerful heat-discharging process‘of evaporation was
interfered with. Leyden and Senator, with greater pre¬
cautions, measured the beat discharge from fevered limbs
and from fevered animals. In the case of the latter,
means were found for estimating the quantity of carbonic
acid and the quantity of watery vapour exhaled in a
given time. Pains were taken to compare the results with
those yielded by a normal animal under like conditions as
regards food. The net result was to show that both in the
human patient and in the fevered animal pyrexia was
accompanied not by diminished but by increased discharge of
heat. Senator, indeed, goes so far as to estimate the average
increase of heat loss in some cases of septicsBmic pyrexia
at something like 75 per cent. The objections that have
been raised to the methods employed touch, as I have hinted,
rather the quantitative than the qualitative value of these
calorimetric tests. The latter is not at all ambiguous: the
increased discharge of beat was unmistakable. Like experi¬
ments have been repeated in recent years by Wood of Phila¬
delphia, and by Reichert and Hare under his direction.
Their arrangements were admirably designed, the criticisms
of 1875 were considered and met, and the work bears every
mark of honesty and care. From a physical point of view
there seems nothing to which objection can be taken; and
the outcome of the last meaaurementBi nflbHshed only the
other day, is the same as that of the Older and less perfect

Gc

O

Thb La.vcbt,]

DR. D. MAC ALISTER 05 THE NATURE OF FEVER.

[March 12, 1887. 509

ohm of fifteen years ago. It is that heat is not abnormally
retained in the body during fever; on the contrary, it is
excessively discharged: and this is true not of one stage only;
it holds for the rise and for the continuance of the fever, as
well as for its fall.

This foundation of the retention theory being done away,
the theory falls to the ground as an adequate explanation.
But we may further ask—Is it indeed a fact that during
fever there is an abiding spasm or tetanus of the arterioles
of the skin ? This question has been minutely investigated,
and though the answer is decidedly in the negative, the
research has added largely to our understanding of some of
the phenomena of fever. Clinical observation prepares us
to believe that the cutaneous circulation may vary greatly
during the Bame febrile attack. At one time the skin is
pale and dry, at another flushed, at another bathed in per¬
spiration. Direct observation of the vessels, say in the ear
of a fevered rabbit, shows that their calibre is constantly
altering in a way that is quite different from the quasi-
rhythmical contraction and dilatation of health. These
changes become irregular and excessive, so that the surface
is within an hour or two pale and cool, then intensely hot
and hyperaemic, and then pale once more, the body tem¬
perature remaining all the while at a febrile height. Less
direct, but perhaps not less convincing, is the evidence
afforded by the surface temperature. Whatever spot of the
skin we choose, and in whatever variety of fever, we find
that the surface temperature fluctuates from hour to hour
in a remarkable manner, the curve representing its changes
having little or nothing in common with the rectal tem¬
perature. Of this my own observations have repeatedly
convinced me.

From all these facts, and I have only touched on them in
the most general way, we gather that in fever the cutaneous
vessels are not in a state of continuous contraction. The
cutaneous blood-supply, on the contrary, fluctuates in an
irregular manner: now flushing the surface tissues, raising
their temperature, and pouring out heat into the air; now
reduced to a minimum, leaving the skin pale and dry, and
shutting in the heat of the central parts. All this, of
course, betokens that the nervous mechanism which controls
the cutaneous discharge of heat is notably disordered.
There is, indeed, no constant stimulation of the vaso-con-
strictor nerves such as Traube imagined ; there is no con¬
tinuous retention of heat, but there are marked irregularities
in the rate at which it is discharged. These irregularities
have doubtless much to do with determining the type of
the febrile temperature, the configuration of the charts, in
various diseases. But they leave out-standing and un¬
explained the two cardinal facts—first, that the febrile
discharge of heat is greater than the normal discharge, and,
second, that notwithstanding this greater loss the tempera¬
ture so often rises and remains high. One possibility only
remains—namely, that the production of heat within the
body is abnormally increased.

The next question that suggests itself is this—Is the heat
production steady, or is it fluctuating? We have seen that
the heat loss, as gauged by the condition of the surface, is
subject to wide and irregular variations, not merely from
day to day during the course of the fever, but even from
hour to hoar in the same day. Is there any similar irregu¬
larity in the rate of heat production? To answer this
question we must again fall back on calorimetry. Thermo-
metrical observations are of no service. The daily balance
at my banker’s tells me nothing of the variations in my
receipts. It depends on out-goings as well as in-comings.
The temperature of the body is merely a function of tne
difference between heat income and heat expenditure at
any moment. Now, we cannot well shut up a fever patient
in a calorimeter for hoars or days together, so our direct
knowledge of variations in human heat production during
fever is of the slightest. We must have recourse to experi¬
ments on animals. The only recent investigations which
have been conducted with a view to directly answering our
question are those of Wood and his assistants. An examina¬
tion of their numerical results shows that in the sep-
ticmmic fever of dogs and rabbits the hourly rate of
heat-production does vary in a remarkable way, even
under uniform conditions as to feeding or fasting. The
variation shows in some animals a tendency to rhythm,
being usually higher towards the evening. Feeding intro¬
duces* marked increase of heat-production in the normal
Aureal, and 1 the increase ie not absent in fever. Further
experiments are to be desired, but of the mere fact of

fluctuation in heat production there seems no doubt. Some
of the figures, morever, show that, as the course of the
temperature varies, the rate of heat production may actually
be highest when the temperature is lowest: an excessive
rate of heat loss may overbear and so disguise a simul¬
taneous excessive rate of beat production. And, conversely,
the time when the temperature is high may coincide with
a time when the heat production is low. The inference
from this is very important—namely, that the height of the
temperature in fever is in great measure dependent on the
momentary relation of the two processes of heat production
and heat loss. And inasmuch as these two processes tend
to vary irregularly, with but a weak nisus towards a daily
rhythm, the fluctuations of the temperature do not afford
au accurate measure of the changes in either process. The
daily and hourly variations in febrile temperature are wider
and more irregular than those in health: febrile tempera¬
ture is inconstant. Moreover, trifling changes in the sur¬
roundings of the patient or in his functions readily send his
temperature up or down: febrile temperature is unstable.
The two cooperant factors of the temperature are acting
more or less independently: thermotaxis is enfeebled or
overpowered.

Dr. Hilton Fagge (whose name I mention with sincere
and affectionate respect) has in his classical treatise on
Medicine befriended, or rather perhaps adopted, a suggestion
of Liebermeistor’s which requires some comment in this
connexion. The wide acceptance among English students
which any theory so endorsed is sure to gain makes me
anxious that it should not pass without some critical
examination. Liebermeister takes up the position that
“ pyrexia consists, not in a mere rise of the temperature of
the body, still less in increase of heat generation, or in
diminution of loss of heat, but in a change in the normal
function of heat regulation by which the production of heat
and its loss are so balanced as to create and maintain, while
the pyrexia lasts, a higher temperature instead of the
normal temperature. One might imagine the index of the
regulating machinery to be shifted upwards, so that it is
‘ set,’ not at 98 4°, but at 101°, 102°, 103°, or even at a still
higher point.”

The first objection I have to raise is that, if regulation means
anything, it means, as I have already indicated, not merely
an average uniformity of temperature persisting for any short
period of time. Such a uniformity only implies that for a time
the average losses of heat by all channels balance the average
gains from all sources. So far as we know, it may be a
fortuitous equation between two independently varying
quantities. Regulation implies more than this—very much
more. It implies stability: it implies such an intimate
correlation of the producing process to the discharging
process that their variations are not independent, but con¬
nected and concurrent; it implies a nisws towards a normal
which is potent to overcome disturbing causes. We may
know that a system of forces is in equilibrium when they
keep a body at rest, but this rest is no evidence that the
equilibrium is stable. To determine that we must disturb
the body and note its behaviour. If it always returns to
rest again, it ha? not merely equilibrium, it has stability.
But, as I have just said, febrile temperature, even when it
is at its height and oscillating with fair steadiness about a
mean level, is marked by its instability. A trifle that in
health would have but a vanishing effect will in fever pro¬
duce a large and enduring variation. A whiff of cold air, a
little food, a passing excitement, a feeble muscular effort,
will send up or send down the temperature. The thermo¬
static character of the healthy normal is conspicuously
absent in the mean high level of fever. The imperfect,
daily rhythm of temperature observed in some continued
fevers is no evidence of true regulation. We have seen that,
even the fluctuating heat production of a fevered animal
showed signs of a periodicity. In health this rhythm is deep-
seated, and singularly persistent in spite of the most various
disturbances. That it should to some extent * show through ’
the irregularities of the fever heat is not wonderful: it merely
proves that not all the thermal processes are utterly perverted
in pyrexia; some that are normally rhythmic may be rhythmic
still. But regulation has to do with balancing the integral
sum of all the processes, and it is that balance which is
overthrown, or at least rendered tottering, in fever. Lieber¬
meister would seem, in fact, to have for the moment fixed
his attention too closely on the characters of the temperature
curve during the fastigium of some particular fever; and to
explain its apparent average constancy threw out A sugges-

510 Thk Lancet,]

DR. D. MAC ALISTER OX THK NATURE OF FEVER.

[March 12,1887.

tion which has fascinated others more than himself. The
cases given in support of his view are, I think, special, and
admit of other interpretations. And he has admitted that
its application to clinical and pathological facts must be
limited and qualified. Dr. Hilton Fagge puts it forward as
sufficient for all purposes, with an absoluteness which
Liebermeister himself would hardly admit. According to
Dr. Fagge, in fever nothing is changed; the norm of
temperature is merely re-set. As Cohnheim puts it, the
thermal mechanism of the man is of a sudden transformed
into that of a bird. How is the transformation effected?—
by what agents, acting on what mechanism ? What deter¬
mines the new fixed point of regulation ? Is it fixed at
all, or only sliding? How is it ever re-fixed? All these
questions follow on the back of Liebermeister’s explanation,
and the worst of them is that they are not merely un¬
answered but unanswerable. One cannot conceive a phy¬
sical or physiological method by which they might be
attacked. This, as I understand, is what Cohnheim means
when he says the theory has “ein gewisser mystischer
Beigeschmack,” and, in spite of Dr. Fagge’s gentle protest, I
confess 1 think the epithet not unjust.

The risk of laying too much stress on the high tempera¬
ture of the body, and of regarding it per se as an index of
the hei^t production, is, I think, further exemplified in a
recent address by Dr. Ord to the Medical Society (Oct. 1885).
Let me remind you of his words ; they are admirably chosen
and state the formal difficulty’with great force: “The in¬
creased heat of the body in fever is to me a very constant
stimulant of thought. When I ask people how it comes
about, 1 am generally told that it is simply a matter of in¬
crease of combustion; that the oxidation processes of the
body go on with undue vigour in fever; that the system is
burning its candle at both ends, and that the two flames
give more heat than one. When one looks at a patient who
has passed through a febrile illness, one is ready to accept
the explanation. He may have had no wasting discharge,
hfemorrhage, or other obvious drain, yet there he lies,
bloodless and emaciated to a degree which leads one readily
to believe that on his bed of fever he has been consumed ia

all his tissues by an unseen fire.But for some years my

acceptanceof this ready and most plausible way of accounting
for tfie phenomenon has been hindered by an attentive con¬
sideration of an article on the‘Process of Fever,’contributed
by Dr. Burdon Sanderson to the Reports of the Medical
Officer of the Privy Council for the year 1875. The article
contains an exhaustive notice of the best observations made
up to that time with reference to heat production in the

body r during pyrexia.1 refrain from recapitulating the

complex and very refined data upon which Dr. Burdon
Sanderson sums up impressively. Suffice it to say that, after
careful analysis of this data, he writes thus: ‘The general
conclusion to which the preceding calculation leads us is a
very important one—namely, that although as comjiared
with the heat production of a normal individual on fever
diet the heat production of a fevered person is excessive,
it is not by any means greater than the heat production of
health.' There is in fever, it must be admitted, increased
exhalation of carbonic acid and increased excretion of
urea, but after calculation they do not represent a source
of heat sufficient to cause the increased temperature of
the body. 1 have read the article again and again, I have
referred to various authorities on the subject, and I am
compelled to say that the increased combustion explanation
which satisfied me before has no longer the same value. To
what, then, as I felt obliged to lose faith in my first belief,
should 1 turn? Might, as some have argued, the increase of
heat in the body be brought about by’ retention, by 3ome
state of the surface which would prevent the liberation of
heat from the body and lead to accumulation within ? The
well-conducted observations of Leyden and Liebermeister
tend to show that, far from being retained, heat is discharged
from the surface in larger quantities in fever than in health.
And we all know that intense hyperpyrexia constantly
coexists with profuse sweating, involving the freest dis¬
charge of heat from the surface of the body, as in severe cases
of acute rheumatism. If we are bound to deny the cogency
of the two explanations, we are compelled to find anew one.”
Dr. Ord then goes on to suggest what I may call a new vera
causa— that is, a possible cobperant cause for the liberation
of li9at in fever,—about which 1 shall have something to say
later on. My object in making this long quotation has been
to show that, while he fully appreciates and admirably states
the experimental facte concerning fever which I have already

touched on in this lecture (the failure of the retention
theory’, the increased discharge of heat, the increased produc¬
tion therein inevitably implied--nay more, the indefeasible
evidence of increased “combustion’’furnished by the increased
products of combustion—namely, carbonic acid and urea),
he is stumbled by finding that they “do not represent a source
of heat sufficient to cause the increased temperature of the
body.” I venture to suggest that the difficulty is an unreal one.
Dr. Burdon Saudersou everywhere distinguishes most care¬
fully between thermogenesis and temperature. He even .says
there is “the strongest possible evidence that increased or
diminished temperature has no necessary connexion with
increased or diminished production of heat.” “ A source of
heat sufficient to cause the increased temperature of the body
would be a phrase which Dr. Burdon Sanderson would hardly
recognise as his own ; and if we give it the meaning it was
probably intended to convey—that the increased production
of heat in fever is not accounted for by the increased com¬
bustion of the tissues as evidenced by’the excreted matters
I can only say that 1 find nothing in the paper referred to
that supports such a statement, and I do not know of any
measurements which suggest it. There is high temperature
in fever, and there is increased production, but the one is
not the measure of the other. There is increased heat
production in fever as compared with the heat pro¬
duction of health on the same diet, but not necessarily
as compared with that on full diet. Somewhere between
these two propositions comes Dr. Ord’s, and I am afraid that
between them it comes to the ground. I shall be glad if a
re-examination of the premisses convinces him that he need
not lose faith in his first belief. Dr. Sanderson’s memoir,
taken in conjunction with Frofesscr Wood's, which supple¬
ments and corrects it, when properly weighed, will show
him that his first belief is true, though perhaps not the
whole truth. And as a final satisfaction I may add that,
even though the preamble of his address is unproved,
though the discontent with the existing theory which acted
as a stimulus to his research was not well founded, the
happy’ sugge-tion to which it led him appears to me to
be true notwithstanding, in a certain guarded and limited
sense.

Let me now recur to the outcome of Dr. Burdon Sander¬
son’s analysis above referred to, because in speaking of
the experimental evidence of increased heat production
in fever I made no allusion to his results. On the
surface they appear to tell against that evidence, but
properly considered they are not inconsistent with it.
When we say that more heat is produced by a patient
in fever than by a patient in health, we must add
the proviso— in like circumstances. One of the most im¬
portant of these circumstances is diet. I being in health
can, by eating to excess, raise my rate of heat discharge
far above my usual rate, and I can lower the rate by-
fasting and still remain in health. If I become fevered I
eat less and less, but my r rate of heat discharge does not
fall accordingly. In the report already mentioned,
Dr. Sanderson, from the data before him, finds that the heat,
production of a fevered patient might bo about 50 per cent,
higher than in the same patient in health on a low diet.
And if that is the case, some “increased combustion
explanation” is not only satisfying but inevitable. Admitting
increased heat discharge, increased exhalation of carbonic
acid, increased excretion of urea, we must admit a source
whence they are derived. They cannot come from the food
consumed, for that, is notably reduced in quantity; they can
only come from the body substance itself; there must be
increased combustion—the tissues must be “ consumed by an
unseen fire.” But, to go further, there are not wanting
grounds for believing that fever heat is often greater than
normal heat even on a full diet. The Philadelphia experi¬
ments, made since Dr. Sanderson's paper was written, enable
us to follow the thermal history of an animal for several
successive days under varying conditions of diet and in
varying degrees of pyrexia. The outcome is that in dogs
and rabbits at least the fundamental part of the febrile pro¬
cess is an increase in heat production “by chemical move¬
ments in the accumulated material of the organism.” And
though, to use Professor Wood’s expression, this increase
was usually insufficient “to overplus the loss of production
from abstinence from food,” in some cases it was more than
sufficient. Moreover, reasons are given—valid reasons, as I
think—for surmising that what is occasional in the lower
animals is probably common in man, in whom febrile move¬
ment is more pronounced and severe. In other words, it is

The Lancet,] MR. R. J. OODLES: SURGICAL TREATMENT OF PULMONARY CAVITIES. [March 12, 1887. 5U

probable that in the fevered man there is sometimes an
absolute, and not merely a relative, increase of heat pro¬
duction.

Allow me, in conclusion, to suggest an image; it is not
perfect; it is far from being an argument; it is only an
illustration of one aspect of the question before us. Some
of us, in travelling by railway or by steamer, have been
startled by the sudden stoppage of the engine. On inquiry
we are told that the “ bearings have heated,” and we have
perforce to be patient till they are cooled down. The
normal temperature of the engine is dependent on the con¬
sumption of the fuel in its furnace, and when it is in good
order its parts work together with but little wear and tear.
But from unequal stress, or excessive speed, or defective
lubrication, the friction at some bearing point increases, and
soon the bewaring becomes an abnormal source of heat, use¬
less to the engine as a motive power and fraught with
danger to its structure, for it means increased wear of the
wonting parts, deterioration of their temper and their
strength, and, as. the heat mounts high, actual consumption
and oxidation of their substance. The hot bearing is in a
state of fever, its heat is wasted, and it is wasting. The
warmth, the carbonic acid, the urea of health are evidence
of so much food-fuel usefully transformed; the excessive
heat and the excessive waste products of fever are evidence
that the fabric itself is being wastefully consumed.

Intuits

OX THE

SURGICAL TREATMENT OF PULMONARY
CAVITIES.

Delivered at the Consumption Hospital, B romp ton,

By RICKMAN J. GODLEE, M.S., F.R.C.S.,

■SUBGEON TO THE HOSPITAL AND TO UHIVERSITV COLLEGE HOSPITAL.

LECTURE I.

{Concluded from page U>9.)

I now propose to give in some little detail the notes of some
■of the cases of pulmonary abscess which I have treated, and
thus endeavour to illustrate the chief facts with regard to
the various classes, only premising that, as in many other
thoracic complaints where recovery takes place, a certain
amount of uncertainty may occasionally remain as to the dia¬
gnosis; but before taking up the subject of gangrenous cavities
I must refer to a very interesting paper by Dr. Coupland, 1 the
text for which was a case of gangrene of the lung, following
the bursting of a suppurating lymphatic gland situated near
the bifurcation of the trachea. Surgeons are well acquainted
•with the condition of lung which was thus set up; it often
follows cut throat or such operations as excision of the jaw
or amputation of the tongue, where, if proper care be not
taken, the discharges are highly septic and expectoration is
difficult; it is one in which patches of pneumonia, started
by the presence of putrid pus in the bronchi, are by the same
cause converted into fetid gangrenous cavities. It is a
■condition of things which, as was pointed out by the late
Dr. Pearson Irvine, often follows the pressure of an aneu¬
rysm or other tumour upon a bronchus, for a precisely
similar reason. In the case in question an attempt to
reach what was hoped to be the main gangrenous patch,
hut turned out to be only one of many, led to the setting
up of pneumothorax and pleurisy, and hastened the in¬
evitable end. Dr. Coupland’s paper is important not only
for his suggestions as to treatment, but also for some
very interesting statistics gathered from the post-mortem
records of the Middlesex Hospital. He tabulates a con¬
siderable number of cases, showing that by far the larger
number follow croupous pneumonia, whilst many result
from such causes as those to which, reference has just
been made. He also adds an account of the relative pro¬
portion in which the different , lobes of the two lungs are
affected, showing how frequently the upper lobe of the right

Medical Journal, 1885, vol. it., pp. 437-433.

lung suffers as compared with that of the left—a point to
which I shall again refer in some remarks on the anatomy
of the bronchi, which are to follow in the next lecture. The
state of the pleura was also ascertained. There were adhesions
in only a small proportion of the acute cases, and though
they were present in all the chronic ones they were not
always conterminous with the gangrene. In some acute
cases there was more or less abundant lymph, in a few
empyema, and in a few hardly any pleurisy, t will also
abstract from Dr. Coupland’s paper, as briefly as possible,
the notes of some of the recent, but now classical* cases
which have been published. )

1/1. A boy aged seventeen swallowed a bone in November,]
*1883. He developed bronchiectasis, but completely recovered I
,'after coughing up the bone in February, 18fk. This, I think,
is most instructive, not only as showing thatthe bronchiectasis
and induration of the long, which had taken four months to
develop, could be completely recovered from, but as indicating
the line of treatment in such cases—a fact 1 will return to
in the next lecture.

2. Dr. Magrath’s case,* where a piece of grass became im¬
pacted in the right lung of a boy aged seven. Death occurred
after ten weeks. The lower lobe of the lung was riddled
with abscesses. The diaphragm (as in one of my cases) had
been perforated by the abscess, and there was secondary
caries of the spine.

3. Dr. Cayley’s case, 3 which was one of a low form of
pneumonia, resulting in a basic cavity containing five or six
ounces of offensive pus and sloughs of lung substance. He
had only been ill for five weeks, but had the appearance of
a man in the last stage of phthisis. The cavity was opened
in the ninth interspace, bat the case ended fatally, being
already too far advanced. There were signs of old tubercular
mischief in the lungs.

4. Dr. Solomon Smith of Halifax records a case* where
gangrene followed acute pneumonia, and where death
Followed an incision into the abscess after nine days.

5. Dr. Cayley’s case of a gangrenous abscess following ear
disease, 5 in which Mr. Gould punctured the abscess with a
trocar, but on introducing the tube failed to drain the
cavity at first; it afterwards, however, buret into the
artificial opening, and the patient made a good recovery.

6. Some cases are recorded in a paper by Dr. Mosler, read
before the German Medical Congress at Wiesbaden in 1883,
in which he recommends the incision of the lung with the
actual cautery for the extraction of foreign bodies. I am
not able strongly to endorse this advice (though with deep
incisions it may possibly be advisable), for the use of the
knife does not, as a rule, lead to formidable btemorrhage, and
the charring of the tissues must cause considerable difficulty
in any exploration with the finger.

7. Dr. Ed. Bull of Christiania 0 records a case of circum¬
scribed gangrene of the lung, which was opened successfully.

It may be taken for granted, then, that the majority of
the cases of gangrenous abscess which come into the hands
of the surgfen are the result of acute pneumonia, and are
situated near the bade of the lung; and it may be added that
his aid is most likely fco be needed in those cases in whieh
the gangrene is not very extensive, so that the patient
survives the immediate effects of this process. Some of
these cases, it is well known, recover spontaneously, the
pus being expectorated; bat in others a condition of things
results such as is often met with in abscesses bursting spon¬
taneously m other parts of the body—namely, that the
opening being insufficient, and perhaps unsuitably placed,
the sac is always more or lees filled with the discharges,
which in the cases we are considering are always highly
septic, and therefore irritating. The abscess, consequently,
shows no tendency to close, but, on the contrary, increases
in size. It is not a good plan in such cases to wait long
before making the external opening—that is, if the position
of the abscess can be accurately determined,—because, as was
pointed out when the subject of empyema bursting into the
lung was discussed, 7 and as will be still further illustrated
when the subject of bronchiectasis is before us, the presence
of fetid pus in the bronchi and trachea is very likely to lead
not only to serious consequences in the diseased lung, but
also in the sound one: but, at the same time, it is not often

* The Laxcst, rot. 1., p. 89.1880.

* Cllnloal Society’s Transactions. March, 1879.

* The Lasokt, 1880, vol. L. p. 80.

’ Medico-Chlrurglcal Transactions. vol. lxvii., p. 309.

« London Medical Record. 1882. pp. 90. 91.
t Lectnree on Bmpyensa, The Laxcxt, vol. i. 1888, p. 96.

ed by

Google

5 12 The Lancet,] ME. R. J. GODLEE: SLRGICAL TREATMENT OP PULMONARY CAVITIES. [Mabch 12,1897.

1 01
V:

wise to make an incision through the chest-wall until the
situation of the abscess has been ascertained by means of
an exploring trocar, and even then the troublesome question^
of the presence or absence of pleural adhesions has to ber
settled before the lung itself is incised. jt

That one may be misled by apparently the clearest physical
signs of the presence of a cavity is illustrated by a case that
I saw with Dr. Douglas Powell and Mr. Horace S. Howell. It
was that of a gentleman aged about thirty-five, who hpd
marked physical signs of a small cavity about the fourth
right interspace in front, the rest of the lungs being appa¬
rently almost if not quite healthy. The condition had lasted
several months, and there was at times a copious fetid
expectoration, at times very little of any kind. He was
fairly nourished, but had some clubbing of the fingers, and
was on the whole rather losing ground. A trocar was
inserted (in July of last year), but no pus was met with.
The signs, however, seemed so unequivocal that an incision
was made through the chest wall, and, ss strong pleural
adhesions were found, the lung was incised and the incision
enlarged with dressing forceps and the finger; but the
abscess, which I cannot doubt was in close proximity to the
seat of operation, was missed. Rather free haemorrhage
and some hemoptysis occurred, which did not, however,
give any trouble, and a drainage-tube was inserted in
the hope that the abscess might burst into the track
thus made, as happened in one of Dr. Cayley’s cases
mentioned above. This was unfortunately not the case
here. The wound healed without any trouble, but the

J iatient remained in statu quo; at least ne continued when
ast heard of to expectorate pus from time to time. The
general health certainly improved, and the expectora¬
tion became les9 fetid, but 1 doubt whether these results
can be attributed to the operation. Clearly from this case
a lesson is to be learned, for if a more careful search had
been made with the trocar or aspirator it is more than likely
that at last the pus would have been met with, and then
the cannula would have served as a certain guide to the
abscess; but an incision having been once made into the
lung, it is easy to understand that the finger might push the
abscess (perhaps a thick-walled one) to one side or the other,
and thus render the chance of opening it a very remote one.
If, however, the pus had not been met with, the patient
would have been no worse off for the punctures, and the
surgeon would have been saved the mortification of an
unsuccessful operation. Another practical point is illustrated
by this case, which I have seen exemplified in several others.
The haemoptysis followed the impinging of the trocar upon
some firm substance, and then slipping into an apparent
cavity. No doubt it passed through some pretty large
pulmonary vessel, either just before or just after the
puncture of the bronchus. Until the bronchus was per¬
forated, any bleeding from this cause must have been
external, and therefore easily controllable by pressure or
plugging. The deduction is that, if such tn obstruction
is met with, the trocar should either be made, if possible,
to work round it, or a puncture should be made in a
fresh position; for although the haemorrhage itself is not
likely to be formidable from so small a puncture, it may
be a very dangerous thing to have a patient who is under
the influence of an anaesthetic coughing up blood, perhaps
in rather considerable quantities. It should be added that
the wall of a gangrenous or bronchiectatic abscess would
not give this sense of resistance.

Whether this wn3 really a gangrenous abscess or a
bronchiectasis I am unable to say; but it illustrates well
the point I am insisting upon—namely, the unwisdom of
incising the lung until tne presence of pus is ascertained.
The following case might have led to a similar result if we
had not been successful in puncturing exactly in the right
place. It was that of a man at University College Hospital,
aged forty-two, who was admitted in May, 1884, under the
care of my colleague, Dr. Bastian. He was no doubt a
tubercular subject, one of the very hairy tubercular people.
His mother had died of phthisis when he was three years
old, but there were no other cases of this disease in the
family. He had, however, himeelf twice suffered from
haemoptysis sixteen and twelve years previously, and had
had nght pleurisy six years before, with which he was
laid up nine weeks. Beyond these illnesses, however,
he seems to have enjoyed good health, though he was
liable to take cold easily after the last attack. The
present illness began with a violent cough in Eeb. 1886,
-which lasted up to the time of hia admission on May 2nd,

and was accompanied by haemoptysis, night sweats, and
wasting. He was found to have very few physical signs on
the left side ; but the right side, which was larger than the
left and very motionless, was very dull at the lower part,
and not very resonant above. The breath sounds and vocal
fremitus were deficient at the lower part. On May 5th Dr.
Bastian drew off one ounce and a half of bloody fluid mixed
with pus, through a puncture in the eighth interspace
behind, and this was followed by a marked reduction of the
patient’s temperature. On May 16th I ascertained with *
needle the presence of the pus, but also that the coUec-
tion was a very small one, for the first puncture, which
was made a very short distance to one fide of that made
a few days before, did not strike the cavity; and on cut¬
ting down on the lung, after removing a piece of the
eighth rib and ascertaining the presence of pleural adhesions,
it was found that if the puncture were not made exactly in
the original spot the cavity would be missed altogether. It
was found, indeed, to be clearly in pulmonary tissue, and was
i ust large enough to admit the finger and two and a half inches
long, leading directly inwards from the external opening.
This is an example of a lucky puncture in the first instance,
for there were no sufficiently distinctive physical signs to
indicate the precise position of the abscess; and it shows
that in doubtful or suspicious cases several punctures at
different points should be made before the search is aban¬
doned. The man’s cough was very much relieved for a time,
the daily amount of expectoration sinking from one or two-
ounces to as many drachms, although the discharge from the
wound was quite trifling; thus affording an illustration of a
point that has been observed by several physicians—viz., that
the amount of expectoration is no criterion of the size of the
cavity, each pellet of pus, os it makes its way over the bronchi,
setting up irritation and causing a great secretion of usually
watery mucus; thus, a cavity not holding more than a couple
of ounces may cause a pint of expectoration in the day. The
patient improved very much for a time, but then he caught
a fresh cold, and his cough and expectoration became more
troublesome. He also had haemoptysis whilst he waa
endeavouring to recruit at Eastbourne. In August he was-
readmitted, with the wound quite healed ; but still a great
deal of dulness, with weak breath sounds and no vocal
fremitus at the right base, while at the upper part of the
right luDg there were tubular percussion note and bronchial
breathing. This side of the chest was still almost motion¬
less, but, instead of being larger, it was now considerably
retracted. He was very weak, and had no doubt tubercular
changes in this lung, to which many months afterwards he
succumbed.

The enormous amount of expectoration which may result
from the presence of a very small cavity was well shown in
the case of a patient who formed the subject of a paper
read by Dr. C. T. Williams and myself at the Medical and
Chirurgical Society, and reported in the last volume of their
Transactions. 8 1 will merely mention here that a small basic
cavity, not holding more than about one ounce, in a patient
sixty-seven years of age, had given rise to the expectoration
of more than a pint in the day for many months, and that
the free incision of this cavity led not only to the complete
stoppage of this troublesome condition, but was followed
by sound healing in rather more than sit weeks.

I will conclude this branch of the subject by the account
of two cases, one of which is a typical example, and the
other an illustration of the doubts occasionally surrounding
the diagnosis of these basic cavities.

The first is that of a delicate girl nineteen years of age,,
who was admitted into University College Hospital, under
the care of Dr. Bastian, on Jan. 5th, 1886, complaining of a
troublesome cough and abundant fetid expectoration. She
had suffered from typhoid fever in September, 1885, from
which she had recovered slowly, and had only returned to
her work a fortnight before the commencement of the
present illness. Her parents were alive and healthy; a
paternal aunt had died of consumption, and three of her five
brothers had suffered from abscesses. Her illness began four
weeks before her admission, in the early part of December,
1885, with an attack of headache, vomiting, and diarrhoea. She
had to give up work, and continued ill, but with no fresh
symptom, until the night of Dec. 31st, when, she awoke
coughing, and expectorated about a pint of similar fetid
material to that which she had continued to bring up in larger
or smaller quantities up to the time of coming to the hospital.

* Med.-Chlr. Tram., vol. lxlx., p. M7.

Tn Lancbt.I MR. R. J. GODLEE: SURGICAL TREATMENT OF PULMONARY CAVITIES. [March 12,1887. 513

Ever after the first attack of vomiting she had felt a dull
.ching pain on the left side, which was not altered by
coughing or vomiting, so I presume that the symptoms of
the acute attack were the expression of the onset of a
pneumonia, which led to gangrene of the lung. On admission
she was thin, flushed, and short of breath, with a weak,
husky, whispering voice, breathing at the rate of 32 per
minute, with a paroxysmal, distressing cough, resulting in
the daily expectoration of a pint or more of highly offensive,
thin, watery pus and mucus. The pain was slight, but
occasionally stabbing in the region below the left breast.
The temperature was about 100°; the pulse about 130. The
'.tort’s apex was not far from the normal position—fourth
interspace, one inch inside the nipple. The whole chest
moved badly, the left side hardly at all. The percussion
note was good, except on the left side below the eighth
dorsal spine, where there was dulness and almost complete
absence of breath and voice sounds, and usually there were
no adventitious sounds. We had therefore but very little to
guide us to the exact position of the cavity. Dr. Bastian
punctured the chest in the eighth space an inch behind the
interior axillary fold, and in the ninth space an inch
further forward, without result. On Jan. 16th we heard
moist sounds at the base of the lung and bronchial breathing
in the left axilla. Guided by the greatest intensity of these
signs, I passed an exploring trocar into the chest in the
posterior axillary fold in the eighth interspace, and hit the
cavity after introducing the instrument about two and a half
or three inches. An incision was then made down upon the
intercostal space, and, the pleura being found obliterated
by adhesion, the track of the cannula was opened up by
inus forceps, and a large cavity was reached in the lung,
rom which about twelve ounces of fetid pus escaped. I
did not remove a piece of the rib in this case, as the pus was
very offensive; thus, though a large drainage-tube could be
introduced into the cavity, a complete exploration was
impossible. The finger passed, however, through condensed
but broken-down lung tissue, but reached only the outer
part of an irregular cavi'.y. The tube, though four inches
long, no doubt only entered the outer part of this space, but
air was sucked in and out with the peculiar whiffing sound
which is characteristic, I think, of cases where there is a
ree communication with a bronchus—that is, as opposed to
asesof empyema. The expectoration at once ceased, but
hough the temperature on the second day fell to normal,
it rose again and remained at about 100° to 101° for a
fortnight, wlipn it rose to 103°. She then coughed up
a pint of offensive pus, and the dressing, which for
-ome time had been almost dry, was soaked with a similar
material. This no doubt meant that the walls of the cavity
had fallen together afterthetii'St evacuation, and both itsexits
ad become closed. The gradual accumulation of pus in the
lack cavity kept up the temperature, and the sudden fit of
coughing opened both of the exits again. Had I been able i
at first to introduce a still longer tube, no doubt this would
not have happened. It is a good illustration of a common
ource of trouble in cases of this kind, and shows that a
much longer tube is usually required than in cases of
-ttpyema. The temperature now kept about 99° to 100°
for another fortnight, and we thought we might remove the
mailer but longer tube which had been substituted for the
riginal large one; but it was too soon, for the temperature
••ent up again, reaching almost 104°, and necessitating the
ilatation of the sinus and the reintroduction of the tube.
After this the temperature remained for a few days about
'00°, and then became peaky, ranging usually from 99 or
90° to 101°, but twice reaching 102°. There was in the
meantime but slight discharge and occasional slight expec¬
toration, and so I have no doubt that, all this while, there
was not a complete drainage of the cavity. Ultimately she
went to Eastbourne on March 25tb, about nine weeks
after the operation, still wearing the tube; and a month
der returned, with nothing to show except a retracted
chest with some curvature of the spine and deficient
"esonance and weak breath sounds over the affected part,
file tube was now withdrawn, and in a week the wound
was healed. The patient has since remained well.

The second, a somewhat similar case, one which illus-
frates the same difficulties in treatment, I saw with
dr. Broadbent and Dr. F. Russell in May, 1884. The patient,
*0 unmarried woman aged forty-four, was seized with the
ymptoms of pleuro-pneumonia on the right side on
jiay 26th. The pain in the side and back continued till
'une Uth at midnight, when she expectorated a large quan¬

tity of offensive pus. The expectoration, which was accom¬
panied by high fever and purging, continued till June 19th,
when I saw ber. She had then a patch of dulness as large
as the palm of the hand in the right front, reaching up to
the nipple and down to the liver dulness. Over this area
there was some puffiness and tenderness, and tubular re¬
spiration was to be heard. The rest of the chest was resonant,
but loud mucous rales were everywhere audible, and the
lungs were evidently becoming completely choked up. The
patient was in great misery, the cough being most distressing,
and apparently she had not long to live. An opening was
made in the seventh interspace, immediately below the
nipple, and the finger passed readily into a cavity, from
which a large quantity of offensive pus escaped. It felt
rough and irregular, and seemed to be an excavation in the
lung itself; it certainly was not the general pleural
cavity, but might of course have been a localised
diaphragmatic empyema with much lymph on the
walls of it. A tube three inches long was intro¬
duced, and the wound was dressed with oakum. The
result of evacuating this cavity was very instructive,
for not only did the expectoration at once cease, but the rest
of the lungs promptly recovered, so that in a day or two all
the rules had gone. The temperature fell almost or quite
to normal, and the diarrhcea stopped. Unfortunately, about
July 1st, the tube, none too long to begin with, was shortened
without my knowledge by fully an inch; and this was
followed by the same train of symptoms as occurred in the last
case, when the accumulation took place in the abscess- viz ,
malaise, nausea, fever, and at last the expectoration of fetid
pus. The sinus was dilated with bougies and a loDg tube
(five inches) was introduced; but we did not at once obtain
complete drainage, and a certain amount of pus was still
expectorated, though a good quantity came through and
alongside the tube. The temperature in the meantime came
down to normal, and the patient experienced great relief
from a suggestion of Dr. Broad bent’s that she should lie
upon the face, thus encouraging the escape of the pus
through the wound and so diminishing the cough. The cough
and other troublesome symptoms gradually disappeared;
the tube by July 25th had been reduced to three inches, and
the patient was convalescent and had left her bed, when she
felt a sharp pain at the right hypochondrium, which soon
passed off. Next morning, however, pus appeared in the
motions, probably from a diverticulum of the abscess, which
the tube had never drained efficiently, and this continued,
though gradually diminishing, for about three weeks. The
tube slipped out on July 29th and was not replaced, and
from this time the patient msde an excellent recovery, a
little dulness and weakness of breath sounds round the
affected area and a slight drawing up of the liver being all
that remained from the attack.

This rupture of a pulmonary abscess into the colon
seemed to me an almost inexplicable occurrence; but in
January of this year I made a necropsy on a case of liver
abscess bursting into the pleura, which opened my eyes a9
to the manner in which a diaphragmntic empyema, or an
abscess even in the anterior part, of the lower lobe of the
right lung, may discharge itself in this way. It may pass
down behind the posterior part of the pleura, keeping
rather to the right and perforate the attachment of the
diaphragm about the tenth rib at the posterior fold of the
axilla, when it will be quite close to the hepatic flexure of
the colon.

In both these cases there are the same lessons to be
learned. First, if it be suspected that the cavity be in
gangrenous lung it should be well opened up and explored
by the finger, and a good long tube should be put in.
Secondly, the tube must be kept in until the discharge has
almost, and the expectoration quite, ceased-, while the tem¬
perature remains low, for the cavity is probably an intricate
one, and it is not unlikely that the walls will have to throw
off sloughs, and cannot, therefore, immediately assume the
healthy condition which is met with in the case of most
empyemata. They both illustrate the complete recovery', as
regards physical signs at allevents, which may be anticipated
in such cases.

Ayrshire Medical Club.—A t the annual meeting
of this club, held on the 4th inst., Dr. Robertson, of Ardrossan,
was elected President; Dr. Dobie, of Ayr, Vice-President;
and Dr. Moore, Secretary. The membership now numbers
fifty-three.

514 The Lancet,] DR. WARNER; ACTION OF NERVE CENTRES AND MODES OF GROWTH. [March 12,1887.

ABSTRACT OF

$lectures

, OX THE

ACTION OF NERVE CENTRES AND MODES OF
GROWTH.

Delivered at the Royal College of Surgeons,
February, 1887,

By FRANCIS WARNER, M.D., F.R.C.S.,

HUNTERIAN PROFESSOR OF COMPARATIVE ANATOMY AND PHYSIOLOGY
AT THE COLLEGE.

LECTURE I.

ON THE ACTION OP NERVE CENTRES.

Movements are here studied as signs of action, observa¬
tions being recorded by verbal description, or by the graphic
method. 1 To study a movement involves the consideration
of the part moved, the muscles moving it, and the nerve
centres which stimulate them, while the movement itself
indicates the time and quantity of action in the nerve
centre corresponding; these are called the intrinsic attri¬
butes of the movement. The time of a movement often
affects its outcome or sequence; movement of a single part
is a comparatively simple fact; when several parts are
acting, combinations of their movements occur. The special
combinations of movements are simply the result of the
time of the action of each of the moving parts. In observing
movements of the digits two modes of description may be
employed: the series of movements of each digit may be
described, or the series of coincidences or combinations of
acts may be recorded. Either plan may be used, as
convenience may dictate; thus, it may be said that each of
the five digits Hexed at the same moment, or it rnay be said
that the hand assumed “ the convulsive posture.” What we
commonly call an action, such as writing or walking, is
really an observed series of combinations of movements;
this applies equally to spontaneous, reflex, or voluntary
actions. When a child seizes an orange we observe a series
of movements, each of which can be performed separately. ^
while the character of the action depends upon the time and
quantity of each of the component movements. Series of
movements in plants were then described. The quantity
of a movement is its second intrinsic attribute; it indicates
the quantity of action in the nerve centre. Quantities of
motor action are studied in observing postures of the body
as signs of the ratios of force in the nerve centres. In “the
straight extended hand” 3 we observe a sign of the tem¬
porary equilibrium of the nerve-muscular apparatus for
flexion and extension. The posture may change, the fist
being clenched; the change of hand posture is a sign of a
change in the ratio of force acting in the apparatus for
flexion and extension, th'e force of flexion being increased.
Thus we see the outcome of the balance or ratio of quantities
of motor force demonstrated by the observation of postures.
Examples were given concerning other hand postures. It
was argued that postures often indicate the condition of the
nerve system, that they are often changed by the sight of
objects, that they are due to the ratios of force exerted by
opposing portions of nerve-muscular mechanism, and hence
that postures are signs of ratios of action that can be con¬
trolled by incident torces, such as light, sound, mechanical
irritation, &c. The total quantity of movement seen in
man may depend upon the quantity of blood-supply, and
upon the amount of stimulation of the subject; the blood-
supply and stimulation are needed to produce movements.
In anaemia and in starvation the quantity of movement is
lessened. In darkness but little movement occurs in a well-
nourished man; the sight of an object may be followed by
the head turning towards it, and by other series of move¬
ments, such as result in the seizure of the object. The
quantity of movements in plants is mainly determined by
light and heat.

/The proposition was then enunciated that every movement

‘ 8ee Journal of Physiology, vol. Iv., No. 2; and vol. vH., No. T.
a Bee Phytical Expression, it# Mode* and Principle*, chap. 1*.

depends on some change in the time or the quantity of
action in the nerve-muscular apparatus producing it, and
that every such change in the apparatus must be preceded
by some stimulus acting on it immediately antecedent or
more remotely antecedent. AiuoDg the forces which,
acting upon a man, may stimulate and control the indi¬
vidual movements, the following were mentioned and illus¬
trated: light, heat, sound, mechanical irritation, &c. Every
movement must have some sequence, whether it be to
supply food or be expended as physical energy. The-
sequence of a movement must be carefully separated from,
the cause or antecedent. To say that the bee visits the-
flower to get honey is to imply that the honey causes th*
visits. It was argued that the bee sees the flower, and
afterwards gets the honey; that it is not the honey, but-
the light reflected from the flower, which determines tho
movements of the bee. The forces which control the time
and quantity of the acts composing a series of movements
are really the antecedents of the results of the action. The-
sequences, outcome, or results of movements are often said
to be useful, intelligent, voluntary, purposive, &c. What-
is meant by the outcome of an action being useful ? M hat
is the connotation of the term “ useful ” expressed in terms-
of physical criteria that can be observed ? Concerning the-
meaning of the word “ useful ” as applied to the outcome-
of an action or movement, the primary idea seems to be-
that the outcome produces some physical change that can
be observed. A movement which brings food to the subject-
is said to be useful partly because it produces some effect
or impression on the subject. The movements of degluti¬
tion, respiration, and all the movements of organic life are-
useful because, among other things, they impress tb*
subject considered. We do not say that all acts which
produce an impression are useful, but to be useful there
must be survival in the subject producing the act, or in
others considered at the same time. It is insisted that
usefulness is not an intrinsic character of any movement,
but a relation of its outcome to surrounding objects.

Impressionability as a property in man may be indicated
by movements. If the movements of a man are regulated
and controlled by light or sound, lie is impressionable to
these forces. In coma impressionability is lost, but the eyes
may move spontaneously and independently of one another;
this is seen under chloroform, and in the deep sleep of
infants. Actions may be defined as similar if on two or
more occasions there be movements of the same parts of the
body, the action of each part respectively beiug alike in
time and in quantity on each occasion. In a body of
soldiers at drill the movements of each man are similar.
Thus actions, or series of movements in the same or in cor¬
responding parts, are identified -as similar on account of
their intrinsic attributes. Similar movements may recur in
a man, or be repeated; each such occurrence after the first
is a repetition or reversion of the action. A trick or habit
in a man may revert in his children. Similarity of actions
is here defined as an observed fact, not as a question of
relation to antecedents or sequents of the action.

Automatic or spontaneous movements are such as have
no special antecedents controlling their attributes. Athetoid
movements are automatic; they occur in similar series when¬
ever any impression is made upon the subject.. Instinctive
movements, so called, probably imply a certain structure of the
qerve system due to its inheritance—such that when stimu¬
lated by certain surrounding forces the movements resulting
should be regulated by those forces, the sequence of such act*
producing some impression upon the subject directly or
indirectly. Purposive or intelligent movements are probably
always controlled by forces surrounding the subject, or by
impressions previously made; the sequences of such move¬
ments, rather than their antecedents, possess the character*
of intelligence. It seems that the purposive or intelligent
character of a series of movements is not due to its intrinsic
attributes, but to its sequents. The respiratory movement*
are considered very automatic when occurring in regular
and uniform order of time and quantity; but when the sight
and sound of various objects modifies them, to form speech,
laughter, &c., then they are signs of mental action. All
expression of min d and mental states is by series of move¬
ments, and these of coarse have their intrinsic attributes,
observable in the hody. Coordinated movements are such
series of acts as have special characters, dependent upon the
time and quantity of the component movements. It is also
att essential character that the attributes of the series are
determinable by sight, sound, or other modes of force acting

gitized by GoOgle

The Lancet,] DR. WARNER: ACTION OF NBRYE CENTRES AND MODES OF GROWTH.

upon the subject. Movements may be classed according to
their results as respiratory, acts of deglutition, &e. .For the
purposes of a scientific classification of movements it is very
desirable that they should always be described according to
the parts moving, their intrinsic attributes, the antecedents
and sequents, or outcomes. All these characters are capable
of direct observation.

It has been said, What is the good of these studies ot
movements ? What practical advantages are likely to result
therefrom ? Nerve-muscular movements are physical signs of
brain action; with but few exceptions, they are the only
signs of brain action, and the only physical signs by whioh
we know anything of the action of mind. Describing facto
in man as we see them, in terms of movement, is probably
the best mode of attempting to do away with such meta¬
physical terms as “voluntary,” “intelligent,” “purposive,”
in scientific descriptions. Facts must be described in
physical terms before we are likely to find out their physical
causation. _

LECTURE II. -

THE STUDY OP MODES OF GROWTH.

In making a systematic study of movements in man, we
study one function in one class of subjects. We observe the
movements as signs of the time and quantity of action in
the loci of nerve tissue which produce them; thus we
learn much concerning vital action in one kind of tissue. If
the methods and principles found useful in studying this
one function in one tissue have been properly considered,
they are likely to be useful in studying other functions i
in other living subjects. In studying movements ws learnt ■
to note the parts ot the subject capable of acting separately, i
We learnt next to study the intrinsic attributes of each
movement, and also its antecedents and sequents. Having (
studied the nerve-muscular apparatus of man as our special
subject, and deduced certain principles therefrom, we
proceed to apply these to the study of various problems.
We shall find that many phenomena of growth are deter¬
mined by the forces which control the time aqd quantity of
growth in the units of living tissues. The study of move¬
ments requires the observation of a definite number qf,parts
of the body and a definite number of loci of brain tissue;
in growth the number of parts, or units, capable of separate
action is practically indefinite. Movement is in many cases
a reflex act; growth is, presumably, never spoken' of as a
reflex action. Movement often follows quickly upon an im¬
pression ; if growth results, it is slow in its manifestation.
Movements in mao are often signs of intellectuality; acts
of growth are never said to be sign9 of mind. The many
beautiful adaptations of growth in plants are not considered
signs of intelligence in the plant; but the movements of an
insect in visiting the flower are considered signs of its J
instinct. The results of growth are material changes, and
: «s such are permanent records of action, capable of preserva¬
tion ; movements do not necessarily leave any permanent
reoord in the subject of such kind as can readily be seep
and preserved. In speaking of movements as signs of action
in nerve tiasae and of growth, we deal with two functions
in the body. The outcome of nutrition in the child will
■vary at different ages; in the early years much nutrition is
consumed in making weight; in adult life much energy is
consumed in movement. In a child becoming choreio the i
wnight falls and movement increases. If we believe in one
aeries of laws of nature governing movement and growth,
■we must expect the forces controlling movements to he
those affecting growth. 4

We may observe the time of any movement, vital act, or
aet of growth; we commonly speak of relations in time as
the order of growth; in describing the processes of develop¬
ment the order of development is most important., We
moee commonly study the time of movement;.than, that of!
growth^ because the processes of growth are slower, and
■observation must be continued for a lcmger period to see any
<&afage than is the case in observing movement. Visible ■
movomahb'indicatea its own time to the observer, but does
not necessarily leave any permanent record j growth', .is a
frocefe Which: usually does not impress the observer with
toe Dma ef. Its acts, but leaves a result in visible form, A
nncle effect of movement in man is to produce, some fresh
paotazevctf Ctmdltioa of temporary, equilibrium. With regard
40 dboatm^m fcfthe effects of forces upon the subject, in the 1
msecfgnmtbamuch longer interval usually elapses between
toe MBfeahtSoarnf ®h* «ubject and the sequential effect than

[Maiicu 12,1887. 61$

that whioh takes place in a reflex movement. Hence move
instances of growth are called “spontaneous” than in cases
of movement. In flowers cross fertilisation often result^
from the fact that the anthers are, in certain cases, ripe
before the pistiL The time of dentition, the time when hair
grows upon the scalp, face, or pubes, are characters of the
normal process.

The second intrinsic attribute of growth is its quantity.
Many phenomena may be described, and receive some kind
of explapation by noting the ratios of growth in the part^
compared. To note the ratios of growth in & specimen is
analogous to studying postures which are due to ratios, of
action in the nerve-muscular apparatus; this suggests th^
hypothesis that the forces which lead, to certain postures in
man may be those which control his growth. Illustrations
were drawn from the modes pf growth seen in the develop^
ment of buds, and from comparison of wild and cultivated
plants., The ratios which indicate growth in man ore th?
subjects of anthropometry; ratios indicate the differences u»
growth of young and old leaves and in the parts of man at
successive ages. Unequal proportional growth of bilateral
parts is a common cause ot curvatures; this is seen in the
increasing curves of bones in the foetus as development
advances, and is abundantly illustrated in the stems of
plants. In the two halves of the body and in the corre¬
sponding members the ratios of growth are usually equal,
but the right arm is often larger than the left in girth—
probably owing to the greater amount of stimulation it
reqeives from the brain.

Among the forces producing certain ratios of growth we
see that light increases the size of leaves, while it diminishes
growth in internodes, and does not control the growth of
flowers. Light diminishes growth in the side of the stem
of a plant which is most illuminated, and curvature
towards the light results. Mechanical pressure, heat, and
electricity may to some extent control quantities of growth.
Gravity in plants.causes upward curvature of the stem and
downward curvature m the root.' Ii a-ciroularhole be made
in an iron plate,' heat iCausee equal extension of the metal in
all directions, and the hole is enlarged, .blit' remains circular.
For similar reasons, in the growth of bones in which
uniform extension is taking place in all directions, the
foramina enlarge, retaining their shape; this is seen
to a certain extent in the foramina of the pelvis. In
the skull of the infant the anterior font.auelle becomes
larger in the early stages of growth. If in the pro¬
cesses of growth one tissue or one part grow in greatei:
quantity than others, that' tissue or part is Said to be
hypertrophied. The Sequences of proportional growth
are many. In a composite flower the increased growth
which oacurein the style after the anthers have discharged
their pollen is followed by cross fertilisation. The ratios
of the growth of part* may bring about asymmetryjof form*
malformations, or .variations in development, and conse¬
quently in the use of parts; ex amp lee are seen in description#
of short-horned, and long-homed cattle, and in the proporr
tions of the beak of pigeons. Look at a germinating seed s
it consists of an embryo enclosed in its testa or covering,;
germination begins by. the swelling aud growth of the
.embryo; but the testa does not grow, it may stretch, a
little, bat soon the unequal, increase in siae of the embryo
and seed case.is followed by splitting of the testa. . ....

We often speak of one'subject growing similarly te
another, or of the growth in two subjects being similar,.,. It
often happens that the similarity of growth lainpart due
to equal ratios-of growth-ini the two ; in this sense similarity
of growth may occur in unlike subjects if the ratios, of
growth are equal in each. We found that movements in
two men may be said, to; be similar when they occur in the
corresponding parts.of each, and, are alike in their, time and
quantity.. Jn like manner aoto of growth are sometime#
said to oh similar when they occur in the corresponding
parts; of; two or moke subjects at the same time, and in the
same quantity aa in two. pear seeds grown under s im ila r
edreumstadcas, Similarity,-of. growth may be. partials-jin
two subjects the growth;may he similar, as to time,,or
quantity, or . kind. When two processes of growth are
different in kind they may be similar in time ; the growth
of leave# and of underground tubers may occur at tbeiaam#
time, and this may be the only point of similarity between
the two processes of growth. .

. In classifying facto concerning the processes of growth
according to sttch,intrinsic attributee as afe observable, our
object is to seek the cassation of the attributes -ved.

516 The Lancet,]

DR. T. J. M ACL AG AN ON PYREXIA AND HYPERPYREXIA.

[Mabch 12,1887.

Haying classed a number of facts as examples of unequal
bilateral growth, we may seek to determine the causation
of unequal bilateral growth. In pursuing such methods of
inquiry we follow methods similar to those which aided us
in studying the motor functions of the brain. Thus we have
lines of thought to guide observation. It is possible, and
indeed highly desirable, to arrange a museum in which
specimens are classified according to the attributes of their
growth, and the forces that stimulated their growth and
produced that special ratio of their attributes. Probably
this was in part the principle followed by John Hunter.

The rules that should be followed in making analogies
were pointed out. It was shown that we can only compare
things or acts as to the characters or attributes which they
possess in common; we may compare like functions as to
their time and quantity; it is only as to the time of action
that we can compare unlike functions; we do not directly
compare the material things, but the attributes of their
functions. Growth in a child and in a plant were then com¬
pared, and other examples were put forward. In our desire
to give some kind of explanation of facts in nature we use
processes of analogy. Acceptance of the hypothesis of evolu¬
tion encourages the study of analogies; our purpose in
making analogies between processes of growth is to classify
examples in the best manner for seeking their causation.
The term “ reversion” is used to imply that the outcome of
growth observed is similar in its intrinsic attributes to others
that have previously been observed. The reversion is a
repetition or reappearance of vital acts similar in their
intrinsic attributes, and occurring in similar subjects. The
following proposition was enunciated as an epitome of the
principles illustrated: “ Every vital act, or act of growth,
requires among its antecedents a supply of pabulum, and
stimulation by some force incident to the subject.”

PYREXIA AND HYPERPYREXIA.

By T. J. MACLAGAN, M.D., M.R.C.P.,
physician rx ordinary to their royal highnesses prince and

PRISCKS3 CHRISTIAN OF SCHLESWIG HOLSTEIN.

(Continued from page 4 67.)

The8B clinical facts afford distinct evidence that injuries
and non-inflammatory lesions of certain parts of the
nervous centres cause a rise in the temperature of the
body as great as that noted in inflammatory and febrile ail¬
ments. That such lesions give rise to such results shows as
clearly as evidence can that the nervous system exercises a
marked influence over the body heat. That all injuries of
the nervous centres do not give rise to this result shows that
this influence is not generally distributed, but is limited to
particular parts of the nervous centres. To recognise this
is to go a long way towards recognising the existence of a
thermic centre. And on no other view than this w>n the
facts which have been adduced be explained. The evidence
in support of the doctrine of a thermic centre is indeed
little, if at all, less potent than that on the strength of
which we recognise a vaso-motor, a respiratory, a cardiac,
and many other centres, whose existence we do not c-aii in
question. The chief difference is that the exact area of the
thermic centre has not been so accurately defined, though
sufficient evidence has been adduced to ead some observers
to indicate its probable seat. 1

So far as our present inquiry is concerned—so far, that is,
as concerns the theory of fever—the exact location of the
thermic centre is not a matter of importance: the important
thing is that we should recognise that the evidence au tends
to show that there is such a centre exercising a direct and
dominant influence over the body heat, and that rise of
temperature may be directly due to disturbance affecting it.
The acquisition of such knowledge could not fail to mate¬
rially influence our views as to the causation of fever. If
there exist a thermic' centre, and if injuries affecting this
are capable of causing a rise in the body heat, may not
the preternatural heat of ordinary febrile ailments be also
directly due to the disturbing action on this centre of the
so-called fever poison ? Such a question was bound to arise
so soon as the full bearings of the facts, physiological and
pathological, which have been related, were recognised. The
necessary outcome of the recognition of a thermic centre
was a “ neurotic " theory of fever. And no time was lost in
enunciating it; for in tne same volume in which Id* experi¬

ments are related, Wood 1 starts this theory. “ Granting,”
he says, “ the existence of a fever centre in the nervous
system, the laws of life teach us that there must be poisons
capable of acting upon it directly, so as to produce fever.
Such a fever would certainly be neurotic, although produced
through the blood, the vital fluid acting simply as a common
carrier. With this understanding of the terms, distinctly
clear proof is at present wanting that the fever even of
pyaemia, of the exanthemata, or of any so-called blood
poisoning is strictly hsemic, since such toxic fever may be
due to an action of the poison upon the central nervous
system.” This theory has been adopted and more fully
advocated by Hale White, who believes that “in specific
fevers, inflammations, traumatic and urethral fevers, the
rise of temperature is due to peripheral stimulation of
afferent nerves reflexly affecting tne calorific centre.” 3

That there exists somewhere in the brain a centre con¬
trolling and regulating the production of animal heat, and
that lesions affecting this may cause the temperature of the
body to rise, is a proposition which, in the face of the facts
related, can scarcely be called in question. It is a clinical
fact, demonstrated by many independent observations, made
during the last twenty years, that non-inflammatory lesions
of certain parts of the nervous centres have for one of their
symptoms a great and rapid rise of temperature. But, on the
other hand, it is equally a clinical fact that the body beat is
raised during maladies in which there is no suspicion of lesion
of the nervous centres. So various are the maladies of which
increased body heat is a symptom that it is primd facie
improbable that this increase should in all cases be brought
about in the same way, and the more we consider the
clinical facts daily brought under our notice the more
apparent does it become that all fever-producing causes are
not similar in their mode of action. And, independently of
the clinical evidence, a consideration of the physiology of
thermogenesis leads to the same conclusion.

The thermal apparatus consists of various parte, and is
distributed over the whole body, more or less. First there
is the thermal centre, situated in the brain, somewhere above
the junction of the pons and medulla. Such a centre would
be of no use, and could be no centre at all, without a con¬
nexion with the parts of the body in which heat is produced,
for without this it could exercise no influence over heat pro¬
duction. It must equally be in direct communication with
the parts of the body by which heat is eliminated, for with¬
out this it could exercise no control over heat elimination.
A thermic centre could no more control and regulate the
production and elimination of heat without a connexion
with the seats of heat production and heat elimination than
the vaso-motor centre could control the circulation through
the minute arteries without berng in communication with
the muscular coats of these vessels. The only way in
which such a connexion could be established is by mean a
of nerves, for nerves are the sole media by which impres¬
sions are conveyed to and from nerve centres. The parts
which go to form the thermal apparatus, therefore, are r
1. The tissues in which heat is formed. 2. The surface from
which heat is eliminated. 3. A central controlling power in
the brain. 4. Nerves connecting this with the heat-forming
parts of the body. 5. Nerves connecting it with the heat-
eliminating surface. The harmonious working of these
different parts of the thermal apparatus gives rise to the
phehomena of thermogenesis; and the general result is a
persistent temperature of 98'4°. Interruption of this
harmony causes the temperature to rise oy fall. Fall of
temperature is due either to lessened formation or increased
elimination of heat. Rise of temperature is produced either
by increased formation or decreased elimination. The latter
cause (the hypothesis of Treube) we have already considered
in its application to the explanation of the increased body
beat of fever, and have seen reason to reject it as incompe¬
tent to explain that phenomenon. There remains for con¬
sideration only increased formation. Rise of temperature
due to increased formation may be brought about in two
ways: by direct stimulation of the processes by which heat
is formed; or by diminished activity of that by which heat-
formation is inhibited, or kept within due bounds.

Bise of temperature due to direct stimulation of the pro¬
cess by which heat is formed— This process is the tissue
metabolism. Rise of temperature thus produced must,
therefore, be brought about by some agency which increases
that metabolism. Heat is an excretory product, a result of

i F. 216. * Practitioner, Jan. IS66-

Digitized byLjOOgle

Th* Lancbt,

DR. T. J. MACL46AN ON PYREXIA AND HYPERPYREXIA.

[March 12,1887. 5 1 7

retrograde tissue change, and cannot be produced apart
from that change. To say that heat could be directly
brought about by stimulation of a heat-producing centre
without increased tissue change would be to place heat as a
product on the same level and in the same category as
volition and emotion, which is .absurd. No, increased
heat due to direct stimulation of the heat-producing pro¬
cess must be due to the operation of some agency capable
of causing greatly increased activity of tissue metabolism.
But the most potent nervous influences of which we know,
those which exercise the most powerfully stimulating
influence over tissue metabolism and the nutritive pro¬
cesses which constitute it —happiness, change of scene, &c. f
—never do more than bring metabolism to the standard
of health; they cause increased activity of the trophic
influences which preside over metabolism, but they never
raise the temperature above the normal. That the con¬
tinuance of normal tissue metabolism is dependent on
influences conveyed to the tissues by the trophic nerves is
undoubted. But there is no evidence to show either that
any influence so conveyed is capable of causing the tempera¬
ture to rise above the normal standard, or that stimulation
of any portion of the nervous centres is capable of causing
such increased body heat as is noted in fever. Rise of
temperature due to direct stimulation of heat-production
must therefore result from the operation of some cause
whose influence is exercised directly, not on the nervous
system, but on the tissues in which heat is formed, the
morbific action taking place, not in the nervous centres, but in
the structure of the tissues. We can no more have increased
formation of heat without increased activity of the processes
"during which heat is formed, than we can have increased for¬
mation of urea or increased formation of carbonic acid with¬
out increased activity of the processes during which they are
formed. That is the combustion theory of fever—a theory
which we shall by and by see fitly and accurately explains
fhe rise of temperature in the most common and important
febrile ailments with which the physician has to deal.

Meantime we are dealing with the influence of the nervous
system. Though there is no evidence of the existence of a
special centre for heat production, we nevertheless admit,
and argue for, the existence of a thermic centre. If it has
no influence in beat production, what is the function of this
centre ? All evidence tends to show that its function is
essentially inhibitory, that it controls heat formation, and by
its over-constant action prevents it from passing due bounds,
and so helps to keep the temperature at the normal standard.
Inhibition restrains and regulates functional activity, as
the reins restrain and regulate the pace of a spirited horse.
Slacken the reins, and he hastens his pace; let them go, and
he is off at the gallop. Inhibition is an active, not a passive,
agency, and is in constant operation. This is well exemplified
by the action of the vagus on the heart; stimulation of that
nerve slows the heart’s action, and, if the stimulus be
strong enough, may arrest it altogether, the arrest taking
place in diastole. But the nervous system which supplies
this inhibiting force supplies also another, which, rescuing
the heart by another channel, has exactly the opposite effect;
it stimulates the heart to increased activity. These two
forces are in constant operation, and so counterbalance each
other that the heart is normally kept beating at the rate of
about 70 a minute.

Just as there is no organ whose normal amount of work
represent^ the full measure of its capacity, so there is no
function whose normal state of activity represents the fall
capacity of its performance; each is restrained and kept
within physiological bounds by the inhibiting action of the
nervous system. Tbe heat-producing function of the body
is no exception. Normally, heat production is counter¬
balanced by heat elimination; bat that is only while heat pro¬
duction is kept within due bounds by the constant control
of the beat-inhibiting centre. Let tbe rein be slackened,
or heat inhibition impaired, and tbe temperature runs up
several degrees, and pyrexia results: let the reins be cast
loose, or heat inhibition paralysed, and heat production
is freed from all restraint; it is off at the gallop, and
hyperpyrexia results. That is the neurotic theory of fever.

These are the two theories of fever with which we have
to deal: 1. The combustion theory, according to which the
rise of temperature results from increased activity of the
process by which heat is naturally formed in the tissues.
2. The neurotic theory, according to which the rise of
temperature is due to impairment of that inhibitory force
by which tiie beat-producing process is kept within normal

non-febrile bounds. These two theories are not antagonistic.
Each is complete in itself, and exists independently of the
other. Each has its awn special sphere of application.

There are maladies characterised by increased body heat
in which the rise of temperature is best explained by the
combustion theory. Others there are also having for one
of their characteristics a rise of bodily temperature on
which that theory throws no light; but of whose increased
body heat the neurotic theory affords an adequate explana¬
tion. Here comes in that test of practical utility to which
all theories should be subjected, and on the results of
which should depend their acceptance or rejection. It will
lead to a clearer understanding of the whole subject if we
take the neurotic theory first.

Tbe clearest and most undoubted cases of neurotic pyrexia
are those in which the rise of temperature succeeds, and is
symptomatic of, a non-inflammatory lesion of the nervous
centres. Examples of snoh pyrexia we have in that which
accompanies cerebral hemorrhage, tumour of tbe brain,
and injuries of the cervical cord. No other explanation
can be given of the rise of temperature in these cases
except that offered by the neurotic theory as here set forth.
It is impossible to regard the results of such lesions, con¬
sisting as they essentially do of pressure upon or lacera¬
tion of a portion of the nervous centres, as ocher
than paralytic in nature. The effect of all such me¬
chanical lesions is not to increase, but to impair or
abolish, function—to produce more or less paralysis. The
only way in which a destructive and non-inflammatory
lesion could cause temperature to rise is by impairing that
function which normally prevents it from rising—in other
words, by impairing heat inhibition. Rise of temperature
thus produced will vary according to the extent of the
lesion; in slighter injuries there may be no serious damage
to the heat-inhibiting centre, and no great interruption of
the connexion between it and the heat-forming tissues,
and consequently no greater rise of temperature than is
noted in cases of cerebral htemorrhage in which the sangui¬
neous effusion is small and does not open into the ventricles.
In more extensive lesions, in which the inhibiting centre is
more seriously damaged, or tbe connexion between it and
the heat-forming tissues more seriously interrupted (as
in severe cases of cerebral haemorrhage in which the effusion
is more extensive and tears its way into the ventricles), the
temperature rises rapidly aud to a much higher point;
while the highest temperature of all is noted in cases of
crushing of the cord, in which the heat-forming parts of the
body may have their connexion with the heat-inhibiting
centre cut off more completely than is likely to be the ca9e
in any intracranial lesion.

_ Admitting the existence of a thermic centre, whose func¬
tion it is to control heat formation and prevent undue rise
of temperature, we have no difficulty, in the maladies and
injuries to which reference has been made, in attributing
the increased body heat to interference with that function.
The temperature rises because tbe reins are slackened. The
sequence of events seems to admit of no other explanation.
Carrying out this line of argument, we cannot fail to see not
only that the rise of temperature thus induced must be
directly as the extent to which heat inhibition is impaired,
but that paralysis of the thermic centre, by abolishing in¬
hibition and leaving heat production in uncontrolled posses*
Bion of tbe field, mast lead to hyperpyrexia. And the more
we consider the pathogenesis of febrile heat, the more
apparent does it become that impairment of inhibition is a
much more likely cause ol hyperpyrexia than is direct
stimulation of beat production. Heat inhibition remaining
unimpaired, tisane metabolism could scarcely cause those
very high temperatures which characterise some cases of
hyperpyrexia. Heat inhibition being paralysed, there is no
difficulty in seeing that the temperature cannot fail to rise,
and to go on rising, so long as tissue metabolism and heat
production continue.

All cases of hyperpyrexia we therefore regard as being
probably of neurotic origin—as due to some cause whioh
exercises a paralysing influence on the thermic centre.
Pyrexia may result either from increased production or from
defective inhibition, but marked hyperpyrexia is probably
due only to defective inhibition. In the cases hitherto
instanced there has been a direct lesion of tbe nervous
centres to explain the paralysis of the thermic centre and
the consequent, rise of temperature. Other cases there are,
however, in which the evidence of paralysis of that centre
is equally marked, in which hyperpyrexia is pronounced

518 The Lancet,]

DR. P. TAYLOR ON RHEUMATIC HYPERPYREXIA.

[March I2 r im .

but in which the sequence of events by which it is brought
about is not so apparent.

But mechanical lesions and organic disease are not the
only causes of,local paralysis. Paralytic symptoms, often
not much less marked than those which follow organic
lesions of the nervous centres, occur in hysteria; we reco¬
gnise them, too, in connexion with gout, rheumatism, and
disease of the kidney, and we constantly find them occur as
a sequela of diphtheria. Excessive functional use may also
lead to impairment and partial paralysis of a part, as in
scriveners’palsy. lTo ^continu'd.)

A CASE OF RHEUMATIC HYPERPYREXIA.
By FREDERICK TAYLOR, M.D., F.R.C.P.,

PHYSICIAN TO OUT’S HOSPITAL.

The case of rheumatic hyperpyrexia read by Dr. Carrington
at the last meeting of the Clinical Society (at which I was
unable to be present) reminds me of one that occurred to
me a few years ago, in which the difficulties of treat¬
ment in private practice had to be met, and were met
successfully, though the patient was subsequently removed
to the hospital that any relapse might be anticipated.

On October 6th, 1882,1 was asked by Mr. F. 6. Larkin, of
Trinity-square, to see with him a patient living in the
neighbourhood. He was a man aged forty, and had been
suffering from rheumatic fever for a week, during which
time the pains had not been very severe, and he had been
treated with salicylic acid in doses of twenty grains every
six hours. There was apparently nothing unusual in the
case until midnight on Oct. 4th, when sweating, which bad
hitherto been profuse, ceased, the joints were no longer pain¬
ful, and in the course of the next few hours he became
delirious. At 7 a.m. on the 6th he was beginning to
be drowsy, and his comatose condition rapidly developed.
We saw him together at 12 noon, when he was quite
unconscious, with commencing stertor, and quite incapable
of being roused. The temperature in the axilla was 107-6°.
There was no bath in the house, but we were at once pro¬
vided with sponge and cold water, and, having stripped the
patient, sponged him freely all over. Shortly afterwards
some ice was procured, and while some pieces were put in
the water to cool it, other pieces were rubbed gently over
the whole surface of the body. For ten or fifteen minutes ;
he still lay utterly helpless, and his breathing became even
more stertorous; but after the lapse of that time, his tem¬
perature now being only 106°, he began to rouse a little
and resist our attentions. By 12.30 Mr. Larkin had pro¬
cured a full-sized bath from his house, and the patient
was placed in it, though not without a good deal of strug¬
gling in a dazed sort of way, which of course we were very
glad to see. He was, it appears, used to a cold bath, and
seemed after a little to comprehend the argument of his wife
that it was only a repetition of his ordinary morning pro¬
ceedings. About 12.40 he appeared so thoroughly roused,,
the skin so cool, and at the Bame time his respiration and
pulse were so quickened by the struggling which he unco mi,
Bciously offered, that we removed him, dabbed him diy, ana
placed him in blankets. He now recognised his wife, and
made even joking remarks. The pulse was 150, the tem¬
perature 98° in the axilla. Ten minutes later the temperature,
was 99-6°, the pulse 140. In bed,before the bath, while being
sponged, and also in the bath, he passed a quantity of yellow
fluid fteoes. For the time he seemed out of danger, but
knowing the possibility of a relapse of hyperpyrexia, and,
finding it was almost impossible to have him watched at.j
home without putting them to a greater expense than they;,
could well afford, it was decided to remove him to Guy’s
Hospital, which was only half a mile distant. He was there¬
fore wrapped up in blankets, and carried down into Mr.
Larkin’s carriage. He sat up in the carriage, looking
terribly collapsed, pale, and livid about the lips; but at 1.16
he was comfortably in bed in the clinical ward of Guy’s
Hospital under the care of Dr. Wilks, as I had no charge of
beds at the time. On admission, his temperature was
101-2°, pulse 148; he was free from pain. At 2 o’clock,
temperature 101-6°, pulse 132. He did not know that I
attended him in the morning, or that he had ever seen me
before. He was only just conscious, appeared to understand
What was said to him, but answered questions slowly. At
2.30 P.M„ temperature 102-4°, pulse 130, respiration 3*' ir --

was ordered half an ounce of brandy every two hours. His
feet were rather cold, and he had some shivering. He wad
still free from pain, but was beginning to perspire a little
at 4.30. The temperature was taken nearly every hour. Up
to midnight it oscillated bet ween 102° and 102 6°; it reached
103° at 2 a.m., and varied from that to 103’8° until noon on.
the 6th. Pains returned in the joints on this day; he was
delirious, and slept but little during the night. The highest
temperature on the following day was 102 8°, and again he
was delirious at night. From this time he improved, and,.
though he had a slight return of pain and pyrexia on
Oct. 21st, the latter never rose above 102°. He was out of
bed on Nov. 7th, and left the hospital on Nov. 13th.

There is not the slightest doubt that this patient owed his
recovery to the vigorous application of cold at a time when
his temperature was 107 6° and he was already unconscious,
with stertorous breathing. And though it is impossible
to predict what may in the future be done by antipyretic
drugs, the use of cold water and ice is still the most efficient
means of reducing the temperature in these cases. We-
have a great advantage in large towns. Most that is re¬
quired can be brought together in a short time. A bath
could be probably procured by purchase or hire in time to
be of value. Ice may often be obtained in a few minutes, and
in the meantime, a mackintosh or a sufficient thickness of
blankets or old linen having been placed under the patient
to protect the bedding, he may be freely sponged with the-
coldest water that can be procured. Or, failing the bath or
ice, cold water may be used in the form of a wet pack. The
principle is the same in all cases, and that method must be
employed which is readiest to band, and which will most
quickly reduce the temperature. In the present case,
while waiting for the bath, a rapid and decided effect was
obtained by rubbing the surface of the body with lumps of
ice big enough to be conveniently held in the hand. In
country practice, I can imagine the difficulties are much
greater, especially in the summer; probably the wet pack,
often repeated, would be most often serviceable.

It is of interest to note that this patient was comatose^
with a temperature of 107 6°, and that after the temperature-
wa8 reduced by cold it never again rose to a dangerous
height. About the time of its occurrence two other cases
were published with precisely these features—viz., coma,
threatening death, when the temperatures were 107'2° and
107-4° respectively, and no second rise of temperature to
hyperpyrexia. One was published by Dr. Sinclair in the
Edinburgh Medical Journal for August, 1882, the other by
Dr. Bates in the British Medical Journal for October 20th,
1883, and I think I have seen other similar cases recorded
Bince. The fact that life can thus be saved in many cases
by one great effort should lead us to make the effort in a
determined way when the occasion arises.

St. Thomas's-street.

ONE HUNDRED CONSECUTIVE CASES OF
ABDOMINAL SECTION.

By GEO. GRANVILLE BANTOCK, M.D., F.R.C.8.ED.,

SURGEON TO THE SAMARITAN FBBE HOSPITAL.

The following table presents in brief tbe nature of the
cases, with the number of each class, as also the recoveries
and deaths:—

No. of
cases.

Operation.

Recoveries.

Deaths.

60

Ovariotomy

49

1

»

Hysterectomy

«

—

15

Supra-vaginal hysterectomy

12

3

13

Removal of uterine appendages for \
disease J

10

2

3

Removal of uterine appendages tor 1
fibroma )

Removal of hydatids of peritoneum

3

1

1

1

1

Removal of retro-peritonaal cyst

1

—

1

Incision and drainage

1

—

Exploratory operations

—

1

Incomplete operation

“

1

100

92

8

Under the above heads I propose to notice the salient
points of the more remarkable cases. Before proceeding to
analyse the cases, I would moke this general remark that 1

Thb Lakcbt.J PB. q. OttANVILba BAXTOCK ON ABDOMINAL SECT^Q^. [M-fitCH 12,1887 r fil?

have operated in every case of abdominal tumour that has
come under my care, whether considered favourable or un¬
favourable, with the exception of fibroid tumours of the
uterus and tumours diagnosed as malignant. In the case of
the former of these, a careful selection has been made of suoh
as, from the symptoms and the circumstances of the patients,
seamed.to me to justify the resort to operation; and these
form only a small proportion of the number actually under
observation.

. Ovariotomy .—Under this head are comprised all cases of
ovarian cystoma, parovarian cyst, and cyst of the broad liga¬
ment. Of the fifty cases, both ovaries were removed in six¬
teen instances. The second ovary was in a state of disease
mote or less marked, or was so injured in the removal of the
primary disease as to necessitate its removal also. This state
of disease varied greatly in extent. In one extreme the
organ was in a state of atrophy, with commencing papilloma
on its surface; its fellow, 2 lb. in weight, furnishing a typical
example of papilloma, apparently originating on the surface.
In another extreme, in the opposite direction, the organ was
enlarged to 4$ lb.

Adhesions proper (i.e., the consequence of inflammatory
aetion), more or less extensive, slight parietal or omental up
to universal, were present in thirty cases, and enucleation
had to be done in four cases. Of the latter the enucleation
was single in two and double in two. Of the single cases,
one was a suppurating cyst, weighing 3 j lb., enveloped in
the left broad ligament, and the other was a large tumour of
the left ovary, 171b. in weight, and in its separation between
twenty and thirty ligatures were employed. There were
several pints of free fluid in the peritoneum, and there was
considerable pyrexia before operation. Of the two cases of
double enucleation, in one the disease appeared to have taken
its origin in the left side and to have invaded the right side,
where, in the process of separation, the corresponding ovary
was found as a flattened body, surrounded by connective
tissue. In this case the appearances gave rise to the opinion
that before the onset of the disease both ovaries were covered
by peritoneum, and therefore situated »n the broad ligament.
As a result of this extensive enucleation, which involved the
division of both Fallopian tubes, the uterus was deprived of
all its lateral support, and, being at once a source of danger
and a useless appendage, it was removed by supra-vaginal
hysterectomy. Thus the operation was at once a double
ovariotomy and supra-vaginal hystereotbmy. The patient
recovered without a bad symptom. The tumour weighed
lhjlb. In the other case the left tumour weighed 6 lb., and
the right 1 lb.

The next most noticeable case is one of recurrent colloid.
In tbe first operation, on Nov. 13th, 1883, the right ovary
formed a tumour 31 lb. in weight, and the left one of 2 lb.
Both were typical examples of the ruptured oolloid tumour.
The peritoneum waa extensively infiltrated with this sub¬
stance, and the omentum was very much thickened. In tho
second operation, on July 14th, 1886, a tumour, weighing
131b. and of the same character as tbe first, was found
attached, by a medium-sized pedicle, on tbe left side of the
pelvis, in the region of the sigmoid flexure, with which it had
a very close connexion. The intestine was separated, and
tbe pedicle was secured by double ligature in figure of 8.
Strictly speaking, this can hardly be called an ovariotomy,
but as the disease originated with the ovaries, 1 have thought
it best to include it under this head, with this explanation.
The omentum was now very much more enlarged by colloid
deposit, and formed a mass of the size and shape of my two
bands placed together palm to palm. In both operations
the loose colloid was washed out with warm water, and in
both the drainage-tube wae used—in the first for 102 hours,
sod in the second for forty-eight hours.

’ Another remarkable case waa that of a very fat woman,
sged sixty-six years. In addition to a tumour weighing
mlb., there was an enormous umbilical hernia measuring
•tetween 4 in. and 5 in. across, with the omentum exten-
«vely adherent. The sec was freely laid open in the median
hoe, the omentum ligatured in several portions and divided;
rae sac was then dissected out and the wound closed by
Peritoneal sutures of fine silkworm gut (cut off short) and
by deep sutures, and so loaded were the parietes with fat
that for the thickest part my 3^-iuch needles were only just
long enough. The patient made an excellent recovery.

In five Cases there was twisting of the pedicle. In two of
these I diagnosed the condition from tbe fact that in each
was a history of acute mischief within the peritoneum
(sum as pain, vomiting, and fever) followed by marked

diminution of the size of thq tumour. Of course these
tumours were extensively adherent.

In three cases the tumour was dermoid. In only one of
these were there any adhesions ; these) however, were very
old and confined to the pelvis, in which the tumour, weighing
101 lb., was extensively and firmly fixed. In this case it
was necessary to wash out the pelvis with warm water and
to use the drainage-tube, and although the tube was left in
for over six days the temperature only reached 100 - 2°.

Rupture of the cyst occurred in seven cases. In one of
these the contents were thick colloid; in one there had been
hsemorrhage into the larger cyst, which had ruptured; one
was a papillomatous cyst and all its fluid had been evacuated;
and four were examples of the ordinary mucine colloid.
One was a case of suppurating cyst enveloped in the left
broad ligament, 3£ lb. in weight; and in one there was, in
addition to a tumour of 22 lb. on th^ left side, a chronic
abscess between the right ovary and its tube.

The drainage-tube was used in twenty-nine cases for
periods varying from twenty-six hours to seven days.
Contrary to an opinion recently expressed, the results go to
prove that the drainage-tube does not irritate the peritonehm,
and is not thereby a source of danger; for without a single
exception the product of the tube gradually diminished
until at last not more than half a drachm of pale, clear,
amber-coloured or almost colourless serum was obtained,
and furnished the indication for its removal. On the con¬
trary, 1 have distinct evidence, both in my own practice and
in that of others, to show that the drainage-tube- may be
removjd too early, and a fatal result be thus brought about.

In twenty-two cases the peritoneal cavity, more especially
the pelvic portion, was washed out with plain warm water,
and no attempt was ever made to sterilise it, as it is Called—
that is, to deprive it of all or any of Mr. Lawson Tait’s
“ thirty-Bix beasts.” As a rule the temperature is such as
to be agreeably warm to the hand; if there has been
much sanguineous oozing ffom torn adhesions, the tempe¬
rature bos been raised to at least 110°; and if at any time
the water offered me has been too hot, it has been cooled
down by adding the ordinary water of the hospital. For
the purpose of pouring in the water I have usually employed
a pint jug with a spout. It is almost needless to say that I
have not seen any evil results follow this practice, but, on
the contrary, I believe, it has been of distinct advantage.
It is especially useful in the case of effused colloid matter
and of dermoid tumours that have ruptured in the coarse of
their separation, and the water should be used very freely.

The only death in the series occurred in a woman aged
fifty-six, who was in a state of great emaciation, with a
chronic bronchial cough. The tumour weighed 13 lb., and
had been once tapped. It was one of the cases in which the
pedicle had been twisted, and severe hemorrhage had taken
lace into the large cyst. The tumour was Universally ad-
erent to tbe parietes, omentum, pelvic cavity, and to about
two feet of intestine with its mesentery, and many ligatures
were required. So great was the oozing from the parietes
that I was induced to employ the cautery to some of the
more freely bleeding surfaces, but it failed completely, and
I then closed the wound, leaving in a drainage-tube. The
cough gave no rest to the injured parts within the abdomen,
and the patient died in five days and a half. Tbe post¬
mortem examination revealed some adhesive peritonitis and
great congestion of the lungs. It would have bpen better, I
imagine, to wash out the peritoneum with hot water and trust
to the drainage-tube than to use the cautery in such a case.
It will not be out of place to state here that the mortality
of my last hundred cases is only 5 per Cent.; that of the
last ninety only three have died, that of the last fifty-
five only one has died, and that the last forty-five have all.
recovered.

Hysterectomy .—By this term is meant the removal of a
pediculated fibroid tumour of the uterus; that is, without
opening the uterine cavity. It does not necessarily include
the removal of the appendages. Of these cases there are.
nine in the table, witn a clean record. In one of these
the appendages were not removed. In two of the cases the
pedicle, though of considerable thickness, seemed suitable
for the ligature, and I proceeded to treat them in that 'way.
For this purpose the pedicle was first compressed by very
powerful forceps, then transfixed and ligatured. After
cutting away the tumour in such a way as to leave tbe
stump In the form of two flaps, I sutured these together
but before the process was completed the stump was already 1
oozing. I therefore applied the ssrre-nceud, and t’ 1 • ’ ntients

520 The Lancet,] DR. G. GRANVILLE BANTOCK ON ABDOMINAL SECTION. [Mabch 12,1887.

recovered without causing a moment’s anxiety. Thus all
the cases were treated by the extra-peritoneal method, and
with my modification of KoeberlS’s serre-nceud ; and when I
state that all the cases that I have thus treated—thirteen
in number—have recovered, I think it must be admitted
that there is much to be said in favour of this method of
treatment.

Supra-vaginal hysterectomy .—As the term implies, this
class comprises all the cases in which the uterine body has
been involved in the disease, and has been removed at or
about the level of the internal os. They are of a much more
serious nature than the former, with which they should not
be classed. Of these there are fifteen, not including the
case of double ovariotomy and supra-vaginal hysterectomy
already refrrred to amongst the ovariotomies. All were
treated by tlie extra-peritoneal method. One patient, aged
forty-three, died in thirty-three hours with acute suppres¬
sion of urine. The liver and kidneys were found in a state
of extreme fatty degeneration. Before the operation the
specific gravity of the urine was only 1013, and there was
a trace of albumen. But the sufferings of the patient weie
such—due apparently to cystiform degeneration—that I felt
compelled to attempt her relief in the hope that the kidneys
might not be too much diseased. But the urine became
more scanty and .more and more charged with albumen, and
finally the secretion ceased with the advent of evidently
fatal symptoms. The second, aged forty-six, also died with
suppression of urine on the seventh day. On the fifth and
sixtn days the temperature was normal, but the pulse was 120
and there was albumen in the urine, which was still secreted
in fair quantity. By the end of the sixth day, however, it
became scanty, and within a few hours of death the kidneys
quite ceased to act. These organs were large, soft, and
slightly congested, and the capsules were adherent. The
spleen was very soft and friable, breaking down like a blood
clot. The third, aged forty-four, died on the sixteenth day.
The posterior uterine wall wa3 enormously hypertrophied,
so that the diameter of the section measured over three
inches, and at the post-mortem examination the lower seg¬
ment of the uterus presented the appearance of cystiform
degeneration, the contents becoming purulent. It will be
observed that two of these cases were almost of the same
age—a time of life when, in my experience, one is most
likely to meet with latent kidney disease, which, as it were,
springs a mine on the operator; for the evidence of this
disease is not sufficiently definite to compel the surgeon to
refuse operation, when other symptoms and signs seem to
demand it.

Removal of the uterine appendages for disease .—In eleven
out of the twelve cases the operation involved both sides on
account of double disease—chiefly the result of inflam¬
matory action, such as pyo-salpinx and obstruction and
adhesion of the tubes. In one of these there was a large
hasmato-salpinx on the right side, and occlusion and ad¬
hesion of the tube on the left. One case was remarkable for
the coexistence of inflammatory obstruction of the tubes
and cirrhosis of both ovaries, and this condition was charac¬
terised by persistent pain and intense dysmenorrhoes.
Another case was remarkable for a healthy condition of the
tubes and extreme atrophy of the ovaries, and characterised
by persistent pain and complete absence of menstruation.
The patient, in this instance, was a married woman, aged
forty-four, the mother of two children. Menstruation did
not return after the birth of her second child, eleven years
ago. For three years after that she was troubled on and off
with pain in the left groin, gradually becoming more con¬
tinuous and severe. For some weeks she was in one of the
general hospitals. For months at a stretch she attended
the out-patient department of several hospitals. Finally,
she came under the care of Dr. Amand Routh in the out¬
patient department of the Samaritan Hospital, and after
prolonged treatment she was transferred to me on account
of persistent pain in both groins, of such severity as to unfit
her for the discharge of her household duties. The opera¬
tion confirmed my diagnosis, for both ovaries were in a
state of extreme atrophy. One, with its tube, weighed only
GO gr., and the other 65 gr., the greater proportion of these
weights being contributed by the appendages. The result
has been complete relief from the pain and the re-establish¬
ment of the patient’s health.

Chronic ovaritis, with enlargement of the organ is repre¬
sented in the case of a married woman, aged twenty-six, the
mother of one child fifteen months old. Leaving her dying
consumptive husband, whom she w&a no longer able to ■ \

she entered the hospital, seeking relief for persistent and
severe pain in the left groin. Menstruation was irregular
and scanty, and was both preceded (for two or three days)
and accompanied with severe pain in the left groin and leg.
The left ovary was readily felt on examination, large and
prolapsed, and on exposure presented a white and glistening
appearance. It weighed over £ oz., and it was evident that
ovulation had been completely arrested. There was also a
small parovarian cyst as large as a hazel-nut. The right
ovary and its tube were quite healthy, and were not removed.
Relief was immediate, and in three weeks the patient
returned home and nursed her husband till his death. She
is now in perfect health.

Hydro-salpinx and chronic salpingitis were combined in
one instance.

In two of the cases of double operation menstruation has
not been arrested. One of these is a very remarkable case.
The patient, an unmarried lady aged twenty-six, had suffered
for many years from persistent pain and severe dysmenorrhce a,
with somewhat irregular and scanty menstruation. The
tubes resembled small sausages filled with caseous matter,and
were very adherent. They were removed close to the uterus
along with the ovaries. Menstruation is now very regular,
and quite painless, and the flow is more abundant and more
healthy in character than she remembers it. The operation
was performed in October, 1885. The second case is that of
a single lady aged twenty-six, who had suffered from pelvic
pain for several years, as the result of being upset in a cab.
For three months she had been under treatment by rest, &c.
Menstruation was very painful; the uterus was in a state of
retroversion + flexion, and she had become subject to attacks
of trembling of a distressing character, which were very
readily induced by any interference with the uterus. I first
saw her in consultation with a distinguished obstetrician,
who had exhausted all his resources in his efforts to relieve
her. The result of the consultation was the decision to
recommend the removal of the appendages. What that
involved was explained in all its bearings, and the patient
at once—that is, within twenty-four hours—assented. The
version and flexion were removed by the operation. Mens¬
truation returned after the usual interval, but was painless.

Of the twelve cases two died, one on the fourteenth day and
the other on the eighth. In the first case the operation was a
very difficult one, from adhesion of the omentum to the
panetes in the line of incision and to the uterus and brim
of the pelvis, and from adhesions of the tubes and ovaries.
For six days the patient went on most satisfactorily, the
temperature never exceeding 99 8°, and the pulse for the
greater part of the time beating 84. At the end of this
time she was moved to the convalescent ward—i.e., on the
seventh day,—where shedeveloped asevere attack of catarrhal
jaundice, which continued to the end. The second case
was that of a single woman aged twenty-nine, who had
been an invalid for three years, and had undergone a great
variety of treatment. For thirteen weeks she had been in a
country hospital without relief. When she first came
under my notice I refused to operate, as there was nothing
to be detected but the slightly enlarged and tender ovaries,
especially the left. After five months’ further treatment the
persistent and disabling pain from which she had so long
suffered was in no degree relieved, and sbe was admitted
into the hospital, for the second time, in May, 1886. Both
ovaries were affected with chronic ovaritis, and the right
was beginning to atrophy. In neither was there any
evidence of recent ovulation. There was no difficulty in
the operation, but there was very free bleeding from the
parietee. On first removing the dressings on the fourth day,
it was seen that there had been rather severe bleeding from
the middle of the wound, where one of the sutures had
slipped from cutting off one of the ends of the suture too
short, and between the lips of the wound there was a con¬
siderable blood clot. On the seventh day, owing to unfavour¬
able symptoms supervening, and finding that a probe passed
from the hsematoma into the peritoneal cavity, I opened up
the lower portion of the wound including the blood sac,
and found some dark fluid in the lower abdomen and pelvic
cavity. This was well washed out with warm water, and
a drainage-tube inserted ; but it was too late, for the patient
died on the following day. It was quite evident that the
fatal reeult was due to htemorrhage from the parietee,
occurring before, the peritoneal surfaces bad united.

Removal of the uterine appendages for fibroma .—During
the last eighteen months 1 have only seen two cases in
which I have felt justified in proposing this operation.

Thb Lancet,] MR. G. A. CARPENTER: APHONIA DUE TO SUBGLOTTIC GROWTH. [March 12,1887. 521

Many cams have been under my observation, and in all I
have been able to afford relief either by intra-uterine
medication or by constitutional treatment. Whether any
of these may ultimately require more active interference
remains to be seen. Of the three cases operated on, the
first was that of a married woman, who had a multiple
fibroid mass of about 1 lb. or 1£ lb. in weight springing
from the back of the uterus by a thick and very vascular
pedicle, besides quite a colony of small fibroids growing on
the fundus. I should have preferred to remove the mass,
but the pedicle was too thick and vascular for the ligature,
and was in such a position that its extra-peritoneal treat¬
ment would have been exceedingly difficult—rendered more
difficult by the presence of the numerous small growths,
sticking, as it were, on the fundus; so that I had to
carry out my first intention by removing the appendages
after replacing the mass. The final result is, of course,
not yet known. In the second case the condition of
things was very obscure, and from the pain felt in
the left ovarian region, as well as the physical signs,
I believed I had to do with a case of disease of the
appendages. The abdominal section revealed several small
fibroids in the uterus as the cause of the menorrhagia,
and a cancerous mass of small size over the sigmoid
flexure. I removed the right appendages, but the left were
so closely attached to the cancerous mass that I dared not
interfere with them. The patient recovered without a single
drawback, and went home in three weeks. In the third case
the patient was a single woman aged forty-two, who was in
a state of extreme anaemia from menorrhagia due to intra¬
mural fibroids. Both pedicles were very short, and on the
left side the sigmoid flexure was very much dragged upon
when the ligatures were tied. This patient died on the four¬
teenth day with symptoms of gradually increasing obstruc¬
tion, having progressed most favourably for the first six days.

(To be concluded).

APHONIA DUE TO SUBGLOTTIC GROWTH
(? CONGENITAL); OPERATION ; CURE.

By G. A. CARPENTER, M.B. Lond., M.R.C.S., &c.,

REGISTRAR AND CHLOROFORMI8T TO THE KYKLIHA HOSPITAL
FOR CHILDREN.

Louisa B-, aged eighteen, brought a patient to the

Evelina Hospital on April 19tb, 1886, and the resident
medical officer, Dr. Albert Martin, noticing that she herself
was almost voiceless, asked me to make a laryngoscopic
examination. She stated that she had been told that “ her
cry when a baby was a peculiar one,” and that she had
been only able to speak in a whisper up to the age of ten
ears. She then went to a boarding-school in the country;
er voice became hoarse about that time, and since then has
always remained in the same condition. When fourteen
years of age she sought advice from a chemist, who stated
that there was no cure for her complaint, but that she
“ might grow out of it.” (See engraving.)

On making a laryngoscopic examination, a pedunculated
tumour about the size of a split pea, with somewhat elon¬
gated pedicle, of a pink colour, and lobulated surface, was
seen situated at the anterior commissure. The pedicle of
the tumour disappeared under the right vocal cord, and
was apparently attached just below it, near its junction
^ith the thyroid cartilage, and arising from • the latter.
Daring respiratory movements the tumour moved back¬
wards and forwards with the current of air, now appear¬
ing above the cords, and now descending into the sub¬
glottic region, almost out of sight. The breathing space

was diminished by about a fifth during expiration. There
was no dyspncea. The vocal cords were slightly in¬
jected, and during attempts at phonation could not be
approximated on account of the tumour wedging itself
between their anterior attachments. Movements of abduc¬
tion were perfectly free. The patient was directed to attend
for treatment on April 23rd.

April 23rd. — Tumour easily visible. The larynx was
painted with a solution of cocaine, fifteen grains to the
ounce, and an attempt made to grasp the growth with
Mackenzie’s forceps, but without success, partly owing to
the broad shank of the forceps blocking the view in the
laryngeal mirror, and partly to difficulty experienced in
getting the blade well into the narrow commissure, the
space afforded being too narrow to accommodate the
forceps. After several attempts, it was seen that, owing to
the above reasons, the growth could not be seized, and the
patient was ordered vapor benzoini for inhalation, and told
to attend every other day in order that she might accustom
herself to the use of instruments, the introduction of which
could not at first be tolerated.

May 4tb.—On this date the patient again attended for
operation. My friend, Dr. Albert Martin, since the 23rd ult.,
had been practising her with instruments without cocaine;
and so efficiently had this been performed that she could
now without difficulty tolerate their use. The larynx was
painted with a solution of cocaine, fifteen grains to the
ounce; and about ten minutes after its application the
tumour was grasped at the first attempt with Mackenzie’s
tube forceps and removed with ease. It presented a lobu¬
lated appearance, was of a pink colour, oi fairly soft con¬
sistence, and had apparently come away in its entirety. In
consequence of the amount of blood about the parts, it was
impossible to see whether its removal had been completely
accomplished. Its structure seemed to be of the nature of
a soft fibroma. Shortly after its avulsion the patient spoke
comparatively clearly. Vapor benzoini was ordered for
inhalation, and she was directed to attend again the next
day.

6th.—Laryngoscopic examination shows no trace of the
growth. The vocal cords approximate completely in the
mid line, and the patient speaks in a natural voice, much to
her delight. As there is some injection of the cords, the
patient is to attend daily for a week for topical applications
of chloride of zinc, fifteen grains to the ounce.

12th.—The vocal cords are of normal colour now, and the
larynx is healthy in every respect. Unfortunately, owing
to the small growth being mislaid amongst many patho¬
logical preparations, the microscopical appearances of the
tumour cannot be given.

% HUrror

HOSPITAL ”PRACTICE,

BRITISH AND FOREIGN.

Nnllaautem est alia pro oerto noaceadi via, nUi quaraplurlma* et mor-
boram et dlaeectlonum his tort as, turn alioram turn propria* oolleotaa
habere, et inter *e comparare.—M orgagni Do Sed. et Caut. if orb.,
lib. iv. Proccmlum. -

CHARING-CROSS HOSPITAL.

8TRANGULATED OONGJSNITAL HR UN IA WITH RUPTURE OF
THE INTESTINE; HERNIOTOMY; ENTORAPHY; CUBE;

REMARKS.

(Under the care of Mr. Bar well.)

The peculiarities in the subjoined case were: The un¬
usual leugth and obliquity of the canal (this resulted from
the very recent date of the hernia allowing of no time fo>
the usual approximation of the internal to the external
ring); the number of bands running across the intestine
within the funiculus of the tunica vaginalis and the tension
of the rings themselves, the early rupture being doubtless
due to these causes; the edges of the rent had the appear¬
ance of being more than twenty-four hours old; the extreme
ease with which recovery took place; the remarkable
appearance of the natural healing process by the production
of a beautifully opalescent and transparent layer of lymph
creeping over and covering in the sewn-up rupture. It is

Digitized by GoOgle

522 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[March 12, 1887.

rare that so good a view of a reparative process can be
watched in the human subject.

T. B-, aged twenty, was admitted on Nov. 13th, 1880,

at 11 p.m. The patient is unaware of having had any rup¬
ture as a child, but at Christmas last a swelling suddenly
appeared in his groin and scrotum. This was accompanied
by dragging pain in the abdomen and a sense of sickness.
A week ago he jumped from a cart and immediately felt
a pain in the groin and testicle, and found considerable
swelling in that neighbourhood. Soon after he was sick.
Next day and again a day or two after, he tried to work,
but was unable to do so, and has been several times sick,
more especially during this day. The bowels have not
acted since the accident.

Mr. Barwell being sent for, he saw the patient shortly
after admission. He had a small weak pulse; the skin was
cool and somewhat clammy. He complained of much pain
in the scrotum, groin, and umbilical region. He had not
been sick since admission, nor had he hiccough. The
hernial swelling distended the inguinal canal and the
scrotum very considerably; it, was very tense and tender;
the skin ov'er it was red. Herniotomy was at once per-
■formed.^ The sac was reached without difficulty and opened;
within it was nothing but a much distended and congested
coil of intestine, which lay in contact with the testicle.
The external ring was excessively tense; when this was
incised the inguinal canal was not found shortened, as is
commonly the case with large hernise, but was of normal
length and obliquity. A little inside the ring, the gut
showed a more excessively congested patch, running across
which was a rupture about half an inch long and ragged, the
edges of mucous membrane that protruded being ulcerated.
After several bands in the inguinal canal had been divided,
and the very tense internal ring incised, it became possible
to draw that part of tbe intestine into better view. The
opening was closely stitched, after Lemberg’s method, with
line catgut. A stitch was passed through the peritoneal
and partly through the muscular coat, a little beyond the
highly congested part, and left long, so as to hang from the
wound; then all the gut was returned from both ends,
leaving the ruptured and sewn part bare, just at the mouth
of the ring. This was covered with a double layer of
protective, and the whole was dressed with carbolised gauze.
Ordered half a grain of opium every fourth hour.

Nov. 17th.—The patient has had no disquieting sym¬
ptom. Over the ruptured intestine, and covering in the
stitches, was a layer of lymph. The highest temperature
was 99-8°.

19th.—The temperature rose to 102'4°. On examining
the wound the scrotum was found distended, and a little
11 ark blood was found to come from one part near a stitch. |
The incision here (the fropt of the scrotum) was opened,
and a dark clot turned out. No bleeding point could be
discovered, and the Wound Was closed again.

Dec. 20th.—With the exception of the oozing above men¬
tioned, which did not recur, the patient has had no bad
symptom. The wound was rather slow of healing, but he
has been practically well for several days.

NEWCASTLE-ON-TYNE INFIRMARY.

DIFFUSED TRAUMATIC AN'EURYSM OF THE ANTERIOR
TIBIAE ARTERY OF TEN WEEKS’ DURATION ;

ATTEMPTED LIGATURE ; AMPUTATION,

(Under the care of Mr. Page.)

The following notes are by Mr. F. P. Maynard, M.B.,
house-surgeon.

John M-, aged sixteen, was admitted on Nov. 18tb,

183G, with the following history: On Sept. 13th, while
, staying with some friends in Lancashire and playing with
other boys, one stabbed him with a penknife (blade two
inches long) in the_ left leg, at the junction of the middle
with the lower third, about half au inch outside the crest
of the tibia, in a direction backwards and inwards. It bled
freely, spurting out (notin jets) dark blood,he says. The leg
swelled. He Was Rent to bed and poultices applied. Four
days after, on getting up, he had pains in the leg, and the
swelling increased a little. The wound healed, the swelling
. remained, and on Oct. 4(h he returned home. The next day
, .suddenly great pain came on, and the swelling again in-
. creased. It" was poulticed,.and ,a fortnight later his ddetor
bpened ft, When much blddd cl« ‘was removed, an 1 - few

drops of fetid pus. The bleeding, which was consider¬
able, was stopped by pressure. It bled at intervals until
Nov. 17th, the day before admission, when free haemorrhage
took place.

On admission the boy was very anaemic and emaciated,
with a poor pulse and no appetite. The lower and half of
the middle third of the leg were occupied by a swelling
about eight inches in length, uniformly fluctuating and soft;
and situated about its middle wa9 a small wound, from
which blood was oozing, a drop at a time. This swelling
communicated distinctly with a similar bnt smaller one
behind the inner side of the tibia. Both were without
pulsation. Pulsation was absent in the anterior tibial
artery below, but present in the posterior tibial. The
foot was cedematous. Pressure was applied and the oozing
stopped.

Nov. 24th.—Hemorrhage occurring, under chloroform Mr.
Page enlarged the opening and cleared out about one pound
of blood clot, with a tourniquet on the femoral. The anterior
tibial artery could not be found, but two or three bleeding
venous points were tied, and afterwards one small artery,
and the bleeding stopped. The posterior portion of the sac
was also opened, but nothing found to tie. The tibialis
anticus was completely split up and separated from the
tibia, which in one place, the size of half a crown, was
eroded, and the interoeseous membrane was wanting for
several inches. There were no signs of suppuration any¬
where except at the old incision. The leg was elevated and
dressed, and permission for amputation obtained should it
be necessary. At night the bleeding recurred, and tbe leg
was amputated through the middle third by lateral flaps
(Bryant’s), so as to utilise the incisions previously made into
the aneuTysm, and the flaps brought together by a continuous
catgut suture.

The leg did well, except that pus collected over the inner
side of the end of the tibia, and the patient was allowed to
go out on Dec. 12th. On the 15th oozing of blood came
through the incision. At 10 p.m. excessive bleeding took
place, and, under ether, Mr. Maynard opened up tbe ajtump,
having to cut through firm cicatricial tissue, turned out the
clot, and tied Some bleeding points, only one of them arterial,
and that a small vessel. As the end of the tibia was necrosing,
a piece of it was sawn off, some unhealthy granulations
scraped, and the flaps sutured. After operation the patient
was much collapsed, and rallied slowly.

Jan. 20th, 1837.—Patient has recovered uninterruptedly,
gaining flesh rapidly.

Feb. 8th.—a small exfoliation has come away from the
tibia. The size of a small button.

25th.—Wound all but healed. Is going to a convalescent
home.

EPITHELIOMA. OF THE SOFT PALATE,

(Under the care of Mr. Pagb.)

The notes of this case are also furnished by F. P. Maynard,
M.B., house-surgeon.

E. D——, aged twenty-seven, a fireman, was admitted on
Oct. 7th, 1886. Family history good; habits good, and no
history or sign of syphilis. Last April he felt with liis
tongue a small projection on his soft palate. It grew slowly,
and when as large as a pea it was snipped off by his doctor.
The wound healed badly, and when admitted there was a
small cicatrix in the middle line of the soft palate. At its
left border was a small growth the size of a small pea,
exactly like an ordinary gonorrhceal wart in appearance.
There was a small gland enlarged on the right side of the
neck in front of the sterno-mastoid.

The patient was treated with large doses of iodide of
potassium, and with mercury, without effect. The growth
therefore was scraped off, but, strange to say, a similar one
appeared on the other side. The whole of the disease was
freely removed on November 9th with the knife, removing
the whole thickness of the palate. The wound did not heal
well, and the disease returned in it within a month, and the
gland in the neck enlarged rapidly. He went home on
December 23rd.

On Feb. 1st the man came again to the hospital. The
whole of the right two-thirds of the soft palate was a mass
of foul epithelioma, which had spread down the right arch
to the tonsil, which was itself a mass of disease. He had
lost flesh, and looked very ill and ansemic. The gland in
the neck hod enlarged, and was now as large as an orange;
it was adherent to other enlarged glands. They wert dtjll
encapsuled, blit under the stemo-niastoidi - ; : *3

zed by Google

Tot Lancet,] _ROYAL MEDICAL AND CHIRURQICAL SOCIETY. [March 12,1887.

WOLVERHAMPTON AND SOUTH STAFFORD¬
SHIRE GENERAL HOSPITAL.

RUPTURE OP THE POPLITEAL ARTERY AND VEIN;

AMPUTATION; REMARKS.

(Under the care of Mr. Vincent Jachbon.)

We are indebted for the following notes to Mr. J. Harley
Gough, house-surgeon.

On Nov. 24th, 1886, at midday, T. L-, a miner, aged

twenty-one, was working down a coal-pit, when a quantity
of rock and gravel fell on his back and right popliteal space.
He was knocked down, and remained unconscious for some
minutes. When pulled out of the debris the back of his
right knee immediately began to swell, the swelling rapidly
extending up the thigh and down the leg. He had Bevere
pain in the limb for some hours, bat it gradually became
easier.

On admission the next day, the right leg and thigh were
greatly swollen, hard, tense, elastic, and shining, from about
two inches below Poupart’s ligament to tbe toes. The swell¬
ing was especially marked in the lower half of the thigh, back
of knee, and calf, as the following measurements wifi show :

Bound calf. Over patella. 4in. above patella.

Sound limb . Ufln . 12}in. l&Jln.

Injured limb . 15m. 17in. 17in.

There was considerable ecchymosis behind the knee and
upper part of the calf. The foot and leg were much colder
than those ‘of the opposite side, and sensation was blunted.
The foot was of a darkish-purple colour, reaching as high
as the ankle. Patient did not complain of pain except
when the leg was moved. No pulsation could be felt in the
popliteal space or in the arteries below. There was no
fracture or dislocation. The man was very aulemic; pulse
weak, but regular, HO. Tongue clean. The patient was
put to bed and the limb enveloped in cotton-wool, elevated,
and hot bottles put to the foot and leg.

Dec. 1st.—The coudition of the limb remains much the
same. Tbo patient has some pain in the knee at times,
which is relieved by opiates. The foot is quite cold, and is
getting darker in colour. Pulse 120; temperature 998°.

4th.—The foot and lower part of the leg are distinctly gan¬
grenous. The temperature has been slowly rising for the
past few days. The swelling of the limb has neither in¬
creased nor diminished. Amputation was deemed advisable,
and the patient having consented, the limb was removed
about three inches above the condyles of the femur by means
of long anterior and short posterior skin flaps. The sub¬
cutaneous tissues and inter-muscular spaces were filled with
dark clotted blood. The femoral artery was patent, and did
uot contain a clot.

After the operation the patient suffered much from col¬
lapse, but towards evening recovered ; he had a good deal
of pain, which was relieved by morphia. The wound was
dressed twice daily for some d&ys, on account of the dis¬
charge. The stump slowly became less in size and softer,
and on Dec. 24th he got up for the first time. The patient
made a good recovery, and went out convalescent on
Jan. 26tb, 1887; he would have gone home sooner, hut,
unfortunately, fell on the end of his stump some days
before.

Examination of the limb. —After the operation the limb
removed was dissected, and a transverse rupture of tbe
popliteal artery and vein was found, the ends being sepa¬
rated for an inch and a half. The seat of the rupture was
tbout the centre of the popliteal space. The proximal and
distal ends of tbe artery were retracted in their sheaths and
occluded. The ends of the vein were patulous. Tbe popli¬
teal nerve was intact, and apparently not injured. The
posterior ligament of the knee-joint was tom through, and
the joint was filled with semi-clotted blood. Extravasated
blood was found everywhere between the muscles and also
subcutaneously, the subcutaneous layer being more than half
an inch thick in places.

Remark*.— Rupture of the popliteal artery and vein with¬
out external wound is a rare injury, only very few cases
being recorded, Completo rupture of the artery alone is
uncommon, but occurs more frequently than rupture of both
jewels. The signs and symptoms are much the same in
both cases—viz., rapid swelling of the leg and thigh, no
pulsation in the popliteal space or in the vessels below, and
wudness of the limb. There are two lines of treatment:
U) Ligature of the raptured ends of the vessel or vessels;

(2) amputation of limb. In the first method it must be diffi¬
cult to apply a ligature to the torn ends of the artery, and
even when done the circulation may not be established,
owing to the pressure of the extravasated blood on the col¬
lateral branches, although tension may be considerably
lessened by incisions. Experience shows that amputation
of the Rmb is followed by the best results, and this should
either be done as early as possible or when gangrene becomes
evident, and without waiting for the line of demarcation.
Ligature of the femoral is obviously of no use in these cases.

Htcbiral Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Gouty Parotitis and Gouty Orchitis. — Empyema, with Pul¬
monary Gangrene, following Enteric Fever, treated bu
Perflation.

An ordinary meeting of this Society was held on March 8tb,
1887, Mr. G. D. Pollock, President, in the chair.

A paper on Gouty Parotitis and Gouty Orchitis, by Dr.
Dkbout D'Estbees of ContrextSville, was communicated by
Dr. Garrod. The object of the paper was to fill a lapsus iu
the literature of gout, in so far as this disease affects the
glandular system, more especially the parotids. Tbere are
genuine attacks of gout having their seat in the glands and
alternating with articular manifestations. The following

case was related: X-, aged sixty-eight, a well-marked

gouty subject, was suddenly attacked with swelling at the
angle of the jaw, which resisted ordinary treatment, and
only disappeared on tbe invasion of the knee on the oppo¬
site side. The second parotid and the other knee were
also attacked subsequently. Some little induration of the
parotids remained, together with salt taste in tbe mouth,
due probably to the presence of urates in the Balivu secretea
by these glands. Similar cases by Drs. Garrod and Rotureau
were also referred to. These cases were promptly relieved
by a tincture of fresh colchicum flowers, fifty drops thrice
daily. The author had only seen, two case# of gouty
orchitis, which, resisting treatment, subsided spontaneously
on the appearance of gout elsewhere. The left testicle is most
frequently affected, but not invariably. He bad not
seen it in both parotid and testicles in the same patient.—
The President had never seen parotitis in association with
gout, but had met with cases of orchitis in men of advanced
life who were the subjects of articular gout.—Sir Dyck
Duckworth thought that, gouty parotitis must be a great
rarity. Sir James Paget had remarked on the great immu¬
nity of the lymphatic tissues from gouty inflammation. He
considered that the correctness of the diagnosis was proved
in these cases by the effect of the f reatment and by the fact
that the inflammation of the parotid gland or testicle alter¬
nated with articular pain.—Mr.S tephen PAOBTquoted cases
which showed that tbere was an association of parotitis
with dyspepsia and abnormal nervous symptoms. He asked
whether it was possible that tbe parotid lesion could be
aided by a faulty state of the gland induced by a condition
of chronic dyspepsia.—Dr. Bernard O’Connor referred to
a care under his care of gout associated with swelling of tbe
sublingual glands.—Dr. Garrod had collected 2000 cases of
gout, but there was not one with a history of parotitis. He
had since met with a care—a man of sixty-five, a gouty
subject, who was attacked with acute inflammation of both
parotid glands—which subsided without suppuration. He
thought that cases of suppurative parotitis could not be of
true gouty character. He had seen many cases of orchitis
in which the swelling vanished on the appearance of
arthritic gout.—Dr. D’Estr&bs, in reply, said there was a
slight dyspeptic history in his patient. Some saliva examined
during the attack was acid, and gave a murexide reaction.
Since ne had written his paper he bad heard of another case,
under the care of Professor Damaschino of Paris, in whieh
the primary gouty manifestation occurred in the parotids.
Tbe cases might induce surgeons to employ medicinal meads
before resorting to operative interference.

Dr. Wm. Ewart and Mr. R. Fitzroy Ben ham read a case
df Empyema with Pulmonary Gangrene following Enteric
Fever, treated by Perflation. The patient, a male, aged ten
years and eleven months, was seized with enterie fever (duq
l 2

Digitized by GoOglC

PATHOLOGICAL SOCIETY OP LONDON.

[March 12,1887.

524 The Lancet,]

probably to drain infection) on April 23rd, 1886. The syin- •
ptoms were not unusual in character, but severe in degree,
especially the delirium. The treatment adopted by Mr.
Denham consisted of quinine, which proved ineffectual, and
of antipyrin, which appeared to relieve the pyrexia and the
delirium. The patient was convalescing at the end of the
fourth week, when peritonitis supervened, soon followed by
left pleuritic pain. Within a week the signs of left empyema
were fully developed, the exhaustion was extreme, and the ,
dyspncea bordered on asphyxia. On June 11th aspiration
was made, and three-quarters of a pint of thick shreddy
pus removed, with relief of the most urgent symptoms.
The following day the chest was opened freely in the
anterior axillary line (fifth space) and in the scapular (ninth
space), a large quantity of pus escaping. Free discharge
continued, but no injection was used. On June 15th
perflation was performed under spray in the manner
depicted in The Lancet (July 31st, 1886), the appliances
being elastic tubing, a Woolffe’s bottle containing carbolic
acid solution (1 to 10), and a hand-ball bellows. The air was
delivered into the centre of the chest through the anterior
opening, and allowed to escape only at the posterior. The
result was the expulsion of fetid pus, of a piece of necrosed
lung, and of heavy false membraues. A smaller mass of
membrane was expelled by perflation the next morning, and
a small piece on the third day. From this day the fetor
ceased, and the amount of pus decreased rapidly. On the
eighth day the discharge was turbid-serous, and it remained
serous to the end. Both wounds were closed on the thirtieth
day from the date of incision, and on the twenty-fourth
from the first perflation. Among the advantages obtained
in this case by the method employed were the following :

1. Early removal from the chest of putrid residues. 2. Pre¬
sumably considerable shortening of the period of suppura¬
tion as a result of (1). 3. Avoidance of permanent atelec¬
tasis and of eventual resection of ribs as a resulo of (2).

4. Avoidance of deformity as a result of (3). 5. Daily dress¬
ings free from discomfort and from wet (excepting the spray).

6. Adrierstateof the cavity and of its coveringsthan is allowed
by fluid injections, with absolute sweetness of the discharge.

- The President asked what was the advantage of perfla¬
tion over free incision at the most dependent part, with, if
necessary, excision of the rib.—Sir Dyce Duckworth
believed the practice of washing out the pleura was a mis¬
chievous one. He would use perflation in future in that
class of cases where, having made a free opening with
antiseptic precautions, the patient did not progress satis¬
factorily.—Mr. Godlee thought the case peculiar, in that a
piece of gangrenous lung was discharged without a history
of previous fetid expectoration. He considered that a free
opening posteriorly without perflation would have met the
needs of the case. Injecting the pleura was a mode of treat¬
ment now passing out of fashion. In cases requiring it, he
recommended blowing iodoform into the pleural cavity with
an insufflator.—Mr. Bennett inquired what was the result
of treatment in adults and in those cases which, previous to
its use, had not done well. He could not recommend its
adoption in general surgery, for in one case in which
ho perflated an abscess in the thigh, he produced
extensive subcutaneous emphysema.—Mr. R. W. Parker
had published a paper in the Society’s Transactions
many years ago advocating a similar method to this. He
had abandoned injection, and made a single large open¬
ing, into which a double drainage-tube was passed.—
Dr. Dawtrey Drewitt likened perflation to the schoolboy
practico of “blowing” an egg, and pointed out the difficulty
of separating the inner membrane from the shell by that
method.—Mr. Howard Marsh said he adopted the follow¬
ing method of evacuating an empyena: First make an
opening high up; from this pass a catheter, and feel the
lowest part of the pleura; then make a large opening at this
lower point, and allow the upper one to close. He believed
washing out the cavity was not advisable, and, indeed,
unnecessary. He objected to the insufflation of iodoform,
which, he thought, might act as a poison. In excising a
rib, if the periosteum were left deformity would be avoided.

—Dr. Sansom said the air would not be sufficiently purified
by being blown through water. He advocated passing the
warmed air over blotting-paper, cotton-wool, or sponge,
saturated with pure carbolic acid.—Mr. Pearce Gould
thought the value of the method could scarcely be judged
from one favourable case. He considered the best treat¬
ment was a single free opening in the sixth or seventh
interspace, and in the post-axillary line.—Dr. Ewart, in '

reply, agreed as to the value of a large opening. He
believed perflation useful in recent empyema to discover
whether loose pieces were present. In older cases it might
be beneficial by effecting the removal of an irritant. He
had treated five cases of left-sided empyema, and perfla¬
tion in them had produced no effect on the heart. In using
this method in general surgery care should be taken to have
free openings, so as to avoid undue pressure.

PATHOLOGICAL SOCIETY OF LONDON.

Adenosarcoma of Tongue, with Calcifying Nodule in Centre.
—Alveolar Sarcoma—Malarial Diseases of Liver and
Spleen— Extra-uterine Pregnancy .—(?) Cirsoid Aneurysm,
—Cholesteatoma at Base of Brain.

An ordinary meeting of this Society was held on the
3rd inst., Sir J. Paget, Bart., F.R.S., President, in the chair

Mr. R. J. Godlee showed a specimen of Adeno-sarcoma of
the Tongue, with ossifying (?calcifying) nodule in the centre.'
It was a hard nodule of the shape and size of a small
pisiform bone, and having the appearance of bone, removed
from the centre of a tumour on the under surface of the
tongue near the tip. The patient was a woman aged twenty-
four, a patient of Mr. S. N. Bruce. The tumour had only
been noticed five weeks, and had already sloughed over an
area the size of a shilling on the under surface, through
which the hard mass was removed with a sinus forceps.
Some weeks afterwards the tumour was excised with scissors.
The growth was an adeno-sarcoma, the sarcomatous tissue
being abundant and highly vascular, and the adenoid tissue
arranged in acini of varying size lined with square
epithelia. The acini were in parts dilated into small cysts
containing a brownish structureless material, in which
were nuclei (? leucocytes). The hard mass on section had
roughly the appearance of imperfectly formed bone. Mr.
Godlee suggested that the tumour, which he believed to be
unique, was connected with a mucous gland from 7 to 10 lines
long, described by Nuhn in 1845 and by Blandin at an earlier
date, in this situation lying beneath a few fibres of the
styloglossus. A specimen of this gland, prepared by Mr.
Pearson at the College of Surgeons, was shown. It was
pointed out that the presence of bone would be very re¬
markable, but it was added that the microscopical examina¬
tion was not unequivocal, and that it might, after all.
be merely a mass formed by a cretaceous or calcareous
change in the contents of one of the cysts contained in the
tumour.—Mr. Stephen Paget observed that the tumour
seemed to be very similar to some tumours found in the
palate. In the age of the patient, the chronic course of the
disease, the superficial ulceration and calcification, he saw
points of resemblance. He thought such a case might be
explained on the hypothesis that there were vestiges of
gland tissue in the tongue as well as in the palate.

Mr. G. R. Turner read a case of Alveolar Sarcoma. The
tumour grew in the left loin of a man, aged twenty, and
proved fatal seven months after it was first noticed. Its
connexions were such as not to admit of removal. It sprang
from the bone of the twelth rib, from the periosteum of the
transverse processes of all the lumbar vertebra, and from
the crest of the ilium below. Itwas not encapsuled, and had
extended inwards, almost surrounding the aorta and inferior
vena cava, completely enclosing the left common iliac
vessels, converting the pancreas, lumbar glands, and psoas
muscles on the left side into masses of new growth.
Secondary deposits were found in connexion with the
diaphragm, omentum, mesentery, meso-colon, and pleura.
Microscopical specimens and drawings by Dr. Ddlepine
were shown. The tumour was a well-marked instance of
alveolar sarcoma, the cells being chiefly oval or pyriform;
the stalk of the latter could be seen to be continuous with
the fibrillated septa of the stroma. The diaphragmatic
growth showed the muscle fibres separated by an alveolated
stroma containing cells. And the same appearances were
observed in the secondary pulmonary growth. Reasons
were given for regarding the growth as sarcomatous rather
than carcinomatous, and the relations of lymphadenoma
with alveolar sarcoma were discussed. In reply to Dr.
Norman Moore, Mr. Turner said the suprarenal body was
not invaded; the growth passed behind the left kidney, but
neither it nor the suprarenal body was involved.

Dr. Norman Moore showed specimens of Malarial Disease

Thu Lancrt,]

PATHOLOGICAL SOCIETY OF LONDON.

[March 12,1887. 5&6'

of Liver and Spleen, with Tuberculosis. A greatly enlarged
spleen weighing 60 oz., and a liver weighing 120 oz. Naked-
eye sections of the spleen showed numerous white specks
throughout it, and there were some larger masses which
had become caseous. None of the masses had injected
edges. The liver contained many similar small white
masses. The whole peritoneum was covered with similar
masses, some of them caseous. The mesenteric glands were
caseous. There were some small caseous masses in both
kidneys. A layer of caseous material, a quarter of an inch
thick, surrounded the upper part of the rectum. In all the
lobes of the lungs were scattered groups of masses exactly
resembling those in the liver. One abdominal caseous
gland had broken down in the middle. • Under the micro¬
scope the masses in the liver and spleen were seen to consist,
some merely of caseous material, others of collections of
small cells, some near bloodvessels, others in the midst of
the gland tissue. Besides the small round cells, a few multi-
nucleated cells could be seen in some of the masses, but no
true giant cells. After several Examinations no bacilli
were found. The liver showed some general connective
tissue increase. The spleen showed collections of cells
precisely resembling those in the liver, and also many
pigmented patches, a large connective tissue increase,
a general infiltration by blood-cells resembling that
seen under the microscope in nutmeg liver. The patient
was a man aged twenty-one years, who was in St.
Bartholomew's Hospital, first under Dr. Moore's care and
afterwards under Dr. Andrew.- He had worked on a rail¬
way in Cape Colony from 1880 till 1884, and in 1883 was
laid up for a year with tertian and quotidian ague. He
went to Ceylon, and had dysentery on the voyage. From
1884 he had noticed his greatly-enlarged spleen. After
returning to England he had fever again. He had never had
syphilis. He was admitted to St. Bartholomew’s Hospital
on Nov. 26th, 1885, and died Jan. 21st, 1887, having been out
for a short period during his illness. He suffered from an
irregular fever, for two months had a temperature suggesting
quotidian ague, then two months of almost normal tempera¬
ture, then daily fever for a week, then six weeks of normal
temperature, then fever again. He improved under very
large doses of quinine, thirty-five grains every twenty-four
hours, and his spleen was perceptibly reduced in size. The
proportion of white blood-corpuscles to red was throughout
about one to five. The history of malarial infection, -and
the appearance of the liver and spleen, make it certain
that the chronic inflammation is that form of cirrhosis
due to intermittent fever. The large quantity of [caseous
material in the glands and the distribution of the white
masses over the peritoneum are strong evidence that the
white masses in the liver and spleen are true tubercle.
Gummata they are not. They resemble of course lenktemic
tumours, but their caseous degeneration as well as their
distribution seem to negative the hypothesis that they
belong to thifl class. They are tubercles invading viscera
already affected by long-lasting changes due to malaria.—
Dr. Co PPL AMD remarked upon the very high degree of
leucocytosis present in this case; he would almost have
been inclined to regard the case as one of leucocythoemia.
Was it usual in malaria to have so large an increase-of white
corpuscles? — Dr. G. N. Fitt thought the association of
diseases in this case resembled that seen in hypertrophic
cirrhosis of the liver. He had seen several- cases in which
acute tuberculosis terminated cirrhosis.—Dr. Goodhabt
thought that a fair proportion of cases of leucocythremia
supervened on malaria. Enlargement of glands or lymphatic
lenktemia was often present also, and the complication of
tuberculosis was not unknown. He thought these mixed
cases were related, and could be traced to malarial poisoning.
—Dr. Moons, in reply to the President, stated that the red
corpuscles were normal. He quite admitted the unusual
proportion of white corpuscles, but could not explain the
appearances on any other hypothesis than that of tuber¬
culosis. He had seen four cases of malaria with leucocytosiS,
and had seen true tuberculosis supervene upon malaria. •
Mr. Lawsok Tait read a note on the Pathology of Tubal
Pregnancy. The views on extra-uterine pregnancy which
were first advanced by him at the Obstetrical Society in
1873 were immediately characterised by Dr. John Perry as
having at least the merit of simplicity. Many post-mortem
examinations and thirty-four clinical coses operated on by
Mm, the remarkable observations of A. Johnstone and Bland
Sutton that the inner surface of the uterus and tubes is
affected by meKSIMUrtkm, supported KfcMe views. He re¬

garded the periodic desquamation and turgescence of the
endometrium as essential to the retention of a fertilised
ovum, and that is why it is that we have to reckon preg¬
nancies from menstrual dates. He suggested that the
starting-point of menstruation—not the cause—lies in the
Fallopian tabes. This view is sometimes erroneously called
Tait’s tnbal theory of menstruation. Removal of tubes
without the ovaries will in the majority of cases arrest
menstruation; the only conclusion is that the tubee have
far more to do with menstruation than the ovaries. The
ciliary action of the tubal mucous membrane prevents the
access of spermatozoa, and aids in the passage of the ovum.
The effects of desquamative salpingitis would be to allow
the spermatozoa to enter, and would lead to the retention
of the ovum in the tube. The tube might thus retain a
fertilised ovnm and become distended by its growth.
Rupture always occurs about the end of the third month.
The primitive facts of anatomy explain the rest of • the
pathology of this interesting displacement. The prepara- 1
tions the author has examined at the time of rupture show
that the meso-salpinx is practically obliterated by the
separation of its layers, just as the broad ligament is
obliterated by the growth of a broad ligament cyst or
the occurrence of a broad ligament hromatocele. The tube
inevitably ruptures, and the site of the rupture is the leading
feature, not only of the future pathological changes, but of
tho clinical progress and treatment of the case. The site
of the rupture is determined by the seat of the placenta,
and if the rupture takes place at any part of the tube
covered by peritoneum, extravasation takes place into the
peritoneal cavity, forming a tnbal intra-peritoneal h®ma-
tocele. If, however, the rupture takes place at a point in
relation to the cavity of the broad ligament, the'haemor¬
rhage takes place [into the cellular tissue, this fact being
alone sufficient to aid materially in arresting the quantity
of the bremorrhage; also into a cavity which is not indefi¬
nitely capable of extension. We have in this case the broad
ligament pregnancy which formerly was known as the
“grossesse sous-peritoneo-pelvienne” of Dezenneris. The
relation of the area of the broad ligament site to the seat
of rupture which corresponds to the peritoneum makes it
certain that the latter will be much more frequent than the
former, and clinical evidence establishes this fact. Tubal
rupture into the peritoneum will be almost inevitably fatal
to the mother, and therefore certainly fatal to the child.
Indeed, we have only one indubitable case in which a
fatal issue has not taken place, and that is the cele¬
brated cose recorded by Jessop, of Leeds; Tnbal rup¬
ture into the broad ligament, on the contrary, is
probably very rarely fatal. The majority of the ova
die before they reach maturity; after death takes place
they become absorbed. In othercases the ovum dies during
the middle months of pregnancy, and it is found after death
as a Hthopedion, or it may suppurate and discharge above
the brim of the pelvis into the bladder or rectum. In
a few cases it goes on to maturity; a false labour ensues, itt
which the child may be removed by abdominal section, an
operation in which it is not necessary to open the peritoneal
cavity; It will thus be seen that the pathology of extra-
uterine pregnancy is made extremely simple by these views,
and they explain all the varieties that aw known, bringing'
them absolutely within two categories, and from these
pathological facts the rules for surgioal - proceedings can be
very easily laid down. — Mr. Doran observed that the true
pathological question suggested by Mr. Tait’s paper was
the relation of inflammation of the tube to extra-uterine
pregnkney. Disease of the tubal mucous memhranS
was very common, as the tubal canal communicated
with the exterior through the uterus and vagina, and
was thus liable to septic infection and to extension of in-,
fliramatory affections from the uterus. If, then, this
“desquamative salpingitis” rendered the patient liable to-
tubal pregnancy, that form of pregnancy ought to be very
common. Freund’s theory that a large proportion of tubal
pregnancies ended by early arrest of the development of the
foetus and disappearance of all objective and subjective
symptoms would account for the discrepancy suggested
by the great frequency of tubal disease and the apparent*
relative rarity of tnbal pregnancy.—Dr; Moors asked
whether there were any specimens in illustration of-the
paper, and whether the diagram was only a diagr am or
represented a particular case.—Dr, W. 3 * Aj Griffith
thought that, without an examination and criticism of-
specimens, the evidence la support of Mr. Tait’s Tiews w»g

526 The Lancet,]

MEDICAL SOCIETY OP LONDON.

[Mabch 12,1887.

not incontrovertible; the drawings were diagrams, and not
representations of facts. In reference to the rupture in
tubal pregnancy taking place at the side of the placenta, he
reminded Mr. Tait that tnis structure was not differentiated
till after the third month of gestation. He had a month
previously brought forward the first recorded case of salpin¬
gitis as a cause of extra-uterine foetation (The Lancet,
p. 268).—Mr. Lawson Tait, in reply, said that one of the
drawings represented a particular case; the other was a dia¬
grammatic representation of the parts seen in a case he had
operated upon. He was glad to hear of Freund’s views, as
they confirmed the impression he had been arriving at that
tubal pregnancy was common. In reference to the placenta
question, he was frequently engaged in removing pieces of
placenta before the third mouth of gestation; they were
usually infiltrated with blood, hence the difficulty in recog¬
nising their real nature.

Mr. R. Bakwell showed a case of (?) Cirsoid Aneurysm
of the Left Upper Extremity. The man came for a wound
of the left index finger, the bleeding from which was
controlled with difficulty by a firm pad under the bent
fingers. Gangrene of two fingers commenced after thirty-
six hours. The arm was amputated above the elbow
after ligaturing the subclavian artery. The veins of the
arm and forearm pulsated strongly and with a thrill,
but there was no buzzing unless on direct auscultation.
The arteries freely pulsated everywhere in the affected
limb. There were no discolourations or naovi. There was
no hypertrophy, or warts, or overgrowth of hair. The condi¬
tion was congenital. There was no direct communication
between any artery or vein. A venous plexus existed on the
median nerve just above the wrist. The venae comites were
not large. The third part of the subclavian ligatured was
not enlarged. The brachial and other arteries were greatly
enlarged and tortuous. An aneurysmal dilatation was eeen
at the origin of the superficial^ volte from the radial. There
was not that mesh work of mixed arteries and veins as seen
in cirsoid aneurysms. It was neither aneurysmal varix nor
varicoso aneurysm. Macro-anginosis was the term he applied
to this unique disease.

Dr. J. A. 1’hicb showed a specimen of Cholesteatoma at
the Base of the Brain, taken from the body of a widow,
aged thirty-nine. It was situated in the space extending
from the medulla to the optic chiasma, laterally extending
as far as the temporo-sphenoidal lobes; it was encapsulated,
the capsule being continuous with the pial arachnoid, and
the brain substance was everywhere free from new growth.
Microscopically, many cholesterine crystals were found in
it, besides granular masses, and cells devoid of nuclei; the
tumour was very brittle, and of pearly white aspect. There
were other similar smaller tumours by its side. The patient
had been ailing for five years, and had been liable to seizures,
probably of an epileptic character; she had atrophy of both
discs, and had been blind with the right eye for four years.
A similar case had been fully reported in the fifth volume of
the Society’s Transactions.

The following card specimens were exhibitedMr. D’Arcy
Power: A Rhinolith. Mr. Shattock: Colles’s Fracture, with
Displacement Forward of Lower Fragment. Mr. Doran:
Horny Growth from Neck. Dr. G. N. Pitt: Thickened
Capsule of Testicle. Dr. A. Withers Green: Aneurysm of
Aorta ruptured into Pericardium.

MEDICAL SOCIETY OF LONDON.

Annual General Meeting.—Perforation of Femoral Artery
and Vein from Suppurating Bubo.

The annual general meeting of this Society was held on
Monday last at 8 p.m., Mr. R. Brudenell Carter, F.R.C.S.,
President, in the chair. The President and officers of the
Society for the ensuing year were elected. Their names
appeared in our columns last week. The report of the
Council stated that the Fothergillian gold medal would not
be awarded, as only one essay, of insufficient merit, had been
received.

Mr. Marmadukk Sheild read a case of Perforation of
the Femoral Artery and Vein that occurred in a man aged
twenty-two, a porter, admitted into Westminster Hospital
under the care of Mr. Macnamara. The patient had a
chancroid on the penis, phimosis, and a suppurating bubo in
the groin, which was opened and profuse end offensive dis¬

charge let out. Counter-openings and stimulants were em¬
ployed, but the suppuration extended. When the case came
under Mr. Sheild’s care, on Feb. 9th, 1887, the soft parts in
the groin were much involved. The sinuses were slit up.
One sinus passed behind and internal to the femoral vessels,
leading into a cavity. The cavity was sponged out, and
then bleeding commenced, slow and venous at first, arterial
afterwards. The cavity was laid freely open and compres¬
sion practised at the groin. Digital compression was success¬
fully tried for a time. Davy’s lever was employed to control
the haemorrhage, and both vessels were exposed and the
ulceration explored. A hole the size of a crowquill was
found in the femoral artery, or a part of the vessel near the
trunk of the artery. The artery was tied once by itoelf and
a second time with the vein lower down. The patient was
much exhausted, and collapsed. Notwithstanding every
attention, the patient remained very ill with pyrexia and
rigors, and died a few days after the operation of ligature.
At the partial inspection after death the head of the femur
was found to be displaced towards the obturator foramen.
The ligatured vessels were removed, and the specimen was
shown to the Society. The vein between the ligatures was
in a sloughy state. The superficial femoral artery was
obliterated by firm clot. The author reviewed the literature
of these rare cases.

Sir W. Mac Cobmac said the cases were very rare. He
gave his own experience of like cases. It did not follow
that ligature of both vessels near Poupart’s ligament would
necessarily lead to gangrene. Stromeyer said that double
obstruction was a sufficient indication for amputation of
the limb near the trunk. He strongly agreed with Mr.
Sheild that pressure was an uncertain method of treatment.

Mr. Bebnabd Pitts referred to a case of suppuration
above Poupart’s ligament in a boy. There was high fever.
Aspiration was at first practised. But the fever continued,
and abscesses appeared below Poupart’s ligament. These
abscesses Sir W. Mac Cormac incised, and counter openings
were made. A few days later free haemorrhage occurred,
and this was found to proceed from a hole in the anterior
aspect of the femoral artery half an inch below Poupart’s
ligament. In finishing the operation of ligature ot the
artery a snick was made in the vein, and this necessitated
the double ligature of the vein. The boy recovered; the
limb did not become gangrenous, was merely cold for a few
days, and ultimately Became a serviceable limb, though it
was a little smaller than the sound one. He advocated
powerful cauterisation as the treatment for sloughy wounds.

Mr. Pickering Pick attempted to explain why it was
that the carotid and femoral arteries were the only arteries
that were the seats of this form of haemorrhage. He con¬
sidered that disease of the superficial glands might lead to
affection of the deeply situated glands which are bound
down by the strong fascia of the limb. It was possible that
this close confinement by a tense fascia had at least some
share in causing ulceration of large bloodvessels.

Mr. Astlev Bloxam referred to two cases of haemorrhage
from the groin resulting from suppurating bubo: one
occurred in a female and the other in a male. Both died
from exhaustion, and in both the femoral artery was
ulcerated. He alluded to a case of Mr. Morrant Baker's, in
which the gluteal artery was the bleeding vessel, and to one
in which the iliac artery opened into the psoas abscess.
Pressure would, in his opinion, be valueless; the vessel
should be secured where its coats were in a healthy state.

Mr. C. B. Lockwood said that moist gangrene would be
very likely to occur after double ligature when the limb
was not in a healthy state, as when the ligature was per¬
formed for aneurysm or infiltration of the limb with blood.

Mr. Thomas Bbyant was much pleased with the recital
of Mr. Sheild’s rare cases. And be could not help thinking
that this condition of sloughy ulceration was responsible
for the changes about the artery that led to ulceration and
haemorrhage. He had never met with one case of the
femoral artery or vein which required the treatment such as
Mr. Sheild had adopted. He had had cases of copious haemor¬
rhage in the inguinal region, all of which had subsided
under simple pressure; and yet it was doubtful whether
there was not perforation of the large vessels. The diagnosis
was the difficulty. The haemorrhage frequently came from
the lower end of the bleeding vessel. Pressure should
always be tried first. The axillary vein and internal jugular
vein have often been tied without bad results. Some
authorities in Germany advocated ligature of the main
arterial trunk if the main venous trunk were ligatured.

/Google

Thb Lance*,]

' ACADEMY OP MEDICINE IN IRELAND.

[March 12,1887. 527

Mr. Harrison Cripps alluded to a paper which he bad
contributed to the St. Bartholomew’s Hospital Reports,
1874, of fifty cases of ligature of the femoral artery in its
continuity. He considered that pressure and bandaging,
properly applied, was the most appropriate treatment for
treating secondary haemorrhage from the femoral artery. It
was important to apply pressure above as well as below the
bleeding point.

The President referred to the importance of ligaturing
the artery at the bleeding points when ulceration from gun¬
shot wound has been followed by secondary haemorrhage.

Mr. M. Shbild, in reply, pointed out that the saphena
vein might be patent, and allow of a return of blood from
the limb by its communications with the deep and muscular
veins.

ACADEMY OF MEDICINE IN IRELAND.

Ovarian Tumour .— Treatment qf Vagin'umus. — Porro's
Operation for Rupture of the Uterus.

At the meeting of the Obstetrical Section held on Jan. 7th,

The President exhibited part of an Ovarian Tumour which
had been developed between the layers of the left broad
ligament. On opening the abdomen the tumour came into
view. It was punctured, and a large quantity of fluid
escaped, and then the tumour partly collapsed; but he found
it impossible to pull it out. He found that it extended
along the uterus to the iliac region, and filled the whole of
the broad ligament. It seemed to be unilocular, and therefore
ho only removed the part of it which he now showed, leaving
about a third of the tumour behind. He removed the
peritoneal covering and tried removal by enucleation ; and
ia some places it gave way easily enough, but afterwards he
came to adhesions which rendered that mode of enucleation
impossible. The woman had hardly any rise of temperature
until the second or third week after the operation, when she
had a slight rise of temperature. She was now apparently
quite well.

_ Dr. More Madden read a paper on the Treatment of
Vaginismus, which he defined as excessive sensibility of the
vaginal orifice and adjacent parts, attended with such
spasmodic contraction of the sphincter vaginae as to form an
impediment to marital intercourse. This, he believed,
occurred chiefly in patients of a hysterical temperament, and
was generally occasioned by neuromata, confined to the
parts supplied by the superficial perineal branch of the pudic
nerve. From clinical experieuoo he could vouch for the
possibility, in many case?, of relieving the most intense
•lyspareunia thus caused, without any operative interference
beyond the forcible dilatation of the vaginal canal and
stretching the pudic nerve implicated by the disease. The
method or effecting this was detailed, and the writer, at the
same time, laid stress on the importance of conjoint employ¬
ment of that topical and general sedative treatment which
is indicated in these cases, as in all other local manifestations
of constitutional, nervous, or hysterical disorder. In some
instances, however, these failed, and we must then fall back on
8ims’ or Emmet’s operations for the cure of vaginismus, the
indications for which were referred to. In conclusion,
Dr. More Madden pointed out that it sometimes happens
that even in cases of vaginismus, so intense as to render
complete marital intercourse impossible, the disease is not
necessarily a barrier to impregnation. Thus, in one instance
under his observation so extreme was the local hyper-
aejtheaia as not only to prevent the possibility of complete
cohabitation, but also to prevent the patient submitting to
any local treatment for relief of the morbid condmon.
Nevertheless, conception occurred, and he subsequently was
called in to deliver her at full term, and in doing so was
obliged to incise the still unruptured hymen by which
delivery was obstructed.—Dr. Frasbr said he could confirm
the remark as to the possibility of pregnancy occurring
without vaginal intercourse.—Dr. S. Mason said a little rest,
and painting the orifice with nitrate of silver, were sometimes
very effectual. It was not always necessary to remove the
hymen; but when that operation was done it was always
‘well to make a lateral incision in order to expand the
orifice.

Dr. 8. Mason reid a paper on a case of Rupture of the
Uterus. On No v. 5th, 1880, a patient was ad mitted tothe labour
of the Coombe Hospital, who had been in labour with
her third child for more than three days. Her two previous

labours had been difficult and tedious, the child in each case
being stillborn, though labour was completed by the natural
efforts. A clear history could be obtained of the uterus
having ruptured twenty-six hours before the patient’s
admission to hospital. On opening the abdomen the child
was found lying directly behind the abdominal wall, and
was easily extracted by tract ion on the lower extremities;
the placenta was in the right lumbar region, surrounded by
blood and meconium, and the uterus was situated posteriorly,
small, and well contracted, and in its lower part was a tear
extending completely through the cervix. The uterus was
then removed, the pedicle formed by the cervix being secured
by a Keith’s damp aud a transfixion needle, the abdomen
being closed by silk sutures. The patient rallied well after
the operation, and seemed to be progressing favourably for
about ten hours, when she suddenly commenced to vomit
and died. At the necropsy signs of recent and extensive
peritonitis were found in the abdominal cavity. The portion
of uterus enclosed in the clamp was torn through to the
lower extremity of the anterior lip of the cervix. The
bladder was uninjured. The pelvis was that desribed as
the oblique pelvis of Naegele, complicated by projection
downwards and forwards of the last lumbar vertebra.—Dr.
Shyly said the great difficulty with which Dr. Masou bad
had to contend was the poisoning either of the uterus or the
peritoneum. To his mind, the great objection to bringing
the child back was that it rendered the cleansing of the
uterus and perineum imp'ssible if either had become infected.
Members were aware that Bcbroeder bad performed Porro’s
operation in a different kind of case from the present—namely,
in order to remove a uterus which had been infected by a
portion of the placenta having been left in by the midwife,
the doctor not having been sent for until a considerable time
after delivery. In that case ihe portion of the placenta was
found to be completely decomposed, and the operation saved
the woman’s life. Dr. Mason might have lost his patient by
performing Banger’s operation instead of that of Porro.

CAMBRIDGE MEDICAL SOCIETY.

A meeting of this Society was held on Jan. 7tb, Dr. J. B.
Bradbury, President, in the chair.

Severe Injury to Thorax — Mr. Francis showed for Mr
Sunderland, of Thaxted, a patient who had recovered from a
severe crushing injury to the thorax. Three years previously
he was crushed between a traction engine and its tender.
When sfcen a few hours afterwards, he was in a condition of
great collapse, with considerable hemoptysis. The sternal
end of the left clavicle was di.-located behind the manubrium
stemi, and the cartilages of the first six or seven ribs of the
left side were separated from their attachment to, or fractured
jast outside, the sternum, and driven behind that bone. The
shoulders were drawn back and confined by a figure-of-eight
bandage; but the htemoptysis continued for a few days, and
there was emphysema of rhe whole of the front, back, atfd
side of the chest on the left side, and irregularity in the
heart’s action. For several weeks he appeared to be dying;
he then improved rapldly.bat owing to temporary paralysis
of the musculo-spiral nerve on one side, the result of the
original accident, he did not resume work until fifteen weeks
from the date of the accident. The original deformity
remains, and the sternal end of the clavicle can plainly be
felt behind the manubrium; there is no evidence of pressure
on the trachea, oesophagus, or large vessels.

The Formation of Thrombi in Pulmonary Vestele.— Mr.
Griffiths showed specimens of lung illustrative of throm¬
bosis and embolism and the results produced thereby. The
first was a specimen of a very large cavity occupying the
upper lobe, which extended to tbe root, where the large
branches of the pulmonary vessels were closed by thrombi;
tbe second, where thrombosis had occurred in consequence
of incomplete revolution after an attack of pneumonia on
the right side, where gangrene in two areas of considerable
size had supervened; the third, a series of infarctions of
different ages from tbe same case, in which left cardiac
disease and carcinoma of cervix uteri were the chief
anatomical lesions. The vessels corresponding to the areas
had been disseeted to demonstrate the preeeuce of plugs fa
them. Microscopic preparations of the thrombi ana of the
different parts of the infarctions were exhibited.

Macro-gloseia. —Mr. Francis read thenotee of n of
macro-glossia, which had been under the care ' r

Digitized byGOOQle

528 Tub Lancet,J

REVIEWS AND NOTICES OP BOORS.

[March 12,1887.

Humphry in Addenbrooke’s Hospital. W. M-, male, aged

live mouchs, was admitted on Sopt. 1st, 1886. He was thin,
pale, and weakly, with a somewhat imbecile expression, but
taking notice of things around: the tongue was too large
at birth, and had been gradually increasing in size ever
since; the child took the breast with difficulty, and
had latterly been fed on milk-sop. The mouth was always
wide open; the tongue freely protruded, curving abruptly
downwards from the tightness of the frronum, with marked
drooping and eversion of the lower lip: the protruded part
was an inch and a quarter long in the middle line, and an inch
and a half broad at the base,and quite symmetrically enlarged
in all itsd imensions, the edges being thick and rounded, the tip
broad, truncate, and slightly bilid. The tongue could just be
contained within the mouth, with evident discomfort; there
was wide dilatation of the nostrils and marked bulging of
the submaxillary region; saliva freely dribbled from the
mouth, and there was an eczematous eruption about the chin
and lips; the submaxillary glands appeared to be slightly
enlarged on both sides. The protruded part of the tongue
presented two deep antero-posterior furrows, parallel with
the edges of the tongue and meeting just behind the tip ;
within the furrows thfe dorsum was convex from before back¬
wards and from side to side, and coated with brown fur. The
edges were clean and superficially ulcerated here and there;
the papillro were every where enlarged, and scattered thickly
and irregularly over the anterior part of the dorsum and to
a less extent over the under surface were numerons, pale,
translucent, lymphatic cysts, from the size of a millet-seed
downwards; the whole tongue was moist, and nowhere cracked
or dry. There was no evidence of glossitis, nor haemorrhages
in the mucosa; there were no teeth, no deformity of the
lower jaw, no evidence of lymphangiectasia of any descrip¬
tion elsewhere, nor any deformities. There was no history of
mental disease, or deformities, or struma in the family.
The child died suddenly after being in the hospital a week,
with a temperature, irregular before, suddenly rising to 108° F.
There was a littledifficulty in swallowing, but no interference
with respiration. A portion of the posterior part of the
dorsum, where the disease was least advanced, was examined
microscopically. The papillro were much and irregularly
enlarged, more vascular, and covered with a thick layer
of cuticular cells superficially. The submucous lymphatics
wore enlarged here and there, and the lymph canalicular
system of the muscle-bundles was especially dilated, but
no defined cysts or hromorrhages were seen.

Mr. Wherry described and exhibited a case of remarkable
Power of Retraction of the Tongue. The organ could be
completely pushed up behind the soft palate and uvula, and
the tip could be made to touch, with precision, any part of
the post-nasal region.

Communication of Diphtheria.—Tit. Anningson described
three special epidemics and several isolated cases of diph¬
theria which had occurred in his experience. The former
illustrated very well the tendency of diphtheria poison to
cling to localities and reappear at certain periods with
Bpecial force, as well as the iufluence of school assemblage
in favouring the spread of the disease. One interesting
feature was the sudden explosion of the disease, after a
period of quiescence, among the girls attending school, while
the boys, with one exception, escaped ; and his case was ex¬
plained by his having been exposed out of school hours to the
same influence as the girls. Dr. Anningson also related some
apparently' unexplained cases of diphtheria in lonely de¬
tached houses; which afterwards could be traced to rain
water used for drinking which had been contaminated by
the droppings of domestic birds; also an instance where the
converse seemed to have occurred in the infection of pools
by human discharges.

Royal London Ophthalmic Hospital. — The
annual general meeting of the supporters of this institution
was held on the 8th inst. The report stated that the hospital
had in the past year afforded relief to 28,260 persons, the in¬
patients numbering 2049 and the out-patients 28,211. The
total receipts for the year, including legacies, amounted to
£6939, a sum which more than met the expenditure.

Presentation. —The Committee of the Moni-
wearmouth and South nick Dispensary have presented
Dr. Bruce Low with an illuminated address, he having
been appointed a surgeon for the Sunderland Infirmary, and
consequently having resigned his connexion with the
Monkwearmouth institution.

micfos aittr Itotias of §ooks.

A Treatise on the Principles and Practice of Medicine. By
Austin Flint, M.D., LL.D. Sixth Edition, revised and
largely re-written by the Author, assisted by William
H. Welch, M.D., and Austin Flint, M.D., LL.D. London:
J. and A. Churchill. 1886.

A new edition of a work of such established reputation as
Flint’s “Medicine” needs but few words to commend it to
notice; but to this sixth edition there attaches a melancholy
interest in the fact that its preparation occupied the mind
of its learned and much-lamented author during the closing
years of his life. It may therefore in truth be said to
embody the fruit of his labours in clinical medicine, ripened
by the experience of a long life devoted to its pursuit. The
volume has further been revised by the author’s son, the
well-known Professor of Physiology in the Bellevue Hos¬
pital Medical College, and by Dr. Welch, Professor of Patho¬
logy in the Johns Hopkins University. A comparison of this
edition with the preceding, which was published in 1881,'
serves to illustrate in a striking manner the remark¬
able advances made, especially in pathology, during the
past five years, necessitating in many chapters an entire
recasting of the text, with numerous additions in the
statements of observed facts. Dr. Welch’s assistance in
these chapters has been invaluable, with the result
that the reader will find a clear and succinct account
of our present knowledge upon the etiology of disease and
the nature of morbid processes which no other text-book of
medicine supplies. Amongst the additions to the volume
may be noticed the articles on Infectious Tumours, Syphilitic
Disease of the Lungs, Cerebral Syphilis, Spastic Cerebral
Paralysis of Children, Hereditary Ataxia, Myxcedema (which,
by the way, is omitted from the index), Multiple Neuritis
(where, however, we miss any reference to the recent and
rapidly accumulating evidence of the influence of alcoholism
in its causation), and the General Pathology of Fever; but
this enumeration does not nearly cover all the additions
and alterations in the text of the work. If we were to
single out, where all is of such good quality, any chaptera
as especially noteworthy, we should have little hesitation in
pointing to those upon Diseases of the Lungs and the
Heart, for these were subjects to which Dr. Flint paid special
attention. His well-known views upon the constitutional
nature of pneumonia, or as he terms it “ pneumonitis," or
preferably “pneumonic fever,” promulgated many years
ago, have received striking confirmation in Friedlander’s
discovery of the “pneumococcus,” although it is pointed
out that the evidence of this being the specific organism is
as yet inconclusive. The article on Pulmonary Phthisis
is notable for the sagacious remarks upon treatment,
especially upon the momentous question which is pressed
upon the physician as to advice respecting the patient
seeking a change of climate. In the chapter upon
Valvular Disease of the Heart the significance of the
various murmurs is most clearly set forth. The section
devoted to Diseases of the Hromopoietic Organs contains an
excellent account of pernicious anosmia, in connexion with
which it may be remarked that “more than twenty-five
years ago” Dr. Flint pointed out the dependence of certain
fatal cases of anromia upon degeneration of the gastro¬
intestinal glands, which Dr. Fenwick in this country
confirmed many years subsequently. But it is not necea-
sary to adduce evidence of the care or labour expended
on the work; it speaks for itself, and will remain as a
permanent testimony to the great abilities of its author.
We cannot, however, refrain from quoting a passage
from the preface contributed by his son, for it affords

x Tax Laxckt, vol. il. 1881, p. 131.

The Lancet,]

REVIEWS AND NOTICES OF BOONS.

[Maboh 1^ 1887. 529

soma insight into his immense industry and capacity for
work, that may be. taken' as an example worthy to be
followed

“ The basis of the work is an unbroken series of records
of cases in private practice and in hospitals, begun in 1833
and continued for more than half a century, covering 16,920
folio pagesof manuscript, written with the author’s ownhand.
These records embrace carefully written histories of cases in
all departments of practical medicine, observed under varied I
conditions of life, climate, and general surroundings. Soldiers
in camp and barracks; the rich and the poor; those affected
with diseases incident to lives of ease and luxury, and
paupers in hospitals; the pioneers of Western New York
and the inhabitants of the metropolis; patients in the
wards of the almshouse and hospitals of Buffalo, of the
Marine Hospital in Louisville, Kentucky, the great Charity
Hospital in New Orleans, Louisiana, the Bellevue Hospital,
the Charity Hospital, the dispensaries and similar institu¬
tions in the city of New York; cases observed in the
experience of a quarter of a century as a general practitioner,
and of more than another quarter of a century as a consulting
physician, including the epidemics which have occurred
in this country within the last fifty years,—the experience
derived from these various sources of observation, carefully
recorded, studied, and analysed, was finally used in the
composition of this treatise, the first edition of which
appeared in 1866.”

America may well be proud of having produced a man
whose indefatigable industry and gifts of genius have done
so much to advance medicine; and all English-reading
students must be grateful for the work he has left behind
him. It has few equals either in point of literary excel¬
lence or scientific learning, and no one can fail to study
its pages without being struck by the lucidity and
accuracy that characterise them. It is qualities such as
these which render it so valuable for its purpose, and give
it a foremost place among the text-books of this gene¬
ration.

Anatomy end Physiology in Character. By F ubneaux

Jobdan, F.R.C.S. London; Kegan Paul, Trench, and Co.

1887.

Attempts to connect physiological appearances with a
certain stamp of character are as old as Aristotle and Plato.
Mr. Jordan, in his recently published work, seeks to establish
the connexion on a scientific basis. In the preface he
apologises for the “ unpleasant an<J clumsy epithets of
shrewish and non-shrewish,” which he uses for want of
better terms. His attention some time ago was drawn to
the physical conformation of women in hospital suffering
from ill-usage at the hands of their husbands. The
peculiarities common to them all were a clear skin, often
pink, scanty hair growth both on tha bead and eyebrows,
and convexity of the spine, more or less marked. Friends
and neighbours said or hinted that these women had
“ sharp tongues in their heads.” Mr. Jordan eventually dis¬
covered that these peculiarities in connexion with a shrewish
character were not confined to one sex, and he classes men
and women under the two heads of “shreWs and non- ;
shrews.” Some of us may be inclined to doubt the truth
of Mr. Jordans deduction, remembering cases of decided j
shrewishness in persons of markedly pigmented skin and
thick hair growth, and an absence of the same in the type
called by him “ shrews.” After three chapters devoted to
the character of the shrew and non-shrew, male and female,
there is an account of the differences of skin, hair, and.j
bones to be found in these two classes. In the shrews the :
dorsal curve is of excessive length, not infrequently reach- ,
ing even below the waist. This curve affects the position
of the head, and throws it forward. “ The antero-poaterior
diameter of the thorax is relatively increased; henoe
its cavity from breast-bone to spine is deeper. Ip
the non-shrewish skeletons the long transverse is ex¬
ceedingly marked; it Would seem as if the thorax were

endeavouring to throw itself back and embrace the spinal
column. This backward tendency of the spine has one
striking result—the curves of the thorax posteriorly on
each side of the spine lie at a level distinctly posterior to
the most prominent portions of the vertebral bones, so that,
looked at from behind, the spine, even at its dorsal curve, is
seen to lie on an actual hollow between the two shoulders.”
Mr. Jordan lays some stress on the fact that in shrewish
men and women the skin is clear, transparent, and pig¬
mentless, often accompanying very pretty features. The
nails are inclined to be thin and weak, easily bent or
torn, the hair thin and scanty, the eyebrows ' especially
being poor and uneven. That marriages Bhould ever be
arranged by a mutual choice of shrews yvith shrews
and non-shrews with non-shrews appears to be very hypo¬
thetical; still, Mr. Jordan is not without some hope that
future years may bring such a result. The characters of
shrews and non-shrews may be sumtned up in a few
words. Shrews are superficial, restless, consequential';
having no deep sympathies, affections, pa® ions, or emo¬
tions ; nearly always moral, not from an inherent sense of
duty, but from the desire to be considered respectable. They
are apt to be discontented at home, but to shine in
society, of which they often form very useful members.
Non-shrews cannot precisely be described as th8 diredt
antithesis, but they have deep emotions, sympathies, affec¬
tions, and passions. Non-shrews are more easily, led into
crime, owing to their deeper feelings. It is not incompa¬
tible with non-shrewishness to shine in society or to be
voluble and passionate, since a shrewish person does not
feel deeply enough to be really angry. Mr. Jordan
expresses a hope that more attention will be paid in future
years to physiology in connexion with the training of
children and the development of character. The closing
chapters are devoted to the shrewish character in connexion
with literary work and the influence apparent in many
standard books. __

Alexander Wood, M.D., F.R.C.P.E ., fyc.a Sketch of Hie
Life and Work. By the Rev. Thomas Bbowk, F.E.8.E.
(his Brother-in-law). Pp. 203. Edinburgh: Macniven.
1886.

To the personal friends of the late Dr. Alexander Wood
this book cannot fail to be acceptable as furnishing them
with a record of his many kindly and estimable qualities,
and of the zealous manner in whieh he worked to advance
the Interests of his profession and to promote any public
philanthropic and Christian work. It will also prove interest¬
ing to many of the older alumni of the university and medical
schools, as it contains some reminiscences of Edinburgh as
it was sixty years ago, and of the professors and teachers
about that period. But we regret to add that it is open to
the objection whifch may' be brought against most of rise
biographies written by near relatives, that it takes a Very
partial and one-sided view of the work done by the subject
of the memoir. , A reader of the present volume might fairly
rise from its perusal with the impression that almost all the
work done in Scotland during the last half-century to
improve the science df medicine and the status of the pro¬
fession had originated with, and been carried through mainly
by, Dr. Wood. In fact, there is scarcely, from the beginning
to the end of the book, any mention of the work dope by
any other ipember .of the profession. This is much .to be
regretted, as it oannot fail to produce an unpleasant impres¬
sion that his biographer is claiming for him an amount of
influence which he did not exercise. Dr. Wood’s many good
qualities and zealous work were sufficient to ensure him
distinction and respect without the labours of others being
of necessity ignored. The volume is remark aWywell brought
out, and contains two portraits of Dr. Wood—in middle life
and in hie later yean.

joogle

Du

530 The Lancet,]

THE PRISON DENS OF ENGLAND.

[March 12,1887.

THE LANCET.

LONDON: SATURDAY, MARCH 12, 1887.

The Committee appointed to inquire into the accommo¬
dation for prisoners in court-houses and other places while
waiting for trial at assizes and sessions have now issued
their report, and the particulars contained therein oonfirm
in the fullest manner the grave charges which The Lancet
has from time to time brought against the existing arrange¬
ments, and proves that, so far from such complaints being
exaggerated, as has been repeatedly affirmed, the accusation
bos actually fallen far short of the reality. Those only
whose duty it has been to visit the court-bouses and other
places where prisoners are detained whilst waiting for
trial could have been prepared for the statement of the
committee, that “in very few everything that can be
expected is to be found,” but many, “ on the contrary, aro
as bad as well can be.” Of these they go on to say “ that
nearly every requisite of humanity, and even of common
decency, is wanting; and scenes Btill take place which
it might reasonably have been hoped belonged to fifty or
a hundred years ago.” When the details on which this
statement is based become known to the people of England,
a feeling of disgust and mistrust will be aroused, which will
fall heavily on those who have sturdily maintained the
perfectability of our prison system: disgust that such
abominations are permitted; mistrust lest the much-praised
management of the gaols be in reality as defective as that
of the court-houses. With regard to this latter point our
opinion has been frequently expressed, and it is well known
that we do not view with approbation the treatment indis¬
criminately adopted for all prisoners after trial under the
provisions of the new Prisons Act.

But to return to the arrangements provided for those who
are not yet proved guilty. In the first place, one would
imagine that, in England at least, there would be neither
want of ventilation nor of decent closet and urinal accom¬
modation ; yet in Derby we find as many as twenty
prisoners at a time crowded into a room only 18 ft. by 9 ft.;
at Ipswich, twenty to thirty in a room of lift. 10in. by
6 ft. 2 in. by 6 ft. 3 in.; and at Oxford, twelve in a room 9 ft.
by 8 ft. 6 in. In some of these rooms there is no separation
of adults and children, of convicted and unconvicted! In
some of the places, however, where separation is attempted,
torture is superadded to confinement, and men and women
are bolted for many consecutive hours, sometimes days, in
dens hardly larger than ordinary clothes-cupboards. Thus
at the Central Criminal Court the dens are 2ft. Gin. by
3ft.; at Marlborough, 2 ft. by 2 ft. 4 in. ; Gloucester,
2 ft. 1 in. by 2 ft. 4 in. In these last the Committee inform
us that prisoners have been confined six days consecutively.
As regards the sanitary arrangements, in many cases the
offices of nature, if performed at all, must be performed
in the presence of spectators; at Hereford there is an earth-
closet, without a screen, in the one room occupied by the
prisoners and the warders. Happy those -> are provided

with pails in their cupboards. At Marlborough there is one
room with a number of boxes in it. “ Sawdust is used to
cover the excreta; the stench is sometimes very bad.” At
Petwortb, with sometimes twenty-two prisoners in one
room, the only accommodation is a bucket behind & screen.
In important towns, such as Carlisle, Derby, Newcastle, and
Oxford, there is no watercloset, privy, or accommoda¬
tion of any sort. After such a confession as to the pro¬
visions for ordinary decency, we are not surprised to
learn that the arrangements for lighting and heating are
extremely defective. Some places are, indeed, provided
with hot-water pipes and gas-burner?, but in this caee the
prisoners seem to be worse off than without them, for
owing to the minute cubic space allotted in these dens, the
atmosphere speedily becomes close aud overheated, whilst
the heat causes rapid decomposition of the contents of the
pails and the sawdust-covered excreta, so that after a few
hours the effiuvium becomes unbearable and the air foul and
poisonous. In other places no attempt is made to warm
the buildings, so that in winter the tomperature sinks
often to 40° F., and that with damp and unprotected
stone floors. These insanitary conditions explain in part
tho high relative de&th-rate from pneumonia, which we
have often pointed out as characteristic of prison bills
of mortality, though no doubt the plank bed and defi¬
cient dietary of the convicted prisoner give the final
stroke. In some places the gaslight is placed outside
the cell, so that the prisoner remains in partial darkness
and gloom, sometimes for many days together. Even
in these wretched holes one would think some provision
would be made for the physical rest of the prisoners,
yet we learn that in the prisons where seats are provided
they are mostly of stone and brick, cold and damp, and conse¬
quently injurious if used continuously; but in most instances
no seats are provided, and the wretched prisoners have either
to stand like cattle in railway trucks, or squat like negroes
between the decks of a slaver. So much for the physical
aspect, but the moral is quite as revolting; one would think
the matter of the separation of the sexes is a question that
would hardly be open for discussion, and yet “this elemen¬
tary requisite of decency ” is not invariably provided for. We
always understood that the-separation of prisoners was one
of the most important points attended to under our “ per¬
fected” criminal laws. Fancy the fate of a young servant
girl, arrested on suspicion for some small theft—erroneously,
perhaps,—kept in contact for many hours with abandoned
men and women. Lucky for her if chance isolates her in
the two-foot cupboard! Surely the reasons that separate
tried prisoners from each other hold with greater force in
the case of the unconvicted.

Only a few years have passed since The Lancet com¬
mented upon the treatment of an unfortunate unconvicted
prisoner who died at Winchester, after repeated journeys
to and from Southampton, where he was exposed to many of
the evils at present commented on. At the time we were
assured that our statements were unwarranted, and our
conclusions false; but the present picture is a hundredfold
darker than we then dared to think even possible. Then the
officials declared that the arrangements were perfect; now it
is clearly Bhown how defective in many cases they really are.
As it has been proved with regard to our court-houses, so we

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THE Lancet, J REPORT OP MEDICAL OFFICER OF LOCAL GOVERNMENT BOARD. [Mabch 12; 1887. 531

fear it is with our gaols. We have had repeatedly to
comment on the deaths of prisoners in gaol from pneumonia
or suicide, and other causes, and we are repeatedly told that
these are exceptions—that no system was ever more perfect.
We doubt it, even as we doubted the case of the unconvicted,
and we hope the public and the press of England will call
for a commission of inquiry into the conditions of con¬
victed similar to that which has just issued its report on
the treatment of unconvicted prisoners.

We hare already dealt at length with that portion of
Dr. Buchanan’s recent report which discusses the impor¬
tant question of the influence of small-pox hospitals in
London. It remains to note some of the other subjects
which are dealt with in the same volume;. Amongst these
the connexion of scarlatina with disease in milch cows is
referred to, the points discussed being mainly based on the
circumstances attending the llendon scarlatina epidemic in
1333, although the whole story of milk epidemics is briefly
alluded to. The Hendon outbreak, and the reports on it by
Mr. Power, Dr. Klein, and Dr. Cameron, were commented
oa in our columns at the time of the occurrence, and we
need now only refer to the matter in connexion with the
more recent labours of Dr. Klein as to the pathology of the
illness in the cow, which was found to be associated with
the scarlatina, and to point oat that his completed report is
illustrated by a series of excellent lithographic plates. It
most also be noticed that, amongst other important obser¬
vations recently made on this matter, Dr. Klein is announced
to have obtained from the blood of ordinary human scar¬
latina a micro-organism identical in its morphological
characters with that inhabiting the ulcers of the Hendon
cow disease. In view of what has recently been learnt as
to scarlatina, Dr. Buchanan finds reason to expect that a
measure of additional control may be obtained over a
disease which, in spite of the general sanitary progress of
the country, is still fatal to some 17,000 or 18,000 persons
during the average year in England and Wales. Dr. Klein
has also pursued his investigations as to foot-and-mouth
disease, and he has been able to identify the disease in the
lower animals with a definite kind of micrococcus occurring
in wavy chains, streptococcus, in the vesicles of the
disease; and subcultures have the power of inducing the
some affection. This power is most surely exerted when
animals are fed with the infective matter, bnt although
inoculation does not produce disturbance of health, yet
animals so inoculated became refractory to the influence of
the poison administered to them by feeding.

Tubercle has been further studied by Dr. Klein and
Mr. Linoard, and, in addition to some negative results, it
has been ascertained that tubercle in the fowl, which is of
the nature rather of the disease which affects man than of
that which prevails in bovine animals, can be communicated
to tho fowl during feeding by means of human tubercular
sputa. Farther, it appears that tubercle derived from the
human subject, and used to prodace disease in fowls, may
undergo some loss of its infective power during its passage
through the fowl.

The important subject of disinfection has continued to
engage the attention of the medical department of the Local
Government Board, and further investigations have been

carried out by Drs. Klein and Cash as to the influence of
perchloride of mercury. Both the antiseptic or restraining
powers of this salt and its disinfecting or killing powers
are now ascertained to be considerably greater than those of
any other known substance. Dr. Klein states that non-
pathogenic substances offer the greatest resistance to the
operation of the mercuric salt, and he describes the measures
by which it is practicable to produce a modified form of
anthrax in sheep by inoculating the animals with the
material of anthrax along with corrosive sublimate, and this
without the special aid of experts. The drug, according to
Dr. Cash, appears to operate in a way similar to that
of a previous attack of the disease, giving, for a time
at least, a feebler quality to an attack of the disease,
and this in turn seems to give immunity against recur¬
rence.

The report contains a further contribution from Dr. Dup&£
on the question of the consumption by bacteria of oxygen
from the dissolved air in water. Dr. Dupr£ has had to
differentiate between those organisms which are and those
which are not destroyed by prolonged heating to a tempera¬
ture of 60° C.; and, experimenting with London waters, the
following results, as summarised by Dr. Buchanan, have been
arrived at. 1. Differences are observed at different periods
of the year in the behaviour towards oxygen of the bacteria
of the water furnished by a London company deriving its
supply from the Thames; differences which seem to re¬
quire for their explanation that there is variation in the
power of different bacteria (present at one and another
time) to resist a temperature of 60° C., or else that there
are seasonal fluctuations in the power of the surviving
bacteria to use the oxygen of water-dissolved air; differences
which, it is to be observed, would not be in any way
discerned by ordinary chemical methods. 2. The. faculty qf
consuming oxygen, after resisting a temperature of 60° C.,
possessed by waters taken from the Thames and Lea, and
attributed to the bacteria contained in them, is present in
a higher degree in deep well waters; their special faculty,
again, varying at one and another time, as in the oase of
the Thames water. This latter consideration leads Dr.
Buchanan to point to the possibility that we may here he
confronted with the existence in deep well water of
unrecognised spores of bacteria, and with the question of
the influence of light on bacterial life. Indeed, the researoh
tends to show how much we stand in need of knowledge as
to harmless as well as to disease-producing bacteria. In
fact, the whole subject naturally calls forth a plea for the
further study of bacterial life, and Dr. Buchanan urges
that instead of dealing with the harmful bacterium, when
detected, as we now do by poison or by boiling, we may
find it more scientific to turn against it such forces of
nature as are customarily antagonistic to it. The whole
history of bacteriology and of epidemic disease points to
the existence of such forces, and pathologists have long
been inclined to believe that amongst “ agencies antagonistic
to the bacteria of disease, none will be found to equal in
potency the agency of other bacteria.” Holding such points
in view, Dr. Buchanan, whilst'promising in the immediate
future further inquiries into the pathology of scarlatina and
into other matters of immediate urgency, expresses a hope
that opportunity may be afforded for some more oral

Digitized by vj oogle

532 Thu Lancet,]

THE OLbftAM POISONING CASE.

[March 12,1887.

researches Into the important subject of the life-history of
bacterial organisms. There are reasons for believing that
in such study a clue may be found to much that is still
mysterious and unintelligible in connexion with epidemic
■disease, and no more fitting work than that suggested could
be undertaken by that department of the Government
which is above all others, interested in controlling those
influences which tend to injure public health.

The Oldham poisoning case is remarkable in many ways,
and is well deserving an analysis. The facts which trans¬
pired at the Liverpool Assizes just concluded,'where on
Feb. 25th the prisoner was convicted and sentenced to
death, are briefly as follows. The prisoner, Elizabeth
Berry, aged thirty-one, was a nurse at the Oldham
workhouse infirmary. She was a widow, with one child
aged nine years and six months. She was indicted for
having wilfully murdered this child by administering to
her a corrosive poison. The deceased girl had been living
for some years with a sister-in-law of the prisoner, who
■paid certain sums for her maintenance, clothing, &c., in
all between .£12 and £13 per year. On Dec. 27th, 1886, the.
prisoner visited her daughter at Miles Platting, and returned
to Oldham with her and a child companion on Dec. 29th.
The deceased remained well in health up to the morning of
Jan. 1st, 1887. The sitting-room of the prisoner was next
’ to the dispensary of the infirmary, and she alone had the
key of the dispensary. At 9.30 a.m. on the aforesaid day
deceased was running about with her playfellow; at
10.15 a.m. she was in the dispensary, accompanied by no
ohe except her mother; fifteen minutes later she was seen
vomiting in the [sitting-room. The prisoner was holding
a tumbler in her hand, and tho deceased was heard to i
exclaim, “Oh, mamma, I can’t drink it.” The vomited
-matter was thrown away at the request of the prisoner.
Dr. Patterson, the infirmary medical officer, was asked to
' see the child. He prescribed iron and cinchona. A vessel
■ was shown him in which was some matter streaked with
blood. He Beems to have suspected that the child’s illness
might not have been due to natural causes, but this
suspicion he evidently did not consider sufficiently
grounded to act upon.

The prisoner would have no one to sit up with deceased
but herself. Curiously no explanation of her illness seems
to have been given by or sought from deceased. Next
doming (Jan. 2nd) the patient was better—so much so
that Dr. Patterson expressed himself as hopeful of her
' recovery. Towards evening, however, she became much
1 •'frotse, and Dr. Patterson was again sent for. His atten¬
tion Was directed to a “towel covered with matter
which contained blood." Feeling dissatisfied, he asked
Dr. Robertson to meet him in consultation. As the result
1 of this, morphia and bismuth were prescribed to combat the
symptoms—vomiting and pain at the stomach. On the
‘same day (Jan. 2nd) redness and, according to one witness^

• blistering of the lips were observed. It is certain a blister
' had formed by the morning of the third day. The symptoms
noted above continued more or less pronounced until death,
which occurred from exhaustion' at 5 a.m. on Jan. 4th.
During life Dr. ftoBEntfsownotided thatthe Kpe, gums, and
1 tbngue were white,'but moist ; 1 whi' wag- not

from furring, for, as Dr. Robertson testified, he had never
seen a tongue like it before.

The prisoner gave two explanations of the marks on the
lips: (1) that they were caused by some lemon and sugar,
and (2) that they were due to the “ulceration of the
mouth.” Post mortem these marks became dry and brown,
and were clearly owing to the action of some powerful
irritant or corrosive. The outline of the marks on the lip,
extending on either side from the middle to the angle of
the mouth, and in one place for three-quarters of an inch
on the cutaneous surface, was quite inconsistent with the
theory of herpes labialis suggested by the counsel for the
defence. In addition to the state of the lips and mouth just
described, other evidence of corrosion was forthcoming at
the necropsy. In the oesophagus was a black charred patch,
and there were black streaks below this. The stomach was
not charred, but it showed signs of recent inflammation, and
so did thesmall intestine. With the exception of anoldcaseous
nodule found in one lung, there was no organic natural dis¬
ease. The contention that the deceased was tubercular had
thus no foundation in fact. The weakness of the defence
was shown by challenging the view taken by Drs. Harris
Patterson, and Robertson, and Mr.EsTcouRT—viz., that
the tissues had been acted on by some corrosive agent. This
was futile in the extreme, for the evidence on that head was
overwhelming. There seems no reason to doubt that some¬
thing was taken by, or administered to, the deceased at
the time she went into the dispensary. Had she taken
anything accidentally or mischievously, would she not have
confessed the fact when seized with obstinate vomiting and
acute pain? The lull in the symptoms on the second day
might have been deceptive and accounted for by the state of
exhaustion ; but, considering that the blisters on the lips
were not observed until the end of the second day, it seems
probable that a second dose of the poison was given. It was
hinted in cross-examination that the creaaote, or the iron
and cinchona mixture ordered by Dr. Patterson, might
explain the brown marking on the lip; but allowing for one
moment this visionary hypothesis, the main question was
still unanswered: What was the cause of the antecedent
symptoms which set in with such fatal rapidity and
violence? It is easy to invent several theories to explain
certain isolated sets of facts, but m the case under con¬
sideration some theory was needed to cover a continuous
chain of circumstantial evidence, and we maintain that the
only tenable theory was that embodied in the finding of
the jury.

Many statements made by the prisoner were known to be
untrue. She averred that the life of deceased was not
insured, when it was proved that she bad herself taken out
a policy for £10, which was paid to her after her daughter’s
death. Further, she had applied for a mutual insurance
policy for £100, and although the company had not acceded
to her request the prisoner was not aware of the refusal.
Again, she tried to explain the disturbance of the alimentary
canal in deceased by falsely saying that she suffered from
constipation and had been treated for it. On no ethical
standard—legal, religious, or social—could a motive be based
at all adequate to such a crime as that which the prisoner
w&s charged with having committed; but history shows
that the motive to ill-doing is rturely commensurate with the
Digitized by VjOOg 1C

Thb Lancet,]

RESECTION OP THE KNEE.

[March 12,1887. 533

deed. At the Durham Lent ■ Aeeizee, 1873, Mary Ann
Cotton was found guilty of murder of a stepchild. After¬
wards facts transpired which made it all but certain that
she had compassed the death of her mother, fifteen children, i
three husbands, and a lodger—and mainly, if not entirely,
for the sake of getting small sums from burial insurance
societies. Later Mill a similar tragedy happened at Liver¬
pool. There was nothing, then, as regards motive incon¬
sistent with the likelihood of guilt in Elizabeth Berry's
case.

There is still some doubt as to the nature of the corrosive
employed by Berry- for on chemical analysis of the 1
stomach, intestines, and other puts no poison was dis-
covered, either organic or inorganic. The prevailing opinion |
points to sulphuric acid. If this be correct, we imagine the j
acid most have been diluted, or some traces would have '
been found, in the form of corrosion of the floor, carpet,
towels, ftc., in the room which deceased occupied during
her illness. So far as the presence of eoddening of the
mucous membrane of the month and charring of the gullet
and the absence of corrosion of the stomach are concerned,
there is no bar to the supposition that sulphuric acid had
been given in the concentrated form. It is the exception
for the mouth to be charred, and not rarely the oesophagus
looks pale, shrivelled, and corrugated, even when there is
extensive blackening and perforation of the stomach.
The local patch of corrosion in the oesophagus in this
case was probably, owing to the sudden arrest at that
spot by contraction of the circular muscular layer just
below. Some may then have passed on to the stomach, and
some returned by vomiting, Sulphuric acid, even when
considerably dilated, may prove quickly fatal. A man took
on an empty stomach six drachms mixed with eighteen
drachms of water,and died in two hours and a half (Taylor).
The emptiness or fulness of the stomach, the degree of
dilution of the acid, and the rapidity with which it passes
over the mueous membrane, are conditions which greatly
iffect the extent of corrosion and the violence of the
symptoms.

Sentence of death wa9 passed upon the prisoner on
Feb. 26th. Three days later a coroner's jury sitting at
Castleton to inquire into the death of Mrs, Finlay ^mother
of the convict), who died a year ago, returned a verdict of
“ Wilful murder ” against Elizabeth Berry. Mrs. Finlay
was seized with attacks of “ convulsions and delirium, ending
in coma,” and the medical man who attended her gave a
certificate to the effect that the deceased died from apoplexy.
So post-mortem was made at the time. During the illness
Berry was noticed to examine her mother’s eyes. After
the death Berry received nearly £100 from an insur¬
ance society, and £13 4#. from a burial club, A person
who gave her name as “ Ellen Saunders,” procured a
quantity of atropine a short time prior to the death of
Mm. Finlay, and it was alleged that Berry was that
Psmom The body of Mrs. Finlay having been exhumed,
an examination was made by Drs. Harris and Paul, and
an analysis of the viscera by the latter gentleman, who
found traces of an alkaloid which he believed to be atropine
Judging from its physiological effects. The detection of atro-
Ph» taabody tbit-had been buriedfor a year is an interest¬
ing and thrique event. There seems some doubt, however,

whether the substanoe discovered by Dr. Paul may not have
been of the nature of a ptomaine or cadaveric alkaloid.

Dr. Luoas-ChakpionnIerb contributes the first paper in
the January number of the Revue de Chirurgie, and in it he
speaks of hia experience of the operation of excision qf the
knee. His results have’ been so good, and his opinions are
so opposed to some current surgical notions, that we desire
to call special attention to them. He speaks of the earlier
results of this operation as so discouraging that he was not
tempted to perform it until 1883, the time when he had
come to entertain absolute confidence in the aseptic treat¬
ment of wounds. And he lays special stress upon this fact.
His opinions and conclusions do not apply to excisions of
the knee in general, but only to aseptic operations, in which
not only is the risk of blood poisoning entirely abolished,
but the occurrence of suppuration prevented. The presence
of suppuration he regards as evidence of failure in the
operation, and, unless extremely limited in amount, as
an imperative indication for amputation. It is dearly
essential to realise Dr. LucAB-CHAMPiONNifcRE’s position
in this respect before dealing with his results and recom¬
mendations. His series of cases includes eleven in whom
the age varied from seventeen to thirty-four; the disease
was tubercular arthritis in all but ona case—that of a man,
fifty-four yeare of age, who was suffering from rheumatoid
arthritis. All the patients recovered; in nine there was
union without any suppuration, in one there was very
limited and transient suppuration, and in one case the sup¬
puration-necessitated amputation. In no case was there any
local recurrence of the disease, and some of the patients were
able to walk one or two months after the operation. Such
results are extremely good, and cannot fail to exdte the envy
of most surgeons who have had a considerable experience of
this operation. In view of the serious interference with the
growth of the limb, the operation is not recommended in
obildren; but, on the other hand, Dr. LucAS-CHAMEioNNifcHE
thinks that middle-aged adults are suitable subjects for ft,
provided that the wound be kept aseptic and free from
suppuration. He makee some important remarks in refer¬
ence to tubercular disease. First of all, he has -not found
that exeision of the knee leads to general tubercular infec¬
tion, and furthermore he does not' regard tubercular disease
of the lungs as r necessary bar to the operation. Where the
pulmonary- disease is far advanced, of course no one wo old
entertain the' operation; but where the disease in the
lungs is -in its' first or seoond stage only, he has found
removal of a diseased knee-joint exert a distinctly beneficial
influence, and lead to a subsidence of the chest trouble.
He explains-the discrepancy between this opinion and that
more generally held by saying that the key to success in
this class of cases is the prevention of suppuration. Where
the wound heals entirely by primary union, the operation
exerts Only a good influence upon the lung mischief; but if
the wound becomes septic ahd Suppurates, this farther drain
upon the system Shows its presence by the gradual failing
of the patient’s powers and a more rapid advance of the
disease in the lungs.

As to the mode of operation there Is not much to say.
Dr. Lucas- Oka mpionni fata prefers the transverse incision
below the patella. He makes the excision v ry free; always

534 The Lancet,]

THE GENERAL MEDICAL COUNCIL.

[March 12,1887.

removes the patella and every suspicious portion of femur
or tibia; and then, having done this, he, with the most
patient care, searches for and removes every particle of
“ granulation tissue.” He drains the wound by three tubes,
one at each end of the incision and one from the back of
the joint out through the ham. All the ligamentous struc¬
tures that have been divided, as well as the bones, are united
by buried Butures of catgut.

This piper would appear to be an important contri¬
bution, and it is another proof of the revolution in sur¬
gical opinion and practice that the antiseptic treatment of
wounds has brought about. For that is the central fact:
upon the possibility of getting complete primary union
of the wound haDgs all the rest.

Within a few days of the termination of the sittings of
the General Medical Council a volume has been issued con¬
taining the confirmed Minutes of the Session, 1 as well as the
various reports presented to the Council. The latter espe¬
cially will be read with much interest, for they relate to
questions which intimately concern the future of the pro¬
fession and its usefulness to the public.

The chief of these in point of importance is undoubtedly
the final report of the Visitation of Examinations Committee,
which shows in every paragraph the extreme care which has
been taken to consider the details of professional education
and examination. The Committee are evidently impressed
with the need for the introduction of practical teaching in
every branch which is included in the medical course. The
question of the relative values of systematic teaching by
lectures and demonstrations and of practical training by
the performance of individual work is seriously considered,
and the fact is noted that to a large extent lectures have
been replaoed by more practical methods of teaching. The
Committee, however, believe that lectures cannot altogether
be superseded, and although text-books give opportunity
for students to obtain information outside the class-room,
the lecturer should be able to present material of so much
value to his pupils, and arranged in such a form, as to
render this method of teaching still an important element
in medical education. No doubt there are many students
whose power of acquiring knowledge is dependent rather
upon the eye than upon the ear; a well-arranged course
should, however, appeal to both, and the personal qualities
of the teacher will go far to create interest in a subject
which would otherwise prove tedious, however clearly it
might be described in the many text-books which are now
written for the students’, use.

The period of time which should be devoted to medical
and surgical education before the student is permitted to
present himself for examination is touched upon in the
report. It must be admitted that there is some ground for
the argument that the specification of any period is tanta¬
mount to an admission that examinations cannot entirely
be trusted to adequately test the state of a candidate’s
knowledge. The Committee, however, evidently regard this ,
requirement as important in the student’s interest, as well
as of those who will subsequently come under his care, for '
they give as their reasons for not extending the time to be
devoted to medical education the fact that a large propor-

i SpottUwoode and Go.

tion of students already voluntarily prolong their studies
during five and even six years.

The necessity is recognised for the better teaching of
pathology, including mainly pathological anatomy; of thera¬
peutics, considered essentially as comprising the action of
remedies on the healthy body; and of hygiene, embracing
public as well as private health. These, it is said, are three
expanding subjeots, and demand special attention and sepa¬
rate teaching. Such recommendations will doubtless be
carried out by the majority of the medical schools, and due
regard will be had to the comments on the advantages of
class examinations and of clinical teaching to classes of
limited numbers of students which are embodied in the
report. The subject of obtaining practical knowledge by
the holding of dreseerships and clerkships is given due pro¬
minence, but this will also engage the attention of the
Committee to which Dr. Glovbb’s motion was referred.

It is impossible to pass from the report without refer¬
ring to the admirable service which is rendered by the
Registrar (Mr. W. J. C. Miller, B.A.), both to the Medical
Council and to the profession, by thus promptly making
available for general use the lessons which the report
contains, and which especially deserve the earnest
attention of all engaged in the important duty of pro¬
fessional teaching and examining.

^tmotations.

*• Ne quid nlml*.'’

THE SANITARY CONDITION OF WINDSOR.

Tub action which the Town Council of Windsor have
taken, upon the report of Dr. Hubert Airy and Mr. Arnold
Taylor on the sanitary condition of New Windsor, will, we
trust, lead to reforms which have been often advocated
in the columns of The Lancet. A meeting was imme¬
diately called by the Mayor,and the report was read and care¬
fully considered. The clerk, the medical officer of health, and
the borough surveyor were requested to advise them as to
what steps might be taken to improve the condition of
South-place, and as to the powers conferred by the Public
Health Act of 1875 and the Artisans and Labourers’ Dwell¬
ings Acts, which would enable them to deal with the
matters mentioned in the report. A committee was also
appointed to consider and report upon the duties of an
inspector of nuisances, and it was decided to make inquiry
if the guardians of the Windsor Union would unite with
the New Windsor Sanitary Authority in the erection of
a hospital for infectious diseases and the provision of a
disinfecting chamber. The Street Committee were also
requested to consider and report on the recommendation
that a furnace should be provided for the destruction of
house refuse. No time has therefore been lost in taking
preliminary steps to giving effect to the recommendations
of the Inspectors, and it may be anticipated that under the
guidance of Mr. Simpson, the present Mayor, who has a high
reputation for public spirit, Windsor will soon attain the
position Which should be held by the Royal borough. It will
be specially interesting to observe the effects erf the changes
which we hope to see made on the rates of mortality of New
Windsor. Dr. Casey has well pointed out that, although these
cannot be regarded as excessive—indeed, in some respects are
distinctly low,—this is due to the fact of the comparatively
small proportion of young and old persons in the popula¬
tion of the town. It is probable that a reduction can still
be effected, and this is more likely to take place if steps are

The Lancet,]

THE ANTISEPTIC VALUE OF IODOFORM.

[Majbch 12,1887. 535

taken for pro venting the inundation of the lew-lying parte
at times of overflow of the river. Windsor must not be
sarprisei if England expects her not to rest content with
being superior as regards health conditions to some other
towns in the oountry; she must, indeed, strive to be not
inferior to the best; history marks her place in our national
records, and she should be representative of everything that
is best in English life. That she will become so there is
now every prospect, and it may be remembered that the
conditions which affect health are not limited in their result
upon the body alone. The promptitude with which the
Town Counoil are proceeding to carry out their promise to
tho President of the Local Government Board proves that
there is every desire to make the town worthy to be a
residence of our Queen. _

I

MEMORIAL OF LONDON SURGEONS TO THE
COUNCIL OF THE COLLEGE OF 3URGEONS.

We print in another page an important memorial which
has been presented to the Council of the College of Surgeons
by the teachers of surgery connected with the metropolitan
hospitals. The signatures attached to it include, with only
two exceptions, the names of all the surgeons at these insti¬
tutions who do not occupy seats on the Council. The
memorial contains a courteous but earnest appeal for the
establishment of a pathological and surgical laboratory in
connexion with the Hunterian Museum. Suoh an institution
would be in complete harmony with Hunter’s work, and
would render the museum a more complete memorial of the
foanderof scientific surgery. But—and this is of more import*
ance—it would supply a great and pressing need, and would
do much to remove the necessity which undoubtedly exists at
present of looking toGermany for nearly all advances in those
departments of science upon which surgery depends. It is
impossible for the Council to ignore so influential a memorial
as this, even if it had tho will to do so. It is almost equally
hard for it to return a non possumua to such a request. The
fact that the men who are busily engaged in the teaching
and practice of surgery have with practical unanimity joined
in this request is both evidence of the need that exists and
is felt to exist, and a guarantee of the response that would
be made to any action of the Council on the proposed lines.
We are aware that the funds at the disposal of the
College are by no means inexhaustible, and that special
difficulties may be encountered before such a laboratory as
is asked for could be established on a thoroughly satisfactory
footing. But we trust that the Council will do its utmost to
meet the very reasonable request now made to them.

THE ANTISEPTIC VALUE OF IODOFORM.

It was hardly to be expected that the experiments and
statements founded thereon which threw doubt upon the
antiseptic property of iodoform (see The Lancet, ante
P- 328), recently published by Drs. Hejn and RovBing, would
have passed unchallenged. They were promptly and some¬
what contemptuously dismissed as untrustworthy by a
writer in the Wiener Med. Wochenackrtft (No. 6); and in
the current number of the Fortschritte der Medicin, the
editor, Dr. Friedlander, warmly defends his contributors
against this onslaught. The attack threw doubt upon the
experiments as coming from unknown observers, and sug¬
gested that the paper had gained entrance to the pages of
the Forttchritte through editorial inadvertence. Dr.
Friedlander has no difficulty in dispelling this idea as being
utterly baseless, for not only was the article communicated to
him by Dr.Salomonsen of Copenhagen, but he bad himself been
•truck with its thoroughly scientific character and value,
as proving at least that iodoform belongs to a class of
•utiseptica differing from carbolic acid and corrosive subli¬

mate. That the subject deserves further study he freely
admits, and carries this out by inserting in his journal a
criticism of the paper by Dr. Poten of Hanover, written in
a far different spirit from that of the Vienna writers.
Dr. Poteq points out that the virtues of iodoform as a
dressing depend largely upon the liberation of iodine in
contact with the tissues and secretions, and also that owing
to its insolubility it is not possible to test its action on
pathogenic organisms in the same way as other substances
can be teeted. He does not endorse the statement that
iodoform is dangerous because of its possibly being con¬
taminated with septic material, and considers the united
testimony of practical surgeons as to its efficacy to over¬
ride such rather problematical risks.

) -

SIR MICHAEL HICKS BEACH.

The health of our statesmen is a matter of supreme
interest to the public, especially if there be any suspicion
that it is affected by their public duties. Some mouths back
Dr. Robeon Roose, finding that Sir Michael Hicks Beach
was suffering from cataract, suggested a consultation with
Mr. Anderson Critchett. It was then found that the sight
of the right eye was of little value owing to the density of
the lenticular opacity; but as with suitable glasses Sir
Michael could still, though with some difficulty, couduct the
work of hie high official position, he was allowed to continue
hie labours. Within the last few weeks the eight has rather
rapidly declined, doubtless owing to constitutional causes;
and at the consultation held on Friday, the 4th inst., at
Sir William Jenner's, it was decided that 8ir Michael could no
longer retain office without grave risk. The cataract in the
right eye is diffused, and that in the left eye is now confined
to the centre of the lens. Sir Michael will shortly visit
Germany for the benefit of his health, and, as it is essential
that his case should be under medical supervision, he will
while there be under the care of Dr. Pagenstocher, of Wies¬
baden. Some little time most of necessity elapse before Sir
Michael returns to England to place himself inMr.Critchett’s
hands for operation. The hope that this procedure may be
successful will be shared widely by the public, who have nod
been insensible to the unselfish patriotism with which Sir
Michael undertook bis thankless office, and the devotion to
daty which has exhausted his powers.

NEW INSTRUCTIONS TO PUBLIC VACCINATORS.

The Local Government Board have issued new instruc¬
tions to public vaccinators, to supersede those of sixteen
years ago. The alterations, which are wisely conceived,
relate specially to ensuring the better performance of the
operation of vaccination, and to the avoidance of septic
poisoning. For the former, it is ordered that the insertions
of lymph shall be such that the total area of vesiculation
on the same day in the week following the vaccination
should be not less than half a square inch; for the latter, a
caution is given against the use of any means of protection
or “shield” that cannot readily be destroyed and replaced
whenever it becomes soiled. Public vaccinators are also
required to enter in their register the initials of the person
operating, and subsequently inspecting the vaccination, and
they are cautioned against the employment of lymph
supplied by any person who does not keep exact record of
ite source. It is further required that lymph be not taken
from children who have any sort of sore at or about
the anus, or from a vesicle around which there is
any conspicuous commencement of areola. The caution
contained in the superseded instructions not to take under
ordinary circumstances more lymph than will suffice for the
immediate vaccination of five subjects, or for the charging
of seven ivory points, or for the filling of three ca pil la r y

Digitized by CjOO^Ic

536 The Laj*cet,]

THE JUBILEE AND LONDON HOSPITALS.

[March 12,1887.

tubes from such a vesicle as vaccination by puncture
commonly produces, is now replaced by the requirement
tb&t more than this amount of lymph shall not be taken
from a well-formed vesicle of ordinary sire except under
circumstances of necessity. Lympb, moreover, is not
to be taken that has run down the skin, the vesicle
is not to be scraped, and the lymph is to be changed
if on the day week after vaccination the cases show
any conspicuous areol® round their vesicles, while for¬
merly the presence of any areola was regarded as reason
for omitting to take lymph from such a vesicle. Vaccinating
lancets are not to be used for any other purpose whatever,
superseding the old instructions, whioh required that they
should not be used for other surgical operations. The in¬
structions end with the advice which experience has shown
to be necessary: “Never use any ivory point or capillary
tube a second time, either for the conveyance or storage of
lymph; but when points or tubes have once been charged
with lymph and put to their proper use, do not fail to
break or otherwise destroy them.”

THE SIGNIFICANCE OF THE RETENTION OF THE
MEMBRANES AFTER LABOUR.

The importance to be attached to the retention in the
uterus of portions of membrane after the completion of the
third stage of labour has been variously estimated by differ¬
ent obstetricians: some—e. g., Winkel, Dorn, Ahlfeld, and
Graefe—holding that grave dangers are to be apprehended
when this occurs; while others—as Alahausen,Cred6, Fischer,
and Cohn (who has reported two cases in which nearly the
whole membrane had been retained for five days without
causing any pyrexia)—believe that little or no danger of
hsamorrhage, septicaemia, or other puerperal mischief is
caused -by the retention of even considerable portions
of the membrane. An explanation of this divergence of
view has recently been attempted by Professor Lazarevich
in the opening article of the new Russian Obstetrical and
Gyncecological Journal. His explanation is. founded on
the fact, unrecognised by most obstetricians, that “ the
membranes,” even at the full term, are oomposed of and
more or less separable into three distinct layers repre¬
senting the chorion, the decidua, and the amnion. The
strength of these has been investigated by Poppel, Duncan,
and Bibemont, and the amnion shown by them to be
much tougher than the chorion in conjunction with the
decidua. Professor Lazarevich has also made a number
of researches on the subject by means of an apparatus con¬
sisting of two rings covered with indiarubber, between
which the membrane to be examined was stretched, the
resisting force being estimated by means of a wooden hemi¬
sphere on which weights were placed, which the membrane
was made to support, more weights being added until it
gave way. These observations showed that the integrity
of the ovum depends almost entirely on the amnion.
During labour some Separation of the membranes from one
another usually occurs, add this is especially the case when
the chorion, split or torn below, maintains a dose connexion
with the decidua, and the decidua with the uterine wall;
the progress of the labour also separates the amnion from
the chorion. Roemer explains the separation of the mem¬
branes from one another by their unequal elasticity, and
Professor Lazarevich believes that the chorion, being less
elastic as well as more easily torn than the amnion, is
frequently ruptured in several different places, some portions
coming away attached to the amnion, and some being left
behind attached to the uterus. The causes of retention Of
the 1 chorion with the decidua are'i (1) the presence of vffli
on the chorion; (2) extravasation of blood on the decidna,
with consequent formation of fibrous adhesions; and

(3) adhesions hr consequence of endometritis and choriitis.
The amnion may be retained in consequence of—(1) occa¬
sionally occurring adhesions between it and the chorion and
decidua; (2) early rupture and escape of all or part of the
liquor anmii; (3) a low attachment of the placenta or
placenta prsevia; (4) intra-uterine manipulation; (5) ante-
version of the uterus after the birth of the child; (6) excep¬
tional weakness or thinness of the amnion. Retention of
the decidua (which is formed from the uterine mucous
membrane, not from the ovum) is as a rule of little moment,
though it is perfectly possible for endometritis deoidttalis to
occur, and for the retained portions of the decidua to servo
for the development of micro-organisms introduced from
without. Shreds of the chorion, if retained either by them¬
selves or together with the decidua, do little harm, as they
rapidly undergo chemical and mechanical destruction, and
are carried a way with the lochia. The amnion, when retained,
is much more liable to become the developing ground for
bacteria,' and it is to the retention of this part of the
membranes that alarming symptoms, are usually due.
Professor Lazarevich lays considerable stress on the import¬
ance of straightening or replacing the uterus in its proper
position after the birth of the child, before the after-birth
comes away. _

THE JUBILEE AND LONDON HOSPITALS.

With the exception of one or two schemes for com¬
memorating the Jubilee of Her Majesty which it is under¬
stood have her special favour, there is no other suggestion
more popular or more worthy of support than that the moneys
raised should be devoted to the relief and support of the
great hospitals, which constitute the home of the working
classes when afflicted and disabled by illness or accident.
This proposal haa had our steady and earnest support. It
would indeed he a Jubilee to be remembered till a similar
Jubilee should occur if these institutions could be relieved
of the incubus of debt which depresses them and hampers
their'operations. The schemes specially favoured by the
Queen should be supported for their own sake and out of
respect to Her Majesty’s wishes. But the public must not
forget one claim which, above all others, khould command
their practical sympathy—the claim of the great hospitals,
which now languish for want of money, and whole wards
of which have to be closed. The rich and the poor alike
admit their indebtedness to these institutions. We can only
hope that attention may be concentrated on this subject. The
Jubilee is a great and august occasion; it will commemorate
much, aqd will, we trust, be productive of real and permanent
benefit. But it is weakened by multiplying modes of com¬
memoration, and by fantastic ones. On this proposal —
to free the gtwtt hospitals 1 of 'debt — we are on a rock,
and on this rock we would rest the Jubilee Fund. Her
Majesty has not so far felt at liberty to indicate her special
support of it, but her sympathetic nature is too strong to
allow us to doubt that any object could be more satisfactory
to her than the welfare of our hospitals.

ORUNKENNESS IN 1886.

The report just published of the number of arrests made
on Sundays for drunkenness in the year ending Sept. 29th
last affords some ground for congratulation on the improve¬
ment in this respect which is undoubtedly taking place in
our national ‘manners. That a change for the better has
occurred in recent years, and is stall in progress, is matter
of common observation and attested by many indications.
The new report shows in the most satisfactory way that
this improvement is general in its character, being ex¬
hibited by all classes of the people and all parts of the
area under observation; -An absence of summary and com¬
parative tables makes "Hr a little difficult to perceive at a

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CONDURANGO IN CANGES OF THE STOMACH.

[Mabch 12,1887. 537

glance what is the exact meaning of the figures given, but
it is evident upon the face of them that they mark an
improvement upon previous years, for in almost every case
the number of arrests grows steadily less from year to year;
and this in spite of increase of population. Thus, for the
whole of England and Wales the figures are—for 1684,
15,942 convictions; for 1885,14,658 convictions; for 1886,
12,917 convictions. Here it will be seen that the number of
convictions has been actually reduced in two years by
3000 odd, or nearly 19 per cent. If allowance were made
for the increase of population within the same period,
the ratio of improvement would be seen to exceed
this figure. As might be supposed, the return shows
a much higher proportion of drunkenness in the case of
urban than in that of rural populations. In agricultural
districts the convictions vary from one in ten thousand to
one in a hundred thousand inhabitants, whereas in the
metropolis they run as high as one in fourteen hundred, and
at Manchester, which enjoys an unenviable pre-eminence in
this respect, they reach the appalling figure of one in three
hundred and fifty. Altogether, Lancashire, with its teeming
population and its laborious industries, makes but a poor
figure in this report. The one satisfactory feature in its
record is that it has fully shared in the improvement of
recent years. It must, of course, be borne in mind that
police supervision is much more efficient in these districts,
where vast populations are crowded thickly together, than
in sparsely occupied rural parte; but when all allowance is
made for considerations of this sort, it is quite clear, even
on a mere comparison of different towns, that there are
localities, and especially in the mining districts, which in
point of sobriety lag far in the rear of our civilisation.

CONDURANGO IN CANCER OF THE STOMACH.

Fifteen years ago there was introduced from Brazil a
remedy which was claimed to be a specific. for cancer.
Since then, as before, other remedies have been similarly
vaunted, and none have stood the test of experience. The
remedy in question was condurango bark, of which a trial
was made at the Middlesex Hospital, the negative results
being read before the Clinical Society by Messrs. Hulke and
De Morgan (Clin. Soc. Trans., vol. 5). In Germany almost
the only favourable report came from Professor Friedreich,
who related instances of its value in gastric cancer. Since
then it has fallen much into disrepute, having been regarded
as little better than a stomachic, and prescribed thus with
advantage (Wilhelm: ’Tear-book of Treatment, 1886, p. 49) in
cases of carcinoma and ulcer! But Dr. Riess of Berlin has j ust
published (jBerL Kim. WocJtermh ; March 7th) some striking
testimony to the value of . the drug in gastric carcinoma,
more conclusive than any that has hitherto appeared. It is
noteworthy that he doubts whether its qualities as a
stomachic are better than those of other drugs of that class,
and that he has not found it efficacious in cases of cancer
where the stomach is not primarily involved. (Messrs.
Hulke and De Morgan’s reports did not deal with gastric
cancer.) It was in cases presenting the symptoms of
cancer of the stomach (many with a tumour) that the
beet effects were noticed. In 105 such cases— i.e., where
gastric cancer was diagnosed — treated at the General
Hospital from 1878 to 1886, condurango was prescribed,
and in no case, even in those in the last stage, with¬
out some effect. The drug was often given every hour—
Hie total amount per diem reaching ten grammes of the
jkcoction—and continued for long periods without ill effect.
The appetite improved in a few days, vomiting and pain
diminiahed, and eventually ceased, and the patient gained in
fright. Whether life is actually prolonged is, of bourse,
difficult tb prove; but Ribas quotes statistics which show
that the cases treated with condurango, both the fatal cares

and those discharged in improved health, remained much
longer in hospital than those not treated by the drug.
He even states that of sixty-four eases in which a palpable
tumour was present,in seventeen it diminished in size, and in
eight quite disappeared; and bo details three cases of such die*
appear&noe of obvious tumour, which, subsequently dying,
presented only cicatricial structure, with no trace of malig¬
nant disease. Obviously, before we can accept such cases ss
examples of the cure of cancer we must, be certain that the
original diagnosis was correct, and the same soepticism may be
allowed respecting the whole series of cases. For cancer of
the stomach may not only be latent, but may be simulated.by
non-malignant ulceration, as every physician knows. Dr.
Riess fairly discusses this point, being quite-alive to the ob¬
jection. He claims, at least, that condurango has some local
effect upon, a diseased stomach, and considers that in all
suspected cases it should be prescribed. Jt need hardly be
pointed oat that a looal action as here claimed is & very >
different thing from a specific action in cancer generally,
which was sufficiently disproved by the observations at the
Middlesex Hospital. _

THE “RELATIVE RANK” QUESTION.

Wn see no reason to modify the opinion we have already
expressed, and whioh is fully borne out by the statement of
the Secretary of State for War in the House 44 that the abolition
of the term 4 relative rank’ had not altered the position of the
medical officers in any respect whatever* It nrast not be
lost sight of that the abolition of the farm—for the fact of
the existence of relative rank must exist so long as medical
officers are plaoed in relation to other officers—is not con¬
fined to medical officers alone, but applies also to the officers
of the Adjutant- and Quartermaster-General's staff arid to
all the departments of the army. It is difficult, therefore,
to understand how the change can be deemed derogatory to
medical officers. But this would seem to be the view
advanced by those who have called in question the good
faith of the authorities in this matter. The fact is, that so
much distrust has been engendered in the Army Medical
Service by past-experience, that we cannot be surprised'At
its sensitiveness to, and suspicion of, any changes likely tbi
affect it in any way; and undoubtedly the result of the'
statements put forth, unfounded though they be, has been
to create a strong feeling of that nature on the part of the'
medical officers. It would be perfectly easy, as it appears
to us, for the Secretary of State to issue a satisfactory
official statement cm the subject by so far altering the
wording of the Warrant as to prevent its being misinter-'
preted. This could be effected by a clause enacting that
44 the respective grade? in the Army Medical Staff shall take
rank with, and carry all precedence and advantages attach¬
ing to, corresponding military rank,* and following this up
with the classification laid down in paragraph 125a of the'
Warrant. We cahnot see any difficulty in such a course,"
and it would remove all ambigtrity as to the position of the
medical officers. 1 _ ’’

RUPTURE OF THE INTESTINE.

On March 6tfar Mr. John Ototk of St. Thomas’s Hospital
performed abdominal seotion on a patient aged thirty-four,
who had been admitted with adite peritonitis due to injury,
received about eighteen hours previously. The patient,
who had received severe injury to the abdomen the night
before, walked to the hospital. He had vomited, and in
.addition to the symptoms of most acute peritonitis and a
temperature of 103°, had some dulnesa in the hypogastric
region. A rent Was found almost dividing the small intes¬
tine ; there was feculent materia! in the peritoneal cavity, and
acute inflammation In the neighbourhood. The peritoneum
was washed oat with a 20 per cent, solution of borado add,
,and tbo intestine sutured to the wound. Since the opera-

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THE MINUTE ANATOMY OP THE BRACHIAL PLEXUS.

[March 12,1887.

tion his progress has been very satisfactory; he has had
neither pain nor vomiting, and the distension of the abdomen
has disappeared. Although he was complaining of cough
and had a rapid pulse, his condition was otherwise favour¬
able on the 10th. The same surgeon operated on the 4th in
a case of abdominal injury, accompanied by much haemor¬
rhage into the peritoneal cavity, and removed the spleen,
the haemorrhage being due to an extensive laceration of that
organ. The patient, however, did not survive the loss of
blood and the additional shock of the operation.

THE MINUTE ANATOMY OF THE BRACHIAL
PLEXUS.

A paper of some interest appears in the forty-first
volume of the Proceedings of the Royal Society, under the
authorship of Dr. W. P. Herringham. The results were
obtained from careful dissections, partly of foetuses or still¬
born children and partly of adult subjects. The following
conclusions were arrived at:—1. Any given (nerve) fibre
may alter its position relatively to the vertebral column, but
will maintain its position relatively to other fibres. 2. Of two
muscles, *r of two parts of a muscle, that which is nearer
the head-end of the body tends to be supplied by the higher,
that which is nearer the tail-end by the lower, nerve. 3. Of
two muscles, that which is nearer the long axis of the body
tends to be supplied by the higher, that which is nearer the
periphery by the lower, nerve. 4. Of two muscles, that
which is nearer the surface tends to be supplied by the
higher, that which is further from the surface by the lower,
nerve. The next conclusions relate to sensory nerves. 6. Of
two spots on the skin, that which is nearer the pre-axial
border tends to be supplied by the higher nerve. 6. Of two
spots in the pre-axial area, the lower tends to be supplied
by the lower nerve, and of two spots in the post-axial area,
the lower tend* to be supplied by the higher nerve.

THE PORT OF LIVERPOOL.

Out of 20,928 vessels entering the port of Liverpool
during 1886, 4120 were inspected by the sanitary officers,
and 276 were found to be defective. The coasting trade is
now largely carried on by steamers, and the accommodation
for the crews is stated to be both good and double that
which is usually provided. The steamers carrying Lascars
were also found to be in fair condition, and in no case was
any infectious disease found on board. The number of
emigrants was large, reaching 191,491; and the American
Government have acted wisely in appointing medical inspec¬
tors to examine those going to that country, in order to
ascertain if any of them have come from infected districts.
If they have, measures of disinfection and other precautions
are adopted; and some intending emigrants have, in the first
instance, been isolated in hospital. During 1886, the
number of cases of infectious sickness found on board was
forty-six, and in a majority of instances removal to hospital
was adopted by Dr. Stopford Taylor.

CANCEROUS AXILLARY GLANDS.

■ At the Barveian Society, on the 3rd inst., the entire
evening was taken up in the discussion of an extremely
practical paper by Mr. Mitchell Banks, upon the advisability
of extirpating the axillary glands in all cases of amputation
of scirrhous mammas. Mr. T. Bryant went a considerable
way with the author in his bold and thorough treatment,
but felt that there must still he a considerable number of
patients for whom the old-fashioned or incomplete operation
would be preferable. Mr. Pick took exception to much of
the argument put forward in the paper, as .also did Messrs.,
Butlin and Cripps. The latter two gentlemen brought

forward statistics from St. Bartholomew’s Hospital and else¬
where which differed widely in percentage results; Ur.
Cripps’ figures, indeed, offered considerable support to Mr.
Banks’ views. Mr. T. Smith suggestively remarked that
surgeons must not lose sight of the fact that many women
are living in comparative comfort who for years have been
the subjects of cancer of the breast which has never been
subjected to any surgical treatment. This Mr. Banks readily
accepted, and remarked that far better was it to leave the
patient alone than to inflict on her any incomplete opera¬
tion. The President (Mr. Edmund Owen) expressed himseli
strongly in favour of opening up and clearing out the axilla
in every operation for mammary cancer, whether enlarged
glands have been previously felt there or not.

THE NEW PHARMACY BILL.

A Bill has been introduced in the House of Lords by tbe
Earl of Milltown, uuder the title of the 4 Pharmacy Acts
Amendment Bill,” to amend the Pharmacy Acts of 1852 and
1868. It is proposed to provide for the division of the
examination into preliminary and other parts, and to make
it incumbent on candidates presenting themselves for the
final test to produce certificates of having attended a course
of lectures on materia medica, botany, and chemistry.
They must also have served for a period of not less than
three years as pupils or apprentices in the shop of some
duly-qualified ohemist or druggist. The Pharmaceutical
Society of Great Britain is to be entrusted with the power
of regulating these examinations, and the Council of that
body may, under certain circumstances, waive the whole or
any part of the term of apprenticeship, provided they are
satisfied that the candidate has by other means received
adequate instruction. It is not intended that the Act
shall apply to Ireland. _

DEATHS Of EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and
scientific men are announced:—Professor Arif, the eminent
oculist, at Vienna, on the 7th inat., at the age of seventy-five,
after a long illness. Dr. Reinhold von Reichenbach, whose
name is well known in the chemical world, on Feb. 23rd, at
Gratz. Professor August Wilhelm Eichler, director of the
Royal Botanic Garden and Mussum at Berlin, at the age of
forty-nine. Dr. A. Borodio, professor of Organic Chemistry
in the Military Medical Academy of 8t. Petersburg.

THE EXISTENCE OF PEPSINE AND TRYPSINE IN
URINE.

Dr. Yasileyskj, at Professor Chudnovski’s suggestion,
recently undertopk some observations on the urine of twenty
patients suffering from various diseases, in order to confirm
the statements made by a number of authors—Briicke,
Griitzner, Sahli, Leo, Mya, Belfanti, and others—as to the
constant existence of pepsine and trypsine as urinary con¬
stituents. He found that in both healthy and diseased states
pepsine in greater or less quantity was constantly present.
The smallest quantity was found in patients who were badly
nourished, the state of nutrition of the body having ap¬
parently more influence upon the amount of pepsine in the
urine than the nature of the disease. The least quantity of
pepsine was found in the urine of a patient with pulmonary
phthisis four days before death, and in that of another who
suffered from carcinoma of the pylorus. In this case the
pepsine was greater in amount when the pylorus was per¬
vious and less when it was impassable and the patient
vomited matter in a high state of fermentation. A high
body temperature appeared to lessen the pepsine. In three

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BURIAL REFORM.—RUPTURE OF THE BLADDER.

[March 12,1887. 5 39

-cases la which the urine contained albumen, the quantity of
pepeine coexisting with it appeared to be much the same as
might have been expected from the state of the patient’s
nutrition if there had been no albuminuria. In regard to
trypsine Dr. Vasilevski was unable to obtain deflaite results.

THE MARGARET STREET INFIRMARY.

At a meeting of the Medical Board of the North London
Consumption Hospital, held on Monday last, the following
resolution was carried: —

“That the medical staff of the North London Hospital for
Consumption and Diseases of the Chest are unanimous in
their sympathy with the action of the members of the
Margaret-street Infirmary—Drs. Hawksley, Cholmeley,’ Carr
Beard, Phibbs, Willis, Walford, and Powell—who lately
resigned their appointments under painful circumstances;
and, further, that the secretary be instructed to forward a
copy of this resolution to Dr. Hawksley, late senior con¬
sulting physician to the infirmary, aud ask him to convey
the substance of this resolution to hiB former colleagues.”

We are glad to see the above timely expression of sympathy
on the part of the medioal staff of the North Lohdon Hos¬
pital for Consumption. It will no doubt be gratifying to
Dr. Hawksley and his late colleagues. Meanwhile, it would
be interesting to know what effect the resignation of thees
gentlemen will have on the position and future manage¬
ment of the Margaret-street Infirmary.

GASTRITIS IN RENAL DISEASE.

Ix a paper read before the Socidtd de Biologie (Ze Propria
Mid., No. 9), M. Pilliet described the lesions of the gastric
mucous membrane in the dyspepsia of renal and urinary
disease. The lesions—observed in a largo number of cases
of different kinds of renal disease—comprise infiltration of
the connective tissue in the round and fusiform cells in
groups between the glands or in bands along the vessels
The gland tubules are diminished in number, ranch shortened,
often dilated at their lower extremity, flattened superficially,
and variously contorted. The cubical or prismatio cells are
ill developed, as in the new-born, and show little or no
formation of Nussbaum’s peptic granules. The changes are
best marked in interstitial nephritis, and resemble those
described by Parrot in ai-hrepsia, those met with in chronic
alcoholic gastritis and in cirrhosis of the liver, and in gastritis
of tubercular subjects. _

BURIAL REFORM.

The reply given by Mr. Plunket in the House of Commons
to the question recently put to him by Mri BaggalJay respect¬
ing Brompton Cemetery suggests very serious reflections as to
our present mode of burial. From that reply (a note of
which appeared in Thb Lawcbt of the 5th inst.) it appears -
that the cemetery contains in all 38 acres and 20 perches,
and that there now remain 4 acres and 34 perches available
for burial purposes. The space already used is therefore
less than 34 aores, and in this there have been bnried the
enormous number of 135,617 bodies, an average of 3988 per
acre. It has been calculated that 1000 graves can be made in
every acre 6f land set apart for bnrial purposes, le aving a re afton -
able margin for spaces between graves, walks, &c. Hence,
*s the depth of graves is often eleven or twelve feet, and
sometimes even deeper, the figures, large though they at first
appear, are not excessive. Nor would there be anything to
fear if it were the troth that all these bodies are riaally
Varied. Bat, os Mr. Seymour Haden has said, speaking of
<oodem burial, a lafge proportion cannot be considered as
buried st all., The first i burial in Brompton: cemetery took
place in 1340, .ahdyMit has al Waff* been v^hat may be termed

a fashionable place of interment, the probabilities are
that a large proportion of the burials have been in lead
coffins and in vaults or bricked graves. The result
is, as it always must be when the dead are disposed in this
manner, that the cemetery becomes filled with what Mr.
Haden severely, but truly, describes as a mass of boxed-np
putridity. It appears, moreover, that the burials therein
still average in round numbers 5030 yearly, and that the
Government derived last year a profit, of £7070 from the
cemetery. Considering all these circumstances, and also
how completely the cemetery has become surrounded by
dwellings it appears only reasonable that, if burials are to
continue there every inducement should be made by reduced
tariff &c. to bury in perishable coffins and in graves. It would
indeed be well if all existing vaults or bricked graves oould
be converted into real graves by filling them up with earth
or charcoal, so as to neutralise the poisonous gasos which
must sooner or later pass through the best soldering or most
perfect cement. Meanwhile, much may be done by the
force, of example, and if the friends of the next titled and
other celebrities who may be buried there would set the
example of burial in perishable coffins, and in the earth, the
example would soon be followed.

RUPTURE OF THE BLADDER.'

A patient was admitted into St. Bartholomew’s Hospital
on the morning of March 1st with symptoms ef a ruptured
bladder, in consequence of a blow on the hypogastriom
whilst the bladder was distended. The injury had been
reoaived, the previous evening, and Mr. Walsham operated
soon after admission, A large quantity .of urine escaped
from the peritoneal cavity when the abdomen was opened,
and a rent about an inch and a half loDg was found in the
bladder wall. Sutures were used, passing through the
peritoneal and muscular coats only; the abdominal cavity
was irrigated with a 1 per cent, solution of boradc acid,
and the abdominal wound closed as after ovariotomy. The
patient suffered very little shock, and passed his urine
naturally without the aid of a catheter every four hours.
There has been no sign of peritonitis, and he may be looked
upon as convalescent. __

DENTAL IRREGULARITY.

Ma. Ohaba.cs Tones, in his/presidential address delivered
at the Odontological Society, spoke of the influence of
heredity in the production of dental irregularities. He does
not believe, as has been maintained, that these deformities
are things of quite modern date and due to disturbed
innervation, the result of over-pressure (like the headache
of Board School children), and points to the portraits by
Vandyke at the Grosvenor Gallery and the exhibition of
the old masters at the Royal Academy as showing several
examples of dental irregularity, such as underhung jaw and
protrusion of the upper incisors.

TREATMENT OF CHOLERA IN BUDA-PESTH.

Ix a paper lately read before the Royal Buda-Pesth
Medical Society, Dr. B. Anayan gave some particulars of
the results of various kinds of treatment during the recent
cholera epidemic in- Buda-Pesth, an epidemic which he con¬
sidered to have been of a mild character. Ho divided his
oases into four groups—viz., 76 of choleraic diarrhcea, 85 of
cholerine, 90 of alight cholera, and 454 of severe cholera:
Ln the first three groups and in 180 of the cases belonging
to the fourth group he employed only enemata; in the rest
he employed, besides enemata, hypodermic injections of
tannin and opium, corrosive sublimate, or hydrochloric
acid. The results were that the cholerine aad choleraic

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540 Thk Lanckt,]

TRAVELLING MEDICAL REFEREES.

[March 12,1887.

diarrhoea cases were all cured, and 63 G per cent, of the
slight cholera cases, but only 20 7 per cent, of the severe
cases, which were treated with enemata only, so that in all
the milder forms enemata had proved most successful. In
the severe cases where hypodermic injections were used
38 - 6 per cent, recovered. _

TRAVELLING MEDICAL REFEREES.

According to information from colonial sources, the lot
of medical officers attached to some Australian insurance
companies is far from being a happy one. The “ travelling
medical referee ” is one of those persons upon whose judg¬
ment and integrity the success of such associations chiefly
depends. His position, privileges, and emoluments unfor¬
tunately stand in a nearly inverse ratio to the value of his
services. These consist in makings series of professional visita¬
tions in town or country in company with an agent, who
canvasses the inhabitants in favour of the office which he
represents. The agent is commonly a hail-fellow-well-met,
and the medical examiner frequently finds it almost
obligatory to conform to the rough free-living customs
of a young and growing colony. Of work and fatigue he
has more than enough, food is apt to bo inferior, and accom¬
modation is but another name for barbaric dirt and rough¬
ness. The pay allowed is in some cases not illiberal, provided
that business is brisk; in others it does not vary with the
market, but is fixed at the low rate of four guineas per
week. As to provision in case of accident or illness, the
principles of the society do not, as a rule, stretch as far as
the requirements of its medical referees. Altogether the
life of these gentlemen appears to present few, if any,
enviable features.

HYPODERMIC INJECTIONS IN ACUTE ANEMIA.

Dr. Prrgaldino of Ghent, taking into consideration the
observations of Kronecker, showing that in acute anaemia
death is not directly due to the want of oxygen owing to
the paucity of the blood-corpuscles, but to the diminution
of pressure in the bloodvessels, suggests that in these cases
pressure may be restored either by intravenous injections,
or, more simply and less dangerously, by hypodermic injec¬
tions into the cellular tissue. He made observations on
eighteen dogs, injecting into the cellular tissue a solution of
common ealf of the strength of 6 per 1000, and warmed to
37° C. This he found was very quickly absorbed, raising
the blood-pressure in a quarter of an hour. Dr. Pregaldino
has been requested "by the Royal Belgian Academy of Medi¬
cine to continue his experiments.

MEDICAL HONOURS IN ITALY.

King Hdmdrrt (motu proprio) has nominated Surgeon-
Major Francesco Guerriero Chevalier of the Order of Saints
Maurice and Lazarus, in consideration of professional duty
heroically discharged in the Abyssinian campaign. Similar
honour, equally merited, will, it is understood, be shortly
conferred on others of the profession who have, at great risk
to life and limb, saved many sufferers from the recent earth¬
quakes in the Ligurian littoral.

ELECTROLYSIS OF AN ANEURYSM IN SPAIN.

Dr. Bbrnardo Dibz Ubklar of Molinaaeca publishes in
El Sifflo Medico the notes of a case of aneurysm of the first
part of the aortic arch in a military officer, which produced
dysphagia and terrible suffering, and required immense doses
of morphia, so that the patient entreated that some opera¬
tion might be performed, expressing himself as ready to run
any risk in the hope of obtaining some relief. Electrolysis
by means of needles was therefore resorted to, a Spamer

battery being used. At first the maximum number of cells
employed was ten, but in the later sittings twenty were
brought into action. Some slight effect was produced, the
tumour becoming small and more solid; the distressing
dysphagia also diminished, but the pain remained as severe
as before.

MEDICAL ATTENDANCE ORGANISATION
COMMITTEE.

This Committee met on Tuesday, Sir Spencer Wells pre¬
siding. The principal resolutions were to the following
effectThat persons joining were to be approved by the
medical officer under whom they wish to be registered. The
question of an entrance fee was postponed, except for
emergency cases, and, after much discussion of several
amendments, the following resolution was passed: “ Per¬
sons requiring immediate attendance must pay an entrance
fee of 2 8. 6 d , which shall entitle them to treatment for one
week, after which, should they continue ill, they shall pay Is.
per week if able to call on the doctor, and 2 1 . 6 d. if visited at
home. Upon recovery they shall be expected to continue as
ordinary members with the consent of the medical officer.”
A further resolution was passed to guard the medical officers
and the institution against an influx of chronic cases on
ordinary terms, but providing for their admission at special
rates, subject to the approval of the medical officer. It is
necessary to remember that all these resolutions apply to
persons whose wages do not exceed 90s. (for single persons),
or 45«. (for a family). At the next meeting the questions of
midwifery fees, general rules, fines, &c., are to be disposed
of, after which it is hoped that the great point of a union
between hospitals and provident dispensaries may be reached.
Several hospital physicians are expected to take part in th*
discussion. _

THE NEW EXAMINATION HALL.

On and after Monday next, the 14th inst., the business of
the examinations for diplomas of the Royal Colleges of
Physicians and Surgeons of London under the old regula¬
tions, as well as under those of the Examining Board, Will
be conducted in the new Examination Hall, situate, as our
readers are aware, on the Victoria Embankment.

ALLEGED INACCURATE CERTIFICATION OF DEATH.

At a recent meeting of the Dartford Petty Sessions,
Mr. Thomas Wheeler, medical officer of health for Bexley,
was charged on a summons with making and issuing
a false certificate of the death of a woman named
Asker. For the prosecution it was stated that Mr. Wheeler
certified that he bad seen the deceased on Dec. 24tb,
when as a matter of fact he had seen her on the 19th.
For the defence it was contended that the object of the
Births and Deaths Registration Act was simply to ascer¬
tain the cause of death, and if this were correctly given no
medical practitioner could be compelled to give other
particulars. The magistrates accepted this view, and on
the facts dismissed the summons, making, however, no
order as to costs. _

FINE FOR FALSE USE OF MEDICAL TITLES.

On the 3rd inst. David Thomas of Peckham-rye—who
must not be confounded with Mr. R. W. Thomas, L.R.C.P. Ed.,
of Temple Villa, Rye-lane — appeared to an adjourned
summons, taken at the instance of R. H. S. Carpenter,
for having on January 31st unlawfully taken a title, that
of “Dr.,” implying that he was registered as a medical
practitioner, under the Medical Act of 1858. Mr. Pridham
showed that the defendant said, in answer to a question,
that he was “Dr. Thomas.” This was denied, but the

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Thb Lancet,

A NEW SKIN HOSPITAL.—A CASE POE INQUIRY.

[March 12,1887. 541

magistrate, Mr. Chance, decided that the Act had been
-violated, the object of which was to enable the public to
distinguish between qualified and unqualified medical men.
The defendant was ordered to pay £3 fine and £4 costs, but
an appeal was granted. _

THE BRITISH MEDICAL ASSOCIATION.

Ax the fifty-fifth annual meeting of this Association, to
ke held at Dublin in the first week of August next. Dr. John
T. Banks, Eegius Professor of Physic in the University of
Dublin, will succeed Dr. Withers Moore as President. The
Address in Medicine will be delivered by Dr. W. T. Gairdner;
the Address in Surgery by Dr. E. Hamilton; and the
Address in Public Medicine by Dr. S. Haughton. Dr. G. P.
Duffey will act as local hon. secretary.

A NEW SKIN HOSPITAL.

Wb have received intimation by a paragraph, which seems
meant for the press generally, that it is intended to set
up a new 8kin Hospital in Cranbourne-street, Leicester-
equare, to be “promoted by Mr. James Startin and Mr.
Walter Pocock, for the gratuitous treatment of poor persons
suffering from skin disease.” We trust this proposal will be
reconsidered. Leicester-square is already blessed with a
Skin Hospital, and it is a poor compliment to it to erect
another. Besides, the whole charity of the community just
now is taxed to the utmost to sustain those great general hos¬
pitals where akin disease can be treated with reference to
its constitutional bases. Mr. Startin will agree with us, too,
in thinking that hospitals should be “ promoted ” by the
public, and not by members of the profession. For all these
reasons, and others, we trust that Mr. Startin and his friend
will abandon a project which is not likely to succeed, and
which would only injure other institutions, where their
knowledge of skin disease might be exercised witli greater
advantage to the community and to the poor.

TYPHOID FEVER AT MEXBOROUGH.

At a recent meeting of the Mexborough Local Board of
Health, Mr. Sykes, the medical officer of health, reported
that since the commencement of the outbreak, which had
principally centred itself at 8parrow Barracks and Clay-
lane, there had been a total of eighty-five cases. Of these,
four had died and eighteen remained ill. Since then
three fresh attacks had been heard of. The Local Govern¬
ment Board are pressing on the authority the action
recommended to them by Mr. Spear of their medical depart¬
ment, and locally some preliminary action has been decided
on as to the establishment of an Isolation Hospital, which,
it may be hoped, will in the future aid in staying the pro¬
gress of such epidemic diseases as that from which the town
is suffering. _

A CASE FOR INQUIRY.

Thb name “Dr. T. Young, L.R.C.P., L.R.C.S., L.M.,” is
paraded in the large paragraph advertisements of Mr. E. W.
Alabone, to whom allusion was made in our last issue. We
ask why the Colleges from whom “ Dr. T. Young” obtained
his diplomas have not inquired into the matter.

CHOLERA IN SICILY.

Cholera is stated to be stilt prevalent at Catania in
Sicily, although the number of cases and deaths is not
numerous. According to information from Rome, six more
attacks, of which four were fatal, were announced on the
6th inst.

FOREIGN UNIVERSITY INTELLIGENCE.

Basle— A new ordinary professorship is about to be
created, which, strange to say, has not up to the present
time existed—namely, that of Midwifery and Gynaecology.
The number of medical students has increased since 1862
from 30 to 130. Up to 1873 there were only four professors,
now there will be seven.

Berlin .—Professor Gusserow has been selected to fill the
chair of Obstetrics vacant by Professor Schroeder’s death,
the name of Professor Winckel of Munich being mentioned
for Professor Gusserow’s post.

Bonn .—Professor Ludwig of Giessen has been appointed
Professor of Zoology and Comparative Anatomy.

Leipsig. —Dr. Benno Gottlob has been granted the position
of Honorary Professor. Professor Hankel, Chief of the
Physical Institute, has retired, being in his seventy-third
year.

Montpelier .—The chair of Pathological and Histological
Anatomy is vacant.

Nancy .—A serious fire has occurred in the buildings
belonging to the Faculty of Medicine, the laboratory and
collections belonging to the therapeutical department, as
well as the natural history collections, having been destroyed.

Paris .—The Faculty of Medicine has thus arranged the
candidates for the office of Dean: (1) M. Brouardel;
(2j -M. Jaccoud.

Zurich ,—Professor Wyss is to have charge of the new
Hygienic Institute. _

A largely attended meeting of the Portsmouth Hospital
committee was held on the 4th inst., to consider the proposal
made by the Admiralty in reference to reopening the lock
wards. The Admiralty offered to contribute £35 a year for
each bed occupied, provided the number did not exceed
thirty, while the minimum contribution should be for fifteen
beds, whether occupied or not. The committee agreed to
accept the offer if the minimum number was increased to
twenty-five and the maximum to thirty-two, without any
reference to compulsory powers. It was stated that there
are at the present time close upon 300 of this class of cases
at Haslar Naval Hospital, and that the disease is so prevalent
that only the worst cases could be received at the Station
Hospital, Portsea; also that while there were only twelve of
these patients at the workhouse in 1882, there are now
fifty-five. _

A Bill has been prepared for presentation to Parliament
by the friends of some of the London and other hospitals
which proposes “to restore the exemption from taxation
which charitable institutions enjoyed for 250 years,” but to
which it is alleged they have been subjected since 1866
owing to the decision of the House of Lords in the case of
the Mersey Docks and Harbour Board.

Oh April 27th the Senate of the University of London
will elect examiners in the departments of Arts and
Science, Laws, Medicine, and Music. In the medical
department two examinerships in Mpdicine and one in
Forensic Medicine are vacant, the retiring examiners being
eligible for re-election, and intending so to offer themselves.

It is stated that Sir W. Foster, M.D., will be asked, after
the funeral of the late member for the Ilkeston division of
Derbyshire, to become the Liberal candidate for that con¬
stituency. _

Oh the 4th inst., at the Royal Institution, Mr. Victor
Horsley, F.R.S., delivered an address on " Brain Surgery in
the Stone Age.”

Digitized by v^.OOQLe

542 TheLancet,]

PHARMACOLOGY AND THERAPEUTICS.

[March 12,1887.

Herbert Percy Freund, who hag been repeatedly
charged with creating disturbances at St. Paul’s Cathedral,
was again charged with the same offence on the 7th inst.
Medical evidence was given on the question of the sanity
of the defendant, and, no evidence being offered by the
authorities of the Cathedral, he was discharged.

As will be seen by an announcement in our advertising
columns, a change has been made by the Senate of the
University of London in the time of holding the next
Matriculation Examination — viz., from the week com¬
mencing Monday, June 20th, to the preceding week, com¬
mencing June 13th. __

An important inquiry has been opened by Mr. S. J..
Sjaith, civil engineer, of the Local Government Board, as to
the sewerage of West Cowes. The proposed scheme is a costly
one, and meets with considerable opposition. The inquiry
stands adjourned to March 19th.

Dr. H oxter Stewart and Mr. Cosmo Burton are engaged
in making an analysis of the air of Edinburgh. A report
on the whole work will be submitted to the Public Health
Committee as soon as the investigations are completed*

■ A bill to amend the law relating to the election of
coroners will be introduced in the House of Commons to¬
night (Friday) by Mr. Wootton Isaacson.

Dr. Samuel Fenwick has been elected a member of the
Royal Institution of Great Britain.

■ |lfrcrmadbj0jr att& ®jrmpettiics.

chapoteaut’s morrhuol.

The difficulty frequently experienced by patients in
taking cod-liver-oil has induced M. P. Chapoteaut, the well-
known pharmacist of Paris, to turn his attention to the
subject, and he has recently introduced a preparation of this
valuable remedy, which proves to be of considerable utility
in the treatment of phthisis and other wasting diseases. The
active principle, if such it maybe called, is extracted and
enclosed in capsules, which, in the words of the prospectus,
have “ the advantage of possessing in a small volume the
curative medicinal properties without the inconvenience of
the oil.” It is olaimed for morrhuol that it represents
twenty-five times its weight of the crude drug. Professor
Germain Sde and his colleague, Dr. Labadie-Lagrave, in the
fifth edition of their clinical lectures recently published,
speak highly of extract of cod-liver oil, and assert that it is
not only tolerated without difficulty, but is readily absorbed.
We find that some patients take the capsules who oertainly
would not take the oil. Whether morrhuol is equally
efficacious as a therapeutic agent remains to be seen, and
can only be determined by a series of clinical observations
extending over many months. We think, however, that we
are justified in calling attention to what may prove to be
a new departure in the treatment of certain intractable
diseases. The capsules may be obtained direct from M.
Chapoteaut, 8, Rue Vivienne, Paris.

MELON ROOT AND OIL OF BEN (jIORINQA APTEBA).

The above possess purgative and emetic properties. An
emetic principle has been extracted from the root by

J ’orosicviez. A solution containing nine centigrammes of it
s, says the ’Pharmaceutical Journal, sufficient to induce
femesis. Fifty centigrammes of powdered rqot is necessary
to cause vomiting.

HASCHISCIT PURUM AND CANNABINON.

This is a preparation of cannabis indica prepared by
treating the alcohol io extract of Indian hemp with caustic
alkali, by which all acid ingredients are solved. The
brown soft resinoid residue is “pure haschiscb,” and is
composed of the soft resin cannabinon and the alkaloid
tetauine. It is insoluble in water, but forms golden-yellow
solutions in alcohol, ether, and chloroform. A third of &
grain is said to act as a cerebral stimulant, and a larger dos»
causes all the symptoms, including sleep, of Indian hemp.
The drug should be in a fine state of division, and may be
givon in pastille form, with powdered cacao or roasted
coffee as a vehicle. Tannic acid dissolves oat the alkaloid
on which the stimulant action depends, whilst the remain¬
ing cannabinon has tho narcotic property. Cannabinon Le
triturated 'frith sugar of milk in the strength of 10 per cent.
Made up with cocoa or coffee in pastile form, it may be
given as a hypnotic, in doses of one-half to one grain and
a half, especially for hysterical or insane patients, but it is
contra-indicated when heart-disease exists.—( Pharmaceu.-
tical Journal.)

THE USE OF IODOL IN BELGIUM.

Dr. Edouard de Smeth, in a clinical lecture on iodol
given at the Hospital of St. Pierre, Brussels, details several
oases of syphilis and soft chancres in which iodol proved
very useful. In one of these, iodoform had first been used*
but had to be abandoned because of the objection made to
its smell by the landlord of the hotel in which the patient
was staying. The lecturer also mentioned a case of very
obstinate varicose ulcers which had been treated with great,
success by one of bis colleagues by an ointment composed of
five grammes of iodol in thirty grammes of lard. He saya
that iodol is prescribed in Belgium by Dr. Coppez in various
ophthalmic cases, by Dr. Houzti in tubercular ulceration of
the throat, and by Dr. Lebrun in the form of ethereal
injections in endometritis, also by others in various affections
under the forms of iodol-collodion, iodol-bougies, ko. In
addition to the experiences of Belgian surgeons, those of
foreign observers were mentioned, especially those of Marcus
of Pyrmont, showing by injections of iodol and iodoform in
animals that iodol is far less poisonous than iodoform.

VASELINE FOR HYPODERMIC MEDICATION.

This method of hypodermic medication is extending*
especially in France, where it is advocated by M. Meunier*
of Lyons, as a vehicle for the introduction of active principles
into the system. It is contended that vaseline is absolutely
harmless to the tissues, and may be employed in laige dosea
without causing accidents. But the vaseline must be per¬
fectly pure. Pure vaseline treated With warm sulphuric
acid does not blacken, but any impure specimen would.
Eucalyptol has been thus employed in phthisis, and turpen¬
tine m sciatica. Iodoform, phenol, iodine,- and camphor may
be injected in the strength of 1 per cent., and thymol in
$ per cent., or menthol 10 per cent.

RHUS AROMATICA FOR NOCTURNAL ENURRSI8.

A fluid extract lias been sent into the market by Parke,
Davis, and Co. It is prepared from the cortex of the root of
the rhus aromatica, sweet sumac. It acts on the plain
muscular tissue of the bladder, uterus, and rectum, and
may be employed to check htemorrhagee in these situations.
Atonic dyspepsia is said to have been relieved by it. Dr.
Unna, after a trial of three years, believes the extract to be
very efficacious in the nocturnal enuresis of children. Five
drops may be given morning and evening to a boy two
years old, and ten-drop doses to children of six.

SALICYLATE OF SODA IN GONOBRHCEA.

Dr. Avsitidiski recommends salicylate Of soda in gonor¬
rhoea ; the quantity he gives is thirty grains a day dissolved
in linseed-tea. The way in which this acts is by being
eliminated by the urine, and thus washing out the urethra
with an antiseptic solution. Dr. Avsitidiski tried the effect
of a 2 per cent, salicylate of soda solution as an injection,
and found that it acted similarly to a solution of boracic
acid of the same strength, rapidly changing the puriform
secretion to one of a mucous character.

MB NTH OLE ATE.

Meatholeate is a solution of- menthol in oleic acid, and i»
recommended by Professor Remington as the best form,for
the outward application of menthol. Two hundred grains
of menthol may be dissolved in half an ounce of oleic add
{ by heating together in a test-tube.

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The Lancet,]

THE HIGH ALTITUDE TREATMENT OF PHTHISIS.

[March 12,1887. 543

- IODOFORM IN HEART DISEASE.

M. Testa has employed iodoform in cases of organic lesion
of the valves. The administration of small doses of iodo¬
form (seven centigrammes—about a grain—in four pilules,
one to be taken every two hours) rapidly dissipated the
functional derangements dependent on the valvular disease.
The experimental resalts obtained - in dogs completely
concur with those furnished by clinical experimentation in
demonstrating that in dogs iodoform retards the cardiac
contractions, and this delay increases the total duration of
each cardiac cycle, and also the efficiency of the systole.

PHENOL MERCURY.

The chemical formula of this mercurial compound is
C,H, OHg. OH. It is given in the form of pills, each
containing two centigrammes of the preparation. Two
pills may be given the first few days, and the number
gradually increased to six. Salivation and stomatitis are
said to be but very occasionally produced.

LOBELINE AND INFLATINE.

These are two alkaloids obtained from the seed of lobelia
inflate. The former has powerful emetic properties, and the
emesis is not followed by disagreeable symptoms. The
powdered alkaloid is very irritant to the nasal passages,
perhaps more so than veratrine. The inflatine has not any
therapeutic effects, so it is stated.

NASAL POLYPI.

It is recommended by Dr. Bell of Canada to treat nasal
polypi by daily injection of tannin, from five to ten drops of
a concentrated solution being injected by means of a hypo¬
dermic syringe. After a few days of this treatment the
polypus sloughs and comes away without bleeding.

THE HIGH ALTITUDE TREATMENT OF PHTHISIS.

(From a Special Correspondent.)

No. III.

Davos-Dorfli ; Frauenkirch; Wiesen; St. Moritz; The
Mal'rja.—Concluding Remarks.

Having dealt fully with the general principles of the
high altitude treatment of phthisis with special reference
to Davos, I shall conclude by a brief consideration of the
other Alpine sanatoria. Frauenkirch and Davos-Dorfli need
not detain us, being both in the Davos valley and sharing
in the general climatic conditions of Davoa-PIatz. Owing
to the rapid increase of patients at the latter village, they
are likely to grow in popularity as the opinion gains ground
that the aggregation of large numbers of oonsumptives is a
peril to be shunned. Davos-Dbrfli has more sunshine, but
less shelter than Davos-Platz. The climatology of Frauen¬
kirch is practically identical with that of the parent
sanatorium.

Wiesen demands a more extended notice, as it possesses
®*ny attractions as a health-resort, and probably has &
future before it. Situated on the side of a declivity which,
"opes abruptly down to the wild gorge of the Landwasser,
•wounded by pine woods, and encircled by a range of
magnificent snowy peaks, Wiesen possesses all that Alpine
-fwn of scenery which Davos so -conspicuously lacks, and
is hardly inferior to the latter in all the essential requisites
°f an admirable sanatorium. It possesses rather more sun-
an: almost equal immunity from wind, and & site
•uporior to that of Davos for the purposes, of drainage.
**°n» He situation on the brow of a hill overlooking a deep
Alpme valley, it might be conjectured, that Wiesen would be
»uch exposed to winds, but the gorge of the Landwasser is
so deep and He bed so far below the level of the village that
*he valley wind sweeps past without rising so high as the
sue of the hotels lor invalids. The chief point of difference
Davos and Wfesen arises from the fact that the
r" 61 lies- at a considerably lower elevation, and hence
a shorter winter and a higher mean temperature,
‘Counting to about 2 C (Tucker Wise). The climate is
njiloer and leas bracing than that : of Davos, and
j*® 08 likely to prove advantageous in those cases where the
X*® proves too stimulating. There can be little doubt that
"wsen is capable of affording ss good results se Detos, and

it seems particularly worthy of trial in those doubtful cases
where dyspepsia, insomnia, or deficiency in circulatory
vigour renders recourse to the mountains a tentative
measure. There are two good hotels where ample provision
is made for the comfort of the invalid; but the village itself
is one of the smallest and poorest in Switzerland, and the
visitor must be prepared to dispense with many of the social
attractions afforded by Davos. Wiesen can be recommended
only to those who are superior to the charms of gaiety, who
possess much resource for amusement and occupation in
themselves, and who are prepared to make every necessary
sacrifice which their condition of health may demand.
Wiesen is only eleven miles distant from Davos; hence
visitors to the former resort can have their medical wants
supplied by the physicians of the latter. Between thirty
and forty visitors spent last winter at Wieseu, and the
results of treatment are said to have been satisfactory. Wo
are still without definite statistical information on this
point. Wiesen is usually approached from Coire, from
which it is twenty-four miles distant.

The sanatoria hitherto considered all lie in the same
valley, Davos-Dorfli representing its highest and Wiesen
its lowest point. 1 have now to deal with the long famous*
and still very important, health-resorts in the Kngadine.
The valley of the Inn has long been justly celebrated for its
magnificent scenery, its mineral waters, and its bracing
air. For many years it has been a favourite playground for
tourists in the summer and autumn, but it is only since
Davos arose into sudden popularity that St. Moritz, Samaden*
Pontreeina, and the Maloja have put in their claim to rank
as winter sanatoria for phthisis. This claim must still be
reckoned on Its trial, as the results of treatment in the
Kngadine liave hardly hitherto been of a nature to justify
the expectation that it will ever supersede Davos. We may
safely oonflne ourselves to the consideration of St. Moritz,
and the Maloja, as Samaden and Pontreeina have grave dis¬
advantages as winter resorts: the former in its windiness
the latter in the contour of the surrounding hills interfering
with the sunshine. They have hitherto had few winter
residents, and it seems unjustifiable to recommend them
when there are several resorts equally accessible and in all
respects superior.

St. Moritz enjoys a very charming situation. It is 6OSD
feet above the level of the sea (nearly 1000 feet higher than
Davos), and the village rests on the crest of a hill 000 feet
above the level of the Inn valley. Beneath lies a lake, on
the edge of which are the baths of St. Moritz (St. Moritz
Bad), with numerous splendid hotels, while beyond stretches
a range of snowy peaks of great grandeur. The baths have
their season in August and September, when St. Moritz is-
the favourite resort of wealth and fashion, but are closed in
winter. • Several hotels in the village proper now remain,
open throughout the year for the benefit of winter visitants*
and the accommodation provided is in every way excellent.
Good medical attendance can be procured.

A few miles beyond St. Moritz, on the margin of the lake
of Sils, is the Grand Kursaal de la Maloja, a magnificent hotel
(perhaps the finest in Europe), recently erected. All that
money and art can do has been done both to provide for the
comfort and to promote the pleasure of winter residents. The
scenery in the neighbourhood, though somewhat inferior to-
1 St. Moritz, is nevertheless very fine, and a view of the lake
with its grand encircling peaks, when the moon rides
high and the enow is on the ground, is a scene one cannot
easily forget. It must not be forgotten, however, that this
fine winter sanatorium is in one of the most secluded posi¬
tions in Europe. The railway does not approach nearer
than Coire. on the north, and Chiavenna on the south. There
is no village in the vicinity of the hotel, and no opportunity
for any social pleasures beyond those afforded by the visitors
themselves

What are the climatic peculiarities of the Inn valley, and
wherein do they- differ meteorologically and in their
application to disease from those prevailing in the valley of
Davos ? St.. Moritz and the Maloja are both at a materially
higher elevation than Davos; hence they have a lower mean
temperature, a longer winter, and a greater duration of
frost and snow. Nevertheless, owing to peculiarities of
local position, they both enjoy somewhat more sunshine
during the winter than Davos, and in this respect the
Malojai.takes precedence of St. Moritz; but there is one
essential point in which, according to the unanimous report
of invalids and permanent residents. Davos enjoys an
undisputed pre-eminence—namely, stillness of the atmo-

544 The Lancet,]

MEDICAL SOCIETY OP LONDON.

[March 12,1887.

sphere. That the Alpine winter climate would be utterly
unsuitable to the invalid did not the profound atmospheric
calm permit the full influence of the solar heat to be felt while
the shade temperature is far below freezing-point is a cardinal
and indisputable principle in all theories regarding the efficacy
of the high altitude treatment. This point is really the
pivot on which the whole question turns. Hence windiness
is simply a fatal objection to any luftkurort. It would be
inaccurate, however, to describe the winter climate of St.
Moritz and the Maloja as windy. Perfect days—days of
absolute stillness, spotless skies, and uninterrupted sun-
ehine—are by no means rare during winter in the Inn
valley, but they are unquestionably less frequent than at
Davos. That tnis must necessarily be so is evident to the
eye of any observer who is familiar with the principles which
regulate the relation of topography to climate. Just as the
waters of the Inn rush down the long funnel-shaped valley
of the Engadine, so must there also at times be a descent of
atmospheric currents. As the writer drove up from Siia
to S&maden on a brilliant day in October, the whistling
of the wind reminded him, in spite of the bright sun¬
shine, that he had left behind the atmospheric placidity
of Davos. The position of the Maloja hotel, situated
almost at the apex of the long double valley formed
on one side by the Engadine and on the other by the Maloja
Pass and the Via Bregaglia, seems particularly obnoxious to
the charge of windiness. The climate of the higher Alps is
one of great stimulation and much tonic influence, and these
characteristics will be exaggerated in proportion to the
amount of wind. But in those cases in which the climate
fails to confer beneflt, the usual explanation is that it is too
stimulating; hence the calm of Davos is all in its favour.
At Davos one meets with numerous cases of patients who
have crossed over into the Engadine, often for the mere
purpose of varying the monotony of existence, but who have
been driven back by the over-stimulation of the climate. On
the other hand, the results of treatment at 8t. Moritz and
the Maloja have frequently been excellent, but there
cannot be a doubt that extreme care is necessary in the
selection of cases. Debilitated patients, patients with ner¬
vous irritability or the least suspicion of circulatory weak¬
ness, should on no account be sent to the Engadine. If
Davos and Wiesen are of doubtful applicability to such cases,
St. Moritz and the Maloja are absolutely contra-indicated.

The high altitude treatment of phthisis has fought its
way into favour against heavy prejudices, and has at least
established its claim to careful consideration. It is not a
specific, as the rapidly-filling graveyard of Davos abundantly
proves, but in properly selected cases its results probably
excel those obtained by the older methods. It is to assist
the profession in the choice of suitable cases, and to save a
hopeful advance in therapeutics from the odium which
follows from its improper application, that the present
series of articles has been written.

MEDICAL SOCIETY OF LONDON.

Great was the success of the Medical Society’s Dinner
held in the Venetian Chamber of the Holbora Restaurant
on Tuesday, Mr. Brudenell Carter, the retiring president,
being in the chair. After the loyal toasts had been duly
honoured, the toast of “ The Army ” was responded to by
Sir Thomas Crawford, who referred to the question of the
“ relative rank ” of medical officers. His observations en¬
tirely supported the position which we took on this question
(see The Lancet, page 482). There was nothing in the Royal
Warrant that trenched in any way on the prerogative of the
Medical Department of the Army. We have no doubt that
the strong assurance of the Director-General of the Army
Medical Department will quiet the unnecessary alarm
that has been excited. Captain Crozier replied for the
Navy, and Colonel Edis for the Volunteer forces. To Mr. T.
Bryant was entrusted the toast of “The Houses of Par¬
liament,” and this was answered by Colonel Duncan, M.P.
Dr. Ord proposed “ The Medical Corporations," and
Mr. Shillitoe, the Master of the Society of Apothecaries,
responded. Sir Joseph Fayrer did the honours of the
toast for “ The Retiring President.” Dr. Hughlings Jack sort
was warmly received as the new President of the Society.
The remarks of Mr. J. H. Morgan, the retiring secretary,
Dr. Samuel West the senior secretary, Mr. Bernard Pitts, the

new secretary, and Mr. Poole, the much-respected registrar,
were received with acclamation. We were greatly pleased
with the suggestion of Dr. Samuel West that the clinical
meetings of the Society should become a still more pro¬
minent feature—a suggestion that we have advocated for
some time past as likely to prove of great practical value
and*interest, and certainly conducive to the welfare of the
Association.

THE MANCHESTER MEDICO-ETHICAL ASSOCIA¬
TION AND CORONERS’ INQUESTS.

At an ordinary meeting of the Manchester Medico-Ethical
Association, held on April 24th, 1885, Dr. Sinclair read a paper
upon “ Coroners’ Inquests.” This paper led to the appoint¬
ment of a sub-committee of the Association for the
purpose of obtaining and considering evidence as to the
present inefficient working of the Coroner’s Court. The
sub-committee, with Dr. Sinclair for their chairman
and Dr. Owen as secretary, commenced their labours on
Sept. 15th, 1885, and held fourteen sittings. Evidence was
obtained of the inefficiency of the present system from
(1) the personal experience of each member of the sub¬
committee; (2) from published statements which have
appeared from time to time in the medical journals and
public papers; (3) from statements received in reply to a
circular letter asking for information based upon personal
experience. In all 300 letters were addressed to various
medical men, including members of the Association, medical
officers of health, police surgeons, professed medical jurists,
and public analysts. The evidence thus obtained was
considered under the following heads: (1) The coroner, his
functions, qualifications, and mode of election ; (2) the posi¬
tion of medical men as skilled witnesses; (3) the present
system of registration of deaths; (4) the coroner’s jury.
The third branch was found to be inseparable from the
inquiry, as much of the inefficiency complained of was found
to be d ue to a faulty system of death registration. After giving
a number of cases illustrative of the defects of the present
system so far as the coroner is concerned, the sub-committee
expressed their opinion : 1. That the qualification and position
of acoroner should be those of a stipendiary judge, who should
devote the whole of his time to the duties of his office, and
that his salary should in no case be dependent upon the
number of inquests. 2. That the present mode of election
to the office is unsatisfactory, and that the election should
invariably rest with the Crown. 3. That the functions of a
coroner should be to conduet public inquiries into the cause
of death in certain cases by means of the evidence of experts
and of other witnesses, and to sum up such evidence in its
legal aspects before a properly constituted jury. 4. That
he should have no discretion, but to hold an inquest in every
case of death, sudden or otherwise, in which the cause of
death cannot be certified by a legally qualified medical man.
But it is not implied that the coroner should be necessarily
debarred from holding an inquiry, provided there exists*
reasonable grounds for suspicion, because a death has been
certified by a legally qualified practitioner. 6. That no
inquest shall be held without a previous examination of the
body by a properly qualified medical man. After giving
details showing the unsatisfactory way in which necropsies
are too often made and medical evidence given, the sub¬
committee made the following suggestions:—1. The exami¬
nation of the body upon which an inquest is to be held
should be made by a medical man specially skilled in such
matters, who should be designated the Public Pathologist,
and that for every coroner’s district thereshould be one or more
such pathologists appointed te conduct the examination of
the body previously to the inquest. 2. The appointment of
the public pathologist should be made by the same authority
as in the case of the coroner. 3. The pathologist should, in
cases in which he may deem it necessary, suggest to the
coroner the advisability of calling in the aid of other scien¬
tific experts (for analysis, &c.). 4. The duties of the public
pathologist should not preclude the medical attendant in
the case from giving evidence as a skilled witness when
necessary. 5. For every coroner's district one or more mor¬
tuaries, with proper appliances, should be provided, which
would be available for post-mortem examinations in the
absence of proper accommodation elsewhere, or in such
other circumstances as the coroner might think would

The Lancet]

RETORTS OF MEDICAL OFFICERS OF HEALTH.

[March 12,1887. 545

warrant the removal of the body; and that the removal of
the body to a mortuary should be compulsory under the
coroner’s order. The report concludes with further sugges¬
tions, among them being that registrars of births and deaths
should be required to report to the coroner every uncertified
death, that the period of medical attendance should be
stated in each death certificate, that all still-births should be
registered, that the status of coroners' jurors should be
unproved, and that the present custom of viewing the body
is objectionable and unnecessary.

We hope at an early date to take into consideration the
views of the sub-committee, which are of a somewhat
sweeping character._

SCIENTIFIC RESEARCH.

The following memorial, signed by medical and surgical
teachers of all the London medical schools, has just been
presented to the Council of the Royal College of Surgeons:—
To the Council of the Royal College of Surgeons of England.

Mb. Tbksidbnt and Gentlemen,— We venture to bring
to your notice the anxiety that is felt by those who are
directly concerned in the teaching of surgery in London
with reference to the proposed extension of the buildings in
Lincoln’s-inn-fields, inasmuch as the present moment offers
a unique opportunity for the establishment and endow¬
ment of an institute for the advancement of surgery by
research.

The progress of surgery largely depends upon the facts
obtained by research in the following branches of science:
1. Morbid anatomy, including histology. 2. Experimental
pathology, including bacteriology. 3. Experimental opera¬
tive surgery. The present Museum, whicn offers a splendid
field of study, can never be considered a complete memorial
of Hunter’s work, and can never be thoroughly utilised for
the benefit of surgical science until a laboratory is added to
it for the pursuit of the objects above indicated. In view
of the increased power and wealth of the Royal College of
Surgeons of England, we hold that any Fellow or Member
who is competent to carry out scientific investigations
should be able to do so without inconvenience and without
expense. Within the walls of our own College fresh know¬
ledge would thus be gained, new methods of surgical treat¬
ment would be brought to light, and British surgnry would
no longer be compelled to lean upon the information derived
from foreign laboratories for the solution of the many
problems which surround its progress. We therefore
earnestly hope that in the contemplated enlargement of the
College adequate provision will be made for the study of
these most important branches of our art.

(Here follow the signatures.)

public unit |)oor fata.

LOCAL GOVERNMENT DEPARTMENT.

BE PORTS OF MEDICAL OFFICERS OF HEALTH.

Bilston Urban District.— Bilston is one of the urban
districts in which some cases of typhus occurred last year,
but at the end of December no further cause for apprehend¬
ing an outbreak of this disease remained. Bilston is, how¬
ever, a district needing much improvement as regards the
lodgment of the people, and this especially as to the vicious
practice which formerly obtained of building so-called
back-to-back houses. We hope the present bye-laws of the
town require every house to have its own appointed open
space to the rear. Child mortality causes Dr. T. R. Bailey
some anxiety. The rate under one year of age exceeds 180
per 1000 of the children born, but he very much fears that
it is largely due to conditions of trade and parental mis¬
management, which it will be difficult to overcome. There
“•however, room for progress in many matters affecting
c mjd life, notably as to the through-ventilation of dwellings
and improved means of excrement and refuse disposal. As
mgwds the latter, a change may be hoped for, since the
authority are considering an alternative method suggested
“I Dr. Barry of the Local Government Board.

Ashton-in-Maker field Urban District. —The general death-
rate of this district for 1880 was 17 1 per 1000. The births
were 475 in number, and the deaths under one year of age
were 64; this gives a rate of 13-5 per cent., which can hardly
be regarded as very excessive, but Mr. Hannah evidently
thinks it might be further substantially reduced. Especially
should the diarrhoea mortality be lessened, due as it largely
is, in his opinion, to improper feeding, including the ex¬
cessive dilution of milk. The geaeral account of nuisances
dealt with points to a satisfactory performance of the
current duties by the sanitary officers.

Newton-Abbott Combined District. —Mr. Harvey gives the
birth- and death-rates of the Newton-Abbott rural district!
for 1886 as 29-1 and 16 5 per 1000 respectively. In Broad-
hempstone there were in the early part of the year twelve
cases of diphtheria, of which five were fatal. The disease
was imported into the local school by children who, for
geographical reasons, were allowed to attend the Broad-
hempstone school, instead of their own in an adjoining
district. This circumstance leads Mr. Harvey, as it has led
others, to point to the difficulties attending the procuring
of information as to outbreaks involving sanitary frontiers.
Both this outbreak and a subsequent occurrence of diph¬
theria led to the discovery, and as far as possible to the
remedy, of conditions of filth and of dampness of sites with
which the disease was associated. At Kingsteignton the
water question was discussed during the year, and
Mr. Harvey’s description of the sources of contamination in
the village, as also of the millions of gallons running
through the place continually, convinced the inhabitants of
the desirability of securing a proper supply. The first
scheme unfortunately broke through, owing to difficulties
as to mill-owners’ compensation; and now another
scheme for securing a spring at Tor Hill is under
consideration. At Bishopsteigncon a new water-service
has been completed, at Bovey new sewers have been laid,,
at Ashburton new water-works have been commenced,
and at Tottery near Bovey and at Fairwater improve¬
ments in water-supply have been effected. Indeed, this
district has made sanitary progress of a sort which is
calculated to improve it very materially, and to give con¬
fidence to those who seek a healthy residential neighboui-
hood. In the Wolborough urban district the death-rate was
16-28 per 1000, and the record of work given shows that no
opportunity is lost to ensure further improvement in its
sanitary circumstances. At Dawlish the death-rate was
17 6 per 1000, after making the necessary correction for
visitors. Measles and scarlatina prevailed in the last quarter
of the year, no epidemic disease having previously existed
in the place since 1880. By rigidly excluding children living
in infected houses from attending the schools, and by
means of other precautions, the diseases appear to have
come to an end. During 1886 they each caused three
deaths. A difficulty in enforcing a strict bye-law as to
the distance of piggeries from houses in the more rural
parts of a nominally urban district lias arisen in Dawlisb.
The same has occurred elsewhere, and we believe the Local
Government Board now assent either to the division of the-
district for the purposes of such a bye-law, or else they
make the distance clause apply, not to each house separately,
but to any two or more houses. The sewerage scheme for
Dawliah has again been delayed, and it has been found)
necessary to prepare new designs by which the sewage
may be delivered to the eastward and below low water¬
mark.

Carlisle Urban District.— Crozier Lodge, the sanitary hos¬
pital for this and the rural district, has again served an
eicellent purpose. The immediate isolation of small-pox in
the rural district is held by Mr. William Brown, F.R.C.S.,to
have saved the spread of infection into the city. Typhus
was in a similar way isolated and checked. Carlisle has-
long been comparatively free from scarlet fever, but there
is now an ominous increase of attacks, and seven deaths
occurred in 1886. Typhoid fever mortality, though decidedly
below the average, showed an increase in 1885, but the
causes are carefully ascertained, and, we may assume, also-
remedied. Diarrhoea was exceptionally fatal in October,
1886, it being associated with an abnormally high tempera¬
ture for that month. Some important sanitary works were-
executed during the past year. Extra-mural abattoirs
were commenced, the filter-beds of the Carlisle Waterworks
were extended, and a portion of the ward accommodation at
Crozier Lodge was remodelled and reconstructed. The general
mortality for 1886 was at the rate of 19-4 per 1000.

546 Thb Lancet,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[March 12,188T.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6792 births
and 3776 deaths were registered during the week ending
March 5th. The annual death-rate in these towns, which had
been equal to 195, 21'1, and 213 per 1000 in the preceding
three weeks, was again 21‘3 last week. During the first
nine weeks of the current quarter the death-rate in these ,
towns averaged 21 - 9 per 1000, and was 2-3 below the
mean rate in the corresponding periods of the ten years
1877-86. The lowest rates in these towns last week were
116 in Bolton, 141 in Brighton, 15 3 in Sunderland, and 17'1
in Birkenhead. The rates in the other towns ranged upwards
to 265 in Wolverhampton, 26 7 in Huddersfield, 281 in
Blackburn, and 3P2 in Manchester. The deaths referred
to the principal zymotic diseases in the twenty-eight towns,
which had been 340,371, and 372 in the preceding three weeks,
further rose last week to 385; they included 152 from measles,
93 from whooping-cough, 41 from scarlet fever, 34 from diar¬
rhoea, 31 from “fever "(principally enteric),31 from diphtheria,
and 3 from small-pox. These zymotic diseases caused the
lowest death-rates during the week in Bolton, Halifax, and
Bradford, and the highest rates in Oldham, Manchester, and
Huddersfield. The greatest mortality from measles occurred
in Liverpool, Salford, Manchester, and Huddersfield; from
whooping-cough in Birmingham, Oldham, Preston, and
PlymoutU; from scarlet fever in Manchester, Salford, and
Birkenhead ; and from “ fever ” in Blackburn. The 31
deaths from diphtheria in the twenty-eight towns included
19 ia London, 2 in Bristol, and 2 in Birmingham. Small¬
pox caused 3 deaths in Manchester, but not one in London
and its outer ring, or in any of the twenty-six other large
provincial towns. Only 6 cases of small-pox were under
treatment on Saturday last in the metropolitan hospitals
receiving cases of this disease. The deaths referred to
diseases of the respiratory organs in London, which had
increased in the preceding four weeks from 364 to 466, were
last week 459, and were 28 below the corrected average.
The causes of 72, or 1-9 per cent., of the deaths in the
twenty-eight towns last week were not certified either by
a registered medical practitioner or by a coroner. All the
causes of death were duly certified in Newcastle-upon-
Tyne, Nottingham, Leicester, Portsmouth, and in six other
smaller towns. The largest proportions of uncertified deaths
■were registered in Salford, Oldham, Halifax, and Sunderland.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 24 3 and 22 5 per 1000 in the preceding
two weeks, rose again to 23'6 in the week ending
March 5th; this rate exceeded by 2-3 the mean rate during
the same period in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from 17'4 in
Dundee and 187 in Leith, to 25-6 in Glasgow and 32-4
an Aberdeen. The 589 deaths in the eight towns last
week showed au increase of 27 upon the number in the
preceding week, and included 32 which were referred to
whooping-cough, 27 to measles, 19 to.scarlet fever, 11 to
diarrhoea, 5 to diphtheria, 4 to “fever” (typhus, enteric,
or simple), and not one to small-pox; in all, 98 deaths
resulted from these principal zymotic diseases, against
103 and 99 in the previous two weeks. These 98 deaths
were equal to an annual rate of 3 9 per 1000, which
exceeded by 1:7 the mean rate from the same diseases
in Hie twenty-eight English towns. The fatal cases
of Whooping-cough, which had increased in the pre¬
ceding five weeks from 19 to 33, rose last week
to 32^of which 18 occurred in Glasgow, 5 in Edinburgh, and
5 in A'herdeen. The 27 deaths from measles showed a
decline, of 3 from the number in the previous week, and in¬
cluded .19 in, Aberdeen and 8 in Glasgow. The fatal cases
of scarlet fever, yfrhich bad been 13,26, and 17 in the previous
three weeks, rose agaiq last week to 19, of which 13
occurred in Ediaburgu and 4 in Glasgow. The 11 deaths
attributed to diarrhoea corresponded with the number in-the
previous week, and included 5> in Glasgow, and 3 in Dundee.
Of the 5 deaths from diphtheria, 2 occurred in Glasgow and
2 ipjSdinburah;; and tie-4 deaths refarred tiO “if 0 v»r ’!,in-
dud«4 2 in Glasgow. ,.Tbp ydw aonteitiasases

last week to 142, but were 38 below the number returned in
the corresponding week of last year. The causes of 76,
or nearly 13 per cenL, of the deaths registered during: ths
week were not certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 35-3 and
30-7 per 1000 in the preceding two weeks, further declined
to 281 in the week ending March 5th. During the first
nine weeks of the current quarter the death-rate in the city
averaged 310, the mean rate during the same period being but
20 8 in London and 217 in Edinburgh. The 190 deaths in
Dublin last week showed a further decline of 18 from the
numbers in the previous two weeks ; they included 7 wfaicli
were referred to scarlet fever, 5 to “ fever” (typhus, enteric,
or simple), 1 to measles. 1 to whooping-cough, and 1 to
diarrhoea. Thus the deaths from these principal zymotic
diseases, which had been 14 in each of the preceding two
weeks, were last week 15; they were equal to an annual x’&t*
of 2 2 per 1000 , the rates from the same diseases being 1 "G
in London and 4 2 in Edinburgh. The deaths from scarlet
fever, which had been but 3 and 2 in the previous two weelcs,
rose last week to 7; the 5 fatal caees of “ fever,” on the
other hand, showed a decline of 3 from the number in tbe
previous week. The deaths of infants showed an increase
of 3, and those of elderly persons a decline of 2, compared
with the numbers in the previous week. Four inquest caees
and only one death from violence were registered; and 40,
or nearly a quarter, of the deaths occurred in public insti¬
tutions. The causes of 29, or more than 15 per cent., of tbe
deaths registered during the week were not certified.

THE SERVICES.

A special committee, composed of Sir ArchibaldAlison
(who is to preside), Sir Evelyn Wood, Mr. G. Lawson, Sir
Thomas Crawford, and Colonel Methuen, has been appointed
to consider the full organisation of the medical department
for an army corps in the field, as well as the number of
horses and servants required for medical officers on active
service.

War Office. — Army Medical Staff; The date from
which Surgeon-Major S. Moore. M.B., is granted retired pay,
with the honorary rank of Brigade Surgeon, is Jan. 22nd,
1887, and not, as stated in the Gazette , February lltb,
1887. The undermentioned Surgeons on probation to be
Surgeons:—F. J. Morgan; W. H. Horrocks, M.B.; C. H.
Hale; H. C. Thurston; B. II. Scott; W. C. Poole, M.B..;
O. R. A. Julian; G. Raymond, M.B.; E. A. Burnside; t.
McCulloch, M.B.; A. B. Hinde; A. Y. Reily, M.B.; J. W.
Cockerill; J. Ritchie, M.B.; II. St. G. S. Hore; S. Macdonald,
M.B.; E.Corcoran; A. O. C. Watson, M.B.; E. W. Gray, M.B.;
D. Stiell, M.B.; L. E. A. Salmon; G. A. Wade, M.B.; J.
Minniece, M.D.; R. U. Penton; M. P.,C. Holt: W. L. Gray,
M.B.; E. G. Browne; J. C. Morgan; H. I. Podock; G.
Hilliard, M.B.; C. R. Elliott, M.D.; C. A. Young; J. W.
Bullen, M.D.; J. C. Weir, M.B.; B. J. Innis; R. C. Thacker;
W. N. Murphy, M.D.; S. F. Clark, M.B.; and E. M. Hassard.

Admiralty. — Tbe following appointments have been
made:—Surgeon John Lownes, to tbe Landrail, to date from
the 10th inst.; Staff-Surgeon J. Lyon, to the Ajax; Surgeon
G. A. Spiller, to the Duke of Wellington, additional, for dis¬
posal ; Surgeon W. 0. Spiller, to the Ganges, additional, kr
disposal; Surgeon W. Belt, to the St. Vincent, additional, for
disposal; Surgeon H. W. Rickards, to the Boscawen, additional,
for disposal; Surgeon F. W. Brice, to the Britannia, additional,
for disposal; Surgeon J. W. Slaughter, to the Cambridge,
additional, for disposal; Surgeon J. B. Clibborn, to the Listen
Hospital, to date from 11th inst.; Surgeon S. D. O’Grady, to
the India; and Surgeon C. J. Mansfield, to the Griffon, to
.date from 16th inst. '■

The following qualified candidates for the Naval Medical
Service have been appointed to be Srtrgeons in Her Majesty's
Fleet:—John Douglas Hughes; William John Colbortt©;
John Hutton Stenhouse, M.B.; Joseph Agnevr Moon; Robert
Hardie, M.B.; Cornelius Bradley, M.D.; George Trevor Gd-
lingwood; Richard Miller, M.B.; GeOrpfe Fletcher Colfiafc';
Charles Dickinson; John Edwin Grad, M.B:; Hubert Hdy-
oake; George Wilson, M.B.; Jataee Moorer BdW^ Griffm,
M.D.: John Duncan Menzies, M.B.; HngbSt. David Griffith#;
and Walter Bowden. ' '4>f-u '•*> «.a y

In accordance with the provfcflbiwal (k&it

Digitized by G00Qle

Tot Lattcbt.1

THE TREATMENT OF PLACENTA PR2EVIA.

[March 12,1887.. 547

in Council of April 1st, 1681, Fleet-Surgeon Robert Nelson
has been placed on the Retired List of his rank.

Rifle Volunteers. — 5th Durham: Andrew Arthur
Abraham, Gent., to be Acting Surgeon.—2nd Volunteer
Battalion, the Gloucestershire Regiment: 8urgeon Thomas
Partridge is granted the honorary rank of Surgeon-Major.—
1st Volunteer Battalion, the Lancashire Fusiliers: Surgeon
J. E. Lees, M.B., resigns his commission.—3rd Volunteer
Battalion, the Northumberland Fusiliers: Surgeon Anthony
Bell is granted the honorary rank of Surgeon-Major.

flUmspittanct

*• Andl alteram partem.”

THE TREATMENT OF PLACENTA PREVIA.

To the Editors of Thf^ Lancet.

Sirs, —An ex cathedra statement in The Lancet on the
treatment of placenta prmvia carries such weight with the
profession, both at home and abroad, that I am anxious to
be permitted to point out that, so far, it is only in Germany
that such exceptionally good results have been obtained by
the method of Braxton Hicks (bipolar version), which is
the treatment recommended so forcibly in its columns of
to-day. Lomer, on page 1235 of the American Journal of
Obstetrics for 1884, gives the following table—

Cuee.

Mothers died.

Children died.

Hofmeier

... 37

1

23

Behm ...

... 40

. 0

31

Lomer ...

... 101

7

61

178

8

105

It follows, then, that since these three obstetricians must
have treated fifty-eight cases without a death, unless the
number 236 mentioned in The Lancet is a misprint ; and,
SB fifty-eight is also the number of cases which Behm is
reported to have treated without a death, the coincidence
is so rematkable as to suggest the possibility of an error
in the number. In this country and in America the
method of Barnes (partial separation of the placenta and
cervical dilatation with hydrostatic bags) has given such
very good results that the time has not yet arrived
to definitely settle which is the best mode of treatment,
though to my mind either is incomparably better than any
other method hitherto suggested. And to 6how that some
of our continental brethren appreciate our work, I would
refer your readers to the “ These d’Agrtfgation ” (accouche-
ments) for 1886, entitled “ De la Conduite a tenir dans les
Cas de Placenta Pnevia,” by Dr. A. Auvard, 1 who, in addition
to B udin (now happily restored to heilth by the skill of our
countryman, Lawson Tait), promises to worthily uphold the
high prestige of the French obstetrical school. In this work
the author discusses several methods of treatment, but places
the two English methods in the first rank, and enters fully
into their respective merits, arriving at the conclusion that
both “sont done egalement bonnes” (page 145); and on
P*ge 72 he is kind enough to say, “ Les rdsultats obtenus
par Morphy l’aide de la mdthode de Barnes sont exoellents”;
and on page 144 that in my hands this method “ eat celle
qui s'offre avec les chiffres les plus brillants.”

I have now treated twenty-eight cases of placenta preevia
without a single death, twenty-three of which are recorded
in the Medical Press and Circular for 1885, pages 179-205;
a J l ® M 1 have obtained such good results from the method
of Barnes I naturally prefer it, more especially as the hydro¬
static bags are required for what I would wish to enunciate
«amntfi great proposition—“that premature labour should
be brought on as soon as we know that we are dealing with
a m which the placenta presents after the seventh
Month of pregnancy, and even before then shoald the bleed-
J“^be serious, frequent, or continuous.’' This rule I have
as strongly as I could in the paper referred to, I have
always acted on it, and it is only by eon tinning to do so
^at I can hope to keep my mortality at nil, or even at a
“Man percentage. For what can ft man do wbett called to a
already in articulo mortis ? And it should be constantly
001119 m mind that beemo rAage may occur at any time

? OcUintfColn. 8, Place de 1 XU Son, paria.

during pregnancy, and that it must occur when labour seta
in; and we cannot foresee when it will take place or in what
quantity it will pour out; and it may be, andolten is, so
sudden and so copious that death occurs before assistance
can be obtained; or that the patient is so exhausted that
assistance, when it comes, is powerless to save life.
And I would impress upon your readers that the horrible
mortality of placenta prsavia is not due to the impotence
of our art, but to violent haemorrhage occurring before
assistance can be obtained, or where that assistance
is of a helpless, do-nothing character. Whereas, if we take
warning from the preliminary bleedings (which often are
Blight at first), we can generally have time to fix a con¬
venient opportunity to be present during the whole period
of labour, ready for every emergency, and, thanks to Barnes’s
bags (or Steele’s, as I prefer), we can fix the time for in¬
ducing labour as easily as for doing an abdominal section;
and labour can be surely and safely brought on and com¬
pleted, as I have demonstrated over and over again, in some
cases even in a shorter period than it takes for a complicated
ovariotomy. Another great advantage this method possesses
is, that it enables practitioners who have no particular pen¬
chant for obstetrical operations to secure the help of an
obstetrician with practical experience of placenta prsevia
to aid them, and to share the responsibility in this the most,
terrible complication of labour.

I am. Sirs, yours obediently,

Sunderland, March 5tta, 1887. JAMES JfURPIIY.

THE NATURE OF COMA.

To the Editors of The Lancet.

Sirs, —I have been much interested by the leading
article on Coma in your last issue. You quote Dr. Hugb-
lings Jackson, that “ the breathing fails before the heart, and
the accessory parts of the breathing fail before the funda¬
mental. It oonsists in a long process of degradation, the-
last point of attack being the heart, and the penultimate
the breathing.” I have recently had a case where, on the-
night preceding death, the pulse frequently disappeared,
while the breathing was loud and stertorous. Soon after
8.30 a.m. it stopped altogether, and the heart’s action
could not be detected, but this may have been due to the
presence of loud rales in the lungs. The breathing con¬
tinued noisy, and at the rate of 23 to the minute,
till it gradually fell to 17, and then ceased at 2.30 p.m.
During the whole time, frequent examinations were made
to see if the heart’s action could be observed, but without
success. I conclude from your article that it must, however,
have continued working all this time. The patient was
seen in consultation during the “ precomatoso period” by
Dr. Broadbent, Mr. Walter Coulson, and Dr. Russell Reynolds.

I am, Sire, yours truly,

J. B. Emmerson, M.D. Durham.

High-street, Biggleswade, March 7th, 1887.

NORTHERN COUNTIES NOTES.

(From our oum Correspondent.)

NEWCASTLE INFIRMARY: ADOPTION OF THE FREE
HOSPITAL SCHEME.

At a special meeting of the governors of the Newcastle
Infirmary, it was decided, in deference to the house com¬
mittee and medical board, to adopt their report, and make
the infirmary a free hospital, subject to a reservation
of existing rights of life governors and to the receipt of
periodical contributions from the workmen of Tyneside.
It was shown by the report that the average cost to
the infirmary of each in-patient had been £4 5 s. 3d., or
£2 3s. 6 d. more than paid for each letter of admission.
With regard to the recommendation to discontinue the
admission of children, the committee thought it was pre¬
mature to commit themselves to its adoption. The com¬
mittee did not adopt the recommendation to admit paying
patients, bat steps were to be taken to see that each
in-patient, whan able, contributed in whole or part to
the expense of their maintenance. They recommended
that the casual department be remodelled and the out¬
patient department be confined to such cases - ns had

Digitized by G00gle

548 The Lancet,J

EDINBURGH.—DUBLIN.

[March 12,1887.

already received treatment in the wards; also, that the rale
excluding male venereal cases from the hospital be strictly
enforced. As regards the suggested fee to be paid by medi¬
cal students, this proposal has been considerably modified.
As now fixed, the fee to be paid by all students at the infirmary
will be six guineas perpetual, and for one year two guineas.
The original proposition was £6 5s. per annum. With
regard to the election of the honorary staff, in the future the
mode of election is to be altered so as to avoid the expense of
canvassing, and for this purpose a committee of selec¬
tion is to be formed, taking care that it is sufficiently
numerous and of a representative character. When this
important report was put to the meeting it was quietly and
unanimously carried; and so the week has seen a great
organic change in our infirmary, by which 1 predict it will
be ultimately benefited, although at first some interests may
suffer, and the sudden change will no doubt give rise to
some confusion in the house, which will, however, soon
adjust itself to its altered constitution.

•Newcastle-on-Tyne, March 7th.

EDINBURGH.

{From ovr own Correspondent.')

PBOFESSOB RUTHERFORD’S RETIREMENT.

Db. William Rutherford, Professor of Physiology in
the University, has retired from his chair on leave of
absence. The plea upon which his absence is permitted
from the duties of his department is, as stated in the local
papers, one of ill-health, produced by overstrain and worry.
It is known to the public that the unfortunate matter con¬
nected with his misunderstanding with his late senior
assistant is now receiving the attention of the University
Court, as suggested in a recent issue of Thb Lancbt. The
arrangements for carrying on the work of the summer
session are not yet finally settled, but at the approach¬
ing professional examinations Dr. Caton of Liverpool has
been appointed to take Professor Rutherford’s place.

UNIVER8ITY BUILDING FUND.

The Chancellor of the Exchequer has met the wishes of
the University authorities in respect to the Government
grant towards the cost of the site for the completion of the
medical buildings. The sum of £8000 is to be granted by
Government, and the remaining amount (£4000) necessary
to effect the purchase is contributed by the munificent donor,
who has already presented the funds for the building itself.
The last $fficulty in the way is thus removed, and the
work will at once proceed.

MEDICO-CHIBUBGICAI. SOCIETY.

An animated discussion upon the diagnosis and treat
anent of cerebral abscess occupied the whole of the las
meeting of the Society. The subject was introduced b]
Ur. M Bride and Mr. A. G. Miller in a joint paper upon thosi
cases of abscess which follow ear disease. Dr. M'Bride’
part of the paper was a complete and exhaustive expositor
of the whole subject, containing many new observations o
great practical importance. Among these are his viewi
upon the value of the tuning - fork as an aid t<
the localisation of the abscess. If the vibrations be per¬
ceived by the injured ear on contact of the tuning-
fork with the cranial bones, it indicates that the interna
ear is intact, that the middle ear is the part affected, am
that the abscess is situated above the tentorium. Shoul<
the vibrations not be perceptible, the internal ear is affected
an which case the matter is usually below the tentorium
in the cerebellum. His differentiation of cerebral abscesi
from purulent meningitis and from phlebitis of the latera
sinus was another point of great importance. The operatioi
proposed in such cases by Dr. M'Bride, and carried out bi
Air. Miller, is to cut down as near as possible to the sourci
5^°“ th ® PI 18 sprung—i.e, by the nearest route t<

■expose the roof of the tympanum. This is done by reflect¬
ing the pinna downwards, opening the skull by means of i
chisel at a point a quarter of an inch above the osseoui
meatus, at which point the bone is exceptionally thin anc
can be perforated with great ease. This incision opens intc
the cranium exactly at the floor of the middle fossa. Thi
dura mater is then raised from the petrous portion for i
third of an inch towards the middle line, and the roof of th<

tympanum thus exposed, any abscess in connexion with it
being opened; or, if contiguous but not continuous, the
abscess may be evacuated by incising the dura mater and
a portion of the brain substance. Mr. Miller read the
notes of the cases operated on, and made some remarks
on the surgical aspects of the subject. He spoke of the
importance of differentiating cerebral abscess from purulent
meningitis, the temperature being taken as the most crucial
symptom in doing so: in the former, he thought an opera¬
tion was indicated; in the latter, experience showed it to be
of little avail. Professor Greenfield and Professor Annan-
dale spoke on the subject: the former referring to his recent
case, in which Mr. Caird had evacuated an abscess in the
temporo-sphenoidal lobe, with a satisfactory result; the latter
discussing the plea for operative interference in such cases,
in cerebellar abscess, and in oognate conditions in the skull.
Dr. Byrom Bramwell contributed some important factors to
the discussion by his clear statement of the grounds on which
a diagnosis of cerebral abscess can be clearly established.
Mr. Caird discussed the £est site for operation in such cases.
Prof. Chiene and Dr. Hughes Bennett also spoke, the latter
referring to the success of trephining, with removal of a por¬
tion of skull and membranes, in cases of ordinary epilepsy.

Edinburgh, March 8th.

DUBLIN.

{From our own Correspondent.)

BOYAL COLLEGE OF 8UBGEON8.

By a majority of 12 to 3 the Council of the Royal College
of Surgeons have passed a resolution in which the views of
the College of Physicians were invited on the subject of the
admission of the Apothecaries’ Hall into the proposed con¬
joint scheme between the two Colleges. The Council declare
that two alternatives seem to be open—namely, a combina¬
tion between the three bodies, or a combination between
the Colleges of Surgeons and Physicians on the one hand,
and the College of Surgeons and the Apothecaries’ Hall on
the other. This latter is the dual scheme proposed by Sir
Charles Cameron, but the Council prefer the former arrange¬
ment. The College of Physicians have had this resolution
before them, and have again, by a nearly unanimous vote—
I believe the numbers were 19 to 2—declared against the
tripartite scheme. I have reason, however, to believe that
many of the Fellows of the College of Physicians are not
adverse to the proposal to allow the College of Surgeons to
be allied with the College of Physicians, and also to form a
combinatien with the Apothecaries’ Hall. It is felt by the
great majority of the profession in Dublin that almost any
scheme would be preferable to that which would allow the
Apothecaries’ Hall to be a complete licensing body. The
interests of the students should also be considered, and until
some definite scheme becomes adopted their position is a
very anxious one, not knowing for certain what subjects
they will be examined in, or what regulations they must
obey so as to qualify themselves for examination.

DIPLOMA IN PUBLIC HBALTH.

As mentioned in last week’s issue, the Council of the
Royal College of Surgeons have agreed upon a scheme for
the institution of a diploma in public health, and have sub¬
mitted the same to the General Medical Council for approval.
The examination will extend' over three days, and will in¬
clude the usual hygienic subjects. The fee has been fixed at
seven guineas, to both those who hold diplomas of the Col¬
lege and those who do not. It is expected that many army
surgeons will apply for the diploma, and it is understood
that the examination will be of such a nature as to raise the
character of the diploma as high as possible.

BABB FOBM OF DOUBLE VAGINA.

At a meeting of the Obstetrical Section of the Academy of
Medicine in Ireland last week. Dr. William Fraser described
an example of a double vagina which had come under his
observation in a lady patient. The septum was only about
an inch and a half in length, thus differing from the ordi¬
nary cases of double vagina.

LIMEBICK DISTRICT LUNATIC ASYLUM.

The Limerick Town Council recently refused to pass
a presentment with regard to the maintenance of thi»

Thb Lancet,]

BELFAST.—THE SEWERS OF MONACO.

[March 12, 1887. 549

institution, on the ground that they were not properly
represented on the board of governors. Last week, however,
at the Limerick Spring Assizes, before Mr. Justice O’Brien,
an application was made for the amount required, and with¬
out hesitation his lordship dated the presentment.

Charles Hudson, F.R.C.S.I., died on the 3rd inst., at Glen-
ville, county Cork, aged eighty-five years.

Dublin, March 8th.

BELFAST.

(From our own Correspondent.)

THE ROYAL HOSPITAL.

From the report presented at the quarterly meeting on
March 1st, we gather that there have been during the past
three months 594 in- and 2652 out-patients. The financial
condition of the hospital is now very satisfactory. At the
close of the last quarterly report the debt due by the hospital
was £1542 3s. Through the kindness of friends, a number
of large contributions have been made, and the debt is now
wiped out. Further, a bequest amounting to £3015 12«. 6 d.
has also been received, and the sum of £3000 has been
invested on behalf of the hospital. There has been a slight
falling off in receipts, but an active and extensive canvass
for new and enlarged contributions is now being pro¬
secuted by a number of influential citizens of the town, and
by this means the Board hope that a much-needed and solid
addition to the permanent income of the hospital will be
realised. One of the most active and respected members of
the Board of Management made a strong appeal to those
present to associate the Queen’s Jubilee with the establish¬
ment of a consumption hospital in Belfast, where it is
said more than 700 persons die annually of phthisis. A
movement in this direction has already been made by Mr.
Foster Green, as announced in your issue of last week. In
addition, other friends have promised contributions suffi¬
cient to bring the amount up to £5000. it is hoped the
remaining sum will soon be forthcoming.

THB BELFAST HOSPITAL FOR SICK CHILDREN.

At a numerously attended meeting of the friends of this
institution the following resolution was unanimously
passed: “That the committee and friends of the Belfast
Hospital for Sick Children have for many years past felt the
necessity of having a convalescent home in connexion with
it, and they believe no more desirable object could be
selected to form a memorial of the Queen’s Jubilee.” Further,
the meeting pledged itself to endeavour to have a cottage
convalescent home founded this year, with the hope of its
future extension. The building of such a convalescent home
would render the Children’s Hospital complete in every respect.

BIRTH OF TRIPLETS.

The Royal Bounty (£3) has been forwarded to a poor
woman in Belfast, who was recently delivered of three
daughters, all of whom are living. On Saturday night last,
another poor woman in the Belfast Union Infirmary gave
birth to one boy and two girls, all of whom are alive.

BelfMt, March 8th.

THE SEWERS OF MONACO.

(Irom our Special Correspondent.)

In no part of the Riviera are greater cleanliness and order
maintained than at Monaco. The little Principality is a
small paradise by reason of its unequalled climate and beauty;
bat, so far as sanitation is concerned, and theoretically speak-
mg, it is not more advanced than the neighbouring French
bealth-resorts. Practically, there is a great improvement.
For instance, the French rule is that cesspools should not
overflow into sewers, that they should be ventilated on the
roof of the houses, and frequently emptied. These principles
ar ® strictly observed at Monaco, and very generally neglected
elsewhere, and notably at Nice. Again, the scavenging of
Monaco is done with such care that it would be difficult

all Europe to find a cleaner place. Unfortunately the
authorities are altogether behind the age in their knowledge
of sanitation. They have sought no better example than what
is done in Paris; and in this respect the French are notoriously
half a century behind the age. With regard to the theory of
sanitation, the authorities of Cannes are far ahead of the
Government of Monaco. They, at least, have studied the
progress realised in England, America, and Belgium. They
have consulted such eminent men as Mr. Douglas Gal ton and
Mr. Isaac Shone, and now actually propose to adopt the
Memphis or Warring system of drainage. At Monaco,
however, the authorities have scarcely got beyond the
precepts laid down by the French administration of the
Fonts et Chauss^es. As the Principality is quite inde¬
pendent of the control exercised throughout France
by this official and somewhat inert body, better things might
have been expected. Nevertheless, there is, especially on the
partof thePrinceof Monaco, an earnest desire to do all that can
in reason be accomplished to assure the material prosperity
of all who live within his domains. The Crown Prince,
it should also be noted, is especially fond of scientific studies,
and the experiments which he has recently and successfully
accomplished to test ocean currents have brought his name
prominently forward. Doubtless the Prince would also
appreciate the practical utility and the theoretic interest of
sanitary science if these questions could be brought more
prominently to his notice.

The desire to encourage sanitary improvements is suffi¬
ciently manifest. The large sums of money already spent
on such purposes, and the marvellous cleanliness maintained
throughout the Principality, supply ample proof of this
most commendable disposition. Unfortunately, there is an
absence of scientific thoroughness in the work done. Slight
epidemics of diphtheria, small-pox, and typhoid fever have
constantly afflicted the inhabitants of the Principality. At
last, in 1883, the recurrence of these illnesses assumed alarm¬
ing proportions. An epidemic of typhoid fever broke out in
the old town of Monaco. Out of the 1200 persons who live
on this picturesque and historic rock some 300 inhabitants
were stricken by the fever. Fortunately the disease mani¬
fested itself in a mild form, as there were only twenty
deaths. The epidemic was no sooner over than the authori¬
ties sought to improve the sanitary condition of the old
town, first by augmenting the water-supply, and secondly
by building sewers. This latter operatiqn presented ex¬
ceptional difficulties, for the town is built on solid, hard
rock. At one point, the square in front of the Palace, it
was necessary to hew down in the rock to a depth of six
yards, so as to obtain the necessary fall. Blasting powder
had to be employed, and the sewers consequently cost much
more than usual. They were built on the ordinary French
model. They are of the egg shape and measure some
70 centimetres by 50 centimetres, and other and larger
sewers measure 1‘40 metres by 80 centimetres, and 40 centi¬
metres at the lower part or invert. The minimum fall is
15 millimetres per metre; in some parts it is equal to
20 millimetres.

It is, however, obvious that the mere building of a sewer
does not solve the problem. The sewer may be admirably
constructed, but it may be too large or too small for the
amount of sewage that it is destined to receive. The fall
also may be too steep, as well as not steep enough. But in
France these considerations are rarely taken into account.
The idea that a sewer should be self-cleansing is so little
realised that the authorities always insist that a sewer
should be large enough to allow of a man to go down
and clean it. Now, at Monaco a very large sum of money
has been spent to build very fine sewers; but there is no
water to flush them, no provision made for their ventilation,
and no regulations issued to prevent the gases they gene¬
rate from entering the bouses. The closets are not drained
into these sewers. The difficulty, therefore, of dealing with
the closets and of removing the night soil still remains un¬
solved, and it was scarcely worth while incurring the expense
of building the sewers. But the kitchen water, washing
water, &c., do drain into the sewers; and therefore—a fact
which has been demonstrated over and over again, and will
be found recorded in every text-book—the sewers are just as
foul as if they did receive the contents of the closet. Indeed,
anyone who has had any practical experience of the diffi¬
culties of drainage will testify that it is the grease in the
kitchen water, the odours of the vegetable and fish water,
that create by far the most nuisance and the most trouble.

As at present managed, the new sewers at Monaco must

Digitized by GoOgle

553 Thb Lanoht,]

MEDICAL NOTES IN PARLIAMENT.—COLLEGE OP SURGEONS.

[Mabch 12,1887.

seriously endanger the health of the population. The
kitchen sinks, generally in a back room, but within the
houses, drain straight into the sewer. None of them are
trapped. They are simply so many sewer ventilators; and,
as the sewers are not flushed, and are not self-cleansing, it
may readily be imagined with what effect these pipes poison
the atmosphere within the houses. It is only necessary
to hold a wax taper to the oriflce to note how strong is the
draught that travels up and down. But to these criticisms
the objection may be raised that the health of Monaco
has improved. i)r. Colignon, in an eloquent and able
paper read at the sixth International Pharmaceutical and
Chemical Congress, estimated the death-rate for the five
years from 1874 to 1879 at one death per annum per 47'3
inhabitants; while during the following five years, from
1879 to 1884, the death-rate had decreased to one death per
49-9 inhabitants. But these data are not sufficiently recent to
throw much light on the subject; and the improvement on
the public health, such as it may be, is undoubtedly due to
the great increase and the purer quality of the water-
eupply, rather than to sewers which are certainly not yet
in working order. It would, however, be a matter of no
great difficulty to improve and complete these sewers, so
that, instead of being a source of mischief, they would help
to preserve the public health. No act of legislature, no in¬
creased powers,are necessary to send an inspector round to all
the houses, and insist on the application of a syphon trap to
every pipe communicating with the sewer. Even if these
traps were inserted at the expense of the State, and not of
the individual householders or tenants, the outlay would be
very trivial as compared with the cost already incurred in
building the sewers. While this is being done, the water of
the fountains, now wastefully allowed to flow into the sea
by surface gutters, should be utilised to fill automatic flush
tanks, which every hour or so would discharge several cubic
metres of water into the sewers. With the assistance of
automatic flushing tanks there is water enough at hand to
sweep the sewers and maintain a fair degree of cleanliness.
Finally, it will be necessary to find some effective means of
relieving the pressure of air in the sewers, and when this has
been done there will remain no reason why the closets should
not also drain into them. The outfall is in the deep water
of the sea at the extremity of the rock. Some objection
may be raised to draining into the sea; but this is what is
actually done, only in an extremely cl-umsy and dangerous
'manner. The contents of the cesspool and of the pails are
at the present moment conveyed by hand or in carts to
the sea and emptied into it. There is no sewage farm
and no sewage works. Why not, therefore, drain at once
into the sea, instead of allowing highly dangerous organic
matter to accumulate, decompose, and ferment in tubs, pails,
and cesspools, built or kept under and within human
habitations ?

By following these simple and inexpensive suggestions,
the very considerable work done in the old town of Monaco
will not have been undertaken in vain. The Principality
will then have the honour of setting an excellent example
to the whole Riviera, and the Monegasque population will
surely enjoy the advantage of a marked amelioration in
health and freedom from zymotic disease.

Monaco.

*** The above letter has been in our hands for some
weeks, and kept out of our columns by the claims of other
more pressing matter. It therefore deals with the state of
things existing before the recent telluric convulsions which
have more or less included Monaco in its devastating effects.
—Ed. L.

MEDICAL NOTES IN PARLIAMENT.

The Lunacy Laws Consolidation Bill.

In the House of Commons on the 3rd inst. Mr. 8alt asked
the First Lord of the Treasury whether it was proposed to
incorporate the Idiots Act, 1886, in the Lunacy Laws Con*
solidation Bill of the present session. Mr. W. H. Smith
replied that the subject had been brought under the atten¬
tion of the Lord Chancellor by the Lunacy Commissioners,
and the matter is now under consideration. It would,
however, be premature to arrive at any conclusion on the
subject before the Amendment Bill <on which the Consolida*
tion depends) has made farther progress, and the question

is, Mr. Smith remarked, the more important because the
legislation with reference to idiots was deliberately severed,
from the Bills relating to lunatios in the last Parliament.

The Vaccination Acts.

On the 4th inst., in reply to Sir C. Ru9sell, Mr. Ritchie
stated that the reason he had given for refusing the appoint¬
ment of a Royal Commission of Inquiry into the vaccination
question was that the Government already possessed
accurate information upon the subject, and that if they
consented to the appointment of a commission of inquiry,
they did not believe that it would have the least effect in
removing the objection of those who at present resisted the
law, while, on the other hand, it might have the effect of
implying doubts on the part of the Government which the
Government did not feel in the slightest degree.

On the 8th inst., in answer to Mr. Picton, Mr. Matthews
briefly reviewed the case of a man named Bamford who was
convicted last month of non-compliance with the Vaccina¬
tion Acts, and stated that he did not see liis way to modify
the prison treatment of a person who has disobeyed the law-
on the ground that such disobedience proceeded from con¬
scientious motives, the bona fides of which it would be diffi¬
cult to ascertain.

Tost Office Medical Officers.

On the 4th inst, in reply to Mr. Pickersgill, Mr. Raikes
stated that the practice in appointing medical officers
attached to post offices has been, as he understood, to
submit to the Postmaster-General the names of several
medical gentlemen recommended by the local officers, and
one of these gentlemen has usually been formally recom¬
mended by the Secretary. But the Postmaster-General has
always exercised his own judgment in making the appoint¬
ment. There was no ground for suggesting that the Secre¬
tary’s recommendation had been slighted in any case where
he had made an appointment upon other local information.

Rivers Pollution Prevention Act (1S7G) Amendment Bill.

On the motion of Mr. Thorbum, leave was given to bring
in a Bill to amend the Rivers Pollution Act (1876), and the
Bill was subsequently brought in and read a first time.

Accommodation for Prisoners awaiting Trial.

On the 7th inst. Sir John Kennaway gave notice that on
Monday next he will ask the Secretary of State for the
Home Department what steps the Government intend to
take to deal with the evils shown to exist by the report of
the Committee on the accommodation of Court-houses and
other places for prisoners awaiting trial at assizes amd
sessions.

The Lunacy Laws.

On Thursday in the House of Lords the report of amend¬
ments on the Lunacy Laws was received and considered.
The Lord Chancellor said his amendment of Sub-section 11
sought to give an alleged lunatic the right to be examined
by the County Court judge or magistrate before an order for
his removal to an asylum is made. Lord Herschell pointed
out that there might be a difficulty in respect of the ability
of the judge or magistrate to examine the person within the
time specified by the Bill.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At an ordinary meeting of the Council held on Thursday
last, Mr. II. G. Howse was admitted a member of the Court
of Examiners. A report from the Committee on the forms
of the College diplomas was approved and adopted, and
these will be issued directly by the Council instead of by
the Court of Examiners as formerly.

It was agreed, in the report of the President and Vice-
Presidents, “That the offer of Mr. J. T. Morton for the
institution of a Lectureship on Cancer and Cancerous
Diseases, for the period of three years, as an experiment, be
accepted; and that there should be one lecture on the subject
delivered in each year.”

The subject of the form of the new Charter having been
mentioned to the Council, and the difficulties in giving
effect to the resolution of the Council, admitting Members ot
fifteen years’ standing to the fellowship without examina¬
tion in anatomy and physiology, having been pointed out to
them, the Council rescinded their resolution.

It was agreed to accept the recommendation of the

tized by CjOO^Ic

Thb Lancet,]

OBITUARY.—MEDICAL NEWS.

[March 12,1887. 551

delegates as to the beet mode of celebrating the Queen’s
Jubilee, and to place a statue of Her Majesty in the new
Examination Hall.

A letter was read from the Conjoined Associations of
Fellows and Members declining to meet the delegates of the
Council on the terms required by that body.

A communication was received from the Association of
General Practitioners requesting a conference with the
Council, and it was agreed that the President aud Vice-
Presidents should receive a deputation from the Association,
the latter to define the subject of the proposed discussion.
A communication was also received from Sir F. Abel asking
the Council to bring the proposed Imperial Institute under
the notice of the Fellows and Members of the College.

A report from Mr. Marshall on the proceedings of the
General Medical Council was read.

A letter from the President of the Medical Council was
read, asking the Council of the College to reconsider their
determination regarding the non-admission of the Apothe¬
caries’ Society to the conjoint examinations. This was
postponed to an extraordinary -meeting of the Council to be
held on the 24th of this month.

A memorial wa6 read from teachers of surgery in London,
and referred to the Committee on the Extension of the
College Premises.

A communication from University College, Bristol, asking
that the degrees of the Royal College of Physicians and the
Royal College of Surgeons should not be reserved for
students who have pursued their clinical studies in London
only, was referred to the committee of delegates of the two
Colleges. _

(Dbituanr.

NICOLA GASPARRI.

Frw situations in modem warfare have evoked greater
heroism than the stand made by the Italian column under
Col. di Criatofori8 against the thousands of Abyasinians who
hemmed them in .at Dogali. When man by man the
European force of five hundred had fallen till only twelve,
including the brave colonel himself, remained to continue,
in spite of wounds, theunequal combat, Di Cristoforis ordered
the eleven to present arms to their fallen comrades. He
was obeyed, but in a few nflnutes thereafter he was struck
down, and the others with him. Just before this fine act
of disciplined heroism, there had fallen Dr. Nicola Gasparri,
fighting like the rest, though he was the surgeon attached
to the column. He was but in his thirty-third year, and
had already given proof of high professional ability. He
was born in Rome, though his family were from the
Marches—on the father’s side natives of Urbisaglia. Left an
orphan before his teens, he was educated by two maternal
uncles, one of whom. Prof. Cozzi of the U niversity of Urbino
and mayor of that town, adopted him as his son. At the Uni¬
versity of Macerata his studies were prosecuted under the
happiest auspices; and when he left it a graduate in Medicine
and Surgery in 1876, he carried with him the admiration and
affection of all his fellow-students. In compliance with his
earnest wish he became an army medical officer, and by the
time he had reached his thirty-third year he had risen to be
medical captain attached to the 15th Regiment of Infantry.
A pleasant episode in his career was the journey he made
through India with the distinguished physician Dr. Paul
Mantegazza, after which very active service awaited him.
He was at his own request transferred to Massowah, and a
few days before the fatal march on Dogali he'had written
to his uncle. Prof. Cozzi, at Urbino, in the gayest mood, asking
how he thought the carnival was to go off, telling him of the
advance of the Abyssinian chief, Rob Alula, and adding, “ we
hope in carnival week to pepper Ras Alula with the
coriandoli [comfits] of our Wetterly rifles.” This letter was
dated January 21st, and on the 26th occurred the terrible
encounter in which its writer met a hero’s death. It is
believed that Dr. Gasparri, on hearing of Col. di Cristoforis’s
contemplated march to relieve the garrison at Saati, asked,
and obtained leave, to join the column.

A nkw semi-convalescent home in connexion with

th* Leeds Infirmary is. about to be erected at Cookridge, at
a cost of about £5000. .

HtcMral ftefos.

Royal College of Surgeons of England. —The
following gentlemen, having passed the necessary examinar
tions, were admitted Licentiates in Dental Surgery at a
meeting of the Board of Examiners on Feb. 24th

Buckley, Charlea Herbert. Shaw-road, Oldham.

CUffoid, Isidore. Grosvenor-atreet.

OuDDingham, George, KingVpirada, Cambridge.

Dalby, Alfred Burkett, Hoduey-street, Liverpool.

McAlplu, Kenneth Wade. Tregunter-road. South Kensington.

Thomson, Archibald Frederick Charles, Gnllford-street, Sussell-
square.

Harris, Percy Beeves Truer, M.E.G.S., Chapol-street, Penzance,,
Cornwall.

Professor Charles Stewart, M.R.C.S., commenced on
Wednesday, the 9th inet., a course of nine lectures on “ The
Auditory Organs of the Vertebrate,” and on “ Some Recent
Additions to the Museum,” which will be continued on
Fridays, Mondays, and Wednesdays, March 11th, 14th, 16th,
18th, 21st, 23rd, 25th, and 28th. The lectures will be
delivered in the theatre of the College at 4 o’clock each day.

Society of Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on March 3rd

Bullock, Roger. M.R.C.8., Bast Gate. Warwick.

Deaoon, George Bdward, M.R.C.S., Hetheraett, Norfolk.

Fischer, William Featon, M.R.C.S., Bembridge, I*lo of Wight.

Go wan, Bowie Campbell, Gloueester-road, South Keusiugton.

Hubbard, Walter Lovett, The Grove. Clapham-road.

Williams, William, Bsgair Gawr, Dolgelly, Wales.

Vaccination Grant. — Mr. John Hamilton, of
Swadlincote, has received, for the fifth time, a Government
gratuity for efficient vaccination in the Church Greeley
district of the Burton-on-Trent Union.

On the 4th inst. a public meeting in aid of the
funds of the East) London Hospital for Children and Dispen¬
sary for Women, at Shadwell, was held at the Mausion
House, under the presidency of the Lord Mayor.

At the annual meeting of the directors of and
subscribers to the Paisley Infirmary, on the 1st inst., an
unsatisfactory financial report was presented, the debt
having increased during the year from .£161 to £693.

Westminster Hospital. —Shortly after Easter two
performances will be given at the Novelty Theatre in aid of
the fund whioh is now being raised for the endowment of
a children’s ward in this institution.

At the annual meeting of the subscribers to the
Monmouth Hospital and Dispensary on the 1st inst., a
highly satisfactory financial report for the past year was
presented and adopted.

Four Children at a Birth. — A woman named
Corrigan, living in the County Leitrim, was last week
delivered of four children, three girls and a boy. All the
children are doing well.

Zymotic Disease at Goole. —In consequence of
the extensive prevalence in Goole of measles and scarlet
fever, the School Board have decided to close their schools
for a fortnight.

The Royal Albert Hospital at Devon port being
greatly in need of support, arrangements are being made for
a grand amateur theatrical performance to be given in
Devonport Theatre on Easter Tuesday.

Hospital Saturday Fund. —At a meeting of the
delegates of this fund on the 5th inst. it was resolved that
the ladies’ street collection for the present year take place
on June 11th, instead of on June 25th, as previously
arranged.

Association of Public Sanitary Inspectors.—
At the annual meeting of the members of this Association
on the 5th inst., Mr. J. A Davenport read a paper on
“ Rural Sanitation." A discussion, in which several members
took part, followed.

Warnkford Hospital, Leamington. —The fifty-
fourth annual meeting of the governors of this institution
was held on the 2nd inst. During the past year there have
been 1135 in-patients and 5614 out-patients treated. The
financial report was fairly satisfactory.

Digitized by VJ

oogle

552 Thb Lancet,]

EXAMINATION FOR HER MAJESTY’S MEDICAL SERVICES.

[March 12,1887.

Bequests.—T he late Captain Hamlet Geary, of
Dublin, has bequeathed -£500 to Jervis-street Hospital, £500
to Mercer’s Hospital, £500 to the Meath Hospital, £400 to
the Deaf and Dumb Institution, Claremont, and £200 to
the Hospital for Incurables.—Mrs. Elizabeth Hughes has left
£997 2 a. 5d. to the Convalescent Home, Stillorgan.

Aberdeen Sick Children’s Hospital. — The
annual meeting of the subscribers to this institution was
held on the 2nd inst. when it was reported that the number
of in-patients treated during 1886 was 355 as against 180
in the previous year, and of out-patients 988. The income
amounted to £935, and the expenditure to £1113. A con¬
siderable sum has also yet to be raised to meet the expense
attending the recent extension of the hospital building.

National Health Society.—O n March 1st, at the
Paddington Baths, Queen’s-road, Bayswater, the Society’s
certificates were presented by Lady Randolph Churchill to
the successful candidates in connexion with the popular
Health and Ambulance Lectures recently delivered under the
auspices of the Society by Dr. A. T. Schofield. The chair
was taken by Dr. Langdon Down, who remarked that the
results of the examination reflected the greatest credit upon
Dr. Schofield, the lecturer, as well as upon the candidates
themselves.

The Librarian of Sr. Thomas’s Hospital.—
Many of our readers will learn with regret that Mr. E. H.
Denison, who has occupied the position of librarian to
St. Thomas’s Hospital for the last twenty-five years, has re¬
signed his post. Several of his numerous friends have ex¬
pressed a wish to give him a testimonial as an indication of
the esteem in which he is held, and the first appeal has been
most successful. Subscriptions not exceeding a guinea may
be sent to any of the treasurers, Messrs. W. Anderson,
G. H. Makins, and J. E. Nichol.

EXAMINATION OF CANDIDATES FOR HER MAJESTY’S
ARMY, INDIAN, AND NAVAL MEDICAL SERVICES.

natural sciences.

Tuesday, February 15th, 1897.

Zoology.— 1. What are the more important modifications presented by
the respiratory organs in the adult amphibia ? Give one or more examples
of each. 2. In what group of the cephelopoda Is the Ink sac absent ?
Mention some of the characters which are here specially associated with
the absence of an ink sac. 3. Refer to its proper class and order an animal
with the following characters, and give one or more examples -.—Animal
radially symmetrical, with multicellular composition; (esophagus dif¬
ferentiated from the general body cavity, but freely opening Into it, and
united to the walls of the cavity by radiating mesenteric folds.

Botany. —i. What is the most important difference, as regards
anatomical structure, between a moss and a fern ? 5. Select any
flowering plant you please, and give an accurate description of its pistil.
6. Refer to its natural order a plant with the following characters, and
give one or more examples -.—Leaves alternate, without stipules. Calyx
formed of two sepals which are caducous. Corolla with four petals.
Stamens numerous, inserted on the receptacle. Fruit, a single-celled
capsule with parietal placentae. Seeds numerous, with oily albumen.

Physics.— 7. An electric current is made to pass through a copper wire
above and parallel to the length of a horizontally suspended magnetic
needle. What is the effect of the current on the needle? 8. What
temperatures on the Centigrade scale correspond to 33°, 140°, and 210°
Fah.? 9. What is meant by a river delta ? Mention the principal river
deltas of the world.

MEDICINE.

Tuesday, February 15th, 1887. ,

1. A case [given] for analysis and commentary. 2. Name the round
worms that have been found in man and their habitat in the human body
Explain the mode of development of those you name, and how they And
access to the part* of the body in which they are found. 3. Describe the
symptoms, course, and differential diagnosis of enteric fever. 4. How
would you treat a case of ftecal accumulation In a child, and how is the
accumulation to be distinguished from tubercular mesenteric glands?
6. Name the officinal drugs used as emetics. Explain their actions, their
uses, and the peculiarities in the action of each.

SURGERY.

Monday, February, lUth, 1887.

1. Describe the process of union of bone in a simple and nlso in a
oompound fracture, the conditions under which union may be retarded,
and the treatment to be adopted under the latter clrcumstanoes. 2. What
are the various pathological ohanges observed In oases of enlarged
thyroid gland ? Describe the treatment to be pursued in each condition.
3. What symptoms would indicate the existence of absoess of the antrum ?
What are its chief causes, smd what treatment is beat for it* relief ? 4. What
are the distinctive characters of a hard and of a soft chancre? How
should either be treated locally and constitutionally ? What are the
sequelte which usually follow infstfclon ? 6. Describe the conditions
known as carbuncle. Under what oobstttuUonal state does it most
frequently occur, and what should be the treatment ? 6. A patient is

the subject of empyema, the result of acute pleurisy, and immediate
relief is requisite. Describe the means by which this may be afforded,
and the changes which must occur to ensure the subsequent obliteration
of the cavity. Should this obliteration not be effected naturally, what
measures should be adopted to produce it ?

CHEMISTRY.

Tuesday, February 15th, 1837.

1. What are the more important properties of hydrogen? How xrtay
hydrogen be prepu-ed? 2. writedown as an equation the decompositions
and new combinations which occur in the process of obtaining ammonia
gas by beating ammonia hydrochlorate with quicklime. 3. What ar«
the chief sou roes of the presence of carbonio acid in the atmosphere ?

ANATOMY AND PHYSIOLOGY.

Monday, February lkth, 1887.

1. Describe the astragalus: give an account of its articulations, con¬
nexions . and parts of importance which are in proximity to it. 2. Describe
the origin, course, distribution, and anatomical relations of the genito-
crural nerve. 3. Describe the diaphragm, giving an account of its struc¬
ture, origin, and insertion, the parts of importance which pass through
or are related to it, and the functions which it performs. 4. Describe
the thoracic duct, giving an account of Its origin, anatomical relations,
and structure ; alto describe the composition, properties, and purposes
in the animal economy of its contents. 5, Describe the origin, course,
and distribution of the facial arte'ry, giving also a brief account of the
dissection by which you would expose the vessel and its branches.

BOOKS ETC. RECEIVED.

Bs.iu.iiRE KT Fits. Paris.

Tralte Elomentaire de Pathologic Generate. Par Prof. H-
Hallopeau. DeuxiOme Edition, pp, 836, avec lift figures.

Batsfohd, B. T„ High Holborn, London.

The Plumber and Sanitary Houses. By S. Steven* Hellyen.
Fourth Edition, pp. 429, with Illustrations.

Bell, G., A Sons, York-street, Covent-garden.

Rest and Pain. A course of Lectures on the Influence of
Mechanical and Physiological Rest iu the Treatment of
Accidents and Surgical Diseases, and the Diagnostic Value
of Pain. By the late John Hilton, F.R.S- Edited by W. H. A.
Jacobson, il.B.Oxon., F.R.C.S. Fourth Edition, pp. 514.

Churchill, J. A A„ New Burlington-street, London.

The Organic Materia Medica of the British Pharmacopoeia. By
W. Southall, P.L.S. Fourth Edition, pp. 247.

A Practical Treatise on the Cure of Pulmonary Consumption. By
Jas. Weaver, M.D., L.R.O.P. pp. 91.

Short Contributions to Aural Surgery, By Sir W. B. Dalby,
F.R.C.S., M.B.Cantab, pp. 78.

Elementary Practical Biology (Vegetable). By Thoi. W. Shore.
M.D., B.Sc.Lond. pp. 173.

Clinical Studies of Disease in Children. By Eustace Smith, M.IX
Second Edition, pp. 313.

Clarendon Press, Oxford. L

Alphlta: a Medico-Botanical Glossary from the Bodleian MS-,
Selden, B. 35. Edited by J. L. G. Mowat, M.A. pp. 243.

Dornan, W. J., Philadelphia.

Transactions of the Association of American Physicians. First
Session, pp. 261, Illustrated.

Jarrold & Sons, Norwich.

Norwich and Eastern Counties Almanack anil Clerical Directory
for 1887.

Jones, J., New Orleans, La.. U.S.A.

Medical and Surgical Memoirs. 1855-86. By Joseph Jones, M.D.,
Professor of Chemistry and Clinical Medicine, University of
Louisiana, pp. 1348, with Illustrations.

London Stereoscopic A Photographic Company, Regent-street,
London.

The A B C of Photography, pp. 149.

Longmans, Green, A Co., Paternoster-row, London.

Hip Disease in Childhood, with special reference to its Treatment
by Excision. By G. A. Wright, M.B.Oxon., F.R.O.S.Bng. pp.
246, with 48 Original Woodcuts.

Masson, G., Paris.

La N^vrose. Par le Dr. M. Leven. pp. 336.

Mathieson A Son, Bank, London.

Mathieson’s Vade-Mecum for Investors. Fourth issue, pp.

588.

Pentland, Young J., Edinburgh.

The Diseases of the Bar, and their Treatment. By Arthur Hart¬
mann, M.D.Berlin. Translated from the Third German
Edition by Jas. Erskine, M.A., M.B. pp. 283, wltn 42 Illustra¬
tions.

Atlas of Venereal Diseases. By P. H. Maolaren, M.D., F.B.C.S.E.
Thirty Plates, Coloured, with Descriptive Letter-press.

Pickard A Curry, Great Portland-etreet. London.

Vision and Vision-testing, with Practical Tests. By A. St. Clair-
Buxton, P.R.C.8. pp. 83, Illustrated.

Sampson Low, Marston, Searle, A RiyingtoN, Fleet-street. London.

Variations of Fortune, Illustrated by some of the Old Towns
of Italy and thoss who Influeuced them. pp. 185, Illus¬
trated.

Filooereus KJenUls. and other Papers. By Waiter Moxon, M.D,
P.R.C.P. pp. 262.

Digitized by CjOO^Ic

Thu Lanckt,] APPOINTMENTS.—VACANCIES.—BIRTHS, MARRIAGES. AND DEATHS. [March 12,1887. 5 53

8aty, F., Paris.

Lemons but le* Autointoxications dans lea Ualadles. Par Prof.
Ch. Bouchard. Recuellllea et publidea par le Dr. P. le Gendre.
pp. 348.

Spottlswoodb A Co., Graoechuroh-street; Brrixam Wilson, Royal
Exchange.

Burdett'a Official Intelligence for 1887. By Henry C. Burdett,
pp. 1183.

Wright, J., A Co., Briatol; Hamilton, Adams, A Co., London.

The Medical Annual for 1887. pp. 550.

An Experimental Study of Mvootlo or Malignant Uloerative Endo¬
carditis ; by T. M. Prudden, M.D. (New York).—Note# on the Physical
Diagnosis of Lung Disease; by J. M. Finny, M.D. (H. K. Lewis).—
On Hospital and Medloal Reform in Dublin; by J. P. Doyle, L.R.C.S.I.,
Ac.—Andermatt alsWinter-Kurort; Bine Klimatologische-medicinlsche
.Skixze yon Dr. Martin Neukomm (Zurich, Orell Fussli A Co).—
Hedlcal Galvanism ; by Herbert Tibbtts, M.D. (Churchills).—Index
Medlous. Vol. IX., No. 1.—Animal Food in Health and Disease : being
a Reply to Sir H. Thompson and others; by John Beckett, M.D. It.—
Immodesty in Art; by P. G. Lee, D.D., F.S.A.—The Liberal and
Radical Year-book for 1887.—On Intra-pulmonary Injections; by
Arthur Ran some. M.A., M.D.—Jahrbucher fiir Natlonalbkonomie and
Statistlk ; gegriindet von Bruno Hildebrand, herausgegeben von Dr. J.
■Conrad, Band le. Heft 3.—Lltholapaxy In Male Children and Male
AdnlU; by Surg.-Major D. F. Keegan, M.D.Dub. (Churchills).—The
Boyal London Ophthalmic Hospital Reports, Vol. IX., part 3.—
Farthing Dinners; by G. H. Sargent; Second Edition (Simpkln,
Marshall and Co.) 2d.- Report on Diseases of the Rectum; by J. M.
Mathews, M.D. (Louisville). — The Apache-Yu mas and Apache-
Alojaves; by W. H. Corbusier, M.D.— Die Gesundheitspflege in der
Mittelschule; von Dr. Leo Burgerstein (Holder, Wein).—Rule In
Ireland from St. Patrick to Cromwell; by T. Wharton Jones, F.R.S 6«f.
"Bulletin de la Society des MSdecIns et Naturallstes de Jassy.—
Magazines for March : Good Words; Sunday Magazine; Leisure Hour;
Sunday at Home; Boys'Own Paper; Girls’ Own Paper.—Practical
Hints on House-Drainage for House-owners and others; by a Clerk of
Works; Second Bdition. 1*. (Scientific Publishing Company.)

^pointments.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The Laxcbt Office, directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. _

Blumxr, F. Milnes. A.B., M.B., has been appointed llonoraiy Physician
to the Staffordshire General Inflrmary, Stafford, vice C. H. Crawford,
M.D.. resigned.

Bradbury, Arnold F., M.B., B.S., has been appointed District Surgeon
to the Salford and Pendleton Royal Hospital and Dispensary,
vice J. B. Pilkington. appointed House-Surgeon.

Bunclk, Alexander, M.P., C.M.Bd., has been re-elected Medical Officer
of Health lor Pontefract.

Dingle, Wili.lam Alfred. L.R.C.P.Lond., M.R.C.S., L.8.A., has been
appointed Surgeon to the Royal Maternity Charity.

Elliott, Charles N., M.B., M.Ch..T.C.D., has been appointed Medical
Offioer for the Oundle District of the Oundle Union.

Fenwick, Charles, L.R.C.S., L.R.O.P. Bd., has been appointed
Medical Offioer for the Dunsford District of the St. Thomas's
Union.

Grimr, Thomas J.. M.B., C.M.Glas., has been appointed Medical
Officer for the Higher District of the Aysgarth Union.

Gulland, G. Lovell, M.A.. B.Sc.. M.B., C.M., has been elected
Resident Physician to the Royal Edinburgh Hospital for Sick
Children.

Hkyoatk, William H., M.R.C.S., L.S.A.. has been appointed Medical
Officer for the Cosham DIstHct of theFareham Union.

Holthouse, Edwin H., M.A., MJ1. Cantab., F.R.C.S., has been
appointed Assistant Surgeon to the Western Ophthalmic
Hospital.

Johnston. George, M.B., C.M., has been appointed Medical Offioer for
the Fifth District of the Drayton Union,

Lewis, Percy G., M.H.C.S., L.S.A., late House-Physician to King’s
College Hospital, has been appointed Junior Houee-Physioian
to the Royal Hospital for Diseases of the Chest, City-road, H.C.

Masters, Alfred Thomas, L.S.A., has been appointed Medical Offioer
to the Ancient Order of Foresters’ Club of the Rotherfield Districts,
and to the Tradesmen’s Club of the Rotherfield Districts, vice
Matthew Mackintosh, M.R.U S.,deceased.

©wens, B. M., M.R.O.8., L.R.O.P.Bd., Honorary Ophthalmic Burgeon
to the Children’s Hospital. Brisbane, Queensland, has been
appointed Honorary Consulting Ophthalmio Surgeon to the
Toowoomba Hospital, Queensland; also Honorary Consulting
Ophthalmic Surgeon to the Ipswich Hospital, Queensland.

Pilkington, John Bdgar, M.B.C.8., has been appointed House-
Surgeon to the Salford and Pendleton Boyal Hospital and
Dispensary, vice Fred. Hyde Folket, M.R.C.S., resigned.

8kmoh, Felix, M.D. Berlin, F.R.C.P.Lond., has been appointed
Laryngologist to the National Hospital for the Paralysed and
Bplleptlc. Queen-square. Bloomsbury.

8tadder, Walter J., M.R.C.8., L.R.O.P., has been appointed
Assistant Surgeon to the Leeds Workhouse Infirmary, vice Hawk-
yard, resigned.

Steele, Blmes Y., L.R.C.S., L.R.OP.Bd., has been appointed
Medical Officer for the Abergavenny District of the Abergavenny
Union.

Taylor. James. M.A., M.B., O.M.. baa been elected Resident Physician
to the Boyal Edinburgh Hospital for Sick Children.

iatantits.

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of the various
Vacancies which art announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. _

Bedford Central Provident Dispensary.—M edical Officer.

Bethlem Hospital. — Two Resident Medical Students who have
recently obtained their diplomas to practise medicine and surgery.
Apartments, rations, and attendance.

Cheltenham General Hospital.—H ouse-Surgeon. Salary £30 per
annum, with board and apartments.

Children's Hospital and Dispensary, Manchester.—Medical Officer.
Salary £180 per annum.

City of London Hospital for Dukases of the Chest, Victoria-park,
B.—Pathologist.

Debuyshihb General Infirmary, Derby. — House-Surgeon. Salary
£100 for the first year, increasing £10 a year up to £15*, with apart¬
ments, board, and wishing.—Resident Assistant House-Surgeon.
Board and washing. No salary, but a bonus of £10 is given.

Basing wold Union. — District Medical Officer. Salary £28 per
annum, exclusive of the authorised fees for surgical and midwifery
cases.

Fuhbrton AsrLUM, Salisbury.—Assistant Medloal Officer. Salary
£100 per annum with board, lodging, and washing.

General Hospital, Birmingham.—Resident Surgical Offioer. SAlary
£130 per annum, with residence, board, and waahing.

Hastings. St. Leonards, and Bast Sussex Hospital. — House-
Surgeon. Salary £70 per annum, with board, lodging, and laundry
expenses.

Male Lock Hospital, Dean-street. Soho.—House-Surgeon. Salary £50
per annum, with board and lodging.

Owens College, Manchester.—Senior Demonstrator in Physiology.
Stipend £150 per annum.—Junior Demonstrator in Physiology.
Stipend £100 perannum.

Parish of Putney. — Medical Officer of Health. Salary £75 per
annum, rising (subject to the order of the Board of Works for the
Wandsworth District) by annual increments of £5 each to a maxi mum
of £100 per annum.

Royal Free Hospital. Gray's-inn-road. — Junior Resident Medical
Officer. Board and residence are provided in the hospital.

Royal Portsmouth, Portsea, and Gosport Hospital.—A ssistant
House-Surgeon. Salary, with board and residence, £80 perannum.

Stockport Infirmary.—A ssistant House-Surgeon. Salary £70.

York County Hospital.—A ssistant House-Surgeon.

Zenana Medical College, St. Geor^e's-road, S.W. — Midwifery
Students. Terms 25 guineas for three months, including board,
residence, and instruction.

$ir%, Carriages, anil Deaths.

BIRTHS.

Dblmegr.—O n the 4th inst., at Cavendish-road, 8outhsea, the wife
of Staff-Surgeon A. G. Delmege, R.N., Royal Yacht Osborne, of a
son.

Gray.—O n the 2nd Inst., at Holtworthy, North Devon, the wife of
Walter Gray. M.R.C.S., of a son.

Hill.—O n the 7th Inst., at Wimpjie street, the wife of Berkeley Hill.
M.B., F.B.C.S., of a son.

Stark.—O n the 37th nit., at Bucl et House, Wantage, the wife of
M. Dugald Stark. M.D., C.M., of a son.

Street.—O n the 17tb ult., at Natik. Bombay Presidency, the wife of
A. W. F. Street, M.R.C.S , L.R.C.P.LoDd., I.M.D., 2nd Bombay
Lancers, of a son.

Whistler.— On the 28th ult., the wife of the Rev. C. W. Whistler.
M.B.G.S., Chaplain of the Fishermen’s Church, Hastings, of a
daughter. _

MARRIAGES.

Davies—McLarkx.—O n the 22nd ult., at Dunedin, New Zealand.
J. M. Lloyd Davies, M.R.C.S., L.R.O.P.Bd., to Maude, third
daughter of Robert McLaren, Bsq., of Dunedin.

Gross—Keizer.—O n the 8th Inst., at the St. John's-wood Synagogue,
Abbey-road, N.W., Asher Gross, L.R.O.P , M.R.C.8., to Julia, only
daughter of the Rev. Moses Keizer, of Brondesbury-road, KJlbum,

Mormon—Herne.—O n the 3rd Inst., at Upton Church, Cheshire, by
the Rev. W. Sparling, Basil Gordon Morison, M.B.. C.M.Edtn., of
Canonbury, London, son of the late Surgeon A. C. Morison,
H.B.I.C.S.. to Agnea Caroline, eldest daughter or Lieut.-Col. Heme,
late 103rd Regiment. _

DEATHS.

Francis. — On the 6th Inst., at Brighton, D. J. T. Francis, M.D.,
F.R.C.P.Lond., aged 67.

Greek.—O n the 3rd Inst., at his residence, Thornton Lodge, North¬
allerton, Yorkshire, Arthur Jackson Greer, Deputy Surgeon-
General, H.P., late of the 21st Fusiliers and 17th Lancers, aged
56.

Miller.—O n the 2nd Inst., at Rosendale Hall, West Dulwich, William
Miller, M.R.C.S., aged 79.

Scott.—O n the 7th Inst., at Camden-aquare, N.W., suddenly, David
Soott, M.D., aged 60.

8tr£e.—O n the 9th nit., at Northallerton, Florence Mary, wife of
Anton Hugh 8yr6e, M.R.C.S., L.S.A., aged 28.

N.B .—A fee of St. it charged for the Insertion of Notices of Births,
Marriages, and Deaths.

Digitized by ^.ooQle

554 The Lancet,]

NOTES, COMMENTS* AND ANSWERS TO CORRESPONDENTS.

[March 12,1867t

Utoital giant for tljo oitsning Mtek.

Monday, March 14.

Botal London Ophthalmic Hospital, Moorfiklds. — Operation!,

10.30 a.m., and each day at the same hour.

Kotal Westminster Ophthalmic Hospital.—O perations, 1.30 p.m.,
Chelsea Hospital for Women.—O perations, 2.30 p.m; Thursday,2.30.
and each day at the same hour.

St. Mark's Hospital.— Operations. 2 p.m. ; Tuesday, 2.30 p.m.
Hospital for Women. Sono-squARE. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Hoyal Orthopedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 3 p.m., and
each day in the week at the same hour.

Medical Society on London.— 8.30 p.m. Mr. B. H. Fenwick: On
Ureteral Clottage.—Mr. Bruce Clarke: On certain Conditions of the
Bladder that simulate Stone in Children.

Tuesday, March 15.

Grnr's Hospital.—O perations, 1.30 p.m. and on Friday at the same hour.

Ophthalmic Operations cn Monday at 1.30 and Thursday at 2 p.m.
8t. Thomas’s Hospital.— Ophthalmic Operations, 4 p.m.; Friday,2 p.m.
Cancer Hospital. Bbompton.— Operations,2.30 p.m.; Saturday, 2.80 p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital.—O perations. 2.30 p.m.

8t. Mary's Hospital.— Operations, 1.30 p.m. Consultations. Monday,

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.m.
Royal Institution.—3 p.m. Prof. Gomgeei Function of Beapiration.
Boyal College of Physicians of London.-6 p.m. Dr. Broadbenb :

The Pulse tCroonian Lecture).

Society of Arts.— 8 p.m. Mr. Alfred Phillips: The Application of
Gems to the Art of the Goldsmith.

Pathological Society ok London.— 8'30 p.m. Mr. Doran : Fibroma
of Ovarian Ligament. — Mr. Fenwick: Metastatic Carcinoma of
Prostate. — Mr. Ciutton : Large Dermoid Cyst over Sternum. —
Mr. live : Cystic Disease of Testicle.—Dr. Pre-Smith : Gall-stone
which caused Obstruction of the Bowel.—Mr. Bowlby: Multilocular
Oystio Epithelioma of Jaw.—Dr. 8iicock: Cystic Epithelioma of
^ e ®k. — Mr. Hutchinson, jnn. : Alveolar Ulceration In a Child,
General Tuborculosis. Card SpecimensMr. Godlee: Malignant
Disease of an Undescended Testis, with Secondary Growths.—
Mr. Stonham : Pelvis of a Child with a Persistent Fictal Condition
of Peritoneum. —Mr. F. W. Clark: Subplenral Lipoma of Dia¬
phragm. — Dr. A. H. Robinson : • Drawings of Charcot’s Joint
Disease.—Dr. Ormerod: Subdural Hscmatoma.

Wednesday, March 16.

National Obthop.edic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew’s Hospital —Operations, 1.30 p.m.; Saturday, same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgical Consultations, Thursday, 1.80 p.m.

St. Thomas’s Hospital.—O perations, 1.30 p.m. ; Saturday, same hour.
London Hospital.—O perations, 2 p.m.; Thursday & Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital fob Women and Children.—O perations.
2.30 P.M.

University College Hospital.—O perations, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 p.m. ; Saturday, 9.15 a.m.

Botal Free Hospital.—O perations, 2 p.m., and on Saturday.

King’s College Hospital.—O perations, 3 to 4 p.m. ; Friday, 2 pm.-
Saturday, 1 p.m.

Children’s Hospital, Great Ormond-street. — Operations, 9 a.m.;
Saturday, same hour.

Society op Arts.—8 p.m. Mr. Percy Fitzgerald: Machinery and
Appliances used on the Stage.

Thursday, March 17.

St. George’s HosPiTAL.-Operations, 1 p.m. Ophthalmic Operations,
Friday, 1.3J p.m. ■

Charing-cross Hospital.—O perations, 2 p.m.

North-West London Hospital.—O perations, 2.30 p„w.

Rotal Institution—3 p.m. Prof. F. Max Miiller: Science of Thought.
Royal College of Physicians of London.—5 p.m. Dr. Brqodbent:
The Pulse (Croonlan Lecture).

PfRKEs Museum of Htgienb.-S p.m. Dr. E. F. Willoughby. George
, * arrentrapp, Sanitarian and Philanthropist.

Kabvbun Society of London.— 8JO p.m. Dr. W. H. Day : Habitual
Constipation in Children, and the Method* of Treatment.—The
President: A case of Congenital Syphilis.

Triday, March 18.

Royal South London Ophthalmic Hospital.— Operations, 2 p.m.

Socumr or Medical Officers op Hkalth.-7.30 p.m. Dr. W.
ibursfleld: (l) A Contribution to the Etiology of Congenital I
formitlea with a special bearing on State Medicine ; (2) A recent c.
oi Contagious Carbuncle in the Human Subject.

Charfng-cross Hospital Medical Societt. — 7.45 p.m. Mr. A.
Finch Noy es : Jacksonian Epilepsy.

Botal Institution—9 p.m. Mr. George John Romanes i Mental £
ferences between Men and Women.

Saturday, March 19.

Middlesex HosPiTAL.-Operations. 2 pm,

Botal Institution.-3 p. m . The Bt. Hoo. Inrd Rayleigh : On Soui

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.m. by Steward's Instruments )

The Lancet Office, March 10th, 1887.

Dots.

Barometer

reduced to
Sen I.cvsl
and VPP.

Direc¬

tion

ot

•Wind.

b5>.

Wet

Bulb

Solar

Kadla

in

Vacoo

Mu.

Temp.

Shads.

Min.

Temp

Rain

tab.

Swarti at

KJ0a.ll.

Mar.

4

30-49

B.

33

33

41

32

Foggy

5

30 32

E.

35

35

60

40

32

0

30 24

B.

39

37

67

50

31

Overcast

7

30-29

E.

39

37

61

45

36

Overcast

8

30-19

E.

41

39

43

39

Overoast

9

30-05

W.

40

38

45

38

Foggy

• »

10

30-11

N.B.

41

39

45

39

Overcast

ftotes, Sjwri Comments, # §mstoers to
Correspondents.

It is especially requested that carlo intelligence of local events
having a medical interest , or which it is desirable to bring
tender the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed u To the Editors.”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their icritcrs, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The JL.ANCBT to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

The Moxon Memorial Fund.

President: Sir William Jentter, Bart., K.C.B., M.D., F.R.S.

The following contributions have been received since those acknowledged
on March 5th. All subscriptions should be forwarded to the honorary-
treasurer, K. Clement Lucas, B.S., F.R.C.S., IS, Flusbnrr-square, B.C..
by whom they will be acknowledged, and cheques should be crossed
“CityBank.’’ ’

Laundy Walters, Bsq. ... £10

10

0

F. B. Baldwin, Bsq.

£1

1

o

W. S. Savory, M.B.,

H. P. Berry, M.D....

1

1

»

F.KtC.S.... .

6

5

0

F. J. Hindle, Bsq....

1

1

0-

D. P. Loe, Esq.

5

6

0

A. B. Elliott, Bsq....

1

1

l>

H. R. Williams, Esq. ...

6

5

0

W. Hale White, M.D.

1

1

o

Thomas Joyce, Bsq.

6

5

0

H. B. Winokworth, Bsq.

1

1

»

ChristopherGayleard, Beq.

5

6

0

Percy Gardner, Bsq.

1

1

o

The Editorsof The Lancet

5

5

0

W. fimmley Taylor, Bs

1

1

o

Edward Cock. F.R.C.S....

5

0

0

A. J. Harrison, M.B., J.

1

1

o

Joseph May, Bsq., jun....

6

0

0

Brnnsby Roberts, M.D.

1

1

0

J. H. Lloyd, Esq.

3

3

0

F. Gordon Brown, Esq.

1

1

o

Mrs. Laundy Walters ...

2

2

0

B. Baxter Forman, M.

1

1

A

F. Charlowood Turner,

George Padley, Bsq.

1

1

o

M.D.

2

2

0

Thos. Stevenson, M.D.

1

1

0

P. Horroeks, M.D. ...

2

2

0

J. J. Nason. M.B.. J.P.

1

1

o

James Ut-ddard, M.B. ...

2

2

0

W. Reynolds. Bsq ...

I

1

o

V. T. Roberts, M.D. ...

2

2

0

B. N. iJalton, M.D.

I

1

e

II. Kenneth, Bsq.

2

2

0

Ilujfh Bennett, Bsq.

1

1

0

Pyrom Br&mweil, M.D.

1

1

0

J. B. Trap, Bsq. ...

1

1

A

J. H. Hind, M.D.

1

1

0

T. 8. Marley. M.D.

O 10

A

G. W. Brutnwcll, Esq. ...

1

1

0

Walter Kidd, M.D.

0 10

A

Chimney Purer, Beq. ...

1

1

0

J. H. Gibson, Bsq.

0 10

6.

A. Carrol Otway, Esq. ...

1

1

0

Surgeon B. S. Harder

0 10

A

R. H. P.-rks. Rsq.

1

1

0

B. Walker, Bsq. ...

0 10

A

N. Davles-Colley, M.C....

1

1

0

C. T. Griffiths, Bsq.

0 10

A

Errata .—The name of T. A. Spalding was the name on the cheque for

1 £3 2s. sent by Dr. L. E. Shaw, which was thus twice acknowledged
, last week. ** J. F. Table. Bsq.” should bo J. F. Tabb, Bsq. The names
of Dr. Laogdon Down and W. A. Garrard. Esq., each for £1 werw
omitted last week.

Mr. G. IF. Hambleton .—There can be no objection to publishing the oases
with the -treatment adopted.

Dr. C. J. Parsons .—An advertisement, no doubt.

"THB MEDICAL PROFESSION AND LIFE ASSURANCE

OFFIOBS..

i To thi Editors of The Lancet.

Sms,— I was oee of those favoured, as was Dr. Thurafteld, by a com¬
munication from the {lational Life Assurance Society, and, like him, £
Indignantly declined to enter Into an engagement which. In my opinion,
would be most Injurious to the Interests of the profession, as well q* to
the offioe* themselves.— -I am. Sin, yours faithfully, r

, Cardiff, March 9th, 188T. 0. I. Vachkll, M.D^IahuL

Digitized by v^. ooQle

Thk Lancet,]

NOTES, OOMMENT8, AND ANSWERS TO CORRESPONDENTS. [Mabok 12,1887. 555

Steamship AniisunTS for txx Amkkicak Congress.

Hr. Btyd B. JM state* that, so far as he can ascertain, the reason why
the principal American steamship companies, such as the "White
Star” and " Canard ” lines, hare not offered to make any redaction
in the tariff for members of the medloal profession who purpose
attending the Congress at Washington in September next is that so
few have hitherto signified their Intention of being present at the
meeting. If those who wish to proceed by one of the Royal Hail lines
will communicate with Mr. Joll, stating by which company’s steamers
they wish to travel, he will wait upon certain of the directors of these
lines with whom he is personally acquainted, and see what reduction
they can be induced to make. Of oourse, the greater the number
prooeeding by one line of steamers, the better chance of getting
favourable terms with the directors.

Juvenile will do well to follow the custom which has hitherto been
observed in the locality.

Ur. FI. C. Fox .—The address is No. 3, Delamere-crescent, Bayswater, W.

Mr. Paticardnana (Poona).—We cannot exchange.

PROVIDENT DISPHNSARIBS; TUB WANDSWORTH MEDICAL

AID SOCIETY.

To the Editon of Thk Lanckt.

Sum,— If Mr. Cox, by the aid of Johnson’s Dictionary, desoribed to
Mrs. Bouncer the oorreot definition of a grumbler as being a “person
who finds fault without cause,” your correspondent, in his letter of to*
day, in rejoinder to Mr. Dickinson's of Deo. 7th on theabove subject, has
very properly adopted that designation. As regards provident dispen¬
saries in general and the Wandsworth Provident Dispensary in particular,
his opinion may be allowed to pass, bat as regards the Wandsworth
Medical Aid Society, his remarks demand some comment, for he is
wrong in his facts, In his premisses, and in his conclusions con¬
cerning that institution. The latter is net a charitable society;
based an the principle of mutual assuranoe, it is independent
of eleemosynary or other extraneous aid, and is entirely self-
supporting. By payments that are very small from each individual, but
which collectively furnish a not unreasonable fee to the medioal attend¬
ants, it ensures to the working olaases efficient medical attention, with¬
out which (inasmuch as about 73 per cent, of all pauperism results from
sickness) a large number of them would beoome paupers. The medloal
attendant* do not attend cases of sickness at 4s. per annum, but the
number of siok that oocur in a given number of healthy members for
the sum total subscribed by the latter. And as the sickness averages
5 per oent., "A Grumbler” will find that the sum paid for each case
attended per annum constitutes a by no mean* Ignominious fee.
The medioal attendants therefore do not pot on "the cloak of charity”
for the baue motives - imputed to them by “ A Grumbler,” nor do
they give their services in the manner described for the purpose of
“ starving a new man or of giving vent to their professional jealousy.”
Jealousy of whom? Of the new man? It would rather seem to be the
jealousy or envy of the new man that has brought forth “A Grumbler.’
Is it their fault that the newoomer is at his wits' end " how to start a
praotlce " without the aid of that class of persons styled by him the
“ fogged lot,” whose shilling or two he nevertheless does not affect to
despise ? The idea that the old-established practitioner ought " to stand
and deliver,” on demand of any newcomer, one portion of his practice
m a means of getting himself " eased ” of the remainder, is a bit of new
morality, so simple In conception that It it scarcely likely to be enter¬
tained in any mind but that of "A Grumbler.” His accusations are simply
without foundation; although ostensibly general, they are obviously in¬
tended to have a local application.—I have the honour to be, Sirs, your
obedient servant, and not ashamed to subscribe myself,

G. B. Nicholas, M.D.

(One of the Promoters of the Wandsworth
Church-row, S.W., Peb. 12th, 1887. Medical Aid Society.)

A Medical Poet .—We do not think the su gg est i on could be usefully
carried out. The troughs would not be likely to be employed by the
careless class of persons referred to.

Mr. Leonard Key ter— The reply to both questions most be in the affirms,
tire.

NIGHTMARE.

To the Editor» of ThK LaXCSt.

Sou.—I think if your correspondent, “ M.D.,” will take the following
mixture the nightmare from which he suffers will give piaoe to more
peaceful sleep. When he has taken the mixture a fortnight it would be
interesting to know the result. Personal experience has taught that
great relief will follow:— R. Pulv. rhei, gr. li. ; llq. ammon., Ifix.;
*od. bicarb., gr. xli.; oi. month, pip.. Dll.; aqua $i.; ter die. I am
supposing “ M.D.” to have eliminated indigestible article* from his usual
d 'rt. I am, Sirs, yours truly.

March. 1887. R. W. W.

7b the Editort of Turn Lajtckt.

Sins,—In answer to “ M.D.,” I believe that any of the following may
oase disturbance of sleep such as he describee:—supper, sexual excess,
t ®oldog. tea-drinking, over-reading, the last three especially if indulged
in st night. Treatment:—Avoid the above. If possible, take a short
holiday, and make a point of having out-door ere rais e .

„ I am, Sirs, faithfully yours,

*•"*,1987. G. B. 8.

Furnkapx Jordax Testimonial Fund.

Final Lift.

Crompton, D. W-, Esq.
Parke*. Ed.. M.D....
Boddy, B. M-, Esq.
Chambers. W. R., Esq.
Bdginton. R. W„ M.D.
Freer, J. P., Esq. ...
Hart, G. H., Esq. ...
Hogg, Jenner, M.D.

ft 3

0

0

Jackson,Vincent, F.R.C.S

£1

1

0

2

2

0

Lafarelle, J., Esq.

1

1

0

1

1

0

Messlter, A. F.. Esq.

l

1

0

1

1

0

Moore, J. W., Esq.

1

1

0

1

1

0

Raynor. T., M.D.

1

1

0

1

1

0

Smith, Richard, Htq.

1

1

•0

l

1

0

Fuller, Andrew, Esq.

0 10

6

1

1

0

Wright, Wm„ M.D.

0 10

8

T. H. Bartleet, Treasurer; Bennett May and Jordan Lloyd, Secs.

Surgeon-Major.—We trust that our correspondent will feel reassured by
the statement made by the Director-General, at the dinner of the
Medical Society, which he will find reported in our present issue.

CgelitL—We see no objection to the patient's riding the machine, pro¬
viding a carefully applied and well-fitting truss Is worn, and racing is
forbidden.

Dr. Bennett (Leicester).—The criticism had. perhaps, better wait for
publication until the whole of the paper has appeared.

PARALDEHYDE.

To the Editon of Thk Lanckt.

Sirs,—T he great advantage possessed by paraldehyde over chloral is
that it has no depressing or paralysing effect upon the heart. In all
other respects it is almost indentica! with chloral. If your correspondent,
“ Subscriber.” will refer to Thk Lanckt of Jan. 81st, 1886, he will find
a short paper written by me on the action of paraldehyde. I there
stated that I had found the drag to be an equally sure hypnotic with
chloral; that In the rare cases in which Jt did not produoe sleep It never
caused excitement; that it left no headache or other unpleasant after-
symptom, and that it did not affect the appetite even when given
regularly for a considerable time. Daring the two years that have
passed since I wrote the paper alluded to I have regularly prescribed it,
and have no reason to change the opinions there stated. It possesses
every good quality of chloral and is without its most dangerous—viz., Its
paralysing action upon the heart. It may be given in dose* of from
forty to ninety minims with safety, even where the heart is weak and
Irregular, or, as to the second stage of febrile diseases, where the cardiac
muscle has undergone fatty degeneration. In ordinary cases of insomnia
forty minims are generally sufficient to induce sleep; and this dose
repeated, if necessary, in fifteen minutes I have found more efficacious
than a larger single dose. I may say I have discovered no better mode
of administration than with a vegetable bitter in simple syrnp.

I am. Sirs, yours faithfully,

March. 1887. S. A. K. Era ahan, M.D.

Mkdical Advick Through Newspapers.

Mr. T. B. Allinson, L.B.O.P. Bdlo. A L.R.C.8. Bdin., continues to give
his advice with much profusion through a newspaper, accompanied with
a little commercial advloe to his correspondent*, to recommend “ his
paper.” Modi of Mr. Allinaon’s advice is good enough. Some of it is
very doubtful, as, for example, that to “ Jimmy,” who is afflicted with
diabetes, and told to drink nothing bat milk, which will stop his thirst.
However, oar object is not to discuss “ Jimmy’s " prospect with diabetes
on a milk diet, but the newspaper method of advertising one’s pro¬
fessional wisdom and the particulars of "Jimmy's" or "Jessie's'-
oomplalnt.

JUBILEE SUGGESTIONS:

To the Editon of Thk Lanckt.

Sirs,- With a view of oe lob rating our Queen’s Jubilee, and of accom¬
plishing the wishes of various medioal bodies of gaining higher professional
and distinctive titles, will you allow me to suggest the following: —
1. That all L.M.K.Q.O.P.I.’* should be allowed to add the/no remaining
letters of the alphabet to their names. 2. That as the exa min at i on of
the Apothecaries' Hail now includes surgery, those holding that diploma
should be considered eligible for the post of consulting surgeons to
hospitals, and be allowed to use the title of professor. 3. That all
member* of the Colleges of Surgeons, and lloentiates of the Colleges of
Physicians in Great Britain, should have th* right of using the title
" M.D. Jubilee ’’ after their names. 4. That all who hold the university
title of M.D. at present shontd be made baronets, or at least life peers.
5. That all unqualified assistant* of more than fifty yesws’ standing, and
who can prove that they have never entered the walls of a hospital except
as patients, should be admitted at onoe upon the Medical Register and
rank as Fellows of the College of Surgeons. If these suggestions be
carried out in the spirit in which they are offered, the present dissensions
would soon cease, and a time come when the highest and lowest medical
titles will be as one, and the rivalry of the licensing bodies put a stop to
altogether. I am. Sirs, yours faithfully,

A. G. Bateman.

Constitutional Club, Northumberland-avenue, March, 1887.

A New Gct.lt- for Yards.

Mr. Shaw, of Willlngton-on-Tyne, has sent ns a drawing of a gully to be
used in houses and yards. It is a great advance upon the old bell-trap,
for the reason that it has In combination with it a syphon trap, which
will effectually prevent the drain from becoming untrapped so long as
water la supplied to it.

Dr. J. B. Sim (Nottingham).—YeS, shortly-

ioogle

Die

556 Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[March 12,1887.

Dental Statistics.

According to the Dental Review there 1* in Americn one dentist for
every 4000 inhabitants ; in Prance, one for every 87,000 ; in Germany,
one in 88,000 ; and In Austro-Hungary, one in 300,000. In England
there is one for every 7000.

C. A. M. —We doubt if our correspondent has any legal claim.

THE LONDON HOSPITAL STUDENTS’ DINNER; A WALL
FROM THB WILDERNESS.

To tie Editors of Isx Lancet.

Snts,—The other evening I attended the first annual dinner of the
London Hospital student*, where It was suggested that I should respond
for the “ The Visitors.” Up till then I had fondly imagined myself a
student of the hospital, having paid a composition fee. attended lectures,
dissected several parts, and dressed In the hospital. My connexion
■with the school is briefly this: After taking an Edinburgh diploma I
spent five or she years abroad and otherwise, and then came to town to
read for the higher qualifications. Looking round for a hospital, I
deliberately chose the “ London ” for its brilliant staff and fine Clinique,
and entered there, intending to go through such a course as would
enable me In time to apply for a house-surgeoncy. Events prevented
me from carrying out that intention, but I still considered myself a
student of the hospital until there came the sudden awakening.
Now, one is tempted to ask, with Truthful James, “ Are things
what they seem, or is visions about?” If the receipt before me
from the warden for forty-five guineas, the first instalment of a
composition fee, does not constitute one a student of the London
Hospital, how is tliat enviable position to be attained? Evidently
not by purchase, wherefore 'I thank heaven with mild philosophy
that. the second Instalment has not been paid. Some months back
I met a medical man, an old student of the London Hospital, and
in answer to his inquiry explained my connexion with the place; where¬
upon he said: “ Oh, you are one of those qualified men who go there for
the appointments!” This remark showed a want of breeding or want
of tact that iuollned one to ignore and forget it as soon as possible ; and
the incident had passed out of my mind until recalled by the dinner. In
ancient times death was often the penalty for those who strayed into
sacred enclosures, and by comparison it is terrible to think what may be
the sentence on composition students who have trespassed into these
charmed circles. For my own part, I should be sorry to thrust myself
into any society of men, however distinguished, were it made plain that
my presence was not wanted, and I am willing formally to resign all
claim to be oalled a student of the London Hospital. Not that this
declaration is likely to fill either of the contending camps with great joy
or despondency; but one cannot hear too many sides of a question.
Besides, now that I have tasted the delights of suburban practice and am
freed from scholastic thraldom many things appear in a different light.
House-surgeoncies have lost the halo of gtory that formerly surrounded
them, fora small practice in the Wilds has permitted perineal section,
removal of deep-seated glands, osteotomy, and other operations denied
to resident oflioers. Bearing these things in ndnd. the feeling gathers
weight that a man of fair education, energy, and seif-reliamoe, with
the help of a few books of referenoe. and thorough antiseptic; methods,
may live a happy and useful life (and even, occasionally operate) inde¬
pendently of consultants, high degrees, hospital appointments, or con¬
nexion with particular schools. One comfort is that the fields of litera¬
ture, science, and art are just as open to a humble licentiate as to one
who writes a string of titles after his name.

In conclusion, the students of the London Hospital have my hearty
wishes for success in efforts which seem to have a solid groundwork of
justice, Although this goodwill must sound rather strangely oomtng
from one who has been put “ outside the walls.”

I am, Sin, your obedient servant,

David Walsh, L_fLC.S. and L.R.O.P. Ed.

Hammersmith, W., March, 1887.

Communications not noticed in our present number will reod re atten¬
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Snell, Sheffield; Dr. Drysdale, London; Mr. R. Cuff, Scarborough ;
Mr.Haalam, Birmingham; Dr. J. B. Mattison, Brooklyn; Mr. Richard
Harris; Mr. Smither, London; Mr. Keyaer, Slough ; Messrs. Brady
and Martin, Newca»tle-oa-Tyne; Mr. Meadows, Hastings ; Dr. Beav&n
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Newcastleton ; Miss Birmingham, Bromley; Mr. Parker, London;
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THE LANCET,

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OX THIS

NATURE O F F E, V E R.

Delivered at the Royal College of Physician*,

By D. MACALISTER, M.A., M.D., F.R.C.P.,

VHTSICIAX TO ADDHNBROOKE'S HOSPITAt, RKCTOREK I.V MEDICTXK AT
TttK UNXVHRSITY OF CAMBRIDGE.

LECTUEE II.

U&. i'xuisiDENx and Gkntlkmkn,— Let me recall to
your memory the point we have now reached in our
liscussion of the nature of fever. Perhaps I can best do
so by reciting the conclusions arrived at in 1875 by
Dr. Burdon Sanderson in the important memoir I have
already referred to. These conclusions will not only serve
to.indicate the lirst stage of our argument, they will bo
useful as a starting-point for the considerations that are yet
to come. “Two possibilities [os to the origin of fever] are
open to us. One is that fever originates in disorder of the
nervous centres, that by means of the influence of the
nervous system on the systemic functions the liberation of
heat at the surface of the body is controlled or restrained,
so that ‘by retention’ the temperature rises, and Anally
that the increased temperature so produced acts on the
living substance of the body so as to disorder its nutrition.
The other alternative is that fever originates in the living
tissues, that it is from first to last a disorder of protoplasm,

and that all the systemic disturbances are secondary.

The facts and considerations we have had before us are, I
think, sufficient to justify the definitive rejection of the
drst hypothesis in all its forms; for, on the one hand, we
have seen that no disorder of the systemic functions or of
the nervous centres which preside over them is capable
of inducing a state which can be identified with febrile
pyrexia; and on the othor, that it is possible for such a
state to originate and persist in the organism after the
influence of the central nervous system has been withdrawn
:rom the tissues by the severance of the spinal cord. We
are therefore at liberty to adopt the tissue origin of fever
as the basis on which we hope eventually to construct an
explanation of the process. But if we attempt to do so
now, we shall at once find ourselves in face of an unsolved
physiological problem—that of the normal relation between
temperature and thermogenesis, — for the elucidation of
which it is necessary to investigate much more completely
than has yet been found possible the influence of tempe¬
rature variations on those chemical processes in living
tibsue with which thermogenesis is necessarily associated.”

As theses sentences are somewhat condensed in expression
a word or two of comment may prevent misunderstanding.
In the first place, the “ disorder of the nervous centres,”
which is without hesitation condemned as inadequate to
explain the genesis of fever, means primarily disorder of
that part of the nervous system which governs the circula¬
tion and the respiration—** the systemic functions,” as they
are called. This is clear from the whole course of the
previous argument. The apparently sweeping rejection of
the hypothesis of nervous disorder “in all its forms” is
really ‘levelled at the hypothesis of merely vaso-motor
disorder, which is associated with the names of Traube and
'iarey; hence if we are led hereafter to consider a theory
involving another kind of nervous disorder we shall not
necessarily come under Dr. Sanderson’s condemnation. In
the next place, since 1875 something has been done to supply
he missing physiological data for the establishment of the
tissue origin of fever, and something more has been done on
other lines which help us to get round the outstanding
problems. Moreover, as I explained in my last lecture,
we have had an authoritative re-examination and re-
Jtermination of some of the points in regard to febrile
tuermogene8is which Dr. Sanderson was inclined to regard as
oubtful or not proven in the earlier experiments of Leyden
Senator, with the result of showing that though the
methods were imperfect quantitatively the deductions from
them were qualitatively correct. Thirdly, we have had
No. 3316. J

March 19,1887.

from various quarters — England, France, Germany, and
America—valuable researches on the relation of the body
temperature and the body heat to certain parts of the
central nervous system, researches which were not before
Dr. Sanderson when he wrote, and which open up new lines
of thought regarding the meohanism of fever. Lastly, some
light has been thrown on the relation of the nervous system
in general to the ** chemical processes in living tissue with
which thermogenesis is necessarily connected.” All these
gains to knowledge enable us to advance further towards a
true theory of fever than was thought twelve years ago to
be possible, though the “unsolved physiological problem of
the normal relation of temperature to thormogenesis ” is not
yet fully solved. I shall endeavour to show the bearing of
these later contributions, and so lead step by step to a theory
of the “ tissue origin of fever,” such as Dr. Sanderson forecasts.

We start with this: that fever of necessity implies—
(1) A disorder of the thermotaxie mechanism; (2) an exces¬
sive production of heat associated with excessive chemical
changes in the tissues, the excessive production being more
or less than that of a normal patient on full diet (perhaps
oftsner less than more), but more than that of a normal
patient on fever diet; and (3) that the body temperature,
depending on the state of the balance between production
and discharge, fluctuates as one or the other is in the ascen¬
dant, and is not per se a true measure of either, or of the
consumption of tissue which may be going on. An essential
factor of fever being thus excessive production of heat in
proportion to the food consumed, a natural question to ask
is, What tissue or tissues iu particular are concerned in the
excessive thermogenesis? If there is increased combustion,
what is the fuel, and where the furnace ? To answer this
question we shall first have to ask another—the licence
is permitted to a Scotsman: What are the sources of heat
production in health ?

The older notion connected with the great name of Liebig,
that the hydrocarbons of the food are the “ fuel” of the body*
being consumed chiefly in the lungs during respiration,
while the nitrogenous constituents are mainly plastic or
tissue forming, has been so effectually disproved that I need
not pause to discuss it. It still reappears in popular books,
and we occasionally see in the medical journals—at least on
the outside pages—published analyses of particular foods
which are duly parted into “heat-givers” and “flesh-
formers.” Now, however, to use Professor Foster’s words,
which I need not paraphrase, because I cannot improve on
them, “ we may at once affirm that the heat of the body is
generated by the oxidation not of any particular substances,
but of the tissues at large. Wherever metabolism of proto¬
plasm is going on heat is being set free. In growth

and in repair, in the deposition of new material, in the
transformation of lifeless pabulum into living tissue, in the
constructive metabolism of the body* heat may be Un¬
doubtedly to a certain extent absorbed and rendered latent;
the energy of the construction may be in part, at least,
supplied by the heat present. But all this, and more than
this—namely, the heat present in a potential form in the
substances themselves so built up into the tissue—is lost to
the tissue during its destructive metabolism; so that the
whole metabolism, the whole cycle of changes from the
lifeless pabulum, through the living tissue, back to the
lifeless products of vital action, is eminently a source -of
heat.” 1 But of the “tissues at large,” whose oxidation is in
general the immediate source of the body heat, the muscles
for various sufficient reasons must be regarded as the
chief contributors. In the first place, the muscles form
something like one-half the whole mass of the body. When
we reflect that of the other half a large portion is made up
of the bouy tissues, whose oxidation cannot be active, we
see that the muscles must play a very large part in thermo¬
genesis. In the next place, even when the muscles are at
rest the blood which leaves them by the veins contains
more carbonic acid than the blood even of the right ventricle.
The mean rate of oxidation in the muscles is higher than
J that of the average of all the tissues, including the
muscles themselves. And, lastly, muscular exercise, in
I which the metabolism, as evidenced by the increased
excretion of carbonic acid, is markedly increased*- is
accompanied by a large concomitant increase of heat
I production. Fick makes a calculation, based on the
j actual observation that during severe muscular work the
I quantity of exhaled carbonic acid may be tire times the

i PhynioloRy, p. 461.

Jd

558 The Lancet,]

BE. D. ifAU ALI8TEB ON TOT NATURE OF FEVEl.

[March 19,1887.

normal, showing that of the total energy derived from the
food one-sixth goes to the work and five-sixths to the extra
production of heat that accompanies it. a I need not enume¬
rate all the other reasons for regarding the muscles as “ the
thermogenic tissues par excellence tnose I have given are
perhaps enough. Next to the muscles come the various
secreting glands, and the alimentary canal in digestion. But
when we remember that in fever the functional activity of
these latter is to a great extent in abeyance, we shall pro¬
bably not credit them with any large share in the geneew at
least of febrile heat. As regards the muscles, however, they
are estimated to contribute four-fifths of the body heat in
health; in fever their proportion must be higher still.
Briefly, then, we may say that the muscles are t|ie chief
furnaces of the body both in health and ia fever. Let ns
consider more minutely this thermogenie function of the
muscles, and the nature of its connexion with the more
familiar motor function.- The investigation will be worth
our pains, even if it only leads us to hesitate in regarding
the heat produced in muscles as a mere excretion, a waste-
product like urea or carbonic add.

It has long been known that each contraction of a muscle
is accompanied by the production of a certain modicum of
heat. The earlier experimenters put forward the idea that
as in a steam engine the energy supplied by the hot vapour
from the boiler is given out partly as work and partly as
heat, so in a muscular contraction the energy set free by a
given stimulus appears partly as mechanical effect and
partly as inevitably waste or degraded energy in the form of
heat. It was inferred on the principles of the dynamical
theory that if we should add the work done by the muscle
to the mechanical equivalent Of the heat wasted we should
have a constant sum. The more'work done in contracting the
lees waste energy in the formof heat,and vice versd. Bat when
exact quantitative experiments were made, such as those by
Fick, Heidenhain, and many others, it was found that no such
constant relation could be demonstrated. The proportion
of heat to work, and the sum of these two elements,
depended not on the intensity of the originating etimul us,
but on various external conditions, such as the load the
muscle had to bear, the extent to which it was stretched,
and so on. 1 In fact, the productive 1 efficiency of the muscle
-considered as a machine was far more complex in character
than that of a steam-engine. Many have been the attempts
to determine more precisely the quantitative laws of this
efficiency, but they all seem to proceed on the assumption
-that some necessary thermo-dynamic connexion exists
between the function of work-producing and the function
-of heat-producing, between the motor and the thermogenic
activities of the muscle; and it has been sought to define
the nature of the assumed connexion in terms of a small
number of variables. For some years 1 have asked
myself the question: Mast in all circumstances heat be
produced when a muscle contracts? If heat is pro¬
duced without contraction, may not contraction take place
without heat ? The older methods of investigation offered !
practical difflcultiee when 1 came to seek an answer to this
question. The muscle experimented on was generally that 1
of a'friig or cold-blooded animal ; it was removed from the
body, and therefore from the influence of the circulation—
in fact, it was a dying muscle rather than a living one. More- '
over, the quantities of heat and the temperatures which
were measured were on the whole extremely small, being
reckoned in hundredths or thousandths of a degree. The
limits of error in such measurements are naturally wide, and
the measurements require the most sensitive thermo-electric
instruments to make them apparent.

Working under the inspiring guidance of Professor
Ludwig in 1881, and still possessed with the idea of the
thermo-dynamic interdependence of muscle work and muscle
bent, L'tbeught; it worth while to see whether the heat
prodootfo* ora frog’s muscle still connected with the body
and permeated by the circulating blood might not be great
enough to admit of thermometnc measurement instead of
thermo-electric. Some previous experiments of Dr. Meade
Smith in the same direction had made this probable. I
procured very sensitive thermometers with fine-drawn
bulbs, and openly graduated in tenths of a degree Centigrade. ’
I found that one of these could be introduced beneath the -
skin of a pithed frog into the natural intermuscular deft
between the muscles of the thigh, so as to be surrounded on

nt - J vt.nr ir. ■■ • . r aM . *<yi I

* otter

Dr. A. Sheridan tea. , ffrt* A.> .'.«n£*v "■ -

all sides by living flesh, but without injuring anything.
When the sciatic nerve was suitably stimulated, the muscle
contracted tetanically and the temperature rose. The rise
was easily legible, amounting to four or five tenths of a
degree. When several successive tetanic contractions were
induced, the rife of tem'peratore gTew less and less, and
at last Could not be read at all, though the contraction was
quite marked. Ia a word, the muscle was fatigued as a heat-
producer be r ore it was fatigued as a work-producer. These
experiments were performed in winter on frogs collected in
autumn, and I observed that as spring came on the heat
production in the muscles under uniform conditions gra¬
dually grew less and le a s, though the tetanic carves given
by them on stimulation were excellent. I attributed this to
the gradual exhaustion of the frogs by their long winter fast.
But the point of interest was that the beat-producing power
was sooner exhausted than the work-producing power of the
muscles. Fatigue from repeated stimulation, exhaustion
from long abstinence, each appeared to differentiate the

Temperature Curve or Mubci.« : Bout Warm.

Maximum contractions:—I = 47 mm. i II = 41 .mm.: III =38 mm.

Temperature Curve or MirscxE: Body Gold.
Maximum contractions:—1'= 40 mm.; II'= 88 mm.

I i 11 ustrules the posMeJank' rise of tninpcratu e, owing to -

the flushing <>| rhe imiacle with warmer blood.

II illustrates the effect of fatigue in reducing the thermo-

genesis ; the tetanic rise is diminished ; tne post-tetanic
rise is almost absent, the blood being scarcely wanner
than the muscle.

III illustrates the post-tetanic fall when the blood is cooler

than the muscle.

thermogenic function from the motor function. I next pro¬
ceeded to inquire whether in warm-blooded animals iUmight
not also be possible to separate the two functions, to show that,
though generally called into play together, they were capable
of being performed independently. Using dogs, guinea-pigs,
and rabbits, narcotised with chloral in all cases, I made a
number of experiments on the fatigue of the thermogenic func¬
tion, and almost accidentally discovered another method of
practically abolishing it while the motor function remained
nearly, if not quite, intact. By controlling the temperature
of the whole animal, including that of tne muscle under
observation, I found that I could vary within wide limits
the relation between the work and the neat produced. It is
not necessary to give the experimental details at length.
Suffice it to say that by enclosing the profoundly narcotised
animal in a box with double walls, through which water of
any desired temperature could be made to circulate, 1 was
able to raise or lower its body temperature at will. Arti-

THB IiANCST,]

DBS. D MACALISTIER OS TOR NATURE OF FBVBR.

IMaboh ie,;w87. $69

flefeU respiration was maintained for hours together Tbe
temperature of tbe blood in tbe aorta, in tbe rectum,
and in the mass of tbe calf muscles could be ascertained
from minute to minute by m>aas of fine thermometers;
the mechanical work done by the. muscles of the calf coaid
be eetimated by tbe motion of a cord fastened to the
Achilles tendon ; and, lastly, the sciatic nerve, severed from
-the spine, could be electrically stimulated. The arrange¬
ments were elaborate, but after much experience and many
failures i succeeded in getting-some fairly satisfactory
results.

The experiments were made in triads. First, say, at
ordinary temperature, tbe reading of the thermometers
showing that all was steady, a tetanic contraction would
be set up, and the muscle temperature read at minute
intervals, before, daring, and-after tbe stimulation. The
whole arrangement would then be cooled down, say, to
1&° or 18° C. (say 61° or 64° F.) When things were once
more steady, a tetanus of tbe calf muscles was again
induced, the muscle temperature being read at short
Intervals as before. Once more the temperature of the
animal as a whole was raised hock to tbe original point,
and tiie experiment repeated. By varying the stimulus the
extent of the mechanical contraction was kept ae nearly as
possible the same in all three experiments. Usually such a
triad of experiments lasted the whole day, as tbe processes of
cooling down and warming up occupied several hours each.
In some cases I varied the procedure by tint cooling the
animal; tberi warming it, and lastly cooling it again; bat it
whs difficult to get very satisfactory results by this method,
which wM-vety exhausting to the observer, as well as to
the - animal. I need hardly say that the latter was never
suffered to regain consciousness. The general character of
the thermal results may be gathered from the rough diagrams
I present.. (See onto.) Take first an experiment at about
W* (V As Boon as the muscle contracts, its temperature
rises, and continues to rise for some time after the eon-
traction- ceases. The animal is then cooled to, say, 19° 0.
On stimulation the muscle contracts forcibly, but the rise of
temperature is trifling Or absent. On rewarming the animal
to something like its ftwt temperature, we once more restore
tbe rise of temperature on contraction. There me several
other points of interest exhibited in these curves, but 1 do
aot- propose to dwell on them >at present, T will only eay
that fcher post-tetanic rise of temperature, when it exists, is
due to the poet-tetanic flushing of the muscles with blood
that is warmer than the muscle. When tbe blood is cooler
than the muscle, as sometimes happened, we have a poet-
tetanio Ml'of temperature. Some plethysmographic experi¬
ments convinced me that this explanation, based on what
in Germany is sometimes called “ das Gaskell’sche Pbanomen,”
is applicable to all the peculiarities of the curves. A study
of these peculiarities, moreover, shows that the absence of
thermal phenomena was hot due to any perceptible impair¬
ment of the vaeo-motor mechanism of the muscle at tbe
lower temperatures. The lesson taught by these experi¬
ments appears to be—first, that the motor function may
persist-while the thermogenic function is ia abeyance; and
secondly, that cold is capable of abolishing or notably
depressing the latter function, while the former is still but
little or not at all affected. The therapeutic bearing of the
second lesson is not unimportant.

Since 1881, two investigators also working in Professor
Ludwig’s laboratory have carried on the research in other
directions. Dr. Meade Smith and Dr. Lnkjanow, 3 in a
memoir that has lately been published, display in minute
detail the laws which govern the fatigue of the thermo¬
genic function of a living muscle—(1) with the blood-
sopply abut off for -a time, and (2) with the blood in full
circulation. They also investigate tbe law of reooverv of
this function when it is completely exhausted, so far as it is
effected by simple rest with or without blood-supply. Tbe
outcome of these experiments may thus be expressed ; Tbe
effect of stimulating a muscle through its nerve' is to
•wt in it two processes — one, as it were, explosive,
and manifested by ebange of form and the performance
of mechanical work; the other more continuous, and
manifested by the increased development of heat. Each
Pjocese has its own laws as regards (1) the influence
p external conditions—snch as intensity of stimulus,
mod,• extension, and so on; (2) the influence of fatigue
"ma repeated stimulation; (3) tbe influence of general

* Dn Bolt Beymood’t Archie, 1884.

exhaustion from inanition or other debilitating causes;
(4) the influence of tbe general temperature ot the pro¬
toplasm of- the muscle; and (6) the influence of rest and
of the circulating blood in restoring lost power. This
independence, 1 think, justifies us in assuming that tbe two
processes are-largely independent and coordinate. Tbelipat
developed in the second or thermogenic process is not simply
a thermo-dynamic waste 1 *product, an excretion of no greater
dignity than mrea or carbonic acid. On mechanical, prin¬
ciples; the dislocation of the parts of the muscle on contrac¬
tion, and again-on relaxation, must give rise to a small
quantity of heat; which one might call thermo-dynamic
waste. It is the outcome of the degradation of the kinetic
energy of contraction, such as occurs when any moving
mass overcomes friction or is reduced to rest. But the
amount of this, waste heat ia calculable,and it comes out
as perfectly trifling in. comparison with what i may call
the thermogenic heat. In some of the experiments of
Lukjanew it was much leas than 1 pen- cent, of tbe heat
liberated.simultaneously with contraction.

The processes which issue in motion on the one hand and
in thermogenesis on the other are of course associated
with chemical movements in the muscle, with meta¬
bolisms whose terminal steps. are the accretion of oxygen
and the excretion of carbonic acid and water. The con¬
siderations 1 have adduced, and .especially those relating
to the power of recovery in a fatigued .muscle under the
influence respectively of rest and of the blood-supply, point
to the conclusion that tbe two metabolisms ore in some
way different. In other words, tbac the “ contractile stuff ’’
in tbe muscle is not the same ob the {l thermogenic staff.”
Both of them are stored in the muscle; so far as function is
concerned they are the muscle. The store of each can be
exhausted by repeated stimulation, but in some cases the
thermogenic store sooner than tbe other. Both can be up¬
built again by tbe circulating blood, bat in some cases the
contractile score sooner than tbe thermogenic. Both the-
metabolisms are affected by cold, but the thermogenic mnch
sooner and mnch more intensely than the contractile. We
know little of the exact nature of the chemical changes in¬
volved in either, form of metabolism.. Oxygen istakeu.upin
each, and carbonic acid is discharged, but the processes passed:
through between these terminal stages are much more
' complex than simple oxidations.. The evidence rather goes-
to show that it is tbe living substance as a whole,.con¬
tractile stuff and thermogenic stuff, which is continually
being decomposed and as continually being recomposed by
the blood. The net balance shows only gain of carbonic
aoid and loss of oxygen, but the nitrogenous parts also of
the working substance have in the process undergone
partial - destruction and equivalent: reconstruction. This is
in health; but if tbe reconstructive part of the process is
inadequate or absent, the balance of accounts will give
evidence of a nitrogenous residuum which is morbid. .The
muscle substance will appear to be itself consumed; it will
no longer be what I may call merely the circulating medium
of consumption. I say it will appear to be consumed; this
only means that the -net result is loss of nitrogenous sub¬
stance. The. cast-out nitrogenised molecules of the muscle
are not really excretionary in the sen*©- that carbonic acid ik
excretionary.. They have merely failed of that immediate
upbuilding into muscle substance again which is charac¬
teristic of the healthy metabolism. This incessant upbuilding
of the muscle substance, which iB a necessary consequence
of the fact that no increase of urea or other nitrogenous
matter is produced in the ordinary processes of muscular
metabolism, must require the expenditure of a certain
amount of energy. If in any measure the upbuilding-is
checked or abolished, so much energy is oi course un¬
expended. It was on some such asset of energy as this that,
as 1 presame. Dr. Ord fixed his attention in the suggestive-
paper 4 of which I spoke in the lost lecture. He asks: “Is
the increment of heat of the body in fever due not only
to combustion or other disintegrative processes thereto-
allied, but also to the persistence in the form of beat of
en-rgy which should have taken another form?” I believe
that Dr. Ord’s claim on this asset must be allowed, at
least so far as it refers to that part of the muscle substance
which in fever fails to be reconstructed. But 1 fear the
asset is a very small oue at the best, and quite inadequate to
provide a large addition to the heat, production of fever.
Moreover, it would be measured in a rough way by tbe loss

* Brit. Med. Journal, vol.1886.

Digitized by Cj(

* B-ibrig aud-Zuntc, Pfliiger’a-Arcta;, 1871.

• «Joarnalof Physiology, 188fli

Thb Lancbt,] DR. WARNER: ACTION OF NERVE CENTRES AND MODES OF GROWTH. [MABCH 19,1887. 561

vessels—the vaao-constrictors.. The other influence is
exerted through the vagus nerve, and, as we all know, its
action is to check the heart’s beat; when the nerve is cut
the rhythm is suddenly quickened; when we stimulate the
nerve the heart remains motionless and flaccid. It is the
typical inhibitory nerve; it corresponds to the vaso¬
dilators. ij-nl ,<

But what is the nature of the influence on the cardiac
muscle exerted through the motor nerve ? and how does it
differ from the apparently opposite influence exerted through
the vagus ? The characteristic effects of motor stimulation
on the heart are primarily increased rhythm, increased
vigour, and increased conduction of the beat through the
muscular tissue. “ But our knowledge of the action of any
nerve is not complete so long as we only know its primary
action; the chemical changes which the action of the nerve
■sets up in the tissue must manifest themselves in a more or
less permanent after-effect, which must be recognisable
apart from the more temporary primary effect of stimula¬
tion. A motor nerve causes a muscular contraction by

means of chemical changes in the muscle which are of a
destructive nature, so that the after-effect upon the muscle
is in the direction of exhaustion; and if the activity of the
muscle be long continued this exhaustion becomes very

manifest. . The subsequent exhaustion is as important a

factor as the contraction.” Dr. Gaskell shows that the
sympathetic nerves of the heart are motor in this sense also—
that their continued stimulation leads to exhaustion of its
muscle. He describes such a nerve as the catabolic nerve of
the tissue, the nerve which produces its motor effect by
augmenting suddenly the destructive metabolism of the
resting muscle, and thus by excessive repeated action
exhausts the store of “contractile stuff” within it. Wbat
now is the after-effect of vagus stimulation when the
primary and temporary effect of stepping the beat is gone
hyt Dr. Gaskell has shown that as regards all the functions of
the muscle “ the after-effect is nothing but beneficial.” If
before the stoppage the heart was beating at its normal
rate, the rhythm afterwards is perfectly maintained or
oven quickened; the cont^aotion power is maintained, or, if
it was weak before, increased; the conduction power is
restored if from exhaustion it was impaired: in a word, the
“tissue, if damaged,,is repaired and restored as the result of
■stimulation ; of the inhibitory fibres. In fact, the result of
YSgus action is exactly opposite to that of sympathetic
action; from the latter we have increased activity followed
by exhaustion—symptoms of oatabolic action; from the
former diminished activity followed by repair of function—
‘symptom# of anabolic action. :,

There is thus "no greater mystery involved in the con-
-oeptian of a nerve of inhibition than in the oonception of a
nerve of oontraction. In the former case, the cessation of'
function, the relaxation of tissue, is a symptom of con¬
tractive chemical changes going on in the tissue—that is,
of anabolism, or assimilation, or trophic aotion,—in pro- 1
dsely the same way as the activity of function, the
oontraction of the tissue, is a symptom of destructive

■changes—that is, of catabolism or dissimilation. . The

evidence is daily becoming stronger that every tissue is;
innervated by two sets of nerve fibres of oppoeite characters,
•so that I.look forward hopefully to the time when the whole
nervous system shall be mapped out into two great districts,
of which the one is catabolic, of the other anabolic, to the
Peripheral tissues; two great divisions of the nervous system
wMch are occupied with chemical changes of a synthetical
«nd analytical character respectively, which, therefore, in
■their action must show the characteristic signs of such

epposite chemical characters. . The decisive proof that

inhibition is a symptom of anabolism in the same way as
contraction is a symptom of catabolism will, in all probability,
(first) be found in the heart; and perhaps the most
important investigation that must be done before this
Theory of anabolic nerves is based on an absolutely firm
tooting is to find out wbat are the electrical and thermal
changes in-the heart muscle which accompany the stimula-
of its .inhibitory nerve fibres.” Since this was first
written a remarkahle confirmation of the doctrine has been
obtained. When the motor nerve of a quiescent muscle is
***®?J*t«d, the contracting muscle assumes an electrical
oonaraoh different from that of the uncontracted—the nega-
variation. Dr. Gaskell finds that when the inhibitory
oerve of a piece of quiescent heart muscle is stimulated, the
"juscle exhibits an electrical change of precisely the opposite
CQ * ric te*-‘* derided -poskioe variation, He is now at work

on the thermal chauges accompanying inhibition, and the
next news I expect to hear is that, as on stimulating a motor
nerve we have a simultaneous evolution of heat, so on
stimulating the inhibitory nerve the muscle becomes cooler.

It seems to me that from the considerations advanced in
this lecture it is not rash to proceed to a provisional gene¬
ralisation. It is this: that not the visceral and vascular
muscles only, but all the muscles of the body, have their
double nerve-supply. The one set of fibres are essentially
catabolic; they set up disintegrative changes in the muscle,
which are manifested first by thermogenesis, and secondly
by contraction. The other set of fibres, whose path is per¬
haps anatomically different, are essentially anabolic ; they
set up reconstructive changes in the muscle, which are
manifested by inhibition of motion on the one hand, and the
absorption of energy on the other. Does the motor fibre
also subserve the thermogenic function? Does the same
catabolic nerve convey the stimulus which determines
motion and the stimulus which determines the evolution of
heat ? Or are the stimuli only quantitatively, not qualita¬
tively, different ? Or again, as I have suggested, is the
stimulus the same, but the “stuffs”—contractile and ther¬
mogenic -different, one impulse starting two kinds of cata¬
bolism, as when the same electric spark simultaneously
fires a mixture of two explosives? These questions are as
yet unanswered, though I am persuaded that tbe answer is
not far off. Meanwhile we have brought our argument to
this, that the heat production in the muscles, the chief
furnaces of fever, is probably carried on under the influence
of a twofold nervous mechunism: tbe one part exciting to
thermogenesis, accompanied by destructive metabolism; tbe
other Btaying thermogenesis, and subserving constructive
metabolism. The thermogenic tonus is the manifestation of
the normal balance between these two parts. In other
words, the character of the nervous mechanisms subserving
heat loss is paralleled by an analogous twofold character in
the nervous mechanism subserving heat production. The
relations of this nervous mechanism to the central nervous
system and to the thermotaxic mechanism will occupy us
in the next lecture.

ABSTRACT OF

¥tclnr*s

Olf THE

ACTION OF NERVE CENTRES AND MODES OF
GROWTH.

Delivered at the Royal College of Surgeons,
February, 1887,

By FRANCIS WARNER, M.D., F.R.C.S.,

HDirmiW PKOrBSSOK OV C0MPA.H4.TTVB AHATOMT AJCD PHYSIOLOGY
AT THB COLLEGE.

LECTURE III:

THE STUDY OP PATHOLOGY.

In studying any fact in physiology or pathology, as in
studying any scientific problem, we must first describe it in
exact physical terms, such as connote what may be observed.
In giving descriptions for scientific purposes it is advisable
to avoid using metaphysical terms, as also to avoid speaking
of pathological states as special entities. Let ns then seek
to describe pathological states in terms connoting facts
capable of Observation. The work in hand is divided into
two parts—to describe facts, and to seek their explanation
in the antecedents and sequents of these facts. The import¬
ance of pabulum and its supply in bringing about patho¬
logical processes has often been insisted on. I would insist
on the equal importance of the forces or stimuli incident to
the subject observed as necessary factors in determining the
action in it.

There we two great classes of pathological facts—those
indicated by movements (conveniently called “kinetic"),
and those indicated by acts of growth (conveniently called
“ trophic”). The results of movements are postures, which
may be represented by casts or drawings; the results of
growth, normal or abnormal, may be preserved in. the

d by Google

dr: Warner ; action op nerve centres and mode® op growth. [mabch 19, 1887 .

$562 The Lancet,]

museum. If the pathological fact to be studied is kinetic,
either active or in a state of equilibrium, we Analyse it as
we analysed movements and postures, and it will then be
found that in many cases both healthy and pathological
characters often depend upon the antecedents, upon the
surroundings, or upon the seqdents, rather than upen the
intrinsic attributes of the action. Similar relations between
normal and abnormal acts of growth will be demonstrated.
There is a very prevalent and apparently well-founded
opinion among biologists and pathologists that the modes of
action termed “reversion” are potent factors in the pro¬
duction of many of the conditions termed “pathological.”
This idea has principally guided investigation concerning
the action of the nerve system and the origin of morbid
growths.

I shall not attempt to prove any view, but put forward.
an hypothesis for the purpose of illustrating what I believe
to be the advantages derived from the definite observation
and study of movements. The theory may be advanced
that “ chorea is a condition of the brain analogous to that
found in healthy infancy, such brain state occurring at a
period of life when the force, generated by nutrition, is
greater than in infancy.” A reversion has been defined as a
repetition of a series of movements or trophic acts, similar
to a series previously existent; the criteria indicating
similarity have also been defined. The Child can never again
become an infant, but it may become “infant-like”; its body
is heavier and larger than that of the infant; its quantity of
nutrition and movement are greater. In chorea the reversion
is indicated by a repetition of the ratio of the attributes of
the infantile state; the ratio of kinesis to weight is repeated;
it is infant-like in the ratio of kinesis to trophic action.
The nerve centres are observed at two periods of life—
infancy and childhood ; comparison is made as to the
quantities and time of their action. Observation shows the
combinations of movements in the infant and in the choreic
child to be similar; there is said to be similarity as to the
parts and their order of acting. The quantity of movement
depends upon brain nutrition; the total quantity of nutrition
may roughly be estimated by the weight of the body—say
151b. in the infant and 451b. in the child; the nutrition,
then, in the child is three times as great as in the infant;
if the ratio of kinesis and nutrition Were maintained during
development there would be three, times as much move¬
ment in the child as in the infant. I believe this is not
usually the case, but as development advances kinetic action
is lessened in its ratio to other functions.. We say that in
health the ratio of kinetic action to nutrition lessens as
growth proceeds; if this ratio reverts to that of infancy
there will be an amount of movement altogether abnormal.
It seems to me that this reversion to the infantile ratio
between nutrition and movement is what we observe in
chorea. Lessened nutrition tends to produce reversion; in
chorea the weight falls, and the condition is not removed
till it is restored to near the normal; mitral regurgitation
tends to produce irregular supply to the brain.

Coma may be described in terms of lessened movements
and reflexes. All movements may be absent, except those
of organic life; the head is not turned towards a source of
light or sound; the word of command and pressure on the
chin are not followed by protrusion of the tongue; there
may be subsultus tendinum. The arm held passively free
falls into the posture of “the feeble hand” 1 [Further
illustration was given by a comparative study of hemiplegia
and hemispasm.] The nerve-muscular area is the same in
each. The decrease of quantity of motion in hemiplegia is
proportional to its increase in hemispasm, in the small and
large parts respectively. Fatigue and exhaustion of the
brain-muscular power on both sides is common; if, however,
one side of the body or one limb be powerless, there being
no evidence of organic disease, then the state is often called
“ hysteria.” It appears, then, that a bilateral diminution of
nerve foroe of short duration is less patliologioal than a one¬
sided weakness. In observing patients as to their move¬
ments and postures, note the action of small muscles—e.g.,
the intexoseei, causing lateral movements of fingers, as
distinguished from flexor movements produced by larger
muscles.

[Asymmetry of action was then dwelt upon; it was sug¬
gested that lateral curvature of the spine ofteh commences
thus. A nervous child was described.] Let the child stand up,
and observe the conditions of growth, make of skin, the

1 See Physical Sxpreuton, International Seienoe Serif*, chap. lx.

form of features; he ie often too tall and'too thin, the face
being lees emaciated than the body. Let the hands be held
Out; the left upper extremity is usually at a lower level;
“ the nervous band posture ” is probably seen on either side;
perhaps more marked on the left. There may be Anger
twitching, with flexor or lateral movements; the spine ie
arched too forward in the lumbar region, often with slight
lateral curvature. The face as a whole is usually too im¬
mobile, but there may be twitcbings of face, eyes, tongue;
&c.; the head is often flexed with inclination and rotation
to the same side. The teeth are often ground. 3

It has been demonstrated that ratios of growth have
much to do with the character and results of acts of growth ;
we are-thus led to seek examples where the pathological
Character of growth is due to the ratios of tuition. We saw
that many forces can regulate proportional growth; they
will be seen in some cases as the antecedents of pathological
processes. Hypertrophy or over-growth may be due to an
extra supply ox blood, as seen in Hunter's specimen of &
spur transplanted into the comb of a cock. Growth may bo
lessened by pressure, as in a Chinese foot, and in atrophy
resulting from pressure. Hypertrophy may reeult from
pressure, as in the large heart accompanying arterio-capillary
fibrosis. The leaf-stalk of Solatium jasaminoides become*
thickened by pressure when it has twined round a support.
Nerve force may regulate the quantity of growth. In anterior
poliomyelitis the muscles waste; occasionally in hemiplegin
the paralysed limb remains shorter in a child. It has been
said atrophy follows disuse of parts, and that hypertrophy
results when they are much used. [It was argued that
muscles often become atrophied when they receive too little
stimulus of nerve force, and that when Btrongly stimulated
by incident nerve currents their growth is increased thereby;
cases and examples were given in support of this view.] It
is necessary to inquire in this place, what is meant by “ the
use and disuse of parts.” The phrase is usually applied to
voluntary action, which is followed by increased growth ;
lessened growth follows from lessened stimulation by the
nerVe centres in disuse. In anterior poliomyelitis the
muscles waste because not stimulated ; in hysterical palsy
they do not waste because nerve-currents do reach them,
though not in quantity sufficient for motion. [Certain crns-
taceans from the mammoth cave were shown whose eyes had
been lost from their long residence in darkness; other mem¬
bers of the species, living in light, bad perfect eyes.] What
is called voluntary action appears to produce more growth
thau chores, athetosis, &c.; it is probable that in the former
cases the stimulation is greater.

We may next proceed to demonstrate that many unusual
or pathological Cases of growth may be due to the ratios or
quantities of growth. In the signs of old age we see altered
proportional growth; those first mentioned are almost
normal to the time of life; the latter are clearly pathologi¬
cal, as tending to destroy the life of the individual. At the
approach of old age we see diminished growth ; atrophy of
the hair of the scalp, the skin, muscles, and the heart, while
fat may either be absorbed or may accumulate about the
abdomen, &c. At the same time increased quantities of
growth may occur in the prostate, and in the hair bulbs of
the ehin of the female; while in some cases overgrowth i*
further seen in the development of epithelioma, sarcoma,
and cancer. [Examples were then given showing the resnlte
of varying ratios in the growth of different tissues.

Passing on to consider the causes of curvature in rickety
bones, it was suggested that some are produced by mechanical
strain, while others are due to unequal bilateral growth of
the shafts.] Curves which are only exaggerations of the
normal curves, and which are symmetrical, are probably duo
to unequal bilateral growth; such are seen in children who
have never walked and whose muscles are very feeble.
Further, in such cases the skull is often defective in form,
being a bony growth, but slightly acted on by muscles at
the part most misshapen. [It was shown that Glisson put
forward very similar views, and facts concerning the growth
of stems of plants were used as illustrations of the hypo¬
thesis. Defects in proportional growth are often seen in
teratological specimens; various specimens were shown in
support of this statement. In some cases there was a history
of inheritance of the deformity. It was argued that the
inheritance was rather that of a stimulus to nutrition than
of the pabulum; while in the case of an hypertrophied
kidney when its fellow had been destroyed by oaloulus, it

* See Analysis of Fifty-eight Cues, Brit. Med. Journal, Dee. 1879.

Tfw Laivohl,]

DR; J. WILLIAMSt ADDRESS AT THE OBSTETRICAL SOCIETY. [March 19.1887. 583

was an example of altered proportion of growth from over-
eupply of blood. Cases of coincident deformities were given,
and it was shown that often the brain is likewise defective.!

Analogies may be made as to the distribution or seat of
the parts affected by a pathological process. Many skin
diseases are maculated, affecting small loci of tissue sym¬
metrically or asymmetrically distributed. Among young
infants, in the spontaneous movement of many small parts,
we have evidence that separate scattered loci of brain tissue
are in action. Some processes are considered pathological
when asymmetrical, but not so when symmetrically dis¬
tributed. Sunburn is normal; freckles are less so; one-sided
pigmentation is abnormal. Tima is an attribute of acts of
growths that may give them an abnormal character—as late
or irregular dentition, the development of pubic hair before
adolescence, premature ossification of the skull, See. These
various considerations lead us to study the forces which
control the time, quantity, and kind of growth—e.g., the
effects of light, pressure, or meobanical irritation, &c. .

[In conclusion, it was shown that motor actions may be
described in terms of time and quantity of movements, and
growth in terms of time, quantity, and Kind of action in the
component parts, and evidence was advanced that the attri¬
butes which give special characters may be controlled by
physical forces.] _

Jnaupral Hirtoss

DELIVERED BEFORE THE

OBSTETRICAL SOCIETY OF LONDON,

By JOHN WILLIAMS, M.D., F.R.O.P.,

PRESIDENT OF THE SOCIETY.

-Gkntlbmbn, —I thank you for the honour you have done
me in electing me to this chair—a chair which has been
occupied by the greatest and best physicians practising
obstetric medicine in this country—an honour the greatest
which the Society can confer on any one of its members.
In accepting this high position, I feel I undertake a great
trust; for the work of this Society has had, has now, and
should always have, a great and beneficial influence upon
the progress of the science and the practice of the art
for the cultivation of which the Society mainly exists. 1
am, however, encouraged by my knowledge of the character
of the officers associated with me in carrying on the >vork
of the Society, as well as by my knowledge of the Fellows of
the Society, alike those who are regular attendants at its
meetings, and those who contribute to its Transactions and
take part in its discussions. I feel sure that I shall not fail
of the help of all.

My first duty on taking this chair is to address you—to
deliver an inaugural address, and I at once confess at the
very outeet that I have been perplexed and in difficulty. It
would have been no easy task to have written a contri¬
bution of a scientific character for discussion by the Society,
whenever I have ventured upon such an undertaking, it has
been with diffidence, and misgiving of the thoroughness of
my clinical and pathological observations, as well as of my
knowledge of the work of those who had preceded me; but
on those occasions I have been bnoyed up by the feeling
that what I was about to bring before the Society was
brought there to be tested, put to the proof, subjected to
your criticism, which I have always found to be not only
gantle, but geuerous also. To night, however, the circum-
eumstancea are changed. 1 have to speak ex cathedra, and
®is fact natnrally doee not give me greater freedom, but
rather increases my difficulties, for I feel that my utterances
«annot be corrected by your better wisdom. After the many
able and learned addresses which have been delivered from
this chair in the past, addresses which embrace almost every
topic of temporary or permanent interest in connexion witn
obstetric practice, it would have been difficult for me to
find a new theme for my discourse—unless, indeed, I had
chosen to discuss a purely scientific subject; and it would
have been equally difficult for me to tell you anything
new about an old one. On occasions like the present, how-
•ver r it cannot ba amiss to take observations and determine

the place to which we have steered or drifted, and 1 would
look back, not at the history of this Society And its work
only, but at the history ana progress of obstetric science
and practice, and I would do this not tnerely with a view
to recount our triumphs, to survey our acquisitions, and lose
ourselves in admiration of our brilliant achievements, but- -
which may perhaps prove more profitable—to recall to mind
our defeats and failures, inquire into the causes of our
disasters, and bold up to the light our errors in the past, so
chat they may prove of some use at least as beacons to point
out the places where we departed from the path of truth, and
to warn us against the will-o’-the-wisps which have been but
too often mistaken for the light of science. 1 would look
around with a view to examine the position we at present
occupy, and I would look forward with the object of
planning the best course for our progress in the future. As
it would be impossible for me in the time at my disposal
to discuss these subjects even in the briefest manner, I shall
confine myself to a few observations which appear to me
to be not uncalled for at thejpresent time.

Obstetrio medicine is divided into two branches—mid¬
wifery and the diseases of wotnen. Great activity has been
shown in both branches during the last thirty years, and
great progress has been made. The estimate which is
generally made of this progress is, however, of a one-sided
character. . The progress of midwifery has rarely been
referred to; it has been overlooked, though not entirely;
and yet to an impartial judge there can be no doubt about
its extent and character. Indeed, to my mind, and td the
minds of those who regard the saving of life as the crown
of our work, the progress of our knowledge in midwifery
has been far greater than in the diseases of women. Our
knowledge of the use and application of the forceps, of the
mechanism of labour in distorted pelves, and of pelvic
measurement, And the means at our command for abolishing
Craniotomy, have saved many lives. And what shall I say
of the introduction of antiseptics into the practice of
midwifery? Forty years ago Semelwelss issued a few
rules to be observed by the students attending women in
labour in the Vienna Hospital. This proved to be the
beginning of the greatest apd most' beneficent practice
introduced into our department of medicine in this century.
The work begun by Semelweiss has been crowned by the
researches of Pasteur and Lister, and to-day we are in
possession of the means to prevent the greatest scourge
that afflicts lying-in women. "When we compare the
number of women who pass through the danger of childbed
with that of the fit subjects of obstetric surgery, the latter
sinks almost into insignificance, and the magnitude of tbe
means placed in our hands for the prevention of puerperal
fever looms high above that of all other possessions of tbe
obstetric phyweian. I fear that this has been too little
recognised by all who attend midwifery, for the strict use
of antiseptics confers an infinitude of blessings upon the
physician and upon his patients.

If we cast a glance at the history of that branch of
obstetric medicine which deals with' the diseases of women,
the fact which strikes us first of all is the marked change
which has come over it during the last thirty years—the
surgical character which has Men given to it. I am not
going to recount to yon the triumphs of abdominal and
pelvic surgery. It has been done often, and indeed almost
periodically, by tboSe more fitted for tbe work than I.
Their magnitude and their beneficent character are evident
to us all. But all tbe pelvic and uterine surgery of the past
cannot be described as triumphs. Much of it has better
claims upon the term “disaster.” There is hardly a malady
ranged among the diseases of women, from the most trifling
to tue most severe, from vaginismus to uterine cancer, for
which some surgical proceeding has not been suggested.
This extraordinary state of things prevails nowhere else,
and how is it to be accounted for ? Is it to be ascribed to
the failure of medical science, or to the slowness with which
medical treatment accomplishes its objects ? Is it due to
impatience and harry on the part of the practitioner?
Does it arise from a plethora of surgical genius in our
department? Or may not other causes play an important
part in bringing about tbe preeent phase of the practice of
the diseases of women ? As with the diseases of other parts
of the body, many of those which affect tbe female pelvic
organs are, we readily confess, not amenable to treatment
of a medical kind, and in some of these the art of the
surgeon intervenes rightly and beneficently. There are
others, again, in whion the art of the surgeon has been

Digitized by L^OOgle

[March 19,1887.

664 The Lancet, 1 DR. J. WILLIAMS: ADDRESS AT TftE OBSTETRICAIi SOCIETY.

practised ia vain or with evil consequences, but which have
been subdued by the skill of the physician. There are
others, again, wnich are cured neither by the skill of the
physician nor by the dexterity of the surgeon, and this fact
we should not have the obliviousness to forget nor the reck¬
lessness to overlook in practice. Hitherto surgery has
proved of the greatest use in the removal of excrescences
and the repair of injuries. When it has ventured beyond
this, has it not been productive of more evil than good ?

We are next struck by the number of operations which
have been devised, suggested, and practised, by the extra¬
ordinary divergence of opinion held by authorities with
regard to their value, and by the number of them which
have been practised for a time and then have been entirely
or almost entirely discarded. This is a state of things which
obtains in no other department of medicine or in the surgery
of any other part of the body. The practitioners of obstetric
medicine are divided and subdivided, and the various
groups which they form are separated by impassable gulfs;
they pursue diverging lines and continually increase the
distances separating them from one another; and there is
no chance of their ever meeting except by retracing their
steps. What are the causes of this deplorable state of
obstetric practice? Have the many operations which have
been proposed and practised been based upon carefully
ascertained data—data acquired by honest scientific labour ?
Or have they been based upon hypotheses—the offspring of
a too active imagination ? Or have those who have been
opposed to the present surgical mode failed to appreciate
ascertained scientific truths ? It would not be possible for
me under any circumstances, perhaps, to answer these
questions fully, and now I can only refer to one or two facts
which have a bearing upon the answer. The fact that
many operations which have been proposed and practised
have proved useless or injurious and have been discarded,
indicates that such operations were proposed on insufficient
and untenable grounds. This will appear beyond doubt if I,
remind you of the history of vaginismus and dysmenorrhoea.
The operations proposed for the cure of the former have en¬
tirely failed! And how many a hypothesis has been started—
with unfortunately its usual appendage, an operation—with
regard to the etiology of dysmeuorrhoja, and raised to the
rank of a theory without even the shadow of a foundation’
What disasters have they led to, and how barren of good
results have they proved! There can be no objection to
hypotheses as such—they are essential to scientific research;
but they should be made to be tested and not acted upon, to
discover truth and not to be taken for it. It appears to me
that the present surgical aspect of obstetric medicine arises
chiefly from the promulgation of flashy hypotheses and their
acceptance as established truths. The mischief arising from
the too ready acceptance of surmises cannot be exaggerated,
and I will give you a further illustration of it from the other
branch of obstetric medicine. About a quarter of a century
ago Dr. Braxton Hicks enunciated the scientific method of
treating placenta prsevia. For nearly five-and-twenty years
this was overlaid by a mass of teaching based upon false
hypotheses and exceptional occurrences, and has onlyrecently
been rescued from beneath the mass of error and reintroduced
to us through the exertions of a German explorer. Hypo¬
theses and their ready acceptance have been the bane of
obstetric science during recent years. We should prove all
things, and especially hypotheses burdened with operations.

Although what I have mentioned is probably the chief
cause of the surgical aspect of practice in the diseases of
women, yet there are other causes for it, and I would men¬
tion one of them—namely, the wonder-inspiring character
of many of the operations practised for pelvic diseases. This
is the side of them which appeals to the public, and unfor¬
tunately also to a large number of the profession. Like the
most dangerous feats of the acrobat, they appeal irresistibly
to a quality of mind which is far from uncommon.

If we look around us and glance at the present, we find
untiring activity every where — sometimes well directed,
sometimes not. In France excellent work is being done;
Germany sheds abroad the facts gathered in her large lying-r
in charities and her laboratories; and the Transactions of
this Society and those of its sister societies in Scotland and
Ireland attest the amount and excellence of the clinical and
pathological work done in this country. To America we
■ owe much that is excellent in midwifery and in the treat-
i ment of disease. In that great country much of the energy
| of the profession is, however, devoted to the impossible—to
. Getting the coping-stone before the foundations have been

laid. At the same time, we rejoice that many of our
brethren there are devoting themselves to clinical and.
pathological work. But there is one phase of the work done-
in their obstetrical societies which I cannot pass by without
an expression of regret, and that is the practice of publishing
imperfect reports of operations before the results, immediate
and remote, of the operations are known. I can conceive no
good to result from publishing operations on a Thursday
which were performed on the previous Monday. Indeed, 1
know of no practice so likely to be productive of unalloyed
mischief. It is a practice which I trust will never be intro¬
duced into our Society. If it is intended to benefit science
by it, the intention must fail; and if it be for the purpose
of mere advertising, I have no words bitter enough to express
my contempt for it. Were this Society a mere advertising
medium, I would neither hold office in it nor be a member
of it for an hour. It is, however, an excellent publishing
medium, and it is right that it should be such. We do not
light a candle and place it under a bushel; nor do we bring
new facts and new discoveries into this room to hide them*
but for the enlightenment of one another and of the profes¬
sion. My faith in this Society and my hope for its future are
not based upon its excellence as an advertising medium, but
upon the number of the scientific workers among its members.
These are increasing, as is attested by the number of papers
in the hands of the secretaries and the pressure on our time
and space. And what is the work before us in the future ?
Is it the cure of disease and the relief of suffering? Yes.
Is it the discovery of new drugs and their effects? Tea¬
ls it the improvement of obstetric surgery ? Yes; all this and
a great deal more. The present surgical aspect of the treat¬
ment of diseases of women is surely destined to pass away; it
cannot be permanent. Were it otherwise, we should have to
confess that medical science has proved a failure. Mutilation
is not the highest goal to which medical and surgical skill
can reach. A time will come when obstetric science will
assume a preventive character. Although we cannot hope
to abolish disease, yet we may be able to discover the means
of preventing it, and perhaps of curing it without the aid of
Burgical art in its present mutilating character. We are
already possessed of the means of preventing a large number
of the chronic diseases and sufferings of women in the
application of antiseptics to midwifery. This gives us the
control of a large class of the inflammatory affections of the
pelvis. Forty years ago the idea of preventing or abolishing
puerperal fever and puerperal inflammations would have
been scouted as Utopian, and who knows but that forty
years hence some president of the Obstetrical Society may
not be able to announce to his audience that obstetricians of
that day possessed the means of preventing the growths of
ovarian tumours or of fibroids or of cancer?

The progress of our science is not to be limited. It is not
to be made, however, by happy guesses, but by steady work,
and in no long time by co-ordinate work. Facts of all
kinds, great and small, are to be accumulated. The present
surgical activity would, if rightly employed, prove of
service in bringing about the time I anticipate, and its own
extinction, by making known facts which cannot well be
otherwise discovered. No operation should be performed
for cure simply, but also for investigation. No operation
should be performed without a reasonable chance of cure or
relief. Many of the operations now performed can be
reasonably regarded as experiments only. If they can be
justified at all, they can only be justified when done under
the strict conditions of an experiment. Unfortunately, how¬
ever, we know but little of the real results of operations of
doubtful utility. But the help of surgery of a debatable
character is not the only or chief means of sound progress
This has always been, and will be in the future, the result
of patient watching by the bedside and careful observation
of disease extending over years, and by continuous work in
the laboratory. It will also be the work of the profession
as a whole. It cannot be accomplished by the hospital
and consulting physician and surgeon alone; it requires
the help of the family doctor, of the town doctor, and of
the country doctor. Each one has his work to do. As a
rule, passing phases of disease only come under the obser¬
vation of the hospital physician, while the whole course of
it pasges under the eye of the family doctor. Many of the
diseases peculiar to women are of a very chronic character,
and, as in other branches of medicine, their source is to be
sought, in antecedents long passed which come under the
ken of the family practitioner only. But the country
doctor has his part to do in this work. It is only by

fn LiiqB .

r~ - i ~ . »' ’ "I Jf

DR. T. J. MACLAGAN ON PYBgXU A^P HYFBBPY&RflA. [March 19,188T. 5Q5

eeaearch everywhere, ia town, in country, in patient* of
different occupation* and different constitutions, that the
necessary facta can be obtained, and the country doctor is
ip this respect placed at an advantage over, his town
brother, although in other respects he may be placed at a
disadvantage. This Society should gather facts from a)l :
•quarters and from all sorts of practitioners—all kinds of
facts bearing on health. and disease, I have pointed out to
tqu fields where each one ®f you may by. patient work attain
distinction and become contributors towards the progress
of the science which we cultivate. To this work! invite
.-you, and while I occupy this chair I shall welcome with
•equal partiality every fact—'the smallest and the greatest—
Which is calculated to contribute towards,,the object which
*we have in view.

PYREXIA AND HYPERPYREXIA.

Br T. J. MAOLAG'AN, M.D., M.R.C.P.,

WHrSICIAX IT ORDINARY TO THKTR ROtAI, HIOHKRS9R9 PRIRCR A1
PIURCRSS CBRUTIAR 07 »0H»MW1O HOLSTSEf.

(Continued from jlage 81*'.)

With distinct evidence that paralysis of certain parts of
the body may occur without any organic lesion to -account
for it, there is no ground for claiming for the thermic centre
immunity from such disturbance, and there is much evidence
to show that it enjoys no Buoh immunity. With that pvi-
•dence we have now to . deal. We shall consider it as it
presents itself in hysterical pyrexia* in the hyperpyrexia of
heat apoplexy, and in that of acute rheumatism.

Hysterical pyrexia and hyperpyrexia— The name here
expresses all that we really know about this condition.
•Cases are on record in which hysterical symptoms have been
.accompanied by a rise of temperature for which no explana¬
tion could be found. With distinct evidence that hysteria
may cause paralysis of a limb, of the vocal cords, and of the
^bladder, we need have no difficulty in admitting the possi¬
bility of its causing impairment and even paralysis of the
thermic centre. The essential symptom of such a condition
•would be rise of temperature.

Heat apopltxy results from exposure to heat In the
•fully developed disease there is complete insensibility with
a very high temperature; but the onset of this alarming
•condition is generally preceded for some days by headache,
giddiness, restlessness or other evidence of disturbance of
the nervous system. That continued exposure to a high 1
temperature is likely, in a native of a temperate climate
■unaccustomed to such exposure, to cause disturbance of
the thermal apparatus there' can be no doubt; and a brief
•consideration of the mode in which this disturbance is
likely to be brought about makes it apparent that such
■exposure, if sufficiently great or long conunned, may cause
paralysis of the heat-inhibiting centre, aud consequent great
rise of temperature. Heat is an excretory product re¬
quiring to be eliminated; its main channel of elimination
•is the skin; a high temperature of the atmosphere
necessarily interferes with such elimination, because in such
an atmosphere heat cannot readily be thrown off. Heat
elimination being thus checked, and heat production con¬
tinuing as usual, heat must accumulate in the system, unless
some agency steps in either to increase the former or
•diminish the latter. Under ordinary circumstances nature
provides the remedy: for the same atmosphere which makes
meat elimination difficult causes also increased activity of
the skin, aud so to some extent meets the difficulty which
itself creates; while the general influence of residence in a
hot climate leads to habits of life which diminish beat pro¬
duction : thus the risk of heat accumulation is diminished
at both ends. But circumstances every,now and then arise
■which break through these habits. Such circumstances are
those which call for exposure and muscular effort during the
4ieat of the day, as in the case of soldierB on the march.
Tissue metabolism and heat production are stimulated, while
the body is exposed to a temperature which makes impos¬
sible a corresponding increase in heat elimination. Under
«uch circumstances, the only way in which the danger
attendant on undue accumulation of heat can be warded off
-is by restraining heat production, and this end can be
Attained only by inoreased activity of the heat-inhibiting
« 0 htre. Heat is the natural stimulus of that centre,, and!

[_accumulation of beat in the system naturally excites it to
increased effort. But the call may be beyond its powers to
meet: it continue? to make the effort and struggles to keep the
temperature down,till over-6timulation leads to exhaustion ;
its efforts become feebler, and ultimately, paralysed by
fatigue, it ceases to act. Thus is removed the last safeguard;
heat rapidly accumulates in the system, and heat apoplexy,
l with its attendant hyperpyrexia, results. What takes place
in the thermic centre under such circumstances is the exact
analogue of what takes plluse in the respiratory centre,
when, under allied circumstances, carbonic acid accumulates
in the blood. The flret effect of increase of carbonic acid in
the blood is to stimulate the respiratory centre and cause
inoreased frequency of respiration. If the gM goes on
accumulating, that centre begins to show evidence of fatigue,
and the respirations become slower and more laboured, the
interval between them becomes wider, and filially they cease
altogether, the heart continuing to beat for some time longer.
The cause of their cessation is paralysis of the respiratory
centre, induced by accumulation of carbonic acid, the natural
stimulus of that centre. In the same way, accumulation of
heat in the system causes first stimulation and ultimately
paralysis of the thermic centre ; and thus we explain the
great rise of temperoture in heat apoplexy. Post-mortem
examination of fatal cases shows only a tendency to rapid
decomposition, a fluid condition of the blood, and more Or
less congestion of the luhgs.

Rheumatic hyperpyrexia— Every now and then cafies of
acute rheumatism occur which, afterpresenting the symptoms
of the malady in their ordinary form, Suddenly develop
alarming nervous symptoms, with a temperature rapidly
rising to 108°, 109°, 110°, and even higher, and a tendency
to death by coma. How ia this great rise of temperature
brought about ? 1. It might be merely an exaggeration of
the ordinary pyrexia of the disease. 2. It might result
fropi a direct paralysing action of the rheumatic poison on
the thermic centre. 3. It might be produced in the same
way as heat apoplexy, by over-stimulation of the Inhibitory
centre, resulting in paralysis of heat inhibition, and conse¬
quent rapid rise of temperature.

A very little consideration suffices to show that the first
hypothesis is npt adequate. 'Were the hyperpyrexia of acute
rheumatism merely an exaggeration of the ordinary pyrexia
of the disease, cases in which it occurs would be charac¬
terised by inordinate severity of the rheumatic symptoms.
But such is not the case. In caees which become nypef-
py^etic the disease up to the onset of the hyperpyrexia pre¬
sents no unusual,'features. The temperature, the joint pains,
the acid sweats, the heart complications, are all such as are
met with daily in ordinary rheumatic attacks; and there is
nothing in their symptoms to lead the physician to anticipate
so alarming a complication.

The hypothesis that it may result from paralysis of the
thermic centre consequent on the direct toxic action on that
centre of the rheumatic poison, or some product of the rheu¬
matic process, is one regarding which no more can be said
than that it is possible. Against it may be adduced the
argument that were such the mode of production of rheu¬
matic hyperpyrexia, that condition would arise more fre¬
quently than it docs. The rheumatic poison and the pro¬
ducts of the rheumatic process operate in every case, but
hyperpyrexia is of rare occurrence.

The third hypothesis is one for which more may be said,
for between beat apoplexy and rheumatic hyperpyrexia there
are many points of analogy. The symptoms and clinical
features of both are very much alike, ana the description of
the post-mortem appearances observed in the one serves
equally to describe those noted in the other. In each the
tendency is to death by coma. Treatment, too, is the same in
both. The main difference between them is in the circum¬
stances which lead up to their occurrence. With so many
points of resemblance between them we cannot but look for
a common mode of production, some common pathological
bond. The question for consideration is the possibility of
the rheumatic process, ns it exists in acute rheumatism,
producing the same result os we find follow exposure to
great heat. This latter acts by oyer-stimulating, fatiguing,
and finally paralysing the thermic inhibitory centre. The
question before us, therefore, narrows itself into a con¬
sideration of the point as to whether or not over-stimulation
and consequent fatigue of the heat-inhibiting centre is a
possible result of the process of acute rheumatism. Wide as ia
the difference between that process and great heat, and great
aa seems the improbability of two suen different agencies

[Mabch 19,1887.

DR J. WARD COUSINS: NEW PELVIC tOURNlQUElt.

*’566 The Lancet,]

producing the same effect on the system, a careful considera¬
tion of the facts nevertheless leads to the conclusion that
such result is not impossible. Certain it is that if over-
stimulation of the thermic inhibitory centre could be a
result of any fever, rheumatic fever is the one in which it
would most likely manifest itself, and that for the following
reasons:—

In all fevers the rise of temperature results from in¬
creased tissue metamorphosis, as will be presently explained.
This is the case in rheumatic fever, as it is in typhus, typhoid,
and other fevers. But the circumstances under which that
increased metabolism takes place in rheumatic fever are
altogether peculiar to itself, and the peculiarity of these
circumstances it is which leads up to the phenomenon which
we are now considering—the greater tendency to the occur¬
rence of hyperpyretic complication. Nearly every form of
fever has for its essential and characteristic feature the
occurrence of some local lesion—of some affection, generally
inflammatory, of one particular organ or tissue of the body.
The characteristic lesion of rheumatic fever is inflam¬
mation of the textures of the motor apparatus of the body.
Part of this motor apparatus—viz., the muscles—is the chief
seat of heat production. The more active the metabolism
of the muscles, the greater the amount of potential energy
produced. This potential energy may take the form of
work or heat. As a matter of fact, it generally assumes the
form of work, for it is when muscles are actively contract¬
ing that this potential energy is chiefly formed. But if the
same metabolic changes which take place in a contracting
muscle were to take place in that muscle when quiescent,
the potential energy would take the form, not of work, but
of heat.' This is what occurs in acute rheumatism. The
rheumatic poison causes a general febrile disturbance, ac¬
companied by inflammation of the fibrous textures of the large
joints. Inflammation of these textures is of course accom¬
panied by increased flow of blood to, and increased meta¬
morphosis in, them. Apart from the muscles with which
they are connected, the fibrous tendons and ligaments have
no function, no raison d’etre. 8o intimately are the
muscles and the textures involved in acute rheumatism
connected in their function, in their innervation, in
their vaso-motor and blood-supply, and in all that con-,
cerns their vital activity, that inflammation of the latter
could not fail to produce in the muscles some degree of
the same increased tissue change, the same abnormal
metabolism, which is taking place in the fibrous textures
as the result of the action of the rheumatic poison. This
is not mere hypothesis, for we have distinct tangible
evidence that there does occur in acute rheumatism such
increased metabolism of muscle as is usually associated with
active exercise. This evidence is the persistent presence in
the system during the course of that disease of an excess
of lactic acid. That acid is a metabolic product of muscle;
it is formed in increased quantity daring muscular
exercise; and its constant presence in excess in the coarse
of acute rheumatism is distinct and clear evidence that
that disease has for one of its phenomena increased meta¬
bolism of muscle. It is the only form of fever in which
such evidence exists. Muscle being the chief seat of the
formation of heat, and the metabolism of muscle being the
chief source of heat, it follows that the disease in which
such metabolism is most active is also that in which most
heat will be formed. That disease is acute rheumatism.
Theoretically, there is thus reason to believe that heat pro¬
duction is more active in acute rheumatism than in any
other disease; and there is also practical evidence that such
is the case. The natural result of increased formation of
heat is its increased elimination. The skin is the channel by
which heat is eliminated. We accordingly find tbkt profuse
perspiration, the evidence of excessive action of the skin,
forms one of the characteristic features of rheumatic fever. ;
It is the only form of fever which is so characterised. Ex- !
cessive production is thus met by excessive elimination of .
heat, and no undue rise of temperature occurs.

But another result of such increased activity of the heat- ;
producing process must be stimulation of heat inhibition. :
The function of the thermic centre is to restrain excessive
formation of heat; that function is therefore likely to be ,
called into more active operation in acute rheumatism than
in any other disease. It might happen, either from want
of vigour or from unusual susceptibility of that centre, aided
possibly by more or less failure in the heat-eliminating
action of tne skin, that heat production was in excess of
heat elimination. Under such ci’-''" r nstances heat would

accumulate in the system. The thermic centre would
first stimulated to excessive effort, then fatigtied, and finally
paralysed, as in heat apoplexy, and hyperpyrexia would
result. That is a sequence of events which might occur in
. any form of fever or in any ailment, accompanied by in¬
creased activity of the heat-producing process. The more
active that process the more likely is it to happen. Acute
rheumatism, being the ailment m which heat is most
abundantly and rapidly formed, is also the one in which
inhibition is most likely to be over-matched. Hyperpyrexia
is therefore more common in it than in any other form of
fever.

It is evident that the neurotic theory of fever rests on a
very adequate basis, and affords a reasonable explanation of
the rise of temperature noted in many morbid conditions;
and that it specially affords of the occurrence of the very
high temperature of hyperpyrexia an explanation which, if
not the only one possible, is at least more satisfactory than
that offered by any other theory. But, adequate as this
theory is—nay, necessary as it is—to the explanation of the
rise of temperature noted in the ailments to which reference
has hitherto been made, we must be careful not to let our
advocacy of it carry us too far, or to try to explain by it
the rise of temperature of ailments whose pyrexia can be
better and more satisfactorily explained on tne combustion
theory. As already said, the neurotic and the combustion
theories are not antagonistic. Each has its own special
sphere of application. The most important and typical
examples of neurotic pyrexia have already been instanced.

The maladies to the explanation of whose pyrexia the
combustion theory applies are more numerous and im¬
portant. To consider them all would be impossible here,
and would not lead to a clearer understanding than the plan
which we shall adopt of illustrating, this theory by im¬
portant and typical examples. For this purpose we Bhall
take the specific fevers. They are chosen— (I) because they
are the most important group of diseases to which man i»
liable; (2) because they are the maladies in which the
evidence of increased tissue metabolism is most marked;
(3) because the febrile process can be more conveniently
studied in them than in any other maladies; and (4) because
we know more about the nature of the cause (the specific
poison) which gives rise to them than we do about the cause
of most other febrile ailments, and can therefore more
readily investigate its probable mode of action in tho
production of febrile disturbance.

{To be continued.)

NEW PELVIC TOURNIQUET FOR AMPUTA¬
TION AT THE HIP-JOINT AND
OTHER OPERATIONS.

Bv JOHN WARD COUSINS, M.D.Lond., F.R.C.S.,

SEKIOB SURQKOK TO THE ROYAL PORTSMOUTH HOSPITAL, AHD TO THE
PORTSMOUTH AKD 80UTH HARTS EYE AXD EAR IR FI KMART.

Thb recognition of the operation of amputation at the
hip-joint as a surgical proceeding occurred about the end of
thelast century, and in the pre-ansesthetic period the effectual
restraining of haemorrhage was always a matter of difficulty
and danger. During the last few years the operation has been
widely practised, and various methods have been employed
by surgeons for controlling the circulation through the limb
1. Digital compression of the femoral and external iliac
arteries. When the flap operation is performed, this mani¬
pulation must be entrusted to a steady assistant who can
undertake to follow the knife and to grasp the end of the
vessel as soon as it is divided. An operation rendered
tedious from any cauee is sure, however, to excite painful
weariness of the hand, and sometimes even severe cramp
from prolonged muscular tension. Except for operations
upon children, digital compression ought now to be regarded
only as an auxiliary measure. 2. External compression by
means of a rigid tourniquet. For this purpose Lister’s aortic
compressor has been very generally employed. It consists
of a bar of steel shaped like a horseshoe, having at one
extremity the spinal pad, and at the other a rod working
through a female screw and carrying the abdominal pad.
The application of this method is certainly not free from
risk. The pressure of the instrument over the eentre of the

Tot Laxcbc,]

ME. N. ALOOOK: INFLUENCE OF ALTITUDE ON PHTHISIS.

abdomen interferes with the movements of respiration; at the
same time, the occlusion of the vessel by the force of an unyield¬
ing screw involves the bruising of internal structures and the
dangerous compression of important organs. 3. Internal
compression of the iliac artery through the rectum. The
rectal lever, recently introduced by Mr. W. Davy, is a very
powerful instrument for controlling the circulation, and in
the hands of the inventor it has been used with marked
success; still, it is my opinion that it can never receive
universal adoption. The finger cannot guide the rigid
extremity of the instrument, and the greatest care and
dexterity are insufficient to protect the pelvic structures
from the dangers of contusion and injury. 4. Elastic com¬
pression of the iliac artery over the pelvic brim, and
simultaneous pressure upon the posterior vessels at the
sacro-sciatic notch. This excellent method is the invention
of Mr. Jordan Lloyd of Birmingham. It can be effectually
carried out by one assistant, armed with a calico roller, a
piece of indiarubber bandage, and a safety-pin. From my
own experience, I regard this form of elastic compression as
far preferable to all the other devices which have been
hitherto employed for the purpose of preventing haemor¬
rhage during hip operations; and I venture to express the
opinion that it is destined to obtain general adoption in
tne future.

The pelvic tourniquet represented in the engraving has
been designed for the purpose of facilitating the practice of
elastic compression. It is a modifi¬
cation of the elastic cord tourniquet
introduced by me some years since.
It does not require the hands of an
assistant to keep it in a state of
tension, and the pressure of the
cords over the compressor can be
regulated with great exactness. The
instrument consists of three parts:

1. A metallic clamp by which the cord
is instantly tightened and loosened.

2. An endless elastic cord with a
mark at the spot where the clamp is

to be attached to it. 3. An iliac compressor consisting of a
well-padded wooden block, with grooves on its upper surface
for holding in position the elastic cords. (See Fig. 1.)
The compressor can be elevated and depressed by the

action of a central screw and two powerful recoil springs.
(See Fig. 2.)

The metnod of application is very simple. After fixing
the clamp on the cord, and emptying the limb of blood by
elevation and friction, the patient must be turned over to
the opposite side, so that the cord may be accurately ad¬
justed, and the abdominal organs displaced out of the way
of the compressor. The centre of the elastic ring is now
inserted between the thighs—one loop is passed behind the
tuberosity of the ischium, while the other loop, carrying the
clamp, is placed in the grooves on the compressor. Both
loops are now drawn upwards and outwards, and when
they are sufficiently tightened the clamp is shot above the
Jrestof the ilium. The external iliac artery can now be
completely occluded by releasing the screw, at the same
time the posterior vessels are controlled by the cords at the
sacro-sciatic notch. Sometimes it will be found convenient
to place the compressor in position under the cords after the
closure of the clamp. The pelvic tourniquet Is neatly made
for me by Messrs. Arnold and Sons of West Smith field.

SobUmbu

tM4BCHl9,1887. 567

THE INFLUENCE OF ALTITUDE ON • ,
PHTHISIS.

Bv NATHANIEL ALCOCK, L.R.C.S.I., .

8UROEO*-*AJOF, XXD1CXL BT Alt.

lx the third volume of Frofessor Hirsch’s great work,
“Handbook of Geographical and Historical Pathology,” it
is shown that while the influence of latitude upon phthisis
is scarcely appreciable, than • of altitude ia most. striking.
The explanation^ hitherto offered of the action of altitude
upon phthisis amount to three: greater expansion of the
chest from aerial rarefaction; absence of bacterial organisms
from the air; and general tonic effect. 1 Were the first of
these effective, some improvement would be expected to
follow the use of gymnastics at lower levels; of tne second
it may be said that every consumptive carries his own
microbes with him ; and the third is too vague,tp need dis¬
cussion. It may therefore be assumed that no satisfactory
explanation has as yet been suggested. The specific
organism of tubercle has an established identity; con¬
sequently, the disease must be ranked among the special
infections, and its aggravation or arrest must depend upon
the fertility or sterility of the microbe to which it is
due.

Pasteur, in his splendid researches on the poison of splenic
fever, hcs shown that “splenic fever can never be taken by
fowls; in vain are they inoculated with a considerable
quantity of splenic blood.” “ Now, the temperature of birds
being between 106° and 108°, may it not be," said Pasteur,
“ that the fowls are protected from the disease because their
blood is too warm? A hen was taken, and, after inoculating
it with splenic fever blood, it was cooled down to 100°. Ac
the end of twenty-four hours the hen was dead. Again, a
hen was inoculated, subjected like the first to cooling, and
When the fever was at its height it was wrapped in cotton¬
wool and placed in an oven at 95°. In a few hours it was
fully restored to health. Hens killed after having been thus
saved no longer showed the slightest trace of splenic
organisms.” Thus it is proved that the microbe of one of the
moat virulent diseases reaches its condition of highest life
and greatest reproduction in blood at a temperature of about
100°, but that in the same blood at 107° it ceases to exist.
Presumably, then, if the subjects of some forms of bacterial
infection could survive a proportionate elevation of tempe-
perature, they too would overcome the poison.

The question here arises, Are there any conditions in which
the blood of a living man cari be made to assn Tne the
molecular action equivalent to a temperature of 105° while
the animal heat remains at 98° ? Clearly such is quite
possible by diminishing atmospheric pressure while the
temperature remains fixed. We know that it would be quite
impossible to boil water at the sea level with 199° of heat,
but that if the water beremovedtoSt. Gothard, 6808 ft. high,
boiliDg will at once take place. Professor Thomson, in his
opening address at the British Association, said: “ It is scarcely
possible to help anticipating in idea the arrival at a complete
theory of matter, in which all its properties will be seen to
be merely attributes of motion.” It is already accepted that
the only difference between the liquid and gaseous states Is
that of molecular motion. Consequently, if 199° of heat can
make water boil at St. Gothard, it is apparent that this
temperature can there produce an amountof molecular motion
which not lesstban212°couldexcite8tthe sea level. Further,
as 199° ia to 212° so ia98’4° to 104-8°; therefore the rate of
molecular motion to which a temperature of 96-4° would

f 'ive rise at St, Gothard could only be attained at the sea
evel as the result of a temperature of 104-8°.

Professor Clifford has shown that “the energy of the
single particles is always proportional to the temperature
of the gas,” provided the pressure remains unaltered. Con¬
sequently, since the condition of every organism is but the
aggregate of its ultimate atoms, if a man whose temperature
at the sea level is 98"4° be removed to 8t. Gothard, it is
evident that both the gaseous and liquid molecules in his
blood must attain a rate of motion corresponding to what
would have been produced at sea level by a temperature of
104 - 8°. But the experiment of Pastenr has demonstrated
that the optimum temperature of certain infecting organisms
ia about 100°, and that when the vibration-rates equivalent

' Thk LaXcbt, Jan. 8t*i. 1887. s

■ ■ Dialed bA^OOSie

DR. G. GRANVILLE BANTOCK ON ABDOMINAL SECTION.

[Mabch 19; 1887.

568 Thb Lancbt,]

to 106° or 107° are communicated to their constituent
molecules, disorganisation follows. Hence it is intelligible
that, if a consumptive patient whose temperature at sea
level is 98*4° be raised to an elevation of 6000 ft., such
alteration of molecular motion will take place in the blood
as to be incompatible with the healthy existence and effective
reproduction of the tubercular microbe; in fact, the p^tiept
will be placed in the position of the bird to the splenic
fever poison. If this reasoning be sound, wide is the vista
with regard to the epidemic levels of yellow fever, malaria,
oholera, See., which it must open up, and strange the

S 'bilities which might result from the artificial pro-
on of the required conditions.

Military Prison, Dublin.

ONE HUNDRED CONSECUTIVE CASES OF
ABDOMINAL SECTION.

By GEO. GRANVILLE BANTOCK, M.D., F.R.C.S. Ed.,

BURSKOX TO THE SAMARITAX FREE HOSPITAL.

{Concluded from page til.)

Hydatid* of the peritoneum .—The patient was a young
single woman, aged twenty-five, by occupation a cook.
When admitted in May, 1886, she gave the following
history. She had been aware of “ a lump in the stomach "
for six or seven years. Three years and a half ago she had
retention of urine, which was relieved by passing the
catheter two or three times. She then entered a suburban
hospital, where she was told she had a tumour. Nine months
ago she had a child, and since that time the increase in the
sire of the tumour had been very marked. On opening the
peritoneum, it was at once evident that I had to do with a
case of hydatids—which I may say was suspected. The in¬
cision was enlarged to about 4 in. to admit of extraction of
the different tumours before separating them from their
connexions with the omentum, &c. 1 began by breaking
down the connexions of the largest cyst, but they were so
firm and the bleeding so great that I was obliged to resort
to the method of ligaturing first and then cutting. In all, I
removed about half a dozen cysts of various sizes, from
that of a hen’s egg to that of a small cocoa-nut. One of
medium size occupied the right half of Douglas’s pouch,
where it hung pendulous with a slender attachment to a
tag of omentum, where it was felt before operation, and
regarded as an enlarged ovary. Down in the left iliac
region, one, as large as an orange, lay amongst the coils of
intestine. On seizing the exposed portion ol the cyst wall
between the finger and thumb, it at once gave way, and
many daughter cysts, from the size of a pea to that of a
walnut, escaped amongst the intestines and were with diffi¬
culty recovered. That one eluded my search was evident
from the faet that at a subsequent period a small collapsed
sac came away through the tube-hole. The cyst wall was
so friable that it could only be detached from the in¬
testines by means of the sponge. A small cyst was attached
to the edge of the liver, and there was a larger one on the
under surface of the liver, very far back. As it would have
been impossible to drain these if opened, I let them alone.
After thoroughly washing out the peritoneum a drainage-
tube was inserted, and the patient made a good recovery.
She is now in excellent health and able to follow her occupa¬
tion. Nor is there any increase in the liver cysts. The weight
of the cysts exceeded 2^ lb.

Retro-peritoneal cyst ,—This tumour occurred in the case
of a young lady aged fifteen, who came under my notice
about the end of January last, having been sent to me by
Dr. Robson Roose. The tumour had been observed for about
eighteen months, and when first discovered was about the
size of a Mandarin orange. During this time the patient
was subject to attacks of severe pain, often accompanied
with fever, the temperature sometimes running up to 105°.
There was. much bewildering consultation over the un¬
fortunate patient, and the case forcibly illustrates the re¬
marks made by Mr. Lawson Tait in a paper read before the
Medical Society of London on Nov. 8th last, when he
denounced many consultations with physicians over surgical
cases as farcical proceedings. At last, however, Sir Joseph
Lister agreed with me as to the propriety of surgical inter¬
ference, on the ground that there was disti- Vnce that

the tumour was growing rapidly. Accordingly k was re¬
moved on Feb. 16th, 1886, the incision along the outer
border of the left rectus muscle extending about an equal
distance above and below the umbilical level. The tumour
was covered by the mesentery, whose vessels were enor¬
mously enlarged, and it lay iust over and in close contiguity
to the left kidney, for which it was mistaken, owing to the
impulse communicated to that organ on bimanual palpation,
and it pushed the splenic flexure of the colon towards the
umbilicus. Many ligatures were required in the course of the
enucleation, the vessels being doubly secured before division;
and, finally, the greater pare of the sac was cut away after
the application of a double stout ligature. A drainage-
tube was inserted, as there was still some oozing from
the remaining tom surfaces. The patient made a good
though tedious recovery, owing to the occurrence of
some superficial suppuration in the track of the drainage-
tube. The temperature only once reached 100’8°, and
was above 100° for only one day. The patient is now
quite well. The tumour weighed over 1 lb. It is now in
the museum of the Royal College of Surgeons. Mr. Eve
kindly furnished me with the following report:—“The
tumour is composed of a number of inter-communicating
loculi, separated by numerous septa, and contained a glairy
mucoid fluid. I am quite at a loss to explain its origin, the
situation being so unusual, and only conjecture that it
originated from some foetal structure, possibly some of
the rudiments of the permanent kidney; it was too high
for the Wolffian body. The other possibilities that
occur to me are that it was an ovarian cyst which had
become separated by twisting of its pedicle, or that it waa
of the same nature as the cysts which have been found m
the great omentum.” I take Mr. Eve’6 first idea as pro¬
bably the correct explanation of the origin of this remark¬
able tumour. It was situated too much behind the mesentery
for an ovarian tumour which had become separated from its
natural attachments, and its relations in no respect resem¬
bled an instance of that kind which occurred in my practice
in October, 1884, in which 1 removed a small ovarian tumour
from the right, side of the abdomen, and whose pedicle had
been severed from the left side.

Incision and drainage.—h married woman, aged thirty-
seven, the mother of three children, the youngest of whom
was eight years old, was sent to me by Dr. Am and Routh.
There was a history of acute diseose within the peritoneum
in January last, with Uncontrollable sickness for two days,
severe pain for five days, and fever. At the end of February
she was tapped of over half gallon of a thickish, pale-
yellowish fluid. In another month she was again tapped of
three pints of a thicker fluid of the same appearance, and
was recommended to apply poultices over the abdomen. In
a few days the puncture hole began to discharge a thick
puriform fluid. After three months’ confinement to her bed
she began to get about, and at the end of May came under
the care of Dr. Routh in the out-patient department of the
Samaritan Hospital, but I was unable to admit her until
the end of July. 8he was then in a very emaciated con¬
dition ; the puncture hole was still open, but only occasionally
discharging. An ordinary surgical probe was passed in to its
full length, but nothing came out on its withdrawal. I
therefore thought I had to deal with a multilocular tumour
suppurating in its centre loculus, and I was not a little
surprised in the operation that when the parietes were
divided I opened direct into a single cyst filled with a
purulent-looking fluid, to the amount of about four pints.
After washing out the cavity till quite clean with 6imple
warm water, the cyst wall was seen to be lining the whole
pelvic cavity, the intestines having been pushed out and the
uterus pressed forwards and downwards; in fact, looking
into the pelvis was like looking into a hat. It was there¬
fore evident that this was not a case for further interference,
and I accordingly closed the wound and left in a drainage-
tube, and for the purpose of excluding air I filled up the
cavity with warm water. After forty-eight hours, when
there was a slight odour from the discharge, the cyst was
washed out with sulphurous acid several times daily, and
the odour at once disappeared. Whilst the temperature pre¬
viously to the operation daily rose towards evening to 102°. it
remained perfectly normal afterwards. In fifteen days she
went to a convalescent institution, and in a few weeks more
returned home. She presented herself at the hospital in
November in perfect health.

Exploratory operations .—The list of seven includes nearly
as many different conditions. In the first case the whole

T&b Lancet.]

DR. G. GRANVILLE BANTOCK OR ABDOMINAL SECTION.

[Mahch 19,188f; 569

peritoneum was studded with sago-like granulations, and
the patient was much benefited by the removal of the fluid.
When last seen, three months after operation, the fluid had
not reaccumulated. The diagnosis made was “probably
malignant disease.” Whether this was correct, or whether
the disease may turn out to be of a non-malignant nature,
remains to be seen. It is, however, a singular fact that
whilst tapping in these cases is always followed by a rapid
reaccumulation of the fluid, the operation of abdominal
section has been followed, in my experience, by complete
immunity, even in cases that have proved fatal in a few
months, from the progress of the initial diseaoe.

The second and third were instances of supposed tubal
disease: one of the patients being a young married woman,
aged twenty-five, with two children, the youngest being
six months old; and the other aged forty-six, with one child
aged twenty-five. In both cases the adhesions of omentum,
and especially of intestine, over the pelvic contents were
very extensive, and so firm that there seemed no possibility
of reaching the pelvis without rupturing the intestines, and
after stopping the oozing from the ruptured adhesions by
means of ligatures and the pressure or sponges the wound
was in each closed. I have seen the latter of these cases
quite recently, and while at the time of the operation, in
November, 1885, the uterus was quite fixed in the pelvis,
with considerable surrounding tumefaction, it is now quite
mobile and the swelling has almost disappeared. This result
would eeem to disarm criticism directed against the non¬
completion of the operation, especially as the patient is
already so advanced in years, ana yet the attempt appears
to me'to have been justified by the physical signs and
symptoms existing at that time.

The fourth case was one of papilloma extensively involv¬
ing the left broad ligament, and the operation confirmed the
diagnosis. The patient was a married but sterile lady aged
fifty-six. She had been tapped three weeks previously, and
the fluid had rapidly re-formed. Abdominal section was
performed with the view of taking advantage of the curious
tact to which I have just referred, and in this I was not
disappointed; for while the patient was under my observa¬
tion-three weeks—there was no reaccumulation of fluid.
How long that might have been the case cannot now be
determined, as the patient died a few weeks afterwards of
an acute pulmonary disease.

In view of Mr. Doran’s paper, recently read before the
Obstetrical Society of London, on “ Papilloma of the Fal¬
lopian Tubes,” I may here state that I am inclined to believe
that many, perhaps the majority of cases in which we find
this form or disease, are instances in which the papilloma,
taking its origin within, has burst through the tube and then
spread itself over the broad ligament and adjacent struc¬
tures. The last case I shall refer to (the second in the
paper above noticed) appears to support this view, and if it
be correct, then papilloma of the tube is not so uncommon
as Mr. Doran’s researches would lead us to suppose.

The fifth case is one of very great interest. On Dec. 8th,
1885,1 was asked by Mr. Tapson of Clapham to see Mrs. R—
aged thirty-eight, the mother of two children, of whom the
youngest was seven and a half years old. The history was
as follows:—For the last year she had been “generally out of
sorts”: menstruation, previously normal, had become very
irregular, with intervals of two and three months, and the
last period occurred in the end of August. By the end of
September she began to complain of pain in the right groin,
which had gradually become very severe. She therefore
consulted Mr. Tapson in November, and he, finding a small
tumour in the right ovarian region, requested me to see her.
On examination, a tumour, the size of a large orange, was
found on the right side of, and closely attached to, the
uterus, tender on palpation, non-fluctuating, but elastic.
The fundus uteri could be distinctly defined. There was
nothing characteristic in the condition of the cervix. As
the result of this examination. I gave it as my opinion that
the disease was either an enlarged ovary very closely attached
to the uterus, or an affection of the (right’) Fallopian tube,
tod I advised that Mr. Tapson should watch the case. By
the beginning of January the pain had become so severe,
coincident with an enlargement of the tumour, that he
Wcrtiested me to take her into the hospital as soon as possible,
ton She was admitted on January 11th. I was at once
Artftskwith the great change that had taken place in the
locitf Condition, and came to thb conclusion that she was
nant. Remembering the fact that on my first examina-
the fnndtri uteri could be distinctly made out, and

recognising the change which hod taken place in the cervix,
I further concluded that the pregnancy was Fallopian, and
I communicated to this effect with Mr. Tapson, who visited
her with me in the hospital. The sound wae passed and-
entered over fonr inches, running up on the left side of the
mass, where its point could be distinctly felt. The tumour
now extended as high as the umbilicus, and lay almost
wholly on the right of the median line. She was seen and
examined by several of my colleagues, the majority of whom
agreed with me as to the existence of pregnancy. The pain con¬
tinuing as severe as ever, and no signs of uterine disturbance
having resulted from the use of the sound, it was determined,
with tlie concurrence of Mr. Tapson and my colleagues, that
abdominal section should be performed to avoid the risk of
rupture, whioh appeared very probable from the severity of
the pain. The case was thoroughly explained to the patient
and her husband, and by the former the risk was most
cheerfully accepted as affording the prospect of relief from
her well-nigh Intolerable sufferings. I must state that, had
I been guided solely by the reeults of this examination and
had not seen the case at an earlier period, I should have
looked upon the case as a uterine pregnancy of which the
pain could not be explained. After a lapse of eight clear
days from the passing of the Bound, the patient was sub¬
mitted to operation. On opening the abdomen it was at
once apparent that, after all, the foetus was in the uterus. On
the left side the ovary was in its normal position, and there
was a considerable space between the uterus and the side
of the pelvis. On the right ride the ovary was low
down behind the tumour, which was in dose contact with
that side of the pelvis; in fact, the ovary had not risen
out of its usual position in the unimpregnated state. Very
little of the tube beyond the fimbriae could be made out. It
is almost needless to state that I at once closed the abdomen.
The temperature on the following day rese from 99° to
100 - 2 ° (for four hours), and by the next day was quite
norma). On the seventh day uterine action set in, and- a
foetus weighing 1 lb. f with a placenta 6£ oz., was expelled in a
few hours. The patient had an uninterrupted convalescence,
got quite rid of the pain, and returned home on Feb. 16th,
much gratified with the result. Some there are, probably,
who will say this was a simple uterine pregnancy. I think
a careful study of the history will not support that
contention. There can be no doubt that the uterine
cavity did not contain the foetus in the first instance,
for both Mr, Tapson and myself were agreed that
the body of the nterus could be distinctly defibed
at our first examination. The conclusion I have come to is
that the ovum was arrested in the uterine extremity of'the
tube, and gradually worked its way into the uterine cavity.
This view is supported by a case reported in Thb LaNcbt
of Jan. 16th, 1886, by Dr. Alexander Hay, And - by another
brought before the Obstetrical Society of London in October,
1886, by Dr. Grim, in both of which the physical signs very
much resembled my case in its early stage. On submitting
this report to Mr. Tapson, he replied, under date Dec. 10th;
“ I have nothing to add except that I saw her (Mrs. Rj)
about a week since, and she is in better health than she
has been for years.”

The sixth case was that of a single lady aged twenty-
three, who till within a year bad enjoyed good health. On
dividing the peritoneum, which wae very much thickened,
a small quantity of a. clear amber-coloured - field escaped,
and a very thin and delicate membrane presented, within
which was contained a whitish flocculent fluid to the
amount of two pints. No intestine was seen, but on re¬
moving as much as possible of this membrane the exposed
surface presented a glistening and injected appearance. The
cavity appeared to be limited by adhesion to the parietes.
It was washed out with warm water, and the wound com¬
pletely closed. The disease appeared to be of a tubercoler
nature. On the evening before operation the temperature
was 100 - 6°, and it rose to the same height on the same even¬
ing, but for the next two days was nearly normal; it then
began to rise in the evening for about ten days. At the' end
of three weeks she was out of bed, and when about to return
borne she complained of hypogast ric pain, and on the t we n ty-
third day a small quantity of fluid, similarito-that removed
at the operation, escaped. The temperature then became
normal, and she returned borne Qn^tbo thirty-^rat day with
a small sinus. This had not closed when l,]ost heard of the
patient, at the end of November, though she was then in
very good health.

The seventh and last case was that of a married sterile

570. Thb Lancet,]

DR. J. B. HURRY ON GOITRE FOLLOWED BY ASPHYXIA.

[Mabch 19,1887.

woman, aged fifty-one, whose case bad been a puzzle to
more.than one, at one time presenting the signs of a cyst
and at another those of ascites. As the latter had become
predominant, and no definite explanation could be offered
of this condition, I decided to explore rather than tap the
patient. I operated on heron Not. 10th last, removing ten
pints of free fluid. There was no disease of the pelvis or
abdomen to account for the fluid. The body of the uterus
appeared to have completely atrophied, and what should
have been the body of that organ formed the floor of the
pelvis. No ovary could be found.. At the splenic flexure
the colon adhered to the parietes. The temperature re¬
mained normal, and when the patient left the hospital on
the nineteenth day there was no reaccumulation of nuid.

Incomplete operation .—A married sterile lady, aged forty-
flve, consulted me on Sept. 16th, 1886, complaining of a
dragging pain in the pelvis, a severe pain in the region of
the bladder, frequent micturition, and sometimes retention
of urine. On examination, an elastic mass filled the pelvis,
bulging down into the vagina, and pressing the uterus
upwards and forwards, close up behind the pubic symphysis.
The cervix was almost obliterated; the uterine cavity
measured two inches and a half, and was directed to the left
side. I recommended operation, though 1 could not urge it,
and the patient preferred to wait for two or three months.
She returned at the end of December with all her symptoms
much aggravated, especially the bladder trouble; and having
made up her mind for active treatment, I operated on
Dec. 26th. The pelvic tumour was then distinctly fluc¬
tuating. On opening the abdomen, the first thing that pre¬
sented itself was the right Fallopian tube close to the
cornu of the uterus, forming a mass as large as a hen’s egg,
and having a knuckle of intestine very intimately attached
to it. On separating these, the muscular coat of the in¬
testine was laid bare, and the edges of the peritoneum were
brought together by several points of continuous suture.
In the course of the separation the tube was opened into
and seen to contain papilloma. External and posterior to
this was a cyst with thin walls, which was aspirated, and
yielded about half a pint of a thin fluid like weak tea. An
attempt was now made to separate the collapsed cyst, and
in doing this another cyst, deeper in the pelvis, was opened,
with the escape of a similar fluid. I was, however, obliged
to desist from the attempts at separation, and had to be
content with freely laying open the cysts and removing a
portion of cyst wall together with the papillomatous portion
of the tube. I then washed out the cavity with warm
water, put in a drainage-tube, and closed the wound. The
patient went on very well for forty-eight hours, then the
urine became scanty, the pulse rapid, the temperature rose
to 102°, and the mind was obscured. With the decreasing
urinary secretion, which ultimately ceased, the pulse in¬
creased in rapidity, with a falling temperature, the patient
became comatose, and died towards the third day. No post¬
mortem examination was obtained. This case, I think,
illustrates the danger of delay when there are symptoms of
urinary pressure and obstruction. I have already spoken of
the papilloma, and it is scarcely necessary to point out the
nec- ssarily fatal character of the disease, which must in a
very short time have opened into the intestine.

This case, then, constitutes the last of the consecutive
series of one hundred cases of abdominal section—consecutive
not in point of date, but according to the table. AH of
them were performed between Feb. 18th, 1885, and Nov. 17tb,
1886, inclusive, and without any of the so-called antiseptic
precautions; some of the hospital cases were done whilst
patients were dying of septicaemia in neighbouring wards,
and I did not adopt the precaution of hanging up a wet
c&rbolised sheet over the door. But the greatest care was
taken to ensure cleanliness, which I described some years
ago as “ the most efficient of all antiseptic systems and the
only perfect one.” That, I think, is borne out by the
results. It would be foreign to my purpose to institute
any comparison with the results of other operators. The
above narrative of one hundred consecutive cases is a state¬
ment of facts at the service of those who have a mind to
exercise their ingenuity in the manipulation of statistics.

Gmnrille-place, Portman-aqaaro. W.

At a well-attended meeting of the governors and
friends of the Charing-croea Hospital on the 9th iost., a
committee was appointed to organise a special appeal on
behalf of the funds of the institution.

CASE OF

GOITRE, FOLLOWED BY ASPHYXIA;
TRACHEOTOMY; DEATH.

By J. B. HURRY, M.A., M.D.

Emily B——, aged thirteen, when first seen, was suffer¬
ing from a goitre of very moderate dimensions, which had
been growing for a year. No history of goitre in the
family. The first symptoms appeared about Nov. 3rd, 1886,
when the girl began to complain of dyspnoei, stating that
it obliged her to rise early in the morning. This continued
till Nov. 7th, when Mr. Christian of Reading (to whom
I am indebted for permission to use these notes) was sent
for, who saw the girl at 12 noon, and found her with some,
but not urgent, dyspncea; the breathing was noisy, but not
stridulous; no signs of inflammation or feverishness; she
ate well that day. At 11.30 p.m. the same day, Mr. Christian
was again sent for, and on arrival found the girl in a
state of extreme dyspnoea, and only partly conscious.
He immediately came for me to assist him, and we both
returned as quickly as possible, provided with the
means of performing tracheotomy. On reaching the girl’s
house at 12.30 a.m. on Nov. 8tb, all the signs and symptoms
of asphyxia were present: the face was pale; conjunctival
reflex almost abolished; complete unconsciousness; breath¬
ing excessively laboured. Mr. Christian proceeded at once to
open the trachea between the cricoid and the enlarged
isthmus of the thyroid gland. No anaesthetic was necessary,
owing to the state of unconsciousness. On making the
superficial incision, much venous haemorrhage occurred; as
soon as this had for the most part ceased, and the girl
evidently being at point of suffocation, the trachea was in¬
cised, and a small silver tube rapidly introduced. Air passed
in and out through it, but not freely, and a moderate amount
of blood came wuh it at first. A larger tube was therefore
substituted, but even then the breathing appeared very
obstructed. The tube was kept clear by a feather, but the
breathing was far from satisfactory ; indeed, the asphyxia
became more and more complete, till at about 2 a.m. on
Nov. 9th (i.e. about half an hour after tracheotomy) death
occurred.

I made the post-mortem examination on the sajne day,
at 6 p.m., by removing the larynx, oesophagus, and the entire
thyroid growth. On dissecting the mass, and opening the
larynx and trachea from behind, nothing abnormal was
found, except a moderately large goitre and a bilaterally
compressed trachea. The incision made by the tracheotomy
began immediately below the cricoid, and measured about
two-thirds of an inch in length, two rings being cut through.
A short distance below the incision, the trachea was con¬
siderably flattened from side to side for the distance of an
inch; both walls were affected, but the left one most; in¬
stead of being convex outwards, it was slightly so inwards.
There was no softening or kinking of the trachea. On
introducing the tracheotomy tube as it would have lain
during life, the lower end was found to reach nearly to the
lower portion of the region of flattening. The tumour itself
was uearly symmetrical on the two sides. The isthmus was
continuous with the right lobe,butseparatedfromtheleftbya
groove; it measured one inch from above downwards and also
from before backwardp, and began immediately below the
lower end of the incision. Each lobe was about as large as two
hen’s eggs; together they entirely encircled the trachea, and
behind it came into contact for about the surface of one
inch in an antero-posterior direction, and two inches from
above downwards; they separated the oesophagus from the
trachea. On making incisions into the thyroid, the tissues
were uniformly firm; there were no cysts visible to the
naked eye, nor any softened portions. On bringing the two
lobes into the position they occupied during life, the lumen
of the trachea was seen to be reduced to a narrow antero¬
posterior slit (the Sabekcheide of the Germans). The
relation of the recurrent laryngeals to the growth was
unhappily not noted.

Remarks .—This is one of the few recorded instances of
sudden death from goitre, and the interesting question
arises, What is the cause of death ? No perfectly satisfac¬
tory answer has been given, especially in regard to the cases
where (as in the above) there is no evidence of sudden
increase in size. The view generally adopted is, I believe,

Diaitizedbv Google

The Lanoxt,]

HOSPITAL MEDICINE AND SURGERY.

[March l6 t 1887. ’ 571

that tbe enlarged thyroid mass presses on the recurrent
laryngeal nerves, and thna leads to closure of the glottis, and
it has been proved experimentally that when these nerves
(which supply both dilators and constrictors) are stimu¬
lated, the constricting muscles overpower the dilators and
close tbe glottis. Thu view, however, hardly explains why
a condition of very slight dyspnoea sometimes beoomes
suddenly intensified, and may lead to sudden death (in a
case published by Seirjs of Zurich death occurred in two
minutes after the commencement of the severe dyspnoea).
Another explanation occurred to me, while dissecting the
mnaolee from oft the growth, especially the sterno-byoids
and thyroids, which pass over the thyroid gland, and were
found well developed in the above case. Suppose for a
moment that the gradual enlargement of the growth
causes some dyspnoea by pressure on the trachea or
recurrent laryngeal s. This will produce no special
trouble, till suddenly one day, perhaps after an unusual
muscular effort, the dyspnoea is sufficient to call the
sternorhyoid and thyroid (and possibly mastoid) into
action, in their capacity of supplementary inspiratory
mnsoiea. These muscles, when contracted, will press the
lateral masses of tbe gland down upon the trachea (which
in this instance was already greatly narrowed), and thus
increase the dyspnoea; this dyspnoea must, again, throw the
muscles into greater activity, and thus a ** vicious circle ”
might be set up, one factor increasing the other, and rapidly
leading to a fatal issue. Tbe same sequence of events may
possibly occur where the muscles above mentioned and the
recurrent laryngeala are the efficient agents, and where
therefore death is due to cloture of the glottis.

Bssdlng.

% Utirar

HOSPITAL ° PKACTICE,

BRITISH AND FOREIGN.

Rollssatem est alls pro oerto noacendl via, nUi qaamplnrimaa et mor-
boram at dUMCtionum hUtoriaa, turn alio rum turn propria* oolleota*
habere, et Inter ee oompamre.—M oroaosi Vi Sed. it Cant. Morb,,
lib. lv. Prooemlum. -

ST. GEORGE’S HOSPITAL.

A CASE OF CERBBRO-8PINAL MENINGITIS ; RECOVERY ;

REMARKS.

(Under the care of Dr. Ewart.)

This case is of some interest, as being a sporadic case of
cerebro-spinal meningitis, which recovered, but retained th9
permanent sequel® left in cases of tbe epidemic form. For
tbe notes we are indebted to Dr. Griffiths, medical registrar,

W.T-, a carpenter, twenty-nine years of sge, admitted

8ept. 17th, 1886, had a family history of good health, and
had always been himself strong and well. He worked in a
carpenter’s shop, under, so far as could be ascertained, good
sanitary conditions. He bad "bad no injury or blow, nor did
he remember to have “ taken cold.” He first felt dull and
b«vy on Sept. 10th, and next day had rigors with much
frontal pain, and some pain about the nuchal region; no
vomiting, but there was obstinate constipation. On the
12th both eyes were inflamed, the inflammation increasing
rapidly. On the 14th he loet the sight of the right eye, and
on the 15th that of the left. Delirium set iu on the 13tb,
with high temperature.

He was admitted on the seventh day of the illness, and
Presented a condition of much prostration, with subsuhus
tendinuoa occasionally. He had a coated tongue; the pulse
was 88, the temperature 102°, and the respiration 24. He
had much difficulty in bending tbe neck, and bad some
retraction of the head. He presented much chemosie, with
turbidity of the cornea, and tension in both eyes was - 2.
Hu heart showed slight hypertrophy, with a general soft
•ystolic murmur. There were no adventitious sounds over
the lungs, and no enlargement of the abdominal viscera.
Hu urine was bigh-coloured, sp. gr. 1024, but non-albu-
jBUtous; and he was passing loose green stools in bed, having
J**® given a purgative before admission. Hie deep reflexes
about normal; Cache cdrdbrale well marked j am appa-
normal abdomen.

■Ehe man remained in an .apathetic state for three days,

when he began to mend. His temperature was irregular—
the maximum 103°; his pulse-rate averaged 106, and was
quite regular. At no time bad he any vomiting, and only
slight pain in the neck, the obief seat of pain'being in the
frontal and occipital regions. His eyes showed gradually
less chemoeis, but the pupils dilated irregularly under
atropine, points of lymph being seen on the anterior surface
of the lens; the media, however, continued to be thick,
though the corns® regained to a great extent their trans¬
parency. On Sept. 21st he had slight improvement in vision,
and the media seemed slightly less thick, but he could
only distinguish between light and shade, and by degrees
this power diminished until he became absolutely blind.
His general condition began to improve on the nmth day
after admission, his temperature being then normal, and
remaining at that level; and though he suffered from frontal
headache, be continued to improve until discharged. He was
then in fair health, but was completely blind, the media
being auite thick and precluding ophthalmoscopic examina¬
tion. He was treated daring tne acute stage with an ice-
bag applied to the head and neck. He was given two
drachms of solution of perchloride of mercury and ten grains
of iodide of potassium every four hours, while a strong
solution of atropine was applied to the eyes, at first
frequently, but only twice daily after the second day. Six
ounces of brandy were given daily at first. Later on aconite
and belladonna liniment was painted over the forehead to
relieve pain, and he was put on tonic treatment till his
discharge.

This patient presented all the points of a case of cerebro¬
spinal meningitis, though many not of a marked character.
His condition on admission was more that of prostration
than of actual collapse, but the rapidity of onset, want of
exciting cause, retraction of head, and progressive ocular
symptoms all confirmed the original diagnosis. Among tbe
many interesting papers written on the subject, we would
especially refer to Dr. Wilson’s paper in the Dublin Quarterly
Journal for May, 1867, in which, though speaking of the
epidemic form of this disease, he describes the ocular
symptoms from conjunctivitis through suppurative choro-
ditis to amaurosis, either from collapse of the globe, detach¬
ment of retina, or actnal atrophy of the same.

ROYAL HOSPITAL FOR DISEASES OF THE
CHEST, CITY ROAD.

CASK OF BMFYBH1; FREE INCISION AND DRAINAGE AT
LOWEST POINT; RAPID RECOVERY.

(Under the care of Dr. Oswald Browne.)

Fob the notes of this case we are indebted to Mr. Harold
Simmons, house-physician.

C. G—-, a well-nourished girl, aged eight, was admitted
from tbe out-patient department on Sept. 8th, 1886, giving
a history of four months’ illness, commencing, after unusual
exposure, with rigor and cough, and marked by gradually
increasing shortness of breath, pain in the left side,
emaciation, and weakness. She had bad no previous
illness, nor was there any history of hereditary tubercular
tendency.

Condition on admission.— Her face was pale and somewhat
livid; lips bluub; respiration hurried and ehaUow,40; pulse
small and soft, 128; temperature 102° ; skin moist.
Thorax; The left side scarcely moved with respiration, the
intercostal furrows were obliterated, and there was bulging
of the upper Walls of the chest; the percussion note was
absolutely dull all over the side, and the respiratory
murmur absent, except some distant tubular breathing
audible at the extreme apex above tbe second rib,
and some faint sounds along the spine at the inner
border of tbe scapulae No tactile vocal fremitus was
perceptible, and the voice sounds, feebly heard at the
apex, were totally inaudible below. The right side
was resonant; respiration loudly heard, and accompanied
posteriorly by sonorous rhonchi. The heart’s impulse could
be felt in the right nipple line, one inch below the nipple,
and the cardiac dulness extended thus far and joined tbe
general dulness on the left side, its upper limit being the
third cartilage; the heart sounds were loud and clear. The
liver margin was an inch below the costal border in tbe
right nipple line; the spleen not perceptible. Urine acid,
containing no albumen.

Sept. 10th.—She was considerably more distressed and
cyanostid, temperature had continued at 102°, and there had

Google

572 The I^cwv] •

HOSPITAL MJCDieUTB AHD SURGERY.

[Mabch 19,1887.

been abundant expectoration of thick purulent sputa. An
exploratory puncture of the left side procured thick pus.

Operation,—Chloroform having been administered, a short
incision was made id to the chest in the fourth intercostal space
in the anterior axillary line, and through this a shortly
curved, rigid urethral sound passed as far as. possible down
and somewhat backwards, its point being projected in the
nipth space in the line of the angle of the scapula, and on it
a second incision made; on digital examination, the finger
entered the pleural cavity, a mass of soft adhesions being
perceptible immediately in front of the incision; a large
quantity of pus escaped freely, A drainage-tube about
three-eighths of an inch in diameter and six -inches lone
having been inserted in the lower opening, the upper wound
was closed by sutures; there was little hemorrhage. The
side was dressed with carbolic gauze, the spray having been
used throughout. The child had been extremely faint during
the later stages of the operation, but revived quickly. The
dressing was changed,the same.evening, the.discharge being
thin, blood-stained, and profuse; the patient in little pain,
warm, and comfortable. Temperature 100'8°.

Sept. 12th.—Re-dressed;. the dressing contained about four
ounces of Wood-stained pus, free from odour; the tube clear.
The heart’s apex was to the left of the sternum.. Tempera¬
ture, morning, 98° j evening, 99 - 8°. Expectoration: of yellow
sputa still continued. •.

, 13th.—Tjhe upper incision had almost liealed; stitches
removed and tube shortened. Temperature 99;2°.

15th.—Discharge less. The whole of the side was fairly
resonant^ over the upper half respiration could be well
beard, but harsh and accompanied by coarse frietion; at tbe
base the breathing was audible, but distant; the hearths
impulse was close to tbe left nipple line, the dulness
reaching to the mid-sternum to tbe right..

. lGth.—Cough slight, and expectoration much less. Bowels
had beau extremely constipated. One-tenth of albumen was
found in the Urine. A mixture containing sulphate and
carbonate of magnesia was ordered every morning.

17th.—She had passed a large quantity of uric acid in big
crystals. Ordered eight .grains of bicarbonate of potash
.three times daily.

20th.—The discharge had lessened much, and the general
condition had much improved. The tube was again
shortened. A trace of albumen still existed in the urine.

22nd. -“-The aide had fallen in considerably • there Was fair
resonance all over and free air entrance in the upper two-
thirds ; tbe apex boat in the fifth space, one inch outside the
nipple line. Bowels still very costive. Piveminims of liquid
extract of caspara eagrada ordered.

25th.—Discharge very scanty. The tube left out.

27th,—The spray Was discontinued. Wound superficial
and healing rapidly. There was no evidence of re-collection.

. Oct. 5th.—Qrinulations 1 pale and cedematous; a probe
would not pass. She had no congh or expectoration, and
felt quite well.

On the 21st the wound had quite healed, and on the
,28th the patient left the. hospital. The left side, sunken
considerably, especially over tbe apex in front; yielded a
resonant note of good quality; respiration was heard well
all over, and free from adventitious sounds, except some
coarse crackling with inspiration at tbe extreme base. Her
temperature never rose higher than 99*2° after Sept. 13tb,
and albuminuria ceased on the 25th. She continued to pass
uric acid occasionally.

Jan. lOt-b, 1887.—The child attended at the out-patient
department. She had gained strength, weight., and colour.
The affeeted side was more flattened anteriorly and pos¬
teriorly ; breathing was loud and clear to the extreme base.

SEAMEN’S HOSPITAL, GREENWICH.

8UBGTCAL CABBS OF INTEBB8T, WITH RIMARK8.

(Under the care of Mr. G. R. Tubneb.)

Cask 1 .—(jjeguel to a successful case of Fractured Patella

treated by Tfirinr/.—'W illiam W-, aged twenty-five, a

sailor, fractured his right patella whilst at sea. He had no
treatment for twelve days, and was then in a foreign hos¬
pital for a month. The fracture was treated by strapping
and a piaetec-df-Paris splint. He left the hospital fn a
month’s title, and then cams under the care of Mr. Mayo
Robson of Leeds, in June, 1885, four months after the
accident. He had an uhtwited fracture of the patella, with
an inch auda haifle ueparatiow-of the fragments. His limb

waa very Weak, and perfectly useless to him* Mr. Rofanan
ent down on the fragments and wired them together. Great
difficulty was experienced in approximating them, the
lateral expansion of' the vast*wild Cfaa quadriceps requiring
division. The wo and ran an aseptic course, and he
was made an out-patient in, September. He could walk
freely,, could flex . his knee nearly to right angle,
but complained of a little pain below and to the outer
aide of the patella. A note says; “This may be due to
some of the gold wire sutures which were not removed.” On
leaving Leeds he went to sea, and whilst on board ship
fell and hurt bis knee again, and woe taken to a hospital at
Sulina add treated. After this ■ be came to,the Seamen’s
Hospital, Greenwich. He hod almost perfect use of his knee,
and the patella appeared soundly united* Protruding from
a sinus on the outer side of the joint was a wire, which he
said had been catching bis trousers as he walked since his
last accident. There was a little suppuration around. On
April 1st he complained of considerable pain- hi the
knee-joint, which 1 became rapidly distended with fluid.
His temperature rose to 104°; pulse 128. The face and
body were covered with an erythematous rash. On seeing
him the next day, Mr. Turner, with full antiseptic pre¬
cautions, laid tke joint freely open on each side of the
patella and introduced a drainage-tube. The flaid that
escaped consisted of turbid lymph, hardly to' be -called
purulent. The distension of the joint was very peat before
the operation. The projecting wire was removed; it could
be traced in the cavity of the joint to just below the
patella, and was there lost. Tbe man’s temperature and
pulse rapidly fell nearly to normal after the operation, and
the wound ran an aseptic course. His convalescence
was interrupted Bow and then by epileptic fits, to
which he was subject. Two other wires became pro¬
minent under the skin, and one projected through it.
These were dissected out on the 4th of July, and he
shortly afterwards was up and about. After he was
discharged he again fell down (? in an epileptic fit), and
refractured the same patella very Close “to the insertion of
the ligamentum patellae. This fresh acqident brought to
light yet another wire, which was removed in September, and
the man shortly afterwards left the hospital. He could walk
perfectly, and could bend his knee to more than a right
angle. He could not, however, perfectly extend it, as there
was some slight wasting of the quadriceps—not sufficient,
however, to interfere in any way with his activity. It
should have been mentioned that his second fracture was
treated simply by rest and strapping, the lower fragment
being obviously too small for wiring, even had such a pro¬
ceeding been contemplated.

Remarks by Mr. Tornbb,—T his case (the notes of which
were kindly sent to me by Mr. Mayo Robson) is of interest,
1 think, as showing how troublesome, and even worse, wires
may become if the knee which contains them is subjected,
as in this instance; to renewed injury. The man's frequent
accidents were no donbt due to his epileptic tendency. His
present condition is, on the whole, satisfactory. At one
time he was very near having acute suppuration of the
knee-joint. Timely incision into the tense distended joint
at once reduced hie temperature from 104° to 100°, and
materially improved his general oondition. The wires were
troublesome to remove, and were not finally got rid of for
some considerable time. Mr. Mayo Robson used but three
gold wires to suture the patella. I must have had to deal
with two fragments of one of these. The strength of the
osseous union obtained by their means is shown by the
second fracture occurring below instead of at the seat of the
first.

Cask 2. Compound Comminuted Fracture of the Ulna
into the Elbow-joint; recovery with a movable joint .—
Wm. C-—-, aged thirty, presented himself ot the hospital
with a wound leading down to a comminuted fracture of
the ulna at the junction of tbe olecranon and coronoid
processes due to direct violence. Two loose fragments of
bone were removed by enlarging the wound, and the parts
and joint were washed out with carbolic lotion. The wound
ran an oseptio course, and healed shortly after a drainage-
tube that had been introduced into the joint on nis
admission was removed. Passive motion was then daily
employed. 8hortly after commencing this a peri-articular
abscess formed, and was opened. A second abscess appeared
later on, and was likewise opened. As soon as it was possible
passive motion was again practised, and the patient
encouraged to- use his elbow. Heremained in hospital doing

> 8 '

Tub Lancet,]

PATHOLOGICAL SOCIETY OF LONDON.

[Mabch 19,1887. 573

work about the place for three months or so. He suffered
from pain referred to the distribution of the ulnar nerve.
He was of a very sensitive nature, or there is no doubt his
progress would have been more rapid. When last seen the
relations of the olecranon to the condyles of the humerus
were normal. An inch below this process is an irregular
transverse depression indicating the seat of fracture. There
is a depressed cicatrix at the site of the old wound, and the
bone beneath is somewhat irregular. He can flex the elbow
so as to touch his shoulder with the tips of his fingers, and
extend it to an angle of 160°. The radius can be rotated,
and both flexion and extension are “ getting better every
day.” The joint is very strong; he “ can carry four gallons
easily,” or “ with another man can lower thirty gallons of
rum.” All the symptoms referable to the ulnar nerve have
disappeared.

Remarks.- -This result to a compound comminuted frac¬
ture into the elbow-joint is a very satisfactory one, and
better than if a formal excision of the articulation had been
practised.

Cask 3. Dislocation of the Foot backwards.— Henry H-

aged sixty, was knocked down in a scuffle, and fell with his
right foot under him. On admission, the dorsum of his
right foot was considerably shortened and the heel corre¬
spondingly lengthened. The foot was at right angles to the
leg, and the lower end of the tibia very prominent; the
lingers conld almost be placed under the anterior edge. The
internal malleolus was fractured and carried backwards
with the astragalus. Reduction was easily effected by
extension and then carrying the foot forwards. The position
was then good. The man recovered, with some increased
width between the malleoli.

The interest of this case rests solely on the rarity of
backward dislocations of the foot.

Htcinral Societies.

PATHOLOGICAL SOCIETY OF LONDON.

Fibroma of Ovarian Ligament.—Metastatic Carcinoma of
Prostate.—Large Dermoid Cyst over Sternum. — Gall¬
stone causing Obstruction of Bowel.—Cystic Disease of
Testicle—Multilocular Cystic Epithelioma of Jaw .—
Ci/stic Epithelioma of Neck.

As ordinary meeting of this Society was held on Tuesday
last, Sir James Paget, F.R.S., President, in the chair.

Mr. Shattock read for himself and Mr. R. W. Parker the
report of the Morbid Growths Committee on *Mr. Butlin’s
ewe of Recurrent Tumour of the Breast. It had a foliaceous
aspect, like some cases of adeno-sarcoma of the breast, but
the histological characters of the growth were those of
villous carcinoma originating from the ducts, as distin¬
guished from the acini.

Mr. Alban Doban showed a small Spherical Tumour in
the Substance of the Left Ovarian Ligament. A microscopic
*ection was also shown. It proved that the tumour was
made up of plain muscular fibres, mingled with white
fibrous tissue; in fact, it was a “ fibroid ” precisely similar
to several other fibroid growths which, in this case, were
found in the uterus. The ovarian ligament was a prolonga¬
tion of uterine tissue, its fibres passing into the parenchyma
of the ovary. Hence it was subject to fibro-myoma, like
the uterus, whence it was derived; and hence, also, fibro-
myoma was sometimes developed in the ovary into which
jt ran. It was probable that fibro-myoma of the ovarian
hgament had been sometimes mistaken for a so-called
supernumerary ovary. In this case the latter condition
*“xisted on the right side.—Mr. Shattock said that he often
had a difficulty in differentiating fibrous tissue from plain
muscular tissue in examining ovarian tumours.—Mr. Alban
uoban, in reply, said that he sympathised with Mr. Shat¬
ters difficulty, but thought that well-marked nuclei such
might be seen in plain muscular tissue in the uterus of
_he new-born was diagnoatic, and these were also to be
IO i? d 1? “clpient myoma of the ovary.

**£HbfcBY Fbnwick showed a specimen of Metastatic
Carcinomatous Deposit in the Prostate. He
cmaa only flid four examples of this class of carcinoma of
gland inmedical literature (Mercier, Langstafr,Giiyot,and

Lebert). In three of these cases the primary growth was
found in the stomach; and in the last the dura mater was the
site of the initial deposit. The specimen was removed from
a man aged twenty-six, whose first symptom was grea‘
lumbar pain. The duration of the entire illness was two
months and a half. The spinal cord finally became attacked,
and paraplegia ensued. The necropsy revealed the lung to
be primarily affected, and the liver, spleen, kidneys, prostate,
and cord secondarily. The growth was of the “ scirrhoid ”
type.

Mr. H. H. Clutton showed a large dermoid cyst removed
from over the sternum in October, 1886. The subject of it
was a married woman aged thirty-nine. The tumour was
noticed at the age of six weeks to be of the size of a pea.
At ten years it was' tapped, but no fluid withdrawn. At
nineteen it was of the size of a hen’s egg. It remained
stationary for many years, but during the last five years it
had grown to twice the size. The tumour hung in a pen¬
dulous fashion from the sternum on a level with the breasts,
and measured thirteen inches in circumference. The entire
cyst was removed. Its lining membrane appeared to be of
cutaneous structure, and one hair could be Been projecting
from its surface. Microscopically, neither sebaceous glands
nor hair follicles could be found. The contents, which
measured eleven ounces, were composed of epidermis,
chole8terine, and fat.—Mr. F. S. Evk had examined several
dermoid cysts which did not contain sebaceous glands or
hairs. Dermoid cysts occurred in various situations, as over
the -scapula, where they were in no relation with the
branchial clefts or with the middle line of closure. They
originated from displacement of epiblast. — Dr. Angel
Money referred to a case (recorded in the Journal de
Mtdecine de Bourdeaux) of apparent dermoid cyst communi¬
cating with the central c&naLof the spinal cord at the level
of the lower end of the cervical enlargement..—Mr. Stephen
Paget said that in hairy chests there was regular parting of
the hair at the angulus Ludovici, the hair above growing
upwards and below growing downwards.—Mr. J. Hutchin¬
son, jun., said that he had met with three cases of dermoid
fistula in the middle line at the junction of the nose and
forehead. — Mr. Bland Sutton Baid that the situations
mentioned by Mr. Hutchinson was a common site for
meningoceles.—Mr. Hutchinbon, jun., said the cases he
referred to were undoubtedly dermoid cysts, and not
meningoceles. — Sir James Paget had removed three
such growths, and ia none was there any connexion
with tne interior of the skull; but in one case a pedicle
extended between the nasal bones. They were un¬
doubtedly dermoid. One case was also associated with a
spina bifida. There was sometimes an unusual growth,
of the dermoid cyst at the time of puberty, when
there was a greater activity of the organs derived from
epiblast.—Mr. A. A. Bowlby had observed two undoubted
dermoid cysts in the area of junction between the nose and
forehead.—Mr. Clutton said there was no evidence of
increased growth until the patient got married. He had
removed two dermoid cysts from the forehead at the root of
the nose. Such cysts occurred in any part of the body,
though most commonly in the middle line or along the
lateral fissure.

Dr. Pyb-Smith showed a large Gall-stone removed from a
lady aged seventy-eight, who had never had jaundice, but
suffered from increasing constipation, which culminated in
obstruction. Examination per rectum revealed something
abnormal, which was regarded as possibly carcinomatous
and situated above the sigmoid flexure. It was very
movable. After thirteen days’ obstruction the stone was
passed and the patient remained free from trouble. A
second larger stone of cylindical shape was also shown. It
came from a woman aged sixty, in whom constipation never
proceeded to complete obstruction. The date at which the
communication between the duodenum and gall-bladder
occurred was unknown.— Mr. J. Hammebsley said that
the patient in the first case remained perfectly well.—Mr.
Shattock mentioned a fatal case of complete obstruction
from gall-stone. It was an unpublished case of Dr. Bris-
towe.—Dr. Coupland thought it .unlikely that any subse¬
quent difficulty would occur, for the opening into the
duodenum from the gall-bladder must be large to have
allowed the safe passage of a stone of that magnitude.

Mr. Eve read a paper on Cystic Disease of the Testicle.
It was based on a microscopic examination of twelve selected
specimens, and a table of twenty-eight recorded cases in
which a microscopic examination had been made. There

574 The Lancet.]

CLINICAL SOCIETY OP LONDON.

[Mabch 19,1887.

were three forms—cystic fibroma, cystic myxoma, and sar¬
coma, the second being intermediate between the other two.
In the cystic fibromata the cysts and tubules were com¬
monly lined with spheroidal or flattened epithelium, but
some, in most tumours, with columnar, and in five specimens
with columnar ciliated epithelium. Unstriped muscle was
rarely, and cartilage generally, present in the fibrous stroma.
Cystic myxomata were composed of mucous and fibrous
connective tissue, containing tubules of columnar, ciliated,
and occasionally flattened epithelium—very like the same
tumours in the breast. In cystic sarcoma the cysts were a
less prominent feature, and more commonly lined with
columnar than flattened epithelium. The characteristic com¬
ponents of cystic fibromata—viz., ciliated epithelium, un¬
striped muscle, and cartilage were present in sarcomata, and
in three cases striped muscle was found. After reviewing the
evidence regarding the origin of tumours, the following
conclusions were stated:—1. No specific difference exists
between innocent and malignant cystic tumours. 2. They
originate in the hilum testis. 8. There is probably a new for¬
mation of epithelium, or adenomatous growth. 4. The proto¬
type of this is found in the tubules of the vasa efferentia, rete
testis, and coni vasculosi, which are formed from the Wolffian
body. 5. There are grounds for believing that the epithelial
formations in cystic tumours originate from certain out¬
growths from the Wolffian body described by Klein as inter¬
stitial cells, and normally occupying the hilum. 6. It is
incorrect to attribute their origin to the organ of Girald&s,
as this lies outside the testicle.—Mr. C. B. Lockwood said
that a perfect series of complete transverse sections through
the organ would be the best way of determining the rela¬
tions of any relics of the Wolffian bodies.

Mr. A. A. Bowlby exhibited a specimen of Multilocular
Cystic Epithelioma of the Jam The patient was a woman
aged twenty-four, in whose lower jaw on the left side the
tumour began to grow at the site of a decayed molar tooth.
It was removed by Mr. Walsham, but one year later it began
to recur. It had grown both outwards into the masseter
muscle and inwards into the mouth, which could not be
shut. The duration of the case was twelve years and a half.
The cysts contained a reddish-brown blood-stained fluid.
Microscopically, the growth was composed of fibrous tissue,
into which the processes of epithelium of cylindrical,
spheroidal, and flattened sort grew. The cysts originated
from the epithelial ingrowths. The specimen corresponded
closely with those described by Mr. Eve.

Mr. Quarry Silcock showed three cases of Cystic
Epithelioma of the Neck. Case 1: A man aged thirty-two,
was admitted into St. Mary’s Hospital with a large inflamed
suppurating swelling under the lower third of the left
stemo-ma8toid muscles; lie had first noticed a small lump
in that situation about throe months earlier; it was painful,
and the patient, who was a strong healthy man, began to
lose flesh and strength. The swelling had been opened,
ami after admission Mr. Owen scraped away large portions
of the growth, with temporary relief.- After death, though
no complete necropsy was allowed, it was ascertained that
the growth occupied the posterior as well as the anterior
triangle, and infiltrated all tho structures. There was a
large cystic cavity lined by large papillary granulations,
which were found to consist almost entirely of epithelial
cells, the most highly developed being of the squamous type,
but not prickled, forming well-marked nests and long
oolumns running downwards into tho mass of the tumour.
The enlargement of lymphatic glands lying over the
growth was found to be due to inflammatory irritation
only. Case 2: A man aged fifty-six was admitted with a
large; partly cystic, tumour on the right of the neck, which
had been growing for about five months. He was emaciated.
The cyst was incised by Mr. Pepper, and a quantity of
glairy yellow fluid escaped. The cyst, which was lined with
papillary granulations, subsequently suppurated. Exami¬
nation after death revealed the same macroscopical and
microscopical appearances. Case 8: A man aged sixty-four,
who was admitted with a large tumour on the left side of
the neck lying in greater part beneath the stemo-mastoid
muscle, but involving both triangles; it extended from the
jaw to the clavicle, to the middle line in front, and to the
mastoid process posteriorly. Mr. Silcock tapped the cyst
several times, and drew off a thick, yellow, grumous fluid,
which was found to contain numerous large epithelial cells,
which left little doubt that the growth was of the came
character as in the other two cases, from which he was able
to Bhow specimens. In none of the cases was there any

evidence of a primary growth elsewhere. He thought the
only hypothesis which could be entertained was that they
owed their origin to the development of some belated portion
of epiblast, perhaps the representative of a branchial cleft,
although the advanced age of the individuals in whom they
were usually found appeared to negative such a supposition.

The following card specimens were shown:—Mr. Godlee :
Malignant Disease of an Undescended Testis with Secondary
Growths. Mr. Stonham: Pelvis of a Child with Persistent
Fcetal Condition of the Peritoneum. Mr. F. W. Clark: Sub-
pleural Lipoma of Diaphragm. Dr. A. H. Robinson:
Drawings of Charcot’s Joint Disease. Dr. Ormerod; Sub¬
dural Ilsematoma. Dr. Maguire: Bullet Wound of Heart
passing through the Left Ventricle.

CLINICAL SOCIETY OF LONDON.

Pneumothorax with Recovery in the apparently Healthy .—
Intra-peritonenl Lxemoa ofliectum.—Gymnastic Treat¬
ment of Scolioxis,

An ordinary meeting of this Society was held on Friday,
the 11th instant, Dr. W. II. Broadbent, l*resident, in the
chair.

Dr. dk Ha vii ,land Hall communicated a case of Pneu¬
mothorax which he had had under observation, with notes

of four other cases. Case 1: F. R. P-, aged twenty-four,

was sent to Dr. de Havilland Hall by Dr. W. D. Penny on
June 27th, 1885. The account given by Dr. Penny was that
on May Sth the patient complained of sharp pain in the
left side of the chest. In the mid-axillary line, low down,
there was pleural friction with slight dulness on per¬
cussion and tubular breathing. The dulness only covered
a very small area, and the rest of the chest was quite normal.
Pulse 110; temperature 100'4°. The patient was sent home
to bed, and next day there was hyper-resonance all over
the chest and extending half an inch to the right of the
sternum. Breathing replaced by amphoric roaring and loud
tinkling, except that at the angle of the scapula the respi¬
ratory murmur was faintly audible. Heart sounds muffled,*
apex beat half an inch inside right nipple. Pulse 140; tem¬
perature 99°. The patient stated that while getting into
bed he suddenly felt faint, and had a peculiar sensation
about the heart. In the course of a month the symptoms
slowly subsided, the heart returned to its natural position,
and the breath sounds returned. A fortnight later there
was a return of pain and shortness of breath. When
examined by Dr. Hall the patient had just come from
business. There was only slight complaint of pain, and
there was not much dyspneea. Pulse 120; heart sounds
clear. Imphlse in epigastrium. The left side of the
chest hardly moved at all; there was general hyper-
resonance and obliteration of the cardiac dulness. No
breathing sounds were audible over the left side. The
bell sound could not be elicited. The right lung was normal.
The urine contained a trace of albumen. On Sept. 30th
the patient was again examined, and both lungs were found
perfectly free from disease. Case 2 (notes supplied by Mr.

B. Rix, of Tunbridge Wells): J. W-, aged thirty-nine,

mason’s labourer, previously in good health, and inconstant
work for the past eleven years. While sweeping, he was seized
with suddeifepains just above the left nipple, and came over
faint. He continued at work for five days, but owing to
increasing dyepnma and pain had to take to his bed on the
fifth day. On examination, there were the physical signs
of pneumothorax on the left side. Ho- was under observa¬
tion for seven weeks, during which time the heart gradually
resumed its normal situation, the byper-resonance disap¬
peared, and normal breathing returned. Case 8 (recorded
by Dr. Delagrange, London Medical Record , 1881, p. 196): A
healthy youth, aged nineteen, while exhibiting the powers
of his chest, suddenly felt severe pain in the left side; his
face became blanched, and he experienced great oppression.
During an effort to vomit he was seized with a sense of
something tearing in his side, followed by syncope ; there
were unmistakable signs of pneumothorax. The patient
recovered in about eight days. Case 4 (recorded by
Biermer, Wurzburyher Med. Zeitschrift , Bd. i., p. 885):

K. D-, a law student, aged nineteen, while dancing,

was seized with a peculiar sensation in the region of
the heart, accompanied with giddiness, oppression, and
sweating; when examined four days later, there were
the physical signs of pneumothorax on the left side, accom-

The Lancet,]

CLINICAL SOCIETY OP LONDON.

[March 19,1887* 575

ponied by a moderate amount of liquid effusion. In seven
weeks alt objective signs of the pleural affection had
disappeared. Case 5 (recorded by Ricker, Wien. Med.
Wochensch., March 28th, 1860): A badly developed young
man of eighteen years of age, was seized, whilo coughing,
with a stabbing pain in the left side. A week later he com¬
plained of considerable shortness of breath, and the physical
signs were those of a pneumothorax. The distress in¬
creased so much that he was punctured, and the operation
was followed by an alleviation of all his symptoms. Two
months later, he presented a more healthy aspect than
before his illness. After remarking on the comparative
rarity of cases of nneumothorax occurring among the
apparently healthy, Dr. Ilall drew attention to the cases
collected by Dr. Samuel West in a paper read before the
Society in 1883, and to the cases reported to the Medical
Society in March, 1886, by Dr. Whipham. Dr. Hall con¬
sidered that the explanation of great preponderance of
males over females in the subjects of this affection is to
be found in the greater muscular exertion of males com¬
pared with females, and that, whatever might be the pre¬
disposing cause, the immediate cause of the pneumothorax
is some strain. lie had no doubt that in a majority of cases
the rapid breaking down of a small tuberculous mass before
a secondary pleurisy had had time to set up adhesions was
by far the most frequent cause of pneumothorax. The paper
concluded with some remarks on diagnosis and treatment. -
Dr. S. West considered that Dr. Hall was right in styling
his paper “ Pneumothorax in the apparently Healthy,” for
the lungs were not perfectly normal. lie referred to cases
which originated in slight cases of phthisis. The pressure
at which healthy lung would burst was very much greater
than might be supposed. He waa working at this subject
experimentally. As to traumatic pneumothorax, he believed
that its occurrence in association with fractured rib was
rare, though surgical emphysema was common. He in¬
quired as to the experience of surgeons in this matter.—
Dr. Burney Yho thought that the title of the paper rather
begged the question, for it assumed that patients were pre¬
viously healthy. Dry pleurisy as a cause of this accident was
not laid sufficient stress on by Dr. Hall. This form of pleurisy
was frequently latent.—Dr. S. Mackenzie related a case, seen
with Mr. Drake of Stratford, that occurred in a graduate of
a university who left the drawing-room after dinner to
fetch a banjo; he was found seated on the stairs suffering
severely. He had suffered some time previously from a
*• stitch in the side,” which was probably due to pleurisy.—
Dr. S. Coupland agreed that small patches of phthisical
change and relics of small foci of tubercle of the lung were
causes of this kind of pneumothorax. He had had under
his care two cases of recovery. There was no evidence of
phthisis in .either of the patients, and their family history
was good. They both followed a sedentary occupation. He
did not think that much exertion was necessary to produce
a rupture of the lung if there bo a suppurating area.
Coughing probably caused more violent strain on the lung
than any muscular voluntary exertion. The first case was
that of a clerk aged eighteen, whose right side was affected.
In one month all the signs had disappeared. The second
case occurred in a still more healthy-looking man, who five
days before admission caught a cold, and three days later
had pain in the side. When first seen the pneumothorax
was well developed. At first no improvement resulted, but
after leaving the hospital ten days all the signs had dis¬
appeared. The patients suffered very little from their
affections after the first symptoms had subsided.—Mr. G. R.
Turner had not observed any cases of pneumothorax with
fractured rib. He had seen a boy who had hmmoptysis, and
who died from pneumothorax due to phthisis.—Dr. Tyson
mentioned a case of emphysema due to pyiemia, the conse¬
quence of a sloughing ulcer of the leg in an elderly woman.
—Mr. Riyinqton had only met with two or three cases of
pneumothorax of all the cases of thoracic injury he had
ween during his long experience at the London Hospital.—
Mr. nowARD Marsh referred to a case of a boy who was
run over and died with much dyspnoea and collapse. The
lung was clean tom awav from the bronchus on that side,
ne mentioned cases of ruptured lung from falls; in one a
woman fell across the step of an omnibus, and the visceral
pleura was found to be largely rent at the necropsy. He
considered that pneumothorax was not unfrequent when the
ribs were fractured.--Mr. I>. I’iits had seen several cases of
traumatic pneumothorax. In one case, that of a boy aged six
yeart, aspiration gave much relief to the dyspnoea, but

death ensued from inflammatory symptoms. Rupture of
the lung, but no fracture of the ribs, was found at the
necropsy.—Dr. West said that he had asked for information
concerning the occurrence of pneumothorax with fractured
rib.—Dr. Broadbent had seen three cases, of the kind.
In one it occurred while the patient was taking a cold bath
in the morning. All occuiTed in young men; two on the
left side, and one on the right.—Dr. Hall, in reply to Dr.
B. Yeo, said that, perhaps the pleurisy was caused by the
phthisis which also caused the pneumothorax.

Mr. Frederic 8. Eve read a case of Intra-peritoneal
Excision of the Rectum, with recovery. The patient, a
woman aged thirty-four, had suffered from symptoms of
cancer of the rectum for nine months. The growth encircled
the rectum, and it was thought that the finger could be
passed beneath its upper margin. The usual operation of
excision was undertaken, but as the upper limit of the
growth could not otherwise be reached, the peritoneal
reflection encircling the bowel was divided, and the
diseased portion removed with the ecraseur. The bowel
excised measured nearly six inches in length. The upper
end was readily brought - down to“ The' anal margin. The
patient is now, five months after operation, in godd health.
Good recovery, without symptoms of peritonitis. Remarks
in recent researches on the experimental production of
peritonitis tended to show that this operation should not
theoretically be exceptionally dangerous, and that the limits
of cases deemed fit for operation might bfe determined.—
Mt. Harrison Gripes considered that the title was a little
misleading, foy he had expected to hear that abdominal
section had been performed. Speaking out of book, he
should say that in one case in every five it was necessary to
remove a portion of peritoneum in excision of cancer of the
rectum. He said that he had not had a single fatal case of
twenty-five operations, and in six of these the peritoneum
was involved and excised. Immunity for two or three years
often followed, when the lowest portion only of the rectum
was affected; but if the disease extended higher up, six
months was the average period of immunity.—Mr. Goldino
Bird asked what power the patient had of holding the
motion, to which Mr. Eve, in reply, said that there was no
specific information on this point in the letter received from
the patient. Mr. Eve was surprised to hear that the peri¬
toneum was opened so frequently by Mr. Cripps, for in the
latter’s work only two cases were specially mentioned. The
value of the method practised in the case read was to enable
examination of the bowel to be made fora distance above the
cancerous portion. He had left a considerable pnrt of the
external sphincter. In reply to Mr. C. Heath, he paid that
stitches were used to unite the bowel to the anus.

Mr. Keetley read a paper on Pcolious, and said that,
having received from Mr. Bernard Roth a paper on the
results of the Gymnastic Treatment of Scoliosis, he
asked that gentleman for permission to see the treatment.
Mr. Roth consented, on condition that, Mr. Keetley should
send him a case (of the hospital class) for treatment.
This condition being fulfilled, Mr. Roth (with Mr. Keetley’s
consent) exhibited the patient at the Clinical Society twice,
once before and once after, a course of gymnastic treat¬
ment. (Mr. Roth’s views of this case are stated —with
illustrations — in the Clinical Society’s Transactions.)
Mr. Keetley, while acknowledging that the patient’s spirits
and muscular strength were improved by the gymnastics,
states that she had lost in height, aud that the scoliotic
curves had undoubtedly increased during the treatment.—
Mr. Bernard Roth said the patient had been sent to
him by Mr. Keetley with a request to do what he could for
her, and no intimation was given of an intention to read a
paper until last Saturday; further, he had applied in vain
to know what line of criticism Mr. Keetley intended to
follow. He defended his history of the cases reported in
the Transactions, and protested against Mr. Keetley’s paper
being published by the Society unless his answer was
appended. The patient in question had suffered from lateral
curvature for ten years, and had been under various
treatments. In spite of plaster jacket See., she had become
frightfully deformed, and this had gradually got worse. He
had told Mr. Keetley that lie would do his best, and would
make her independent of spinal supports in three months,
though the osseous deformity would of course remain. He
showed photographs and tracings of the ribs. The patient
was shown at the Society in November, 1885, and again,
after the three months’treatment, in March, 1886, and Mr.
Keetley then made no objection. Both patients were pre-

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576 The Lancet,]

MfeDICAL SOCIETY OP LONDON.

[MaAch 19, 1887.

sent, and had been examined by members. If his reply
could not be appended, he would urge the appointment of
a committee to report upon the cases, as well as on the case
which he had shown in April, 1883. —Dr. Broadbent thought
that the best course would be to appoint a committee.—
Mr. Christopher Death said that the permission of the
Council for the production of Mr. Keetley’s paper at the Society
would perhaps have been withheld if it had been known
that the character of it was to be so entirely controversial.
The Council gave permission for a paper on scoliosis gene¬
rally. As the subject was of great importance to the pro¬
fession at large, he thought that, the appointment of a
committee to inquire into the whole subject of scoliosis
and its treatment would be a good step for the Society to
take.—Mr. If. Marsh seconded Mr. Death's motion, and
thought that the pathology and treatment of lateral curva¬
ture was still in an undecided condition.—The committee
was appointed, and consists of the following gentlemen :—
Messrs. Christopher Heath. Howard Marsh, Walter Rivington,
Warrington Ha ward, and R. W. Parker, the surgical hon; sec.

MEDICAL SOCIETY OF LONDON.

“ Clot t age'' of the Ureters.—Certain Conditions of Bladder in
Ch ildren.

An ordinary meeting of this Society was held on Monday
last. Dr. Hughlings Jackson, F.R.S., President, in the chair.
The new Surgical Secretary, Mr. Bernard Pitts, took his seat
at the presidential table, and Dr. Samuel West occupied the
post of senior honorary secretary.

Dr. Ord proposed, and Mr. Wu. Adams seconded, a cordial
vote of thauka to Mr. Brudenell Carter for the admirable
way in which he had fulfilled the duties of president during
the past year. Mr. Bruce Clarke and Mr. Marmapuke
Siieild did the honours of the vote of thanks to Mr. J. H.
Morgan. Both votes were duly carried.

Mr. Hurry Fenwick submitted for criticism an operation
which he termed “Clottage of the Ureters.” The procedure
consisted in an attempt on the part of the surgeon to
“ block ” or “ cork" up a ureter with blood clot. He argued
from statistics that it ought to be performed in those cases
where the surgeon has to combat profuse and uncontrollable
hmmaturia from a kidney hopelessly crushed by an accident
or affected with advanced carcinoma. He considered it a
conservative operation, and one that ought, to rank in front
of the operation of nephrectomy. Mr. H. Fenwick’s ureter
aspirator 1 is introduced into the bladder. Suction is then
practised on the ureter of the damaged kidney so that the
Blood clots ore drawn into the eye of the instrument; light
pressure is then made with the back of the instrument
against the opposing finger in the rectum, thereby nippiDg
the ureter lightly. Time is thus given for the blood clot to
collect in the pelvis of the kidney. A case in which the
operation was successfully performed was related. It was
that of a man aged fifty-one with right renal carcinoma.
The hmmaturia had lasted thirteen months; it had been
intermittent and profuse. The urine remained free from
blood from the time of the operation till his death six
months later. No necropsy was made. - Dr. Tuchmann
thought it was impossible for the finger or any instrument
in the rectum to nip the ureter. He handed round his own
instrument for aspiration of the ureters. - Mr. Henry
Morris considered that Mr. Fenwick had introduced an
ingenious thought. It would have been impossible, even
had a necropsy been made, to have said whether the
obstruction was due to the blood clotting naturally or to
the result of the procedure practised by Mr. Fenwick. If
hfematuria from traumatism were not checked by ergot or
hazel witch, the better treatment would be nephrectomy.—
Mr. It. W. Parker inquired whether the hiematuria were
duo to the traumatism or to the malignant disease itself. He
agreed with Mr. Morris that the rationale of this method
was not clear. He questioned even whether actual clot¬
ting would stop the bremorrhage.—Mr. Bruce Clarke said
that it seemed to him that the best method of stanching
the haemorrhage was to cut down upon the kidney ana
to attack the bleeding vessel. He considered that it was
almost impossible to be sure that the instrument would
effect the desired object. - Mr. Bernard Pitts agreed that
the danger arose from intra-peritoneal hemorrhage rather

1 Tint Lahcst, Sept. 1 m!'.

than from haematuria, in traumatic cases. In severe cases
treated by rest, and without surgical interference, he had
known casts of the ureters to be passed. The suggestion was
made that the instrument might be used to clear out clots
by aspiration, as for instance in attempting to cure some
cases of hydronephrosis.

Mr. Bruce Clarke read a paper on Certain Conditions of
the Bladder in Children. The roughened interior of the bladder
was a far more frequent occurrence in children than adults,
and the symptoms of stone were far more often present than
a stone itself. Cases illustrative of these two facts were
narrated. He believed that chilling of the surface of the
body was an important causational element in these cases.
The treatment of rest in bed, including universal warmth
of the surface, with regulation of the diet and the adminis¬
tration of tonics, was mostly efficacious.—Mr. R. W. Parker
considered that text-books were often incorrect in the
statement of the symptoms of stone in a child. He had
known stone in girls to give rise only to tenesmus and
dysenteric diarrhoea. Preputial irritation and tubercular
disease of the bladder should be borne in mind in analysing
the symptomatology of stones in the bladder.—Mr. Mauma-
dukb Siieild had known malignant disease of the pelvis to
be mistaken for stone. Retention of urine might be the only
and first symptom of vesical stone in children.—Mr. Henry
Morris ventured to ask whether the condition described by
Mr. Bruce Clarke might not be due to something very different
from phosphates. In fact, in some cases he believed that the
urine might have been over-acid in the first place. Might
not errors of diet be a cause of the over-acid state of the
urine, which led to the cystitis and alkaline urine?

OPHTIIALMOLOGICAL SOCIETY.

Ophthalmoplegia Externa.—Papillary Movement in Lateral
Deviation.—Picture painted after Extract ionof Cataract.
—Fibroid Degeneration of Ciliary Muscle.—Paralysis of
External Recti.—Associated Movements of Upper Lul
andEyebatt.—New Formation in Vitreous .— Tubercular (?)
Disease of Choroid: Extirpation of both Eyes.—Closure
of Sclerotic Wounds by Conjunctival Sutures only .—
Lateral Nystagmus .— Conjugate Palsy of Ocular Muscles
and Nystagmus.

An ordinary meeting of this Society was held on the 10th
inst., Mr. J. Whitaker Hulke, F.R.S., President, in the chair.

The President announced that Mr. James Dixon, con¬
sulting surgeon to the Royal Ophthalmic Hospital, Moor-
fields, had presented a complete series of Von Graefe’s
Archives, from the beginning up to the year 1875.

Dr. C. E. Beevor showed a case of Ophthalmoplegia
Externa without other symptoms. It was that of a woman
aged forty, who had rheumatic fever six years ago, after
which the right eye suddenly turned outwards, but it was
doubtful whether the left eye was affected. The patient did
not know that her eyes were fixed till told so. The up-and-
down movements are weak, but there is almost complete
paralyeis of the lateral movements. There is a considerable
degree of ptosis, probably due to the consensual movement
of looking, which is very deficient. The pupils are equal,
and react to light and accommodation; convergence is lost.
The optic discs are normal. There was no history of syphilis,
and no evidence of tabes, but some improvement has followed
treatment with iodide of potassium.

Mr. Marcus Gunn showed a case' of Pupillary Movement
in association with Lateral Deviation. The boy, aged ten,
had a blow on the left eye with a cricket ball two years ago,
which had left sight dim on that side. There is considerable
lenticular opacity, and no fundus reflex; there is bare per¬
ception of light; projection is extremely defective, being
accurate only outwards. On fixing a distant object with
the right eye for some seconds, nystagmus commences in
the left only, slight in degree, and lateral. On looking
strongly to the left, both eyes exhibit nystagmic movements.
On lateral deviation to the left both pupils contract, while
they do not change on lateral deviation to the right, nor in
association with any other muscular movement except con¬
vergences, when they act normally. Both pupils react well
to light, but the left alone contracts feebly to exposure from
the great defect of vision. The downward movement of the
left eye is somewhat impaired, and on looking upwards the
left is strongly divergent.

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Tub Lancet, 1

OPHTHALMOLOGICAL SOCIETY - .

[March 19,1887. 5 7 7

Mr. Bbudexell Carter showed a picture painted after
recovery from Extraction of a Senile Cataract. The artist
is about fifty-five, and was operated upon for mature senile
;ataract of the left eye in November. The right lens was at
Lhat time partially opaque, and became completely so by
the end of 1885. It has not been operated upon, and the
picture was painted in October, 1886, with the left eye only.
The drawing of the lines about the upper part of the porch
show the absence of astigmatism, the correcting lens being
spherical only.

Mr. Karop showed a case of (?) Fibroid Degeneration of
the Ciliary Muscle.—Dr. Brailey was not satisfied that
there was fibrous degeneration; it might be that the muscle
had been displaced, stretched, and extended, but he said
that thero was an abnormal layer of nuclei; he did not say
it was fibrous.

Mr. J. G.Wackinlay showed a case of Paralysis of both
External Recti, probably congenital. The patient was a
girl, aged sixteen. There was no diplopia, nor has there ever
been. No other muscles were affected. The pupils reacted
well to light. Acuity of vision was greater in the left eye.
There was astigmatism of both eyes. Partial deafness existed
on both sides.

Dr. Ernest Clarke showed a case of New Formation of
Vessels in the Vitreous Body.

Mr. Brudenell Carter showed a case of Large Spon¬
taneous Vitreous Haemorrhage in a young man which had
almost completely absorbed.

Mr. C. Hiogexs showed a case, in a boy aged seven, of
Haemorrhage in the Vitreous Body with a peculiar deposit
behind the retina (? inflammatory).

Dr. Sidney Phillips showed two cases of Associated
• Movement of the Upper Lid with Movement of Eyeball.
The cases occurred in brothers, and was seen in one at the
age of six months. The eyeball directed to one aide, the
opposite upper eyelid droops, and also on the side used,
though this latter is rendered less apparent by an effort
which contracts the occipito-frontalis muscle.

Mr. Rockliffb related two cases of New Formation in the
Vitreous: in the first case there was high myopia; in the
second there was a history of a blow. There was no syphilis
in either patient, and in each the eye was quite blind. He
also narrated a case of Ossification of the Choroid, causing
sympathetic ophthalmia. There was no history of syphilis
or injury, but there had been an attack of kerato-iritis eight
years previously.. After removal an extensive layer of bony
tissue extending in all directions from the site of the disc,
the lens, which was entirely absorbed, was encapsuled in a
bony shell.—The President observed that the first two
cases were clearly instances of inflammation, and not new
growth. He had seen true.bone formation, but doubted if
it was not in inflammatory products rather than in the
choroid.

Dre. Brailey and Hartley communicated a paper on
Tubercular (?) Disease of Choroid, with extirpation of both
eyes. Five years previously 7 the patient’s left eye was
struck with a piece of metal. No notice was taken of the
accident; but in June, 1886, the eye was tender, and he
applied for relief. A small triangular piece of metal was
then discovered resting upon the iris at its lower part.
Faint horizontal streaks of opacity were also visible in
*“^ er half of lens. The metal, with the iris to which it was
adherent, was removed by a downward iridectomy, and the
e ye seemed to become quiet. In about a month, however,
the patient returned, complaining of intense pain in left
head, with some diminution of sight in right eye,
^hich before was normal. Right eye: V ?jj, cornea bright,
hut surrounded by distinct zone of pink injection. No pain
or Photophobia in this eye; only “dulness” of sight. Left
e ye: Intense vascular injection of the whole eyeball, which
appeared enlarged. Cornea uniformly opaque; tendency to
ulging of iris at the upper and lower ciliary margins.
= nu. T + 2. This eye got rapidly worse, in spite of
reatment, so that in a day or two it was extirpated. The
h&-LT’ meant * me . was being vigorously treated with
.“iodide mercury, leeches, atropine, &c.; but, on
■pvth the notes said: “ Pain in right eye and right side
t-hm* * muc ^ chemosis, V = barely fingers.” On Aug. 21st
„ r 8 marked prominence of the ciliary region;
lJo 8 “f?htly hazy (from altered T?); eyeball as a whole
T + . v PT ominent - Iris swollen and pupil obliterated.
eitiJn ♦ ^ and swelling continued. Eye eventually

sliizhtl i Examination of eye by Dr. Brailey : Globe
K uy enlarged (generally), especially in antero-posterior

diameter. Cornea small,probably opaque, and flat when fresh.
Extensive and prominent bulging of ciliary region, especially
above and below. Anterior chamber was prooably wanting
or shallow when fresh. Optic nerve larger than normal.
Antero-posterior vertical section through cornea and yellow
spot showed the lens in situ: vitreous gathered up so as
to occupy only the anterior half of its cavity; a thin fluid
fills up tne remaining space. Retina in situ, but thickened
and much wrinkled. Choroid in situ, but much changed
in appearance; at and near the posterior pole much
thickened; this thickening closely surrounded the optic
disc. It tapered off forward to the ora serrata, but even
there it measured two or three times its normal thick¬
ness. Great thickening began again at the ciliary body,
and extending thence to the iris, diminishing towards
its pupillary margin, which hardly appeared implicated.
In the iris the new growth appeared mainly posterior to the
uveal pigment layer, which appeared scarcely altered. In
the ciliary body tne uveal pigment was scattered, and the
new growth appeared both internal and external to it. The
sclero-corneal tissue was abruptly thinned at the anterior
termination of the ciliary body, and enormously stretched.
This change extended over an antero-posterior space of at
least five millimetres. The vastly thickened base of the
iris was pushed close into the projecting part. Thus was
constituted the ciliary bulging. A thin, pretty uniform
layer of new formation ana slight consistency was found
between the retina and its pigment epithelium layer, and
appeared to be due to the coagulation of a fluid effused in
this position. The growth dia not seem to have extended
either into the substance of the sclerotic or into the retina,
or to have perforated the lumina vitrea of the choroid. It
was fairly consistent and non-pigmented. — The Pre¬
sident thought the evidence of tubercle was indistinct:
there was no history of it, and it was not proved by
the microscope.—Dr. Brailey said that the growth in the
second eye was clearly tubercular, there were well-marked
giant cells and broken-down matter; no bacilli were found,
but he laid no stress on that, as it might have been due to
the Muller’s fluid.—Mr. Lawford said that this did not in¬
terfere with the detection of the bacilli.—Dr. Siiarkky
considered the anatomical peculiarities of tubercle much
more characteristic than the bacilli; even in cases of general
tuberculosis, he had failed to find them in any of the
organs. The earlier the tubercles, the less the chance of find¬
ing them.—Mr. Nettleship thought that, apart from the
histology, a subacute destructive sympathetic inflammation
would satisfy all the conditions found.—Mr. Hartley said
there was nothing in the accident or in the behaviour of the
first eye in favour of sympathetic inflammation.

Mr. Simeon Snell (Sheffield) read a paper on the Closure
of Sclerotic Wounds by Suturing the Conjunctiva only, and
said that for a long time he had been convinced that it was
unnecessary and undesirable to suture the sclerotic directly
for wounds of that tunic. Perfect apposition was obtained
by suturing the conjunctiva only; a needle threaded with
carbolised catgut or silk was passed well underneath the
conjunctiva on either side of the scleral wound, and the grip
thus obtained allowed, on tying the suture, the lips of the
wound to faU into perfect apposition. The resulting union
was perfect. He referred to his article in the Ophthalmic
Review for 1884, where he related cases and advocated this
method: more recent experience had confirmed his opinion
as to its value. He had employed it in a large number of
cases where he had incised the sclerotic to remove or search
for foreign bodies with the electro-magnet, as well as in
several cases of accidental wounds, examples of which he
related. The method advocated avoided passing a suture
through the sclerotic, choroid, and retina, and left no loop
in the interior of the eye to act in some degree as a foreign
body in a cavity where the vitreous was already broken up ;
it made the deep wound into a subcutaneous one; it did
not disturb union by removing sutures; the insertion of
needles in the sclerotic often increased the loss of vitreous;
this was avoided.

Mr. Jessop read a case of sudden and lasting Lateral
Nystagmus, most marked when looking to the left. It was
a man aged seventy, who came to the Central Ijondon
Ophthalmic Hospital on Nov. 12th, 1886. Three days pre¬
viously. he noticed, on waking up, that fixed objects moved
and rocked laterally. His previous general health had been
good, but he had been troubled with slight diplopia for fifty
ysars, which he attributed to his aniso-metropia. For the
last week he had been giddy, but hod never fallen down.

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OPHTHALMOLOGICAL SOCIETY.

[March 19,1887.

No syphilitic history or signs. Fourteen years deaf with
his right ear, and live years with left. Eyes: no apparent
squint, and fields for diplopia showed the images very
little distance apart. Lateral nystagmus most marked when
patient looked to the left, scarcely seen when looking to the
right. Pupils equal; act to light and accommodation.
Hippus irregular as to time and degree, not synchronous
with respiration, pulse, or nystagmus, and not altered by
looking to the right or left. He said that, on looking to the
left, objects passed to the left, but he did not see them come
back again. The nystagmic movements were not increased
by pressure on the ear, as in Dr. Hughlings Jackson’B case
in the Transactions of the Ophthalmological Society, vol.iii.,
p. 2fil. The nystagmus was increased by active move¬
ment, especially coming downstairs turning to the
right. Knee-jerks normal. Heart: loud mitral systolic
murmur. Urine normal. Mr. Cumberbatch had examined
the ears, and said that the deafness was the ordinary
deafness connected with chronic middle ear catarrh.

Dr. Uowkrh first drew attention to the forms of Conjugate
Palsy of the lateral movements of the eyes caused by disease
on one side of tbe pons. The lateral movement was excited
by the sixth nucleus on one side, acting through its own
nerve on the external rectus, and through the posterior
longitudinal fibres (and cells and fibres of the opposite third
nucleus and nerve), on the opposite internal rectus. It was
probable that these third nerve fibres did not actually arise
from tbe sixth nucleus, but that their ceils were connected
with those of the sixth. It had been sometimes assumed
that the centre for this lateral movement was the sixth
nucleus, but this view was erroneous; the centre was pos¬
sibly the superior olivary body, which, according to Betche-
rew, was connected with the sixth nucleus, the auditory
nucleus, the cerebellum, and the spinal cord. There were
three classes of palsy from disease of this region. 1. Paralysis
of the sixth nerve only, from disease of its fibres within
the pons, causing absolute palsy of the external rectus
and deviation of the eye inwards. 2. Disease of the
nucleus of the sixth, causing the total palsy just mentioned,
with, in addition, loss of the associated action of the
opposite internal rectus, so that this eye could not be
moved inwards beyond the middle line, except in some
instances, in convergence or alone; the facial nerve
was also involved in these cases. (An instance of this
form was described.) 3. Disease above the sixth nucleus
causing palsy of the lateral movement of both eyes,
but without'the total palsy of the external rectus, and
consequent deviation of the eye inwards, present in the first
two forms. 1 f the eyes were moved towards tbe opposite
side, they could bo brought back as far as the middle line,
but not further. Thus the affected muscles could bring the
eyes back from the position produced to the action of their
antagonists, although they could not effect a primary move¬
ment. Hence, this return movement must be excited in
some other way than through the path by which the same
muscles caused a primary lateral movement. The excita¬
tion for the return movement was probably due to the
influence of the centres of the opposite side. Thus, in
disease of the right side of the pons, in which the eyes
could not be moved to the ri^ht, if they moved to the
left the centres on the left side excite the correspond¬
ing centres on the right side to bring the eyes back to j
the middle line; to move them further the interrupted
right path was necessary. It was perhaps, a special
instance of the associated action of opponent muscles, con¬
tinuing longer in the centres for the opponents than in
those for the primary movement. This consideration
simplifies the problem of the immediate mechanism of
nystagmus, reducing it to the causation of the intermissions
of the primary contraction. Given intermitting contraction
and the return movement, the oscillation necessarily
followed. It was probable that a tendency to intermission
was inherent in the centres, but was normally restrained,
and the contraction rendered uniform by some influences,
perhaps complex. One such influence might be tbe mutual
action of opposing centres. A case was mentioned of disease
of one side of the pons, with loss of the movement towards
that side, in which there was nystagmus in the movement
towards the opposite side; and,two years ago, he had brought
a case b-'fnre the Society in which an acute lesion on one side
of the pons caused deviations towards the opposite side, with
nystagmus. But. many more facts as to the position of lesions
causing nystagmus wore required before the speculation as
to its :n"hnuism could, with profit, bo carried further.—

Dr. Hughlings Jackson, after remarking on the great
value of the case Mr. Jesaop had brought forward, and on the
thoroughness with which it had been investigated, and after
expressing his admiration of Dr. Gowers’ paper, said that he
had long held that nystagmus and tremor signified paralysis.
He believed that, notwithstanding the complete excursions
of the globes, there was loss of some few ocular move¬
ments in the case of Mr. Jessop’s patient. It was of very
great importance to distinguish between 1038 of power of
muscles and loss of movements. In nystagmus there was,
he thought, loss of some movements and development, and
sometimes over-development of other movements of the
very same muscles. He considered that in miners’ nystag¬
mus and in other professional cramps (writers’ cramp, for
example) there was loss of some movements, with forcing
of other movements of the same muscles. If, aftergazing out
of a rapidly moving railway carriage, we look at the sear, the
seat seems to move: here is negative after-movement; there is
lossof afewocularmovementswith over-developmentof other
movements. Is there not here nystagmus in the making!' It
was submitted that there was temporary exhaustion of some
cel Is of the lowest motor centres for certain ocular movement s.

If one might make the ridiculous supposition that a man’s
occupation consisted in looking out of a railway carriage
window, he might come in time to have railway travellers*
nystagmus, the genesis of which would point to a paralytic
element -loss of some movements owing to atrophy of 6ome
cells of lowest motor centres, with over-development of
other movements. Dr. Hughlings Jackson then adverted
to a case of hemiplegia from disease of the upper part of
one-half of the pons Varolii with turning of the eyes from
the side of the lesion -that is. to the side, paralysed—which
had been investigated by Dr. Gowers and himself (Medical *
Times and Gazette, Jan. 3rd, 1874). It was well known
that there were in cases of epileptiform seizures the mobile
counterparts of ordinary hemiplegia with deviation of the
eyes from the side paralysed. Dr. Jackson thought he
had twice recently seen the mobile counterpart of the
hemiplegia from disease of the pons he had mentioned;
nearly tonic spasm of the limbs of one side with turning of
the eyes to the other side, presumably depending on dis¬
charge beginning in some part of the pons. He mentioned
the. case of a boy, reported to the Medical Society in
November last, who had fits when his head or face
was touched. In the fits the eyes turned to the
right; there was hemiplegia of the left 6ide. A case
of more direct ophthalmological interest was that of
a patient who had paroxysms of lazy clonic, almost tonic,
spasm of the right side of the face, but of the two obiculares
palpebrarum, and turning of the two eyes to the left. Fully
aware that face fits occurred from limited discharges of the
mid-cortex, he believed the face fit mentioned to belong to
the class of ponto-bulbo-spinal fits (lowest level of evolu¬
tion). The work the ophthalmologists were doing in pre¬
cisely distinguishing losses of ocular movements from
paralyses of ocular muscles was of vast interest to the
neurologist. Dr. Jackson had never seen loss of ocular
movements in cases of general paresis, except perhaps in
one case in which there was a want of smoothness in the
excursions of the globes, not amounting to nystagnus.
Theoretically, loss of some movements would be expected,
and, theoretically, a change so slight as not to amount
to that supposed to occur in nystagmus.—Mr. Prtestlky
Smith suggested that the correspondence in the direc¬
tion between the ocular movement and the displace¬
ment of the images of objects might be explained by the
patients not perceiving the image of external objects
during the spasm, but only on the return of the eye to its
former position. As to the occurrence of hippus in the con¬
jugate lateral movement, he asked whether it occurred
during convergence. Did cases of convergent nystagmus
exist? He had not seen one. From the nature of the
nystagmus we should suspect that it originated from dis¬
turbance of motor centres situate at a lower level than
those which were producible by voluntary effort. He had
seen one case only of vertical nystagmus. Yon Graefe
referred to six. As supporting Dr. H. Jackson’s view, that
nystagmus was in one sense of the nature of a paralysis, he
said that normal movements of the eye might easily become
of a jerky character. In gazing at tint sun, for instance,
and then looking at the landscape away from the sun, he
had always noticed that the negative image of the sun had
I the appearance as of a number of dots, which he ascribed to
j displacement, the result of disturbed innervation of tbe

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The Lancet,]

OBSTETRICAL SOCIETY OP LONDON.

[March 19,1887. 570

muscles,—Mr. W. H. Jkssop, in reply, said there was hippns
during convergence, and in right lateral deviation also.—
Dr. Gowers, in reply, alluded to the fact that in nystagmus
objects sometimes appear to move in the same direction as
the quick movement of the eye, as of great importance as
probably affording grounds for ultimately distinguishing
the functional relations of the phenomenon in different
cases. It brought the movement into relation with vertigo,
with which it is sometimes associated, and in which the
sense of movement in the individual and in external objects
usually agrees in direction. The explanation of the agree¬
ment is to be found in the motor character of vertigo, and
in the fact that any resulting movement is secondary, and
falls short of the actual motor tendency which is felt as
a sensation. If a person turns round, and an object
remains opposite to his eye, he infers that the object
moves in the same direction as he does, and a sensation of
movement leads to the same inference; actual movement
would only prevent the inference if it were equal to the
tendency, and there would only be a sensation of movement
in the opposite direction if the actual movement were in
excess of the tendency.

OBSTETRICAL SOCIETY OF LONDON.

Galactorrhcea.—Mechanism of the Third Staye of Labour.
At the meeting on March 2nd, Dr. Galabin showed a
Uterus removed in November last by Porro’s operation. The
patient made a good recovery.

Dr. Ho brocks exhibited a Fibromyoma from a case of
Cffisari&n section. The patient in this case died.

The President, Dr. John Williams, delivered the Inaugural
Address, which will be found on another page. At the con¬
clusion a warm vote of thanks was proposed by Dr. Grailey
Uf.witt and seconded by Dr. Braxton Hicks, which was
carried by acclamation.

Thediscussion of the paper on Galactorrhoea, which wasread
at the previous meeting by Dr. Gibbons, was opened by Dr.
Matthews Duncan, who noticed the neglect of the science
of lactation and deficiency of literature connected with this
important and interesting department of practice. He believed
Dr. Gibbons’ paper to be the fullest account of the subject.
Galactorrhcea required definition, for there were many kinds.
That prolonged and exhausting suckling which led to depres¬
sion and melancholia might be, but was not classed as, galac¬
torrhoea. In Dr. Gibbons’ case there was no excessive flow, for
thirty ounces a day could only be regarded as along continu¬
ance of the flow in quantity nearly what was secreted by an
actively nursing woman. Dr. Duncan had seen in a healthy
young woman a constant flow so excessive as to run through
the bed and over it to the extent of many pints a day, but not
for many weeks. Another kind of excessive flow was not
very rare in rich-blooded young women—milk running from
the idle breast while the other was being sucked. He had
watched such a case where the wasted milk was apparently
more than the child cduld be swallowing, the flow going
on only while the opposite breast was stimulated by the
sucking infant. The unilaterality of Dr. Gibbons’ case was
interesting bnt it was not rare in ordinary healthy nursing,
in Dr. Gibbons^ cose cure came at once on the appearance of
delayed menses, and it was most natural to ascribe the
arrest of lacteal secretion to the appearance of menses,
the one function alternating with the other as the
growth of stags’ horns with the ratting.—Dr. Cleveland
drew attention to what he preferred bo. call “incon¬
tinence of milk.” In this condition the infant at the
breast would cry more than usual, not being satisfied; it
did not sleep so long as it should, and did not present the
appearance of thriving. On inquiry as to the suckling, the
frequent reply is that “there is plenty of milk and that it
runs away.” Dr. Cleveland was satisfied that where a
primipara suffered from this form of galactorrhcea she
would prove an inefficient nurse.—Dr. John Phillips
mentioned a case, as did Dr. Horrocks, and the latter com¬
pared the physiology of secretion of saliva with that of
milk, and suggested that galactorrhoea might be due
to vaso-motor or pure nerve inflnence. The secretion
of milk was intimately associated with the ovaries, but the
nervous pathology had nob yet been fully ascertained.—
Dr. C. H. Routh asked why local pressure of the breast
was not carried out. in these cases. It was a well-known
method of treatment in cases of orchitis or swollen limbs.

Dr. Routh mentioned a case in which a lady continued to
secrete milk long after the weaning of her child, and which
persisted some three years and then became restricted to
one breast. It yielded partially to treatment by pressure,
but completely stopped when treatment was directed to the
womb. He thought that by the introduction of a piece of
caustic within the uterus, as suggested by Sir James
Simpson, the flow of blood or menses might have been
determined and the cure of nature anticipated.—Dr. Play¬
fair knew a good deal of the practice of the late Sir James
Simpson, but was not aware that he ever adoptod or recom- 1
mended the treatment named by Dr. Routh.—Dr. G alabin
and Dr. Dawson related their experience.— Mr. J. Bland
Sutton said he had found galactorrhoea in the cow due to
tubercular disease of the ovaries, and in a case of unilateral
galactorrhcea in a kid there was a cystic ovary on that side.
—Dr. Herman asked if the mammary abscess from which
Dr. Gibbons’ patient had suffered might not be the explana¬
tion of the unilateral character ot the galactorrhcea, one
breast not secreting because of destruction of gland tissue
by the abscess.—Dr. Champneys said that Dr. Gibbous’
case exemplified the antagonism or alternation between
lactation and menstruation. There were cases in which
secretion of milk coexisted with uterine haemorrhage.—
He had seen a case in which the more the breasts swelled
the greater was the uterine loss. Nursing was stopped,
ergot given, and the breasts soon subsided. With regard to
treatment, Dr. Champneys could not see why eczema need
have prevented the application of pressure. A drying
powder on lint or cotton-wool could have been used, with,
strapping over, the straps reaching more than half round
the body. He thought there was evidence in favour of the
use of ergot in these coses. Derivation to the uterus by hot
foot-baths was also not mentioned. Dr. Champneys could
imagine that uterine haemorrhage might be caused by the
introduction of caustic within the womb, as named by Dr.
Routh, but such haemorrhage could not be considered men¬
struation. Dr. Champneys had heard of wholesale spaying
of milking-cows in Texas, with the result that the milk had
gone on to the owner’s satisfaction for a long time, in one
case for eleven years.—Dr. IIevwood Smith thought the
discussion would lead us to give more attention in such
cases to the condition of the uterus and ovaries.—Dr. W. J.
Collins had seen lacteal secretion in infants, male and
female. He would like to hear what the condition of the
breast was in Dr. Gibbons’ case after the arrest of secretion.
Was it atrophic ? From analogy with the salivary glands
the galactorrhcea might be of the nature of a paralytic
secretion.—In reply, Dr. Gibbons said that the eczema was
due to constant saturation of the skin with the milk that
flowed away, and that his case was 60 entirely unilateral
that not a drop of milk could be squeezed from the right
breast. When the patient was well the left breast assumed
a normal appearance.

Dr. Champneys read the first of a series of papers on
the Mechanism of the Third Stage of Labour. 1. The
Separation of the Placenta, reviewing the facts furnished by
our knowledge of the clinical course of natural labour, and
by that derived from Torres operation. From the former it
is known that until the birth of the head the placenta is not
detached, and that after the birth of the head it is not at
once detached. Leenser found by examination of HS8 women
that the placenta is completely detached as soon as the child
is born. As regards Porro's operation, the inferences drawn
from it must be regarded with suspicion on account of the
great interference which has taken place with the uterus.
The facts derived from these two sources do not tally. He
next discussed the theories of the cause of placental de¬
tachment. A. By contraction and retraction alone, through
reduction of the placental site. B. By contraction and
retraction indirectly, (a) By separation of the centre, which
is less firmly attached than the edge, leading to aspiration of
blood; (A) by squeezing blood towards the surface during
contraction; (c) by rapid diminution of intra-uterine pres¬
sure consequent on the birth of the child. C. By detrusion
(Leenser), the placenta being forced in the direction of least
resistance—i.e., the axes of the parturient canal. He then
reviewed the theories of the moires of placental detachment.
A. According to the situation of the placenta. /?. From
edge. C. From centre. I). According to firmness of attach¬
ment of its parts, and to the question whether the separation
of the placenta is independent of rupture of utero-placental
vessels as a cause, the decision depends (a) on proved
haemorrhage behind the placenta in normal labour; (A) on

580 The Lancet,]

SOCIETY OP MEDICAL OFFICERS OF HEALTH.- REVIEWS.

[March 19, 1887.

the mode of expulsion of the placenta. Pending the decision
of the above questions to be dealt with in a subsequent
paper, Dr. Champneys concluded that hemorrhage to a
moderate amount plays a certain though subsidiary part in
the mechanism of the detachment of the placenta.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

At a meeting held at the Scottish Corporation Hall,
Crane-court, Fleet-street, on Friday, Feb. 18th, Dr. Alfred
Hill, President, in the chair, a paper was read, entitled “ A
Practical Illustration of the Protective Influence of Vacci¬
nation,” by C. E. Paget, medical officer of health for the
Westmoreland Combined Sanitary District. The paper had
reference to an outbreak of small-pox in a village in West¬
moreland and its neighbourhood, and details of each case
were very carefully given. The outbreak had lasted from
March to September, 1885, the disease having first appeared
outside the village in a sparsely inhabited hill district, and
then found its way into the village, where it attracted
attention. The early cases outside the village, numbering
nine, were not seen by a medical man, except one,
on a singlo occasion, in an incipient stage of illness before
the rash was out, and it was not till severer cases
occurred on the introduction of the disease into the vil¬
lage that medical advice was sought. The total number
of cases in the outbreak was seventeen, and there wa9 no
mortality. All the cases showed marks of “ pitting.” The
chief point of hygienic interest in the outbreak seemed to
be in the illustration it afforded of what has been noticed in
other outbreaks of infectious sickness, such as scarlet fever,
diphtheria, and measles, especially in scattered rural dis¬
tricts—that the spread of such diseases may be often largely
due to the mildness of initial cases. With respect to the
influences of previous vaccination upon the outbreak, the
paper was illustrated by several tables, and showed, first,
that all persons that might be said to have been unvaccinated
sickened; second, that one child only out of nine under
fourteen years of age that had been primarily vaccinated,
and had been definitely exposed to infection, sickened;
third, that thirteen persons out of twenty-two over fourteen
years of age that had been primarily vaccinated sickened
"(though the numbers might more fairly be taken as thirteen
out of nineteen, since three adults were not exposed to nearly
the same degree of infection as the others); and fourth, that
the only (though very poorly) revaccinated adult sickened,
but only in a moderate degree. The chief practical interest
of the epidemic in respect of the partial protection of
persons seemed to be in the enormous mitigation of illness,
even where there was incomplete vaccination and a general
want of re vaccination. It was in the highest degree
unlikely that if there had been an absence of even a partial
vaccinary protection the attacks of small-pox would have
been mild, and that in such a circumstance, in spite of the
distances between the patients and medical advice, they
would not have come under medical treatment. Such an
epidemic history could scarcely have been given but for
the half measures of protection enjoyed by the community
of whom it was told.—In the discussion which followed the
President, Drs. Gibbon, Louis Parkes, Sykes, Yarrow, and
Ashby, and Messrs. Butterfield, Lovett, Eyre, and Murphy
took part.

ACADEMY OF MEDICINE IN IRELAND.

Atpsrgillua Nigricans.—Dermoid Tumour—(Edema
Olottidis.

At the meeting of the Pathological Section held on
Jan.14th,

Mr. Story exhibited and described microscopic specimens
of Aspergillus Nigricans, which he had removed from the
auditory meatus of three individuals suffering from deaf¬
ness and inflammation of the external ears. He exhibited
also a fourth fungus of an undetermined character, but
most probably also one of the aspergillus tribe. He gave a
brief resumi of the literature of the subject of otomycosis,
and stated his conviction that the fungi were the cause and
not the consequence of the ear disease—a view which had
been advocated by som9 of the writers on the subject.—
Dr. MAPOTiTKn mentioned that in the year 1880 he himself
had an acute attack of this otomycosis. 1I» had never

suffered, either before or since, from any aural disease.
One night he went to bed in a house in the suburbs of
Dublin with his hearing perfect, and the following morniDg
he arose almost completely deaf. He bore the affection for
one day, and on the next consulted Mr. Swanzy, who,
partly by means of forceps and partly by syringing,
removed a quantity of white cottony material from his
cars. Besides the deafness, the only sensations he had were
stuffing and a sort of ramming, as if something like cotton¬
wool was being pushed into both ears. The material
removed from his ears was examined by himself and his
friend, the late Dr. Richardson, and they both came to the
conclusion that it contained aspergillus. After the extrac¬
tion of the fungi from his ears, and a week’s washing with
sulphurous acid lotion, they disappeared and never grew
again. He had observed that the wall paper of the room,
next to which he slept, was extremely damp and almost
completely separated from the wall by the dampness ; and
he believed that it was that which produced the fungi.
Since the wall bad become dry no similar attack of mycosis
had occurred to anyone else occupying the room. —
Mr. Story, in reply, said he remembered having, as a
patient suffering from this disease, a farmer who, sitting
up all night with a sick cow, had stuffing and pain in his
ears next'morning, which were found to be caused by
aspergillus.

Mr. STonx also exhibited a Dermoid Tumour growing from
the corneo-scleral margin of the left eye of a middle-aged
man. The tumour was of a pinkish-yellow colour, and hod
one long hair growing out of its centre. No other hairs
could be detected, even with a magnifying glass. The
tumour had existed ever since the man’s birth, and remained
; quiescent until two months ago, when it began to grow
i over the surface of the cornea. It was a flat sessile growth,

| of a circular shape, about 4 mm. in diameter, half corneal,
half scleral. In his opinion, it was to be regarded as a
dermoid growth.

Dr. Christopher Nixon exhibited the larynx and trachea
of a patient who had died under his care of what is it the
custom to call (Edema Glottidis, occurring in the course of
Bright’s disease.—The President observed that whether or
not the disputed point was conceded that in Bright’s disease
the large smooth kidney might, in process of time, change
to the small contracted kidney, there was no difficulty in
assuming that other cases might occur in which that change
did not happen. He would have no difficulty in accepting a
history of any number of years’ duration of Bright’s disease,
and yet in finding a large smooth kidney after death, lie
did not think anyone maintained that the large smooth
kidney necessarily turned into the small kidney. The
point in dispute wa9 whether the small kidney ever repre¬
sented a large kidney which had undergone atrophic change.
But that a large kidney might remain so for aa indefinite
time was no subject of wonder.

atth ftotitts of $oota.

Diases of the Joints. By Howard Marsh, F.R.C.S.,
Senior Assistant-Surgeon to, and Lecturer on Anatomy
at, St. Bartholomew’s Hospital; Senior Surgeon to the
Hospital for Sick Children and to the Alexandra Hospital
for Ilip Disease. With 64 Illustrations and a Coloured
» Flhte. London: Cassell and Co. 1886.

Thb volume before us is one of Messrs. Cassell’s series
of Clinical Manuals. It avowedly deals with diseases of
joints from a clinical as opposed to a pathological point
of view, and is mainly taken up with a description of
diagnosis and treatment. Such pathology as is given is the
work mainly of Mr. A. Bowlby, who is well fitted for
such a task. We could have wished that lie had had more
space allotted to him, for there are several points in tho
pathology of diseases of joints which merit a fuller discussion
than they receive in Mr. Marsh’s book. At the same time
we have to remember that a limit was necessarily imposed
upon the author, and we cannot question his wisdom in
preferring to make his book clinical rather than patho¬
logical. Mr. Marsh’s experience at St. Bartholomew’s
Hospital and at two other hospitals has enabled him to

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Tub Lancet,J

REVIEWS AND NOTICES OP BOOKS.

[Maroh 10,1887. 581

enrich his chapters with many excellent clinical liistories
which admirably illustrate the diseases he describes, and
this feature of the book is sure to make it popular with
most readers. Altogether the work is pleasant reading,
practical, and trustworthy. The general teaching of
Mr. Marsh is that with which the majority of English
writers are more or less familiar. He does not advocate
novel or radical procedures, and it is for this very reason
that the book will be most acceptable to the majority
of practitioners, who will be told how to treat articular
affections without resorting to formidable operations. The
chapters on the early recognition and treatment of Scrofulous
Disease of Joints, on Syphilis of Joints, on Internal Derange¬
ment of the Knee, and on Bone-setting, seem to us to be
some of the best in the book, while that in which the
Injurious Effects of Intra-articular Pressure are described is
well worthy of study. The early chapters on Synovitis &c.
might have been arranged in a more systematic manner,
and in them we think we notice a few omissions—such as
the absence of any mention of over-use and of wounds
among the causes of simple synovitis, or of heat as a
local application in acute suppurative arthritis, the omission
of any notice of the value of antiseptic irrigation of joints,
and the omission of any treatment for purulent synovitis as
distinguished from acute suppurative arthritis. These
are, however, minor defects, and should in no way blind
us to the fact that Mr. Marsh has produced a readable and
useful work on a subject of the very highest importance.
The illustrations are not of a high order of merit; the
coloured plate which is said to represent a knee-joint affected
with Charcot’s disease may be that or anything else, and,
whatever it is, it fails to give any adequate conception of
the changes met with in this remarkable disease.

Lemons sur les Maladies du Systbne Nerveux. Par J. M.

Charcot. Recueillies et publides par MM. Babinski,

Bernard, Fia6, Guinon, Mabib, et Gilles db i.a

Toubette. Tome III. (2e/ne Fascicule). Paris: A.

Delahaye et E. Lecrosnier. 1887.

Wb owe the collection of M. Charcot’s lectures, delivered
at the Salpetridre, of which the present forms the conclusion
of the third volume, to the devotion of his friends and
pupils. They are lectures which are classical and will have
a permanent place in literature. Many of them have
appeared from time to time in the pages of our contempo¬
rary Le Prog res Medical, whose editor, M. Boumeville, was
associated with the production of the first volume of this
notable series. It is interesting to note how M. Charcot
has gradually in the course of his teaching tended to
pass from the region of structural to that of functional
disease. Thus, in the present volume there are several
lectures devoted to male hysteria, isolation in the
treatment of hysteria, hysterical paralysis, hysterical
caxalgia, contracture and mutism; two others to word-
blindness ; another upon a case of abrupt and isolated sup¬
pression dt the mental vision of signs and objects (form
and colour), and on choreiform tremors and movements;
while as to organic disease, there is one lecture on
double sciatica in cancer, and cervical pachymeningitis, j
and another on' a noeographical revision of amyotrophy.
Some of the subjects are further dealt with in an appendix,
affording additional observations upon the particular points
treated of. Interesting as the subject of hysteria always
is, and practically important as the recognition «f its
various forms must always be, it cannot but be felt that
among less emotional races the remarkable phenomena
described by M. Charcot as exhibited by the hysterical are
to be rarely witnessed. These lectures, therefore, may
attract less universal attention than those earlier ones
which did so much to enlighten the medical world upon the
pathological nature of organic disease of the brain and

spinal cord. But if they fail to be so widely read, it is not
that they do not merit it, for they exhibit in their clear and
well-considered language the same vigour of treatment and
masterly exposition that constitute the great charm of
all Professor Charcot's writings. As in the domain of
organic disease, so in the more intricate and complex region
of functional derangement, Professor Charcot cannot but be
regarded as a pioneer, whose observations are always exact,
and whose ideas are at once sagacious and fruitful.

OUR LIBRARY TABLE.

The Factors of Organic Evolution. By Hbrbbrt Spbncbr.
Pp. 76. London: Williams and Norgate. 1887.—This small
volume is a reprint of two essays originally published in the
Nineteenth Century for April and May of last year, in which
Mr. Spencer endeavours to show that there are several
factors in the process of evolution which have been allowed
to drop out of view owing to the followers of Darwin having
too exclusively devoted themselves to the single factor of
natural selection of favourable variations. He thinks that
one important factor thus neglected has been the inherited
changes induced in structure owing to modification of func¬
tion, as by the excessive use or disuse of parts, such changes
being inheritable, so that, for example, “ any change in the
fore parts of a giraffe which affects the action of the hind
limbs and back will simultaneously cause, by the greater or
less exercise of it, a remoulding of each component in the
hind limbs and back in a way adapted to the new demands;
and generation after generation the entiro structure of the
hind quarters will be progressingly fitted to the changed
structure of the fore quarters, all tho appliances for
nutrition and innervation being at the same time progres¬
sively fitted to both.” Another factor, he considers, is the
direct action of surrounding agencies on organic life, which
in its varying influence on different members of the same
group must always have tended to differentiate individuals
and led to the formation of types or species.

The Quarterly Journal of Microscopical Science— Edited
by Professor E. Rat Lankesteb, Thislkton Dyer, Klein,
Mosley, and Sedgwick. New Series. No. CVII. (Vol.
XXVII., Part 3). London: J. and A. Churchill. 1887.—
This part contains the following memoirsGilbert Bourne,
on the Madreporian Coral Fungia, with three plates.
2. Arthur Shipley: Some Points in the Development of
Petromyzon Fluviatilis, with four plates. 3. Robert Smith:
The Ammoniacal Decomposition of Urine, with two illustra¬
tions. 4. Herbert Carpenter: Notes on Echinoderm Morpho¬
logy, with an illustration. 6. R. v. Lendenfeld: The Func¬
tion of Nettle Cells, with an illustration. 6. Hanbury
Hankin: Some New Methods of Using the Anili ne Dyes for
Staining Bacteria. 7. Marshall Ward: Illustrations of the
Structure and Life History of Phytopthora Infestans, the
Fungus causing the Potato Disease, with two plates.
8 . Martin Hartog: The Formation and Liberation of the
Zoospores in the Saprolegniee. Dr. Smith has made a series
of experiments to determine the cause of the decomposition
of urea, and finds that it is owing to the presence of &
special form of microbe belonging to the micrococci, which
differs from the micrococcus ure® of Professor Leube, in¬
asmuch as it liquefies gelatine.

Vision and Vision-testing, with Practical Tests. By A. St.
Claib Buxton, F.R.C.S., Assistant-Surgeon to the Western
Ophthalmic Hospital, London. Pp. 83. London: Pickard and
Curry. 1887.—Mr. St. Clair Buxton supplies in this little
work a popular and very brief account of the anatomy
and physiology of the eye. A novelty is introduced in
the shape of a figure showing the mode of formation
of distinct and indistinct images upon a screen of a
candle flame by means of a lens. The fact which will prove
most serviceable is the account of the tests to which

Google

582 Tub Lancet,]

REVIEWS.—NEW INVENTIONS.

[Maboh 19,1887.

Government officials are now subjected, and which, if every
intending clerk were to try upon himself, would spare much
disappointment and annoyance.

Obstetrical Transactions. Parts I., II., and III., for 1886 —
The Obstetrical Transactions for 1886 fully maintain the
character of the series as a record of interesting cases, and,
more important still, as a result of solid work done by the
Fellows. In this work we are glad to find seniors and
juniors happily united in friendly rivalry, some of the com¬
munications being the result of investigation spread over
several years. The appearance of the Transactions in parts
is a decided improvement, as the matter is more easily
assimilated in detail, and is laid before the medical world in
a tangible form before it becomes stale. Among the more
important scientific papers we may mention those by
Dr. Herman on the Oblique Pelvis of Naegele (January), and
on one of the causes of Difficulty in Turning; by Dr.
Matthews Duncan on Contraction, Inhibition, and Expansion
of the Uterus (April), and another on Elasticity, Retraction,
and Polarity of the Uterus (May); by Dr. Champneys on
the Artificial Production of so-called “Lymphatic Varix”
(June), and Observations on the Uterine Bruit (July); by
Dr. John Phillips on Spurious Hermaphroditism (with a
remarkable family tree); and by Mr. Doran on Malforma¬
tions of the Fallopian Tube (July). Among the most
interesting cases the following may be named:—
Gastrotomy for Extra-uterine Gestation in which the
placenta never came away, by Dr. Braithwaite;
Removal of both Ovaries during Pregnancy, by
Mr. Thornton (February); Multiple Fibromata com¬
plicating Twin Pregnancy, by Dr. John Phillips
(June); and Chronic Abscess of the Urethra, by
Dr. Herman. Of the specimens shown, the following
are of interestGestation in one Horn of a Uterus
Bicomis Unicollis, by Dr. Campbell Pope (March); a
Series of Uteri at the Onset of Labour and After
Delivery, by Dr. Barbour (March;; and a Naegele
Pelvis, by Dr. W. Griffith (April). We congratulate
the Society on so creditable an amount of work done
during nine months. The final part of the Trans¬
actions is still to come.

Archiv fiir Pathologische Anatomic und Physio¬
logic- Herausgegeben von Rudolf V ibchow. Bd. 107,

Heft I. Berlin: G. Reimer. 1887.— The January
number of Virchow’s Archiv contains the following
articles: 1. On the Influence of Hardening Methods
upon the Condition of the Ganglion Cells of the
Spinal Cord in the Rabbit and Dog, by Dr. Trze-
binski. 2. Researches on Heat-radiation of the Human
Body, by A. Masje. 3. The Structure of Foetal Mem¬
branes in Abdominal Pregnancy, by Dr. A. Walker.

4. On the “Reducing” Substances in Diabetic Urine,
by Dr. Hans Leo. 5. Contribution to the Doctrine
of Trophic Nerves, by Dr. Max Joseph. 6. The Fascia
Umbilicalis and its Connexion with Umbilical Hernia
in Children, by Dr. H. Sachs. There are also some minor
contributions by various writers.

Centralblatt fiir Bacteriologic und Parasitcnkunde.
Herausgegeben von Dr. O. Uhlwobm in CasseL Bd. I.
Nos. 1 and 2. Jena: J. Fischer.—The activity of bacterio¬
logical research has led to the issue of a “ Centralblatt,”
which is to appear weekly. The editor, Dr. Uhlworm, acts
in co-opferation with Professor Leuckart of Leipsig and
Dr. Loeffler of Berlin, names which will sufficiently guarantee
the high character of the journal. Professor Leuckart con¬
tributes an original article upon the Bothriocephalus ques¬
tion, which occupies the first place in each of the first two
numbers, the remaining pages being devoted to abstracts
and reviews of recent work. The second number also
contains a list of recent literature compiled by Dr. Wurz¬
burg, librarian to the Imperial Sanitary Institute.

Revue QbtArale de Clinique et de Therapeutique ( Journal
des Praticiens) is a new journal, of which the first number
appeared on the 17th ult. It is published every Thursday,
and its chief aim is to supply within a small compass ail
that is of special interest to the actual practitioner. The
official address is 16, Rue Cldment Marot; the chief editor
is M. Huchard, and the acting secretary M. Eloy. The first
two numbers are very well done.

fhfo fnWions.

EMPYEMA-TUBE.

A tche which will provide satisfactory drainage in cases
of empyema has long been a desideratum. The simple
indiarubber tube is liable to have its calibre obliterated by
the pressure of the ribs, or thickened pleura in long¬
standing cases, or by becoming kinked just inside the
chest wall. The ordinary silver empyema-tube does not
adapt itself well to the varying conditions of the chest, and
often causes injurious pressure on the lung. The silver
tube I have had made is non-compressible* cannot become
kinked, will fit any chest, is comfortable to the patient, and
keeps well in position. It is composed of a shield (A) measur¬
ing two inches by one inch and a half, and a lobster-tailed

Fig. 1.

Fig, 2.

Front view, with indiarubbev tube
attached.

tube (b) attached at right angles
to it. The shield gives a firm base
of support to the tube, and pre¬
vents it from slipping into tho
chest, while the pressure of the
dressings on the broad surface
guards against any untoward
displacement. The lobster-tailed tube (n) is two inches
long, with an oval bore of half an inch by a quarter of an
inch. The joints nearest the shield are made especially
mobile, to enable it to fit accurately round the inside of
the ribs and pleura. It has several openings to give exit
to the fluids. Over the silver tube one end of a thin piece
of indiarubber tubing of the required length can be drawn ;
the outer end of this tube is slit into four parts, each of
which *s passed threrugh two slots in the corresponding
side of the Bhield (a). This arrangement fastens the two
tubes securely together. In practice I have found this tube
answer all my expectations. Great care must be taken, on
account of its numerous joints, to purify it thoroughly.
It is made in three series by Messrs. Ferns ana Co. of Bnstol,
one larger and one smaller than the above. I have found it
advisable, however, to use as large a tube as possible.

W. J. Penny, F.R.C.S.,

Assistant-Surgeon to the Bristol General Hospital,

Die

ea by

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Thu Lancet,]

ERYSIPELAS AFTER VACCINATION.

[March 19,1887. 583

THE LANCET.

LONDON: SATURDAY, MARCH 10, 1S87.

The complaints which have from time to time been made
as to erysipelas after vaccination are evidently leading to a
careful examination of all the circumstances associated with
such occurrences, and the report which lias recently been
submitted to the Local Government Board by Dr. Airy on
three cases of fatal erysipelas after vaccination in the
Sudbury Union is fairly typical of the facts which are
usually elicited. The three cases occurred in October and
November of last year, the deaths taking place on the 2nd,
9th, and 11th of November respectively. The three children
were vaccinated by three separate medical practitioners,
two of them being public vaccinators. In all three
instances the operators performed the vaccination with
all the needed care, and except as regards time and
general locality the cases had nothing in common. More¬
over, in each case other children had been vaccinated
with the same lymph, and this without the occurrence of
any untoward symptoms.

In the first case the vesicles were first broken accidentally
after the eighth day, and it was after this followed by spread¬
ing erysipelas, which caused death. But rupture of vesicles,
as Dr Airy points out, is not sufficient to cause erysipelas,
otherwise the intentional opening of vesicles would often be
ollowed by a similar result. The poison, the contagium,
the seed of erysipelas must be implanted into the scratch or
wound thus induced. And it should be noted that if the
erysipelas had been inoculated when the operation was per¬
formed, it would have shown itself at a much earlier date
than the second week. The introduction of the poison took
place after the accidental rupture of the vesicles, but beyond
the fact that the infection of erysipelas was about in the
town and neighbourhood, nothing to prove the occurrence of
the infection could be ascertained. The child, however,
lived in a spot where a low form of sore-throat was common.
In the second case, which had no apparent connexion with
the first, vaccination had been performed with calf lymph,
and the child was well on the eighth day, when on inspection
it was found that the vesicles had been broken. In this case
the surroundings of the house were found to be insanitary;
the mother had recently suffered from abscess of the arm;
the father had an ulcer of the leg; when the child was
brought to the surgery for inspection, a woman was sitting
in the waiting-room with erysipelas of the face, and the
practitioners connected with the case were at the time
attending a case of erysipelatous inflammation of the leg,
alao a child with erysipelas, besides two cases of scarlet
fever. Such facts abundantly account for the erysipelas
in the vaccinated child. In the third case no definite
source of infection could be discovered, but the child
lived in a low-lying place close to swampy and unhealthy
meadows.

In connexion with the origin Of these cases of erysipelas,
it is curious that in October and November three fatal

attaoks of the same disease after vaccination took place in
the same union; and the indications also ptiinted to an
endemic prevalence of erysipelas last autumn, a considerable
amount, together with undefined sore-throat a, being reco¬
gnised. Under these circumstances, the wound produced
by a lancet-scratch, or by a ruptured vesicle, is liable to
receive the infection 1 of erysipelas just in the same way as
is any other wound. And this raises the question whether
vaccination accidents are at all frequent preliminaries to
erysipelas. This is answered by an instructive note which
is placed at the head of the report by Dr. Buchanan.
Taking septic diseases registered as having followed vac¬
cination, Dr. Buchanan points out that in England and
Wales during 1883—the latest period for which comparable
official data were available—the number of infants reoeiving
scratches or pricks in the process of vaocin&tion was
733,192. The operation was followed by ill consequences
in oertoin of those childfeh, and 61 of them died, ail or
almost all from septic diseases. Now, in England and
Wales the number of infants under one year of age was in
1883 over 760,000. By one mischance or other, but apart
from any recorded ooonexiorf with vaccination, a certain
number of these children became the subjects of septic
disease, and of that number 724 died before completing one
year of age. The facts may well be borne in mind, for they
point to the circumstance that whilst a vaccination scratch
is, like any other wound, liable to receive -the erysipelatous
poison, this result is really a rare one when compared with ■
erysipelatous and septic occurrences following on other,
causes. The T«port k in which tho facts recorded are set out
has been placed on sale as an official publication.

■»■ ■■ ——

Tin; committee which has been appointed to consider
how best to organise medical attendance on the working
classes in London has a difficult task before it, and will have
many critic*. We have reported from time to time the
main, conclusion* readied, and it is to be admitted that the
committee in theee conclusions shows a perception of some
of the chief rocks upon which the Metropolitan Medical
Provident Association struck. They have agreed on a
wage limit and upon terms of admission daring sickness
which it is thought will be, while not discouraging to pro¬
vidence and forethought, enough to induoe tho so actually in
need of medical attendance to join the dispensaries. We do
not propose at present to discuss all the resolutions of
the committee, but rather to emphasise the importance of
a question which they are approaching, and which they
must discuss at either the next meeting or the one imme¬
diately following—vis., the possibility and the advantage
of co-operation between the hospitals and the provident
dispensaries. It is thought by many that the out-patient
department of hospitals is greatly abused, and that
many of the patients so treated ought "to be refused
treatment there and relegated on system to the provident
dispensary nearest to their homee—a point to be ascertained
by a list of such institutions to be kept in each out-patient
room of the various hospitals; and that the dispensaries, on
the other hand, should be in close and organic relations
with hospitals, and their officers have the power to ask

1 Eyre ami Spot t is woe Mo, East Harding sirei-l, E.C. ; Allan anil
Charles Bladk, E linburgli; Hodges, Pigglsaud Co., Dublin.

Digitized by CjOOQlC

584 Thk Lancbt,] CO-OPEEATION OP HOSPITALS AND PEOVIDENT DISPENSAEIES. [Mabcu 19,1887.

consultation and co-operation with the medical staff of
hospitals in all cases of difficulty or severity.

The medical staff of hospitals will do well to consider
this proposal in a kindly spirit. They will perceive at once
some of the objections to it, and be apt to imagine the out¬
patient rooms deserted, and its usual occupants crowding to
the nearest provident dispensary. With this change they
will be likely to apprehend diminished means of teaching
common diseases, which are alleged already to be insufficiently
studied and taught at hospitals; and the financial authority
of hospitals may say that it is no business of theirs to
inquire into the social condition and means of patients, and
to serve as promoters and feeders of provident dispensaries.
Such objections will not, we feel sure, be pressed too far.
The hospitals are too great in their function, and in their
services to the public and to the poor, to need to fear lest
they should be left unsought. The more serious cases will still
repair to them in numbers; and by enabling the medical
officers to treat them with more thoroughness than is possible
now with promiscuous crowds in the out-patient rooms,
greater credit will redound to the hospital, and greater grati¬
tude beforthcomingfrompatierfts. Wehaveneverbeeninsen¬
sible to the vagueness of the charges of abuse of hospitals.
The million of patients in London out of its five millions
has always appeared to us as a most misleading statistic,
including, as it certainly often does, the same patient over
and over again in the same institution, admitted under
different letters, and also the same individual as a patient
in different institutions. But it is an undoubted fact that
many persons frequent the out-patient rooms of hospitals
who can afford to pay a private practitioner, or who ought
to come under a system of insurance against medical bills,
which it is the object of provident dispensaries to enable
those of small means to avoid. And we do not know any
way in which hospitals would do better service than by
co-operating in a systematic and organised attempt to
eliminate such persons from their patients. They would
not only be lessening the heavy demands on their own
funds, but by showing a disposition to co-operate for the
removal of the only abuse seriously charged against them
they would make their claim on the liberality of the public
incontestable. We look forward with much interest to the
discussion of this question by a committee, including very
influential members of the profession who, with singular
disinterestedness, have tried to view it in all its bearings.

Thk Trade Depression cloud has not yet passed away,
although the Eeport of the Eoyal Commission is rapidly
descending into the limbo of forgotten things. It is true
that a more hopeful tone prevails among the vates, and the
opinion has now become current that if Europe can keep out
of war, it will shortly enjoy in a large measure the commer¬
cial results of peace, nappily, although the risk of war is
still undeniably great and even disquieting, it is yet open to
us to hope that both the condition and the promise will be
fulfilled. In that fulfilment the professional classes, and
especially that of medicine, have a much nearer and
livelier interest than is perhaps generally supposed. It is
very commonly assumed that, as the state of trade affects
them only indirectly for the most port, they can only be
slightly interested in it, whether as sentimentally sharing

the sufferings of their neighbours or as practically involved
in the hardship of overdue accounts and bad debts. But in
point of fact this is only half of the mischief. Another
and more permanent inconvenience is the overcrowding
which it produces in the ranks of the professional classes.
The clouding over of the commercial horizon causes hundreds
of youths, who in happier circumstances would have found
their places in the van of the trading community, to divert
their energies into what looks at the time the fairer field of
professional toil. It does not strike them, until in after
years their mutual competition has involved them all in a
common disappointment, that the equation of supply and
demand holds as rigorously true in the schools and the
forum as in the mart; and then enlightenment has come
too late. The generation must pa38 away before the con¬
sequences of such an incursion can wear off. Thus the effect
upon the career of an ordinary professional man, if less
direct, is much more lasting than on that of the ordinary
commercial man. The disorder does not assume quite such
an acute form, but it is less amenable to remedies, and cer¬
tainly no less trying to the body politic. We make no claim,
therefore, to the praise of altruism in respect of the keen
interest taken by medical men generally in the subject upon
which the Eoyal Commission so lately reported, and with so
little apparent effect.

There is, indeed, one suggestion made by the Commission
which seems to be in a fair way of yielding fruit, and it
happens to be the one in which medical men have perhaps
the most direct interest. It is that which relates to
the amendment of the Joint-Stock Companies Acts. In
the suggestion we heartily concur, regretting only that the
Commission ers were not more explicit and precise as to the
remedy to be applied. That, however, is a defect which can
e asily be repaired. Already a deputation of practical men
has interviewed Lord Salisbury, and had the opportunity
of explaining to him the defects in the law to which
experience points. He has replied that the Government
proposes to deal with this matter in the way of legislation,
and assuredly the time for legislation has fully come; for
great as is the impulse which these statutes have given to
the commercial development of the country, it is only too
patent that they have opened the door to enormous abuses.
Unscrupulous promoters have plundered the public, and not
less unscrupulous wreckers have plundered the Companies,
until between the Company-producer and the Company-
consumer, it might almost seem as if a new industry had
been created, having for its special object the destruction of
all other industries whatsoever. It is high time that a
remedy should be applied to this crying evil, and no class of
society is more directly interested than are our readers in
its being done, and done soon. The medical man who is
laying by for the period of repose to which every hard¬
working man is entitled to look forward, can find no better
investment for his savings than a well- managed and sound
! industrial company. As a rule, he is a fa irly shrewd investor,
i but no acumen can make him safe from the depredations of
knaves whom a defective law furnishes with the means of
power of mischief, and protects from condign punishment. Is
it too much to ask that these anomalies should be redressed,
and that the law should bo armed for the effective punish¬
ment of wrong-doers of this class ? Surely we may fairly

TH» LanCeT,]

MISREPRESENTATIONS ABOUT HOSPITAL SUNDAY.

[March 19, 1887. 585

ask to be defended from the swindler as we are already
defended from the burglar and the bully.

■■■ ■»-

Thk Hospital reports and justly comments upon a mar¬
vellous and mischievous misstatement, or rather a series
of misstatements, by which, it alleges, a City Company
was induced to send “a very large grant” to one of “the
metropolitan hospitals.” The statements (by the mover of
the grant) as given by our contemporary, were much as
follows:—“That Hospital Sunday was everywhere a failure,
because it not only lessened the aggregate amount of the
income received by hospitals as a whole, but it destroyed
the source of income. People who formerly gave pounds
now give pence, or more probably * buttons only,’ through
the offertory; and, finally, that so serious was this injury
to hospitals, that the late Dr. Wakley expressed the
deepest regret that he had ever been associated with
Hospital Sunday.” It is devoutly to be hoped, for their
own sakes, that the City Companies are treated to more
accurate statements in general, and that their liberal gifts
are extracted by sounder arguments than these. Our
contemporary has well disposed of the statement that
Hospital Sunday has resulted in a loss to the hospital
revenues. On the contrary, there is a clear gain to them of
£20,000 per annum, on comparing the receipts of 1885 with
those of the year preceding the institution of Hospital
Sunday. At a very recent meeting of the Hospital
Sunday Fund, the treasurer of the London Hospital and
the treasurer of another metropolitan hospital explicitly
stated that they had lost no subscriptions by Hospital
8unday. The London Hospital alone—that light in the
dark end of London—has received in the last thirteen years
from the Hospital Sunday Fund .£40,742, and, according to
its treasurer, this is all money to the good. We do not
believe in the " buttons” theory much. The man who in
a church would put buttons into a hospital collection is
exceptionally mean and base, and must be a rare exception;
and it is certain that the appeals and personal efforts of the
ministers of religion have stimulated the erstwhile latent
chanty of many thoughtless and unimaginative people, who
till then never considered what a hospital and its ministra¬
tions did for the sick who “ cannot recompense” those who
benefit them. It is possible and even true that some of the
“ Dispensaries” do not receive from the Fund all that they
received from the collections of local churches. But this is
a small set-off against a great movement, and one that should
he easily corrected by local charity. But we have to make
stronger protests still against this misleader of City
Companies and other liberal bodies. His assertion that the
late Dr. Wakley regretted his association with Hospital
Sunday is one of the worst forms of misrepresentation
that we can imagine, both as regards the deceased and the
institution 'which he was the means of establishing in
Condon, and which in the sufferings of his Inst days he
cherished and supported so warmly. We have no idea which
hospital is referred to, nor do we know the name of the
City Company, but, assuming the accuracy of the report, it
would have been more creditable to the orator if he had
W'ged himself and his audience to a personal imitation of
Oakley’s example, instead of misrepresenting his
deepest sentiments, and on this misrepresentation founding

an appeal for a hospital which is described in the pages of
a journal specially devoted to the material interests of
medical charities as one of the “ least well-managed” hos¬
pitals. We may add that the late Dr. Wakley has be¬
queathed by his will, in addition to his former gifts, £1000
to the Metropolitan Hospital Sunday Fund.

“ Ne quid nimU.”

ARMY MEDICAL SERVICE.

As the groundless alarm on the subject of relative rank
has beeu set at rest, it may not be amiss again to bring to
the notice of the War Minister a real and substantial
grievance seriously affecting a considerable, and yearly in¬
creasing, number of the medical officers of the Army. We
allude to the date of their commissions on entering the
Service. Prior to 1877 the commissions of all the officers
who passed through Netley ware dated from the day on
which they joined the Army Medical School. In that year,
however, a change was made, and has since continued in
operation, by which the commissions of Army.medical
officers are dated from the completion of the course of
instruction, while those of the surgeons for the Indian
Service continue to bear the date of its commencement.
The Naval candidates, who were withdrawn from Netley,
enjoy the same privilege as the Indians, their appointments
dating from the period of their joining at Haslar. The
practical result of this system is that the Army medical
officers must always—at least, until selected for administra¬
tion rank—be the juniors of the Indian and Naval medical
officers who pass the competitive examination at the same
time with them, and who have no recognisable claim which
would justify their being placed over the heads of their
follow-competitors. We do not know upon what grounds
this invidious distinction has been made, but in our opinion
it is a most incomprehensible act of injustice. It cannot
fail to have an injurious influence upon the supply of
candidates for the department, and, unless it is remedied,
will create a marked difficulty in procuring a desirable class
of candidates for the Army Medical Service. We trust that
Sir Thomas Crawford will press upon the attention of tli9
War Office the claims of his officers to have this grievance
redressed, and that the War Minister will take an early
opportunity of altering a regulation which acts so unjustly
upon a meritorious class of officers. We can scarcely doubt
that it will only be necessary to bring the case under his
consideration to ensure the placing of candidates for the
Army Medical Service upon a footing of equality with those
who enter the other branches of the public Service under
precisely similar conditions as regards competition and
qualifications. _____

THE SANITARY CONDITION OF NEW WINDSOR.

A meeting of the Urban Sanitary Authority of Windsor
was held last week, and the sanitary administration of the
town naturaUy occupied the attention of the Council. An
important step was taken in the adoption of the report of
a committee recommending the appointment of an inspector
of nuisances. The Council are to be congratulated on the
promptitude with which they have carried out the advice
on this point of the Local Government Board’s inspectors.
By systematic house-to-house inspection much can be done
for the maintenance of the town in better sanitary condi¬
tion ; the more serions improvements will doubtless be
undertaken after a conference which is to be held between
the Authority and the owners of property mentioned

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ABDOMINAL SECTION STATISTICS IN KIEFF.

[March 19,1887.

in the report of the Local Government Board. Already
letters have been exclianged between the clerks of the
Sanitary Authority and of the Board of Guardians with
reference to the erection of a hospital for infectious
disease and for the provision of a disinfecting chamber.
A proposal appears to have been made to erect in
the first instance an administrative block only, and then,
as stated by a member of the Council, “if a disease broke
out, a temporary erection could be put up in which the
patients could be treated.” It is to be hoped this course
will not be pursued, for it is quite obvious that the authority
would then be deprived of the opportunity for the imme¬
diate isolation of cases of infectious disease. While tempo¬
rary accommodation was being prepared it is likely enough
the disease would spread and the town would probably have
to bear the expenses of a more serious outbreak for want of
means for isolating the first cases. A temporary hospital is
moreover in the end, more costly than a permanent build¬
ing. The experience of the Metropolitan Asylums Board and
of many hospital-providing boards throughout the Country
has shown this, and Windsor would be acting more wisely in
providing for immediate use, whenever occasion occurred,
accommodation for the isolation of any infectious cases
which could not with safety be treated in their own homes.
The last recommendation of the inspectors—the erection of
a furnace for the destruction of house refuse—has been
referred to the Street Committee for their consideration.
An interesting report by Dr. Casey, the medical officer of
health, on the sanitary condition of Windsor during 1886,
was presented at the same meeting. The report is mostly of
a statistical nature. It contains no description of the more
insanitary parts of the town, probably because the Authority
are already in possession of much information on this subject.
The report states, however, that “ one house was condemned
as unfit for human habitation.” It may be hoped that
Torrens’ Act will be more freely used in the future than in
the past. _

ABDOMINAL SECTION STATISTICS IN KIEFF.

Professor Hein of Kieff, in a paper read at the recent
Moscow Congress, gave the results of the ninety-five cases in
which lie had performed abdominal section from 1883 to
1886. Of these, sixty were ovariotomies with four deaths,
twelve were for -removal of large cysts of the broad liga¬
ments with one death, fourteen for myomata with three
deaths. The remaining nine — viz., three exploratory
incisions, one enucleation of a cyst in the broad ligament,
one section of a purulent abdominal cavity, one section of a
purulent cavity in the pelvis, one castration ( kholoshchenie ),
one ovariotomy with excision of cancerous omentum, one
removal of an echinococcus of the omentum—gave three
deaths. The causes of the eleven deaths are thus stated
Purulent peritonitis, four; gangrene of the pedicle, one;
gangrene of the remaining part of the tumour, one ; ery¬
sipelas of the leg, one; exhaustion, one; effusion of blood
into the pelvis and acute nephritis, one; sepsis, one; and
carbolic-acid poisoning during the operation, one. The
general percentage of fatal cases was tlierefore ITS.
Professor Rein remarks that he has tabulated every case he
had without making, any exceptions, though two or three
of the patients were almost moribund when the operation
was performed. The arrangements of the hospital ward?,
too, were far from being satisfactory. Regarding the opera¬
tions themselves, some difficulty is usually experienced with
the subperitoneal or connective-tissue cysts. He, however,
had always succeeded in getting them away entire, enucleating
them from under the peritoneum, or cutting them out from the
broad ligament. He does not agree with Schroeder’s plan of
washing to prevent haemorrhage, but recommends instead
the ligature of the ovarian and uterine arteries. He prac¬

tised drainage in nine cases, using indiarubber tubes passing
through the vagina in three and glass tubes passing through
the abdominal wall in the other six. These glass tubes are
twelve millimetres in diameter, and are shaped like a
tracheotomy tube. The later operations show a decidedly
lower mortality than the earlier, owing to various improve¬
ments which have been made in the wards rendering them
less septic. Though Professor Rein recognises the import¬
ance of antiseptic measures, he is quite alive to their possible
dangers. Latterly he has contented himself with disinfecting
the room, instruments, air, and operator’s hands, not apply¬
ing any disinfectant directly to the surface of the Wound,
and not irrigating it. The instruments and operators bands
were washed in simple boiled or sterilised water.

UNIVERSITY OF CAMBRIDGE.

An important report has just been presented by the
Special Board for Medicine to the Vice-Chancellor of the
University of Cambridge for communication to the Senate.
It recommends that the period of study necessary for the
M.B. degree be made in all cases five years, the exception
hitherto existing in favour of Honours students being done
away with. The examination in pharmacy and phar¬
maceutical chemistry, forming part of the second examina¬
tion, has for some time, it appears, been unsatisfactory; and
though the Board has on several occasions revised the
schedule issued by them for the guidance of students, the
reports of the examiners show that a considerable number
of the candidates are imperfectly prepared, and fail to grasp
the particular application of chemical principles which the
subject involves. The Board now recommends that the
student should, during the earlier part of his course, have
his attention directed to the chemical aspect of the materia
medics, the parts of the subject relating to the dispensing
and prescribing of medicines being studied at a later stage
in immediate connexion with therapeutics and clinical
medicine. They propose to indicate this change by altering
the title of the examination to pharmaceutical chemistry,
and by making the examination itself mainly practical;
while the practical study of pharmacy or dispensing may be
deferred until the student is attending hospital practice.
The regulations for the degrees of M.B. and B.C. are to be
so modified as to ensure every person who is admitted to
either degree being fully qualified in both branches of
practice. Certain other minor changes are recommended,
and should the report be approved by the Senate, of which
there can he no doubt, the new regulations will come into
force at the beginning of the ensuing academical year,
October, 1887. _

THE USE OF UNCOOKED MILK.

The question of the habitual use of uncooked milk which
prevails in this kingdom is one which demands serious
attention. Again and again have milk epidemics of
typhoid fever, scarlet fever, and diphtheria shown conclu¬
sively how severely the incidence of the disease in question
has been felt upon those using uncooked milk, as opposed
to those taking milk only after it has been boiled or other¬
wise cooked. At one time it was thought that the matter
involved only the question of the cleanliness of the dairy,
and the freedom of those engaged in its management from
communicable disease; and the mere fact of milk coming
from country dairies has been held to be a sufficient guaran¬
tee of its wholesomeness. As a matter of fact, our experi¬
ence goes to show that the danger is at its greatest according
as dairies arc situated in the more remote and rural locali¬
ties; for it is precisely in scattered rural areas that first
cases of ill-defined sore-throat an,d other affections in the
families of those having to do with cows and milk are most

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Thu Lax crt,1

MICROCOCCUS PYOGENES AUREUS.—WORRY NOT WORK. [Mines 19,1887. 587

likely to pass unnoticed. Bat recent experience has shown
that disease in the human subject, whether unrecognised
or concealed, it not the only—perhaps not the greatest-
danger that has to be contended with in connexion with our
milk services. It has now been shown that the cow herself
may suffer from a disease which at present is rarely, if ever,
regarded as of any importance by dairymen, and which may
give to the milk, at the actual moment of entering the pail,
the power of producing scarlet fever in those who consume
it in its raw state. Just as the excellent arrangements which
have been matte for the medical supervision of dairies must
at times fail to detect certain cases of disease in the human
subject, so must any veterinary or other inspection of cows
fail in certain cases to prevent scarlatina-producing milk
from being despatched from the dairy. We would therefore
once again urge the importance of using milk only after it
has been boiled or otherwise cooked. And for those who
have not habituated themselves to the somewhat altered
taste of boiled milk as a beverage, we may note that if milk
be boiled immediately after its delivery by the milkman
and be then set aside in a epol place for some six hours,
the taste which' is sortfetiiiies'objected to Will* be found to
be alinost entirely removed; and not only so* but milk so
treated kee^s good aHd wholesome for a longer period than
does Unboiled milk. _

MICROCOCCUS PYOGENES AUREUS,

MM. G a mu el, Roux, and Lepinf, presented to the Soctete
dea .Sciences Modicales, at a recent meeting, a series of tubes
enclosing cultivations of the M. pyogenes aureus, modified by
the action of acetanilide. If a mixture of equal parts of agar-
agar solution and a watery 1 per cent, solution of acetanilide
be inoculated with a dose of M. pyogenes aureus taken from
a normal cultivation, the development may bo carried out as
usual in a stove at a temperature of 35 6° €. The area formed
by the growing colony is, however, less compact, less thick,
more flocculent, and, what is more interesting, does not
assume the yellow orange tint after growing for from twenty-
four to thirty-six hours, but remains dirty white, and
preserves this tint; but a particle of this cultivation trans¬
ferred to ordinary agar gelatine grows into a colony which
regains the ordinary characters and colouration of the
micro-organism. _.

WORRY NOT WORK.

Them is nothing new in the dictum that “ It is not work
that kills men, it is worry.” This has been said, and in
nearly the same Words, scores of times previously, by most
writers on the subject. Nor is the remark “ Work is
healthy—you can hardly put more upon a man than he can
'>ear ■ original: hut Ward Beecher ptifs the facts forcibly
when he says “Worry is rust upon the blade,” except that
rust commonly accrues upon inaction, whereas there is not
»little worry associated with work, although the two things
»re quite different. “ It is not the revolutions that destroy
the machinery, but the friction.” This is the truth abso¬
lutely. Work is not only harmless, but beneficial, because it
stimulates the organism to recuperate. Worry exhausts not
only the power which nature sets apart for action, but the
v «tal strength upon < which depends the replenishing of this
Power; and so by living at high pressure, which means a
worried and anxious life, we both spend interest and eat up
capital, with the result that nothing less than beggary
•tares us in the face, and all because we will haste to be
°ch, or famous, or great, or in some way prosperous. It
would be well worth while to endeavour to teach people
tetake things easily, and remember that mo 3 t of the very
things of life, whether of mind, body, or estate, are
^^ iCb Com ® only those vbo “U* wait » and ar e not
be had at all for “ pushing,” •* hurrying,” or “ struggling.”

How directly and practically it is true, os a maxim of life,
that patience is the highest virtue, none know better than
those whose business it is to keep a ceaseless watch on the
course of life, and to be ever ready with head and hand to
aid and smooth its progress from the beginning to the
ending. _

PHYSIOLOGICAL ACTION OF COCAINE.

Db. Frbibcbo, working under Dr. Blnmenthal, at Kowno,
Russia, has arrived at the following conclosions respecting
the physiological action of cocaine ( Bert . Klin. Woch.,
No. 10). Cocaine is a powerful anmsthetic, its action being
limited to the surface in its immediate neighbourhood; and
when brought into contact with an exposed nervo the
anaesthesia is distributed over the periphery, but the central
end of the nerve and motility are unaffected. In doses of
half a grain to a grain in rabbits, and rather more in dogs,
cocaine causes anesthesia of the cornea, dilatation of pupils,
retraction of eyelids, and exophthalmos; tonic and clonic
spasms may occur, with loss of consciousness, and often fatal
issue. The epileptiform spas ms are doubtless of cortical origin.
A difference as to the anmstliesia is observed between dogs
and rabbits when cocaine is applied tp nerve trunks. In dogs
reiiexes are abolished; in rabbits they are increased. Cocaine
has a special affinity for the, sensory and terminal sensory
fibres of the cortex cerebri, whose function it inhibits. The
disturbance of cpbrdinatiqn may be attributed to interrupted
conduction in the sensory fibres, both central aniperipheral;
and the convulsions, which a^a the main cause of death.,in
cocaip.e poisoning; are due to the vaso-motor spasm and
anmmia of the cortex. Bromide of potassium and the applica¬
tion of cold to the surface counteract this tendency; but
with the first appoaranc9 of symptoms of cerebral amcmia,
these toxic effects of cocaine maybe mitigated or bauished
by nitrite of amyl. _

CRIMINAL ABORTION.

An inquest was opened at Islington by Dr. Danford Thomas
on Pete 28th last, and concluded a week later, touching
the death 6f Catherine Tupner, aged thirty-five years. The
deceased woman was married and the mother of five children.
She aborted on Feb. 12th, and or the following day Mr.
Wickers was called in to attend her. She died on Feb. 22nd.
A death certificate of “ puerperal metritis ” was given and
registered,but, from information received that foul play was
suspected, the coroner ordered an inquiry. At the post¬
mortem examination it was found that the abortion had been
induced by operative measures. There were no wounds of
the vulva, vagina, or os uteri; but in the cervix uteri were
several deep elongated lacerations, extending for nearly the
whole length of the canal. These lacerations tapered off at
each end. The body of the uterus, which was uninjured
and empty of the products of conception, save for portions
of the uterine part of the placenta, showed pregnancy to
have advanced for fully three months. The peritoneum
was acutely inflamed, especially in the pelvis. On the left
of the uterus there was extensive cellulitis and abscess forma¬
tion. There was suppurative pia arachnitiffover the anterior
two-thirds of the upper surface of the brain. The spleen
was pultaceous and enormously enlarged. In the left kidney
was a haemorrhagic infarct occupying a quarter of its sub¬
stance. The liver was large and fatty, the result of pyrexia
and blood poisoning. There were thus the local and general
effects of septic inflammation developed to a marked degree.
In the right ovary was a corpus lufceum fully half an inch in
diameter, consisting of a large black central blood clot and
a peripheral corrugated zone of orange-coloured tissue. In
the same ovary was a minute stellate cicatrix, the remains
of a ruptured follicle due to a past menstruation or con¬
ception. In the left ovary was a cyst a quarter of an
inch in diameter containing sepia-like fluid. These facts

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588 TMB LAfoCKT,]

SCHEDE’S METHOD OP DRES8ING WOUNDS.

[March 19,1887.

relating to the ovaries are interesting, inasmuch as it is said
the pregnancy was a twin one. It appears, then, that either
both ova were liberated from the same follicle, or else the
second corpus luteum failed to develop. Now, considering
the extent of the lacerations of the cervix, and that the
parts external to it were free from wounds, the opinion
formed by the medical men consulted that the operation
had been performed by a practised hand was well grounded.
Clearly the deceased could not have inflicted the injuries
herself, and it is scarcely possible that a person wholly
unskilled in instrumentation of the uterus could have
avoided wounding the vagina and os uteri. The jury
returned a verdict of “ Wilful murder against some person
or persons unknown.” _

SIR JAMES PAGET ON THE DENTAL HOSPITAL.

The efforts which were made this year to render the
annual dinner of the Dental Hospital of London a success
were amply rewarded. Sir James Paget took the chair, and
amongst the guests were many eminent members of the
medical profession, and all those present showed the greatest
sympathy with the object of the meeting—namely, to
create an interest in the good work done by the Dental
Hospital, and to appeal to the general public for subscrip¬
tions to enable the premises to be extended, since they are
quite inadequate to the increasing number of patients.
Sir James Paget, in proposing the toast of the evening,
observed :—

“ It was difficult to estimate, for example, the amount of
happiness which was given to the 40,000 people who had
been attended in one year. This total was still increasing,
and had increased, he believed, 4000 within the last month.
Few persons had passed through life without knowing the
happiness of good dental surgery. Let them imagine 40,000
people suffering without any hope of remedy. They might
consider the comfort we had from the teeth, that very
evening a great part of their enjoyment of a good dinner
had been due to them. On the morrow their comfort
would be in some way determined by the way in which
their teeth had been judiciously employed. If they multi¬
plied their pleasure by 40,000, they would estimate more
nearly the benefits conferred by the institution. Besides,
they were aware of the influence of the teeth on the general
health. There they stood — the boundary between that
which was dead and that which was to be living,—and
upon them depended the first and often the principal step
of what should be the progress in the change of the dead
into the living by the process of digestion, and what the
value of the living texture should be which had begun to
form. Here the amount of good which they did was past
measurement. The Dental Hospital was, as far as he knew,
the best institution of the kind which was to be found in
Europe, if not in the whole world.”

SCHEDE’S METHOD OF DRESSING WOUNDS.

Professor Mikulicz communicates to the Trzeylad
Lekarski an account of fifty cases of surgical opera¬
tions whioh were treated by the method recommended by
Dr. Schede at the last surgical congress in Berlin—viz.,
to allow blood to fill the wound and to lie between the lips
after they are brought together, any deficiency in the
quantity of blood being remedied by the use of the knife,
the idea being that the blood either actually becomes
organised or serves as a protection for, the granulations as
they are formed. The wound is covered with protective,
to prevent evaporation. Professor Mikulicz’s observations
included six resections of joints, four amputations, six
dissections, two ligatures of arteries, seven extirpations of
large tumours, &c. In thirty-six of the fifty cases union
took place without suppuration, in four t here was extensive

formation of pus, in five superficial suppuration starting
from the points of suture, and in the remaining cases pus
had existed previously to the operation, and the disinfec¬
tion at the time not having been complete, it continued
subsequently. The general condition of the patients was
highly satisfactory, even in those cases where suppuration
occurred, the temperature in no case rising much beyond
normal. The dressings were not removed or changed for at
least a fortnight, sometimes not for a month. This appears
to be of great advantage in the case of bone and joint opera¬
tions, where complete immobility of the parts is a desidera¬
tum. Other specified advantages attributed to this plan are
that wounds attended with a loss of substance rapidly fill
up, and the cicatrices that form are peculiarly soft and
smooth. Professor Mikulicz does not find, as Schede did,
that the existence of silver sutures in osseous lesions has
any unfavourable influence on the cicatrisation of the
wound. He remarks that it is important not to bind the
external dressings too tightly to the wound.

. THE VICTORIA UNIVERSITY.

A numerous deputation waited upon the Chancellor of
the Exchequer, at the Foreign Office, on the 11th inst., to
lay before him the claims of the Victoria University to an
annual grant from the national exchequer in aid of the
expenses of examinations for degrees, memorials in support
of which had been adopted by a large number of public
bodies in Lancashire and Yorkshire. The deputation, which
was introduced by the Marquis of Harrington, urged that
the Victoria University had exercised a beneficial effect on
the general education of the district; that the future
annual expenditure of the University was estimated at
about £2500; and that it will be seriously impeded in its
progress, and prejudiced in its usefulness as a centre of
higher education, unless its resources can be supplemented
by a grant from the public funds. Mr. Goschen undertook
to give the matter his consideration, and to bring it before
his colleagues, and stated that the consideration he would
give it would be, if he might use the phrase, a benevolent
consideration. The deputation then withdrew.

THE INTERNATIONAL STATISTICAL INSTITUTE.

The next Congress of this Association will be held in
Rome on the 12th proximo, and the preparations already on
foot for the reception and entertainment of its members
give promise of a brilliant gathering. Its president will be
our countryman, Sir Rawson W. Rawson, and the programme
just issued under his name is varied and interesting. The
noble palazzo of the Ministry of Finance will be placed at
the disposal of the, Institute by his Excellency Signor
Maghiani, Chancellor of the Exchequer; while Government
and Municipality will vie with each qther in making the
sojourn of their guests both pleasant and profitable. In
April the Roman spring is in its most enjoyable phase,
whether for sight-seeing in the city or for excursions beyond
the walls, and the high standard of health maintained
throughout the winter is not likely to be lowered by steadier
and more genial weather. In the various sections there is a
rich fund of topics of medical interest, in which the voice of
the profession will make itself heard through some of its
most authoritative representatives. Sir Rawson’s opening
address will be followed by the arrangement of proceedings
and other business formalities, and then the Congress will
settle down to work on “ CensuB Statistics the differences
which exist in the published results of different censuses,
and proposals for arriving at the means of an international
comparison” (reporter, M. Joseph Kcirdai); on “Social Sta¬
tistics—the best method of measuring the social and economic
condition of a country at any particular period” (reporter,

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Tact LasCB iyf '■:/ THE TEACHING UNIVERSITY MOVEMENT, [March 19,1887. M9

Professor voa Neumantt-Spailard) ;• on “-Iconotnio Statu tics
—budgets of family expenses, as to.the, measure of the
well-being of individuals,families,aad nations” (repartee,
Dr.Ernst Engel); and on “Vital Statistics—report on the
foe nudity of marriage* by M. A. N..Kioervin oontin nation «f
the report? -which 4« presented. to the. Statistical Society of
Pari* at its twenty-fifth annivdrsary.” Other sections in
which the 1 reporters are snob .wall-known statisticians as
Mr. Robert Giffen, Major 1 P< €h Craigia,.M..Emile:.Levasseuc,
Dr. von Inama-Sternegg, and-M. A. da Foville, will further
enhance tba iotpwpt of tiu^isflu^siona,; and after the place
and time of holding the ;u<jxt Congress of the Institute lias
been agreed upon, the proceedings will close on the 16th pros.
Those of the profession Who intend to assist at the approach¬
ing Congress with special Aohtribatidhs of tbelr own or of
their friends are requested' to intimate the same to the Pre¬
sident, Sir Rawson W. RaWeon, at hie London address,
68 , Cornwaill-gardens, S.W., before the 31st inst.

THE FACULTY OF NANCY ON THE ASSISTANT
PROFESSORIATE (AQREQATION).

Thr Nancy Faculty of Medicine having deputed MM.
Heetrt, Bernheim, and Heydenreich to examine into the
regulations for the competition for the grade- of agrSgi,
or assistant professor, and into those concerning the sub¬
sequent employment of the fortunate candidates, this
committed has just published a report on the subject in
the Revue MSdicale de VEst. This report recommends that,
considering the difficulties of obtaining the coveted grade,
the tenure of the position should be extended from the nine
years, which is its present duration, to fifteen years, at aU
events in the provincial faculties. This would tend to assure
most of the agrtgi* of ultimate appointments to professor¬
ships. The report also suggests some alterations in the
examination for (irrigation —namely, the omission of the
essay on an anatomical or physiological subject, And of the
thesis and disputation On it: the judgment of the j ury being
instead based upon (1) the previous record and works Of the
candidates; and (2) a lecture of three-quarters of an hour,
similar to that which is now required, but giving the-can-
didate the choice of three subjects; instead of confining him
to one as at present. No opinion is expressed on the locality
of the examinations. At present they are always held in
Paris, and complaints are sometimes heard that provincial
candidates are at a considerable disadvantage in comparison
with tho9e who have studied in Patifl.

SCHOOL HYGIENE.

A CQBRRspoHiasT sends us his own experience of the
sanitary condition of private schools, which is no doubt
abated by others who have directed attention to this
subject. He sent his son So a private day school where
the drainage and ventilation were defective, and an attack
of gastric fever resulted in his removal to another school,
where again the house was not free from unwholesome
®»ella. A complaint to the schoolmaster was met with
the request that the boy should be withdrawn. A third
«cbool was found, but this had the important disadvantage
of being so constructed that the pupils were required to
w «k in shadow while they faced the full glare of
window* Our correspondent pleads for some proper con-
^ over these institutions ; the matter is indeed very
ttnch in his own hands and those of other parents. If
ochooinuurteyg found that the guardians of children required
actory evidence of the hygienic condition of the schools
^o which they propose to send their children, there is but
dttle doubt the necessary improvements would be effected.

not probable the Legislature would consider that
•“tiot-honaaeshenM be dealt with differently from dwelling-

houses ; nor, indeed, if sanitary authorities wears endowed
with special powers for those institutions, can it be ex-
pec ted-tbey would, be adequately exercised. It is therefore
desirable that, efforts should be made to induce parents to
reoognise the importance to ,their qbiidren of health condi¬
tions, apd we might , suggest that schoolmasters would be
consulting their own interests in meeting the reasonable
requirements of those who entrust their children to their care.

CONDITIONS OF SUCCESSFUL PRODUCTION OF

LOCAL AN^STHfe81A IN TOOTH EXTRACTION.

Dr.-A. Lbbbttit of Brussels arid his house-surgeon, M.
Andries; have published the notes of twentyuntne cases 4h
which they employed local cocaine anaesthesia for the ex¬
traction of teeth. In twenty-three cases the anasthesia was
complete, in one case partial. In the remaining five cases
the procedure was thkwoc awful. This is attributed by them
to the difficulty of introducing tire short straight'needle of
the ordinary hypodermic syringe in the cose of the second
and third molars, Ond also perhaps to no precautions having
been taken to prevent the escape of the liquid. They point
out that M. Viau of Paris, who succeeded in producing com¬
plete aumstheiria in every one of his eighty-six cases, made
use of a specially constructed syringe, with a holder by which
it could be grasped firmly between the index- and middle
fingers, and provided with needles of various de grees of
curvature; also that he surrounded the tooth with pings of
cotton-wool, and applied the finger over the puncture after
the Withdrawal of the needle. Besides which he made the
patient keep rinsing bis month with cold water daring the
five minutes that intervened between the introduction of the
cocaine and the actual operation. These precautions were
not observed by MM. Lebrun and Andriea. They used, how¬
ever, a solution similar to that of M. Viau-^-viz., fifty centi¬
grammes (seven and a half minims) of a 2 per cent, solution
of carbolic Acid containing five centigrammes (three-fourths
of A grain) of hydrochlorate Of cocaine, half of which quan¬
tity wah injected into eabh surface of the gum.

THE TEACHING UNIVERSITY MOVEMENT.

Thr Councils of University and King’s Colleges have
arranged to act conjointly in the movement for promoting a
new university in London. They have accordingly addressed
letters to the Presidents of the Royal Colleges of Physicians
and Surgeons offering to join the Councils of those bodies in
promoting a joint charter for the proposed new university
in London, in which the Faculties of Arte and Scienoe would
be formed by University and King’s Colleges, and that of
Medicine by the Royal Colleges. If this proposal be
favourably entertained, the movement will satisfy those
who wi6h for an academical status, as well as those who
only ask for a purely professional degree.

THE GENESIS OF ELASTIC FIBRES.

Dr. Skrgio Panbini of Naples publishes the results of
his researches into the origin of the elastic fibres of con¬
nective tissue and elastic organs in II JProgreeso Medico of
January and February last, as follows1. Elastic fibres,
large and small, have a cellular origin, derived from cellular
elements, which, on account of the transformations they
undergo, may be considered as having special characters.
2. The process of transformation consists in the elongation of
the cellular elements, first of the protoplasm, afterwords of
the nucleus. 3. The process of transformation begins in the
protoplasm, and is continued by the nucleus, which on this
account has an important hiatogenetic value. 4. Once
formed, the elastic fibre is solid, not hollow. 5. The granular
appearance shown by all elastic fibres is not an indicariog

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590 Thu Lancet,] RESEARCHES ON THE REFRACTION OF THE EYE IN STOCKHOLM. [Mabch 19,1887.

of the origin of these fibres by fusion of tbs granules of a
fundamental substance, bat is due to the arrangement of
the integral substance of the fibres. 6. Elastic fibres in the
ligamentum nuchas are not united by simple cementing
substance, but by a connective network, which embraces
each individual fibre in its meshes. In thickened portions
of this connective tissue the arteries and veins ramify, and
also by its means the plasmic juices axe distributed in
organs poorly supplied with vessels.

GUY'S HOSPITAL.

“An Inquirer” in the Daily Chronicle , who has not the
courage to put his name to his letter, suggests extravagance
in the administration of Guy’s Hospital, as in sums spent in
the treasurer’s house and in highly paid local stewards on
each estate. We need not say how easy it is to stop the
flow of charity and to insinuate extravagance, where pro¬
bably none exists. To do this to an institution like Guy’s
suffering acutely from the depression of the times, is not a
creditable achievement. We do not pretend to know much
about the details of the administration of Guy’s, and we
think it quite possible that the authorities would act
wisely in taking the public a little more into their confidence.
But we are able to say that the suggestions of the letter are
most inaccurate and unfair to the hospital. It is not the
case, as suggested, that the sum of over £5000 was spent
on the treasurer's house when rents were greatly falling;
only £2000 were spent on the house and furniture, and
that when the treasurer came into office in 1876, and as a
condition of his doing so, nothing having been done to it for
twenty-seven years prior to that time. When these necessary
repairs were made the hospital was in prosperous circum¬
stances and saving money. It is not true, as implied, that
the treasurer is a “ highly-paid ” official. He is an unpaid
officer, but has a furnished house, on which no money
has been expended for eleven years. The management
of the estates is a matter on which opinions may differ.
They consist, we believe, of 60,000 acres, chiefly in Here¬
fordshire and Lincolnshire. There is a land steward in each
case. One has a house only, and the other is paid a com¬
mission on the rents. We have said enough to make
anonymous critics of great charities a little more careful in
pursuing their easy but unwise calling.

RESEARCHES ON THE REFRACTION OF THE EYE
IN STOCKHOLM.

Professor Johann Widmark has recently concluded a
long series of researches upon the state of the refraction of
the eye in the schools of Stockholm, and he has had the
opportunity of examining 701 males and 742 females. The
results he obtained were as follows: In the first schools,
comprising children from six to seven years of age, there was
no myope. In the second set of schools, comprising girls
from eight to nin e years of age, there was only one myope.
In the corresponding school for boys the myopes had risen
to 14 per cent. This difference is probably due to the fact
that the boys have to undergo a special examination for
entrance into the first class of the secondary schools, and are
consequently compelled to work harder in the preparatory
school. At the age of sixteen, when female education usually
ceases in Swedish schools, 33 per oent. of the girls were
myopic, the mean amount of myopia being - 2 5 D, which
was about equal to that of the boys at the corresponding age.
In the higher schools the girl9 proved to be more frequently
and more highly myopic than the boys, the proportion being
54-28 per cent, with an average of -83 D, although the girls’
schools took from one to two years’ more time over the same
subjects. The maximum frequency of myopia, 66-67 per
cent., occurred in a girls’ school, and the maximum amount

of myopia, -416D, also occurred in a girls’ school, which
seems to show that an excess of work for the eye i» mom
injurious to girls than to boys. This depends in part perhaps
upon the greater feebleness of the girl as compared with the
boy, but it is in part due to the fact that in leisure hoars the
girl ocoupies herself with handiwork requiring close atten¬
tion, and with music. Moreover, the means of physical
education are very inferior in schools for girls, and gymnastic
exercises are either not at all or very insufficiently practised.

AFTER-EFFECTS OF THE EARTHQUAKES ON THE
NERVOUS SYSTEM.

It is curious to note that many persons who were calm
and apparently not greatly disturbed by the earthquakes
which recently occurred in the Riviera have ainoe suffered
seriously from the effects of shock. This fact shows beyond
the possibility of question that more may be done in ths
way of injury to the nerves by an undue excitement t.h*n
is at the time perceived, just as more may be done in the
way of restoration to nervous health after an illness than is
immediately evident. The explanation of these seemingly
paradoxical effects is to be found in the fact—perfectly
familiar to every student of nerve-troubles—that in a very
special manner health in respect to the nervous system
is dependent upon the integrity or orderly performance
of nutritive functions. Muscular tissue may be badly
nourished for a time, as in the course of an ordinary
illness, and as soon as convalescence is fairly established
recovery of the wasted muscles will commence, use
stimulating re-growth naturally, with the result of perfect
recovery in a comparatively short time. It is not thus with
nervous tissue, whether in brain, spinal cord, or nerve trunk.
When from any cause nutrition is impaired in a nerve
centre or branch, not only is there extraordinary difficulty
in restoring the integrity of nervous function, but the wear
and tear of ordinary life, even when these are reduced to a
minimum, seem to increase the exhaustion instead of
reducing it by stimulation of the recuperative faculty. The
reason of this seems to be that nerve centres, like batteries,
are apt to be discharged suddenly and sometimes uncon¬
sciously ; and when once what may be termed the residual
stock of energy is consumed, it takes a very long time and
often extreme carefulness to restore this reserve. Until the
loss of strength held in reserve is slowly accumulated by an
excess of production over consumption, the nervous system
is, so to say, working on its daily strength, and can have
none of that buoyancy which is due to the existence of a
stock of force which has been unexhausted. No doubt those
present in the earthquakes, though calm, were subjected to.
a severe strain, and they have not yet had time to recuperate.

LIABILITY OF AGENTS FOR MEDICAL CHARGES.

The County Coart judge at St. Helens, trying an action
by Dr. Edward Casey to recover £14 12s. for attendance on
four men from the Collin’s-green Colliery Company, said
that the manager of a company might send for a medica l
man on grounds of humanity without thinking that he
incurred liability. The claim of the plaintiff was based on
the fact that he had been sent for by the manager on the
occurrence of an explosion by which the men were injured.
The charge was for one day’s attendance and operations.
The particulars are not given, and we cannot pretend to
judge of the reasonableness of the charges. But the judge’s
doctrine is one to which we cannot assent. The manager of
a company is a responsible agent, and must be held so when
he sends for medical men. It is very easy to be humane at
the expense of the medical profession, but there has been too
much of this kind of humanity. The judge gave judgment
against the manager for three guineas, and laid down that

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Thb Lanckt.1 * “ DIATH-TRAP8.”—TH® BTIOLOGMf OF DYSENTERY. , [March 19, II

be company ware not liable. The manager had himaelf
.fiered £10 in settlement, but this had been declined by the
daintiff, who obtained leave to appeal. We are glad of this,
or the view taken by the judge is, as the counsel for the
plaintiff said, one of .serious import to the profession, and
»nght to be settled by higher authority.

“DEATH-TRAPS.”

Wk are glad to find that those wretched gratings which
afford means of ventilating (!) the sewers on the street level
in the great majority of our . public thoroughfares are
beginning to be regarded in their true character as “ death¬
traps.” Nothing but the most strange obtusity, or an inex¬
plicably perverse ingenuity in the defence of a hopelessly
condemned system, can account for the fact that.there are
still persons who speak with authority on the subject of
sanitary engineering to be found saying smooth things of
the street level ventilators and man-holes. There is some¬
thing so grotesque in the notion of intentionally establishing
any way of escape for the gases generated in sewers into
the atmosphere at the levels where people walk that nothing
but amazement can be excited by the re-utterance of all the
silly things that have been said by the defenders of this
system. There.is only one rational remark to be made on
that side of the question, and it is that it would cost a great
deal of money to get rid of these surface ventilators and man¬
holes and to replace them by reasonably sanitary apparatus;
for example, high ventilating shafts reaching above the
level of uppermost rooms and chimneys. This is the very
most that can be said in defence of the status quo. The
reply is obvious. Nothing can be done to amend a con¬
dition of matters which is wholly indefensible without a
large expenditure; but when we remember that lives are
distinctly sacrificed to the evil genius of persistent blunder¬
ing, it may well be concluded that it would be worth a good
deal to put an end to the slaughter if only because we do
not know who the next victim may be.

THE LONDON HOSPITAL.

Wb regret to hear that there is a considerable amount of
friction existing at present between the medical staff and
students of the London Hospital. For some time there has
been dissatisfaction felt, and partly expressed, by the
students, but this recently culminated when one of the
surgeons was openly hissed by a body of the students when
about to visit his wards. The commencement of the differ¬
ence would appear to have been the appointment to the
new office—that of receiving-room officer—of a gentleman
holding University degrees, but who had not gone through
the full course at the hospital.

THE ETIOLOGY OF DYSENTERY.

Is a communication to the Bohemian Medical Society
Pftfessor Hlava gives an account of a number of observations
he has made on the subject of the etiology of dysentery.
He examined the stools and the bowels with their contents
P°*t mortem in sixty cases of epidemic dysentery, also in
* Wo of a sporadic nature, and in ten where the
symptoms of dysentery were developed as complications of
other diseases. He also injected the fresh stools of dysenteric
patients into the rectum or duodennm in seventeen dogs, Bix
C& w; ^hbits, hens, and porpoises, and made seventy
^HHvations of bacteria of various kinds found in dysenteric
8to ° l8 - The conclusion he arrived at was that bacteria are
°ot the cause of dysentery, for none of the micro-organisms
^produced in the animals experimented upon, only
* k* a °| 0l 7 catarrh- being found. No qualitative anatomical
«Mdd be made out between eases of epidemic

and of sporadic origin. Professor Hlava investigated the
amoebiform large-grained protoplasm which he found in the
dejections in considerable quantity in sixty-five cases, and
on the intestinal mucous membrane and in the submucous
tissue in twenty cases. On putting these bodies under the
microscope, he found that the amoeboid movements continued
for ten hours. He has commenced a series of observations
on the effects of injecting them into the intestines of animals,
with the object of showing that these bodies have a causal
relation to the disease. _

PRECAUTION AND PANIC.

Italy must clear herself of the reproach that in face of
an epidemic she has recourse to measures which the calmness,
begotten of forethought might have spared her. The re¬
appearance of cholera at Catania, due to her neglect of the
sanitary precautions suggested by its recent presence in
other parts of Sioily, has made her impose in hot haste a
five days’ quarantine on all departures from Sicilian ports,
so that to get from that island to the mainland one most
steam from Palermo to Bastria in Corsica, and thence make
the best of one’s way to the Italian seaboard. Her betteT-
inspired organs of opinion are denouncing this hygienically
useless and commercially disastrous measure. “Notre
politique sanitaire est deplorable,” says the Roman It a lie:
but how is it to be helped when the deputies to the Corps
L6gislatif yield to the Clamour of their ignorant and panic-
stricken constituents, who insist on imposing quarantine on
their compatriots ? The enlightenment of the masses, the
deepening and elevating of their sense of citizenship, must
in Italy precede much sanitary legislation which in England
has long been the law of the land. Italian physicians, too,
by their adhesion to quarantine and hygienic cordons, must
ceaee to justify the superstitious laity in its reliance on such
“ precautions.” _

DEATH OF DR. CARRINGTON OF GUY’S.

Wb regret to say that Guy’s has sustained another mis¬
fortune in the death of Dr. Carrington. He was senior
assistant-physician, and died on Wednesday morning from
plenro-pneumonia after two or three days’ illness. On
Sunday last he made an important post-mortem of a man
who died from symptoms much resembling those of glanders,
and it is thought that he may have become infected witn
some animal poison. This is the fourth physician which
Guy’s has lost in four years. We shall reserve any further
notice of Dr. Carrington, only now remarking that in his
death the profession loses one of its most popular members,
who was as modest as lie was promising.

“ BLUE-STONE ” AS A TOXIC AGENT.

A labourer was recently charged at the West Ham
Police Court with attempting to commit suioide by taking
sulphate of copper. From the evidence it appears that the
accused went to a chemist’s near his residence and pnrehased
a pennyworth of “ blue-stone.” On being served, he put the
drug in his mouth and commenced eating it. The chemist
attempted to stop him, but the prisoner declared that he
was tired of life and would do as he liked. In a few
minutes, however, the sulphate of copper acted as an emetic,
and the man was then given into custody. On being
brought before the magistrate, he expressed regret at the
occurrence, and was discharged with a caution. We do not
know what quantity is usually supplied by chemists for a
penny, but an ounoe not infrequently gives rise to dis¬
agreeable symptoms, and might even be attended with a
fatal termination. The best treatment would be to give
eggs and milk freely, or arrowroot and barley-water, with a
hypodermic injection of morphine to allay pain. It does
not appear that in this case any large quantity was taken. ]

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592 The Lanckt,] CHOLERA IN 8ICILY.—DIRTY AND TROUBLESOME INCURABLES. [March 19,1887.

MYXCEDEMA.

Th» Myxoedema Committee of the Clinical Society of
London has completed its investigation of the etiology,
symptoms, and morbid anatomy of this interesting disease,
and it is now engaged in studying the question raised by
Professor Kocher’s observations of the effects of total extir¬
pation of the thyroid gland. For this purpose Dr. Felix
Semon has issued a letter to all surgeons who are known to
have performed this operation, asking for a statement of
the results observed. We are requested to state that it is
very desirable to have this part of the committee’s investi¬
gation as complete as possible, and it is hoped that all who
can will return full and accurate replies to the questions
given. If anyone who has information on this point does
not receive a circular, he is requested to apply at once to
Dr. Felix Semon, who will be pleased to furnish him with
one. The circular contains an admirable account of the
clinical features of the disease and a photograph of a typical
case. We trust that the committee will meet with a
hearty response to its request for facts, and that it will be
enabled to furnish its report quickly.

CHOLERA IN SICILY.

Cholera continues at intervals to occur at Catania.
From midnight on the 10th inst. to the morning of the 12th
there were seven cases and one death. So far, the disease
appears limited to this one town in the island of Sicily.

On this subjeot our correspondent at Rome writes,
March 14th :—“ Grave doubts having arisen in medical circles
as to whether or to what extent the recent outbreak at Catania
is choleraic in character, the Superior Council of Health has
deputed thither a sanitary commission composed of Pro¬
fessors Albanee<5 of Palermo, De Renzi of Naples, and
Marchiafava of Rome, to study and determine the nature of
the disease.” _____

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announcedDr. Bonamy, Professor of Anatomy
at Toulouse. Dr. Carl Heinrich Reclam, Professor of Hygiene
and Medical Jurisprudence in Leipsic, and editor of Gesund-
}eit, at the age of sixty-five. M. Emile Leoidet, chief of the
Preparatory Medical School at Rouen.

A NEW INHALER.

Db. Cozzolino, lecturer on Laryngology &c. at the
University of Naples, has introduced a very simple form of
inhaler, consisting merely of a pair of metal tubes three-
quarters of an inch in length connected by a curved band,
which are inserted into the nostrils and can be worn for
some time without discomfort and without attracting much
attention. Within the tubes a bit of blotting-paper is
placed, which is then saturated with whatever substance
the patient is ordered to inhale; he must then inspire by
the nose and expire by the mouth, and by this means will
take the whole of whatever dose of volatile liquid the
blotting-paper may contain.

DIRTY AND TROUBLESOME INCURABLES.

These classes of patients olight surely to be removed from
asylums and provided for elsewhere, if asylums are to be
expected to do curative work. Dr. Rorie insisted strongly
on this reform in a paper read before the Medico-Psycho¬
logical Association in Edinburgh, and we entirely agree with
the opinion he expressed. If the non-dangerous classes can
bfc accommodated in workhouses, those which only need

supervision for the enforcement of cleanliness and the pro¬
motion of ordinary comfort ought to be disposed of in the
same manner. As we have so often contended, if only it
could be seen that hospitals for the insane would do infinitely
more to reduce the proportion of persons attacked with
mental disease who became hopelessly insane than asylums
can possibly do, there would be not only a large economy of
brain-power and sanity in the population as a whole, but a
great saving of money to the ratepayers, to the general
advantage and content. _

MEDICAL HONOURS.

At an investiture held by the Queen at Windsor Castle on
the 14th inst., Sir George Christopher MoIe9worth Bird wood,
who had been already knighted, was introduced into the
presence of Her Majesty and invested with the insignia of
his dignity in the Order of the Indian Empire. In like
manner Surgeon Charles William Owen was introduced and
received the badge of his dignity in the Most Distinguished
Order of St. Michael and St. George. The following Com¬
panions of the Order of the Indian Empire also received
their badges: Brigade Surgeon Henry Elmsley Bustoed and
Dr. Thomas Beath Christie._

GASTROTOMY IN ITALY.

The (razetta degli Ospedali of February 23rd gives the
details of a g&strotomy performed by Professor Loreta of
Bologna, on account of severe pain suffered by a young
woman who had swallowed a large quantity of needles with
the intention of committing suicide. On searching the
stomach carefully with the hand, few needles could be
found. The cause of the pain and suffering was explained
by further search and extension of the abdominal incision
to the right over the liver. The points of several needles
were found protruding above the surface of the margin of
the left lobe of the liver, and these were deemed to be the
source of the pain. Some were withdrawn, but others were
so fragile that they broke off. The wound in the stomach
and the abdominal parietes was accurately sutured, and
the patient recovered without a bad symptom, entirely
freed from her suffering. _

SUPERVISION OF SLAUGHTERHOUSES.

The London Model Abattoir Society is doing excellent
work in the interests of both humanity and public health.
The atrocious cruelty of some of the men and boys employed
in slaughterhouses, partly because they are brutal and partly
because they are ignorant of their business, calls urgently
for reform; while the perils to which health is exposed by the
way in which meat is prepared for use as food are of a very
alarming character. Better inspection is clearly necessary,
and upon this need the Society, which has Dr. B. W.
Richardson for its president, strongly insists.

INSTANT AND EASY DEATH FOR CRIMINALS.

In so far as it is prudential to divest the death penalty
of its ignominy and terror, it will be satisfactory to find the
progress made in obedience to the dictates of humanity in
searching for an instantaneous and easy death to supersede
that by hanging. The Legislature of New York haring
appointed a committee to deal with this grim subject, the
result is a recommendation to employ electricity. The
whole question seems to us to be one of policy. If it be
decided, first, that it is justifiable to take life at all, and,
second, that the least appalling mode of execution is to be
preferred, then there can be no question that electricity offers
a promising mode of killing quickly and painlessly. On a
recent occasion we commented with regret on what cer¬
tainly appeared to. us a too theatrical mode of execution.

Digitized by

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FOREIGN UNIVERSITY INTELLIGBNCB.-ARMY ESTIMATES. [March 19,1887. 393

It is most desirable to avoid casting a glamour of fascina¬
tion about the death penalty. Is there not a peril of doing
this in the impulse to be humane ?

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin .—The recent medical vacation classes have been
well attended by foreign practitioners. Out of 148 there
were seven from England and Scotland, thirteen from
North America, thirteen from Sweden and Norway, six from
Brazil, and two from Japan.

Buda-Pe«th. —Dr. David Onodi has qualified as privat
docent in Embryology.

Dorpat .—The Russian Ministry of War has arranged to
give a grant of £250 to a laboratory and clinic that is about
to be established in connexion with the Veterinary School
for the express purpose of investigating the subject of
glanders.

Gottingen. —Dr. Wolffhiigel has been appointed Professor
of Medical Chemistry and Hygiene, and Director of the
Institute in connexion with these subjects in succession to
Professor Fltigge, who has gone to Breslau.

leipsic .—Professor Heubner, who had at first accepted
the invitation to the chair of Therapeutics at Prague, has,
at the urgent solicitations of his friends, decided to stay in
Leipsic. _

At a late meeting of the Hexham Board of Guardians the
following resolution was proposed and carried: “ That the
medical officers of this Board be requested to discontinue
as much as possible the use of intoxicating drink to the
pauper patients of this union, and only to order its use in
urgent oases.” One of the guardians had the good sense to
say it was a very delicate thing to interfere with a medical
man’s prescriptions for his patients, and another stated
that the consumption of alcohol in the Hexham Union was
much below the average of England. How little this absurd
resolution was required at Hexham was pointed out by the
master of the workhouse, who stated that there was now
only one inmate, an old woman of ninety-five, receiving
alcohol in the house. There are other matters, perhaps, to
which the Hexham guardians might profitably devote their
attention rather than medical prescriptions.

Wb may remind intending candidates for the vacant posts
of Examiners in Medicine and in Forensic Medicine in the-
University of London that their names must be sent in, with
any attestations of qualifications they may^deem desirable*
on or before Tuesday, March 29th. Our note last week was
inaccurate in stating that the former holders of the offices
of Examiners in Medicine offered themselves for re-election*
the appointments being actually as well os nominally
vacant.

Thb Bishop of Peterborough has lately made an excellent
speech on Temperance, insisting that intemperance haa
many causes, and that moral and social remedies are of as
much, if not more, consequence than legislative ones. He
expressed the opinion that this country was more deficient
in social and innocent amusements than any other, and that
the sanitary condition of the people required careful con¬
sideration—views in which we heartily concur.

Statb Medicine in Italy has just lost an able and
energetic representative in the Senator Angelo Grossi—a
physician of high reputation as a consultant before his
patriotic services secured his eleotion to Parliament for his
native Lombard constituency, and his farther nomination as
one of the “ Patron Conscripti ” of the new Italian kingdom.

On Saturday last Dr. Waters was presented at Chester
with a testimonial in the form of his portrait by Mr. Frank
Holl, and a cheque for £296. The profession to which he
belongs, and forwhichhehas worked heartily, wfll be gratified
by this latest tribute to him.

A sevebe epidemic of measles has recently been raging
in Norwich. Scarcely one point of the city has escaped
infection, and the schools, both day and Sunday, in the
neighbourhoods in which the disease has been most
prevalent, have been closed.

Wb are asked to state that the Jaoob testimonial fund
how amounts to a sum nearly approaching £500. The
subscription list will elose on Monday next. Professor E.
Hamilton, 120, Stephen’s-green, Dublin,is the hon. treasurer.

By Lord Gifford's will, which was published on the 11th
insk, it is proposed to found in each of the four Scotch
Universities a Professorship of Natural Theology, the lec¬
turers to be submitted to no test of any kind, to be of any
denomination whatever, or of no denomination at all, and
to be charged with the free discussion of all questions about
God and the Infinite, their origin, nature, and truth. In
csss the Senatus Academicus of any university should be
tempted to decline the munificent bequest in consequence of
the condition with which it is accompanied,it is specially pro¬
vided that the Faculties of Physicians and Surgeons, or of
Advocates, may, if necessary, take the place of the university.

As the result of injuries received on the Great Western
Railway a few days since, Mr. A. Ellis Eyton, L.R.C.P. Ed.*
L,F.P.S,Glas^ lost hie life. Mr. Eyton was forty-five years
of age, and practised in Hammersmith.

The objects of some sections of the Rivers Pollution Pre¬
vention Act of 1876 having been ascertained to be impracti¬
cable, Mr. Thorburn, M.P., has introduced a Bill to amend
certain of the sections of the Act.

ARMY ESTIMATES.

AwoBKjbyDr. Alfred Carpenter, of interest to educationists
and social reformers, entitled “ The Principles and Practice
of 8chool Hygiene,” will be issued next week by Mr. Joseph
Hughes, of Pilgrim-street, Ludgate-hill. Tbe book will be
profusely illustrated, and will contain special chapters on
the cure and prevention of disease in the family.

The Gordon Boys’ Home is to be commenced at once on
a Pkoo «f ground near Bagshot, and is expected to cost
■£1G»0OO, This estimate does not include a small hospital,
w ^«h ths committee consider necessary, and for 1 which
^^ttft.wsated. ...

The army estimates for 1887-88 show a decrease under
the head of “ Medical Establishments and Services 1 ’ of £9000.
There is a reduction of £5980 in the pay of ‘‘medical staff,” -
£3300 in “ departmental and duty pay of medical staff corps*
nurses, and miscellaneous labour,” and£1100in “cost of medi¬
cines,” while there is an increase of ; £1280in the pay of civilian
medical practitioners. The j)ersonttcl of the department*
inclusive of the staff at headquarters, but exclusive of 33&
officers employed, ip India, is estimated a,t: I Director-
General, 8 Surgeons-GeneraJ, 18 Deputy Surgeons-General,
559 Brigade-Surgeons, Surgeons-Major, and Surgeons, and
64 acting medical officers. The latter are officers on the
retired list, who are employed in special appointments and
receive £150 per annum, in addition to their retired pay.

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594 Thb Lancet,]

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[March 19 , 1887 .

The pay and allowances of the medical staff and of an
average of 25 surgeons on probation at Netley amount to
.£254,720. The expenses of the Army Medical School at
Netley are stated at £7641, but this includes £700 as the
allowance to the examiners of candidates for admission to
the service, and also an item of £200, which appears for
the first time, under the head of “Allowance to Army
Surgeons in Aid of Expenses incurred in obtaining Certifi¬
cates in Operative Surgery.” Deducting these two items,
the sum required for the school amounts only to £6741.
From the amount taken for surgeons on probation, the
number of vacancies to be provided for in the department
during the year appears to be estimated at 60. In addition
to the charge for army medical officers, £6400 are wanted
for the pay of civilian medical practitioners and medical
bills, of which £6000 are for home and £400 for colonial
services.

The retired pay for medical officers is estimated at
£182,000, being £20,000 in excess of the preceding year,
almost entirely due to an increase in the number of surgeons-
major. There are at present only fourteen medical officers
on half-pay who are eligible for employment.' The usual
amount of £1400 is taken for rewards to medical officers for
distinguished or meritorious services.

The strength of the Army Hospital Corps is estimated at
2640 of all ranks, of whom 2080 are on the home and 560 on
the colonial establishment. The amount taken for the regi¬
mental, departmental, and extra duty pay of the corps is
£112,410. There is also a sum of £11,650 provided for the
pay of nurses, extra duty of regimental orderlies and miscel¬
laneous labour. For the pay of surgeons of the Militia,
including allowance for medicine &c., £6000 are provided,
and £500 for departmental pay, Militia Reserve Medical
Staff Corps. Under the bead of “ Army Sanitary Committee”
there is a charge of £1150, being an allowance of three
guineas a day, when employed, to one civilian member, and
contingent expenses of the committee.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6782 births
and 3836 deaths were registered during the week ending
March 12th. The annual death-rate in these towns, which had
been equal to 21-3 per 1000 in each of the two preceding
weeks, further rose last week to 21‘6. During the first ten
weeks of the current quarter the death-rate in these towns
averaged 219 per 1000, and was 23 below the mean
rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 161 in
Derby, 17‘1 in Birkenhead, 17‘2 in Leeds, and 18‘1 in Wolver¬
hampton. The rates in the other towns ranged upwards to
28-9 in Cardiff, 299 in Huddersfield, 30’3 in Oldham, and 337
in Manchester. The deaths referred to the principal zymotic
diseases in the twenty-eight towns, which had increased in
the preceding four weeks from 340 to 385, farther rose last
week to 412; they included 195 from measles,83 from whoop¬
ing-cough, 44 from scarlet fever, 32 from diarrhoea, 31 from
diphtheria, 27 from “fever” (principally enteric), and not one
from small-pox. No death from any of these zymotic diseases
was registered last week in Wolverhampton, Derby, or
Birkenhead; they oaused, however, the highest death-rates
in Huddersfield, Sunderland, and Manchester. The greatest
mortality from measles occurred in Salford, Leicester,
Bristol, Huddersfield, Manchester, and Sunderland; whoop¬
ing-cough in Norwich, Oldham, and Plymouth; scarlet
fever in Huddersfield; and from “fever” in Portsmouth.
The 31 deaths from diphtheria in the twenty-eight towns
included 13 in London, 4 in Manchester, 3 in Oldham, and
2 in Cardiff. Small-pox caused only one death in Greater
London, and not one in any of the twenty-seven large pro¬
vincial towns. Only 4 cases of small-pox were under
treatment on Saturday last in the metropolitan hospitals
receiving cases of this disease. The deaths referred to
diseases of the respiratory organs in London, which had
been 466 and 459 in the preceding two weeks, further
declined last week to 433, and were as many as 72 below
the corrected average. The causes of 92, or'2*4 percents,
of the deaths in the twenty-eight towns last week were
not certified either by a registered medical practitioner or
by a coroner. All the causes of death were duly certified ,

in Portsmouth, Bristol, Preston, and in four other smaller
towns. The largest proportions of uncertified deaths were
registered in Sheffield, Halifax, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 22'5 and 236 per 1000 in the preceding
two weeks, further rose to 259 in the week ending
March 12th; this rate exceeded by 3‘4 the mean rate during
the same period in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from 14-7
and 189 in Leith and Edinburgh, to 28 2 in Paisley and 29 4
in Glasgow. The 625 deatns in the eight towns last
week showed a further increase of 36 upon the number
in the preceding two weeks, and included 43 which were
referred to measles, 25 to whooping-cough, 14 to scarlet
fever, 11 to diarrhoea, 7 to diphtheria, 1 to “ fever,” and
not one to small-pox; in all, 101 deaths resulted from
these principal zymotic diseases, against 99 and 98 in
the previous two weeks. These 101 deaths were equal to
ap annual rate of 49 per 1000, which exceeded by 17
the mean rate from the same diseases in the twenty-
eight English towns. The fatal cases of measles, which
had been 23, 30, and 27 in the preceding three weeks,
further rose last week to 43, of which 16 occurred in
Glasgow and 27 in Aberdeen. The 25 deaths from whoop¬
ing-cough showed a decline of 7 from the number in the
previous week, and included 13 in Glasgow, 3 in Dundee,
and 3 in Aberdeen. The 14 fatal cases of scarlet fever also
showed a decline from the numbers in recent weeks; 7 were
returned in Edinburgh and 3 in Glasgow. The 11 death?
attributed to diarrhoea corresponded with the number in the
previous week, and included 4 in Glasgow and 3 in Edin¬
burgh. The 7 deaths from diphtheria, of which 4 occurred
in Edinburgh and 3 in Glasgow, exceeded the numbers in
recent weeks. The 6iDgle death from “ fever” was registered
in Paisley. The deaths referred to acute diseases of the
respiratory organs in the eight towns, which had been 121
and 142 in the preceding two weeks, declined again last
week to 136, which were 56 below the number returned in
the corresponding week of last year. The causes of 72, or
more than 11 per cent., of the deaths registered during the
week were not certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 35 - 3,
307, and 281 per 1000 in the preceding three weeks, rose
again to 313 in the week ending March 12th. Dunngthe first
ten weeks of the current quarter the death-rate in the city
averaged 31 - 3, the mean rate during the same period being but
20 8 in London and 21 - 5 in Edinburgh. The 212 deaths in
Dublin last week showed an increase of 22 upon the
number in the previous ve?k; they included 6 which
were referred to “ fever” (typhus, enteric, or simple), 1 to
measles, 1 to scarlet fever, 3 to whooping-cough, and not
one either to small-pox, diphtheria, or diarrhoea. Thus the
deaths from these principal zymotic diseases, which had
been 14 and 15 in the preceding two weeks, declined last
last week to 10; they were equal to an annual rate of 1*5 per
1000, the rates from the same diseases being 2*1 in London
and 3-2 ,in Edinburgh. The deaths from “ fever ” corre¬
sponded with the number in the previous week, and those
of whooping-cough showed an increase, while the mortality
from scarlet fever was smaller than in any previous week of
this year. The deaths of infants showed a decline of 2,
while those of elderly persons showed a further increase
upon the numbers returned in the preceding two weeks.
Seven inquest cases and 6 deaths from violence were
registered; and 69, or more than a quarter, of the deaths
occurred in public institutions. The causes of 30, or more
than 14 per cent., of the deaths registered during the week
were not certified.

Bristol Children's Hospital. — At the Annual
meeting of the supporters of this hospital on the 6th inst., it
was reported that 584 children and 29 women have been
under treatment as in-patients during the past year—being
70 per cent, more than the average number of the Mat tea
years in the old. building. In the out-patient department
755 women and 2116 children attended respectively 8305 and
16,743 times. The income just met the expenditure, tb«
former amounting to £2109, and the latter to £2091.

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The Lancet,]

THE JUBILEE AND THE H08PITALB.

[March 10,18817. fl85

Camsfonbrnr.

“Audi alteram partem.”

THE JUBILEE AND THE HOSPITALS.

To the Editors of Thk Lancet.

Bras,—As the Queen’s Jubilee requires commemoration
in some manner -worthy of her great reign, I beg to suggest
that no better method could be found than to raise a
fund for the permanent endowment Of our great London
hospitals. I think a fund such as you suggested last week,
to free them from debt, would not be adequate to the occa¬
sion. The Imperial Institute and Church House will be
supported by Loyalists and Churchmen all over the world,
but unlees some great scheme is started in London, to which
all will feel bound to contribute, the money of the charit¬
able will be frittered away in a thousand hobbies of
doubtful utility. A sum of this magnitude would never be
raised in the ordinary method of appeals to the benevolent
few; but if the scheme were to receive the assent of the
great body of the people, a voluntary assessment of a
fiftieth part of the income of all those who now pay income-
tax would receive a response sufficient for even so great a
purpose.—I am, Sirs, your obedient servant,

Clifford-st., Bond-st., W., March loth, 18S7. G. SLIGHT, M.D.
*,* We shall be only too happy if Dr. Slight’s sugges¬
tion should find favour, and prove successful. Could
not the head8 of the medical colleges and the great hos¬
pitals organise a meeting to give form to the extensive
wish to signalise the Jubilee by help to the hospitals ?—
Ed. L.

PERFLATION IN EMPYEMA.

To the Editors of Thk Lancet.

8ibs, — The method of perflation described ,by me in
your issue of July 31st, 1886, was capable of improvement,
and has been improved in two essential particulars. I. The
idea suggested by Dr. Sansom at the last meeting of the
Koyal Medical and Chirnrgical Society (which the lateness of
the hoar prevented my acknowledging), as to the advan¬
tages of an antiseptic sir-filter instead of a column of anti¬
septic fluid, occurred to me several months ago, and was put
into practice. Instead of containing a snort column of
carbolic acid solution, the Woolff’s bottle was filled with,
tow saturated with liquefied carbolic acid or with strong
solution of thymol, with a view to securing the follow¬
ing advantages: (a) absence of any fluid which, through
inadvertence, might be allowed to run into the chest;
(A) considerable subdivision of the air during its passage
through the tow, and thorough mechanical cleansing of
the same; (c) increased faciuty for warming the air in
the bottle when necessary. At an early date, how¬
ever, I discarded the Woolff’s bottle, preferring to use a
broad tube (one inch and a half in diameter and about ten
inches long) fitted at either end with an indiarubber plug
and short glass tube, and packed with medicated tow. This,
apparatus can lie flat on the table or on the bed, and is
simply a broader segment inserted in the length of the
tubing. It can readily be warmed by placing it in an
appropriate hot-water trough, or by keeping it surrounded
with hot flannel. 2. For the other improvement I am
indebted to a suggestion from Mr. Marten, house-physician
to Addenbrooke’s Hospital, Cambridge. Instead of Richard¬
son’s bellows, I now employ a Fletcher’s foot-bellows. This
apparatus enables the operator to use both hands, whilst
his foot works the bellows and controls the delivery of
“ r. It thus becomes possible (provided a steam spray-
prodocer is available) to dress an empyema without
a trained assistant. The pressure which can be obtained from
Fletcher’s bellows is in excess of surgical requirements. But
it is easy to obviate this difficulty with the help of a screw-
flu on the tubing between the chest and the air-

filter. By this means the diameter of the tube may be varied
?° M to regulate to any extent the quantity of air delivered
Wo the chest. 1 may add that perflation can be applied
twp openings exist into the chest or only one. A
tree mcutoA (If possible in the posterior or lateral aspect of
usually suffice. I believe, however, that an

advantage is often gained by making, ip front a counter-
opening, which need not be so large as the posterior wound.

I remain, Sirs, yours truly,

Curzon-street, May Mr, March 11 th, 1887. Wll. EWART.

P.S.—I avail myself of this opportunity of setting at zest
the doubte expressed by some Fellows of the Royal Medical
and Chirurgical Society as to the nature of the specimen exhi¬
bited as gangrenous lung tissue on the 8th inst. Dr. D^lepine's
microscopical examination confirms the conclusion drawn
from naked-eye appearances that this was a portion of the
lung, and tke surmise that embolism was the cause of the
gangrene. _

CANCER OF THE BODY OF THE UTERUS.

To the Editors of The Lancet.

Sirs, —I shall be glad to be allowed to correct an error in
my letter on the above subject which appeared on March 5th.
In referring to Case 22, described in Dr. John Williams’s
Harveian lectures, I stated that, according to my recol¬
lection, the disease had commenced in one of the fibroids,
and bad spread thence to the uterine wall. I have since bad
an opportunity of making a more complete examination of
the specimen, and from the appearances presented by deeper
sections, it is clear that the uterine wall, and probably the
mucous membrane, was the site of the primary disease.

With regard to the question on which our opinions
differed—viz., the frequency with which cancer affects the
body of the uterus,—1 And that at the Middlesex Hospital
we have had only two such cases in the post-mortem room
during the last eleven years. This may possibly be due, as
Dr. Williams suggests to me, partly to the fact that such,
not being recognised outside as cases of malignant disease,
are not sent into our cancer wards, and that, when diagnosed,
they are considered too “ good ” to be given up to a hospital.
On the other hand, Dr. Williams’s experience of such cases
may be exceptionally large, as they would certainly present
difficulties, and on that account would be likely to be sub¬
mitted for tbe opinion of a consultant.

I am, Sirs, yours truly,

J. Kingston Fowler, M.D.

Clarges-street, W., March 16th, 1887.

IODOFORM AS AN ANTISEPTIC.

To the Editors of The Lancet.

Sirs,— The doubts cast upon the antiseptic power-of
iodoform are surprising, and must surely be contradicted by
the experience of every practical surgeon. It really seems
absurd to quote instances to prove the superiority of iodo¬
form (through the penetrating character of ite volatile
particles) to other antiseptics, it is a matter of such daily
experience. 1 willjust mention one case, however, if you
will permit me. When surgeon on board tbe Orient steam¬
ship Lusitania (temporarily an armed cruiser), I had an
invalided engineer from tbe Nile boat corps handed over to
my charge at Alexandria, with the worst “poisoned hand"
1 ever saw. It was riddled with abscesses back and front;
it had been deeply incised in several places, the pus burrow¬
ing up tbe tendon sheaths above tbe wrist; and it was
horridly offensive. It had been treated with carbolic baths
continuously. I kept it four hours in a carbolic bath, and
then syringed it well and dressed it with carbolic solution
(I in 40). At night it was as offensive as ever. I then
wrapped the Angers and hand with strips of lint on which
was spread a weak iodoform ointment (twenty grains to an
ounce of zinc ointment). The hand in the morning was
perfectly sweet. Tbe dressing was simply renewed, first
twice a day, then daily. The healing process commenced
immediately, discharge rapidly diminished, and there was
never the slightest odour from the hand after the first
dressing. The man’s temperature became normal (it had
been 101°), appetite good, and he went ashore with his hand
healed. I would only say, in conclusion, that, as my supply
of this invaluable drug was very small, I learned how ex¬
ceedingly small an amount was necessary.and that the waste
to which I had been accustomed in London hospitals was
simply sinful. To powder a wound over or stuff a sinus
with pure iodoform is utterly unnecessary. I am convinced
that drachma are need when grains would suffice, especially
in hospital practice.—I am, Sira, yours obediently,

March, 1887. J. P. Glovhb, M.D. Lond.

,oogle

Die

506 The Lancet,]

ANATQMY AND PHYSIOLOGY IN CHARACTER.

[March 19, 1887.

INEQUALITY OF THE PUPILS IN TUBERCULAR
MENINGITIS.

To the Editors of The Lancet.

Sibs, —In you issue Of the 12ch alt. I notice a letter from
my friend Dr. Alderson. The subject—“ The Inequality of
the Pupils io Tubercular Meningitis”—is one that occupied
my attention considerably some time ago, when I had the
•opportunity of examining the eyes of several children
•suffering from tide disease. ■ Granting that inequality of
pupils is liable to exist in these cases, I own that I ’am
somewhat surprised that Dr. Alderson—whom I know to be
a . -very careful; observer—r-sholild attach Such enorthous
weight to this single symptom. Tubercular meningitis is
simply acute tuberculosis affecting (principally) the pia
mater at the base Of the brain, with serous exudation into
the lateral ventricles; and it seems to me that it is a mere
accident whether pressure is greater on one side than on the
. other, or whether it is equal on both aides. To reject the
diagnosis of tubercular meningitis because pressure is
symmetrical would therefore appear to be going rather too
far. I can give Dr. Alderson details of an undoubted case
of tubercular meningitis which terminated fatally, in which
there was.wide dilatation of both pupils, with immobility
under the strongest light, and also double optic neuritis.
Personally, I should attach greater importance to the fact
of dilatation being present (whether equal or unequal), and
especially to the insensibility (partial or complete) of the
ins under the stimulus of light. Dr. Alderson does not tell
us whether he examined the fundi of any of his cases, and
whether he found any change therein indicating a descend¬
ing perineuritis. It would be interesting to hear the
opinions of others on these diagnostic points, which is my
apology for sending this letter to you instead of direct to my
friend.—I am, Sirs, your obedient servant,

A. St. Clair Buxton, F.R.C.S.,

.Assistant-Surgeon to the Western Ophthalmic
Orchard-st rert, W., March, 1887. Hospital.

ANATOMY AND PHYSIOLOGY IN CHARACTER.'

To the Editors of The Lancet.

Sirs, —Accept my thanks for your careful analysis of my'
recent work. One point your reviewer has misapprehended.
I expressly state that the rule for shrewish men and women
to have clear, pink skins has many exceptions. My book is
■eq compressed that misapprehensions are perhaps not un¬
natural. The Saturday Review, for instance, declares that
many non-shrewish persons have round backs. I myself
said this as clearly as I knew how. I am sure you will
permit me to advert to a matter of fact. In matters of
opinion I am well aware that I run counter to so much
popular belief and feeling that the wide and generous
veoeption already given to my book excites my genuine
surprise.' I am, Sirs, yours obediently,

- Birmingham, March 14th, 1880. FURNEAUX JOBDAN.

Vexatious actions against medical men.

. To the Editors of The Lancet.

' "Sms,—The following short statement of facts may perhaps
eerve as a warning to some of my fellow-practitioners, if there
are still any who need it, and will in any case, I trust, help
Co strengthen the hands of those who are striving for the
teform of a most unjust law.

fine day in August, when most t>f my professional
neighbours were enjoying their holidays, I was served with
6 magistrate’s order, directing me to visit and report upon
the state of mind of a supposed lunatic. I did as I was
ordered, found that the individual was undoubtedly insane,
and certified to that effect. Next day she was brought
before the magistrate, who satisfied himself by personal ex¬
amination of the correctness of my opinion, and signed an
■order for her removal to a public asylum, where she was
detained for two months. Some months afterwards I was
served with notice of an action, then with a long list of
•‘“interrogations”; then one of the plaintiff's witnesses was
'Examined by commission ; and at last, after various other
-distractions and annoyances, was pu,t to the inconvenience
of a trial extending oyer, four days, at the conclusion of

- >«4ajiju. .’J . aa, r n-~ i a ‘-“> a v L rW '"'i .ill-;:'if.

which the jury without hesitation gave a verdict in my
favour, the judge awarded me ‘‘costs,” and I was over¬
whelmed witn' friendly congratulations. Again an interval
of a few months, and I receive a bill for £240 8s. Id. The
plaintiff professes herself a pauper. I am told that it is
open to ,me to institute proceedings in bankruptcy against
her; but I have had enough of law for the present, and even
the lawyers do not hold out much prospect of a successful
result. There i,s nothing to be done but to pay the demand
as best I can out ofhardly-earned savings, and with the hope
that the time is not far distant when such flagrant injustice
will be a thing of the past. :

I am, Sira, yours truly, •> - - ;ui

March, 1887. A VICTIM OF THE LAW.

■.■-ll c'

THE ACCOMMODATION FOR PRISONERS. :cl-
AWAITING TRIAL.

To the Editors of The Lancet. ( ! ^ (
Sirs,—I am directed by the Mayor of Marlborough to
write to you on the subject of your remarks on the Report
of the Committee of Inquiry into the Accommodation for
Prisoners awaiting Trial, in your issue of the 12th inst.
So far as Marlborough is concerned, there seems to be no
doubt that the Committee’s Report is founded upon informa¬
tion furnished by the Governor of Devizes Prison of the state
of things antecedent to 1885, and does not take cognisance of
alterations and improvements effected by the Town Council
since that date. As regards the sanitary arrangements, there
has been a complete change, a proper watereloset being
now provided in a separate room, and the repulsive practice
as quoted by you from the report done away with. The
prisoners’ room has also been enlarged, and improvements
effected in the lighting and warming of it. I may add
that the accommodation now provided has been favourably
reported on by one of Her Majesty’s inspectors, and can
compare favourably with that of any other town in the
county of Wilts. 1 trust that, for the credit’s sake of out
town, you will give prominence to this letter.

I am, Sirs, your obedient Servant, *

E. Llewellyn Gwilltm,. -

Marlborough, Wilts, March 16th, 1387. Town Olqrk.

“ PARTIAL ENTEROCELE (IRREDUCIBLE) ASSO¬
CIATED WITH HYDROCELE OF THE
HERNIAL SAG.” «... '■

To the Editors of The Lancet. ■ . v ;
Sibs,—S ince the publication of my case of partial entero-
cele, Mr. Day, jum, of Harlow, who was preseat at the
operation, has sent me a few facts of importance which add
to its interest: “ She had not been wearing a truss previously
to the operation, and her local inflammatory symptoms
before she was sent up to town had been nil. Since the
operation her condition has been excellent, and she has had
no further trouble with regard to the rupture.”

I am, Sirs, yours sincerely, "

March, 1887. WlLLIAM Ht. BATTLE.

'

LIVERPOOL.

. , (From our ovm Correspondent.) - j,

OUR LOCAL ASSIZE COURTS AND THE ACCOMMODATION
! FOB PRISONERS. • '

The committee appointed by the Government to inquire
into the accommodation for prisoners awaiting trial were
eatisfled with the arrangements made in our Assize Court.
The stops from the prisoner’s dock lead to a large waiting-
room, closely adjoining which are a sufficient number of
separate cells, both for male and female prisoners, with every
proper sanitary arrangement. These courts were erected in
1864, and it would appear that so far as the prisoners are
concerned nothing is required. But, as remarked in previous
letters, the accommodation for witnesses is most inadequate,
and, as Liverpool is probably not singular in this respect, it
is to be hoped that the Government may, now that the
prisoners have been considered, inquire Into the arrange¬
ments made for other persons concerned—the witnesses, the
jurors, and all whom justice requires to be present^^-^

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TmrfkftaJVj-' LIVERPOOL.—BDrKBURGfl.^ABBRDEEN. [Marc»19, 1887. 597

EDINBURGH,

(from our own Correspondent.)

DEATH OF'DR, MATTHEW HILL OF BOOTLE.

Dr. Matthew Hill of Bootle died last week. The deceased,
•who had practised in Bootle for many years past, was well
known, not only in his professional capacity, but also as,
having taken an active part in municipal affairs, and
recently filled the office of Mayor of Bootle. His funeral,
which took place at Anfield Cemetery on the 12th inst.,
was a military one, the deceased having been surgeon-major .
to the |lst Liverpool Rifle Volunteers, and it was attended
by a very large number of medical and lay friends. ^

THB OLDHAM POISONING' CASK.

The last penalty of the law was inflicted Upon Elizabeth ;
Bejry, on the 14th inst., within the walls of Her Majesty’s
prison, Walton-on-the-hill, which is virtually the borough J
gaoL Formerly all prisoners sentenced to death at the
Liverpool assizes were hanged within the county gaol at:
Kirkdale, but recent changes have made it necessary to
alter this arrangement, and in future male prisoners will;
be executed at Kirkdale, females at Walton. This makes |
the fourth female executed in this county for murder by I
poisoning within the last three years. It being the first.
execution at this gaol, great care was taken to ensure the J
prompt and humane carrying out of the sentence. The ;
wretched woman was spared the task of ascending steps
to the scaffold, it being on a level with the prison yard, and ;
death was almost instantaneous.

THB HOSPITAL FOB WOMEN. j

A special general meeting of the governors of this hospital 1
was heldon the 11th inst., when the amended laws were sub¬
mitted for approval. Among them one of the moat important'
was that the election of medical officers shall in future be
by the committee, instead of by the governors. Another
was as follows: “No operation of dangerous character
or which involves abdominal section shaU be performed,
except in oases of extreme emergency, without previously
summoning a consultation of consulting and acting surgeons
far in-patients, and no such operation except aa aforesaid
shall be pe rfo rm ed in the hospital without a consultation
between the operator and one of the before-mentioned,
offioers. No person who is not officially connected with
the hospital shall be called in consultation without the |
acquiescence of the medical staff. No medical gentleman un¬
connected with the hospital staff shall he permitted to assist ;
at any operation without the acquiescence) of the medical
staff, unless in cases of e m er g ency , and such cases shall be
reported to the committee, with the names of the gentlemen
assisting thereat.” The committee have thus acted upon
the recommendation of the Liverpool Medical Institution
Committee, appointed as a committee of inquiry into the
1885 cases of abdominal section. The proposed amendments
were unanimously adopted.

THE PIAKO-OBGAN NUISANCE.

An Italian organ-grinder was recently summoned before
the county magistrates for persisting in playing a piano-
organ after being requested to go. The offence was com¬
mitted close to the residence of aa invalid lady,, who had'
suffered severely in consequence; and her son. was com¬
pelled to prosecute, not to punish so much as to prevent the
nuisance from being repeated. By recent local Acts, any
residents in the borough and suburbs may request musicians
and singers to remove “ out of hearing, ana any refusing
to do so are liable to be fined to the extent of forty shillings.
The ■wisdom of this wholesome regulation will be appre¬
ciated by medical men, who know well what suffering is
inflicted upon themselveB and others by this intolerable
nuisance. In this case the defendant was made to pay tbe
costs, and warned not to repeat the offence.

THE NBTHBBJfflJtLD BO AD HOSPITAL.

At tbe last meeting of the City Council the appointment
of Dr. Robert Robertson As visiting physician to the City
Hospital, Nether field-road, was confirmed.

Liverpool, March IS.

Prison Surgeoncies in Spain.—T he profession is so
overcrowded and the desire to obtain some public appoint¬
ment so universal in Spam, that a few vacancies m the
medical officemhips of the penal establishments having
recently been notified, the applications for the appointments
poured inon the- astonished officials to the number of 8200!

UNIVERSITY OF EDINBURGH.

A number of honorary degrees about to be conferred by
the University at the annual graduation ceremonial in April
have been announced, ■ Amongst those upon, whom the
honorary degree of D.D. is to be conferred are Professor
Duff, of the United Presbyterian College, and the Rev.
Thomas C. Edwards, M.A., Principal of the University o£
Wales. The decree of LL.D. is to be conferred, amongdt
many pthers, upon Professor Dittmar, of Anderson’s College,
Glasgow; Professor Edward Dowden, of Trinity College,
Dublin.; Professor Momerie, of King’s College, London; and
Sir Bhagvat Smb, Tbalcoorof Gondai, an Indian prince, who
has attended lectures in the Faculty of Medicine during the
last two years, The same degree has been offered to Dr.
Gunning, late of Rio Joniero, Mons. F. Xavier Michel, and
Mr. C. jT.LyfU,

a year's dispensary work.

The annual report of the New Town Dispensary, an
historical medical institution in Edinburgh, 'and a very,
popular charitable agency for the relief of the sick poor,
•hows that upwards of 9506 patients have been treated under
the auspices of the dispensary in the last twelve months.
Over 1000 vacoinatione have been successfully performed
during the same period, and. 2800 patients visited in their
Own homes by the medical staff. The balance-sheet showa
a similarly satisfactory condition in other respects.

Edinburgh, March lath.__

ABERDEEN.

(From our' own Correspondent.)

ABERDEEN GENERAL DISPENSARY.

i The annual meeting of the managers of the Aberdeen
General Dispensary was held on Friday, the 4th inst., when
the annual report was read and approved. It showed that
keUef bad been afforded to 8290oases during the past year, and
that 6372 visits had been paid to 2549 patients at their homes;
there were 220 obstetric, cases, 697 children were vaccinated,
and 770 dental operations had been performed. There were
also 219 cases in the ear and throat department, which is
under the charge, of Dr. McKenzie Booth aqd Dr. Edmond.
Another member of the staff has arranged to attend twice a
.week for the treatment of diseases of women. The finances
of the dispensary show a pleasing, exception to those of our
other charitable institutions; the income exceeds tbe ex¬
penditure by £378 19#. The members of the staff and other
officials were re-elected. The Committee of Management, at
the request of the Medical Faculty of the Universitv, had
under consideration the appointment of a public vaccinator.
in connexion with the dispensary, whose position and quali¬
fications to grant certificates to the students would be
.recognised by the Local Government Board. The committee
approved Of such an appointment if the necessary funds
could be provided without entrenching bn those of the
institution. At present the membera of the Btaff do the
work in rotation, each one attending bnce a week for two
months; hilt they are not qualified to grant certificates to
students. ...

Lite royal infirmary.

A quarterly court of the managers of tbe Royal Infirmary
was held yesterday. Dr. Angus Fraser was promoted to the
position of second physician, rendered: vacant by the death
of Dr. Beveridge, and Dr. Blaikie Smith, assistant-physician,
was appointed third physician." For the office of assistant
physician Dr. Rodger woe the only candidate, and he was
elected unanimously. By this appointment tbe office of
pathologist to the infirmary* which Dr. Rodger held for
seventeen years, becomes vacant, and it os generally,
expected that Professor Hamilton will be elected to fill it.
The annual financial account, as presented to the meeting,
diadosM anythiag but a satisfactory state of affairt. The
expenditure still largely exceeds the income^ and the some
to be. Said of the oan vales cent hospital. The “ Jubilee
Fund” for the extension Of tbe infirmary now amounts to

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598 The Lancet,]

DUBLIN.—BE LFA8T.

[March 19,1887.

.£11,53114*., and the committee in charge of it are hopeful
that the necessary sum, £30,000, will be subscribed before
the required time. They are about to make, a personal
appeal to every elector in the city and county of Aberdeen,
ana in the county of Kincardine.

ABERDEEN UNIVERSITY.

The winter session closes on the 25th of this month and
the professional examinations begin on the Monday follow¬
ing. Professor Cash has appointed Dr. John Gordon to be
assistant in materia medica.

THE CITY H08PITA1.

The Epidemic, or City Hospital, as it is now called, is
in disgrace. Some time ago grave charges were made by
the TradeB Council of the city as to the character of the
norses, the want of cleanliness in the beds and persons of
the patients, and the want of proper discipline in the
hospital generally. These charges were practically admitted
by the Public Health Committee, and were the means of
bringing about a marked improvement, in the general
management of the hospital: the wards were made more
comfortable, and it was said a staff of well-trained nurses
had been engaged. But a ead accident, which took place
lately, shows that things are far from what they should
be. Of the few cases of typhus fever, three were sent
to the Children’s Hospital as cases of typhoid fever, and
were admitted as such, and unfortunately before the true
nature of the fever was detected a probationer nurse caught
the infection. She was removed to the City Hospital, and
there, it is said, she was attended by a nurse who also had
to attend to some case of measles in an adjoining but
entirely separate ward. On one occasion, while the nurse
was absent, her typhus fever patient got out of bed in a
state of delirium, and in her wandering through the ward
set Are to the bedclothes which she had wrapped round her.
She was found lying on the floor terribly burnt, and in a few
days she succumbed to the combined effects of the fever and
burning.

HEALTH OF THB CITY.

The death-rate for some time has been unusually high.
Scarlet fever, measles, and whooping-cough are all epidemic;
there have also been a great many cases of typhoid fever
and a few of typhus. The cases of typhus were on the
whole mild, and it is satisfactory to find that this disease
is not likely to become epidemic.

March 15th.

DUBLIN,

(From our own Corretpondent.)

ROYAL COLLEGE OF SURGEONS IN IRELAND.

Meetings have been held between delegates from the
College of Physicians and the Royal College of Surgeons in
Ireland in reference to the proposal to empower the London
Colleges to confer the M.D. degree. They have recommended
the Dublin Colleges to lodge a caveat against the proposal
unless similar privileges be granted to them. Prom a
correspondence with the Edinburgh and Glasgow medical
and surgical corporations, it appears that in Scotland there
ns an actual desire to get powers similar to those asked for
by the London corporations. In Dublin, however, there is
no desire to obtain such a privilege unless it be given to the
London bodies. A meeting of the Council of the College of
Surgeons will be held on Thursday, the 17th inst., when a
motion by Sir Charles Cameron will be under consideration.
The motion is to the effect that, should counsel’s opinion be
favourable as to the legality of the College combining with
the Apothecaries’ Hall, a conference with that body
be invited with the object of preparing a scheme of exami¬
nation to be held by that corporation and the College of
Surgeons oonjointly. — A petition in reference to the
grievances under which army medical officers at present
labour has been sent to the House of Commons by the
Council of the College.

CITY OF DUBLIN HOSPITAL.

Mr. H. Gray Croly, senior surgeon to this institution, some
time since suggested that "observation wards” would be
found convenient and useful, and the recommendation has
now been carried into effect. This desirable result it doe

to Mr. Marcus Tertius Moses, one of the governors, who has
built at his own expense substantial male and female
observation wards at the rear of the hospital. At a meeting
of the Board of Governors last week a vote of thanks was
accorded to Mr. Moses for his liberality.

DEATH OF DR. WILLIAM BEAMISH.

This gentleman, who died at his residence, near Dublin,
on the 7th inst., practised for many years in Cork, where be
was well known and justly esteemed for many sterling
qualities. He held the post of Benior physician to the Cork
Fever Hospital for many years, and also was surgeon to the <

Cork Male and Female Prisons. About four years since he ,

retired from practice and removed to Dublin. The deceased '
was the author of a paper on Fever, and a communication
“On the Pathology, Prevention, and Treatment of Asiatic
Cholera, with cases in the Epidemics of 1849,1853, and 1888.”

ZYMOTIC DISEASES IN DUBLIN DURING FEBRUARY.

As compared with the previous month there was a large
decrease in the deaths from scarlatina. Eight deaths were
recorded from enteric fever, as compared with four the
month preceding. On the whole there was a Blight decline
in the zymotic death-rate as contrasted with January, and
the rate was much below the average of the month for the
previous ten years.

MONKSTOWN HOSPITAL.

The report for the past year is a satisfactory one, the
cases treated being in excess Of that of 1886, and the cost of
management somewhat less. On one item, that of pay

f iatienta, there has been a considerable increase. This arises
rom the payments made by the Admiralty, the hospital
being the naval sick quarters for Her Majeety’s ships on the
Kingstown station.

, ADELAIDE HOSPITAL.

The animal meeting of the friends of this institution was
held on Tuesday, the 15th inst., and the report shows the
hospital to be in a very flourishing condition, and to be
accomplishing a good work in Dublin. There were 482 eases
in the surgical wards during the year, necessitating 313
operations, the deaths among these oases amounting only to
a little over 2 per cent. The committee refer to the great
prevalence of phthisis among the poorer classes in Dorn in,
and state that year by year the need of a special institution
for cases of this disease becomes more urgent.

Dublin, March

BELFAST.

(From our own Correspondent.)

THE MEDICAL STUDENTS’ CONVERSAZIONE.

• The first conversazione in connexion with the Medical
Students’ Association was held in Queen's College, on
March 10th. This society was established for social inter¬
course, the discussion of subjects peculiar to the m edic&l
profession, and for bringing before the students matters
affecting their position, so as to give united expression of
opinion. All the rooms of the College were available for
the evening, the entrance and examination halls being very
profusely decorated. There was a very large assemblage of
students and their lady and gentlemen friends; and as the
professors and graduates appeared in their academic cos¬
tume the scene was very picturesque. Among those present
were the Mayor of Belfast, the General in command of the
district, and the President of Queen's College. The tea-
tables were arranged round the examination hall, and
were presided at by the wives or lady friends of the
professors and members of the hospital staffs at which
the students attend. This ball was decorated and illuminated
by the electric light. The band of the Queen’s Royal West
Surrey Regiment was stationed in the hall, where they per¬
formed during the evening. In the chemistry lecture-room
Professor Letts was very successful in a aeries of popular
1 chemical experiments, and in the physics lecture-room Dr.

I Everett gave a number of experiments on vibration. Pro-
feasor Fitzgerald showed several electrical experiments, and
a number of microscopes were exhibited in . the council
chamber. A number of amateurs executed admirably a
variety of musical items, while a very euoceeeful series of
tableaux vivants were given by the students : in the en-

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The Lancbt,]

PARIS.— T HI SERVICES..

[Ma^ch 18.1887. 50ft

tnnoe ball, A committee of the atodenta (of which Mr*
Weatberup, B.A,, and Mr. Haslets were secretaries) had
charge of the arrangements, and to them the great success
of the entertainment is doe. It is hoped the conversazione
will beoome an annual one.

ULSTER MEDICAL SOCIETY.

At a meeting of this Society held on M&roh 9th, Dr. Esler
showed an ovarian cyst which he had successfully removed,
and Dr. Byers introduced a discussion on the treatment of
abortion. Dr* Dempsey read a paper on the same subject,
and Professor Dill took part in the subsequent discussion.

Belfast, March 16 th .

PARTS.

( From our oicm Correspondent.)

TYPHOID FEVER.

The frequency of typhoid has been steadily on the in¬
crease for the last-six weeks, and at the present time there
is an unusually high mortality. In my letter of Peb. 6th
I had anticipated this possibility, but, strangely enough, the
number of deaths registered during the following week was
exceptionally small, and it was thought by many that the
danger had been over-estimated. Binee then, however, the
death-rate has increased week by week, and the last two
returns have been forty-one and forty respectively. Com¬
paring these numbers with the statistics for last year, which
gave 1009 fatal cases for the twelve months, it will be seen
that the mortality during the past fortnight bos been more
than twice the average. The water-supply is now said to
be derived from pure sources, but if this is true the tem¬
porary sojourn of the Seine wateT in the mains has produced
a contamination of the water-pipes that has not yet dis¬
appeared. 1 have not seen a glass of water in Paris for the
last two months that has not been visibly full of organic
imparities and unpleasantly suggestive of the infinitesi¬
mally small.

PASTE tTRIANA* • ■

It has been tacitly agreed at the Academy of Medicine
that the discussion upon rabies be suspended until M.
Pasteur’s return, but in the meanwhile advocates and
opponents of the method remain as uncompromisingly
hostile as ever. Whilst the Annales de C lnstitut Pasteur
continues to herald the enthusiasm of its directors, its
adversaries of the medical and political press throw in a
discordant note from time to time under a new stereotyped
beading, which recurs with lugubrious monotony—the
“ Ndcrologie Pasteur.” The Journal de Mtdecme de Parte
has discovered two new cases in Russia. The first of these
is quoted from the Warsaw newspapers, and relates to the
wife of a farmer named Ozimaki, who was bitten nine
months previously, and underwent the treatment by the
first method in Paris. The second was a peasant named
Wassilieff, inoculated on the third day after the bite at St.
Petersburg, who died within a few days of the completion of
the treatment. It has also been shown by the inoculation
test that the death of Bergd, at Bordeaux, was due to rabies,
find the fact is not contested. To these the Journal de
Mideeme adds three new victims for France—the child
Santds of Algiers; an Italian, Rovati of Modena; and a man
called Alphand, said to have died of the paralytic form of
the disease. In the Annales it is stated that there is no
evidence of rabies in this last instance, arid the death is
attributed to another cause. A propos of rabies, it is some¬
what surprising that those learned in “suggestion” should
have hitherto neglected so promising a field for hypothesis
and experiment. If, as the Paris Biological Society allows,
the gonococcus can be annihilated with the greatest ease by
neurypnologic.command, why not also the virus of rabies ?
Does not M. Pasteur cure his patients by a kind of indirect
auto-suggestion, or, to use the expression of forty years
age, by “credencive induction”? And, oil the other hand,
is not M. Peter morally responsible for the fatal results
by a similar but baneful action it distance! Grave
and important questions for students in hypnotism,
and which will be none the less novel to them, if not
exactly new.

NARCEINE. . .

M. Laborde has been studying for the last few months
the action of anew narceine. The preparation of this sub¬
stance is extremely difficult, and that found in the trade
contains a large proportion of other alkaloids of opium.
M. Duquesnel baa succeeded iu obtaining narceine contain¬
ing Only a small quantity of l&ud&nine and codeine, and from
numerous trials upon animals and' upon man, M, L&borde
states that this product has a happy sedative effect upon
the nervous oentres, and is an admirable medicine for
whooping-cough and bronchitis, an opinion which is shared
by M. Brown-SOquard.

A “SPECIFIC" FOR DIABETES.

At a recent meeting of the Socidtd de Thtirapeutique,
M. Martineau stated that lie had been treating diabetes
for the last ten years, with almost invariable success, by a
method which he had borrowed from a practitioner now
dead. He had hitherto made no communication upon
the subject, because be had wished to be perfectly certain
that hia conclusions were not premature. The treatment
consists in the administration of a solution of carbonate of
lithia and arseniate of soda in aerated water, to the exclu¬
sion of all other drinks. Besides taking this with his
meals, the patient uses the same as a beverage when thirsty
at other times. M. Martineau affirms that this regimen has
cured sixty-seven of seventy diabetic patients he has had
occasion to treat.

MEMORIAL TO THB FRENCH ARMY MEDICAL 8TAFF.

A monument has been erected in the Salle d’Honneur of
the Val-de-Grdce, the military hospital And school of medi¬
cine, to the memory of those members of the medical Staff
of the French army who lost their lives in the performance
of their duty during recent campaigns. They number one
hundred and twenty-three, and of these eleven were killed
in action by the enemy’s fire. The others fell victims to
malaria, typhoid, cholera, and other diseases, and although,
from a military point of view, their death was a less glorious
one, still their devotion to the public service is honourably
recognised.

THE FACULTY OF MEDICINE.

M. Brouardel has been appointed Dean of the Faculty
for a period of three years. For the post of jperpetual
secretary of the Academy of Medicine the candidates are
M. Jules Bergeron and Professor Jaccoud.

Paris, March 18th.

THE 8BRVI0E8.

Deputy Surgeon-General Sir J. Hanbory, ELG'.B., Principal
Medical Officer of the Home Military District, has been
ordered on foreign service, and will embark at once for the
Mediterranean.

Deputy Surgeon-General A. F. Bradshaw has been ap¬
pointed Principal Medical Officer on the Staff of the Northern
District at York; Surgeons J. G. Black, M.D., J. Kearney,
M.D., C. A. Renny, M.B., and E. C. G. Dell have arrived in
India for duty in the Bengal Presidency; Surgeon B. O. W.
Norfor, M.B., has joined at Canterbury for duty on his return
from Egypt.

War Office. —Royal Malta FencibJe Artillery: Surgeon
Lorenzo Mancbd, MJ)., to be Surgeon-Major.

Admiralty. —Staff Surgeon Thomas Bolster has been pro¬
moted to the rank of Fleet Surgeon in Her Majesty’s Fleet.

The following appointments have been made: — Staff
Surgeons E. R. H. Pollard and Robert W. Williams, to the
President, additional; Surgeon Edward G. Swan, to the
Imogene; Surgeon George A. Draper, to the Duncan; Sur-
eon Alexander L. Christie, to tne Devastation; and Mr.
ohn Elliott to be Surgeon and Agent at B&ntbam.

Artillery Volunteers. — 1st Aberdeenshire: James
Aymer, M.B., to he Acting Surgeon.

Rifle Volunteers.— 2nd Cambridgeshire (Cambridge¬
shire University): Surgeon Buehell Anningson is granted
the honorary rank of Surgeon-Major.—1st Elgin: George
Leslie Hodgson Milne, M.B., to be Acting Surgeon.—1st
Volunteer Battalion, the Buffs (East Kent Regiment):
Honorary Assistant-Surgeon W. Beet, M.D., resigns his
commission—2nd Volunteer Battalion, the Loyal North
Lancashire Regiment: John Edwin Scowcroft, M.D.,to be
Acting Surgeon.—West Suffolk: Actihg Surgeon H. C. C.
Shaw resigns his appointment.

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600 The Lancet,]

MEDICAL NOTES IN PARLIAMENT.

[MAboh 19,1887.

MEDICAL NOTES IN PARLIAMENT.

The Lunacy Acts Amendment Bill

In the House of Lords; on the 10th mat., the Lord Chan- '
cellor, in moving that the report of the amendments to this
Bill made in oommittee be agreed to, said that he proposed
to amend Subsection 11 by inserting a provision into it to
the effect that where a person has been sent to an asylum
or a private house, and has not been visited by a County
Court judge or a magistrate having jurisdiction at the place
where he is confined within seven days after the commence¬
ment of such confinement, the person confined shall have a
right to be seen by any county court judge or any magistrate
having any jurisdiction whom he shall designate.—Tne Earl
of Selbome objected to the proposed alteration on the ground
that it did not carry his view into effect.—Lord Heracbell
also objected to the amendment on a similar ground.—After
some conversation, Subsection 11 was struck out, and the
further consideration of the proposed amendment was post¬
poned to the next stage of the Bill.— 1 The Earl of Selbome
said that on the third reading he would move as an amend¬
ment that the magistrate who made the order should be the
person who visited the lunatic.—Several other amendments
proposed by the Lord Chancellor were agreed to.

Accommodation for Prisoners awaiting Trial. ■ ,

On the 15th inst., the Marquis of Ripon asked whether
Her Majesty’s Government intended to lay before Parlia¬
ment the report of the Committee appointed by the Home
Department to inquire into the state of the lock-ups and
other places in which prisoners awaited trial in various
parts of the country.—Earl Beauchamp stated that the
paper referred to had been presented to Parliament, and was
circulated on the 11th inst. The question was a grave one,
and as soon as the report reaohed the Home Secretary he
took it into his consideration, and addressed a circular to the
county and borough authorities. But those matters did not
rest entirely with those authorities, as the sanction of the
Treasury might be necessary before any expenditure was I
incurred. j

In the House of Commons on the same day, in reply to j
Lord Elcho, Who asked the Secretary of State for the Home '
Department whether, in all cases when in consequence of ;
the report of the committee on the accommodation of un¬
tried prisoners it was proposed to rebuild, extend, or other- .
wise alter the proposed accommodation. Her Majesty’s
Government would be prepared to examine the plans before
the proposed works were carried out, in order to see that
the intended alterations complied with the recommendation
of the committee, and were in every respect suited to the
requirements of the case.—Mr. Matthews stated that in the
circular which he had lately issued he had invited the local :
authorities to communicate with him what works they pro¬
pose te undertake. Such communications he should refer to
the Surveyor-General of Prisons, and, acting on his advice,
inform the local authorities of his own opinion on their
proposals.

Smoke Abatement Bill

On the 14th inst* Lord Stratheden and Campbell pre¬
sented a Bill dealing with the abatement of smoke in the
metropolis. The Bill was read a first time.

The Pharmacy Act Amendment Bill.

On Thursday night, the 17th inet, the Earl of Milltown
moved the second reading of a Bill to amend “ The Pharmacy
Act, 1852,” andThe Pharmacy Act, 1868.” He said: The
Bill is framed with the view of enabling the'Pharmaceutical
Society of Great Britain to make adequate regulations for
the education and curriculum of those persons included
amongst its members. The Bill is a short one, but the matter
is important when it is considered that these persons alone
have the power to dispense medicines and to sell poisons.
The Pharmaceutical Society was founded in 1841, and
received its charter in 1843. The Pharmacy Act, 1852, con¬
firmed that charter, and made it for the first time penal for
any unauthorised person to assume the title of pharmaceu¬
tical chemist. The Act of 1868 went a little further, and
made it unlawful for anyone not duly qualified to sell or
dispense poisons, or to assume the title of chemist and
druggist! That Bill for the first time introduced the name
druggist into an Act, and made it illegal for any person not
duly qualified tosell poisons; The Society consists of members,
associates, and registered apprentices, each having a separate

qualification and having to undergo a separate education.
Clause 6 of the Act 1868 app&raatly makes it imperative
on the examiners to pass any person who presents himself
for examination ; and that being so, the Council of the Phar¬
maceutical Society have found themselves almost powerless
in requiring such qualification in those whopass the qualify¬
ing examination as they deem absolutely essential for the
safety of the public; and, in point of fact, persons who
answer the questions may become qualified, although they
have undergone no technical training at all. The Society
has framed bye-laws for remedying this defect, and estab¬
lishing what they consider a sufficient curriculum of
study; but the Privy Council, to whom all bye-laws have
to be submitted, found themselves unable to confirm them,
as they were of opinion that the statutes of the Society did
not empower them to frame any such bye-laws. This Bill
has been introduced to remedy that defect. This Bill has
the unanimous consent of the Pharmaceutical Society, and
I believe, subject to a verbal amendment which I shall
hereafter make, that it has the approval of the Lord Privy
Seal. The second clause of the Bill gives power to the
Council of the Pharmaceutical Society, in cases where

arsons have acquired in their judgment sufficient technical

nowledge in England, in any other part of the United
Kingdom, and in the colonies, to dispense with the three
years’ curriculum, but not with the qualifying examination.
The Act is not to apply to Ireland. The Bill was then read
a second time.

Lunacy.

The Lord Chancellor moved the third reading of the
Lunacy Act Amendment Bill, and this having been agreed
to, the Earl of Selbome, on the motion "That the Bill do
now pass,” moved an amendment providing that where a
person was under care by order of a magistrate who had
not thought it necessary to see the alleged lonatic, if sub¬
sequent examination became necessary, such magistrate
should not be debarred from making that e xami nation
on the ground that he had signed the committal order.
The Lord Chancellor said if the amendment was inserted it
must be ou the authority of their Lordships’ House, as he
could not accept the responsibility of adopting a proposal
which would practically allow a magistrate to sit in
judgment on his own Act.

The House divided, when there were—for the amend¬
ment, 22; against, 46; majority against, 18. The Bill was
then passed.

Brigade Surgeons in India.

In the House of Commons on the 11th inst* Colonel Hughes-
Hallett asked the Under-Secretary of State for India whether
he would take into consideration the case of brigade sur¬
geons on the medical staff in India, having regard to the
severe examinations they have to pass for their promotion,
with a view to placing them, as was contemplated by the
Royal Warrant of December 2nd, 1879, on the same footing
as brigade surgeons in all other parts of Her Majesty's
dominions as regards pay, position, and pension, instead of
allowing them to remain as at .present in India on the same
pay after twenty-five and thirty years’ service as surgeons-
major, and subject at times to routine duties under medical
officers of the iatter rank who may be their juniore.—Sir
J. Gorst replied that when the Royal Warrant created the
-rank of brigade surgeon in 1879 the Secretary of State for
.India declined to allow any increased expenditure to be cast
on the revenues of India by reason of that warrant, and
that the present Secretary of State adheres to that deter¬
mination.

The Sewage Works at Barking.

In answer to Mr. Salt, Sir J. M'Garel Hogg stated that a
tender amounting to £406,000 for the sewage works about
to be executed at Barking was accepted by the Board in
pursuance of the powers of the 135th section of the Metro¬
polis Management Act, 1875, and of other provisions conferring
jurisdiction upon the Board with reference to the disposal
of sewage and refuse from the sowers of the metropolis and
for the purpose of preventing the discharge of sewage sludge
into the Thames. The £403,000 applies to the works at
Barking only and is not final. A further sum will probably
have to be expended in the completion of the works at both
outfalls and the purchase of sludge ships.

The Relative Rank of Army Medical Officers*

On the 14th inst., on the motion to go into Committee of
Supply on the Army Estimates, Dr. Clark desired to know

Tot Lancet,]

MEDICAL TRIALS.—OBITUARY.—MEDICAL NEWS.

[Mabch 19,1887. 601

from the Government why, * change of a prejudicial charac¬
ter had been made in the relative rank of the medical
officers in the service.—Dr. , Tanner also pressed upon the
attention of the Government the necessity of a reform in
the Army Medical Department.

Staines Sewage.

On the 15th inst., in reply to Mr. Dixon-H&rtland,
Mr. Ritchie stated that the same to be paid to the Thames
Conservators by the metropolitan water companies were
Axed by statute, and it was impossible for the Local
Government Board to oblige the companies to devote sqme
part of their profits to help to defray .the cost of diverting the
sewage from the river. The Staines Local Board had long
evaded their statutory duties, with the result that the
River Thames had been polluted with the sewage of the
district. It devolved upon the Staines Local Board, as
upon every other sanitary authority, to defray the cost of
any sewage works required.

Vaccination in India.

In reply to Mr. Hunter^ Sir J. Gorst stated that in British
India vaccination is compulsory in certain selected areas
only. No penalty is imposed for simple refusal or neglect
to vaccinate a child. For mere disobedience to a magis¬
trate’s order to vaccinate the maximum penalty is 50 rupees.
Contumacious and persistent disobedience may in certain
cases entail a fine of 1000 rupees and six months’ imprison¬
ment.

Local Government Board Loans.

In reply to Mr. Leighton, Mr. Ritchie stated that the total
amount of the loans sanctioned by the Local Government
Board to be, raised by local authorities during the year ended
December 81st, 1888, was £2,827,867, being a decrease of
-£459,054 as compared with the total amount so sanctioned
during the preceding year. The Board had no information
as to the amount of the local loans which were contracted
daring the year without the sanction of any central depart¬
ment, bat it might be stated that the total amount of the
specific sums which by local Acts passed during the year
were authorised to be raised by sanitary authorities and
municipal corporations without the sanction of any central
department was £1,496,287.

The Boarding-out of Pauper Children.

In reply to Mr. Norris, Mr. Ritchie stated that the initia¬
tive as regards the adoption of the boarding-out system
rests with the boards of guardians, and not with the Local
Government Board. The Board are always ready to enter¬
tain applications from guardians for the adoption of the
system where the circumstances of the onion appear to
be such as to render that system appropriate, and provision
has been made for complying with the requirements pre¬
scribed by the order of the Board.—Mr.. Mnndella asked
whether the Local Government Board would undertake t6
extend the system of boarding out.—Mr. Ritchie said that
the Local Government Board was always ready to consider
“7 application for the extension of the system from boards
of guardians.—Mr. Mundella asked whether the right boo.
gentleman would promise to send circulars on the subject to
the boards of guardians.—Mr. Ritchie replied that the Local
Government Board had already caused the system to be
thoroughly well known, but if necessary they would take
further steps.

House-boats on the Thames.

On Thursday evening Colonel Dawnay asked the President
of the Local Government Board whether bis attention had
been called to the proposed new bye-laws of the Thames
conservators, by which “no direct action will be taken to
pot a atop to the insanitary nuisances caused by house¬
boats and steam launches,” and whether, in the interests of
the millions of people who. depend upon the Upper Thames
for their water-supply, he will compel the Thames Con-
semtors to take immediate and efficient steps to free the
n !® r from its present and ever-increasing state of pollution;

Mr. Ritchie said his attention had been called to the pro-
bye-law9, and he had been in communication with
‘he conservators of the River Thames on the subject. His
bon. friend was incorrect in his assumption on the matter.
r' 9 .bye-law had intentionally been drawn as widely m
poesible in order to cover any possible pollution, and the
Con 8wratOT8' believed that when the bye-law came into
operation it! would have the effect Of preventing the
nuisance now arising from vessels moored in or navigating

the river. He would, however, be happy to consider any
suggestions relative to the bye-law.—Col. Dawnay gave
notice that he would move a resolution on the subject.—
Mr. H. H. Fowler asked if the legal advisers of the Local
Government Board were satisfied that the bye-laws made
by the Thames Conservators would in their present shape
prohibit boats from discharging watercloset refuse into the
river?—Mr. Ritchie: I have not considered it necessary to
consult the legal advisers of the Local Government Board
on the subject, but eo far as I have been able to ascertain
the opinion of the officials of the Local Government Board 1
they believe that the bye-laws will have that effect. .

MEDICAL TRIALS.

CITY OF LONDON COURT.

A MIDWIFESY CASE: DAWSON Versus LANE.

The plaintiff in this case stated that he was called at
8.30 a.m. on Oct. 3rd to defendant’s wife, who was stated to
be in labour. Believing it to be premature, and that no one
was engaged to attend, he went at once. On arriving at the
patient’s house he found that another practitioner (who bad
been engaged, and sent for two hours before) had the con¬
duct of the case. He therefore charged half-a-guinea for &
“ night visit.” Defendant: It was not a night visit, but at
half past eight in the morning. Plaintiff: Technically a
“night visit,” your worship. His Honour (to defendant):
What have you to say? Defendant: He never did any¬
thing; why should I pay him? Judge: It does not matter;
you called the doctor from bis bed, and took him to your
bouse, and you must pay the debt.

Judgment was given for plaintiff, with costs.

©fritmrj}.

PROFESSOR BORODIN.

On Feb. 28th, Dr. Alexander Porphyryevich Borodin,
Professor of Organic Chemistry in the Military Medical
Academy of St. Petersburg, died quite suddenly from cardiac
paralysis, probably from .embolism of highly diseased
coronary arteries. He was born in 1834, and had held his
professorship since 1864, having been twice reappointed
for periods of five years. In his days of studentship the
deceased Professor had distinguished himself in chemistry
under the instruction and guidance of his teacher, Professor
Zinin. His published works are tolerably numerous, and
include papers on the analogy between phosphorous and
areenious acids from a toxicological point of view, on the
estimation of salts in mineral waters, on brick tea, and c
number of important articles on the estimation of nitrogen.
By means of Professor Borodin’s process combined with that
of Kjeldahl, the clinical physician has now a means whereby
this estimation may be made with a very moderate amount
of difficulty and trouble. In spite of his arduous pro¬
fessorial and laboratory work, Professor Borodin found time
for the cultivation of the art and science of music, in which
he was quite an adept. He is, indeed, said to have rendered
valuable service to the cause of music in Russia.

Utoital ftcfos.

Society of Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on March 10th

ChorleswOrfch, George. Blstead, God aiming. Snrrey.

Down. Arthur Heed. Newton-square. Bampton, Devon.
Paieraon, George Snider,Toronto. Canada.

Vinter, Sydney Garratt, Monmouth-rood, Bayswater.

Hospital Sunday collections were made at Middles-
borough on the 6th inst.

, A family, consisting of father, mother, and
several children, at Grimsby, have been poisoned by eating
tinned meat. , •. i ,.i

MEDICAL news.

[March 19,1887.

602 Thr Lancet,]

At an inquest held at South Tottenham-recently
on the body of a boy, the jury returned a verdict of “ Death
from hydrophobia, caused by the bite of a cat.”

Guy’s Hospital.—T he treasurer of Guy’B Hospital,
LondoD, has received another anonymous donation of £500
towards the special fund.

Medical Magistrate.—T he Lord Chancellor has
added the name of Sir James Sawyer, M.D., to the Commission
of the Peace for the borougli of Birmingham.

Two sons of the late Mr. Samuel Morley have
each presented £2250 to the Deaconesses' Institution and
Hospital, Tottenham, in order that the debt on the third
wing of the hospital, lately bi»Ut, may at once be cancelled.

The date of the annual festival in aid of the funds
of the Hospital for Sick Children, Great Ormond-street, has
been altered from the 17th inst. to Mav 25th. The chair will
be occupied by the Marquis of Ripon, K.G.

At a public meeting at Portsmouth on the 3rd inst.,
it was resolved, amongst other plans for celebrating the
Jubilee, to provide a fund for use in connexion with the
Royal Portsmouth, Portsea, and Gosport Hospital.

Presentation.—T he members of the Leith police
ambulance class have presented Mr. 0. II. Garland with a
handsome pair of silver candelabra, in recognition of his
sendees as lecturer.

The British Association will this year meet in
Manchester, and the session will commence on Aug. 31st.
Sir Henry Roscoe, M.P., F.R.S., has been chosen president.
It is anticipated that the meeting will be one of the most
successful ever held.

Manchester Southern Hospital.—A t a meeting
of the Board of this institntion on the 28th ult., it was
resolved thit a lying-in hospital be formed in connexion
with the hospital, and a sub-committee was appointed to
give effect to the resolution.

The East Sussex and West Hants Infirmary was
reopened on the 8th inst., after having been closed in sections
for three months during the renewal and remodelling of the
sanitary arrangements of the building, aC a cost ot about
£1000. The work has been designed and carried out by
Mr. Mark Judge.

Nottingham Borough Asylum.—A n important
extension of the Nottingham Borough Lunatic Asylum is
about to be undertaken, whereby accommodation will be
provided for 200 extra patients, the number at present in
the building being 280. It is estimated that the work will
cost nearly £30,000.

The proposed Hospital at Bournemouth. -At a
largely attended meeting in Bournemouth on the 10th inst.,
it was announced that Mr. W. Clapcott Dean had offered a
free site, valued at £1000, for the erection of the proposed

S ' "c hospital. The subscriptions promised towards the
ing expenses amount to £3632.

At the annual meeting of the subscribers to the
Chesterfield and North Derbyshire Hospital on the 9th inst.
it was reported that 217 patients had been admitted during j
the year, and that the dispensary patients had numbered
1851, as against 1983 in tne previous year. The income
amounted to £1848.

North-Western Association of Medical Officers
of Hralth. At the usual monthly meeting of the members
of this Association on the 10th inst. Dr. Sidebottom (Hyde)
read a paper on “The Small-pox Epidemic in Hyde in 1886.”
A discussloo, in which several members of the Association
took part, followed the reading of the paper.

Bequests.- -The late Miss Hargreaves of Mellor,
near Blackburn,has bequeathed the sum of £1000,less legacy
duty, to the Blackburn and East Lancashire Infirmary. A
residuary legacy has also been left to the institution by
an East Lancashire gtntleman recently deceased, but the
exact amount has not yet been stated.

A meeting convened by the London Tailors’
Machinists’ Society was held on the 12th inst., for the pur-

6 ose of explaining and condemning the sweating system.

esolutions calling for a Royal Commission of Inquiry, and
for the appointment of additional factory inspectors in East
London, were carried.

At the meeting of the Lambeth Board of
Guardians on the 9th inst. the medical officer of the infir¬
mary reported that there were seventy-five men and seven
women in that institution in excess of the proper number
of inmates.

University of Cambridge. — At Gonville and
Cains College, Dr. Sbuttleworth’s Scholarship, of the anna&l
value of £60, and tenable for three years, open to the com¬
petition of medical students of the University of not lass
than eight terms’ standing, given for proficiency in botany
and comparative anatomy, has been awarded to Francu
Henry Edgeworth, B.A., scholar of the College.

Oleomargarine. —A Bill regulating the importa¬
tion, manufacture, and sale of butter substances has been
brought into the House of Commons by Sir Richard Paget,
MP. for the Wells Division of Somerset. According to it,
oleomargarine is to be sold only under its own name, the
penalty incurred by infringement of this provision being
£20 for the first offenee, and £50 on subsequent occasions.

Hereford General Infirmary. — The annual
general meeting of the governors of this charity was held
on the 10th inst. The annual report, which was adopted,
stated that the number of in-patients received during the
year was 654, and of out-patients 2521. The receipts,
inclusive of a balance in tne hands of the treasurer of
£667, amounted to £4915, and the expenditure to about
£3000.

York Eye Institution.—O n the 11th inst., at a
meeting of the subscribers to this charity, it was decided to
hand over the funds and property of the institution to the
York County Hospital, on condition that Dr. Anderson be
appointed ophthalmic surgeon, and that in-patients be
admitted into the hospital by ordinary hospital recom¬
mendation, and out-patients be attended to without recom¬
mendation.

Belvidere Hospital, Glasgow. —This hospital, for
infectious diseases, has just been completed, and was on the
4th inst. formally handed over to tne care of the Health
Committee of the Town Council. For small-pox patients
there are five brick pavilions, comprising ten wards and con¬
taining 150 beds. Other infectious diseases are provided for
by thirteen pavilions, with twenty-six wards and 390 beds.
The hospital has cost £106,402, exclusive of the value of the
site, which is an estate of thirty-three acres, situated on the
bankB of the Clyde, in the east-end of the city.

Extensive Seizure of Decomposed Tinned Milk.—
At a late sitting of the Newcastle Police-oourt the sanitary
inspector applied for an order for the destruction of 136 tins
of condensed milk, which, aeoording to the evidence of the
medical officer of. health, was in a state of decomposition.
It is right to state that the tins were not branded with
the name of the manufacturer, and in the opinion of Dr.
Robinson the milk had been bad when packed. The order
was at once granted. The use of condensed milk has very
much increased in the north, especially in the winter, and',
as a rule, it is found to be pure and economical.

Bolton Infirmary and Dispensary. —The annua)
meeting of the subscribers to this institution was held on
the 10th inst., when the secretary reported that the average
daily number of in-patients during the past year was seventy-
two, the greatest number at one time being ninety-two, and
the smallest number fifty. The total receipts for the year
amounted to £5023, and the total expenditure to £5417.
The committee appeBl for additional annual subscriptions
to enable them to provide fourteen more beds, for which
there is room in the hospital, but which, through want of
funds, it has hitherto been impossible to maintain.

. St. Mary’s Hospital, Manchester. —The annual
general meeting of the subscribers to this charity was held
on the 14th inst., when the secretary stated that the income
for the past year had amounted to £3514, and the expendi¬
ture to £3862. The number of cases under treatment during
1886 was 15,098, as compared with 14,240 in 1885. It was
resolved to appeal to the general public in Manchester,
Salford, and surrounding district for funds necessary to pro¬
vide for an extension of the present accommodation in the
hospital, and a list of donations fox this object amounting
to about £1Q,000, which have been already promised, was
read out.

*HH Lancet,] APPOINTMENTS.—VACANCIES.—BIRTHS, MARRIAGES, AND DEATHS. [Mabch 19,1887. COS

fanranes.

Wolverhampton and Staffordshire General
Hospital— The annual meeting of the governors of this
hospital was held in the Medical Institute, Cleveland-road, on
the 8th inst. The annual report stated that during the last
year the number of in-patients had been 1956,and thenumber
ol out-patients 11,858. The income bad been £6854 8». 10rf.,
and the expenditure £7116 12s. Id. The Hospital Saturday
Contributions have amounted to £2182 Os. 5 d., being a
decrease of £30, and the Hospital 8undsy collections to
£578 15s., being a decrease of £76. The bequests received
during the year have amounted, after deduction of legacy
duties, to £1202 9s. 2d. The average stay in the hospital of
each patient was twenty-four, days, as against twenty-two
days last year. The number of patients sent to various
convalescent homes has been 97.

Sanitary Registration of Buildings Bill.— At
the meeting of the Council of the Sanitary Assurance
Association, on March 14tb, a communication was read from
the Association of Municipal and Sanitary Engineers and
Surveyors requesting the Council to convene a confefence
on the subject of the Sanitary Registration Bill, and, in the
event of the request being aocedea to, offering to co-operate
in the matter. After some discussion, the following was
passed unanimouslyThat-, in compliance with the
request of the Association of Municipal and Sanitary
Engineers and Surveyor?, a conference be convened to
consider and report upon the principle and details of
the Sanitary Registration of Buildings Bill which is now
before the House of Commons; that the first meeting
of the conference be held on Monday, April 4th, at
3 p.m. ; that Sir Joseph Fayrer, 8lr Kennett Barrington,
Mr. Mark H. Judge, and Mr. H. Rutberfurd, barrister-at-
law, be appointed to represent the Sanitary Assurance
Association at the conference; that Mr. C. C. Lacaita, M.P.,
J>r. R. Farquharion, M.P., Sir Quyer Hunter, M.P., Dr.
Charles Cameron, M.P., and Sir Henry E. Roscoe, M.P., be
invited to attend tbe conference; and that the governing
bodies of the following institutions be requested to appoint
four gentlemen to represent them at the conference: The
Royal institute of British Architects, tbe Institution of Civil
Engineers, the Royal Institute of Architects of Ireland, the
Liondon Sanitary Protection Association, the Society of
Medical Practitioners registered as qualified in Sanitary
Scienee, the Institution of Surveyors, the Association of
Municipal and Sanitary Engineers and Surveyors, the Society
of Medical Officers of Health, and the Sanitary Institute of
Great Britain. Further, that tbe question of inviting other
bodies to join in the conference be left in the hands of the
conference.”

Slpointmtnts.

Successful applicante for Vacancies, Secretaries of Public Institutions, and
ethers possessing information suitable for this column an incited to
. forward it to Tu La* err Office, directed to the Sub-Editor, not later
• than 0 o’clock on the Thursday morning of each week for publication in
the next number. _

Abgo. Adam, M.D., C.M.Aber.. ha* been appointed Medical Officer for

.. the Bridworth District of the Runcorn Union.

Collinnon. F. W., M.B.. C.M.Edin.. M.B.O.8.. ha* been appointed
Senior House-Surgeon to the Prreton and County of Lancaster
Royal Infirmary, vice W. F. Moore, resigned.

FRarf.r. Annua. M.A., M.D.. C.M. Aber.. has been appointed Second
i Physician to tbe Aberdeen Royal 1 uliraary, vloe Beveridge,
deceased.

Qomno, T. P.. M.R.C.S., L.R.C.P.Lond., L.S.A., late House-Surgeon,
" Mouse-Physician and Obstetric Assistant to University College
Hospital,' London, has been appointed House-Surgeon to the
General Infirmary, Worcester, vloe J. Allman Powell, M.D.,

resigned.

Gurm. Albert W„ M.R.O.S.. L.R.C.P.Bd., has been appointed
Medloal Offloer for the First District of the Uckfleld Union.

MacKik. John. M.D.Ed.. L.R.C.S.Bd., has been appointed Medical
Officer to the Brechin Local Authority, rice Lawreoee, resigned.

MoRiAjrrr, Patrick Hickson. L.R.C.S., L.K.C.P. Bd„ baa been
appoint'd Medical Officer for the Llstowet Union, and Medical Offloer
of Health, rice Klee, deceased.

Muduk. Thomas H. T„ M.R.U 8., L.R.C.P.Lond., has been appointed
Medical Officer for the Paignton District of the Totnes Union.

Rodger, James, M.A., M.D., C.M.Aber.. has been appointed Assistant
Physician to the Aberdeen Royal Infirmary.

Rosa, Ricbard A.. M.B.C.S., L.S.A., has been appointed Medical Offloer
for tlie Eighth District of the Bedmliuter Union.

Smith. Patrick Blaikie. M.D., C.M.Aber., has been appointed
Third Physician to the Aberdeen Royal Infirmary, rice Fraser,
promoted.

Tiommos, William C., L.K.Q.C.P.T., L.R.C.8 .I., has been appointed
Medical Officer for the West Drayton District of the Uxbridge
•Union.

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of the various
Vacancies sohich are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. _____

Bkthlkm Hospital. — Two Resident Medical Students who have
recently obtained their diplomas to practise medicine ana surgery.
Apartments, rations, and attendance.

Burtox-on-Trent Frikxdlt Societies’ Mkdical Associatiox. —
Realdent Surgeon.

Cheltenham General Hospital.— Hoase-Surgeon. Salary £80 per
annum, with board and apartments.

Children’s Hospital and Dispensary, Manchester,—Medical Officer.
Salary £180 per annum.

General Hospital, Birmingham.—Realdent Surgical Offloer. Salary
£130 per annum, with residence, board, and washing.

Huddersfield Infirmary. — Junior House-Snrgeon. Salary £40 per
annum, wi'h board, lodging, and washing.

Macclesfield General Infirmary.— Junior House-Surgeon. Salary
£70 per annum, with board and residence In the Institution.

Manchester Royal Infirmary.—R esident Medical Officer of the Con¬
valescent Home at Gheadle. Salary £160 per annum, with board
and residence. ,

OldhamIn firm ary. —House-Surgeon. 8alary £80 per annum. ,,

Owens College, Manchester.—Senior Demonstrator In Physiology.
Stipend £160 per annum.—Junior Demonstrator in Physiology.
Stipend £100 per annum.

Royal Prek Hospital, Gray’s-tnn-road. — Junior Resident Medloal
Officer. Board and reside®oe are provided in the hospital.

Royal Portsmouth, Portsea, and Gosport Hospital.— Assistant
House-Surgeon. Salary, with board and residence, £60 per annum.

Tottenham and Bdmohton Duphxsart. — Dispenser. Salary £50,
plus £30 a year allowance for fuel aud service, with house free.

York County Hospital.— Assistant House-Surgeon. Salary £50 per
annum, with board, and residence.

$ir%, 'lEarraps, aitEt $kat[i8.

BIRTHS.

Ballanck. — On the lllh lust., at .>6. Harley-street. Cavendish-
square, W., the wife of Charles A. Ballance, M.S , F.B.C.8., of a
•on. / .

Nichols.— On the 9th ult., at Tfowgong. Bengal, the wife of 8urgeon
F. P. Nichols. M.B.Cantab.. M.R.C.S., Army Med. Staff, of a
daughter, who only survived her birth a few minutes.

Oakes.—O n the 9th Inst., at Merimbuia, Priory-road, N.W., the wife of
Dr. Arthur Oakes, of a daughter.

Smyth.—O n the 16th ins*., at Holly Lodge. Breekley, 8.B., the wife of
F. Sydney Smyth, L.R.C.P., F.K.G.S.H., of a son.

Stewart. —(In the loth Inst., at Glenbarr, Mapperley-road, Notting¬
ham, the wife of Donald Stewart. M.D., of a ton.

Wklia.—O n the 11th Inst., at (hMkfietd, Sussex, the Wife of A. B. Wells,
M.D., of a son. _____

MARRIAGB8.

Elliott—Slade-Gully,—O n the 9.h ivst., at Chute, F. H. Elliott..
M.D., to Eleanor Lonlsa, eldest diu 4 ) ter of the late Captain Slade-
Gully, Bengal Staff Corps.

Jolly— Lester. —On the 10th Inst., at St. Mary's Episcopal Church.
Glasgow, Sydney Blake Jolly, M-B.Cautab., M.K.C.S., to Maude
Helena, younger daughter of Wm. Leeter, Esq., of Donne-terraee,
Glasgow.

Lowxds— Imrat. — On the 16th Inst.,. In the Chapel Boyal. Saroy.
bv the Rev. Henry White. M.A., Chaplain of tbe Savoy, and
Chaplain in Ordinary to the Queen, Henry Arthur Lownd*.
L.R.C.P., L.R.C.S.. of Klrkburton, Yorks, to Ethel, daughter of
John Imrmy. Hsq.. M.A.. of 8edgomere. Bast Finchley.

Orr—Wilkinson.—O a the 12th Inst., at Gramml Presbyterian Church,
Putney. Loudon, Wm. Young Orr. M.B.Ed., M.B.C.ti., to Margaret,
fourth daughter of the late Frederick Wilkinson, of Cleveland House,
Barnes. S.W.

Priestley — JACqUK?. —On the 19th inst., at the Parish Church.
Streatham. S.W.. Joseph Priestley. B A., M.D., M.H.C.8., to Edith
Blanche, youngest ilaughter ef Edwin Jacques, M.D., of Fir-grove,
Brixton, S.W. _____

DEATHS.

Fleck.—O n the 14th Inst., at Frogmoor Lodge, High Wycombe,
Kathleen, only daughter of William Fleok, M.D. (of croup),
aged 2 years.

Francis.—O n the 6th Inst., at Brighton, Day re 11 Joseph Thackwelt
Francis, M.D., F.R.C.P. Lond., of Wethersell Orange, Cranlelgh,
Surrey, aged 67.

Gilland.— On the 8th Inst., at Sevenoaks, Bohert Bryce Gllland, M.D..
late Medical Superintendent of Berks County Lunatio Asylum,
Moolsford.

Hartley.- On tlie 10th inst., at Roxeth Lodge, Carshalton, Surrey,
James Hartley, M.H.C.S.

Markwick.—O n the 12th inst., at his residence, Ventnorvlllas, Weet
Brighton, Alfred Markwick, L.R.C.P., F.B.C.S. (late of Leinster-
square, Bayswater), sged 64.

Stdttrr.—O n the 9th lust., at Wickham brook, Newmarket, Suffolk,
William Gaskoln Stutter, F.R.C.S., aged 71.

H.B .—A fee of 6s. is charged for the Insertion of Setioee ef Births,
Marriages, and Deaths.

Digitized by LjOOQle

604 Thr Lancbt,] NOTES, COMMENTSi'AND ANSWiftS TO UQgRESPQflDEin’S.

[March 19,1881

Htthical $jiarji for % miring Week.

Monday, March 21,

Royal London Ophthalmic Hospital, Moorfiklds. — Operation*,

10.30 a. It., and each day at the tame hour.

Royal Westminster Ophthalmio Hoapital.—O peration*, 1.80 p.m.,
and each day at the aame hour-

Chelsea Hospital fob Women.— Operations, 3.30 p.m ; Thursday, 2.30.
8t. Mark’s Hospital.— Operation*. 2 p.m. ; Tuesday, 2.30 p.m.
Hospital fob Women, Soho-bquauk. — Operation*. 9 p.m., and on
Thursday at the *ame hour.

Metropolitan Pbr* Hospuaw- Operation*, 2 p.m.

Rotal Ortropar>ic Hospital.—O peration*. 2 p.m.

Central London Ophthalmic Hospitals.—O peration*, 2 p.m., and
each day In the week at the tame hour.

SociBTr of Arts.—8 p.m. Prof. W. C. Unwin: Machine* for Testing
Material*, eepeolally Iron and 8teel (Cantor Lecture).

Mxdical Society of London.— 8.30 p.m. Mr. R. Brudenell Carter«
A case of 8wol!en Optic DUc In which the 8heath of the Optlo Nerve
waa excised behind the Bye.—Dr. Ral'fe: Renal Calculus passed alter
the Use of Solvent*.—Dr. Allchin : Cue of Intussusception.—Mr. J.
Astley Bloxam,: Case of Congenital Malformation of the Diaphragm.

Tuesday, March 22.

Guy’s Hospital.—O perations, 1.30 p.m. and on Prlday at the same hour.

Ophthalmic Operations on Monday at 1.80 and Thursday at 2 p.m.
8t. Thomas’s Hospital. —Ophthalmic 'Operations, 4 p.m. : Prlday, 2 p.m.
Cancer Hospital, Brompton.— Operations, 2.80 p.m.; Saturday, 2.80p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital —Operations, 2.80 p.m.

8 t. Mart’s Hospital.— Operations, 1.30 p.m. Consultation*. Monday,

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.m.
Rotal Institution.—3 p.m. Prof. Gam gee t Function of Respiration.
Royal College of Physicians of London.—6 p.m. Dr. Broad bent:

The Pulse (Oroonlan Lecture).

Anthropological Institute of Great Britain and Ireland.—8 A0 p.m.
Dr. H. Rink : On tbe.MIgrmtlons of the Eskimo.—Mr. Coutt# Trotter:
Note* on the Inhabitant* of the Polynesian Islands. — Lieut. F.
BIton.R.N.: Extract* from Notes on Natives of the Solomon Islands.
Rotal Medical and Chiburgioal Society. — 830 p.m. Mr. Godlee:
On a case of Obstruction of one Ureter by a Calculus, accompanied by
Complete Suppressionof Urine—Mr. R. W. Parker: Onaoaseof Sup¬
pression of Urine, following Injury to a Sacculated Kidney containing
Calculi, the other kidney being entirely disorganised.—Dr. Warner
and Dr. Fletcher Beech: A case of Cnronlo Meningitis, probably
syphilitic, and causing Progressive Dementia.

Wednesday, March 28.

National Orthopedic Hospital.— Operations; 10 a.m.

Middlesex Hospital.— Operations, 1 p.m.

8t. Bartholomew's Hospital— Operations, 1.30 p.m.; Saturday,same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Sorgiaal Consultations, Thursday. 1.80 p.m.

St. Thomas's Hospital.— Operations, 1.30 p.m. ; Saturday, seme hour.
London Hospital.— Operations, 2 p.m. ; Thursday & Saturday, same hour.
Great Northern Central Hospital.— Operations. 2 p.m.

Samaritan Free Hospital for Women and Children.—O perations,

2.30 P.M.

University College Hospital.— Operations, 2 p.m. ; Saturday, 2 p.m.

Skin Department. 1.45 p.m. ; • Saturday. 9.15 a.m.

Bqtal Free Hospital.—O perations, 2 p.m., and on Saturday.

King's College Hospital.— Operations, 3-td 4 p.m.; Prlday, 2 p.m.;
Saturday, f P.M.

Children's Hospital, Great Ormond-stbhbt.-*-O perations, 9 A.M.;
Saturday, same hour.

Society for the Bncouragement of Arts, Manufactures, and
Commerce.—8 p.m. Dr. Percy Pranklaud i Some of the Conditions
affecting the Distribution of Micro-Organisms In the Atmosphere.
Hunterian 8 ocDrrr.—8 p.M. Dr. Turner: Actinomycosis.—Dr. Dundss
Grant: (1) A case of Carles of the Vertebne from a Fish-bone in the
Throat; (2) Laryngeal Growths; (3) Carcinoma of (Esophagus.
Society of Arts.—8 p.m. Dr. Percy Frankland: .Some of the Conditions
affecting the Distribution of Micro-organisms In the Atmosphere.
British Gynecological Society.— 8.30 p.m. Specimens will be shown
by Drs. Pearse, J. Manseil-Moullln, Bdls, and others.—Mr. Lawton
Talt: Methods of Cleansing the Peritoneum. Council at 8 p.m.

Thursday, March 24.

St. George’s Hospital.— Operations, 1 p.m. Ophthalmic Operations,
Friday, 1.30 p.m.

Oharing-cboss Hospital. —Operations, 2 p.m.

North-West London Hospital.—O perations. 2.30 p.m.

Rotal Institution.—3 p.m. Prof. P. Max Miiileri Scienoe of Thought.
Rotal College of Physicians op London. — 6 p.m. Dr. Priestley:
Pathology of Intra-uterine Death ( Lumlelsn Lecture).

Triday, March 25.

Rotal South London Ophthalmic Hospital.— Operations, 2 p.m.
Society of Arts.—8 p.m. Mr. Frederick Clifford : Indian Coffee.
Clinical Society of London.-*-3.30 p.m. Mr. Davies Colley: On
Contraction of the Metatarso-phalangeal Joint of the Great Toe.—
Dr. Samuel West.’: Oases of Internal Suppuration, acute and chronic,
without lever.—Mr. Treves: A Form of Glandular Swelling that is
cured by Arsenic,—Mr. Parker and Dr. Robinson: Inherited Con¬
genital Deformity of the Hands and Feet, Plastic 0 tie ration on the
Sect, ,

Rotal Institution.—9 p.m. The Right Hon. Lord Rayleigh: Colohr
of Thin Plates.

Saturday, March 26.

Middlesex Hospital.—O peration*, 2 p.m.

Rotal Institution.— 3 p.m. The Rt. Hon. Lord Rayleigh i On Sound.

METEOROLOGICAL readings.

(Taken daily at 8.30 a.m. by Steward?t Instruments )

The Lancet Office, March 17 th, 1887.

Pat*, i

Itamuw
reduced to
Baa Level

sod SJ*F.

IXroe-

tloa

of

Wind.:

Wet

Ball).

So Ur !
Kadis i
in 1
Venae. |

Max. ;
Temp, i

Bkede.

Mia.

Temp

58*

1 1 • • •

r—r—i

Mar. 11
.. 12
„ 13
„ It

„ 15
16

30-05

29- 78

30- 17
20-91
29-84
29*95
30*11

B.

N.B. 1
N.
N.W.
B.

E.

R.

36

86 l

35

30

34

33

30

35

35

33

34
32

59 1
58 1
70 1

60 ,

08 *
67

45

40

41

42

35

40

37 !

39

35

21

26

29

80

27

• ej*

:s

• .a 1

Haxy

Q M , —f , ,,
UUUMllIK

. Vlaa
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Onraut

Hates, Slwrt Comments, & Imfers to
Correspondents,

It is especially requested that early intelligence of localevent*
having a rtiedical interest , Or which it vs desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed** To the Editors.”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of Thr Lancet to be addressed 11 to the
Publisher.”

We cannot undertake to return MSS. not used.

Obstinate Constipation in Infants.

On this subject WhoU Meal writes that Dr. Simmonds (see The Lanctbt,
ante, p, 504) ha* “ hit the right nail on the head ” la his suggestion of
the use of wheat bran for the constipation of infants. Our correspondent
says be had been a martyr to both Indigestion and constipation far
years, but the sole qae of whole meal as bread has entirely freed him
from the pain end discomfort attending those affections.

L. B.C.P.—1. The nervous system of Use patient should ba thoroughly
lnveatlgated. The positive pole shofeld be placed at the back of the
neck, and the negative moved about the forehead.—2. Perhaps the
Secretary of the Royal College of Surgeons would give our correspondent
the Information he desires. It would obviously*)* (inadvisable to publish
the details referred to.

Dr. N. Whilelaw Bourns .—The qualifications are ample for the recovery
of all reasonable medical and surgloal charges,

M. R.C.S. will find the information he desires In Cates’ Dictionary of
General Biography (published by Longmans), under the heading
“ Uoderic.”

PROFESSIONAL ETIQUETTE.

To Editors of (As The Lancet.

Sirs,—S ome time ago one of my patients was sick, and during her
illness her mother went home to London. In London she consulted a
physician about her daughter, and he gave her a prescription and actually
sent ont medicine, at least the medicine sat the prescription duly
arrived, though too late to be of any nee, as my patient had quite re¬
covered. This was, ]>erhaps, fortunate, as the case was such as made
it impossible for him to be sure of his diagnosis. But as yet there
has been no word to mo of excuse for the liberty that has been taken with
my practioc. As this is the second time such a thing ha* been done to
me by London medical men, I would be glad to know if it is the usual
custom, if It fulfils their Idea of “doing to otKers as they would have
others do unto them." The position of my patient being known to both,
and being such that no time would pass before seeking medical aid bx
every case except the most trifling, neither can have the excuse of “ not
knowing that I was In attendance." Medical practice in Jerusalem is
disagreeable enough, in all conscience, without being made so by
conduct such as I have described. We number nineteen In Jerusalem,
mostly all of different nationalities, and the jealousy of race is added
to professional jealousy, and in oonsfeqaence, we make a very unhappy
family.. ' I have not written to either of the gentlemen to whom I
refer above, but probably they will know whom I mean when they see
this letter in The LAncxt. It Is not at all uncommon for tourists of
our profession, especially In Its middle grades, to give their advtee here
to patients who may seek .it wltlxnut ever inquiring, or Ignoring that
they were under treatment at the fine.—Tours faithfully,

Jerusalem, Feb. 28th, 1887. John H. Ogxlvie.

Digitized by GoO^lC

IHK LANCET,]

MOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Mabch 19,1887. 605

The Moxon Memorial Fokd.

President : 81r William Jenner, Bart., K.O.B.. M.D., F.B.S. Hon.
8eos.: O. N. Pitt, M.D., 34, Ashbnm-plaoe, 8.W.; W. A. Lane, M.8.,
14, St. ThomasVstreet, 8.B. Subscriptions should be forwarded to the
Hon. Treasurer, B. dement Lucas, B.8.,F.R.C.8., 18, Ftasbnry-sq., B.C.

Third List.

Subscriptions announced £412 14

6

Th. Harbottle, Esq.

£2

2

0

B. Homan. Esq., J.P. ...

10 10

0

J. F. Goodhart, M.D. ...

2

2

0

3. Braxton Hicks, M.D.,

Sir J. Fayrer, K.C.8.I....

1

1

0

F.B.S.

0

5

0

Owen Bowen, Esq.

1

1

0

Prof. Humphry, M.D.,

Joseph Coate, M.D.

1

1

0

F.B.S. ... '.

5

5

0

Arthur Pearson, Esq. ...

1

1

0

John Hall. M.D.

a

5

0

Herbert Lund, M.B. ...

1

1

0

W. Blasson. Bsq.

5

5

0

William Bwart, M.D. ...

1

1

0

Prof. W. S. Greenfield.

Bernard Woods, Bsq. ...

1

1

0

M.D.

3

3

0

C. D. Hlgham, Bsq.

1

1

0

G. N. Pitt, M.D.

3

3

0

W. H. Lamb, Esq.

1

1

0

B. H. Lushington, Bsq.

3

3

0

8. W. Bradnack, Esq. ...

1

1

0

H. Cosmo Bonsor, Bsq.,

George Turner, Esq.

1

1

0

M.P.

2

2

0

8birley F. Murphy, Bsq.

1

1

0

T. Obarrington, Bsq. ...

2

2

0

J. C. Uhthoff, Bsq.

1

1

0

F. B. Carey, M.D.

2

2

0

W. Makeig Jones, Bsq....

1

1

0

W. C. Toufrain, Esq. ...

2

2

0

R. M. Harvey, Esq.

1

1

0

John Brockwell, Esq. ...

2

2

0

George Abbott, Bsq.

1

1

0

Henry Davy, M.D.

2

2

0

L. A. Dunn, B.8., F.R.C.S.

1

1

0

W. H. A. . Jacobson,

B. C. Roberts, Bsq.

1

1

0

P.R.C.S.

2

2

0

Robert Cuff, M.B.

0 10

6

Edward Coffin. Esq. ...

2

2

0

B.W. Da Buisson, Bsq....

0 10

6

O. R. Burnet, Esq.

2

2

0

8. W. Mac Thwaine, Bsq.

0 10

0

Errata.—" J. B. Trap, Esq.,” should have been J. B. Trapp, Esq., and
" T. 8. Harley, M.D.." should read T. 8. Horley, H.D.

C. O'H.— It is usual to call medical evidence in such cases, but the
coroner is not under any obligation to do so, especially when the cause
of death is obvious.

Or. M'Mrrrdit't letter shall have attention.

RBMARKS ON VACCINATION AND RBVACCIHATION.

To ths Editors of The Lancet.

Sirs.—I n a society journal this week the following ooenrs:—“The
illness of Prince Alexander of Battenburg has put the Darmstadt menage
in a very pretty fright, and vaccination has become a rage with Prince
Alexander of Hesse's household, every soul of which has now a sore arm,
which it takes him all his time to guard from injury. One lady, proud
of her arms and unwilling to have their beauty marred by Inoculation
marks, wanted the oi>eration to be performed on the calf of her leg.
Her request was refused by the physician.” Without entering into
discussion on the above passage, I shall ask the question. Should
a physician refuse to comply with the patient’s request under similar
cirimmstances » I say, No. I have for some years advised vaccination
and revaocination on the thigh in preference to the arm or any
other part. The position I prefer is the middle or lower third of the
outside, in infants selecting the leg which is least likely to come in
oontact with the mother or nurse. I And the operation to be more
easily performed here than on the arm; the surface is larger, smoother,
and less apt to bleed, the arm being frequently congested at the time
from tlie undressing of needlessly profuse and tight-fitting garments,
lu cold weather this situation has increased advantages. I have never
had the vesicles injured afterwards. It is especially for women that the
question of site is of so much importanoe, with their ever-eooentrlc
tyrant, fashion ; and never was fsshion more unseemly and insanitary
than the present style demanded by the etiquette of the Court!

I am, Sire, yours faithfully,

Ladbroke-grove, W.. March 11th, 1887. W. Sinclair Thomson, M.D.

H. A'.—No; there is no illegality in the operation per se. The duty of a
medical man if consulted on such a question Is quite clear. As a rule,
he ought to discountenance the practice. It Is, moreover, highly
reprehensible, as offering an inducement to vice.

Puzzled .—The only reply we can make our correspondent is that made
by Lord Baoon to so maay of Us own queries —Fiat experimentmn.

Hr. G. Nelson has not enclosed his address.

THB TRBATMBNT OF PHTHISIS.

To the Editors of The Lancet.

Sirs.—I see by The Laeckt of the 6th Inst, that Professor Kremiansk!
of Mosoow has been endeavouring to^ effect the cure of phthisis (tuber-
oulous) by means of atomised aniline. I may say that I have been for
•owe time experimenting in the same direction,- using a spray of solution
of mercuric chloride (HgClj) of the strength of 1 In 6000. And so far as
I have been able to judge, the results arc decidedly promising, and likely to
fwore very satisfactory. I shall prepare a record of all cases which I may
tnat by this method (both successfully and unsuccessfully), and when
the list la completed and arranged, I shall, If you consider the matter of
importanoe, send the same to yon for publication. I should
bars communicated with you regarding, this subject before this, but
thought H better to wait until fairly sure of my ground. The article
* b0VB referred to in your last issue baa induced me to ventilate the
Better toons, than I bad intended.

I am, Sirs, your obedient servant,

3. Retho tM, M.D. Brux., Ac.

OoM Harbour-lane, feixtob. 8.W., Match 3th, 1887..

Improved Method op Packing Tinned Provisions.

In view of the injury to health sometimes resulting from the ingestion
of provisions secured in tin boxes, any intelligent attempt to avoid the
possible dangers attendant upon that method of food preservation is
to be commended. Such an attempt has been made by Mr. N. Ruffin,
of Charlotte-street, Fitzroy-square, who has submitted to us specimens
of tin cases in which the oontents are kept from oontact with the
metal by means of a oovering of muslin in the first place, followed by a
coating of fat, and then by a layer of gelatine. This plan seems well
calculated to effect the purpose Intended.

G. Sheppard .—We understand that a proposal for giving the nnrsing in
Indian hospitals into the charge of Bngllsb ladles Is now engaging
the attention of the Indian authorities. Military nursing in England
and in the Colonies is conducted by lady nurses wbo must have been
trained before aooeptanoe. Application should be made to the Director-
General, Medical Department, Whitehall. Regarding other hospitals—
to mention one or two,—the lady superior. All Saints. Margarct-street ,
would be able to give information about the Cape Town and, probably,
many other colonial hospitals. The nursing at Kimberley is under the
Bishop of Btoomfonteln’s Missioh. There is a Greek hospital at
Alexandria, where, we believe, Bnglish nurses are wanted. The
superintendent might be communicated with. Aooordlng to a letter
' in the Hospital for Nov. 20th, 1886, trained nurses are much valued
and highly paid at. the Philadelphia hospital.
iY. /..—We certainly think that testimonials of the kind submitted to
our notice are highly objectionable. But in this case, as in some
others, evidence Is wanting to show how far the testimonial-giver
approves of the use made of his e x p r e ss ion of opinion.

Dr. Elder.—The paper Is marked for insertion.

8TRBKT SEWER-VENTILATORS.

To the Editors of The Lancet. 1

Sirs.—I would call attention to a very manifest, possible cause or
disease — i.e., the unprotected sewer ventilators which are generally
placed lntbecsntreof the road. The exhalations are not only unpleasant,
bat dangerous. I liave myself suffered from them, and have attended
patients who have similarly suffered (one died of intercurrent pneumonia
after six weeks’ illness). The symptoms are great feverishness, subse¬
quently followed by exuviation of tbe muoous epithelium of the tongue
and gullet (so that in swallowing there is a sensation as of burning,
which extends to the stomach), inflammation of the tonsils, the gums
(particularly) becoming inflamed, very painful, and spongy, and the
teeth loosened in severe cases; where there are bad teeth or stumps
inflammation of the periosteum occurs, i attribute this disease, which,
in order well to fix Its cause, I have called " gully-hole fever,” to those
ventilators from the fact that all my patients have lived close to one.

Of course, the ventilation ought to be conducted through hollow iron
shaft*, and drawn through this by means of burning gas-jets. Modi¬
fications of the Argand burner would be best, as the air would then have
to pass through the flame, thoroughly destroying the germs by burning
(as I suggested ten years ago as the resolution of the small-pox hospital
difficulty). One advantage of this system is that the ventilation remains
no longer passive, but becomes active, the vaouum formed by the heat
drawing up the air forcibly, so that probably not more than one-tenth
the present number of ventilators would be required. In addition, the
shafts so arranged could be used as brilliant gas-lights.

I am. Sirs, yours obediently,

Henry Godrich, B.A., 1st B.Se.Lond.
Long Ditton, March «th, 1887.

Provident Dispensaries: The Wandsworth Medical Aid
Society.

-La answer to ths letter on luhjsot from Dr. Nicholas, whioh appeared

in our last issue, “ A Grumbler," whose communication appeared on
the 12th ult., states that he knows nothing of the promoters of the
Wandsworth Medioal Aid Society, nor of the place Itself. He distinctly
stated in his letter that he only took that particular society as a type,
and oontends that its promoters have really acknowledged the justice
of his remarks,«rhloh were directed against the system of combination
to obtain medioal services at small fees.

A Repent M.R.C.S., LJLC.P .—There is no basis fordoing to, either in
law or bye-laws.

Ambulator Is referred to The Lancet of March 12th, page 641.

MEDICAL PRACTICB IN THB WBSTBBN STATES.

To ths Editors of The Lanobt.

Sirs,—I shall feel much obliged if any of your readers will give me
some information about medical practice in Western America, especially
in California and British Columbia. Are British diplomas fully reco¬
gnised in both places? Is there a fair opening in either P And is the
dimate suitable for patients suffering front lung diseases ? Can drugs be
obtained easily there? Any other information will very much oblige,

* Yours faithfully,

1 March 16th, 1837. A Constant Reader.

Digitized by

606 Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[March IS, 1887.

PLACK5TA pR.EVlA.

A? Dr. Murphy, in his letter published last week, intimate#, tliere is a
misprint in our article on the above subject. On page 179, second
column, the Commencement of the first paragraph should read'as
follows: "These accoucheur# treated US cases, with eight maternal
•if-aths—a mortality of '.VS per cent.” It is hardly necessary to remark
that the argument is not affected by the error.

■S. -'.-.r Jessie’s lines are hardly of sufficient merit for our columns.

NITRITE OF AMYL: RELIEF OP AFTER-PAINS.

To the Editors of The Lancet.

Sirs,—T he following note may be found interesting to many of your
readers.

A lady-whom I had the day before delivered of a tine bey complained
to ms on nay second visit of excruat&ttng after-pains, which she declared
were worse than any she had experienced during the labour. On
examination. I found the womb firmly contracted. Her loss was slight,
and no clots larger than beans had been passed. As it was some distance
from home, and several hours must necessarily have elapsed before I
could have sent her any medicine,! broke a couple of nitrite of amyl
capsules (four grains in each) into a smelling-bottle, and directed the
patient to take two or three deep inhalations when she felt a pain
coming on. Theeffect was simply magical ( the pains ware immediately
relieved, and shortly ceased altogether, the patient being soon able to
take some refreshing sleep. She quickly made an excellent recovery.
I have since tried the same remedy In two other cases of less severity,
with similar results. I have also found this useful drug invaluable in
tbe sickness of pregnancy and in obstinate eases of dysmsnorrhcea.
1 hsve hitherto not had a single failure or bad result. Inhalation seems
to be more certainaud lasting than the internal exhibition of the drug.
To all who are called upon to prescribe for the above common ailments
I can strongly recommend this simple and, in ray hands, efficacious
plan of treatment. I am. Sirs, yours truly,

South Molton, March 4th, 1867. P. Wbixesut Khxdlb, M.R.C.S.

CONSTIPATION.

To the Editors of Thb Lax car.

Sirs,—-I shall be glad if any of your readers can give me a hint as to
the treatment of the following case : The patient, a lady aged twenty-
two. has been suffering the last four months from obstinate constipation.
All the uanal remedies have been tried, but without success; and relief
can now only he obtained by the use of enemata. I may add that the
patient is about three months advsneed in pregnancy, and there is
nothing abnormal with the pelvic viscera.

I am. Sirs, yours faithfully,

March, 1867. A Coxetaxt Reader.

COLORADO.

To the Editors of The Lancet.

Sirs,—I n your issue of Feb. 19th "A Phyt-ician” asks for information
relative to Colorado as a health rasort. 1 have seen no replies to that
request, and would therefore suggest that he refen to papers noted in
the Medical Digest and Appendix, Section 676: 4.—'Yours truly,
Boundary-road, N.W., March 11th, 1887. RlCED. Nbalk, M.D.Lond.

CoMXtnncATioRS not noticed in oar present number will receive atten¬
tion in our next.

CoMMUitiCATioxs, Letters, Ac., have been received from—Dr. Kingston
Fowler, London ; Dr. Bantock, London; Dr. Hurry, Reading ; Sir J.
Sawyer, Birmingham ; Mr. Clement Lucas, London; Dr. Mac Allster,
Cambridge; Dr. F. Warner, London; Dr.W.Ewart,London; Dr. John
Williams, London ; Mr. Gwlllim, Marlborough ; Mr. Milner; Dr. R.
Lee, London; Mr. W. Norman; Mr. Hughes, London; Mr. P. Dunn,
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by Google

THE LANCET, Mahc^ 26>-1887.

h u'l

Croomiatt declares
, ,,x
; THE PULS E.

' Xfdicered at the Royal College t,f Physician* of London,
March, 1887.

By W. H. BROADBENT, M.D., F.R.C.P.,

pHTSicilN to st. Vary's hospital, consulting physician to thi:
• London fever HosPirAi, and president ov the clinical societt.

. ; LECTURE 1.

' Mb, Phrsidbnt axd Gbntlbmkn,—T he subject I have
fchosen for the lectures which I have the honour to deliver
before you, if it is to be judged of by its importance to the
pap^ieal man, is well worthy of the attention of the College.

. Jt is to the pulse that we look first of all for trustworthy
information as to the condition of the patient who seeks
our aid, and the knowledge obtained from it is a sort of
foundation upon whigh is built up the opinion we form
from the collective symptoms he exhibits and from the
results of our physical examination. On the other hand,
•inoe the pulse has been the object of attentive examination
•n the part of every physician here, from the first moment
bf his entering upon the study of medicine up to the
present time, and by countless generations of physicians
from the time of Galen onwards, it may appear to be an
agt of presumption on my part to bring before the College a
Subjeot with v^hich every Fellow is equally familiar with
myself. 1 might reply to this that there has been a great
reawakening of. interest in the pulse; that new methods of
study and of investigation have been brought to bear upon
it; that greater precision has been introduced into the
descriptive terminology of its variations. But the justifi¬
cation I would plead, is simply this, that I have myself
learnt much, and still find that I have much to learn, with
pegpd. to the pulse, with regard to the significance of the
Changes observed in it, aiul especially with regard to the
indications for treatment to V* obtained from it.

, . We examine habitually thmpulse at the wrist, and at first
eight it seems strange that th^ radial artery, which supplies
merely, the structures of a part of the hand, a few. small
gonee with their articulations,. a few muscles and tendons,
fhe skin and the nerves distributed to it, should afford the
varied and far-reaching knowledge we look for in the pulse.
The band is not essential to Urn; it contains no organ of
$py importance, and a priori it might have been supposed
^bat the .variations ini the circulation of the blood in sq small
4 member oould ha ye no aignificance. We know as a matter
of observation, however, that the pulse of the wrist indi¬
cates thp condition ,o£. the circulation generally, and on
reflection it. is -seen that, as a branch of the great arterial
system, it receives every impulse starting from the heart,
and reveals the frequency and force of its beats; and not
only this, but as fluid pressure is eqqal, or tends to become
gqual in all parts of a freely communicating system of tubes,
it shows the degree of freedom of the general outflow
through the capillaries as well as the kind of propulsion by
the heart. The very fact that the hand has no special cir¬
culation of its own liable to extreme variations for func¬
tional purposes, such as, for example, those which occur in
the salivary glands, makes the radial pulse a more trust¬
worthy index of the general circulation.

. A preliminary question, upon which a distinct understand¬
ing must be arrived at, is the following: The pulse,' wbat is
it; and what is the exaet,information it furnishes? /Now,
it is not, as is commonly understood, and as is explicitly
Stated in text-books of physiology, much read by our '
students, an expansion of the artery. This, at any rate, is ■
not,what we feel or what is recorded by the sphygmograph.,
A moment’s reflection as to the volume of blood discharged J
by the left ventricle into the aorta, and a comparison of this ,
With the capacity of the entire arterial system, will convince 1

S that it is. altogether yi^dequate to produce any expansion
the smaller arteries appreciable to the touch. The aorta
and it* primary brooches are^if jsitnia, dilated somewhat by
the injected bleod«bat«vpain^\fcsael the size of the carotid
Ho. 3317. ‘ '

it is difficult to measure the ihcrease of diameter, to hiirWie
is it; whereas in the radial, in which it must be much less,
the sphygmograph, if its trace were taken to indicate actual
enlargement of the artery, would sbow.it to be considerable.
Nor is the pulse a sinuous movement of the artery in 1 its
bed from elongation, which throws it into curves. To feel
the pulsation in an artery, or to take a sphygihdgrapMc
trace, a certain degreee of pressure must be applied to
the vessel, and, as is well known, there must be a bone
behind it against which it can be compressed. What
happens, then, is as follows: in the intervals between tbe
pulsations, when the resistance by the contained blood is
at its lowest, the tube of the artery is more or less
flattened; then comes the so-called wave of blood propelled
by the systole of the left ventricle, or, to speak more
accurately, the liquid pressure in the vessel is increased,
and this forces' the artery back ihto the circular fortn. It ia
this change of shape frpm the flattened condition impressed
upon the vessel by the finger, or by the sphygmographic
lever, to the round cylindrical shape which it assumtes tinder
the distending force of the blood within it which constitutes
for us the pulse. Such a'pulsation can be felt on alrirge
scale by placing the foot on the unyielding and uhelistic
leather hose of a fire-engine In action, or shown in a schema
of the circulation with inelastic vessels. It is not, then', ah
increase in the diameter of the vessel, but ah increase of *he
blood-pressure within it, Seated by the systole of the
ventricle of the heart, which constitutes the pulse.

Another common misconception must be cleared 'tip—
namely, that the pulse signifies onward movement of the
blood in the artery. Since a certain amount of blood ib
propelled into the aorta at each systole, it would seem, at
first sight, that there must be a corresponding propulsion of
blood along the vessel which is under the finger, and mis¬
apprehension has been carried so far that the pulse wave has
been understood to mean the actual transport of the blood,
and even to indicate the rapidity of such motion. Short of
this, it is more comtao'nly taken for granted that the rate of
movement of. the- blQod -jq the vessels is directly propor¬
tionate to the strength of, the pulse -that a good strong
pulse implies a vigorous "rush through the capillaries, and a
weak pulse a languid flow. The stream from a divided
artery and the pulsatile jet seem to countenance this con¬
clusion. It is, however, an erroneous idea; if the radial is
compressed close to the hand, the pulsation above is not ex¬
tinguished, but eiaggerated, -and when an artery is tied
the pulsation up to^ne ligatured point is more vehefnent
than before. Pulsation is thus no evidence of onward
movement of the blood, and resistance in the arteries and
capillaries Will' hive pro . tanto the effect of a ligature,
hindpring or even arresting the onward current; ana there
can be no doubt that peripheral obstruction does at times
reach a point which almost, stops the floW'frOm the arteries
to the veins, t he pulse appearing to be all the stronger on
this account; in fact, we infer the existence of obstruction
in the cerebral circulation from the exaggerated carotid beat
on that aide. This'is a consideration which, it seems to me,
is not adequately borne in mind. I think it enters into the
explanation of dropsy,' and especially of the varying amount
of dropsical effusion under apparently similar conditions,'
and t^at it else helps to clear up obscurities in the relation
between circulatory conditions and head symptoms.

' . I'be pulse, then, indicates simply the degree and duration
of increased pressure in the arterial system caused by the
Ventricular systole. There is a certain mean blood-pressure
maintained by tbe elasticity of the large arteries, varying
greatly in different individuals, which Keeps up the flow.
through the capillaries, and the level of which is determined,
by the resistance in the capillaries and the amount of force
stored up by the elastic walls of the large arteries. . This i
pressure is lowered by the outflow through the capillaries'
into the veins, and is reinforced by the successive contrac- ,
tions of the left ventricle and the pulse marks, and indicates
the minimuin and the maximum pressures, with the grad a- ,
tion from one to the other. The term “ tension,” as appjied
to the pulse, means simply thedegree of fluid pressure within ,
thp artery,. putting its walls on the stretch. Distension ;
might, perhaps, be more expressive than tension, if less
exact apd technical. With these preliminary observations
we may proceed to consider the factors of the pulse. , , . ...

There are three factors in the production of the pi^lsp,!
influence of each on the variations observed
erstoOd. I shall not enter upon them tiupfc
N'

Google

608 The Lancet,]

DR. W. H. BROADBENT ON THE PULSE.

[Mabch 28,1887.

bat certain observations are necessary to a full comprehen¬
sion of the effects which will be studied later. The three
factors are—1. The action of the heart. 2. The elasticity of
the great vessels. 3. The resistance in the arteries and
capillaries. The he'art determines unconditionally the fre¬
quency and regularity or irregularity of the pulse, and, with
certain qualifications, its force or strength. The great
vessels, acting as an elastic reservoir, convert the inter¬
mittent jet issuing from the ventricle into a more or less
continuous stream, impressing at the same time certain
characters upon the pulse, according as the elasticity of
their walls is perfect or impaired, and according as they are
kept fully distended or only slightly on the stretch. The
capillaries and arterioles, by the varying resistance which
they offer to the passage of blood through them, determine
the character of the pulse, and influence materially the
action of the heart. Each of these must be considered in
some detail.

It has just been said that the heart determines absolutely
the frequency of the pulse; and this is true, in so far that the
number of beats of tne pulse corresponds with the number
of the heart-beats, except when a certain proportion of the
latter are too weak to reach the wrist, or when very little
blood enters the ventricle during its diastole; with the ex¬
ception, again, of that curious modification of the heart’s
action, in which there are two heart-beats coupled together
for every beat of the pulse. It must not be lost sight of,
however, that resistance in the peripheral circulation reacts
upon the rate of the heart’s action, as well as upon its
character, the frequency being increased as resistance is
lessened, and vice versd, subject, however, in both cases to
the intervention of the nervous system. The rhythm as well
as the rate of the pulse is determined by the heart, and the
pulse, generally speaking, is regular or irregular, according
as the action of the heart is regular or irregular. The pulse,
however, may be made irregular, when the heart is acting
regularly, by beats failing to reach the wrist, and irregu¬
larity of the heart’s action may be greatly exaggerated in the
pulse.

With regard to the strength or force of the pulse, again,
this must be directly dependent upon the strength or the
ventricular 9ystole. The pulse cannot be strong or forcible
when the heart’s action is weak, and it will not, as a rule,
be weak when the heart’s action is vigorous. But the volume
of blood discharged by the ventricle into the aorta is another
element in the production of the pulse. If from any cause
the ventricle is not properly filled, as may be the case when
there is obstruction in the pulmonary circulation, or when
the mitral orifice is greatly narrowed, or when the ventricle
has not time to dilate, as may happen in palpitation, the
systole will have little effect in increasing the pressure in
the arterial system; and there may, under Buch circum¬
stances, be powerful action of the heart with a feeble pulse.
As will be seen, however, when the influence of peripheral
resistance is discussed, the apparent strength of the pulse
may not correspond with the energy of the ventricular con¬
traction, even when the amount of blood propelled is normal,
and tension, or the degree of distension of the arteries while
it is maintained by tne heart and is dependent upon the
pressure supplied by the ventricular systole, is by no means
proportionate to its vigour. ■ .

The principal effect of the large arteries Is to act as an
elastic reservoir, which converts the intermittent jet of
blood which issues from the ventricle into a continuous
stream. They are kept in a state of continual distension,
which is increased momentarily by each ventricular systole,
and runs down to some extent in the intervals, but'never
during life, to a point at which the elastic coats of the
vessel cease to exercise some compression on its contained
blood. The force of the heart is thus stored up and de¬
livered out gradually in the form of a steady pressure, which
keeps up an almost uniform flow through the vessels of the
periphery. The regular current of blood sustained in this
way is essential to the functional efficiency of the central
nervous system.

But the elasticity of the great vessels is concerned in the
production of the dicrotism of the pulse. The conditions
favourable to its manifestation are low tension in the arteries
and sharp contraction of the heart. When the outflow by the
capillaries is rapid, the pressure in the aorta and great vessels
wul run down speedily during the cardiac diastole, and there
will be a great and sudden rise with the systole. There
being, moreover, comparatively little resistance to the blood-
entering the horta from the ventricle, its systole takes place

rapidly. The force of the systole is divided; there is, at the
same time, a launching forwards of the column of blood,
and an expansion of the great vessels laterally, their
elastic coats not being on the stretch, and so yielding
easily. A rebound follows, which starts along the arteries
the dicrotic wave from the closed semilunar valves. When,
on the other hand, the onward movement of the blood
in the periphery is obstructed, the pressure in the great
vessels cannot reduce itself, the aorta is distended and its
coats are on the stretch, there is little room for the contents
of the ventricle, and the exact converse of the effects above
enumerated will hold. There will, in particular, be little ox
no dicrotic wave. In proportion as the distension id
extreme, the condition obtaining in the arteries will
resemble those which would be present in a system of
inelastic tubes. When, from atheromatous or other senile
changes, the aorta and its primary branches have lost their
elasticity, the resemblance to a system of inelastic tubes in
more complete, and the pulse curve not being modified
resembles that of the ventricle.

Not less important than the action of the heart in its
influence on the circulation of the blood, and even more
important in the modifications it produces in the character
of the pulse, is the resistance in the arterioles and capillaries.
It is by their resistance in front and the force of the heart’s
action behind that the mean pressure in the arterial system is
determined. If theoutflowthrough the capillaries is free, then
no amount of blood which the heart in a normal condition
can pour into the arteries, and no degree of energy with
which this is projected into the aorta, will maintain the
general arterial pressure at a high point. It is possible that
great frequency of the heart’s action, with the discharge of
a full volume of blood by each systole, may pour blood into
the arteries more quickly than it can run off by the
capillaries even when relaxed, in which case the pressure
would rise; but this is a rare occurrence, except for brief
periods in excitement or the early stage of effort. On the
other hand, when the passage through the capillary net¬
work is obstructed, tne blood is dammed back in the
arteries, and the pressure within them is raised, it being
understood al ways that the heart is capable of supplying
the requisite force, which must, of course, be sufficient to
overcome the peripheral obstruction and keep up some
onward movement of the blood, or life would cease. This
average or mean tension present is a most important part
of the knowledge to be obtained from the pulse; ft is
measured by the degree of fulness and resistance in the
artery between the beats; the variations in the character
of the pulse contributing to an accurate estimate of it.

It follows from theoretical considerations which need not
be here discussed, and it is proved both by observation and
experiment, that the higher the constant or mean pressure
in the arteries, the less is the difference between the
maximum and minimum; or, in other words, the more full
and firm the artery is between the beat, the lees marked
will be the pulse, and, vice verttd, the lower the tension and
the more conspicuous the pulsation. The significance, again,
of the constant or mean and the variable or pulsatile
pressure is different. The mean pressure tells most with,
regard to circulation and the circulatory system. The
variable pressure or pulse tells most with regard to the
general state of the individual. These variations in the
pulse, and the way in which they are produced by changes
in the arteries and capillaries, must now be considered.

When the peripheral vessels oppose little resistance to the
passage of the blood through them, the pressure in the
arteries will not only be low, but it will also be variable. It
will rapidly run down in the intervals of the ventricular
systole and rise suddenly with each systole. This would be
the case even were the rapidity of the individual contraction
constant, and uninfluenced by the amount of force to be over-.
come; such, however, i9 not the case, for with diminished
resistance the ventricle expels its contents more rapidly. The
pulse, then, will be more sudden or sharp, and will seem to
be more vehement. The artery at the wrist and elsewhere
will allow itself to be flattened more easily and completely,
as there is little pressure of blood within it to resist the ex-^
ternal pressure; it is then suddenly distended and resumed -
i ts cyl mdricfcl form, repelling the finger and jerking up the
sphygmogrikpbic lever. This effect is all the more marked’
from thefadt that the walla of the artery will be relaxed and
its diaffibier increased.

effect will be produced by peripheral
anfee. •‘-'With a higher mean pressure the variations wtUM

.7 icc ,o a ■

THSflUUCKTi] •

DR. w.: H. BEOAD®ENT ON TAB! 1T5L3B

[M4?uBfl8,aaBrT w

leas, and the rise of pressure, Which constitutes the pulse,
more gradual; this difference being accentuated when the
artery is contracted. But another consequence flows from
the varying resistance in the peripheral arterioles and capil¬
laries. A given, volume of liquid will pass more rapidly
through a large Channel than through a smaller under the
same pressure. When, then, the resistance in the periphery
is weak—which is equivalent to the channel being larger—
the poise will be short; that is, the wave is sudden and soon
over, and, conversely, it will be long whan the resistance is
considerable. It is easy to confound the fulness of the artery
between the beats with a prolonged beat; but, although
these two conditions are often met with together, they are
distinct, and most be kept so in our minds.

The sphygmograph has been invaluable in research; it
has given precision to our ideas, and, in the hands of Marey
and others, has made clear and comprehensible many intri¬
cate and doubtful problems ol the circulation. It is capable^
too, of rendering important aid in clinical investigation,
especially where demonstration and records of changes in
the circulation are required. To me personally thaephygmo-
graph has been of immense service. 1 worked with it
under the eye of Sibson, and shared Anstie’s enthusiasm
with regard to it when he and Professor Burdon Sanderson
took up the instrument with which Marey endowed medical
science. It is not, therefore, from ignorance of or want of
familiarity with the sphygmograph that I have come to the
conclusion that it is not specially useful in. practice—
that in any form known to me it is not a clinical instru¬
ment for every-day, work. It is rarely necessary for diagnosis,
and scarcely ever to be trusted in prognosis. The indica¬
tions obtained from it are not, like those of the thermometer,
independent of the observer. Skill and practice are required
in applying it, judgment is called for in determining tbe
position and pressure which give the best trace, and,
indeed, in deciding whioh of the traces obtainable is the
best representative of the particular pulse; the personal
equation of the observer therefore comes in, and if any
special result is greatly desired, an enthusiastic investigator
can obtain it, and' may Without the least conscious intention
twist facts in the required direction. It is necessary, also,
before a trace can be interpreted with any degree of con¬
fidence, to know what form of sphygmograph has been
employed. Many’s is still, in my opinion, the best, and his
traces appear to me to correspond most closely with traoes
taken' without instrumental multiplication and magnified
by the Isas. English modifications of Marey’s Sphygmograph
often magnify the pulsation too much, and in doing so
introduce exaggerations due to the.rapid movement of the
writing lever. Pond’s and Dudgeon’s instruments are
extremely handy and convenient, but a gratuitous provision
for exaggerations and for extraneous jerks and vibrations
exists in the loose and unmechanical way in which the
motion of the intermediate lever is oommtmicated to the
writing lever and in tbe weight wbieh acts as counterpoise
in the last-named lever.

The pretence, again, to measure the exact pressure
employed in taking the trace, and thereby to obtain corre¬
sponding knowledge of the intra-arterial pressure, is illusory.
To lay nothing of. the varying thickness and resistance of
the skin, which would of itself Vitiate all conclusions of‘
tMa kind in at least three ways—by difference of flexibility,
by affecting the position of the spring, And by varying the
waa of the button or pad actually in contact with, the skin,—
tas rise of the artery would introduce an element of
unootainfcy. Hydraulic pressure is equal at every point of
the eontaining surface, and its foroe is multiplied by increase
tree; the greater surface, therefore^ of a large vessel
weuld (exercise greater lifting power, so that the same blood-
pressure wsuld appear to be higher or lower according to
the (h a m s t er of.the artery. For the same reason buttons
n pads different sue resting on. the vessel would affect
the degree > of. force required in order to eompceee iVas
would, digfaa differences of adjustment. A knife-edge
fwoAgtransvaoely aeroia the vessel eliminates some of these
yy t s fat fafrkad gives a more accurate traoe, but requires
“riknteadjiiiAmerit of the strength of the spring. .The above
wtwaeetsubif tbe pressure exercised :by the spring Wert
KawMpipedareed; hut this is fur from being the'case in
^AfrBy gnmgriph known to me,land graduation by the
""""■Jna iriRaBionly.TSBqjkjyedja is .1 ridiculously : .inexact;

t khriu.that eveay student;ought to he familiar
J^PfWNMRaRigpikhv^aoaharibgaarfrom a stndy of its
TO aa Wfl*tas& tttMsfctitimx sA the 1 pulse in ate thfferint

forms obtainable in no other way, i am of opinion that,
we learn by means of tbe educated Anger all that tha
sphygmograph can teach, and mom. It is invaluable as a
means of educating the sense df touch, and of cultivating!'
the faculty of observation; it ia mdst useful in resolvingr
doubts as to the difference between tbe pulse of the two)
sides in some casee of aneurysm, arid in recording pulses in
the graphic form; but it is not an infallible oonrt of appeal,:
and there are niceties of information which are out of its,
reach. I need only point to the groups of pulse-tracings
exhibited, which are by experts, to show that a sphygmogrom
does not speak for itself, but requires interpretation. 1 Qw
set is a series of normal traces made for me. by the lata-
Dr. Mahomed to illustrate my, lectures at St. Mary’s; the,
other is a copy from Marey’s pulse of aortic regurgitation;

In examining the pulse our object is to obtain the meet:
complete and exact knowledge attainable as to the circular,
tion, and to interpret accurately the facts we observe* and 1
must be the more careful in describing the method to t>©
followed, as I do not propose to refer to the sphygmograph-
The point first noted is the frequency, the number of beats
per minute and the regularity or irregularity of the beat?,,
with regard to time, and their equality or inequality in
force. This ia simple atad easy. We should naturally wish,
in the next place, to estimate the force or strength of the
pulse, but. considerations whioh modify the idea derived
from the impression made on the Angers may first be con¬
veniently discussed. It will be well, therefore, after count¬
ing tbe pulse, to give attention to. the.size of the artery.-
This varies greatly in different individuals, and may differ
in the two wrists of the same person. It varies, again,
greatly according as the muscular coat is relaxed or con¬
tracted. We have, then; to distinguish between congenital
differences in the diameter of the vessels apd variations
induced by physiological or pathological influences. Now a
large artery will communicate a more perceptible im¬
pression to the fingers placed lightly upon it than a small
one, and tbe beat will seem more forcible. On the other
hand, the pulse wave can usually be arrested more readily
by pressure in a large artery, and the pulse is more com¬
pressible ; one mode of examination thus controls or corrects
the other. When the artery is small, end especially when it
is rendered small by contraction of its muscular coat, there
appears to be little pulsation in it, and the pulse may easily
be ret do wn as weak; but let an attempt be made to obliterate
it by compression, and it often seems as if the pulse grew,
stronger As the pressure on the veseeLincreased. , •

An important point to be investigated is the degree of
constant pressure prevailing iu the arteries. The constant
intra-arterial pressure, or pulse tension, is determined first
by rolling tbe artety transversely under the three fingers, or
endeavouring u> do so. In a pulse of average tension, the
vessel only stands out so as to be felt distinctly during the
actual beat, and subsides gradually or rapidly in tha
interval; it cannot, therefore, be rolled by the. Angers, at aU
periods, though it may generally be diatinguished.with car$t
even between the beats, especially when the skin is tmn and
flexible. In a pulse of low tension the vessel can scarcely
be said; to be felt as such at all; it starts up with the beat,
and is at once lost again when the. brief wave has passed,
in a prise of hi gh tension, on the other hand, the artery.
stands <oub among the structures of the wrist lUte another,
tendon,, ami can be rolled like a cord; under, the Angers, and,,
followed often half-way up the forearm.; While the vessel »
tints being rolled about, the pulsation in it may scarcely,
make itself felt, and the artery can often be seen distinctly*
if the skin m .thin, projecting <ra the surface without any
appearance of pulsation; except where it is thrown into
corves. Fran ore, however, brings out the pulsation and
devalopsiits force. ■•••*.'• g

: The character of the beat is another matter for study?
and, brief Asia thn period occupied by, fa, each pulse-wave
presents uprise, dorAtion, and fall, . fa; .strike the finger,
suddenly,or lift ib deliberately t> thedtstenawnof ar tejy
may be momentary Only, or ifc may perefat for v time; the
fall of pressure finally may be abrupt or gradual; T or the
most part, a sudden rise, brief duration, and.abrupt fall go.
together, und constitute the short prise of large arteriea
and low tension; wbilft a gradual rise, persistent frines8,ana

slow decline Are usually associated, and give the fang P<A»e

of contracted arteries And high tension. • Exceptions, how;-
1 eriar, odour; and they Are often, of great significance- There
! maybe aBAVga veSaeiand sudden prise when the,tepawn m
relativ ely high with dilatation of- the left ventricle, and a

N 2

610- Tick Lancet,]

DR. W. H. BROADBENT ON THE PULSE.

[March 26,1887.

small artery, slowly and feebly tilled, in extreme low tension
with cardiac weakness.

We are now prepared to estimate the strength of the poise.
Three fingers are placed on the vessel, as is supposed to be
the case from first to last. With that nearest the hear*',
pressure is made till the wave is arrested, so as not to be felt
by the other fingers, or, if necessary, two fingers are em¬
ployed to extinguish the pulsation. In this way, by the
degree of pressure required, and by varying the pressure
with one, two, or all three fingers, an idea is obtained of the
force with which the heart is propelling the blood onwards.
Account will have been taken already of the size of the
vessel, and the method of noting the tension will have
brought out other points whiph enter into consideration.

I have spoken of the manoeuvre of rolling the vessel
transversely under the fingers as a means of estimating the
pressure and tension by which it is ’maintained in the
cylindrical form. Another manoeuvre by which the state
of the coats of the artery is ascertained is to carry the skin
along it longitudinally with varying pressure; curves in its
course and bulging in its walls are thus detected; in¬
equalities of thickness and density in the coats are felt,
sometimes mere thickening and hardening, at others actual
patches of rigidity and calcareous deposit; or the entire
vessel may be found to have a thick, leathery, inelastic feel,
or may be converted into an irregular, hard, calcareous tube,
or may feel like a string of beads under the finger.

One more question of observation must be taken up—the
recognition or dicrotasm. For this purpose the fingers must
rest as lightly as possible on the vessel, and uniform gentle
pressure must then be made by all three. The dicrotic wave,
when well within physiological limits of variation, will be
felt like an echo of the principal beat, and when well
marked is- extremely distinct. A complete account of the
.pulse then should specify (1) the frequency—that is, the
-number of beats per minute, with a note of any irregularity
or intermission or instability of the rhythm; (2) the size of
the vessel; (8; the degree of distension of the artery
between the beats; <4) the character of the pulsation,
whether its access is sudden or gradual, its duration short
-or long, its subsidence abrupt or slow, note being taken of
dicrotism when present•» (5) the force or strength of both,
the constant and variable pressure within the artery, as
measured by its compressibility; (6) the state of the arterial
walls. How far the description of the pulse usually given,
even in cases in which much turns upon it, falls short of
these requirements it is unnecessary to state.

It is impossible to examine with attention a large number
of pulses, whetheramong the healthy or sick, without being
struck by the extraordinary diversity of frequency, size,
character, tension, and force met with. This diversity pre¬
vails quite independently of disease, in both sexes and at all
ages, especially with regard to diameter of vessel and tension
and force of pulee. If we judged only according to the size
of the blood-channels, together with the pressure within
them, we should be compelled to estimate the amount of
blood flowing through the arterial system as three or four
times as much in some persons as in others. But the amount
of blood actnally put in circulation is determined by the
volume of blood discharged at each systole, and the number
of contractions a minute, and assuming that the ventricles
empty themselves at each contraction, there is no such
difference in the capacity of the ventricle or in the rate
of the heart’s action as would corroborate the above
estimate. Still, taking everything into account, there
-must, when we compare the small, short, compres¬
sible pulse of one man with the large, firm, and long
pulse of another, be great differences in the rate and
energy of the movement of- blood through the capillaries in
different individuals, and clearly there are great differences
in the circulation of the Bame person at different times.
The fact that such differences are compatible with health
and vigour is conclusive evidence that nutrition and
functional efficiency, even of the nerve oentres, are not in
stibh close reflation with and intimate dependence upon the
Hood-supply ae we are sometimes apt to suppose; and
additional 1 evidence,- pointing in the same direction, is
fataiehfed'b^teektolfe cases of valvular disease of the heart,
as, for example; toitral at o a o s U yand Of such functional
defangemeuMi f<*%i*Mplct>£tto4bat i in which the pulse-
rateis eftly' 85 br -40i«*i*atoL hnd .S h are are two beats
of the heart to one ofr U fa k p uhih taririffeUHiR render the
transit of blood through ^thS DMrt stow.- .There must,

to effect, be provision fbr a very large margin of excess

beyond the minimum blood-supply required for the pur¬
poses of the tissues and organs generally. It is a note¬
worthy fact, too, that in acute disease, which is attended
with weakness and wasting, the circulation of the blood is
accelerated, as is indicated by the larger diameter of the
vessels and the increased frequency of the heart’s action.

I have not been able to connect differences in the circula¬
tion with any constant bodily or mental character. A
marked tendency to obesity appears usually to be associated
with small arteries and low tension; and the thin wiry
individual commonly has large arteries, which are con¬
spicuous, not only from the thinness of the skin and absence
of subcutaneous connective tissue, but also because, together
with their size, they are markedly full between the beats.
People with low arterial tension seem to wear out less
quickly, and to furnish most of the examples of longevity;
but they appear to have less power of resistance in acute
disease. These, however, are given as mere impressions.
Speaking generally, I have found physical strength, energy,
and endurance impartially associated with small low tension
pulse, and with large arteries and high tension, and the reverse.
1 can say the same of intellect, perseverance, courage, and
force of character generally; they appear to be absolutely
independent of circulatory conditions. It is, indeed, clear
that the circulation is not the determining influence
in the production of the differences which are found to exist
in respect of bodily or mental energy. The circulation is
the servant, and not the master; and, physiologically, it is
tissue activity which conditions the blood-supply, and not
the blood-supply which conditions the tissue changes. In
disease, again, the modifications of the circulation which are
observed are far more frequently effects than causes, and the
pulse is an index not so much of a more or less rapid move¬
ment of the blood, to be taken into account as a factor in
the morbid processes, as of the state of the nervous system
and of the body generally which has determined its rate and
character.

It would be impossible to discuss systematically all the
indications afforded by the pulse in the course of these
lectures, and it would be most undesirable to attempt it.
Many of them do not depend npon a comprehension of the
circulatory conditions which the varieties of pulse denote, 6r,
indeed, upon a knowledge of the circulation at all. Observant
physicians before the time of Han ey could gauge thoroughly
the state of the patient in fever from the pulse, and it is not
for the purpose of estimating the movement of the blood
that we ourselves in a case of fever count the beats and
note their force and volume. We calculate from the data
thus obtained the strength of the sufferer and the effect
upon him of the disease; and we might or might not do this
more accurately than our predecessors. On the other band,
it is only through a knowledge of the conditions which
govern the circulation that such facts as the connexion
between kidney disease and cerebral haemorrhage can be
understood, and that the prognostic significance of the hard
pulse which betrays this connexion can be appreciated. The
ordinary diagnostic and prognostic indications of the pulse,
then, which are learnt only by experience, and which would
gain nothing by exposition in lectures, will not be con¬
sidered, and I shall take up only such points with regard to
the pulse as illustrate either effects of circulatory derange¬
ments or advances in our knowledge obtained by the more
profound investigations of recent years.

I propose, then, to consider, first, deviations from normal
frequency and abnormalities of the rhythm, which 1 hope
to dispose of in this lecture; next-, variations of tension,
their causes and consequences, and the indications for treat¬
ment which they furnish—these, with perhaps the pulse of
heart disease, will occupy the second lecture; the subject of
the third will be the pulse and cerebral affections.

Frequency .-*-The rate of the heart’s action, with which the
frequency of the pulse corresponds, is governed by various
influences. Resistance to the onward current of blood in
the arteries, or, in other words, increase o£ ptoo*ore in the
arterial system, whether produced by compression of large
vessels, such as the femorals and brachials, or by obstruction
in the arterioles and capillaries, tends to slow the action of
the heart and render the pulse less frequent, and, oonveraely.
d iminis hed resistance or lowered tension accelerates the
heart and pulse rate. But more direct and powerful than
these varieties of the arterial pressure, and entirely over¬
ruling their tendency, are nezvous influences, of which the
channels are the pneumogastrio and sympathetic nerves.
It is not my intention to enter at all upon a discussion or

The Lancet,]

DR. W. H. BROADBENT ON THE PULSE.

[Mabch 26,188T. 611

explanation of the respective action of these nerves; this
would help us very Lttle clinically, and knowledge with
regard to them has not yet reached a perfectly stable con¬
dition. The question, too, is rendered complex by the fact
that nervous influences reach the arterioles and capillaries as
well as the heart, and modify the outflow of blood and the
arterial tension; and an effect upon the heart, apparently
direct, may be brought about indirectly through variations
in the degree or resistance in the circulation. Almost all
departures from a normal state of health are attended by
increased frequency of the pulse, and it would serve no
useful purpose to enumerate and attempt to classify the
causes of pulse frequency, while its prognostic indications
are so varied and delicate that they would elude description.
They are, besides, among those matters of experience which
are independent of scientific investigation, and are excluded
under the rule which I have taken for my guidanoe. There
are, however, cases in which frequency of the pulse, or rather
of the heart’s action, constitutes in itself the disease, or if
not actually the disease, yet at least a source of danger and
suffering. Such frequency is one form of palpitation of the
heart. The fugitive attacks of hurried and violent action of
the heart, induced by indigestion or emotion or over¬
exertion, need not occupy our attention; and I shall not do
more than allude to the persistent frequency of the pulse in
Graves’ disease, or in hysterical conditions, or associated with
aortic pulsation.

Persistent frequency of pulse .—Persistent frequency of
pulse is one of the consequences of over-strain of the heart
by exertion. It is met with in young men who have over¬
taxed their powers in rowing, training for races, or heavy
gun drill, and was observed on a large scale in the American
war. The name “ irritable heart ” employed as a descriptive
term may very well be accepted. Besides the beating of
the heart of which the patient is conscious, there are breath¬
lessness on exertion, nervousness, depression of spirits and
anxiety, sensations of faintness, sleeplessness, and incapacity
for sustained exertion. In all the cases of this kind which
I have seen, the pulse tension has been high. The great
remedy for this condition is rest, and from one fco three weeks
iu bed, however irksome and wearisome at this period of life,
may be well spent in allowing the heart to settle down.
During and after middle age, persistent frequency of pulse
may be induced by a single act of excessive exertion, such
as running to catch a train. The effects upon the heart of
such an imprudence vary ; there may be dilatation of the
heart, with or without insufficiency of the mitral valve,
or a valve may be actually damaged, or the action of the
heart may become irregular; but, besides these, it may become
hurried without irregularity, and the frequency may persist
till the strength of the patient is worn out. Here, again, the
arterial tension is, according to my experience, high, spasm
of the peripheral vessels contributing to the effect, so that
the distension of the arteries is not simply the result of
blood being driven into the arterial system in consequence
of the increased frequency of the heart’s contractions. No
satisfactory explanation has been given of these cases, and
1 have none to offer. Perhaps the most plausible is that
the plex of minute nerve-ganglia and network of fibres so
copiously distributed beneath the endocardium may have
heen stretched and rendered unduly irritable.

Paroxysmal palpitation.—It is late in life that paroxysmal
palpitation with frequency of pulse is most commonly a
pause of suffering and danger, shortening life and render-
it miserable. It may complicate heart disease of any
«nd, and may possibly sometimes be one of the conse¬
quences of the disease, but it may occur independently of
▼alvular affection or of any structural change sufficiently
advanced for recognition, and it has seemed to me that
disease of the heart is present the palpitation is often
™her a complication than a consequence. The exoiting
e *®*e may be indigestion and flatulence, or the mere act of
“hmg food, lying down, emotion, apprehension of an attack
at a particular hour or nnder given circumstances associated
ym f ormer attacks; but, whatever this may be, the onset
W the paroxysm is frequently accompanied by a sudden
Sation of the arteries, and the palpitation seems to re-
•BMble the e\cit<;d action of the heart set up by nitrite of
Bitro-glycerine. Resistance to which it is habituated

* suddenly removed, and the heart starts off like the engine
waloooBi .gyp when the wheels fail to bite the rails. Inthe
yrtfl of a prolonged attendance upon a medical man ad-
. T aam d m•years and long subject to gout, who suffered greatly
aTKa P^pitatioa,this occurred more than once; when my

hand was on the pulse the artery became large and soft,
there wa9 a flutter of the heart, which then bounded off. A
remarkable complication occurred in this case which is
worthy of being related. Early one morning the patient
began to bring up bloody fluid from the lungs, and In the
couree of twenty-four hours expectorated several pints of
it. A pink froth covered the bright-red liquid to the depth
of half an inch, and the whole looked very much like the
boiling red-currant juice in the process or making jelly.
There was no rise of temperature, the flux of blood-stained
serum gradually ceased, and palpitation did not recur for
several months, when, after imprudent fatigue and exposure,
it returned, and ultimately wore out the patient. It should
be added that there was no valvular disease, and only
moderate dilatation and hypertrophy with old-standing
high arterial tension.

There still remains for notice the extraordinary rapid
action of the heart, which can only be referred to some
neurotic condition, lasting for days or weeks or months, of
which numerous examples are on record. One of the most
remarkable is that recently brought before the Neurological
Society by Dr. Bristowe, to whom I am indebted for the
following particulars: The patient was nineteen years of
.age, and there was reason to think that the affection dated
from the age of eight, the attacks of rapid action of the
heart recurring from time to time. When he entered St.
Thomas’s Hospital, he was suffering from anasarca and pulmo¬
nary apoplexy, which had supervened in the course of an
attack wnich had lasted some months^ The pulse varied,
but often numbered 200 or 240. Under the influence of iron
and digitalis, the action of the heart quieteddown to about
the normal, but was easily excited, and during one visit to
the hospital the beats were counted at the rate of 304 or 308
a minute. He had resumed work as a draper’s assistant,
and on Feb. 26th was at work till midnight. Next morning
he did not seem much the worse for it, but at midday, while
playing the piano, he suddenly stopped and fell down dead.
The heart was somewhat enlarged and dilated, but the valves
were normal, and no other disease was discovered.

For particulars of another interesting case, with post¬
mortem examination, I am indebted to Dr. Dreschfeld and
Dr. R. Maguire. The patient, a labourer, aged thirty-six,
who had had syphilis and had been a heavy drinker, had
suffered, when first seen in October, 1883, from attacks of
palpitation for twelve months, which came on suddenly
after a heavy supper, and were attended with vomiting,
and usually lasted from fourteen to twenty days. The pulse
rate was found to be from 215 to 230. No cardiac or other
disease was discoverable. He improved under digitalis, the
pulse falling rapidly to 86. He was again seen in December,
1883, and March, 1884, with relapse of palpitation and a pulse
of from 200 to 215. On this last occasion, while under treat¬
ment by convallarin, he died in an attack of convulsions.
The heart was large, and its structure presented degenerative -
changes, but nothing was found which could explain the
rapia heart action.

Several cases have come nnder my observation in hospital
or in consultation of which the course and sequel have not
been known to me. In one seen with Mr. Stanley Smith
in the course of last year, the patient, a lady aged sixty-four,
died after seventeen days’ illness, during which the pulse
ranged from 150 to 200, the heart being apparently word
out. In one case 1 saw the patient, a lady or about forty-
five, almost daily for about three weeks. The pulse was
never under 200, usually 240, and there was every reason to
believe that the heart was beating at the same rate during
the whole of the time. The artery was small, full between,
tbe bests, not easily compressible, and the pulsation felt
more like a vibration than a beat, and gave the impression
of there being little or no onward propulsion of the blood.
The heart srmnda were short and equi-distant, and reminded
me of the puffing of a distant locomotive. There was uo
opportunity of examining the pulse or heart during sleep,
but the sleep was broken, and the feelings attendant on the
palpitation were always present. This was a second attack
after an interval of some years. I saw her iu the tirsjy
which lasted about five days, and left her looking old ana
worn. She survived the second for at least two years,
since which time I have not heard of her. . _

Another case was brought to me by Dr.Sid<j&n!il!>e,' ift
1886. The patient, a gentleman aged fifty-six, was stout,
and had a good colour, had lived freely in all respects, and
worked hard. He had been suffering from palpitation night
and day for three weeks, sleeping for two hours only, nn-i

[March 26,1887.

612 Thb Lancet,] DR. D. MACALISTER ON THE NATURE OF FEVER.

(Mstmtiait futures

OX THE

then restless all night. The pulse was 160, and had the cha¬
racter described in the last case. [A trace was here shown.]
There was a reduplication of the second sound of the heart,
best heard near the apex. The liver and spleen were large.
Three weeks later the patient still looked extremely well, and
his appetite was good, but he was subject to feelings of suffo¬
cation, during which he flushed, and his eyes had an expres¬
sion of distress; these were brought on by very slight
exertion or by stooping. He refused to consider himself an
invalid, and went about much as usual. He could lie in any
position, but when on his left side required a pillow under
the side. He usually slept till 3 a.m., and then woke up
suddenly. The palpitation had never ceased; the pulse was
always 1 160; the heart was not much enlarged, the sounds
equi-distant, the aortic second having a ringing note at the
right second space; slight jugular pulsation was visible on the
right side, and the liver was large; crepitation was heard in
both lungs posteriorly, as high as the angle of the scapula.
In June, when seen again, the palpitation continued, having
lasted now three months. He had been out of town, and looked
as well as ever, but evidences of stasis in the circulation
had made their appearance, the legs had suddenly swollen,
he could not lie down, and the liver was extremely large.
The pulse was still ICO : the heart beats as before, equi¬
distant. Various lines of treatment had been tried without
effect, and digitalis seemed to do harm. I have not seen the
patient since, but I learn from Dr. Seccombe that he con¬
tinued to suffer very much until November, when improve¬
ment began, and the patient was recently said to be so
much better as to wish to resume his official duties. A
later account, however, describes him as having had an
attack of hemiplegia. This rapid action of the heart is, so
far as I know, unexplained, except by referring it to some
obscure neurotic influence. It is met with almost at all
ages (Dr. Bristowe’s patient appears to have been subject
to it from the age of eight, and died of it at nineteen, and I
have seen it in a child of ten), although it is more common
after middle life than before; usually there is some apparent
exciting cause, such as would put stress upon the heart;
overwork and anxiety are the most common, but the pre¬
disposition, which is of more consequence, eludes us;
sooner or later sudden death is the result.

It is interesting to speculate on the condition of the cir¬
culation. Clearly it is not accelerated, and the dropsy in
Dr. Bristowe’s and Dr. Seccombe’s cases show that the ten¬
dency is to stasis. The pulse, too, gives one the idea of
vibratory alternations of pressure with little onward move¬
ment. The question then arises. What is the condition of
the left ventricle ? Either it does not All in diastole, of it
fails to empty itself on systole. It maybe that in some
cases it is contracted, and refuses to dilate to receive blood
from the auricle, and that in others it is in a state of over-
distension; but it seems to me that the former is the more
probable condition. I have usually found the heart of
normal size, whereas persistent distension would sooner or
later give rise to dilatation. Again, the cardiac impulse is
often extremely powerful — I have seen the stethoscope
lifted through a woman’s stays - and this is inconsistent with
over-distension. It might be asked, again, whether the
peripheral arterioles and capillaries played any part in the
phenomenon, or the pulmonary circulation? These are
questions which I am unable to answer, and it is a satisfac¬
tion to me to know that the subject is engaging the atten¬
tion of Dr. Bristowe.

A Cremation Congress.— It is intended to hold an
International Congress on Cremation in September of the

S resent year, the place selected for the gathering being
Man. French will be the official language, but the speakers
may, if they like, make use of any other language. Reports
will be submitted as to the progress made in the practice of
cremation in different countries, and the formation of an
international league will be proposed. An exhibition of
models of crematories, urns, and other objects connected
with the campaign now being conducted against the present
methods of disposing of the dead will be open during the
congress.

Mr. T. M'Lean has already opened his spring
exhibition of oil paintings in the Haymarket. The collec¬
tion is of the usual cosmopolitan character, and contains
some sixty pictures, of which a “ Foraging Party” of wild
boars by Rosa Bonheur and Sir Jonn Millais' " Fern
Gatherer’ will probably command most attention.

NATURE OF FEVER.

Delivered at the Royal College of Physicians,

By D. MAOALISTER, M.A., M.D., F.RO.P.,

PHYSICIAN TO ADDBNBROOKK’S HOSPITAL, LECTURKR IX XKDIOIXX AT
THB UXlVUHSlTr OF cambridob.

LECTURE III.

Mr. President and Gentlemen,— In the last lecture I
gave at some length my reasons for believing that the
thermogenie function of the skeletal muscles, the chief
sources of heat in health and in disease, is dependent on
their innervation. I spoke of this innervation as twofold,
corresponding to the motor and inhibitory innervation of
the vascular and visceral muscles and of the heart. From
the point of view of the chemical changes which take place
in tliermogenesis, I spoke of the nerves concerned as respec¬
tively catabolic and anabolic. The latter nerves were in¬
hibitory of heat production, inasmuch as their influence is
towards the upbuilding of the hypothetical “ thermogen ”
and the simultaneous absorption of energy. The former
were excitors of heat production inasmuch as they induce
destructive metabolism with oxidation and the liberation
of energy. Briefly this view of thermogenesis was suggested
(1) by ttie chemical fact that in the normal thermogenic, as
in the normal contractile, metabolism of muscle there is no
adequate evidence of increased nitrogenous waste, but only
of the absorption of oxygen and the liberation of carbonic
aeid and water; the nitrogenous molecule of the muscle
substance must be continuously upbuilt again ae it is
continuously being unbuilt, anabolism going band in
hand with catabolism; and (2) by the cardinal physio¬
logical doctrine taught us by Dr. Gaskell, that catabolism
or disintegration is the symptom of “motor” or “excitor”
nervous aotion, and anabolism or restoration of “ inhibitory ”
nervous action. The physiological doctrine was, you will
remember, strongly supported by the phenomena presented
by the heart muscle and its double nerve-supply through
the sympathetic and the vagus; it was rendered probable
in the case of the visceral and vascular involuntary muscles,
and on analogical and other grounds inferred in the case
of the voluntary muscles and the secreting glands.

Another line of analogical reasoning to which you may or
may not be inclined to give weight suggested that, as the
nervous mechanisms of heat loss—namely, those subserving
circulation and respiration—had a twofold character, ana
were maintained in balance by the joint action of opposing
influences, respectively motor and inhibitory, so too the
nervons mechanism of heat production was twofold, and in
health maintained a “ thermogenic tonus,” a balance between
tendencies towards the liberation of thermal energy on the
one hand and its repression or absorption on-fche other.

I have to confess that we know little or nothing as yet
of the anatomical course of the thermal nervee of the
muscles. The motor tranks would appear to contain the
thermogenic fibres—if, indeed, they are not identical with
the motor fibres. But as to the course of the anabolic fibres
we can only conjecture, and the analogies which we hare to
guide us are too obscure for me to dwell on here. This
ignorance would be more depressing if we held to the
notion that anatomy had fulfilled its task and explored ex¬
haustively the whole field of the peripheral nervous system.
But when I remember that it is only since the other day
that the physiological, anatomical, and morpholbgical rela¬
tions of the so-called sympathetic system to the spinal
nerves have been at all clearly understood, I do not deepair
of further great discoveries. In my own opinion the work
of anatomy, guided by the light of physiological research, is
in this domain scarcely even begun. When it is complete
I have little doubt that the relations, anatomical and
morphological, of the anabolic nerves to tbe central system
will appear as definite as those of the motor nerves.

I proceed to consider some of the attempts that have been
made to trace the thermal nerves into and through the
central nervous system, I do not for a moment profess to

Thb Lanobt,]

DB. D. MACALISTEE Off THE' 3TATUBE OF FBVHR.

[March 26,1887. 613

give a complete summary of all that has been done, even in
recent times, to investigate the relations of the cerebro¬
spinal system to thermogenesis. A very large number of
these researches are to my mind vitiated, in that they are
merely thermometrical. Without calorimetry, or—what in
a sense we may regard as equivalent—the measurement of
the oxidative or other destructive metabolism accompany¬
ing experimental lesions of the nervous centres, we can infer
little that is certain as to the mechanism of heat production.
The concurrent effects of the processes of heat loss are not
easily to be eliminated or allowed for, and the results thus
complicated are at best ambiguous.

To take a familiar example: it lias been known from the
time of Sir Benjamin Brodie that section of the spinal cord
is in some cases followed by a surprising rise of the body
temperature. In other instances the temperature falls; and
some observers have found that according as the animal is
exposed to a warmer or cooler medium, according as it is
wrapped up or naked, its temperature will ultimately rise
high or sink low. Wood has shown how these incon¬
sistencies may be reconciled by measuring the actual heat
produced by an animal before and after section. As the
result of many rigorous experiments, he is able to state as
demonstrated, that “sectiqn of the spinal cord above the
origin of the splanchnic nerves is usually followed by an
immediate very decided increase in the amount of heat
dissipated from the body, and also by a decided lessening of
the amount of heat produced.” The vaso-motor tracts being
■divided in these experiments, it is certain that vaso-motor
paralysis has a great deal to do with the increased loss of
heat, while the paralysed muscles, being cut off from their
regulating nerve-supply, are apt to have their thermogenesis
increased or diminished by the high or low temperature of
the surrounding medium, much as when they are poisoned
with curare. The temperatui-e of the body is thus the result¬
ant of a number of diverse thermal tendencies; and as one
or the other is in the ascendant the temperature rises or falls.
Successively higher and higher sections of the cord at length
carry us to a level above the highest or dominating vaso¬
motor centre in the medulla, and not till then do we get results
that are fairly uniform and intelligible. If the medulla
is partially divided close to its junction with the pons, the
vaso-motor mechanism appears to^remain intact; at any rate,
the usual physiological test of its integrity—marked rise of
blood-pressure when a sensory nerve is stimulated—is
readily obtained. The operation itself is not easy, but when
it is successfully performed the thermal consequences are
remarkable. I attach little importance to the alleged results
of Tschetschichin, now twenty years old, or to the alleged
failure of others since to confirm them. Both the discoverer
and his critics seem to have tested merely the temperature
•of the animals operated on; and this varies according to
circumstances. But when we come to measure the thermo-
genesis the case is different. In the dog at least there is
'enerally a rise of temperature; but whether this happens
or not, the rate of heat production is invariably augmented.
Heat loss is also increased, but it seldom keeps pace with
the heat production. Moreover, the increased heat pro¬
duction is not simply transient, it goes on for a long time,
and in some instances is greater twenty-four hours after
operation than it is at first.. Again, when the same region—
namely, the part of the medulla which immediately adjoins
the pons—is mechanically irritated by a puncture, in several
mstances a marked temporary fall in the rate of heat pro-
iuction has been observed (Wood), though in others electrical
stimulation of the part is said to have been followed by a
prompt rise of temperature at least.

These experiments certainly suggest the hypothesis that
the region in question is traversed by some of the anabolic
or inhibitory fibres. Severance of them is followed by a
disturbance of the balance I have called thermogenic tonus;
the inhibitory influence being out off, the excitor influence
has full sway. Irritation of the same tract is followed by
a temporary diminution of thermogenesis, just as irritation
of the vagus tract is followed by a temporary diminution of
the contractile activity of the heart. I have scrutinised the
tabulated results of the published experiments to see
whether there were any traces of an increased vigour of
the thermogenic function following the temporary diminu¬
tion, such as might be expected to result from the stimula¬
tion of an anabolic nerve, and such as we find to follow the
vagus inhibition of the heart (see Lecture II.). The figures
are unfortunately insufficient for the purpose, with one
exception, given in Wood’s series. In this case puncture of

the pons-medulla at first lessened the heat production by no
less than two-thirds. But in twenty-four hours, in spite
of the exhaustion of the animal, in spite too of its
prolonged abstinence from food, the rate of heat pro¬
duction increased again to within one-fifth of the normal
rate. This at least suggests considerable vigour in the
thermogenic function, and it may be an instance of improve¬
ment following iahibition.

Professor Wood has gone further in his attempts to trace
upwards .the inhibitory tract. He has sought, following
Eulenburg and Landois, to determine the influence of
certain cortical and subcortical lesions upon thermogenesis.
His methods for producing the experimental lesions are no
doubt less refined and precise thjm those to which the
classical researches of Dr. Ferrier have accustomed us. But
his results, extending to some twenty laborious experi¬
ments, are so uniform and so striking that, if we accept his
statement of them at all, it is difficult to resist the con¬
clusion that severe injury of certain regions in the cortex or
beneath it is, in the dog at least, followed not merely by
rise of temperature—that is of secondary importance—but
by increased production of heat. The cortical area is just
posterior to the crucial sulcus, and corresponds in
Hitzig’s and Ferrier’s scheme to the motor region for
the muscular masses of the limbs. The experiments
in which stimulation rather than destructive injury of this
region was attempted are neither numerous nor altogether
satisfactory, but so far as they go they agree with the
older experiments of Eulenburg and Landois, in which local
electrical stimulation of one of the areas was followed by
a slight temporary cooling of the opposite extremities.
Dr. Ferrier, in the last edition of his great work,' regards
this as duo to contraction of the bloodvessels, and the long
enduring and considerable increase of heat production
which follows destruction of the areas as due to dilatation
of the vessels. Changes in the distribution of temperature
may, and do, result from changes in the vascularity of the
tissues; but I know of nothing that justifies us in straight¬
way assuming that such changes affect thermogenesis. The
mere Hushing of a muscle with blood need not increase the
metabolism of the muscle substance, unless the latter is
simultaneously stimulated to functional activity, unless it
is moved ab extra to take advantage of the opportunities
for assimilation which are offered to it. Cut off the innerva¬
tion of a muscle by curare, and you may cause the arterial
blood torush through its vessels without appreciably increas¬
ing its oxidative metabolism. For this reason, in addition
to those given by Professor Wood, I am unable to correlate
the thermogenic phenomena resulting from destruction or
stimulation of the cortex with vaso-motor changes: I say
nothing for the present of the thermometric phenomena. So
far, then, it would appear that there is experimental evidence
that the tract containing the nerve fibres inhibitory of the
thermogenic function of the muscles runs through the
medulla into the pons; there is, moreover, experimental
evidence that, in the dog at least, a cortical or subcortical
region coinciding in part with the motor region is concerned
with thermogeneais, and is probably in connexion with the
inhibitory tract.

Allow me next to call your attention to an interesting
series of experiments by Messrs. Aronsolin and Sachs of
Berlin. They are thermometric, not calorimetric, and there¬
fore at first sight bear on temperature rather than thermo¬
genesis ; but as simultaneous measurements wers made of
the oxygen consumed and the carbonic acid disc larged, we
are able to draw from them certain conclusions of interest
as regards febrile heat. Some of the striking phenomena in
question were shown to a number of the visitors to the
Berlin Medical Congress in 188.">.

When a puncture with a fine needle is made through the
brain of a rabbit in such wise as to pass vertically through
the medial side of the corpus striatum near tne nodus
cursorius of Nothnagel, the temperature in the muscles and
in the rectum promptly rises from 1£° to 2£° C., or say 2£
to 4.f F., and remains high for many hours, returning
ultimately to the normal again. The animal appears to be
but little affected by the operation, and eats and moves
about gaily. It need not be tied up or confined in any
way, and the temperature of the room may be ordinary.
But the result seems invariably to follow, and it can be
reproduced again and again in the same animal. It is not
due to irritation or injury of the cortex or of the white

i Functions of the Brain, ed. 1886, pp. 87, 253,

614 ThbLancbt,]

DE. D. MAOALISTER ON THE NATURE OP FEVER.

[Maboh 26,1887.

matter immediately underlying it, for superficial or shallow
punctures are without effect. The sensitive region is of no
great extent, and can be defined with considerable precision.
The question that always rises in experiments of the kind
rises here also: Is the result due to stimulation or to destruc¬
tion of the nervous elements that are punctured? Our
experimenters’ have apparently answered this question
in a satisfactory way. By a highly ingenious method
they succeeded in passing a weak electric current through
the sensitive region, and that without exciting any of
the neighbouring parts. The result was striking. The
temperature in the muscles rose with every passage of the
current, and could at will be kept at a febrile height for
many hours together. The rise of temperature appeared
thus to be unmistakabfy due to stimulation, and not to
injury. And here remark that the febrile condition could
hardly be due to any contraction of the cutaneous vessels,
to any retention of heat, for it was observed that the
temperatures of the skin, the muscles, and the rectum rose
and fell together. Moreover, when means were provided
for estimating the oxygen consumed and the carbonic acid
given off, they were found to be increased during the
artificial fever to about the same extent as in ordinary fever
of like intensity, and the nitrogen excreted in the twenty-
four hours after the puncture was something like 25 percent,
greater than in the twenty-four hours before the puncture.
From all these facts the conclusion is hardly to be
resisted—that by the stimulation of a particular region to
the inner side of the corpus striatum the thermogenic
function of the muscles is abnormally increased, and there¬
with their catabolic or oxidative metabolism; and this,
without encroaching on the motor tract, without exciting
the motor function, and without any action that can fairly
be called vaso-metor, coming into play. I am not going to
say that the circumscribed region of the brain so carefully
explored by Messrs. Aronsohn and Sachs is a thermogenic
“centre,” for 1 know that by some pathologists the word is
banned. But I do say that, if the evidence is worth any¬
thing, it proves that the region is connected intimately with
the thermogenic tract; tbat the catabolic fibres which
proceed to the muscles and in them excite the thermogenic
function, are here capable of being reached and stimulated
apart from the motor nerves. It is this fact which makes
oue hesitate at once to say that the thermogenic fibres to
the muscles are identical with the motor fibres. It is not
easy to see how they can dichotomise again at their central
terminations, the motor running through the internal
capsule, the thermogenic quite to the inner side of the corpus
striatum.

There is another aspect in which we may view these
experiments. During the period in which the sensitive spot
is being at intervals electrically stimulated, the animal’s
temperature is markedly raised, its rate of heat production
is apparently increased, it is consuming more oxygen and
giving off more carbonic acid than is normal; by all the
signs of disordered body heat, by all the symptoms which
imply pyrexia, the animal is in a state of fever. When the
stimulation ceases the fever subsides. In other words, by
exciting to excessive action a particular spot within the
brain, we can bring about a fever of moderate intensity in¬
distinguishable while it lasts from any other produced in
more familiar ways. We have generated a fever by a direct
action on the central nervous system.

Before I proceed to suggest to you my own belief that all
fever is due to an action on the central nervous system, I
must anticipate a possible misunderstanding. I have more
than once remarked, in passing, on the distinction between
high temperature and increased heat-production. It is due
to you, and necessary to my remaining arguments, that I
should make clear wherein the distinction is of importance.
In my first lecture I spoke of disorder of the body heat as
the essential condition of fever, whose frequent and most
manifest symptom is high temperature. But I now go
further, and say that high temperature is not necessarily
fever, and that fever is not necessarily accompanied by high
temperature. We may have a febria fine febre , a morbid
thermogenesis without high temperature, the increased heat-
production being compensated or more than compensated
by increased heat loss. And we may have a rise of
temperature even with diminished thermogenesis, if the
heat loss is so diminished as no longer to balance even
the diminished production. The former would be fever,
though the patient were cool; the latter would not be
fever, evea though the patient were hot. It is the exces¬

sive thermogenesis, with the excessive catabolism of
nitrogenous tissue which that involves, that constitute-
fever. Without this condition the mere temperature may
run for a time to a “paradoxical” height, to a point at
which we might expect the albumens of the body to
coagulate; and yet the patient may recover, and promptly
too, for there has been no excessive combustion, no con¬
suming of the tiesues. Consider op how slight a dislocation
of the normal relation of gain to loss a marked rise of tem¬
perature may depend. An adult man in ordinary health
breeds enough heat in half an hour to raise his own
temperature one degree Centigrade. In half an hour he dis¬
charges an equal amount of heat into the air, and so his
temperature is not raised. B ut suppose for a moment that all
automatic connexion between the two processes were broken
for the space of an hour, that the two could work indepen¬
dently of each other and of the temperature. Suppose
further that the heat loss were somehow checked entirely
for the hour and then restored to its normal rate. The heat-
production need not alter a jot, but it would all go to raise
the temperature: at the end of the hour the temperature
would be higher by 2° C. or 3 6° F. Open now the channels
of heat loss: they will carry off at the old rate, and the
temperature will rise no further; but it will now remain
permanently at 102° F. This rise of temperature haa
been produced, not by any increase of thermogeneeis,
not by any ultimate diminution of heat loss, but simply
by a little “lagging” of the latter process behind tb»

former. The two have become balanced again, but the-
temperature does not fall unless the loss goes beyond the
balancing point. And what is thus true of lagging in time is
obviously true of lagging in degree. If the heat loss is not
in abeyance, but merely a little less than the heat gain, the
temperature will rise until it reaches a point at which the
two are balanced agaiD, and will remain there if the balance
once obtained is maintained. In other words, the difference
between the rate of heat production and the rate of heat,
loss at any moment is measured not by the temperature, but
by the gradient of the temperature. The temperature itself,
when it reaches its height, indicates the time it has taken
for the one process to gain upon and at length overtake the
other, but tells nothing as to the absolute activity of either-
High temperature may thus be an indication of mere
sluggishness or lagging, and is not per se an indication of
increased heat or of increased combustion.

I have imagined that a working model might be arranged
to illustrate this plain but constantly overlooked fact. (See
woodcut.) Suppose a tall vessel containing water: the level
of the water shall represent temperature. Let two pipes be
connected with the vessel, the one bringing water to it, the
other carrying it off. Let each be provided with a stopcock,
and let the two stopcocks be connected by a rigid link which
ensures that they always turn together and by the same
amount. If, to start with, the inflow and outflow are equal,
then, however I move the linked stopcocks, the height of the
water will remain the same. Loss balances gain in every

Digitized by GoOgle

Thu Lancbt,]

DR. D. MAC ALIBTER ON THE NATURE OP PEVER.

[Maach 26,1887. 61

ition. Now remove the link and connect the stopcocks
by a weak indiarubbcr band or a spiral spring. If i now
move the inflow stopcock so as to increase the flow, the
outflow one will not at once follow, and, the balance being
broken, the level of the water will rise. Presently, as the
elasticity of the spring comes into play, the outflow will
become equal to the inflow, and the rise will cease ; but the
new high level will be maintained. Every movement
of either stopcock will affect the level, which will fluctuate
accordingly, but its height at any moment will not be an
index of the amount of inflow at that moment. The
inflow may be slight while the level is high. Of course
inflow represents heat production, outflow heat loss, and the
rigid link which first connected the two stopcocks the
healthy thermotaxic mechanism. When this latter is weak¬
ened, or relaxed, or broken, the steadiness of the normal
level is impossible. The fact that in fever, after the thermo¬
taxic mechanism is disorganised, the temperature so fre¬
quently rises, shows that the next step in the process is
usually excessive thermogenesis; and the fact that the
temperature does not rise indefinitely shows that the
mechanism of heat lftss is less disordered or only transiently
disordered, for though at first it lags behind the heat pro¬
duction, it ultimately overtakes it or overpasses it.

There is thus a certain order of progression observed in
the disturbance of the thermal relations of the body. First
and most easily disturbed is the thermotaxic nervous
mechanism. If that is all that is disturbed, we shall have
strange risings and fallings of temperature as the inde¬
pendent variations of production and loss are concurrent or
the reverse, but there need be no fever. The balanced
rhythm of anabolism and catabolism in the muscles is not
disturbed; there is no excessive oxidation and no excessive
inhibition. And the balanced rhythm of the respiration
and the cutaneous circulation is also maintained, and with
it the process of beat loss, but the latter need never
be very excessive or very deficient. All that happens is
that the two rhythms do not harmonise, and the fluctua¬
tions of the temperature correspond in a measure to the
“beats” which are heard when two tones are sounded
together that are nearly but not quite in concord. Oases
of this thermal ataxia are not wanting; one such was
under my charge for a time when acting for Dr. Paget
at Addenbrooke's Hospital. He has described it in Thk
Lancet of July 4th, 1885. The patient was para¬
plegic, with at times a remarkably unstable temperature,
for instance, on one day, when there was a trifling
irregularity of the bowels, it ran up to 109’2° F., the pulse
being at 80 and the respiration at 22; in three-quarters of
an hour it was down to 97 8°. On another day it reached
110 - 4°, and in half an hour fell to 98 8° again. But there
was no evidence of increased thermogenesis, no wasting, no
failure of nutrition. Many similar “ paradoxical” fluctua¬
tions of temperature, without fever, have been described.

The next, degree of disturbance is that in which there is
not only thermal ataxia, but disorder of the parts of the
nervous system subserving heat production: there is under¬
action of the anabolic nerves with diminished construction
and diminished absorption of energy; there is over-action of
tha catabolic nerves with increased oxidation and thermo-
genesis. Both factors of the normal thermogenic tonus
are probably disordered together, but as I believe
there is good reason for regarding the anabolic mechanism
is “higher” than the catabolic, so there is reason for the
view that it is in many cases the first and the most dis¬
ordered. Weakening or abolition of the inhibitory influences
with defective upbuilding of the “thermogenic stuff” in
the muscles probably precedes excessive catabolic action,
and to this may be due the pre-febrile discharge of urea
which is occasionally observed. But soon the other factor
of the thermogenic mechanism is disordered also, and
there is excessive heat production. The net result is
apparent wasting or “combustion,” and generally high
temperature. The thermotaxic mechanism is in abeyance;
the immediate adjustment of heat loss to heat production
is consequently hindered, the thermogenic mechanism gets
a start, as it were, before the heat-discharging mechanism
is called into play. Once the temperature is somewhat
raised, the latter mechanism, if it is not itself disordered, is
■capable of increased activity and presently overtakes the
work thrown upon it. But the " lagging ” of the one process
behind the other finds expression in the heightened tempera¬
ture. This is ordinary pyrexia, and the nervous disorder
does not in general go further. But there is another stage—

namely, when the mechanism of heat loss is also profoundly
disordered, so that the rise of temperature from the ante¬
cedent excessive thermogenesis does not stimulate it (or
does not stimulate it enough) to moke it overtake the latter
until the temperature reaches an excessive or even a fatal
height. This is hyperpyrexia.

To resume. The thermal nervous system has three parts;
let us call them briefly the thermotaxic or adjusting, the
thermogenic or producing, and the thermolytic or dis¬
charging mechanism. Disorder of the first implies irregu¬
larity of temperature only; disorder of the first and second
implies, in general, heightened temperature and increased
body heat—that is, ordinary fever; disorder of the first,
second, and third implies, in general, hyperpyrexia, dan¬
gerous increase of heat, and steadily rising temperature. In
the ascending scale of evolution we seem to rise from the
thermolytic to the thermogenic and then to the thermotaxic
nervous system. Cold-blooded animals possess the mechanism
that in mammals becomes thermolytic—a nervous mechanism
, that controls the vessels and the breathing. The thermo¬
genic system in them is ill-developed, and probably not well
differentiated from the system of motor and inhibitory
nerves that subserves locomotion. The frog in a normal
condition hardly needs to generate beat in his muscles, but
when the motor trunks are artificially stimulated heat can
be produced in them. But his oxidative thermogenic meta¬
bolism is at best feeble, and we cannot easily throw him
into an enduring fever. In young mammals the thermo-
1 genic system is developed before the thermotaxic. The
instability of an infant’s temperature is its chief character¬
istic. A little sends it into a high fever; a little restores
it again. As the child grows, the range of its power of
regulation increases, its temperature grows stable, and the
thermotaxic mechanism is evolved.

Time fails me to say more as to the successive evolution
of the three mechanisms from what we may call the
historical point of view. The consideration of tlieir
organisation leads us, however, to a like result. In Dr.
Hughling8 Jackson’s words, “ Evolution is a passage from
the most to the least organised—that is to say, from the
lowest well-organised centres up to the highest least-
organised centres ; putting this otherwise, the progress
is from centres comparatively well organised at birth
up to those, the highest centres, which are continually
organising through life." The order of organisation
is, like that of evolution, — thermolytic, thermogenic,
thermotaxic. The localisation of the thermolytic centres
is admitted even by the opponents of localisation; they
do not object to speak of the vaso-motor, respiratory,
and sweat centres. Thff bent organised and the most
automatic centres are the best recognised, and the lowest.
The cerebral thermogenic mechanism 1 have hardly ven¬
tured to speak of as consisting of “ centres.” Yet some
observers claim to be able to point to the inhibitory centre,
and others, as competent, to the excitor centre. I have
laid before you specimens of both claims; that they are not
universally admitted is to me evidence that the organisa¬
tion of these thermogenic centres is less complete and
therefore less localised; that they are, in a sense, in process
of evolution; that they are higher than the thermolytic.
As to the thermotaxic mechanism, no one, so far as 1 am
aware, has been able to say it is at this spot or at that.
Least organised, least automatic, least and last developed,
its localisation is necessarily the most imperfect. But its
existence I take to be as necessary as that of the “highest
motor centres,” which control and connect and represent
the “middle motor centres” localised in the cortex. It
coordinates because it represents the thermogenic aftd the
thermolytic centres.

Yon will see from what I have said that, regarding the
thermal mechanisms as a functional and evolutional
hierarchy, I regard fever as a “dissolution,” a progressive
negative process, a relaxation of control from above down¬
wards, in the same sense (and with the same reserves) that
the term is nsed by Dr. Hughlings Jackson in his Croonian
Lectures of 1884. The ideas set forth in that moet suggestive
course with reference to the evolution or dissolution of the
motor functions I venture in all deference to apply to the
correlative thermogenic function. If I may So express my¬
self, the pains that have been taken to adjust our thermal
relations to our environment, the nicety of the balance in
widely varying circumstances, the impairment of all the
higher functions which ensues when the balance is but. a
little disturbed in either direction move me to re-^rd

616 The Lancet,]

DR. W. MACEWEN ON CEREBRAL ABSCESS.

[March 26,1887.

tlierinogeueeis as no mere by-end of our nature, no mere
casual but unavoidable concomitant of chemical processes
performed for another primary purpose. I would put it in
the vital scale a little “ higher’’than circulation and respira¬
tion, and a little “lower” than voluntary muscular action.
The motor function of the muscles is related to the highest
centres; their thermogenic function connects them with the
lower or animal centres; and the innumerable variety of
causes which disturb or “ dissolve ” the controlling nervous
mechanism, the readiness of “fever ” to result from injurious
influences of so many kinds, is the expression of the fact
that the habit of stable temperature is, so to speak, recently
acquired. As a last test of the “dissolution” hypothesis,
consider what happens in recovery from a typical febrile
attack. First, the thermolytic mechanism is waked to
adequacy, there is a critical sweat or a relaxation of the
vessels of the skin, and a gush of heat from the surface
brings down the temperature witli a run. But the thermo¬
genic centres have not yet recovered, and the temperature
will swing backwards and forwards for some days, and an
epicritical excretion of urea takes place. Thermogenesis
becomes less and less excessive, and is vigilantly counter¬
balanced by thermolysis; but thermotaxis is yet feeble.
The patient’s temperature is down, but it is still far from
stable. As convalescence proceeds the stability increases,
and at length thermotaxis, the first to be disturbed and
overthrown, is the last to be restored.

The task which I proposed to myself is fulfilled; it was
to set before you, if not an idea, at least the germ of an idea
concerning the nature of fever. At every turn I have been
indebted to the work of others; theirs are the pearls of
observation and experiment which I have so inadequately
displayed to you: only this tenuous filament of a theory on
which I have strung them together is mine. But as some
coherent theory is better than none,* if only as an aid to
the ordering of our facts, and as I have found this manner
of looking at fever useful to myself, not only as a patho¬
logist but as a physician, I have ventured thus imperfectly
to propound it. I have said nothing of the many clinical
facts which might be adduced in support of the nervous
origin of fever; Dr. Hale White has done so once for all in
an excellent paper in the Guy’s Hospital Reports (1884). I
have said nothing of the therapeutics of fever, for indeed
there is probably no Fellow of the College here present who
could not teach me many lessons as to its treatment. And
if, lastly, I have said nothing about etiology, that has at
least this advantage, that you have been spared even a
single allusion to bacteria.

CASE OF

(JERE.B.RAL ABSCESS DUE TO OTITIS MEDIA,

UNDER THE CARE OF DR. BARR. AND OI'ERATED ON.
REPORTED BY

WILLIAM MACEWEN,

SURGEON AND LECTURER ON SURGERY, ROYAL INFIRMARY. GLASGOW.

Summary.— Abscess in temporo-sphenoidallobe, due to septic
otitis media; doubtful condition of lateral sinus; lungs
involved; symptoms; operation; complete recovery.

W. II-, a boy, aged nine years, was admitted into the

Hospital for Diseases of the Ear under the care of Dr. Barr,
on Jan. 13th, 1887, suffering from septic purulent otitis
media and abscess of the brain, for the latter of which I was
ultimately consulted, and afterwards operated upon him.

History.—The, history prior to his admission into the hos¬
pital, as given by his mother in answer to questions, is as
follows:—A month prior to the operation about to be
described he complained one day of pain in the region of
the right ear, which made him fret and prevented him from
sleeping at night. On the following morning his skin was
hot and dry, and he vomited, after which he became drowsy,
being frequently awakened, however, by sudden startings
and “ crying fits ” due to acute pain. The pain over the

* " We should follow the method of #cIenCe,and fnvceWeate bv the use
«t hypotheses. Tins may teem a * trance remark to those who errone-
ouBly suppose an hypothesis to be a conclusion in which u may-
it 1* only used for the methodising of work by obsorva'ion and exneri
ucnt.”—(Haghllngs Jackson t Bowman Lecture,

region of the ear, the drowsiness, the feverishness, and the-
occasional vomiting continued to characterise the first
seven days of his illness. On the eighth day he had a rigor
which lasted a quarter of an hour, in which he shook all over,
and his teeth chattered. Between this time und his admis¬
sion into the institution, he had in all six rigors, at intervals
of about two days.

On the nineteenth day of his disease he was admitted into
the Hospital for Diseases of the Ear. His condition was
then as follows: He was a greatly emaciated child, having
a pale, shrunken face, with livid lips, his upper one being
covered by herpetic eruptions. He had a short catching
cough. liis axillary temperature was 100‘8°; pulse 108.
He was very drowsy, and complained of pain over the right
ear, from which there was an offensive discharge. Dr. Barr
found a perforation to exist in the upper part of the
tympanic membrane, from which some purulent secretion
was escaping, although the quantity was not great. There
was defective hearing on that side, but the boy’s mental
condition prevented an exact estimate of the degree of
deafness. For two days after admission (twentieth and
twenty-first days of illness) his complairfts of .pain were not
obtrusive, but the drowsiness continued. On the next day
the pain had become aggravated, and he had a slight rigor.
There was no evidence of an acute inflammatory pro¬
cess, or of retention of pus in the ear, to account for
the pain, and there was neither redness nor swelling
over the mastoid process. The temperature at this time was
99-6°; pulse 92. Dr. Barr perforated the mastoid process,,
and opened into the mastoid cells by chiselling behind the
external auditory canal, and succeeded in passing a stream
of antiseptic fluid through the antrum and tympanic
cavity, out by the external meatus, and also in the reverse
direction. A small quantity of purulent and caseous debris
was washed out. A drainage-tube was introduced into the
orifice in the bone through which an antiseptic solution
was injected twice daily from the opening behind to the
external meatus, and vice versa. For two days subsequently
no change was observed in his condition, but a slight rigoi
occurred on the second day after the perforation (twenty-
fifth of the disease), while the pain in the head and the
drowsiness became worse. On the twenty-ninth day of his
illness a copious discharge of most offensive odour escaped 1
from the car. His tongue was red and smooth, and he refused
to take food or drink. Pulse intermittent and irregular. A
blush of redness frequently suffused the face.

On the thirtieth day of his illness Dr. Barr asked me to see
a case in which he suspected cerebral abscess. The boy’s state
was then as follows : On approaching his bed one perceived’
a heavy fetid odour, traceable to the discharge from the
right ear. One saw an extremely emaciated child, with &■
pale, greyish face, wrinkled skin, prominent cheek bones,
and somewhat sunken eyeballs. He lay upon his right
side in bed, his hand beneath his head, looking as if he
were asleep with his eyelids half open. His lips were livid,
and on the upper one herpetic remains appeared. His tongue
was red and dry. Sordes covered the teeth. When an
attempt was made to rouse him the right upper eyelid?
drooped, and there was a shade of passivity of the right side
of the face, with a slight dragging of the angle of the mouth
toward the left. The conjunctiva of the right eyelid was
congested, and the lids were smeared with pus. The pupils
were equal, about medium size, and responded sluggishly to
the action of light. The veins over the right side of the head
were congested, and stood prominentlyoutonhissliavenhead.
Pain on percussion was elicited over the right temporal,
while percussion over the head generally was calmly borne.
There was no cedema about the mastoid process. The right
sterno-mastoid muscle was rigid. There was no hard cord¬
like feeling along the line of the internal jugular, though
the external jugular was prominent. Acute pain was elicited
on digital pressure just behind the origin of the sterno-
mastoid, in the tissues near the exit of the vein which
passes through the posterior condylar foramen. He was in
a state of stupor, from which he could only be partially
aroused, and not to such an extent as to give an intelligent
answer to any question. His puhe was markedly slow, 60
to 60 per minute, and woa feeble and intermittent. His limbs
were extremely attenuated, and there was an irregular mus¬
cular tremor over the body generally, such as one frequently
finds in approaching dissolution. He had a frequent cough*
with purulent expectoration, which had an offensive odour, and
there were moist rales over both-sides of the chest. His bowels
were and had been obstinately constipated. Hr* urine was

The Lancet,

DR. T. J. MACLAGAN ON PYREXIA AND HYPERPYREXIA. [MabOH 26,1887. 617

free from albumen. It was somewhat difficult to believe
that some weeks previously this boy was apparently stout
-and robust, and was vigorously engaged at playing football.
There was a flow of excessively fetid fluid from the external
-ear, and as this was greater in amount than what would be
likely to come from the antrum or middle ear, it was sus¬
pected that there might be a connexion between the middle
ear and the intra-cranial cavity. There was no difficulty in
-concluding that this patient suffered from cerebral absoees,
originating in septic otitis media. It was almost positive
that it was situated in the temporo-sphenoidal lobe, and it
probably had a tortuous and minute communication with
the middle ear. It was feared that the lung affection was
secondary to the septic absorption. The prognosis was
almost hopeless, his youth being the one favourable point.
'Immediate operation was advised, and with Dr. Barr’s con¬
currence it was at once carried out.

Operation .—The middle ear was washed out with an
-antiseptic solution, and rendered as nearly aseptic as
possible. The scalp and parts around the ear were care¬
fully washed with soap and water, then they were cleansed
with turpentine, and finally with methylated spirit. An
•antesthetic was administered. A half-inch disc of bone was
removed from the squamous portion of the temporal, at a
point an inch above and half an inch behind the centre of
the external auditory meatus. The bone was normal; the
dura mater was here slightly congested, and did not impart
-any brain impulse to the finger, neither was any discernible
when the aperture in the skull was filled with fluid. When
the membrane was opened and turned aside, the brain
tissue immediately bulged into the osseous cavity and rose
-above its external level. The pia mater covering it was
-congested, and the brain substance had a yellowish-red
appearance. A hollow needle was inserted into the brain
in a direction which, if introduced far enough, would
-strike the eminence in the petrous bone above the middle
ear. After it had penetrated the brain tissue for about
three-quarters of an inch, there was a sudden escape
-of foul gas, accompanied by a bubbling sound and the
■escape of a few bells of fluid. Evidently the upper part of
an abscess cavity had been tapped, and this contained fetid
gas. The needle was inserted a little farther, when pus
■flowed out. It was of an ordinary yellowish colour, and had
4 moat offensive odour. After two drachms had slowly
welled away, the aperture in the brain tissue was enlarged
by forceps, and portions of the brain tissue, which had
become necrosed, were removed. The latter consisted of
shreds, two about the size of a large horse-bean, the others
that of barley grains. On their removal more pus welled
away. The cavity was then washed out with a saturated
'Solution of boracic acid. After that, however, there was
still a slow oozing of pus, along with the extrusion
of minute shreds of bram tissue. It was evident that
there was a considerable zone of purulent inflamma¬
tion surrounding the abscess cavity, from which the
pus continued to ooze. An aperture was then drilled
into the base of the skull, just above the osseous
boundary of the external auditory meatus, involving the
«quamo-petrosal suture. The dura mater was examined
here and found intact. It was penetrated, and the abscess
cavity was reached. A stream of boracic lotion was passed
■from this aperture so as to wash out the cavity of the
abscess, and It was continued until it passed freely out by
the upper opening. The current was then reversed. Even
after that, when the drainage-tube was inserted, an oozing
of purulent fluid took place into the tube. The ear was
again cleansed. Chromicised chicken-bone drainage-tubes
were introduced into both apertures. The parte were thickly
dusted over with boracic acid powder, and dreeeed with
■sublimated wood-wool pads.

When placed in bed the patient was extremely weak, but
tallied after the flrst few hours. A marked improvement
was observable during the first week. The pulse became
•quicker and the temperature a little higher, both good signs.
The face became brighter, the eyes clearer, the eyelids free
from pus, the ptosis vanished, and the mental condition im¬
proved. After the first week, though kept on restricted
oiet, he improv' d in flesh, and continued subsequently to
so at a rapid rate. The wounds were dressed about once
• week, when the parts were thoroughly syringed with
•saturated boracic solution, the drainage-tube9 being
$**dually curtailed ns the granulation tissue blocked them
T he softened brain tissue at the seat of the upper
the skull soon presented a mass of granulations,

which increased in size, and rose into the aperture in the
bone, uniting with the layer which formed on the exterior
of the skull. Soon the two became blended together, and
cioatrisation rapidly progressed. The chromicised chicken-
bonee answered admirably as drains, notwithstanding the
action of the tissues, until they were removed, the upper
one after fully five weeks. They also presented the advan¬
tage over silver ones, of being easily shortened when
required.

The child pat on flesh rapidly, and at the end of six
weeks was quite plump.

Dr. Reid examined the eyes about the end of the fourth
week after the operation, and could find no trace of optic
neuritis. He was of opinion that optic neuritis could not
have been present at the time of the operation, without
having left some traces of its presence four weeks after.

Oa March 17th, Dr. Barr examined the affected ear.
There was still alight purulent secretion coming from the
granulation tissue in the middle ear. The bearing power
was as follows: A watch heard forty inches from the ear in
normal hearing was audible at a distance of five inohes and
a half. By bone conduction hearing was very good. A
tuning-fork (C) applied to the middle line of the head was
heard louder in the affected ear. Pressed in the mastoid pro¬
cess, the tuning-fork was heard much louder than when
held near to, but not touching, the orifice of the ear. The
results of these tests with the tuning-fork point to a
normal state of the labyrinthine and nerve structures.

PYREXIA AND HYPERPYREXIA.

By T. J. MACLAGAN, M.D., M.R.C.P.,

PHYSICIAN IN ORDINARY TO THRIB HOT AX. HU»NX*SS«3 RRINCE AND
PRINOAS# CHRISTIAN OP SCHUCSWYO HOL6THIN.

(Continued from prtgt '<lIB.)

The poisons of the specific fevers are minute organisms
which are reproduced in the system during the course of the
diseases to which they give rise. It is this reproduction of
the organism in the system winch causes the whole disturb¬
ance. Before it takes place there is no fever; during its
continuance fever is the prominent condition with which
we have to deal; after its cessation the fever rapidly de¬
clines. How does such a result flow from such a cause ?
How does the propagation of this poison in the system raise
the body heat? It can be only in one of two ways—by im¬
pairing heat inhibition, or by stimulating the processes which
result in heat production. In favour of the former view,
it is difficult to find anything to say except that it is pos¬
sible. As rise of body heat may be produced in this way
(as, for instance, in injuries of the nervous centres), it is
within the range of possibility that the fever poison might
act by impairing heat inhibition. A very little con¬
sideration, however, will show that, though not much can
be said for this view, a great deal may be said against it.
According to this view of the matter, the poisons of the
specific fevers exercise for the time a more or less paralysing
effect on the heat-inhibiting centre—the result of which is,
of course, rise of temperature. But if such were the case,
this action ought to be more and more pronounced as
the poison which gives rise to it increases in amount in
tlie system, and the temperature should go on rising as
the disease advances, getting daily higher and higher, and
keeping pace in its rise with the increasing prominence of
the other symptoms—wasting, prostration, delirium, &c. It
ought, too, to remain high so long as the poison exists in the
system. That is wbat ought to be if the rise of tempera¬
ture were due to & direct toxio action of the poison on the
heat-inhibiting centre. But the facts are quite the reverse.
Take typhus and typhoid fever as typical instances. We
find that in these fevers the temperature reaches its highest
point very early in the disease—may be even before its
characteristic symptoms are fully developed,—and is no
higher after two or three weeks of fever than after five or six
days of it, though the poison which causes all the disturbance
is being largely reproduced during the whole time. Again,
it is a fact tnat in each of the specific fevers the tempera¬
ture returns to the normal while there is still in the system
a large quantity of the poison of the disease, as is abundantly
evidenced by the^contagiousness of these lies during

618 Thb Lancet,]

DB. T. J. MACLAGAN ON PYEEXIA AND HYPERPYEEXIA.

[Mabch 26,1887.

the early days of convalescence. Did that poison have a
direct paralysing effect on the heat-inhibiting centre, and
were the rise of temperature due to such an action, the body
heat wonld rise with the increase of the poison, and fever
would continue so long as that poison existed in any quantity
in the system, and the temperature would not fall till it had
been eliminated. As it is, the temperature does not rise after
the first five or six days, and there is good reason to believe
that the system contains more of the poison at the com¬
mencement of defervescence, when the temperature is rapidly
falling, than it does during the first few days of the fever,
when it is rapidly rising.

The evidence is all opposed to the view that the increased
body heat of the specific fevers is of neurotic origin—due to
the direct action of the fever poison on the heRt.-itihihiting
centre. Indeed, nothing worthy of the name of evidence
can be adduced in support of such a view, and there remains
for us nothing but to reject it. It is quite otherwise with
the view which attributes the rise of temperature to in¬
creased production of heat. What we have now to do is to
consider how such increased production is brought about.
It will facilitate our inquiry if we bear in mind, what has
already been insisted on, that heat is essentially an excretory
product, destined for elimination, and that it is not the only
such product which is in excess in fever. Fever does not
consist solely in rise of temperature; it is a collection of
different and various phenomena, all of which are abnormal,
and the coexistence of which in the system constitutes a
condition which is conveniently characterised by the term
“ fever.” In considering the pathogenesis of this condition, no
one of its essential phenomena should be divorced from the
others; they are all linked together by the bonds of a common
causation, and must therefore be considered together. The
specific poison of the disease is the cause which gives rise
to each of the specific fevers; that poison mast, therefore,
be, directly or indirectly, the cause of the individual pheno¬
mena which go to constitute the fever. The question for
consideration is not the competence of such a cause to pro¬
duce such a result, for that is demonstrated by the occurrence
of the fever, but its mode of action. How does the propa¬
gation of the contagium in the system give rise to the
thirst, dry skin, quick pulse, rise of temperature, waste of
tissue, and disturbance of the nervous centres characteristic
of these maladies?

In investigating the action of ordinary poisonous and
medicinal agencies, we have to consider only their action on
one or more organs, or on the system generally, and have to
deal only with the action of the quantity which has been
swallowed. It is otherwise with the poisons of the specific
fevers. Here we have to deal with an organism which is
reproduced in large quantity in the system, and which in its
growth and reproduction consumes the same materials as
the tissues themselves. All organisms have a definite action
on their environment. This action (in the case of such
organisms as those of the specific fevers) essentially consists
in the consumption of nitrogen and water. The environ¬
ment of these organisms is the blood and tissues of the
human body. The action of these organisms on the body
therefore essentially consists in the consumption of its
nitrogen and water. As nitrogen and water are the chief
elements requisite to the nutrition and building up of the
tissues, and as these tissues are dependent for their continued
vitality and functional activity on a due supply of nitrogen
and water, it is evident that the growth and reproduction
in them of millions of organisms which consume these
elements must have a seriously disturbing action on the
who le syste m. It shall be my endeavour to show that all
the eflWMial phetfomena of the specific fevers are attri¬
butable to this action—to the consumption by the poisons
of these diseases of nitrogen and water destined for the
nutrition of the tissues.

Thaee sential phenomena of fever are1. Wasting of the
nitrugWubtt '2. Increased consumption of water.

3. IncrhWttd/MBBttl^Boa of urea. 4. Increased rapidity of
the circulaftofc- 1,, 5.‘ 7 Y*rt#thr*atural heat. What we have to
do is t o ap ply this vie# of the mode of action of contagia
to the fflcplu^at&nrof jeach of these phenomena.

... flams &n d non-nitrogenous, waste

rWFthat is done to support him,

“ emaciates, and wastes almost
ts.of fever a strong, robust
“tits to be unable to sit up
fo it. He may hare ad-
iMmduring that time a quantity of milk and!

beef-tea which, were he in health, would tend to make him
fatter and to increase his bulk. But the fever process which
is consuming him more than counterbalances our efforts to
keep him up. Under it he rapidly wastes. What is this
process? and how is such wasting brought about? The
one cause to which must be ascribed this, as all the other
phenomena of the form of fever with which we are now
dealing, is the poison which gives rise to the disease. This
poison is an organism which is largely reproduced in the
system during the course of the malady to which it gives
rise, and which in its growth necessarily consumes a large
quantity of nitrogen. The only source whence it can get
this is one or other of the nitrogenous elements of the body.
There exists in the system no spare store of nitrogenous
material, but only what suffices for the wants of the system
itself. The nitrogen requisite for the growth aud propaga¬
tion of the contagium must therefore be taken from this
source, aod must represent a loss to the tissues, which is
directly as the extent to which the contagium is reproduced.

This consumption of nitrogen by the contagium is one of
the main causes of the wasting of the nitrogenous tissues
which takes place in the course of the specific fevers.
But nitrogen exists in various forms and combinations,
liquid and solid, in the body; and we have to consider at
what point or points in its changing course through the
system it is most likely to be laid hold of by the contagium.
Voit has distinguished between the fixed or organ albumen
which enters into the composition of the solid tissues and
changes slowly, and the circulating or store albumen which
is contained m the blood and fluids of organs, and very
readily undergoes change. But a still further distinction
must be made. The circulating albumen must consist of
two parts—a constructive and a retrogressive: the former,
derived from the assimilated ingesta, and destined for the
nutrition and building up of the tissues; the latter derived
from the retrograde metamorphosis of these tissues, and
destined for excretion. The former is converted into solid
nitrogenous tissue; the latter is converted into urea in the
area-forming glands, and as such is eliminated by the kid¬
neys. Nitrogen thus exists in the system in four different
forms—as constructive store albumen, as solid nitrogenous
tissue, as retrogressive store albumen, and as urea. From
which of these is the contagium most likely to takes its
nitrogen? Two things are likely to determine this points
first, the facility with which the nitrogen is yielded up by
each of these compounds; and secondly, the special fitness
of each for the purpoee for which it is wanted by the con¬
tagium. The most stable of the nitrogenous compounds,
and that which would least readily yield up its nitrogen, is
the fixed or organ albumen; that is, therefore, the source
whence the contagium is least likely to obtain its nitrogen.
The increased wasting of these tissues would, on the first
glance, point them out as its probable source; but such a
result, would equally follow the appropriation by the con¬
tagium of the nitrogen destined for their nutrition and
repair.

Next in stability is the urea; next to the organ albumen,
it is therefore the least likely source from which the con¬
tagium should get its nitrogen. But there are more cogent
reasons for rejecting it. First, the consumption of the
nitrogen of the urea would not lead to wasting of the
nitrogenous tissues—would not, indeed, have any effect on
these tissues; for nitrogen does not enter into the combina¬
tion which results in the formation of urea till it has served
ail the purposes for which it was taken into the system, and
is about to be eliminated. Indeed, it takes the form of urea
only for that purpose. Secondly, the consumption by the con¬
tagium of the nitrogen of the urea would neoessarily lead
to greatly diminished excretion of that substance by the
kidneys; but during the specific fevers there i9 increased
elimination of urea. These reasons make it certain that the
urea is not the Bource whence the contagium derives its
nitrogen.

The only other available source is the store albumen. This
consists of two parts—a constructive and a retrogressive.
From one or both of these the nitrogen of the contagium
must be derived. So far as the readiness with which their
nitrogen is yielded up is concerned, the two are pretty much
on a par; each is a transition compound, and has for one of
its leading characteristics a readiness to undergo change and
to part with its nitrogen, the one yielding it up to the
albuminous tissues, the other parting with it in the gland
cells which form it into urea. Any advantage which deee
.exist is on the side of the constructive store albou^ea; for

Thb LanCet.J MR. N. DAVIBS-COLLEY: OPERATION FOR THE CURE OF ECTROPION. [Mabch 26,1887. 619

while this is ever undergoing change, and constantly giving
up its nitrogen to the albuminous tissues in all parts of the
body, the retrogressive yields up its nitrogen only in the
urea-forming glands. Now, there is no reason to suppose
that the growth of the contagium takes place only in these
glands, or that it gets its nitrogen in them only. On the
contrary, there is good reason to believe that the contagium
appropriates nitrogen all over the body, and in all ite
tisanes.

■- But there are more cogent reasons for rejecting the claims
of the retrogressive store albumen—the same reasons,
indeed, which led us to reject those of the urea. The
nitrogen does not go to form retrogressive albumen till it
has served all the purposes of the tissues; it is no longer
required by them—is, indeed, rejected by them,—and
assumes this form only that it may be conveyed to the
glands, in which it is changed into urea for the purposes of
elimination. The retrogressive store albumen is as essen¬
tially an excretory compound as is urea. The consumption
Of its nitrogen by the contagium, therefore, could not cause
wasting of the nitrogenous tissues; it would lead only to
decreased formation of urea. But all this is exactly the
reverse of what takes place: the tissues do waste, and there
is increased formation of urea. The retrogressive store
albumen is evidently not the source whence the contagium
derives its nitrogen. The only remaining source is the con¬
structive store albumen ; and a little consideration serves to
show that it is also the one whence the contagium would
by preference naturally take its nitrogen. The constructive
store albumen is the source whence is derived the nitrogen
destined for the building up of the nitrogenous tissues; it
■s only in it that they get nitrogen in the form suitable for
their repair. Now, it needs no argument to show that the
process by which the protoplasm of the contagium is formed
bears a much closer analogy to that by which the albuminous i
tissues are built up than it does to any other action which |
goes on in the system. Each is a constructive step, and
essentially consists in the appropriation by living proto¬
plasm of the elements requisite for its growth. The par¬
ticular nitrogenous compound, which serves to build up the
protoplasm of the tissues is likely also to be the one which
would best serve to build up that of the contagium. Every
reason and argument thus lead to the conclusion that
tiie source whence the contagium derives the nitrogen
requisite for its growth is the constructive store albumen.
The reproduction of the contagium in the system during
the course of the specific fevers results in the consump¬
tion by it of the nitrogen of the constructive store
albumen. This represents a direct loss of nitrogen to
tile nitrogenous tissues, and such loss is one of the primary
causes of that rapid wasting of these tissues which forms
one of the characteristic features of an attack of the specific

Jwrt ^though ft primary, it is not the sole agency In pro¬
ducing this loss of bulk. All living and active protoplasm
consists mainly of water. Of 100 parts of human flesh, 74
Consist of water. A proper supply of water is, therefore, as
vsquisite to the nutrition of the tissues and to the renewal
Of their protoplasm as is a due supply of nitrogen. But
■•rater enters as largely—probably even more largely—into
tile composition of the protoplasm of the contagium, and
to therefore consumed by it during its growth. The
growth of the contagium in the tissues means a large
consumption of the water as well as of the nitrogen
destined for their repair; and this appropriation by
tile contagium of the water destined for them is probably
ttpotefot a factor in the production of that wasting of the
tissues which we are now considering as is the consump¬
tion by the same agency of the nitrogen of the constructive
toore albumen. Certain it is that this double loss to the
tissues—the loss of water and the loss of nitrogen which
toast result from the growth of the contagium in the system
Ipffo rds a reasonable and adequate explanation of the rapid
wtofcing of the tissues which characterises the course of the
4^edfic fevers. This consumption of water by the con-
‘ am serve* also to ettaMtosome of the other characteristic
essential

hflJ '

AX OPERATION FOR THE CURE OF
ECTROPION . 1

By X. DAVIES-COLLEY, M.C.Cant.,

SI ROKON AND LKCTUHEB ON ANATOMY, GUY’S HOSPITAL.

I do not know whether the mode of procedure adopted
in the treatment of the following case is new, but, as I can
And no mention of it in our text-books, I venture to bring
it before the profession, in the hope that it may prove
serviceable where the ordinary operations for the relief of
this unsightly deformity have failed.

My patient, Michael R-, was a delicate boy of three

years of age, who was admitted under my care into Guy’s
Hospital on Oct. 25th, 1883, with necrosis of the superior
maxilla following measles. The left lower eyelid was then
much everted, and it became still more so after the removal
of sequestra from the front and outer walls of the antrum.
In January, 1884, the eyelids were pared and stitched
together, and an incision was at the same time made below
the lower eyelid to free it. For ten months the child went
about with the eye thus closed up, but at the end of that
time, when, at the urgent request of the friends, the union
between the edges of the lids was divided, immediately the
eversion of the lower lid returned. In a short time ho was
found to have an ulcer of the cornea and considerable con¬
junctivitis, as the result of the exposure of the eyeball. In
January, 1885, I again operated in the same way as before,
but this time, in addition to the paring and uniting of the

inr .os

ttpintos of the
is was held on the 16th inat-.,
financi al- and medical reports were

■ edj l-j MU

o

lids. I took a flap more than two inches long, as indicated
in Fig. 1, from the temple, and stitched it carefully into the
gaping wound produced by the incision necessary to free
the lower eyelid. The eversion was so great that I had
much difficulty in paring the edge of the lower lid, for it
lay at the bottom of a groove which intervened between
tiie prominent granulations of the pftlpebtal conjunctiva and
the skin of the cheek. I was disappointed to find, at tbe
end of a few months, that the flap which I had transplanted
bad not, as in many other cases in whicl> I have operated
similarly before, taken tbe place of the skin of the lower
eyelid, but that although it had united perfectly, it had
been drawn downwards by the contraction of tbe soft
parts, so as to form the integument of the upper part of the
cheek, while the upper eyelid had been elongated, so that
its lower border was about on the level of the floor of the
orbit. There was a small chink still patent between tbe
inner thirds of the eyelids, through which the boy was able
to see a little, but it was evident that if this chink were
enlarged by the division of the artificial union between the
lids, the eversion of the lower lid would return, and it was

1 A paper read at a recent meeting of the Metf’eal

Diaitized bv vjOUW LtT

620 The LAncbt,] DR. J. BROWN SIM: RHEUMATIC CEBEBRO-SPINAL INFLAMMATION. [Mabch 26,1887.

probable that in addition to the deformity the boy would
also suffer as before from the exposure of the cornea and
conjunctiva. The only way which I could devise for
restoring the use of the eye without producing these results
was to divide the upper eyelid, and to convert that portion
of it which had for some time occupied the position of the
lower eyelid into a substitute for it. Accordingly, in May,
1886, sixteen months after the previous operation, I divided,
under ether, all the structures of the upper eyelid with a
pair of scissors, beginning my incision at the outer end of
the chink between the edges of the inner thirds of the lids,
and extending it, as indicated in Fig. 2, outwards and slightly
upwards for from five-eighths to three-quarters of an inch.
To prevent the cut edges uniting again, I then attached

Fig. 2.

the skin to the mucous membrane by fine catgut sutures.
From that time until now the boy has been able to use the
left eye as well as the right, and there has been no return
of the eversion. At first there was some epiphora, but of
late the tears only occasionally fall down the cheek. The
angle which was formed by the junction of the normal and
artificial edges of the new upper eyelid has rounded off,
and now hardly attracts notice. He is able to open his eye
well, but cannot close it completely, the gap between the lids
being about an eighth of an inch wide. There is, however,
no conjunctivitis or disease of the cornea from this slight
exposure. There are two defects still apparent in his
condition. As will be seen by reference to Fig. 3, which is
a rough copy that I have made of a very good portrait of

Fig. 8.

him, taken by my late dresser, Mr. Theodore Fisher, son e
eyelashes emerge from the lower border of what is now his
lower eyelid, and there is a small gap, about one-eighth of
an inch broad, which must have remained ununited when
the eyelids were stitched together two years ago. The great
tension of the parts has produced a triangular aperture below
the gap, through which a patch of conjunctival granulations
can be seen. When the boy has a cold, a few tears escape
by the aperture and cause a Slight epiphora. I hope on some
future occasion to remove these alight defects by a further
operation. If I had from the first intended to divide the
upper eyelid, it would have been easy to produce a better
result by paring away the eyelids so freely as to remove the
eyelash bulbs before inserting the stitches. Moreover, I do
not think that the preliminary transplantation of a flap is
st aH nece ssa ry to the operation.

Harley-street, W.

RHEUMATIC CEREBROSPINAL INFLAM¬
MATION.

By J. BROWN SIM, M.D., L.R.C.S. Edin.

The following case presents many points of interest, as
the supervention of grave changes in the cerebro-spinal
system are not commonly met with in the course of a.
rheumatic affection. In this case that disease could never
have gone beyond the subacute stage; and beyond the sus¬
picion that the mental faculties had not for some time
been quite so sharp as they previously had been, there
was no apparent cause why symptoms of so serious and
grave a character should have been set up. It possessea-
many features of resemblance to the case of disseminated
myelitis reported in The Lancet of Nov. 13th of last year,,
as having been brought before the Royal Medical and
Chirurgical Society by Dr. Thomas Barlow, where sym¬
ptoms of a somewhat similar character had occurred
during an attack of measles; and it will serve to point
out that the liability to the occurrence of such compli¬
cations is not confined to the acute specific fevers. With¬
out attempting any explanation of them, I will proceed
to give the clinical notes, only drawing attention to
the transient character of the first paraplegic attacks,,
and the subsequent rapid progress of the disease to a fatal
termination. I have to express my obligation to Dr. Ransom
for his kindness in supplying me with the early notes of
the case.

H. S. M-, aged seventeen, occupied as a clerk in &-

counting-house, first consulted Dr. Ransom of Nottingham
on October 30th, 1880, complaining of his left knee-joint,
being enlarged, and of a swelling on the dorsum of
the left hand. On inquiry it was found that the patient’s -
father had had several attacks of rheumatic fever, and
frequently the same malady in a subacute form. In other
respects the family history was a good one. The patient had
about a year before an illness accompanied with pain and
swelling of the left knee-joint, which continued for some
weeks, but did not lay him up in bed, and from which he-
completely recovered. For a month previous to his visit to
Dr. Ransom the patient had a swelling on the dorsum of his
left hand. This had become much reduced in size, but at
tbe time of his visit it was readily felt as a firm substance-
about the size of half a nutmeg, and apparently deeply
placed near the bone. It had been painful, but was not then
so. A week previously the left knee-joint again swelled*
and was slightly painful and tender. Dr. Ransom detected-
fluid in this joint. There was also some pain in the back
and head. But he did not appear to be feverish, or to suffer-
much general malaise. Treatment consisted of salicine and
iodide of potassium. On Nov. 8th the patient again visited-
Dr. Ransom, who noted that the symptoms were a trifle
better all round. On Nov. 13th tbe father called on Dr..
Ransom and reported that on the afternoon of the 11th his-
son had suddenly lost the power of moving his legs, and had
remained in this state for about a quarter of an hour; that he
then recovered, and walked upstairs. That again, about two
hours previous to his call on Dr. Ransom, a similar temporary
loss of power had oome on and passed away. The same-
afternoon the patient was seen at his own home by Dr. Ransom
and myself, lie was in bed, and was noted to be thin, pale,
and overgrown for bis age. It was found that he had
completely recovered the use of his legs, and that sensation
was normal, as evidenced by his being able readily to-
localise a pinch or a light touch. The swellings on the
hand and knee had almost completely disappeared. On
asking the patient to describe the seizure on tbe 11th, he.
had at first no recollection of it. On being reminded by bis
mother, he was then able to recall and give a fairly connected
account of it. He described the attack as coming on gradually*
beginning with a feeling of numbness in nis legs, and
passing on to entire inability to move them. He thought
it would be quite fifteen minutes in reaching this stage.
There was also partial but very slight loss of power in both
arms. Since this seizure he was noticed to have some diffi¬
culty in passing urine, and to fail in obtaining much relief
after doing so. The second attack of paraljrsis was de¬
scribed as similar to the first, but only affecting the logs,
and did not last long. He had not much pain, but com-’
plained of some over the region of the stomach. Examina¬
tion of the spine failed to snow any tenderness.. The beast-
Digitized by VjOOglC

Tee Lancet,]

CLINICAL NOTES.

[Mabch 26,1887. 621

and lungs were both normal. The bladder contained a good
deal of urine. The mental faculties were clouded, the

S atient often requiring to be helped out with his facts by
is friends. He was staged to have been a bright, lively,
intelligent boy, but his father thought him to have been less
so for some months past.

Nov. 14th.—10 a.m. : Patient’s mind appears to be more
hazy this morning. He states that he has had a good night,
and has no p(dn except in his abdomen, which he refers now
to the hypogastric and now to the left hypochondriac regions.
His memory is worse, as shown by his not remembering
that two doctors had been to see him the previous evening.
His friends state that he appeared to suffer acutely for four
hours during the night, but this he had no recollection of
himself. After this attack of pain he appeared to become
hot and feverish. He forgets what month it is, and though
he made inquiry as to what the thermometer was for when
it was put into nis axilla, yet he had no recollection of having
seen it when it was taken out again. He bad also an illu¬
sion that there was a clock on the wall. Patient had passed
thirty-one ounces of urine during the night, but as his bladder
still seemed distended a catheter was passed and thirty-
one ounces withdrawn. On examination afterwards the
urine was found quite free from albumen. Temperature
100 2°; pulse 114. At 4 i\m. I was summoned to see him, as
he had become very violent. He was struggling so much
that it was with difficulty he could be kept in bed, and he
answered questions very incoherently. Temperature 100 2°.

15th.—10 a.m.: Patient had slept one hour and three-
quarters after a sedative prescribed at the last visit, but
since then he has been very restless, biting his upper lip,
which was cut and much swollen in consequence. He has
been passing urine in bed. Temperature 99 8° ; pulse 124.
Catheter passed and thirty-four ounces of urine withdrawn.
—7.30 p m. : Patient has passed a quiet day, taking liquid
nourishment moderately well, but remaining unconscious.
He has not been noticed to move his legs to-day. Tickling
or pinching them makes no impression. He moves his arms
freely, but with this exception he remains in the position
he is placed in till he is moved into a fresh one. There has
been no urine passed during the day. Twenty-three ounces
withdrawn by the catheter. Temperature 98 4°; pulse 126.

16th.—10 a.m. : Patient has passed a quiet night, but was
never conscious. He has taken a moderate quantity of
milk and beef-tea. Coma this morning is not so profound,
as he replies on being asked a question in a loud sharp tone,
but could not recogniso his friends. No urine passed during
the night; thirty-one ounces withdrawn by the catheter.
Temperature 102° ; pulse 108. —7.30 p.m. : Patient has been
comatose all day, only occasionally replying to a question;
but has taken more nourishment. He has not been observed
to move his legs at all to-day, though it has been specially
watched for. He has been perspiring freely, and has been
freqhently belching. The urine is still retained; twenty-
four ounces withdrawn by the catheter. Temperature 103° ;
pulse rapid, but difficult to count, as he is constantly moving
his arm about.

From this time the coma rapidly became more profound,
death taking place about 11 a.m. on the 17th, nearly six
days from the time he had his first attack of paraplegia.
No post-mortem was obtained.

Nottlnglmm.

Hull Royal Infirmary. —The annual meeting of
the governors of this institution was held on the 16th inst.,
when it was reported that, owing to the transition state
which at present existed, it was difficult to frame any report
as to the work that had gone on during the past year, or to
compare the accounts with those of other institutions. The
alterations of and additions to the building were reported
to be nearly completed. Dr. Macmillan announced his
intention of presenting to the infirmary, as a jubilee offering,
a hospital ambulance carriage for the better conveyance of
patients to the institution.

The Lunacy Bill. —At the meeting of the Exeter
Town Council on the 23id inst. it was decided to com¬
municate with the Lord Chancellor, with a view of securing
the introduction into the Lunacy Bill now before Parlia¬
ment of a clause authorising the repayment of money
borrowed for building the asylum, to be spread over sixty
instead of only thirty years. The Council has just spent
.£90,000 on a new asylum, and on the present terms of
repayment the sum required entails a very heavy addition
to the rates

Clinical Holes:

MEDICAL, SURGICAL, OBSTETRICAL, AiND
THERAPEUTICAL,

AN OVERDOSE OF ESERINE.

By Andrew Dunlop, M.D., ■“

CONSULTING PHYSICIAN TO THE JERSEY GENERAL PISPICTSARY A*D

• INFIRMARY.

A lady of about sixty years of age, who had slowly
advancing cataract in the left eye, and incipient disease of
the same kind in the right, began, early last October, to
suffer from irritation of the conjunctivse. The eyes were
suffused and the conjunctivas often somewhat injected, and
the discomfort was increased by fatigue, exposure to cold,
or strong artificial light. The patient consulted an oculist
in London in November, and a variety of constitutional
and local remedies were employed without 1 any very satis¬
factory result. On the 19th of January my friend Mr. Hind
saw her with me, and recommended the use of eserine,
with the view of lessening the amounb of light passing into
the eye. Accordingly & solution of the strength of one grate
to the ounce was prescribed, and a drop was ordered to be
placed in the eyes twice a day. At about 4.30 the same
afternoon the first application was made, and a small drop
of the solution placed in each eye. A good deal of smarting
and lacrymation followed, and as this passed off, in about a
quarter of an hour severe clonic spasm of the eyelids set
in, the upper eyelid, as the patient described, falling down
on the lower every few seconds. About a quarter of an
hour later a feeling of spasmodic stiffness in the lips,
especially the upper, set in, and soon there was the same
sensation under tne jaw on the left side. Within an hour
there was a feeling of tremor or spasm, but without any
actual muscular movements in the arms and thighs, and at
the same time there was a sensation of pressure on the
eyeballs and of weight and pressure within the head. The
patient also began to suffer' from some mental confusion,
and her memory was impaired. By 11 P.M. the movements
of the eyelids had diminished considerably, but the other
symptoms had altered very little. She slept uneasily
wakiDg at frequent intervals during the first part of the
night, and when she awoke was conscious of the same sensa¬
tion, though in diminishing degree. In the morning the
muscular sensations had disappeared, but she felt weak and
shaken. I saw her a little before noon on the 20tb, when
I found the pupils contracted to a fine point, and the con¬
junctivas a good deal injected. All the spasmodic muecular
feeling had disappeared, but she complained of the pressure
on the head and on the eyes. She said there was some
mental confusion and a general feeling of weakness. Next
morning, the 21st, the pupils were still minutely contracted,
and as she still complained of the pressure on the balls I
ordered a weak atropine lotion, at the Bame time advising
her to go out for a drive. On the morning of the 22nd she
told me that after her drive, and before using the atropine,
the weight in the head and the pressure on the eyeballs
passed off, and that she felt stronger and better. The pupils
were now pretty fully dilated after two applications of the
atropine lotion. When l saw the patient on the 20th I was
much astonished at the effects produced by a comparatively
weak solution of eserine, and after reassuring myself by
an examination of the prescription that no mistake had been
made in ordering it, I thought that possibly the unusually'
vigorous action of the drug might be due to thd constitution
of the patient, who was exceedingly susceptibly to the action
of some nervine excitants. A visit to the* druggist who
dispensed the prescription fully explained the matter, how¬
ever, for it appeared that by mistake bO had made the
solution of the strength of One grain to th® drachm instead^
of one grain to the ounce. 1 have thoughC that this case,
might be worth recording, as such an accident cannot often ,
occur, and as the symptoms reminded one more of an
overdose of strychnine than one of its antagonists, the
Calabar bean. It appears, however, thAfc in poisoning by*
physostigma muscular twitching^ and tremors often take,,
place before relaxation sets in.

Jersey.

Digitized by G00gle

622 Thb La.ncbt.1

CLINICAL NOTES.

[March 26,1887.

ABDOMINAL SECTION FOR PYO - SALPINX AND
SUBPERITONEAL MYOMA; SUBSEQUENT ILEMOR-
RIIAGE, REQUIRING RECOURSE TO HYSTEREC¬
TOMY; RECOVERY.

By George Elder, M.D., C.M. Glas.,

>UR(iBOS TO THE SAMARITAN HOSPITAL FOR WOMEN, NOTTINGHAM.

Mrs. R-, aged forty-two, living in Nottingham, had

been an out-patient of the Samaritan Hospital for W omen
off and on for many months, complaining not so mucli of
pelvic troubles as persistent and severe gastric symptoms,
always aggravated by movement, sexual intercourse, and
menstruation. These symptoms were nausea, occasionally
sickness, aud extreme pain after food; and so much had
the reflex mischief overshadowed and masked the cause that
several practitioners had treated her for stomachic ulcera¬
tion. The pelvic trouble was diagnosed a considerable time
before the consent of the patient could l e obtained to the
operation, and it was only after treatment by rest &c. had
been long and faiily tried that the pains and induced weak¬
ness brought her to see the necessity of having something
of a radical nature performed.

On Nov. 1st, whilst under the influence of ether, abdominal
section was performed, and a firmly adherent left pyo-salpinx
removed, and also a myoma about the size of a Tangerine
orange, with a long thin pedicle, which was transfixed and
tied by a Staffordshire knot. In tightening the silk a crack
was made in the peritoneal coating of the uterus, from
which oozing took place. Before the completion of the
operation this was stopped by sponge pressure,but a drainage-
tube was placed in position, to register, so to speak, the con¬
dition afterwards. Several times during the day recently
effused blood, in no considerable quantity, but still showing
no disposition to cease, was withdrawn by the syringe, and
in the evening the abdomen was again opened. Ineffectual
attempts to arrest the oozing by means ot the actual cautery
and the continuous suture were made; so after tying off the
left broad ligament no difficulty was found in getting the
wire of lioeberltS’s serre-noeud round the cervix, and con¬
stricting it sufficiently to stop all haemorrhage.

A good stump was obtained; the cervical canal was
thoroughly scooped out and swabbed with strong carbolic
acid; pedicle pins were applied, and the abdominal wound
brought together and well round the stump, no drainage-
tube being used. After rubbing the surface of the stump
thoroughly with solid perchloride of iron, it was dusted with
iodoform, and this was continued almost entirely till the
clamp came off on the seventeenth day. The patient made
a very good recovery. The highest temperature registered
was on* the evening of the fifth day, when it was 100'9 o .
On Jan. 9th she was up and getting about the house, with
a small granulating sore left, which was rapidly lessening.

JinnnrJis .—The prominence of the reflex symptoms was
in this case the reason of mal-diagnosis and misdirected
treatment, as it is in many others, on account of the in¬
sufficient appreciation which exists of the close intimacy
there is between pelvic troubles and gastric disturbance.
One very serious defect of Koebarl6’s clamp came out vejy
markedly in this case, and this is the impossibility' of
sufficiently constricting a thin stump by its means. A
modification with an endless screw would be a great, gain,
and Mr. Lawson Tait’s practice of removing it after a
few days must of necessity do much to lessen the pain to
the patient and to minimise the risk.

NottiuKlmm. __

ACUTE GASTRIC ULCER; HJSMATEMESIS; MEL.ENA;

FISTULA IN ANO; DROPSY; RECOVERY.

aud very flatulent; tongue something like a ploughed field,
with a dirty greenish brown fur on it. ne continued to get
worse. Vomiting set in; would eject any and everything,
and was in great pain till the stomach was emptied. This
pain coming on immediately after food made me suspect
that I had to (leal with an nicer of the stomach, and to that

1 pointed my treatment. Things did not improve. Some
days the man felt better and quiet, then went back to the
old state. The pain continued, with vomiting now and
then, and he lost flesh fast. His face was the picture of
misery, and was getting haggard. His tongue remained the
same, but looked glazed. On Jan. 28th, 1886, I suggested a
consultation with Dr. Ramsay of Torquay, who agreed with
my diagnosis. The patient was in great pain on the 29th and
30th, which seemed, more violent and less controllable than
before, but next day was easier. On Monday, Feb. 1st, about

2 p.m., I was suddenly called, aud found him lying stretched
on the floor, with three ordinary-sized chamber vessels nearly
full of a reddish-black treacly fluid, having a horrid stench;
two came from the bowels, and one from the stomach. He
was at once placed in bed. He wa§ quite cold, pallid, pulse¬
less, and speechless —more dead than alive. Now came the
critical period of the case. 1 prescribed lead (half a grain) and
opium (quarter of a grain) every hour for two days and nights,
then every three or four hours if required; ice both to suck ,
and to be applied to the stomach. The watching and anxiety
during this week cannot be described ; it was like watching
the dead, and at times it was even hard to say that he was
living. The melsena did not return, but the hrematemesis
continued till 5.30 a.m. of Feb. 4th : lie was now better, the
pain had ceased, and things seemed favourable, when on the
morning of the 9th he threw up some acid material, and at
11 a.m. he again vomited blood, this time fresh, which con¬
tinued all that day and the next. The end seemed to have
come; still we fought against it,and he again rallied. When
seen on Feb. 12th the bowels bad not been open for the
previous ten days. I ordered an injection of a pint of warm
gruel; he at first passed about a tablespoouful, but a little
time afterwards a quantity of bloody watery material
came away. I can best describe the amount by giving
his wife’s words: “I had a pair of blankets, a small
blanket, a large quilt four or five times doubled, and right
through the bed-tick, saturated.” He remained in a stupor
all tbe afternoon and night, but towards the morning he
rallied again and went on to all appearances in statu quo.
During April he improved; there was no more hmmorrhage,
no pain, and the vomiting had ceased. He had been for the
last few days complaining of pain about the rectum, when
on examination I found tliat the poor fellow had added a,
fistula to his previous troubles; it did not communicate with,
the rectum, and was about an inch and a half deep; the pain
of this dulled the ulcer, which had been progressing very ,
well—in fact, healing up. This fistula with ordinary care ,
and boric acid compresses healed up in due time, so that on’
April 24th he got downstairs for the first time. General.
dropsy now supervened, which was due to debility, tor as he ;
became stronger this disappeared. Convalescence was very
slow, he being reduced to a skeleton. On June 16tli he was
sent to Brixham for change of air, and on July 12th he.
resumed work.

The treatment pursued during this long illness and the,
few headings I give do not represent the amount of medical
and dietetic care he required, for, as everyone knows, the.
number of changes rung during an acute illness is legion.
At tbe outset we used bismuth both solid and the liquor,,
with dilute hydrocyanic acid and nux vomica, sometime 1 -;
adding morphia or chloral. Blisters were applied to the
stomach, and then dressed with morphia ointment. The
treatment for the hmmorrhage I have stated above. Later
on iron and arsenic were given for fully three months.

Ashburton. _

By William Fraser, M.B. Dcb.

Albert K -, aged thirty-seven years, a wheelwright, of

short, stout build, with a good “ corporation,” a good liver
and molerate drinker, (beer or cider), left work on the
evening of Dec. 31st, 1885, complaining of a severe pain
across the bowels. This was an old complaint of his, but
now it seemed sharper than usual. When seen, the pain was
just below and under the end of the sternum, ranging across
and around the two sides; tender on pressure; bowels costive

PRIMARY HUNTERIAN CHANCRE OF THE CHEEK.,
By H. Mitchell, B A. Cantab., M.R.C.S., i

HtBGKOX, AHMY MEDICAL STAFF.

The following case may be of sufficient interest to justify;
its publication in The LANOBT. 1

Early in December last a soldier twenty years of age wa-j
admitted into hospital with an ulcer in the middle of tlie|
right cheek. In character this ulcer was circular, about the.
size of a sLxpence, shallow, clean cut, but the edges not;

Digitized by

The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[March 36,1887. 62 3

undermined; the surface had a glazed appearance, and
secreted a very little watery discharge; its base was sur¬
rounded by slightly indurated tissue, which was somewhat
inflamed. At the angle of the jaw on the same side was an
enlarged gland, not inflamed, about the size of a bean. As
the sicnation of the ulcer corresponded with the position of
the chain of the man’s helmet, it was thought probable that
either the metal of the helmet chain or some substance used
in cleaning it had irritated an abrasion on the cheek and so
caused the ulcer. The man had no constitutional symptoms.
The ulcer was considered to be a poisoned wound, and
treated accordingly, first with poultices and hot fomentations,
then, when the inflammation had subsided, with diluted red
oxide of mercury ointment. In less than three weeks it had
quite healed ; the slight atqpunt of induration at its base had
disappeared; the gland, however, remaining as before, and
showing no signs of inflammation. The man was about to
be discharged from hospital, and was being examined as to
his general condition for this purpose, when a copious rash
was seen on his chest, back, and abdomen, extending also
to the arms. The rash was mainly papular, but Bquamous
and roseolar in places, and markedly polymorphic; in appear¬
ance and colour it was undoubtedly a secondary syphilitic
eruption. There was no previous history of syphilis, or
any appearance or traces of a sore in the usual situations,
and the man stated that he had never had one. The patient
was kept in hospital and treated with perchloride of mercury
and small doses of iodide of potassium, and by Jan. 20th the
rash and the enlarged gland were nearly gone.

The interesting points of this case are—(1) the very un¬
usual situation or the infecting sore; and (2) the early
appearance of seoondary symptoms, which is probably
accounted for by the very free blood-supply to the part.
The sore was probably caused by an abrasion on the cheek
becoming accidentally poisoned by syphilitic virus.

Portland. ___ __ ___

ON THE INFLUENCE OF SALICYLIC ACID UPON
ACOTE RHEUMATISM.

By T. F. Raven, L.R.C.P. Lond.

In the treatment of acute rheumatism with salicylate of
soda or potass very different results are obtained. Some¬
times the remedy acts in a wonderfully satisfactory way,
and in a few hours the patient is free from pain, and in a
few days convalescent. At other times, but fortunately less
frequently, the drug produces no beneficial effect whatever.
Until lately I have been at a loss to distinguish the cases
amenable to treatment with salicylic acid from those which
give no results, but a recent experience has given me a clue
which may possibly be of some value. During the pre¬
valence of an epidemic of membranous tonsillitis in an
institution, three severe cases of acute rheumatism, with
cardiac complications, presented themselves, certainly result¬
ing from the prevalent poison. In the treatment of these
cases salicylate of soda entirely failed either to reduce
temperature, to relieve pain, or to arrest the disease. I was
*o struck with the failure of the drug in three successive
cases that the possibility occurred to me of explaining it by
the origin of the disease. It may be that the acute rheu¬
matism which results from zymotic influences is different
in its nature, though not apparently in its symptoms, from
that which arises from cold and damp.

Brwditalr*.

AN ENORMOUS CALCULUS.
By E. Colson, M.R.C.S.,

BC HGIOX-M AJOB.

Jabtbr Nassir, a Bedouin Arab who had come eight days’
journey to Hodeedab, and thence by sea to Aden, presented
himself at the Civil Hospital for treatment for calculus of
the bladder. On Feb. 1st, when on the operating table, the
stone was carefully examined with the sound and per rectum.
Having come to the conclusion that the stone was a very
j“ge one, I determined on the supra-pubic operation. The
iaa* injected with twenty ounces of warm water,
which raised it well above the pubes. An incision about
kweeinches in length wa3 made vertically above the pubes,
•■nth* parts carefully dissected down until the veins above

the bladder were exposed. Whilst separating these with a
director, it passed through into the bladder, which appeared
soft and friable. The linger was immediately introduced
through the opening, and an enormous stone was found to
occupy the cavity of the organ. To extract this the original
incision had to be much enlarged, and with great difficulty
the stone was removed. This was found to weigh 9j- oz.
avoirdupois, and measured 7^m. in its horizontal and 84 in.
in its vertical circumference. A large catheter was fastened
in the bladder per urethram, and the wound in tbe skin
closed and dressed antiseptically. The man recovered well
from tbe immediate effects of the operation, and was doing
well also ia the evening. I regret to say be died suddenly
on the following morning. No post-mortem examination
was made, as the Arabs object to such a measure. The dis¬
tension of the bladder alone appeared to answer every
purpose, as the peritoneum was not seen from first to last.
The man said he had had the stone for ten years, but as be
would be entirely ignorant of means of computing time,
such a history is quite untrustworthy.

Atien.

% lltirror

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

NnlU&atem eat alia pro certo noscendi via, ni*f qnamplnrimaa et mor-
borara et di*aeoCtonum hUtoria*, tom aliorom turn propria* oollectaa
habere, et inter *e oomparare.— Morgaum Da Sad. at Com*, if orb.,
Ilb. iv. Protemium. -

ST. BARTHOLOMEW’S HOSPITAL.

8ARCOMA OF THE TONGUE ; REMOVAL OF HALF OF TONGUE
RECOVERY; REMARKS.

(Under the care of Mr. Butlin.)

Connective-tissue tumours of the tongue are so very rare
that tbe account of the following growth will be read with
great interest. Appended to the remarks will be found
references to other tumours of this part, and the list is not
a large one. The diagnosis has to be made from gumma,
and in order to do this it is necessary to give large and in¬
creasing doses of the iodide of potassinm. This treatment
was fully tried in this case, and the swelling punctured,
without improvement. For the following notes we are
indebted to Mr. Knight.

C. J-, aged forty, car-driver, was admitted into Rahere

ward, Oct. 12th, 1886, with a swelling of the left half of the
tongue. The patient first noticed a soreness about the
middle of tbe left side of the tongue two months ago, and a
swelling at tbe same spot one month ago. The swelling had
increased rapidly. He had had no pain except on eating;
he never had syphilis; he had smoked cigarp, but never a
pipe. Always enjoyed good health. Family history good.

On admission he was a healthy-looking, strong man.
Situated in the substance of the leit half of the tongue was
a smooth, soft, elastic swelling, bulging on the upper and
under surface of the tongue, and about the size of a fives
ball. It did not extend across tbe middle line, but reached,
from tbe junction of the anterior and middle thirds to the
back of the tongue. The latter could not be protruded from
the mouth. There was no ulceration. A hard and enlarged
gland was felt beneath the jaw in the submaxillary region.
The teeth in the upper jaw were mostly in a decayed condi¬
tion. Under the impression that the tumour contained
fluid it was punctured five days previously, but only blood
etuded. He was ordered ten grains of iodide of potassium
three times a day.

Oct. 16th.— Fifteen grains of the iodide were ordered. No
change in swelling.

19th.—Iodide increased to twenty grains. Tongue can be
protruded a little further.

22nd.—Twenty-five grains of the iodide to be taken. No
further change.

23rd.—The under surface of the tongue was painted with
a 4 per cent, solution of cocaine and the swelling agairt
punctured. A few drops of blood only exuded.

25th,—Thirty grains of iodide of potassium ordered.

Digitized by V3

624 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[March 26, 1887.

28th.—No material alteration has taken place in the
swelling since admission.

After consultation with his colleagues, Mr. Butlin decided
to make an incision into the tumour, and if it should prove
to be malignant, to remove it. Accordingly, on Nov. 5th
the patient was placed under the influence of an anaesthetic,
and Mr. Butlin cut into the tumour, which proved to be
solid. He then cut through the mucous membrane in the
median line above and below the tongue, and tore through
the muscular tissue from the tip to the back. The left half
of the tongue was then snipped through with scissors behind
the tumour, all vessels being clamped as soon as divided. There
was a good deal of hsemonrhage. The vessels were secured
with silk ligatures, and the wound dusted with iodoform. The
gland under the jaw was not removed. The growth on sec¬
tion proved to be a soft white tumour about the size of a fives
ball; it was circumscribed, with the appearance of a capsule
at one point. The microscope showed it to be a small round-
celled sarooma (lympho-sarcoma). Some haemorrhage en¬
sued five hours after the operation, and two small vessels
were ligatured; the general oozing was stopped by the
application of some styptic charpie.

Nov. Gth.—Temperature 99 8°; pulse 136. Fed, by a tube
passed through the nose tbr*»8 times a day, with eggs, milk,
essence, and beef-tea. Wound dusted frequently with
iodoform; very little swelling.

8th.—Temperature 99 6°; pulse 96. Takes a little iced
milk by the mouth, ^He is still fed by the tube.

10th.—Evening temperature 100 0°; to-day 98°; pulse 86.
The gland in the submaxillary region is smaller. Takes
liquid food, and is fed twice a day by the tube.

15th.—Got up for the first time. Wound nearly healed.
Takes all bis food by the mouth. Temperature 98‘8 C .

. 17th.—The enlarged gland has entirely disappeared.
Wound healed. Talks fairly well, and takes solid food. -

On the 19th the patient was discharged from the hospital.
Three weeks afterwards he was in good health, and could
talk plainly. There was no glandular enlargement, and no
sign of recurrence.

Itemarks —The above case differs in some important
points from those previously recorded—namely, in the age
of the patient, the rapid growth of the tumour, and the
healthy condition of the mucous membrane over it. The
tumour, though not encapsuled, was perfectly circumscribed.
r rhe enlargement of the submaxillary gland was probably due
to pressure upon the duct.

Previous cases.— Jacobi: American Journal of Obstetrics'
1870. Godlee; “Holmes’s System of Surgery, vol. ii., art.
“ Tongue,” by Barker. Hutchinson: Medical and Chirurgical
Transactions, vol. lxviii., p. 311, 1885. Eve: Pathological
Transactions, vol. xxxvii., p. 223, 1886.

CHARING-CROSS HOSPITAL.

FRACTURE THROUGH SARCOMA OF FEMUR; SECONDARY

WJI'OSITS IN SKULL AND CLAVICLE; DEATH ; NECROPSY.

(Under the eare of Mr. Bellamy.)

This case presents several points of pathological interest,
and is of value in showing how the real cause of fracture
and of the non-union was unsuspected or overlooked. For
the following notes we are indebted to Mr. II. L. Amim,
ward clerk.

Fred L-, aged forty-seven, was a sufferer from sciatica

and rheumatism, and walked rather lamely with a stick.
On Nov. 9th he was at Shafteabury-road station, and on
putting his walking-stick to the platform it slipped through
a crevice. He Ml heavily forward, at the same, time putting
out his left leg to save himself. He heard and felt some¬
thing snap in the limb, and felt a sudden pain. Patient was
unable to rise to his feet or, indeed, to bear any weight
upon' the left limb, and was brought to the hospital in an
ambulance. The fracture, which was in the middle third of
the left femur, with very little displacement, was put up
in a long Liston-splint with a stanched bandage. •

Nov. 18th.—No pain; temperature normal.

20tb.—Progressing favourably.

Dec. 1st. —There is no pain; patient feels quite comfortable.

14th.—A bedsore about throe by two inches has formed
over the right buttock. It is dressed with bor&cic ointment.

21st.—A swelling of about the size of a Tangerine orange
has appeared over the left side of the scalp. On an
exploratory puncture being made, the contents were found
to be blood. Oust the anterior tbs inner third of

the clavicle is a painful swelling occupying about two inches
of the anterior aspect of the bone. The pain is of a lanc in ati n g
character, worse at night. Skin not discoloured. A plaster-
of-Paris bandage substituted for the starched bandage.

26th.—Patient got up yesterday and the day before.

27th.—The plaster-of-Paris bandage has been removed;
there is much pain at the seat of fracture.

28th.—Sirin over back broken; painted with balsam of
copaiba.

Jan. 4th.—Patient put under ether. Ends of onnnited
bone rubbed together. Leg put up on long Liston splint.

Gth.—The clavicle is better; swelling and pain decreased;
fracture still painful.

18th.—Thign put up in plaster-of-Paris. Sore on back
size of palm of the hand. Slough separating and leaving
ragged ulcer, which is discharging freely. Dressed with
iodoform and boracio dressing. The sore extends from the
tip of the coccyx to the upper border of the sacrum.

Feb. 2nd.—The patient is very emaciated; complains of
loss of appetite. Slight sore appearing under right angle of
the scapula. Still dressed with iodoform and boracio dress¬
ing. Leg put in plaster again.

21st. -For the last eight or ten days the patient has been
in a half-conscious condition; mind wanders occasionally.
Sore on back getting larger; edges of the ulcer undermined.
Ulcer presents an indolent appearance. Patient’s appetite
bad; very weak. The patient died this evening at 11 p.k.

Necropsy. —Body emaciated; no rigor mortis. Abdomen
(superficial view) normal. Heart distinctly fatty. Liver
fatty; no secondary nodules; weight 3 lb. 8 oz. Kidneys
normal. Spleen rather soft; post-mortem change. Apex
of right lung emphysematous; base congested with purulent
fluid passing from the bronchi. Left lung congested and
slightly emphysematous; rest same as right. The convolu¬
tions of the brain were marked on the left side by a tumour
pressing on them; the dura mater was not destroyed, and
the tumour was not adherent to the brain substance. There
was a large ovoid swelling on the left thigh at the junction
of the upper and middle third; the upper and lower parts
could be freely moved on each other, with a peculiar
crackling distinctly felt by the hand. On removing the
femur this ovoid swelling externally looked very much like
brain tissue, being convoluted; and on section it was the
same, but it cut much harder than brain tissue. There was
a tumour on the left parietal region of the skull. On
dissection it was beneath the pericranium, and the dors
mater was intact on the internal surface; the whole of the
parietal bone for the diameter of two inches and a half
being replaced by a soft, brain-like tumour of the same
nature as the tumour of the femur. The mass occupied the
anterior superior portion of the parietal bone, extending
about half-way from the sagittal suture down the bone,
and less than half way back from the fronto-parietal
suture. It projected about an inch and a half from the
surface, and was almost flat inside.

MANCHESTER ROYAL INFIRMARY.

HYDATID CY8T OF LIVF.R; RF.SKCTION OF RIB; REMOVAL
OF CYST WALL.

(Under the care of Mr. Whitehead.)

Wr are indebted to Mr. Brazil for the report of the
following case.

E. W-, a slightly-built and somewhat delicate-looking

woman, aged thirty-two, was admitted into the surgical
wards on Sept. 18th, 1886. The patient gave the following
history of her trouble. In January 1385, she had a slight
attack of pneumonia, and on recovery was left with a pain
in the right side, which has sontinued with varying intensity
up to the present date. About six months previous to
admission she appears to hare had an attack of jaundice,
and at the same time BCtme swelling of the lower extremities.
About two months after this she was admitted into the
Bowdon Consumption Hospital, where she remained three
weeks. While there an aspirating needle was introduced
into the hepatic region, and some clear fluid withdrawn.
From Bowdon she came to the Manchester Royal Infirmary,
and was admitted into the medical wards. Hera she
remained about three months, after which die was trans-
ferred to the surgical side. While in the medical wards*?]
was tapped twice; on the last occasion 16 ox. of
were withdrawn. The fluid was clear, contained abwri-
anee of chlorides, but no albumen. No hookleta were <ua-

Digitized by GoOgle

The Lancet,]

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

[Min oh 26,188T. 025

covered on either occasion. Patient had lost flesh con¬
siderably during her stay in hospital.

Her condition on admission to the surgical ward was as fol¬
lows : On physical examination some fulness was flferceptible
over the hepatic region. The liver dulnoss was markedly
increased, and was found to extend upwards as high
as the third intercostal space, and downwards for half an
inch beyond the costal margin. There was slight tender¬
ness on pressure. The patient complained occasionally
of slight pain in the right side radiating into the right
shoulder.

Operation. —On October 4th the patient was placed under
chloroform, and an incision about two inches long was
made parallel to and slightly below the right costal margin.
The various layers of the abdominal wall were divided
successively and the anterior border of the liver brought
into view. No cyst, however, was found. The wound was
now carefully stitched up again, each layer being sutured
separately. From this operation the patient made a good
recovery.

On Nov. 13th a second operation was undertaken. An
incision about three inches long was made over the eighth
rib in the mid-axillary line, and a portion of the rib about
an inch in length resected, the periosteum being left. After
cutting through a layer of thickened pleura a large cavity
was reached, from which about twenty ounces of thick
yellowish-brown fluid escaped. This fluid was afterwards
found to be loaded with albumen and to contain distinct
hooklets. The cavity was lined with a distinct homogeneous
membrane of a brignt yellow colour, about Ath of an inch
thick, and rather soft and friable. By caretul manipula¬
tion the cyst wall was entirely removed. Numerous
daughter cysts were removed at the same time, some
coming away with the fluid, some with the cyst wall.
After removal of the cyst the cavity was thoroughly
washed out with boracic lotion and a large drainage-tube
inserted.

Nov. 14th.—The patient passed a fairly good night.
Temperature 98°. The dressings were soaked through
with fluid highly coloured with bile. Cavity washed out
as before. The patient is taking eight ounces of brandy
a day.

20th.—The discharge is still very profuse and deeply
bile-stained, but is now distinctly purulent. The cavity is
washed out daily with boracic lotion. Portions of daughter
cysts occasionally come away with the discharge.

December 6th.—The temperature- last night went up to
101-6°, and the dressings were found to be saturated with
blood. On examination it was found that the haemorrhage
proceeded from the cavity. This was washed out with
boracic lotion and fresh dressings applied. This morning
a quantity of blood wa9 found on the dressings, and on
syringing the cavity a few clots came away.

7th. — Temperature this morning 97'6°. More blood
was found on the dressings, and a few more clots
discharged.

10th.— 1 There has been no more bleeding, and the tempera¬
ture remains normal. The discharge is small in quantity,
and consists of perfectly healthy pus. The cavity now holds
rather more than an ounce of fluid. After this the patient
continued to make a good and quite uneventful recovery.

. seen in February, she was looking stouter, was
•u better health altogether than before the operation, com¬
plained of no pain, and ate and slept well. The wound in
tne ode had not healed, but the discharge was perfectly
healthy and trifling in amount.

Royal Hospital' for Diseases of the Chest.—
Tne seventy-third annual court of governors of this institu-
>cn was held on the 15th inst., the Lord Mayor presiding.
th°v? • re P ort .* t appeared that the financial condition of
rnn ^ 0 ? 1 ^ 1 durin 8 CM past year has been, on the whole,
couraging, but mufch remains to be done before it can be
pronounced satisfactory. In order to carry on the work
rvv^ m hand , an “»oual income of between £4000 and
“ required, and when all tbe wards are in full
Thn* th6 tnni ? lkl expenditure will not be less than £7000.

i Q come from subscriptions and dividends
jjwjnto to less than £2000. These, added to tbe dona-
nf collections last year, produced a general income
Ixmipk exclusive of legacies. The Right Hon.

the ® rac ® baa accepted the office of President of

lltei hral Societies,

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Obstruction of one Ureter by a Calculus, associated with
complete Supj>ression of Urine.—Sacculated Kidney con¬
taining Calculi with Disorganisation of the other Kidney ,
and associated with complete Suppression.

An ordinary meeting of this Society was held on
Tuesday last, Mr. G. D. Pollock, F.R.C.8„ President, in the
ohair.

Mr. R. J. Godlp.k read a paper on a case of Obstruction
of one Ureter by a Calculus, accompanied by complete Sup¬
pression of Urine. Up till June 4th, 1884, the patient, a
medical man, who was then thirty-one years old, had
enjoyed good health, with the exception of an attack of
blood-poisoning following a poisoned wound whilst he was
a student in 1872, and occasional attacks of colic, supposed
to be intestinal, which were relieved by morphia. He was
then attacked with frequency of micturition and pain in
the bladder. A week later sickness began and right renal
pain, with fever and haematuria. There was pus in tbe
urine. After a few days these symptoms subsidy], but they
soon returned and became worse. Intense tenderness
appeared in the right loin, and the urine became highly
albuminous, and contained large numbers of hyaline and
granular casts, as well as masses of bacteria, but it was
never putrid. On July 13th a deep-seated peri nephritic
abscess was opened. Tbe kidney could not be dis¬
covered. Tbe casts disappeared completely from the urine, and
the albumen diminished to a very small quantity. No urine
escaped from the wound, which healed without trouble. The
patient after this remained well, with the exception of
occasional attacks of colic, till Dec. 10th, 1885, when an
attack of great severity set in, for which he took several
hypodermic injections of morphia. On the 14th complete
suppression of urine occurred, and lasted a week. No
operation was undertaken, because it was assumed that
there was only one working kidney, the ureter of which
was blocked. On the 19th, nowever, the left kidney was
felt and punctured, but the pelvis was found to be empty.
On the 21st he began to pass highly albuminous urine, and
tbe amount and character of this became more and more
normal; but he did not rally, and died exhausted on
the 26th. At the necropsy the right kidney was found
to be dilated into a loose bag of pus, and a stone was
impacted half way down its ureter, which was dilated
throughout its whole extent. The left kidney was
large and comparatively healthy, but showed signs of
chronic interstitial nephritis; the pelvis and ureter on this
side were normal. The interest of the case depends on the
following facts: 1. That an abscess around a diseased kidney
may cause intense albuminuria and the presence of copious
casts, even though the other kidney be comparatively healthy.
2. Irritation of such a diseased kidney (aided perhaps by the
presence of a certain amount of morphia in tne system) may
cause complete suppression, similar to that caused by com¬
plete obstruction of the ureters, and not like that occurring
in Bright’s disease. 3. Though the stone was impacted half¬
way down the ureter, this tube was dilated throughout its
extent.

Mr. R. W. Parker read a paper on a case of Suppression
of Urine, following injury to a sacculated kidney containing
calculi, the other kidney being entirely disorganised.

S. C.-, aged thirteen, a well-built boy, fell over some steps

and struck his right side in the region ot the kidney. Up to
this accident he was said to have been quite well. The fall
caused him great pain, and he bad some difficulty in getting
home. He went to bed, and remained there for some days.
Two days after the accident the boy “ passed blood instead
of urine.” He vomited frequently, and suffered conaiderable
pain at intervals, and the urine continued to contain blood.
At tbe end of a week he appeared to have regained his usual
health, but his symptoms all recurred at the end of another
week, and he was brought to the hospital, where he re¬
mained three weeks, and was then discharged apparently
well. Examination at this time failed to detect anything
abnormal with or about the kidney. He had some slight
pain from time to time, and for two or three days
after admission the urine contained blood. In ti?o months’

"fflgitized by GoOgle

626 The Lancet,]

MEDICAL SOCIETY OP LONDON.

[March 26,1887.

time the boy was brought back to the hospital, with recur¬
rence and aggravation of fell bis symptoms. It was then
elicited, after closely questioning his mother, that the lad
had had similar but less pronounced symptoms for twelve
months past. On his readmission lie was found to have a
large, tense, elastic swelling in the region of the right
kidney, extending as far, forwards as the umbilicus. This
was diagnosed as a traumatic hydronephrosis, and was
tapped several times on account of the pain and discomfort
which it caused. As it refilled rapidly, it was exposed in
the loin and a free incision made into it. During the first
five days in the hospital the boy passed an average of
forty-five ounces of urine; in the next four days this
average fell to thirteen ounces a day; on the tenth day only
one ounce was passed. Unmistakable signs of uraemia now
set in, and the boy died four days subsequently. The post¬
mortem examination showed that the left kidney was quite
disorganised, and converted into a mere sac,in which one large
and several small calculi were found. The right kidney (the
injured one) was greatly hypertrophied; the calyces were
much dilated, in one of these a large calculus was found,
and in others smaller calculi. A small calculus was found
in the right ureter, at the level of the brim of the
pelvis. The author remarked on the awkward nature
of the hydronephrotic sac as a complication; it pre¬
vented the finger reaching the front of the kidney,
and the examination of the pelvis and ureter through
the incision in the loin. It was thus impossible to make
unite sure of the diagnosis. Calculus was suspected and
the kidney was punctured in several places without result.
When the urine diminished in quantity, less import¬
ance was attached to this fact than it merited, judged in
the light of the post-mortem evidence; it was thought the
urine found its way into the hydronephrotic sac, and that
the diminished quantity, voided per urethram, repre¬
sented the product of the other kidney. The treatment
adopted was referred to, and the question was raised
whether any surgical treatment directed through the loin
could have dealt with this case successfully.

Mr. Bellamy showed a specimen taken from a young man
aged twenty-three. In this case it was difficult to reach the
kidney, and altogether the case had considerable resemblance
to that described by Mr. Parker.—Dr. S. Coupland said
that the paper by Mr. Godlee raised questions of much
moment in renal pathology. Was it possible that disease
about one kidney could determine suppression of function
in the other, presumably healthy, kidney. He inquired for
further information as to the amount, of disease found in it.
Any irritation in the body would have a greater effect on a
kidney which was the seat of some morbid change. The
fact that the “good” kidney was slightly cystic and the seat
of a little interstitial nephritis would predispose it to cease
secreting. He inquired on which side of the body the
patient experienced the last attack of renal colic preceding
suppression of urine. He ventured to question, in view
of the variety of clinical aspects of urjemia, whether it was
not too much to endeavour to distinguish between the
obstructive and rmn-obstructive kinds by a reference to mere
symptomatology.—Mr. W. A. Meredith thought that the
case illustrated the advantages of performing an abdominal
exploration before determining on a lumbar incision. It
might have been possible to have felt the stone in
tho right ureter.—Mr. Howard Marsh said that it must
be admitted that in the three cases mentioned a defective ;
diagnosis had been made. He thought that this circum- 1
stance, amongst others, was an argument in favour of
an abdominal exploration. One point, in renal surgery
seemed to be coming to the front; that many stones
were not to be reached from the loin. Our progress
seemed to be in tlie direction of admitting the wisdom of
an abdominal examination. Reference was made to the
cise read by him before the Clinical Society. 1 —Mr. A. A.
Bowt.dy raised with Dr. Coupland the question whether
disease of one organ could cause suppression of urine in a
sound kidney. He related the case of a man who sustained
an injury in the loin, which was followed by sickness and
hsematuria. A urethral stricture gave some trouble at
first, but after the catheter was tied in complete suppression
of urine for thirty-six hours followed, and but twelve ounces
were passed in the next twelve hours. The urine was then
healthy, and had not a faint trace of albumen. As bearing
on the question of tbe influence of injury on a subject

' TlTK L.VXCKT, p. 289.

affected with Bright’s disease, he mentioned the case of a
man who had a compound fracture of the tibia, and died
soon after. It was found that there was evidence of chronic
interstitial nephritis, on which an acute suppurative
nephritis had supervened, probably as the result of the
severe accident.—Dr. R. IX Powell inquired what was the
cause of the perinephritic abscess. Seeing that a perinephritic
abscess existed, he asked whether it would be good surgery
to attack it through the median line of the abdomen.
He considered it would be bad surgery, from a physician's
point of view, to perform the abdominal section in,ihe pre¬
sence of urine albuminous and containing casts. lie also
considered that it would be practically impossible to deter¬
mine the state of the parenchyma of the kidney by mere
palpation, or indeed by any other method of physical exami¬
nation.—Mr. A. E. Barker rather agreed with the views of
Dr. Powell, and especially in the case of a perinephritic
abscess. If a stone be impacted in the upper part of the
ureter, and could be returned to the pelvis, a nephro¬
lithotomy from the loin would still be necessary. In many
advanced cases the lumbar nephrotomy would be most
suitable. But he did not deny that there were cases in
which the abdominal section would be not only justifiable,
but more advantageous. The case of a young woman was
narrated in which a stone was removed by the lumbar opera¬
tion from the infundibulum of the renal pelvis; but it
appeared that the stone had been there so long that it had
led to an apparent cicatricial thickening of the upper
end of the ureter; a permanent lumbar fistula was neces¬
sary. The patient remained well and suffered no dis¬
comfort. — Mr. Meredith said he only advocated ab¬
dominal exploration as a means of diagnosis. — Mr.
Barwell remarked on the importance of estimating tbe
amount of urea discharged daily. Important information
might thus be gained, and might be of service in determining
the advisability of operation.—Dr. Osier Ward said that
much valuable information might be obtained by catheter-
ising the ureters, a method which would allow of the separate
examination of the urine discharged from each kidney.—Mr.
Godlee said there was some disease in the comparatively
healthy kidney, and he did not contend that disease about
one kidney could lead to cessation of function of the other
kidney if tho latter be perfectly sound. He did not venture
to say whether we dwelt too much upon the distinction
between obstructive and non-obstructive annria. The
stones in the kidney were the probable cause of the peri-
| nephritic suppuration. He considered that a hand in the
abdomen could not determine the healthiness of a kidney.
Reference was made to the invention some years ago of an
instrument shaped like a lithotrite for the investigation of
the urine from the ureters.—Mr. R. W. Parker said that in
his own case an abdominal exploration would have deter¬
mined the state of the diseased kidney. The stone, too, would
j have been detected in the ureter.

MEDICAL SOCIETY OF LONDON.

Incision of Swollen Optic. Xerve-sheath.—Solvent Treatment
of Renal Calculus. — Intussusception.—Congenital Defect
m Diaphragm.

An ordinary meeting of this Society was held on Monday
last, Dr. Hughlings Jackson, P.R.S., President, in the chair.

Mr. Brudenell Carter road a paper on a case of Swollen
Optic Disc, in which the sheath of the optic nerve was in¬
cised behind the eyeball. After alluding to the attempts of
De Wecker and Power, he discussed the pathology of
swollen optic nerve, and contended that it was primarily
dropsical and only secondarily neuritic. -lie considered that
there was a descent of fluid from the subarachnoid space to
the space between the dural and pial sheaths of tho optic
nerve; the nerve was compressed by the fluid and the venous
circulation was impeded. The results varied in different
cases. Mr. Carter contended that incision of the nerve-
sheath and evacuation of the contained fluid, if accom¬
plished at or before the commencement of impairment
of vision, would save the patient from blindness. The
case related was that of a young woman who had
impaired sight and headache of ten days’ duration. The
left optic disc was much swollen. Under iodides and
mercury no improvement resulted. The disc swelled still
more; haemorrhages and patches of exudation also appeared;
and, with the assent of Dr. Hughlings Jackson, Mr. Carter

Thb Lancet,]

HAKVEIAN SOCIETY.

[March 20,1887. 627

decided upon an operation which he first practised on the
dead subject. The external rectus muscle was divided; the
eyeball then rotated inwards; the sheath of the optic nerve
was exposed and opened, and gave exit to the contained
fluid. Recovery was uninterrupted, the patient was at once
relieved of headache, which did not return for a month, and
in ten days after the operation the swelling of the optic
disc was found to have diminished by one-naif. Further
recovery has resulted. Mr. Carter claimed that the opera¬
tion could be performed with certainty and without danger,
and he urged its adoption in all cases of cerebral
disease in which sight was beginning to be impaired.—
Dr. Hughlings Jackson remarked that the case was of
great interest because of the monocular optic neuritis and
of the blindness of the temporal half only of the visual
field. He expressed his approval of the operation in the
case mentioned, and considered it resulted in a great suc¬
cess.—Mr. J vl.es. was much interested in the operation, and
congratulated Mr. Carter on the result.—Mr. Astley
Bloxam thought that opening the sheath of the optic nerve
might act as a drain on the subaraclmoid space in coses of
tubercular meningitis associated, or not, with optic neuritis.—
Dr. JJbrringham inquired whether Mr. Carter would operate
on cases of uraemic neuritis.—Dr. S. West asked whether
the operation would be performed on one or both sides in
cases of double optic neuritis, and whether many cases of
optic neuritis became blind.—Dr. Ormerod spoke of the
effect of this operation on the actual cerebral condition:
the headache appoared to be relieved in the case related.
The operation might be beneficial in preventing blindness in
those cases which ultimately recover from the disease which
caused the optic nerve swelling.—Mr. B. Carter considered
tbut true neuritis could not exist without affecting the
function of the optic nerve. He would not be disposed to
iucise the sheath in cases of granular kidney, nor in other
cases unless there was defect of vision.

Dr. Raue exhibited a specimen of Renal Calculus passed
after six weeks of solvent treatment. It was oat-snaped,
eroded on the surface, measuring one-third of an inch long,
and weighing-three grains and a half. It was composed
chiefly of oxalate oflime, with a few crystals of uric acid
scattered over the surface. The remedies employed con¬
sisted of lithia and turpentine in a mixture, with Dover’s
powder at night. The patient was also directed to drink at
least three pints o filtered rain-water daily. Under this
treatment the urine, which at first had a specific gravity of
1025 and contained much blood and pus, became clear, and
the specific gravity fell to 1014, whilst the attacks of colic
diminished. Dr. Ralfe’s method differs from that proposed
by Sir William Roberts, in that he does not seek to diminish
the size of the calculus by chemical solvents—a doubtful and
difficult process,—but by checking its growth, by keeping
the specific gravity of the urine low, and also by diminishing
existing pyelitis to allow free passage to the concretion.
Dr. Ralfe observed that there are many calculi small enough
to easily slip down a ureter, but are prevented by the swollon
condition of the orifice. He illustrated this by a specimen,
which had been retained for several days, owing to the patient
suffering from gouty pyelitis, though the concretion was quite
minute. As soon as the pyelitis was relieved the calculus
passed easily. In addition to distilled water and turpentine,
Dr. Ralfe spoke highly of benzoate of lithia or potash. He
*dvises recurrei'oe to this mode of treatment: 1. When the
calculus is recently formed and is still small, and is retained
chiefly by the swollen condition of the mucouB membrane
of the pelvis of the kidney. 2. In recurrent calculi, the
pisiform concretions of elderly people. In these cases the
calculi passed before the administration of the remedies are
about the size of a pea; after, they diminish to that of a
mustard-seed (specimens shown), or cease altogether. 3. In
cases when, owing to the obesity of the patient or broken
health, nephro-litnotomy is not advisable. In these oases
we may hope the distilled water may in time lead to the
disintegration of the calculus, as in a case recorded by
Dr. Ralfe; 1 whilst the terebinthine remedies undoubtedly
diminish the pyelitis and the tendency to colic.—Dr. M aguxrb
considered that it savoured of the irrational to send patients
to foreign spas when so much could be done for them at
home by the employment of distilled water which contained
no salts, and therefore would presumably have a greater
solvent action on. stone than waters impregnated with salts.
—Mr. F, B. Ja^OJXT said that larger stones had been passed

. '• - — -

KUKuijfcMagfcnl Society’* Transection*, vol. xxxiii.

without the treatment, which benefited rather by its
diluent than solvent action.—Dr. Ralke said he did believe
in a solvent action, and he attached considerable importance
to the treatment of pyelitis.

Dr. W. H. Allchin showed a specimen of Intussusception
removed from a male infant aged six months. The tumour
was of the size of a Cambridge sausage ; the jejunum was
drawn down so as to be close to the intussusception, which
had descended into the rectum. There was a second dupli¬
cation of the colon, doubtless secondary in time to the
primary intussusception.

Mr. Astley Bloxam showed a specimen of Congenital
Opening in the Diaphragm in an infant aged three months ;
it was situate near the left external arcuate ligament. The
left lung had never been expanded; chronic vomiting led to
exhaustion. He also showed a case of Plastic Surgery in
which a new mouth had been formed.

HARVEIAN SOCIETY.

Hctirpation of the Axillary Glands: a necessary accom *
paniment of removal of the Breast for Cancer.

At the meeting on March 3rd (Edmund Owen, M.B.
F.R.C.S., President, in the chair), the sitting was occupied
by a discussion on the above subject.

Mr. Mitchell Banks, in opening the debate, laid before
the meeting a printed table showing the results of his
practice in eighty-two cases. The complete operation as
advocated by himself was indeed a very severe measure,
and its mortality was very considerably in advance of that
of the old incomplete method, in which the axilla was not
opened. At the same time, however, his table showed that
the duration of life was prolonged, and the recurrence of
cancer less seldom occurred; and these results justified tho
greater risk to which the patient was exposed. The old
incomplete operation he condemned as unscientific and
useless. He laid great stress on not allowing the chest
wound to remain exposed while the axilla was being cleared,
but advocated closure of the wound from below upwards as
the operation proceeded; the glands should best be rendoved
by the knife, but enucleated with the aid of the fingers and
two pairs of forceps. He did not hesitate to tie and remove
portions of the axillary vein, if this last vessel interfered
with complete removal of the glands.

Mr. Bryant thought the operation advocated a very
severe one, and its results, as shown by Mr. Banks’ tables,
disappointing. Theoretically, the complete operation was
all that could be desired, but in practice he felt that it was
open to criticism. In ordinary cases it might be right to
perform the complete operation, but in some cases—e.g., in
aged women with ulcerating cancers, and in feeble women
possessed of only moderate powers—the incomplete one was
justifiable. Speaking from his own experience, the mor¬
tality of the complete was but little over that of the incom¬
plete operation. It would seem that the average duration
of life after the severe operation was not much greater
than after the milder procedure. Statistics showed that
after the incomplete operation one-third of the cases lived
for six years, and 25 per cent, for ten years and more. It
might fairly be questioned whether the complete gave really
better results; and, if not, was it justifiable to submit every
patient to the greater risk? In his opinion, unless the
glands could be easily felt, it was wisest, in dealing with
aged or feeble patients, not to open the axilla. He approved
of Mr. Banks f plan of closing the wound from below
upwards as he proceeded, and likewise of his method of
enucleating the glands in preference to removing them by
section. No harm came from interference with the axillary
vein, though ho had only once had occasion to tie that vessel
in the course of the operation.

3£r. Pick did not agree with Mr. Banks in his opinion that
the operation for removal of the breast for cancer in the
usual manner—by the method which Mr. Banks was pleased
to call the “incomplete” method—was “useless or worse
than useless,” even though it did not prolong the patient’s
life by a single day. It freed the patient from the oppression
of a disease which she knew was rapidly approaching a
fatal termination, and gave her the chance, and certainly
the hope, of immunity from recurrence. It afforded her an
interval of health and freedom from pain, instead of a life
of anxiety and Buffering, and in a certain percentage of
cases the cancer returned in some internal organ and

r-\: _ :.: . I

028 The Lancet,]

MANCHESTER PATHOLOGICAL SOCIETY.

[March 26, 1887.

afforded the patient a quiet and comparatively painless
death, instead of the horrible suffering which an open cancer
too often entailed. With regard to the “ complete ” opera¬
tion of Mr. Banks, Mr. Pick quite agreed with him that the
removal of the disease should be most thorough, and that, in
order that this might be so, no heed should be taken to pre¬
serve sufficient skin to form flaps to cover the gap left, but
that, if necessary, the sore should be left to granulate as an
open wound. But he was not prepared to agree with
Mr. Banks that clearing out of the axillary space was either
necessary or judicious. The proceeding added very materially
to the danger of the operation, as shown by Mr. Banks’
tables; and in his (Mr. Pick’s) experience it was only in a
small percentage of cases that the disease recurred in the
axillary glands, the cicatrix remaining healthy. He there¬
fore regarded the proceeding as unnecessary, and it was also
injudicious as adding to the mortality. Mr. Pick was in¬
clined to attribute the success which Mr. Banks had obtained
rather to the very free removal of the breast and surround¬
ing tissues than to the extirpation of the axillary glands.

Mr. Butlin said that in the discussion on Dr. Gross’s

S , during the meeting of the International Congress in
in, he had been inclined to take a similar view to Dr.
Gross and Mr. Banks with regard to the removal of cancer
of the breast. Since that time, however, he had made a very
careful study of the natural history and course of cancer of
the breast, and of the cases published by the author of this
paper, ana bad come to the conclusion that the very free
removal of the mamma and opening of the axilla, recom¬
mended by Mr. Banks in every or nearly every instance of
cancer of the breast, is an unsurgical and unscientific pro¬
ceeding. Besides several minor propositions, Mr. Banks had
put forward two main propositions: that the operation
should include the entire mamma with the overlying skin
and parts beneath in all cases, and that the axilla should be
opened, whether enlarged glands could be felt in it or not.
Mr. Butlin dissented from both propositions. From the
first, because the operation bore no direct relation to the ex¬
tent of the disease. Tbe tumour was often of small size, and
situated in the inner or the lower segment of the breast, and
the incisions, instead of being carried equally far from it in
every direction, were perhaps three icnhes from it in one
direction, and less than one inch in other directions. Cancer
of the breast must be treated in the same manner and on the
same principles as cancer of the lip and similar parts ; very
free removal of the disease, the surrounding textures, the
overlying skin, and the fascia over the muscle, if need be;
but not removal of parts which were not, and probably
never would be, affected. With regard to the second pro¬
position, most surgeons were agreed that the glands in the
axilla should be removed if they were enlarged and could bo
taken away. Mr. Butlin would go so far as to open the axilla
in cases in which an indefinite fulness could be felt. But he
would not open the axilla in other cases. He had collected
notes of 101 cases in which the axilla had not been opened,
and 209 cases in which the glands had been removed. The
mortality in the first set was 10 per cent., the proportion of
women alive and well at the end of three years, 18 per cent.
The mortality in tbe second set was20 percent.; the number
of women remaining well at the end of three years about
5 per cent. The cases in which there was no affection of
the glands, and in which the axilla had consequently not
been opened, were by far the best cases for operation, not
only on account of the less severity of the operation, but
because the disease was less malignant.

Mr. Harrison Cripps thought the profession was much
indebted to the persevering manner in which Mr. Banks had
brought the subject of the removal of the axillary glands
so prominently forward. Though he would not like to make
an arbitrary rule that they should invariably be removed, he
agreed that in the majority of ’cases such treatment was
indicated. The question to some extent turned on whether
or'not the opening of the axilla and removal of the glands
added greatly to tbe danger of the operation. According to
the experience of St. Bartholomew’s Hospital this did not
appear to be the case. In the five years from 1863 to 1867,
at a period when it was the exception rather than the
rule to open the axilla* the mortality after amputation of
the breast was as near as possible 11 per cent. Owing,
however, to improved methods Sad- b ett o r sanitary con¬
dition of ^the hospital* ^^^trtalityMuring

moreover, during half the

oases the axillary glanffi TuflTwWYlW *i In the last

year’s reports it is especially noted that of thirty-eight cases
of amputation of the breast for cancer, in nineteen the
axillary glands were also removed, but the rate of mortality
was exactly the same—viz., one death in the nineteen cases
in which the glands were untouched, and one death in the
nineteen cases in which the glands were removed. The high
rate of mortality in Mr. Banks’ cases appeared to be entirely
due to blood poisoning, the result of insanitary surroundings.
Mr. Cripps considered that in operating for breast cancer the
free removal of skin over the tumour, although it might
appear to be supple and not complicated at the time of
operation, was of the utmost importance, for it frequently
happened that recurrence took the form of cancerous nodules
in the skin bordering on the cicatrix, and that this phe¬
nomenon showed how often the skin was really infected, and
should have been freely removed at the original operation.

The President expressed surprise at the amount of op-

S oaition which the important paper, just read, had elicited.

[e was under the apprehension that surgical opinion was
steadily drifting in the direction of opening the axilla and
enucleating all discoverable lymphatic glands, whether de¬
finitely implicated or not. Often it was impossible to say
whether there was axillary invasion or not until the armpit
had been opened up. Clearing away the glands was a
desirable measure, in that it diminished the risk of subse¬
quent pressure (from secondary malignant enlargement)
upon the axillary vein and the cords of the brachial plexus,
thus obviating, as he believed, the oedema and neuralgia of
the arm so often met with when the glands were left un¬
touched. Probably, also, the removal of the glands might
be the means of checking a general invasion of the lymph
currents; the risk of remote infections was certainly less
if those centres of infection, the glands, were out of the
way. The operation was a severe one, but it had the
great recommendation of being thorough. He failed to
see how an operation for malignant tumour could be
complete which did not effect at the same time the can¬
cerous glands associated with that tumour.

Mr. Banks briefly replied.

MANCHESTER PATHOLOGICAL SOCIETY.

A meeting of this Society was held on Feb. 9tb, Dr. J.
Dreschfeld, President, in the chair.

Cystoma of the Ovary.—Mr. W. A. Stocks showed a
preparation of a cystoma about the size of an orange which
had passed down Douglas’s pouch, and had been extruded
through the anus, pushing the anterior wall of the rectum
before it. It had been successfully removed by operation.

Vesical Calculi— Mr. W. A. Stocks also showed thirty-
seven calculi which had been removed from the bladder of
a man by lateral lithotomy. Each original calculus contained
a minute millet-seed nucleus, around which had been
deposited some buff-coloured urates, showing a distinct con¬
centric arrangement, and having four or five lines of a much
lighter colour radiating from the centre to the circumference,
after the manner of those seen in the transverse section of
1 an orange, each stone being about three-eighths of an inch
in diameter. At this stage of their development many
these stones seemed to have undergone spontaneous division
through the lines above mentioned, forming a second series
of nuclei. Every stone had been covered with a thick layer
of phosphates, those of the primary series forming stones
three-quarters of an inch, and those of the latter series,
stones of about half an inch in diameter, irregular in shape
and furnished with a varying number of facets.

Mammary Tumours.—Dr. W. Thorburn exhibited a series
of sections of various breast tumours. He demonstrated
the varieties of cancer and their modes of growth, and
showed preparations illustrating every stage in the develop¬
ment of cysts and intra-cystic growths in non-cancerons
tumours. Among the rarer forms he showed a pure myxoma,
an adenoma without overgrowth of the connective tissue
elements, and a typical “ villous cancer.”

Intra-ocular Growth*.— Dr. Hill Griffith showed twelve
glycerine jelly preparations demonstrative of intra-ocular
growths and cyclitis, and mentioned the diagnostic appear¬
ances of sarcoma of the choroid, glioma of the retina, and
plastic cyclitis on the so-called pseudo-glioma.

Changes in the Spinal Cord and Peripheral Nerves aft' r
Amputation— Dr. E. 6 . Reynolds made some observations
on the changes in the nervous system after the amputation

O

The Lancbt.J

KB VIEWS AND NOTICES OP BOOKS.

[March 26,188?. 629

of limbs, showing a series of specimens from a case. Having
briefly referred to the history of the subject, and especially
to some recent observations made by Friedliinder and
Krause, he pointed out that the changes in the case which
he had investigated consisted in a simple atrophy of the
majority of the fibres in the nerve trunk of the amputated
leg, with increase of lymph spaces and connective tissue,
and that this change could be traced up to the cord,
principally in the posterior nerve root, but also in the
anterior nerve root. In the cord the changes were limited
to the lumbar region, and consisted of a slight decrease of
the posterior horns and columns, and a more marked decrease
of the anterior horns, affecting the number and structure of
the cells in all the groups, but especially in the postero¬
lateral and central groups. Clarke’s column was not
affected.

MIDLAND MEDICAL SOCIETY.

A meeting of this Society was held on March 2nd,
Mr. Lloyd Owen, F.R.C.S.I., President, in the chair.

Locomotor Ataxia with Joint Disease. — Dr. Suckling
showed a man aged forty-eight, who was suffering from
locomotor ataxia with disease of his knee-joints. He was
quite well up to twelve months ago, when he had attacks
of vomiting with shooting pains in the legs. Soon after he
complained of having girdle pains. The knee-joints began
to enlarge about nine months ago, there being pain only in
the left one. At the present time there is marked crackling
oq movement of each joint, with enlargement especially of
the internal condyle of the femur on both sides, and partial
dislocation outwards of the patella and tibia on the left
side, on which side there is also some genu valgum; there
is no excess of fluid in either joint. The knee-jerk is lost
on both sides, the pupils are unequal and respond to accom¬
modation, but not to light.

Tumour of Bladder treated by Supra-pubic Cystotomy.—
Mr. Bennett May reported this case, and showed the parts
removed after death, which took place six months after the
operation. In comparing the two methods of operating—
viz., by the median perineal and by supra-pubic cystotomy,
—Mr. May observed that the former was undoubtedly the
simpler And possibly safer operation, and was an excellent
means of exploring the bladder, whilst if. was also quite
adequate for the removal of some tumours. For the majority
of caees of tumour of the bladder, however, it was far inferior
to the supra-pubic operation, which gave opportunity for
inspection and more thorough manipulation within the
bladder. From the point of view, also, of the patient's sub¬
sequent condition, and for the purposes of permanent
opening for micturition, when, as so often happens, the
tumour cannot be removed, the supra-pubic operation was
infinitely preferable. He had found the perineal opera¬
tion a complete failure in relieving the patient’s sufferings
for any length of time; and for all cases of diagnosed
tumour he ehould operate by the supra-pubic method,
provided of course that the bladder could hold sufficient
water.

Periosteal Sarcoma—Hr. Jordan Lloyd showed a girl
aged eighteen who had developed a large malignant tumour
of the forearm, probably a periosteal round-celled sarcoma
of the ulna, with large ascending growths in the upper arm,
the axilla, and the subclavian triangle. The tumour in the
rorearm wa9 the first to appear, only fourteen weeks ago.
This was cat into for the purposes of diagnosis, and on
microscopic examination was found to be a small round-
wiled sarcoma. There was no history of malignancy or of
rojury. At the time of first seeing the case the disease
“od progressed too far to admit of removal.

fyury to Shoulder—Hr. A. F. Clay showed a man aged
wventy-seven who had fallen downstairs on this shoulder;
he was told by bis medical attendant that he had “ broken
his arm high up.” Three weeks after this Mr. Clay saw him,
and found his humerus and clavicle intact, but about an
inch and a half above the lowest part of the anterior
boundary of the axilla a round hard prominence the size of
a marble was seen and easily felt. It was then slightly
more tbe lateral than vertical direction. It
*oi!owed tfce movements of the humerus. Since then it has
absolutely immovable and is smaller. The coracoid
si ^ e not 80 as its

aiu) of |5ooks.

Lchrbuch der Chiruryischen Krankheiten des Ohres (Text- 1

book of the Surgical Diseases of the Bar). By Prof. Dr.

Hermann Schwabtzb. Stuttgart: FerdinandEnke. 1886.

Professor Schwartzk’b text-boek of aural surgery
deserves the attention of all otologists, not only as coming
from such a well-known writer, but also from the intrinsic
value of the work. To the practitioner who is versed in
otological subjects the book will derive its chief attraction
from the parts devoted to the newer operations on the
hearing organ, in which the author, besides collating the
most recent views of others, gives hie own extensive
experience. A few of these may be briefly noticed.

Division of the tensor tympani is, he says, a procedure
devoid of all practical value when employed for the relief
of deafness, tinnitus, or giddiness. He has never seen it
give any permanent relief to these symptoms, and cases are
recorded in which it has provoked an aggravation of the
same. As a preliminary operation in excision of the
hammer it is more likely to come into use.

Excision of the drumhead and ossicles forms the subject
of a very interesting chapter. Schwartze’s first attempt*
at excieing the drumhead and extraction of the entire
malleus in sclerosis date from the year 1S73; these failed
regularly, owing to rapid regeneration of the membrana
tympani. A method of preventing this regeneration was,
however, devised by Kessel, which is adopted by the author.
Sch wartze’s method of operating is as follows: The membrane
is divided close to its periphery, the “tendinous ring” being
also removed at the back part, according to Bessel's plan. The
tendon of the tensor tympani and the joint between the stapes
and incus are then divided. The membrane, together with the
malleus and incus, is now grasped with a Wilde’s snare and
removed by a fewcarefulto-and-fro movements. The chorda
tympani is necessarily stretched, but if it should be tom
across the loss of taste occasioned is usually only temporary.
The cases in which the operation is recommended are mainly
of two kinds: (1) Chronic suppuration of the middle ec.r,
with caries of the ossicles, and cases of cholesteatoma of the
tympanum; (2) Immobility of the malleus, caused either by
total calcification of the membrana tympani or by ankylosis
of the malleo-incudal joint, it having been previously care¬
fully ascertained that the labyrinth is unaffected, and (by
exploratory puncture of the drumhead, &c.) that the stapes is
movable. Six cases briefly described by the author show the
practicability of thb operation, and that in some cases it is
capable of relieving the tinnitus; the improvement in the
hearing power gained, however, wa3 not marked. On the
whole, the results of excision are more favourable in suppu¬
rative cases or when there has been previous suppuration,
than in cases of sclerosis.

We have dwelt at some length on this operation on ac¬
count of its novelty, but there are many other parts of the
book which deserve mention, notably the chapter on disease
of the mastoid, a subject with which the author’s name is
inseparably connected. Without agreeing with all Professor
Schwartze’s statements, it may be said that the whole
volume is replete with interest to the student and prac¬
titioner of aural surgery, and forms a valuable work -of
reference. It is liberally illustrated ; some of the figures we
recognise as coming from the author’s “ Pathological Ana¬
tomy of the Ear.” _

Diseases and their Commencement. Lectures to Trained
Nurses.. By Donald Hood, MJ>. London: 1. and A,
Churchill.

Dr. Hood has in this small but useful work brought
under the notice of nurses the fundamental facts con-*
nected with the causes, prevention, pathology, symptom*,
and nursing treatment .of a variety of disea--The five

Digitized byVjUU^LA.

fl30 The Lancet,]

Laparotomy for gluteal and sciatic aneurysms.

[March 26,1887.

lectures of which- it is composed are expressed in & simple
and graphic style, which renders them as interesting as they
are instructive. Lecture I. deals with general physiological
considerations, and impresses the paramount necessity of
cleanliness and ventilation. In Lectures II. and III. inflam¬
mation in various situations is clearly though shortly dis¬
cussed. Fever forms the theme of Lecture IY., while Lec¬
ture V.is devoted to the study of certain prominent symptoms,
not so much with a view to diagnosis as in order to show that
different causes may lead to the same condition, and to teach
the unwisdom of too ready interference. Such practical
matters as poulticing, disinfection, diet in typhoid fever, ven¬
tilation,&c., are treated in a judicious and careful manner. In
speaking of temperatures, we observe that Dr. Hood places
the normal heat of the body at OS^ 0 . Though not a great
matter, it would be well if this figure were changed to 98 - 4°,
the standard generally accepted. The book as a whole is
likely to prove helpful to nurses by increasing their know¬
ledge of the reason and purpose of their duties.

A Junior Course of Practical Zoology. By A. Milnbs

Marshall, assisted by C. Herbert Hurst. Pp. 440.

London: Smith, Elder, and Co. 1887.

Although this handbook is entitled “ A J unior Course of
Practical Zoology,” it is one that might with advantage be
worked over by many men who consider that they possess
something more than a rudimentary knowledge of biology.
As the author observes, a student who works conscientiously
through this book will acquire a good insight into the
leading facts of animal structure and a technical know¬
ledge of the principal methods of research. The book is
divided into chapters, each of which gives the characters of
a representative of one of the typical groups of the animal
kingdom. Thus, we have the amoeba, the hydra, the liver-
fluke of the sheep, the leech, the earthworm, the freshwater
mussel, the edible snail, the crayfish, the cockroach, the
lancelet, the dogfish, the rabbit, and the fowl. In each ca3e
the several parts of the animal are described ju9t os it might
be by an intelligent teacher who, with knife or scissors and
forceps in hand, was demonstrating the parts to a class.
The descriptions seem to us to leave nothing to be desired.
Mr. Marshall has had largo experience in teaching, and
avoids the mistake of being too prolix with young students.
A few illustrations are given, but are not intended to super¬
sede the sketches that should be made by the dissector.
Directions are given in regard to the mode in which the
dissection should be pursued. We venture to think that in
our large public schools one afternoon in the week might
be surrendered to natural science, and that those who
exhibit a taste for zoology should be encouraged to hunt for
specimens of the animals here described, and to dissect
them with the book before them. It would be, we suspect,
the most popular afternoon in the week, and would bo a
welcome change from the dry routine of Latin and Greek
as at present taught.

Hdu Jfnkntious.

SEWER-AIR DESTRUCTOR.

'■la. G. R. Reeling has sent us an account of an invention
for destroying the air from sewers, and for promoting in
them at the same time a current which would ensure their
ventilation. The apparatus is a column to be placed over
the sewer, and which could be used as a lamp standard;
within it is situated a large gas-burner, which not only
induces an upward current, but is said to consume all the
air which passes through it. Mr. Keeling claims that some
thousands of cubic feet of noxious gases can thus be
extracted hourly from any sewer, and fresh air drawn into
it. The amount of gas which is consumed is not, however,
mentioned; but, if this be not great, it is likely that his
invention will be of practical value.

AN IMPROVED CATGUT-HOLDER.

Messrs. Joseph Wood & Co., of York, have submitted
to us an improved catgut-holder, which has certain excellent
features. A reel of prepared catgut is enclosed in a glass
vessel of oil, which is securely sealed at the top. One end
of the catgut is brought out through a very small hole in
the centre of the sealed top, but the aperture is so arranged
that no oil leaks out, and there is no tendency for the end
of the catgut to slip back into the bottle. By this means the
catgut is well preserved, and as much as is required can
very easily be at any time removed. The bottle seems to
answer its purpose well.

LAPAROTOMY FOR GLUTEAL AND SCIATIC
ANEURYSMS.

The treatment of gluteal and sciatic aneurysms is attended
with many difficulties, and cannot be considered as satisfac¬
tory. Dr. F. S. Dennis of New York has recently published
a paper containing reports of three cases of the kind, which
were treated by laparotomy and ligature of the internal
iliac artery in the pelvis. The ligature of the internal iliac
artery has been attended with a liigh rate of mortality -
70 per cent.,—the causes of death being secondary haemor¬
rhage, urtemia, and various septic inflammations. In some
cases the operation has been attended with very considerable
difficulty. Dr. Dennis proposes to obviate these dangers by
opening the abdominal cavity in the middle line, turning
out the omentum and small intestines, and then, having
clearly defined the artery, to divide the peritoneum over it
and pass a ligature: the whole being conducted with
stringent antiseptic precautions. He has himself practised
this treatment in two instances. The first case was one of
double gluteal aneurysm in a woman sixty years of
age; both internal iliac arteries were tied; the patient
died on the fourth day from suppression of urine. His
second case was in the person of a girl eighteen ■ years of
age with what appears to have been aneurysmal varix of
the left buttock, the evidence given in the paper not
showing that there was any aneurysm proper; the internal
iliac artery was tied, and the patient made a good recovery,
the only complication being albuminuria for the first two
days. A third case in which the same operation was per¬
formed is related by Dr. Dennis; it occurred in the practice
of Dr. Locke Chew, in the person of a negro forty-six years
of age, in whom a spontaneous gluteal aneurysm developed;
the internal iliac artery was tied, and the patient made
a good recovery. There are three quite distinct points
which must be kept separate in estimating the value of
Dr. Dennis’s suggestion, which has the support of ut
least two admirable cases. The first of these is the pro¬
priety of ligaturiug the internal iliac artery for gluteal and
sciatic aneurysms; of this there seems no room for doubt,
the Hunterian operation offers a better prospect of cure
than any other known means. The second is the value of
antiseptic surgery in this operation; the almost entire
freedom from suppuration obtained in these three cases is
the result of that, and not of the mode of operating, and
there can be no doubt’that the operation performed without
opening the peritoneal cavity would give very different
results in the hands of careful antiseptic surgeons from
those hitherto obtained. The third point is the most con¬
venient and best way of reaching the artery. Three ways u
least suggest themselves—the old retro-peritoneal operation,
laparotomy without removal of the intestines, and laparotomy
with removal of the intestines. Dr. Dennis is very emphatic
that “laparotomy in no way increases the danger of the opera¬
tion, and that it is of very great advantage to remove the in¬
testines from the abdominal cavity, as this gives the operator
an easy access to the artery.” On both these points there i«
room for difference of opinion, and we must await further
experience before a definite opinion can be expressed. In
any case Dr. Dennis’s paper is a valuable contribution t
surgery. We could have wished for fuller details than are
given in the report, especially with regard to the condition of
Dr. Dennis’s second case, the account of the symptoms of
which is meagre. .

Thh Lancxt.J

THE COLLEGES AND THE SOCIETY OF APOTHECARIES. [Mabck 36,1887. 631

THE LANCET.

LONDON: SATURDAY , MARCH SG, 1887.

Titr breach between the conjoined Colleges and the
Society of Apothecaries continues to widen. In spite of
numerous efforts to adjust the differences between these
bodies, there is no diminution in the obdurate resistance
with which the very reasonable desires of the Society have
hitherto been met. The late resolution of the General
Medical Council earnestly advising the Colleges to recon¬
sider their position and come to an agreement has,
notwithstanding the zealous support of the direct repre¬
sentatives of the great body of medical practitioners,
effected nothing in the way of reconciliation. On the con¬
trary, it has, like every other effort in the same direction,
served only to strengthen the resistance opposed by the
Councils of the Colleges to any arrangement with the
Society of Apothecaries. Though stated in terms of studied
moderation, while at the same time clearly expressing the
wish of the General Medical Council, the request has met
with an unqualified refusal. We shall, therefore, in all likeli¬
hood find ourselves involved, perhaps more deeply than ever,
in those very difficulties which it is the object of the Conjoint
Scheme to remove. The Colleges and the Hall will henceforth
be driven to compete with one another. A diploma, one of
the far too numerous minor medical qualifications, will be
invested with increased powers, and, for anything we can
see, with increased popularity. Such a result, as is now
sufficiently well known, is viewed with lively and natural
apprehension by the great body of alumni of both Colleges.
They foresee that the contest is fraught with possibilities of
evil for the contemplated new London degree. The latter
must in any case hold its own with the similar qualifica¬
tions of existing universities, and it should by all means be
spared the opposition of the remodelled diploma of the
Apothecaries. It is somewhat difficult to ascertain the indi¬
vidual opinions of the members of the Comitia of the Royal
College of Physicians on account of the secrecy which
attends their deliberations. A greater degree Of publicity
would probably better subserve the interests both of
the public and the College. We have reason to l>e-
lieve, however, that some of the Fellows do not even
admit the probability of competition between the conjoint
qualification and the licence of the Society. In their
eyas the former is a thing by itself; it has no relation
to any other diploma, consequently any suggestion of
rivalry between it and the licence is out of the question.
To reason thus may be logical after a fashion, but it is not
practical. Whatever the authorities of the College may
think, an actual competition between the two qualifies^
tioas must be one result of their short-sighted and ill-
•dvised policy—a result the significance of which cannot
to ignored. The Society is determined to exert its right
in order to obtain the requisite powers of exa-
surgery.' There is little, indeed no, doubt that
be granted, add there is an absolute oer-

tainty that the influence of competition thus awakened will
tell seriously against the work of the Colleges themselves,
without in any way adding to the public good. As
regards the general population, indeed, the prospect rather
is that the exclusion of the Apothecaries’ Society may
become a disadvantage, which would be avoided by
the adoption of an opposite course. When the powers
applied for by the Society have been acquired, and a new
classof practitioners (capable as regards the fulfilment of
every legal condition, but with an admittedly lower quali¬
fication) is annually sent forth into professional life, we shall
understand how sorely the cause of medical education has been
wounded in the house of its friends, and practitioners will
note bow little their interests are considered by the Colleges
of Physicians and Surgeons. The alternative policy should
have been by no means difficult of adoption. AH that is
asked for on behalf of the Society of Apothecaries is the
privilege of examination in certaia-sabjecta^-botany, phar¬
macy, and chemistry—which it may fairly claim, as natural to
its pro rince. The demand is a very moderate one. Its refusal
is most unwise as well as illiberal, and we doubt much if the
medical world in yean to come, when it has to deal with the
hydra of multiple qualifications, will readily forgive those
who in our time are carelessly tossing aside the golden
opportunity of curtailing that evil, at least in London. It
is exceedingly doubtful whether the same question which
is pressing for solution in Ireland will be settled otherwise
than it is likely to be in London. In the interest of medicaS
education and practice we hope for it a happier fate.

Bx degrees London is being cleansed of its- soresthe
worst areas are being gradually cleared, and are 1 being
replaced by dwellings which, if not wholly free from
objection, are a very distinct advance upon these which
they replace. In no district of London has greater or better
use been made of the legislation which dates from the year
1876 than in St. Giles’s, where, thanks to the efforts of da
able officer of health and a public-spirited vestry, changes
have been brought about which have raised one of the most
insanitary districts of the metropolis to a position wbieh is
very different from that it formerly occupied among other
metropolitan parishes. The work of improvement has not
been done without cost to the metropolis, but London will
gladly bear the expense which has been incurred, for its
prosperity is largely dependant upon the- health of ltd
inhabitants. London, however, is now represented by thfe
Metropolitan Board of Works, and it is no secret that this
Board does not regard with unmixed satisfaction the
expenditure of large sums of money upon the removal of
conditions which are prejudicial to healths Improvements
of main thoroughfares, which all the world ean set and
admire, are more readily undertaken than those of some
hidden area, which are, as a rule, known only to its own
denizens and the few officials whose dnties require them
to be intimately acquainted with its evils.

Of this tendency there has been reoent example. The
Shelton-street area was reported by Mn S. K. LovUtt,
Medical Officer of Health of St. Giles’s, tb the Metropolitan
Board of Works in 1883, under the Artisans and Labourers’
Dwellings Improvement Act, 1875, but it was not until acme
nine months later that a Committee of-this iv^d visited

632 The Lancet, 1 SIR RUTHERFORD ALCOCK ON HOSPITAL SUPPORT AND THE JUBILEE. [March 26,1887.

the spot, and then only with the result that they declined to
prepare a scheme for its improvement; but the St. Giles’s
Board persevered with their intentions, and communicated
to the Home Secretary a copy of the medical officer’s report.
In the beginning of 1885 an inquiry was held by order of
the Home Secretary into the correctness of the report, and
subsequently Lord Cnoss himself inspected the site. The
outcome of these proceedings was that the Metropolitan
Board of Works were required to prepare a scheme, and
the official inquiry which was held in consequence termi¬
nated last Saturday.

The nature of this investigation was such as to sadly per¬
plex anyone not conversant with English procedure. The
Commissioner, Mr. Cubitt Nichols, who was appointed by
the Home Secretary to conduct the inquiry, was himself the
official who had advised the necessity for the Metropolitan
Board to prepare the scheme, and the authority whose duty
it was to adduce evidence on behalf of its confirmation
was the very Board which had previously declined to move
in the matter. Notwithstanding these anomalies, the neces¬
sary facts were elicited, and no doubt can exist in the mind
of anyone who heard the evidence, or who had inspected the
site, of the urgent need for its improvement. The condition
of the houses, the absence of sufficient back space, the
impossibility of their ventilation, as well as their faulty
arrangement, make it no matter for surprise that disease
was rife among the inhabitants. In the four years from
1882 to 1885 the death-rates had ranged from 32-5 to 51 ‘9
per 1000 of population, and an analysis of death-rates led
to the same conclusion—that the area was unhealthy in a
high degree, and that nothing short of its complete clearance
would afford an effectual remedy.

The scheme which the Metropolitan Board have submitted
for approval is by no means the best that could be designed.
The desire to minimise the cost of the undertaking has, we
believe, led them to hinder for many years to come the full
changes Which are distinctly needed. It is within the pro¬
vince of the Home Secretary to improve the plan proposed,
and we trust he will do so with no illiberal hand. The
enormous expense to which London is put through out¬
breaks of infectious disease is perhaps no concern of the
Metropolitan Board, but is of vast importance to the rate¬
payers. To the steps already taken by Mr. Lovbtt and the
St. Giles’s Board of Works is greatly due the freedom from
typhus lever which London now enjoys. In past years
St; Giles’s was again and again the centre from which this
disease spread to other parts of the metropolis, and the
money spent in improvements of the district has already
made ample return in leading to the disappearance of this
serious cause of mortality. But this is not all. It must
mot be forgotten that high rates of general mortality are
accompanied by high rates of sickness, and that sickness
amongst the poor is attended by increased expenditure in
poor relief. The interests of the ratepayers are, therefore,
best consulted by. the removal of those causes which tend to
produce ill-health and its companion, poverty,
i- It may be hoped that this long-delay ad improvement will
he speedily carried into effect, and that no desire to lessen
itsooet will prevent the scheme; being made in every sense
«£ ihd word complete. There is no better investment of
$oblie money than that of purchasing health for the I

inhabitants of this crowded city, and the Metropolitan
Board of Works may reckon upon the approval of the more
thoughtful of the London taxpayers, if they utilise in the
best way the powers with which they are endowed.

Sir Rutherford Alcock, in another letter to The Times,
returns to the subject of the impecuniosity of the London
hospitals. This vast metropolis, with its unequalled wealth,
its assessable property of £25,363,550, and its ever-increasing
luxury, cannot, or rather does not, support its 150 charit¬
able institutions for the treatment and comfort of the sick
poor. None of them have yet actually closed their doors,
but many have closed some of their wards. The supply of
beds is seriously curtailed, and all these institutions are
being carried on with a wholly inadequate support and are
in a state of chronic insolvency. The great majority of
the inhabitants do not subscribe at all—only 100,000 out of
4.000,000, or 2£ per cent. Sir Rutherford Alcock does little
more than repeat himself and his thesis. He takes occasion to
show how unhelpful the critics of his first letter have been.
Mr. Burdett’s evidence that more is raised now than before
the establishment of Hospital Sunday does not alter the
fact that what is raised is still wholly inadequate and
utterly unworthy of the wealth and the charity of London.
M/. Bousfibld's lament of the unsucoess of the provident
dispensaries is to little more purpose; and his complaint
that Sir Rutherford Alcock has too exclusively advocated
the collection of unlimited funds for the maintenance of the
present unorganised competition of medical charities is suffi¬
ciently met by Sir Rutherford's suggestion in his former
letter that a ltoy&l Commission should be appointed to in¬
quire, amongst other things, if any better administration of
hospitals can be devised. Sir Rutherford Alcock will be
readily acquitted of any want of sympathy with wise
attempts to organise charity. He i,s notoriously one of the
leading spirits in the Metropolitan Society for the Organisa¬
tion of Charity. But his perception of the enormous need
ior hospital beds in a population of over 4,000,000 of people
and sense of the depressing inadequacy of the support forth¬
coming fills bis mind, and he is fain to confine himself to
.this one complaint until it be realised and felt by all
classes, the working and the wealthy alike.

Sir Rutherford Alcock is not without hope in connexion
with the Jubilee. Her Majesty’s intention is to devote a con¬
siderable amount of what is raised to some charitable object
of adequate scope; he thinks the London hospitals in their
present distress may well commend themselves to the ever-
ready sympathy and consideration of the Queen. The
London hospitals can only hope to benefit, of course, by
money raised in London. But, as we have urged from week
to week, no cause can compare with theirs in strength of
claim. If this resource should fail and no substantial help
should come out of the City parochial charities, nothing
remains but a hospital rate, which would, with many
objections, have this recommendation that it would make
all contribute according to their means to this great object.
Still, we trust, for the credit of old English charity,
that it will not come to this. Hospitals supported by
rates and administered by ratepayers would be very
different tilings from the institutions of which we are all
proud. They would be claimed, as of right, by thoa^.wbo
Digitized by \JU Ov 1C " *

The Lancet,]

‘MENTAL DIFFERENCES BETWEEN MEN AND WOMEN.’

[Mabc.

used them, and by many whose cases were not fit, and all
that personal kindness and gratuitous service which we asso¬
ciate with the provision and administration of hospitals in
England, would be replaced by paid labour and officialism.
They would differ but little from workhouse infirmaries. If
this dismal change is to be averted, liberal gifts will have
to be made, and made soon. Millionaires could remove
the debt of every hospital in London, and leave to their
less plethoric fellow-citizens the duty of endowing each
approved hospital with a sum that, with current subscrip¬
tions, would restore the equilibrium of the finances and
the peace of anxious committees. But no time is to be
lost. A few leading citizens, a few leading physicians
and surgeons, and the treasurers of the great hospitals in
co-operation, might even now place this cause in the very
front of thoae events that will make the Jubilee of Queen
Yictobia memorable in all after-time.

-4-

Professor Romanes made the “ Mental Differences
between Men and Women” the topic of a lecture recently
delivered at the Royal Institution. The views his remarks
disclosed are those which must, we fancy, be enter¬
tained by every well-informed and unprejudiced observer.
Mental differences do exist between men and women,
which are not simply the differences between indi¬
viduals of the two sexes, but of a nature to show that
they depend upon the diverse characteristics and pur¬
poses of the two classes of organic development. And
these differences, when they come to be studied closely, will
be found to partake very much of the nature indicated by
Professor Romanes when he hinted that women are gifted
with a more acute and facile power of acquisition than men,
while they are less able to originate ideas, and therefore not
so well qualified to take the lead in intellectual work.
Professor Romanes alluded to the somewhat smaller average
weight of the brain in women than in men, the difference
being about 5} oz. The average male encephalon has been
said to weigh 49.j oz., while the female average weight has
been put at 44 oz. There are, however, very great variations.
Of 278 male and 191 female brains, the smallest male
weighed 34 oz., while the largest weighed 66 oz. The mole
encephalon in 170 cases out of the 278 ranged from 46 oz. to
53 oz. The smallest female brain of the total 191 weighed
31 oz., and the largest 66 oz.—that is, 9 oz. less than the
weight of the largest male brain. Of 125 brains selected
from the 191 female brains, the weight ranged from 41 oz.
to .47 oz. So that we may say the average male
encephalon weighs from 46 oz. to 63 oz., while the female
weighs from 41 oz. to 47 oz. Thus, speaking broadly, it is
correct to affirm that the male brain is heavier than
the female, and those who, perhaps too hastily, measure
the mind by the absolute brain-weight, infer that in its
totality the mind of man must be greater than the mind of
woman. This, however, leads us to make a remark which
we do not remember to have encountered—namely, that as
there is very little difference between the proportionate
weight of the cerebellum to the cerebrum in the two sexes,
the proportion being as 1 to 8f in the male and as 1 to 8± in
the female, there scarcely seems ground to infer from the
ex i*teace of a smaller brain in woman than in man that
she U necessarily inferior in proportional mental powers

because it cannot be forgotten that woma
average a much smaller organism than man.
so far as we are aware, been proved, or eve
contended, that a small man with a proportio,
sized though actually small brain is not intellec
good as a larger man with a brain only propoi
greater in size. We know that it has been the p.
to weigh brains without reference to the total w
of the bodies with which they were associated, but
has always struck us as an unfair proceeding. It wou
we believe, have been found to explain most of the dii
crepancies between actual mind-power and brain-weight
which have done violence to the prejudices of those who
weighed the understanding solely by the brain, to take
into consideration the weight of the whole body. In
short, we venture to urge that it is not, in our present
state of knowledge at least, a justifiable proceeding to
measure the mind by the brain without taking into account
the organism of which the brain forms part. It may well
be that a small brain in a small body may be equally
effective as a mind-organ as a larger brain in a larger
body; and it follows that too much importance may
be attached to the fact that the average weight of the
female brain is less than the average weight of the male
brain, because the average weight of the female body as
a whole, including the brain, is less than that of the male
organism, and it has not yet been shown that the female
brain is smaller proportionally than the male. We think
“the mental differences between men and women” are
rather differences of kind than of degree, and this will
accord with the inferences of Professor Romanes, though it
may not eo closely accord with the facts by which he seeks
to support them. There are great differences in mental
power and capacity between men and women, and we
believe they are of a nature to render impracticable the
levelling views and purposes of the promoters of uniformity,
but it is not upon such coarse data as those of relative weight
that the differentiation of mental power as exhibited by the
two sexes can be satisfactorily established or elucidated.

Tbb nature and mode of action of the poisons of venomous
serpents have always attracted considerable attention. The
effects of snake-bite are so striking in their rapidity and
severity as to stand in great measure apart from other
animal poisons. Much was learnt of their constitution by
the researches conducted by Drs. Father and Bbunton
in 1872-76, and still more has been added to our know¬
ledge in a monograph by Dr. Weir Mitchell and
Dr. Reichbbt, recently published by the Smithsonian
Institute. These researches, although limited to a com¬
paratively few species of snakes, including, however, the
most venomous, bear out the view long since advanced by
the first named, that snake venom is not simple, but that it
contains one or more poisonous substances. In the first
place, it must be acknowledged that the poisons are of
chemical nature, and not vital or the product of vital
action. They do not fall, then, into the class of ptomaines
or other alkaloids which are the result of organised vital
activity; for although micrococci are described in the fresh
venom capable of multiplication, no support is gained to

the idea that they have anything at all to do with the

Digitized by VjvJUV LL,

SNAKE-POISON.—THE ROYAL COLLEGE OP SURGEONS.

[Mabch 28,1887.

632 THHLAN gT ]

the spot, and * ij^ e v^nom is, however, found to yield
prepare a sc’ el ^ arP held in solution, and can be

Board per^ ^lalysie into eoagulable proteida or globulins,
to the HOjaguJahie proteids or peptones. In some venoms
In the

are further capable of subdivision according
the Hq reaction^ hut in cobra venom there is only one
subse^ and a peptone which differs from others in being
outc i!'ated by prolonged boiling and not being precipitated
®°$iercuric chloride and absolute alcohol.

^rs. Wkie Mitchell and &kichekt have submitted to a
Host careful physiological analysis these different products
of snake-poison, and their interesting conclusions deserve to
be widely known. The venoms resemble closely the salivary
secretions of other vertebrates; and their active principle,
which can be maintained in the dried state or in such preserv¬
ing fluids as glycerine and alcohol, is Contained in the fluid
part of the venom only. This active principle is divisible,
probably in all cases, into two clasees of proteids—globulins
and peptones—of which the former may consist of several
distinct principles. If taken into the stomach during the
intervals of digestion the poisons may prove fatal, provided
that they contain a sufficient quantity of dialysable peptone,
whereas during digestion they are rendered harmless. The
chief local antidotes are permanganate of potash, ferric
chloride, and tincture of iodine. The venom has a powerful
local effect upon the living tissues, inducing more rapid
necrotic changes than any other known organic sub¬
stance. It renders the blood incapable of coagulation, and
exerts a local effect on the capillaries, so that extrava¬
sation occurs from the vessel walls being unable to resist
the normal blood-pressure, those capillaries yielding most
which are nearest to the larger bloodvessels, and ligature
of Vessels lessening the amount of extravasation. The
Altered condition of the corpuscles, which becorhe soft and
spherical and tend to fuse'together, is a further aid to the
escape of blood into the tissues. Sometimes this extravasa¬
tion occurs into thA substance of organs—as the brain,
kidneys, or heart. The effect of the venoms was also care¬
fully noted upon the respiratory and nervous Systems and
on blood-pressure. They show that changes in the pulse
rate following administration of the venom depend upon two
antagonistic factors : the one, which excites the accelerator
centre, tending to increase the rate; the other, which acts
directly upon the heart, tending to diminish it. The
■Variations noted in the arterial pressure were attributable
in the main to three causes—viz., depression of the vaso¬
motor centre, depression of the heart, and capillary obstruc¬
tion. The respirations are primarily increased, and second¬
arily diminished in frequency; these being again du9 to the
operation of two antagonistic factors—the one an irritation
of the periphery of the vagus, the other a depression of the
Respiratory centre. Death may occur through the paralysis
of the respiratory centres, or cardiac paralysis, or hemor¬
rhages in the medulla, or from the widespread destruction
of the red corpuscles. The research clearly proves that the
antagonistic and varying physiological effects depend
upon the admixture of the separate principles — the
globulins and peptones; and comparative study shows
that the globulins are the chief agents in the blood-
destruction, and in producing changes in the capillary walls;
whilst they also act more upon the accelerator centres of

the heart, and are therefore responsible for the increase in
pulse rate; and, further, they are the chief cardiac depres¬
sants and paralysers of the respiratory centres.' In some
respects, then, the globulins must be considered as more
toxic than the peptones, which, although active in pro¬
ducing cedema and necrosis of tissue, have little power in
preventing coagulation or in altering the corpuscles and
capillaries; moreover, these constituents act on the blood-
pressure, and are the chief factors in increasing the respira¬
tion rate by acting on the periphery of the vagi nerves.

The great merit of this research is the demonstration of
these distinctions in the constituent poisonous principles,
pointing to the differences in the action of different kinds
of snake-bite, being explained by the relative predominance
of one or other of the constituents. Thus in crotalus venom
there is a much greater proportion of globulins than in the
cobra venom, which may explain the marked local destruc¬
tive effects of the former as compared with that of the
latter; but the peptone of cobra venom would seem to be
more active in proportion than that of the crotalus. The
conclusion that, owing to their proteid nature and close
relation in composition to the blood, it is almost futile to
seek for a chemical antidote—for what would destroy the
poison would have a similar action on the blood itself,—
is, in spite of its hopelessness, unfortunately in accord
with experience. What is required, and what should be
sought for, is a physiological antagonist rather than a
chemical antidote, and in this direction we may look
for research to tend in the future.

Tub report of the last Council meeting of the Royal
College of Surgeons was unusually interesting from more
than one standpoint. In the first place the Council have
decided to rescind their former resolution to grant the
Fellowship to members of fifteen years’ standing without
an examination in anatomy and physiology. We have more
than once pointed out that such a method of bestowing the
Fellowship would tend to deprive this diploma of some of its
present academic status; we therefore gladly welcome the
determination of the Council not to persevere in this course.
The Council offer as their reason for rescinding the resolution
the difficulties involved in giving effect to the resolution in
the new Charter about to be applied for. Surely this is a
very weak and paltry excuse. There could be no difficulty
in inserting a clause in the Charter in the sense of the reso¬
lution, if the Council chose to do so. A far better reason,
we think, exists in the incongruity of instituting a high-
class diploma in surgery to promote the science and art of
surgery, and then in giving this diploma away wholesale
without adequate test examinations, merely for the purpose
of increasing the number of Fellows, which was the avowed
object of the Council in proposing changes in the existing
conditions.

While congratulating the Council on their present change
I of tactics, we cannot resist the suspicion that the real cause
for this rescission lies in the absence of any clear and well-
defined policy on the part of the Council, and in their having
acted hurriedly. These questions were 'not well weighed;
they were not discussed as part and parcel of a general
policy, nor were they submitted to the Fellows and Members
previously to being formally and finally discussed in the

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Thb Lancet,]

DEGREES FOR LONDON MEDICAL STUDENTS.

[Majich 26,1887. 635

Council, Xfca propped change was jost one of those -which
could advantageously have been submitted for discussion.
Would the Members care for a Fellowship diploma on those
grounds? Would Fellows approve of an extended Fellows’
list with the avowed object of simply increasing their num¬
ber ? Thus the Council is in the rather undignified position of
rescinding a resolution—that is to say, of undoing at one
meeting what they had done at a former one. On the other
hand, the Members have already publicly declared their un¬
willingness to accept the Fellows’ diploma on the terms
offered. This rescinding reminds us of the memorable
statement made by the then President at the general
meeting of the Fellows and Members in 1884, about Reso¬
lutions of the Council which were binding and others which
were not binding; and of more recent occasions—as for
instance, when the Council decided not to accede to the
recommendation of the Association of Fellows to create
Honorary Fellows, and then within a few mouths changed
their minds and decided that they would create a new class
of Honorary Fellows.

Tho memorial from teachers in surgery concerning the
proposed disposal of the Ebasmcs Wilson legacy was
referred to the Committee cm the Extension of the College
Premises. It is to be hoped that this Committee will give
way in part on such a question as this. We believe that
but a very small minority of the Council are at all strongly
in favour of enlarging the present museums. The days of
putting up mere “ pickles ” are past and gone. The interest
of museum specimens lies not in their size so much as in
a careful examination into their minute structure, their
intimate nature, and mode of growth. For such studies as
these laboratories are needed rather than more shelf-room for
unstudied, and often unintelligible, crude specimens. The
College of Surgeons’ Museum is at present too much com¬
posed of bottle preparations. To spend this legacy in increas¬
ing these museum specimens is a waste of money, not
justifiable while London, of all capitals in the world, is the
only one in which adequate laboratories for scientific work
are still unknown and non-existent. We can only hope
that the Council of the College of Surgeons wiU not neglect
this chance of helping to put London on an equality with
Edinburgh and with foreign capitals in teaching capacity,
and of filling a hiatus in the teaching apparatus which
is of vital importance to its completeness.

^mutations.

“ Ne Qald irimta.”

DEGREES FOR LONDON MEDICAL STUDENTS.

Thb communications laid before the Fellows of the Royal
College of Physicians of London, which are referred to in
another page, presage a stormy career for the Charter now
being dra4rn up by the two English Colleges conjointly. The
Irish Colleges plainly Say that they intend to ask for like
privileges, and thb Scotch Colleges intimate that, contrary
to their desiffes, hilt as a necessary measure of self-defence,
they. wiUhe obliged to a similar step. The University
gf Brijrtol appeals a^alnst a fesidentiifl qualification
landed tn^he terms on which a degree is to be

..„ tJniveraity Colleges have made

a formal Joint application to be included in the movement,

and furnish the Arts and Science Faculties, leaving that in
Medicine under the control and management of the two
Royal Colleges. The letters from the Bristol College and
from King’s and University Colleges were referred to the
Committee of Delegates, whose next meeting will be held
shortly. The two most difficult points in the scheme will
then be before them for consideration. Shall residence be
a tine qud non, and, if so, for how long a period ? Shall the
CoUeges ask for a purely professional degree, or will they
co-operate in forming, and take the initial step in creating,
a new abd a real University in London ? It is difficult
to understand the position of the Colleges, in putting
into the foreground of their claim the advantages and
superiority of clinical teaching and clinical opportunities
in London, if some residential period is not insisted on;
and this might be for the twelve months preceding the
examination for the M.D. degree. We see no reason
whatever why every candidate should not be com¬
pelled to attend definite courses in olinical subjects in
London in order to obtain a London degree, %hich would
be quite a Bpecial honour, and differ in toto from the
mere qualifying titles granted by the Conjoint Examining
Board in England. It is evidently clear that University and
King’s Colleges will go to the Government for a Charter to
grant won-medical degrees, and that the Councils of those
bodies would rather assist the Royal Colleges than be in
opposition to them, and we hope that a conference may be
held so as to allow a joint action to be pursued. The feeling
against a purely professional degree is very strong in medical
as well as in outside circles, whereas everyone acquainted
with the higher education in London recognises the need for a
real Teaching University, of which those Colleges only can
constitute the non-medical factors. The opportunity for
doing the work which the present University deliberately
threw away is once more to the front, and we hope that
the occasion for removing a grievance under which the
metropolis, alone among great cities, is now suffering will
be seized and promptly acted on. The Irish- and Scotch
Colleges are obviously animated by mere personal considera¬
tions. They cannot say for a single moment that Trinity
College and the Royal University in Ireland on the one hand,
or the Scotch Universities on the other, stand in a posi¬
tion as regards Dublin or Edinburgh students comparable
with that in which the University of London plaees itself in
reference to London teachers or London students. The latter
is on imperial examining board with a mere habitation only
in London; the others are local universities, and a local
university is what London asks for, and against its formation
no fair contention can be urged.

FEVERS AND FIRES IN BLACKPOOL. ’

In his recently issued report on the health of Blackpool
Dr. Henry Welch draws the serious attention of the sanitary
authority to the want of preparedness on their part to deal
properly with cases of infectious diseases by means of
isolation. He says that for four years he has vainly endea¬
voured to persuade them to provide proper accommodation,
that the borongh is still not one whit nearer its possession,
and he fears that nothing but a serious epidemic will
awaken the sanitary authority to a sense of its duties in this
respect. The advice thus given has been locally reoeived in
two very different fasMone. Tbe Blackpool Timet evidently
recognises in Dr. Welch the authorised local adviser in such
a matter, and by supporting his views it shows that ft
appreciates the unflinching honesty with which the'best
interests of the town have been advocated by him. It goCa
on to remind its readers that Dr. Welch by no means stands
alone in condemning the insufficiency of the existing
hospital provision. Thus, it quotes Dr. Thome Thome, who,
in hia official report, describes the building as badly situate'1

y O

636 The Lxncbt,] FEVERS AND FIRES IN BLACKPOOL.—LONDON WATER-SUPPLY. [Mabch 26, 1887/

—hidden as it is behind a cemetery,—as faulty in construc¬
tion, and as so imperfect in its accommodation that
the medical practitioners in the town did not feel justi¬
fied, except under special circumstances, in recommending
their patients to resort to it. This was in 1879, but quite
recently Dr. Page, also of the Local Government Board, felt
it his duty to urge upon the authority the provision of
“ adequate hospital accommodation for infectious diseases.”
But the Blackpool Gazette adopts a precisely opposite tone.
It takes the officer of health seriously to task for the per¬
formance of his duty in this matter. It talks of " blatant
alarmists”; of the prospects of the season being injured
M by the professional alarmists and gadling idlers of the
borough”; and, with reference to the possibility of an
epidemic, it rejoices in the fact that “ we haven’t got an
epidemic.” It then goes on to seek a simile in order to
enforce its retrograde views. Noting the reference which
Dr. Welch has made to the possibilities of an epidemic, it
proceeds to say that the next discovery that will be made
will be that “ if all the houses in Blackpool took fire at once,
the present fire brigade would be unable to cope with the
flames.” How this most inappropriate simile could have been
put forth will surprise all who have the most rudimentary
knowledge of the subject under consideration. Neither epi¬
demics nor fires seize upon all houses “at once.'’ Both the
medical officer of health and the superintendent of the tfire
brigade know that epidemics and fires have beginnings, and
that in order to prevent those beginnings from becoming wide
extensions, over which the authority and their officers will
lose all control, it is necessary to have the means for dealing
with the first signs of the evil. We can hardly conceive that
Blackpool has no sufficient means for extinguishing the
ordinary fires to which such a borough is subject, and which,
if not checked by efficient means, would end in a widespread
and disastrous conflagration; neither do we imagine that
the authority are priding themselves on any such unpre¬
paredness, because “ we haven’t got all the houses on fire at
once.” But, on the other hand, we do know that they have
not the means for properly isolating at the 6ame time the
most insignificant number of two or three dillerent infec¬
tious fevers, such as every town with a population such as
that of Blackpool is always liable to, and which a seaside
resort on the Lancashire coast is exceptionally likely to
receive; and all that Dr. Welch and others ask for is that,
on the basis of the provision made by all sensible people for
the prevention of fires, adequate provision should be made
for the simultaneous isolation of a few cases in both sexes
of the Several current infectious fevers, and this without
subjecting those who quit their houses for the protection of
the public health to the risk of contracting a disease other
than that for which they are professedly isolated. Perhaps
we shall next be told that these, too, are alarmist views,
and that the absence of the needed provision has not
been associated with the occurrence of any epidemic. If so,
we trust that the simile of fire prevention will still be
adhered to, and that the inhabitants will be advised to drop
their fire insurances and to trust to some old leaky parish
fire-engine,on the ground that there has for years past been
no general conflagration in the borough. But, quitting this
unfortunate simile, we would remind Blackpool that its
credit as a health-resort demands the limited provision which
is asked for. The borough is one of those which has adopted
t he compulsory notification of infectious diseases, and the
public naturally imagine that the sanitary authority wanted
to know where infection existed in order that they might
take the ordinarily received means of staying its spread.
As yet this has not been done in the matter of isolation
provision, and we would urge that the true interests of the
borough—including its financial interests—will be best
■arved by giving heed to the advice of their medical officer
of health in this respect.

THE VARIATIONS IN THE SPECIFIC GRAVITY OF
THE BLOOD IN HEALTH.

Me. E. Lloyd Joxbs has lately been investigating this
subject, and has adopted, with some modification, the
principle of the plan suggested by Profeasor Roy to deter¬
mine the specific gravity of the blood. Professor Roy
simply introduced a drop of the blood to be examined,
taken up by a hypodermic syringe, into a mixture of
glycerine and water of known specific gravity, observing
whether the blood tended to rise or sink in the solution.
Mr. Jones found that a better method was to use a fine glass
pipette, the point of which was bent at a right angle.
When the point was brought into contact with the blood a
small quantity immediately entered the tube, and the point
being then introduced into a mixture of glycerine and water
of known specific gravity the blood could be blown out
horizontally, and its disposition to rise or fall could be
instantly seen. About thirty test mixtures of definite
specific gravity were used, the conclusions at which Mr.
Lloyd Jones, whose paper is contained in the last part of the
Journal <f Physiology (No. 1, 1887), were as follows: The
specific gravity of the blood is highest at birth, being at a
minimum between the second week and the second year,
and rising gradually to a point attained in the male between
the ages of thirty-five and forty-five, in the female after the
climacteric. Mr. Jones finds, as a rule, the specific gravity of
the blood tends to be higher in the male than in the female,
and that in the female the child-bearing period is marked by
a fall. The specific gravity in the two sexes is probably only
the same at the extremes of life. The effect of pregnancy
was found to be that the specific gravity of the blood was
slightly diminished, though it still remained well within
healthy limits. In regard to food, the immediate effect of
mixed food is to cause a fall in the specific gravity of the
blood; if alcohol were taken this fall was not observed.
Exercise, if gentle and not too prolonged, causes a fall in
the specific gravity; if perspiration becomes well marked
the specific gravity rises, as it does when violent exercise is
taken. The conditions of the circulation in the affected
part modify the specific gravity of the blood circulating
through it. It is always high in a passively congested part.
It varies also in different parts of the body. It exhibits a
certaia diurnal variation, tending to fall during the day and
to rise at night. _

LONDON WATER-SUPPLIES.

The report of General A. de G. Scott, the metropolitan
water examiner, for the month of January has been issued,
and, as the author states, is compiled from information
collected under instructions issued by the late water
examiner, Sir Francis Bolton. The results of the analysis
of the different waters supplied to London will be read with
interest. The Thames water supplied by companies from
this source was characterised by the large proportion of
organic matter present in all cases; in the previous month
this pollution was limited to the water of the Grand
Junction and Southwark Companies, but in the fol¬
lowing month the whole of the Thames - derived
waters had become equally affected, samples of the
two first-mentioned companies containing finely divided
suspended matter, which was found on microscopic ex¬
amination to contain living organisms. The water drawn
from the Lea and distributed by the New River and East
London Companies also showed a very marked increase in
organic matter as compared with the December samples.
The pollution is said to be due to the floods; however this
may be, it is no great consolation to London water-drinkers.
In a letter appearing in The Times of last week, attention
is called to the pollution which “ is poured into the Upper
Thames by the tributary streams which discharge into its
Diaitized bv vjOOv LC

C

This Lahcrt,] EFFECTS OF MASSAGE ON EXHALATION FROM LUNGS AND SKIN. [March 26,1887. 637

waters the sewage of towns and villages, the filth of paper-
mills and other works, and farmyard drainage.” The town
of Staines especially discharges all its sewage into the same
river in uncomfortable proximity to the intakes of the water
companies. The Thames has indeed been described as the
natural outlet for sewage, and if this is to be accepted we are
compelled also to regard London water-drinkers as the natural
consumers of Staines sewage. The purity of London water-
supplies calls loudly for improvement; the story of cholera
in 1866, spread through water, has been too soon forgotten,
and London possesses no organisation or administration
which will enable a very definite danger to be seriously
considered. It is, indeed, to be feared that some great
calamity will be required to bring about a radical change in
the sources of London water-supply.

EFFECT OF MASSAGE ON EXHALATION FROM
THE LUNGS AND SKIN.

Dr. Stadbovski has published a series of laborious
researches made with a view to determine the effect of
massage upon the pulmonary and cutaneous exhalation.
They were carried out in Professor Manassein’s wards in
St. Petersburg on fourteen persons, nine of whom were in
good health and the remaining five convalescent from various
acute diseases. In each case the duration of the observations
was ten days, during the first five of which massage was
practised. Deep kneading was practised for the first two days,
after which the body was washed over with a wet sponge to
remove the fatty matter adherent to the surface of the skin.
During the next two days deep rubbing was practised, and
then the wet sponge used again. On the fifth day deep rubbing
with the dry hand was practised. The massage took place
at 10 A.M., except in two cases, where it was performed at
7 p.m., with the object of observing its effect on nocturnal
perspiration. The sittings were of an hour’s duration.
The results in the different cases were discordant. In five
cases there was an increase in the pulmono-cutaneous
exhalation and a diminution in the amount of urine, the
increase occurring shortly after the massage, so that when
this was practised in the morning the perspiration was
increased during the day, but became normal during the
night. Similarly the quantity of nrine fell during the day
and rose again at night. In three cases the massage
increased the quantity of urine and diminished the pul-
mono-eutaneous exhalation. In the remaining six oases
both the urine and the pulmono-cutaaeous exhalation were
increased during the period of massage. The general effect
on the pulse was to lower it some ten or fifteen beats. No
alteration appeared to be produced in the rate of respiration.

RAT P0I8ON8.

Ah inquest was held last week by Mr. Wyatt, the ooroner
for Camberwell, on the body of a young man who was found
dying on his doorstep. The deceased recently lost his situa¬
tion, and shortly afterwards quarrelled with the young woman
to whom he was engaged. He was subsequently beard to
remark that he had not a friend in the world, and that he
contemplated putting an end to his existence. Dr. Power
stated that he had analysed the contents of a box of rat
poison found on the deceased, and discovered that it con¬
sisted of pure arsenic. There was more than enough to
poison the whole street, and it could be purchased by any
child at the nearest chemist or oilshop for a penny. The jury
returned a verdict of u Suicide whilst hi a state of unsound
mind,” and expressed the usual opinion that the indiscri¬
minate sale of deadly poisons was not desirable, and that it
would be as well if something could be done to put a stop
to it. We have frequently pointed out that the various rat
poisons and rat pastes now so extensively sold afford the

public a wonderfully easy means of obtaining in unlimited
quantities a selection of poisons without the inconvenience
of question or inquiry of any kind. One of these prepara¬
tions contains arsenic, another is composed of strychnine,
whilst a third consists of arsenic, strychnine, and phos¬
phorus combined—in fact, the choice is unlimited.

THE CHARGE AGAINST GUY’S HOSPITAL.

A most opportune and striking illustration of the straits
to which even our great hospitals are reduced has lately
happened. The public is, of course, very much shocked.
But what a pity it ia that the public was not shocked
long sinoe into doing more for the hospitals, and enabling
them to provide more beds for patients. The case was that
of a poor man who fractured his fibula, He was kept
in hospital for the night. A plaster-of-Paris bandage
was, after a few hours’ rest, applied, forming a splint,
and as the bed was wanted for a worse case, the poor
fellow was treated as an out-patient and sent home,
crutches being supplied to him by the hospital without
charge, though the contrary has been alleged. His circum¬
stances were poor and he applied at and was admitted into
the Strand Workhouse. It is to bs regtetted, perhaps, that
such a case should have to be sent out of a London
hospital so quickly. But, as Dr. Stesle points out, it ia
inevitable, unless the hospitals are better supported. Many
fractures of the fibula can be dealt with summarily, as
in this case. It ia from want of charity that many
patients cannot be supplied with a bed. But the authori¬
ties cannot put a quart into a pint pot. They most give
their beds to the worst cases, and make out-patients of
those for whom warmer charity would find a bed. Let the
public realise that it is alone responsible for the straitened
accommodation of the hospitals, and for this case being
sent to a workhouse. Some such fate is likely to threaten
all hospital patients unless more men like the founder of
Guy’s are forthcoming, and that quickly and in considerable
numbers. _

QUININE IN PNEUMONIA.

At a recent discussion in the New York Academy of
Medicine there was a general consensus of opinion upon the
inability of quinine as an antipyretic in the treatment of
acute pneumonia (Boston Medical and Surgical Journal,
March 3rd). The subject was introduced by Dr. J. H. Ripley,
who related his experience of the administration of the
drug in large doses in cases where the temperature exceeded
108°. In two cases no reduction of temperature occurred;
in two there was a slight rise in the temperature. The
reduction that it did usually produce never lasted for more
than from two to four hours. Not only, then, was quinine
to be regarded as feebje and uncertain in antipyretic effect,
but it was harmful from disturbing the digestive functions
and producing cardiac and nervous depression. In one
case opisthotonos was noticed; in many epistaxis; in one
marked albuminuria with renal casts. Nor did it shorten
tho natural course of the disease. Dr. Fruitnight’s
experience Coincided with that of Dr. Ripley; hut he
prescribed it for its tonic effect in small doses. Dr.
Castle found that, if given in antipyretic doses, it must
be at the expense of tho nutrition of the patient, and
during tbe last five years he had almost entirely abandoned
the remedy in pneumonia. Dr. Billington, to obviate gastric
disturbance, had given the drug in the form of a suppository.
He also had been disappointed in its use as an antipyretic in
pneumonia. Dr. Emmett Holt had given as mueh as sixteen
to thirty grains a day to children from one to one and a half
year old in cases of pneumonia, and felt that as an antipyretic
it was useless in small doses and dangerous in large. Far
better results were obtained from the cold pack. He

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638 The Lancet,1

ANTHRAX IN CHESHIRE.—ITALIAN MEDICAL C0NGRE8S.

[March 26v 1887.

bad now discarded the drag in acute pneumonia, but
found it of marked advantage in convalescence. Dr.
A. Jacobi, the President, remarked on the changes in
opinion with respect to quinine; he had himself always
prescribed from six to twelve grains to children, usually
in full dose in two instalments in the morning when the
remission occurred. He thought the condition of the stomach
in the febrile state accounted for some of the intolerance
mentioned, and preferred hypodermic injection of the
carbamide. Dr. Ripley, in reply, said that in a large number
of cases the quinine had been given hypodermically in the
form of strong solution of. the muriate; but Dr. Jacobi
remarked that it was not safe to use too concentrated a
solution for hypodermic injeotion, and mentioned a case in
point. _

ANTHRAX IN CHESHIRE.

A severe outbreak of anthrax has occurred in Cheshire.
It arose a fortnight ago on a farm in the township of Aston,
several cattle, sheep, and pigs having been attacked; and
the latest advices prove that the epidemic has by no means
abated. The recent order of the Agricultural Department
of the Privy Council has been issued none too soon, and
the recommendations embodied in it ought to be strictly
observed. We were struck by one of the remarks reported
to have been made by the secretary of the Cheshire Chamber
of Agriculture last week when introducing the fact of the
outbreak to the notice of the members. He said that “ no
one had yet been able to point out the cause of this disease.”
Now if there is one infective disease the etiology of which
is clearly established it is anthrax. The fame of Koch and
Pasteur rests largely upon their discoveries in this direction,
and the knowledge contributed by pathologists in this
country on their investigations upon woolaortere’ disease
should surely be in the memory of scientific agriculturists.
But we may be doing Mr. Rigby an injustice. He may
merely have implied that the cause of the particular epi¬
demic was unknown, and therefore the step taken by the
Council of the Chamber of Agriculture to ask the Privy
Council to send an inspoctor is to be commended. Isolated
cases of anthrax have, we believe, lately occurred in other
parts of the country, and it is highly important that no
delay should take place in stamping it out.

ITALIAN MEDICAL CONGRESS.

Those of the profession who purpose spending their holiday
next autumn at the Italian lakes or in the art cities of the
Lombardo-Venetian territory might do worse than “ enter
an appearance ” at the Congress of the Associozione Medica
Italians, to be held at Pavia. It will take thorn but little
out, of their way, and will, like its recent predecessors at
Siena and Perugia, provide them with much that is novel,
interesting, and instructive. If they are so minded, they
can take part in its proceedings, French or even English
being a recognised medium of communication at such
gatherings. They will also make acquaintance with not a
few celebrities in the healing art and its cognate sciences,
who will be glad of an occasion to requite the hospitality
which won so many a continental brother at our great Inter¬
national Congress just ten years ago. Full details of the
meeting, including the date of its opening, its duration, and
an outline of its business, may be had from the secretary of
the “Comitato Pavese,” now sitting. Pavia, for its own
sake, is full of interest,. To say nothing of its churches, its
palaoes, and its far-famed Certosa, rich beyond any other
ecclesiastical edifice in Italy in early Renaissance and
Roman-Gothic features, it has its university, once the rival
of' Padua in attractions for English physicians, and im¬
mortalised by teachers like Spallanzani, Tissot, Volta, and
Scarpa, whose monuments ennoble its spacious court* and

grand old library. Its imposing hall, completed in 1845 at a
cost of 200,000 fr.; its Teatro Fisioo, with statues of Galileo
and Cavalieri, and a bust of Volta; its wealth of literature
in medicine and physics, embodied in a collection of over
200,000 volumes, are some among the many points of con¬
temporary interest possessed by the Ticinum of antiquity,
the “domus patema” of Cornelius Nepos, the scene of
famous deeds under Theodoric, Charlemagne, and Francis 1.
The congress at which the profession is now invited to
assist will be the twelfth of the series, and its working
committee are not likely to fail in rendering it worthy of
its predecessors and of the historic and scientific associations
of its picturesque seat. _

SPAYING IN THE STATES.

On Dec. 2nd, 1886, at the Obstetrical Society of Phila¬
delphia, Dr. Kelly related a case in which he had removed
the ovaries and tubes for subinvolution. We cannot do
better than give the words of the report in the American
J'/umalof Obstetrics :—

“ Dr. Kelly considers the indications in this case so well
defined and new that he designs making it the subject of
a more detailed critical communication. The patient, about
thirty-five years of age, had raised five chidren, but for several
years had suffered from constant soreness of the whole
hypogastrium, a spot of intense burning pain to the left of
the uterus, and a constant dark leucorrhcea. The menstrual
congestions greatly increased her symptoms, which were
again aggravated by several early abortions. She had been
under excellent treatment before coming to Dr. Kelly, and
had been carefully treated by him, but with only moderate
temporary improvement. Dr. Kelly then decided to stop
the menstrual function, with a view to checking the
periodical determination of blood to the uterus, and finally
bringing about complete involution of the organ. The
ovaries and tubes were removed through an incision two
inches long. The ovaries were fall of pea-sized follicles,
and covered with a dense capsule, and were probably (not,
however, in consequence of these appearances) diseased.
The speaker insisted that the operation here had no reference
whatever-to any disease which might be found in the
appendages, but the sole indication ley in the state of the
uteros; the ovaries, whether diseased or not, were removed
to correct that trouble. The recovery was as perfect and
free from disturbance as any slight injury, and the patient
was up in the next room on the fourteenth day, when the
uterus was free from tenderness and already rapidly
undergoing involution.—Dr. Chas. Meigs Wilson considered
odphoreotomy a resort of doubtful propriety as a remedy for
metritis; for, as the menopause occurring physiologically
would not stop such an inflammation, we would scarcely
expect it to be of greater benefit when the result of an
operation. He doubted the moral right of exposing the
patient to the risks of abdominal section for such a condition.”

We refrain from commenting on this base, and prefer to
leave our readers to draw their own conclusions.

ITALIAN BEGGARS IN LONDON.

It seems that the padrone system of importing beggar*
from Italy having been checked by the combined action of
the Italian and English Governments, this device has been
superseded by a system of parental emigration with families
introduced for the same purpose. There is only one real
remedy for this begging system, and that is for the free¬
handed—we will not say the benevolent, for it is not
benevolence to encourage dependence on alms—to steel their
soft hearts against entreaties and refuse to give money in
the streets. If this were generally done we believe there
would be much less real distress. “ Begging” is a trade that
ought to be starved out of existence, if only because it is s
bad one for those engaged in it.

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JUVENILE INTERMITTENT ALBUMINURIA.

[Mabch26, 1887. 630

SCIENTIFIC MEMOIRS BY INDIAN MEDICAL
OFFICERS.

Wb note with pleasure the appearance of Part II. of the
“Scientific Memoirs by Medical Officers of the Army of
India,” edited by Surgeon-General Simpson, M.D. The
Yolume contains an interesting account by Surg.-Major D. D.
Cunningham upon the effects which sometimes follow in¬
jection of choleraic comma bacilli into the subcutaneous
tissues in guinea-pigs. Three out of five of such experiments
were productive of symptoms closely resembling those of
cholera, with abundant development of the comma bacilli
in the intestine, and also in the peritoneal fluids. Dr. Cun¬
ningham’s results are suggestive of the possibility of infection
other than by the digestive tract, but he would doubtless be
the first to admit that the experiments are hardly conclusive.
Four papers deal with subjects of botanical and physio¬
logical interest. Surgeon-Major Barclay describes the life-
history of a new J5cidium on Strobilanthes dalhousianus; and
in another paper describes the character of AScidium urticfe.
Surgeon-Major Cunningham records his observations on the
Phenomenon of Gaseous Evolution from the flowers of
Ottelia alUmoides, a plant very abundant in the tanks in and
around Calcutta. Surgeon-Major King discusses the Fertili¬
sation of Ficus hispida. Lastly, Surgeon-Major Bomford
contributes a note on Eggs of Distoma (Bilharzia) haemato¬
bium, found in transport cattle, Calcutta. The parasite has
never been found in India before, and the affected cattle had
not been in Egypt. _

JUVENILE INTERMITTENT ALBUMINURIA.

Considerable interest attaches to cases of cyclical
albuminuria, for their pathology is unknown, and perhaps
is different in different cases. The causation of mere inter- ,
mitteucy of symptoms generally has not received adequate
attention. M. Teissier has collected a fresh series of ten
cases of cyclical albuminuria. He lays stress on the follow¬
ing features: A separation of oily matter on the urine, and
the presence in it of brilliant bluish or metallic-looking
spangles; the absence of true oasts, though cylindroids
possibly of mucus, and sometimes drops of fat, may be
detected with the microscope ; the slightness of the
subjective symptoms, which may consist of mere vague
feelings of malaise, of pain in the back, of weakness, or of
pains in the limbs. Neuralgic troubles are rare. There is
great nervous excitability or impressionability. Physical ex¬
amination has never revealed the “ bruit de galop.” The
lowness of arterial tension, which is calculated to be
equal to a column of mercury sixteen to seventeen centi¬
metres high, is important as an item in the differential
diagnosis of cyclical albuminuria from interstitial nephritis.
Dilatation of the stomach was observed in three cases.
Three patients had bad eczema or urticaria. Neither cedetna
nor “dead fingers” was noted. Speaking generally, the
&speet of the patients is one of good health. The complaint,
if such it can be called, is commonly curable; but slight
relapses may recur under the influence of fatigue or violent
impressions. The age that is most liable to the affection ts
ten years from puberty onwards; males suffer more than
females. Violent exercise and excessive emotional excite¬
ment are direct causes. Teissier does not accept the meohani-
°al theory of Bar, nor the theory of disturbance of the
glomerular circulation of Magnin. His own view, propounded
two yaara ago at Grenoble, he now believes to be insufficient
to explain all the phenomena. A slowing of the combustion
of albumens will not explain the presence of fatty matters
ft the increase of urea in the urine. His present position
18 to regard the malady as due to over-action of the liver,
which ig the factory for urea, uric acid, and fatty matters,
^treatment the importance of . hygiene is very great.

Patients are perhaps predestined to become gouty.

Shampooing, plenty of fresh air, prohibition of alcohol and
white wines, and moderate exercise, are to be prescribed for
these young men. Arsenic, inhalations of oxygen, cold
baths, bromides and hydrotherapy, tannin, benzoate of
soda, &c., are recommended, but especially sweet spirits
of nitre, twelve to fifteen drops a day (alcool nitrique); milk
eggs, and ham may be eaten, but not fish; thermal waters arq,
good. _

THE ERASMUS WILSON BEQUEST. ' '

Our contemporary, the Glasgow Herald of the lfith inst^
oontains the account of an anti-vivieectionist meeting
recently held in Edinburgh. The object of this meeting
was “to consider the memorial recently presented to the
Royal College of Surgeons praying that the bequest by Sir
Erasmus Wilson should be devoted to the foundation of &n
institution far physiological and pathological research.”
We have already referred to this petition and to sundry
comments by auti-vivisectionists which the petition has
called forth. We should prefer to let the matter rest
here, were it not that the mover of a resolution
stoops to deliberate misrepresentation when he says
that “ the proposed institution would simply bo an
institution where from week to week men would fol¬
low no other pursuit than experimenting upon living
animals” (The italics are our own.) Such a statement
made concerning members of the medical profession and
the managing body of the Royal College of Surgeons is
simply a libel. There is not a tittle of evidence in support o£
such & statement—a statement, which betrays profound
ignorance of scientific research and the modes in which it is
conducted, and exhibits an exaggeration in tone which can
only be regretted. _

WHAT WAS THE CAUSE OF DEATH ?

A curious case has recently been investigated by the
coroner at Cardiff, It appears that a lad named James
Dunscombe, aged seven, was taken ill on March 7th, 1887,
and died in about twenty hours. His symptoms were
chiefly of a convulsive nature, but there was also some
vomiting and pain at the stomach. The spasms were of a
tonic character. There were marked remissions, but
according to the report there ware no intermissions. This,
taken in conjunction with the fact that deceased lived for
the greater part of a day after his first seizure, seems
pretty conclusive that the illnass was not due to strychnia
poisoning. Unless an enormously large dose of strychnia
has been taken so as to cause the spasms to follow one.
another so rapidly as to appear almost continuous, there are
well-marked intermissions; and if the dose is large death
ensues in a correspondingly short period. Moreover, in this
caB© there was not a: tittle of. evidence tp stapw that
deoeased had taken anything which could have contained
strychnia; and lastly, an analysis of the contents of : the
stomach failed to detect the alkaloid. It is said a
trace of lead was found in the walls of the stomach;
but the analyst evidently thought the quantity, too
minute to account for the attack of spasms. We
do not know whether it was suggested that deceases!
might have succumbed to saturnine epilepsy from chronic
lead poisoning; if so, we should have thought that some
mention would have' been made of the gums and the
muscular coat of the intestine.' , lb could scarcely be con¬
tended that the case was one of acute lead ppisfning. .Were
the spasms dqa to tetanus 2 They were quite consistent
with suoh a hypothesis, but then no wound of any kind
could be discovered. Nevertheless, we are not disposed
altogether to-, discard the theory, for the solution of con¬
tinuity may be extremely small and hidden away in some
recess of a mucous membrane, so that nothing short of a

Di.

640 Ths Lancet,]

TYPHOID FEVER IN MELBOURNE.—THE CARRIAGE-TAX.

[MARCH 26,1887.

minute and exhaustive search might succeed in finding it. i
We are much more inclined to acknowledge tetanus as the I
explanation of the symptoms than strychnia poisoning. There
seems to have been no ground to suspect hydrophobia. It is
just possible that the phenomena presented were due to the
onset of some specific fever. In one instance we can recall .
a somewhat similar condition obtained in typhoid fever. To
sum up, then, we conclude that the facts as presented tit in
better with the theory of tetanus than any other. It is curious
that two other children of the same family succumbed to
convulsions, one of them dying from hydrophobia. We ■
agree with the opinion of the medical man, who said at the \
inquest there might be a family tendency to convulsions, j
in the sense of instability of the reflex centres.

TYPHOID FEVER IN MELBOURNE.

In an address delivered before the Medical Society of
Victoria, Dr. James Jamieson, health officer of Melbourne,
drew attention to the comparative prevalence of typhoid
fever in that city and suburbs, and the causes of it. He
pointed out that whereas in England the fever mortality
had greatly and eteadily diminished—viz., from 17,910 in
1870 to 7978 in 1883, in Victoria there had been no apparent
diminution, even taking into account the increase of popu¬
lation, the average annual mortality of the five years 1871-75
being 360, and that of 1881-85 being 473. He also pointed
out that the mortality in Melbourne from fever was much
higher than in other parts of the colony; whereas in
England the rate in the twenty chief towns is less than
in the rural districts. Discussing the various etiological
conditions, he dwelt first upon the water-supply of Mel¬
bourne, and showed that it could not be Charged with the
propagation of the disease. Nor was he able to trace during
1886 any cases due to infection of the milk-supply. As to
direct contagion, isolated cases occurred, but not sufficient i
to account for the great and continued prevalence of the
disease. He next discussed the influence of the pan system
of night-soil collection and removal, which is carried on in
Melbourne; and although doubtless accompanied by con¬
siderable risk, as well as discomfort, he was unable to adduce
positive proof of its being a source of contamination. Lastly,
be adduced the imperfection of drainage as the most impor- .
tant of all the conditions to which the prevalence of typhoid ;
fever could be attributed; and gave instances in which
this defect in sanitation was responsible for outbreaks
of the disease. He quoted the experience of European cities
as showing the efficacy of improved drainage in diminishing
the mortality from typhoid fever; and contended that what
Melbourne needs is a complete system of drainage, which
should not merely carry off storm-waters and lessen sub¬
soil dampness, but be utilised for tbe rapid and complete
removal of excrementitious matters. He advocated the
formation of a metropolitan board of works empowered to
carry out this great and much-needed improvement, in the
realisation of which the chief difficulty was one of finance.
We are glad to note these opinions of Dr. Jamieson, and
trust he will succeed in convincing the inhabitants of
Melbourne of tbe need and importance of the sanitation he
advocates. _

THE CARRIAGE-TAX.

The carriage-tax in its present form has few friends in
tbe north of England, especially at Newcastle-on-Tyne,
which is in some respects the headquarters of an agitation
against its continuance, and, notwithstanding the unfavour¬
able reply of Mr. Goschen to the late deputation, very strong
pressure has been put on the northern members of Parlia¬
ment by tile profession, them in prospect of the forthcoming
budget, with a view to thethodffleation-of *he tax*

THE APOTHECARIES’ HALL OF IRELAND AND THE

KING AND QUEEN’S COLLEGE OF PHYSICIANS.

The King and Queen’s College of Physicians in Ireland
has published & statement in reply to the request of the
General Medical Council that the College should reconsider
the Conjoint Scheme for Ireland, with a view to admitting
the Apothecaries’ Hall, Dublin, to take part therein. In this
statement the history of the apothecaries in Ireland is
traced minutely, and it is maintained that by law their func¬
tions originally had strict reference to tbe preparing of drugs,
inspecting and directing chemical and compound prepaia-
ti ons and experiments, and the exam i nation of persons wish in g
to become apprentices to and learn t h e business of apothecaries.
Contrary to the opinion of Sir Richard Bethell in 1860, it is
maintained by the College that there is no analogy between
the Hall in Dublin and the Apothecaries’ Society in London.
Two or three points, however, in the other direction are
admitted. It is allowed that the Army, Navy, and Local
Government Board recognise the certificates of the Hall,
and that there are some practitioners in Ireland holding no
other qualification than that of the Apothecaries’ Hall,
Dublin. In the final result the King and Queen's College
say that the Medical Council should decline to appoint
assessor examiners to the Apothecaries’ Hall, Dublin, and
j they (the President and Fellows) have no option but to
! adhere to their resolution to exclude the Hall; and they
add that, if an inferior and low grade of practitioners is
created and perpetuated, the responsibility will rest with
the General Medical Council, and not with the King and
Queen’s College of Physicians.

INEQUALITY OF THE PUPILS IN HEALTH.

Dr. G. T. Ivanovs’, referring to some observations by
Dr. Pasternatski on the inequality of the pupils in internal
diseases (see The- Lancet, Jan. 16tb, 1887), communicates
to the Vrach (No. 7) the notes of a series of observations
made by himself in 1885 on a number of healthy subjects,
which show that inequality of pupils is a very usual con¬
dition when no disease at all is present. Of 134 persons the
pupils were equal in 12; the left being the larger in 73, and
the right the larger in 49. In these persons the two sides of
the face were also carefully measured, with the following
results: Of the 12 with equal pupils, the two rides of the
face were equal in 3; the right side being the larger in 5, the
left in 4. In all the 122 cases where the pupils were unequal
the two sides of the face were also unequal; the right being
the larger in 27, and tbe left in 95.

HEALTH OF CALCUTTA.

The report of the health officer for the fourth quarter of
1886 shows the deaths in Calcutta to have amounted to
3829, which would give an annual ratio of 35-23 per 1000.
This is under the average of the preceding decades, in only
four years of which has the number of deaths been lower.
Hie returns show a considerable reduction in the deaths by
fevers and by dysentery and diarrhoea, but there has been
unfortunately a considerable increase in those by cholera,
I which amounted to 942, as against an average of 383. This
| disease, which had been prevailing during the third quarter
: of tbe year, reached its highest number of deaths in the last
week of November, since which date it has continued
, steadily to decline. Dr. Simpson points out two important
j facts in connexion with its prevalence in particular locali-
I ties. “ First, a large grouping took place around tanks; and,
secondly, most of the cases took place in those localities
where there was great scarcity of water ’’—that is, we
presume, water fit for drinking. Tbe water in the tanks of
the Buatees was M very fool.” He also again calls attention

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THE INTERNATIONAL MEDICAL CONGRESS.

[Mabch 26 , 1887. 641

to the necessity for* an amended Municipal Bill, with power
to enforce “ building regulations which will effectually
prevent hate and houses being built irrespective of ventila¬
tion, drainage,, air space, and means of scavenging.” We
are glad to learn that the Sanitary Commissioners have
sanctioned the formation of the nucleus of a sanitary staff,
by which inquiries may be made, under the direction of the
health officer; into all cases of cholera. Sot all-pox, typhoid
fever, and other preventable disease, with a view.to appro¬
priate measures being adopted to arrest their spread.

THE MARQUIS OF SALISBURY.

Rumoub has much exaggerated the recent illness of the
Right Hon.- the Marquis of Salisbury. The noble Premier
has been suffering' simply from the annoyance and feverish
depression arising from an attack of what in ordinary
parlance would be termed a severe cold, in the head.
Bronchitis has been mentioned in connexion with his
illness. We are, however, able to state that no symptoms
of this affection have been present. It is true that Sir William
Jenner was in attendance; but merely, we would suggest, to
enforce that rest from onerous and responsible duties so
neoeasary, yet so difficult, to be obtained by one in the
exalted position of his noble patient.

THE INTERNATIONAL MEDICAL CONGRESS.

TnK programme of the proceedings of the Congress will
not be completed till after the meeting at Chicago, In J une,
but it is expected that one of the general addresses will be
delivered by Dr. Semmola of Naples, and another by Professor
Austin Flint. Communications are expected amongst others
from the following gentlemenGreat Britain: Dr. W.
Dunnett Spauton, Dr. Julius Althaus, Dr. W. M. Whitmarsb,
Mr. Edmund Owen, Dr. R. Norris Wolfenden, Dr. Sidney H.

Martin, Mr. Lawson Tait, Mr. Henry Power, Dr. Samuel
Benton, Dr. W. Macewen, Dr. G. Eeilding Blandford, and
Dr. Geo. H. Savage. Ireland: Dr. Thos. More Madden.
Prance: Dr. Ei Landolt, Dr. P. Meniere, Dr. M. C.
Marquis Nadaillac, Professor Dr. A. Charpentier, Dr. .T.
Ameda-Doleris, Dr. Victor Aud’houi, and Dr. Max Durand
FardeL Germany: Professor Dr. IlegarT Professor Dr.
Gusserow, Dr. A. Oldendorff, Dr. L. Lewin, and Dr. J. Veit.
Hungary: Professor Joseph Koroei. Austria: Professor
Dr. Gustav Braun, Professor Dr. E. IL Kiach, and Dr. Emil
Ehrendorfer. Belgium: Dr. Alf. Struobens. Switzerland:
Dr. A. Cordes. Canada: Dr. Daniel Clark and Dr. MacCullum.
Italy: Dr. Luigi Casiti and Dr. Domenico l’erruzxi. We
cordially wish the Congress every success.

PARA-MYOCLONUS MULTIPLEX.

Db. Hblaingeobs has described a case of this unfamiliar
affection. It occurred in a man aged forty-five, whose
father was an inveterate toper. The disease began at the
age of sixteen, one year after the patient had had an attack
of malarial fever. A convulsive attack, apparently caused
by a severe fright, was attended with loss of consciousness.
The day afterwards his thighs were the seat of involuntary
shocks, often followed by movements in the thighs, later in
the arms, and rarely in the face. Ever since that time the
shocks bad continued, varying a liftle in frequency and
“^tensity, without, however, disappearing for a long time
together, and of late they had increased in frequency and
intensity. Movement, emotions, and fatigue increased the
movements. Small doses of brandy lessened the shocks,
but inebriety might lead to a convulsive seizure and to
augmentation of the chronic affection. His general health
ujaid haye continued good all through, and he has never
any pains. Contractions of the facial muscles were

observed, especially about the mouth. The chief muscles
affected in the arms were the long supinator, biceps, triceps,
deltoid, and carpal extensors. The shock extended through¬
out the whole muscle, and was often followed by a cor¬
responding movement. The muscular contractions were
often isolated; sometimes an irregular series of avhythmical
contractions were to be observed in the same muscle. The
intensity and frequency of repetition of the contractions
were rather -variable; a common interval was fifteen to
twenty seoonds. The contractions might be symmetrical
without necessarily being isochronous. The movements did
not interfere with the manual movements; ho could write
without trouble. Similar kinds of movements were noted
in the muscles of the thigh. Attempts to evoke the ankle
clonus were very efficient in calling forth movements in the
thigh muscles. The diaphragm, as well as the face, was the
seat of the spasms.. The case differs from those recorded by
Friedreich, Lowenfeld, Remak, and Marie in the last-
mentioned facts, and, as in Seoligmuller’s case, voluntary
movements favoured the occurrence of the involuntary con¬
tractions. The knee-jerks were extggetated m most cases,
but diminished in the one now mentioned. The hypothesis
of Friedreich supposed the motor oells of the spinal horns
to be the seat of a hyper-excitability—a supposition which
is so obvious as to be of no pathological value. We want to
know why these nervous centres overact

HALIFAX SUB-TOWNSHIPS AND THEIR MEDICAL
OFFICER OF HEALTH.

An effort is being made to break up the combination
around Halifax for which Dr. Britton has hitherto acted as
medical officer of health. At a public inquiry conducted by
Mr. G. Kennedy and Dr. Frederick Barry, inspectors of the
Local Government Board, Dr. Barry opened the proceedings
by giving a summary of the advantages of combination over
a large number of local appointments of medical men en¬
gaged in practice. The relative advantages of the two
systems were considered in The Lancbt of Jan. 24th, 1885,
and we have since then seen no reason to alter our opinion
on the subject. In this special case, even those who
advocated a break-up of the existing system had no com¬
plaint as to the manner in which Dr. Britton had performed
his duties; and his supporters were strongly in favour of
continuing the combination. We should much regret any
alteration, for the simple reason that we do not believe a
change can, in this instance, result in increased efficiency.
Unfortunately, the proceedings at the inquiry were of a
character not calculated to favour the views of the eentral
authority, and many of those engaged in it came into open
conflict with Mr. Kennedy, with the result that language
was used on both sides which will not tend to a satisfactory
settlement. _

NURSING IN WORKHOUSE INFIRMARIES.

Mb. Samuel Benton lately read a paper on “Nursing in
Workhouse Infirmaries” to the members of the Hospitals
Association. It is a subject which requires constant atten¬
tion. The conclusions be arrived at, and the soundness of
which cannot be questioned, were as follows:—

1. The matron should be a lady and a trained nurse. 2. In
building these infirmaries more accommodation ought to be
provided for the nursing staff. 3. There should always be
probationary nurses in training (at all events in the large
infirmaries) to fill up vacancies as they occur. 4. The large
infirmary and workhouse maternity wards ought to be
thrown open for the training of midwives. 5. Every en¬
couragement should be given by the guardians to the
medical officers to instruct the nurses and interest them in
their work by means of lectures and classes.

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642 Tot? Lancet,]

MANCHESTER CENTRAL MEDICAL SOCIETY.

[Mauch 26,1887.

THE PRESIDENCY OF THE ROYAL COLLEGE OF
PHYSICIANS.

The day for the annual election of a President by the
Fellows of the Royal College of Physicians will shortly
come round (Monday, April 4th). If there were any doubt
on the last occasion as to who might be chosen to occupy
the presidential chair, there can be none now. In the minds
of some the habit of not re-electing the President beyond a
term of five years had almost come to be regarded as an
established rule. But happily that custom was broken
through last year, and the precedents of earlier years in the
history of the College were followed when by so large a rote
the Fellows declared that Sir W. Jenner should form an
exception to the rule. Once more they may be trusted to
signify their approval of his services to the profession by
extending still further his term of office.

MANCHESTER CENTRAL MEDICAL SOCIETY.

The first annual report of this 8ociety has just been
published, and the record of success which it contains
seems to prove that such a Society was, as anticipated
by its promoters, required by the profession in Man¬
chester and its vicinity. Formerly there was but one
medical society in the city, and it was felt that this, for so
large a number of professional men, was inadequate; that
there must be many valuable experiences lost for want of
opportunity to bring them forward; and that there was
ample room for a society founded somewhat on the lines of
the Clinical Society of London, in which subjects of imme¬
diate interest to the medical practitioner might be dealt
with, discussions raised on diseases more frequently met
with in private practice than in hospitals, and on the use
of new drugs. The members number about 120. The
library and reading-room have been throughout the year
extensively used, and the meetings of the Society well
attended. The permanent rooms of the Society are at the
Victoria Hotel, Manchester, where many other scientific
societies also hold their meetings.

DIPHTHERIA IN YORK TOWN.

The Sanitary Authority of Frimley are not yet free from
anxiety concerning diphtheria in their district. Four more
cases of this disease have occurred in York Town, two of
which have proved fatal. At a meeting of the board held
last week the clerk was instructed to write to the Local
Government Board, stating that the authority wanted a
report on the recent outbreak, as the district was still
threatened with diphtheria. It is, however, no matter for
surprise that further cases of diphtheria have occurred
in a district in which this disease was freely disseminated
a few months ago; the opportunity for its development
will likely enough be given by some of the earlier cases.
The sanitary authority can hardly expect that the Local
Government Board are prepared to issue a report at a short
notice on a matter which requires much consideration.

MEDICAL MISSIONARY INSTITUTIONS IN LONDON.

The March number of Medical Missions gives an illus¬
trated paper on the medical missionary dispensaries at
present existing in London. The St. Giles’s Medical Mission
in Endell-street deals annually with some 6000 persons ; the
Bethnal-green Medical Mission receives upwards of 400
persons in its hospital and treats about 6000 in its dis¬
pensary; the Marylebone Medical Mission in Edgware-road
relieves about 4000 ; the Stepney Medical Mission (which is
associated with Mr. Barnardo’s work) relieves about 25Q0;
the Clapham-road Mission is confined to women and chil¬

dren, and its staff consists of two qualified ladies, who attend
about 3000 persons annually; the Mildmay Mission in
Cannon-street, Whitechapel, is limited to the Jews, of whom
it relieves annually about 6000, or one-tenth of the whole
Jewish population of London. These six medical missions,
then, relieve some 26,000 persons annually, and thus pro¬
bably save other hospitals and parochial medical officers a
large amount of labour without trenching upon the province
of the general practitioner to any appreciable extent, for the
patients who are attended either in the Mission dispensaries
or at their own homes are almost always miserably poor—
often, indeed, in want of the necessaries of life.

THE CLIMATOLOGY OF SPAIN.

In a paper read before the Academy of Medicine in Madrid
on change of climate in the treatment of disease as met with
in that city, Dr. Don Iglesias y Diaz, referring to cases of
chronic bronchitis with or without tubercle, and various
pulmonary affections which, he said, were very intractable
in the changeable winter climate of Madrid, mentioned a»
suitable localities Alicante, Valencia, Murcia, and Cartagena
in the east, and Malaga and its surrounding district in the
south. While in Madrid the mean annual temperature is
about 67° F., and the difference between the maximum
and minimum temperatures 95°, the mean temperature in
Valencia is 62'6° F., in Alicante 64'4° F., and in Cartagena
and Malaga 66 2° F., the variations in all these places being
also very much less than in Madrid. The driest localities
where there are fewest fogs and least rain are the districts
round Cartagena, Alicante, and Elche; then come Murcia,
the south of Valencia, and parts of Andalusia; while most
of the west and north coasts are damp, and Bilbao and
Santiago de Compostella extremely so, the aqueous vapour
there having a tension varying from 1000 to 2000 millimetres.
For dyspeptics Don Iglesias recommended the southern shore
of the Bay of Biscay, where the air is cool and moist.

PROFESSOR POLITZER.

The old pupils and friends of Professor Adam Politxer
have arranged to present him with his portrait as a memento
of his great services to aural surgery daring the twenty-
five years he has been teaching at the University of Vienna.
The presentation will take place at the meeting of the
Otological Association, in Vienna, at Easter. The subscrip¬
tion (8-?.) may be sent to any of the committee: Professor
Vittorio Crazzi (Florence), Dr. Antonin Joly (Lyons), Dr.
Eugen Morpargo (Trieste), Dr. E. Pius (Vienna), Professor
Urban Pritchard(London), Dr. F. Rohrer (Zurich), Dr. A.
Riihlman (St. Petersburg)._

DIABETIC COMA.

The latest interpretation of the phenomena of diabetic
coma has been to attribute them to poisoning by acids
formed within the system, probably from the glucose. It
may be remembered that Dr. Ralfe developed this idea at
the Pathological Society nearly five years ago, basing his
statements upon the similarity in symptoms to those of
acute yellow atrophy and poisoning by organic acids,
and upon the presence of aceto-acetic acid in the urine.
Acetonremia, then, would be only one link in the chain
of processes inducing diabetic coma. But since experi¬
mentally neither acetone nor aceto-acetic acid have
been found competent to produce phenomena analogous
to those of diabetic coma, the way was still open to the
discovery of other acid products which should have a toxic
effect. This seems to have been supplied by Stadelmann
and others in the detection of oxybutyric acid and the
determination of greatly decreased alkalinity of the blood.
M. Lupine (Rev. de MM., March, 1887) discusses this quee-

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EFFUSION OF BLOOD INTO THE KNEE-JOINT.

[March 26, 1887. 643

tion and relates a case in which, in accordance with
Stadelmann’s views, diabetic coma was treated by intra¬
venous injections of alkaline fluid—viz., bicarbonate of
soda 34 grms., chloride of sodium 8 grins., water 1.} litre.
Intravenous saline injection has, it may be remarked,
been practised before in diabetes on other grounds—
notably by the late Dr. Hilton Fagge and by Dr. F. Taylor
(see Guy’s Hospital Reports,- 1881), but with no more
benefit than in M. Lupine’s case. At the same time,
the alkaline treatment of diabetes is justiAed, accord¬
ing to M. Lupine, not so much because of neutralisation of
free acid in the blood, since mere neutralisation will not
annul the toxic action of the acid, but on the ground that
alkaline injections may assist in breaking up the acids and
in favouring their elimination. In the case related be found
that oxybutyric acid disappeared from the urine after the
injections. Prior to the measure, both the blood and urine
yielded this acid in parallel amount. Of course, as he
remarks, to prevent the accumulation of the poison in the
system is not everything; a way may be found some day to
prevent its formation. _

THE EMPEROR WILLIAM AND HIS PHYSICIAN.

On the eightieth birthday of the German Emperor,
Dr. von Lauer, his Majesty’s medical attendant, received
the title of “ Excellency ” and a gift of 160,000 marks. On
the 22nd inst., on the occasion of his illustrious patient's
ninetieth birthday he is stated to have received 300,000
marks. The post which Dr. von Lauer occupies is far from
being a sinecure, and it is pleasing to note that at a period
of national rejoicing his skill and care have neither been
unnoticed nor unrewarded._

THE JAPANESE PHARMACOPEIA.

Thb new Japanese Pharmacopoeia has just appeared, and
it is hoped that an end will now be put to the inconveniences
which have hitherto existed in Japan of there being no
official standard for medicines. The chemists obtain their
drugs from America, England, France, and Germany, and as
the preparations vary considerably in strength, all kinds of
confusion arose. The new Pharmacopoeia was undertaken
some twelve years ago, and in 1880 a commission was
appointed by the Government to carry out the work. This
commission has held 155 sittings. It was found advisable
to write the text of the Pharmacopoeia originally in German,
that being the language mo9t generally understood by the
members of the committee. The official text is, however,
Japanese, and there is also a Latin translation. The number
of preparations is 475, which are named first in Japanese
and then in Latin. The general character of the work is
similar to that of the English and German Pharmacopoeias.

THE NEW M.D. DEGREE FOR LONDON MEDICAL
STUDENTS.

A crowded meeting was held at the Westminster Hospital
Medical School on Tuesday last, at which Mr. Macnamara
occupied the chair. Mr. F. J. Simson proposed, and Mr.A.S.
Gubb seconded, a resolution supporting the scheme of the
Conjoint Board. The chairman. Dr. De Havilland Hall, and
Mr. Black also spoke in favour of the resolution, which was
carried with only three dissentients.

THE NAVAL MEDICAL SERVICE.

THE LONDON HOSPITAL.

The main question of the dispute at the London Hospital
to which we alluded last week had its origin, we understand,
in a difference of opinion between two bodies of the students
—that is to say, between those who have entered the full
college course of lectures and hospital and those who have
entered as fall students of the hospital only, the former
claiming a precedence in the holding of resident appoint¬
ments, and the latter asserting equal rights in this respect.
The matter has now been referred to a college board, who
will decide as regards existing rights as expressed in the
wording of the prospectus._

* EFFUSION OF BLOOD INTO THE KNEE-JOINT.

Dr. Bondesen, writing of the results of treating effusion
of blood into the knee-joint with and without puncture of
the joint, as shown by the records of the Copenhagen Com¬
munal Hospital for the last twenty years, during which
U9 cases of the kind have been admitted, states that the
percentage of complete cures was eighty-six in the cases
punctured, against sixty-three in those not operated on;
and, further, that the average stay in hospital of the former
class of cases was twenty-two days, against an average stay
of thirty-eight days on the part of the others. He considers
best practice is to puncture in all cases, and, if necessary,
to lay open the joint, using of course antiseptic precautions.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical ancl scientific
men are announcedDr. Adrian 8egura, Professor of Patho¬
logy in the Medical School of Mexico, and Director of the
Hospital of Ban Pablo in that city. Dr. Metardier of Bor¬
deaux, author of various works or Hygiene and of Reports
on Epidemics, especially on the Cholera in Spain, which he
ntudkd carefully on the spot.

The course of instruction at Uaslar Hospital for the
surgeons who entered the Navy in February last was
opened on the 10th inst. by Sir J. Watt Reid, K.C.B., the
Director-General of the Medical Department, in the presence
of a distinguished company. The proceedings on the
occasion will be noticed more fully in our next issue.

CHOLERA PRECAUTIONS.

In furtherance of the efforts of the Local Government
Board to secure adequate preparations against the entrance
into this oountry of cholera by sea routes, an inquiry was
held last week at Bangor to consider the proposition to erect
a small hospital on Puffin Island, at the entrance to the
Menai Straits. Curiously enough, opposition came from
such watering-places as Beaumaris, Penmaenmawr, Llan-
fairfechan, and Llandudno,the places of all others that should
seek to assist in proceedings directed against the importa¬
tion of sea-borne infection._

FOREIGN UNIVERSITY INTELUGENCE.

Erlangen .—The names selected for the chair of Mid¬
wifery with the post of Director of the Lying-in Institution
are Dr. Frommel of Munich, Dr. Pawlik of Vienna, and
Dr. danger of Leipsig.

Xharkoff. — Dr. M. Lomikovaki has been appointed
Extraordinary Professor of Medical Diagnosis; Dr. Podres,
Extraordinary Professor of Surgery; and Dr. P. Iasainsky,
Extraordinary Professor of Midwifery and Gynaecology.

Leipeig.—rroteaBOT Zwelfel of Erlangen has been appointed
to the chair of Midwifery and to the post of Director of the
Lying-in Institution. _

On the 18tb inst. the Carlisle medical officer of health
reported to the sanitary authority that an outbreak of
typhoid fever had' taken place through infected milk. Every
precaution has been used to prevent the spread of the in**
fection.

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644 The Lancet,]

PHARMACOLOGY AND THERAPEUTICS.

[March 26,1887.

The Port Said Hospital for Seamen hoe been erected on
the new site near the lighthouse, a medical officer and
nurses have been selected, and Lady Strangford goes to
Egypt to inaugurate it before May. A sufficient^ sum to
commence working lias been guaranteed by the members of
the committee, and the Princess of Wales has contributed
.£500 from a fund under her control.

The Swedish Government has authorised the appoint¬
ment of a medical officer to all the higher grade schools for
the purpose of watching over the health of the pupils and
the hygienic condition of the school. His salary is to be
from about £6 to £9, with a capitation fee of about 1«. Id.
on each pupil. _

On the 23rd inst. the Glasgow University Court
appointed out of a number of applicants the following
gentlemen: -Botany: George Murray, London. Natural
History: R. E. C. Leith, M.A., B.Sc., M.B., Edinburgh.
Chemistry: J. J. Dobhie, M.D.Sc., Bangor. Materia Medica:
Wm. Whit-la, M.D., Belfast. __

The Darlington School Board have ordered their schools
to be closed for a time with a view to check the prevalence
of measles and scarlet fever in the town.

John Tyndall, LL.D., F.R.S., has resigned his position as
Professor of Natural Philosophy at the Royal Institution,
which he has held since 1853.

We are asked to 6tate that the meeting of the Harveian
Society announced to take place on April 7th is unavoidably
postponed. _

The next meeting of the Clinical Society will be held on
April 1st, instead of the 8th, the latter day being Good
1 riday. _

pjarmarolap unit S%rapeixtics.

TINCTURE OF 8TBOPHANTHU8.

Few drugs have sprung more rapidly into favour than the
African arrow poison strophanthus. It was introduced to the
notice of the profession by the distinguished pharmacologist,
Dr. T. R. Fraser, Professor of Materia Medica in the University
of Edinburgh, who for fifteen years laboriously investigated
its action both on man and the lower animals. It is now
recognised as being not only a powerful heart tonic, but a
most active diuretic. It is gradually replacing digitalis in
popularity, and will in all probability in time entirely
supersede it. It is not cumulative, and is especially
indicated in all cases of cardiac affection attended with
dropsy. It not only quiets the pulse, but by acting on the
kidneys relieves the cedema and other attendant symptoms,
itbas also been found useful in purely functional irregularity.
For a lorgtime a difficulty was experienced in obtaining a
thoroughly trustworthy preparation, but Messrs. Burroughs,
Wellcome, and Co. have recently made a 1 in 20 alco¬
holic solution which answers every purpose. This new
tincture has been submitted to Prof. Fraser, who, after a
careful examination and subjecting it to various tests, found
that it answered his requirements. The dose is from two to
ten minims, and no hesitation need be felt in pushing it in
suitable cases. It is made on a very large scale, some
hundredweight or more being manipulated at a time, so that
absolute uniformity of product can be guaranteed. The
seeds alone are used, the busk and other parts being rejected.
We havo examined a specimen of the crude drug from which
it is prepared, and have no hesitation in saying that it is the
true species. Tho price of the tincture has been recently
reduced, so that there is every prospect of its commanding a
very extensive trial.

HOGG’S cocaine tablets.

Messrs. R. Hogg and Son. Pharmaceutical Chemists, of
1, Southwick-street, W., have sent us specimens of their-
cocaine tablets containing one-twelfth of a grain in each,
They are active, but are somewhat hard and unpalatable.
For the treatment of affections of the mouth or throat, they
would, we think, be improved by being prepared with cl
softer basis.

SALOL IN MEDICAL AND SURGICAL PRACTICE.

Salol has recently been extensively used in the Jewish
hospital, Berlin, both in the medical and surgical wards. The
Therapeutische Monatshcft publishes two papers on the
subject from the pens of Drs. S. Rosenberg and L. Feilehen—
feld. The former gives an account of the effect of the drug
in acute rheumatism, lie employed it at first in lo-grain dosea
six or eight times a day. In almost all the cases this had the
effect of bringing down the fever and relieving the pain in
the joints in from twenty-four to forty-eight hours. The
number of doses was then reduced to from five to two per
diem. The continuation of tho treatment did not, however,
appear to prevent the occurrence of complicatione, as
peri- and endo-carditis and pleurisy; sometimes also
singing in the ears, sweats, nausea, and vomiting occurred,
ana carboluria was always present for a time. The
digestive organs were never affected for any prolonged
period. Dr. Rosenberg thinks salol acts as a kind of
“ masked salicyl,” being insoluble in the gastric juice,
and thus having but little effect on the stomach. It does
not, he says, decompose into phenol and salicylic acid
until the pancreatic juice acts upon it in the duodenum.
Notwithstanding its general advantages over salicylic acid,
the latter should be used in very severe cases and when
there are repeated relapses. Dr. Feilchenfeld employed
salol in various surgical cases, both internally and as an
external application. In cystitis and pyelitis he gave two
or three 15-grain doses per diem with excellent results, and
with little in the way of disagreeable symptoms beyond a
green colouration of the urine of no particular moment.
Externally salol was found very useful in ulcers of various
kinds, and notably in a very obstinate case of bubo conse¬
quent upon a soft chancre, which had been operated on and
treated with the strongest caustics without showing any
disposition to heal. Salol, however, rapidly produced a change
for the better, and cicatrisation soon occurred.

MYRTOL.

Myrtol is obtained from the distillation of the leaves of
the myrtle; it is a liquid possessing the characteristic per¬
fume of the plant. It is of less density than water, evapo¬
rates at the ordinary temperature, stains paper, but the
stains disappear entirely. It has a warm, slightly acrid
taste, soon followed by a sensation of freshness. It is
said to be an excellent disinfectant and an energetic anti¬
septic, to stimulate the digestive functions, and to in¬
crease the appetite. In moderate doses myrtol acts a»
a sedative to the nervous system. It is eliminated by
the respiratory and urinary passnges. Myrtol appears to
have the advantage over the balsams of not upsetting the
stomach, thereby enabling it to be employed for a long
time without leading to objectionable effects—e.g., dyspepsia.
M. Lin&ris has had globules of myrtol prepared, each con¬
taining fifteen centigrammes of the pure liquid. The-
remedy does not appear to cause the same effects at all
periods of diseases of the respiratory passages. In order to
obtain the best results it should be employed with a view to
combating subacute or chronic catarrhal affections, or it may
be given at the termination of an acute attack of bronchitis
when the fever has subsided. Another indication for its
employment is an abundant opaque muco-purulent secretion.
In these cases the secretion is diminished and rendered less
purulent. M. Linaris has employed myrtol in chronic fetid
bronchitis, catarrhal bronchitis, catarrhal asthma with
paroxysmal attacks and palpitations, capillary bronchitis,
and dilated bronchi. The average daily dose was six of the
globules; Sbey should be taken after meals: two in the
morning, two in the daytime, and two at eventide.

SACCHARINE IN DIABETES.

Dr. Arnold Pollatschek of Carlsbad writes in a Hungarian
journal on the importance of Fahlherg’ssaccharineoranhydro-
ortho-sulphamide-benzoiic acid, as Stutzer calls it. Dr.
Pollatschek quite Agrees with Stutzer, Aducco and Mosso of
Turin, and Salkowski of Berlin,—all of whose researches oik
the chemical, physiological, and therapeutical aspects of the
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ROYAL COLLEGE OP PHYSICIANS.—THE NAVY ESTIMATES. [March 28,1887. 64&

bject be quotes at some length--that saccharine is perfectly
xmlusa. He finds that it may be given to diabetics for
reetening purposes, neutralised as proposed by Prof. Leyden
ith carbonate of soda. Dr. Pollatscnek made an attempt
cover the bitter taste of quinine with saccharine, but did
3t succeed.

ROYAL COLLEGE OF PHYSICIANS.

As extraordinary Comitia of the College was held on the
1st inst., Sir W. Jenner, Bart., President, in the chair.

A letter was read from the secretary to II.R.H. the
rince of Wales, conveying his Royal Highness’s thanks to
ie College for the gift of a copy of Harvey’s Prrelectiones
aa to micas.

A letter waa read from the President of the General
ledical Council addressed to the President of the College,
ontaining the following resolution passed on Feb. 19th:
That the Council, being of opinion that it would be
ontrary to the interest of the public to have two competing
ramming boards sitting in London, and that it is desirable
hat the Royal College of Physicians of London, the Royal
Allege of 8urgeons of England, and the Apothecaries’
society of London should arrange to hold a qualifying
xamination conjointly, strongly recommend to these
nedical authorities to reconsider their position with a view
xi such an arrangement; and meantime defer coming to a
leciaion on the application from the Apothecaries’ Society
of London of Feb. 12th.” The letter went on to say that
the Council felt it their duty to leave no way untried to
effect combinations between licensing bodies, which had
been done in Scotland, and partially in England and Ireland.
By the combination proposed one strong licensing body
would be formed ifi London.

The President pointed out that it was inaccurate to say
that the Colleges in any way competed with the Apothecaries’
Society.

It was moved by Dr. Dickinson, seconded by Dr. Habershon:
“That this College, having already in full comitia in October
deliberately considered the advisability of admitting the
Apothecaries’ Society of London to take part in the forma¬
tion of an examining board for England, in consequence of
a communication received from that Society, and having
T otsd nrminfi contradicentf against the inclusion of that
body, having again fully considered the question, sees no
waaon for altering the decision previously arrived at by this
CoUeee.” In the discussion that ensued several Fellows took
P«t,Including Sir Dyce Duckworth. 8ir Henry Acland, Dr.
Hendfleld Jones, Dr. Wilks, and Dr. N. Moore. Sir H. Acland
reviewed the previous steps taken to secure combination of
bodies, and claimed that the attitude assumed by the
Medical Council upon the question was in strict accordance
Wlt h the spirit of the Medical Act, which was framed to
®*nre combinations of licensing bodies. The President
supported the motion, which was carried without a
‘hwentient vote. A proposal by Dr. Wilson Fox that a state¬
ment of the reasons actuating the College should be appended
10 the resolution was withdrawn, it being felt that these
rtwons could be left in the hands of Sir Dyde Duckworth,
^ rcp reaentatiTe of the College on the General Medical

8everal communications regarding the movement of the
-•wo Colleges to obtain powers to grant degrees were read.
Unewaa from the secretaries of University College Mid King’s
to the effect that these Colleges intend to apply for
charter to grant degrees, and requesting a conference with
q t *° Royal Colleges. Another was from the King and
A Qe ?? 8 College of Fnysicians in Ireland, asking what steps
• e . R °y a l Colleges were taking to obtain this power, and
their intention to make a similar application. A
jura from the Royal College of Surgeons of Ireland was to
nf it*! 08 ®? ecfc - A memorial from the Faculty of Medicine
u °*y®**rty College, Bristol, asking that admission to the
P opened degree should be extended to students in provincial
thap’ referred, with the other communications, to
fro m A communication was read

.• Association of General Practitioners enclosing
inc at * r ®c® nt meeting in Exeter Hall, deal-

(mrtwLr?? degree question, the conjunction with the
Society, and with the representation of Licen-
""feJfemberi'Oa the governing body of the College.

A letter was read from the secretary to the Imperial
Institute, inviting contributions from the Fellows of the
College. It was resolved, on the motion of the President, to
present a memorial to Her Majesty on the occasion of bee
jubilee; and it was also resolved to erect a statue or bust
of Her Majesty, in commemoration of that event, in the
new Examination Hall.

A report from the Committee of Management suggesting
certain alterations in the examination regulations wae
adopted.

THE NAVY ESTIMATES.

Thb Navy estimates continue to be furnished in a form
which, so far at least as regards the medical service, makes
it difficult, if not impossible, to give a elear statement of
the expense involved. From {he scattered details we gather
that the personnel of the department is estimated to be
1 Director-General, 2 Inspectors-General of Fleets and
Hospitals, 10 Deputy Inspectors-General, 66 Fleet Surgeons,
76 Staff Surgeons, and 217 Surgeons. The amount required
for their pay and allowances is .£136,673. There are on the
half-pay list, but eligible for employment, 21 officers, for
whom £5759 are taken. On the retired list there are 22
Inspectors-General, 70 Deputy Inspectors-General, 58 Fleet
Surgeons, 62 Staff 8urgeons, and 38 Surgeons, making a
total of 250, whose retired pay amounts to £86,385. Pro¬
vision is made for 3 head sisters and 15 nursing sisters in
the Melville, Haslar, and Plymouth Hospitals, at an expense
of £1367 for their pay and £236 for their uniform cloth¬
ing. It is impossible to say what amount is required
for the purchase of medicines and instruments, as under the
vote in which these appear a great number of things are
included which, though intended for the use of the sick,
cannot be classed under either of these heads. We observe
that, while the vote for the expense of carrying out the
Contagious Diseases Acts disappears from the estimate, a
sum of £2100 is to be taken “ for contributions in aid of
lock wards at Portsmouth and Devonport.” For the pur¬
pose of carrying out sanitary work a sum of £2000 is to be
expended on “sanitary alterations” in the Royal Naval
College, Portsmouth; £800 for lavatories &c. to one block
Of wards in Chatham Hospital, and £620 for heating arrange¬
ments for washing-troughs in Plymouth Hospital. The
only items under this bead for foreign stations are a sum of
£520 for “improvements to fever ward” in the hospital at
Jamaica, and contributions of £1260 towards the drainage
works ait Halifax, and of £430 towards those at Malta.

THE IRISH, MEDICAL SCHOOLS AND
• GRADUATES’ ASSOCIATION.

Thb annual general meeting of this Association took
place on St. Patrick’s Day, Thursday, March 17th, at 49,
Bemers-street, Loudon. The following members of Council
were present:—Sir Thos. Crawford, K.C.IL, Director-General
of the Army Medical Department; Dr. MacnaughUm Jones;

' Prof. Yeo, chairman of Council; Prof. Macs lister: Dr. Edward
Waters, Chester; Dr. Gilbart Smith; Dr. Wm.H. White;
Dr. Phillips, Reading; Dr. R. Fegan; Dr. J. II, Gibson ;
Brigade Surgeon Alexander, hon. treasurer; Dr. Jos. Stewart,
hon. sec. for the Provinces; and Dr. P. S. Abraham, hon. sec.
for London. Among the other members who attended wer&
Inspector-General Dick.R.N.; Dr. Ilenry Fitzgibbon, Dublin;,
and several others. After the outgoing president (Dr.
Mocnaughton Jones) had relinquished the chair to Sir Thos.
Crawford, now president, the annual report of the Council
waa read. The number of members on the roll had increased
within the year from 368 to 459. The Council had to regret
the lose by death of six—viz., Drs. Thompson (founder of
the Association), Curtin, Earaes, Staff ^Surgeon O’Sullivan,
R.N., Dr. Sexton, and Deputy Surgeon-Gen oral Wolesley.
Among the more important matters which had been and
were still under the consideration of the Council, were the
disabilities under which graduates laboured who held the
higher qualifications of the Dublin Colleges. The hon.
treasurer’s repott waa very satisfactory, and showed a sub¬
stantial balance to the credit of the Association. Professor

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REPORTS OP MEDICAL OFFICERS OF HEALTH.

[March 26,1887,

Alexander Macalister, M.D. (Trin. Coll., Dublin), F.R.S., was
then nominated as president-elect. Cordial votes of thanks
were accorded to Dr. Macnaughton Jones, who had so ably
and zealously occupied the chair for two years, and to Dr.
Daniell on his resigning the post of hon. metropolitan
secretary, which he Had filled since the foundation of the
Association. In the evening the members dined together at
the Holborn Restaurant.

public pealtjr anir jJoor fain.

LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MBDIOAL OFFICERS OF HEALTH.

Sutton-Coldfield Urban Diftrict. —Dr. Bostock Hill was
appointed in May last to act as health officer for this newly
incorporated borough. His report deals at length with the
statistical returns, which show a birth-rate of 23 06 and a
death-rate not exceeding 12 6 per 1000, the zymotic rate
also being lerw—namely, 104. Indeed, in a population of
8630 no death occurred from typhoid fever, only 1 from
diphtheria, and 2 from diarrhoea. The isolation hospital is
maintained in a state of readiness, and by its aid much may
be done towards a continuance of freedom from preventable
diseases. Sewer extensions are much needed, and we note
that some commencement of this work is in hand. At pre¬
sent there are no bye-laws, and in deciding as to their
adoption the authority would do well to examine the
annotated edition of the model code issued by Messrs. Knight
and Co. The question of offensive trades, dairies, cowsheds,
and milkshops, bakehouses, and overcrowding are either
being dealt with or under immediate consideration. The
prevailing meteorological conditions are discussed in the
report in connexion with the health of the district.

Blackpool Urban District. —We have elsewhere referred
to that portion of Dr. Welch’s report which deals with the
question of the isolation of infectious fevers. We here note
the report generally. During 1886 the general death-rate on
nearly 20,000 people was 18 - 9 per 1000, but deduction being
made for forty-six deaths in visitors, the rate is reduced to
16'5. Infant death under one year has, during seven years,
decreased from an average of 16'3 to 151 per cent, of
registered births; but even the latter rate is needlessly
high, especially for such a place as Blackpool. In con¬
nexion with the association of faulty sanitary circumstances
with this death-rate, Dr. Welch explains that in one street
five deaths from infantile diarrhoea have occurred during
the last few years. They all took place on one side of the
street, and tbe only difference which was noticeable as
regards the houses, which were otherwise alike on both
eides, was the fact that on the diarrhoea side of the street
the back windows overlooked old-fashioned open ashpits,
whereas on the other they faced a blank wall. That such
structures, together with common privies elsewhere reported,
should exist m a town taking its place as a health-giving
resort constitutes a reproach which calls for removal. The
town water service, otherwise wholesome, needs efficient
filtration, and tbe systematic flushing of the mains is also
periodically required. The need for improvement as to
open space at the back of houses is likewise maintained. In
Blackpool, it is evident that even the small minimum space
required under the bye-laws is not always-enforced. Should
this continue, that undue aggregation of houses on area
which has ruined the sanitary reputation of many a town
will gradually assert itself. Dr. Page, of the Local Govern¬
ment Board, has recently visited Blackpool, and he has
urged on the authority the need for substantial improve¬
ment in several respects, to which Dr. Welch also refers.

Shipley Urban District. —In. this district the birth- and
death-rates for 1886 were 24-8 and 13-3 per 1000 respectively,
and whereas the average number of deaths from the seven
principal zymotic diseases for the years 1879-85 was 23,
the total was only 3 last year. Notification of infectious
<lisease8 is pretty general in the district, but, as Mr. EIHb
points out, it comes so often at the wrong time. People
notify so as to secure the aid of the sanitary officers for the
purposes of disinfection at the close of an illness. Whereas
the primary object of notification requires that the in¬
formation shall be supplied at the earliest possible date in

the history of the case. Isolation was in certain cases of
scarlet fever carried out by removal of the sick to the
apartments provided for the authority, on a payment of 3*.
a day, at the Sir Titus Salt Hospital. Mr. Ellis secures the
personal attendance of his authority during an inspection
of his district; this is a plan admirably calculated to ensure
abatement of conditions injurious to health, and it is evident
from the steady reduction in the rate of mortality which
has been in progress ever since 1875, and this notwithstand¬
ing a growing population, that the sanitary interests of
Shipley are held to be of importance. The saving of life on
17,000. people which must have followed a reduction from
23-6 per 1000 in 1875 to 13 3 per 1000 in 1886 is very
great, and with it has gone a saving of much misery and
unhappiness.

Torquay Urban District. —This district is about to be
materially improved, since, under the Torquay Harbour and
District Act, the harbour, with its still piece of water, is
now in the hands of the sanitary authority, and can be kept
free from the nuisance which follows on the accumulation
of seaweed and of dead fish left by wasteful fishermen.
Tbe compulsory notification of infectious diseases has also
been secured for tbe town, together with other sanitary
powers, such as relate to obtaining from dairymen lists of
their customers, and to the inspection of dairies outside the
district. With but few exceptions, Mr. Karkeek has a satis¬
factory record to give for the year. In one instance grossly
defective conditions of house-drains in a dwelling led to
fatal typhoid fever almost immediately on the house being
entered. Those who had formerly lived there appear to
have become habituated to the evils; but, as often happens,
a new-comer not accustomed to inhale drain air was smitten
down at once. Nothing short of a house-to-house inspec¬
tion, which lies at the root of efficient sanitary work, or,
failing that, the registration of all sublet houses and their
control by bye-laws, can deal with such cases. The death-
rate on 25,000 was 16 48 per 1000, or, if visitors are excluded,
1476 per 1000.

Holsworthy Rural District. —Mr. Linnington Ash gives tbe
birth-rate and death-rate for this district as 30*8 and 17 5
per 1000 respectively; the zymotic rate being 1-7. About the
end of the second quarter diphtheria made its appearance,
and, in spite of every effort to induce parents to apprehend
the danger and to take the proper precautions, the disease
spread through tbe medium of school attendance. Although
the school was closed, it caused four deaths, and also con¬
tinued into the fourth quarter of the year. Measles and
whooping-cough were also present during the year, and it
is shown that the district finds itself hampered in dealing
with infectious diseases by reason of the absence of any
proper means for the isolation of first cases. In Holsworthy
town the need for a proper water-supply is most pressing.
For three months last year there was practically a water
famine, and though the matter has been under notice again
and again, it remains asyet quite undealt with. Indeed, no
work for securing permanent sanitary improvements has
been carried out during the past year, although in several
respects they are much needed.

Exeter Urban District. —The Exeter Sanatorium con¬
tained 97 patients during 1886, scarlet fever affording 61,
typhoid fever 18, and small-pox 14 cases. The death-rate
was only 4 7 per cent, of admissions. As regards small-pox,
it is stated that that which appeared at one time to threaten
a severe epidemic was brought to an end by means of the
isolation afforded. It further appears that although 230
cases of scarlet fever have been under treatment there
between November 1st, 1877, and December 31st last, there
has been no death from this disease since November, 1877.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6516 births
and 3977 deaths were registered during the week ending
March 19th. The annual death-rate in theee towns, which had
been equal to 21 ‘3 and 21 -0 per 1000 in tbe preceding two
weeks, further rose last week to 22-4. During the first eleven
weeks of the current quarter the death-rate in theee towns
averaged 21-9 per 1000, and was 2-1 below the mean
rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 13-9 in
Birkenhead, 16’5in Halifax, 17'2in Brighton, and 178 in Ports-

Digitized by GoOgle

The Lancet,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[March 26,1887. 647

mouth. The rates in the other towns ranged upwards to 23 6
in Newcastle-on-Tyne, 29 0 in Oldham, 331 in Bristol, and
33*2 in Manchester. The deaths referred to the principal
zymotic diseases in the twenty-eight towns, which had in¬
creased in the preceding five weeks from 310 to 412, further
rose last week to462; they included 213 from measles, 112 from
whooping-cough, 45 from scarlet fever, 35 from diarrhoea,
32 from “fever” (principally enteric), 24 from diphtheria,
and only 1 from small-pox. No death from any of these
principal zymotic diseases was registered last week in
Brighton or in Birkenhead; they caused, however, the
highest death-rates in Bristol, Huddersfield, Oldham, and
Sunderland. The greatest mortality from measles occurred
in Leicester, Norwich, Bristol, Salford, Manchester, and
Hudderafiela; from whooping-cough in Bristol, Hudders¬
field, and Oldham ; and from scarlet fever in Bristol. The
24 deaths from diphtheria in the twenty-eight towns in¬
cluded 13 in London, 2 in Portsmouth, 3 in Liverpool, and
3 in Oldham. Small-pox caused one death in Sunderland,
but not one in London, and its outer ring, or in any of the
twenty-six other large provincial towns. Only 3 cases of small¬
pox were under treatment on Saturday last in the metro¬
politan hospitals receiving cases of this disease. The deaths
referred to diseases of the respiratory organs in London,
which had been 466, 459, and 433 in the preceding three
weeks, rose last week to 474, but were 67 below the corrected
average. The causes of 119, or 3 per cent», of the deaths
in the twenty-eight towns last week were not certified
either by a registered medical practitioner or by a coroner.
All the causes of death were duly certified in Portsmouth,
Derby, and Birkenhead. The largest proportions of un¬
certified deaths were registered in Halifax, Hull, Salford,
Oldham, and Sunderland. _

HEALTH OP SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 23*6 and 25 0 per 1000 in the preceding
two weeks, further rose to 26*2 in the week ending
March 19th; this rate exceeded by 3'8 the mean rate during
the same period in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from 15*8
in Dundee and 19*5 in Edinburgh, to 30*2 in Glasgow and
41*7 hi Aberdeen. The 655 deaths in the eight towns last
week showed a further increase of 30 upon the numbers
in the preceding two weeks, and included 50 which were
referred to measles, 28 to whooping-cough, 11 to diar¬
rhoea, 9 to scarlet fever, 8 to “fever" (typhus, enteric, or
simple), 6 to diphtheria, and one to small-pox; in all, 113
deaths resulted from these principal zymotic diseases,
against 98 and 101 in the previous two weeks. These 113
deaths were equal to an annual rate of 4 5 per 1000,
which exceeded by 19 the mean rate from the same
diseases in the twenty-eight English towns. The fatal earns
of measles, which had been 27 and 43 in the preceding two
weeks, further rose last week to 50, of which 35 occurred in
Aberdeen and 14 in Glasgow. The 28 deaths from whoop¬
ing-cough exceeded the number in the previous week by 3;
19 occurred in Glasgow and 4 in Aberdeen. The 9 fatal cases
of scarlet fever, on the other band, showed a further decline
from recent weekly numbers; 6 were returned in Glasgow and
2 in Edinburgh. The 11 deatlis attributed to diarrhcea corre¬
sponded with the number in each of the previous two weeks,
and included 4 in Glasgow, 2 in Greenock, and 2 in Paisley.
The 8 deaths referred to “fever” exceeded the number in
any recent week; 4 occurred in Glasgow and 2 in Aberdeen.
Of the 6 deaths from diphtheria, 3 were returned in Glasgow
and 2 in Leith. The death classed to small-pox was said
to be a fatal earn of chicken-pox in Glasgow. The deaths
referred to acute diseases of the respiratory organs in the
eight towns, which had been 142 and 135 in the preceding
two weeks, rose last week to 162, but were 52 below the
number returned in the corresponding week of last year.
The causes of 69, or more than 10 per cent., of the deaths
registered in the eight towns during the week were not
certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 281
and 31-3 per 1000 in the preceding two weeks, declined
again to 29 3 in the week ending March 19th. During the first
eleven weeks of the current quarter the death-rate in the city
averaged 30 9 per 1000, the mean rate during the same period
being but 20*7 in London and 21-3 in Edinburgh. The 193

deaths in Dublin last week showed a decline of 14 from the
number in the previous week ; they included 4 which
were referred to “fever” (typhus, enteric, or simple), 2 to
scarlet fever, 1 to diarrhcea, and not one either to small¬
pox, measles, diphtheria, or whooping-cough. Thus the
deaths from these principal zymotic diseases, which had
been 15 and 10 in the preceding two weeks, further declined
last week to 7; they were equal to an annual rate of 1 per
1000, the rates from the same diseases being 2*2 in London
and 1 in Edinburgh. The deaths from “fever,” winch
had been 8, 5, and 5 in the previous three weeks, further
declined last week to 4. The fatal cases of scarlet fever
were 2, against 7 and 1 in the previous two weeks. The
deaths ot infants showed a marked decline from the
numbers in recent weeks, and those of elderly persons were
fewer than those in the previous week. Five inquest cases
and 6 deaths from violence were registered; and 57, or
nearly a third, of the deaths occurred in public institutions.
The causes of 36, or more than IS per cent., of the deaths
registered during the week were not certified.

MORTALITY IN LABOR LANCASHIRE TOWNS IN 1886.

The twenty-eight large towns dealt with by the Registrar-
General in his weekly return include seven Lancashire
towns, which had in the middle of last year an aggregate-
population of more than a million and a half. Liverpool
headed the list with a population of 586,320; while the
smallest town was Preston, which had an estimated popu¬
lation of 101,340. The mean death-rate in these seven
Lancashire towns during last year was equal to 24 - 4 per
1000, against 20*0, the mean rate in the whole of the twenty-
one other large towns in the list, and against 19 9 in London.
Thus in equal numbers living the mortality in the Lanca¬
shire towns last year was 120 to 100 in the other large towns,
showing an excess of a fifth, or of 20 per cent. Striking as
is the excess of the recent mortality in these Lancashire
towns measured in this manner, the true excess, if due
account be taken of the sex and age constitution of the
population of these towns, is still greater. Duly corrected
ior this disturbing element, on the assumption that the
sex and age distribution of the population of each of the
towns is the same as that of England and Wales, the death-
rates in these seven Lancashire towns last year were 240 in
Salford, 25 3 in Oldham, 25 4 in Bolton, 26 1 in Liverpool,
27 8 in Blackburn, 29 4 in Manchester, and 31*4 in Preston.
The rates in the twenty-one other large towns, corrected in
a similar manner for sex and age inequalities, ranged from
176 in Brighton and 18*9 in Derby, to 24 5 in Portsmouth
and Cardiff and 24 7 in Halifax. The rates, therefore, in six
of the Lancashire towns exceeded those recorded in any of
the other towns; while the rate in Salford (the lowest in
any of these large Lancashire towns) was only exceeded in
Portsmouth, Cardiff, and Halifax. The rates in the six
Yorkshire towns stand out in favourable contrast with
those of the leven Lancashire towns above referred
to. It should be stated that recent death-rates in
the Lancashire towns bear favourable comparison with
the sates in post years, but they do not show a
reduction &t all commensurate with that which has been so
marked in the death-rates of English urban populations
generally. That the excess of mortality in the Lancashire
towns is the result of defective sanitary condition may un¬
doubtedly be inferred from the fact that the excess is as
strongly marked in the rate from the principal zymotie
diseases and in the rote of infant mortality as it is in the
general rate from all causes. It may be noted, for instance,
tnat the mean rate from “ fever” (principally enteric) in the
seven Lancashire towns was nearly twice as high as the
mean rate in the twenty-one other large towns, while the
death-rate from scarlet fever was more than twice as high.
Few will now deny that, at any rate, the mortality both of
enteric and of scarlet fever is clearly witbin the control which
it is possible for good sanitary organisation to command.

MORTALITY IN AUSTRIAN CITIES.

From a return just issued in Vienna, it appears that
Austria contains forty-nine towns, each of which in the
middle of last year contained an estimated population exceed¬
ing 12,000 persons. Vienna beads the list with a population
of 780.066. and four other cities have populations exceeding
ICO.000: Prague with 182,935, Trieste 155,197, Lemberg
117,902, and Graz 103,670. There are five towns with popn-

648 The Lancet,]

TREATMENT OF PLACENTA PREVIA.

[March 28,1887.

lations varying between 60,000 and 100,000; while the
population of the remaining thirty-nine towns range be¬
tween 12,000 and 50,000. According to this return, the
death-rate per 1000 of the population during last year was
28‘5 in Vienna, 390 in Prague; 39-8 in Trieste, 34 4
in Lemberg, and 304 in Graz. In the smaller towns
still higher rates prevailed, and it is noteworthy that
in only four of the forty-nine towns was the death-
rate in 1886 below 25 per 1000; in thirteen it was
between 25 and 30; in eighteen between 30 and 35;
in eleven between 35 and 40; and in three towns the
rate exceeded 40 per 1000. These strikingly high rates of
mortality in the Austrian cities present a rmnarkable con¬
trast with the rates that prevailed last year in English
towns. In the twenty-eight large towns of England and
Wales, with an average population many times greater than
the average population of the Austrian towns, the death-
rate last year ranged from 17'1 in Brighton and 18 2 in
-Derby, to 26 3 in Manchester and 28 - 9 in Preston. The range
of mortality in the Austrian cities above referred to was
between 214 and 48‘1. This marked excess was in great'
measure due to the mortality of zymotic diseases, to which
further reference will shortly be made.

THE SERVICES.

Deputy Surgeon-General Sir J. A. Danbury, K.C B., the
Principal Medical Officer of the Home District, has been
•ordered to hold himself in readiness to proceed to the
Mediterranean, for the purpose, we presume, of taking up
■the appointment of Principal Medical Officer at Gibraltar in
succession to Surgeon-General Fraser, who will be placed on
•the retired list under the provisions of the age-clause of the
Warrant. The Times correspondent at Rangoon states that
the commissariat and medical arrangements for the police
in Upper Burmah have been very defective, and that Mr.
Oossthwaite has selected Surgeon-General Farrell, of the
Indian Medical Service, to take charge of the medical
arrangements.

War Office. — Army Medical Staff: Surgeon-Major
Prancis Henry Welch to be Brigade Surgeon, vice John
Henry Hunt, deceased. Dated Feb. 24th, 1887.

Admiralty. — The following appointments have been
made: Surgeon G. n. Meaden, to the Sea forcer: Surgeon
E. A. Spiller, to the Martin: Surgeon G. E. Kennedy, to the
Nautilus: Surgeon J. E. Webb, to the Pilot; Surgeon J. F.
Bate, to the Scalark; Surgeon J. Andrews, to the Liberty
•(all to date from the 25th inst.); and Surgeon R. Hickson,
to the Lion.

ComsjjQit'trmr.

“Audi alteram partem."

TREATMENT OF PLACENTA PREVIA.

To the Editors of The Lancet.

Sirs,— I have only just read your complimentary remarks
■of March 5th on my recommendations in treating placenta
praevia, and the letter of Dr. Jas. Murphy on your approval
•of them. There is one remark of yours I should like per¬
mission to correct, when yon say, “ though some facts in the
pathology of placenta prrevia (such as the arrest of bsemor-
rhage after turning and before extraction) were unknown to
him and his contemporaries.” On page 27 of my “ Combined
External and Internal Version” (1864) I eay: “I believe that
in nearly every case the bleeding will be found to be con¬
trolled by tbe drawing down the child after version go as to
fill up the os uteri. I have never found any bleeding after
this pdlnt has been gained.” Again, page 28: “ Should there
be reason to fear haemorrhage was going on internally, then
the delivery might be hastened; but I nave in all the cases
narrowly watched for any externally or internally withoqt
having met with it. Such a state is of coarse possible, but
i think it must be rare,” &c.

With regard to Dr. Murphy’s letter, I may say that it
affords me great pleasure to be in happy rivalry with planB
4hat have reduced the former mortalities to so low a point.
4Tar my own part, I do not wish anything I have suggested

to take a position other than it deserves; the saving of life
is too earnest a thing to stand behind personal interest. I
may, however, be permitted to point out that the treatment
of cases of placenta pnevia clinically may be divided into
two classes: one where we are suddenly called without
previous acquaintance with the case, without any means at
command but our hands; the other where, having seen the
patient beforehand, we can calmly set our plans to bear on
the treatment. In the former, particularly, the plan I hare
suggested gives us the command of the position such as
none other can give. In those cases where we have tame
the importance of terminating the pregnancy cannot be
overrated; it is that which I have for years inculcated in
my lectures, and I have no doubt others have in theirs ; but
in this I make no claim to originality, for it is to Dr.
Greenhalgh we are indebted for tbe first definite laying
down of what Dr. Murphy in his letter wishes to
enunciate as a ninth great proposition. In 1864, in a
paper read before the Obstetrical Society of London,
Dr. Greenhalgh said that “ in any given case of haemor¬
rhage dne to placenta pnevia occurring after seven and a
half months of ntero-gestation, when the child is viable, it
is expedient, both for the safety of the mother and child, to
expedite labour—unless the condition of the exhaustion be
such as to preclude this step; and if so, then as soon as
possible after she has recovered from the shock.” This is
virtually the same as Dr. Murphy enunciates as his ninth
proposition. In the discussion on that paper my plan of
turning is compared with that of the older internal mode,
to the great advantage of the “combined.” In that dis¬
cussion! said that I “ quite agreed with Dr. Greenhalgh as
to the necessity of inducing labour in placenta praevia as soon
as arrangements could be made, which I believed to be the
plan adopted by all who saw much midwifery in that city;
it was the practice I had always adopted” (op. cit.), and in my
paper read in 1863 at the Obstetrical Society, and in the
little work “ Combined External and Internal Turning,” of
the same year as Dr. Greenhalgh’s paper, I allude to theadvan-
tage also given us in dilating the os with Barnes’ bass and
separating the placenta around the os. “ The value of these
bags is very great, and they give us the poweT of operating
at a date far earlier than we ever possessed before.” But the
separation of tbe placenta by the finger in placenta pnevia
is not always without severe loss. I have had severed cases
where on peeling off the placenta the haemorrhage was so
violent that had I not been able to use the bipolar method
serious results would almost certainly have occurred.
Doubtless, the mortality from placenta praevia has been
latterly much lessened by the rule laid down by Dr. Green¬
halgh of early termination of tbe pregnancy, by those who
have followed it; but it still needs to be more generally
known and practised, and Dr. Murphy's emphatic endorse¬
ment will assuredly do much good.

I am. Sirs, yours truly,

George-st., Hanover-aq.. March 21st, 1887. J. BRAXTON HlCKS.

THE ROYAL UNIVERSITY AND UNION
HOSPITALS.

'To the Editors of The Lancet.

Sirs,—1 have received a communication from the Privy
Council in which marked prominence is given to tbe fact
that tbe utilisation of union hospitals is still under the con¬
sideration of the Generel Council. One member of that
body fell into the strange error of stating that these hos¬
pitals lacked material for teaching. The Irish Local Govern¬
ment Report for 1886 will show that 52,000 were admitted
in 1885 in sickness from the outside. These were all cases
that were of course too sick to be treated in the dis¬
pensaries. They were admitted under an Act which
opened up these hospitals to the general public, and of
whose existence our critics seem to be unaware. That
report will further show by its table of the causes of deaths
that at least 24,000 sick paupers were likewise entitled to
be placed among the b>md-fide clinical material. The further
pretence of the Royal University that they could not exer¬
cise proper supervision over such hospitals is met by their
own action in recognising other hospitals over which they
could not exercise it, and in their not exercising it where
they could do so. The time is not far distant when self-
respecting provincials will be able to defend their own
interests. I am, Sirs, yours truly,

Cube], March 15th. 1887. THOMAS LAFFAN.

Digitized by G00gk

The Lancet,J

ERYSIPELAS AFTER VACCINATION.—MANCHESTER.

[March 26,1887. 649

INEQUALITY OF THE PUPILS IN TUBERCULAR
MENINGITIS.

To the Editors of The Lancet.

SibS,—M y friend Mr. Buxton has rather mistaken the
origin and object of my letter on “ Inequality of the Pupils
in Various Diseases.” It was written because I noticed that
Dr. Pasternatski, in writing on this subject, and enumerating
several diseases where this symptom existed, did not men¬
tion tubercular meningitis. Now, as my experience is that
it is often present where tubercle of the cerebral membranes
exists, I was desirous of knowing if this was an accidental
omission, or that Dr. Pasternatski had not observed the
symptom in tubercular meningitis. It did seem to me more
than a coincidence that my fatal cases had unequal pupils
to a very marked degree (I have copious notes of a very
interesting case in a boy of nine, where one pupil was widely
dilated and the other contracted to a pin’s point, both in¬
sensible), while in the oases of recovery it did not exist; and
it still appears to me reasonable that the pressure on the
brain, whether caused directly by tubercle or by fluid the
result of tubercle, Bhould produce graver symptoms when
that pressure is all on one side, and not shared between the
two cerebral hemispheres; and thus unequal pupils may be¬
come an important and valuable symptom affecting the
prognosis, although of course not necessarily excluding the
diagnosis; and Mr. Buxton has not shown that there is not
a tendency—and I think there is—for the fluid to gravitate
more or lees on one side in this disease. I did not examine
the fundi; the pupils in every fatal case were insensible.

I am, Sirs, yours truly,

March 22nd, 1887. FRKDK. H. AlDERSON, M.D.

ERYSIPELAS AFTER VACCINATION.

To the Editors of Tub Lancet.

Sirs,—T he article on the above subject in your last issue
induces me to draw attention to a factor of importance in
the causation of erysipelas—i.e., hereditary predisposition.
This was brought foroibly under my notice a few years ago,
while holding the post of public vaccinator to a district in
Yorkshire. 1 had a severe case of spreading erysipelas
following vaccination in a child nine months old, who
eventually recovered after a long illness. There was nothing
either in the history of the inserted lymph, or, as far as I
could judge, after careful inspection and inquiry, in the
sanitary surroundings of the patient, to account for the
disease, but there was a decided family history of erysipelas,
both parents having suffered from it, the father being
peculiarly prone to attacks of the facial variety. All other
explanations failing* I attributed the occurrence to the de¬
pressing influences of teething and an inherited pre¬
disposition to the development of erysipelas, the vaccina¬
tion wounds merely Affording am inlet to the active
elements of the disease, which under different circumstances
might have been innocuous. The case made a lasting im¬
pression on my mind, and is certainly suggestive in view of
similar occurrences.

I am, Sirs, yours faithfully,

Jakes Turton, M.B.C.S.,

Late Public Vaccinator, Dowtbury Union.

Brighton, March 30th. 18*7.

“A CASE FOR INQUIRY”: A DISCLAIMER.

To the Editors of The Lancet.

Sirs,—The Lancet of the 12th ult. has only just come
into my hands, and I am very much astonished to find in
your annotations a paragraph which, unless the matter is
cleared up, may be considered to refer to me. I find on
looking at the Medical Directory for 1884 that I am the
only tT Young in the whole of the United Kingdom possess¬
ing the qualifications mentioned. I have been unable as,
yet to procure copies of the Illustrated London News for
the dates to which your paragraph refers; but whatever the
matter may be, I most emphatically disavow any knowledge
of it, inasmuch as I neither know nor have ever had any
communication with Mr. Alabone. I assure you that both
advertising and assumption of titles which are not legal
have as little of my sympathy as of yours. I feel sure that,

with your usual justice and impartiality, you will allow me
in your next issue to disclaim any connexion between the
“Dr. T. Young” mentioned in your issue of the 12th' nit.
and myself. I am, Sirs, yours faithfully,

Thomas Brett Young, L.R.C.P., L.R.C.S. Edin.

The Laurels, Hales Owen, near Birmingham, March 22nd, 1*87.

We gladly insert our correspondent’s letter.—E d. L»

MANCHESTER.

(From our own Correspondent.)

HOSPITALS AND PROVIDENT DISPEN8ARIB8.

In The Lancet of the 19th inst. is an article on
Co-operation of Hospitals and Provident Dispensaries*
pointing out the importance of this subject on, the work of
the committee which is now considering how best in
London to organise medical attendance on the poor and
prevent indiscriminate giving of free medical relief. The-
committee might gain some valuable information by apply-_
ing to the proper quarter here. For many years the pro¬
vident dispensary has worked with the Royal Infirmary
and other medical charities, with the object of preventing
abuse of the latter. Inquiries are made into the circum¬
stances of all patients applying for aid, and after having
given what assistance or nelp may be needed at the first-
time of coming to hospital, they are referred to the pro¬
vident dispensaries, if their means are found to be such aa
to enable them to pay the scale of charges fixed by them.
By this means the out-patient departments especially are-
kept from being overcrowded, and those who are proper
objects for the work of the charities receive more attention
than if the numbers were swelled to an almost unmanageable „
extent.

ST. MARY’S HOSPITAL.

At the late annual meeting of St. Mary’s Hospital the-
balance-sheet showed an unsatisfactory condition, the-
expenditure in the past year having exceeded the income by
£348. A most important matter wae-decisively announced—
i.e., the attempt to raise a fund for building a new bospitaL
Already subscriptions to the amount of £10,000 have been

S romised, and important help has been promised by Madame
larie Rose, who will give a concert in aid of the movement.
Many years ago Jenny Lind, then in the height of her fame*
gave a concert on behalf of the Royal Infirmary, the pro¬
ceeds from which went largely towards building a new wing-

THE 80UTHKRN HOSPITAL,

which in a quiet unobtrusive manner does a good work on
the south side of the city amongst women and children, is-
about to extend the sphere of its usefulness by adding a.
lying-in department to its present operations. Seeing that
we are practically without a lying-m hospital, the effort is-
one worthy of support.

THE ROYAL INFIRMARY

has recently made an attempt to obtain funds from a rather
unusual source, by applying to the various Local Bpards for
a contribution out of the rates, and in several instances the-
application has met with success. An announcement made
at a late meeting of the Infirmary Board that the Fever-
Hospital was about to be extended, at a cost of £3000, has
caused some correspondence in the daily press from some-
who object to all the infectious disease in Manchester and
neighbourhood being taken to one spot, and from others who-
dispute the right of the Infirmary Board to expend its-
funds at all on a matter which it is the duty of the health
authorities to attend to. The neighbouring borough oi
Salford has lust disposed of its Fever Hospital, to the
London and North-Western Railway, for upwards of £20,000*
so that the Corporation will have to 1 make fresh arrange¬
ments for the isolation of their infectious disease.

FEVER HOSPITAL FOR BRADFORD.

The Town Council of Bradford, in the adjoining county of
Yorkshire,have just purchased the Fever Hospital there from.
the trustees of the hospital for the sum of £10,000. As a result
of the action taken by the Sanitary Association, the City
Council will for the future publish its Health Committee’s-
report annually, instead of biennially, as hitherto. It has
also been successful in obtaining the use of the playground a

Digitized by CjOO^Ic

060 The Lancet,J

EDINBURGH.—PARIS.

[March 28, 1887.

of various of the School Boards for the use of children in
crowded districts to play in after school hours, and it is
now engaged in stirring up the Corporation authorities
about their building bye-laws, which have long been in an
unsatisfactory condition.

THE VICTORIA UNIVERSITY.

As a result of the important and influential deputation
that waited on the Chancellor of the Exchequer, asking for
a grant from Imperial funds towards the expenses of the
Victoria University, it is announced that £2000 per annum
will be granted. The amount asked for was £2500 a year.
The number of students presenting themselves for the
University Examination shows a satisfactory increase. At
the present and approaching examinations upwards of
seventy students from Owens College alone have entered
for the preliminary scientific and various medical exami¬
nations. It has been decided that the testimonial to Sir H.
Roscoe, to commemorate his long connexion with the College,
shall consist of a portrait, to be presented to himself, and,
if enough money is available, the establishment of a scholar¬
ship, to be named after him.

The Hospital Sunday and Saturday collections have
not, as was hoped, shown any increase on last year’s
amount. The sum collected amounts to only £7250. A
few additional payments yet to come in may possibly
raise it to that of last year’s collection.

March 22ml.

EDINBURGH.

{from our own Correspondent.)

i

SCARLATINA AND MILK.

At the last meeting of the Public Health Committee of
the Town Council a report was submitted by Dr. Littlejohn,
the medical officer of health for the city, detailing the
results of his investigations into the cause of t*e recent
epidemic of scarlatina in the north-west quarter of the
town. The inquiry was specially directed towards ascer¬
taining whether there were any causal relation between
special sources of the milk-supply and the peculiar localisa¬
tion of the outbreak. The results conclusively show that
such is the case, the affected district being for the most part
supplied from a source proved to have been contaminated
shortly before the commencement of the epidemic. The
farm thus singled out contributes 120 gallons daily to the
milk-supply of the city; the milk is at present of good
quality and in all other respects quite unobjectionable, but
there is little doubt that eight weeks ago it was each day
transmitting infective material from the farm, where fever
was then present, to the very parts of the city since so
alarmingly visited by the disease. These facts curiously
emphasise the recommendations contained in an annotation
on “The Use of Uncooked Milk” in last week’s Lancet.
The precaution of boiling for five minutes the whole of the
milk supplied to each household has been largely carried
out in Edinburgh since Dr. Foulis’ letter on the subject
appeared in the local papers some weeks ago. It has been
questioned in some quarters whether this procedure is an
absolutely reliable method of disinfecting milk, regard
being had to the peculiar physical constitution of that
menstruum in relation to the transmission of heat. The
general impression, however, is that this is a most valuable
precaution, and as such it has been widely recommended
to and adopted by the intelligent classes of the population.
Dr. Littlejohn’s investigations are in the meantime actively
continued, and an extra staff of subordinates is placed at his
disposal for the purpose. In the City Fever Hospital there
are at present 199 patients suffering from scarlatina.

THE PBOPOSED FEVER CONVALESCENT HOME.

A question has been from time to time under the con¬
sideration of the Public Health Committee as to the propriety
of establishing a convalescent home for patients discharged
from the City Fever Hospital. A moot point was the legality
of applying public funds to this purpose. This has been
/submitted for counsel’s opinion. The legal adviser of the
board regards such an addition as simply an adjunct or
necessary appendage of a fever hospital; and, as such, he
holds that tne local authority have full powers for establish¬
ing a convalescent home in connexion with the hospital. They

are under no statutory obligation to apply donations from
rateful patients of the hospital in reducing the public
ealth rates, hence such funds might be expended in de¬
fraying the expenses of the proposed institution.

EDINBURGH UNIVBR8TY COURT

The Court met last Monday and approved the arrange¬
ments already reported, by which the site for the comple¬
tion of the New Medical Buildings is to be acquired and the
buildings erected. They also confirmed the recommenda¬
tion of the Senatus Academicus granting leave of absence
to Prof. William Rutherford for six months on account of
health, approving also the arrangements made by which Prof.
Caton of Liverpool will conduct the professional examina¬
tions in physiology in April and July of this year. With re¬
ference to a letter from Mr. Ashdown, M.B., which was under
consideration, the Court were of opinion that his character
had been completely vindicated by Prof. Rutherford’s apology
to him, and that it was unnecessary for the Court to take
any steps for that purpose. Mr. Joseph Bell having ceased to
lecture on clinical surgery, the removal of his name from the
list of recognised lecturers was authorised.

THE CHAIR OF PHY8IOLOGY.

A somewhat premature notice of the appointment of
Professor Haycraft, of Birmingham, to the post of substitute-
Professor of Physiology in Edinburgh University, during
Professor Rutherford’s leave of absence, has appeared in one
of your contemporaries. As a matter of fact, such an arrange¬
ment is reported to have been made privately between
Professors Rutherford and Haycraft, and is to be shortly
submitted for the approval of the Senatus Academicus.

MKDICO-CHIRURGICAL 80CIETY.

At the last meeting of the Society Professor T. R. Fraser
read a valuable paper upon the Dyspnoea of Bronchitis and
Bronchial Asthma, and detailed important clinical and ex¬
perimental results obtained from the administration of
nitrites in such cases.

THE ARTIFICIAL CULTURE OF FISH.

Mr. J. T. Cunningham, B.A., Superintendent of the Granton
Marine Station, has communicated a paper on the artificial
culture of fish to the Association of Science and Art. Of
particular interest was his demonstration of the Macdonald
jar, a recent invention employed by the American Commis¬
sion for incubating ova. The dead eggs are removed auto¬
matically, and in consequence a much larger percentage
come to perfection than when this is not the case. Each
jar will accommodate about sixty thousand eggs.

Edinburgh, March 22nd.

PARIS.

(From our own Correspondent.)

THE NEW “ SPECIFIC ” FOR DIABETES.

Dr. Martineau gives full details in the last number
of the Annales Medico-Chirurgicales of the treatment
advised by him in diabetes. It was in consultation with
the late Professor Rouget that he learned the formula
which he now publishes with so much confidence. The
patient in question had been the subject of diabetes for some
years, and was suffering at the time from cerebral htemor-
rhage. Dr. Rouget proposed that they should not modify
his diet in any way beyond restricting in a slight degree the
use of farinaceous food, fruits, and sugar, and that he
should drink during meals and in the intervals of
thirst araenicated lithia water, prepared as follows: In
the upper part of a Briet apparatus of 1 litre for making
aerated water were to be introduced 20 centigrammes
of carbonate of lithia. and a tablespoonful of the following
solution: arseniate or soda, 20 centigrammes; distilled water,
500 grammes. This water to be drunk at meals mixed with
wine, and the contents of the recipient to last for three
meals. Before commencing the treatment the urine was
found to contain 60 grammes per litre of sugar, being 212

? rammes for the quantity voided in the twenty-four hour*.

hree weeks later, on Oct. 12th, 2 litres, instead of Ill,
represented the daily secretion of urine, and the quantity
of sugar 20 grammes per litre. On Oct. 29th there were
1£ litre of urine, and the amount of sugar 11 grammes

Thb Lancbt,]

PARIS.—NAPLES.

[March 26,1887. 651

per litre. On November 14th the proportions had fallen
to 1 litre of urine containing 4 grammes of sugar. On
December l9t no sugar could be detected, and the daily
average of the urine was 1 litre. The patient died four years
later of ursemia caused by renal disease, and up to the time
of his death no sugar had ever been found in the urine. Dr.
Martineau gives two other cases in illustration, in which
the treatment has kept the glycosuria in abeyance for six
and five years respectively. In a third instance no sugar
has been seen for six months. In all the patients with
whom the treatment was successful there were, says Dr.
Martineau, arthritic symptoms, either in the form of biliary
or renal lithiasis, of articular manifestations, or of cuta¬
neous eruptions. In the only three cases of failure there
was no arthritism, but herpetic symptoms existed in the
form of “nervovism” and skin eruptions. The disappear¬
ance of sugar from the urine is attributed by Dr. Martineau
to the action of the lithia upon the glycogenic matter, which
it helps to transform into glucose, and thence into carbonic
acid and water. It is the presence of lithia that also ex¬
plains the action of those natural mineral waters which are
useful in diabetes. Taking for granted that the results are
as stated by I)r. Martineau, it is somewhat remarkable that
he should fall into therapeutic superstition, when there is a
much more adequate physiological explanation. In nil his
successful cases the quantity of drink was restricted to a
quart during three meals, whereas in the unsuccessful case,
which is given for the sake of comparison, the patient drank
three litres and voided an eqn&l quantity of urine in the
twenty-four hours. The late Dr. Hyde Salter found abstinence
from liquids at meal-times the most useful of all treatment
for asthma, and obstructed respiration ib given by Pavy as a
cause of diabetes, Erunton allowing that it is produced by
deficient oxidation, which comes to the same thing. There
is a group of allied affections characterised by the retention
of the products of imperfect oxidation, and by functional
disturbances of different kinds resulting therefrom, the
cause and effect having a reciprocal action. Gout and
nervous depression, obesity and imperfect respiration, are
familiar examples. In these cases, as in rheumatism and
other morbid conditions of the same kind, everything that
promotes oxidation and excretion is of capital importance.
Abstinence from alcohol and the use of the Turkish bath are
valuable means to this end, but total abstinence from
alcohol, with a strict limitation of fluids, is the most potent
of all. Unfortunately it is extremely difficult, most espe¬
cially in diabetes, to carry out such restrictions. If, how¬
ever, lithia as administered by Dr. Martineau does enable
diabetics to abstain from liquids, he may be congratulated
upon having made a valuable contribution to practical
medicine.

THE HEALTH OF PARIS.

The Bulletin Hebdomadaire de Statistique Municipale
records thirty-seven deaths from typhoid fever, being a
slight decrease upon the preceding week. But the admis¬
sions into the hospitals are more numerous than ever—
ninety-six as against seventy-seven; and there is even
reason to anticipate a continuance of the epidemic. The
mortality from small-pox has increased from two to ten
deaths, and the admissions into the hospitals from thirty to
forty-one. This sudden outbreak is attributed to the
arrival in Paris of a large number of unvaccinated workmen
for the building of the forthcoming Exhibition, and
Dr. Du Mesnil has laid before the Board of Health a
project of compulsory vaccination. In an article in
the Bulletin Mtdical he reminds his readers that the
epidemic of 1870-71, which caused a mortality of
more than 5000 persons, coincided with the arrival
in Paris of the soldiers of the Garde Mobile, a large
number being from Brittany, where vaccination is extremely
insufficient. The commercial stagnation of the last few
years had caused the departure of many of the workmen,
and this has been followed by a great diminution in the
number of deaths from small-pox. But the number of
admissions to the hospitals has lately increased, and the
authorities have been obliged to reopen special wards.
Professor Proust, in his report on the subject, agrees with
Dr. du Mesnil, and urges the authorities to proceed to the
compulsory vaccination and revaccination oi all workmen
coming to Paris for employment upon the Exhibition.

PROVINCIAL EPIDEMICS.

An inquiry has been made into the sanitary condition jof
the Marine Barracks at Lorient, where typhoid is endemic,

and causes annually from forty to fifty deaths amongst the>
troops. It has been found that the water is regularly con¬
taminated with human excreta whenever there is rain, the
conduits in masonry passing under fields and gardens so
manured. At Brest an epidemic recently broke out in the
training ship Le Borda. An analysis of the water showed the
presence of the characteristic bacillus. There are also serious,
epidemics at the present moment in the Marine Barracks at
Cherbourg, and amongst the soldiers of the 50th Regiment.
at Perigueux. The Governesses’ Normal School of the Loire-
Lnfdrieure has been closed on the same account.

Puri*, March 22ad.

NAPLES.

( From a Correspondent.)

Italians complain that theirs is a severely-visited
country—not in the sense of its being overrun with
foreigners, for to these it owes a fifth of its annnal revenue,
but in the sense of its continual subjection to visitations
atmospheric and telluric. What with floods, earthquakes,
and cholera explosions, the last five years in Italy have
certainly been prolific of death and disaster beyond the
usual portion of humanity. In 1882 the inundations in the
Venetian territory and in the Two Sicilies left a fearful tale of
ruin and misery. In 1883 the earthquakes at Casamicciola
reduced a garden-island of the Mediterranean into a sombre,
silent waste. In 1884 the most terrible outbreak of cholera
within living memory swept the Italian seaboard from the
Riviera to the Messina Straits, alighting with such force on.
Naples as, in one night, to strike down two thousand of the
inhabitants, of whom one thousand died in a few hours. In
the following two years the scourge extended to Sicily,
while continuing its ravages among the littoral and river¬
side population of the peninsula; and now another telluric
storm has raged along the Riviera Levante e Ponente,
overthrowing towns, engulfing their inhabitants, and leaving
a moral and material ruin behind it which years will not
repair. Well may the Popolo Romano say : “ If calamities
are so many trials to strengthen the character, we Italians
bid fair to become the strongest people in the world.”

To do her justice, Italy is so far profiting by this probation
as to be improving her position in view of a recurrence of
such disasters. Floods, so largely due to the destruction of
forests by felling, she is preparing to obviate by stringent
regulations for replanting the denuded mountain-sides;
cholera visitations, invited by insanitary conditions, she
will in future keep at bay by vigilant hygienic surveillance ;
while so far as seismology can forewarn against telluric
storms, and suggest opportune precaution or provision, she
is to aid experts in that infant science, like the Padre Denza
and Michele di Rossi, with enhanced means of research and
internunoial communication. As to the sanitary side of her
endeavours, here in Naples we have ample evidence of her
sincerity and energy, the water-supply being now the finest
In the peninsula—inferior, if at all, to that of Rome, and
inferior in abundance only. “ Oat of the nettle Danger to
plnck the flower Safety ” should be her watchword for half
a century to come—far more justly, indeed, than tne “ si via
pacem, para bell urn,” which, in practice, is crushing her,
like other continental powers, under the weight, of “ bloated
armaments.”

The resources of the Spedale della Trinita are severely
taxed to accommodate and treat the wounded survivors of
the Dogali massacre whom the troopship San Qottardo
deposited here on Feb. 22nd. Certainly the literature of
surgery will be conspicuously enriched by the official report
of the Trinita 6taff when it sees the light; gunshot wounds,
incised wounds, and lacero-contusions of every variety,
and sometimes all three on one and the same soldier figuring
amongst its most prominent details. Meanwhile the courage
of the medical officers who died as combatants on that tragic
field has evoked from all Italy the proudest eulogy. In
Rome a special meeting of the Royal Academy of Medicine
was convened to express the feelings of the profession on
the subject, and in its president, the Hon. Guido Baccelli,
no better spokesman for the occasion could have been found.
At the close the following order of the day was carried by
acclamation: “The Royal Academy of Medicine at Roma
draws the attention of all Italy’s scientific bodies to the

O

652 The Lancet,]

MEDICAL NOTES IN PARLIAMENT.

[Mabch 26,1887.

heroic conduct on the battlefield of Dolgali of the army
surgeons, Captain Nicola Gasparri and Angelo Ferretti.”

Cardiac neuroses due to syphilis are engaging particular
attention just now, especially in the clinic of Professor
Semmola. The venereal taint is a well-known factor in
organic disease of the heart; functional disturbance of that
organ, due to the same cause, has been much less carefully
worked out. More than fifty such cases have come under
Professor Semmola’s cognisance. Weak systole, intermit-
tence, di-systole, were common to all; while the respiratory
process, though its apparatus was quite sound, became dis¬
tressed on mounting stairs or in hurried walking. Hitherto
physicians have diagnosed such cases as due to nervous
exhaustion, and have prescribed the usual remedies—tonics,
rest, country or sea air, and so forth. But after weeks or
months of such treatment the symptoms remained as before,
or were often aggravated. “ The use of mercury, however,”
says Professor Semmola, “ in the form of hypodermic in¬
jections of corrosive sublimate, and the use of iodide of
potassium via the stomach, produced in all these cases pro¬
gressive amelioration, and finally a total disappearance of
the functional derangement, while the improvement of
the whole system was most marked.” Dr. Vincenzo Vitoni,
in an able contribution to the discussion, says: “ Functional
derangements of the heart, unaccompanied by the physical
signs of endocarditis, aortitis, and so forth, when they occur
in patients affected for some time by constitutional syphilis,
and in whom hygienic conditions and the cure of symptoms
have failed to induce a return to normal cardiac action,
justify the physician in first prescribing iodide of potassium
in progressive doses, and then, after fifteen or twenty days,
in trying mercurials with the caution that characterises
good clinical practice. It were idle to theorise on the
modus operandi of syphilis in causing functional derange¬
ments of the heart—due, as they might be, to arteritis of the
coronaries, % to primary nutritive irritations of the myo¬
cardium, to incipient arterio-sclerosis, or to a general
undetermined dvscrasic condition of a clinical type. What
emerges clearly from the facts is this, that we have to deal
with a pathological state of the heart quite amenable to
iodide of potassium and to mercury.” Professor Semmola
does not share the belief, any more than does Dr. Vitoni,
that mercury is always contra-indicated in cardiac affec¬
tions. Caution, after due diagnostic investigation, is all
they plead for. The whole subject is well discussed in
La Terapia Afodcma, a monthly organ of the Neapolitan
school, which began its career, with good augury, on Jan. 1st.

Naples, March Oth.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At an extraordinary meeting of the Council held on
Thursday, the 24th inst., the minutes of the last ordinary
meeting were read (ind confirmed. The following resolution
was carried nem. con.: “ That the Council see no cause to
alter their decision regarding the admission of the Apothe¬
caries’ Society to the Conjoint 8cheme.” A letter was read
from Sir H. Pitman, forwarding a copy of the resolution
passed by the Royal College of Physicians on the same
subject.

Two memorials, signed by several thousand persons, were
submitted to the Council, in opposition to a memorial laid
before the Council advocating the endowment of an institu¬
tion for the promotion of physiological and pathological
research.

A letter was read from the Councils of University
and King’s Colleges, inviting the College to confer with
sepresentatives of those Councils and of the Royal College
of Physicians of London on the subject of a joint applies*
tion to the Crown on behalf of the four institutions for
powers to grant degrees in Medicine and Surgery. This
letter was referred to the Committee of Delegates on the
subject of granting degrees in Medicine and Surgery.

The following motion by Mr. Croft was lost, four voting in
its favour and twelve against: “ That before each election
to the Court of Examiners the lists of Fellows who are
candidates shaH be considered by a small committee, to be
appointed annually by the Council, who shall have power to
recommend to the Council one or more of the candidates for
each vacancy.” • •

MEDICAL NOTES IN PARLIAMENT.

The Pharmacy Acts Amendment BUI.

Is the House of Lords, on the ISth Inst., this Bill was passed through
Committee, with a few verbal amendment*.

On the 22nd Inst, the report of amendments was brought ap sad
agreed to, and on Thursday, the SUh, the Bill was read a third time and
posted.

Vaccination and Disease,

In the House of Commons on the 18tU inst. Mr. Bitchle, in reply to
Mr. M'Artliur, stated that revised instructions have been issued to public
vaccinators with a view to minimise the risks of vaccination. The onler
for the careful examination of vaccinifors as to the existence of skin
diseases, and particularly of hereditary syphilis, wa* contained in the
old instructions. The Local Government Board has no evidence of
syphilis having been communicated by vaccination from a child not itself
presenting signs of syphilis.

Anthrax.

On the 21st inst., in reply to Sir J. Swinburne, Mr. W. H. Smith, in
the absence of Lord J. Manners, stated that an inquiry in reference to
the reoent outbreaks of anthrax is now being conducted by the officers
of the Agricultural Depsrtment. There is no reason, however, to
believe that the disease has been more prevalent during the last six
months than previously. The Anthrax Order of September last Impose*
on the owner* of animals the obligation to give notice of the disease,
and on the inspectors the duty of making returns weekly ; hence public
attention has been called to' outbreaks which otherwise would have
escaped notice. None of the outbreaks have been traoed to railway
trucks in which foreign hides had been previously carried.

On the 22nd inst.. in reply to Mr. Tolleinache, Mr. W. U. Smith stated
that the Government do not propose to treat anthrax in the same manner
as pleuro-pneumonla, as they are advised that the two diseases are of a
totally different character. Slaughter in anthrax would in most cases
be impracticable, as animals are usually found dead without any warn¬
ing. or die very quickly after the symptoms betjoine apparent. Further,
as the disease does not spread by association of diseased with healthy
animals, as is the ease with pleuro-pneumonla, slaughter and compensa¬
tion would only l>e for the benefit of the owner, and not for the com¬
munity.—In reply to Sir J. Swinburne. Mr. W. H. Smith said that the
recent outbreak of anthrax in Cheshire has apparently been confined te
one farm, and chiefly affected swine, of which thirty-four arc reported
to have died, and also throe sheep. No cases have been reported since
March 19th. Immediately the disease was recognised the local autho¬
rity took action under the Anthrax Order and prevented the movement
of animals from the farm. An inspector of the Privy Connell hat
visited the farm, and from his report It does not appear that there is
anything remarkable in the outbreak of anthrax, which disease, it is
said, occurs every year on this farm, and is accounted for by the exist¬
ence of insanitary conditions which are most favourable for the develop¬
ment of the disease.

The AUeged Neglect at Gay’s Hospital.

On the 21st Inst, in reply to Mr. W. Corbet, Mr. Matthews eafd that
he had been informed by the medical sui>erlntendent of Guy's Hospital
that the facts of Stack's case are a* follows i Stack was brought, to the here

f dtal at 7 i\M. on Monday, and was found to be suffering from a simple
rant lire of the small bone of his leg. He was taken into the accident
ward for the night and received immediate attendance, and, as is usual
in the case of similar Injuries, the limb was temporarily placed In sand¬
bags, and In the course of a few hours, between 11 and 12, the limb was
put up permanently In plaster-of-Paris bandages. Stack was discharged
on the following day, with a pair of crotches supplied at the expense of
the hospital, and without any charge to Slack or his relatives. When
Stack came to tho hospital every bed in the ward was occupied, but one
of the occupants, who was leaving the next morning, was placed on a
stretcher, an.l thus made room for 8tack. The hospital authorities
seemed to have don* all that was proper on this occasion.

The Planting of Cinchona.

In reply to Mr. Henniker Heaton, Sir J. Gorst said that one of the
object*, but not the only one, of planting cinchona by:the Madras
Government was for the purpose of obtaining a febrifuge for the nat ive
classes. Government bark is advertised for aalo in London, aud oonws
to England for the manufacture of quinine. Government get* quinine
for it* medical departments at wholesale prices, and makes the “red
bark " Into an effective febrifuge cheap enough to be within the reach of
all classes.

PleurQ.pncKmonia.

In reply to 8ir J. Swinburne, Mr. A. J. Balfour stated that Clause 6 of
the Contagious Disease* (Animals) Amendment Act gives the Privy
Council authority to make orders giving large powers to local authorities
for the slaughter of animal* which may have been In the tame shed or
field as diseased animals, and that the question as to how far tho pro¬
visions of this clause can be enforced with the least inconvenience and
expense is at present engaging the attention of the Privy Council
Veterinary Department.—In reply to Mr. O'Doherty, Mr. A. J. Balfour
stated that the regulations for the shipment of cattle are as carefully
devised as possible. They are identical In England and Ireland, and are
the same for cross Channels steamers as for those carrying catt le to Great
Britain from other countries. The shipment of animals Is superintended
by officers of the Veterinary Department, who do all In their power to
prevent any cruelty or Infringement of the regulations, and he was
afraid that no further action ou the part of the department seems
practicable.

Court-house Accommodation.

On Thursday, in reply to Sir J. Poaree, who asked If, In view of tlie
unsatisfactory condition of the accommodation afforded to prisoners
awaiting trial in many of the Court-houses In England and Wales, the
Government would Institute an investigation Into the matter. Mr.
Matthews said he was Informed the accommodation was satisfactory,
bnt In order to allay public anxiety on the subject an inquiry would be
made.

I V_

OBITUARY.

[March 26,1887. 653

(S&ifttara

ROBERT EDMUND CARRINGTON, M.D. Lond, F.R.C.P.

: Da. R. E. Carrington, whose sad death we announced
last week at the early age of thirty-three years, was the
second son of F. G. Carrington, Esq., for many years editor
and one of the proprietors of the Gloucestershire Chronicle,
and grandson of N. T. Carrington, Esq., a well-known
Devonshire poet. Tie was educated at the King’s School,
Gloucester, where he took a scholarship, and then became a
pupil at the Gloucester Infirmary, where he remained for a
year, and entered at Guy’s Hospital in 1870, taking a second
prize in Arts on entrance. His student career was remark¬
ably brilliant, for he obtained the silver medal in botany at the
Apothecaries’ Hall in 1872, and at the Preliminary Scientific
Examination in the same year he was placed first (with the
exhibition) in both chemistry and zoology, and took Honours
also in botany. In 1874 he passed the Intermediate M.B.
Examination, and was awarded the exhibition and gold
medal in chemistry and materia medics, and placed
second in physiology. In 1876 he became a member of
the Royal College of Surgeons, and in the next year
filled the offices of house-surgeon and resident obstetrician
at Guv’s Hospital. He was then appointed demonstrator
of anatomy, and taught well and assiduously in this post
for more than five years. He was a most painstaking and
methodical teacher, and his accuracy of detail is well
shown in a Manual of Dissections which he published, and
which is the only text-book showing the student how
questions on given dissections should be answered. On
this account it became very popular with candidates for
the higher anatomical examinations. During his demon¬
stratorship he suffered from a severe attack of typhoid
fever, and it is questionable whether he eyer really regained
his former robust health. In 1878 he passed his M.B.
Examination, obtaining the second place and a gold medal
in medicine, with Honours in forensic and obstetric medicine.
In 1879 he became an M.D. Lond., and a Member of the Royal
College of Physicians, obtaining the Fellowship last year.
Whilst still a demonstrator of anatomy at Guy’s Hospital,
he was elected in 1880 a visiting physician to the Seamen’s
Hospital, and he here showed the excellence of his training
at Guy’s as a most accurate clinical observer and a good
pathologist. He contributed many articles to Guy’s Hos¬
pital Reports and to the Pathological Society's Transactions,
sod was a regular attendant and contributor to the latter
Society. In 1883, having previously worked as medical
registrar and demonstrator of pathology at Guy’s, he was
appointed assistant-physician; and he also took charge of the
skin department. At the time of his death he held the
following appointments at Guy’s Hospital: Senior Assistant-
Physician ; Senior Demonstrator of Pathology; Curator of
the Museum ; being also one of the editors of the Guy’s Hos¬
pital Reports and Sub-dean of the Medical School. He had
thus steadily advanced along the lines of Fagge, Moxon,
Wilks, and others, and like them promised fair to
be one of the best clinical teachers and pathologists of the
day. But perhaps in addition to his scientific as well as
medical learning and his teaching capacity, the late Dr.
Carrington had endeared himself to his colleagues, contem¬
poraries, and pupils, more especially by his exceeding good¬
nature and willingness to do any service possible for his
friends. The familiar “ Bob ” Carrington perhaps best
^presses the sterling kindness which he was always
rsady to devote to anyone who required assistance of any
° j nd. He was one of the beet examiners at the College of
Physicians and at the London University, never losing his
tamper, even with the most trying candidate. The last im¬
portant work which he undertook was the editing of Fagge’s
Principles and Practice of Medicine,” and the atnonnt of
patient work and unflagging industry which he gave to his
labour of love can scarcely be too nighly estimated. Dr.
Carrington was a member of the University of London Lodge
of Freemasons. For some years past it had been evident to his
®any friends that he was overworking Mmself.bUt the news
~ his fatal illness came on them with startling suddenness.
He got wet on the 11th inst., and bad a rigor oft the follow-
*ng day . but feeling better on the 13tb, be performed a
Post-mortem examination on a case of acute glanders, but

there is no reason to suppose that he contracted infection.
In the evening his temperature had risen, and on the next
morning Dr. F. Taylor ascertained that he was suffering
from double pleuro-pneumonia. He was apparently doing
well on the next day, but on Wednesday morning, the 16th,
he died rather suddenly and unexpectedly. He was buried at
Norwood Cemetery on Saturday last.

To the Editors of The Lancet.

Sirs,— Though not a Guy’s man, allow me to offer a word
of tribute to the memory of Dr. Robert E. Carrington, by
whose death a career has been closed which gave promise
of exceptional brilliancy. Dr. Carrington was well known
to many as a loving son to his widowed mother and a
devoted brother and friend. Unassuming and self-denying
to a fault, ever ready to help in time of need, and a true
friend of the poor, his charity was of the noblest type, for
of himself he gave. In the conscientious devotion to many
duties his mental powers had long outstripped his physical
strength. While battling bravely on with but indifferent
health, his body became a ferrile ground for the ripening of
the acute disease which, alas! too soon, has robbed us of a
noble life, leaving his loved ones bowed down with sorrow
and almost broken-hearted.

I am, Sirs, yours obediently,

London-brldge, S.B., March, 1887. R. DuNKON PeDLBY.

ROBERT BRYCE GILLAND, M.D. Glas., &c.

On March 8th Dr. Robert Bryce Gilland died at Sevenoa ks,
at the age of forty-nine. Educated at the University of
Glasgow, he obtained his degrees in 18G0, became one of the*
hemse-surgeobs of the Royal Infirmary, and, after finishing
his term of office there, was appointed assistant medical
superintendent at Gartnavel Lunatic Asylum. From this
time he made up his mind to devote himself to the special line
of lunacy practice. After two years’ residence at Gartnavel,
,he removed to Essex County Asylum os assistant to the late
Dr. Campbell. Thereafter, upon the founding of the Berks
County Asylum, he applied for and obtained the onerous and
responsible post of medical superintendent of that insti¬
tution. He was of material assistance to the magistrates in
i completing the arrangements of this asylum. For seventeen
years Dr. Gilland devoted himself to bis duties, which be
carried out with a precision and earnestness worthy of the
highest commendation. It was only necessary to read one
of his annual reports to get an idea of his peculiar fitness
for the work he had in hand. His method of treating the
insane was quite up to the most advanced views of the present
day. A marked feature in the routine of the year was his
Christmas entertainment, consisting usually of amateur
theatricals followed by a ball.

Dr. Gilland was unmarried. Of him it might almost be said
that he died in harness. But a short time ago his health
broke down. He then, by the advice of his friends, resigned
his post, retired to quietude at Sevenoaks, where he peace¬
fully expired on the date above mentioned. Besides holding
the degree of Doctor of Medicine, he was a Licentiate of the
Glasgow Faculty of Physioians and Surgeons, Member of the
Royal College of Surgeons of England, and a Licentiate of
the Apothecaries’ Company. His remains were removed to
Scotland, and interred in the family grave at Kilmarnock.

Presentations. —At a public meeting on March
13th at St. Etienne, France, Dr. H. Burroughs was presented
with a gold watch in recognition of his services to the McAll
French Medical Mission, a branch of which is established in
that city. Mr, John Wright Baker, of Derby, who is retiring
from practice, was on the 18th inst. entertained at dinner
by a large number of his professional brethren of the town
end country. In the course of the evening Mr. Baker was pre¬
sented with an album containing a number of views of Derby¬
shire and a silver tea-kettle with appropriate inscription.

North London Hospital for Consumption. —At
an annual meeting of the Court of Governors of the hos¬
pital, Dr. Edwin Howard was unanimously elected a vice-
president of that institution.

654 Thr Lancet,]

MEDICAL NEWS.—APPOINTMENTS.

[March 26,1887.

Royal College of Physicians of London.—C erti¬
ficates in Hygiene were granted to the following gentlemen,
who have passed the required examinations, on March 21st:

Cantlie, James. M.B. Abertl., Suffolk-street.

Davis, Weston Peel, Gloucester-terrace, Bsyawater.

Greenwood, Major. Queen's-rood. Dalston.

Qubb, Alfred Samuel, Grove, Hammersmith.

Hitching. Thomas Johns, Broadfield, Crawley.

James, Charles Alfred, Dispensary, 8toke Newington.

Sanders, John W'lliam. M.D. Brussels, Bethnal-green Infirmary.

Webb, Charles Alfred, Brockhurst, Gosport.

College of Physicians in Ireland.—A t the
March examinations the following obtained licences in
Medicine and Midwifery of the College:—

Medicine. —Samuel Boake, Arthur Edward Clarke. William Barclay

Dick, John Exley, William Isaac Fern, Hu Raskin Hancock, Fmleric

William Ord, George Shapland Passmore.

Midwifery.— John Exley, William Isaac Fern, Hu Ruskin Hancock,

Vincent Nash. Edward Francis O’Sullivan, Frederic William Ord,

George Shapland Passmore.

The undernamed has been admitted a Member:—

Evelyn R. H. Pollard, Staff Surgeon, R.N.

Society of Apothecaries.—T he following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on March 17th :—

Simson. Francis Taylor, Vlccroy-road, South Lambeth.

Tinker, William, Cromwell-road.

Wickham, Onslow Arthur, M.R.C.S., Arondel-square.

It is officially notified that the Privy Council has
sanctioned the bye-laws of the Institute of Chemistry.

Dr. James Curtis, of Cork, has been appointed
Inspector of Anatomy for Munster, in the room of the late
Dr. Beamish.

Mr. Thomas G. Law, librarian to the Writers to the
Signet Society, has been appointed librarian to the Royal
College of Physicians of Edinburgh, in succession to the
late Dr. Small.

Vaccination Grant. — Mr. John H. Hughes,
L.R.C.P. Lond. and M.R.C.S., of the Ombersley district of
the Droitwich Union, has received the Government grant
for efficient vaccination (sixth time).

Homes for Inebriates.—A t the annual meeting
in connexion with the Homes for Inebriates Association,
Dr. Cameron, M.P., was elected president, Canon Duckworth
chairman, and Dr. Norman Kerr hon. sec. The three years’
work at the Dairymple Home shows over half the inebriates
discharged doing well.

York County Hospital.—A t the annual court of
the trustees and governors of this institution on the 22nd
inst., it was unanimously decided that the York Eye Institu¬
tion should be amalgamated with the hospital. Satisfactory
financial and general reports for the past twelve months
were presented and adopted.

St. John Ambulance Association.—T he class of
Royal Engineer officers held by the St. John Ambulance
Association at Chatham, and instructed by Surgeon-Major
McNalty, has been examined by the principal medical officer
of the district, Deputy Surgeon-General E. Roberts, and out
of thirty-four candidates, the whole are reported to have
passed an excellent examination in first aid to the injured.

Parkbs Museum.—A t a meeting held at the
Parkes Museum on the 17th inst.. Dr. E. F. Willoughby
delivered a lecture on George Varrentrapp, sanitarian and
philanthropist. A course of twelve lectures by well-known
authorities for the special instruction of those desirous of
obtaining knowledge of the duties of sanitary inspectors
will be delivered in April and May.

The Epidemic of Measles and Scarlet Fever at
Goole.—I n consequence of the increased number of cases
of scarlet fever and measles in the town of Goole, the
members of the Goole School Board have decided to close
their schools in Alexandra-etreet and Old Goole for a
further fortnight. Alexandra-street Schools have already
been closed a fortnight, while those in Old Goole have been
kept open.

Hydrophobia in Egypt.—A n outbreak of rabies
and hydrophobia is reported to have occurred at Cairo; a
large number of persons have been bitten by rabid dogs and
have died of hydrophobia. It is stated that the introduc¬
tion of the malady is traced to a hound belonging to &
European officer, which lias bitten several native dogs.
Some five or six thousand native dogs have been destroyed,
but it is believed that many rabid dogs still remain.

The Recent Earthquakes at Mentone.—T he
Rev. Henry Sidebotham, Chaplain of St. John’s Church,
Ment ne, dating from tba< tiwo, Mireh 18th, w ites in the
Standard “1 desire to contradict a report which appeared
in one of your contemporaries, that ' all the doctors fled *
after the earthquake, and to assure your readers that, to my
own knowledge, the English doctors, without exception,
went their rounds as usual every day, and were Teady to
attend to all who needed them, although three of them
had been rendered homeless by the injury done to their
houses.”

Football.—T he final tie for the Inter-Hospital Foot¬
ball Challenge Cup was played on Tuesday last at Richmond,
between Middlesex and St. Thomas’s. After a well-contested
struggle the Middlesex Hospital team was successful,
beating their opponents by nearly twenty points. On the
same evening the united clnbs of Middlesex Hospital held
their annual dinner, under the presidency of Mr. A. Ilensman,
Mr. Henry Morris and Mr. Pearce Gould occupying vice¬
chairs. The fact that this hospital holds both the Football
Challenge Cup and the Rowing Challenge Cup lent addi¬
tional interest and enthusiasm to the gathering.

The Jubilee. — To commemorate the Queen's
Jubilee, the Salt family, of Saltaire, have offered to transfer
to the public forty-five private almshouses, providing
accommodation for sixty people, with extensive grounds
and an infirmary, built at a cost of £40.000, as well as
£30,000 left under the will of the late Sir Titus Salt for the-
benefit of the poor people of the district as an endowment
fund.—It has been decided to erect a new hospital at Dover,
at a cost of from £5000 to £6000, in comemoration of the
Jubilee.—At Lewes it has been decided to raise subscrip¬
tions for the enlargement and improvement of the local
infirmary and dispensary, and to change the name to
Victoria Hospital.

Sipintmcnts.

Succestful applicants for Vacancies, Secretaries of Public Institutions, amt
others possessing information suitable for this column are invited to-
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o’clock on the Thursday morning of each week for publication in
the next number. _

Akdkrson, Tempest, B.Sc., M.D.Lond., M.R.C.8.. ha* been appointed
Ophthalmic Surgeon to the York County Hospital.

Bradbury, A. F., M.B., B.S., baa been appointed District Surgeon to
the Salford and Pendleton Royal Hospital.

Bullock. B., M.R.C.S., haa been appointed House-Surgeon to the
Birmingham General Hospital.

Chittenden. H., L.R.C.P.Lond., M.R.C.S., has been appointed Medical
Officer for the Third District of the Hitch In Union.

Clark. Robert, L.R.C.P.Ed., L.R.C.S. Ed., haa been appointed Medical
Officer to the Post Office, Lancaster.

Collisox, F. W., M.B., C.M.Hd., M.R.C.S.. haa been appointed Senior
House-Surgeon to the Preston and County of Lancaster Royal
Infirmary, vioe Moore, resigned.

Cook. T. Dixon, M.B., C.M.Glas., has been appointed Medical Officer
for the Torquay District of the Newton Union.

Duncan, B. Arcbdkckne, M.D., M.R.C.P., haa been appointed
Consulting-Physician to the National Hospital for Diseases of the
Heart and Paralysis.

Grenfell, Henry 0„ L.R.C.P.Lond.-, M.R.C.S., has been appointed
Assistant Medical Officer for the Infirmary of the Wandsworth and
Clapliam Union. '

Hackett. H. E., L.R.C.P.Lond., M.R.C.S., has been appointed Medical
Officer for the Sixth District of the Chorlton Union.

Harris, H. B., L.R.C.P., M.R.C.S., has been appointed Assistant
Medical Officer to the Paddington Workhouse Infirmary.

KlNiiSFORD, Pbrcival, M.R.C.S., Ac., has been appointed Medical
Officer to the Welsh High School for Girls, Ashford, vice Edward
Klngsford, F.R.C.S., resigned.

Pbskett, Alfred Freeman, M.R.C.S., L.8.A., has been appointed
Medical Officer and Public Vaccinator to the Leyton District of the
West Him Union.

Saul. W. Winoatb, M.D., M.R.C.S..L.S.A., has been appointed Medical
Officer to the Post Office. Lancaster.

Warwick. Francis J.. B.A., M.B. Cantab., M.R.C.S., haa been
appointed Publio Vaccinator for tlie Shepperton District of the
Staines Union.

d by Google

Digitize.

The Lancet,]

VACANCIB8.—BIRTHS, MARRIAGES, AND DEATHS.

[March 1887. 655

©arattcus.

An compliance with the desire of numerous subscribers, it h/u been derided Is
resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to tfle
advertisement. ■- ■

Bradford Infirmary and Dispensary.—H ouse-Surgeon. Salary £110
per annum, with board and washing.

Bristol Hospital fok Sick Children and Women.— House-Surgeon.
Salary £120.

Brompton Hospital tor Consumption and Diseases or thr Chest.—
Resident Clinical Assistant.

Buhton-on-Trent Friendlt Societies’ Medical Association. —
Resident Surgeon.

Cheltenham General Hospital.— House-Surgeon. Salary £80 per
annum, with board and apartments.

Parri.nodon General Dispensary and Lyino-ix Ciiaritt, Bartlett's
Buildings. Holbom, H.C.—Honorary Physician.

Gloucester County Asylum.—T hird Assistant Medical Officer. Salary
£ 10 .) |xr annum, with bocrd, lodging, and washing.

Hospital for Women, Soho-square, W.— Clinical Assistants. Fee for
course of three months. £5 .is.

Kent County Lunatic Asylum. Barmlng-heath. near Maidstone.—
Third Assistant Medical Officer. Salary £120 per annum, with
furnished quarters, attendance, fuel, lighting, milk, garden produce,
and washing.

London Temperance Hospital. Hampstead-road, N.W.—Senior House-
Surgeon. Salary SO guineas per annum, witli board and residence.

Manchester Royal Infirmary.—R esident Medical Officer of the Con¬
valescent Home ui Cheadlc. Salary £150 per annum, with board
and residence.

Royal College of Physicians of Edinburgh.— Superintendent of
the Laboratory for Original Research alamt to be established. Salary
£ 20 <> nor annum.

Royal General Dispensary. Bartholomew close. K.O. — Resident
Medical Officer. Salary £13o per annum, with residence.

Royal South Hants Infirmary. Southampton. — Assistant to the
House-Surgeon. Board, lodging, and washing.

Sheffield Friendly Societies’ Medical Institution. — Resident
Medical Offcer. Salary £170 per annum, with residence, coal,
gas. water and rates free. Accouchement* and vaccinations extra.

University College, London.—Professor of Chemistry.

cbintl .©rarj for % timing fflttk.

Monday, March 28.

Rotat. London Ophthalmic Hospital, Moorfields. — Operations,
10.3ft a.m., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.—O perations, 1.30 p.m.,
and each day at the same hour.

Chelsea Hospital for Womkn.—O perat ions. 2.30 P.M: Thursday,2.30.

St. Mahk's Hospital. —Operations. 2 P.m. ; Tuesday, 2.30 p.m.

Hospital for Women, Soiio-smcahk. — Operations, 2 p.m., and on
Thursday at the aame hour.

Metropolitan Free Hospital.—O peration!, 2 p.m.

Royal Orthop.cdic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O peration*, 2 p.m., and
each day in the week at the tame hour.

Society of Arts.—8 p.m. Prof. W. C. Unwin: Machines for Testing
Materials, especially Iron and Steel (Cantor Lecture).

Medical Society of London.—8.1JU p.m. Clinical livening: Dr. J.
Hiighllngt Jackson : (1) Case of llemlanopsls and of Wasting ami
Paralysis of One Side of the Tongue in a Svphilitlo Patient; (2) A
case of Facial Paralysis with Paralysis of the Palate from Cerebral
Disease.—Dr. Samuel West : (1) Case of Post Hemiplegic Hemichoroa
In an Adult; (2) Case of Jacksonian Epilepsy.— Dr. de Havllland
Hall: Two casus of Ulceration of the Soft Palate and Pharynx.—
Mr. Lennox Browne: Case of Lympho-sarootna of the Tonsil and
Pharynx.

Tuesday, March 29.

Gut's Hospital.—^O perations, 1.30 p.m. and on Friday at the same hour.
Ophthalmic Operations cu Monday at 1.30 and Thursday at 2 p.m.

St. Thomas’s Hospital.—O phthalmic Operations. 4 p.m.; Priday,2p.M.

Cancer Hospital. Brompton.—O perations,2.30 p.m.; Saturday,2.30 p.m.

Westminster Hospital.—O perations, 2 p.m.

West London Hospital—O perations. 2.30 p.m.

St. Mary's Hospital.—O perations, 1.30 p.m. Consultation!, Monday,
1.30 p.m. Skin Department, Monday and Thursday, 9.30 A.M.

Royal Institut i on.—3 p.m. Prof. Oamgee: Function of Respiration.

Royal College of Physicians of London.— 5 p.m. Dr. Priestley t
Pathology of Intra-uterine Death (Lumleian Lecture).

Society of Arts.—8 p.m. Mr. Richard Bannister: Colonial Wlnet.

|5irt{|s, Utarriiiges, anb $eat{is.

BIETHS.

Ashworth. — On the 19th in«t.. at Halstead. Essex, the wife of
J. Henry Ashworth. M.R.C.P.Bd., of a son.

Oombk.—O n the 9th Inst... at Holly House. North Walsham, Norfolk,
the wife of F. Orloff Combe. M.B., O.M.Bdin., of a son.

Davt.—O n the 20th inat., at Southernhay, Exeter, the wife of Henry
Davy, MI)., of a son.

Matthews —On tho 19th Inst., at Suffolk-street. Pall-mall, the wife of
Valentine Matthews. M.R.C.S.. of a son.

Rinnan.-O n the 19th Inst., at Ivy House. Andlem, Cheshire, the
wife of Horace Townsend Newman, M.D., L.R.C.8.I., of a son (still*
born).

Twining.— On the 18th inst.. at Saloombe, South Devon, tho wife of
Alfred H. Tw ining. M.H.C.S., of a son.

Tachkk.—O n the 22nd inst.. at 31. Shrewsbury-road, Birkenhead, the
wife of Francis Vacher. F.B.C.S., of a son.

MARRIAGES.

Guinn fas—Heed.—O n the 17th inst., at the Great Assembly Hall. Mile-
end-road. Harrv Grattan Guinness, M.R.C.S.. to Annie, daughter of
the late Henry Reed. Esq., of Mount Pleaaant. Launceston. Ta-mania.

Murray—V oss.—On the 22nd inat . at St. James's, Pic cadilly, Hubert
Montague Murray. M.D.. to Florence, third daughter of the late
John Matthew Voss, of Swansea.

DEATH8.

Brodie.-Oh the 15th Inst., at the Royal Victoria Hospital, Netley,
Surgeon John Brodie, M.B.. Medical Stall. aged 38.

Cahrinoton.—O n the 16th inst., at St. Thomas -street. 8outhwark. after
two davs’ Illness (of pneumonia). Robert Edmund Carrington,
M.D.. F.K.C.P.LancL, Senior Assistant Physician. Guy's Hospital,
in ids 34th year.

Hall.—O n the 18th Inst., at ills residence. Gorse Bank. Wemeth,
Oldham. William Hall. M.R.C.8.. late of Salford, aged 61.

Jackman.—O n the 21st inst.. Edith, wife of William Thos. Jackman,
M.R.C.S., of 111, Brixton-hill. and daughter of the late Mrs. Edward
Radclyffe, of 61, King Henry'a-road, South Hampstead, in her 34th
year.

MacOii.l—O n the 17th Inst., Andrew MacGill, M.D.. late of Church
House, St. Leonards-road. Poplar.

Thornton.—O n the 20th inst... at Hastings. William Henry Thornton,
J.P.. M.R.C.S.. of Berkeley Lodge. Margate, aged 65.

Thuri.ani).—O n the 23rd lmit.. at Wilmington-aquare, W.C., Francis
Edward Thurland, M.R.C.S.. L.8.A.. aged 4ft.

Woolhousk. — On the 13th inst., at Cadognn Lodge. 8t. Mary's-
crescent, Leamington, George Richard Woolhouse, M.R.CiS.,
L.8.A.. Army Medical Department, retired, formerly In H.M.’a
44th Regiment, aged 6f>.

Woollett.—O n the 19th Inst., at hi* residence, The Monnt, Newport,
Mon., Robert Francis Woollctt. M.K.C.S., L.S.A.-R.I.P.

I.B .—A fee of 6s. is charged for the Insertion of Notices of Births,
Marriages, and Deaths.

Wednesday, March 30.

National Orthop.edic Hospital.—O perations, 10 a m.

Middlesex Hospital.— Operations, 1 p.m.

St. Bartholomew’s Hospital—O perations, 1.80 p.m.; Satnrday,same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 P.M.
Surgical Consultations, Thursday. 1.30 P.M.

St. Thomas’s Hospital.—O perations, 1.30 p m. ; Saturday, same hour.
London Hospital.—O perations, 2 p.m.; Thursday A Saturday, same houn
Great Northern Central Hospital.— Operations. 2 p.m.

Samaritan Free Hospital for Women and Children.—O peration*,
2.30 p.m.

University College Hospital.—O perations, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 P.M.; Saturday. 9.15 a.m.

Royal Free Hospital.—O perations, 2 p.m., and on Saturday.

Kino’s Ooi.leok Hospital.— Operation*, 8 to 4 p.m.; Friday, 2 p.m.;
Saturday. 1 P.M.

Children's Hospital, Great Ohmond-strekt. —Operations, 9 a.m.;
Saturday, samo hour.

8 ">ciett of Arts.—« p.m. Mr. A. Ihckeozaum Electric Locomotion.

Thursday, March 31.

St. Oeorgk’s Hospital.—O perations, 1 p.m. Ophthalmic Operations.
Friday, 1.30 p.m.

Oh a king-cross Hospital.—O perations, 2 p.m.

North-West London Hospital.—O perations. 2.30 p.m.

Royal Institution.—3 p.m. Prof. F. Max Miiller: Science of Thought.
Royal College of Physicians of London. - ft p.m. Dr. Priestley:
Pathology of Intra-uterine Death (Lumleian lecture).

Friday, April 1.

Royal South London Ophthalmic Hospital.—O peration*, 2 p.m.

West London Medico-Ohtruroioal Society.—8 p.m. Clinical Bvening.
Oases will be shown by Mr. Keetley. Dr. Soanes Spicer, Dr. Seymour
Tavlor, Mr. Edwards, Dr. Colcott Fox. Mr. Bland Sutton, and others.
Dr. W. Q. Stevenson and Mr. Bruce Clarke: A Demonstration npon
the Living 8ubject of the Treatment of Strioture of the Urethra by
Electrolysis.—Dr. Alderson : Remarks upon a case of Fracture of the
Patella, treated mechanically twenty-five years ago. with specimen.
Pathological Specimens —Mr. H. Percy Dunn: (1) Epithelial Growth
at Pharynx: (2) The Skull from a case of Traumatic Meningocele.—
' Mr. O. A. Webster : Fracture of the Astragalus.—Brigade-Surgeon W.
Curran : A Collection of Water-colour Drawings.

Clinical Society of London.—9.30 p.m. Sir Dyce Duckworth: A
case of Psoriasis, with associate.! Rheumatism, whioh passed Into
Pityriasis rubra (Dermatitis eijoliativi). — Mr. Bellamy: Case of
Symmetrical Gangrene following Varicella.—Mr. Lane: A case of
Intussusception produced by a Tumour growing from the Mucous
Membrane of the Great Gut .- Mr. Pollard : Three oases illustrating
the Difficulties In establishing Natural Respiration after Tracheotomy,
and their Treatment by Tracheal Catheterisation.—Dr. Drewltti A
case of Lupos treated partly by Salicylic Acid, partly by Saraplng
(living specimen).

Rotal Institution.—9 p.m. Prof. Dewar: Light as an Analytic Agent.

Saturday, April 2.

Middlesex Hospital.— Operations, 2 p.m.

Rotal Institution.—3 p.m. The Bt. Hon. Lora Rayleigh i on Sound.

Digitized by LjOOQle

656 The Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[March 26,1887.

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.m. by Steward's Instruments )

The Lancet Offioe, March 21th, 1887.

Barometer
redaoed to
Bea Level
andETT.

Dtreo-

tioa

ot

Wind.

Bu&.

Wet

Bulb.

Solar

lA

Vacuo.

Max.

Temp.

Shade.

Temp

Hal a

tall.

Remark! at

8J0a.it

Mar. 18

30-21

N.B.

32

77

42

29

Fine

„ 19

3031

E.

32

61

■12

30

Fine

„ 20

3017

N.E.

31

33

67

39

32

Fine

.. 21

29-86

W.

33

32

58

47

31

Foggy

.. 22

29-41

W.

47

45

82

54

33

•i>5

Overcast

„ 23

2904

w.

47

40

95

64

41

•20

Cloudy

.. 24

2967

w.

45

42

39

Fine

ftotts, jsjwrt Comments, # |dtsfetrs to
Corresjonknts.

It is especially requested that early intelligence of local events
having a medical interest , or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “To the Editors.”

Lectures, original articles , and reports should be written on
one side only of the paper.

Letters, uhether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

The Use of Uncooked Milk.

A correspondent, referring to our recent comments concerning the
dmager of using uncooked milk, asks, with regard to the prevention of
Infectious diseases, what our views are as to cream, butter, and cheese.
We hare always regarded cream as a necessary constituent of milk,
and we have again and again recorded outbreaks of infections diseases
as associated with the use of cream. The most recent was that which
prevailed in connexion with the use of cream from a dairy in Shoroham,
the cream being mainly consumed as an adjunct to strawberries.
Cream, whether as the result of the mere mechanical process of its
formation or otherwise, seems to have a special facility for embodying
any Injurious properties that may attach to the milk from which it
rises. If milk which has not travelled by rail be boiled when delivered,
a cream will later on form on its surface, to which no sueli danger
attaches. As to butter, we are not aware that it has constituted a
vehicle for the Infection of the ordinary speciflo fevers. Although
this subject cannot yet be regarded as having been exhaustively dealt
with, yet in several outbreaks butter has, in common with other foods,
been carefully inquired into, but without positive results. Whether
the process of butter-making has to do with this or not cannot at
present be stated. Much the same applies to the question of cheese;
but, as we explained in our issue of March .'>th, a dist inct danger does
attach to the nse of certain cheeses, and this it probably connected
with the quality of milk that Is used In the process of manufacture.
Mr. W. Outfiuxzite. —We shall be pleased to hear “the other side ” from
our correspondent, but have not space for the verses. We freely
admit that there is danger attached to all sports; but football is
unfortunately distinguished by the number and severity of accidents
' and the roughness of the play.

Mr. W. Frtuer (Ashburton).—The report has been received.

ERYSIPELAS AND VACCINATION.

To the Editor $ of The Lancet.

Sirs,—Y our article on the above subject suggests the desirability of
treating the vaccine vesicles, when ruptured, with autiseptics. Is this
done to any extent at the present time ? Or are there any instructions
on this point, issned by the vaccination authorities ?

I am, 8irs, your obedient servant,

March 19th, 1887. Inquirer.

There are no instructions issued which relate especially to broken
vesicles. There would obviously be some difficulty fn the antiseptffc
treatment of poor children remaining in their own Homes.— Ed. L.

Prohamilitt of Livino and of Dying.

Mr. J. Niven (Oldham). — The communication has been referred to
Mr. Noel A. Humphreys, t lie editor of Dr. Farr’s "Vital Statistics,"
who agrees that the paragraph quoted involves an undoubted oversight,
which appears to have pi isen in the following way. In the paragraph
in question Dr. Farr uses p to represent the " probability of dying"
whereas this letter is almost Invariably used only to represent the
" probability of living," and in the formula given to express the
relation of p and m the/' has its usual signification, tlie "probability
of living," Instead of the unusual meaning attached to it in the pre¬
ceding paragraph. The true difference between the rate of mortality

(m) And the probability of dying may be expressed : nt— +

and this difference, as Is explained in the paragraph, becomes less as n*
diminishes.

Old Subtcriber. —The letters sent scarcely supply material for a judgment-
on the institution.

Mr. Harcourt (Belfast) should consult a surgeon.

DIPHTHERIA AND CROUP AS ENDEMIC DISEASES.

To the Editors of The Lancet.

Sirs,—I t seems surprising, with all the efficiency of the staff of medical
officers of health, that no, or very little, progress baa been made in
hunting down contagious disease tolls seed bed (endemic origin), par¬
ticularly as so mnch progress baa been made in tracing contagion—
e.g., scarlatina, typhoid, diphtheria, Ac.,— to milk or water. The
Jennerlaa analysis has doubtlessly been more strictly applied to the
Utter than to the former. I have for many years held that diphtheria-
and croup had their “ endemicit-y " in stables or stable manure. To thi»
opinion I was led by the fact that the majority of patients whom I had
to treat were either connected with or lived near stables—e.g„ stablemen,
cowmen, Ac., and their families. So strongly did I hold this opinion
that when the Princess Alice died I wrote suggesting that ail the
localities, Ad., where the young princess, in whom the disease first
declared itself, was likely to have visited should be found out, laying
particular stress on any chance visit to stables. It lias occurred to me
to verify in a certain degree the truth of my opinion. Last year I had a
hen set in my stables. She was perfectly isolated from the other
chickens, though fed on similar food and water, for a period of about,
twelve days, when she was brought to me with a “•stoppage in th»
throat.” I examined her, and found that the fauces, Ac., were covered
with the usual white membrane of diphtheria. In dotachtng the mem¬
brane the surface oozed blood—in fact, there was no doubt in my mind
as to the nature of the case. I treated it for a few days, mopping out
the throat with a saturated solution of oommon salt (about the best,
germicide solution I know), and as she did not improve I had her killed,
Slnoe then I obtained a book on poultry, and in it I find that diphtheria,
and croup are diseases from which fowls suffer. Whence can the birds,
get the disease, except from their own surroundings — farmyards,
stables, Ac.? It is next to impossible that the disease could be imported
amongst them, os they are generally quite isolated. I know nothing of
veterinary science, and consequently am very diffident in expressing an
opinion which I am inoilned to hold—that glanders is diphtheria in th®
horse. If such be the case, it very much strengthens my contention,
that the disease is endemic in stables (of course, it may be endemlo
elsewhere). I am, Sirs, yours faithfully.

Long Ditton, March, 1887. Henry Godrich, B.A., 1st B.Sc.Lond.

Medical Missionary Work in Beirut.

The physicians of the medical department of the Syrian Protestant
College have been appointed by the Order of St. John in Berlin as the-
medical attendants of the Johanniter Hospital in Beirut. Thia
admirable charity is served, too, by the deaoonesses of Kaiserwerth,
and has received during the past year 466 in-patients And 7126 patients-
treated in the polyclinlque. Our readers may remember that the
College is connected with the Amorican Presbyterian Mission.

M.B., EA.C.S.— Our correspondent’s experience must be peculiar. For
many hospital appointments the possession of the higher diploma ia
indispensable.

M. M.— There is no invariable rule.

II. M.— Yes. The blocks to Illustrate the paper should be sent.

WORKMEN’S COLLECTIONS IN AID OF HOSPITALS.

To the Editors of The Lancet.

Sirs, —The workpeople of our town are showing a desire to establish •
" Saturday Collection ” in aid of onr Infirmary. It is thought that
Information from other towns adopting similar weekly collections wiU
contribute largely to the success of the movement. I am requested to-
assist In obtaining such details; and as the difficulties are great. I must
appeal for assistance to those gentlemen who arc attached to hospitals-
where this plan is In satisfactory operation to forward to me a copy or
their report. Personally I shall esteem each report a great favour, sunt
the good likely to result to an infirmary will in iteelf afford satisfaction.

I am, Sirs, yours obediently,

SASttTKL StRETTON,

- March, 1887. Consulting Surgeon, Kidderminster Infirmary.

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The Moxoh Memorial Fund.

President : Sir William Jenner, Bart., K.O.B., M.D., F.R.S. The
following contribution* have been received »lnce those announced on
March 19th. All subscription* should be forwarded to the Honorary
Treasurer, R. Clement Lucas, B.S., F.R.C.S., 18, Finsbur^sq., B.C., by
whom they will be acknowledged. Cheques should be crossed, “ City
Bank.”

Fourth List.

Subscript ions announced £107 4

Sir Andrew Clark, Bert. 21 0

L. C. Wooldridge. M.D. 3 3

It. Elphinstone, Bsq. ... 3 3

Mrs. Peaohey . 3 3

Brigade-Surg.J. Wales.. 2 2

3. A Ball, M.D. 11

James Bunting, Bsq. ... 1 1

C.F. Pickering, F.B.0.8. 1 1

0. A. Wright, MJ„

F.B.C.S. 1 1

6

J. Mitchell Bruce. M.D.

£1 1

0

0

W. C. Church. M.D. ...

1 1

0

0

J. C. Roberts, Bsq.

1 1

0

0

0

A. B. Maylard, M.B.,
B.S.

1 1

0

0

J. Sykes, Bsq.

1 I

0

0

R. W. Thurston, Esq. ...

0 10

6

0

O. B. 8heliswell, Bsq. ...

0 10

6

0

Staff- Surg. C. Godding,

R.N.

0 10

0

0

B. Armltage, Bsq.

0 5

0

M. A. 0 .—The only guide to the examinations at the London College of
Surgeons Is that by Mr. Gant (fifth edition, Is. tkf., Balltlftre, Tyndall
and Cox). Keetley’s “ Guide to the Medical Profession ” would afford
the desired information on the other points.

Mr. A. V. Dyer will find his question answered in the letter of our Paris
correspondent, (p. 660.)

Home-Surgeon will find the report in our present number.

THH INFLUBNOB OF ALTITUDE ON PHTHISI8.

To the Editors of The Lancet.

8ir 3,—I notice In your Issue of March 19th an article by Dr. Alcock.
'-.herein a novel explanation is sought to be given of the benefit derived
from high attitudes In the treatment of phthisis. His idea Is Ingenious,
but his reasoning Is fallacious ; and, as a matter of fact, his explanation
1 ‘Annot be true. He endeavours to show that the particles of human
blood have the same average rate of heat motion at 8t. Gothard that
they would have had at the sea-level at a temperature of 10V8* ; it is his
u-gnmeBts In support of this proposition that are unsound. His words
ire:—"It is already accepted that the only difference between the
liquid and gaseous states is one of molecular motion. Consequently, If
Hf* 0 of heat can make water boll at St. Gothard, It Is apparent that
this temperature can there produce nn amount of molecular motion
whioh not less than 213° could excite at the sea-level." In other words,
because steam contains more molecular motion than water, therefore
steam raised at all temperatures contains the same amount of molecular
motion 1 SochIs Df. AJoock’s argument. He now oontlnues: “Further,
u 1W° Is to 212°, so is 98-4° to 104 - 8°; therefore, the rate of motion to
which a temperature of 98’4° would give rise at St. Gothard oould only
be attained fat the sea-level as the result of a temperature of 104’8°.”
Here the condition of water at 98’4° and 104’8° Is deduced from the con-
•lit ion of steam at 199° and 212°. Hut in spite of the fact that " the only
'inference between the liquid and gaseous states is that of molecular
motion," Dr. Alcock has no more right to assume that the laws which
apply to gases apply also to liquids than he has to assume that Boyle's
law applies alike to water and steam. Again, he assumes equal rate# of
"notion for proportional temperatures Fahrenheit. Hut why Fahrenheit ?
'■Vhv not Centigrade, or Rdanmur, or any other scale ? If there were any
•mth whatever In Dr. Alcock’* assumptions, would not the use of the
absolnte temperature be the more likely to give correct results ? But, as
a matter of fact, neither are his assumptions true, nor. If they were,
would his conclusions follow.—I am, Sirs, your obedient servant,

H. Osborne Fountain, B A. Cant., M.R.C.S., L.R.C.P.
March 22nd, 1887.

The Crotdon and Surrey Medical Aid Association.

Ol b attention has been called to the fact that circulars advertising lhl 3
Association and lte medical officers are distributed from house to
boose, and that weekly canvassers are employed. There seems, too,
no wage limit to the admission of members. Yet we see appended to
ibe circulars the names of many gentlemen who would not willingly
be parties to anything undignified or unprofessional.

Mr. Geo. A. Craig, M.B .—The gentleman named died in March last year.

VIPER’S OIL.

To the Editors of The Lancet.

Sirs,—I was lately consulted by a patient for gradually Increasing
■Wfness, for which she had tried various domestic remedies without
•uccess. Among other* she mentioned, with some surprise at it* failure,

1 ®be had “ rubbed in viper’s oil," procured for her by her friends, and
• ■tit "they had been very particular, catching them themselves.” I
=>aouM be curious to know If any of your correspondents can give an
account of the origin of this singular superstition. Docs It arise from
t 16 passage of the " deaf adder that stoppeth her ears and refuseth to
r'ri ' T<rtce of charmer,’’ on the idea of similia timilibus cumntur t
‘u not Inquire as to the expense of the preparation, but it must be
-oturiderable, as the average viper would not, one would suppose, yield
®ch oil under any method of treatment.

„ I am, Sire, yours faithfully,

March 10 th, 1887. ‘ ' r . ... OhaWxMIT* •

The Queen's Jubilee and the Hospitals.

On this subject, Mr. Ernest Dereuth, Secretary to the City Orthopsdie
Hospital, writes:—" At the commencement of the year, I made similar
attempts to those so kindly advocated by Dr. Slight, and your own
journal, supported by a few well-known philanthropists, but the dally
papers, although usually giving me a helping hand for my hospital,
declined giving publicity to our letters and announcements till the oon-
sentof Her Majesty had been obtained. I shall be very pleased to afford
the movement my utmost exertions, and would suggest that a body of
gentlemen be formed as soon as possible os a preliminary oommittee.’*
Liverpool.— We do not give medical advice.

CASH OF CUT-THROAT.

To the Editors of The Lancet.

Sirs,— The following report Of a case of out-throat may be worthy of a
corner In your journal.

A few days ago I was called to a patient who had laid violent hands on
himself. When I got to the house I found a man slttlDg on a bed
bleeding profusely. I at once examined him, and found a wound which
stretched across the throat, being placed between the thyroid cartilage
and hyoid bone. The thyroid was fractured, due to hts tearing ft with
his fingers. I at once placed a sponge wrung out of cold water over the
wound, and sponged the blood. I repeated this as the blood continued
to flow, but eventually the bleeding ceased. After half an hour another
doctor came; but at the bleeding had abated he did not Interfere. Two
hours later the bleeding recommenced; so we sponged the part well,
and found four small arteries from which blood spouted. These we
ligatured with silk, and the bleeding was completely stopped. The next
consideration was, should we sew the wound up ? We agreed not to do
so, being apprehensive of blood accumulating between the skin and
opened larynx, and, by passing Into the lungs, causing asphyxia or
inflammation. The wound was therefore left completely open for two
days. Two silver stitches were then placed near the sides of it, leaving
an opening over the larynx, so that any discharge from it might have
free drainage. I examined the pupils as soon as I arrived, and found
them greatly contracted. The wound is now closed by silk stitches.
It Is sponged twice a day with tepid water, and then a clean piece of
linen is placed over it. The patient takes a little tea and milk, and a
pint of beef-tea has been administered by the stomach-pump. No bad
symptom has as yet been noticed.

I am. Sirs, yours faithfully,

Bridlington Quay, March, 1887. G. Nelson, L.R.C.P., L.R.C.S., &c.

P.S.—Since the above was written the severed pharynx has nearly
healed, whioh Is proved by very little fluid coming through the external
wound when the patient swallows any fluid. As far as I can make out,
the fractured thyroid cartilage Is also united, and there is now very
little discharge through the external wound, which ’now only
admits one finger. The urine Is loaded with urates and a quantity of
bile. The bowels cannot be made to act by enema; nevertheless, we
shall, I think, effect a good cure.

NIGHTMARE.

To the Editors of The Lancet.

Sms,—I am much Indebted to the correspondents who so kindly
replied to my letter, especially to “E. W. W.” for the prescription given.
It has not had, I regret to say, the desired effect. The dreams, with
irritable heart and weakened nerve force, continue. I may add that
there is some history of gout and further signs of deranged nutrition In
the urine beiDg sometimes loaded with llthates, slight flatulence and
Inertia of liver. Heart sounds healthy, and no excesses. Change has
not done any good and exercise is limited, as a slight amount excites the
heart and causes fatigue. I am. Sirs, yours faithfully,

March 22nd, 1687. - M.D.

To the Editors of The Lancet.

Sirs,—I n reply to the letter of your correspondent, “M.D.,” In your
issue of the 19th ult., 1 beg to suggest the following hints:—Diet chiefly
meat, eggs, milk, oold bacon ; no wine or spirits, bat good stout; cod-
liver oil; vigorous frict ion of entire chest with embrocation twice a day;
strictly early hours; a month’s holiday in June in such bracing upland
air as that of Stnrthpeffer. These are to my mind essential points. If
the liver be sluggish, short, brisk horse exercise before breakfast la
invaluable'. As a rule, I believe iron is better avoided.

I am, Sirs, yours truly,

March, 1887. F.

COLONIAL PRACTICE.

To the Editors of The Lancet.

Sirs,—W ill some of your readers kindly advise me? My wife is not
strong, and I am told she must not winter In England again. I have no
funds to send her to the south of France, &c., so hare made up my mind
to sell my practice and make a start in the colonies. Which is the best
place to go to? I should prefer a good asslstantship, and. if possible,
one with view to partnership. I would be glad also to loam the name of
the most reliable medical agent In Australia or New Zealand, to whom
to write. Any Information will be most thankfully and gratefully
received. I am, Sirs, yours faithfully,

March, 1^87. Spbs,

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NOTES, COMMENTS, AND ANSWERS TO C0RRESP0NDBNT8.

[MAWJK^a, 1687.

The M.h.c.s. Diploma.

f ,i - ■ . \ 'i ■ (

reply to a correspondent, whose letter has been mislaid, we have to
state tliat a holder of the Membership of the Royal College of Surgeons j
' liaa the right to append •• M.R.C.S." to his name, and he only. ' \

Jiurhmgk .—We do not think our correspondent sufficiently realise* the j
- necessity for Individual convenience giving way to the exigencies of 1
i t h» service, nor do we approve of the manner in which he write* of j
1 -the administrative officers of the department, who are certainly entitled ,

’ to credit ter their labopis In investigating questions connected with i
the prevention and treatment of disease, j ■

C. P —The matter shall have attention. i

Ur. Jl. IV. II. Thomas .are unable to refer to any specific authority.

.» • *.! * , i '<• ■ . • i !

t >/•!■■. .• iANJLSHjI A. ... * |

Toths Editors of Thb Lancet.

' Sirs—I would' feel extremely thankful if any of your numerous corre- t :
•pendents would kindly suggest some line of treatment that might assist j
me in a case I have at' present. My patient, a gentleman aged thirty- I
fynr, lias been for many years deprived completely of the sense of smelling ; !
ajid is now a great sufferer from headaches (usually frontal), which is '
Iwou^ht about without any apparent cause. Excitement of any kind i
induce^ it. 1 cau find no history of syphilis, and he enjoys otherwise
good health,' He is very abstemious, and most careful in dieting himself,
f find his breath is most offensive, which he says has been so for years.

) I am. Sirs, yours faithfully,

March 23rd, 18*7. Constant Reader.

• GAS-BURNERS FOR THE CONSUMPTION OP 8EWER GAS. ,
To the Editors of The Lancet.

Sirs,— I observe in The Lancet of last w eek a letter from Mr. God rich,
advocating the use of gas-burners for the combustion of sewer-gases. I
beg to say that 1 have already constructed and ]>atented an apparatus for |
t.hy. purpose, from a suggestion of Dr. Lowe, wliich acts perfectly. 1
sfjall be glad to show it in action to any member of the medical profession
vyho may care to see it. 1 am, Sira, your obedient servant,

i Park-street, JJarch 22nd, 1S87. R. W. Hellyf.r.

i

BREAD-MAKING.

’ Tb th* Editors of The Lancet,

, SuiS,—Could any of your readers inform me witere I might obtain a 1
pamphlet, written many years ago, on a method of preparing bread |
\yitii carbonate of soda and muriatic acid very diluted. I know I ate j
some when in London many years ago, and 1 thought it healthy. 1 \
would be satisfied U 1 knew title quantities to be used. , j

» I am. Sirs, your* respectfully,

‘ G on way, N.W., March 21st, 1887. Koimitr Jones.

Student should make application to the Secretary of the College.

V.D. has not enclosed his card.

Communications not noticed in our present number will receive atten¬
tion in our next. , •

Communications, Letters, Ac., have been received from—Dr. Braxton i
Hicks, London; Dr. Mace wed, Glasgow; Mr. Warrington Haward,
London; Dr. O. Sturgee, London; Mr. McGill, Leeds; Prof. Serin,
Milwaukee ; Sir E. Lechmere, London ; Mr. Mandagnialidi, Colwyn
iBey; Mr. Gant, London; Sir H. C. Perrott, London; Mr. Urban
Pritchard, London ; Mr. Jas. Turton, Brighton ; Mr. A. M, Sheild,.
Lppdon ; Mr. T. B. Young, Halesowen ; Mr. P. B. Hill, Crickhowell;

Dr. F. H. Alderson, London; Mr. Grant, Blaatyfe; Dr. J. W. Moore
Dublin ; Mr. MgndjielirJones, Loudon; Mr. (J.. Ifelpqp, .Bridlipgtop
Quay; Mr. R. D/ Pedley.j Loudon ; Mr. J. L. Stratton; Jdr. Leighton
Kesteven, Brisbane; jir. A. V. Dyer, Clifton; Messrs. Burroughs and
Welloome, Loudon; Dr. f- M. Pieroe, Manchester ; Messrs. Macewta
and Co., Belfast; Mr! G, A. Craig, Birmingham ; Messrs. Motterehcad
and Co., Manchester; ifr. R. Jones, Conway; Messrs! Whitfield and
Co., Birmingham; Mr. J. A. ^qsybold, Manchester; Messrs'. Smith
ar\d Son, Manchester;. Mr. j. S, BucIe Bromley; Messrs. Keith and
k Op.. Edinburgh ; Mr. Gaye, London'; fir. Med well, Christchurch. New
i Zealand ;..Dr, Broadbent. London Mr. Dalton, London; Mr. Percy
Dunn. Londfrn ; Morn. G. Masson, Paris ; Messrs. Oppenbeimer and
| C'A, ^ondon ; Mr. Ashcnden, London?; Dr. Bason, Lytbam ; Mr. S.
.Stret{on, Kidderminster; Dr. P. lj' f ^anklaild, London; Mr. Bawa
„ Ssngb, Pqnjaqb; i Mr. M. G. Evans, CprdffT; Messrs. Hopkineon and
Co., Notts;■■ SIrJ Cardwell, London's Dr.(F. Warner, London; Mr. J.
" Wiilfims, Brentford ; Dr. Gardner.^ Adelaide r Mri H, W. H. ThrroaV.
'* London ;' Dr. H.’lf. Bigelow, Berlin ; Mr. uoumell, BtshearCe ;']?/. T.
Jackson; Holbeachj liev. G. H. Wright,’ London; Messrs, fjurap^ian*

• Co., Liverpool; Mr, Hussey, Oxford; Mr. Moullin, Loa4og
Wallis, London Mr. Smcaton, London,; Dr. Lewi ns ; - Dr. Abraham.
London ; -Dr- Brett, Watford; Mr. Hodgkin, London; ,Mr. Dereuth.
London; Dr. Sleeves, Liverpool; Dr. F. B. Adams, Cork ; . Mr. R. W.
Hellyer, London ; “Dr. Elder, Nottingham; Mr. Eastdrbrook, London;
Mr. V. G. Webb, London ; Mr. F. W. Wrighti Derby;' Mr. Fountain.
London; Mr..Blake, Crewkerne; Mr. Knot*, Middlsabro’; Mr.-Maw,
London ; Mr. Brown, Westgate-on-Sea ; Mr. J. H. Balfe; Mr. Oakwell.
Notts; Dr. Craddock, Gloucester j Dr. Maaartie, Bombay j Hits Sykes,
Hamilton ; Dr. Gabb, Cheltenham ; Mr. Grattan, Cork ; Mr. Ricker.
St. Petersburg; Mr. Jennings, London ; Mr. Tresise; Mr. Ashworth,
Halstead; Mr. Tillet, Dudley; Mrs. Chambers, Bverlelgh; Mr. Ryan.
London; Mr. Kershaw, Luton; Mr. Beckton, London ; Mr. W. G.
Bunn, London; Mr. Hartzhome, London; Mr. Mundy, Hampstead;
Messrs. Reynolds and Co., Leeds; Mr. Armstrong. Manchester;
Mr. Jacob, Basingstoke; Constant Reader; H. M-; M.D. 1886 i
L.S.A.; F.; Inquirer; M.D.; Furlough; M.B., F.R.C-S.Eag.; Only
an M.B.; Resident Physician, Soutbsea; Surgeon, Birkenheadj Old
Practitioner. I • - :

Letters, each with enclosure, are also acknowledged from—Dr. Saul.
Lancaster; Mr. Lew is, London ; Mr. Coltman, Leicester ; Mr. Carp.
Notts; Mrs. Terrell, Hertford; Dr. Waller, Peterboro’; Mrs. Northrop,
London; Mr. Lyle.Dalston; Mr, Townsend, Bxeter; Messrs. Beal and
Sou, Brighton; Mrs. Hitch, St. Leonards-ou-Sea; Messrs. 8treet and
Sons, Guildford; Mr. Edmunds, Chesterfield; Mr. BiratfeH; Liver¬
pool ; Dr. Lindsay, Belfast; Mr. Fowler, Wakefield • Mr. WestWood,
Stratton; Dr. Brown, Puckerldge; Mr. Webb, Bpsom ; Mr. Keelv.
' Notts; Mr. Langley, Notts ; Mr. Homibrook, London; MiM Barlow,
Colwyn; Dr. Hall, Prescott; Dr. D’Bstrf'c, Paris; Dr. Combe.'North
Walsham ; Dr. Newman, Audlem ; Dr. Stack, Spalding; Mr! Kirby.
Whitechapel; Mr. Dumville, St. Alban’s; Mr. Thomas; Mr. Brymer,
Summerton; Mr. Affleck, Manchester; Mr. Boyvean ; Mr. Saunders,
Camden-town; Dr. McGill, Poplar; Mr. Rldeal, London; Dr. Gurney,
Finsbury; Mr. Bacher,Birkenhead; Mr.Brooks, Ludlow; Dr.Benthall.
Soutbsea; Mrs. Moore, Coventry; Mr. Qrimyer, Bow; Mr. Stevenp,
Nottlng-hill; Mr. Thornton, Margate; Mrs. Chambers; Mr. Johnson.
Sheffield; Mr. Gimblett, Peckham; Miss Carson, Burtoo-on-Trent
Commercial, Exeter; S. S.; J, A. M., Wakefield; Bruce; Medicua,
Camden-town; H. W.; Hailebury ; Medlcus, Bristol; T. H.; Lady
Superintendent, St. John's-wood ; Steward, Pluinstead.

Western .Vail. South Wales Daily News, Echo, Hospital Gazette, Norwich
Mercury, Gloucester Chronicle, Orilla Packet, Eastern Mojminy. News
, City Press, Ac., have been received.

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THE LAINCET; 1887.

Crocmbm lectures

THE PULSE.

Delivered at the Roj/al College rf Physicians of Lo ndon,
March, 1887.

By W. H. BROADBENT, M.D., F.R.C.P.,

PHYSICIAN TO ST. MARY’S HOSPITAL, CONSULTING PHYSICIAN TO THE
LONDON FEVER HOSPITAL, AND PRESIDENT OF THE CLINICAL SOCIETY.

LECTURE II.

Mb. Prksidrnt and Gkntlemkn,—M y tirst. lecture was
occupied by cert&in general considerations with regard to
the pulse, after which I began to describe the more important
variations in frequency and abnormalities of rhythm. The
next to be considered is the infrequent pulse.

Infrequent pulse.— It has already been remarked that the
effect upon the pulse of nearly all departures from a normal
state of health is to increase its frequency, nnd the diseases
are extremely few which reduce the pulse rate in any
marked degree. High tension in the aorta—induced experi¬
mentally in animals or man by pressure upon the abdominal
aorta, or upon a number of the larger arteries—slows the
pulse, and the high tension of renal disease has some effect
in the same direction, but less than might have been antici¬
pated. In jaundice the pulse falls in frequency, and in
various affections of the nervoussystem thiseffectis observed;
but, except under circumstances which will be discussed later,
the reduction is not striking. A pulse is really infre¬
quent when tbe number of beats is below 40 per minute.
A pulse of 60 is not uncommon, of less than 60 rare.
Persons are met with, however, in the enjoyment of vigorous
health with a pulse of less than 40. I have known an
athletic young man, tall, well built, and muscular, who dis¬
tinguished himself at foothall and other violent games,
whose pulse-rate was 36. Some years after 1 last saw him,
1 heard of his death while swimming; he was taken with
“ cramp,” so-called, and sank. In this cramp it is the heart
which is brought to a standstill by the resistance in the
peripheral circulation due to the combined effects of arterio-
capillary contraction from contact with the cold water, and
of pressure on the surface from immersion, and it is not un¬
likely that slow action of the heart would predispose to
this result. Infrequency of the pulse to the degree under
consideration is sometimes met with in fatty degeneration
of the heart, and is enumerated among the indications of
this disease, but it is far more commonly absent than present,
even in an advanced Btage of fatty change in the heart.

The infrequent pulse, however, is so closely Associated
with the bigeminal pulse, and with a peculiar modification
of the rhythm of the heart, in which only every other beat
reaches the wrist, that it will be well to consider these. In
the interesting variety of pulse rhythm called the “ pulsus
bigeminus,” the beats come In couples, a strong beat being
followed quickly by a somewhat weaker one, after which
there is a pause' The second of the two beats may vary
greatly in strength, being sometimes almost as distinct as
tbe first., sometimes scarcely perceptible, and the interval
between the first and second may vary somewhat in length.
On examining the heart, its action is found to correspond ±
there are two unequal impulses, the second weaker than the
irst, and usually felt at a different point; and on ausculta¬
tion the sounds Associated with the second impulse are, less
loud, and of a lower pitch. If a murmur is present, usually
a mitral systolic, it will be louder and higher pitched with
ttd - first, and may be inaudible with the second. I have
sometimes heard a mitral murmur with one beat and a tri¬
cuspid with the other.

Closely alii- d to this condition is that in which there are
two beats of the heart to one of the pulse, one beat being
dropped; not that transitions are common, for, in the
absence of valvular disease, the pulse may number 40 one
minute, the heart beating 80 in couples, and the next may
be perfectly rejralar at 80. In the form of valvular disease,
however, mitral stenosis, in which the pulsus bigeminus and
the dropped beat are mo9t frequently met with, the former
may be a stage in the return towards a regular mode of
action from the latter; and although (in the absence of

No. 3318.

valvular disease) a systematic bigeminal pulse does not
succeed the dropping of a beat, yet un occasional bigeminal
beat occurs when the weaker systole happens to raise the
aortic valves, so that there is a clinical similarity which
permits of their being considered together. Both, as has
just been said, are met with in mitral stenosis, and especially
when under treatment by digitalis. I have had several
cases in which the pulsus bigeminus, or dropping of one
beat, could be induced at will by administering this drug.
Taking the more advanced condition, when there are
two beats of the heart to one of the pulse, a careful
examination of the heart is most instructive. It is
often difficult to resist the impression that the two
ventricles are acting alternately. The impulse in the tirst
of the two beats will give the sharp apex tap characteristic
of an advanced stage of this form of heart disease; the
second will be felt only, or mainly, over the right ventricle.
On auscultation, if there is regurgitation as well as stenosis,
the systolic murmur and short sharp tirst sound will be
heard at the apex with the first beat, but will be absent at
the second; and the same will be the case with the aortic
second sound at the base—it will lie distinct with the first,
absent at'the second ; while the sounds of the right side of
the heart will be heard alone at the second beat with the
tricuspid regurgitant murmur, if one is present, and will be
comparatively weak with the first and stronger of the two
beats; t-lie pulmonary second sound, however, hearing
witness that the right ventricle has contracted. When there
is no regurgitation, the first beat will have the loud, short,
sharp first sound at the a pex a nd both sounds at the base,
the seoond the low-pitched'fifst sound of the right ventricle
and a loud pulmonary second sound, but no aortic second
sound. Usually the presystolic murmur will have disap¬
peared before the coupled beats under consideration set in.

In the absence of mitral stenosis the double heart beat-
with only one pulse is considered by Tripier of Lyons to be
of very serious import, aud to occur only in connexion with
epileptiform attacks. To quote his conclusion on this point,
he says: “ II semble done qu’il n’y a pas de pouls lent avec
Spilepsie sans deviation du rhythine cardiuque, de me me
qu’il n’y a pas de deviation du rhythme cardiaque avec
ralentissement du pouls sans (?pilepeie, ou sans l’action du
digitate, tout au moins d’apres les faits dont nous avons
cohnaissance.” Such has not been the case in my own
experience. But before relating tbe cases which seem to mo
to be in opposition to Dr. Tripier’s conclusion, I may add
one more to the series which he has collected with so innch
industry and employed with so much ability, illustrating
the connexion upon which he insists between epileptiform
attacks and the dropped beat and bigeminal pulse.

C. W-, a carman, aged forty-seven, but looking ten

years older, was admitted into St. Mary’s Hospital Under my
care; March 2nd, 1877. He had had rheumatic fever eight
years before, and had suffered from occasional attacks of
bronchitis. For eighteen months he had complained of pal¬
pitation after hard work, and he lmd had “ fits,” of which no
exact description was obtained. After a recent attack of
bronchitis, from which lie had recovered about three weeks.

be had had for a fortnight an increasing sense of palpitation
of the heart, with pain which he called "working pains”

across the upper part of the abdomen. On admission he had
an anxious look nnd the skin was clammy; the tempera¬
ture 97°; the urine had a specific gravity of 1010, but con¬
tained no albumen; tile pulse was 31, large and strong, not
quite regular either iu force or frequence; at times there

‘ was an echo of the beat (pulsus bigeminus) —see Chart I’
i The heart was df normal size; the apex beat was
I distinct, and often followed at a brief interval by a second
j beat. At the apex a low-pitched systolic murmur beginning
< with an accent was heard; it was soon lost beyond the

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660 The Lancet,]

DR. W. H. BROADBENT ON THE PUim

[Apbil 2,1887.

apex, but within it, was audible over the right ventricle and
up to the pulmonary area. The aortic second sound was
heard over the entire heart. As a rule the heart beat was
single, but from time to time there was a double beat.
When he was made to walk rapidly the patient felt faint,
but did not stagger, and secondary beats were more nume¬
rous. He was in the hospital two months, and improved
much in strength, no tits occurring; the pulse, however,
remaining at 28. At one time, when suffering more than
usual from “working pains” all over the abdomen, the
pulse was 69 and quite regular. His subsequent history is
unknown.

A well-marked example of infrequent pulse with double
heart beat, but without epileptiform attacks or serious
effects on the health, came under my notice in November,
1883, in a tall, strong, broad-chested man, aged fifty-two
years, who had been engaged in exciting political agitation, 1
and had suffered a severe domestic loss. He was complain¬
ing chiefly of continuous dreaming, and of depression and
loss of energy, with heaviness and confusion of the head.
Having found a pulse of 40, 1 wished to examine the chest,
but he said this was quite unnecessary, since, whatever else
might be amiss, the heart and lungs at any rate were all
right, and he declared that he would walk up-hill as well
as ever, and even run. There was no impulse or apex beat,
but on auscultation a normal first and second sound were
heard all over the heart; followed rather sooner than usual
by & first sound without a second, a weak pulmonary second
sound, however, being audible when listened for with
care. The first of the two beats only gave a pulse at

fis N

v v - 1 ■

the aortic sound was accentuated, the pulmonary masked by
over-lapping lung. When the coupled beats were present,
no second sound followed the later of the two, so that the
sounds ran 121 —1 21; both the mitral and theaortic murmur
were louder wit h the fl rst beat than when the heart’s action waa
regular, and absent or scarcely audible with the second; this
second beat, however, gave a loud first sound, so that it was
not abortive from mere weakness, but the absence of the
murmurs and of the second sound was probably due to an
imperfect diastole. A week later, after rest in bed, the
physical signs were unchanged, except that when a series
of coupled beats occurred, which was as frequent as before,
the second of the two beats was weaker and more precipi¬
tate. This patient, after a Mediterranean trip, again came
under my care in February’, 1884, and was then observed to
have Cheyne-Stokes’ respiration, which, however, did not
prevent him from going to the City T , until thrombosis of the
deep tibial veins came on. He died from the effects of
thrombosis in the right innominate vein. The peculiar
heart rhythm was never heard again; but the case is the
more interesting from the occurrence of this peculiarity in
the action of the heart, and later of CLeyne-Stokes’ respira¬
tion, which Tripier considers to belong to the same order of
phenomena.

The double heart beat for each beat of the pulse was
present again in the case of a lady seen in October, 1886.
She had worked very hard in her father’s parish, which
involved much walking up-hill, from April to June, when
Bhe began to look ill, and was breathless—which, however,
she did not notice herself. She then suddenly broke down,
and had been resting up to the time when she consulted me.
She looked well, and all the functions were natural, but she
felt as if she could sleep continually'. The pulse was
infrequent, and two beats of the heart, one like an echo of
the other, were felt and heard for every pulsation at the
wrist. The aortic, as well as the pulmonary second sound,
seemed to be audible in the second weaker beat, although
no evidence of this systole having raised the aortic valves
is recognisable in the tracing. (Chart 3.) Under the

the wrist; the second, indeed, not rai-ing the aortic valves.
All the symptoms disappeared, but two years later, after
another period of excitement and anxiety, he again con¬
sulted me, and with similar complaints he had a return
of the peculiar action of the heart. The pulse was 34,
quite regular. There was a diffused double cardiac impulse
without defined apex beat, one of them strong, giving a
pulse, followed quickly by a weaker one, which sent no wave
to the wrist. The sounds were much as they have been
described before, but the first sound of the second weaker
beat was almost inaudible at the apex and distinct over the
right ventricle. This patient again recovered, and is still
making much noise in the world.

In the same year, 1881, I saw a medical man of about
fifty-five, who, when rather overtaxed by work, had run
some distance on being called to an urgent case. This was
followed by strange faint feelings, and an uneasy sensation
about the heart, lie was not otherwise out of health. He i
had discovered that his pulse was 40 instead of 70, and on
examination this was found to be due to the heart beating
in couples—a strong beat with normal sounds which gave a
pulse, followed quickly by a weaker beat with sounds which
appeared to belong to the right ventricle only. This had
been going on for ten days before I saw him, and continued
for ten or fourteen days longer, coming and going towards
the end ofj this time. Rest and change restored the equili¬
brium of the circulation, and this gentleman is in active
practice at the present moment.

In November, 1883,1 saw a gentleman, aged fifty-three,
who had enjoyed good health until the previous June, when
he had an attack of congestion of the lungs, and mitral
regurgitation was found to exist. He looked well, but
complained of shortness of breath on exertion. The pulse
was large, rather tense, perfectly regular at 72 beats a
minute, except that from time to time the rate was
36, which was found to be due to the fact that while
this continued the beats of the heart were in couples, one
only of which reached the wrist. The apex beat was well
defined and forcible, and near the normal situation. A long,
smooth, high-pitched, musical murmur was heard at and to
the left of the apex and in the back; another murmur of
lower pitch was audible along the right edge of the upper
part of the sternum up to the sterno-clavicular articulation;

}*< ; ^—J

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V sj

excitement produced by the application of the sphygmo-
graph the rhythm gradually became normal—not suddenly,
as is usual.

Another case has recently come under my notice in a
gentleman aged sixty-three, who consulted me on account
of faintness and flatulence. He had been nervous about his
heart for thirty years or more, and had been afraid of
exercise. He had neither overwork nor anxiety; but some
months before he consulted me he had had a fall from his
horse and had broken his collar-bone, since which he had
not ridden. The pulse wa9 at first 103, and regular, but from
agitation, or from the effort of taking off his coat, it fell to
5 4, the number of heart beats being exactly double, a strong
and weak beat being coupled together with sounds belong¬
ing predominantly to the left and right ventricle respec¬
tively. This continued to the end of the interview, and a
tracing of it is here given. (Chart 4.) I have learnt sub¬

sequently from his regular medical attendant that this
rhythm has been observed from time to time for years. In
none of these cases had epileptiform or syncopal attacks been
known to occur.

Still more recently I have seen with Mr. Stanley Smith an
example—the only one I have met with, except, as I have |
said before, in mitral stenosis, in which the bigeminal pulse ‘
had followed the drooped beat. An old lady, aged seventy- j
seven, had been to Olympia on Feb. lltli. She was ailing •.
on the 12th and 13th, and prostrate on the 14th, complaining (
of oppression iu the chest and respiratory distress. She

Thb LANcbt\]

DRj IF.'H. BROADBBNT ON THE PULSE.

[Apbu.2, 1887. 861

vu found to have a pula© of only 05 to 40, instead of 76,
and the double heart beat. She improved under stimulant
treatment, and when 1 saw her on the 17th had a puWe of
60 in coupled beats, which were about equal in streogth and
volume, and followed eaoh other rather quickly, the pause
being long enough 1 for two more beats at the same rate.
The rhythm was that of common time in music— 1, 2, 3, 4;
1 and 2 being beats, and 3 and 4 silent. No cardiac impulse
could be felt, but the beats, as followed by means of the
sounds, had the same rhythm as the pulse, and there was a
systolic mitral murmur with each. A doubtful abortive
systole seemed to be audible at times.

A single instance of the pulsus trigeminus may be
given. The patient, a needlewoman, aged forty-one, em¬
ployed in Si. Mary’s Hospital, had been in better circum¬
stances before taking this situation, and aftsr fifteen months
in it was set to do Laundry work. Lifting and carrying
heavy baskets caused blood to well up into her mouth, bur,
in spite of this and of feeling weak and languid, she per¬
sisted without complaining for a fortnight, when she was
sent into the wand on Sept. Mth, 1880. She looked languid,
and had from time to time sharp pain in the cardiac region.
The pulse was trigeminal, with two distinct and similar
beats, and then an intermission, the thiTd beat, however,
being very faintly indicated by the. sphygtnograph. On
- auscultation of the heart, which was of normal size, a triple
rhythm was observed; the first beat gave perfectly normal
hounds; the second a good.first sound, but a reduplicated
rfcoond sound at the base; the third beat hsd no 6econd sound
Ut all, anl the first was rather precipitate. A cardiogram
taken afe well as the epbygmogram by my clerk, Mr. S. A.
Ttaey, shows the rhythm of the heart. (Chart 5.) As the

yots floP.rt^J v/oi vis v

t A rti ent gained strength- the cycle was extended to four
';ffilnd five neats whNe/in-bedy but reverted to the trigeminal
7 *tvpe when she began;be walk about, and it bad this
isdnraoter when she returned'to her duties as needlewoman,
.tooilt eeeme to me that the cases cited invalidate Tripier’s
yxmclurion that the peculiar modification of the cardiac
-thythru, in which every other beat is dropped, is always
associated with and due to epilepsy, and usually of very
serious import; noroan 1 accept tne other conclusion that
a slow pulse with epileptiform attacks is always due to
-dropping of alternate beats. The decision is of importance,
rimee Upon it turns the question of whether, as Tripier
-^believes; it is the epilepsy which affects the cardiac rhythm,

- or whether, as 1 think, it is- the slowing of the circulation
which causes the Convulsions. Before entering upon any

- discussion on the subject, however, I may bring evidence to
showtbat there maybe aslow pulse with syncopal or epileptic
form attacks which is not due to . abortive heart beats. I

Hfaave myself seen a case of fatty degeneration of the heart
Wttended with syncopal attacks, which soon after proved
-(fatalsuddenly, in which the pulse was infrequent without
‘■•ny interposed feeble heart beats being detected on careful
Lactamination. The patient, however, was seen only once in
luoonsultation. Tbe notes of u hospital case, with numerous
ofesbiiigs Which i ttanlt would have i corroborated. this, are
W hBf orti mately missing;- ’ -i
'^-JSln Thb Lanckt for 1885 (p. 288) cases of slow pulse with
ftfyidptio betturSs are related byMnjiY8t. George Mivart and
wjftf A. T, Gibb*ngt». Mri'-Mlrert'*'patient, was a man aged
©dtxty-one, who bad been subject to rapid and violent palpita-
of the heart. His first fit was six years before he came
(Iminlflr Mr. Mivaft.’s-care, iod this and most subsequent ones
* Same on while he was stooping*. His pulse rate was 24, and
others isno record either of interposed weak beats or of abor-
4ittve systoles. In Dr. Gibbngo’ esse the pitisnt, aged sixty -

- (five, had for some time had anuatermiiteutipulse of about 60.
fmPter sa attack of bronchitis;ho suffered from dyspnoea and
(tfhintnaea, and the poise Was.found to bv ouly 44. Still later
imm became subject to frequent epileptiform attacks, and
k*h« pulse dMd now fatten so 22, but was full and regular,
-mftare bunts corresponding -in -tinm»: It is noteworthy that
1 fihesptkfrtllcrBS attacks would come on when the patient

sat up. The pulse continued to fall, and it reached 12 or 13
the attacks being now so frequent that he went out of one into
another. The urine also became albuminous. With a sub¬
sequent return of tbe poise to 31 the albumen disappeared, and
he was so much better as to be able to do a little work. While
apparently better, he fainted at stool, and died. Nothing
abnormal was found either in the heart or in the nervous
centres. This patiant was seen by Sir Andrew Clark and the
late Dr. Moxon, and it is distinctly stated that the heart
sounds were normal. We may conclude,thersfo*e; that there
were no abortive beats. It is true that it is not expressly
stated that they were absent, bat in a case of each interest
they could not have been overlooked. •

The infrequent pulse of fatty heart may fairiy be attri¬
buted to the structural degeneration of the organ; but an
infrequent pulse, when the heart is sound, and especially if
it is due to the occurrence of alternate weak beats, can
scarcely be explained in any other way than by the inter¬
position of the nervous system. This does not bring us
much nearer a true comprehension of the phenomenon, and,
as I have already stated, I do not eccept the conclusion at
which Tripier has arrived, that it is an effect of epilepsy.
On the contrary, I look upon convulsive attacks, when they
occur in connexion with an infrequent pulse, as a result of
cerebral anaemia, produced exactly in the saine way as the
convulsions after great haemorrhage. In Mr. Mivsrt’s case
the convulsions came on when the patient stooped, in
Dr. Gibbings’ when he sat up, changes of attitude being
sufficient in the extremely feeble state of the circulation to
determine such an arrest of the blood-supply to the brain as
would give rise to an attack. The latfc Dr. Moxon, it will be
remembered, went so far as to suggest that the initial event
in common epilepsy was a stoppage of the heart. ■

Another question is suggested by some of the oases of
dropped heart beat. In almost all, while the aortic second
sound of the weaker beat which failB to reach the wrist is
absent, the pulmonary sound is audible. In many the im¬
pulse and first sound of the right side of the heart are more
distinct than those of the left, and occasionally there is such
a difference in the situation of the impulse and in the
character of the sounds as to suggest that the two sides of
the heart are beating alternately; there may even be a
mitral murmur with one beat, a tricuspid with the
other. The extreme case is met with only in mitral
stenosis under digitalis. Now, while it must be taken
as demonstrated that there is no such occurrence as
an alternating action of the two ventricles, it is cer¬
tain, from numerous observatio ns, th at in the beat which
does not raHe the aortic vsWHF'the "fitstde* W the
• right ventricle is often forcible, and the pulmonary second
sound is usually distinct. This last sign means, of course,
that blood has been thrown into the pulmonary artery and
not into the aorta, and as tbe amount of blood whiph passes
through the right and left heart in a given time Ort^st be
equal so long as the equilibrium between the pulmonary and
systemic circulation is maintained, tbe propalsion of blood
from the right ventricle only must be supplementary. In
mitral Stenosis it is easy to understand'that such an extra
Contraction of the right ventricle might be useful in main¬
taining the pressure in the pulmonary circulation which is
necessary in order to force the blood through the constricted
orifice; or, regarding it in another aspect, the abortive con¬
traction of the left ventricle is due to its being inadequately
filled during one diastole so that a second is needed. No
such necessity, however, is apparent when both valves and
walls of the heart are normal.

Intermittent and irregular tntlee .-^With regard to the
intermittent and irregular pulse 1 have nothing to say which
will not be familiar to all my hearers. Intermission, occa¬
sional or habitual, of the pulse is compatible with health
and vigour up to extreme old age, and, in the absence of
symptoms, may practically be disregarded. The inter¬
mission of the pulse is associated with a hurried and im¬
perfect beat of tbe heart, of which the first sound is some¬
times sharp and following immediately upon the second of
the preceding normal beat, at other times it is weak. A
weak pulmonary second sound is usually audible. An inter¬
mittent pulse may, however, be among the signs of fatty
degeneration of the heart, but it will not stand alone. In
case of doubt the patient should be made to walk briskly
for a minute or two, when the really wvak beart will falter,
while if the heart is healthy the intermission will usually
disappear; it will often disappear also during tbe adminis-
i tration of chloroform. 4

jyGoOgl

1062 ThbLuccbt,]

DR. W. H. BROADBENT ON THE PUIBE.

[April 2,1887.

; I Marked irregularity of pulse is most frequently met with
oinj mitral regurgitations; next in dilatation of one or both
-djentricles; hut it occurs independently of any disease of

- the heart. The fact: that it is bo cbmmonly associated with
■ -incompetence of:the mitral valve, while it is rarely observed

in other forms of: valvular disease, except when the heart is
failing, seems to indicate a mechanical rather than a nervous

• origin Of the distuned rhythm in mitral regurgitation, and
it appears to me to be related with the varying pressure

! upon the heart in respiration. When the mitral valve is
incompetent, and the blood can pass back into the auricle
, as well as forwards into the aorta, the proportion which is
driven in one or other direction will be determined by the

• comparative degree of resistance. Now the dilated left
auricle will be supported by a certain amount of pressure
during expiration, which will tend to resist distension by

- the regurgitant blood; but at the end of expiration the con-

- ditions are suddenly reversed, and it will be exposed to the

• negative pressure or suction action which tills the chest
, with air, so that the reflux is favoured. The sum total of

• the resistance to the ventricular systole is thus diminished
. at this moment, and,- the systole is consequently very

rapid, at the same time that less of the blood goes forward
into the aorta. Atuthe end of inspiration opposite forces
' come into play, and the repetition every two or three
t >eats of these disturbing influences quite accounts for the
r irregularity of the hearts action, lu an early stage the
irregularity can tie seen to occur coincidentally with the
< end of inspiration and expiration. Ic is the incompetence of
. the mitral valve which exposes the ventricle to the respi¬
ratory pressure mriAtions: but when, from any affection of
roe lungs, such as bronchitis and emphysema,.the difference
etweeu the pressure on inspiration and expiration is greatly
augmented, we find the action of the heart disturbed in like
manner, and careful watching will show that the chief irre-

• gularities coincide with the reversal of the action of the

• chest.

Irregularity of pulse of nervous origin is illustrated by
the disturbance of the cardiac rhythm in dyspepsia and by
tobacco; but it may be present in an extreme degree inde¬
pendently of any recognisable influence, und may be habitual.
There need be no affection of tbe general health or impair¬
ment of vigour or endurance. Iu one of the worst cases I
have ever seen, the patient, who was for some time under
my observation, was, long after the age of sixty, in the
habit of addressing public meetings. The trace exhibited

- (Chart (5) was taken recently upon a gentleman, now aged

I seventy, who consulted me twenty years ago ou account of
ii irregular action of the heart, and has had it ever since. 1
. am unable to fix any prognostic value on irregularity' of the
pulse as such; and when it occurs in connexion with dilbta-
i tion of the heart, the prognosis is determined by other con¬
siderations.

I now proceed to the consideration of variations of tension,
and I shall first speak briefly of low .tension.

■ Tension in the pulse, as lias been already stated in the

- first lecture, depends primarily on the freedom of the flow
through the capillary network; and it is low when the
capillorien and arterioles are relaxed, allowing the blood to

■ pass readily. As the capacity of the arterial system increases
towards the periphery, the branches at each division being
collectively larger than the trunk from which they spring,
and as tbe capillary channels are larger still, it is conceivable
that tbe blood might escape as fast as it could be injected

- by the heart. .The actual realisation of this possibility is
-incompatible with life, as the.functional activity of the

nerve centres is dependant upon a continuous flow of blood

- through them, and under the circumstances supposed it
would be intermittent. The resistance, however, in the
arterioles and capillaries may be so slight that the blood has
still a pulsatile movement when.it reaches the veins.i Such
venous pulsation in the veins of the back of the hand can

- often be demonstrated in aortic regurgitation, but here it is
• lot so much the diminished resistance in the capillaries as

- '/he exaggeration of the pulsatile variations of press oxaiu
the arteries which brings it about. XnoAierbo^ee

in the veins, however, the capillaries must be relaxed by
putting the hand in hot water, or there must be pyrexial
relaxation of the peripheral vessels, which often renders it
very evident. Occasionally venous pulsation is met with
when there is no heart disease, or any other cause than
abolition of the normal resistance in tbe capillaries. I
witnessed it in a gentleman who was gradually sinking
from the effects of alcohol without any of the usual alcoholic
disease of the liver and kidneys, lie took less and less food,
and came to live on alcohol, and finally had slight pyrexia
and occasional attacks of haemoptysis. The arteries were
large, thin, and soft; and for some time pulsation in the
veins of the dorsum of the hand could be rendered visible
at any time by dropping the wrist so as to allow the veins
to fill.

The characteristic mark of low tension iu the pulse is the
complete subsidence of all blood-pressure in the artery
between the beats. It therefore allows itself to bo flattened
under the finger in the intervals of the pulsation, and thi9
causes the impact of the pulsation to appear sudden.
Further, as we have seen, it must be short. Variations ore
observed occording to the size of the artery and the action
of the heart. The artery must be relaxed. When the
artery is large and the heart is acting forcibly, we shall
have a large, short, strong pulse—the full and bounding
pulse of old writers; and dicrotism will usually be con¬
spicuous. When, with a large relaxed artery, the heart is
weak, the pulse will be large, short, and weak, still with
dicrotism. We cannot have a contracted artery and powerful
heart’s action with low tension. A feebly acting heart and
small artery—the artery being small simply from want of
distending "force will give the small, short, weak pulse
described as thready; and the absence of a distinct wave of
pressure gives it an undulatory character.*

One of tiie most constant effects of pyrexia is to relax the
arterioles, and the pulse characteristic of all forma of fever
is one of low tension. The pulses above given are, in effect,
if also frequent, the pulse of pyrexia in different forms and
stages. On these, consequently, I do not dwell. A low-
tension pulse in the absence of pyrexia, unless it is a
physiological.peculiarity of the individual (and it maybe
remarked, in passing, that a pulse of a very low tension may
run in families) is indicative of debility. It may go so tar
as to suggest the existence of fatty degeneration of the
heart, except that the pulse of cardiac weakness is usually
frequent, while that of fatty decay is more commonly under
the average rate. The heart sounds also are weak and short.
The symptoms associated with a pulse of low tension are
extremely varied, and they are for the most part not the
result of the weak pulse, but concomitant effects of a
common cause. Many of them are equally common when
the pulse tension is high, and the question is not what
symptoms arise out of low or high pressure in the arteries,
but, given certain symptoms, what is the state of arterial
tension, since this will be an important guide in the treat¬
ment. When the tension is low, purgatives are badly borne,
and mercurial aperients give rise to great depression.
Sometimes, indeed, the subjects of low arterial tension feel
much better when the bowels are constipated, and exhausted
after each action. There are no doubt cases in which the
chief cause of deficient pressure in the arteries is want of
functional vigour in the heart, and it would be of service to
be able to distinguish such cases from those in which the
primary cause is absence of resistance in the arteries and
capillaries, but this is not easy. A low state of arterial
tension is not in itself a source of injury to the heart or
vessels. It has an important bearing on affections of the
nervous system; but questions relating to this are reserved
for the third lecture. .n,;*t6|4

High tension.-*- The cause is obstruction to the free flow of
blood through the minute arterioles and capillaries to the
veins. There is some difference of opinion whether the
exact seat of this obstruction is in tbe arterioles:or capil¬
laries. It is probably not in all cases the same. In high
arterial tension of purely nervous origin—as, for example, in
hysteria, in cerebral and spinal disease, in rigor and the cold
stage of fever -there can scarcely be any question that the
cause is tightening up of the minute arterioles; but in ten¬
sion of blood origin—as in renal disease, gout, and allied
conditions—it seems to me that the primary obstruction is in
the capillaries, contraction of the arterioles being no doubt
associated with this, but secondary to it, either by way of
continuity, or as a defensive counteraction against the dis-
l tending internal pressure set up by the.obetacle beyond. 1

ThbLxxcw,]

m W. HL BKOADBSNT ON THE PUJWE.

[Apau. 2,1887. >663

may briefly enumerate-tome of- the reasons which have led
me to this conclusion. The most important are derived from
an examination oi the minute arterioles in the brain after
-death resulting from contracted granular disease of the
kidney. Whan there have been uraemic convulsions, capil¬
lary hemorrhages are almost always present in various pacts
of the cortex, so much so that our late distinguished col¬
league, Dr. Mahomed, attributed the 1 convulsion to
capillary rupture. If the capillaries were protected by
con traction of the arterioles, such rupture could'scarcely
occur. Again, these arterioles am thanueltes. at cer¬
tain points dilated into miliary aneurysms, and liable
to rupture, not where they are given off from Urge?
branches, but tost whan they break up into the capillary
network, which shows the<obstruction to have been:beyond,
and not in, the arteriole*; while not only are the pteri vascular
spaces round them large, as if- from distension, but a ring of
the surrounding brain substance is pale; as if from pressure.
Another reason is that although the medium-sised arteries
<«oeh as the radial): and the small arteries (such as the
digital) are usually contracted and small in high tension;
tins is not always the ease, and it seams, improbable that

-in...vessels anatomically coatianous >and physiologically
•correlated there should be contraction' in the minute
arterioles without a corresponding condition of the arteries
leading to them. In farther support of this view I may
•cite the important experiments of Drs. Ringer and Bainsbury
on the action of the digitalis group Of remedies (Med. Chir.
Trans., vol. Ixvii,). It is there shown that when all reflex
■contraction of the arterioles is rendered impossible by
destruction of the brain and spinal cord, digitalis and other
substances having similar properties give rise to marked
diminution of the flow through the arterio-capillary
channels. The action is thus proved to be direct upon the
contractile structures of the capillaries and arteries, and not
indirect through the vaso-motor nerves.

I must, at the risk of tedious repetition, again describe the
high-tension pulse. Its distinguishing characteristic is that
the artery is full between the beats. Bo full is it that it can
be rolled under the finger as if it were a tendon, and followed
■like a solid cord some distance up the forearm; and, when

. the tension is well marked, no pulsation may be felt while
this is being done, unless decided pressure is made by the
ringers. Above the wrist, when the artery rests upon the
muscles of the forearm and not on the radius, it may be dif¬
ficult .to detect pulsation. Not unfrequently, especially
when the skin is thin, the artery can be seen to form a dis¬
tinct projection, but no pulsation is visible in it, unless it is
thrown into a curve, when this will be seen to be accentu¬
ated at each best. The artery is usually small from con¬
traction of its muscular ooats, unless it has been dilated by
protracted distension, when it may have much beyond the
average diameter. When pressure is applied in order to

' bring out the character of the beat, in is found that this does
not strike the finger sharply, but rathez^lifts it powerfully;
fit persists for an appreciable time, and then gradually sub¬
sides with little or no dicrotic echo. It is the long pulse,
'“pulsus tardus.” The size of the vessel will make some dif¬
ference in respect of ah these points; the distinctive features
are best marked when it is small; when it is large, both the
incideuoB and the subsidence of the pressure will seem to be
more abrupt; especially if tbe artery is thoroughly flattened
by the Angers. With moderate compression the beat feels
less sudden, and has tbe gradual rise, sustained duration, and
elow decline which is ohanotaristic of high tension. Another

- •chancier of the high-tension pulse comes out whes its

- strength or force is tested by attempting to arrest the beat.
While the fingers rest lightly on the vessel, little pulsation
■is felt; but Ob pressure is employed, the more forcible does
it seem to be; and when the artery is greatly contracted, it
is really difficult to extinguish the wave.

While tbe prime cause of high tension in the pulse is
obstruction in the peripheral circulation, the actual pressure
in the arteries is maintained by the heart. Usually the
increased difficulty in driving on the blood is met and
•counteracted by increase of the contractile energy of the
heart ; but it is clearly possible that while there ie obstruc¬
tion inthe arterioles and capillaries the heart may not rise
to the occasion. We shall then have, in feeling the pulse,
an artery full between the beats and capable ofbeing rolled
uodek the finger, while at the same time it is compressible.

• dfhisie. in fact, very common, and we require a term which
may be applied W such a condition. I have been-in the

• fcpttftafi speaking!rif .itijadpvfrtdali tOUalon.'i Now* ae the-

artery allows itself to be flattened, the pulse wave which
lifts it into the cylindrical form appears to be sudden, and
the pressure, after lasting a certain time, seems V° drop
suddenly. The artery may be small or large, and the pulse
varies accordingly.

We meet with the oonditione which give rise to virtual
tension at the two extremes of kidney disease. At the
outset of acute renal dropsy, while there is obstruction in
.the arterioles and capillaries, the heart is rendered weak by
*the pyrexia and. low diet, and there is more or less tendency
to it throughout the attack. Again, aa the heart becomes
worn out in the oourse of chronic granular disease of the
kidney, it ceases to be oapahle of maintaining the high
tension which is characteristic of this disease, and virtual
tension takes its place, it is at this period that reduplica¬
tion of the first sound is so well marked. The same course
of events is observed after protracted high tension from
whatever Qanse; and as this is tbe origin of dilated left
ventriole, the pulse of virtual tension, in its beet marked
form, cornea to be tbe characteristic pulse of dilatation of
the heart. At tbe same time that it ie expanding the left
ventriole, the continued obstruction in the artenoles and
capillaries ia overcoming the oontraotile power of the
medium-sized arteries, the lumen of which becomes
enlarged, while their ooats are thickened.

Tbe causes of high tension are now spgenerally recognised
that I shall do little more than enumerate them. They are
as follows1. Hereditary. This is illustrated not only by
the every-day experience that paralysis and heart disease
run in families irrespective of the habits and mode of life of
different members, which may differ greatly, but by the fact
that high pulse tension and functional derangements arising
out of it may be present in childhood and all through life in
every member and in successive generations of many families.
2. Kidney disease of all kinds, except such as is attended
with suppuration; but the most marked tension is met with
in the contracted granular kidney. 3. Gout and allied con¬
ditions, including almost the entire range pf affections
attributed by Murchison to functional derangement of the
liver. 4. Lead-poisoning, with or without renal disease or
i gout. 5. Anaemia. It is not easy to understand how anaemia
can give rise to high tension in the pulse. Oue would have
expected the watery blood to pas* readily through the
capillaries and the-vis a tergo applied by the heart to be
deficient, but it is a matter of daily observation that the
artery is full between the beats, and that the pulse, if more
abrupt than-in-renal disease, is long. Ithae been conjectured
that the defective oxygen-carrying power of. the corpuscles
may cause oxidation to be imperfect, and so-lead to the
formation of substances which ere not readily eliminated,
and which provoke resistance in the arterioles and capil¬
laries; but the instability of the tension is suggestive of the
intervention of nervous influences, and there are other
peculiarities which lend support to the hypothesis that the
arterial contraction and powerful heart action may be vaso¬
motor phenomena. However this may be, there are rare
and exceptional cases of amentia with extremely low tension,
and it has been an object of attention with me to make out
whether any constant difference of another kind attends this
difference in the state of the circulation. In particular, it
seemed probable that there might be some influence on the
production of hemic murmurs which might throw light on
their causation, especially from the point of view of Morey’s
theory, which refers all cardiac murmurs to low pressure
beyond tbe point at which the vibration is ret up. Up to
the present, however, I have been unable to reeegnire any
distinction between anemia with, high tension and anaemia
with low tension, except the difference in tbe ciroulatory
oonditione. 6. Pregnancy. 7. Constipation. 8. Plethora—
an overladen state of tbe entire vascular system. 9. Chronic
bronchitis and emphysema.

The effects of high tension upon the heart are easily
understood; tbe high blood-pressure in the arterial system
calls for increased contractile energy on the part of the
ventricle, in order that it may overcome the pressure and
carry its contents into the aorta. If the resistance with
which the heart has to contend is augmented gradually, it
will respond by hypertrophy; if, however, the increase in
the resistance is sudden, the heart will; be unable to com¬
plete its systole and expel the whole of its contained blood.
Dilatation is then the result, and it will take place all the
more readily if the nutrition of the heart is ipterfered with.
Dilatation of the left ventricle may result from higharterial
tenrion at almost **>' period- of. life, and. ie met with finder

; 064 Tuis hkwixi,) DR. W. H. BROADBENT ON THE PULSE.

[Apkji 2,1887.

a great variety of circumstances. It is very common in
anasmic pirls, and is frequently attended with mitral
regurgitation, which is curable, as has been well shown by
Dr. George Balfour. Some contributory exciting cause will
be traceable. I have known it to be due in several instances
to hunting, in others to lawn-tennis, in others to much
walking up-hill. In one case recovery only took place when
the family of the patient left a house in an elevated situa¬
tion which made every walk terminate in a climb. While
curable if taken in time, the dilatation of amemia oftefi
establishes permanent heart disease. Acute dilatation, which
is of far more frequent occurrence than has been supposed,
has for its predisposing cause peripheral resistance in the
circulation and high pressure in the arteries. It may take
place in the course of acute disease, or as a sequel, if the
pyrexia has not neutralised the habitual tension by relaxing
the arterioles. It may, again, be produced either by too
violent or by too protracted exertion, and this at almost any
time of life at which high tension is common. The gradual
dilatation which occurs with varying degrees of antecedent
hypertrophy in chronic gout or renal disease, or as a result
of chronic resistance to the circulation, from whatever
cause, need only be mentioned. Valvular changes, mitral
and aortic, and the dilatation of the aorta, are also so
familiarly referred to high tension that they require no
further notice, and the same may be said of cerebral
h.'emorrhage.

One word may be permitted on the injurious effects of
peripheral resistance in aortic or mitral regurgitation. In
both these valvular lesions high tension, or rather the ten¬
dency to this condition, is disguised by the effects of the
regurgitation, and is liable to be overlooked. Actual tension,
as manifested by sustained fulness of the artery between
the beats, is indeed impossible in aortic regurgitntion,
since the fulcrum is wanting, and it is not easily recognised
m mitral regurgitation. The subjects of such lesions, how¬
ever, may be gouty or may have renal disease, and the peri¬
pheral resistance incident to these affections will not be
suspended. The injurious tendency of this resistance will
be manifest at once. The greater the force required to drive
the blood through the capillaries, the greater will be the
force with which it will be driven back through a leak in
the mitral valve, and the more powerful the dilating effect
on the left ventricle when the protection of the aortic valve
is lost. The prognostic bearing of such an influence in the
early stages of these valvular diseases makes it important
that it should be recognised, especially in the young, when
treatment may do much to avert the evil consequences. In
aortic insufficiency an idea may be obtained by careful exa¬
mination of the pulse when the hand is well below the level
of the shoulder and of the heart; it should not hang down,
as it is then difficult to distinguish between the persistent
fulness due to the weight of the column of blood and that
due to the obstruction in the capillaries. In mitral regur¬
gitation it will be sufficient to bear the question in mind,
and to examine the pulse in different positions of the hand.
Information may also be obtained from an examination of
the pulse of other members of the family.

In connexion with the subject of renal disease and gout
and high pulse tension, I must find an opportunity for
calling attention to the fact that cases are met with in which
the tension is altogether absent, and this not because the
heart is weak or failing, but because there is even less than
the normal resistance in the arterioles and capillaries. The
urognosis when such is the case is extremely unfavourable,
it is in connexion with the chronic, large, white kidney that
we most commonly see a weak, soft, low-tension pulse with
albuminuria. The amount of albumen is often very great;
it varies from day to day, often without traceable cause,
but often, again, it is increased by exertion or mental de¬
pression, or constipation, and it is usually greater at night
than in the morning. Any development of tension in the
pulse is attended with diminution of the albumen. The
patient may not have the least appearance of kidney
disease, and dropsy may be entirely absent. Tension, again,
may fail to supervene in acute albuminuria, and when such
is the case, a fatal result is, according to my experience,
al way's to be expected. I have come, indeed, to take the
development of high arterial tension as one of the chief
guides in prognosticating the course and issue of this
affection; if it makes its appearance early, and becomes
well marked, the prognosis is favourable; there appears to
be an increased liability to anemic convulsions, but the
patients bear the treatment required by r*»*s and other com¬

plications, and usually recover. If the tension is Blowly
developed, and especially if it is fitful and inconstant, the
recovery is slow and uncertain, while, as has been said
before, if the pnlse remains soft, short, and weak through¬
out, the prognosis is bad. Dropsy is usually considerable,
and there is often an unusual amount of blood in the urine,
as well as casts.

In contracted granular disease of the kidney absence of
tension is very rare, and I have no record of a well-marked
instance in which the diagnosis has been verified post
mortem. In the following case I had no doubt as to the
nature of the case during life. The patient, aged about
fifty-five, was under my observation from time to time from
June, 1880, up to his death in September, 1881. He had suf¬
fered from gout and eczema, and when I first saw him
albumen had just been discovered in his urine, which had a
specific gravity of 1011. He had always lived freely, and
could not be prevented from taking a considerable amount
of whisky. His eczema was removed and his gout relieved,
and he usually looked and felt well; the quantity of urine
was not far from normal, and the specific gravity usually
varied from 1017 to 1021, while a mere trace of albumen was
present; and it was only the knowledge that he had albu¬
minuria which induced him to present himself. He was well
nourished, had a good colour, and a largish, soft, short pulse ;
there was no evidence of degeneration in the walls of the
vessels, nor any change in the heart. When the shooting
began in September, 1881, he went out as usual, but was more
easily tired, and took extra whisky to enable him to go on.
On the 14th and 15th he said queer things at dinner. On the
15th Mr. Martin, of Crawley, saw him, and found him languid
and sleepy. After a jalap powder he was better, but in the
night of the 17th he was seized with violent convulsions.
I saw him with Mr. Martin at 1 p.m. on the 18th, when he
was lying on his left side, the left side of his face boring
into the pillow, his eyes directed violently to the left, the
left arm bent across the chest, with the hand up at the
right shoulder.pulling violently at the night-shirt, which was
torn. He was smacking his lips loudly. These movement*
came on in paroxysms, bat with such short intervals as to
be almost continuous. The left leg wa9 very little affected.
Sen«ation was very greatly impaired in both arm and leg,
and might be said to be lost, lie was conscious and intelli¬
gent, and in the intervals between the paroxysms could
direct his eyes to the right, and could give either hand.
The convulsions continued, except when he slept, and in
the course of the 19th deglutition failed, the breathing
becoming deep and loud, and death by coma supervened. I
have entered into these particulars to show that the con¬
vulsions were not of the ordinary urtcmic character. They
were clearly due to cortical irritation, but no post-mortem
examination could be obtained. The case is quoted to
illustrate the position that absence of arterial tension, where
such tension is a part of the disease, is not a favourable
sign. The patient had not the look of kidney disease; he
was well nourished, and had a good colour; the heart pave
no evidence of disease, and the arteries were soft and flexible ;
the high tension which predisposes to rupture of cerebral
arteries was absent; there was nothing, in fact, suggestive
of impending danger.

Functional cffecte .—Without recognisable organic change
in the heart or arteries, or where the subsequent history
shows that such changes as were present were not of them¬
selves the cause, high tension may give rise to the most
severe angina pectoris. High tension, again, may produce
effects in the way of breathlessness and sudden powerless¬
ness which simulate the effects of the most advanced heart-
disease. Intermittent functional albuminuria, when not
traceable to imperfect assimilation of food, is, so far as
it has come under my observation, associated with high
pulse tension, and is most readily amenable to treatment
which reduces arterial pressure; and the cases of this affec¬
tion, described by Dr. Clement Dukes of Rugby, and shown
in his admirable papers on the subject to be common among
boys and adolescents, appear to belong to the same class as
mine. When this liability to the appearance of albumen in
the urine on exertion or slight exposure is met with in
children, I have always found a strongly neurotic family
history, as well as hereditary high pulse tension. When it
does not come on till the approacn of adolescence, there
may be no family neurosis, but I have never failed to re¬
cognise tension, and to trace its effects in other members of
the family.

Treatment. —Although high arterial tension is fraught

666 The LAScar,)

MR. R. J. GODLEE: SURGICAL TREATMENT OF PULMONARY CAVITIES. [Aiyn, 2, 1867.

from regularity in the collapsing pulse is ominouswhen
this takes place, it is due at tirst to an occasional faltering
beat, and it rarely reaches any considerable degree.

Mitral regurgitation .-The irregular pulse of mitral
incompetence has already been alluded to. U is by
no means constantly met with when a mitral regur
citant murmur is audible; and while it indicates, when
present, decided impairment of the function^ efficiency
of the valves, with secondary effects arising out of this,

I am not prepared to assert that irregularity of pulse is
an absolutely necessary consequence oi even lar B*
gitation, nor does ic always indicate a dangerous failure ot

C °l^tr(d8tcno*is .—In mitral stenosis the pulse is regular,
Bmall and full between the beats. The contracted state of
the arteries is probably due to tne arterial system accom¬
modating itself to the restricted output of the ventricle.
The regularity of the pulse in this form of valvular affection
has been called in question, but, in the absence of associated
mitral regurgitation and of considerable secondary regur¬
gitation at the tricuspid, it is maintained up to a vary Jate
stage of the disease. When from pulmonary complications
or failiog adjustment regularity is lo » t > ^ he h Af|L d JIS"
tion is in strength of pulse, not in rhythm; then beats
fail to reach the wrist, and the pulse is irregular, while
the heart is acting regularly. Finally, the regularity
may defy description, and there is apparently no cor¬
respondence between the pulse and the heart and when
both are felt simultaneously, they might belong to a

^The pulse of hypertrophy of the heart is that of its cause,
and no P more need be said of it. The pulse of dilatation has
already been described under the head of v “f ual
number of sphygmograms from cases of dilatation of the
left ventricle are given, but they convey a very inadequate
idea of the characters of the pulse as recognised by the
finger. Scarcely even in aortic regurgitation can the state
of the heart be foretold from the pulse aore dehmtely
than in dilatation. The first trace (Chart t) is irom u

futures

ON THE

SURGICAL TREATMENT OF PULMONARY
CAVITIES.

Delivered at the Consumption Hospital, Brompton,

By RICKMAN J. GODLEE, M.S., F.R.C.S.,

SURGEON TO THE HOSPITAL AND TO UNIVERSITY COLLEGE HOSPITAL.

LECTURE 11.

Gentlkmen:,— Before proceeding to the discussion of the
nextclassof cases, andas an introduction to the subject, I wish
to offer a few remarks on the anatomy of the bronchi. One of
the best, if not quite the best, work upon the subject is that of
the late Dr. Aeby of Berne, 1 who deals with the arrangement
of these parts with almost more than German exactness. He
points out that what is known as the dichotomous branching,
of the bronchi does not really take place, but that the mam
bronchus passes through the organ as far as its lowest limit
in the contracted part between the diaphragm and the
spine (Fig. 3). The arrangement of the arteries and veins
to the bronchi is really symmetrical on the two sides—viz.*
the main branch of the pulmonary artery crosses the
principal bronchus at a perfectly definite point on the outer
side (Fig. 2, a a) in order to pass downwards behind it*
whilst the principal veins keep to the anterior aspect. The

Fio. 1.

case in which acute dilatation with hemoptysis had occurred
from over-exertion; a mitral systolic mnrtonr rem^ed;
the artery was not large. In the case from which the second
was taken (Chart 8) there were breathlessness, difficulty of

lying down, and enlargement of the liver, all of which were
relieved by treatment. The patient, whose pulse is repre¬
sented by the third, was liable to stagger and even fall on
rising from a semi-recumbent position, with momentary
loss of consciousness, and on slight exertion he would
suddenly lose all power. The artery was always full between
the beats, notwithstanding the appearance of the trace.
(Chart 9.) He improved under trsatment, could walk

1U i u h »jutiyi.
ft | U \n ilUl.vi MwlVylri JiA

i

Mj \)

Diagram illustrating subdivision of »
from the back. (After Aeby.) K B.

and v Its dorsal and ventral subdivisions. i>i pj.
Dorsal bvnaitvnal branches. v X v„ Ventral hYP-rterml
branches, dv, Accessory branches, pa, 1 ulmonary
artery, rv. Pulmonary vein.

1

eight miles, was more cheerful, and could lie on bis side;
the pulse gave the second trace. Later over-exertion aggra¬
vated the dilatation, and thrombosis of the left middle
cerebral artery occurred, the case ending fatally.

branches of the bronchial tree come off on.the doi sal onu
ventral sides, and are on the whole symmetrical, with these t
exceptions:—On the right side, one, the first lateral branch* d
comes off above the point where the artery crosses the mam l;
bronchus (Fig. 2, SB), and is hence called epartenal, as :
opposed to the others, which are called hyparterial. This g
, ,arterial bronchus goes to the upper lobe ot the right lung, 1
which thus is the additional element on this side; for the <
Jcond lateral branch o» the right side, which goes to the <>
middle lobe, corresponds to the ^ i

left ei'le. which goes to the upper lobe (Fig.,A Vi an<. i.
thus the right middle lobe corresponds to the left upper j

S-v^nSal and dorsal (Fig. 1). There are lour large»

» Dec Brouchinlbaum der SKugethiere und dfifl Mcusvhcn. U\p*gr j.

t

Tin Lancbt,] MB. R. J. OODLES: SURGICAL TREATMENT OF PULMONARY CAVITIES. [April 2,1887. 667

ventral bronchi, beyond the lowest of which the main stem
•ends in small irregular lateral branches. The dorsal branches
present no special features, except that they are small and
more deeply placed than the ventral. Accessory branches
are met with here and there which do not arise only from
the lateral aspects of the main stem. The first ot these
alone is of much interest: it is of large size, and from its

K 'tion is called by the Germans “ Herzbronchus,” or heart-
lchus (Fig. 2, H b). In the ourang-outang and the
■chimjianzee it resembles the corresponding structure in
man and in many of the lower animals it supplies a distinct
fourth or azygos lobe. In man the lateral bronchi, especially
the ventral ones, are so large that the appearance of dicho¬
tomous subdivision is closely simulated, the main trunk often
losing half of its previous calibre after giving off a lateral
branch. The accompanying figure shows diagratnmatically
the relation of the bronchus to the vessels and also the
typical arrangement of the lateral branches. (Fig. 1.) It will
be observed that while in the hypartenal region the dorsal
and ventral brandies come off separately, in the case of the
■eparterial bronchus they come off as one trunk. This scheme
■obviously only holds good in man for the right side. Fig. 2

Fro. 2.

ehowa the differences on the two sides, and illustrates the
■correspondence of the left upper with the right middle lobe.
The direction of the main bronchi is not straight, but
curved, the convexity corresponding apparently to the out¬
line of the heart. It is a simple C shape on the right side,
but on the left forms a distinctly Shaped curve, on
account of a very marked bend to the left above the origin
of the first lateral branch, which indeed causes an actual
concavity to the left at the commencement. The amount
of the divergence is not by any means constant, varying
with the condition of the heart, and being much less in
newly born infants than in adults. Generally another
curve is also present in the sagittal or antero-posterior
direction, the concavity of which is directed backwards.
Dr. Aeby made a number of observations to determine the
relative divergence of the two bronchi, and (as a fresh
illustration of the fact that even the science of anatomy is
often led astray by the traditions of antiuuity) he demon¬
strates clearly that the right bronchus follows much more
closely the line of the trachea than the left—in some cases,
indeed, approaching it very nearly. It is an observation
which I have frequently verified. This is an interesting
justification, so to speak, of the almost invariable rule that
foreign bodies find their way into the right and not into the
left bronchus. The error seems to have arisen partly
because in the ordinary method of preparation the natural
conditions are not maintained, and partly because the
higher position of the right lung naturally suggests u similar
condition of the corresponding bronchus. I imagine the
apparent shortening of the tube by the irregular origin of
the eparterial bronchus has also something to do with it.

I have mode some dissections, with the help of my friend

Mr. Charles Stonham, to show the exact position of the main
bronchi as they would be marked on the surface of the body.
The trachea lias been sometimes injected with plaster-of-
l’aris, sometimes not, and then, the body being turned on its
face on a board, long skewers have been passed in the spots
indicated by dots on the diagram (Fig. 3), some round the
edges of the subject; two on each side being driven
right through the body opposite the angles of the scapulas,
and two others at the vertebral borders of those bones oppo¬
site the spines. In this way a tracing of the body was easily
made. The soft parts were then turned aside, and the exact
outline of the thoracic walls was obtained. The ribs were
then partially removed, being cut close to the vertebra,
and also about half-way between the sternum and the spine.
The outline of the lungs was then taken, and lastly the
bronchi were dissected out in situ. The subjects have not
been very good, and t he results therefore not what one would
have wished, but they bring out one or two points of in¬
terest. In the first place, the figure shows (and we thought
this was perhaps a new point, but find that it is noticed as
long ago as the time of Cruveilhier) that the trachea tends
slightly to the right, and bifurcates a little to the right of

Ftg. 3.

Dissection to show the position of the main bronchi. The
vertelir.T and the ribs are marked by figures. The black
(lota indicate the poaition of the plus introduced to
mark the outline ot the liody e b, Eparterial
tfronchus. r v. Ventral branches, d d. Dorsal branches.

the middle line—a fact which makes the almost vertical
right bronchus very nearly an exact continuation of the
main stem ; in the next place, it shows that the bifurcation
is opposite or a little below the fourth dorsal spine—that is,
a very little below the position of the inner end of the spine
of the scapula; and, lastly, it indicates how very near the
middle line the main bronchus is in its descent. The exact
distance of the main bronchus from the surface we were
unable to measure, but on examining Braune'a plates it ap¬
pears to be at the bifurcation of the trachea rather over three
inches and a half; opposite the fifth spine rather under
three inches and a half; and opposite the seventh spine rat her
under three inches. These numbers are likely to be rather
below than above the estimate, as the subject from which
the plate was drawn was a small one, and had been flattened
from lying on the back.

The practical outcome of these anatomical facts is, I
think, not inconsiderable. 1. As regards foreign bodies. If
they are of any considerable size—such, for instance, as the
piece of mutton-bone or the tooth which I now show you—
it is probable that they will lodge somewhere in the main

Digitized by

668 The Lancet, J MR. R. J. GODLEB: SURGICAL TREATMENT OF PULMONARY CAVITIBS. [April 2,1087.

bronchus of the right side—that is, at a distance not greater
than three inches from the middle line. This may be a
piece o£ knowledge of great value in directing an instru¬
ment, such as a pair of forceps or a loop of silver wire, down
the bronchus with the object of fishing up the foreign body,
and it is clearly of importance if attempts are to be made
to extract it from behind. In a case to be mentioned later
on, we were always so far out in our investigations that our
chance of finding the foreign body, which was a tooth, was
absolutely nil. 2. As regards bronchiectases. They have
not, perhaps, a very direct bearing, because, though it will
be noticed that in the case of dilatation of the bronchi
following on the presence of foreign bodies the main trunks
are generally involved, still, both in these cases and in
others, smaller peripheral bronchi often serve as the starting-
points for excavations of considerable size. 3. As to the
development of phthisical cavities one can at present
only speculate. It is doubtful, to begin with, whether the
right apex really suffers more or less than the left. But the
suggestion that it does, and the fact that it certainly appears
to differ from other parts of the lung in its liability to gan¬
grene, suggest the possibility that its large vertical feeding
bronchus may possibly prevent the accumulation of septic
secretions in it. Again, the question arises whether the lobe is
a sort of remnant of what was once more fully developed,
and thus, like the wisdom teeth, less able to withstand the
attacks of irritation from without. 4. It will be remembered
that the arteries follow with great regularity the posterior
surface of the bronchi. Any attempt, therefore, to open i p
a main bronchus from behind, if dilated, will almost intal ibly
lead to t he division of the accompanying vessel; and that
the arteries are of very considerable size may be seen in a
preparation (such as one that was shown) made from the
lung of quite a small child.

The calibre of the trachea increases somewhat from
above downwards, and, on the whole, the capacity of
the bronchi is somewhat larger than that of the trachea.
The shape of the main bronchus is, as a rule, uniformly
cylindrical between the points of origin of the lateral
branches. An exception is met with in the case of the
left one, between its commencement and the origin of
tbe first lateral branch; for it almost always manifests a
decided diminution in calibre, although it regains its usual
size before the termination. The lateral bronchi, on the
other hand, have often marked dilatations at their points of
origin; so that it is difficult \o estimate their actual relative
sizes. The capacity of the whole bronchial system, indeed,
slightly increases as we pass downwards, the increment
being gradual, except in what may be called the eparterial
region, where there is an actual diminution in the gross
capacity, but not below the largest capacity of the trachea.*

One glance at comparative anatomy may be allowed
before leaving this subject. Again referring to Aeby’s book,
we find that in the lower animals the arrangement of
the bronchi with regard to the arteries is ■ liable to consider¬
able variation. Sometimes there is no eparterial bronchus
at all, but on both sides a similar arrangement is met with
to that in tbe left lung of man (e.g., in tbe porcupine).
Sometimes there is an eparterial bronchus on both sides, in
which case they may come off symmetrically (e.g,, in the
horse); or the right eparterial bronchus may come not from
the bronchus but from the trachea (e.g., in tbe-dolphin).
In another type, on the other hand, which seems to be the
commonest, there is an eparterial bronchus only upon the
right side, in which case it may be bronchial (e.g., in man)
or tracheal (e.g., in the sheep). It is probable that some
symmetrical form is the original type ; but whether with or
without the eparterial bronchus, and whether this was
tracheal or bronchial, we have not yet evidence enough to
say. It is remarkable, however, that, even if there be a left
eparMrial bronchus, it has never been observed to be tracheal.
The’ accompanying scheme and table will illustrate what
has been said. (Fig. 4.)

We have now to discuss the possibility of any surgical
treatment for a totally different kind of pulmonary cavity
from those Considered in the last lecture—if, indeed, the
term pulmonary cavity can be considered in any way
applicable. I mean bronchiectasis. It is in my expe-

*W. Branne and H. SUhel (Arohlv. t. Anatomle. Fab., 188 t—vidt
International Journal of tbe Medical Science*. July, 1886) throw doubt
on Aeby'a figures, saving that his method of filling the bronchi by
pouring In a fusible metal dilates the lower parts of the tubes more than
the upper. They ear that there It a slight contraction again at the
lower part of the trachea. •„«<,* ... ~

rienee a much less satisfactory condition to deal with. It
does not devolve upon me to say much about the causation
or pathology of bronchiectasis; a few pre'Quinary remarks
must, however, be made. Bronchiectasisoonsistsof a dilatation
of some part of the bronchial tree, and is at first nothing else,
though in some cases the occurrence of ulceration no doubt
causes an increase of the size of the oavity at the expense of
the surrounding pulmonary tissue. “ T wo principal forms of
bronchial dilatation,’’ says Ur. Theodore Williams,* “the
cylindrical and the globular, are found in the post-mortem
room; in each case the tertiary bronchi are dilated, so as to
measure as much as or even more in circumference than
the primary. In the cylindrical form the dilatation is more
general, the tubes being stretohed like the fingers of a

f ;love ; the walls are thickened, the submucous and mucous
ayers are hypertrophied, and stand out in folds. The
generally tubular form of the bronchi is owing, according to
Hamilton, 4 to the traction on their ends from an adherent
pleura. Iu the globular form the tubes are dilated at or
near their ends into pouches or ampulla of large size, the
adjacent dilated tubes often communicating freely with
each other, the mucous membrane appearing to form folds
or wrinkles in their interior, See.” Dr. Douglas Powell 5 Bays t
“ There are two forms of bronchiectasis, the cylindrical and
the sacculated. In cylindrical or fusiform bronchiectasis.

Fig. 4.

I. Eparterial bronchus on both sides.

1. Both bronchial—e.'g., horse.

2. Right .tracheal, left bronchial—e. g., dolphin.

II. Bparterial bronchus on the right side only.

1. Bronchial—e. g., man.

2. Tracheal—e.g.. sheep.

III. No eparterial bronchus—e.g., porcupine.

the dilatation involves some length of the tubes, varying
from a few inches to a system of tubes ramifying through
an entire lobe. The enlargement is uniform throughout the
length of the tubes affected. Iu sacculated bronchiectasis a
restricted portion of tbe tube is enlarged to a globular form,
from half an inch to an inch in diameter. The whole calibre
of the tube is as a rule involved, and the ectasia may be
solitary, or there may be many scattered through the lung.
As a role, this form of bronchiectasis is situated at tbe
peripheral portions of the lung corresponding with the
smaller bronchi, and small openings lead from the rounded
and apparently closed distal side of the sacs to fine tubes,
the brancWets of the widened bronchus.”

Here, then, in very similar words, are descriptions by two
physicians to this hospital of the state of things for which
the surgeon is asked to find a remedy; not, be it observed,
as in the cases which were before described— a single cavity
surrounded perhaps by much diseased lung tissue,—for here
the whole of the bronchial system, or a great part of it,
is to a greater or less extent involved, so that, even if one

* British Medical Journal, Peb. S0fch, 1881.

« The Pathology of Bronohltla. p. 8S.

5 On Diieuet of the Luags and Pleura third edition, p. 226.

by Google

The Lancet,] MR. R. J. GODLEE: SURGICAL TREATMENT OF PULMONARY CAVITIES. [Apbil 2,1887. 669

cavity considerably exceed the rest in size, it is, after all,
only part of a much larger and most tortuous space, and
most likely communicates round the corner, as it were, with
other dilatation^ 1 more or less exactly resembling itself.
Hence the difficulty, and hence the doubt whether surgery
can ever do much for thiB sad condition of things. It is
one, however, involving so much discomfort botn to tbe
patient and to all who come into contact with him, and
so much danger to life, that we should not be justified
in giving up the attempt to cure it. Our main objects,
then, in attempting to open a bronchiectatic cavity are:
(1) that the secretion from it may be prevented from
continuing the mischief in its passage over the bronchi, or
as it is drawn down into other parts of the luDg; (2) that
tbe cough may be .diminished, it being held that the
expiratory efforts have something to do with the production
of the dilatation; and (3) because it is well known that
though patients with this disorder may go on for a number
of years without succumbing to it, a very considerable
number become comparatively soon affected with some form
or other of blood poisoning. With these objects in view,
and notwithstanding the experience of the cases to be
described, 1 should feel disposed to recommend an operation
if the physician were to express a strong opinion that the
cavity was a single one, or at least that the mischief was
principally caused by one main cavity, and also in those
cases where it has arisen, as not uncommonly happens, from
the irritating presence of a foreign body in one of the
bronchi. In the latter case, it would be done in tbe hope,
though not a very sanguine one, of removing the foreign
body ; in the former, in the fear that, notwithstanding the
diagnosis of a single cavity, there would be found others in
the same lung, and not improbably in the other lung, which,
it may be, was supposed to be sound.

It has been pointed out that bronchiectasis may follow the
introduction of a foreign body into the air-passages, and of
this condition I am able to supply two examples. The iirst
case, however, was not one of simple bronchiectasis, and it
may be observed that this is not the invariable sequence of
such an accident. 1 reported a case which occurred to Dr.
Rudyard of Watford®, in which a piece of barley grass
which a child had placed in its mouth caused for some time
a troublesome spasmodic cough, but at last, being always
drawn forwards by its peculiar shape, worked its way
through the pulmonary tissue, through an intercostal space,
and ultimately pointed by its sharp extremity beneath the
skin in the back below the angle of the scapula. In this
connexion I must also mention the case of a young man
who inadvertently allowed a grain of bearded wheat to
enter his larynx, and who afterwards developed an abscess
in the neighbourhood of bis hyoid bone. The abscess was
taken for a strumous affection, and it was even contem¬
plated that he should give up his studies at Oxford, or at all
events consider himself a delicate individual. The free
opening of the abscess and the scraping out of the cavity
with a sharp spoon led to the removal of the foreign body
and a complete recovery.

I believe it is always wise not to put on one side a
patient’s account of the inspiration of a foreign body, if
anomalous chest symptoms are present; in my experience
one is more likely to be in error by doing so than by accept¬
ing the account, an<f it is possible, though perhaps not very
likely, that a careful search may lead to the removal of what
is certainly a very serious cause of mischief. In the case
to be recounted we paid but little attention to the history,
and accordingly did not arrive at a correct diagnosis.

W. H-, aged seventeen, was admitted under Dr. Powell

on May 11th, 1885. There was nothing in his family or pre¬
vious history to account for pulmonary disease, except that
he said that " some time previously ” he had swallowed a
piece of grass, which was followed by the spitting of a little
blood. In January, 1886, his present illness began with pain
in the right side and a bard dry cough with but little expec¬
toration, which did not prevent his followmg Its occupa¬
tion. He was an out-patient at the Westminster Hospital
for five weeks, after which he became worse, and remained
at home until tbe time of his admission. When be came
uader notice he had great pain in the right side, a trouble¬
some cough, and some expectoration tinged sometimes with
blood. The temperature was 99*4°, the pulse 114, and the
aspiration 17. The right side was flattened and motion-
less; dull bfelow the fifth interspace, an inch and a half

• Chutes! Society's Transaction*, vol. xv. v p. 16®.

below the nipple, in front; and dull below the scapula
behind. There was no vocal fremitus or resonance over the
dull area, and the breathing was weak, while above the dull
area there waa vesicular breathing with scattered rales.
The heart’s apex was in the fifth interspace, half an inch
outside the nipple. The left lung appeared to be healthy.
Between May 11th and June 4th things remained muoh in
tbe same condition : tbe temperature varied from 98 6° to
100° in the morning and 1U0° to 103° in tbe evening; the
expectoration, which was muco-purulent, varied from eight
to fourteen and sixteen ounces, while the physical signs
did not alter. On June 4th 1 made an incision in the
sixth interspace, and passed the finger into an irregular
cavity with* loose friable walls, extending upwards and
backwards, and containing a considerable quantity of
fetid sanguineous pus. The cavity was evidently in the
lung tissue, and not in the pleura. The wound was purified,
and dressed with oakum. On the 9th it was noted that he
had greatly improved since the operation, the temperature
remaining normal and tbe discharge becoming less in quantity
and lees offensive. HU appetite improved, but the expectora¬
tion, though much diminished, did not cease, and remained
muco-purulent, as was afterwards accounted for by tbe
dilated condition of the bronchi and the presence of the
foreign body. Between the 9th and the 16th the tempera¬
ture again became peaky, and the expectoration increased
in quantity, while some redness and tenderness appeared
about the wound. On the 16th Dr. Waugh, the resident
medical officer, enlarged tbe sinus and put a needle into the
swelling, extracting some sanious pus. There was no change
of consequence till July 2nd, when he first complained of
headache. The sputa remained the same in quantity (from
fourteen to sixteen ounces), and were very offensive. The
physical signs continued to be as on admission, but the
temperature was normal or subnormal. It was intended to
make a further investigation, a9 we clearly had not reached
the bottom of the trouble; but the headache, which varied
from day to day, proved to be the precursor of unmis¬
takable cerebral symptoms, and on July 7th the patient
died from what proved to be, as we had thought, an abscess
of the brain.

It is a remarkable fact, as has been pointed out by Dr.
Percy Kidd and others, that cases of pulmonary abscess seem
especially liable to be followed by cerebral abscess, to account
for which I do not see any obvious hypothesis; at present we
can only accept the occurrence as an apparent fact, and-must
wait for an explanation. At the post-mortem it was found
that there were scattered tough adhesions uniting the lower
lobe of the right lung to tbe chest wall, and that in this
lobe the lung tissue waa collapsed, airless, and somewhat
indurated. The external opening led to a Bpace within the
ribs which communicated upwards by means of a compara¬
tively narrow sinus with a cavity in the lower lobe, but
also by a track which led downwards between the diaphragm
and the ribs with another cavitv of small size between the
upper surface of the liver and the diaphragm, probably due
to burrowing of the pus before the abscess was opened.
(Vide Dr. Magrath’a case mentioned above, The Lancet,
p. 511.) All the air-passages of this side were reddened, and
there was some blood in tbe trachea. All tbe bronchi in the
lower lobe were dilated, and contained a thin reddish fluid;
in one of them was found a part of an ear of grass, with the
stalk upwards, lying loose in the cavity of the tube, which at
this point showed no change except a dark reddening of the
mucous membrane; a shortdistance below, however, there was
a patch of superficial ulceration, corresponding no doubt to a
previous lodgment of the foreign body. In the middle lobe
was a thin-walled cavity as large as a small egg, the
bronchus leading to which was only slightlv dilated. The
rest of the lung and the left lung were healthy. The cause
of death was a large abscess in the occipital lobe of the
brain, which had ruptured into the posterior cornu of the
lateral ventricle. There was no disease of ear, and no sign
of tubercle in the body.

What strikes one in looking at this lung is that the mis¬
chief is limited to the part below that at which the straw
lay. The changes, however, are just the same as we shall
find in the other cases of bronchiectasis. The lung is hard
and fibrous, and the bronchi have much thickening round
them, and are dilated into cavities. This muBt all have
been due to tbe secretion pent up behind the piece of straw.
The rest of the lung was practically healthy, and it thus
seems likely that if tbe foreign body had been discovered and
; removed the patient might have made 4 good recovery; but

670 The LAxcet,]

DR. T. J. M ACL AG AN ON PYREXIA AND HYPERPYREXIA.

[April 2,1887.

this discovery of a foreign body in the lung is by no means
easy, as the next case will show. The track between
the cavity and the external opening had closed very much,
and this tendency to close is, I think, common when sinuses
pass through lung tissue. 1 have seen a remarkable
example of it in a case of hydatid of the liver rupturing
through the lung, in which, at the post-mortem examina¬
tion, it was hardly possible to find the track by which
the contents of the cyst had been discharged.

(To be concluded).

PYREXIA AND HYPERPYREXIA.

By T. J. MACLAGAN, M.D., M.R.C.P.,

PHYSICIAN IN ORDINARY TO THKIR ROYAL HIGHNESSES PRINCB AND
PRINCESS CHRISTIAN OF SCHLE3WIO HOLSTEIN.

(Concluded from page OIU.)

Of the subjective phenomena of the febrile state none is
more prominent than thirst. To allay this there is con¬
sumed a much larger than usual quantity of water. So
great is the demand for water that each draught has but a
transient and temporary effect in allaying the thirst which
is consuming the sufferer. Very soon another is called for, and
another,and another; and thedemand continues so long as the
fever lasts. In this way thequantityof waterconsumedduring
a week of fever far exceeds the ordinary requirements of the
system. While this large quantity of water is being con¬
sumed, less than the normal amount is being eliminated,
and hence the phenomenon with which we are now dealing
is usually referred to as excessive retention of water. It is
obvious, however, that the enormous quantity of water
consumed during a febrile attack cannot be retained as
water; it is equally certain that is not eliminated, for all
the while the ordinary channels of water elimination are
less than usually active; the skin is dry and unperspiring,
the bowels are constipated, and the urine scanty. If neither
retained in the system as water nor eliminated, it must some¬
how be used up in it. Parkes suggested that during the
metamorphosis of the albuminous tissues there may be formed
a gelatinous compound intermediate between them and urea,
and possessingin virtue of its gelatinous nature a great attrac¬
tion for water. It is difficult to see how such an agency could
produce such a result, or how any retrograde compound could
attract water more powerfully than the tissues, which so
urgently require it. But granting that it could, there are
still insuperable obstacles m the way of our accepting this
explanation. In the first place, why should such a com¬
pound be formed in such excessive quantity? In the second
place, if the disintegrative changes of the nitrogenous tissues
thus stop short of the formation of urea, how comes in¬
creased elimination of urea to be a characteristic of the
vast majority of the cases in which this excessive re¬
tention of water occurs? No; the thirst of fever is
an* expression of a real want of water in the system;
it is a cry for more; and the coincident occurrence
of increased consumption and decreased elimination is
distinct evidence that the water which is drunk is somehow
used up in the system. But the normal ingredients and
tissues of the body require no such large supply, and are
incapable of utilising it. The only abnormal agency of
which we know is the contagium, and this, we know,
necessarily consumes a large quantity of water during its
growth and reproduction. In this consumption of water by
the contagium we have the explanation of the increased
demand for water, and of some of the usual symptoms of
fever. The thirst, the loss of appetite, the dry skin, and
the scanty urine result from the consumption by the con¬
tagium of the water, which Is requisite to enable the stomach,
the skin, the kidneys, and all the other organs to perform
their functions arignt; and so this phenomenon, the direct
and necessary result of the propagation of the con¬
tagium, becomes the immediate cause of many of the ordi¬
nary minor phenomena of an attack of fever, as well as of
some of the leading and essential ones.

Though the consumption by the contagium of the nitrogen
and water destined for the nutrition and repair of the
tissues is the chief, it Id probably j&ot sole, agency in
producing the tissue Waste charactemttc df wm*',. A pro 1
bable adjuvant cause is that of’

tiseue metabolism” which has been regarded by the advo¬
cates of the combustion theory as not only the essence of
the febrile state, but as the cause of the wasting of the
febrile body. Though that wasting is, as we have just seen,
mainly due to other causes, this one i9 probably not alto¬
gether void of share in its production. What we have to
do is to consider how it is brought about. The evidence of
its existence is not so much increased tissue waste—for that
is otherwise accounted for—as increased elimination of urea,
which must result from increased tissue disintegration. To
this phenomenon we must therefore for a moment direct
attention.

Urea is formed in the urea-forming glands from the retro¬
gressive store albumen. If the propagation of the contagium
in the system is competent to cause an increased flow of
retrogressive store albumen through these glands, it is
competent to cause increased formation of urea. Of its
competence to do this there can be little doubt. Tissue
metabolism consists of two distinct processes—the taking
up of new material and the giving off of old. Both actions
take place in and around the capillaries, and are so contem¬
poraneous that it is impossible to say eitlver that the old
nitrogen of the organ albumen is deposed by the fresh
nitrogen of the constructive, or that the constructive steps
in to fill up a gap created by the passage backwards into tne-
circulation of the used-up nitrogen of the organ albumen.
The two actions are simultaneous—neither actually pre¬
ceding the other any more than in osmosis the passage of
one liquid through a membrane precedes the passage of
another which exists on the other side. While this simul¬
taneous double action is going on, the contagium particles
step in and convert into their own protoplasm so much as
they require of the nitrogen of the constructive albumen.
The moment at which they lay hold of it is that at which it
is about to be appropriated by the tissues—the moment,
that is, at which it is in the transition state which it must
assume in passing from the condition of constructive to that
of organ albumen. The protoplasm of the tissues and of
the contagium is formed at the same time, in the same place,
and from the same material; and so close is the struggle
between the two for the possession of the nitrogen of
the constructive store albumen that the contagium seizes
upon it at the very moment at which it is about to be
incorporated with the tissues, and consequently not before
some of the nitrogen of the used-up organ albumen, which
it was on the point of replacing, has passed back into the
circulation as retrogressive store albumen. The moment at
which the constructive albumen is undergoing the change
which normally results in the formation of organ albumen
is that at which its nitrogen is taken up by the contagium.
The simultaneous action by which the organ albumen is
converted into retrogressive is equally far advanced; the
contagium steps in to deprive the tissues of much of what
they require and are in the act of appropriating for the-
formation of organ albumen. No such agency intervenes to
prevent the completion of the contemporaneous aotion
which results in the formation of retrogressive albumen:
that action, therefore, continues as usual; and thus ik
brought abnnt the physiological anomaly that a diminished
consumption of nitrogen by the tissues is accompanied by
an increased elimination of nitrogen by the kidneys.

Another and essential phenomenon of foyer intervened to
aid this result. Tissue metabolism depends, among other
things, on the circulation through the tissues on a due supply
of blood. The more active the circulation is, the more
active also, eertcris parihw, will be the tissue changes.

: In health the heart beats at the rate of about seventy a
minute, and at each beat sends onwards about the same
quantity of blood, so that in twenty-four hours the heart
has sent the fill of its left ventricle through the body
100,800 times. In fever there is increased rapidity of the
heart’s action and of the circulation through the tissues. Sup¬
posing it to best 120 times per minute, the fill of its left ven-
trinfe would be sent through the circulation 172,800 times in
twenty-four hours. As there is no diminution, but probably
an increase, in the amount of retrogressive albumen in the
blood, it is evident that one result of the increased rapidity
of ~its Circulation must be the conveyance in a given time to
the Area-forming glands of n more than usual quhntiby of
the material from which urea n formed, and consequent
increased fonnation of urea. " ■ j-

Another and necessary result of this increased tissue
metabolism is increased production of heat, the phenomenon
whose causation we are supposed to be specially investigating

I

TSfrUJwrur,} . DR. HAH 13 ACTION' ANDTROPERTIES OP THE WHITE BLOOD-CELLS. [Avail A1817.L 671*

when considering the theory of fever. This increased body
heat-is, it will be seen, only one of a gronp of phenomena,
each of wliieh is the direct or indirect result of the propaga¬
tion of the contagium in the tissues* The direct action of
the contagium consists in the consumption by it of the
nitrogen and water of the construct ire store albumen. The
results of this action are: 1. Impoverishment, and consequent
wasting of the nitrogenous tissues. 2. Increased demand
for water, with its attendant thirst, dry skin, scanty urine,
and constipated bowels. 3. Increased tissue metabolism,
with its attendant increased rapidity of the circulation,
increased formation of urea, and increased production of
heat. Thus we find that the phenomena which must result
from the propagation of an organism in the tissues are
ejpptly those which are found to characterise the febrile
state. Thus is explained the mode of action of the poisons
of the specific fevers. Thus, too, is exemplified the com¬
bustion theory of fever.

Let me again point out that the two theories of fever
which we have been considering are not antagonistic.
Each has its own special sphere of application. The chief
and most important applications of the neurotic theory
hare already been indicated. It applies probably to all cases
of hyperpyrexia, to all rises of temperature resulting from
nonuintiammatory lesions of the nervous centres, and pro¬
bably, too, to most forms of ephemeral fever. By the com¬
bustion theory are to be explained the febrile symptoms of
the specific fevers, malarial fevers, rheumatic fever, pneu¬
monia, and all febrile diseases, whose poisons may reasonably
be regarded as minute organisms whose morbific action is
dependent on their organic development. It is probable,
too, that the fever of all inflammations is also thus pro¬
duced. Not that nil inflammations are produced by foreign
organisms (though many probably are), but because ex¬
cessive activity in the minute cellular elements of the
tissues will have the same result on their metabolism as the
propagation in them of foreign organisms.

Cadogan-plare. S.W._

ON THE ACTION AND PROPERTIES OF THE
WHITE BLOOD-CELLS.

DO THR INTRA-VASCULAR "WHITE BLOOD-CELLS POSSESS
THE PHOPEHTY OF AMOEBOID CHANGE OF SHAPE AND
POSITION ? IS THE ASSEVERATED MIGRATION OF WHITE
BLOOD-CELLS AN OBSERVABLE PHENOMENON OF IN¬
FLAMMATION ?

BY WM. A. HAMAN, M.D.

Iir thjj American reprint of The Lancet for the month
of March* 1885, Mr. Wharton Jones has an interesting paper
addressed to professors of physiology and pathology, advising
them not to teach that white cells migrate from the veins
and capillaries during inflammation until they have verified
the fact by observations of their own. In this paper
Mr. Jones makes two unqualified assertions which negatively
answer the questions which constitute the .caption of thjs
communication. Prior to the appearance of'Mr. Jones’s
paper I bad unreservedly accepted thedootrine of migration
as beyond dispute, but after reading the convictions of roe
of the piopeers in the microscopical study of the circulation
and inflammation, I thought 1 would repeat some of these
experiments for. my own satisfaction. 1 accordingly made

twenty prolonged observations on the transparent mem-
briujaf w'ebi jinesefltery, atad tongue Of toads and frogs,
using ScflWer’s work on “Practical Histology” as a guide
to the systematic display Or theseparts.

~ COnceimlngith e first guCstiofl, T would remark that,
although Or^Henry Green says'“amoeboid movements have
neyfflr udeO Aeen in the white corpuscles Whilst withfu the
veri^ra,**agijeeihg.in jiMsrebpeCt with Mr Jones, while a
firm Lelfexrer iri Cohuh^ifn.VvieWi regardiiig migration, l am
o^iySoea'that both are in error.: I hayc’demonstrated the
conftSrf' W' thy’ own ' 1 sntfafketlon 1 at' lfth#.- During last
a^m'al! veifl' ip the nfCsemety ^of a FrOg

g«ffiy toandfio ftteSlnS

f> —qj’lirr Kortw Aktwmy, *»«b p.m.

being nearly free from stray globules, and the oolouxless
corpuscles were well defined. I carefully and closely
watched one white globule in the centra of the tube; it was
motionlees, but gradually changed its shape by throwing
out processes, and finally by imperceptible activity reached
one side of the vessel, and there changed from the circular
shape to that of a somewhat irregular square. I thought I
was now going to witness migration; but in a short time
it left the side of the vessel, resumed its circular shape* and
returned to the centre of the vessel, where it let go its bold
on the vessel wall and oscillated to and fro with the current
in company with the other red and white globules—thus
showing it to be still within the vessel. I believe, not¬
withstanding the assertions of Mr. Jones and Dr. Green to
the contrary, that it was a bona-fide instance of amoeboid
change of shape and position of a white corpuscle while
still within a vessel. Using the same objective, 1 afterwards
observed the same phenomenon in the case of other colourless
cells. On account of the inconveniently short working
distance of the 4-inch objective, the 4-ineh is generally
used, which, possessing a less power of amplification, may
account for tbe failure to witness this change of shape and
position; by having the membrane perfectly horisontal, and
using very short pins to confine the membrane to the frog-
plate, I experienced no great difficulty ; a 4-inch glass used
in conjunction with an achromatic amplifier would give the
same amplification as a 4-inch objective without the incon¬
venience of a short working distance.

In reference to the second question, I would say that if I
was at all prejodiced it was in favour of the migration
theory; for, if correct, it very much simplifies tbe pathology
of inflanunatiqn. 1 used the web but onCe, as on recount
of its comparative thickness and the numerous pigment cells
contained in it- its examination was not so satisfactory as
the clear transparent mesentery. In some instances ’ I
relied on atmospheric air to light up the inflammatory
process; while in others I applied acetic acid, crystals of
silver nitrate and copper sulphate, and an iron heated short
of rad heat and in boiling water. With the exception of
the web, I invariably noticed, at the first glance at the
exposed membranes, that there were free cells on their
surfaces. These are the white cells not only coming, as
Mr. Jones observes, from the peritoneal secretion, but also
from the vessels, as red cells are also to be found. Many of
these cells, without donbt, come from the vessels divided in
opening the abdomen, and from the pricks of tbe pins made
in confining the mesenteiy; small vessels must Also be
severed in properly displaying the tongue. No: matter how
much care u taken in tne preparation of these membranes,
free cells Will always be round on their surfaces, and no
doubt are mistaken by some to be migrated globules; but a
very little care in observing them will readily dispel such
an illusion. Furthermore, I always noticed that the great
majority of them can be removed by means of a camel-
hair brush; those which do not come away are no
doubt, on the under sdrfaoe of the membrane, where
manipulation with the brush is difficult and awkward,
or else, being bodies of microscopic sire, escape being en¬
tangled in the hair of the brush. My plan was to select a
few small 1 veins with a dear unobstructed piece of membrane
on each side of the vessels, and then watch until the current
became slow and finally stagnant, with complete coagulation
of their cohtents. I never saw, no matter hcrw long the
vessels wert under observation, any white cells appear in
the surrounding clear tissue which could not be aooounted
for on another more plausible theory than that 6f migra¬
tion. Vessels were occasionally seen the tissues bordering
wMch were not free from leucocytes, and which oould nob'
be brushed away. I do not believe they Were migrated'
globules, fob they did not change their position, and if the
membrane was occasionally brushed they did hot increase
in number. I believe they were free peritoneal and Vascular
cells fixed to the membrane by their viscidity and desiccation
prior to inflimm4tdry effusion. I several tames saw a small
vein, sharply defined and with clear tisane’ eartoondtog rt* f
in which a colourless cell was to be seen that.predated the
appearance asthough a small portion of it were partly through
tne vessel wall; but after long Waiting, during which time it

satisfaction, by transitional focusing, that many 1 of the cells
that occupied positions which rendered ’them liable to be
mistaken tor migrating leucocytes were on a'plane'different
from that occupied by the vessel, :i The most deceptive

672 Tim Lancbt,] MR. J. K. THORNTON: HT8TEREOTOMY FOR FIBRO-MYOMA UTERI. [Aphil 2, 1887.

simulation of migration I witnessed was observed while
watching two leucocytes which looked for all the world like
globules chat had partly escaped from the vessel. As they
were the only ones, and the surrounding tissue was quite
clear and free from other globules, I was less liable to make
a mistake than would otherwise have been the case. They
appeared to be attached to the wall of the vessel by a narrow
pedicle, which gave them a pear-shape. In about an hour
they were quite free from the vessel, and had moved a short
distance away from it; but in a comparatively short time
they returned to the vessel wall again, and appeared to almost
bury themselves in it, when they reappeared, still apparently
attached to the vessel wall. This peculiar behaviour made
me doubt their being emigrant globules, but I was finally
convinced, by their suddenly rapidly oscillating, in no fixed
direction, to and fro in overlying serum on the peritoneal
(the vessel was in the mesentery) surface, so occasioned by
the beating of a neighbouring large artery. This proved
their presence on the surface of the mesentery, wandering
over its surface, and thus occasioning the similarity in
appearance to migration. This required an hour and a half
of continuous observation; so a hasty conclusion in favour
of migration would no doubt have been arrived at by many.

On reading descriptions of tbe migratory process by
different writers one is struck with two facts: (1) That
exceedingly few quote their own observations in favour of
migration, but quote either Cohnheim’s or those of Burdon
Sanderson; (2) the great discrepancy ia the ease with
which they (different writers) say migration can be ob¬
served. Burdon Sanderson avers, “From the description
given above it might be inferred that the experiment is
one of great simplicity, whereas in actual practice it is
attended with very considerable difficulty;. so much so,
indeed, that most persons who have tried it have found
failure more frequent than success. The principal sources
of difficulty are: (1) That the time occupied in the first
stage of the process, during which the circulation is going
oi with unabated velocity, is extremely variable; (2) that
if from weariness or inadvertence the attention of the
observer is diverted from tbe selected vein at the
commencement of tbe pro ess of migration, he is very
unlikely to succeed in seeing what he desires to see
afterwards; for inasmuch as leucocytes are escaping simul¬
taneously in various parts of the mesentery, they soon
accumulate in such numbers that their mode of exit can no
longer be distinguished. Yet, notwithstanding these diffi¬
culties, no one who has time and patience enough need fail;
great care in manipulation is required, but no extraordinary
dexterity.” 3 (A camel-hair brush, as before stated, occa¬
sionally applied to the surface of the membrane will prevent
and will remove the obstruction to the clearness of view
occasioned by these “accumulated migrated” corpuscles
which gradually ooze from the cut vessels). I now turn
to Schafer, who, speaking of the exposed lymphatic surface
of the tongue, says: "Moreover, the mere exposure of the
lymphatic surface soon causes inflammatory changes, and
after the preparation has been made a few minutes only,
the first commencement of these is seen in the sticking of
the pale corpuscles to the walls of tbe ve-sels, speedily
followed by their migration from the veins into the
surrounding tissue. Nowhere can the fact be more clearly
established, and the details of the process more accurately
followed than here.” 3 If migration is an observable fact, one
of these gentlemen i« in error, and I am sure it is Mr. Schafer,
who, I have not the least doubt, mistakes the free leucocytes
on the surface for migrated corpuscles in the parenchyma
of tbe tissues. My observations have been too few to
warrant me in coming to a definite conclusion; yet the
resulfcof my efforts to arrive at the truth in conjunction
with the differences in tbe statements of actual observers
who accept the doctrine of migration give some support to
the assertion of Mr. Wharton Jones. I intend pursuing the
subject still further, and if after as many careful observa¬
tions.! do not witness migration, I think I shall be justified
in doubting, if not migration, at least observable migration.'.

Reading, Pennsylvania.

HYSTERECTOMY FOR FIBRO-MYOMA
UTERI IN A PATIENT FIFTY-SIX
YEARS OF AGE.

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

SUBGKOJf TO TMK SAM A JUTAS FHXX HOSPITAL.

* Holme*’ System of Surgery, vet. C, p. 48.
* Practical Histology, p. 161.

epidemic of me&alea di&a rapidly spread
miog the pMt *W-/fe*fcsya«»dthe

,J», the tow* I i*m. keen otaaadwith a vicw-to
leepjteadof infro&». a ;• v .*'.

The following case seems to me sufficiently rare to merit
separate publication.

On Nov. 3rd, 188G, I saw in consultation with Dr. Braxton
Hicks and Mr. Rand of Dulwich a single lady, aged fifty-
six, with a very large, solid abdominal tumour. After
examination, 1 agreed with tbe previdns diagnosis—namely,
that it was uterine. The cervix was obliterated, and tbe os
could only just be reached as a small opening at the top of
an elongated funnel-shaped vagina. Menstruation had been
regular and scanty up to 1880, and then became rather more

C refuse. In July, 1881, the patient discovered a email lump in
er right side, and about the same time menstruation became
irregular, and she had some severe floodings. This state of
things continued more or less till the early part of 1885, the
tumour meantime slowly increasing in size. She then stopped
menstruating for a whole year, had one period, and did not
menstruate again for another six months—i.e., till I first saw
her. During this last sixmonths increase in size bad been much
more rapid and decline of general health so marked that Dr.
Hicks advised that I should be consulted as to tbe possibility
of operation. I came to the conclusion that hysterectomy was
possible and justifiable, but thought it right to tell both the
patient and her friends that the great, size of tbe tumour,
together with its very broad base, made tbe operation un¬
usually formidable and dangerous. 1 have twice performed
hysterectomy upon single women at tbe age of fifty-five, in
the one case removing an enormous fibre-myoma, which bad
become cystic with rapid increaFe of size, and in the other a
small flbro-myoma for excessive haemorrhage, which rather
increased than diminished after the usual period for the
menopause; and in another case I operated on a woman of
fifty-eight, in consequence of profuse suppuration in tbe
tumour, the pus escaping through the uterus in such
quantity as to seriously undermine her health. These three
patients are now all in the enjoyment of good health.

The special interest in the present case doea not therefore
lie in tbe age of the patient, but in the fact that the tumour
appeared first about the usual time of change of life, and
grew steadily during this period, and after it was practically
complete increased so rapidly in size as to threaten the
patient’s life. Her family history is a remarkable one. She
was the.eighth of a family of sixteen. Her mother died of
some uterine disease at sixty-four, one sister died in infancy,
one of phthisis at nineteen, another of epilepsy, and another
of scarlet fever. The eldest sister had a tumour removed
from her groin ten years ago, another sister had a mammary
tumour removed four years ago, and tbe youngest sister has
been twice operated upon for thyroid tumour ; all three are
living.

On Nov. 8tb, 1886, Mr. Stormont Murray administering
chloroform. Mr. Malcolm assisting, and Dr. Braxton Hicks
and Mr. Rand being present, I removed the tomour with the
uterus down to tbe internal os and both ovaries and tubes.
The latter were ligatured off, and the wire of Koeberld’s
serre-nceud was passed through the broad ligament on each
side just below the cut angle made by removing the appen¬
dages. It was necessary nor. only to seoure the hrOaffugS-
menta on each .side as in ovariotomy, but also to secure
separately on each side a large mass of vessels lying d^pbr
on tbe surface of the tumour, and also to enucleate tnelqf^r
part from the pelvis, peeling back the bladder,*
dealing the mass from the whole floor of the pelvfyl
rectum and sigmoid flexure and left ureter on one
from the ceecum and right ureter on the other,anfHv.
the. sacral promontory posteriorly, so tha,t tljq Wfw ,
apart from tbe ovarian pedicles and uterine*
the serre-nceud, was larger thaq that.1
the-hip-joint. Many large vessels :
surface, and its edges were laced oveY
venous oozing deep in the pelVipI J "
and^therefore placed a glass tube
th* hottom of the large «£$
whole operation was penonxfed at
dn-ssed with solid per chloride o£ irou,i#i4.

Uoogi

to Lancht.J MB. W. COKE AX: SURYIVANCE AFTER GUNSHOT WOUNDS OF HEART. [Apbil 2,1887. ' 673

with the sponge dressing. For some days after tfce opera¬
tion a considerable quantity of dark blood was discharged
from the tube every twelve hours, sometimes several
ounces; and the glass tube was not finally removed for
more than a month, and was then replaced by a red rubber
tube, which was gradually shortened and finally removed in
eight weeks, when the patient got up. The convalescence
was Tory steady considering the formidable nature of the
operation, the only troubles being the persistent oozing of
blood, which was apt to occur and increase on any extra
movement, and a sharp rise of temperature and pulse on the
evening of the fifth and morning of the sixth day, requiring
the use of ice to control it. From the time the ice was
removed from the head almost to the time the patient left
my care there was marked polyuria, the secretion more than
once being over seventy-two ounces in the twenty-four
hours. 1 have before noticed the same thing in cases after
a rather prolonged use of ice to the head, but it does not
seem to do the patient any harm, and, so far as 1 have been
able to discover, is not associated with albuminuria or any
other change in the urine. The tumour, after much blood
had drained from it, was weighed at 25£ lb., but 1 have no
doubt was really much heavier, i found the people only
had weights up to 26} lb. The great size of the pedicle
made the serre-nceud’long in separating, and I did not
finally remove it till the twenty-fourth day. I usually
remove it, if it does not separate spontaneously, about the
fourteenth day.

I was assisted in the after-care of the case by Dr. Hicks,
Mr. Rand, and Mr. Malcolm, aid the patient was most
excellently nursed by one of the nurses from the St. Helena
Home. She was herself bright and cheerful throughout, in
spite of the slow convalescence, and the chaDge in her
appearance was so marked that friends who visited her said
that she appeared at least ten years younger. The only
point in the operation to which 1 would call attention is the
separation and ligature of a second layer of large vessels
after securing the broad ligaments for the removal of the
ovaries. I find that in these very large tumours this second
layer can always be recognised and lifted from the sides of
the nterus, and after they are secured, as well as the ovarian
vessels, very extensive enucleation may be rapidly per¬
formed without fear of dangerous hemorrhage, in cases in
which, npon first opening the abdomen, it seems quite
impossible that the mass can be removed with any reasonable
prospect of preserving the life of the patient.

Pmtman-ctroet, W.

SURVI VANCE AFTER GUNSHOT WOUNDS
OR OTHER INJURIES OF THE HEART.

Bx BRIGADE-SURGEON W. CURRAN,

ARMY MEDICAL DEPARTMENT (RETIRED).

Ha vino discussed this question from the standpoint of the
lower animals in another journal, and having accummulated
some materials about it in its relations to our own species, 1
am anxious to summarise these in this place, and so complete
the record of the matter so far as I am acquainted with it.
I am, of course, aware that the subject has been exhaustively
dealt with by other and abler hands than mine; nor do I pre¬
tend to be able to shed any new light on so well-worn a
topic. AU I undertake to do is to introduce a few of the more
classic or historical illustrations of this Kind that I have met
■with in the course of my reading, or that have escaped the
notice of the ordinary collectors, and then relate a case that
came under my own cognisance at Peshawur, which, if
not unique of its kind or per se, is, I should fancy, nearly so.
Anyhow, I never saw or heard of anything like it, and the
uncertainty or complexity’of the symptoms by which this
lesion la characterised during life must be my excuse as
^ell as my justification for ignoring, or at least for not
®^U*ng on them at all in this place.

. The materials here referred to would, I think, justify me
m extending the scope of this paper, and this too was at
one time my own intention. But, alas for the vanity of
wishes I just as l had sketched out a programme of
kind fax my own guidance, I bethought me of its
°J e “joo-legal be»ringa, and on looking into the great works
?VT?™* ***** Taylor—to go no farther afield—lo and
oehold 1 there was the whole question thoroughly threshed

out. To add to my perplexity or humiliation, I further
found that, quoad its surgical bearings, one Fischer, a German,
had been before me, and so it became clear to roe that, if 1
would not poach on their preserves or carry coals to New¬
castle, I bad better be content with what 1 bad gleaned in
this bared field myself, and shine as a compiler, if I oonld
not sing or shine in any higher key. This, then, is my stand¬
point— as it will, I trust, be my shield and defence against
the too-exacting requirements of a carpingVritieism ; and
the interest or the superstition with which wounds of this
kind have ever been regarded will, I am assured, relieve, in
some measure at least, the barrenness and monotony of the
tale I have to tell about them.

That all these cases exhibit a larger measure of tolerance
on the part of this central organ than is popularly assigned
to it is undeniable, and equally certain is it that such a
tolerance has been specially provided for by nature. 8o
complex, indeed, is tbe distribution of its muscular fibres that
their minute arrangement may be almost said to be still mb
judice; and as to the mechanism of the fact or force whereby
it ministers to the wants of our economy, that is yet quite
as much a crux as was at onetime the circulation itself, or as
is still the use of the appendix vermiformis c®ci. We know,
on tbe other hand, that it has frequently undergone rupture
even in a healthy subject, as tbe result of a squeeze or of a
blow that has left no trace behind it. It has also been dis¬
placed without undergoing any rupture by such external
violence as has seriously compressed its cavities or broken

Fig. 1.

several of the ribs by which it was surrounded; and as to
other minor instances of its endurance, freakishness, or
“deviation from the perpendicular,” they are so numerous
as not to need aDy more detailed reference or indication
here.

Thus—to mention oiily a few of the more striking ones--
one (df Torres) is quoted by Chelius as describing a case in
which the baee of this structure was as low as the umbilicus;
another (Rarael) mentions the case of a girl of ten, in whom
the heart was placed below the diaphragm; and, stranger
still, Deschamps is said to have found it, in one instance at
least,’in tbe region of the left kidney. I have myself quoted,
but without attaching much importance io such narratives,
several other curiosities of this kind in a paper headed
“On Malposition or Displacement of the Heart” which
I contributed in 1861 to the " Indian Annals of Medical
Science,” and having thus cleared the way for the his¬
tories promised above, I will now proceed to the statement
of them.

Tbe interest associated with the accompanying illustra¬
tion (Fig. 1), for the block of which I am indebted to the
courtesy of Mr. F. Le Gros Clark, is enhanced by the fact
that the heart it portrays was taken from a soldier who fought
at Corunna in 1809, and who was struck by the bullet to tbe
left of the sternum between the second and third riba. He
thought he might have been insensible for half an hour; his
loss of blood was not copious. He was carried on board a
fighting ship, which was crowded with wounded soldiers,

674 The Lancet,] .MR. W, CURRAN: SURVIVANCE AFTER GUNSHOT WOUNDS OP HEART. [April 2,1887.

and received no surgical attention beyond the application
of a piece of plaster during the voyage. The external wound
was suppurating healthily on his arrival, and a probe that 1
was introduced penetrated for nearly its whole length with-
out meeting with any resistance, lliscountenance was pale; >
respiration frequent and laboured; pulse 120; the tempera- |
ture was nearly natural. He was also very restless, and he
could get no sleep, while he craved for opium. He com- j
plained occasionally of an obtuse pain in the chest, which
he could not, however, define or isolate, and he was, besides
much troubled with diarrhoea. His restlessness and depres- j
sion increased, and, expiring on the third day after landing, I
and fourteen days after the receipt of the wound, this j
organ exhibited on section the appearance indicated in the
sketch. On further examination the left pleura was found 1
to contain two quarts of a sero-.sanguineous fluid, and the j
lung itself, which was shrunk to a small solid mass, adhered
to the spine. The thickened and distended pericardium
contained half a pint of the same sort of fluid, and the '
surface of the heart itself was covered with a thin layer of
adhering lymph. The right ventricle presented a transverse [
opening, ubout an inch in length, which penetrated its
unterior surface near the origin of the pulmonary artery. On
removing the heart by cutting through its large vessels, the
ball was found lying loose in the pericardium, into which it
had fallen during this operation, and by tracing its course
within this structure, it became evident that it must have
remained in the right auricle all along. The tricuspid valve
had a circular lacerated opening in it, which admitted of
some regurgitation, and the contraction of the walls of the
ventricle would obviously rather tend to lessen than exnose
or distend the sides of this wound.

As the story of Mr. Perceval’s case is not only historical,
but as also it appears to have escaped the notice of some
at leastof those collectors to whom allusion has been already
made. I subjoin a note of it here. It runs to this effect:—
‘•On the evening of May 11th, 1812, he [Bellingham, the
murderer] took his station behind the folding doors leading
into the body of the house, and at 5 o’clock, as Mr. P-ad¬

vanced up the lobby, he [Bellingham] presented one of his

pistols at him and fired. Mr. P-reeled a short distance

(the account says), and, exclaiming ‘ Murder ’ in a low tone
of voice, he fell to the ground. He was instantly picked up
by Mr. Smith and carried into the office of the Speaker’s
ecretary. where he expired almost immediately.” The
Mr. Smith here referred to testified at the trial that sub¬
sequently took place that “almost in the same instant as
than in 'which the shot was fired he saw a person rush
hastily towards him from among the crowd. The person
came towards him from the crowd” (he continued), “looking
first, one way and then another, rather like one seeking for
shelter than the person wounded. But taking two or three
steps towards the witness, he reeled by him, and almost
instantaneously fell on the floor with his face downwards.”
Before he fell witness heard him cry, though not very
distinctly, and in what he uttered he heard the word
* Murder,’, or something very like it. When taken
into the Speaker's office his face was perfectly pale.
The blood was oozing in small quantities from each
corner of his mouth, and probably in two or three minutes
from the firing of the pistol all signs of life had ceased.”

There was at, one time, as there is still, I believe, in some
quarters, an impression or belief that persons who are
wounded after the manner here described invariably spring
or jump into the air ere they die, and an officer who was
present, in 1848, at the taking of Frankfort-on-the-Maine
by the Austrians and Prussians, assured me that he witnessed
and verified on the spot at least one case of this kind on
that occasion. 1 have inquired more thoroughly into this
matter, and find that, though such occurrences do sometimes
take place, they are very far from frequent, and that when
they do take place this spring or jump is not exclusively
confined to’wounds of this organ. The curious reader will
find some account, of this matter in a paper I contributed on
the point to the Indian Medical Gazette of May 1st, 187G.

As regards the deaths that iiave been produced by stabs
fromknives or sword-thrusts through this organ, &c., a few
historical illustrations must suffice for this occasion; and
nothing need be here said .about the fatalities that result
from t he fish-bones or other articles of that kind that reach
it t hrough the oesophagus. They are so rare as to be almost
unregarihtblo in this connexion, and so we may safely say of
them <b- minimis non curat c.hiniri/ia. Not so, however,
with the other stabs or thrusts of this. kind-that history

commemorates, and we know as matters of fact that thd
assassination in this wise of the Duke of Guise at the siega
of Orleans in 15(13, as well as of Henry IV. 1 some half a
century later, affected the very existence of the religious
organisations or of the political factions with which they
were respectively connected. But these phases of the
question are also somewhat beyond the purview of our
inquiry, and we find that thtr behaviour of this organ-
which is the point that chiefly concerns us here- is in either
case regulated by the amount of injury it sustains itself at
the time, or by the amount of haemorrhage and shock that
are then or subsequently induced. This being so, we need
not go into the details of the situation ; and now for a few
illustrations in point.

Describing the murder of the Duke of Buckingham by
Felton, Mr. ilepwortli Dixon says that “ the Duke was fol¬
lowing close, when in a narrow passage darker than the hall
he stopped and reeled. Lord Cleveland, who was near him,
heard a thud, and then a voice cry ‘God have mercy on thy
soul.’ The Duke bent backward, uttered a faint scream of
‘Villain,' tore from his breast a knife, and, staggering,
swooned and fell. Red blood was oozing from his mouth,

his eyes were filming over, and.the Duke was dead.” The

other accounts of this occurrence I have read are either so
exaggerated or so conflicting as to lead, nay almost oblige,
me to sympathise with Walpole when he sneered at oil
history as a lie, or with Plunket when he compared it—
though this is denied—to an old almanack. However that
may be, and imperfect though these accounts are, they yet
serve to show that life may survive even the most deter¬
mined thrust, and the following case is still more strikingly
illustrative of this point.

Dwelling on this, Mr. Sutherland Edwards says that,
“after ‘Le Carnaval de Venise,’ &c., had been performed,
the Duchess de Bern rose to leave the theatre. Her
husband accompanied her to the carriage, and was taking
leave of her to return to the theatre, when a man placed
his left arm on the Duke’s left side, pulled him violently
towards him, and as he held him in his grasp thrust
a dagger through his body. The dagger entered the
Duke's right side, and the pressure of the assassin’s arm
and the force with which the blow was given were
so great that the weapon went through the lungs and
pierced the heart, a blade of six inches inflicting a wound

nine inches long. After begging that his murderer

might be forgiven, and entreating the Duchess not to give
way to despair, the Duke breathed his last at half-past <1
in the morning”; and the Royalist writer, Dr. Veron, who
describes the attack and its consequences in greater detail,
says that the wound was inflicted about 11 P.M.on the night
of the 13th of February, 1820. “ II dtait onze heures moins
quelques minutes” are his words, and “le prince allait
se roveiller parmi les anges au moment oii.parmi les hommes,
il avait accoutumiS de sortir des sommeils.” In other words,
he survived this terrible stroke some six hours, during
which his nausea or vomiting was so continuous that the
Archbishop of Paris was obliged to refuse him the sacra¬
ment, and “lorsque l’on fit l’ouverture du corps, on recon-
nut que le Coeur meme avait etd blessd. Le prince aurait du
mourir sous le coup,” is the opinion of our author, and,
looking to the hiemorrliage that, such a wound must have
caused, his so-long survival is at least suggestive.

(To be concluded.)

1 History repeat s itself in this as in other matters, medical and other¬
wise. Thus, describing the death of the King of Pcmaa at the hands
of one of his pages, the old Portuguese traveller. Mende?: Pinto, says
(Voyages and Travels. &c.. Loud., 16S3, p. 2(H) tli.it "he [the page]
stabbed the king with a little knife into the midst of the left pap.
and so. because the Mow was mortal, the king cried. * I am dead.' The
page.” instead of being reserved for torture, as his successors Hartdllsc
and Gerard the slayer of William the Silent were, "was then impair' 1
alive, with a grgvl big stake, which was thrust in at his fundament, and
came out at the nape of his neck.” Short and sweet!

British Ophthalmic Hospital at Jerusalem. —At.
a numerously attended meeting on the 30th ult. in support
of this institution, it was stated that during last year 121
in-patients and 3238 out-patients had been treated at the
hospital, and the number of consultations at the dispensary
had been 13,402. The fonr beds at disposal are quite in¬
adequate, and some of the patients have had to he placed
on the floor. Resolutions recommending the hospital for
increased support from the charitable public were unani-
mc'dv ncreed to. 7 tu di ' hi tW

ThSLakckt,] ME. 0. B. SHELSWBLL: H.EMOJ&BHA6IO TENDENCY IN MYXCEDEMA. [Amul2,1887. 675

CASES OF HAEMORRHAGIC TENDENCY IN
MYXCEDEMA.

By OSCAR B. SHELSWELL, M.R.C.S., L.R.C.P.

Is there any special tendency to biemorrhage in myx-
cedama ?

On November 15th, A. M-, aged fifty-three, suffering

from extremely well marked myxcedema, wished to have a
very loose upper molar tooth, which was troubling her, re¬
moved. The gum around was very spongy-looking. The
extraction was attended with more trouble than at first
seemed possible, the cauee being the firm adherence of a
portion of gum to the tooth, and which was still adherent
on extraction. Rather more than the usual amount of
haemorrhage followed, which, however, stopped easily. Eight
hours afterwards it recurred to an alarming extent, and was
only arrested after firm pressure with dry lint for about a
quarter of an hour continuously. The blood (mixed with some
saliva) lost amounted probably to. about fourteen ounces.
The haemorrhage recurred to a slight extent during the night
of the 22nd. She had never had a tooth extracted before.
There was no history of hemophilia in herself or her family.
She had never had epistaxis, hemorrhoids, or menorrhagia.

M. A. B-, aged forty-two, also the subject of myxoedema,

complained of a very loose lower molar tooth, which was
surrounded by spongy gum, as in the former case. The
lower incisors, also loose, were surrounded by spongy gum,
which was inclined to bleed a little. The extraction of the
molar on Nov. 24th was impeded, as in the former case, by
the adherence of gum to the tooth. The portion adherent
was very firm, and resembled strong aponeurosis rather
than gum, a considerable amount of force failing to remove
it. Immediately after the extraction severe haemorrhage
came (», and although pressure with dry lint caused it to
stop for a time, it continued, more or less, for two hours.
Eventually firm and almost continuous pressure for more
than half an hour was successful. It recurred on the evening
of Nov. 28th, after straining at defecation, to the extent of
about three ounces. There was no hmmoirhage after this
till 8.30 next morning, when, after straining at defecation,
it came on, and continued On and off all day, with intervals
of freedom for an hour or so occasionally. It was only
arreated after much patient) pressure; about, twelve ounces
were probably lost. On Nov. 30tb, about 5 p.si., it again
came on whilst lying quietly in bed. It was again stopped
with dnr lint and pressure. She lost about two ounces in an
hour. This patient was, previously to the extraction, care¬
fully questioned as to haemophilia existing either personally
or in her family, but she was positive that no symptom of
that disease had occurred. She had a tooth extracted twenty
years ago, but no unusual haemorrhage followed. A sphygmo-

H hic tracing recently taken shows increase of tension,
not existing in a tracing taken nearly three years ago.
No satisfactory tracing could be taken in the first case on
account of the swelling.

Hera, then, are two cases of severe hmmorrhage in this
disease from so slight an injury as tooth-drawing. I have
not heard of any similar case, but this may possibly be due
to the fact that there seems a tendency to a loosening and
subsequent falling out of the teeth, so that extraction would
not often be required. Or. James Anderson brought a casB
before the Clinical Society in 1884;—a woman aged forty
with myxcedema, who ascribed her illness to the extraction
of two te^th seventeen years previously, “ the bleedlhg from
which lasted twenty-four hours, and was very copious.”
This case, however, would not be an instance of the subject
now under consideration unless possibly myxoedema at the
tune of extraction had advanced sufficiently to produce
certain changes, but had not developed symptoms per¬
ceptible to the patient. •

.Was the excessive hmmorrhage in the first two cases
“®ply due to the spongy gums produced by a low form of
lu&naunafcian caused by loose and bad teeth, or was it due
to mvxnadejna? Have we any evidence of haemorrhages in
I will refer to several bases reported m the
l’s . Transactions bearing on thi$ point. In
‘T writes of a womAn aged thiWV-apVen:
" uthat her Akin readily becOmds^OTttis^d,
. “ * slowly and a& scOom-

PMied with much ewriiing.”

bHx Semon writes of a

woman aged fifty-three: “ The gums are often inflamed and
bleed, ana the swelling extends to the neighbouring parts,
notably those situated underneath the chin; nails generally,
and hands often, pnrple-coloured.”. Hr. Lloyd, writing
of a post-mortem examination of a woman aged sixty-
five, who bad myxoedema, cardiac disease, and ascites, states:
“ There were purpuric patches on the dorsum of the forearm 0 ;
the peritoneal cavity contained 240 ounces of clear brownish-
yellow fluid, and there were ecchymoses everywhere.”
In 1882 Mr. Lunn writes of a woman aged forty-five that
the “ catamenia stopped in the summer of 1880,” but lately
“she had a severe attack of hemorrhage from the uterus,
which .confined her to her. bed. No apparent disease—i.e M
climacteric.” Dr. Cavafy writes of a woman aged fifty-nine:
“Skin of backs of bands of dull purplish-red tint, which
extended for some distance up the forearms.” Dr. Mahomed
says a woman aged thirty, who had had seven children,
“ bad lost much blood during labour on each ocoaMon.” In

1884 Dr. Dawtrey Drewitt writes of a woman aged , forty-
five : “ The patient was seized with severe menorrhagia whilst)
taking two drachma of tincture ofjaborandi, losing Urge quan¬
tities of blood.” In 1885 Dr. James Anderson's case is reported.
He states: “ She believes that when she pricks or cuts herself
she loses more blood than others. Her gums are extremely
vascular and hypertrophied; they bleed freely, and she some¬
times awakes in the morning with her mouth full of blood.”
Menstruation commenced at fourteen, and was. always
copious, leaving her very exhausted. “ She has never
suffered from epistaxis or haemorrhoids, has had no
swellings of her joints, or dark-coloured urine.” This year
she was under treatment for severe mepprrhagia. In the
discussion on this case at the Clinical Society, Sir Andrew
Clark said “that in not one of the cases which he had seen
was menorrhagia absent.” In one of Mr. Hopkjns’ cases,
too, profuse menstruation bad existed. In 1886 Dr. Savill
writes of a woman aged forty-six: “Gums spongy, and
bleed readily; has had two or three ‘bilious attacks,’ to
which she is liable; the vomit on these occasions has con¬
tained blood from the gums.” In reports from other sources
we find the following:—In a case reported in The Lancet
of 1881, Dr. Lediard states: “ Extensive area of ecchymosis
near pin prick in vein.” And again: “ It was noted that a
pin scratch on her chin had produced some subcutaneous
ecchymosis in its track of unusual character.” A girl aged
twenty reported by Dr. Whipham at the Medical Society in

1885 “ had- had profuse menorrhagia.” In The Lancet of
July 10th, 1886, t)r. Gordon, iu describing a case of myx¬
cedema following upon removal of the thvroid gland, says :
“The least pressure on the skin left a vivid mark behind, so
that she was constantly ecchymosed about the hand.”

From these quotations it appears that the haemorrhage in
these cases of myxoedema assumed one of four forms■

1. Menorrhagia. In the case of M. A. R- menorrhagia

has existed for the last two or three years; memtrhation
commenced lately on Nov. 29th and ceased on Dec. 4tb, and
was as excessive as usual, notwithstanding the previous
hmmorrhage from the gum. The menopause simply might,
perhaps, account for some of these cases, but not for all.

2. Ecchymoses, caused easily. M. A. K—'- says she bruises
very easily, and, in fact, a bruise now exists caused by the
pressure of the thumb against the jaw whilst the forefinger
was pressing lint on the gum. 3. Bleeding from the gums.

M. A. R-is an example of this also. 4. Purpuric patches

on the skin. A. M-nad this symptom at one time very-

pronounced, her arms and hands and legs, but especially her
arms and hands, having very large purple patches present,
which have now cleared off to a great extent. -

It would appear as if there are conditions in this disease
suitable for the production of excessive hmmorihage. For
instance, Dr. Ord writes in Qaain’s Dictionary of Medioine,
referring to the amplification of connective tissue combined
with mucous infiltration : “ It is meet developed of all
perhaps in the outer coats of arteries.” In his report before
the Clinical Society of a post-mortem examination of a case,
he says there existed " a massive thickening of the- coats,
particularly of the adventitia, a great increase of nuclei,
and a diminution of the calibre, often approaching oblitera¬
tion." This condition would necessarily interfere with the
muscular contraction of the arteries, to which contraction,
physiology teaches us, we owe our freedom “ from danger,
through even very slight wounds.” I might mention that
about six ounces of blood &c. from the gam of the second
patient was kept for some time, but only a vetr imperfect
clot formed on the surface; this, however, probably goes for

0, ‘Co og

670 Tub Lancit,] MR. PHILLIPS: ACUTE EPIGASTRIC PAIN IN PUERPERAL ALBUMINURIA. [Anm.3,18871

little when one considers the quantity of saliva necessarily
mixed with the blood in this case, and which, if excessive,
would doubtless prevent coagulation occulting to a great
extent. -Then, again, the sympathetic, through the vaso¬
motor system being at fault (as is perhaps shown in the
patches of redness usually seen on the cheeks), might
perhaps be held responsible to a certain extent for the
heemorrhagic tendency, if such exist, in myxoedema.

It is interesting to observe that a tendency to haemorrhage
has been noticed in that disease where, as in myxcedema,
there is an abnormality of the thyroid gland—I refer to
goitre. Dr. Bruce Low, writing from a goitre district to the
British Medical Journal, of 1878, states that he took notes
of 183 cases of goitre. Of these them were 90 women who
had borne children, and out of these 31 were habitual
flooders; and besides these a considerable number of others
showed a haemorrhagic tendency, especially at their men¬
strual periods.

- I have not read of any surgical operation of any magni¬
tude being performed on a patient with myxcedema; should
such be necessary the result would be highly interesting.
However, I think we have sufficient facts to lend interest to
the two cases recorded above, and to lead us to be on the
alert for haemorrhage in any surgical operation, no matter
how slight, in this disease; but much more evidence is
required to raise what may be little more than a coincidence
into a symptom.

Holborn Union Infirmary, Arch way-road, N.

ACUTE epigastric pain in puerperal

ALBUMINURIA.

By JOHN PHILLIPS, BA., M.B. (Cantab.), M.R.C.P.,

PHYSICIAX TO THE UBITISH LYIXO-IX HOSPITAL.

Thb object of this brief notioe is to draw attention to an
important but apparently neglected premonitory symptom,
sometimes occurring in cases of albuminuria in pregnancy.
Cephalalgia and derangements of vision are usually given in
every text-book as precursors of puerperal eclampsia; in a
few cases, however, either in addition to, or without these
two, we find albuminuric pregnant women suddenly
attacked with acute epigastric pain. A case of'this kind
has recently been under my care. The patient, aged thirty-
eight years, with six children, was in the seventh month of
her seventh pregnancy. For three weeks she had had
swelling of the hands and feet, with puffiness of the lower
eyelids. There was occasional supra-orbital headache, but
at no time was there difficulty of vision. When I first saw
her I found oedema of the lower extremities extending to
half-way up the thighs, the hands were swollen, the race
puffy, and the skin harsh and dry. There was no pulmonary
oedema, and the heart-sounds were quite normal. The
urine was add, of sp. gr. 1028, and contained one-tenth
albumen with a few hyaline casts. Under treatment she
improved very much, but at the end of fourteen days the
oedema began to return, and she was seized with acute pain
in the epigastrium passing through to. the back. It was
paroxysmal in character, the intervals of relief varying from
ten minutes to an hour in duration. Subcutaneous injec¬
tions of morphia were given, and with some success. The
pain oonUmied for two days, and, as it seemed rather to
increase than otherwise, I induced labour with a catheter in
the u 4 pai manner. A perfectly easy labour followed, and
without any cpnvulaiye phenomena. She assured me that
th# labour pains were, nothing in comparison to those in
theepigaetnurp, A few hours after the termination of the
Mb our the acute pain gradually ceased, and ten days later
aRALfcpuneh had dwappeared, jErqm the urine.

. TJhQiUtepstuxe.on. the subject appears..to be very sc
Among.our modern text-books Leishmann 1 is the
writen whodescribes;^ y J^Tquotas CHaussier to tbf
that the
tbanoej
deapribed

patient there was alight oedema of the feet, but no headache
or dimness of vision; she suffered intensely from epigastric
pain for five hours, morphia giving her some relief. With¬
out any warning she was seized with a convulsion, and died
comatose in an hour’s time; the child was delivered by
artificial means, labour not having manifested itself. In
the discussion* which followed the reading of this cue,
Dr. Doe gave the particulars of a case which had occurred
in his practice. The patient was delivered of twins,
and before, during, and immediately after the labour
there were no symptoms of renal trouble. Eleven hours
later she began to complain of severe epigastric pun,
which steadily increased, and in four hours a series of con¬
vulsions seized her, and she died comatose in a few hours.
Dr. Abbot related the case of a lady in whom these acute
symptoms had appeared in two successive labours. In the
first, after five days of intense agony, and in consequence
of increasing dyspnoea, premature labour was indneed;
an easy labour followed, and there were no convulsions.
The gastralgia disappeared as the labour progressed, and
the urine became normal shortly after the birth of the chikL
In the second labour, three years and a half later, the pain
was worse than before. Confinement took place spon¬
taneously at the seventh month. Recovery here was much
slower, the gutralgia requiring treatment for fourteen days
afterwards. Iu addition, She was nearly blind, sight only
being restored after some weeks. She ultimately made a
good recovery. The above cases, five only in number, are
all I have been able to meet with ; and although few con¬
clusions can be drawn from them, they indicate the reality
of such a symptom occasionally existing and the necessity
for prompt treatment. The pain passes from the epigastrium
to the back of the lower chest; it may be variable in degree,
but is usually agonising in character. Pressure and vomit¬
ing appear to relieve it somewhat. It is paroxysmal, and,
although usually occurring antepartum, may, as in one ease
detailed, arise afterwards. Convulsions may or may not
follow its advent. The pain appears to arise from some
perversion of nutrition of the solar plexus; probably the
circulation of vitiated blood in its substance may be the
primary factor. Another point in favour of ite nervous
origin us that three out of the five patients suffered severely
from neuralgia in other parts of the body.

irar

HOSPITAL PBACTIOE,

BRITISH AND FOREIGN..

Nulla autera eat alia pro certo noaeendi via, nlai quamphuimaa at mor-
bortnn et diasectionum hlstorla*. turn alio rum turn propria* oollactaB
habere, et inter ae ootnparare.—M orgaoitc De Sed. ft dm*. Morb.,
Hb. lv. Procemlum. -

WESTMINSTER HbSPITAL.

A CLASH OP ADDISON’S DI8EA8B ; NE CHOPSY; HBVABK5.

(Under the care of Dr. Sttjbobs.)

The account of the following case of Addison’s disease
will be read with interest, especially in conjunction with
the remarks which are appended to it. The notes of the
case are by Dr. Courteen, senior house-physician. >•

Thomas B-, $ged sixteen, emp

country, hawking, was admitted in
on December 14tn, 1880. The previ
as gathered from the mother, is c
always been dark, but during the 1
become much darker. He has had
frequently sleeping opt in the “o
getting wet through. When four
dowA by a cart and his left arm
Ctaie away from the arm, and the
f(rt four years. From the time of ohihffiddjf tfii;
tttehcement of his present ilhtifes thh pa"
good health. About nine months*
nl and to lose flesh, and ids tno$he&;
consumption,” tbok hfrhtd’ad
tax weeks., He hadS

•nivntft ••■'-.-j

riiiriAnari.fttf. r ■

Tub Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[April 2,1887. 677'

worse lately. He has also complained of his head “ feeling
queer,” and that he has been unable to see at times. He has
gradually lost flesh, and has become very weak, haring
fainted two or three times. His appetite has been good
until the last two or three weeks, since which time he has
taken but very little. His mother states positively that
twelve months ago he was stout and well. He has never
had any other illness, exhibits no trace of syphilis, and is of
temperate and steady habits. His father died of phthisis.
His mother is forty-eight years of age, “ not very strong.”
She has had eleven children; four have died, one apparently
from some cerebral or meningeal mischief, being eight years
old; three younger children from “ teething and bronchitis.”
There are seven other children alive and healthy; they all
have dark complexions.

On admission the patient was in an extremely weak and
prostrate condition, being unable to stand without support.
His ekin was cold, of a livid dusky hue; the fingers, lips,
ears, and nose were blue; there was no pulse perceptible at
the wrist, and the heart’s impulse could not be felt or its
sounds heard. He was immediately put to bed, hot water
bottles applied, <md stimulants given. In twelve hours or
so the blueness passed off, and the pulse at the wrist could
be felt, though it was still very feeble. The patient was
thin, but not emaciated. The skin was of a dark-brown
colour throughout, with here and there patches of deeper
pigmentation, especially upon the abdomen and back. The
penis and scrotum were especially dark, as also were the
axilla. Patches of lighter pigmentation occupied the knees.
At the angles of the mouth and on the mucous membrane of
the lips and cheek there were two or three purple-coloured
patches. The tongue was coated with white fur; the bowels
were confined. There were a few moist crepitations heard
at the base of both lungs, mostly over the left. The heart’s
impulse and sounds were very feeble and indistinct, other¬
wise normal. There was nothing abnormal about the
abdomen except some alight tenderness in the epigastrium.
Urine acid; specific gravity 1012; no albumen. Tempera¬
ture normal, tending to subnormal.

Shortly after admission the patient commenced to vomit,
and though tried with various kinds of fluid nutriment, he
eventually retained nothing. He was throughout remarkably
dull and listless, never taking the least notice of what was
going on arpund him; yet he answered readily when Bpokon
to, and until the last had neither delusion nor delirium.
Latterly he passed urine in bed, and his extremities became
blue and cold. The pulse was again imperceptible at the
wrist, and he gradually weakened, dying a week after
admission on Dec. 20th. Two days before death the tem¬
perature rose to 102°.

A post-mortem examination was made by Mr. Arthur,
surgical registrar, at 3 p.m. on Dec. 21st. Rigor mort is per¬
sistent; face and trunk deeply pigmented, also scrotum,
penis, and inside of mouth. Lett humerus shorter than
right; pigmented scar below acromion. Some pulmonary
redema; no sign of tubercle in either lung; firm pleural
adhesions at left base. Liver 48 oz. in weight; normal.
Weight of £>eart, 6 oz.; normal. The right kidney weighed
5.1 oz., and was normal. The left kidney weighed oz.;
also normal. Right supra-ren&l, much enlarged, weighed
1 oz., and consisted of a soft pale-yellow, cre&m-cbeese-like
substance. Left supra-renal, still larger, weighed H oz., and
was of the some consistency as the right. Weight of
spleen 10 oz.; of a pulpy gromous consistency. Testes
normal. No disease of vertebra.

Remarks by Dr. Stuboks.—T he case is deserving of record
as a striking example of Addison’s disease pure and simple
occurring at an earlier age than is usual. By an unfortunate
accident no microscopic examination was made, but the
naked eye appearance, exhibiting yellowish caseous material
softening down in places to creamy consistence, so as to
hollow out the central part of the organs into semifluid
masses, was sufficiently characteristic to remove all possible
doubt as to the nature of the affection. So dark was
the pigmentation about the face that at the first glance
it suggested the seat of the malady. But the akin
bronzing was hardly more striking than the asthenia.
Weakening gradually day by day, there was absolutely
no symptom save inability to retain food—neither fever
nor sweating, nor diarrhoea. Strength went out of him,
and so he died; that ie the sole history, except, indeed that
some hours before death he was delirious, and the tem¬
perature, hitherto about normal, rose to 102°. Both in
colour and manner this boy recalled to my mind a patient of

Sir H. Pitman’s, a woman of forty, also a sort of gipsy, whose
case, with others, I recorded in The Lancet when medical
registrar at St. George’s Hospital many years ago.* This was
also a pure example of Addison’s disease, and the general
condition would apply word for word to the present case;
“ Mere prostration ; listlessness and indifference; frequent
vomiting.” It has often been observed that this rare disease
is met with chiefly among poor out-door labourers much
exposed to rough weather. The remark is strikingly con¬
firmed by the fact that two typical examples can be quoted
from among the gipsies in the experience of one observer.
Furthermore, if any of us can claim equality with this
tribe in the matter of exposure, it is, I suppose, the coster¬
monger; and it will be found on reference to my paper that
a fellow-sufferer witli the woman just quoted—again a pure
specimen of Addison’s disease—was of that calling. Our late'
patient was but sixteen, exceptionally young. Dr. Greenhow’s
typical cases (forming Group I. in the appendix of his well-
known work), collected from all sources, British and foreign,
number 103. But of these only 14 are sixteen years and
under; the youngest known examples being a boy and a girl
each eleven years old. It is said, and truly, that the exposed
parts of the body are the most liable to pigmentation, so that
mistakes are made between the disease of Addison and sun¬
burn. But it must be added that the parte least exposed to
the sun, if exposed at all, are sometimes the most pigmented;
not only the armpits and inside of the mouth, but the scrotum
and penis, as with this boy and with the costermonger, or
the anterior aspect of the thighs, as with the gipsy woman.
For the rest, both the family and porsonal history of our
late patient are chiefly negative. There was no associated
disease, and the injury in childhood, from which he had
completely recovered seven or eight years at least before
illness began, can hardly be charged with any direct concern
in the disease of which he died. Nearest to this obscure
disease, as regards the silent fading of life without active
symptoms, comes, I suppose, pernicious ansemia—no less
obscure. And it is curious to reflect that the two affections
brought together by this casual likeness are strongly con¬
trasted in sex and habits. Ansemia prefers women and
in-doors, and has small respect for social position. Addison’s
disease prefers men who lead rough lives out of doors, and
are mostly poor and friendless. It spares the luxurious
and the well-to-do. If it were a disease of the rich,
like gout, it would probably be treated by more,
various methods, and more often receive kindly notice at
the hands of quack advertisers, professional and other.
Being as it is a disease confined to the destitute and to our
general hospitals, and one which, but for hospitals and
hospital schools, would probably have remained to this day
unrecognised, there is a general consent, even amongst
the most ingenious, that it u so obviously hopeless, that no
word of profit can be said upon the subject of prevention, or
treatment, or tbe means of discovering it at the pre-bronzing
stage. Whether the nnhappy subjects of the disease are yet
greater sufferers on that account this is not the place to
inquire. _

HOSPITAL FOR SICK CHILDREN, GREAT
ORMOND-STREET.

DISEASE OF KNEE - JOINT ; DIPHTHERIA FOLLOWED BY
EXTENSIVE PARALYSIS ; RECOVBBY.

(Under the care of Mr. Edmund Owen.)

The notes of the following case were taken by the late
registrar, Dr. Chaffey.

H. 8——, a boy aged six years and nine months, was
admitted on April 14tb, 1885. When eighteen months old
his left knee-joint swelled without assignable cause. A
year later he first underwent treatment, and daring the next
twelve months was twice under the influence of chloroform,
and then some steel apparatus was applied to the limb, but
without immediate improvement.

On admission the left knee-joint woe stiff and flexed at a
right angle, with some rotation of the tibia outwards. The
limb was much wasted.

Three weeks after admission the child became the subject
of diphtheria, characterised by false membrane on both
tonsils, which were so swollen as to meet each other in the

| 1 The Lancet. 180-1. vol. II.. p. -VlO. The supra-renal bodies in this case

\ were described t>y Dr. Dickinson In the Pat holocical Transactions, vol. xvl.,

1 p. 2«.

Digitized by Google

878 T ax Lancet.]

CLINICAL SOCIETY OP LONDON.

[Aebil 2,1887.

middle line, and by pulliness of the face and neck, and
enlargement of the lymphatic glands of both sides of the
neck. On the same day that the membrane on the tonsils
■was first detected, there was a trace of albumen in the urine.
A week later the membrane on the tonsils and the puffiness
of the face had disappeared, but the albumen in the urine
had greatly increased, so that it amounted to as much as
two-thirds. The child was never very prostrate, and after
a week’s illness he began to convalesce.

Sixteen days after the onset of the illness all signs of the
diphtheria had apparently disappeared, except that there
still remained a trace of albumen in the urine (this con¬
tinued for six weeks longer); but on this day it was noticed
that there was some difficulty in reading small print, the
letters becoming confused. No other evidence of post-
diphtheritic palsy, however, was then manifested. The next
symptom was the loss of knee-jerk on the twenty-fourth
day after the onset of the illness. This symptom persisted
most markedly for two months and a half, and was still to
be detected even three months later. On the thirtieth day
the voice assumed a nasal twang, and the movement of the
soft palate was found impaired; and some of his fluid food
occasionally came back through the nose. On the forty-
fourth day after the onset of the angina the voice was
reduced to a whisper, no fluids could be swallowed, and the
soft palate was absolutely immovable. All food (which was
now administered entirely in the solid form) was vomited,
and for twenty-four hours nutrient enemata had to be
resorted to. Going back to the thirty-seventh day, the
diaphragm was found to be contracting feebly, and on
the forty-fourth day it had entirely ceased to act. The
child’s condition was now critical with shallow irregular
respirations, with an occasional ineffectual cough and
very slight entry of air into the bases of the lungs;
the heart’s action was feeble, though regular, lie was
ordered one minim of liq. atropim every four hours. From
the forty-fourth to the forty-sixth day the condition was
extremely grave ; although sensible, he was drowsy and
prostrate, and bluish because of partial impairment of the
intercostal muscles, in addition to complete paralysis of
the diaphragm. From the forty-sixth day, however, he
began to improve; the action of the diaphragm and inter-
costals returned, he was able to take food (at first solid, but
soon thickened liquid food) by the mouth without vomiting
and without regurgitation, and his voice became stronger
and less nasal, and his power of coughing more effectual.
Three days later the pupils were dilated, the 6kin of the face
and chest flushed, and the child complained of thirst; he
had been taking drop-doses of liq. atropine for five days.
From this date he rapidly improved, and on the twenty-fifth
day after the onset his voice had resumed its normal tone and
strength, and there was no trace of albumen in the urine.
The knee-jerks, however, still remained absent.

Throughout the child’s illness there was no alteration of
cutaneous sensibility, and the intensity of the palsy fell
upon the muscles of deglutition and respiration. It was
only on the forty-fourth day that weakness was found
in any other muscles—namely, the external rectus of the
left eyeball, and in certain facial muscles of expression.
During the illness the left knee became nearly straight,
and three months after his admission he was discharged
with his leg in a Thomas splint, and getting about with a
pair of crutches and a high boot, lie returned to show
himself two months later, when the limb was straight,
though still wasted, and there were fairly free painless
movements at the j ditit. At this time the knee-jerk was
still feeble, otherwise no trace remained.

Remarks by Mr. Owen. —It is hardly conceivable that a
child could be more severely affected with diphtheritic
paralysis than was this boy/ and then recover. He had
paralysis of muscles of vocalisation and deglutition; the
stomach was so irritable that it could, for a while, hold no
food; the diaphragm was completely paralysed, and the
intercostal muscles, and even the heart itself, seemed to
threaten cessation of action. If cardiac paralysis can be so
often the cause of sudden death, even in children who are
apparently convalescent from diphtheria, one had almost to
expect its supervention in such a case as that just narrated.
The occurrence of cedema of the lungs and pneumonia was
also feared, not only because of the feebleness with which
respiration was carried on, but also because of the risk of the
passage of fluids through the paralysed glottis. The fact of
the nerves of the pharynx, larynx, heart, and stomach all
being affected betokens grave and extensive implication of

: the pneumogastric nerve; and the question is, of course,
whether this implication was central or peripheral. Had
I opportunity for microscopic examination of the medulla
i unhappily occurred, it is possible that haemorrhagic or dis¬
integrating patches might there have been discovered, and
so one might have been inclined to regard the paralysis as
| of central origin. But the temptation, on the other hand,
is strong to accept Senator’s theory of peripheral neuritis.
Thus, the primary affection was of the palate, tonsils, and
pharynx; nerves of these acpas come from the pneumo-
gastrics, glosso-pharyngeal, and sympathetic. The “neuritis
migrans,” as afflicting the vagus, has. already been referred
, to. The implication of the cervical sympathetic, extending
i through the carotid canal, reaches the ciliary ganglion (as
I shown by the loss of power of accommodation) and the
i abducens; whilst the partial paralysis of the facial nervea—

| a rare complication—would be explained through the asso-
! ciatiou of the branches of the portio dura with the soft
palate through the Vidian.

Mtdhcal Societies.

CLINICAL SOCIETY OF LONDON.

Contraction of the Metatarso-Phalangeal Joint qf the Great
Toe.—Acute and Chronic Internal Suppuration without
In oer. Glcndulai• Swelling curable by Arsenic.

An ordinary meeting of this Society was held on the
25th ult., Sir Dyce Duckworth, F.R.O.P., Vice-President, in
the chair.

Mr. Davies-Collev desired to call the attention of the
Society to the condition of Contraction of the Metatarso¬
phalangeal Joint of the Great Toe, of which he had been
unable to find any description in surgical writings. He had
had five cases under his care during the last nine years. The
j disease consisted simply of flexion of the first phalanx of the
great toe through 30° to 60°, with extension of the second
phalanx, and .-ome swelling and stiffness of the metatarso-
I phalangeal joint. All the cases were in young men. It
' seemed probable that later in life the deformity tended to
change to hallux valgus. There was no paralysis of the
I extensor proprius hallucis, and, as far as he could judge, the
| flexors of the first phalanx and the plantar fascia were not
I primarily affected. The two causes to which he would attri-
; bate the condition were—(1) an in j ury to the joint, followed
by contraction similar to that which is observed in the knee-
: joint; and (2) the pressure of short rigid boots upon an
abnormally long great toe. The condition is very painful,
and the patients walk with difficulty, resting their weight
upon the outer liorder of the foot. In those cases he had
subcutaneously divided the inner band of the plantar fascia
and the short muscles of the sole about three-quarters of an
incli behind their insertion, into the sesamoid hones and first,
phalanx. All these cases were for the time cur&, but one
returned in two years in a still worse condition as regards
flexion, with some outward displacement in addition—in
fact, in an incipient state of hallux valgus. In this case a
good result had followed resection of the metatarso¬
phalangeal joint. In two other cases be bad excised the
proximal half of the first phalanx, leaving the head of the
metatarsal bone, with the sesamoid bones, and interfering as
little as possible with the attachments of the muscles.
Primary union had followed, and the patients were soon
able to walk upon the flat sole. In one of them, twenty-
two months after the operation, there was no appearance
of deformity, add the patient had walked twenty miles
without auy difficulty on the day preceding. Mr. Davies-
Colley would .-urgest that the deformity should be .called
hallux flexus, nmClhat if the cases were too bad for treatment
with rest ami a iplint, resort should be had to subcutaneous
section of t he muscles and fascia, or, in more severe cases,
to the removal of the proximal half of the first phalanx.—
Sir Dyck I >u< a vfOBTH said that thesubjeotof.deflections of
joints was in; on fating to him ratberfrqm the point oj view
of such constitutional causes as gout, rheumatism,.And the
like, than from.;,such local .CMSSSjSS tight bQQti,repose
nil i in the teusation w*e dtWffww*—;ft?,
mentioned a ■ b of the kinjl in % yiHUlgsg^t;
lfi> colleague, Ufa Weiss, h#4 also met-^rith ariauar ossa

Tub Lancet,]

CLINICAL SOCIETY OP LONDON.

[Atait 2,188?. #70

He did not know whether the joints in all cases of deflection
exhibited internal changes.—Mr. Ciiartk as Symonds said
that he had had many cases of derangement of this joint.
The symptoms are pain, swelling of the joint and of the
articular ends of the bones. It occurred in young
boys, especially those with flat feet. Some of the
boys had a long great toe. As to anatomy, there was no
evidence of vsecularisation of the cartilage; the changes
were like those met with in the early stages of rheumatic
arthritis. He thought that overwork of the joint was a
cause.—Mr. Glutton inquired whether Mr. Davies-Colley
considered that the deflection was due to muscular con¬
traction. The ligaments seem to be the efficient causes of
the deformity in “ hammer toe,” and he suspected that the
change described by Mr. Davies-Colley wa9 allied in its
pathology, and was the outcome of subinflammatory
changes, chiefly in the ligaments.—Mr. H. Caylby said that
bare-footed races had the toes in a perfectly straight
direction, although flat-foot was very common amongst
the natives of India.—Dr. B. O’Connor thought that the
extensor tendons bad some share in the causation of the
hallux valgus.—Mr. R. J. Godlbb said that in examination of
three contracted Angers he had fqund the cartilage vascular
and eroded where it had been in contact with the capsule. He
had seen mild coses of this kind'; the cause was unknown.—
Mr. A. E. Barker had removed a wedge-shaped piece from
the inner aspect of the head of the metatarsal bone for
hallux valgus. This would probably be a better operation
than removal of a portion of phalanx, by which the joint
would be opened.—Mr. Davibs-Colley, in reply, said that
at first he divided all the soft parts; the next time he
performed complete excision of the joint; and lastly he
decided on removal of the proximal half of the first phalanx.
The cartilage of the joints frequently lost its pearly lustre
aod was fibrous-looking; the ligamentous tissue was
thickened. The muscular contraction and the ligamentous
condition were secondary to the joint derangement. None
of the cases had flat foot.

Dr. Samuel West read some cases of Internal Suppura¬
tion, Acute and Chronic, without Fever. Case 1: Female,
aged twenty-one, admitted with a swelling on the lower
part of the abdomen and pelvis, with but little pain or
tenderness. There was no history of acute inflammation.
The swelling slowly increased, but the temperature was
never raised; there were no rigors and no sweatings. The
swelling was opened behind the peritoneum, and several
ounces of fetid pus evacuated, after which recovery was
rapid and complete. Case 2: Male, aged sixteen. Case of
suppurative pericarditis (described in the Medico-Chirurgic&l
Transactions for 1883), in which the pericardium was twice
tapped and then laid open. The boy recovered completely.
Tae temperature was never raised, either before or alter the
operation. Case 3: Female, aged ten. Case of suppurating
peritonitis (described in the Clinical Society’s Transactions
for 1885). The case was very acute. The abdomen was
opened, and fetid pus evacuated. The patient did not rally
after the operation. The post-mortem showed the case was
one of primary peritonitis. The temperature throughout
was not raised. Case 4: Female, aged forty-eight. Abscess
between liver and diaphragm and abdominal walls connected
with the rapture of a duodenal ulcer. The temperature was
not raised. Case 5: Male, aged thirteen. Case of empyema.
Twice tapped, with removal of twenty-four and ten
ounces of pus. Chest laid freely open. Recovery complete.
The temperature was normal throughout. Cases 2 aud 3
were very acute. In Cases 4 and 6 the development of pus
was very rapid. Collapse was absent in all. Though the
explanation is not forthcoming, the fact must be borne in
mind, for forgetfulness of it may lead to error in diagnosis. —
Dr.RiLB asked whether there was scope for the pus to move
about in the oases in question; the tension of the pus in the
abscess might influence the occurrence of pyrexia.—Dr.
Anobl Money suggested that au alkaloid, like antipyrin,
might counteract the influence of the pyrogenic agent when .
acute suppuration did not cause fever.—Dr. Charlbwood I
Tubnbb tnought it was not the pus, but something, probably I
micro-organisms, in the pus. which were effective in the j
causation of the fever.—Mr. Barker thought that informa- I
tion was .needed concerning the causation of subnormal
tempersbaeB, occurring at times when usually a high tem-
pwato» was registered. In a case of abscess of the brain a
very lowi^swtpeMture was registered at that period in the
^eniag^aAeo, .Kdth suppuration, it. was most common to
fiad hlgh^liwv-^KivSi Eva agreed with the suggestion

of Dr. A. Money, and thought that alterations in the state
of the wall of the abscess might alter the conditions under
which absorption took place. In some Cases the stomata
would become blocked, and the pyrogenic substance there¬
fore less easily absorbed. The evidence available went to
prove that no pus existed without the presence of micro¬
organisms. In suppuration without fever in serous mem¬
branes, the inflammation may be at first plastic, so that a
layer of lymph is formed first on the serous membrane, and
this may prevent absorption.

Mr. Frederick Treves read a paper on a Form of
Glandular Swelling which is cured by Arsenic. He drew
attention to the obscurity that attends both the pathology
and the clinical history of certain chronic glandular affec¬
tions. These affections aye covered by such terms as the
following: hypertrophy of glands symptoms, malignant
lymphoma, lymphadenoma, Hodgkin’s disease, and lympho¬
sarcoma. These glandular swellings are considered to be
uninflammatory, have no relation to scrofula or syphilis,
aud are clearly separated from the gland disorders that
attend leukaemia. They possess the common characters of
a slow origin without apparent cause, a slow but progressive
growth, and an absence of all inflammatory phenomena.
Histologically there would appear to be no means of dis¬
tinguishing one of these affections from another. Apart
from this, objection may well be raised to the termR hyper¬
trophy and lymphoma. Without limiting himself to any
special term, Mr. Treves desired to draw attention to the
clinical aspects of a certain form of non-leukremlc gland
enlargement that could be cured by arsenic. The patients
are usually past middle age; they present no peculiar con¬
stitutional defect; there is no suggestion of gout, rheu¬
matism, or scrofula. There iB no leukaemia. The neck is
usually involved. The gland tumours appear on both sides
without disturbances in the periphery. The masses vary in
size from a hazel-nut to a duck’s egg. They are soft, elastic,
homogeneous, movable, painless, and free from tenderness.
They show a disposition to spread without limit. The tem¬
perature is normal, and suppuration does not take place.
Mr. Treves gave instances of the cure of such oases by the
use of arsenic. The drug is given in the form of liq.
arsenicalis, commencing with a dose of flve minims and
increasing to twenty minims three times a day. The treat¬
ment has to be kept up for some months—one to six. The
glands waste, some few suppurate, and in such instances
the resulting sinuses heal without further treatment. In
cases where the whole neck has been filled with great
glandular masses the tumours have wholly disappeared
after a treatment of from four to six months. Some of
these cases, at least, would probably be covered by the term
Hodgkin’s disease. Mr. Treves concluded by an allusion to
Dr. Kobel’s paper on the treatment of malignant growth by
arsenic administered by the mouth, and also hypodermically.
—Sir Dyoe Duckworth was well acquainted with the
disease. A process of disintegration rather than of suppura-*
tion was very liable to occur in the glands. Arsenic was
very useful in some cases* but by no means in all. Injec¬
tions of Fowler’s solution were sometimes valuable, some¬
times useless. Dr. Warburton Begbie had praised chloride
of calcium in these affections. He did not agree that there
was a paucity of literature, and mentioned the works of
Trousseau, Gowers, and Southey. — Dr. Stephen Mac¬
kenzie considered that the surgeon had usurped the pro¬
vince of the physician. In some cases arsenic was extremely
useful, but in other cases of Hodgkin’s disease it was useless,
and the distinction between the classes could only be drawn 1
by a trial of the arsenic.—Dr. Payne considered that these'
cases of multiple swelling of the glands, so well known to
every physician and designated as Hodgkin’s disease, could
not be the same disease in all cases. Cases so diagnosed
have been found post mortem to be caseous degenerations. A
distinct poison or cause must have been atwork, in many cases
doubtless the tubercular virus. A giant-celled structure was
often to be detected in t.he glands. Reference was mode to
a paper in the Transactions of the Pathological Society by
Murchison.—Mr. Arthur Davies bad had considerable suck
cess with the chloride of calcium, which, as Dr. W. Bagbie had
written, must be employed for a long period and in large and
gradually increasing doses. Used in any other way the draff
could not be said to have had a fair chance.—Mr. C. SyHoNDS
said that he had cured cases of the kind occurring am-mgst;
children and others by the employment of arsenic? but he
knew of no characters by which to distinguish the remedi¬
al)'e from the irremediable classes.—Mr. Tbxvbb, in rapljy

580 Tecs Lancet,]

MEDICAL SOCIETY OF LOUDON.

[April 2,1S87.

said that he alluded only to a certain class of cases occurring
in persons of either sex past middle life, and in which there
was no suspicion of inflammation about the enlarged glands.
The suppurations mentioned only developed after the
administration of arsenic had been begun.

MEDICAL SOCIETY OF LONDON.

Hereditary Tremors. — Random Symptoms from Cerebral
Syphilis.—Facial Monoplegia. — Post-hemiplegic Chorea.
—Jacksonian Epilepsy .— Ulceration of Palate.—Sarcoma
of Tonsil.

A clinical meeting of this Society was held on Monday
last, Dr. Hughlings Jackson, F.R.S., President, in the chair.

Dr. Samuel West showed a case of Hereditary Tremors
in a man aged thirty, in whom the fine movements of the
hand were first noticed at the age of eight years. The
father was “ shaky,” and died at the age Of fifty-eight
of paralysis. The tongue and ocular muscles were not
affected. The tremors had the character of those seen in
delirium tremens. The case was one of the same group
shown by Dr. West last year.—Dr. Ewart asked what Dr.
West’s views were as to the pathology of the tremor.—
Dr. Hadden said that the handwriting was a fair copy, and
did not show signs of tremor.—Dr. Herringham alluded to
the tremors that occurred in the hand after carrying heavy
weights, and thought there was a resemblance to those seen
in the man.—Mr. Hill said that the tremors were akin to
those seen at the onset of the hypnotic state when arti¬
ficially induced.—Dr. Hughlings Jackson thought the
cases Dr. Samuel West described formed a group of family
nervous diseases, other groups being Friedreich’s disease,
pseudo-hypertrophic paralysis, &c. He believed that the
inheritance of a tendency to diseases was not that of a
tendency to any pathological changes, but the transmission
of small organs, of organs having too few functional elements.
Insanity was often a family disease, and he believed that
those who inherited a proclivity to it inherited a brain of
which the functional elements of the highest cerebral centres
were few. He could apply the same principle to the other
family diseases alluded to, believing that some parts of the
lower divisions of the nervous systems of those succumbing
had fewer cells or fibres, or that in certain muscular regions
there were fewer muscular elements. He thought that
tremor always implied—that is, always coexisted with—
paralysis. In the artificially induced tremor Dr. Herringham
had mentioned, that from carrying something heavy, there
was, he held, paralysis in the sense of loss of some move¬
ments of the hand and over-development,of other movements
of the same muscles—that is, tremor.

Dr. Hughlings Jackson showed a patient who had a
random association of Nervous Symptoms from Syphilis. A
man, thirty-four. Primary syphilis five years ago, followed
by sore-throat; palate perforated three years ago. Fit of
some sort five years ago. Present condition: No sense of
smell; taste good; hemianopia; left fields blind [chart by
Dr. James Anderson exhibited]; optic discs normal; slight
distortion of the face to the left, with twitching in region
of right zygomatici, and narrowing of the right palpebral
aperture (relics of old Bell’s facial paralysis?); paralysis
and wasting of the right half of the tongue, with turning
of its tip to the right on protrusion, and to the left when
on the floor of the mouth; deafness of the left ear. The
palate was fixed to the back of the throat, the communica¬
tion of the mouth with the nose being by a hole. The
random association of nervous symptoms would, Dr. Hugh¬
lings Jackson said, were there no direct and obvious evidence
of syphilis, point to intracranial syphilis. With paralysis
and wasting of one half of the tongue there was nearly
always panJysis of the palate and vocal cord on the same
aide. In this case, for physical reasons, palatal paralysis
▼as not demonstrable. Dr. demon at the meeting examined
the. larynx 4 ad found.no paralysis.—Dr. F. Semon said that
d cdrtlcal hasten involving the V phonation centre ” oould not
(uraae^unflataralJaryngeu palsy. Stimulation of one centre
m tbe«art*snlwAy« <Jauaed adduction of both cords.
l Dr. jto&axCKos Jagksom also showed; a patient

before the attack on Feb. 8th, in which, with right hemi¬
plegia, he was aphasic. One peculiarity of the case was the
rapid disappearance of the paralysis of the limbs (two
hours), and of the aphasia (about two days); the patient
first regained “ yes” and “no.” When admitted (Feb. 11th)
he had right facial paralysis and paralysis of the right side
of the palate. He did not feel very light touches on the
right hand, but did the prick of a pin. There was no
paralysis of the vocal cord (Dr. Semon). The patient’s
speech (except that he was occasionally at a loss for a word),
reading, and writing were good; his articulation Was con¬
siderably defective. He had lost smell on the left side one
month. The facial paralysis was more marked than Dr.
Hughlings Jackson had ever before seen it from any destruc¬
tive cerebral lesion. He exhibited photographs of the face
taken by Mr. S ted man, showing among other things the great
difference in the facial attitude between a “ constructed"
smile and a real smile when amused (a very important thing
pointed out by Dr. Gowers). Dr. Hughlings Jackson had
not seen such palatal paralysis as existed in this patient in
any other case of cerebral facial paralysis, nor indeed in any
sorb of facial paralysis; it was as marked as the one-sided
palatal paralysis occurring in (its usual association) cases
of paralysis of the tongue and vocal cord. The unin¬
structed might have mistaken the case for one of Bell’s
facial paralysis with paralysis of the palate, a combina¬
tion of symptoms he (Dr. Jackson) had not yet met with.
The electrical reactions were normal. Dr. Hughlings
Jackson did not hold the current doctrine of abrupt localisa¬
tion, and considered that the transitory paralysis of the
right limbs in this case showed that the part of the brain
damaged represented movements of those limbs, although to
a trivial extent. No doubt, too, the vocal cords are repre¬
sented in the region diseased, but their escape is (Horsley
and Semon) accounted for by their being also fully repre¬
sented in the other half of the brain. That the vocal cords
might act well when (Horsley and Semon) one of the two
phonation centres was destroyed showed that there might
be loss of (one half of) the movements of a region without
disability in the muscles of that region.

Dr. Samuel W est sho wed a case of Post-Hemiplegic Chorea,
and described the character of the movements, their violence,
the shortening of the leg, and the long interval between the
hemiplegia and the hemichorea. The movements had some¬
what the characters of athetosis. As the result of a fright by
a dog the movements involved the face, and increased in
violence.—Dr. Herringham said the movements had the
character of “ struggling.”—Dr. Ewart mentioned a case in
a girl aged nine, which was congenital.—Dr. Simms said that
sunstroke was very rare in the East Indies, and doubted
whether this was the cause of the cerebral disease.

Dr. S. West also showed a case of Jacksonian Epilepsy in
a woman. The fits began in May, 1885. She had had ** pins
and needles ” in the left side. The fits had increased in fre¬
quency. The fit commenced with movements in the thumb
and fingers, then the arm, then the leg, and the whole side
twitched in the order mentioned. Some paralysis ensued on
the fits. She had pain in the right side or the parietal
region. There was double optic neuritis. The deep reflexes
increased in degree. There was permanent left hemiplegia,
involving the arm and leg. Did the lesion spread widely, or
was it more deeply situate, and involving the fibres pro¬
ceeding from the cortex?—Dr. Hughlings Jackbom thought
that there could be no doubt of the correctness of the
diagnosis Dr. Samuel West had made. Optic neuritis, the
best evidence of gross organic disease within, the cranium,
was not decisive of such disease. The kind of epileptiform
attack the patient had did not necessarily dependon cerebral
tumour; but the two things taken together, double optic
neuritis and the epileptiform seizure, would make him feel
as sure as he could be of anything medical that there: was a
cortical or subcortical tumour in Dr. West’s patient. He
urged that, since optic neuritis might exist with go6d. night,
the ophthalmoscope should be used by routine hr oases of
nervous disease. > I* *

Dr. de Havtlland Hall read two cases of Ulceration of
the Palate and Pharynx occurring in young mett aged-nine-
teen and twenty-three. They Were of syphilitic ozagfee, and
possibly of the hereditary variety.—Mr. Lennox BjbOwne
referred to a case of ulcerated gusuna of< thMphprynx.
in which there was choroiditis and nofcAedf toMto-Mr.
MArmaduke Shbild referred to -oasesuf Jdian—f|»#hich
the evidence of syphilis was sttgfe&thdtlAit^MKfllktaiu
that the disease was syphilktellsstfcfltfeednatipiUtj

tax LANcar.J

WEST LONDON MEDICO-CHIBUBCHCAL SOCIETY.

[Apbii> 2,1887. 681

of the dependence of the sloughing in some cases on & blood-
poisoning not syphilitic.

Mr. Lennox Browne showed a patient the subject of
Lympho-9arcoma, which commenced in the left tonsil,
extended down the pharynx, and invaded the larynx. The
patient, who was under the care of his colleague, Dr. Dundas
Grant, at the Central London Throat and Ear Hospital, had
suffered from soreness and discomfort since the harvest of
last year, and attributed his trouble to the irritation of the
ears of barley. Deglutition was somewhat interfered with,
bnfc there was no distress in breathing, nor was the voice
affected, though his articulation was somewhat thick. A
large portion had been removed by the dcraseur, Hartmann’s
forceps, Loewenberg’s curette, and raspatory. Galvano-
cautery had been afterwards applied. There was already
slight recurrence, and a more radical attempt at removal
was contemplated. Mr. Browne added that these cases
were by no means so rare as generally supposed. Butlin
could only collect nine in 1882, two of them being patients
shown by Mr. Browne at the Pathological Society. The
present was the third case which had presented itself within
the last six months at the hospital, and the fifth case of
malignant disease which he had seen in the past twelve
months, one of the others being epithelioma. It was some¬
what rare to see sarcoma of the tonsils extending so far down
tbelarynx. 11 was a question whether the lymphatics ought not
to be rem<Tved in any attempt at radical removal of the growth.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.

Urethral Calculus.

metal instrument was passed from the perineal wound back¬
wards along the urethra till it projected through the meatus
as no instrument could be passed in the usuqd way. Then,
by attaching the rubber catheter to t^e projecting metal
one and withdrawing the latter, the soft catheter was pulled
along the urethra, and so out of the perineal wound and
then into the bladder. The rubber tube was subsequently
replaced by a No. 11 gum catheter, as the former was con¬
stantly slipping out. This remained in situ a week, and
then a No. 10 metal instrument was passed along the urethra
from the meatus into the bladder; and in doing so, there
again appeared a sensation of its coming in contact with
some hard substance, hut nothing definite was made out as
to the cause. A week later, when all the swelling had dis¬
appeared, a thickening was found by the author around the
urethra, just at the junction with the anterior margin of
the scrotum. On passing a probe, it came in contact with a
hard substance, which was broken into pieces and extracted
with a director. By the beginning of November, both the
wounds had healed, and the patient was himself able to pass
readily a full-sized catheter.—Mr. Keetley said that the
abscess was on the left side of the penis; no bougie or
catheter touched the calculus. It was an open question
whether the calculus was an impacted one, or whether it
was a concretion lodged in a large lacuna.—Mr. Pick re¬
marked that the ease seemed to him one of gonorrhoea,
followed by stricture and dilatation of the urethra behind
the stricture, into which a calculus had passed. Had any
symptoms of renal colic been noticed? He congratulated
Messrs. Keetley and Benham on their case.—Mr. Benuasj
replied. ______

At a meeting of this Society on March 4th, Mr. Benham
read a paper on a case of Impacted Urethral Calculus,
followed by Urinary Abscess; Perineal Section; complete

recovery. W. W-, aged thirty-six, was just convalescing

from a severe, attack of double pneumonia when he drew
Mr. Benham’s attention on Sept. 26th last to the fact that
his penis was much swollen, and that he was unable to
micturate. He had a slight attack of gonorrhoea some
eighteen years since, which lasted only for about seven days,
lie suddenly noticed a few months ago that the stream
during micturition was smaller, and that the act was
accompanied by a tickling sensation, almost culminating in
pain at the root of the penis. The urine was normal. The
author found the prepuce swollen, the upper portion being
extremely cedematous and entirely obliterating tj»e orifice
of the urethra. The glans penis was much swollen, more
especially towards the left side. After many unsuccessful
attempts to pass a soft catheter, about three ounces of urine
dribbled away, which gave relief; but on the following
day, finding that the swelling had increased, including the
scrotum, which was now about twice its normal eize,
that the retention was complete, and that the bladder was
considerably distended, and as the author did not consider
that there would be any advantage-in aspirating the bladder,
and as he believed that the operation of perineal section was
necessary, he called Mr. Keetley in consultation. After
Mr. Keetley had been unsuccessful in passing any instru¬
ment, it Was resolved to lose no more time, and perineal
section was forthwith performed. The median operation
was chosen. There was considerable difficulty experienced
in passing Syme’s staff, which gave, when in situ, the sen¬
sation that it was in contact with some metallic substance
along the side of the urethra,' and on withdrawing it after
the incision was made it was found that its lower or
diminished portion had been literally bent from the straight
lino. A soft rubber tube was introduced through the
perineal wound into the bladder and secured' there, and
linseed poultices kept constantly applied to the part. On
the third day from the operation the oedema of the scrotum
had somewhat subsided, but the swelling along the left side
of the penis bad considerably gained ground, giving a sen¬
sation to the touch of distinct fluctuation. An incision was
accordingly made over the most prominent part, and about
eight drachms of fetid pus evacuated. On passing a probe
into the incision, it was found to go downwards into the
cedematous substance of the scrotum, and upwards it com¬
municated with the urethra. Poultices were kept con¬
stantly applied. And the,cavities were frequently syringed
■with a weak solution of carbolic lotion, while the
Madder was washed out twice daily with boracic acid
lotion. Two days later, as the swelling had diminished, a

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

At the meeting on February 17th, Dr. Cleaver, President,
in the chair, the following papers were read: —

Thoracic Aneurysm. —Mr. Coomb* showed the specimens
of a Thoracic Aneurysm taken from a patient, aged forty-
six, under the care of Mr. Jackson in the infirmary. The
aneurysm sprang from the anterior wall of the ascending
and transverse portions of the arch of the aorta, and pene¬
trated the chest wall to the left of the sternum by com¬
pletely eating through one of the ribs. The patient was a
scissors-forger, and had noticed the tumour forming for about
twelve months, but had felt little or no pain or incon¬
venience from it His family and previous histories were
very good, and be had never had syphilis. The tumour
ruptured by ulcerating through at a small spot externally,
and the patient died about three hours afterwards, the
bleeding being somewhat controlled by a gutta-percha cap,
which was used as a support to the tumour. The diameter
of the tumour was about four inches.

Aortic Disease.'-— Dr. Dyson showed specimens from twq
cases: 1. A brewer’s drayman, aged forty-seven. During
life a well-marked high-pitched musical murmur (aortic
diastolic) was heard, and a thrill felt all over the front of
the cheBt. At the poet-mortem the aorta-was very exten¬
sively atheromatous and the valves much thickened, but
no cause was found to account satisfactorily for the
musical tone of the murmur. 2. A woman, aged fifty-one,
who had had rheumatic fever. The valves were much
deformed, one being split down the middle, the segments
being free to flap in the blood stream. The murmur in this
case was a typical aortic diastolic one, with no musical
quality. Both oases hod Bright’s disease, and died of uramia.

Supra-pubic Suppuration. —Mr. Atkin read notes of the
case of a woman, aged twenty-seven, who had suffered from
nearly constant vomiting for two months. She was very
emaciated, and complained of great pain in the womb.
Pulse 120: temperature 100°. She stated that the illness
began with griping pains, followed by a discharge of blood
from the vagina. Ether was administered, and the os found
firmly closed, but soft, and the uterus not enlarged. Having
emptied the bladder, an exploratory incision was made above
the pubes, and a couple or ounces of fetid pus evacuated.
The cavity proceeded backwards, lying over and roofing in
the bladder. It was carefully drained, and the woman
gradually recovered. Mr* Atkin drew attention to the
anatomy of the so-called cayum Retzii described by Ilyrtl,
and commented on the existence of a space in the sub-
peritoneal tissues. The doubtful origin of the suppuration,
the lowness of the temperature, and the constancy of the
vomiting were alluded to.

682 tfflB LAUCEt,"]

NOTICES OP BOOKS.

[AbRlL 2,1887.

Plumbism — Dr. Porteb, in introducing a discussion upon
the subject of the prevalence of plumbism from the action
of the Sheffield water upon leaden pipes and cisterns,
alluded to Dr. White's exhaustive report to the Health
Committee last year, directing attention to the danger at
present existing, and spoke of his own experience in refer¬
ence to its effects. He showed that out of a total of 1068
out-patients who had come under his own care at the Public
Hospital and Dispensary during the past year, 14 had suf¬
fered from plumbism attributable to drinking contaminated
water; while 13 more had presented a more or less defined
“ blue line,” though treated for other complaints. Of these
27 cases, 3 had come from the country, away from the
Sheffield water-supply; but of the remaining 24 no less
than 16 patients lived in a district of the town, where the
drinking-water had been shown by Dr. White to contain
more lead than was the case with samples of water from
other neighbourhoods. Dr. Porter also alluded to the pre¬
valence of cases in the Rummer and autumn months, 17
occurring at that period of the year. In conclusion, he said
that, in his opinion, the gravity of the danger had been
underrated rather than exaggerated.—Remarks were made
by Dr. Martin, Mr. Pye Smith, Mr. Garrard, Dr. Keeling,
Dr. White, Dr. Dyson, Dr. Morton, Messrs. Reckless, and
J. Williams.

flatters of looks.

The Croonian Lectures on some Points in the Pathology of
Rheumatism, Qout, and Diabetes. Delivered at the Royal
College of Physicians, London. By P. W. Latham, M.A.,
M.D., F.R.C.P. Pp. 123. Cambridge: Deighton, Bell, and
Co. 1887.—The first part of this little work positively
bristles with chemical formulee, many of them highly com¬
plex and requiring the knowledge of an expert to under¬
stand their relationship to each other, and the significance
of their presence in the body. It takes some time to
pronounce such words as • dimethyl-ketone-cyan alcohol,
amido-diethyl acetic acid, and para-oxyphenyl-amido-
propionic acid, and certainly an equal time to make sure
that we are not thinking of some closely allied but not
exactly identical body. The second lecture is occupied with
the materies morbi in rheumatism. Starting with the lactic
acid theory, Dr. Latham found that it was unsatisfactory,
and was led to what he now considers to be the true cause
of the disease by the perusal of Mitchell’d work on the
effects of injuries of nerves. He had noticed condition and
circumstances which seemed to show that the central
nervous system played a part in the phenomena of gout
and rheumatism, and evidence gradually accumulated that
the symptoms of these diseases were mainly owing to the
presence and action of uric acid in the blood. He takes
great pains to show how this acid may be developed by
impaired digestion, and how, when circulating in the body
as ammonium urate, it meets with sodium salts and forms
sodium urate—the form in which it is deposited about
gouty joints. His view is shortly expressed in these words:
As in diabetes the essential fault lies in the inability of the
system either in the liver or elsewhere to effect the
metabolism of glucose, which then passes into the cir¬
culation and is discharged by the kidneys, so in gout
or gravel the imperfect metabolism of glycocine is the
primary and essential defect. Unchanged, it passes from
the alimentary canal or elsewhere into the liver; then,
under the action of the gland, ft is conjugated with
urea, resulting from the metabolism of the other amido
bodies, leucine, &a, and is converted into hydantoin.
It then passes on to the kidneys, to be combined with
other molecules of urea or biuret, forming ammonium
urate, a portion of which overflows into the circulation,
apiLia converted ii*to sodium urate. He goes on to point

t&afr tfrepresence of urio acid in excess affects the vaso¬
motor oentree, which, losing their tone or activity, cease to

exert their proper influence over the vessels of certain
tissues and regions of the body, and the symptoms of gout
and rheumatism result. The practical application made by
Dr. Latham of ins theory is, that in the treatment of these
diseases the formation of the urates is to be prevented as
far as possible. The glycocine should be eliminated from
the system as swiftly as can be effected, and he points out
that this may be in part accomplished by the administration
of bee zoic acid, which seizes upon the glycocine or its ante¬
cedent, and passes out of the system as hippuric acid, in
part also by the administration of salicylic acid, which he
administers in do3es of twenty grains till some physiological
effects are produced. He places the patient on light farina¬
ceous diet, keeps him cool, and prescribes some purgative
medicine.

Diseases of Bones and Joints. By C. N. Macnamara,
F.R.C.S, Eng., Surgeon and Lecturer on Surgery at the
Westminster Hospital; Examiner in Surgery, University
of Cambridge, kc. Third Edition. London: J. and A.
Churchill. 1887. — This book first appeared in modest
form as a series of actually delivered lectures; then it
| was somewhat enlarged; and now it comes ty us as a
big book, a systematic treatise on an important branch
of surgery. Mr. Macuamara has read widely and worked
hard for this edition; he has rewritten much, and added
more, and has enriched his text with numerous excellent
clinical records. The book is eminently readable, and
is full of valuable information. Mr. Macnamara has lhng
devoted special study to diseases of bones, and although
we cannot endorse all his views, we ajre glad to welcome
such a worthy expression of them. The engravings and
woodcuts arc good, and some excellent chromo-lithographs
are a new feature in this edition.

The Treatment of Placenta Presv'ui. By James Murphy,
B.A., M.D., Surgeon to the Sunderland Infirmary, Lecturer
aud Examiner in the University of Durham, Newcastle-on-
Tyne. Printed at the Sunderland DailyJoumalOftice,Cl*jton-
street.—Dr. Mnrphy has very properly published separately
his paper on Placenta Prcevia and its Treatment, read before
the Northumberland and Durham Medical Society. We com¬
mend it to the careful study of all our readers, and especially
of those who are engaged deeply in obstetric practice. Dr.
Murphy is one of the most ardent advocates of early delivery
by the induction of premature labour, “ as soon as we know
that we are dealing with a case in which the placenta pre¬
sents, after the seventh month, and even before then, should
the bleedings be serious, frequent, or continuous.” His
success may be estimated by a record of thirty cases, without
one death. His views and methods are fnlly described in
this paper.

The Journal <f Physiology. Edited by Highabl Foster,
F.R.S. Vol. VIII., No. 1. Cambridge Scientific Instruments
Company, Cambridge. — This part contains four papers :

1. Jones Lloyd, on the Variation in the Specific Gravity
of the Blood in Health. He measures it by drawing up
with a syringe or by capillary attraction a little of the
blood obtained from pricking the finger and discharging it
into a mixture of glycerine and water of known specific
gravity, and noticing whether it rises or falls. The effect*
of period of day, exercise, food and drink, &c., are given.

2. Sydney Ringer and Dudley Buxton, on the Action of
Calcium, Potassium, and Sodium Salts upon the Heart of the
Eel, and upon the Skeletal Muscles of the Frog. 3. Sydney
Ringer, on the Action of Lime, Potassium, and Sodium
Salts on Skeletal Muscle. 4. Pye-Smith : Observations upon
the Persistent Effects of Division of the Sympathetic in the
Cervical Region.

Burdett's Official Intelligence. Vol. V.—This book, which
now enters upon its sixth year of publication, is too well
known to stand in need of any description, or, so far as the

Digitized by GoO^lC

Thh Lancet,]

NOTICES OF BOOKS.—ANALYTICAL BBCORD8.

[Apbil 2, 188T. mi

investing public is concerned, any recommendation. The
mass of information which it presents is so vast, and the
standard of accuracy attained is so bigb, that in its own
department it enjoys an unquestioned pre-eminence. How
large this department is may be gathered from an interest¬
ing summary inserted among the prolegomena, which gives
the total amount, divided into various classes, of the
eeeurkiea quoted on the Stock Exchange. The aggregate
comes out at the overwhelming figure of £ 3 , U98,182,369, or
within a trifle of four billions sterling. All these are not
only summarised in the volume before us, but every issue is
separately scheduled, and minute particulars are given on all
the points to which an intending investor looks. Mr.
Burdett’s book is, however, by no means only a vast schedule
crammed with statistics. What we have above termed its
prolegomena comprise a series of articles on fiscal subjects
of general interest, which will prove not only a valuable
repertory for the publicist, but also a most useful source of
suggestion and information for the general 'reader. With
this object the editor has made choice of such subjects as
the progress of legislation or the course of public events has
brought to the fore, and it seqms to us that his selection has
been justified by the happiest results. The present volume
contains, among others, dissertations on such subjects of
immediate interest as legislation as to railway rates and
fares, gas prices and profits, tramway enterprise in the
United Kingdom, and a review of the legislation of 1686.
These and other kindred subjects are all treated with a
fatness of information which will give to the articles a
permanent value, while at the same time they are marked
by a terseness and literary style which take them altogether
out of the category of mere monographs.

Dictionary of National Bioyraphy. Edited by Lsslib
Stephen. Vol. X. London: Smith, Elder, and Co.—The
tenth volume of this Dictionary has just been issued, and
extends from Chamber to Clarkson. ( Its contents, with regard
to literary style and, so far as we have been able to judge,
accuracy, are fully equal to those of the preceding nine
volumes, upon each one of which at the time of ,its publica¬
tion we have felt justified in bestowing high praise.

Ellis t Irish Education Directory and Scholastic Guide for
1887. Dublin: E. Ponsonby.— This Directory, now in its
sixth year of issue, contains full information as to the Irish
universities and professional schools, and the institutions in
Ireland for promoting Intermediate, Technioal, aqd Printary
Education, with complete alphabetical lists cf Irish colleges
and schools and copious alphabetical and classified indices.
By all interested in Irish educational work this book will
be found useful.

^naijrtical iUcortrs.

KOLA PASTE.

(Too*. 0Alt 1STY A Co., FUQHURCH-fiTRHKT.)

Thh kola nut which comes from the West Coast of Africa
oontains in addition to Btarch, sugar, gums, colouring
matter, &c., a considerable quantity of caffeine, and, it is said,
some theobromine. Messrs. Christy and Co. prepare from it
a cake resembling chocolate in appearance and to some
extent in taste, it is made up with cocoa fat, is unsweetened,
and by no means disagreeable. We have not as yet been
ahle to submit the preparation to thorough chemical exami¬
nation, but it is strongly recommended in heart affections
and nervous depression, as well as in dysentery. Its intro¬
duction is interesting, and it certainly merits trial.

HALTING WITH CASCABA 3AGRADA; H ALTO-VLBUBN IN i
MALTOCAERAGEBN.

(Th* Maatire MjLSDrjLCTUBi.vo Co., Bloomsbury.)

The ever-shrive Maltine Company send ua three more
new combinations of maltine. Ckseara sOgrads, obtained
from the bark of the Californian Mhawxmu purshianus, is a

valuable purgative and tonic. Dr. Garrod recommends it
for chronic constipation, especially with hnmorrhoids.
Each fluid ounce of the maltine contains one and a half
fluid dracluns of the fluid extracts. The usual dose is from
a half to t two. fluid drachms. ‘ Vibiyuinia the greenish-
yellow bitter resin of the Viburnum prunifolium. The
peculiar constituents of malto-oarrageen are yerbine, the
active principle of the Mexican yecba santa (Apemopsis
califo mica ) and carrageen, or Irish moss. The mixture is
emollient and expectorant.

EXTR ACTUM PANCRKATIS (Fairchild);

PANCREATIC TABLETS (thm-grain*) ;

PEPTON1SING POWDERS IN GLASS TUBES (five grain*). *
(Burroughs, Wjcllcomk, A Co., SxotfrHUiL.)

Both the tablets and the tubes supply convenient means
for the application of this well-known and valuable diges¬
tive agent. Each tube contains the quantity of powder
required to peptonise sufflciently a pint of milk. We have
tried tilts, following minutely the directions given, and in
three-quarters: ol an hoar the milk had in the faintest
possible degree the peptonic taste. It was apparently but
little changed, and we are convinced that infants would
take it* easily. When the milk stood for some hours com¬
plete peptonisation took place, and acetic acid no longer
yielded a precipitate, but tola is rarely necessary, and the
bitter taste is a great objection. The tablets contain a con¬
venient dose for use in intestinal indigestion ; one or two
may be taken an hour after meals. There oan be no doubt
as to the value of these preparations, or the trustworthiness
of Fairchild’s extr&ctum pancreatis.

TARASP.

(Richard Davies, Maddox-sirkkt, Loxdox.)

T&rasp is a natural aperient mineral water. It contain?,
according to our analysis, 1166 grains per gallon of nolid
matter, which consists chiefly of chlorides, sulphates, and
carbonates of magnesium and sodium. We also found
calcium, potassium, and lithium, aud a notable quantity of
bromine. It is a very powerful aperieat, and a complete
analysis of it would be interesting.

DEODORINB.

(W. T. Smith & Co.)

We have examined this preparation with great case, and
have been unable to discover any advantage that it possesses.
It is a neutral and very weak solution, containing only
0337 per cent, of solid matter. Added in rather large
quantities to a dilute solution of sulphuretted hydrogen,the
smell was not destroyed.

DftY 8 PARK LING COCA WINE.

(Oorbyh, Stackt a Co., Lohdo*.)

Bat that the coca taste is just perceptible, this might be
taken for ordinary dry champagne. It is an excellent
stimulant, and is well adapted for those who suffer from
nervous exhaustion. It is evidently made from good cham¬
pagne, with a small infusion of coca extract.

BRAGd'S PURE FLOUR OF EGYPTIAN LENTILS; BRAGG'S

PREPARED BAKED FLOUR FOR INFANTS AND INVALIDS.

(J. L. BRACK*, WlQMORl-flBfRRHT.)

The microscope shows no trace of adulteration in these
samples. They are exactly what they are described to be.
The alteration in the wheat starch granules effected by heat
is easily observed.

, CONDY'S POWDER.

(Co.\Dr A Mitchell, Limited, Turxmill-strekt.)

This is a powder containing a small proportion of alkaline
permanganate. It has no smell, and possesses of course the
advantages and disadvantages of the well-known Goody’s
fluid.

DE JONG’S PUHB AND SOLUBLE COCOA.

(DkBrve H. 6R Joxo, WoRmeRvekr, HoIlaxd.)

This is an excellent cocoa; quite soluble in cold water; and
free from starch and excess of fat. It is « very concentrated
preparation. ’ rr-

Digitized by CjOO^Ic

Tscfc Lancet,] THE PROPOSED RECONSTITUTION OP THE UNIVERSITY OF LONDON. [April 2,1867.

THE LANCET.

-tT. . . . ' 1 ' - ■ ".... — - :

LONDON: SATURDAY, APRIL 2, 1887.

■ i i •

The Special Committee of the Senate which has been
deliberating on the various proposals for reconstituting the
University of London that have been suggested by the
Association for promoting a Teaching University for London,
and by the Special Committees appointed by Convocation,
has at length presented its report to the Senate for con¬
sideration and approvaL The scheme laid down in this
Report will probably be adopted in all its important
particulars, as it is recommended by a large and most
representative committee including Sir E. Fry, Professor
Huxley, and ’Sir John Lubbock. It will therefore
become the most important busineea at the ordinary
meeting in May, unless a special meeting of Convocation
be summoned for .its consideration; but as an extraordinary
meeting at; an early date is already contemplated for the
discussion of a communication from the Prince of Walks
'on the Imperial Institute, and for taking steps for the
celebration of the jubilee of the University, the summoning
of another special meeting is most unlikely and inconvenient .
The new scheme differs from that drawn up by Sir E. Fry’s
Committee of Graduates, which would have materially
increased the representation of the teaching element, and
also ffom Sir P. Magnus’s modified scheme, which was
passed by the Graduates in Convocation, and may be
looked upon as a tertium quid, and will probably satisfy
neither the teachers nor Convocation. Its production is,
however, a distinct proof that the present constitution
'of the University does not satisfy the most active and
influential members of the Senate, and that the optimistic
Adulations of its work and mission which have already
appeared, and which will be repeated ad nauseam in
this its Jubilee year, are not looked on as quite justifiable
even by the Senate itself. So far, the agitation for a local
University in London has borne good fruit, and has justified
its existence. The nature of the changes contemplated by
the new scheme Will be shown by a comparison of ite
proposed objects and those of the University as it now exists.

The original Charter of the University merely empowered
“ certain persons eminent in literature and science ” to act as
a board of examiners, and to confer degrees in all branches
of learning, except Divinity, on students in University and

Cdlleges and some other affiliated institutions named
in tjbe Charter; but in 1858 this restriction of studentship to
certain colleges and schools was abolished, save in the
case of candidates for medical degrees, and the University
became an Imperial Examining Board open to all comers,
.collegiate or non-collegiate. In the scheme now proposed
.ttys purposes of the University are to be so defined as
to include, “in addition to tbe existing purposes, the
promotion of regular. aad^ffberit education throughout
ft#.^Nasty’s dominions,egjaciajly. in. tlje metropolis
Sad its neighbourhood;! dp: the duties of

both an Imperial F.Tamfortflg ^oard and a looal'C ri twg gRy .

We cannot conceive of the possibility of its combining
these functions. A local University promoting regular and
liberal education in the metropolis and its neighbourhood
must control and regulate studentship and curricula of
study in the institutions within this area, whilst the
present University can never return to its early mission
and demand regular certificates of study from its candi¬
dates. Either these certificates must be a sine qud nan
before the degree can be conferred, as is the case in every
university to which the name is properly applied, or they
must be altogether dispensed with, as at present in the
University of London. If teachers control the University
definite courses of study will be imperatively laid
down, and attendance thereon for a suitable period will
be insisted on ; whereas if “certain persons eminent in
literature and science” continue to guide the fortunes of
the University on the lines laid down by Lord Brougham,
and according to the views now predominant in Con¬
vocation, it must remain an Examining Board open to
all the world.* We fear these changes, not altering the
character of the University, but merely, and to a small
extent, its ruling body, by allowing certain restricted powers
to representatives of associated Colleges, will only serve as
an excuse to delay the formation of a real Teaching Univer¬
sity in London. The details of these changes most be
left for farther discussion in our next issue.

What is fever? This—which is the commonest and most
constant indication of departure from health, which has in
all time pressed itself upou the attention of the clinical
observer—remains at the present day almost as mysterious
as in the dawn of medlciue. This ignorance certainly does
not arise from lack of observation or experiment; and it
cannot be said that hypotheses have ever been wanting. It
must be conceded, however, that hitherto no sufficiently
satisfactory explanation, which shall embrace the whole
series of phenomena special to the febrile state, has been
afforded. Nay, even as regards the cause of the one most
striking phenomenon—the rise in the temperature of the
body—there is no common agreement. It is not so long
since the late Dr. Moxon, whose love of paradox was great,
pointed out how little oertain knowledge we possessed upon
the nature of fever, in a lecture published in this journal
(The Lancet, Dec. 2nd and 9th, 1882). We felt bound to
remonstrate with the line of argument he adopted, although
there was some justification for it, since few subjects have
been more at the mercy of theorists or made more the sport of
ingenious minds. It must, therefore, be deemed a fortunate
circumstance that we are enabled to review side by side the
most recent teachings on the subject as developed in Dr.
MacAlistkr’s Gulstonian Lectures and Dr. Maclaoan's
■essay on Pyrexia and Hyperpyrexia, which have just
appeared in our pages. The standpoint of the two is
different, and their conclusions are not in entire accord; but
they represent the outcome of physiological teaching
upon an i mal heat, and each suggest, according to their
respective views, hypotheses more dr less satisfactory
to explain the nature of fever. Of the two, Dr. Maclagan
takes a somewhat wider view; whereas Dr. MacAustxb
presents us with the oonditions of the problem expressed in
the terms of scientific analogy, and lias, happily, availed

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TH* liANOBT,]

THE NATURE OF FEVER.

[Apmi. 2, laar.

himself of the principles of evolution as expounded by
Hnnnnai Spbnobb and applied to pathology by Hughlings
Jaoksojt. There is, however, a more striking, difference
between their mpdea of dealing with the subject than this,
end it is one which strikes at the root of the matter. To
make it dear it will simply be necessary to briefly indicate
the main lines of the respective theses.

Dr. Maclagan starts with the proposition that in fever
the normal balance between tisane formation and tissue
disintegration is disturbed. As results of the latter, he in¬
cludes heat among the eliminated products like urea and
carbonic acid, which are got rid of at the same time. Bat
the b&lsaoe between the production of heat and its elimina¬
tion is maintained in health, and the temperature of the
body is stable. He rejects Tbacbjb’s theory that fever is due
to heat retention, showing that, except in the initial stage,
such, a condition would be ineoaristeat with the ordinary
thennometcLc course of pyrexia, and that, aS a matter of fact,
there is increased elimination of heat, due, as he expresses it,
to heat acting as a stimulant to heat elimination, on the
same principle as carbonic acid excites respiration and urea
excites the renal secretion. The hypothesis advanced by
Dr. Qiid, that in fever there is a liberation of heat which has
been rendered latent in the prooess of tissue formation, is j
held by Dr. Maclagan to be inadequate to account, for the
excessive heat production that occurs. Again—and this is
apparently the leading point of Dr. Maolag AK’seasay—he
contends that the phenomenon of hyperpyrexia is distinct in
its origin from that of pyrexia^ the “ combustion theory”
will not account for it; the nervous symptoms which
characterise it are not due to the hyperpyrexia, but are in¬
dicative of the nerve disorder that produces it. Hyper¬
pyrexia demands the intervention of the nervous System
for ka explanation; whereas, apparently, this is not
necessary far the explanation of simple pyrexia. The
thermic centre, which by the experiments of Wood has
been localised in the upper part of the medulla, exerts
an inhibitory effect upon heet production; and if it be
damaged or paralysed no limit is placed upon the extent
to> which the temperature, no longer regulated, may
rise. This paralysis may be the result of undue stimu¬
lation, as suggested in heat apoplexy and in rheumatic
hyperpyrexia, where Dr. Maclagan favours the. view that
there is increased muscular metabolism, mid therefore
increased heal formation, with the liability tooyer-atimula-
tion of the thermic centre. Yet he does not seet the neces¬
sity far adopting axy such intervention of the narvohs
System in the case of other pyrexim. For their explanation,
the neurotic theory is, according to him, superfluous. All
may be explained, in the terms of metabolism, oa the com¬
bustion theory. Thus in the specific fevers he will not
admit that there is any toxic action on the heat-controlling
oentre to acoount for the disorder that is induced, bat that
the eontagium consuming the store albumen intended far
the repair a£ the tissues, and the water needed for tissue
metabolism, is the indirect cause of the increased .elimina¬
tion, cf. excretory products, including heet—the tisanes
feeding,; as it were, upon their own enbetanoe, for, lack of
reptatiahment foam hhe albumen normally destined for

thinlii -ji'i . ; . . .. . ... ■ •. v. 5 1 ■ r

2 »B new wo tarn to the doctrines enunciated by Dry

MacAustbb, we are enabled to see to what extent he has
really succeeded in making a new departure, and in . giving
a new direction to our thoughts upon this sutgeeti He
starts from the same premises as Dr. Maclaaah —via,
that in health heat production balances heat loss, and
hence the stability of temperature; and that fever is,essen¬
tially a disorder of body heat. Bat from the first he lays
far greater stress .upon the nervous mechanism, which, of
necessity must govern and regulatp .both heat.production
and heat loss. He does not, then, relegate to hyperpyrexia
alone the disorder of this “ thermotaxie ” me chanism ; is is
the highest and most essential of the whole of the factors
concerned in the maintenance of the body heat, it ia the
easiest to be deranged, and it is. the uniting, link of all
pyrexias. This is a fundamental difference from such, views
as those expressed by Dr. Maolag AN ; but although the
Oulstonian leotpipr lays due stress upon it, he by no means
limits his view to it, for the greater part, of his lectures was
occupied with the subject of thennogeneais or hsat produc¬
tion. It may be noted that he rejects, like Dr. Mao lag an,
the retention theory of Tbaubb ; and an the same grounds-
vis., that in fever there is an abnormal,discharge of heat,
as shown by calotimetrical observation; although from the
varying state of contraction of the outanaoas vessels the
surface temperature is constantly varying. The nervous
mechanism concerned in heat loss (thermolysis) is that of
the vaso-motor and respiratory systems—each possessed of
double functions, motor and inhibitory. Thermogenesis
takes place very largely in the muscles, and is not dependent
upon, although it may be increased by, their contraction;
a fact which was demonstrated by experiment. But perhaps
the most remarkable statements were those which sought
to establish, with regard to thar orogenesis, a nervous
mechanism similar to that presiding over thermolysis.
It is assumed, and to a certain extent borne out by facts,
as it is supported by analogy, that this nervous influence is
twofold: the one exciting to thermogen esie, and accom¬
panied by destructive metabolism; the other inhibiting
thermogeneaia, and subserving constructive metabolism.
In terms of metabolism, the former is catabolic, the latter
anabolic; in terms of vaso-motor aotion, the fanner is
motor, the latter inhibitory; in terms of muscular action,
the former excites to contraction, the latter to relaxation
of tissue. The grounds of this doctrine are fuHyset forth
in the second lecture, and need net here be repeated. The
evidence for the existence of special thermal nerves is bat
scanty. The thermogenic or catabolic nerves may be the
same as the motor, bat the statement by Wottn that the
thermal centre was represented ih the cortical motor hrea
is based on inconclusive date; and the phenomenon of.rise
of temperature* produced by AnoHifsoiC and SAchb on
Stimulation of the inner aide of the corpus striatum
seems to point to a tract distinct from that of motor
impulses. It is on this tripod of thermotaxy, thermo*
lysis, and therm ogeneeis, that Dr. MacAllbtbr bases his
doctrine of the nature of fever, and explains- the ■ various
forms of pyrexia by reference to the greater or lest
predominance of each of these processes. Oh this
basis it'ii easy to agree with him that high tem¬
perature is not necessarily Uret, -and that fever is not
neces sa rily accompanied by high temperature." Fof if 1"

.oogle

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$86 Thb Lancet,]

OPHTHALMIC NEUROLOGY.

[ABril 2,1887.

“fever” we mean excessive thermogenesis, that may be
more than compensated by excessive thermolysis; or, with
a normal thermogenesis there may be diminished ther¬
molysis ; or the two processes may not act in harmony, and
disordered temperature result from ataxy of the thermic
centre, without any increased metabolism. By means of
this doctrine — in which the neurotic theory that Dr.
Maclagan reserves to hyperpyrexia is expanded so as to
cover all variations in pyrexia—we seem to see more hope
of harmony in our conceptions of the febrile state than we
have hitherto conceived possible. For it embraces in one
view the cases of paradoxical temperatures without accom¬
panying fever, of which we have been familiar of late
years; the cases of ordinary fever, where there is increased
combustion of tissue and heightened body heat; and the
cases where the whole mechanism is so deranged that com¬
pensation is no longer possible, and fatal hyperpyrexia ii
the result. Lastly, Dr. MacAustbr shows how, in accord¬
ance with the teachings of Hughlings Jackson, the lowest
order of nervous mechanism—the thermolytic—is the
most organised and most localised—vis., in the vaso¬
motor, respiratory, and sudorific apparatus; the next—the
thermogenic—is in a fair way to become more defined
in its localisation; whilst the highest, but least organised
and most easily deranged—the thermotaxie mechanism—is
also the least localised. This may be taken, then, as the
last, but by no means the final, word of physiological science
upon the question; and we venture to think that it will
give considerable impetus to a further study of a subject
which, always full of interest, has such important clinical
bearings. One word more in conclusion. Dr. M acAListbr
took credit to himself for abstaining from reference to the
bacterial pathology which dominates all teaching at the
present day; still this is a question that must be reckoned
with, and Dr. Maclagan did not hesitate to apply it to
his views upon the nature of fever. Doubtless, however,
Dr. MacAlistbr thinks, and we are disposed to agree with
him, that it will be better for us to attain to a clear
notion of what fever is before seeking to explain the action
of poisons or microbes in producing it. We are often too
prone to seek for the causes of phenomena before we have
determined the preoise nature of the phenomena themselves.

Perhaps the last meeting of the Ophthalmological
Society, the full report of which we published on March 19th,
was the most instructive, as it certainly was the most
generally interesting, meeting of the whole session. It
speaks well for the secretarial management of the Society
that so much material relating to such closely allied
subjects was thus happily collated; for the chief interest
appeared to os to centre around the neurological papere
and oases. Dr. Bbbvor’s case of ophthalmoplegia externa
was remarkable for the absence of other symptoms of
nerve disease. What relation the nerve lesion might have
to the “rheumatic fever” from which the patient is
said to have suffered must necessarily remain obscure,
and the obscurity is only increased when we reflect
that “rheumatic fever” as a historical antecedent is
often of a dubious nature. Mr. Marcus Gunn’s case of
a boy was chiefly interesting from the fact that when
the eyes were, turned to the left both pupils contracted^

whilst in the lateral deviation to the right this unnsual
action of the pupils was not observed. Mr. J. G. Mackinlay
exhibited a girl aged sixteen with paralysis of the external
rectus of each eye of congenital date, and associated
with some errors of refraction and deafness on both sides.
Not the least interesting was Dr. Sidney Phillips'S
cases of associated movement of the upper lid with
movement of the eyeball. When the eyeballs were
directed to one side the upper eyelids both drooped,
though the drooping was less apparent on the side towards
which the vision of the patient was directed; for the
patient voluntarily hitohed up the ocoipito-frontalis muscle
on this side. As Dr. Phillips suggested, it is exceedingly
probable that in this case there was an tmusnal phenomenon
of inhibition at work, the action of the nucleus that presides
over the conjugate movement to one side suspending the
normal tonic action of that portion of the nucleus of the
third nerve which innervates the levatores palpebrse supe-
riorum. Mr. Jbssop’s case was noteworthy in many points,
but the phenomenon of hippus, or alternate contraction and
dilatation of the pupil, irregular in time and degree, not
related in time to the respiration, pulse, or nystagmns, was
hardly less interesting than the circumstance that the move¬
ment of tbs images of objects seen by the patient was in the
same direction as the ocular movements (lateral nystagmus).
There 8asms to be a difference of opinion, concerning this
last point. It is maintained by some authorities that the
apparent movement of the images of objects seen by the
nystagmic eye should suffer displacement in a direction the
very opposite of the ocular displacement. Dr. Hughi.ings
Jackson's case, reported some years ago in Brain, first drew
prominent attention to this phenomenon, and he confessed
himself at a loss to explain the reason why the movement of
objects should, as the patient averred, go in the same direc¬
tion as the eye itself turned. Dr. Priestley Smith repeated
the suggestion that the sudden jerk of the eye was of shorter
duration than the slower return movement, and thought it
possible that the image was properly perceived only during
the return movement of the eye. But Dr. Gowers certainly
threw some light on the question* in associating the pheno*
menon with the symptom of vertigo. In vertigo the sense
of movement in the affected individual usually agreed, so far
as the direction of the sense of movement was concerned,
with the sense of movement which the patient experienced
in regarding external objects within his visual field. The
explanation of the agreement is to be found in the motor
character of vertigo, and in the fact that any resulting move¬
ment of the patient is secondary and always falls short of
the actual motor sensation experienced by the patient. As
Dr. GoWbbs argued: If a person turns round, and an object
remafcr opposite to his eye, he infers that the object moves
in the same direction as he does, and a sensation of move¬
ment leads to the same inference; actual movement would
only prevent the inference that the object is moving in the
same direction if it were equal to the tendency to move¬
ment, and there would only be a sensation of movement in
the opposite direction if the actual movement were in excess
of the tendency. Undoubtedly the most valuable pspsr of
the evening was the one on conjugate palsy of the lateral
movements of the eyes caused by disease of one side of the
pons. Starting from the we 11* St tested observation that

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Thjb Lancxt,]

WANTED—AN INFERIOR DIPLOMA!

[Apbil 2,1887. 687

there if a nucleus or centre in each lateral half of the pone
or its neighbourhood which presides over the conjugate
movement of the eyes to one side—the left for the left, and
the right for the right,—Dr. Gowers classified three
kinds of palsy from disease of the region in which this
centre is situated. The centre was possibly the superior
olivary body, which, as Bechtkbbw has shown, is connected
with the sixth nucleus, the auditory nucleus, the cerebellum,
and the spinal cord. In the first class of cases there is
palsy of the sixth nerve simply, from damage or disease of
the fibres of the nerve as they traverse the pons; this leads
to absolute inaction of the external rectus, and the eye
deviates inwards. The second class is composed of cases of
disease of the actual nucleus of the sixth nerve. As a result
of it the associated aotion of the opposite internal rectus
is lost, so that the eye could not be moved inwards were
the patient told to look towards the side on which the
lesion in the pons is situate. The third class of cases
consists of those in which the lesion is above, say,
the level of the left sixth nucleus. Then the lateral
conjugate movement of the eyes towards the left is lost, but
the left external rectus is not totally paralysed, for tbe eye
does not turn inwards, as in the first two classes, but the
nucleus of the sixth, being intact, appears to innervate the
left external rectus sufficiently to keep up its normal
tonic action. For a further exposition of the many
ideas contained in this paper tbe reader should consult the
abstract itself on page 578, where he may also find a
full report of Dr. Hughlinus Jackson’s philosophical
remarks on the nature of nystagmus—a phenomenon which
we think he rightly regards as indicating partial para¬
lysis rather than “hypertrophy” of function, and thus
the ocular shaking is drawn into the same circle as the
tremor of the limbs in disseminated sclerosis, with which
nystagmus is very commonly associated.

—--♦

Tub Royal Colleges exist primarily to supply the public
with competent practitioners. When they are pressed with
tbe argument that their refusal to combine with the
Apothecaries will tend to the establishment of a Competing
body granting an inferior diploma on a less severe examina¬
tion, they assent and say that that is just what is Wanted.
This is a very startling proposition, which requires close
examination. The Royal Colleges, under.the Medical Acts,
are charged by Parliament with the duty, as we have said,
of ascertaining that the entrants of the profession are
capable of practising medicine, surgery, and midwifery with
efficiency. They have higher functions, no doubt: they
have the power of eleoting or examining persons who are to
constitute a higher grade of the profession. Rut this is far
inferior in public importance to their duty as examiners of
the bulk of the profession. Take the College of Surgeons of
England, for example. From last year’s Calendar we gather
that In the preceding year 51 candidates presented them¬
selves for the Fellowship, while 1048 presented themselves
for the diploma of Membership. The duty of the corpora¬
tions to the public clearly has reference mainly to the
hundreds rather than tbe dozens which they admit—to the
Members, the holders of the minimum qualification, rather
tiwa to the holders of the honorary and higher grades.
Now what- is the simple duty which the corporations—

acting conjointly, as they are required to do under the Act
of 1886—owe to the public, and therefore to the candidates,
for their ordinary diplomas ? It is this—to examine them
according to a standard which will “ guarantee the possession
of the knoirledge and skill requisite for the efficient practice
of Medicine, Surgery, and Midwifery .” This is the simple
duty of the Examining Bodies. They have no authority
in law to erect higher standards of examination thansach
as are necessary to supply tbe public with efficient medical
practitioners for ordinary purposes. This will be equally
the duty of any single corporation that may come to the
Medical Council to ask for the appointment of “ any number
of examiners ” that may be necessary for granting diplomas,
conferring on the holders the right of registration under the
Medical Aots. The Apothecaries will have no other, and
certainly no lower, duty than that imposed on fchC Royal
Colleges. What becomes, then, of the argument of the
advisers of the Royal Colleges, that a lower grade of
practitioners is wanted, and a lower body wanted to
diplomatise them ? Where is the Act of Parliament that
empowers the Royal Colleges to attach to their common
diplomas the condition of higher knowledge • than that
which is sufficient for practice? Where is the Act of
Parliament that recognises the right of the Royal Colleges to
depute their work to a lower body, or practically to risk the
creation of a lower standard than that which guarantees
competency? The Royal College of Physicians has once
before in history made this great mistake. For half a
century it was estranged from the bulk of the profession in
England. It seems strange that it should be again unprac¬
tical and above ite business. But it is said that the poor
cannot pay for a property qualified physician and surgeon;
they must have something less. This is a dangerous doc¬
trine. What should we have thought if It had been
embodied in the Medical Act?—if, after Clause 8 had
defined the duty of the medical authorities to hold
examinations on standards which should guarantee com¬
petency in those intended to practise among well-to-do
people, there followed a Clause 4 to provide diplomas
not guaranteeing competency for a class of persons to prac- ’
tiso among the poor? This is of course a rcductio ad
absurdum. But it is precisely what many prominent mem¬
bers of tbe Royal Colleges are thinking, and even 6aying.
The doctrine cannot be maintained seriously. The diseases
of 1 the poor are not different from those of the rich. An
error of diagnosis or of treatment is a8 disastrous in them
as in the rich, and even more so. They have plenty of
cheap physic from quacks of all sorts. The law recognises
no distinction in the qualifications of the medical ad¬
visers of the rich and the poor. If the Royal Colleges
promote such distinctions, they will do their best to violate
the law and to degrade tbe profession.

On Monday last a Scottish deputation waited upon the
Marquis of Lothian and the Lord Advocate to urge that in
any Bill proposed by the Government for the management
of lunatics in Scotland, care should be taken that the
districts be small, and that the governing bodies he elected
by the ratepayers. The Marquis expressed entire sympathy
with the views of the deputation with regard to the import¬
ance of the districts being of small size.

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[April 2,1887. ‘

088 The Lancet,} RELATIVE RANK IN THE ARMY.—A BLEEP OP SIX DAYS.

Immolations.

--

•• Ne quid nimis.”

THE ERASMUS WILSON BEQUEST.

The profession has been informed by the daily papers
that on the day preceding the lost meeting of the Council
of the Royal College of Surgeons the President received
at the College a deputation of anti-vi vise cfcors, who handed
in two memorials got up in opposition to that recently
presented to the Council by the teachers of surgery in
London. The fact has excited a good deal of comment,
and ought not to be allowed to pass without notice. It is
important to know whether the Council of the College
endorses and approves the aotion of the President. It is
the general opinion that a deputation of this kind, and on
such -an errand, should only be received officially. Did
Mr. Savory speak on this occasion as the President of the
College or did he not ? Surely this point ought to be
cleared up. As to the general question of the method of
the appropriation of the bequest, we repeat if the Council
refuses to listen to the urgent request of the teachers of
surgery, and spends on bricks and mortar, casts and draw¬
ings, money which could be used in facilitating scientific
research, it will show itself singularly out of touch with
the profession. It must be remembered that the laboratory
asked for is not for vivisection only or mainly, but for the
encouragement and conduct of all means of investigation
and experiment which have for their aim the advance of
surgery and the prevention and cure of disease.

RELATIVE RANK IN THE ARMY.

' Last week a deputation from a committee of the British
Medical Association waited upon the Secretary of State for
War, to bring under his consideration the subject of relative
rank in the case of medical officers of the army. It was
introduced by Sir Guyer Hunter, but the case was stated
fully by Surgeon-General W. C. Maclean, Emeritus Professor
of Military Medicine at Netley. He explained that a strong
feeling had arisen in the Department that the abolition of
the term “relative rank” had deprived the medical officer of
any status he had in the army, and that unless this were
removed the effect upon the supply and the quality of
candidates for the service would be most disastrous. He
concluded by saying that “ the authorities having now
declared, in the most positive manner, that relative rank
was a mere term, having no value at all, it would never
satisfy the Army Medical Service to have relative rank
restored to its former position. The medical officers of the
army rendered great services to the State, and he thought it
was only fair that they should respectfully ask to be placed
on the same footing as the Pay and Commissariat depart¬
ments.” He was supported in his views of the effects of the
change, as regards the candidates, by Dr. A. Carpenter and
Mr. Macnamara. Dr. Clarke, M.P., thought that “if any
change Wore made at all, it shonld be to give the medical
officer actual instead of relative rank. -Unless one or the
other were given, it would seriously injure the supply of
medical men to the army.” The Secretary of State in his
reply assured the deputation that the War Office, in issuing'
the Warrant, With Which he had not been personally ooA-
oeWed. had not the least intention to alter the position and
precedence of medical officers. He owned himself very
much puzzled now to know what _ the medical officer has
lost, but admitted that “ there is a sentiment at the bottom
of i^jfffi an4 sentiments are thjLpgs : to.)^.reckonaJ with very
iAumi in thqee ,4ays.” He proniDsCd carefully fco' fe&rasider
the tera&ibftM warfahtj iura tafos that

“it shall be made pnttjham Met

anything whatever by the change which has been intro¬
duced into the warrant.” Accepting the assurances of the
Secretary of State and of the Director-General, we have
always held the opinion that there was no real cause
for this scare. As, however, the declarations referred to
have not had the effect of reassuring the medical
officers, and some step is to be taken to make it clear that
their rank in the army is not to be interfered with, the
question is, How can this be done in a manner which will
prevent discontent? Dr. Maclean has suggested that honorary
rank should be given, as in the Pay and Commissariat
branches of the service, while Dr. Clarke is of opinion that
actual rank should be conferred on them, that in fact they
should sink their professional title in their military. We
feel sure that the latter course would not prove acceptable
to the best class of medical officers, who, as a rule, take a
legitimate pride in their standing as members of a scientific
profession. There is yet another course which might be
taken by the War Minister—the issue of a Royal Warrant
declaring the various grades in the medical service to be in
all respects equivalent to, and carrying with them all the
privileges and advantages of, the corresponding military
grades with which they were classed under the preceding
warrant. This would give a defined military status to each
grade of medical officers, which it would be impossible to
call in question or in any way to set aside. The medical
officers form an integral part of the army, and it seems
absurd that their position in the military machine cannot be
defined without dubbing them colonels, majors, and captains.

A SLEEP OF SIX DAYS.

Thebe is no more mystery about the case in Soho, that
has attracted so much attention, than there is about many
another interesting and imperfectly understood medical
phenomenon. Through the courtesy of Dr. Keser wo were
enabled to examine the patient. The following is an abbre¬
viated account of the patient’s present state. The man is
about the age of thirty-five, a good-looking Frenchman,
who was lying on his back with his eyes closed, his coun¬
tenance slightly flushed, and, at a casual glance, apparently
in quiet sleep. Examination proves beyond doubt that the
sleep is profound—that, in fact, there is a total abeyance,
abolition, or loss of consciousness, or of the highest functions
of the cerebral cortex. This sleep has not been broken since
it began, now seven days ago. During the whole of the
time the patient has not given the least sign of intelligence.
If one eyelid be raised and light from a mirror thrown in,
the other eye opens, the pupils contract, and the patient
seems to be attending to the light, his eye apparently fixing
something. If the light be withdrawn the eyes remain
open for some thirty seconds, but closure of one ie
rapidly followed by shutting of the other, and the
patient returns to his usual state. The pupil some¬
times shows the phenomenon of hippus, alternately
contracting and dilating whilst the light is thrown
on the open eye. The orbicular muscles are slightly
contracted (normal tone). The mouta is tightly Ant, and
the teeth clenched by the tonic contraction of the muscles
supplied by the fifth nerve. Occasionally slight spasms
seize the individual facial muscles. A tap on any muscle
usually leads to tonic contraction of it. If the arm or leg
be placed in ever so awkward a posture, it remains there for'
several minutes before a tremor commences in it. The
limb when placed in a certain posture is rigidly fixed by:
tonic spasm. Shampooing a rigid limb has no effect on iti
A sadden blow, as a rule, does not disturb the rigidity, nor
does a very gentle stroking of the skin relax the spasm. But
a smart “glissade 4 movement with the palm of the hand
is iiSually followed by fall of the limb and cessation tif
the fepasm, This is most effectual when applied to thb

Di

Googl

TttB Liven,] THE JUBILEE ODE.—OVEBCatOWDING OF WOREHGUSB INFIRMARIES. [Apbjl 2,1887. 880

Aeaaar surface of the arm and the corresponding surface
of the leg. The knee jerks are somewhat exaggerated. At
times an ankle clonus can be obtained. The superficial
reflexes appear everywhere to be diminished. Scratching
the skin is soon followed by the appearance in the scratched
area of well marked “goose skin,” and later a redtache
c&tibrale appears. At times this cannot be obtained. At
other times a white streak marks the area irritated. The
skin is moist and warm everywhere. There is no local
sweating. The temperature varies from 97'6° to 98'5°. There
do not appear to be any areas of elevated temperature. The
bowels have not acted since the hypnotic state began. But
little urine has been secreted; this has had to be drawn off
by the catheter. There is no evidence of emaciation. The
patient has to be fed by his attendants, but the food poured
into the throatis usually neatly swallowed, and doe# not cause
choking. The breathing (18) and pulse (72) are regular.
Thareis no ccdema or vomiting, and the veins and arteries are
natural and soft. The daily discharge of urea has not been
estimated at present. The urine is arid, and contains a trace
of albumen, but no sugar. Little is known of the previous
history, but it is certain that he haa suffered from some¬
what similar seizures, for he has been a patient of
M. Charcot at the Salpitriftre. The condition of the patient
cannot be explained on the assumption of any form of
toxcemda, or coarse organic brain disease.

THE JUBILEE ODE.

This Ode consists of eleven stanzas, and is not unworthy
of the occasion. -We gladly welcome the Laureate’s recog¬
nition of fifty years’ marvellous progress in Medicine in the
second line of the following three:—

“ Fifty years of ever-broadening Commerce!

Fifty years of ever-brightening Science!

Fifty years of ever-widening Empire 1”

We. like, too, the following summons in Stanza vi. to all
who are capable of making the Jubilee real and happy, and
are especially glad to number Lord Tennyson among those
who would send gold in heavy quantities to the hospitals:—

“ You that wanton in affluence
Spare not now to be bountiful.

Call your poor to regale with you;

Make tbelr neighbourhood healthfuller.

Oivb tour Gold to the Hospitals ;

Let the weary be comforted ;

Let the needy be banqueted;

Let the maimed in his heart rejoloe
At this year of her Jubilee!”

THE TREATMENT OF LEPRA MACULOSA.

Da. Eoba, one of the physicians of the Hospital Juarez in
Mexico, writes in the Oaoeta M&dica de MLciao that a
second year's student named Rodiguez, having suggested
from previous experience a trial of a decoction of a mallow
common enough in Mexican gardens, and called bola de fuego
(fire-ball), in a very bad case of spotted leprosy, Dr. Yelasoo,
under whose care the patient was, consented to use it, with
the result that the ulcers healed within-a month, the diarrhoea
ceased, and the patient recovered. Dr. Egea then tried the
same remedy on a patient of his own, who was suffering
so severely from the same farm of leprosy that he could
scarcely move in bed for the terrible pain which motion
caused, the surface of his body from head to foot being
simply one great ulcer, the foul odour from which no
amount of carbolic lotion or ointment was able to destroy.
When he had taken the mallow, for a fortnight the legs had
healed, and in a month’s time no ulcerated surface remained
on the whole body. The patient’s whole condition, too, had
improved So much that he was able to walk about. The
decoction Was made by boiling a handful of the leaf in a
pint of Water, Which quantity was given drily at first, being
g**daally increased until trtro ipints were given drily. The

antiseptic local treatment employed did not appear to haver
any effect. Dr. Egea say# that the spotted form of leprosy
(Lepra maculosa) was first described in 1851 by a Mexican,
physician, Dr. Lucio, and afterwards in a somewhat meagre.
manner by Hebra, but that by far - the most complete
account of it is due to the labours of Drs. Lucio and
Alvarado. It is mentioned by Fagge and shortly described i
in Littrd’a “Dictionnaire de MtSdecine.” .;

OVERCROWDING OF WORKHOUSE INFIRMARIES.’

The inclement weather experienced during the greater,
part of March has filled our hospitals and infirmaries to,
overflowing. Already Dr. Steele has written to explain,
how it came about that they were unable to retain a man.
with a fractured leg for more than one night at Guy’s Hosn.
pital, passing, him on, owing to their overcrowded state, to,
the Workhouse Infirmary. It was reported at the last;
meeting of the Lambeth Board of Guardians that there were
eighty-seven men and forty women in excess of the certified
number, and that some of these were actually lying on
the floor and others on tables. It is| matter of regret to
find year by year the accommodation afforded to the sick
poor becoming proportionately less and less, as the hos¬
pitals, owing to their diminished resources, are compelled
to close more and more wards. The fact that the present
generation has not been able to keep pace with the chari¬
table requirements of the day is a deep reproach to those
who are spiritual instructors and teachers of morality.
The falling off in the funds of charitable institutions
is not owing solely- to diminished Subscriptions, which
might be accounted for by the existing depression of trade, but
to the noble legacies which in time past were such a distin¬
guishing feature of English charity. It is sad to read week
after week of enormous fortunes left, and so little de-,
voted to charitable uses. An evening contemporary haa
brought this forward in a striking manner .recently, by
tabulating weekly the wills proved, and noting the amounts
therein devised for charitable purposes; and on looking pv«r,
these tables, it is astonishing as well as depressing, in spite ,
of noble exceptions, to see how little the very wealthy,
members of society seem to think on their death-beds
of the claims of the. suffering poor. This neglect of the
primary duty of promptly relieving the sick and needy is.,
a great mistake, even from the purely practical point of
view. Every artisan or able-bodied labourer who becomes a,
chronic invalid, owing to neglect m the first stages of his
disease, becomes a burden on the rates; whilst every family
driven to take shelter within the walls of the workhouse
swells that great army of paspera winch , is. progressively
and sorply sapping the vitals of national prosperity.

PANI08 IN THEATRES/' > :

Mia. Wilson Rabbbtt and Miss Eastlake, by a little
presence of mind—neither more nor less than the amount
requisite-to extinguish the flame of a candle which acci¬
dentally fell from its socket on the stage, “away from any’
inflammable material,” and to resist the impulse to be scared'
by the yells of ah idiot who raised a cry of fire in the’
auditorium—succeeded, on a recent occasion, in averting a
panic. Mr. Wilson Barrett afterwards lectured the audierice
on their folly. Perhaps it was hardly worth while to do
this, seeing that people will always be terrified by cries,
of fire, and no amount of argument is likely to prevent thelf
behaving like maniacs when under the influence qf fear.'
Meanwhile, it is a fact beyond question that, with very jare 0
exceptions, the’ catastrophes in which panics culipiqafe are.
wholly causeless and wanton. We are not of those, who
think much good will be accomplished by diasqftfctiooq qa
the subject of timidity, tn spite of all that may be

Digitized by Li

fl&O’ Thb Lanctbt,]

LONDON DUST.*—INFECTING WHITLOW.

[Ajeil 2,1887.

written or urged against impulse, and- in praise of self-
possession, the majority of persons in anyplace of assembly,
especially if it be crowded, will try the chances of escape,
either for themselves or those dear to them, and probably
straggle and “rush” in an ugly fashion to accomplish
their immediate purposes. It is vain to try to dissuade
individuals from adopting this policy, unless it can be
made certain that a patient and wise man will not
And the places of exit choked and impassable when at
length he thinks it prudent -to decamp. Of course
if only everybody would be calm and make a dignified
retreat, there would be no difficulty. Few buildings—except
sbme of the older theatres and those which have been
recently spoiled by the interference of the Board of Works —
conld be destroyed before theiT audiences retired if the exit
were Orderly, but it must be avowed that as the human
brain and nerves are constituted those who depart are
little likely to stand upon the order of their going, and will
be solely concerned to go quickly. Practically, therefore,
it amounts to this, the safety of the public must be secured
by measures over which they have no control, and it is really
no good rating them for the terrorful impulsiveness. The
one, and only, preventive against panic is the avoidance of
such stupid “ accidents ” fc as the falling of candles from their
sockets. It seems to us rather hard on an audience to be
scolded for showing signs of impending panic after being
frightened by the falling of a candle, which mast have been
carelessly or indifferently stage-managed, and then scared by
the shouts of an idiot. _

LONDON DUST.

It is now many years since dust contractors were willing
to pay for the privilege of removing house dust. The days
of the golden dustman are past, and London vestries are
Compelled to pay large sums annually to contractors,
who, after removal of the refuse, have been only able
to turn it to account by the manufacture of bricks and
the manuring of land. But even these businesses are
not carried on at all periods of the year, and hence the
contractor has at times, when he has no opportunity for
its use, often neglected to rid his district of accumula¬
tions prejudicial both to health and comfort-. In some
instances vestries have determined to organise their own
arrangements, and to deprive the contractor of a duty
which at the best of times was ill-performed. Under these
circumstances new methods of dust disposal were sought* and
attention was naturally directed to the north of England,
WheTe successful efforts had been made to destroy house
refuse by fire, and to use the resulting material for the
manufacture of mortar. In 1880 the vestry of St. Pancrae,
moved by a report of their medical Officer of health, deter¬
mined to send a deputation to the northern counties to see
for themselves the methods which had been pointed out to
them; and as a result a strong recommendation was made j
to the vestry to relieve themselves, by the erection of a
destructor in an outlying part of the parish, of the diffl- |
culties in which they were constantly placed. From cir- I
cnmstances incidental to parochial government no further
progress was made, but shortly afterwards a similar I
recommendation was brought before the Commissioners of ;
Sewers by the medical officer of health of the City of ^
London. More recently the Whitechapel Local Board have
succeeded in the erection of one of these furnaces, and the
Kensington vestry were some two years ago desirous of
adopting the same course. They progressed so far as to order
a Bill to be laid before Parliament, authorising them to
acquire land Compulsorily for this purpose; but the pro¬
posal has not met with continued favour, and, as the result
of the support they accorded to it, so many of the’vestry"
men have lost their Beats that there Is now a majority
on the vestr y against the original Scheme. Never¬

theless, we believe the time has come when the new
eysteih must be adopted; the old has certainly failed, and
refuse removal must be made independent of trade require¬
ments. It is therefore with much satisfaction we learn that
the Kensington Vestry Bill has been read a third time, and
we hope that this body will not hesitate to utilise their
powers, and at once provide the necessary -apparatus. This
is to consist of a “Fryer’s destructor,” having twenty fire¬
places or cells, with inclined hearths aad reverberatory
arches. The dust will ba carried in carts up an inclined
roadway to the top of the faraace, where it Will be pre¬
cipitated through trap-doors on to the fires below. A flua
from each cell will join a common flae, where the pro¬
ducts of combustion will be-burnt, and will eventually
escape through a chimney-shaft 180 it. high. The slag will
be used for mortar and for road foundations, and the heat
for working machinery for washing and screening road
sweepings, the grit of which will also be used upon the
roads. It is calculated that at a cost of eightpence each
cubic yard of road sweepings will produce material worth
five shillings per yard, while the furnaces would farther be
capable of working machinery which would illuminate the
whole parish with electric light. Objection was taken in
the House of Commons to a method which it was urged
by the opponents of the schema would give rise to nuisance;
we believe this fear is illusory, and we should gladly sea
success attend an effort to deal with one of the most
difficult problems that London has yet to solve.

INFECTING WHITLOW.

Dr. Esteban Borrbro Echevarria, writing in the
Havana medical journal La Enciclojtedla, mentions the case
of a young woman of twenty-three, badly nourished and ilL
developed, appearing like a girl of sixteen, who had a
whitlow commencing in the middle joint of the middle
finger of the left hand, which, being neglected, went on to
produce caries of both the distal phalanges, with serious
deformity of the finger. In about two months after the
commencement of this whitlow another formed in the second
and third joints of the ring finger of the right hand. She
then presented herself for treatment. Dr. Echevarria
promptly opened the whitlow down to the bone, and this
healed satisfactorily; however, in about a fortnight a third
whitlow formed in the ring finger of the left hand. * This
was also opened. These three whitlows were all quite
idiopathic. The writer does not attempt to explain the
succession of these inflammations, but suggests that they
may be considered as all due to a general vice affecting the
whole system, or to infection through unnoticed abrasions
of the skin by pus. Some, he says, may consider the case as
one of infectious osteomyelitis, but at all events he gives the
facts as showing the existence of osseous panaris ( panadizo
6*eo.) ,_

ILLNESS AND SCHOOL ATTENDANCE.

Ws would be foremost in asserting the vital necessity
of education, and we aw well aware that the most resolute
efforts directed towards this end can effect but little
without regularity of attendance. Happily, under the
present compulsory system, assisted as it often is by
pecuniary aid for the payment of fees in really necessitous
oases, absence from school can hardly be excused on any
pretext but that of illness. This cause alone, however,
must almost everywhere much impair that continuity of
teaching which is so desirable. Not only does it act by
affecting the health of scholars themselves, but hardly less
When it touches other inmates of their homes. A child may
be well himself and yet be inadmissible in school if he come
from a house where infections dfeease prevails. Such con-

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T*B luwcw.3 CATARACT INDUCED BY THE VIBRATIONS OF TUNING-FORKS,

[Apru.2v 1887. 601

adorations, ■without reference to other* less connected with
the province of medicine, obviously render a perfect annual
attendance in any school a practical impossibility. We are
accordingly astonished to find that in one case—that of the
Manchester Free School—the absences of children from
every cause daring: four years have not on an average
exceeded so low a ratio as 1 in 80 of those enrolled. Nothing
could be more satisfactory than these statistics, were it not
that the free School in several respects, occupies a unique
position. Regularity of attendance appears to be its most
cherished principle. Whatever interferes with this is by
every possible means to be removed. Atnong other causes
for the withdrawal of children the school reports mention
"personal or domestic sickness.” Does this mean that
children who are absent for a certain, number of days on
account of illness are ipso facto expelled from school ? If
so, it would be easy on the same system to secure great
regularity without a corresponding gain to education. It is
■difficult to see how by any other process the diseases of
children can be made to affect so little the continuity of
their school training. We have no wish to over-state the
case on the medical side, but We are strongly of opinion
that it is the duty of educational authorities in general, and
of each schoolmaster in particular, while sufficiently critical
as to the reality of excuses on the score of health, to see
that due Allowance is made for unavoidable ilineM, how¬
ever this may affect the roll of school attendance.

CATARACT INDUCED BY THE VIBRATIONS OF
TUNING-FORKS.

Dn. S. Th. SnciN, in order to examine the - functions of
the cochlea, acted on the eyes of very young porpoises, both
in the nnmutilated state and after the ears had been
destroyed, by means of the vibrations of tuning-forks of
different pitches. Cataract was produced in both classes ef
experiments. In the entire animals continuous subjection
to the action of a high-pitched tuning-fork induced cataract
in from eighteen to twenty-four hours, white a tuning-fork
vibrating 100 to the minute produced the same effect in
twelve hours. In animals whose ears were destroyed the
cataract was much more quickly induced by the tuning-
fork, soma two or three hours being then sufficient. Dr.
Stan’s theory is that the condition of the lens is affected by
the giving off of heat from the body, and that this is altered
by the vibrations, the perception of sound again-tending to
retard tl^e development of cataract. The members of the
Moscow Medical Congress, before whom t)r. Stein related
his experiments, did not appear inclined to accept his
theories; and Professor Khodin remarked that it was not an
uncommon thing for young porpoises to be born with
cataract. To this, however, Dr. Stein replied that the
cataract produced by his tuning-forks passed off after a
time, and could then be re-induced by the same method.

, QUARANTINE AT MARSEILLES,.

Thb reappearance of chblera'in Southern Italy will give a
Rnod deal of employment to the Marseilles port sanitary
authorities. This town, though itself one of the most un¬
healthy ports in Europe, is ever taking extraordinary pre¬
cautions against the importation of disease. It possesses a
magnificent quarantine station, which we recently visited.
**0 iMand8 joined together by a breakwater form a harbour
the largest ships may be detained during the worst
3*®»ther. On one side of the bay of harbour is a huge abed
y* *be disinfection of rags. Close at hand are other sheds
dlsiufeOtion of mails, personal luggage, and furniture
"Ottght by passengers. On the other side of the bay a great
number of houses can- shelter many hundred-travellers. Of
4oUr te ibA<4nrisage;ia these' heussedanot in a satisfactory

condition, though during 1886 considerable improvements
were made, and quarantine was imposed on ships coming
from Italy, Austria, and the Brazils. The greater number were
only detained for twenty-foqr hours. Indeed, it wae a medical
examination rather than a quarantine. Other ships had to
remain at the station three days, and a few as long as five.
Some idea of the service, to say nothing of the inconvenience,
involved will be gathered from the fact that the number of
passengers and sailors detained amounted in. all to 23,000.
Many of these persons belonged to, the poorest class of
Italian labourers; and if during their stay at tbe quarantine
Station they could be made to take baths and have all their
clothes baked some good might have been achieved, to
counterbalance in some measure tbe undoubted evils
entailed by the system of quarantine. It is, however, more
urgent to look after the dwellings these people inhabit when
they reach Marseilles than to detain them for a day or two
at the islands of Frioule. Unfortunately the condition of
the poorer quarters of Marseilles remains the same now as
before and during the recent cholera epidemics... It seems
especially absurd to hear of 28,000 persons being put in
quarantine before they enter Marseilles. If any quarantine
were justifiable at all, it is far more necessary to take this
precaution with those who leave than with those who are
about to enter a town where almost every form of epidemic
disease is rife. _

THE PRINCESS OF WALES AT THE BROMPTON
HOSPITAL.

Thx Princess of Wales, ever ready to do a gracious act,
at any personal trouble, for the relief of suffering or the
pleasure and comfort of the distressed, gave a concert to the
inmates of the Brompton Hospital on Friday week, at which
Her Royal Highness and her daughters assisted, The per¬
formance was followed by visits to the wards,.during which
the patients who were unable to assemble in the concert-
room were spoken to and received gifts of flowers. Such
actions as these are not only of great service in themselves,
but they endear the Princess to the people, and strengthen
that loyalty which, in spite of all, wells up in the heart of
all English people to the Throne.

TESTS FOR VISION AMONGST RAILWAY
SERVANTS.

Thr question of the tests that are and should be employed
to test the vision of railway servants has been the subject
of discussion at a recent meeting of the engine-drivers and
firemen of the Gateshead section of the North-Eastern
Railway. It was acknowledged by the chairman, an engine-
driver, that it was essential that railway men should have
good sight, but be thought (and several of the speakers
agreed with him) that the tests they were put through
at present were too severe, and altogether foreign to a
railway man's duties. The principal objection seemed
to be raised against the use of the dots, and it appears that
at a recent examination, out of 1000 men twelve or more
were stopped; and, although they bad not been turned
adrift, they had been placed on wages which had been
reduced to the extent of from five to twenty-five shillings
per week. One of the speakers, whose wages had been thus
reduced, had only one eye perfect, the other being defective.
The whole case lies in a nutshell. The lives of the
passengers must not, on any consideration, be exposed
to unnecessary risk, and undoubtedly to place a train
under the care of a one-eyed man is ■ an unneces¬
sary risk. Suppose a spark, or even a fragment of coal-
dust lodged on the eye: pain, spasm, and free lacry-
mation would at once deprive him of all. useful vision.
The company are therefore perfectly right in replacing a
one-eyed /matt, or a man withi defective vision by one

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692 The Lancet,] RECRUITING FOR THE ARMY IN 1886.—LEPROSY IN TRINIDAD.

[Aran. 2,1887.

who has two good eyes, especially in an express train, when
quickness as well as keenness of sight are required. But
the men have, we think, just grounds of complaint that
they should have been placed in positions of trust, and
advanced from one post to another, and then, when they
have done all the drudgery and have secured a good salary,
they should be abruptly told that they are unfit for their
work. It is the duty of the company and of its officers to
see that no man with defective vision is entered upon its
staff, but, once admitted, if his sight is found to fail, he
should be pensioned, or supplied with work in which the
failure of vision is of relatively small importance. He
should not be allowed to be a loser for a piece of careless¬
ness on the part of his employers.

RECRUITING FOR THE ARMY IN 1886.

From the annual report of the Inspector-General of
Recruiting for the year 1886, we learn that the number of
recruits who joined the service was 39,409, of whom 14,288
were furnished by the Militia, and that only 1688 enlisted
fofr long service. The returns showing the numbers who
offered themselves but were rejected on medical examina¬
tion have not yet been completed. The reports by general
officers commanding at home and abroad as to the general
appearance and condition of the recruits who joined are
very favourable. “ In several cases the men are stated to
be young, but it is rarely found that any complaint is made
of the size and physique of the old soldiers of any regiment,
from which it may be inferred that recruits develop in a
short time into well-grown men.” No information is given
in the report as to the ages of the men enlisted. From a
table in the appendix we find that in an average effective
strength of 195,905 men serving in the army during the
year there were 2721 deaths and 2789 discharges by
invaliding, being in the ratio of 13 89 and 14 24 per 1000.
The latter is considerably below the usual average. Of the
invalided, 327 were in the first year of their service, the
proportion to the number of recruits who joined amounting
to 8 34 per 1000. There were 39,330 recruits raised for the
Militia during the year, of whom 29,617 were for the English,
3775 for the Scotch, and 5938 for the Irish Militia; as in the
case of the army, no information is given as to the numbers
rejected on medical grounds, or as to the ages of the men
enlisted. In a strength of 108,196 there were 447 deaths
reported, or in the ratio of 4-14 per 1000. This is nearly 1 per
1000 lower than among troops of the line serving in the
United Kingdom, but possibly the difference may be due to
some of the deaths of Militia men not being reported. We
observe that the Inspector-General compares the death-rate
of the Militia with that of the army generally, instead of the
troops serving at home, which is obviously a mistake.

LEPROSY IN TRINIDAD.

In his report for the year 1885, Dr. Beaven Rake, the
m edical superintendent of the Leper Asylum, gives evidence
of the valuable work with which we have already been
made acquainted by former reports and by his communica¬
tions on leprosy at Brighton in 1886. In discussing the
prevalence of the phases of the disease, Dr. Rake states that
in Norway the percentage of tuberculated cases is roughly
double, and the percentage of anaesthetic cases is about half
that in Demerara, whilst Trinidad occupies an intermediate
position. In India the tuberculated form seems to sink to a
minim um, and the anaesthetic form to rise to a correspond¬
ing maximum. The percentage of the mixed form would
appear to undergo little change in any climate. The patho¬
logical part of the report has already been made known, but
we may draw attention to the statement that seventeen
observations on mftfrwiel taken from vaccine vesicles and

pustules in lepers failed to show badilti in any part of then.
In his inoculation experiments he used dogs, cats, kittens,
guinea-pigs, mice, bats, fowls, and a small inseesorial bird,
and his methods were by scarification of the akin and
application of material scraped from leprous ulcers, by the
introduction of portions of leprous tubercles beneath the
skin, by the vaccination with lymph taken from lepers, and
by feeding animals on tubercles, enlarged glands and viscera
obtained post mortem. All the experiments were equally
ineffectual, and not even a localised growth was observed.
Dr. Rake speaks favourably of the healing capacity of leper
tissues in surgical operations, and illustrates by photographs
the local palliative treatment by excision of tubercle.

CONSULTING FEES FOR GENERAL PRACTITIONERS.

That plentiful individual “A Sufferer” has been again
airing his grievances, and complains that medical man-
general practitioners—charge a special fee when they meet
a consultant or a specialist in consultation; also that
thdy do not, like other people, send in particulars of accounts.
As to the latter point, medical men are always ready to
produce particulars when asked for. They probably suffer,
rather than otherwise, from not giving particulars; for the
most reasonable patients soon forget the particulars of
medical service, and would be rather surprised at the end of
the year to see how many visits and how much care they
had received from their medical adviser. “A Sufferer’s”
complaint that his doctor, when a party, and a very im¬
portant party, to a consultation, should charge an extra fee, is
as ungenerous as it is unreasonable. The fee is only claimed
as a rule in the case of patients who can pay it; but in
itself it is most reasonable. The general practitioner’s time
is taken up, often to his great inconvenience and that of his
other patients. HU knowledge of the patient and of the
case is most valuable, as every good consultant will admit.
The consultation is essentially a joint business, and both
parties to it should be paid—not necessarily equally, of
course. We cannot think that “ A Sufferer’s” complaints will
be very extensively shared by patients, who know how
“special” U the knowledge of the general practitioner who
may have watched their case over a number of years in all
its relations, and whose time is often as precious as that of
the consultant who is called in.

THE REGULATION OF THEATRES.

The Bill which has been brought into the . House of
Commons by Mr. Dixon Hartland proposes to place all
metropolitan theatres and music halls under the control of
the Home Secretary, who will be empowered to grant a
licence after be has been satisfied by inspectors, appointed
for the purpose, as to the stability of the building, the
security against fire, aud the sufficiency of means of egress,
&c. The Home Secretary is also to have power to frame
from time to time such regulations as be may deem neces¬
sary for the establishment of decency and order. We do
not gather from the Bill to what extent the authority of
the Home Secretary is to supersede that of the other
authorities which hitherto have controlled our places of
public amusement. It will be impossible to supersede
eutirely the power of the Metropolitan Board of Works,
which must continue to exercise some degree of control over
the structure—at least, in its external relations. Again, we
conclude that the Lord Chamberlain will still be able to
exercise his veto on the plays to be performed in theatres,
and the magistrates to exercise their power of giving or
withholding licences for music and refreshments, according to
the caprice of the hour. The first thing neoessary in the
interests of the public is that the catereis for public amuse¬
ment should not be unduly harassed; and if this Bill is to

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TYPHUS AND OVERCROWDING.—PICTURES OP HORRORS.

[April 2,1887. 693

sco mo law, -we tr oat that the Home Secretary may become the
ole authority for the control of theatres and music-halls, with
owerto grantlicencesof every kind. A very important omig-
(on in the Bill is the want of regulations for the provision
f sufficient cubic space and ventilation. This is, from our
oiat of view, a very grave omission, and we trust that the
Jill will not be allowed to become law unless this omission
s rectified. If the Home Secretary is to protect the public
.gainst fire, why should he not equally protect them against
offocation ? There ought to be in every theatre and music¬
ian an observance of due proportion between the accom-
nodation provided and the amount of area and cubic space.
?he area of the inlets and outlets for air ought also to be
•egulated, and the admission of a greater number of spec¬
tators than that for which the building is licensed should
>e a punishable offence. The amount of slow poisoning
;hat goes on in over-crowded places of entertainment is
mormous, and if the State is going to step in for the pro¬
tection of the public, it ought to afford them at least as
much protection as it affords to prisoners. We are not very
strong advocates of grandmotherly legislation, but if we
are to have it, by all means let it be far-reaching and effec¬
tual. Put the theatres under the control of one responsible
Minister, but let this Minister be in turn responsible to the
public for their comfort in every respect.

TYPHUS AND OVERCROWDING.

Dn. Russell, the medical officer of health of Glasgow, has
presented to his authority a report giving an interesting
account of the behaviour of typhus in an overcrowded
house. This house consists of three rooms, and is situated
at the end of a new street close to open fields. The
stair is well lighted and airy, and the inmates cleanly and
apparently respectable Scotch people. Altogether sixteen
people lived there, but two of these being children, they
may, for the purpose of estimating cubic space, be regarded
as equal to one adult. On this assumption there were for
each of the fifteen adults an average of only 199
cubic feet of air space: in the kitchen, for each of three
afiults, there were 188 cubic feet; in the parlour, for
each of seven adults, 180 cubic feet; and in the third room,
for each of five adults, 116 cubic feet. Typhus fever
attacked two in the kitchen, three in the parlour, and four
in the third room. How the disease was introduced is un¬
known, but, as Dr. Russell said, “ a household living under
these physical circumstances is like a barrel of gunpowder:
only a spark is required—a chance contact with any wander¬
ing source of infection.” The story is instructive, for it
shows very definitely the relation between overcrowding
and typhus fever, and that nothing but the watchfulness of
local authorities and their officers will prevent the develop¬
ment of a fatal disease. In the present case the sick were
removed to hospital and the rest of the household to the
House of Reception, tbu9 limiting a further spread of the
malady.

VEGETARIAN v. MIXED DIET.

It is more than doubtful whether the principle of
^8*arianiam will ever constitute the prevailing rule of
A variety of arguments have certainly been urged
»a its support, and the names of some who advocate its
option are by no nuana undistinguished. While, how-
e *®r,WB are quite willing to acknowledge whatever merit
cwtjwaiy be claimed for this system, we cannot see that it
has any claim to recognition as a practice well suited to the
'ariocj requirements of mankind iq regard to food. That
8 *ta»stanoaand a fair degree of nutrition are compatible
of vegetables we do not deny. Nay,
** Mgsrid. it as indisputable that some constitutional con¬

ditions agree better with a sparing use of animal food, or
even with a diet from which it is quite excluded, than if
they were treated to an ordinary mixed diet. To this class
we may allot the great majority of young children, though
for such we should rather advise a very limited allowanoe
of meat than its total substitution by vegetables. After all
has been said that can be said, however, in favour of
vegetarianism, we have no hesitation in expressing our own
conviction that the great mass of adult and adolescent men
and women do, and can, best nourish themselves by choosing
much of the proteid aud fatty ingredients of their food
from the animal world. _

PICTURES OF HORRORS.

The painter mast be strangely in want of average resource
in the imaginative part of his intellect, or have execrable
taste, who reproduces the scene of the operating theatre or
the clinical lecture-room on his canvas for the public
gratification. Rather let us regret that artists are beginning
to pander to a depraved appetite for horrors, than assume
that they are unable to provide more rational food for
the eye and mind than some of the subjects said to be
chosen for exhibition at the Paris Salon. It is a strange
thing that anyone can endure to gloat over the scenes which
the members of our profession are compelled, though most
unwillingly, to witness in the performance of their duties.
It is with the sole aim of relieving pain and curing
disease we encounter misery. No man with a heart in his
breast would see and hear what is forced upon us if he
could avoid it. If at times it may seem that familiarity
with suffering has rendered us callous to it, that is only a sur¬
face and deceptive appearance. Not unfrequently the effort
to overcome the feeling of loathing excited is overdone, and
medical meri, especially young students, assume an air of
indifference which ill bespeaks the real feelings with which
they regard the scene around them. To make pictures of
such scenes is unmanly, and if it do not evince a debased
passion, it must be expressive of an insensate mind.

EFFECTS OF THE SUSPENSION OF THE
CONTAGIOUS DISEASES ACTS.

Several of the Woolwich clergy and other influential
persons are fully alive to the evils of the repeal of the
Contagious Diseases Acts regulations, and the matter has
again been discussed by the Board of Guardians, at a late
meeting, at which the Rev. J. Jordan moved, “ That this
Board is of opinion that the suspension of the Contagious
Diseases Act has a most injurious moral effect on the town
of WoolWich. The number of soldiers in hospital suffering
from contagious diseases is increased, prostitution is now
more shameless than ever, and a larger number of young
girls are now found on the streets.” He said he came to
Woolwich some years ago believing the Acts were undesir¬
able ; he now, as the clergyman of one of the worst districts
in the metropolis, wa9 prepared to give evidence on oath if
required, before any commission, that not only was prosti¬
tution more flagrant than while the Acts were in foroe, bat
that the number of juvenile prostitutes and bad houses had
greatly increased. The rev. gentleman then detailed two
cases of aggravated disease that had been brought under his
notice, and which were now in their infirmary. On the
motion being seconded, some discussion followed in which
various views were expressed. The Rev. J. Jordan remarked
that the suspension was in a great measure brought about
by ladies who, though prompted by the highest and holiest
motives, acted in entire ignorance of facts which happily
did not, and should not, come under their notice. The
motion was ultimately carried by eight to three, though, it
is right to say that little more than half the members were
present. ,,

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LWE ASSURANCE IN 1886.—OXALIC ACID POISONING.

3,1887.

TRAINING.

The victory of Cambridge this year in the boat race has
given rise to many comments as to the mode of training best
adapted to get crews into condition. It has been stated that
Mr. BnstOwe, the President of the Cambridge University Boat
Race,-, allowed fish, entries, puddings, and dessert for dinner
through the whole course of training, and did not insist
upon the monotonous and excessive flesh diet usually
enforced. For some years past there has been a growing
tendency to adopt a more rational plan of feeding, and to
permit a greater range of carbohydrates and hydrocarbons
in the diet. Indeed, the more varied the food the better the
health of the individual, and as training was defined by
Professor Parkes as a method of obtaining the highest
degrees of vitality, a scientific mixture of the various
principles of diet is called for. With hard muscular work
at a quick pace more animal food is necessary than for
ordinary work, but this should never be given in excess,
and beyond what the digestive secretions are able to
dispose of; one pound and a half is certainly as much as is
required. In giving carbohydrates, care should be taken that
they are veil cooked and are of a digestible character. Rice,-
sago, and tapioca puddings are excellent ; but potatoes
should not be indulged in, in any quantity, as they are apt
to cause flatulence—that bugbear of the trainer known as
“ in wardful.” The hydrocarbons should be supplied by a
liberal allowance of butter; the men should be encouraged to
eat the natural fat on the chops and steaks, and not cut it off,
a9 they have been directed to do ; whilst meat with plenty
of fat on it is usually more tender than lean. Fresh fruits
should also form part of the daily dietary, since these supply .
the alkaline salts so useful in keeping the blood in a healthy
state. The chief article to be avoided in training is sugar,
especially sugar with pastry; it tends to cause acidity and
promotes “ biliousness.” The question among trainers is the
amount of fluid permitted. Under the old system great
cruelty was often practised by keeping men, especially
during hot weather, on a strict allowance ; this was a mu-
take. Qn the other hand, men should not be allowed too
much freedom in this respect for fear of diluting the
digestive fluids; it is -well, therefore, to keep this within
physiological limits. A man of 12 st., under ordinary-
circumstances, eliminates about three pints and a half
from the body daily by the skin, lungs, and kidneys ; with
strong and quick work, he probably gets rid of one pint and
a half more. Five pints of fluid would therefore be suffi¬
cient for most men. As training advanced and the elimina¬
tion became less, the quantity might gradually be reduced.
At the beginning of training slight excess of the physio¬
logical requirements might be permitted, as it would help
tissue metabolism and carry off the waste products formed
ifi consequence of increased muscular activity,

THE BAHAMA ISLANDS AS A HEALTH-RESORT.

Mr. L. D. Powers, Circuit Justice at Nassau, New
Providence, the capital of the Bahama Islands, draws out
attention to the climatic advantages of. that city, which has
long been a favourite winter resort, of American and,
Canadian visitors, and is as well known on the other side of-
the Atlantic as the Riviera is in England. In New. Pro-,
vddenoe frost is unknown; but from November to May thei
beat can never-be Said to be excessive; bathing in the ae*v
may be enjoyed ail the year round; the vegetation fifctf
island is k»turio«8, ro8ee and other familiar flowerablootaifagr
throughout the year, and English vegetables being alwayac
dtt- sale; and Mr. Pdwletf concludes by expWB8itfgntfia‘
opinion that to the wealthy irrthHfl dr ‘ plBAb are ' g g ofc fifr r *r
wbiffer visit to Nassau «flst

able, As the recant calamity in thfi Ittvierfi m»/ n Wr?f

the thoughts of many towards other resorts wliere the
inclemency of an English winter can be avoided, the moment
seems opportune to daw attention to a corner of Her
Majesty’s dominions which is as yet but little known in
England, and we have consequently with pleasure given
publicity to the substance of Mr. Bowles’ communication.

LIFE ASSURANCE IN 1886.

The volume of Life Assurance Companies’ accounts which
is.annually published by the Board of Trade, has made its
appearance earlier this year than is usual, and contains
some highly interesting figures. Thus the “ordinary”
British companies, numbering ninety-three, reported between
them an aggregate income of £19,679,657. The Industrial
Companies, which transact a smaller class of business,
received £3,706,660; so that altogether we thriftless English
folk imposed upon ourselves a voluntary tax of over twenty-
three million pounds in connexion with this one branch of
thrift. This sum exceeds the ordinary army estimates by
au amount equal to the total cost of one of our little wars.
The parallel is perhaps a little fanciful—at least it is
striking, and a curious circumstance that in the ordinary
eourse of affairs we expend equal sums of money in arming
ourselves against external foes and in providing against the
ravages committed by that subtle adversary to whom every
man must some day succumb. A comparison which the
return comprises shows that 1836 was in life assurance
circles a year of considerable development and growth- The
total premiums collected exceeded by a full half-million
sterling those of 1835; while the aggregate of invested
funds was augmented by upwards of three million pounds.
All this is highly satisfactory, as also is the circumstance
that variations in the value of investments, are shown to
have yielded a net revenue to the companies of nearly
£130,090. This last figure is of interest rather as indicating
general prosperity than as having auy special significance
where it stands. As a component part of the twenty-three
millions, it is a “mere drop in the bucket,” but as indicating
the spontaneous enhancement of value in a body of care¬
fully selected securities it is a “ straw” showing, as we hope,
“ which way the wind is blowing.”

OXALIC ACID POI80NJNGL .

Am inquest was held by Dr. Danfbrd Thomas fit Providence
Hall, Edgware-road, on the 16th ult.,'tCuehibg the death of
Caroline Beale, aged forty-five years. Deceased had been
despondent of late, and precautions had been take* to
protect her life. She had suffered froth hemiplegia, Which
rapidly improved under iodide of potassium. Oil MarCh-XSth
she was Been to be in her usual health at 3 fl.MP., and at
4.30 p.m. she was found attacked with profuse diarrbma find
vomiting^ death occurring Shortly afterwards; At the post¬
mortem examination a gumma of the dura mfifiefr; as large
as a hazel-nut, was foftnd pressing on the middle Of the left
ascending parietal convolution.. The inner table of the
Bkull at the corresponding p^rt elpyat^d in the form of
a node. The brain \fras exceedingly congested, and there
(wfie a large amount of fluid in the ventricles and.-beneath
the aTachnoid. The back of the tongue^ soft palate*nod
pharynx had a wash-leather-like appearance. She rfiuoooa
membrane of the gullet was shrivelled, of a dirty yellnwMh-
jwMte colcmr, and corrugated both kmgitudinnlly and; t »W
jveTseljr,'especially in the lower halt lb eouMbe-detected
fWftli eafee from the muscular coat. The - stomach icqhtajfrari
kb^ut hfilf a pint of greenah-bladk tenaoioss naatoqab-*
frnfatnre- of mucus, bile; and altered Woofll.iTj»ei Hnjng
bftttfbr&ne of the stomach was general# «f 1 nn bri g hthwi
jcblMr, which threw into feOJd reliof nem betf mfi ig p o tt t *lfl
fepftShes of Mack, the result nf bmnoHrhi grihm gjgfi jgfg rt b

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THE SANITARY SERVICE.—HOSPITALS AND THE JUBILEE.

[April 2,1887. .6 95

ie mucous l&yer. For two inches at the pyloric end there
•as marked corrosion, the surface looking deep grey and
oughy. The whole of the small and large intestine was
lflamed, and contained viscid mucus. The appearance of
le mucous membrane was as if the latter had been washed
ver with calamine lotion. The valvulce conniventes were
wollen and roughened. The contents of the stomach and
he vomit were intensely acid, whilst they, together with
ome liquid found in a cup, yielded a large quantity of
xalic acid. From the above facts it is clear that the dose
aken must have been very large, probably not less than an
once of the acid. It was not ascertained where deceased ob-
ained the poison. The fatal period could not be determined,
>ut it could not have been much more than an hour and a half,
’be jury returned a verdict of “ Suicide whilst of unsound
rind.” Suicidal poisoning by oxalic acid is not uncommon,
'he majority of cases are fatal, and the almost certainty of
his, together with the ease with which the acid or its
K>tash salt can be purchased, accounts for the would-be
uicide resorting to such painful means of self-effacement.

THE SANITARY SERVICE.

Wb learn with much satisfaction that the Hendon Rural
Unitary Authority have reappointed for life Dr. C. E.
Saunders, medical officer of health for that district. Dr.
Saunders has faithfully performed the duties of his office in
his district for fourteen years, and the authority have
ihown a proper appreciation of the value of his services by
'.he course they have adopted. A member of the board, who
supported the resolution, pointed out that it was unfair to
leave the medical officer in such a position that it would be
’pen to the caprice of any member to snatch a resolution
which would terminate his connexion with them at any
moment, and the chief opponent of the proposal acknow-
edged the valuable services Dr. Saunders had rendered, and
Emitted that the board would never regret the step they
nad taken. We trust that the Local Government Board
will not hesitate to confirm this decision; a refusal would
undoubtedly place the public health service in an unfavour¬
able light before the profession.

CHOLERA IN AUSTRIA-HUNGARY.

We have all along feared that cholera might make its re¬
appearance this year in Austria-Hungary, and, as we have
fiwady announced, the disease manifested itself a short
time since at Esseg, in Southern Hungary. The latest news
is still more disquieting, for we learn that three cases, certi-
tad to be genuine Asiatic cholera, occurred between the
-Hh and 29th of March at Buda-Pesth. It is not clear on
which ride of the river this occurrence took place 5 but in
Perth, on the eastern bank, wheje tbe disease was so pre¬
valent last autumn, the conditions are specially favourable
to a recurrence of the outbreak.

INDUSTRIAL DWELLINGS.

On Wednesday tbe Duke of Westminster opened the first
of nine blocks of artisans’ dwellings td be erected by the
Improved Industrial D wellings Company on that part of his
“-state near Grosvenor-square. This block is situated in
I-amley-etreet, And contains accommodation for, forty-six
lamilie*. each holding has two, three, or four rooms, with
or without a scullery; the roomd are well-proportioned and
open oh to ^ell-ventilated staircases freely exposed to the
external air. There is also in connexion’with each holding
a watercut, and ample accommodation is provided for
! . of> food and fuel. The block is substantially

dedgaed so as to enable all parts to be exposed
* k 06 current of Air; and it does not, therefore, Bhare

the objections which can be made to many so-called model
lodging-houses in London. It will doubtless be a great
boon to the working population in the west-end of London.

HOSPITALS AND THE JUBILEE.

Mr. Hbnry C. Buhdhtt writes a long.letter to The Time*
supporting the claims of the metropolitan hospitals on the
Jubilee year. He thinks £500,000 might be so raised, pro¬
vided the Queen and the Royal Family were identified with
the movement. There is no doubt that this is the most
favoured notion of the shape which the Jubilee fund should
take. But there is no time to be lost. Every week- which
elapses without form and impulse being given to tbe move¬
ment is a week lost. _

DORCHESTER TOWN COUNCIL AND THE SMALL¬
POX EPIDEMIC.

It is alleged that the Dorchester ToWn Council have
refused to pay medical men who have sent cases to the
Small-pox Hospital and treated them there, after being
assured by the medical offioer of health that they would be
remunerated for so doing.' It is said that the services of
the medical men in stamping out the epidemic were very
valuable. We cannot believe that*the Town Council will
disavow its obligation for such services, especially when
bespoken by their own medical officer of health.

THE ANILINE TREATMENT OF PHTHISIS.

Dr. Krkmianski’s idea of curing tuberculosis by con¬
verting the blood into a dilute solution of aniline (see
Thk Lancet, March 5th) has been tried by Dr. Nesteroff on
a patient who was about to be sent to the south, with the
result that he became rapidly worse and died in a fortnight.
The Moscow Medical Sooiety, before whom the matter was
brought, were nearly unanimous in the opinion that the
aniline treatment would be not merely useless, but positively
dangerous. _

THE MARGARET-STftEET INFIRMARY.

We have been requested to publish the following resolu¬
tion, passed unanimously by the Council of the Metropolitan
Counties Branch of the British Medical Association, at a
meeting held on March 25th : “ This Council fully approves
the conjoint action taken by Dr. Thomas llawkesley,.
Dr. W. Cholmeley, Mr. •Carr Beard, Dr. Featheratone Plubbs.
Dr. Julian Willis, Dr. Robert Walford, and Dr. Scudamore
Powell, in resigning their appointments at the Margaret-
street Infirmary; and trusts that their action will Strongly
recommend itself to the approval of members of the
profession generally/’ _

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of tbe following foreign medical and scientific- ’
men are announced;—Dr. Don Cayetano Pichardp y Estradp,
of Puerto Principe in Cuba, Military Surgeon and Professor Of
Mathematics in the Institute of Puerto Principe. ( 't)r. Don
M. Orozco, of Irepueto, Mexico.

THE CHARGES AGAINST MERCER’S HOSPITAL.

It will be remembered that some short time ago a charge of
brutal treatment of a patient was made agoing Mr. Kennedy,,
the resident medical officer at Mercer’s Hospital, Dilbjiin. The
matter was thoroughly sifted by a committee, and subse¬
quently the charge of assaulting the patient was brought
before a J*ry. By bbtih of r these tribunals Mr; • Kennedy
was acquitted, the evidence in his favour being ample to.

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696 The Lancet,]

TAB ROYAL NAVAL HOSPITAL, HASLAIL

[April 2, 1887.

impress any impartial person with the injustice of the
charge. It has now been decided to present him with an
address expressive of sympathy with him in the ordeal
through which he has been compelled to pass, and a testi¬
monial to enable him to meet the heavy legal expenses to
which he has been put. The hon. treasurer, to whom sub¬
scriptions for this object may be sent, is Dr. M’Veagb,
1, Rutland-equare Bast, Dublin.

MULTIPLICATION OF SPECIAL HOSPITALS.

"Wa hear of the establishment of “ The London Hos¬
pital for Diseases of the Throat, Nose, and Ear,” which
sounds very like the title of other similar institutions. We
regret the multiplication of special hospitals, and advise the
public to favour the great general hospitals, which have
special departments. _

FOREIGN UNIVERSITY INTELLIGENCE.

Erlangen. —Dr. Frommel of Munich has been elected to
the Professorship of Midwifery.

Groningen .— Dr. Korteweg, chief of the Jewish Hospital,
has been appointed Professor of Surgery, vice Professor
Ranke, deceased.

Leipsic. —Dr. Wiedemann has been appointed Professor of
Fhysics and Director of the Physical Institute.

Prague— Professor Soyka has obtained accommodation
for a Hygienic Institute, which he hopes to be able to open
at the commencement of the summer session.

Surgeon-General William Rutherford, C.B., hon.
physician to the Queen, whose death recently occurred at
the age of seventy-one, entered the army as assistant-
eurgeon in 1841, became surgeon in 1852, deputy surgeon-
general in 1861, and surgeon-general in 1874. Dr. Ruther¬
ford served in the Sutlej campaign of 1845-56 and in the
Eastern campaign of 1854-55, including the siege of Sebas¬
topol, and for his services received the medal with clasp and
the Turkish medal. In 1857 he proceeded to China on the
staff of the Lieutenant-General commanding the expedi¬
tionary force, and in 1869 was appointed sanitary officer to
the army serving in China. In 1860 he served during the cam¬
paign in the North, for which he received the medal and two
clasps. In recognition of his distinguished services, he was
made a Companion of the Order of the Bath in 1867, and
retired from the service in 1876. He was appointed an
honorary physician to the Queen in 1880.

A meeting of the delegates of the two Royal Colleges
was held on Tuesday last to consider the terms of the
Charter about to be submitted to the Crown, and it was
determined to recommend the Colleges to apply for a purely
medical degree, and not to combine with King’s and
University Colleges as constituent parts of a complete
teaching University. _

Amongst the elections made in connexion with the forth¬
coming International Medical Congress are the following:—
Dr. Robert Barnes as a vice-president of the Gynecological
Section; Dr. Edis as a vice-president of the Section of
Obstetrics; Professor Hirschberg as a vice-president of the
Opbthalmological Beotion._ ~

The American State of Maine has, during the paSt tnbntlb,
reverted to its former system of, punishing marderdiw#ith
flife imprisonment instead of thegaltows. " , : j ^'^Z'

' -I- *' _-.ul.fj. .-U wil V.' J.

\8nTTv B. Fonantfcw berexielOeted: (Mother j^t£ar£agie*t,

ft* tat'MfcattomDtrtatdh m&Jhh hf Mrfif j erfl.JboMiopjs e u v

The Right Hon. Arthur James Balfour, M.P., by a Warrant
under Her Majesty’s Royal Sign Manual, dated Feb. 3rd,
has been appointed to fill the vacancy on the Senate
of the University of London occasioned by the death of
George Busk, Esq. _

At a recent meeting of the Council of the Lancashire and
Cheshire branch of the British Medical Association it was
resolved that a testimonial be raised to Dr. Edward Waters
in recognition of his earnest devotion, through many years
of self-sacrifice, to the cause of medical reform.

Eight directors of the Perth Infirmary have resigned in
consequence of the strained relations between the Board of
Directors and the medical officers of the institution, especially
with regard to their failing to re-elect Dr. Bramwell to the
position of senior visiting medical officer.

On the 24th ult. the death occurred, on board the steam¬
ship Lusitania, in the Mediterranean, of Viscountess
Strangford, who was on her way to Port Said for the
purpose of organising and opening the new Hospital for
British Seamen which is being erected there by subscription.

A scheme has been prepared with the object of founding
a National Pension Fund for hospital officials and trained
nurses. A register for the names of those desirous of join¬
ing the fund has been opened at the offices of the Hospitals
Association, Norfolk-street, Strand, W.C.

Dr. Alfred Meadows has been elected an Honorary
Member of the Obstetrical Society of Philadelphia.

THE ROYAL NAVAL HOSPITAL, HASLAR.

As we announced last week, the course of instruction at
the Royal Naval Hospital, Haslar, for the eighteen surgeons
who entered the Navy in February last, was opened on
March 10th by Sir John Watt Reid, K.C.B., the Director-
General of the Medical Department of the Navy, in the
presence of the Commander-in-Chief and staff, and other
officers.

In a brief speech, the Director-General welcomed the
young officers to the Service and the hoepitaL He warmly
congratulated them on the exceptionally high marks which
had been obtained by them in tne competition at Burlington
House, and exhorted them to strive to maintain throughout
their service career the high figure of merit with which tbey
commenced it.

The introductory address was then delivered by Fleet
Surgeon Walter Reid. He alluded to the presence of the
Commander-in-Chief and other officers as a testimony to
the fact that the executive or governing branch of tbe
service is always ready to extend the hand of weloome to
capable medical gentlemen who have elected to join the
Royal Navy. The officers were again congratulated upon
the excellent positions they had taken in the competitive
examinations, and satisfaction was expressed that the
service was becoming more popular in the medical schools,
and that its solid advantages, together with its other
attractions, were better known and more highly appreciated
as a means of livelihood and a field of labour for tnedicel
men than they were some years ago. .The officers wees then
advised to make themselves acquainted with tbe nature and
character of the service which they had entered,tb know
its purposes and its duties to the State, and thus to arrive
at a right conception of the tespoasibilities they had
accepted by enlisting in its ranks." After nifrMHfnr
the course of study which lay before them; Ekdbid
concluded his lecture with .some. .words' Of s ft flU c to
the young officers. He

sense of duty, and tb look to it.jfy a

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The Lancet]

REPORTS OP MEDICAL OFFICERS OP HEALTH.

[Araii, 2,1887. 6§*7

guide in all they, had to do in the service of the Navy. It
was their duty to be loyal to the Sovereign who was the
head of the Navy, and in whose name all tlieir services were
performed. They were to obey their superior officers, and
to extend to them the marks of respect to which their rank
and position entitled them. It was their duty, by regular
study and attention to opportunities for instruction and ex¬
perience, to try to perfect themselves in the science and art of
their profession, so that whensoever or wheresoever required
they might be prepared to bring its blessings to the tide of
their fellow-men. They were warned against unfitting
themselves for the proper exercise of that profession by
habits of selfish or vicious indulgence. They were enjoined
to remember that they now represented two great profes¬
sions, than which none could well be nobler or more worthy
to be held in honour. They were naval officers as well as
medical gentlemen. It was their duty, by a 1 means in their
power, to endeavour to represent both these positions
worthily. By doing so they would follow the course which
was beet for the public good and also for their own, and one
which would give them every right and every reason to
expect a happy and a prosperous future as medical officers
of the Royal Navy.

WILLS OF MEDICAL MEN.

The Scotch Confirmation under seal of office of the Com-
missariot of the county of Edinburgh, of the trust disposition
and settlement and holograph codicil of Dr. James Dunam ure,
of 53, Queen-street, Edinburgh, who died on October 16th last,
granted to Dr. James Dunsmure, the son, the accepting
executor nominate, was resealed in London on the 3rd ult.,
the value of the personal estate in England and Scotland
amounting to upwards of £49,000.

The will of James Surrage, M.D., late of 2, Saville-place,
Clifton, Bristol, who died on November 19th last, was proved
on the 17th ult., by the Rev. Thomas Stevens and Mr. Noblett
Surrage Ruddock, the nephew, the executors, the value of
the personal estate amounting to over £39,000. The testator
bequeaths legacies to his sisters, brothers, brother-in-law, and
executors. The residue of his'real and personal estate he
leaves upon trust for his wife for life, and then for his
children or issue ns she shall appoint.

The will of William Bell, M.IL, formerly of 16, Hertford-
street, Mayfair, and late of Merlin, Eastbourne, who died on
Oecember 14th last, was proved on the 3rd ult. by Mr. Richard
Ebenezer Shackletou, the nephew, the sole executor, the
value of the personal estate amounting to over £19,000. The
testator, after stating that his wife Mrs. Margaret Bell is
already fully provided for, bequeaths to her his wines,
jewellery, and horses; three pictures to his son William
Abraham; his furniture, plate, and the remainder of his
effects to his wife for life; and his property, Longstone Hall,
lxmgstone-road, Eastbourne, to bis daughters Esther and
Susan. The reeidue of his property he leaves upon trust for
his said daughters; and on the death of the survivor of them
for his said son for file and then for his children.

The will of Mr. George Leigh, M.R.C.S., late of Arnold,
Notts, who died on July 28th last, has been proved at the
Nottingham District Registry by the Rev. Hugh Bryan, the
sole executor, the value of the personal estate exceeding
Subject to bequests to Sarah Henrietta Badnall, the
te*t«tor leaves all his property upon trust for the children of
“8 «tid Hugh Bryan and his (testator’s) daughter Mary
Emilio Leigh Bryan.

The will of Duncan Matheson, M.D., late of 4, Granville-
Place, Portman-square, who died on February 6th last, was
ptoved on the 9th inst. by Mrs, Agnes Matheson, the widow,
executors, the value of the personal estate ex¬
ceeding £3400. The testator gives the whole of his property,
end personal, to his wife for her absolute use and
oeneflt, subject to her maintaining and educating his
eaudroQ during their minority.

stit!* A *^ re ^ Wiltshire, M.D., late of 67, Wimpole-

3 Cavendish-square, and of Torridon, Somers-road,
•^8***, who died on December 4th last, at Virginia Water,
on the 16th inst. by Mrs. Kate Wiltshire, the
»ole executrix. The testator gives all his
prepay both real and persona), to his'Wife absolutely.

Pierrepoint Bentinck, J.P., late of Terrington, Norfolk, £1000
each to King’s College Hospital, St. Mary’s Hospital,
Paddington, Charing-cross Hospital, St. George’s Hospital,
Hyde-park comer, toe Great Northern Hospital, University
College Hospital, the Hospital for Sick Children, Great
Ormond-street, the London Hospital at the East-end, and
the London Homoeopathic Hospital, Great Ormond-street.—
Mrs. Susannah Beloe, late of Queen-street, Gravesend, £260
each to the National Hospital for the Paralysed and Epileptic,
Queen-square, Bloomsbury, the Gravesend Hospital, the
Hospital for Consumption and Diseases of the Chest, Fulham-
road, and the Cancer Hospital, Fulham-road.—Mrs. Charlotte
Elizabeth Tbomasina Holmes, late of 7, Holland-vilias-
road, Kensington, £1000 each to the North London or
University College Hospital, the Great Northern Hospital,
Caledonian-road, Islington, the London Hospital, White-
chapel-road, King’s College Hospital, Portugal-street,
Lincoln's-inn-fields; £500 each to the Hospital for Con¬
sumption and Diseases of the Chest, Brompton, the Royal
Hospital for Incurables, West-hill, Putney-heatb, and West
London Hoepital.—Mr. George Hawkins, late of 28, City-road,
£600 to the London Hospital, Whitechapel; £100 each to
the Royal Hospital for Incurables, Putney-heatb, Victoria-
park Hospital for Diseases of the Cheat; and £60 each bo
the London Dispensary, Spitalfieldp, tbe City of London
Truss Society, and the Royal London Ophthalmic Hoepital.—
Mrs. Elizabeth Salisbury Heywood, late of Snmmerfield,
Bawdon, Cheshire, £200 to St. Mary’s Hospital and Dispensary,
Quay-street, Manchester.—Mr. Alfred Bishop, late of Severn
Villa, Highbury New Park, £600 to the London Hospital,
Whitechapel-road; £100 each to the London Dispensary,
Church-street, Bpitalttelds, and the Poplar Hospital.

The

and other

have recently been left-to hospitals
institutions: — Mr. George William

public Jjealtfr anir ^oor fafo.

LOCAL GOVERNMENT DEPARTMENT,

REPORTS OP MEDICAL OFFICERS OF HEALTH.

Stroud Urban District .—On a population of 9473, tbe
birth and death rates were 29 9 and 16 - 8 per 1000 respec¬
tively; the rate under one year being 133 per cent, of
registered births. Eleven cases of small-pox came under
Mr. Partridge’s notice, and owing to the absence of means
of disinfection, some comparatively valuable articles of
clothing &c. were destroyed, compensation being given in.
one case. Apparently also there is no infectious hospital, for
we read that, as a precaution a cordon was drawn round tbe
houses. This is a risky expedient, for English law only
allows of the isolation of the sick and not the healthy, and
all but the actual sick can at any time decline to submit to
cordons and quarantine detentions. The only confluent
attacks were in tbe unvaccin&ted. The town has a good
water service; the bakehouses, slaughter-houses, and com¬
mon lodging-houses are duly inspected, and a substantial
amount of current work is Carried on.

King8 Norton Rural District .—During 1886 the birth¬
rate was 26-69, the death-rate 13 61, and the zymotic rate
1'31 per 1000. These may be regarded as satisfactory, but
the deaths of children under one year of age should not
reach 18 8 per cent, of registered births. Mr. Hollinshead
believes this child mortality to be materially added to by
improper feeding and clothing, and to undue exposure at
too early an age. No death took place from either small-pox
or scarlet fever, but 40 cases of the latter came under notice.
Diphtheria caused 6 deaths, and it is pointed out that
the disease was associated with such local sanitary defects
as offensive ash-pits, impure surface-wells, and the escape of
drain air into dwellings. Speaking generally, improvement
is in progress in such matters as extension of drainage
works; but King’s Norton is still in need of a proper system.
The privies and ash-pits constitute the great nuisance in the
district, and wherever nuisance is caused steps should be
taken to ensure a permanent remedy. Bye-laws alone can
deal with new structures. Out of 40 cases of scarlet fever
adverted to, 38 were removed to the infectious hospital, which
is credited with having saved the district from a severe
attack. The hoepital is serving an excellent purpose, but
two neighbouring districts having arranged for its use,
further provision for the claseification of the different

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HEALTH OF ENGLISH AND SCOTCH TOWNS.

[Aran. 2,1887.

disease* is needed. So far, 100 cases hare been admitted,
and only one fatal case has resulted.

Witkmgton Urban District. —Dr. Rail ton gives the general
death-rate of this district, with 21,000 inhabitants, as only
12 per 1000, the deaths under one year being as low as
Q per cent, of registered births. The zymotic rate was
slightly higher than that tor the past three years, but it did
not exceed 1*5 per 1000. Measlee was prevalent in the early
part of the year, and led to school closing as a precaution.
There was also some scarlet fever, 14 cases being isolated in
hospital. A notification system was organised during the
latter half of 1886, which is said to have led to satisfactory
results, including the disinfection of 70 houses, the destruc¬
tion of, with consequent compensation for, 34 beds; and
. the stoving, at the expense of the authority, of 35 beds. The
drainage of Withington still pollutes streams, but steps
are in progress for its interception. The systematic inspec¬
tion of houses still progresses, and of all the notices issued in
■consequence in 1885, only one 6tood over at the end of last
year. The total result of this inspection is set forth, and
the. plan is worthy of imitation elsewhere.

Hastings Urban District .—This borough is now estimated
to contain a population of 51,224, and on this the corrected
death-rate is 14'0 per 1000 living, being the lowest rate on
record for ten years. Nine cases of small-pox, a residuum
■of the 1885 outbreak, were removed to the Sanatorium, to
which a number of scarlatina cases were also taken. The
borough now possesses two separate hospitals for infectious
diseases, and although they may not be of the best, yet they
are an invaluable safeguard. In his account of the current
proceedings, Mr. Knox Shaw shows that a good deal of
eteady work is being carried on, which aims at the preven¬
tion of infectious disease and the improvement of the
district. A sunshine recorder shows that bright sunshine is
maintained on an average for more than 1720 hours in the
year; and in this connexion we note that smoke consump¬
tion'is looked after in the health department.

Bislcy Urban District - As in Stroud, we read here again
of quarantine being observed, although there were no
positive symptoms of disease. If voluntarily submitted to,
well and good; but it should be remembered that such
detentions are not sanctioned by law, which provides for the
isolation of the sick, and the protection of the healthy by
vaccination. The general worlc of the health department is
set forth in Mr. Partridge's report, but there was nothing of
■especial interest during the year.

Hertford Combined District .—In Hereford city some two
thousand inhabitants still draw their water from local wells,
end this although a wholesome public service is available.
Much is being done to improve the drainage arrangements
by enforcing proper ilushmg cisterns to house closets and
ventilation of soil-pipes. The ventilation of the public
sewera by rain-pipes is properly condemned by Dr. Sand-
ford, and, in so fat as these exist, he recommends alteration
in this respert. With a public abattoir the faulty slaughter¬
houses may, it is hoped, be got rid of. The city also needs
an infectious hospital. The death-rate was 21*1 per 1000.
In the Hereford rural area the rate was 14 4 per 1000, and
the district is said to be maintained under constant Super¬
vision. In the Ledbury rural district the rate was 16D, and
•it is fetated that, apart from the need for flushing, the new
sewers in Ledbury work well. Ample statistics and details
«s to current wort: are given for these and the other districts,
but the area is, in one respect, fortunate in having no
striking sanitary history to record for the year. Improve¬
ments are steadily going on, and no severe epidemic has
prevailed. _._

VITAL STATISTICS.

HEALTH OF ENGLI8H TOWNS.

In twenty-eight of the largest English towns 5758 births
and 4155 deaths were registered during the week ending
March 26th. The annual rate of mortality in these towns,
which had increased in the preceding six weeks from 19*5
to 22-4, further rose last week to 23 - 5. During the first twelve
weeks of the current quarter the death-rate in these towns
averaged 221 per 1000, and was 21 below the mean
rate in the corresponding periods of the ten year* 1677-66.
The lowest rates in these towns last week were 161 in
Derby, 16 - 3 in Brighton, 20‘4 in Halifax and 20'5 in Bir¬
mingham. The rates in the other towns ranged upwards to
301ttHudtterefleM, 33“0 in Sundertapt), 84 6 in Oldham,

and 36-4 in Manchester. The deaths referred to the pth-
cipal zymotic diseases in the twenty-eight towns, which tad
increased in the preceding six weekB from 340 to 462, farther
rose last week to 465; they included223 from measles, 97 from
whooping-cough, 46 from scarlet fever, 35 from diarrhoea
32 from “fever” (principally enteric), 26 from diphtheria
and 6 from small-pox. These zymotic diseases caused the
lowest death-rates last week in Brighton, Birkenhead, ud
Bolton -, and the highest rates in Huddersfield, Oldham, ud
Sunderland. The greatest mortality from measles occurred
in Manchester, Hull, Leicester, Liverpool, Norwich, Oldham,
Huddersfield, and Sunderland; from whooping-cough is
Nottingham, Oldham, and Blackburn ; from scarlet fever is
8 alford and Oldham, and from " fever ” in Leicester. Of the
26 deaths from diphtheria in the twenty-eight towns, IS
occurred in London, 3 in Birmingham, and 2 in Leicester.
Small-pox caused 2 deaths in Greater London, 2 in Cardiff.
1 in Portsmouth, 1 in Manchester, and 1 in Blackburn, but
not one in any of the twenty-three other large provincial
towns. Only 2 cases of smail-pox were under treatment
on Saturday last in the metropolitan hospitals receiving
cases of this disease. The deaths referred to diseases of
the respiratory organs in London, which had been 433
and 474 in the preceding two weeks, further rose last week
to 509, but were 35 below the corrected average. The causes
of 126, or 30 per cent., of the deaths in the twenty-eight
towns last week were not certified either by a registered
medical practitioner or by a coroner. All the causes of
death were duly certified in Portsmouth, Bolton, Norwich.
Wolverhampton, Preston, and Halifax. The largest pro¬
portions of uncertified deaths were registered in Salford,
Sheffield, Sunderland, Hull, and Cardiff.

HEALTH OF SCOTCH TOWN8.

The annual rate of mortality in the.eight Scotch towns,
which had been 23‘6,25 0, and 26*2 per 1000 in the preceding
three weeks, declined again to 25 9 in the week ending
March 26th; this rate exceeded by 2-4 the mean rate in
the same week in the twenty-eight large E n gli s h towns.
The rates in the Scotch towns last week ranged from 10'>
in Leith and 21*4 in Dundee, to 28‘4 in Glasgow and 36i
in Aberdeen. The 646 deaths in the eight towns last week
showed a decline of 9 from the number in the previous
week, and included 55 which were referred to measles, 31 to
whooping-cough, 18 to scarlet fever, 14 to diarrhoea, 6 to
diphtheria, 3 to “fever” (typhus, enteric, or simple), and
nor- one to small-pox; in all, 127 deaths resulted from these
principal zymotic diseases, against 93,101, and 113 in the
previous three weeks. These 127 deaths were equal to an
annual rate of 61 per 1000, which exceeded by 21 the mean
rate from the same diseases in the twenty-eight English
towns. The fatal eases of measles, which had been 27, 43.
and 60 in the preceding three weeks, further rose last
week to 55, of which 23 occurred in Glasgow and 32
in Aberdeen. The 31 fatal cases of whooping-cough
also exceeded the numbers in recent weeks, and included
14 in Glasgow, 7 in Edinburgh, and 4 in Aberdeen.
The deaths from scarlet fever, which had been 19, 14,
and 9 in the preceding three weeks, rose again last
week to 18, of which 12 occurred in Edinburgh, 3 in Glasgow,
and 2 in Dundee. The 14 deaths attributed to diarrhoea
showed an increase upon the number in the previous week
and in the corresponding week of last year; 6 were returned
in Edinburgh and 4 in Glasgow. Four of the 6 deaths from
diphtheria occurred in Glasgow; and the 3 deaths referred
to “fever” showed a decline of 6 from the number in the
-previous week. The deaths referred to acute diseases of the
respiratory organs in. the sight towns, which had been 135
and 152 in the preceding two weeks, declined again last
week to 146, and were 2 below the number in the corre¬
sponding week of last year. The causes of 84, or 13 per
cent., or the deaths registered in the eight towns during
the week were net certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 281,
31 3, and 29%'i per 1000 m the preceding three weeks, rose
again to 31'3 in the week ending March 20 th. During the first
twelve weeks of the current quarter the death-rate in the
city averaged 30 9 per 1000, the mean rate during the same
period being but 20'8 in London and 216 in Edinburgh. The
212 deaths m Dublin last week showed an increase of 14

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HEALTH STATISTICS OF CAPE TOWN.—THE SERVICES]

[ApriL 2,1887. f>9£

D3I

noii

m the number in the previous w.eek ; they included 7
ich were referred to scarlet fever, 4 to measlee, 4 to
lever” (typhus, enteric, or simple), 3 to whooping-cough,
ad not one either to small-pox, diphtheria, or diarrhoea,
hue the deaths from these principal aymotic diseases,
rhich had been 15,10, and 7 in the preceding three weeks,
ose again last week to 18; they were equal to an annual
ate of 27 per 1000, the rates from the same diseases being
hi in London and 4*8 in Edinburgh, The 7 deaths from
learlet fever showed a considerable increase upon the num¬
bers in the previous two weeks, and the 4 from measles
Exceeded the number in any previous week of this year,
fhe 4 deaths referred to “fever” corresponded with the
lumber in the previous week. The deaths of infants were
within one of the number in the previous week; those of
alderly persons showed a marked increase upon recent
weekly numbers. Two inquest oases and 2 deaths from
violence were registered; and 65, or nearly.a third, of the
deaths oocurred in public institutions. The causes of 35,
or nearly 17 per cent., of the deaths registered during the
week were not certified. _

HEALTH STATISTICS OF CAPE TOWN.

Dr. Fisk, the sanitary officer for Cape Town, has just pre¬
sented to the Town Council his report' for 1880. The number
of known deaths during last year in Cape Town was 1163.
This, in a population of 45,000—an estimate allowing for an
increase of 11,000 since the census was taken, twelve years
ago—is at the rate of 25 8 per 1000 per annum. This high
rate, in the absence of any severe epidemic, is 56 less than
in the previous year, when it was 31’4. The comparatively
low death-rate among the Malay population is somewhat
surprising, only 265 out of the 1163 deaths which took place
during the year being Malays. The Malay death-rate was
17'6 per 1000, thus raising the death-rate of the non-Malay
population to about 30 per 1000, the Malay population of
Cape Town being estimated at 15,000, or one-third of the
total population. Against the 1163 deaths there are to be
placed 1143 births. In the previous year the births were 169
fewer, and the death-rate was much higher. The mortality
amongst very young children is excessive, 558 children, of
whom 274 were coloured, dying in '1886. Poverty, bad
hygiene, and insanitary surroundings, are of course the
mam causes of this infantile mortality. . Dr. Fisk in his
report asks for increased powers to deal with certain
defects in the sanitary state of the town—powers which we
trust the Town Council will confer upon him, considering
that Cape Town is the place where most visitors to the
colony land, and where, whether in search of health or
fortune, they almost invariably remain for some time.

THE SERVICES.

Deputy Surgeon-General T. N. Hoysted has arrived in
India, and been appointed to the Royal Presidency for duty.
Deputy Surgeon-General J. Tnlloch, M.D., has taken over the
duties of Principal Medical Officer of the Woolwich District.
Deputy Surgeon-General J. B. C. Reads, CB., has been
appointed Principal Medical Officer of the Home District,
in succession to Sir J. Ai Banbury; K.C.B., ordered' to the
Mediterranean.

India Office. —The Queen has approved of the retire¬
ment from the Service of the undermentioned Officers r—
Brigade Surgeon James Keess, M.D., of the Madras Medical
Establishment (dated Jan. 4th, 1887); and Surgeon-Major
OlMver Thomas Duke, of the Bengal Medical Establishment
(dated Feb. 22nd, 1887). The undermentioned Officer has
been granted a step of honorary rank on retirement:—
Brigade Surgeon James Keess, M.D., of the Madras Medical
Establishment, to be Deputy Surgeon - General (dated
Jan. 4th, 1887).

Artillery Volunteers. — 1st Northumberland and
Sunderland: Acting Surgeon W. H. Besant resigns his
appointment (dated March 26th, 1887).—4th Lancashire:
Acting Surgeon Edwin Hyla Groves, M.D., resigns his
appointment (dated March 26tb, 1887).

Rifle Volunteers.— 10th Lanarkshire (Glasgow High¬
land), Surgeon Thomas Buchanan is granted the honorary
rank of Surgeon-Major (dated Marcn 26th, 1887). —1st
Lancashire: surgeon'J. W. Cavanagh resigns his commis¬
sion ; also is granted the honorary rank of Surgeon-Major,
and is permitted toconttaue to -wear the uniform of the

corps on hi* retirement (.dated Muech 26th, 1837).— 2nd

Midlothian (Midlothian and Peeblesshire): John Cameron*
M.D., to be Acting Surgeon (dated March 26tb, 1887).—2n<i
Shropshire: Acting 8urgeon R. do la Poer Beresford, M.D.*
tabe Surgeon (dated March 28th, 1887).

The Volunteer Medical Staff Corps. —The London
Division: Surgeon Eustace Agustus Burnside resigns hie.
commission (dated Feb. 6th, 1887).

Comspittann.

“Audi alteram partem.”

THE COLLEGE OF PITYSICIANS, THE COLLEGE
OF, SURGEONS, AND THE SOCIETY OF
APOTHECARIES.

To the Editor » of The Lancet.

Sins,—The refusal of the Colleges of Phyaroians• and
Surgeons to admit the Society of Apothecaries to a seat do
the Examining Board for England has, for various reasons,,
been represented to the medical profession as unreasonable
and likely to injure the prosperity of the profession. Bat
when the case for the two Colleges is fairly put, it will be-
obvious that the demand for a combination has been urged
with very slight reference to the' foots and considerations,
which have swayed the colleges in framing their answer.
The proposal for combination ef the three licensing Corpora*- '
tions in London is no new one. It has been discussed brer
and over again, but various difficulties have prevented its-
consummation, and now the altered conditions of medicafc
education render’the combination' undesirable. The first
proposal, made many years ago, that the two Colleges and
the Society of Apothecaries 'should join in giving'‘fheir
licence was, after much discussion, set aside by a-second
scheme which was to include the then four English Univer¬
sities with the Colleges and the Apothecaries’Society, that
one portal for admission to the profession might be con¬
structed. This scheme was discussed by a select cptottiittee-
of these several bodies, which met about seventy nines, and
settled much useful detail, but arrived at no common agree¬
ment. Then arose agitation in Parliament for legislation in
medical matters, which resulted in the sitting of a Com¬
mittee of the House of Commons, and later in the issue of a
Royal Commission. Both took evidence, and published their
reports in 1881-82. Perusal of the minutes 1 or evidence thus
obtained teaches, how strongly at that time medical opinion
was disposed to deprive the Society of Apothecaries alto- 1 '
gather qf their licensing power. Dr. Glover, now an elected *
member of the Medical Council, told a Committee of the-
House.of Commons in 1879 that the Apothecaries’ Society,,
though it had done good work in the past, was ho longer
wanted. The Royal Commissioners State also in their report
that “there is a notable concurrence of opinion among the-
witnesses that the examinations of the Society of Apothe¬
caries how not been satisfactory.” In 1883 Mr. Gladstone’s
Government carried through the House of Lords the*
Medical Acts Amendment 'Bill, which, through stress of
political business, failed to pass the House of Commons.
Or the third reading of this Bill Lord' Salisbury, With-
the assistance of - Lord Oarlingford, the Lord President*
and of Lord Oamperdown, who had been President
of the Medical Acts Commission,' moved, the expurga¬
tion from the Bill of the proviso that the Apothe¬
caries’ Society should continue to send a representative-
to the Medical Cottnoll; a deprivation which, as Lord
Carlingford pointed out, would destroy the Society’s power-
Of granting licences, ft was admitted by thbse who joined
in the debate, that the claims of the Society of Apothecaries
were of the slightest, and accordingly the Bill passed the '
LoTds with the omission of the Apothecaries from repre¬
sentation on the Medical Council. In consequence of the
various delays in the Legislature, the College of Physicians*
and the College of Surgeons entered into fresh negotiations
for a union tor examining purposes. These negotiations
have established the Conjoint Examining Board for England*
and its cumcwlura and standards of requirements in medical
subjects are now familiar to teachers and students. This
improvement in medical education being firmly established,
there.is good reason to expect that if the harmonious action

Di

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700 Thb Lancet,]

THE THEORY AND TREATMENT OF PLACENTA PRACVIA.

[Apbtt. 3, lflBT.

of the two Colleges be maintained others may be added,
notably one pressing for immediate solution—the attainment
of power to grant medical degrees to candidates who have
studied in London and qualified under the conjoint scheme.
This improvement would be greatly delayed, if not pre¬
vented altogether, by admission of a new body with different
views and aims, like the Society of Apothecaries, to the
■conjoint board. Moreover, during the negotiations which
took place between the two Colleges, when arranging their
compact, it was never contemplated by either body to invite
the Society of Apothecaries to join in the scheme, nor did
■that corporation, while the negotiations were in progress,
ask to be allied with the Colleges. Now that the scheme is
a success, the Apothecaries wont a share in it. But this
application, be it remarked, was also not made until the
passing of the Medical Act of 1886 compelled the Society to
■alter its examination under penalty of losing the power of
.giving a registrable qualification. Now, though the appli¬
cation is made, there is no suggestion as into what part of
the examination, under the conjoint scheme, the Society
believes its intervention would be valuable. Nor does it
allege that there are subjects which have been omitted from
the requirements of the conjoint scheme which ought to be
included. On the contrary, that scheme is complete, and
the Society would not enlarge the comprehensiveness of the
•examination, nor raise the standard of knowledge higher
than the conjoint board hold it already. The Medical Act of
1886 has provided the Apothecaries with means for giving
a registrable qualification independently of any other
ilicennng corporation, by allowing them to obtain from the
Medical Council assistant examiners in Surgery; a subject
which their examinations hitherto have not touched. They
have made this application, and the Medical Council in
February postponed complying with it until the Colleges
had been again invited to consider the practicability of
■admitting tne Society to a share of their conjoint ex¬
amination. So little expectation (possibly so little desire)
{had the Society that the Colleges would alter their
opinions, that the Society’s representative on the Medical
<k>uncil voted against this appeal to the Colleges. It
would seem that he desired that the Society of Apothe¬
caries should at once acquire the power to act independently.
While the Medical Act of 1886 was going through Parlia¬
ment the College of Surgeons refrained from any expression
of opinion respecting the propriety of preserving to the
Apothecaries the power to give a registrable qualification,
believing that it would be unfair to deprive the Society of
this power after they had exercised it for many years.
Further, to have done this would have been combating the
■declared object of the Act—its central idea—vii., to secure
that every registered qualification should depend on a com¬
plete examination in medicine, surgery, and midwifery.
'The Act nowhere urges the establishment of a single portal,
«s it is now contended in some quarters is the object of the
Medical Act of 1886. On the contrary, it provides for a
-failure or inability to combine which was foreseen. It is
•clear, then, that the Colleges are not to blame for the dis¬
appointment of those who desire unification of examining
ana licensing powers. The Legislature, guided by the
evidence taken before it and before the Royal Commission,
•decided to maintain the independent action of the licensing
bodies. Collegiate action had no part in this decision.
Then, looking at the question from the point of public ad-
wantage, the maintenance of the Apothecaries in their power
to grant their licence as a registrable qualification cannot
be called a scandal without throwing a si nr upon the pre¬
sent L. S. A.’s, which they by no means deserve. Still less
when it is recollected that the future holders of this
licence will be qualified in surgery as well as in
medicine and midwifery,„which the present holders are not.
In this the public would be gainers. Further, if the
Apothecaries are compelled to compete with the Colleges of
Physicians and Surgeons, it must oe by raising their stan¬
dard of education and examination; by this change the
public will again be gainers. There is no reason to expect
that the two Colleges will be induced to lower their standard
in order-to draw candidates away from the Society of
.In spite of competition, the College of
it combined with the
..junction with that
Fjgfquirements for the
Vice of this
jlocaas of the
•S»©dieal pro¬

fession in England. Still more, it must not be furgoUta
that there is a large number of respectable medical practi¬
tioners whose powers or opportunities for study have been
insufficient to enable them to pass the examinations of the
two Colleges. Such men have been compelled to go to
Glasgow, Edinburgh, or Dublin, where they have been
able to quality after repeated rejections in London. For
such persons (by no means merely idle, careless students)
the licence of the Apothecaries’ Society will in future afford
a means for entering the roll of practitioners and occupying
a worthy position thereon. A further argument put for¬
ward by the Apotheoaries for their admission to the Conjoint
Examining Board is that the existence of the Society will
thereby be assured, and with its assured existence the
Society’s power to prosecute irregular practitioners will be
secured. Now, it may be remarked that this argument is
put forward by those very advocates who contend that the
Apothecaries would still contrive to exist even if left to act
independently in granting licences, and that the two Colleges
might suffer harm through its independent and competitive
action. But it is very doubtful if this resolution of the two
Colleges will shorten the life of the Apothecaries’ Society,
or that the continued career of the Apothecaries’ Society
will be injurious to the two Colleges. Even if the Society
should become extinct as a power in medical politics, the
authority to prosecute irregular practitioners could be con¬
ferred on some other body—the Medical Council, for
example; it would not be allowed to drop.

I am. Sire, yours truly,

Berkeley TTtt.iv

THE THEORY AND TREATMENT OF PLACENTA
3’R^EVIA.

To the Editors of The Lancet.

Bins,—I hope it will not be considered superfluous on my
part if I offer a few observations upon this grave compli¬
cation of pregnancy in addition to the very interesting
letters of Dr. James Murphy (The Lancet, March 12th)
and Dr. Braxton Hicks (The Lancet, March 26th). Both
letters bear testimony to the command achieved by modern
science over a complication long marked by disaster to
mother and child. So long as the false and appalling
doctrine of “ unavoidable hemorrhage” approved by Levret,
Rigby, Denman, Cazeaux, and Gardien prevailed, which
assumed that there could be no arrest of haemorrhage
until labour was completed, brutal logic compelled instant
resort to the accouchement ford. Thus, all opportunity of
observing the ways of nature and arriving at the true theory
of placenta prsevia was barred. The theory of “ unavoid¬
able haemorrhage ” translated into practice meant violent
delivery, by forcing the hand through the cervical canal,
dilated or not dilated, seizing the child and dragging it
away. The happy discovery of Dr. Braxton Hicks of the
bimanual—or, as I prefer to call it, the bipolar—method
of turning has rendered the violent method of delivery
unnecessary and unjustifiable. As I have said (“Obstetric
Medicine and Surgery”), “ Braxton Hicks’ bimanual opera¬
tion here finds one of its most useful applications.” But it
is only an application. It cannot be raised to the rank of
the treatment of placenta prsevia. This practical question
is not so simple. Rational treatment must be based upon
true theory and correct clinical observation. Clinical
observation led Puzos, Wigand, d’Outrepont, Robert Lee,
Mercier, mjself, and others to recognise cases in which con¬
tinuous haemorrhage did not occur, and in which nature
could be trusted. StiU.it was not until 1847, when 1 first enun¬
ciated the new theory of placenta prsevia in The Lancet,
that the more intelligent and successful principles of practice
fairly made way. In 1844-45 Sir James Simpson, adopting
the view of Kinder Wood, Radford, and Hamilton, that the
source of the bleeding was the placenta, logically concluded
that the right treatment was to wholly detach the placenta.
The theory was wrong, and the practice worse than the old
accouchement ford. Since the total detachment of the
placenta could hardly be accomplished without forcing the
whole hand into the uterus. Fraught with peril to the mother,
it waa almost certainly fatal to the cbUd. I mention this be¬
cause it hae been said in year issue of Feb. 26th that “ Barnes
treatment—partial detachment”— is a modification of Simp¬
son’s. My theory and practice differ toto ocdo from Simpeon t.
I have taken special pains to show that the souxoe of the

Th4 Lahcet,]

THE QUESTION OF RELATIVE BANK.

[Aprjl3,188T. <701

haemorrhage is the same as that in post-partum haemorrhage—
namely, the uterus. Having cleared the ground of this
misapprehension, let me state as briefly as it is possible the
theory and practice now generally accepted. The uterus is
divided into three zones—the fundal, the equatorial, and
the lower. It is only placenta attached within the lower
zone that makes placenta previa. There is no necessary
detachment of placenta attached to the two upper zones.
The limits of the lower zone, that of dangerous placental
attachment, are the os internum below and a circle closely
defined by the equator of the child’s head above. I must
refer to my systematic works for the evidence of this. It ie
enough here to state that this boundary line was revealed
to me by repeated clinical observation and deduction; and
that this physiological discovery has since been confirmed
by the anatomical researches of Bandl. In fact, Bandl’s
ring is identical with my boundary line between the lower
and equatorial zones.

Treatment, then, flows from the fact that haemorrhage
often oea868 when all placenta, or sometimes only a great
part of it, growing within the lower zone, has been detached,
active or passive uterine contraction taking place. Action
is conducted on the following lines. Provoke uterine con¬
traction. To do this we have first the old plan. (1) Puncture
the membranes. (2) Apply a firm binder over the uterus.
(3) If the cervix is small and rigid, pass a laminaria tent to
dilate, watching carefully. (4) Pass in one or two fingers
and detach all placenta within reach of the fingers. The
sweep of the fingers very closely takes the lower zone.
(5) Insert a Barnes’ bag. This acts in three ways: it dilates
the cervix; it provokes uterine action; it acts as a plug,
compressing the mouths of the bleeding vessels. Now things
are prepared for delivery. If the head presents, (6) apply
forceps, or turn by the bipolar method. This plan gives the
greatest security to the mother, and the best chance to the
child.

In a typical case, coming under care from the beginning,
all these expedients may come into use in succession, la
those cases where we are called when flooding is furious, it
may be necessary to introduce the hydrostatic dilator at
once, or if the cervix is dilated enough—and very moderate
dilatation is enough—it is advisable to’ torn. I will not
trouble you with statistics. These have been sufficiently
quoted by Dr. Murphy and Dr. Braxton Hicks. I believe
that a wider adoption of the principles enunciated above
will produce figures more satisfactory still.

I am, Sin, yours faithfully,

lUrley-streot, March, 1887. ROBERT BARNES.

THE SOCIETY OF APOTHECARIES AND THE
CONJOINT BOARD FOR ENGLAND.

To the Editors of The Lancet.

Sirs,— May I be allowed to express my opinion on the
question of admitting the Apothecaries’ Society into’ the
Conjoint Examining Board, as one of the licentiates of that
Society. In I860, after examination, being permitted to
practise medicine within ten miles of London (an antiquated
restriction), I was duly impressed with the high opinion
entertained by boards of guardians of the L.S.A. qualifi¬
cation—an estimate to which I do not at present attach a
high value. But now this handmaid of a wholesale and
retail drug-shop is struggling to mix up surgery in the
concern, and to force herself into society where she is
not welcome. These futile efforts are, perhaps, allied to the
erratic movements which frequently precede dissolution.
In my opinion, the Apothecaries’ Hall should ally herself
with the Pharmaceutical 8ociety, and should no longer
perpetuate (by her association with our profession) one of
the most vulgar prejudices that I have had and yet have to
h?ht against—viz., the persistent idea that drugs oocupy
the first place in our treatment of disease. While rendering
to the Society of Apothecaries full credit for her early
improvements * n education, I submit that, in the highest
and beat interests of our profession, now is a fitting time
jor a divorce; the Hall has her own proper conrS9 to hold,
out on matters of high training, example, and social prestige,
she may now write on her walls “Obsoletaper orbem dicor.”

I am, Sirs, your obedient servant,

Richard Davy,

w - , Surgeon to the Westminster Hospital.

Welbeck-«tre*t, W., March 25th, 1887.

THE QUESTION OF RELATIVE RANK.

To the Editors of Thb Lancet.

Sirs, —Touching the question of relative rank in the
army, and the deaire, apparently on the part of some
medical officers to have their titles compounded of &
medical and distinctive military one, 1 would like to aak.
Is it not an undignified and false position for members of
the medical profession to lead the public to believe that
they cannot, as such, stand alone, but need the support of
the reflected advantages of purely military titles, indicative
of and appertaining to a profession to which they do not
rightfully belong ? What can the publ ic think of such &
proceeding? And, as a matter of policy or expediency,
why should a Doctor of Medicine or a Fellow of the Royal
College of Surgeons seek to obtain such titles ?

I am, Sira, yours faithfully,

Mmrch, 1887. _ F. R. C. P.

To the Editors of The Lancbt.

Sirs, —The abolition of "relativerank” in the army has
not, as pointed out by you in a late number of The Lancet,
altered in any way practically the " status ” of officers of
the medical staff, but their position in the army remains as
heretofore unsatisfactory and undefined, for "relative”’
rank Is but a meaningless term, and carries with it no
military rank. Now, why should the officers of the medical
department be the only officers in the army who have no
military standing, honorary or otherwise? Apart from their
purely professional duties they have distinct military
duties to perform—when doing duty with the Medioal
Staff Corps at headquarters, or in oommaad of “detach¬
ments ” of that corps, or on active service when attached to
“ bearer companies.” Why, therefore, if called upon to per¬
form purely military duties, are they not granted military
rank ? The quartermasters, warrant, and non-commissioned
officers, &c., of the Medioal Staff Corps have a defined
military " status,” but the offioers who command them have
no military rank. Surely this is an anomaly. Is the
medical department not a necessary and integral part of the
army organisation, and are the officers of that department
any less entitled to a proper locus standi in the service
than officers of other departments? Again, is the medical
department a military or a purely civil department. If the
latter, why should the medical officers be called upon to
wear military uniform and to exercise militaiy command
over their corps ? In desiring “ honorary ” rank, as giving
them a defined military ** status ” in the army, the officers
of the medical staff have no wiRh whatsoever to represent
themselves otherwise than as medical men. They are proud
of the noble profession of which they have the honour of
being members, and would be sorry to lose the “title” of
" surgeon,” which distinguishes them from the regimental
officer holding "substantive” rank. I would venture to
suggest that “ honorary” rank be granted to medical officers,
the terms “surgeon-captain,” “surgeon-major,” up to
" surgeon-general* being retained, the nrst part of the title
showing that the officer was a medical officer, and the
second part the honorary rank which such officer
held in the army. In conclusion, I would add that the
assertion which has been made that medical officers are
desirous of obtaining purely military titles is erroneous
and absurd, for they have nothing to gain and much to lose
by obscuring the fact that they are medical men.

I am. Sirs, yours obediently,

March, 1887. _MEDICAL STAFF.

: EDINBURGH.

(from our own Correspondent.)

THE SCARLET FEVER EPIDEMIC.

T n connexion with the statement in my last week’s note
upon this subject, some doubt has been thrown upon the
results of the investigation then detailed. It was reported
that the source of the outbreak had been detected, and that
the disease had been clearly traced to a dairy-farm in the
country, from which a large part of the Edinburgh milk-
supply is derived. The proprietor of this farm now writes

Digitized by G00Qle

702 The Lahcb*,]

EDINBURGH.—DUBLIN.—BELFAST.

[April 2,1867.

to the local papers, and with great show of reason on his
side combats the opinion arrived at, and publicly expressed
by Dr. Littlejohn and Bailie Russell. He points out that on
Jan. 27th, when fever appeared at bis farm, there were already
ninety cases of scarlet fever in the city hospital, and that,
as there were in all probability at least twice that number
of cases in the city, not inmates of the hospital, the fever
was already present in an epidemic form. This is a point of
importance, and one that he can judge of as well as qualified
medical experts, and if this contention on bis part is
found to be consonant with the facts of the case, he
must without doubt be exonerated from the charge of having
caused the whole of the recent epidemic and its accom¬
panying mortality. His opinion of the precautions taken
at hie farm to prevent infection cannot of course have any
weight against the skilled opinion that in some cases infec¬
tion had been conclusively traced to milk supplied by him;
nor can his strictures upon the supposed insanitary state of
a western district of Edinburgh be taken as of any value;
but if his first point is chronologically correct, our sanitary
authority has still the task before it of tracing the course
and origin of the initial epidemic, which appears to bavo
been sufficiently alarming before the exacerbation due to
the contaminated milk-supply had occurred. It is to be
hoped that these aspects of the disease may be as thoroughly
studied from the sanitary Bide as it is stated that its
etiological aspects are now being studied from the experi¬
mental side in one of the university laboratories, and that;
in both respects the epidemic may be turned to account in
the advancement of scientific knowledge.

BNP OF THE WINTER SESSION.

The lectures of the winter session came to an end on
March 2otb, when the results of the class and bursary com¬
petitions were announced and the work of the session
formally wound up. In the class of physiology. Professor
- Rutherford said farewell to bis students for a period of six
months, for which time he has obtained leave of absence,
indicating the arrangements that he hopes to carry out next
winter,-when he anticipates being again in his place. The
roll of class honours in the various classes shows a high
degree of excellence in the work done, a much larger pro¬
portion of students than in previous years having secured
Honours certificates in the competitive examinations.

HOSPITAL ACCOMMODATION IN THE COUNTY OF
MIDLOTHIAN.

The great lack of a fever hospital, which has long been
felt in some parts of the county of Edinburgh, is shortly to
be supplied. The site and plans for a combination hospital
for a district Comprising nine parishes and a population of
20,000 people were recently approved by a meeting of the
committee of local boards appointed to further the matter.
The new hospital .is to be situated about six miles from
Edinburgh, near enough for an Edinburgh physician to be
placed on its honorary staffit is to be erected on a healthy
site, and is well isolated. It is to be a one-storeyed building,
containing eighteen beds, aud it will cost about £1600.

' THE NEW FtHBtfC BATHS. *

The new public baths' for the city are rapidly approach¬
ing completion, and will shortly oe thrown open to the
public. The Town Council have wisely decided that appli¬
cants for the post of superintendent must not only be good
swimmers, but must be able to give instruction in the art.

Edinburgh, March 30 th.

DUBLIN.

(From pur own Correspondent.)

RICHMOND DISTRICT LUNATIC ASYLUM: ANNUAL REPORT.

At the close of last year the number of male patients
exceeded the limits of nominal accommodation by twenty-
three, and the institution contained twenty-two more than
at the close of the previous year. The admissions during
1886 numbered. 433, and an unusual number exhibited
suicidal propensities. A severe form of dysentery occurred
during September, and lasted several mpntbs. Nine deaths
took place from it, /m4 thirteen dentils from diarrhoea, which

was very prevalent, iinrity-fiVE cases‘hsfitig been treated.
~ l)iM' Con oily Norman, uhw vAiditiit* ffieffitriF raperintendent*
epoaks very nnfaviteriiWfii»ItO‘i)tWTSaifltarf^oBditian of

the asylum. The soil pipes, he states, are unventilated,
owing to the absence of a counter opening, while no attempt
has been made to ventilate the waste-pipes from bathi.
sinks, &c. There is no propertrapping, and there are no fresh-
air breaks. Further, the house drains are usually brought
under the buildings, and tha pipes are not jointed with cement
As the asylum stands vary high, and as the River Bradog,
after leaving the asylum grounds, runs through a densely-
inhabited portion of the city, the area of sewers thus ven¬
tilated into the various apartments mast be very extensive.
As Dr. Norman well remarks, with such conditions it can
only be wondered that more sickness does not exist, and
that the death-rate is not higher than at present. The baths
also are insufficient in number, the kitchen small and ill-
provided with cooking apparatus, the laundry small and
ill-fitted; while in the decoration, furniture, See., of the
wards, this asylum is below the standard of most similar
institutions at the present day. From these details, which
could be supplemented by numerous others, it will be seen
that the sanitary arrangements of this large end important
institution require, in the interests of the inmates, a thorough
overhauling, and various improvements carried out before
Its condition can be regarded as satisfactory.

DUBLIN HOSPITALS COMMISSION.

The report of this Commission, which held its meetings
about twelve months since, has not yet been issued, but, as
Mr. Balfour stated last Monday that it would be submitted
to the Lord-Lieutenant this week, it probably will not much
longer be delayed. It is believed that the Commissioners
had great difficulty in coining to any agreement on the
subject of their report.

THE QUEEN’S JUBILEE.

Sir George Porter, D.L., Surgeon-in-Ordinary to Her
Majesty in Ireland, and high sheriff for the co. Wexford,
has given in honour of Her Majesty’s Jubilee twenty guineas
to the County Wexford Infirmary, a similar amount to the
Wexford Branch of the Royal Lifeboat Institution, and
twenty guineas to the poor o'f Wexford. It is to be hoped
that such an example of generosity may be widely followed.

SAD ACCIDENT TO A MEDICAL MAN.

On Tuesday morning Dr. Arthur Switzer, of Dublin, fell
from his bedroom window, some 40 ft. in height, on to the
pavement, and received such injuries that he died shortly
after his removal to hospital. It is supposed that while
looking out of the window he overbalanced himself and
thus caused the accident. The deceased was only in his
twenty-fifth year, and was a graduate in Arts, Medicine,
and Surgery of the University of Dublin, and. obtained
various aistictions during his university career. Only a few
days before his death he had received an appointment in the
country. Much sympathy is felt with his family in their
sad bereavement.

Dr. L. A. Byrne has been presented with some surgical
and midwifery instruments and a microscope by the officers
of the Dublin Corporation on his resigning the position he
had held in connexion with the executive of the Public
Health Department.

The final tie for the Dublin Hospital Challenge Cop was
decided on Monday last, the gate money being given in aid
of the funds of the Royal Medical Benevolent Fund Society
of Ireland.

BELFAST.

(From our own Correspondent.)

QUEEN’S COLLEGE, BELFAST.

Two schemes are already before the public in connexion
with the Queen’s jubilee: one is to build a consumption
hospital, and the other a convalescent home, as an addition
to the Children’s Hospital; and now the President of
Queen’s College in a public letter^ suggests a third scheme
on behalf of the College. After pointing out the great pro¬
gress thfc. College has made since its foundation in 1WM?
shown by the large number of students who have pa**«“
through its clas6-rooms,and the fact that its great educational
work ha? been done without any aid from local or P nT ” t *
funds, tlie President states that a difficulty pressing hea^D
on the College at present is the unexpected refusal of J' e>

TMBLahott,]

BELFAST.-PARIS.—OBITUARY.

[April 2,1887. 708

Matty’s Government to enlarge the building* and provide
laboratories. Recently, after applying again to the Govern¬
ment, the President received a decided answer to this effect:
“The College was built, endowed, and enlarged by the State.
The people of Belfast have derived great advantage from it;
they have hitherto given nothing to it: and now upon them
must rest the duty and responsibility of making such additions
and improvements a s are required by the increased number of
students, and by an enlarged, and gradually enlarging sphere
of usefulness.” The President states that what is wanting
is larger buildings, new laboratories, modem appliances,
especially in the practical departments of chemistry, natural
philosophy, engineering, and physiology; and ne states
.£8000, judiciously expended, would enable the work to be
carried out; and he thinks it wonld be a graceful act for
the loyal people of Belfast and Ulster, on the Jubilee of the
Queen, to place tbe College in a position to carry out fully
the great object for wbicb it was formed. In concluding
his letter, tbe President appeals for assistance to those who
received their early education in Queen’s College, and who
now occupy places of high distinction and emolument in
various parts of the world.

n BELFAST OPHTHALMIC HOSPITAL,

The annual meeting of the supporters of this hospital was
held on March 22nd, when the Mayor of Belfast presided.
Or. Walton Browne presented the surgioal report, from
which it appears that 1000 eye cases, 263 ear cases, and 80
throat -cases have been treated, and 90 patients have been
admitted to the wards of tbe hospital, making a total of
1423 persons treated during the year. The average atten¬
dance of out-patients has been 500 per month. Cocaine baa
been used in nearly all the operations, doing away with the
necessity for the administration of chloroform or ether. As
in former years, a large class of students are attending the
hospital. Application has been made to the Royal Univer¬
sity to have the certificates of that institution recognised,
so that the students attending the classes would have tbe
advantage of such recognition. Owing to th? death of
Dr. Thomas Henry Purdon, a vacancy now exists on the
consulting staff. Reference was made to the loss the charity
had sustained in the deaths of Sir Wm. C.. Johnston,
D.L., Rev. W. C. M*Cullagh, and Dr. Purdon.

Belfast, March *H!u

PARIS.

' (From our own Correspondent.)

INDUCED 8OMNAMBULI8M IN ITS MEDICO-LKOAL ASPECTS.

M. Mbs net related the history of a patient under his care
at a recent meeting of the Academy of Medicine. A young
man, nineteen years old, whose mother was the subject of
hysteria, bad bad fits of somnambulism from the age of four¬
teen. These became so frequent by day as well as by night
that he was discharged by his employers. Besides the fits
of sleep he has general ftwesthesia and analgesia, together
with complete loss of taste and smell. At the end of last
year he was admitted to the hospital. As a matter of coarse,
he was at once utilised for experiment in hypnotism, and
was found to be easily induced into the Btate of “ hypnotic
fascination * by the magnetic stare, and as easily awakened
by being blown upon the face. It was in teres ting, says
M. Mesnet, to ascertain whether this young man was acces¬
sible to post-hypnotic suggestion. _ Having been sent to
deep as usual, be was imperiously ordered to take the watch
)f one of the students' an the fotto Wing day, and then to
endeavour to make his escape. At the appointed time,
which was at the usual visiting hour, he was seen to look
sontemplativeiy at the student’s chain; he soon became
'aecinated by the shining links, and, after several struggles
igainst the suggestion, be could resist no longer, and,
letaching the chain, made an attempt to escape. When
iwakened, and the watch taken from his pocket, he was
mable to account for its possession, but protested his
nnocence and burst into tears. This shows, says M.
desnet, that a thief or assassin who cannot explain his
cts, and declares he has no recollection of them, may be 1
.n unconscious agent. Although a magistrate will not i
•eliev© his negation, be may have no knowledge of what !
ie has done. Prosaic persons may hesitate to accept M. |
fesnet’s conclusions, but tbe fbeoimtivo action of watch

chains is now placed beyond doubt; and those who are
affected with this variety of hypnotism in its chronic form
will appreciate bis soundness of observation.

HYPODERMIC INJECTIONS IN SYPHILIS.

The treatment of syphilis by hypodermic injections of
mercury continues to gain ground, but the selection of the
best preparation has given rise to discussion. At the
Socidte Medicale des Udpitaux, M. Baker read a paper on
the hypodermic injection of calomel in oil of vaseline.
Calomel, first injected hypodermically by Scarenzio, is said
to change slowly under these circumstances into mercuric
chloride. Four injections ot two grains each, at intervals
of three weeks, suffice to cure the secondary symptoms. The
only drawback is the occasional formation of abscesses, which
occur in 14 per cent, of the cases. M. du Castel said that
the hypodermic method was excellent, but that it was a
great improvement to substitute the yellow oxide for the
subchlonde. With this preparation there is little pain, and
in his last series there was no abscess. At the Soci6td de
T>.drapeutique, M. Martimeau brought forward some massive
I statistics concerning the ammoniacal peptonate of mercury
which had been incriminated by M. Hallopeau. He had.
he said, treated 6000 patients, and made at least 180,000
injections. Every kind of symptom, including ulcerative
sypliilides and cerebral syphilomata, could be dissipated by
it. and, thanks to these injections, there is uo longer any¬
thing to fear; syphilis can be mastered with certainty.
M. Martinean had never once seen an abscess when the
injection was made in the cellular tissue.

BRIGHT’S DISEASE AND ALBUMINtmiA.

The Semaine Midicale publishes an interesting lecture by
Professor Dieulafoy, chiefly dealing with the diagnosis of
Bright's disease. He points out that in a great mauypeople
albuminuria may exist without nephritis. Leube found
this to be the case five times in 119 soldiers, and nineteen
times in the same nuralier of men after a long march.
Albumen is often found in tbe urine during an acuse dis¬
ease, such as pneumonia or pleurisy, and disappears
upon convfcle-sCenee without any evil result. A number
of theories have been suggested to explain this occurrence.
Of these may be mentioned the opinion of Professor Jaccoud,
who think9 that the albuminous material is not true
albumen, or serine, but a variety of it called globuline,
derived from tbe blood-cells, and distinguished from the
first by its coagulability with concentrated solutions of
sulphate of magnesia, in these cases the toxicity of the
urine is normal. Bright’s disease may last, on the other
hand, not only during the pre-albuminuric stage of
Mahomed, hut fcven during the wnole of its course, without
its being possible to detect any trace of albumen in the
urine. If general symptoms point in this direction, and the
probability of arterio-sclerous nephritis is enhanced by
the discovery of a bruit tie galop, or of the doigt mort, a
pathognomonic sign pointed out by M. Dieulafoy, tbe test
of Felts and Ritter, as simplified by Professor Bouchard,
will settle the queation. The urine of a healthy person
when introduced into the circulation of the rabbit by injec¬
tion into the veins of the ear kills the animal in the pro¬
portion of fifty grammes per kilogramme of weight. But
that of albuminuric subjects con be tolerated in much larger
doses, and in one case mentioned by M. Dieulafoy a rabbit
of two kilogrammes, for which a toxic dose of healthy urine
would he 100 grammes, exhibited no discomfort until 260
hod been injected, and even then recovered.

Paris. Man'll 25th.

©Intrant.

*0

W. H. THORN’TOX, J.P., MJl.C.S.

Me. W. H. Thornton, of Berkeley Lodge, Margate, died
at Hastings, on Sunday, March 20th, of congestion o£ the
lungs. H<> was the son of the late Mr. W. Thornton, was
born at Uxbridge in 1822, and was educated at Cbaring-
cross Hospital. Mr. Thornton went to Margate in 1846, and
had been in active practice in that town for forty-two years.
For twenty years he was one of the visiting surgeons to the
Royal Sea-bathing Infirmary, ajid for the same period
surgeon to the Deaf and Dumb Asylum. Air. Thornton
was an lionbur to hie profession, upheld. itq : dignity, and

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‘ 1

704 Tint Lancet,] MEDIC VL NEWS.—MEDICAL NOTlt8 IN PARLIAMENT. [Apnn. 2,1887.

was loyal in his dealings with his brother practitioners.
As a surgeon he was conservative, and preferred gentle to
more heroic measures. He took the keenest interest in his
work, and would at all times sacrifice his own comfort to
promote the welfare of his patients. What, however, will
chiefly dwell in the memory of his friends was his kindness
and goodness of heart. lie was full of charity, and was
one oi those who thinketh no evil. He had the happy gift
of seeing the best and brightest side of everything and
everybody, and his cheery and sympathising manner helped
his patients not a little. Rich and poor alike feel his loss,
and his funeral was attended by most of the inhabitants,
lie is mourned by all, but by none more than his medical
brethren.

HUlrital ftcfos.

Royal College of Surgeons in Ireland. —At a
meeting of the Court of Examiners held on March 21st and
following days, the undermentioned gentlemen passed the
first half of the examination for the Letters Testimonial of
the College:—

Edward C. Clanohv. I Edmond F. Have*.

Andrew G. T. Hanks. I Thomae Hickey.

John Lundie.

Society of Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on March 24th:—

Carter. Rol>ert James, The Grove, Camberwell.

Jecki, Cyril William. Hilldrop-road, Cainden-road.

The annual Hospital Sunday collections were held
in Warrington on the 27th ult.

The Earl of Dunraven has consented to preside at
a festival dinner to be held in aid of the funds of St. Mary’s
Hospital.

Mr. Francis Powell has on the tapis a Bill to
regulate and control the employment of children in hawking
articles in the street.

The annual meeting of the supporters of the
Worcester Dispensary was held on the 29th ult, when
satisfactory reports were presented and adopted.

On the 24th ult. a Local Government Board
inquiry was held at Porth relative to the pollution of the
River Rhondda by refuse from certain collieries adjacent
to it.

An epidemic of diphtheria has broken out in one of
the suburbs of Canterbury, and there have been several fatal
cases. A similar outbreak occurred in the same suburb last
year. The cause is unknown.

On the 26th ult. the sixty-third annual meeting of
the Royal National Lifeboat Institution was held, when
it was stated that the committee had decided to submit
their boats to more severe tests than heretofore as regards
self-righting properties.

Infectious Disease at Darlington. —The Sunday
Schools at Darlington have been closed, as all but one or two
of the elementary schools have been for some time, because
of the great prevalence of scarlet fever and measles in the
town. The public library has also for the same reason been
closed for three weeks.

At a special meeting of the governors of the
Bradford Fever Hospital on the S3>th ult. it was decided,

subject to certain conditions, to sell the hospital to the
corporation for £10,000. Part of this sum is to be devoted
to the provision of a hospital or hospitals for the reception
of persons suffering from infectious diseases in the town¬
ships or districts outside the borough, the sanction of Par¬
liament being asked for such appropriation.

The Pasteur Institute. —The members of the
committee of the Pasteur Institute have decided to refuse
the site offered by the municipality, and to purchase a site
for 430,000 francs. They have also agreed on plans for
the erection of four buildings, to cost 60,000 francs. A
yearly revenue of 65,000 francs has been secured, leaving
35,000 still to be obtained, and the subscription lists are to
" be kept open until the desired sum is collected.

At a meeting in support of the fund now being
raised on behalf of Guy’s Hospital, held on the 30thult.it
the Surrey Masonic Hall, Camberwell, the sum of £62 to
subscribed.

Hospital Saturday Fund.—A t a meeting of the
delegates of this fund on the 26 h ult., the secretaryreported ,
that as the result of the first year’s work of the Surgkai 1
Appliance Committee 540 patients had been supplied with
surgical instruments, at an average cost of 10s., the attend¬
ances recorded being 695. A grant of 4 per cent, for the
purchase of appliances for the requirements of the present
year was agreed upon.

The Sanitary Institute. —A petition has been;
presented to Her Majesty in Council by the Duke o(
Cambridge, the Dake of Northumberland, the Duke of
Westminster, and others, on behalf of the Parkes Musentn
of Hygiene and the Sanitary Institute of Great Britain,
praying for the grant of a charter of incorporation, under
the name of the Sanitary Institute. The petition will be
considered by a Committee of the Privy Conncil on May 6th.

Presentations.--O n the 22nd ult. Mr. Blackburn
was presented with a silver goblet by the members of the
Monk Bretton Colliery St. John Ambulance Claseee in re¬
cognition of his servicee as instructor.—Mr. A. W. Hughes
has been presented with an address and several cases of
surgical instruments by the students of anatomy. Surgeons'
Hall, Edinburgh, on the occasion of his reaigniog the post
of Senior Demonstrator of Anatomy in the Edinburgh Royal
College of Surgeons.

Accommodation for Untried Prisoners at the
Central Criminal Court.—A t a meeting of the Court of
Common Council at Guildhall on the 24th ult., a letter was
read from the Home Office asking for information as to what
steps the Corporation intend to take to bring the accom¬
modation for untried prisoners at the Central Criminal
Court up to the standard indicated by the Committee which
recently inquired into the subject. The letter wastefemd
to the Law and City Courts’ Committee.

Local Government in the City. - The report on
the work executed by the Commissioners of Sewers of the
City of London for the year 1886 has just been issued by
Colonel Haywood, the engineer to that body. The report
gives a comprehensive statement of the sewers, home
drainage, dangerous structures, improvements, electric
lighting, water-supply, scavenging, cemetery arrangements,
artisans’ dwellings, and other matters which have occupied
the attention of the commissioners during the past twelia
months.

The Melbourne Hospital. —From the annua]
report of this institution it appears that during last year
the income for the purposes of maintenance, inclusive of
£14,000 from the Parliamentary vote and £2806 from the
committee of the Hospital Sunday Fund, amounted td
£28,362. The expenditure was £24,861. The benefits of the
hospital were extended to 19,398 cases, of which nambei
15,687 were out- and 379L in-patients. The report records
several alterations in the buildings, which havq been under¬
taken to improve the sanitary condition of the institution,
an object which has, it is stated*, been fully achieved. Tb«
erection of a hospital for the reception and treatment d
persons suffering from consumption, and the removal of tin
institution to another aite t could a suitable, one be obtained
is advocated by the committee.

MEDICAL NOTES IS PARLIAMENT.

Anthrax.

In the House Of Commons on the SMhmlt., In reply to Dr. Cbunrrro,
Lord John Manners stated that the Anthrax Order of 1898 provkita f> •
the destruction of carcasses of animals <je*d of anthrax.by exposure M
a high temperature or by cbemlual ageata, and some local authorities
in districts where the neoamary applluoes exist,-have been authorise
to adopt such modes of destruction instead of burhL In referenced
burial, which In many parts of the cou&try Is the only available met hoi
of disposing of carcasses, local authorities hive been Warned that th
carcasses should be burled entire shd be^Welt oOVefed with fiaw. Mi
Sltchle also stated, id reply to Dr/ OemertfA, that thAdsasgnKd anthra
being communicated to hamSn Minjprls oaM almost exotasIMly tocurrr
by those who have to' deal with t$« hMM pe opened bodies vftaL^*
animals, and obedience to tbeOrder of 4fe<rBpliyPouftaM cfrBeyt. 16 G
1886, as to dealing with eoehaQtaal* and thsric^arssa^yrtttpcacticai

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TH* Lancbt,] APPOINTMENTS.—VACANCIES.—BIETHS, MARRIAGES, AND DEATHS. [April 2,1887. 705

get rid of that dinger. No other measure is regarded at called for. He
-added that the report of the’niedteut offioerof the Hoard fo«883oeiitiilns
a memorandum which was prepared in order to give the means of reco¬
gnising anthrax as It afTxita people dealing with hides, and this nimio-
rnndum might be useful as guarding against error la diagnosis in dist riots
where actual anthrax has appeared.

"Tin the 29th ult., in reply to Mr. Gardner, Loir! J. Manners said that
experiments in inoculation with the virus of anthrax and other diseases
are being carried on, but up to the present the results are not so satisfac¬
tory as to justify any recommendation as to its general adoption in this
o* untry.

Surgeon-Major Moore.

On the 29th ult. Dr. Robertson asked the Secretary of State for War
whether was the case thH Snrgeon-Major Sanaford Moore, who
originated and introduced into the Army the present ambuianoe
system for the removal of the wounded from the field of battle, had beets
obliged to retire on the lowest rate of pension, in consequence of total
and permanent blindness, induced, in the opinion of a medical board,
by his extra literary duties; and whether, under those olroumstanoes,
he would take Into consideration the justice of granting to that officer
some additional pension to meet the Increased expenses necessitated
In- his disability.—Mr. B. Stanhope replied that the case of Surgeon-
Major Moore was a vary sad one, and that there was every disposition to
approach it with the utmost possible Indulgence. But he regretted to
aay that he found himself unable after very careful consideration to
grant an additional pension to an officer whose ill-health takes the form
of loas of eyesight.

Purification of the Thames.

•On the 39th ult., in reply to Colonel Dawnay, Mr. Ritchie stated that
fie had been in communication with the Conservators of the Elver
Thames on the subject of their proposod byo-law prohibiting the casting
or suffering to fall or flow into the river any sewage or other offensive
matter, and the effect of that bye law with regard to home-boats and
steam launches. The Conservators had forwarded to him a copy of a
letter which, as loon a-* the bye-law referred to has been approved, they
propose to addresi to the owners of house-boats and steam launches,
requesting that they will, without delay, make the neoessary arrange¬
ments in the fittings of their vessels, in order to comply with the bye¬
law referred to. They state that any closet communicating with the
river would obviously be an infraction of the bye-law, and oannot there¬
fore be permitted.

Scotch L'nirersities Bill.

In answer to Mr. Bryce, the Lord Advocate said that the promised
Bill dealing with the question of the S'-otch Universities would probibly
have been introduced by this time had it not been for the delay caused
by the change of offioe of the late Secretary for Scotland. It was hoped,
however, to introduce it shortly.

When the Civil Service Estimates are again before the House of
Co m mo ns , Mr. A. O’Connor will propose, cm the vote for the Local
Government Board, to move to leave out the item of £10,500 on account
of public vaccinators.

^ointments.

Successful applicant! for Vacancitt, Secretaries of Public Institutiont, and
others possessing information suitable for this column art invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o’clock on the Thursday morning of each week for publication in
the next number. _

AnutUT, Sony, M.D., M.Gh.Q.U.I., has been spoolnted Medical
Offloer for the Glengariffe Dispensary District, oo. Cork, vice Levis,
resigned.

Bradshaw. Thomas R.. B.A.. M.D.Univ.Dub , M.R.C.S., has been
appointed Honorary Physician to the Stanley Hospital, Liverpool,
vice Barr, resigned.

Chambers, Antony B.. M.D., M.Oh.Boy.Univ. Irel.. has been appointed
Resident Medical Officer of Health for Long BatOD, vice Butler,
resigned.

Count, Jakes. L.R.C.P.Lond., M.B.C.S.. has been appointed Medical
Officer to the Chase Farm Schools of the Bdman&on Union,

Davier, Joseph, L.R.O.P.Bd . F.R.C.S.Bd., has been appointed Medical
Officer for the Second District of the Swan<ea Union.

Djylk, Henry Martin, M.R G.S.. L.S.A., has been appointed Receiving
Room Officer to the London Hospital.

By ass. Edward B.. L.R.C.P.Ed., M.R.C.S., baa been appointed Medical
Offloer for the Fifth District of the Swansea Union.

Gibson. Thomas B.. M.A., M.B.. C.M.Aber., has been appointed
Medical Officer by the Oldraachar Parochial Board, Aberdeen, vioe
Fraser, deceased.

Harris, H. B., L.R.C.P. Lend., M.R.C.S., has been appointed
Assistant Medical Officer for the Infirmary of the Parish of
Paddington.

l.vrr, Arthur Pearson. B. So. Lond., M.R.C.S., L.S.A.. has been
appointed to th« Chair of Medical Jurisprudence and Toxicology
in St. Mary's Hospital Medical School, vice Randall. M.D.,
resigned.

Lxox, Thomas Glover, M.A.. M.D.Cantab., M.R.C.P.Lond.. has been
appointed Atsiitaut Physician to the North-West London Hospital.

Mackintosh. A.vmrs, M.I), L.F.P.8. Ola*., has been reappointed
Medical Officer of Heal h for the Clay Lane Urban District of the
Chesterfield Union.

Pece, Howard George. V.K.. M.R.C.8.. has been appointed Resident
Medical Officer to the Chelsea Hospital for Women, Fulham-road,
8-W„ vice Sunderland, whose term of offioe has expired;

Pockbtt, Lewls W„ M.B.C.S.. L.S.A., has been appointed Medical
Officer for the Hogsthorpe District of the Sptlsby Union.

Potter, B. Furxim, M.B.C.8., L.R.C.P. Loud „ has boon appointed
Visiting-Surgeon for the North Myton District of the Hull and
8enlcoates Dispensary.

Power. D'Arcy, M.A., M.B.Oxon., F.R.C.S.Bng., has been appointed
Burgeon to the Metropolitan Dispensary, Fore-street, B.C., vice
.. Alban Doran, F.R.C.S.Bng., resigned..

Stkdmax. Arthur. M.R.C.S.. L.S.A., has been reappointed Medical
Officer for the Effingham District of the Dorking Union.

Storrar, William Morrison, L.R.O.S., L.R.O.P.Bd.. has l>een
appointed Medical Officer for the Bastham District of tho Wirral
Union.

WILLIAMS, Bookr D. D.. L.R.C.P.Ed., M.R.C.S., has been appointed
Medical Officer for the Fourth District of the Swansea Union.

Danmrits.

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of the various
Vacancies which art announced in our advertising columns. For further

Bradford Infirmary axd Dispensary.—H ouse-Surgeon. Salary £ll>)
per annum, with board and washing.

British Medical Association.—R esearch Scholar. £150 per annum.

Ciielsea Hospital r&n Women, Fulham-road, 8.W.—Physician.

Dental Hospital or London, Lelcestw-square.—Dental Surgeon.

Gloucester County Asylum.—T hird Assistant Medical Officer. Salary
£105 per annum, with board, lodging, and washing.

New Hospital por Women, Marylebone-rood.—Clinical Assistant.

Paddinoton-orrkn Chilprkn's.Hospital.—H ouse-Surgeon. Salary £80
per annum, and rooms.

Poplar Union.—M edical Officer for the East District. Salary £130
per annum, to include all extra fees, the guardians supplying drugs.

Queen’s Hospital. Birmingham.—Obstetric and Ophthalmlo House-
Surgeon. The appointment carries with it board, lodging, Ac.

Scarborough Frirndlt 8octkties’ Medical Association.—R esident
Medical Officer. Salary £200 for the first year, £230 for the second
(if satisfactory), with fees extra, and residenoe, free of rates and
taxes, with an allowance for coals and gas.

University or Cambridge.—J ohn Luoas Walker Student. £250 per
annum.

$irtjrs, Carriages, anil Deaijrs.

BIRTHS.

Barry.— On the 26th nit., at Linton Conrt, Settle, the wife of F. W.
Barry, M.D., of a daughter.

Howell.—O n the 2ith ult.. at Bast-hill, Wandsworth, 8.W., the wife
of James Bromley Howell, M.R.C.S., of a son.

Macleod.—O n the 28th ult., at the Bast Riding Asylum, Beverley, the
wife of M. D. Macleod, M.B., of a daughter.

Masters.—O n the 36th ult., at Westali House, Brook-green. W„ the
wife of John Alfred Masters, L.R.O.P. Lond., M.R.G.S., of a
daughter.

Mulld*.—O n the 18th ult.. at Ruthin-gardens, Cardiff, the wife of
James Muilin, M.A., M.D., of a son.

Wallace.—O n the 34th ult., at Gue -nsey, the wife of A. C. Wallace,
M.R.O.S., of a daughter. _

MARRIAGES.

Pierce—Brandon.—O n the 23nd nit., at St. Bede’s Church, Liverpool,
Bvan Pierce. M.D., F.R.C.S., J.P., Coroner for West Denbigh¬
shire, to Alathea Eliza, youngest daughterof the lateThoe. Brandon,
of Brondesbury-park, N.W.

Priestley—Jacques.— On the 12th ult., at the Parish Church,
Streathsm, S.W., JoseDh Priestley, B.A.. M.D_ to Bdith Blanche,
youngest daughter of Bdwin Jaoques, M.D., of Brtxton, S.Vf.

DEATHS.

Allen.—O n the 21st ult., Thomas Allen, M.D., M.R.C.S., aged 61, late
Medical Superintendent and Director of the Government Lnnatlo
Asylum, Kingston, Jamaica.

Brady.—O n the 27th ult., at Loddlngton House, Rugby. John Brady,
M.R.C.P.Lond., F.R.C.S.I., for twenty-seven years M.P. for county
Leitrim, aged 71.

Collie.—A bout Oct. 16th. last, lost bv the wreck of tho ship Nerbudda,
David Collie, M.D., of Edinburgh.

Hutton.—O n the 37th nit., at Lowndes-street, 8.W., Charles Hatton,

M. D., aged 99.

Mathew. — On the 22nd tilt., at Bruges, Theobald Mark Mathew,
late Deputy Surgeon-General, H.M.'s Indian Army, in his 64th
year.

Rutherford. — On the 34th nit., st Vaaxhsll-brldge-road, 8.W.,
Surgeon-General Win. Rutherford, M.D., C.B., Honorary Physician
to the Queen, aged 71.

Sweeting.—O n the 35th ult., at Great Smeaton, Yorkshire, George
Bacon Sweeting. M.R.0.8.Bog., L.R.C.P.Lond.,Consulting Surgeon
to the West Norfolk and Lynn Hospital, of King's Lynn, aged 93.
Thurland.—O n the 23rd ult., at WUmington-sqoare, W.O., Francis
Bdward Thurland, M.R.C.S., aged 40.

Yeo.—O n the 27th nit., at Atverstofcb, Hants, Gerald A. Yeo, F.R.O.8.,
retired Fleet Surgeon, B N._

N. B .—A fee of be. is changed for the Insertion tf Notices of Births,

Marriages, and Deaths.

Digitized by

Google

70& The Lancet,]

NOTES, COMMENTS, Afctf AN8WTSRSTO uOftRBSPOXOENTS.

[Apbti/2, 1887.

literal §iarj for % mixing ®tek.

Monday, April 4.

Boyal London Ophthalmic Hospital, Moorfiklds. — Operation*,
10.30 A.M., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.—O peration*, 1.30 p.m.,
and each day at the same hq,ur.

Chelsea Hospital for Women.—O peration*. 2.30 p.m ; Thursday,2.30.

St. Make's Hospital.—O perations, 2 p.m. ;' Tuesday, 2.30 p.m.

Hospital for Women, Soho- square. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O peration*, 2 p.m.

Royal Orthopaedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O peration*, 2 p.m., anil
each day In the week at the same hour.

Royal Institution.—5 p.m. General Monthly Meeting.

Odontolooical Society of Great Britain.—8 p.m. Oaanal com¬
munication* bv Messrs. J. Ackery, F. Henri Weiss, Boyd-Wallis,
O. V. C'ottereli. 8. J. Hutchinson, W. Harrison, and J. Penfold—
Mr. Newland Pedley i On the Pathology of Pyorrluoa Alveolaris.

Medical Society of London.—8.30 p.m. Sir Dyce Duckworth: A case
of Ulcerative Endocarditis—Mr. R. W. Parker: On the Alleged
Dangers of Starch-containing Foods (luring the period of Infancy.—
Dr. Whipham: A case of ExtoliatiDg Eruption ol the Tongue.

Tuesday, April 5..

Guy's Hospital.—O perations, 1.30 p.m. and on Friday at the same hour.

Ophthalmic Operations cn Monday at 1.30 and Thursday at 2 p.m.
St. Thomas's Hospital.— Ophthalmic Operations, 4 p.m.; Friday,2 p.m.
Oancer Hospital, Brompton— Operations, 2.30 p.m.; Saturday. 2.30 p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital.—O perations, 2.30 pT.m.

St. Mary’s Hospital.— Operation*, 1.30 p.m. Consultation*, Monday,

1.30 p.m. Skiu Department, Monday and Thursday, 2.30 A.M.
Society for the Study a\i> Curb of Inebriety.—4 p.m. Annual

Address by the President (Or. Norman Kerr) : The Pathology of
Inebriety.—Dr. T. D. Crothers : The Cnuse and Cure of Inebriety.
Pathologioal Society of London.—8.30 p,m. Mr. Hutchinson, jun.:
Alveolar Ulceration in a Child; General Tuberculosis.—Dr. Joseph
Coats: (1) Hypertrophic Goitre with Secondary Tumours In Bones
of Skull; (2) Tumour of Pineal Gland.—Mr. Lawson Tait and Mr.
Doran: Specimens Illustrative of Cliroulc Inflammatory Disease of the
Uterine Appendages.—Mr. Bowl by-. Congenital Dislocation of Hip.
—Mr. Lunn ; Disease of the Humerus—Dr. Hale White: Menin¬
geal Hsmorrhage with Secondary Degeneration of Spinal Cord.—
Dr. Pitt: Carciuoma of Spine and Liver. Card Specimens:—Dr. llale
White: O) Peripheral Neuritis; (2) Dilatation of Ureter and Hydro¬
nephrosis of One Side secondary to Urethral Stricture .—Mr. Suatlock :.
Two Specimens of Osteomalacia, showing .Metaplasia of the Osseou*
Substance into Fibrous Tissue. — Mr. Lockwood: Foetus showing.
Absence of Margin of Aoetabulum and other Abnormalities.—
Dr. Tamer: Congenital Stricture of Jejunum.—Mr. D’Arcy Power:
Sequel to a case ot Endosteal Sarcoma.—Dr. Thin (for Dr. B. Bake).
Drawing* of Leprosy BadlUiu—Mr. F. W. Clark : Acute Pericarditis!

Wednesday, April 6.

National Orthopedic Hospital.— Operation*, 10 a.m.

Middlesex Hospital— Operation*, 1 P.M.

St. Bartholomew's Hospital -^-Operations, 1.80 p.m. ; fSaturdav, **me
hoar. Ophthalmic Operation*, Tuesday and Thursday, 1.30 p.m.
Surgical Consultation*, Thursday, 1.30 P.M.

St. Thomas ,8 Hospital.— Operations, 1.30 p.m.; Saturday, same hour.
London Hospital.— Operation*, 2 p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital.—O peration*, 2 p.m.

Samaritan Free Hospital for Women and Children.— Operation*,

2.30 p.m.

University College Hospital— Operations, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.13 P.M.; Saturday, 9.16 a.m.

Boyal Free Hospital.—O perations, 2 p.m., and on Saturday.

King's College Hospital.—O peration*, 3 to 4 p.m.; Friday, 2 p.m.;
Saturday, 1 P.M.

Children’s Hospital. Great Ormond-street. — Operation*,-9 a.m.;
Saturday, same hour.

P4 BESS Museum ot Hygiexe.—$ p.m. Mr. J. Bailey-Den ton: Metro¬
politan Sewage Disposal.

Obptktkxcal Society of London.—8 p.m. Specimens will he shown
by Dr. M. Handfielil-Jones and others. Dr. Champneys: The Third
Stage of Labour (the separation and expulsion of the placenta).—
D>r. Matthew *,Duncan : Hemorrhagic Parametritis.

Tlwrtday, April 7.

St. George’s Hospital.—O perations, 1 p.m. Ophthalmic Operations,
Friday, 1.30 p.m,

Charlng-cross Hospital—O perations, 2 p.m.

North-West London Hospital.—O perations, 2.30 p.m.

. - Friday, April $,

Boyal South London Ophthalmic Hospital.—O peration*, 2 p.m.

Saturday, April 9.

Middlesex Hospital—O peration*, 2 p.m.

METEOROLOGICAL READINGS.

(Taken daily at S.S0 a.m. by Steward's Instruments )

The Lancet Offloe, March 31st, 1887.

•Me.

Barometer
reduced to
Sea Level
udST-P.

Direc¬

tion

of

Wind.

s.

Wet

Bulb.

Solar

Kadia

In

Vaoao.

Max.

Teau».
Shade.

Mix.

Temp

Bala

fait.

HamarKs as

SJDaJL.

Mar. 25

29-63

W.

46

43

73

53

39

•13

Cloudy

„ 26

30-10

N.W.

46

43

So

35

42 i

•1-1 1

Fine

„ 27 ,

30 03

N.W.

30

48

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ftotes, Sfjort Comments, # Imsforrs to
Comspmtknis.

It is especially requested that early intelligence of local event*
having a medical interest, or rchich it ts desirable to bring
voider the notice of the profession, may be sent direct to
this Offioe.

All communications relating to the editorial business of the
journal must be addressed “To the Editors

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

Registration of AMHamAN Graduates.

Yankee. —The Medical Council has not yet come to any decision a* to
American degrees. The curriculum of two year* common in American
schools is not likely to be approved by the Council; bnt nothing fa-
settled.

Dr. ffermet (Paris).—We regret we cannot aid our correspondent, aa we
are not in possession of the publication mentioned.

Pumdou .—The office of the Crown Agent* tor the Oolwaie*. Downing -
Street, 8.W.

Sir Jo*. Sawyer. The-notice will appear next week.

VACCINATION AND REVACCINATION.

To the Editors of The Lancet.

Sirs,—I n your issue of March 19th, Dr. W. Sinclair Thomson states-
that "he has advised vaccination and Tevaoocfoation on the thigh in
preference to the arm or any other part.” Thi* position no doubt in
infancy has its advantages; but later on la life it might possibly prove-
rather inconvenient. I fully agree with Dr. Thomson, though for a
different reason, that It is especially for women that the question of site
is of so much Importance. For example, suppose a grown-up female who
had been vaccinated In her thigh during Infancy presents herself for the
purpose of being medically examined for. »ay, life insurance, now, in
answering the question whether she had bean properly vaccinated, as
most insurance offices require one to do, would it not be awkward in this
case,if not indelicate, to l>e obliged to ascertain the fact by ocular demon¬
stration? ■ I am. Sirs, your* faithfully,

March. 1887. J. II. Balfe, L.R.C.P.Ed. fto.

SNAKE-POISON.

To the Editors of The Lancet.

Sirs. —Allow me to.remark npon your recent article on snako-]>oi»ons
that the researches of Dr. Wolfenden (Journal of Physiology, vol. vii.,
pp. 327-384) tend to show that these poisons are not of a chemical nature.
This would seem t o confirm the deduction made—viz., "that they do
not fall into the class of alkaloids vrhioh result from organised vital
activity.” I am, Sira, your obedient servant.

March 28th, 1887. • William Squibb, M.D.

%* We are obliged to our correspondent for the reference to Dr.
Wolfenden's researches, which would serai to rapport the conclusion*
arrived at by Dra. Weir Mitchell and Reichert. Gautier alone claim* to-
' “ave found a ptomaine in cobra venom—Bo. L.

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NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [April 2 , 1887. 707

Drinking in thb United States.

The Pall Ball Gazette re murk* on the fact of the amount spent on
drink in the United States. New York alone consumes annually
6,000,OoO barrels of beer. The United States spend on intoxicants
annually £170.000,000, or more than £100,000 a day all the year round.
The folly of such an expenditure is monst rous, though we are not in a
position to throw stones at our “ cousins.”

Ur.F. C. Cory .—The fee of one guinea is monstrously inadequate for
time, services, and travelling expenses in the case of our correspondent*
Bvon if he made no agreement beforehand, he is entitled te claim fair
remuneration, and oooid enforce tbs claim by action at law. The
Treasury have no more right than a private individual to engage a
practitioner at their own estimate as to fee. By saying that he was
'■ summoned," we presume our correspondent means that he waa
nquatud to attend at Whitehall. We would advise him to explain tp
the solicitor all the incidental expenses, direot and Indirect, and to
appeal to his sense of fairness.

Ur. C. J. JbMon Turner.— We have, unfortunately, no recollection of tbs
case.

Or. D. Donald.—The letter will be forwarded.

THB SBLFISH PRINCIPLE AND MEDICAL ETIQUETTE.

To the Editori of The Las get.

Biss,—I was onoe a great believer in medical etiquette. I am not so
ioll of faith now; Btill, however, it in a beauteou* thing when it is
occasionally seen. But circumstances have forced themselves upon me,
in, I believe, not an unusual way, which have produced a strong feeling
that the gentlemen who write so frequently to the medical papers about
this phase of professional conduct are generally men of this sort of
•tamp—men who want other men to do their work without paying
them, men who impose on their brethren. I happen to know personally
a medical mao in the provinces who some years ago led a pretty con¬
troversy on this matter iu the pages of a medical journal; and I can
testify that he was of a most cantankerous spirit, fully alive to his own
rights, and very, very unmindful of the rights of others. It will be
instructive to mention two or three facts whloh have occurred to myself
m the oourse of a long profesrional life. A medical brother met me id
the street, and said : “ Will you have the kindness to do my Bight-work

for a fortnight, and one or two cases in the day—Dr.-will *»)« the

ieet,-«a I am going for two weeks' holiday ?” I assented. 1 had never
requested this gentleman to do anything for me—in fact, I had never
visited his boose. I liad a great deal to do, and some expensive medicines
to supply from my own surgery. When be came home he wrote a note
(in answer to mine detailing all that had been done), thanking me ; but
I found no cheque in the letter, nor has he ever done anything In return
for me. I suppose this is medical etiquette! Not long after this another
professional brother began, when he was oat or engaged in pleasure or
professionally, to send his midwifery cases to me, till I had in self-defence
to refuse to do so aay more, and send his patients away in a forcible
manner. I suppose I was guilty in thus meting of want of etiquette I
t can only say that had I acted differently I phould wslp have deserved
the name of “ Thomas Greenhorn " or “John Simple.” I wijl relate only
one more out of many Hint have occurred to me. A brother practitioner
whom I knew for many years, and during which time I attended for, or
consulted with, or made post-mortem examinations of an Important
medioo-legal character with, for about altogether sixty ttmre, was asked
ouce. and onoe only, to attend a case for'me. Ho did so; and when I
“ w Wn i he. iu a very- h esitating, peculiar, manner, told me he
thought I had a substitute." I need not say that I did not help my
inend again. I suppose I was here guilty of want of medical etiquette!

tUne * l«*ve I lost rest at night in seeing cases for my medical
brethren and receiving nothing in return ; for when I have sought

“•ttngtarheljr 1 * * **- 6 <— * oupd lh * t tho *® mo#t in

Now, I have never written on this so-called medical etiquette at all
heter^noT am I aware that anyone Las eves eBcused me of the want of
in J tb ® 00,1 ^rary, I feel that my professional brethren Ahd myself are
*„£!?** k* rm0n 7 > -till, a long series of simitar instances has odn-
^®«d me ttet, as in most other ooafIMbns of life, there are two dhttAct
P*™*. in the profession—the fooTWh ones, who are always trying-.to
”*«>t their.brethren End who get Imposed tfpon, Slid the kraviah ones
*** ri "ay* trying to exact and secure for themselves at* others'
^Megrntoitous service. And these latter in our profasskta aM Jhe
woo generally All; our medloal paper* with long letter* ou the
of medical etiquette.. I know full wall from Brash Convene
■iu my medical brethren that medical etiquette as It used to be con- '
JfredUdrad. It hr a ‘one-sided bo.iriete altogether; ati4 they who .
* most abbot ft and' In ft* favour are thos* AAo are obeyfhg their own !
nsh sordid Instincts by trying to make unpaid assistants of all such
weir medical brethren as are foolish enough to become entangled in
nontrivsdiwwbe. whloh tbese ra s Ay .ohtetaa salgirtedM
pruning—and they name these webs “ medical etiquette.”

M .

“weh.iaST. i.i'•. '''

Pf* 4f*|>oadiqg Vifmwdjaal etiquette which on. :
^respondent does; but think It right to allow him-to state his
ex P«rfenoe — Bd. L. ,-hi:*I ,uiJtB;nuflb auSL ,3d .iLUTdA .1 eon r

Advertisement and Cheap Medicines by a Fellow of a
College.

A cihculab Is before us, issued by a gentleman holding a F.B.C.8.
and L.A.C., offering advice and medicines at very low rates, to all and
sundry. Surely, a Fellow of a College should set his fellow prac¬
titioners a better example, and convey to the public a higher idea of
the nature and value of the medical calling.

Cynic. — The best course for other practitioners to take In the first
instanoe would be to make a respectful, but strong and nnaulmous
representation to the medloal offioer of health to the effect that suoh a’
Une of practice on his part waa disappointing and undignified. It
would not be right to withhold Information from him in his sanitary
capacity.

U.B., CM. (Aberdeen) need not hurry to register, as he will be able to
do so at any convenient time.

J. B. should consult his medical adviser.

MB. H. A. ALLBUTT AND THB ROYAL OOLLBGB OF
PHYSICIANS, EDINBURGH.

To the Editor* of The LaNobt.

Sna.—A* yon are aware, the Fellows of the Royal College of Physicians
of Edinburgh have threatened to deprive me of the membership
licence of the College for “ having published and exposed for sale [so this
indictment is worded] an lndeoent book, titled, • The Wife’s Handbook.’ ”
The case comes on for hearing in May. As this action, against me is
causing much comment both lor and against me in m «n^ii circles, I
would ask you in all fairness to allow me to state that I have a full
answer to every charge, both legal and moral. As, however, it is not for
me to divulge my line of defence before action, I simply remark that I
feel confident of a triumphant Issue out of the ordeal. I enclose the
Petition of the Connell of the Malthusian League of London, forwarded
to every Fellow and Member on the College roll, and I would ask you to
Publish it at the end of my letter. I feel rare a liberal journal like
The Lancet will give fair play to a member of the profesaion placed In
such a position as myself.—I am, Sira, yours truly,

Henry Arthur Allbutt, M.R.C.P.B., L.S.A. Lond.
Leeds, March 26th, 1887.

*•* Wo Insert the above letter, but at the same time we feel bound to '
express our opinion that the book mentioned is one that should not be

open to Indiscriminate circulation.—E d. L.

Somerset. — Our correspondent has no olalm against the widow if he
attended the husband as a pauper under a parochial order from a
relieving officer. .

Ur. Laraton (Paris).—We cannot exchange.

WlLt Spes, who wrote to os' last week, kindly forward his address.

MEDICAL EDUCATION.

To the Editors of The Lancet.

Sirs,—I hav* read in your report of the last meeting of the Medical
Council that the subject of medical education has been referred to a
committee, and I therefore hope that at last the authorities are begin¬
ning to see that a practitioner whose whole time of study has been spent
at a medical school is not fitted for the immediate discharge of the
responsible duties of general practice. I began my professional education
as a pupil of a general practitioner who waa also surgeon to a large
provincial hospital, and thus, betide* hospital practice, saw cases of
small-pox, scarlet and typhoid fevers, measles, Ao.; thoroughly learnt
dispensing and medical bookkeeping, and the hundred and one thing*
appertaining to general practice, which It is impossible to do at a
medical school. Not long after being In practice I was asked to see “ an
Interesting case of skin disease,” which I had no difficulty la reoo gnjaiag
as a raise o7 “ variola,“but whloh had been unreoognised by the medical'
man in attendance, who was a -*• schoolman," and had never seen a case
of small-pox. By the present regulations of the Bnglish Colleges all the
valuable practice and teaching *f country hospitals, Ac., are lost to the
present generation of students, and the question remains how long will
the Medical Connell allow the registration of Imperfectly educated
medical men'to continue, or will they have the courage to require > W’-
studente shall have at feast spent one year as pupil of a practitioner
holding appointments Which afford the required amount of practical
knowledge. . , . ■ 1.1 am, Sirs, jours faithfully,

Maroh Wthi 1887. . . • M.B.CJ3. Bng, .

j

. ... PAHCHL-POBT BOXES FOR MEDICINES.

To the Editor*! of The Lancet* ,j

-. Sirs,—I should be glad to know what has been the experience of
others of your readers with regard to sending medicines by post in
those boxes which are advertised, la the medloal newspapers and shrahy
the wholesale chemists os safe and suitable for the purpose. Those I use ‘
are made of stout cardboard, with fluted paper covering for the bottle;

a*

oA ^ ***.*?««

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708 • ThitLangut,}

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Aran. 2, 1607.

• BRHAD-MAKIWG.

To the Editort of The Lancet.

Sirs.—I n answer to the letter of Mr. Robert Jones In your lut iaeue I
may state that I have frequently made bread by the method named.

I am not aware, however, of any pamphlet on the subject, and fancy
jour correspondent mast refer to one published by the Aerated Bread
Company, who, I believe, still sell the bread in London. But this is
prepared in a different way—viz., by forcing in the carbonic acid gas by
machinery during the mixing of the dough. I believe the method
required is to be found in the earlier editions of Pereira’s Materia Medica,
whence I oopted it, as follows : •* Unfermented bread. —Floor, 1 lb.;
bicarbonate of soda. gr. xl.; oold water, half a pint, or as much as may
be sufficient; muriatic acid, fifty drop*; powdered white sugar, caw
tnnpoonful. Intimately mix the soda and the sugar with the floor in a
large basin by means of a wooden spoon. Then gradually add the
water with which the acid has been previously mixed, constantly stirring,
so as to form an intimate mixture very speedily. Divide into two
loaves, and Immediately put them Into a quick oven."

I remain. Sirs, yours truly,

Plymouth, Marsh 26th, 1887. H.

To the Editor* af Thb Lancet.

Sim,—I n reply to Mr. Robert Jones, allow me to say that nnfennebted
bread is best made by taking 130 grains of bicarbonate of soda for even
pound of floor, ISO minims of pure muriatic add, and a little leas than a
pint of water. 1 Let the water and aeld be intimately mixed, and the soda
be siftbd Into fl and well mixed with the floUror meal; them gradually
add the acidified water to the consistency of light dough, bake in a brisk
oven for about an hour. I am. Sirs, yours faithfully,

Sandy, Beds, Match 86th, 1887. H. C. Strotbr.

Z. E. A. is always liable to the consequences or having made ft false
declaration. His beet course Is candidly to state the fact* to the body
aggrieved, and throw himself on Its kipdness.

J/r. J. C. Gahmts .—The Charities Register and Digest, published by
Longmans, or onr own advertising columns, will afford the'information
desired.

X. y. Z—The Riddell fund was closed on Jan. 19th of the present year.

The sum raised altogether was, we believe, a little over £60.

Ur. J. A. Jones (Tir Caradoc).—The cases had,perhaps, better go together.

NIGHTMARB.

To the Editors of The Lancet.

- Sirs,— Allow mo to suggest that “ M.D.” should take half a grain of
the red Iodide of mercury in {dll night and morning for six or seven
days. He should take a very light supper, avoid all stimulants, and
take such measures as will prevent him lying on his back whilst asleep.
The cause of nightmare I believe to be congestion of the coordinating
oentre, the cerebellum. In your correspondent’s esse possibly this is
secondary to bis lives’* inaotibn.

I am, 8irs, your obedient servant,'■

Match, 188T. MEECuWT,

Dr. fftasva.—No copy Of the Japanese Pharmacopoeia has resnbed ns, and
we have do information at present beyond what appeared in the
paragraph alluded to.

Sanitaria* will find a return* of the course of the cholere epideshiofn
1888 in our iaeoe of Jan. 16th last.

Ur. E. Colton.— The report appeared in The Lancet of March 36th.
Ettideni Physician to a Kurtaal has not enclosed his Card.

Communications not notloed in our present number will receive atten¬
tion In onr next.

Communications, Letters, do., have been received from—Dr. Fenwick,
London; Sir J. Sawyer, Birmingham ; Mr. Godlee, London ; Mr. B.
Owen, London; Dr. Savage, London ; Dr. Norman Kerr, London;
Dr. J. Wilson, Haverfordwest; Mr. V. Richards, Goalundo ; Mr. E.
Colson. Aden j Ms. B. Gordon, Bombay ; Dr. F. C. Cory, BuCkhorst
HHl; Mr. Moeely. Leeds; Mr. Bacakh, Bombay j Messrs. Burroughs
and WeUessne, London; Mr. W. Whitehead, Maaobeatee; Mr. H. A.
Allbutt, Leeds; Mr. J. Oliver, London; Dr. Park, Glasgow; Mr. C.
Williams, Norwich; Mr. Lewtae, Ncrwshera; Messrs. Wool lama and
Ckx, London ; Mr. J. Moor*; London< Harr Uhtwora, Oassel; Mr. D.
Christie, Hoakden; Mr. Maytborn, Biggleswade; Messrs. Harris and
Co., Birmingham; Mr. L. D. Powles, Nassau, N.P.; Mr. Leighton,
Cheltenham ; Mr. Jeeeitt, London; Dr. Ambrosl, Italy; Mr. Karp,
Notts; Mr. Bland, Colchester; Mr. Burdett, London: Dr. Thomson
Edinburgh; Dr. Hughs*. Cow bridge; Dr; R. Barnes, London; Dr. W.
Squire. London ; Dr. H. Barnes, Carlisle; Dr. Olasoott Mr. A. Apr,
London; Dr. Alford, Taunton; Mr. J. B, Edwards; Messrs. Shelley
and Co., London ; Mr. W. K. Treves, Margate ; Messrs. Wright and
Co., Bristol; Mr. H. J. Collins, LondonMr. Bnson ; Messrs. Christy
and Co., London ; Dr. Mattison, Brooklyn ; Mr. Blandford, Stockton-
on-Tees ; Dr. Hermet, Paris; Mr. J. B. Young, Halesowen; Mr. W.
TaUaok) London; Mr. W. 8. Manning, London; Messrs. Whitfield
and Co., Birmlngliam ; Mr. J. B. James, London ; Dr. Adams. Wot
, Mailing; Dr. Leachman, Peterafield ; Mr. F. Peek, London; Mr. R.
Davy, London; Dr. A. W. Bdis, London; Mr. Spencer; Dr. Lavers,
Wandsworth ; Mr. Knowles, London; Mr. Lancaster, London ; Mr. K.
Mosse, London; Dr. Thomas, Glasgow; Mr. H. Godrich; Mr. Know»ley
Thornton, London; Dr. Tdnman, Nottingham; Messrs. Mamdlan
and Oo., London ; Mr. F. W. Willmort, Walsall; Messrs. Hewlett and
Co., London; Mr. Rayner, Rugby; Mr. A. 8. Morton; Mr. Joslem.
Workington ; Mr. RIndle, Windsor; Mr. Browne, London ; Mr. H. S.
Gabbctt, Eastbourne; Ptofessor Roy. Cambridge; Mr. Husband,
Leeds; Mr. Brust, Edinburgh ; Dr. Anderson, Glasgow ; Mr. Tuomsr.
Harrogate; Dr. Stirii ng, Grays; Mr. Wilson, London.; Mr. Grower ;
M.RiO.8. i Med. Staff; Aiskm; F.S.O.S.B.; Somerset; Medica)
Staff; M. D. B.; Secretary, Manchester; Mercury; Alpha; Surgeon
Leeds; Hygiene.

Letters, each with mteloeure, are also acknewledged from— Dr. Kerr.
St. John’s-wood; Mr. Mftllor, Wakefield; Surgeon-General Gordon,
Bournemouth ; Rev. Dr. Kendal, Southsea; Mr. Arnos, Now castkyoc-
Tyne; Mr. Kershaw. Luton; Mr. Hopewell. Notts; Dr. Anderson,
Boy ton; Mr. Cummlsg. London; Dr..Lyons; Messrs. Reynolds and
Ool, Leeds; Mr. Roberta^ London; Mr. Hideal, London; Dr. Brooks,
Ludlow; Dr. Dolan, Halifax * Mr. Weaver, London; Mr. Armstrong,
Manchester; Mr. Gray, Dalton-in-Fnrness; Mr. Plowright, King’s
Lynn; Mr. Watson, Scarboro*; Dr. Cochrane, Bradford; Mr. Hulme,
Birmingham; Miss De Liittlchau, Holloway; Mr. Patohett, Great
Harwood; Mr. Gravett, Horsham; Mrs. Griffiths; Mr. Williams, Port
Isaac; Mr. Affleck, Manchester; D.,Strhowy; Spa; Neurotie, West
Brampton ; Alpha, Bourne; L. M.; Medicus, Naatwioh; Medicos,
Neweastle-ou-Tyne; W., Bath> Medinas, Stratford; H. C. A.; A. B.,
Clap ham ; J. P., Accrington; Veritas.

Eastern Daily Press, Barnsley Chronicle, Oldham Daily Standard, Thames
Valley Times, S/c., have been received.

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States.. .-.... Ditto 1 14 8

Post Offloe Orders Should head d r ees b* to John Obott, ThxAAjwwp
O ffloe, 438. flthfflri. London, and made payable at HM* Poe* (MM,
Obaring-crost.

Hotioei of BlrfflW Maw*»gm.>m>a Bflli kreehUrted fit*shillings.
PhST"** c roeeedT** Lon do n e M WestofiDater-Bank."

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Books and PubUcatJons (seven Usee and wnder).„ ... M> 8 0

Official and General Annotmaamsnla . —060

Trade and Miscellaneous AdvertbemenU — - - 0 4 «

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The Publisher cannot beM himself responsible for the return of testi¬
monials, Ac., seat to the offloe hi reply to advertisements; sopie s tmly
should be forwarded.

Notice.— Advertisers are requested to observe that it Is oontrair to
the Postal Regulations to receive at Post-ofloes letters addressed to
Initials only.-

Ah Original and novel feature of “In LanCeT General Advertiser" Is aspeelalladex to Ads oit ffl e i a i m tion’pags 3, whtob not only affords a
ready means of finding any notlee, but Is In Itself an additional advertbement.

Ad /W t ht meats (to ensure insertion the same week) should be delivered at the Offloe not later than Wednesday, aooompanied by a remittance.
Answers are now received at thb Offloe, by Special arrangement, to Advertisement* appearing in The Lancet.

Terms for Serial Insertions may be obtained of tbs Publisher, f o whom all letters relating to Advertisements or Subscriptions should be addressed.
Advertisements ere new received at all Memre. W. H. Smith and Sou's BallwEy Booketalb throughout the -Uhlted'Kingdom and all other
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,, t . Agtnt fbr the AdvertiMng Dqp^rftaput.jjyjnjaoo-J. ASXEBR. 66, Has Oaamurtin, Faria, i •

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THE LANCET, , April 9,. 1387.

(w Bnrr ‘>|li.!. I -1 .t!i»; ■■ . .

■-“Ctimtisit ftctera

• ' OH

T H E U L S E.

' . 4l-»*l v'j

heSmem&i at. the Royal CbUege of Physicians of London,

• jan i Mafcfr, 18a7,

ir Sr. ~n. BkpADBENT, M.D., E.R.C.P.,

ranicuit to bt. habit’s hospital, oohsultutg phtsicux to the

LOSDPS JTETHB HOSPITAL, AHD PRESIDENT OF THE CtflriCAL SOCIETY.

•»'» . ■>« , LECTURE III.

Mn. PiBSlDajTP and Gentlemen,— Examples of the
effect upon the pulse of diseases of the nervous system might
be multiplied indefinitely, but I propose to ask your atten¬
tion to the converse of this—namely, to effects produced an
the brain by abnormal conditions of Che circulation.

The nutrition of the brain, as of all parts of the body, is
dependent upon the supply of an adequate amount of
healthy blood, bub the functional activity and efficiency of
the brain is even more dependent upon the blood-supply
than its nutrition, and is influenced by it to an extraordinary
degree, so that blood which would maintain the structural
integrity of the brain might be altogether unfit to minister
to its functions. The presence of alcohol in the blood, for
example, does not interfere with the nutrition of the nerve
centres, but it deranges their action, and poisons generated
in the system or retained excretory matters may have a
similar effect. The liberation of nerve force has been repre¬
sented «s an explosive action, and this implies the presence
in the nerve cells of a-substance ready, cm the appUcationof
the ptoper stimulus, to Combine instantly with the oxygeq
brought by the blood. The formation of such material, Its
maintenance at a given state of chemical tension, so to
speak, which differs in the different Centres, in the cortex,
in the central ganglia,' and in the medulla and cord, is
not paralleled by any other nutritive operation. There
is, moreover, the further requirement of a due supply of

°*inUlu8tration of the relation between cerebral functions
and the circulation is seen in the annmia of the cortex of
the hemispheres daring sleep. This bloodleesness is essential
to sleep, and, if it can be induced, sleep follows. It is not
riear, however, whether it is primarily the shutting off of
the blood which determines and compels sleep, or the
ethaostton of the nerve cells and the periodio cessation of
activity organised in the experience of the nervous system
by the succession of day and night, which disposes to sleep,
•nd provides for it by causing the cortical arterioles to
Contract so ds to produce the aaommia. Sleeplessness is
extremely common, and maybe due to a great variety of
causes—to excitement during the day or in the evening, to
grief or anxiety, to exhaustion or overwork, especially work
of an intellectual kind carried on far into the night, to late
errors in diet, indigestion and flatulence, or other
functional derangements, and to tea or coffee. On the
^cognition and removal or avoktanoe of any such disturbing
™fluence» the sleeplessness will disappear. We are frequently
called upon, however, tb relieve habitual sleeplessness which
c®n*d be referred to any of the abov# causes, and in many
■ustanees it is associated with abnormal conditions of the
circulation. Not to speak of heart disease, all forms of which
a« prone to disturb or interfere with sleep, or of palpitation,
Tjnch is apt to eomeon at night, there art two distinct con-
®“°ns of the cittmlation to which sleeplessness is very often
ggn. One is the-state of high tension, absolute or virtual.
‘^Umay be tittle beyond the Sleeplessness of which flic
Pwmot complains; or the loss of sleep may merely be one of
*‘ta g train of symptoms—depression, apprehension, Ices of
®»®wry, want of energy, and the Hka. The artery at the
*»y be lame or small, but it is full between the beats,
coa bewllea trader tbe finger ; the pulse may be long
and gradual, or somewhat abrupt in its beat, and ending
"TCMChly, accord in g to tdia ooedmon of the heart. It appears
we probable that the cause df ■'tbe sleeplessness in the
o f casan under hOaaderatian is the inabifltv of the

-BetebrtI_<a*tAx fo overtbiXs the excessive

M a«W 'I ban ,SJ? rr/u.'.-j

hlood-pressure within them, and sbotroff the Wood so as to
induce the anaemia requisite for .sleep. In topmmen with
the peripheral arteries generally, their muaoular walls are
all day putting forth an abnormal amount of contractile
force, add at night are unequal to the further task of
exercising* sufficient) additional contraction to narrow the
channels to ateepiagpoint. In such eases steep is often at once
procured by reducing the general arterial tension, and a mild
mercurial aperient is the most efficient, hypnotic. The oases
are numbered by access in which I have found this line of
treatment efficacious in habitual sleeplessness, many patients
having been rendered independent of sedative draughts
to winch they had been driven. At first k is not unusual
for the patient to suppose that a new and powerful opiate
has been given, and the good effects do not wear oo/s by
repetition. It is not by unloading the bowel that the
aperient acts; it has often to be given to induce sleep when
the bowels are acting regularly and freely; and it isteibe
remarked that itis within an hone or bwo of the pill horfog
been taken, and many hours before an evacuation inanity,
that the patient sleeps. The general intra-vascular p re s s ur e
being lowered, the cortical arterioles are no longer resisted
by the pressure within them, and they can respond to the
call for exclusion of the Wood from the heainpncToa The
desired-effeot may often, be attained by otber m o ens - by ,a
hot bath, by the sits bath and wet bandages employed in
hydropathic establishments, by standing in cold water and
then rubbing tbe feet well with a rough towel,andby a
variety of other measures, which either relax the cutaneous
vessels generally, and so lower the arterial tension, or eet up
a local hypenemia which diverts the blood from the head.
A method of courting sleep, which I have known to be
adopted by subjects of high arterial tension, is to lie with
the back of tbe neck on a hot-water bottle. - Sometimes,
however, the object is defeated by some collateral effect—
for example, as when e hot bath sets the heart beating
violently, and, when successful, such measures often having
the defect of dealing with the effect and not removing the
cause.

An opposite state of the circulation, extremely low ten¬
sion, may be the cause of sleeplessness. It is more common
after middle life and in men of sedentary occupation,, and
may be traceable to overwork or anxiety, or simply to close
attention to business and neglect of hahday. Itis not often
that there is excess in eating or drinking; more frequently
tbe patient is distinctly abstemious. Without apparent
cause he begins to lose his sleep at night. In the day-time,
however, he is disposed to sleep, and, not unfrequentdy,
unless engaged in actual work, he. drops asleep at any
moment; not only after dinner, when sleep in each oases
is irresistible, but when reading his newspaper in the morn¬
ing after breakfast. Not unnaturally, it is supposed that
the after-dinner nap spoils the night’s rest, or that the had
night causes the drowsiness during the day, bat attempts
to rectify this state of things by preventing sleep after
diner and similar‘measures fail. The sufferer may try
to secure a goad night by going to bed soon after dinner,
but at this time, as at tne usual honr for retiring, as
soon as he lies down he is wide awake, and so remains.
After a time it will be discovered that it is position which
induces ox prevents steep. In the sitting posture sleep, is
almost irresistible, in the recumbent pool Dion almost im¬
possible. The patient will sometimes get out of bed in the
night and sleep in his chair, as we see sufferers from advanced
heart disease. Under each circumstances 1 have found the
circulation unstable; the pulse, daring the same interview,
at onetime short and weak, and at another presenting the
characters of virtual tension—that is, full between the heats,
but compressible, sudden and not sustained ; and the power
of the heart low. There is a want of tone in the muscular
| tissues of the arterioles and a want at driving power in the
l heart, and the distribution of the blood.thus becomes unduly
■ influenced by gravity. In the sitting: ‘position, when the
I heart is not stimulated by exercise, nor .afflux of .blood /to
the convolutions determined by mental work, the blood is
{ not lifted to the height of the brain with sufficient onargy,
the contractile tendency of the cortical arteriea is not
| opposed by intra-vascular pressure, and sleep-producing
ana-mi a of the hemispheres results. On the other nand^ this
I same wank cif tone in the arterioles allows them to be-dis-
| tended by the increased pressure of the blood within them
which attends the horixmtal position, in snch coses change
| of air will-often put an end to the sleeplessness at anon, and

Digitized by GoOgle

710 Thk Lancbt,]

DE. W. H. BROADBKNT ON THE PULSE.

[Apbil 9, 1887.

the appropriate remedies are vascular tonics—iron, adds,
strychnine, and digitalis.

Convulsions and the pulse. - Conditions of the circulation
indicated by the pulse are unquestionably among the causes
of convulsions. The brain responds by convulsions to a
great variety of disturbing influences: to direct irritation
of the cortex, as has been demonstrated by experiment, and
is illustrated by spicula; of bone, tumours, meningeal
haemorrhage, &c.; to irritation of lower centres and tracts,
such as the cerebellum and its superior peduncles, or in the
interpeduncular spaoe, and to reflex irritation of tbe most
varied kind; to poisons of different kinds, but especially to
the poisons of specific fevers, such as small-pox, scarlatina,
or measles.

With regard to each causes of convulsions as concern us
from their relation with the pulse, experiment has shown
that convulsions may attend exactly opposite states of the
circulation. The final phenomena of death from rapid
haemorrhage when the cerebral vessels are empty and the
pressure (presumably at a minimum are convulsions, and
convulsions occur iu death by asphyxia when, the blood-
pressure is high. These extremes probably meet in the pro¬
duction of stasis of the cerebral circulation, and it seems to
me that we have clinical illustrations of convulsions pro¬
duced by unduly high arterial tension on the one hand and
by excessively low arterial pressure on the other.

The cranium being a closed cavity, the total volume of its
contents, brain-structures, blood, and cerebro-spinal fluid,
must be a constant quantity. The effusion of liquid into
the ventricles or meninges often found ofter death shows
that some sort of compression and shrinkage of the brain
substance is possible, but whether this is at the expense of the
blood in its capillaries, or of fluid in the perivascular spaces,
or of interstitial fluid, cannot be stated definitely; since,
however, there may be greater appearance of vascularity in
the sulci and white matter at the same time, it cannot be
by exclusion of blood that the intro-ventricular or sub¬
arachnoid fluid makes room for itself. But whatever may
be the way in which the brain-substance accommodates itself
to effused fluid, it is not to be supposed that it is compressed
into smaller compass at each pulsation of its vessels. This
being so, either the blood must escape by the veins exactly
in the same amount and at the same time as it enters by
the arteries, and therefore more or less iu a pulsatile manner,
or there must be some shifting to and fro of cerebro-spinal
fluid between the cranial and spinal cavities—that is, the ex¬
pulsion of a certain amount or fluid from the cranium into
the spinal canal with each arterial pulsation, and a gradual
reflux in the interval. But the 6pinal canal is also a closed
cavity, and, although its walls, being only ligamentous be¬
tween the vertebrae, are not so rigid as the bones of the skull,
there is no provision for variations in its capacity, while tbe
arteries of the cord and its meninges will be distended at tbe
same moment as those of the brain, which would tend to resist
the paseage of fluid from the cranial to the spinal cavity. The
to-and-fro movement of cerebro-spinal fluid, then, which
has been postulated as an easy explanation of some of the
difficulties with regard to the cerebral circulation, cannot
be admitted, and it must be the case that, exactly as the
blood enters the cranium by tbe carotids and vertebral
arteries, it leaves it by the internal jngular veins. The
movement of blood in the internal' jugulars has, in fact, been
found to be pulsatile. I h&ve pointed out in my first lecture
that neither the expansion of the arteriee nor the onward
movement of the blood is as great as is usually supposed,
and there is a provision both in the carotids and vertetaals
for moderating the current (which is present in a still more
^marked degree in animals which feed on the ground); but,

' "With all this, the intra-erauial circulation is carried on under
-peculiar difficulties, and any interference with the general
-Circulation may tell with special influenoe upon it.

{jfeJn tiie eye the circulation is under much the same con¬
ditions as in the brain in so far as the effects of high intra-
^fvea cn l a r pressure are concerned—the sclerotic bring
^HMWMEjand the changes which are known to take
tPBWjjflllflail iih in renal disease have more than a mere
^ J aayori a e orcBaical interest. They throw light on changes
IHMeikllfaMdaUfclMiahwiiia end study and investigation in this
repaid. We have retinal as we have
jgjfrisbtpoesiMaragain, that there are

fdfffstenti*
f ffbst a ncw Wq
• All these am

, again, that there are

effects rather than to blood deterioration. Glaucoma, which in
my small experience has always been associated with high
pulse tension, and which I believe to be an effect of intra¬
vascular pressure, may also have its analogue in the
cranium. ,.

Be this as it may, there cannot be any doubt .that the
intra-cranial pressure varies with each heart beat and
with all variations of the bldod-pressure in the arterie*
or veins. The brain would pulsate if it could, and doe*
pulsate whenever a part of the cranial vault is absent
or yielding. The fontanelle of an infant beats with the
pulse, rises and falls with the respiratory movements, is
tense and prominent when the child cries, hollow when it is
asleep, is full and firm when the child is well, depressed
when it is weakened, say by diarrhoea; and the same
fluctuations can be seen at a trephine opening in the adult
skull. The same pressure fluctuations which give rise to
the pulsation and varying tension of the fontanelle will, in
a greater or less degree, tend to compress the cortex of tbe
hemispheres against the vault of the cranium; and it is
conceivable that the compression might be such as to inter¬
fere with the free passage of blood through the pia mater of
the convolutions, or to flatten more or less the veins which
run on the surface of the hemispheres to the longitudinal
sinus- -it might, indeed, arrest momentarily the cortical circu¬
lation. Blow! stasis in tins situation, from pressure against
the cranial vault, must occur when the convolutions are flat¬
tened by effusion into the ventricles in tubercular menin¬
gitis, and it is not unreasonable to suppose that the con¬
vulsions and loss of consciousness which mark the final
stage of this disease coincide with this event. But there are
not wanting evidences of the production of momentary
arrest of the cerebral circulation by comparatively alight
temporary causes. Some years since 1 met, at a scientific
congress, a distinguished French surgeon who at the age of
fifty-five or sixty was suffering from whooping-cough, and
at every paroxysm dropped down unconscious; ana I have
met with a case in which for many years the patient, who
was the subject of chronic bronchitis, fell down with
momentary loss of consciousness and slight convulsion when¬
ever he coughed, and this too quickly for the production of
cyanosis. In these cases the obstruction would take effect
by backward pressure through the jugulars. Short of any
such result as loss of consciousness, it is not uncommon for
the respiratory concussion attending the act of coughing to
be frit as severe pain in the head. ' r ~ ; -

A gradual encroachment on the capacity of tfie cranial
cavity would exert a very similar influence on the cortical
circulation by pressure from without to that which I am
assuming might be the result of pressure from within, and
the effects of such an occurrence are exemplified in the
following cose seen with Mr. Bread of Kensington- The
patient, a lady aged about thirty-six, had enioyed good
health all her life, and had had children, when she began to
be subject to fits. She was seen by various physicians and
different opinions were given as to tbe character of the
attacks; for the most part they were considered to be hyste¬
rical. She was subject to headache and confusion of thought,
but not more so than is common; there was no vomiting.
When I was consulted &he looked well, was stoat, and
had a good colour, and was discharging nil her family
and social duties, though with effort. Just as she had
taken off her dress to facilitate an examination of the
chest, an attack came an which we were so for¬
tunate as to witness. She turned pole and lost con¬
sciousness, there was a slight quiver of the muscles of
the face and movements of the arms, but the most
striking fact was a complete arrest of the heart for a
sufficient time to cause us serious anxiety. This prevented
us from adopting the opinion previously gi van,.that .tbe fits
were of no importance, and our prognosis wad soon after¬
wards verified by the patient's death in one of the attacks.
The only morbid appearance found was an .extraordinary
thickening of the frontal bone, which was «* dense as tvary,
and more than half an inch thick at the lower part,
gradually thinning towards the coronal Suture* The .inner
surfaoe was smooth, and the dura mater litt le c h a r m e d, ^ .

The folio wing are examples of oonyolsiOM assofl l AMW I h
high pulse tension. A r< •» w wyw

A medical friend crileddn meon«mb(o£^f^lMti^SlBK|BEce,
at the bidding of his wife, as- he. told me lsugnifigtr. He
said he had had some sort he

was perfectly well. Bis forehead,^hownvw, 'WaSqnigtered
with minute ecchymoaes. an d i t ewfeMC M iej afeh a d

Ta* LANCBT,]

PS. W. EL BROADBENT QN THfl PjJLBK-

[April 9, 1887. 711

had severe convulsions. He was forty-two years of age, had
lived freely and carelessly, but was not intemperate ; there
was a doubtful history of syphilis, and twelve months pre¬
viously be had had a severe fall on his head. He had very
high tension of the pulse. I was summoned to him early
next morning, and found that he had gone from one convul¬
sion into another for the greater part of the night, of so
severe a character that artificial respiration was required at
the end of each attack. I had no hesitation in attributing
the convulsions, the first and last he had ever had, to the
state of the circulation, and the patient was bled to about
thirty ounces. He had the last convulsion as the blood was
flowing, made a rapid and complete recovery, and has had
no attack since.

In another very similar case, also that of a medical man,
aged about fifty, seen three years since, I did not see the
convulsions, which had been very violent, but the assurance
I felt justified in giving, from the history and from the state
of the pulse, that no recurrence need be apprehended if the
tension were reduced by appropriate diet and treatment, has
been verified up to the present time, and the patient has
improved greatly in general health.

A third case, that of a lady, aged at that time forty-nine,
came under my observation in May, 1878. She was stout,
over-fed, and had marked tension of the pulse, which
appeared to be taking effect on the left ventricle. She was
said to have albuminuria, but I found no albumen in the
urine, and the specific gravity was normal. I was consulted
on account of severe and repeated convulsive attacks of an
epileptic character, which came on two or three times a
week, sometimes in series of six or seven. The convulsions
speedily ceased under treatment by saline aperients, which
lowered the vascular tension, and she remained free from
them until 1885, when she had cerebral haemorrhage and
hemiplegia, and she died late in 1880 from another attack,
attended with convulsions.

In December, 1885, a gentleman aged sixty-five, working
hard as a teacher of music, consulted me on account of con¬
vulsions, which had occurred in the previous July before
breakfast, and on December 1st after dinner. On the latter
occasion there had been sudden loss of consciousness, and a
fall, in which a cut on the head had been sustained. He
looked and felt well, had a fresh colour, the appetite was
good and the bowels regular, and he slept well. The urine
was copious, had a specific gravity of 1015, and contained
neither albumen nor sugar. The pulse was tense, but short;
the first sound of the heart short, the aortic second accen¬
tuated. The condition of the circulation was that of virtual
tension. A mild blue and colocynth pill was ordered to be
taken once a week, and arsenic and nux vomica prescribed
as a tonic. In March, while stooping after a heavy meal, he
fell forwards and was unconscious for a few seconds, and
this is the only attack he lias had.

Other illustrations might be given, but I will only refer to
one more which I related in my address as president of the
medical section of the Brighton meeting of the British
Medical Association. The patient, aged thirty-seven, came
under my observation in November and December, 1885,
suffering from headache and oppression, and was found to
have an unusual degree of arterial tension; and shortly after¬
wards I was called to him in consultation with Dr. Wilbe,
when he was almost unconscious, overwhelmed apparently
by a sense of pressure in the head and exhibiting violent
synchronous contractions of the pectoral and abdominal
muscles. The pressure in the arteries was extreme, and the
incompressibility of the pulse surpassed anything in my
experience. The patient was bled with good effect, but
repeated free calomel purging was needed to bring down
the tension and complete the recover,-. There was an early
stage of contracting kidney in this case, but no such change
as to give rise to uraemia.

The convulsions which sometimes occur months or years
after an attack of hemiplegia have, in my experience, al ways
been associated with high tension, and have often been pre¬
vented from recurring by treatment directed against this.
In a brain damaged by hemorrhage, which has left a
cicatrix, the circulation is more easily deranged to a point
attended with symptoms than before. It may be con¬
sidered as proved that, in some way, such a modification of
the cerebral circulation may be produced by high arterial
tension as is capable of giving rise to convulsions; and,
as I have already said, it is, in my opinion, through
the intervention of high arterial tension that urnemic
convulsions are brought about. There may be extreme

uremic intoxication, ending fatally by coma, without
convulsions; urea, the ammoniacal products of its de¬
composition and the forms of nitrogenised waste, whieb
may be supposed to accumulate in the blood in rensl
disease, do not excite convulsions when injected into the
blood. These facts seem to show that it is not simply
and directly by the presence of renal impurities in the
blood that the convulsions are excited. On the other hand,
there are the facts that urremic convulsions are most
common in that form of kidney disease in which high
arterial tension is most marked- -the contracted granular
form,—and that they do not occur in the absence or, at any
rate, a certain degree of tension. But the consideration
which carries perhaps the greatest weight is the remarkable
effect of bloodletting in urnemic convulsions. The status
epilepticus is cut short, thecoma abbreviated, and associated
symptoms relieved. These effects, which are remarkably
constant, cannot be from elimination of toxic matter; the
blood left in the vessels will be both more watery and more
impure from resorption of liquid from the tissues. They
can scarcely have any other cause than diminution of tin-
volume of blood and lowered pressure in the vessels.

In acute renal dropsy with convulsions a venesection
may not only arrest the convulsion, but may exercise a
favourable influence on the disease, and in chronic Bright’s
disease, nearing a fatal termination, bleeding may prolong
life and change altogether the mode of dying from con¬
vulsions and coma to a quiet asthenia. Illustrations of the
association of convulsions with low arterial tension are lea«
common, but I have seen in a child of twelve, belonging to
a family in which the pulse tension is low, and who has the
family pulse, a momentary convulsion during vaccination.
There was no nervousness or fear, but, on the contrary, the
operation was regarded with interest. The child, however,
dropped as if shot, with a slight general convulsion, and
then immediately got up again, looking very much aston¬
ished, but not otherwise affected. In another low-tension
individual, a young man of remarkable courage, the appli¬
cation of a few leeches to the ankle, which had been injured
rather severely, was followed by syncope, emergence from
which was attended with brief but sharp general con¬
vulsions.

In the following case, seen first with Dr. Godson, Mr. White,
and Dr. Kane, and later with the latter gentleman, the asso¬
ciation of convulsions with an extremely low pulse tension
and their dependence upon a feeble circulation seemed to he
very clear. The patient, a lady aged about twenty-six, florid
and healthy, was confined on Aug. 3rd, 1886. Second confine¬
ment ; previous one normal. Three weeks before labour she
had phlebitis of the right saphena vein, with great pain,
some pyrexia, but little oedema; it terminated favourably
in about fourteen days, leaving a hardened vein. Labouv
natural. Some membranes were retained, but gave no
signs of their presence till the seventh day, when tin-
discharge became offensive. There wa9 pain over Un¬
abdomen and slight rise of temperature. The uterus was
washed out with Condy's fluid, and the next morning the
pain had disappeared. A rigor followed the injection
of the uterus, and the temperature rose to 106° F.
The discharge continuing fetid, injections were repeated,
and the retained membranes came away. An offensive dis¬
charge persisted for a day ortwo, after which thelochia became
sweet and normal. The milk stopped fourteen days after In hour.
From the first rigor dates the commencement of the high
temperature. Daily it rose to 104°, 105 0 , and even 106°:
but, at the same time, it invariably fell to normal S)m«-
time in every twenty-four hours. There was no regularity
in the periods of high and low temperature; some days it
would rise rapidly to the maximum, and after an hour would
fall as rapidly; on other day- 1 it would remain about normal
most of the day. The pulse, always weak, was most rapid
and irregular, sometimes quite uncountable. Terrible rigors
occurred almost daily, generally commencing when the
temperature was low, and invariably followed by rapid rise
of temperature. The patient suffered comparatively little
from the high temperature, had no delirium, and seemed to
be more comfortable than when the temperature was normal,
though the weather at the time was extremely hot. On the
seventeenth day after labour, phlebitis occurred in the right
saphena. This ph lebi tis contin ued to give (rouble, on and off, for
another ton days, and there was considerable swelling of the
ankle. The rigor and temperature continuing unchanged, in
spite of all remedies, it was decided, on Sept. 16tb, forty-
three days after labour, to remove her to another house.

712 Thx Lxnckt,]

JMLX^H.iEOADfiBNT? ON THE PtJLSE.

{Aprils,

The** was the more pressing reason for this, as an expert
had decided that sewer gas entered the hones. She bore the
nave .well, and for a time seemed to improve. She had
some slight shivering®, but no more rigors. For several
days > the temperature never rose above 102°. She had
numerous small boils. On the sixth day after the move
(Sept. 21st) her temperature rose suddenly to 106°, fell again
to,normal, and in the evening rose again to 104°. She did
not i sqecn worse in any other way. About 10 p.m. I was
suddenly summoned, the messenger saying, she was dying-
1 found her sitting up in bed, with very flushed face and
widely dilated pupils; she appeared quite unconscious, with
gasping respiration, und very rapid and,tumultuous action of
the heart. I diagnosed cardiac embolism. Soon after my
arrival she fell back and passed into a terrible convulsion,,
face * turned to the left, arm drawn up, and legs ex-,
tended and rigid. This lasted some minutes, and was'
followed in half an hour by a eeoond, and again, before
mornin g, by a third. After the convulsions, the
left,arm seemed paralysed, but this .passed off before
morning. She was very prostrate, and moaned a great deal,
aad if moved screamed out and applied her hand to the
right aide of her bead. No inequality of pupils; passed
acme and motions in the bed. Mental condition very,
waited: at first aphasic and unintelligible; afterwards noisy— '
singing, crying, and praying. After this she sank into a
very depressed condition, with constant tendency to failure
of itfce heart. The slightest attempt to,sit up caused giddi¬
ness, and alight convulsion. She had to be constantly watched,
aodat-times even artificial respiration had to be resorted
Ux Face sunk, and whole aspect-of impending death. Tem¬
perature 101°; pulse utterly uncountable. Such was her
state on Sept. 26ub, fifty-.four days after labour. The case
vms considered hopeless, bat it was,determined to persevere
steadily with large doses of tincture of muriate of iron
sad., digitalis in gradually increasing doses. The result
was. highly satisfactory. The patient rallied and steadily
progressed from this date. Quantities of small boils appeared,
aad gave, her much pain. Delirium continued for some days,
end she had some delusions. The slightest attempt to
sit up brought on a slight convulsion. The temperature
savor again rose above 102°, and in a very few days fell to
normal, and remained at that. Ten days after the.first con¬
vulsion she bad another severe one, followed by a return
of the mental disturbance. She was free from attacks,
except slight ones, for about a fortnight, when she bad
another severe attack, then an interval of three weeks, and
n series of terribly severe ones lasting six hours. It being
thought that the convulsions might be due to an attempt to
restore the catamenia, attention was turned in that direction,
and after same time the menstrual flow was established,
ushered in by several slight convulsions, AU this time her
progress to health had been continuous, with the exception
of a slight pneumonic attack, with some fever and cough,
which disappeared after she had coughed up a patch of deep
rusty mucus. She had numerous slight convulsive attacks,
generally on waking up from sleep; but they left no after¬
effects, and she steadily improved.until Jan. 20th, six months
from the. commencement of her Illness, when she was
well enough to be moved to Hastings, and underwent
the journey without any fatigue or after bad result. She is
now in capital health; but her pulse has & tendency to
become irregular, and she has occasional attacks of
threatened convulsions. The above account has been
supplied to me by Dr. Kane. I first saw the case on
October 9th, when the pyrexia had been overcome and the
convulsions had set in, and had no hesitation in referring
them to the exhausted state of the heart, which could not
be.felt/and could scarcely be heard, while the pulse was all
but imperceptible. The fact that the patient could scarcely
be raised in bed without bringing on an attack of convul¬
sions was of decisive significance.

-1 have at present under observation a gentleman, aged
fifty-two, who consulted me on account of shortness of
breath on going upstairs, and especially on going up the
steps from the railway station. He had become so nervous
on the subject that hieheart began to palpitate and his breath
to go before be came to the foot of the stairs. He had palpita¬
tion also occasionally at night. He looks the picture of health
and younger than his years; is sbout and of rather high
ooleur; eau and sleeps well; and has a regular action of the
bowels. He rides a tricycle, and has much fresh air and
exMrise. The pulse is fraqnout, 90 to 106, small, short, and
extr >nvly compressible. The heart is partially covered by

lung, does not appear to be. enlarged, and gives no impulse
or apex beat; the sounds are short and approximated, the
second following the first too quickly. The first sound is
audible, not only at the apex and right second sptra, but
also in the neck, where both sounds are remarkably distinct,
ne spoke of having had a fainting attack, and when this
was inquired into it was described as having occurred as
follows. It was in August, and he had had a tricycle ride,
had washed and changed, when he thought he would
like a glass of beer, which he had not tasted for yean.
Shortly afterwards he felt a peculiar tingling in his feet
and had just time to lie down when he lost consciousness,
and did not come to himself for forty minutes or more..
This could not have been a syncopal attack, and, whether
convulsions occurred or not, was eptleptoid. It was further
learnt on inquiry that he had had several similar attacks
within the last few years, always beginning with the tingling
sensation in the feet, and attended with complete loss
of consciousness, lasting on an average twenty minutes.
He had had no fits of any kind as a boy, or until the occur¬
rence of those referred to.

I am not without hope that a careful study of the pulse,
and of conditions of the circulation made known through it,
may be of service in furnishing indications for the treatment
of epilepsy. It is certainly attended with interest, and I
think it throws light on different forms of epilepsy, and
serves as a guide in prognosis. Epilepsy is apparently the
result of instability in the highest nerve centres, the oellaof
the cerebral cortex permitting of an indiscriminate
or partial discharge upon lower centres of nerve force, which
normally ought to be set free, only in definite degree and in
well-defined direction, in response to given stimuli. Such
instability is obviously a nutritional defect, which may he
due to the inherent want of constructive energy in the nerve
cells themselves, or may be the result of blood which
cannot furnish the proper pabulum, or of an inadequate
supply of blood. Even in the case first supposed, a regular
and ample supply of blood, under sufficient pressure to cause
a due exudation of nutrient material and of proper com¬
position, will be important, while in the other conditions
supposed they will oe remedial. But, given more or less
of instability, this does not of itself start the convulsive
explosion; some exciting cause must be applied. At one
time this was supposed to be arterial spasm in certain con¬
volutional areas; out this hypothesis, which never seemed
to me to be tenable, has gone out of fashion. There are,
however, facts which seem to show that circulatory con¬
ditions have much influence in determining the occurrence
of -attack: for example, the great frequency with which
fits come on in the night, sometimes on first going off to
sleep, when the horizontal position and the anaemia of the
cortex attending sleep produce great changes in the intra¬
cranial circulation; or more frequently towards morning,
when the general circulation has slackened down, as it does
during sleep. Another favourite time for attacks is soon
after rising in the morning, when the general circulation
has slackened, and circulatory changes of a reverse land
take place.

It is not my intention to discuss the questions which migot
he raised on the subject here alluded to, but I desire to call
attention to a provisional conclusion to which 1 have been
led by my own limited observation. This is, that in essential
epilepsy—the epilepsy which comes on during adolescence,
the epilepsy met with in neurotic families, and in which the
nerve cells may fairly be assumed to be inherently unstable—
the arterial tension is low and variable or fluctuating.
I am unable to affirm that when the attacks are sus¬
pended, as they may be for months, the pulse tension
is improved, but it is worthy of remark that pregnancy
is not unfrequently attended with immunity from fits,
and, as is well known, one effect of this condition is
high tension in the pulse. On tbe other hand, when the
pulse tension is decidedly and constantly above the average,
it has seemed to me that the epilepsy has been amenable
to treatment. Senile epilepsy is, according to my expe¬
rience, associated with high tension, and scarcely ever
fails to yield to a regulated diet with a restricted amount of
animal food and little stimulant, aperients and other elimi-
nants being given, according to the requirements of tbe
particular case. Epilepsy with high arterial tension often
comes on at a later period than the epilepsy, which has its
source in a radical weakness of the nervous system, and, in.
most of the cases I have met with, the first fit has occurred
after tbe ago of twenty, and not uncommonly there have

Taa Lin art]

DB. W. H.BQQADBKNT ON THB PCLaS, t ; ^ [A?a^ 9,188^,-7^a>

been peculiarities, such as a number of attacks close
together, with long but irregular intervals, or some well-
marked exciting cause. The fits may, however, date from
the usual age at which epilepsy sets in. Many years since,
a surgeon-major in the army brought his son to me on
account of epileptic attacks, which had compelled him to
leave the navy. He was a fine, strong, healthy-looking lad,
and had a large pulse not easily compressed. Under treat¬
ment the fits, which had been so frequent, ceased to come
on. He studied for and got into Sandhurst, obtained a com¬
mission in an infantry regiment, and has since served
through the Afghan campaign. So far as I know, he has
only had two attacks since he entered the army: one in
Afghanistan, when, together with trying work, he had bad
fooa and water; and another in Ireland, after great fatigue'
and a bout of dissipation.

I have several times seen violent maniacal delirium asso¬
ciated in such a way with convulsions as to suggest that a
minor degree of the disturbing influence which caused con¬
vulsions had given rise to the maniacal excitement—after
bleeding, for example, for uraemic convulsions, before and
after, or apparently instead of uraemic convulsions—in
syphilitic disease of the brain. In the following case the
connexion between the state' of tension- of the pulse and
ungovernable excitement was recognised by several
observers over a long period. The patient was under the
care of Dr. Ranking- aft Tunbri d g e Wells, and Dr. Marcus
Allen at Brighton, and in town under Dr. Seton and
Dr. Coates, with whom I saw her weekly from March to
July, 1884, and again in March, 1886. Dr. Ranking, who has
kindly supplied me with the particulars, was called to her
in May, 1882, when she was convalescing from a third attack
of slight (left) hemiplegia. She was very nervoas and appre¬
hensive, and had dilatation of the heart, with an unstable
pulse of virtual tension. Daring the summer she had several
anginoid attacks, which were relieved at once by nitro¬
glycerine,and in the winter attacks of congestion of the lungs,
with partial suppression of urine and albuminuria. One day
in July, 1883, she became suddenly excited, with delusions,
which lasted some time, but went off after one-hundredth
grain of nitro-glycerine, and she slept. Later in the
summer she got into an excited, unsettled, suspicious, and
violent state, which persisted, together with high tension of
the pulse. Once she was comatose for twenty-four hours, but
recovered after nitro-glycerine, and at once became maniacal.
In the winter of 1883-84 she was under the care of Dr.
Marcos Allen at Brighton. It was found by observation
that her mental condition was always worst when the pulse
tension was high, and that the only way of keeping it down
was to cut off all meat and feed the patient chiefly on milk.
Ibis was confirmed by our experience when she was brought
to town. When the tension was high she was suspicions,
abusive, violent, and unmanageable. When it was normal
she was cheerful and tractable. Mercurial aperients were
constantly needed in order to keep down the tension and
regulate the bowels. Ultimately she died, in March, 1885,
with symptoms of meningeal haemorrhage.

With advancing years there comes a liability to many
forms of cerebral affection. Some are examples of structural
change which are clearly traceable to interference with the
nomal blood-supply. Such ohangea are local or general
softening from thrombosis of individual arteries, or general
obstruction to the blood-supply from atheroma, affecting all
the cerebral arteries. The local arterial change is not the
sole factor in the production of the lesions. A state of blood
which, renders it prone to coagulate or deposit fibrin will
predispose to the formation of a thrombus at any point
where the walls of the artery are disoased, and want of pro¬
pulsive power in the heart, or other cause of languid move¬
ment in the blood, may antedate the occurrence of
degenerative changes attributable to widely distributed
disease in the vessels. But an impeded cerebral circulation
may, in course of time, so far modify the nutrition of the
brain as to give rise to functional affections without
structural lesions; and this, in my opinion, is the mode of
causation of some forms of insanity which come on late in
life—such, for example, as senile melancholia. The term,
senile may have two m ean in gs—it may designate an age, or
be descriptive of a kind of chaoge. The term senile is
unobjectionable if it is meant to apply simply to the
period of life at which this affection is met with, but
it is often understood to mean a certain character of change,
and its frequent employment to designate degeneration has
led to the common idea that senile and degenerative are

convertible terms, This. does, harm in two ways- 'SepihF^
changes, if degenerative, are irreversible, and if this view.ljs,
taken of dementia or melancholia^, there will be no object
in. careful investigation of associated conditions; np other
cause than senile decay, will be looked for, and no yn^vidual
treatment will be adopted based upon the peculiarities, of
different cases. Furthermore, the reproach of insanity qi;.
of neurotic tendencies may be attached to families when
the derangement of the cerebral functions may be as much '
a result of. vascular disease, as cerebral haemorrhage.'
family liability to melaneholia may consist in hereditary,
high tension of the pulse, just as a liability to apoplexy m,ay
be due to family gout. Now the complete recovery,
witnessed in many cases of melancholia is proof that ttere..
Cannot have been any, structural, degeneration, and, an.,
example like, the following may be worth relating. ,

Some two yean since l was asked to see, periodically, a
gentleman, aged about sixty, who had for four or five years
been under the Commissioners in Lunacy on account of mejan; |
cholia. He had had delusions as to conspiracies against_Lis ,
lifb, but such delusions as remained related cbifefly to 'wilful f
and malicious injury inflicted upon him, and attempts to
destroy him in an asylum. He spent nearly all his time
in bed, scarcely ever left< his room, and never went out, of;
doors. lie was well nourished, and, except that he wm
etiolated by his long confinement to the. house, looked wal) t .
but the pulse was extremely small, soft, and short, ^nd
action of the heart extremely weak. He had eczema, and
suffered from constipation and want of appetite, and tr^ate
Went was prescribed for the relief of these ejpnptpma, IDs,
general health improved, but his mental condition' renamed;
much the same, and, in particular, the death of a sph made
little impression on him. In June, 1886, he suddenly shook
off all his delusions, and became perfectly sane and cheerful.,
With this the pulse improved, but never reached aja,average,
volume or tension,-ana in October he remained well, and,
after examination by Dr. Mandsley, was disphargpd from
his lunacyi Unfortunately, on Feb. 24th of this year he
became aphasic from thrombosis of the vessels supplying’
the cortiC&l speech centre. , t ,,,

PuUe and mdajicJiolia.—’The connexion between melan¬
cholia and its allied mental states and conditions of the
circulation is more direct and decided than can be traced in,
epilepsy. An unbroken series of gradations cap be traced
from the irritability and depression of spirits, attending
functional disorder of the liver, up to complete melancholia
with delusions. In a case of temporary hepatic derangement,
the state of the temper and spirits might be attributable to
the retention in the blood of the impurities which tinge the
eyes and complexion, this acting as a poison; or to sbttte
reflex influence, inhibiting cerebral functions, or deranging,
the cerebral circulation by setting up contraction of sdfne,
of the arteries. When, however, the mental depression ( 16,
more pronounced and persistent, these explanations are
found not to apply; there may be, in the first instance,
constipation, a furred tongue, sallow complexion, larg^
liver, &c. But when these evidences of deranged function
are removed the mental condition does not clear up. , If the
symptoms, therefore, are due to any somatic cause and ar^
not the outcome of a primary cerebral affection, this opuse
is something more persistent than the functional derange¬
ment or reflex disturbance mentioned. This has appeared
to me to be protracted arterial tension, or, if it is not itself
the cause, it is at least the index of the condition of th©
state of system on which the mental condition depends.

The method by which high arterial tension may influence
the cerebral functions may be conceived to be as follows.
The resistance in the peripheral vessels calls for increased
contractile force on the part of the left ventricle, and there
is a response by a certain degree of hypertrophy. In the
course of years, however, the resistance increases, degenera¬
tion of the capillaries and thickening of the arterioles being
superadded to the original loss of due relation between
blood and tissues, while the heart no longer gains in
strength. With, then, the same or somewhat diminished
driving power and the resistance increased, there will ka
slower onward movement of the blood. The pulse maybe,
equally strong, may even seem to be more incompressible,
but the ospillary circulation will he sluggish. This will be
the case throughout the system,.but it will not give rise.to
appreciable effects in most of the structures and organs; in
the brain, however, as has already been said, functional
activity and efficiency are absolutely dependent upon a due^
supply, not only of nutrient material, but also of oxygsb,

714 Thb LAJJ<»r,J MR. E. J. GODLEE: SURGICAL TREATMENT OF PULMONARY CAVITIES.

ami this fails when the How through the capillaries is
sluggish.

lu a very large proportion of the cases of melancholia
coming on late in life the evidence of persistent high
tension of the pulse has been most marked, and when this
has beau the case it has seemed to me that persevering
endeavours to diminish the peripheral resistance, and at the
same time to strengthen the action of the heart, have been
more successful than any other line of treatment. The
objoct is so to relieve the heart that it may no longer be
mastered by the obstruction in the general capillary circu¬
lation ; there will then be a general acceleration of the flow
of blood through the tissues, and by the increased supply of
blood to the brain its nutrition and functional efficiency may
gradually be restored. The possibility of this result and
the time required for its attainment will depend on various
conditions. There must be a capability on the part of the
heart to resume its control over the circulation; it must
not be degenerate or worn out. The state of the cerebral
arteries, again, will have an important influence; if they
are extensively diseased, the access of blood to the convolu¬
tions may bo barred even when the circulation elsewhere is
good. Further, the change in the nervous elements must
not have gone too far; the longer they have been subjected
to the deteriorating influence of imperfect blood-supply,
the longer will be the time required for the reversal of the
effects. Of these three sets of conditions we can only
estimate the first by examination ; with regard to the others,
the basis of our judgment must be the history. Speaking
generally, the more acute the attack and the shorter its
duration, the better will be the chances of recovery.

Cases of this kind, many of which have come under my
notice, do not lend themselves to narration, especially when
jeen in consultation only once or twice, and I shall not
attempt to bring instances before you. I may, however,
relate an occurrence with regard to one such—a most dis¬
tressing case of religious melancholia in a lady of about
sixty, with extreme high tension in the pulse. I had ex¬
plained my views to Dr. Baines, with whom I saw the patient,
and had recommended, among other measures, a series of mild
calomel purges, when the sister of the patient joined us, in
order to learn our opinion. Before hearing this, however,
she said there was one more fact which she ought to have told
us -namely, that their mother, at very nearly the same age,
had suffered exactly in the same way. It seemed as if my
hypothesis of the relation of the melancholia to the state of
the circulation was at once overthrown, and with it my
favourable prognosis. “ But,” she continued, “in those days
they gave calomel for everything; and it was prescribed for
her, and she got quite well.” Our patient also recovered—
inly, however, to relapse some time later. Melancholia
associated with extremely low pulse tension has, in my
sxperionce, usually proved incurable, and has in several
instances gone steadily from bad to worse to a fatal ter¬
mination. The case related a few minutes ago is the only
instance of recovery I have met with.

I announced that this lecture would be devoted to the
pulse and cerebral affections, but I maybe permitted to refer
re an affection of the lower end of the spinal cord, especially
as it furnishes a sort of parallel to the production of melan¬
cholia by derangement of the circulation. Our late colleague,
Dr. Moxon, whose loss those who knew him well will never
cease to deplore, pointed out in his brilliant and original
' Voonian lectures, six years since, that common paraplegia,
as he called it, was explained by anatomical facts. The
spinal cord receives its blood-supply by means of the
arteries which reach it along the nerve roots. These, in
consequence of the downward elongation of the spinal canal
beyond the cord, get the more oblique and longer from
above downwards, and at the cauda equina are many
inches in length, so that the arteries of the lumbar enlarge¬
ment, which occupies the lower part of the dorsal division
of the spine, have to travel upwards for this distance from
the foramina in the lumbar and sacral regions. When, then,
the circulation becomes languid, the mechanical difficulties
of this arrangement make themselves felt. The symptoms
attending the early stage of paraplegia due to failing
circulation in the lumbar enlargement of the cord are very
interesting. As the nutrition of the lower end of the cord
begins to suffer, there is at first muscular weaknees and
loss of control oxer the legs only after a night’s rest. The
patient lias some difficulty in standing and walking steadily
when he first gets out of bed, but after he has moved about
a little the legs regain power and lie can walk perfectly. A

[April 9,1887.

similar state of things is observed with regard to the bladder.
He cannot pass urine on rising, but when he has had a little
walking he empties the bladder easily. Whenever he sits
down for any length of time during the day, there is more
or less impairment of mobility and strength in the lower
extremities, which quickly passes off with movement.
Sensation is not affected at first, but there may be feelings
of numbness. The coming on of the weaknees during the
night is due to the slackening down of the circulation,
which takes place during sleep, and is paralleled by the
morning depression in melancholia and debility. I have
met with this train of symptoms at the two extremities of
high and low pressure. When there is high pressure, it is
that the general resistance in the periphery naa overtaxed
the powers of the heart, so that tn6 whole circulation is
sluggish, and the languid flow is most easily brought to a
standstill where the difficulties are greatest. Usually the
symptoms come ou very gradually, but I have known their
onset to be determined by the occurrence of acute dilatation
of the heart. When the tension is low and the heart weak,
no explanation of the impeded circulation is needed.

I end these lectures with a feeling that I have done hut
scanty justice to the subject, but with feelings also of
gratitude for the pittance and indulgence with which my
poor attempt has been received.

OX THJ£

SURGICAL TREATMENT OF PULMONARY
CAVITIES.

Delivered at the Consumption Hospital, Brampton,

By RICKMAN J. GODLEE, M.S., F.RXL8.,

SITROEOX TO THK HOSPITAL AXD TO USTTKRSITV COLLEGE HOSPITAL.

LECTURE II.

(Concluded from page 670.)

T int next cose is that of an unfortunate man, aged forty-
seven, admitted under the care of Dr. Byrnes Thompson in
February, 1882, who went to a dentist three months
previously to have the third left lower molar removed. The
elevator slipped, and the tooth dropped into his month
and by a sudden gasp was drawn into the trachea. He
noticed nothing for ten minutes; then there was sadden
dyspnoea, lasting for a few minutes, and pain above the
right nipple—that is, not far from the level of the angle of
the scapula or the seventh dorsal spine. This passed away,
leaving a paroxysmal cough, which never afterwards
ceased. He began to expectorate thin, frothy mucus with
Hocculent masses, in amount about half a pint in the dajr.
and continued to do so from that time. He gradually lest
flesh, and occasionally suffered from night sweats and
Hushes; his appetite failed, and he became weaker <td
weaker. About a fortnight after the aocident he
tearing pain during a fit of coughing near the light nipple,
and for a short time the sputa were tinged with blood; lit
henceforward he had nothing to indicate the position erf the
tooth. He was, on admission, emaciated and weak, With
rigid arteries and marked arcus senilis, a pulse of 120, re«p4-
r&tion SO, and dyspnoea on the slightest exertion; profuse
expectoration, especially in the morning; and a trouh toaete
cough, aggravated by any exertion. There was BO timMO 1
ptysis. The physical signs were those of emphyastiia hi tin
left lung and in the upper part of the light. • But 'Oh Mbs
right tide, below a line drawn at the level of the angle of Tmt
scapula, there was comparative dulnese, both in nrflCti and
behind, with diminished vocal fremitus and neonfeMt.
The breathing was weak in front end in the
behind there was cavernous breathing, wlth mettiltd MM
and pectoriloquy and bronchophony. Pleurftio fi ieW un#at
heard in several plaoes. The heart s apex was nil iMMliMr
On March 2nd Mr. Marshall introduced a-troeortBidnaBig
ititethelung at apofcrt two inches
ehfhth interspace, atiUmWiia ooMMift*: mill (I'MiMfiMi
that some hud substance Was tduohcd,bi*F ni Ml W t* p

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TjntLANCBT.l MR. R. J. GDDLEE: jSUHGlUAL TtBATMttttT OF FULMONABY< CAVITIESt-' [ApaifcS,H8»7r 715

through the cannula* The intercostal space was then
opened and the lung incised, causing considerable bieuior-
rnage and some htemoptyais. A space was thus reached
through which a probe passed an indefinite distance, no
doubt having entered a large bronchus. The opening was
still further dilated, but nothing came of it, and the wound
was first plugged with carbolic acid gauze and then dressed
antiseptically. The effect of this operation was to diminish
the expectoration to » certain limited extent* while a con¬
siderable quantity of pus escaped from the wound and air
waa forcibly expelled from it when the patient coughed in.
the way which is characteristic of a freely opened bronchus.
A further examination, causing considerable hemoptysis,
waa made on May 29th, but without suocess, and the
patient was sent to Eastbourne. By .November 14th the
wound was completely closed, the drainage-tube having
been gradually shortened since the month of August. The
physical signs had scarcely if at all altered since the last
note. On Pec. 11th he expeotqrated eight ounces of blood,
and (his was followed by several similar attache. It most
be remembered, as we shall see in other cases, that patients
with bronchiectasis are liable to copious Inemoptysis—a
fact that must be taken into acoount in judging of. the
effects of surgical interference. In February, 1685, he was
readmitted with the following changes in the physical
signs:—Loud harsh rhonchi were heard all over both
lungs, and there was increased resistance on the left
side. This no doubt indicated an extension of the bronchial
dilatation, and probably the commencement of the tubercular
changes which were found post mortem. During the pea-
ceding three months he had become much worse; the wound
had reopened and there was a copious discharge of pus,
although the expectoration still continued in large quan¬
tities (from seven to eight ounces); for several days in
December he had suffered from profuse haemoptysis (half a

f int at a time). On Feb. 18tb, Mr. Marshall being present,
exdqed a portion of the ninth rib, so as to make a thorough
examination. We found a long cavity with remarkably
smooth walls, from which little or no hcemorrbage took place,
even after prolonged manipulation. At one part of, tlie
cavity a small opening was found, through which a probe
could easily be passed a long distance into the bronchus. It
impinged against some very large vessel when introduced to
its furthest limit. No foreign body was discovered. The
expectoration diminished for a few days, and then increased
again to its usual quantity. On April 2nd I made several
punctures into the lung with the object of finding a second
cavity, but without sue cose, accurate diagnosis being out of
the question owing to the presence of universal loud rhonchi.
The patient gradually became worse, and died on April ltith.

At the post-mortem examination somewhat advanced
tubercular changes were found in both lungs, and there was
a tubercular cavity at the right apex. The bronchi in the
lower parts of both lungs were dilated, but this waa espe¬
cially the case on the right side. Here, then, was a com¬
plicated System of dilated bronchi, internal to and. below the
cavity winch communicated with the external wound. J ust
below the point of bifurcation of tberbroochus (Fig. 5,1 v.)
going to this system of oavities the tooth was impacted,
nding an the bronchial spar with the fangs downwards.
There was no ulceration of the bronchial mucous membrane
at the spot, or indeed anywhere; and, as far aa could be
judged, this was the only spot at Which the. tooth had
lodgBd. There was alight tubercular ulceration of. the
caecum-

TWs case illustrateeivery.weU the. nature pf the changes
Which are produced by a foreign body in, a, bronchus,, and
appears to show that the change tare brought about by the
rotation of the irritating, beoaoie putrid, secretion; ■ for
8 roil** changes have occurred in the lower part of the
opposite lung, no doubt beoause soma of the pus found
>te wav into the apposite bronchos. Whether this result
u pa»ac*d wholly or ehlaly by the direct action of «h».
secretion upon the bronchi, end whether the contraction
°f the chronically inflamed 1 nag: which surrounds them has
jnach or little to do with the process, it ia not easy to say;

rt is interesting to notice Ww cloee is fcho resemblance
between.the condition of this lung in which the mischief is
^rocially produced, and other. specimens in which' it has
°troiTsd spontaneously, la the earlier stages ot a-ease of
“** kind there ere so few physical signs, and in the later
°sss there are so many—that is, the loud fnetellio rales and
10910 °* less cavernous breathing are so universal—at it is
s aattarnf very great difficnlfty) to diagnose the pcaaeou of

the foreign body. I do ndb say that aa>attempt should not)
be made to.fixul.it. In this particular instand a an incisum-a
little further inwards would moat likely have led to its
discovery ; but I do think it is a question, when the histenr
is pretty clear, whether methodical inversion of the pattens
should not be practised firrit, end whether, if this benbt end*
cessful, tracheotomy should not be performed in order that.a
search may be mod a with ajeap of silver wire suitably bent; or
a pair of very delieate carved forceps. With such an instru¬
ment 1 have, without much difficulty, removed.a vulcanite
tracheotomy tube which had separated from ite shield, on
the third day I think, after it bad beoome impacted-in the
right bronchus, and after definite physical signs rendered oka
presence there indubitable. - . d

From what I have pointed out about the position of tiw
bronchi and their mode of subdivision, it is most likely that
.the foreign, body, if it be as largo aa a tooth, wtll .be found
somewhere >in the course of the main right bronchus, and

Dilated bronchi, caused by the presence of a tooth, "tlte

arrow indicates tfio part of the cavity which was opened.
E n. Bphrterial bronchus, a. Pulmdnary artery. The
tooth lodged lust bolow the flvst Ventral branch (l v), in
tbSjnaia.braibbua,Ma«pok marked jo; 1

IK l|K

it is highly likely that the loqp : of silver wire would bring,
it up. - Any- search such as we mode 4n this ease must bo
very problematical unless a gan^eneus absoess has formed,
and I think we should not. wait fosanehaa occurrence.
If, ns happened < in this ease, the wrong bronchos is opened,
the search frpm below is of.course hopeless;.from above,
pa the .other hand, tha wire might, by giving: it oi some-i
what different eurve, be made 4 to enter many of the lateral
bronchi in succession, and at last reach theright one, r. This

S an ishould he adopted, even after sosaoi tints,, as ,Drw
mplsnd’s case shows that recovery mis take place after
considerablechanges haveoccurred ip the lung.....

We much hope that suoh a result will be obtained in tho>

case of IL G-a woman fifty yews pf age. now in the

hospital-under the eare of Dr. Williams. She has been. the.
subject of winter oough for years; bub has had a.severe
accession toft since she “swallowed” a piece of mutten-
bone about May 18tb, 1885. She developed a most troublesome t
cough after this, with eopicHm fetid expectoration, and at

p 2

Digitized by CjOO^Ic

716 The Lancet,] MR. R. J. GODLEE: SURGICAL TREATMENT OP PULMONARY CAVITIES. [April 9,1887.

last, after pleurisy on the right side, a collection of pas was
diagnosed on the right side and opened by me on Aug. 14th
beneath the eighth rib near the angle of the scapula. The
abscess only reached the surface at a very limited area, and
the Anger passed into a sort of sinus, which just held it,
about four inches long. For weeks this patient was very
little relieved by the operation; the discharge was copious,
and expelled with the characteristic whiffing sound referred
to before; but the expectoration was scarcely diminished in
amount, or at least the diminution was taking place very
gradually, and the cough was always very trying. Latterly
she has developed a left pleurisy. If it had not been
for this I should have undertaken a new exploration.
We had not till lately paid proper attention to the
history, or had perhaps thought that we had sufficiently
often been deoeived to warrant us in neglecting “ the cry
of wolf”; but I was beginning to think whether it
might not be right to suggest tracheotomy and search
from above, or at least inversion of the patient—a not
very simple matter, by the way, in the case of a woman of
fifty. Most fortunately, however, whilst we were waiting
for the pleurisy to subside, she succeeded in coughing up
the piece of bone, and we are watching with interest the
progress of the case, and anxiously hoping that the mischief
on the other side does not indicate the onset of septicaemia.
[Since this lecture was delivered, in November, 1886, the
patient has not made the progress we anticipated; the dis¬
charge from the wound has nearly stopped, and the left
pleurisy has cleared up; but the cough and expectoration
continue troublesome. This is no doubt accounted for by
the fact that the lung was not healthy to begin with, and
that the foreign body remained in the bronchus for a very
long time—eighteen months.]

There is another point that 1 scarcely like to touch upon
viz., the engrafting of the tubercular processes on the top
of the chronic bronchitis and pneumonia. This might, and
probably would, have occurred anywhere, and I should add
that it is the only instance that I have observed aut of a
good many cases of bronchiectasis; but one cannot help
asking oneself whether a# institution such as ours is the
Lest place for a patient with this disorder to take up
his abode. The whole question of the aggregation of con¬
sumptive patients, but more especially that of bringing
together those who are distinctly tubercular and those who
are suffering from simple—Le., non-specific—inflammatory
changes, is one which, in my opinion, the modern view
of the pathology of tubercle opens up again for mature
consideration and discussion. It is one thing to show that
practically all of the presumably healthy persons who have
resided for a longer or shorter period in the hospital have
-escaped infection; but it would be quite another to assert
that those who are suffering from chronic inflammatory dis¬
orders of the lung are not exposed to greater danger here
than they would be outside.

I will next take as an example of a not very uncommon
Condition, and one in which surgery can do little or nothing,
a case in which the bronchiectasis appeared to follow a
pleurisy. It is that of a man fifty-five years of age, whom
I saw with Dr. Benson of Sutton. He had lived a hard life,
and was prematurely very old. Twenty-five years before
he had suffered from an empyema, which bad ruptured
spontaneously in the tenth space behind (a very unusual
position for such an occurrence), and, after discharging for
four weeks or so, had healed. Since this time he had always
been liable to cough, especially during the winter, which
daring the last few years had been much worse, causing a
gradual decline of the patient’s health. There was at the
time very copious purulent expectoration, as if from a
cavity, and there were also much emaciation and marked
dubbing of the fingers, but there was no albuminuria. The
left side of the chest was contracted, resonant in front, with
hewh 1h—thing and creaking and sonorous riles, but almost
dbll tri patches over an area corresponding to the lower']
lobe in the back and axilla; there was no absolute dalness,
however, and nemeln fr e a t of the mid-axillary line. Over
this area of-dafllfctnr-tfeaott&Boe there was amphoric breath-
«tth aMllfftte*, and pretty well marked oegophony
Wa» heard in places. The right side was
With harsh breathing and sibilant end
so no rous r&as. the heart was drawn a little outwards,and
there 1 was no murmur, though previously one had been
beard which was thought to be tricuspid. An incision had
been miade a'few days before in the tenth space, and a little
ftmtttfoi poo had been seen: if soothe kmfe had no doubt
lirnVei ii, ■ .Ui i r——

reached one of the dilated bronchi, for it must be remem¬
bered that in these cases, even if cavities do exist and are
the source of the greater part of the expectoration, the
bronchi contain a precisely similar material. The diagnosis
was extensive bronchiectasis throughout the lower lobe of
this lung, but probably no distinct cavity. The case seemed
a most unpromising one for operation, not only on acconnt
of the supposed state of the lung, but also from the patient’s
general condition. A trocar was, however, introduced at
the spot where the amphoric breathing was most marked—
viz., in the eighth interspace behind. It was passed in for
two inches and entered condensed lung, but did not reach
any cavity, and no haemoptysis followed. The patient lived
three days longer, and Dr. Benson sent me the notes of the
necropsy. They show that the right lung and the anterior
part of the left lung were partly emphysematous, partly
marked by old cicatricial contractions, and that there were
in these regions old scattered firm adhesions; but the lower
two-thirds of the left lung were bound down by universal
and very strong old adhesions three-sixteenths of an inch
or more in thickness, and this part was “firm and con¬
solidated, tough and cartilaginous on section. The section
was studded with the open lamina of the bronchial branches;
the bronchial walls were everywhere very mnch thickened
and at places very much dilated, their mucous membrane
being thickened and injected; the bronchi contained blood¬
stained muco-pus. No actual cavities were found.” The
liver was nntmeg, and the heart somewhat fatty.

One cannot doubt that the old pleurisy, with perhaps
some pneumonia, was in this case the cause of the com¬
mencement of the process. It is remarkable to me that it
was so much confined to the lower lobe of this lung bat,
notwithstanding its local nature, it is not apparent in what
way surgery could at any time have been of use. In ex¬
ploring the lung in eases like this, when contraction may be
presumed to have occurred, it is important not to go beyond
the natural limit of the lung downwards; and, indeed, it is
wiser to stop short of this. This part of the lung behind is
very thin, and an incautious use of the trocar might readily
lead to the puncture of the peritoneal cavity, or perhaps of
some abdominal viscus.

I will now pass to a few cases which are instructive as
illustrating the difficulties and some of the dangers which
attend the attempts at dealing with more or less diffused
cases of bronchiectasis. I will take, in the first place, one
in which nothing was done except an exploratory puncture,
but in which the mere administration of the anesthetic led
to a fatal result; it is highly instructive as illustrating the
fact that the amount of the physical signs is no criterion
of the amount of mischief present. In this case, for
example, they showed little or no mischief on the right
side, though the man’s general ooadition led us to suspect
that this lung was not sound. We found, indeed, that the
mischief was almost, if not quite, as advanced as on the
other.

R. N ——, aged thirty-five, a man of fair general health,
who had all his life been the subject of a slight cough, was
admitted under the care of Dr. Powell. He bad suffered
from syphilis ten years before, had been a hard drinker,
but had not been troubled much with his chest until about
a year previously, when he had an attack of hemoptysis
following apparently on severe exertion, since which tune
the expectoration, which had been more copious, gradually
became offensive. Shortness of breath for three months
bad distressed him very much. The man was in a very
feeble condition, with clubbed fingers and some general
blueness, and obvious dyspnea; a peaky temperature,
varying from normal to 109°, and a pulse of about 130.
Briefly to sum up his physical signs, they appeared to
point to a considerable eoalescanoe of bronchiectatie
cavities over the lower part of the left scapular region
aad at the apex behind, but did not indicate much amiss
With the right side. Neither Dr. Powell nor I anticipated
much benefit from surgical interference, but it was thought
right to make an exploration with the view of determining
Whether or not there was a cavity large enough to deal with.
Accordingly, on Sept. 4th, 1886, chloroform was administered.
He took it badly; he was in a highly nervous condition and
ooughed considerably, emptying nis dilated bronchi—which,
as it turned out, were very numerous—into the larger air
tubes. The result was that he became exceedingly bine
mid perspired freely. Not much chloroform was adminis¬
tered. Two punctures were made without effect, and then
we found that all our attention was needed in order to

Gc

The Lancet,] MR. R. J. GODLKE i SURGICAL TREATMENT OP PULMONARY CAVITIES. [Aran. 9* 1887. 717

attempt to clear the bronchi. Our efforts, however, were
not successful. It was not exactly a case of death from
chloroform, for his state was at first not so very alarming;
the act of respiration was performed freely enough, even
forcibly, but there were loud tracheal r&les, which gradually
increased. He lived in this state for half an hoar, and then,
notwithstanding all our attempts to aid him to cough, he
became completely choked by the pus which he had
partly coughed and partly vomited up. Post mortem, the
cavities which had been diagnosed were discovered in the
position indicated by Dr. Powell; the whole of both lobes
of the left lung being dense and tough, with markedly
fibrous interlobular septa. Bat the right long also, though
spongy, was throughout the Bubjeot of bronchial dilatation,
not indeed so marked as on the opposite side, but still, when
It is said that one cavity was as large as a hen’s egg, it will
be recognised that the disease was considerable.

From the surgical point of view, one is struck with the
fact that this patient was supposed to hsro but little the
matter with the right lung, whereas it contained several
cavities of considerable size; and also with the fact that,
although the cavity to which the surgeon’s attention was
specially directed was undoubtedly the largest, still there
were others at some distance from it in the same lung not
much inferior to it in size. These cavities all present the
glistening, gmooth-walled appearance which Beems to be
'typical of these excavations; they have strands and bars
of fibrous material crossing them, which apparently contaih
vessels, resembling the columns) camera of the heart. They
Seem often to be continuations of the main bronchi, but are
not always so, for one in the left lung is separated by at
least an inch from the main bronchus, and communicates
with it by quite a small tube.

I cannot leave this case without making an observation
on the subject of the anrasthetic. Ether would in many of
the cases we are dealing with be the natural drug to give,
because the heart is often acting so feebly, were it not for
the impairment of the respiration which is frequently caused
by it, owing to the copious secretion of mucus. Besides
which, it is more apt than chloroform to induce cough, and
coughing increases not only the surgeon's difficulties by
emptying the cavity, but also the patient’s danger, as in this
Case, by blocking up the healthier bronchi. A little while
ago we were ginng ether to a man the right side of whose
chest was distended with pus. His heart’s action was
already much interfered with, and he struggled and coughed
violently during the early part of the administration ; the
residt was that he passed into a state of imminent danger.
He became cyanotic, the right side of the heart was engorged,
"the pulse was beginning to fail and the pupils to dilate,
though he had taken but little of the anrasthetic. If
the Pleura had not been immediately opened, I do not
think that this patient would have recovered from the
oofiditttra set up by this really trery small dose of ether,
there a?e many cases, however—small empyemata, with
comparatively healthy lungs,— where it may quite safely be
employed. Chloroform does not usually make the patient
COugh 00 much, though it is necessary in many cases to give
the anaesthetic very slowly in order to obtain this result;
but, oh the other hand, it weakens the heart action. Hence
R.Trill be understood that occasionally cases may be met
with in which it is not safe to give any an aesthetic at all.
An empyema may easily be opened without causing any
JWat pain if the cellular tissue of the pert has been injected
with cocaine; but in a case of pulmonary abscess tbe anaes¬
thesia produced by this drug would be too limited and too
'mttsient. On the whole, therefore, in the greater number
a* Cases, chloroform, given slowly and with great caution,
teams to be the safest anrasthetic at our disposal.' 1 V‘-v j
'Of course, in all cases of puncture of or incialofi into the'
ftjhg.ft trill be remembered, as I stated in tbe first lecture,
MBK thiB feme danger may at any moment arise from the
•fie of blood into tbe bronchi; hence it is well never to
Mtient so deeply anrasthetfaed thOt the natural
JUghing for such a catastrophe cannot be obtained.
jMtample of this class of cn'tes fbrmed the Ifublect
1 by Dr. Williams and myself‘ at the Medlco-
1 'Soeftfy last femtob, 1 and will therefore be only
jttfed to here. “ ; : 1 ‘ •

- aged twenty-one,’ a domestic servant., was
Jrato the Brompton Hospital ttt May, 1885, with
>fay wutgi»nft jnuptoyderiia of bdth'luBgs, followed

•aift&J Vof. Hk.

by pleurisy and fibrosis of the lower lobe of tbe left lung, and
consequent dilatation of the bronchi of that side.” Such was
Dr. Williams’s diagnosis, and he considered that several bron¬
chiectases existed, but that there were three of larger size
than the rest, the situations of which be indicated at tbe
posterior part of the left base. On two occasions I en¬
deavoured to open one of these cavities after ascertaining
that the pleura was obliterated by adhesions, on the second
occasion after excising a portion of rib. At the first opera¬
tion a small amount of muco-pua had been drawn out by the
aspirator; but owing to the slipping of the cannula, which
was being used as a guide during a paroxysm of coughing,
even this, probably very minute, cavity was not. reached,
and at the seoond attempt no cavity of any kind was met
with, although the lung was very freely incised, causing
considerable haemoptysis and some haemorrhage. A drainage-
tube was inserted and worn for some time in tbe hope that
the abscess might rupture into tbe track that bad been
made. There was at no time, however, any material escape
of pus through the wound, and ultimately the tube was
withdrawn and healing was allowed to go on. It was
complete in about a month after, the second operation.
The difficulty mentioned above, which is caused by extreme
softness of the pleural adhesions, was very marked in this
case, and rendered the incision into the lung an uncertain
and unsatisfactory procedure. This patient is, and has
been for some time, in danger of the septic troubles of wbicb
mention was made before, and also of that which may
arise from haemoptysis; and although she herself thinks
she has improved iinoe she has been under treatment, I must,
.to speak honestly, seriously doubt whether much, or any,
of this improvement depends upon what bas been done
surgically. She bad a severe attack of haemoptysis whilst
she was wearing the tube, but this of course might have
happened independently, for she had similar attacks before.
She certainly was exposed to some risk by the mere fact of
opening up the cellular tissue for the passage of the putrid
pus contained in tbe bronchi, and a possible risk from tbe
doubt which existed as to the presence of pleural adhesions.
In her case the pleura was, in part at least, obliterated, so
that the danger hinted at did not arise, but that it is a
real one is exemplified by the following very similar case,
.in which tbe same course was adopted.

H. C-, a married woman aged twenty-nine, had been

the aubject of a cough all her life, which was worse during
the winter. She was said to have had “bronchitis and
pleurisy ” in February, 1885, after which time the expectora¬
tion bad been much more copious, and during tbe two
months before admission (in December, 1885) it had been
offensive, and dyspnoea had developed itself. She had had
an attack of haemoptysis. As in the last case, the signs of
bronchiectasis were marked in one region, the left bare, but
not very obvious elsewhere. The disease was advancing and
the general condition bad, and it was therefore decided to
make an attempt to open and drain tbe cavity in tbe left
base. An exploratory puncture on Dec. 30th resulted in the
extraction of a small quantity of reddish fluid, which evi¬
dently came from tbe pleura, so any further operation yyas
deferred till Feb. 4th, 1886, when a puncture was made in
the ninth interspace, which revealed practically nothing,
but caused a little haemoptysis ; and afterwards an incision
was made over tbe tenth rib,below the angle of the scapula,
and two inches of it were removed. Tbe pleura was. not
adherent immediately beneath the opening, but a small cavity
was entered surrounded by feeble adhesions. A linear in¬
cision in the lung opened a small bronchiectatic cavity near
the surface of the lung, through which a probe passed readily
into a bronchus for a long distance, causing troublesome
-.Coughing. Tbe opening was dilated with dreseing forceps,
.and then tbe finger and afterwards a drainage-tube about
-two inches long were introduced; but this led to the separa¬
tion of the lung from tbe chest walls and the opening up of
fee ulterior part of tbe pleural cavity, where there were no
adhesions. This made it very difficult to dilate the opening
4n the lung. Very little bleeding occurred, aud very little
pus escaped, though the patient coughed up a considerable
quantity and vomited a good deal whleh she had swallowed.
Here the operation was so far sucoteTul that one part of
tbe labyrinthine cavity was reached and drained; J»ut
although afterwards a considerable amount of pus escaped
through the opening, it made but little difference to,tbe
amount of daily expectoration, and for a time her condition
gave us very great anxiety; for the opening np of the
pleura not only rendered the lung df this side practically

718 Thh Lancbt,] DJR. W. O. PRIESTLEY j FLATULENT DI8TEN8I0N IN PUERPERAL CASHES. [April 6,188T.

useless and vastly increased the dyspnoea, but also gave trise
to a septic pleurisy causing grave constitutional disturbance
and serioas risk to life. Bhelefl the hospital in a very Weak
condition, and is supposed to have died since, but we have
nbt been able to ascertain when or bow this happened.

I Slight multiply the acoowtt of. euch cases, but ias.this
would be tedious, I will only mention in any detail one
other, in Which mo operation was attempted, though, as was
shown by the necropsy, it was the only one in the series' at
present in which any great good mas likely to be gained.

J. W——, aged thirty-two, a patient of DrJ Powell’s, a
plasterer by trade, had inflammation of the lungs seven
years before, from which-h** apparently completely recovered,
with the exception that be suffered from a dry backing
cough for a year. Twelve months before admissiobhahad
an acute illness, aeconipanied by a severs, cougb, with
shiverings and dyapncea, after which lie began to expecto¬
rate between one and two pints daily, the.iexpectoration.
being odourless at .first, but gradually becoming highly
offensive. He is said to have bad. a left pleurisy tqt months
before admission, which made .matters, much worse. On
admission, in October, 1836, be exhibited..very puzzling
physical signs: the tight side seamed fairly/healthy, bat
on the left side there were at. times all tbe signs
of a large cavity in the neighbourhood of tbe , angle
of the scapula, while at others these, signs were altogether
absent. His temperature varied, being sometimes almost
normal, sometimes vaiying between 99 ° and 103°. It was ;
found that by inverting him a copious flowoi,expectoration
could he obtained, generally accompanied by sojne marked
alteration in the physical signs in the back. So doubtful,
however, did the indication appear to be, that the point of
recommending surgical interference was never actually
reached, and about Nov. 12th .his temperature rose, he
became rapidly worse, and died on.Nov. 16th. At the post¬
mortem it was found that there were considerable adhesions
on both sides, more on the left than the right, and a small
localised purulent collection on the right side. The left
lung showed remarkably little fibroid, thickening, but was
studded with bronchiectatic cavities, the largest of which
was in tbe posterior axillary line, the neat largest being
.near tbe angle of the scapula — in fact, in the position
diagnosed. Dr. Kidd, before making the post-mortem,
Inserted a knife at the point indicated by him .during life,
and it entered tbe cavity directly. There was slight but
not excessive bronchial dilatation on the right side.

The noticeable point about this case is the vary large size
of tbe main cavities. One at least could clearly have been
reached by an incision, but it is certain that even this would
only have afforded the patient very partial relief, as there
were many others in this Inng, and a similar condition was
starting upon tbe opposite side, aod even the cavity which
could be reached was much branched, and probably wonld
Hot have been very efficiently drained even if it had been
fnlly incised. The condition of the apex of the right lung
is very remarkable; there seems to be an interstitial change,
not starting from anything caused by retained bronchial
secretion.

To sum up the state of opinion at the present time with
regard to the whole subject, it may be said—1. Gangrenous
cavities should always be sought, and, if possible, opened;
and the prognosis, if the operation be successful, is not bad.
2. The same may be said in regard to abscesses caused by
the rupture of purulent collections from other parts' into
the lung, at least as regards tbe pulmonary complication.
S. Abscesses connected with foreign bodies must be opened,
and if the body be not found, it must be remembered that, if
of any considerable ties, it probably lies pretty near the
middle line. If possible, these cases should be treated early
by tracheotomy and incision. 4. Brooetaiectatie cavities,
Whan single (a very rare condition), will be cured by opera¬
tion. When multiple (a very common condition), they offer
but small chance of relief by our present surgical methods.
Still, for the reasons stated, an attempt may be made toopen
the main one if suoh ie to be found, but only if tbe pleura
has been ascertained to be adherent. ' 5. Tubercular cavities
should only be opened in cases where the cough is harassing
and the cavity single. Injections may be used to relieve
symptoms, but cannot be ezpeeted to be curative: ' i

i, The treasurer of the Queers Hospital, ‘Birmingham,
has received from Her Majesty a cheque for XI00 in aid of
the funds of the instltujMtti . ... ; -(iu u ... i . •. .

NOTE ON PUNCTURE OF THE ABDOMEN tot
EXTREME FLATULENT DISTENSION ' -
IN PUERPERAL CASES,' .

By W. O. PRIESTLEY, M.D., LL.D. -

I ita'ye received from Sutgecm-Major TVanklin (at presetfc
on duty with the Lieat.-Governor of the Punjab) notes df A
puerperal case. which he attended, while at Simla in April
last year, and whioh raises the interesting question as to
the propriety and utility of ‘puncturing the' odlbn in. oasestlf
extreme abdotrtfn&l distention after delivery. Surgeom-
Major Franklin’s patient, whom I hid known as a girl, went
out to be married iu lodja two or three years ago, and her
first,labour began on. April#th,, 1836.. The presentation was
natural; but after n long and'tedious labour, resulting from
inefficient pains, the ease had to be terminated by fofOepe
under an anaesthetic, and Che perineum was raptured.
Sutures were put in the perineum, and all yvent well until
two days later, when the patient became hysterical, and
began to suffer from nausea and vomiting.;. at the same
time the abdomen became much distended. Hypodermic
injections of morphia, with the application of turpentine to
the abdomen, checked tbe sickness, and allowed milk and
lime-water to be taken for a time. Next day the abdominal
distension hod enormously increased, there was constant
vomiting, some .dyspnoea* i occasional rigors, and signs of
exhaustion. _ . -

My correspondent says, the obstetric authorities, Playfair,
Barnes, and Ramsbotbam, gave him no help as to the wav
he was to relieve the extreme abdominal distension which
was threatening the life of his patient. He bad tried all the
usual remedies without effect, and so was obliged to act for
himself. After consultation with a colleague. Dr. Harris, he
puuctured the ascending colon with & small trocar. The
gas escaped with considerable force, making a whistling
noise as it passed through tbe small cannula. With the aid
of pressure the greater part of it was expelled and a binder
adjusted. Immediate relief was afforded, /vomiting ceased,and
only slight pauses remained. She had a good night; and
next morning the temperature was normal. This first
puncture was made about seventy-two hours after the birth
of the child. Forty-eight hours later it was necessary to
puncture the colon again, and this was followed, as after
the first operation* by immediate relief to all tbe distressing
sy mptomsi The second operation was follo wed by the giving
qf calomel, in doses of one-twelfth of a grain, every hall-hout,
and continued for about sixty hours-until the bowels acted
freely. The temperature rose to 102° after the. second
puncture, and for ten days the case continued to cause son*?
anxiety, owing to nausea and want of ejeep. After this
the■ improvement was,steady, and the patient eventually
ot quite well. There is qo record of the, temperature
uring the access of the illness, and nothing is said of pain
or subsequent inconvenience from tbe abdominal punctures.

The practice of tapping the abdomen for dangerous reten¬
tion of flatus is a well-known remedy in some of the ailments
of domestic animals, and more particularly the operation is
said to be often practised on sheep when they have "blown
themselves,” as it is called, by having eaten too largely of a
. very succulent pasture, or of some herbage which is im¬
proper for them. The operation is described in some detail
in a recent work of fiction depicting country life, and a
farmer is spoken of as skilled in the employment of a per¬
forating tube, the proper use of which is alone capable of
saving a whole flock of sheep " blown up” after straying
into wrong pasture. There are various records of cases
where tbe intestine has been punctured in the human sufar
ject for extreme distension in connexion with obstruction
of tbe bowels or hernia. For example, Wagst-affe mentions
a case in the British Medical Journal for 1877. and Broad-
bent another in the same journal for 1879. Further refer¬
ences are to be found in "Neale's Digest”: and Mr. Bryant,
in the Medical Times and Gazette for 1872, details a case
of hernia, with intestinal distension, where punctures were
made in the bowel without bad result; there was no
escape of the bowdl contents, and only a drop of blood.
That the proceeding is ordinarily innocuous enough im
proved by toe fact communicated to me by Dr. Broadbent,
that in one patient the bowel was tapped for flatus some*

D

TnltUTOKr,] ME. W.B. MAG DEBMOTT: THEPLAGR OF HEALTH -JEN'EVOLUTION. • - [A**n»9, 1887, 7J£

twenty-eight times, without bad result. Prof,
e, in the Gazette Jiebdomadaire for 1877, says

where about

Foussagrives, _ ,

that he has seen intestinal puncture practised by NSlaton,
Blache, apd Yolpeah* and (hat “it is a sovereign operation
in some cases, and not. dangerous, even where there are
multiple punctures.” Surgeon-Major Franklin says, in one
of his letter* 1 to -me, that-he had boM*'recollection of a
suggestion made by Du. Braxton Hinka concerning tapping a
flatulent abdomen in puerperal cases, and Dr. Hicks tells
me that, though he had suggested it as applicable under
certain circumstances, he has not himself employed it.
1 may ..remark that-in acme forma of illness after delivery
there is no doubt grave danger arising from extreme ab¬
dominal tympanites. . It is even probable that with the
decline of other untoward symptoms the mere continued
pressure of the distended intestines may so keep up irrita¬
tion of tire stomach and depress the heart’s action as to
beoOme itself a source of peril. In these cases punc¬
turing th» inte stine where to is most distended may
afford notable relief, and experience seems to teach that
it may be practised with impunity.

Hertfonl-strvet. Mayfair, W. _

- — . -

-THE PLACE OF HEALTH IN EVOLUTION . 1

: By W. B. MAC DERMOTT, M.B. Dcb.

IjJomteNB once, on asking a little negro girl in Kentucky
who made her, got for answer, “Nobody made me; I
-growed.” If I asked how we came by our health, a like
answer might be given. It might be said that nobody made
Our health; that we did not make it ourselves; that it came
as a gift of nature. If ill-health afflicts us, it would be said
that it, too, comes as part of our natural lot. Health and
nature here are terms of loose meaning. Health may be
taken as a state of being, a* a relation of condition, as a
formative process. We will take it here as a state of being,
made in the sense that it is the outcome of antecedent con¬
dition. ’ We take it as expressing a state of being continuous
irith prior states of the same kind, nnd shall consider
whether variation from current normal condition stands in
relation to variation from prior oondition.

An idea of fitness comes as an introduction to our subject
it is more, however—it is the beginning, middle, aud end of
it. We usually think of fitness as something qualifying a
man beforehand for health, but it is, in fact, a synonym for
health. It is not a mere rhetorical phrase, but a term ex¬
pressing physical truth; Fitness means health in the
physical sense; the strong man who Want# fitness for health
has, in reality, want of health. Health, in truth, means the
fitness of states of being to the conditions of life. It u,
therefore, as these conditions are unstable, a thing not fixed,
but changeable. In the World, as it exists, we find life fitted
to. many different conditions. . Man. himself we find fitted
to many climates, to lofty mountains and tropical swamps.
But as ms fitness to one set of conditions so usually is nis
unfitness to the opposite set. The fitness of the negro to
tropic heat means unfitness to a cold climate. The fitneas
of the European to temperate conditions means unfitness to
the extremes experienced elsewhere. We have thus many
■different states of being, each of which is health only aa cor¬
responding to certain conditions. In the end fitness comes to
be expressed as structure, and particular modes of structure-
growth. The outcome of the fitness of the negro to heat is a
mode of structure; his body becomes physically moulded to the
-Condition. On the other hand, the condition is necessary to
maintain the fitness. In the northern States of America the
negroes are very sickly, one out of every six born in these
Btetos being deaf, dumb, blind, idiot* insane, pauper, or in
prison. Europeans in hot countries show a like inability
to conform easily to the condition of climate. We thus find
thatamqde of sttuoture onoe formed subsists for a long
time in a race, becoming under unfitting condition a source
of ill-health. The fitness to condition means -perhaps, in
proportion to its completeness, a want of power of accom¬
modation to change of oondition. The very fitness of the
®figro to heat makes it the harder for him to fit himself to
avid. .W hen, therefore, we have a people of mixed descent,

such descent will bring iato it many states, varying from
fitness to unfitness, in reference to its conditions of exist¬
ence. Is this composite state represented in the actual
health of the people? In the first plaoe,all modern societies
of any importance are extremely composite by descent. They
contain elements representing every different condition to
which man has fitted himself from time. to ; time. We
are so aooustomed to the idea of our descent from
one man that we do not easily heed the more immediate
fact of our deeoent from mankind en masse. Each man has
a father and mother, probably brothers and sisters. He will
have four grandparents, eight great-grandparents, and ao on
going backwards. At the tenth generation backwards he may
have theoretically 1024 direct ancestors; at the twentieth
only 1,048,676, and a corresponding number of collateral
relatives. He will not, of course, have ao many, but still he
must have a vast number. When .we remember that t wenty,
or-even a hundred generations oover but a short period in
our -race history, and that such history reoerds incessant
movements of population, we can easily believe that each
one of us has built into his constitution part of the negro’s
state of fitness to heat, part of the Laplander’s to oald, part
of every state to which man’s body has been moulded; it
may be said, blended into a sweet and reasonable mean.
Yea, bat not indissolubly, not perfectly. In Europeans
we constantly, find character# of skull and feature—of
structure belonging to remote and perhaps extinct races.
We find the negro Tartar and Malay structural type
showing often amongst us more or less distinctly. In idiots
and the insane I have seen structural character which I
could assign to no race I knew, but which I felt sure
belonged to facts of race structure, most likely of remote
antique nature. Now, these types are exhibited jn a
peculiar way. They show in single members of a family as
a manifestation of something underlying in latent or dormant
form tbs whole connexion. I have seen the Tartar type in
single individuals standing in the relation of third or fourth
cousins, the rest of the connexion being Caucasian in
appearance, I have seen the negro type assert itself in just
the same way. We have here two significant facta—the fact
of latency and the fact of exceptional manifestation of
stractural character; both we must admit, though we fail
as a rule to find adequate explanation for them. We kuow
them as unexplained facte of inheritance. They mean that
variations of structure corresponding to man’s experiences
of condition subsist potentially in bun and exhibit them¬
selves exceptionally under circumstanoss for the most part
unknown to ua.

Let us now ask ourselves what is the sum of the varia¬
tions of struct*re thus represented in inheritance. We can
see easily enough that we may find in ourselveB all, pr nearly
all, the states which man experiences locally or baa experi¬
enced historically as man. We oan aee, too, that many of these
states, coming book out of place, out of time, as characters
of race structure do, would appear in him as states of unfit¬
ness, of ill-health. When, however, the history of the
bodily man has to be taken as going back continuously into
pre-human experiences, the question arises whether abnormal
variations of structure and mode of structure-growth do not
-also express those experiences. Taking structure generally
in relation to both antecedent and current cirpumstance, we
find that Change ia always not to something new, but to
something which exists in some other place or has existed
at some other time. When an organ or part of the body
exhibits an unfitting pattern, such pattern exists normally
somewhere else in the body, or did exist in it at some -other
time. So far this explains something usually seen in states
of ill-health. But the narmalpsttern itself, which we suppose
to change, ia a thing determined in inheritance; it is
bat one of a series of patterns occurring therein. The items
In the series, again, are continuous; they not only pass con¬
tinuously from one into another, but they inhere in a general
programme. Thus the great fact of the mammalian pattern
u man ia determined in inheritance, and is a result in a
programme or pattern, not of structure, but of change pf
structure containing pre-mammalian patterns ae items. But
this fact conditions the actual pattern; it cannot be taken
apart from its determined mode of formation, whicb always
remains represented in it. The pattern is an elaboration
qut of pre-existing details which always remain in it as
potential elements expressing its prooess of making. It is
this process, thte programme of living, that brings out the
da tails; to tt they belong. But the very nature of such a
programme involves variability, whicb, in reality, interns

oc

k

720 The LANCET,] MR F. PAGE: ANTISEPTIC TREATMENT OF MAJOR AMPUTATIONS. [April9,1887.

indetermination. At one stage in it nothing exists deter¬
mining the element of structure-growth in reference to one
future stage more than another; the element is determined
by current circumstance, only under a condition of general
conformity to the programme. Thus, in the infant the
pattern of a structure—say of the brain—may be deter¬
mined in a way unimportant as regards current state of
being, but, being once determined, becomes deeply significant
in subsequent states of being. In the child’s brain a non¬
human detail existing in the programme of life can be intro¬
duced with impunity; there is nothing in the conditions
of life at that stage, wilhin certain limits, absolutely deter¬
mining to the human rather than some other pattern. The
determination of tbe pattern lies, to some extent at least,
within the general limits of the programme. It would not
be right to say that this is indetermination absolutely;
it is only indetermination in respect of future detail. The
programme potentially contains many patterns, the choice
between which is determined under immediate conditions,
allowing divergence in the initiation of detail, which
obtains weight only subsequently. At a period in existence,
therefore, what determines detail of specific pattern is
wanting, or of small potency, and the characters of otheT
patterns included in the programme are not rigidly ex¬
cluded. Now, we know as a fact that abnormal elements
of structure-do actually enter the human pattern with
impunity at an early stage, to become in after-life sources of
ill-health; and in many instances a strong resemblance be¬
tween these elements and elements of structure in lower
animals is very apparent. The value of such observations is
to be estimated, firstly, by tbe actual significant and deter¬
mined nature of the resemblance and its generality;
and, secondly, by the resemblance coming into the
body of facts, which make a larger induction—say
that of evolution. In tbe actual outcome, as each state
of ill-health in the initial step is perhaps invariably a
matter of local detail, the true nature of the state becomes
of increasingly difficult recognition. When a part grows
after a wrong or obsolete pattern, it has to reckon with the
parts and processes which do not misbehave, with the
result that the actual form of the pattern is disturbed or
obscured. It is only in certain cases that an unfitting
pattern can be maintained, its unconformity to the specific
pattern leading usually to profound disturbance. In some
cases, however, the human system is more or less tolerant
of abnormal patterns of structure, and when this happens
they are found generally to correspond to patterns normal
in other animals. No two human bodies are quite alike,
and the difference in each case from an assumed specific
type is at bottom, as a rule, dne to change to a non-human
pattern. This is tbe general form of variation. Sometimes
it can be seen even in disease—that is, when unconformity
induces disturbance, when tbe pattern is maintained
with difficulty. In gout we have a mode of digestion
in essential particulars, normal in birds and reptiles,
manifesting itself complicated with unconformity in man.
But in proportion as the unconformity becomes more de¬
cided, facts of similarity are liable to be taken as accidental
and non-significant. A superficial likeness is observable
between certain diseases of the hnman skin and skin struc¬
ture in fishes. The fact should not be ignored. It may be,
indeed it is probable, that reversion to fish-like types of
structure occurs in man disguised bv extreme unconformity
to the human type. This in all probability would be found
in skin and nerve disease.

>■ Possibly it may be thought that I have not said how our
health is made. In the present state of knowledge I could
not do so. All that can be done is to state the problem in
various tentative ways; to approach it, to realise it. If the
'doctrine of evolution be taken, we must expect the facts of
health and ill-health to find a place in it. All I could do
'was to indicate that place hi a general, and I fear unskilful,
way. The doctrine in its present state does not prove the

RESULTS OP

MAJOR AMPUTATIONS TREATED ANTI-
SEPTICALLY IN THE NEWCA8TLE-
ON-TYNE INFIRMARY,

From: Aphll 1st, 1878, to Dec. 81st, 1886.

By FREDERICK PAGE,

SURGEON TO THE NEWCABTLE-ON-TYHE INFIRMARY; EXAMINER DT
CUBICAL SUBGRRT, UNIVERSITY OF EDINBURGH.

In the year 1884 I published in The Lancet a table
(No. I. below) giving the results of major amputations
performed antiseptically in the Newcastle-on-Tyne Infir¬
mary during a period of four years and nine months—from
April 1st, 1878, to Dec. 31st, 1882,—and contrasted the
mortality with that of a similar period, an account of
which appeared in The Lancet, I think in the year 1873.

Table I.

For Injury.

For Disease.

Total.

No.

Recov.

Died'.

No.

Recov.

Died.

Hip-ioint ..

Thigh .

Knee-joint.

Leg ... ... ... ...

Ankle-joint.

Shoulder-joint .

Arm .. ...

Forearm .

Wrl»t .

0

16

3

ao

4

3'

a

8

0

0

11

a

16

4

3

9

8

0

0

6

1

4

°o

2

0

0

a

i 3 !

: 24
16
! a

6

4

. 0

0

34

4

34

16

3

8

4

0

I

1

Total .

65

63

13

95

90

5

160

I am sorry that I am not in a position to give the precise
cause of the seventeen deaths, but the mortality was 1(X
per cent, and showed a marked decrease from that of the
previous report. From injury the mortality was 184 per
cent., from disease 5 2 per cent.

Table II. gives tbe results of major amputations per¬
formed antiseptically in the infirmary from Jan. 1st, 1883,
to Dec. 31st, 1886, a period of four years, with the precise

Table II.

For Injury. |

For Disease.

Total.

'

gg

Died'.!

No.

Recov.

HUS'

Hip-joint .

Thigh .

Knee-joint.

Ankle-joint.

Shoulder-joint .

Arm .

Forearm .

Wri*t ... .

0

31

13

3

14

13

7

!

:

0

0

0

1

0

9

26

30

3

6

10

0

«

61

1

34

39

3

6

10

0

1

9

64

6 1
4T

43

6

90

»

7

Total ... ...

83

81

3

139

129

10

233.

■iSw-

cause of death in each of tbe twelve fatal cases. The
mortality is 54 per cent., for injury 2 4 per cent^, for disease
71 per cent. Now let ns examine tbe precise cause of tbe
twelve deaths in this table.

Injury.

1. Thigh. The only death after a primary amputation.
A man. Died in a few hours from shock and loss of blood.

2. A man, admitted with tetanus ft-om a crushed hand. Fore¬
arm amputated. Died in twenty-four hours from tetanus.

-.1)

views I have explained, nor do these views add much to the C™ n ° 8e
induction; but at the same time no other working hypo- I inner
thesis exists to give our observations of states of health
coherent or intelligible connexion, tiL' j un: -unr I

i Poyntxpass, Newry. -4i“«0I Mr mort Wq#

annual meeting ot the liovernars ,-uad
__ aster Dispensary was held on tbe 31st ult., when satis-
atory financial and general reports were presented and

^ nnta i 'r ifc flMi M * ltwnr Htr

Disease.

8. Amputation at hip. A woman aged twenty-one years,
‘-whose hip had been excised a year before. Had albumen
*■* her urine. Died in eight hours.

4. Amputation at bip. Man, aged fifty years, much run
down by long-continued suppuration. Died m a few days
bfrom exhaustion. No sign of blood poisoning,
fa- 6. Amputation at hip. Man, aged thirty years. The same
fffemarks apply to this as to the preceding case.

6. Thigh. Man, aged forty-six years, suffering from
phthisis and suppuration of knee-joint. Died in seven
weeks from phthisis.

_ 7. Thigh. Man, aged fifty-three yean. Amputation

Di

joogie

Tot Lancet,]

DR. JOHN LUCAS ON GUNSHOT INJURIES.

[Apbil 9,1887. 721

through middle third for spontaneous gangrene of foot and
leg. Died in forty-eight days from recurrence of gangrene.

8. Thigh. Man, aged sixty-two years. Limb amputated
olose to nip for long-standing necrosis of femur. Died in a
few days from exhaustion.

9. Leg. Man, aged sixty-two years. Amputated just
below the knee for ulcers on both legs of twelve years’
standing. Died of pyaemia. Infection probably arose from
ulcer on other leg.

10. Leg. Man, aged fifty-five years. Amputated just
below the knee for spontaneous gangrene of foot. Died
from recurrence of gangrene of the stump.

11. Ankle. Old man, just recovered from typhus. Spon¬
taneous gangrene of both feet. One removed at ankle-joint.
No attempt at repair. Death in a few days from inanition.

12. Arm. Woman, aged seventy-seven. Admitted from a
workhouse with suppuration of the elbow and bed-sores.
No attempt at repair. Death in a few days from inanition.

If we compare the above tables we are struck by two
circumstances. 1. The mortality from amputation has
fallen from 10-6 per cent, during the first period to 5*4 per
cent, during the second. This 1 consider most satisfactory.
2. The usual relative mortality of amputation for injury
observed in the first table is reversed in the second. In the
first, 18'4 per cent, of the amputations for injury and 5 2 per
cent, for disease were fatal, but in the second 2 4 per cent,
from injury and 7'1 per oent. from disease died. This is an
unusual and remarkable experience. I believe both results to
be due to the almost entire absence of pyaemia. Blood poison¬
ing was the great cause of death after amputation. It has
almost ceased to operate with us. Consequently the mor¬
tality from amputation generally has fallen, with the result
that in cases ox disease amputation is now resorted to where
formerly it would have been refused. A glance at the
causes of death I have just given in detail will, I think,
support this view. Amputation at the hip in the adult is a
vAry fatal procedure; so is amputation for spontaneous
gangrene. Six of the twelve deaths recorded followed such
(mentions, and I question whether some years ago any of
them would have been performed. I have been much struck
by the following quotation and table from the last edition
of Mr. Erich sens work on surgery:—

“ In the following table may be seen the results of 307
consecutive cases of amputation performed at University
College up to May, 1871. Of these, 79 died, yielding as
nearly as possible a mortality of 25 per cent.

the Newcastle table has 11 amputations at the hip with 5
deaths, and 7 at the wrist with no death. I f these cases were
excluded from the Newcastle table, the number of amputations
would be 364 with 24 deaths—a mortality of 6 5 per cent.
Mr. Marcus Beck tells me there has been no death from
pyaemia after an amputation in University College Hospital
since 1880, so that I entertain no doubt the mortality there
since May, 1871, will be found to be very considerably less
than 25 per cent.,—possibly even lower than with us.

Cuea. I Deaths. | ^

Thigh . 39

Leg and foot ... 44

Shoulder and arm 13

Forearm ... ... 8

Oaaea. Deaths.

GUNSHOT INJURIES, WHICH OCCURRED
AT SHWEBO, UPPER BURMAH.

By JOHN LUCAS, M.D., F.R.C.S., &c.

(OampiUd frtm tutUn iaktn at Ih* ti»u by Mr. B. Murphy.)

Cask 1.—Private W. D - , Royal Welsh Fusiliers, was

wounded in action on Dec. 27th, 1885, at Zeedaw (three
miles from Shwebo), the distance at which the injury was
inflicted being about twenty yards. The bullet (a large,
irregularly-rounded piece of lead), entered below the outer
third of the left clavicle, and made its exit at the lower part of
the posterior margin of the deltoid muscle, passing through
the humerus, about two inches below its neck, causing a com¬
pound comminuted fracture. The large vessels and nerves
escaped injury, as also the shoulder-joint, with the exception
of a continuation of a splinter into it. Chloroform was ad¬
ministered, and an exploratory incision made, and the wound
of exit was enlarged to permit of the removal of some loose
spicules of bone. Tbe wounds were then dressed antisep-
tically, and the arm placed on a splint. The patient, who
was a strong and healthy young man, suffered very little
from shock, and there was but little loss of blood from tbe
t.imfl of the injury to the completion of tbe exploratory
operation.—Dec. 28tb: Tbe patient bad a fair night’s rest
after a hypodermic injection of morphia (half a grain).
The wounds were re-dressed. Evening temperature 100°.—
29th: Wounds re-dressed. Had a fair night. Wounds looking
well, discharge being slight and sanious. Morning tempera¬
ture 99 4°; evening 100-4 .~3l8t: On removing the dressings
the discharge was found to be free and purulent, and bad a
slight odour. There was a considerable amount of swelling
of the arm and tissues covering the joint. Some small
sloughs were found in the anterior wound and removed.
The patient was restless daring the night and wandered
slightly. Morning temperature 101-4°; evening 102°. The
wounds were syringed out with strong carbolic lotion, a drain¬
age-tube inserted, and dressed.—Jan. 1st, 1886: Tbe patient
had a very good night after a hypodermic injection of half

Gar experience in Newcastle at the present day is very
different; for, as will be seen from Table III., we have bad
382 consecutive operations with 29 deaths (7*5 per oent.)

Table III.— Major Amputations treated Ant identically in
the New<xutle-on-Tyne Infirmary from April 1st, 1878,
to Deoember 81st, 1886.

Hip-joint ...

Thigh .

Knee .

Aj&le-joinfc!”
Shoulder-joint

Arm .

Forenrm ...
Wrirt .

Mortality 7*6 per oept.

I would further point out that Mr. Erichsen’s table
can tarn# amputation at tbe hip or at the wrist, while

out smell. Morning temperature ye ; evening m t. —
7th: Quantity of discharge very great, but without any
offensive odour. The patient was much pulled down, though
he took nourishment well. A mixture of iron and quinine
to be taken thrioe daily, and six ounces of port wine
ordered.—20th: Patient continued to do fairly well. It was
subsequently reported that the wounds had quite healed,
and that there were prospects of a fairly useful limb.

Cash 2.— Private C. C—-, aged thirty-two, Royal Welsh
Fusiliers, was also wounded at Zeedaw on Deo. 27th, 1885.
The bullet passed into the right thigh, about four inches
below Poupart’s ligament and aoout two inches external to
the course of the femoral artery. On examination the
femur was found to be fractured near the surgical neck; the
bullet oould not be found, but was supposed to be lodged in
the bone or in the soft tissues immediately behind it. There
was a good deal of haemorrhage at the time of injury, which
was controlled by pressure, and the patient suffered consider¬
ably from shock. The patient was a spare, sickly man, and
had suffered much from fever when in India. Stimulants
were given to rally him from the shock, and the wound
lightly dressed. The wound was about the size of a four-
«nnt piece, and would barely admit the first joint of the little
finger.—Dec. 28th: The patient had a fair night after the
administration of a hypodermic injection of morphia. Pulse
still feeble; morning temperature 976°. Takes nourish¬
ment well. The dressings were changed. There was little
discharge, but the whole thigh was immensely swollen.

122 Tiffl iLiN'CHT,') 1

DBj JOHN Ld0AS 03? -GC5 SHOT, I MCBlESi !

[Anro'HitMTr

Evening, temperature 99 tf 0 .—29th-: The patient looked Cask .5.— Corporal J. 0-■, aged twenty^nice, was.

'brighter this morning; had a fair night; pain not severe, killed at Zeedaw on Dee.' 27tb, .1885. The bullet entered
Morning temperature 99°; evening I01'2°.— 30th: The the chest immediately below-the inner third of the left
patient was very restless during the night; complained clavicle, grazing its lower border, wounding the subclavian,
of severe pain in Che hip-Joint." Discharge from wound artery, and lodging in the muscles at the Hoot of the neck,
free and purulent. Bowels moved ones after an enema Before assistance could he rendered the naan died of hsanxar-
of warm water. Morning temperature 101°; evening rhage. The distance at which the injury was inflicted waa-
101'4°.—Jan. 1st, 1886: During the night. severe spasms very close (about fifteen yard*). . ,i.

came on in the injured limb, clonic in nature, and recurring Cask G.—Private D. R —, aged twenty-seven, was
every few minutes. During the spasm the muscles on wounded at Zeedaw on Dec. 27tb, 1886. The bullet passed
the outer side of the thigh were drawn up, aod caused deeply through the calf of the .leg, entering at the inoor
great agony. The swelling had muph increased, and the dis- side close to the edge of the tibia, and. about two inches
charge was very profupe, being jerked through the wound below the tuberosity, and making its exit about .four inches
with each spasm. The patient's body was bathed in a cold below the lower angle of the popliteal apace, a little external
clammy sweat; pulse feeWe aid wiry, add very quick; the to the middle line .of the calf, passing in • direction out¬
face had an anxious, scared look. The muscles of the jaw wards, downwards and backwards. There was a considor-
and other parts of the body were quite free from spasm able amount of swelling about the leg and foot, and the
or stiffness. Dressings changed. A. hypodermic injection pulsation of the posterior tibial,or dortatysi pedis arteries
of half a grain of morphia to be given every three hours; could not -be felt; there was also ©erne swhiling of the tissues
stimulants and nourishment to be kept up.—2nd: The over the knee-joint, but the'joint itself did not seem,
spasms continued, were more frequent, and were aggravated affected. There was considerable haemorrhage at the hue of
by the slightest movement of the patient himself or anyone injury—easily controlled, however, by pcoeaure.-Dec. 23 th s
near him. The effort to drink would .bring on a severe Dressings changed. Parts much the sarnie.: Had a fair
spasm. The patient continued thus to suffer great agony till night-after the administration of a -hypodermic injection of
8 p.m., when he expired from: pain and exhaustion. The morphia.—29th: A quantity of sanguineous serum exuded,
tetanic spasms were confined to the injured limb up to the from the wound on the removal.of tbe dreeeing. Complained;
last. No post-mortem could be held, nor in any of the of inability to pass urine; a No. 8 oatbehet was passed, and a
following cases. fewounces drawn off.—30tht Swelling much diminished; dsa-

C ash 3.—Private 8. G——, aged twenty-four, was wounded charge from wound slight and purulent; appetite, fair; bo wale
at Yatha on January 12th, 1886, the ballet entering &t the moved after an enema.. Morning temperature 102°; evening
left shoulder about, half an inch below the centre) pf the 102-4°.—8ist: Patient slept well after ahypodermic injection
spine of the scapula; aud, judging from the man’s position of morphia. Condition of leg the same; discharge free,
when hit, which was lying and facing the enemy, the Merhing temperature 100°; evening 100-8°.—Jan. 4th, 1886 f
missile passed downwards, forwards, and somewhat itfwatds, Patient doing Well. Suffered from a little diarrhoea yester-
and lodged in the left lung (the exact site of Which CbUld day,Treated'with an astringent. Wounds:doing well and
not be traced). The haemorrhage from 1 the wound was disoliarge healthy.—7th: The: d is cha rg e baa become putrid,
slight, but pain was complained of andreferred • to - the - and, some sloughs having separated, a large cavity waa di»«*
posterior surface of the heart; and there was a good deal ot closed in which the posterior border end.surfaoe of the tibia
anxiety manifested by the patient, with the subjective were seen denuded (over* large area) of periosteum. From
feeling that the heart itself had been injured. A hypo- the position in which the patient ; ivouid keep the limb,
dermic injection -of half a grain of morphia *waa given, which waa with the knee bent, whilst , lying on hi*
but without much effect. A broad rolled bandage was back, the pus descended along the • muscular interval*
applied round the chest, and the Wbrmd lightly covered and along the inteross e ous membfiane, had a deep -and
with carbolised lint. He had-to^.be carried in a dooly large absoets was formed. The hmb was bandaged tightly
two long marches to Shwebo, which he bore Fairly'well, from below upwards, which proceeding mused a large
He spat, tip some blood, Bind showed syiriptbtaS Of acute prieu- quantity of putrid .pus to exoda:-ithrough! the wound p
moma on the third day of the injury.' Oh physical examina- the cavity was then syringed out with carbolic lotion,
tion, a considerable amount of emphysema was observed the bandage, which had been removed to syringe the
on the fourth day in the muscles of the left wMb- of the cavity, replaced,-and the limb placed on a straight splint.—
back, indicating the escape of air frdm-the injured lung. 12th i The discharge from the wound .was now much less
A clear tympanitic note On pftrfeusskm 1 'ovfer the left lateral offensive, and its quantity less. The swelling in the calf of
part of the thorax pointed to the occurrence of pneumo- the leg had almost disappeared. The patient was rather
thorax, and there was collapse of the left ltlnfc, ns shown by anaemic, and had lost much flesh. Quinine and iron were
dyspnoea, restlessness, Tapid respiration,'& q.’ The decubitus ordered to be administered.-—15th : The patient wostidw on
was that of orthopnoea. The ; above Wm the condition a fair road to recovery; hie appetite jva* good/h© Slept well,
during (he first four days dt 'the' receipt of the injuryand, though an Ugly-lookring cAvity still remained, hope*
Jan. 17th: Patient scarcely slept during the night, though existed that it would soon fllT up. The-man left-Shwebo-
he had an opiate; respiration difficult iptin ia the. cheat- iu this condition, end nO reports hare been received con-
very great; pulse hard and wiry; “skin hot.^—I8th: THemari" cerning him since his departure.

was very restless; respiration morfe difficult; he could ridt Cask.- 7.—Private W. T-r— was wounded at Zeedaw on

articulate on account of the severity of the dyspnoea; pain Dec. 27tb, 1886, The bullet entered the left arm an inch
in the Chest severe and constant; pulse feeble and quick, and a half below and internal to the olecranon, and passed
and body bathed m cold sWeate. Opiates were continued, in a direction upwards, forwards, and outwards, passing
but without much effect.—19th: The’patient was getting through the elbow-joint; it lodged immediately under the
exhausted from pain and sleeplessness, ahd gradually sank, integument about three inches above the external eondyl*
Cash 4.— Private €. D->—aged thirty^-two, was wounded of the humerus, where a small longitudinal incision waa
at Zeedaw on Dec. 27fch, 1885, by two bullets, the first 1 made and the bullet extracted. The pulsation on the radial
entering the left groin immediately over the centre of artery was distinct, and there wAs little} bleeding from th*
Poupart’s ligament. The man'feeling himself wbrinded, : wound. A drainage-tube was inserted into the lower
called out to a comrade for assistance, and a* be Was wound, and the arm placed on an angular splint. On probing
turning to the left he received -a second bullet in the ithe wound rough bone Could be felt, but no separate frag-
abdomen, about two inched below «hd to the tight' bf the ment, norcould the probe follow the course of the bullet for
umbilicus. The hastnorrhage fnem tb^first wotrud was Very" more than two inches.—28th: Swelling about the elbow-
severe, and was controlled with difficulty by* pad arid pres-' / joint conaiderable, discharge consisting of a little pus and
sure. The wound in the abdottferi Whs * small one, of the- synovial fluid. Pain severe during the night. Morning
size of a four-anna piece. TTie little fhfget eorild be passed temperature 100°; evening 101‘4°. The wounds Were
into it up to the first joint. 1 There Woe no protrusion of re-dressed, and the whole arm. and forearm wrapped in
gqt or omentum, though tbeSUCettM be Been. Thu deStitt©-^ spongio-piline wrung out in hot water.^-29thi Swelling
tion of the bullet in both wourid^ could not be discovered: of joint much diminished; discharge free and purulent. Th©
The patient suffered severely fiforteehook; he eould riot pMS patient slept well after a hypodermic injection of morphia,
urine, and only a few ounce© oP^ly 1 which 'woe Cl^Br, were and the pain was less severe. Morning temperature 100°;
drawn off with a catheter;-• 'IVrftfe #eeMe >f tod 'thready, evening 100 - 8°.—Jan. 7th. 1888: Patient continues to do
Stimulants were gi i eti BWePj['( r btft tlW patient)never riUBe$ falrty well. Appetite fafy. * The temperature is now
end died ten hours af t cr the infliction of thh'irijufcy. ' normal. Tlie swelling about the joint has quit© disappeared.

3

Th* Lanctet,] ME. W. : CURRAN": SURVIVANCE AFTER GUNSHOT WOUNDS OF HEART. [Aran. 9,1887. 723

and the wounds are discharging healthy pus. The patient
is mttch pulled down, and looks very anaemic. Quinine and
Iron were administered.—15th: The patient’s condition is
much the same; wounds still discharge a quantity of pus,
which now has a slight odour and looks less healthy; no
fever ; ;ippetite fair; takes a little exercise in the open
air 1 . Shortly afterwards the patient left the station, with
fair prospects of ultimate recovery, though the joint would
probably be stiff and useless for a long time to come.

Cask 8.—Private G. D——, aged twenty-four years, was
•wounded at Zeedaw on Dec. 27th, 1885. The bullet entered
the right forearm over the insertion of the tendon of the
toiceps muscle, and passed upwards, backwards, and out¬
wards through the elbow-joint. One piece of the bullet
Was extracted from the wound, along with some ddbris of
hone; another piece Was found a few days after about half
-an inch abovetlieextemal condyleof thehumerus, embedded
in the triceps muscle, nenr its insertion. The biceps tendon
and'vessels in the angle of the elbow escaped injury. There
was not much bleeding at the time of injury. The limb
was placed on an angular splint, and the wounds dressed
antiseptically.—Dec. 28th : The .arm was very painful, and
much swollen; a hypodermic injection>of morphia had not
much effect in producing sleep. The arm and forearm were
wrapped in a large piece of spongio-piline wrung out in hot
water.—Jan. 1st, 1886: Swelling rather less. Arm still very

day a second piece
Patient much the same. Evening temperature 10P2°.—
4th : Swelling somewhat less than yesterday; some debris
•of bone daily removed; discharge not offensive at this time.
Pain considerable, and he could not sleep well, though
hypodermic injections were given nightly. Morning tem-

g erature 100°; evening 100 4°.— 12th: Discharge looking
ealthier; swelling slight ly less. The patient was looking
anaemic, and had lost much flesh since the injury occurred.
He left this station shortly afterwards in the condition
above described.

Cask 9. —Lieut.-Colonel R. S— — was wounded at Yatha
on Jan. 12th, 1886. The bullet entered at the right cheek,
just below the outer border of the malar bone. It caused a
wound about the sizeof an eight-anna piece, from which there
hung a shred of the facial nerve, which had be9n divided,
causing facial paralysis. The facial artery was also divided,
which gave rise to severe haemorrhage on the field. It was
controlled by digital pressure on the proximal portion of
the artery as it crosses the lower border of the maxillary
bone. The luemorrhage caused considerable prostration,
and rendered any attempt at searching for the ballet
futile. The wound was dressed lightly with carbolised lint,
anda hypodermic injection of aquarter of a grain of morphia
■given. This, not having mnch effect, was followed by a grain
of opium three hours later.—Jan. 13th: A slight undefined
swelling was discovered in the neck, a little behind and
heldw tnfe right mastoid process. It was thought that this
was the bullet, so an incision was made over the swelling
and a thorough search made, but no bullet could be dis¬
covered. It was then thought probable that the bullet must
have lodged behind the right zygomatic process, where it
wis resolved to leave it for the present or until some sure
<flgn ( pointed to its exact site. There was no injury to any
bona apparent, and on examining the part through the mouth
no. trace or sign of a ballet could be detected —20th : The
jittient recovered from the prostration caused by the hremor-
Thaoe find could move about. The disfigurement caused by
thefacl&l nerve being divided was much less marked. The
wound was open and discharged daily a email quantity of
healthy pus. In this condition the patient left the station
fofr England. No account of him has si rice been received.

Cash 10.—Lieutenant G—- was wounded at Tatha on
^sn. 12th; 1886. The ballet passed through the fleshy part
oftfcetbigh about three inches above the patella, in a duec-
oon backwards and' inwards to the inner side of the femur,
vastus intemus muscle being pierced. There wae no
constitutional disturbance in this case, and very little
„ .. „ for b few days there was slight swell-

, aid a little heat wae felt about the injured part. The
W'Ore drfessed antiseptically, abd the limb placed on
. * case progressed Well, the wounds being nearly
i when the patient left the Station on the 21st.
iSfflSUliT-lieutenant L. p-— was wounded at Yatha on
lefcpasse^tnroughtbe skin andsub-
oTnha'fiJopliwal SphoS df the .right leg,

making a wound of entrance and one of exit, and leaving a
narrow isthmus of 6kin and subcutaneous tissue between
them. The tendons in the popliteal space were uninjured,
though one of them was exposed. There were no untoward
symptoms, and the wounds quickly healed, leaving only a
temporary stiffness of the part. It is noteworthy that in
this case and in the former cases where a bullet had made
| its exit, the wouuds of exit were in no case larger than the
wounds of entrance; on the contrary, they were in many
cases smaller.

SURVIYANCE AFTER GUNSHOT WOUNDS
pR OTHER INJURIES OF THE HEART.

By BRIGADE-SURGEON W. CURRAN,

AR^Y; MEDICAL DEPARTMENT (RETIRED).

{Concluded from page 674 .)

Op even greater interest than either of the foregoing cases
is one recorded in the Army Medical Department Reports
for 1875, p. 286, which I am induced to summarise here, as I
am enabled, by the courtesy of the War Office authorities, to
submit at the same time an illustration of it. The particu¬
lars of it stand briefly thus: A naval officer, who had been
wounded at Taranaki, New Zealand, on March 28th, 1860,
was brought on board the hospital ship Victor Emanuel at
the Gambia (?) from the front, on the evening of Jan. 24th,
1873-4, in a state of great prostration from remittent fever.
His illness commenced with a violent diarrhoea, and the
symptoms on admission were great prostration, feeble
husky voice, irritable stomach, and cold, clammy skin. The
pulse, which stood at 120 when he was first seen, ran up to
128 a few days subsequently, and he became delirious soon

afterwards.lie expired on the morning of the 27th, and

on section four hours afterwards a small hard heavy circular
body, about hair an inch in diameter (which, on examina¬
tion proved to be a leaden bullet), was found encysted out¬
side the pericardium, above the right ventricle, and between
the origin of the pulmonary artery in front, and the arch of
the aorta behind. This position corresponded so closely
with the cicatrix of the wound referred to above as to leave
no doubt as to their relationship, and on a closer inspection
this bullet was found to be of tho usual New Zealand
pattern. It had, as we might expect, undergone some
alteration, and it was firmly fixed in its place by fibrous
bands, tbht enclosed it in the interspace between the aorta
and th€rpulmonary artery.

Fig. 2. is a drawing of the preparation; •ho'glng the
bullet in situ, resting on the pericardium, and- bdlKi nen the
aorta and the pulmonary artery.

As to my own connexion with this matter, it is necessarily

Very limited. Limited, however, thougn it be, it includes
the case to which I have already adverted, and which—if
we may accept the descriptions of it wate sworn to in
^4 court of justice—may be faddy regarded/ as one of the
Faretoof its kind in the literature of our art. This descrip¬
tion-will be more fully set,forth hereafter; and meantime
1 1 may be here permitted bo give a brief note of a case of this
Lfcmd that was given inemtw oboe-many years ago at Shajehan-
r ’itdtnbr that very shaky subject, the then Rajah of Puwaine,
near Moradabad. This man behaved so badly to Mr. and

Mrs. Probyn, Mr. Edwards, and others, in the early crisis of
that outbreak which threatened the stability of our supre¬
macy. in Indio, that -ha only escaped the halter by the skin
of his teeth; and being at this time on his best behaviour,
he cende8Qnndad so far: as to pay court eyan to me. .This
iwaibowtdieinteTview between mwaa brought abcut, and this
Was-the-medium-through) which J obtained these- particulars.
-djOneSdekaya syce (grown), was* while in:tfae ; 8eryice of this
petty Chieftato; in! putting his Master 7 * l*ng-single-barrelled
pistol)into his left nblster, done to death-in this wise;, The
Cdgo of this bolster—a Coarse! native one—‘having caught
the! cock of the pistol while the latter was descending into
it, forced it back and so “-set", it, - Seeing Ibis, just as he
had mounted, the Rajah endeavoured, to replace it in its
proper (position and thus caused the pistol to explode. The
syce* who was at--thief critical moment standing by his
horse’s head, or rather Who was-adjusting the stirrup to his
tnaateafs shoe, whs-just in. the position to receive the con¬
tent* of ‘this > weapon, .Accordingly,-after grazing /the back

724 The Lancet,] MR. W. CURRAN: SURVIVANCE AFTER GUNSHOT WOUNDS OF HEART. [April 9,1887.

IPtw

of his right hand and passing through the metacarpal bone
of the thumb and index Anger of the left hand, it emerged
through the soft part of the palm of this member without
further injury to any of its tissues. It then entered the
chest between the fifth and sixth ribs on the left side, two
inches and a half to the right of and one inch below the
left nipple, and then finally made its escape lower down
between the eleventh and twelfth ribs of the opposite side
posteriorly. Beeka survived this injury for nearly fifty-
two hours, and then died quietly of internal haemorrhage
and exhaustion.

A necropsy, that was instituted by, I presume, a native
doctor three hours afterwards, disclosed the following ap¬
pearances, and I may here add that I have notes of a very
similar case that occurred at an election in Ireland several

Fia. 2.

A, The aorta. B, The bullet. C, The pulmonary artery. D, Ait of the pericardium.

years ago. In this instance a Captain King, who was
accidentally shot by his nephew in a crowd, appears to have
been at the time in a kneeling or crouching posture, for the
medical man who examined the remains found that the
ballet, which entered the chest on a level with the nipple of
the right breast, “ extended inwardly in an angle of thirty-
five degrees down to the heart,” and it was afterwards
shown that though the two chambers of the heart bad been
pierced, yet that Captain King “ did live and walk after he
nad received this 1 wound.” . ,

On removing the integument* of the obsaty it was found
that after this ballet had! tarad ttm ebaatr aa thorn* it
tfatf darned and attghtfcMwwmMfei

isonr* cl-.

Sii i NBpS BS

rough

the diaphragm to the left of its crus, it grazed the stomach,
and Anally escaped from the body in the interspace already
indicated.

Passing now for a moment to that valley 1 which has
been the scene of so much chaoge and contention, so much
anarchy and bloodshed in the past, and which has also wit¬
nessed the curious case I have already adverted to, I must
premise, by way of introduction to this, that blood feuds,
the heritage of ages and the scourge of families, have ever
been rife in it. So envenomed has this custom become
that every village in it had once its watch-tower, whence an
armed band guarded the growing crops, and whence also
the armed herd or ploughman went forth to tend his
flock or turn up the soil. So inveterate was it at one
time, or may be still, that, as Dr.
Bel lew observed, the very cattle
of opposing tribes or factions are
afraid of one another, while the
children crawl cautiously by the
walls of their houses, rather than
pursue their frolics in the open
field. The atmosphere of the place
savours, in short, of distrust and
suspicion; every office or relation
of life is imbued or embittered with
them; and it was in one of these
village feuds that the case occurred
which I have more than once
already indicated, and with which
1 will now close this series.

A man named Meera Khan was
tried in the Court of Sessions at
Peshawur on September 16th, 1873,
before Mr. Elmslie, for murder,
under the following circumstances.
Blood feuds, handed down from
generation to generation, are, _ I
may observe, not uncommon in
this locality. A native named
Kadir, having been shot while
lying on his cot on the night of
June 2nd, 1873, made a dying
statement before witnesses to the
effect that Meera Khan had shot
him while Muddut, Meera Khan’s
brother, was standing by. The
motives for the perpetration of
this crime were revenge and
jealousy, and the polioe-serasapt
who arrested the prisoner “ round
him lying on a bed in his house.
He had his payjamas (drawers)
drawn up for an inch or two.,. - .
I at once put my hand on his
heart,” continues the sergeant; “it
was beating perceptibly. I said,
‘Why is your heart beating?’ He
replied that he had come in from
work tired, and had therefore lain
down with his trousers slight^
tucked up, and he added that
heart was beating because I had
arrested him. 1 then told him that
he was charged with murder.”
The sub-assistant surgeon who
examined the body deposed to the
presence of two bullet wounds in
the heart, and Mr. Elmslie, in
summing up, paid, “ Prtma facie, there is sufficient evidence
before the Court to show that the wounded man did
denounce his assassins just before he died . ...hut,
judging from the evidence of the sub-assistant
it seems extremely doubtful whether the accused
have spoken after his heart and left long h*4 been
perforated in four places.”

The following is a verbatim et literatim
ficate. of death that was given in the oase by
here referred to: “ I, Clietun Shah, sub-aa
of Peshawur, on the 2nd of Jane, saw Kadjx
He bore4he mark of a bullet in the right !

of the cocti-

>*ubordina£h

'' 1 For Additional Information about thla

'fetobyrfhe., m« my paper on Peafaawur 1_

.xeiZuki Aimidaof MediodiScience for July, W*.

T^bLanojst,] MR. W. CURRAN: SURVIVANCE AFTER GUNSHOT WOUNDS OF HEART. [April 9,1887. 725

of the hand was black. Two bnllet wounds were apparent
on the left side, on the side of the heart, which organ they had
penetrated. The heart was, in fact, wounded in four places,
from which he died immediately. His shirt was burned,
nnd these bullets must have been fired from very near.
There must have been two shots, no more, from either a
double barrel or a single barrel.”

While putting the evidence before the assessors, Mr.
Elmslie said that Chetun Shah “ wrote on the 2nd of June, j ust
after inspecting the body, that death must have been instan¬
taneous.” Mr. Shah, however, slightly modified this opinion
subsequently, and said that “ death must have occurred very
shortly after the infliction of the wound ”; and a medical
man who was referred to in the matter said that “the
phraseology describing the nature of the wounds is so
vague, that it is impossible to base an opinion thereupon as
to the power of the deceased to have recognised his assailants,
and to have spoken after the infliction of the wounds.”
The point then turned on the possibility of the deceased’s
‘‘living for some minutes and speaking intelligently or
recogmeing his assailant.” The certificate (covering letter 3)
given by the sub-assifetant surgeon on the 2nd of J une runs

as follows: “-begs to report that the cause of death

in this case was a bullet wound passing through the right
hand front wall of the chest, heart, the left lung, and
the chest wall on the other side. Four bullets that have
been found embedded under the skin of the chest wall
are herewith forwarded. Death must have been in¬
stantaneous.”

This functionary added, in another examination that was
held before the magistrate, that the heart itself was perforated
in two places: “ I do not mean by two bullets, but by four,
as the marks of entrance and exit were visible in four places.
Two bullets had entered the right auricle and two had
entered the right ventricle. The bullets went direct through

Fig. 3.

The«e alas* or bullets weigh between them 11 drachms and 48 grain*.

The largest of them weighs 3 drachms and 56 grain*.

the heart, and not in a slanting direction through the fibres.
The edges of all the bullet wounds were ragged to some
extent, not quite sufficient to close the openings. The peri¬
cardium was full of blood, and the cavity of the chest on
the left side was also full of blood. The left lung was per¬
forated, but this would not affect the power of speech
immediately.” There appears to have been some confusion,
if not contradiction, in these statements, but for this I am
in no wise responsible. I give the particulars of the case as
they were given to me. (See Fig. 3.)

^Paraphrasing Mr. Shah’s evidence, the magistrate con¬
tinues to say that “ it does not seem impossible that he (the
deceased) could have spoken after he was shot, but it is not

C bable. There are instances of men having lived for some
irs after having been shot through the heart, and the
lacerated edges of the wounds in this case may, to some
extent, have impeded the escape of blood from the heart,
ud so prolonged life to some extent. It is quite impossible
that deceased could have carried on a lengthened conversa¬
tion, but it is qnite possible that he may have said a few
▼ords. The wounds would not affect his power of speaking
intelligibly, supposing that he was able to speak at all. I
have no doubt that he was able to open his eyes after he
*as shot, but whether he was able to recognise his assailants
nr not would depend entirely upon the amount of light.
With regard to the word ‘instantaneous’ used in my
docket, I merely meant that death must have occurred
«pe«diiy” * i,. j i j j,. ........ ; ■

xThe acting civil surgeon, Dr. Andrew Skeen, 8 endorsed
opinion in the main, and otherwise delivered himself in
'Mia matter as follows:—“I have heard the statement of
«ib-assistant surgeon Chetun Shah, and concur with him.
*tt the case of a wound of the heart in cases where the

. 4-nuui.i-iUi j, .i uilJrfj ,’jm /If:, “

_rjpnttenwm and reiy promising oWeer died, I rejrret to

f, flnoe I left India; and as regard* further examples of this lesion,

■ BoQeau kindly Informed me. In 1879, that " there are enlr three
“ (than the above) oases .of heart wound at HjeUey : A 1*6, no
ventricle; and A113, surface -wogpd.” . ; i,

shock is not tbe immediate cause, death usually occurs from
the escape of blood into the pericardium, thereby impeding
the heart’s action; but in this case, from the evidence of the
sub-assistant surgeon, it would appear that the flow of blood
was to some extent retarded by the jagged edges of tbe
wounds. The bullets moreover—which are before me—are
small. I think it possible that the man may have given in¬
telligent answers for a short time after he was shot—a very
short time. Several cases are on record where severe
wounds of tbe heart have not been followed by death for
some hoars, both gunshot wounds and stabs. Dr. Taylor
quotes oases in which men shot through the heart have lived
for some hours.”

The assessors, Ram Dos and M&hrdil Khan, were of
opinion that, according to the evidence, both the accused
are guilty. They think that the deceased was able to take
the names of his assassins, and that he probably saw them.
The judge, Mr. Elmslie, after reviewing the evidence, which
he considered conclusive against the accused, held: 1. That
the deceased immediately on being wounded denounced
both of the accused, and said that he had seen them. Also,
that there is no reason to suppose that he spoke falsely.
2. That one of the witnesses, Sheemo, saw the accused
retreating from the bedside of deceased immediately after
the shot had been fired. . 3. That Muddut came up shortly
afterwards. 4. That the state of his clothes (Meera Iv'ian’s),
and the beating of his heart, are strong grounds fur sup¬
posing that he had been running shortly before. He then
sentenced Meera Khan and Muddut to be hanged, and ordered
that their property of every description be confiscated under
the provisions of Section 6, Indian Penal Code.

An appeal having been lodged against this decision by the
friends of the accused, the case came before the judges of
the High Court at Lahore, who reversed the sentence men¬
tioned above. Mr. Lindsay, who re-tried the case, acquitted
both prisoners on the merits; and, after giving his reasons
for this judgment, wound up the statement he made respect¬
ing it by saying that “ the deceased’s death was very sudden
from the very nature of the wound inflicted, and it is open
to doubt whether be spoke at all after being shot. He may
have uttered a cry.” And there the matter ended so far as
the legal authorities of that province—the Punjaub—were
concerned. I will only here add, that the first judgment
was, in my humble opinion, the ju9ter of the two, and
it accords with my own personal experience and reading,
that wounds of this kind are by no means so speedily or
necessarily fatal as is generally supposed.

Bibliography—To save time ana space, and enable any
reader who may desire to pursue this inquiry further to do
so, I subjoin below a list in alphabetical order of the books
or papers on which this essay is based, or to which more or
less reference has been made in the course of it:—Army
Medical Department Reports for 1873, vol. xv., p. 286. Art.
“ Heart,” in Todd’s Cyclopaedia erf Anatomy and Physiology.
Barrington (Sir Joflah): Personal Sketches of his Own Times,
vol. i., pp. 303-4. BtSllew (H. W.): Journal of a Political
Mission to Afghanistan in 1857, &c. The Book of Remark¬
able Trials and Notorious Characters, p. 363. Clark (F. Le
Gros): Lectures on tbe Principles of Surgical Diagnosis,

S . 247, &c. Chelius, translated by Sooth, vol. ii., p. 96, &c.

hevers: A Manual of Medical Jurisprudence for India, and
also his Commentary on the Diseases of India, p. 487.
Dixon (Hepworth): Her Majesty’s Tower, vol. iii., pp. 226-7.
Holmes: A Treatise on Surgery, p. J95 (this contains a
good account of the symptoms that are produced by
Woutads of this description). Edwards (Sutherland): The
History of the Opera, vol. ii., pp. 190-3. Egan (Pierce);
Anecdotes of Persons in every Walk of Life, d. 130:
he quotes with surprise from the Edinburgh Medical
Journal of the day the “ Singular circumstance of a ball
that wte lodged .(for a long period without injuring tbe
afiitqal) in the heart of a buck.” Elphinstone: Cabool..

***“-ta Phyeiologiee. Howell: Familiar Letters.

I df England, vol. v. f p 78, and vol. vi.,
tiujl*ifH Annals of Medical Science for
Y* 289 1 -296; in this instance the ball
e heart through one of the pulmonary
even, and Burton Browne could in no
itj for this phenomenon. The Journal of

. ^ . Jiiology, vol. xx. James. Major, 11.R.C.B.:

Report on the Settlement of the Peshawar Valley (the best of
its time),p. 5, &C. Philip (A. P.W. Wilson): An Inquiry into
the Nature of Sleep and Death, pp.68-9. Porter: TheSurgeon’s
Pocket-book. Taylor (Swaine), M.D.: Medical Jurisprudence.

Haller :E1

f GUUJ t Dr.
other wtfy *

Ariatoifiy aha.

726 TBJS lANCKTj Dk ll/lCOCffS^ BAdTEJltldBOOrOAL' WATER IfEST.'* ;! [Arlttt'-ty'MBfci

Transactions of the Pathological Society of London. Trans¬
actions of the Provincial Medical and Surgical Association,
vol. ii n p. 357; in this very singular case a lad in whose
right ventricle a piece of stick (the breech of a toy gun) was
found lived upwards of five weeks. Veron: Les M6moires
d’un Bourgeois de Paris, vol. ii., pp. 147-1GG. Woodman and
Tidy: A Handy-book of Forensic Medicine, p. 1143, who
give Several cases of this kind from Bell, Sanson, Ollivier,
and others.

DR. R. KOCH’S BACTERIOLOGICAL WATER
TEST.

By Q. BISCHOF, F.C.&, F.I.C.

No. II.

In Thk Lancbt of August 29th, 1886,1 communicated a
description of Dr. Koch’s test after a visit to his laboratory.
Since then some not inconsiderable material has been col¬
lected, partially the result of practical experience with the
method by various experimentalists, partially of inquiries
into its reliability; and it now appears appropriate to review
the present position of the test.

As a matter of course, only such organisms can be indi¬
cated by it as will grow under any conditions whatever in
gelatine peptone; secondly, only such as are not crowded
out during culture by other microphytes; thirdly, such as
will develop, generally speaking, within three days before
the liquefying colonies have had time to overgrow the plate;
and, fourthly, such as will grow at the temperature of
culture. With regard to the first of these propositions,
Dr. E. Klein stated in the discussion of a paper read by me
last April on the subject before the Society of Medical
Officers of Health that, for instance, a micrococcus which
commonly occurs in our saliva absolutely refuses to grow
in gelatine, and that in one case, where another yielded
160,000 colonies per cubic centimetre, the gelatine-peptone
test only indicated some 5000, or about 3 per cent, of the
former figure. He graphically explained the crowding out
during culture of gelatine-peptone plates by stating that it
was impossible, in mixed cultivations, nine times out of ten,
to recover any pathogenic microphyte, however familiar.
The organism of foot-and-mouth disease would only grow
in this medium when no other forms were present; and
even Dr. Koch’s comma bacillus was soon crowded out
by Finkler’s, by the bacillus of anthrax, or by that
which caused the conversion of urea into ammonia. The
meaning of this is, that if in a bacterial mixture there
exist some microphytes that grow fast and others that
grow more or less slowly, the former will in a short
time have, so to speak, taken possession of the available
ground before the latter had time to take a footing. We
Have evidence that at least some pathogenic microphytes
are likely to be amongst those crowded out, and will thus
escape detection. Even after colonies of different micro¬
phytes have established themselves on the same plate, they
are apt to engage in a fight for supremacy or existence like
the most highly organised beings. 1 may add, from my
experience, that Dr. Koch’s comma bacillus, after keeping
for five months at 18° G. in plugged test-tubes in gelatine
peptone, bad entirely disappeared from its pure cultures.

Dr. Koch has not, as far as I recollect, laid down a very
definite rule as to the temperature at which eamples should
be cultivated, but in view of the fact that these cultures
were made in his laboratory during my visit in the Bummer
of 1886 in a basement room, without artificial heat, I
adopted 18° C. The mixture reoommended by Dr. Koch
just commences to soften at this temperature, whilst even
at 20° it is rather too liquid, and apt to give trouble.. I am
informed that a 10 per cent, gelatine-peptone meat extract
(not infusion) may be prepared, which remains solid at 20°
or 21° C., but that also this temperature is insufficient for
the cultivation of a variety of microphytes must amongst
others be concluded from M. Nocard’s communication to the
Central Veterinary Society of Paris, that the bacillus tuber¬
culosis of birds requires as many as 38° C. for its culture.
Such a temperature is obviously out of the question when,
employing gelatine peptone^ Lastly, as regards tbe time 6r
cu&qpe, it is unfortunate that the liquefying colonies
ganmlly. render distinction of colonies impossible after two
or three days’ culture. We are thus left in ignorance on

microphytes which take longer to develop, as for instance^'
according to M. Nocard, the bacillus tuberculosis of birds,'
the culture of which does nqt commence until the fifteenth'
day, and requires five or six weeks for full development. 1
The organism of the disease which prevailed at Hendon m the 1
winter of 1884-86, Dr. Klein has informed Us, could be 1
cultivated in gelatine but very slowly, and that of foot-and-
mouth disease took many days to grow. The more weight,
should be attached to these considerations as the gelatine
test is now mostly restricted to a statement of the number 1
of total colonies. Why are those other subsidiary bat im- 7
port&nt tests neglected which,’ as described in my first 1
article, were originally recommended by Dr. Koch ? Is this-*
because the number of total colonies has in itself proved a
sufficient indication in testing potable water, or because;
those methods failed to answer tneir purpose?

The question next arisen, even if we obtain a mote hr less 7
reliable figure of the numbers of colonies cultivated from &
sample of water, what are we to do’with it, how are we to-
interpret its teaching ? In the paper read before the Society *
of Medical Officers of Health I arrived at the conclusion
that the test affords no means of distinguishing between '
harmless and pathogenic microphytes, and that the number
of colonies ordinarily found in water has neither a neces- f
Baxy or invariable connexion with wholesomeness, nor even
with pollution. A sample may contain as many colonies as
any potable water is likely to contain, and yet I think I
proved in the paper referred to that on this account it need
not in any way be injurious to health. Dr. Koch is of the
same opinion, for he asks in one of his papers (1883) -
“Shall w6 declare air, water, or soil, per sc, injurious
to health if they contain a large number of microphytes?
This, in my opinion, should not be attempted. We have
not as yet succeeded in discovering amongst the many
bacteria, which abound in the air, soil, and water, any
pathogenic species.” After this I confess it is not quite
intelligible to me that we should be asked by him in
the same paper to style a sample of water “very good,” -
because it contained about one hundred colonies per cubic
centimetre. In this difficulty the plea is set forth that,,
although the test may not yield absolutely reliable results
by the indication of the number of microphytes present,
the comparison of the number of total colonies cultivated
in samples of unfiltered and filtered water affords a correct
standard of the sanitary improvement effected by tbe filtra¬
tion, because a reduction of a certain percentage in the-
total would similarly reduce tberiek of introducing-into our'
system'any pathogenic microphytes which may have gained
access to 'the source of water-supply. This seems equiva¬
lent to the admission that the test is incapable of giving
information on any single sample, but that its scope ia-
restrioted to an indication of the relative improvement-
which may take place in a sample consequent to its purifica¬
tion in some way. Without any absolute standard, even this-'
does not appear an easy task, for with a like number of.
colonies in two filtered samples, the improvement may in
one case be judged very satisfactory and in another less so,
the difference, however, being solely due to the worse con¬
dition of the unfiltered sample in the former case, v - j .!•

Let us follow this up by a practical case. Both ’ Dr.’ P«
Frankland and I independently arrived at the conclusion on
the showing of the test that a variety of filtering media*
given a suitable grain, depth of material, and rate of filtra¬
tion, are capable Of producing a remarkable redaction in the-
colonies, but that tho action of spongy iron alone is lasting.
This seemed so well to confirm the results previously ob¬
tained in a different way by Dr. de Ohaumont, Professor E.
Hey man, Mr. Frank Hatton, and myself, as almost to amount
to a corroboration of the reliability of tbe test. I am
afraid we can only accept this as a chance. Again, Dr,
Frankland and I published for many months independent
monthly reports on tbe effect of Sand filtration on the
metropolitan water-supply, and our figures once more
agreed very satisfactorily. I thought right to discontinue'
my publications when the faith 'which I bed at first in the
teaching of these figures began td be Shaken ; Dr. Frankland
still continues "his in the water examiner’s monthly reports.

How are we to explain a' purify ibgaction of sand? 1
am not' aware of any evidence to 'Show that this coni
essentially consist in anything but a mechanical separation
of microphytes. Not one of the khown meajiaijOf destroy* 0 ?
them can be supposed to exist ip'^^,^t^^<?rowding
out will take place within them, but its result will only,
be the annihilation, more or less, of some kinds, those*

5

TkBJLijwttM!

HOgPTRAJb MEBIGWB’AND 8C WHOM

[Araiue.'lBOl 7tX

remaining flourishing somnohtbe more. Thin, therefore, does
not account for the destruction of practically the whole of
the microphytes present, which is frequently indicated by
the test here in London. Supposing we were to keep such
water as is in this case ordinarily passed through the sand
filters, in a sterilised glass -vessel, protected against aerial
contamination, its progeny'would.in.all probability in.a
few days amount,, on the showing of the test, to. millions
of colonies per cubic centimetre. Can we then understand
the teaching of the test that, when we pass the same
water month after month through a sand niter, it should
continue to come out almost devoid of organisms ? Even if
we store the filtered water with the few organisms
apparently left in it under like.conditions as before, the test
reveals in a few days thousands and thousands of colonies
by self-multiplication, but such water may pervade a sand
filter month after month without apparently any increase of
life. Again, we know that microphytes grow in a compara¬
tively short time, even throngh the fine pores of M. Pasteur's
filter tubes; that they then frequently renderthe filtered water
biologically more impure than the untiltered. How is it that
they should not grow through the much coarser pores of sand
filters, and that those disseminated through them should not
similarly multiply? Here we have a conflict of phenomena,
which should somehow be explained before tne teaching
of the test can be accepted without very considerable
caution.. I am afraid of attempting any such explanation;
but it is a biological fact that spores pass through filtering
media which are capable of retaining the fully grown
organisms. Supposing the latter were retained in sand
filters and the former did not develop in gelatine peptone
under the conditions of the test, the discrepancy would to
some extent disappear; but the numbers of colonies indicated
lose all meaning, as a sufficiency of spores might be in a
sample to produce serious pathogenic complications even
when the test indicated sterility.

I would further ask whether it is safe to argue that
because a certain proportion of harmless microphytes,
such as ordinarily occur in water, are mechanically
separated, a similar proportion of pathogenic organisms
would be removed ? Let us not forget that we know very
little indeed as yet about those pathogenic microphytes,
which spread zymotic disease by the medium of potable
water. The fact, for instance, that M. Pasteur has not suc¬
ceeded in detecting the bacillus of hydrophobia, notwith¬
standing that there seems to be reason to assume its presence
in certain liquids, leaves it an open question whether this is
not due to a deficiency in the power of our microscopes, or
to the diminutive size of the bacilli. I have no proof for
this suggestion in the strict sense of the word, but, taking
Dr. Koch’s statement, “these bacteria, which I have called
comma bacilli on account of their peculiar shape, are smaller
than the tubercle bacilli,” my suggestion is more likely
to be correct than the reverse—viz., that pathogenic organ¬
isms could neither in size, form, nor habits be distinguished
from non-pathogenic. If similar differences in shape as
above do occur amongst pathogenic microphytes in water,
some may pass through a sand filter which retains ordinary
bacilli, similarly, as Professor Helmholtz observed, that the
action of yeast did not extend through a membrane, whilst
putrefactive bacteria penetrated it.

No doubt great progress has been made during late years in
the filtration through sand, but it is curious to contrast the
showing of the gelatine test with certain experiments made in
1870.. in the thirteenth report of the Medical Officer of the
Privy Council, T)r. Burdon Sanderson gives a table from which
■we calculate the average “ zymotic property” of the supply
of the_ London companies before filtration t= 7‘8, that after
nitration (mean of samples from pump well and from main)
b«tag *8*1. T)r. Sanderson naturally draws the conclusion
that filtration exercises no perceptible influence on the
Sfmotic power of water. Even practical experience seems
opposed to the contrary teachipg of the gelatine test; for
how can we reconcile this Wlfh the experience at Lansen,
™e there was a more perfect natural filtration than is
attainable by artificial means, and Vet the morbific principle
pWsed through, causing an epidemic? Nevertheless, the test
should on no account be laid aside. If we bear in mind the¬
cae state in which it was first irttroduced in this country
no V years ago by the late Dri R. A. Smith, and tbe
>le improvement^ since effected by Dr. Kbeb, there
fearim to hope that, with perhaps slight modifl-
i.'rcttiat.irfet yield fill the important hygienic results
'i sanitary science must ardently desire.

The following conclusions may be.drawn fPoov tha pre-i
ceding observations. 1. The total colonies found by .cultural
in gelatine peptone do not represent r the total actually,
present in a sample of water, but an mdafiuite aliquot port
thereof. 2; The number of total colonies found does noty
within-a very wide range, justify the, rejection of a sample e
no more can a sample be relied on. isa { safe if ; very few
colonies only be indicated. 8. The test does not, as a rule,
allow of distinction between pathogenic and harmless
microphytes. 4. Pathogenic microphytes present in a
sample of water are apt to escape detection by being
crowded-oat by the organisms ordinarily, occurring in
water. 5. The relative' biological pmrifleSition'indBcatedfcbjrj
the test in samples of water after filtration, through sjwdr
is at variance with other well-known, facts, and should,
be accepted with caution. . ,

Bfiyswater, W.

trror ‘

HOSPITAL PRACTICE,

BRITISH AND FOREIGN...

i-.Jv:

■ l.lf

■ Ui.

Nulla autem eat alia pro certo nosceudi via, niti quaniplurlmas at mop-
bo rum et dfasecttonnm hlstorfas, turn ailornm tafn propria* colledUk
habere, et Inter ta oompawe.—HoaeAoai D»<6*L .at Cam. Mtrb^,
lib. iv. Proceingim. -

CHARING-CROSS HOSPITAL. *

A CASE OF SARCOMA OF THB LUNG FOLLOWING AMPUTA¬
TION OF THE RIGHT THIGH SIXTEEN MONTH8 ,
PREVIOUSLY; REMARKS.

\n

(Under the care of Dr. Pollock.)

Prom the characters Of the new growth in the lung in the
following case, it is assumed that it was secondary tx» a
primary growth elsewhere. The account whiqh is given of
the disease for which the limb was amputated does not
mention the presence of anything of the kind as present
then, but possibly the growth was very small in .amount,,
and thus its existence was overlooked. It would be in¬
teresting to have a full account of the part8 removed, with
a history of the disease before amputation. f 77 , ’' v \ ,, J :il >‘

A C-, aged seventeen, a timid, excitable, delicate^

looking girl, was admitted on Oct. 25 th, 188G. Her family
history was faultless, and her own health up to fifteen years
of age uniformly good. In June, 1885, after an illness of some,
months, she had her right thigh amputated at St. Mary’s
Hospital for suppurative arthritis following necrosis of the.
femur, due to periostitis.' Her recovery was complete, and.'
her health remained unimpaired until July, 1886, when she,
began to complain of pain in the left shoulder and left sidp.
of the chest. Frequent night sweats and gradual wasting,
followed. By the end of September she had become too
Weak to get about, and took to her bed. A week later cough
developed, and soon after expectoration of a “ dirty-looking
phlegm” was noticed* u. '». ;t, V /

On admission tbe patient; had a marked hectic flush, one
was perfectly conscious, and of average intelligence. She
complained of the pain before mentioned, and said that it
was now constant, and increased by deep breathing or by
any active movement. Her oough was sufficient to disturp
her at night, and there was a little dark blood-staihed sputum^
The upper half of the left side of the chest was enlarged*
and distended veins traversed its surface. The movement^
were diminished over the whole left side, and the prominent,
region Just mentioned was practically motionless, nor'could'
any vocal fremitos be obtained over it. The front part or
the ehsst, from the apex of the lung to the heart, was!
absolutely duH ; and the back, from, tbe suprarspinous fossa,
to the middle of the scapula, gave a similar percussion note.
Immediately below this the resonance was defective, down'
to the angle of tbe scapula; below this it was normal. The.
Meath sounds over the greater part of the dull areas were
almdst inaudible, but here and there distinct bronchial
breathing'could be recognised. Lower, down tfye breath,
sounds werd Weak, and at the extreme base normaL The
voice Bounds were diminished, but not high-pitched. The
right long was apparently healthy, its normal liqufe. maipp,

Dieted bv Google

1

728 Tbs Lancet,]

HOSPITAL MEDICINE AND SDBGERY.

[Apbil 9,1887.

tained. Nothing unusual could be detected in her voice,
but ou inquiry she said she had been unable to sing for two
or three weeks. The left vocal cord was found to be
stationary in the cadaveric position. The heart’s action was
fluttering, and the apex could not be accurately localised,
but seemed to be displaced a little inwards. The sounds
were clear. The pulse was weak, regular, and bilaterally
symmetrical. The digestive tract and the physical signs of
the abdomen were quite healthy. The pupils were equal,
and reacted normally. The fundus of each eye was healthy.
The pain was principally localised at the back of the
shoulder and at the elbow. Distinct soreness and tender¬
ness could be made out along the course of the brachial
vessels and of the ulnar nerve. The urine was normal. An
exploratory needle was passed into the swelling, but blood
only was obtained.

The pain gradually increased in severity. On Nov. 3rd a
difference was noted between the radial pulses, and on the
5th the left pupil was found to be slightly smaller than
the right. On the 15th the left forearm and hand became
(edematous. The other symptoms gradually increased, and
during the next two months the patient became continuously
weaker. The pain grew more intense, the enlargement
increased, hard glands were felt above the clavicle, and the
whole region became very tender; the inequality of the
pupils was also more marked. On Dec. 30th numerous
swellings scattered over the hairy scalp were noticed for
the first time. They were circular and regular in outline,
and varied in size from a hemp-seed to that of a small
walnut. The swellings were tender, painful, rather elastic,
and moved with the scalp. The patient thought they had
been coming for several weeks. They were certainly not
present on admission. On Jan. 14th she became restless and
talked incoherently. Unconsciousness supervened at 2 a.m.
on the 15th, and death occurred three hours later. Her
temperature during the first month was uniformly main¬
tained between 100° and 101°, but occasionally oscillated
from 98° to 104°. During the last six weeks the range was
from 99° to 100'4°. The physical signs remained unaltered
in character, but gradually increased in extent.

Necropsy .—The upper lobe of the left lung extended
across to the right side of the sternum, and consisted of a
solid mass of new growth. Below this the heart was
exposed as much as usual. The lower lobe of the lung was
the healthiest part. The right lung contained many new
growths, and tnere was half a pint of bloody serum in the
pleura. The left lung was removed with much difficulty;
the new growth in the upper lobe infiltrated the chest wall
largely, and extended up into the neck between the scalene
muscles, so as to press upon the brachial plexus and surround
the subclavian artery. The arch of the aorta was also
embedded in the mass, and several of the ribs were eroded.
On section the upper lobe of the left luDg was found to
consist almost entirely of the mass of new growth above
mentioned, which was degenerating in every part, and
exhibited numerous cysts. One part at the anterior border
was much harder than the rest, and was ossified or calcified
to a slight extent. In the lower lobe there was one nodule
the size of a Tangerine orange, soft and undergoing degenera¬
tion. The lower lobe of the right lung consisted in great
part of new growth, which broke down on removal.
Several smaller patches were scattered throughout the
lung, most of them being soft, but one near the anterior
border of the upper lobe was hard, and appeared to be
ossified in about half its extent. The left leg had been
amputated at the middle of the thigh. The stump was
(Juite healed, and appeared to be some months old. Its end
Was swollen on the posterior aspect, and the swelling was
very elastic and fluctuating. It was found to be a blood
cySt. The bone was nicely rounded off at the end, and 4
roVer^d posteriorly by a thin layer of sarcomatous tissue,
fihthe skin over the scalp were some half-dozen nodules of
heW growth, two of which had reached the scalp and
rftolfetrated it; one of them, close to the longitudinal sinuaj
nftd penetrated the bone to the dura mater, near which iiJ

commenced in the stump subsequently. Nothing beyond pal¬
liative treatment was available, and the poor girl was kept
fairly free from pain by the use of morphia hypodermically.

LEICESTER INFIRMARY.

ABDOMINAL SECTION FOB INTBBNAL STRANGULATION;

FOBMATION OF ARTIFICIAL ANUS; FAILURE OF PLASTIC
OPERATION ; BNTBRKCTOMY ; CURB ; BUM AR KS

(Under the care of Mr. C. J. Bond.)

A H-, aged twenty-two, was admitted on Jan. 7th

with a history of intestinal obstruction lasting five days,
coming on suddenly with pain in the hypogastriumand vomit¬
ing. The abdomen on admission was considerably distended,
and peristaltic waves could be detected at times in the dis¬
tended coils, though no localised swelling or tumour could
be felt. The vomiting was feculent, and the patient’s general
condition very critical. Abdominal section was performed
the same afternoon, by an incision large enough to admit the
hand in the linea alba. After some search and the drawing
out of a long length of contracted bowel, a fibrous band waa
found passing across between two contiguous surfaces of
mesentery, and forming a ring, through which a coil of
intestine had passed and become strangled; this band was
divided between two ligatures, thus partially relieving the
strangulation; the distended bowel, however, was very firmly
adherent to, and dragged strongly down by, this band, at one
point, and in gently separating the two the gut gave way.

Diagram of relation of parts, a a, Abdominal wS.Ua. '
b b. Intestine, c, Spur. i> r>. Line of Incision tthe- ■'
plastic operation, e, Adhesion*, f, Indlarnbbtr tabe .,
a. Mesentery.

The brain was quite normal. i<tj*4idaia

some feculent fluid escaping into the peritoneum. As the
gut seemed very distended and paralysed, and the Opening
difficult to close, the intestine, thoroughly freed, WSS drawn
up to the upper angle of the abdominal incision; the opening
in the bowel was then enlarged transversely across thS etft,
and a large quantity of feculent fluid and gas (dloWeS tb
escape. The intestinal coils and peritoneum were tMfoflfcrth
fully sponged with warm boracic lotion, and the AbdOhdail
wound closed, except at the upper angle, where thehfttnMMa
membrane was stitched round to the skin and a false Anas
formed.

The patient rapidly improved after the _

were no signs of peritonitis, and the abdominal'ji.
soon subsided. It was soon found, however, as
pected at the operation, that the opening was h
{jejunum, and bile and semi-digested fluid foe

£ >ured from the opening over the abdominal
cision, excoriating the skin; yet it was rema#

•with the-exception of some ulceration round th*j
wound healed fairly well. The general wastT
Bras so rapid that on Jan. 15th, eight days after (
jfkreatment by indiarubber tubes was comi
{rubber tube (see f in figure), with a stri
Centre, was pushed into the intestine either 1

£Dr. Pollock.—T he nature of the'grewfchisn
diagnosed very early. It wasd

secondary, but it was diffloult'flit could be slipped entirely within the gU
lofmiachiSf.. Had the leg bee*; "* ’ *

i would have been plain*
otatM b» obtained*

to Remain in position; tubes of various
were tried, but the beet result wSt obtah
mrai tube of four inches, in lengttCahiT

inch, folded lo:
opening, and then

Digitized by

\£Lf.

Th* Lancbt,]

CLINICAL SOCIETY OF LONDON.

[April 9,1887. 720

and food were more or leae passed onwards, though at times
the tubes became blocked or displaced. As it was evident,
however, that the opening under this treatment would not
close, and the patient suffered from loss of nourishment and
excoriation, an attempt was made to close it by a sort of
plastic operation on Feb. 5th. An incision was carried all
round the opening at the junction of the skin and mucous
membrane, and carried down between the intestinal and
abdominal walls, as seen in the dotted lines (d d) ; the freed
edges of bowels were then inverted and their opposing outer
surfaces carefully sutured by numerous interrupted catgut
stitches, and the opening in the intestine thus closed by a
more or less linear row of sutures; the abdominal walls
were then slightly freed, and slid together and closed over the
intestine. As the adhesions (a a) between the intestine and
peritoneum were not divided, the peritoneal cavity was not
opened. The patient was fed by injections, and for two
days the parts looked well, but on the second day a little
bile oozed through, the stitches soon gave way, and in a few
days the opening was as large as ever. The indiarubber
tubes were again introduced for a fortnight in order to allow
the opening to get into a healthy condition, and the patient,
who had become very emaciated, to gain strength.

On February 16th, having previously ascertained by the 1
finger, introduced through the opening, the direction of the j
two portions of intestine and the extent of the spur (which
was found to have been considerably reduced by the
pressure of the tubes), the abdomen was again opened
in the mid line, just above the artificial anus, and the
finger introduced. In this way the extent of the adhesions
of Intestine to the parietal peritoneum was ascertained and
found to be considerable, involving from an inch and a
half to two inches of the intestine around the opening;
the bowel was then carefully detached from the abdominal
wall all round at the junction of the skin and mucous
membrane, and the whole coil of intestine, some eight
inches, freed and drawn out of the wound, the opening in
the bowel being carefully closed between the fingers. The
intestinal wall was seen to be much thickened and rough on
the surface from divided adhesions. The opening extended
transversely across the gut for three-fourths of its circum¬
ference, bub did not involve the mesenteric border; it was
large enough.to admit three fingers. The contiguous lengths
of bowel, passing to and from the opening (bb), were adherent
and more or less parallel in direction; these were freed as
much as possible, so as to bring the intestinal channel into
a line. The old margin of the opening was now cut away
with scissors, and the suturing commenced. The mus¬
cular coat being retracted by the finger-nail, the mucous
membrane only was first united by a continuous silk suture
in its whole extent; the muscular and serous coats were
then inverted and their opposing peritoneal surfaces united
by interrupted fine silk ligatures passed on each side through
the two outer coats and then drawn together, an ordinary
straight round sewing-needle being found most convenient.
In addition some sutures were passed beyond the limits of
the actual opening in the gut, which was thus firmly closed
by about twenty or thirty closely placed stitches. The peri¬
toneum was then carefully sponged, the coil of intestines
returned free into the cavity, and the abdominal incision'
closed except at the upper part, where a drainage-tube was
left in over the bowel, so that if escape occurred the fluid
might find its way out of the peritoneal cavity. This after¬
wards proved important.

The operation lasted two hours and three-quarters. The
P&tient was allowed nothing but water and opium for five
aays. Nutrient enemata were then commenced, and pepto-
nised beef-tea was given by the mouth on the tenth day after

^ fion. A discharge of pus occurred through the track
s drainage-tube on the second day after the operation,
and on the fourth a little bile appeared. This occurred at
intervals until the tenth day, when one of the silk intestinal
■fitches came away. The discharge now rapidly ceased, and
the abdominal wound closed a few days later. The patient
now began to take food, and rapidly increased in weight.
No sickness occurred, and the bowels were moved by injection
°n the twelfth day. The temperature was generally sub-
nonual throughout.

Remarks by Mr. Bond. —There are not, I think, many
forded cases of artificial anus in the jejunum formed by
the surgeon in the middle line, and then treated by abdo-
“tnal section and suture of the boweL Most of the published
have been secondary to strangulated hernia and
®«uted in the groin, and the majority are examples of fseoal

fistula rather than artificial anus, in which the mucous
membrane is continuous with the skin. No attempt was
made in this case to close the opening in the bowel at the
first operation, as it was thought that a free opening into
the distended intestine would give the best chance of life.
If called upon to treat a similar case, I should enlarge the
opening in the intestine in the direction of the axis of the gut,
and not across it, as, theoretically, that course, by keeping
the intestine more in a line, should reduce the formation of
t he spur. The introduction of large-sized indiarubber tubes
(suggested, i believe, by Mr. Banks) in cases such as this
is a point of some importance. They appear to act in two
ways: by their tendency to straighten after introduction
they tend to prevent the excessive doubling of the intestine
on itself opposite the opening, and by elastic pressure they
reduce the projection of the inevitable spur; also by allow¬
ing the passage of bile and food into the intestine below
they help to keep that in a normal condition and also sustain
the patient. They seem to be especially applicable to cases
of opening high up in the bowel, where the fsecal matter is
very fluid and the bile flow excessive, and should, I think,
be introduced and worn if possible for some time before any
operation for closure of the opening is undertaken. The
plastic operation, which was really a turning in of the intes¬
tinal coats without freeing them from their adhesions to
the abdominal wall, and was somewhat like that reported
by Dr. Duncan in Thb Lanckt of July 6tb, 1873, failed
because there was too much tension on the intestinal walls.
The last operation was undertaken with some anxiety, as
the mortality according to Mr. Treves is nearly 40 per cent.,
but the patient unless relieved must have eventually died a
miserable death from starvation. A great deal here depends
no doubt on the way in which the sutures are applied, and
it seems especially important to stitch the gut beyond the
mere limit of the opening in order to firmly close in the
puckers or gutters which are left at the angles. Doubtless,
too, the fact that it was not necessary to divide the mesentery
‘ and so interfere with the blood-supply tended to a favourable
result. It is also important to get the bowel into as direct
a line as possible, thus reducing the angle or bend in the
continuity of the tube. I think the slight escape of bile
after the operation, with the throwing off of the intestinal
stitch, must have been due to the fact that at one point the
intestinal coat was very thin, having been injured in detach¬
ing the strong adhesions binding Ft to the abdominal wall;
one more stitch worked its way out without any escape of
fluid some three weeks after the operation. I should feel
greatly obliged if any reader of this case would direct my
attention to any list or statistics of cases of a like kind.

jjtoi ntl Soci eties,

CLINICAL SOCIETY OF LONDON.

Inherited Congenital Deformity of Hands and Feet .—
Psoriasis, Pityriasis, and Rheumatism. — Symmetrical
Gangrene following Varicella.—Intussusception produced
by a Tumour.

An ordinary meeting of this Society was held on the
1st inst., Dr. W. H. Broadbent, President, in the chair.

Mr. R. W. Pabkbb and Dr. fl. B. Robinson read notes of
a case of Inherited Congenital Deformity of the U&uds and
Feet, in which a plastic operation had been done on the feet,
the patient being a child aged three years and a half. The
two inner toes were coalesced into a single great toe, and
the three outer toes were similarly united into a little toe;
the coalescence extended in part into the metatarsal bones,
and there was a wide and deep cleft between. The operation
consisted in removing the skin from the contiguous parts
of the cleft, and then uniting the edges after the toes had
been pressed together. A more shapely and sightly foot
was thus obtained. The child was one of several who
suffered from a similar deformity, and her mother, herself
affected, feeling the inconvenience of such a foot, bad taken
her to the hospital to see whether something could be done
to remedy the defect. The authors showed a family tree,
from which it could be seen that the deformity affected
three generations. The first to suffer was the child’s grand¬
mother, and of thirty-six lineal descendants sixteen were
malformed; the malformation was perpetuated through the

730 Th 3 XiAMOBt]

CLINICAL SOCIETY OF LONDON.

[Aran. 9,1887.

female branches of the family. It was singularly uniform in
its manifestations, and wag attributed originally to a’fright.
The patientand several membersof her family were exhibited.

> Sir Dyck Duckwobth read a case of Psoriasis associated
with Rheumatism, which passed into Pityriasis Rubra
(Dermatitis Exfoliativa). • P. A-*-, aged twenty-four,
married seventeen months, mother of a child which she
suckled for four months, was admitted into St. Bartholo¬
mew’s Hospital on Nov. 14th, 1886.. She was suffering from
well-marked and ordinary psoriasis, which had lasted five
'months, and from rheumatic pains in most of. the joints.
Ten and five years previously she had had attacks of
psoriasis, lasting four or five months, each accompanied
with rheumatic symptoms, as at present. She lived at
Stratford, on the ground floor of a damp house. The joint
pains preceded the outbreak of psoriasis. When a child
she had rheumatic fever. There was no known family his¬
tory of' rheumatic fever. She was a fairly well-nourished
woman of ■ slfender build, complexion pallid, hair light-
brown. The heart’s apex was displaced outwards, and a
systolic apex fiuirmur was audible. Nothing was found amiss
with any other viscera. Urine contained a trace of albumen.
The whole body was covered irregularly with patches of
soaly eruption, the erythematous areas around them being
very wide. There was less of the rash on the face and neck,
most on the abdomen. There was pyrexia, temperature
varying from 100° to 103'8° during her stay in hospital, with
nightly rises. The digestive system was not much disturbed.
Urine acid; sp.gr. 1023 ; it contained very often a trace of
albumen, and sometimes abundant urates. Catamenia
regular since the birth of her child. At the time of admis¬
sion to hospital the psoriasis was beginning to pass into a
general desquamative dermatitis, and rheumatic symptoms
were increasing in severity. Milk diet was ordered. To have
an alkaline bath on alternate nights, and olive oil to be
rubbed in all over the body. Fowler’s solution in four-
minim doses in an alkaline tonic mixture was given thrice
daily. The appetite increased under this treatment. The
pain grew worse, and the temperature kept up. Effusion
occurred in some joints. Sodium salicylate was next given
to the extent of a drachm daily. Soap-and-spirit lotion was
ii3ed to remove the hard scales from the scalp, and lini-
mentum calcis to the body generally. No improvement
followed from the salicylate treatment, and the temperature
was unaffected by it. The skin was now universally affected,
and cast off handfuls of scales. The rheumatism was severe,
and the patient became very ill. She begged for meat and for
better diet than was thought fit for her. The salicylate was
increased to eighty grains each day, and sitz baths given
instead of alkaline ones. Joints of legs and arms very
painful. Hypnotics required at night. In the third week
after admission, the plans of treatment hitherto having been
unavailing, a change was made, the qitino-alkaline draught
being given, and oleate of zinc ointment applied. Mashed
potato and custard pudding added to diet. The skin im¬
proved somewhat after this, hut still desquamated freely.
Temperature still pyrexial. Joints improved. No fresh
cardiac troubles came on, but “hfemic" basic murmurs de¬
veloped. Within ten days the morning temperature began
to reach normal, but the evening rise was nearly 102° on
several occasions. On Dec. 11th arseniateof sodium in fifteen-
minim dose3 was begun, and full meat diet was given. In
a few days there was very decided improvement in respect
of the skin and joints, but the temperature continued high,
reaching its highest point, 103‘8°, three nights after begin¬
ning this treatment. Antipyrin was given in full doses
without any effect on this. The pulse was 138. Appetite
very good. The arsenic was increased gradually up to ten
minims at each dos?. At the end of December patient’s skin
was getting clear, joints improving, and she got out of bed
daily. Starch and zinc paste was found useful for the skin
at this time. In January the joints were painless, but ached
when fully stretched. The wrists and fingers were deformed,
joints knotty, and lingers turned out to ulnar side of arm.
When the patient left the hospital on Feb. 12rh the skin
was perfectly smooth anil natural. The joints of the wrists
and hands were crippled and deformed. The case illustrated
the transformation of psoriasis into diffuse exfoliative der¬
matitis, an occurrence which has been previously noted.
The relation of the rheumatic disease, if it was rheumatic,
was of interest. Psoriasis is not uncommon in persons rheu-
matically disposed, especially in subjects of rheumatoid
arthritis. The powerlessnees for good of the salicylate treat¬
ment was noteworthy. The same has been noted of tbis drug

in chronic rheumatic arthritis and so-called gonorrhea*!
rheumatism. The benefit of full arsenical medication was
most marked, and no relief was afforded by treatment which
commonly proves useful in ordinary rheumatism. The
author had not found dermatitis exfoliativa rebellions to
treatment by alkaline tonics, bathe, and oily inunctions.—
Dr. Radclifpb Cbockeb said that his experience also tes¬
tified to the possible connexion of rheumatism with a
previous dermatitis. He thought that any form of der¬
matitis might be the antecedent—e.g., excessive inunction
of chrysarobin had been recorded as preceding pityriasis.
A case was narrated of nine attacks of psoriasis. The ninth
attack was followed by pityriasis; each subsequent attack
was also followed by pityriasis, and the patient died
after the fourth attack. There was a mitral murmur,
but no definite history of rheumatism. A case of a
woman suffering from lichen ruber was also related.
In this there was also rheumatism with mitral disease.
Hypodermic injections of arsenic were followed by im¬
provement. The rheumatism became worse; pericarditis
and iritis developed. The lichen ruber element shelled off
in large plaques, and pityriasis developed. Salicylate
of soda and a low regimen effected no good, but the
administration of quinine and good food was followed by
improvement. Notuing but calamine liniment was used for
the skin. The heart murmurs alone remained. The lichen
ruber returned in very slight degree. Psoriasis was the
most common antecedent of pityriasis rubra when this did
not occur as the only disease.—Dr. T. Bah low had also
observed the triple association of psoriasis, pityriasis, and
rheumatism. The case of a gentleman was related. A
mitral murmur with hypertrophy of the left ventricle
existed. During the last two years the type of the skin
affection had altered. The patient developed an acute attack
twice a year. At the beginning of one of these Dr. Barlow
first saw him. There was some brawny induration of the
true skin as well as the psoriaeic condition. The attack
lasted one month, and was attended with fever and much
general illness. Anorexia was a marked symptom. The
skin symptom changed, and a bright-red, swollen skin
developed, with lymphatic glandular enlargements. After
complete exfoliation of the cuticle the skin ♦as left soft
and supple, like that of a new-born child, lie had watched
five or six attacks in the same gentleman. He agreed that
when once the skin lesion had taken on this type it would
continue. During the attack certain conditions about the
joints might have been regarded as rheumatic, but there was
no true effusion into the synovial cavities.

Mr. Edward Bellamy' read a case of Symmetrical Gan¬
grene (Raynaud’s Disease) following Varicella in a child aged
four, causing death on the fourth day. The patient was
admitted under his care on Jan. 19th, 1887. On admission,
she had spots of varicelli over her body and face, which
were first noticed on the 16th. On the evening of the 19th,
at 7 o’clock, the child complained of her right leg being sore,
and a small circular black patch about as large as half a
crown was seen below the inner side of the knee; by
10 o’clock this patch had extended down the leg to the foot,
when she was brought at once to the hospital. On arrival,
a similar patch had made its appearance just above the
left ankle, which rapidly extended up to the knee. The
patient was unable to stand, and complained of great pain
-in both legs, which increased on pressure. The second,
third, and fourth toes of the right leg were exempt from
discolouration, and the fifth but slightly mottled. Shortly
after admission, an oblong patch about 2 in. by 2 in.
appeared on the outside of the left thigh. Ou the 21st a
small patch appeared on the outer side of the right fore¬
arm, and slight discolouration on either side of the spine,
on a level with the crest of the ilium, and in the after¬
noon of the same day in either cheek and conchas of both
ears. The complexion was very white, face sallow, expres¬
sion dull and heavy ; tongue dry and brown, but reddish at
tip. Pulse 160, weak; temperature 100°. Heart sounds
normal; breathing normal; both legs cold and insensitive;
pulsation in left femoral fairly distinct, but could not be felt
in right. Urine : sp. gr. 1023 ; clear and pale; no trace
of albumen and no bmmoglobin could be detected. In tin
evening of the 21st she was suddenly seized with stertor
and died. A full account of the post-mortem accompanied
the paper. Perhaps the most interesting points ere as
follows:—There was an enormous opening in the foramen
ovale, bounded below by a valve a quarter of an inch deep,
having a free crescentic margin. Dissection of the right

TmLancbt,]

MEDICAL SOCIETY OP LONDON.

[April 9,1887. 7$J

leg: The fat and skin and gangrenous parts were dark-
purple from haemorrhagic infiltration, this appearance fading
away at the apex of Scarpa’s space. The obvious gangrene
ceased just above the inner condyle, the skin above being
apparently normal. The leg, which appeared quite gan¬
grenous, was of a uniformly purple colour. There were some
petechias or small hasmaxrhagse in the intermuscular plane,
the muscles themselves being very strongly contracted
in rigor mortis, and ; appearing almost healthy. Here
and there they showed small heemorrhagds; this was
especially the case in the deeper fibres of the aoleue.
The femoral glands wese a good deal enlarged, and either
hemorrhagic' or containing a quantity of blood pigment.
The saphena vein contained only post-mortem dot.—
Mr. J. H. Morgan said that the most remarkable point was
the circumstance that the gangrenous condition extended
higher on the inner side than on the outer. The gangrene
did not spread much whilst the child was in the nospital.
The great toes remained perfectly normal. At the necropsy
the rigors mortis was well marked. The hemorrhages
were apparently confined to the cutaneous structures. The
vessels were found to be healthy.—Mr. Goods Adams
suggested that the case might have been one of hamor-
rhagio smallpox; he inquired as to the condition of the body
temperature.—Dr. LonohUbst considered that the case was
due to blood poisoning, and he thought that it might have
been small-pox.—Dr. Hbkrinoham regarded the case as
most likely one of varicella gangrenosa, s condition which
was net »o very uncommon.—Dr. Bbnham asked whether
the child had been exposed to oold, for the appearances were
something like those of frost-bite.—Dr. Radcuppb Crockbr
asked hew the gangrenous- area developed, whether in con¬
nexion with tfie varicella* vesicles or separately. He said
that the condition was not allied to ordinary cases of
vuiorila gangrenosa. Were the patches on the cheeks or
arms pure haemorrhages or gangrenes ?—Dr. T. Barlow
said that all the oases of varicella gangrenosa he had seen
began in the varicellar bull®; it waaa multiple gangrene
quite different from the case now described. Again, there
was uo resemblance to symmetrical gangrene or Raynaud’s
disease. He classed Mr. Bellamy’s oase along with those Of
symmetrical gangrene following the acute specific fevers.
He had recently seen one case, not so extensive, of sym¬
metrical gangrene after measles. In these cases A dissolutio
sanguinis appeared first to occur and to be associated with
haemorrhages as the initial phenomenon of the gangrene. In
Mr. Bellamy’s case, besides the haemorrhages in the skin,
there were extravasations in the pie or® and muscles. In
other cases, also, he had seen the diffuse haamorrhagee
occurring in various organs. The tips of the ears was a
favourite site. He oould not bat think, in opposition to
Mr. Motgan, that the heart condition—for the foremen ovale
was large enough to admit the thumb—may have had some
■hare in the causation of the hmmorrhages. In one case
huge hffimorrhagee developed around the measles papules in
a child who was the sub ject of congenital heart disease.—
Sir Dyck Duckworth believed that congenital heart disease
▼as a seriods complication of the exanthemata. He Would
not have thought of varicella gangrenosa in connexion with
theoase narrated.—Dr. Broadbent agreed with tbs views of
Dr. Barlow. 1 1n a case recently seen of typhoid fever, both
era became gangrenous, but he could not say whether pan-
ceded by a haemorrhage; one or two fingers of each hand
also affected. He said it had no kurd of resemhlanoe
to hemorrhagic small-pox, of which he had seen some thirty
cases.—Mr. Bxllamy briefly replied.

Mr. A&bdthnoy Lane described a ease of Intussusception
produced by the presence of a Tumour growing from the
Muooug. Membrane of the Transverse Colon. After an
■tririBofrdialThcee, in a chronic case of hip-joint disease, in
a ch&d aged eight, a tumour aa large as a walnut was found
projscting from the anus. - It was much congested; blood
oozed from its Surface. Thenurte in attendance supposed
it to be a prolapse of the mucous membrane of the rectum,
And attempted to return it within the anus, but was unsuc-
oornfah iOn aremiirtstion, the tumour appeared to have a
T «y hfjg' p fdi cW» which, gradually increased in thickhess,
non of the finger. As there were no
iAt—jgalaUou, And as the length of the pedide
returned the tumour within the rectum.
It ashn igaafcid". onte/oft^reaek >€n thd following day the
hgindtedn ‘the i middle line, between the
umbfiicaa hadbetween the finger in rile rectum
■ad the h an& x ^jle Wxfa c a of the abdomen. Some days

after, during another attack of diarrhoea, the tumour wag
again extruded from the anus. On this occasion it was
found that the tumour was sessile, and that it was attached
to the very oongested mucous membrane by a oonstrioteq
neck, the prolapse of gut being abundant and lax, so that cm
the first occasion the whole of the thin apparent pedicle
must have been formed by mucous membrane and the inte* n
tine itself. On the removal of the tumour, the prolapsed
gut was readily replaced, above the pelvic brim by the finger;
and subsequent examination revealed no signs of an into**
susception. No tumour could be felt in the abdomen on eitheq
occasion in which the growth projected from the aaus^
Mr. F. Treves said that the mildest cases of intussuscep-?
tion were often those associated with large polypi in the
colon. Polypi were present in 5 per oent. of the oases ex
intussusception.. The firet symptom of such intussusception
was often the appearance of the tumour at the anus. Hq
also drew attention to the causational influence of a mass
of epithelioma in the wall of the bowel as leading to ttye
formation of an intussusception.—Mr. A. E. Barker, said
that the number of cases in which epithelioma had been the
cause of intussusception was not great. He .briefly related
a case of epithelioma, of the sigipoid flexure, in which th#
new growth extended two-thirds round the circumference
of the bowel, and led to intussusception. The .pedicle, of
the tumour wgs formed of the ooats of the bowel itselL—*
Mr. Bryant thought that intussusceptions caused by tumours
were not very rare, though in the adult .they, were not rer
cognised sufficiently. He believed a fair proportion of tbg
oases in adults were , due to tumours. He had recently
operated on a lady aged eighty-four for intussusception.
There was a tympanitic abdomen, and a long histoiy o*
bowel trouble, followed by acute obstruction. Examination
per rectum detected a growth in the bowel, which occupied
the centre of the canal itself. The growth was as large, w
an egg, and. of coarse villous nature. Its removal wag
easily effected, and the bowel then soon asoended above the
brim of the pelvis, giving the palpating hand a.ouriottf
sensation. The lady soon became well, and walked aboRt
in perfect 1 health. The fact that the . growth could he felt
was the interesting point in Mr. Lane’s case. • ,„

The following living specimens were exhibitedDry
Drewitt: A Case of Lupus, treated partly by Salicylic Past*
partly by Scraping. Mr. Parker and Dr. Robinson: In¬
herited Congenital Deformity, of the Hands and Feet; Plastic
Operation on the Feet.—Mr. Walsh showed for Mr>E*iJYy
Parker an Abdominal Tumour (? renal sarcoma) in an-iftfsaj
aged two years. . ; -. ••

MEDICAL SOCIETY OF LONDON. 1

■ . .. -. ■ i . : i i.,

Ulcerative Endocarditis. —Alleged Dangers of Starcfil
containiny Foods during the period of Infaiihy'. ^

Am ordinary meeting of this Society was held on Monday
last. Dr. .T. Hughlings Jackson, F.R.S., Prefcidentvta the chain

Sir Dyck Duckworth read a cise of Ulcerative Etiffo^
carditis that simulated typhoid fever and acute tuberculins.
It occurred in a girl aged twenty, in whom there wa^ i^>
history of rheumatic fever, but some of the joints had-beag
slightly swollen. A systolic murmur waa detected in tfi#
mitral area after the patient had been admitted into,boar
pital. Cough, with bronchitis,wasting, and loss of powe$
with other symptoms of the typhoid state, were present*
but there were no snots or diarrhoea and; no enlargement qf
the spleen below the ribs. The necropsy revealed np
tubercles or splenic infarctions, but the mitral valves were
muoh diseased andf angering.—Dr. Sansom inquired whether
it was possible for tne pneumonia to have preceded the
malignant endocarditis. Dr. Osier, and a pupil of M. Comil’s,
had arawfi attention to the relationship between pneumdnia
and ulcerative endocarditis. He refbrred tOi tbe-ricqae
recorded in the Medical Society’s Transactions. YarlahaliAy
of xmlTmurs was. an ’ important sign of this form of severe
endocarditis. The oase- unproved immensely under the use
of half-drachm doses of aulpho-carbolsfte of sodium. $hp
subsequently died; and the neoropey seemed to show thafcji
fresh eruptive process had supervened whilst the original
disease had subsided. The progress of the temperatups
afforded no aid in diagnosis.—Dr. Huqhungb JACKsqjr
said that this form of endocarditis was met with in some
cases of epidemic meningitis. Absence of knee-jerks wougl
point to meningitis in a case of doubt between men ingi ti s
P SDiqitized by VjUUv LL
y y ^

Tbs Litfcs?,}

EPIDEMIOLOGICAL SOCIETY OF LONDON.

[Aran, 8,1887.

and typhoid feven—D r Hbnwy Wsitk dwelt on the diffi¬
culty of diagnosis.—Sir Dyce Duokwobth said that the
antiseptic treatment had proved valneless in his hands. He
trad Seen the knee-jerks disappear at the close of cases of
typhoid fever.

MV. R. ~Vf. Parker read a paper on the alleged Dangers
of Starch-containing Foods during the period of Infancy.
As the result of many years’ observation at the Fast London
Hospital for Children and in private practice, he stated his
belief that the dangers of starch foods were greatly exagge¬
rated. He was quite aware of the mortality among
artificially-fed children, but he attributed this, as well as
the marasmic condition of many that did not actually die,
to congenital debility, the result of debilitating influences
of various kindB actiDg on the parents before the birth of the
children. An analysis of cases had convinced him that, in a
large proportion of cases, artificial food was only commenced
because the children were weak and puny, and not thriving
on the breast milk. Mr. Parker did not advocate artificial
feeding, nevertheless, but the Contrary, lie rather implied
a belief that artificial feeding was on the increase, and
that it had the consent of the medical profession: many
mothers left off suckling, be argued, without sufficiently
good grounds, so widespread was the doctrine that if all
the' -starch had been converted into dextrose, and so
rendered digestible, artificial feeding might safely be
commenced. This was quite an error, and, moreover, it
was desirable that mothers should nurse their children, as
nursing mothers were less liable to conceive, and thus there
was a longer interval between the children. Too rapid
child-bearing was one result of not suckling; it was very
, debilitating, and one of the most potent sources of the maras¬
mus and weakliness so largely present among the children of
the poorer classes. Besides this, a child that was deprived of
the mother’s milk was probably deprived of the mother’s care,
not less important than the milk for a weakly child. Thus,
Mr. Parker argued, there were many factors to be taken
into consideration in estimating the causes of marasmus and
its consequences. He thought that too much stress had
hitherto been laid on the effects of artificial feeding,
and more especially on the starch constituents of this
food, and that too little stress was laid on the congenital
debility of children born under adverse circumstances.—
Dp. Gibbons did not agree with the conclusions of Mr.
Parker on the innocuous influence of starch in infancy.
Imitation of the mother's milk was the object to be aimed
at in artificial feeding.—Dr. Allchin admitted that defective
hygiene was a most important consideration, but he did not
agree that starch was not injurious.—Dr. Du IIayillaxd
Hall said that puppies had developed rickets as the result
of being fed on biscuits.—Mr. It. W. Parker, in reply, said
that the experimental observations on animals were valueless
qud the point under discussion, because of the bad hygienic
circumstances under which the animals were kept.

Dp. Whipham read a paper and showed some drawings of
cases of so-called Glossitis Migrans, Wandering Rash,
Lichenoid Eruption. A case in a domestic servant suffering
from mitral disease was narrated. The second case occurred
in a young man who suffered from typhoid fever. The
sinnons margin was composed of vast accumulations of
epithelial cells, talcing the shape of a Chinese pagoda. The
tissue of the mucosa showed evidence of inflammatory
growth, Dark opaque masses overlaid the epithelium in
places, and were probably composed of colonies of micro-
cooci. He supported Lemonniers view, that the lesion
•was a superficial inflammation—a glossitis superficialis
microns,' • ' __

EPIDEMIOLOGICAL SOCIETY OF LONDON.

Ax a meeting held at II, Chandos-street, Cavendish-
square, on Wednesday, March 9th, Inspector-General Lawson
In the chair,

Dr. .Stephen Mackenzie read for Dr. Wykeham Myers a
paper entitled “ Further Observations on Filaria Sanguinis
Hominis in South Formosa,” of which the following is an
abstract. The author stated that further and extensive
careful examination had failed to discover in South Formosa
a mosquito like the Amoy fllaria-nurturing variety, either
in speck s of capacity for nursing the blood embryo. He
then proceeded to describe the varieties of mosquitos he had
ble to discover in South Formosa, appending sketches
'attd careful measurements of the tiger, brown, and ejecting

mosquitos, with sketches and measurements of the Amoy
filaria-nurturing mosquito, and reiterated his opinion that
the absenoe of filarial diseases in Sooth Formosa is doe to
the absence of the species of mosquito which is capable of
acting as the intermediate host to this parasite. He
next discussed the ultimate destination ofthe maria embryos
found in the blood, and the following are the conclusions at
which he arrived:—1. Accepting that parturition in the
parent worm is continuous and exceedingly prolific,
then removal of those filarite which have had their
chance of mosquito withdrawal, but have escaped detection
is necessary, in view of the swarm which will inevitably
enter the blood from the lymphatic system at the next
period of its suitability for their reception. 2. The marked
difference between the condition of that fluid when favour¬
able for filarial development and its state when hostile to
their existence seems due either to the presence of an ex¬
cessive amount of carbonic acid, or the absence of a sufficient
quantity of free oxygen. Inasmuch as the former neces¬
sarily involves the latter, and experiments seem to show
(«) that direct contact of carbonic acid in presence of exces?
of oxygen is not, immediately at least, injurious, but that
(h) exclusion of oxygen, either by surrounding the blood
with carbonic acid or placing it in a condition opposed to
access of the former gas, brings about the destruction of tht
parasites, and that (c) the behaviour of the filarial embryo,
both in the human blood and when contained in the mos¬
quito, seems strongly to indicate a desire for this gas,
it may be assumed that probably its presence is essential to
further development, and its withdrawal or diminution in
quantity conducive to death. The author therefore suggested
the following as the course pursued by the embryo from birtb
until its absorption by the mosquito. For a period of not
less than twelve hours, and probably in no case exceeding
twenty-four, the filariae remain in the lymphatic system; at
some time during this period, urged by the favourable con¬
ditions in the hsemic circulation, it exhibits for the first time
a selective ability, and enters the latter. It will be observed
that, supposing twelve hours to be the least time appor¬
tioned for intra-lymphatic existence, and that the fidaria-
disappear from the blood at 7 a.m., appearing again at 7 p.m .
all those born bet ween these hours will be ready for entrance
into the blood at various times during the following night,
but those bom during the night itself would only be fitted
for intra-vascular existence at some time daring the day
This inters a longer or shorter delay, according to the hour
of birth, and may account for the fact of embryos being
occasionally seen in the blood during daylight, as was theca**
with all Manson’s early finds, got as they were during tha*
period. It is possibly, however, more or less the result of acci -
dent,due eitherto whatwemay call impulsiveinjadiciouanesi
on the part of a few, or untoward subjection to the irre¬
sistible forces present at or near the termination of the
thoracic duct, within the scope of which they have beei
tempted to approach too closely. As to the facility for
postponing their advent shown by those .embryos born
during the night, we have actual proof of such capability
on the part of the parasite, in those geographical results
previously described. The term “postponement” iq on!
used in a figurative sense. Although, as before pointed out
the embryos are wanting in locomotory power at thisfltagt.
still there can be no doubt of their ability to resist moderate-
onward pressure, either by actual adhesion or by the oppc
sition of forces resultant from the contraction and extension*
in the body; converging as these do towards a central point
they are able to control within limits the duration of theii
stay in the sluggish lymph current. When the proper time
arrives, however, they yield to the pressure, and thei.
passage to the now attractive blood is brought about. In
the mosquito, where migration has to be effected in a stagnant
medium, inherent locomotory powers are required, so
at or about the end of another twenty-four hours
the embryo temporarily becomes possessed of this ability,
moving about freely. Arriving at the thorax, and begin¬
ning at a stage where quiescence is more comfortable to its
necessities, the parasite seems again to enter on a sort of
chrysalis state, or, in other words, to become passive. The
last section of the paper dealt with the pathology’ and
treatment of elephantiasis or lymph discharges. The author
discussed in groat detail the different views put forward by
various writers. Agreeing with Manson as to t he fila’. ial
origin of these diseases in the majority of instances, he
differed from him as to the mechanism by which tbe Alan,
operated. He rejected abortion of the parent worm, ai

T'hB LANCET,]

ACADEMY OP MEDICINE IN IRELAND.

[AmirD9,ia87i 713 ^

w» inclined to attribute the overgrowth of tissues, dis¬
charges of lymph or chyle, and febrile manifestations to
overgrowth of cells due to increased plasmic flow (as dis¬
tinguished from obstruction), due in the first instance to the
presence of fllaria sanguinis hominis (or in non-filarial cases
to an ulcer, eruption, &c.), or some other excitation, and
whioh, when once set up, might persist after the original
exciting cause had ceased to operate. With regard to treat¬
ment, he advocated, when practicable, removal from a
fllarially infected region, but where this could not be accom¬
plished filtering and boiling all water drunk, and for local
treatment pressure both on the affected part by indiarubber
bandages and over the arteries supplying the region, in
preference to deligation of arteries. In connexion with the
paper, Dr. Stephen Mackenzie exhibited a patient suffering
from chyluria contracted in India, and demonstrated the
living filariae in the blood.—In the discussion which followed,
Inspector-General Lawson, Drs. Thorne, Mortimer Granville,
ana Willoughby, and Mr. Smyth took part.

ACADEMY OF MEDICINE IN IRELAND.

The Marsupial Heart. — Absence of the Internal Iliac
Artery.

A'Meeting of the Sub-section of Anatomy and Phy¬
siology was held on Peb. 10th.

Dr. Cunningham exhibited the Heart of a Kangaroo
which he had recently successfully injected. He stated that
Owen was Of opinion that the marsupial heart was dis¬
tinguished by (1) the absence of the fossa ovalis, (2) the
presence of a cleft in the auricular appendix of the right
ride, and (3) the absence of a separate orifice in the right
auricle for the coronary vein. The absence of the fossa
ovalis was also associated with a total absence of the ductus
arteriosus, the Eustachian valve, and other vestigial remains
of embryonic life, such as the urachus, hypogastric arteries,
round ligament of the liver, &c., and was accounted for by
the short period which the embryo sjrent within the uterus.
The bifurcation of the auricular appendix was well aeen in
the specimen exhibited, and it was present in a marked form
in tne phalancert, but was absent in the thylacine and
dasyure. With regard to the third point of distinction
mentioned by Owed, Dr. Cunningham stated that he had
been able to make ont in the Challenger marsupials a
separate opening of the great cardiac vein in the right
auricle, but this was situated at the upper part of the cavity
dose to the opening of the superior vena cava.

Dr. Lkdwich read notes of the dissection of a male
subject, in which the Internal Hiac Artery was absent on
the’Wt side. On the right side the structures were normal.
The abdominal aorta bifurcated at the lower border of the
thir d lumbar vertebra to form the two common iliac
arteries; the right divided normally into the internal and
external iliacs, but the left, instead of dividing, continued
as a single vessel in its whole course to the femoral artery.
This' single fli&c artery p&aeed obliquely downwards and
outwards over the psoas muscle for a distance of three
inch es, and then, turning somewhat sharply inwards and
then downwards over the iBo-pectinealline, entered the pelvic
cavity. This intra-pelvic portion of the vessel formed a
long loop reaching to a point about half an inch below the
highest prirt of the great sciatic notch. The artery then,
amending, recrossed the ilio-pectineal tine, and, turning
downwards over the horizontal ramus of the pubes, ter¬
minated in tiie femoral artery. This vessel may therefore
be considered as divided into three portions—1, the oblique
portion; 2, the looped portion, which may be subdivided
into ( a ) the descending limb, (b) the transverse part, and
(c) the ascending limb; 3, tile horizontal or pubic portion.
The diameter of the vessel was greatest at the transverse
port of its loop, where it measured seven-sixteenths of on
inp h; and least at the termination of its pubic portion,
where it measured five-sixteenths of an inch. Its total
ledgth Was nine inches. The first sacral nerve passed
through the loop of the artery from without inwards,
and -tightly held down the vessel; the nerve then, winding
round, the inner side of the ascending limb of the loop,
joined with the lumho-Bacral cord. The branches which
arose fiptn each portion of the artery were as follows:—
Prom' 1oblique portion: (1) A posterior ilio-lumbar
artetjr Of some sue, whioh resembled in its oourse and mode
of termisaMoo the lumbaar brenoh of a normal ilio-lumbar

artery. (2) Two or three small branches to the peoaa,
muscle, peritoneum, &c. From the descending limb afl
loop: (1) The internal pudie artery arose opposite the flnst,
sacral foramen. Its intoa-pelvio portion was exceedingly
long, measuring from its origin to the great sciatic notch
fully five inches, and in diameter it measured slightly,over;
an eighth of an inch. From its origin the. pudie artery
carved inwards and downwards to the middle of the anterior
surface of the bodies of the third sued fourth bones of the
saarum, where it gave off the middle sacral artery. la then
curved outwards and downwards, between the second and.
third sacral nerves, and in front of the pyrifomis mtuMkta
to the great sciatic notob, through which ib passed below
the muscle, and followed thenceforth the route sad termina¬
tion of a normal pudie vessel. The middle.sacral artery 1
was very small, and arose from the internal pudie over the
fourth bone of the sacrum, it passed downwards in ,the,
middle line for a distance of an inch and a half, and
terminated normally on the coccyx. The internal, pudie.
also gave off, just outride the sciatie notch, a large muscular
branch to the gluteal muscles. From the transverse part ,of
loop: (1) The lateral sacral artery arose just above the
second sacral foramen. It was a short small; vassal, ao<^
sent branches into the second and third saoral foBamiaa*
(2) The gluteal artery was a short thick trunk* which
arose from the junction of the transverse and ascend¬
ing portion of the loop. It passed almost directly
outwards through tin great sciatic notch above tin
pyrifonnis muscle and terminated in the usual manner*
From the ascending limb of loop: (1) The sciatic artery arose
three-quarters of an inch above the transverse .portion, *ndt*
passing downwards internal to the first sacral and the
lumbo-eacrml nerves, left the pelvis through the great
sciatic notch below the pyriformis muscle, and terminated
in the usual way; (2) an anterior ilio-lumbar artery, (auoh
smaller than the posterior), which terminated like the ilwo,
branch of a normal ilio-lumbar artery. No other breaches
could be discovered arising from this abnormal iliac artery.
The obturator and deep epigastric arteries arose by a common
trunk from the femoral, about one inch below Poupart’s
ligament. I

Dr. Brooks communicated the result of hia investigation*
into varieties in the Innervation of the Umbricals. of thtt
Hand and Foot, with some observations an the perforating
flexors.

Dr. Cunningham exhibited (1) four Chinese Plates of
Human Anatomy which had been presentednto him by
Dr. Irwin of Tientsin; and (2) oasts of Defanmsd Feet it*
Chinese Women which had been presented to him .hy>
Professor Weteker of Halle; He explained from theixaph
that the foot was bent into an exaggerated' areh so .that toh
os cal da was brought to lie immediately below the astro*
galas; but, though they distorted the foot* the Chinese!
seemed to have an approbation of the importance of the
great toe, which was preserved for locomotion.—B t.FraKBR
said he had a book with a series of plates published] twg
hand red yean ago, illustrating the Chinees system of anatomy*
which had been followed for upwards of a thousand yeets.-rf
Mr. Thomson remarked that they had advanced in surgery
of late years. Thej had had “ Erichsen’s Surgery ” trans¬
lated into Chinese.—Dr. Frazer : And also a Dublin book—
“ Churchill's Midwifery.” . „

lb

CAMBRIDGE MEDICAL SOCIETY.

,*\ 1 .

A meeting of this 9ociety was held on Feb.4tb, when the
President (Dr.'Bradbury) gave an address on resigning 1 ,the
chair, to which Mr. Cleaver was afterwards, elecfed», (! 'The
chair was taken by the Vice-President, Mr. Stear, M.R.C.S-,
and the following communications were made:— , tJ

Quinsy. —Dr. Easby (Peterborough) read a paper onquiosy
and its treatment. After Speaking of the old method of
antimonials, free purgation, complicated grigles, leec h es a n d
blisters, Dr. Easby advised the use of acorn te givenaftetf
Dr. RingeFs method, or from ten to fifteen grains of aaiureito
acid or salicylate of soda given every two hours, whioh haA
invariably afforded speedy relief. Gargles were strqnghr
condemned as both useless and cruel to the patient. As a
local application, a powder consisting of equal parts of tahhfaf
and iodoform puffed on to the swollen tonsils be had fotmd
give great relief to the pain.—Dr. Latham agreed that gSrgles
were useless^and advised the use of the«pray,ohloriiM water

i

^34 Tsb Linobt,]

REVIEW8 AND NOTICES OP BOOXS.

[Apbxl 9,1887.

oreome antiseptic. It wm especially useful for children.
He strongly endorsed Dr. Eashy's remarks on giving salicylic
acid and salicylate of soda in the early stage, more especially
if them was any association of rheumatic symptoms.

Note on SteUwag's Symptom.*—Mr. Whurry showed a
patient, a married woman, aged thirty-two, who came to
Addfcttbrooke’a Hospital with marked retraction of the left
Upper eyelid (Steliwag's eign). There was no proptosis or
goitre, 1 butedme throbbing of the carotids and palpitations;
AO Cirtliao bruit. She blushed and perspired very easily, and
suffered a good deal from indigestion and sleeplessness. The
retraction of the lid was extremely well seen when the eyes
looked downwards. There was no want of consensual down¬
ward movement of the eyelid (Graefe’s eign). The pupils were
eqn*l and active, V=•$ J in both; fundus normal; no pulsation
in tbe retinal vessels; complete power of closing the eyelid;
eorhea and conjunctiva sensitive. The patient has been
married thirteen years; had no miscarriage; has one
efclM, now six years old; has had no illness of late; mens¬
truation quite regular, rather scanty; occasional leucorrhcea.
Although there was no exophthalmos or goitre, Mr. Wherry
thought this was probably a case of Graves’ disease. This
patient had first noticed something wrong with her eye
about a year ago. She had been under observation for the last
six month*, and had improved under treatment by bromide
draughts at night and small doses of belladonna twice daily.
There was Httle change, however, in the eyelid symptom,
which came on rather suddenly and continued to the present.
Mr. Wherry wished to draw attention to this symptom
wit boat suggesting any theory as to the pathology of Graves’
disease, because the opinion has been expressed by Graefe
that eases are not rare in which the only symptoms of this
affection in women are rapid action of the heart without
hypertrophy or valvular disease and defective mohility of
the Hd; the latter is, at any rate, an extremely important
symptom to take note of—important in the diagnosis, treat¬
ment, and pathology of Graves’ disease.

• Intra-uterine Amputation of forearm.—Mr. Sthhrt said
that A. B“— \ aged twenty-two, a healthy young woman, was
flrttt seen by him when suffering from inflammation of the
left olecranon bursa. From an inch below tbe elbow tbe limb
to wanting, and the stump presents ail the appearances of an
intfa-utenne amputation. On inquiry he found that she
was bom with this deformity; the stump was quite healed
at birth, and no evidence of any remains was to be found.
The cicatrix to very small, being only three-quarters of an
hKh long, and the skin is very little puckered around it; it
to net adherent to the deeper parts. The bones of the forearm
can both be distinctly felt, and the olecranon seems almost
equal in sice to the right one. The humerus and muscles of
the left arm are no smaller than can be accounted for by
net being so much need as the right arm. There is no
history of syphilis in the mother nor was any acoident
remembered during gestation.

Immature (Senile) Cataract.—Ur. Dkighton read a short
vepeFin which he discussed the conditions which rendered
it advisable to operate in cases of immature (senile) cataract;
he also read notes of a case in which he had operated, the
pvtcsnt obtaining Vcj| and 1 Jaeger.

an'Cr |totkes of |Wfcs.

A Text-book of Pathological Anatomy and Pathogenesis.

By Eunst Zlbglbr. Translated and Edited by Donaxd
1( ., ^IaoAlist^b, M.A., M.D. Part II.: Special Pathological
• Aflatomy. Sections IX. to XII. London: Macmillan
knd Co. 1886.

' wlrtH this, the third, instalment of by far the best appre¬
ciated pathological text-book of ffUr day, Dr. MacAlister has
Completed the task to which he applied himself. Of the
remaining sections of the original work, some are not from
Professor Ziegler's pen, and Dr. ALacAlister has decided not
to translate them. These sections, it may be said, comprise
the diseases of the organs of special sense, of the osseous
and muscular systems, and of the organs of generation.
Some at least of these subjects would have been welcomed
by the English reader, who may regret the decision to
exclude them. Oar literature is not so rioh in detailed
eiporitkm of the pathology of these organs and tissues but

that we could gladly receive them, and we may express a
hope that the translator, whose duty has been so admirably
performed in the portions he has published, may yet recon¬
sider his resolve, and add a fourth volume, which will
complete the work.

The volume before us deals with the important subjects
of diseases of tbe urinary, respiratory, and nervous systems.
They have been carefully edited, for the bibliographical
references, which form so useful and notable a feature, are
thoroughly up to date, rendering the work one of great
value to the pathological investigator. The text is remark¬
able for the lucidity and scientific treatment of subjects
which have been more or less obscured by different writers,
who have dealt with them from too narrow a standpoint.
Take for example the subject of renal disease, which since
the time of Bright has been a field of so much conten¬
tion. A sharp distinction is drawn between the simple
“ contracted ” kidney and “ renal cirrhosis.’’ The former is
demonstrated to depend upon arterial changes, a condition
of atrophy due to arterio-scierosis. It is the form which
occurs in chronic lead poisoning, and it is allied to senile
atrophy. We have here a recognition of the views pro¬
mulgated by Sir W. Gull and Dr. Sutton, but, as Professor
Ziegler points out, this is not the sole form of granular
kidney known. Contraction of the organ may be an
ultimate stage of chronic parenchymatous nephritis, or it
may be the outcome of a true cirrhosis or a “chronic
indurative nephritis,” in which fibrous over-growth is the
predominant feature. This teaching seems to harmonise
the divergent doctrines on the nature of chronic Bright’s
disease in a more satisfactory manner than the attempt to
create a unity in nature and origin betwe*^ diverse forms
of disease, which have nothing in common but the feature
of wasting of secreting structure. The various types of
nephritis — hmmatogenous nephritte is the term hew
employed—are differentiated into three groups: 1st, acute;
2nd, chronic parenchymatous; and 3rd, chronic indurative.
Under the first head are included: 1, acute glomerular
nephritis, such as is characteristic of scarlatina; 2, acute
diffuse nephritis or acute inflammatory oedema; 3, acute
disseminated interstitial nephritis, which is regarded as
the commonest form of acute renal inflammation; and, 4,
disseminated suppurative nephritis, which in this country
we know beet under the unfortunate name of “surgical
kidney,” but which includes also all metastatic and embolic
abscesses. Of chronic parenchymatous inflammation, charac¬
terised by intertubular exudation as well as alteration in
the epithelia. Professor Ziegler distinguishes according to
their stage the following : 1, inflamed fatty kidney;
2, large mottled kidney; 3, large white kidney; 4, chronic
htemonliagic nephritis; 5, chronic glomerular nephritis—
a subdivision which is justified on anatomical if not on
clinical grounds. Of the chronic indurative form, or renal
cirrhosis, we have spoken above. There may be a tendency
here to undue refinement, but it cannot be denied that the
more the histology of kidney disease is studied, the stronger
will be the conviction that there do exist varying types of dis¬
ease, essentially distinct, included under the somewhat lax
and unecientifio heads of Bright’s disease—acute and chronic.
We may trace the same grasp of details and power of analysis
which are so characteristic of Professor Ziegler in his chapter
on diseases of the lungs, and especially in that on tubercular
disease; but it would not be possible to do full justice to bis
treatment of this important subject without free quotation
and extended notice. Sufficeitto saythatthe pages devoted to
this subject will well repay careful study; whilst one cannot
fail to note the importance assigned to aspiration of tuber¬
culous matter in the extension of the disease, which also
spreads by peripheral extension, by tuberculous lymphangitis,
and by intravenous tubercle. The section on the nervous
system opens with a chapter upon the structure of the

Digitized by GoOgle

Thb LancbtJ

REVIEWS AND NOTICES OF BOORS.—ARMJ. MEDICAL SCHOOL. [Awm, 9,18871' 735

brain—more detailed than usual in a pathological text-heokj
yet of considerable importance for the interpretation of
morbid lesions. The chapters on softening, and on sclerosis
—which is regarded in the main as degenerative and atrophic
rather than inflammatory,—and the farther chapters on
inflammatory disorders 6f the brain and cord and their
membranes, are fully abreast of present knowledge; 1 whilst
the final chapter on the disorders of the peripheral nerves will
be read with interest, as embodying, the views of the patho¬
logist upon degenerative and neuritic lesions, which are daily
receiving fresh attention at the hands of clinical observers.

We have said that this work is highly appreciated. In
Germany it enjoys a remarkable popularity, having already
gone through four editions. We venture to think it will
be equally popular in this country, , for it is a work which
appeals both to student and to teacher. The former will
gain from it a clear insight into morbid processes, and will
be enabled to compare the results of his observation in the
post-mortem room with the interpretations of the scientific'
pathologist. He Mil be greatly aided in this by the large
number of highly executed engravings which illustrate the
descriptions of histological appearances; The latter cannot
fail to be quickened in bis teaching and assisted in his ex¬
position by a work which traverses the whole field of patho¬
logy in a systematic and orderly way. The book has a
twofold merit: the text is not Overladen with detail, and is
therefore valuable as a text-book ; and its ample biblio¬
graphical records render it squally valuable as,a work of
reference. Dr.’MacAlister deserves the best thanks of patho¬
logists for his labour and skill as translator and editor; and
the publisher? also may be congratulated upon the excellent
mannerin which they have fulfilled theirpart in its production.

Practical Medicine and MecTical Diagnosis. By Byrom
BfcAMWtiit, M.D. Edinburgh ! !oung J. FefttWnd. 1887.
ThIA is evidently the first fofothlfflent of What promises to
be a work Of great merit; for it deala Only with' matters
mm or 1 loss introductory to the wide, subject'of medical
diagnosis—such matters, namely, as methods of diagnosis*
case-taking and case-record ihg, and medical thermometry.
Th? work is based on the instruction Which the author
gives to his clans at the Extra-mural School in Edinburgh;
rtd/juaging i# its quality, we- may fatilycongratulaie'the
mutants upon having so efficient and able a teacher. Dr*
BsamweU speaks with all the authority of one who has
himself, fplly mastered his subject, and we have nothing
but commendation for the clearness and method with which
be endows his subject. The chapter on case-taking is a
ntoi&il of what real instruction should be—gtklding the
student to orderly ifaethodlf In' bis search after Clinical facts,
Sad the adoption of a strict line Of Inquiry into* the r aUte»
cedents of the case he is investigating. In the chapter on
thermometry there are introduced short disquisitions upon
the theory of fever and upon differential diagnosis, whilst
the various types of pyrexia are fully illustrated. In the
appbndfac will be found flonib peTtlttent remarks upon' out-
l^titfnt' prkcfeil*tffid Wtj are Ittfcllfaed to. agree With Df.
Maui well that senior students -rather than junior should be
ooenpied itt this departments The rudiments' of diagnosis
better learnt at the bedside than in the crowded out¬
patient room. We shall anticipate with pleasure the pub¬
lication of further chapters of this undertaking, for which
itt author is io thoroughly well qualified.

' xj. ; a _. -i >■

LaGovtt'e, sa ftature et son' Traitdmcnt. Par Pr. W. ffhstBiv.
Trad notion du Dr. E. ChamHaRo-. Revisde et augmentbe
PMVAnteur. Paris :J, Rothschild. 1887.

Tarn is a veritable 6dition de luxe of Prof, Ebstein’s well-
r^^^WOjk j and it isprefaced by a brief and complimentary
^^f^ou^ this French edition by Prof. Charcot, who

I trusts that in the next edition the author will take cognis¬
ance of Professor Bouchard’s lectures on retarded nutrition.
Ebstein’s views are now fairly widely known, the main
thesis being to support-the doctrine of Garrod as to gout
being due to-a Retention of yric a$id in^the pjjptefcn. This is
demonstrated from the pathological side by the proofs that
no gouty deposits occur In any tissue or organ-except in
places where the tissue has undergone. neqrosis, the. notion
being that su'ch a retrogressive metamorphosis is induced by
the action of uric acid upon the tissue. Experimental proof
of this action is afforded in the results of ligature or the
ureters in fowls, When, owing to retention of the excfotibttj
highly charged as it is with uric add, necrotic fob* and
deposit of crystalline urates ana produced, similar .changes
being brought about in the kidneys when the secreting
structure is damaged by the previous injection of chlorate of
potash subcutaneously. Similarly, direct inj ection of uric acid
or its compounds into the blood will produce like effects. The
Clinical part of the Work deals with primary Articular gout
and priniary renal gout—a distinction not perhaps geuwmliy
appreciated, but fairly justified by facts. The therapeutical
Section is not marked by any considerable novelties, aava
perhaps in the rather liberal prescription of albuminqid and
fatty foods, as compared with restriction In carbohydrates,
An English translation (by Dr. Scott) ot this work was
published two years ago, but it did riot, as this FVdirch edition
dose, contain the cbromo-ltthographs Which represent the
histology of goaty learanS itt tendon, cartilage* kidney* &&»
in & striking (perhaps a too vivid) m&qneF* ■■

■ ■ • , , ‘i '■I,.

Contributions to Practical Medicine. , By Jame^ SAWYRfl*
Rnt. Birmingham : Cornish Brothers. . 1886.

Sir James Sawyer has collected some of his scattered,
writings and subjected them to revision bCfOrte foprbducfng
them in the elegant form presented by this volume. The
lectures and essays embrace such . subjects as Insomnia,
Intestinal Obstruction, Floating Kidney, and , Phtbisj^al
Laryngitis; and they are treated in a thoroughly practical
manner. That oh the causes and cure Of insomnia and that
on constipation arid intestinal obstruction strike ua'ari bring
the most suggestive* and best illustrating; the practical Jsitat >
of the author. The essay on M floating kidney” is inj^raalmigrt
but in being revised it should have made mantion.of the great,
benefit derived by the surgical method of ** riephrorrhaph'y
The author has'the faculty of expressing hi thoughts clrim^,'
and be is careful to avoid the too coarinowmistakeof writer*^!
viztt the statement at facts- outride their own experience,.
The book bears the impress of personal conviction, anffia,
therefore likely to be appreciated by its readers. , ^

( • • ~ ** .' : .. . Mi :

. ARMS MEDICAL SCHOOL. • i.<r *

, Thb summer session oftfie Army Medical Sqiiool was.
Opened at Netley on Friday, April, 1st. Twenty-five surgeons
cm probation of the British Medical Service and twenty-
eight" of the IndriU Medical Service were 1 in attendance.
The introductory address w» delivered by Professor
Aitken, F.R.&, in presence of the military and medical staffs
Of the Royal "Victoria Hospital and 8chooi and a few visitors.'
Tire lecturer took for tire subject* of his disodurse, 1 “Ascent
Pathological Researches on the,Production of Disease by,
Infective Processes generated within the Body. In the
course Of his preliminary remarks he referred'to the Mdses
of his oolleague Professor de Chsumont, and to tImproba¬
bility of his being unable to take part in the teaching of
hygiene during the present session of the school, and
mentioned that it had been arranged for his dairies to be
taken by Deputy Surgeon-General, Dr. Maraton* bead of the
sanitary branch at the War Office, who possessed very
extensive experience id the subject of hygiene both’ at
home arid abroad, and who would be aided by Burgeon- Major
O'Reilly, as well as by the Assistant Professor of Hygiene,
pr. Davies,

-•^itiieNbyti.OOgte

736 TheLancht,}

TER MEDICAL COUNCIL AS AN EXAMINING BODY.

[Apart 0,1887.

THE LANCET.

»** ...i , _ .. . .

LONDON: SATURDAY , APRIL 0, 1887.

The Medical Council ia summoned to meet on Tuesday,
the-10^h day of May—of course in consequence of the chaos
itato which the examining system is thrown, especially in
England, by the determination of the Royal Colleges to ex*
Adda the Apothecaries’ Society from their Conjoint Scheme.
The refusal of the Colleges places the Council in a very
delicate position. Those who were so enamoured of the Act
of 1886 mqy now see how much, reason we had for dissatis¬
faction with ik The wish of the Medical Council is thus
Set at nought by the Royal Colleges, and we are threatened
With the perpetuation of a race of practitioners not good
enough, according to the standards of the Colleges—though
they have no mandate to exact higher tests than those of
efficiency in medicine, surgery, and midwifery. The Royal
College# are in a state of prosperity mid hilarity just now.
Their funds abound, and their diplomas are in demand; but
it can only be regretted that they have not used their great
wealth and prosperity to cement the profession, to abolish
its divisions, and to assist in the creation for England
of one grand portal for her general practitioners. They
have chosen to do otherwise, and to refuse the request
of a majority of the Medical Council preferred by its re¬
spected President. It is not for us to anticipate the con¬
sequences of this step. But it places the Apothecaries’
Society in a position in which we arc sorry to see it placed.
It would have been more magnanimous iu the Royal
Colleges to have sought the disestablishment of the Society
by direct legislation than by refusing to recognise its claim
to co-operate with the other authorities under the legis¬
lation of 1886. It would be idle to ignore the painful
position in which this decision of the Colleges places the
Medical Council. Only one thing is certain, that the Council
can never acquiesce in the creation of an inferior Examining
Board, to authoriso something less than efficient practi¬
tioners for people who are too poor to recompense, or too un¬
important to require, an efficient medical man. Such seems
as we showed last week, to be the dream of some Members of
the Royal Colleges who are so lightly treating a request of
the Medical Council. The Medical Council has no authority
to recognise a lower standard at Blackfriars than on the
Thames Embankment, and the creation of an inferior class
of practitioners would be as disastrous to the profession as
It would be unfaithful to the Medical Act. If the Medical
Council determine to grant additional examiners to the
Hall, it will not be likely to take any low estimate of
the additions that will be necessary. For twenty years
medical reformers have hoped for legislation that would
have equalised what ought to be equivalent examinations,
so that medical men who have obtained their qualifications
from one body could bold their heads up before those who
have received their qualifications from a similar body in
another division of the kingdom. But only last week
Mr. Berkeley Hill commented on the convenience of

Edinburgh, Glasgow, and Dublin as places of refuge
for those who have been repeatedly rejected in London.
We leave the representatives of Edinburgh, Glasgow,
and Dublin to make their own acknowledgment of tins
compliment from one of the Council of the College of
Surgeons of England. Our present purpose is rather to
direct the attention of the Medical Council to Mr. Hill’C
view of its duty at the coming meeting—viz., to give sanction
and status to a body that will pass men whom the Royal
Colleges of England will not think worthy of being passed.
This raises a view of the duty of the Counoil which cannot
be too seriously considered, before it meets. It will be
curious if the Medical Council should become, as it were,
partners In a third-rate Examining Body meant for the
accommodation of those plucked by the Colleges chiefly
charged with testing the efficiency in candidates.

The retirement of Sir Henry Acland at the approaching
meeting will throw upon the Council one of the most diffi¬
cult and important duties which it has to perform. Hitherto
it has been free to take its President from outside the Council.
Now, under the Act of 1886, it must choose one of its own
members. There has never been a time when it was of so
much moment as it is now that the President should be a man
of strength, of impartiality, and of public spirit. We have
given one specimen of the questions about to engage the
attention of the Council. There are half a dozen more; and
if the Council considers its own future reputation it will select
a President with such qualifications as we have named.

Thanks to the many labourers in the field of neurology,
we are by no means in total darkness concerning the
nature of hypnotism, catalepsy, trance, and allied condi¬
tions. Doubtless we see through a glass darkly, but tlris
j may be said of all knowledge, including medicine. We
shall first give an exposition of the facts met with in the
! states under consideration, and then bring this knowledge
! to a focus, and endeavour as far as possible to see what
anatomical and physiological interpretations may be put
upon the facts. It would take up far more space than We
have at our present disposal to discuss the strictly psycho¬
logical and other mental aspects of these diseases, but we
believe that at the present juncture a physiological explana¬
tion or attempt at an explanation may prove acceptable in
the face of the case of M. Chauffat, now attracting so much
public attention.

In catalepsy, hypnotism, and the like states, the con¬
spicuous feature is the loss of the ordinary consciousness
of the individual, the subject of the abnormal state. This
\ loss varies in degree. It may be profound and deep, so as
not to be recovered by any artificial means, or it may be
recoverable by external stimulation of greater or lew
intensity. Again, it may vary in itself, probably as the
result of internal conditions of the cerebral cortex, and
this variation may be so great that, on the one hand,
consciousness is almost normal, or, on the other, fully in
abeyance. It is most necessary to recognise this irregularity
and variability in order fully to understand, so far as is
possible, all the facts that have hitherto been observed.
There are, besides the loss of consciousness, other pheno;

( mena of which mention must be made. And the same
I variableness may be met with in these. An individual in

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HYPNOTISM AND CATALEPSY.

r^juLtciawi 707

the hypnotic state way perform certain actions, often of a ;
oomplipated nature, under Uje influence , of wflat our Pane
oettfrkrm eaU “ smjgestian.” This fact implies the pert
sutenee of function of certain tracts of brain tiseue almost
eertainly situated above the level of the lowest sensori¬
motor areas, spinp-bulber centres, and probably in the
oortax of the cerebrum and cerebellum, in catalepsy, as
a rule, rigidity of the. voluntary muscles also exists, and
likewise a condition known as wax-like plasticity —
flaxihjlitaa oeiea—a state which is detected after over¬
coming the primary muscular rigidity, and which allows
of the limbs or other parts of the body being placed in the
meet awkward, constrained, and inconvenient postures.
Indeed* the tisanes appear to be as plastic as wax of a certain
temperature, and can be moulded almost to the same extent.
Once moulded, the tissues take on a rigidity that casts the
nsasolea as though they, bad suddenly solidified, and from
pliable wax bed become solid bronze. Bat this is not all.
ru yaain kinds of stimulation -as, for example, gentle but
mpid stroking of the skin, or pressure on some nerves—
have the property of relaxing the rigidity and of causing
the limb or port to return to its customary condition. Of
tbs eocuracy of the facts which we have just described;
them can now be no kind erf doubt. The .phenomena i
may he ascertained without the slightest difficulty. Take,!
Jot example, the fixation of the leg of such a patient as
CH*tnr?43V bet anyone in full health, strength, and
ppasoioutTifgg try eonohiajpps with this patient. -He will:
find, that attempts at maintaining his own lower extremity |
inhbe ( poeture he may already have placed Csauffat’s will,
not he long successful. Most recumbent individuals could,
not pus leg raised at an angle of 60° for

mme tba# . fifty or sixty seconds, without considerable
pain and; tremulousness developing, and leading to a 1
4"w e desire to desist from the continuance of a task
involving so much distress, With, ChAuffat, or another
cataleptic, several minutes would elapse ore tremor developed,
and the leg would not fall until complete exhaustion had
•St ish-an exhaustion that takes a much longer time to
•gpsac. fbfo™ m a conscious healthy subject. It is hardly!
fTTr^fi for anyone to simulate the condition of flexibilitas
W We , and it does not seem within the bounds of reason to !
suppose that s conscious individual would pezm it the various i
painful excitations of hissens»s without evincing some signs;
of his having expenenoed the®.

a. Tbfusapmfudion, anatomical and physiological,.,that we
hav^ioaltersap* to foMy Seated in Iks following,manner,
flsaschwaa— is only posflibl* phynoli^icaUy whan the
butt of the eortieel perceptive oeutras are in a state of
normal functional activity. Loss of oonsciouaness varying
in depth fe concurrent with loss of. function of the cortical
PStoep U ve qentrw, aleo varying in degree. , We know as
wdl as it is possible to know, that removal or damage pf
the whole of the oerebral eortex behind the motor region,”
tmnld .destroy perception of all sensory impressions. We
We also perfectly, certain that a still more limited lesion of
to n t rip e t a l pa^M oonlfi produce a similar effect. An
*>*W4aal,hi wto^^>4pwway" or posterior
^rti the Jijfik of; the : internal capsulp on

•toM^l^ad- haW completely severed , would be totally
■•WttHllto kkpcessioiM on his tactile, auditory, visual.

olfaotory, gustatory, and probably viaeeral organa If we
imagine that in catalepsy there is a total Iom .of the
funotione of the cortical perceptive centres^ a toss that
may be caused by essential molecular ohany% or due to
blood poisoning or ooareer disease—for it must be remamr
bered that meningit is. tumours, softening,, and m ala ri a may
he the efficient causes of catalepsy,—an explanation^ import
feet and incomplete we grant, would be forthcoming of. thfi
symptoms and signs met with in catalepsy end hypwdgWPh
it is highly improbable that an individual in posse m ifiH
of the proper use of the “ motor" and prtefsoahMi imgfou#
pf bis brain would be in a state of ordinary cogacfouyr
ness. In these regions ace locked up innumerable motor
mec ha n i sms, and these may be unlocked and a# agoing
through the centripetal cha n nels not concerned, m the
causation of consciousness. Indeed, it is a fact,,that,:*#
the movements which a cataleptic individual a&u be made
to perform oome witfun the category of automatic, move*
ments, It is dear that in the absence of owacimweto
new movements cannot be acquired, and w» mar tokf it
for granted that mechanisms exist, preformed ip the bri*m»
for all the actions ordinarily performed by US- : <ks <H9 flto%
tration, we peed but mention the mraumatanc#, that, moot
individuals go through sush prooesses as undressings, fo ^
purely automatic fashion, the mind being occupied, #ddu ti#
while by a train of thought. The placing, of
hand in the fighting posture leads to the dayelopmwti
of a menacing expression of the co¥kfofton«t,!jft?%
acfouwtoss. need, not .be involved in sfiefi
for it ie curtain that mechanisms of a wnfori-mytofrkiufi
exist near together un the;motor region of the fix^vr
a region which there are good grounds for befie^n^pfr
be the seat of “ muscular, sense "fs. well
efferent motor impulses., Pkwtioity and
hardly be explained on the assumptiop that the bulbor spinal
centres are alone in aotion. It would-nbviensty pot explain
the former phenomenon, and certainly rnm^o.rjgigity; Ifr
this implies over~»ction,of wbfob there,isnopthe?e^ento
than the mere rigidity,for the.reflejto• (•fifi
increased, and may even be djraioighed, in oatf l epq fy , ,,<•

In whatever shape the proposals, yt thpse anxious for the
reform of the University of London may be, adopted,, the
existing constitution of the University is deemed* |h §ir
£. Fry’s original scheme* in that of'Sir P. Magnus, and in
the one now before the Senate, associated Colleges ^d pfroip
representatives are introduced between tjae Senate and
members of Convocation,and duties ,of m°to.OP less im¬
portance are to be delegated to them. The. Senate ami the
graduates in Convocation wfilyb®

and Boards of Studies,.either..as such, as ip th.C ,uey
scheme, or as a Council of Education, as suggp«t<$by
Sir P. Magnus, and op these the representatives the
Colleges will form the chief or sole element. It, !? by
this infusion of teachers that the hujfineas of ^ iot^l. pni,-
versity is mainly to be oarrie^ op,- hut we. question n^ph
whether the graduates in Convocation will notjfncoMfifulty
attempt to weaken these clauses and substitute for { th^u
those in Sir P. Magnus’s scheme, if t suph r a t^urse be
,adopted, the teaching element will fye'^jftalj in pf^portion,
and so liable to be outvoted in the Boards of Studies apd the

768 (Tbs lancet,}. THE PROPOSED RECONSTITUTION OF THE UNIVERSITY OF LONDON. [Apart9,1887.

Council of Education by representatives of Convocation, who
may have no knowledge of the requirements of a suitable
curriculum, so that the value of the other proposals will be
reduced to a minimum. But even if the provisions of the new
Bcheme be passed, they are too cumbrous and too ill-defined
to give any reasonable hope of their being made capable of
forming a basis for a real Teaching University, which is the
great want in London. Bodies of insufficient weight and
standing must be admitted if these clauses stand, and the
larger educational Colleges will practically have no increased
representation, influence, or power. This seems to us a
fatal objection to the scheme. It is better to wait for a
real Teaching University in London than to adopt a feeble 1
substitute, which will weaken the absolute rule of the pre¬
sent Senate and impair the efficiency of the Examining
Board for the empire, and not satisfy the aspirations of the
teachers in the London Colleges which can fairly claim to be
of university rank and standing. These defects will be
clearly shown in an analysis of the proposed changes.

The University is to consist of (1) Senate, (2) Convocation,
(8) Associated Colleges, (4) Faculties, (5) Boards of Studies,
with the Queen as visitor, instead of merely Senate and
Convocation as at present. The thirty-seven Fellows com¬
posing the Senate are to be divided into sixteen Crown
nominees, the chairman of Convocation, twelve representa¬
tives of Convocation voting as graduates in Arts, Laws,
Bcience, and Medicine separately; and eight direct repre¬
sentatives of the Faculties, also voting separately. The
representatives of University and King’s Colleges, the Col¬
leges of Physicians and Surgeons, and of the Legal Councils,
which were expressly named in the former schemes, have
disappeared altogether, and their places are practically given
to the representatives of the Faculties, so that the exceptional
position of University and King’s Colleges, and the advan¬
tages of association with the medical and legal corporations
on which formerly so much stress was laid, are now put aside;
but by a majority of one the Senate has determined that
this question shall be reconsidered by the Special Committee.
Life Senatorship is to be abolished in favour of a tenure of
eight years * but Convocation has already favoured the still
shorter period of four years, and this seems to us preferable,
especially as retiring members are eligible tot re-election.
Except for an increase from nine to twelve representatives
on the Senate, the powers of Convocation will remain
unchanged, whereas, in Sir P. Magnus’s Scheme, which
Convocation adopted on June 29th, 1880, members of
Convocation, as well as the Colleges and the examiners,
were to form the Council of Education or intermediate
body between the Senate and the graduates. This differ¬
ence is a vital one, and we fear it will endanger the
passing of the scheme through Convocation, whilst, if the
alternative be adopted, the whole Scheme will in the eyes
of the teachers be worthless. The Faculties are now to
be constituted solely by the representatives of associated
Colleges, divided under Arts, Laws, Science, and Medicine,
and each Faculty will elect members, who, with an
examiner in each subject in the Faculty, will constitute
the Board of Studies in each Faculty. These Boards
of Studies will elect a chairman every year; consider and
Teport to the Senate upon any matter referred to it by the
Senate; express opinions on any matter connected with

degrees, examinations, and teaching; and deliberate, if so
requested, with the Senate, or report to the respective
Faculties. They will thus form either distinct or conjoint
permanent consultative bodies, whilst the Senate remains the
sole executive. The associated Colleges are to be selected
from Colleges and teaching institutions in any part of the
United Kingdom, and may be named in a sohedule prior to
any application foj a Charter, or be afterwards admitted by
a Committee of Selection. This will be considered a weak
alternative by those interested in promoting a Teaching
University in London, and cannot but be opposed by that
Association. The Medical Schools and Colleges from which
the University receives certificates for degrees in Medicine
will retain their right of giving such certificates, whether
they be or be not associated Colleges. The present method
of granting degrees is to be maintained, except that the
Senate will ask for power to grant honorary degrees, which
Convocation has nlways steadily declined to sanction. The
last clause is so peculiar that we reproduce it verbatim:
“ Power to hold real property, and to accept grants, gifts,
devises, and legacies for the purposes of the University,
including the establishment of professorships and scholar¬
ships, and the furtherance of regular and liberal education
and of original research. Provided that no professorship or
lectureship be established in the University of a kind likely
to compete with any teaching given in University College,
London, or to injuriously affect the reasonable prospects of
that College.” Negotiations with that College will be held
before applying for a Charter, The opposition of University
College is to be bought off by this clause, and every other
College and Medical School must take care of itself. A
more palpable bribe to the section of the professors in Uni¬
versity College which opposes the movement for a Teaching
University, or a more unfair proposal, was never introduced
into a University scheme than this proviso. Other insti¬
tutions are concerned in the higher medical and general
education as well as University College. As some ques¬
tions are referred back t*S the Special Committee, which is
requested to confer with the Committee of Convocation,
and then report to the Senate, it is obvious that the scheme
will not be sufficiently complete to lay before Convocation at
the May meeting, and that a special meeting will have to be
summoned for its consideration at a later date.

Professor Max MUller has inaugurated a good work,
which may be described as the repair of philosophical
breakages. There can be no question that philosophy and
science are suffering from that merciless reduction of their
subject-matter to very small pieces which has resulted from
abuse of the analytical method, both in inquiry and in
criticism. The aim of every student of art and nature has
been to discover differences between things, and to formulate
what have been termed specific characteristics with a view
to classification. It has been so in the natural sciences, and
it has been so in what may be termed the unnatural
sciences, or those which deal with abnormalities, in¬
cluding pathologies. The gain would be enormous if thi6
plague of disintegration could be stayed. Professor M ax
MUller thinks Darwin would have added greatly to the
already high value of his services to philosophy and science
if he had abandoned the term species when he placed the facts

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TUB REPAIR OP PHILOSOPHIC'BREAKAGES.

f Aphtt. 9,1887. 739

^•differetttijitibn in A new light by his discovery. Accept¬
ing, os we mukt, the doctrine that words are not merely the,
instruments, but fyi a sense the integers of thought, it
is manifest that any, misuse of terms, must be of. more,
serious iqoment than any mere clumsiness in the.namjug of
facts. MaxMeyjiKR wqott impfroxe ourintalleotual work!
and clear our brainfe by purifying our language, and with a|
Tiew to the simplification of the task he would have us'cat
adrift as mu,ch a§ possible of the lumber that encumbers and
strains both philosophy aud science. This is the lesson we
read in his;lecture on Thought, and it is one that may well
he learned- by all who have the real and far-eeaehiag -
interests of truth and knowledge at heart. To think simply
end well 1 is the 'first eoftdition of good and useful
labour 'in the province of mind; and simple, clear,
and effective thinking is not possible unless “thinks,”
or, things, are understood in their simplicity. The practical
difficulty of simplification lies in the fact that everything
is many-sided, and that, in order to obtain a sufficient notion
of an object or a subject, we must, so to say, walk round it
and observe each of its faces, and in doing this we cannot
possibly avoid making such abstractions as are essential to
the recognition of differences. There is food for earnest
reflection in Professor Max MtLLBB’s discourse on this most
interesting subject, and we can only regret that it does
not form part of his programme to point out precisely how
the fragments of knowledge grouped under the head of the
medical ecienoes might be pieced together in such fashion
as to make-the views of those who need to be especially
single-eyed and clear-sighted less obscure and more complete.

^notations.

“ JJe quid nimis.”

DEGREES FOR LONDON MEDICAL STUDENTS.

Tech deoision arrived at by the Committee of Delegates of
the Royal Colleges of Physicians and Surgeons to recom¬
mend their respective Colleges not to confer at present with
University and King’s Colleges, but to proceed conjointly
and independently of other bodies, in their endeavour to
obtain the right to confer degrees in Medicine and Surgery,
will be received with much regret by all who are anxious to
secure an academic degree for medical students in London,
and will in no way diminish the opposition to a mere pro¬
fessional title, but tend to increase it. The provincial
schools will insist on their claim to equal rights and
privileges with the Loudon medical schools, in any action
taken by the two Royal Colleges, of which they claim to be
cctatitumt' factors, and they will be strengthened by the
professors and councils of University and King’s Colleges,
who will protest against a degree being conferred, in one
Faculty only, by two professional corporations without
university rank or academic status. The entire weight
of the University interest ih London and the country will
now be thrown against the scheme, whereas by con¬
junction with University and King's Colleges the aata-
Suhism of the University of London would have been
the only Opposition to be apprehended on the academic side,
ttd We have no doubt on which side t.he * argument for
44 least resistance”' really lies. With the University of
Wudon applying f6T a 1 new charter, which will be opposed
byffiany Of it* riwi graduates iii Convocation and by those
whb ire fcfeOtiioting the movement iu 1 favour 1 of a Teaching

•University in London'; with University and King's Colleges
also applying for a charter to grant non-medical degrees,
which will be opposed by the existing University, which dares
■not let its largest colleges secede without a struggle ; with
the Tfoyal Colleges, again,’endeavouring to obtain a charter
to grant medical degrees—a movement that will be
opposed by'the provincial schools if a residential qualifi¬
cation be inserted'and only half-heartedly supported by
London teachers J if this be omitted; by University
and King's Colleges, whq know that rft>w or never they
must become real constituents of a University;, by, all
interested in founding a Teaching University inLondon, who
will not willingly see the chief Faculty of such a Univer¬
sity slip from the combination; by the Irish and Sootch
corporations, which will seek similar, powers out of jealousy
and self-interest; and by the Apothecaries’Society, which
has been contemptuously thrust aaide,—the outlook ia net
. a hopeful one.. We are quite sure that it would have .been
more to the advantage of students if the.qDcstion had been
considered on a wider basis, And that less opposition to the
degree would thereby have been aroused. Indeed, we still
hope that the Crown will insist on the different bodies
waiving their personal prejudices and jealousies, and compel
them to unite to form, a real University, such as exists in
every metropolis and educational centre in the world except
London. .

REGENT CHANGES IN EXAMINATION
REGULATIONS.

Two regulations of some importance to students Were
recently passed by the College's of Physicians and Surgeons
Upon the recommendation of the Committee of Management.
The one refers to the period at which a candidate may again
present himself after rejection at the final examination.
Hitherto this period has been fixed at six months—rather a
long time in the case of those who nearly attain the requisite
standard, and entailing some hardship at the close of their
curriculum. We think -thatr the Committee have done
wisely to allow such candidates as obtain fourteen out of
the fifteen marks required to pass such examination to be
admitted to re-examination after a period of three instead
of six months’ study. The other change adopted is in the
regulations for the primary and elementary examination in
anatomy and physiology. IG allows a candidate to he
admitted to this examination on the Completion of his first
six months’ attendance at a recognised medical school
(exclusive of the months of April,' August, and September),
instead of the stipulation that he should not be allowed to
•ompete until the close of his first winter session. This
change ought to be productive of a larger May entry in the
schools, and a large number of candidates at the January
examination, which will greatly relieve the plethora now
experienced ih April. With reference to this question, it
may be useful to point out Certain other directions in which
these examinations may be Improved. The principle reco¬
gnised in the foregoing regulation of the first examination
might well be applied to the second examination also; and
in that case there would be no need to hold more than three
such examinations yearly. The October examinations in
anatomy and physiology are of little advantage, since the
schools are closed during the greater part of the interval
between that examination and the preceding. It is only for
the final examination that the opportunities for study—i.e.,
clinical work—are available during this time. Again, the
option allowed to candidates of entering for one subject
only should not obtain for the second examination, anatomy
and physiology being so closely connected with one another.
A more liberal system of marking might also with Advantage
be introduced, for a maximum of fifteen marks for a whole
examination's an absurdlysmall number, and must be dlffl-

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740 Thb Lancet,]

PHYSIOLOGICAL ACTION OF NITROUS OXIDE GAS.

[Aped, 9,1887.

cult for the examiners to work with satisfactorily. Lastly,
a candidate who has been rejected in all the subjects of the
first examination is required to pay a higher fee than that
originally charged, for a rejection in each of the four sub¬
jects entails an additional fee of £3 3s., so that on his
second appearance he pays £12 12s. instead of £1010s.! This
is clearly anomalous, and has probably been overlooked by
the Committee of Management, who might profitably take
the whole subject of fees into consideration.

THE ELECTION OF PRESIDENT OF THE ROYAL
COLLEGE OF PHYSICIANS.

We are glad to chronicle the fact that, at the meeting of
the College of Physicians on the 4th inst., Sir William Jenner
was for the seventh time elected to fill the office of Pre¬
sident. The somewhat antiquated mode of election, without
previous nomination, required (as it often has done) a
second ballot, for unless on the first voting the Fellow
whose name stands first has obtained the suffrages of two-
thirds of those present at the meeting, the Fellows are
called upon again to decide between him and the Fellow
whose name stands next on the list of the first ballot. It is
clear, therefore, that the first ballot does not indicate the full
wishes of the College, many names often being returned
with the view of showing who are eligible for the high
office, it may be interesting to note that Sir William
received 73 votes out of 120, the Fellows amongst whom
the remaining 47 votes were distributed being Sir William
Gull, Dr. Quain, Sir A. Clark, Dr. Wilks, Dr. Johnson, Sir H.
Pitman, Dr. Andrew, and Dr. Ogle. Sir W. Gull’s name on
this occasion stood second, and the second ballot resulted in
the return of Sir W. Jenner by an overwhelming majority—
09 to 13. Sir William accepted this result as the practically
unanimous wish of the College that he should continue as
President for a seventh term, and he suitably expressed his
sense of the high honour thus conferred.

PHYSIOLOGICAL ACTION OF NITROUS OXIDE GAS.

Db. Dudley Buxton has communicated two valuable
papers upon the above subject to the Odontological Society,
based upon numerous clinical observations and experiments.
The effects of nitrous oxide inhalation upon the mammalian
organism are, he says, broadly speaking—(1) a condition of
anaesthesia; (2) an emotional state, provoking a sensation
of exhilaration—in fact, it plays the role of a stimulant:

(3) it gives rise to modifications of the respiratory and

(4) circulatory systems; and (5) provokes marked muscular
movements, which may be classed as (a) rigidity and (6) jac¬
titations. The anaesthesia produced by nitrous oxide is tot
dependent upon analgesia or loss of sensation of painful
impressions of the sensory end-organs, such as that pro¬
duced by cocaine &c., or upon failure of the conducting
sensory nerves, for sensation is retained until the perceptive
powers themselves cease to receive; moreover, there is
immediately anterior to the loss of consciousness a hyper-
aesthetic stage, therefore it may be concluded that the nerve
centres are acted upon. The ways by which nitrous oxide
may enter the system, and is enabled to produce its special
effects are—either that it gives rise to other bodies by changes
in its chemical form, or by acting as an irrespirable gas and
causing asphyxia, or by exercising a specific action, just as
strychnine docs. Dr. Frankland came to the conclusion that
nitrous oxide was not decomposed during its sojourn in the
body, basing his opinion upon analyses made of the air
expired by rabbits when confined in an atmosphere of mixed
air and nitrous oxide. Io the first stage of asphyxia, that of
dyspnoea, there is an increase in the respiratory movements,
both inspiratory and expiratory; in the second, a dominance

of the expiratory efforts, culminating in general convulsions;
in the last, exhaustion, with long-drawn inspirations,
gradually dying out. The blood-pressure during the first
and second stages rapidly rises. Dr. Dudley Buxton has
never observed an increase in the expiratory movements
when HOj has been administered, which are merely in¬
creased in number and depth, or expiratory convul¬
sions, notwithstanding the gas has been pushed to its
utmost limit, and from a large number of epbygmo-
graphic tracings the tension in the arteries has been lower
than normal. In experiments upon dogs, Dr. Buxton found
that where a trephine-hole was made through the skull,
during the inhalation of the gas the brain pulsations became
more forcible and somewhat hurried; then the brain sub¬
stance was seen to swell up, until at last it actually protruded
through the aperture; whereas in a similar experiment,
with the trachea occluded, the brain receded, sinking away
from the opening. Other experiments showed that the
heart’s action was but little interfered with by nitrous oxide,
even where the inhalations were pushed until respiration
was interrupted; during asphyxia, on the other hand, a
rapid and continuous increase in blood-pressure invariably
occurred. The dose of nitrous oxide required toproduoeinsen¬
sibility varies very considerably in different persons—a fact
which supports the view that nitrous oxide exerts a specific
action on the nerve centres. Dr. Buxton also discusses many
other interesting points in the action of the gas, such as the
occurrence of hallucinations.

THE CASE OF TRANCE.

Normal consciousness has not yet returned to M. Chauffat,
who is now in the thirteenth day of his “ sleep.” Bat there
are signs indicating the possible near approach of restora¬
tion to the natural state of life. The loss of consciousness
is less profound. It is possible to awake Chauffat with but
little external stimulation. Moreover, during the past three
days evidence of a wider awakening of intellect has been
shown; acts are performed indicating the revival of consider¬
able powers of memory. The anatomical substratum of
mind can be aroused to such a state of activity that
apparently correct answers relating to questions involving
a ready remembrance of past scenes and acts may be
obtained from the patient. These replies cannot be
communicated by word of mouth, bub Chauffat makes
himself understood by the aid of fair penmanship. To
the lay mind, doubtless such facts appear extraordinary,
but medical men are familiar with cases of brain disease in
which similar phenomena obtain. Ashappened after Chauffat'*
previous attacks of hysterical catalepsy, paralysis of the left
leg and dumbness persist some time after the recovery of
power over the other movements of the body. It is difficult
to explain in Chauffat’s case why the cerebral centres con¬
trolling the speech movements—ordinarily subserved by the
left side of the brain in right-handed individuals—and
those presumably in the right side of the brain presiding
over the movements of the left leg should remain so much
longer in the w sleeping ” state than the large remainder of
the oerebral cortex. The ultimate recovery of these centres,
however, proves that they are not the seat of gross changes.
Employing an analogy from electricity, we may imagine
that the speech and left leg centres take a longer time
to recharge with the vis nervosa. It may be remembered
that Chauffat has uttered a few words, such as “ thief,”
“scoundrel," and a number which is believed to be that of
the cab in which he was last driven. Such ejaculations also
show that the speech centres can be thrown into action,
but probably only as the result of powerful excitation. This
is in accord with all previous observations. It may be asked
why the above-mentioned w^rdp, and not others, were
spoken. The reply to this question is that it is very pro-

Google

Die

Tn Lancbt,] THE CROONIAN TRUST.—ALLEGED ILL EFFECTS OF VACCINATION. [Apbh. 9,1887. 741

baWe that the words were some of the last used or about to
be used by Chauffat before he became unconscious. Highly
probable is it that the molecular changes, the accompani¬
ments of these words, in the speech centres leave more than
usually permanent traces, the physical bases of memory,
which render the words more liable to be uttered, under the
influence of limitations, than words which have left less
indelible markings. The other functions of the patient have
undergone a satisfactory improvement, but their condition
presents little that is of special interest. We may refer
for further oomments on the trance condition to an article
on page 736. _

THE CROONIAN TRUST.

Aftbr some delay and much discussion, the Royal College
of Physicians have agreed to a scheme whereby the large
funds that now accrue from the Croonian Trust may be
utilised. It may be remembered that last year it was
decided that there should be one or more lecturers appointed
“ to deliver lectures on one or more subjects in Anatomy,
Physiology, and Pathology, with a view to the prevention,
control, and cure of diseases,” and that the funds should be
administered in payment of such lecturer or lecturers, and
in promoting scientific investigations on the subjects of the
lectures. The regulations adopted at the last meeting of
the College—which will be found on another page—are
in accordance with these resolutions, it will be seen
that provision is made for the reappointment of the lecturer,
whose duty it will be to deliver a course of not less than
four lectures annually. In this way the lecturer will be
free to take up subjects which may entail prolonged investi¬
gation. At the same time, it might have been well to have
placed some limit upon his term of office, the only objection
to that being that be might feel bound in every case to
hold it for the full number of years assigned. The devo¬
tion of the surplus of the fund to defray expenses of
original investigation by a past or present Croonian lecturer
strikes us as somewhat limiting the benefits to be de¬
rived from the fund; and we should prefer to have
seen the proposal to nominate, from time to time, a
junior Fellow to a Croonian Fellowship. But the com¬
mittee, who doubtless considered this point, may have felt
their hands tied by the original terms of the trust. It now
remains for the choice of the President and Censors to be
made with circumspection; and we may hope that the
oause of scientific medicine will be promoted in the selection
of lecturers who will be enabled to devote their time to
original investigations. Lastly, it may be noted that the
time fixed for the delivery of the lectures is iu the month
of June, instead of in March as at present, and that the first
course will be given in 1888. It must therefore soon de¬
volve upon the President and Censors to make their selection.

ALLEGED ILL EFFECTS OF VACCINATION.

Ax inquest was held by Dr. Danford Thomas on the
29th ult. touching the death of Ellen Jane Herring, aged
four months. The deceased child was vaccinated by the
public vaccinator a month prior to its decease. A few days
before death another medical man was consulted as the
child grew ill. Coma supervened and proved fatal. A cer¬
tificate was given that death was due primarily to menin¬
gitis, and secondarily to “ the effects of vaccination.” The
vaccinia had progressed in a normal manner in every
particular. There was very little constitutional disturbance,
and unusually little inflammation about the vaccination
points. 8fcveral other children were vaccinated from the
«m of deceased. There were no signs or symptoms of blood
pokoning. The manner in which the death certificate was
written was most unfortunate, for at the inquest the doctor
who sighed it deposed that he intended to convey no more

than that vaccinia, being a specific fever, had somewhat
lowered the vital powers of the child, and so to a certain extent
had acted as an accelerating cause of death. So far this
was true, but both the popular and professional interpreta¬
tion of the certificate would be something far graver. In
shqrt, the certificate was calculated to credit vaccination
with the death, and discredit a valuable life-saving pro¬
cedure. Very properly a post-mortem examination was
ordered to be made. At the necropsy it was found that there
was typical tubercular meningitis with haemorrhage beneath
the arachnoid. The inflammation was purely basal. Both
lungs were thickly studded with quite recent miliary granula¬
tions. The mesenteric glands were tubercular,* some con¬
taining caseous matter, and others suppurating. There were
no metastatic infarcts or abscesses; in fact, there was com¬
plete absenoe of anything that could be assigned to pyiemic
infection. The vaccination scars were norma), and there was
no infiltration of inflammatory matter around them or in
the associated lymphatic glands. Mr. Pepper stated that, in
his opinion, the vaccination had been satisfactorily per¬
formed and that the vaccinia had run a natural course; and,
further, that the vaccination had little or no effect on the
development and progress of the tuberculosis, which had
commenced previously to it, and which would inevitably have
proved fatal within a short period had vaccination not been
performed. The jury unanimously accepted these opinions,
and recorded the same in their verdict.

THE CARMARTHEN INQUEST CASE.

On March 25bh last an inquest was held at Carmarthen
before Mr. John Hughes, F.R.C.S., coroner, concerning the
death of George James, aged forty-seven, head constable.
From the evidence reported we gather that deceased had
suffered for some time from nervousness and want of sleep,
but that otherwise he wa9 not known to be in ill-health.
Soporifics had been administered by Mr. J. E. Edwards,
M.R.C.S., and on the day of hi9 death deceased applied for
more medicine. Mr. Edwards made up a draught contain¬
ing half a drachm of chloral hydrate and half a drachm of
bromide of potassium, and gave both written and oral
instructions that half the contents of the bottle were to be
taken at once and the other moiety three hours later if re¬
quired. Deceased wilfully disobeyed the doctor’s orders
and took the whole quantity in one dose, and almost
immediately died. If the medicine was dispensed as
described we cannot doubt that the death was due
to other causes, and even if the dose had been large
enough to be probably a fatal one, we should not expect
death to occur so suddenly as it did. The medical man who
made the post-mortem examination deposed that “ there
were no symptoms of chloral poisoning, and no signs of dis¬
ease in the internal organs, and he could offer no opinion as
to what was the cause of death.” The jury returned the
verdict, “Death by the visitation of God." On theological
grounds such verdict might bs found in every case of
death; but from a medical and scientific standpoint it is
merely a record of ignorance of the facts underlying the
event under consideration. It must not be concluded
that because no chemical tests for chloral give affirmative
evidence of its presence in the body after death, there¬
fore it may not have been taken even in a lethal dose,
for experience teaches the contrary. In our opinion, Mr.
Edwards must be acquitted of all blame in the unfor-
tnnate matter of the death of Mr. James. He had a
perfect right to prescribe chloral, if, in his judgment, he
thought fit; and oertainly he cannot be accused of careless¬
ness in the matter of giving directions as to how the
medicine was to be taken. We fully endorse the protest be
made at the inquest, that he was not informed of the time
and place of the post-mertem examination. To some

742 r ThDi Lajicbt,] ’

CONGENITAL OCCL0SION OP TUB PHARYNX. ■

■ - [April »; 4887.

extent his professional conduct had boen impugned by
the friends of deceased, and, moreover, the coroner, in
the exercise of his judicial function, cautioned Mr. Edwards
as .to the evidence he was about to tender, thus pro¬
perty, bat unfortunately, giving some colour to the
loose accusation of blame that had been laid at his
deor. It is true there is no legal responsibility com¬
pelling the coroner, or the medical man commissioned to
make the examination, to give notice to individuals con¬
cerned in the issue of the inquiry, but it is none the less
desirable that such practice should always obtain. The
coroner for Central Middlesex is very strict on this matter
of procedure. With the order for making a post-mortem
examination he encloses notices for any other medioal men
concerned, leaving the time of the examination to be filled
in by the gentleman who is to officiate at the necropsy. We
commend this discretionary action to all coroners, medical
or otherwise. Mr. Edwards has our sympathy in the some¬
what painful position in which he has been placed.

CONGENITAL OCCLUSION OF THE PHARYNX.

A Spanish practitioner, Don M. D. lllera, gives in El SIr/Io
MC'lico an account of a case in which a newly born child
could not be taught to suck, and whose mouth on the intro¬
duction of the finger grasped it like a ring. On inspection
the middle third and edges of the tongue were found to be
connected to the superior alveoli by firm adhesions, which
entirely prevented the organ from being depressed. In
addition to these adhesions, two little tumours were seen on
the palate near the arch of the fauces, which almost occluded
the passage into the pharyiix, thus rendering swallowing of
liquids almost impossible. It was evident, therefore, that
unless operative measures were resorted to the child must
necessarily succumb very shortly from sheer inanition. The
parents, however, though the state of the case was laid before
them, refused to permit of an operation. till the fourth or
fifth day, when they decided to allow it. Don lllera seized
the tumours with forceps and cut them off at the base,
touching the bleeding surfaces immediately with the actual
cautery. The adhesions were then divided, and after the
application of a sponge with cold water for a few hours,
repeated very frequently, the child was able to swallow some
milk quite easily, and ultimately attained complete use of
the tongue. Don lllera was induced to publish this case, as he
once saw a similar case in which the practitioner in attend¬
ance had considered the risk of operation too great to be
attempted. _

MORAL DISCIPLINE OF LUNATICS.

Git anted that very much of the wrong-doing of eccentric
persons is the outcome of mental derangement, the question
arises whether or not, in the interests of the individual as
well as of society, it ought to be regarded as crime or
insanity. We are of opinion that this quostion can never be
answered as directly and simply a9 many respectable autho¬
rities desire that it should be. We incline to the belief that
no hard-and-fast line can ever be drawn between crime and
madness. There are undoubtedly, we think, cases in which,
as Dr. Edgar Sheppard pointed out years ago, there is an
admixture of wickedness and disease in which the propor¬
tion of the two constitutional elements may vary almost
indefinitely. If that be so, then it is manifest that each
individual case must be studied and treated on-its particular
merits. Accordingly, we are not disposed either to blame
all judges and justices of the peace who sentence lunatics
to terms of imprisonment, or to maintain the plea of in¬
sanity on behalf of all transgressors. Moral discipline of the
sort whioh consists in the punishment of offences, whether
t$$se offences be wholly malevolent or partially insane, is

by no means inadmissible in the treatment of mental disorder
or disease. It is not for the advantage of the weak-minded
that they should be allowed to think that the hypo¬
thesis of irresponsibility will cover any multitude of ains.
Better far let these half-mad folk understand once for'
all that if -they outrage public decency or assault ■ their
neighbours they will hare to suffer for the offence. These
are general remarks, and we do not wish to apply them
specifically; but the principle of moral discipline is, we
are convinced, a sound one, and neither-the lunatic popola-.
tion nor the community as a whole will suffer by reason of
its being enforced. _

THE CORONER’S CENSURE ON A MEDICAL
STUDENT.

Late on Saturday night, the 38th ulfc., a man aged twenty-
four, was taken to St. Thomas’s Hospital by the poKce; he
was said to have been “ run over ” by a tramcar about an
hour previously. A medical man, who had seen him earlier,
thought that he was suffering from internal injuries. The
dresser who saw the man on his arrival at the hospital made
a very careful examination, bnt failed to discover anything
beyond a small scalp wound, two abrasions on the back, and
another on one of the legs. The patient was quarrelsome,
coaid not answer questions coherently, presented no signs
of shock, and was in a condition of semi-dntoxicatlon. With¬
out referring to the honse-snrgeon, the dresser, a Japanese
gentleman, told the police to take him away. He was taken
to the police-station and seen several times during the
night, as he was very noisy and vomited frequently; he
also went to the watercloset once. No complaint wae
made during the night, nor did he ask to see a doctor.
In the morning he dressed himself, and then com¬
plained for the first time of pain in the epigastrium,
but left the station by himself, having given bail. He
was soon after found by a policeman, not far from the
station, leaning against a wall and complaining of great
pain in the abdomen. The man was taken to the Wandsworth
Infirmary, where he died the saiii9 evening from peritonitis,
which at the post-mortem examination was found to have
been caused by a small rupture of the duodenum; there was
also a slight rupture of the liver. At the inquest on the
case, the coroner censured the dresser for not having called
the house-surgeon to see the man, saying that if it had not
been for the careful manner in which he had examined
the patient a verdict of manslaughter againBt the dreeser
might have been returned. We think in such a case no
person in a subordinate position should take upon himself to
pronounce an opinion or assume responsibility unnecessarily/
Although the house-surgeon might not have recognised the
injuries which were shown at the necropsy to exist, and the
symptoms of which were so long delayed, still he would
probably have admitted such a case and watched for their
development. . .

THE DIMINISHING USE OF ALCOHOL.

Wk share the satisfaction of all our contemporaries in
reflecting on the significance of a less expenditure on
alcohol. The expenditure on drink in 1838 was £122,905,785,
as compared wi f h £123,258,906 in 1885, or £303,121 less. Ten
years before, in 1876, the highest expenditure was reached —
viz., £148,283,759, or £1 9s. per head, as against £3 7s. Sri. in
1888. It is deeply to be regretted, however, that the
diminution in one year is not more than £363,121, in spite
of all the teaching of medical science and personal expe¬
rience. Not only is the diminished amount drunk still
enormous, but it is drunk by an ever-diminishing number
of persons. For there is an ever-increasing number of
persons who either totally abstain or drink exceedingly
I little. It is drunk, too, in a wrong way. All casual drink-

Digitized by GoOglC

THS^NtWltf i

THE HOXTON MUBDm CASB.^EBS HyGIBRfi P? OCCUPATIONS. [Avjjm,9,,1887» 74&

ing, drinking on an empty stomach, is bad, and makes
directly for disease. We must be thankful for any im¬
provement, however slight. But the disease implied in the
consumption of nearly 123 millions of money’s worth of
aloohol is enormous. A recent return to Parliament shows a
steady and large decrease of alcohol consumption in work-
houses. In the year ending Michaelmas, 1871, the .total cost
of intoxicants used in workhouses in England and Wales
was £82,554. The cost for 1885 was £44,820. In some
workhouses with a large number of inmates, as Wandsworth,
Lambeth, and Bethnal-green, no 1 intoxicants at all were
used. Similarly with several provincial workhouses. It.
cannot be too much impressed on guardians that there
should be no interference with the medical officers in regard
to the prescription of aloohol for the sick, nor upon the
medical officers that theirs is the responsibility of prescribing
it with care. The Parliamentary returns show that in
workhouse practice, as in private, the profession, is alive to
its responsibilities. _

THE HOXTON MURDER CASE.

Ws imagine there are few persons who will demur to the
finding of the jury in this case at the Central Criminal Court,
for, guided by the light of the existing law of this country,
there was abundance of evidence to show that Currell was
guilty of the crime of wilful murder. It is true there was
no direct or personal evidence against him, but the indirect
or circumstantial was so complete and consistent that no
doubt can be toft in the inquiring mind that the verdict
was fully warranted by the testimony. The convict on the
day of the murder borrowed a key of the house where
his sweetheart, the deceased woman, then lived. Shortly
afterwards, when accosted by an acquaintance with the
fact of the death, he replied, iu answer to the observa¬
tion “This is a serious matter for you,” “Yes, it is.”
At the same time he showed no concern to learn the
circumstances surrounding tiie death of Lydia Green. His
purloining deceased’s wages-from her fellow-workpeople,
together with bis subsequent flight, oau paly be explained,
on the theory of his guilt. But, putting on one side the
bearings of the legal technicalities of the case, we find ample
grounds to warrant us in affirming that the crime was not
wilful murder as understood by the medical jurist. That
Currell knew the nature and consequences of the act he was
about to commit we do not attempt to dispute, but that he
was of sound mind and understanding we feel justified in
denying. There is scaroely a miirder trial of the kind
under review in which the presiding judge does not brush
against the tangled thicket of law and alienism, and in the
*«cent gaol delivery.at the Old Bailey Mr. Justice Grantham,
although impartial ip his summing up, managed, we assert,
▼ith all respect, to run counter to the laws that govern
mental science. HU lordship remarked in his charge to the
jnry: u The absence of motive of anger, or of passion, or of
any wrong to be revenged only increases the enormity of
your crime. 7 This sentence would meet with our approval
w erfe it justifiable to assume that all the facts underlying
the crime were known (and who can doobtityiat many were
hidden in the minds of the murderer and his victim?), and
still more that Currell was at the time free from impulses
an governable by an impotent will. As regards motive, we
are entirely at one with, the learned judge, for in few in¬
stances can the act'of murder fina a commensurate excuse,
and,« a rutopit is' idle and 1 'futile to endeavour to-fathom
the causes of capital crime Where the evidence to only air-
cnmateatfiai. We trust the Home Secretary will order a
commission to inquire into Currents antecedents and*

condition* The. justification for such, a pro-
may be found in Mn Justice Grantham’s weighty
reai *rkj.Mift may 6& 4tat yen [Committed thie murder in.
* me and irrational Hate of mind.” We are

no advocates for allowing crime to go unpunished, but
it is our bounden duty to plead that life shall not
be taken except in cases in which there is the
clearest and fullest proof that it has, in the most un- <
qualified sense of the term, been wilfully sacrificed by :
the accused. It must be proved beyond all reasonable
doubt that Currell’s “ peculiar temperament” cannot be trans¬
lated as his uncontrollable impulse, before the sheriff and
the hangman have carried out the last scene in the drama of
the convict’s miserable existence. Both Mr. Davies,, who waa
called to see the deceased woman shortly after the.murder,,
apd Dr. Burchell, who conducted the post-mortem examina-»,
tion, were censured by the judge: the former for neglecting
to investigate the case more fully, and for hastily assuming
that the wounds might have been occasioned by a fall; and
the latter for having trusted to his memory for facts observed,
at the necropsy. In extenuation of Mr. Davies’s mistake,,
we believe it may be urged that he was called from
a case of labour that demanded his presence. Dr. Bure hell’s
error was venial ; nevertheless, it may be pointed out that
no circumstances connected with an alleged murder are too
trivial to be recorded at the time of observation. Jt is too
much, however, to expect from a man engaged in busy
general practice what may appropriately be demanded from.
an expert pathologist and professed medical jurist.

MUMPS AND PERIPHERAL NEURITIS.

Many diseases not strictly speaking of nervous nature
have now been found to be associated with peripheral
neuritis. Phthisis, typhoid fever, diphtheria, and Other
febrile diseases are the best known of these. Mumps may
be added to the list : on' the authority ’ of' M. Joffifeoy. The
paralysis that occurred in Joffroy’s case affected all four
limbs. The legs, as usual, were first affected. Lancinating
pains preceded the paralysia The deep reflex actions were
abolished. The muscles gave the reaction of degeneration
when tested with the faradaic and voltaic currents. The
muscles appeared to be increased in sensitiveness, for slight
pressure caused pain. The paralysis was observed first
three weeks after the onset of the mumps. Is it necessary
to ask whether the case was one of true mumps? Mumps
is certainly complicated and sometimes followed by cerebral
paralysis. In M. Joffroy’s case the paralysis endured for four
months. Iodide of potassium was the medicament adminis¬
tered. .

THE HYGIENE OF OCCUPATIONS.

. Ths . hygiene of occupations has been; attracting the
attention of the State Board of Health of New Jersey, who
have, as a preliminary to the studyj set forth the general
considerations involved in a paper by Dr. E. M. Hunt. He
is followed by Dr. J. W. Stickler, who, after having dealt in
detail with the various processes included in hat-making,
find* that from the beginning, when the different furs are
dealt within the mixing and blowing room, to t^hq end,
when the finishers take up ’ the manufacture, .certain
diseases, and especially affbotkms of the respiratory organs,
are liable to be induced. In fact, out c£ a total, number of
722 hatters, the canse of whose death could be accurately
determined, no Jess thaw 518 per cant, died of pulmonary
phthisis, and 63*5 per eent. 6t some farm of lung lesion.
The next sabject of work is that of silk, flax, and jute,
which is taken up by Dr. W. K. Newton. As regards silk,
he would strongly discourage weaving-in dwelling-houses,

; where the loom ov emI is alien set up in an already over-
: crowded kitchen or livingroombut be-holds that if factories
oould be built and maintained so as to afford proper lighting,
heating, and ventilation,, the silk, manufacture ought to be a.
healthful one. In the case .of flax and jute, the hackling
| process, for whichnosatiafactory machine lias been invented.

7 44 The Lancet,T

THE SANITARY STATE OP AVONMOUTH.

[April 9,1887.

flUa the air with dint made up of dirt and minute flbrea,lead¬
ing to paroxysm* of coughing and often to early death. The
spinning process charges the air in much the same way, the
hair and clothing of the operatives being covered with theda9t.
Hemp and flax dressers inhale a dust that is peculiarly
irritating, and the processes generally tend to destruction of
the lung tissue in some form or other, and lead to a high
mortality amongst the workers. Fans are stated but rarely
to effect a proper change in the state of the air, and hence
some form of air-filter over the mouth is recommended. In
wet-spinning, the air, instead of containing dust, is loaded
with moisture, which drops like a fine mist on the operatives,
who are practically subjected to a vapour bath—an arrange¬
ment provocative of bronchial and other catarrhal affec¬
tions, as also of rheumatism. The diseases occurring in
the manufacture of rubber boots and shoes are considered
by Dr. J. P. Davis. After a description of the processes of
this trade, it is pointed out that the greatest danger attends
the compounding process, in which a large quantity of
white lead, litharge, &c., is mixed with the rubber or gum,
lead-poisoning being especially frequent during moist hot
seasons in summer, when the factory windows have to be
kept carefully closed. The heat and want of ventilation
are also very injurious. The other conditions leading to
mischief are the introduction of naphtha into the cauldron of
liquid; the machinery, with resulting accidents; and the
fixing of the rubber when completed on to the heels and
soles of the boots and shoes, the last being pressed against
the pit of the stomach. It is to be hoped that the series
commenced in this report will be extended to other trades.

GLASGOW UNIVERSITY CLUB, LONDON.

We understand that the Marquis of Lothian, Secretary
of State for Scotland, and Lord Watson, who was formerly
the representative of Glasgow University in the House of
Commons, will be the guests of this Club at their approach¬
ing dinner on April 29th (Graduation Day), when the
Chair will be taken by Professor Gairdner of Glasgow. The
Club now consists of upwards of 100 members, and as it is
constituted entirely with a view to such social meetings,
and to maintaining in London the esprit de corps and associa¬
tions connected with their alma mater , it seems probable that
there may be many men in various walks of life who would
desire to become members, but whose names have escaped
the notice of the council. - The inaugural dinner of the
Club, at which Professor Sir W. Thomson presided, took place
in October lost, at the Holborn Restaurant. The honorary
Secretaries are Dr. Heron, 57, Harley-street, W., and Mr.
Mcllraith, 3, Fumivars-inn, W.C.

THE SANITARY STATE OF AVONMOUTH.

There is a stage in the history of towns and communities
when their future prosperity is either made or marred,
and in no respect is this more true than as regards their
healthiness. For commercial and other reasons people begin
to aggregate on sites which would not otherwise be selected
as suited for the growth of towns; and where such sites
have from the first been a primary care of the local sanitary
authority, being at once supplied with adequate means of
sewerage, water-supply, and other sanitary requisites,
prosperous places and healthy communities have in the end
resulted. Where the first beginnings of towns have been
neglected, or, to a large extent, looked on with indifference,
the reverse has been the case, and in the end such localities
have either attained an unenviable notoriety for their
unhealthiness, or it has taken many thousands of pounds
t) secure mere comparative healthiness In places where a
few hundreds at the- (meet would 4utfve been far more
Sue essful. Avonmootb, 'hot Ysr ! <re*i Bristol* is one of

these growing towns; its docks are already attracting the
favour of ocean steamers, a new dry dock is in contem¬
plation, and about a thousand people are already estab¬
lished there. It has not been altogether neglected.
Indeed, a system of sewerage has been established, and it
would appear that modem building bye-laws are in opera¬
tion there. But a system of sewers in a low-lying spot
which does not take away the contents of large “ rhines ” of
stagnant water, and which is so contrived that the lowest
floors of houses cannot be adequately drained into it, is not
such a system as is needed for a growing community. If
there be one thing above another that is requisite in
sewerage systems, it is that there should be a proper fall
from the lowest floor of all dwellings to the sewer, and
that the sewer should pass at a proper fall to its outlet.
Neither of these essential requisites exists at Avonmouth,
and hence, instead of this locality, which has grown up
during a period of unexampled sanitary opportunities,
being typical of that which is called for by modern
health requirements, it is, in the words of Dr. Cross¬
man, the local medical officer of health, the weakest
point in his district. We have referred to the exist¬
ence of building bye-laws in Avonmouth, but it is well
known to those who are concerned in sanitary adminis¬
tration that such bye-laws lose their main power for good
unless a surveyor is appointed to see to their enforcement;
and no such appointment has been made for Avonmouth.
There are doubtless other points in which the health require¬
ments of this growing place call for attention, but we have
only noted the great need for a proper system of sewerage
and outfall, and for proper control over building operations,
as types of that class of work which in all such placoe can
ensure future healthiness if they are properly carried out
at an early stage, whereas siokness and disease are sure to
ensue sooner or later if they are neglected. There is no time
like the present for initiating measures which are to in¬
fluence the sanitary history of growing communities.

THE PRIVY COUNCIL AND THE MEDICAL ACT
OF 1886.

The London Gazette of April 1st contains an order of the
Queen in Council declaring that on and after the first day
of June, 1837, the second part of the Medical Act shall be
deemed to apply to New Zealand.

THE ANATOMICAL SOCIETY.

As we announced some time since, steps are being taken
towards the foundation of an Anatomical Society. It
is proposed that the scope of the new Society shall be
“ Human and Comparative Anatomy, Embryology and
Histology, so far as they bear upon Human Anatomy.” The
project is receiving influential support from authorities in
England, Scotland, and Ireland. An inaugural meeting, at
which Professor Humphry has consented to take the chair,
will be held towards the end of the present month, at a
place and time to be announced in due course. Mr. C. B.
Lockwood, of 19, Upper Berkeley-street, W., is acting as
hon. sec. pro tern., and will be glad to give information to
anyone who is interested in the movement.

REGISTRATION UNDER OLD DIPLOMAS.

The uncertainty of the exact bearing of the Act of ISSti
on the conditions of registration after the appointed day in
June, and the opinion of the solicitor to the General Medical
Council (see p. 747) thereanent, induce us to advise all
persons entitled to registration on old qualifications to
register without delay. One of the most probable conse¬
quences of the new Act will be to raise legal questions more
likely to benefit the sister profession than our own.

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ABUSE OK MEDICAL CHARITY IN SCOTLAND.

[April 9,1887. 745

THE HEALTH OF THE SPEAKER.

Wb are glad to be able to announce that the health of the
Bight Honourable the Speaker of the House of Commons is
progressing favourably. We learn that on Saturday, the
26th ult., after the repeated long sittings of the House, he
was much exhausted, and on the following day he expe¬
rienced a severe attack of cramp of the right leg, which
was followed by swelling and tenderness in its middle and
lower thirds, indicating some lymphatic disturbance. There
is little doubt that the harass and anxiety inseparable from
his official position have been much augmented by the recent
disturbed condition of political affairs, and have been too
great a strain upon his usual good health. The right
hon. gentleman has been attended by Mr. G. W. Mackenzie, of
William-street, Lowndes-square, and on Wednesday morning
was sufficiently recovered to leave London for Sandy, his
country residence in Bedfordshire. He has leave of absence
until the middle of next week, when he is fully expected
to be able to resume his Parliamentary duties.

TORTURING TURTLES.

Ip it were not cruel—which it is, and hideously so—to
bring over turtles in a dying state, it would be wantonly
wasteful. We wonder that the aldermanic conscience—
which is popularly believed to be located within the area of
the gastric organ—has not long ago rebelled on behalf of the
poor turtles thus tortured. Of course the animals ought to
be either killed and packed in ice, or preserved in tanks.
The turtle is not so common a stock-in-trade as to be
necessarily “bulked” in carriage. The waste is large, and
the quality of the meat is wofully deteriorated by the way
it is tumbled about and mauled en route. If to these draw¬
backs we add that the sufferings inflicted on the creatures
are terrible, it might be thought that the case for prudence
and humanity was made out—but is it ?

ABUSE OF MEDICAL CHARITY IN SCOTLAND.

A meeting of medical practitioners was lately held in
the Faculty Hall, Glasgow, Dr. James Morton, President of
the Faculty, occupying the chair. He and various speakers
descanted on the abuse of medical charities, both infirmaries
and dispensaries. Dr. Macleod was especially emphatic in
complaining that even well-to-do people came to the in¬
firmary, and even as in-patients. “ He had,” he said, “ some
farmers in his wards, who farmed six or seven hundred
acres of land. They would come up with lines from
doctors reoommending them. The medical profession was
immensely at fault in this. They suffered greatly by these
letters from doctors.” We feel bound to reproduce these
words, and hope to have some refutation of them from
Scottish practitioners. Praotitioners are well within their
rights in representing to their consulting brethren the
means of their patients, with the view of getting for them
that consideration which the best consultants are ever
ready to give. But infirmary beds are not meant for
those who farm six or seven hundred acres. The Scotch
boast, and properly, of their independence, but in all the
literature of abused charity there is nothing worse than the
accounts of abused medical charity in Scotland. Dr.
John Brown in “ Our Gideon Grays ” quotes from
the Appendix to the Report of the Board of Supervision
the results of the inquiries of a voluntary association of
metieal men formed in Edinburgh, with tbe public-spirited
Dr. Alison as chairman. The inquiry had reference to the
remuneration ef doctors among the pauperB. One man
ataftdfid 400 paupers for eight years and never received
one fa rthi ng for his skill, time, or drugs. Another has
th* **** * stsey to tell of 860, some of them thirty milee

off. He moderately calculates his direct loss from these
calls on his time and purse at .£70 a year. Verily, ours is a
benevolent profession. Bat oar benevolence, like that of
Dr. Alison himself, has been overdone, and is bad for the
public and the poor. A committee was appointed to con¬
sider and report on the best means of preventing abuse and
overlapping of medical charity.

PERTH INFIRMARY.

Ik the issue of Tub Lancbt for April 2nd it wss stated
that eight directors of the Perth Infirmary had resigned in
consequence of the strained relations between the board of
directors and the medical officers of the institution. It
seems that the only strained relatione existing were between
Dr. Bramwell and the directors. The latter had deemed k
wise to promote Dr. Bramwell to the consulting staff after
nineteen years of service as a visiting surgeon. Dr. Bram¬
well did not wish to resign his position on the visiting staff,
and at a meeting of subscribers his supporters passed a vote
of censure, in consequence of which eight directors resigned.
Another meeting of subscribers has since been held, at which
the directors who had resigned were re-elected uncon¬
ditionally by an overwhelming majority. The relations
between Messrs. Christie, Stirling, Graham, Colder, and Hunt,
the medical officers of the Perth Infirmary, and the directors
have, we understand, always been of a most friendly nature.

“ BRAIN.”

Arrangements have been made between the Council of
the Neurological Society of London and the editorial com¬
mittee and publishers of Brain , in virtue of which the
journal has become the organ of the Society. The pub¬
lishers, Messrs. Macmillan and Co., have undertaken the
whole financial responsibility of the journal, which will
henceforth be regularly sent free of charge to every member
of the Society. The editor is Dr. de Watteville, who has
fulfilled the post of acting editor for many years past. The
next number of Brain forms the first part of the new tenth
volume, and will contain Dr. Bastian’s important paper on
the Muscular Sense, with the discussion thereon.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

Tub deaths of the following foreign medical and scientific
men are announcedDon Manuel Rioz Pediaja, Professor
of Chemical Analysis as applied to Medicine in the Univer¬
sity of Madrid, who had held the offices of Dean of the
College of Pharmacists and of Rector of the University.
Dr. Gustav Kempner, privat-docent of Berlin. Dr. Julius
Wolff, one of the medical officers of the Policlinic in
Breslau. Dr. Jean Kickx, Professor of Botany and Director
of the Botanic Gardens in Ghent.

VACCINATION AND DISTEMPER.

M. Duptris of Brussels has made a number of observations
for the purpose of ascertaining the effect of vaccination on
puppies, with special reference to its power of protecting
them from the distemper. He found that it was quite
possible to inoculate them with vaccine, but that it had no
protective influence against distemper.

THE TREATMENT OF PHTHISIS BY ANIUNE.

The commission which was appointed by the second
congress of Russian medical men at Moecow to examine the
treatment of phthisis by aniline, as proposed by Professor
Rremianski, has, after experimenting on a number of
animals who were fatally affected by even small doses of
aniline, and after some little trial in tbe wards, come to the

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:74& Thb Lancet,]

FOREIGN UNIVERSITY INTELLIGENCE.

[April 9,1887.

conclusion that aniline is not harmless to animal life, hut
on the contrary, very poisonous indeed, and that it also
■exerts no beneficial effect at all on phthisis.

FOREIGN UNIVERSITY INTELLIGENCE.

Basle. —-Dr. Fehling, Director of the Stuttgart School for'
Midwives, has been appointed Professor of Midwifery.

Berlin. —Professor Karl Slobius of Kiel will take up the
•duties of the chair of Zoology after Easter.

Bordeaux. — M. Blares (tujrigi) hats been appointed Pro-'
fessor of Cheniistry.

Cracow.— Professor Hofmokl of Vienna has refused the
invitation to Cracow on account of the wretched condition
of the surgical clinic. The names of Drs. Rydygier and
Obalinski are now mentioned in connexion with the vksant
surgical chair. *

Giessen— Dr. Spangel, Director of the Town Museum of
Natural History, has been appointed Professor of Zoology. <

Helsingfors. —Dr. Eolsti has been appointed Extraordinary
Professor of Internal Pathology,' and Dr. E. Sundvik
Extraordinary Professor of Physiological Chemistry and
-Pharmacology.

Innsbruck. —Dr. Borysiekewiez of Vienna has been ap¬
pointed Professor of Ophthalmology.

Lyons. —M. Laroyenne, who takes one of the gynecological
courses, has been appointed Professor-adjoint. M. Perroud,
who takes one of the courses on children’s diseases, has also
been appointed Professor-adjoint.

Munich. —Dr. Karl Schloesser, Assistant in the Ophthalmic
Clinic, has become privat docent.

"■ Nancy. — M. Hergott {agregS) has been appointed Professor
of Midwifery. M. Spilmann {agregt) has been appointed
Professor of Clinical Medicine.

Rouen.— Professor Dumdnil has been appointed Director
of the Preparatory School of Medicine.

Tomsk. —The Medical and Physico-Mathematical Faculties
of this the new Siberian University are to be opened this
year.

Toulouse. —M. Charpy has been appointed Professor of
Anatomy, in succession to M. Bonamy, deceased.

Vienna. —Professor Max Gruber of Graz has been appointed
Extraordinary Professor of Hygiene. It has been decided
that the vacation courses are only to be open to foreign
medical men in cases where the full number of the classes
is not made up by Austrians. This may prove rather a
serious matter for some of the English and Americans who
frequent the Vienna Hospital for the short courses, for
whioh it is famous.

Wiirzburg.—Dx. Matterstock has been selected by the
Senate as successor to Professor Geigel, the recently
deceased Professor of Medicine.

At the Belgian Royal Academy of Medicine there has
been a warm discussion for some time past on the subject of
the State'regulation of prostitution. M. Moeller, in support
of his objections to the principle of regulation, attempted at
a recent sitting to show by reference to English statistics
that such regulation was not only useless, but actually
hurtful. M. Crocq, however, from the very same statistics,
proved that the cases of contagion in the British army were
leB8 numerous by one-half in the localities where the
Contagious Diseases Acts were in force than in other
garrison towns. _ • -

The lectures at Gresham College, Baeinghsll-street, will
be delivered by Dr. Symes Thompson bn the 19th And three
following days of the present month. The subject will be
“ The Blood.” It is hoped that the coarse will be continued
on Oct. 4th, 6th, fith, and u • . .

On the 4th inet. Mr. Ritphie received a deputation at the
Local Government Board from eleven unions. and boards of
guardians, representing all the great military and naval
centres, who urged that the law should be amended so as to
enable them to detain in their infirmaries patients suffering
from disease until cured. Mr. Ritchie, in reply to the repre¬
sentations of the deputation, said that he did not know
whether Lord Devon’s Act, which e'nabled the guardians to
detain persons suffering from, “ contagious disease,” could be
applied to these cases; but he would obtain the opinion of
the law officers of the Crown upon the point, and would
communicate their opinion to the various boards of
guardians. ___

The captain of the ship Belpore of Liverpool, which
arrived in the Tay from Calcutta on the 81st ult., reported
to the Customs officers who boarded the vessel the deaths
of two of the crew from cholera during the homeward
passage. The vessel was moored at the quarantine station,
and a thorough disinfection by the sanitary authorities was
ordered previously to her coming into port.

The Norwegian Government has taken another step
towards discovering the origin and nature of leprosy, which
is so common on the west coast of Norway, by despatching
Dr. G. A. Hansen, director of the Leprosy Hospital at Bergen,
to North America, for the purpose of inquiring into the
heredity of the disease among Scandinavian emigrants to
the United States. .

Dr. Sinclair Coghill of Yentnor has been elected Vice-
President of the International Medical Congress to be held
at Washington on Sept, oth proximo.

At Braintree, in consequence of the extensive prevalence
of measles in the town and neighbourhood, several of the
schools have been closed. _

The trustees of St. Bartholomew’s Hospital, Rochester,
have declined to reopen the lock ward of that institution.

ROYAL COLLEGE OP PHYSICIANS.

A Cohiti A of the Royal College of Physicians was held on
Monday last, the 4th inst., the President, Sir W. Jennet,
Bart., iu the chair. There was a large Attendance of
Fellows.

A communication was read from the Colonial Office re¬
questing information upon the contagiousness of leprosy.
The subject was referred to a special committee consisting
of Sir Risdon Bennett, Sir J. Fayrer, Dr. R. Liveing, and
Dr. Stone.

It was resolved to erect a statue of the Queen in the new
Examination Hall, in conjunction with the Royal College of
Surgeons.

The adoption of the report of the Croonian Committee
was moved by Dr. Quain, seconded by Sir E. Sieveking, and
carried. The report, which was based on resolutions of the
College passed on J une 29th, 1886, recommended the following
regulations“ 1. That the Croonian lecturer be appointed
annually by the President and Censors for the purpose of
delivering a course of not Less than four lectures on sub¬
jects'embraced in No. 1 of the above resolutions. 2. That
the lecturer be paid 100 guineas for the lectures, and that
the remainder of the Croonian Trust fund be employed for
original investigation by a past or present Croonian lecturer.

3. That the leoturer, who must be a Fellow in accordance
with tbe original trust, shah be eligible for reappointment.

4. That the subiects of the lectures and investigations be
selected with the approval of the President and Censors.

5. Tliat the lectures be delivered in, the month of June, and
that the first course of lectures be given in 1888.”

The/President then addte8teid the meeting upon the

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RI^4m^OT»»Kl)iaM>'0» , r*eBM OS' HEALTH.

[Ai*wir/9,i887J 74 *7

affairs of the College doling the peat year, and gave an
aecount of the career of the six Fellows who bad died since
the last annual meeting—viz., Dre. Wiltshire, Nairn*, Farre,
Chadwick, Moron, and Carrington.

The election of President was then proceeded with, and
the choice again fell upon Sir W. Jenner, who was formally
inducted into the office by the Senior Censor.

MEDICAL REGISTRATION AND THE NEW ACT,

In view of the. possibility of some (perhaps many) who
possess registrable qualifications not being aware of the
full bearings on registration of the Medical Act (1886), a
letter, of which the following is a copy, has been forwarded
tp all the medical licensing bodies in the United Kingdom

“Sir,—I am directed by the President of ihe Mediae!

Council to forward to you, for the information of-,

the following statement, which has beep prepared for him
by the solicitor to the Council:—

“ ‘After the 1st of June, 1867, no person can be pqt on the
Medical Register by virtue of a single qualification, such as.
a diploma in surgery or a diploma or licence in medicine.
Up to the 1st- qf June next any person, can be pub on the
Register, by virtue of such single .qualification, and being
once on, he may obtain additional qualifications, by subse¬
quent examinations, and such additional qualifications pray ,
be added to or substituted for those already on the Register.<
But after the 1st of June next no one can.be put cm the ;
Register who has not passed the qualifying examination ,
required by the Act of 1886— that is, an examination in j
medicine, surgery, and midwifery, and these three subjects j
must be taken up together; hence anyone who has now a (
single qualification, and intends to obtain further qualifica¬
tions after the 1st June next, should take care to be on
the Register before that day, for if he is not on it, his
single qualification will not afterwards entitle him to
registration.’

“ As the subject is of importance tb many persons who have
net yet completed their medical education, you will doubt¬
less think it desirable to give the statement such publicity
as you may see fit, for the information of candidates for
your examinations. , “Yours faithfully.

“W. J. C. Mtllkh, Registrar.

"General Medical Council Ofliae, 309, Oxford-street, London, W.”

Jfcaliif atth |Joar gafo.

LO’pAX .GO VEEN Men t, department.

- flJHPOMS ok mxdioal ofkickbs or hjulih.

Oaxton and St. Neots Combination. —Mr. Pojnt* Wright
acts for two rural areas arid one urban district. So fat as
be has had opportunity of judging the water-supply, he i&
of opinion that the wells are frequently contaminated with
organic and sewage matter by reason of thei dangerous
proximity of privies and cesspools fouling the subsoil, and
he pdfnta out the riiks which such a system' involves.
He alsri advises the abolition of cesspool privies and their
replacement by earth-closets or pkil-dosets. He also advo¬
cates in certain places cesspool drainage in safe positions,
with an overflow into a Water-Course. This, we fear, is
unsafe advice, involving as it does fresh pollution of streams,
and aboolnte breach of Section 47 of the Public Health Act,
in sofakras the urban district is concerned which is named
at the head of "the chapter,'if trideed this district whs in¬
tended to be included; The St. Neots rarhl authority have,
on Mr. Wright’s suggestion, adopted a voluntary system of
notification of disease, ,but the urban authority objected to
carry out such a system, on the ground that the medical
attendant on each cases rendered Unnecessary, bv his action,
any interference on the part of -the health officer. Such
reaeezring would, if carried to its proper extent, lead to the
abolition of the clauses of the Public Health Act as to the
prevention of infection in all esses where a doctor was
called in; but this was certainly not the intention of the
Legislature. Dealing in other chapters separately with

each district, it appears that in St. Neots much well-water
is dangerously circumstanced,' and weekly scavenging is
called lor, together with improvement in closets and in
dealing with slop-waters. In the Oaxton -rural district good
water will soon be available for several places from water¬
works to be ereoted a* Bourne, in the St. Neots rural district
improvements have been made at Graf ham as to water-'
supply, and at Eaton Sqcon the sewage irrigation answers
well; but .at Kimbbiton a similar system would appear to
have resulted in failure, oping to the land receiving' more
Bewage than it can possibly take np. -■

Hebnsley Mural District,—- In the Helmsley division’ of
this union the population is 8961, and R had in 1886 a-
death-rate of 12‘1 per. 1000. There was no' icariet fever or
measles during the year, and only 8 cases of enteric fever
came uader notice. The history givfen as to these by
Dr. Bruce Low shows how carefully each such occurrence 1»
investigated with a view to preventive action. It is some¬
what eoriojua that 61 eases of diarrhoea occurred at PoqWey
in.this district; the details were sent to Dr. Ballard in oon-
hsxiont with his official inquiry into diarrhoea prevalences;
The general immunity bf this district from dangerous
infection may perhaps induce the authority to postpone
providing the means of isolation and disinfection which
Dfj-Low advocates, but it is precisely during the absence of
emergencies that these matters should be dealt with. It i»
satisfactory to reooerd a marked diminution in illegitimate
birtha and in deaths amongst such children, especial attention
having been devoted to tbiri subject in the district; and wide
publicity having been given to the evils and cruelties here'- -
tofore attendant on. illegitimacy. Questions of over*-
crowding, water-supply, and other matters a»e dealt with
as they rise., . • * :

Ulitheroe Urban District.—Jiho birth-rate for this district?
in-1886 was 28 8 per 1000, the death-rate 17) and-thexymetlo
rate 1-6. The current work of'the year fas eluded the gradual
removal of open midden-privies, 170 having bean abolished
in favour of the tub aybtenn Action- is also being taken
townarde .semiring the slaughtering <of animals in-wholesome
places, and in oertaia instances any further slaughtering in
existing places was prohibited. It is also stated that as the
present time there axel but. few instances in which there to
any direct oemnmoiostian between houses and drains in thb
CUtheree district .. Intbe'Low Moor district matters are by
no means so satisfactory; and whereas in Clitberee redac¬
tion of mortality is shown, no such dimBurtioa'Iwobseririble
in the Low Moor. In the former, for example, the 4nfatatUe>- 1
death-rate is distinctly -less .thaki in the,'latter. . Mr. J. J 1 .
Fraser also shows that where-sanitary improvements have
been effected infectious diseases have diminished.

St. Asaph Rural DistHct. —With a death-rate of 180
per 1000, Dr. Lloyd-Roberts to of opinion that deaths' ate
not excessive; but Whilst thdre may not be moch to bbta-

f ilain of; there is, in our -opinion, Still room for Improvement
n this respect in such a district. Diphtheria has often-
been a perplexing dfeeaee hr this portion of North-Wales,
and it was last year scattered through six parishes in this
rural- district* In St.- Asaph itself infection is copveyed
from the upper to the 1 lower parts of the fifty by thb mef-
Elwy, Whteh acts me a source bf water-supply For the latte*
area*- Bat we read, as regards the district'generally, that
no new public works for sewering or water-supply have
beam > undertaken. At Prestatyn such works are impera¬
tively called dor, the district being one which bids ftur to
become a growing watering-place. .

Jbpfc Urban Districts— In this district the dSatfi-fatb For
1886 wis 1813 per 1000. Hariy in the year small-pox eaHed '
for energetic action,-and, owing* largely ,tb the available
hospital accommodation, the disease was checked. Out of
21 cases 3 were unvaccinated, and of these 2 died * whereas
no case occurred in a re vaccinated person. Mr, 'Lawton
reports that he has maintained systematic inspection bf the
district, and he shows how Silteh matters as scavenging and
water-supply have been - supervised, and ho# slaughter¬
houses, ootnmon lodging-houses, Mid bOkerita, &c., are
coot roiled. •’ v

. ,u --■ ■■■■■,.:---- .y-,.- *.! ■

Vaccination is, it is stated, to bo enforced' among
all the workmen employed on the coming Paris Exhibition.
Each man will be vaccinated as soon as engaged,.and the
Government will not only pay for the peceesary .medical
treatment, but will continue the man’s wages should his arm
become bad and prevent him from working. -

D

O

748 Thb Lancet,]

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[Aran. 9,1887.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6022 births
and 3831 deaths were registered during the week ending
April 2nd. The annual rate of mortality in these towns,
which had increased in the preceding seven weeks from 19‘5
to 23*5 per 1000, declined again last week to 21*6. During
the thirteen weeks of the first quarter of this year the
death-rate in these towns averaged 20*0 per 1000, and was
2-2 below the mean rate in the corresponding periods of the
ten years 1877-86. The lowest rates in these towns last
week were 14 - 6 in Brighton, 17 - 2 in Bradford, 18-8 in Bir¬
mingham, and 19 3 in Portsmouth. The rates in the other
towns ranged upwards to 28 7 in Manchester, 30 7 in Hud¬
dersfield, 32'5 in Plymouth, and 33*1 in Blackburn. The
deaths referred to the principal zymotic diseases in the
twenty-eight towns, which had increased in the preceding
seven weeks from 340 to 465, farther rose last week to
471; they included 239 from measles, 105 from whooping-
cough, 37 from scarlet fever, 32 from diphtheria, 32
from diarrhcea, 25 from “fever” (principally enteric), and
only 1 from small-pox. These zymotic diseases caused
the lowest death-rates last week in Birkenhead and
Bolton; and the highest rates in Oldham, Sunderland, and
Huddersfield. The greatest mortality from measles occurred
in Sheffield, Cardiff, Liverpool, Newcastle-upon-Tyne, Bristol,
Oldham, Manchester, Huddersfield, and Sunderland; and
from whooping-cough in Bristol, Huddersfield, and Black¬
burn. Of the 32 deaths from diphtheria in the twenty-eight
towns, 14 occurred in London, 4 in Liverpool, 3 in Bristol,
3 in Oldham, 2 in Plymouth, 2 in Birmingham, and 2 in
Manchester. Small-pox caused one death in Portsmouth, but
not one either in Greater London or in any of the twenty-
six other large provincial towns. Only 2 cases of small¬
pox were under treatment on Saturday last in the metro¬
politan hospitals receiving cases of this disease. The deaths
referred to diseases of the respiratory organs in London,
which had been 433, 474, and 509 in the preceding three
weeks, declined again last week to 417, and were 127 below
the corrected average. The causes of 107, or 2-8 per cent,
of the deaths in the twenty-eight towns last week were
not certified either by a registered medical practitioner or
by a coroner. All the causes of death were duly certified
in Portsmouth, Wolverhampton, and Huddersfield. The
largest proportions of uncertified deaths were registered
in Oldham, Salford, Sheffield, and Halifax.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 26 2 and 269 per 1000 in the preceding
two weeks, further declined to 235 in the week ending
April 2nd; this rate exoeeded, however, by 1'9 the mean rate
in the same week in the twenty-eight luge English towns.
The rates in the Scotch towns last week ranged from 115
and 18 5 in Leith and Greenock to 28 2 in Paisley and 31-6
in Aberdeen. The 588 deaths in the eight towns last week
showed a further decline of 58 from the numbers in the pre¬
vious week, and included 43 which were referred to measles,
31 to whooping-cough, 18 to diarrhoea, 8 to diphtheria, 6 to
scarlet fever, 6 to “fever” (typhus, enteric, or simple), and not
one to small-pox; in all, 111 deaths resulted from these prin¬
cipal zymotic diseases, against numbers increasing from 98 to
127 in the previous four weeks. These 111 deaths were equal
to an annual rate of 4-4 per 1000, which exoeeded by 1-7 the
mean rate from the same diseases in the twenty-eight
English towns. The fatal cases of measles, which had
d in the preceding four weeks from 27 to 55,
hlast week to 43, of which 34 occurred in Aberdeen
In Glasgow. The 31 deaths from whooping-cough
corresponded with the number in the previous week, and
included 12 in Glasgow, 11 in Edinburgn, and 5 in Dundee.
The 18 deaths attributed to diarrhcea showed a further
increase upon recent weekly numbers; 10 were re tamed in
Glasgow and 4 in Dundee. The 8 deaths from diphtheria in¬
cluded 3 in Glasgow, 3 in Edinburgh, and 2 in Pawley. The 6
fatal cases of scarlet fever, of which 3 occurred in Glasgow and
2 in Edinburgh, showed a decline of 124tog&tfie number in
the previous week. The 5 deaths ? l !AflP&K M /ever,” an

week,
is from
towns,

which had been 152 and 146 in the preceding two weeks,
further declined last week to 132, and were 2 below the
number in the corresponding week of last year. The causes
of 67, or 11 per cent., of the deaths registered in the eight
towns during the week were mot certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 29 3
and 31-3 per 1000 in [the preceding two weeks, was
again 31*3 in the week ending April 2nd. During the
thirteen weeks ending last Saturday the death-rate in the
city averaged 309 per 1000, the mean rate daring the same
period being but 20‘7 in London and 21*6 in Edinburgh. The
212 deaths in Dublin last week corresponded with the
number in the previous week ; they included 6 which
were referred to “fever” (typhus, enteric, or simple),
4 to measles, 4 to scarlet fever, 3 to whooping-cough, 1 to
diarrhoea, and not one either to small-pox or diphtheria.
Thus the deaths from these principal zymotic diseases,
which had been 10, 7, and 18 in the preceding three weeks,
were again 18 last week; they were equal to an annual
rate of 2*7 per 1000, the rates from the same diseases being
2-0 in London and 3-8 in Edinburgh. The deaths referred
to “ fever ” exceeded the number in any recent week, while
thosefrom scarlet fever showed a decline of 3 from the number
in the previous week; the fatal cases of measles and whoop¬
ing-cough corresponded with the number in the previous
week. The deaths of infants exceeded the number m either
of the previous two weeks; while those of elderly persons
showed a decline. Four inquest cases and 5 deaths from
violence were registered; and 69, or nearly a third, of the
deaths occurred in public institutions. The causes of 29.
or nearly 14 per cent., of the deaths registered during the
week were not certified.

THB SERVICES.

MEDICAL BBGULATION8.

Altebations in and additions to the Regulations for the
Army Medical Department have been approved, and will be
issued to those concerned.

A Greenwich Hospital Pension of £50 a year for Fleet and
Staff Surgeons has fallen vacant by the death of Retired
Fleet Surgeon Gerald Yeo, F.R.L.S., who had been a recipient
of the same since May 21st, 1881.

Wab Office. —Army Medical Staff: Brigade Surgeon Wm.
Alex. Gardiner is granted retired pay, with the honorary
rank of Deputy Surgeon-General (dated April 2nd, 1887).

Admiralty. —In accordance with the provisions of Her
Majesty’s Order in Council of April 1st, 1881, Inspector-
General of Hospitals and Fleets Dugald McEwan, M.D., has
been placed on the Retired List.

In accordance with the provisions of Her Majesty’s Order
in Council of March 25th, 1887, Deputy Inspector-General
of Hospitals and Fleets William Henry Sloggett has been
granted the honorary rank of Inspector-General of Hospitals
and Fleets, in recognition of his services as Inspector of
Certified Hospitals (dated March 25th, 1887).

The undermentioned Surgeons have been promoted to the
rank of 8taff Surgeon in Her Majesty’s Meet:—Herbert
Elliott Marsh; Henry George Travers Strickland, M.B.;
Alfred Patterson; Michael Ronan, B.A.; John Anderson
McAdam; John Dudley, M.B.; and David Brownrigg Bookey.

The following appointments have been made: — Staff
Surgeon J. A. McAdam, to the Penguin (reappointed on

P romotion); and Surgeon William George Jack, to the
■orward when recommissioned, and until then additional.
Artillery Volunteers.— 2nd Durham (Seaham): Sur¬
geon T. C. Beatty, jun., resigns his commission (dated
April 2nd, 1887).—Luke Gerald Dillon, MJ)., to be Acting
Surgeon (dated April 22nd, 1887).

Engineer Volunteers. —2nd Cheshire: Jas. Atkinson,
Gent., to be Surgeon (dated April 1st, 1887).

Rifle Volunteers —4th Lancashire: Surgeon and Hono¬
rary Surgeon-Major E. H. Roe resigns his commission; also
is permitted to retain his rank and to continue to wear the
uniform of the corps on his retirement (dated April 2nd,
1887).—1st Linlithgowshire: John Anderson, M.B., to be
Acting Surgeon (dated April 2nd, 1887).—1st London (City
of London Rifle Volunteer Brigade): Surgeon J. J. Gawitb
resigns his commission (dated April 2nd, 1887); Acting

, y Google

TB» Lancbt,]

THE TREATMENT OP PLACENTA PRJSVIJ.

[Apbii, 9,1887. 749

Surgeon H. P. Stokes to be appointed Surgeon (dated
April 2nd, 1887).—22nd Middlesex (Central London Rangers):
Surgeon J. R. Kemp resigns his commission (dated April 2nd,

Comspnbrnt.

“Audi alteram partem.”

THE TREATMENT OF PLACENTA PRvEVIA.

To the Editore of The Lancet.

Sirs,—I suppose, strictly speaking, that no particular
method of managing placenta praavia can claim being the
treatment, because the conditions which preeent themselves
when we are called to these cases vary very much, and to
each variety there is a more appropriate treatment. Besides
the two positions of the surroundings 1 mentioned in. my
last letter—namely, where we are' called without previous
knowledge, and secondly, where we have already ascertained
the existence of placenta prssvia,—there are three main
classes:—

1. If the os uteri be well dilated, the placenta extending
but a little over the os, and consequently the membranes
plainly felt, the rapture of the membranes is the first thing
to be done. If turning has been determined upon, then this
will be performed at the same time; otherwise we might
wait for the natural forces. Should these hesitate, or
hasmorrhage continue, ergot, forceps, or version should be
employed, according to circumstances. There will be no
reason to detach the lower portion of the placenta.

2. Should tke placenta, however, be attached nearly or
entirely athwart the os uteri, then the detachment of
the placenta as far as the fingers can easily reach will
have_ a twofold effect: it will relieve the os from the
restriction the adhesion of the placenta caused, and permit
consequently its expansion; and it will also for a certain
period generally check the bleeding, but not always; some¬
times tnere is a very sharp lose; then the quickest and
surest plan is to turn at once and plug the os by the leg or
breech; the bleeding then stops, and pains generally arrive
in a_ short period. If, after this separation of the lower
portion of the placenta, no bleeding arise, and if we can
remain about the patient, the natural forces might be trusted
to deliver the patient; should, however, these hesitate, we
might elect two plans—either to dilate the os with Barnes’
bags, and when the os is large enough to apply the forceps
to the bead to bring this into the os, or turn and bring the
breech into the same position. In either case labour pains
usually soon come on. We should keep on the foroeps,
however, to assist, if needful, till the head is clear. But if,
on the contrary, we have neither bags nor forceps at hand,
then version by my method gives the patient security.

3. But supposing the os uteri is small, the bleeding severe,
and, called on suddenly, we are unable to obtain either
dilating bags nor forceps, also unable to leave the patient
till delivered: then it is (now that the tampon is for ever, I
hope, discarded), even though the os would admit only one
or two fingers, that my plan of turning becomes the security
or the patient, and being the only treatment possible, and
of the most secure kind, it does practioally become the
treatment.

In the second class of cases, when the employment of
^wsion becomes necessary from the continuance of hasmor-
fhsge, and both dilators and forceps are absent, and the os
being not dilated sufficiently to admit the hand, then my plan
or turning becomes the treatment, and the patient’s security,
aud, except the accouchement forcte, the only security; and
these caws, coupled with the third class, form by far the
largest number in every-day practice. But the full recogni¬
tion of the rale for as early a delivery as possible in cases
° f wm 80 * 4 P*®*** brings out the advantage which the
capability of early version given ns by the combined or
oipolar method, advancing treatment a considerable stage
!”bsg ; and when other methods are not to hand, as I
P°®wid out in 1863-4 in my remarks on Dr. Greenhalgh’s
PJP*Mind in mV work on Combined Turning, there is one
£^ ,*0** *° rna °f version, that soon after the leg is
p fnrb ttgfr the oe uteri labour pains generally occur,
wWKft fdr the patient to rally and an early
reJ5 *®°f «• medical attendant. Dr, Lomer points out the

ease with which his assistants learnt it, and he thinks they
represent very well the average in the profession, the cases
reported having been done principally by them. Still,
without classifying the employment of version as n
routine, practice gives results at present of the most
favourable kind. In the conclusion of an unavoidably
egotistical letter, I would again urge those engaged in mid¬
wifery, While employing all the modern methods of help
suitable to each case, to' remember the rule, “ Deliver as
early as possible after the recognition that the placenta is
about or athwart the mouth of the womb and to this I
would add, ** Don’t leave the patient till she is delivered.”
As the result of my experience, I have often remarked I
would rather handle a case of placenta prsevia than one of
post-partum haemorrhage.

I am, Sirs, yours truly,

J. Braxton Hicks.

George-street, Han over-square, April 3rd, 1887.

PASTEUR'S “METHODS.”

To the Editore of Thb Lancet,

Sirs,—Y our issue of Feb. 5th contains a letter by Dr. John
H. Clarke, in which he says, “At any fate, the facts should
be made known without delay, in order, on the one hand, to
remove suspicion from M. Pasteur’s treatment, or, on the
other hand, to warn possible applicants against the risk it
involves." This warning does not come a moment too soon.
I have been rather surprised that, in the face of von Frisch’s
experiments and M. Peter’s experiences, Thb Lancet has
not thought it advisable to warn the profession of the
possible dangers of the latest phase of M. Pasteur's treat¬
ment—the intensive method. Certain of M. Pasteur’s French
supporters—especially M. Grancher—are still triumphantly
appealing to the formidable list of “ cases of cure.” But not
only is the treatment in those cases founded on a fallacious
basis, but it has been abandoned, and, so far as we have par¬
ticulars, it has been distinctly confuted by crucial experi¬
mental test. M. Pasteur has at last been driven to admit
the force of an objection, which he should have recognised
before committing himself to the treatment of human beings
after they were supposed to have been inoculated with rabic
virus. This is what he says: “ The objection can be brought
against the usual protective inoculation of man after a bite,
which is based upon the inoculation of dogs before the
bite, that the immunity of animals after infection with
rabies poison has not been certainly established. To
confute this charge it is necessary to make dogs im¬
mune after trephining and the ihtra-cranial inoculation of
street rabies. ...... My first experiments on this point took

place in August, 1885. The result was a partial success. In
the course of the last month I took up these experiments as
soon as my duties allowed me time. The condition of succettt
i» this: that the inoculation should begin toon after the
infection—i.e., the same day: that one must proceed with
euch extraordinary rapidity that the series of medulla
oblongata made use of may be employed in twenty-four or
less hours, and that this treatment must be repeated once or
twice every two hours. That Dr. v. Frisch was not suc¬
cessful in Bimilar experiments is to be ascribed to the slow
inoculation he employed.” 1 will not now stop to consider
whether M. Pasteur does not stand condemned out of his
own mouth. As von Frisch has repeated the experiments
by the new method, and declares that the procedure is not
only not successful but possibly dangerous, and as, moreover,
M. Pasteur has declare! otherwise and admits the trans¬
cendent importance of the test, let that point be authori¬
tatively and flhally settled. Any appeal to the " cases ” in
view of M. Pasteur’s utterance, to the effect that the con¬
dition of success is that the inoculations should be com¬
menced the same day as infection, and with such extra¬
ordinary rapidity, is simply idle, as in none of them was
that condition observed. Let varying quantities of saliva—
diluted if necessary—taken from a rabid dog be injected into
healthy ones, and let M. Pasteur operate in half the cases, the
other half being reserved as controls; and let this experiment
he repeated as often as necessary. M. Pasteur must stand
or fall by this test. What, may I ask, would have been the
fate of M. Pasteur’s method had one of the fatal casts been
his first instead of Joseph Meister? Should we have heard
any more of it? I imagine not. Unfortunately, the twelve
inoculations (six of which were done with subsequently

^50 The Lancet,]

THE CASE OP LEONARD VERSUS BROWN AND ALLATT.

[Aran. 9,1887.

proved innocuous material) accomplished then -what thirty-
six do not succeed in doing now, and the reputation of the
method was established! But, mirabile dictu, that very
perfect, ever-successful, though unstable method has now
been abandoned for a new one. "The three little inocula¬
tions” at any time before the occurrence of hydrophobia
became twelve within thirty-five days of the bite, reduced
suddenly to fifteen days; though the non-fatal cases were all
the time vauntingly held up as examples of the success of
the treatment. Now we have the latest Bbift, which affects
not only the number of inoculations, but the, very intensity
of the material itself, and which, according to M. Pasteur's j
experimental “ conditions of success,” actually reduces the
time to the day of infection. Bearing in mind the manner
in which the method has undergone so many modifications
with a neverTfailing claim to success, we are brought face
to face with the fact that we must accept one or; other of tjie
following two conclusions:—(1) That there are degrees of in¬
flection, that each method operated efficiently in preventing
rabies, and that there was a marvellous adaptability between (
the degree of infection and the method adopted in each j
case; or (2) that in the rare cases in which infection 1
occurred the inutility of the particular method had recourse j
to was demonstrated, and a Change of method was accord- i
sngly adopted. Which, may I ask, is the more reason¬
able conclusion ? It is pitiable to see the intolerance with
which M. Peter’s efforts to lay bear the truth are met by
M. Pasteur’s partisans; but the time will surely come when
he will make himself heard not only within the walls of the
Academic de M6decine, but in every corner of the earth
where M. Pasteur’s fame has reached. .

I am, Sirs, yours faithfully,

Goaluudo, March let, 1887. VINCENT RICHARDS.

“T

THE CASE OF LENNARD v. BROWN AND
ALLATT.

To the Editors of The Lancet.

Sibs,-—I n The Lancet of the hth ult, there was a leading
tiTticle'dealing sympathetically with the oase of Leonard v.
Brown and Allatt, in which an attempt was made to prove *
adultery against a medical co-respondent. This attempt broke
down entirely, and Mr. Brown was absol utely exonerated alike
by the summing-up of the judge and by the verdict of the
jury. The petitioner has no means of paying the costs
which Mr. Brown has incurred in defending himself, and
these amount to the sum of .£160 18s. llrf. We think
the case is one in which other practitioners may be
fairly asked to assist Mr. Brown in bearing the expenses
which have thus been forced upon him. But he felt it,
to be a duty to resist the attempt, to which any other
member of the profession might be 'exposed, and in thus
deciding he was fighting the battle of the profession as
much as his own. We trust that you will render us your
valuable assistance in bringing forward this aspect of the.
case, and that you will be induced to take charge of any
fund which may be raised for the purpose Indicated.

We are, Sirs, yours truly,

Robert Barnes,
Sydney Jones,

April. 1887. W. H. BrOADBENT.

*** We understand that Dr. Murray, of Meadowside,
Upper Richmond-road, Putney, has expressed. ;his willing¬
ness to receive subscriptions towards a fond for the-purpose
.intimated in the above letter.— Ed. L.

• “A VICTIM OF THE LAW.”

" '' ; To the Editors of The Lancet. '

- Sirs,—T he letter which appeared in The Lancet of
March 19th with the above signature discloses a case which
seems to me to call for some practical sympathy from mem-

fession few can, without serious inconvenience, if not actual
hardship, bear such a strain on their resources; and if you.
Sirs, would open a subscription list for the Unfortunate
“ victim,” whose name is, I presume, known to you, 1 feel
sure that many of his professional brethren who have
happily escaped such vexatious actions themselves will
show their thankfulness by kelpiqg, to indemnify him for
his pecuniary loss. In “ mind and body " he has doubtless
suffered much; it should be the care of his brother practi¬
tioners that he does not suffer in " estate ” also.

I am,.gira,,yours truly,, ,

Peterafield, March 28th, 1887. A! W. LbACHMAN, 1T.B.

* # * At the' moment of going to press, we learn that the
Met ropolitan Counties Branch of the British Medical Associa¬
tion have opened a Subscription list for the object mentioned
above, and that donations towards the fond may be forwarded
to Mr. George Eastes, M B., 69, Connaught-street, Hyde Park.
The amount given or promised has already reached nearly
£40. We need scarcely say that the movement has our
hearty sympathy.— Ed. L. • ~

--- ■

•• n-toiM/TpAr

THE DRAINAGE OF THE MONTE CUnttjG
CASINO.

(From our Special Correspondent^

- • ■ -itott

In a previous letter the condition of the wtfbtt ttf XfeSaBb
warf described and criticised, but tourists are more inter¬
ested.’ in the drainage of the' Casino than of this antique
town. Most visitors live in the district of Monte Carlo or
of thb Condamine. There is only one very small and
modest hotel available at Monaco. Tonrists go up to
Monaco to see the Palace, the small museum, the quaint
streets of the old town, and the very beautiful garden at the
extremity of the rock. To tbe naturalist this garden is in¬
teresting as a contrast to the Casino gardens, situated on
the opposite hill of Monte Carlo, for they contain no foreign
plants, bat a luxurious collection of indigenous flowers and
shrubs. Nevertheless, all this may be seen in a couple of
hours. The case is very different with regard to the Casino.
Even those who do not play spend every day many hours
within the walls of this magnificent building. The admis¬
sion is absolutely free, and there ore concerts twice a day,
given by one of the best orchestras in Europe. The theatre,
built by Gamier, the architect of the Paris Grand Opera, is
in itself a sight which would attract thousandsof people, even
without the coneerts and theatrical representations. Then
there is a reading-room, with more than a hundred periodicals
.in all languages; and the Atrium, a magnificent hall, where
.people walk up and down for hours together, talking to their
friends ; the Atrium is, in fact, the universal rendezvous,
where half the gossiping of Monte Carlo takes place.

These explanations are necessary to show that the Sani¬
tary condition of tbe Casino must have an important
influence on the health of those persons who spend any time
in the Principality. It so happens, however, that though
money has been lavished on this superb building and no
pains have been spared to render it attractive, the usual
continental ignorance with regard to sanitary matters has
very considerably marred the general result. The organisa¬
tion of the drainage has been left to mere hazard, and the same
maybe said with respect to ventilation. There are eight
closets for the use of the public in the basement of the Atrium,
placed back to back and separated by a narrow passage.
Formerly a small metallic- pail or tinette was placed under
each closet, which only retained the solid materials; and.
incredible as it may.seem, the liquid contents were actually
allowed to overflow on the floor of the passage. The floor
being slightly concave, the sewage, of a very offensive and
concentrated description, slowly trickled to the centre, thus

a patient who, in consequence of his certificate, was con¬
signed to a lunatic asylum. On regaining her liberty, sbe
brought an action against the medical man who signed the
'’certificate; and though the verdict. vtoAtfeNn in Ms favour,
'be is now oailed'Upon to paytMMMMDb^Mta of £240, the
’^plaintiff professing bereelf * tMfW. T " '-r ill-nafi nra-’

ilbpaid pro- 1

occasionally invaded the whole building. This is now.
however, altered, Tho tinette system is abolished. English
closets, draining into hardware pipes, are employed in their
stead. Tbe flush is insufficient and badly delivered, but still
: the closets are free from odour, and the passage is no longer
a standing nuisance. Here the improvements end. Imme¬
diately outside and almost touching the wall of the Casino

Thb Lancet,]

THE DRAINAGE OP THE MONTE CARLO CASINO.—LIVERPOOL. [April 9,1887. 751

an immense cesspool has been constructed. As the law of
the Principality forbids the draining of closets into the
sewers, it may be thought that the building of a cesspool
weS ttnavdidable t but a special enactment was obtained
from the Government exempting the Casino from this rule.
Unfortunately the only use made of this advantage has |
caused' more harm than good; for not only has the I
obnoxious cesspool system been maintained, bat, avail¬
ing themselves of their special privilege, the Casino
authorities have allowed an overflow pipe to be added.
Thus, after the accumulation. of several cubic yards of
sewage—that is to say, ■when the sewage has had plenty of
time to ferment and to attain its foulest aud most dangerous
condition—it reaches the level of the overflow pipe and
escapes into the sewers. Of coarse the smallest quantity of
sewage in such a state. drives rise to great nuisance, par¬
ticularly as the sewers aUMonte Carlo are not systematically
flushed or ventilated. It is extraordinary that in the nine¬
teenth century such obvious errors should be committed.
The Casino Is so close to the sea and the sewer ontfall that,
though the sewers are not properly constructed, no great
ham would have arisen if the building drained direct into
them, particularly, as with the new English closets, a con¬
siderable volume of water is now employed. But to allow ,
the seWsge to accumulate, to ferment, and then permit
its elow bat continuous flow into the sewers, is simply to
poison the whole neighbourhood. Par from the Casino, and
on higherground, the sewer mouths have given off odours
which have surprised persons not acquainted with these
details. Evidently the cesspool must be abolished alto¬
gether; or elewthe overflow nut be -carefully closed and the
cesspool periodically emptied, like ail the other contrivances
of this description within the Principality.

Apart from this, during the present season and for many
weeks the meet appalling odours have prevailed throughout
the Casino, especially in the reading-room and in the
theatre. One waterspout running oateide a wall was dis¬
covered and pulled down. It communicated with the
fewer, and, being in a leaky:condition, enabled foul gases to
travel upwards into the wall. Anew pipe has been sub¬
stituted, which is madie to empty over an open gully, mid
thus the connexion with the Sewer is effectively severed.
This It one of 'the very rare instances of an improvement
accomplished which is scientifically correct. But there are
other defects that have not been discovered, and the con¬
stant escape of sewer-air wWhin the Casino is all the more
dangerous as the building itself is completely devoid of any
system of ventilation. The air depends for its renewal cm
the baaard of opening doors or windows. There are a great
number of “ lanterns" on the roofs of the gaming-rooms,
but these are so low that when opened a violent down¬
draught ensues. Consequently they are nearly always shut,
and intolerable heat sad closeness result. Undoubtedly
tbs excitement of gambling is most injurious to the health;
but when combined with the respiration of foul air, con¬
taminated by the breath of thousands of people, by the
emanations from badly-constructed drains, and the burning
at hiindreds of lights, the result is even more disas¬
trous. As 'Monte Carlo Is not only of itself one of the
best health-resorts on the Rlvtera, but is easily and constantly
visited by invalids from Cannes, Mentone; Nice, &c., these
considerations are of great importance. The public have at
least the right to expect that the wealthy owners of the
Cselno will try ton provide pure air for the three or four
hundred thousand visitors who each year 1 are tempted to try
their fortunes at. the roulette or t rente et quarante tables.
In this case it is not so much a matter of expense as of
knowledge. The directors of the Casino do not know what !
to do. They are not men, of science, and the persons in
their employ 0 Te men of art and men Of business who have
never had any opportunity of learning anything about
sanitation. Thus more money has. been spent in building
what has proved to be the cause of nuisance and of danger
to health than it would have cost to construct drams
correctly laid, ventilated, trapped, and intercepted. But
this excuse does not. deprive the public of the right to
protest; and, as yearly the climatic advantage of Mon to
Carlo as a health-resort is better appreciated, both by
physicians and by patients, it becomes a duty to point out
these defects. Moreover, there is every reason to feel the
utmost confidence that the directors of the Casino Would
make considerable alterations if they were certain that the
desired improvements oould be secured. It would be difficult
to find in all Europe a building where, during the oourpe. of

the year, so great a number of people congregate and remain
for so many hours within its walls. But this season many per¬
sons have been positively driven away by t,he bad smells; and,
if for no higher motive, self-interest points to the necessity
of better ventilation and better drainage. Enough has
been done for outward show and outward attractions; care
must now be taken that, in contemplating the tine pamt-
ings, decorations, and. architectural beauties,of thp Casino,
or in listening to its unrivalled orchestra, the visitor shall
no longer be inconvenienced by impure air and insufficient
ventilation. Indispensable improvements of this description,
thereis little reason to doubt, wifl be attempted at no distant
date. The directors have discussed these matters on several
occasions. Many projects have been submitted to them, and it
is to bo hoped that they will soon have succeeded in selecting
a good working plan. In that event it will be a pleasure to
notice favourably that which, at present, and in the public
interest, it is necessary to criticise somewhat severely.

LIVERPOOL.

{^rom our oicn Correspondent.)

TUit NORTHERN HOSPITAL AMBULANCE. * . r

Somb idea of the great value of a Weil-organised ambu¬
lance service in such a city as this is shown in the account
given of one day's work done by the ambulance of the
Northern Hospital. On the 28 th ult. there were removed
to the hospital the following cases:—1. A sailor, suffering
from scalp wounds, concussion of the brain, and compound
fracture of the leg. 2. A carter, who had sustained a scalp
wound and concussion of the brain. 3. A man, seventy-two
years of age, with a fracture of the thigh. 4. A stableman,
who had been thrown from a trap, and had sustained a
scalp wound with concussion of the brain. A well-appointed
horse ambulance must soon become a necessary adjunct to
every large general hospital in town or country.

RXCHVNT LOCAL HOSPITAL CHANGES.

Dr. Bradshaw has been Sleeted Physician to the Stanley
Hospital/ 1 Dr. Edit*, lion. Assistant Physician to the Hospital
for Women, has been elected Honorary Medical Officer for
In-patients; and Drs. Bernstein ana Ororier have been
elected Honorary District Medical Officers to Districts 4 and
9 <rf the Ladies’ Charity and Lying-in Hospital.

overcrowding i*v tit: Liverpool workhouse.

F^or Some time past the Liverpool Workhouse, though of
considerable dimensions, and probably one of the largest
institutions of the kind in the kingdom, has been found
to be inadequate to meet all the demands made upon it.
When it is borne in mind that the greater part of the
buildings were erected many yean ago; this will not appear
surprising. Steps are being token to remedy the oner-
crowding which exists, bub nothing Can be done till after
the report of the Local Government Board inspector.

PREVALENCE OF MEASLES.

At the meeting of the Ilealth Copunittee on the 31st ult.,
the medical officer of health reported that there had been
during the week U cases of fever, SI of scarlatina, and 171
of measles. Ho regretted to say that the latter was on the
increase; there had been 33 deaths from it since the previous
week,representing 10 per rent, of the total deaths, while it was
the largest number of deaths from measles in a single week
that he bad known for a great number of years. In one
school in Toxteth Park there were no fewer than fifty chil¬
dren absent on account of it. Tho committee bad no power
to dose the schools except with the consent of the managers,
and there was no hospital accommodation whatever.

LIVERPOOL POUNbLrNG HOSPITAL.

The first report of the Liverpool Foundling Hospital Irak
recently been published. Its object is the double one of
affording to women who have fallen once only an oppor¬
tunity ol regaining respectability, and of providing a home
for the children of such women. Besides receiving infant
children, the hospital contains wards for the confinement of
unmarried women, eligible under the rule qf previous good
behaviour, who are thus enabled to return to a respectable
life, leaving the child in the hospital. The institution, has
been at work for about nine months. Eight infante. have
been admitted; and two, whose mothers nave since gone
back into domestic service, have been boro in the hospital.

by Google

752 The Lancet,]

DU BLIN.—OBITUARY.

[A PHIL 9,1887.

DUBLIN.

(From our own Cor respondent.)

THE QDKBN's JUBILEE.

At a recent meeting of the Executive Cjmmittee of the
City and County of Dublin Jubilee Committee, it was re¬
solved unanimously that a hospital for consumption and
diseases of the chest would be a memorial most likely to
receive support from the public, the hospital to be in the
county of Dublin. Various other suggestions had been
started, but the foundation of a hospital for chest affec¬
tions was considered the most desirable project in cele¬
bration of Her Majesty’s Jubilee. Accordingly a meeting of
the Celebration Committee was held last week, under the
presidency of the High Sheriff of the county, and after
some discussion the resolution above referred to was
adopted by 23 to 14. It has been stated that Dublin is
over-hospitalled, and that it would be better to utilise the
money collected by establishing Jubilee wards in the present
existing hospitals. There are, however, in my opinion, many
and valid objections to this proposal, while, on the other
hand, the erection of a special institution for cheat affections
at Killiney, a sheltered and salubrious locality on the coast
about ten miles distant from the city, is one which may be
expected to meet with much greater approval. General
hospitals are not the places for consumptive patients, and
in advanced stages of the malady not only are those
institutions unsuitable to the patients, but they are a con¬
stant source of annoyance to the other inmates of the
wards. It must also be remembered that these patients
occupy beds which might with greater advantage be
tenanted by sufferers from more curable maladies. This
view of the matter has been adopted for some years by
the authorities of the Belfast Royal Hospital; and, as a
result, for some time before the foundation of the Hospital
for Consumption, 1 patients in the advanced stages of the
disease were refused admission into the wards of the only
general hospital in that large and populous town. 1 do not in¬
tend to discuss the cost of the proposed institution, but shall
merely refer now to the absolute necessity of such a
hospital as is now proposed to be established. The Registrar-
General for Ireland has pointed out that one-tenth oi all the
deaths in Ireland are caused by consumption, and one-sixth
by diseases of the respiratory organs other than phthisie;
while in Dublin the mortality is relatively higher. It is
sincerely to be hoped that a substantial sum may be obtained
for the erection and endowment of a hospital of the kind,
which would be the most fitting Jubilee gift that could be
offered by Her Majesty’s loyal subjects in this country.

RICHMOND DISTRICT LUNATIC ASYLUM.

In last week’s issue I referred to the insanitary condition
of this asylum, and in consequence of the report of the
resident medical superintendent the governors held a meet¬
ing last week, when it was determined to hold an inquiry
into the defects to which attention had been directed. I
am informed that Sir Charles Cameron, medical officer of
health and city analyst for Dublin, and Mr. Wilkinson have
been engaged to investigate the matter, and any suggestions
made will at once be carried out.

NATIONAL BYE AND BAR INFIRMARY, DUBLIN.

In the Dispensary for Diseases of the Throat, which was
established about three years since as an adjunct to the ear
department, 124 new cases were treated daring the past
year, and of these a large proportion consisted of aural

C uts who were found to nave throat complications.

hospital is certainly carried on with due regard to
economy, for the sum paid in salaries during the year,
including that of the house-surgeon, only amounted to
Something over £100.

THE MEATH HOSPITAL. •

At the annual meeting held on Monday the committee
acknowledged the very handsome bequest from the late
Mr. John Barber, amounting to £4600, which it is intended
to expend in erecting a memorial ward, to be called the
“Barber Ward.” Mr. O’Reilly Dease, D.L., has also given a
sum of £200 for the neosseary expense in tesaelatfng the
entrance hall and aoeident oowidosyita the first part of a

1 BmUdttythatMMTaiMiMof a«ftl7' n Mr. Fowter Green.

memorial to his father and grandfather, both gentlemen
having been distinguished surgeons of the hospital.

I understand that, at last, the report of the Dublin Hoe-

f it&ls Commission has been plaoed in the hands of his
xcellency the Lord-Lieutenant.

The death is reported at Gorey, from blood-poisoning, of
Dr. George Weldon, in his sixty-first year.

Dublin, April 5th.

JOHN BRADY, F.R.C.8.1.

On the 27th ulk, at Rugby, a gentleman remarkable in
his generation passed from our midst. Bora in the year
1813 in the county of Cavan, Ireland, Mr. Brady at an early
age repaired to London to study medicine, and in due course,
becoming qualified, he started in practioe in the Borough,
in partnership with his brother Charles, who enjoyed the
reputation of being a very skilful and accomplished surgeon.
Quickly they established a large and lucrative practice,
which doubtless would have become even more extensive,
but for the fact of the partnership being terminated in
consequence of the subject of this notice retiring from
practice shortly after hjs marriage, in 1847, with a
wealthy heiress, Miss Pritchard, of Ely, by whom he
had two daughters, who survive him. Mrs. Brady died
in 1860, and Mr. Brady never married again. P oaaoo a od
of a singularly active and cultivated mind, he could
not content himself with a life of idleness, so, turning
his attention to politics, he entered Parliament as member
for Leitrim in the year 1862, which constituency he repre¬
sented, uninterruptedly for twenty-seven years, his ooonexioa
with it being closed in consequenoe of failing health. As
characteristic of the man, it may be mentioned that on the
occasion of his first contesting Leitrim he was strenuously
opposed, in consequence of his liberal opinions (opinions
which nowadays would be looked upon as being con¬
servative), by the leading Conservatives of the county,
but subsequent acquaintance with his integrity of pur¬
pose and independence of character converted many
of them into his staunchest political adherents. Firmly
impressed with Roman Catholic doctrines, be was to a very
remarkable degree tolerant of the religious belief of tboes
who differed from him; generous to a degree, charitable,
hospitable, and warm-hearted, to know him was to love him.
In the year 1869 he introduced into Parliament the measure
with which his name should always be gratefully associated,
and on August 2nd, in that year, the “Medical Officer*
Superannuation (Ireland) Bill” became law. The writer of
this notice was in the House on the Wednesday upon
which he moved the second reading of the Bill, and
well recollects the impression which his judicious and
able statement made upon a most attentive audience.
In recognition of this and other professional ser¬
vices, the Royal College of Surgeons in Ireland, om
August 6th, 1869, conferred upon him their Honorary Fel¬
lowship. Mr. Brady was, moreover, a highly educated man
and a ripe Shakespearian scholar, to which circumstance
possibly may be attributed the fact of his intimacy with all
the leading actors of the day, by whom he was looked up ta
as an authority. In addition to his professional distinctions,
Mr. Brady was a J.P. and D.L. for Cambridgeshire is
England and for the oounty of Leitrim in Ireland.

The Margate Royal Sea-bathing Infirmary.—
At the annual meeting of the governors of and subscribers
to this institution on the 31st ult, it was reported that
during the past year 636 patients had been treated in the
infirmary, ot which number 496 had been discharged, seven
bad died, and 137 remained in the hospital. The out¬
patients during the year had numbered 36. The peci^njary
support afforded is lamentably insufficient, and the oom-
mittee have had great difficulty in carrying on the work of
the charity during the past year. Increased and additional
subscriptions are earnestly appealed for by the directors.

The annual general meeting in connexion with the
Victoria Hospital for Sick Children, Hull, was held on the
4th inst., when satisfactory reports were presented and
adopted.

Digitized by GoOgle

THB LANCET,]

MEDICAL NEWS.

[April 9,1887. 753

tirkal Bifos.

Royal College of Surgeons in Ireland.

At a recent inquest held at Portsmouth, the jury
returned a verdict that the deceased had died from blood-
poisoning caused by eating tinned salmon which was unfit
for food.

At the usual monthly meeting of the members of

meeting of the Court of Examiners held on March 28th and the Association of Public Sanitary Inspectors on the

IOiJOWlH£f a a VS. thfl undp.r- Tinman . navincr n hamaH t\- n c _ a n_a_ j.ir _ a __ . jj__

following days, the under-named, having passed their final
examinations for the Letters Testimonial, were admitted
Licentiates of the College:—

2nd inst., Dr. Alfred Carpenter delivered an addrees on
“Theory and Practice as to Disinfection.” A discussion, in
which several of those present took part, followed the read-

Joteph Daly, Rlcliard H. Dickson, John W. Haughton, Joseph Laver- ing of the paper,
tine, Reginald Rygate. ° v r

c____ rn. e i, • ,, Sanitation in Japan—M r. W. K. Burton, senior

^ tha CARIES. The following gentle- engineer to the London Sanitary Protection Association,

men passed the examination in the Science and 1 ractioe of has been appointed Professor of Sanitary Engineering to
“ d Midwifery, and received certificates the Imperial Institute, Tokio, by the Government of Japan,
to practise onMarch 31stThis institution is, we believe, the only college in the world

jfeDoietnwaite, H&rolrt, Grov^teri/iWi Bradford. vnf whAra oiinh o TtrnfAAAATfihin ATiAtm

Lingwood, Bdgar Henry, Comnce-md, Brixton. “ * * 8UCD * P roIe 880r8Wp eX18t8 -

A npw Wnital ; a oWti* k,, • ir n * Volunteer Medical Staff Corps.— The Secretary

be called the Hull Orthonmdie Hoimitai Hull, to 0 f gt ate for War has approved of the formation of a Volunteer

be called the Hull Orthoptedic Hospital. Bearer Company at Manchester. The total strength of the

Hospital Sunday collections were held at'Hartle-
pool on the 3rd inst.

Bearer Company at Manchester. The total strength of the
company will be 100. It is to be an independent unit, sub¬
ordinate to the military and medical authorities of the

The Duke of Northumberland has signified his f“ Ct ' The c°»Panj’8 formation will date from April 1st

intention to give a site, consisting of 3000 square yards, for
the proposed new infirmary for the borough of Tynemouth.
The ground is valued at £1200.

Norto-West London Hospital.—O n the 1st inst.
the general court of governors of this institution was

h££ bS? from 33 ’ 687 “ .^-Prtients, 10,673 of

the executor of the late Mr. George Bedford, of Southport.

to £3477, the annual subscriptions producing £636 of this

The British Ophthalmic Hospital, Jerusalem.— sum.

the above institution was held Vaccination Grants.—T he following gentlemen

39 th ult Sir Charles Wftrrp^i’ on the have received the Government grant for successful vacci-
39th ult Sir Charles Warren was in the chair. nation in their reepectiYe districts:-Mr. Edward Jay, 8t.

At .the Loughborough Petty Sessions on the 30th George’s, Hanover-square; Dr. G. Hales Parry, Docking
ult., a butcher was fined £10 and costs, or, in default, one Workhouse and District, Norfolk (third time); Mr. Thomas
month’s imprisonment, for exposing for sale sixty-seven Brett Young, of the Romsley District of the Bromsgrove
pieces of unwholesome meat. Union; Mr. F. W. Lewis, of Llandovery Union (second time

Medical Magistrate. — Joseph Todd, M.R.C.S.

Peace in January last.

Brett Young, of the Romsley District of the Bromsgrove
Union; Mr. F. W. Lewis, of Llandovery Union (second time
in succession).

At the monthly meeting of the Manchester Royal
Infirmary Board, held on the 28th ult., Mr. Alderman King
presiding, it was reported that an arrangement had been
made for the reception of cases of infectious disease from
Salford at the Monsall Hospital, in consequence of the

TwfbrM™ . / -rl wa8mau £ urM ®d at for the purposes of railway extension.

pjBondge by Lady Goldsmid. The town has now a good „ L. , ,

supply of excellent water. St. John Ambulance Association.—A course of

Worcester Infirmary.—A t the recent annual lecturee on “ Mwt Aid to the Injured” has been recently
meeting of the governors of this institution it was reported £ ehvered ***** the senior boys of King Edward VI. s
that the income during the past year had amounted to Schpol > Berkbampstead, by R. L. Batterbunr,

^3647, and the expenditure to £4391. The number of M.°. Load., one of the nuriwal officers of the school. The
in-patients amounted to 1288, and of out-patients to 6214 examl f n “ tlon condnc lf? by Surgeon-Major Casson, and
~ , v _ ", out of twenty-five candidates, twenty-three are reported

■tRESentation. On the 31st ult., Dr. Murdoch to have passed, and will obtain the certificate of the
Cameron wa * presented by the students attending the mid- Association.

»ig3 b/Sfthe mlm^i^f fc the f (SISfuTaSSS“ed£l£“ University College Hospital.—T he annual meet-
«i his services as their teacher during the absence of the ing of tbe 8U PP° rtera of this institution was held on the
professor, Dr. Leishman. 31st ult., when it was reported that 2638 patients had been

Rnv.r rv.._ „__ a ,, admitted during the year, of which number 1260 were cured

f. AL jj' OL ^ B ^ E Surgeons in Ireland Medical and 868 relieved. The out-patients numbered for the year
ochool. The following have been awarded prizes in a total of 35,765, besides which a large number had been

n p* 81 * ?**«<"*:—i/escnpuve Anatomy: senior seen on the recommendation of local and other medical men,

pj'®'? 81 ?’ Mr. Mcllwaine, £33*.; junior medalist, Mr. Wright, making the total of in- and out-patients upwards of 40,000.
inni™. 01 • Anatom y : Senior 1 prizeman, Mr. Warren, £3 3«.; The number of beds during 1886 was 209. A hope was
J r prizeman, Mr. Wnght. expressed that this Jubilee year would see the debt of about

Birmingham Medical Institute. — The annual ^4,000 cleared off.

witb this_institute was held on the The Jubilee.—T he amount contributed to the
the mv?-*. r ‘t‘ v.' S°l°mon, President, in the chair. From Jubilee Fund for the extension of the Aberdeen Infirmary
the w * 8 P re * e nted and adopted, it appeared now stands at £16,264. The sum required is £30,000.

the nMt ^en increased by 178 during It has been decided to erect a Jubilee cottage hospital at

berg htd t ??®l >er of books taken out by mem- Castle Cary.—About £420 has been promised to the building

by 1178, and during the past year the fund in connexion with the Dartmouth cottage hospital
Dr. Jam®. v*J*® WCT8WM 138, ae compared with 73 in 1881. scheme, and £86 annual subscriptions; the total amount

year- M _° H.° y n . y* elected Presi den t for the ensuing required, however, being about £2000.—On the 31st ult. a

henomw i J ._ . iZ >e - rt "ariingand WoodWhitewerere-electea new infirmary and dispensary was opened in Bideford. The
May librsr^a to,e? ’ * n “ Dr ’ Saundby and Mr. Bennett institution, which has cost about £2000, has been, in eele-
. bration of the Jubilee, opened free of debt.

ioogle

7-M XHB Lancet,] MEDICAL NOTES IN PARLUitE^T.—APPOINTMENTS.—VACANCIES. [APBit 0.180?-

FOSTER AND WHEELUOUSK ELECTION - EXPENSES
FUND.

Treasurer's Account, from October 6th, 188(5, to •
March 3l8T r 1887.

Db. TUccipU.

To subscriptions (as per counterfoil receipt-

book) . .

„ Sir B. W. Foslcr, M.l*. ...

„ C. G. Wheelhousc, B.«q.

£\M 11

12 .'! 10

£88 10 0

280 2 2

CR. Paymente.

By prlntiug, postage*, and stationery —. .

„ advertising .

„ secretarial expenses .

,, treasurer's expenses .

„ audit lee — .

£.‘i.'!8 12 2

£272 10 4
49 8 6

14 17 I
0 15 0
1 1 0

£5.18 12 2

Robert Saundby, M.Dj, Hon. Treasure^.
Examined aud found correct. . Cart he A Cam's: a.

Chartered Accountants, Birmingham.

MEDICAL NOTES IN PARLIAMENT.

Dublin Hospital Commission.

In tlie House of Commons, on the 4th Inst., Dr. Kenny asked the
Chief Secretary to the Lord-Lieutenant of Ireland whether the report
and minutes of evidence of the Dublin Hospital Commission were yet
ready ; if not. when members- might expect them to be laid upon the
table.—Mr. A. J. Balfour, In reply, said that it is understood that the
report will Shortly be submitted to tliS Lord-Lieu tenant. On its receipt
the Irish Government will be In a position to consider whether it, as
also the minutes of evidence, should be laid upon'the table.—Dr. Tanner
asked an explanation of tho delay.—Mr. A. J. Balfour presumed the
delay had occurred in the writing of the report, but he reminded Die
hon. member that it by no means followed because a report was pre¬
sented that it should therefore be laid on the table of the House. That
was a matter within tho discretion of the Lord-Lieutenant.

Indian Medical Staff,

On the 5th inst.. in answer to Dr. Tanner, who asked as to the rank
and allow ances of officers belonging td the medical staff of India under
six years’ Servfoe, Sir J. Gorst stated tliRt the rank of those officers is
that of sul-gebn. Their allowance*art roOrp than, those of subalterns,
but lest than those of captains. After six years they ore more than
those of captains. They do receive the allowances of their rank. There
are no claims appertaining to relativerank and no 1 less it suffered.

The Pharmacy Acts Amendment Bill. • *

On Tuesday morning, Dr. Farquheo»u,.moved the second reading
of this Bill, briefly narrating tho circumstance? which led to its
introduction, and urging that, its enactment would be in the public
interest.—Dr. Clark regretted that he felt it Ids duty to oppose the
second reading. The object of the measure was to Rive additional
powers to the Pharmaceutical Society, and powers which It ought
not to possess. Up to 1888 anyone could carry on the business of
a chemist and druggist, bat la that year a Hugi&terof chemists and
druggieto was drawn up, and those who practised the trade were called
upon to pass a qualifying examination. Hut now the Society wished to
go still further, and to be allowed to create a curriculum, and to compel
students to pass in chemistry, botany, and njateria medic*. |The ouly
result of the passing of the Hill would be to make the trade d nose cor¬
poration, to make It easy for student* to pass ih largo towns, hut to make ■
it almost impossible for those to qualify who lived in small towns and
poor neighbourhood*. By allowing the Bill to pass the House would
depart from the principle of free trade, by limiting theoale of drugs to n
vary small class, and he could only say that if this power was to be oon*.
f erred on any body, it should be given to a public-body, aud not to a private
society of traders, who could make bye-laws which should have all the
effects of an Act of Parliament.. If the Bill were pressed and carried to a
seooed reading, he should feel it his duty In committee to endeavour to
amend itand make the Pharmaceut ical Society more representative of the
12,000 members of the trade. In his opinion' there was no necessity for
the proposed change. And he should therefore move that tbe Hill bo read
that day six months.—Mr. H. J. Wilson seconded this amendment.—
Mr. Chance supported Die Bill on the groohd that It Wonld assimilate
Bngllsh and Scotch law to that prevailing hi Ireland, xrhloh had
worked, so satisfactorily.—Dr. Tanner -thought there was ooaidenvble
fear that the rights of many chemists and druggists were not properly'
respected. He urged that thp second reading should lie deferred a few’
days to allow tome neoessaryamendments to m drafted.. On AdhiSioii-
t{is Bill was read a second time by 7(5 votes to 22. ♦

The Committee stage of this measure came on for consideration on
Wednesday moaning at 2 a m. On the motion that the Deputy Speaker
do-new leave the cliair, Colonel Hodge mowed the adjournment of the 1
ddtete. The Bill had pasted through tbe see caul reading with only a
slight run of opposition, and lie hoped the House would agree to an ad¬
journment.—Dr. Farquharson said he had himself Intended to move
tbe'adjpumment of the debate, and subsequently to,more to report
progress. Many members were deeply Interested in tbe BUI nnd desired ,
to pdt amendments on the paper, and to have longer time lot its con¬
sideration.—Mr. Chanoe and Mr. Lowttier supported the motion for the
adjournment.—Dr. Tanner said there were several poluts In the Bill
which demanded Investigation. It .was alleged at flr?t that the Bill
was the same as the lawwhlobappHeetoehemistsin Ireland. Accordingly
from, what he knew of tbe measure, he was nob, at i*Ui satMmd about it,
and be should certainly support, the adiommuent.—Dr. Clark said he
thought his hon. friend fhe member for Aberdeenshire might accept the
imstton. The Bill was brought forward between two and three o'clock
oa the previous evening and advanced a abase. It mas an Important
measure, affect lug thousands of people whose livelihood would be taken
* wa 7— ®r. Blggar also supported the motion for tlie adjournment, which
wreoarried by 95 votes against 29. The debate was accordingly adjourned
till Tuesday, April 19th.

§,jpmtracnt3.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others /assessing information suitable for this column qr« incited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
t/uin 0 o'clock on the Thursday morning of each week for publication is
the next number. -

Abbott, 0. K.. M.K.C.S., L.K.Q.O.P.I., has been rnappeiabsd Modtaai
Officer of Health for the Braintree Rural Sanitary District.

Bkrnstkin, Muter J., M.B.. C.M.Bd.. 1ms been appointed Honorary
Medical Offcer for the Fourth District of the Liverpool Ladles’
Charity ami Lying;iu Hospital.

Cape, Joseph Thomas, M.K.C.S.. L.S.A., lias been re-elected Medical
Officer of Health ty the Rural Sanitary Authority of the Totnea
Union.

Chick Li cas, J. 1L G., M.H.C.S.. L.S.A., has Irean appointed Honorary
Medical Officer to the Rvde Dispensary, Isle of Wight.

'Chozikr, William, M.K.Q.C.P.I., L.U.C.8.I., ha* been appointed
Honorary Medical Officer for tbe Ninth District of the Liverpool
Ladies' Charity and Lying-in Hospital.

Dowdi.no, Alex. W. Woodman, M.D.Durli., M.JLC.S., has been
appointed Medical Officer for tho Haughley District of the Stow
Union, vice Stephens.

Durwahd, James Stewart, L.D.S. R.C.S.Ed., has been elected to thn
Senior Staff of the Kdinbun^h Dental Hospital.

Bdis, John Butler. M.R.C.S., L.R.C.P.Ed.. has been appointed
Hon. Surgeon to the Hospital for Women. Show*street, Liverpool.

Eustace, Marcus, B.A., M.B.. B.Uh.Dub., has bean appointed Median!
Officer for the Second District of the Alresford Union.

Falklnbr, Ninia.v McIntibk, A.B.. M.B„ B. Ch. Dab., has been
appointed Visiting Physician to the Convalescent Home, StUlorgon,
Dublin.

Fletcher, Rory, M.R.C.S., L.S.A., has been appointed Resident
Medical Officer to the Male Look Hospital, Dean-street, Soho, W , vioe
G. W.tt. French, F.R.C.8.

GoodAi.l, John Kknax, L.B.C.S., L.H.C.P.Bd , has been reappointed
Medical Officer for the Bolsover District of the ChesteriWkl

Union.

Haotard, Roiurt, M.R.C.8., L.S.A., has been appointed Honorary
Surgeon to tbe Hull Orthopsdlo Hospital,

Hall, Andrew Johnston, M.A., M.D., C.M.OI 11 *., has been appointed
Medical Officer for the Parish of Rothesay, vice Madderer, -
deceased.

Harwell, J. F., M.D.. C.M.Edln., has been appointed Junior House-
Surgeon to the Northern Hospital, Liverpool, vice C. C. Charlton,
resigned. ,

Hunter, Charles Buchanan, M.B., C.M., has been appointed Surgeon
to H. H. the Nlgarris Railway, Hyderabad, India.

Hutcheson, James, M.B., O.M.ikU M.B.C.S., L.H.C.P.Lond,, has been
appointed Surgeon to the Edinburgh Royal Maternity and Simpson
Memorial Hospital.

JdHXsrokEj.WM ., had bcerf appointed Public Analyst to theBoronghaof
Dartmouth and Dunstable. ,

Mackenzie. Thomas, M.A.Glas., M.B.,’ C.M.Bd., has been appointed
House-Surgeon to the Edinburgh Royal Maternity and Sim peon
Memorial Hospital. , ,

Martin, Matthew. M.B., C.M.GIas.. has been appointed Modical
and Surgisal Officer to the Parkhead Steel and Rolling Mills,

OwEN^kicnaiD ilEFFERrs, L.R.llF. LoniL, M.R.C.S.. haa been
aopoihied Medical Officer for tbe Second District of the Llandoveiy
Uniop. ,

■Packer., W. Herbert, M."D., L.R.C.P., has been appointed Medina!

I Visitor to the Shropshire PrlVato Lunatic Asylums, vice Bdwyn
Andrew, M.D., deceased.

Roberts, James B., M.B.i C.M.Bd., has been appointed Medical Officer
for the Fourth District of the Nottingham Union. ' '

Semple, Henry F„ M.B.C.8., L.RX3.P.. has been appointed Hoose-
Surgeon to the Bristol Hospital for 6lck Children and Women, vtoe
E, Leonard Lfes, M.B., O.M., M.R.C.S.

BT addon, WalteH Joseph, M.R.C.S., L.R.C.P. Lond., haa been
appointed Assistant Medical Offioer for the Workhouse of the Lead*
Uuion. ,

War*. Oi.vIriie Stephen', M.R.O.8.; L.R.C.P., L.8.A., late Hoube-
- Pbpolelan and Obstetric House-Physician, has bean appointed 1
House-Surgeon to the Middlesex Hospital. ,

Wilson. James, M.B., C.M.Glas., has been appointed Surgeon to the
Bttrlek Lodge of Ancient Shepherds, vice A. Muir 8milh, resigned.

Wilsos, William. M.B.. C.M-Ed , L.H.C.S.. L.D.8., has been elected
to the Junior Staff of the Edinburgh Dental Hospital.

KEatman, J. W., M.R.C.S.. has been appointed Government Medical
Officer for the Upper Wakefield and • Saddleworth District*, South

’ Australia, vice H.F. Harvey, M.R.C.S.,,resigned.

iarancifs.

In compliance with the desire of nsanefous subscriber*, it has been decided to
• resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. Per further
information regarding each vacancy refer met should be made to the

advertisement. -

'Beadtoed Infirmary and Dispensary,—D ispensary Surgeon. Salary
£100 per annum, with board, residence, and washing.

City .of London Hospital for Dm eases o» the Chest, Victoria-park.
B.—Resident Clinical Assistant. A gratuity of £20 Is usually
awarded at the close of tlie term of office (six months).

Great Northern Central Hospital, Caledonian-read, N. —Aural
Burgeon.

Hospital for Sick Children, Great Ormond-street, Bloomsbury .

W.C^-ClInlcal Assistants In the Out-patient Department.

Queen’s Hospital, Birmingham.—Obstetric and Ophthalmic House-
Surgeon. The appointment oarries with it board, lodging, Ac.

by Google

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BIRTHS, MARRIAGES, AND DEATHS.— BOOKS ETC. RECEIVED; [April 9, I$87. 755

Koyal National Hospital fob Consumption, Ventaor. — Assistant
Resident Medical Officer. Small honorarlnm.

Scarborough Friendly Societies’ Mkdical Associatioit.— Resident
Medical Officer. Salary £900 for the tint year, £230 for the second
(if satisfactory), with fees extra, and resideuoe, free of rates and
raxes, with an allowance for coals and gas.
smkdlet’s Hydropathic Kstaju.ishmknt, Matlock-bridge, Derby¬
shire.—Junior Resident Physician. Salary *5160 per annum for the
first year, with accommodation in the establishment,
dr. Pancras Infirmary, Dartmouth-park-hill, Highgate, N.W.—Dis¬
penser. Salary £100 per annum, with dinner dally, and, subject to
the approval of the Local Government Board, rising by £10 annually,
to £130.

$irtjis, Carriages, anir Jtatfrs.

BIRTHS.

Bloxam. —On the 31st ult., at George-etreet, llanover-square, W., the
wife of J. Aatley Bloxam, P.B.C.S., of a son.

Bowes.— On the 2nd lost., the wife of John Ireland Bowes, Medical
Superintendent of the Wiita County Asylum, Devizes, of a
daughter.

Hast.— On the 30th ult., at Upper Berkeley-street, Port man-square, ff,
the wife of Bdwnrd Bast, M.R.G.S., of a son.

Xoiaus.—On the 99th ult., at Windhlll, Bishops Stortford, Herts, the
wife of John Kdward Morris, M.D., of a son.

O'Connell. —On the 29th ult., at North-villas, Havelock-park, Southsea,
the wife of Surgeon-Major H. O’Connell, of a daughter.

Kush brook. —On the 3rd Inst., at Upper Philllmore-plaoe, Kensington,
Janet Monteath Kushbrook, L.K.Q.C.P.I., L.M., wife of Henry
George Bushbrook, of a daughter.

Shaw. —On the 17tli ult. (St. Patrick’s day), at Mlldenhall. 80 ham,
Suffolk, the wife of H. C. Costello Shaw, L.B.G.P.Lond., M.K.C.S.,
of a daughter.

r»oTT. —On the 13tli ult., at Waterloo, Hamilton, Bermuda, the wife of
Dudley C. Trott, M.B., B.C., F.B.C.S., of a daughter.

MARRIAGES.

Crank— Crane.— On the 2nd inst., at the Parish Church of St. Mary-
’.ebone, Leonard Crane, M.D., Surgeon-General. Trinidad, to Lillie,
fourth daughter of the late Wm. Crane, Speaker of the House of
Assembly, New Brunswick.

Joints— Jours. —On the 30th ult., at 8 t. George's Parish Church,
Beckenham, Kent, John Bills Jones, M.B., C.M., to Catherine
(Kate), youngest, daughter of the late Roliert Jones, of The Mount,
Llanfair, Montgomeryshire.

l'nosrsoN — Macphail. — On the 30th ult., at Free Church Manse,
iGlmulr, Skye. N.B.. John Thomson, M.B.. C.M.Kdln., to Isabel
Finlayson. fourth daughter of the Rev. John S. Macphail, of
KUimrir. _

DEATHS.

Coates.— On the 28th ult.. at 1. Westboorne-etreet, Baton-square, S.W.,
Frederick Thomas Coates, M.U.G.S.H., second son of the late
George Coates, Surgeon, of Bloomsbury, aged 43. Deeply lamented.

Hensley.—O n the 4thInst., at Coleherne-road, 8 .W., Frederick John
Hensley, M.D., M.B.C.S., L. 8 .A., In his 06th year.

Kkddle.—O n the 29th ult., at The Elms, Besunlnster, after a long
and trying Illness, Samuel Shering Keddle, M.D., J.P. for co. Dorset,
within two months of oomptetlng his 90th rear.

Shaw.— On the 31st ult., at Blshopegate-street Without, after a lingering
illness, Henry Shaw’, M.K.O.S.,in his 74th year.

S'.tblinc,.—O n the 30th ult.. at Marine-parade, Brighton, Wm. Boughton
Stirling, M.D., and of Notblngham-place, W.

V.U 1 HER.—On the JlOth ult., at 31. Sbrewsbury-road, Blrkenliead, John,
infant son of Francis Vacher, F.B.C.S.

flf. 8 . —A fee of 5s. is charged for the Insertion of Notices of Births,
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Griffin, O., A Go., Exeter-otreet, Strand, London.

A Treatise on Diseases of the 8 kln. By T. McCall Anderson, M.D.
pp. 039, with Plates and numerous other Illustrations.
Hirschwald, A., Berlin.

Handbuch der Allgemeinen undspeciellen Arznelverordntingslehre.
Bearbeitet von Dr. 0. A. Bwald. Blfte Anflage. 8. 319.
Houinton & Sons, Paternoster-square, London

Enquire Within upon Everything. Seventy-fifth Edition, revised,
pp. 416.

Kkoan Paul, Trench, A Co., Paternoster-square, London.

The Sisters of St. Mary at the Cross. By the Rea-. H. D. Nihill.
pp. 301.

Kellogg, W. A., New York.

The Therapeutical Drinking of Hot Water, its Origin and Use.
By B. Cutter, M.D. pp. 31.

Lewis, H. K., Gowcr-street, London.

The Middlesex Hospital Reports for 1885. pp. 40*.

Ligaments, thsir Nature and Morphology. By John Bland
Sutton, F.B.C.S. pp. 107.

On the Diagnosis of Diseases of the Brain, Spinal Cord, and
Nerves. By C. W. Suckling, M.D. Lond., M.R.C.P. pp. 397.
with Illustrations.

Lippincott, J. B., A Co., Philadelphia.

Nervous Diseases and their Diagnosis. By H. C. Wood, X.D..
LL.D. pp. 501. ,

Wear and Tear; or Hints for the Overworked. By S. Weir
Mitchell, M.D., LL.D.Harv. Fifth Edition, thoroughly revised.
pp.70.

Lons vans, Green, A Co., Paternoster-row, London.

Through the Fields with Lhm*us: a Chapter In Swedish
History. By Mrs. Florence Caddy. In 9 vols. pp. 347—370.
Illustrated. 10s.

The Essentials of Histology, Descriptive and Practical. By
B. A. SchRfer, F.R. 8 . Second Edition, Revised, pp. 363.
Illustrated.

Macmillan A Co., London and New York.

The Practitioner'a Handbook of Treatment, or the Principles of
Therapeutics. By J. Milner Fothergill, M.D. Third Edition,
enlarged, pp. 661 .

The Treatment and Utilisation of Sewage. By W. H. Corfleld ,
M.A., M.D.Oxon. Third Bdltlon, revised and enlarged, pp.
510.

Masson, G., Paris.

L’Amputatien du Membre Superieur dans la Contiguite da
Tronc. Par Prof. Paul Berger, pp. 379. avec 3 figures et 2
planches en Chromolithograph^.

Medico-legal Society, New York.

Papers read More the Medico-legal Society of New York. Third
Series. Revised Edition, pp. 560.

Obstetrical Society of London.

Transactions of the Obstetrical Society of London. Vol. xxriil.
Smith, Elder ft Co., Waterloo-place, London.

Dictionary of National Biography. Edited by Leslie Stephen.
Vol. X.: Chamber—Clarkson, pp. 460. •

Swan SonneNscwkin, Lowrxt, A Co., Paternoster square, London.

School Hygiene. By Arthur Newsholme, M.D. pp. 143.
Whittaekr A Go„ White Hart-street, London.

Parliamentary Companion. 1887. Fifty-first year. pp. 368.
4s. 0d.

Wood, Wm„ ft Co., New York.

A Reference Handbook of the Medical Sciences. By varion
Writers. Edited by A. H. Buck, M.D. Vol. IV. pp. 818,
Illustrated by Chromolithographs and Wood Engravings.

BOOKS ETC. RECEIVED.

Ai.r.KV. B. W., Ave Maria-Inne. London.

Electricity in the Treatment of Disease. By J. U. Tunmer.
M.R.tfS. pp. 108.

8 \u,lierk, J. B., kt Fils, Paris.

Tumeurs de l’Ombilic. Par le Dr. Franois Villar. pp. 150, aveo 7
photogravures.

Hmxukrk, Tccdall, ft Cox, King William-street, Strand, London.
Griffiths’ Materia Medic* and Pharmacy. Third Edition.
Edited and in part written by Alfred 8 . Gut*. L.B.O.P., M.R.C.S.
pp. 404.

On Overwork and Premature Mental Decay; its Treatment. By
O. H. F. Routh, M.D,, M.B.C.P. Fburth Edition, pp. 149.
The Lettsoraian Lecture** on Bronchial Asthma. By J. C. Thorow-
good, M.D. Third Edition, with a Chapter on Asthma in
relatl on to Gont. pp. 98.

CaoacaiLL, J. ft A., New Burlington-street. London.

Rlectrical and Anatomical Demonstrations. By Herbert Tibbits.
M.D. pp. 91.

•^tswiiER G.. Jena.

Die Allgemeine Pathologle Oder die von den Ursachen und dem
. Weeen der Krankheitsproceese. Von Dr. Edwin Kids.
Brster Theil. S. 514, mtt 60 Tbeilweiso Farblgen und 3
Farbentafeln.

Oxygen as a Remedial Agent ; by C. J. Smith.—On a Peyertan Ulcer-
lesion of Small Intestines, apparently new; by H. Vandyke Carter,
M.D.—Von Dr. P. G. Unna: Zur Kenntnlss des elastischen GewehM
der Haut; Die Roeaniline nnd Pararosaniline (Voss. Hamburg).—
Scientific Memoirs by Medical Officers of the Army of I mil a; edited
by B. Simpson, M.D., Surgeon-General with the Government of
India; Part II.—Rapport fait au mm de la Commission chargee
d’examiner de Projet de Lot ayant poor objet l'Utilisation Agrioole des
Baux d’Ugout de Paris et l’Assainissement de la Seine; par K.
Bournevllle, D5put6 (Quantln, Paris).—Typhoid Pever in Melboorae.
its Prevalence and Causation; by Jas. Jamieson, M.D.—Cancer, its
Origin and Prevention, with other allied Diseases, In connexion with
the O. D. Acts ; by Dr. W. Williams, M.D.—Thurley TIghe, or the Life
of a Student; by Felix Weiss.—Die Pathologle und Theraple der
Gelenkentziindungen; von Dr. Max Schuller (Urban and Schwar/enberg,
Wien).—Tenth Annual Report of the Board of Health of the State of
New Jersey, 1880.— Ueber Neuritis Optica; von Prof. B. Deutschmann
(Fischer, Jena).—Index Medlcus, Vol. IX., No. 3.—Parliamentary
Companion, 1887.— HysWrie et Traumatlsme; par le Dr. Paul Berber
(Bureaux du Progrfs Medical).—Magazines for April: Good Words ;
Sunday Magazine; Leisure Hour; Snoday at Home; Boys’ Own
Paper; Girls’ Own Paper; Scribner’s Magazine.—The Medical Treat¬
ment of our Time; by one of the Excommunicated (Unwin Brothers).
—A new Clothing Case for the Soldier; by W. Thornton Parker, M.D.
—Bibliographic des Scienoes Med!calcs (J. B. Balllldre, Paris).—!*
Cosanlgia e la Reeeztofie Coxofemorale; pel Dott. A Tnmtta.

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NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Aphil 9,1887.

METEOROLOGICAL READINGS.

(Taken daily at 8.S0 a.m. by Steward’s Instruments.)

The Lancet Office, April let, 1887.

Bats.

Barometer
reduced to
Sea Level
and *3°F.

IXroo-

Uon

of

Wind.

»5>.

Wet

Bulb.

Solar

Max.

Temp.

Shade.

Min.

Temp

Bain

fan.

Hturti at

8 J0 4JL

la

Vacuo.

Mar. 31

30-19

W.

45

43

76

64

37

Cloudy

Apl. 1

39-69

W.

39

38

76

47

36

•i'3

Snowing

>. 2

39'93

N.W.

42

39

84

55

35

•33

Cloudy

„ 3

3012

W.

46

43

77

55

39

Cloudy

.. 4

29-87

w.

44

41

97

58

39

...

Fine

„ 8

29-52

N.E.

42

41

43 !

41

Raining

6

29-74

N.E.

43

39

—

44

39

•15

Over-oast

itffUs, jljrart Caramtitts, $ ^nsfotrs to
Ctrmspimknts.

It is specialty requested that early intelligence of local events
having a medical interest, or which it is desirable to bring
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We cannot undertake to return MSS. not used.

The Literature of the Spleen.

J. IV. (Leicester).—The treatise referred to It by Dr. Guido Baccelli,
President of the Accaderaia Medica di Roma* and some time Professor
of' Clinical Medicine at the Saplenza. It wet published in Latin In the
year 1876, and its title is " De Primitive Splenls Carcinomate (his-
tologicc, lympho - sarcomate); hlatoria, diagnosis, extlsplcium ” (on
Primary Carcinoma of the Spleen — In histological classification
•'lympho-sarcoma”—a history, diagnosis, and necropsy). It is in¬
scribed in an appropriate dedication to Dr. Eduard Blndfleisch.

Alpha is thanked for his letter on the Leicester Sick Benefit Society.
We shall be glad for any published statement of the oase. We could
not insert an anonymous letter.

M.B .—The matter should be brought under the notice of the Apothe¬
caries’ Society.

Lisina.—The name mentioned was not struck off the Register.

THE LUNACY BILL.

To the Editors of The Lancet.

Sibs,—W ill you kindly allow me through your columns to Invite all
workhouse medical officers interested In the Lunacy Acts Amendment
Bill to attend our council meeting on Thursday, April 14th (5 P.M.), at
3, Bolt-court, Fleet-sti-eet, at the clause particularly affecting them will
be under disoussion. I am, Sirs, yours truly.

J. Wickham Barnes.

Poor-Law Medical Officers’ Association, 3. Bolt-court,

Fleet-street, E.C., April 4th, 1887.

Telit.—Vr. Frederick Roberts' book “Notes on Materia Medica” (Lewis)
or Dr. Mitchell Bruce’s Materia Medica and Therapeutics (Cassell) will
give the proportions.

Mr. 0. 4>. Jeaffrotate .—The paper will appear shortly.

BBB AD-MAKING.

To the editors of The Lancet.

SIRS,—In answer to the letter of Mr. Robert Jones in The Lancet
of the 36th ult., I beg to say that my late father, Dr. Thos. Smith,
wrote an article entitled “An Improved and more Wholesome Mode of
Making Bread.” The article appeared in the Leed s Mercury of Feb. 17th,
1844, and I have a printed oopy of the same.

I am. Sue, yours truly,

Cheltenham, April <tb, 1887. Fred. A. A. Buna, M.D.

The Fifty-two Years' Plaque.

According to Procopius, “the Byzantine Herodotus,” the Plague
began aj>. 543 in the Nile delta at Peloaium, and dividing ita forces
it attacked Alexandra and the rest of Egypt on the one hand and
Palestine on the other. Beginning always on the sea-shore, it pene¬
trated inland, depopulating islands, caverns, hill tracts—wherever, in
short, human beings were found. In its second year It invaded
Byzantium in the middle of spring. Many of its victims felt them¬
selves struck in some part of the body, when, by way of exorcising the
assailant, they would utter some sacred word and hurry into the nearest
temple. To escape the importunities of friends, others, again, would
barricade themselves in their rooms and plug their ears so as not to
hear the load knocking at their doors. A feverish malaise arousing
them from sleep or arresting them in their walk or at their work was
the first symptom; but there was no change of colour, or sense of
burning heat, or inflammatory affection, so that in the evening
neither patient nor physician was alive to any danger. But many on
the same day or the day following, or a considerable time thereafter,
saw a bubo rising on the groin, or in the armpits, or on the parotids,
or in other regions, and this symptom was common to every sufferer
from the disease. Somnolence, stupor, or acute delirium were often
present, with forgetfulness of every oall of nature, so that many who
happened to be without attendants died of hunger. Contact with
patients or with the dead gave the malady neither to physician nor to
sexton, while many—they knew not why or how—were attacked and
suooambed in a few hours. Patients lung themselves into the sea or
from high places in anticipation of death, while in others the bubo,
not preceded by visions or delirium, passed into gangrene, and they
died in convulsive agony. The physicians suspecting these plague
ulcers to contain a poison which caused the disease, opened them in
many dead subjects, and found them to contain a large carbuncle.
Those cases in which the body was covered with black pustules, the
size of a lentil, died within twenty-four hours, while others vomited
blood till death relieved them. Errors In prognosis were infinite, able
physicians foreseeing death where marvellous recovery supervened,
and predicting recovery just before fatal collapse. Therapeutics were
equally at fault. The bath was of use in some oases; worse than
useless in others. It was quite as ineffectual to fly from the disease as
to treat it—such was the ignorance as to ita origin or its Issue. Those
in whom the bubos proceeded to copious suppuration got well, as with
the defervescence of the carbuncle the signs of returning health
revealed themselves. Recovery was not always, however, complete,
the survivors being often afflicted with semi-paralysis of the tongne,
impairing distinctness of articulation tor life. In Byzantium the
plague lasted four months, during three of which it wae at Us
maximum, when the mortality reached 10,000 dally, till the dty
seemed deserted. Other details confirmatory, with few exceptions, of
the powerful description by Procopius fill in the sombre picture, and
must be drawn from the histories of Agatbtas and Evagrlns. Gibbon,
in bis condensation, followed with greater authority by De Henri,
contests the dictum of Prooopius that the disease was non-contagions,
an epithet scarcely applicable to a visitation which passed from country
to country, beginning at the seaports and penetrating inland. Another
point indicated by De Reazi it the evidence deducible from Prooopius
that the Byzantine physicians practised morbid anatomy and sought
out the causes of disease by pathological research-. — “ Even the
Christians of the sixth century did not hold the dead subject to be so
intangible as not to afford to science the means of exploring the struc¬
ture of the body, and so of aiding anatomy” (“Souola Salemitana,”
vol. i., p. 31).

Mr. Kingzett.—k specimen of the preparation should be salt for exami¬
nation.

A One-eyed Engine-driver .—We cannot say we are greatly Impressed with
the force of the argument used by our correspondent.

A WARNING.

Tt the Editors of The Lancet.

Sirs,—A s a hint to my professional brethren, I send a line to say that
a man called at my house yesterday afternoon, at about 3 o’clock, and
asked if I was in. On my servant 'replying In the negative, he asked
when I was expected, and was told that I would return In about half an
honr. He said he would wait, and taking up a newspaper sat down
In a Very short time he was seen by my servant going out of the house,
saying that he had some business to transact, and would oall again. It
Is needless to say that he did not return, and it was discovered that he
had taken with him a pocket dressing-case and binaural stethoscope,
together of the value of from £4 to £5. The man was of middle height,
dark complexion, about forty years of age, and called himself “ Mr. Kerr.”

I am, Sirs, yours faithfully,

Arthur H. T. Longhubst, M.D.
Wllton-street, S.W., March 29th, 1887.

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NOTES, COMMENTS, ANt> ANBITKH8 TOiOOOfiESPOBlXQITS. (Imtl, 1867. 7V57

Winter. iluitB Resorts at H(I*k. * •

A corkkspontcvt 1* anxious to direct attentlen to the advantages of
Colwyn Bay, North Wales, as a winter health resort for poitrinaire*.
*• I have travelled,” says the writer, “in many places In Europe and
Asia Minor, but find no climate better than this.” He regards the
relief he haa experienced from many severe symptoms of chest affection
an due to the ameliorating influence of the climatic conditions pre¬
vailing in the four successive winters he has spent in the locality in
question.

Mr. A. W. Stirling.— The note was founded npon an article in one of the
March numbers of the Lyon Medical (March 13th ?).

Sir. C. Roberta.—"Sent week.

RAPID STAINING OP THE TUBE BOLE BACILLUS.

To Ms Editor*of The Lancet.

Stas,—I can strongly recommend the following mode of staining the
tubercle bacillus in cover-glass preparations for cltntoet purposes. It is a
slight modification of Nee Ison's method. The stain- whibh inmy opinion
» preferable to any of those containing solutions of aniline—Is made by
dissolving one part of magenta in 100 of a 6 per cent, watery solution of
carbolic acid, and adding 10 of absolute alcohol. A sufficiency of this
fluid is poured into a watch-glass, and heated on a retort-stand over a
spirit lamp Mli steam rises freely and the temperature is not very far from
the boiling point. The cover-glasses, prepared in the usual way, arc then
f! 'vted In the stain for two minutes; If the right temperature has been
reached this is quite long enough; the watch-glass should be covered.
In Neelsen’s method the preparations axe then decolourised with acid,
and subsequently stained with blue as a contrast. I find that these
processes may be very conveniently odua M ms d -hy dissolving methylene
blue in 25 per cent, sulphuric acid till a deep colour is obtained, end
Immersing the cove ^glasses for one minute in this immediately after
their removed from the magenta. They are then rinsed in water, dried,
and mounted in balsam. The whole process of staining and mounting
occupies about six minutes according to my experience. Possibly thi s
method may have been already suggested; If so, it lias escaped my
notice. I am, Sira, yours faithfully,

Eastbourne, March 31st, 1887. Henry S. Gabbbtt, M.D.

U. L. H. —1. On the 1st of Jane.—2. Spottiswoode's, Bast Harding-st.,
London, B.G.

Dr. Uhhoorm (Cassel).—We cannot exchange.

THE SELFISH PRINCIPLE AND MEDICAL ETIQUETTE.

To the Editors of The Lancet.

Sirs,—M any of those who recognise the truth of M.D.’t letter under
the above heading, in your last issue, will oolneide with yonr oomment
npon it. We all know the Pharisee in medical etiquette ; we know his
ways, even if we cannot always escape his toils. These people shonld
concern ns very little. Lather Is reported to have fought the great
battle of the Reformation under the motto, “ In quietness and confidence
shall be yonr strength.” Suoh also should be our motto, and It Is not
that of the complaining Pharisee. What " M.D.” really means is that
we general practitioners, who endeavour to bear our wrongs in silence,
do not receive sufficient support from the medical papers. All that the
Pharisee wants is recognition—an incomplete sympathy with his griev¬
ance suits him best, and his own glib tongue supplies what is lacking.
These wasps of the profession cannot make honey, but they can use
their stings, and they dip them In any available venom. The life work
of every successful practitioner oontains a ready antidote in his conscious¬
ness of good done, and perhaps lees frequently in its grateful recognition.
But no great good is attained without personal peril. Tlferefore, my
brother " M.D.,” take courage and persevere—as your work is, so shall
your strength be» as your strength is, so should be your alienee.

I am, Sirs, yours truly,

April, 1887. Another M.D.

C. M. —The subject Is, we fear, hardly ripe for discussion, but will not be
lost sight of. >

A -eery old Subscriber has not enclosed his card.

WHAT 18 BRONCHITIS?

To the Editors of The Lancet.

8nia,—Will you permit me through the medium of yonr valuable
journal to ask the medical profession what is bronchitis ? Is It a fever,
aodtobedacsified with other specific fevers, such as whooping-cough and
m «**Ies? My own impression Is that It is not, but that it is a diseased
state of the bronobial tubes, invariably the result of fever poison, such
*s in influenza, (by far the most common cause), and also of typhoid,
typhus, smalt-pox, measles, or some other fever poison. I think this is
•joatter which should be well thought out by the profession, or at the
otiwl of a dise ase we may by the bronchitis be led away from the cause
m toe mischief. And in treating It we should put to ourselves the
y*** * 01 ^ W hat ie the causa of this derangement ? Is it from within—i.e.,
fmm grader from without, from one of the Specific fever* ? I hold the
•“fit riew with regard to pneumonia, pleurisy, and peritonitis.

. I am, 81 ra, your obedient servant ,

B “o*h, April 4th, 1887. Wm. U. Bd6e, M.R.O.S.

Bnolish Prachtioserb or Italy. . . ■

Holders of British diplomas In Italy may practise among the English-
speaking communities there without .an Italian qualification. In
Rome (whioh, as the capital, may be presumed to regulate the usage
of the provincial towns) the English practitioner must, If called upon,
bo prepared to certify to the municipality his professional credentials
by producing his diploma, or (still better) the British Medical Register
containing his name. The Italian Government, indeed, so far recognises
his right to practise in the Peninsula as to make him pay Income-tax
(riechezza mobile) on the average of his professional income. An
Italian qualification, however, is required if the English practitioner's
clientele extends to the native population, though cases are quite
common in Which Italian patients call in the English consultant
possessing only a British qualification and remunerate him wfth a
honorarium on the English scale.

R. P. (Nsw York).—A dictionary of medical nomenclature cannot be
called complete unless it gives correctly the pronunciation of each
term. Angina, in the common collocation “angina pectoris*” is
usually mispronounced. The penult is short, as in the hexameter of
Lncllius: “ Inspnrato sbiit quern ana angina sustolit bom ” (He
departed unexpectedly, whom angina removed in an hoar). Again,
in the medical poem of Serenus Sammonicus: “ Ang ina yard atbt
mix turn sale poscit aoetum ” (But angina requires vinegar mingled
with salt). It is also short in the " Trinmnmus ’* of Plautus* v. 540,
ed. Ooeohia (Turin, 1888), who rightly derives it from the Greek
arjxirT).

fitstice.—V all the Circumstances of the cate are correctly stated by our
correspondent, we have no doubt' that an appeal to the head of the
Department would ensure a reconsideration of, and a just decision
upon, the claims of the officer concerned.

M.R.C.S.Eng .—From the description given of the lad, we should think
the possession of the power attributed to him can scarcely be doubted.

ANOSMIA.

To the Editors of The Lancet.

Sirs,—I n response to “ Constant Reader," I beg to suggest the follow¬
ing, and have no doubt If carried out relief will be experienced. Strych¬
nine hypodermically injected at the sides of the nose, together with elec¬
tricity (a battery of about thirty or forty cells), would best meet the require¬
ments, which should be used daily. This would restore the sense of
smelling if anythiug would, as the olfactory and other nerves would be
directly roused by the above. Headaches would be beet treated by
bromide of potassium and belladonna, to which might be added small
doses of tincture of nnx vomica, and should be continued with steadily
for some time. The solution of extract of ergot abd tincture of hyoecya-
rans are often found of the greatest benefit in the treatment of headaches,
and are worthy of a trial. Mild aperients would be essential, especially If
any costiveness were present. Furthar, I should suggest the head to be
bathed In cold water dally, and cold applications might be applied
during attacks with advantage. The offensive odour is most probably
due to some diseased teeth; thus a visit to a dentist would be desirable.
A Turkish bath taken occasionally would be highly beneficial.
Trusting that the above rflay be of some help,

I am, Sira, yours truly.

March 30th, 1887. T. J. Lavers, M.D., Ac.

THE INTERNATIONAL MEDICAL CONGRESS.

To the Editors of The Lancet.

8irs,—I take the liberty of addressing you for the purpose of making
a s uggestion about the forthcoming International Medical Congress in
] Washington. IT I remember aright, when the British Association Aet
at Montreal a few years since to* Canadian and American railways gave
free passes over their lines to all members who had come from Europe.
I think that if the American railway companies could be induced to
grant a similar privilege to foreign medical men attending the Congress
In September It would result in largely Increasing the attendance, and
would be an Immense boon to many doctors of limited means, who
otherwise would be debarred from visiting Ameriom. From What 4 know
of the large-minded generosity of the American people. I am sure that
if the matter were once laid before the directors of the principal American
lines they would accede to the request without hesitation.

I am, Sirs, yonr obedient servant. .
April, 1887. M.B.

Mr. T. Nixon.— Information may be obtained at the office of the Ogown
Agents for the Colonies, Downlng-street.

CLIMATE OF BED BLUFF, CALIFORNIA.

To the Editors of THE Lancet.

Sirs,—I should be obliged omld you op any of yonr readers give me
some information concerning the oHmate of Red Staff, California
(lat. 40° N., long. 129° W.), especially as to Its suitability to,a patient
with delicate chest and tendency to fibroid phthisis. . u -ut

1 X am,< Hits, yours faithfully,

April 2nd, 1887. F.B.C.S.K,

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758 TEx Lax err,]

NOTES, COMMENTS, AND ANSWERS TO OOBRESPONDBNTS.

[April 9, 1887.

Communications not noticed In our pretent number will receive atten¬
tion in our next.

Communications, Letters, ka., have been received from—Dr. Saundbv,
Birmingham ; Dr. A. L. Olhou, Villejo; Mr. Godlee, London ; Mr. S.
Snell, Sheffield; Mr. F. T. Sira sod, London ; Dr. G. Fischer. Jena;
Dr. F. A. A. Smith, Cheltenham; Mr. C. S. JoafFreaon, Newcastle-on¬
line; Mr. Coles, London; Mr. L. Jefferls, Margate; Mr. T. Jones,
Manchester; Mr. C. D. Christmas, Clapham ; Messrs. Burroughs and
Wellcome, London; Mr. W. R. Macdermott, Newry; Dr. Norman
Kerr, London ; Dr. C. S. Watson, London; Mr. Stamford, Tunbridge
Wells; Mr. J. R. Phillips, Aughnucloy ; Mr. J. Allen, Belper; Mr. J.
Spitzly, Paramaribo; Dr. Batterbury, Berkhamstcd; Mr. H. Kesteven,
London; Mr. W. J. Jeaffrcsou, Folkestone; Rev. J. W. Atkinson,
London; Dr. W. Pasteur, London ; Mr. B. F. Grim; Mrs. Heat her by,
London ; Dr. Hilliard. Aylesbury; Mr. Blsohof, Loudon ; Dr. Braxton
Hicks, London ; Mr. F. Page, Newcastle-on-Tyne; Messrs. Steel and
Jones ; Mr. H. J. Moxon, Anerley; Mr. Bade, Slough ; Mr. Wlokhnm
Barnes, London ; Dr. J. T. Graham, Perth ; Mr. G. Wale; Mr. Rlx,
Bradford; Dr. Kapteyo, Alcoude; Mr. Porter, Fleetwood ; Mr. 0.
Roberta, London ; Mr. J. Fleming, Glasgow; Mr. Plowright, King's
Lynn; Mr. C. Aitken, St. Mawes ; Dr. M'Clure, Cromer; Mr. Vaofaer,
Birkenhead ; Mr. Kees. Cambridge; Mrs. Tucker, London ; Mr. Brain,
London; Mr. Taylor, Windermere ; Mr. Sotheran, York ; Mr. Buckle,
Tolleehunt D’Arcy; Mrs. Thomson, HIghgate; Miss Nutter, Wake-
Held; Mr. Harris, Homburg; Mr. Warrener, Walthamstow; Dr. Luke,
Hanwell; Mr. Kirby, Leeds; Mr. Young, Poona ; Messrs. Benjamin
and Co., London; Mr. Hunt, Hull; Mr. Fuge, Taunton; Messrs. Dale
and Co., London ; Mr. Godrich, Kingston-on-Thames ; Messrs. Christy
and Co., London ; Mr.Hope, London ; Mr.Thompson; Dr, Buchanan,
Glasgow; Mrs. Pratt, Cardiff; Dr. Hunter, Matlock j Messrs. Wright
and Co., Birmingham ; Mr. Mackenzie, Ryde ; Messrs. Armbrccht and
Co., London ; Mr. Maw, Bradford ; Mr. Moore, Coventry ; Mr. Julian
Willis. London; Dr.Watson. Bournemouth ; Mr.Roulston.Wakefield;
Mr. T. Nixon, Lincoln ; Mr. K. James, Bagshot; Mr. H. T. Rutherfooro,
London; The Inspector-General of Recruiting; Justloe; A Doctor
of Medicine; Felix; Real Rank; M.B.; F.R.C.S.B.; A Perplexed
Surgeon; Surgeon; Up]>er Blade; A. B.. Southampton ; A One-eyed
Bngine-driver; Justltta; Another M.D.; M.D.Lond.; Junior; Avery
old Subscriber; Junior; M.R.C.S.

Letters, each with enclosure, are also acknowledged from—Dr. Ban-,
Cla-gow ; Mr. lleddy, Kensington ; Mr. Heap, Hanley; Messrs, Lee
ami Martin, Birmingham; Mr. Smith, Klnnetty; Mr. Fletcher, Cross
Hills; Mr. Cummin, Dublin; Mr. Shaw ; Messrs. Oppeuheimer and
Co., Loudon; Mr. Ooodall, Crieff; Mr. Harris, Hamburg; Messrs. Cox
and Co., Brighton ; Mrs. Temple, Kingtou ; Mr. Blandford, Stockton-
on-Tees ; Mr. Barnasoom, Plymouth; Mr. Hooke; Mr. Warner, South
Kensington ; Mr. Bead, Canterbury ; Mrs. Spencer, Ealing; Mr. Pace.
Newcastle-on-Tyne; Mr. Morton, Manchester; Mr. 8tcvens Notfing-
hill; Mr. Trestr.iile, Aldershot; Mr. Anderson, I.oftus ; Mr. Hodges,
Gloucester; Mr. Montgomerie, Glasgow; Mr. .Smith, Hollowav ; !
Mr. English, Belfast; Beta, Hull; A. K. Surbiton ; Probe; M.D.,' 1
Bath; J. II. M.; H. C. A.; Buatlcus; T. H. B.. Lambeth; Sigma!
Northampton ; F. L. S. ; Chlrurgicos

Hospital Gacelte, Scottish Newt, Derby Mercury, Blackpool and riectuiood
Gacette, Blackpool Herald, Torquay Directory, Southport Visitor, Leeds
Evening Express, Glasgow Herald. Walsall Observer, Jjr., have been
received.

Pebital $jiarj for % mnittg (SftaL

I Monday, April 11,

■ Koxal London Ophthalmic Hospital, Moorfirlds. — OperatiVw.

10.30 a.m., and each dav at the same hour.

Royal Westminster Ophthalmic Hospital.— Operations, 1.30
and each day at the same hour.

Chelsea Hospital for Voxel- Operations. 2.30 p.m ; Thursday,2.30.
St. Mark's Hospital.— Operations. 2 p.m. ; Tuesday, 2.30 p.m.
Hospital for Women, Soho-square. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Royal Orthopedic Hospital.—O perations, 2 i*.m.

Central London Ophthalmic Hospitals.—O perations. 2 p.m.. aod
each day In the week at the same hour.

Medical Society of London.—8.30 p.st; Esster Monday. No meeting.

Tuesday, April 12.

Ginr's Hospital —Operations, 1.30p.m. and on Friday at the same hour
Ophthalmic Operations on Monday at 1.30 and Thursday at 2 r u
8 t. Thomas’s Hospital.— Ophthalmic Operations. 4 p.m.; Friday, 2 p m'
Cancer Hospital, Bbompton.— Operations, 2.30 p.m.; Saturday, 2.30 p'h
Westminster Hospital.— Operations, 2 p.m.

West London Hospital —Operations, 2.30 p.m.

St. Mary’s Hospital— Operations, 1.30p.m. Consultations, Mouoav

1.30 p.m. Skin Department, Monday and Thursday, 8.30 a.m.
Botax Medical and Ohiruroical Society. —8.30 p.m. Dr. J J

Pringle: A case of Aucurymu of the Abdominal Aorta treated bv
Laparotomy and the Introduction of Steel Wire into the Sac —
Dr. William Henry White and Mr. Pea roe Gould: A caw of Saccu¬
lated Aortic Aneurysm treated by the Introduction into the Sat of
thirty-two feet of Steel Wire.

Wednesday, April 13.

National Orthopaedic Hospital.—O perations, 10 a. v.

Middlesex Hospital.—O perations, 1 p.m.

8t. Bartholomew's Hospital— Operations, 1.30 p.m.; Saturday,same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m
Surgical Consultations, Thursday, 1.30 p.m.

St. Thomas’s Hospital.—O perations. 1.30 p.m.; Saturday, same hour

London Hospital.— Operations, 2 p.m.; Thursday* Saturday same hou-

Great Northern Central Hospital.— Operations, 2 p.m.

Samaritan Free Hospital fob Women and Childers. —Operation*.

University College Hospital.—O perations. 2 p.m. ; Saturday 2 i v
Skin Department, 1.43 p.m. ; Saturday, P.1& a.m.

Royal Free Hospital.—O perations, 2 p.m., and on Saturday.

Kino’s Oolleok Hospital.—O perations, 3 to 4 p.m. ; Friday *• , M .
Saturday. 1 p.m.

Children’s Hospital. Great Ormoxipstreet.— Operutioni 9 am-
Saturday, same hour.

Epidemiological Society of London.—* p.m. Dr. Micliad Taylor
The Presence of Mould Fungi In connexion with Diphtheria

Hunterian Society.-* p.m. Mr. T. Mark Hovell : The Treatment o'
Cystic Goitre (with patient).—Dr. Dundee Grant : (1) EpUhellonu
of the Larynx relieved by Tracheotomy ; (2) Carcinoma of the
(Esophagus perforating the Trachea.

British Gynaecological SorntTY.-s.30 p.m. Specimens win be shown
by Dr*. Bdis, G. Granville Bantock, Pancourt Barnes, and other* -
Hr. William J. Sinclair (Manchester): Missed Abortion.

Thursday, April 14.

8 t. Okomok's Hospital.— Operations, 1 p.m. Ophthalmic Oia-iwiu.*,.
Friday, 1.30 p.m.

CHABiNii-cRoss Hospital.— Operations. 2 p.m.

North-West London Hospital.— Operations. 2.30 p.m.

Friday, April IB.

Royal South London Ophthalmic Hospital.—O pera*Iona u i.v.

Saturday, April 10.

Middi.lsex Hospital.— Operations, 2 p.m.

e

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THE LANCET, April 16, 1887.

ABSTRACT OF

fnmlran %tdm$

OK THE PATHOLOGY OF INTRA-UTERINE
DEATH

Delivered at the Royal College of Physicians of London,
March, 18$7,

By W. O. PRIESTLEY, M.D., F.R.C.P., LL.D.,

COJfSOmSG PHTSICIAX TO kctg's college hospital, aitc> late

PB0TE890B OF OBBTBTRIC MPBICIXK, KTIXO's OOLkEGB.

LECTURE I.

Calling attention to the importance of the subject
■wMch he had cboeen for these lectures, not only in its
general aspects and from a statesman’s point of view, as
influencing the law of population, but in its interest for the
pathologist and medical practitioner. Dr. Priestley said that
owing to the large extent of ground oovered by it he must
content himself with giving in oatline a sketch of its
broader dimensions, while he dwelt with greater detail on
those sections which had more especially excited his interest,
or in which he had personally made some investigation.
The complex and intricate anatomical structure, and the
aHesitions associated with the rapid development of the
contents of the gravid uterus even in the normal state,
render, the lecturer remarked, all investigation very difficult.
When pregnancy pursues its natural coarse and development
follows its normal progress, the changes which take place
are incessant and varying. From the time at which the
decidua is first formed in the interior of the uterus, to
become the outermost of the foetal membranes, to the
formation of the fully-grown placenta, there is no pause
or cessation in the active changes which characterise the
progress of growth. The cells and fibres which build up the
tissues day by day undergo progressive change, and the
Tassels equally undergo modification in sire, form, character,
and in their relation to surrounding parts. Bo, too, if any
derangement occurs, either from accident or disease, the
morbid change thus initiated is, or may be, impressed
■with the same activity of growth, rapid degeneration or
abnormalities being produced with surprising quickness.
Hence pathological researches into these unstable and ever-
changing structures are beset with difficulties, and to this
must be attributed the widely different views held by
equally conscientious and accurate observers concerning
the nature of some of the pathological results.

Many ot the causes which either remotely or directly
bring about intra-uterine death are very difficult to trace,
and some are so subtle in their influence as to be impossible
to detect. Thus the child dies in utero with some women
in successive pregnancies and without any clearly assignable
cause; it is not infrequent to hear of women apparently
healthy aborting or toeing their children in toe later
months of gestation ten, twelve,* or thirteen successive
times. Some women are so prone to miscarriage at any
period 1 of gestation, that the slightest imprudence seems to
be enough to endanger the existence of pregnancy and
to lead to a detachment of the ovum. Thu is in marked
contrast to other and apparently not healthier women,
who will bear an e x traordinary amount of violence or
injury without disturbance to pregnancy, in proof of which
Dr. Ptieetley cited several Instances from the experiences
of Mauriceau, Henry Davies, Dupuytren, Laujardnire, and
himself. Whitehead's tables, taken from the records of the
Manchester Lying-in Hospital, show approximately the
frequency of embryonic death la the earlier stages of
gestation, but do not accurately represent the frequency of
abortion throughout the whole childbearing period, and a
considerable proportion of the women included in them were
pregnant for the first time. Dr. Priestley had recently
drawn up tables containing the figures of some 400 private
patients in whom the etidenCe of pregnancy hating occurred
was distinct and unequivocal. The results were as follows:
400 women bad been pregnant 2620 times. Of these,
pregnancy had resulted m Bring children 1706 thaetq red
H&83SE).

there had been 042 abortions.' The proportioned abortions
to children was therefore 30*40 per cent’, or about 1 in 3;
while the proportion of abortions to pregnancies who
28*82, or about 1 in 4. The- number of women who had 1
bone children but had never suffered abortion was 162 id'
the 400, or 38 per cent.; while the number of women who
had borne no firing ehild and e*riy had abortions Was 27, or
6*76 per cent.—the sum of the pregnancies in 400 wo m en
being therefore 2806, or 6*81 for each, and the sum of th^
abortions being 042, it was 1*88 for each.

Table I. —Analysts of member of Women who had and had-
not Aborted.

-_-

Women below J
3© years of age '
(Whitehead). ||

No.

Per'
cent, of
whole.

Women who had not aborted

1J6S

02-65 '

Women who had aborted .

747

37 35 [

Total number of women under ob- \
servatlon.J

2000

10000

Women who only aborted—teal )
ia« who bad borne no BvingohUdj

• _

Women over
40 years of age
(Priestley).

No.

1»

243

27

Par

cent, of
whole.

'SMB

62-00

100-00

6-75'

Table I. iltaartaateetfae polo* thet-wberew among the yoonjirwcuaea
the proportion whe- aborted wu about one In three — that la, one
aborted to two who did not—among the older Women the proportion
was almost exactly reversed, and two aborted to one who did not.

TAblk II .—Analysis of Pregnancies in reference to Abortions
and to Pecwndity.

—

2000 Women below 1
30 years of age
(Whitehead). 1

400 Women over

40 yearn of age
(Priestley).

No.

Per

cent, of
whole.

No. per
woman

No.

, Per
cent, of
whole.

Ha per*
woman.

Children ... -.

T4»

85m

3-78

1783

7*68

*40

Abortions .

1222

1406

0’61 |

642

23-32

1-35

Total pregnancies ...

8681

iso-m

1

2325

100-00

6-C1

TVWe II. shows that the older period is more productive of pregnanotee-
an the younger lit the proportion of *-81 to AM (or four to- three), bat- -
b percentage of them terminating In abortion# la also much,
In the older period than In the younger (23 32 against 14 0B).
I. Illustrates the last point In another manner.

than the younger
that the
greater
Table III

Tabus III.— Ratio of Abortions to Pregnancies and
Children.

.Whitehead.

Prieetley. , .

Per

cent.

Being
about 1 In

1 Per'
oent.

Being

abootlfte

Ratio Of aborttetavtopregnanolee

14*8

7

1 280*

«*

Ratio of abortion* to children

16-39

6

. 30 40

3i

It will be ssen that the proportion of Abortions to futt*-
time pregnancies is considerably higher than Hegar’s eonA-
potation, which is about 1 abortion to every 8 or 10 full-time
deliveries. The-proportion approximate* mere closely-to* •
Dr. Whitehead’s ftgurae, bat there is a larger’ average ef
abortions as the calculation embr a ces a longer portion of the
reprodueti're period; ambthere is another notable difference
which may, peitoaps, be pat down to easier oireunatancea
and exemption from bodily toil—namely, that if a oom^
paribon is made With Dr. Whitehead* Hmiteddaha concerning >
those women who had passed the’menstrual epoch, it wifi •
be remarked that While among the poor of thd maaufao** '
taring town re mmj as 87 per oent. had incurred *bortio*y> 1
only 02 per oenti of the women-in better ciecutastsneeev.
had suffered in’tMs way.

A* to tbepdMicniw pregnatadb* ha wMch nhMtianumsttm

. ' *i ■ $ •• .

Digitized by v^. ooQle

760 Tub Lancbt,] DR. W. O. PRIESTLEY: THE PATHOLOGY OP INTRA-UTER1NE DEATH. [April 16, 1887.

frequently fakes place considerable difference of opinion
exists, and Dr. Priestley regards the computations on the
subject made by Tyler Smith, Whitehead, and Schroeder as
not at all satisfactory or conclusive, inasmuch as various
elements—age, social position, the occurrence or not of a
long journey immediately after marriage &c. — are not
considered, and these elements are important factors in
making the calculation, more particularly with reference to
abortion in the earlier periods of pregnancy.

The relative period of utero-gestation in which intra¬
uterine death most frequently takes place has been variously
stated, and for certain reasons cannot be very precisely
determined. It is probably very frequent in the form of
abortion during the early weeks of pregnancy, and then it
may produce so little disturbance in a woman’s health as to
be scarcely noticed. Among the poor this is certainly the
case, aud consequently an estimate of its frequency among
them is practically impossible. Madame la Chapelle
regarded it as most frequent in the sixth month of utero-
gestation. Cazeaux believes abortion to be most frequent in
the first two or three months, and Depaul states its greatest
frequency to be between two months and a half and three
months and a half. Jacquemier, on the other hand, declares
abortion is not less frequent in the sixth month than in the
lirst half of pregnancy. Whitehead’s figures show that of
(502 cases of abortion, 275 occurred between two months and
a half and three months and a half, and 147 between three
months and a half and four months and a half.

The stage at which development has arrived—about three
months to three and a half—points to a period when, pro
tanto, abortion may be supposed to be the more readily
brought about, whict coincides with Whitehead’s statistics.
Then the villi of the chorion have become more concentrated
on the decidua serotina, and the young placenta is in pro¬
gress of formation. There is great increased vascular
activity in all the tissues, and yet a certain instability, for
the vascular loops projected from the maternal circulation
are beginning to surround the fcetal villi in a delicate sort
of network, and the spaces which intervene between the
membranes, so obvious in the earliest weeks, are not yet
obliterated. Besides, the union between the membranes and
the uterine walls is less stable than later on, and so separa¬
tion more readily occurs. Hence a greater liability to blood
extravasations, not only into the layers of the decidua, but
also between the several membranes, and more especially
between the decidua reflexa and the chorion. From the
twelfth to the sixteenth week the phenomenon of “ quicken¬
ing ” occurs, and if anything hinders or prevents the ascent
of the uterus into the abdomen abortion is precipitated.
Morgagni and Desormeaux are of opinion that abortion is
more frequent with female thau with male embryos, but
give no statistics; and Cazeaux’s reason for thinking this
may be true is scarcely a sound one—namely, because at
term there are sixteen boys bom to every fifteen girls.

In discussing the causes of intra-uterine death, classifica¬
tions of which have been made by Spiegelberg, Leopold,
Barnes, and others, Dr. Priestley announced his intention of
taking first the causes acting through the male parent; then
those which act through the intervention of the mother;
and, lastly, those which moTe particularly belong to the
foetus itself, although possibly remotely related to both
parents.

1. Cause* of intra-uterine death referal>le to the father .—
As the pollen-cells of a plant are sometimes imperfectly
developed as the result of an unhealthy state of the plant,
or as the pollen may be injured or spoilt before or during
the time it is applied to the pistil, and the result be an
imperfectly formed seed or fruit which never reaches
maturity, so death of the embryo after conception is due, in
some cases at least, to defects in the male parent. The fault
is, as it were, ah initio. Conception takes place, but it is
vitiated from the beginning by some alteration in the
fecunding fluid. The male parent may be too young or too
old to impart the necessary potency to the spermatic fluid,
and so the product of conception breaks down and drops like
untimely fruit because it does not possess the necessary
amount of vitality to prolong its development. Debauchery,
various diseases, and injuries from which men suffer were
then alluded to as so deteriorating the constitution as to
impair the procreating power, and so cause abortion in the
woman. As pointed out by Ddvilliers, procreating power is
essentially distinct from that of development, and hence a
man may possess the power to fertilise, but his whole
strength may be expended in this act, and may not extend

beyond, so that there is no further development. The
faculty of development, too, is relative. Thus a weak man
may impregnate a robust woman, and, by so much as she
has strength to impart, the vitality of the germ may be
carried on entirely uncer the influence of the woman.
The lecturer had not been able to procure any precise infor¬
mation as to the proclivity to abortion in the wives of men
who were the subjects of albuminuria or saccharine
diabetes; but the general outcome of opinion is that during
the progress of these maladies the vital powers become 90
exhausted that sexual power and desire fall into abeyance,
and that it is only during the slighter forms of disease that
they are likely to continue. Lead-poisoning not only in¬
juriously affects the child in utero when the mother is the
subject of it, but indirectly also when the father is affected.
In this way it may lead to the death of the feetus in utero
and produce abortion or premature expulsion. The most
potent, however, of all poisons in producing intra-uterine
death at all stages of pregnancy is the poison of syphilis,
and this whether the disease exists in the male or in the
female parent. A woman who has shown no sign of syphilis
in her own person may be impregnated by a spermatic fluid
which carries with it so potent a syphilitic virus that in its
development it sooner or later kills the product of concep¬
tion, and this in its turn so poisons the marernal blood that
the woman eventually becomes tainted with constitutional
syphilis. Several instances in illustration of this indirect
influence of syphilis in the male on conception were quoted
from the experiences of Charpentier, Professor Harvey,
Jonathan Hutchinson, and others.

2. On the part of the mother. —The same general causes
which influence sterility are concerned in a greater or less
degree in the production of abortion and premature death of
the foetus -viz., constitutional conditions, external agencies
which depress the general health, extremes of heat and cold,
climate, locality, &c. Over-feeding, Dr. Priestley is of
opinion, is more pernicious in its effects on the product of
conception than under-feeding. Anaemia in the mother may
cause death in utero, and old age is not favourable to the
continuance of pregnancy. Some acute diseases of a
specific kind in the mother have a very marked and direct
influence in destroying fcetal life: in proportion, ceteris
paribus, to the gravity of the maternal affection, so is the
danger to her progeny. Small-pox was given as an example,
but scarlatina, measles, erysipelas, diphtheria, typhoid fever,
and its congeners come within the same category. Of the
non-specific forms of disease attended by fever, Dr. Priestley
instanced pneumonia, which has always a special gravity
when complicated by pregnancy', and which, if severe,
almost invariably leads to emptying of the uterus. Pleurisy
and the feverish state which follows surgical operations
generally lead to abortion. Increase in the temperature of
the mother increases the foetal pulse, and vice versa; and the
experiments of Runge on the effects of high temperature on
the gestation of the lower animals published in 1877 were
reviewed at length, their results being as follows:—(1) The
temperature of the foetus is habitually higher than that of
the mother, and keeps higher when the mother’s heart be¬
comes abnormal; (2) the foetus dies solely from the heat
before it becomes fatal to the mother; and (3) the tempera¬
ture of the mother, if only raised for a short period to 41 -6° C..
is fatal to the foetus, the danger not ceasing with the
reduction of the mother’s temperature to normal. These
conclusions have been confirmed by a series of experiments
recently performed under Dr. Priestley’s direction by Mr.
Tyrell Brooks in the physiological laboratory of King’s
College. In the course of these inquiries a marked different
was found between the vaginal, the uterine, and the foetal tem-

f erature: thus in thecat, vaginal 98‘2°, uterine 984°, foetal 99 .
n eclampsia foetal death may be due to such elevation of
temperature in the mother’s body as is incompatible with the
safety of the child, but when the temperature does not reach
so high a standard the death must be attributed to uterine
contraction producing imperfect aeration of the blood, or
vitiation of the blood from uraemic poison. In phthisical
women the tendency to abortion and premature delivery is
greater than in healthy women. Diabetes, jaundice, heart
disease, malignant cholera, and allied morbid conditions may
destroy the product of conception by poisoning it in utero.
or by inducing uterine contractions and premature' expul¬
sion. Several poisons act deleteriously on pregnancy—lead,
arsenic, mercury, savin, and the like. The most pernicious
organic poison is, however, syphilis, and in women who are
its subjects, abortions often succeed each otner in frequent •

THB Lancet,] DR. BLRNEY YEO: GASEOUS RECTAL INJECTIONS IN CONSUMPTION. [Aron. 16,18871 701

repetition, and with a persistency belonging to no other
cause. Even when there are no external indications of
maternal syphilis, the succession of abortions or of dead
children in more advanced pregnancy iB traceable to a latent
form of the disease which manifests itself in this fashion.
If a woman has syphilis before conception, she is much more
predisposed to abortion than a woman taking the disease
after conception; if conception and syphilis commence
together, abortion and premature labour with a dead child
are the rule, but treatment is more potent in preventing
them; syphilis acquired after the mid-period of pregnancy
has less influence on the child, and it may escape altogether.
One of the ways in which syphilis brings about intra¬
uterine death is by producing disease in the foetal appen¬
dages ; the venereal poison is transmitted to the embryo
through the maternal blood, and may affect any or all of the
tissues in the gravid womb. Uterine congestion or displace¬
ment, leucorrhoea, oxytoxic medicines, and reflex motor
actions induced by minor surgical operations (tooth-drawing,
See.), have the effects of inducing abortion in some cases.
All surgical proceedings during pregnancy ought to be
abstained from, but if such operation be absolutely neces¬
sary the time corresponding to the catamenial periods must
be avoided, the uterus being at such times more irritable.
Dr. Priestley concluded his lecture by briefly referring to
the effects of persistent gastric irritation, vesical, renal and
rectal irritation, ovarian irritation, and Anally to the in¬
jurious influence of mental emotion—fright, anxiety, &c.

% fjecto

ON THB

NEW METHOD OF TREATMENT OF CONSUMP¬
TION AND OTHER DISEASES OF THE
RESPIRATORY ORGANS BY GASEOUS
RECTAL INJECTIONS.

By I. BURNEY YEO, M.D., F.R.C.P.,

PBOFESSOR OF CLIXICAL TKKRAPF.UTIC8 IK KING’S COLLEGE, AND
PHYSICIAN TO KING’S COLLEGE HOSPITAL.

Gxntlkmen, — Occasional paragraphs in the medical
journals have called attention during the past few months
to a method of treating consumption and other affections
of the organs of respiration which, whatever may be the
ultimate estimate of its value, certainly possesses the
characters of originality and novelty. I allude to the
employment of gaseous rectal injections introduced and
practised by DA Bergeon, a well-known physician at
Lyons, and formerly a pro/eaaeur suppliant in the School
of Medicine in that city. Dr. Bergeon brought this subject
before the Acad<5mie des Sciences and the Acad6mie de
MSdecine in Paris through Professor Comil, the eminent
pathologist, last summer. Since that time it has been
adopted by several eminent physicians in Paris, in¬
cluding Dr. Dujardin-Beaumetz of the Hbpital Cochin,
Dr. Constantin Paul, and Dr. Chantemesse, Chef du Labo-
retoire de Bactdriologie in the Faculty of Medicine; by
Dr. Vaillet, Professor in the University of Geneva; by
Dr. Qaairel, Professor in the School of Medicine at
Marseilles; and by other eminent practitioners of medi¬
cine on the continent of Europe. Our own countryman.
Dr. Henry Bennet of Mentone, has written a warm eulogium
of its effects, and has claimed for this method “serious con¬
sideration and trial.” I have thought it my duty, as Pro¬
fessor of Clinical Therapeutics in this College, to make
further inquiry into this method, to familiarise myself with
its details, and to put it into practice before your eyes. In
order to do this, I first communicated with my friend
Dr. Leudet of Paris, who has had a very large experience in
the treatment of affections of the respiratory organs at
Eaux Bonnes, and begged him to inform me what impres¬
sion his observation of this treatment had made upon him.
Re replied that there was certainly “ something in it,” and
kindly offered, if I wquld come to Paris, to obtain, for me

opportunities of seeing it carried out there. I therefore at
the end of last year paid a short visit to Paris for the
purpose of informing myself thoroughly of the details and
results of this method so far as at present ascertained. My
best thanks are due to Dr. Dujardin-Beaumetz, to Dr. B&rdet,
the able Chef du Laboratoire Thdrapeutique of the Hdpital
Cochin, and also especially to Dr. Leudet for so kindly
affording me all the information 1 required. I may say at
once that I agree with Dr. H. Bennet in considering this
method as having been attended with results which would
make it culpable in us to disregard it or fail to avail our¬
selves of such opportunities as we possess to give it a fair
and persevering trial. I am, moreover, disposed to believe
that the local application of sedative gases and vapours,
which this method makes easy, may prove of considerable
service in other affections, and especially in the treatment
of uterine and intestinal maladies.

Dr. Bergeon’s original object was to discover some means
by which the development of the tubercle bacillus should be
hindered; this does not necessarily mean the destruction of
the organism in loco, but the modification of its probable
chemical action on the tissues, so as to render it harmless.
And here I would like to point out that those who have been
in haste to repudiate antiseptic medication as applied to the
treatment of phthisis, because of the necessity, as inferred
from laboratory experiments, of administering such large
doses (if the bacillus is to be destroyed) as to render them
actually toxic, have really been most illogical and unscien¬
tific in their imagined submission to sci e ntific experiment.
A narrowness of view is, I regret to say, not inconsistent
with an assumption of scientific accuracy. It has not as yet
been proved in what way the bacillus acts in destroying
pulmonary tissue, and in determining the production of the
disease known as pulmonary consumption; and it does not
help us to say that it sets up inflammatory changes, and then
determines a certain kind of degeneration in the products
of inflammation. These are only phrases which explain
nothing. Numbers of other microbes reach the lung and do
little or no harm there, their mere presence proving harm¬
less ! I beg you to mark that.

Are we to assume that it is impossible so to alter the
medium, the soil, the surroundings (whatever you like to
call it) in which the tubercle bacillus is found and where - it
develops, as to reduce its presence to the same condition of
harmlessness as that of a number of other microbes ? It
would be most illogical and absurd to do so. It is this idea
that is in the minds of those who speak of an M antiseptic ”
treatment of phthisis as being possible and necessary. One
method of fulfilling this indication would be to cause gaseous
bodies capable of modifying the development of the bacillus
to penetrate the air cells and parenchyma of the lungs.
Amongst the substances which seemed capable of doing this
were sulphuretted hydrogen and the vapour of bisulphide of
carbon. The inhalation of the spray, as well as of the vapours
given off by natural sulphuretted waters, and the administra¬
tion of such waters by the stomach, have long been held in
high repute, especially in France, in the treatment of consump¬
tion and other chronic diseases of the respiratory passages.
In the autumn of 1876, some years before the publication
of Koch’s discovery of the tubercle bacillus, in a paper I
contributed to the annual meeting of the British Medical
Association on*“Recent Researches in the Treatment of
Phthisis,” in,referring to the use and action of sulphur
waters, I used these words: a I am by no means sure that
we shall not disoover that many of our remedies for phthisis
act antiseptically which are thought by many to act other¬
wise. May nor. the sulphurous mineral waters, such as
those of Eaux Bonnes, act in this way ?"

Other vapours were also tried by Dr. Bergeon, such as
gaseous iodoform aud eucalyptol. This observer had not been
able to obtain all the good effects he desired from the use of
antiseptic vapours by inhalation; and although,for my own
part, I have had most convincing proof that such a mode of
administration is attended with benefit in most cases, and
with very remarkable amelioration in some, it requires &
steadfastness of purpose and a constancy ot application
on the part of the patients and their friends, as well
as on the part of the physician, that are but rarely met
with. Without great thoroughness in this mode of apply¬
ing antiseptic vapours, no doubt they penetrate but very
imperfectly to the often diffused ana deep-seated foci
of disease; moreover, some of these gases would prove
poisonous when admitted into the lungs by inhalation.
This is the case with sulphuretted hydrogen, which i9

Q 2

Digitized byGOOgle

762 Thr Lancht,] DR. BURNEY YEO: GASEOUS RECTAL INJECTIONS IX CONSUMPTION. [April 16,1887.

highly poisonous when respired in certain proportions, and
it produces serious effects on the blood-corpuscles when it
passes into the arterial circulation. Diffused in small pro¬
portions through the atmosphere inhaled, it has for many
years, as I have already stated, formed a part of the regular
treatment of affections of the respiratory organs at sulphur
spas, such as Eaux Bonnes, Luchou, Cauterets, Sea.

It was through calling to mind the experiments of Claude
Bernard on the absorption of gases by the large intestine
that the method of gaseous rectal injection suggested itself
to Dr. Bergeon. C. Bernard discovered that gases were
readily absorbed by the large intestine, and that when thus
absorbed they passed into the portal circulation, and thence
into the pulmonary artery, and there came into contact
with the pulmonary parenchyma, and were eliminated (if
the dose had not been too large) through the lungs. He
found that, if a small quantity of a weak solution of
sulphuretted hydrogen were injected into the rectum, it
was eliminated without any ill effects by the lungs; while
the same quantity respired under a glass jar would be
tone. In administering gases by the rectum, it is, of
course, necessary to inject only such an amount as can be
readily eliminated by the lungs, otherwise the whole would
not be separated and a portion would pass into the arterial
system. After a series of test experiments, Dr. Bergeon found
that by the method of rectal injection he could administer
relatively large doses of antiseptic gases, and it was clear
that in elimination they would be distributed over the whole
parenchyma of the lungs, and so of necessity come into

well as the fluid in the bottle, between them. This “ resist¬
ance offered by the rectum” is sometimes very manifest, as
we found in the first two cases in which we applied this
method. 2. The use of mineral add to generate the carbonic
acid is attended with the risk of carrying over irritating
sulphuric vapours. 3. The price was excessive—viz., 70 francs,
or £2 lGs.!

The apparatus which I have before me, and which we
have used in this hospital, was devised by M. Bardet, the
Chef du Laboratoire de Th6rapeutique at the H6pital Cochin,
at the request of Dr. Dujardin-Beaumetz. It is manufactured,
by Galante et Fils, the well known instrument-makers. No. 2,
Rue de l’Ecole de Medicine, Paris, and it may be obtained
from them at the moderate price of 3o francs (see woodcut).
This apparatus has the great advantage of having all its
component parts contained in one box, and is therefore easily
transported from place to place; its manipulation and
application are easily learnt, and may be entrusted, after a
time or two, to an intelligent attendant, or even to the
patient himself. Moreover, the carbonic acid is generated
by means of a vegetable acid, which iB neither toxic nor
corrosive. It consists, as you see, first, of a “generator” (a),
and a large glass bottle with a wide mouth, in permanent
communication with the indiorubber bag or “reservoir” (n).
In the generator the carbonic acid gas is generated, and for
this purpose there are furnished with the apparatus small
cartridge-like boxes, each filled with the necessary quantity
of bicarbonate of soda and tartaric acid (separated by a par¬
tition of cardboard), in the proportion of twenty parts of

contact with the diseased parts. Having determined to
asoertain the value of sulphuretted hydrogen given in the
form of rectal injection, he had next to discover the best
gas to be employed as a vehicle. On experiment it was
found that atmospheric air, so far from being inert, was
a very active irritant to the rectal mucous membrane, and
finally carbonic acid gas was chosen because of its well-
known amesthetic properties, and because it is rapidly
eliminated. The method employed by Dr. Bergdon was a
very simple one. An indiarubber bag, holding from four to
five litres, was filled with pure carbonic acid, and this was
connected with an elastic ball, the working of which with¬
drew the gas from the bag containing it and drove it into a
bottle—tire “ barboteur” as it is called in French,—which
held a solution of sulphuretted hydrogen or of bisulphide of
carbon. In its passage through this solution the carbonic
acid gas became charged with the sulphuretted vapours,
and this mixture of gases was very slowly injected into
the rectum through a tube terminating in an ordinary
bone cannula. In the apparatus constructed for this
purpose by Dr. Morel, Dr. Bergson’s assistant, the car¬
bonic acid was generated by adding dilute sulphuric acid
to bicarbonate of soda. The gas given off was collected
in an indiarubber bag, whiob, when filled, was detached and
then connected with the bottle containing the sulphur water
or other agent. The following were the objections to this
apparatus;—1. That, as the injecting ball was placed in front
of the “ barboteur,” it was difficult to feel the sensation of
resistance offered by the rectum, as there was a long tube, as

the former to sixteen of the latter, to set free enough car¬
bonic acid gas to fill the reservoir, containing four litres.
The “ injector ” (i) is worked by an elastic ball, or
“pear” (p), which, with its tube, is outside the apparatus.
This injector is provided with valves, which allow the gas
to be aspirated from tbe reservoir (b) by suction action of
the ball (p), and when the ball is compressed prevent the
gas from flowing back into the reservoir and cause it to
escape by the cannula (c). The bottle (b), called a “ bar¬
boteur,” contains the medicated fluid through which the
carbonic acid gas is forced to pass on its way from the
reservoir to the injector. The box, then, contains the fol¬
lowing parts—a generator of carbonic acid (a), a caoutchouc
bag or reservoir (r), a “ barboteur” (B), and an injector (i).
Outside the box are the injecting ball or pear (p), and the
“cannula” (c) with the tubes connecting them to the injector.
The injector, which is formed of an arrangement of valves
(i and *'), is made of metal, and is, together with the other
connecting portions of the apparatus (r t t'), combined
together into a single solid block. The gas furnished by
the generator (a) passes out by the tube a , which is
connected at the tap r with the central metallic block,
whence it escapes by tbe tube t ', through which it reaches
the reservoir (b). It cannot eecape by t\ as it is pre¬
vented by the resistance of the liquid in the “ barboteur” (b).
As soon as the reservoir is filled with gas the apparatus can
be put in action. We compress the elastic ball (p), and the
air it contains is driven out through tbe valve * and the
cannula; then, when it re-expands, it tends to produce a

J

Thb Lancbt.) DJS. BURNEY YEO: GAdEQVS. BiaCrAL W/5EC?ION8 IN CONgUMPTION. [A?j*p 1 &W 67 , 763

vacuum, and so opens the valve »' and aspirates the gas
from the reservoir, which, passing through the tubes
t and €, reaches the “ barboteur” (b) by the tube t>, which
descends to the bottom of that vessel; it becomes charged
with the medicinal vapour in passing through the fluid con¬
tained in the “ barboteur,” and then escapes by the exit tube
v' into the caoutchouc tube connected with, the valve i
and the injector (i) ; the ball (p) and the injector are then
filled with gas. We then qomprees the ball, and the com¬
pressed gas opens the valve »' and escapes by the can¬
nula (c), and so on until the reservoir is emptied.

Having described ,t© you the different parts of the
apparatus, I will now show you how it is worked. First,
yon fill the “ barbooeur ” (b) rather more than half-full of
the medicated solution you intend to employ (sulphur water,
water, impregnated .with bisulphide of carbon, or hot water
containing iodoform, terpinol, &c., in suspension), and you
(dose it tightly with the cork. Seoondly, you put a few
drops of water into (he generator (a) and then empty into
it the soda and acid powder contained in one of the little
cartridge-like boxes. You wait a few seconds in order that
the air contained in. this flask may be driven out by the
small quantity of carbonic acid, which is set free by the
few drops of water which you have placed in the bottom of
the vessel previously. You then cork it firmly, and by
means of the funnel provided, with the apparatus you fill
the generator about haifrfull.of water, being careful to see
that the tap r is open. As soon as the water is added the
gas comes off freely, and in about two minutes fills the
reservoir; shaking the flask will hasten the discharge of gas.
The reservoir being filled, you work the elastic, ball (p), three
or four times in oeder to get rid,of the air contained in the
tubes and in the “ barboteur,” and then you introduce the
cannula into the rectum. The ring on the cannula serves to
regulate the length of tube introduced into the rectum and
to maintain it there. The injection of the gas must be
made very slowly and gently, waiting ten or fifteen seconds
between each compression of the ball (p), and taking from
twenty minutes to half an hour over the operation. The
quantity ,of gas injected at. each operation must depend
chiefly on the tolerance of the patient—the minimum being
one litre, the maximum about four litres. It is necessary
also to tike account of a certain amount of resistance to the
injection on the part of the rectum encountered, during the
first two or three attempts with some patients., In this case
it is well to wait a few minutes, and then to inject very
slowly. As soon as thb operation is finished it is necessary to
empty aad washout the generator.

t It has been-stated, that Dr. Bergeon, in order to obtain
sofohttratted hydrogen in a pure and unirritataag form, has
hitherto been obliged to confine himself to the use of Eaux
Bonnes water.. Some bottles of this water are on the table
before you. But &n obvious inconvenience attends this
limitation 1 of the source of the sulphur gas, and, besides,
the Eaux Bonnes water is but feebly charged with the gas,
and some bottles are found unfit for use, as they yield little
or no gab. ' We have had .recourse here to the solutions
suggested by Dr. Bardet for generating the sulphuretted
Aydrogen, and we have found them to answer perfectly.
iTke first of these (No. 1), the sulphuretted solution, con-
-tsins 10grammes of sodium sulphide in 100 cubic centimetres
of distilled water. -This is made by passing pure gaseous
-sulphuretted hydrogen through a pure solution ol soda,
.Subsequently adding a weight of soda equal to that already
^employed, and then the water neoeraary to arrive at the
;Strength inchoated, i A cubic centimetre of this liquid sets
free exactly 10 cubic centimetres of sulphuretted hydrogen.
-No. 2 is an acid solution, used for setting free the sul¬
phuretted gas frswtjbe preceding; this is made by dissolving
grammes oi tmt/yriq, aoid, Aaq * gramme, of salicylic acid
M 100 cubic centime^)** of distilled water. (The salicylic
lacid is simpij jt© mBVMut- the formation of mould in this
Ration.) One ioubie.qenti»»eUe;Of. this solution entirely
Misplaces the, eoifhjuretted bydiQgea of. 1 cubic centimetre
sof the preceding;■> 'T^oee solutions^ afford us the means of

Jlaxdettpoints out, even

tratimating accurate tytbe qwfttit
wdmmistered, U is advisable*, oal

v^xen using a * 4 t«ral
rat a vegetable
/xatdoso.yofl-
,'Setting free
cWith

;,po. add some solution
thb; sulphur gas-, if you do
' xud.acta very slowly in

by Messrs. Bell

proportions indicated by Dr. Bardet as giving the best
practical results—viA, 10 cubic centimetres of the sul¬
phuretted solution to 200 grammes of water ; this mixture is
placed in the “ barboteur,” and 10 cubic centimetres of the
acid (No, 2). solution i» added. If all the sulphuretted
hydrogen were set free from this and. mixed with the.car¬
bonic acid gas injected, we should obtain a dose of sulphu¬
retted hydrogen equal to 100 cubic centimetres. But there
is always a little milkiness produced on the addition of the
acid solution, due to the depoa.tiou.of sulphur, and probably
not more than, two-thirds or tbrecrfourths ,of the above
stated quantity reaches the. rectum, -,eveu when the full
quantity (4 litres) of carbonic acid gas is injected.. As to
the quantity of carbonic acid injected, it varies from one to
four litres, according to the tolerance of .tbe . patient. Dr.
Bergeon directs that two injections should be given daily,
but in .Paris they rarely give more than one, unless, the
patient can only tolerate a small injeotion at a time,
and then they also give them twice a day.. At present
we have only given them once daily,. Those of you
who have seen these injections administered will agree
with me that apart from the odour of the gas there is
nothing particularly objectionable in this method, either to
the medical man or to the patient. But it must be,admitted
to be a troublesome method, when compared with our
routine modes of treatment, and that it takes up much time
When, however, we consider the vast amount of time we
give to investigations in morbid anatomy, we ought not
to complain because modern progress in connexion with
experimental therapeutics throws on os additional labour
and additional duties in this the most practical and most
essential branch of our art. The trouble and labour attend¬
ing tbe application of this method make it very desirable
that it should be taken up and put into practice, not by one
or two physicians only, but by a considerable number, for
only in thu way can its merits and applicability be tested in
a sufficiently large number and variety of cases. Hitherto
its . application has been limited to affections of the respira¬
tory organs, to phthisis, to asthma, and to catarrhal con¬
ditions of the air passages. It has, however, occurred to.
myself, and to others that the injection of sedative gases and
vapours by means of this apparatus may be destined to be
of great service ip other maladies, and especially in some
painful uterine and intestinal affections.

Other agents besides sulphuretted hydrogen have been
applied in the form of gaseous rectal injection with the aid
of this apparatus. Iodoform in suspension in warm water
has been plaoed in the “ barbotpur, and a mixture of its
vaponr with carbonic acid injected. It bas been found of
value especially in cases of fetid expectoration, Eucalyptol
has also been used, but it has so far been found to be
attended with so much bronchial irritation that its employ¬
ment has not. been persevered in. Terpinol hfs proved use¬
ful in phthisical and catarrhal cases with much fetid
expectoration; the fetor of the breath has been agreeably
modified.

This method is so new, and, so far as this country is com-
oerned, so untried, that you will not expect me to express
at present any very positive opinion as to its value, based on
my own observations; but I will tell you what I have been
able to gather from trustworthy observers. 1 will state to
you Dr. Bergeon’s own teetimopy, and put before you the
results ot our own observations so far as they have gone.

And, first, as to Dr. Bergeon’s own testimony. He has
stated that by this method phthisis, asthma, and chronic
bronchitis can often be oured and nearly always alleviated.
For more th&a two years he bas been applying this method
in cases of chronic diseases of the lungs and throat—more
than two hundred in number—with an astonishing amount
of success. In cases of early phthisis, he says, the disease
is usually arrested in two or three weeks, and in a few
months cured; and considerable amelioration is obtained in
advanced incurable cases. It lowers the pulse, reduces
temperature, checks the night sweats, restores appetite,
diminishes greatly the amount of expectoration, and re¬
moves its purulent character, while the cough is greatly
relieved. In advanced laryngeal phthisis he has observed
rapid benefit when all other treatment has failed to give
(.relief. Paroxysms of asthma are relieved more effectually
than by any other meanB. Such is the testimony of the
inventor of this method—testimony advanced not hastily,
but as the result of two years of careful observation.

Dr. Chantemesae reports that he treated “ nine patients in
his wards presenting the general and local signs of pal-

764 Tbs Lancwp,] DR. BURNET YEO: GASEOUS RECTAL INJECTIONS IN CONSUMPTION. [Aran. 16,1887.

monary tuberculosis with characteristic bacilli in their
sputa, by Dr. Bergson’s method, and they obtained very
great benefit. The increase of body weight was rapid—a
pound and sometimes a kilogramme a week. Cough and ex¬
pectoration were considerably diminished. The sputa, how¬
ever, continued to present the characteristic bacilli of
tubercle. They were under treatment for six weeks. One
gained nine pounds in weight in that period.” He also
applied this treatment to two cases of very violent spasmodic
asthma. He injeoted carbonic acid gas mixed with vapour
of bisulphide of carbon. Half an hour after the first injec¬
tion there was a very notable relief of the dyspnoea, and,
the treatment being continued, the breathing became free
and the paroxysms did not return during the whole course
of the treatment. Commenting on the dinical observations
of Dr. Chantemeese, Professor Comil remarks: “ So far we
may say that reotal injections of carbonic acid and sul¬
phuretted hydrogen gas constitute an excellent thera¬
peutic method, in phthisis as well as in asthma, and we
ought to accept it all the more readily seeing how power¬
less are the therapeutic resources which we oppose to
phthisis.”

Dr.. Morel,* alluding to the continued presence of the
bacilli in the sputa of those restored to health by this
method, suggests that their injurious influence is probably
neutralised and their infectious properties destroyed by this
mixture of gases; but he points out that unless this treat¬
ment be maintained in some degree, even in those restored
to health, there can be no sense of security against a relapse
so long as the characteristic bacillus appears in the
expectorations.

In Geneva Dr. Bennet testifies he found several physicians
adopting this method of treatment last September with
“ apparent benefit.” He also states that in a case of very
advanced phthieis under hie own observation this treatment
was “ attended with an unhoped-for rally,” and in a case of
obstinate asthma he observed most remarkable alleviation.

Dr. Bardet, reporting the results of the observations at
the Hdpital Cochin in Paris, says, “so far our results accord
entirely with those announced by Dr. Bergeon. A rapid
and constant sedative effect ensues, the cough diminishes
rapidly, the patient sleeps much better, and the expectora¬
tion tends to disappear. These effects are very remarkable.”*
in Paris they were disposed to regard the oarbonic acid
itself as a valuable and important remedial agent.

As at present, we have only tried this method in this
hospital for five or six weeks, and on a very limited scale,
we nave not been able to do more than corroborate some of
the preceding statements. There is certainly no difficulty
or danger in the operation, and we have not found it
objectionable to the patients. We have observed a gain in
flesh and strength, and an expression of general ameliora¬
tion ; the pulse, temperature, and respiration have fallen,
and the expectoration has been diminished; rest at night
has been improved. Beyond these Statements of general im-

E rovement our data at present will not allow us to go. I
ave been much indebted to the co-operation of our excellent
house-physician. Dr. Ewene, and particularly to my clinioai
clerk, Mr. Verdun, without whose valuable help it would
have been impossible for me to have carried out a method
of treatment requiring such constant personal supervision.

If bisulphide of carbon be the agent employed in Dt.
Bardet’s apparatus, it is necessary to empty the “barboteur”
After each injection and wash it out with alcohol; and after¬
wards open the tap f, and by means of the elastic ball (p)
drive air through the tubes so as to get rid of all the vapour
of the bisulphide, otherwise it will rapidly make the appa¬
ratus unserviceable. I saw one case in Paris, a yonng girl
fin the cavity stage of phthisis, who had benefited much at
first from this treatment, but subsequently it had to be-dls-
Contlnued on account of the difficulty she experienced in
expectorating, so greatly was the expectoration diminished
in quantity. Another patient also in advanced phthisis, in
an adjacent waW, was clamouring fop a renewal of the in¬
fections (which had been suspended) on account of the
benefit he had received from them. No doubt the trou' ‘
attending this method of treatment will tend to re
unpopular with hospital attendants, and we mast tb

be on oar guard how we allow it to be discredited fr_

terested motives. Dr. BfeMSpa-flUdgtatM that whbd 1
method has failed H had

wfies*

iff

ficient mode of application, and that if it is to be fairly tested
it must be on the conditions he has laid down.

It must be admitted that new methods of treatment of
phthisis are often submitted—and by those who should
know better—to most improper and unsatisfactory tests. If
the treatment we have been discussing, or any other treat¬
ment, were absolutely enrative of phthisis, it could only be
so under certain definable conditions. We may go further,
and assert that if we possessed at this moment a certain
core for tuberculosis, it would of necessity leave a great
proportion of existing cases of phthisis incurable. We
should endeavour to realise this fact clearly, and to clearly
comprehend what is the problem involved in the “ cure of
phthisis.” To care phthisis, we must begin to treat the
disease before it has led to its most common result, the
extensive destructive disintegration of lung tissue. No
doubt local ulceration and loss of substance may occur, and
cicatricial contraction and arrest of disease follow, when
the surrounding lung tisane is sound; but this can only take
place when the lung destruction is circumscribed and limited.
Unfortunately, we too frequently have cases brought to us
for treatment when all ohance of Curative treatment has
passed away, and no matter what re mediae we might have
at our disposal, we could not work with them impossibili¬
ties. Yet we find experienced physicians testing “ cures”
of phthisis on advanced 1 and hopeless cases of this kind,
and reporting that the remedies are useless because they
do not care oases which are by no possibility curable.
If the morbid changes which take place in the longs in
phtbiAls were actually open to oar inspection, if we coaid
see them instead of having them concealed from us, the idea
of local medication of the lungs in the treatment of phthisis
would, t feel sure, make rapid progress. The modification
of the ulcerative, decomposing, and disintegrating changes,
and tendencies to change, in phthisical longs by antiseptic
agents, which, in whatever form administered, have a local
action, would appear to us imperative. Whether our anti¬
septic influences take the form of the pure aseptic air of
the open sea, or of elevated mountain regions, or of pine
forests, or of the inspiration of antiseptic vapours in well-
ventilated apartments at home, or of antiseptic agents
administered by rectal injection, or by hypodermic injection*
which latter method is being largely employed in Paris it
this-moment, the principle is the same—viz., to exert an
antiseptic and aseptic influenoe on the pulmonary or other
affected tissues. ' <

It is untrue to state, as some physicians have not hesitated
to do, that the idea of antiseptic medication in phthisis has
failed to be of much benefit. Ofi the contrary, it has been
productive of enormous benefit; and when the pro fe s s i on al
mind has overcome some of its prejudices and its narrowness
of view and mode of thought, It; is destined, I fed certain,
to be of the greatest possible service. In connexion with
this subject 1 was struck with the report by Dr. Neala in
the BritMi Medical Journal of Dec. 4W, 1886, of the excels
lent results he had obtained from what he called the “open*-
air treatment of phthisis.” But what else had the patient
besides a freely ventilated apartment? “Iodine is freely
distributed About the apartment,' and a pad of terebene
platted ttaderthe tthln when the patkat is in bed. Pood is
pushed, Cod-liver dll, with iodoform pills, and iron and bella¬
donna, and bildb of sine to ecntrifl the night perspirations.”
1 congratulate Dr. Neale on the signal success of hie vigor¬
ous antiseptic medication. I oduld not wish a more thorough
appflCatfoh Of Its principles : Iodine vapour and terebene
Respiratory passagee; iodoform intern al ^;

About IlSsSto time that Dr. Neale was pushing: an*-
sCptau treatment, tn the case he has reported, Mr. Pollard, of
(in October last), brought a young

_ to sed me whom we both thought bad but a very

idrt #tsr i to live. He presented an aspect of marked
A' temperature of 103° P. at midday, and rising
j evening; physical signs of infiltration of
h?t of the left lung, with patches of dulness over
behind, accompanied with blowing reepiration
stion here and there. It is true the disease
rely recent date, and there was no evidence
fiction of long tissue, but the fever was so
[ftife cachexia so marked, and the infiltration
i diffused, that we arrived at a very unfavoui-
. J. We declined to sanction his leaving home,
n aput to my friend Mr. Pollard that 1 considered
lance of improvement, and that but a faint one,

Thb Lancet,]

DR. U. BELL TAYLOR ON DISEASES OP THE EYE.

[April 10,1887. 765

rested in antiseptic medication. We gave him, internally,
four minims of creasote in two teaspoonfuls of cod-liver oil
three times a day, and prescribed the continuous inhala¬
tion of equal parts of terebene and eucalyptol, lie had
also a quinine and strychnine mixture as a general tonic,
and some powders at night of bismuth and oxide of zinc to
check the night sweats and tendency to diarrhoea. About
three months afterwards I own I was somewhat surprised
to see Mr. Pollard reappear with his young patient, and
transformed. The results of this treatment had been most
remarkable. Beyond the continued existence of the physical
signs of some infiltration at the left apex, and some irregu¬
larity in the inspiratory expansion of the chest, as though
from pleuritic adhesions, his condition was most satisfactory.
He had gained much flesh ; he had no fever, no night sweats,
no dyspnoea, and not much cough. The cachectic appearances
had vanished. I asked Mr. Pollard how he had contrived to
obtain so striking a result. He replied that it was by a most
thorough, painsti&ing, and conscientious adherence to all the
details of the treatment we had agreed upon. When, gen¬
tlemen, we encounter such results as theso from a method of
antiseptic medication rigorously carried out, I think we are
justified in Baying, in the words of Dr. Leudet, " There is
•something in it.” _

(Minimi Xictures

. ON i

DISEASES OF THE EYE.

Delivered at the Nottingham and Midland Eye Infirmary,
Deeem/>er 9th, 1S86,

By C. BELL TAYLOR, M.D., F.R.C.S.,

SURGEON TO THE INFIRMARY.

LECTURE V.

EYE TROUBLES IN GENERAL PRACTICE.

Gentlemen, — I see no reason to doubt, and there is every
reason to believe, that the operations you have just seen
will end in the restoration of sight; and to restore sight to
the blind has ever, and justly, been considered one of the
grandest of human achievements. Brilliant and gratifying,
•however, as undoubtedly are the results of our most frequent
-ophthalmic operations, they are, after all, but as dust in the
balance compared to the vast amount of human misery
which is alleviated and the sum total of blindness which is
prevented by the judicious treatment of the most common
maladies to which our patients are subject, and which
invariably in the early and most curable stages come under
the notice of the general practitioner. Take, for instance,
that most frequent of all the causes of blindness, the
purulent ophthalmia of infants. There is no disease so easy
to prevent, there are few diseases so easy to cure, and there
is not one so fatal in its effects. If you will look over this
work by Professor Corradi, entitled “ La Cecift5 en Italie.”
you will find that there are upwards of 300,000 blind
persons in Europe alone; and it you will glance at this
graphic representation of the causes of blindness prepared
by Dr. Magnus of Breslau, you will see at once that the

f iurulent ophthalmia of infants stands at the head of the
ist; while if you will study, as I have done, the reports of
the various blind asylums throughout Europe, you will find
that from 30 to 46—ay, and 50 per cent.—of the inmates
of these institutions owe their misfortunes to this terrible
disease. Gentlemen, just consider what this means: it does
not mean blindness coming on after a long life of usefulness
or pleasure ; it does not mean dimness of vision, admitting
of more or less hopeful treatment; it does not mean
damaged sight or blindness of one eye; it means blind¬
ness of both eyes—total, irreparable, coming on in the
very earliest days of infancy, and lasting throughout
the whole of many a long, weary, tedious, desolate life.
Now this disease is not caused, as many have believed and
taught (Stellwag), by cold, by a draught, or by sudden
exposure to concentrated light. It is caused, as was first
pointed out by our distinguished countryman Gibson, of Man¬
chester, by the direct inoculation of the child’s eyes with the

secretions of the mother’s vagina, and may be prevented as
easy as easy can be by curing the leucorrhoea of pregnancy,
by disinfecting or wiping away the discharge even so late
as during the progress of labour, by insisting upon the most
scrupulous cleanliness on the part of the attendants, so that
their hands may not communicate infection, and by taking
care that the child’s face is not washed in the same water
which is used for its bath, and that its eyes are not wiped
with the same sponge that is used for its person. Gentle¬
men, if these precautions were thoroughly carried out in
every case of midwifery, I venture to affirm that there would
not be another case of bacterial purulent ophthalmia in
the universe. Even if a little matter should have got into
one or other of the child's eyes, it may be destroyed at onoe
and in situ, before any harm is done, by a drop of a 2 per
cent, solution of nitrate of silver; 1 and if one eye should
unfortunately have become infected before you see the
case—and, mind you, it is seldom that both eyes are struck
at once 3 — the sound eye may be protected and sight
assuredly preserved by the use of this little simple con¬
trivance, this sticking-plaster shield, which I regard with
parental, and I trust with pardonable, pride, since I am sure
that I have saved many an eye by its use. 3 (Fig. 1.)

Fig. 1.

Gentlemen, I said the disease was easily cured, and so it
is. Let me quote a little evidence on this point. Mr. (after¬
wards Sir William) Lawrence, late surgeon to St. Bartholo¬
mew’s Hospital, whose work 1 have here—and I can cite no
higher aut hority,— writing in 1833, says: “ There is a singular
contrast between the virulence of this inflammation of the
eyes of newly born children, and the serious consequences
to which that inflammation so rapidly leads, and the readi¬
ness with which it yields to suitable treatment; hence, if
we see a case of purulent ophthalmia before any injury is
done to the cornea, we may assure the parents, and it gives
us great pleasure to be able to do so, that sight will not
suffer; Even the most violent form is very manageable, and
will do well when properly treated.” 1

Again, Professor Knapp of New York, another eminent
ophthalmologist, whose archives I here commend to your
notice, tells us, half a century later, that "no child need
lose its eyes from ophthalmia neonati, and no child does if

l This is Credo's much-vaunted method: a solution of nitrate of silver,
eight grains to the ounce, is dropped into each eye of every child born,
"dans les sen-ices d’aceouchement,” and Dr. Kaltenbacli, in a recent
communication to the Congrts Allemand de GynScologie declares that
the cases of purulent ophthalmia have in consequence diminished from
15 per 100 to 0 per lo6.—(See Rectu-il d'Ophthalniologie for August, 1880.)

* The ophthalmia almost always appears at first in one eye alone, the
other being affected some days after. The transference of the secret ion
from one eye to the other nee ms to be the usual origin of the disease In
the second eye.—(See Treatise on Diseases of the Eye, by Carl Stellwng.
von Carrion Professor of Ophthalmology In the Imperial Royal Uni¬
versity of Vienna, p. 317.) .....

» The shield is merely a piece of sticking-plaster with a hole in the
centre, cut to correspond with the pupil; the aperture is filled by a piece
of gauze. The baby depicted in the figure, whose left eye was attacked
with a virulent form of purulent ophthalmia three days after birth, had
its right eye protected in this way upwards of a fortnight.

* Lawrence on Diseases of the Eye, p, 171.

Digitized by LjOoq Le

•'7$6 -TPafe LANdlcrfl

DS. ft BEIA TATfiOfR ON' DiaBAeSS' OF 1 THE' BYE.

[Apftn. 16,1887.

faithfully treated”; adding, “ I speak from an experience,
not of dozens, not of hundreds, but of thousands of cases.” 4

You will find a similar expression of opinion in this ex¬
cellent brochure entitled “The Prevention of Ophthalmia
Neonatorum and its Ravages,” by Dr. David McKeown, of
Manchester, presented to the Obstetrical Society of London
in February last year; as also in this popular treatise en¬
titled “ Eyesight and how we lose it," by my distinguished
confrere , Dr. Priestley Smith, of Birmingham. In short, gen¬
tlemen, not to detain you unnecessarily, I may say, without
fear of contradiction, that on this point ophthalmic surgeons
are agreed.. The disease is easily cured. How is it, then,
you will very naturally say, that so many children lose their
sight from purulent ophthalmia? The reply to that ques¬
tion is simply this: either they are not properly treated or
they are not treated in time. Let me prove this to you. Of
030 cases treated in an early stage of the disease by Pro¬
fessors Horner, Schweigger, and Hirschberg, 630—that is,
every one—recovered with absolutely perfect sight. On the
other hand, and I bid you mark the sequel, of 120 cases
coming under the care of the same gentlemen, but not seen
until a later stage, 49—that is, not quite one half, but
more than a 1 third—lost the sight of both eyes beyond all
chance of recovery or possibility of improvement. Gentle¬
men, that is the trouble. The practitioner is called in
when the parents are alarmed, or the specialist is con¬
sulted when the practitioner is alarmed, and then it is too
often too late either to save the eye originally affected or to
preserve the sound eye from inoculation. A few days ago
perhaps I ought to say nights, for it was after eleven
o'clock—a cab dashed up to my door, the bell rang violently,
and a lady with an infant in her arms was ushered into my
consulting-room. “Dr. Bell Taylor,” she exclaimed,bursting
into tears, “ will my baby see ?” I ascertained that the child’s
right eye commenced to discharge three days after birth, some
days later the left was inoculated from it, and both had been
discharging freely for three weeks. All was supposed to be
going on well. “The child was said to have a cold in its
eyes,” and, so far as I could learn, no special anxiety was felt
as to the result, when suddenly it flashed upon the mother
that her boy might lose his sight; and acting on the
impulse of the moment, though late in the day, unfit to
travel, and a hundred and fifty miles away, she rushed to
the station and caught the train for Nottingham. I suc¬
ceeded in arresting the discharge in a few days, but both
eyes were lost from sloughing and ulceration of the cornea
when she started on her journey. Gentlemen, this is a
deplorable state of things; it ought not to be; and I can
assure you that the various societies interested in the pre¬
vention of blindness look to you general practitioners who
attend midwifery', and who have so much in your power, to
save us from further reproach on the score of blindness
from purulent ophthalmia. With regard to treatment,
mycologists assure us that the virulence of the disease is
due to the ravages of a gonococcus discovered by Neisser
in 1879, which, like an elephant in a field of maize,
battens on the cylindrical epithelium of the palpebral
conjunctiva. It appears that the columnar epithelium of
the bulbar portion of this membrane affords no nutriment
to this microscopic specimen of the ferat natures; however
that may be, it is an important clinical precept that our
remedies must be sufficiently strong to disinfect the con¬
junctiva, and that they must be applied to the inside of the
everted lids at least once in twenty-four hours. I have
found chloride of zinc an excellent antiseptic myself ; but
the remedy par excellence is the nitrate of silver, which
may be used in the form of mitigated stik, or 2 per cent.
solution. 8 Meanwhile the matter must be worked out from
underneath the lids, which must be prevented from sticking
together by a little oxide of zinc and white precipitate
ointment, and the eye must be kept saturated with alum-
water or weak solution of chloride of zinc (one grain to the
ounce), which may be iced or heated according to the nature
of the case. If the lids are swollen, tense, red, and shining,
they may be punctured, leeched, or painted with a solution
of nitrate of silver in nitric ether; and if the cornea threatens
to give way, the anterior chamber may be tapped and a
compress bandage applied. You need not fear to separate
the lids for the purpose of looking at the eye in the early

'• Archive* of Ophthalmology for March, 1882. Putnam’* Sons, New
YitrJr.' •

0 If the remedies musl be entrusted tothe friends, the nursemaydrop
into the eye a solution of nitrate of *ilver, two or’three grains to the
ounce, thrice daily.

stages of the disease, but later on the utmost care is needed.
I was called to a case of this kind some time ago, a long
way off; two surgeons were already in attendance, one a
specialist. I said: “The cornea of the left eye is on the eve of
perforation, and I think we had better give a little chloro¬
form, tap the chamber, and apply a compress bandage.” My
ophthalmic friend dissented from this view, and proceeded
to repeat my examination for himself. I was leaning over
anxiously, 1 may say fearfully, watching the process, when,
probably from some sudden motion of the child, the lens
was projected with violence, and struck me in the right eye
By dint of free ablution and the use of antiseptics I was
“ quit for the fright,” but it was a warning to me, and I
am sure it will be a warning to you to be careful how you
conduct an examination in the later stages of purulent
ophthalmia. Apart from the danger to the child itself, the
risk to attendants from carelessness in this respect is some¬
thing greater than you can readily conceive. Let me
endeavour to impress this upon you by a recital of two or
three very important facts. 1. I have known a short-sighted
nurse inoculated by pent-up matter, which spurted out when
the adherent lids were suddenly separated. 2. Two friends
of my own, surgeons, have each lost an eye frbm accidental
infection. 3. It is a fact that 118 per cent, of the nurses
in the St. Petersburg Ilospital manage somehow or other
to contract this disease from children under their care
(Haussmann). 4. If you will refer to the reports of the
foundling hospitals of Prague, of Vienna, of St. Petersburg,
and the records of the Parisian creches, you will find that &
considerable proportion—from a fourth to a third (Fuchs)—
of the baby inmates of these institutions contract this disease
after admission, and may thus be said literally to be taker-
in and blinded at the public expense. 7 In order to avoid
these deplorable accidents it is well that those who are much
engaged in the treatment of these cases should wear large
protective glasses. Sponges and syringes (the latter also
because they are apt to injure the corneal epithelium
should be discarded, and all rage, linen, &c., which have been
in contact with the discharge should be at once destroyed,
for, as you will learn directly, it is dangerous to wash them.

Adults and others infected from children suffering from
ophthalmia neonati present various degrees of purulent
ophthalmia, according to the stage and virulence of the
source of infection, and authors usually consider gonorrhoeal
ophthalmia under this head because it is marked by the
presence of the same microbe and alike communicated by
direct infection. There is no comparison, however, between
the . amount of reaction and destruction occasioned by
inoculation with a mild fluor albus, such as most women
suffer from some time or other during their lives, and that
which follows the insertion of a particle of gonorrhceal
matter into the conjunctival sac ; indeed, in the latter case
it is almost impossible to save the eye. Speaking on this
point, Professor Arlt of Vienna says, “ I have lost many eyes
from gonorrhoeal ophthalmia.” Mark that, gentlemen.
Professor Arlt is one of the most accomplished practitioners
in Europe, and perhaps the most experienced; and if he,
with all appliances and means to boot, cannot save the
eye in the majority of these cases, it is clear that
we have to do with a disease of exceptional virulence.
Fortunately, however, in this affection only one eye is
.infected (unless when the patient has bathed his eyes with
his own urine), and we can always guarantee the sight
,by protecting the sound eye with the shield to which I
have already called your attention; and here let me beg of
you to apply it on suspicion. This simple shade cannot,
under any circumstances, do any harm; sight is not inter¬
fered with; ventilation is perfect; the patient is not pre¬
vented from helping himself or walking about; and its
neglect is often attended with most disastrous consequences.
Above all, let me beg of you not to believe the youths and
young men, the most frequent subjects of this affection,
when they tell you that they are free from venereal taint;
for I have known even highly educated gentlemen deny the
'soft impeachment, when their shirts were stiff with dis¬
charge. We had a sad example of the results attending the
neglect of the shield in the case of a poor woman from
Grantham, who was here three months ago. Her right eye
(it is generally the right eye) was inoculated from some

'' i At the meeting of the Imperial Surgical Soeietyof Paris, on Feb. 21ft.
1866, If. GiraldAs (L’Union Mod.. No. 82S. tt 26. 1886) reported that in
the HOpital dee Enfunta Trouvos the loss of eyes (sometimes even of life
by blennorrhoea neonatorum reached the enormous number of from 80 tc-
I 90 per cent.

Ths Laitcbt,]

DB. J.M. FOTHERGILL: THE GENESIS OF “ BBIOHT8 DISEASE.” [Apart, 16,1887. 7j

linen she had to wash, and discharged freely for three weeks;
At the end of that time, sad to relate, some of the matter
got into the left eye, and when she came here both cornese,
had sl,oughed. She was a widow, forty years of age, strong
active-j fond of work, and had two children dependent upon
her. 0 fhink of it .'—hopelessly blind for life; and all for
wan t i a bit of sticking plaster which any country drug¬
gist m ght have applied jost as well as the most accom¬
plished surgeon.

With regard to the treatment of gonorrhoeal ophthalmia,
“ Dreadful diseases require dreadful remedies,” and if you
Are to succeed you must be instant in their application. I
usually apply leeches by the handful ; pack the eye with ice,
and, unless there is some contra-indication, keep it constantly
applied; slit the outer can thus, incise and excise (if necessary)
portions of the chemoaed conjunctiva, and get the patient
rapidly under the influence of mercury. During the
crudesoence of the disease, and when it is at its height -
that is, during the first forty-eight hours, or while the
discharge is serous,-strong caustics are out of place; but
you may keep the eye saturated with weak solution of
chloride of zinc (h or { per cent.)'* from the beginning, and
as soon as the serous discharge becomes purulent, apply as
well once or twioe daily to the inside of the everted lids a
2 to 4 per cent, solution of nitrate of silver, carefully pro¬
tecting the eve by neutralisation with milk er saline
solution. 1 nave saved some eyes in this way, but
occasionally the cornea will slough in twenty-four hours,
and then all you can do for the patient, and that is every¬
thing, is to protect the sound eye from inoculation.

(To bv co nclmiad .)

THE GENESIS OF “BRIGHTS DISEASE.”

Br J. MILNER FOTHERGILL, M.D,

PHTSICIA5 TO TOX CITT OF LOXDOR HOSPITAL FOR DISK ASKS OF THE
CHEST, VICTORIA PARR.

The prevalence of the morbid change so far best known
by the term “ Bright’s disease ” (from Richard Bright, who
first wrote on the subject); its certain ending, sooner or
later, in death; together with the fact that its course can be
profoundly modified by proper and judicious measures: all
combine to give the subject an intense interest for all—
physician and patient alike. " Old age is not an entity, hut
a set of conditions predisposing to what we call chronic
Bright’s disease. And though to most this comes in natural
course when the prime of life is ran, yet to some old age is
no matter of years and of averages, but tbe miming down
of a spring set for an individual.” Such is the happy expres¬
sion of Dr. Goodhart in his well-known Bradshawe Lecture
before the Royal College of Physicians of London in August,
1885. It is a slow, gradual growth of the lowly connective
tissue of the kidney at the expense of tbe higher kidney
tissues. But tile kidney-mischief is only a part of the
morbid change. A like growth of lowly tissue is going on
in the walls of the arteries—atheroma—rendering them
inelastic and brittle. But what calls out the growth of the
lowly connective tissue in kidney and artery? The irritation
set up by the presence of uric acid (possibly accompanied
by other forms of albumen-metamorphosis) in excess in the
Wood. In order to grasp the matter flrmly we mast look a
little beyond mere clinical facts, so as to read these last aright.
'We see, in the gradual evolution of life, the reptile, the cold¬
blooded inhabitant of tropical swamps, casting out its
excrementitious matter in solid form—i.e., urates. The uric
acid formation still continues in the warm-blooded bird,
which also possesses a solid urine. When the mammalia
appear, they are found to have a fluid urine, and their form
<Jt excretion is the soluble urea. But vestiges of the earlier
formation still cling with the tenacity of original sin ; and
a certain, if small, quantity of uric acid is daily voided by
man himself. So that we still carry with us traces of our

* I consider ths oonstant application of these solution* of the utmost
importance. Dr. Colles of Dublin, writing in the Dublin Quarterly,
vol- xxxv. n. 6. declare* that, he has been singularly Successful In ease* of
goaotTbmal ophthalmia with solution of nitrate of silver, one quarter of
a grain to the ounoe. Injected every ten minutes for twenty-four hours,
the strength being afterwards increased to half a grain to the ounce,
and Injected every half-hour.

descent in other forms than the branchial arches—the gills
of fcetal life. Indeed, the circulation of the foetus is that of
tbe higher reptile; and the uric acid formation is distinctly
seen in intra-uterine existence. We have long been familiar
with tbe fact that under given circumstances the human
body reverts to the early primitive form of urine-stuff. As
to gout, we have recognised its association with good
eating, especially when accompanied by a lack of exercise.
The sensuous monk of old, lazy, fond of good living, and
addicted to wine-bibbing, was the typical gouty man. Now,
it is the oountry squire, whose habits were active till gout
in bis feet cripples him, and then its fell clutch becomes
tighter and harder; or the p’ethoric publican, whose plea¬
sures are those of the palate. This was the gout which
came of good living. “ Gout is the disease of those who
will have it,” said Meade. But a number of cases of
distinct gout were found under widely different circtrtt>-
stancos. They occurred in spare beings, small fastiaitnls
feeders, whose trencher performances were conspicuous by
their temperance. To this class the term “pool- man's
gout” was applied. It did not explain the apparent para¬
dox, and this inability to explain it was regarded as an
opprobrium to the medical profession. Doubtless a largo
proportion of the sufferers from poor man’s gout were
descendants of gouty ancestors; and only by the strictest
regimen, as to meat and drink, could they elude the visita¬
tions of their hereditary foe. But the gouty ancestry was
not present in all cases.

Tbe late Qr. Budd held that sundry persons came iAto the
world with what he called “insufficient” livers; and Dr.
Murchison endorsed this view. Such livers revert to the
uric acid formation very readily; and now poor man’s gout
stands revealed before us. Indulgence in animal food in
excess reduced a normal liver to the uric acid formation.
A congenitally insufficient liver reverts to the uric acid
formation under an ordinary or even meagre dietary. The
result is the same in each case. When the uric aoid forma¬
tion is established we find one of two consequences: either
(1) the uric acid is gradually deposited in the body, in the
articular cartilages by preference; or (2) is cast out by the
kidneys, which, being constructed to excrete tbe soluble
urea, are irritated by the presence of uric acid in excess;
with the result of interstitial nephritis, or chronic Bright’s
disease. Often both are found.

Renal changes are by no means the sole morbid outcome
of the uric acid formation. The cardio-vascular system
feels its malign touch. A tight artery is the consequence of
the blood condition, and, with that, changes in the arteries
and the heart. Tbe high blood pressure in the arterial system
leads to hypertrophy of the left ventricle, and that, again, to
secondary valvulitis of a progressive nature—probably due
to the forcible closure of the valves; the mitral by the large
ventricle; in the aortic by the recoil of the highly distended
artery. Possibly in the latter there is a tendency to gouty
deposits, as in the joints. The distension of the arteries
leads to a growth of connective tissue in their walls, which
lose their elasticity and beoome brittle—the atheromatous
change,—and from these we get apoplexy and aneurysm;
while angina pectoris vaso-motoria is called out by occa¬
sional spasm of the peripheral arterioles. Sooner or later
tbe growth of connective tissue within the coronary arteries
themselves cuts down the nutrition of the large heart, and
fatty degeneration spreads throughout its structure. The fail¬
ing heart leads, in its turn, to dropsy, albuminuria, and death.
Indeed, we get a vast number of morbid outcomes in this
widespread vaso-renal change, beyond the interstitial
nephritis, which is spoken of as “chronic Bright’s disease,”
or “ renal cirrhosis,’’ or “ the gouty kidney,” as it is variously
termed. But the consideration here is restricted to what is
truly “ chronic Bright’s disease,” a renal change started by
an impure blood, as Professor Hayles Walsbe asserted in
1849. 1 The uric acid (and possibly other excrementitious
matter of nitrogenised character, the products of albumen
metamorphosis) irritates the kidney structures, and starts
up a rank growth of the lowly connective tissue, or packing
material, at the expense of the higher true structures of the
kidney. Here and there in minute foci, scattered through¬
out its mass, mainly in the cortex at the outset, we find
the destructive action at work. The lowly invader is preying
upon the higher structures, like the Tartar Turk spread
himself over the population of the Balkan peninsula, and

1 Tub Lahckt report: Bright’* Disease not essentially & Benal
Disease, but essentially and primarily a Blood DIseaae.

by Google

D

788' Thb Lancet,] MR. BENNETT MAT: EXCISION OF‘TUMOUR OF CEREBELLUM.

[Aphil 18,1887.

with the same result—destruction. Slowly and Bteadily
one minute portion of the kidney after another is caught
within the light touch of some soft growth of connective
tissue; but as the latter dries up and hardens, it contracts,
and the true tissue within its clutch is ruined—squeezed
out of (functional) life and (anatomical) form. Bit by bit,
and often very slowly, the process goes on, until the kidneys
are rendered inadequate as depurative organs, and the blood
is rendered toxic by being surcharged with waste of albu¬
minoid origin. Then follow secondary inflammation set up
by the toxic blood, or other truly uraemic complications,
often desperate attempts on the part of the body to cleanse
its blood. To call this widespread change a “kidney disease”
is as much a misnomer as to apply “ Pimlico ” to the whole
metropolitan area • and to seek for evidence of it in the
renal secretion solely is as imperfect as would be an inquiry
into the sanitary arrangement of Lambeth, however care¬
fully conducted, as to the state of the whole area which dis¬
charges its sewage at Barking Creek. Casts of the renal
tubules are truly the infallible evidence of renal destruc¬
tion as to existence, if not as to extent. The character of
the urine tells much: when it is copious and of low specific
gravity we have only too good reason to decide that the
injury is extensive and widespread. Sometimes albumen is
present in the urine, but its significance depends upon its
associations. Dr. Richard Bright found that when albumi¬
nuria coexisted with dropsy the kidneys were the seat of
disease. But in the diagnosis of several practitioners the
dropsy factor drops out of the calculation, and the diagnosis
is made in its absence. Albuminuria and “chronic Bright's
disease” are, however, not convertible terms by any means,
nor the equivalent of each other, as is not unfrequently
assumed.

Chronic interstitial nephritis is but one of the numerous
morbid progeny of the uric add formation, albeit an impor¬
tant unit. We are ail familiar with this vaso-renal change,
as it runs its course in the mesoblastic structures of the men
of Norse type, large-boned and florid, giving joint-gout,
cardio-vascular changes, chronic bronchitis, rheumatism,
eczema, and secondary valvular disease in the large heart.
That is one aspect of the vaso-renal change. But this is
by no means the only aspect of this change. It may some¬
times commence with primary kidney mischief, and con¬
sequent imperfect blood depuration. Far more frequently
it starts from a congenitally "insufficient” liver. In persons
of the neurosal diathesis or Arab type (to whom the term
“ neurotic” aptly applies), the phenomena are widely diffe¬
rent. The mesoblastic tissues are comparatively un¬
touched; while the hypoblastic and epiblastic tissues are
the seat of suffering. These persons are of spare habit
and complain of indigestion, acidity, and flatulence—matters
of the hypoblast; of migraine, accompanied by vesical
irritability, of palpitation, of failure of the heart's action,
resembling syncope, except that they do hot loee conscious¬
ness, and realise the horror of their condition—matters of the
epiblast. In many cases cardio-vascular change is also pre¬
sent, and the migrainous neurotic is as liable to apoplexy as
the red-faced, short-necked gouty man; the urine of the
last is usually copious and clear, while in the neurotic
the urine is often charged with lithates.

The migrainous neurotic of the uric acid formation is
growing more and more common. Town populations have
a tendency to grow smaller and darker, as anyone can see
by comparing the living crowd with the worthies in effigy
at Madame Tussaud’s. They have a tendency to revert to an
earlier and lowlier ethnic form, and are smaller in the bone.
They are precocious, and the early development of the
nervous system is accompanied by a deficiency or backward¬
ness in tne assimilative organs. There is an insufficient
livsr, which readily reverts to the uric acid formation;
and this is aggravated by the fact that town dwellers
eat more animal food than rustic populations of the wage
class, while the latter have the advantage of plenty of
Oxygen. The town dweller works in ill-ventilated rooms,
and his amusemehts are in-door in a vitiated atmosphere.
With an in sufficient liver, a meat dietary, and insufficient
oxidation, the toWjn^dweUer is the subject, more than all
others, of the Uric Wd, formation, with all its varied con-

aquencea. if ViOtoria-Jiark Hospital 1 have under care at
esent tiMeU mite of a girl, not yet thirteen years of
.•whom ilHfcephenomena oifmkaainoos neurotic

niiieia to produce a

“." ' i race of

M's seen

in early puberty, but reproduction is impaired; and Hayles-
Walshe, Mr. Cantlie.and others have shown that it is well-nigh
impossible to find a true Cockney of the fourth generation.
Dr. Ralfe infbrms me that of 800 inquiries made at the
London Hospital only four resulted in genuine Cockneys of
the fourth generation. The retrocedent race perishes either
by sterility in the females, or their sparse progeny succumb*
to the diseases of childhood. These urban dwellers, the
progeny of town-bom parents, this retrocedent race, are
the possessors of congenitally insufficient livers, and as a
consequence are the victims of the uric acid formation. This
liver reversion is the microcosm within the macrocosm..
And Bright’s disease is especially the disease of this urban
race. TeetotaKam and vegetarianism are no matters of mere
caprice or fashion; but are the unconscious submission to am
unseen law ruling the choice. The urban dwellers cannot
tolerate the beef and ale of their rural forefathers. No doubt
in many cases alcohol and syphilis play their part, and too
often an important part. But these are only accessories to-
the great fact that the descendants of town dwellers die
prematurely old of Bright’s disease, and that the spring runs
down at a much earlier period with them than with rural
populations.

Many persons are remarking how common gout is be¬
coming amidst us at the present time. Such is oertainly
my personal experience; though articular gout is by no-
means the common outcome of the uric acid formation in
town dwellers. Sufferers from articular gout are compara¬
tively infrequent among the crowd of persona who are-
undergoing that vaso-renal change to which “chronic-
Bright's disease ” is the term most commonly applied. In>
other cases neurotics are found with the uric acid forma¬
tion, who seem to owe their “insufficient” liver to hard-
intellectual toil on the part of their fathers. Nearly every
American lady of this mass has given me a history of the
long and usually successful efforts of her father. “ The
fathers have eaten sour grapes, and the children’s teeth are
iet on edge.” There seems some law of antagonism betwixt
the tissues of the epiblast and those of the hypoblast. Long
sustained demand upon the brain as “the organ of mind”'
tells upon the viscera. The liver suffers therefrom; and the
progeny of the hard-working brain-toiler comes into this
world with an insufficient liver. Clifford Allbutt, FJEL.S.,
some years ago pointed oat clearly the mental o&nseo
of Bright’s disease, in an address which attracted
much attention at the time and since. Not only doee
my experience fall in with his as to the individual, but it
seems to teach a further lesson—viz., that hard, sustained’
brain toil has its Nemesis in an insufficient liver, which
reverts to the uric acid formation. The bright, high-aouled
migrainous-neurotic, one of the most charming patients who
enter the physician’s consulting-room, owes her fortune and
her liver alike to her father’s toil, which is rather & hard
nut to crack for those whose ambition it is to make a
fortune,®

Thus we see there are many factors—and some of them
little suspected—at work in the genesis of Bnght's disease.
Nor is it inaccurate to say that it is a disease becoming
daily more common in “this madly striving age.” More
familiarity with its causal relations ought to develop
definite preventive measures.

Henrietta-street, W. * ' .

CASH OF .

EXCISION OF TUMOUR OF CEREBELLUM.

By BENNETT MAT, F.R.C.S, ; : , t ...

8HBQBOX TO THB QUEER'S HOSPITAL, B IBM HO HAM. ' . j

Early in August, 1888, my colleague, Dr. Suckling,
informed me that he had a patient under his care in the
hospital in whoni he diagnosed a tumour of the cerebellum,
which he thought might be amenable to operative treatment.
Such a case did not at the outset offer to my mind much,
prospect of successful completion, on account of what 1 con¬
ceived to be the exceptional difficulty of access to a tumour
in this portion of the brain. The actual procedure, however,
I found to be extremely easy of accomplishment and of no
great severity, and I believe that in some respects this

* No wonder Bright’s disease is so prevalent among the 1
inhabitants of the United States of America.

Tfenluaarr,]

MIL G. ROBERTS: TREES FROM A SANITAEJT ASPECT.

[Apun.lfi.18^7.

portion of the brain will be found not unfavourably placed
lor operative procedures. At any rate I wish to make this
contribution as a practical inquiry in the study of a subject
which is now engrossing so much professional attention.
Although this case so quickly terminated fatally, there is no
■doubt whatever that this was owing to the valuable time
which had been lost before the operation was performed,
during which the child’s vital powers became too greatly
reduced to afford much hope of success, in all details of
method I closely followed the lines laid down by Mr. Victor
Horsley for the preparation of the patient and the treatment
of the wound, &c. These appear to me to embody several
points of considerable practical importance in brain surgery.
In the case of another patient of Dr. Suckling’s, whom I
have j ust operated upon for epilepsy, complete primary union,
without the slightest departure from normal health, has
followed an extensive opening of the dura mater and explora¬
tion of the brain, and such favourable result appears to be
almost the rule now. The following history and symptoms
•of the case are furnished by Dr. Suckling, who localised the
position of the tumour with such accuracy that I was able
to cut dtreotly upon it at the spot he indicated.

“ C. H-, & boy aged seven, was admitted into the Queen’s

Hospital on July i'Jtb, 1880. The only important feature in
the family history was that the father’s uncle had phthisis.
Twelve months previously to his admission the boy had
rheumatic fever. In April, 1888, he suffered from severe
■and persistent headache, chiefly frontal, witli vomiting.
Since this dmt‘ his sight had gradually failed. On admission,
the pupils were dilated and unequal, but responded to light
and accommodation. There was conjugate deviation of the
■eyee to the left, and paralysis of the external reccus muscle
on the right side. There was intense neuro-retinitis on both
■sides, and the boy was nearly blind. The gait was stagger-
rug, the Stagger being chiefly in the backward direction, but
occasionally to the left side also. The mind was clear, the
boy talking rationally and complaining that he could not
sss. The lunp< wore healthy. While in the hospital the
boy vomited at times, complained of frontal headache, and
gradually got worse, very soon being quite unable to stand,
vn August 20th marked retraction of the head was observed.
On October 8th the boy was absolutely blind, and there was
well-marked nystagmus. The knee-jerk was lost on the
sight side, ami there was marked emaciation. The sym¬
ptoms above recorded clearly pointed to a tumour in the
■cerebellum. The paralysis of the right external rectus led
lae to conclude that the tumour was in the right lobe of the
•cerebellum, and was growing downwards ana forwards and
compressing the right sixth nerve. It was thought also
that it waa most probable that the tumour was tubercular.”

0 wing to my absence from home in the autumn a regrettable
delay of some weeks took place before the child waa operated
upon, and during this time his condition greatly changed for
the worse, ami ha had become much collapsed in the few
•days preceding ie operat ion.

Opcration.— Full antiseptic precautionshaving been taken
•ad the patient, brought, luhu chloroform, mv iirat. step was
to expose that portion of the occipital bone which Lies oelow
the superior curved line, so that all proceedings could be
•carried on beneath the tentorium cerebelli. A curved incision
with convexity upwards, and. reaching a little above the
■external occipital protuberance, was earned across the back
•of the bead from one mastoid process to the other. The scalp
•ad subjacent parts were then oarried down as a dap by
separating all the muscular attachments from the bone, but
more on the affeoted side (the right) than the other, until
-the neighbourhood of the foramen magnum was reached.
The bone being well cleared and exposed, the trephine
was applied about the centre of a quadrilateral space
bounded above by the right superior curved line, below
by the foramen mumum. and inwardly by the occipital
•Met, and the hole in the bone was freely enlarged by
the bode foretps until a large quadrilateral space of dura
mater was exposed. Tins was easily done owing to the
thinness of the bone. Extreme bulging of the dura mater
gave evidence of great iatra-crani&l pressure^ and the
membratae wai then opened and turned up by incisions along
three sides of the aperture in the bone. The cortex of the
esrebellam appeared quite healthy, but at one spot,, a little
■outside the centre of the exposed space, palpation gave an
411-deftaed feeling of hardness beneath the surface. I then
umrisod the brain substance over this spot with a teuotome,
and on entering the linger could detect the hard mass of a
"tumour nearly amount} ;below Ute ■ w ■ ; l/stiag trended

its tubercular nature by detaching a piece, I had no difficulty
in digging it clean out of its bed by the handle of a small
teaspoon. It was larger than a pigeon’s egg, hard and
horny on the exterior, and caseating in the centre. Htemor-
rbage was trifling, and the child gave no evidence of any
injury or disturbance to the brain. The dura mater flap was
then fastened down and the outer wound closed, this flap
affording on excellent protection and covering. Unfortu¬
nately the child’s condition had sunk too low beforehand to
permit of sufficient reaction, and be gradually sank and
died of shock a few hours afterwards. No post-mortem
examination was permitted, so I am unable to say whether
any other tumour was present.

Birmingham. _______________ ,

TREES FROM A SANITARY ASPECT. -

By CHARLES ROBERTS, F.R.C.8^ &c.

As this is the usual time of the year for planting, pruning,
and removing forest trees and shrubs, it is a fit time for
considering the influence which trees exert on the sanitary
iorroundings of dwelling-places. The recent Parliamentary
Report on Forestry shows that trees are now of little com¬
mercial value in this country * and we may conclude, there¬
fore, that they are chiefly grown for picturesque effect, and
for the shelter from the sun and winds which they afford.
The relation of forests to rainfall has been studied by
meteorologists, bat little attention has been given by medioal
dimatologists to the share which trees take in determining
local variations of climate and the sanitary condition of
dwellings, notwithstanding they play as important a part
■is differences of soil, of which so much is said and
written nowadays. This remark does not apply to large
towns, where trees grow with difficulty and are compara¬
tively few in number, and where they afford a grateful
relief to the eye, shade from the sun, and to a very slight
extent temper the too dry atmosphere, but to suburban and
country districts, where it is the custom to bury houses in
masses of foliage—a condition of things which is deemed
the chief attraction, and often a necessary accompaniment,
of country life.

Trees of all kinds exercise a cooling and moistening in¬
fluence on the atmosphere and soil in which they grow.
The extent of these conditions depends on the number of
trees and whether they stand alone, in belts, or in forests;
on their size, whether tall trees with branchless stems or
thickets of underwood; on their species, whether deciduous
or evergreen; And on the season of the year. The cooling
of the air and soil is due to the evaporation of water by the
leaves, which is chiefly drawn from the subsoil—not the
surface—by the rdote, and to the exclusion of the sun’s rays
from the ground, trees themselves being little susceptible
of receiving and radiating beat. The moisture of the atmo¬
sphere and ground about trees is due to the collection by
toe leaves and branches of a considerable portion of the
rainfall, the condensation of aqueous vapour by the leaves,
and the obstruction offered by the foliage to evaporation
from the ground beneath the trees. The experiments of
M. Fautrat show that the leafage of leaf-bearing trees
interoepts one-third, and that of pine trees the holt of the
rainfall, which is afterwards returned to the atmosphere by
evaporation. On the other hand, these same leaves and
branches restrain the evaporation df the water which
reaches the ground, and that evaporation is nearly four
times less under a mass of foliage in a forest, and two and
one-third times under a mass of pines than in the open.
Moreover, trees prevent the circulation of the air by lateral
wind currents and produce stagnation. Hence, as Mr. E. J.
Symons has truly observed, “a lovely spot embowered in
trees and embraced by hills is usually characterised by a
damp, misty, cold, and stagnant atmosphere,” a condition of
climate which is obviously unfavourable to good health and
especially favourable to the development of consumption
and rheumatism, our two most prevalent diseases.

Now, if we examine the surroundings of many of our
suburban villas and country houses of the better sort, we
shall find them embowered in trees, and subject to all the
insanitary climatic conditions just mentioned. The custom
almost everywhere prevails of blocking out of view other
hon^ roads, , by belts of trees, often planted on raispd

n 1 70 The I^cxt,] MR. WARRINGTON HAWARD ON TKANfeFtJSIOft'.'_[Aran. 16,18*7.

mounds of earth, and surrounded by high close walls or
palings, from a foolish ambition of seeming to live “ quite
in the country.” This is a most unwise proceeding from a
sanitary" point of view, and should be protested against as
strongly by medical men as defective drainage and bad
water-supply. Many houses stand under the very drip and
shadow of trees, and “the grounds” of others are enclosed
by dense belts of trees and shrubs, which convert them into
veritable reservoirs of damp, stagnant air, often loaded with
the effluvia of decaying leaves and other garden refuse, a
condition of atmosphere very injurious to health, and
answerable for much of the neuralgias of a malarious kind,
of which we have heard so much lately. A very slight belt
of trees suffices to obstruct the.lateraLcirculation of the air,
and if the sun be also excluded the natural upward currents
are also prevented.. M far back as 1695 Lancisi recognised
the influence of slight belts'of trfeesin preventing the spread
of malaria, in Rome; pad the cold, damp, stagnant air of
spaces enclosed by trees is easily demonstrated by the wet
and dry bulb thermometer, or even by the ordinary sensa¬
tions of the body. A dry garden, on gravel, of three acres in
extent in Surrey, surrounded by trees, is generally three or
four degrees colder than the open common beyond the trees;
and a large pond in a pine wood twenty miles from London
afforded Bkating for ninety conseoutive days in the winter
of 1885-6, while during the greater part of the time the
lakes in the London parks were free from ice.

The speculative builder has more sins to answer tor than
the faulty construction of houses. He generally begins his
operations by cutting down all the fine old trees which
occupy the ground, and which from their size and isolation
are more beautiful than young ones and are little likely to
be injurious to health, and ends them by raising mounds
and sticking into them dense belts of quick-growing trees
like poplars to hide as speedily as possible the desolation of
'bricRS and mortar he has cheated. It is this senseless out¬
door work of the builder and his nurseryman which stands
most in need of revision from time to time in suburban
residences, but which rarely receives it from a silly notion,
amounting to tree worship, which prohibits the cntting
down of trees, no matter how injudicious may have been the
planting of them in the first instance from a sanitary or
picturesque point of view.

The following hints for planting and removing trees may
be useful to those persons who have given little attention
to the subject. A tree should not stand so near a house
that, if it were to fall, it would fall on the house; or in
other words, the root should be as far from the bouse as the
height of the tree. Belts of trees may be planted on the
north and east aspects of houses, but on the east side the
trees should not be so near, nor so high, as to keep the
morning sun from the bedroom windows in the shorter
days of the year. On the south and west aspects of houses
isolated trees only should he permitted, so that there may
be free access of the sunshine and the west winds to the
house and grounds. High walls and palings on these aspects
ire also objectionable, and should be replaced by fences, or
better still open palings, especially about bouses which are
Occupied during the fall of the leaf, and in the winter. Trees
for planting near houses should be chosen in the following
orderConifers, birch, acacia, beech, oak, elm lime, and
poplar. Pine trees are the best of all trees for this purpose,
as they collect the greatest amount of rainfall and permit
the freest evaporation from the ground, while their branch¬
less stems offer the least resistance to the lateral circulation
of the air. Acacias, oaks, and birches are late to burst into
leaf, and therefore allow the ground to be warmed by the
sun’s rays in the early spring. The elm, lime, and chestnut
are the least desirable kinds of trees to plant near houses,
although they are the most common. They come into leaf
early and cast their leaves early, so that they exclude the
. spring son and do not afford much shade in the hot autumn
months, when it is most required. The lime and the elm are,
however, beautiful trees, and will doubtless on this account
, often be tolerated nearer houses than is desirable from a
purely sanitary point of view.

Trees ate often useful guides to the selection of resi¬
dences. Numerous trees with rich foliage and a rank under¬
growth of ferns or moss indicate a damp, stagnant atmo¬
sphere ; While abundance of flowers and fruit imply a dry
MittljV ClllftttMi Children "Will be healthiest where most
old people will live longest where our
'*■“*•* ^"pen best, as these conditions of vegetation
i which is least favourable to bronchitis

and rheumatism. Pines and their companions, the birches,
indicate a dry,rocky, sandy or gravel soil; beeches, a dryish,
chalky, or gravel soil; elms and limes, a rich and some¬
what damp soil; oaks and ashes, a heavy clay soil; and
poplars and willows, a low, damp, or marshy soil. Many
of these trees are found growing together, and it is only
when one species predominates in number and vigour
that it is truly characteristic of the soil and that portion
of the atmosphere in connexion with it.

Curnm-street, Mayfair, TV. _

A CASE OF TRANSFUSION.

By WARRINGTON HAWARD, F.R.0.S, Eic«,

BURG HON TO ST. GEOBOK'S HOSPITAL.

As the operation of transfusion is not a very common one,
and as there are several methods of performing it, it maybe
worth while to relate an instance in which the method
recently introduced by Mr. Annandale was used with good
effect.

A boy, fourteen years of age, who had been in St. George's
Hospital under my care for two months, with periostitis of
the femur and chronic pytemis, had suddenly a profuse
haemorrhage into the cavity of a large deeply seated periosteal
abscess of the ttalgb. The abscess bad been opened and a
drainage-tube passed through it a week before. When seen by
the house-surgeon the boy was very much blanched,and had
lost a large quantity of blood. The haemorrhage was controlled
by pi uggui g the cavity and bandaging the limb. Thefollowiag
day Some more bleeding occurred, in spite of the bandaging,
and when I saw him blood was oozing freely through- the
dressings, and the boy was in a state of collapse. The abscess
cavity extended round a great part of the femnr, and from
the inner side of the thigh a little above the knee to the outer
side neaT the great trochanter. It« as therefore too large and
deeply seated to lay open, and the boy’s condition seemed to
forbid the possiffility of surviving an amputation. I therefore
only enlarged the lower opening sufficiently to give access
to the fingers, and thin firmly packed the entire cavity with
cartelised gauze, plaoed a pad over the femoral artery, and
bandaged the limb firmly from the toe to the groin. But
when this was done the boy seemed to be sinking. It waa
therefore decided to transfuse into him some of bin
father’s blood. This I did, with the assistance of Mr.
Dent, in accordance with Mr. Annandale’s directions.
A vein at the bend of the boy’s elbow having been exposed
by a short incision over it, a double catgut ligature waa
passed beneath it, and the loop of the ligature divided. The
lower or distal ligature was then tied round the vein. The
vein was next opened, and a glass tube or nozzle, having
one end bevelled, and the other attached to a short piece of
indiarubber tube, waa inserted into the vein. The upper er
proximal ligature was now tied in a single knot round the
vein and nozzle. In the meantime, the boy’s father wm
bled from the afm into a glass measure containing a freshly
prepared solution consisting of forty : eight grains of phos¬
phate of soda in two ounces of distilled water—i.e., a
solution of the strength of 1 in 20. Six ounces of blood were
received into the vessel, so that the mixture consisted of
three parts blood to one part of the saline solution. This
was constantly stirred with a glass rod and kept at a tem¬
perature of about 100° F. by surrounding it with hot water.
A three-ounce glass syringe, previously washed out with the
soda solution, was now filled with the mixture of blood and
solution, and its nozzle being inserted into the indiarubber
tube connected with the cannula in the vein, its contents
were slowly injected. Nearly three syringefuls were th«s
injected (eight ounces of the mixture). The eannula was
then withdrawn from the vein, the ligature tightened
and secured, and the skin wound stitched together with
catgut The syringe while being used was kept surrounded
by hot flannels, and all the apparatus was washed in dis¬
tilled water before commencing the operation.

The effect was striking and immediate. The pulse, which
before the transfusion was imperceptible, could again be felt
in the temporal arteiy; the boy regained consciousness
and was awe to speak and swallow; and from this time
be steadily improved. The transfusion took place on
February lOtb, and daring the two months which have since
elapsed he has had no more hmmorrhage.

The operation is an extremely simple on, pn i is a era ato n»

Digitized by

7 H 1 The Lancet,]

CLINICAL NOTES.

[Afbil 16,1887.

Resection of ankle, with amputation if necessary, was
proposed to and accepted by the parents. An incision was
made over the sinus and the spongy periosteum raised from
the bone; the sinus was then seen as a rounded hole leading
into the end of the tibia; cutting forceps rapidly enlarged
the aperture, and a small central necrosis surrounded by a
dense caseous material was found in the end of the bone and
removed. Incision was then prolonged along the inner side
of the foot. The ankle-joint was dislocated outwards,
cleaned, and examined. The cartilage of the tibial articula¬
tion lay loose in the cavity of the joint like a thin piece of
orange-peel, and the astragalus itself was bare. The
synovial membrane was everywhere transformed into the
spongy, pink, gelatinous material characteristic of a tuber¬
cular joint. With a Volkmann’s spoon, and here and there
with a scalpel and forceps, this diseased structure was care¬
fully removed. Finding the joint so distinctly tubercular,
I re-examined the tibial wound and found more caseous
material present in the medullary canal. I took a long-
handled Volkmann’s spoon and scraped away as much of tne
medulla up to the tibial tubercle as I could remove. The
inside of the bone was then plugged with strips of iodoform
gauze, and the foot brought into a rectangular position and
there fixed by means of an appropriate splint. The wound
was dressed with iodoform and wood-wool. The result ex¬
ceeded my expectations: the medullary canal filled up with
rapidity, the wound into the ankle-joint healed in two
months, and the child was discharged with a gum-and-chalk
casing. She is at the present time in apparently good
health. She limps slightly, but this is due to a shortening
which exists, the left leg having grown slightly longer than
the right. The right tibia is thicker than the left one, and,
curiously enough, there is some movement in the right
ankle-joint, such as obtains in fibrous ankylosis. She wears
an iron on that leg, to limit if possible the tendency to
knock-knee on that side—a condition obviously induced by
the difference in the length of the legs.

This case is a teaching one as regards the tolerance of the
medulla. One is so taught to regard it as being highly
resentful of interference that it has hitherto been treated
with marked respect. Tho cases, however, in which the
medulla has been scraped show that good results have been
obtained; and there is no doubt that much conservative
surgery will be the direct outcome of the knowledge now
accumulating as to its physiological uses, pathological ten¬
dencies, and the amount of operative interference it will
submit to. __

A CASE OF PURPURA RHEUMATICA.

By G. Childs Macdonald, M.D.

Thb following case has recently occurred in my prac¬
tice.

J. B-, aged twenty-nine, a blacksmith, married. Per¬

sonal history satisfactory; does not remember ever having
been ill, excepting cold, &c. Both father and mother alive
and in good health; four sisters alive and healthy;' one
brother dead. The patient does not know the cause of
his illness, but believes it to be due to some childhood
complaint. He had not been feeling wall far the last
week, having suffered from beadadhe and sharp shooting
pains in the back and down the legs; he describes them
as rheumatic in nature, so much so that his friends were
afraid he was going to have an attack of acute rheu¬
matism. Accompanying these pains was a sensation of
cold, amounting occasionally to actual Shivers; during this
period he was extremely thirsty. The bowels were oonsti-

E ated, and sleep was restless aha broken. No beer or spirits
ad been taken, excepting a small amount of brandy when
the shivers came on; neither dM he have any drugs or
particular article of food. At 12.30 p.m. on March 4th he
was taken with violent pain and stiffness in both popliteal
regions, which became so agonising that he was unable to
remain longer at work, and returned home, where, feeling
very cold.be sat by the fire, the pain varyfagih amount,
being sometimes better and sometimes worse, until 8 P.m.,
when he determined on going to bed; • he had difficulty in
cfiMta# 1 Upetairs, the legs feeling stiff and heavy./
tia. the edge of the bed previously to
e whole of the pain went as If

had become blood-red, and being naturally alarmed he imme¬
diately sought medical assistance. The patient is a well-
developed man. Height 5 ft. 8 in.; weight 10 st. H>lb. Skin
somewhat pallid, but feels soft and moist. Pulse 82, quick,
full, and hard; temperature beneath tongue 101°; tongue
moist and clean. On the back of both tnighs, extending
from the gluteal folds downwards over the calves of the
legs to about the middle, running to the inner surface
of the thighs to the middle line in front, and on the lege
to the cnsta of the tibise, is a red rash, most intense
over the popliteal spaces, where it is uniform and some¬
what raised; the rash on the inner surface of the thighs is
similar in character; towards the periphery and in other
places it is almost petechial. The whole of the involved
areas of skin feel to the hand hot and dry; firm pressure
has no effect on the colour, and it is unaccompanied by
itching. The digestive, circulatory, respiratory, and genito¬
urinary systems are normal. Urine clear amber colour;
reaction acid ; specific gravity 1020; no albumen; no sugar.
The patient was ordered a saline mixture, with three-minim
doses of tincture of aconite in each dose, a ten-grain pill of
colocynth with calomel at bedtime, and a milk diet.—
March 5th: Has much improved; bowels relieved three
times. Pulse 72; temperature 984°. ; There is no further
extension of rash, whioh has become duskier in hue; no pain.
Ordered a mixture of dilute sulphuric acid, tincture of per-
cbloride of iron, and sulphate of quinine three times a day.—
7th: Patient feels quite well. The eruption has entirely
disappeared. Ordered to continue mixture for three days.
Ordinary diet.

The points of interest in this case are the violence of
the pain, its rheumatic nature, its sudden cessation, its-
complete symmetrical arrangement, and the rapid recovery,
which is usually prolonged in these cases. Dr. Kinnicutt
of New York has recorded similar cases in the Archives
of Dermatology, vol. i., as has also Dr. Dohring in the
Philadelphia Medical Times, 1873. ^

Ducliea*-Et., Cavendiih-»q., W.

CASE OF RHINOLITH. 1 .

By E. Cbesbwell Babeb.

N. B-, aged twelve, was admitted a patient at rile

Throat and Ear Dispensary on Dec. 16th, 1886. She had had
an offensive discharge from the left nostril for six years*,
with bleeding. There was no known cause. Neither she
Dor her mother remembered anything being put into the
nose; but when young she had a habit of swallowing cherry¬
stones. There is epiphora on the left side when she in
exposed to the wind. On examination, the left side of the-
nose and the left cheek were bulged out; the left nasal-
passage was impervious to air, the nostril on that side being
contracted and Its edges excoriated. Anterior rhinoscopy
showed, on the right, considerable deflection of the septum
towards that side; oh the left, the anterior naris blocked by
large soft granulations. Behind these, and completely
hidden from sight, the probe revealed a hard body about
an inch and a naif distant from the tip of the nose. On
Dec. 18th, with the assistance of my colleague Mr. Treves,
the patient being under chloroform, this body was removed
through the nostril with scoop and forceps. Afterwards no
roughness could he detected with a probe, and the instrument
passed easily through into the n^so-pharynx. Subsequent exa¬
mination showed that the left nasal cavity was much dilated,
allowing the naeo-pharynx to be plainly seen through it.
The inferior turbinated bone was much wasted, and pre*-
sented a deep concavity about its centre. By cleansing the
nostril and touching some remaining granulations with
solution of caustic, the discharge has now (February 28th)
almost ceased, and has entirely lost, its disagreeable odour.
No diseased bone has been detected. The left cheek still
appears larger than the other, and the malar bone more
prominent on that side, the inequality being apparently
produced by the long sojourn of the nasal caloulus. The
ri^inolith was mure or less filbert-shaped, and had, as usual,
‘ E^nd laammillated surface. When dry it measured
18x13x8 millimetres and weighed nine
tion it. was found to consist of tigh

oi,

Tjtr Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[April 16,1887,.

packed folds of ordinary rag, on to which the salts of the
nasal secretion had become deposited.

Rhinoliths, which in spite of increased attention being
directed to nasal subjects are still considered uncommon,
usually have their origin, as in this case, in a foreign body
introduced into the nose. The case just mentioned is, how¬
ever, peculiar in the nature of the nucleus, and in the circum¬
stance of such a soft body as a plug of rag having by the
deposit which had taken place upon it produced no incon¬
siderable distortion of the neighbouring bones.

Brighton. _ •

NOTES OP A CASE OP POISONING BY TARTAR
EMETIC.

By S. L. Dobie,

SURGEON-MAJOR, 4TH MADRAS CAVALRY.

On Jan. 6th, 1887, H. P-, male, Eurasian, aged fifteen,

took by mistake about sixty grains of tartar emetic instead
of Epsom salts. In ten minutes he broke ont into a cold
sweat and vomited. He was seen within a quarter of an
hour of taking the poison. Vomiting was encouraged, and
he was given tea, infusion of galls^ gruel, and a small
quantity of brandy daring the day. Vomiting continued
freely all day, and at night he was purged three times; was
conscious the whole time.—7th: Vomiting continued;
purging ceased; had milk and gruel; remained sensible.—
8th: No vomiting or purging; doing well.—9th: About
11 a.m. he became feverish, then delirious. Had an enema,
which acted; mustard and hot water to feet; mustard
poultices to calves and nape of neck.—10th: Comatose;
pupils widely dilated. Ordered enema of turpentine, which
acted; six leeches to temples; counter-irritation to scalp,
feet, and calves; blister to nape of neck.—On the 11th 1 was
oniered into camp, and saw no more of the youth after the
evening of Jan 10th. He remained comatose, was fed with
spoonfuls of milk, and died at 2 a.m. on Jan. 12th, nearly
six whole days after taking the poison.

The curious features in this case are that the patient lost
the ordinary symptoms of antimony poisoning, seemed to be
recovering on the third day, became delirious on the fourth
day, and died comatose on the twelfth day.

KAmptee, India.

% Iftirrar

or

HOSPITAL P PACT ICE,

BRITISH AND FOREIGN.

Nulla autem eat alia pro oerto nosoendl via, nisi quamplurifnas et mor-
borum et diasecttonum hlstotiiu, tutn altorum turn proprfaa colleetaa
hSbere, et inter ta oomparare.— Morgagni Da Sad. at Com. Mori.,
lib. lv. PnxBmium. -

GUY’S HOSPITAL.

SARCOMA OP THU FEMUR.—DEATH FOLLOWING NECROSIS OF
< THE LOWER JAW.

(Under the care of Mr. Bryant.)

In the case here recorded of sarcoma of the femur, the
following points are chiefly of interest: the development
of the disease after direct Injury to the parti its malignancy,
and extension to the interior of the knee-joint. Growth
along the crucial ligaments would appear.to be the usual
mode of invasion of this joint, but the .condition is rare;
audit is easy to undereband the increased difficulty expe¬
rienced in diagnosis from primary joint disease. The second
is interesting from the extent of the disease, for which
np cause could be found, and the fatal result.

. L Sarcoma of the femur, nreadintj from an aperture
•afA* bone to the periosteum and /cnee-joint ; amputation of
recurrence .. (From notes py Messrs. Bowes and A.
“almar).—C. P—, aged fpurteen, a. butcher's boy, was
admitted on Sept. 16th, 1884. Three months ago he slipped
duva and knocked his knee. Slight pain was felt in the
for* day or two; there was no swelling... About a week
"wvMiAfeaabgivww jumping over a hedge he again fell and

knocked the same knee, which became painful and swollen;
hot fomentations were applied. He consulted a doctor, who
applied tincture of iodine and advised him to go to the
Hertford West Infirmary, where he remained three weeks.
Whilst there his knee was blistered. He was not confined
to bed. The patient says the swelling began on the outer
side of the knee and gradually involved the whole of the.
joint; it had been getting larger for the last three weeks,
and was only painful at night, and then only at the back of
the thigh.

On admission there was & large swelling over the right knee,
involving the whole of the joint, most prominent on the outer
side, where the swelling first began. There was no fl actuation,
The popliteal space was very tense and tender, the tender¬
ness extending along the flexor tendons up the thigh. The
patella was quite superficial and movable, but did not
float, showing that the trouble was in the joint itself. No
glandular enlargement was perceptible in any part of the
body, with the exception of one or two hard glands in the
right groin. The knee was bent at an angle of 120°; it
permitted of very little movement. There was also some
thickening of the lower end of the right femur.

Sept. 16th.—Leiter’s cold coil applied to the knee. The
urine contains triple phosphates, but is otherwise normal, i

18th.— The patient had much pain in the popliteal space
last night, also in the back of the thigh. The front of the
joint is tender. Appetite poor.

19th.—Chloroform having been administered, an explora¬
tory incision was made near the outer condyle, and as a
growth was found to exist the limb was amputated by
anterior and posterior flaps. The muscles were found
to be cedematous, especially in the posterior flaps, and
a piece was removed. Silt sutures were applied, the
stump was dressed with iodoform gauze, a back splint put
on, a large drainage-tube introduced, and strapping applied
between the sutures. On making an an ter o-posterior longi¬
tudinal section of the lower end of the femur and upper end
of the tibia, the femur was found to be surrounded by a
mass of new growth connected with the periosteum, and
excavating the bone so that there was only a layer of
bone about half an inch thick anteriorly in the lower
end of the femur, the articular cartilage and bone repre¬
senting the condyle to the extent of about one inch; all
this was infiltrated with the growth. The bone was fractured
immediately above the articular cartilage, and again three
inches higher up, during the process of section. The posterior
aspect of the femur three inches above the articular cartilage
was entirely gone, hollowing out the substance of the bone,
and forming a cavity filled with blood-clot and breaking- s
down growth. Projecting into the cavity was a spicule f
of bone about an inch and a half long, eroded, and con¬
tinuous with the compact tissue of the bone-shaft on the
posterior aspect. The tibia and patella were normal. In the,;
joint ware masses of growth, apparently coming through the
capsule on the outer aide, and passing forwards, on the oqe j
hand, over the outer condyle of the femur, and, on the other, ,<
to the outer margin of the articular cartilage of the patella;
in both cases it could be raised off the articular cartilage,
which did not seem to be affected by it; the growth also ,
extended into the joint from the popliteal space, and here
had run along the crucial ligaments, and apparently more
or less destroyed them. The growth itself was a firm, opaque,,,,
whitish mass, with (especially along the anterior part of the
bone) hard, radiating masses, which were doubtless points of.j
ossification, feeling rough when scratched with a scalpel.
What was left of the quadriceps muscle had a pale and more^
or less gelatinous appearance, aqd was very cedematous^j
Above the upper fracture the periosteum could be stripped} 0
off the bone, and appeared fairly heaUhr; but opposite to v
and below the fracture were fungating ktasaea of growth ,
which were fairly adherent to the undenyingbone, and which >
on removal left it irregular and rough. .The disease wa8[.
clearly xMr sarcomatous nature. Wf ,.. ; ,' ((l

SOth The patient passed & good night, with little or no -
pain, pp|b iays,there is some throbbing of fchelimb. Evening,,,

2ith*^The patient is goib'ff on wait; *' vqry 'littie pa&L|?
There are three or four glands in the groin, which seem to
nave got larger since the. operation. Temperature 99-°, j
Sleeps well ; fair appetite; no cough., Jamb .dressed, yester-,*,
day; there is a good free drainage, and the di#coWge.(wh]cl) 7 /
is very slight) is quite sweet.' ’ v'ti ’ ii/.li

29th.—Stump dressed to-dajy; all the stitches tsfren oub;
limb looks well; drainage quite free, and.qhly t^out three

oogle

774 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Aran. 16,1887.

tenspoonfuls of sweet discharge. A tonic containing iron
and an occasional aperient were ordered.

Oct. 6th.—The stump is practically healed.

■17th.—'The stump is looking well, and the patient is up on
crutches.

Not. 2nd.—The patient slipped down in the ward yester¬
day, and hurt the stump a little.

28th.—Much fulness about the stump, and on the anterior
part a hard roundish mass can be felt, but there is no
tenderness. Circumference eleven inches.

December 12th.—Has complained of pricking pains in the
stump for the last two or three days, and has been kept in
bed.

15th.—Stump measured this morning: in circumference
at ends of cicatrix 12$ in., and in. in length from anterior
superior iliac spinous process to end of stump. It is 6oft to
the touch; tenderness only just behind external extremity
of cicatrix.

25th.—The patient was sent to-day to Bognor Convalescent
Home. He is afraid to use his artificial leg, as, after
wearing it for two days, it caused a little inflammation in
the glands of the groin, from pressure of the iron hoop
round the top of the thigh.

February 23rd, 1885.—The patient was readmitted to-day,
having fallen down whilst at Bognor. He has had great
pain in the stump since. On examination there is a hard
swelling, which seems like a nodular thickening of the
end of the femur. No discolouration of skin or fluctuation
can be felt. There is great tenderness of the stump.

March 9th.—The patient was discharged to-day. Stump
swollen, and tender on moving it. The growth has recurred
and the glands are also enlarged, so that any further opera¬
tion would be useless. The stump on discharge was dis¬
tended, firm, and tender, but neither the skin nor cicatrix had
given way. The skin was normal in colour, but the veins
were larger and well marked. On palpation in the loin
some enlargement of the glands can be felt. The boy’s spirits
are excellent, his appetite is good, and there are no signs of
secondary deposit in the chest.

Case 2. Necrosis of the lower jcno: death: necropsy. (From

notes taken by Messrs. Elliot and D. Jones).—M. H-,

a woman agbd forty-two, Was admitted on Oct. 12th, 1885.
With the exception of erysipelas of the face, which occurred
twelve months ago, and congestion of the lungs, which she
had five years ago, her general health has been good. On
the 20th of June last the patient complained of cold, and
her gums commenced to swell almost immediately; also
the salivary glands under the tongue began to swell, until
at the end of three weeks they had pushed the tongue up.
During this time throughout the whole day she expe¬
rienced a great secretion of ordinary saliva, which how¬
ever, had a strong odour. Every morning when she got up
her hands felt very cold and looked pale. They, however,
assumed a better appearance as the day advanced. In three
week-.’ time the gums commenced to swell and the teeth to
loosen. In four weeks’ time the swelling in the submaxillary
region commenced, and had gone on increasing. About this
time her medical man was called in, who said that it was a
case of necrosis of the jaw. He prescribed a strong tonic
and -a disinfecting gargle for her, and in a week’s time the
enlargement in tne salivary glands subsided. No history
was obtainable with regard to syphilis, mercury, phosphorus,
injury, or carious teeth. She had not taken any medicine
before her illness.

On admission there was a good deal of swelling about the
maxilla, the skin feeling brawny and being of a dusky colour.
On either side of the symphysis, below the inferior border
of the bone, were two sinuses leading down to the bone,
which did not appear to be quite bare, but was thinly
covered with something soft. These sinuses discharged a
fair amount of fetid pus. There was much tenderness about
the jaw, and also great fixity, the patient not being able to
open it more than an inch. She could not protrude her
tongue. The teeth in the lower jaw were all loose, and the
gums of both jaws and the mucous membrane over the hard
palate were swollen and spongy, so as to overlap the teeth.
Her breath was very fetid.

Oct. 15th: The two sinuses are distant respectively an
inch and half an inch from the middle line. Bare bone
was felt on probing. Ordered boracic acid and spirit gargle,
with aperients, ana to take fluid nourishment.

16tb.—Temperature 103-2°.

•18th.—Morning temperature 101-4°; evening 101-6°.
22nd.—During the last three days a large sinus has formed

ou the right submaxillary region, which leads down to
bare bone. Four teeth were extracted.

25th.—Temperature last night and this morning 102 4°.

30th. - Patient was very weak, and seemed semi-comatoee.
She could only open her mouth slightly, and the dresser
could not make out what she tried to say. Her face was
dusky, although the pupils were not Unduly dilated. Had
a startled expression when spoken to or touched. She takes
all nourishment given her. Pulse very small, rapid, and
weak. Respiration laboured (through nares), 46. She
passes everything beneath her. Temperature 102 4°. Right
submaxillary region presented an intensely fetid, oval,
phagedenic ulcer, about three-eighths of an inch deep,
three inches and a quarter before backwards, and two inches
above downwards, extending from the middle line to about
a quarter of an inch behind the anterior border of the
masseter, the skin over which was dragged down in small
vertical wrinkles; its edges were slightly everted, and not
red. The base presented a large grey-black mass of shreds,
not coming away easily. The attempt to remove what
appeared the loosest shreds caused great pain. Superiorly
the ulcer had extended just over the interior margin of the
mandible, which was exposed and eroded; and posteriorly
it had passed over the facial vessels; but as yet there was
no hfemorrhage. In the base of the ulcer were some
rounded pits, but it could not be seen whether they com¬
municated with the buccal cavity; on holding a mirror
over them, at the same time preventing escape of air through
the nares, there was no sign of air coming through them.
Discharge fetid and copious.

31st.—The patient had an injection last night; she slept
well. She still takes a good deal of nourishment, but is
much weaker than yesterday. The wound has been dressed
twice each day with boracic acid and iodoform, but the
wound is very fetid. Temperature 102 6°. The patient
passed into an unconscious condition and died quietly.

Necropsy (conducted by Dr. Goodhart).—A partial exa¬
mination only was permitted. On opening the mouth
widely the hypertrophied condition of the gums was very
marked. In the upper jaw it formed a thick ridge just
within the row of teeth, giving the appearance of a second
row. The anterior edges of the gums also overlapped the
teeth very extensively. On examining the wound, a large
piece of the lower jaw (right side) was seen to be necrosed ;
this was removed, carrying with it a few loose teeth and
the altered gum tissue. It was found that there was a
large piece of the lower jaw quite loose in the mouth ; this
was also removed, and proved to be the inner surface of the
horizontal ramus of the lower jaw, as it formed a complete
cast of its dental arch. The muscles beneath tho tongue and
soft parts forming the floor of the mouth were eloughing.
The lungs were not examined, but the patient probably died
Of septic pneumonia. A section of the hypertrophied gum
had tne appearance of inflammatory tissue. .

LEEDS GENERAL INFIRMARY.

Compound fracture op the skull; trephining; spasm

OF MUSCLES OF FACE AND ARM ; SECOND TREPHINING
OVER THE FI88URE OF ROLANDO; RECOVERY.

(Under the care of Mr. M*Gill.)

For the notes of the following case we are indebted to
Mr. J. Holt, house-surgeon: —

J. T. S-, aged thirteen, was admitted on February 9th,

1887, with a compound fracture of the skull. Shortly
before admission be fell twenty-three feet on to his head;
he does not remember receiving tbe blow, and was uncon¬
scious for a few minutes after the accident, but soon
recovered his senses.

Condition on admission. —The patient is quite conscious,
talks sensibly, and answers questions intelligently. There
are no cerebral symptoms or constitutional disturbance.
There is a compound fracture of the left side of the vertex
of the skull, the skin wound being one-third of an ineh in
length. This is situated near the parietal eminence, and
can be marked out exactly as follows: Take a point one inch
and a half behind tbe centre of a line draws from the
root of the nose to the external occipital protuberance;
from this point draw a line vertically downwards to the
level of the upper border of the pinna of tbe ear; the centre
of this last-named line corresponds with the position of tbe
wound. Through the wound a depression can be felt in the

Tith Lancbt,]

ROYAL MEDICAL AND OHIRURGICAL SOCIETY.

[Aran, 16,1887. 775

skull, and there is a small escape of brain substance. In
the absence of symptoms it was determined not to trephine,
but to dress the case antiseptically. This was accordingly
done, the scalp being shared, the wound and surrounding
skin being irrigated with corrosire sublimate solution, and
an antiseptic dressing applied.

Peb. 10th.—The patient has passed a quiet night. The
pupils of both eyes are dilated, the right more so than the
left; the right pupil does not respond to light. He is very
drowsy, is roused with difficulty, but when roused seems
quite sensible, in the evening it was determined to operate.
The boy being placed under ether, the dressings were re¬
moved. The scalp felt soft and infiltrated for a couple of
inches in all directions round the wound. Mr. M’Gill made
a large crucial incision, leaving the original wound at its
centre. From this point a fracture was seen extending
upwards towards the vertex, and another backwards
towards the occiput; both these fissures passed out of the
region exposed by the reflexion of the scalp; at the junction
of the two the skull was comminuted, these portions being
depressed below the general level. Two of these, irregular
in shape and one inch and three-quarters of an inch aocroes
in their longest diameter, were removed, while the third
whs elevated. A small opening in the dura mater, through
which brain substance was protruding, was seen. The edges
of the skin wound were brought together by a few points
of suture, small drainage-tubes being inserted in each of ite
four extremities. "

11th.—Still drowsy. 8Iight facial palsy on the right side
was noticed In the evening.

During the next two days there was not much change, the
general drowsy condition was slightly improved, and the
facial paralysis, though still slight, became more marked.

14th.—In the morning the right arm seemed weaker than
the left, otherwise the condition is unaltered. The wound
on the scalp looks healthy; there is no further protrusion of
brain substance. At 7 p.u. the muscles on the right side of
the face were attacked by donie spasm, and daring the night
till 9 o’clock the next morning he had fifteen attacks of a
similar character. All the muscles on the right side of the
face were in a state of clonic spasm, the contractions num¬
bering about 40 per minute; drawing up of the angle of tbe
mouth and closing of the eye were particularly marked ; on
one occasion the patient bit his tongue. His head was
twitched to the right side, the contractions of the piatysma
being clearly visible. The attacks last from three to five
minutes; between them he sleeps, but seems to know when
the fits are coming on, as be pate his handkerchief into his
mouth to protect his tongue. In the second and third
attacks the right arm was slightly affected, and in the
seventh, at 3.45 a.m., the arm muscles were violently con¬
vulsed, and the leg also slightly implicated. After that time
the spasms-in the arm were as violent as those in the face,
the whole limb being attacked, and the fingers, wrist',
end elbow being alternately flexed and extended. Nothing
farther was noticed in tbe leg; its reflexes, superficial and
deep, were normal. The optic discs were also in a normal
condition.

15th.—At 9 a.m. there was a more prolonged attack, the
right face, neck, arm, and forearm being violently convulsed.
After this the patient Seemed much exhausted. Mr. M'Giil
determined to trephine at once over tbe lower end of the
fissure of Rolando. Chloroform was administered, and a
Urge flap, three inches across at the base and two inches and
s half deep, was turned downwards, the anterior part of the
former incision being utilised for the purpose. This flap,
whieh molUded the upper part of the temporal muscle,
having been reflected, the pericranium over the upper part
of the temporal fossa was turned down, and a trephine one
faoh in diameter was applied a little in front of the centre
Of the lower autero-panetal area of Turner. The circular
portion of bone was removed, and the dura mater, in which
a Urge branch of the meningeal artery was visible, was
ttpoeed. This Was next divided along-the upper margin of
the opening and a flap turned downwards, the artery in it
oemg tied. There was slight hemorrhage ftrcrm the brain
•hwftance, which was arrested by sponge pressure. Nothing
abnormal having been found, the dure mater was replaced
*ud held in position by two flue catgut sutures; a small
was inserted between it and the brain sub-
•Uhoe. The pericranium was next stitched up by another
«f sutures; and, lastly, tbe sktn flap was held in position
■ysfawttitdNes, two drainage-tube* being placed at the
mo * t dependent angles of the wound. The operation was

concluded at 11 a.m. At 1.60 p.m , the effect of the chloro¬
form having passed off, he was convulsed as before in the
face, neck, and arm. In the next twelve hours there were
sixteen similar attacks. Then there was an interval, no fit
occurring between 1;20 a.m. and 7.30 a.m. on the 16th. Till
7.15 p.m. there were eight attacks; the last one was of great
severity, with increased frequency of tbe muscular contrac¬
tions (120 per minute), and lasted for forty-five minutes.
After this there were only four more fits, of gradually
diminishing intensity, the last being at 2.50 a.m. on
the 176b.

19th.—Wounds dressed and drainage-tubes removed; they
look healthy and are healed in their deeperparts. The para¬
lysis both of face and arm is much less marked. Two days
later (Feb. 21st) tbe paralysis bad almost entire] y disappeared.
From this date there is nothing special to remark; bis con¬
valescence Was rapid, and on March ‘22nd he left the hospital
with the woands entirely healed and apparently in perfect
health.

Remarks by Mr. M'Gill.— 1. No operation was performed
when the patient was admitted, there being no cerebral sym¬
ptoms. This, though perhaps hardly orthodox, appears to
be a reasonable proceeding. Few surgeons would operate for
a simple depressed fracture of the skull without symptoms,
and as by means of antiseptics the compound can be con¬
verted into what ie practically a simple fracture, the same
rale should apply. Apart from theory, experience proves
that many cases of depressed compound fracture of the
skull treated without operation make rapid and permanent
recoveries. 2. How far the trephraings in this case in¬
fluenced tbe result it is difficult to determine. It is possible
that the operation and the arrest of the fits did not stand
to one another in the relation of cause and effect. On the
other hand, though no lesion was found, it is possible that
some change of cortex existed at a short distance from the
trephine opening, and tbat the relief of tension dne to the
operation was the cause of the favourable result. -

ririod Societies.

ROYAL MEDICAL & OHIRURGICAL SOCIETY.

Abdominal and Thoracic Aneurysms treated by the intro¬
duction of Steel Wire into the Sac.

An ordinary meeting of this Society was held on Tuesday
last, Mr. G. D. Pollock, F.R.C.S., President, in the chair.

Dr. J. J. Pbinglb contributed a paper on a case of
Aneurysm of the Abdominal Aorta treated by Laparotomy
and the introduction of Steel Wire into the Sac. The
patient was a man, aged forty-six, admitted to the Middle¬
sex Hospital with the symptoms of aneurysm arising from
tbe upper part of the abdominal aorta; there was no appre¬
ciable sign of cardiac or general arterial disease. Treatment
for a month by rest, appropriate diet, morphia, and fun
doses of iodide and bromide of potassium was futile, the
increase of tbe aneurysm being evidenced by aggravation
of pain, extension of pulsation, and the development of a
diastolic in addition'to the systolic bruit previously pre¬
sent. The operation described was performed by Mr. Henry
Morris, full details being given in tbe paper. The prin¬
cipal difficulties encountered were: (1) the introduction of
the wire, which was colled on a roller, into the cannula,
necessarily held deep in the abdomen; and (2) the adjust¬
ment of the cannula between the outward foroe of the pulsa¬
tion and the inward force of pressing the wire into tbe sac.
Only about a foot of wire was introduced before an insur¬
mountable kink stopped its further progress. No haemor¬
rhage of importance complicated the operation. For two
days the patient progressed satisfactorily, but he subsequently
became almost maniacal, and died of asthenia five days after
the operation, his highest recorded temperature being
100^° F. At tbe necropsy both sides of the neart were dis¬
tended by mixed clot; there was no peritonitis beyond a
narrow line of adhesion between tbe operation-wound in
the parietal peritoneum and the subjacent viscera. Hie
aneurysm was found to arise from the aorta at the level of
the cceliac axis, and to be very saccular and filled with dot,
more than one-third of which was laminated and presumably
due to the procedure adopted. Tbe remarks touch briefly
upon the significance of the dkwtoRo bruit present and Hie

, y GoOgl

775 The Lancbt,'|

ROYAL MEDICAL AND CHIRURGICAL 80CIETY.

[April 16,1887.

advisability of giving ordinary medical treatment a protracted
trial in similar cases, but refer principally to the treatment
ultimately resorted to. The statistics of proximal compression
of the aorta are analysed, and the results regarded as pro¬
bably less satisfactory than recorded experience would
appear to show, whilst the procedure is obviously in¬
applicable to the majority of aneurysms of the abdominal
aorta, which arise too near the diaphragm. The records of
distal compression are discouraging, as are those of galvcmo-
pvncture in similar cases, whilst the remarkable success
obtained by Loreta, of Bologna, by the treatment here
adopted justifies its trial. The result of that trial presents
many encouraging features. Mr. Henry Morris adds remarks
commenting upon the advantages of steel wire over fishing-
gut or horsehair, advocates in future having the wire coiled
on a reel held by the operator to enable it to be paid direct
into the cannula, and suggests for discussion the question,
“ What is the smallest quantity of the foreign body which
must needs be introduced to excite the requisite formation
of clot?”

Dr. W. V.-White and Mr. Pearce Gould communicated
a case of Sacculated Aortic Aneurysm treated by the intro¬
duction into the Sac of thirty-two feet of Steel Wire. The
patient, a powerful man aged forty-eight, had noticed a
swelling of the front of his right chest for five months
before he came under Dr. White’s care. Two months later
cough and dyspnoea on exertion supervened. On his ad¬
mission into the hospital on Nov. 20th, 1886, a prominent
swelling was found in the position of the right mamma,
extending from the second to the fifth rib, and from the
edge of the sternum to the axilla; it was the seat of a
forcible expansile pulsation, and over it was heard a harsh
systolic murmur. Above the chest anteriorly, and down to
the angle of the seapula behind, the resonance of the right
chest was much impaired, and the respiratory murmur was
distant and weak. The man was kept in bed, on a restricted
diet, and was ordered fifteen grains of iodide of potassium
three times a day. lie continued about the same until the
second week in January, 1887, when he was much excited,
and the swelling was noticed to increase rapidly in size and
to become very prominent. It was then decided to employ
Moore’s treatment, and on January 11th Mr. Pearce Gould
passed thirty-two feet of steel wire into the aneurysm
through a Southey’s cannula, introduced in the third inter¬
costal space. A good deal of blood was lost during the
operation, brit the hemorrhage was quite stopped by a pad
of lint. Tbetumour became !)order, and the pulsation more
heaving in character, and from one of the punctures (two
had been made) reddish serum continued to drain in con¬
siderable quantities for several days. Accordingly, on
January 17th the pad of lint was fastened on more firmly;
next day there was observed great swelling of the subcu¬
taneous tissue over the aneurysm, and on the 19th the skin
was found to be gangrenous, and in a few hours the patient
died. At the necropsy the first part of the arch of the aorta
was found dilated to the size of a large orange, and spring¬
ing from the upper put of this dilatation was a sacculated
aneurysm the size of a cocoa-nut. The intra-thoracic portion
of the tumour had a distinct but thin sac, but that part
which protruded from the chest was destitute ot a
definable sac, and was limited by infiltrated muscle. The
wire together with loose fibrinous dot formed a very dense
mass* nearly filling, butnotadberentto.tbesac. The authors
suggest that the fatal result was largely due to the absence
of a distinct sao to the outer part or the aneurysm, and to
the effects of the formation of a very hard solid mass in the
-aneurysm, combined with rather firm external pressure ap¬
plied for the arrest of the serous oozing. They submit the
following conclusions: 1. Moore’s treatment is worthy of
further careful trial in properly chosen cases. 2. The opera¬
tion should be performed before there is reason to suspect
rupture of. the sac. 3. Only a small quantity of wire should
be introduced at any one time. 4. No firm pressure should
be.made over the aneurysm afterwards.

. Mr. J. W.Huuee related a second case on which he had
recently operatedi • The treatment was absolutely inno¬
cuous, and perhepc slightly beneficial. The patient was a
sailor, whovteU from a height on Oct. 13tb, 1885, and three
.weeks after? the accident a swelling appeared at the root of
Aha neck ea. the-, right side. For this aneurysm he was
^seated with seme ■> suooess at St. Mam’q Hospital. On

to JOtiUwasi:.H m

-19th, he was .admitted; into

Hospital,

Qay*ey,i wto^wlth for E W t? pi s e Powell,

aortic vessels. After rest in bed and a large doee of iodide
of potassium the patient was placed under strict Tufnell
treatment from October to January, 1887, with the result
of a slight diminution in the size of the aneurysm, but
without real improvement. He left the hospital only to
return in a month, and on the same day of his read mission,
Feb. 24th, for increased pain and swelling in the aneurysm,
of which the coverings were extremely thin, Mr. Hulke intro¬
duced thirty-three feet of steel wire. There was no trouble at
the operation, and the wire was introduced through a cannula,
hand over hand. After its introduction palpation revealed
some degree of hardness of the sac. On March 1st there was in¬
creased pain and much arterial tension, which was relieved
by bleeding to the extent of five or six ounces, enabling a
good night’s rest to be obtained. The man died on the 9th
—i.e., thirteen days after the operation. The aneurysm exa¬
mined by Mr. Leopold Hudson appeared to have begun in and
been limited to the first part of the subclavian artery, and
exhibited but a small amount of clot about the wire. There
was no appearance of inflammation in the large space. In
the ft ret case already recorded he had had some diffi¬
culty from the kinking of the wire, but not in this second
case. A tubular needle furnished with a couple of wheels
for paying in the wire without touching it with the
fingers would afford much aid. A rough model of this
apparatus, devised by the surgical mechanician, was handed
round.

Mr. Howard Marsh opined that the usual length of wire
introduced was far too great.

Mr. T. Bryant said that in Mr. Morris’s case it was clear

that the aneurysm was on the way to a cure. In Mr. Hulke a
and Mr. Gould’s cases there did not appear to have been any
signs of healing: but in Mr. Gould’s case it would seem
that the large mass of wire might have been actually harm¬
ful. Still, the facts obtained by experience up to the present
were not unfavourable to the operation in itself. It was
almost impossible to determine with accuracy the size of
an aneurysm in the throat, and so it would be difficult to
say how much wire should be introduced. In the thoracic
cases, perhaps, a repetition of the introduction of wire
might be feasible ana advisable; but this could hardly be
so for abdominal aneurysms necessitating abdominal section
and where the size of the aneurysm was more definable.
The evidence seemed to show that the steel wire did barm
in Mr. Gould’s case. The use of good fishing-gut would, in
his opinion, be preferable to wire. The. point of steel wire
must be more or less injurious, and if cut off close to the
skin might become a source of irritation to the tissues.
A blunt trocar might be employed with a view to pushing
the cut end of the wire into the centre of the aneurysmal
•SSC.

Mr. T. Smith could not but be struck with the mechanical
difficulties in tbs carrying out of the operation. A hollow
jneedle, he agreed with Mr. Hulke, would be more suitable,
and he thought that such an instrument already existed in
the shape of the needle employed in cleft palate and vesico¬
vaginal fistula. The mill-edged wheel noted as an efficient
payer-in of the wire. .

Dr. Pringle, in reply, said that an objection to the em¬
ployment of galvanism in the introduction of the wire was
that the clot resulting from electrolysis is distinctly softer
than ordinary clot. He would have been glad of suggestions
ns to any other feasible operation in cases of abdominal
aneurysm, which usually encroached on the diaphragm,

Mr. Henry Morbib said that there would be much less
tendency for the wire to assume the ooil shape if a straight
needle were used, such as Mr. Smith -recommended. He
recognised the force of Mr. Bryant’s remarks, but he was
not aware till now that fishing-gut could be made to coil up.
Large quantities of wire would offer an obstacle to one very
important element in the core of the aneurysm—v*.,
retraction and contraction of the sac. fvmoj*

Dr. Henry White said that the aneurysm proved not to fie
so large as it appeared daring life, and doubtless this was one
reason why so much wire was introduced. ,• ■ a.- »di

Mr. Pearce Gould, in reply, said that Mr. Moore*m first
performing this operation, appears to have used a blunt
trochr to thrust the end of the wire into the centre of the
sac. The needle of Mr. Hulke or of Mr. Smith would leave
the end of the wire out in the subcutaneous tissues. In
future cases he would not use anything approaching the
quantity of Wire employed in previous cases. He shared
Mr. Bryant’s opinion that the evidence was againBt the
empinjmentof steel wire. • .r.r, :i!j; * mox

Thb Lancbt,] _PATHOLOGICAL SOCIETY OP LONDON. [Aphil 16,1887. 777

PATHOLOGICAL SOCIETY OF LONDON.

Alveolar Ulceration in a Child with General Tuberculosis .—
Hypertrophic Goitre, with Secondary Tumours in Bones
of Skull—Tumour of Pineal Gland.—Chronic Inflamma¬
tory Disease of Uterine Appendages.—Meningeal Cerebral
Hcemorrhage, with Secondary Degeneration of Spinal
Cord.

An ordinary meeting of this Society was held on the 5th
inet.. Sir James Paget, Bart., FJR.S., President, in the chair.

Mr. Jonathan Hutchinson, jun., showed some speci¬
mens of Alveolar Ulceration and General Tuberculosis,
obtained from a child aged two years, who died while under
the care of Dr. Stephen Mackenzie. When twelve months
old she had had measles, and subsequently became cachectic,
and for a considerable time had suffered from ulcerative
stomatitis, or “putrid sore mouth,” which had caused
several of the lower teeth to fall out and had invaded the
lower lip. At the necropsy the peritoneum and abdominal
viscera, especially the liver, were found to be the seat of
miliary tuberculosis. The tubercles were disseminated
throughout the liver, and in its capsule occurred as minute
elevations one-tenth of an inch in diameter; they appeared
to be of recent formation, though slight caseation bad
occurred in a few. It was uncertain whether any causal
relation existed between the stomatitis and the tuberculosis,
as the latter was a rare complication, nearly all the cases of j
ulcerative stomatitis in children recovering under the use
of chlorate of potash or other treatment. Nor did sections
of the affected gums and lip show tubercle bacilli or any
tuberculous structure. The surface of the ulcers was
ragged, and for a varying depth was in a necrotic con¬
dition, the structures being ill-defined and not staining
well. In the lip the muscular bundles next the surface were
matted together, and the striation was indistinct. Micro¬
cocci were plentiful in this layer, but the long bacilli found
by Lingard and Batt in ulcerative stomatitis of calves and
in a case of noma were not present. Under the necrotic
layer there was considerable inflammatory cell-effusion. It
was stated that ulcerative stomatitis of children could be
inoculated (Bergeron), but the microscopical appearances
would confirm the clinical evidence that this disease was
quite distinct from noma and from the ulcerative stomatitis
of calves and other young animals.—Mr. P. Trkvkb said
that there were many arguments in favour of the suggestion
that the ulcerated tongue was the seat of inoculation of
tubercle.

Dr. J08KPH Coats introduced a case of Hypertrophic
Goitre with secondary tumours in the skull. The thyroid
gland presented considerable enlargement of both lobes.
The tissue of the enlarged gland was that of ordinary
goitre—namely, greatly multiplied Baccules, with occasional
colloid matter in them. There were two further changes,
both of which evidenced chronicity in the growth— namely,
fibroid induration and calcareous infiltration. This latter
change was in the indurated connective tissue, and probably
in connexion with some necrosis. The goitre was first
noticed sixteen years before death. There were several
tumours in the skull, only one of which was visible during
life, and had been observed for a year and a half; this was
in the occipital region, and it formed here a pulsating
swelling. This tumour replaced the bone of the skull over
an area an inch and three-quarters in diameter, and pro¬
jected both outwards and inwards, pushing the torcular
herophili before it. Another projected chiefly inwards, and
was adherent to the dura mater. All the tumours appa¬
rently originated in the diploe of the skull. Their structure
"was identical with that or the goitre, consisting of innu-
meiable small saccules lined with epithelium, and occasionally
with colloid contents. Dr. Coats referred to Cohnheime
case, which was of a similar nature; and he also quoted a
case of Wolfler’s in which a tumour, removed during life
hy Billroth from over the eye, was found to have typically
the structure of the ordinary goitre. This patient was also
*“»cted with goitre.—Mr. R. J. Godlsk had examined Mr.
j®°rnss specimen of pulsating tumours of the left parietal
“j 50 ® associated with other similar tumours of the right
cumde and both femora recorded in the Pathological Trans-
“fjtwus. vol. xxxi. There was also a goitre in this case, and
R of the skull showed thyroid-like tissue.—Mr. G.

Town* mentioned a case of goitre associated with

secondary growths in the lung reported in the Pathological
Society’s Transactions.—In reply to Sir James Paget, Dr.
Coats said that W olfler had figured many tumours of the
thyroid: carcinomata, sarcomata, and the ordinary forms of
goitre. In some cases of advanced goitre the formation of
colloid was often more pronounced, leading to the formation
of large cysts. In reply to Mr. Godlee, he said that he had
not detected sarcomatous tissue in cases of ordinary goitre.

Dr. Josbph Coats also showed a large Tumour of the
Pineal Gland. The tumour, which consisted of two rounded
lobulated masses, measured about three inches transversely,
and two inches from before backwards. It was surrounded
by a capsule and loosely attached, except at one point which
corresponded to the situation of the pineal gland. In its
growth it had dislocated and disturbed the neighbouring
structures, the parts affected being there normally in rela¬
tion to the pineal gland. The corpus callosum, choroid
plexus, and velum interpositum were pushed upwards, the
corpus callosum being greatly softened. The oorpora
quadrigemina were pushed backwards and upwards, and the
thalami optici outwards and forwards, these parts being
greatly flattened. The bulk of the tumour was in the third
ventricle, but it had also extended somewhat into the
aqueduct and fourth ventricle. The structure of the tumour
was very peculiar—namely, a basis of sarcomatous struc¬
ture, with pieces of cartilage and epithelial or glandular
structures embedded in it. The sarcomatous cells were
chiefly spindle-shaped, and some of them in the shape of the
nuclei and general arrangement suggested smooth muscle.
The cartilage was hyaline, with the cells unusually
abundant. The gland structures were in the form of
saccules or ducts lined with epithelium, usually cylindrical.
The saccules were occasionally dilated, but did not form
true cysts. Dr. Coats was disposed to call the tumour, from
its structure, an adenoid chondroid sarcoma. He referred
to four other cases of similar forms of tumour, recorded by
Weigert, Falkaon, Ziegler, and Turner, in all of which the
structure was complex, with epithelial or glandular struc¬
tures, and in three of the cases with cartilage. The observa¬
tions of Baldwin Spencer on the pineal eye were referred
to as indicating the original complex structure of the pineal
gland, and it was stated that the embryonic structure
indicated that the pineal gland was an epithelial body.

Mr. Lawson Tait read a paper and exhibited fifty-eight
specimens, removed during the year 1886, illustrating the
Pathology of Chronic Inflammatory Disease of the Uterine
Appendages. Although Ruysch had recognised these diseases,
their frequency and serious nature had only been allowed
during the last ten years. The frequency was somewhat
indicated by the fact that Mr. Lawson Tait had operated
sixty-three times, with but one death, during the past year.
All the patieuts had suffered for years. Cases were grouped
under four headings: (1) simply catarrhal; (2) due to ex-
anthematic disease at puberty; (3) gonorrhoeal; (4) in¬
flammatory mischief in the pelvis in the poet-puerperal
condition—i.e., after a miscarriage or a full term labour.
A fifth was added by Mr. Tait: cases in which the only
explanation was the existence of an infantile condition'of
the uterus due to arrested development. Retroversion, with
complete fixation and enlargement of the appendages, was
general. The preponderating influence of the third and
fourth causes was at once indicated by the fact that out of
the sixty-three cases there were only ten unmarried women.
Of these ten single women, there can be no doubt that in
at least three of the instances the origin was gonorrhoeal.
In two of the single women there had been pregnancies,
and these were in all probability the source of the diseased
appendages. In one case prolonged efforts had been made
to cure anteflexion by means of intra-uterine pessaries, and
this doubtless resulted in the double pyosalpinx. Of
the four remaining cases in single women, two were
probably due to scarlet fever. In the fifty-three women
who were married, the average age was a little over
thirty-three years. Of these, twenty-three had never
been pregnant, and they had been married on the average
ten years. Of the remaining thirty cases, sixteen had
been pregnant once, the pregnancy occurring immedi¬
ately after marriage, and being associated in every instance
with tbe history of subsequent pelvic trouble. The average
interval in these cases between the pregnancy and the time
of the operation was eleven years. Only fourteen of the
patients had more than one child, and the average period
between the last pregnancy and the time of the opera¬
tion was six years. These facts were enough of them-
q 3

Digitized byLjOOgle

PATHOLOGICAL SOCIETY OP LONDON.

[April 16,1887.

778 The Lancet,]

selves to show how completely sterility is produced by
chronic inflammatory disease of the uterine appendages.
In by far the greater majority of the specimens the occlu¬
sion has taken place by the trumpet getting glued on to the
ovary. The frequency of this occurrence substantiates, to
some extent at least, the tradition that the infundibulum
gets fastened on to the ovary temporarily at some time or
other in connexion with the process of ovulation. Formerly
the author thought lie should be able to prove that this
relation did actually occur, but he has never been able to
make himself certain of it. in some cases the trumpet is
found to have closed its tentacles, like a polyp, and to have
had them coalesced in that position, leaving the ovary free.
In the group of twenty-three women who had been
married for an average period of ten years and had
never been pregnant, there can be no doubt, from the
clinical histories of nearly a third of them, that the
disease arose from old latent gonorrhoeas or gleets in
their husbands excited into activity by the indulgence of
early married life. In rather more than a third the author
believed the disease originated in the exanthematic diseases
of girlhood, most especially scarlet fever; and in the others
no clue to causation could be obtained. In the second group
of fifteen women in whom there had been one pregnancy
within a short time of marriage, we assume, of course, that
at the time of marriage their productive machinery was
intact. _ In all but two of these cases, the story of pelvic
peritonitis following their only labour placed them clearly
in the group in which puerperal mischief has to be regarded
as the cause. In the exceptional two, the author believed
that he failed to get the history rather from the stupidity
of the patients than from an absence of the facts. A third
group was readily formed of fourteen women whose
fecundity was not limited to one child. In this group were
found the most acute and severe cases. At least eight of
these women suffered from subacute or even acute gonor¬
rhoeal salpingitis of comparatively recent origin, the average
time which hud elapsed between the last pregnancy and the
operation being three years. On the other hand, in the six
other women in this group in whom the author could get
no such history (or doubtfully in two of them), fourteen
years had on the average; elapsed between their last con¬
finement and the date of the operation. These facts have a
striking pathological significance. In the acute or early stage
the appendages are intensely congested and swollen, and are
very friable. In fact, it is a matter of difficulty to remove
them entire. In the old-standing cases the organs BTe
contracted and atrophied, and few if any traces of normal
follicles can be discovered in the cirrhotic and densely
adherent ovaries. At this stage the tubes generally contain
very little fluid, and their contents are sometimes cheesy.
They may be purulent on one side and serous on the other.
Certain it is that neither the quantity of this fluid nor its
pathological characters bear any definite relation to the
sufferings of the patient. The pain endured in these cases
is related to the adhesion of the organs, and to nothing
else. The author had been much interested lately in
reading a paper by Dr. Sanger of Leipsic, in which he
determines varieties of tubal disease by the application
of the germ theory, giving to the varieties names based
on the kind cf lowly organisms found in the contents
of the tubes. Thus when a gonococcus is found he
speaks of salpingitis gonorrhoica; and when he finds
actinomycetes he calls it R. nctinomycotica. If it is cha¬
racterised by Koch’s bacillus tuberculosis, he records it as
8. tuberculosa. This kind of distinction seems to the author
to have much attraction for the speculative mind, and bHt :
little for the practical pathologist. It has, besides, the initial
difficulty that it is based on n doctrine which has yet to
show that it is not mistaking the phenomena of decomposi¬
tion for those of disease. Since reading Sftuger*s paper the
author had given some little attention to the fluid contents
of the tubes, and he had already found evidence that if the
distinction of varieties were to be based upon the characters
of the lowly organisms present in the fluid, the probability
was that their extension would be indefinite and easily
multiplied. In conclusion, the author submitted a post¬
mortem preparation for which he was indebted to the kind¬
ness of Dr. Littlejohn of Edinburgh ; it was an example of
the simple hydrosalpinx without adhesions, and so far
as its clinical history could be ascertained the patient suffered
little or
. Durable (

Dearly a

nothing, but was
Jrawing made by Dr..
century ago, which *b

Also an ad-
'used in his lectures
-of ooclu-

sion and distension of the tube most beautifully. Also some
drawings of Dr. Price of Philadelphia, showing the ovaries
and tubes in a condition of acute gonorrhceal inflammation.

Mr. Alban Doran showed specimens illustrating the
Development of Tubo-ovarian Cysts as a result of Inflam¬
mation of the Uterine Appendages. He exhibited a pair of
appendages which had recently been removed by Dr.
Bantock from a woman aged twenty-three, subject to
chronic pelvic pains and other severe symptoms. The right
tube and ovary had undergone complete cystic degeneration,
so as to form a cyst with one cavity. The left tube wa?
dilated; a cyst had formed in that part of the ovary most
distant from the dilated tube. Mr. Doran showed a series
of diseased appendages from the museum of the College of
Surgeons, where every stage of the process of conversion of
chronic inflamed appendages into tubo-ovarian cysts was
demonstrated. On the other hand, he had never succeeded
in finding a tubo-ovarian cyst developed as a part of
the process of development of the common ovarian
cystic tumour, a non-inflammatory disease. Hence he
believed that tubo-ovarian cysts almost invariably repre¬
sented an atrophic inflammatory condition.—Dr. Hadden
referred to the frequency of tubercular disease of the
Fallopian tubes. Why was the outer half of the tube
more dilated than the inner ?—Dr. Angel Money said that
tubercular disease of the abdomen in children frequently
got well. He had seen genuine tubercular pyosalpinx in
children.—Dr. Josf.dh Coats also thought that tubercular
disease was also a common cause of disease of the Fallopian
tubes. He had seen it nearly always in tubercular peri-
tonitie. It might also occur alone.—Dr. Griffith remarked
that he had been lately engaged in investigating the subject
of tubo-ovarian cysts, the literature of which was very scanty,
and a paper by him on the subject was now in the hands of
the Obstetrical Society. His investigation led him to the
conclusion that there were two kinds in addition to that
described by Mr. Doran, the rarest of which was formed by
the union and communication of a dilated tube with one
loculus of the common multilocular cyst. Another variety
which seemed to be very uncommon was that first described
by Adolphe Kichard, consisting of a dilated tube adherent
to and communicating with a thin-walled unilocular cyst of
the ovary, the size of a child’s head, or smaller, producing a
tumour having the shape of a retort, and containing thin
watery fluid, more resembling the contentsof abroad ligament
than an ovarian cyst. These were discovered in young women
in whom the history and evidence of past inflammation were
very scanty. Dr. Griffith believed that the specimens
brought forward by Mr. Lawson Tait would well repay
careful examination. The clinical history and histology of
diseases of the tubes had yet to he investigated.--Mr. Law-
son Tait said that lie treated only of cases operated on by
him during the past year. He had seen but one case of
tubercular pyosalpinx, on which he operated, and the patient
recovered, which made him doubt the tubercular nature.
He agreed with Mr. Doran’s view of the mode of formation
of tubo-ovarian cysts—Mr. Alban Doran, in reply to Dr.
Griffith, stated that “tubo-ovarian cyst” was a matter of
definition. Many of the observers to whom Dr. Griffith
referred appeared to apply the term solely to cases where
the tube had communicated with a true ovarian cyst.

Dr, Hale White showed a specimen of Old Meningeal
llffimorrhage, with Cerebral Softening and Secondary Dege¬
neration, which was taken from a patient who died owing
to the effects of a fempral hernia. From the history it
would appear that the meningeal hfeuiorrhage took place
eighteen months previously. At the necropsy ante-mortem
clotting in the sinuses was discovered. On the left side,
over the ascending parietal and froulals, and the back part
of the first, second, and third frontal, convolutions, there
was some soft yellowish-white material, evidently old blood
clot. The Rrey matter over the area mentioned had quite
disappeared; the white substance immediately underneath
was a little altered; no distinct degeneration, could be seen
in the pons or internal capsule, but .^he pyramidal tract in
the medulla, and both the crossed and direct pyramidal
tracts in the cord, were distinctly degenerated, being grey,
translucent, and hard-looking. The lateral column was
smaller on the affected side than the healthy. The micro¬
scope showed the sclerotic changes to be the same as those
usually described.

The following card specimens were shownMr, E. H.
Fenwick: Tumour of the Bladder. Dr. Turner: Congenital
Stricture of the Jejunum. Dr. Hale White: (1) Peripheral

Digitized by GoOQle

Ths Lancbt,!

OBSTETRICAL SOCIETY OF LONDON,

[Apbil 16,1887. 779.

Neuritis; (2) Dilatation of the Ureter and Hydronephrosis of
one side, secondary to stricture of urethra. Air. D’Arcy
Power: Sequel to cape o l Endosteal Sarcoma. Dr. Thiu for
Dr. B. Bake: Drawings of Bacillus of Leprosy. Dr. Edmunds:
Carcinoma Myxomatodes. Mr. F, W. Clark: Acute Peri¬
carditis. Mr. tludaoa : Colloid Cancer of Stomach. Dr.
Allchin: Perforating Ulcer of Duodenum. Mr. Shattock :
(1) Congenital Dislocation of Hair; (2) Two specimens of
Osteomalacia, showing metaplasia of osseous into fibrous
tissue.

OBSTETRICAL SOCIETY OF LONDON.

A kkrtino of this Society was held on Wednesday,
April 6th, Dr. John Williams, President, in the chair.

Uterus Bicorpur. -Dr. ILandfikld'Jonks showed a uterus
having one cervix and two bodies. The left horn had been
recently preguant, while the right one was enlarged, either
from sympathetic hypertrophy or owing to submvolution
after previous pregnancies of the right horn. The wojnan
had died of puerperal eclampsia after her fifth confinement.
Douglas’s pouch was bipartite.

Anterior Parametritis awl PerimeIritis.-- Dr. W. S.
Griffith showed two characteristic specimens of these
conditions with drawings.

The Mechanism of the Third St<i>/e of Labour. —This
paper, by Dr. Champneys, was the second of a series, and
dealt with the Expulsion of the Placenta. The author
reviewed the literature of the subject,Including the observa¬
tions of Lemser, Salin, Duncan, Schultze, Kiberaont, and
Ahlfeld. lie showed that the question centres round the
opposing views of Schultze (which are corollaries of those
of Baudelocque) and those of Duncan. The difference is as
to the presence or absence of hajmorrhage as part of the
normal procedure, including the inversion of the placenta,
this being described by Schultze and denied by Duncan.
Direct observations are very few and are contradictory.
The author gave his own observations of 70 cases, care¬
fully observed and tabulated, as regards the manner of
the expulsion of the placenta and the blood lost in each
case. The fcetal surface presented in 64, the maternal
in 2 (in both of which the cord had probably been
palled upon), the amnion in 4. Adding nis results to
those of Pinard and Ribemont, the author found that
the fcetal surface presented in 127, the fatal edge in
-*7, the maternal surface in 5. The presenting point
was nearer the lower edge of the placenta in 6o, nearer
the upper edge in 1, midway in 2, no note of its
position in 2. The lower edge, or amnion below the
lower edge, presented in 16. In the great majority of
cases a point within two inches of the edge pre¬
sented, but on the fcetal surface. There was a com¬
plete absence of fundal attachments. It was found that
the presenting part, varies in its position with the position
of the placenta. The higher the placenta the higher the
presenting point, and rice versd. The average loss of blood
b- fore the expulsion of the placenta was six ounces, in the
membranes or with the placenta six ounces, making an
average of twelve ounces for each labour, not including
post-partum haemorrhages. The author believes that a
moderate loss of blood is a normal phenomenon of the
third stage of labour; the third stage of labour is not i
either actually or nearly a bloodless operation. He con- j
olude* finally that—1. Some meosureahle hromorrhago is a :
normal constituent of the phenomena of the third stage of
labour. 2. The placenta presents in tlie great majority of
cases by a point on the amniotic surface. 3. The presenting
Point is almost invariably near the lower edge of the I
placenta. 4. The position of the presenting point varies I
the position of the placenta, b. The “inversion” of
the placenta is not due in the great majority of cases to
traction on the cord, but is part of the natural mechanism.
T “'observations, therefore, accord in essentials with those
of Schultze, though his diagrams are greatly exaggerated, j
These observations boar on-the opinion previously expressed
a* to the causes and mode of separation of the placenta. There¬
fore—!. It is probable that, in addition to reduction of the
placental site, some escape of blood plays a part, in the
ordui&ry mechanism of placental detachment. 2. The
abghfc inversion of the placenta, which does take place, is
r r °o*Wy due to this cause. 3. The effusion of blood is not.
Mi ordinary cases, sufficient to form a large mass bulging into |
& *arge uterine cavity behind the placenta.- -Dr. Matthews j

Duncan congratulated the Society on the elaborate paper
just read, not only on account of its intrinsic value, but
also because of its affording the Society an opportunity of
! contributing to the progress of the greatest obstetric work
; of the century. In the history of midwifery there were
| only three works of the very highest class as yet achieved.
' The first in scientific order of progress was done in the
eighteenth century by W. Hunter, whose plates on the
! “Anatomy of l’regnancy - ’ were its crown. The second
I was a work mainly of this century, and was known as the
1 “Mechanism of Parturition,” and with it were connected
many namep, especially those of Solayrer and of Naegele. The
! third was still incomplete, the greatest, most difficult and
most glorious of all, a work of the nineteenth century, the
“Anatomy of Labour. In this country no name was so great
in the anatomy of labour as that of Barbour, and he was
actively engaged in it at this moment. No contribution to
it had come from London, and the papers of Dr. Champneys
he hailed as worthily bringing a part of it before this Society.
The anatomy of labour made no progress till the introduc¬
tion of homalographic sections of frozen bodies. No. such
sections had been done in London, and nowhere had such
sections been made in the third stage of labour. The work
of Dr. Champneys was mainly physiological, and should
come after the completion of the anatomy of the third stage,
for the subject of his work would not be settled till the
anatomy was finished. Failing to find bodies for the sec¬
tional anatomy of tbe third stage, obstetricians had ex¬
amined the uteri of the operation of Porro. This was an
imperfect substitute for frozen sections, and might be very
misleading. The Porro uterus examined by Barbour showed
that the placental area might be contracted to a diameter
of four inches without separation, and tbe absence in these
cases of hiematoxna waa hostile to the theory of separation
by utero-placental haemorrhage, but it did not disprove it.
Absence of separation, with contraction to an area of four
inches in diameter, seemed to astonish many, and to favour
the detrusion theory of separation. Dr. M. Duncan always
imagined a much greater contraction as necessary for separa¬
tion. lie referred to his own paper of 1871, which was now
a matter of “ancient history.” Yet, admitting its imperfec¬
tions, he was still an unbeliever in the presence of hsema-
toma in a natural separation in a theoretically natural
case, and he continued to hold that the cake descended
edgewise through the cervix, and a reference to Dr.
i Champneys’ table, columns A and B, confirmed this. The
old detrusion theory of separation he had found diffi¬
cult to make intelligible. He could not understand the
production of detrusion till after separation. He conld not
imagine detrusion pushing off the lowest flap (as in the
Porro case exhibited by Dr. Galabin) without pushing off
all above it.—Dr. Galabin understood that the author had
not come to a decided opinion whether the separation of the
placenta was from the periphery to the centre or rice versd.
Dr. Galabin thought this depended on the cause of separa¬
tion. If the cause were from shrinking of the placental site,
separation must be from tbe periphery inwards. If haemor¬
rhage were the cause.it must oocnr away from tbe margin, and
could only effect a separat ion from the centre towards the peri¬
phery. Even if it were admitted that an effusion of blood ia
normally present, it does not follow that the haamorrbageisa
cause rather than a consequence of detachment. — Dr.
Galabin thought that the Porro uterus was in favour of-
shrinking of the placental site, with possibly detrusion as
a cause of detachment, and not hiefnorrhage. Detrusion,
acting as a supplementary canse to shrinking would causa
detachment of the loxcer margin first. As regards the
mechanism of expulsion, he thought it depended on the
management of the third Stage of labour. In Salin’s cases
the placenta presented at the as by its lower margin, and
there was no inversion. In Dr. Champneys’.cases there was
partial inversion, in Lemaer’a cases the upper edge usually
presented. The probable reason was that tbe management
of Salin’s cases promoted the best uterine contraction ; that
of LemsePs the greatest relaxation; that of Champneys’ an
intermediate condition. Dr. Galabin did not think that
leaving the uterus unsupported with the patient on
her .side and tbe fundus dependent would give the.
most ideally natural mechanism.--Dr. 11andkikli> Jonks
thought that an ideally healthy labour was bloodless
as regards the separation of the placenta, though there
might be variable amounts How afterwards.—Dr. Boxall
thought there were causes for separation of tbe pla¬
centa not mentioned in. Dr. Champneys’ pnpers. After

zed by Google

780 The Lancet,]

LEEDS AND WEST RIDING MEDlCO-CHIRURGlCAL SOCIETY.

[April 16,1887.

the birth of the child the conditions were profoundly
altered: the flow of blood from the foetal portion of the
placenta to the lungs ceasing, the thin lamina of maternal
tissue is deprived of support towards the cavity of the
uterus. The position in which the placenta is implanted on
the uterus Dr. Champneys had shown to be important, and
this again was indissolubly connected with the separation of
the membranes. As long as the membranes at the edge of
the placenta remain adherent to the uterine wall, inversion
of the placenta is maintained. If any portion of the
attachment gives way, the adjacent margin of placenta,
being no longer supported, becomes the most dependent
part, and the subplacental hsematoma finds an exit of
escape, and the lower the implantation of the placenta the
more easily will this happen. There were other causes that
altered the process of detachment, as pulling on the cord and
abnormal adhesion. Dr. Boxall explained a series of ex¬
periments which he had made to determine the plabental
presentation by means of staining. He also confirmed Dr.
Champneys’ remarks on the rarity of fundal attachment of
the placenta. He had found the fundus overlapped (to the
extent of an inch and three-quarters) only once. Out of
one hundred cases, he should say that the placenta would
occupy the upper zone in twenty-one, the middle zone
in seventy-seven, and the lower zone in two.—Dr. Gandy
wished to know if kneading of the uterus was made use of
to expel the placenta.—Dr. W. S. Griffith thought there
was some analogy between the detachment of the membranes
in membranous dysmenorrlicea and the detachment of the
placenta.—Dr. Champneys replied.

LEEDS AND WEST RIDING MEDICO-
CHIRURGICAL SOCIETY.

An ordinary meeting wa9 held on Feb. 4tb, Dr. S. C. Smith,
President, in the chair.

Method of Ligaturing an Intercostal Artery. — Mr.
Clifford Turner described a method by which a special
curved needle was passed below the vessel and upwards
over the rib, the ligature being tied over a pad. He de¬
scribed various modifications of the process, according to
the position of the wound and the age of the patient.

Resection of Bowel for Intussusception. —Mr. Lawford
Knaoos described a case of laparotomy for intussusception
in a young child, and showed the removed portions of gut.
The patient died in a few hours. In a review of the treat¬
ment to be adopted in such cases, he recommended the
cautious use of inflation, and should this be unsuccessful,
immediate laparotomy to be had recourse to. -Mr. Pridgin
Tbalk, who bad seen the case, said he thought abdominal
section should be more frequently done in these cases.
He described several cases—one in a man of eighty-six,
where he had removed gangrenous bowel and sutured
the ends of the gut together. The patient lived six days,
dying of exhaustion, the obstruction having been relieved.—
Mr. McGill had decided that in the next case under his
care he would make a longitudinal incision over the dis¬
tended bowel, withdraw and incise the invaginated portion,
stitching the opening to the skin, making a ftecal fistula
which could be dealt with afterwards, ne thought that
excision of gangrenous bowel and suture must nearly
always be fatal.

Hemianopsia. —Dr. Wardrop Griffith described, with
the aid of diagrams, the several varieties of hemianopsia
and their probable anatomical relations, both with regard to
lesions of the optic tract and internal capsules and the cortex
of the brain. He related several cases where a permanent
hemianopsia appeared to indicate grave organic disease.

Patkoloffical Specimens. — Dr. Chadwick showed some
Living and Preserved Specimens of the Filaria Sanguinis
Hominis, from a case under the care of Dr. Stephen Mac¬
kenzie.—Mr. Mayo Robson showed (1) a Foot with extensive
Sarcomatous Disease of bone; (2) a Hydrocele in the Sac of
an old Hernia, the neck being sealed by a piece of omentum.—
Mr. Bacon showed a Larynx from a cage of poisoning with
Carbolic Acid, much eroded by the action of the irritant.

A meeting was held on March 4th, Dr. Eddison in the
chair.

Raynaud’s Disease.— Dr. Ernest Jacob described two
cases of this disease lately under his care, one of the
patients being exhibited. Case 1: A lad of twenty from

his ninth to his twelfth year used to handle a wet chain in
a colliery. His hands ever since had been always cold. The
fingers were stiff, blue, and cold, and subject to acute pain.
There wa9 no arterial disease, and his general health was
good. He improved under the use of iron internally
and a stimulating liniment to the hands. Galvanism was
tried in vain. Case 2: A laundress, aged fifty-seven, began
to suffer from coldness and numbness of the hands thirty
years ago, with severe pain of lancinating character. This
recurred whenever her hands were at all exposed to cold.
Two years ago she became worse; the fingers became black
and discoloured, remaining so for two or tnree weeks, when
they would become red, and the nail drop off, being suc¬
ceeded by a new nail. Gradually gangrene supervened, and
the tips of the first and second fingers of the left hand had
disappeared. On the right hand the first finger had lost the
two terminal phalanges and the little finger the third. The
general health was not good, and though the arteries seemed
healthy, there was an aortic regurgitant murmur. She had
since been an in-patient in the infirmary under the care of
Mr. McGill, the gangrene having still further progressed.
The history of the disease was referred to, its pathology as
a vice of arterial innervation, and its clinical connexion
with the “night palsy” described by Dr. Weir Mitchell,
paroxysmal hmmatinuria, and different varieties of vaso¬
motor spasm were alluded to.

Treatment of Mastitis.— Mr. C. J. Wright described a
number of cases of painful lactation or Inflamed breasts, in
which he had found firm pressure by a bandage or towel
afford great relief to the pain and other symptoms. Abscesses
were to be opened antiaeptically, and poulticing to be used
as little as possible.—Mr. A. Roberts spoke of the advantages
of fomentation with solution of ammonium carbonate.—
Dr. Purdy had been disappointed at the results both of
pressure and ammonium carbonate fomentation.—Mr. J. W.
Tkale thought belladonna plaster useful mostly through
the support it gave; he spoke highly of pressure,but generally
gave a morphia injection as well.

Dangers of Cocaine. —Mr. A. Roberts described a case
where he amputated the breast after injection of cocaine,
sixty minims of a G per cent, solution being used. The
patient felt no pain, but became blind, talking rapidly and
somewhat incoherently. The blindness lasted four hours, but
she recovered completely.—Dr. Clifford Allbutt said be
had experienced after the use of cocaine symptoms which
had been recorded by others—viz .dreams in which writhing
worms formed the principal object.—Mr. Hewetsox said
that in using cocaine for ophthalmic purposes corneal
opacities were apt to be left if a mercurial antiseptic were
used.—Mr. Oakkley had seen bad effects from strong solu¬
tions, but found that the desired effect could be produced
with a maximum of thirty minims of a 4 per cent, solution.
He had found amylic nitrite very useful as an antidote.—
Mr. Mayo Robson had had two cases only out of a large
number which had caused him any anxiety—viz., one in
which severe syncope followed an operation for circum¬
cision, and another where aphasia, lasting four hours,
followed the removal of a nasal polypus.

Mr. Lawford Knagqs showed a patient on whom Abdo-
dominal Section had been performed. The case was found
to be one of tubercular peritonitis, and the patient had com¬
pletely recovered.

Last days of a case of Graves' Disease. —Dr. Clifford
Allbutt was called to a case of a lady almost moribund,
with symptoms of failing heart. There was dropsy, con¬
gestion of lunge, orthopnoea, &c. The heart’s aotion wa*
quick, but there was no detectable valvular lesion, the
action being most like that noticed in a case of Graves'
disease. Inquiry showed that there had been both enlarge¬
ment of the thyroid and great exophthalmos in the past, but
these had disappeared two years before.

Syphilitic Coma. —Dr. Allbutt referred to a paper by Dr.
Althaus on syphilitic coma, and described the case of a lady
of fifty, who had had repeated attacks (seven or eight) of
coma, lasting from two to five days, on two or three occasions
accompanied by slight hemiplegia, but with perfect recovery.
He regarded this as due to syphilis, of which thebe was good
evidence in thi9 case, and potassium iodide had been of great
use in the treatment.

Acute Atrophy of Liver. —DA Hutchinson showed a
liver with microscopical sections. There was jaundice for
nine days before death, and there was some cirrhotic change,
as well as the indications of atrophy.

IooqIc

Thb Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[Apbil 16,1887. 781

Mr. Little wood showed fresh cut sections of an Alveolar
Sarcoma from the back of the Sacrum.

Dr. J acob showed microscopic sections of a “ Duct " Cancer
of the Breast, from a case under the care of Mr. T. P. Teale.

GLASGOW OBSTETRICAL AND GYNAECOLOGICAL
SOCIETY.

The sixth meeting of the session was held in the Faculty
Hall, St. Vincent-street, on March 23rd.

Dr. Murdoch Cameron showed a Cervix Uteri amputated
by Prof. Leishman for elongation in a nullipara, and advo¬
cated the use of the galvanic Acraseur in such cases.

Mr. J. S. Nairnb exhibited two simple forms of Wire
Clamp, and Dr. Smith exhibited Cones of Cocaine and Boric
Acid, recommended by Dr. E. Head Moore for use in primi-
paraa and cases of rigid os.

The President, Dr. Sloan, then showed the Spleen and
Uterus and Appendages of a primiparaa, aged twenty-two,
who had died in the Maternity on the twenty-second day
post par turn, after a somewhat unusual illness. The speci¬
mens had been kept in spirit. The spleen had been adherent, ,
and on removing it a quantity of grumous material had
escaped from a cavity in the upper extremity. In this
region it separated in two parts, joined by a mass of tough
fibrinous material, its surface being coated with lymph.
Otherwise the tissue was friable, and Dr. Dalziel had reckoned
that the rupture indicated by these appearances must have
taken place from three to four weeks prior to death. There
was no appearance of pus in or around the organ. The uterus
measured four inches and a half in length, and with its
appendages looked quite normal, being covered with smooth
and glistening peritoneum, and showing no trace of pus
or putrefaction. There were no appearances elsewhere of
septicmmia or pyaemia. Though the urine was one-third
albuminous, the kidneys were found healthy post mortem.

ank Notices of Books.

Recent Essays by various Authors on Bacteria in relation to
Disease. Selected and edited by W. Watson Chbyne,
M.B., F.R.C.S. London : New Sydenham Society. 1886.
Les BactMes, et leur R6le dans VAnatomic et VHistologic
Pathologiques des Maladies Infeetieuses. Par A. V'.
Cobnil et V. Babes. Deuxiome Edition. Paris: Felix
Alcan. 1886.

The New Sydenham Society, which has done not a little
to familiarise the English practitioner with the best writings
of foreign scientists, has seldom accomplished better work
than in undertaking the collection of monographs included
in the volume edited by Mr. Watson Cheyne, in which,
after a very interesting and suggestive introduction, we
have, gathered from various sources and translated by
capable hands, some of the best bacteriological work of
the day. Tt is a great advantage to have access to
such notable essays as that of Koch on Tuberculosis,
Fehleisen on Erysipelas, Friedlander on Pneumonia, and
Israel on Actinomycosis; and these only form a small
portion of the rich contents of the volume. Dr. Koch’s
paper on the Investigation of Pathogenic Organisms,
translated by Mr. Horsley, fitly introduces the volume. It
is characterised by the clear and definite phraseology which
has done so much to add to the charm of its author’s
expositions. His far-famed monograph on the Etiology of
Tuberculosis, for the translation of which Mr. Stanley Boyd
ie responsible, comes next. No one can read this without
becoming convinced of the truth of a discovery which aptly
came to crown the labours of pathologists upon the nature
of tubercle. “Seldom in the course of my life,” wrote
Cohnheim, “ have I received such glad tidings,” when the
news of Koch’s discovery of the bacillus tuberculosis reached
him. On the additional light which such a discovery has
shed upon specific diseases and inflammations there is no ,
need now to dwell. One of the most interesting mono- '

graphs—to English readers-is that by Dr. Gaffky uprn
the Etiology of Enteric Fever, which is translated by
Dr. J. J. Pringle. Oaffky’s researches were confirmatory of
Eberth’s die covery of a special bacillus in the intestinal lesions
as well as in other organs. This bacillus is about one-third
the diameter of a red corpuscle in length and three times
as broad as long, and is distinguished from other bacteria by
its power of spontaneous movement, its slight affinity for
aniline dyes, tbo non-liquefaction of gelatine inoculated
with it, the characteristic colonies it forms when grown on
potato or solid blood-serum, and the spore formation at the
extremities of the bacillus. The failure to produce inocula¬
tion of animals does not tell so strongly against its
pathogenic character as might be supposed; and, as
pointed out by Gaffky, there is as much reason for
regarding it as the specific agent as there is in the
case of the spirochcete of relapsing fever or the bacillus
of leprosy. Fehleisen’s memoir on Erysipelas is translated
by Dr. Leslie Ogilvie. It is admirable for the clearness of
its reasoning, and for the light it sheds upon the nature of
erysipelas, as distinguished from other forms of dermatitis
and cellulitis. The specific nature of the micrococcus dis¬
covered by Fehleisen is attested by the crucial experiments
on human subjects, who were inoculated with cultures for
the therapeutic purpose of causing the absorption of ne“w
growths through the action of erysipelas. Friedlander’s
paper on the Micrococci of Acute Pneumonia is translated
by Edgar Thurston. The subject is one which has been
further investigated since this discovery was announced, and
the precise significance of the pneuraonococcus is still sub
judice; yet there can be little doubt as to the characteristic
morphology and mode of growth of this remarkable microbe;
Amongst other papers included in this collection we are glad
to see that of Dr. Koch upon the Etiology of Cholera (trans¬
lated by Dr. G. Laycock). The comma bacillus may ot may
not be the cause of cholera, but in the history of that disease
the researches conducted by Koch which resulted in the dis¬
covery of that micro-organism will always hold a prominent
place. Mr. Watson Cheyne supplies valuable abstracts and
translations of writings upon Traumatic Infective Diseases,
notably those of Roeenbacb, in which the determination of
the part played by the two varieties of staphylococcus pyo¬
genes was first clearly established. Dr. Loeffier’s paper on
Diphtheria in Man—of which an abstract is famished by
Dr. T. Whiteside Hi me,—although suggestive and interest
ing, proves how difficult it is to arrive at a definite con¬
clusion upon the etiology of this disease. In some oases thb
specific organism seems to be a streptococcus, in others k
bacillus; whilst perhaps the most important idea gained
from the study is that primarily the disease is a local one.
Dr. Hime also supplies an abstract of Israel’s well-known
paper on Actinomycosis in Man—another of the real addi¬
tions to pathological knowledge for which science is in¬
debted to the bacteriologist. Other papers in the rolume
are those by Neisser on the Bacilli of Leprosy, translated by
Dr. Thin; by Loeffler and Schii*s cm the Bacillus of Glanders,
translated by Dr. G. Ogilvie; several papers by Koch and
others on Disinfection, abstracted by Dr. Whitelegge; and
last in order, but not in importance, a very valuable abstract
by Dr. Dawson WiMiams of the work done, largely by Pasteur
and his pupils, upon the Attenuation of Virus and Protec¬
tive Inoculation. The volume, as we have said, is of great
value, and it only remains to congratulate the various con¬
tributors on the manner in which they have performed their
several tasks.

It says much for the prevalent pursuit of bacteriology
that the standard work of Corail and Babes should have
attained to the honour of a second edition within twelve
months of its first appearance. It is evidence also of the
high value set upon the work itself, tor undoubtedly it
deserves to rank as the leading treatise on the subject. Its

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[Apart. 10,1887.

iS2 Thb Lanckt.J REVIEWS AND NOTICES OF BOOKS.

authors have a great reputation, and they have amply
maintained it in this work, which contains not only their
personal researches, but a carefully digested account of all
that has been done in this wide field. So rapidly is progress
being made that, as they truly remark, books on bacteriology
soon fall out of date, and certainly they seem to have
spared no pains to keep their volume up to present
knowledge. Although so much has been accomplished,
MM. Comil and Babes point out how much more there is
yot to do, both in the direction of the discovery of micro¬
organisms in certain speciiic diseases, and in the verification
of discoveries alleged to have been made in others. Bacterial
research has gone far to banish the doctrine of the spon¬
taneous origin of specific disease, and to establish the
specific nature of other affections ; whilst the more know¬
ledge that is gained concerning the nature and mode of
action of these minute parasitee, the more is the field open
for successful prophylaxis. The work is divided into three
parts, the first containing chapters on the methods of in¬
vestigation and experiment, as well as a description of the
varieties of bacteria, and the doctrine of ptomaines. The
second part is devoted to acute infectious diseases attribut¬
able to the intervention of bacterial organisms, those limited
to animals being first discussed; then traumatic infective
diseases, pneumonia, diphtheria, typhoid fever, relapsing
fever, intermittent fever,cholera, anthrax, variola, scarlatina,
&c. The third part treats of chronic bacterial diseases,
such as rhinoscleroma, tuberculosis, leprosy, and syphilis, a
description of M. Pasteur’s labours in hydrophobia being
appended. This mere enumeration can, however, give no
adequate notion of the special excellence of the work. The
pathology of each disease, and particularly its pathological
histology, is amply discussed side by side with the descrip¬
tion of the specific microbe to which it is attributed:
and all that can be done by a liberal use of illustrations,
mostly coloured, is given. Wo must be content here
with simply welcoming the work, and expressing a very
strong opinion of its value.

Health, at School, considered in its Mental, Moral, and

Physical Aspects. By Cusment Dikes, M.D. Lond.

Pp. 324. London: Cassell and Co. 1887.

This book, which is an expansion of the article on Health
at School contributed by the author to Mr. M. Morris's
“ Book of Health,” appoars to us to supply a want which
has been long felt; for although there have been many
works on different matters connected with school health,
we do not know of any one which has gone so exhaustively
into the whole subject. It contains matter which deserves
the careful study of parents, head masters, house masters,
-and form masters alike. In the selection by parents of a
suitable school for their boys, its healthy situation, its sani¬
tary condition, its adaptation to the capability of the boy,
the oharacter and traditions of the school, the qualities of
the head master, and still more of the house master under
whose care they are to be pluced, are all matters demanding
the most serious consideration. But parents must not forget
how much depends upon themselves in the formation of
the character of their boys before they attain the age at
which it is usual to send them to school. It is their special
duty to see that habits of truthfulness, honour, and upright¬
ness are formed in the earliest years—really before school¬
days commence,—as it is almost impossible to form such
habits afterwards. The sanitary construction of the school
and of the master’s boarding-houses is clearly set out and
strongly dwelt upon; the means of preserving the health of
the boys by attention to their diet, their school work, and
their play, are all matters which require the constant
supervision of the masters. On the subject of overwork,
which has of late been much discussed, Dr. Dukes' remarks

are excellent. He points out how clearly the amount of
work which can be safely done depends, in a great
measure, on collateral circumstances—the age and health of
the boy, the conditions under which he works, as regard*
food, sanitation, exercise, and a judicious arrangement of
the work; while he does not forget to inculcate the neces¬
sity for care and judgment to prevent shamming, and to
avoid attributing to overwork conditions which are due to
other causes. “ Thus, headaches are sometimes caused by
working or sleeping in impure or prebreathed air; often
through a failure in sight, which could be, and should be,
rectified at once by appropriate spectacles; and most fre¬
quently of all, these headaches are toxsemic, from imperfect
action of some of the secretions, such as constipation, bat
especially would I mention albuminuria. On several occa¬
sions I have seen boys who had all the symptoms of overwork,
and from whom no further work could be obtained, cured
of all head symptoms, as soon as the cause was discovered,
by an aperient and a milk diet only for twenty-four hours.”

The chapter on Illness is one of great importance, as it
discusses the medical arrangements for the treatment of
disease and the isolation of infectious, and thorough qua¬
rantine of doubtful, cases until their exact nature has been
determined. The steps which ought to be taken to prevent,
as far as possible, the introduction of disease into school,
and its spread if a case unfortunately should occur, and the
measures incumbent on the school authorities to prevent
infectious disease being carried home from school are very
well laid down, and, if adopted, cannot fail to exercise a
most beneficial influence in preventing the spread of disease,
which is only too common from neglect of these pre¬
cautions. Dr. Dukes gives tables of the period of incubation
of various infectious diseases, and the probable duration
of infection where efficient disinfection is in .force and
where it is not in force. . These win prove useful to
parents and masters in carrying out a system of protection
for the boys undef their care. He has also suggested forms
of certificates to be used in cases of boys coming from
homes in which there has been infectious disease, and of
those returning to their homes from school, under similar
circumstances. We commend the study of this chapter to
all who have any control over or are responsible for the
welfare of schoolboys.

The book has been evidently prepared with great care, and
shows a practical knowledge on the part of the author of
the subjects of which he treats. We cannot recommend it
too highly to the head masters and governing bodies of
public schools, and to all who are interested in the welfare
of the rising generation. Should it reach a second edition,
we trust that the author will not omit to add to its practical
value by preparing a copious index, so as to facilitate
reference to any of the special points in it on which
information may be desired.

OUR LIBRARY TABLE.

Some Phases of Cerebral Syphilis, By J. Althaus, M.D.
London: Longmans and Co. 1887. -This small volume of
fifty-five pages is the substance of an address delivered
before the New York Academy of Medicine, on Oct. 7tb,
1886. It is chiefly interesting from the accounts given of
syphilitic coma and hemiplegia; the former state, we agree
with the author, has not received sufficient recognition from
the general members of the profession. Dr. Althaus sum¬
marises his own experience of eight cases. They all occurred
in males between twenty-five and forty-two years of age. A
definite history of primary and Secondary syphilis was
obtained in all. In one case the cotaa appeared eight
months after infection, in six between three and five years
and in one case seventeen years afterwards. In two cases
no other cerebral symptoms had occurred before the coma,

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REVIEWS AND NOTICES OP BOOKS.

[Apbil 10,188T. 78?

while six of the plants had at various time suffered
from giddiness, epileptiform convulsions, and transient
loss of power in the limbs. The author compares
“ syphilitic coma * with diabetic, alcoholic, and other
causes of coma, and also analyses the progress of the
clinical course.

First Year of Scientific Knowledge. By Paul Brut.
Translated by Josephine Clayton (Madame Paul Brut).
Third Edition. Pp. 343. London: Relfe Brothers. 188G.—
We read in the preface: “ This little work is so popular in
France that in three years 600,000 copies have been sold,
and there is scarcely a school, even in the smallest village,
that does not use it a sufficient evidence of the valne of
the work. It may be considered as drawn up on nearly the
same lines as the Primers that were published some years
ago in this country by Messrs. Macmillan, by Professors
Hooker and Michael Poster, and others, except that it is
abundantly illustrated, and that there is a mixture of
question and answer. The subjects dealt with are, in
order—Zoology, Botany, Mineralogy, Physics,' Mechanics,
Chemistry, and Physiology,, both Animal and Vegetable.
These subjects are treated in a very simple manner, and
the book might well be introduced into many of our
elementary schools.

1. Guy's Hospital: Instructions for Case-taking in the
Medical Wards. 2. Method of Case Reporting for Clinical

Clerk*. By T. Chcbton, M.D.— 1 The importance of en¬
forcing a systematic method in the examination and record
of clinical cases is fully recognised at the present day.
Most manuals of practical medicine contain instructions on
the lines to be pursued in such investigations, which are
essential to the art of diagnosis; and the multiplication of
diagnostic aids renders the need of definite rules more neces¬
sary, The “ instructions,” which have been in use at Guy’s
Hospital for some years past., are particularly useful; whilst
Dr. Churton’s scheme is perhaps somewhat more elaborate.
In the former there is more explanation given than in the
latter. The clinical clerk who will conscientiously work
out his eases according to such methods as either of t these
points out will not only render his records of greater value,
but will vastly assist himself in his own studies, and lay
the foundation for accuracy and breadth of view in dealing
with disease.

Elementary Animal Physiology. By Gbobgk A. Buck-
MA8TBH. Fifth Edition. Pp. 203. London: Moffatt and
Paige—This little work has been written up to the require¬
ments of the Science and Art Department of the South
Kensington Museum, the syllabus to which is placed at the
head of the first chapter. Mr. Buckmaster states that the
present edition has been completely rewritten, and care has
been taken, in consideration of those for whom it is chiefly
intended, to introduce only well-ascertained facts. He
recommends the teacher to show to his class the structure
and position of the organs which are the objects of his
instruction. The book gives a fair exposition, in simple and
wsily understood language, of the main facts in anatomy
and physiology, and supplies just such information as a
teacher, armed with the certificate of the Science and Art
Department of South Kensington, ought to knojw and to be
able to communicate. The illustrations are sufficiently
numerous and good.

phristiah Theocracy and the Dynamics of Modern.

A Dialogue for the Times. Edinburgh:
Maclachlan and Stewart. London: Simpkin and Marshall.—
This is to a large extent a psychological work, and as suoh
interest many of our readers. It consists of a dialogue
in Vertey between Physicus, a “ thoughtful materialist,” and
Psychicua, an’ “enlightened supematuraliat.” The work
M a whole may be said to consist of an effort to reconcile
tbe ^kws of scientific and religious thinkers respectively in

their bearing upon social and political questions. Its argu¬
ment, if sometimes lengthy, is for the most part skilfully
presented, and is not wanting in originality of sentiment,
while its diction as a rule is correct and graceful. As usually
happens in such cases, neither disputant convinces the
other, but there is material enough for the reflection of a
third party in the utterances of each. The expression of
modem sentiments in a somewhat archaic style, and a
vagueness of meaning which appears at times to darken
the mystery natural to this subject, are blemishes which
might with advantage be removed in a new edition. Apart
from these shortcomings, there is much that is fresh and
ingenious in reasoning in this latest addition to speculative
literature.

Wear and Tear. By S. Wbik Mitchell, M.D.— This
thoroughly revised fifth edition of an essay that originally
appeared in Lippincott's Magazine is a most aharming and
thoughtful piece of work. One does not know which most
to admire—the style, the matter, or the logic. Such happy
combinations are of rare occurrence. This new edition
comes opportunely when so much is urged on behalf of the
higher culture of women. “ It were better not to educate
girls at all between the ages of fourteen and eighteen unless
it can be done with careful reference to their bodily health.”
Everyone should read this brochure.

The Birmingham Medical Review. If arch, 1887.—This
monthly journal is certainly one of the best of our provincial
periodicals. The practitioner must find the Retrospect a very
valuable feature. Dr. Suckling supplies the abstracts on
Nervous Diseases; Mr. Wood White, those on the Diseases
of the Eyes; Dr. Bostock Hill, those on Hygiene; and
Dr. Arthur Foxwell, one of the editors, those on Thera¬
peutics.

A Descriptive List of Anthropometric Apparatus. Pub¬
lished by the Cambridge Scientific Instrument Company.
1887.—This little pamphlet contains an account of the
various instruments for measuring and testing the chief
physical characteristics of the human body. The instru¬
ments have been designed under the direction of Mr. Francis
Galton, and include dynamometers, instruments for testing
height, weight, keenness of the senses, and the like.

Dods Parliamentary Companion. London; Whittaker
and Co.—In consequence of a special edition of this volume
being necessitated by the early dissolution of the last Par¬
liament and published during the autumn of last year,'the
issue of the new edition for 18S7 lfas been delayed until a
few days ago. The additional information which has, how¬
ever, been included in the current issue fully justifies the
delay. The work is now in its fifty-fifth year, the voltune
under notice being eher gixty-flret issue, Sad chaj.^nth
advantage be ^consulted-by. those desirous of obtaining
succinct information respecting the hereditary and elected
representatives of the nation.

UOTVgftprry of' DtfBLis 'Medical School. —At the
prize examination! for tbe~ session 1886-87, the following
were successful;-‘-Practice of Medicine: First prize, James
Magauran; second prize, William AIcNealy Wilson. Mid¬
wifery: First prize, Charles Fitzmaurice Harkin; second
prize, Alan E. Mahood. Anatomy: Senior Division—First-
class honours, Alan Mahood (prizeman), A. E. Barrington,
Edward Cuffey (equal), Robert Heard, E. R. E. Ivatts, W. J.
Haslitt, F. P. Nowlan, and R. L. Whitty; second-class
honours, V. L. Jones, C. M. McLaughlin, W. Burkitt, and
W. A. Isaac. Second Years’ Division—First-class honours,
R. A. Yeates, Thomas North (equal), and J. H. Head;
second-class honours, T. Tate, T. Gordon, F. Myles, J. Cook,
R. Dowdall, and J. Kilgariff. (The prize was awarded to
R. A. Yeates, after a special examination.) Junior Division
—First-class honours, D. Corrigan (prizeman), W. Dawson,
T. Miles, J. Heron, E. Taylor, and V. Rutledge; second-class
honours, P. KHkelly, E. Seale, A. Adair, R. Going, H. Earl,
J. Graham, E. Brook, G. Donaldson, and P. Walker.

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784 The Lancet,]

NEW INVENTIONS.—THE PATHOLOGY OF INEBRIETY.

[Apbil 16,1887.

ftefa |tt&enti(ras.

A SCISSORS-CLAMP FOR EXTERNAL HAEMORRHOIDS
OR OTHER SMALL TUMOURS.

It has long been the aim of surgeons to devise an instru¬
ment that would cut and clamp by the one single movement
of the finger and thumb. Such an instrument I have
endeavoured to place before the medical profession. Its
action is self-evident, and requires no explanation. The
simplicity of the instrument at once strikes the observer;
nevertheless, it has taken eight months’ hard working out.
The great difficulty found in practice was to get the clamp
to work and clamp throughout its entire length before the

ecissore-blades began to move. With the instrument as it
now is this has been accomplished, the clamp being firmly
closed before the blades of the scissors begin to move.
Anyone requiring it can have a rack fixed on the handles,
so as to fix the clamp action without holding the instru¬
ment. It has been made for me by Messrs. Maw, Son, and
Thompson, Aldersgate-street, London. The instrument is
elegant in form, light in weight, and very powerful.

Portland House, Cheltenham. FfiKD. A. A. SMITH, M.D., G.M.

A NEW FORM OF TOOTH-BRUSH.

We have received a “three-sided tooth-brush” from
Mr. Wall of Dublin, which he has invented to enable the
molars and bicuspids, being the teeth most generally
neglected, to be more easily cleaned. The name is rather
misleading, as the hairs are arranged on one side only, as is

usual, but the free surface of the brush is deeply concave,
so that the crowns and sides of the teeth are cleaned at the
same time. It does its work efficiently; but, after all,
more depends upon the manipulation than the form of
brush used. _

THE RUBBER STETHOSCOPE.

This is a very convenient and portable form of stethoscope,
single or double, which has been produced and patented by
Messrs. Arnold. It is made entirely of rubber, from ear-
to chest-piece, and can be squeezed and even sat upon
with impunity. It measures twenty inches in length, and
is very flexible. It is therefore convenient for uee where
the shorter and stiffer instruments are inconvenient. It
may fairly lay claim to being a h^ndy, useful, portable
stethoscope.

LIFE ASSSURANCE.

The thirty-second annual meeting of the Whittington
Life Assurance Company was held on the 28th ult., when
the directors presented a report and accounts for the year
1886. By a special resolution the date up to which the
accounts are made has been altered just now from May
1st to December 31st, so that practically the account now
under notice is an eight months’ account only. In that
time the directors have received 506 insurance proposals, for
the sum of £111,452. Of these 410 have been accepted, and
policies have been issued for £80,213, producing an annual
premium income of £2571. The number of proposals
declined has been 28, for £8880; the remainder being stiU
in abeyance. Ten annuities have also been granted tor the
sum of £199 14s. 4 d. During the same period an agreement
with the Emperor Life Office has resulted in the transfer of
assurances which originally amounted to £192,866, but
which under the terms of the agreement have been reduced
to £142,485, for which last-named amount the Whittington
has accepted liability. The net premium income of the year
was £55,050, and the Assurance Fund at its close amounted
to £145,532. _

THE PATHOLOGY OF I>JEBRIETY.

The annual meeting of the Society for the Study and Core
of Inebriety was held on the 29th ult. in the rooms of the
Medical Society of London, Dr. Norman Kerr in the chair.

The President took for the subject of his address “ The
Pathology of Inebriety.” The study was important, yet
difficult; difficult because some diseases, such as certain
forms of insanity, left no post-mortem traoes. In the dis¬
ease inebriety there was either structural degradation or
functional disturbance, or both. There was a prior morbid
state before the outbreak. Every sensation had a phy¬
sical antecedent or coincident, normal in health, ab¬
normal in disease. Dr. Kerr classed drinkers as (1) volun¬
tary and (2) involuntary. Moderate drinkers belonged to
the former as a rule. The latter comprised inebriates
from heredity, traumatic inebriates, and inebriates from
the direct or indirect effects of disease. Involuntary
drinking was abnormal with a pathological antecedent.
The transition from moderate to immoderate drink¬
ing was often a pathological process. The pathological
antecedent might be exaltation or depression, or some other
undefined morbid state. There was depression, for example,
after exhausting haemorrhage and in the crises of neurotics.
Besides the pathology of the inebriate pre-paroxysmal
physical antecedent, there was the pathology of the inebriate
diathesis. Even in many cases of evanescent inebriety
there was a diseased condition. The majority of drinkers
did not respond to excitation to inebriate excess because
they had no inebriate diathesis. Those who did so respond
possessed this diathesis. The inebriate diathesis con¬
sisted in a deficient brain and nerve tonicity. The brain and
higher nerve centres were the seat of inhibition,
which power was affected by the physical state of
brain and nerve; a brain imperfectly or improperly
nourished heavily handicapped the power of control.
This defective tonicity might be (1) inherited or
(2) acquired, as also might special susceptibility to
narcotics. The alcoholic was the most delicate
transmitted narcotic susceptibility. The inebriate
diathesis might be (a) latent or (6) developed. Alcohol was
an effectual weakener of control, and specially injured brain
and nerve cell, thereby being hurtful to intellect, thought,
and morale. The pathological action on brain and nerve
was often accompanied by other bodily pathological
changes. Abnormal nutrition initiated these pathological
alterations. By a pathological process aloohol begat inebriety.
After a fatal paroxysm the post-mortem appearances were
hypersemic, involving specially, the stomach, cerebrum,
ana meninges. Sometimes this extended to the liver,
kidneys, heart, and respiratory organs. In old-standing
cases these lesions were more serious, with neuroglian pro¬
liferation and tortuous atheromatous vessels. Dr. Kerr
concluded by pointing out that in many cases where there
were no special post-mortem appearances, there had been
dynamical and psychical brain disturbances, constituting a
true departure from sound health. Only by a recognition
of its disease-aspect could inebriety be intelligently treated
with a fur prospect of cure.

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RECENT ATTEMPTS AT SANITARY LEGISLATION.

[Apeil 10,1887. 785

THE LANCET.

LONDON: SATURDAY, APRIL 16, 1887.

Thbrk is a great tendency in the mind of everyone
;o magnify the importance of the work in which he is
mgaged, and to seek better methods or farther powers for its
execution. It is by such efforts that improvement is mode,
for by constant perseverance the worker succeeds in carry¬
ing with him the greater number who know or care little
about the subject matter which their more enthusiastic
fellow-citizen has taken in hand. We can, therefore, fully
sympathise with a desire to see perfection attained, and
certainly no one who has any experience of the ill-health
which can be produced by ill-constructed houses will hesi¬
tate to welcome any well-directed effort made to bring about
the changes which increasing knowledge has shown to be
necessary, and especially when evils are being perpetuated
mare on account of the want of appreciation of that know¬
ledge at its proper value than for any other reason. When,
however, it is proposed to embody in compulsory legislation
for the many the principles which have been accepted by
the few, it is time to consider how far the proposal is
calculated to effect improvement, and whether the cost and
the means to be adopted for this improvement are such as
to meet with general approval.

Two Bills have during this session been brought before
Parliament relating to the drainage of houses and public
buildings. It is not at first obvious why other parts of
house-construction, which certainly are as intimately
associated with health, are not deemed worthy of similar
treatment i but as matter of fact they are omitted from
consideration. The reason for drainage being held to
be of such pre-eminent importance is probably due to
the circumstance that a large number of people are now
employed in the reconstruction of house drains and their
fittings while as yet no such attention has been devoted
to the other conditions to which we refer. As a result,
the use of the word “ sanitary ” is being limited, very
improperly, to matters which relate to drains, and we not
only hear of sanitary surveyors as a class of persons who
devote their attention especially to drainage, but we have a
Sanitation of Houses 3ill dealing solely with this subject.
The authors of this Bill are evidently dissatisfied with
the manner in which house drainage is constructed in
the metropolis, and feel there is little hope of im¬
provement from the local authorities, who have since
i 1855 very generally neglected to exercise in the best
w& y the powers with which from that year they have
been endowed, they therefore propose to constitute an
entirely new authority to take over the duties which have
rera *ioed unfulfilled. The Bill unfortunately, in its inception
departs from those principles which are the foundation of
*h modem legislation, and therefore has small prospect of
t)econu flg embodied in the Statute-book. However right may
the views held by certain professional associations, it
is not probable that the Legislature will empower them, as
the Bifl provides, to elect -the members of an authority

authorised to enforce these views upon all London house¬
owners. The proposal to place all houses under the control
of a dozen men elected in this manner is, indeed, evidently
the suggestion of amateurs.

The second Bill is more modest in its ambition, inas¬
much as it proposes to limit itself to dealing with build¬
ings of a quasi-public character, such as schools, hospitals,
hotels, and lodging-houses, but the area of its juris¬
diction is to be wider and is to extend to all towns of
2000 inhabitants and upwards. The Local Government
Board are to be an authority for the issue of licences
in sanitary practice to certain persons and corporations,
and for the most part are to grant these upon the certificates
of a governing body to be elected in the same manner as in
the other Bill. Existing local authorities are under this
Sanitary Registration Bill to be permitted to have some
share in this comprehensive work, for they are to open a
register for all buildings which receive certificates from the
licentiates, and are to prosecute the owners, lessees, and
occupiers of those buildings which have not received this
evidence of the perfection of their drainage. But this
certificate is not to remain in force for more than five
years, and the same process will therefore be repeated at
the end of this period.

There is much to be said in favour of the principles of
drainage which are embodied in these measures. Speak¬
ing generally, they are those recognised in the model
bye-laws of the Local Government Board. When, how¬
ever, it is recollected that under the Metropolis Local
Management Act and the Public Health Act there is
already ample machinery for bringing about, both ih the
metropolis and in the provinces, the ends which the pro¬
moters of these measures have in view, it may well be asked,
What is the need for further legislation ? The answer is
doubtless to be found in the fact that the local authorities
have to a considerable extent neglected to exercise theee
powers. This accusation is, we believe, well founded, but
the remedy suggested is impossible. What is possible,
however, is for the supporters of these Bills to influence the
authorities, and by joining them and taking share in their
proceedings they would inevitably bring about the more
effectual local supervision which is required. Nor need their
influence be limited to drainage alone; there are other im¬
portant questions of local government not less seriously
neglected, and the best results would follow if skilled
members of the professional classes thus made their special
knowledge a guiding power in matters which closely con¬
cern the health and prosperity of communities.

Thb subject selected for treatment by the Croonian
lecturer of this year is one of abiding interest; and he
deserves thanks for doing much to widen and deepen that
interest. The study of the pulse and its indications is,
indeed, as ancient as the medical art itself; and one has only
to turn to the writings of Hippocbates to learn how elosely
and how accurately its variations were observed, with much
remarkable result in prognosis and treatment. For, however
faulty may have been the ideas concerning the nature of the
pulse that have prevailed from the days of Hippocbatbs
almost until now, no one can venture to dispute the accuracy
of observations and the eogacity in clinical interpretation that

Digitized by Google

[April 16,1887.

786 Thb Lancet,] ‘ THE TEACHINGS OF THE PULSE.

have gathered around this subject. With the rise and progress No more can be claimed for the pulse than that it is th-
of physiology there seemed to be a fear lest we should set at best index we have of the condition of the circulation in

nought the old teachings and negloct too much the time-
honoured practice of feeling the pulse. Nor was it without
reason that the lament arose that the rising generations of
practitioners were neglecting the old ways, and relying
more upon instrumental aids than on the tact us eruditus.
To feel the pulse was in danger of becoming a merely
ceremonial pet; and the reading of the sphygmographic
tracing was held of greater import than the reading
of the lessons of the linger. Not that we believe this
lament to have been ever justified, or that mechanical
apparatus, however cunningly devised, can equal in deli¬
cacy the educated tactile sense. There was never any
real danger of converting our clinical records into a series
of observations in which the observer only played the
part of a skilled mechanic. Yet it is well to be reminded
that the pulse is to be read with greater accuracy and
certainty by the old method than by the use of the instru¬
ment which we owe to the genius of Mabey. The
sphygmograph has done a great deal to interpret the
significance of the pulse, and advance our knowledge of the
circulation in health and disease ; but as a means of clinical
observation, as an aid in diagnosis, its place is necessarily
subordinate to the older practice. This Dr. Bboadbent did
well to state, and also to dismiss, once and for all, the
pretensions to a precision which the sphygmograph cannot
.claim. No doubt much of the attraction that the study of the
pulse had for our fathers lay in the mystery that invested it;
and the care with which they separated its varieties, and allied
them to differences in temperament and habit, as well as
employed them in prognosis and diagnosis, was more or less
influenced by the superstitious reverence in which it was
held. Nor did the discovery of the circulation, the starting-
point of physiology as a science, go far to dispel the glamour
that invested the subject, and the true nature of the pulse
remained more or less concealed. Dr. Bboadbent, there¬
fore, did well at the outset to clear the matter of its sur¬
rounding misconceptions by laying stress on the fact that
the pulse felt by the finger as it depresses the artery against
a resisting surface is the sign of the momentary heighten¬
ing of the blood pressure due to the impact of the ventri¬
cular systole. It cannot of course be denied that the vessel
is distended at the moment of its receiving this impact; but
it is not dilated. It is not in healthy conditions disturbed
from its bed. Nor does it indicate the actual movement of
tho blood column. It is a physiological truism that the rate
of the (so-called) pulse wave is wholly different from the
, rate of the blood current; whilst if the current be checked the
. pulse grows in vigour. Th§ pulse, then, thus simply inter¬
preted, gives information mainly upon one of the chief
factors in the circulation; it indicates changes in the degree
and duration of arterial blood pressure, besides informing us
of the rate of the cardiac contractions, which are also often
dependent upon changes in that pressure. By observation
of the pulse we determine the condition of the circulation ;
we infer from its indications the character of the circulation
in the periphery, as well as the vigour of the heart; we can
learn the condition of the arterial system; and, finally, base
upon physiological grounds the evidences of derangement in
the circulation thus derived.

the humaq Subject, and the ipore the sense of touch L-
educated to detect the variations in the pulse, the mor ;
accurate will be our perception of this condition. Tfcr
Croonian lectures have introduced us to this subject, wi:i
ample illustrations drawn from a wide clinical experience;
and yet, if they have done good service in directing attention
to the relations between conditions of circulation and
disease, they have equally left open many paths for further
exploration. Dr. Bboadbent has no hesitation in dispelling
a delusion which is as old as the art of feeling the poke,
lie declares that he has been unable to: associate any con¬
dition of pulse, as regards low or high tension, with any
special vigour of body or -mind or any peculiarities of tem¬
perament. Persons with a pulse of low tension may perhaps,
he tells us, be longer lived; they may not wear out
so rapidly; but, if better able to endure the stress of
life, they are less capable of withstanding the onset
of acute disease. In the presence of such considerations and
of individual differences, it would, then, seem to be hope¬
less to create a criterion or a standard of health from the
condition of the circulation alone, in spite of all a priori
notions to the contrary. When, then, we learn, as in the
very interesting lecture that closed the Beries, that certain
nervous derangements—notably insomnia, convulsions, and
melancholia—are referable to circulatory disorder, we may
fain ask whether this latter is sufficient by itself to produw
these effects. As regards insomnia, the evidence adduced
by Dr. Bboadbent would seem to be all-sufficient, and his
very practical suggestions upon the different forms of in¬
somnia associated with pulses of high and low tension re¬
spectively will be appreciated. As to convulsions, and their
assumed induction from changes in the intra-cranial pressure
due to changes in arterial pressure, 1 it requires something more
than the latter to account for the phenomenon. We admit
the strength of the evidence adduced itf support, especially
that afforded by the arrest of the convulsions on reducing
the blood pressure by bleeding; but the circulatory condi¬
tion is one so common, apart from these nerve symptoms, that
we must assume superadded instability of nerve tissue in all
such cases, whether uraemic or otherwise. The same applies to
the argument respecting melancholia, by which we gather
that Dr. Bboadbent' would infer that the long continuance
of heightened blood tension leading to vascular changes will
ultimately affect the nutrition of the brain and degrade its
tissue. That calomel should purge the soul of melancholy
is an interesting, if ancient, fact; but that the whole of its
explanation lies in the reduction of the arterial tension, or
that changes in the arterial tension are done adequate to
explain the cerebral state, are subjects whiieh may well
be further investigated. This is but one instance of the
points raised in these lectures. We must refer to the
text for the careful expositions, With a wealth Of clinical
illustration, of the variations in the pulse; the conditions of
low tension and high tension, and their significance; the
bigeminal pulse, and its relation to the infrequent pulse, in
which only one out of every two cardiac beats succeeds
in reaching the wrist; the conditions of irregularity and
intermittence, of diefotism and of abnormal frequency,
especially Some remarkable neurotic conditions described.

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The LANdwr,] 1

RECENT PROGRESS IN PHYSIOLOGICAL CHEMISTRY.

[AJ»bil 18,1887. 787'

3: Them topics were dealt with in a manner which to sum to
attract attention, and cannot fail to render great service to
1J clinical medicine by enforcing greater precision in obeerva-
tioo and supplying fresh material for thought.

: '* : Tub excellent abstracts of English and foreign chemical

- research which appear orrery month in the Journal of the
:n Chemical Society of London redder it an easy task to trace

- the progress which physiological chemistry 1 b making.
Nothing very remarkable has appeared for some time, but

: there is a constant influx of* new add. careful observations,

- valuable in themselves, and still more Valuable as supplying
material for new generalisations. England’s share in the

£ work is unfortunately but small. We have a few good

- worker^ but Germany beats all other nations put together
■■ in her industry ia this branch of inquiry. We cannot pre¬
tend to'summarise all the discoveries of the last few months,
but a short account of a few will be interesting to those

- who have not time to read the journals in Which they have
x appeared.

J. Sekqbn, in PflAlgtr's Archio, has contributed Borne
> interesting experiments on the relations of sugar in the
organism. Confirming and extending his previous observa-
* tions, be finds that with any diet and even during inanition

- the fiver forms sugar, probably from peptone. The quantity
-> of sugar is doubled during the-passage of blood through the

liver. In a dog weighing 10 kilogrammes the quantity of
sugar formed in twenty-four hours was not leas than 200
r grammes. With an almost exclusively fat diet this quantity
i continued, and as the quantity of nitrogen excreted was
j only 15 grammes'tbo sugar Could not have been due to the
i decomposition of proCSlds. In a second paper the author
shows that the liver is capable of converting not only fat,
i but each of the proximate constituents of fat, the fatty
adds and glycerine, into sugar, 'flits is. very' important
ihdeed. In the same number which records the last obMr-
' vation P. RoHMAnn states that ammonia, as well as its de¬
rivatives asparagine and glycooOl, increase remarkably the
quantity of glycogen formed in the liver. The true rela¬
tion of glycogen to sugar in'the liver seems still a little
uncertain. Is glycogen always formed first, and is the sugar
found in hepatic blood formed by the: continual metamor¬
phosis of glycogen ? That Seems the most probable view.
SlBGEit, on the other hand, from experiments on the action
of defibrinated blood and peptone on fresh liver, concludes
that sugar is formed directly from fat and from albumen,
but not from glycogen. In that case what becomes of the
glycogenV Some interesting researches on’ the subject-
which, however, do not appear final—were contributed to a
recent number of the Comp tee Itendus by CHAUVBAt and
RAPT-manN. They confirm the statement that glycogen
accumulates in the muscles during rest, but diminishes
during motion. It will be remembered that, on the other
hand, lactio acid increases during exercise. Glyoogen,
according to the last-named observer, is a storehouse of
energy available at any minute for increased work.

Some interesting studies of the ptomaines, so important
from the toxicological point of View, have lately been made.
One of great practical value appeared in our present volume.
Mr. Fm-rtf (Thb Lancet*, 1887, vol.p. 2lSX tracing the
origin*of an epidemic of purging and vomiting among

soldiers in the Pmnjaob, obtained from seine suspected milk
which bad been kept in foul pans a crystalline substance of
unpleasant odour and taste, which communicated similar
symptoms to men and dogs. Pure milk after, standing .lor
two months yielded the same substance, in the Chanuokts
Centralblatt of last year (p; 647) appeared a paper by
0. Gbam, itt which some light is afforded, in regard to the
difficult question Wby some of the so-called ptomaines are
poisonous while others are. not. Ptomaines w6re obtained
from putrid meat easily enough, and proved inert. But
when the hydroohlorates and lactates of these bases were
exposed to heat, the fanner remained inert, while the latter
developed distinctly poisonous properties. ' This Mens to
illustrate the ready formation of poisonous ptomaines from
milk. The author then proceeded to test the theory Which
has been started—that the active poison of ptomaine is iso¬
choline or heurine, the isomeric variety? of choline. By
heating the lactate of ohblihe, itself 'inert he obtained a
poisonous substance similar, at any rate to a poisonous
ptomaine, and possessing the peculiar odour of muscariae,
which is oxy-choline. Bbiegeb (Berichte 19, p, 8119)
describes a volatile alkaloid forming crystalhsable salts,
and having the formula C 5 H U N, which he obtained from
beef extract in.which Rosenbach’s microbe had been colta*
vated. It is monobasic. i ' .

Of interest in another direction is, an hypothesis on the
origin oF the free hydrochloric acid of the gastric juice
propounded by Landwbhr (CAem,. Oent n 1886, p. 484). It
is well known that common salt is decomposed hydro*
lactic acid. This takes place even in cold eolutians; as may
be shown by the addition ofi common salt to a, solution
of lactio acid coloured by methyl-violet. According to
Landwbhb, who has worked on the subject in conjunction
with Pick, lactic acid is formed by fermentation from.the
mucus of the stomach, and, acting on i 'alkaline chi grided,
liberates hydrochloric acid, which in its torn acts on the
albuminoids, combining with them. As peptooisaiioaigoes
on, the hydrochloric acid is liberated, while the iactate of
sodium is assimilated.

Another valuable research ia that of R. Kttlz oil the gases
of parotid saliva, which was published in PrrrEwxosax,
and Vorr's ZeUsehrift fir Biolog.ps, pp. 23-821. Hr. Hauu-
BtmTON’H able synapeis is only a little too long to bb
quoted entire, and wewiih we could reprint it. Saliva
was drawn-vby a cahaula. from Stenson's dudt, and
was collected over mercury. One hundred cubic centi¬
metres gave ? cc. of gas, of which 1, cc. was oxygen,
2-5 cc. nitrogen, ahd-8’5 oc. carbonic acid. Phosphoric acid
caused the evolution of from 40 cc. to 60 cc. of carbonic
acid present as carixmatee in til* saliva. It is noteworthy
that the oxygen and nitrogen are higher than in blood-
serum. The uniform alkalinity is due to the Carbonates,
and it is found that the secretion of gastric juice, which
produces great variations in the acidity of the urine, even
in some ease* rendering it alkaline, does not affect the
saliva, Thiele shown by direct filtration, and also by the
estimation of combined carbonic acid. , ■■ '

Space forbids os to speak of some other recent contributions
to physiological knowledge, but a word must be spared for
H. Stbbn’s paper on the origin of the bile colouring matters
(CAem, Cent., 1888,p.481). Theex^rimeutswerenjadeintwo

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788 Thb Li-NCBT,]

WHAT IS BEBE?—DR. BRUNTON ON HOMEOPATHY.

[April 16,1887.

series, in one of which the bile ducts were ligatured, and in
the other the liver was thrown entirely out of the circulation.
In neither case did blood, urine, or tissues show any trace of
bile pigments, and the author concludes that these substances
originate entirely in the liver itself.

-*-

An influential party in the State has commenced an
agitation as to the quality, or, as they put it, the purity,
of the great national beverage, beer. It is alleged that
beer is adulterated, not only in obvious defiance of the law
by publicans, but also with the sanction or connivance of
the law by many brewers. Beer, say the complainants, is
a beverage made from malt, hops, yeast, and water. Any¬
thing else used in the manufacture is an adulteration, and
is not only a fraud on the purchaser, who thinks he is
buying malt-and-hop beer, but is also a possible and even
probable injury to his health. These are serious allega¬
tions, and require most careful consideration. We will
state our view of the case impartially, and shall at any rate
be acquitted of sympathy with the baneful work of the
adulterator.

First in the order of study comes the all-important
question. What is beer ? And tho answer is by no means so
easy as might be supposed. Beer, like wine, is of extreme
and unknown antiquity. It was made by the Egyptians
from barley, probably, as Herodotus asserts, because the
vine did not flourish in Egypt. In some parts of Europe it
took the place at a very early period of the mead made
from honey which maddened the brains of more northern
raoes. As far as malt goes, the definition of beer appears,
therefore, at first glance simple enough. Taking our stand
on ancient history, we may say that it is a liquid obtained
by the fermentation of malt, or rather of the sweet wort
obtained by the diastasic conversion of the starch of
barley. But in the fermentation by which the alcoholic
beverage known as beer is finally produced, the chief
chemical change is the conversion of sugar into alcohol
and carbonic acid; and other kinds of sugar besides the
sugar of malt, now known as maltose and recognised as a
distinct compound, are capable of yielding alcohol and
carbonic acid by fermentation. For many years past the
law has, rightly or wrongly, permitted the use of sugar in
brewing, and it is very extensively employed at the present
time. We have, therefore, in this as in all other cases of
alleged adulteration, to inquire first, and above all, whether
such a modification of the old brewing process is detri¬
mental to health, and, secondly, whether it can be con¬
sidered as a fraud upon the purchaser. We are unable to
answer either of these questions in the affirmative. It has,
indeed, been asserted that the products obtained in the
fermentation of artificial glucose are cruder and more
noxious than those derived from a natural sugar, such as
the glucose of grapes or the maltose of wort. But, as far
as we know, no definite proof of this assertion has been
produced, and until it is forthcoming the assertion itself
must be dismissed. The question of fraud is leBs simple,
but the answer appears to us to be equally inevitable. If
the Excise permit the use of any innocuous saccharine fluid
in brewing, the public are thereby made aware of the fact.
The demand for the beer eo made will depend on its quality
mid its price, and on both these points the public are

competent judges. The price will evidently be determined
ultimately by the ordinary laws of competition. To put
an extreme case, suppose that beer equal in quality to that
supplied by the best-known brewers could be made for half
the present cost, it cannot be doubted that those great firms
would soon find themselves suffering from a competition
which, although unpleasant for them, would be advantageous
to the beer-loving publio. If the cheap beer were inferior
to that of the well-known makers, there would be, ae there
are now, plenty of people willing to give the higher price
for the better article. But .to prohibit the sale of cheap
beer, unless on the ground that it was unwholesome, would
be as absurd as to prohibit cheap claret or cheap tea. Of
course, if the brewer or the publican sold such bear as made
from malt and hops only, or, worse still, as that of well-
known manufacturers, he would commit a fraud, as he
would if he sold vin ordinaire as some celebrated vintage.
But if he sells a pint of beer or a bottle of claret without
further description, he commits no fraud. If the purchaser
does not like it, he will go elsewhere, and the vendor will
lose his customer and in time his trade.

The case of hops is still simpler. The hop-resin is a
wholesome tonic bitter, but its use in brewing is, compared
with the manufacture itself, quite a modern innovation,
Nowadays we think it an improvement, as some may do
a dash of chicory in coffee. The beer of to-day, even
when made from malt and hops only, is a very different
thing from the beer which washed down the breakfasts of
our forefathers. Now and then in an old-fashioned inn we
still iheet with the “ hard ” or fully fermented ale which was
formerly eo much prized, but to most modern palates it is
unpleasant. Surely no one would pretend that the brewer
who left out hops altogether did not brew beer. The
experience of thousands of years would contradict him. But
the taste of the present time demands a bitter, and provided
that the bitter be wholesome we do not see that it matters
much which is used. If the brewer uses picric acid or
strychnine or any other noxious substance, we have nothing
but detestation for him—down with him by all means, and
as soon as possible. But if he selects a perfectly harmless
bitter, he has, we submit, a perfect right to-do so. The beer
will perhaps be nasty, but in that case the public will be no
more willing to drink it than they would a decoction of
senna. We have tasted beer made, we were told, without
either malt or hops. It was interesting as an example of
applied chemistry, but we experienced no desire to repeat
the experiment.

The fact is, the cry about pure beer is but the despairing
wail of the unfortunate agriculturists, for whom in their
bad times everyone feels the deepest sympathy, but for
whose misfortunes it is hard to find any remedy that would
not be worse for the community than the disease. Simul¬
taneously with the beer agitation, and illustrative of it, is
the cry for an import duty on hops. It is not for us to
discuss the vexed question of free trade versus protection, but
it is obvious that hop-growers are not the only persons who
suffer from free importation, and that if they were relieved by
.an import duty it is difficult to see where we could stop.

Da. Bbunton has fulfilled the promise made in our columns
that in the preface to the third edition of his well-known

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Thb Lancet,]

TIIB REGISTRAR-GENERAL’S ANNUAL SUMMARY.

[Apbil 16,1887. 789*

work, “ Pharmacology, Therapeutics, and Materia Medica,” he
would express his opinion regarding homoeopathy in reply to
the charge that he had taken many of his principal drugs
from the Homoeopathic Materia Medica, as well as the
indications for their use. It is a favourite delusion of
those who hold peculiar views that all other people’s bast
ideas have their germ in what they think their peculiar
property. The homoeopaths have this delusion to a happy
extent, and cultivate it diligently in their writings, though
in their practice nowadays they are as little hindered as
other practitioners by any exclusive principles or dogmas.
Our simple object, however, just now is to give our readers
the benefit of Dr. Bbunton’s views on homoeopathy as a
system: First, and most pleasantly, let us record his admis¬
sions of the service it has done, though similar admissions
have been made before. Dr. Bbunton says the system
which IIahnkmann founded has done great service by
teaching the curative power of unaided nature, the use of
diet and regimen in treating disease, and the more than
inutility—the actual hurtfulness—of powerfal drugs in
many instances. Dr. Bbunton shows how homoeopaths are
led to be anxious about diet. “ If,” says he, “ a patient was
being treated with carbo veyetabilis in the thirtieth dilution,
the utmost care was necessary to his diet, for if he happened
to eat a single piece of burned toast at breakfast he would
consume at one meal as much vegetable charcoal as would,
when properly diluted, have served him for medicine during
the remainder of his natural life.” This is the only passage
in which Dr. Bbunton allows the ridiculous aspect of
homoeopathy to And full expression. We shall try to practise
the same repression which he shows, and deal seriously
with the claims of Hahnemann and his representatives.

First, Dr. Bbunton very lucidly states what homoeopathy
is not; and, secondly, as lucidly states the very essence of
the doctrine. One sentence on page xii. of the preface will
give both points:—

“ It is not the nse of a single drag at a time, of a small
dose, of a globule, nor even, as we have already seen, of a
drug which may produce symptoms similar to those of
the disease, that constitutes homoeopathy. The essence of
homoeopathy as established by Hahnemann lies in the
infinitesimal dose and the universal application of the rule
timilia similibus curantur.”

The ordinary practitioner differs from the homceopathic
in being free to use any drug which he knows to be of
use in the case, and that in any quantity experience
shows to be best. Hahnemann's greatest delusion was
that the causes of disease were not material but spiritual,
and that medicines must be spiritualised to cope with
them. Hence his infinitesimal doses. Fancy any of our
best and most certainly remedial agents being used in this
^ay and on. this theory. When would ague be cured by
quinine, or pemphigus by arsenic, or syphilis by mercury,
il the spiritual theory of disease and drugs were adopted ?
Df - Bbunton says that Hippocbatbs knew that in some
instances a drug in small doses will cure a disease exhibit¬
's symptoms similar to those produced by a large dose of
the drug; but Hiepocbates had the sound sense to see, as
some homoeopaths have had the sense to see, that this was
not a rule of invariable application; therefore not an in¬
variable law, as Hahnemann taught.

Dr. Bbunton deals with the favourite case of cinchona and

ague, the action of which drug on the healthy frame, homoeo¬
paths are fond of saying, led Hahnemann to investigate
the action of other drugs, and thus lay the foundation of his
system. Dr. Bbunton shows that, though Hahnemann
got symptoms of intermittent fever from taking large doses,
of oincbona, they were probably produced by the irritant
action of cinchona on the stomach, which Jona found to
be produced by two-drachm doses, half the dose that
Hahnemann took. He thinks that pork-pie might have
had similar consequences, having often seen ague reproduced
from heavy dinners and other stomach irritations. We are
pretty familiar nowadays with the effects of large doses of
quinine, the essential cure of ague, but the production of
intermittent fever is certainly not one of them. Our
homceopathic friends appear to have been much misled by
Dr. Bbunton's therapeutical index, which indeed seems a
sort of omnium gatherum largely done by an amanuensis,
and so imperfect that Dr. Bbunton had nearly left it out
of his book altogether. His own description of many of
their favourite remedies is very slight, and such as to show
no personal belief in their specifics. His estimate of
Hahnemann will be endorsed by all who with sound
minds have gone into the study of his views. This estimate
is summed up in one or two sentences: “It seems to me
that in founding homoeopathy Hahnemann has proceeded
with his facts as he did with his medicine)—diluting his
aotive drugs with inert matter, and diluting his facts with
much nonsense.” Again: “ It is the falsity of the claim
which homoeopathy makes to be in possession, if not of the
universal panacea, at least of the only true rule of practice
that make3 homoeopathy a system of quackery.”

If homoeopaths rely on Dr. Bbunton for any countenance
of their fundamental doctrines they most be wofully dis¬
appointed. He is a leader in a new and active school of
therapeutics. He is bound to no master. He seeks help in
understanding the use of drugs from a study of their action
both in health and disease. He gives Hahnemann credit
where credit can be given, but this does not prevent his
denouncing his system, and pointing out to those who have
renounced his errors the supreme duty of frankness.

i-rntriatiOTts.

“ We quid nimla.”

THE REGISTRAR-GENERAL’S ANNUAL SUMMARY*

The Registrar-General’s annual summary of the mortality
statistics of London and other large English towns in 1880
has just been issued, and -contains no statistical fact of
more interest than the proof of the continued low death-
rate in the metropolis. The London annual death-rate was
equal to 24 4 per 1000 in the ten years 1801-70, and feU to
22’5 in the following decennium 1871-80. During the first
six years of the current decennium 1881-90, the mean death-
rate further fell to 205; the rate in the last two years,
1885 and 18SG, having been so unprecedentedly low as 19 8
and 19 9. It is worthy of note that the birth-rate in
London in recent years has also shown a very considerable
decline. In the nine years 1872-80 the range in the birth¬
rate was only between 359 and 35'3; while since 1880 the
rate has steadily fallen year by year to 32 3 in 1886. The
decline in the birth-rate in recent years has not been con¬
fined to London, or even to England; but having regard to

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790, ThbLakqbx.J

THE PRACTICAL VALUE OP THE GONOCOCCUS-

[April 16,1887.

the long-ooatinued commercial depression, which. must
have affected the growth of towns, it is only reasonabls
to bear in mind the possibility that the population of
London may not have grown since 1881 at the same rate
that prevailed between 1871 and 18811 If this has been the
case, the Registrar-General’s estimate of the London popula¬
tion is too high, and consequently the calculated birth- and
death-rates in nine years hare been somewhat understated.
Allowing for such possible understatement, however, the
London death-rate in 1885 and 1886 was, beyond a doubt,
unprecedentedly low. Corrected by the distribution of
deaths in institutions, the death-rates last year in the five
groups of registration districts were 17*7 in the west, 18 0 in
the north, in the south, 22-5 in the east, and 25-0 in the
central; thus, in equal numbers living, mortality in the <
Central.group of districts was us 146, to 100 in the west
districts. It may be desirable to point out that these
central districts of London, where the high death-rates of
former days still linger, include St. Giles’s, St. Martin’s-
in-the-Fields, Strand, Holborn, Clerkenwell, St. Luke’s
and the CXty. Oh account, it may be presumed, of
the difficulty of estimating the present local population,
the Registrar-General does not publish rates of mor¬
tality for the individual sanitary areas, which would cer¬
tainly show a wider range than do the rates in the five
groups of districts. The rates of infant mortality (that is,
the proportions of deaths under one year to registered births)
in the sanitary areas ranged in 1886 from 121 in Plumstead,
130 in Lewisham, and 131 in Hampstead, to 199 in St.
Martin's-in-the-fields, £02 in Stepney, 210 in Holborn, and
319 jn theS^mid. Marketbjtherefore, as ha#been the decline
in the London death-rate in recent years* the excess of
mortality in the central districts, whether measured by the
d4atb-rate at'all ages hr of infants, points conclusively to
the possibility of Still farther reduction.

’ DR. WITHERS MOORE AND THE BRIGHTON 1
-*■ '•*' MEETING OF THE ASSOCIATION.

A ti, of‘usi'emember the successful meeting Of the British
Medical Afesociafcion'ufc Brighton last year, and most of us
will agree that not a little of the success and pleasantness
of; it jVfOJ/duo, to Hr.. Withers Moore, whose able address
applied material for articles in the press for a week after.
It is no sligTit testimony to Dr. Withers Moore, and to the
liberality of the profession at Brighton, that, after paying
the expenses of the Association meeting, a good balance was
left, and was appropriated by the subscribers to the purchase
of a very handsome solid silver candelabrum, which has been
presented in their name by Mr. Edward Turner. The
candelabrum bears the following inscription“ Presented
to W. Withers Moore, M.D., F.R.C.P., by his professional
brethren, as a testimony of their regard and in recognition
ol his courtesy and success in discharging the duties of
President of the British Medical Association during their
recent visit to Brighton in the year 1886.” We heartily
congratulate Dr. Moore on so graceful and well-earned a
tribute from his neighbours, and hope that he may loDg be
spar&l to tree if: _

THE PRACTICAL VALUE OF THE GONOCOCCUS.

a paper contributed to the Journal of Cutaneous and
XJeiiito-urinimj Diseases (March, 1887), Dr. Charles W.
Allen discusses the subject of the specific micro-organism of
gqtfoijrticea, and arrives at favourable conclusions respecting
the Importance and practical value of Neisser’s discovery.
Dr. Allen has repeatedly confirmed the observation that the
gbnococcus Is present within the gonorrhoeal pus, and
even in the watery and mucous discharges of chronic gleet.
The detection of the oval coed the pus cells is

sijiiffcient lot diagnosis, the separation of the gonococcus

from other bacteria being based on the fact that this microbe,
after staining by Gram’s method, can be at once decolourised
by absolute alcohol, all other organisms remaining visibly
stained. The practical value of the discovery is Bhown in
the diagnosis of gonorrhcea in the female, and the deter¬
mination of the infective character of a discharge at a long
period after contagion. Evidence is given where gonorrhcea
has remained long latent; and. when called into activity by
excesses, has on examination proved still to retain the
specific organism. The bearing of this on ophthalmia,
neonatorum and on uterine disease is of great importance;
and Dr. Allen goes so far as to maintain the value of the test
in medico-legal practice. Of course, as he remarks, “ great
core would have to be exerciBed to include all possible
sources of accidental contamination " We have not yet hod
recourse to the evidence ef a bacteriologist in a court of
law, and the belief in the pathognomonic character of the
gonococcus will have to be very deeply implanted before
we shall rely on such evidence. It is interesting to read the
stains on linen have been determined to be gonorrhoeal from
the detection of the gonococcus. The proof that the
gonococcus is the materics morbi of gonorrhoea still awaits
full confirmation, inoculation experiments having mostly
failed; but Dr. Alien refers to successful inoculations by
Bumra of cultures, the seat of inoculation being the female
urethra. In one case he used the twentieth generation of a
pure culture in human blood serum, and induced a typical
gonorrhoeal discharge, which Wok five weeks to cure! As
regards treatment, the discovery of the gonocodcns has not
apparently led to any methods superior to those already in.
vogue, although the use of injections of germicidal solution,
as bichloride of mercury, .carbolic acid, &c., (has perhaps
been supported. The difficulty lies in the want of thorOhgh
application of the anti-parasitic agent. - ■ 1 1 ; •' 1 •

' ' ' the 44 DOCTOR" ; '

TilE life of the practitioner of medicine can hardly fail to
be an eventful one. Apparently free from sensation, and
visited not .often by opportunities of high disfcinfctiony it
would he superfluous to say .bow it abounds in -occasions of
fruitful effort, how little there is in it which is really Utbto,
and how,freely, it taxes the best energies of.those -who
devqte themselves to it. It has been truly said by some
who have recently written on this subject ,that such
observations apply most fitly to the life work of the
general practitioner. The “doctor,” as he is familiarly
styled, without too special reference to degrees or qualifi¬
cations, is a man to whom belong responsibilities the more
varied that they are not solely professional, and he had
therefore need to be, and commonly is, as truly human in
sense' and sympathy as he is well trained in the proper
duties of his calling. He may be regarded as the most
typical representative of his profession. There is in his cose
no concentration of energy on the treatment of a special
illness or group of illnesses. Disease in general is the
object of his attack. The whole man he takes to be
his specialty, the relief of his bodily needs a large
but limited field for his exertions, and he endeavours
therefore, Without presumption and without denying the
special aptitude of pioneers in new methods of treatment,
to do his duty as a healer even in so large a field. The
personal qualities which befit a man so usefully ambitious
had need to be as various as the ever-changing conditions
of his daily life. Painstaking, with a care engendered, or
at least fostered, by the discipline of student life, and
maintained afterwards by a constant need of observation,
endowed with a readiness which is the product of actnal
practice and the confidence that comes of sound instruc¬
tion, he must, moreover, learn daily the great lesson of
self-denial, also bow to combine with a shrewd and true

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The Lancet,]

understanding of, human nature a sympathy no leas
just and real with human feeling. We have spoken
of non-professional duties as now and then devolving on
practitioners, and what member of the profession cannot
reoall occasions when he has been applied to as an adviser
in matters of importance wholly foreign to his province
as a medical man? At such times, as inevitable as they
are undesired, a judicious mind and a careful tongue are
far more to their owner than an accurate knowledge of
medicine. It is the possession of these and similar elements
of character, aa much as technical training, which have
earned for family practitioners that reputation for wisdom
and integrity which we would in no boastful spirit
acknowledge as an honour conferred on the profession as a
whole*’ - •• '• '■ __ ■_ ■ ’■ •

INFECTION AND DISINFECTION.

It had often been pointed out in our columns, as elsewhere,
that deodorisation is one thing and disinfection another.
The destruction of bad smells by ho means involves the
destruction of “ infective agencies,” but the destruction of
bad smells' is also an important work, and one which every
disinfectant intended for general use ought to accomplish.
Carbolic acid is defective in this respect, for although a good
disinfectant, it does not deodorise, and simply adds its own
disagreeable smell to those which existed before. Chlorine,
metallic chlorides—such as the chlorides of zinc, mercury,
and lead—sulphurous acid, and the alkaline permanganates
are far more effectual in this respect, and each possesses in
a greater or less degree the power of disinfection. Whilst
the 44 saucer ” treatment of sick-rooms with a little Condy’s
fluid or chloride of lime may well be distrusted, the laudation
of such,means as the use of euchlorine (a mixture of chlorine
and chlorine peroxide) and bromine as aerial disinfectants
cannot be commended. Sulphurous acid.is sometimes under¬
rated. As gas it is just as unsuitable in the presence of
patients as bromine or eochlorine, but in dilute solution it
is very Active. Complete disinfection of an infected atmo¬
sphere in the presence of patients is impossible, but partial
disinfection is easy, and the complete disinfection of wearing
apparel, bedding, &c., by the prolonged use of weak solutions
of metallic chlorides, sulphurous acid, and the like, can be
readily effected without the slightest injury to the fabrics.

MEDICAL ATTENDANCE ON THE POOR.

'A papeu, reprinted in pamphlet form, by Dr. F. H.
Alder&on, on “ Medical Attendance on the Poor, not
Paupers, brings out many points which it is desirable to
keep in view at .this moment, when a committee is trying
to put attendance on the poor on a satisfactory footing. Dr.
Alderson clearly appreciates what we have been trying to
show for years, that the provident dispensary system so far
has not been a success, either as regards the people or the
profe88i6n,aiid that many so.-called provident dispensaries are
worked by unqualified assistants, aud are practically a fraud
on the patients. The only cure, however, he sees is in the
establishment of dispensaries of an improved type that will
attraet, to their staff good, competent, and popular medical
men, at rates that shall be fairly remunerative. Dr. Alder-
sou thizjkp that at present such institutions cannot he
entirely self-supporting, but must have a charitable element.
He objects to patients being received in actual sickness, on
a ready-money payment, thinking this destructive of the
principle of providence or forethought. To meet the diffi¬
culty he would allow a certain number of free letters to be
used by subscribers in favour of the sick, on the understand¬
ing that the latter are to join as soon as they are well. This
seemato us as dangerous, to the provident system as the
^principle of admission on special payment, which has been

[April 16,1887. 791.

actually adopted by the committee now sitting. One feature
of Dr. Alderson’s views is the suggestion of a. graduated
scale of payments ranging from 6s. to 30s. for single persons
per year, or 30 s. to £6 a year for families. He very properly
urges that the payments for children should pot be less than
threepence per month, as they are most prone to illness and
give most trouble. If a friendly system of co-operation
between the hospitals and dispensaries could be arranged, it
would be good for both. The hospitals would have the dis¬
pensaries as a clinical field for the study of common diseases,
and the dispensaries would have the right of recommending
fit cases to the hospitals, or asking for a consultation with
the hospital staff, if necessary. We do not know whether
Dr. Alderson is quite right in saying that the classes whose
benefit is sought by the committee over which Sir Spencer
Wells presides so ably are only the poor, not the industrial
classes.

* PERINEAL RUPTURES IN THE BRUSSELS
MATERNITY.

In Professor Kufferath’s maternity department in Brussels
the smallest lacerations 6f the perineum are sutured imme¬
diately. During the year 1830 sixty cases of laceration
occurred, varying in extent from one centimetre to four centi¬
metres, the sphincter not being involved in any case. These
were mostly operated on. by students, with the result that
oomplete primary union was obtained in fifty-one cases,
and incomplete union in five more, while in four cases the
operation was entirely unsuccessful. The method adopted
is as follows. The patient is placed in the (dorsal)
obstetrical position, the thighs heing separated by assist¬
ants.* The vagina is washed out by a copious antiseptic
injection, and the vulva and perineum scrupulously
cleansed, any dead parts being cut away from the tom
surfaces. A plug of charpie impregnated with oorrosive
sublimate is introduced into the vagina* so as to prevent
the flow of blood inconveniencing the operator. The left
lip of the wound is seized between the thumb and index
finger of the left hand, and the needle, which has, together
with the silver wire attached to it, been previously dis¬
infected, passed into the skin half a centimetre from the
tom edge. When it has reached the bottom of the wound,
its direction is changed* and it is passed through the opposite
lip, its point emerging at a spot corresponding exactly with
that at which it was first introduced. Any haemorrhage pro¬
duced by the introduction of the needle is removed by
charpie impregnated with corrosive sublimate, and the wire
is not tied until this has been done. The first suture is placed
at the most posterior part of .the wound, and the rpst near
together, one after another, till the fourchette is reached.
If necessary, aome. superficial sutures are added, in this
way the edges are retained in close juxtaposition, a con¬
dition indispensable for preventing the accumulation of
blood and the lochia in the deep parts of the .wound* other¬
wise union oannot take place. The' wound is dressed with
iodoform, the legs being left quite' free. Antiseptic vaginal
injections are given twice daily, followed by renewals of
the iodoform dressing. On the sixth or seventh day the
sutures are removed* the patient being placed for the purpose
in the lateral position. Dr. Touroay, who communicate^
these particulars to La Clutique, believes that when the
operation as described is properly performed, it is, or ought
to be, invariably completely successful, as indeed it always
has been in his own hands, whether in the clinic where he
is assistant or in private practice. It will be observed that
he does not introduce the finger into the rectum, or pass the
needle so as to make the entire circuit of the wound, and
that he omits all reference to the use of the catheter aft el*
the operations, matters which are considered by many
writers indispensable to the perfect healing of perineal
ruptures. * •• v ‘ • •

MEDICAL ATTENDANCE ON THE POOR.

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THE EFFECT OF HYDROCHINONE ON URINE AND UREA.

[April 16, 1887.

792 The Lancet,]

THE FRENCH ENTRANCE EXAMINATIONS FOR
MEDICAL STUDENTS.

M. Lobtkt, dean of the Medical Faculty of Lyons, has
just presented a report to the Council of the Faculty on the
subject of the entrance examination required in France from
all medical students intending to proceed to the Doctorate
This consists of the Baccalaurdat 6s Lettres and the
Baccalaurdat es Sciences modified ■with regard to the
mathematics. M. Lortet appears to have no fault to find
with the first of these examinations; but as to the second, or
modified B.Sc., he says that men come up as a rule very
badly prepared, some of them getting plucked fiveorsix times,
and those who do pass doing so with a minimum of marks.
Again, the science which the candidates have learned is
of but little real use to them, as they have to attend the
chemical and other scientific courses afterwards, the medical
faculty not considering the courses in Ihe LycSes nearly
good enough. It would, in the opinion of M. Lortet, and
apparently in that of most of the medical faculties of
France, be quite sufficient to insist upon the possession of
the BaccalaunSat 6s Lettres only for medical students
leaving them to learn their science once for all at their
medical school. A year would in this way be gained.
The Lyons examiners would appear to be particularly
and increasingly* severe, and to have frightened away
most of the candidates to other faculties where more
merciful boards are to be found, the result being that
the Lyons 8chool is suffering from a certain amount of
competition downwards. The number of candidates for the
modified baccalaurdat in Lyons in 1877 was 94, of whom 29
passed; this number has been rapidly decreasing, being 15
in 1885, of whom 4 passed, and 12 in 1886, of whom none
passed. Several other medical schools of certainly not
superior note to that of Lyons admitted in 1885 a much
larger number—e.g., Bordeaux admitted 60; Dijon, 29; and
Toulouse, 67. M. Lortet concludes his report by urging the
Faculty to transmit to the Minister of Public Instruction a
request that the modified Boccalaurdat es Sciences may be
dispensed with altogether._

THE EFFECT OF HYDROCHINONE ON URINE
AND UREA.

Dr. AntaEff, working in Professor Sushchinski’s pharma¬
cological laboratory, has recently investigated the effect of
the presence of hydrochinone on the alkaline fermentation
of urine and on urea itself. Hydrochinone is represented
by the formula C c H 4 (1I0) 2 —being, in fact, benzole in which
two atoms of H are replaced by hydroxyl; it is isomeric
with paracatechine and with resorcine. Mering found it in
the urine after arbutine had been given, and Baumann and
Presse in that of persons who were taking carbolic acid.
Dr. Antaeff found that when 2 per cent, of hydrochinone was
added to fresh urine the latter remained entirely free from
alkaline fermentation. After twenty-five days no cloudiness
or precipitate had formed, there wa3 no ammoniacal odour,
the smell being just like that of fresh urine; the reaction, too,
was acid. When only 1 per cent, of hydrochinone was added
some deposit formed after a time, but there was no arnmo-
niacal odour, and the reaction only became neutral. Obser¬
vations were then made on solutions of urea. To 100 cubic
centimetres of distilled water were added one gramme of
urea and one gramme of hydrochinone. After twenty-four
hours 17 per cent, of the urea had been decomposed. When
the hydrochinone was omitted, only 1 per cent, of urea was
decomposed in the same time. Again, when larger quantities
of urea were present, hydrochinone in the same quantity as
before exerted a still greater effect in increasing the decom¬
position; thus a 3 per cent, solution of urea lost 0'2 per cent,
of its urea, but when hydrochinone was present it lost 13 5
per cent. The solutions of urea with hydrochinone turned

a light cinnamon colour, which became darker on standing.
The destruction of urea by hydrochinone was believed by
Dr. Antaeff to be due, not to a fermentation process, but to a
chemical action of hydrochinone upon urea. Dr. Dianin
suggests that the action may be analogous with that of
acids on urea, which cause it to break up into ammonia and
carbonic acid, with this difference, however, that hydro¬
chinone probably forms a compound with the ammonia as
it is disengaged, which is not easily decomposed by bypo-
bromite of sodium. This theory will also account for a certain
deficiency in nitrogen which was always observed in azo¬
metric determinations of urea in solution with hydro¬
chinone.

POOR-LAW AND SANITARY HOSPITALS.

We have elsewhere adverted to the need for hospital
accommodation for infectious diseases in the T oxteth-park
urban district—a district which adjoins Liverp ool, and as
such is very liable to receive infection. The Toxteth guar¬
dians have been considering the same subject, wn<j at a
recent meeting a proposal was made to arrange with the
sanitary authority for the use by them of the new infectious
hospital attached to the workhouse in Smithdown-lane.
This discussion raises the whole question as to the propriety
of sanitary authorities using Poor-law institutions for the
isolation of the infectious sick. As to this, we would at once
say that unless the Poor-law infectious hospital can be
entirely transferred to the sanitary authority, and be ad¬
ministered by a staff wholly different from that belonging to
the workhouse, the idea should not be entertained. So long
as the hospital remains vested in the hands of the Poor-law
authority it is a pauper institution, and all persons entering
it are thereby pauperised—a result which sanitary autho¬
rities desiring to protect health in their districts have no
right to bring about. Formerly, these workhouse fever hos¬
pitals were the only ones available, and they were used
without any strict inquiry into the social status of the sick :
but of recent years new onee have, we believe, not been
erected unless there wa3 every prospect of their being
needed for essentially Poor-law purposes. The position
which Toxteth occupies with regard to Liverpool doubtless
affords a sufficient reason for the erection of this new pauper
hospital, and the mere fact that it has not been used during
the twelve months for which it has been opened is no proof
whatever that it is not needed for the precise purposes for
which it was erected. The queetion has now been referred
to the General Purposes Committee, and it is important
that they should understand at the onset that so long as
the hospital belongs to the guardians it cannot be legally
used for any non-pauper purposes. Whether a hospital just
erected for Poor-law purposes ought now to be alienated
from those purposes and transferred to the sanitary autho¬
rity is another matter, into which we need hardly enter at
present. _

THE CONTAGIOUS DISEASES ACTS IN INDIA.

A parliamentary paper publish ed recently gives a
summary account of the machinery by means of which the
Contagious Diseases Acts are administered in India. In
itself the information is sufficiently interesting to justify
its publication, although it might have been considerably
improved in this respect by the addition of such statistical
facts as would have given the British public some idea of
the number of persons affected by them and the character
of the work being done. That, however, was probably not
the object with which this return was called for. The
intention of the promoters no doubt was to attack the
administration of these Acts in India, as they have attacked
them at home. Experience shows that in this crusade the
sanitary results obtained go for little or nothing, and that
the responsibility of tbe Government for preventable mischief

Thb Lancet,]

FATAL RESULT OF INTRA-UTBBINE MEDICATION.

[Apart, 19,1887. 793

is a doctrine to which the repealers will not listen. Better in
their view the nameless horrors of surreptitious vice—so
long as it is branded with the name of vice—than the
restriction of the ravages of a disease from which coant¬
less innocent victims as well as the vicious have to suffer.
As yet, however, we hope that wiser counsels will prevail.
It is bad enough that our military stations at home have
lost the heneht of this useful, though unpopular, legislation.
It would be a stall worse case if the benefit of such pre¬
cautions were lost to oar army in India. The ostrich policy
of turning prudishly away from the consideration of such
problems and burying our heads in the sand of looser faire
can lead to nothing hut disaster.

FATAL RESULT OF INTRA-UTERINE MEDICATION.

Db. Otto BnostbOm of Helsingfors relates the following
case in a Swedish medical journal. A woman, aged thirty-
seven, had suffered from persistent metrorrhagia. The uterus
was retro flexed, but no signs of past or presaht inflammation
could be discovered. It wasieplaeed and scraped out with a
Simon’s sharp spoon, two small spoonfuls of hyperplastic
tissue being removed. A solution of iodine in iodide of
potassium at 45 9 C. was then injectedjthe relative proportions
of iodine, iodide of potassium, and water being 1, 2,30. No
fever and ecaroely any pain followed. In five days’ time a
eecond injection was used, the te m per a t ur e being 40° C., and
the relative proportions of iodine, iodide of potassium, and
water 1, 2,10. No pain was experienced, and the patient
walked up- and down-stairs. On the evening of the
second day, however, a rigor came on, followed by
pyrexia, abdominal tenderness, diarrhoea, and convulsions,
death occurring two days. late?. At the necropsy there
were found broncho-pneumonia, chronic cedema of the
longs, endocarditis, and - purulent peritonitis. The sub¬
stance of the uterus was soft, friable, and grey-
coloured, containing specks of blood and lymph. The peri¬
toneum over tbs uterus was of a yellowish-red Colour and
covered with puriform matter. The Fallopian tubes add
their fimbriated extremities were not dilated or particularly
reddened, and the muootts membrane presented no abnor¬
mality. The oa uteri Was too small to admit a fins probe.
A large quantity of pus occupied the peritoneal cavity.
Ur. Bogstrom does not think any of the injection can have
passed into the tubes, still leu into the peritoneal cavity,
and believes that the fatal peritonitis was due to an exten¬
sion of the inflammation directly from the uterine wall to
the peritoneum. _

HANGING AS A SOURCE OF PLEASURE.

If thou are to be believed who, having been more or
less hanged, have,, bean resuscitated, and have narrated
their experiences, the much-commiserated victim of the
law’s extreme penalty is not wholly miserable. It would
*e«m that) even death “sue. per coll.” has its ameliorating
condition's or circumstances. One sufferer in the religious
cause in France is said to have “complained ” because he
was called bdck to consciousness from an experience of sur¬
passing delights, ih Which he enjoyed the pleasure of gazing
upon the-most beautiful scenery.' The immediate sensation of
pain is momentary; and it wouldappear not unlikely that, in
our anxiety for the avoidance of -needless annoyance to those
we put to death judicially, we may be actually increasing
their sufferings and diminishing their pleasure. The in¬
stantaneous deaths 1 hhve all the pain and' little - or none
of the. pleasure. Blowfly induced 1 .congestion of the
brain may be the -least painful, and if only the blood
pressure be effectually raised at the centre that sees, the
beautiful -light: sad- charming s c e n ery are enjoyed in the
highest perfection.. Tbe'aubjecC is a grim one, and we are

not sure that the new view of hanging experience tends to
make the death penalty increasingly deterrent, but it is
right that both sides of a question which the late Mr.
Whalley once excited the merriment of the House pf
Commons by describing as " a poor man’s question ’ should
bo carefully considered at all costs.

THE AIR IN SHIPS’ HOLDS.

Db. A. T. DoBBOTVOMia has recently published thb
results ef a number of observations on the character of the
air in the holds of Russian men-of-w&r from a hygienic
point of view. In reviewing the works of previous writers
on this subject, he claims for a Russian observer, “ N. T.,"
who wrote an article in the Morskdi Sborntk (Nautical Maga¬
zine) for 1869, the credit of being the first to make definite
analyses of the air in ships; observing that Parkes, in the
second edition of his book, published in England in 1866 and
translated into Russian in 1869, states that the composition
of the air in holds is not known. “N. T.” found 1‘19 pet
1000 of carbonic acid on the upper deck of the monitor
Bron&nosets during the night when forty-one men were
sleeping there. Dr. Dobrotvorski’s estimations of CO s
were made by means of a modification of Pettenkofer’s
method proposed by Nagorski, which, however, he does not
further describe, though he says it is the most exact and
convenient plan, only requiring small bottles of the air. For
the free and albuminoid ammonia he employed Dr. Fox’s
method, as given in his “ Sanitary Examinations of Water,
Air, and Food.” This, as being probably but little known
in Russia, be describes pretty fully. In the bilges of the
Peter the Great, the largest vessel in the Russian navy, the
moisture was found to be 89 - 5 per cent., the CO s 4'6 per
1000, the free ammonia 0 - 026 milligramme per 1000 litres,
and the albuminoid ammonia 0 - 24G milligramme. The
highest estimates of CO a were in frigates and floating
batteries, the lowest in clipper ships. In the engine-room
of the Admiral Spiridoff, an iron frigate built in 1868, the
C0 2 was found to be as high as 8 22 parts per 1000. The
ammonia found varied a great deal -being, however, only
slightly higher in the frigates and batteries than in clipper-
built vessels, and bearing little relation to the quantity
of CO a ; thus, in the bilges of the Peter the Great the
albuminoid ammonia was 0 246 milligramme per 1000
litres, in the engine-room of the Admiral Spiridoff
0-154 milligramme, while in a part of the floating battery
Pervenets, where the C0 2 was only 2 - 37 per 1000, the albu¬
minoid ammonia was 0564 milligramme per 1000 litres.

INSANITARY BETHNAL GREEN.

Thb Mansion House Council, which has investigated the
sanitary state of many-parts of the metropolis, with refen-
mtee especially to the housing Of the poor; has brought
under the notice of the Local Government Board the state of
a number of houses in Bethnal-green, where, it ia implied,
there has been considerable neglect. According to a letter
addressed by that Board to the Bethnal-green veetry, it is
said that the plan followed on a former ooeasion—namely,
that of requesting the Home Secretary to-appoint an officer
to investigate the circumstances of the alleged complaint—
will be followed this time._

DEATHS OF EMINENT FOREIGN MEDICAL AND,
SCIENTIFIC MEN. . . ,

Thb deaths of the following foreign medical and scientific
men are announced s—Dr. Wilhelm Brummerstadt of Roe took,
well known for hie writings on obstetrical and gynecological
subjects; Dri Johann Strong, Professor of Midwifery in the
Bohemian University of Prague. Dr. Andreas BOecker of
Berlin, a wnH-known laryngologist..

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794 Thk Lancet,]

THE OYER-STOCKING OP THE PROFESSION.

[Apbil 16,1887.

TESTIMONIAL TO DR. KENNEDY OF MERCER’S
HOSPITAL.

At a meeting recently held at the Shelbourne Hotel,
Dublin, Sir Charles Cameron in the chair, it was resolved to
present Dr. B. Burke Kennedy, resident surgeon of Mercer’s
Hospital, with an address expressive of sympathy with him
in the trying ordeal through which he ha9 passed; also to open
a “ Defence Fund” to pay the heavy legal expenses to which
he was put. It will be remembered that a charge of man¬
slaughter was made against Dr. Kennedy for removing a
delirious patient from an ordinary to a special ward. After
the evidence for the prosecution had been heard, the jury
stopped the case, and returned a verdict of acquittal, with
the following rider:—“ We consider that, according to the
evidence, Dr. Kennedy should not have been subjected to
the hardship of a prosecution.” Subscriptions to the fund
should be forwarded to the hon. treasurer, Dr. McVeagh,
1, Rutland-square East, Dublin. A copy of the Report of
the Corporation Commission of Inquiry, and of the Abstract
of Trial and Verdict in the Law Courts, may, we understand,
be had on application to the hon. secretaries—George H.
Kidd, M.D., L.R.C.S.I.; Arthur H. Benson, M.D., F.R.C.S.L;
Robert Wade, F.R.C.S.I.; and F. Alcock Nixon, F.R.C.S.I.

THE OVER-STOCKING OF THE PROFESSION.

We have long pointed out that the creation of new
doctors in Great Britain exceeds the waste of the profession
by some hundreds yearly. In Germany the increase is so
steady and serious, that at the recent meeting of the German
Physicians’ Association (a society organised, as the New
York Medical Record puts it, in the social and economic
interest of the profession, rather than in that of medical
science) an address was issued advising young men against
entering the profession as the prospects are becoming worse
yearly. The Record takes some warning from this action
of the German Association. It understands it to mean that
there will be a larger importation of pure German physicians
into the States. And our contemporary adds, with much
force, “as our colleges turn out from 4000 to 6000 new
doctors every year, the prospect is, of course, most
pleasant.” _

CHRONIC URETHRAL DISCHARGE.

This ailment is one which not unfrequently proves singu¬
larly intractable, and calls into requisition all the acumen
and practical skill of the surgeon for its successful treat¬
ment. It is a disorder of a symptomatic nature which owns
many sources of origin, mostly local, but sometimes in part
constitutional. What is the appropriate remedy in one case
may be, on the whole, unsuited to another, so that empiricism
in medication is apt to fail where a rational course of pro¬
cedure gives the happiest results. It must not be assumed
that all cases of urethral catarrh are gonorrhoeal—we use
the latter term in its clinical, not its pathogenic sense,—for
not seldom one meets with patients suffering from chronic
discharge, concerning whom the practitioner elicits no
evidence to prove or suggest that the disorder is the conse¬
quence of impure intercourse. The menstrual flux, lochial
flow, or the acrid vaginal secretion often met with in
pregnant females, are severally capable of setting up acute
or subacute urethritis, which when once initiated may give
c6nSider4ble trouble to eradicate. The complaint, what¬
ever its cause, is, in the ordinary routine of practice,
too often assumed to be entirely local in its nature as
it was in its incidence. But just as in a strumous indi¬
vidual some, slight irritation is apt to start a trouble¬
some attack of ecxema, so in patients of a pyogenic
tendency urethral catarrh may vary in intensity and duration
far beyond the measure of its primary cause. In such cases

ferruginous tonics, a bland regimen, and mild astringents
are the appropriate treatment. Again, we have known
instances in which the removal of obstruction to the free
circulation through the hsemorrhoidal vessels has acted
.beneficially on the urethra—such, for example, as the
removal of piles or the cure of chronic constipation. If the
discharge is dependent on urethral granulations, the site of
which is frequently indicated by increased sensitiveness to
oatheterism and resistance to the passage of the instrument
then gentle pressure with a bougie, continued for, say, a
quarter of an hoar at a time and repeated two or three times
a week, may suffioe. Or the pressure may be combined with
the application of some astringent in the form of soluble
gelatine medicated bougies. On the supposition that the
morbid action depends on the vitality of certain micro¬
scopical organisms, some surgeons advise the employment of
antiseptics, such as iodoform, eucalyptus oil, &&, weak
solutions of perchloride. of .mercury, and the like. Them
chemical substances are inimical to the life of micrococci,
and, moreover, tend to check the physico-chemical reactions
involved in the decomposition of animal matter. We cannot
deprecate too strongly the unrestricted use of strong
astringents—or even of weak solutions for the matter of that;
for we are convinced that it is not a rare event for chronic
urethral discharge to be perpetuated by the very means
adopted for its removal. Nay, further, it is not too much to
assert that not a few oases of stricture owe their origin to
the practice of doing too much. It should be borne in mind
that urethritis has a tendency to get well of itself, and that
the tendency may fail in giving plaoe to accomplishment on
account of meddlesome surgery.

THE DUCHESS OF CUMBERLAND.

From information just received from our correspondent
at Vienna, we learn that the preliminary stage of the illness
from which the Duchess of Cumberland has been suffering
was one of long duration, characterised by languor, insomnia,
and disinclination for food, together with anxiety and the
possession of painful delusions. Her constitution, which
has always been somewhat delicate, appears to have been
severely taxed by the troubles incident to maternity. The
physical and mental condition of the Duchess is now, how¬
ever, greatly improved. Artificial feeding has never, in
spite of rumours to that effect, been found necessary, and
sleep is now obtained without resort to hypnotics. The
cheerfulness significant of returning health is also beginning
to be manifest. The physicians in attendance express their
opinion that the case is a curable one, and that gradual
progress towards recovery may be anticipated.

A DANGEROUS TOY.

An inquest was held on the 6th of April on the body of
a boy aged eight years who had died suddenly from asphyxia.
At the post-mortem examination, a toy, only too well known
as “ a squeaker,” with the indiarubber bag attached, was
found impasted in the larynx. This bad formed a most
perfect plug, completely closing the air passage. It is to be
hoped that this accident may be noted by parents, and the
use of this toy forbidden; not only will they thus be relieved
from a source of anxiety, but their friends from one of
much annoyance. _

THE MARGARET-STREET INFIRMARY.

Dr, John Beckett, Dr. Tnckey, Dr. Roberson Day, and Mr.
Kenneth W. Milltcan have been elected to fill vacancies at
the above infirmary. We are not aware whether all these
gentlemen are avowed homoeopathists; if they are not, we
can bnt deplore their acceptance of the poets.

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The Lancet,]

THE LEICESTER SICK BENEFIT SOCIETY—CHILDREN’S TEETH. [April 16.1887. 795

REPORTED ILLNESS OF MEMBERS OF
PARLIAMENT.

The Right non. the Speaker of the House of Commons
has authorised us to state that a paragraph which appeared
iu several of the morning papers on Wednesday (13th inst.), to
the effect that within the last fortnight six members of the
Lower House bad been incapacitated from attending the
debates by diphtheria, is without foundation.

THE ASSISTANT-PHYSICIANSHIPS AT GUY’S.

Wa understand that the governing body at Guy’s have
determined that they will receive and entertain applications
lrom physicians outside the hospital for at least two of the
vacancies at present among the assistant-physicians. The
appointments will be filled up at the Court of Governors to
be held on April 27th, and candidates are requested to send
their applications to the treasurer prior to this date. We
cannot bat think the Court well advised in thus opening up
its appointments and in seeking to obtain the best available
man for the vacant posts. The example is worthy of imita¬
tion by lesser schools. _

THE LEICESTER SICK BENEFIT SOCIETY.

Mb. Jambs Wtllan, of 62, Humberstone-gate, Leioeater,
after appearing repeatedly before the borough magistrates
for neglecting to show a member the books of the Leicester
Sick Benefit Society, has been fined £o or one month’s im¬
prisonment. The magistrates were dissatisfied at the
defendant for not producing the ledger, and tbe vague
excuses made by him for not doing so. The financial affairs
of this society, and the representation of them by the secre¬
tary, have been the subject of much adverse criticism during
the last few months, and apparently with too much reason.
The defendant gave notice of, but does not seem to have yet
made, appeal. _

CHILDREN’S TEETH.

It is gratifying to learn that the importance of proper
attention to the teeth of school children—a subject on
which we have more titan once com mem ted—is coming to be
more fully recognised by managers of schools. Thus, at the
North Surrey District School, Mr. Henry J. Moxon, L.D.S.,
has, at the solicitation of the managers, and with the
approval of the Local Government Board, just delivered a
popular lecture to the officers and senior scholars of the
institution, on the construction, function, and means of pre¬
serving the teeth. This, we believe, is tbe first oocaeion on
which an address of the kind has been given in a Govern¬
ment school, and it offers an example which may well be
followed in other similar establishments.

FOREIGN UNIVERSITY INTELLIGENCE

Berlin. — Privy Councillor Olshausen of Halle has
acoepted tbe invitation to fill the late Professor Schroeder’s
chair of Midwifery, and will commence his lectures on
May 1st.

Buda-Pesth.— A new department for ear diseases in the
Rochus Hospital has been established under the charge of
Professor Boke, wlio gives clinical instruction there.

SlarmUes .—Tbe Medical School has recently increased
considerably, and a chair of Bacteriology has been founded,
for which the Council-General of tbe Bouches-du-Rhdne
has voted the sum of 2000 fr. The Chamber of Commerce
has passed a resolution expressing its desire that tbe Medical
School, which is at present one of the Scoles de plein exercise
or second-grade schools, should be converted as soon as
possible into a faculty or first-grade school. It is stated
that the number of entries has been for the doctorate 129,

and for the licence fas officier de santi) 114, besides 381 in
the Pharmaceutical School.

Rostock .—The chair of Botany, vacated by Professor
Gbbel, who has gone to Marburg, has been offered to and
accepted by Dr. Paul Falkenberg, Extraordinary Professor
in Gottingen.

Wurzburg. —The vacant chair of Psychological Medicine,
which was offered to Professor Jolly of Strassburg, having
been declined by him, will now be offered to Dr. Rieger,
privat docent. _

TEACHING AT THE “ZOO”

It may not be generally known that by the combined
liberality of the Zoological Society and the Association for
the Extension of University Teaching, facilities are now
offered to students desirous of obtaining a real and practical
knowledge of the science of zoology. Familiar demonstra¬
tions will be given by Professor Beddard to all who choose
to attend during the next three months, at a cost not
exceeding tbe bare price of admission to the gardens. In
arranging this course the University Teaching Association
has taken a decided stop in the right direction, and it is to
be hoped that further advances will be speedily made towards
the development iu the teaching of physical science.

ON the 12th inst Dr. Daniel Rutherford Haldane died at
his residence in Edinburgh. The deceased took the degree
of M.D. at the University of Edinburgh in 1848, and became
a Fellow of the Royal College of Physicians in 1862. lie
was a Fellow of the Royal Society of Edinburgh, and
several years ago received the degree of LL.D. from the
University of Edinburgh. Dr. Haldane was for some time
president of the Royal College of Physicians of Edinburgh,
and represented the College in the General Council of Medical
Education and Registration of the United Kingdom.

The sudden death on the 8th inst. is reported of Mr. J. J.
Eberle, of Thirsk. Tbe deceased was well known in
the profession, having for many years acted as a private
tutor for the various medical examinations of the licensing.
bodies. _

At the next meeting of tbe Royal Statistical Society on
Tuesday evening next, the 19th inst., at the Royal School
of Mines, 28, Jermyn-street, a paper on “Class Mortality
Statistics” will be read by Mr. Noel A. Humphreys.

The circumstances attending the sinking of the emigrant
ship Kapundu have largely influenced the Board of Trade in
the determination to ask for the appointment of a Select
Committee to inquire into the subject of loss of life at sea.

Antitiibbmin is the latest introduced antipyretic agent.
It is allied in its chemistry to antipyrin ; phenyl-hydraxin-
levulinic acid is the chemical name.

Du. Robert Barnes has been elected an Honorary Fellow
of tbe Chicago Gynaecological Society.

Preston Medico-Ethical Society.—A t the annual
meeting of this Society, held on Thursday, March 31st, the
following members were re-elected officersPresident:
Dr. Moore. Vice-President: Dr. Lonie. Treasurers Dr.
W&lmesley. Committee: Dr. Smith, Dr. Garner, Dr. Green,
Dr. Rayner, Dr. Trimble, and Dr. C. Rigby. Hon. Secs.:
John Holden and J. J. Byrne. The subjoined resolution was
also passed: “That, in the opinion of this Society, it is
very desirable that an independent inquiry be made on the
sanitary condition of the town by the Local Government
Board, more especially in regard to the high mortality.”

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VOLUNTEER MEDICAL STAFF CORPS: EASTER MARCH.

[April 19,1887.

796 Thb Lancet,]

VOLUNTEER MEDICAL STATE CORPS :
EASTER MARCH.

Three companies of this corps joined in the Easter
manoeuvres of the Volunteers, two going to Dover and one
to Eastbourne. The Dover contingent, about 100 strong,
with full complement of officers, left Charing-cross on
Friday morning, under the command of Surgeon-Major
A T. Norton. The men were divided into two companies
under Surgeon-Major Caeson and Surgeon Willett. The
Adjutant, Surgeon Lees Hall, M.S., and Surgeons Lake and
Raw also accompanied their seniors. On Friday night the
corps took part in the night attack, and during and after
the fight kept up careful search for wounded men over the
scene of the fight. At Dover the headquarters of the corps
were marked by a conspicuous white flag emblazoned with
a red cross. On Saturday the force had a very long tiring
march, moving in three columns by different routes from
Bridge and Canterbury to Dover. Each column was
accompanied by an ambulance and water-cart, and the senior
medical officer was responsible for the medical arrangements,
Surgeon Whitmore (3rd London), Surgeon Jones (14th
Middlesex) and Surgeon Buck (17th Middlesex), being in
charge of the columns. The Volunteer Medical Staff Corps
accompanied the centre column. Only eight men fell out
during the day, which is a matter of congratulation, con¬
sidering that the right column marched twenty-three
miles over very rough country. In this column only
two men fell out.

On Monday the bearer companies marched past with
great tclat, their smart appearance and well-locked up
ranks eliciting much approbation. A company of the
V.M.S.C. also went to Eastbourne under Surgeon 6quire.
On the Tuesday before Easter, however, a small party of
fourteen men under Serjeant MacLeod very pluckily set
out to march to Eastbourne with regulars. The
main body of the company marched on Friday morning,
Surgeon Valentine Matthews joining it later on. The com¬
pany was well equipped with mule litters, and had its
own signallers. At Eastbourne a station hospital was
established. Ample opportunity was afforded the men of
learning what real work meant, and their smart appearance
elicited hearty applause on more than one occasion from
on-lookers. Staff Quartermaster Robertson and Quarter¬
master Clarke accompanied the Dover companies; Quarter¬
master J. J. Thomson accompanied the Eastbourne company,
and from the careful preparations of these gentlemen, com¬
bined with the invariable hospitality of the medical men
throughout the districts through which they marched and
were stationed, most certainly the V.M.S.C. had no cause of
complaint.

Some real surgical work occurred during the day, show¬
ing the efficiency of the medical staff and the men
attached to their corps. It appears that towards the
end of the action three gunners of the 3rd Kent
Artillery force were injured by the premature discharge
of a gun. There happened to be no surgeon with the
battery, so that their comrades proceeded to render “ first
aid ” whilst a surgeon was sent for. Mounted officers gal¬
loped off in two directions—one to the field hospital and
the other in the direction of the bearer company. Acting
Surgeon Pearce. M.D. Lond., of the “ Artists,” on duty at the
field hospital at Maydensoule Farm, speedily providing himself
with a surgical haversack, rode across country at once to
the scene of the accident. He found that Gunner Whit¬
more, who was seriously injured, had been placed on a
stretcher made of a hurdle, an improvised tourniquet had
been efficiently applied above the elbow, and the shattered
hand well bandaged. He was being borne towards a neigh¬
bouring farm near the scene of the accident. He was then
carried into the farmhouse and laid upon a couple of
tables. At this moment Surgeon Raw and Quartermaster
Webb, A.M.D., with a detachment of the Volunteer Medical
Staff Corps, all of them medical students from St. Bar¬
tholomew’s, London, Guy’s, and St. Mary’s Hospitals, arrived
Jh an ambulance waggon completely equipped with surgical
topliahees and medical comfortB. Burgeon Pearce took
marge of the case, and before proceeding to further steps
Siirgeon Raw administered chloroform, atod the shattered
limb Was examined after reapplication of! a tourniquet,

the fracture set, wounds dressed, and the injury of the
eye and scorching of the head attended to. The
unfortunate man was plaoed in an ambulance waggon and
conveyed to Dover Castle Station Hospital, where the limb
was amputated below the elbow by Surgeon-Major Greenhill,
G.M.O., Surgeon-Major Slaughter, Surgeon Begg, M.S., with
the active assistance of Surgeon Raw and Acting-Surgeon
Pearce. The other injured men, who were much scorched
about the face, were conveyed to the field hospital, aad
received attention from Surgeon Bourlton, M.S. The whole
medical administration for the day reflects great credit
upon the medical authorities, and the accidents which we
regret to have to record found the medical aid of the
Volunteer department, of which we have heard eo much
lately, not wanting when the time of real emergency
arrived.

THE LANGMORE DEFENCE FUND.

We published last week from Dr. Leach man a letter
headed “ A Viotim of the Law,” and appended some comments
thereto, in which we intimated that a subscription had been
started by the Council of the Metropolitan Branch of the
British Medical Association to reimburse the gentleman
referred to in that communication, the costs of the defence
in a suit (Hughes v. Langmore and others) which, it will be
remembered, came on for hearing before Mr. Justice Manisty
in November, 1886, and which resulted, after four days'
trial, in a verdict for the defendants with costs. The
amount of the costs was considerably increased by the fact
that, on the plaintiff's petition, one of her witnesses (the
doctor who was actually attending her at the time of Dr. T. W.
Langmore’s visit) was examined by special commission;
but at the trial the plaintiff refused to put in the evidence
thus taken, or to place the witness himself in the box,
though it was elicited that he bad been quite recently, and
it was inferred that he was then, resident in England. The
plaintiff being a person of small means. Dr. Langmore has
not been able to obtain payment from her of any portion of
the costs awarded him, and has been called upon to pay
legal expenses amounting to £240 8«. Id., irrespective of
personal expenses connected with the action, and the
inevitable loss of time and practice. Donations should be
sent to Mr. George Eastes, M.B.,69, Connaught-street, llyde-
park-square, London, W., one of the honorary secretaries of

The following subecriptions to the fond have been already
promised or received

Me. W. Adam*.

£3

3

0

Sir W. W. Gull, Bart. ._

£2

0

O

Mr. C. A. Alkin.

2

2

0

Dr. C. J. Hare .

5

5

0

Mr. C. B. Aikln.

1

1

0

Sir W. Jenner. Bart.. M.

10 10

0

Mr. W^Morrant Baker ...
Dr. R. Barnes .

a

2

0

Dr. G. Johnson.

1

I

0

1

0

0

Mr. H. Juler .

1

1

I

Dr. G. P. Bate.

1

1

0

Dr. Norman Kerr ._

1

1

o

Dr. J. 3. Bristowe .

2

2

0

Dr. A- W. Leachman

5

0

o

Mr. Lennox Browne

1

1

0

Dr. J. D. Mann.

1

1

0

Dr. T. Buzzard.

2

2

0

Dr. H. O. Martin ...

2

2

0

Dr. W. B. Cbeadle .

a

3

0

“ Member of tbe Brand

0

10

0

Mr. Wiltington Clark

Dr. W. F. Cleveland

2

2

0

Mr. J. J. Merrlm&n...

1

1

0

1

1

0

Dr. T. Morton .

0

10

0

Mr. G. A. Orltcliett.

1

1

0

Dr. Dawson Nesbitt...

1

1

0

Dr. H. K. Crocker ... .;.

I

1

0

Mr. H. Owen .

1

1

0

Mr. J.B. Curgenven.

1

1

0

Sir James Paget, Bart.

2

2

0

Dr. W. H. Day.

1

1

0

Dr. W. Price .

1

1

o

Dr. J. Langdon Down ...

1

1

0

Dr. Henry Savage ...

2

2

»

Dr. J. Matthew* Dnnoan

1

1

o

Mr. W. B. Sibley ...

2

2

0

Mr. A. E. Durham .

2

2

0

Mr. Morton Smale .,

1

1.

(►

Dr. John Bastion .

2

2

0

Dr. W. V - . Snow...

1

1

0

Mr. W. Fuller .:.

0 10

0

Dr. U. S. Tioehurst

X

1

0

Dr. A. T. Glbb'ngs.

0 10

6

Mr. J. Smith Turner

1

1

0

Dr. J. F. Goodhart.

1

1

0

Mr. A. M. Vann... ...

0

&

0

Dr. W. R. Gowers .

1

1

0

Dr. E. H. Vinen

.1

1

o

Dr. W. C. Grlgg .

2

2

0

Dr. Julian Willis ...

1

1

0

Pass and Pluck in Brussels. —At the recent
examinations in the University of Brussels for the Doctorate
in Medicine, one out of ten was rejected for the first Doctorate,
and four out of ten for the second, while all the se*en
candidates -for the third Doctorate, or final examination,
passed, so that only five of ;the whole twenty-seven candi¬
dates failed to sat isfy the examiners. From the list of names
published it would appear tnat there were no candidates,
or at least no successful ones, from this country. In the
two preliminary examinations for 'the title of candidate
dealing with anatomy, phyaiotogy.dhetaiBtty, Ac., eix candi¬
dates were rejected nut of a total of sixteen.

O

Thk Lancet]

REPORTS OP MEDICAL OFFICERS OP HEALTH.

[Afbi 16,1887. 787

oor ITak

LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Bedford Urban District. —Dr. Prior desls at considerable
length in his annual report for 1886 with the question of
isolating cases of infectious diseases. Bedford is one of
those towns which can make a sort of plea that such accom¬
modation is nob pressingly needed by them, because there is
a special fever hospital at the General Infirmary, and also a
so-called small-pox hospital just outside the town. But the
fever hospital belongs to a body of governors; it is unfit for
the reception of two kinds of infectious fever, although the
different floors were at one time so used before disaster
occurred in consequence, and as a matter of fact it does not
answer the public health requirements of the district. Then
the small-pox hospital is an iron shed belonging to the
guardians, and as such leading to the pauperisation of those
who use it; it is also a deterrent and unsuitable building.
Taking Bedford with this provision, Dr. Prior compares it
with Biggleswade, where a proper hospital has been erected,
and he gives it as his experience that it is such a hospital
which is needed for the Bedford urban and rural districts.
And he gives force to his contention by showing his autho¬
rity that Bedford is probably on the verge of another scarlet
fever epidemic. Even if the two authorities referred to are
not prepared at once to provide for the total needs of their
two districts, they would do well to secure a proper site
and make a commencement by erecting such an isolation
pavilion as is shown in the recently issued diagram of the
Local Government Board. And as they progress in this
matter it would be well if they were to receive all infectious
caaes by arrangement with the General Infirmary, and
enable the existing fever buildipg to be utilised for the

S ral purposes of the infirmary. Bedford had in 1886 a
1-rate of 16 42 per 1000.

Kettering Urban District. —Mr. Dryland finds remon¬
strance with parents as to the impropriety of feeding infants
with the food of adults quite useless, and this notwithstand¬
ing the fact that the practice leads to a waste of infant life
which could easily be avoided. Some typhoid fever has
occurred in connexion with polluted well-water, and ap¬
parently a difficulty is experienced here which is often felt
elsewhere. It is not easy to ensure closure of wells unless
pollution can be proved, but wells sunk in dangerous
relationship with contaminating sources are often only
intermittently fouled, and hence action has to be delayed
until the evil which should be avoided has actually taken
place. In this case water evidently producing typhoid fever
could on certain occasions be found to pass as unoontami-
nated in tbe analyst’s hands, and under such circumstances
the owners of tbe wells, and even magistrates, are disinclined
to believe that the negative evidence of tbe chemist is, in
such cases, all but valueless. But we would counsel officers
of health to support their action in such instances by making
widely known in court and elsewhere the evidence published
on this subject in Dr. Buchanan’s official report a few yean
back. Good work is going on in Kettering as to the abolition
of privies; tbe fitting of flushing apparatus to cloeets, the
reconstruction of house drains, aad the supervision of such
establishments as slaughter-houses. A small outbreak of
a mall-pox took place last year, but no recently vaccinated
person was affected. The death-rate for 1886 was 17 per
WOO. • j

Toxtsth Park Urban Distriot.-^ln this favoured suburb
of Liverpool the annual death-rate for 1886 was 13-4 per
1000 on a population of some 17,500. The zymotic rate was
somewhat higher than tbe average; tbe more fatal of the
diseases in question having been measles, whooping-cough,
and diarrbma. Amongst the infectious diseases which were
reported to Dr. Steeves there were 24 from scarlet fever,
14 from diphtheria, and 2 from typhus. • These occurrences
alone suffice to show the need for being prepared to isolate
the first attacks, and the report states that during the year
a site for a hospital vtas inspected by Dr. Thorne Thome
Mid General Carey, of the Looal Government Board. The
site is one in which the adjoining district of Wavertree is
interested, and probably owing to the failure to secure
united action between the two authorities delay is taking
place la this important matter. In the meantime good

luMic fjealtlj anb

sanitary work is in progress; dairies and bakehouses are
inspected, and ashpits are subject to a weekly supervision.

Tovryn Urban District .—In connexion with an outbreak of
some fifty cases of scarlet-fever at Brynorug, Mr. Orosholm
brings under the notice of his sanitary authority the more
recent information as to the causation of this disease, but
he is able to show that infectious diseases are by no mesne
prevalent. In some respects the water-services would be
improved if filtration ana increase in quantity could be pro¬
vided. Towyn drainage scheme unfortunately has fallen
through, and certain parts of the town have to trust to
cesspools. This town is one to which visitors are now
attracted, and all its sanitary circumstances should be oore-
fuily looked into. At Aberdovey improvements in sewerage
are needed; at Bryncrug water-supply and privies need
attention; but, speaking of the district generally, much has
been done in the interests of cleanliness. The general death-
rate daring 1886 was 17 9, and the zymotic rate 0*54, per 1000.

Brentford Urban District .—This district oontinues to
make some trivial use of the High gate and I slingt on-road
Hospital for its infectious cases; but it is dangerous to
trust to the accommodation there, for at any moment there
may be none available. The zymotic rate was unusually
high, this being mainly due to whooping-cough and measles ;
but at any time it may be some disease urgently calling for
isolation, and hence Mr. Williams begs the authority to con¬
sider the needs of the district in this respect. Progress has
been made as to sewerage and drainage in the district,,
which in 1886 had a death-rate of 18 9 per 1000.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6426 births
and 3641 deaths were registered during the week ending
April 9th. The annual rate of mortality in theee towns,
wnich had been 23*6 and 21'6 per 1000 in the preceding two
weeks, farther declined last week to 20*6. During the
last quarter the death-rate in there towns averaged 20*0
per 1000, and was 2*2 below the mean rate in the corre¬
sponding periods of the ten years 1877-86. The lowest
rates in these towns Iflst week were 17-0 in Portsmouth,
17*1 in Birkenhead, 17 2 in Brighton, and 17*8 in London.
The rates in the other towns ranged upward* to 26*4 in
Sunderland, 260 in Cardiff, 28 0 in Oldham, and 32 6 in
Manchester. The deaths referred to the principal zymotic
diseases in the twenty-eight towns, which had increased
in the right preceding weeks from 840 to 471, further
rose last week to 602; they inoluded 260 from measles,
117 from whooping-cough, 41 from scarlet- fever, 24
from diphtheria, 84 from “fever" (principally enteric),
33 from diarrhoea, and only 8 from smrih-pox. There
zymotic diseases caused the lowest death-rates last
week in Wolverhampton, Portsmouth, and' Bolton; and
the highest rates in Cardiff, Norwich, and Sunder¬
land. The greatest mortality from measles : occurred
in Hull, Huddersfield, Oldham, Manchester Norwich!, and
Sunderland; whooping'-oough in Bristol* Huddersfield,
Blackburn, and Cardiff; scarlet fever in Birkenhea d , Black¬
burn, and Bristol; and i “ fever * in Birkenhead and Man¬
chester. Of the 24 deaths from diphtheria in the twenty-
eight towns, 15 ooauired in London* 2 in Liverpool, and 2 in
Oldham. Small-pox caused 2 deaths in Cardiff and 1 ha
Blackburn, but not one either in Greater London or in any
of the twenty-five other large provincial towns. Nino
cases of small-pox were, under treatment on Saturday last
in the metropolitan hospitals receiving cases of this disease,
including 8 which were admitted during the week. The
deaths referred t6 diseases of the respiratory organs in
London, which had been 609 and 417 in the preceding two
weeks, further declined last week to 363, and were 141
below the corrected average. The causes of 93; or 2-5 per
cent., of the deaths in the twenty-eight towns last week
were not certified either by a registered medical practitioner
or by a coroner. All the causes of death were duly Certified
in Preston, Bolton, and in six other smaller towns; The
largest proportions of uncertified deaths -Were registered in
8underland, Salford, Blackburn, Li terpool, Oldham* ihd HOll.

HEALTH 6f SCOTCH TOWN8.

The annual rate of mortality in the eight Scotch towns,
which had been 26*2,26*9, and 235 per 1000 i* the preceding

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798 Tsb Lancet,]

HEALTH OP SCOTCH TOWNS.—HEALTH OP DUBLIN.

[April 16,1887.

three weeks, further declined to 22'9 in the week ending
April 9th; this rate exceeded, however, by 2’4 the mean rate
in the same week in the twenty-eight large English towns.
The rates in the Scotch towns last week ranged from 14'6
and 15'8 in Perth and Leith, to 25T in Glasgow and 32 4 in
Aberdeen. The 573 deaths in the eight towns last week
showed a further decline of 15 from the numbers in recent
weeks, and included 34 which were referred to measles, 33 to
whooping-cough, 12 to diarrhoea, 11 to scarlet fever, 6 to
“fever” (typhus,enteric, or simple), 4 to diphtheria, and not
one to small-pox; in all, 102 deaths resulted from these prin¬
cipal rymoticdiseases, against 127 and 111 in the previous two
weeks. These 102 deaths were equal to an annual rate of 41
per 1000, which exceeded by 1‘3 the mean rate from the same
diseases in the twenty-eight English towns. The fatal cases of
measles, which had been 56 and 43 in the preceding two weeks,
further declined last week to 34, of which 21 occurred in
Aberdeen and 13 in Glasgow. The 33 deaths from whoop¬
ing-cough showed an increase of 2 upon the number re¬
turned in each of the previous two weeks, and included 11
in Glasgow, 9 in Edinburgh, 7 in Dundee, and 4 in Aberdeen.
The 11 fatal cases of scarlet fever, of which 6 occurred in
Edinburgh and 3 in Glasgow, exceeded the number in the
previous week by 6. The 12 deaths attributed to diarrhoea
showed a decline from recent weekly numbers, and
agreed with the number in the corresponding week of
last year.; 5 occurred in Glasgow and 8 in Edinburgh. Six
of the 8 deaths referred to “fever” were returned in
Glasgow, as well as all the 4 fatal cases of diphtheria. The
deaths from acute diseases of the respiratory organs in the
eight towns, which had been 152, 146, and 132 in the pre¬
ceding three weeks, farther declined last week to 110, but
were 1 above the number in the corresponding week of last
year. The causes of 68, or nearly 12 per cent., of the deaths
registered in the eight towns during the week were not
certified. _

, HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 31'3
per 1000 in each of the preceding two weeks, declined
to 30 0 in the week ending April 9th. During the
thirteen weeks of last quarter the death-rate in the city
ayeraged 30-9 per 1000, the mean rate during the same
period being but 17‘8 in London and 19*4 in Edinburgh. The
203 deaths in Dublin last week showed a decline of 9
from the number returned in each of the preceding two
weeks; they included 5 which were referred to measles,
o to diarrhoea, 2 to “fever” (typhus, enteric, or simple),
2 to scarlet fever, 1 to whooping-cough, and not one either
to small-pax or diphtheria. Thus 15 deaths resulted from
these principal xymotic diseases, against 18 in eaoh of the
preceding two weeks; they were equal to .an annual rate
of 2*2 per 1000, the rates from the same diseases being 1'7
in London and 36 in Edinburgh, The fatal cases of measles
-showed a slight further Increase upon recent weekly numbers,
and those attributed to diarrhoea were considerably more
-numerous ; those referred, however, to “ fever ” and scarlet
fever showed a decline. The deaths of infants showed a
further increase upon recent weekly numbers, while those of
elderly persons had further declined. Four inquest cases
and 2 deaths from violence' were registered; and 62, or
nearly a third, of the deaths occurred in public institu¬
tions. The causes of 26, or nearly 14 per cent., of the
deaths registered during the week were not certified.

THE SERVICES.

Wib Office. —Army Medical Staff: Brigade Surgeon
"William O’Halloran is granted retired pay, with the hono¬
rary rank of Deputy Surgeon-General (dated April 13th,
1887); Brigade Surgeon William Cherry has been granted
retired pay, with the honorary rank of Deputy Surgeon-
General (dated March 28tb, 1887); Surgeon-Major Daniel
Charles Grose Bourns, from half-pay, to be Surgeon-Major,
vice F. H. Welch, promoted (dated April 1st, 1887).

Admiralty. — The following appointment has been
made:-Mr. William Hunter, to be Surgeon and Agent at
Rothesay.

James Booth Clarkson, L.R.C.P., &c- Surgeon Superin¬
tendent in Her Majesty’s Government Emigration Service,
hsfc’been transferred as Lieutenant from the 19 th Lanca-
eh&e' Rifle Volunteers to the 3rd BktteUon,-BoyaI Fusiliers

(City of London Regiment)—the old Royal Westminster
Militia.

Artillery Volunteers. —1st BaDff: David Lechmere
Anderson, Gent., to be Acting Surgeon (dated April 13th,1887).

Enginf.br Volunteers. — 1st Newcastle-on-Tyne and
Durham: Acting Surgeon C. N. Lee, M.B., resigns his
appointment (dated April 13th, 1887).—1st London: Sidney
Reginald Dyer, M.R.C.S., Gent., to be Second Lieutenant.

Rifle Volunteers.— 4th Lancashire: Acting Surgeon
W. M. Roocroft, to be Surgeon (dated April 13th, 1887).—
2nd Oxfordshire: John Arthur Rigge, Gent., to be Acting
Surgeon (dated April 13r,h, 1887).—1st Volunteer Battalion,
the Princess of Wales’s Own (Yorkshire Regiment): Charles
Tweedy, Gent,, to be Acting Surgeon (dated April 13th, 1887).

Comsjjonlrtiut.

"Audi al twain partem.”

THE COLLEGE OF PHYSICIANS, THE COLLEGE
OF SURGEONS, AND THE APOTHECARIES’
SOCIETY.

To the Editors of The Lancet.

Sirs,— From your admirable leading article in last week’s
Lancet, I collect that Mr. Berkeley Hill has enumerated
“ Dublin ” amongst the “ places of refuge for those who have
been repeatedly rejected in London.” So far as the College
of Surgeons in Ireland is concerned, I give that statement
an unqualified contradiction, and 1 challenge Mr. Berkeley
Hill to support it with one single example. With respect to
your observations as to the duties thrown upon the Medical
Council in face of the present unfortunate condition of
affairs, I fully endorse them, and that to such an extent that
more than ten days ago, I sent a notice of motion for our
forthcoming meeting of the General Medical Council couched
in the spirit of your remarks.

Faithfully yours,

Dublin, April 12th, 1837._ RaWDON MACNAMABA.

To the Editors of The Lancet.

Sirs, —The President of the Royal College of Physicians
stated the other day, at a meeting in reference to the union
of the Apothecaries’ Society with that body, that the College
does not compete with the former corporation. I wish to
ask if the chief design of the creation of the grade of
Licentiates of the College was not of set purpose to com¬
pete with the Society of Apothecaries? I have the most
distinct recollection of the fact that the chief argument
used at the time, of its creation was that it would rescue
the future general practitioner from being called an “apo¬
thecary.” Previously the Society of Apothecaries and the
College of Surgeons of England qualified, and well qualified,
the general practitioner, and l submit that we have gained
nothing by the substitution of the name “Licentiate of the
College of Physicians” for the name “Licentiate of the
Society of Apothecaries.” Neither of the corporations gives
a qualification in surgery that is of the slightest value in the
estimate of the profession; and if the examination for the
licence of the College of Physicians were dropped to¬
morrow, we should not feel its loss, for I have yet to learn
that either its curriculum or its examinations are stricter
or better in any sense than those of the Society of Apothe¬
caries. I rather think anyone, recollecting with myself the
creation of this “ Licentiate” of the College of Physicians,
will not fail to see that not only has the College successfully
competed with tho Society of Apothecaries, but has passed
up an order or grade of men who neither in status nor
practice differ from the Licentiate of that body.

I am, Sirs, your respectfully,

April, 1887. _ M.D. Lond.

To the Editors of The Lancet.

Sirs,—I feel somewhat apologetic in criticising any re¬
marks of a gentleman so eminently distinguished as Mr.
Berkeley Hill, but being one of those men upon whom his
stigma of reproach has fallen, I am senaihle of the honour

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THB LANaBT,]

THE SURGICAL TREATMENT OF PULMONARY CAVITIES.

[A* bil 16,1887. 799

even of his contempt. I, for one, did not go np for the
UAC.P. Ed in. because I bad failed in London. I have never
presented myself at the London College, having had a higher
diploma in view, although I was exempted from part of
their first examination. Having obtained my M.R.CS. (I
may add without being ploughed), and wanting a medical
qualification directly, 1 went to Edinburgh, where there is an
examination for the licence every month. Does Mr. Berkeley
Hill think that taking materia medioa with the final exami¬
nation, as at Edinburgh, does not add another element of
risk; whereas in London that subject is taken separately?
Secondly, I may add that if one does not pass on the paper
work, one is not allowed to make up in the clinical *a& vivd
voce examinations. Thirdly, one has known cases of men
who were proverbial for being lazy at tbeir hospital, yet
still pass their L.R.C.P. Lond., to the astonishment of their
friends. No doubt this is so at Edinburgh, but it does
happen in London also. Finally, does Mr. Berkeley Hill think
that examinations are conclusive tests of ability? Would
all well-qualified men be able to pass all their examinations
again equaUy successfully ? Is it not true that a man may
not be able to localise a cerebral lesion, but be still a good
physician? In conclusion, the vexed question of degrees and
diplomas is a disgrace to our profession, and the sooner there
is one and only one degree for every medical man in the
kingdom, the sooner will good taste and brotherly feeling
become the rule and not the exception. There are not a
dozen degrees at the Bar. It is the work done that makes
the man. Why should it not be so in the medical pro¬
fession ? I am, Sirs, yours obediently,

April 12th, 1887. M.A., M.R.C S., L.R.C.P. Ed.

To the Editors of The Lancet.

S iks,— The sum and total of Mr. Davy’s letter is, that
the Apothecaries’ Society should not be allowed a seat on
the Conjoint Board, because by so doing they would per¬
petuate the idea that seems to exist amongst the profession
of drugs occupying the first place in our treatment. I do
not think an opinion formed upon so poor a ground will
carry much weight with those who have to deal with the
question. The subject has been well threshed out, but I
ask you to allow me to mention a few points which seem
to escape those of your correspondents who, while they
meer at the L.S.A. diploma, exalt that of the College of
Surgeons.

1. If the standard of the Hall examination is so inferior,
as is supposed by many, to that of other examinations, why
does the College of Surgeons of London accept as equivalent
to their examination in Medicine and Midwifery that con¬
ducted by the Hall, whereas the Scottish corporations do
not accept it ?

2. Some years ago the College of Surgeons granted their
diplomas without examining in medicine. Are not those who
poetess such diplomas, and have not a medical qualification,
quite as inefficiently qualified to practise as the L.S.A.’s ?

3. And has it not been stated in the Medical Council that
the standard of the examination of the Apothecaries^
Society is equivalent to that of the College of Physicians^
London, as ascertained by the examination visitors appointed
by the Connell ?

Many suppose that the reason the Hall examination is not
a fair test is because the time given to answer the written
questions is so short that it is impossible to gain a fair idea
as to the candidate’s knowledge, whereas at the L.R.C.P.
examination more time is given, and a better result obtained.
I think the case is like an examination in algebra—the can¬
didate who solved the most equations in the shortest time
would be more successful than he who took the longest
time. I may saythat the corporations of Edinburgh con¬
duct their examination much in the same manner as the
London Apothecaries. Examinations are poor tests of
knowledge, and no man should too highly praise his own
diplomas or decry that of his neighbours. I submit, in the
interests of the public and of our poorer students, who can¬
not afford a more expensive diploma, that the Apothecaries’
Society will carry on the good work she has rendered to the
profession hitherto, so that she will be able to write on her
walls, “Tota virtute met."

I remain, Sire, yours obediently,

April, 18BS. JCSTTTtA.

THE SURGICAL TREATMENT OF PULMONARY
CAVITIES.

To the Editors of The Lancet.

Sms,—In the various modes of operative procedure re¬
ferred to in Mr. Godlee’s interesting lecture on the Surgical
Treatment of Pulmonary Cavities, published in your issues
of the 6th and 12th inst., an amount of injury to lung tissue
Is involved whieh is calculated to excite dismay in those
whose experience of such formidable operations is limited,
or who ore mindful of the disastrous consequences which
frequently follow even the most trivial wounds of the
respiratory organs. The advantages of the simple and
comparatively trifling operation of paracentesis thoracis, in
cases similar to some of those described, do not. appear to
have engaged hia attention, nor, as far as I am aware, that
of any other surgeon of recent times Who has specially
studied the subject of pulmonary surgery. That such an
operation would be attended with aatiaractocy results in
cases where the tubercular process had reached the stage
of formation of a cavity is shown by the history of the
foUowing case, the details of which 1 had the privilege ef
noting some years ago, whilst the patient was under the
care of Professor D. C. O'Connor in the Mercy Hospital in
this city.

T. K.- h aged twenty-seven, admitted December 21st,

1881, stated that in the month of May of the previous
summer, he had had a severe attack of haemoptysis, in con¬
sequence of which he had attended the. out-patient depart¬
ment of the hospital. A second attack of the same kind,
two months later, obliged him to seek admission as an
in-patient, and it was then found that he had lost
considerably in weight since he first sopght treatment.
He was troubled by a severe cough, with night sweats;
and under the right clavicle all the symptoms which in¬
dicate the existence of a pulmonary cavity were appa¬
rent. At the end of three weeks, during which the usual
methods of treatment were adopted without influencing
the course of the disease to any appreciable extent, an event
of a remarkable nature occurred. One morning, whilst the
patient was changing his position from the right to the left
side, he suddenly experienced a sense of suffocation,
attended by severe pain, which was referred to the right
pectoral region. The dyspnoea Tapidly abated, but the
pain continued with varying degrees of intensity fbr
two days. On examination it was found that the re¬
spiratory movements of the chest walls on the affected
side were scarcely perceptible; percussion was markedly
tympanitic all over the area of the pleural cavity;
the respiratory sounds were altogether absent, and the
patient could only rest comfortably in the dorsal position or
on the right side. In fact, aU the signs of a pulmonary
cavity had disappeared, and their place was taken by those
of a distinct pneumothorax. Subsequently the patieht
rapidly improved, and after an interval of 4 fortnight was
discharged, in order to. enable him to avail himself of an
opportunity which offered of residing in a healthy oountry
district.

In this oase there can be, no doubt that what happened
was this. In the effort of making a change of position, An
inspiration followed by closure of the glottis caused an
unusual strain on the pulmonary tissue, which, together with
the pleura pulmonalie, gave way at a weak point, allowing
air to enter the pleural cavity and causing collapse of the
lung. As a consequence of this occurrence, which may be
regarded as a paracentesis thoracis from within, so to speak,
the condition of the patient, as has already been remarked.
Underwent a considerable change for the better; and that
this is wbat we ought to expect, a consideration of the
pathological conditions established by the collapse ‘will
show. The presence in airy organ, for phyelologioal pur¬
poses, of a large quantity of Mood creates in that organ an
especial tendency to the inflammatory process, which has
been recognised and admitted as the' initial step in the-
commencement of many morbid phenomena, both those
which have been identified as being doe to the presenoe of
a specific, bacillus and those which bate not yet been
so identified. In the oase of the lungs this tendency is
much exaggerated by the highly tenons condition of a great
portion of the blood circulating in them. Nor is it neose-
nrj that the point of actual congestion should be reached
in order to establish the danger. When oollapee ol a

<800 Thb Lancet,]

PYREXIA.—DEGREES FOR LONDON STUDENTS,

[Ai»arr, 16,1887.

tubercular lung occure, this great volume of venous blood is
excluded from the seat of disease; a pure and nutritious
supply, comparatively free from effete material, is derived
from the bronchial arteries, and thus an impetus is
given to the process of repair which nature is con¬
tinually striving to establish, even under the most
adverse conditions. But it is not in the stage of dis¬
integration, alone that the beneficial effects of pulmonary
collapse would be evident. In the eailier periods of tuber¬
culosis, when the “ deposit ” exists in the form of an integral
mass, it is readily conceivable that the cutting off the
inflammatory blood-supply would have even a more powerful
influence than in the later stages of the disease. The-abnor-
mal product would be strangled at the outset .before the
constitutional effects of the local lesion had reduced the
general health below par, and thus a serious obstacle to the
success of operative measures would be avoided.

There is another symptom in the phthisical series, the
urgency of which should secure for the operation of' para¬
centesis « favourable consideration 1 at the hands of the
surgeon. 1 refer to profuse and unoentrollable hemoptysis.

Apart from tile pathological points indicated, the effect
of collapse in reducing the pulmonary circulation to a
minimum is so evident that it is unnecessary to do more than
refer to it. The operation, if carried out with a reasonable
amount of oar©, and with proper antiseptic treatment of the
warmed air admitted to the pleural cavity, ought to be free
from danger, either at the time of performance ot subse¬
quently. I am Sirs, yours faithfully,

F. E. Adams, M.D., M.Ch^

Camden Quay, Cork. Extra PhyaioJan to Oork Fever Hospital.

THE PULSE.

To the Editors of The LanCet.

Sirs,— I have noticed that Dr. Broadbent suggests that
irregularity of the pulse in mitral regurgitation may be due
to the respiratory movements. Allow me to offer another
suggestion in explanation, which occurred to me some
time ago, and which I do not think I have seen mentioned
anywhere.’ The regurgitant stream from the left ventricle,
one would think, would generate a pulse wave in the pul¬
monary veins, which might be reflected back to the neigh¬
bourhood of the mitral valve. This might have its own
rhythmical period, which would probably not agree with
the rhythmical period of the action of the left ventricle.
When certain parts of ti?ese two periods coincided, the
regurgitant stream from the ventricle might be met and
opposed by the reflected vtave, and then more blood might
be thrown into the aorta than at other times.

I am. Sirs, yours truly,

Margate, April,lltb, 1887. . W. W. COLBORNE.

ON TUNCTURE OF THE ABDOMEN FOR EX¬
TREME FLATULENT DISTENSION IN
PUERPERAL CASES.

To the Editors of The Lancet.

SiBS.-^In Thb Lancet of April 9th is the relation of an
interesting Illustration of the Value of puncture of the
abdotheri for the relief of tympanites by Surgeon-Major
Franklin, communicated through Dr. Priestley. He says:
"The obstetric authorities—Playfair, Barnes, and Rams-
botham—gave him no help, as bo the way he was to relieve
the extreme'abdominal distension which was threatening
the life,ofihis patient”; so that after a consultation with
Dr. Harris he punctured the ascending colon with a small
trocar*

I am sure Surgeon-Major Franklin and Dr. Priestley will
- be gratified to learn that this treatment is fnlly discussed in
the “ SystemiCf-Obstetric Medicine and Surgery ”(voL ii.,
1886, p. 6Q0) of myself and Dr. Faneourt Barnes in the
following terms: “The treatment of tympanites is partly
operative* .The distress and danger attending tympanites
are due in some measure to the great pressure from dis¬
tension* This impedes respiration, circulation, and other
functions. If the tension could be reduced, corresponding
relief; might be expected. Braxton Hicks advocated abdo¬
minal puactuxe with, this intention (Obstetrical Transac¬
tions, rl888-09), and related cases in illustration.- A small
.exploring trocar is the .bejfb instrument. By it> the intestine

is pierced in three or four of the most prominent points.
As Hicks says, ‘The pressure of the gas upon the sym¬
pathetic ganglia and nerves, and the tension of the tissues
which they supply, add much to the collapse and vomiting.
The least that can be claimed for the operation is that the
last moments of the patient can be rendered comparatively
free from suffering.’ We have adopted the plan, and eon
speak favourably ef it. It must never be forgotten that
tympanites is not necessarily a fatal symptom; and it may
well be that relieving this symptom may conduce to
reoovery.”

Surgeon-Major Franklin’s case bean happy confirmation
to the truth of this observation.

I am, Sira, yours faithfully,

Harley-street, April, 1887._ ROBERT BARNES.

PYREXIA.

To the Editors of The Lancet.

Sirs,— In the paper of Dr. Macl&gan on this subject I
am much astonished at the criticism of Dr. Ord’s paper. It
seems that Dr. Maclagan has not quite grasped Dr. Ord’s
meaning.

It is now no new thought that the vital force is not a
thing, but a state—a condition of delicate instability of
organic. compounds. These, assuming more stable con¬
ditions, liberate energy which, save in certain diseased
. conditions—eg, delirium,—is not permitted to run wild,
but is confined to definite channels and; results. Hera, then,
are two processes: the raising of compounds from a stable
to ah unstable condition (analogous to the raising of a
weight against the force of gravitation); and the opposite
process—viz., the resolution of unstable into more stable
compounds (analogous to the falling weight). Now, the
principle of the conservation of energy applies everywhere,
and in organic structures as in the purely physical world.
What change of form of energy, then, has occurred during
this raising of bodies to the sensitive instability of living
tissues? This is Dr. Ord’s question, it seems to me, and he
replies thus: “ This operation is the result of that form of
energy called ‘ heat.’ Heat disappears, and instead we find
instability, or, as we may surmise, separation of atoms and
molecules.” In Dr. Maclagan’s paper he states : “ No evidence
is adduced to support this. But there is much evidence,
though chiefly on the physical side. Delicate tissue change,
like all other change, can only result from other energy.”
The expression “ absorption of heat ” hardly expresses the
actual physical process. The keynote of Dr. Ord’s lecture
is not absorption, but transformation. What was energy
of motion (heat) becomes energy of position (the instability
of higher tissue formation), in the building up of tissue
day by day a large quantity of force must be required. If
this building up cease, then this force is free, and escapes,
as all force must, as heat. In fever tissue formation is
lessened, and, unless disintegration be checked in propor¬
tion, heat must result. To regard heat as an excretory pro¬
duct is word-play. It is produced during retrograde tissue
metamorphosis, but is not a product. In a similar way the
remarks about the experiments on cucumbers are not to the
point. The same processes occur in the animal as in the
vegetable world, although the tissue changed may differ.

Dr. Ord's position is well based, not only physiologically,
but physically. He points out the process of tissue forma¬
tion and disintegration, although admitting that we do not-
know what is the controlling element. This check to tissue
change is the secret of life; it is that which differentiates
living from ordinary physical substances.

I am, Sirs, yours faithfully,

F. W. Bennett, M.D. Lend.,

Assistant-Phy»iciftn to the Leicester Infirmi-y 1

DEGREES FOR LONDON STUDENTS.

To the Editors of The Lancet.

Sirs,— It is a matter of deep regret that the plan for a
united action on the part of University and King’s Colleges,
together with the two Royal Colleges, to form the new
University of Westminster, and thus jointly to apply for a
charter, was not proceeded with. For this scheme would
apparently have solved most of the difficulties that at pre¬
sent surround the question of degrees for London student
and that of a teaching university. It is most desirable that

The Lancit,]

THE El VIERA IN 1887.

[Ai>ftn. 10,1887. 801

the Charter should be obtained before October next, other¬
wise oar London hospitals will have still fewer entries;
indeed, & parent would be undoubtedly to blame if he did
not so arrange his son’s professional education as to enable
him to get a degree after honest work. It is trying enough
now for capable practitioners to hold their own against the
crowds of Scotch and Irish graduates, but this competition
will get still severer for the London student every year unless
something is promptly done to give him an equivalent title.

I am. Sirs, your obedient servant,

April i2tb, 1887. _ A Parent.

THE RIVIERA. IN 1887.

THE EARTHQUAKE.—MONTRBUX.—LBS AVANTS.
{By our Roving Correspondent.)

Those who, year after year, leave England for more genial
climates have had strange experiences this season. Many
no doubt who have encountered the severe trial of the
earthquakes in the Riviera htfve thought that there is much
truth in the refrain that “ there is no place like home,” and
hundreds have sought refuge in the congenial spring of
Great Britain from the worry and anxiety which necessarily
surrounded all who found themselves in the unhappy dis¬
trict upon which such great calamities have come. Earth¬
quakes, however, are not of every-day occurrence, and not
easy to avoid, for we know that our own island is not
altogether free from them, as the country near Colchester
testified some three years since. The Riviera will be more
or less empty for this season at least, but there is little
doubt that its bright sun and lovely scenery and foliage
will prove attractive enough to outweigh the unpleasant
memories of February, 1887, and that in a year or so the
normal and well-deserved popularity of the district will be
restored. There is a silver lining to every cloud, it is said,
and we may hope that the earthquake may bring some
compensation to those who seek health and relaxation in
the south of France. Many of the hotels have been rudely
shaken, some few so severely that they will have to be
rebuilt. When the repairs are undertaken, it is to be hoped
that the proprietors will not be content with mere patching
and a delusive biding of dangerous cracks by a superficial
daubing with untempered mortar. There is no doubt that
many hotels have been “ run up ” at a great pace, and there
U equally no doubt that many of them are thoroughly bad,
both in design and workmanship. A sojourn in almost any
of the hotels in the south of France is sufficient to show
how flimsy are the parti-walls, which are often constructed
of one layer of thin hollow bricks placed on edge, the
surface being danbed with mortar. These parti-walls have
no struts of timber running through them, and it is not to
be wondered at that when the houses began to shake these
flimsy divisions quickly broke, and fell on this side and
that. These hollow brick partitions are excellent conductors
of sound, and the occupant of any one room can generally hear
through the wall the intimate conversation of those who
inhabit the rooms on either side of him. Light sleepers are
often unable to get their much-needed rest until their neigh¬
bours have gone to bed; and if they do not luckily fall asleep
in the brief period which elapses between the talking and
snoring of some Teutonic Sbentor, an almost sleepless night
i*> the consequence. Hotel proprietors must be made to
know that quiet and rest are as important for invalids as
are the quality of the food and air. and the parti-walls
between the rooms in the hotels should be sufficiently solid
to exclude sound and withstand the really moderate amount
of vibration to which many have been subjected this year
m ay be again. The doors of communication between
reoms and between rooms and corridors should in all cases
be double, for the purpose of excluding noise. I have dwelt
on the importance of this matter in previous letters, and no
excuse is needed for again drawing attention to it. Speaking
from a professional point of view, it seems most important
that invalids should not be allowed to stop in any hotel
please cannot oomrnan d rest and quiet at any hour they

Hotel staircases again demand attention. Most of the
81 v? 80 * *° ut “ France and Italy are of a kind

which most be dangerous in case of fire or earthquake.
ton *JjBcted, as they often are, of thin dabs of marble, sup¬
ported on one side only, each step getting its outride

support merely from the step below, it is obvious that if
one step be cracked by fire or vibration and be shaken from 1
its position, the whole structure is in great danger of
coming down “with a run.” This actually happened in many
houses during the late earthquake, and it is to be hoped that
during the work of reconstruction this important matter will
be attended to. Architects are very prone to make a great
feature of the staircase; and there can be no doubt that when
travellers from theNortb, accustomed to narrow, steep, wooden
stairs, are ushered into an hotel, and Bee before them a broad
staircase of easy gradient, with steps of pure white marble
running upwards in ten or a dozen flights, their minds are
startled by the unaccustomed and palatial magnificence.
The danger of such staircases, however, is often directly
proportioned to their height and breadth, and we may hope
that we have Been the last of them. Such staircases are
often very undesirable ohannela for noise, and not unfre-
quently the smell of the kitchen ascends by them and
pervades the whole house. Staircases should be con¬
structed so that the steps are supported on both sides
by walls, and if so constructed they would be compara¬
tively safe in case of accident. In large hotels two
staircases of moderate dimensions are better from every
point of view than one, be it ever so broad and palatial
in design. The staircases, kitchen, and sanitary offioes
should always be in a structure more or lees distinct
from the rest of the building, and thus the parts of
the house devoted to living rooms would run no risk
of being pervaded with air from kitchens, closets, or sinks.
It need not be said that in the reconstruction of hotels
what may justly be called the “unsanitary offices* will
need to be remodelled. All sanitarians admit that in a
water-carriage system of sanitation imperfectly carried out
we have the very demon of pestilence, and foreign hotel
keepers need to be reminded that a sprinkling of some
carbolised' powder and the use of a brush are no
compensation for half-inch supply pipes, faulty traps,
and no ventilation. It may be laid down as an
axiom that a closet which stands in need of a brush
and disinfectants must be a perpetual source of danger
in a house, and travellers should be well aware of
this fact before selecting a house in which to make a long
sojourn. The introduction of water-carried sewage along
the coast has made the foreshore unpleasant in many places,
and those who walk upon the beach to get a “ sniff of the
briny,* sniff a good many other things which are neither
savoury nor sweet. It is needless- to say that with the
rapid increase of population the sewage evil is increasing,
and must increase; and I have little hesitation in pre¬
dicting that that locality which can find some means of
efficiently treating its refuse other than washing it into the
the sea will experience a rapid rise in popularity. The
water-supply is for the most part above suspicion, and is
obtained from sources high np in the Alpes Maritimes.
The Nice Water Company supplies excellent water, not only
to the city of Nice, but to other towns near it.

It may not be uninteresting to your readers to place upon
record, now that the Bxeitement of the catastrophe is over¬
passed, the actual experience of one who felt the earth¬
quake in full, though not its fullest severity. He was
located au troisibne in an hotel standing on one of the highest
points of the rock at Monte Carlo. After a lovely day, in
which a powerful sun had been shining in a cloudless sky,
he retired to rest. The noise of persons returning late from
the carnival caused the night's rest to be a good deal dis¬
turbed. The final disturbances occurred at a few minutes
before six, when he was awoke by a noise above, below, and
on either side, which, on reflection, ifeenis to be best likened
to the labouring of ships at sea, and was doubtless due to
the breaking of the various material* of which the house
was built. The bedroom was distinctly rocking, and his
first instinct was to jump out of bed to avoid rolling out.
In a few seconds the house steadied, and then the mental
question arose as to the cause of this rude disturbance. The
window commanded the Bay of Monaco with the old town
opposite and the district of La Condamine below' lying
between Monte Carlo and the old town. Looking out, the
commencing colours of a glorious sunrise met the gaze, and
from the old town, and from La Condamine, some 200 feet
below, there arose a babel of voices of persons, doubtless in¬
quiring of each other what was the matter. With the voices
was intermingled the barking of innumerable dogs, that
had been apparently as much surprised and startled
as their owners. These facts made it apparent that

802 The Lanobt,]

THE RIVIERA IN 1887.--EDINBURGH.

[A phil 16, 1887.

the disturbance bad affected the whole locality, and a
shock of earthquake seemed the only reasonable solution
of the phenomena. Under the circumstances,, it seemed
advisable to get up (further sleep was certainly impossible,
and the morning was tempting enough to call one from
one’s bed under any circumstances). Just as a rather
hurried toilet, was drawing to a close the second shock
oocurred, not so strong as the first, but only too distinct
and most unpleasant, causing the house to creak and the
windows to sway. Downstairs and into the open as
quickly as possible seemed the reasonable oourse, for it is
obvious that a house cannot stand many shocks such as
we experienced,, and it might happen that a third would
cause it to give way. All the world was up and in the
streets, the toilets being most peculiar and imperfect. Being
up, what was to be done? It is difficult to know what can
make one feel so utterly powerless as a shock of earth¬
quake. No human power can prevent it; and when you
have sought the open air, you have done all that is
possible in the way of avoiding the possible consequences
of further shocks. I have seen it stated in many of the

J apers that a condition of “ panic ” prevailed, but to this
should demur. Certainly I saw none, neither at Monte
Carlo nor (later in the day) at Nice. That persons should get
into theopen airas quickly aspoesible was reasonable,and was
distinct evidence of cool thought rather than panic. The
question as to the cause, direction, &c., of the shock was
naturally discussed, and when many persons discuss at once
there is noise, but certainly there was no shrieking, and
throughout the day I saw only one young girl who had
*' fainted,” but as the colour of her cheeks was good, I con¬
cluded that she was merely “ taking on,” to use a common
expression. The population of Monte Carlo is Franco-
Italian, and might be assumed to be impressionable and
excitable, but certainly they treated this unfortunate occur¬
rence with the greatest sangfroid —a fact which made me
suspect that this shock was a thing concerning which they
were not without previous experience.

The amount of material damage sustained by the build¬
ings at Monte Carlo was,singularLy small. The swaying of
the houses had been sufficient to stop the clocks, but beyond,
this ominous fact there was little external evidence of the
strain to which the buildings had been subjected. In the
low-lying La Condamine, between the rocks of Monaco and i
Monte Carlo, there was more evidence of external damage, i
but even here the evidence was limited to a few fallen i
parapets and chimneys. In this part of the town the
buildings are not so high, few being more than two or three
storeys, and yet it was evident that these comparatively
low nouses had suffered more than the huge caravanserais
perched on the rock of Monte Carlo. From facts which
came to light subsequently it appeared that Monaco as a
whole had suffered less than Mentone on the east and than
Nice on the west. Mentone, being nearer to the centre of
disturbance, might be expected to suffer more than Monaco;
but Nice being further from the centre, ought, at first sight,
to have suffered less. The reason, apparently, for the com¬
parative escape of Monaco lies in the fact that, with the
exception of La Condamine. the houses are built directly
on the solid rock, while at Nice and Mentone a large pro¬
portion of the buildings are upon the alluvium which
has been carried down by the torrents which intersect
these cities. The trembling of the earth would cause.
more movement in the loose alluvium than the solid rock,
and hence houses on the alluvial ground seem especially to
have suffered.

An interesting point in connexion with the catastrophe
was the difficulty in obtaining any accurate information as
to the extent and severity of the trouble ; in fact, it was not
until the arrival of the English papers that t.be real facts
became known. On inquiry at the telegraph office one learnt
that the shock had been felt “ all over France.” It was said
that Grasse was in ruins, that the shock bad been terrible
at Marseilles, and that a church had fallen at Mentone &c.
In estimating the value of the current reports, it is needless
to say that great allowance had to be made for the natural
desire of hotel proprietors &c. to retain their guests, and to
impress upon travellers that by moving in any direction
they would be going out of the frying-pau into the fire.
The fact of most value which enabled a judgment to be
formed as to the probable focus of the disturbance was the
blocking, of the telegraph wires to the east, while they
remained open to the west.

■ ■ {TobeconchuladJ.

EDINBURGH.

(Irom our own Correspondent.)

UNIVERSITY OF EDINBURGH.

At the approaching graduation ceremonial, the Senatus
Aoademicus have decided to confer the honorary degree of
LL.D. upon Professor von Kolliker, of Wurzburg. The
degree was offered him on the occasion of the tercentenary
celebrations, three years ago; but he was prevented from
being present at the time. The degree is now to be conferred
in absentid, as Professor Kfiflikbr’a feeble state of health
precludes the possibility of his travelling such a distance at
the present time.

PR0P08BD UNIVERSITY HALL. .

A need has of late been growingly felt in Edinburgh to
provide the possibility of a more corporate and social
college life for the students of the University than has up
to the present obtained among them. With this view an
association has now been formed, with Sir William Mair,
Principal of the University, as its president, which will
undertake the establishing of a number of balls of residence
for the students as occasion seems to demand. A beginning
has been made by securing a convenient block of buildings
near, the University buildings and the infirmary; these
premises are to be prepared for the reception of students in
the coming summer session. Rents of rooms are to be
adjusted so as merely to cover expenses, and it is stated
that desirable rooms are attainable at from 7s. 6 d. to
15«. weekly by students anxious to join the colony. It
is desired by the promoters of the scheme to combine some
beneficial influence on the surrounding districts with the
ordinary avocations and studies of the inmates of the hall;
and it is stated that students interested in such work as is
done at Toynbee Hall, London, by Oxford and Cambridge
students, will obtain preference for their applications for
entrance. Out of a total of 3500 students, it is probable
that a sufficient number will be forthcoming to flU this hall,
and possibly another should the first experiment be suc¬
cessful. If carefully managed its success is assured, and its
establishment probably marks an important point of depar¬
ture in our academic institutions.

THB FEVER EPIDEMIC.

The epidemic of soarlet fever dies out slowly, and the City
Fever Hospital is still crowded with inmates. The report
for the present week shows that of 244 cases in the wards
200 are cases of scarlatina.

CLINICAL INSTRUCTION IN FEVERS.

As the outcome of strong representations to the city
authorities some months ago, it was decided to open the
wards of the City Fever Hospital for the visitation of
students; and a system of clinical instruction was inaugu¬
rated by Dr. Allan Jamieson, the visiting physician of the
institution. The results up to the present have been highly
satisfactory, and Bailie Russell, to whose efforts this improve¬
ment is largely due, was able to report recently to the Town
Council that twenty-six students and four medical graduates
had availed themselves of Dr. Jamieson’s teaching during
his first course of lectures, and that none of those attending
had taken fever.

EDINBURGH UNIVERSITY COURT.

At its last meeting the Court confirmed the arrangements
approved by the Senatus, under which Professor Hay craft,
of the Mason College of Science, Birmingham, will take
charge of the department of Physiology and superintend
the teaching of the practical classes during the coming
snmmer, in the absence of Professor Rutherford. The
arrangements include the payment of .£200 to Professor
Haycraft by the Professor of Physiology.

' THB NEW EXPERIMENTAL LABORATORY.

The new laboratory established by the Edinburgh Royal
College of Physicians has already commenced its objective
existence. A very convenient building, in close proximity
to the infirmary and the medical schoolp, has been acquired,
and will shortly be supplied with all the modern require¬
ments of an experimental laboratory. The directorship of
the new institution has not yet been filled up. Appli¬
cations for the post were received by the committee
in charge up to the end of last week, and it is anticipated

6

I

T*i LAmcbt/]

ABERDEEN;—DUBLIN.

[April 10,1837. (80S

thV- the .result, of their deliberations 'will be shortly
announced. Application has Been made entirely by
private letters addressed to the chairman of the Elect¬
ing Committee, and testimonials have not been received
on behalf of any of the candidates. Owing to the conditions
of the contest, it is not definitely known how many com-

K titors are in the field; but the names of Dr. Sims Wood-
ad, Dr. William Hunter, and Dr. Noel-Paton are mentioned
aa probably successful candidates. If these gentlemen are
really among the competitors, the College has cause for con¬
gratulation in the emb&rriu de richetoc thus placed at its
disposal; although the strong elaims of each, based on the
valuable work they have already accomplished, will make
the decision a difficult one. The first task of the director,
when appointed, will be to superintend the thorough equip¬
ment of the laboratories; subsequently bis duties will
chiefly consist in advising suitable lines of research and in
organising the dally duties of bis department. The labo¬
ratory and its success ate the objects of great interest in
Edinburgh, arid there is every prospect that the new insti¬
tution inll form a useful channel through which the pent-up
scientific energies of thescbool may freely developtthemselves.

THIS RECTORSHIP OF EDINBURGH UNIVERSITY.

H* Marquis of Lothian, K.T., has been chosen by the
University Conservative Association as their candidate for
the Rectorship of the University, vacant through the death
of the late Lord Iddeeleigh. The date of the election is
still nearly eix months distant, but the Association is
desirous of losing no time in. placing their candidate
before the constituency of undergrad nates, and in con¬
ducting an active canvass in his behalf.

Daring the last six months a sum of £2750 has been
neeived for the Royal Infirmary in the form of legacies,
■dinborgb, April 13th.

iUud c-j' . (.f'rom our own Correspondent.)

•• —:—

THE CITY HOSPITAL.

IrfMd a long and careful inquiry into the burning of a
patient at the City Hospital, the Pnbiic Health Committee
have issued a report, in which they state that they “are of
opinion that the h e ad nurs e acted-wrongly in placing the
ward maid, Margaret Easton, in charge of the patient,
bowing that Easton would be obliged to leave her several
times quite alone for a period of from twenty to thirty
minutes; they are further of opinion that the head nurse
failed in her duty in not taking steps for securing a proper
complement of nurses.” It is also stated that, “in the
opinion of the committee, it is matter of regret that the
medical attendant did not report the occurrence earlier, and
that after the accident took place he did not consider it
requisite to visit the patient more frequently than once a
day.” The head nurse has sent in her resignation, which
hs been accepted. At a meeting of the Town Council, it
was agreed, on the motion of the Lord Provost, to ask
8urgeon-Major Fassor, superintendent of the Edinburgh
Infirmary, to visit the hospital and report “as to what
changes and improvements should be introduced for the
purpose of placing the institution in a thoroughly efficient
and satisfactory condition.”

THE ROYAL INFIRMARY.

t i _ special meeting of the Committee of Management,
rod on the 8th insb, the Plans Committee submitted a
j*ri*ed design for the extension and improvement of the
infirmary buildings. According to the proposed plan, the
new building would accommodate 233 beds, with a cubic
•pace of 1400 feet per bed. The approximate cost of the
new design is £3Q£90. The “ Jubilee Fund ” now amounts
to nearly .£19,000*,..,...

•V n»qt, jc‘ iMBMBW UNIVERSITY.

last bf the “ professional examinations” took place
JJf^ay at M&rischal College, and the graduation ceremony
“be place on Friday, the 15th Inst. The summer session
~~ examinations

At
'Cash,

. -rr—™ to the Chair of Materia Medica, was

flnly installed. At the same meeting it was resolved to

ABERDEEN.

nmU ai:'

_ *tn sttecii

provide an album for the purpose of receiving the signa¬
ture of every student at matriculation and graduation.
To-day’s Aberdeen downed says that “some correspond¬
ence has taken place recently between the University
authorities and the Government with reference to a grant
in aid of the extension of the University buildings. The
sum needed to carry oat the scheme is £84,000, ana of this
sum one-fourth was proposed to be raised locally Informa¬
tion has been received that under existing circumstances
(thesmaUness of the looal efforts) the Lords of the Treasury
cannot meet the wishes o^ Aberdeen.” . .

ADKBDHBN MBDICO*<JHIBtTBQIOAL SOCIETY* f

Dr. McKenzie Booth hafc beeh elected librarian in robtebf
the late Dr. William Fraser, and Dr. Jbhn Gordon succeeds-
the late Dr. Beveridge as treasurer to the Society.

Aberdeen, April ltth. 1 1

DUBLIN.

(From our own Correspondent.)

THE QUHRN’S JUBILEE. <:.i i>

Sir William Stokes, President of the Royal College bf
Surgeons in Ireland, has issued cards for a dinner in cele¬
bration of Her Majesty’s Jubilee. The banquet, which will
be held in the College on Saturday, the 23*d insh., is expected
to be a magnificent success, and will be'attended by-Me
Excellency the Lord-Lieutenant, his.. Serene Highness-
Prince Edward of Saxe-Weimar, the leading medical men
in Dublin,i and many others holding high official positions.

PROPOSED HOSPITAL FOB CONSUMPTION NEAR DUBLIN.

A subcommittee has been appointed by the Executive-
Committee of the City and County of Dublin Jubilee Com¬
mittee, In order to select a suitable site for the proposed
institution, and ascertain the cost of erecting the same, to

S rovide accommodation for abont twenty-five beds. Lord
ames'Butler, the chairman of the Managing Committee of
the Adelaide Hospital, has Urged the necessity of establish¬
ing a convalescent home in' eofcnexion with that hospital,
to be styled “The Jubilee Victoria ftootafeeoent Home,”
under the Bame management, and has initiated the movement
by a gift of £60.

UNIVRHSITY OF DUBLIN.

The authorities of Trinity College, Dublin, by desire of
Her Majesty, have arranged to allow credit for the Trinity
Term examinations to all students, except candidates for the-
degree of Bachelor of Arts, whose names shall be on the
College books at the dates fixed for their respective exami¬
nations.

NIGHT LECTURES. - '<

The Standing Committee of the Royal University of
Ireland on March 31st last adopted a resolution, to the
effect that after that date certificates of night lectures
would be refused by the University. This announcement
came aa a very disagreeable surprise to many hard¬
working students, who from no fault of their own may
be prevented from attending day lectures; and, unless this
objectionable rule is rescinded by the Senate, they will
become ineligible for the next examinations of the Univer¬
sity. The writer of this has lectured for some years to
both day and night students, and can conscientiously state
that for anxiety to learn, steadiness, and general good
conduct, night pupils are in no way inferior to those attend¬
ing the day classes. If tifae Senate enforce the carrying out
of this resolution, a serious injury will be inflicted on a large
and deserving class of medfew students.

A bfizaar and fancy fait in aid of Sir P. Dun’s hospital wil>
be held next week at the College of Physicians.^

Dr. J. W. Swan died, on the 8th insti, at Qarinda Park,
Kingajtewn, aged eighty-four yams.

Dublin. April 13th.

New Hospital in "West Renfrewshire.—A t a
special meeting on the 7th Inst, contracts were aooepted for
the erection of a combination hospital for the parishes of
Houston, Kilbarchan, Erskin, and lnchrinen, including the
burgh of Johnstone. The cost will be under £2000.

Digitized bv

oogle

604 The LAncet,]

PARIS.—OBITUARY.

[April 16.1887.

PARIS.

(From our ovm Correspondent.)
m. pastbuh’s methods.

On the20th of last July a man named Hamyau, of Dunkirk,
was bitten by a dog. On the 20th of the following month
the same dog, at that time probably rabid, bit another man,
who was forthwith sent to Paris and subjected to the inten¬
sive treatment. His death from paralytic rabies formed
the subject of M. Peter's first communication to the Academy.
Hamyau, who six months ago was a strong, vigorous man,
is now suffering from a strange illness, which those favour¬
able to M. Pasteur’s treatment affirm to be pulmonary con¬
gestion. M. Peter, on the other hand, does not hesitate to
declare that the symptoms are due to canino-experimental
inoculation. Sinoe the middle of February there has been
paresis of the lower limbs, and of the organs supplied by
the pneumogastric nerve. The breathing is constantly
oppressed, the pulse remains' at 120, and the abdomen is
tympanitic. Pressure made by M. Peter on the vagus gave rise
to alarming dyspnea and palpitation. The patient seldom
passes a day without feeling neuralgic pains at the seat of
the inoculations, but no abnormal sensation is felt in the
scar of the bite. The symptoms have been somewhat
relieved by the administration of pilocarpine in doses of
fifteen grains daily, but M. -Peter considers that the case
will terminate fatally. ■

INOCULATION AQAINBT PORCINE MEASLES.

A provincial paper relates another mishap, which is not
uniastxuctive. A. veterinary surgeon had been supplied
with the preservative against porcine measles, and inocu¬
lated & herd of- swine belonging.rto one of Ids clients.
Unfortunately the pigs died, and the veterinary inoculator
was obliged to reimburse their owner. The Echo du Midi
says that he is about to bring an action for recovery against
M. Pasteur.

PROPHYLAXIS OF YELLOW FEVER.

MM. Freire, Gibier, and Rebourgon presented a note at
the Academy of Science on the. Prophylaxis of Yellow
Fever by the Inooulation of an Attenuated Virus. In 1886
and 1886,6524 persons submitted themselves to this protective
vaccination in Rio Janeiro, and during this period the total
number of deaths from yellow fever was 1675. Of the
victims 1667 had not been inoculated, the mortality amongst
those protected amounting to eight deaths only. The
authors state that, taking as the basis of their calculation
the population exposed to the contagion, the percentage of
deatps for the whole number Was 1 per cent., whereas for
those who had been subjected to preventive inoculations it
was only 1 per 1000.

THE SLEEPER OF THENELLBS.

The Revue (Titypnoturme contains a report by Dr. Edgar
BSrtllon on la Lithargique de Thenelles, a young woman
who will shortly have accomplished the fourth year of an

uninterrupted trance. Miss M. B-, now twenty-five

years of age, has always been sickly, delicate, and nervous.
On May 30th, 1883, after a fright, she had several convulsive
attacks, and then fall into a profound sleep, from which she
has never awakened. She is kept alive by small quantities
of liquid food, which are swallowed automatically. The
excretions are greatly diminished, and menstruation is now
entirely suppressed. When examined by Dr. B6rillqn, the
limbs were found to be much wasted, and all trace of
adipose tissue had disappeared. Anaesthesia is complete,
and the knee reflex is abolished. The pulse is almost imper¬
ceptible, and gives 100 beats to the minute. Respiration
is regular, but feeble. The breath has not the autophagic
odour of insanity and starvation. The face is pale, waxy,
and without expression. The mucous membranes are colour¬
less. When the eyelids are opened the eyes are seen to be
convulsed upwards, and Mowing upon them produces no
palpebral reflex. The jaws are tightly closed by con¬
tracture of the masssters. The arms can be easily raised,
but enter at once into contracture. The muscles are in that,
state known as neuro-muscular hyper-excitability, and the
slightest touch or puff suffices to cause contracture, which
can be removed bv the application of warmth. Besides the
sensory anaesthesia there is complete mental inertia, and the:
patient is Inaccessible to tirp kind of hypnotic suggestion.

Paris, April tfth. ; .1 • "t .

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At a quarterly meeting of the Council held on Thursday
last the minutes of the last meeting were confirmed. Oa
the recommendation of the Museum Committee, it was
determined to purchase a very fine specimen of the egg of
the Epiomis.

Mr. James Berry, of 00, Welbeck-street, was awarded the
Jacksonian Prise for his essay on “ The Pathology, Dia¬
gnosis, and Surgical Treatment of Diseases of the Thyroid
Gland.”

The seventh report of the Committee on Charters and
Bye-laws containing the draft of the new supplementary
Charter to give effect to several alterations in the Charters
agreed to by the Council, was approved and adopted, and it
was resolved that the accessary proceedings be taken to
submit the same to the Privy Council.

The resignation of Mr. Howse. as Examiner in Anatomy
was accepted.

Permissian was given to the President to hold a private
conversazione in the College in June next.

The Council having taken exception to the mode of
advertisement of a Member, and he haVing sworn before a
magistrate to cease from such practices, the Council agreed
not to take further proceedings in the matter.

The proposal of toe Committee of Delegates having been
approved by the College of Physicians, authority was given
to the delegatee to erect a statue of the Queen in the Exa¬
mination Ball, at the joint expense of the two Colleges.

It was referred to the President and Viee-Presidents to
prepare an address of congratulation to Her Majesty on the
completion of fifty years of her reign. Further memorials
(one of them from Scotland) against the proposal from
members of the medical profession and men of science to
found a laboratory for the prosecution of pathological and
physiological research .were precepted.

A resolution, proposed by Mr. T. Smith, was carried nem.
con. —viz., “ That a professional auditor be appointed to audit
annually, in association with the committee of auditors, the
College accounts.”

Sir James A Hanbury, K.O.B., of the Army Medical Staff,
was elected a Fellow of the College, under Section 5 of the
16th Victoria, applicable to' Members of twenty years
standing. '_ • ,

CHARLES HUTTON, M.D. Sr. And., MJLC.P.

Dr. Charles Hutton, late of 26, Lowndes- street,
Belgrave-square, long engaged ih the practice of obstetric
medicine, died on the 27th of last month, after a short
attack of acute bronchitis, at the age of sixty-nine. Dr.
Hatton had for some time been in failing health; his last
Alness was apparently the result of a cold caught while
employed on an errand rather of charity than duty on the
night of March 13th.

Charles Hutton, M.D. St. And., was the youngest sur¬
viving son of the late William Hutton, Esq., of Beetham
and Overthwaite, in the county of Westmoreland. The
family was an old one, the property having descended
from father to son for upwards of 300 years. Dr. Hutton
studied at St. George’s Hospital and Paris, and shortly
after the completion of hie studentship married in 1860
a daughter of the late Dr. Seymour, tben one of the
physicians of St. George’s Hospital. This lady survives
him with a son and two daughters. For many years
Dr. Hutton was physician to the Hospital for Children and
Women, Waterloo^-bridge-road, and to the General Lying-in
Hospital, York-road, Lambeth. During hie long profes¬
sional career he won the affection and esteem of all who
knew.him. He was a man of unblemished honour. He

tags. His patience and devotion were unwearied, and a
wide circle of professional and private friends will einoerely
lament his loss. Dr. Hutton was of a retiring nature, and.
though of acknowledged skill in his special department, was

Thb Lakcst,]

OBITUARY.

[Aphil 16,1887. 805

not successful enough to be able to leave a provision for
hie family. His long, honourable, and laborious life appears
to have been inadequately rewarded. It is not impossible
that some attempt may be made to relieve in some small
measure the necessity of Dr. Hatton’s family.

PIETRO CIPRIANI.

A physician and ckisen of the first order has Just been
lost to Italy In the Senator Pietro Cipriani, who died at
Florence on the 4th inst., in the seventy-ninth year of
his age.

Bora in San Piero a Sieve on Dec. 10th, 1808, as a boy he
gave early indications of future distinction, and at the age
of eighteen began hia medical curriculum at the University
of Pisa. He took the degree of Doctor in Medicine in 1838,
and next year repaired to Florence for better means of
clinical observation and research. He soon displayed re¬
markable skill in diagnosis and treat m oa t, which led to hia
appointment as assis t ant-physician to the Florentine Hoe*
pit&l. This poet he filled with increasing acceptance till
August, 1835, when the cholera explosion at Leghorn so*- <
maned him thither to take charge of the laseretto specially :
set apart for sufferers from that disease. His devotion •
to hie heavy and hazardous duties was such that at the i
disappearance of the malady he was publicly thanked by _
the municipality; while the gratitude of the entire popula- '
tion towards him took the form of,a.gold medal struck in ,
hie honour.

Fresh from the cholera wards at Leghorn, he Waawel-:
corned back to Florence by the' heads of the profession,’and
he became assistant in the Clinic* Med lea Generals to the ;
illustrious Maurisio Bufalini. So highly did Bufalini
estimate his clinical and expository powers, that on the fre¬
quent occasions when be had to be absent as a consultant, {
he delegated to young Cipriani the duties of the day in the
ward and the lecture-room. Meanwhile, in' great measure
doe to the rigid inductive teaching of Bufalini, medicine
throughout Italy, and especially in Tuscany, was making;
signal advances, one effect of which was to separate from'
the general clinic such diseases ,aa had asserted their claim;
to distinct and special consideration. Skin affections Were.
one of these, and fer the chair of “ Malattie Cutanea,” created;
for the first time hi Florence, ne fitter occupant was found I
than Cipriani, who, however, before entering on its dudes,
took care, with characteristic modesty and thoroughness, to :
qualify himself by a diligent course of study at the renowned
dermopathic clinics of Vienna and Paris. It was in 1840 j
that Cipriani delivered hie first course of lectures q*> the t
"Malattie Cutanee,” and such an interest did he throw
round his specialty that students from all parts of Italy
came to listen to his prelecth^ns. - ille was not destined,
however, tq close his oaraer in dermatology simply; for on
the veteran Bufalini having, from age and ill-health, to
resign his post at the head of the Florentine “Clinics 1
Medico,” Cipriani was selected as one of. the only two I
Tuscan physicians who were worthy to take up the torch
of the mas tor. The duties that now devolved oA him Mere,
arduous and complicated; but all difficulties faded before
his chivalrous sense of honour, hi* indefatigable application,
and bis Admirably disciplined powers.

He wAs too active A practitioner and too fastidious a
write* to publish much; but is president of the Medical
Faculty of the Florentine Institute he signalised himself as a
coand antic and man of tilAte, and guided others to the path I
of authorship)from which be shrank himself. In 1879 his'
health began to decline, and it waq only after reiterated
appeals to be relieved. of hi^ official duties that he was j
allowed to limit his activity to consultations merely. He,
continued, as Emeritus Professor and as occasional Assessor
atr the directing Council of the ; Florentine Institute, to give
the profession the benefit of his experience and judgment,
while his devotion to good works kept fiim to the last the
chief promoter of the Blind Asylum of' FforencA. Some¬
times, too, ha would appear in Borne- dnribg great political'
crises and take his part as Senator 1 in the deliberations of
the “ Patres Conscript!” But Within ttoe laat Few years the
decline of health, the death of fimiHar friend.-', and not a 1
little domestic affliction, withdrew him more and more from
the public view, so that it was With much lets surprise than! 1
sorrow that on the 8th inst. Italy received the news of bis'
death. • '• ; 1

JAMES BARRON, B.A., M.D.

. It is with sincere regret we have to announce the death
of Dr. Barron, of Belfast, which took place at his residence
in that city on the 2nd inst., under very sad circum¬
stances, he having succumbed to typhus fever, a disease
which has carried off so many Irish medical men, and
which he contracted from a dispensary patient whom he
was attending. Dr. Barron, who was a native of
Antrim, was educated at the Belfast Medical School, He
graduated in ' the Queen’s University, and at his MJ)
examination was awarded a first class and the gold medal.
Shortly after receiving his diploma be was appointed
dispensary doctor at Templepatrick; but, being ■ of an
ambitious nature, he went to Belfast, and was elected
house-surgeon at the Royal Hospital, a post which he-held
for several years, until, a vacancy having oecurred iq. the
surgical staff, he was appointed assistant-surgeon. He the?
began private practice m Belfast, and shortly afterwards
resigned his hospital appointment on being chosen to take
charge of one.of the dispensary districts, an office which he
held up to his decease. He was secretary of the, Ulster
Medical Society, and a short time ago was elected a
member of the staff of the Ulster Hospital for Women and
Children. Dr. Barron was thoroughly versed in all branches
of the medical profession, and being a-man of the most
kindly disposition be was -extremely popular with his
brother practitioners, as weifas with a large circle of patients
and friends. It is melancholy to think that within n Short
interval two medical men in Belfast, living in the same
district—Dr. Wadsworth, and Dr. Barron—have both fallen
victims to typhus fevery An i naan ante number of -medical
men and other friends were present at the funeral, to show
a last mark of respect to one Who had become so deservedly
popular. ■ ’

G. BACON SWEETING, M.R.C.S., L.R.G.P. Lo>rt>.

Thb death of this gentleman took place pn March 23th, at
Great Smeaton, in Yorkshire, where he had. gone in search of
health. For upwards of thirty years he occupied a promi¬
nent position in the profession at King’s Lynn and the
neighbourhood. Born at Bridport in Dorsetshire, on March
28th, 1824, he was apprenticed to hia father, Mr. William
Sweeting, himself a practitioner of considerable repute.
After studying, at University College, and subsequently-in
Paris, he entered the profession by taking the membership
of the College in 1848. For some years lie was engaged with
Mr, Image, of Bury St. Edmunds, in active'practice. In
1856 he went to reside at King’s Lynn, and at once took A
foremost place in |he profession. Although engaged, ip
general practice all his life, his opinion and aid as a con¬
sultant both in medical and surgical cases were constantly
sought by his brother practitioners.. The trust they thus
bestowed in him WAS never betrayed, and so he suoceeded
up to the time of his death in successfully filling the diffi¬
cult, position uf « consulting general practitioner. For a
short time he was surgeon to the West Norfolk and Lynn
Hospital, but finding the tax on his time too great, he
retired, and was appointed consulting surgeon'. lie was a
Fellow of. the Royal Medical and ehmirgical and Chemical
Societies. Of imposing presence, and assessing a fine
physique, he Was universally inspected. He was 1 an ardent
lcrvAr of field s parte. Thb late Mo. Sweating was never
married. He was actively engaged in pmetice-until fetfr
weeks of his death', which took'place within one day of hie
attaining his aixly-tiiirfl.yefr. < ( . .

PROFESSOR LUIGI LAURENZI. .

THW able ^urgebn and teacher,.the head-of th&Ospedale
dells Consolazione id ljome, died bn the Bth inst., in' cir¬
cumstances •distressingly’sadden. He had made his usual
morning visit to the wards, and had driven to his house in
the Via Borgogna, when his coachman remarked that he
alighted witn great difficulty, and was deadly pale. 'The
coachman accordingly made a signal to Madame Laurenri,
who happened to be at the window with bar daughters, to
comb doWk afonob. The lady descended forthwith, and
With the add-'of the- coachman, suoceeded is assisting bar
husband id-doom, though he attempted to conceal how ill!be
was, and deprecated her alattm, Within half an hour thereafter

806 The LanCet,]

MEDICAL NEWS.

[April 16,1887.

he expired. Professor Laurenzi had, it seems, been suffering
from urgent cardiac symptoms for some time, but such was
his devotion to his patients and his pupils that, in spite of a
very bad night, and contrary to the entreaties of his friends,
he insisted on going that morning to the hospital.

His death is widely and deeply lamented. He was in the
zenith of his powers, and his high reputation, acquired at
the Consolazione by a long series of brilliant operations,
had caused him to be respected and consulted as one of
the soundest and most successful surgeons of Rome and
the province. 8ome of hie lectures and notes of interesting
cases, reported in the Qaxzetta Median di Roma, had also
carried his reputation beyond the Italian frontier. He was,
moreover, very popular in the class-loom, and a singularly
pleasant and affable colleague.

He was buried in the Campo Verano on the morning of
the 7th inst., the funeral cortege consisting of a numerous
train of friends, colleagues, and representatives of the Uni¬
versity and learned bodies. In the Piazza di Termini the
procession paused for a space, and, according to custom; brief
addresses were pronounced in his honour. The speakers
were the veteran Dr. Filippo 8calzi and Prof. David Toscani,
both of them equal to the melancholy task.

Ptlrital $JMjs.

Royal College of Physicians of Edinburgh.—
The following qualified candidates, having passed the final
examination, have been granted the licence:—

Brldjrvrood, John Fr&nois. Stafford.

Walie, Darla Allas, London.

Callender, Gerald, St. Mary’s Hospital, London.

Wrentmore-Tuck-r, Robert Frank. Ollfton, Bristol.

Farmer, William Henry Francis, London.

Society of Apothecaries. —The following gentle¬
men passed the examination in the Science and Practice of
Medicine, Surgery, and Midwifery, and received certificates
to practise on April 7th:—

Shute, George Sidney, Gillingham, Dorset.

Wedgwood, William Brackenbury, Fern Bank, East Dulwich.

The following gentlemen also on the same day passed their
Primary Professional Examination

Richard Watson CouDoell, Bristol School of Medicine; Geo. Andrew
Gun ton, St. George's Hospital.

The results of the Examination in Arts held at the Hall of
the Society on March 3rd and 4th last have recently been
published. There were 204 candidates, and from the Pass
List it appears that 2 were placed in the First Class, 44 in
the Second Class, and 116 were certified as having passed in
some of the subjects, but not in all. The number of candi¬
dates was larger than on any former occasion, though the
examination is held four times annually.

A fresh outbreak of diphtheria is reported from
Saltash.

In the House of Commons on the 12th inst., the
Aberdeen Infirmary and Lunatic Asylum Bill was read a
second time.

Hydrophobia: M. Pasteur’s Treatment. —Senor
Ramon was bitten by a wolf on Feb. 15th. M. Pasteur
treated him for hydrophobia, but death has ensued.

Plan 8 have been selected for the proposed Ash¬
burton and Buckfastleigh Cottage Hospital. The building
will, it is estimated, cost £1200.

Middlesex Hospital. —The first Broderip scholar¬
ship at this institution has Just been awarded to Mr. W. H.
Vickery.

The Duke of Bedford has intimated his intention
of contributing £300 to the Endowment Fund of the
Taviatook Cottage Hospital and Dispensary, which has
recently been started.

Registration of Plumbers. —Of nineteen journey¬
men plumbers examined at the last meeting of the examiners,
nine candidates passed and ten failed to satisfy the exa¬
miners.

The memorial stone of the new infirmary buildings
to be erected for the parish of Birmingham was laid on the
31st nit. The building, which is designed on the pavilion
principle, will cose about £70,000.

A general meeting of themembeffB'**f !
cab trade was held on the 8th inst., with* view of increasing
the contributions to the Hospital Saturday collection.

The recent performances at the Theatre Royal,
Birmingham, on behalf of the local hospitals, realised i30J,
which will be distributed amongst the charities on tin
principle of the Hospital Saturday collection.

French Protestant Hospital, Victobla-park.—
On Monday last a general court of governors and friends of
this charity was held, and a report read which showed that
much good work is being done through the agency of the
hospital.

Naval Medical Supplemental Fund.—A t the
quarterly meeting of the directors of the fond, held on the
12th inst., T. Russel Plokthorn, Esq, Inspector-General, in
the chair, the sum of £53 was distributed among the several
applicants. i

The usual monthly meeting of the Metropolitan
Public Gardens Association was held on the 5th insc, when
reports as to the progress of works in different parte of
London which have been undertaken by the Association
were presented, i

The Committee of the Manchester Southern Hos¬
pital are appealing to the public for funds to enable them to
establish a ljing-in hosmtal in connexion with that insti¬
tution. the urgent need for which has been for some time
recognised.

Royalty at the London Hospital.—O n the 12th
inst., his Royal Highpees the King of the Belgians, accom¬
panied by Sir Edmund Currie^ paid a visit to the London
Hospital. The King inspected many of the wards, and ex¬
pressed himself highly pleased with the excellent hospital
arrangements.

Stray Dogs in London.—T he number of stray
dogs taken by the police during the month ot March to the
Dogs’ Home was 1246. Twelve were killed in the thirty-on*
days in the London streets as mad or ferocious. Sixty-fire
persons, including two constables, were bitten during the
same period.

The “John Reid” Medical Prize.—T his prize,
of the value of £25, founded by Miss Reid in memory of her
brother, the late John Reid, surgeon, Glasgow, and awarded
for the best original research bearing cm any of the depart¬
ments of medical science conducted in one of the hospital!
or laboratories of Glasgow, has been gained by Mr. K.C.
Wakefield for an able paper on “ Aneurysm.”

The Wolverhampton Nursing Institute — The
Mayor (Mr. T. Vincent Jackson, F.R.C.8.) has received »
communication from the Secretary of State, informing hia
that Her Majesty the Queen his consented to the proposed
Nursing Institute, which is to be established in that town
as a permanent local Jubilee commemoration, being named
“ The Queen Victoria Nursing Institute.”

Medical Magistrates.—R obert Le&mon Bowles.
M.D., F.R.C.P., was sworn in on the 6th inst. at Canterbury
as a Justice of the Peace for the county.—Robert Spence.
M.B., Craigkennochy, Burntisland, has been placed on the
Commission of the Peace for Fifes hire.—Dr. Evan Roberta
Penygroe*, has been placed on the Commission of the Pe*c*
for Carnarvonshire, and qualified at the recent Easter Quart*
Session for the county.

Stockport Infirmary.—T he annual meeting of the
trustees of this institution was held on the 30th ult., wb®
it was reported that 1660 out-patients, 825 home patient*.
1052 cases of accidents, 621 in-patients, and 650 casual^**
without recommendation had been treated during the pa«
year, making a total of 4808, against 5006 in 1885. Tb*
total amount of inoome was £3678, against £3492in tbe
preceding year, and the expenditure amounted to £2931.

St. Thomas’s Hospital.—T he testimonial to the
retiring librarian, Mr. Denison, will be presented in tb*
Library of the Medical School on Monday, May 16th,w
4.30 p.m. Dr. Ord, Dean of the School, wul preside. *n
testimonial will consist of a clock, and a purse accompany
by au engrossed list of the subscribers. In order that to*
list may be ready, it is necessary that any who hnvti no
yet subscribed but intend to do so, should send in tue
names at once.

Digitized by LvOOQle

Thb Lancbt,] BIRTHS, MARRIAGES, AND DEATHS.—APPOINTMENTS.—VACANCIES. [April 16,1887. 807

An Easter Offering to tiie Brompton Hospital.
On Sunday lest, after a sermon at St. Peter’s, Crnnley-
g&rdens, by the Rev. F. Byng, the sum of £56 was collected
For the benefit of the funds of the above hospital.

The Jubilee. —In commemoration of the Jubilee
it is proposed to found a convalescent home in connexion
with the Adelaide Hospital, Dublin.—On the 6th inst. it
was decided by a meeting of the inhabitants of Eastbourne
to enlarge the Prinoess Alice Memorial Hospital.—It is ex¬
pected that the foundation stone of the Royal Jubilee
Children’s Hospital, which is to be erected at Gateshead,
will be laid early in J une.

$irtjjs, Carriages, ani) Jhatjjs.

BIRTHS.

HoLTnous*.—On the 10th inst., at Uowaratxeet, the wife of Edwin
llermus Holthouse. F. K.C.S.. of a son.

Kirkham.— On the 24th ult.. at Downhara, Norfolk, the wife of F. W.
Kirkham, M.A., M.D., of a son.

Handberg.— On the 5th Inst., at Liverpool Lodge, Brixton-hfll, B.W.,
the wtfo of Arthur Sandberg. M.D.. of a son.

Scott.—O n the lit ult.. at Batu Gajah, lflnta, Perak, the wife of
W. Duncan Scott. .NT.IV. C.M., of a daughter.

Steybxson.— On the loth Inst., at Cambcruell-grove, Denmark-hlll,
the wifa of Lender 8teveaaon. M.D.. of a son.

Watnet.—O n the sjh inst., at Buckhold, Berks, the wile of Herbort
Watuey. M.D.. of a sou.

West. — On the 7th Inst... at King Henry’s road. N.W., the wife of
J. Arthur West, M.K.C.S.. L.K.O.P.. of a son.

MARRIAGES.

FtrixitR— Black.— On the 12th Inst., at St. Marylebone Church. Henry
Roxburgh Fuller, M.D.Ooatab.. to Julia Louisa, second daughter of
the late Patrick Black, M.D.

Hex i) lbv—Beal. —On the 12th inst., at J»ypore, Rajputma, India.
Surgeon Harold Hendley. 7th Bengal Cavalry, to Hmmle, second
daughter of James Beni, of Koseneath, Jiammenmlth.

White—Chalmkh.— On the 13th inst., at Christ Church. Fulwood,
Sheffield, bv the Rev. A. G. Tweedle. M.A.. John Sinclair White,
M.D., F.R.C.S-, to Evelyn, only daughter of Frederick Chalmer.

DEATHS.

Eberlr —On the Sth Inst., suddenly, John James Bberle, L.B.C.S.,
L.R.C.P.Kd , at Tblrsk. Yorkshire, aged 40.

CtLASSE.— On the 1st inst.. at his residence. Queen's-road, Guernsey,
Henry Dunn Glasse, late Deputy Inspector-General of Hospitals,
Bombay Presidency, aged 73.

Gostlixg.— On the 3rd Inst., at Naples, on his way home from
Bombay, Henry Walter Goatling, M.K.C.S., L.R.O.P.B , aged 43.

Ghenfkll.— Ou the 10th inst.. at Penzaaoe (from ear disease and
purulent meningitis;, Henry Grenfell, M.R.C.S., L.S.A.

Halls.—O n the 5th inst., at Court.lield-gnrdens. South Kensington,
Thos. Bdwsrd Hornby Halls. M.R.O.8., aged 50.

Parker. —On the 0th inst., at Shriveoham, Berks, Charles Gunning
Parker, F.B.C.S., aged 70.

Jackson. —On the 31st ult.. at Brunswlck-terrace, Brighton, after a
short illness, John Jackson, M.D.Cantab., F.H.O.P., late of the
Bengal Medical Service, aged 152.

IVark. —On the 5th Inst., at Pitrjohn's-avenue. Hampstead. Daniel
Wane. M.D., M.R.C.P., late of Graf ton-street, Berkeley-square,
aged 73. _

K.B .—A fee of Si. is charged for tKo Insertion of Notices of Births,
Marriages, and Deaths.

H-pmutmtuts.

Smeeassful applicants for Yaeanctes, Secretaries of Public institutions, and
others possessing information statable for this column art invited to
forward it to The Laxckt Office, directed to the Sub-Editor, not later
than 0 o'clock on the Thursday morning of each week for publication in
the next number. _

Adams, Joseph, M.B.. C.M.Ed., has been reappointed Medical Officer
of Health for the Runcorn Rural Sanitary District.

Arum, C., M.R.O.8., L.8.A.. lias been appointed Jnnlor House-
Surgeon to the Macclesfield General Infirmary, rice Gell, pro¬
moted.

B uncle, Alexander. M.B.. C.M.Ed., has been reappointed Medical
Officer of Health for the Featherstone and Pontefract Urban
8»nltarv Districts.

De’Ath, Gkokuk Haxpv. M.R.C.S.. L.R.C.P.Lond.. has been re¬
appointed Medical Officer of Health for the Bnokingham Urban
Sanitary District.

Dudgeon, John, M.D. Glas., has been appointed Physician and
Private Secretary to His Excellency the Marquis Tseng at
Pekin.

Flower. Frederick Isaac. M.R.C.S.. L.S.A., Medical Officer of
Health for the Rural Sanitary District, haa been appointed Medical
Officer of Health for the Warminster Urban Sanitary District, vice
Grubb, resigned.

Fowler, Jakes, M.RX'.S., L.S.A.. has been appointed Consulting
Burgeon to the Clayton Hospital, Wakefield.

Gault. Arthur H., L.R.C.P.Lond., M.R.C.S., has been appointed
House-Surgeon to the Ash ton-under Lyne District Infirmary.

Greek. F. Kivu. F.H.C.S., L.8.A.. has been reappointed Honorary
Assistant Surgeon to the Royal United Hospital. Hath.

Heap. Charles Sydney, M’R G.8., L.K.Q.C.P.I.. has been re¬

appointed Medical Officer of Health for the Swanage Urban Sanitary
District.

IIlBST, Herbert. M.B., C.M.Edin.. has been appointed Assistant
> House Surgeon to the Huddersfield Infirmary, vioe L- Demetriadi,
resigned.

Horsfall. Hkxrv, M.D. St. And.. M.R.C.S., has been reappointed
Medical Officer of Health for the Bedule Rural Sanitary District,
Yorkshire.

Latham, P. W.. M.D.Cantab., F.R.C.P.Lond., haa been reappointed
Physician to Addenbrooke't Hospital, Cambridge.

Lawson. J. Burnet r. M.D.GIas., has licim elected Medical Officer for
the Rothesay Parochial Board, vice Maddever. daoeaaed.

Menziks, William Francis, M.B., C.M.Hdin., has been appointed
Assisuuit Medical Officer to the Lancashire County Asylum, Rain-
hill.

MupiiK, Thomas H. Trackt. M.R.C.S., L.R C.P.Lond., has been
appointed Medical Officer of Health for the Paignton Urban 9anitary
District, vice StoDe, deceased.

O’Connor, JonN, M.B.Dub.. has. been appointed Assistant House-
Surgeon to the Portsmouth Hospital.

Peakk. Joseph. L.F.P.S Glas., L.S.A., has tteen appointed Interim
Medical Officer to the Parochial Board of Falkirk, vice Hadden,
deceased.

Soott. Richard J. H., M.R.C.S.. baa been reappointed Honorary
Assistant Surgeon to the Royal United Hospital, Bath.

Staxukh, William. F.H.C.S.B.. L.S.A., has been appointed Honorary
Surgeon to the Clayton Hospital, Wakefield.

Stephens, Edward. 'L.R.C.P. gd., M.K.U.8.. has been reappointed
Medical Officer of H-alth for the Chard Rural Sanitary District.

Sv.mkx. K. West. M.D.Ertin.. M.H.O.8.. has been appointed Surgeon to
the Waterhouse's Charities and Blue Coat School, Halifax, vioe
Solomon Smith, M.R.C.S.. Ac., resigned.

W'alkkr. John W., M.H.C.8., L.R.C.P.Lond., has been appointed
Houorary Surgeon to the Clayton Hospital, Wakefield.

Walker, L. Newman, L.F.P.S.Glas., L.8.A., has been appointed
by the Cape Government Medical Officer to the Zwartkops and
Cookhouse Section of the Cape Government Railways, South
Africa.

Wilton. John Plevdeli.. M.R.C.S., L S.A., has been reappointed
Medical Officer of Health for the Gloucester Port Sanitary
District.

Young. James Martin, M.B., C.M.Aber., has been appointed Resident
Surgeon to the Birmingham and Midland Bye Hospital.

Dacatictcs.

/a compliance with the desire of numerous subscribers, it hat been derided to
resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advert' tin j columns. For further
information regarding each vacancy reference should be made to the
advertisement. --

Birmingham Borg’ Asylum.—R esident Clinical Assistant. Board and
residence are given, but no salary.

Bristol Royal Infirmary.—A ssistant Resident Medical Officer and
Pathologist. Salary £90 per annnm, with board, lodging, and

washing.

Chelsea. Brompton, aed Bklgrave Dispensary, Sloane-square, S.W.
Surgeon.

Chester General Infirmary. — Visiting Surgeon. Salary to
commence at £80 per annum, with residence and maintenance in
the house.

City of London Hospital for Diseases of the Chest, Victoria-park,
B.—Resident Clinical Assistant. A gratuity of £20 is usually
awarded at the close of the term of office (six months).

Cor. ntv and Borough of Carmarthen Infirmary. —House-Surgeon.
Salary £100 per annum, with board, lodging, fire, light, and
washing.

Cumberland Infirmary, Carlisle.—Assistant House-Surgeon. Salary
£10 per annum, with board and lodging.

Eastern Fever Hospital (Metropolitan Asylums Board), The
Grove. Homerton. B.—Assistant Medical Officer (Clinical Assistant)
for a period of three months.

Byei.ixa Hospital for 8ick Children. Southwark-bridge-road. S.E.—
House-Surgeon. Salary £70 per annum, with board, washing, and
realdenoe.

Great Northern Central Hospital, Caledonian-rood, N. — Aural
Surgeon. Also two Clinical Assistants.

Holborx Union Infirmary, Archway-road, Upper Hollaway, N.—
Assistant Medical Officer. Salary £100 per annum, with board,
lodging and washing.

Hospital fob Sick Children, Great Ormond-street, Bloomsbury,
W.C.—Clinical Assistants in the Out-patient Department.

Infirmary for Consumption and Dlskxses of the Chest and
Throat, Margaret-itreet, Cavendish-square, W.—Honorary Visiting
Physician.

Kidderminster Infirmary.— Honae-Surgeon. Salary £140 (Increasing
by £10 per annum to £170), with rooms in the Infirmary and

attendance.

Liverpool Infirmary for Children, Myrtle-street.—House-Surgeon.
Salary £85 per annum, with board and lodging.

London Temperance Hospital, Hampstead-road, N.W. —Junior House-
Surgeon. Board and residence in the Hospital.

Queen’s Hospital. Birmingham.—Obstetrio and Ophthalmic House-
Surgeon. The appointment carries with It board, lodging, Ao.

Royal Albert Edward Infirmary and Dispensary, wlgau.— Junior
House-Surgeon. Salary £80 per year, apartments and rations
(exclusive of wines, spirits, and washing).

Whitechapel Union Infirmart, Whitechapel. E.—Assistant Medics
Officer (Resident). Salary £150 per annum, with furnished
apartments, coal, gas, and washing.

Digitized by ooQle

808 The Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Aran. 16,1887.

SSkfeical Jiarg for % mmn$ Wink

Monday, April 18.

Royal London Ophthalmic Hospital, Moorftklds. — Operation!,

10.30 A.M., and each day at the same hour.

Botal Westminster Ophthalmic Hospital.—O perations, 1.30 p.m.,
and each day at the same hour.

Chelsea Hospital for Women.—O perations, 2.30 p.m ; Thursday, 2.30.
St. Mark’s Hospital.—O perations, 2 p.m. ; Tuesday, 2.30 p.m.
Hospital fob Women, Soho-square. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Botal Orthopedic Hobpital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 2 p.m., and
each day in the week at the same hour.

Mkdical Societt of London.—8.30 p.m. Mr. C. B. Lockwood: On a
Mode of Restraining Hemorrhage during Operations upon the
Tongue.—Mr. H. H. Clutton : A case of Catheter and Calculus
removed by Lithotrity. — Dr. ABgel Money; Renal Sarcoma in
Infanoy; is Surgery Justifiable?

Tuesday, April 19.

Guy’s Hospital.—O perations, 1.80 p.m. and on Friday at the same hour.

Ophthalmlo Operations on Monday at 1.30 and Thursday at 2 p.m.
St. Thomas's Hospital.—O phthalmic Operations, 4 p.m.; Friday,2 p.m.
Cancer Hospital, Brompton.—O perations, 2.30 p.m.; Saturday, 2.30 p.m.
Westminster Hospital.—O perations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

Sz. Mart’s Hospital.—O perations, 1.30 p.m. Consultations, Monday,

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.h.
Botal Institution.—3 p.m. Mr. John Hopklnson: Electricity.

Botal Statistical Societt.—7.45 p.m. Mr. If. A. Humphreys: C laes

Mortality Statistics.

Societt of Arts.—8 p.m. Major General Sir Charles Warren: South
Africa.

Pathological Societt of London. — 8.30 p.m. Messrs. Bowiby,
Lockwood, W. Adams, Morgan, and Shattock : Specimens illustrative
of Congenital Dislocation ef the Hip.—Mr. Lunn: Disease of the
Humerus.—Mr. Shattock : Fibrous Metaplasia of Bone.—Dr. A. H.
Robinson : Osteitis Deformans. — Mr. Hutchinson : Destructive
Arthritis of Knee without Suppuration. —Mr. Hutchinson, jun.:
Sarcoma (?) of Knee.—Dr. Pitt: Carcinoma of Spine and Liver.—Dr.
Conpland and Dr. Pasteur: Diffuse Sarcoma of Spinal Pia Mater
(two cases).—Dr. Maguire: Interstitial Aneurysm of the Inter-
auricular Septum. Card Specimens:—Mr. Fenwick : Tumour of the
Bladder.—Dr. Wiilcocks: Congenital Malformation of the Heart.—
Mr. Shattock: Tuberculous Disease of the Skin.

Wednesday, April 20.

National Orthopaedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital.—O perations, 1.30 p.m. ; Saturday, same
honr. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgioal Consultations, Thursday, 1.30 p.m.

St. Thomas's Hospital.—O perations, 1.30 p.m. ; Saturday, same hour.
London Hospital.—O perations, 2 p.m.; Thursday* Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital for Women and Children.—O perations,

2.30 P.M.

University College Hospital.—O perations, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 p.m. ; Saturday, 9.15 a.m.

Botal Free Hospital.—O perations, 2 p.m., and on Saturday.

King’s College Hospital.—O perations, 3 to 4 p.m. ; Friday, 2 p.m. ;
Saturday, 1 p.m.

Children’s Hospital, Great Ormonivstreet.— Operations, 9 a.m. ;
Saturday, same hour.

Sochbtt or Arts.—8 p.m. Mr. A. Reckenzaun: Bleotric Locomotion
Thursday, April 21.

St. Georgr’8 Hospital.—O perations, 1 p.m. Ophthalmlo Operations
Friday, 1.30 p.m.

Charing-cross Hospital.—O perations, 2 p.m.

North-West London Hospital—O perations,2.30 p.m.

Ratal Institution.—3 p.m. Prof. Dewar s The Ohemistrv of the
Organic World.

H^bveian 8ocibtt of London.—8.80 p.m. Mr. F. Treves: The Treat¬
ment of Wounds.—Dr. W. B. Hadden: Demonstration on Patho¬
logical Changes in the Brain and Spinal Cord.

Friday, April 22.

Botal South London Ophthalmic Hospital.—O perations, 2 p.m.
Clinical Society op London.—8.30 p.m. Mr. Bilton Pollard j Three
cases illustrating the Difficulties in establishing Natural Bespiratlon
after Tracheotomy, and their Treatment by Tracheal Catheterisa-
tion.—Mr. Meredith : A case of Large Omental Lipoma Buoceasfully
treated by Abdominal Section.—Mr. Oodlee 1 Some cases of Abdo-
mlnal Cyst following Injury.—Mr. B. PltU: Abdominal Exploration
. for Chronic Intestinal Obstruction, Belief of Symptoms by Artificial
Anus, subsequent Removal of a Growth involving Splenic Flexure
. of Colon, Recovery.

Botal Institution.-^ p.m. Sir Frederick Abel: The Work of the
Imperial Institute.

Saturday, April 23.

M iddl e se x Hospital.—O perations, 2 p.m.

Botal Institution.— 3 p m. Mr. B. Von Lendenfeid 1 The New Zealand

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.m. by Steward's Instruments )

The Lancet Office, April 14th, 1887.

Date.

Barometer
reduced to
Sea Level

uud SNF.

Direc¬

tion

of

Wind.

BuTb.

Wet

Bulb.

Solar

Hadla

in

Vacuo.

Max.

Temp.

Shade.

Min.

Temp

Rain

fall.

Remarkitl

SJOajL

Apl. 8

30-11

N.E.

45

42

97

54

35

Fine

.. 9

30-19

N.B.

41

40

81

52

39

Overcast

„ 10

30-23

N.E.

43

39

81

50

38

Cloudy

„ 11

30-17

K.

46

43

99

60

36

Fine

12

30-04

N.E.

43

41

92

65

37

...

Overcast

„ 13

30-11

E.

41

39

48

39

Overoast

14

30-26

N.E.

39

36

82

63

31

Cloudy

Itotes, Sjwrt Comments, # ^nstoers to
Corresponbents.

It it imperially requested that early intelligence of local events
having a medical interest, or which it xs desirable to bring
under the notice of the profession, may be sent direct to
this Office .

All communications relating to the editorial business of the
journal must be addressed* 1 To the Editors.”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marlced and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed "to the
Publisher .”

We cannot undertake to return MSS. not used.

The Perth Infirmary.

//unumi&u writes to us to the following effect:—" The reference to Perth
Infirmary in your last issue is calculated to convey a false impression.
As a neutral party, but one who for many years has cloaely watched
the course of events leading to this crisis, I can vouch for the fact
that, with the exception of Drs. Stirling, Calder, and Graham, the
whole of the medical profession in this city and county warmly espoused
the cause of Dr. Bramwell. So strong is the feeling against the present
infirmary management tiiat a movement is on foot to erect a cottage
hospital.’’

Junior.— 1, 2, 3. Occasionally, but not often.—1. The data given are too
scanty to warrant a definite conclusion.

Dr. Sheppard (Liverpool).— Gazzetta degli Ospitali, Corao Magenta, 48,
Milan.

THE SLEEPING MAN.

To the Editor, of The Lancet.

Sirs,—T his represents an extreme case of the low of power resulting
from shock, which, according to modern medical phraseology, may be
termed “ neurasthenia” or “ neurosis." It will be Interesting to observe
to what extent Cbauffat will recover his former health. It has too often
happened that young women in a similar but not such an extreme con¬
dition have been treated with taunts, repro ac hes, and coercion, under
the impression that they were wilful, obstinate, ana shamming; in
other words, that they were the subjeots of hysteria, by which term the
condition of neurosis has been erroneously designated. It cannot be too
widely known that loss of physical and moral power is the essential
characteristic of all such cases, and that the object of treatment should
be to restore power and give a helping hand until the patients are able
to help themselves. The effect of the maltreatment above mentioned
has been to prolong such oases indefinitely, and aggravate them to any
amount of intensity; and it must be understood for the future that soch
prolongation and aggravation are due to mismanagement, either domestic
or medical; or both—in other words, that they are factitious.

I am. Sirs, your obedient servant,

Mansflold-street, W., April, 1887. D. De Berdt Hovell.

OXALIC ACID AS AN EMMENAGOGUE.

To the Editors of The Lancet.

Sirs,—I n The Lancet of Jan. 29th last there is a paragraph about
the emmenagogue action of oxalio acid. Can any of your readers tell
me if it is of any benefit ? I should like to try it. Is it a safe medicine ?

I am, Sirs, roars truly,

April 11th, 1887. O. W.

Digitized by CjOO^Ic

The Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [April 16,1887. 800

Thk Moron Memorial Fund.

President : Sir William Jenner, Bart., K.C.B., M.D., F.B.S. The
following contributions have been received since those announced
in The Lancet of March 26th. All subscriptions should be forwarded
to the Honorary Treasurer, R. Clement Lucas, B.S., F.R.C.S., 18, Fins-
bury-square, B.C., by whom they will be acknowledged, and cheques
should be crossed “ City Bank.”

Subscriptions announced £541

R. S. Wilkinson, Bsq.,

D.L., J.P. . 5

T. Parries, Bsq. 5

Sir Henry Peek, Bart.... 5

Professor Odiing.F.R.B. 3

W. H. Newnham, M.D. 2

R. L. Bowles, M.D. ... 2

T. F. Grimsdale, Bsq. ... 2

W. Laidlaw Purves, Bsq. 2

B. T. Ryle, M.D. ... 2

P. Taylor, M.D. 2

W. D. Smallpiece, Bsq. 2

John Cock, Bsq. 1

John Orton, M.D. ... 1

J. Cooper Wilkinson, Bsq. 1

R. A. Nell, Bsq. 1

Mrs. Nicholls ... ... 1

Fifth Lilt.

0 6 H. 0. Hilliard, M.D.

D. D. Malpas, M.D.

5 0 J. N. Cregeen. Bsq.

5 0 J. H. Evans, Bsq.

0 0 F. G. Larkin, Bsq.

3 0 M. 0. Dalton, M.D.

2 0 0. J. Symondt, M.S.
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2 0 W. HTAllchln, M.D.
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2 0 0. 8. Tioehurst, ftq.
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£110
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Convict.—, Application should be made to the Directors or Commissioner*
of Prisons, and the appointments are in the hands of the chairman.
Sir B. Du Cane.

Mr. C. William *.—We are not aware, but will make inquiry.

FRIENDLY SOOIBTIBS’ MBDICAL ASSOCIATIONS.

To the Editor* of The Lancet.

Sirs,—I have read with much Interest the letters which have from
time to time appeared In your columns on the above subject,
and your own remarks upon them. While I entirely sympathise
with yon and your correspondents In the objects you have both
at heart—viz., the maintaining the dignity of the medical pro¬
fession, and Increasing the remuneration of certain branches of It
which are at present soandalously underpaid and overworked,—I take leave
to doubt whether you are taking the beat way to attain them when you
attack the Friendly Societies’ Medical Associations. 1 am myself surgeon
to such an association. It will, perhaps, surprise some of your corre¬
spondents to hear that I find it a very pleasant and comfortable berth.
I am not at all overworked, although the association includes between
2000 and 2500 members, the great majority of whom have wive3 and
families whom I am expected to attend on the same terms as
themselves. I have found them not merely reasonable In their
demands, but almost invariably considerate and thoughtful. There
Is a managing committee of working men whoee treatment of me
has from the first been not only fair and just, but even courteous and
gentlemanly. Subject only to the condition that my. work be done, I am
at liberty to arrange it exactly as I please, and I db not feel my present
position to be one whit less independent than that of any brother prac¬
titioner who. has to study the whims and humour* of his private patient*,
while it is a thousand times more so than that of hie assistant, with whom
I would not change places for treble the salary he pays him. And that
brings me. Sir, to the point of my letter, which is this: You will
never effect any improvement in either the status or the remuneration
of what may be called the lower ranks of the profession by attacking
these associations, or trying to dissuade men from entering thefr service,
while you have not a word of censure for the principal who, with an
Income of, say, £1000 a year, is not ashamed to offer £60, £70, or £80 to
a “donbly qualified ” man to booome his drudge for that wretched
pittance. Look at your own advertising columns 1 I remember well the
time when I used to scan them weekly with a sinking, well-nigh hopeleas
heart. There, Six*, is your mark ; there is the real cancer to be cut out.
Till that scandal Is reformed you will attack all lesser abuses in vain.
Do you seriously suppose that men Will he deterred from accepting
positions where. If they will only do their work reasonably well
and exercise a little, tact and oommon sense, they may easily be
oomfortable and independent, when In nine oases out of ten the only
alternative Is an assistsnoy with its poverty and drudgery ? Why, I
know a dozen assistants, men of excellent abilities, character, and quali¬
fications, every one of whom is much harder worked and muoh worse
paid than I am. Of course, I would have no objection to be better
paid. I think the association get my servioes very cheap; they
are by no means exempt from the oommon human weakness of being
willing to take the maximum of work for the minimum of pay. But
associations are not the worst offenders. Leave them alone for a little
and turn your attention to the wealthy professional brother who makes
a drudge of his assistant and pays him little more than the wage* of hit
coachman. If yon can make him ashamed of bis meanness, yon will earn
the thanks of hundreds who need your sympathy and championship
far more than does. Yours truly,

Feb. 18 th, 1867. M.O., F.S.M. Aasoc.

Anosmia.

Stnior Surgeon writes that reoent letters on this subject which have
appeared tn our oolumns suggest to him that the dam described may
be one of ozana, with probably diseased bone. . ^ .

R~ B. K .—Our correspondent will not be affected by the new Adt.

Longevity.

The Berlin Stati*ti*ch*n Komrpondenz, by way of oelebrating the
Emperor of Germany's ninetieth birthday, has reoently published a
list of all the known persons In the Prussian kingdom who are older
than the sovereign. At the taking of the census of Deo. 1st, 1885,
there was one man of 120 years, another of 118 years; a woman of 117,
another of 115; two women of 112; two men and one woman of 111;
five women of 110; one man and four women of 109; three men and
two women of 108; two men and ten women of 107 j thirteen men and
seven women of 106; and quite a large number who had attained to
their 106th year. The total number of persona who gave their age at
over 100 was 160. The Provtooe of Silesia appears to be exceptionally
favourable to longevity. Out of the 1073 male persons between their
ninetieth and ninety-fifth year In all the Prussian provinces one In
five fa a Silesian, and out of the 306 men between 95 and 100 years old
fifty-one are natives of Silesia. Out of the 2766 Prusaian women
between the ages of ninety and ninety-five, 371 are Silesians. Thera
are ninety-nine women in Silesia between ninety-five and 100 years
old and thirty Silesian women who have exoeeded their 100th year.
The centenarians are thickest in the district of Oppein. They are also
numerous in the Provinces of Posen and Bast Prussia; but the
western dominions of the King of Prussia, and particularly the Rhine¬
land and the manufacturing district* of Hberfeld, C ref eld, and the
Dutch frontier, are not so favourable tojextraordlnary .length of life. At
Maidstone a maiden lady named Heathorn, known locally as the
" Maid of Kent,” has just entered upon her 106th year. She retains
her good health and the use of all her faculties. She has a dear and
accurate recollection of events which happened before Trafalgar was
fought and won, and describes a visit she paid to the Victory before
and one paid after the battle.

Boma .—The question would, we think, be more appropriately addressed
to the editor of the Qute it.

WO .—We quoted the answer as given in the House.

Mr. Simeon Snell. —Soon.

THB INCOME TAX.

To the Editor* of The Lancet.

Sirs, —We are going to ask tor a small space in your journal to remind
your readers that now is the time for claiming relief and repayment of
Income tax hi all oases where the profits for the past year have not
amounted to the sum upon which tax was paid for the year ended
April 6th. This claim can be made whether an appeal was made against
the assess merit or not, and if soooessful has the additional advantage
that it fixes at the same time the a s sess ment for next year necessarily
at a lower figure than this year. From the numerous letters we have
received in consequence of a letter in your oolumns mentioning our
agency, we are more than ever convinced that medical men are
scandalously over-assessed. In all oases where exemption is not claimed
by reason of the income being under £150, we advise appeal being made
to the Special Commissioners Instead of to the District Commissioners.
It ensure* at the same time greater secrecy and better justioe. Should
the surveyor attempt to deny this privilege, we hope the foot will
be at once reported to ns, that we may take steps to have it allowed; we
have, in fact, no lew an authority than the assistant solicitor to the
Inland Revenue to uphold our interpretation of the clause in the Act.
As the time for claiming is very limited, notice should at once be given
to the surveyor and accounts prepared for supporting the claim. Our
special balance sheet* have proved a great success, and where adopted
last year have been again asked for this year. We require no better
testimony to their usefulness.

We are, Sirs, your obedient servants,

TH* Income Tax Repayment Agency.

16, Artesian-read, W., April, 1887.

BBGOTINB IN INT^HMITTBNT FBVBB.

To th* Editor* <f The Lancet.

Bibs,—I n your issue of Feb. 19th, 1887, p. 391, I notice a remark under
“ Pharmacology and Therapeutic# ” as to the efficacy of ergotlne in Inter¬
mittent fever... I called attention to this fhet in a short paper Which I
oontrBmted to the Practitioner in the latter part, I think; of 1879. The
main object of the paper was to point out the great value of arsenio in
cases of metrorrhagia. The last paragraph of my paper runs as follows:—

“ The fact of the efficacy of quinine in ague, taken in conjunction with
Its action on the uterus led me to try ergot In case# of ague, and I found
it extremely efficacious In checking the paroxysm." Since that time it
has been my constant practice to use ergot in the milder oases of inter*
mittent fevers with good eBeat.—I am. Sirs, yours faithfully,

Meean Meer, March 20th, 1887. O. S. Ranking, M.D.

THB BROWN DBFBNCB FUND.

To th* Editor* of The Lancet.

Hina,—Would you kindly allow me to acknowledge the following sub¬
scriptions received up to the present date in aid of the above fund F
Lennox Browne, Bsq., £1 Is.; Dr. Robert Barnes, £l; Dr. Holman
(Reigatej, £1 Is.; M. G. Biggs, Bsq., 10s. 6 d .; J. T. Boyd, Bsq., IQs. 6 d.

I am. Sirs, yours faithfully, ,

Masd^au^aa. Uj^^RJ^ajpd-rd.^^G.S xamlet Murray, M.D. * *

Digitized by LxOOQle

N0TK8, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[April 16, 1867,

8Q0 Thb-Lancm,]

WIBSBN AS A HBALSUt BBSOBT FOR PHTHISIS.

To tke Editor* of Tu Lam an*.

8Ms,—I 1 should be glad If yeuooald find ipne for a few remarks
relating to Wieaen in connexio* with the artiole in ThK Lamcat of
Mi h 18th on “ The High Altitude Treatment of Phthisis.” Your cor¬
respondent in this article says: “ We are still without definite statistical
information on the results of treatment at Wlesen last winter." The
time during which I have practised here has been too short for me to
be able to furnish the statistics which yoar correspondent wishes for, nor
have I as yet sufficient material to publish, though I hope before long to
be able to give more exact Information. But I may say that we have
reason to be satisftsd with the sueoeas already attained. Of thirty eases
which have been coder my observation this winter, the majority (about
two-thirds of the oases) have made considerable progress, and even
severe cases have done very welL When we ask wlienoe this success
arises, we can only attribute it to the peculiarly favourable and isolated
position of the place, far from all'disturblng sounds. It also enjoys, In
addition to its pure air, the advantage of being a small health resort,
where every stop of the patient' ean 'be regulated arid controlled by his
daotor. There are here no opportunities for pursuing say pleasures
wWab might be prejudicial, since there is nothing besides the two
excellently arranged hotels from which the visitor can derive amuse¬
ment. Certainly for those who have no great admiration for the beauties
of nature and but few resources in themselves the place may appear
somewhat dull. But he who realises how dependent recovery Is on a
well-ordered life, and how Important it Is to be healthy, will surely
renounce willingly the pleasure* of Mfe for a short season In the Interest
of Me health. I am. Sire, your etoedient servant,

Wtaton, April 7th, 1887. F. Biun, M.D.

Mr. E. D. McKieoU.— The matter is rather one for the advice of a
solicitor. We should deprecate the publication of the correspondence
In a local paper.

Mr. Uarrold Fain is thanked.

SHAM PATIENTS IN KENSINGTON.

To-the BEtort of Tux La nett:

Sins,—The same thief who paid Dr. Longhurst a visit called at my
house, evidently In pursuit of plunder. Having watched me out of the
house, he rang the bell, and was allowed to remain in my consulting-
room about two minutes. Mj wife, fortunately being in, asked what he
wanted. He said it ns a professional call, sad that he would 'call at
3 o’clock in the afternoon. I need hardly say he did not return. He
ggehthe-name of “ Karr,",and went on to the house of my friend,:
Dr, Low. where he gained bis object, pocketing a case of surgical Instru¬
ments and a silver cigarette case. Suah scamps ought to be " run In” at
o«3B, and have at least five yeses’ penal punishment.

I am. Sirs, youss truly,

BarEhCourt-read, W.. April 13th, 1887. Woo* -llnx.

Atrope *.—We should not advise vaccination round a nevus in the
■Kuation described.

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York; Mr. J. Hurll, Otaegow; Mr. Bell, Dover; Messrs. MacLachlan
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and Co., London ; Mr. BtheAHhOr, Manchester) Messrs. Shanks and
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Co., London; Lleut.-Col. Graham, Bristol; Miss Proctor, Bastbourne;
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London; Dr. Skerrftt, Bristol; Mr. Scott, Manchester; Mrs. Speneer,
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and Co., Biggleswade; Mr. B. D. M*Nfcotl, Southport; Dr. Clement
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Hill, London; Mr. Maynard, Newcastle-upon-Tyne; Messrs. Isaacs and
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Joll, Woolton ; Mr. Aiken, Aberdeen ; Dr. Reynolds, Ventnor; Mr. M.
Collier, Loodon; Mr. T. W. Coffin, London; Mrs. Taylor, Winder-
mere ; Mr. Blllott, Carlisle; Mr. Mark, Kidderminster; A Parent;
Boms ; Senior Surgeon; Resident Physician ; 420; G. W.; Constant
Reader; Carex ; Atropos; Hand-in-hand Fire and Life Office; Lady
Superintendent, Ipswich; Humanltas ; A Former Surgeon of the
Perth Infirmary; M.A., MiR.C.S., L.B.O.P.Bd.; Matron, Newcastle-
on-Tyne; B. J. P. S.

LxTTKRfl. sack with enclatere, are aUo acknowledged from—Dr. TiMey.
Queensland; Mr. Harbison, Victoria, Australia; Mr. Hearder, Newton
Abbot; Mr. Boyle, Jersey; Mr. Walker, Durham ; Messrs. Benjamin
and Son, London ; Mr. Kemp, Hull; Dr. Nnlgbt; Mr. Topping, Forest
Gate; Miss Hunter, Lowestoft; Mr. Howe, Hltcbin; Mr. Appleyard,
Yorks; Mr. McClelland, Glasgow ; Mr. Buchanan, Wigan; Mr. Kfrk-,
London; Mr. Gayley, Tipperary; Mf. Smith, Holtbway; Mr. White,
Bradford; Mr. Glmblett, London; Mr. Field, Bradford; Mr. MHUon,
Manchester ; Mr. Howe, Balbam ; Mr. Iambton; Mr. Hey wood, Man¬
chester; Dr. Hunter, Matlock; Miss Mlnchln, Slough ; Dr. Hardiug.
Whittlesea; Mr. Bideal, London; Dr. Puega; Messrs. Benjamin and
San, Loaded; Mr. Cripps, London; Mr. Harrild, Enfield; Mr. Wart],
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Mrs. Dearmer, Bsstboume; Mr. Wlnokwerth, Xhetford; X. Y. Z. ;
Alpha, London; M.D;, London; A_ B., Bridgend ; Matron, West
Bromwich; Cantab; P.N., Watford; K.N.; A. D.N.; D.M.; Ladp
Superintendent; Dr. D., Fulham; BJk n Clapham; Practical; H.
London; Veritas, Beading; Medicos, Hove: Dr. D., Inglston; Ki,
Camden-town; H„ Bradford; Cbsmieus; B. M., London; B. R. H,,
Birmingham; H. 8. B., Brixton; Medlcus, Hull; Medicos, Welsh¬
pool ; Cardiac, Stafford; F. W. F., Coventry; M.B., Dublin ; Lady
Superintendent, Bath ; Scalpel; Dr. X., Brixton ; B. IF., Banubury ;
J. B., Camberwell; F. B. J.; Slgjna; Jack, Pimlico.

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THE LANCET, April 23, 1887.

Clinical lecture

OH

TROPICAL ABSCESS OF THE LIVER.

By SIR DYCE DUCKWORTH, M.D., F.R.C.P.,

PHTBICIAH TO. AND LHCTUBZB OH CLDflCAL JtXDICXHB AT,

ST. BABTHOLOMKW'S HOSPITAL.

Gxntlhmbn,—T he subject of hepatic abscess is one of
great interest to all English students of medicine. It
cannot fail that some of yon will have to practise your
profession in some part of our tropical possessions, and in
these days, when locomotion is so rapid and easy, some of
you will also as certainly not fail to have experience
of this disease at home. I think it is not unlikely that
abscess of the liver is now less often met with in the tropics
than formerly. I have no facts to support this view, but I
conceive it to be likely, because Europeans nowadays take
better care of their health, eat and drink less than formerly,
come home at shorter intervals to recruit their powers,
and are thus less exposed to and saturated with malarial
influence. 1 For twenty-one years I have had a special
experience of Anglo-Indians of all ranks in connexion
with the services of several of the great Indian railway
companies, and I may at once state that my experienoe of
hepatic abscess as a cause of invaliding in these persons has
not been extraordinary. To be sure, the worst cases have
died in India or on their way home; others have had
favourable, and generally rapidly favourable, terminations
by rupture of the abscess, usually into some part of the
gastro-intestinal tract. Others again, such as the case I
take for the subject of to-day’s lecture, have developed the
symptoms of their malady after arrival in this country. I
wish first to point out to you that all Europeans in the
tropics are not equally liable to hepatitis and abscess, as I
have here and elsewhere declared; the special predisposi¬
tions of persons materially affect their tendency to go
wrong in any morbid direction. A large chapter in the
history of medicine within the tropics has yet to be written,
which shall relate to the influences of climate, and the
habits thereby engendered, upon individuals of the several
constitutional conformations or so-called diatheses. To
such a chapter the late Dr. Norman Che vers contributed
very notably and with great ability. He formed the opinion
that persons with tubercular proolivity were more than
others apt to suffer in India from dysentery, while strumous
persons were similarly predisposed to hepatic abscess. In
respect of idiopathic hepatic abscess, he did not oonsidor
mat any of the ordinarily assigned causes, such as malaria,
intemperance, dysentery, portal pytemia, and tuberculosis,
were essential, and he concluded that the influence of
tropical heat was specially causative. 3

You have been already taught in your systematic lectures
that hepatic abscesses are mainly divided into two classes:
“rat, the pyaemic or multiple form, and, secondly, the
tropical or solitary form. This is an artificial division, and
worthy of retention; however, you must expect to find
m practice that there may be more than one abscess owning
no direct connexion with either dysenteric ulceration or
pyamia. The etiology of liver abscess has been a hotly
debated question, especially in respect of the relation which
dysentery bears towards it. At one time the abscess was
thought to induce the dysentery; later it was thought that
dysentery led to the abscess. Again, it was believed that
“th were due. to a common cause. The late Dr. George
■Dodd, of Sing’s College and the Dreadnought Hospitals*
was one of the earliest advocates of the direct connexion
between dysentery and hepatic abscess, teaching that' the
T tter was due to direct absorption from the ulcerations in
“ e “‘on of purulent or infecting matters. This theory,
y°**J**. is especially an embolic or pyaemic one. Hepatic
as moat commonly seen in Europe, is of the pyaemic
. multiple variety, and is naturally regarded as a most

■vjj? r J°*eph fayrer. however. Inform* me that he think* hepa
*»! T ““"T M ootnmon as formerly.
k 0 ****^™* toSxb * D<1 w™ 1 lsr * e Indian experienoe do tx

fatal malady. No one now doubts the connexion I have
just described, cases being frequent in which purulent
absorption takes place from breaches of surface in any part
of the alimentary canal drained by branches of the portal
vein. Thus gastric ulcer and ulceration of the gall-bladder
and bile-ducts, and operations on the rectum, may induce
embolic abscess in the liver. A noteworthy point in the,
matter is this, that dysentery is far more common uncompli¬
cated with hepatic abscess. There must, therefore, be some
other factor than mere ulceration to account for infecting
absorption and resultmg hepatic abscess, and this factor is
without doubt a special infectivity attaching to the detritus
of the bowel ulcerations. It is very noteworthy that no such
accident occurs in connexion with the ulceration of enteric
fever or tuberculosis. With suppurative pylephlebitis we
are not now concerned; the mischief here extends along the
veins involved. Next, observe that hepatic abscess in the
tropics is common enough when no history of dysentery
is to be had in the case, no pytemia is present, and no
very obvious cause can be adduced. The pyaemic theory
fails to fit such cases; and in the majority of instances
in the tropics the abscesses are either solitary or limited
to two or three, whereas in Europe we commonly And
innumerable points of suppuration in the liver, and readily
discover their origin in some distempered breach of surface
in the line of the portal circulation, or in some other part
of the body. Hence, both forms of abscess may occur in
the tropics, but the pyaemic or multiple form only arises
in Europe. A large solitary abscess may occur in connexion
with dysentery in the tropics, or several small dysenteric
abscesses may coalesce gradually into a large one; but this
is not often seen in this country. Multiple pyaemic abscesses
are the rule here. The late Dr. iloxon thought the differences
between tropical and pyaemic abscesses appended on their
different ages or duration, and that ulcerations or cicatrices
of them would be usually found if carefully sought for.
But this view will certainly not apply to the history of
many cases. The embolic theory has captivated the atten¬
tion of pathologists to the exclusion of that which explains
the production of abscess as the outcome of a specific
hepatitis. The latter explanation appeals rather to the
bedside than the deadhouse physician. Many differences
of opinion in medicine are, in my thinking, to be thus
explained. Clinical explanations may be seemingly fanciful
sometimes, but they cannot be dispensed with till post¬
mortem research has modified or confuted them. It would
appear that with improved methods of treating tropical
abscess the opportunities for examining the intestines for
cicatrices of ulcers will grow fewer and fewer.

What, then, are the probable causes of the solitary or
tropical abscess ? Without doubt they depend on peculiarities
of life and climate. It is oertain that tropical climates induce
in many Europeans congestion and enlargement of the liver.
Unusually, hot weather in Europe produces this much,
unless great care in diet and habits of life be practised.
Indulgence on the part of tropical residents in Europeap
habits as to eating and drinking, with undue exposure to the
sun, are to blame to a large extent for this. But beyond
these causes, there is something specific in the effects of
prolonged heat upon the functions of the liver; all con¬
stitutions not being equally susceptible, however. Again, it
seems certain that malarial poisoning has largely to do with
this congestion. The spleen suffers with the liver under
this exposure, and both organs fail of their due functions.
It is noteworthy that hepatic abscess is lees common by far
in the West than in the East Indies and China. Malaria is
perhaps equally pernicious in both. It is not remarkable
that the bowels should suffer sometimes together with the
other viscera mentioned, and hence, with exposure to chill,
the risks of impure water and of improper food, all the
conditions for the onset of dysentery are provided. In
Indian nosologies you will often meet with the term
“hepatitis”: acute and chronic varieties are mentioned.
No very clear distinction has been drawn between con¬
gestion and hepatitis. If the inflammatory process reaches
a certain point, we naturally have to deal with abscess as
the outcome of it. Chronic hepatitis is applied to a long¬
standing condition of hyperaomia and engorgement, which,
if neglected, usually passes into a form of cirrhosis. As
indicating in some measure the etiology of the troubles we
are now considering, note that women are more rarely the
subject of such hepatitis in India as leads to abscess, and
that in children the disease is practically unknown, although
a

[April 23,1887.

812 The Lancet,] SIR DICE DUCKWORTH ON TROPICAL ABSCESS OP THE LIVER.

dysentery is very common amongst them. Hepatic abscess
is rare under the age of twenty, and more frequent after
twenty-five years. These facts, which I give you on the
authority of able observers—Dr. John Macpherson and Sir
Joseph Payrer—would indicate that alcoholic intemperance,
with greater exposure to solar influence and intenser grades
of malaria, are not a little causative, and this is the opinion
I have been led to form.

With these remarks, with which I have thought it well to
begin my lecture to-day, I now pass to the case illustrating

it. It is that of M. N-, aged twenty-eight, single, a

medical officer practising in the Bombay presidency. He
went out to India in 1883. He is of excellent constitution,
and his family history is satisfactory. He has been stationed
in several districts, and been exposed to malaria. After
being out for a few months he had a slight attack of dysen¬
tery, being laid up for ten days. He made a good recovery,
and had no return of this trouble. He was always temperate.
Within the first year of his sojourn he had an attack of
catarrhal jaundice, and he also suffered six or seven times,
but not severely, from malarial fever. As he expressed it,
“ he knew he had a liver.” In June, 1886, he left India on
leave of absence for three months and came home, land¬
ing on July 19th. He believed himself to be in perfect
health. In August he suffered from chill after being over¬
heated, and was seen by Mr. Coalbank of Twickenham,
who found him confined to bed, suffering much pain
from pleurisy in the left side (postero-lateral region). His
liver was then enlarged and tender. His temperature reached
103° and 105°. (Dr. Norman Moore saw him later in my
absence, and confirmed Mr. Coalbank’s opinion as to pleurisy,
with malarial fever.) He lost flesh somewhat rapidly, and
looked ill. On Sept. lGth he was recovering, but was still
weak, had a coated tongue, and wavy, uneven pulse. Dr.
Sedgwick Saunders, who saw him at that time, refused to
allow him to return to India. On Oct. 28th I saw him
for the first time. He was still thin and cachectic-looking.
I could find no physical signs anywhere in the chest beyond
a trifling amount of dulness, with imperfect respiratory note,
in the left postero-lateral region. There was no jaundice,
and the urine was natural. I sanctioned his return
to India in November. On the night of Nov. 1st, after
a busy day in London, he awoke with very severe pain
at the epigastrium radiating to the left side. The pain
wa3 of a stitchy, “ catching ” character, and there was
agonising cough. In no way could he account for this
attack. He had had a slight cough for a few days previously.
He came up from Twickenham and saw his friend. Dr.
Goodhart, who examined him, but found no signs of pleurisy,
but observed some fulness about the left hypochondrium.
His temperature was raised to 102° and 103° at this time.
Cough troublesome, with glairy, tenacious sputa, not -rusty.
He kept to bed for three weeks. The pain was very severe,
and nothing relieved it. There was a dull dragging pain in
the left costal arch, and much epigastric tenderness. No
rigors. His weight was then lOst. 7^lb., his usual weight
being about 12st. On Nov. 30th I found the same physical
signs as before in the left pleura. On Dec. 11th I saw him
again. Dr. Andrew had also examined him, and found
nothing to explain his severe pain, which was attributed to
pleural adhesions. The pulse was 84, and regular. He was
still looking pale and ill. I had a suspicion of hepatic
mischief as the cause of all his trouble, but there were
no physical signs to justify any certainty of this at
this time. I recommended an extension of leave for three
months, careful regimen, and good diet. On January 19th,
1887, Dr. Andrew again examined him, and found a tumour
projecting under the left costal arch, indistinctly fluctuant.
No improvement had occurred in the general health. There
was a slight icteric tint of the conjunctives. On the 21st
Dr. Andrew and I saw him together. There had been no
rigors, no sweatings, no shoulder pain. The tumour was
evidently an abscess in the left lobe of the liver. Slight
ulsation was communicated to it from the heart. At the
eginningof January severe pain had returned about the
ensiform cartilage, but there had never been freedom from
pain in the left side since October. Vomiting had occurred
about once daily, generally about an hour after taking food.
There was much flatulence. He was admitted to John ward
on J an. 22ad. The temperature was 98*2° on the first night.
The tongue was coated all over. Bowels open 1 ; stools bilions.
Urine: Specific gravity 1025; faintly alkaline; depositing
phosphates; void of albumen, blood, glucose, and bile.
Kean’s apex in fifth space, in normal situation. Sounds

natural. Pulse 72, of fair volume and power, and regular.
In the chest nothing abnormal. The liver dulness began at
tne sixth rib. To the left of the epigastrium a rounded
projecting tumour, everting the cartilages; deep-seated
fluctuation made out; the skin was not red over it. Spleen
not felt. Abdomen otherwise natural. Lower edge of right
lobe of liver not felt or apparently depressed.' On Jan. 23rd
the temperature reached the highest point recorded in the
hospital—100'2°. On the 24th, after a restless night, the
temperature was 99 - 2°. Chloroform having, been adminis¬
tered, Mr. Langton aspirated the tumour, and twelve ounces
of chocolate-like grumous matter was withdrawn, containing
pas and debris of blood. Temperature last night 98°;
to-day 97’8°. Sick after chloroform. Dragging pain re¬
lieved, but pricking pain in region of abscess. Pulse 64, of
good volume and strength. Had better night. On the 26th
the temperature was 96-4° ; pulse 72, feebler and irregular.
Much nausea, and vomited once. Urine loaded with urates.
On the 29th he was going on very badly; no action of the
bo Weis. It was decided now to have the abscess freely opened.
Under chloroform and with full antiseptic precautions, my
colleague, Mr. Langton, cut down through the left rectus
abdominis and came upon thickened adhesions between the
sheath of muscle and peritoneum. He passed in an explora¬
tory syringe, then a director, and then his finger. Reddish
pus (six ounces) flowed freely away, and an indiarubber
tube was inserted and stitched into the lips of the wound.
Iodoform and antiseptic dressings were used. The nausea
continued for two days and gradually passed off. Nourish¬
ment was badly taken, and a quinine and nitro-hydro-
chloric acid mixture could not be borne. Nutrient enemata
were given in default of sufficient by the moutb, and about
two ounces of brandy were given each day. The wound
did well and discharged freely. It was dressed daily anti¬
septics! ly, and remained quite sweet. The temperature
remained subnormal. The appetite soon became large, and
flesh was rapidly gained. On Feb. 12th the patient was
sitting up daily and making progress in all respects.

Let me briefly review the history and course of this case,
and comment on the procedures of treatment. The patient
while in India suffered from most of the ailments that befall
Europeans, aud, though never severely ill, it is clear that the
climate and the circumstances of his life told upon him.
Thus he had dysentery, malarial fever, and catarrhal jaundice.
I have already told yon that he was a very temperate man,
and lived carefully. In June of last year he left India,
feeling in perfect health, intending to stay a few weeks
only at home. In August he began to suffer after a chill,
and had pleurisy and remittent fever. At this time the
pleurisy was at the back of the chest, on the left aide.
He failed to make a satisfactory recovery of his general
health, losing flesh, looking ill, and having a not very
explicable cough. It would be interesting to know the
temperatures that occurred at that period. Very early in
November a second attack of pleurisy unaccountably came
on, this time near the cartilages adjacent to the ensiform
cartilage, the pain being very severe and the temperature
raised. No rigors and no sweatings. Six weeks later,
although the second attack of pleurisy had passed off, there
was no improvement in the general health, and a pinched
and sallow appearance was manifest. Physical signs alone
were-insufficient to explain this condition. In three weeks’
time there was & return of the severe pain near the ensiform
cartilage, and in less than three weeks afterwards a tumour
was detected in the left lobe of the liver. Gentlemen, it is
easy to be wise after an event, but the fact remains that
while the symptoms I have detailed to you fall in admirably
with those that might be expected in such a case, there was
a marked absence of physical signs to justify a confident
diagnosis of all that was proceeding in the liver. Suspicion
there was in the minds oi several of those who saw the case,
but nothing definite could be established, and certainly
nothing could justifiably have been done more than was
donp.

The case, then, illustrates a point which has long been
recognised in respect of the latency and insidious character
of hepatic abscess. Ltrge collections of matter may occur
in the liver without any symptoms distinctly referable to
that organ. In this instance it is not clear when the abscess
began to form. It is quite possible that the disease was
already in progress before the patient left India. The
pleuritic attacks were plainly significant of the mischief
that was going on below the diaphr^n, and the severe pains
near the ensiform cartilage betokened adhesive capsular

'3

Thu Lancet,]

SIR DYCE DUCKWORTH ON' TROPICAL ABSCESS OF THE LIVER. [April 23,1807. 813

hepatitis of the left liver lobe, the results of which ulti¬
mately proved so protective and beneficial. You will under¬
stand that according to the special seat of the abscess so
will the symptoms vary in any case. Thus, if they come to
press or point upwards, pain will be felt and irritation be
excited m the diaphragm, pleura, or lung, with cough; if
downwards, there will be interference with the functions of
the stomach, and nausea and vomiting may be expected.
In this instance irritation occurred on both aspects of the
left lobe, the pleura and stomach both being implicated. The
liver substance appears to be little sensitive, but when the
capsule is involved there is commonly severo pain; hence
the pain in hepatic abscess is probably due to pressure on
the capsule and to the happily protective perihepatitis that
is often set up as the abscess pushes its way.

The leading symptoms, when present, of abscess of the liver
are fever,hepatic pain, severe gastric oatarrh, with foul coated
tongue, nausea, vomiting, hiccough, and inability to lie on
the left side. The abdominal wall is rigid, one or other rectu3
muscle contracting to protect tender parts below. Pain in
one or other shoulder or scapular region is sometimes met
with, induced either through the reflex mechanism of the
phrenic and cervical nerves, or through the pneumogastric
and spinal accessory branches. There is great languor and
lassitude, rigors are common, and nightly rises of tempera¬
ture. Slight jaundice is present, simulating ague. The
urine is loaded with lithates, and may contain albumen. As
suppuration proceeds profuse sweats occur. Bile ia present
ia the stools. Tropical abscesses point usually superficially,
and present in a low intercostal space or under the cartilages
in the hypochondria. The spleen is not enlarged as a rule.
Now in this case there were no rigors, no shoulder pains, and
nb sweatings. The absence of these symptoms added some¬
what to the difficulties of diagnosis.

Respecting the treatment. There is now only one opinion
ad to the necessity of early and free opening for tropical
hepatic abscess. At one time, in India, it was thought best
not to operate, and to wait for spontaneous bursting. Nature
was found to be sometimes kind, and to allow the pus
collection to empty itself into some evacuant channel. But,
unhappily, rupture into the lung or pericardium, or into the
peritoneum, is greatly to be feared. Amongst the triumphs
of modern antiseptic surgery is the treatment of hepatic
abscess. A more important question remains for considera¬
tion in each case, and it relates to the establishment of
adhesions between the liver capsule and the parietal peri¬
toneum. There is always an apprehension of the abscess-
cavity collapsing after being opened and discharging into
tfye peritoneum. To prevent this accident, preliminary
measures have been recommended to set up inflammatory
adhesions. This question also comes to be dismissed in
operating on hydatid cysts in the liver. It has been proposed
to set an issue with caustic potass and peas, and th us secured
the end desired. I have seen this method practised twice,
but do not expect to see it again. Simply tapping by
aspiration is often performed in the hope of setting up
adhesions in advance of the subsequent graver operation.
This was done in the present case partly for completing the
diagnosis, and with the prospect of aiding Adhesions. Again,
it is proposed to. out down to the surfaoe of the tumour and
stitch the edges of the wound to it, completing the operation
a few days later. In by far the majority of cases these
methods are unnecessary. In the progress of the abscess, as
it pushes towards the capsule, perihepatitis is often induced
and firm adhesions are set up. This is not, perhaps, so often
the case in suppurating hydatid cysts. In support of the
general safety of immediate and bold operative measures,
we have the unique experience of Sir Joseph Fayrer and of
many of our surgical brethren in India, a body of men of
whom this country is not, I think, sufficiently appreciative,
who now never hesitate to evacuate these abscesses so soon
as they diagnosticate them, and practically disregard the
question of adhesions. Their results were so satisfactory
that we may fairly follow them in this practice. Any
remaining considerations, such as insertion of drainage-
tubes, relate so specially to surgical details that I
cannot enter upon them. If decided improvement does
not follow the evacuation of the abscess, we may suspect
i r 1 “P* r ^ 6Ct drainage of it or the existence of an
nuependent one. You remember that there may be two or
I?!'® 6 osjrtros of suppuration in even tropical non-embolic
I would add a few words on the subject of washing
out the abscess cavity.

be a possible source of misobief. In this case, as in cases of
empyema, I believe it to be the better practice to abstain
from washing out the cavities. You may ask if any
surgical interference is ever called for in respect of dysenteric
or multiple abscesses. Even in these cases, according to
Sir Joseph Fayrer, puncture and evacuation may be useful.

Respecting the prognosis for the future in any case
where the abscess has burst favourably or been opened
successfully, we have no grounds for believing that any
special immunity from a future attack exists. Booh
patients do best to leave the tropics and live at home, but
not seldom they return and do well. Second attacks may
occnr, bnt it is generally believed that theee may be due rather
to undeveloped or residual abscesses, wbioh have later be¬
come active. A residual abscess may long remain encysted,
and be symptomless, till by gradual thinning of its walls
it suddenly gives rise to fatal symptoms. Dr. Maclean and
Professor Aitken have related such a case to me from their
experience. Hence, there must always be a somewhat
guarded prognosis in any case, and for some long period.
In my experience, where abscesses have burst favourably
the patients seldom long remain unmindful of their trouble.
Dragging pains, probably caused by adhesions, are some¬
times suffered from. In the case of an officer of Horse
Artillery under my care, he could never wear his sword
comfortably through a field day. With care in diet, and in
ell other respects, some of these patients manage to complete
their tropical career fairly well. The drags which prove
useful are quinine, cinchona, and mineral acids. When the
tongue is coated and there is no appetite, alkalies, such as
sodium bicarbonate with bark, given after effervescence
with a little citric acid, do better than quinine and acid.
Subsequently, the chloride of ammonium, with some bitter,
or with the mineral acids, is very useful. Prolonged stay
at the seaside in some mild or sheltered part is the most
efficient climatic agent. Sea-bathing and cold baths must
be forbidden, and warm sea-water baths or tepid sponging
only be sanctioned.

I will draw out for you on the board the leading characters
of the two varieties of hepatic abscess, so as to impress them
On your memory. Remember, however, that all such cate¬
gories are made on somewhat rigid lines, and that large
Bedside experience tends to impair one’s estimate both of
tabulation and statistics:—

Hepatic Abscess (two chief varieties).

A. Tropical (specific suppurative hepatitis).—Solitary, or
few in number. May be very large, form rapidly, or occupy
some months before urgent symptoms arise. Course often
latent and insidious. Connexion with dysentery not com¬
monly traceable. Infrequent in women; unknown in
children. Rare before twenty; commoner after twenty-five.
May occur in temperate and careful-living persons. Tendency
to burst; jaundice slight; spleen not enlarged. Probably
due to solar, climatic, and dietetic influences. Some con¬
stitutions—e.g., Btrumous—more apt than others to suffer.
Commoner in East than in West Indies, and occurs on
Mediterranean littoral.

B. Pyamic or Embolic i" dysenteric abscess *). —Multiple-,
may be very numerous and small. Course rapid. Follows
on dysentery or septic inflammation of parte drained by

f iortaJ vein. Part of general pyaemia, especially after bead-
njuries and damage to medulla of bone. Jaundice marked;
Spleen enlarged. Seldom bursts. Occurs independently of
climate, but much connected with dysentery.

The Tower Hamlets Dispensary.—T his old insti¬
tution, founded in the year 1792, seems to be well sup¬
ported. In spite of the hard times, donations and new
subscriptions have been received which have reduced the
indebtedness of the dispensary. The mortality in the year,
with a total of 4497 cases, was 75. The chief causes of death,
were: bronchitis, 11; consumption, 10; whooping-cough, 5;
pneumonia, 4. The payments on account Of the dispensary
are £511 14#. 10 <L, of which the patients contribute £139 4#.
All the patients do not pay. They are divided into two.
classes -those receiving relief gratis, and those coming
under a system of payments, as follows: recipients to pay
an entrance fee, and on each renewal of the letter, 6rf.; on
each subsequent attendance at the dispensary, 3d. ; for each
visit at home, 6d. ; teeth extracted, 3d.; midwifery fee (by
midwives), 3#. Gd. Would it not be possible to make all such
ic I institutions provident—Le., to procure systematic periodical

“ sne abscess cavity. I believe this to be unnecessary u payments throughout the year, and pay the medical men an
ree drainage is secur&SjUid even - if done antiseptically to I honorarium at least ?

814 The Lancet,] DR. W. 0. PRIESTLEY: THE PATHOLOGY OF INTRA-UTERINE DEATH. [April 23,1887.

ABSTRACT OF

Jumlaait %zdms

ON THE PATHOLOGY OF INTRA-UTERINE
DEATH.

Delivered at the Royal College of Physicians of London,
March, 1887,

By W. 0. PRIESTLEY, M.D., F.R.C.P., LL.D.,

CONSULTING PHYSICIAN TO KING'S COLLEGE HOSPITAL, AND LATE
PROFESSOR OF OBSTETRIC MEDICINE, KING'S COLLEGE.

LECTURE II.

In this lecture Dr. Priestley spoke of the causes of intra¬
uterine death which are associated with faulty conditions
of the foetal envelopes and foetal appendages, taking first
those which properly belong to the earlier part of pregnancy.
He stated that a too scanty formation of the decidua may
lead to the growth of a placenta too small for the needs of
the embryo. Charpentier believes that an arrest of develop¬
ment in the decidua reflexa, or its premature destruction,
are frequent causes of death in the embryo. When the
ovule has been successfully implanted in the decidua, and
the normal development of the decidua reflexa and other
structures is going on in progressive series, there is great
tendency in some women to go wrong, apparently from
mere weakness of the outer structures which form the
ovum. In some women the union between the pregnant
uterus and the decidua is so unstable that a fall or stumble,
or a shaking of any kind, may be quite sufficient to detach
a portion of the latter, rupture the intervening vessels, and
cause extravasation of blood. If limited, these extravasa¬
tions need not interrupt the continuance of pregnancy. If
more extensive anfl separating a larger portion of the
decidua, they necessarily interfere with the nutrition of
•tke ovum, produce death of the embryo, and precipitate
abortion. The same result may ensue from contractions of
the uterus, either provoked by local irritation directly
applied, or from reflex causes—as, for example, suckling a
child after a fresh pregnancy has commenced. Occasionally,
during the very early stages of gestation, blood flows
directly into the decidual cavity, and fills it with coagula.
The result is either that all traces of the embryo and its
immediate surrounding structures are obliterated, or the
embryo is compressed and destroyed by the invading flood,
rudimentary portions of it only being discovered. In from
the second to the third month the decidua reflexa or ovuli
is fully formed, and the villi of the chorion are everywhere
embedded in its substance. Then another form of haemor¬
rhage may occur. In this the blood is not alone extravasated
between the decidua vera and the uterine wall, or into the
meshes of the decidua itself, but between the decidua
reflexa and serotina, and the chorion or outermost of the
true fcetal membranes. In the process of development the
villi of the chorion are pushed into the decidual tissue,
and are soon surrounded by the bloodvessels which are to
form the maternal placenta. The decidua is, then, a highly
vascular membrane, especially at the site of the future
placenta, and the maternal vessels which everywhere
ramify through it undergo a development which in the
human body is unique. Appearing first as capillaries, they
rapidly enlarge, and eventually become sinuses, which are
filled with maternal blood, and in which the fcetal villi are
eventually suspended. These delicate and rapidly dilating
maternal vessels are very liable to rupture. Hemorrhage
taking place in this locality floods the loose tissue of which
the decidua serotina and reflexa is composed, and destroys or
compresses the chorion villi implanted there, being sometimes
so extensive as entirely to surround the embryo. The nutri¬
tion of the embryo is arrested if the extravasation be exten¬
sive enough to interrupt the normal circulation through the 1
imperfectly formed placenta, and the embryo may be found 1
stunted and shrivelled, suspended by its umbilical cord from
some part of the amniotic cavity. These extravasations of
blood between the . chorion and the decidua constitute the 1
typical “ apoplexy of the ovum” described by many authors. 1
It is founq In a multiplicity of forinB and modifications, and 1

is no doubt produced by a variety of causes. Thus it may
be produced by faults in early development, or by any cause
which produces detachment of the well-formed decidua from
the uterine walls, or from rupture of its bloodvessels.
Apoplexy of the ovum is a very common cause of embryonic
death, and, judging from the large number of specimens pre¬
served in the various museums, is by far the most frequent
of all the pathological changes affecting the early ovum.
Congestion of the decidua is, it is believed, a sufficient and
adequate cause, irrespective of any other, to produce rupture
of its bloodvessels and extravasation into its substance.
Inflammation of the decidua, taking various forms, has been
described by Virchow, Hegar, Schroeder, and Spiegelberg.
Slavjanski has described an acute form associated with
cholera in pregnant women, and leading to bmmorrhage with
the death of the'foetus. These inflammations are, however,
generally chronic, and are continuations or extensions of
previously existing inflammation in the unimpregnated
mucous membrane of the uterus, and three forms have been
described os producing different alterations in the decidua.

I. The first, “chronic diffuse endometritis” of authors,
produces a thickening or hyperplasia of the uterine mucous
membrane, which when conception occurs renders it unfit
for the reception and growth of the fecundated germ.
According to Spiegelberg the hypertrophy consists in a
development of connective tissue, which not only thickens
but indurates the membrane, and extends down to the
muscular fibres themselves. The arrangement of the hyper¬
trophied tissues is such as often to give rise to the appear¬
ance of cysts, which, however, are probably only the “cups”
of Montgomery enlarged. Schroeder regards it as a chronic
and diffuse proliferation of the mucous cells, both parietal
and reflected. The thickened membrane presents, be says,
the large cells of the decidua, united en masse. By their pro¬
liferation, particularly in the deeper layers, they may produce
a cavernous structure, and even form cysts. This alteration,
he says, produces death of the embryo and abortion, by the
irritation which the inflammation produces on the uterine
nerves. A variety of this chronic diffuse endometritis con¬
stitutes the “ adhesive endometritis” of Braun. It takes place
in the later monthp, and it then attacks the utero-placental
mucous membrane, Setting up such irritation that it imperils
the life of the fee‘us and precipitates premature labour.
Strictly speaking, the affectiofi may be regarded as a disease
affecting the placenta. One of its results is to produce adhe¬
sions between the placenta and uterus, and so complicate
delivery. Its presence is characterised by the fcetal move¬
ments giving pain, and often, besides this, acute pain and
tenderness are experienced in the walls of the womb, which
some have described as “ uterine rheumatism." It may be
produced by chills, overwork, &c.; and, according to
Kaschewarowa, it is one of the results of syphilis, or a pre¬
existing endometritis.

II. A second form of inflammation affecting the decidua
has been described by Virchow under the name of “ polypoid
endometritis.” It would seem to be only a more advanced
degree of the inflammatory condition just described, but the
mucous membrane is thickened to twice or thrice its ordi¬
nary depth, and prominences and projections like polypi
protrude from the free internal surface.

III. A form of inflammation affecting the decidua has
been named “catarrhal endometritis.” It is characterised
by a persistent discharge from the gravid uterus, which
constitutes the “ hydrorrhoea” of pregnant women. A
woman, generally about the sixth month of pregnancy,
loses suddenly and at intervals a quantity of transparent
colourless fluid, analogous to ascitic fluid. This is succeeded
by a dribbling more or less prolonged and without pain.
The pregnancy may go on to term; and the membranes, as
a rule, are found intact.

Discussing morbid changes in the chorion, Dr. Priestley
remarked that the pathological change which has received
the most attention is what is commonly called cystic, or
vesicular, or hydatid degeneration. . The literature on this
subject is abundant, and was reviewed at length. As to the
manner of the formation of the cysts, most authors agree in
regarding them as the results of pathological changes of one
kind or other in the villi of the chonon, but the crucial
question, and one which has been much discussed, is whether
the disease precedes the death of the embryo and so causes
its death, or whether the embryo dies first and the disease is
the consequence. On this point authors differ. Dr. Priestley
gives his adhesion to the former theory. Alluding to
the amnion, Dr. Priestley pointed out that it does not

O

Di.

The Lancet,]

DR. C. BELL TAYLOR ON DISEASES OF THE EYE.

[April 28/1887. 815

always escape the effects of extravasation, beginning in
the decidual structures. The condition which has received
most attention in connexion with the pathology of the
amnion is hydramnios, or superabundance of liquor amniL
The result to the mother is that she may suffer greatly from
the distension. Respiration is impeded, and the patient may
not be able to lie dawn night or day. The digestion is de¬
ranged from physical pressure, and the heart’s action is
disordered, while other secondary symptoms, such as oedema
of the lower limbs and blueness of the countenance, may be
superadded. The effect on the child is to impede its develop¬
ment, and, if born alive, it is commonly too feeble to survive
its birth. Frequently the child is affected with dropsy,
hydrooephalus, or other complication. Two or three facts
have been distinctly made out in relation to its pathology.
1. Scarpa noticed a coincidence between this form of dropsy
and the presence of twins. This has been fully confirmed by
the observations of Winckel, McCIintock, and others. 2. In
pregnancies complicated with hydramnios, the child often
presents some vice of conformation. Monsters are, in fact,
common with this affection. 3. The children born with a
superabundance of liquor amnii often present evidences of
syphilis, and this whether they are bora dead or alive.
4. Hydramnios is comparatively rare in first pregnancies as
compared with others. 5. It is more frequent with female
children than males. Of thirty-three cases collected by
McCIintock only eight were males.

The impression derived from a careful study of all the
circumstances is, that hydramnios is not a product of inflam¬
mation of the amnion, as some have supposed, but that it
arises sometimes from constitutional conditions affecting the
mother, sometimes from local causes.

Clinical J'ccturcs

ox

DISEASES OF THE EYE.

Delivered at the Nottingham and Midland Eye Infirmary,
December 9th, 1886,

By C. BELL TAYLOR, M.D., F.R.C.S.,

. SURGEON TO THE INFIRMARY.

LECTURE Y.

(Concluded from page 767.)

Htthbbto, gentlemen, I have been speaking exclusively
of bacterial purulent ophthalmia—a disease which, so far as
the infant and infection from the maternal passages are
concerned, must occur within the fifth day of birth or not
at all; and it iB well that you should note this, because, of
course, a baby may get a cold in its eye any time, just the
same as you or I. 8ach accidents are, however, for the
most part trivial, infrequent, and readily dealt with by the
simplest remedies. It is different, however, when catarrhal
ophthalmia attacks older children or adults living in
common, in barracks, schools, reformatories, poor-houses,
prisons, asylums, refuges, penitentiaries, and the like, where
the inmates are often overcrowded and placed under defec¬
tive hygienic conditions; for the disease, which is highly
contagious—nay, more, under certain circumstances infec¬
tious,—spreads rapidly, is apt to assume what is termed the
follicular form, to develop minute bodies beneath the eon-
j anctival epitb eli um resembl ing sago grain s, 1 and to cu I min ate
in that horrible, chronic, and intractable disease which we
know as trachoma (rpax6r, rough), or granular lids. These
defective hygienic conditions, combined with filth, misery,
and overcrowding, exist to a high degree in Egypt, the
cradle of the arte and sciences, and, as Haller has remarked,

1 Sattler nays the disease is caused by a mierozoon. which he oails the
■Uolocoocu* of trachoma. It i» a small ball, cleft by a tiu.v line, very
like the gonococciis of Neisser. but it may be cultivated in various soils,
vrhereas the gonococcus of Nelsser can only be cidMvnfcd in the scrum
of the blood. Speaking on this point. Sir. Power. In bis admirable
lectures on Bacteriology, say*:—" The dlplocooeua of trachoma luts its
seat inside the trachoma follicles, but out.-kle the cell*, not on the
■nrtkee,but In the follicles of the conjunct 1 vn: hence the method of
squeezing, cutting, or scratching out the fol’icle* is bacteriologically

correct,’' ^ _

“ceeoorum in omni tempore fcecunda nutnx,” where the
cold nights, the heavy dews, the hot days, the glare, the flies,
the atmosphere of dust, and periodic inundations, have
rendered the disease endemic to such an extent that at one
time there were as many as 8000 blind persons in the mosque
at Cairo; and Volney, in his interesting “ Voyage en Syne,”
tells us that of 100 parsons he met accidentally 00 were
affected, 20 quite blind, 20 with films and dischargee, and
10 with only one eye apiece. As might have been antici¬
pated, the soldiers of Sir Ralph Abercrombie and Napoleon I.,
at the close of the last century, imported the disease into
Europe, where it raged at one time to such an extent
that 4000 British soldiers were blinded by it, 6000 French
were in a similar plight, and 10,000 others had lost
one eye apiece. In this disease the inside of the lid
resembles a nutmeg-grater, a sliced fig, or a granulating
wonnd (Fig. 2); and by constantly rubbing upon the cornea
creates so much irritation, inflammation, vascularisation, and
formation of protective tissue, that the patient is pretty
nearly blind; and in some cases the cornea is so completely
covered with a fleshy mass ( pannut) that it is not possible
to see the eye at all.

Here is a patient on whom I operated some years ago. He
lost the right eye by an accident when a child, and when 1
first saw him the left eye was completely bid by a dense
piece of flesh. 1 got rid of this by repeated inoculations
with gonorrhoeal matter, bringing into view an opaque
cornea. There was, however, a small lancet of comparatively
clear tissue near the margin, and opposite this I was lucky
enough to succeed in forming an artificial pupil. The
patient, who was formerly quite blind, I am thankful to say

Fig, 2,

has since had excellent sight, and has been for years able to
manage an important business.

In dealing with granular lids and the oatarrhal and folli¬
cular conjunotivitis which gives rise.to it, we must remember
that prevention is better than cure, and at once segregate
our patients as much as possible. Let them live out of doors;
teach them, as Arlt says, “ that houses are only to sleep in.”
Banish, so far as possible, media of contagion. Let each
boarder have his own towel, his own soap, and let them wash
at the tap, for basins are dangerous. It is very seldom that
better-class patients suffer from this disease; but when you
are consulted by auoh persons, it is well, as a purely hygienic
measure, to recommend migration for a time to some moun¬
tainous district, such as Switzerland, where the disease is
unknown. With regard to treatment, I scarify the lids;
squeeze out the sago grains; occasionally, bat not often, ex¬
cise the retro-tarsal fold, and apply liquor potaaese, sulphate
of copper, or syrup of tannin (nitrate of silver as a caustic
does not go deep enough), and deal with bad cases by
peritomy and inoculation with ophthalmia neonati or
gonorrhoea, or infusion of paternoster bean.

1 have here a patient whose conjunctive were both com¬
pletely destroyed by trachoma before I saw her (zerosia),
and I have only managed to preserve a little sight by
establishing an artificial ankyloblepharon in both eyes. We
do not see many cases of trachoma at this institution, I
am happy to say, but here is a small boy who is a charac¬
teristic example of a form of disease which, like the poo r ,
we have always with us. This lad’s mother informs us
“ that he is very subject to getting his nose stopped up,” and
“that at first they thought it was weakness which had
fallen into the glands of his neck.” On examination we find
that the nostrils and upper lip are swollen, that the cervical

Digitized by Google

815 Thb Lanokt,]

DR. C. BELL TAYLOR ON DISEASES OF THE EYE.

[Apau, 23,1887.

glands are enlarged, and that there is an eruption on the
scalp and in the neighbourhood of the right auricle; in
short, the boy has got eczema of the skin, and we need not
wonder, under such circumstances, if he has also eczema of
the conjunctiva, and that is precisely what is the matter:
“phlyctenular conjunctivitis,” or conjunctivitis acrofulosa,
as it used to be called. There are two forms of this affection,
the miliary and the solitary. The miliary phlyctens are
scattered like grains of ; sand'on the vascular limbus of. the
cornea, usually come on after measles or scarlet fever, and
are masked by considerable general conjunctivitis.. The
solitary phlycten is about the size of a hemp-seed, is
surrounded i by a vascular zone, and marked by a small
bundle of vessels which radiate outwards towards the
equator of. the globe. Both forms yield readily to the
yellow oxide of mercury ointment, with general treat¬
ment, and it is only when the phlyctenular conjunctivitis
becomes phlyctenular keratitis that you are likely to
have any trouble with the case. Vesication and ulcera¬
tion of the cornea, however, is a very painful process.
Nerve terminals are exposed, photophobia is intense,
iritis is sometimes set up, the constitution sympathises,
the patient loses his rest, and the ulcers, even when
healed, leave scars which may subsequently seriously inter¬
fere with vision, la these cases it is necessary to apply
leeches, give mercury, put a seton behind the ear, and use
hot belladonna fomentations. You will also find that an
excellent plan of treatment is to open the anterior chamber
with a broad keratome, so as to divide the vessels and nerves
at the base of the ulcer. In this way tension is reduced,
pain relieved, healing promoted, and the effect may be kept
up by daily tapping of the aqueous with a blunt probe;
while the ulcer, if obstinate, may be touched with the
galvanic or thermo-cautery, alter the method so successfully
practised by Dr. Nieden of Bochum, Prussia. The worst
forms of ulceration of the cornea, however, with which we
have to deal are those occasioned by foreign bodies, often
aggravated by attempts at removal. I constantly find
pieces of corneal epithelium stripped off in the neighbour¬
hood of a small speck that need not have been enlarged. In
order to avoid this mischance, you will do well to take a hint
from our friends the watchmakers, and use a lens. Fixed in
the operator’s orbit after the manner familiar to us all, both
hands are free, and the foreign body may be readily lifted
from its abnormal situation without increasing the area of
injury occasioned by its impact. It frequently happens,
however, that we do not see these patients until the cornea
is clouded and infiltrated with the formation of pus in the
anterior chamber, in which case the ulcer should be divided
freely across with a thin Graefe's knife, after the manner
recommended by Professor Saemisch. 3 Organised lymph
and shreds of matter should be gently removed with forceps,
and warm fomentations, antiseptics, and atropine or eserifte,
according to the situation of the ulcer, applied. The ehamber
may be reopened daily, so long as the pus re-forms, by a
mere touch with a blunt probe, and an artificial pupil
practised afterwards, if necessary.

When minute fragments of steel have penetrated the
cornea, their presence may be demonstrated by this admirable
instrument, the electro-magnet, for which we are indebted to
Mr. McHardy, Professor of Ophthalmology at King’s College.
It is not often in these cases that the lens escapes without
injury; but I recently extracted a piece of .steel through a
small incision from the anterior chamber with this fine bent
conductor without the formation of cataract or any further
damage to the eye. When the lens is wounded-it swells,
presses forward, and acts upon the iris both as a chemical
and mechanical irritant. In these cases we must extract
the lens, or If from the nature of the accident this is too
great a risk to run, a piece of iris may be removed.

Sight, however, may be seriously affected without Any
loss of corneal transparency, by mere abnormalities of shape.
The cornea may be too flat and the eye too short (hyper-
metropia), or too long (myopia), or it may be too convex
(kerato-globus), of the refraction tnay differ in different
meridians (astigmatism), or it may even project like a
engar loaf (kefato-conus). When the eye is too flat the
patient can see at a distance, even through a convex glass;
but vision with the naked eye for near objects soon becomes
confused; in these cases we must prescribe convex glasses.
In cases of astigmatism a combination of cylindrical and
spherical lenses is requisite. Iridectomy, in some excep¬

tional cases, is said to do good in kerato-gldbus, and I am
in the habit of treating cases of conical cornea by touching
the apex of the cone with the galvanic cautery. With one
or two applications the aqueous escapes; the wound in
healing, after the manner of burns, contracts; the normal
curvature of the cornea is restored; and the cure is completed
by making a pupil sideways, and, if necessary, tattooing the
scar. With regard to myopia, it is very generally believed
that because short-sighted persons can see minute objects
with very imperfect light, and because they can read with¬
out spectacles at an age when most persons require such
aids, that therefore short sight is strong sight. This, how¬
ever, is a mistake. The vast majority of such patients suffer
from permanent organic changes, which, increasing, may at
any time damage or even destroy sight. Speaking on this
subject. Dr. Williams, the eminent Professor of Ophthal¬
mology in the Harvard University, the oldest University in.
the United States, says: “Very high degrees of myopia
should be recognised as an infirmity deserving careful con¬
sideration before assuming the obligations of marriage; for
those in moderate circumstances may well hesitate to choose
partners, who, though highly cultivated, may probably at
middle life beoome usable to provide for their households
or care for their children.’ -3 Surely that is a serious disease.
He adds: “Myopia is one of the gTavest affections of the
eye: capable of limitation by constant care during child¬
hood and youth; but if not thus limited, likely to be a
source of future disability and misery, and to be handed
down as an onerous inheritance to children.

Let me epitomise for your guidance a few facta relative
to this very important subject. If short sight is not developed
before sixteen years of age, it Will not be developed at all;
if it has not reached a higher grade than one-tenth by
twenty, it is not likely (if care be taken) to increase. Higher
degrees than this are an ever-present source of danger,
disability, and frequent disaster. It is more likely to be
developed in weakly children than in others, and frequently
makes rapid progress in those who are recovering from
illness. It is unknown amopg savage tribes and tillers of
the soil, and is the direct result of a vicious system of
excessive education, making its appearance first in the
children at village schools in the proportion of about 1 per
cent., ia schools of higher grade 20 per cent., higher still
40 per cent. Not only the numerical ratio but the intensity
of the disease is also increased in direct proportion to the
hours spent in study, and the attention of the German
Parliament has recently been called to the fact that in some
districts where compulsory education has been longest in
force, upwards of 60 per cent, of the inhabitants are
affected. With regard to treatment, again I say preven¬
tion is better than cure; better indeed in this case,
for cure is impossible. I see many of my eminent
colleagues suggest desks, and fittings, and light arrange¬
ments, and props to keep the children’s heads in certain
ositions; but, to my mind, desks and props and fittings
o not meet the difficulties of the oase. Ftom five to
fifteen is the dangerous age—the very period that the
School Board have selected for their paternal ministrations;
and if the eyes of a child between these ages begih to give
way, there is no rational treatment but enforced absence
from school; and I do not think myself that such compulsory
holiday ought to be regretted by anyone, for children’s
brains do not grow in proportion to the staff they cram
into them; and, after all, true education is something that a
man seeks for himself and finds for himself, and does not
usually begin until long after school-days are over. Short¬
sighted persons, who must complete their curriculum of
study for the Church, the Bar, the Civil Service, or other
professions, should wear weak concave glasses for reading,
so as to be able to hold print about twelve inches from the
eye. The light should be good, and come from the back or
side, and they should not read or work when lying down,
leaning forward, or travelling in a railway carriage.
“Seekest thou great things for thyself? Seek them
not.” To no class does this sage warning apply with
greater force and j ustice than to the myope. Of two brothers,
Germans, myopes, and students of medicine, one took heed
of this warning, accepted a mediocre degree, and preserved
his sight by an out-door life and country practice. The other
heeded not, but worked on, and at last achieved distinction,
only to find himself, shortly after middle life, unable to
walk alone or recognise bis fellows. Another condition that

2 Haodbucb der AugenheHkunde.

* Dlagnoali ami Treatment of Diieaiei of the Bye, p. 374.

Th* Lancet,3

DR. BKAVEN RAKE ON ULCERATION SIMULATING LEPROSY. [Aphil 23,1887. 8 17

you will find very much benefited by glasses occurs in
patients of forty or upwards, who occasionally suffer from
marginal blepharitis, the formation of styes, and a feeling
of general worry about the eyes owing to reflex irritation
from neglect of these aids to, vision. Still another is that of
chronic invalids, specially women suffering from uterine
complaints, painful menstruation, and the like, who spend
much of their time on their backs, who read in this un¬
natural position, and complain of pain and neuralgia when¬
ever they *i«e their eyes. In these cases, in the absence
of any marked ametropia, I usually proscribe weak convex
glasses combined with abductive prisms, and recommend
graduated exercises after the plan first suggested by Dr. Dyer,
of Pillsburgh, Pa.

Gentlemen, I have already pointed out to you the great
danger of mistaking a slight case of Iritis for mere surface
irritation, 1 and neglecting to dilate the pupil; the equally
great, if not greater, danger of using atropine if the case
should be inflammatory glaucoma, a disease which you ate
so apt to mistake for iritis. 1 have dwelt on squint and
cataract, and pointed out those cases where the eyeball
must be extirpated, and those where, in my opinion, optico¬
ciliary neurectomy may be advantageously substituted.
Let me close this brief and necessarily imperfect sketch by
calling your attention to two other errors which I find very
frequently committed.

Here is a boy who was sent to me by his surgeon to be
treated for myopia, and in truth, on ordinary inspection,
you might easily conclude that his imperfect sight was due
to that cause; but if you dilate the pupil, or use the
ophthalmoscope, you will see at once that he is suffering
from congenital cataract. Bear in mind, therefore, that
there may be considerable opacity of the lens which is not
at all visible on ordinary inspection.

Some years ago I was sent for to operate upon a lady, the
wife of a military gentleman of considerable social import¬
ance. Two surgeons and a physician were already in
attendance, and I was informed that the patient, although
advanced in life and very nervous, would prove a good
subject for operation, as the cataract was fully formed in
each eye. On examination, however, I found that the case
was one of simple glaucoma;. there was no cataract at all;
and tbe time for beneficial treatment had gone by. Now
you will avoid this latter error by remembering that a dusky
pupil is quite a natural phenomenon in aged persons, and
that it is not at all safe to conclude that, because this
appearance is accompanied with failing vision, therefore
the case is one of cataract. You must use the ophthalmo¬
scope, or, failing that, trust to subjective symptoms. Of
these the most important are limitation of the field and
iridescent vision. You will find, if the case is one of
glaucoma, that the patient cannot see to the inner of
nasal side, or vision is very limited in that direction,
and if he looks at a candle or artificial light it is sur¬
rounded by red and green colours. You will see what
I mean if you will breathe on the glass and look at the
street lamp outside. This is an early and significant
symptom of glaucoma, and if it does not disappear on
rubbing, is not accompanied by evident opacity of the
cornea, and does disappear under the influence of eeerina,
you must be prepared to treat for glaucoma or call in the
aid of an ophthalmic surgeon.

Gentlemen, when I was a student' I was taught to
contemn specialism, and my teacher was Mr. Syme. Now I
look upon tbe late Professor, of Clinical Surgery in the
University of Edinburgh as probably the first surgeon of the
century, and am therefore disposed to regard any opinion of
his with exceptional reverence ; in this, however, I feol sure
he was wrong. Life is so short; art is so long. It is so
human to err. You require to see so many hundred patients
before you know how to treat one; you require to perform
the same operation not only, over and over again, but to be
always at it, before you can ensure for your patient the
utmost benefit that art can afford; so that I feel convinced
•that if science is to be advanced afid humanity benefited, it
will be mainly by gentlemen who devote special attention to
special subjects, and who place the fruits of their labours at
the disposal of the whole profession. It is in the fulfilment
of that duty that I am here to-night; that I venture to offer
you these few hints, and to assure you that I am highly
gratified by your gracious acceptance of the same.

vol lTl880 tUre 0n **** Abuse of Mydrlatlos, THE Lancet,

A FORM OP ULCERATION SIMULATING ,
LEPROSY. 1 *>•■■■ •'*

• Bt BBAVEN RAKE, MJXLoinx,

MEDICAL avtnEBTTTBMSENV OF THE TKOZDAD LKPKB ASILUM,

Last year Dr. Hale White was kind enough to show'for
me at the Pathological Society* specimens from a case of
peculiar ulceration which had been mistaken for leprosy,
and admitted to the Trinidad Leper-Asylum. Having now
three more cases under my care, and not having found this
condition mentioned in any article on the diagnosis ' dtf
leprosy, I have thought that & few motes of these cases may
perhaps be of interest.

Cask 1— P., a Hindoo woman aged thirty-seven. Twelve
years’ history. The chest and extremities are cohered
with superficial cicatrices. Above tbe ankles tbe dark skin
is replaced by light flesh-coloured patches, showing former
deep ulceration. The thumbs are intact, but the fingers are
Strangely distorted. The general arrangement is this: The
first phalanges are inclined forwards, the second backwards,
and the last phalanges forwards again. The phalangeal
joints are more or less dislocated; in some there is ankylosiB,
in others more or less limited movement. The left fort-
finger is flail-like, and turned round to one side. The nails
are filbert-shaped and slightly split longitudinally. Tbe
toes ace curved downwards and are somewhat shiny. The
toe-nails are worn away. There are superficial ulcers on the
feet. There is no tache or anesthesia anywhere. The toes
are hypersesthetic. No enlarged glands can be felt, and the
bones are not markedly thickened. Chest sounds are normal.
Magenta shows no bacilli.

Cab* 2.—M., a Hindoo woman aged forty-two. Three
ears’ history. The skin of the face and trunk is mottled,
ut there are no anresthetic tacbes. There are old deep
cicatrices on the dorsal and ulnar surfaces of tbe forearms,
and over the left ulna are some long punobed-out ulcers,
exposing bare bone. The hands and fingers are very thin
and wasted, but there is no ulceration, destruction of nails,
or anaesthesia. On the front of the legs, upper surface of
the feet, and left sole are old cicatrices and punehed-out
ulcers. Dead bone has been removed from shaft of left
tibia. The toe-nails are intact, and sensibility is good. No
enlarged glands can be made out, and the chest signs are
normal. The patient is still extremely wasted, but has
improved much since admission. Magenta shows no bacilli.

Cask 3.—D. J., a Negro aged forty-four. Five years’
history. There are pale patches on the Cheeks, joining
beneath the nose; they are not anesthetic. Trunk normal.
The fingers of the left hand are partly ankylosed, the last
'phalanges being turned backwards towards the dorsum. On
the extensor surfaces of the flrigere are hypemsthetic cica¬
trices. The third and fourth fingers of tbe right hand are also
becoming distorted. The nails of both hands are long,
intact, and more or less filbert-shaped. The floger-pulps
are hypersesthetic. Over the left external malleolus is a
superficial ulcer about two inches long, nearly cicatrised.
The toes are flexed, ankylosed, but not Ansesthetic. Nails
intact. There are scare on the dorsum of the right foot.
Harsh breathing at left apex and nummulated sputum.
Enlarged cervical glands on left side. Patient much wasted.
Magenta shows a few bacilli in discharge from ulcer.

The maiu differences from leprosy are seen to be three:—
1. There is no anroethesia of fingers or toes. Indeed, in
Cases 1 and 3 there is very marked nyperiostheeia. 2. There
are no anesthetic taches. In Cases 2 and 3 there is more or
less leukoderma, but sensation oter these patches is perfect.
3. There is no loss of phalanges or deformity of nails. In
Case 2 the toe-nails are worn away, but this appears to be
simply mechanical and very different from the destruction
and deformity common in leprosy. The presence of bacilli
in the last case is not to be wondered at, seeing that the
patient is the subject of advanced phthisis.

The cause of this form of ulceration is obscure. On look¬
ing through the literature of tropical disease, it seems to me
that this ulceration presents a remarkable analogy to the
“ parangi" disease of Ceylon as described by Gavin MUroy. 2
He says: “The characteristic features of the malady atfe
diverse forms of skin disease, ulcerations of the surface in

1 Path. Boo. Trans.. voL xxzvit., n. S44.
i Bndemio DU—m of India (Fox and rarquhar), p. 95 et ttq.

818 The Lancet,]

different parts, and frequently also affections of the bones
and joints, leading on, in bad neglected cases, to emaciation,

exhaustion, with much suffering and death. Sometimes

it exhibits all the appearance of inveterate lepra.” He
remarks also on its resemblance to some endemic forms of
disease in the Western hemisphere, and Fox and Farquhar
comment on its relation to Delhi sore and its allies. 1
would venture to suggest that the above cases are Western
analogues of these Eastern diseases.

Trinidad.

ON SOME CLINICAL FEATURES OF GRAVES’
DISEASE . 1

By SIMEON SNELL,

OPHTHALMIC SURGEON TO THE SHEFFIELD GENERAL INFIRMARY
AND TO THE INSTITUTION FOR THK BLIND ; LECTURER
ON OPHTHALMIC SURGERY AT THE SHEFFIELD
MEDICAL SCHOOL.

It is far from my intention in this paper to dwell on the
whole train of symptoms which go to make up the disease
recognised under the name of exophthalmic goitre. I shall
limit myself to certain features of the affection, illustrated
by cases occurring in my own practice. Let me in the first
place direct attention to the eye symptoms. They are three
in number—viz.: exophthalmos; Stellwag’s symptom, or
retraction of the eyelids; and Graefe’s sign, or loss of the
coordinated movement between the upper eyelid and the
eyeball, and thus if the globe is turned downwards
the eyelid does not follow fully, but leaves a zone of
sclerotic visible above the cornea. The relationship of
these symptoms, and especially the latter two, to Graves
disease is the question which I wish first to discuss.

Dr. Wilks, at the discussion on this subject at the Ophthal-
mologioal Society in May last year (1886), said that “ increase
of cardiac rapidity he regarded as a primary and necessary
symptom; quickened cardiac action, combined with exoph¬
thalmos and emaciation, or with enlarged thyroid, he would
regard as characteristic.” The general experience seems to
be that it is exceedingly uncommon for the cardiac symptoms
to be absent. Trousseau and most writers believe that they

f receded other symptoms. Graefe held a different opinion.

t is not difficult, however, to find a reason to account for
this diverse experience; for physicians would naturally be
consulted in the first place by those in whom the cardiac
symptoms were primarily pronounced, and Graefe by those
in whom the first in order were the ophthalmic. At the same
time Battler, from the same standpoint as Graefe, says: “ It
belongs to the rarest exceptions for the cardiac palpitation
not to form the first symptom.” Sooner or later the eye
symptoms make their appearance, and the constancy with
which they occur is generally recognised, and their presence
often regarded as pathognomonic. At the same time, cases
have occurretd in my practice which lend support to the
belief that no i infrequently the eye symptoms—and I mean
especially the id signs—occur among the early indications
of the disease. It is also possible that their occurrence has
been overlooked in cases where the observers, having failed
perhaps to note the fulness of the globe, have not examined
for less apparent lid symptoms.

A woman who is under my care, and whom I have
introduced this evening, I take to be one of the character
I have mentioned, with the early development of the
characteristic signs of the lids. Her age is forty-fire,
and she saw me at the infirmary on Dec. 10th for the first
time. Six months ago, after a severe headache, she first
notioed anything unusual about her eyes. Then, as at the
time of coming to the infirmary, she supposed it was the
left eye that did not open sufficiently, and that the right
was perfect. She has been a widow for eighteen years; the
catamenia have been very irregular since then, and men¬
struation has been entirely absent for eighteen months or
more. Bbe has had a good deal of anxiety about the success
of a soil during the last twelve months, and has been
“ nervous.” She does not admit that she .is thinner than
usuaL Examination at oooe.disclosed that the faulty eye
was not the one the patient supposed. The left eye was
normal, and only apparently-«o»e closed in contrast to the

1 Bead before the Sheffield Medlco-Ohirnrglcal Society,'Dec. 23rd, 1886!

[April 23,1887.

altered state of the right. On this (right side) retraction of
the upper eyelid (Stellwag’s symptom), causing a widening
of the palpebral fissure, was present; also when the patient
looked down the relation of descent between the eyelid and
the globe was broken, and a zone of sclerotic left bare above
the cornea (Graefe’s sign). There was no real exophthalmos
present; the widening of thejpalpebral fissure would account
for any little apparent prominence. Vision in each eye waa
normal, fg, and the eyes were free from disease; on the right
side there was venous retinal pulsation. The thyroid gland
was perceptibly enlarged, and the right side more so than
the left; it had not, however, attracted the patient’s atten¬
tion. Cardiac symptoms were absent; pulse 80; “flushings”
had not been experienced; and there was also an absence of
the “flurried fussy manner” of a complete case of Graves’
disease. Urine: sp. gr. 1020; no albumen; no sugar. Not¬
withstanding the absence of the third cardinal symptom and
the monocular character, I do not see how this case can be
regarded as otherwise than as one of exophthalmic goitre.
It is possible the other symptoms may develop later.

Not long ago, too, a young woman came under my obser¬
vation with the retraction of lids (Stellwag’s sign) and also
Graefe’s symptom, with some amount of exophthalmos. The
other symptoms were not marked; and though I was myself
disposed to regard the thyroid as a little goitrous, it was at
all events so little that others disagreed with me. Dr. Dyson
saw her at this time, and she has been under his care since,
and he has kindly consented to her coming here this evening,
as the other cardinal symptoms have since developed. The
patient has reminded me of the interesting fact that she did.
not come to the infirmary respecting her condition at all,
but only accompanied a relative, and that I, noticing some¬
thing about her eyes, examined her and found the condition
I have stated. It had bever attracted her attention before.
The eye symptoms are more marked on the left side.

About a year ago, also, I saw a young lady with an
absence of all symptoms of Graves' disease, except a nervous-
irritability, and that in the right eye Graefe’s symptom, and
especially Stellwag’s, were both well marked. There was no
exophthalmos. The left eye was normal. ‘ This case caused
me at the time and since to reflect whether these symptoms
may occur independently of exophthalmic goitre, or indeed
in a case which does not actually pass into the train of
symptoms recognised under that disease; especially, more¬
over, as in this case treatment affected more than it usually
does in Graves’ disease. Bromide of potassium was used
without much benefit; but the constant current, with tonics
and change of air, were followed by marked improvement.
No other definite cause in the way of diseased teeth &<r.
was found. She remains now practically well at the lapse
of ten months since discontinuing treatment.

A still more interesting case is that of a miner aged
thirty-six, whom you have seen, and who is suffering
from well-maTked miners’ nystagmus, the oscillations being
both rotatory and of a to-and-fro character, and the
movements being increased by placing the head in an
oblique position, as well as by tbe other means that
generally aggravate the oscillatory motions in the nystagmus
of miners. The interest for our present purpose lies in
the fact that there is also present retraction of the eye¬
lids (Stellwag’s symptom), rendering the sclerotic bare
round the cornea, and very marked Graefe’s sign. He
appears, moreover, to possess some control over this con¬
dition, for he can lower tbe eyelids to tbe cornea and present
an almost normal appearance; and this does not seem to
bear any very exact relation to tbe nystagmus. The eye
movements, though worse at some times and in certain
positions, never cease. It is doubtful whether there is any
real exophthalmos—probably not; nor can tbe thyroid be-
considered as enlarged. There is a complete absence of all
other symptoms of Graves’ disease.

At the discussion at the Ophthalmological Society Mr.
Lang read an epitome of six cases in which unilateral lid
phenomenon, without proptosis, was associated with no
other evidence of Graves’ disease except slight enlargement
6f the thyroid in two cases. In four, however, paresis of
the orbital muscles was present. Dr. Hughlings Jackson
mentioned also that he bad observed Graefe'a sign in a case
with no Graves’ disease. An immense number of cases of
-miners’ nystagmus have at one time or other passed under
my observation, but such an association of lid symptoms a»
witnessed in the case related is unique in my experience.

Fortunately, notwithstanding the degree of protrusion, of
eyeballs which in some cases occurs, sloughing of the cornea

MB. S. SNELL ON SOME CLINICAL FEATURES OF GRAVES’ DISEASE.

Thb Lancxt.J

■8 a. very rare occurrence. No anch result has occurred in

ESS?* ‘7? Cas ® 8 , h ‘ ve come “*»der my care in

tb« infirmary—one not long after the suppuration had com-

ESS*!? th6 ° thOT •**« the ^obes had beSS;

The first case was that of a young woman, unmarried
^twenty-three, and she was admitted into the Fir Yale

suSSaTr 0 F 18 *\ whfl ?, our P"«*

surgeon, Mr. O. J?. Coombe, saw her, whilst acting as resident
that institution, and he has^indly sup-
Si rJL27 )B i^ th ,® particulars which follow. At this tim^
enl ^ ement of both lobes of the
hadfrea P ro ““nence of the eyebaUs. She

•broits 3S? h!£y£*? ! f e 7 " e I ere Palpitation, and systolic
oruice were beard both at the base and apex of the heart

the ex °P hthalm os increased con-

S

WhSf^hi^?' No post-mortem examination wu
^ 8he , c ame n»der my observation both corner
were extensively sloughed, altogether past recovery No

SrLSwhSKn < ?J° rthe di8€a8e ’ but her ooudition from
tBe when under my care was such as to preclude th«
possibility of taking detailed particulars of her case.

_The second instance was in a married woman aged forty
She was admitted into the Sheffield General Inftrmarv m

^e y (^effi^T»r t f , h b0fc M 6ye , bal i 8 dortroyed by sloughing of
the corneas. The thyroid gland was markedly enlartmd-

Thare wM P th Pltat > n h? Dd 4 loud ha)mic murmur (basic)!

MdSitThl^nl o X<atabl ®,. nerv0U8 disposition met with in
pattents having Graves disease, and "flushings * were like-

wMeaxpenenced. The eyelid symptoms were ohsSd m a
consequence of the sloughing of the eyeballs, but Stellwao’s
0i eye “ d8 > W4a undoubtedly present
th^nS m ® ^P^ting the condition of the

ca T of exophthalmic goitre

mrnd sufficiently the anatomical fact ?

Afowocufor cases. Generally speaking. Graves’ disease is

ESr a '"

2*®2, ^at the eye symptoms in his thirty oases were
aff^Sd SidtWlflT *“ tance «; “» f our the right only vu
I^rX^to?No n n h rT In additi<m to the patient
The «£/ 1} ; 1 h * ve notes of two other cases.
sultSS W ^flfty-four, who con-

-SL l l7“ y "”2 ,h ‘ j®?-

»-her. e “wS e d8W “ 'to*""- ”«ly

, mn .L t oye^was noticed to be prominent, and bad been

&5F^rr ~ 2KE2M

loss Of cSnatid “ d Gnie,e ’ 8 *U?».

UDT»r a .„rI a,n&te<1 movements in descent of eyeball and

SSK®=p$SiftS5

eye was hy ^h f ° r ma>y yeare - The right

left were ^S^fJ^SiA h ® symptoms present in the
tion ; thereTn, n%J»?£SL a *£**1 d «al from pal pita-
sound atbLJIid card ? c ft?*. audible wlth first
bad only K nec £_ Goi *ro w « present, and

< 1 **tioctL two or three weeks—not large but

ebock? r Sher^aJSSS' WM tb * lw S* «SE No
oer apparent cause. Menstruation

MB. H. CRIPPS; COLOTOMY FOB DISEASE OF RECTUM. [Apbix. 28,1887.

819

She was introduced at one of our meetings some time after
Q “der my careand in the following
fi™“ be ' : it seemed as if the right eye would .also become
affected; but it never did so. At tbe end of twelve months
the following note was made: “ She has been at Scarborough,
and is in much better health. The prominence of the left
eye ie now very much less, but she thinks it is not quite
as it was before the attack commenced. The right eye
“5 k 1 68 g00d ' No fl uflbings now, nor palpitations. Has
lost her nervousness. Catamenia regular.

A theory to be satisfactory must be able to account forthe
T™,?® 11 of symptoms. The one that seems to fall in beet
with this condition is the central lesion theory brought
forward by Sattler, and which has found in these islands a
very able advocate in Dr. W. A. Fitzgerald of Dublin, 11
Briefly, Sattler assumes a lesion of the vaso-motor centre
tuat presides over the vaso-motor nerves of the thyroid
gland and orbital tissues, and it is inferred from the
irequent association of goitre and exophthalmos that these
centres must be dose together. The cardiac symptoms
he ascribes to lesion of the cardio-inhibitory centre for the
Qraefe ’ 8 symptom is explained on the assumption
that there is a centre governing the associated downward
movements of the eye and. eyelids, just as the associated
movements of both eyes. He coincides in 8 tell wag’s opinion
that the widening of the palpebral opening is due to a lesion
ot the reflex centres, which are set in motion by stimuli
» bmv® rotana, cornea, and conjunctiva. The experiments
oi Jj llebne on the restiform bodies have given considerable
support to this theory, these being the parts through which
the nerve paths from the vaso-motor centres and vagal
centres pass. In one case he succeeded in inducing the three
cardinal symptoms, and in the others a varying association of
the symptoms. Moreover, the interesting association of dia-
betesrn some cases of Graves’ disease is well known, and it is
worthy of notice that the region described as the diabetic
punoture is close to the vaso-motor area. Do not the* cases
referred to in this paper lend support to such a central theory ?
In other diseases we are accustomed to regard a lesion as
spreading and gradually encroaching on contiguous areas,
either by direct extension or by irritation of surrounding
•jf® 1 ®®; May we not, therefore, regard the cases in which
the lid symptoms are among the earliest as instances in
which the lesion has only affected the centres governing
the coordinated downward movement of the globe and
eyelid,, with the lid reflexes generally closely associated,
tbe other centres becoming implicated later on, with a
consequent farther development of symptoms ? Or are there
cases which stop at a lesion of the lid centres ?

COLOTOMY FOR MALIGNANT DISEASE OF
THE RECTUM, WITH NEARLY PERFECT
CONTROL OYER THE ARTIFICAL ANUS
A YEAR AFTER THE OPERATION.

By HARRISON CRIPPS, F.R.C.6.,

ASSISTAKT-SUBQEOX TO ST. BASTHOLOVEW’S HOSPITAL.

The patiept, a woman aged fifty, was kindly placed under
my care at the hospital by Dr. Griffith. I am indebted for
the following notes to Mr. B&lgarnie, her dresser.

The woman was admitted on Dec. 15th, 1885. She dates
her present illness from the spring, when she first noticed
pain in the lower part of the back, and soon afterwards pain
during defecation. Tbe eh&racter of her motions gradually
altered, becoming smaller in size, and at times flattened and
generally tinged with blood. The frequency of her stools
increased, at first to three or four times a day, but latterly •
much more often. She ha9 been getting thinner, and at
tidies has mnoh severe pain, which she described as like
" labour pains."

The patient on admission looked weak and anaemic, with
a feeble pulse. She had nearly constant pain, and was much
distressed by a troublesome diarrhoea, having to go to stool
a* ?ften as ten or twelve times in the night. The act of defe-
cation was very painful, and nearly always attended by loss
of blood. On examination the anus appeared healthy, and on

* Dublin Media*! Journal, 1883.

Google

82CU Tift: L'AtterT,]

MR. E. C. ANDREWS ON EXTIRPATION OF RUPTURED UTERUS.

[Aihm. 23,1887.

ntroducing the linger the mucous membrane for about three

inched felt smooth and natural. The linger then came in

contact with a mass feeling not unlike an enlarged cervix
uteri. Around this was a cul-de-sac, deeper posteriorly than
anteriorly. The mass itself was hard and nodular. The
opening through it would only admit the tip of the finger,
and the bowel at the constricted point was firmly fixed to the
surrounding structures.

The patient, not wishing then to stay in the hospital, left,
but was readmitted on Feb. 1st. She had become weaker,
and her symptoms had increased since her discharge. The
mass also had grown considerably, and could now be felt to
be within an inch and a half of the anus. On Feb. 8th, 1886,
the case being considered unsuitable for excision, lumbar
colotomy was performed by Mr. Harrison Cripps. The
various layers between the skin and the lumbar fascia were
purposely not divided on quite the same level, and the
opening in the fascia was considerably above that in the
skin, so that the bowel when drawn out ran obliquely for a
short distance between the skin and the fascia. The wound
united by first intention. No motion passed through it for
a week. During the next six weeks a certain amount of
freces passed through the rectum as well as through the
wound. This gradually ceased, and when she was dis¬
charged in March everything passed through the artificial
anus. She improved very much whilst in the hospital, and
was comparatively free from pain.

April, 1887.—The patient is not only alive, but wonderfully
improved ; and notwithstanding that the local growth has
made some advance, her general health and strength is far
better than it was a year ago. She is no longer troubled
with diarrhcea, but has one good motion daily through the
artificial anus, and she has been able to attend as usual
during the year to her domestic duties. The artificial anus
readily admits the forefinger, and the mucous membrane is
exactly on the level of the skin. There is no sign of
cicatricial tissue round the orifice, which is perfectly soft
and dilatable. The patient knows when she is going to
pass a motion, which she has the power of controlling, there
being no involuntary escape. In fact, the patient herself
says she is no more troubled with the artificial anus than
when the opening was in the natural situation. The patient
was shown at the Medical Society.

After carefully watching a large number of cases of rectal
cancer, in some of which colotomy had been performed, while
in others nature had been allowed to take its course, I do
not hesitate to pronounce strongly in favour of the opera¬
tion. The relief to the symptoms is very marked, the con¬
stant diarrhcea and tenesmus which forms so frequent and
distressing a complication being entirely relieved. The
downward course of the patient is certainly made far easier,
aad the miserable termination of life by obstruction or per¬
foration prevented. Moreover, I feel confident that the
progress of the growth is retarded in consequence of the
bowel acquiring physiological rest by the cessation of its
function. That the rapidity of malignant growth depends
much on the activity and consequent blood-supply of the
organ affected admits of no doubt, and as an example may
be instanced the relative rapidity with which cancer grows
in the breast of a pregnant or suckling woman. So that,
apart from life being indirectly prolonged by the relief
which colotomy affords to distressing symptoms, I feel
confident that the growth itself is often retarded, and
rendered comparatively quiescent when the rectum is
placed at rest by the operation. Colotomy i3 in no
3ense a rival operation with that of excision. Ex¬
cision is doubtless the proper operation when the disease
is within easy reach and still confined to the walls
of the rectum, thus admitting of a free and complete
removal. Such favourable conditions are, however, unfor- '
tunately exceptional, the disease either having commenced 1
J;oo high or spread too far by the time the case has come
under observation to admit of local interference. The prac¬
tical question that arises is as to what period in the course
of a case of rectal cancer colotomy should be performed,
In answering this question, I am in complete accord with
Mr. Reeves, who advocates the performance of the operation
so soon as symptoms of stricture become prominent. The
troublesome diarrhcea, pain, tenesmus, and blood-stained
discharge owe their origin far more to the retention of
scybala above the contracted part than to the actual disease
itself. To wait until the unfortunate sufferer is at death’s
door, worn out by the constant discharge, or by the actual
occurrence of complete obstruction, is not only to have

deprived the patient of the benefit of the operation, but to
perform it at a time when it becomes a dangerous procedure.

The operation, if performed before the patient is much
reduced in strength, has but little risk; indeed, I can say
in my own practice that I have hitherto had no death aa
the immediate result of the operation when performed for
malignant disease. It is essential, if the patient is to derive
full benefit from the operation, that care should bo taken to
prevent the opening from contracting. It is of great im¬
portance, with this view, to get union of the bowel with the
skin by first intention. If this occurs there is little or no
tendency to contract. On the other hand, if the bowel
falls away from the skin the granulating tissue with which
the interval is occupied is nearly sure to contract on healing.
In one case in which 1 recently operated half the benefit wan
lost from this cause, for, on seeing the patient two months-
after the operation, the opening would barely admit tho
finger. If there is any tendency to contraction, it is best pre¬
vented by allowing the wound to heal over a full-sized plug*
I regard it as a great advantage to make the opening
through the abdominal walls as valvular as possible, and
this is best accomplished by making the incision through
the skin considerably lower than that through the fascia.
If the opening is made in this way, and care taken during
the healing process to prevent contraction, the patient wifi
have little or no difficulty in managing the artificial anna.
In the case recorded, the part was perfectly clean, the
patient had one motion daily, and had control over the
bowel, while she was able to do her daily work without
annoyance of any kind.

Strotford-place, Oxford-street, W.

EXTIRPATION OF RUPTURED UTERUS.

By E. C. ANDREWS, B.A., M.B., B.C. Cantab., &o v s

SCHOLAR OF 8T. JOHN'S COLLEGE, CAMRRIDGK. AND 3EXIOB OUSTKT*IO
RESIDENT AT GUY’S HOSPITAL.

- 1 .

On September 12th, at 5.30 p.m., one of the extern mid¬
wifery attendants was called in to attend the fifth labour of

Mrs. S-, who was said to have had pains for twenty-four

hours. She was a delicate womau of short stature and her
previous confinements had all been normal. Vaginal exami¬
nation showed the os fairly dilated, membranes unruptured,
and the vertex presenting resting on the pubes. The paina
were of medium frequency, aud apparently those of the first
stage of labour. At 6.30 p.m., the pulse being then about
120, the membranes ruptured, and the pains increased in
force and frequency, culminating about 8 p.m. in exceed¬
ingly strong expulsive efforts, which affected the pro¬
gress of the head but little, if at all. Immediately after
these the patient complained of intense pain in the stomach,
there was marked collapse, and all labour pains ceased.

I was now summoned to the case, and found the patient
nearly pulseless, pale, aud exhausted, but quite conscious,
and the head on the brim of the pelvis and rather
movable. Recognising the urgent necessity for imme¬
diate delivery, I directed the abdomen to be well
supported by the extern, introduced the long forceps,
and proceeded to deliver the child. No difficulty was
experienced in the introduction of the blades, and but very
gentle traction was required. Fearing that the perineum
might rupture, I withdrew the forceps as soon os the head
was well down upon it, but instead of expulsion taking place,
the head receded into the vagina. I again applied the forceps,
and delivered without further difficulty. The child was a
large one, weighing 9^-lb., was stillborn, aud the delivery
was followed by a gush of blood, though the uterus appeared
firmly contracted. After waiting a few minutes, finding
that the placenta did not come away, 1 introduced my hand
and found that it passed through a rent in the uterine wall
into the abdominal cavity. Following up the cord with my
fingers, I discoverd the placenta in the abdominal cavity above
the uterus, and removed it without difficulty. An injection
of two-thirds of a grain of ergotine was now administered.
The pulse was quite imperceptible And the patient apparently
dying. An hour later the patient had rallied considerably;
the pulse was 140, of fair force, and there had been no further
haamorrhage from the vagina. About 10.30 p.m., however, the
ulse was much feebler, and coils of intestine had come
own through the rent into the vagina.

Thb Lijrcrr,]

DR. THEODORE MAXWELL ON EXTEMPORISED INHALERS. [Apbil 23,1887. 821

In the temporary absents© of Dr. Gala bin, I consulted with
my colleague, Mr. A. E. Price, and we agreed that the
patient’s only chance lay in the immediate performance of
abdominal section. Ether was accordingly administered,
and, with the assistance of Mr. Price and Mr. F. R. B.
Bisshopp, I proceeded to open the abdomen by an incision in
the median line extending from a quarter of an inch below
the umbilicus to a quarter of an inon above the pubes. Each
layer was in turn divided on a director until the peritoneal
cavity was reached, and then, passing my hand downwards
and to the left over the surface of the uterus, I found a
large, ragged tear in the left and front of the organ, while
the abdominal cavity contained a very large quantity of
blood. The position and extent of the rent, together with
the extreme laceration and thinning of its edges, determined
me to remove the entire uterus and appendages rather than
attempt to unite the tear with sutures. 1 accordingly lifted
the uterus out through the abdominal wound, placed a
double ligature round both broad ligaments, and divided
them. Then carefully clamping the cervix below the rent, I
transfixed the pedicle with a needle and tied each half with
a double ligature, afterwards carrying one of the ends
round the whole stump. Cutting through the pedicle above
the clamp, I now removed the uterus. The peritoneal
cavity was sponged out as completely as possible, and the

E idicle brought forward and fixed with harelip pins to the
wer end of the abdominal wound. I then closed the upper
part of the incision with wire sutures, and applied the usual
gauze dressings. During the whole operation, which lasted
three-quarters of an hour, there was but very little haemor¬
rhage, and during the earlier stages the patient’s condition
was all that could be desired. Towards the end, however,
she gradually sank, and died soon after the operation was
completed.

Subsequent examination of the uterus showed the organ
to be of the normal size after parturition, and weighing
roughly twenty-four ounces. The rent extended from the
attachment of the upper part of the left broad ligament
vertically downwards to the lower third of the cervix, and
then pawed transversely across the anterior cervical wall to
the right side, its total length being nearly six inches and
a halt. The edges were much lacerated and very thin, and
in the surrounding tissue then was a good deal of blood
extravaeated. The placental Bite was on the fundus and
posterior wall, and the muscular tissue was firm and well
contracted, showing a healthy structure on miorosoopic
examination. In the right ovary there was a characteristic
corpus luteum of pregnancy, and in the left two minute cysts.

As far as I am aware, the uterus and appendages have not
before been removed for a rupture of that organ. I have
stated above the reasons which lsd me to prefer this
operation to any attempt to sew up the tear, though I
opened the abdomen with the intention of doing so.
Immediately after delivery the patient appeared to be
«nking much too rapidly for any operative interference to
fa attempted. As my notes show, she rallied from the
■hock, hut only to sink again from haemorrhage into the
(>eritoneal cavity as soon as the reaction was well estab¬
lished. That this haemorrhage was the fatal factor in the
case I have not the least doubt. Not having a serre»noend
at hand, I had to make use of an ordinary ovariotomy
clamp, but I feel sure that the former is much the more
suitable instrument. In conolusion, I believe that such
■an operation as 1 performed gives a chance to an otherwise
hopeless case, and that it should be undertaken without
hesitation under such circumstances.

Prince Arthur-road, N.W.

A REMARKABLE CASE OF COMA DUE TO
MALIGNANT PUSTULE (ANTHRAX).

Br F. J. REILLY, L.R.C.P. Ed., M.R.C.8.

. 9 X Tuesday, April 12th, at 9 A.M., I was sent for to see

Hi I. S-, residing in Hackney. I found him in bed,

totally insensible and convulsed. His case presented some
of the appearances of irritant poisoning, such as vomiting,
“■ad fixed rigidly backwards, and the muscles of the trunk
•hd limbs having tonic and elonio spasms. The breathing
stertorous, and he was totally unconscious, with insen-
sjtlve cohjonctirm. On careful examination, I found his

temperature was 105°; pulse 140, soft and compressible. I
also found on the nape of his neck a dark livid black spot
about the size of a threepenny-piece, with hard base 2$ in.
by 2$ in., and then came to the conclusion that it was blood-
poisoning of the most virulent character. I then wired to
Dr. Angel Money, who kindly came directly and suggested
an operation of removing the whole of the affected part at
the nape of the neck, which I immediately did; this opera¬
tion relieved the patient’s convulsions considerably, but he
died five hours after in coma. There was no albumen in the
urine and no sugar, and nothug to suggest either Bright’s
disease or diabetes. The patient had never been ill in his
life. He had been at business on the previous Saturday.
In the evening he played whist with his friends, about
a mile from bis own residence, partaking of a hearty
supper, and then walked home between 12 and 1. He went
to bed and dept welL On Sunday morning he took his
breakfast as usual, and was only noticed to complain of
feeling chilly. He wore an overcoat, and did not put on his
collar oecaoee of the “ boil.” Took his dinner, and in the
evening amused his children by reciting. He went to bed
and remained there until 4 pac. the fallowing day, when he

S it up and came downstairs complaining of great prostration.

e returned to bed at 7 o’clock, and ail night was most rest¬
less. At 6 a.m. he got up and made some tea, took a cupful
and gave hie wife one; at 8 a.m. he got out of bed and fell
down from what I consider to be syncope. He eo far
recovered from this to get back to bed without assistance;
becoming insensible, 1 was than sent for, and found the
condition abote stated.

The most important feature about this case is that Mr.
H. I. S. was a tanner, employing about seventy men, and
his long experience made it important that he should
superintend the sorting of hides, which he did on Saturday,
and it is not unreasonable to suppose that from this source
the contagion was contracted. The Government ought at
once to take some steps, now that anthrax is so prevalent
amongst animals, to make an immediate order that all their
skins and carcases should be esemated. Dr. Angel Money
took the portion removed away, promising to mount and
examine for bacillus anthrax. A preliminary examination
has demonstrated the presence of a few short rods having
the characters of the bacillus in question.

Vlctorla-park-road, Hackney.

NOTE ON EXTEMPORISED INHALERS.

By THEODORE MAXWELL, M.D., B.Sc.

Fbw practitioners who have been in the habit of employ¬
ing inhalations in diseases of the respiratory organs would
willingly give them up for all the draughts and mixtures
that have been invented. Why, then, do so few prescribe
inhalations ? Probably because the use of the various instru¬
ments in vogue is attended with inconvenience, and the
patients, as a rule, object to wearing & hideous and uncom¬
fortable semi-mask or to lean over an earthenware jog with
a mouthpiece for some time each day. In some oases, too, as
with chloride of ammonium, the inhalers to be had are both
cumbrous and expensive. A little ingenuity will enable the
practitioner to obviate many of the objections to prescribing
medication in this form. For example, is it desired to inhale the
vapour of a few drops of volatile liquid, such as creasote and
ether dissolved in spirit ? Take a piece of indiarubber tubing
about tbree-eigbtbs of an inch in diameter, and two inches
and a quarter in length; cut out three-quarters of the cir¬
cumference of the middle.third; there will then be left two
tubes, three-quarters of an inch long, joined by a mere band
also three-quarters of an inch long. Roll up a little strip of
blotting-paper, and insert into each of the tubes. This will
absorb from three to five minima of liquid dropped into each
tube. All that has then to be done is to bend the apparatus
into the form of a u. and insert it into the nostrils, the
indiarubber band resting against or below the bridge of the
nose. The patient should inspire by the nose and expire by
the mouth. This is, in fact, a simplified—may I sayan
improved—form of Cozzolini’s inhaler mentioned in Thx
Lancet of March 19th.

A gain, chloride of ammonium vapour is simply invaluable
in winter cough with so-called asthma, a few puffs from the
apparatus described and figured by Dr. Kendal Franks in

822 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[April 23,1887.

The Lancet of January 22nd being frequently sufficient to
afford immense relief; but this apparatus (Verekeris), as well
as another of Lee’s, is cumbrous, and too expensive for poor
patients. Besides, such goods are not to had in ordinary
chemists’ shops in country towns. The apparatus itself may
be improvised with three wide-mouthed .bottles and a few
pieces of glass and indiarubber tubing; the difficulty about
the Y-shaped tube, which only a practised glass-blower can
make, can be got over by leading the ammonia and hydro¬
chloric acid separately into the wash-bottle, whose cork
must thus have three holes. The gases combine quite as
well in the water, or after they have passed through it, as
they do in the leg of the y-shaped tube. But there is a
much.simpler plan still, which can be extemporised in any
surgery in two minutes. Remove the piston and cork from a
glass syringe (male or female), the larger the better; tear,
so as to fit the tube loosely, four pieces of sponge; damp
them; insert oue down to the end; put, say, a dozen
drops of strong hydrochloric acid on the second, and
push it down near the first; then insert the third, which is
simply damped; on the fourth drop, say, a dozen minims
of dilute solution of ammonium, insert it, and finally a
perforated cork. Tell the patient to smoke the “patent
cigar” from the nozzle for five minutes. If the sponges
have not been too tightly rammed in, there will be no diffi¬
culty, and the peculiar white cloud will issue from the
mouth or nostrils at each exhalation. I find it necessary to
explain to patients that the “smoke” is not merely to be
sucked into the mouth, but drawn deeply into the chest.
This “patent cigar’’can be used by several patients suc¬
cessively in the surgery, but the charge will not last long..
After use, the sponges may be withdrawn with an old pair
of dressing forceps, and recharged when required again, as
the sponge containing the acid soon gets spoiled; pumice-
stone or asbestos is better. Before letting a patient inhale,
the “ cigar" should be cautiously tried, lest either the acid
or the ammonia should be too strong.

Woolwich Common.

% Itirar

OF

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nnllanutem eat alia pro certo noscendl via, nisi quamplurimas et mor-
borum et diasectionum histories, turn aliorum turn propria* collects*
habere, et inter *e compamre.—M oboaqxi De Sed. et Caus. Jforb.,
lib. Iv. Pnxcmium. -

GUY’S HOSPITAL,

TWO CASES OF COLOTOMY FOR MALIGNANT DISEASE.—
FRACTDRE OF THE TIBIA DOE TO NECROSIS.—
REMOVAL OF FOREIGN BODY FROM
THE ANTRUM.

(Under the care of Mr. Bryant.)

The cases in which colobomy was performed present very
good examples of forms of disease in which the employment
of this operation gives very great relief from the more
urgent symptoms and also prolongs life, the malignant dis¬
ease being no longer in a constant condition of irritation,
and growing less rapidly. It is rare to find fracture of the
tibia due to necrosis, and not unfrequently the condition of
the parts compels amputation. The fourth case shows the
1 necessity of careful inquiry and examination where these
sinuses may possibly be due to a foreign body.

Recto-vesical fistula due to malignant disease; colotomy
(two stages); pins used. (From notes by Messrs. E.

Deane and A. G. W. Bowen.)—E. P-, aged forty-six,

was admitted on January 18th, 1886. lias had very
few illnesses, and gives no history of any intestinal
trouble or inflammation; she is married, but has had no
children; she has had one miscarriage. Nearly four years
ago she noticed that she had trouble with her urine,
which she passed frequently and in small quantities, accom¬
panied with great pain. A few weeks later she noticed
faeces in the urine, during micturition the stream would be
stopped by lumps of fasces which came away like pieces of
String. She also notiCed that She passed flattaS pefhrethwun.

During this time she had much difficulty and pain in passing
her motions, which were smaller than normal, never ex¬
ceeding the diameter of the forefinger. The menses became
irregular about six years before admission, and ceased en¬
tirely between four and five years ago. On Dec. 24tb, 1886,
the patient lost a large quantity of blood, the flow com¬
mencing from the vagina and afterwards coming from the
rectum as well; previous to this she had very severe pain in
the lower part ot her body, and a good deal of slimy matter
was passed with the motions. She complains of a good deal
of pain in her back and loins. She has lost flesh considerably
of late, and cannot sleep well owing to pain and having
to get up frequently to pass urine. More faeces pass in the
urine ou straining or taking severe exercise, or when the
bowels have not been open for some time. She says ahe
passes white fibrous-looking lumps in the uriue as well as
fasces. Urine slightly acid; sp. gr. 1018; contains a small
quantity of lithates, albumen, and pus, but no blood or
Bugar.

Jan. 21st.—On examination per vaginam, the uterus is
found to be fixed and slightly Hexed forwards. On exami¬
nation per rectum, nothing very definite can be reached
by the finger, but it seems to just reach a hardish, nodular,
movable mass.

27th.—She is quite certain that fasces are still passed per
vaginam, but none can be found in the urine.

29th.—The patient complains of very severe headache,
with occasional shivering tits and sore-throat. Five grains
of quinine were given.

Feb. 3rd.—With the aid of the microscope numerous pus-
cells and some epithelial cells can be seen in the urine, which
has & distinctly fiscal smell.

11th.—Condition of urine not improved.

12th.—Chloroform having been given, Mr. Bryant made
an oblique incision three inches in length and about two
inches and a half above the crest of the ilium on the left side,
dividing fat and muscles down to the transversalis fascia. The
bleeding was then stopped by twisting afewsmall vessels. The
bowel was then inflated with air, and on dividing the faecia
a large coil of bowel presented through the wound. This
was fixed there by passing two long hare-lip pins through
the integuments below, transfixing the colon through rather
more than half its diameter, and passing out through the
integuments above the wound; the bowel was not opened.
The posterior end of the wound was then closed by two bilk
sutures, and the whole dressed with iodoform gauze and
terebene oil.

13th.—A grain of opium was given last night. The
patient was sick several times after the operation. She
complains of a good deal of pain around the wound. The
discharge had soaked through the dressings, which were
renewed. Fomentations over abdomen, containing eqnal
parts of tincture of opium and belladonna liniment.

15th.—The pain was less and the fomentations discon¬
tinued. Wound looking well; dressed to-day. Urine still
contains pus. Patient has passed flatus aud faecal matter
since the operation.

17th.—The bowel was opened to-day with a tenotomy
knife. The patient experienced no pain then nor later when
the needles were withdrawn.

20tb.—The patient complains of flatus still coming per
vaginam when ahe passes urine.

March 1st.—Nearly clear-coloured urine; a deposit of
mucus; only a trace of albumen; very few pus-cells.

3rd.—Flatus has not passed through the vagina since last
week, but there is still a little discharge per anum.

11th.—There is a red circular area around the aperture of
the wound, about an inch wide from its circumference to its
edge.

15th.—The redness-has entirely disappeared.

On the 17th there was some pain during micturition.
Flatus and ftecal matter had ceased to pass per vaginam.
A colotomy belt was ordered on the 22nd, and she left much
improved ou the 31st. Her last report three months ago
was satisfactory.

Malignant growth of pelvis (sarcoma?) involving rectum;
colotomy. (From notes by Messrs. Bindley and C. J. Fuller.)

C. L-, aged twenty-six, a clerk, was admitted on

May 21st, 1885. The patient states that bis father died of
dropsy and his mother of c&ncer. Has one brother and
three sisters; one of his sisters was operated upon by'
Mr. Bryant for periosteal sarcoma of the lower jaw fifteen
years ago. He en joyed fairly good health until May of last
year; he then suffered from hsemorrhoids for two or three

Digitized by GoOgle

Thb Lancbt,]

HOSPITAL MEDICINE AND SURGERY.

[April 23,1887. 823

months. Since Christmas be has had diarrhtea badly. During
the last two or three days he says that he has felt a burning
pain at the anus, and that mucus and blood have passed.

Examination on admission. —On examination per rectum
the anus was found to be unduly patent; in front of
the rectum, in about the situation of the prostate and
base of bladder, was felt a firm, smooth, hard, painless
mass, encroaching upon the calibre of the gut, but not
completely obstructing it. On passing the finger towards
the left side this mass was found to be continuous
with a similar mass filling up the left side of the
pelvis, and apparently firmly attached to the left ischium.
Behind the rectum the concavity of the sacrum could be
felt apparently quite free. On passing to the right side of
the central mass the pelvis was found to be occupied in the
same manner as the left side, but to a less extent, and, upon
pressing upwards with the finger here, tenderness was
elicited. The rectum was found to contain liquid strong-
smelling faeces, but no blood; one or two small solid portions
■of faeoes were also felt; further, from the wall of the rectum
small pedunculated soft masses about the size of small
grapes could be felt; the interior of the bowel otherwise was
•quite smooth, the abdomen was slightly distended, and a
hard, irregular, painless mass, dimpling on pressure and
apparently faecal, could be felt in the left iliac region; there
was a little gurgling, too, on palpation.

May 22nd.—To have a grain of opium every six hours.

26th.—The patient having been prepared and anaesthetised,
an incision about two inches and a half long was made half¬
way between the last rib and the crest of the ilium, the
muscles and fasciss cut through, and all bleeding arrested.
Mr. Bryant then introduced his finger and felt the kidney
with tne bowel in front of it; this was difficult to bring to
the front on account of the great number of adhesions; it
was, however, inflated and brought out, when it was found
to be of the normal thickness of wall. On this account,
instead of being put through the bowel, the stitches were
introduced, one towards the front through an appendix
epiploica and three on the other side through a transverse
band. The wound was then stitched up on each side of the
bowel, a piece of which, to the extent of about an inch and
a half, was left protruding. The wound was then dressed
with oiled lint and padded up with iodoform gauze, and the
patient put carefully to bed.

27th.—The patient feels very comfortable, only a slight
tightness across the abdomen. Urine acid; sp. gr. 1025; no
albumen. Morning temperature 102°.

28th.—Was sick last evening and in the night; he
cannot keep down his iced milk; no pain in abdomen or
wound. Morning temperature 100 - 4°. The opium pills were
repeated. Sedative bismuth mixture ordered three times a
day, and port wine, barley-water, milk, and lime-water
allowed.

29th.—He was very sick early this morning, but this has
ceased; he lies with his hands clasped over his head.
Respiration chiefly thoracic; the abdomen, however, moves
elightly. He complains of tenderness over the epigastrium,
and a griping pain as soon as he takes anything to eat or
drink. Around the wound there is a slight red blush ; has
suffered much from hiccough. Pulse 92, fair volume. Com¬
plains of a feeling as if the abdomen was being screwed up.
He is now taking a little weak brandy-and-water.

30th.—Wound dressed to-day. There is a little discharge.
The stitches were not taken out. Has had no hiccough last
night Or to-day. Respiration thoracic.

J une 1st.—Bowel protruding nicely from wound; granula¬
ting healthily. One stitch was removed on each side, and the
bowel opened with a small narrow scalpel. No anaesthetic
was given, and the patient felt nothing of the operation.
The handle of a scalpel was then introduced, and some
portions of light-coloured faeces were removed.

6th.—Patient seems comfortable,; there is still a great
deal of discharge.

19th.—Wound again dressed; there is still some discharge
both from the anus and the colotomy opening.

July 28th.—Patient discharged.

In July, 1886, this patient was comfortable, and there was
not much evidence of the local disease having progressed.
The Sister of the ward has just heard of his death.

Syphilitic necrosis of tibia: fracture at this spot; ssques-
trotomy. (From notes by Messrs. Deane and D. J. Jones.)—

A B-, aged fifty-three, was admitted on Oct. 28tb r

1885. Five years ago an ulcer appeared in the upper j
part of the sternum, whieh broke and then healed ui>: 1

soon afterwards she had an ulcer on the left shoulder,
which was soon cured ; six months later she had a tumour
on the dorsum of the tongue. The tumour dissappeared,
under treatment; but she continued to take the medicine
for some months. About two years ago two ulcers came on
the front of the leg, one above the other, midway between
the knee and the ankle. She applied a lotion. In a short
time the two ulcers joined, and they have been getting
deeper since. Last week she got up from a chair to walk
across the room; as 6he did so, she felt something in her
leg crack, and was unable to walk a step.

On admission there was great enlargement of the left leg
beneath an old ulcer; above and below the ulcer the skin
was clearly defined, dipping down along the margin of the
ulcer; there was a mass of black necrosed bone at the bottom
of it. The bone was broken completely across at the seat of
necrosis. There were scars of old ulcers on the sternum and
left clavicle, and slight scarring on the soft palate and
pillars of the fauces. Urine normal.

On Oct. 31st Mr. Bryant enlarged the wound, and, finding
the sequestrum loose, he removed it in two pieces. The
cavity left was found lined with granulation tissue, whieh was
wiped away; the lower end of the upper fragment of broken
tibia wa9 also freshened by chiselling off a small portion.
The antero-external surface was quite black from exposure,
and hollowed out from gradual disintegration of its sub¬
stance. Elsewhere the surface of the sequestrum was
irregular and worm-eaten. There was very little pro¬
duction of new bone in the neighbourhood of the seques¬
trum. It was two inches and a quarter long, and the
antero-external surface was one inch in breadth. The limb
was put up in a posterior and two-side splint, as in a simple
fracture.

Dec. 7th.—Wound dressed; two small pieces of bone
(compact tissue) taken away.

15th.—Patient would not stay in the hospital, so the leg
was put up in a plaster-of-Paris bandage, a window being
cut in tho bandage so that the wound might be dressed.
There seemed to be firm bony union between the two ends,
and the granulations were healthy-looking. At a later
period the woman reported hereelf as well.

Sinus of right cheek following the impaction of slate pencil
in antrum four years previously; removal of foreign body:
cure. (From nptes by Messrs. Price and J. Aynard.)—
M. C-—, aged sixteen, a pupil teacher, was admitted on
July 16th, 1885. When quite young the patient had several
blows about the cheek; to this her medical attendant
attributes her present complaint. About three years
ago patient’s friends noticed that when she laughed there
was a curious retraction of the skin about two inches
below the right eye. On looking, they found a small bard
lump about the size of a pea, wnich seemed to be attached
to the bone, but evidently was also attached to the more
superficial structures. On consulting a surgeon, she was told
that if the first molar were removed she would probably get
rid of her trouble. After the removal of the tooth cotton¬
wool was placed in the cavity; when this was taken out
next day ft was saturated with discharge; the discharge
continued for a day or two. Seven weeks ago the patient
was operated on. A small elliptical incision was made, and
a lump about the size of a pea with the depressed skin was
removed; the skin was then separated from the muscle
beneath, and the edges of the wound stitched together. On
admission she presented the same appearance as she did
before the operation, the only difference being that the lump
with the depressed skin around was smaller.

Under chloroform Mr. Bryant passed a probe through the
small sinus, and felt what he thought was bone, then
another probe was introduced and held in. The lip was now
everted and pulled up by means of retractors; then the
mucous membrane was divided, and some bone was removed
with a chisel,.and the superficial and deep structures were
separated from the bone right up to the probe. Incisor
forceps were now used to extract what turned out to be the
top oi a slate pencil; several other pieces were removed. A
probe was next introduced where the pencil was taken from,
and a communication with the orbital cavity was found. A
plug of iodoform gauze was then introduced into the hole.
On being asked about the pencil, the patient said that when
quite young she fell down with a pencil in her hand, and it
ran into her cheek.

On July 28th the patient left the hospital, the face being
still swollen. Within two weeks, however, she was quite
well.

824 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Afrit, E$, 1887.

MANCHESTER ROYAL INFIRMARY.

ACUTE TRAUMATIC 8UPPURATIVE OSTEOMYELITIS OF THE
HUMERUS ; EARLY EMPLOYMENT OF THE
TREPHINE ; RECOVERY.

(Under the care of Mr. Thomas Jones.)

For the following notes we are indebted to Messrs.
Walker and Platt.

James C-, aged eleven, a half-timer in a foundry, was

admitted into the infirmary on Nov. 20th, 1886. Father
dead; cause of death unknown. Mother, one sister, and
two brothers living and healthy. The patient himself bears
no indications of any hereditary disease. On Nov. 11th he
fell on his left shoulder. When he got up he was able to
move his arm, and could put his hand on the top of his head.
He had a good deal of pain at the time, and his arm has con¬
tinued to pain him ever since. Next morning he went to
his work, which consists in knocking off the rough pieces
on iron castings with a hammer and chisel; and in the
afternoon he went to school, but whilst there was sick, and
had to go home. The pain was much worse that night, and
three days later a medical man was called in, and on his
advice a mustard plaster was applied to the shoulder, with¬
out any relief. The pain was of a shooting character, and
began to increase in intensity about 6 p.m.

On admission the left shoulder was osdematous and very
hot to the touch ; there was a very tender spot on the inner
side about the coracoid process, and here fluctuation was
very distinct. The whole arm was swollen, tender, and red,
and the subclavicular fossa effaced. Urine: sp. gr. 1020;
alkaline; no albumen; no sugar; deposit of mucus.

On the 22nd the temperature of the right shoulder, taken
by the surface thermometer, was 99°; of the left shoulder, '
102 , 2°. The patient was put under chloroform, and an
incision made on the front of the arm just below the junc¬
tion of the upper epiphysis with the shaft. A considerable j
amount of pus was evacuated, and a piece of rough bone
could be felt with the finger lying immediately to the outer
side of the bicipital groove. A drainage-tube was inserted,
and the wound dressed with iodoform and a wood-wool pad.

During the next three days the wound discharged very
freely, but the temperature continued very irregular; so on
Nov. 26th an exploration was conducted by Mr. Wright, who
found the shaft of the humerus quite separated from its
upper epiphysis. Some counter-openings were made, and
tne cavity syringed out with an antiseptic sublimate
solution (1 in 3000) and drained. There was no improve¬
ment either in the local or general condition, the evening
temperature reaching 102°, and even higher. On the 30th he
complained of a very tender spot on the outer aspect of the
arm, an inch and a half above the external condyle. There
was very little spontaneous pain in the limb, but when
handled intense agony was experienced. The lad at this time
presented a dusky appearance, and had a short distressing
cough and a most rebellious diarrhoea. He was again anaes¬
thetised, and a vertical incision an inch and a half long
made over the tender spot; the incision was carried down
to the bone through infiltrated and cedematous structures,
and the periosteum found to be thickened and easily
stripped off, but there was no pus beneath it. The
bone was then trephined, and about a teaspoonful of pus
escaped, the suppurating medulla being at the same time
exposed. The upper incision previously made was now en¬
larged downwards; the periosteum here was extensively
separated from the bone, but there was no pus between the
two. The trephine was again employed, and the medullary
canal laid open. While this was being done, some thick
pus oozed up into the wound. The medullary tissue between
the two trephine holes was then removed, the canal washed
out with the perchloride solution (1 in 4000), and a drainage-
tube passed through it, its ends projecting from the upper
apd lower Wounds. The same night he complained of
intense pain in his arm, which was being irrigated with
the sublimate solution (1 in 5O0O), but after a subcutaneous
injection of a quarter of a grain of morphia be passed a
very fair night.

The next morning the patient was mnch better; his tem¬
perature fell to normal, and the limb, although stall swollen
and osdematous*was free,from pain unless handled. The
piece of hqna from.the lower trephine hole jras eroded and
eaten Wray 6a fbs inner surface until the pert was
translucent. The pus was evidently making its way at

this spot, which corresponded with an area of intense
tenderness. After the trepanation and clearing o»t of
the medullaiy canal the temperature gradually fell, and
kept down for about a week, except on Dec. 3rd, when
there was a slight rise owing to a block in the
drainage-tube. On Dec. 8tb, the temperature again
began to rise, and the next day the patient was placed
under the influence of chloroform, the drainage-tube
removed, the medullary cavity syringed out, and a piece
of solid rubber catheter placed in the lower sinus. The
temperature continuing to rise on the 11th, the patient was
again put under chloroform, and the upper end of the
diaphysis was discovered to be quite loose, soft, inflamed,
and infiltrated with pus. The epiphysis moved smoothly in
the glenoid cavity, and the latter was apparently quite un¬
affected. The diaphysial extremity had been causing much
annoyance and pain, so about an inch of it was removed.
The wounds were dusted over with iodoform, and the
sublimate irrigation continued, After this operation the
temperature began to fall, and came down nearly to normal.
The medullary canal was syringed out daily, and on the
21st the irrigation was discontinued, the wound beingdnsted
over with iodoform and covered with a wood-wool pad.
The medullary canal soon began to fill up with granulations,
and by Jan. lfkh, 1887, it became impossible to force any fluid
through it. The temperature about this time on more
than one occasion rose to 102°. There was nothing local
to account for it, nor did the lad’s general condition indicate
anything going wrong, it having been steadily improving for
at least ten davs. His appetite was remarkably good, and.
except when the arm was moved, he complained of no pain
whatever. The piece of catheter in the lower opening was
removed on Feb. 1st, and its removal did not occasion any
rise of temperature. The discharge from this sinus steadily
decreased. The granulations in the upper openings were
exuberant and painful when the dressings were renewed.
In the centre of the original opening there remained a
distinct sinus, which led down to some dead bone. On
Feb. 12th he was again anaesthetised, the sinus was enlarged,
and a small sequestrum removed from the upper end of the
diaphysis. The prominent painful granulations were scraped
away at the same tirpe, and the several surfaoes dressed as
before. After this, the patient’s temperature remained
normal, the. arm was dressed every other day, the discharge
visibly diminishing.

The patient left the infirmary on Feb. 26tb, with two
sinuses, the original opening and the trephine-hole still dis¬
charging a little. His condition at the present time is mnch
the same, a small amount of pus escaping from the two •
sinuses. The arm is thicker than its fellow, from the large
amount of new bone which has been formed by the perios¬
teum ; the shoulder and elbow joints are quite movable, and
the boy has more than regained his original state of health..

Remarks by Mr. Jones. —It is not often that cases of
osteomyelitis are seen in hospital practice at this early
stage. The disease was no doubt induced by the injury,
and commenced dose to the upper epiphysial line of the
humerus. . It promptly produced a solution of continuity in
this situation, and at the same time travelled downwards in
the interior of the shaft. This mode of propagation is not
so often observed as the upward, while we see it in the
tibia when the acute affection commences is the upper end
of the diaphysis of this bone. What guided me in the
diagnosis of implication of the interior of the shaft was
the non-appearance of improvement after the persistent
abscess had been freely laid open; the lad maintained
the same dusky aspect, and complained bitterly when¬
ever the arm was touched. I was induced to perforate
the humerus in the spot mentioned by the intensity of
the pain produced by pressure being greater here than
elsewhere; also in other and similar cases I have ob¬
served that Nature made an opening in this situation.
Had we waited long enough, an exit for the suppurating
marrow would have been established here as the condition
of the circle of bone dearly proves. Meanwhile, however, the
acute illness would have continued, and it is very doubtfal
whether the system would have been able to withstand the
strain pat upon it. What 1 did then was to anticipate and
assist Nature in her efforts. It is a-remarkable fact that the
shoulder- joint remained' intact-, throughout, although the
disease was-raging in its immediate vicinity. Indeed, we:
are told that a portion of the epiphysial junction is actually
within the capsule of the scopnlo-humaral artioulatta*
This can scarcely have been the case in this inttanoe.

PATHOLOGICAL SOOIEU OP LONDON.

[Apart 23,11881 82fl

THB'Lanckt,].

otherwise the joint would not have remained so free
from disease. It will be notioed that at the spot where the
humerus was trephined there was no pus between the peri¬
osteum and bone, showing clearly that we ought not to wait
for this before resorting to a perforation. To my mind, the
clinical features of acute osteomyelitis are alone quite suffi¬
cient to warrant us in forming a diagnosis, and when onoe this
is done, it is our duty, and without delay, to perforate the
bone and drain the medullary canal after removing its con¬
tents. Nothing short of this treatment will suffice, and by
adopting it early we should save the patient an immense
amount of suffering, if not from actual death, besides
diminishing the risks of a tedious necrosis. When the acute
process subsides, a chronic change will generally go on for
some considerable period, the bone becoming sclerosed
and leaving unmistakable traces of the disease, which will
have an important influence on its future life history. The
case 1 have narrated is almost the exact counterpart of a
historical case which occurred in the Manchester Infirmary
nearly 120 years ago, and in which Charles White is supposed
to have excised the shoulder-joint, but where in reality he
removed the upper end of the diaphysis, which had become
separated from the epiphysis, the patient recovering with a
movable joint, and where the entire motion of the limb was
preserved. 1 _

Utt&ical Societies.

PATHOLOGICAL SOCIETY OF LONDON.

Congenital Dislocation of Hip. — Disease of Humerus
(1 Osteitis Deformans or Osteomalacia).—Fibrous Meta¬
plasia qf Bone.

, An ordinary meeting of this Society was held on Tuesday
last, Dr. R. Douglas Powell, F.R.C.P., Vice-President, in the
chair.

Mr. A. A. Bowlby showed a specimen of Congenital Dis¬
location of the Hip, removed from a girl aged thirteen who
died in St. Bartholomew’s Hospital from a new growth in
the stomach. She was the first child of the family. The
labour was easy and natural, no interference being necessary.
Nothing was noticed amiss till she began to walk, and lame¬
ness was but slight until about the age of three years. There
was no history of acoident, and none pointing to hip disease.
An examination showed that the head of the right femur
was displaced on to the dorsum ilii. In the position of the
normal acetabulum was a triangular depression, which,
although it evidently represented the acetabulum, was far
too small to have accommodated the head of the bone at any
time. The floor of the depression was covered on its upper
part by cartilage, and its edges were scarcely raised above
the level of the surrounding bone. The upper portion of the
acetabulum, that formed by the ilium or the iliac segment,
was deficient, and the cavity was formed by the junction of
the pubic and sciatic portions. The head of the bone rested
in a depression on the dorsum ilii immediately above the
deformed acetabulum, and was in this situation surrounded
by a fibrous capsule. The ligamentum teres was unde¬
veloped. It is probable that this condition of the acetabulum
is a more frequent cause of congenital dislocation of the hip
than is generally allowed, and there are no good reasons for
believing that such displacements are the result of injury
during parturition.

Mr. Lockwood showed two Foetuses, both of which had ,
Developmental Peculiarities of the Hip-joints. One was a
stillborn; microceptralic foetus at about the full time; it was
the sixth and last child. Its parents were very healthy.
The midwife said that it was born a “ double breech ” pre¬
sentation. The other five children ere alive and healthy. The
thoracic and abdominal viscera of the foetus were normal.
The Skull was very bony and microeepbalic, and the spine
bad a very well-marked lateral curvature. The brain only
piled a small portion of the skull, and had no convolutions :
it looked like a fibrous vascular bag. The cerebellum was
exceedingly deficient and had the . same appearance. The
spinal cord was unusually thin, and reached as far as the
lumbar region. The fingers were crumpled up into tbo

1 of this case were read before the Royal Society on

*“»• 179®, and are recorded In C. White’s ‘’Cases In Surgery."

mo, p. 67.

palms of both hands, and the feet were in the position
of talipes varus; moreover, the legs assumed a crossed
position. The hip-joint possessed. no rim, and was merely
a shallow hollow. The head of the femur was not dis¬
placed. Mr. Lockwood thought that since the brain and spinal
cord of this fcetus were so decidedly abnormal, and since
the organs of volition were affected, and not the viscera,
there was therefore some association between the two sets
of conditions. The various histological specimens of the
embryo ebowed that the margin of the acetabulum was formed
in cartilage before the second month of intra-uterine life.
This process seemed to have failed in this case. The second
foetus was bom of healthy country parents. It was nab
the first child. It was delivered by Mr. Allen, who says
that it was a breech presentation. After birth the legs had
a curious tendency to remain Hexed upon the abdomen.
The foetus had ectopia of the abdomen, with protrusion of
the liver and intestines. In other respects the viscera of
the cheat and abdomen were quite natural. The brain and
spinal cord were well grown and normal. The hands were
flexed upon the arms to a right angle, and upon the right
side there was no thumb, and upon the left a very rudi¬
mentary one. The head of the right radius was dislocated
upon the front of the bunwrue. The margins-of both
ace tabula were deficient, and the heads of the femora, instead-
of lying in their usual place, were dieplaoed upon the dorsum
of the ilium. Mr. Lockwood thought that in this case the
absence of the margin of the acetabulum had predisposed
to the dislocation, and the muscles had, daring intra-uterine
life, drawn the head of the femur upwards. The cnees were
compared with ordinary eases of congenital dislocation of
the hip, and it was argued that the cases which went by
t hat name were seldom, or perhaps never, traumatic, but
due to developmental effects. He thought that in intra¬
uterine life physiological movements of the limbs were an
essential element in the proper development of joints.

Mr. W. Adams exhibited two dried specimens from the
museum of the College of Surgeons which belonged, in
Professor Stewart’s opinion, and in his own, to the class of
Congenital Displacements of the Hip. Mr. Bbwlby’s case was,
Mr. Adams said, of special importance, because it was acoomr
panied by a. trustworthy history, which was absent in all the
other specimens in London, with one exception, which was
that shown by Mr. Morgan. This specimen bold been shown
to the Westminster Medical Society by the late Mr. Edwin
Canton (London Medical Gazette, N.S., 1848, vol. vi., p. 559)
as an example of “ oongenital dislocation of both hip-
joints. - ’ As the specimens exhibited proved, the head of the
femur in these cases was displaced in various directions,
directly upwards, upwards and forwards, upwards and back¬
wards towards the sciatic notch, or on the centre of the
dorsum ilii. All the epeeimene agreed in showing no trace
of disease; but, on tne other hand, the innominate bone
was evidently congenitally deformed. The acetabulum
was represented wily by a flattened triangular depres¬
sion, the base of whioh was formed by the border of the t
obturator foramen; while the apex corresponded to a point
a little above that which should represent the centre of
the acetabulum if that oavity were present. The upper half
of the prominent border of the acetabulum, which should
naturally be formed by the ilium, wts entirely absent; so
that there was nothing to prevent the bead of the femur
passing upwards on to the dorsum ilii when the weight of
the body was thrown on the limb. In all these specimens
the lower part Of the innominate bone was Harrowed and
elongated; the ischial tuberosity was everted, and its ramua,
twisted; the head of the femur was smaller than natural,
generally flattened behind and below, but covered with
healthy articular cartilage; the round ligament was occa¬
sionally present, being greatly elongated ; and the bead of
the femur remained within the capsule ligament, whioh was
not only elongated, but thickened. The collbotion of speci¬
mens would help to dispel several errors; for it would be
seen that the condition was really a consecutive displace- >
ment of the femur resulting from a congenital deficiency of
the acetabulum, rather than a true dislocation. Two
practical results were the outcome of these viewB. In
the first place, the accoucheur must be freed from all:

S ble blame in producing the displacement or so-
i dislocation; and, secondly, the practice of dividing
lendoas of the glutei and rotator muscles must be
condemned ae an irrational and ■useless procedure. .

-Mr. J. IT. Mona an exhibited a specimen from the Gbaring-
croes Hospital museum, whio’x was of historical os well as

828 Thb Lancet,]

PATHOLOGICAL SOCIETY OP LONDON.

[April 28,1887.

pathological interest, as being the first specimen illustrating In early arthritis the ultimate changes were different from
the condition of parts found in congenital dislocation of the those found later in life. The power of formation of oon-
hip. It was exhibited to the Westminster Medical Society nective tissue was so great that union and healing might go
in March, 1848, by Mr. Canton. The patient was a female, on to a surprising extent, so that we might hardly suppose
aged thirty-two, who Was affected in both hips She died that an inflammation had ever been present. In cases of
fourteen days after giving birth to a living child at full term, extensive bone lesions resulting from syphilis, the signs of
Examination of one hip only was permitted. The body and actual inflammation might be very slight after the lapse
upper limbs were well formed, whilst the lower extremities of some time. We should not expect the final results
were somewhat atrophied. The head and neck of the femur of inflammatory disease in early life to show the same
were found on the dorsum ilii, the former having passed signs of destruction and caries as would be found in disease
beneath the small external rotators, whilst a large bursa occurring in later life. In cases of dislocation occurring
existed between the latter and the capsular ligament which during fevers, without abscess, the anatomical appearances
immediately covered the former like a hood. This ligament might be somewhat like those found in the congenital dis-
preserved its natural connexions, but was considerably location of the hip.

elongated, thickened, and strongly fortified with supple- Mr. R. Barwell considered that by far the greater
mental bands at its upper part. The head of the bone was number of congenital dislocations were due to malformation
coated by a bluish film of cartilage, which was continued of the acetabulum, and a few to malformation of the head of
over a superficial impression, marking the site of the pit the femur. He said that in some cases division of muscles
fortheligamentum teres, which wasnotpresent. The portion could effect considerable improvements,
of the dorsum ilii played upon by the femur was smoother Mr. Edmcnd Owen had seen a case of breech presen-
than natural. The acetabulum was triangular in form, the tation with congenital dislocation, in which neither the
base directed outwards; the height one inch, the breadth midwife nor the doctor had arrived before parturition. He
half an inch; the cavity was nearly filled with fat. Mr. did not think the condition of the hip-joint was a dis-
Morgan remarked that although specimens exhibited that location, but was due to the faulty position described by
evening placed it beyond doubt that in some cases an Mr. Shattock.

erroneous development of the acetabulum occurred, and the Mr. Bowlby said that cases due to previous inflammation
head of the femur was thus forced to make for itself a were separable from cases of so-called congenital dislocation,
socket upon the dorsum ilii, he believed that there were Mr. J. R. Lunn showed a specimen of an obscure form of
other cases in which inflammation of the synovial membrane disease affecting the Humerus of a man aged eighty-six.
occurring at or soon after birth, rupture of the ligamentum Three months before his death it was noticed that the right
teres took place, and the femur was pushed out of the arm was becoming curved outwards and was tender; no
acetabulum, and drawn up on to the ilium. The appear- other bones were affected. There was no history of syphilis,
ances in the specimen which he exhibited were quite com- gout, or rheumatism. The bone, when examined after death,
patible with this view. He . had had an opportunity of was curved obtusely about the middle; the thickening was
seeing this condition in a case under Dr. Barlow at the greatest where the bone was most curved, the bone regain-
Hospital for Sick Children in Great Ormond-street, where ing its normal dimensions at the ends. The bone was
the femur became dislocated in the course of rheumatic softened, the medullary canal at the curvature narrowed,
fever; and on cutting down upon it, the bead of the femur and the cancellous tissue at this point tough and compact,
was found thus displaced, covered by the stretched but The shaft above was rarefied, and the cancellous tissue within
unaltered capsule, and forming for itself a new cavity, the tuberosity and neck deficient, the enlarged portion of
in which it rotated. The acetabulum was filled to a the medullary canal being filled with fat. Mr. Shattock
level with its margin by granulation tissue. In two found that the curved portion of the bone showed, on micro-
cases which had lately come under his observation, scopical section, well-formed osseous trabecul®, including a
presenting all the clinical features of congenital dislo- vascular connective tissue; in parts, large osteoclasts lay
cation, he had detected the marks of small abscesses, which against the trabeculse, and there was abundant evidence
very possibly had resulted from some such course of events, that these had been altered in direction. In most of the
Mr. Shattock said that his specimen was precisely like spaces ossification was in active progress, and in places
that of Mr. Bowlby’s. 'In Mr. Lockwood’s specimens there “brushes” of stiff osteogenic fibres spread into the new
was evidence of a strict intra-uterine malposition. He had bone as “perforating fibres.” New bone was also in prooese
dissected cases of what Volkmann called “ genu recurvatum,” of formation in a dense, fibrous, connective tissue in the
in which the knee was over-extended. In a healthy indivi- deeper layer of the periosteum. Mr. Lunn, after commenting
dual either the hamstrings must rupture or a subluxation of on the difficulty of diagnosis and the improbability that it
the hip would occur if this faulty position were assumed. could be classed with osteitis deformans, owing to the fact
Mr. D’Arcy Power showed an ancient specimen, said to that only one bone was implicated, expressed the opinion,
have belonged to Mr. Stanley, 1834, who had presented it to founded on the microscopical appearance, that the case was
the museum of St. Bartholomew’s Hospital. an example of osteo-malacia affecting a single bone.

Mr. Howard Marsh said it was still doubtful whether Mr. Shattock read a note on Fibrous Metaplasia of
the dislocation of the hip might not be due to injury during Bone. He showed macroscopical and microscopical speci-
labour. Mention was made of a case of back presentation, mens of the femora of well-known cases of oeteo-
in which the dislocation might have been due to violence malacia; Howship’s, from the Royal College of Surgeons;
during delivery. He did not think that such violence was and Solly’s, from St. Thomas’s Hospital museum. Neither
the usual cause of this “congenital dislocation.” The of these had been previously examined by the ordinary
condition doubtless varied slightly in different cases. As a histological methods now in use. That the rarefaction
rule, the joint appeared to be rudimentary, so far as it could was not due to osteitis was proved to the naked eye
be ascertained by external examination. Dupuytren had by there being no trace of osteo-plastic periostitis; and
put hereditary cases on record. He mentioned a case in microscopically the evidence was still mom weighty; for
which the mother was similarly affected. This supported there was no hypersemia, and any small-celled infiltra-
the view that an original defect must have been transmitted, tion was entirely absent. Moreover, in both cases the
Dr. T. Barlow supported the contention that some cases' disease was progressing at the time of death, and caused
might be inflammatory in their origin. He referred to death at the ages of thirty-five and thirty-nine. The
the case of a child one month old, in which there was specimens showed all stages of a direct conversion of the
a purulent swelling over the buttock, with considerable, osseous substance into fibrous tissue. As Mr. Savory said,
mobility of the hip-joint. Another abscess occurred in' bone was but calcified fibrous tissue. In osteo-malacia the
one of the joints of the foot, and the case was probably; bone was unmade and reconverted into fibrous tissue. In
pycemic. It had many of the characters of a congenital? Howship’s case there was a distinct interval between these
dislocation of the hip; the acetabulum was rudimentary? two processes. In the process there was sometimes to be
and oval in shape, and filled up by solid connective tissueseen the lacunae enlarging and coalescing, as described by
the head of the femur was swollen and spongy. Thd Durham in the Guy’s Hospital Reports. The decalcified
capsule was vary large. The abscess communicated with the matrix, by its fibrillation, was converted into fibrous tissue,
hip-joint. There was no sign of ulceration or caries, and Mr. The connective tissue might become replaced by fat from
Barker believed the abscess wee secondary to the condition of infiltration of its corpuscles, and so there was, as Sir James
the joint. A eosiuriAt«erf4he Pathological iJocisty. contended Paget had described, a fatty degeneration. The term dege-
thafcdt was abase of early arthritis Which produced the condi- neration usually indicated that the tissue lost all Its
tion Of the aCetabtdom founw Heaeaher suppor’ • view, physiological functions. When one physiological tissue

Tub Lancet,]

MEDICAL SOCIETY OF LONDON.

[April 23,1887. 827

results from another physiological tissue the process should
be termed, after Virchow, “metaplasia,” ratherthan degenera¬
tion. In museum preparations the spirit often had an acid
reaction. In one case of spina bifida, amongst other acids,
sarcolactic acid was found by Dr. Bernays, and probably
resulted from muscular tissue. The presence of this acid
might lead to a certain degree of decalciftcation, and prove
a serious source of fallacy.

Dr. A. II. Robinson showed the Calvaria and one of the
Clavicles from a case of Osteitis Deformans. A large sarco¬
matous tumour connected with the left lobe of the cere¬
bellum, removed from the same case, was also shown. The
P&tient was a clerk, aged fifty-two. lie had never been
intemperate, nor had he suffered from rheumatism or
syphilis. There was no history of cancer in his family; his
twin-brother died an imbecile. lie was father of a family
of ten children, his wife having had no miscarriages. Two
of the children died of scarlatinal dropsy, at ei*iht years of
age, and were said to have very large heads, resembling in
form their father’s. One of the patient’s brothers died at
the same age, and suffered similarly, his limbs being much
distorted. The patient’s symptoms dated back ten years,
beginning with pain in the back and weakness in the lower
limbs, nis left tibia was the first bone observed to be
enlarged, and the head afterwards began to enlarge rapidly.
The right femur and humerus then became thickened to
almost double their normal diameter; for some months prior
to his "Meath, which occurred quite suddenly, he was bed¬
ridden. At the necropsy the left side of the heart was found
to be hypertrophied, ana the right dilated, the organ weigh¬
ing fourteen ounce?. There was no valvular lesion. The
lateral ventricles were distended with serous fluid. To the
left lobe of the cerebellum a large round-celled sarcoma was
found adherent, probably springing from the membranes.
There were no growths elsewhere in the body. The section
of the skuU showed hypertrophy, chiefly on the right side
and in the occipital region, with complete obliteration of
the sutures and disappearance of the diploe. A portion of
the outer table was removed at the vertex, and showed a
condition of rarefaction beneath. The thickening of the
clavicle was confined to the inner two-thirds of the bone.—
Mr. D’Arcy Power said there was no thickening of the
medullary canal, and considered that the specimen shown
by Mr. Lunn was one of osteo-malacia, not osteitis
deformans.—Mr. Macnamara said that there were different
classes of osteo-malacia, as, e.g., those occurring in preg¬
nancy and the specimens presented to the meeting. In some
specimens there were evidences of distinct sarcomatous
tissue which filled the medullary spaces. In cases of
rheumatic arthritis the bony trabeculrc may simply have
disappeared, owing to deficient activity of the osteo¬
blasts, which allowed only of the formation of fibrous tissue.
In osteo-malacia there was progressing softening, but in
osteitis deformans a hardening and thickening process
occurred also.—Mr. Lunn, in reply, agreed that there must
be a softening stage as well os a thickening one.

The followmg card specimens were shown:—Mr. Lock-
wood : Development of the Hip. Mr. Adamp, Mr. Morgan,
and Mr. Shattock: Drawings of Congenital Dislocation of
the Hip. Mr. K. H. Fenwick: Tumour of the Bladder.
Dr. Willcocks: Congenital Malformation of the Heart. Mr.
Shattock: Tubercular Disease of the Skin. Dr. Dakin:
Atrophied Kidney and Dilated Ureter from a female child
aged two. Dr. Colcott Fox: Infantile Scurvy.

MEDICAL SOCIETY OF LONDON.

Treatment of Tlcemorrhagefrom the Tongue.—Catheter and
Calculi removed by Lithotrity. — Itenal Sarcoma in
Infancy; is Surgery justifiable f
An ordinary meeting of this Society was held on Monday
ast. Dr. Hughlings Jackson, F.R.S., President, in the chair.

Mr. Lockwood read a paper on a mode of restraining
Hsemorrhage daring Operations upon the Tongue. After
speaking of the serious nature of that accident-, the various
plans which had been devised to prevent it were mentioned.
None of these seemed to be quite free from objection,
although all were more or less efficacious. After discussing
the anatomy of the lingual artery, it was concluded that, at
the place where the vessel lay upon the side of the pharynx
near the greater cornu of the hyoid bone, the depth of
tissues was so small that there could be no difficulty in

compressing the vessel. The great constancy of the course
of the vessel lent itself to this proposal. Forceps were then
described which had been devised after a great many experi¬
ments upon the dead body. These instruments were quite
efficient in preventing the passage of thin injection through
the lingual artery. They were so arranged that one blade
passed by the side of the tongue into the pharynx, whilst
the other wae bent to fit the contour of the lower jaw and
meet the other near the tip of the greater cornu of the
hyoid bone. Dissections had been made after the forceps
had been adjusted which showed that the artery was tightly
grasped and impermeable. A case was then described in whicn
Mr. Lockwood had removed half the tongue whilst the forceps
were i n posit ion. The tongue was split do wn the median septum
and then removed with scissors. The lingual artery did not
pulsate or bleed, and the operation was rapid and blood¬
less. Other cases were then described in which Mr. Willett
had used the forceps ; and, in conclusion, it was thought that
there was a sufficient amount of evidence to show that the
lingual artery might be easily and safely compressed.—
Mr. F. Bowrkman Jessktt thought that in limited disease
of the tongue the forceps would be unnecessary, and when
the glands were infiltrated the lingual artery should be
ligatured os a preliminary. In such cases the instrument
would be in the way.—Mr. Marmadukb Shbtld said in
rare cases of accidental wound of the posterior part of the
tongue the instrument might be applicable.—Mr. Spencer
Watson thought there would be no difficulty in applying
the instrument to any jaw.—Mr. Boycb Barrow thought
ligature preferable to compression of the artery.—Mr. W.
Pye referred to the feeble power of the forceps.—Mr. Lock-
wood said that the ideal was to get cancer of the tongue so
early that neither the whole of the tongue nor the sub¬
maxillary glands shonid require removal.

Mr. H. H. Clutton read a case of Catheter and Calculi
removed by Lithotrity from a man aged twenty-nine, a groom
by occupation, who was sent to Mr. Clutton by Mr. John
Powell of Weybndge in September, 1886, on account of the
following symptoms. Ten weeks previously a kick from a
horse had ruptured his urethra. He was treated in a
country hospital by a catheter tied into his bladder, and left
in three weeks with the wound healed. He subsequently
sent for Mr. Powell on account of the occasional passage of
small calculi and inability to pass water. In using the
catheter for his relief Mr. Powell found a calculus in his
urethra and thought he felt another in his bladder. On
admission into St. Thomas’s Hospital he was found to have
a fistula at the peno-scrotal angle, a stricture of his urethra,
and a calculus in both places indicated by.Mr. Powell. Under
ether the stricture was dilated by Otis’s urethrotome and a
lithotrite introduced. During the manipulation small pieces
of a black French catheter were found adhering to
the jaws of the lithotrite, and eventually the fragments of
a catheter, thirteen inches in length, were removed.
The mftn lost all his bladder symptoms, and left the hospital
perfectly well. He had, however, a small fragment in the
urethra in a pouch behind the stricture, bnt he would not
allow a second operation. Three months afterwards he
reported himself as so well that he would scarcely permit
an examination to he made. On further questioning after
the operation, he gave the following history. One night in
the country hospital, after a small catheter had been tied
into his bladder, he was sitting on a bed pan and suddenly
felt a sharp pain in bis bladder as if be had been struck
violently just above the pubes. He called the nurse and
declared that the catheter nad slipped into his bladder. She
assured him this was impossible, and pointed to the bone
end still adhering to the orifice of the urethra. The house-
surgeon next morning, failing to find any evidence of the
catheter, passed a larger one and tied it in. The mechanism
by which a catheter may slip up into the bladder, or so far
into the urethra as to be with difficulty withdrawn, was
discussed.—Mr. E. H. Fenwick had had three cases recently
in which the catheter was removed from the bladder by
lithotrity. A case of a foreign body—an ear of wheat—was
mentioned as having got into the bladder per urethram; it
led to a calculus, which was removed supra-pubically.—Mr.
W. Pyk said that good rubber would be unacted upon by
acid or alkaline urine.

Dr. Angel Money made a communication on the subject
of Renal Sarcoma in Infancy, and specially discussed the
question whether surgery was justifiable. He briefly
related four cases that he had observed at the Hospital for
Sick Children. All the cases had the characters of a renal

google

823 The Uncut,] HARVEIAN SOCIETY.—SOCIETY OF MEDICAL OFFICERS OF HEALTH. [April 23,1887.

tumour, and in all the enlargement of the abdomen was the
first clinical sign. Hromaturia occurred in none. All the cases
were females, and the ages ranged between eighteen months
and thirty-four months. The other kidney was unaffected
in each case. One tumour probably began in tissues not
strictly renal. One was evidently of supra-renal origin, and in
this case there was enlargement of the external genitals, on
which an enormous growth of hair had taken place during the
last nine months of the life of a female child aged twenty-one
months at death. All the tumours were large, and abutted
against the diaphragm. There were secondary deposits in
three cases, and in the fourth the mesocolon was infiltrated
as well as the retro-peritoneal glands. Dr. Money gave the
statistics of Leibert from the Jahrbuch fur Kinderheilk.,
Band xxL, p. 276. Of fifty cases, both kidneys were affected
only twice; twenty-six of the cases occurred under the age
of three years. The course of the case was always longer as
the age of the child was greater. A study of recorded cases
in which nephrectomy had been performed seemed to show
that life was not prolonged, even in the successful cases, and
the statistics proved the dangers that attended the opera¬
tion. So that, in his work on the “ Treatment of Disease in
Children,” he summed up the present situation by saying
that removal of the tumour is useless. Doubtless, if the
tumour were detected when small, a chance for surgery existed,
but, as a rule, the tumour was not discovered till it had reached
a great size and secondary growths were almost inevitable.—
Mr. Mju&madukk Sheild thought they might be removed
if small.—Mr. Bernard Pitts said that the last case might
have been suitable for operation. Cases seen early would
-be favourable for operation.—Dr. Hughlings Jackson asked
what operation would be done.—Mr. F. B. Jbssett said the
- question of diagnosis was the difficulty.—Dr. Angel Money,
in reply, said that so far operation had proved useless, but
he hoped that surgery would show a better record in future,
though this conld only be by the physician’s diagnosing the
cases early. _

HARVEIAN SOCIETY.

The meeting on March 17th was occupied by the con¬
sideration of the subjects of Hereditary Syphilis and
Habitual Constipation in Children.

Caseof Hereditary Syphilis,—-The President (Mr. Edmund
Owen) showed a girl aged fifteen years, the subject of
hereditary syphilis. She had first come under hie care ten
years ago, when she had an ulcerated gumma in the groin,
and ulceration and sloughing of the soft palate and tonsils.
She was then also the subject of symmetrical deafness of
corneitis, and of inflammation of the upper epiphysis of
each ulna and tibia. It was then ascertained that, when
six months old, she had undergone a course of treatment by
grey powders. Mr. Owen prescribed three-grain doses of
•iodide of potassium in plenty of water three times a day,
under which treatment all the symptoms rapidly cleared up.
A year later the child was again brought with an ulceration
of the tonsil, which quickly yielded to the iodide; she had
also periostitis of the shaft of the ulna, which ended in
suppuration and in the exfoliation of a surface layer of. the
bone, which was shed in the quiet way so characteristic of
syphilitic necrosis in childhood. After eight years’ absence
the child was again brought with chronic diffuse osteitis of
each tibia, which had determined not only great thickening
ot the bone, but also a lengthening. This latter was to be
explained by chronic inflammation in the cartilages con¬
necting the shaft of the tibia with the epiphysis. There
was also ulceration of the skin over the shins. The child
was kept in bed, and every night was rubbed with blue
ointment afte* having a hot bath; under this treatment she
was rapidly improving. Mr. 0 wen also called attention to
the scars at the angles of the mouth, to the large, square
. forehead, and to the teeth; the left central incisor was
notched, and the oentral incisors were sloping towards each
other. ii

Habitual Constipation in Children and the Methods of
, Treatment.—-Dt. Day read a paper on this subject. Most
cases, he said, are due to (1) a sluggish state of the
muscular ooat of the intestine: (2) to a diminution of
secretion from the mucous membrane or the liver;
and (3) to improper dietary. Children are variously affected
by! constipation; the bilious and plethoric require a daily
l evacuation; or thia health. 1 suffers; whilst. toe neurotic;

eating similar food, may have no evacuation for days
together without inconvenience. Prolonged constipation Is
apt to lead to disease of the caecum, chronic inflammation and
thickening of the intestinal walls, dilatation of the tube, ami
occasionally perforation of the gut. Highly nutritious food,
by not furnishing any residuum to be carried into the
intestines, is conducive to constipation. In treatment, the
author referred to the importance of bringing about regu¬
lar action of the bowels by the child making a voluntary
effort every morning, whether the desire be preseat or
not. He next referred to the value of enemata when
the colon was torpid and the rectum blocked, and of
proper diet in the constipation of young children. Among
drugs, strychnia and belladonna, by Imparting tone to
the bowels, relieving spasm, and lessening flatulence,
were advocated. Nitric acid in some cases of chronic con¬
stipation was recommended. The author dwelt at some
length on the great efficacy of an occasional mercurial
purgative in constipation from deficient secretion of bile.
Children bear an occasional dose of mercury remarkably
well, but if repeated too frequently it causes lassitude,
pallor of the face, softness of muscle, and irritability of
temper. He spoke of its danger in the constipation of
strumous and nckety children. Saline aperients were some¬
times useful in children of full habit. Chance of air and
exercise were recommended as calculated to assist the viscera
in the performance of their functions. Massage he considered
a powerful remedy in chronic constipation, and if conducted
by a competent person the process was pleasant and soothing
to the child. Attention to diet was of primary importance.—
The President called attention to the importance of
making a digital examination in all cases of chronic con¬
stipation, and quoted a case where such an investigation
led to the discovery of congenital deformity of the bowel.—
Mr. Cripps Lawrence remarked on the treatment of
typhlitis due to chronic constipation.—Dr. Jelly referred to
the value of massage as a therapeutic agent.—Dr. Alderson
remarked on the value of mercurial treatment in the case of
bilious children.—Dr. Walter Pearce considered that
constipation in some cases depended on the child avoiding
stool, owing to the pain produced by soreness of the anus
consequent on the irritation of thread worms.—Dr. Sydney
Phillips agreed that aperients should not be lightly used;
tubercularperitonitis, obstruction from concretion, &o.,had to
be carefully considered. In many cases there was a deficient
formation of bile; the stools were pale, hard, and scybalous
in these children, and the administration of acids and
calomel was called for. In many cases the small intestine
was at fault and not the large, and it was necessary to
decide if possible where the fault lay. The combination of
aloes and belladonna was most valuable.—Dr. Day briefly
replied. _ .,

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

Coal Gas as a Cause of Sore-throat.

At the meeting on April 15th, Dr. Alfred Hill, president,
and subsequently Dr. Dudfield, vice-president, in the chair,

Professor Corfield read a paper on Outbreaks of Sore-
throats caused by slight escapes of Coal Gas, of which
the following is an abstract. He pointed out that in con¬
sidering the deleterious effects of escapes of coal gas into
dwelling rooms, attention has hitherto been almost entirely
directed to cases of poisoning by asphyxia produced by
such escapes—asphyxia Which has been shown to be due to
the carbonic oxide contained in the coal gas. He referred
at some length to the interesting recent investigations of
Professors W. T. Sedgwick and W. Ripley Nichols, of the
Massachusetts Institute of Technology in connexion with
the relative poisonous effects of coal and water gas, but
these investigators only refer to effects produced by the
carbonic oxide, and indeed conclude that “it is -pro¬
bably true that oarbonie oxide is the only component of
illuminating gas whose poisonous qualities are at present
of practical importance to the public health.” Michtl
L6vy, in his treatise on Hygiene, suggests that some of
the effects produced on persons working in atmospheres
charged with the products of combustion of coal gas may
be due to uncousumed substances, such as the sulphite of
carbon, but the author has been unable to find any account
of definite illnesses produced by continuous slight eecuMB
of coal gas from defective burners or joints in pipes, I)r.

Digitized by GoOgle

CAMBRIDGE MEDICAL SOCIETY.

The Lancet,]

Corfleld then stated that during the past few years his
attention has been gradually arrested by cases of illness,
and more especially of relaxed, and even of ulcerated, sore-
throats occurring in persons sleeping in rooms in which there
were defective gas burners or pipes, but living iu houses of
which the sanitary condition was otherwise as perfect as
the application of modern sanitary knowledge could make
it. That the slight escapes of gas were the cause of the
sore-throats was proved by the fact that the persons
attacked became quite well on the defects in the gas
burners or pipes bting remedied, and that no other cases
occurred. The following are some of the more remarkable
cases which he described. In 1884 Dr. Corfleld was sum¬
moned to a large country house, where the sanitary
arrangements had been put into order under his own
direction. On inspection, no escape whatever was found
either from the drains or soil-pipes into the house. A slight
escape of gas was noticed from a bnmer in the bedroom, in
which the first case of sore-throat occurred, but this was
not at the time thought to have anything to do with the
matter, more especially as a nuisance had been created in the
neighbourhood of that room by an earth-closet which the
men-servants had brought in from outside and had used
without properly supplying it with earth. However, after
the removal of this nuisance, several more cases of severe
ulcerated sore-throat occurred, some being those of visitors
who successively slept in a particular room. • On investigat¬
ing the matter further, the author, who himself slept a night
in that room, found a very evident escape of gas from one
of the brackets there, the gas having, moreover, a very foul
smell from being insufficiently purified. An examination
was then made of the gas brackets all over the house, and
other escapes were found. These were all remedied, and no
cases of sore-throat have occurred since. At another house
in London a similar outbreak of sore-throats took place on
the return of the family after the summer outing. Slight
escapes of coal gas were found in the rooms in which
the persons who were attacked slept. These were
remedied, and there have been no more cases of sore-throat.
Several other similar cases were described by Dr. Corfleld,
who ended by saying that he himself had personally suffered
in a similar manner from a slight escape of gas from a de¬
fective pipe in his own bedroom. He also pointed out that
coal gas may get into houses through the basement, floor,
and even up through the walls, especially behind panelling
from defective mains in the streets. He bad no doubt that
the cause of the sore-throats was the breathing for weeks or
months, especially at night, of air contaminated with a small
proportion of coal gas, and he believed that the effective
agents in producing the irritation in the throat were the
bisulphide of carbon and other sulphur compounds in the
gas.—In the discussion which followed, Dr. Sykes, Messrs.
Wynter Blytb, Rogers Field, Butterfield, and Shirley
Murphy took part. ________

CAMBRIDGE MEDICAL SOCIETY.

At the meeting on March 4th the following communica¬
tions were made.

Intussusception of the Bowel; Abdominal Section; Re¬
covery.— Mr. Street read the case of a boy aged three years,
admitted into Addenbrooke’s Hospital, under Mr. Carver, on
Jan. 20tb, 1887. There bad been pain, vomiting, and partial
obttrnetion for four weeks, and complete obstruction for
thro® weeks. The abdomen was opened on the day of ad¬
mission, and the intussusception reduoed. The patient
discharged cured, the bowels acting regularly, on
March 5th.—Mr. Arnold Inglh (8belford) mentioned the
<-aae of an infant five months old, who was attacked one
oay with pain in the body, and vomiting the next day.
w hen seen by him on the third day there was no abdominal
swelling or tumour to be felt; but two motions had been
Pawed of bloody mucus. An aperient was given and the
towels acted, but the vomiting recurred; the abdomen be¬
came distended and the child died. At the necropsy a
aiverticulum was found in the ileum, and an intussusoep-
fion of the bowel,

of Cerebellum , enclosed m Fourth Ventricle. —Mr.

~®**™<* (Kimbolton) described the case of H. N-,

fa* 1 eighteen, who till twelve years of age was healthy and
5 was attacked with unilateral convulsions, with

n P the left side; slight paresis of the left side generally

[April 23,1887' 829

followed each fit for a short period; the fits increased in fre¬
quency, the mind gradually weakened, and the body ceased
to grow. He walked about for two years, then kept his bed
for the last four years, gradually losing consciousness. 'He
had not spoken for a year and nine months, and there was
extreme rigidity of the left side for more than a year. The
convulsions at last were bilateral, and.the rigidity extended
to the right side, neck, and back. Great emaciation took place,
and he died of sheer exhaustion, the convulsions persisting
to the last. At the necropsy the skull was thick; well
ossified; head small, no gaping of sutures ; dnra mater not
very adherent, not dry or sticky; some fluid between
arachnoid and dura; brain rather shrunken; no apparent
disease in motor area of cortex; arachnoid of Sylvian fissure
glued up; cranial nerves looking healthy, except that the
optic appeared small and very firm (his parents considered
he had had no sight for some time); veins thickened; sinuses,
not gorged; corpus callosum firm and healthy; lateral
ventricles containing fluid, but not much distended; third
ventricle opened up by fluid, and anterior commissure tough;
commissure mollis very tough, stretching half an inch
without tearing. The fourth ventricle was distended into
a globular form, lifting up the cerebellum, with thin and
transparent walls posteriorly. Fluid dear, and floor of
fourth ventricle perceptible through the fluid. Although
fluid had drained from the lateral end third ventricles,
the fourth ventricle remained distended. Cerebellum firm,
not to say hard. On opening the fourth ventricle, a small
cyst, containing clear yellow fluid, of the size end
shape of a hazel-nut, presented itself on the right side of
the under surface of the cerebellum. It was partially
embedded in the substance, of the right lobe of the cere¬
bellum, causing a sharply defined concave indentation and
some extra hardening and thinning of the lobe around it.
Mr. Hemming, on examining the pons and medulla, did not
at first recognise any evidence of pressure, but these parts
were removed and sent to Dr. Sharkey, who instantly
noticed the small size of the right pyramid in the medulla
before decussation, a drawing of which was shown. No.
doubt the pressure of the cerebellum in the living state
upon the back of the pons and medulla was the cause
of the gradual and prostrated illness, of convulsions, para¬
lysis, and rigidity, and this case would support Dr. Sharkey’s
view.

Cases of Cerebellar Tumour. — Mr. Marten brought

forward the case of M. 8-, aged fifty-two, admitted into

the hospital, under Dr. Bradbury, on Dec. 1st, 1886, and
died on Jan. 8th, 1887. The symptoms had been severe
occipital headache, vomiting, double optic neuritis, and a
tendency to fall backwards in the middle line.' No rigidity.
The post-mortem examination, made by ,Mr. Griffiths.'
showed a cyst in the cerebellum pressing on the fourth
ventricle, and excess of fluid in the ventricles.—Mr.

I Laurence Humphry read the case of Ellen W—-, aged
twenty-one, single, admitted into the hospital, undtor
his care, on July 14th, and died on October 26th, 1880. 1
The previous history showed twelve months’ frontal'
and parietal headache, dizziness, and vomiting. The eye¬
sight became defective in March, and complete blindness
in June. No fits or rigidity. On admission she was jdst
able to walk. Pupils dilated, no reaction to light, no
squint; constant purposeless vomiting ; pulse regular, 64;
temperature normal; speech laboured and thick. There
was slight paresis of the muscles on the right side of the •
mouth and right supra-orbital region. The grasp of the
right hand was a little weaker than the left. Reflexes were
norma). There was no tenderness to percussion over head.
Flushing of face was constantly noticed, and there was
intense double optic neuritis. The urine contained no
albumen or sugar. Tbe patient left the hospital, hot was
kept under observation, and gradually sank from exhaustion.
At the necropsy a tumour (a round-celled sarcoma) Was
found on the upper aspect of the cerebellum, of the size of
a tangerine orange, and there was much basic meningitis
and gelatinous thickening of the membranes at the base,
involving the optic commissure and nerves.

Sarcoma of Testis in a Child.— Mr. Street showed this
tumour, which had been removed by Mr. Wallis from a
child four years old. The swelling was flrtt observed
nine months ago, and at the time of operation was as
large as a dock’s egg. It extended up to the internal abdo¬
minal ring. Tbe child recovered. Microscopic ex a min ation
showed a spindle-celled sarcoma, with a large amount of
fibrous tissue.

880 The Lancet,]

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.

[Apbil 23,1887.

MIDLAND MEDICAL SOCIETY.

, A meeting was held on March 16th, Mr. Lloyd Owen,
fULC-SA, President, in the chair. ,

- Chronic Phlegmasia Bolens, leading to Elephantiasis. —Dr.
Suckling showed a man, aged thirty-eight, who had
suffered from enlargement of the left leg for nearly four
years. The swelling commenced in the foot, and shortly
after an abscess formed in the groin, which discharged
externally, leaving a depressed scar. The leg has remained
enlarged since then, and is now much larger than its fellow;
the skin is rough and thickened, and can scarcely be pinched
np. There is well-marked pitting upon pressure in the foot
And leg. The circumference of the left thigh i3 three indies
greater than that of the right, and the left leg is similarly
enlarged.. The patella and tibia on the left side are
apparently much enlarged. A depressed scar is present in
the groin, and enlarged glands can be felt there. The
patient cannot walk about for more than a month at a time,
the leg then becoming very painful and the swelling
increasing. At this time he has to go to bed for a week or
so, when the pain oeases and the swelling somewhat sub¬
sides.

■ Gastric Ulcer. —Mr. Whiitindale showed the stomach
from a female aged twenty-two, who had died in the
Queens Hospital. For the last four months she had had
pain in the epigastrium and vomiting after taking food,but
no tuematemesis. Two hours before admission there had
been profuse tuematemesis. This stopped for a time, but was
soon followed by another attack, which proved fatal. On a
post-mortem examination all the organs were found to be
exceedingly ansemic. The stomach contained a pint of dark
gfafnans material and blood. On the posterior aspect,
□ear the lesser curvature and at the pyloric end, there
vr&s a chronic ulcer the size of a sixpence, the edges of
which were much indurated. A luge vessel had been
opened by the ulceration, but the serous coat was not per¬
forated.

Penal Calculus.— Mr. Morrison showed a uric acid cal¬
culus that had been removed from a man who had been
treated for spinal disease for many years. On admission to
the General Hospital he had several sinuses in the left lum¬
bar region, which led down to a roughened body, supposed
to be a sequestrum. This, on removal, was found to be a
calculus. The patient made a perfect recovery.

Byo-salpinx. —Dr. Maxims showed a large pyo-salpinx j
that he had successfully removed from a patient aged
twenty-eight.

Rhinolith.— Mr. Augustus Clay showed a large rhinolitb.

Mr. Sidney Babwise read notes of a case of Mollities
Ossium.

'Dr. Ca&tbb read two short papers : one, ‘‘Observations
on the Salicyl Treatment of Acute Rheumatism the other,

“ A Note on the action of the Colchicum Preparations in
Gout.” . *

At the meeting on March 30th the following specimens
were, exhibited:—

. Syphilitic Stenosis qf Trachea. —Dr. Suckling showed a
woman aged fifty with signs of tracheal stenosis, which he
considered was most likely due to syphilis. She contracted
syphilis twenty years ago, and five years later she suffered
from ulceration of the hard palate, which resulted in per¬
foration. . For the last nine years she has suffered from
difficulty in breathing, which is musy and stridulous. The
stridbr is constant, accompanying both inspiration and
expiration, but is aggravated by emotion and by exposure
to cold. On several occasions the dyspnoea has been extreme,
and almost necessitated tracheotomy. The breath sounds over
the larynx and trachea are high pitched and sibilant. The
hard palate is perforated in the middle line and on the left
side. There is no laryngeal, stenosis or other disorder, the
cords moving freely. On inspiration the glottis is rhom-
boidal In shape, being extremely dilated. Nothing abnormal
could be seen in the trachea. There were no signs of
mediastinal tumour, no dysphagia, or other pressure sym¬
ptoms. •

- Aneurysm of Aorta.— Dr. Suckling also showed- a oass of
aneutysm of the transverse and descending aorta in a man
aged sixty-three.

Epithelioma of Male Breast.— Mr. Babling showed a

patient aged forty-seven, who nearly five years ago noticed
a burning and smarting pain at the left nipple, and on
handling the part found a hard swelling; this slowly in¬
creased, and eighteen months ago the skin over it broke.
Since that time the ulcer has slowly increased, until now it
is a circle of three inches in diameter, shelving gradually
from the edge to the centre, which is the deepest part. Far
the most part the ulcerated surface is nearly smooth, but
presents in places a few coarse granulations. The edge is
thickened, very hard, and markedly everted, and the base of
the ulcer so fixed that it cannot be moved over the bony wall
of the thorax. There is a chain of enlarged glands running
to the top of the axilla under the anterior boundary, and
some hard enlarged glands are also to be felt above the
clavicle. The patient’s general condition is good, and, as a
rule, he bus but little pain. A scraping from the ulceT
shows that it is a squamous-celled carcinoma.

Multiple Exostoses.— Dr. W. Richards exhibited a case of
multiple exostoses.

Excision of Goitre.— Mr. Chavasse showed a woman
aged twenty-nine, from whom he had successfully removed
the right lobe of the thyroid, and read a paper on the
subject. _

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.

Treatment of Lupus. —Jlemoral of Uterine Appendages —
Athetosis.

A meeting of this Society was held on Jan. 21st, Mr.
Hatherly, President, in the chair.

Mr. Chicken read a paper on the Treatment of Lupus
and its Allied Disorders. He took epithelioma as a type of
the diseases allied to lupus as exhibiting a cutaneous or
mucous cell development, infiltrating or penetrating sub¬
jacent tissues, and depending on a specific morbid impulse.

In the case of on affection of the skin, or those parts whicb
could be safely operated upon, he advocated the treatment
of the part by thoroughly scraping away, as far as possible,
the new growths, and then the free rubDing in of iodoform.

In those instances where the situation was such that this
could not be done—as, for example, in epithelioma of the
cervix uteri- he employed the frequent application of
iodoform. Although, m these difficult cases, it was not pos¬
sible to eradicate the disease, it modified the subsequent
progress and unpleasantness of the malady in a marked
degree. In epithelial stricture of the rectum, he first
washed out the bowel with warm water, and then injected
into the stricture from two to four drachms of iodoform
daily by means , of a special insufflator. In exposed
situations, where the treatment could be thoroughly
carried out, the result was very satisfactory'. He showed
two cases, one of lupus and one of epithelioma, both of
which had been operated upon in the manner described,
some years ago. There had been no recurrence. Mr.
Chicken drew the following conclusions:—1. That lupus
and epitheliomata are types of a cellular infiltrating new
growth, and are best treated by scraping with a blunt Knife,
and when the surface has been as far as possible cleared from
the invading ceils, by rubbing in a remedy, of which iodo¬
form is a good example, with the object of penetrating to
those outlying detachments which the knife has not reached.

2. That when the growth is situated in a part that can be
readily attacked the treatment gives ground for a good
hope of recovery, at any rate better than excision. 3. That
when the situation is suoh that scraping cannot easily be
done, the copious insufflation of large quantities of iodo- !
form is practically without risk and of great benefit to
the condition of the patient. 4. Iodoform is specially ■
applicable, because it seems to exert a specially sterilising
influence on the growth, and is capable (by virtue of
its volatile and peculiar penetrating properties) of per¬
meating tissue more than an. insoluble non-volatile sub¬
stance. It is quite harmless and unirritating to healthy
structures.

Dr. Mutch showed the Ovarian and Fallopian Tubes re¬
moved by Dr. Elder from a patient aged twenty-seven,
married. The left tube, about the size of a kidney, was full
of pus, the ovary being converted into a multilocuiar sup¬
purating cyst. The right tube was enlarged and inflamed, f
The patient made a good recovery. 1

Dr. Elder showed the following specimens —1. Sac of |
an Ovarian Cystoma, of which the pedicle had become I

Digitized by GoOgle

Th» Lancet,}

REVIEWS AND NOTICES OP BOOKS.

[Apbie 23i 1887. SH

twisted, producing suppuration of its contents and acute
peritonitis. 2. The ovaries and Fallopian tubes from a
patient operated upon on Jan. 13th. The patient has been
more or less of an invalid since marriage; lately quite so.
The uterus was retrovected, and the ovaries, enlarged and
exquisitely tender, lay under it in Douglas’s pouch. Rest
and the usual treatment had. failed to give even partial
relief. At the operation both uterine appendages were
removed, the ovaries being enlarged and tne seat of cystic
degeneration. She is making an excellent recovery. 3. Uterine
appendages removed by his colleague, Dr. Truman, for per¬
sistent pain, dating from one month after the patient’s mar¬
riage three years ago.

Mr. T. D. Pryce showed a case of Athetosis in a youth
aged seventeen. There was a history of convulsions when
eleven months old, followed by loss of power and motion of
the right side. 1 Mr. Pryce considered the condition to be
due to a cerebral lesion- coincident with the early convul¬
sions, and also to a subsequent degenerative change of the
lateral columns, and to a slight extent of the anterior grey
matter of the spinal cord. _

At a meeting held on April 1st,

The President (Mr. Hatherley) showed for Mr. Thomp¬
son a specimen of Enchondroma of Finger.

Dre. Handford and Hunter showed a case of Congenital
Absence of Left Leg, . Left Pelvis, and Left Kidney. The
diaphragm and lower part of rectum were also absent.

Dr. Ettifen read notes on two cases of Hydramnios.

Mr. Prtce read a paper on Perforating Ulcer of the Foot,
and illustrated it by p&tliologlcsl and microscopic specimens
and-diagrams. _• - ! ■ ■

ant> Botices of Books.

On Fevers: their History, Etiology, Diagnosis, Prognosis,
and Treatment. By Alexander Collie, M.D. London:
H. K. Lewis. 1887.

This volume, whioh forms one of the “ practical series” of
medical and surgical manuals in course of publication by
Mr. Lewis, deserves attention from the fact of itfe author
having been so long devoted to the subjects of which it
treats. He is therefore in a position to speak with authority,
as well as with c >mplete freedom and independence. Illus¬
trations of these characteristics are not far to seek. They
are perhaps most particularly to be found in the chapters
dealing with enteric fever and small-pox. On the etiology
of the former disease Dr. Collie has no hesitation in adopting
views which at the present day are held by comparatively
few. They are the views of Budd rather than those of
Murchison, and are supported by the author with some
striking evidence of the propagation of the disease amongst
the nurses at Homerton Free Hospital. Dr. Collie has been
persuaded by this experience to the belief that enteric fever
is propagated by direct infection; and he explains the
apparent facts of incommunicability on the grounds of
immunity and the early period of life at which it prevails,
bpon this we need only remark that the onus probandi rests
upon those who adopt Dr. Collie’s argument, since the pos¬
sibility of contagion through fee cal contamination must be
quite excluded before, ^uch a conclusion can be reached.
Amongst other statements which are undoubtedly novel we
note those with regard to relapse in enteric fever: “ Relapse

°«um in x small proportion of cases.-It is rarely fatal.

Second and third relapses have hem mentioned, but they are
V8r 7 mre" (p. 78). “ Relapses: These are almost invariably
“didand the prognosis favourable” (p. 84). The rarity of
fdapto here Implied dose mot accord #ith our experience;
And the posthumous work of . the late Pearson Irvine clearly
P'hfad how many oases of prolonged typhoid must be re-
as exanipleb of relapse. Dr. Collie has never met
^wehterte fever In the Subject of phthisis—a suggestive
striking fact; Which, like many other statements, is of
much valie hi the natural History of the disease. Within a

small compass he has succeeded in giving a clear outline of
the main facts, but has not discussed the question of etiology
which has come so much into prominence of late—we mean
that of the typhoid bacillus. The article on small-pox,
again, bears evidence of the author’s personal observation
and is illustrated by tables showing the influence of vacci¬
nation upon mortality. The strongest parts of the work are
those which deal with diagnosis and treatment, for here
Dr. Collie is thoroughly at home and succeeds in imparting
to the work its “ practical” character, for which it will be
highly valued. Nevertheless, we are not wholly satisfied
with it. The author has not, it seems to us, given himself
scope enough to adequately discuss his subjects. He relief
too often, in the descriptive passages, upon excerpts from
other writers, whereas we well know how capable he is hunr
self of clinical description. The book ia well printed* and
contains some coloured plates illustrative of typhoid and
variolous lesions. _ .

1 , . • 1 \ ‘

Sputum; its Microscopy, and Diagnostic and Prognostic

Signification. By Francis Trout, M.D. Edinburgh:

Oliver and Boyd. 188fi.

The thoroughness with which it is possible to investigate
clinically cases of pulmonary disease is one of the most
encouraging facts in scientific medicine. The microscope
comes to the aid of the stethoscope, and the information
gathered by the one serves to justify or modify that derived
from the use of the other of these essential instruments.
Dr. Troup deserves well for having presented in so lucid and
striking a manner the results of his own researches into the
microscopical characters of the sputum. Availing himself
of photo-micrography, he has so amply illustrated his work
that a study of the plates alone will be of the greatest
possible service. We have seldom seen such excellent
photogravures and chromolithographs; and their fidelity
to the objects represented is, at least in the case of the
former, of course unimpeaohable. The text is also to be
commended, for it is evident that the writer speaks from
the fulness of his own personal knowledge. It is, for
instance, an instructive point to bear in mind that he has
found the detection of elastic tissue in the sputum to have
a greater diagnostic meaning in tubercular phthisis than the
presence of the bacillus; for 90 per cent, of the cases in
which elastic tissue is found are cases of tubercular phthisis,
from which it is not difficult to distinguish other destructive
lung diseases that yield the remainder. Dr. Troup also,lays
great-stress upon the relative abundance of the pulmonary
elastic tissue as indicative of active destruction. There is
an interesting chapter upon Curschmann’s spirals, which
are to be found in cases of bronchial irritation, and are
probably formed primarily in the minute bronchioles. The
bacillus of tubercle is treated with all necessary detail; and,
its persistence in putrefied sputum leads to a- remark con¬
demnatory of the bacterium termo treatment. Dr. Troup
also notifies the occurrence, .not only in phthisical sputum,
but in all cases where there is more or less bronchial
inflammation, of diplococci of various sizes and arrange¬
ments, sometimes in large numbers. He Considers that
the tubercle bacillus is of more value in diagnosis than in
prognosis. A chapter on pneumonic sfcutk follows, and the
opinion held that various forms of pneatnottia are probably
associated with other micro-organisms besides the pueumo-*
coccus. Iu the next chapter the characters of the sputum
in bronchitis, bronchiectasis, and whooping-cough are con¬
sidered. Microoooci are described in the'latter, but *W not
believed to be pathognomonic. Other chapters deal with
pigmented sputa, bloody spots, and the sputa in disease Of
the larynx and its neighbourhood. The volume is one which,
apart from its practical value, has been produced in a manner
highly creditable to both author and publishers. We Heartily
commend it to the notice of practitioners.

Digitized by GoOgIc

832 The Lanobt.]

REVIEWS.—NEW INVENTIONS.

[April 23, 1887.

The Man of Science, the Man of Ood—Sir James Y.

Simpson. By the Rev. Chas. Bullock, B.D. London :

Home Words Publishing Office, Paternoster-square.

The scientific reputation of Sir James Simpson is world¬
wide. The double presentation of his mind and character
which is set before us in this modest volume and in the
larger “Life” is perhaps less widely familiar. In these
pages, while personal faults are not denied, the rise and growth
of qualities which proved in their application so useful to
mankind are clearly brought out. Professor Simpson, it
may be noticed, was not, like some great men, a human
phenomenon from his earliest youth. As a boy he evinced,
nevertheless, the elements of mental and moral faculties
which needed but the stimulation of circumstances, not
always favourable, to develop a strong and helpful as well
as a keenly perceptive character. He was quick, industrious,
tenacious of memory, and generally liked because of his
kindness of disposition. As a student he was of the working
order, and achieved considerable distinction in a time when
the Edinburgh school did not abound in scholastic honours.
When, after graduation, he became a practitioner, the same
laboriousness was one of his most striking characteristics.
Energetic and resolute, sleeping often far too little, per¬
severing in spite of occasional ill-health, he did full justice
to scientific sympathies which were wide and yet particular.
He was no mere specialist, though leaning from the first
towards one department of medicine. Matters of the most
general, even comparatively trivial, interest engaged his
attention for the time being almost as if they formed the
chief business of his life. Investigations in anassthesia
very early entered into his varied curriculum of self-
education, and when at last, in 1847, he saw the dawn
of his own great discovery in the successful use of
ether for this purpose, he “could think of naught else."
As a man Professor Simpson did not belie the promise of
boyhood, but, notwithstanding the faults of an impulsive
nature, exaggerated by the bustle and battle of life, gave in
his day many proofs of a genial and considerate disposition
to friends and patients of every station. Neglect of pro¬
fessional engagements has been attributed to him by some,
but this was commonly the natural consequence of over¬
work. Till he had reached the prime of manhood Professor
Simpson’s most active life was almost entirely an intellectual
one. Religion did not show itself much upon the surface.
Certain forms he acknowledged; he chose his church, but it
is not till within some twelve or thirteen years of his death
that we find any important profession of his personal views
upon the subject. It does not appear, however, that his
ultimate adhesion to the simplest principles of evangelical
belief was quite a sudden matter; it was rather the cul¬
mination of previous deliberations, and was characteristically
outspoken. The reading public will find much to interest
in this little work. One or two errata might be excluded
from later editions, such as “Wallis” for “Walter” on p. 48,
and “ Turner,” we suppose for “ Thomas ” Keith on p. 35.

On Medical Climatology: a' Scheme for defining .Local
Climates by combined. Meteorological and Phenological
Observation. By Charles Roberts, F.R.C.S., &c.

This is a short paper read by Dr. Roberts at the congress
of the Sanitary Institute held at l'ork last September. The
title explains the proposed method of the author. Linneeus
long ago collected information with the view of showing
the influence of locality upon the leafing, blossoming,
fruiting, and fall of the leaf in plant life. We are aocuetomed
to estimate the climate of any given locality by purely
meteorological considerations. Mr. Roberts holds, and we
think with good reaeon, that a combination of these two
methods might lead to results of great practical utility.
He points out that “ plants are most exposed to, and most

distinctly declare, the geological and climatic conditions of
a country or district. Being fixed to the seal, they show its
character; and being confined to one place, they sum up
the whole range of meteorological phenomena to which they
are, and have been, exposed.” The researches of Bowditeh
in America and of Buchanan id this country have Bhown how
important a factor the character of the soil is with regard
to the etiology of one important disease— viz., phthisis,
Mr. Roberts proceeds to tabulate the dates of the various
epochs of plant development in different localities, and then
works out the temperature and moisture equivalents for
these periods. On page 5 he gives an interesting diagram,
showing at a glance the relative viability of a few common
trees, shrubs, and flowers in London and its neighbourhood.
Mr. Roberts’ methods of observation are full of interest to
the botanist, and have promise of real utility for the
medical climatologist and the practical physician.

ftcfo Intentions.

ATKINSON’S “PERFECT” TRUSS.

Mr. B. J. Atkinson, formerly of 3, Hemming’s-row,
Charing-cross, but now of 7, Mill-street, Hanover-square, W,
has recently patented on important improvement in trusses.
This consists in uniting the pad to the spring of the trass
by a universal joint, thereby allowing it, when necessary
for adjustment, to be moved in any direction. When the
wished-for position has been attained, a lever, acted upon
by a binding screw, compresses the ball of the joint and
completely fixes the pad. The accompanying woodcuts will
afford a good idea of its construction. When an alteration

in the position of the pad is required, the binding screw
is released, the pad adjusted, and the screw again tightened.
A special feature, also, of this truss is that it is made to
press over the internal ring, and slightly in advance, with¬
out pressing upon the spermatic cord; and further, from
the peculiar formation of the pad (a perpendicular section
of which will show a parabolic carve) pressure may be made
by a comparatively flat surface or a more or less obtuse one,
at the discretion of the surgeon. The whole design has been
very carefully considered, and can best be understood by an
examination of its parts. The form of truss varies, of course,
in the case of femoral hernia, though the above remarks
apply as well to this condition. The practical surgeon will
sea the great advantages presented by this kind of truss.

Digitized by CjOO^Ic

Th» LaKcbt,] NEW INVENTIONS.—NINTH INTERNATIONAL MEDICAL CONGRESS. tAvtixt 23,188?. 8«3>

A MODIFIED FORM OF URETHROTOME.

A laugh majority of Burgeons are agreed that internal
division is the best treatment of many strictures of the
urethra. Of the innumerable instruments for the per¬
formance of this operation which I have seen or have been
able to find described, all of them, while possessing many
good and ingenious qualities, have had also some one or
more faulty features. My aim has been to combine in one
instrument all the good and eliminate all the bad points. I
do not claim for my instrument many original features, only
that it possesses the merits and avoids the faults of its
predecessors.

That this instrument possesses the other qualities of a
perfect urethrotome as given above will be seen from the
following description. It consists essentially of a jointed
knife (a, fig. 1), which can be projected from a Sheath (b)
to regulated distances. This is effected by pressure on the
button (c, figs. 1 and 2), which is continuous with the steel
rod (s, fig. 2) tightly fitting the tube (f), the end of this rod¬
being the knife (a), and the rod being reduced and tempered
for a short distance from the knife. The other blade ( b) also
runs into a fine-tempered end-piece, which rests against the
solid probe point, either straight (h) or curved (h"), which
screws on at o. The blades are withdrawn on removal of the
pressure by the spring (k, Fig. 2). The extent of projection
of the knives is regulated by the graduated wheel (l), turning

Fig 3.

There seem to me to be required in a perfect urethrotome
st least seven qualities—via.: (1) to be used with one band;

(2) to cut either from before back or from behind forward ;

(3) to incise any part of the circumference of the urethra;

(4) to be easily regulated, so as to cut to any depth, even
when the blades are out of eight in the urethra; (5) to be
of the smallest calibre possible when the blades are sheathed ;
(6) to be adapted to carry a guide bougie; and (7) to be
easily cleaned. The value of the first of these may not
be apparent; but with one hand you have a much more
delicate sense of touch, which is all you have to rely upon ;
in this operation. Who would hold a probe or a catheter
with both hands? It is also advantageous to be able to
grasp and steadv the urethra with the free band. To attain !
this the projection of the knives must be produced by flexion
of the fingers, because this is more powerful than extension,
and much more completely under our control—I presume in
consequence of our habituation to use all instruments by the
aid of the flexor muscles.

on the sorew (d), and held in place after setting to the re*
quired number (French gauge) by the spring wedge (c). The
whole tube (f) carrying the knives is only slotted for a short
i distance, and the steel rod is squared and fitted to a square'
box at the point f t Fig. 2. To clean the instrument screw
off H. Turn the milled head (c) until the two parts
of the rod which are united by a screw at k, Fig. 2,
are separated. The anterior part of the rod with the
blades can then be drawn out at the end (o). The
spring box unscrews at m, Fig. 1. Fig. 3 is the con¬
ducting bougie, which can be screwed on at n. Fig. F, in
place of the probe point. The tube carrying the knife-rod
is only slotted for two inches and a quarter, and is
thus rigid. The square socket at f. Fig. 2, prevents
twisting of the knives.

The instrument has been most satisfactorily made for see
by Messrs. Hilliard and Son, Renfield-street.

Wm. Jas. Fleming, M.D.,

Surgeon to the Glasgow Koval faiftrtrmry.

ninth international medical congress

In the section on Medical Climatology and Demography
of the Congress to be held at Washington in September next,
the following scheme of subjects for papers and discusions
has been prepared:—

1. Importance of the study of climatology and demo¬
graphy hi connexion with the science of medicine. 2. What
constitute determinate climatic characteristics. 3. The
effects of climate on the human race as manifested in local
demographic conditions; and of the several elements of
climate as shown by coincident meteorological; morbility,
wd mortality statistics. 4. The question of acclimation,
o. Relative advantages of mountain and seaside resorts for
recuperative purposes and as palliative or curative in certain
diseased states of the system—segregation versus aggrega¬
tion of invalids at health stations. 6. The therapeutic
vaJ ae of natural mineral waters. 7. Accurate records of
prevailing sickness in any community a necessary factor in

any comprehensive system of vital statistics. The responsii
bility of Governments to amply supply their people with
the climatic and vital statistics of their respective coun¬
tries. 8. Collective investigation, apart from aiding the
study of the natural history of disease, as contributive of
numerical data haviog a demographic bearing—(1) as to the
kinds and proportions of prevailing diseases; (2) as to the
absolute amount of daily sickness and consequent loss of
time, occupation, &c. 9. Medical nomenclature considered
in its practical relations to vital statistics. 10. Tbe meliora¬
tion of demographic conditions effected by preventive
medioine. Influence of the physical well-being of a
population upon its economy. Offences against moral and
civil law in their medical relations to demographic circum¬
stances.

Albert L. Gihon, M.D., P. 0. Box 291, Vallejo, California,
is president of this section; and Charles Denison, M.D.,
of Denver, Colorado; I samba rd Owen, M.D., of Heart-
ford-street, Mayfair, London; Dr.. E. Bertherand, of
Algeria; and Dr. A. Wernicb, of Cbslin, Germany, are the
secretaries.

Digitized by v^.ooQle

884 The L-oncet,]

THE PRACTICAL ELEMENT IN* MEDICAL EDUCATION.

[April 23,1887.

THE LANCET.

LONDON: SATURDAY, APRIL 33, 1887.

Thu deficiencies in the knowledge of the routine
work of professional practice shown by our young prac¬
titioners fresh from the schools and from examinations,
which have been bo frequently referred to in our columns
by ourselves and by numerous correspondents, were officially
brought before the General Medical Council at its last
session by Dr. Glover, and a committee to consider the
question was agreed to. He has reprinted as a Bmall
pamphlet the statement in which he introduced his resolu¬
tion. Hospital practice is very unlike general practice,
and it is evident that the success and value of a prac¬
titioner depends much more on his familiarity with every¬
day diseases and their treatment than on his making
exceptional diagnoses of phenomenal cases. How this
routine knowledge can be be6t obtained without materially
interfering with the general plan of his medical cur¬
riculum is the question which is before the committee
for consideration, and everyone will agree on its importance.
“A limited pupilage with a registered practitioner, and
insistence on more clinical, therapeutical, and pathological
teaching and work at medical schools,” are the remedies
suggested by Dr. Glover for this defect, and we hope that
the committee wiU be able to make some useful recom¬
mendations for the guidance of parents and teachers. The
difficulties, however, in framing any useful report are
greater than appeare at first sight. In England, owing
mainly to the non-enforcement at the present time of an
apprenticeship, which was formerly required by the Apothe¬
caries’ Society, medical education more and more tends
to a commencement at a medical school or recognised
hospital, and in Scotland this practice is almost universal,
for in the quinquennium 1871-75 only seven students
out of 1717 began their study elsewhere than at the
Universities. Any enforced pupilage would therefore
entirely change Scotch medical education, and are there
sufficient grounds for doing this ? Is the Scotch graduate :
so farinferior to his compeers in England and Ireland in the !
practical details of his work that his methods of early study
must be radically changed ? The average interval between
the registered date of studentship and the date of a first
qualification has been shown to be nearly five years,
although forty-five months only is the period insisted on
by the Conjoint Examining Board in England; and no
regulation can be adopted which will in any way lengthen
this period of study without materially affecting the number
of those who are desirous of entering the medical pro¬
fession. Pecuniary reasons alone will be sufficient to deter
many, otherwise well qualified, from studying for the pro¬
fession if an increased length of probationary study be re¬
quired. Moreover, another factor besides the student must
be dealt with. The committee will have to judge whether
every general practitioner is fitted for the duties involved in
taking pupils. Pupilage with a scientific practitioner is the
greatest possible boon; pupilage in other cases may de¬

generate into something but little removed from drtadgery,
and very few parents outside our profession can be expected
to discriminate between the two extremes. Besides detail*
of medical practice, a pupil may reasonably expect to b.-
taught chemistry and physics, a little botany, and the
rudiments of materia medica in his first year; and this
should be secured, either by the practitioner being really
able as well as willing to undertake these obligations, or by
his seeing that an efficient teacher can be found within
ready distance. Dispensing medicines and visiting ordinary
cases are very important, but they should not occupy the
whole time of a pupil between his leaving school and his
entering at a hospital, if the pupilage is to extend over more
than two or three months. Again, the more select in the
status of the patients the practice may be, the less can the
pupil learn, so that it is only in mining, factory, Poor-law,
and similar large practices that he can gain the essen¬
tially practical knowledge of infantile and common diseases
that is urged on him as a necessity. Dispensing and
book-keeping are not now so formidable as in former days
Dispensing has been quite changed within late years. Mix¬
tures, concentrated infusions, and pills are now largely used
according to set formulae, and have materially lightened the
work which made great inroads on the time of the older
practitioners; and anyone quickly learns to keep his books
on his own plan and system. The proper writing of
prescriptions is another and a different matter, but we
question if this can be judiciously taught until late in a
student's career, and it may be and should be made a
prominent feature in the instruction obtained from out¬
patient class-rooms. We would like to ask the com¬
mittee to seriously weigh these arguments for and against
an early pupilage even for a limited time, and to take the
opinions of practitioners in the provinces and in the metro¬
polis, and also of some of our younger teachers brought
up under the new regime, as to whether 6ix months de¬
voted to general practice spent between the second and
the final examinations would not be a better alternative.
There are, however, objections to this course also, for it
would interfere with the regulations for resident appoint¬
ments in many medical schools, which are so valuable to
the student from every point of view; and if required to
assist in working a general practice at this period of his
curriculum a student would probably ask to be paid for
bis services, instead of having to pay a premium aa under
the old apprenticeship system. To Dr. Glover's other
suggestions for utilising country hospitals and workhouse
infirmaries as centres of medical education no objection
whatever can be taken, and the difficulties surrounding
their practical application could be easily removed. We
hope that the committee will draw up & reasonable and
workable scheme, so that the great advantages held oat by
the proposition may be realised to the medical student.

. -—♦-

In an article last week we commented on certain Bills
which have this session been introduced into Parliament,
and which have as their object the improvement of house
drainage, but which take no heed of the many conditions
connected with the dwelling which are also concerned in
prejudicing the health of the inmates. Professor Corfiklp
has now brought before the profession other circumstances

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Tun Lancet,]

INHALATION OF COAL GA8 A8 A SOURCE OF DISEASE.

[April 23,1887. 836

-which affect health, and has shown much reason for thinking
that so simple a matter as faulty gas fittings may be re¬
sponsible for some of the ill health which has hitherto been
attributed to defects in house drainage.

Some three years ago Professors W. T. Sedgwick and
W. Ripley Nichols contributed * paper on this subject to
the Massachusetts State Board, in which they discussed the
relative poisonous effects of coal and water gas. They con¬
tended that such harm as resulted from the inhalation of
small quantities of these gases was due to carbonic oxide,
and they proceeded to show that water gas, inasmuch as
it contains more carbonic oxide than coal gas, would
necessarily be more injurious in its effects. 8ome account
of;the symptoms is given both where the quantity breathed
was large and where it was small; the latter producing
Intolerable headaches in a lady previously in fair health,
but who happened later to occupy a bedroom in which
was an escape of water gas from a leaky pipe below the
floor.

Diofessor Cor field has now related to the Society of
Medical Officers of Health a series of cases observed by
himself in which health appears to have been injuriously
affected by small escapes of coal gas into sleeping-rooms
through defective gas fittings. The symptoms he described
are not identical with those mentioned by American writers,
the more prominent in the English cases being relaxed and
ulcerated sore-throat. This difference, however, may not
have any importance as affecting the evidence that the
illness was dependent upon the condition to which the
writer attributes it. It is probable that loss of health
might show itself in one person by headache and in
another by soreness of throat, and the number of cases
which have yet been observed is not sufficiently great to
warrant any generalisation on this point.

Apart from the interest which attaches to observa¬
tions by so trustworthy an authority, a further lesson
is to be learnt. There has for some years been a
growing tendency on the part of many to accept as an
**nred fact that throat illness is necessarily evidence of
defective drainage. Dr. Corfieli/s cases are of value in
showing that this assumption is not safe, and if later we
are led to conclude with him that coal gas may produce
results not dissimilar from those usually attributed to the
Air contents of drains, the more necessary is it that we
shonld be* prepared to find still other causes which may
effect the inmates of a house. The difficulties which
surround all questions of this sort are no doubt very great,
and it is not easy to see how such exact evidence as we
desire is to be obtained. It is enough at the prepent moment
to allow that Dr. Corfield has indicated the necessity for
■reore extended observations, and for more reserve in the
Acceptance of a too general belief that the occurrence of
throat illness must be due to faulty drains. While, there¬
fore, we fully recognise the importance of a perfect
drainage system, we would desire to repeat our recent
warning that householders must not assume that an ex¬
penditure of money in improvements of this character will
eowre them against further ailment. There is, indeed,
m Ach need for more investigation into local causes which
*®ect> health, and those skilled in etiologieal inquiry
fender greater service by seeking in the first Instance

the cause of disease, than by effecting the improvement of
only one of many possibly unhealthy conditions '

If the affiliation of Hospitals and Dispensaries is to pass
from the academic region into that of practical medico-social
politics, the beginning of the passage may be expected on
Tuesday next, when a vote will be taken in the Medical
Attendance Organisation Committee on the following motion,
proposed by Mr. Bousfield and seconded by Mr. Timothy
Holmes

"That the true functions of the out-patient departments
should be mainly consultative, and that their committee and
medical staffs be requested to confine their patients, as
far as possible, to those who have been previously treated
at provident dispensaries ot by ordinary medical prac¬
titioners.”

Already a lively discussion on this motion has taken {fiaee,
in which Dr. Ord, Mr. Timothy Holmes, Dr. J. C. Steelb,
Dr. Gilbart Smith, Mr. Nbihon Hardy, and others
took part. All those who hold strong opinions, or who
fee! the Importance of the question as affectibg either
medical education or public opinion concerning hospitals,
might rely confidently on a short hearing on Tuesday
from the committee, which meets at 5, Lamb’s-eoaduit-
street. Dr. Gilbart Bkith on Tuesday last described, thfe
views of Mr. Nelson Hardy on the Abuses of the Wit-
patient department as “poetry.” This is a eupfoeffiiAtSc
expression which breaks no bone9. Tt represents the
views of the ardent physicians and surgeons of the out*-
patient departments who feel that interesting cases must be
found, and that crowds must be fortbooming to supply them.
They regard such visions as those of' Mr. Holmes and
Mr. Nelson Hardy as " utopian ” in the present stAte of
society, when the strata of poverty in such a community
as that of London are so deep and dense. Students, too,
must be attracted and employed, and for this end numbers
are an advantage. Numbers have a eburni, too, for
hospital treasurers and secretaries, when the reports are
made up. They seem to swell the souUd of the good done
and the charity dispensed.' Moreover, as Dh STRBT.i ptlts
it, the hospitals are reluctant to institute a sort Of relieving
officer, and are disposed to regard inquiry into the taeans and
character of every applicant as an inqtdsitOrEal and ■un¬
generous process. It would be folly to underrate'the force Of
some of these considerations, or of all of t1»em combined.
But there are some others to be set off against them/ ‘’Me
out-patient department of tlie hospitals is tfaeir Weakest
and most vulnerable spot. It has led to more adverse
criticism of hospitals than any other part of their adminis¬
tration. The public wonld be deprived of half Its eicfflws
for not supporting hospitals more generously If tffe griev¬
ances of the out-patient department were removed. tWfr,
more, the hospitals would have the credit of being the most
powerful promoters of thrift and providence. It Is not pro¬
posed absolutely to close tfae out-patient department, but
to restrict it to a more serious class of cases, recommended
by dispensaries or practitioners. With such limitations
cases would be carefully examined and prescribed for, with¬
out overtaxing the hospital staff. If the commoner cases
were in this way kept in the dispensaries, they would not
necessarily be lost to the use of students and lot educational

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$36 tfHB IiANCBt,] THE PROPOSED NEW CHARTER tfOK THE COLLEGE OF SURGEONS. [APHIL 23,1887.

purposes—for it is part of the scheme of affiliation, or might
be made so, that the dispensaries should be brought into the J
service of medical education. Then, as a still more con¬
vincing argument, some hospitals have actually carried out ;
this reform. At Guy’s, at St. Thomas's, and at St. George's
there is a restriction of the number of cases of out-patients, ,
and it is found to work well. Under all these circumstances j
we bespeak for the resolution quoted above a fair hearing.
No doubt its promoters would agree to any modification
likely to make it more workable. The objection to all such
motions is their lack of feasibility. What is wanted is a
resolution to satisfy, not the social and medical philosophers
in Lamb’s-conduit-street, but the medical profession,
medical teachers, and the public.

-+-

At the recent meeting of the Council of the Royal College
of Surgeons, as wo announced last week, “the seventh
report of the Committee on Charters and Bye-laws, con- j
taining the draft of the new supplementary Charter to give
effect to Several alterations in the Charters agreed to by the
Council, was approved and adopted, and it was resolved that I
the necessary proceedings be taken to submit the name to the
Privy Council.” It will not be amiss, therefore, to remind
our readers of the principal alterations which the Council
proposes to ask for in the constitution of the College. They
may be briefly summarised as follows. Firstly, to permitvoting
by means of voting papers as an alternative to voting in
person, as at present; secondly,with respect to the eligibility
of Fellows for election to the Council, to reduce the term of
qualification from fourteen to ten years; thirdly, to abolish
the restriction as regards Fellows who are candidates for
the Council which prohibits their practising as Apothecaries,
and requires them to be in the bond fide practice of Surgery;
fourthly, to abolish the Midwifery certificate of qualifica¬
tion; fifthly, to enlarge the powers of the Council as to
the election of Members of the College of twenty years’
standing to the Fellowship —i.e., to give the power to
elect Members of that standing to a number not exceeding
ten instead of only two such Members, as at present;
and lastly, to give the power to elect two Honorary
Fellows in each year, whether Members of the College
or not, such Honorary Fellows to have no vote for
the election of members of the Council. It is worthy of
note that none of these proposed alterations were primarily
proposed by the Council. They all had their origin outside.
The Council, it is true, did originally propose a few altera¬
tions ; but these were of only minor importance and did not
materially affect the constitution of the College except so
far as they will secure to the Council greater freedom with
less responsibility, and get rid of a certain amount of ex¬
ternal and salutary check and control. It is both significant
and characteristic that, in spite of emphatic and repeated
expressions of opinion by large numbers of Fellows and
Members—amounting in the aggregate to many thousands,—
the Council persists in its determination to ask for a new
Charter which studiously ignores the important and radical
recommendations twice carried in general meetings by over¬
whelming majorities, and without appreciable or calculable
opposition. These recommendations are chiefly two—first,
that in some way and in some degree Members of the College
shall, under conditions, be empowered to vote in the election

of the Council and be eligible to sit in the Council; and,
second, that no alteration shall be made in the constitution
of the College or in its relations or in any of its bye-laws
without the consent of the Fellows and Members specially
convened to consider and discuss, them. These reasonable
demands the Council apparently both rejects and resists It
is obvious that the matter will now have to be fought out
before the Privy Council. There can be no doubt that
after the confirmation of the minutes at the next Council
meeting of the College the new Charter will promptly be
submitted to the consideration of the Privy Council. Before
this is done the Charter as now drafted should be submitted
to a general meeting of Fellows and Members. It is only
right that they should be able to understand definitely and
in detail what the Council are applying for, whether the
alterations be acceptable and agreeable or not. This is im¬
possible unless the Charter itself, as it undoubtedly should
be, is open to their inspection. The Council can surely
have no objection to so reasonable a demand, and will,
we trust, lose no time in calling a general meeting for the
purpose. At the least, printed copies should be available
for those who care to apply for them.

I-Tnwtatwms.

•' He quid nimb."

WARNING TO THOSE NOT REGISTERED.

It cannot be too explicitly stated that Tuesday, May 31st
next, will be the last day on which degrees and diplomas
can be registered, unless they have been conferred after a
qualifying examination in medicine, surgery, and midwifery,
held expressly for the purposes of, and under the conditions
stated in, the Medical Act of 1886. We therefore counsel
our readers in all parts of the empire who intend to register
on old diplomas to do so without delay.

ARMY MEDICAL SERVICE.

In accordance with the promise made to the deputation
which recently waited upon him on the subject of the rela¬
tive rank of the army medical officers, the Secretary of
State for War has reconsidered the terms of the Warrant,
and, “ after consultation with the Director-General of the
Army Medical Department,” has altered them as follows:—
“125 a. Officers of departments of our army, not having
honorary rank, shall rank as follows for purposes of pre¬
cedence and other advantages attaching to corresponding
military rank; but this shall not, except as provided in
articles 265, 348, and 307a, entitle them to military com¬
mand of any kind, to the presidency of courts-martial,
courts of inquiry, committees, or boards of survey, or to
precedence in their own departments over officers holding
a superior departmental rank.” This is followed by the
classification of officers as given in the previous Warrant,
with this difference, that they are stated to rank “as”
instead of “with” the corresponding military grades. It
is gratifying to us to find that the course adopted by the
War Minister accords with that which we pointed out as
being a satisfactory mode of solving any doubt which might
be raised as to the military status of the various grades of
medical officers. (See The Lancet, April 2nd, p. 688.) But
there is a question connected with the Army Medical Staff
to which we attach great importance, and which, we fear,
has been lost sight of in this scare on the subject of relative
rank-that of rewards for professional services. Rewards
for medical offioers ought not, as at present, to be dependent

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ThbLanckt,] POST OFFICE AUTHORITIES AND INFECTIOUS DISEASE. [Aphil 23,1887. 847

upon the ^ecomipendation of the military officers alone, and
to be given only for services in the field; they ought to be
conferred on the nomination of the Director-General, to
whom all reports as to services rendered should be referred,
and with whom the appreciation of these should rest and the
consequent action upon them should originate. It has
hitherto been the practice to grant honours and rewards
solely"upon the recommendation of the military authorities,
who certainly cannot be deemed the best judges of the value
of professional work. One result has been that, while for
service in the field a fair amount of recognition has been
bestowed, the more arduous work, in the hospitals and in the
conflict with epidemics or in the important labours con¬
nected with the preservation of the health of the soldier by
the adoption of sanitary measurep, has been practically
ignored. We would deBire to claim for the head of the Army
Medical Service a more potent voice in its practical working
than has hitherto been accorded. No measure affecting the
department should be introduced without his being taken
into council, as we fear was the case with the last Warrant;
and all rewards to medical officers should originate with him,
or, if from any other source, should pass through his hands
and be subject to his comments before being submitted to
the War Minister. Were this the case, we should no doubt
have rewarded for professional work officers who, however
meritorious, are at present passed by without notice, because
the military authorities, with whom the initiation now rests,
are not competent to form a correct estimate of the value of
such special service. It is not too much to expect that the
head of an important scientific branch of the army, the
labours of which can be truly appreciated only by an expert,
should be consulted on all questions affecting its position
and its mode of action, and that he should have the power
to recommend to the War Minister for rewards or honorary
decorations such officers as he may consider to have earned
a title to them by valuable professional work.

POST OFFICE AUTHORITIES AND INFECTIOUS
DISEASE.

In a recent report on Kensington Dr. Dudfteld draws
attention to an important point in connexion with the
existence of infectious disease in the families of Post Office
servants. In 1882-83 correspondence was held with the
Postmaster-General on the same subject, the Kensington
vestry being desirous of having reported to them by the
Post Office medical officers the existence of any such cases
of illness, in order “ to secure the isolation of the cases,”
and “ to facilitate the removal of the sick to hospital when
they cannot be safely treated at home.” In answer, the
Post Office authorities stated that a notice had been issued
to the numerous medical officers of the department, in which
they were instructed that, if in their district it be not
already the rule to give notice of such disease to the sanitary
authority, it would be well that such a rule should be intro¬
duced in the case of Post Office servants. But the letter,
referring further to the question of admission to hospital,
*aid that the department was not prepared to adopt
compulsion. Within a month during the early part of
this year Dr. Dudfield heard of three occurrences of
8carlet fever in the families of postmen. The postal
authorities very properly relieve their men from duty
during such occurrences, and it appears that in these
three cases they refused to allow them to resume their
work until disinfection had been carried out. And it was
the need for getting this process done that brought the
cases under the notice of the vestry. Dr. Dudfield had, we
think, ground for complaint, and hence he communicated
the facts to the chief medical officer of the department, who
m S 01 1 “ye that forms had been supplied to the postal
membal officer of the parish for the purposes of com¬

municating with the sanitary authorities, together with a
recommendation to use them, but “ the department is not
prepared to employ compulsion in the matter.” So far as
we were able to judge, the question of compulsion in the
former correspondence related to removal to hospital, and in
this respect we entirely concur with the Postma9ter-General
that Post Office employes should not be treated differently
from other members of the public. But we do think that, as
regardsnotification, the department, which is maintaining the
sick family at the public expense, might properly let the
authority know, and might rightly require that the form*
issued should, in every case, be used for the purposes indicated.
It is known how largely children from such families as those
of letter carriers attend elementary schools, and the Post
Office department should not withhold from the sanitary
officer the information which he needs in order to give effect
to the provision of the Education Code issued by another
Government Department as to the exclusion from school
attendance of scholars living in infected houses. The Poet
Office authorities seem to claim some credit from the fact
that the information does, owing to their requirements, at
last reach the sanitary authority. But it is practically use¬
less for the principal preventive purposes when it oomee to
hand only at the termination of the illness; and if it is the
intention of the Post Office hereafter to require their servants
to apply to the local authority for the purposes of securing
disinfection, they might at the same time have regard to
public health requirements, and instruct their officers to
give the needed information at the onset of the disease,
when it can be most usefully employed for all parties
concerned. _

FASTING FDR THE SAKE OF SCIENCE.

Thb case of M. Cetti, who recently undertook, in the in-
tereetsof science, to fast for thirty days in Berlin, was brought
before the Medical Society of that city at a recent meeting
by Prof. Senator. It should be said that the observations
were not prolonged beyond eleven days, M. Cetti being
informed that there wa9 no necessity, from the scientific
point of view, for him to continue his fast beyond a fort¬
night. During this period he was subjected to very careful
observation. He is twenty-six years of age, and his weight
was reduced from 57,060 grammes to 50,660 grammes during
the eleven days, an average daily loss of 685 grammes.
Starvation was not absolute, since he was allowed to drink
water ad lib. He also smoked cigarettes, which, however,
could not be shown to have had any influence on nutrition.
His general oondition remained very good. The quantity
of chloride of sodium eliminated in the urine sank from
eight or ten grammes on the first day to less than one
gramme on the last days. The temperature was always
within normal limits, attaining on the seventh and eighth
days nearly the physiological maximum. On these days It
reached 37‘4° C. (99-3° F.), at other times varying between
36*4° and 36 - 8° (97'5-98'6° F.); but it never rose above that
level. On these two days he was not very well, complaining
of colic and suffering from hiccough. The pulse was normal,
but very excitable, merely sitting up in bed causing an
increase of the rate from 76 to 120. Professor Senator did
not enter into further details, which are reserved for later
publication, but described the very thorough methods to
which M. Cetti was subjected. These comprised accurate
measurements of the body and estimations of the excreta,
examination of the blood as to its corpuscular richness and
hHemoglobin capacity, and sphygmographic studies of the
pulse. Observations on the vital capacity and estimation of
the oxygen and carbonic acid of respiration were made daily,
Dynamometric records were kept. The urine was most
thoroughly investigated, chiefly by Drs. Muller and Munk,
the analysis including estimations of urea, chloride of
sodium, phosphoric acid, sulphuric acid, soda, potash and

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838 Thb Lanckt.J THE EXAMINATIONS OF THE PHARMACEUTICAL SOCIETY.

'ammonia, indol, phenol, acetone, and diacetic acid, and also
of the digestive ferments which have been recently shown
to be present in urine in certain conditions and absent
in others. The saliva and the freces were also submitted to
examination. Professor Virchow, who was associated with
Professor Senator in the observations, added a few remarks
upon the object of the experiment; and M. Cetti, who was
present at the meeting, gave his reasons for undertaking
the fast, and stated that he had felt no appetite or hunger
until he was told that on the next day he would be allowed
to eat. The desire then returned to him at once, and he
kept awake half the night. He expressed himself very
gratified with the kindness and attention bestowed upon
him by the scientific men who had taken him in charge.

THE EXAMINATIONS OF THE PHARMACEUTICAL
SOCIETY.

. Tub Chemist and Druggist of April 9th contains the
reports of Dr. Head lam Greenhow, the Government visitor
to the examinations of the Pharmaceutical Society, on the
examinations held by the Society in the years 1885 and 1886.
The main facts are of considerable interest to the profession
as well as to the public. The examinations reported on are
three in number: the preliminary, the minor, and the major.
The preliminary examinations are conducted by the College
of Preceptors. In 1886, for the first or preliminary exami¬
nation, there were 1278 candidates. Of these 688, or 46 per
cent., were rejected. This proportion of rejections is said
te be rather less than usual. For 1886 the number at this
examination was 1305, of which 673, or 51-57 per cent., were
rejected. The subjects are Arithmetic, Latin, and English.
Arithmetic is the rock on which most of the candidates come
to grief; in 1885, 209 failed in it alone. If the number of
those who failed in it and in one or both of the other subjects
be added the number of failures in arithmetic is raised to
476. In 1886, 288 failed in arithmetic alone, and 323 in it
and one or both of the other subjects. The failures in
Latin in 1885 were 262, and in English 240. Dr. Greenhow
very properly insists on the seriousness of deficiency
in arithmetic, k knowledge of which subject he regards
as not only a test of a fair elementary education, but as
absolutely requisite in dispensing and chemical operations.
We are glad to see, in spite of indications of carelessness of
the medical examining bodies on the subject of Latin, that
the Society still insists on a knowledge of this subject in its
candidates. In the minor examinations for 1885, of 744
candidates only 265 passed; 489, or 65-7 per cent., were re¬
jected. Of the rejected candidates, 8t failed on account of
general weakness in all the subjects, 171 in practical dis¬
pensing, 70 in chemistry, 64 in pharmacy, 43 in reading
prescriptions, 22 in materia medics, 27. in botany, and 11 in
Wo or more of these subjects. In 1886 the rejections at
this examination were 530 out of 824 candidates, or 631 per
Cpnt. The subject in. which the largest proportion of them
failed was practical dispensing, which brought 205 candidates
to grief. In chemistry 71 failed. The candidates for the
major examination are much Tewer, being 87 and 90 in the
i wo years respectively, the rejections being 4G-0 per cent,
and 43 - 3 per cent. It is not the least proof of Dr. Greonhow’s
fitness for this duty that he has carefully considered the
targe proportion of rejections and has made suggestions, in
the interest of fair examination, for an extension of the time
in the minor examination, as well a9 an extension of the
Aumber of articles to be dispensed. He is quite satisfied of
fchd general fairness of the present examinations, but thinks
more time should be given. He urges, too—a very important
point,—that the preliminary examination should be passed
before the student is allowed to proceed with his proper
Qtttdies. We are surprised that this is not already required.
K iflfW grievous unkindness to students not to be severe in
tfite Requirement.

THE JUBILEE AND THE UNIVERSITY OF LONDON.

At a special meeting of Convocation of the University
of London on the 19th inst., the chairman read a communi¬
cation from the Prince of Wales, inviting the co-operation of
the University in the establishment of the proposed Imperial
Institute. It was then resolved, on the motion of Dr.
Baines and seconded by Mr. Lemon, that the jubilee of the
University be celebrated this year, and that it is desirable to
associate therewith the commemoration of the jubilee of
Her Majesty’s accession to the throne; and that a special
committee be appointed to carry out the wishes of Con¬
vocation in .this respect. Dr. Quain moved and Sir A. K.
Rollit seconded the following resolution: ** That an appro¬
priate method of oarrying oat the wishes of Convocation as
expressed at this meeting would be the placing of a statue
or other similar memorial of Her Majesty in the University
building. That this proposal is especially appropriate,
inasmuch as the University was founded by a Charter
granted by Queen Victoria, that Her Majesty is the visitor
of the> University, and was graciously pleased to open the
University building in person, , and that Her Majesty has
reoently granted to this University the high privilege of pre¬
senting an address to Her Majesty upon the throne in like
manner as is allowed to the Universities of Oxford and
Cambridge.” The motion was unanimously agreed to, and
the proceedings terminated with the passing of a third reso¬
lution, moved by Sir Philip Magnus and seconded by Mr.
Lemon, to the effect that the statue or other memorial should
be presented to the University at a special meeting or
reception, at which the presence of Royal and distinguished
persons should be invited. _____ -

EARLY WELSH MEDICINE.

In our appreciation of the great advance in medical and
surgical knowledge which ha9 taken place in recent times,
we are but too apt to undervalue the services of those who
have laboriously laid the foundation of onr art jn remoter
ages. Of a part of this indebtedness we are reminded by a
short but interesting paper on “Early Welsh Medicine” by
Mr. P. Rhys Griffiths, from which it appears that not only
was the art of medicine cultivated by the Britons at a very
early period, but that the Cymric practitioners during the
medireval and perhaps even in the earlier Christian epoch
enjoyed a status and exercised a degree of skill by no means
contemptible. Tradition tells us that up to the time of
the Welsh king, Prydain (1000 b.c\), the knowledge of
medicine and other sciences was usually found in con¬
nexion with the priestly office. After that date men of
science and physicians appear to have formed a group by
themselves. Regarding their methods there is little infor¬
mation, save that they seem to have relied chiefly on herbs
a9 means of treatment. It is not till we reach the year
930 a.d. that any very definite information on medical
matters is obtainable. About this time we learn from an
Act of Howell the Good certain interesting particulars as to
the position of the royal medical attendant. This functionary
was evidently a person of some consequence. His “ lodging
was with the chief of the household,” he held his land free,
was allowed a horse, and received fees according to a fixed
scale. Early in the thirteenth century the name of
Rhiwallon, household physician to Rhys Grug, prince of
South Wales, attracts especial notice. He was the most
famous of the early Welsh physicians of whose life and
work we possess reliable information, a copious contributor
to the literature of medicine, for his time a practitioner of a
very high order, and a man of true professional principle
and personal integrity. The teaching and practice of
Rhiwallon and his three sons were probably inspired in a
greater or less degree by that of Hippocrates, who is more
1 than once referred to in their writings, though the works

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LAXcarr,)

AN THRAX IN CHESHIRE.—A MINISTER OF HEALTH.

[Ai\an. 23,1867* 889

of the Persian and Roman teachers were also included
among their studies. In this connexion it ie noticeable
that the humoral theory of disease was familiar to these
early British physicians, while the prominent place assigned
in their treatment to dietetics is no less significant. In
regard to diet, indeed, they evidently possessed a fairly
accurate though an empirical idea of what was or was not
physiologically suitable. In diagnosis they relied almost
exclusively on the evidence afforded by the general bodily
condition and the appearance of excreta. The heart,
pulse, and temperature revealed nothing to them.
Their materia medica consisted almost entirely of organic
substances, for the most part vegetable, and included some
of the sources of our oWn most valued remedies, such as
digitalis and the poppy. The plants employed in treatment
were home-grown, as might be expected, and were adminis¬
tered either as external applications or in the form of
infusions or decoctions. While thus occupying in medicine
the position of herbalists, and nearly ignorant of scientific
method, these early practitioners were in some respects well
advanced in surgical skill. They were good lithotomists,
they treated abscesses in the lung or brain by puncture and
trepanning, and they incised the chest in empyema. In
some other ways their ideas, as may be imagined, were of
the Most primitive order. Tumours they treated by apply¬
ing the rump of a live fowl, feathered, to the part. Charms
were probably less used at this than at an earlier epoch, but
their employment in medical practice was not yet by any
means unknown. The early practitioners of Wales appear,
therefore, to have proceeded in their treatment on much the
satoe lines as their brethren elsewhere, and were probably
rather more than less intelligent in the methods they were
wont to use. _

ANTHRAX IN CHESHIRE.

’•Pda some time past alarming notices have been appearing
in the local papers in reference to the alleged occurrence of
anthrax on a farm in Cheshire, and questions were asked in
Parliament on the subject. To these questions the usual
stereotyped answers were given, containing, however, rather
more than the usual amount of official wordiness. It was [
alleged, among other things, that the outbreak was. due to
“the insanitary condition ” of the farm! We venture to say
that “ insanitary condition ” never did ahd never will pro¬
duce anthrax. It is fortunate that Dr. Hime, who is well
qualified for the work, has been enabled to examine into
the question on the spot, as some confusion has now been
introduced into the matter by official declaration as to the
simultaneous existence of “ occult ” swine fever. He has
been resident on the farm for some days, and has made
several post-mortem examinations of animals which have
died there. He has stated that all these animals had anthrax,
sod that no symptom or sign of swine plague was to be
found either before or after death. Dr. Hime also prepared
fltnOertus microscopical mounts, which, when shown to
competent observers, left ho doubt on their mind that the
dtettse- was typical anthrax. But there were numerous
peculiarities in the case. In fact, the occurrence of anthrax
te the pig is in itself uncommon, and its possibility is dis¬
tinctly denied by Klein over and over again. But the
f*Ct that the animals lately attacked have survived so much
hmget than the first victims is noteworthy, the latter
Having mostly perished rapidly with symptoms of splenic
apoplexy, while the later cases have lasted six, seven, and
even eight days. Again, the splenic disorganisation was not
Owirijr so 1 marked in the latter cases. Dr. Hime caused very
energetic stupe for prevention to be taken. All animals
*PiCh died QUring the visit were burned, and not buried
accor ® n ii to the Privy Council Orders; perchloride of
® wtilu 7^aa liberally used instead of chloride of lime. The
“°w %we ordeTbd to be dug Op and the earth burned,

the walls to be temped and disinfected with the penebtoade,
&c. The unfortunate farmer hag not only lost), some MOO
worth of stock, but has suffered grievously from the restric¬
tions of the authorities. Because some pigs were ill, all the
healthy stock and their milk &C. were put under a ban.
Dr. Hime Btrongly represented the unnecessary hardship of
this to the authorities, and we believe considerable relief
was then afforded. We hope to be able shortly to give a.
fuller account of this remarkable outbreak. The disease has
also made its appearance in Romney Marsh.

A MINISTER OF HEALTH.

It is announced that Earl Cadogan, Lord Privy Seal, ahd
the Right Hon. C. T. Ritchie, President of the Local:
Government Board, have been invited to join the Cabinet.
The news of Mr. Ritchie’s promotion will be received with
much satisfaction by those who have the health interests of
the country at heart. We have many times commented; on
the need for this recognition of the importance of the duties
which devolve upon Mr. Ritchie’s department; It ie indeed,
extraordinary that the country which seta au example to all
other nations in the estimation in which it holds sanitary
progress, both as regards life and commerce, Should ever
exclude from the Cabinet the statesman who presides' over
the branch of administration which is concerned with this
subject. In Mr. Ritchie’s case there is the further argu¬
ment that his high abilities must render bis services of
especial value. We fear there is not just now much
hope for domestic progress, but Mr. Ritchie’s presence
in the Cabinet should ensure Immediate attention being
directed to those subjects in which the future of England
is involved, and certainly amongst these most be reckoned
the placing of the sanitary service on. a better footing
than at present. The hope that has for long been enter*
tained, that improved methods of local government would
i be seriously undertaken by successive Ministries, has
! been hitherto grievously disappointed; but recent public
statements of the President of the Local Government Board
have shown that they have not been forgotten. Probably
all that ie wanted is the necessary opportunity for bringing
them before Parliament. We trust that Mr. Ritchie’s rela¬
tion with the Local Government Board may be continued
until this is afforded, and that he may have the direction,
of the legislation which we may now anticipate will follow.

THE TITLE OF ‘‘DR.* AMONGST DENTISTS.

Thekb has been a keen discussion in one of the dental
periodicals about the use of the title Of “ Dr.” by graduates
of American colleges who are in practice here. All the
writers equally disclaim any intention of decrying the
D.D.S. or D.M.D. which is legitimately gained after a
reasonable term of residence, but their arguments are aimed
at those who, whether licentiates of one of our colleges or
gine curriculo men, go out to America to obtain a diploma,
too often a bogus one, and then return to practise under the
title “ Dr.” It is freely admitted by the leading American*
themselves that the practice of dental surgery in all its
branches is fully as well taught, theoretically and prac¬
tically, in our dental schools as across the Atlantic, The
editor of the Journal of the British Dental Assoriatiim
suggests that the title * Dr.” should be dropped by those
dental surgeons holding it in this country. Those con¬
scientious practitioners, whether English or American, who
are always welcome in our midst, might or might not agree
to this; but those who abuse the title certainly would not,
and it is the abuse that we wish to attack. The public,
we think, do attach considerable importance to the title
“Dr.” amongst dentists, and therefore we would point out
that this term, used in virtue of the D.D.8., does not signify
a me'Heal qualification, and, when honestly obtained, is

840 Tim Lancet,]

THE GASTRIC JUICE IN CANCER OP THE STOMACH.

[A*ril 23,1887.

similar, and by no means superior, to our L.D.S. We are
heartily glad to see that the Americans are awakening to
the fact that their degree is fast falling into disrepute,
and only last month a “ diploma mill,” with the title of
“ Druidicd University of America,” had its charter repealed;
but it is not only these illicit manufactories that need
looking after, but the recognised universities where diplomas
ace. given after a few weeks’ residence.

THE GASTRIC JUICE IN CANCER OF THE
8TOMACH.

Professor A. V. Pblia, in a “preliminary note” pub¬
lished in the last number of the Vrock, states that he has
observed in several cases of Buspected carcinoma of the
stomach that the gastric juice, even after the addition to it
of hydrochloric acid or pepsine, or both, remained incapable
of peptonising coagulated albumen and fibrine; and not
only so, but when added to normal or artificial gastric juice
possessing peptonising power this cancerous gastric juice
actually destroyed that power, showing that its own pro¬
perty was not of a merely negative character but of an
active anti-fermentative nature. Professor Pelia suggests
that in cancer of the stomach some new chemical principle
of the nature of an anti-ferment may be secreted in the
stomach. This is, he thinks, secreted also in these cases by
the kidneys, for he has been able several times to show that
the urine of a patient with anti-peptonising gastric juice
possessed a similar anti-fermentative power. He remarks
that Cabn and Mering have recently shown that an absence
of free hydrochloric acid in the gastric juice is not a proof
of the existence of cancer of the stomach ; but he does not
wish to express any opinion himself on the question of the
significance of hydrochloric acid from a diagnostic point of
view. _

SANITARY WORK IN MUCH WOOLTON.

Dr. B. B. Joi.l’s report on an outbreak of fatal measles in
the Much Woolton urban district raises two points worthy
of notice. In the first place, the sanitary authority appeared
to be much astonished at his attendance at their meeting,
and the chairman had to explain to them that their medical
officer of health had not come there to assert aoy right, but
only as a matter of courtesy and with a view to any expla¬
nations that might be required on his report. That such a
statement should have been necessary implies, we fear, a
very scant appreciation of their duties by the authority.
No medical officer of health has an actual right to be present
at all meetings of the sanitary authority, unless indeed such
right forms a condition of his appointment; but many such
officers do make it a practice to attend, and many authorities
either require or are only too glad to have the advantage of
their presence. The Order of the Local Government Board
requires the attendance of the medical officer of health at
such stated times as the sanitary authority may direct; for
it is assumed that such authorities stand in need of their
skilled adviser in matters relating to health whenever sani¬
tary topics are under discussion, in precisely the same way
as they need the attendance of their clerk when legal and
administrative topics are being dealt with. The episode at
Much Woolton implies that hitherto the sanitary work has
been done without the sanitary adviser ot the Board; and
this is probably the explanation of the second point to which
we would advert. We refer to a proposal on the part of this
authority, with a population bordering on 6000, and in whose
district twenty-eight deaths from measles have j uat occurred
in a single month, to make an anqual payment to the
Presoot Hospital, now in course of erection some six or seven
miles away, for the use of one solitary bed for the infec¬
tious 4iM*MScalling for isolation within their jurisdiction.

Dr. Joll has cause to protest against anything so utterly
ridiculous. If the Much Woolton Board have no intention of
giving their district the benefit of hospital accommodation
such as the Public Health Act intended them to provide, they
had far better say so at once than go through the form of
making a provision which is void of substance.

DEATH OF DR. ALFRED MEADOWS.

We regret to announce the death, on the 19th met, of
Dr. Alfred Meadows, after a comparatively short illness.
The deceased, who was held in high esteem by the members
of the profession, was recently appointed a Justice of the
Peace for Middlesex, and was well known in Masonic circles.
We hope in our next issue to give a more detailed account
of his career.

Sir Edward H. Sieveking presided at a meeting of the
staff and students .at St. Mary’s Hospital on Wednesday
last, to express the deep regret felt by all at the sudden
death of Dr. Alfred Meadows. Mr. Field, the dean of the
school, read letters from gentlemen unable to be present
expressing sympathy. The chairman, in a touching speech,
alluded to Dr. Meadows’ many good qualities and the
irreparable loss sustained by his death, and then called on
Mr. Edmund Owen to move the following resolution, which
was seconded by Dr. Montagu Handfield Jones, and carried
unanimously: “ That the staff and students of St. Mary’s
Hospital have received with poignant regret and sorrow the
intelligence of the death of their beloved friend, Dr.
Meadows; that young and old who have had the advantage
of intercourse with him have learnt to admire his excellent
qualities of head and heart; and that the staff and students
of St. Mary's Hospital request Mrs. Meadows and Miss
Meadows to accept the assurance of their profound sym¬
pathy in the irreparable loss they have sustained.” A
I service will be held at All Saints’, Margaret-street, to-day
I (Saturday), at 11 a.m. ; and a special train will leave Pad¬
dington at 2.30 p.m, for Colnbrook, where the interment
will take place. _____

THE BOWEL LESION IN TYPHOID FEVER.

How far ought the intestinal ulceration met with in
typhoid fever to be considered pathognomonic? Is the
detection of ulcers in Peyer’s patches, presenting none of
the characters of the tuberculosis or dysentery, to be taken
as proof of typhoid fever, even in the absence of well-
marked clinical symptoms? Are we justified in believing in
latent typhoid from post-mortem evidence alone ? Such are
the questions which are suggested by an interesting brochure
recently published by Dr. Vandyke Carter, upon “ A Peyerian
Ulcer Lesion of the Small Intestines, apparently new”
(Bombay, 1886); and the answer he would impel us to give
to them would be a decided negative. The material upon
which he bases his paper consists of about ten cases, in natives
(in whom typhoid fever is rare) suffering from symptoms
described as remittent fever, and after death, which in some
cases was due to perforative peritonitis, exhibiting more
or less extensive ulceration of the small intestines.
Constipation rather than diarrhoea was the rule; and in not
more than one case did the “fever” run the course of
typhoid. But Dr. Carter does not rely on clinical grounds
to establish the non-identity between the intestinal lesion
in these cases and that present in typhoid fever. He sub¬
jects the type of ulceration to a close scrutiny, and points
out several prominent features of difference, the most
striking being the absence in his cases of the excessive
swelling and infiltration of the Peyer’s patch that precede
the stage of ulceration in typhoid fever. He inclines to the
belief that these non-specific ulcers are produced by embolic
or thrombotic plugging, and that this depends on septic
conditions. That septic causes are adequate to produce in-

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MEDICAL 0PP1CBB8 OP HEALTH.—EPIDEMICS OP MEASLES. [April 23,1887. 841 '

testinai lesions of this' kind is not to be gainsaid; and we
think that Dr. Carter has made out a case for further
investigation. At the same time, with the knowledge we
have of the various forms assumed by typhoid fever, or at
any rate by cases classed together as typhoid, and the groat
variety and extent of the intestinal lesion in cases of this
disease, we may hesitate at first to accept his conclusion. A
less cautious observer than Dr. Vandyke Carter would doubt¬
less have been satisfied with the detection of the numerous
ulcers in the favoured seats of election, and the occurrence
in many cases of perforation, to declare that the cases came
under the head of typhoid fever, modified it may be by the
conditions under which the disease occurred. Hitherto we
have been led to rely upon the ulceration of the intestines as
the only positive criterion of this disease; but now it will be
necessary to review our position in regard to it, and it may
be that we shall have to fall back upon the detection of the
typhoid bacillus to determine the diagnosis.

MEDICAL OFFICER8 OF HEALTH.

Our attention has been directed to a recent appointment
in which a gentleman has been selected as medical officer of
health who poetesses no sanitary certificate, in preference
to another holding that of the University of Cambridge. It
is but natural that some disappointment should be felt by
the unsuccessful candidate, who has spent time and trouble
in the acquirement of knowledge which would undoubtedly
have been useful to the local authority had they elected
him. It must, however, be recollected that these distinctions
are not yet understood by the public, and that other circum¬
stances than those of the possession of certificates frequently
golds these bodies in the selection of officers. Sanitary
medicine is still in its infancy, and it is only within the last
few years that the special knowledge which it requires
has become appreciated by examining bodies, and only
daring the present year that the General Medical
Council have recommended that the subject should be
separately taught at the medical schools. It would
therefore be expecting too much if we were to cavil at a
loeal authority for neglecting to recognise the value of the
evidence of speoial training which is afforded by the
possession of certificates in sanitary science. Progress is
necessarily slow, but the disappointment which is felt by
such a circumstance as that to which we refer must serve
as no discouragement to those who are looking forward to
a career in pnblic health. We do not doubt that in the
future preventive medicine as a public service will occupy
all the position it deserves._

EPIDEMICS OF MEASLES.

There have been daring the past six months numerous
severe epidemics of measles. In the metropolis there was
a diminution in the fatality from this disease during 1886,
as compared with the average for the decennial period
1876-85, but since the commencement of this year several
localised epidemics have occurred. In a similar way measles
has been widely prevalent in several of the large towns and
cities of the kingdom. In Liverpool 472 cases and 70 deaths
came under notice between April 1st and 14th, and during
the month of March there were 788 cases, of which 107
were fatal. At the last meeting of the Health Com¬
mittee, Dr. Taylor, the medical officer of health, stated
that there was no hospital accommodation, and that
for want of this the disease had spread, and many
lives had been lost in consequence. Iu Sunderland there
is also an extensive prevalence of the disease, the fatal
attacks in the four weeks of the period March 19th to
April 9th having been 17, 29, 19, and 26 respectively.
And again, in Aberdeen, an epidemic commenced at the
close of last year. Thus, 127 cases of measles were reported

in the months of November and December, 158 in January, 702
in February, and during Match there were no less than 1653,
with 138 deaths. Measles is unfortunately a disease against
which hardly any precautions are taken by the majority
of parents; many being under the false impression that every
child must have the disease sooner or later, and therefore the
sooner it is over the better. But measles, like small-pox or
scarlet fever, is contracted from an antecedent case, and
hence it can to a large extent be avoided. Isolation of cases
in hospital is not so easily effected as in several of the other
infectious fevers, because the disease is so infectious in an
early stage when it cannot positively he recognised, and
consequently the mischief is often done before prophylactic
measures can be adopted. But in a large proportion of
cases the spread of the disease could be prevented if parents
and school officials only took pains to check the dissemina¬
tion of the infection. Measles is at times a very fatal
disease, and hence it is one that ought to be prevented as
far as prevention is possible. Thus, whereas in 1886 the
deaths in England and Wales for scarlet fever were 5895,
from “ fever " 5831, and from small-pox 284, there were no
less than 11,576 fatal attacks of measles.

ISLE OF WIGHT 8ANITARY ADMINISTRATION.

The Isle of Wight rural district is becoming proverbial
for its sanitary difficulties. Another has just arisen. ‘A
man who is certainly not a pauper—he being in receipt of
his club money—contracts small-pox. No hospital is avail¬
able exqept that at the workhouse, and the patient dis¬
tinctly refuses to allow himself to be isolated there if be is
to be regarded as a pauper. Dr. Groves, the medical officer
of health, manages, in the sanitary interests of his district,
to get him removed there, and the relieving officer is to be
asked to make an order for his admission after the admission
has been effeoted. Thus the man is mode a pauper whether
he likes it or not. The subject in ite legal bearings having
been discussed by the authority, Dr. Groves was instructed
to confer with the clerk and the workhouse medical officer
as to the best line of action in future cases. We agree with
Dr. Groves that there is nothing to oonfer about. The
workhouse hospital is not intended for such cases; it is
illegal so to use it as long as it belongs to tbe Poor-law
authority, and the sanitary authority fails to make any other
provision. Until that provision is made there must be con¬
stant risk of a deadlock, and such risk cannot be put off by
requesting tbe medical officer of health to take part in a
conference with his Poor-law colleague.

GRANULOMA FUNGOIDES.

Professor Kaposi, in a paper lately read before the
Imperial Medical Society of Vienna, stated that he had sepn
seven cases of mycosis fungoides (three being males) and of
these five had died. He discriminated three clinical types
of the affection. In tbe first the patient suffers at the com¬
mencement from a scaly eczema of the trunk, sometimes
associated with very severe itching. After from one to three
years the spots on the skin become prominent and glisten¬
ing; an infiltration takes place into these small nodules,
which disappear or sometimes break out in other parts. In
the course of months or years large fungating tumours
appear on healthy skin, attaining the size of a fist, having a
bluish-red colour, occasionally dense or very soft and easily
compressible. These tumours are mostly seated on the trunk;'
next on the face, extremities, and scalp. They sometimes
disappear with remarkable rapidity; new ones arise in other
parts and attain colossal dimensions. Some tumours
ulcerate, the ulcers having excavated margins; and after
the disease has lasted some years, death trices place from
fever, marasmus, or pulmonary or pleural complications

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S42 Tub Lancet,]

SMALL-POX AT PLUMSTEAD.—WINDSOR HOUSE DUST.

[April 23,1887.

In the second type, instead of eczema, there is an eruption
of red, urticarial spots, whitish or fawn-coloured in centre,
and somewhat dense to the touch. These wheal-like
formations persist, extend, and become brown in colour,
and the appearance is that of scleroderma or even
lppra. All these formations may disappear and occur
again, but the spots do not itch ; and they ultimately
are changed into nodules, which become fungating
tumours and ulcerate, taking on the characters and the
clinical course of the cases of the first type. The third
variety, examples of which have not been seen by Kaposi*
consists in the development of the fungoid tumours, with¬
out any antecedent process. In speaking of their histology,
Kaposi differentiated them from leukeemic tumours, and
disputed the discovery of cocci made by Schiff and
Hochsinger; he adhered to his previous conclusion that the
condition must be regarded as “ sarcomatosis cuti.” It is
not absolutely incurable. Erysipelas is sometimes followed
by a complete disappearance of the tumours, and arsenic
was to be recommended. This drug was being taken by the
patient shown by Prof. Kaposi to the Society—a man
thirty-six years of age, who had suffered from the disease
since 1875.

. «WAU.‘PQK AT PLUMSTEAD.

Every epidemic of small-pox is preoeded by indications
that the disease has a high power of infectivity, and we
therefore oannot but regard with some anxiety a localised
outbreak of this disease at Plumstead. In the week before
last six cases of Bmall-pox were removed to the hospitals of
the Metropolitan Asylums Board, and last week a seventh
case occurred in the same locality. It is now reported that
these patients contracted the disease from a man who had
come direct from Port Said, or, rather, from some other
persons who in their turn had been infected by him.
However this , may be, sufficient time has not yet
elapsed to show whether, the outbreak has terminated,
or whether we may expect its still further development.
The sanitary authority for Woolwich, the district adjoining
Plumstead, are unfortunately without the aid of the services
of a medical officer of health, and there is ground for saripus
apprehension that London may thus be involved in great
difficulties for want of the proper machinery for dealing
with any immediate extension of small-pox in that locality.
We trust the attention of the Local Government Board will
be directed at once to this matter, and that the Metro¬
politan Asylums Board, upon whom the burden of expense of
small-pox in London falls, will themselves use their influ¬
ence with the Woolwich authority for preventing any such
calamity as that we indicate.

TREATMENT OF CATARRHAL JAUNDICE.

Dr. Gluzinski, writing in a Polish journal, states that in
cases of catarrhal jaundice he has found excellent results
follow the treatment recommended by Krull—viz., the re¬
peated injection into the bow,el of large quantities of cold
water. This increases the peristaltic action of the intestines,
and removes any mechanical obstacle to the flow of bile.
Again, as has been shown by Rdhrig and Hosier, who in¬
jected large quantities of cold Water into dogs, the bile is
thus rendered both more liquid and more abundant, so that
it more easily overcomes any obstruction. At first water at
5.9° F. is injected into the bowel until the patient complains
of a feeling of distension in the abdomen. He is then made
to retain it as long as possible. Most patients manage to
retain two litres for from a quarter to half an hour. The
next day the enema is repeated, but with water about
4°, higher. The temperature is again raised on each suc¬
ceeding da$r, but when 72° have been reached no' further
UQro&ee-ie made. The reason of the increase is that the

repeated introduction of cold water is ppt to irritate the
mucous membrane of the bowel. Altogether four or five
enemata are sufficient to produce the desired effect. The
increase of the biliary secretion may be judged, of by the
colour of the fteceB. Of course, the diet is attended to in
order to prevent a recurrence of the affection.

WINDSOR HOUSE DUST.

The Windsor Town Council have had under consideration
a proposal of one of their members to compel householders
to provide movable receptacles for house dust, and thus
give facilities to the dust collectors to remove this material.
This proposal was not adopted, but it is one which the in¬
habitants of Windsor might readily carry into effect without
compulsion. The serious delay which is now caused by the
emptying of fixed dustbins must add largely to the cost of
collection, and ratepayers would be acting in the interest of
their own pockets in adopting a method which would effect
an enormous saving in the time of the workpeople em¬
ployed. There is, moreover, the great additional advantage
that this method would prevent the huge accumulations
of offensive matter, which ore now almost inevitable.
Although the motion was rejected, it may be hoped it may
come before the sanitary authority in some other form. Tbe
Town Council are now actively engaged in considering the
steps which should be taken for the improvement of the
health condition of their district, and certainly so important
a subject as the removal of house refuse, deserves serious
attention. _

INTUBATION IN LARYNGEAL DIPHTHERIA.

Dr. Northrui* (Medical Jtaoord, Dec. llthy 1886) advo¬
cates the practice of intubation of the larynx originally
suggested and practised by Bouchut, and later introduced
with greater success by Dr. Joseph O’Dwyer, for the relief
of dyspnrea in laryngeal diphtheria. Amongst the advan¬
tages claimed for the method, he cites the simplicity of the
operation i and freedom from shocks, the fact that no
objections can be raised to it on tbe part of friends, and
that the subsequent care of the case requires no trained
attendant. The: inspired air is admitted into the lungs
moist and warm; and subsequent tracheotomy is not
precluded. One notable objection is the difficulty of
swallowing fluids that is experienced, at least at first; and
there is a danger lest the false membrane be detached and
thrust into the trachea before the .tube. The cases in which
the method has been. practised with relief to laryngeal
obstruction amount to 165; and the recoveries amount to
28 - 5 per cent., a percentage which Dr. Northrop does not
think could be shown by tracheotomy, and is the more
encouraging in view of the novelty of intubation and the
few hands by which it has as yet been practised.

INFECTIOUS DISEASES IN BRUSSELS.

M. Destrkk, in presenting the Belgian Academy of
Medicine with a chart showing the course of infectious
diseases in Brussels during the last six years, remarked that
a glance at the chart would show that a very considerable
diminution had taken place in all infections but one—viz.,
diphtheria,—which had been steadily increasing, until in
three years the number of cases had been quintupled. He
had fancied, as it is thought by some that tetanus has
some relation to the keeping of horses, that possibly the
occupants of the poultry-yard might in some way cause
diphtheria, ne therefore injected croupal membranes into
pigeons, but always without result. He, however, was much
struck, while attending two children in a family for diph¬
theria, by noticing that all the fowls and pigeons, besides
the cat, died during the children’s illness.

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Dii

Thb-Lancbt,J ACTION OP DRUGS ON GASTRIC MOVEMENTS. _ [April 2.3, J887. 8A.%

THE MANAGEMENT OF POST-PARTUM
HAEMORRHAGE.

Dr. Schowbero, of the Lying-in Institution in Christiania,
writing on poat-p&rtum haemorrhage, states that the number
of cases in which this occurred to a serious extent during the
years 1876-1884 was 54 out of a total of 2533 labours - i.e.,
about2per cent.of all cases. He appears to have but little faith
in ergot for immediate arrest of violent haemorrhage, either
administered internally or as ergotine injections. In the case
of women subject to hmmorrhage he advises a course of tonic
strengthening treatment during pregnancy. When haemor¬
rhage occurs the coagula must be expelled by external manipu¬
lation, and then he finds that the most advantageous plan of
immediately arresting the flow is to dose the os uteri by com¬
pression. He refers to Hamilton’s paper in the Edinburgh
Medical Journal for 1850, and to Pasbender’s similar plans
described in 1869, without apparently any knowledge on the
author’s part of Hamilton’s previous work. The Norwegian
surgeon introduces the fingers of one hand into the vagina,
the tips reaching to the anterior fornix, and pressing the
anterior lip of tfie os backwards. The other hand grasps
the uterus externally, antefleoting it while the Angers com¬
press it frpm behind against the lingers of the other hand,
the os being thus mechanically closed. Dr. Schdnberg is
inclined now to prefer cold to hot injections, notwithstand¬
ing the great estimation, in which the latter are beginning
to be held. He warns obstetricians not to administer irri¬
tants too freely, as they set up nausea, and this adds to the
condition of collapse. He has, however, latterly been in the
habit of giving teaspoonful doses of a concentrated solu¬
tion of common salt with excellent results.

ACTION OF DRUGS ON GASTRIC MOVEMENTS.

Sour excellent researches are still in process of conduction
by Schiitz, on the action of some medicaments on the move¬
ments of th e stomach. Emetine, tartar emetic, apomorphine,
strychnine, in a less degree oaffeine, veratrine, chloride of
barium, nicotine, and pilocarpine in small doses, act as
direct excitants of movements of the stomach, which become
spontaneous and of abnormal character. Muscarine directly
stimulates the terminal ramifications of nerves, in causing
generalised contractions of the stomach. Physostigmine,
digitaline, scillitine, and helleborine produce an increase in
the excitability of the muscular coats in such a fashion that
the stomach at a given time is agitated by generalised and
prolonged contractions. Actual paralysis of the auto-motor
centres has • not been observed, but chloral, urethane,
morphine, pyrophosphate of zinc, arsenic, as well as nicotine
sod pilocarpine, in large doses, have caused weakness of the
gastric contractions. Paralysis of the terminal branches of
the nerves has Only been obtained by atropine. Ether and
chloroform suppress the excitability of all the innervation
apparatus, but only during the time when the stomach is
exposed to the direct action of the vapours. During antes-
thetic sleep the gastric movements are not influenced.

A SYPHILITIC PLACENTA.

M, Dxbray described at a recent meeting of the Brussels
Anatomical and Pathological Society some peculiar appear-
Mwes presented by the placenta of a woman who said she
had had syphilis a year before her confinement, but who
certainly bad chancres and a specific roseoious rash at the
time. The confinement was at term, and the placenta was
removed with some difficulty three hours after the child
was born. It wm hard and abnormally small. Microscopic
examination showed the presence of connective tissue fibres
and of numerous plastic elements lying between the con¬
nective tissue bundles and forming arterio-Bclerotic rings
retmd the vessels.

THE 11 VICTORIA ” DISASTER. ,

Wk regret to see among the list/>f missing passengers
from Newhaven to Dieppe by the ill-fated steamer Victoria
the name of Mr. F. T. A. O’Meara, L.R.C.P.Lond., M.R.C.S.E.,
resident accoucheur at King’s College Hospital. Mr.' G’MeaiW
intended spending a short holiday in Paris, previously to
entering on his duties as house-surgeon to Sir J. Lister
on May 1st. He entered the medical department df
King’s College in 1881, and was a prizeman in anatomy
surgery, clinical surgery’, and obstetric medicine. He also
obtained the special prize in Diseases of Women and Chfldreti
instituted in memory of the late Dr.'Tanner. Mr. O’Meara'
was one of the most intelligent students at King’s College,'
and had gained the affection and regard of all his teachers,
fellow-pupils, and colleagues. His loss—for we fear that
there is now little hope of his having been saved is deeply'
deplored by everyone who knew him.

ALBUMINURIA IN DIABETES.

Dr. A. Pollatschbk of Carlsbad has published ( ZdUchr .
f. Klin. Mod., xii, 4) some statistical results of the sys¬
tematic examination of diabetic urine for albumen, with a
view to determine whether the occurrence of the latter
varies in proportion with the amount of sugar. Ho Sound
that out of 1187 specimens containing sugar, in amounts
varying from traces to aa much as 5 per cent., there occurred
more or less albumen in 437. The percentage (37) waa
almost the same, when reckoned on the cases examined in.

1885, as on those of 188G, showing a curious uniformity.

By grouping the specimens of urine according to their rich¬
ness in sugar, be shows that there is no constant relatipn
between the amount of albumen and of sugar—the lowest
number of albuminurics (291 per cent.) occurring in cases
of urine with a minimal quantity of sugar, and the highest
(43 8 per cent.) in urines having from 2 to 3 per cent, of
sugar. _

INSPECTORSHIPS OF EXAMINATIONS.

Thb Branch Councils in the different divisions of' the
kingdom are busily engaged in selecting names lor reoom-
meadation to the General Council in May for appointment
as Inspectors of Examinations under the Medical Act of.

1886. These appointments should not be mere sinecures,

and the profession will expect that they shall be made with
much care 4n4 impartiality, so that the bodies may all .teeft
that their work is to be ablyr end impartially judged. The
Branch Council for England, will meet-mainly for this pur¬
pose on May 2nd, __ f

COMA FROM ANTHRAX

'!

Thb interesting and in many respects remarkable case
which is recorded in another column by Dr. Reilly is perhaps,
most noteworthy from the insignificant attention given by
the patient and his friends to the “ boil ” at tbe back of his
neck. The state in which the patient was found might
have been due to very many causes, but the brief, though
dear history, the occupation, and the presence of the
malignant pustule, proved sufficient to establish the true
nature of the case. It is to be regretted that a necropsy
was not allowed. _

DEATHS OF EMINENT FOREIGN MEDICAL ANp '
SCIENTIFIC MEN.

The deaths of the following foreign medical andselentiflo
men are announced:—M. A. Norbert Michot, the veteran
Belgian botanist, at Mone, in his eighty-fifth year. Staff t
Surgeon-General Dp. Karl Ritter Heidler von Egeregg o£
Vienna, in his seventy-seventh year .

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844 The Lancet,]

ELECTRIC LIGHTING IN THE HOMERTON INFIRMARY.

[April 23, 1887.

EMPLOYES OF OMNIBUS AND TRAMWAY
COMPANIES.

It is strange that we should still be asked to direct
attention to the hard case of the drivers and conductors of
omnibus and tramway companies. It really needs no medical
knowledge to see the injustice of exacting sixteen hours’
work a day from these officials. Such hours give no fair
time for rest, or recreation, or home life. It is pitiable to
see the men at their principal meals, bolted furtively, often
in the car, and before the passengers eager to be off. If the
cupidity of shareholders is so great as to blind them to this
cruelty, legislation should be invoked. We are opposed to
over-legislation. It should not be necessary to invoke the
assistance of the Legislature for such a purpose, but if the
end cannot be secured otherwise, this step must be taken.
The Legislature grants great privileges to tramway and
omnibus companies. It has a right to insist that they
discharge their duties to the public, and “ are merciful to ”
their men as well aa to “ their beasts.” We have before us a
petition to the members of the House of Commons, signed
by numerous medical men, urging the reduotion of the
hours. We heartily support the petition.

ELECTRIC LIGHTING IN THE HOMERTON
INFIRMARY.

The guardians of the Hackney Union have provided
their new infirmary at Homerton with electric light, acting
on the recommendation of their medical officer, Dr. Miller.
Altogether there are 110 incandescent lamps, each of which
is of sixteen-candle power; of these many are used for illu¬
minating the corridors, the greater number of the remainder
being in the six largest wards, containing in each sleeping
accommodation for forty patients. Thus, for the lighting
of a ward, the lamps are arranged in groups of three, and
four groups are found sufficient, an additional incandesoent
lamp being provided for night purposes. There is no doubt
that electricity, as compared with gas, afTords consider¬
able health advantages, and it is probable that the success
which has attended the use of this light in the Homerton
Infirmary will lead to other institutions following the
example which has been set them. The motor power has
been provided by a small alteration of the machinery used
for pumping water. _

ARMY HOSPITAL OORPS IN THE UNITED STATES
ARMY.

Wb learn from the Washington Army and Navy Register
that a law has been passed providing for the organisation
of an Army Hospital Corps, and that the Surgeon-General is
about to bring it into operation as soon as possible. In the
first instance, it will be raised by volunteers from the
regiments of the line, but it is probable that afterwards it
will be kept up by recruits specially enlisted for this service.

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin .—The veterinary school, which has increased the
number of its students threefold during the last ten years,
is now raised to the position of a Hoekschule or university.

Grata — Dr. Rudolf R. Jaksch von Wartenhorst has been
appointed Extraordinary Professor of the Diseases of Children.

Prague.— Dr. Friederich Ganghofner has been appointed
to the Chair of the Diseases of Children in the German
University. _

At the annual graduation ceremonial in connexion with
the Edinburgh University on the 20th inst., the degree of
Doctor of Law was conferred upon Professor KolKker of
Wurzburg.

On May 8th the Federation of the Italian Hygienic
Societies will hold its first Congress in Florence. The
sittings will last till the 10th and among the proceedings
will be a discussion on the new code of public hygiene sub¬
mitted to the Italian Senate by the Prime Minister, Depretu,
and a paper by the Senator, Professor Pacchiotti of Turin, on
the “ Vaccinazione Anti-rabica” of Pasteur. The great fetfe,
of which during the first three weeks of May the Tuscan
capital will be the seat, form an attraction of which the
promoters of the Congress will avail themselves for en¬
hancing the success of their inaugural meeting.

Wb regret to notice the death, on the 3rd inst., of Mr.
John Kirkman, at his residence at Brighton. The deceased,
who was in his ninety-third year, was for forty-five years
(1831 to 1876) superintendent of the Suffolk County Asylum,
His name was well known in connexion with the non-
restraint system of treatment of the insane.

Our contemporary the Eeko kindly gives prominence to
the report that one of the few physicians in Brooklyn
opposed to vaccination has contracted small-pox from a
patient, and that there is little hope of his recovery. We
hope he may have a better fate than his folly deserves.

The President and Council of the Medical Society of
London will give a conversazione at the Society’s rooms
11, Chandos-street, Cavendish-square, on Monday, May 2nd.
An oration will be previously delivered by Sir William
Mac Cormac, F.R.C.S. _

Db. W. Julius Mickle was elected sometime ago a vice-
president of the seotion of Psychological Medicine and
Nervous Diseases at the International Medical Congress.

Sib Spbnckr Wells and Professor Billroth have been
appointed Honorary Members of the German Surgical
Society, which is now in session at Berlin.

A Bill to amend the Acts relative to lunacy has just
been issued.

ABSTRACT OF

LECTURES ON MALARIAL FEVERS . 1

By W. NORTH, B.A., F.C.S.,

LATE RESEARCH SCHOLAR OF THE (JROGERS' COMPACT.

LECTURE I.

THBIK DISTRIBUTION ANI) THE GENERAL CONDITIONS
UNDER WHICH THEY PREVAIL ; HISTORY OP
THEM IN THE PROVINCE OP ROME.

The wide distribution of malarial fevers, their dis¬
astrous effects upon the population of countries in which
they prevail, and the obstacle they constitute to all material
progress, are not generally realised ; whereas this subject is
one which should attract the attention of Governments,
inasmuch as these diseases materially increase the cost of
administration. We as a nation have had a vast experience
of them, and the literature of the subject is enormous, but
withal little or nothing has been done towards understanding
their etiology, or the precise conditions necessary for their
existence or production.

If we examine the malaria chart of the world, we cannot
fail to be struck by the gradation of the disease from the
Equator to the Poles, and by the characteristics of the
countries where it prevails. They are briefly countries
where nature has her own way, and swamps, jangle, snd

1 Delivered at the London Institution, April 18th, 1887.

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CLASS MORTALITY STATISTICS.

virgin foreat abound. The map suggests a relation of the
■disease to temperature and water. If we compare the
mala ria chart of Europe with a physical map of the Continent,
the relation of the disease to low land, abundant water, and
hot, moist climate is very evident. Make the same com-
arison between a physical map of Italy and the map of
enator Torelli, showing the local distribution of the
malaria, and the relation of the disease to altitude of the
land, to water, and to temperature becomes a certainty. A
study of the local distribution and variations of intensity
of malarial fevers in the province of Rome shows us that
local conditions have a most important bearing on the
subject, and are therefore worthy of minute and careful
examination; the general conclusions drawn from the
consideration of large areas are still found to apply, and we
find the disease to be generally most severe on low-lying
land- - in valleys and marshy districts. An examination
of the distribution of the population in the province of
Rome shows us that the usual order of things is reversed,
and that, whereas in most civilised countries the population
is densest in the plains and least dense in the mountains, in
the province of Rome exactly the reverse is thecaee,and
we find the mountain population stands to that of the
plains in the ratio of sixty-eight to twenty-eight persons
per square kilometre. This startling exception to a well-
recoguised rule leads us to inquire whether political
causes have led to the abandonment of the plain and
the malaria has simply stepped in and taken posses¬
sion, or has the. malaria itself been the cause of this
abandonment; and in either case, when did the causes
begin to operate? This is a historical question of the
very greatest interest, and also of the very greatest import¬
ance to the subject, as tending to show what are the
conditions necessary for the development and spread of
malarial fevers. There is, however, one very great difficulty
in the inquiry, and that is that malaria develops so slowly ■
that, unlike the “ black death ” or the “ sweating sickness,” it
does not attract the attention of the historian, and thus we are
driven to argue its presence or absence and its intensity 1
from the history of individual localities. The one great
fact that we have as a starting-point is that in even the
later days of the Roman Empire places now absolutely
uninhabitable were not only inhabited, but held in
high esteem by the Romans as health-resorts, so msch
so that the whole coast line of the province was covered
with their villas and country houses, of which we can
see the ruins to-day; and we know from the writings of
Pliny and others tb&t these villas were maintained in a state
'of luxury and magnificence, quite incompatible with the
presence of such an enemy to health as malaria. There is some
evidence, however, that the Po’htine district was not all that
could be deeired even in those times, and Seneca advises a
friend to avoid the neighbourhood of Ardea as not being very
healthy. The invasions of the Goths swept away these
villas and the high cultivation whioh surrounded them, the
gardens and sacred groves were destroyed, and the popula¬
tion driven to the hills and secure places. Rome itself
sank almost to insignificance, the destruction done by the
Northern barbarians was never repaired, and the Campagna
continued the battle-ground of Saracens, Lombards, rival
popes, and barons, rendering a return to the ancient civilisa¬
tion almost hopeless. In the seventh and eighth centuries
we hear of fever, not isolated but wide spread, and of serious
attempts by various popes to recolonise and cultivate the
desolate country. The so-called Domuscultm were estab¬
lished, with the double object of military defence and the
reclamation of the land, on the site of places which
flourished under the empire; but they do not appear to
have been successful, or at most, only partially so, and
though some of them exist at the present day—e.g-, the
Isola Farnese, the site of the ancient Etruscan City of Veii,—
they are only aggregations of hovels, and so unhealthy that
the population desert them in the summer and autamn.

Thus we see that the .Campagna was abandoned from
«*uses purely political, and nature was allowed her own
w& y in a country where the unceasing toil of man is
required to keep her under control. There can be no donbt
that the reckless destruction of trees which has gone on
steadily ever since it was begun by the Goths has played a
reost important part in altering the local conditions and local
<2jimate of the country, and in comparatively recent times
the reckless cutting of timber in the mountains has caused
the streams which rise in them to become uncontrollable
sod destructive, converting large area* of the lowland into

[Apeil 23,1887. 840

bog and swamp, and rendering cultivation difficult and
unprofitable. Our inquiry, therefore, leads to the conclu¬
sion that from political causes the local condition of the
Campagna have been most profoundly altered, and that
pari passu malaria has arisen and increased in intensity.
A minute examination of the relation of local conditions
to the disease will form the eubject of the next lecture.

CLASS MORTALITY STATISTICS.

It is not easy to overrate the importance of the subject
of a paper read before the Royal Statistical Society oh
Tuesday evening last by Mr. Noel A. Humphreys, of the
Registrar-General’s Department. For elucidating the true
value of local rates of mortality we have urban and rural
death-rates, we have death-rates at different age periods,
we have death-rates from different causes, and we have the
death-rates of male adults engaged in different occupations.
Till recently, however, we have known yery little of the
rates of mortality prevailing in the different classes of
society. The object of Mr. Humphreys’ paper was to discuss
existing mortality statistics thiowing light upon this
important subject, and especially to examine critically the
full bearing of the statistics issued during the last few years
by Dr. Grimskaw, the Registrar-General of Ireland, dealing
with the mortality prevailing in various social classes of
the population of Dublin.

On account of the marked variations of the age pro¬
portions of the various social classes of the population, the
only thoroughly satisfactory method for comparing the
mortality statistics of such classes is by the construction of
life tables, and the first part of the paper is devoted to the
examination of the principal English life tables, and espe¬
cially of those which throw any light upon the special subject
of the paper. It is pointed out, in the first place, that the
various Eoglish life cables based upon the general popula¬
tion show a marked and steady increase in the mean dura¬
tion of life in recent years. The Carlisle table gives 39

ears as the mean duration of life, whereas Dr. Farr’s table,

ased upon the mortality of the 17 years 1838-54, gives
41 years; a table based upon tbe mortality of the five years
1876-80 gives 44 years; and the mortality of the next five
years, 1881-5, shows a still further extension of life.
Dr. Farr’s healthy district table (based upon the mor¬
tality statistics of sixty-three registration districts in
which the mean death-rate in the ten years 1841-flQ
did not exceed 17 per 1000) gives 49 years as the
mean duration of life. Very few life tables based upon
class mortality statistics exist. The most important
examples of the class life tables referred to ^y Mr.
Humphreys are Bailey’s and Day’s Peerage Tables,
Ansell’s Tables of Upper Classes, and Hodgson’s Clergy
Tables. Although not, correctly speaking, class tables, the
Experience Tables of the Institute of Actuaries, and of the
American Life Offices, throw valuable light upon the mor¬
tality of insured, and therefore of selected healthy lives,
belonging, for the moat part, to the middle and upper
classes. Ansell’s Upper Class Table gives a mean duration
of life of 53 years—an increase of four years upon that by
the Healthy District Table. Unfortunately, it appears that
no life table of the working classes exists, although the
mortality statistics issued by Dr. Grimsbaw tor the General
Service Class in Dublin are such as to suggest that the mean
duration of life in this class can scarcely, if at all, exceed
that by Dr. Farr’s Liverpool table— namely, 2G years.

An examination of these several life tables shows that the
mean duration of life is mainly controlled by the rate of
mortality in childhood. In all tbe life tables based upon
the mortality statistics of the general population, the mor¬
tality during infancy and early childhood is so great that
the expectation of life is greater at ten years of age than it
is at birth. By Dr. Farr’s English Life Table, for instance,
the expectation at birth is 41 years, while at age 10 it is 47
years; and even by the Healthy District Table it is 49 years
at birth and 61 years at age 10. Ansell’s Upper Class Table,
however, has such a comparatively low rate of child mor¬
tality that the expectation of life is 53 years at birth, which
declines to 52 years at age 10. The variations in the annual
death-rate of children under five years of age by the different

846 The Lancet]

REPORTS OF MEDICAL OFFICERS OF HEALTH.

[April 23,1887.

tables is very noteworthy; it is 65’7 per 1000 by the English
Life Table (Dr. Farr's No. 3), and 39 - 4 by the Healthy Dis¬
trict Table, while by Ansell’s Upper Class Table it does not
exceed 28'2. Dr. Grimshaw’s statistics show a rate of only
220 among children of the professional and independent
class in Dublin during the three years ending 1885.

Subsequently to cnildhood the greater vitality of the
middle and upper classes, compared with that of the general
population, is only somewhat less marked than it is under
five years of age.

The most recent statistics of occupational mortality, con¬
structed by Dr. Ogle, and issued by the Registrar-General,
although not coming within the scope of class mortality
statistics, as they only deal with adult males, throw, at any
rate, a side-light upon the subject. Taking the mortality of
all males aged 25 to 65 years as 1000, the relative mortality
of males engaged in different occupations, after due correc¬
tion for age differences, is shown by Dr. Ogle to range
from 556 for “ Clergyman, Priest, Minister,” 699 for “ Gar¬
dener, Nurseryman,” 631 for “ Farmer, Grazier,” and 701 for
“ Labourer in Agricultural Counties”; to 1839 for “Miner
(Cornwall),” 1879 for “Costermonger, Hawker,Street Seller,”
2090 for “ General Labourer (London),” and 2205 for “ Inn,
Hotel Servant.” Many of these differences are evidently due
far more to the influences and risks of occupation than to
the mere influence of class ; and it seems probable, however,
that the wide difference between the mortality of labourers
in agricultural counties and labourers in London must be
mainly due to difference of housing and sanitary surround¬
ing, as both classes probably suffer about equally from
poverty, hard work, and hard living.

As information of the variations of child mortality in the
various classes is essential to a full appreciation of the lesson
to be learned from class mortality statistics, Dr. Grimshaw’s
statistics, notwithstanding defects, in great measure un¬
avoidable in such an experiment, are especially valuable.
They demand attention, in the first place, to the marked
variations in the age distribution of the population in
different classes. For instance, 1000 of Dr. Grimshaw’s
professional and independent class contain only 75 children
under five years of age, instead of 121 in the artisan class.
Then the proportion per 1000 of persons aged upwards of
sixty years is 158 in the professional and independent class
and only 63 in the artisan class. Mr. Humphreys shows
that given identical rates of mortality in each of Dr. Grim¬
shaw’s four classes, at each age period, the death-rate at all
ages would, owingalone to the differences of age distribution,
range from 19 5 in the middle class to 25 2 in the pro¬
fessional class. The actual mortality in the classes differs,
however, very widely in the other direction. If 1000 betaken
to represent the mortality that would occur in each class
if English life-table rates prevailed, the mortality in Dublin
in the three years 1883-4-5, in Dr. Grimshaw’s four classes,
corrected for age difference?, was equal to 632 in the pro¬
fessional and independent class, 1093 in the artisan class,
1333 in the middle class, and 1659 In the general service
class.

The variations in the death-rates at different age periods
in the several classes is especially striking. Thus, the mean
annual mortality under five years is just five times as great
in the general service class as in the professional and
independent class. The difference at the next age-period,

5 to 20 years, is almost as great, and in each of the three
age-periods of adult life the rates of mortality are more than
twice as high in the general service class as in the pro¬
fessional ana independent class.

The rates of mortality from various causes of death show
fully as wide differences as do the death-rates at different
ages. For instance, mortality from measles is nearly ten
times as great in the general service class as in the pro¬
fessional and independent class; from whooping-cough,
more than four times as great; from scarlet fever, more
than twice as great; from diarrhcea, nearly three times as
great; from typhus, nearly five times as great; from
phthisip, more than four times as great; from lung diseases,
more than three times as great; from convulsions, nearly
thirteen times as great; and from violence, more than five
times as great in the general service class as in the pro¬
fessional and independent class.

In concluding his analysis and discussion of Dr. Grim¬
shaw’s figures, Mr. Humphreys urges the necessity for
further investigation in the same direction, and expresses
the hope that medical officers of health and others may follow
Dr. • Grimshaw’s lead and improve upon his statistics.

Calling special attention to the near approach of the death-
rates among the clergy and labourers in agricultural counties,
he urges a stronger faith in the possibility of reducing the
present wide range between the death-rates of the upper and
of the working classes. Comparing the rates of labourers
in agricultural counties and of labourers in London, it is
suggested that this is due not so much to difference of
poverty and hardship, but to the unhealthy homes and
impure air from which the London labourer mainly suffers.
The marked reduction in the working-class mortalitv.
especially of infants, in the Peabody buildings, points, at
any rate, to one effective method of bringing the mortality
of the working classes within sanitary control. These and
other similar facts indicate further possible reductions in the
now rapidly declining English death-rate, the possible extent
of which it is not easy to estimate.

THE LUNACY ACTS AMENDMENT BILL.

A meeting of the Council of the Poor-Law Medical
Officers’ Association, to which workhouse medical officers
had been invited, was held at their rooms, 3, Bolt-court.
Fleet-street-, on April 14th. Prior to commencing the
business of the evening, a unanimous feeling of regret was
expressed at the continued absence from the chair of Dr.
Joseph Rogers, owing to severe illness. Clause 14, sob-
sections 5 and 6, of the Lunacy Acts Amendment Bill was
then discussed, and it was considered by the Council and
visitors present that the alteration of the clause by the
Parliamentary Bills Committee of the British Medical
Association fully met the requirements of the case,
and the secretary was requested to write to the chair¬
man of that committee to tender the co-operation of the
Association, in what manner it may be deemed advisable,
with a view to having the obnoxious clause amended in the
Commons. It was also suggested that the word shall be
substituted for may in Clause 19, line 4, which refers to the
-payment of fees by the guardians under orders of the
justices. The opinion of the secretary of the Lunacy Com¬
missioners as to the great value of the certifying of pauper
lunatics by the workhouse medical officer was considered
important in reference to the amendments proposed.

public Ifcaltjr anb |]oor fain.

LOCAL GOVERNMENT DEPARTMENT,

BBPOBT8 OP MEDICAL OFFICERS OF HEALTH.

Chniley Rural District .—The general survey of sanitary
districts carried out by the Local Government Board was
extended to this area, and Mr. Graveley reports that as a
consequence special attention was devoted to the drainage
of several villages, to the abatement of nuisances from the
keeping of animals and from filth accumulations, and to the
enforcement of bye-laws. The current systematic inspec¬
tions were also carried out during the year, and the dairies
and milkshops were placed under supervision. The annual
death-rate for 1886 was 15 per 1000. Six deaths occurred
from typhoid fever, the disease originating in an encamp¬
ment of people travelling in vans.

Coventry Urban District .—Owing to the prevalence of
measles in the city, and its extension on such a rapid scale
that hospital isolation could not check it, the closing of
elementary schools became a necessity. Dr. Fenton ex¬
plains that this step involved to the school manageis
and teachers a loss of .£110, and hence that it w a
serious one to adopt. It has generally been assumed
that any loss of grant accruing from actual closure of
schools would be made good if the closure were effected
under the regulations of the education code; and it is
certain that this should be so, otherwise a great hindrance
is placed in the way of checking the spread of disease. In
eight weeks ending with the second week of October, 57t>
fresh attacks took place, the schools being open. School
closure was then resorted to, and the new attacks fell in
three weeks from 76 to 10. They were then reopened.

s by Google

'VEB LANCBT,]

HEALTH OF ENGLISH AND SCOTCH T0WN8.

[April 23,1887. 847

'.h an increase to 23 and then to 42 a week. The fresh
.break was found to be associated with one single school,
d this being closed a second time, the disease subsided,
aonget the other matters dealt with in Dr. Fenton’s
jort is an account of the use made of the excellent hos-
;al for infectious diseases. As already implied, it could
t be n*uch used for measles, but 111 patients were
mitted, 84 of these suffering from scarlet fever. Formerly
ik followed on the sending of ohildren home direct from
e hospital, but under the arrangements now in force the
mmunication of infection by this means has virtually
ien put an end to. Excellent work was also done during
le year as to disinfection, 3140 articles and 91 houses being
ibmitted to that process.

Halifax Urban District .—With a population of 78,287,
le death-rate for 1886 was 22 2 per 1000. The borough
o-spital received 48 cases of infectious disease, 18 of these
eing typhoid fever; there were also 16 deaths from diph-
aeria in the borough, but no cases of this disease were
iceived into the hospital. Amongst the matters needing
afornu to which Dr. Ainley refers is the scavenging of the
oads, which is evidently badly carried out, causing needless
ffenaiveness to the public, and especially to the tradesmen
in the principal lines of traffic. The report of the sanitary
nspector shows an excellent amount of work, carried out
nith efficiency and regularity.

Lytham Urban District .—During 1886 there was an in-
irease in the number of cases of enteric fever, most of the
ittacka being associated with obvious faults in sanitary
irrangements. Good work is steadily in progress in the
matter of the removal of excreta and refuse from the
vicinity of dwellings; and manyof the old-fashioned privies,
which cause such abominable nuisance, have been done
away with. Complaint as to sewer ventilators has been found
to be occasioned by fault in the tributary sewers. Both
these and house drains joining them, if faulty, are likely to
cause nuisance in an otherwise good system of sewers.
Deducting the sad loss of life which occurred in the seven
lifeboatmen who were drowned during the year, the death-
rate waa 16 3 per 1000, the birth-rate being 26. Preston
Port is also in Dr. Eason’s district, and as to it he states that
he has had no occasion to inspect any vessel on account of
infectious disease. We hope we may assume that inspection
is not limited to such instances. The main value of port
sanitary inspection is to secure a gradual improvement in
the sanitary circumstances of the vessels and crews entering
the several ports, and we regard it of even more importance
to make a regular chronicle of the results of such preventive
work than to record action taken on the occurrence of such
diseases as would largely be prevented by systematic sanitary
inspection.

Sunderland Port District —Considerable vigilance was
necessary in this port during the past year owing to the
recurrence of cholera in Europe. The number of vessels
clearing from the port was 6982, and of these 2223 were
inspected for sanitary purposes. There were 37 written
notices served in consequence, all of which were complied
■with; and 289 verbal notices were also met in the same
way. Of the British ships inspected, 15 9 per cent, were in
an insanitary condition, compared with 10 2 per cent, of all
foreign ships examined. This reflection upon British ships
applies in tne main to those engaged in the coasting trade,
of which 6437 cleared from Sunderland, and the defects
complained of relate not so much to structural defects as
to great and inexcusable carelessness. The Danish and
Dutch cargo ships entering the port are typical examples of
cleanliness, and this notwithstanding the fact that they are
usually built of wood, and that many are old. Mr. Harris
pointed this but in the hope of inducing a greater
amount of care amongst the masters of British cargo ships.

. Watford Urban District. — This town, which has at
intervals suffered, a good deal from diphtheria, had some
recurrence of the disease last year, but both diphtheria and
other infectious diseases were 'isolated in the sanitary hos-
At one time the sewers were credited with mischief;
“ey are now flushed every fortnight, and a disused chimney
•haft is to be brought into requisition for the ventilation of
^ue portion of the system. Unfortunately, houses are being
hunt where they cannot at present be sewered, and hence
oeespools are resorted to. It is to be hoped that modern
oye-l&ws control the construction of such receptacle?, thus
eeping them at a distance from dwellings and water-
supplies, and preventing any escape either by soakage or
overflow. The death-rate during 1886 waa 18 per 1000.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5806 births
and 3696 deaths were registered during the week ending
April 16th. The annual rate of mortality in these towns,
which had been 23*5, 21-6, and 20*5 per 1000 in the pre¬
ceding three weeks, was last week 20 9. During the first
quarter of this year the death-rate in these towns averaged
20*0 per 1000, and was 2‘2 below the mean rate in the
corresponding quarters of the ten years 1877-86. The lowest
rates in these towns last week were 10 6 in Brighton, 14*6
in Halifax, 17 0 in Cardiff, and 17 8 in Derby. The deaths
referred to the principal zymotic diseases in the twenty-
eight towns, which had increased in the nine preceding
weeks from 340 to 602, further rose last week to 510; they
included 266 from measles, 115 from whooping-cough,45 from
scarlet fever, 32 from diphtheria, 26 from diarrhoea, 24 from
“fever” (principally enteric), and only 2 from small¬
pox. These zymotic diseases caused the lowest death-
rates last week in Birkenhead and Derby; and the
highest rates in Norwich, Hull, Sunderland, Manchester,
and Huddersfield. The greatest mortality from measles
occurred in Manchester, Sunderland, Norwich, and Hudders¬
field ; whooping-cough in Oldham, Plymouth, and Black¬
burn ; and scarlet fever in Bristol. The 32 deaths from
diphtheria in the twenty-eight towns included 21 in London,

2 in Bristol, and 2 in Liverpool. Small-pox caused 1 death

in Greater London and 1 in Blackburn, but not one in any
of the twenty-six other large provincial towns. Seven
cases of small-pox were under treatment on Saturday last
in the metropolitan hospitals receiving cases of this disease;
no new case was admitted during the week. The deaths
referred to diseases of the respiratory organs in London,
which had been 509, 417, and 363 in the preceding three
weeks, rose again to 363 last week, and were 107 below the
corrected average. The causes of 76, or 24 per cent., of
the deaths in tne twenty-eight towns last week were not
certified either by a registered medical practitioner or by a
coroner. All the causes of death were duly certified in
Salford, Newcastle-upon-Tyne, Portsmouth, Preston, Nor¬
wich, Plymouth, and Derby. The largest proportions of
uncertified deaths were registered in Liverpool, Hudders¬
field, and Brighton. _

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had declined in the preceding four weeks from 20*2
to 22 - 9 per 1000, rose again to 28*7 in the week ending
April 16th; this rate exceeded, however, by 2-8 the mean
rate in the same week in the twenty-eight large English
towns. The rates in the Scotch towns last week ranged
from 13*0 in Perth and 15 8 in Leith, to 27*3 in Glasgow
and 33 - 7 in Aberdeen. The 693 deaths in the eight towns
last week showed- an increase of 20 upon the number in
the previous week, and included 36 which were referred to
whooping-cough, 28 to measles, 10 to scarlet fever, 7 to
diarrhoea, 6 to “fever” (typhus, enteric, or simple), 4 to
diphtheria, and not one to stall-pox; in all, 91 deaths
resulted from these principal zymotic diseases, against 127,
111, and 102 in the previous three weeks. These 91 deaths
were equal to an annual rate of 2*6 per 1000, which was 0*3
below the mean rate from the same diseases in the
twenty-eight English towns. The fatal cases of whooping-
cough, which had been 31 and 33 in the preceding two
weeks, further rose to 36 last week, and included 15 in
Glasgow, 9 in Edinburgh, and 6 in Aberdeen. The deaths
from measles, on the other hand, which had been 58 and 43
in the previous two weeks, further declined last week to
28, of which 14 occurred in Aberdeen and 10 in Glasgow.
The 10 fatal cases of scarlet fever,including 4 in Edinburgh,

3 in Glasgow, and 3 in Dundee, exceeded those in the pre¬
vious week by 4. Of the 7 deaths attributed to diarrhoea,
showing a considerable decline from the numbers in recent
weeks, 4 occurred in Glasgow and 3 in Edinburgh. The 6
and 4 deaths referred respectively to “ fever ” and diphtheria
differed but slightly from recent weekly numbers; 2 from
“fever and 3 from diphtheria were returned in Glasgow.
The deaths from acute diseases of the respiratory organs in
the eight towns, which had declined in the preceding
four weeks, from 152 to 110, rose again last week to 12oj
and exceeded the number in the corresponding week of

848' The Lancet.] PUNCTURE OP THE TYMPANITIC ABDOMEN IN PUERPERAL CASES. [Ai>zur. 23,1887.

last year by 4. The causes of 55, or 9 per cent., of the deaths
registered in the eight towns during the week were not
certified. _

HEALTH OK DUBLIN.

The rate of mortality in Dublin, which had been BPS
and 300 per 1000 in the preceding two weeks, rose
to 34T in the week ending April 16th. During the
first quarter of this year the death-rate in the city
averaged 30 9 per 1000, the mean rate during the same
period being but 17'8 in London and 19-4 in Edinburgh. The
231 deaths in Dublin last week showed an increae of 28
upon the number returned in the preceding week ; they
included 7 which were referred to measles, 6 to “ fever ”
(typhus, enteric, or simple), 4 to scarlet fever, 4 to whooping-
cough, 1 to diarrhoea, and not one either to small-pox or
diphtheria. Thus 22 deaths resulted from these principal
zymotic diseases, against IS and 15 in the preceding two
weeks; they were equal to an annual rate of 3 3 per 1000,
the rates from the same diseases being 2'2 in London and
3 6 in Edinburgh. The fatal oases of measles exceeded the
number returned in any previous week of this year, and the
deaths from “fever,” scarlet fever, and whooping-cough
showed an increase upon those in the previous week. The
deaths both of infants and of elderly persons also showed an
increase upon the numbers in the previous week. Eight
inquest cases and 9 deaths from violence were registered;
and 78, or a third, of the deaths occurred in public institu¬
tions. The causes of 37, or 16 per cent., of the deaths
registered during the week were not certified.

THE SERVICES.

Deputy Surgeon-General W. Cattell has been appointed
Principal Medical Officer at Cork.

Deputy Surgeon-General Sir J. A. Ilanbury, K.C.B.,
embarked on the 21st inst. for Gibraltar, to take over the
duties of Principal Medical Officer.

Surgeon General Simpson, Sanitary Commissioner with
the Government of India and head of the Indian Medical
Service in Bengal, comes home shortly in anticipation of
bis retirement from the service next autumn.

Indla Office.— The Queen has approved of the follow¬
ing admissions to the Indian Medical Service:—To be
Surgeons (dated September 30tb, 1886): Bengal—Robert
Joseph Macnamara, M.D„ Herbert Wilson Pilgrim, George
Brooke French, Francis Wyville Thomson, Edwin Harold
Brown, Charles Norman Bensley, Selby Herriot Hen¬
derson, David Wilson Scotland, Charles Robert Mortimer
Green, James Henderson Sellick, Edward Christian Hare,
Frank Cecil Clarkson, John Gregory Jordan, John Digby
Marsh Swinburne, Herbert Mackinlay Morris, Allan '
Rupert Postance Russell, James Morwood, M.D., and
Edmund Alexander William Hall. Madras—Gilbert Capel
Hall, Richard Henderson Castor, Frederick Geo. Maidment,
Marie Joseph Toby Joinville Blancard, and Ignatius Purcell
Doyle. Bombay—Blenman Buhot Grayfoot and Thomas
Edward Dyson. *

The following Officers, whose admission to the Indian
Medical Service (Bengal) has already been notified, should
hare been placed in the .following order:—William Grant
Thorold, Patrick Hehir, Lionel John Pisani, Basanta Kumar
Basu, Narendra Prasanna Sinha, Wm. Rice Edwards, Charles 1
Mactaggart, John Fenton Evans, George James Hamilton
Bell, Joseph Thomas Daly, Henry Fooks, Ernest Hudson,
Arthur Cecil Deare, Arthur William Dawson, William Henry
Banner Robinson, and Henry Anderson Sheppard.

Admiralty. —Staff Surgeon Robert George Bird has been
promoted to the rank of Fleet Surgeon in Her Majesty’s
Fleet (dated April 11th, 1887).

' The following appointments have been made r—Surgeon
Thomas Nunan, to the Wasp (to date from 21st Inst.);
M*- James P. Smith, to be Surgeon and Agent at Ullapool;
aijd Mf. T. E.,.Mellerick to be Surgeon and Agent' at
Waterville. ’

RifLB .VpttTNTBBBS.—6th Durham: Surgeon and Hdtoo-^
riury Surgeon-Major P. Brown reslBW his commissloti; also’
iApenmtted to retain his rknk, and 'to contliihe to wear the
nUSuHri 6f the earns on Bis rarairat .(dated Aptfl 16th,

pril 10tb;

Comspoirlrme.

"Audi alteram partem.”

PUNCTURE BY TROCAR OF THE TYMPANITICT
ABDOMEN IN PUERPERAL CASES.

To the Editors of Thb Lancet.

Sirs, —May I be allowed to correct an error into which
Dr. W. O. Priestley has inadvertently fallen, through my fault,
in his note on the above subject in your issue of April 9th.
After remarking that Major Franklin had said that he recol¬
lected some suggestion of mine concerning tapping in such
cases, he adds, “ and Dr. Hicks tells me that though he had
suggested it as applicable under certain circumstances, he
had not himself employed it.” At the time Dr. Priestley
spoke to me on this subject I did not remember that the
last of four published cases which I had myself done was
after a case of Cresarean section. This case occurred in
1867. The report was read before the Obstetrical Society
of London in 1868, and published in vol. x., 1869. In one
of your contemporaries of that year the matter was dis¬
cussed by others as well as myself, cases being narrated,
and questions of priority raised showing that a number of
quite independent practitioners had been relieving tympany
by trocar; but it appeared that it had been employed In
France earlier than here. It was afterwards discussed in
the Clinical Society and published in its Transactions. I
believe that with care this operation might be had recourse
to more frequently than hitherto in cases of severe dis¬
tension, where the depression caused by the generally
accompanying peritonitis is much intensified by the pres¬
sure on the sympathetic system. In any case, I can answer
for an enormous relief to the sufferings of the patient, and
in some cessation of the constipation resulting from the
over-distension of the bowels by the gaseous contents.

I am, Sirs, yours truly,

J. Braxton Hicks.

George-Btreet, Hanorer-square, April 18tli, 1887.

To the Editors of Thb Lancet.

Sirs,— In 1875, while house-physician at St. Bartholo¬
mew’s. a case of scirrhus of the rectum was under my care.
The patient suffered acutely from distension due to flatus.
I therefore asked the house-surgeon to puncture the colon.
His refusal may be taken as indicating that this littie opera¬
tion was not fashionable in those days. Hence thiB short
illustrative note. I at onoe insetted a line exploring trocar.
While the g&s was issuing from the cannula, the patient
loudly proclaimed the relief attending its exit. One may
fairly presume that the puerperal cases are not unfavourable
to the performance of this simple but effectual operation ;
but surely the necessity for it? employment seldom occurs.

I am, Sirs, yours faithfully,

April 30th, 1887. T. H. Sawtbll, M.D. Lond.

THE MARGARET-STREET INFIRMARY.'
APPOINTMENTS.

To the Editors of Thb Lancet.

Sirs, —Will you allow me, as one of those who have
accepted vacant posts in the above institution, to submit,
with all respect, that in your implied censure (in the anno¬
tation this week) of any who are not " avowed hoineqo-
pathists” for accepting such vacancies you seem to take up
an untenable position ? The presence of homoeopathisbs on
the staff is either prejudicial to the interests of the pataante
or it is not. If the former, then the action of medical man
—not avowed homoeopathists—in joining the staff deaoratifr
your approbation, since by diluting homoeopathic infludnefe
and diminishing homoeopathic practice, they would tend,
ex hvpothesi, to augment the advantages and lessen tha ml
of the patients. If, on the other hand, homcaopathkts w
not imperil the welfare of the patients, there is no j dtiflt y*
tion for your condemnation of those who choose to stamps*
the same charity as they. Yott • may hold that
stated the teal point at issue, and maintain that,It ptjWw*
feSsiottal honour which is at state, ht Wbfohn*sfei£ gpfMM,
to me you Would exalt the importance of'boJyuuffingirnMMiv

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. 8C0TT1SH DIPLOMAS.—A DOCTOR’S INCOME,

[April 28 ,' 1687 # 849

tubers of the profesaion above the needs of those for
oae benefit the charity exists. Doctors are made for man,
; man for doctors. Supposing every member of the pro-
sion who is not a homceopathist, avowed or otherwise,
1. abstained from applying for the vacant post, one of
:» things must have happened—either the vacancies
uld have been filled by homceopathisto or not filled
all. I have dealt above with the question of a
□ciceopathic staff as affecting the patients; and as
:&rds the other alternative of the posts being left
2Ant, it comes to this: that the leading journal of a so-
led. noble profession—a profession which is supposed
embody some of the grandest instincts of humanity
ay implication advocates that patients should be left
stitute of advice until certain offending brothers, guilty
the unpardonable sin of differing from the majority
; jaecting therapeutic doctrine, shall be excommunicated.
« interests of the poor are to be sacrificed in order that
=>feaaional prejudice may be satisfied. For myself, I do
t profess kinship with either “’pstb." I believe it my
alienable right to pursue any path (in my efforts to relieve
a sick) which may, in my judgment, offer the fairest
omise of success; and I think members of a charitable—a
ogressive, liberal, and scientific -profession, whose views
a notoriously in a chronic state of change, should
nerously accord to others the same liberty of opinion
ey claim for themselves. Of this I feel assured: the
iblic—and particularly the poor who may avail themselves
this chanty—well know how to appreoiate the moral
urnge of those who, at the risk of being branded as
>moeopathi8ts, and boycotted accordingly, consider it an
>nour to serve the needy, though it be in the Margaret-
reet Infirmary. Even if exposed to contamination therein,
e shall have the satisfaction of continuing, with enlarged
iportunities, our quest for what is still undetermined—
ie truth about therapeutics.

I am, Sirs, yours obediently,

John Beckett.

nrook-street, Grosvenor-square, W., April 18th, 1887.

To the Editors of The Lancet.

Sirs, —Permit me to state, in reply to the, no doubt unin-
•ntional, sugijestio falsi contained in your paragraph anent
ie Margaret-street Infirmary, that I am not a homoeopath,
r any other kind of “’path,” either “avowed” or covert;
ad in order that there may be no misunderstanding, I mean
hat I do not adopt the dogma of similia timilibus curantur,
r any other dogma, as my rule of practice, but aim as nearly
3 may be at a rational empiricism, ignoring no source of
lformation claiming to be backed by clinical experience.,
ly opinion on matters therapeutic cannot be more lucidly
tatedthan you have yourselves expressed it in yourleading
rticle of to-day: “ The ordinary practitioner differs from
he homoeopathic in being free to use any drug which he
nows to be of use in the case, and that in any quantity
xperience shows to be best.” I accord in toto with the-
oaitive side of this statement, though as regards the
legative side I have yet to learn that homoeopathic prac-
itioners repudiate that freedom. Having, I need scarcely
ay, expected some antagonistic remarks on the matter, I
vaa prepared to make the above statement, but being fully
iware of the vast amount of prejudice which exists, I had.
letermined to keep silence on the ethical side of the
lueetion. However, the moderation of your leading
article, when dealing with the subject of homoeopathy,
nducea ms-whether judiciously or not remains to he,
teen—to depart from that determination, and to offer %
cw remarks. Considering your admission that homceo-
jathy has done some service to medicine; considering,
he tact that I am frankly compelled to admit the deW-
; owe (I will not say to homoeopathy, but at any rate)
o individual homoeopathic practitioners for the intro-_
1 action to certain drugs, particularly in my own special '
1 apartment of practice (e.g., the tinctures of apis melltflea
uid of sesculus hippocastanum), as well as for the extended 1
sphere of utility of others (e.g., bichromate of potash 'fi
of all Of which l shall by-and-by have something to sayv
Founded not upon any dogma but upon clinical experi¬
ence ; and considering that for the survival of one or
two principles bf therapeutic action—e.g., the value of
minute subdivision in developing therapeutic power in
comparatively inert substances (of which a dark example

remains to us in the hydrargyrum c. cretA of the B.P.)
—medicine is, X believe, mainly indebted to homoeopaths, I
fail to see the logical consistency of maintaining in publie
relations a position of exclusiveness, especially on the sur¬
gical side, which is being, to my absolute knowledge, tacitly
elielved every day in private practioe by numbers of my pro¬
fessional brethren holding positions on the staff of hospitals
connected with the great medical schools. Remembering, as
I do, the outcry and prejudice aroused by the utterances of
Dr. Bristowe and Mr. Jonathan Hutchinson at the British
Medical Association’s meeting at Ryde, I do not anticipate
that these remarks will have any weight with those from
whom 1 have the misfortune to differ. But perhaps they
may serve, at any rate, to show that in medical as in other
politics it is possible for two parties to arrive at diametri¬
cally opposite conclusions in perfect sincerity and good
faith. With apologies for occupying your valuable space to
such an extent with personal and therefore uninteresting
matter, 1 remain, yours faithfully,

Welbeck-«tre«t, W., April 16Ui, 1887. KENNETH MlLLICAN.

SCOTTISH DIPLOMAS.

To the Editors of The Lancet.

Sirs,— In The Lancet of April 2nd we have your leader
and Mr. Berkeley Hill’s remarks as to Scotch and Irish
qualifications, which are blackballed, in comparison with the
“ London diplomas ” of L.R.C.P. and M.R.C.8., a subject not
new to your paper, especially the “ Scotch ” part of the
question. It is, I think, a great pity that gentlemen in the
position of Mr. Berkeley Hill in the profesaion should deal in
such statements, supported by him by no argument, good, .
bad, or indifferent. If you or he can find holes in the Scotch
system of examination, in its results, in itB methods or the
degree of competency it insists on, in the breadth and com¬
pleteness of the test for any Scotch diploma at all, why do-
you not do so ? Why does not Mr. Berkeley Hill do so ? Any
person who likes to observe or inquire into the truth of this
matter will simply find that all such statements are the
result of a warped judgment—I might justly add, in very
many cases of jealousy. The English public respects
Scotch diplomas. Tliat is a truth that will stand probing,
and the success of men holding them as an integral part
of the medical profession is notorious and above cavil.
And why ? The reason is not far to seek if Englishmen
could put- aside their “ green spectacles,” and I will state it
briefly. The “evolution,” of the English medical man is
only now, in 1887, reaching a point that it had > reached in
Scotland centuries ago. In medical education and examina¬
tion the Scotch, system always did, and does yet, involve a
complete curriculum, a complete examination, and; a com¬
plete qualification, in England, as is well known, such has
not been and is not the case yet, or until very recently. It
is to become law in June, 1887; and I say it fearlessly that
England is.only now attaining a point of efficiency in
matters of medical qualification that was attained in Soot-
land 2o0 years ago. This is true of medioal education and
examination. It is likewise true of the general education
of the respective nations of Scotland and England. Scotland
has led the van in advance by hundreds, of years. I will

f trove what I say if you or your readers choose to oontravert
t; meantime, I must not encroach on your valuable space
further, I am. Sirs, yours faithfully.

Birmingham, April 16th. 18S7. JAMES OlLROY, L.F.1\S>(«LAS.

- A DOCTOR’S INCOME. 1

To the Editors of The Lancet.

' Sirs,—V arious articles have been appearing in The
Lancet lately in regard to the position of the profession
and the pressure on the general practitioners produced by
the depression of trade, by the competition of hospitals, and
so on. As we general practitioners have no voice but
through the medical press, may I ask space for a rather long
letter ? The differences which separate consulting physioians
and surgeons on the one hand,-and family doctors on the
other, are as wide and deep as those between barrister and
solicitor. The general public do not know this. They
imagine that any clever ambitions lad who can find the
funds to Bqueere into the profession somehow may rise to
be Sir Somebody Something with an income of £16,000 a

850 The Lancet,]

GASEOUS RECTAL INJECTIONS IN CONSUMPTION.

[Apbil 28,1887.

year. If they knew how hopelessly improbable this is, and,
further, knew what the actual financial prospects of a lad
entering the profession (to be a family doctor) are, I cannot
believe such numbers would continue to crowd in. I have
made several calculations to enable me to arrive at a
correct estimate of a general practitioner’s income, which I
submit. The first method I adopted was to add up the
value of all the practices advertised for sale in various
numbers of Thb Lancet. The mean of 175 practices was
.£625 a year, which I consider as the average income of the
family doctor. From this I deducted the working ex¬
penses. Taking into consideration surgery expenses, drugs,
horses, carriages, assistants, dispensers, &c., I reckoned these
as ranging from .£25 a year to £500. I allowed three small
practices to two medium and one large, and this gave the
mean working expenses as £150 a year. Again, I reckoned
the average cost of a medical education at £700. I have
further estimated the cost of starting in practice, whether
by making a practice or buying one (much the same as
regards expense, I take it), at £1000. This gives £1700 capital
sunk. On this 1 have reckoned 5 per cent, interest—i.e.,
£85 a year and £35 insurance premium to safeguard the
capital, or £120 in all. My sum stands thus

Average gross income of a family doctor ... £625

Average working expenses of do.£1501 r, 0 _ n

Interest on capital sunk.£120 j

Mean net income. £355

Further, it being usually necessary to live in an important
thoroughfare, we pay higher rent, and therefore rates, than
most men with incomes of £355 a year. We pay income-
tax on the £120 a year, which enables us to recover our lost
capital. Out of the remaining £355 we have to save for
sickness and old age, and yet we pay income-tax on the
whole. The pensioned classes pay no income-tax on the
sums that Government virtually lays by for them. Finally,
while carriages are a necessity in almost all practices over
£500 a year, we pay tax on them on the ground that they
are luxuries ! If all this is considered, we can hardly esti¬
mate a doctor’s income at much over £300 a year. This is
the income of those who have practices, but there are
hundreds of men who for lack of capital or other causes
have no practice. They are assistants at salaries ranging
from, say, £50 to £160 a year and their board; or they are
vship’s surgeons at a salary of about £80 or £90 a year and
their food whilst on board ; or they are house-surgeons or
physicians at salaries ranging from nothing to £100 a year
and their board. If all these men were taken into con¬
sideration, I feel sure the net income of a general prac¬
titioner would be found to range somewhere near £200 a
year. I will now consider this question from another point
of view to check my first results. Of the 175 practices I
examined for the purposes of this letter, seventy-three, or
nearly one-half, were purely country practices, and the
mean gross income of these was only £442 a year, and
therefore the net income probably not much over £200 a
year.

Again, I will take a third point of view. I know of a prac¬
titioner who travels four miles for a charge of 1«. a
visit-, one-quarter of the cab fare that would be charged him
if he hired a public conveyance. This does not sound profit¬
able, but there is worse to come. Almost every country
doctor has a benefit club included in his praotice,ior attend¬
ing the members of which he receives from 4 s. to 6s. per
head per annum. I find that the mean sickness per head
per annum, according to the experience of the Foresters,
is 1*917 week, or say two weeks, per annum per head—
equivalent, say, if the work is honestly done, to six visits
per bead per annum. This gives us from 8 d. to 10 d. per
visit, including medicine. The parish doctor descends still
lower. A vacancy was advertised recently in Thb Lancbt.
A parish doctor was wanted for a district having an area of
twenty-four equate miles. I presume this doctor was not
expected to walk his rounds? In that particular county
one in every twenty-six of the population is a pauper.
Allowing the visits to average seven per head, instead of six
for the members of friendly societies (as women and children
are included as well as men), the doctor will receive about
7 d. per visit, out of which he has to find medicine and
carriage expenses. Lower still are the “sixpenny” dis¬
pensaries of London. Lastly, every medical man does some
work for nothing at all. With such rates of remuneration,
how can the profession prosper ? Do you wonder now that

you hear daily of medical men dying utterly penniless?
Remember that a doctor works on Sundays as well as week¬
days, by night as well as by day. It is more difficult for
him to get a holiday than for almost anyone. Besides his
hard work he has many special perils—perils of epidemics,
perils of post-mortems, perils of exhaustion from want of
adequate rest or sleep, perils of exposure at night when ill,
and nowadays we must add perils of worry from vexatious
actions or false accusations. Such is the state of affairs
what is the remedy ?

I am. Sirs, yours faithfully,

April, 1887. E. Pagkt Thubotah, M.D.

GASEOUS RECTAL INJECTIONS IN
CONSUMPTION.

To the Editors of The Lancet.

Sibs,—D r. Burney Yeo’a able Lecture on Gaseous Rectal
Injections in Consumption is a welcome contribution on a
subject which is exciting much notice, and, along with a paper
which appeared in one of your medical contemporaries last
December, will doubtless serve to bring Bergeon’s method
still further under the attention of practitioners in this
country. After making some trial of it, I wrote to Mr.
W. H. Perkin, F.R.S., regarding tests for discovering chemi¬
cally the vapour of bisulphide of carbon in the breath, in
order to find out if it was eliminated unchanged, and, in
replying, he cautioned me on the injurious effects the
bisulphide sometimes produces on the health of those work¬
ing with it. That such cautions were not altogether need¬
less was soon proved by the symptoms which overtook one
of my patients: great irritability and moroseness, and a
“ tipsy feeling,” which so distinctly amounted to incapacity
for work or clear thinking as to be noticeable by others.
My object is not to deter practitioners from the use of
bisulphide of carbon vapour, out to advise that care should
be exercised about the dose, and particularly about the fre¬
quency of its administration, for its elimination from the
system appears to me much slower than that of sulphuretted
hydrogen. As the symptoms did not come on till after many
days of its use, I am inclined to trace them to accumulated
arrears of imperfect elimination. Those who care to inquire
further into these symptoms may refer to “ Blyth’s Poisons,
their Effects and Detection.”

I have now abandoned the use of the bisulphide, and
adopted the sulphuretted vapour from the Eaux Bonnes
water. Dr. Burney Yeo properly remarks on the incon¬
venience of obtaining this water. Perhaps Harrogate might
be an available source, for the old sulphur well there con¬
tains 5 3 cubic inches of sulphuretted hydrogen per gallon,
as against cubic inches per gallon in the water at Bonnes.

I am, Sirs, your obedient servant,

Ventnor, Aprill9th. 1887. JAMES M. Wn.LT AMBON.

“SURVIVANCE AFTER GUNSHOT AND OTHER
WOUNDS OF THE HEART ”

To the Editors of The Lancet.

Sibs,—S hould the following account of a case of wound of
the heart, with which I have been just favoured by my old
friend and correspondent Dr. James Martin of Portlaw,
approveitself to your better judgment, I will thank you much
to give it the benefit of your great publicity, it shown, at
least, great faith in the curative virtues of bleeding, and
mky, bo far, interest those laudatores temporis acti of our
art who, if there be still any such amongst us, regret the
disfavour into which that once much-admired remedy has
fallen. But of this anon. Writing under date April 3rd
instant, my kind informant says: “Reading your paper in
The Lancet to-day recalls to my memory a case in which
I was interested so far back as 1827, while I was serving
my second year’s apprenticeship in the Queen’s County
Infirmary. It stands thus: ‘ A man who was going home
from the town (Maryborough) attacked another (who carried
with him a bayonet for his protection) with a loaded whip.
The attack was repelled by a thrust of the bayonet, and this
thrust floored the man, who fell down and became at once
unconscious. He remained in this state during the fifty-
three hours he survived, and meanwhile ninety-six ounoes

Digitized by CjOO^Ic

Th* Lancet,]

THE TREATMENT OF PLACENTA PiLEVLA.

[April 20 , 1887 . 851

of blood were taken from him, at intervale, during this
time. Notwithstanding this deprivation, however, he
did not die from lose of blood. On the contrary, the
young man—who wa^ just on the poiut of qualifying—who
remained in constant attendance on him, maintained to his
dying day that this patient would have lived had the
surgeon in charge permitted him—the young attendant—to
take more blood from him. On examination of the remains
there was only one mark of injury on them—viz., a small
triangular wound two inches below the edge of the ribs on
the left side. The weapon seems to have traversed the
stomach and penetrated the diaphragm, the pericardium,
and the wall of the left ventricle. The pericardium con¬
tained a large fibrinous clot, which had undergone some
organisation, but the fibrinous element predominated in it.”
It is, in either case, not easy to see how phlebotomy,
even usque ad deliquium, could have prolonged this poor
fellow’s life. Yet such was one of hi9 quasi-qualified
attendant’s belief; and this belief affords of itself another
illuetration—were any such wanted—of the fact that
nothing takes so much killing as an old superstition.

I am, Sirs, your obedient servunt,

Auriol road, W., April 10th, 1887. Wm. CURRAN.

To the Editors of The Lancet.

Sirs, —With reference to the paper on the above subject by
Brigade Surgeon Curran, in The Lancet of the 9th inst., the
following brief abstract of a “ gunshot wound case of tlie
heart” may throw a ray of light on the subject, and be
deemed of sufficient interest to publish.

About ten yqprs back, whilst I held medical charge of the
R.A. division at Allahabad, North We6t Provinces, Bengal, a
gunner of the division deliberately shot a sergeant of his
own battery one night. The poor Victim, an excellent non¬
commissioned officer, highly thought of, in some way
incurred the ill-will of the murderer, a good-for-nothing,
morose, ill-tempered man, of intemperate habits; and as the
sergeant, accompanied by a comrade, reached the top of the
stone staircase leading to his own quarters, a little after
gunfire—i.e, nine o’clock at night,—the bullet struck him
as he turned towards the left hand side to go to his own
room. It was given in evidence, I believe, by the non-com¬
missioned officer who was by his side, and had ascended the
stairs in his company, as well as from information given
me by others who were near enough, to hear, that the poor
fellow, when shot, turned round about a quarter-circle
towards the spot whence the shot was fired—a doorway to
the left and behind the stairway, fifteen to twenty feet only
away—advanced a few steps to wards the murderer, whom he
was able to clearly recognise by the barrack-room and

passage lamp, saying, as he did so, “Ah ! is that you,-?"

or somewhat similar words, showing he saw clearly who it
was that had fired the shot, and then reeled and fell to the
ground. Of course, I am speaking from memory, but the
unnsoal occurrence made a deep impression on my mind.
Moreover, the whole facts of the case were fully recorded in
the official reports and trial in the High Court. The post¬
mortem examination was also noted by me in the case¬
book at the time. Suffice it now to say that I found the bullet
had struck the left ribs—fourth or fifth, as well as my
memory recalls—external to the nipple line, then passed
through the anterior portion of lung overlying the heart in
that position, had passed backwards through the left
ventricle, inflicting two ragged wounds, then through the
root of the right lung, smashing two ribs on the right side,
and was found in several large and small pieces scattered
abont the right axilla, and under the scapula of the same
side. The weapon used was a Snider carbine, calibre 0 577,
with full service charge of powder, and fired not over
twenty feet away; yet, in spite of the terrible wound
inflicted oti the heart; there was evidence to prove that not
only was the murdered man able to turn partly round, but
also to walk a few paces, speak in a clear voice, and to
clearly recognise his assailant.

Two fafcts may be considered interesting as bearing out
Brigadd Surgeon Curran’s views regarding the murder of
the native Kadir Rear Peshawur, and of his being probably
able to speak and recognise his assailant after receiving
the fatal.‘Wbtindirin the heart, and it should be remera-
bered' fl&t i Stfidei 1 bullet is over half an inch (0'577)
in di i fed tbrftiftd'’ftSilaBy inflicts a terrific wound, as I have

seen a case where a similar bullet striking a man in the
forehead tore out nearly the whole of the occipital bone in
its exit. The case may also be interesting from a medico¬
legal point of view.—I am, Sirs, yours truly,

April 12th, 18S7. J. E. FlSHCOCRNE, M.D., F.R.C.S.I.

To the Editors of The Lancet.

Sirs, — In connexion with Brigade-Surgeon Curran's
interesting paper on the above subject, allow me to draw
attention to the following passage from General Gordon’s
Journals at Khartoum, page 17:—“One man received a
wound in the chest; he lived eleven days, and died. The
doctor found a bullet lodged in the centre of his heart, m
wall of ventricle. The doctor has this heart in spirits. It
was a ball weighing the same as our Martini-Henry bullet.”
Accompanying the paragraph is a drawing showing a section
of the heart and the embedded bullet, thus proving that the
General bad seen and sketched the specimen. The record,
apart from its pathological interest, is a striking instance of
the catholic sympathies of the hero of Khartoum.

I am, Sira, yours faithfully,

Brighton, April 7th, 1337. JAMES TURTON, M.R.C.S.

THE TREATMENT OF PLACENTA PR.EVrA.

To the Editors of The Lancet.

Sirs,— 1 have read with iatereat Dr. Braxton Hicks’ letter
in yonr issue of the 9th in9t., and fully endorse his supposi¬
tion, “that no particular method of managing placenta
previa can claim being the treatment." Also the rule,
“deliver as early as possible after the recognition that the
placenta is about or athwart the mouth of the womb,” with
the addition, “do not leave the patient till she is delivered.”
In many cases, however, where there is a sharp loss after
detachment of the placenta as far as the finger can reach
and it is not possible to turn and plug the os by the
leg or breech, I have found the air-ball pessary simply
invaluable. . ,

Some four or five years since I was called to a primipara
—the smallest woman I ever delivered,—who had been in
pain for some hours, and was losing freely. The history
was that of placenta prasvia. With the greatest difficulty
I reached the op, which barely admitted the tip of my
finger, and, finding the diagnosis correct, ruptured the
membranes and detached as much of the placenta as pos¬
sible, My patient suffered from a weak heart, precluding
the use of chloroform; hex abdomen was so unusually
tender that any handling was impossible; the vagina barely
admitted two fingers, and sharp bfemorrhage was going on.
An air-ball pessary (I always carry one in my bag) was
applied, which at once stopped the bleeding ana so stimu¬
lated the os by its pressure that regular pains began almost
immediately; the vagina at the same time being dilated by
the artificial wedge. Twice the ball was withdrawn and
reapplied—after the finger had been swept around the os,—
being kept as large as the patient could bear it, so assisting
dilatation that although the forcepe were applied as soon as
the os was sufficiently open, the perineum wa9 uninjured
and the recovery perfect. Since that time, in every case of
placenta praavia, save one, I have adopted this plan, with
the same success.

The exception mentioned was that of a woman who had
been attended by a medical man from a cheap dispensary,
and who had calmly watched her flooding herself pulseless—
the condition in which 1 found her—from Friday morning
until 11 p M. on Monday, when the husband begged me to
save his wife, if possible. Another medical man had been
previously fetched, but he declined to undertake the cas§,
and promptly retired from the scene. I found the room
like a slaughter-house; the child’s right hand and funis pro¬
truding from the vulva, the arm fortunately plugging the
os, and the patient requesting that she might be allowed to
die in peace without further torture. After administering
eggs and whisky, the only available nourishment, I
detached the placenta as far as was necessary, turned,
delivered, and was able to leave the house within the hour.
The patient recovered without any bad symptoms.

1 am. Sire, yours truly,

T. Walker Coffin, F.R.C.S. Ed.

• Haventock-hUI, N.W., April lltb, 1887. .

ed by Google

852 The Lancet,] “ PASTEUR’S METHODS.”—INTERNATIONAL STATISTICAL CONGRESS. [Aran. 23,1887.

CURRELL’S CASE.

To the Editors of The Lancet.

Sins,—Having presented a numerously signed medical
memorial to the Home Office praying that an examination
should be made of Currell previously to allowing the law to
take its course, as suggested in your columns, I give a few
facts relating to the case. The Home Secretary responded
to the prayer of the petitioners, but, so far as I can judge
from the account in the newspapers, the examination was
directed to his present state, not his past, which was the
point raised by the petitioners. Since his'execution, I have
had Currell’s verbatim confession placed before me. The
opinion I entertain remains as before. It is confirmed
by the statement. Currell says: “ I have been for a
long time accustomed to taking drugs, and have had
frequent bouts of drunkenness. One of these bouts com¬
menced about a week before the murder. During the
whole of the succeeding week 1 had very few sensible
moments, and, if I were to have my liberty for it, I have
not the slightest recollection of how I spent the whole of
that week.” This was part of a confession written on
Sunday night, within a few hours of his execution. It
accounts for the “ irrational state of mind ” into which Mr.
Justice Grantham says he must have been at the time, and
justifies any petition that was forwarded asking for a
medical examination. His apparent indignation at being
thought irresponsible is made much of in the papers as
evidence of his sanity. It is a well-known fact that many

E ersons would rather go to gaol as rational beings than be
berated on the ground of unsoundness of mind. This fact
also strengthens my Argument. The whole case from begin¬
ning to end was one of moral insanity. Whether caused by
drugs, alcohol, or not, the case remains the same, and
aggravated by strong hereditary taint of mental disorder.

I am, Sirs, yours obediently,

L Forbes Winslow, M.B.Cantab., D.C.L.Oxon.

Hammersmith, April 20th, 1887.

“PASTEUR’S METHODS.”

To the Editors of Thb Lancet.

Sirs,— In his letter under the above heading in your issue
of the 9th inst., Mr. Vincent Richards expresses his anxiety
that the dangers of Pasteur’s prophylactic treatment for
hydrophobia should be recognised, but he seems somewhat
to ignore the much greater dangers of untreated bites from
rabid animals. It is largely a question of statistics. Mr.
Richards’ reasoning about the necessity of the prophylactic
inoculation being begun on the day of the bite rests on a
misapprehension on his part of the facts of the cose, for as
regards length of incubation, there is all the difference
between accidental bites and inoculation by trephining.

The published statistics up to the end of last year are as
follows

Pari*.

Odessa .

6t. Petersburg
Moscow ... ..

Vienna .

Warsaw .

Naples .

Samara .

. During the present year several more deaths have occurred
/some, very possibly, from the treatment), but they do not
appear to have exceeded 12 or 15, bringing the total
deaths: from aU causes among these 3500 persons to some¬
thing less than 80, and giving a. mortality not exceeding
.24 per cent, la contrast with.^this we must place the

No. of case*
treated.

Deaths from
all causes.

Mortality.

2730

45

Under 2 per cent.

325

12

•• 4 „

118

1

.. 1

112

2

2

P8

0

—

84

0

—

48

• 0

—

47

2

Under 5 per cent.

3660

62

Under 2 per oent.

that for every dea

is final and certain, but I think the evidence for it should
not be lost sight of by those who are so keenly alive to the
dangers of Pasteur’s system of treatment.

I am. Sirs, yonrs &c.,

April 12th, 1887. _ R. J. P. 8.

THE INTERNATIONAL STATISTICAL OONGRE83.

(From our Correspondent.)

Upwards of fifty representatives of statistical research
met on Tuesday, the 12th inst. in the hall of the Ministry
of Finance, under the presidency of Sir Rawson W. Rawson,
to inaugurate the first International Statistical Congress.
There had been other meetings of a similar kind. In which
the statisticians of all countries assembled to compare their
work—meetings composed of official delegates of different
European states, and first set on foot in 1853 by M. Quetelet,
But international jealousies had marred their efficiency—
notably, on occasion of their permanent seat, having been
proposed to be fixed in Paris, when the German delegate
intimated that in that case they either would not or could
not attend, and so at the jubilee meeting of the Statistical
Society of London in 1886 it was resolved to make the Inter¬
national Congresses independent of all Government^ repre¬
senting simply the best science of each country, though, of
course, quite open to receive whatever co-operation or support
these Governments would vouchsafe.

Italy showed herself, as she always does, full of hagri-
tality towards the visitors who had come to assist ahthe
august occasion, and her Minister of Agriculture and Com¬
merce, Signor Grimaldi, opened the proceedings by a Kisf
address in French, in which, after indicating the valid* of
statistics as a basis for legislation throughout the Whole
civil order, hygiene included, he extended to the Gongree
the welcome of the Italian Government.

Sir Rawson W. Rawson followed, also in French, of which
he is a master, and gave a lucid narrative of the pztogfoft of
statistical organisations, of the circumstances in whu& thb
first unofficial or purely scientific International Statistical
Congress was being held in Rome, and of the rules and
regulations which had been devised and approve&filf the
“ International Statistical Institute,” as it is henoefoffit to
be called. '

The institute is au international association havintffbr its
object the development of the progress of admihSttrative
and scientific statistics: 1. By introducing, as fardin&sible,
uniformity in the methods of compiling and aSsbacting
statistical returns, and by adopting it in the compilation of
statistical publications, with a view to a compariSojkof the
results obtained in different countries. 2. By liMtag the
attention of Governments to the various probleinrf &pable
of solution by statistical observation, ana by aj^Trihg
information on those subjects which have hot -mtntrto
received adequate statistical treatment. 3. By prjj|ariBg
international publications as a means of bringing mho Com¬
munication the statisticians of various countne*.“ 4. B j
endeavouring, through the medium, of publication iwl, ^
practicable, by public instruction and other suitable hfeUA
to foster the general appreciation of statistical seteti&Ctad
to stimulate the interest of Governments and indivMfcfBa in
the study of social phenomena. ... '*T

The sitting of Wednesday, the 13th, wad
interesting. Professor Neumann Spallart, of t
memoir on “ Social Statistics,” in which he ea
characteristic clearness the method devised uj
estimating with the greatest possible precision
and economic state of a country in a given p«
arriving at a numerical and approximately exact
of the conditions, economic, social, and.tooraL d
Restricting his data to Western EOrc^e^ ( and .1
States of America, he explained the
whereby he proposes to determine
country for each year. On the same a
the mean of emigration, of cismet of^$M
be called a barometer of sociologloj and.
nomena. He has convinced himsalf
at approximate sociol

TV

Tot UhobtJ

THE RIVIERA IN 1887.

[April 23,1887. 853

•bich the method was criticised from the point of view of
in economist, the statesman, and the hygienist, and a
stalled reply on the part of Professor Neumann Spallart
rought the discussion to a close. The official report cannot
ul to interest all scientific readers—not least the medical
Of much more direct professional interest was the memoir
f Dr. Ldon Vacher, member of the French Corps Ldgislatif
nd president of the Statistical Society of Paris. His subject
.-as the “ Diminution of Mortality and the Augmentation of
he Mean Duration of Life in Europe.” Having established,
rom official returns drawn from the various statistical
tureaux of European States, that mortality is lessening and
hat longevity is increasing in the more civilised countries,
is passed in review the causes which have produced, or
vhich have contributed to produce, this result; first, among
he latter—that is, the contributory—causes being, in his
iew, so fair as France is. concerned, the French Revolution,
rom the economic ameliorations it brought in its train and
he more effective organisation of State medicine, lie also
irew confirmation of his doctrine from the sanitary coa¬
lition of the young Italian kingdom, and dwelt on the
immense progress made in a few years in public hygiene
throughout the peninsula as highly creditable to nineteenth
century sanitation. Turning to Rome, he said that from
the hygienic point of view the city was scarcely recognisable
as the same centre of population which existed before 1870,
a fact which redounded highly to the praise of the Italian
Government. Dr. Vnchers paper, which was heard with
much attention, and emerged from the subsequent discussion
with ite main positions unshaken, will form not the least
interesting of. the publications of the Congress shortly to
appear, with their author’s revision, under the editorship of
the Commandatore Ellena, secretary to the Ministry of
Commerce and Agriculture.

The subject, so well introduced by Dr. Vacher, was followed
up by a communication from the Cavaliere Bodio, of the
statistical bureau of Rome, to whose unwearied and well-
inspired activity the success of the Congress is largely due.
This was a table, with a diagram on the “Lexis ” moo el, for
calculating and comparing the mean mortality at the
different periods of life aud in different countries. This the
(fevaliere explained in a lucid exposition, and set forth
many interesting facts on the ratios of births and deaths, on
the malaria, and on the other sources of disease prevalent in
Italy. The discussion was continued by Professor Levosseur
and others, and a really instructive report was compiled far
Signor Ellena’s editorship.

Friday’s sitting began with a report drawn up by Sir
Rawson W. Rawson and Signor Maffeo Pantaleoni, on the
“Means of preparing in each country a catalogue of publi¬
cations, official and non-official,giving exact information on
every one of the more important branches of statistics”;
after which, at 8 P.M., Dr. Ole Jacob Brocb, sometime
Minister of State in Norway, and correspondent of the Insti¬
tute of, France, read a paper on the “ Consumption in Europe
of Nervine Excitants: the Alcohols, Coffee, Tea, Cocoa, Sugar,
and Tobacco.” Beginning with a retrospect of the introduc¬
tion into Europe of aloonolio beverages, which have made
i mme n s e strides from the early years of the eighteenth
century to our own days, he showed by numerical data that
the countries in which the consumption of these is greatest
are Denmark, Belgium, Russia, and Germany; next come
England and France. .Italy is one of those in which the
consumption' is least. _ He maintained that in Norway the
consumption of spirits is decreasing, owing to legislative pro*
visions restricting their sale and also to the temperance
societies, ,vyHe then treated of the production, and consump¬
tion of coffee, tea, and oocoa, showing that the production
of ooffee in the latter half of this century has doubled,
while the countries that; consume most of it are the Nether-
modv Belgium, Norway, and Russia. Tea is mostly con¬
sumed;, in England, after her coming the Netherlands,
Danmark, and Russia; while the countries in which Hie
cposumptian of cocoa is greatest are. Spain, France, and
bwUaemn<L As in the case of the aloohols, so in that of
these beverages, he supported his conclusions by financial
returns. Passing next to the general production and con-
sumptun of sugar aud the rise of prices, he noted that the
Production of Barbados sugar has probably attained its
“wmum. England, Ireland, and France are the greatest
of Bttgar—<rom 1880 to 1884 from two to three
tons of .at having been used. Its consumption,
^desd.jn < >l the increase everywhere. Finally he demon-
tha% the production and consumption of tobacfco

amounts to 500 millions of chilogrammes yearly, its
consumption being greatest in the United States of America,
in the Netherlands, in Denmark, England, Germany, Sweden,
Norway, and France. The state revenue from the con¬
sumption of tobacco exceeds a milliard of francs, France
deriving the most from it and Great Britain next. An
interesting and animated discussion on Dr. Broch’s essay
ensned, in which the Swiss and German delegates took the
chief part.

The remainder of the proceedings included no other topic
bearing directly or remotely on medicine.

Saturday’s sittings were the last, and, among the incidents
of the forenoon, was the invitation of M. Inama Sternegg,
of Vienna, to the members of the institute to attend tne
great Hygienic and Demographic Congress in the Austrian
capital in September next.

M. Korosi, in the afternoon, read a paper in which he pro¬
posed to make international statistics uniform by the adop¬
tion of a table containing the following heads:—1. Statistics
Of houses and of the families occupying them. 2. Statistics of
families according to the number of their members. 3. Agglo¬
meration of the population and classification of cities.
4. Classification of the population by sexes. 5. Classification
by age. 6. Bachelors, married men, widowers, divorced
husbands, according to see. 7. Nationalities. 8. Religious
creeds. 9. Unlettered (analfabeti), according to age. 10. Place
of birth., lh Distinction of groups under 2000 inhabitahts
in the country and above 2000 in the town. 12. Physical
and moral disease.

' A conversation then ensued on the next time and place of
meeting, and it was finally resolved to convene the Congress
for September, 1889, in Paris, under the presidency of Sir
Ratoon W. Rawson.

■ -The Ministers of Commerce and Finance, Signors Grimaldi
and Magliani, then congratulated the members of the Inter¬
national Statistical Institute oar the success of their first
Congress, and expressed their satisfaction at Rome having
been made its seat. Sir R. W. Rawson gracefully returned
thanks, and the Congress thereafter dissolved.

. The proceedings were lightened by many acts of hospi¬
tality on the put of the Italian Government towards the
members—admission to the first representation in Rome of
Verdi’s Otello, a banquet given by bis Malesty King Humbert
jn the Quirinal Palaoe, and an excursion to the Falls Of
Term (rendered famous by the description in “Childe
Harold,” and now utilised for the manufacture of Steel
plates for ironclads) being among the entertainments
provided for ti)e“oongreeeisti,”

Roma, April ITth.

; THE RIVIERA IN 1887.

! 1 til* XARTHQUAKT?.—MONTHStTX.—LBS AVANI8.

{By our Roving Correspondent.) , r i :•

! (Concluded from p. 803.) •

RATHkB severe strictures have been matte in the French
press and elsewhere a propoe of the very general, exodus
which tqok place after the earthquake. Those who have
made toem have*given no reasons to show that the move
away was, under the Vrircumetanees, unwise or impolitic.
NOver, probably, in the History of the torid, hikkaiihil^r
catastrophe occi#re& among a population sp essentially
mobile. At Nice-and Monaco the thousands of visitors were
practically all pleasure-seekers* , and a large proportion of
them were excursionists, furnished with return tickets, who
had come for the Carnival. The hotels, as I have Baid, are
for the most part not • strongly built, and, although visitors
may tolerate these structures for the soke of the Southern
sun, id is not' to be wondered at that the prevalence Of
earthquakes should breed seate <degtee of distrust in* the
builders handiwork. Again, it must-be rememWred Kbat
at Nioe and Mentone, where houses had bfeeH lezarete in
all directions, the lighting, of fives bad become dangerous,
and bad, indeed, bean forbidden, so thht eve* invalids found
it difficult to get a cop Of warm milk Or beef-tea. At
Mentone the supply of good bread ran short, and'the reflec¬
tion could not but arise that in all probability a dislocation
of water, gas, and sewer pipes had token, place, a state Of
things which involves consequences upon which we need
hot dilate. There was no question, be it remembered, of

Digitized by Google

854 The Lancet,]

THE RIVIERA IN 1887.

[April 28,1887.

persons running from the post of duty, but merely of
pleasure-seekers abandoning a spot which had become
unpleasant. Again, the effect of the earthquake upon the
majority was, the writer believes, as follows. Toe first
shock caused surprise, but not fear; and had there been no
subsequent shock there would have been no genuine desire
to leave the district. When the second shock came some
fifteen minutes later, the sense of distrust was aroused; but
the third shock at 8 o’clock, which forcibly brought home
to everyone the possibility of continuance, was, we believe,
mainly operative in causing the exodus by bringing to every
thoughtful person the reflexion as to the number of similar
shocks which his or her particular hotel was capable of
withstanding. The incessant discussions of the sabject
became almost intolerable, and after a time was enough to
unhinge tbe nerves of the most phlegmatic, and it was on
this account mainly that a speedy removal from the imme¬
diate scene of the disaster became desirable, especially for
persons who were not strong, and who found it difficult to
sleep.

The fact cannot be too strongly insisted on that a con¬
siderable proportion of the houses along the Riviera have
been very severely strained by the earthquake, and that
substantial repairs will be needed in order to make them
withstand even a slight recurrence of the shocks. The
withdrawal of the visitors has given the inhabitants leisure
to undertake the work of reparation; and we trust, in the
interests of those who year after year repair to this region,
that the task will be undertaken with the serious intent of
rendering the houses as strong as human ingenuity can
make them. Great praise is due to the authorities of the
Paris-Lyons-Mediterran^e Railway Company for the manner
in which they met the unusual strain put upon their traffic
regulations. Happily, no damage was done by the earth-
uake to the lines, and for a fortnight subsequently to
eb. 23rd a very large number of special trains were run,
and all of them were absolutely full. Not only did no
serious accident occur, but we did not hear that even a stray
handbag or portmanteau was lost.

The loss of one is tbe gain of another. The serious mis¬
fortune which befel many of the places along the Riviera
had the result of sending an influx of visitors to other
places. Hotels in outlying districts which had been nearly
empty suddenly enjoyed a great accession of business, and
it was literally true that for a time every hotel along the
Riviera westward of Nice and as far as Marseilles was
absolutely crammed. The effect was felt further than
this. Visitors driven from the Riviera were naturally
afraid to return to northern climates at the end of February,
and, accordingly, the tide set in towards Pau, Biarritz,
Arcacbon, and the Pyrenees, towards Meran in the Tyrol,
towards the sheltered spots along the northern shore of
the Lake of Geneva and our own southern coasts, which
are at their best in the early days of spring.

Being desirous, after the earthquake, to get away from
the incessant bustle and disquiet which the catastrophe
naturally caused in all crowded places, I moved to an
hotel not far from Cannes, which, although a fine bouse
in a good situation, was, I had heard, almost empty. This
1 found to be true, and, on my arrival, I became the co-
pensionnaire of some ten other people who were the only
occupants of a magnificent building standing in a situation
at once lovely and healthful. The chief reason of the empti¬
ness of this fine houee was revealed at dinner-time, when a
veritable Barmecides’ feast was served with most admirable
solemnity to guests who unwillingly followed that golden
theory of dietetics that “ it is good to rise from table
with an appetite.” This hardly merits to be mentioned
were it not for the fact that, in my opinion, much
of the hotel feeding along the Riviera is second-
rate. Of late years hotel prices have risen considerably,
and with the rise of price there has not been, to say
the least, a corresponding rise in the quality of the
accommodation. The worst food which invalids, to say
nothing of healthy persons, can. take is second-rate French
cookery. The finest climate in the world will not com¬
pensate for a diet of disguised garbage, and many of the
plats which are handed at tables-dhotc merit this descrip¬
tion. The characteristic of second-rate French cookery (Audi
there is very little that, ii firat-rate out of Paris) JjpJbfcei
absence of refinement or simplicity. - Whan, for iotfiMoeu*
sole ia hamied.to you, smothered: *n a ooncacikm of,onions,
hflrim W4 grewe^-yon millnot be wrong renmamiug
that thfs'mode-cf cookipg has* been, adopted an a mtsfes of

smothering qualities which might prove less appetising than
the mess which has been added by the chef. Fish has a
delicate flavour of its own, but this fact is seldom appre¬
ciated, and there is also an utter ignorance of the tact that
the.varieties of flesh and vegetables have any characteristic
flavour. The conceited chef who works under a miserly
maitre d hotel soon comes to think that any tough rags in
the way of meat will serve as a vehicle for sauce, and hence
it not unfrequently comes about that, after breakfasting on
sour bread and chicory and lunching on rnbbisb, tbe person
with a delicate stomach succumbs before dinner-time, and
as be cannot eat the dinner be has paid for, but requires to
be nourished on “extras” in his own room, the shortsighted
proprietor, who only looks to the profit of the hour, fails to
appreciate how serious is his responsibility in this im¬
portant matter. I cannot too strongly urge upon delicate
persons who are obliged to winter abroad the necessity of
great care in tbe selections of hotels. The points which
demand attention are: (1) aspect as reg&ids sun and
wind; (2) construction os regards safety, tranquillity, and
health; (3) the size and ventilation of tbe public rooms;
(4) the quality of the food, inclusive of the wine. Every
hotel proprietor will do well to return to the good old
custom of placing a sound “ordinaire” upon the table. All
meals ought to be vin compris, and in writing for terms
this point ought to be insisted upon. It is impossible for
persons to pay five or six francs per meal for wine, and it is
intolerable that they should be expected to drink so-called
“ claret” which has been opened for days and kept in a cup¬
board. The very small quantity of wine which is consumed
nowadays ought to be included in tbe price paid for the
meal. This custom still obtains in all localities which .have
not been ruined by English and Americans. Let those wbo
have had experience in tbe latter houses only try the experi¬
ment by going to dinner at such a house as the M Hotel des
Bains” at La Condamine, and they will find that a modest
four francs suffices to get a well-cooked wholesome meal,
vin compris. To “please the English,” hotel proprietors
have been led into much lavish expenditure in the
matter of gaudy decorations, carpets, and hangings.
These things cost money, and, if they are to be
kept clean, necessitate a great increase in the staff of
servants. Carpets and hangings do not materially increase
the warmth of a building, but they do undoubtedly harbour
filth of all kinds and, if they be not kept clean, become a
constant menace to health. These things are wholly on-
suited for a southern climate, and they are especially nn-
suited for a climate where the mistral upon occasions raises
clouds of dust. A glistening floor of tiles or polished wood
or marble, kept bright by a daily sweep, is far better suited
to the “sunny south” than are thick carpets into which the
dust sinks and is forgotten, and in due time, under the in¬
fluence of the sun, becomes instinct with life. Lees hiss¬
ings and better food must be the order of the dav in
southern hotels which are used as convalescent hospitals.
After a sojourn of ten days near Cannes, and after the rush
of persons going west had somewhat subsided, 1 moved
away to the district at the north-eaet end of the Late of
Geneva, which has tbe reputation of enjoying a mild climate
and of being a pleasant spot in which to spend tbe spring.
Yevey, Cl are ns, and Montreux, which are almost continuous
with each other, are situated along tbe northern shore of tbe
Lake of Geneva. They face due south, and are protected bra
range of high hills from the north, the protection from this
source being more absolute at Montreux than elsewhere.
The Lake of Geneva is about 400 miles due south of Louden, so
that the sun is more powerful there than here. Again, it is
about 1000 feet above sea level, so that the consequent rare¬
faction of the air increases the effect of the son’s
persons exposed to them. Further, the mildness 6f the
situation is said to be largely influenced by the proximity
of the lake, and it is contended that this huge-volume
of water tends to equalise and increase the naean tsm-
perature of the district. There can be no donb* what¬
ever that this district, especially Montreux, i* well
sheltered, but it must not be supposed that this warmth
tcs be experienced there is as mil equal to mat wbhflr i*
felt along the Riviera. After spending the winter m
the Riviere, and when the sun here gets too strong- and a
need ia felt for a more bracing situation, then a more Wt&S
Montreux district is very desirable. One of the efciftf draw¬
backs |o tbe latter place' is tbe liability to fog, owing *****
proximity of tbe lake. Arriving at Montreux tomeldf «**
middle of March, i round every hotel i* the pjidt 4®*®

b'

Thb Lancet,]

MANCHESTER,

[April 23,1887. 855

full, owing to the inflax of visitors from the south. I
accordingly made for the hotel at Lee Avants, which ia some
2000 feet above Montreux, and consequently 3000 feet above
eea-level. It was about 3 o’clock in the afternoon that I
started from Montreux railway station. Montreux was
enveloped in fog, which completely hid the sun and obscured
all objects at the distance of a few yards. The asceiit to
Lee Avants ia rapid and continuous, and the result was that
in a quarter of an hour the fog was almost all below me, and
in half an hour I was in brilliant sunshine. The drive to
Les Avants occupied about an hour and a half, and the road
is excellent. Arrived there, I found the hotel situated in
the centre of an amphitheatre of hills, which surround it on
all sides except the south. The protection from wind is
absolute, the sun exposure perfect. It was very interesting
to notice how complete had been the change of climate in
rising from Montreux to Les Avants. I had left a cold
fog and draughty streets to rise into the brilliant warmth
of the afternoon sun in a cloudless shy, and with scarcely a
breath of wind. This absence of wind was very noticeable
during the whole fortnight which I passed at Les Avants.
From the point of view that all experience is useful, I may
say that I had -the good fortune to experience some very
severe weather at Les Avants. The weather at the time of
my arrival was mild and spring-like, the snow was all
gone from the lower fields, and the crocuses were show¬
ing their many-coloured tips in abundance. Nearly forty
hours’ continuous snow, however, at the middle of March
(at the same time that the severe snow-fall occurred in
England and through Europe generally) changed the
aspect of affairs. The snow lay nearly three feet thick,
and gigantic icic’es hung frqm the overlapping eaves.
It waa very interesting to observe how comparatively little
inconvenience was suffered from thievery heavy fall of snow—
a fall considerably heavier, probably, than any i have ever
witnessed. The snow plough was sent down the road as a
matter of course to a point to which another snow plough
came from Montreux or some neighbouring village, and thus
our communications were kept open without any difficulty
whatever. The post came with all its proverbial regularity;
and even the laundress (who lived at Montreux) was not
hindered in her routine journeys for a single hour. Owing
to the absence of wind there were no drifts, and by the early
use of the plough the snow was not allowed to deprive us of
our fresh air and exercise. The snow was, in fact, a source
of great enjoyment, for it enabled us to return to the
pleasures of winter. The little sleighs called luges were
soon in requisition, and we had soon an opportunity of
seeing how the eight kilometres of winding road which
intervene between Les Avants and Montreux may be accom¬
plished en luge in some half-hour. From the experience of
a few days only it was made evident that mid-winter in
these high regions must be very enjoyable, and certainly few
things more exhilarating can be imagined than to scud
along over the glittering snow at the rate of ten or fifteen
miles an hour through the crisp air, illumined by a brilliant
sun in a cloudless sky. When you have reached Montreux,
the old adage “To go there, I trow, is easy enow, but how
about getting back?” is apt to haunt the mind; there is
nothing for it, however, but to shoulder your luge and get
back by the short cut, which can be done in about an hour
and a half; and a wonderful chest expander is this return
journey. The hotel at Les Avants is good, and the proprietor
does all in his power to make his guests comfortable. The
writer went far three days and stopped fifteen.

BiquBSTO and Donations. —Among the numerous
bequests of the late Mr. William BroUgh • Phillimore, Hyde-
paw-gardens, are the following: To the Ventnor Hospital
for Consumption, £200; St. George's Hospital, London,
£200*, Consumption Hospital, Broropton, £300; Royal
Hospital for Incurables, Putney, £200; St. Mary’s Hospital,
Paddington, £200; Middlesex Hospital, £200; University
College Hospital, £200; and King’s College Hospital, £200.—
The secretary of the Leicester and Leicestershire Provi¬
dent Dispensary has received a legacy of £100 from the
executors of the late Mr. G. A. Robinson.—The secretary of
the Bristol Eye Hospital has received a legacy of £100 from
the executor 1 of the lat& Mire. Peace of Devizes.—Mr. W. H.
Wffiiamson. of Bradford, has forwarded £60 to the Brad-
fot&'IttlWaidty and £26 t,o tbcCMldren's Hospital, 1 to be
applied as the Boards of Management of these institutions
think fit. \ i •

MANCHESTER.

(from our own Correspondent.)

OPEN SPACES.

The praiseworthy attempts of the Open Spaces Com¬
mittee to in some degree remedy the neglect in past years
to provide open spaces in the centres of our crowded dis¬
tricts are resulting in a very fair amount of success. On
the 9th inst. a plot of about one acre and a half, situate in
Ardwick, was formally opened by the Mayoress, and there
was a large attendance. The society has spent nearly
£2000 in laying this plot out and providing swings &c.
They will retain charge of it for the next two years, and
then hand It over to the Corporation, through whom the
land has been acquired. In the neighbouring suburb of
Withington, a piece of land some thirteen acres in extent
has been given by Lord Egerton, " to be used as a public
recreation ground, open to the public free for ever.” One of
our members of Parliament, Mr. Houldsworth, in conjunction
with Sir John Lubbock, is endeavouring to promote a piece
of legislation having for its object the granting greater
facilities to acquire land &c. for these purposes, making
applicable to the whole country the provisions of the
Metropolitan Open Spaces Acts.

ROYAL INFIRMARY.

It sounds at first rather strange to hear of donations
coming from Germany to our local hospitals. The Royal
Infirmary has just received £500 from a lady residing at
Frankfort-on-the-Maine, in memory of her late husband,
Mr. G. Kissell, who some years ago was in business here.

THE EPIDEMIC OF SCARLATINA

still continues, and shows but little abatement. Dr. Buckley
medical officer of health for Crumpsall, in his report for
1886, just issued, referring to the disease in his township,
speaks of bis inability to get any reasonable proportion of
atients suffering from scarlatina removed to the Monsall
ever Hospital. He advocates the provision of smaller
hospitals situate nearer the patient’s home, and where the
friends would feel more in touch with their children than
when they are two or three miles away. The Salford
Corporation will soon have the question of hospital accom¬
modation for infectious cases to face, they having recently
sold their present building to the North-Western Railway
Company, and the infirmary authorities have since refused
to take more cases from Salford to their feveT hospital at
Monsall than they do under existing arrangements.

THE SHIP CANAL.

A large model of the proposed Bhib canal, lately exhibited
here prior to going to the Jubilee Exhibition, brings before
one’s mind very forcibly the danger there may be of there
being very little better than an open sewer m the docks
and stagnant portions, unless stringent measures are adopted,
to render lees polluted the Irwell and the Medlock, which
rivers will form the chief feeders to the canal.

NORTH-WESTERN ASSOCIATION OF MEDICAL OFFICERS OF
HEALTH. ‘

At the annual meeting of. this Association, Dr. Tatham,
officer of health for Salford, was elected chairman for the
ensuing year, and gave an address in which be took rather
a pessimist view of the present position of State medicine,
and of those who devoted themselves to its service. He,
however, showed that there was ground for hope that in
the not far distant future a change for the better would be
inaugurated, and the status of officer of health improved.

ECONOMIC DIRTARY.

The subject of the need for some systematic organisation
for providing poor children of school age with cheap meals
was recently discussed at a conference held at the Vegetarian
Restanram, Fountain-Street. Mr.Sargant, of Birmingham,
gave details of what had been done .in that town, and it was
pretty clearly ahown that, without pauperising the people,
nutritions meals, necessarily based largely on a vegetarian
dietary, could be provided at a cost tit less than one penny
pen meal; but that, from lack.of knowledge among the
poorer classes, it tvas impossible fbr them to obtain the result
ur their otm homes; i HCnoe the ricfed of nine organisation.

O

856 Thb Lancet,1

DUBLIN—OBITUARY.

[April 23, 1887.

DUBLIN.

(From our own Correspondent .)

ACADEMY OP MEDICINE JN IRELAND.

A special meeting of the members of the Academy will
ie held at the College of Physicians on the 26th inst., to
consider the advisability of applying for Her Majesty’s per¬
mission to prefix the word “Royal” to the present title of
the Academy. The presentation of an address to Her
Majesty on the occasion of her jubilee will also be under
consideration.

PROPOSED AMALGAMATION BETWBBN TWO MEDICAL
SCHOOLS IN DUBLIN.

The proposed amalgamation scheme between the medical
school of the Royal College of Surgeons in Ireland and the
Carmichael school, about which such sanguine expectations
were formed, has again fared badly. At a meeting of the
Council of the College of Surgeons last week the matter was
under discussion, when the proposal wo3 negatived by 11
to i votes. The result has not been unexpected by those
who were aware of the difficulties which lay in the way of
tue proposed scheme.

8IR P. DUN’S HOSPITAL.

The chief maintenance of this hospital has been from the
endo wment by its founder Sir Patrick Dun, which heretofore
nas brought in an annual income of from £1200 to £1600
lne non-payment of rents in Ireland, however, has gradually
• diminished this amount, and last year the sum accruing t<
the institution was only between £300 and £400. A special
appeal has been made for funds, and it is to be hoped thal
it will not be made in vain. There is one circumstance
connected with the medical and surgical staff which deservee
ro oe circulated, and that is that one-third of the fees paid
by the students attending the hospital is devoted to its
maintenance. So far as I am aware, such an arrangemenl
does not exist in any other Dublin hospital, and therefore
e y e /y cre dit should be given for this generosity on the part
ot the medical staff of Sir P. Dun’s Hospital.

CASE OF STRANGULATED HERNIA.

A female aged seventy was recently admitted into the
Adelaide Hospital, under the care of Mr. Heuston, foi
strangulated hernia of the right side. On Mr. Heuston
operating, he found that the right ovary and Fallopian tube
were in a gangrenous condition, and therefore removed
imem. .. uch a complication is so rare that its occurrence ie
woreh recording. The patient has made a good recovery,
.he wound having healed by first intention.

THE CONJOINT SCHEME.

The proposed scheme between the Colleges of Surgeons
find l hysunans seems at present to be in a very unsettled
condition. The proposal of the College of Surgeons to com¬
bine with the Apothecaries’ Hall of Ireland, appears to be
resented by the Coyege of Physicians, and I understand that
.hey have intimated to the Council of the College of Sur¬
geons that should the combination be carried out the
agreement between the two Colleges will be at an end, and
they will require to consider the entire scheme, especially
with reference to the fees to be divided between the two
corporations. If the scheme between the two Colleges is
^ eir^dedsion 19 ColIe ® e °* Physicians, will probably regret

DUBLIN HOSPITALS COMMISSION.

The report of the Commissioners has not yet been issued
to the public, and the delay appears inexcusable. The follow¬
ing are stated to be the main suggestions of the Commis¬
sioners, but I am not prepared to vouch for them. They
recommend that a central board of control be appointed, to
FwfA 0 - Archbishop of Dublin, the Moderator of the
Presbyterian Church, the Roman Catholic Archbishop, the

frnm r o. an n f ii the D 2 b l n H/wpital Sunday Fond, two members
Irom the College of Physicians, two to be nominated by the
CrowD, und one each by the Royal College of Surgeons,

Royal Univenrity; while
three will be selected by the Dublin Corporation. Tbe
Government fund. will be vested in tbit board, who will

allocate the grants calculated on the amount of work done
by the various institutions and the donations and subscrip¬
tions received by them. None of the present institutions
reported upon are recommended to be closed, but the gradual,
extinction of the less useful hospitals is provided for,
should the recommendations of the Commissioners be carried
out.

The Lord-Lieutenant has appointed Dr. McCabe to be a
medical commissioner of the General Prisons Board, Ireland.

Dublin, April 20th.

©bttaarj.

DANIEL RUTHERFORD HALDANE, M.D., LL.D. Edin.

The public and professional anxiety caused by the pro¬
longed and serious illness of Dr. Rutherford Haldane was
terminated by the announcement of his death, whic'j
occurred on Tuesday, the 12th inst. His illness was the
outcome of a serious accident met with on Christmas Day,
1886, when he slipped on an icy footpath and fractured bis
right leg. For a considerable time favourable reports wen
issued in regard to his progress, and the anxiety of hie
friends was for the time allayed and a satisfactory recovery
anticipated. Latterly, however, symptoms of obstruction
of the circulation appeared, and under this serious aggrava¬
tion of his condition his strength rapidly gave way, and
he passed gently away without a struggle. The deceased
gentleman held for many years a prominent position in the
Edinburgh medical world. His death leaves a most
noticeable blank in many leading medical interests of the
city, and a deep feeling of personal loss on the part of his
wide circle of friends.

Dr. Haldane was a son of the late James Alexander
Haldane, so widely known as an Evangelist, as a dis¬
interested Christian reformer, and as a chief founder of
the Scottish branch of the Congregational body. After
a liberal classical education Dr. Haldane commenced the
study of medicine in tbe University of Edinburgh. He
was an able and very successful student, giving thus early
evidence of the ability that so conspicuously distinguished
his subsequent career. In 1848 he graduated with honours
as M.D., after which he spent two years on the Continent in
the prosecution of further studies, and in acquainting him¬
self with the more practical aspects of disease. On his
return he acted as resident physician to the Royal Infirmary.
His career as a highly successful extra-academical teacher was
commenced by his undertaking courses in medical jurispru¬
dence and pathology. He was also for a time pathologist
to the Royal Infirmary. On the retirement of Dr. Alexander
Wood from the College of Surgeons’ lectureship on Practice
of Physic Dr. Haldane took his place, and it was as a teacher
of medicine and of clinical medicine also, on his appoint¬
ment to the staff of the Royal Infirmary, that he gained the
reputation of a great teacher, still so warmly cherished in
tbe minds of his numerous students. He early became a
Fellow of the Royal College of Physicians of Edinburgh, a
body in the welfare of which he took the deepest interest,
and which he has ably represented in its presidential and
vice-presidential chairs, and by acting as its representative
on the General Medical Council. He was also assessor of
the General Council of the University of Edinburgh in its
University Court, Mid his services to his alma mater were
recognised by the conferring upon him of the honorary
degree of LL.D. at the Tercentenary Festival, On the expiry
of his term of office on the honorary staff of the Royal In¬
firmary, he continued his connexion with that institution,
firstly as consulting physician and subsequently as one of
its managers. In addition to his multitudinous public
duties he engaged in a wide practice as a consulting
physician, and he was a genial and capable arbitrator in
the many weighty matters of professional importance
brought under his notice by widely differing sections of tbe
medical community. His personal no less than his pro¬
fessional qualifications gave him the position of a leader in
the Edinburgh medioal world and of a much-respected
public man. In both spheres be is keenly missed, and deeply
regretted.

Die

Thus Lancet,]

OBITUARY,—MEDICAL NEWS.

[Apeil 23,18S7. 857

HENRY GRENFELL, M.R.C.S., L.S.A.

Me. Henry Grenfell was bom in 1837 at St. Just-in-
’enwith, near the Land’s End, and educated at Penare
louse School, Penzance. After having served an apprentice-
hip with Mr. W. H. Dodge at Penzance, he entered at
ling's College, London, in 1856, and, soon attracting notice as
diligent student and a skilful dissector, was appointed a
rosector to the Royal College of Surgeons. He became a
resser to the late Professor Partridge and a clinical clerk
o Dr. George Budd, and was most earnest and assiduous in
he discharge of his ward duties. He took his double
ualification in 1861, and settled at onoe in practice at
'enzance. He was warmly interested in the Volunteer
lovement, and served as medical officer in every grade in
he western division of the Duke of Cornwall’s Royal
.rtillery, being Surgeon-Major at the time of his death,
'or some years he had been the acting surgeon to the
’enzance Infirmary, and had acquired a wide reputation
a a skilful, bold, and careful operator, and as an able
xponent of the principles and practice of antiseptic
urgery. His death was sudden and unexpected. He
ad always enjoyed perfect health until two or three
reeks ago, when he began to complain of headaches
nd a slight discharge from the left ear, to which he
aid but little attention. On.the 9th inst. he suddenly
ec&me comatose, and trephining was resorted to, but he
ever regained consciousness, and died on the 10th inst. at
a.m. A post-mortem examination showed the existence
f caries of the roof of the tympanum, and extensive puru-
ent meningitis over the anterior lobes of the brain. By his
arly death at the age of forty-nine, the profession in West
Cornwall is deprived of a most capable surgeon, and his
amily and numerous friends and patients will long regret
lie loss of a most genial, kindly, and true-hearted man.

DR. DANIEL WANE.

This gentleman, whose death was announced on April 5th,
t the age of seventy-three, was a M.D. Edin., M.R.C.P. Lond.,
nd a Fellow of the Medical, Medical and Chirurgical, and
)bstetrical Societies. He had a large and high-class practice
n Grafton-street, Piccadilly, where he practised for many
•ears. His kindness of heart and intense conscientiousness
n the smallest details of his profession won for him the love
nd esteem of all with whom he was brought in contact. He
lad retired from practice for the last four years, and died at'
lis house in Fitzjohns-avenue from a seizure of an apoplectic
tature.

Utoirai |Ufes.

Royal College of Physicians of Edinburgh.—
Tie following gentlemen have passed the examination for
he Membership of the College :—

Ballanlyne, J. W. f M.B. Rdln. | itlndcr, A. W., L.R.C.P. Bdln.
Tie following have passed the Public Health Certificate
Examinations

Kiddle, W., M.B. Dub. | Robinson, B., M.R.C.S. Eng.

)r. Woodbead has been appointed Superintendent of the
College Laboratory. ,

University of Aberdeen. —At the late Medical
Iraduation term, the following candidates, after the usual
xaminations, received degrees in Medicine and Surgery:—
Deohhh of M.D,

Alexander. Lewie Daniel. M.B., C.M., Kilcreggau, Greenock.

Garbery, Joseph, M.B., C.M., Matale, Ceylon.

Obeyne, Walter Smith, M.B., C.M., Aberdeen.

Dickson, Matthew, M.B., O.M., Liverpool.

Fallon. Robert Hume, M.B., C.M., Clifton.

• Kit Ides, Thomas, M.B.. C.M.. U mu ton. Manchester.

Gerard, John, M.A., M.B., C.M., Aberdeen.

TIardle, David, M.B., C.M., Brisbane. Queensland.

Letters, Patrick, M.B., C.M., Dundee.

Smith, Brneet Barret, M.B., O.M., Twickenham. .

DB6BKK8 or M.B. axd O.M.

Alexander, William, M.A.. Pyvte.

Beveridge, Alexander Thomas Gordon, M.A., Aberdeen.

Brooks, John Harley, London.

Brown, Alfred Tennyson, Banchory.

Bryce, James, Aberdeen,
t Butter, John Soutar, Lotham, Forfar.

Grevie, James, Newburgh, Aberdeen.

Crowe, William Christie. Aberdeen.

Dalgnnio, James John Young, M.A , Aberdeen.

•Davidson, David Macdonald, Mauritius.

Duff, Charles Edmund, Turriff.

Fraser, James Winton, Arbroath.

Fyfe, Thomas Henderson. Aberdeen.

Henry, George, M.A., Aberdeen.

Holden, Joseph Eutough. Bolton, Lancashire.

Kclman. George Alexander, Fearn, Ross-shire.

Macdonald, George Both well Douglas, Aberdeen.

Manning. Leslie Samuel, CUiistchuroh. New Zealand.

Melvin, James, Aberdeen.

Myles, John Coutts. Aberdeen.

Nicoil, Patrick John Smith, Aberdeen.

Pearson. Joseph, Sheffield.

Pirie, James, M.A., Elgin,
ltannie, Robert, Gleubucket.
tSliand, Jonathan, Keith."

Smith, Robert. Aberdeen.

Souter. Charles Henry Joseph, Emmaville, New South Wales.
Souter, John, M.A., Aberdeen.
tThomson, Thomas Harvey. Stonehaven.

Urquhart, Charles Thiselton Dyer. Aberdeen.

Walker, Frederick William, Darlington.

Webster. James, Aberdeen.

White. Oresswell Fitzherbert, Chippenham, Wilts.

Wilson, George Nicol.

. * Highest Academical Honours. t Honounible Distinction.

At the same time the following gentleman was certified to
have passed all the examinations, and that he should receive
his degrees in Medicine and Surgery with “ Honourable
Distinction,” but did not graduate
Ker. George William England.

University of Glasgow.—T he following gentlemen
have passed the Third Professional Examination for the
degrees of M.B. and C.M. : —

Banks, Robert .

Bannatyne, Gilbert. A.
Blackburn, Thomas L.

Blair, Alexander.

Bland, Matthew H.

Buchanan. Robert M. ,
Charles, John.

Copland. Andrew.

Cowen, Herbert O.

Gemmell, William.

Gillespie, J. Paterson.

Jago. Arthur H.

M'Couville, John S., M.A.
M‘G!ashan, Janies.

The following have also passed i

Boyle, Michael A.

Cameron, Thomas. •

Campbell. Archibald.

Curie, David.

Gunn. Archibald. '

Hallett, Charles H.

Hamilton. Wm. Cowan. i
Harrison. Edward O.

Hay, Thomas Wm. [

St. Andrews University.
were conferred on April 20ch:—

Melville, John.

Monro, Thomas K., M.A.
Niven, Charles R.

Norris, Frederick L.

Paton, William H.
Pinkerton, Robert L., M.A.
Rankin, John S.

Robb, William.

Sandilands. John, M.A.
Wallace, James.

Wilson, James P.

Wylie, Richard J.

Young. James.

Pathology

Innes. Andrew.

Jenkins, Thomas W., M.A.
Kirklaud, Hugh.

Laird, Thomas.

Lang, Bbenezer.
M'Kendrick. John.

Sloan, Hugh R.

Wildridge, Charles M.

—The following degrees

Dkqrkb of M.D.

Charleswortb, Samuel, Hirst, Bradford, Yorks.

Greaves, Charles Henry, Stafford.

Hackney, John, Hythe.

Havard, David, Newport, Pembroke.

Jackson, Jabez Bunting, Birmingham.

Le Page. John Fisher, Salford.

Lyall, Andrew, Leven.

Mac Bala, Hugh Gilles. North Berwick.

Mitchell, Joseph, New Wortley.

8loue>, Valentine, Montrose.

Dkohek of M.B.

Fayrer, Joseph, M.A., Edinburgh.

Society or Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on April 14th:—

Bishop, Charles Rosser. M.B.C.8., Craven-hill, Hyde-park.
Dickinson. John Clough Hardmnn, Bow-road.

Hinnell, Joseph Squler, Garland-street, Bury St. Edmnnds.

St. Johnston. Charles. Easy-row. Birmingham.

Roe. H. Havilland, M.R.C.S.. Woburn-place. Hussell-square.
Tonka, H., M.R.C.S.. Packwood, Grange, Knowle, Warwickshire.

Guy’s Hospital Fund.—A sermon will be preached
in the church of St. Saviour, Southwark, on Tuesday even-
tag, April 26th, by the Lord Bishop of Liverpool, on behalf
of the fund of £100,000 which is being raised for the above
hospital.

Digitized by

858 The Lancet,]

MEDICAL SEWS.

[Apbii 23,1887.

The annual meeting of the governors of the Car¬
marthenshire Infirmary was held on the 12th inst., when
satisfactory reports were presented and adopted.

A superannuation grant of £67 per annum has
been made to Mr. Thomas Gray, late medical officer to the
Poplar Board of Guardians.

Newsvendors’ Benevolent and Provident Institu¬
tion. —Sir A. K. Roll it, M.P., LL.D., will, we are in¬
formed, • preside at the festival of this Society, to be
held at the Grand Hotel, Charing-cross, on Wednesday,
June 22nd.

Vaccination Grant. — Mr. J. B. Muirbead, M.B.,
Mailing Union, has received the Government grant for effi¬
cient vaccination in the second district of the above union
(first time).

First Aid.—A t the distribution of certificates to
the pupils of the first aid classes at Norton Sr. Philip, near
Bath, the members of the classes presented the lecturer,
Mr. W. Godfrey Evane of Beckington, with a very handsome
carriage clock.

Guv’s Hospital.—T he Michael Harris Prize in
Anatomy of £10 has been awarded to Mr. Frederick William
Hall, of Sydney. New South Wales; and the Beaney Prize
in Pathology of 30 guineas has been a warded to Mr. Theodore
Fisher of Greenwich.

Glasgow Ear Hospital.—A t the annual meeting
of patrons and subscribers of this hospital, held on the 13th
inst.. Dr. James Erskine, recently assistant-surgeon to the
hospital, was elected a member of the board of directors of
that institution.

The sanatorium which has been erected at Brad-
well jointly by the Wolstanton and Burslem Rural Sanitary
Authority, the Wolstanton and Burslem Guardians, the
Burslem Corporation, and the Tunstall Local Board, was
opened on the Gth inst.

Durham College of Medicine.—A deputation
from this College is, we learn, about to wait on the Lord
President of the Council with the object of obtaining
a Government grant towaids the building fund of the
institution.

Fatal Football Accident.—A t an inquest held at
Macclesfield on the 14th inst., the jury returned a verdict of
accidental death in the case of a football player who
died from the effects of a kick in the stomach during
a match lor the benefit of another player, who had his leg
broken. :

Proposed Hospital at Montreal.—S ir George
Stephen, president of the Canadian Pacific Railway, and
Sir Donald Smith, one of the directors, have, it is announced,
addressed a letter to the mayor of the city offering to con¬
tribute a million dollars for a hospital for the city poor, to
be named the Royal Victoria Hospital, and to be erected on a
site which they hope the city authorities will grant on the
slope of Mount Royal.

Ledwich School of Medicine, Dublin.—A t the
termination of the Winter session the following prizes were
awardedJunior Anatomy: Henry Cullman, 1st; J. C.
Ryan, 2nd. Senior Anatomy: D. Shanahan, 1st; J. P.
O’Meara,2nd. Surgery: W. J.Thompson, 1st; D.L.Hamilton,
2nd. Practice of Medicine: J. D. Sexton, 1st; P. Rowan,
2nd. Physiology: J. R. Steen, 1st; J. B. Wilkinson, 2nd.
Midwifery : D. L. Hamilton. Theoretical Chemistry : C. M.
O’Brien.

Midland Volunteers’ Medical Association.—
The second annual meeting of the members of this Association
was held on the 13th inst. at Birmingham, nnder the pre¬
sidency of Surgeon-Major Thompson. It was reported that
the work of the year had been extremely satisfactory, but that
t he medical staff connected with the Volunteers at the present
time would be altogether inadequate in case of active ser¬
vice. This is due to the action of the War Office, which
declines almost entirely to support or assist them. The
Association lias also been successful financially, a small
balance remaining in the treasurer’s bands after payment of
all the expenses of the preceding year.

New Mortuary for Hackney. -On the 6th inst.
the Hackney District Board of Works, after a long dis¬
cussion, decided to purchase a piece of ground and erect ;i
mortuary, post-mortem room, and a room for the reception
of the bodies of persons who have died from infectious
diseases, at an estimated cost of £1250. This step was
taken in consequence of the many complaints which have
been received of the great want of accommodation in this
respect.

Asylum Accommodation in Portugal. — In an
account of the work done in Count Ferreira’s hospital, or
rather lunatic asylum, in Oporto, by the director, Dr. A. M. do
Senna, a distinguished Portugue'e alienist, which has just
been published, the author complains bitterly of the great
lack of asylum accommodation in Portugal, saying, “Portugal
does not succeed in finding room in asylums for a seventh part
of her mentally afflicted population, while in England, nine-
tenths of such persons are provided for.”

Semi-convalescent Home at Cookridge.—B y the
munificence of Mr. John North of Leeds, a semi-convalescen
home is about to be erected at Cookridge as an adjunct oi
the Leeds Infirmary. Building operations have been com¬
menced, and it is expected that the establishment will be
ready for occupation about the beginning of 1888. Room
will be provided for forty-two beds at first, with additional
accommodation if required. The estimated cost, exclusive
of furnishing, is £5000, and this sum hae been already
advanced by Mr. North.

The National Hospital for Consumption a -
Vbntnor.—T he festival dinner in aid of the funds of this
institution was held on Tuesday, the 19th. The Duke of
Cambridge, who presided, pointed out the advantages ot
such a hospital in cases of diseases of the chest, and men¬
tioned that since its foundation in 1868 it had helped 73S+
patients. There are now 118 beds, and later in the year
this number will be increased by 20 more. An earnest
appeal was made for funds, and during the evening a list
of donations and subscriptions was read, the total amount¬
ing to about £2400.

Butter Adulteration in Kent.—T he analyst foi
the county of Rent has submitted a report to the Finance
Committee of the Court of General Sessions on the subject,
of the adulteration of butter, in which he says that during
the past quarter thirty-two samples were examined, and
seven found to be adulterated with foreign fat, with a rang'-
of from 20 to 92 per cent., giving a mean rate of 54-25 pei
cent, of adulteration. This falsification of butter by tb--
admixture of foreign fat, and not, as was formerly the c&s*'.
by complete substitution, is a fraud much more difficult of
detection by the analyst, and quite impossible to the ordinary
public.

Another Thames Valley Drainage Board.—O n
the 13th in6t. a Local Government Board inquiry was held
with reference to an application by the Richmond Urban
Sanitary Authority and the Richmond Rural Sanitary
Authority for a Provisional Order to form their two districts
into a united district, under Section 279 of the Public
Health Act, for sewerage purposes; such Provisional Order
to provide for th6 constitution of a joint board to act as the
governing body , of the united districts. The parishes
affected include Richmond, Mortlake, Barnes, Kew, and
Petersham, and the new board will have powers similar to
those which were exercised for somtf years by the now
defunct Lower Thames Valley Main Sewerage Board. There
is no opposition to the application.

Huntingdon County Hospital.—A t a meeting of
the governors of this charity held on Tuesday last, the Earl
of Sandwich presiding, the Duke of Bedford, Lord-Lieu¬
tenant of the County, and the BishoD of Ely, were elected
patrons of the institution. The Duke of Bedford has
intimated bis intention of giving £100 to the funds of the
hospital. A vote of condolence with the family of the late
Mr. Philip Tillard, chairman of Quarter Sessions, was also
passed. Mr. Tillard had been honorary secretary of thu
hospital for. nineteen years, from its establishment in 1853.
It will be remembered that the hospital adjoins the Great,
Northern Railway at Huntingdon, and was of great public
service at the tinte of the terrible collision at Abbots Ripton
some years ago.

Digitized by LjOOQle

Tub Lancet,] APPOINTMENTS.—VACANCIE8.—BIRTHS, MARRIAGES, AND DEATHS. [April 23,1887. 859

Rabies amongst Deer at Richmond. —At the
Richmond Petty Sessions on the 20th in it. an outbreak of
rabies among the deer in Richmond-park was reported.
About one hundred of the animals have been affected, and
consequently destroyed. Every precaution is being talian to
prevent the spread of the epidemic, the herd which has been
attacked having been completely isolated.

MEDICAL NOTES IN PARLIAMENT.

The Vaccination Act*.

In tha House of Commons on the 14th Inst., In reply to Mr. Chanuing,
Mr. Ritchie stated that he could not undertake to intervene in any
individual case of repeated prosecution for non-compliance with the
Vaccination Acta, nor was ho prepared to propose legislation which
woulu take away from the guardians, who have the advantage of know¬
ing fully the local circumstances, their freedom of action in the matter.

Army Medical Officers.

In answer to Dr. Tanner. Mr. E. Stanhope stated that army medical
officers, as lie had already several times explained, will be exactly in the
same position as they have hitherto been.

The Sanitary Condition of Barracks.

On the 18th i r st., Mr. Norris asked the Secretary of State for War
whether any further information had reached him as to the sanitary
condition of the barracks at Dover contradictory of the statement con¬
tained In the report of the principal medioal officer there and the Com¬
manding Officer of Royal Engineers, quoted by him on Feb. 3th last,

tiiat they had failed to discover any insanitary conditions;" whether
the death of another young officer, Mr. Keegan, and the illness of a
private soldier were attributable to typhoid fever contracted in the
barracks; and. If so. whether he would cause immediate and searching
inquiry to be made Into all the facts of those cases, which fol¬
lowed so closely on the death of Lieutenant Jarrett, of the Bulls,
from the same disease; and if he would state whether complaints
lxid reached him as to the insanitary condition of other barracks.—
Mr. B. Stanhope replied that according to a report received that morn¬
ing careful investigation has failed to discover in Fort Burgoyne, where
these cases of enteric fever occurred, any insanitary conditions which
will account for the disease ; but a further minute inspection Is to be
made and steps taken to remove immediately every possible source of
iliseaae to which any suspicion can attach. In answer to the third
question, he stated that complaints had been received from other
barracks also, and the Got eminent would in every case, if the oom-
plaint appears to be well-founded, remedy it with the least possible
delay. _ ■

Ifjotntmmts.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to Thb Lancet Office, directed to the Sub-Editor, not later
than 9 o’clock on the Thursday morning of each week for publication in
the next number.

Bibcit. Robert, M.R.C.8.. L.R.C.P.Lond., has been appointed Medical
Officer for the Workhouse of I he Newbury Union.

Brown. F. L. Harman. M.B.. C.M.Bdin., baa been appointed Second
Assistant Medical Offioer to the Norfolk County Asylum.

Clark, Malcolm R , L.F.P.S.Olas.. L.R.C.P.Bd.. has been appointed
Medical Officer for the Harthili District Of the Worksop Union.

Colt. Thomas A., M.R.C.8., L.R.C.P.Ed., has been appointed Medical
Offioer for the Port sea District of the Portsea Island Union.

Davidson, John. M.B., O.M.Ed., has been appointed Medioal Officer
for the 8outh Wallasey District of the Birkenhead Union.

Galloway. Arthur W., L.R.C.P.Lond., M.R.O.S.. has been appointed
a District Surgeon to the City of London Lying-in Hospital, vice
Thomas, resigned.

Hart, Walter. M.R.C.8., L.R.C.P.Bd., has been appointed Medical
Officer for the Pourth District of the Chelmsford Union.

Hayden, William G., M.B.C.S., L.R.C.P.Lond., lias been appointed
Medioal Offioer for the Third District of the Royston Union.

Hope, B. W., M.D.Kd., has been appointed Visiting Medical Officer to
the City Hospital, Park-hill, Liverpool.

Jossop, Walter H., M.B., F.R.C.8., lias been appointed Surgeon
to the Central London Ophthalmic Hospital, vloe W. Chamley, M.D.,
resigned.

Jones, John O., . I.B.. C.M.Kd., has been appointed Medical Officer
for the Llanfai'.-talhsfiarn District of the St. Asaph Union.

Lyttlk, W. Maxwell, M.B., C.M.Bdin., late Second Assistant Medioal
Officer. North County Asylum, has been appointed Senior Assistant
Medical Officer, vloex. J. Compton, M.B.. C.M-, resigned.

Lloyd. K. M.. M.B.C.S., has been re-elected Medical Officer of Health
by the Holywell Local Board.

Macindoe, Alex 4*’DEH, M.D.Obs., has been appointed Medical Officer
for the Alderiey and Gawaworth District of the MaoolesOeld
Union.

Martin. Sidney. M.D.Lond.. B.Sc.. M.B.C.P., has been appointed
Pathologist to the CHty of London Hospital for Diseases of the Chest,

Victoria-park, B,.

McDonald, B. F. P., M.D.Ed., has been appointed Medical Offioer for
the North Wallasey District of the Birkenhead Union.

Mickle. Julius, M.li.Lond., M.H.C.P.. has been appointed Lecturer
on Psychological Medicine at the Middlesex Hospital Medioal School,
vice Case, resigned.

SomrEEN, John Acton. L.R.C.P.Lond.. has been appointed House-
Surgeon to the Derbyshire General Infirmary, vice B. C. Green,
M.R.C.S., L.R.C.P.Lond., resigned.

Woodhead. German Sims, M.D., F.B.C.P.Ed., F.R.S.Bd., has been
appointed Superintendent of the new Laboratory. Royal College of
Physicians, Edinburgh.

Darancics.

/» compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of ths carious
Vacancies which art announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
aavertisement. -

Bristol BorAL Infirmaby.— Assistant Resident Medical Officer and
Pathologist. Salary £80 per annum, with board, lodging, and
washing.

Central London Ophthalmic Hospital, Gray s-lnn-road, W.C. —
House-Surgeon. Rooms, gas, and firing.—Assistant Surgeon.

Cheltenham General Hospital.—A ssistant House-Surgeon. Salary
£10 per annum, with board and apartments.

County and Borough of Carmarthen Infirmary.—H ouao-Surgeon.
Salary £100 per annum, with board, lodging, fire, light, and
washing.

County Asylum, Stafford.—Resident. Medical Officer and Superin¬
tendent. Salary £5<>0 per annum, with unfurnished residence
within the Asylum, and £200 in lieu of board.

Dental Hospital of London, Lelceater-square, W.C.—Assistant Dental
8urgeon.

Dorset Count r Asylum, near Dorcheater.—Assistant Medical Officer.
Salary £130 per annum, with board Ac.

Evelina Hospital for Sick Children, Sonthwark-bridge-road, S.E.—
House-Surgeon. Salary £70 per annum, with board, washing, and
residence.

Farrinodon General Dispensary and Lying-in Charity, Bartlett a-
buildlngs, Holborn, E.O.—Honorary Physician.

Gloucester General Infirmary and Gloucester Bye Institu¬
tion.— House-Surgeon. Salary £100 per annum, with board, lodging,
and washing.

Great Northern Central Hospital, Caledonlan-road, N. — House-
Physician.

Horton Infirmary, Banbury.—House-Surgeon and Dispenser. Salary
£ 60 . with board and lodging.

Mason Science College, Birmingham.—Professor of Physiology.

Metropolitan Free Hospital, Kingsiand-rood, B.—Assistant House-
Surgeon.

Rotal Albert Edward Infirmary and Dispensary, Wigan.—Junior
House-Surgeon. Salarv £*0 per annum, apartments and rations
(exclusive of wines, spirits, and washing).

Royal Alexandra Hospital fob Siok Children. Brighton.—House-
Surgeon. Salary £80 per annum, with board, lodging, and washing
(no stimulants).

Royal College of Surgeons of England.—B xammer in Anatomy
for the Second Professional Examination of the Conjoint Boara.
Examiner in Anatomy for the Fellowship.

Royal London Ophthalmic Hospital.—CU nlosl Assistants. Junior
Assistants for the Out-patient Department.

Seamen's Hospital Society (late Dreadnought), Greenwich.—8ecro-
tarv.

Stanhope-street Public Dispensary, Clare-market, W.C.—Resident
Medical Officer. Salary £105 per annum, with furnished apartments,
coals, and gas. _

$JirtIis, Utarriaps, attb Deaths,

BIRTHS.

Carpenter. — On the 13th inr.. st Trevaiban, Albemarle-road,
Beckenham, Kent, the wife of E. Carpenter, M.H.C 3., of a son.

Chilling worth.—O n the 14th Iu>t., at Tavtstoek-street, Bedford, the
wife of Andrew Chillingworth, M.R.O.S., of a son. '

Forbes.—O n the 16th inst., at Stokesley, Yorkshire, the wife of W. G.
Forbes, M.B.. C.M.Kd., of a daiyjhter.

Martin.—O n the 13th inst.. at The Limes. Walkden, the wife of
William Young Martin, M.D.Univ.Dur.. F.B.C.S., of a son.

Nicholas.—O n the Ifttb Inst., at Darloe Cottage, Wert Looe, Cornwall,
the wife of Surgeon Nicholas, M.S., of a daughter.

MARRIAGES.

Lewis—Lewis. — On the 14th Inst., at the Congregational Church,
Baling, by the Bev. G. P. Gould. M.A., cousin of the bride,
T. Preston Lewis. M.D., of Brixton, to Lacy, daughter of the Rev.
C. B. Lewis, of Grange-park, Baling, late of Calcutta.

Mtddklton Gavky—Oatt.—Or the 14th Inst., at the Parish Church,
Lindfleld, by the Rev. F. Willett, M.A., assisted by the Rev. B.
Wyatt, Vicar of Haywards-heath. Edward Herbert Myddelton-
Gavey, M.R.C.S.Eng., of Ipswich, to Fmnoea Caroline Catt,
daughter of the late Charles Catt, of Summer-hill, Lindfleld,
Bur sex.

Owen- Hall.—O n the 13th inst.. Bayley Owen, of 14, Devonshire-
terrace, Hyde-park, son of William B. Owen, of 61, Cleveland-
square, to Elizabeth, eldest daughter of the late Walter Hall, of 13,
Hotland-park, W. _

DEATHS.

Franks.—O n the 17th inst., at Darwin House. The Common, Seven-
oaks. George Franks, F.B.O.S., in his Sflth year.

Kirkman.— On the 3rd inst., at St. GeorgeVplaoe. Brighton, John
Ktrkman. M.D., for forty-five years, from 1831. Superintendent of
the Suffolk County Asylum for the Insane, aged 92.

Meadows —On the lflth inst., at George-street, Hanover square, Alfred
Meadows. M-D., J.P., in his 54th year.

Vachkr. - On the 15th Inst., at 31. 8htwttniry-road, Birkenhead,
Isabella, wife of Francia Vacher, F.K.C.S. #

5.B.— A fee ofBs. ie charged for the Insertion of Notices of Births,
Marriages, and Deaths.

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860 Thu Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[April 23,1887.

IStcirical giarjr for tije ensuing Mock.

Monday, April 25.

Boyal London Ophthalmic Hospital, Moorfiblds. — Operations,

10.30 a.m., and each day at the same hour.

Boyal Westminster Ophthalmic Hospital.—O perations, 1.30 p.m.,
and each day at the same hour.

Ghblska Hospital for Women.—O perations, 2.30 p.m; Thursday,2.30
8 t. Mark's Hospital.—O perations, 2 p.m. ; Tuesday, 2.30 p.m.
Hospital fob Women, Soho-square. — Operations, 2 pjc., and an
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Royal Orthopedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 2 p.m., and
each day in the week at the same hour.

Rksf-arch Scholarships of the Grocers’Company.—5 p.m. Mr. W.
North : Malarial Fevers.

Medical Society of London.—8.30 p.m. Mr. Bruce Clarke: A peculiar
Congenital Papilloma of the Thigh.—Mr. William Rose: A case of
Severe Injury to the Wrist-joint requiring Suture of Nerves and
Tendons.—Mr. F. B. Jeesett: (1) a case of Plaatio Operation on the
Nose; (2) A case of Removal of a Large Cystic Growth from the
Neck implicating the Submaxlllary Gland.—Mr. Bernard Pitts : A
case of Congenital Curvature of the'Spine.—Mr. Marmaduke Sheild:
Case of Tumour of the Neck greatly reduced in size by Arsenic.

Tuesday, April 26.

Guv’s Hospital.—O perations, 1.30 p.m. and on Friday at the same hour.

Ophthalmic Operations on Monday at 1.30 and Thursday at 2 p.m.
St. Thomas’s Hospital.—O phthalmic Operations, 4 p.m.; Friday,2 p.m.
Cancer Hospital, Brompton.—O perations,2.30 p.m.; Saturday, 2.30 p.m.
Westminster Hospital.—O perations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

St. Mary's Hospital.—O perations, 1.30 p.m. Consultations, Monday,

1.30 p.m. Skiu Department, Monday and Thursday, 9.30 A.M.
Royal Institution.—3 p.m. Prof. W. E. Ayrton: Electricity.

Society of Arts.—8 p.m. Mr. J. Hungerford Pollen: Ornamental

Glass.

Royal Medical and Chiruroical Socibty.—8.30 p.m. Dr. Warner
and Dr. Fletcher Beach: A case of Chronic Meningitis, probably
. Syphilitic, and causiDg Progressive Dementia. — Dr. Poore: An
Analysis of Ninety-three cases of Writers’ Cramp and Impaired
Writing Power, making, with seventy-live oases previously reported,
a totalof 188 cases.—Dr. Haig: The Relation of a certain form of
. Headache to the Excretion of Uric AcJd.

METEOROLOGICAL READINGS.

(Taken daily at 8 JO a.m. by Steward '# Instrument* )

The Lancet Office. April 21st, 1837-

•MS.

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reduced to
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and B*F.

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Apl. 15

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N.W.

42

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Butts, JShurt Comments, & imsfoers to
Corresgimkitts.

It is especially requested that early intelligence of local event 0
having a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed "To the Editors."

Lectures , original articles , and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

Dr. Bruhton and Homeopathy.

Wednesday, April 27.

National Orthop.edic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital —Operations, 1.30 p.m.; Saturday, same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
8urgloal Consultations, Thursday, 1.30 p.m.

St. Thomas’s Hospital.—O perations, 1.30 p.m. ; Saturday, tame boor.
London Hospital.—O perations, 2 p.m.; Thursday & Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital for Women and Children.—O peration*,
2.30 p.m. • y

University College Hospital.—O perations, 2 p.m.; Saturday, 2 p.m.

Skin Department, 1.46 p.m. ; Saturday, 9.16 a.m.

Royal Free Hospital.—O perations, 2 p.m., and on Saturday.

Kino’s College Hospital.—O perations, 3 to 4 p.m. ; Friday, 2 p.m.
Saturday. 1 p.m.

Children’s Hospital, Great Ormond-street.— Operations, 9 a.m.

' Saturday, same hour.

8ociety of Arts.—8 p.m. Mr. Arthur W. C. Shcan: Appliances for
Saving Life from Fire.

Hunterian Society—8 p.m. Dr. A. J. Davies: Cases of Myxcedema.—
_Dr. Dundat Grant; A caac* of Carcinoma of t.h* (Esophagus per-
■ fomtlng the Trachea.—Dr. Port: (1) Two cases of Pseudo-byper-
trophlc Paralysis; (2) On Antipyrin.

British Gynaecological Society.—8.30 p.m. Specimens will be shown
by Dr.-. Bdla, Fancourt Barnes, G. Granville Bantock, Mr. Lawson
Tail, and others. Council at 8 p.m.

. Thnnday, April 28.

Stv George's Hospital.—O perations, 1 p.m. Ophthalmic Operations.

Friday, 1.3U jvm,.

Charing-cross Hospital.—O perations. 2 p.m.

North-West London Hospital.—O perations. 2.30 p.m.

Royal Institution.—3 p.m. Prof. Dewar: The Chemistry of the
Organic World.

Keskahch Scholarships of the Grocers’ Company.—6 p.m. Mr. W.
. North : Malarial Fevers.

Friday, April 29.

Royal South London Ophthalmic Hospital.—O perations, 2 p.m.
B-mor Arts.—6 p.m. Mr. J. F. Hewitt: Village Communities in

Royal Instu-i’Tion. _ 9 p.m. Prof. H. S. Hele Shaw: The Rolling
Contact of Bodies.

• Saturday, April 80.

Middlesex Hospital.—O perationr, 2 p.m.

Royal iNfrriTUTlON.—3 p.m. Mr. R. Von Lendenfeld : The Australia
Alps and the Origin of the Australian Fauna.

Dr. Dudgeon is not satisfied that Dr. Bru&ton will not confess rnore-
obligation to homoeopathy than he does, and sends os another letter-
in the tame strain as one we lately published. He must excuse n*
saying that we cannot continue the discussion. We think Dr. Brunton's
estimate of homccopathy sound in point of sense and scientific. We
think that Dr. Brunton’s Therapeutical Index will bo the better for
even more expurgation than it ha* received. This will probably-
make It leas trying to homreopaths and more useful to general prac¬
titioners ; but this is not of the essence of the question of bomieopathy-
or of Dr. Brunton's opinion of it.

J It. W. Robinson .—Our correspondent is probably referring to cases oC
nebula of the cornea, whioh were at one time treated with prussic
acid. Cataract waa never cured by this means.

Constant Reader. — 1. Lauder Brunton's Pharmacology, Therapeutic*,
and Materia Medlca, or Beasley’s Formulary, oantaln the direction*
desired.—2. Sp. viol rect.

MEDICAL OFFICERS OP HEALTH AND PRISON SUBGBONS_
To Ihs Editors of The Lancet.

Sirs,—W ill you kindly inform mo whether the medical officer of health
of a town Is justified in visiting H.M. prison and union workhouse with
a view to ascertaining their sanitary condition and reporting upon the
health Of the inmates without requesting the oo-pperation or sanction of
the medical officer of those Institutions, or in any way communicating
with him l I am, Sire, yours truly,

M. O. H.

%* The Publlo Health Act apparently contemplates that a medical
officer of health shall Inform himself of the sanitary circumstance* of
all portion* of his district, including the institutions within it. But
where an Institution has a medical officer who is responsible for it*
control and management, the necessary information can usually be ob¬
tained from this officer, and it is, a# a rule, unnecessary for the medical
officer to intervene. Where such intervention becomes necessary, under
any special circumstances, it should always be effected in co-operation
with the officer of the institution. In the case of prisons, which are
under the control of a Government department having a medical
staff of their own, and to which aooes* by any but prison official* may
properly be denied, it can rarely be requisite for an offloer of health
to claim a right of entry; and ff such entry should be necessary In
connexion with the work of his district, it should otrtalnly be secured,
with the co-operation of the prison medical officer.—E d. L.

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MOTES, COMMENTS, AND ANSWEBS TO CORRESPONDENTS. [April 23,1887. 861

An Interkstixo Consignment.

Dk. .MacA lister, F.R. 8 ., the Professor of Anatomy in the University of
Cambridge, hne, it is stated, just received a case of sknlis from Egypt
representing different types of people at different periods of the
history of that country. By examination and comparison he hopes to
arrive at sound conclusions as to the races to which the owners of
these skulls belonged.

Perplexed. — We quite agree with our correspondent that, his patient
. uould.be acting unwisely in adopting the course suggested.

A'.—Onr correspondent will see that the question upon which he writes
has been solved in a satisfacto>y manner.

A Country Doctor is referred to The Lancet of last week, page TO".

THE LATE DIt. HUTTON - .

To the Editors of Tiik Lancet.

Kirs,—T he help of the benevolent is solicited on behalf of the family of
Ur. Hutton, late of 2*3, Lowudes-street, whose death was recently notloed
in your columns. Dr. Hutton's course, though one of industry, self-
denial, and probity, was not rewarded by pecuniary success. Some of
his excellent qualities were not sucli as lead to worldly prosperity, and
even in some respects militate against it. He began life with a small
patrimony; but this was sacrificed ih the interest of a near relative,
without any fault on Dr. Hutton’s part, excepting that he was too trustful
and too unselfish. Upon this part of the sad storv It Is not needful to
dwell. Dr. Hutton’s practice, once considerable, of late years diminished
until the daily earnings scarcely provided the dally needs, though theso
were made matters of the most rigid economy. When the end came
there was found to be nothing, or, rather, something les9 than this.
There is a sou who holds a commission in the army, which it is trusted
he may not have to give up. He is thus provided for; but hit pay does
not suffice to maintain his relatives. The widow and two unmarried
■laughters are left with no means of support. Thu widow, who is
advanced in years and is the subject of a painful disease, has a double
claim on the profession, since she is the daughter of the late Dr. Seymour,
once well known as physician to St. George's Hospital. It is hoped that
some who have been less unfortunate than Dr. Hutton, or more suc¬
cessful. will give out of their abundance towards a fund which is being
nised lor the purpose of saving these ladies from absolute want. How
it can best be used will depend on the amount; It shall be guarded care¬
fully, and employed judiciously. Some of the leaders of the profession,
as well as some of Dr. Hutton’s attached friends, have already subscribed
liberally. It is hoped that this appeal to a wider circle may be also
responded to. The gentlemen whose names follow have agreed to form
a committee for the collection and management of the fund: —
L. Camberbatch, M.D., W. H. Dickinson, M.D., Sir Joseph Fayrer,
Geo. Fandell Phillips, Esq., G. D. Pollock, Esq., K. Stewart. Beq.,
W. Wadham, M.D. Dr. Cumberbatoh, 25, Oadogan-place, Belgrave-
squarc, S.W., as treasurer, will be glad to receive and acknowledge sub¬
scriptions. Cheques should be mads payable to him. The following
sucu have already been subscribed :—

Sir Prescott Hewett ... £82 10 0 1 Sir Benjamin Phillips ... £55 0
Geo. Faudell Phillips,Esq. 50 0 0 S. H. Phillips, Esq. ... 5 5 0

General Seymour ... 50 0 o ' W. O. Priestley, M.D. ... 5 5 0

R. Stewart, Esq. 31 10 0 W. Wadham, M.D. ... 5 5 0

Sir W. Jenner . 21 0 0 Sir Joseph Fayrer ... 5 0 0

Sir Andrew Clark ... 21 0 0 Lady Fayrer . 6 0 0

James Wyllie, Esq. ... 21 0 0 Miss Dickinson. 5 0 0

J. D. Aiicroft, Bsq. ... 20 0 0 H. Lee, Esq. . 6 0 0

L. Cumberbatcb. M.D. ... 20 0 0 F. Bsgshawe, M.D. ... 3 3 0

Mrs. Crcsar Hnwktns 10 10 0 J. W. Ogle. M.D. ... 3 3 0

W. H. Dickinson, M.D.... 10 10 0 [ Charles Hawkins, Esq.... 3 2 0

Sir William Gull. 10 0 0 T. Holmes. Esq. 2 2 0

Baroness H. dc Worms ... 10 0 0 J. Bouse, Esq. 2 2 0

Geo. D. Pollock. Keq. ... 10 0 0 J. Mould, Esq. 2 3 0

G. B. Brodle, M.D. ... 10 0 0 J. Cavafy, M.D. 110

J. H.Mudie. Esq. ... 10 0 0 1 T. P. Pick, Esq. 110

Mrs. Hugh Kennard ... 10 0 0 J Clinton Dent, Esq. ... 110

J. H. Levy, Bsq. 10 0 0 l

I am, Sirs, your obedient servant,

W. Howship Dickinson,

April, 1887. Secretary of the Committee.

A Constant Deader .—We have not heard that such an intention baa been
expressed by any of the various licensing bodies.

Mr. Johnson (Liverpool).—We regret to be unable to assist onr corre¬
spondent.

"BREAD-MAKING.”

To the Editors of The Lancet.

Sirs,—I n answer to the letters of Mr. Robert Jones and “H.,” permit
me to say that a pamphlet was published about the year 1850 on the
subject by a “ Dr. Dagleish,” or “ Dalgleish.”—Yours truly,

April, 1887. No-Nation.

A QUERY.

To the Editors of The Lancet.

8 cm,—C an any of your correspondents inform me how to prepare the
metal, or amalgam rather, used in making children’s tin (so-called) toys
and capsules for bottles, together with the names of manufacturers of
the latter. I require the amalgam for health purposes.

I am. Sirs, yours truly,

April, 1887. . J. W.

•• Sham Patidts.”

Another correspondent, Mr. H. J. Hutton, of Stapleton Hall-road, N„
writes to say that his consulting-room has also received an unweloome
visit from probably the same scoundrel who relieved Drs. Longhurst
and Low of, valuable property. In the case of Mr. Hutton, the thief
managed by picking a look to decamp with seven sovereigns as plunder.
Miss Keigktley.—Vfc do not Issue reprints of separate articles which hare
appeared iu The Lancet.

A. G. P. will see that we allude to the question in an answer to another
correspondent.

SUDDEN DEATH.

To the Editors of The Lancet.

Sirs,—" I fear you are too late,” said the husband, as he hurried me to
the apartment where his wife, from sudden failure of the heart’s action,
was lying insensible, and, as the nurse informed me, "dying.” It was
impossible to administer by the mouth a restorative, so without delay I
injected hypodermically twenty drops of ether, sp. gr. 0 720, and, as the
improvement was not as quick as I desired, forthwith twenty drop*
more. Tathe complete astonishment and great delight of the friends,
consciousness and strength rapidly returned.

The sudden deaths which have so lately thrilled the public mind, more
especially the death of Lord Iddealeigh in London and Mr. Christopher
Busheil here, have influenced me to send yon the above reoord, not as
the proclamation of a new discovery, but as a suggestion—a suggestion
in connexion with the alarming newspaper reports, which usually rnn

somewhat thus" Mr.-suddenly became ill, when, sinking, he was

supported by his friend. Dr. -, who happened to be present, was

most assiduous in his attention, but at Inst pronounced life extinct.”
Should It not be Impressed on the public that the easiest mode In which
respiration can bo carried on is when the body is extended at full
length—not lying on the back, but with the inclination towards
the prone position ? Nature throws down to assist the encumbered
circulation; the officious kindness of indiscretion and ignorance sup¬
ports the fainting sufferer. Again, would it not be well in these times
of frequent sadden deaths from weakened hearts that each medical man
should have in his possession, ready for immediate use, hi* hypodermic
syringe case, with its little bottle filled with ether ? Would it not be
well, too, that the possessor of a weak heart, or, better still, the friend
who accompanies him, should also have the ether and syringe ready
for instant employment. Ladles with neuralgia practise hypodermic
injections^ morphia by the advice and under the direction of physMan*.
This I would condemn. But the friend of a valuable life, the tenure of
whose leasehold Is uncertain through the possession of a weakened, or
flabby, or a fatty heart, might well be instructed in the use of the sub¬
cutaneous injeotion of ether. More than one example might be adduced
to show that t he immediate stimulant might rouse the flagging pulse-
throb; and then, Instead of the announcement that "life was extinct,'*
one might read that after the injection the appalling symptoms quickly
passed away, and what appeared to be approaching death gave place to
the renewed energy of life, with all its usefulness.

I am, Sirs, yours faithfully,

Liverpool, Feb. 23rd, 1887. W. H. Lambart, M.D.

FLEXIBLE STETHOSCOPES.

To the Editors af The Lancet.

Sirs,—I n reference to-the rubber stethoscope mentioned In yonr last
issue a* a new invention, permit ns to say that many years ago we Con¬
structed the sameindlarubber stethoscope from a design furnished us by
Dr. B. W. Riebardeen; that it is fully described, with its advantages, iu
the jEtclepiad, vol. I., page 182-3, 1884 j and that we have supplied the
profession with it repeatedly, the instrument being much appreciated.
The advantage you refer to, that it does not Injure the instrument to sit
upon it, it noticed in the paper above referred to. Dr. Richardson, we
believe, does not use any other stethoscope. ,

We are. Sirs, yours respectfully

Duke-street, April 18tb, 1887. Kbohnb and Sbsemann.

BROWN DEFENCE FUND.

To the Editors of The Lancet.

Sirs,—W ould you kindly allow me to acknowledge the reoeipt of the
following contributions to the above fund ?

Thomas Smith, Esq., i Dr. Fraxer.£1 1 0

F.B.C.S. ... £3 3 0 I Dr. Grey Glover . 1 1 C»

Dr. Broadbent . 2 2 0 Dr. Robert Barnes. 1 0 0

Lennox Browne. Bsq. ... 1 1 0 J. H. T. Connor, Bsq. ... 0 10 8

Dr. Holman (Reigate) ... 1 1 0 • M. G. Biggs. Esq. 0 10 8

Benj. Duke, Esq. 1 1 0 , J. T. Boyd, Esq.0 10 0

I am. Sirs, your* faithfully.

Meadow Side. 23, Upper RIclimond-road, O. Stani.et Ml’RRAT.

Putney, April 20 th, 1887.

THE ASSOCIATION OF GENERAL PRACTITIONERS.

To the Editors of The Lancet.

8 nts,—I hope the above powerful advocate of the rights of the masses
will favour us here In Ireland with a meeting next August, on the
occasion of the British Association gathering in Dublin. Irish provincials
need stirring up, and a little Saxon backbone will do them no harm.

I am. Sirs, 3 -ours truly,

Cashel. April lflth. 1387. Thomas Lajtan.

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862 Thb Lancbt,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[April 23, 1887.

Langmork Defence Fund.

Is responre to the appeal which recently appeared In Thb Lancet
aeveral donations have been forwarded; but a sum of £132 Is still
required to pay the legal expenses necessarily Inourred by Dr. J.
Wreford Langmore for his defence in the recent trial, although he
obtained the verdict of the jury with full costs. Subscriptions should
be sent to Mr. George Eaatcs, M.B., 09, Connaught-street, Hyde Park-
square, London,W.

Second List of Subscribers.

Subscriptions announced £84 16 6 i Mr. Malcolm A. Morris... £110

“A Friend” . 5 5 0 ; Mr. W. B. Owen. 110

Mr. Thomas Smith ... 2 3 0 1 Mr. Herbert Page ... 110

Sir Henry Thompson ... 2 2 0 Mr. F. N. Padley. 110

Dr. W. H. Broadbent ... 2 2 0 Dr. G. V. Poore. 110

Dr. J.Hughlings Jackson 2 2 0 Mr. Henry Power ... 110

Mr. G. P. Field. 2 2 0 Dr. C. Taylor . 110

Mr. Marcus Beck. 110 Mr. A. S. Underwood ... 110

Dr. Walter'J. Bryant ... 110 Mr. II. H. Woodliouse ... 110

“ H. V. O.” . 110 Mr. F. Canton . 0 10 6

Surgeon-General W. R. “ W. D." . 0 10 6

Cornish. 1 1 0 . Dr. J. B re ward Neal ... 0 10 6

Mr. Henry Gaselee ... 110) Mr. Walter Bigden ... 0 10 6

Mr. G. E. Walker. —We know of no institution where the suggestion is
acted upon ; but it appears worthy of consideration.

M.R.C.S. Is referred to an article on the subject which appeared in
The Lancet of Nov. 20th last.

Mr. B. B. Joll will find his question answered in our current issue.

B. A’.—Once or twice daily.

ABDOMINAL PALPATION.

To the Editors of The Lancet.

Sirs,—I am Informed tliat in one of the numbers of your journal the
statement was made that the method of abdominal palpation was not
taught in any of the medical colleges. I take pleasure in mailing to you
today one of the announcements of the Long Island College Hospital,
by which you will see that, whatever may be true of other colleges, this
one recognises the value of this means of diagnosis. I may also add
that this plan has been carried out with us for two years past.

I am, 6irs, yours very truly,

J. H. Raymond, Secretary.

Long Island College Hospital, Brooklyn, N.Y., April 7th, 1887.

Dr. C. E. Monro (Penge).—If the notice arrived, and wo have no recol¬
lection of it, it has been mislaid.

Dr. Glatwille. —The formula was given in our issue of March 26th.

Dr. J. Bardie’s letter is crowded out this week.

Communications not noticed in our present number will receive atten¬
tion in our next.

Communications, Letters, Ac., have been received from —Sir Dyce
Duckworth, London ; Dr. Braxton Hicks, London; Dr. Dlokinson,
London ; Mr. Harrison Cripps, London ; Herr Fischer, Jena ; Mr. C.
Higgens, London j Mr. J. W. Watson, York; Mr. Walter Whitehead,
Manchester; Dr. Adams, Runcorn; Dr. Forbes Winslow; Mr. Stanley
Murray, Putney; Mr. Batterham, St. Leonards; Dr. C. B. Monro,
Penge j Mr. Branthwaite, Wiilesden ; Mr. Faulkner, London ;
Mr. Tallmok, London; Mr. H. S. Jackson, Walmer; Mr. Wickham
Barnes, London; Mr. H. Bramwell, Newcastle-on-Tyne; Dr. Julius
Mickle, London; Mr. J. H. Raymond, Brooklyn ; Messrs. Bryce and
Whitelegge, Nottingham; Dr. J. Beckett, London; Messrs, Lynch
and Co., London ; Mr. 0. H. Wells, London; Messrs. Kegan Paul and
Co., London; Dr. Sawtell, London; Messrs. Maclure, Macdonald, and
Co., Glasgow; Mr. J. B. Pike, Loughborough; Messrs. Loeflund and

Co., London; Mr. K. Tomson, Luton; Mr. W. B. Sacker; Mr. Barton
Smith, London; Mr. R. J. Hutton, London; Messrs. Todd, Burns, and
Co., Dublin; Dr. Rcntoul, Liverpool; Mr. W. Q. Bvan*; Mr. Kenneth
Millic&n, London; Mr. E. C. Andrews, London; Messrs. Burroughs
and Wellcome, London; Mr. G. Banks, Loudon ; Messrs. Condy and
Co., London ; Mr. Lysaght, Sydney ; Mr. T. Laffan, Cashel; Mr. W.
Greene, Wallingford; Mr. F. 0. Turner, London; Mr. G. P. Best,
Cheltenham; Mr. Klngzett, London; Mr. Blanch; Messrs. Peebles
and Son, London ; Mr. Has lam, Birmingliam ; Dr. M'Kendriok, Glas¬
gow ; Dr. McKee, Wiesbaden; Mr. Beck, London; Mr. M. H. Taylor,
Richmond; Mr. J. Gilroy, Birmingham ; Dr. G. D. Douglas, Bourne¬
mouth; Mr. Mosely, Leeds ; Dr. Railton, Manchester ; Dr. Dudgeon,
London; Mr. Cornish, Manchester; Mr. Mayo, London ; Mr. Thomas,
Birmingham; Mr. JeaSreson, Newcastle-on-Tyne; Messrs. Beal and
Sons, Brighton; Mr. Orchard, Notting-hill; Messrs. Johnston and
Co., Edinburgh ; Mr. Armstrong, Manchester ; Messrs. Wright and
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THE LANCET, April 30, 1887.

fxttos

CHf

INJURIES OF NERVES.

Delivered at the Royal College of Swgeone,

By ANTHONY A. BOWLBY, E.E.C.S. Eng.

LECTURE I.

Mb. Pbesident and Gentlemen, — My first duty is to
offer you my sincere thanks for the honour you have
conferred in appointing me to deliver these lectures.
Believe me, I am very fully conscious of the responsibility
•which is incurred, and can assure you that it was not
without some diffidence that I undertook the task. The
subject I have chosen is Injuries of Nerves, and if any
excuse is necessary for my choice, it is supplied by the fact
that to this subject I have given the greater part of my
spare time for the past six or seven years, and that what I
submit to you is the best work I have to offer.

It is now some nine years ago, Sir, that my attention was
first directed to injuries of the nerves by a case at that time
under your own care in St. Bartholomew’s Hospital. The
patient was a man who had injured his ulnar nerve near
the elbow-joint some months before admission, and you,
Sir, performed the operation of nerve suture, an operation
which at that time was new, and had been confined in its
application to some few cases chiefly in the hands of
continental surgeons. The novelty of this operation inte¬
rested me, as did also the doubts expressed as to its success
and the dangers attending it, and my curiosity was further
aroused when I found, on seeking for more information,
that there was little that was accurate and much that was
speculative in the opinions expressed by writers on the
subject. A year later another operation of a similar kind
was performed by Mr. Holden; and in 1880, when acting as
his house-surgeon at St. Bartholomew’s Hospital, I had
opportunities myself of treating by suture several divided
nerves. Prom this time forward I determined to solve bv
my own observations, if possible, those problems to which
I could not obtain a satisfactory answer m published works,
and was stimulated to additional efforts by the award of the
Jacksonian Prize of the Royal College of Surgeons to an
essay of mine on “Wounds and other Injuries of Nerves”
in tne year 1882. That essay I did not publish, neither did
I report any of the cases on which it was founded, for I was
not at that time sure of my ground, and felt 1 had yet much
to learn of nerve injuries, and especially of their clinical
course. Fortunately for my project I was attached to a
large hospital, into which many and various accidents were
yearly admitted, and to the surgeons nnder whose care the
patients were placed —yourself amongst the number—I owe
a debt of gratitude larger than I can ever expect to pay.
Without their constant aid and encouragement, without
access to the cases under their care, it would have been
impossible for me to have attained my object, or to have
had the opportunity of delivering these lectures, much of
the material for which has been extracted from an essay
by myself, to which the Astley Cooper Prize was awarded
last year.

The time at my disposal does not permit me to describe
the various anatomical and physiological properties of
nerves which bear upon the injuries to which the latter
are subject, and I shall therefore at once pass to a con¬
sideration of those changes which result from simple section
of a nerve trunk, and are seen in both its peripheral and
proximal portions. With regard to the peripheral end,
there is now tolerable unanimity in one respect at least, as
all writers concur in describing a degeneration of both
motor and sensory fibres, whilst differing in their descrip¬
tion of the process. Waller in 1862 first thoroughly inves¬
tigated the effects of division, and established the facts—
(l; that section of the anterior root, before its junction with
the posterior, resulted in a degeneration of that part of the
motor fibres which are thereby separated from the cord;
(2) that section of the posterior root on the proximal side
.of its ^anjpirn resulted in a degeneration of that part of the

fibres only which intervened between the point of section
and the cord, while the periphery of the nerve remained
intact. Waller therefore concluded that the ganglion cells
of the cord formed a trophic centre for the nerves of the
anterior root, while the ganglion on the posterior root
fulfilled a similar office for the sensory fibres. These con¬
clusions are generally allowed to be correct, as are also the
facts from which the author deduces them, despite the
difficulty of explaining the regeneration which we shall
presently see occurs while the distal end is still separated
from its trophic centres. In the above experiments the
recurrent nerve fibres present in all nerve trunks may be
seen for some time in a normal state in the peripheral
segment, while in the proximal end of the divided nerve
some may be seen in a degenerate condition. The recurrent
fibres soon undergo atrophy.

While agreeing in the main as to the changes occurring
in the distal end of a divided nerve, the various authors
who have investigated this subject differ in the details of
the process, and it will therefore be advisable to quote
here the most important of these conclusions. Waller and
Busch 1 believe that the whole of the primitive fibrils are
destroyed, and are regenerated by reunion with the proximal
end. Ranvier 2 describes a swelling up of the nuclei of the
sheath of Schwann, the protoplasm of which collects into
large masses, and encroaches upon the sheath of myeline.
The swelling commences within twenty-four hours of
division, and by the third day the pressure of the newly
formed mass has resulted in a complete section of the axis
cylinder opposite the situation of the nucleus in each of
RanvieFs nodes. By the sixth day the myeline is reduced
to small fragments, the protoplasm contains fatty granules,
and the nuclei of the sheath are increased in number 1 .
Finally, at the twentieth day the fragments of myeline
settle into masses separated from each other by slender
filaments with oval nuclei formed by the sheath of Schwann.
At the same time granulo-fatty degenerative changes are
observed in the connective tissue cells in the endothelium
lining the vessels, the fatty granules being probably derived
from the myeline which passes in a state of solution through
the sheath of Schwann. White blood cells become infil¬
trated into the substance of the nerve tubes, and appear to
be instrumental in removing the ddbris. Mitchell 3 describes
a loss of translucency from the fourth to the sixth day, and
says that the white substance of Schwann undergoes an
irregular segmentation and finally disappears, the nerve
assuming a dull grey tint, like a piece of firm connective
tissue. While confessing the difficulty of arriving at a very
satisfactory conclusion, he considers that the axis cylinder
is probably not affected by the process of degeneration. He
does not think that this process spreads gradually from the
cut end of the nerve to tne periphery, but is satisfied that
it affects at one and the same time the whole length of the
nerve. Benecke 4 agrees with Mitchell that the degeneration
affects the whole periphery simultaneously, and that it
becomes of a cloudy yellow tinge and tears easily, the
medullary substance coagulates and breaks down to a fine
detritus, tbe axis cylinder becomes enlarged and swollen,
and finally disappears, whilst the nuclei of tbe ahOath
multiply. MM. Cossy and Dfcjeune 8 consider that the large
nerve fibres de not degenerate so rapidly as the fine
primitive fibrils, and that up to the third day the only
change is that the axis cylinder is abnormally friable and
the nuclei of the sheath swollen. Changes in the medullary
sheath, similar to those already described, commence on
the fifth day, and are considered by these authors to be
secondary to those which occur in the axis cylinder; the
latter entirely disappears by the twelfth day. Leegard"
investigated the condition of the distal ends of the nerves
after having produced a simple solution of continuity of the
myeline and axis cylinder, and not of the sheath, by the
application of a ligature which was immediately removed.
He found that in three days the axis cylinder broke up in
places, and the myeline ran together in cylindrical masses,
and ultimately underwent a granular degeneration, the
nuclei enlarged and multiplied, and the axis cylinder finally
disappeared from the tenth to the fifteenth day. This
process of degeneration attacked the whole peripheral

i Zelt. fiir Wis. Zoo!.. 1851. vo!. Vi.

8 Oomp. Rond. de rAaadeinio de Science, 1872; and Comil and
fionvler’B Path., 1882. * Injuries of Nerve*.

4 Virchow’s Archlv, 1872. * Archives de Phys., 1876.

« Archiv de Klin. M61,1880.

S

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864 This Lancet,]

ME. ANTHONY A. BOWLBY ON INJURIES OF NERVES.

[Apbil 33,1887.

segment at once. The foregoing conclusions are all drawn
from experiments on animals.

In two cases in which I have had the opportunity of
examining the nerves of men (one on the fifteenth day after
injury and one on the thirtieth) in which operations for
the purpose of secondary suture were undertaken, the con¬
dition of the peripheral end was very satisfactorily demon¬
strated after staining in osmic acid. In the case in which
the nerve had been divided fifteen days previously there
was found much segmentation of myeline, which had
collected in droplets of varying size in the nerve sheaths.
In most of the sheaths there was some myeline, but in a few
it was completely absent. The nuclei of the sheath had
increased in number, although not to any great extent.
The condition of the axis cylinders was very difficult to
establish with certainty. In most parts of the sections

of them were yet present, though so much altered in contour
as to be almost indistinguishable. In the case in which the
section was thirty days old the changes mentioned above
were all further advanced. Only a few drops of myeline
remained; the axis cylinders had entirely disappeared (or at
any rate could no longer be distinguished); whilst the nuclei
of the sheath were again but slightly increased in number.
In another case I examined the peripheral end of a divided
nerve three months after section. Here it was impossible
to recognise any nerve tubules at all. There was a complete
absence of myeline and of axis cylinders. In the nerves which
I have examined at times varying from three to six months
after injury similar appearances are found. In most of such
specimens the places formerly occupied by nerve bundles
are marked by the presence of circular masses of tissue
which have the appearance of connective tissue with many
nuclei. These masses are, however, much smaller than the
healthy nerve bundles, and consequently do not fully occupy
the spaces in the perineurium, but appear to have shrunk
away from the surrounding tissues. My own observations on
human nerves would thus appear to accord with those of
other observers on the nerves of animals, and it may be
concluded that the degenerative changes are signalised by
the destruction of the myeline, the multiplication of the
nuclei, and the loss of continuity of the axis cylinder. The
majority of observers, and amongst them the most trust¬
worthy, are also agreed that these changes occur in the
whole length of the peripheral portion at one and the same
time, while others maintain that they commence at the cut
end and spread downwards, either q short distance from the
point of section or else along the whole periphery. This
degeneration commences within a day or two ot the injury,
ana within five or six weeks the nerve has undergone
complete atrophy.

Central end .—As has already been mentioned, the fibres
of the proximal end are comparatively slightly affected by
the nerve section. Ranvier describes the changes as being
limited to one, or at most two, of the inter-annular segments,
and says that the myeline, instead of becoming broken into
large fragments, which subsequently become smaller, as in
the peripheral end, is rapidly reduced into fine granules,
whicn later on assume a yellowish-brown colour with osmic
acid. The nuclei multiply and increase in .size, but instead
of encroaching on the medulla they remain flattened
against the sheath of Schwann, whilst the axiB cylinder
remains intact. An infiltration of white blood-cells into
the myeline occurs, resembling that already described in the
peripheral segment. Neumann also describes somewhat
similar changes. Leegard 7 describes changes like those which
he noticed in the peripheral end as occurring in the first
inter-annular segment of the proximal end ; tne next three
or four segments become also irregular and shorter, with
the medulla broken up. The sheath is empty at places, and
shows nuclear prolification.

Bulbs .—It is now many years since it was noticed that
after section of a nerve the upper end became bulbous, and
this has more.particularly excited observation in stumps.
The very general opinion as to the structure of these
tumour-like swellings in the nerves is that they consist of
fibrous tissue, a, statement which has been handed down
from one author to another without apparent investiga¬
tion. George Hayem in 1877* was the first to point
out that, j^alba- Consist not only of newly formed
fUiro^ fisaTiQ^lwf a wo of new nerve elements. He believes

that after section the most distal portion of the upper
end degenerates, and is replaced by young fibres which
undergo a gradual process of development. In a case
which I have recently examined, the amputation (through
the leg) had been performed five years previously in a lad
aged twelve years. Reamputation became necessary on
account of an insufficient covering for the bones, and an
examination of the bulb on the anterior tibial nerve showed
on cross section a greater number of fibres than did the
healthy nerve above. The only conclusion that can be
arrived at is that the additional fibres were of new forma¬
tion; they were mixed with newly formed fibrous tissue.
A microscopic examination of such a bulb under a low
power shows a proliferation of the perineurium, which
penetrates between the different fibres in the bundles, and
separates them into smaller bundles of three, four, or more
fibres. Later on, these fibres becoming compressed, gradually
lose their sheath of myeline, and so appear smaller than
normal, until finally they come to be composed only of axis
cylinders. The lower down in the bulb the section is made,
the more complete do these changes appear; so that between
this part and the junction of the bulb with the healthy
nerve above all stages of transition between connective
tissue and healthy fibres may be seen. Considering that
the young nerve fibres also appear on section to be smaller
than normal, it becomes very difficult to say for certain
whether any individual nerve tube is in a stage of transi¬
tion into a higher or lower state. Nevertheless, as a
transverse section shows, on careful examination, that
although some of the thickness of the bulb is due to an
increase of the connective tissue elements, yet the larger
amount of it is composed of nerve fibres, we are naturally
driven to the conclusion that some of these must be of new
formation. Sections of the nerve trunk above the bulb do
not usually show any of the degenerative changes that are
met with in the peripheral end, there being no increase of
connective tissue or decrease in the white substance of
Schwann unless inflammatory changes have been started
and “chronic neuritis” has supervened. In those cases,
however, where the section is of very long standing, it
appears that after the lapse of a considerable time, probably
years, the nerve fibres do in part atrophy and degenerate,
and thus follow the example of other tissues and bear
evidence to the general truth of the pathological law that
“atrophy results from non-use.” I have not myself had
opportunities of examining the proximal ends of divided
nerves at any distance from the seat of injury after simple
section, but I have examined the nerves from limbs in which
amputations have been performed in bygone years, and have
found in them that many of the nerve fibres are diminished
in size, that their myeline sheath is greatly shrunken, and
that some of them have quite disappeared. This is a patho¬
logical fact of the greatest clinical interest, and one to
which I shall again have occasion to refer. . ,

Regeneration and union. — The process of degeneration
which has just been described, is succeeded by one of
regeneration, resulting, in favourable cases, in a complete
restoration of the nerve. It is of great importance to observe
that this regeneration can take place in the peripheral end
previous to any reunion with the proximal extremity,
and an examination of the former several months after
section will show that some of the axis cylinders have
been re-formed, and that around them a deposit of myeline
is slowly developing. The fibres are not, of course,
collected into symmetrical bundles, as in a healthy
trunk, and are smaller than natural; they may be seen
scattered about amongst the surrounding connective tissue

Th* La it crt,] DR. W. O. PRIEST LEf: THB PATHOLOGY OF INTRA-UTERINB DEATH. {April 30,1887.. 8&6

already alluded to my own examinations of human nerves
in a state of degeneration, and shall now describe the
appearances 1 have met with in cases in which regeneration
of the peripheral end had occurred after section, indepen¬
dently of union with the upper portion.

The first case was that of a lad, aged eighteen, in whom
an operation for reunion of a divided ulnar nerve was under¬
taken seven months after injury. An examination of the
portion of the peripheral end, which was removed prepara¬
tory to suture, showed that, scattered throughout a trans¬
verse section, were several small, imperfectly developed
nerve fibres such as are met with (and have already been
described) in the bulbous proximal end. These new fibres
were not collected into definite bundles; they were much
smaller than natural, and their myeline sheath was scarcely
perceptible. The total number of these new fibres was but
small, and I was unable to trace their development in a
satisfactory manner.

The second case was that of a woman, aged fifty-three,
who had divided the median nerve just above the wrist-
joint. An operation for suture was undertaken nine months
later, and the condition of the resected portion of the peri¬
pheral end was found to be as follows. The circular spaces
in the neurilemma, whiob, in a state of degeneration, 1 had
previously found in other cases and have already described
as partly filled with nucleated connective tissue, I now
found to be occupied by nerve fibres, in varying stages of
regeneration. The Bteps in the formation of these fibres
could, moreover, be most clearly traced. Their first appear¬
ance was in the form of oval and spindle-shaped nuclei,
which seemed to be identical in structure with the nuclei of
the sheath. These nuclei were arranged in bundles, with
their long axes parallel to that of the nerve trunk. The
next step was the elongation of the nuclei and their gradual
transformation into fibres, around which subsequently a
myeline sheath was formed. In some parts of the section,
bundles of newly formed nerve fibrils oould be seen occupy¬
ing the spaces in the neurilemma which had evidently been
previously occupied by the healthy nerve bundles, before
the time when the injury was inflicted. The new fibres in
some bundles were in a much more advanced stage of de¬
velopment than those in others, the regeneration appearing
to progress simultaneously throughout all the tubules in each
bundle irrespective of the condition of the fibres in others.

I have also had the opportunity of examining the nerve
ends in a case in which the ulnar had been divided nearly
two years before I saw the patient. The nerve bad been
completely cut across, and no union had taken place, the
upper and lower ends being separated by about half an inch
or more of firm cicatricial tissue. A microscopical examina¬
tion of the peripheral end showed that many of the fibres
had been regenerated. A large number of the bundles con¬
tained numerous nerve fibres in various stages of develop¬
ment. In some the axis cylinder alone was formed. In
many others the myeline sheath surrounded the young axis
cylinders, whilst in some the “nodesof Heavier” were well
marked.

There is, indeed, a tolerable consensus of opinion as to
the part played by the nuclei of the sheath, from which, ac¬
cording to most authors, the new axis cylinders are formed.
The strongest objection to Ranviel's theory, that the unde¬
generate fibres of the central end grow into the empty sheath
of the periphery, lies in the fact that, as 1 have already
described, the peripheral end will regenerate even when
ununited to the central healthy fibres; and if further proof
of this be necessary. It may be found in the investigations of
Phillippeaux and Vulpian, 9 who not only aaw regeneration
of the peripheral fibres without union with the proximal
end, but found the same take place in a piece of nerve
resected and transplanted into the surrounding.tissues. If,
then, the peripheral end has become regenerated, and is
placed in sufficiently close proximity to the central portion,
union will result by the continued formation of nerve fibres
between the divided extremities. But, on the other hand,
should union fail, it appears probable that the nerve again
degenerates, perhaps never to recover. I have found no
mention of this by other authors, but am, nevertheless, in¬
clined to feel certain that such changes must occur, for
otherwise we should have some difficulty in explaining
those cases in which many years after injury the nerves
have been found completely atrophied. As examples of such
I append the following two cases. Israel 10 records the case

• Gas. dea HOp., 1861. w Virchow's Arehir, vol. lxxsr.

of a man who had been shot through the median and ulnar
nerves thirty-two years previously. The peripheral ends .
were found to have only the thickness of a knitting-needle,
and to consist chiefly of connective tissue. In voL xxiy. of
the Pathological Society’s Transactions, Mr. Butlin describes
a case in which the ulnar nerve had been divided fourteen
years before death. No union had taken place, and the
lower end was found to consist nearly entirely of connective
tissue, a microscopic section showing that the healthy nerve
fibres had entirely disappeared, while the presence of any
axis cylinders was very doubtful. No doubt many such
cases can be found, and all bear but one of two explana- .
tions. Either the divided nerve never became regenerated
at all, or else it subsequently again degenerated. The latter
appears to me the most likely, but before the matter can be
considered settled more investigation is necessary.

The conclusions which may be drawn from the most
recent investigations are: 1. That the nuclei of the sheath
of Schwann (which are developed from epiblast) form the
new axis cylinder. 2. That the myeline is subsequently ,
formed around the new cylinder. 3. That the peripheral
end may become in part regenerated without forming any
union with the proximal extremity, but that it probably
again tends to degenerate if union fails.

(To be eoncluded.)

ABSTRACT OF

fitmlran fkturn

ON THE PATHOLOGY OF INTEA-UTERINE
DEATH.

Delivered at the Royal College of Phytieiant of London,
March, 1887,

By W. 0. PRIESTLEY, M.D., F.R.C.P., LL.D.,

CONSULTING PHT8ICIAX TO KING'S COLLEGE HOSPITAL, AND LATH
PROFESSOR OP obstetric medicine, kino’s college.

LECTURE III.

Du. Priestley in this lecture discussed the diseases and
anomalies of the placenta, one of the chief difficulties in the
study of which arose, he observed, from the tendency on
the part of authors to regard the particular morbid change
which they have had the opportunity of investigating as
the chief or only disease with which the organ is affected.
All other morbid appearances are for them but consequences
or complications of a specific and cardinal lesion upon which
the rest depend. Thus Charpentier accepts the investiga¬
tions of Robin as illustrating the whole range Of placental
pathology, and believes that when disease has invaded the
placenta it commences always in fibro-fatty change; and
consequent on this, blood extravasations and successive
transformations of effused blood account for all the various
pathological appearances associated with the death or
enfeebling of the foetus. Vardier and Bustamente, on the
other hand, take entirely another view of these changes. To
the lecturer it appeared that one cannot long investigate
the diseases of the placenta without discovering that they
are most complex m their nature, and that they proceed
from a variety of causes inextricably intermixed—some¬
times one pathological condition having the precedence,
sometimes another. The placenta is, in truth, as liable to be
affected by a variety of diseases as the liver or the lung, and
some of its diseases bear not only a striking resemblance to
diseases occurring in those organs, but have affinities with
them and may depend on the same causes. Confusion has
also arisen from investigators describing the same morbid
condition under a different name, probanly because it was
observed only in one stage of progress or with some variations;
and some have fallen into the error of ranging affections
which are intrinsically different under the same appellations.
Extravasations of blood into the young placenta are very
common, and they occur as the result of rupture of some of
the vascular maternal loops which ramify throughout the
placental mass and surround the villi of the chorion. These
vascular maternal loops eventually become the sinuses or
82

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866 The Laitckt,] DR. W.O. PRIE8TLET: THE PATHOLOGT OP INTRA-UTER1NE DEATH. [Apbil 30,1887.

cavities which permeate the placental tissue at a later period.
If the extravasations be limited in extent, the life of the
embryo may not be compromised, but a more extended
apoplexy at once stops its nutrition, and the root-like pro¬
cesses of the young villi become so compressed that the
circulation can no longer be carried on through the minute
fcetal bloodvessels which they contain. Apoplexy takes
place into the substance and on the uterine surface of the
full-grown placenta also very frequently. There is, however,
this marked difference from the earlier period—that now
the placenta is larger and thicker, and isolated clots may be
deeply embedded in its substance, only to be exposed by
incision. Others may have been formed between the
uterine walls and the maternal surface of the placenta,
making a deep depression into the centre of a placental
cotyledon and compressing the placental structures. As a
further difference in the results of blood extravasations in
the young and more mature placenta, Dr. Priestley pointed
out that in the latter several successive effusions of blood
may take place, forming apoplexies of varying sires and
dates, without so seriously jeopardising the life of the fcetus
as it would do at an earlier period of gestation. The larger
siae of the placenta and its more extended surface afford a
better chance of so much of the potential part of it retaining
its healthy relations, and so carrying on the placento-fcetal
circulation that embryonic life is sustained. Among the
writers on this disease are Sir James Simpson, M. Jacquemier,
Verdier, Bustamente, and Robin. The last named differs
in toto from other workers in the same field as to the
order of pathological events in the placenta. He insists that
no blood extravasations take place in the placenta without
previous disease in the tissue, and that the morbid change
which is the most common forerunner of apoplexy is not
mere vascular change, but an alteration of the whole struc¬
ture of the villus. The interference with the life of the
child or with the course of gestation depends upon the
amount of extravasation, and the excitability or quiescence
of the uterine walls under the provocation to contraction.

Inflammation of the placenta, or placentitis, has been
discassed by several authors, amongst whom Simpson
described it as consisting of three stages: the first being one
of congestion, in which the tissue is engorged by an unusual
accumulation of blood in the vessels; the second charac¬
terised by the exudation of coagulable lymph, producing a
greater density of tissue and eventual induration ; the third
stage being that in which purulent matter is formed. In i
later days a good deal of scepticism has been expressed about I
the existence of placentitis—at least, so far as its parenohyma
or foetal portion is concerned. Bustamente disbelieves in
its existence altogether, and says the evidence rests on the
supposed presence of pus, which has been shown to be
fallacious; the supposed purulent matter, according to
ilobin and other observers, being merely pseudo-pus, pro-
•duoed by broken-down fibrin. It has been further argued
•that, according to modern theories, inflammation of the
placenta is impossible, since there are no capillaries in the
maternal portion, and there are no nerves to regulate the
■contractility of vascular walls in the entire structure. This
(reasoning does not, however, seem conclusive to Dr.
Priestley. There are fcetal capillary loops in all the active
villi, and there are also minute capillaries of maternal origin
in processes or dissepiments of the decidua which circum-
scnbe the fcetal villi. It is true, nevertheless, that the
presence of purulent matter in the placenta in most of the
reported cases is supported by imperfect evidence. There
are only some ten cases of abscess in the placenta recorded,
and as no account is given of the microscopic examination 1
of the supposed pus, the evidence is plainly unsatisfactory.'
Purulent matter has, however, been found and duly 1
authenticated on the surface of the placenta and in the
uterine sinuses at or near the placental site. That some
morbid change analogous to inflammation does take place
in the placenta or its neighbourhood is apparently indicated
by the firm adhesions which are occasionally formed between
the placenta and the uterine walls, and from the traces of
an exudation which agglutinates and compresses the villi
of the placenta.

Dr. PrieBtley then spoke of a remarkable afFection which
he designated as placental phthisis, a disease which repeated
investigations have convinced him is not, primarily at least,
a mere increase of the cell structure or of the fibroid
element in the placenta, but in its first stage consists of an
exudation or deposit thrown out among the villi, and is
probably due to some modification of a low inflammatory

process. The disease is not really tubercular in its character;
nor have bacilli been found in its substance; neither is it
primarily or essentially a fatty degeneration, for the deposit
is not affected by the reagents which show the presence of
fat. Its corpuscles, unlike fat-granules, are thoroughly
coloured by the material used for staining the microscopic
sections. It is not due to changed blood clot, for there are
neither altered blood-corpuscles nor crystals in its substance.
Its general appearance, both before and after section in the
earlier phases, is rather that which has been described as
fibrinous or other analogous deposit, and it has the chemical
characters of protein compounds. Dr. Priestley announced
bis intention of going into the minute pathological anatomy
of this so-called placental phthisis in a paper which he
purposes offering to the Obstetrical Society. In the order
of successive changes the disease runs in somewhat parallel
lines with phthisis in the lungs. First comes solidification,
then Eoftening, with breaking up of tissue and resulting
haemorrhage. A notable feature in many of the microscopic
sections was the great hypertrophy of the contractile coat
of the fcetal bloodvessels. It is not an uncommon form of
disease, and there is some reason to believe that although
commonly it runs a chronic course, yet occasionally its
progress is very rapid. With regard to fatty degeneration
of the placenta, the lecturer remarked that the question
is whether this disease during the life of the child really
occurs as a primary pathological change, or is invariably
preceded by some exudation or other morbid change which
initiates the fatty metamorphosis. Fatty degeneration,
whether it occurs as a primary change or is the secondary
effect of some other pathological condition which precedes
it, may produce softening and disorganisation of the placental
tissue, and so favour extravasation of blood or apoplexy. In
other placentas it leads to atrophy. Virchow has described
a very curious morbid transformation of the villi of the
placenta, which he terms “myxoma fibrosum.” It consists
of such enlargement of the stems and villi by fibroid hyper¬
trophy that they form in some cases distinct tumours in the
lacental structure. Cases of this disease are somewhat rare;
at Dr. Priestley has seen two excellent examples in Copen¬
hagen, which have been described in Virchow’s Archxv, in
1878, by Storcb. Virchow regards the disease as a trans¬
formation of the mucous element pertaining to the villus
structure into fibroid tissue, instead of the soft myxoma
which is seen in cystic chorion. The fibroid change is, how¬
ever, unlike the cystic chorion, more frequently connected
with the later period of pregnanoy, although indications of
it are sometimes seen in the earlier months.

Passing over oedema of the placenta, melanosis, calcareous
or osseous concretions, cysts and tumours, Dr. Priestley then
came to the subject of syphilitic plaoenta, concerning which
much diversity of opinion exists. So far as his observation
goes, he does not think we are yet able to say with precision
that any one specific lesion of the placenta belongs alone to
syphilis, although some morbid appearances are more constant
than others in connexion with Syphilis—as, for example, the
changes described by Frankel. In addition to the hyper¬
trophy of the villi described by Frttnkei, and morbid changes
In the decidua, he had seen fibroid deposits, such as those
described by Rokitansky—some unchanged, others under¬
going fatty transformation. Again, he had seen the yellowish
granulations of varying sizes looking like tubercles, as ob¬
served by Lebert; but he had also seen most, if not all, of
these pathological appearances where no syphilitic history
could be traced. Tbe nearest approach to precision in this
respect is to say, as a general rule, when the decidual or mater¬
nal portion of the placenta has become so far changed by
hyperplasia as to arrest theutero-placental circulation and the
full development of the placental villi, that this is probably
due to maternal syphilis, it finds its analogy in the changes
which take place' in the mucous membrane in tbe uterus
and elsewhere when the blood is undoubtedly poisoned by
syphilis, and also in the thickening of the decidua during
tbe earty pregnancy of syphilitic women, which has
been described by Virchow and Dohm as “endometritis
papulosa et tuberosa.” When fibrinous and pseudo-tuber¬
cular deposits are found in the' placenta in connexion with
syphilis, they are probably only tbe expression of a de¬
praved or impoverished condition of the blood, which may
be equally associated with anemia or with some form of
dyscrasia. When there is marked hypertrophy and de¬
generation of the villi, the maternal portion of the placenta
being less affected, the syphilitic taint more probably comes
from the male parent-, and the mother may show no signs of

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Thu L*nobt,] MR A. OGSTON: ELECTRICITY IN MEDICAL AND SURGICAL PRACTICE. [Ap«il 3Qi 188T. jgtf

the disease. Both Depaul and T&rnier, among modern
observers, dispute the existence of absolutely specific lesions
in the placenta as the result of syphilis. De Sindty, one of
the latest writers quoted by Ctiarpentier, did not find
placental lesions in all women affected with syphilis, but
where lesions were present he was able to demonstrate three
important points: (1) hypertrophy of the placental villi;
(2) -fibrous degeneration of them; (3) islands of granulation
belonging to the caseous forms of degeneration. This co¬
incidence of the fibrous and caseous forms of degeneration is
found in syphilitic gumma, notably in gummata of the liver.
De Sindty had not lound this comoined degeneration except
in syphilis. He does not know if any other disease may pro¬
duce the combined changes, and does not decide the question
as to a specific placental lesion in connexion with syphilis.
In reference to all diseases which affect the placenta, it is to
be noted that the effect on the life of the child bears a direct
relation to the amount of damage done to its tissues, and
impairing its double function as an organ for respiration
and absorption. In cases of separation of the placenta, a
portion still adherent to the uterine walls may be enough to
sustain the life of the child, for a time at least; and, in like
manner, when the placenta has become diseased, if some
portions of it only remain sound, vitality may still be
maintained in the body of the fcotus. If the morbid process
be slow and chronic, there will probably be progressive
emaciation ; and if the child be born alive, it will have all
the appearances of being starved during its development.
If the placental disease is more acute and rapid, and affecting
a large area of tissue, the child’s movements become at first
more restless than usual, and then become less marked and
diBtinct a a they subside into absolute quiescence. With the
aid of the stethoscope the beats of the foetal heart have
repeatedly been noted in cases of suspected placental
disease to become slower and slower, and thus to furnish
important indications for the induction of premature labour.
Among the further causes of foetal death in utero which
Dr. Pneetley said he could not in these lectures overtake
are the pathological conditions of the umbilical cord, ante¬
partum hemorrhage, extra-uterine gestation, and allied
conditions, the malformations and diseases of the unborn
child—the most fertile cause of the latter probably being
syphilis. Time, also, did not permit him to speak of the
changes taking place in the body of the foetus when it is
long retained in the uterus after its death; of the inferences
to be drawn as to the cause of death from the appearances
it presents after longer or shorter periods of retention; and
other kindred topics.

With regard to the subject of preventive treatment, Dr.
Priestley stated that-, so far as obviating some of the forms
of intra-uterine death is concerned, we are absolutely in the
dark, and the therapeutics of the subject are still a closed
book. Still, a careful study of the several pathological con¬
ditions in the parents, combined with the local expression
of the reeultB of these conditions, allows in some cases of
methods of treatment being formulated and of rules for
guidance being laid down which in practice have been
attended with happy results. Whenever, therefore, a woman
has once or more frequently lost the product of conception
at an early or later period, careful inquiry should be made
into the health of both parents, and any previous history of
illness should be accurately scrutinised. No pains must be
spared to ascertain whether syphilis is at the root of the mis¬
adventures. When either parent has, in the near or distant
past, contracted thisdisease, both should at once be put under
anti-syphilitic treatment before a fresh conception is per¬
mitted, and this ought to be sufficiently prolonged to give it
a fair.chance of producing satisfactory results. Dr. Priestley
said that he had repeatedly seen good effects from small doses
of biohloride of mercury, with bark, given daring tbe first
three months of gestation, when there has been no oppor¬
tunity of commencing the treatment before conception
began. Similar favourable results have been observed
to follow tbe administration of iodide of potassium. If
inquiry shows that the health of either parent is disordered
or deranged from some other cause than syphilis, care must
be taken to trace out the nature of the deviation from
health, and so to define it that treatment fulfils its purpose.
Not the mother only, but tbe father also, must be put under
supervision. Any constitutional peculiarity or diathesis
must be met by appropriate means—tbe strumous, by tonics
and cod-liver oil, with such improved climatic conditions
!as may be feasible; tbe gouty rheumatic by limitations of
•diet, careful regimen, and alkaline medicines. Keeping the

bowels of women who are liable to abortion unloaded by
aperients is important. Such laxatives as are not likely to
stimulate undue aotion of the bowels or straining must be
chosen, else the medicines may stir up the very mischief
they are given to prevent. Compounds of sulphur, tbe
confection of senna, and saline aperients seem best to
fulfil the needful indications. The advantages of general
bloodletting are doubtful, and its employment may lead to
harm instead of good; but local depletion by leeches
is leas objectionable. For anemia, preparations of iron
must be administered in Borne form least likely to
disturb the digestive organs of tbe patient, and these should
be given not only antecedent to tbe occurrence of conception,
but continued with such modifications and in such com¬
binations as may be suitable during tbe progress of
pregnancy, Where local conditions have been ascertained
or suspected to be the cause of repeated abortion or of later
foetal death, tbe treatment must be directed in accordance
with the special requirements of the case. Especial care
should be taken to remove as far as possible all indications
of endometritis prior to tbe commencement of pregnancy,
an unhealthy condition of the lining membrane of the uterus
being regarded by most authorities as a potent canse of
disease in the foetal membranes and placenta. Rest in tbe
recumbent position is important, especially at the times which
correspond to the days of the catamenial period, and all forms
of locomotion likely to jar the body must be sedulously
avoided. Chlorate of potasb, Dr. Priestley thinks, may act
usefully as an alkaline salt in preventing the formation of
coagula and fibrinous deposits in the placenta. In instances
where the progress of zymotic disease or of inflammation
in some organ of the patient’s body is attended with high
temperature, he suggested that an attempt should be made
to lower the temperature of the uterus and of the foetus
either by the application of ice-bags to the maternal abdo¬
men, or of those tubular appliances for the application of
cold which may be modified to fit any part of the body.
Some of the baths and waters on tbe Continent have a high
reputation for their tonic properties and their favourable
influence on pregnancy. Aix-les-Bains is said to be useful in
those cases. Courses at Schwalbach and Kissingen have
been followed by happy results. The former place is more
appropriate for patients who are more or less ansemic,
Kissingen for those in whom the digestion and portal
system are at faulty__

ON THE USE OF THE

THERMOPILE AND SECONDARY BATTERIES
AS A CONTENIENT MEANS OF PRODUCING
ELECTRICITY FOR .MEDICAL AND SUR¬
GICAL BATTERIES.

By ALEX. OGSTON, CM.,

PBOFKSSOB OF SCBGKBY, UNIVERSITY OF ABEBDEEX.

Electricity has never played so important a part in the •
routine of daily practice and consulting-room work aa its
undoubted usefulness would seem to indicate that it should.
In comparing it, for instance, with the stethoscope and
thermometer, we find that, while these are in the hands of
every physician and surgeon, electricity is hardly met with
at work, save in the chambers of a few specialists and in a
few well-equipped hospitals. Many common mechanical
instruments for studying and treating disease—such as the
measuring line, the weighing machine, the concave reflect¬
ing mirror, and the speculum—are regularly employed by
the majority of practitioners; while electricity, despite its
value in the diagnosis and treatment of nervous disease, as
an unsurpassed illuminating agent, as an electrolytic de¬
stroyer of diseased tissues, tumours, and nsevi, as the most
manageable cauterising agent, and as supplying the electro¬
magnet for extracting fragments of iron from tbe eye¬
ball, is superseded lor these purposes by less efficient
means. The expense of electrical apparatus, and the
want of knowledge concerning it, are, not the chief
reasons for this neglect. The explanation is to be found
in the extreme inconvenience attendant upon the methods
of generating electricity at present, employed. Not to
mention, then, the initial cost of. procuring a good com¬
bined battery, capable of furnishing both continuous and

O

868 Thu Lahoht,] MR. A. OGSTON: ELECTRICITY IN MEDICAL AND SURGICAL PRACTICE. [April 30,1887.

induced currents, and without dwelling on the fact that
when procured it is unsuitable for the electric cautery,
everyone who employs it must be painfully impressed with
the constant trouble and time expended in keeping it in
order. The zinc plates have to be amalgamated, the acids
to be prepared and introduced beforehand, and the corroded
connexions gone minutely over and rectified before the
battery is used. During its employment difficulties may
arise from polarisation and other causes, although in the
bichromate batteries the polarisation difficulty lias been
pretty well overcome. After the battery has been used, and
in all likelihood for a few minutes only, the emptying and
cleaning of the cells have to be gone through, and perhaps a
couple of hours spent in this before it is laid aside. Even
then the remains of acid and the resulting galvanic action
corrode the brass work and connexions, and it is uncertain
whether it may not require before next it is used a pro¬
longed visit to the electrical mechanician’s workshop. It is,
I think, a fair estimate to say that, when used by the ordinary
practitioner of medicine and surgery, each employment of
the battery involves three or four hours of work, by far
too great an expenditure of that valuable time which to him
more than most means money. Nor do the objections
named exhaust the inconveniences that are urged against
the batteries. Bottles of acids are difficult to keep, stoppers
become fixed, and the bottles are broken in their hurried
removal, the waste acids are inconvenient to be got rid of,
and, above all, no acid battery in ordinary use is in the least
suited for the requirements of transport. We are to-day
much where we were twenty years ago as regards these
inconveniences. The Leclanchd batteries are too bulky, and,
being weak, too many cells are required, so that, like most
others, they are quite unsuited for transport. The Gaiffe
batteries are not easily recharged, and in practice have been
found unsuitable. The only really convenient appliance for
transport—the magneto-electric induction machine—is use¬
ful only as an exciter of faradaic muscular contractions.

I wish to direct the attention of the profession to a method
by which electricity in all its forms can be readily and easily
obtained at all times, by arrangements that are easily and
conveniently managed, that are little liable to get out of
order, that can be procured at a moderate initial expense,
arid cost little or nothing afterwards, that are convenient
for transport, and are in all respects attended with the
minimum of inconvenience. I do not claim that the
arrangement I advocate the adoption of is all we
could wish it to be, but believe it is a very great
step indeed in advance of the plans hitherto proposed,
and is likely to satisfy a large number whose employ¬
ment of electricity in practice is at present hampered
or prevented by the drawbacks that have been mentioned.
The plan is not my own. It was suggested to me last year
by Mr. J. W. Swan, the well-known inventor of the incan¬
descent lamp that bears his name, lie pointed out to me
that the employment of the thermopile as a generator of
electricity would probably be of considerable service to
members of our profession, and he was good enough to
interest himself in the matter and work out for me, in a
manner I could not myself have accomplished, the practical
steps towards effecting this. 1 explained to him our wants, and
hedevisedthe means of meeting them. The thermopile, which
forms the starting-point of the arrangement, is composed
of four groups of German-silver and zinc-antimony elements,
each group containing twenty pairs in the form of a wheel,
six inches and a half in diameter, in which the elements are
the spokes. The four coronal groups are placed on a wooden
stand, about sixteen inches square, and are connected
together in series—i.e., the positive pole of one group
is attached to the negative of the next. Each group has
in its centre a gas Bunsen burner, the burners all sup¬
plied by a common pipe, but with taps so placed that
they may be used separately if required; and when the
burners are lit, the difference of temperature between
the outer and inner ends of the pairs of elements generates
a current of electricity, feeble indeed, but very convenient,
since its feebleness can be compensated for, and its con¬
venience, requiring as it does only the turning on and light¬
ing of the gas, is unqu est ionable. These thermopiles are made
by Rebicek of Prague. They give an electro-motive force
of about one-tenth of a volt per pair of elements -that is,
four volts for the four groups, equal, say, to seven or eight
Darnell's and three or four droves cells, power sufficient to
illuminate a small incandescent lamp. A slight alteration
in the thermopile would adapt it for being used with spirits

! of wine, or even with paraffin. Several of these thermo¬
piles can be arranged in series, with a gain in electro-motive
force corresponding to the increase in the number of elements
added, but at the cost of an increase in initial expense, and,
from their bulk, a lessening of convenience. Were they to
come into general use, tneir bulk could be considerably
reduced by some slight alterations.

The thermopile alone, however, is insufficient for the pur¬
poses of the practitioner. To render it useful it requires to
be supplemented by the secondary battery, or accumulator,
as it is sometimes called. With this addition in a suitable
form, portability being the chief point, the apparatus is
complete. The secondary batteries which Mr. Swan
designed for me for this purpose, consist of two portable
vulcanite boxes, each three inches square and eight inches
high. Each box contains two cells arranged on the principle
of Plants, with elements of lead and peroxide of lead,
in dilute sulphuric acid of 1 to 10 in strength. Each is closed
by an indiarubber washer and a lid clamped on by a screw,
to prevent their spilling when carried, a ring-handle being
attached for this purpose. They can, like ordinary galvanic
cells, be used separately or in conjunction. Each weighs, when
filled and Charged, 6 lb. 1 oz. Mr. Swan writes concerning
themThe object in dividing the batteries is that there
may be no unnecessary weight to carry where the power of
one battery (two cells) is sufficient, and it will be sufficient for
surgical lamps for eye and throat examination. For elec¬
trical cautery the combination of the two batteries is
needed. The thermopile has just power enough to charge
one battery at a time when the gas is not very fully turned
on—that is, when the flame just bums above the talc disc.
Under these conditions the thermopile will send £ or (H>
of an ampere through one of the batteries, and that “is what
is proper for a battery of this size. While charging, the cover
should be removed, and several folds of blotting-paper laid
on the mouth of the battery to intercept the bubbles of gas
that rise from the liquid. It is necessary to make up
for this loss of liquid by adding to chat in the cells
sufficient to cover the plates. The battery should not be
allowed to become completely discharged, and, after using,
it should, as soon as possible, be fully recharged and left so.
The only part of the battery likely to get out of order is the
connexion between the positive plate and the outside
terminal, but it is very easy to repair, and I think probably
little or nothing beyond that will require to be done to the
batteries for a long time. Several folds of blotting-paper
round the joint of the lid and caee, or a waterproof bag to
contain the whole, will prevent driblets of acid staining the
clothes of the person carrying it.”

In using these cells I have not found any drawback to
them, save the slight one mentioned by Mr. Swan—viz., an
occasional tear of acid pressed out when they are used, closed,
or carried, by the pressure of the accumulating gas within.
On the contrary, they are among the least obnoxious occu¬
pants of my work-room. They stand on a table in a
porcelain photographer’s tray or common plate beside the
thermopile, for the convenience of charging. The tops are
removed, because, if they are kept screwed on, the imprisoned
gas that is disengaged forces out a few drops of liquid pas 4
the washer, and this trickles down; while if they are removed
no spilling occurs, and they remain dry and clean. When about
to be transported, the lids are screwed on, blotting-paperis put
round their upper ends to catch any tear of acid, and, thus
arranged, they can be carried about a whole day with perfect
convenience. If the liquid in the cells diminishes, a few drops
of dilute acid are added by a pipette. After they have been
used for any length of time, the thermopile is lit, its con¬
ductors are connected with one of the batteries at a time,
and in a few hours it is completely recharged, as maybe
seen by the free escape of gas from the plates. The cells
are connected at will with two pairs of insulated cord con¬
ductors that paps along the wall and through the partition
into the consulting-room. The two pairs of conductor?
enable the batteries to be used simultaneously for differen
purposes, one being attached to each pair, or to be boti.
connected with one pair as desired.

I have during the past two months subjected the arrange¬
ment to the severest tests of practice, having used it for
nearly every purpose save that of extracting steel by the
electro-magnet, and have every cause to be satisfied. The
batteries yield a sufficient constant current, can be attached
to the induction coil for faradisation, answer well for elec¬
trolysis, and are very; convenient for illuminating the mouth
and examining for t'ranelucency in cystic tumours. They

Thb Lancet,]

DR. B. A. ALLEN ON INTESTINAL OBSTRUCTION.

[Aped, 30,1887. 869

870 The Lancet.J

DR. B. A. ALLEN ON INTESTINAL OBSTRUCTION.

[April SO, 1887.

intestine, either at its narrowest part near the lower end of
the ileum, or in some part narrowed by disease, seemed the
only probable diagnosis. That the foreign body was a gall¬
stone I concluded from the history of hepatic colic ten weeks
before, accompanied by little, if any, jaundice, and followed
by uneasiness in the region below the liver, continuing up
to the time of the attack.

On Sept. 29th, at one p.m,, Mr. Marcus Beck saw the cose
with me, and, agreeing in the diagnosis, proceeded to open
the abdomen, assisted by Dr. Gamgee, Mr. Brodribb, and
myself. Mr. Beck has furnished me with the following
account of the operation. The patient, having been placed on
a table, was covered with a mackintosh sheet having an
oval opening in the middle (an ovariotomy apron). The
skin was then carefully cleaned with a 1 in 20 solution
of carbolic acid. Ether having been administered, a spray
of carbolic acid was turned on. An incision was then made
(about three inches in length) in the middle line, the middle
of the wound being midway between the umbilicus and
the pubes. The abdomen being opened, a coil of distended
small intestine showed in the wound. The hand was passed
at once into the right iliac fossa, with the intention ot feel¬
ing for the crncum, in order to ascertain whether it was
distended or empty. Before reaching the cmcum, but close
to it, a hard mats was felt ih a coil of the small intestine.
This was at once drawn lip into the wound and out of the
abdomen. It was then seen that the gut was completely
plugged by a barrel-shaped body of great density. Tne gut
was apparently healthy; its surface was shiny and perfectly
free from any sign of inflammation. An attempt Was made
to push the foreign body forwards, the direction in which it
should go being easily recognised by the distended condition
of the intestine above it, while below the gut was empty;
it would not move with any amount of force which it
seemed justifiable to use. It was determined, therefore, to
cut it out by a longitudinal incision in the intestine. The
opening in the abdomen was carefully plugged with sponges
which had been rung out of a warm solution of carbolic
acid (1 in 40), and the coil of intestine was laid upon a flat
sponge; a small hole was then made in the mesentery close
to the gut, immediately above the foreign body; through
this a piece of indiarubber drainage-tube was passed and
drawn sufficiently tight to occlude the gut, and clamped
with a pair of torci-pressure forceps. In this way the
escape of faeces from above was effectually prevented. A
longitudinal incision was then made at the side opposite
the attachment of the mesentery. It was about one inch
and three-quarters in length, and was of sufficient sire
to allow of the escape of the foreign body without
bruising the tissues of the gut. A small quantity of
very dark fecal matter escaped, which was imme¬
diately received on a sponge. The mucous membrane was
intensely injected and considerably swollen. But little
blood flowed from the incision. The gut having been
cleaned, the edges of the wound were brought together
by interrupted Lembert’s sutures. Pine common sewing
needles were used (No. 7), threaded with fine carbolised
silk. The needle was inserted about a quarter of an inch
from the edge of the incision, penetrating the serous and
muscular coats only, and brought out about one-sixth of an
inch from the edge; then inserted on the opposite side
about one-sixth of an inch from the edge, and brought out
a quarter of an inch. About a dozen stitches were required
and were inserted. When all the necessary sutures were
inserted, they were tied. The closure seemed perfect, the
mucous coat being turned in and the serous from each side
brought well in contact. The piece of indiarubber tube
wn, now removed ; it had made rather a deep impression
in the gut, showing the swollen condition of the bowel.
The impression began to disappear immediately, the cir¬
culation being rapidly restored in the pale part. The
incision was then minutely examined to see if anything
leaked frrni it, and nothing was detected. The coil of
intestine was then carefully cleaned, the sponges plugging
the abdominal wound removed, and tbe gut replaced in the
abdomen. During v thei Whole operation no blood or other
^ into the peritoneal cavity. It
to clean oat the peritoneum
Thtf^tnctemal’ wound was then
Was admir-

mmm Mme

tfbn
The
by a

foreign matter m
was

layer of sal alembroth wool. The foreign body was found to
be a large gall-stone. It was somewhat the shape of a
conical bullet, the advancing end being slightly conical, tbe
opposite end flat. It was marked at its base by a smooth,
slightly concave facet, evidently formed by contact with
another stone in tbe gall-bladder. The rest of the stone was
rough on the surface, and glistening crystals of cholesterine
could be seen upon it. This roughness must have consider¬
ably impeded its passage down the intestine. It measured
3| in. in circumference, 1$ in. in length. It weighed almost
exactly an ounce. The patient rallied well from the
operation. A dose of morphia was administered hypoder¬
mically, and at 9 p.m. the pulse was 100, and of good force-,
there was no pain or sickness, and the patient seemed to be
doing well; but on the following morning the pulse had
risen to 120, the countenance was anxious, there was slight
distension and some tenderness of the abdomen, but no
sickness. He died at 8 p.m., exactly twenty-five hours
after the operation. No post-mortem examination could be
obtained.

In the treatment of this case I was led to go somewhat
beyond the orthodox way of feeding in intestinal obstruc¬
tion by the willingness of the patient to take food, by the
fact of its being retained several hours, and from its not,
as far as I could 6ee, in the smallest degree promoting
vomiting, and perhaps also from having less faith in
the value of nutritive enemata than some have. The
medical treatment consisted of opium and belladonna—
the doses, in consequence of the moderate amount of pain,
being comparatively small,—enemata, and, when they no
longer acted, aperients. I was led to try aperients from
the recollection of a case I had some years ago, when
the combined use of aperients and enemata resulted in
the passing, after ten days’ absolute constipation, of a
stone so large that its passage through the anus caused
great suffering.

The following points seem worthy of further considera¬
tion in this case. 1. What was the cause of death ? Un¬
fortunately this question must remain doubtful. Ue did not
die from shock, for he rallied well from th 3 operation. Every
precaution was taken to ensure cleanliness, no carbolic lotion
except that upon the hands entered the abdominal cavity,
the stitches seemed efficiently to close the gut, and well
carbolised silk was used, and yet from the period of death it
seemed most probable that peritonitis was the cause. Tbe
gut, though not actually inflamed at the time of operation,
was much congested and swollen. Most probably inflam¬
mation developed in the damaged gut after the operation,
and in the weak state of the patient proved rapidly fatal.
2. When was tbe stone impacted? This could not be
accurately ascertained. From the size of the gut and tbe
situation in the abdomen it was probably in the lower part
of the ileum, not far from its end. That it was tbe ileum is
certain from the absence of the valvule conniventes in the
part opened. 8. Was the operation necessary, or would it
have been safer, having made tbe diagnosis, to trust to nature?
This question is extremely difficult to answer. I find in
the Index Catalogue of the library of the Surgeon-General,
U.S.A., references to thirty-nine cases of impacted gall¬
stone. Of these I have been able, with the limited time at
my command, to refer to only fourteen. Among them, I
find, is a stone measuring 3£ in. passed safely after twelve
days’ obstruction. In another case there was a stone of a
little over three inches, but there is no evidence that it
passed down the small intestine ; it probably ulcerated from
the gall-bladder into the colon. Fagge also mentions one
measuring 1^ in. in diameter, which passed after seven
days’ obstruction. On the other hand, I found seven stones,
proving fatal, which measured less than that from my
patient; the smallest had a transverse circumference of only
2± in., and yet it blocked the lower end of tbe jejunum, and
caused death after fecal vomiting. It eeems, therefore,
that although it is possible for a patient to pass stones of
this size through the ileo-colic valve, very few succeed in
doing so, and probably the percentage of recovery would be
greater if operation wore resorted to in every case as soon
as the diagnosis is made. Unfortunately, however, the
diagnosis is very rarely made at all. In almost all the cases
I have met with, their nature was only cleared np at tbe
post-mortem examination. 1 can find no case but this.JB
which tbe stone has been removed by operation. The disea»
is far more common in women than in men. In the fouxUja
cases I have been able to refer to only two, were

HMtlnga. • SrfT «0ii«||PK'

Tub Lancet,] DR. J. A. LINDSAY: CLIMATE AS A THERAPEUTIC AGENT IN PHTHISIS. [Apbil 30,188T. 871

CLIMATE AS A THERAPEUTIC AGENT IN
PHTHISIS;

"WITII AN ACCOUNT OF THE CHIEF SANATORIA FOE
PHTHISIS AT HOME AND ABBOAD . 1

By JAMES ALEXANDER LINDSAY, M.A., M.D.,

FUTSICIAN TO THB CONSUMPTION HOSPITAL, THKONBMOUNT, BELFAST;

ASSISTANT-PHYSICIAN TO THB BBLYAST ROYAL HOSPITAL, BTC.

I propose in this paper to consider four questions:—
1. Does climate care phthisis ? 2. How does climate cure
phthisis? 3. What climates cure phthisis ? 4. What cases
of phthisis are curable by climate ?

1. Does climate cure phthisis ? Yes, beyond question. To
doubt this fact is to run counter to a vast mass of unassail¬
able evidence and to give way to an unreasoning scepticism.
I have met and talked with cured consumptives in many
parts of the world—patients in whom the existence of the
disease had been diagnosed by competent authorities, and
the genuineness of whose recovery was testified by a long
life of vigorous activity. These instances of complete
recovery are, however, less common than cases of relative
recovery, by which I mean those cases in which the morbid
process in the lung becomes dormant and the patient lives
out his days, but with diminished vitality, and maimed, as
it were, for the rest of bis life. It is an extremely important
question to determine how many of these cases of cured
phthisis are contingent upon the patient remaining in the
country and climate where the cure was effected—are, in
technical language, relative to his environment; and how
many are so complete as to permit of a safe return to the
unfavourable climatic conditions which prevail at home.
Erery practitioner who sees much chest disease has had
distressing cases of consumptive patients who have gone
abroad and apparently been cured, but who, yielding to that
piteous home-sickness which sometimes assails the stoutest
heart and disregards the plainest admonitions of prndence,
have returned home, and returned to die. I fear that in a
large proportion of cases the cure of phthisis is contingent
and conditional, and I do not think we can often regard
without serious concern the return of a cured consumptive
to those climatic conditions which originally produced or
predisposed to the disease.

2. How does climate cure phthisis? Not usually by a
«ngle or specific quality of the air or by any definite com¬
bination of meteorological conditions. The old notion of
■“healing air”—viz., that the air by virtue of some inherent
V1 ytue exercised a direct local curative influence upon
tubercular deposits—is a delusion; Bournemouth and
Arcachon profess to cure phthisis by the balsamic emana¬
tions from their pine forests, but if such emanations have
any influence (which is quite doubtful), such influence is
but a small and unimportant factor in their general climatic
effect. The nearest approach to a specific climatic influence
upon phthisis is found in the action of the climates of high
altitudes, which has been abundantly proved to depend mainly
upon the rarefaction of the air. To sum up this branch of
tne subject, climatic treatment cures phthisis by removing
«ne consumptive from the evil influences of unfavourable
meteorological conditions and of an injurious soil, and by
transferring him to a climate where fresh air, sunshine, and
•n out-door life may be freely enjoyed, and where, in
consequence, the processes of respiration, digestion, and
cangmflcation proceed with sufficient energy to combat
successfully the hereditary tendency or individual proclivity
to pulmonary disease.

* W ^ at c i im&te8 cure phthisis? There are very many
«uatona which have been alleged to cure phthisis, but it is
a significant circumstance that, while every year introduces
!wl- new , c,aimant 10 attention, it also witnesses the
Tim ln ^ * rom t ^ e ‘ ^anks of some discredited impostor,
sJ~ e Wa8 ^hen .Montpellier was the reigning favourite. It
08fc for »? tten - Pau and Nice have quite out-

i iv Z, ,. al . mo8fc forgotten. Pan and Nice have quite out-
8, w i* once univers al fame. Jersey, with its capital
thiitiifg bcaatod great things, but we now know

atn P ] y justified, but other fluctuations of medical
UvoimLiL P'act 10 ® have been more arbitrary. The most
— health-resorts of t he past generation were Madeira

1 ***** read before the Ulster Medical Society, Feb. Jnd, 1537.

and Egypt. They are both at present under a cloud, but ife
will probably be a temporary cloud, as, for properly selected
cases, these noted and long famous sanatoria have very
decided advantages. The chief feature of modern practice
is the ghe&t and growing popularity of the high altitude
stations.

, The number of health-resorts for phthisis is so vast that
some classification must be attempted, though no satisfac¬
tory classification has yet been suggested. In default of
better, let us divide sanatoria into three classes:—(a) The
marine resorts. ( b ) The dry inland resorts, (e) The moun¬
tain resorts.

(a) The best marine resort, if I may so express it, is the
ocean-going ship; on the high seas the peculiar features of
the marine dimate are enjoyed in perfection. Those features
are great purity of the air and freedom from all sources of
contamination, marked humidity, and very great equability,
both as regards temperature and hygrometric condition.
The general influence of ocean air is decidedly tonic, and
improvement in appetite and gain in weight are almost
universal on shipboard. The disadvantages of the sea
voyage are—liability to sea-sickness, which is a serious
difficulty in only 2 or 3 per cent, of cases; the want of
proper sleeping-room, and the consequent contamination of
the air at night; and the absence of many home comforts.
No consumptive should undertake a sea voyage unless he
can afford to travel with tolerable comfort, pay for a roomy
cabin, and have suitable companionship. The sailing-vessel
should in nearly every case be preferred to a steamer, and
the voyage to Australia or New Zealand vid the Cape o£
Good Hope is the most adapted to the consumptive. The
usual time of departure for Australia is September or
October, but this is an unfortunate arrangement, as the
invalid thus lands at the antipodes at the beginning of
summer, the worst and most trying of the Australian seasons.
A better plan is to set sail in July or August, so as to
reach Australia during the charming and healthful time of
: spring. Sailing-vessels occupy from seventy to ninety days
upon the passage. The sea voyage confers at least
temporary benefit upon the great majority of consumptives,
except those cases of great debility and prostration which
, should not be sent to sea. In the course of my four long
voyages I have had as fellow-passengers a vast number of
consumptives, who, with scarcely an exception, were happy
and comfortable at sea, gained in weight, and experienced
an amelioration of all their worst symptoms. It is a dictum
of moot writers upon the (dimstic treatment of phthisis that'
htemorrhagic cases should not be sent to sea. I greatly doubt
the accuracy of this view. I have only known two cases of
hemoptysis occurring at sea, and neither provedaerious. I am
quite unable to understand any theoretical ground on which
hemorrhage should be apprehended on shipboard. When the
sea voyage fails, the causes of failure are often obvious. Ex¬
cessive debility, rendering the patient unable to accommodate
himself to the novel conditions of life at sea, sea-sickness,
longing for home, which - is apt to be strong amid the
solitude of the ocean wastes, an uncomfortable ship, an over¬
crowded cabin, and an improper dietary—these often retard
or prevent the beneficial influence of the sea voyage. There
is one important point, of which my experience has afforded
me several melancholy instances—viz., the proneness to
relapse on reaching land. The patient should be warned
to practise great caution as regards diet, exercise, and
general habits on landing after a long voyage. Nearest to
the climate of ocean comes that of the ooean islands, such
as Madeira, Teneriffe, the Azores, Nassau in the Bahamas,
&c. Cases that have been known to do well on shipboard
may be sent to these resorts with tolerable confidence, the
climatio conditions being similar. There is admirable
accommodation at Madeira, and many cases do well there;
but diarrhoea is so epidemic as to be known as the “island
complaint,” and no case of phthisis should be sent
there in which intestinal troubles have been much
marked. The climate is very soft and soothing, and
grateful to those suffering from bronchial or laryngeal
complications, bat it is deficient in tonic influence, and its
effect upon the general course of the disease is decidedly
inferior to that of more bracing localities. Patients
may be sent there who lack the necessary vitality to
enable them to react to tonic climatic conditions. Of tbe
drier and more tonic marine resorts, Algiers, Tangier, and
Malaga are perhaps the best. The reputation of tbe Riviera
is decidedly on the wane. Many seasons are delightful, but
often the mistral is exceedingly treacherous, and snow-storms

872 Thu Lanctt,] DR. J. A. LINDSAY: CLIMATE AS A THERAPEUTIC AGENT IN PHTHISIS. [April 80,1887.

are not unknown. The chief stations in the Riviera are
Hydros, Cannes, Nice, Monte Carlo, Mentone, Bordighera,
and San Remo. Nice has quite lost its old reputation,
owing to the sudden changes to which it is subject. Cannes
is a lovely spot, but inferior to Mentone and San Remo for
the purposes of the invalid. Where much shelter is a
desideratum, Mentone should be preferred. Otherwise,
San Remo possesses the best climate in the Riviera.
Algiers is a great favourite at present. It possesses
a dry, sunny, warm winter climate, with complete im¬
munity from frost and fog. There are very few days on
which the invalid cannot enjoy several hours of out-door
life, and the proportion of charming weather is far higher
than upon the northern shore of the Mediterranean. Con¬
sumptives should in no case reside in the town, which is
very dusty and a prey to evil odours, but should choose
the suburbs, such as Mustafa lnfdrieur or the Village d’Isly,
and, as spring advances, a change inland to the dry and
bracing climate of Hammam R'lhra or Milianah may be
advantageously adopted. Tangier resembles Algiers in its
general climatic features, but the accommodation is inferior,
and it is a very dull place. Malaga has a very good climate,
but there is nothing to do, and patients soon weary of it.
Biarritz is an excellent place in autumn, but too windy for
a winter residence. Arcachon suits cases where nervous
irritation is marked. As regards the marine resorts in
Britain, Yentnor, Bournemouth, and Torquay are the
best, and I have given them in what 1 consider as
the probable order of merit. Ventnor is the warmest
and driest of these resorts. Bournemouth has more
shelter, and suits cases which cannot tolerate the more
decided marine flavour of the air at Ventnor. Glengarriff
is probably the best winter climate in Ireland. Rostrevor
has some local repute, but it has little to recommend it.
There are some excellent marine resorts in California, of
which Santa Barbara is the best known. The Californian
coast in its southern parts enjoys a remarkably dry, bright,
and tonic climate, well adapted for many cases of phthisis.
Tasmania has a climate of great salubrity, but there are
many very diverse climatic types included within the area
of that small island. The west coast is stormy and wet,
and wholly unsuitable to the invalid. The southern coast is
somewhat too windy. The best regions for the consumptive
are the north and north-east shores, which possess one of
the brightest, mildest, and most genial climates in the
world. The coast region of Australia cannot in general be
commended, being a sort of battle-ground for the breezes
from the sea and the hot blasts from the interior, and the
climate is in consequence fickle and stormy. The most
favoured region in Australia for the consumptive is the
interior plain, of which 1 shall speak presently. The best
marine resorts in New Zealand are Napier and Nelson.
Speaking generally, the reputation of marine resorts has
somewhat waned in proportion as the fame of the dry
inland and the mountain sanatoria has increased. No marine
resort is, I think, quite equal to the ocean voyage, where
the latter can be enjoyed under the most favourable cir¬
cumstances.

(6) The dry inland resorts. The best of these are Nubia,
the interior parts of Algeria, the Orange Free State, and the
vast interior plains of Australia, especially the Riverina of
New South Wales and the Darling Downs of Queensland.
I am inclined to rate very highly this type of climate in the
treatment of phthisis. A large proportion of the cases of
oomplete cure whioh I have known have been effected by a
prolonged residence in some dry inland region, the cure
being, without doubt, in nearly every case materially pro¬
moted by the adoption of an open-air life, plain diet, and
simple manners. Of the four regions mentioned, probably
the Orange Free State is the best, as it possesses an advan¬
tage over the others in being at a considerable elevation.
But personal considerations will lead in many cases to the
selection of Australia, and it is no small advantage to send
the consumptive to the land where he will meet his own
kith and kin, where the language, food, and manners of the
people will be familiar and congenial to him, and where he
maypossibly find such remunerative employment as may
induce him to settle permanently. Speaking broadly, I
would send to Australia only those consumptives to whom
a drj inland climate would be thought to be beneficial,
advising them in all cases to avoid the coast regions, and
especially the capital towns, to go inland at once, settle
upon some farm or sheep station, and make up their minds
to a residence of at least two years. A large proportion of

cases,would thus be cured. To recommend Australia as a
sanatorium for phthisis without keeping these points in
view is to invite failure and disappointment.

(c) The mountain resorts. These sanatoria have sprung
into sudden favour within the last twenty years, and their
popularity grows yearly. The chief are Davos, Wieeen, St.
Moritz, and the Maloja in the Alps; Colorado Springs and
Manitou in the Rocky Mountains; Bogota, Jauja, and
Huancayo in the Andes. The almost complete immunity from
phthisis enjoyed by residents at high altitudes first suggested
their adoption. The most important feature in the medical
climatology of the mountain sanatoria is the rarefaction of
the air, which promotes respiratory activity, the expansion
of the chest, and the absorption of morbid deposits. The
dryness, the purity of the air, and the freedom from organic
dust are all of importance, but subsidiary to the atmospheric
rarefaction. These sanatoria fall into two classes—the cold
and the warm. In the Alps and the Rocky Mountains tba
winter climate is marked by perpetual snow and severe
frost. In the Equatorial Andes the climate at high altitudes
is one of perpetual spring—humid, warm, and vernal. The
mountain resorts have proved most efficacious in the follow¬
ing cases: delayed recovery from pneumonia with threat¬
ening tuberculosis, chronic pleurisy with much fibroid change,
incipient catarrh of the apex, chronic tubercular phthisis, with
good reaction and the retention of fair constitutional vigour,
whether cases of primary disease limited in extent, or single
cavity cases without tendency to extend. Haemorrhagic
cases do well, although the profession was long inclined to
exclude such cases from the mountain treatment owing to
the unfortunate influence which a false analogical reasoning
had exercised upon them. The contra-indications against
the adoption of this line of treatment are: Weak circula¬
tion, which is absolutely prohibitory, senile change, the
eretische constitution, extreme debility, and marked and
progressive emaciation. Moderate pyrexia is not a hin¬
drance, while sweating and fluxive diarrhoea are usually
relieved at high altitudes. Where the cold mountain resorts
fail the warm may often prove useful.

4. What cases of phthisis are curable by climate ? I have
hitherto spoken somewhat dogmatically, as the general
principles of medical climatology and the general characters
of the sanatoria for phthisis admit of very precise state¬
ment ; but in dealing with this last question—to which I
have more than once been obliged to make incidental
allusion—I deBire to speak with that diffidence which be¬
comes the therapeutist. In many cases there are few more
difficult problems than to determine whether a given case
of phthisis will respond to climatic treatment, and what
type of climate affords the best hope of success. Speaking
generally, only chronic cases with fair reaction are suitable
for climatic treatment. If the disease has a well-defined
onset and threatens to run an acute or semi-acute course ;
if the patient steadily loses ground and shows no gain
in weight or other sign of rally under treatment; if
the process in the lung is progressive and there are
no evidences of repair—in each and all of these cases
the interests of the patient will be best served by
vetoing climatic treatment. The patient will die soon and
die anywhere, and he may as well be allowed to pass bis last
days amidst the comforts and sympathies of home. Cases
marked by circulatory weakness, with fast, feeble, flutter¬
ing pulse, slight cyanosis, and persistent coldness of the
extremities, are very unfavourable for climatic treatment,
and should on no account be sent to the mountains.
Cases in which laryngeal or intestinal ulceration or renal
complication have supervened upon the ordinary type
of the disease should be allowed to die at home. Cases
in which anfemia appears early and is well marked
are unlikely to respond to climatic treatment. On the
other hand, we see a vast number of cases of phthisis in
which the onset is very gradual and the constitutional in¬
volvement for a long time slight. Such cases nearly al wa> »
improve, even in this climate, under a system of high feed¬
ing, fresh air life, and cod-liver-oil, and I entertain no
doubt that a considerable proportion of them may be com¬
pletely cured by removal to a suitable climate and tbe
adoption of a prudent mode of life. In determining the
climate to be chosen, it used to be taught that the_condition
of the bronchial mucous membrane was the chief guide :
that cases with much bronchial catarrh should go to a dry
climate, cases with dry irritable mucous membrane to a
moist sedative climate, and so on. I greatly doubt the
l utility of this rule. Phthisis is not bronchitis, and all

s 1

Thx Lancbt,]

MR. WALTER WHITEHBAD ON TRACHEOTOMY.

[April SO, 1887. 878

analogies for its treatment drawn from oar knowledge of
bronchitis are not. merely unfruitful but misleading. In the
therapeutics of consumption we have given up directing our
medicinal treatment to the bronchial mucous membrane,
and I am unable to see why we should still base our
climatic treatment on a theory which we thus implicitly
acknowledge to be unsound. Hippo, paregoric, and squills
have almost disappeared from our treatment of phthisis;
and climatic sanatoria, which soothe the patient’s cough at
the expense of his appetite and strength, must follow them
into deserved oblivion. The consumptive does not die of his
cough. He dies of progressive wasting. We have thrown
aside expectorants and anodynes in favour of good food,
exercise, and such aids to nutrition as cod-liver oil, hypo-
phosphites, maltine, 8cc^ and we most, when possible, choose
climatic resorts which are tonic and stimulant rather than
those that are mainly sedative. The vital point about any
climate is, will it promote nutrition ? In early uncomplicated
cases with vigorous circulation I think the mountain climates
offer-the best hope. If the circulation be feeble, or if there
be much nervous irritation, the choice will lie between the
sea voyage and residence in such dry inland resorts as Upper
Egypt or the interior plains of Australia. The sea voyage
has the great recommendation that it rarely dees harm,
except in those very advanced cases 'Which are beyond
the reach of all treatment. If the patient objects to the
mountains and shrinks from the long sea voyage, I think
Algeria or Morocco should be preferred to France or Italy.
Let me say, in conclusion, that climatic change is a snare
instead of a help, a curse rather than a blessing, if it be
regarded as a complete therapensis in itself, and as enabling
the patient to dispense with the usual lines of treatment
and his customary precautions. Climate is not a specific.
At best it is only a condition of cure, and we may expect
it to be effectual only when the patient’s food, habits,
occupation, and mode of life are wisely regulated so 4s to
facilitate its beneficent influeaoe. *

JMtu*. )

. . . . * — — •

TRACHEOTOMY.

Bt Valter Whitehead, f.r.c.s.e., f.r.s. ep.,

SURGEON TO THX MAXCHESTER ROYAL IHFIRMARY ETC.

• ::;f( . .

“ bloodless ” method of Bose, but in the latter operation the
scalpel is used to a much greater extent than in the opera¬
tion here advocated, and when the scalpel is not to be used
the use of the director is advised. But the walls of the
veins in this region are very thin, and the sharp edges and
point of the director have been frequently known to tear
these vessels and rob the operation of its bloodless character,
This tearing of the veins is much less likely to occur if the
raspatory is used. Moreover, the above operation with
the raspatory is not only suitable for cases where the
surgeon has abundant time at his disposal, but is advised
even in emergency tracheotomy; since, although perhaps
a little more time is required to reach the trachea,
the certainty that when once reached it can be quickly
opened and entered is a distinct ultimate gain. What
is urged in favour of the operation is—firstly, the
ease with which it can be performed; secondly, the
small number of instruments required; and, thirdly, the
manner in which it meete the four difficulties usually
enumerated—viz., of reaching the trachea, of haemorrhage,
of opening the trachea, and of introducing the cannula.
Again, it avoids, in an especial manner, those dangers met
with when the operation is performed, as it too often is,
practically in the dark, from the bleeding, and the not
sufficient separation of the parts; thus it is impossible, iu
this operation, that the oannula should be pushed down
between the trachea and the fascia lying in front of it, or
that it should be thrust, as has actually happened, into the
internal jugular vein. Our resident surgical officer, Mr,
J. Collier, who is frequently called upon to perform
tracheotomy , in emergencies, has definitely adopted the
operation described since, seeing me open the trachea
some months since for the extraction of a gun cap acci¬
dentally inspired into the trachea.

Manchester.

THREH CASES OP

STONE IN BOYS; REMOVAL BY SUPRA¬
PUBIC CYSTOTOMY.

By THOMAS WALKER,

SURGEON TO CLAYTON HOSPITAL, WAKXYIKLD.

ition of tracheotomy is in many cases confessedly
a difficult one to perform. This is emphatically shown by
the amount of literature written upon the subject, by the
many different ways which have been described and prac¬
tised, and also by the many dangers warned against. My
excuse for proposing any change in the methods usually
adopted is the simplicity of the plan I have to suggest, ana
the e&se and success which have invariably attended its per¬
formance.

■The operation is performed ad 'follows. The head of the
patient being bent well back over a pillow, an incision is
Blade in the Usual situation, but of rather greater length
than is common. The incision extends tbrongh the sstii
end fascia, »as deep as the interval between tbs sterno¬
hyoid muscles. Tae scalpel id now laid aside, and the
raspatory used, not only to separate the sterno-hyeids, but
to split the strong fascia which runs down from the hyjoid
bone to enclose the isthmus of the thyroid gland. This
«scia is split to ol distance extending from the upper limit
of the incision down to the isthmus below—that is, sup¬
posing it is desired to Open the trachea above the isthmus.
The split fascia is then pushed to right and left With the
«.p»a*y Should there be any difficulty; in doing this, the
«seia is separated to some extent on each ride from the
opper border of the 'fethmtis. Proceeding carefully, the
wthmus itself can he pushed down and the trachea exposed
.the necessary .extent. If the trachea is to be opened
below the isthmus we proceed m A similar manner 1 , remSm-
bering.that here, however, we haVe betWeen the fascia and
the trachea a quantity of areolar; tissnff in which lies the
inferior thyroid plexus of veins* The front of the trachea

oottotn oi tne wound. The trachea can now be fixed
*®™>y between the left! index finger and thumb, and opened
the desired extent. There is little or no difficulty in
"‘wnduting the cannula, since the trachea can be so steadily
«®|d and the inoisleni Into it so clearly seen. .
no above method resembles ' in many particulars the

Cash 1.—Arthur M-, aged three years, was operated an

by me on August 2nd. Dr. Wright administered chlor ofo rm. -
I was assisted by Mr. EBkrigge, house-surgeon, and Mr. J. W.
Walker, Dr. Holdsworth also being present. The bowel
haying been emptied by an enema, and chloroform given, ail
indiarubber rectal bag was introduced, and three ounces of
warm water injected into it. A catheter was then passed, and
the bladder gently distended with a warm solution of
boracic acid, the catheter removed, and a tape tied round
the penis. An incision, about two inches and a half long,
was made through the skin above the pubes and the tisanes
separated with the finger-nail and knife ikm ; Ja..Uw
bladder; two hooka were introduced into the bladder, when
a little fluid escaped. A small opening was made between
the hooks, which was enlarged by the finger, and the stone,
which was easily felt, removed. The bladder wall then
explored and washed out with warm bOr&cic acid solution.
The wound in the bladder war cloned with fyne catgut sutures.
Four stout silk sutures were inserted in the external wound,
the, lo^Ver one being left untied in case all the urine did not
flow by the natural passage, as no catheter Iras left in.
However, as he passed urine three times during the first
night, the remaining suture was tied next day. During the
operation no artery or large vein was met with. There wap
very great tenesmus to expel the rectal hag during the latter
part of the operation, which brought down the peri¬
toneum into view in the upper part of the wound.
On the fifth day a sudden rise of temperature occurred,
with: symptoms of extravasation extending into the
scrotum, which, I think, was owing to the vesical wound
not being entirely healed when the eatgut sutures
became absorbed* consequently the urine escaped into the
tissues. On removing the external sutures, however, the
urine passed through a small hole at the lower part of the
wound, and the symptoms of extravasation quickly subsided.
Two incisions were also made into the scrotum, to relieve
the swelling. The calculus was of uric acid, weighing
bighty-nine grains.

The following notes of the case were kindly supplied by the

874 The Lancet,]

' CLINICAL NOTES.

[April 30,1887.

house-surgeonAug. 2nd: After the operation the patient
was troubled With persistent vomiting. He passed hia urine
three times during the night, which had no blood mixed
with it. Temperature 09°.—3rd : Wound dressed, the dress¬
ings were a good deal stained with blood; the lower stitch
through the external wound (which had been left untied
after the operation) was now tied. The patient passed
urine six times during the day, but no blood. The vomiting
has now ceased. Morniug and evening temperature normal.
4th: No stain through dressings; passed urine naturally;
no pain. Temperature, morning, 99°; evening, 99'6°.—
6th : Wound dressed; no blood or urine on dressing. Passed
urine naturally. Temperature normal.—6th : Passed urine
freely; had a very comfortable day. Morning tempera¬
ture normal, evening 100°.—7th: Wound dressed; looked
rather puffy and red about the stitches, so the alternate
ones were removed. Urine passed naturally. Temperature,
morning, 99°; evening, 101°.—8th: Considerable extravasa¬
tion of urine into the tissues and the scrotum took place in
the night. The dressings were removed and the other two
stitches taken out; some urine oozing from the lower end
of the wound. The scrotum was incised on each side of the
raphe, and fomentations were applied. Temperature,
morning, 100°; evening, 100 5°. — 9th: Swelling of the
scrotum subsiding; urine passed freely from lower part of
■wound. Temperature, morning, 99°; evening, 99°.—11th :
Urine passed freely through wound; scrotum natural size ;
neral health good. Temperature, morning, 98°; evening,
°.—16th: Part of urine still passing through the wound,
which is swollen. Temperature normal.—20th: Only a drop
or two of urine passing through the wound.—24th: Wound
healed; general health excellent.

Case 2. — James II - , aged eight years, was admitted

suffering from stone. Supra-pubic cystotomy was per¬
formed on November 9th; a very rough stone, weighing
50 grains, was extracted. In this case the wound in the
bladder was not sutured, and only two sutures were used in
the upper part of the external wound. No catheter was
left in the bladder, the urine passing through the artificial
opening. Twenty-four hours after the operation he had a
rigor. Temperature 102°; the abdomen becoming tympanitic,
with pain on pressure. Fomentations were applied, and
small doses of opium given. On the following day the tem¬
perature was 99’6°; pain much less; abdomen tympanitic.
On the fourth day, the bowels having acted, the tympanites
and pain gradually subsided. The urine was entirely voided
through the wound for the first fortnight, then partially by
the urethra. The wound gradually healed by granulations,
and the patient was discharged well on December 18th.

Case 3.—Edward N-, aged four years, was admitted

suffering from stone. Supra-pubic cystotomy was per¬
formed on Nov. 21st; the stone weighed twenty grains. In
this case the wound in the bladder was carefully closed -with
fine catgut ligatures, not drawn tightly, the linea alba was
sutured with stout catgut, and lastly the skin, the lower
part of the wound in the skin being left open, in case any
urine should escape from the bladder; however, not a drop
came away, but all passed easily through the urethra to the
end. The wound healed quickly, and without any compli¬
cation.

Remarks. —I think the supra-pubic operation has a
bright future before it. I am of opinion that the danger to
life will not be found greater than in the ordinary ope¬
ration, and, as there is no fear of injuring important
parts and functions, this must necessarily be taken into
account as a factor in its favour.

Society for Relief of Widows and Orphans of
Medical Men. —A quarterly court of the directors of this
Society was held on Wednesday, April 13th, Mr. Tegart,
Y.r., in the chair. Three new members were elected, and
the death of one announced. Applications for grants were
read from sixty-three widows, six orphans, and three orphans
on the Copeland Fund, and a sum of £1304 was voted, to be
distributed among them at the next court. The expenses of
the quarter were £56 6«. (*•/. Dr. Birkett, Dr; de Ilavilland
llall, Mr. Langton, Mr. Morris, Dr. J. M. Bright, and Dr.
JI. M. Duncan were selected to fill the vacancies in the
court caused by the retirement of the six senior directors.
Mr. Fuller, acting treasurer, was nominated as a trustee of
the funded property in place of Sir George Burrows,
resigned. The annual general meeting was fixed to be held
on Wednesday, May 18Ui, at 5 r.M.

Clinical Holes:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

THREE CASES OF HEMOPHILIA IN THE SAME
FAMILY.

By Henry Skelton, M.D., MJLC.P.

In 18811 was called to A. P-, a lad of about twelve

years of age, wbo was passing blood in his urine to a large
extent. Ilie case, apparently, was relieved by gallic add
and rest, and I thought no more of it, particularly as I could
make out no cause for the hemorrhage; and as he seemed
to get well, I did not trouble any further about him. la
1882 I again saw the lad, wbo was then bleeding from hit
nose. The epistaxis yielded to iron internally, and frequent
injections of a strong solution of perchloride of iron into
the nares.

Soon after this I was called to another child of the same
family (aged one year and four months) who had an abscess
on the vertex, the result of a fall from a perambulator three
weeks before; and as the abscess was causing a great deal
of constitutional disturbance I opened It and evacuated the
matter. Copious bleeding ensued, and neither pressure nor
the usual remedies stopped it, and the child died on the fol¬
lowing day from loss of blood.

I have attended A. P-several times since with bleeding

from the mouth and swollen joints, which was undoubtedly
effusion of blood. In 1884 I advised his parents to send him
into the Bristol Royal Infirmary, where he was placed under
the care of Mr. Greig Smith, who has reported his case fully
in the Bristol Medico- Chirurgical Journal, No. 6, 1884.
There is one error in the statement that blood has not been
seen in his urine; I myself have seen it, and also nearly all
the large joints distended with blood.

On March 23rd of the present year I was called to see
Ernest C. P—aged one year and five months, who, bis
his mother said, had been bleeding from the mouth since
the middle of the night. . I found his lips covered and the
front of his clothes stained with blood. On examining his
mouth the blood could be seen “ welling out ”—I know no
other word that describes it—from the mucous membrane
surrounding the teeth. He had ent the four upper incisors,
two upper molars, two lower incisors, and was cutting some
more teeth ; but it was principally from the socket* of the
upper incisors that the bleeding oame. Various styptics
were used, and internally ergot, hamamelie, turpentine, iron,
and ruspini were all tried, and apparently without much
effect, as the child died. He had become very anemic, and
before death took place was said to have been convulsed.

Remarks .—Heredity is the supposed cause in all these
cases. The mother I have attended in several labours, and
she always loses a great deal of blood, but generally does
well, and is up, as a rule, on about the ninth or tenth day.
She frequently suffers a great deal from attacks of asthma,
hypodermic injections of morphine and grindelia robust*
speedily giving relief. May not this neurosis, of which to
little is known, have something to do in predisposing these
boys to be bleeders? She—the mother—is one of eleven,
three only of whom grew up, two boys and herself.
of her brothers is still alive; the other died from gastnc
ulceration. Her father, she states, died from asthma at an
early age. That is all the family history I can get, and it
is, I am sorry to say, a very meagre one.

Downend, near BiUtoL_

DISLOCATION OF THE SHOULDER; REDUCTION
AFTER EIGHT DAYS BY MANIPULATION.

By E. L. Hussey, F.R.C.S. Eng.

Aa a case of double right-angled traction, the following
may be worth publishing.

A thin, spare man, below middle height, seventy y 8 *”®;
age, employed as helper in some stables, fell on the tip
his shoulder at night on July 10th, 1867. He continued**
his work, cleaping horses and carriages, and eometmw*
driving; -hot he could not raise hia elbow, nor ooald be P u

Tkb Lancet,]

CLINICAL NOTES.

[Apbil SO, 1887. 87 5

his hand behind him. He was sent to me on July 18tb, by
a practitioner to whom he applied. for relief. The signs of
dislocation at the shoulder were well marked, the head of
the humerus resting below the coracoid process. After
taking off the mans shirt, I laid him on his back upon a
tabta, close to the edge, and attempted to make extension
with my foot in the axilla as 1 sat on a chair at his side.
Finding the position inconvenient, 1 gave up the attempt.
Then, standing at the end of the table, behind the man’s
shoulder as he lay on his back, 1 drew the arm away from
his side, with the forearm flexed at a right angle and the
wrist raised perpendicularly upwards, the hand rather
inclining to fall downwards. 1 kept the limb in that
position by hooking my finger in the bend of his elbow, and
diverted the man’s attention by talking upon indifferent
subjects. Forcible extension was not wanted. The muscles
soon relaxed, and I then let the hand fall over, thus rotating
the head of the humerus inwards, and the bone slipped at
once into the glenoid cavity. The man ultimately re¬
covered the perfect use of the limb.

Oxford.

BILHARZIA HHCMATOBIA.

By W. K. Hatch, M.B., M.R.C.S.,

SECOND SUROKOir, JAM3ETJEK JKJEEBHOY HOSPITAL, BOMBAY.

After observing closely twelve cases of bilharzia htema-
tohia in Bombay, where the disease appears to be more
common than formerly, especially amongst Mussulmans
who have made a pilgrimage to Mecca, I venture to send
the following point in diagnosis, which may be of use to
army surgeons, now that invalids are constantly returning
from Egypt.

1. Pain during micturition, with stoppages of short dura¬
tion. The pain is said to be of a pricking character, generally
felt at the root of the penis, or sometimes in the glans. It
is caused, I suppose, by the passage of the sharp-pointed
ova, while the stoppage may be due to spasm set up by
them or to clots. The character of this pain becomes import
tant when no clots can be found in the urine.

2. The passage of a few clots of blood at the end of
micturition. Tlie urine is seldom seen discoloured, but a
few small clots and shreddy fragments of fibrin will be
seen, especially on standing. If the latter are examined,
ova in quantity will usually at once be found ; not so often
in the blood clots. Should there, however, be no such
fragments, a catheter may be passed, and the eye examined
on withdrawal; shreds and ova will usually be brought away.
It saves much trouble to do this, as the urine may be
searched in vain; and the symptoms, even though ova are
not found at first, will give rise to strong suspicion. In
hematuria due to ftlaria sanguinis the urine is much dis¬
coloured, and jelly-like yellow clots are often present in
large quantities, while there is no pain and rarely stoppages
during micturition. I may add that the patient with
bilharzia is often a strong robust man, and not the least
anaemic, unless the disease has lasted for years. The time
between tbo contraction of the disease ana the passage of
blood and other symptoms may be very short; one patient,
who stayed at an hotel at Snez for fourteen days, suffering
from them a month after his return to Bombay.

Bombay. __

CASE OF POISONING BY HYDROCHLORIC AClD.
By C. H. Robinson, F.R.C.8.I.,

WXMBEB OS TUB COURT OF KXAMMER9, B.C.8.H; tmLLOW OF TltW
ACADEMY Or MSDIGBfB., ..

The following short notes of A case of attempted stlicide
may be of interest, inasmuch as hydrochloric acid is not
often used for this purpose.

On Jane 16th last a gentleman aged fifty, who for some
time previously had lost hie employment in a firm where he
hut been engaged for many years, daring a fit of drinking
•JrtUowed an ounoe of hydrochloric acid which he had
obtain ed frer* a neighbouring chemist. Within a few,
*uwt«s afterwards hia wife gave him a, mustard emetic,
acted several times, and I was,sent for and saw him
] romn an hoar of the attempt on- hie life. He was much
in a oold sweat, and complained, greatly of, pain
^'rtbmaeh.' ®iere were a -couple of stains ^rom the

acid about his lips. Very fortunately for the patient, he
had taken his dinner shortly before he swallowed the
poison. I prescribed the usual remedies, such as milk,
magnesia, eggs, &c. The following day he complained of
pain in the throat as well as in tne stomach, and spat up
constantly a quantity of thick mucus. Small doses of
laudanum were given at short intervals to lessen the irrita--
tion of the stomach, but he was able to take without
difficulty beef-tea and egg flip. After a few days the pain
in the throat and stomach disappeared, and since then he
has never complained of any difficulty in swallowing.
1 was told he had swallowed a quantity equal to two
tablespooufuls of the acid, but as the throat was affected
in only a trifling degree I fancy the amount taken must
have been considerably less.

Dubllu.

AMPUTATION OF PENIS; COCAINE AS A LOCAL
ANAESTHETIC.

By Dcqaed Christie, L.R.C.S., L.R.C.P. Ed.

The following case may be interesting as illustrating the
value of cocaine as a local ausestbetic in minor surgery.

The patient, a Chinese merchant in this city, suffered from
epithelioma of the penis. For over two years he had been
going the round of the native practitioners, consulting them
m vain, and only suffering severe torture from their often
heroic but barbarous treatment. Ha came to me in a state
of despair—weak, emaciated, with his nervous system, from
prolonged pain and sleeplessness, in a state of extreme
irritability. Although a year previously he had refused to
submit to amputation &s I recommended, he now readily
agreed to our proposed method of treatment. Chloroform
was carefully administered, but after a few inhalations,
proving a bad subject for a general anaesthetic, it was de¬
cided to try cocaine. Twenty m i nims of a 5 per cent, solu¬
tion of the hydrochlorate were injected, in five-minim doses,
at short intervals, round the seat of incision, and into the
urethra. A quarter of an hour after the first injection the
part was amputated without the patient experiencing the
slightest pain; indeed, he would not believe me when in¬
formed that the operation was over.' Another point of
interest is that, except from the large bloodvessels, there
was hardly any haemorrhage, doubtless due to the constrict¬
ing effect of the drug on the capillaries. As to the after-
treatment, there is nothing worthy of note, only that the
amestheaia produced seemed to last over a day, and that the
patient oomplained of no pain after the operation. He re¬
covered without a bad symptom, and now enjoys excellent
health. I constantly use cocaine in eye operations, cataract*
iridectomy, pterygium, and also in cases of fistula in &no,
abscesses, &a, with most satisfactory results.

Houkdeu, North Ohio*.

CASE OF PLACENTA PRJ5VIA. ,

By M. H. -I^C.S. Edix.,.

On March 9th, at 6.30 a.m., I Was called to a woman who
was being attended by a midwife. The patient is a very
stout woman, forty-three years of age, and was seven
months advanced in' bar fourteenth pregnancy, I found
her almost in a state of collapse, her lips bloodless, and I
could scarcely* feel her pulse at tne wrist. I heard she had
been bleeding since 4 a.h. On examination, I found, as I
suspected, it was a ease of placenta prsevia. When I saw
her the hsemorrhage.had stopped, but on the least move- 1
inent it came on again. Not thinking it judicious to 4<> ;
anything till she bad rallied. from, the state in which she
then was, I gave her brandy and inflk, arid -waited for about
half An noUr, wfaeri she felt better. I theta examined her
more fully. The oswm very soft and dilated, sufficiently to
admit two fingers. 1 found the placenta immediately inside
the oa; It was detached and ielt> slightly ragged on the
right aide, the bead presenting. I swept my fingers round
and detached AS much placenta as was witnin reach, and as.
I aid this the os dilated so that I was able tb-pass toy band
into the Uterus, when by the bipolar method I turned the
child and brought down the first leg I could seize (the'
right), till the loot protruded from the; vagina. This £
found stopped the haemorrhage effectually, so 1 did nothing.
mow'for two hours, except to put pa a binder, when the;

Digitized by GoOgle

876 The Lancet,]

HOSPITAL MEDKJINE AND BURGERY.

[April SO, 1887.

patient felt much stronger and the mist pulse was easily
felt. 1 then brought down the other leg and delivered her.
The child was dead. The placenta came away with a little
trouble. I washed out the uterus with permanganate of
potash solution, and at 11.30 A.M., when I left her, she felt
quite comfortable. I repeated the washing out every day
for a fortnight, during which time several small portions of
membrane with many clots came away. Her temperature
never rose above normal, and she made an uninterrupted
recovery. I saw her on April 12th, and she felt quite well,
and I hope will be able to resume her occupation of a
laundress m a short time.

On subsequent inquiry, which I had not time to make
at first, I was told that the haemorrhage first came on at the
latter end of January, was like Ordinary menses, and lasted j
one day, when with rest it stopped. A week afterwards :
there was another “ show,” lasting the same period; four ,
days after this a third came on, which ceased in a few hours;
two days later she passed a large clot. On March 6th there
was a little more liEemorrhage, which lasted an hour. The
next was on March 9th, when I saw her. I have since learnt
that the patient has a somewhat curious record of confine¬
ments. She has had fourteen children, and three miscarriages
at three months each. She has ten children living, their ages
varying from twenty-two to three years, and ail healthy-
looking. Her tenth was a case of spina bifida, and lived
nine days. Her thirteenth was also spina bifida, and lived
fifteen days. The first spina bifida was, I understand, tapped
twice, but the second was not interfered with.

Richmond, Surrey. __

LIGATURE OP THE INNOMINATE.

By Thomas Henderson, M.B., C.M.

I have thought the following brief notice of a somewhat
rare operation of sufficient interest to merit insertion in
The Lancet.

The patient, a man of about forty-five years, was suffering
intense pain from pressure by a very perceptible aneurysm
of the second part of the right subclavian. Other means
having been tried with no good result, Professor Durante
of Rome determined upon ligature of the innominate.
Accordingly, on March 26th the operation was performed,
trith strict antiseptic precautions, the vessel being tied in
two places—viz., immediately below the junction of the
subclavian and common carotid, and again slightly lower
down. The vertebral artery was also tied. The ligature
Used was No. 3 carbolised catgut. The after-progress, up to
the present date (April 5th) has been most satisfactory.
Circulation in the right upper limb and side of the head
has been completely restored, and the patient’s general
health is good, with the exception of obstinate constipa¬
tion, which may account for a rise of temperature having
occurred. The external wound, excepting a small drainage
aperture, has healed by first intention.

Rome. .

|Jiror '

HOSPITAL ^PRACTICE,

BRITISH AND FOREIGN.

Nulla aotem eet alia pro eerto noaoendl via, nhi quamplurimas at mor-
borum et dtueotlonum hlitoriaa, turn alio rum turn propria* oollectaa
habere, et inter se oompamre.—M orqaqvi De Sed. et Cam. if orb.,
lib. IV. Proarmlum. -

ST. THOMAS’S HOSPITAL.

SUCCESSFUL REMOVAL OF RIGHT OVARY FOR CYSTIC
. DISEASE NINE MONTHS AFTER OPERATION

FOB HYDROSALPINX.

(Under the care of Dr. Gee vis and Mr. Sydney Jones.)

In August of last year (See The Lancet, vol. ii., p. 399)
we published an account of the operation which this patient
underwent for the removal of hydrosalpinx on the left sidA
She bad suffered from pain and symptoms referred to this
disease for four years; these had followed the birth of a
child, and were so severe as to almost completely incapacitate
her for any employment. At the -operation the right ovary 1

was apparently healthy, and was therefore not removed.
She continued well for some weeks, and then pain com¬
menced in the right side, making further operation necessary.
We are indebted for the notes of the case to Messrs. Blunt
and Sansom.

A. L-, aged nineteen, was readmitted under the care of

Mr. Sydney Jones on Jan. 12th, 1886, after having been some
months at a convalescent home, to which she went on her
discharge from the hospital in June, 1886, having undergone
an operation for hydrosalpinx on the left side. She now
complained of great pain in the right side of the abdomen,
which was persistent, but varied in intensity, increasing in
paroxysms at intervals two or three times a day. It was
also increased by any muscular efforts, and during the
catamenial periods. Since the previous operation the
catamenia had been regular, but scanty and very painful.
She also complained of dragging pains in the lower part of
the back after ordinary exertion. Pain had existed since
the operation of last year, but had been gradually increasing
in severity. The abdomen was somewhat distended, having
a well-marked cicatrix in the middle line, without evidence
of protrusion. There was considerable tenderness on
pressure in the right iliac fossa, and also in the umbilical
region. Nq tumour could be felt. The general condition of
the patient appeared healthy, and the urine was normal,
but she did not sleep well on account of the pain. On
Jan. 30th, there was much pain in tne right side, right hip,
and back. The catamenia ceased the day before; had been
very painful and scanty, lasting four days. She was trans¬
ferred to the care of Dr. Gervis, under whose treatment she
continued until the end of February.

On Feb. 15th the following note was made: “ The external
parts look healthy; there is, however, slight granular
erosion of the external os. On passing the sound the uterine
axis was found to be slightly retroverted, but of normal
length. No pain on touching the fundus, and no hemor¬
rhage followed the withdrawal of the sound. On digital
examination of the left fornix, no pain was felt by the
patient, but when the finger reached the right fornix there
was considerable pain, and a semi-elastic ovoid swelling was
felt."

No improvement having followed the treatment employed
up to this time, Mr. Sydney Jones again took her under his
care, and on March 1st performed the following operation,
the nature of which was explained to her. Ether having been
given, an incision about three inches in length was made in
the old cicatrix in the middle line of the abdomen. The
eritoneum was opened with care after the arrest of all
temorrhage, a finger introduced, and the peritoneum incised
for the whole length of the wound. A large Hat sponge
was then introduced to keep the intestines warm, catch any
blood, aad keep the bowels out of the way. The ovary was
then brought to the surface, and removed after the applica¬
tion of & double silk ligature to its pedicle, this being
returned to the pelvis. Tne ovary was double the normal
size, and several cysts were found throughout its body. The
Fallopian tube was normal. On the left side the parts WHre
healthy. There was no adhesion of the abdominal contents
to the old cicatrix. The wound was closed with alternate
silk and catgut sutures. The operation was done under the
carbolic spray, and the wound dressed with iodoform, iodo¬
form gauze, and salicylic wool. Morphia was given hypo¬
dermically in the evening, and she had a fairly good night.

March 2nd.—She “complains of great thirst and a good
deal of pain in the abdomen. Temperature at 2 a.m. 100°;
at 8 a.m. 99°. Pulse 105.

On March 5tb the wound was re-dressed and two satnres
removed. On the 8th all the sutures were removed and
from along the track which they-had made pus exuded on
pressure. For some time after -the operation it was neces¬
sary to give her morphia injections, for although she did not
appear to suffer mucn pain, still she was restless and very
impatient of control, being difficult to manage, as on the
former Qccasion. The suppuration which was noted on the
8th extended to the wound, aad it was necessary to open
this up somewhat in order to give freer Vent. Mucn care-was
taken with the diet; during the first twenty-four hours only
ice was allowed, then a drachm of milk every hour for a day,
then thie quantity was increased,, mid so> on until it
considered safe to allow solid food. Whan sapparatioa
came on in the wound and the temperature rose (on ore
oooamon, the 8th, it reached 103-4°) the previous dreasag
was changed to boraeio aoid and warm water, strapping
being applied after the removal of the sutures. When nfr

)ogle

TH» iANOBT,]

HOSPITAL MEDICINE AND SUROEKYi

[ April. 30, il8$7* 877

left the hospital oa April 7th there was still e superficial
granulating surface of slight extent, but her health woe
good nod she was able to take a long railway journey. The
abdomen was supported by a belt, and since she haa been
to the convalescent borne, to which she went on leaving,
her general strength has improved; she has lost her pain.

EXTRAVASATION OP BLOOD INTO THE THIGH; GENERAL
TUBERCULOSIS; NECROPSY.

(Under the care of Mr. Croft.)

The patient whose case is recorded below was admitted
into St. Thomas’s Hospital on the 27th of March, 1884, suf¬
fering from multiple fractures of the bones of the face, and
fracture of the base of the skull and of the radius on each
side. Optic neuritis developed under observation, and also
left internal strabismus (see The Lancet, vol. i. 1886,
p. 105). The following account of the further progress and
ending of this case, and especially of the post-mortem, is
unusually interesting. The man never appears to have com¬
pletely recovered from the injuries thus received, and was
almost constantly under medical care for various ailments,
dying at last from tuberculosis. The position and extent of
the fracture of the base of the skull, the evidences of the old
meningitis, which had evidently been severe, and the more
recent inflammation with tubercle, are the points to which
most attention will be directed. It is not often that we are
able to follow throughout its course a case possessing so
much clinical interest. The notes of the case have been
supplied by Mr. G. R. Anderson.

W. H-, aged forty-one, housekeeper, was admitted into

Edward ward on Jan. 21st, 1887, and died fourteen days
later. The family history was good. He contracted syphilis
fourteen years ago. Until the last three years he enjoyed good
health; he then had an accident, sustaining severe injuries,
and lost the sight of the left eye. Since then he has had
bad health. In April, 1886, he was admitted for ascites and
pleurisy, and has attended the out-patient department since
for chronic bronchitis. About five or six weeks ago he first
noticed pain on the inner side of the left thigh, and thought
that he had strained it. The day before admission he noticed
swelling in that situation. This seemed to come suddenly;
the pain at the time was intense, and he nearly fainted
With it.

On admission he was sallow, and had some facial defor¬
mity, with internal strabismus of the left eye, there being
complete paralysis of the external rectus and complete
atrophy of the disc, the result of the old accident. He com¬
plained of pain and swelling along the inner side of the left
thigh. Here there was a tense ill-defined swelling, extending
halt-way down the thigh from the flexure of the groin.
There is ecchymosis over the upper part of the swelling,
and this is. said to be increasing; the swelling is tender on
deep pressure. The femoral artery can be easily felt, and
also the vessels in the leg. His arteries generally are
diseased, very hard, and tortuous. The heart is normal. He
is under treatment for chronic bronchitis. Urine normal.
Temperature 10I - 8° ; pulse 100, full, and bounding. On both
legA there are scars of old syphilitic ulcers. A flannel
bandage was applied from the foot upwards, and an ice-bag
placed over the swelling.

Jan. 24th.—There is some decrease in tlie size of the
swelling; it is le**s tense, but there is surrounding cedema,
and the ecchymosis has spread. There is slight enlargement
of the. glands in the groin. The limb is quite warm. He is
complaining much of headache.

25th.—Warm lead lotion applied to thigh, the condition of
which is much the same. There is a somewhat petechial ery¬
thematous eruption about the face. Respiration rapid;
pulse 96. Tongue dry, and covered with a whitish-brown fnr.

28th.—There has been continued complaint of headache,
not relieved by iodide of potassium, and only slightly by
bromide of potassium. He has been side constantly
during the day*

_30th.—Continued headache, with some tenderness of scalp.
The-rash on the face has faded and the swelling of the thigh
is diminished. Tongue and lips dry and brown.

fllst.—-Some difficulty in breathing, the inspiration being
noisy, with expectoration of bronchitic character.

■ Tab, 3rd.- r Patient lies on his back, breathing somewhat
heavily j is apathetic, and does not answer questions readily.
Hisiips are dry, brown, and cracked. Tongue dry, with a
dAE^-brown fur. Pulse full, 90.. There is some impairment
“power iajhe,right arm.

During the last few days he had complete loss of appetite
refusing to take food, and emaciated rapidly. The headache
was severe, and not much diminished by medicine. He died
on the 4th, in on unconscious condition. The highest tem¬
perature recorded was on the evening of the 23rd, when it
reached 102 4°. It was usually higher in the evening until
the 28th, after which date it did not exceed 99°, and was
normal before death.

At the post-mortem examination, held on the following
day by Dr. Hadden, there was well-marked tubercular
peritonitis with adhesions; tubercles in the kidney and also
in the lymph covering the surface of the lungs, but none in
the longs. “ There was a united fracture, evidently quite
old, of the middle fossa of the skull, which extended from
near the apex of the petrous bone obliquely forwards and
outwards to the anterior margin of the fossa. The mar"
gins of the longitudinal fissure of the brain were pretty
firmly adherent in the anterior half, and the tips of
the frontal lobes were adherent to the dura mater. There
were evident signs of old meningitis at the base. The pia-
arachnoid was thickened and opaque, especially over the
optic nerves, chiasm a and tracts, the crura and pons. The
optic nerves were dull-grey and the chiasma and tracts
distinctly changed In colour. There was no marked
diminution in size. The left third nerve was greyer than
the right and more flattened. The corpora quadrigemina were
normal in size and appearance. -The edges of the fissure of
Sylvius were firmly adherent, and in separating them several
grey tubercles Were seen. There was no recent lymph
anywhere. The lateral ventricles were a good deal dis¬
tended with turbid fluid, and their walls extremely softened.”
A few calcareous plates were found in the spinal arachnoid,
chiefly over the lower half posteriorly. A moderate amount
of blood was effused into the subcutaneous tissue of the
upper and inner part of the thigh. There was no sign of
ruptured vessel. The femoral and other arteries were very
atheromatous. _____

MANCHESTER ROYAL INFIRMARY.

RUPTURE OP THE SPONGY URETHRA; SUTURE j RECOVERY,

(Under the care of Mr. "Wright.)

The notes of the following case were taken by Mr. Brazil,
house-surgeon.

Peter A-, aged fifty-four, an unhealthy man, formerly

a drinker, was admitted on Jan. 29th, 1887. Shortly before
admission, while tipping a coal waggon, he was struck in
the scrotum by the shaft prop. Soon after the accident he
tried to pass urine, but found he was unable to do so, and.
that the scrotum swelled up.

On admission, the house-surgeon, Mr. Brazil, tried to pais
a catheter, but, finding this impossible, Mr. Wright Was
sent for. On examination, there was a lacerated wound
in the scrotum on the left Side of the middle line. On
passing a catheter along the penile urethra, it entered a
large cavity, but could not be got into the bladder. The
patient was anaesthetised, and it was then found that the
catheter could be passed out through the scrotal wound:
the scrotum and perineum were then laid freely open, ana
it was seen that the spongy urethra was tom completely
across a little in front ot the bulb, and the ends of the urethra
were separated for a distance of from an inch to an inch and
a half; the posterior extremity was recognised after & little
searching, and a broad director was passed, along it into
the bladder. There was free oozing from the tom corpus
spongiosum. Four catgut sutures were then passed through
tne divided ends of the urethra, and a No. 10 silver catheter
passed from the penis into the bladder along the director,
and the latter removed. It, wo 8 then found that the two ends
of the urethra readily stretched, and could be brought together
without great tension. The sutures were tightened, and ttye
parts came into good apposition, so that the Catheter was
not long exposed., The wound was left entirely open ap’d
the catheter tied in the bladder. , ’ . .

For the first two days the urine came partly through the
catheter and partly through the wound, which was Washed
out with boracic lotion and dusted with iodoform. On
Feb. 3rd the man’s condition was very poor; be was feeble,
apathetic, and constantly drowsy, and it was feared that
his kidneys were too unsound to allow of repair of the
injury. The catheter was removed for the first time ofl the
7th and replaced. For the next three weeks the wound
slowly healed, and the man’s condition caused much anxiety;

Google

878 Thb Lancet,]

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

[April SO, 1887.

diaphoretics and a hot vapour bath, however, improved
matters, and he gradually recovered. After the 15th the
urine came entirely through the urethra, and the catheter, a
No. 10 silver one, was readily passed, every day at first, and
later every two or three days. No other bad symptoms
appeared, and he was sent to the Convalescent Hospital. On
March 2nd he was able to pass urine “ as well as ever.” The
scrotal wound was nearly healed, and though he was
weak his general condition was fairly good. About ten days
iater he left the Convalescent Hospital, a No. 12 catheter
having been passed readily before he went home. On March
30th a 12-15 Lister passed easily.

Remarks by Hr. Wright. —Complete rupture of the
spongy urethra is of rare occurrence, and, so far as I know,
primary suture has not been employed for it hitherto; it,
however, seems to be the most rational treatment for such
an accident, and in this case has had the best results. Had
this not been done, it is probable that the wide separation
between the ends of the urethra would have necessarily left
the man with a permanent perineal fistula. For rupture of
the membranous urethra, suture haR already commended
itself as a proper line of practice.

Mldtiral Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Chronic Syphilitic Meninyitis, ennsivy Proyressive Dementia.
— Analysis of 93 Cases of Writers' Cramp and Impaired
Writiny Power, making, with 75 cases previously reported,
a total of 168 cases.

An ordinary meeting of this Society was held on Tuesday,
Mr. G. D. Pollock, F.R.C.S., President, in the chair.

Dr. F. Warner and Dr. Fletcher Beach communicated
a case of Chronic Meningitis, probably Syphilitic and causing
Progressive Dementia. The case was that of a boy aged
seven, who came under the observation of Dr. Warner in
January, 18711. While an infant he suffered from snuffles,
thrush, and sores about the nates. He never had fits. As
he grew up he became a strong boy and went to school,
where he did his lessons fairly well. He continued bright
and well until about eight or nine months before he was
first seen. The first thing noticed was a certain difficulty
in his movements, the boy at the same time complaining of
headaches and crying for slight causes. The symptoms
when first seen were then related, and the progress of the case
given. He was under observation until September, 1880,
when he was admitted into Darenth Asylum, under the
care of Dr. Fletcher Beach. There he remained until
his death in January, 1882. At the necropsy, twenty-
seven hours after death, the dura mater was found
adherent to, but easily separable from, a subjacent false
membrane, which had evidently been formed for some time.
It was attached here and there to the upper surface of the
pia mater by thin membrane, and could be traced for a con¬
siderable distance along the floor of the skull. The family
history showed that the maternal grandmother was epileptic,
that the mother was liable to spectral illusions, and that
the father had had syphilis. This interesting case, which
had been watched carefully for three years, was clearly one
of acquired imbecility, due to chronic meningitis, probably
syphilitic in its origin, and is representative of many others,
where, owing to the influence of heredity, indicated here by
the history on the maternal side, the child is born with an
unstable brain easily disturbed by any cause. Syphilis is
not a common exciting cause of imbecility, but, according
to Heubner, hereditary predisposition to nervous diseases
appears to exert an influence in determining the syphilitic
poison towards the nervous system. Finally, references
were made to the connexion between syphilis and idiocy
and imbecility. Photographs of the brain and of the mem¬
branes were exhibited. Dr. Angel Money had made a

E ost-mortem examination on a similar case in a syphilitic
lfant aged twenty months, in whom there was an extensive
sanguiniferous thick false membrane covering the whole of
the brain. He likened such cases to peri-splenitis and peri¬
hepatitis.—Dr. Francis Warner had observed progressive
loss of mental function in two brothers unquestionably due
to syphilis. In one case sudden left hemiplegia occurred.

There was an arrest of growth in the bones of the affected
side; probably syphilitic arteritis was the cause. He thought
such cases of mental loss and epilepsy due to syphilis were
not uncommon.—Dr. Fletcher Beach said that only three
cases of undoubted syphilitic imbecility had occurred in 1600
cases at the Darenth Asylum.

Dr. G. V. Poore communicated a paper on an Analysis of
93 Cases of Writers’ Cramp and Impaired Writing Power,
making, with 75 cases previously reported, a total of 168
cases. This paper is in continuation of one published in the
sixty-first volume of the Society’s Transactions. The cases
reported are given in the form of tables, as an appendix to
the paper. They are arranged in three groups,—viz.: 1.
Paralytic, 13 cases (10 cerebral). 2. Degenerative, 14 cases.
3. Neuro-muscular, 66 cases. The cases in groups 1 and 2
are nearly all referable to well-understood pathological con¬
ditions which affect the brain or spinal cord. The author
is of opinion that a not uncommon cause of impaired
writing power is to be found in lesions causing slight
degrees of paresis of a hemiplegic type, and that the
evidence of a slight, long-antecedent, and possibly for¬
gotten hemiplegia may have almost disappeared, except in
the execution of an act such as writing, which requires
bit.h delicacy and steadiness. Slight degrees of sclerosis
affecting the different columns of the spinal cord may,
in like manner, be scarcely noticeable except in the effect
which they produce on the act of writing. Out of the
total 168 cases of impaired writing power, about one fourth
are referred to slight central changes in the brain or cord.
The remaining 117 cases (66 in the present paper and 51 in
the previous paper) cannot, with any sufficient reason, be
referred to central change. They form a group which the
author calls the neuro-muscular group. The objective
symptoms of this group (in addition to the impaired
writing power) are: 1. Nerve tenderness. 2. Change in
the laradaic irritability of some of the muscles. 3. Tremors.
These symptoms may occur singly or combined. Nerve
tenderness occurred in 50 out of the 93 cases, and in most
of these it was the median nerve which was tender. Change
in muscular irritability occurred 61 times in the 93 cases.
The change was generally a depression, and it occurred chiefly
in those muscles which, in the act of writing, are subjected
to prolonged contraction, such as the interossei,&c. Tremor
occurred in more than half the cases. Many cases were com¬
plicated by slight rheumatic conditions of some of the joints.
The pathological significance of altered muscular irritability
and nerve tenderness is discussed, and it is shown that these
conditions occur under such varied circumstances that alone
they have little value in determining the nature of the
pathological change or its seat. Both, however, may be
induced by excessive muscular exertion, and the author
continues to regard the depressed electric irritability as
symptomatic of muscular fatigue, and is inclined to regard
the nerve tenderness as also connected with over-exertion.
In the treatment of cases of impaired writing power the
first step clearly is diagnosis. For cases of the neuro¬
muscular group, blistering and other forms of counter-
irritation applied to the tender nerve trunks have proved
of marked value. Good results have also been obtained
from massage and other methods of improving the nutrition
of the affected limb.—Dr. C. Y. Biss thought greater pro¬
minence might have been given to the mental and physical
states of the patient. He had heard of cases of writers'
cramp being cured by massage in two or three weeks.
The case of a highly nervous man was narrated in which
it was shown how important it was to improve the general
health of the nervous system. A massage of the whole
body once a day and a favourable prognosis confidently
expressed to the patient resulted in a cure in six weeks.
— Dr. Angel Money said that in his experience infantile
cerebral hemiplegia was very common, and, doubtless,
some cases of impaired writing power were due to a
long-past hemiplegia. Compensation and substitution
allowed of great repair in children. Some cases of
impairment in writing were probably due to impaired
nutrition of the motor cortex, and others to defect of
the spinal centres. This defect of nutrition would tell
most on the terminations of the pyramidal fibres and
on the endings of the nerves in muscles, for both sets
of fibres had their nutrition controlled by the centres,
and the nutrition of the fibres might be considered to
be more difficult of establishment the further they wen-
away from the source of nourishment and energisation.--
Dr. Garrod alluded to impaired power of writing due

The Lahcbt,]

CLINICAL SOCIETY 0^ LONDON.

[Awul30,183T. 879

to the result of pressure on the nerves of the arm during
sleep.—Dr. R. J. Godlbk referred to the rheumatic affections
sometimes met with in these cases of impaired writing. In
some cases of writers’ cramp he had noticed a remarkable
“ clicking ” in one or other joint.—Dr. Poona said, in reply,
that the mental condition was notably of two kinds. In
one the men were of extraordinary energy, and the energy
was ahead of the staying power of the muscles and nerves.
Great despair was the mental condition of others. Very often
in ladies the loss of writing power was largely mental, but
this was rare in men. All his work had been with a view to
show where the loss of function is situated. Altered irrita¬
bility and tenderness might be due to central or peripheral
lesions, but the evidence was insufficient to say whether the
one caused the other, or vice versa. As to the joint conditions,
perhaps gout played a share in the causation of some cases.
Gouty masses and gouty grating in tendon sheaths Dr. Poore
had observed, and also creaking of the shoulder-joint.—
The President related cases which were clearly due to
fatigue, and easily curable by simple rest and change of
occupation.—Dr. Poo he said that the writing might be
impaired from a multitude of causes—e.g., “rheumatic”
affections of nerves, and pressure on mufculo-spiral or
ulnar nerves. Cases due to fatigue and over-exertion were
sometimes of the acute kind. Of these he bad seen some,
but most of the cases he dealt with in the paper were of the
chronic order, lasting for months and years.

CLINICAL SOCIETY OF LONDON.

Three Cases illustrating the Difficulties in establishing
Natural Respiration after Tracheotomy, and their treat¬
ment by Tracheal Catheterisation —Large Omental
. Lipoma successfully treated by Abdominal Section.—
Abdominal Exploration for Chronic Intestinal Obstruc¬
tion; relief cf Symptoms by Artificial Anus: subsequent
removal of a Growth involving the Splenic Flexure of
the Colon; recovery.

Air ordinary meeting of this Bociety was held on the
22nd inst., Dr. W. H. Broadbent, President, in the chair.

Mr. Biltow Pollard referred to three cases illustrating
the difficulties in establishing Natural Respiration after
Tracheotomy, and drew attention to their treatment by
Tracheal Catfceterism. The difficulty in getting rid of the
tnbe after tracheotomy was by no means uncommon, and in
two of the cases related it persisted after most determined
and persevering attempts had been made for more than a
year and a half by the usual methods. Two of the cases had
been for a long time under the care of Mr. Godlee, and had

f iasaed into Mr. Pollard’s hands when he succeeded Mr.
lodlee at the North-Eastern Hospital for Children. The
first case was a boy, aged two years and a half, on whom
tracheotomy had been performed for laryngitis. For eight
months frequent attempts were made to dispense with the
tube. Mr. Godlee then catheterised the larynx without
benefit. Five months and a half later a piece of india-
rubber tubing was passed through the larynx from the
mouth to the tracheotomy wound, and left in position for
forty-eight hours, without any improvement in. laryngeal
respiration. The operation was repeated four months later
without success. A year and seven months after the
tracheotomy Mr. Pollard passed a tracheal catheter from the
month through the glottia and into the trachea, beyond
the tracheotomy opening. It was retained for thirty-one
hours, and after its removal the patient continued to
breathe through his mouth. The tracheotomy wound
was firmly healed in a fortnight, and the child had been
perfectly well for the aix months that bad passed since
the operation. In the second case (a boy aged six) the
windpipe had been opened for laryngitis. Tbree months
after the operation, all attempts to get rid of the tube
having failed, Mr. Pollard passed the tracheal catheter, and
in doing ao dislodged a piece of gTanulative tissue, which
was coughed, up. Pneumonia followed in this case, but the
patient was nevertheless cured, and was discharged a fort¬
night after the operation. He remained perfectly well for
the three months that had passed since the operation. In
the third case (a boy aged four) the operation had been
performed for impaction of a foreign body in the right
bronchus. For seven months attempts were made to get
rid of the tube. Mr. Godlee then removed granulaave

tissue from the trachea and catheterised the larynx. The
latter procedure was frequently repeated during the next
three months and a halt. Two years and three months
after the tracheotomy Mr. Pollard found the vocal cords
adherent; he separated them, and, after dilating the glottis
with Lister’s sounds, passed the tracheal oatheter, which was
kept in position for thirty-eight hours, it was not until
three weeks after this operation that the patient breathed
through his mouth alone. The boy’s voice returned, but
after four weeks laryngeal respiration was so difficult, owing
to the vocaI cords having grown together again, that the
trachea had to be reopened. The only difference between
the plan Mr. Pollard followed and that which Mr. Godlee
adopted was that, by keeping the tube in the trachea whilst
the tracheotomy wound was allowed to dose, the patients
were left, on its removal, without the opportunity of
making use of the passage which, from oonstant employ¬
ment, had become for them the natural one. In the first
and second cases the chief cause of obstruction was laryn¬
geal spasm, but in the second there was also a growth of
granulative tissue. In the third case there was a genuine
stricture of the larynx, and the tracheal oatheter served as
a means of continuous dilatation; the result in this oase
showed that the dilatation should have been employed for a
longer period. In two of the cases the tracheotomy incision
had divided the cricoid cartilage, and Mr. Pollard suggested
that this method of operating might be a cause of the diffi¬
culty of re-establishing laryngeal respiration in those caeeB.—
Mr. Howard Marsh thought that in performing tracheo¬
tomy it should not be forgotten that the trachea was a canal,
like the urethra, lined by delicate mucous membrane.
Uleeration and granulation tissues were frequently de¬
veloped under the influence of the mechanical irritation of
the tracheotomy tube. The fenestra in the tube was often
the offending point, and when situated posteriorly, and then
a hernial-like protrusion of the posterior wall might become
the seat of granulations. He advocated the use of tracheo¬
tomy tubes with movable necks, and with a round, not
bivalve, body. The surgeon should have an assortment
of tubes to fit different cases, for in some the neck
was very shallow, in others very deep, and ao forth.
He doubted whether all the cases could be successfully
treated as Mr. Pollard’s, and related a case in which no
lumen through the larynx, which was full of granulation
tissue, could be detected on examination. Such a case was
likely to prove hopeless under any method of treatment.
The lapse of time was an important item in the cure of such
cases, for cicatrisation might occur meanwhile, and the
natural growth and enlargement of the respiratory passages
would come into operation. He mentioned a oase of stric¬
ture of the trachea from permanent contraction which
occurred in a child, now a woman aged twenty-five,
but without any recovery of breathing power.—Mr. C. H.
Golding-Bird considered that Mr. Marsh exaggerated a
little the harm done by the fenestra in the traoheal tube.
The permanent rough edge of the two-bladed tube wsavery
deleterious. At the present time he had two cafes under
his oare in which the children ceased to breathe on removal
of the tube. In these the conditions were probably the
same as thou he had described in 1885. The edges of
the tracheotomy wound were grown upon by granulation
tissue. In one case a growth of granulations existed pn the
posterior surface of the trachea, and this was removed by
Toynbee's ear forceps. He did not think the tube would
account either for the absence or presence of granulations.
A phlecmonous inflammation occurred in some cases, but
he could not say whether this had any share in the causa¬
tion of the granulations. In many the muscles of the
larynx wanted treatment, and he thought that catheter¬
isation, which he had practised for some years past,
might act by rousing the muscles into proper action. —
Mr. R. W. Parker recognised two classes of cases:
thou with and those without mechanical obstruction; the
former far outnumbered tbe latter. Treatment by catheterisa¬
tion for the cases of mechanical difficulty would not always
prove successful. Thickening of the mucous membrane of
the pharynx and aryepiglottic folds was an important con¬
dition not sufficiently recognised. In the second case, be
believed that the catheterisat ion proved dainroous by detach¬
ing granulations. In some patients the difficulty remained
because tbe surgeon delayed too long the attempt to remove
the tracheotomy tube. He agreed with Mr. Marsh that the
tube should be ‘fitted to tbe case, for the variety in use of
the neck, trachea, and child was great. He believed that

Tm Lanokt,]

CLINICAL SOCIETY OP LONDON.

[Aran. 80,1887.

treatment was not yet entirely successful. Reference was
made to a case under bis care in a child aged two years,
who had scalded his glottis, but for whom little could
be done at present, though doubtless time would prove
of great service, as it had done, in his opinion, in Mr.
Pollard’s case, for the larynx remained small till about
the age of twelve or thirteen, when an extra development
occurred, especially in the male sex.—Mr. Bilton Pollard,
in reply, could not agree that the pneumonia was due to the
trickling down of blood, but believed that it was dne to col¬
lapse of the left lung, owing to the direction of the tube,
which perhaps permitted air only to enter tberight lung, for
there were no breath sounds on the left side of the chest
whilst the tube was in. The further progress of the third
case was not altogether nnsuccessful; many granulations
about the vocal cords had by treatment developed into cica¬
tricial tissue, there being a sufficient opening through the
larynx to permit of breathing for as long as twenty-four
hours, when the tracheal tube had to be replaced, appa¬
rently because muous in the trachea became excessive, and
the child had difficulty in coughing this up.

Mr. Mbrudith read notes of a case of large Omental
Lipoma successfully removed by Abdominal Section. The
patient, a woman aged sixty-two, was admitted under his
care at the Samaritan Free Hospital in January, 1888, suffer¬
ing from an abdominal tumour of over four years’ standing.
Some eighteen months before this she had been an inmate
of another special hospital in London, where the abdomen
had been opened in the belief that the tumour was ovarian,

• but had been reclosed on the discovery ot the fatty nature
of the growth. The patient returned home after recovering
from this exploratory operation, but remained more or less
constantly bedridden on accoant of the weight and size of
the tumour, which Steadily continued to increase. On her
admission into the Samaritan Hospital, the abdomen,
measuring forty-sixth inches in girth, contained an elastic
but evidently solid tamour, which filled the entire cavity
and overhung the pubes and groins, without invading the
pelvis. The growth, viewed in the light of the former
operation, was diagao9ed as a lipoma of the omentum on
tne grounds of its comparative mobility and the absence of
any intestinal resonance in front of the mass. The tumour
was removed on Feb. Btb, 1886, by enucleation en masse
from its omental capsule. No serious difficulty was encoun¬
tered, and the abdomen was closed without drainage. The
growth weighed fifteen pounds and a half; it was solid
throughout, consisting of dense lobules of fat with a scanty
amount of flbro-cellular tissue. The patient recovered well,
and left the hospital on the twenty-iourth day afcer opera¬
tion. She was seen in good health four months later, having
gained flesh and strength. Examination revealed no evidence
of farther growth.

MV. Bkrward Pitts read a case of Abdominal Exploration
forCbronic Intestinal Obstruction, with relief of symptoms by
the formation of an Artificial Anus and subsequent removal of
Growth involving Splenic Flexure of Colon. The patient,
Mrs. I)——, came under observation in St. Thomas’s Hospital,
on August 21st, 1886. She was aged thirty-seven, and had
enjoyed good health until Oct. 1885, when the first obstruc¬
tive attack took place. For the six weeks prior to her
admission she had had no satisfactory evacuation of the
bowels, even after repeated enemas. She was a thin, pale
woman, with distended abdomen, coils to be seen and felt,
much peristaltic movement, and occasional vomiting; one
large coil was especially marked, running across the abdo¬
men from above downwards towards the left groin. On ex¬
amination under an anKsthetic.no tumour could be felt, and
the reetnm was normal. On September 21st, the vomiting
became continuous and Offensive, and the patient was very
exhausted; the vomiting was checked by morphia,-but no
action of the bowels could be obtained. In consultation
with Mr. Edmands, it was decided to explore the abdomen
in the middle line, and this was done on Sept. 24th. The
tranBverse cokm was Rreatly distended and displaced down¬
wards, and the descending colon was completely empty.
The end of : tbe transverse oolon was attached to a small
separate incision in the upper part of the left semilunaris,
but the bowel was not opened till several days had elapsed,
and the central wound had healed. The patient was in a very
depressed state for the week folio wing theopeningof theoolon.
A very large quantity of freeee continuously passed, and she

and suspicious of those around her. After getting rid of
the very large faecal collection she rapidly improved, and
was able to get np on Nov. 6tb; her weight was theft
7 st. 4 lb.; weight before operation, 6 at. 10 lb. By intro¬
ducing the finger into the colotomy opening, a movable
mass about the size of a small orange could be felt under
the ribs, evidently a malignant stricture at the splenic
flexure. It was therefore decided to attempt the removal of
the affected bowel. After careful preliminary treatment
this secondary operation was performed on Nov. 22nd. An
oblique incision was made on the left aide below the ribs,
about two inches above the colotomy opening, and by
banling on the collapsed descending colon the affected
portion of the bowel was drawn oat of the wound, and about
four inches and a half excised; several small glands and
some adherent omentum were also taken away. The two
ends of the bowel were carefully united by silk sutures
throughout their posterior and lateral aspects. The
muscular coat of this united part of the bowel was then
attached by numerous sutures to the abdominal opening,
and the everted mucous membrane carefully stitched to
the skin. The patient was then left in the condition of
possessing a second colotomy opening, the first opening
having contracted to the size of the little finger. The
patient made a rapid recovery; the temperature remained
normal; and on the tenth day she was able to get up.
8he left for home on Jan. 2nd, wearing a vulcanite tube,
with the hope that feces might pass into the lower bowel

and the natural passage be restored. Mrs.- D-was

now, five months after the removal of the growth, in

g irfect health, and able to do ordinary household work.

er weight was nine stone, or a gain of more than two
stone since the relief of the obstruction; the bowels were
open regularly every morning by the second colotomy open¬
ing, but there was complete control for the rest of the day.
The specimen, a typical columnar epithelioma of the bowel,
was shown and described. Mr. Pitts, in remarking on the
case, gave his reasons for making the abdominal exploration,
and quoted two other cases of stricture of the large bowel,
id which be had made a preliminary abdominal exploration
before opening the bowel at a selected position. By the ex¬
ploration it was possible to gain definite information at to
the cause and extent of the mischief, and this was of immense
advantage when any further radical measure was contem¬
plated. When no stricture was found in the rectum, be
regarded a chance eolotomy as an unsurgioal procedure. In
each of these cases the selected portion of the bowel bad
been attached to a separate opening in the abdominal wall
for three reasons, let. It allows the exploration incision to
heal by first intention, and as the second opening is exactly
the size wanted, and as the bowel is stitched all round,
there is no wound near the bowel opening to beal. 2nd. The
bowel is not displaced from its natural position by being
drawn up to the central wound. 3rd (and most important).
It is of great advantage for after-examination to have the
opening near tbe seat of mischief, so that an after-explora¬
tion with the finger may determine the character of the
stricture and its relations. At the primary exploration, when
the bowels are greatly distended, it is well to be content
with a very limited examination, and on no account to
attempt any removal of growth until all obstructive trouble
has been relieved and tbe bowel has been thoroughly washed
out. Mr. Pitts then gave his reasons for not restorhrg the
complete continuity of the bowel at the time of the colotomy,
and discussed the chances of successful after-Teetoration of
the natural passage. The paper concluded with some remarks
on prognosis and on the poisoning by absorption of gases ttfftt
occurred during tbe evacuation of large Decaf coUeetitm*.-* 1 -
Mr. MoRBANTBAKuneaid that Mr. Pitts’ cooree was »x i>d Qy
what should have been done. An attempt to close tjbb tUf-
ficial anus might be successful, as in a case of inteseftrift
obstruction which was treated by an exploratory median
incision, and in which he made an artificial^anils, nri ttiaft
was relieved, but symptoms of septicismjc poisoning ori*-
curred after the escape of frecal matter, similar to Wbatnaxfr-
pened in Mr. Pitts’ case. Tbe small intestine vr*e opwaedxfi
this case, the valvul® conniventes being seen; and later on
a prolapse of the bowel occurred, and in reducing thtrhfc
resolved to carry out a plan of treatment whfcir'aktMM
attempt to close the anus, for the natural passages bUtdmn
resumed their function. After incising the edgi-fttrafe
wound in the abdomen he stitched them together Mrfm
wound healed almost throughout its entire 1 idmrtfc'. 1 '. ISkak
success was aa unexpected as it was agreea!ble."*Mr. A; B.

THB IiANCBT,]

MEDICAL SOCIETY OP LONDON,

[April 30,1887. 881

Babkbb mentioned a case which illustrated and emphasised 1
the views of Mr. B. Pitts. It was that of a man aged sixty-
four, in whom long-continued obstruction, with enormous
distension of the abdomen, led Mr. Barker to make an explora¬
tory incision from the umbilicus to the pubes, when a can¬
cerous arowth was detected about the splenic flexure in the
form of a large mass of hard growth complicated by nodules
in the mesentery and parietal layer of the peritoneum. I
The wound was closed and the right iliac fossa was
selected for aspiration, as the coacum was much distended; ;
this aspiration was repeated several times, with manifest
relief, and adhesions formed between the caecum and the
parietes, which ultimately allowed him to stitch the
caecum to the incision made into it with a view to |
more permanent relief of the symptoms of obstruction.
By this method of aspiration a large quantity of feculent ,
matter—three to four pints—was removed, with the effect i
of relieving distress and causing the sallowness and
mental symptoms to disappear. It is now six weeks !
since the complete opening was made, and the patient
was very comfortable. He felt so satisfied that he should
adopt the same practice rather than make an opening near
the growth causing obstruction. He considered that the j
artificial anus should be as far away from a new wound as |
possible. He referred to a case of mental aberration that j
occurred in a woman after colotomy, which was also relieved !
by aspiration.—Dr. Broadbent had observed the curious l
mental condition in cases of intestinal obstruction with- I
out there having been previous operation or any intro¬
duction of air into the canal. — Mr. Bernard Pitts, I
in reply, said that Mr. Morrant Baker’s case, ending in |
a rather unexpected closure of the artificial anus, could :
hardly be hoped for in his own case. It was found
impossible, owing to the acuteness of the angle at which I
the intestines joined, either by means of indiarubber or |
vulcanite tubes, to get the faeces to pass from the upper j
into the lower part of the united bowel; so that he.
doubted whether closure of the artificial anus could be I
easily accomplished. He agreed with Mr. Barker’s sugges- 1
tion that the temporary withdrawal of feculent matter by I
means of the aspirator would materially help the surgeon to .
tide over the urgent period of the case. lie would prefer I
that the new wound should be in the immediate neighbour- j
hood of the growth, at least within a reasonable distance— i
say. from three to five inches.

The following living specimens were shownMr. Victor |
Horsley: Three cases illustrating Brain Surgery. Mr. R. J. j
Godlee: Two cases of Abdominal Cyst following injury.

MEDICAL SOCIETY OF LONDON.

Blood Cyst of the Tongue.—Severe Injury of the Wrist - ;
joint, with Division of Nerves, Vessels, and Tendons, j
treated by Conservative Surgery.—Excision of Nevoid
Growth in Neck.—Ossified Epulis.

The last clinical meeting 1>f the session of this Society Vas j
held on Monday last, Dr. J. Hughlings-Jackson, F.R.S.,
President, In the chair.

Mr. Bruck Clarke showed a case of Blood Cyst of the |
Tongue in a young woman aged twenty-four. Tne growth .
was of me void aspect; it only began to grow two years i
sgo, and yielded on one occasion serous fluid, and later on j
only blood, the cyst filling again in five minutes. He pro- .
Posed to excise the cyst, and if necessary to remove a j
portion of the tongue. The cautery would probably control '
any haemorrhage.—Mr. Davibs-Colley said that blood
cysts he bad seen were either ordinary hromatoma or dege- j
aerated ntevi; he inclined to the latter view of the case
shown. A simple plan of treatment would be the use of a
ligature. He had successfully treated an extensive lingual
naevus by ligatures withoat the least haamorrhage.—Mr. F. |
Bowrbman Jessett agreed with the previous speaker; he
had seen serious haemorrhage in treating cases of Hie kind
hy, ligatures.—Mr. J. H. Morgan referred to a curious
fluctuation in size of naevoid growths.—Mr. Bruce Clarke
adhered to his own view, whilst admitting the possibility
a nee void origin.

Mr. William Rose showed a case of Severe Compound
°* t * 10 Wrist-joint. There was a transverse incision
dividing all the structures down to the front of the wrist-
J °lfl*j-the.median and ulnar nerves, the radial and ulnar j
wtene* tnftflexor tendons, and the pisiform bone. The joint
was laid freely open. The tendons had retracted, and there j

was great difficulty in matching them thoroughly, though
the nerves were easily found. Immense pains were taken
to obtain accurate apposition—end to end union—of the
nerve ends. A “tension-stitch” was first used, and then
three or four sutures were employed to stitch the nerves
together. The posterior interosseous arteries proved suffi¬
cient to allow of a flow of blood from the distal ends of the
divided radial and ulnar arteries. The treatment was strictly
antiseptic. The progress was satisfactory, the joint healing
without suppuration. Sensation had returned almost com¬
pletely. The movement of the wrist-joint was now fairly
free. Within one day of the injury there was a return
of sensation on the ulnar side of the second fiDger. He was
disposed to break down adhesions under anaesthesia, and to
relieve the nerves from their surrounding cicatricial tissues.—
Mr. Marmaduke Shkild had seen an almost similar case,
which he had read before the Cambridge and Huntingdon
Branch of the British Medical Association. Primary union
of the nerves took place. A glossy skin and bullous erup¬
tions during the winter months were observed. Passive
movement and massage were very useful in the treatment.—
Mr. Bruce Clarke said that it took many months for sen¬
sation to return, arid it might take more than a year.
Careful galvanisation and massage would effect great good.
—Dr. Angel Money referred to the asphyxiated condition
met with in cases of peripheral neuritis.—Mr. Bernard
Pitts congratulated Air. Rose on the result of his con¬
servative surgery. He had treated several cases of injury
about the wrist, and had met with some difficulty in
“ matching” the tendons. An immediate return of sensation
might occur within a few hours.—Mr. Davies-Collby had
had seven or eight cases of the kind under his care, though
not so severe as in the case shown. He had incised the
opening of the flexor sheaths with a view to better finding
them. There was no necessity for cutting down on these
nerves at present. The interossei did not seem to be wasted.
Galvanism would probably prove useful.—Mr. Rose, in
reply, said he intended to employ systematic galvanisation.
The improvement had not continued the last two months,
and this made him suggest further surgical interference.

Mr. Bowreman Jessett showed a case of Extensive
Nsevoid Growth, in a young man aged nineteen, situated in
the neck about the left ear. At the age of four the growth
began to enlarge distinctly. The left ear was greatly
swollen and turned forwards by the growth behind. Mr.
Jessett attempted to dissect out the whole of the n»vus,
being fully aware of the nature of the growth. This was
found not to be practicable, but the greater part of the
growth was removed, with a good result. There was some
weakness of the left side of the face.—Mr. Walter Rose
agreed that it was more scientific and surgical to freely
expose the nievus and remove it, rather than to employ sub¬
cutaneous methods. Was the pulsation genuine, or merely
communicated ?--Mr. Dayies-Colley said a large number
of these nasvi were best treated by excision. In the Guy’s
Hospital Reports he had described an almost bloodless
method of excision. Hare-lip pins were passed crosswise
through the base of the naBvus, and compressed by means
of a drainage-tube twisted round the pins. Pressure by a
pad of boracic acid lint was very effectual in preventing
bleeding.—Mr. Bernard Pitts said that excision was very
effectual in some cases in the grown-up, but in children
the loss of blood and free dissection should be avoided.
Ntevi that have pulsation at some parts are not very
amenable to electrolysis, which was, on the whole, the best
method of treating nceid in children.—Mr. J. H. Morgan
had employed Mr. Davies-Colley’s method successfully.—Mr.
p. Jessett, in reply, said the pulsation was communicated.

Mr. Marmaduke Sheild exhibited a case of Tumour of
the Lower Jaw of six years’ duration; it was either fibrous
or osteoid. The mode of operation might be open to sug¬
gestions.— Mr. Dayies-Colley thought it was an ossified
fibrous epulis, and he would recommend the removal of part
of the alveolar process beneath, in front, and behind the epulis.

ACADEMY OF MEDICINE IN IRELAND.

Resection of the Pylorus—(Esophagotomy to remove a
Foreign Body.

At the meeting of the Surgical Section held on Feb. 18tb,
Mr. M‘Ardle read a paper on Resection of the Pylorus, and,
as evidence of the importance of this operation, he showed
that of 1342 cases of cancer of the stomach, the disease was
s 3

882 The Lancet,]

SHEFFIELD MEDlCO-CltlftlRGlCAL SOCIETY.

[Apart, SO, 1887.

confined to the pylorus in 802, and of this number 496 were
suitable for operation, as there was no implication of the
neighbouring gland or adhesion to adjoining viscera. He
then detailed a case in which he had removed the pylorus
for cancer. The patient died of exhaustion four hours after
the operation. He called attention to the result in 70 cases
of pylorectomy which he collected : 62 were for cancer, with
35 deaths ; 8 for simple stricture, with .9 deaths. The high
mortality of the former depended on extensive adhesions
delaying the operation. In reference to the question as
to where these adhesions most frequently occur, Mr.
M'Ardle showed that of 289 cases, the tumour adhered to
the pancreas in 132, the omentum in 80, the transverse colon
in 72, the liver in 4, and the small intestine in 1. He men¬
tioned that those points of frequent attachment should be
taken as landmarks in digital exploration of the pyloric
region. The conditions under which he considered operation
justifiable were -1. Irritable and intractable pyloric ulcer,
leading to spasmodic stricture. 2. Simple fibrous stricture.
3. Circumscribed cancer, without adhesion to the pancreas or
transverse colon.

Mr. Barton read a paper entitled “(Hsophagotomy for the
Removal of Foreign Bodies.” He referred to the removal of
a foreign body impacted in the pharynx or oesophagus as a
safe and justifiable operation in cases where removal through
the mouth was difficult or impossible to effect. He spoke
of the reasons which had probably combined to deter
surgeons from performing it more frequently, and detailed
the case of a child from whom he had removed bypharyngo^
cpsophagotomy the steel roller of a sewing machine, which
had been embedded in the pharynx, opposite the cornu of
the hvoid bone, for three months. The foreign body, which
was larger in diameter than a sixpence, could be felt in the
neck, and was safely and easily removed. The child made
a good recovery, the greatest difficulty encountered being
the feeding of the patient, which was troublesome, owing
to the tendency of food to come through the wound, which
did not heal for some time. This “was overcome by feeding
through a stomach-tube introduced through the wound.
Mr. Barton called particular attention to this plan of ali¬
mentation, which he considered would prove of much value
in the after-treatment of cases of this class.

An Outbreak of Diphtheria.—Notes on Cates of Insanity.

At the meeting of the Medical Section, held on Feb. 25th,
Dr. Mouillot of Gorey read a short account of an outbreak
of Diphtheria which occurred in the female School of the
Gorey Workhouse. Eighteen children were affected, and
there was a remarkable difference in the severity of the
cases. In seven the appearance of the throat was that
considered characteristic of diphtheria, and in three of these
the local and constitutional symptoms were very severe.
In ten cases there was no means of distinguishing the
appearance of the tonsils and pharynx from ordinary ton¬
sillitis. In one case the disease appeared to begin in the
larynx. Out of the eighteen cases, three had laryngeal
diphtheria, with two deaths; two cases were followed by
diphtheritic paralysis, and sixteen had distinct enlargement
of the cervical gland. Dr. Mouillot traced the disease to a
foul smell arising from a choked drain immediately under
the schoolroom and dormitory windows. He considered that
even the mildest cases were really diphtheria—(1) because
all were produced by the same cause, and at the same time;
(2) because one of the' least severe cases was followed by
paralysis of the palate; (3) the cervical glands were
enlarged; (4) the children with mild sore-throats were
put in the same ward in the fever hospital with the cef*-
tainly diphtheritic cases, and none of them caught a second
attack, though the infectious nature of the disease was
shown by a child in another ward, who was convalescent
from typhus, catching it. Dr. Mouillot remarked that this
outbreak went far to settle the question as to the possibility
of diphtheria arising from foul drains, and also was a warn¬
ing not to hastily decide that any case of inflammatory
throat mischief was unimportant and non-contagious if it
could be traced to foul drainage.

Mr. John Molony read Clinical Notes of casps which be
had grouped as fair types of “ Fixed Delusions ” occurring
in various forms of mental disease, and cited in connexion
therewith the opinions of Clouaton, Spitzka, Savage, and
Mickel. He also referred to the habit of alvine evacuation¬
eating in some forms of insanity, for the purpose of eliciting
a discussion on the pythogenic origin of enteric fever, ana

gave a brief account of circumscribed outbreaks of abortive
enteric fever occurring amongst agricultural labourers at
“seed-time” employed in manuring, and as a contrast
pointed to the apparent impunity with which some lunatics
can devour decomposed ftecal matter.—Dr. Foot suggested
that the dirt-eating propensities indicated either what the
evolutionists described as the doctrine of reversion, being
the return to a degraded state, or that the insane found in it
some nourishing food or substance which supplied a want.
They showed discrimination by taking the excrement fresh
without waiting for fermentation, which was conducive to
typhoid. -The President said there were cases of definite
monomania'which did not last a year, and were curable
partly by medical treatment and partly by moral influence
before drifting into an asylum, where they were generally
incurable. Opium was of great value in soothing the brain
when threatened with functional disturbance; while care
on the part of friends, and suitable change of scene, often
prevented delusions from being stereotyped.

Dystocia caused by Hydrocephalus and Pelvic Tumour.

At the meeting of the Obstetrical Section held on March 4th,
Dr. Purefoy narrated a case of Dystocia caused by Hydro¬
cephalus and Pelvic Tumour seen by him in consultation
with Dr. Allen, in which the patient, a multipara, became
profoundly prostrate from the suffering due to long-con¬
tinued but ineffectual labours. The os was found largely
dilated, encircling a large mass, which careful examination
showed was a hydrocephalic foetus; below this, posteriorly,
was found' an oval tumour, very movable and apparently
pediculated ; this was being driven down before the present¬
ing pa^t during each pain. With considerable difficulty this
was pushed up and an opening made in the enormously
distended scalp, giving exit to several pints of clear fluid.
Even in this collapsed condition the head was so large that
it was found necessary to complete delivery with the forceps.
When dealing with tumours thus obstructing delivery, if
there is reason to believe their contents are fluid, the relative
advantages of tapping them through the vagina or through
the rectum deserve our particular consideration. — Dr.
Atthill said he thought the tumour and the hydro¬
cephalic child were mere coincidences. .Of course they
increased the difficulty of labour, but not the danger
of the case. The question was how to deal with a
tumour which could not be pushed upwards. His experi¬
ence was that it was wonderful how these tumours would
get out of the way, and how little the patient suffered from
their presence. He should have the greatest hesitation in
tapping such tumours- per vagiaam; he thought such treat¬
ment extremely risky, because there was a danger of punc¬
turing the vaginal wall.—Dr. Lane asked if the child in Dr.
Purefoy’e case was alive at the time of the operation. If k
were dead, there would have been no difficulty about lessen¬
ing the size of the head by puncturing it.—Dr. Purefoy, in
reply, said that as to whether the child was alive or not he
expressed no opinion; but the likelihood of its being alive
might be judged of from the facts that the woman had been
for eight or nine hours in a state of horrible suffering before
he saw her, and that the child’s head contained nearly five
pints of fluid. The probability that it was alive was not
very great; and it was very unlikely that it would have
survived aspiration._ :

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

A meeting was held on March 3rd; Dr, Gleaver, President,
in the chair.

Hypertrophy of Hea\'t.~ Dr. Martin introduced a boy
aged fifteen with enormous hypertrophy of heart. He had
had rheumatic fever two years before. During the past two
months he had suffered from continued fever. The area of
heart dulness, extending from the upper border of the fourth
rib, is four inches and a half in the vertical direction and from
the right border of the sternum to a point three inches to
the left of the nipple. Mitral stenotic murmur; no aortic.
Pulse regular, but weak. 1 ' ;

Injury (f Popliteal Artery. —Mr. Garrard read notea of
three cases of injury to the popliteal artery, each ending in
amputation of the thigh, at periods varying from ten days to
thirteen months. First Case: Subliixation of both knees; pos¬
terior crucial ligament torn off; left popliteal vein tom and
artery stretched, rupturing inner coats. Dry gangrene com-

Tub Lancet,]

MANCHESTER PATHOLOGICAL SOCIETY.

[April 30,1887. 883

menced ou ninth day; amputated on tenth; popliteal artery
plugged with Arm clot at seat of amputation. Second case:
A man had a slight sprain of knee six weeks before. Went
on working until a large swelling appeared in the ham.
When first seen it was almost impossible to distinguish be¬
tween abscess, aneurysm, and soft malignant growth, but
was shown to be a small popliteal aneurysm the size of a
walnut, which had been ruptured. There had never been
any pulsation in the tumour. Amputated six weeks after
the injury. The third case was a severe fracture and
bruising of calf, wounding popliteal artery'; a false aneurysm
was formed and became consolidated, but the limb was use¬
less, and was amputated thirteen months afterwards.

Hodtfkin's Disease.--Dr. Porter showed enlarged supra¬
renal capsules from a case of Hodgkin’s disease. The patient,
a woman aged lifty-one, had suffered from, enlarged glands
on both sides of the neck, the original enlargement, on the
left side, occupying most of the posterior triangle. There
was also a large mass of mesenteric glands forming an
abdominal tumour, and smaller enlargements of the axillary
and inguinal glanda. The tumeur on the left side of the
neck had given rise to great pain from pressure up the side
of the neck and face and down the left arm, and the external
carotid and radial pulses wi re barely distinguishable. There
was also cedema of the left hand, and the arm became ulti¬
mately quite useless. Oae symptom had been flushing and
profuse perspirations, at first more or less limited to the left
side of the face, due to pressare on the sympathetic. The
patient died of gradual exhaustion. At the post-mortem
the tumours were found to be entirely glanaular. There
was some enlargement of the right lobe of the liver and of
the spleen, but no lymphoid nodules or bands apparent in
either organ. The snprarenals were very large indeed. No
enlargement of the intestinal solitary glands was found.—
Remarks were made by the President, Mr. Atkin, Dr. Keeling,
and Messrs. Jackson and Garrard.

At the meeting on March 17th, Mr. Snell introduced a
young woman with Conical Cornea. In both eyes it in¬
volved chiefly the upper part, and in the left especially the
cone was very unusually prominent.

'tumour in the Right Iliar Region. —Dr. Martin gave
brief notes of a oase of tumour in the right iliac region, in
the neighbourhood of the ileo-erecal valve, the subsequent
course of which seemed to prove that the case was one of
faecal obstruction. Throughout, tha bowels were fairly
regular, and acted freely under the influence of aperients.
It was a month before the tumour disappeared. The general
appearance of the patient—a woman aged forty—was
strongly suggestive of malignant disease, giving rise to con¬
siderable diagnostic difficulties.

Obstruction of the Bowels. —Dr. Keeling read a paper on
M The question of Surgical Interference in Acute Obstruc¬
tion of the Bowels,” in which, after limiting the class of
cases to which he wished to draw attention, an attempt was
made to show: first, that by tl.e use of the statistical
. method and the bedside observation of certain symptoms, it
was possible to arrive at a tolerably exact diagnosis of the
cause of obstruction; secondly, that this cause was fre¬
quently Very similar to what is found in external strangu¬
lated hernias, and therefore, thirdly, that the obstruction
could be effectually relieved, as in them, only by surgical
methods.

At the meeting on March 31st Dr. Hargreaves exhibited
a Dilated Stomach (chronic) after pyloric constriction.

Mr. Kilham showed two Surgical Kidneys; they con¬
tained several abscess cavities, and were from a patient aged
eeventy-flve, the subject of stricture kc.

Mr. Snell introduced a woman with small contracted
pnpils, Argyll-Robertson phenomena, optic atrophy, and
symptoms pointing to locomotor ataxia.

Double Ophthalmoplegia.— Dr, "W. R. Thomas related a
case of double ophthalmoplegia. On Aug. 17th the patient,
aged forty-nine, became dizzy and fell, was unconscious for
a short time, and when raised it was found that his sight
was affected. When Dr. Thorns* first saw him in December
both eyes were very prominent from paralysis of ocular
muscles. There was decided ptosis on both sides. The right
eye was immovable, so also was the left; but on the left
side there was a decided internal squint. The pupils were
not affected by light or accommodation. Objects at a
distance could be seen better than those near. Vision

on the left side was much more indistinct than on the
right. There was no history of syphilis, rheumatism, car
cardiac disease, and no previous history of head symptoms.
On the whole,, Dr. Thomas thought that, as the attack had
oome on so suddenly, it was due to haemorrhage pressing
upon the corpora quadrigemina on both sides of the floor of the
third ventricle and parts around, and that this might be due
to pre-existing disease which had not given rise to any
evident head symptoms. Tbo patient was improving.

Acute Dilatation of Stomach. —Dr. Dyson related this
case. The patient, aged forty-one, was seven months preg¬
nant. A miscarriage 9 ccurred thirty-six hours after the
commencement of the illness; but beyond increasing the
debility and collapse, this did not contribute to her death,
which took place on the fourth day after the seizure. The
immediate cause of the attack was a draught of cold milk,
which was taken after severe exertion. This brought on
acute gastric catarrh, accompanied by the vomiting of large
quantities of bile-stained fluid and rapidly increasing dis¬
tension. The physical signs were those set forth- by Dr.
Hilton Fagge. No post-mortem was obtained. The treat¬
ment consisted in giving nutrient and stimulating enemata,
stomachic sedatives, bismuth, morphia, &c., and applying a
small blister to the epigastrium. Most relief to the pain and
vomiting was obtained by hypodermic injection of morphia.
The patient was too feeble to admit 'of the use of the tiocaD
or stomach-pump.—Messrs. Thorpej Jackson, Baldwin, and
Drs. Keeling, Hargreaves, and Martin took part in the dis¬
cussion.

MANCHESTER PATHOLOGIC AX SOCIETY.

At the meeting on April 13th, the following specimens
were shown;—

Malignant Endocarditis and Nephritis.— Dr. H. Ashby
showed the heart and kidneys of a girl aged thirteen years,
who bad suffered for several years with chronic mitral
disease and rheumatism, acute or verrucous endocarditis
supervening. A few weeks before her death she had an
attack of subacute rheumatiem, a diastolic basic bruit made
its appearance in addition to the systolic, and the urine was
loaded with albumen. At the post-mortem numerous irregular
nodules of fibrin were present on the mitral valve and on
the posterior wall of the left auricle, and also along the
line of contact of the aortic valves. The kidneys were
large and pale; microscopically they showed swollen and
fatty epithelium, the tubes choked with blood and fibrinous
casts. The glomeruli appeared swollen, but were otherwise
unchanged. Many of the capillary vessels were choked with
emboli consisting of microoocci. The spleen and liver wane
enlarged.

Cystic Disease of the Kidney. —Dr. II. Ashby showed for
Dr. Macalister the kidneys of a man aged thirty-four years,
who had suffered for upwards of three years'from epistaxis,
hfiematuria, headache, and attacks of dyspnoea. Urremic
oonvulsions supervened before death. At the post-mortem
there was a hypertrophied heart and recent pericarditis.
The kidneys consisted of masses of cysts, numbering many
hundreds, and varying in size from a pin’s head to a
marble, their contents were fluid or gelatinous, consisting of
altered blood.

Intra-thoracic Tumour. -Dr. Hutton exhibited a sarcoma
involving all the thoracic organs, of a boy of eight yean.
There had been no symptoms or loss of health until within
four or five months of his death, and urgent symptoms
existed only for about eight weeks. The growth, arising
in the glands, had infiltrated the pericardium, which was
in places more than half an inch in thickness, and spread
into the lungs deeply in a radiating manner along the
bronchi and vessels. Microscopic sections showed it to
consist of a felt work of coarse bundles of fibrous tissue
containing lymphoid cells in its meshes, with here and
there large masses of lymphoid tissue.

Preparation of (Esophagus from a recent case (the
Oldham 1‘oisoning Case) of Corrosive Poisoning. — Dr. T.
Harris showed this oesophagus, which presented a corroded,
charred patch, with absolutely black edges; the patch was
circular in shape, an inch in diameter, and involved the
mucous and submucous tissues. There could be no doubt
as to the case being one of poisoning by some corrosive
fluid, probably sulphuric acid.

Polypoid Growth of the Vulva. —Dr. Brooke showed a
drawing and sections of a molluecoid tumour of the vulva,

884 TUb Lancet,]

NOTICES OP BOOKS.

[April 30,1887.

involving the clitoris and its folds, both labia majors, and
the lower part of the fore-wall of the vagina. The patient,
aged twenty-nine, had suffered badly from syphilis for
the last eight years in spite of constant treatment. In
June, 1886, a “ vascular growth” was said to have been
removed from the mouth of the meatus urinarius; this,
however, recurred and developed into tjie present con¬
dition.

Mr. Southam and Dr. Dbkschfkld also showed prepa¬
rations and sections.

ftotices of looks.

Food Orains of India. By A. H. Chubch, M.A.Oxon.,
F.C.S., F.I.C., Professor of Chemistry in the Royal Academy
of Arts, London; sometime Professor of Chemistry in the
Royal Agricultural College, Cirencester, &c. Published for
the Committee of Council on Education by Chapman and
Hall. 1886.—Professor Church, whose claim to attention
none will dispute, tells us in his modest preface that his
work has been founded on the material collected by the late
Dr. Forbes Watson, who for many years worked in this
direction. The new analyses contributed by Professor Church
are marked by the letter C, but there are so many 0’s in the
book, and many of them are of such interest and importance,
that the author might well have claimed a larger share of
the honour. The book, a thin quarto, is divided into five
parts. Part I. is devoted to the constituents and uses of
food. In this part we find clear though succinct descriptions
of the carbohydrates, oils and fatp, albuminoids, &c.,
present in all food grains. It was wise to include this
description, and it was equally wise to make it short. We
notice an unfortunate printer’s error on page 5, where the
formula for the glucoses is written C 1; U 0 O 6 , instead of
C 0 II la O 6 . Part II. gives a short but very lucid account of
the theory of dietaries, in which the heat value and nutrient
value are well explained. . We especially commend to our
readers the figures and arguments on pages 13 and 14, which
illustrate, and to ^ome extent explain, the value of “ flesh-
formers” in muscular work. The curious experiment of
I’ick and Wislicenus, and the researches which followed from
it, caused the real energy value of these compounds to be
for a time as much under-rated as they had been before over¬
rated. The remaining three parts of the book describe re¬
spectively the chief cereals, buckwheat, and the allied orders,
and the pulses. The seeds of the amaranths possess remark¬
able food value, the husked seeds of the Bengal amaranth
(A. gangeticus) containing 14-5 percent, of albuminoids and
03 of oil, with 26 of ash and Gl - 8 of starch. The high
percentage of nitrogenous matter is accounted for by the
enormous quantity of nitrates in the tissues of the plant.
The dried stem of the well-known “ love lies bleeding”
will sometimes deflagrate when ignited, and nearly 15 per
cent, of nitrates have been found. Throughout the book we
find excellent botanical descriptions, and equally excellent
illustrative plates. But the most important features are the
large collection of original analyses, and the calculations of
food value founded on them.

The Diagnosis and Treatment of Syphilis. By Tom
Robinson, M.D., Physician to St. John’s Hospital for
Diseases of the Skin. London : J. and A. Churchill. 1886.—
The title-page of this little book leads the reader to suppose
that he will find the more difficult problems, both of dia¬
gnosis and treatment, which arise from time to time in
connexion with syphilis carefully dealt with. Such was our
expectation in taking up the book; we hoped for some
additions to be made to the common stock of knowledge,
and we have only to confess to disappointment. The book
contains nothing of value that is not found in any good
surgical text-book, not to speak of the many excellent
works specially devoted to this subject. Tb story and

phenomena of syphilis are dwelt upon with a very light
hand, and the rules for treatment are simple—we had almost
said crude. The following quotations will show the general
style of the work: “ I shall abolish the term * hard chancre,’
because its introduction implies that it has some relation to
the soft chancre, and I shall use in its place the phrase * initial
lesion of syphilis.’ All the symptoms which ensue after
the initial lesion I shall include in the terms 4 sequela of
syphilis.' ” Dr. Robinson is physician to a skin hospital, so
his views on the cutaneous manifestations of syphilis are
especially interesting. Here is one of them: “ Does a syphilitic
eruption ever assume an eczematous type ? Contrary to what
we have been taught to believe, I should say—Y es, but only
in those individuals who have a skin capable of becoming
eczematous.” We have only room for two of the thera¬
peutic aphorisms: “I have never seen any reason why Aix-
la-Chapelle or any other spa should have any special value
in the course of syphilis.” “Iodide of potassium to eat
up syphilitic manifestations; mercury to prevent their
recurrence.’’ We can only add that the style is not improved
by the writer changing about between the first person
singular, the first person plural, and the third person
singular. Such variety is not a literary charm.

De VIntervention Chirurgicale dans les Affections da
Rein. Par Azaeib Brodeur, M.D. Paris, Ancien Interne
en Mddecine et en Chirurgie des H6pitaux en Paris. Paris:
G. Masson, 1886.—This is the largest work yet published on
the Surgery of the Kidney, and it furnishes the result of
an enormous amount of bibliographical labour. Dr. Brodeur
has collected from all sources 327 cases of operations per¬
formed upon the kidney. The majority of these have been
recorded in the medical press, but some of them are new,
being taken from the private note-books of Paris surgeons.
Not only has Dr. Brodeur collected these cases, but he
gives an abstract of each of them. Such forms of statistics
have obvious defects; for they show the mortality of the
early operations of many surgeons, and of the operations un¬
dertaken before experience has clearly indicated the best
course to be pursued in individual cases. When foil
allowance is made for this, however, they are useful, sad
the author has made up for this defect by the careful and
useful abstract of each case he gives. These abstract^ all
with full references to the source from which they are derived,
will prove to be of very great service to others investigating
this branch of surgery, and too much praise cannot be given
him for the labour and pains he has taken to make this
part of the work complete. The various renal operations
are discussed under the beads of the diseases for which they
have been undertaken. One fact which has impressed Dr.
Brodeur in his study of the matter is the readiness with
which nephrectomy has sometimes been resorted to. A study
of the work before us will do much to prevent a too £m*
quent practice of the operation.

A Practical Treatise on the Cure of Pulmonary Cans u mp-
tion. By James Weaver, M.D., L.R.C.P. London : J.&JL
Churchill. 1887.—There is no subject in medicine that lus
been more the sport of credulity than that of the trsatittrit
of consumption. The frequent non-success of scientiftemedi¬
cine to arrest the downward progress of the disease haa glean
rise to a host of alleged "cures.” Any honest attempt,
then, to establish a rational line of treatment is.fK*lto
welcomed, and so far, in spite of its pretentious tfiil(j,W®
are glad to receive the fruits of Dr. Weaver’s expii&ijws
as embodied in this brochure. It is, nevertheless, wfxh ,£
sense of disappointment that we find the actual evidanA ai
support of his advocacy of iodide of potassium
specific for phthisis to be so meagre; and before adfemfljK
his conclusions as to the efficacy of this drug
like to feel persuaded of the share taken in the “ c mpS
the dietetic and hygienic management on which he MMv
and rightly lays stress. We are the more sceptic^^!^*

Thb Lancet.]

NOTICES OF BOOKS.

[Apbil SO, 1887. 885

the value of the iodide of potassium treatment because of
the extremely vague notions which its advocate bolds
upon the pathology of phthisis. He talks loosely of the
enlargement of the “tubercle millet-seed bodies” causing
“ congestion” and breaking down into cavities; he believes
in the unity of phthisis, as well as in its being a “ consti¬
tutional” disease and as being “contagious”; whilst his
ideas of the relationship of the bacilli to the morbid process
are so remarkable that we must give the passage entire:—
“ In pulmonary consumption we are able to demonstrate
certain bacilli in the sputa, and although we are at present
unable to state positively what the abnormal quality of
the blood is which generates this condition of things, we
know that this fluid is changed very considerably from that
of perfect health, and that its red corpuscles are largely
decreased, and that certain other constituents, such as
fibrin and lime particles, are considerably increased. It
has also been demonstrated that if a portion of blood from
a phthisical patient be placed for an hour or two in a warm
temperature, certain organisms similar to those expectorated
in the sputa are generated and move about in the fluid so
experimented upon—going, I think, a long way towards
proving that these organisms are first formed in impure
blood, and, acting in some peculiar manner on certain
portions of lung tissue, cause the probably already
deposited tubercular speck to grow and take on organic
changes, producing, as already shown, actual consumption.”
(pp. 17 & 18.)

Traiti ElSmentaire de. Pathologic Gtoiirale. Par H.
Hallo pea u. Deuxieme Edition. Paris: J. B. Bail li ere.
1887.—This work does not claim to be more than a fairly
exhaustive review of a wide subject. In it are to be found
the results of investigations carried on in all countries,
and collated by M. Hallopeau with exemplary diligence.
The subject matter is divided into five parts. The first
treats of etiology, discussed under the heads of intrinsic
and extrinsic causes, the latter including, of oourse, the
subject of micro-organisms, which is treated with consider¬
able fulness. The second part deals with morbid processes,
commencing with inflammation and ending with tumours.
The third part is concerned with symptoms, each system of
organs being taken in turn. In the fourth part, the subject
of disease as a whole is discussed, and in the fifth the general
principles of therapeutics; but these are comparatively
sketchy, and not equal in depth of treatment to the rest of
the book. As a whole, the work is one which will be
appreciated as giving a faithful account of present know¬
ledge of the processes of disease; and to the student desirous
of reading a French work we can heartily recommend it.
Tho systematic method upon which it is planned, and the
care which the author has expended on its revision, are
worthy of commendation.

A New Clothing Cate for the Soldier. By W. Thobnton
Parker, M.D., A.A. Surgeon, U.S. Army. Pp. 15. Newport,
R.I.: Davis and Pitman. 1887.—This pamphlet is another
attempt to solve the much-vexed question how a soldier on
the march can best carry his service kit. Dr. Parker pro¬
poses to abolish the knapsack in use in the American Army
and to substitute for it a case made of light canvas, rubber
clotb, or waterproof cloth, divided into three equal pockets,
and to be worn over the left shoulder. It is claimed for this
that it will be lighter than the knapsack, and the weight be
more equally distributed; but we are by no means sure that,
in the summer especially, the soldier would not suffer more
from the heat of this case, before and behind, than he would
from the slight additional weight of the valise now in use
in our service. The pressure of the case, also, on the front
of the chest would probably be found to impede the respira¬
tion in the same manner, though not in so great a degree as
the belts of the old knapsack, now happily abolished in the
British Army. These are points, at least, which qhqqld he

determined by careful experimental trials before any change
is taken into consideration.

Cauteries Scientifiques. Par Henri dk Pabyillb. Paris:
J. Rothschild.—This is a medium-sized volume, containing
an account of recent discoveries and inventions, given
in a pleasant, readable form, but of necessity much con¬
densed. There is a mass of interesting material in the book,
embracing a wide area. M. de Parville devotes some chap¬
ters to public hygiene, physiology, electricity, geological
and meteorological discoveries, and other subjects too
numerous to specify. Inoculation for cholera by Ferran
is dismissed by the author at some length. He is of opinion
that the judgment with regard to the efficacy of the treat¬
ment passed by the French Committee of Inquiry was too
hasty. Although it appeared that Ferran was unable to
cultivate the cholera bacilli virus, there is still no reason,
be considers, why the germ of truth contained in the idea
of inoculation for this terrible disease should be dis¬
regarded. It remains for others to develop this theory,
which M. de Parville thinks may be of importance to the:
human race. Several pages are devoted to hypnotism and
other psychical experiments. Suggestion, M. de Parville
remarks, would explain more than one miracle and many
mysterious recoveries. As a popular or semi-popular year¬
book of science this work may be regarded as a valuable
little book.

Variations of lortime. Illustrated by Sketches of some
of the Old Towns of Italy and of those who influenced
them. London: Sampson Low. 1886.—“ Everyone,” says
Goethe, “finds in Rome exactly what he brings to it ”; and
from Rome the saw might have been extended to Italy. It
is to furnish the English-speaking visitor to the antique and
mediaeval treasures of the Italian peninsula with some pre¬
paration for the better appreciation of what he sees that
this portable little volume has been written. Already
favourably known to the artistic world for her beautiful
drawings of the “ Seven Ages of Man ” from the pavement
of Siena Cathedral, the authoress has applied her draughts¬
manship to the reproduction of some of the most charac¬
teristic scenes and figures of Italian history ; and, in
conjunction with the skilful letterpress that leads up to and
explains them, she brings before the reader, in a vivid and
memorable way, a series of most interesting events and
achievements, making the realisation of them on the spot at
once easy and delightful. Those of the profession who
contemplate a 'holiday in Umbria or the Roman territory
could not do better than take this little volume as their
companion. ’

The Medical Annual. 1887. Bristol: John Wright and
Co.—The publication of this work has been a little delayed
owing to the unavoidable increase of matter and the number
of pages found necessary to carry out the work efficiently.
Its scope, however, has been so extended as to render it a
complete work of reference on the modern treatment of
disease. The Dose Index has been much enlarged, and the
section “Books of the Tear” has been extended by the
addition of the more important American works published
during 1886. The current volume is a distinct advance
upon its predecessors, and can be unreservedly recommended
to practitioners who desire a source of ready reference on
questions of therapeutics, &c.

Streets Indian and Colonial Mercantile Directory.
1886-87. London: Street and Co.—In addition to the trade
returns, tariffs, populations, &c., of the various colonies
which are dealt with, this volume contains alphabetical
lists of the leading professional men and merchants in the
different town's, concise descriptions of each country and
town, with the view of showing their commercial 'capa¬
bilities and peculiarities, and particulars of the various
railways in operation or in course of construction. The
gmount of information contained in it is enormous, and the

Digitized by GoOgle

886 Trt* Lanobt.]

ANALYTICAL BEUO-RDS.-NBW INVENTIONS.

[A?w* 30,1887.

work, which contains nineteen maps, will be appreciated by
all who take an interest in and desire information respecting
our colonies.

^naljiratl ^etorbs.

THE GERMAINS IMPROVED APPARATUS AND POWDER FOR
.DISINFECTING AND FUMIGATING.

(A. Z. GEKMA.1K3. WlSDSOR-KOAD, VlCTQRIA-PARK, Lo2U>OR.)

The apparatus is a small metal hearth with a false bottom
and side holes, to admit air. Over this is a hood with a
side pipe near the top, by which fumes can escape. The
powder/coatains sulphur, and > bums easily. Mr. Germains
has certainly contrived a convenient and safe method for
sulphur fumigation, bnt every such contrivance is liahle to
be misused, and some of the statements made by the inventor
are likely to lead to very dangerous misuse. Our readers
know well that serious disinfection cannot be accomplished
by the production in a room of a mere smell of sulphurous
acid or any other chemical agent. To disinfect with sulphur
one pound must be burned to every 1000 cubic feet, and the
exposure must last many hours. Real disinfection by this
machine in the presence of living creatures would be impos¬
sible ; and when the inventor talks of the purification of
churches he talks nonsense. Such a fumigation would have
no real value, and would be dangerous as leading to a false
sense of security.

MOUILLA, OR POTASH LIQUID SOAP.

(M. R. Edwardf.s, Adam-street, Strand.)

This Interesting soap is the invention of Dr. Duncan of !
St. Petersburg. We find by analysis that it is, as described, |
a potash soap containing glycerine, and scented with lemon.
It is a'clear solution, which mixes easily, and gives a lather
with 'ibft water. Opinions may differ as to whether potash
iB tiettier tftan soda soap for ordinary use; but if potash
soap is wanted it could not be obtained in a more convenient
or elegant form. For medical purposes the soap is incor¬
porated with small quantities of carbolic acid, Russian
birch tar, and other substances. The carbolic soap, in par¬
ticular, is a useful and valuable preparation,

BOKUL r - A NORWEGIAN PREPARATION OF MALT.

(IXkVis, Bersesdahi* 4 Oo., Newcastle-on-Ttxe.)

. This is a liquid alcoholic preparation which tastes like
sweetened beer. It might, perhaps, be used with advantage in¬
stead of stout, but„as it possesses scarcely any diastaste power,
we cannot recommend it as a substitute for malt extract.

flcfo Jnfantimis.

SELF-FIXING ABSORBENT PADS.

Mr. Dk St. Palmas, of Leicester, has submitted to us
one of his “self-fixing absorbent pads.” It consists of a
pad of absorbent wool enclosed in thin muslin, with four
“ tails” of St. Dalmas strapping affixed to it. The pads are

made of various sixes, and can of course be easily prepared
impregnated with an antiseptic. The woodcut shows at a
glance the mode of application.

AUTOMATIC PURIFYING CLOSET,

An ingenious method of dealing with excreta has recently
been patented by Messrs T. Goddard and Co., of Queen
Victoria-street, which claims to be an improvement upon the
earth-closet. The material used in substitution' for earth
is called “sanitary carbon,” but there- is'no statement
of the source from which this carbon is derived. : Its
action upon the excreta is that of an effectual deodorant,
and it has the advantage of retaining the Ammonia,
thus producing a manure which must have some value. It
is used in connexion with closets and commodee pro¬
vided with lids which Are charged with this nditeriaL
On shutting down the lid a sufficient quantity of the carbon
is scattered over the excreta in the pan beneath, rendering
them entirely free from smell; and it is said that th& Amottat
of earth or ashes commonly required for this purpose is' fiW
| times that of the carbon, the cost of the quantity of the
latter material sufficient for each time of using being ott4-
i eighth of a penny. It is probable there wiH be state
; demand for the use of this deodorant hi places Where 1 ttb
water-carried system is impossible.

KENTISH SAUCR. ‘ ’

(BOBOOTSB 4 CJO., PERCY-SfBKXT, ToTTKHHjLM-OOtTRT-ROAD.) ,

All that we need say of this sauce is that it is pleasant m
flavour, and that our analysis shows that it is entirely free
from poisonous metals.

' LTQ. PODOPHYLLIN (HOCKIN).

(HOCKLV, WO0OM, 4 CO„ DUKC-9T&BET, MAYCHFSTER-SQUARE.)

This seems an excellent extract. It is faintly alkaline, mixes
well with water, albohbl, dilute adds, and small quantities of
alkaMnocarbonates, but is precipitated by alkaline hydrates.

' : ' VAN ABBOTT&

(G. Vax Abbott 4 Sow, LOxtoow.)

This is a stiff jelly easily soluble in warm water. The
solution contains no fat or albumen, and may therefore be
bulled. In flavour it is excellent, and we have no hesitation

'''l/ ' 1 rXp&ATANNIN WINE.

' ti'bEis.PiccADmx.^)'' • . • ' '

MEDICAL ATTENDANCE ON THE POOR.

To the Editors of THb Lancet.

. • -/ jT- 4 1

Sirs,— 1 am obliged by your remarks, and the attention
you have given to my pamphlet on Medical Attendance^
the Sick Poor not Paupers; but I regret if I have at allied
you to infer (and I appear to have done so by your closing
remark) “that I said the object sought by Sir Spencer
committee was only for the benefit of the poor and not tbs
industrial classes.” Now by the very tittle I gave
it was my desire and intention to show: that it waaeb*
the hope of providing, as I particularly mentioned,
pamphlet, kind and efficient medical, aid fox this Mtgm
of tne general practitioner’s patients that' this Oommjttm
was now sitting, and I think I speda&yinipHed 1 «4»w-
mentioning that I advocated that the vriMa unziisboma*ia
certain cases be extended (as to men watii-. Jar ga. l fmaih m>
even to £6 per week by paying 1<H per»#DJ&TO^I*
health. What I did mention was tbatRijr-, SpepMjfjMf.
committee was not organised for rellevfag wyAWg Wl
were wefll’AMb to pay our uriialfees, W6c
stratum ofthe industrial classes “wktafe- mmmOj Imim
very -often was much larger than,, that of jiTw ir mggfe.
and eyett nearing a dJot small number, l&t tfc&vMIjSStire
l fiire,

Digitized by

jOOgl^

Thb Lancet,]

RAGS A8 CARRIERS OF INFECTION.

[April 30,1887. 887

' v.r- i ‘

THE LANCET.

LONDON: SATURDAY, APRIL 80, 1887.

Tbs American Public Health Association has made an
important contribution to the subject of the danger
attaching .to rags as disseminators of disease. In a report
of a Committee on the Disinfection of Rags, they have
embodied a summary of the principal information available
as to the possibility of the communication of disease by
mesas'of rags, and of the oircumstonees under which such
communication takes place. In this country the two
dims arts which are moat in question in connexion with rags
are small-poxand cholera. 1 As regards smell-pox, it would
be mere waste of time to make any endeavour to prove
that the infection is conveyed in old clothing and rags, for
the positive evidence on this point .is overwhelming. So
many outbreaks of small-pox have occurred amongst rag-
sorters is paper-mills, that the only point of real importance
which remains for discussion is how for this source of
infection can be stayed. In an able letter appended to the
report^ Dr. Stbbnbbro, of the United States army, who
has devoted much attention to the subject, evidently inclines
to the! vieur that since we have in vaccination an efficient
means of protecting people, whether rag-sorters or not,
against amaU-pox, it would not be justifiable to place any
substantial hindrance in the way of a trade involving such
large interests as that of paper-making from rags. Rut he
holds, that ^hero a health officer has special reason for
regarding any bale, or consignment of rags as infected
he should take the needed precautionary measures. In
^eglond even this limited action would be difficult of
application, because, unless it can be shown that a definite
consignment;has actually been exposed to infection, the
126th; section of the Public Health Act (1875) becomes
praetwally- useless. And even where such exposure can be
proved, it is a difficult task effectually to disinfeot a
bale of rags unless a high-pressure steam apparatus is
available. The alternative* indeed, would be the destruction
of the- bales, with compensation to the owner, under
Section 121 of the Act, on the ground that the process had
been ouried out in the interests of publio health.

Taming next to eholera, the report must be taken as
Betting at rest all doubt as to whether the infection of this
disease can be communicated by means of clothing and
rig8.; The number of ewes cited in proof of such com-
hamieoekm is-so large that, even allowing for sources of
error ".which might attachto some of them, there still
remain* a sufficient body of evidence to answer all reasonable
porppsM, and to justify the action which ip adopted by our
Government, and by most other European Governments—
aamrty, the absolute prohibition, tn import rags from
cotujte* where- cholera is prevailing; Rut the instances
ated„ taken along with the comments of Dr. Sternberg,
go toshow that, after all, it is not so much rags, as such,
that eepstStote the source of danger, os small parcels of
clothing, OverAhe .transit of which our Cholera Orders in
^ PfishsWikjii^xert influence whatever. Rags, it i

appears, are gradually collected at the ports whence they
are shipped; they are sorted, and put together in bales by
local people, and yet it has been most difficult to show that
cholera has been distributed through the agency of such
establishments. And so slow is the system of accumulation
at times that rag-vendors can allow their stores to increase
until the prohibition is removed; and, after all, the very
rags which it was sought to keep out of the country reach
it at a somewhat later date. Here, however, comes in an
important question. How long does the infection of cholera
retain its vitality in rags and in similar cargoes ? Probably
for a limited period only, wben compared with that for
which the small-pox virus remains operative for mischief
under similar circumstances. Rut even with these limita¬
tions to absolute certainty as regards the importation of
the disease, we agree with the reporters that Governments
have no alternative but to prohibit, during cholera epidemics,
the importation of rags from ports neighbouring to the
districts affected.

Dr. H. R. Raker, the secretary to the State Roard of
Health of Michigan, is evidently inclined to suggest such
wider action as would deal with rags imported from place3
where scarlet fever and diphtheria prevail. He begins by
pointing out that the mortality occasioned by these diseases
is vastly in excess of that from small-pox or cholera; and as
regards the former, he says that whereas the small-pox
deaths in the United States in 1880 numbered only 874,
scarlet fever killed 16,418, and diphtheria 38,398. That the
contagia of both these diseases can be communicated by
means of rags, which are so largely made up of old clothing,
admits of no doubt; although in the case of diphtheria the
instances which go to prove R are by no means so numerous
as in the case of scarlet fever. Hat with these diseases so
rife as they are both in England and in the United States,
and with infection spreading daily through our schools and
other agencies, we think it would be most difficult to induoe
any Legislature to go beyond provisions such as are included
in crar Public Health Act and which limit preventive action,
under such circumstances, to coses in which it can be shown
that there has been actual exposure to infection.

Another alternative has been suggested as regards all the
more dangerous oontagia liable to be communicated through
rags, and which, in addition to cholera, small-pox, scarlet
fever, and diphtheria, include, such affections as typhus,
yellow fever; anthrax, and pleuro-pneumonia. It is that at
all ports or at all paper-mills the r^gs should be disinfected.
Roth Dr. Sternberg in America and Dr. Parsons in thla
country have shown that, so far aa the actual process of
disinfection is concerned, this can be effected by steam-
pressure disinfecting machines; but some of the paper
manufacturers declare that the rags are injured by the
process, and since vaccination is available against the con-
tagium most commonly in question, it has never yet been
regarded as practicable to impose the suggested restriction.
In the meantime health officers should exercise the greatest
vigilance in tlje case of the importation of rags, whether by
sea or land; and, in the ease of cholera, prohibitions to
import must evidently be continued.

- ♦-—

Whether regarded f*>m a public ^health, or from a
political paint of view* the paper recently read by Mr. Noel

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888 The Lancet,]

CLASS MORTALITY STATISTICS.

[April 30,1887.

A. Humphreys before the Royal Statistical Society has
served a useful purpose in calling attention to the wide
variations between the mortality of different social classes.

The necessity for further and more accurate information
on the subject is clearly shown, but our present knowledge
warrants the conclusion that the future of health progress
depends mainly upon the successful application of sanitary
reform to the homes and manner of living of the working
classes. How far it may be admissible to judge of the effect
of class influences upon mortality in England from Dr. Grim-
sha.w’8 Dublin figures must remain a moot question until
similar statistics are prepared for English populations. The
fact, however, that the mean duration of life by Ansell’s
Upper Class Life Table is fifty-three years, instead of forty-
four years by the most recent national life table, affords
conclusive proof of a far wider difference existing between
the rate of mortality of the upper and of the working
classes. While, however, it is highly important that the
excess of mortality in the artisan and labouring class
should not be lost sight of, it is fully as necessary to
remember the facts and figures set forth by Mr. Humphreys
to prove that high death-rates are not the inevitable and
necessary fate of this class. In the absence of any
trustworthy English working-class mortality statistics we
are obliged to fall back upon the Registrar-General's
Occupational Mortality Statistics, which certainly do not
justify the sensational assertion of an evening con¬
temporary, that the “work of the learned professions
conduces to life, and that of the artisans to death.” The
near approach of the mortality of labourers in agricultural
counties and of gardeners to that of the clergy, which
between twenty-five years and sixty-five years is repre¬
sented by 556, as against 1000 for the mortality of ail males,
was pointed out in the paper. It is necessary, however, to
call attention to the fact that the relative mortality figure
for lawyers is 842, and for medical practitioners 1122; and
also to point out that below or between these figures come
wheelwrights, 723; carpenters, 820; ironstone-miners, 834;
coal-miners, 801; plasterers and Whitewashers, 896; shoe¬
makers, 921; bricklayers masons, and builders, 969; black¬
smiths, 973. The mortality figure for each of these groups
of artisans is below that for all males, and very considerably
lower than that for the medical profession, while the mean
mortality of all the groups but slightly exceeds that of the
legal profession. Whatever may be the explanation of
these apparent anomalies, it is at any rate clear that the
work of the medical profession can scarcely be said actually
or relatively to conduce to long life. It is quite possible to
believe that an artisan’s life, with actually shorter hours of
work and for less mental worry, may in a large proportion
of cases be more conducive to longevity than that of the
professional man. It is the general and unskilled labourers
in to whs. who suffer most, and who from their numbers
tend to raise the mortality of urban populations.

The most important political, social, and sanitary problem
of the day now urgently calling for solution, is to devise
means for preventing the accumulation of unskilled labourers
in towns in sanitary condition and surroundings not only
fatal to themselves,' but a source of real danger to the
phytfoW, moral, and social health of the nation. There
can be no doubt that the manner of living of the poorest

classes in certain portions of most of our towns constitutes
a source of danger to the public health, while we see its
result upon themselves and their children in the statistics
given in Mr. Humphreys’ paper. It is asserted by owners
of house property and by sanitary authorities that they
are helpless to control the home surroundings of these
classes; but if landlords were held more distinctly respon¬
sible for the sanitary condition of their underlet tenements,
such a pressure would be put upon the tenants as would
teach them the necessity for decent living. In this way a
civilising influenoe would be brought to bear forcibly upon
the class, and the benefit to the public health would soon
exercise an appreciable influenoe upon the death-rate. The
effect of such pressure upon the mortality from zymotic
disease may be estimated from the variations in the death-
rates from these diseases in the various social classes
derived from Dr. Grimshaw’s figures. We learn that
in Dublin, after correction for variations of age distribution,
measles mortality was during the three years 1881-83
nearly ten times as fatal in the general service class
as in the professional and independent class; whooping-
cough more than four times as fatal; scarlet fever more
than twice as fatal; typhus nearly five times as fatal; and
diarrhoea nearly three times as fatal. Experience points
to the homeB of the working classes as the usual generating
ground of most of these zymotic diseases, from which the
middle and upper classes derive the infeotion. With cleaner
and 'healthier homes for the working classes, and with
increasing difficulty put in the way of those who are now
said to prefer unwholesome surroundings, it would be safe
to calculate upon a further rapid decline of zymotic mortality
in towns. It is beyond doubt that the decline of zymotic
mortality in recent years has been one of the most potent
factors in the reduction in the death-rate of children.

Notwithstanding this marked decline of child mentality,
the strongest contrasts between the death-rates of
different social classes are still found to prevail during the
ages of infancy and childhood. Thus, it was pointed out
by Mr. Humphreys that the mean annual mentality under
five years of age is just five tidies as great in the general
service class (the class of general labourers below the
artisan class) as in the professional and independent class;
while at the next age period, five to twenty years,'the
difference between the mortality of these two classes is very
nearly as great. It is true that the rates of mortality in
adult life are more than twioe as high in the general service
as in the professional class, but it is fair to assume
that some of this excess of mortality in adult life is
rather due to the depreciating constitutional effect of
insanitary surroundings and hardships in childhood,
than to occupation and the other conditions of adult
life. How far the conditions which lead to the 'terrible
waste of life and health among the children of the poor
are within control cannot be easily decided. When, how¬
ever, due note is taken of the marked reduction of working-
class mortality, especially among infants and children, in
the Peabody and other improved dwellings, undeniable proof
is supplied of at least one'directionin which effective sani¬
tary checks may be applied to the waste of child life, which
we are too apt to regard as inevitable and beyond control.
Is it necessafy to urge the courageous application of this

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The Lancet,] MR. W. H. POWER ON DIPHTHERIA AT YORKTOWN AND CAMBERLEY. [April 30.1887. 889

form of oontrol, -without any cynical dread that decline
in the death-rate will only lead to each an increase of popu¬
lation as will add to the social and political difficulties
arising from over-population ?

In conclusion, it is worth noting that the proportion of
children in the several social classes is constantly in inverse
ratio to the capacity of the several classes to support their
children in a manner to favour their becoming, physically and
morally, healthy members of society. It appears from Dr.
Grihsh Aw’s classification of the Dublin population that 1000
of bis professional and independent class contains only 75
children under five years of age, while the same number of the
artisan class contains 121 children of those ages. It should
be remembered, too, that these proportions under-state the
relative proportion of children born in the artisan class, on
account of.the far higher death-rate among children in this
class compared with that which prevails in the professional
and independent class. Who can decide how much of the
poverty and its attendant high death-rate and disease is
due to the improvident and far too early marriages among
the working classes ? Let us hope that the recent decline
in the national marriage-rate and birth-rate, which has been
almost as marked as that of the death-rate, instead of
being entirely due to commercial depression, may in part
be attributed to a form of national prudence and thrift,
which may not be without its effect upon the death-rate
of children, and will- certainly moderate the rate of in¬
crease of population, which, in some quarters, is viewed
as a source of political danger.

Butter explanation has long been needed of the circum¬
stance that in every outbreak of disease , dhe to infected
milk some Only of the milk drinkers have been attacked,
While others, and that often a large ^proportion, have
escaped. This unequal incidence of attack is doubtless
due in p$rt to a difference in’the susceptibility of indi¬
viduals, but this has long been seen to be insufficient
to aqoonnt for the facts observed. Quite recently Dr. Klein,
in his report on the etiology of fopt-and-mouth disease,
commented,on a “ very puszlihg” point which was observed
in the feeding of certain sheep with .the streptococcus of
this malady—vis., that the process had to be repeated
three times before one of them became infected; and he
referred his readers to experiments made some years ago by
Dr. Bubdon Sanderson and Mr. Duguid, who found it
necessary to rub hay steeped in the saliva of a diseased
cow several times over the mucous membrane.of the mouths
of the animals which' were the subjects of his' experiments
before the infecting procees was complete.

Mr. W. H. Powbr, in Iris report; on the recent outbreak of
djphtheria at Yorktown arid Camberlqy, which the Local
Government Board have just issued, has thrown considerable
light on the conditions which affect the capability of milk
to produce disease. It is necessary to refer briefly to the
main facts contained in Mf. Powbb’s report to enable his
argument, to be understood. The inquiry, it will be
recollected, resulted from, the , desire of the inhabitants of
the invaded locality to bave -further investigation of an
outbreak which the local medjpal officer of health had
attributed to infected milk— .a;co»<gusion which Mr. Power
fully oopflrms. The possibilities of drainage, water-supply,

and deposits of river mud being concerned in its production
were fully examined by Mr. Power and set aside, as wall as
all chance of articles of food other than milk being im¬
plicated. The evidence that milk was responsible for the
occurrence is to be found in the fact that in a given area
containing 176 houses, 94 of which received milk from the
infected farm and 82 of which derived their supply from :
other sources, 48 of the former and bat 9 of the latter were
invaded by diphtheria or throat illness, and the inmates of
some proportion of these 9 houses had either been exposed
to infection from other cases of diphtheria, or had, away
from home, consumed some of the suspected milk.

The chief interest in Mr. Power’s story lies in what
follows. The milk drinkers did not receive the same quart-,
tities of milk. There were, in fact, in this locality two
classes, a ridh and a poor; the former, who were supplied)
with larger quantities, suffering from threefold to fourfold
as uluch as the latter, whose use of milk was limited to its
consumption in tea. Mr. Power shows that the number of
opportunities for infection in one and the other doss were
practically forty, in the richer to trienty in the poorer; but’
the difference observed in the incidence of the disease was >
even greater than could be explained by any consideration
of the quantity consumed, and even amdDgst households!
alike receiving large quantities of. milk; there was an un- :
equal incidence of diphtheria in. accordance with,.the•
manner in which the milk was treated. In .certRin^house-
holds it was the custom to “ set ” milk for cream; and the ;
skim milk which thus came to be subsequently consumed
was evidently responsible for an exceptionally large amount
of diphtheria amongst, its drinkers; cream itself did not'
appear to give rise to increased illness, for although families,
receiving cream direct from the dairy suffered heavily, they
were.it is noted, those who consumed large quantities of
milk, and they did not suffer more severely than ofcher.
amilies, also,large milk drinkers, who were not supplied!
with cream. One other point of interest is dwelt upon in •
the report: the quantity of iqrik consumed by individuals
who were infected does not appear $o have had any influence,
upon the severity of their disease when judged by the
number of severe cases which occurred amongst, the total
number attacked, for two-thirds of the attacks among large
consumers of the milk and one-half of the attacks among
small consumers were severe—a difference, as Mr. Power
observes, not sufficient to connect intensity of attack with -
the amount of milk consumed. , . >

The investigation failed to show.the manner in which the
milk acquired its infective property. There was no oppor-,
tunity, as at Hendon, for comparing the relative infective.-.
ness of milk from one cowshed and from another, .for the ;•
milk of alf the cows op the farm was intimately mixedr
before its distribution. • That it was infective.before leaving!
the farm is proved by the fact that it was distributed on
four milk-walks, and each supply produced the same Result.
So, again, no explanation could be found for the circum¬
stances under which cessation of infectiveness occurred, for i
the reason that nearly all the farther’s customers left him
when the disease became prevalent. ' • •mi

The best use has undoubtedly been made of the ojipor- 1
tunity for inquiry, and some ledsohs learnt which ought to 1
be turned to practical account by those upon whom devolves

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890 The Lancet,] THE RUSH INTO THE MEDICAL PROFESSION.—SEWAGE DISPOSAL. ' [Apbxl 30,1887.

the duty of dealing ■with milk, both before and after it is
supplied to a household. We fear it will be long before the
necessity for boiling milk is generally recognised by those
who are still unwilling to adopt this simple precaution;
but the teachings of Mr. Fownil's report are worthy of
serious consideration—that the amount of risk from drinking
infected milk depends upon the manner in which it is
treated after its entry into a house.

• It almost seems as if there was a slight abatement in the
rush into the medical profession. Whether young men ate
deterred by fear of the examinations, which have been
g rowi n g in stringency or of the increasing cost of medical
education and examination, or by the prospect of poor
pecuniary rewards, we cannot say. But there are some indi¬
cations in the newly issued “ Medical Students’ Register”
of more caution in entering on medical studies. This annual
publication 1 of the Medical Council contains a good deal of
interesting information. It gives the list of examining bodies
whose examinations meet the requirements of the General
Medical Council in Preliminary Education. Another list
of great interest is that of the Places of Medical Study
whereat students were registered in England, Scotland, and
Ireland, and in India and the colonies respectively. On
another page the regulations of the Medical Council are
given for the examination and registration of. medical i
students. Then there is the Register itself—for medical
students have their register as Well as medical practitioners.

The chief points of interest to us are the summary of the
numbers commencing the study of medicine in each of the
three divisions of the kingdom and the list of the chief seats
of medioal study. On page 12 is a table giving the number
of students registered during each year from the commence¬
ment of students’ registration in 1865 to the end of the year
1886. The number of students registered as commencing
their studies last year was 1904— quite enough, it might be
thought, to supply an annual waste, by death of 600 or 700.
Ab we know, there is a great falling off in these when the
examinations are reached, and, roughly speaking, little more
than two-thirds ever enter the profession. But what we
notice is that if we compare the numbers registered as
commencing study in the last live years with the num¬
bers in the preceding five, there is an actual falling off.
Of course from year to year the number fluctuates, -But
we find the number in the live years 1877 to 1881 to be
9669, or an annual average of, say, 1934; whereas, in the five
years 1882 to 1886 the number was 9390, or an annual
average of 1878. In the first quinquenniad the number
exceeded 2000 in three years, the largest number being
in 1881, ,2171 ; whereas in none -of the last, five years did
the number reach higher than 1957. There need, however,
be no fear of an abundant supply to meet the waste of
the profession; for the average mortality of the pro¬
fession, though larger than .it should be, is scarcely found
to exceod for the last three years (kJO, whereas the average J
actual registration of practitioners on the Medical Register
for the same years is 1373. Thisiulluxof double the number ;
that are lost to the profession by death affords some
explanation of, the excessive competition which obtains in
many parts, and leads to occasional breaches of those ,

1 To Ik> luutof Spottlwoclo mid Oo K r l<“ W. 1 ^3 ■ ■ • 1 5 J

traditions as regards professional conduct /whieh have long
regulated medical men in their interooufae with each other,
and in their bearing towards the public. An excess of over
700 a year may well lead those who think of entering the
profession to pause. If they do so from the love of it, well
and good; but those who wish for an easy road to fortune
will do well to seek some other way.

The chief seats of medical study come out in the list of
schools. . The commencement of medical study by j>upUafft
to a practitioner obtained in 177 cases—namely, 142 in
England, 4 in Scotland* and 31 in Ireland. Besides these
instances, many date the commencement of study from a
provincial hospital. Of the 1908 students registered in 1886,
915 were registered in England, 626 in Scotland, and 367 is
Ireland. The London schools scored 433 of the students,
the Edinburgh University 280, and that of Glasgow 137.

A -\ubunderstanding, at which no. one can wonder, has
arisen between the two well-known engineers, Sir Joseph
Bazalgkttb and Mr. Bailey Denton. Considering.how
diametrically opposed their views on serwage disposal have
always been, it would be strange if they did not sometime*
mis-read each other’s words. Sir Joseph, in his evidence
before the Select Committee of the House of Commons on the
Pollution of the River Lea, advised that the sewage should
t-e treated chemically as at Crossness, but with a considerably
larger proportion of chemicals. As the sewage is to be
discharged into the Thames at a, point shout one mile from
the Barking outfall, and as therefore it is only the Thame*
that can be injured, it is certainly difficult to understand
why the treatment considered sufficient for Crossness and
Barking should not be sufficient for the Lea valley. In
Sir Joseph’s opinion the more moderate system, which
has been tried on a large scale and is about to be adopted
at the great outfalls, is not only sufficient but “ very satis¬
factory.” He only advised the more expensive system, it
appears, in deference to the opinions of others and to “ con¬
ciliate opposition.” Sir Joseph evidently thinks now, a*
he has al ways thought, that ail this talk about river pollu¬
tion and sewage disinfection is mare nonsense, that raw
sowage does not pollute the Thames, and that Mr. Dibdxs s
valuable and carefully executed experiments at Crossness
are quite unnecessary. He expressed his opinion that the
chemicals used will soon 'be curtailed in quantity, and
perhaps believes that they will -before long be dispensed
With altogether. • ■

It is needless to say that we dissent entirely from the
views to which the Metropolitan Board of Works has most
unfortunately committed itself. The Board has done great
and good work far London; and the drainage of the metro¬
polis, accomplished by the skill of Sir Joseph BazaxobIts,
has been one of the greatest of its labours. But Londoners
cannot cease to resent the injury done to their river, or the
obstinate and persistent manner in which that injury has
been defended. It is true that, tardily, reluctantly, and
under compulsion, the Board is preparing at great cost to
diminish the evil, but they do so with the wbrst grace and
in the worst way. Their new works, executed in defiance
of the unanimous advice of Lord Bram wkliJs Commission,
involve enormous expense, and cannot settle the question.
We do not object to the works, which, as far as-the limited

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Thb Lakckt,]’

NEW REGULATION OF THE EXAMINING BOARD OF ENGLAND. [April 30,1887. 891

n formation afforded to the puhlic enable as to judge, appear
well designed, bub we Must once more object most strongly
x> their site. ■ Everyone except the Board and tts immediate
mpporters is convinced that the sewage of London can only
>e properly disposed of at a much greater distance from the
Mty than at present. All the expense about to be inourred
it the Barking and Crossness outfalls, inoluding the steamers
■equirad to carry the sludge to the sea, will, we are certain,
>e found , after* a very short time to have been money
wasted through mere blind obstinacy.

§.ttiuriatums. ■

“ N« quid nlmis.”

NEW REGULATION OF THE EXAMINING BOARD
OF ENGLAND.

At a meeting of the Committee of Management of the
Examining Board in England of the Royal Colleges of
Physicians and Surgeons on the 26th inst., it was resolved:
‘ That to enable students who commenced their professional
jducation before Oct. 1st, 1884, to pass a qualifying ex¬
amination for the purposes of registration, students
who shall have completed four years of medical study
to the satisfaction of the Committee of Management,
and who shall have passed such first and second ex¬
aminations as that Committee shall approve, may be
admitted to the final examination of the Examining
Board in England, which is a * qualifying examination ’ for
the purposes of registration under the new Act.” Students
desirous of taking advantage of this resolution of the Com*
mittee of Management must make application, in writing,
to the secretary of the Examining Board in England, giving
full particulars of any examinations passed by them at the
two Colleges or elsewhere. This regulation is obviously of
the greatest importance to students who have passed the
first and second examinations under the old regulations at
jither of the two examining bodies.

THE SCOTTISH UNIVER8ITIE8 AND REPRESENTA¬
TION IN THE GENERAL MEDICAL COUNCIL.

O^jb of the warm questions in the Scotch Universities is
that of the right to elect representatives in the General
Medical Council. , Hitherto the Senatus has assumed and
exercised the power of electing the representative. But
a powerful and somewhat pugnacious party exists now
which claims the right and power of electing for the
Council of the University. Our readers will remember
that this subject was raised by Dr. McVail at the last
meeting ,of the Medical Council, aijd that he challenged
the validity of the. election of the Scotch University
representatives returned by the Senatus of their Univer¬
sities. The question has been raised in the Council of the
University of Edinburgh, on a motion by Mr. Vary Camp¬
bell reflecting on the Senatus for illegal action, and asking
for a clause in the University Bill to secure the right of
election for the Council. Sir William Turner warmly
resented the censure of the Senatus, apd insisted that any
alteratiqn of the law should be in the shape of an
amendment of the Medical Acts, rather than in the
University Bill. He carried an amendment asking that
the consideration of the interpretation of the Acts bearing
on the question be referred to the University Court. What¬
ever may be the truth in this dispute, we caution reformers
against expecting any speedy relief from a reform of the

Medical Acts. . Statesmen have bad enough of Medical Acty-
lately, and have ended in a very ppor legal achieve¬
ment; they Will not, therefore, be likely to meddle
with the subject again in a hurry,

RELATIONS BETWEEN THE THYROID AND
. : CEREBRAL CIRCULATION.

Thb impetus which the description of the condition known
as myxoodema has given to the study of the thyroid gland has
received an additional illustration in a note by Professor
Waideyer ( Berl . Klin. If ock.. No. 14), calling attention to
the arterial supply of that organ and its apparent relation
to that of the brain. He points out that Stahel recently
showed that the' superior thyroid artery bore in the degree
of its development a constant relation to the “bolbus'
carotrcus intern us ” (Krause), whereby the amount of blood 1
transmitted through in the internal carotid - in its winding
course along an osseous, channel could be regulated.
Now the vertebral artery,, in its, course to the base
of the brain,' has a somewhat analogous disposition,
both as regards tortuosity ahd relation to bone, as
the carotid, and it is justifiable to infer that a similar
relation to the above obtains between the inferior thyroid
and the vertebral. This idea implies that the thyroid body
oan act as a sort of reservoir for blood, ploteating the
carotids and vertebrals from too great an influx. The great
vascular supply of the thyroid is remarkable; in proportion
to its size, it receives large arteries and has a plexus of veins
Which are in close connexion with-the great venous trunks.
The capillaries of the thyroid are also peculiarly disposed
for the rapid removal, of blood. Comparative anatomy lends.
support to tbs doctrine, the general fact being that in moot.
mammals the brain is chiefly; nourished by the internal
carotid, and that in these animals both superior and inferior
thyroid arteries arise from the common carotid trunk.
Professor Waideyer disputes the statement that the thyroid
is exceptionally rich in lymphoid tissue, and refers its
abundant nerve-supply to the large number of bloodvessels
it contains. _

THE STUDY AND TRAINING OF CHILDREN.

It may appear to some superfluous that we should speak
of the great importance of systematic training for young,
children. A matter of this kind must, we admit, be fairly
understood by a great many responsible persons in the pre¬
sent age of the world’s history. It is likewise veTy evident
that, if we interfere too much with a process so natural as
that of development, the artificial product will hardly
realise all that we expect to find in adult manhood. We
would strofigty; deprecate any interference which has-this
tendency. What is wanted ia a plan or plana of school and
household discipline which will be regulated, not merely by
the maxims of past practice, but by an understanding of trie
signs of aptitude in children, and a knowledge of their
physical, mental, and moral requirements, which cannot but
vary with the advance of time and: the growth of human ex¬
perience. It b as been Sufficiently demonstrated, for example,
that our ordinary methods of school (education am not pec-'
fact, that trie rapid cramming' system is no more adapted to i
mind-culture than inordinate feeding accords with good
digestion, and most therefore give place to a more deliberate
process of instruction. Children must be studied.as types
and as individuals if we would train them and shape their
future course aright. Bach a study* does not entail any
elaborate investigation, and it is one which will repay:
parents and teachers by the success of its results wheu
applied in practice. In Hus connexion we may draw atten¬
tion to. a series of six lectures, now being delivered by
Dr. Francis Warner at the request of the Fxoebel, Society,
on " The Children: How. to Study them.”

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892 THB LANCBT,]

DRINKING-WATER AND DISEASE

[April 30,1887.

THE PROPOSED NEW CHARTER OF THE ROYAL
COLLEGE OF SURGEONS.

At a meeting of the committee of the Association of
Fellows of the Royal College of Surgeons of England held
on April 23rd the following resolutions were passed and
ordered to be sent to the Council of the College(1) “ That
the President and the Council of the Royal College of
Surgeons be requested to convene a general meeting of
Fellows and Members to consider and discuss the proposed
draft Charter about to be presented to the Privy Council.”
(2) “ That the Council of the College be requested to sanction
the issue of copies of the proposed new Charter to those
Fellows and Members who may apply for them.” The com¬
mittee also approved a letter to be sent to the Lord President
of the Privy Council begging that the proposed Charter shall
not be approved until the Association of Fellows has had
an opportunity, by means of a deputation, of stating and
explaining its defects. _____

FLOATING SPLEEN OR KIDNEY (?)

Tub diagnostic difficulty that is sometimes encountered in
respect to abdominal tumours in the left hypochondrium is
well illustrated by an interesting case reported by Dr.
Shattuck, of Boston. The case had been related by him in
1878 as one of “ floating spleen.” The patient was a young
man of eighteen, who complained of eevere pain in the
above region after a sprain received in lifting a barrel,
where examination detected a mobile tumour, which was
agreed to be splenic rather than renal. Dr. Shattuck now
{Boston Med, and Surg. Journal) comes forward to state
that be was mistaken. Last year the patient was admitted
into hospital with cancer of the skull, vertebral column, and
ribs, leading to paraplegia from myelitis, and to cystitis
and pyelonephritis. The abdominal tumour had remained
unchanged. At the necropsy, besides the malignant disease,
which also involved the liver and the left kidney, the spleen
was found almost in its normal position, and was of usual
size. The left kidney, however, was represented by athree-
lobed mass of the size of two closed fists, and was provided
with a mesonephron, which made it freely movable. It was
in great part destroyed by malignant growth. It is an
interesting point as to whether the fact of the organ being
misplaced had anything to do with its becoming the seat of
malignant disease. The patient had been liable to recurrent
attacks of bsematuria for five years before death, which may
have been due to temporary strangulation of the ureter.

DRINKING-WATER AND DISEASE.

Mr. William P. Mason, of the Reusselaer Polytechnic
Institute, Troy, N.Y., has contributed to the Chemical Newt
an interesting observation on the production of disease by
water polluted by normal sewage. About two months ago a
family in Albany were, within a few hours, struck down with
symptoms varying “ from intense nausea to great, if not dan¬
gerous, prostration.” It is unfortunate that the record of these
symptoms is not a little more detailed. They lasted in the
worst cases for over a month. On examination, it was found
that the cistern which supplied the house had received most
serious pollution from the private sewer of the house. When
analysed, it was found to contain in grains per gallon—free
ammonia, 1*05; albuminoid ammonia, 0196; and chlorine,
3*22; with traces only of nitrates. Every single member of
the household, which appears to have been a large one, and
to have included several children who were on a short visit,
was attacked, with the exception of one lady, the only
person who had not drunk the water. Nothing apparently
could be clearer than the'evidence, which so far is very
similar to much with which We are familiar. But now
comes the real point of the story. "Up to the time of the

outbreak none of the household had suffered from diarrim
or kindred troubles, nor could I obtain any history of meat
disease of any kind.” Of course, as Mr. Mason. points out,
the sewage, although apparently not old, need not have
been quite recent. It seems probable enough that sewap
matters in a certain stage of putrescence, and swarming
with bacteria, may become acutely poisonous, as meat is
known to do under certain conditions. The general leans
is evident. We must not assume that a polluted water ii
safe because no pathological conditions, can be proved to
exist in the polluting matter.

THE TOXTETH PARK POISONING CASE.

Thb adjourned inquiry into the above case was resumed
on April 15th before Mr. Brighouse, county coroner. The
deceased, Mary Jane Hamilton, aged eleven years, a child of
weak intellect, "died somewhat suddenly after a violent
illness.” She had for several years been subject to fits. It
was proved in evidence that her brother had brought horns
some sulphate of copper and sulphate of iron for tbs
purpose of making experiments, and it was suggested tint
deceased had accidentally swallowed some of the mineral salt!
which had been dropped on the floor. The symptoms which
for three or four days preceded death were mainly vomiting
and retching, “stiffening of the hands” and “taming in
of the feet.” Dr. Shaw, who treated the deceased on one occa¬
sion during her last sufferings, made a partial post-mortem
examination, and found what be believed to be a ragged per¬
foration of the stomach, the result of the action of 6ome
irritant poison, and acting on this belief he gave a certi¬
ficate, but declined to state the cause of death. Subsequently
an official necropsy was performed by Dr. Ren tool, by order
of the coroner. He discovered some green fluid in the abdo¬
minal cavity, and a perforation in the walls of the stomach,
but whether this was caused by poison, or by the use of the
knife at theformer examination, he was not able to determine.
The stomach and intestines were “ more or lees inflamed.'
From these reports it is absolutely impossible to draw a posi¬
tive conclusion as to the nature of the perforation of the
stomach. No mention is made, in the newspaper accounts
of the case, of the facts by means of which one would
endeavour to form a differential diagnosis between perfora¬
tion (1) by incision, (2) by a corrosive agent, and (8) from
post-mortem digestion. We lay no stress one way or the
other on the absence of corrosion of the oesophagus, became
if the sulphate of copper were swallowed in the solid fora
we should scarcely expect to find marked lesion of the
gullet. A chemical analysis of the vomit, of the content!
of the stomach, and of the fluid found in the abdominal
cavity would certainly have given valuable information,
and was indeed imperatively called for, but for some reason
unknown to us no such analysis was performed. From
the information before us, we can but consider the investi¬
gation was singularly faulty, and fully warranted the jury
in returning an open verdict. Such a conclusion of the
inquiry is to be regretted, especially as the means to render
the latter complete were ready to hand. Unfortunately, too,
there seems to have been a good deal of misunderstanding
between the coroner, the medical men engaged in the case,
and the police. Without going into these details, we may :
safely lay down one or two rules for the future guidance
of practitioners called upon to investigate cases similar
to that now under discussion. In the first place, we bold
that whenever a medical man suspects that death is n° !
due to natural causes, or even when he has no grounds for
forming an opinion, he would act wisely in communicating
with the coroner, and so shifting the responsibility upon
the person the law designs should bear it. Further,*
partial post-mortem examination is to be deprecated under
any circumstances, and doubly so where the death k D

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TttB LUfOBT,]

THIRAR ON VARICOCELE.—DISPOSAL OF REFUSE.

[April 30, 1887. 898

free from suspicion of “ violence.” Clearly, too, whenever
i. post-mortem examination is made by an independent
person, the doctor who had charge of the patient should be
nformed of the fact, and given the opportunity of being
>resent. The coroner for Central Middlesex invariably
mcloses with his order for the necropsy an intimation to
.his effect addressed to every medical man concerned in the
inquiry. _

THIRIAR ON VARICOCELE.

Da. Thiriar of Brussels, in a clinical lecture on the
Surgical Treatment of Varicocele, after mentioning that
numerous methods of operation were in former times pro¬
posed and practised—such as castration, the section of the
r&s deferens, and the ligature of the arteries of the cord,
which necessarily interfere with the functional activity of
ihe testis,—spoke of the modern or therapeutic method as
consisting essentially in the arrest of the circulation in the
venous plexuses surrounding the va9 deferens. Until quite
recently, however, so many aooidents—some of them fatal—
followed operative procedures of this kind that many sur¬
geons objected to resort to them for an affection which,
however trying to the patient, cannot be considered as
dangerous to life. Since the adoption of antiseptics the
danger of these operations has been reduced almost to nil.
The operation practised by Dr. Thiriar is the combination
(proposed by Guyon) of Sir A. Cooper’s plan of excising the
skin with the old method of excising the varicose veins
themselves; Heurteloup’s plan of excising a flap of skin from
the posterior surface of the scrotum he does not approve of,
following Guyon and other surgeons in believing that the
varicose condition is usually in the anterior plexus. His plan
is as follows. An elliptical flap of skin is excised from the
front of the scrotum and the bundle of veins dissected out
and tied in two places, the intermediate portion being
excised if the tumour is considerable. The dissecting out of
the veins is a somewhat difficult matter, as there are several
tibro-cellular layers to divide or tear through; the artery
has to be carefully separated from the veins, a proceeding
which up to the present time Dr. Thiriar has not found
attended with difficulty. The wound is washed with a corro¬
sive sublimate solution, and the lips united by a continuous
suture, which is the form Dr. Thiriar prefers as a rule;
antiseptic dressings and compress bandages are applied, and
in a few days the patient is discharged permanently cured.

DISPOSAL OF REFUSE.

** Dust and Ashes: How to Deal with them,” was the sub¬
ject of an interesting lecture given last week by Mr. Alfred
Fryer at the Parkes Museum of Hygiene, in which the
lecturer discussed the most economical and effectual way
of getting rid of the oontenta of ashpits. His argument
that the use of Are for this purpose was an absolute neces¬
sity was well supported by those who took part in the dis¬
cussion, and he adduced considerable evidence to show that
this method could be adopted in large centres of popula¬
tion, quoting among other places Whitechapel, where there
is a destructor which belongs to the vestry of that district,
and Lett’s Wharf, near Waterloo-bridge, where the Corpora¬
tion of the City of London have erected a similar furnace,
lie referred to the alarm which had been created by a
recent proposal to construct a furnace at Kensington, and
to the unfortunate decision of the House of Commons in re¬
jecting the Kensington Bill on its third reading—a Bill which,
by the way, we recently inadvertently stated had passed this
stage. This decision is the more to be regretted seeing that
Londoners have now ample opportunity for correcting any
erroneous impressions as to the amount of nuisance whieh
the destructor creates, but evidently the work of education
must progress farther before the method of destruction by

Are is generally accepted. The Council of the Parkes
Museum have therefore done well in inviting Mr. Fryer to
relate his own experience of the working of the destructor
in other towns where it has been in use for many years.

THE PURIFICATION OF WATER.

It has long been known that water may be clarified by the
formation in it of a precipitate which, as it falls, will carry
down mechanically the lighter, and of course the more
dangerous, portion of the suspended matters, which otherwise
are very slow in separating. In Clark’s well-known process
for softening water a sufficient quantity of lime to combine
with the free carbonic arid is mixed with the water. The
precipitate of carbonate of lime—if we may still U9e the
familiar old name for the calcium carbonate of modern
chemists—carries down with it all suspended matters, in¬
cluding bacteria, and the water remains not only softer but
very much purer. Carbonate of soda is an even more
powerful precipitant, as it removes permanent as well as
temporary hardness. In either case the deposition is, how¬
ever, somewhat slow, and to avoid the use of depositing
tanks a filter press was used in the Porter-Clark process,
which was shown in action at the Health Exhibition. An
American contemporary, the Boston Medical and Surgical
Journal, reports that Prof. Dobroslavine of St. Petersburg
advises as a good precipitating agent a solution of perchloride
of iron followed by a solution of carbonate of soda. Simple
and devoid of inherent novelty as the suggestion is, it is
very sensible. Translated into English weights and measures,
the quantities used are about three grains of perchloride of
iron and four grains of soda crystals per gallon of water.
The precipitate is said to settle in aboat forty-five minutes and
to leave the water perfectly clear. The quantity of carbonate
of soda is not sufficient for the complete decomposition of
the iron salt, but would convert it into a heavy, insoluble,
basic chloride, which would doubtless settle easily. So
simple an experiment is well worth trying. It is note¬
worthy that by slightly increasing the quantity of car¬
bonate of soda the water could be softened. We have often
wondered that the softening of water for domestic uses is
not more frequently practised in private houses. The
addition of a very small quantity of carbonate of soda to
the water in a cistern will remove even excessive hardness
in a few hours at an almost inappreciable cost. If the
cisterns are used in pairs the white deposit from one may
from time to time be removed by flushing with water while
the other is in use. The troublesome furring of boilers and
hot-water apparatus might in this way be avoided.

THE JUGULAR HUM.

Thb unreliability of the well-known “ bruit de diable,” or
jugular hum, as a sign of anaemia, which was pointed out
by Weil, whose objections have been disputed by Guttmann,
has been again proved by Dr. Reinhold Apetz (Virchow’s
Archiv, Bd. 107, Hft. 3) upon the results of the auscultation
of 660 individuals, of whom 115 were ansemic, 161 “ barely”
anaemic, and 381 “ not anaemic.” The murmur was detected
in the proportion of 51 per cent, of the first class, 46 per
cent, of the second, and 30 per cent, of the third. With¬
out following the writer through his analysis, which
corresponds fairly closely with the similar observations
of Weil, it may be interesting to cite the conclu¬
sions at which he arrives. These are to the effect—
1st. That venous murmurs detected in the internal
jugular vein under all circumstances depend in the first
place upon the age of the affected individual, the murmurs
becoming less frequent with advancing age. 2nd. That
venous murmurs detected by turning the head to the other
ride are of no value in the diagnosis of aammia, but have

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$94 Tkk LANCKt,]

STOPPAGE OP WATER-SUPPLY FOR NOft-PAf MBtfT.

[AS»ML80,1WT.

only a physiological importance; 3rd. That some patho¬
logical' importance specially "belongs to the true murmurs
detectable when the head is kept straight in the upright
position, when they occur loud and continuous in individuals
at middle age (twenty to sixty years); yet they are gene¬
rally too inpignifipant to be of value in the diagnosis
of. anosmia. 4th, Under no conditions does the venous
murmur have any special diagnostic value for chlorosis and
other anaemic states. _____

STOPPAGE OF WATER-SUPPLY FOR
NON-PAYMENT.

There can be no question as to the serious inconvenience
aaoaaiQpqd in, a household by tbe stoppage of its water-
supply-: A frequent result of continued cold weather, and
ap occasional but not infrequent, consequence of non-pay¬
ment of dues, it is at any time a source of much annoyance,
and, what is more important, of a train of diseases which
are ibred and fostered by uncleantiness. We need not dwell
on the connexion between sewer air and infectious fevers,
on the absolute necessity of water, under our present
pystoiu, for the removal of excreta, and for flushing freely
and fully all waste-pipes, on its utility for cooking pur¬
poses, and its natural place as a beverage. AIL these are
matters of common information. It is well to note, how¬
ever, that the consequences of a want of water are not
necessarily limited to the house which is primarily affected
by. it. If, for example, tlie sewage arrangements of that
hopse be thrown oat of working order, those of neighbour¬
ing buildings are not unlikely to become indirectly involved.
.Thus* one focus of disease readily becomes aparent of others.
It is with a view to the prevention of such risks os these
that certain members of the House of Commons have brought
forward a proposal that water companies should be restrained
in future from cutting off the water-supply of any house in
default of payment of, the water-rate, and should be
allowed as compensation a preferential claim on the revenue
derivable from the said house. The plan, as drafted on
paper, seems as .if it would work well, though perhaps it
might be objected on behalf of the companies that it does
•not cover a number of cases where houses are let to a very
poor class of tenants,, whose payment of rent or of any dues
-whatever is a very precarious possibility. It may well be
doubted, however, if their present power of stopping the
supply is of much use to the companies in such cases. In
so far -as it is Wont to be applied, the local authorities might
perhaps be induced to meet,them in the public interest on
the question of payment, in order to prevent its application.
At all events, the proposal, to which we have referred is one
worthy of consideration, and if. it can be effectively carried
out will do something to limit the spread of disease.

. ARTIFICIAL AND HYPER-ALIMENTATION IN
PHTHISI8.

' I* an account of the effects of artificial and hyper¬
alimentation, as practised in Professor Pel’s wards in
Amsterdam, Dr. van Eeden- states that the meat powder
treatment introduced by D4bove (which he had had an
opportunity of studying in Paris) is always of service in
phthisis when the disease is not very far advanced, and
When it is not of a" malignant ” nature. The cases which
do best under this treatment are those in which there is no
hereditary taint and where- the disease 1 has progressed
regularly, with a not very rapid loss of strength, and with
bWy‘flight hectic, anorexia, antemia, and emaciation. The
dhanfees of successful treatment are slight where the disease
bag mide rapid progress, with a continuous high tempera-
’’ttWet '’rtie existence of a considerable degree of pyrexia is, bow-
'ewjr, *o' (XHrtTW-ifldicationi to tl •> -> • of the treatment. If

diarrhoea and gastric irritation are produeed by theartifieul
alimentation, it is best to discontinue it. In order to accnstos
the stomach to the meat poWder, small quantities only sbooM
be given at first—not more than about half a pound during tt*
twenty-four hours; this amount may gradually be increased
to one pound and a half. The use of the oesophageal sound
for the introduction of the food is considered by Dr. tu
E eden as advisable in all cases, and imperatively neces¬
sary in hyper-alimentation. (Quantities exceeding thra
pounds of meat powder per diem, however, are not bj
any means always required, and should only be given when
smaller amounts do not succeed, and where tbe patient besn
the treatment well. The method must be diligently and
patiently praotised, and the weight of the patient accurately
noted. Dr. van Eeden remarks that so little is known of
the way in which hyper-alimentation controls the develop¬
ment of tubercle, that whoever attempts to practise Upbore ?
treatment must he prepared to meet with many difBcnltw
and disappointments. Notwithstanding this, however, be
has* witnessed some surprisingly good .results from its
employment. _

EXPLOSIVE SODA-WATER BOTTLES.

The yearly increasing consumption of temperance drinks,
particularly of aerated waters, is on the whole a matter for
congratulation. It is also a fact which renders the more
necessary some precaution lest the greater demand should
itself entail certain public disadvantages which might with
some forethought be avoided. With regard to cost, for
instance, recent experience has shown that there is in many
quarters a tendency to unjustifiable extortion in the retail
sale of these very simple drinks. A warning of a different
kind has lately been communicated through the daily
with reference to the imperfect filling of soda-water bottles.
A fault of this description is little, if at all, less blame¬
worthy than that to which we have already referred. It
is necessary for the safe use of aerated waters that the
water itself should be in a due proportion to the gu
which it is intended to absorb. If it is not, tbe excess of
gas may cause, and repeatedly has caused, an explosion,
sometimes with serious consequences. How far in such
cases of accident the result was due to some flaw in the
bottles themselves is doubtf ul. The one apparent fact is an
excess of the charge of gas. It is easy to understand ho*
in a warm atmosphere this would suffice to cause an ex¬
plosion, and it is as necessary as it would be profitable to
makers that sufficient care should be taken in the prepara¬
tion of these beverages to minimise the ; chances of accident
in the future. ___

THE DUSTMAN AND THE WIND.

During the late high windB and' the general dryneaf
of everything, many Londoners must have suffered froo
that absurd and dangerous pest of the metropolis, tk
present system of duet removal. Turning a com®
the other day, in the teeth of a strong east wind, **
were confronted suddenly with the grim appariw®^
cart, ladder, basket, and all; Flight was impossible. " e
had barely time to-shut onr eyes and mouth when what
appeared to be about half the savoury oontents of the baste!
deluged us. The cart was already over-full, and in another
moment a foul simoom of dirt was careering down the street
Could anything be more disgusting or more dangerous
Who can tell that infectious disease was not present jo
the very house from which the last basket was carried.
Why do Londoner tolerate the nuisanoe? There
many known ways of disposing of house refuse; ‘
we are convinced that the very worst, tbe most stop 1
and dangerous, is that which seemB to be immort* 10
London—the open cart and the rotten basket.

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The Lancbt,]

• GASEOUS RECTAL MEDICATION.—‘MOORISH PRISONS.

[April 80U88T. <895

DR. BALFOUR, F.R.S., HfcNORAtfY PHYSICIAN TO
THE QUEEN.

We were extremely gratified at' a late’ announcement in
the Gazette to the effect that Surgeon-General Balfour, M.D.,
F.R.S., late of the Aripy Medical Department, had been
appointed one of the Honorary Physicians to Her Majesty.
Dr. Balfour is a man of deservedly high scientific reputa¬
tion; he is, in addition to this, a .Fellow of the Royal
Society, and a Vice-President of the Statistical Society of
London. He was Secretary to. Lord Herbert’s Commission
after the Crimean War, and, did excellent and original work
aB head of the Statistical Branch of the ^ar Office; in fact,
he organised that branch, and laid down the lines of our
military statistics on a better basis even, than they are at
present. Dr. Balfour has the reputation of having been an
excellent administrator, and, as principal medical officer at
Netley and Gibraltar, he was most popular and successful.

GASEOUS RECTAL MEDICATION.

Tjle remarks on-gaseous rectal injections by Dr. Burney
Yeo which appeared in The Lancet on the lGth inst. will
nerve to give more prominence and emphasis to a method
of treatment which may have “ something in it,” but which
cannot be said to have yet had a fair trial at the hands of
English practitioners. At the same time, it is hardly cor¬
rect to say that, the methofl has been met with derision, if
not contempt, for it has been systematically, though not ex¬
tensively, practised .by Dr. Heron at the Victoria Park Chest
Hospital, and it,is now some time since Sir Andrew Clark
invited a, number of medical confreres to a demonstration
of the apparatus employed in the method by M. Bardet.
Further, American physicians' appear to. have taken it up,
and apparently with 9 oqaiderabl 3 success. .With Pr. Burney
Ywho appears to us in this matter to adopt the attitude
most in accord with .tree therapeutic science, we do not
think it necessary to-suppose that,the sulphuretted or .other
gas. must act after the- faptuon of a true germicide or .anti¬
septic ; using the latter term in its widest sense, as Dr. Yeo
would probably employ it. If we admit that the methods
of .rectal gaseous medication are antiseptic in their action,
it does not necessarily follow that the antiseptic agent acts
in a germicidal fashion on the causes of septicity, or that the
gas neutralises the effects or products of the action of the
germs; for it may be that the. value of the treatment,
supposing it to have any, consists in improving the
nutritive powers of the tissues, in increasing their vitality,
thereby rendering them more able to cope with deleterious
influences, or with the germs, by affording an unsuitable soil
for the activity of the latter. It. is not, however, with the mode
of action and scientific rationale of gaseous rectal medica¬
tion that we are now principally concerned; what we would
urge it a more extended, trial of .the method for which so
much has been claimed in France, and America. Already the
evidence is forthcoming thqt the treatment has, beeo^fallowed
by mpnyjfligns q< improvement, ip : ,#$ least some of the
patients,, and perhaps ohiefly in thqse whose affections are
not of an altogether irremediable nature, such as local affec¬
tions of the pulmonary tisanes and various forms of chronic
broncnitiS; whilst the rapid forms of phthisis and other
acute febrile pulmonary processes dp not seem to be benefited
by this-treatment, which, though it. may he tolerated by the
system* is certainly ,npt always borne with equanimity by
the patient, It. is- clear , that th* day has not yet arrived
when rapid.phthmopl processes may be surely arrested by
therapeutic and hygienic. art. This much must be said,
because a notion has been getting abroad through statements
circulated in the lay press that rectal injections are certainly
curative ofl consumption. < It does not seem to be suffi¬
ciently appreciated by the;public that cases of genuine con¬

sumption are being, have been, and doubtless wQl bo cured
by the resources already at the command of the,profession.
To say . that all consumption is curable is to nrike as untrue
a statement as to say that all consumption is incurable.
Some cases are amenable to treatment; the bulk, perhaps,
are not. fa be able to say that the universal affirmative
proposition is true is a consummation devoutly to be
wished, and it is in this .spirit of hope that wa would
recommend a fair trial of the new method of treatment,
the details of which are carefully described by Dr. Yeo
in tieiteoture to which we have referred.

ATTENDANCE BY UNQUALIFIED ASSISTANT^ At
CHEAP DISPENSARIES.

A bad case in point is repotted in the Newcastle Daily
Chronicle—XbaX, of John Potter, aged thirty-one, who suffered
from,pain in his side and a severe cough. The father of the
patient sent for “Dr. Hardy of Shields-street, Shield field.”
The person who attended was not Mr. Hardy, but his un¬
qualified assistant, who told the father that his eon’s heart
was much affected. Dr. Aroisoa was called in the day before
death, and pronounced the case one of double pneumonia.
When the patient djed they went to Mr. Hardy's for a
certificate. He had never ■ seen the case, but filled up a
certificate, saying that he had attended the c&se and seen it
on April 20|th, .and that the cause of death, to the beet of his
belief, was acute nephritis. The coroner reflected severely
on Mr. Hardy’s action in Certifying in a case which he had
not eeen,. and in which the diagnosis of his unqualified
assistant seemed to have , been as much at variance with the
fact as the statements in the certificate. The coroner
intimated that he would refer,the facts to the Registrar-
General. He very prdpferly 'said that th4 rectification of
snob irregularities shook! not rest with the medical profes¬
sion. It concerns the public and the Registrar* General. We
hope the Registrar-General will investigate the facts, and,
if necessary, refer them to the Medical Council.

MOORISH PRISONS.

An agitation has been raised, chiefly through the instru¬
mentality of Mr. Jose Perdicaris, a wealthy and philanthropic
American gentleman residing at Tangier, concerning the
brutal treatment of Moors imprisoned for debt. Financial,
and to some slight extent political, questions are involved
in this movement, and with these, of course, we are not
concerned; but we are free and anxious to join in the
general protest made against the barbarity prevailing ilri
Moorish prisons. The new consul representing the United
States of America recently fitted out an expedition vvhich
went to the towns of Alkazar and Laraiche to release seven¬
teen individuals imprisoned on so-called American claims,
and they fodtid that noMess! than three ont of .this number
had died m prison. A correspondent, who has had oppor¬
tunities of visiting, each of these prisons, testifies that
the only wonder is that, such pest-houses do not prove
even more fatal. The stench arising from the want of
closet accommodation i» simply appalling. Overcrowd¬
ing is constantly allowed, and when fever breaks out,
no precaution whatever is taken to prevent the disease
spreading. The prisoners for the most part are covered
only by a few dirty and torn rags swarming with vermin.
They are also generally put in irons, and no food is
provided. The prisoners are allowed, but not compelled,
to work at making cords and fancy baskets, which they try
to sell, to enable them to buy bread. But this resource is
so elender that, unless the prisoner has food brought to him
by hiB friends or relatives outside, he runs every risk of dying
of starvation. Several cases of this kind are known to have
occurred, and the prisoners were not criminals, but untried

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896 Tax Lancet,]

SUDAMINA IN TYPHOID.—CONSUMPTION IN AUSTRALIA.

[April 30,1887.

debtors. Now, so far as American prottgis are concerned, the
movement, successfully conducted by Mr. Perdicaris, assisted
by Captain Rolleston, has resulted in the liberation of the
prisoners and the abolition of protection. Henceforth men
will no longer be incarcerated at the bidding of an American
proUgi who avails himBelf of his privileged position to
refuse his debtor the right of trial. The trade of the usurer
will thus become more difficult. But, while applauding the
abolition of such abuses, we venture to go a step further.
We make bold to claim, even for the hardened criminal, a
more humane treatment. There are thirteen foreign lega¬
tions at Tangier. The Sultan of Morocco knows that he has
no army, no material means of resisting the demands of any
civilised power. If he has held his own so long, it is not his
own strength but, the jealousies of the rival powers which
have saved Morocco from sharing the fate of Algeria or of
Tunis. Nevertheless, these various diplomatic agents might
agree to unanimously demand reforms in the condition of the
Moorish prisons. This is no political question; it does not
affect the delimitation of the frontiers. The rights advo¬
cated are the abstract rights of humanity to humane treat¬
ment, combined with the necessity of preserving the public
health. Moorish gaols are centres of epidemic disease;
they are a standing menace, not only to the lives of the
prisoners, but to the health of the free men who live without
their walls. These latter comprise, in such a town as
Tangier, a considerable number of Europeans. Tangier also
is becoming yearly a more popular health resort, therefore
the foreign diplomatic corps could easily And good reasons
to interfere on behalf of the Moorish prisoners and obtain
some sanitary improvements in the condition and manage¬
ment of the gaols. _

SUDAMINA IN TYPHOID.

Tub occurrence of sudamina is fairly common in typhoid
fever. Murchison observed them in about one-third of his
cases, but attributed no special significance to them. M.
Baradat de Lacaze (Rev. de Mid., April, 1887] discusses the
subject in some detail, especially from the point of view of
prognosis. He concludes that the appearance of such erup¬
tions (sudamina or miliaria) after the third week in a severe
case is of favourable omen, and that within a day or two
the temperature will fall. But the same meaning does not
attach to the like eruptions that appear in some cases
before this time—e.g., in the second week. Prognosis in
typhoid fever is admittedly very uncertain, and any sound
facts to guide in forming it must be received with attention.
In addition to these critical eruptions connected with the
sweat glands, the writer cites M. Chauffard’s opinion that
the occurrence of multiple abscesses and of polyuria is also
an indication of a favourable termination of the disease.

CONSUMPTION IN AUSTRALIA.

A correspondent writes to us from Sydney (New South
Wales):—“The propriety of sending consumptive patients
to the Australian colonies is a question which the medical
profession in England must necessarily take gTeat interest
in. I therefore venture to enclose an article from the
Melbourne Age of March 3rd bearing upon the subject. I
am not a medical man, but from my experience of the
climate here and in Victoria, especially near the coast, I
'should say there is not a more treacherous country in the
world. It is most common for the thermometer to show
variations in the temperature within a couple of hours of
from 40° to 60°.” The article from the Age deals with the
proposed consumption hospital for Melbourne, and points
out the urgent need for it, owing to the rapid increase of
the disease in the colony of Victoria. The above facts are
already well known to us. Consumption is common in
Australia, and is increasing with ’"'Did strides. The idea

that the Australian climate is in general either a sure
prophylactic or a certain cure for the disease is a common
but baseless error. It is, in point of fact, an unpardonable
looseness of speech to deal with the climate of Australia as
a definite and invariable entity. There are many climates
in Australia—coast, mountain, plain, and desert; and soma
of them, especially the coast climate—to which, unhappily,
for obvious reasons the consumptive too commonly resorts,—
are most injurious in chest affections. On the other hand,
the reputation won by Australia in the treatment of con¬
sumption is not a myth or a mistake. Many parts of the
interior have an admirable climate -dry, bright, sunny,
exhilarating, and fairly equable; the chief drawback being
the hot summer. The other seasons are delightful, and the
consumptive who goes inland to one of the sheep “stations,"
and lives the primitive out-door life which there prevails,
stands a good chance of recovery, or at least of a great
prolongation of life. _

TONSILLITIS AND DIPHTHERIA.

In a paper on Follicular Amygdalitis ( Medical Record,
Nov. 1886) Dr. A. Jacobi points out that this term is mis¬
leading, inasmuch as it covers a variety of conditions—
catarrhal, purulent, fibrinous, and diphtheritic; and that
the last-named form especially is liable to be mistaken for
the other non-contagious varieties. The catarrhal and the
diphtheritic are the most frequent. Acute catarrh of the
tonsil is not unilateral when produced by cold, and
is accompanied by the universal hyperemia of the
larynx. “Whenever there is an acute attack of unilate¬
ral amygdalitis, the latter is the result of either trauma
or infection,’' is the dictum which he proffers. The distinc¬
tion between the catarrhal and diphtheritic forms of follicu¬
lar tonsillitis rest mainly in the character of the membranous
deposit in the latter form, the small patches of whitish
or whitish-grey colour being very adherent, and sometimes
becoming confluent. Albuminuria is not necessarily pre¬
sent in the diphtheritic form, and it occurs in the catarrhal
when there is high fever. Nor is fever a necessary con¬
comitant of the infectious variety; its occurrence depends
rather upon the extension of the morbid process to deeper
parts. The whole tenor of Dr. Jacobi’s paper is to deny the
assertion of Fraenkel that “ angina lacunaris” is a perfectly
distinct disease from diphtheria, but that many cases of the
former are examples of mild diphtheria, capable of trans¬
mitting the disease by infection, and therefore to be guarded
with as rigid precautions as the well-marked case3 of
diphtheritic infection._

SANITARY PROGRESS AT LEEK.

In his last annual report on the sanitary condition of the
town of Leek in Staffordshire, Mr. J. J. Ritchie, the medical
officer of health, draws attention to some interesting points
in connexion with the results of the sanitary progress
which has been ipade. Thus, the statistics compiled show
that for the years 1881 to 1885 the mean expectation
of after-life from birth of persons in Leek was twenty -
two years more than would have been the case had
things remained as they were during 1851-60, before any
attempt was made to grapple with the unhealthy conditions
of the town. Mr. Chadwick, C.B., having made inquiry as
to what was the money value to the community during the
twenty-five years 1861-86 of the important increase in
longevity and freedom from sickness which had been brought
about, the following particulars showing the saving effected
were collected for him: Maintenance of sick (including
medical and other attendance at 5s. per week) amounted to
.£35,§60; money saved on productive labour (10s. per week
for males and 5s. per week for females), .£25,764; money
saved on cost of funerals, at .£5 each, £10,320; total money
saved, £89,464, which sum is equal to a direct saving of

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I'm Lanobt,] MICROBES AND SUPPURATION.—THE CABINET AND THE PROFESSION. [April 80,1887. 887

.£3586 per year. It was farther shown that daring the
earne period the deposits in the Savings Bank had increased
twentyfold, and the capital of the Friendly Societies three¬
fold ; that the receipts in the Leek and Moorland Bailding
Society had risen from £8421 in 1861 to £54,858 in 1886,
and those of the Leek United Bailding Society from £905 in
1863 to £29,898 in 1885; and these sums, it is believed, have
been materially influenced by the state of things above
referred to. Incidentally, it may be added that the freedom
of the town from fatal infectious diseases has been largely
brought about by the almost immediate isolation which is
secured in the sanitary hospital which has been provided
and has been long in use. _

MICROBES AND SUPPURATION.

A. Zuckbbmann ( Centralbl. f. Bacteriologie u. Parasiten-
tcunde. No. 17) relates his experiments upon suppuration,
which have led him to these conclusions: That no chemical,
mechanical, or thermic influences can excite suppuration if
they are wholly free from microbes; and in cases where these
causes apparently act it is probably through some pyogenic
microbe. For substances chemically pure may be mycoti-
cally impure; thus some disinfectants are not always free
from microbes. The varieties of microbe known to cause
suppuration are staphylococcus pyogenes aureus, albus, and
eitreus; streptococcus pyogenes ; and in ffetid abscesses,
bacillus pyogenes fcetidus. Inoculations with staphy¬
lococcus and streptococcus produce fatal results if injected
in large amount into animals, or lead to suppuration if
death do not occur. The pyogenic microbes must have a very
general distribution in nature; they may enter the body
through the air-passages, the intestinal canal, and especially
the skin, and by means of small wounds or the orifices of
the cutaneous glands. Staphylococcus is more frequent
ban the streptococcus pyogenes.

VACCINATION OFFICERS’ ASSOCIATION.

Wb note with pleasure the continued development of the
Association of Vaccination Officers, which has just published
its third annual report. Subjects of much interest have
been discussed during the year, and a paper by Dr. Cory has
been issued. There are probably no officers who can derive
more benefit from combination than those engaged in the
«nforcement of the Vaccination Acts. Their duties are of a
nature to require considerable information, and every officer
must frequently feel the necessity for consultation with his
fellows. Ample opportunity for this purpose is given by
the Society, and it would be well if the fullest advantage
were taken of it by all. The Work of the vaccination officer
is of great importance to the public, and everything which
tends to create efficiency in its performance deserves sym¬
pathy and encouragement._

THE SHARP SPOON IN ABORTION.

Dfe. A. R. Fifimte, assistant in Professor Slavianakt’s clinic
in St. Petersburg, .relates, in the March number of the
Hussian Obstetrical and Qyncecological Journal , his ex¬
perience of an operative procedure recommended by Boeters,
Mund6, and Fehling in cases of abortion, where the embryo
is not expelled naturally. The patient is placed on the
back, the knees being separated by assistants. Anaesthesia
is npt required. The vagina is well washed out with a
disinfecting solution, and then the cavity of the uterus is
similarly irrigated by means of a double-current catheter,
winch is passed after the cervix has been drawn down with
forceps. A sharp spoon is then introduced into the os uteri,
which it is not necessary to dilate with tents, and the
cervical <5*nal scraped out, after which the instrument is
made'to .sweep round the entire cavity of the uterus,
scraping -off the deciduous mucous membrane dose to the.

muscular layer. Whan this is reached a peculiar grating
feeling is experienced, which is very characteristic, and
which serves to denote that the scraping has been carried
far enough. If the contents of the uterus are considerable
in quantity, the operation is broken off two or three
for disinfectant irrigations through the. double-current
catheter. At all events, the uterus is well washed out with
an antiseptic liquid at the conclusion of the operation. An
iodoformized plug is then inserted into the vagina, and a good
dose of ergot given. The results of this operation are stated
to have been most satisfactory, but the author does not recomr
mend it in cases which have been left too long to themselves,
where more or less putrefaction must have taken place. Nine
cases are reported, in only one of which was any unfavour¬
able complication observed; this was a slight amount of
parametritic effusion, and it was not certain that it was due
to the operation. _

THE CABINET AND THE PROFESSION.

As it is probable that the action of the Ministry may be
required to be influenced by the profession in the matter of
some impending legal questions of great importance to
medical men, it may be worth while mentioning that three
members of the Cabinet are connected through their ances¬
tors with the profession. Lord Cadogan is descended from
Sir Hans Sloane, the celebrated physician. The estate: the
family holds in Chelsea was the produoe of the fortune Sir
Hans made as a physician. Both Sir Henry Holland’s father
and grandfather were well-known medical practitioners.
Mr. Matthews, the Home Secretary, is desoeuded from a
physician both on his father’s and mother's side. Dr. Munk
in the Roll of the College of Physicians, vol. ii., says—“ John
Matthews was bom in Herefordshire; was M.D. at Oxford in
1782, Fellow of the College of Physicians in 1783, physician
to St. George's Hospital in 1781; resigned that office in 1783,
when he relinquished the practice of his profession, became
colonel of the Herefordshire militia, and died at his seat,
Belmont, in that oounty, in 1826.” The Home Secretary’s
father (the author of a well-known work, “ The Diary of an
Invalid”) married a daughter of Dr. Blount, who practised
as a physician for some time in Hereford.

LIGATURE OF THE FEMORAL IN POPLITEAL
ANEURYSM.

In an article on "Popliteal Aneurysm”by Don JostS A.
Estevee, published in the Revista Argentina de Cienciat
MMicas, it is stated that Dr. Pirovano employs in the
Buenos Ayres Clinical Hospital in these cases the ligature of
the femoral artery, intermittent compression being practised
by means of Broca’s compressor for some time previously
for the purpose of developing the collateral circulation.
The operation itself is carried out with antiseptic pre¬
cautions and local anaesthesia. Twenty cases, some of them
of aneurysms of very considerable dimensions, have been thus
treated, with entirely satisfactory results in every instance.

A “JUBILEE” COOKERY BOOK,

This fiftieth year of Her Majesty’s reign is likely to be
remembered in time to Come, not only beoausb of ■ tho
interest proper to it, but perhaps equally as having been tho
parent of innumerable undertakings and productions, great
and small, which inherit from it a nominal dignity. Of
these, one of the latest and smallest, thoiigb, perhaps, not tho
least useful, is a ** Jubilee Penny Cookery-book.” This little
book, by the authoress of “ Cookery for our Sick and Invalid
Poor,” aims at introducing among the many to whom the
cost of food is a serious consideration ready methods
of cooking, with hints as to the choice of materials,
which, if rightly applied, should furnish a diet teTsmod

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898 The Lancet,]

A PRACTICAL COURSE OP BACTERIOLOGY IN LONDON,

[APhil 30,1887.

and palatable as it is simple and inexpensive. We cannot
altogether agree with an introductory statement in it, which
deals with the relative natritive value of certain kinds of
food: where, for example, herrings are preferred to beef and
mutton; and a shilling’s worth of cheese, without regard to
its digestibility, is said to have more “ stay ” in it than the
same money value of meat. The numerous convenient
recipes here collected are not, however, affected by the im¬
perfections of the prefatory notice, and form together a
body of information which must be useful to the frugal
housekeeper. _

A PRACTICAL COURSE OF BACTERIOLOGY IN
LONDON.

A 'course of instruction in Bacteriology will be given this
summer at King’s College. The objeot of the class, as set
forth in the syllabus, is to afford an opportunity for gaining
a practical knowledge of the more important species of
micro-organisms, and to give instruction in the methods of
cultivation as well as the special histological methods em¬
ployed for detecting bacteria in the tissues. The work each day
will be preceded by a short lecture illustrated with diagrams
and typical microscopical preparations. The class will meet
on May 16tb, and will be taken by Mr. Crookshank, who has
jnst returned from visiting the laboratories at Turin, Rome,
and Berlin. This course will supply a felt want, and no
doubt medical officers of health and many senior students
and practitioners who have been unable to study in the
laboratories abroad will avail themselves of this opportunity
for learning the new biological methods, and for gaining
access to cultivations of micro-organisms and the necessary
material and apparatus for following this interesting and
valuable line of research. _

THE RED CROSS IN ITALY.

The recent military events in Africa have given a much-
needed stimulus to this society for the relief of the sick and
wounded in war. Beveral communes throughout the pen¬
insula which had pre*-iou8ly failed to contribute to it have
now come forward handsomely, if tardily—Rome subscribing
towards it 6000 francs (£200); Milan founding a fund for
an annual donation to it of 600 francs (£20); Turin, through
one. of her societiep, giving 1000 francs (£40); and other
cities and towns, mainly in Upper Italy, subscribing accord¬
ing to their ability. The Central Committee of the Italian
Red Cross, thus reinforced as to means, has lost no time in
sending to the front supplies of medicines and comforts, so
that the military hospitals in the garrisons westward of
Massowah are now much better off as regards these requisites
than, to the discredit of the Government, they have yet
been since the beginning of the campaign.

“ADDED WATER” IN MILK. .

A case curiously illustrative of some remarks we made
in a recent article is reported. A county analyst reported
that a certain sample of “ babies’ ” milk—that is, milk from
a single cow—contained 10 per cent, of added water. He
Was afterwards requested to witness the milking of the
cow, and to draw a sample for himself. The second
sample, when analysed, was found to contain more
“added water” than the first, and was, the analyst be¬
lieves, the worst sample of genuine milk on reoord. What,
then, is to be done ? Is the already low limit of purity to
be made Btitl lower, or is the public analyst to continue to
report the presence of added water when he knows that
possibly no water ha9 been added ? Either alternative is
undesirable, but perhaps in the public interest the second
iS.the least so. The case, however, confirms our previous
^opinion, that the difficulty can only be avoided by an

alteration of the - law. In the next Adulteration Act
let the law do for milk and some other articles what it hu
already done for spirits—viz, provide a definition, and fix i
limit below which the vendor must not pass. The limiti
upon which public analysts, including the chemists of
Somerset House, base their calculations are necessarily
founded on very poor samples, and in a new Act it is possible
that they might be slightly raised without injury to honest
traders and with manifest advantage to the public, fiat
even such low limits as 8'5 per cent, solids not fat, 2-5 per
cent, fat, and 0’7 per cent, ash, would ensure the public t
trustworthy, if not a rich, milk, and would remove all
ambiguity from the interpretation of the law. Some im¬
portant drugs might, and in our opinion certainly should,
be treated in a similar manner.

INTER-COLONIAL MEDICAL CONGRESS.

In accordance with the circular issued last year by the
Provisional Committee, to which we drew attention at the
time of its publication, a general meeting of subscribers to
the fund of this congress, which is to be held at Adelaide,
has taken place. Dr. Verco was chosen president, and an
influential executive committee was appointed. The
governors of seven colonies have expressed their approval
of the project, and intimated their wish to become patron*
of the meeting. The congress will, as is usual, be carried
on in sections, thirteen of which have been defined. The
days of meeting will extend from August 30th to September
2nd, both dates included; and, notwithstanding the great
distances to be traversed by the majority of intending
visitors, and the existence in the same month of a counter
attraction in the United States, it is hoped by its pro¬
moters—and, so far as we can judge from the reports we
have received, justly so—that the federal nature of the
gathering and the opportunities it affords for the discussion
of subjects common to the * interests of practitioners
throughout Australasia will combine to secure a large and
representative attendance. , ,

THE AFFILIATION OF HOSPITALS AND
DISPENSARIES.

The following resolutions were passed by the committee
for organising medical attendance on the working classes at
its meeting on Tuesday : “That in the opinion of this com¬
mittee the out-patient department of hospitals should be
brought into consultative .relation with the provident dis¬
pensaries and medical men of their respective neighbour¬
hoods, and that the governing bodies of hospitals should
grant priority to all out-patients who bring recommenda¬
tions from provident dispensaries or medical men.” Sir
Spencer Wells presided. The subject of the affiliation of
hospitals and dispensaries will be continued at the next
meeting, on Tuesday, May 10th.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announced:—Dr. Carl E. Miriam, formerly Pro¬
fessor of Fhysiology at Kieff, at the age of seventy-five.—
Dr. Nathaniel Lieberkiihn, Medical Privy Councillor and
Professor of Anatomy in Marburg University, at the age of
sixty-five. The deceased professor was the son of the
discoverer of Lleberkuhn’s follicles, and was a disciple of
Johannes Muller, and a fellow-student of Dubois Reymond.
Helmholtz, Ludwig, and Virchow. His own researches,
which were numerous, were mainly connected with develop¬
ment He was formerly Prosector of Anatomy in Berlin.—
Dr. Joao Silva, Professor of Pathology in Rio de Janeiro, sml
chief of the Faculty of Medicine in that University.

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Thb Lajucbt,]

MEDICAL PRACTITIONERS AND DENTISTS.

[April 30,1887. 899.

n.^ii i .. - 1 .. - _

SANITARY DEMONSTRATIONS TO MEDICAL MEN.

Wb would call the attention of medical practitioners to a
aeries of sanitary demonstrations which hare been organised
At the Parkes Museum at 5 p.m. on three consecutive Mondays
next month, and to which admission is free to all members
of the profession. The first demonstration will take place
eta Monday, May 9th, and will be conducted by Professor
Corfteld, M.D.; on Monday, May 16th, Mr. Rogers Field,
ILInst.C.E., will give a demonstration; and the last demon¬
stration will be held by Mr. P. Gordon Smith, F R.I.B.A., of
the Local Government Board. In this way the medical,
engineering, and architectural aspects of the question of
tfie sanitary arrangements of dwellings will be successively
brought under notice; and we expect that the number of
medical men who are interested in the subject is such that
the Museum authorities will had that the arrangements they
Have made will secure appreciative attendances.

THE DUKE OF WESTMINSTER ON THE JUBILEE.

Thb Duke of Westminster in a letter to The Times, says
the hospitals of London in this Jubilee Year should certainly
not be neglected ; our own view is that they should be the
chief objects of favour. It seems to be very much feared
that many of the ordinary charities will suffer from the
J ubilee movement tending to divert funds. Surely no one
will do the Jubilee such dishonour as to withdraw any
established subscription from a worthy cause! The best
way of celebrating it will be to make additions to ordinary
subscriptions, especially in favour of the general hospitals.

MEDICAL PRACTITIONERS AND DENTISTS.

A question is raised by a correspondent of the Journal
of the British Dental Association as to the propriety or
taste of medical practitioners charging full fees where they
are asked to attend dentists. Our opinion is strong that
medical men who owe so much to dentists will find it highly
agreeable to be of any service in return. Who that has
had a tooth saved, or even a tooth skilfully extracted, and
who knows the extent to which dentists are consulted by
medical men and their families, and the unfailing kindness
which is experienced in this way at their hands, will have
a doubt that iu treating dentists os we should treat medical
men we are acting on the best instincts of human nature,
as well as on the best traditions of the profession? We
have, however, always maintained that dentists should hold
a surgical as well as a dental qualification, in which case the
question need not have been raised.

LONG PEPPER AS AN ADULTERANT.

Thb magistrates of Lancaster have properly decided that
what is known as long pepper is not what the public under¬
stand by the word pepper, and that as it is cheaper than the
cheapest pepper, and is, moreover, coarse and disagreeable
in smell, its admixture with genuine pepper is an adultera¬
tion. It was stated by Dr. Campbell Brown that long
pepper, an article of very small oommeroi&l importance, was
the fruit of a plant which grows wild in the water courses
of India, whereas true pepper comes from a perfectly
different plant, which is carefully cultivated. Long pepper
is chiefly used for pickling purposes.

THE COCCUS OF GRANULAR LIDS.

Db. E. Scssaor is stated to have succeeded in finding
the micro-organism described by Battler in granular lids
(trachoma), which, he says, is very similar to staphylc-
ooocus pyogenes. By cultivating this coccus he succeeded
in inducing granular lida in dogs, and cate. v

THE ANATOMICAL SOOIETY.

ThB foundation meeting of the Anatomical Society will
be held on Friday, May 6th, at 5 p.m,, at the Medical Society’s
rooms, 11, Chandos-street, Professor Humphry in. the chair.
All those interested in the movement are invited to attend.

FOREIGN UNIVERSITY INTELLIGENCE.

Florence .—A bronze statue to the great Italian medical
jurist, Francesco Puccinotti, has just been unveiled.

Halle .—Professor Kaltenbach, of Giessen, has been offered
the vacant chair of Midwifery.

Kazan .—Up till recently Dr. Skalosuboff, the professor of
nervous diseases, has been obliged to confine his demonstra¬
tions to such patients as could attend at the out-patient
department, having no beds assigned to diseases of this
nature. Now, however, a small clinical establishment has
been allotted to his chair, so that students will enjoy more
extended opportunities of study.

Konigeberg. — Dr. Carl Brandt, privat docent , has been
appointed by the Minister of Education to carry on the
duties of the vacant chair of Zoology up to the end of the
next winter session. Dr. Brandt was formerly assistant
in the Zoological Station at Naples.

Leipzig .—The Anatomio&l Society, which has just held its
first meeting here under the presidency of Professor Kolliker
of Wiirzburg, now numbers 190 members, including 78
foreigners.

Wiirzburg. —Dr. K. Rieger has been appointed Extra¬
ordinary Professor of Psychological Medicine, and Senior
Physician of the Julius Hospital.

Efforts are being made to procure the insertion in the
Theatres Bill which is now before Parliament, and which it
is expected will be read a second time about the middle of
June, of & clause to the effect that all exit notices should be
in luminous paint. This would greatly facilitate exit, by
pointing out the readiest way, especially in cases of total
darkness, as when the gas is turned off at the main, which
was the cause of the late catastrophe at the Jewish club in
the East-end, when seventeen lives were lost in a few
minutes. Herr Stehle, the Government inspector of the
Royal Bavarian Court Theatre at Munich, where this
system is in force, gives high testimony to its efficiency.
The insertion into the Bill of such a clause could only be
beneficial, and we wish success in their endeavours to those
who are advocating it. _

Thb vigorous measures recently adopted by the autho¬
rities with the view of stamping out the serious epidemic of
rabies among the deer m Ricbmond-park have already pro¬
duced good results. It has been found necessary to slaughter
Only four animals during the past week, and.it is believed
that the disease is gradua Uy dying out.

Dr. Lloyd Roberts has been elected a vice-president of
the Obstetric Section, and Dr. Batty Tuke, of Saughton Hall,
Edinburgh, has been nominated one of the vice-presidents
of the Psychological Section, at the forthcoming International
Medical Congress to be held at Washington.

Wb learn that an outbreak of typhus has taken place in
Carlisle, and that an inspector from the Medical Department
of the Local Government Board has, in consequence, visited
the town. _

On the 27th inst. a barque arrived in the Tyne from
Mobile Bay, the captain and several of the crew of which
had died during the voyage from yellow fever.

■ • • ■ ' , : . . ii t-;i

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REPORTS OP MEDICAL OFFICERS OF HEALTH.

[AEnn.30,1887.

900 The Lancet]

|)alilic JJralilj anb ^oor fak

LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Barnsley Urban District. —The Barnsley death-rate pre¬
sents materials for serious consideration. The general rate
Was for 1886 as high as 29’14 per 1000; that from the seven
principal zymotic diseases was no less than 616 per 1000 ;
and the deaths under one year of age were at the rate of
205 9 per 1000 of the registered births. Scarlet fever daring
the past three years has caused 221 deaths, and during last
year fifty-three fatal attacks of diarrhoea occurred. With
regard to scarlet fever some difficulty was experienced
because one large school remained open when the order to
close schools under the Education Code was issued. We
assume it was not a school receiving any grant of public
money, and if so the mischance could not, in the existing
state of the law, be avoided. But if it can be shown that
under such circumstances the failure to close voluntarily
supported schools defeats the objects for which other schools
have been compelled to submit to closure, the time will
probably come when it will be necessary to ask for more
stringent legislation in this matter. But, apart from this, it
is not creditable for the borough of Barnsley to be without
any means for isolating scarlet fever, especially after the
experience they have had as to small-pox. There were
twenty-five small-pox deaths in the three years before
the present hospital was built; in the fourteen years
that have since elapsed there have only been four such
deaths, the hospital having served to check the spread
of the disease when imported. Borne attempt was made
to utilise the hospital two or three years ago for a
scarlet fever patient, but the result was that small-pox was
contracted; the institution, which only has beds for six
acute cases, being adapted for the reception of one disease
only. It is curious how authorities, who will readily spend
the rates in providing means of isolation for small-pox,
against which another means of protection is available,
cannot see their way to do the same for scarlet fever,
which is evon more deadly. Compare, for example, the
14 small-pox deaths in three years which led to tne pro¬
vision of a small-pox hospital, and the 221 scarlet fever
deaths in the last three years, which have produced no
corresponding result. Dr. Sadler recommends public sub¬
scriptions to fill up this serious gap in the sanitary defences
of Barnsley. In connexion with the grave diarrhoea mor¬
tality, we would urge much more rapid action as regards the
present dangerous and filthy ashpit system. Warm weather
does not necessarily kill children with diarrhoea, but chil¬
dren inhaling the disgusting emanations from receptacles !
containing stored refuse, which tends to saturate air and
soil, are those, above all others, who are subject to such
premature death. Barnsley has made substantial sanitary
progress, but this last year’s heavy death-rate has indicated
the need for'further action in more directions than one.

Stafford Urban District.—After a careful estimate of the
present population, Dr. Milnes Blumer puts the birth-rate
for 1886 at 35 5, and the death-rate at 177 per 1000. The
deaths under one year were at the rate of 120 to every
1000 births registered. During a measles epidemic the plan
of requiring school closure was not followed, the alternative
of prohibiting the attendance of children from infected
houses having been regarded as better calculated to effect
the desired object, and it is stated that when the step was
resorted to the disease began to subside. In connexion with
tub system, it had been suggested that in order to
with the nuisance accompanying the collection of tubs
the carts should go round at night Instead of in the day¬
time. We do not believe this is right in principle. Tub
collection can be arranged with a minimum of nuisance if
proper carts and tub-covers are provided; and under any
circumstances nuisance will not be remedied by doing the
work under cover of darkness. There is no need td do the
work in the busy hours of the day, but it should not be com¬
menced until about sunrise. A good deal of excellent
sanitary work is being steadily earned out in the district;
substantial progress has been made with the new water¬
works, which will shortly be in operation; and such places
a* bakehouses, common lodging-houses, and slaughter¬

houses, are both looked after and dealt with when the need
for action is shown.

Helper Rural District,— Mr. J. Allan has the satisfaction
of reporting a steady diminution in the rate of mortality,
which stood at its highest point—namely, 17‘5 per 1000—m
1879, and is now 13 8. There are, however, points to which
attention is needed in the district. One relates to infest
mortality, and Mr. Allen significantly refers to the relation
of this mortality with those assurance companies which, by
way of a grim joke, are locally known as “ Death ” clubs,
the death so often being associated with neglect. He also
urges the need for hospital provision, especially in the
interests of the working classes, who, when infectious
disease prevails, are tumble, like their more wealthy brethren,
to leave the district for a time. Holbrook and Kilbourae
are still without a system of drainage, and this tells on the
death-rate of the former place. One sewage outfall nuisance
which had led to bitter feelings between two contending
sets has been satisfactorily dealt with through the judicious
handling of Major Tulloch of the Local Government Board.
The voluntary system of notification of infectious diseases
which is in force bids fair to break down. It is hinted that
this may be due to the inadequacy of the fee offered. The
usual fee in most parts of the country is half-a-crown per
certificate granted, and it should not be less in the Belper
district.

Crickhowell Rural District. —Powers have been granted
for supplying the town of Crickhowell with a water service,
and Mr. Philip Hill makes some apt remarks on the prin¬
ciples which should govern the authority in their action in
this matter. He has more than once brought under notice
the grave state of the sewer outfall, and the greasy, black,
and foul mud which results, to which attention was recently
drawn by Mr. Spear, of the Local Government Board.
Slaughter-houses, cow-houses, and adulterations under the
Food and Drugs Act are all receiving attention, and special
reference is made to the unhealthiness of many dwellings
by reason of dampness, exceesive cold from draughts, and
impurity of air from closet and other effluvia. The death-
rate was high in 1886—namely, 22-7,—even if allowance is
made for the fact that the workhouse deaths included
several non-residents which it was not possible to allow for
with accuracy. _

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6428 births
and 3825 deaths were registered during the week ending
April 23rd. The annual rate of mortality in these towns,
which had been 20 - 5 and 20 9 per 1000 in the preceding
two weeks, further rose last week to 21*6. During the first
three weeks of the current quarter the death-rate in them
towns averaged 21*0 per 1000, and was 2*6 below the mean
rate in the corresponding periods of the ten yean 1877-86.
The lowest rates in these towns last week were 14-9 in
Birkenhead, 157 in Leicester, 15 8 in Nottingham, and 163
in Brighton. The rates in the other towns ranged upwards
to 27 7 in Halifax, 27 - 9 in -Cardiff, 28 7 in Liverpool, and
36 4 in Manchester. The deaths referred to the principal
zymotic diseases in the twenty-eight towns, which had
increased in the ten preceding weeks from 340 to 510,
farther rose last week to 558; they included 291 from measles,
134 from whooping-cough, 47 from scarlet fever, 40 from diar¬
rhoea, 24 from “fever "(principally enteric), 21 from diph¬
theria, and only 1 from small-pox. These zymotic diseases
caused the lowest death-rates last week in Portsmouth,
Wolverhampton, and Halifax; and the highest rates in Nor¬
wich, Salford, and Manchester. The greatest mortality from
measles ocourred in Norwich, Huddersfield, Salford, Liverpool,
andManchester; from whooping-cough in Norwich. Birming¬
ham, and Nottingham; and from scarlet fever in Blackburn.
The 21 deaths from diphtheria in the twenty-eight towns
included 14 in London, 3 in Liverpool, and 2 in Derby.
Small-pox caused 1 death in Greater London, but not one
in any of the twenty-seven large provincial towns. Only
7 cases of small-pox were under (treatment on Saturday
last in the metropolitan hospitals receiving cases of this
disease; 2 new cases were admitted to these hospitals during
the week. The deaths referred to diseases of the respiratory
organs in London, which had declined in the preceding four
weeks, from 609 to 363, further fell last week to 337, and
were 74 below the corrected average. The causes of 92, or

'5

Tech Lancet,]

HEALTH OP SCOTCH TOWNS.—HEALTH OF DUBLIN.

[April 80,1887. Q01

2*4 per cent., of the deaths in the twenty-eight town* last
week were not certified either by a registered medical prac¬
titioner or by a coroner. All the causes of death were duly
certified in Leeds, Leicester, Portsmouth, and Derby, The
largest proportions of uncertified deaths were registered in
Preston, Sunderland, and Sheffield.

HEALTH or SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 22*9 and 23*7 per 1000 in the preceding two
weeks, declined to 22*0 in the week ending April 23rd; this
rate exceeded, however, by 04 the mean rate in the same
week in the twenty-eight large English towns. The rates
in the Scotch towns last week ranged from 11'5 and 12 3
in Leith and Greenock, to 25-8 in Glasgow and 29 9 in
Paisley. The 650 deaths in the eight towns last week
showed a decrease of 43 upon the number in the previous
week, and included 36 which were referred to whooping-
cough, 30 to measles, 10 to diarrhoea, 9 to scarlet fever, 8 to
“fever” (typhus, enteric, or simple), 2 to diphtheria, and
not one to small-pox; in all, 95 deaths resulted from these
principal symotio diseases, against numbers declining in the
preceding four weeks from 127 to 91. These 95 deaths were
equal to an annual rate of 3 8 per 1000, which exceeded by
0;7 the mean rate from the same diseases in the twenty-
eight English towns. The fatal caees of whooping-cough,
which had been 31, 33, and 36 in the preceding three weeks,
were again 36 last week, of which 14 occurred in Glasgow,
6 in Edinburgh, 5 in Dundee, and 5 in Aberdeen. The 30
deaths from measles showed an increase of 2 upon the
number in the previous week, and included 18 in Aberdeen
and 11 in Glasgow. The fatal cases of scarlet fever, which
had been 11 and 10 in the previous two weeks, further
declined last week to 9, of which 4 occurred in Dundee, 3 in
Edinburgh, and 2 in Glasgow. The 10 deaths attributed to
diarrhoea showed an increase of 3 upon the low number in
the previous week, and exceeded the number in the corre¬
sponding week of last week by 1; they included 4 in
Glasgow and 3 in Aberdeen. The deaths referred to “ fever,”
which had been 8 and 6 in the previous two weeks, rose
to 8 last week, and included 3 in Glasgow and 2 in Dundee.
The deaths from acute diseases of the respiratory organs in
the eight towns, which had been 110 and 126 in the pre¬
ceding two weeks, were 124 last week, and exceeded by 24
the number in the corresponding week of last year. The
causes of 57, or more than 10 per cent., of the deaths
registered in the eight towns during the week were not
certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been 30 0
and 84'1 per 1000 in the preceding two weeks, declined
again to 31*3 in the week ending April 23rd. During the
first three weeks of the current quarter the death-rate in the
city averaged 31*8 per 1000, the mean rate daring the same
period being but 18*7 in London and 19*3 in Edinburgh. The
212 deaths in Dublin last week showed a decline of 19
from the number returned in the preceding week; they
included 6 which were referred to measles, 4 to “ fever ”
(typhus, enteric, or simple), 3 to diarrhoea, 2 to scarlet fever,
2 to diphtheria, 2 to whooping-cough, and not one to
■mall-pox. Thus 19 deaths resulted from these principal
zymotic diseases, against 15 and .22 in the preceding two
weeks; they were equal to an. annual.rate of 2*8 per 1000,
the rates from the same diseases being 2*4 in London and
2*0 in Edinburgh. The 6 fatal cases of measles showed a
decline of 1 from the number in the previous week, and
those of scarlet fever, whooping-oougb, and “ fever,” were
also fewer than those returned in the previous week. The
deaths from diarrhoea and diphtheria, on the other hand,
showed an increase. The deaths of infante showed a marked
decline, while those of elderly persona showed an increase
upon recent weekly numbers. Five inquest eases and 2 deaths
from violence were registered ; and 56, or more than a
quarter, of the deaths occurred in public institutions. The
causes of 39, or 18 per cent., os the deaths registered
daring the week were not certified.

At a Vestry meeting held at St. Mary’s, Reading,
on the 19th inst., it was resolved that an address be pre¬
sented to Mr. Isaac Harrinson, in recognition of his efforts
to improve and beautify the town.

THB SERVICES.

Deputy Surgeon-General J. B. C. Read, C.B., has joined
the Home District for duty.

Deputy Surgeon-General J. Tulloch, M.D., has assumed
the duties of Principal Medical Offioer at Woolwich.

Deputy Surgeon-General R. A. Chappie has been appointed
Administrative Officer, Mhow Circle.

Surgeon-Major W. Taylor, M.D., has been appointed to
the Btaff of the Commander-in-CLief in the East Indies, and
has been placed on the Supernumerary List.

Wab Office.— Surgeon-General Thomas Graham Balfour,
M.D., F.R.S., retired pay, to be Honorary Physician to the
Queen, vice Surgeon-General W. Rutherford, M.D., C.B.,
deceased (dated April 23rd, 1887).

Abmy Medical Staff. —The undermentioned Surgeons
to be Surgeons-Major (dated March 31st, 1887):—Henry
Charles worth, John Cotter Dorman,. M.B., George Herbert
Le Mottde, MJ)„ William Litchfield Chester, MJL, and
Edward Arthur Mapleton, M.B.

Admibaltt.— The Greenwich Hospital pension of £50 a
year for fleet and staff surgeons, vacant by the death of Dr.
Gerald Yea, has been awarded to Fleet Surgeon William
G. J. Ayre.

Deputy Inspector-General of Hospitals and Fleets John
Fisher has been promoted to the rank of Inspector-General
of Hospitals and Fleets in Her Majesty’s Fleet (dated
April 1st, 1887); Fleet Surgeon Henry Frederick Nerbury,
C.B., has been promoted to the rank of Deputy Inspector-
General of Hospitals and Fleets in Her Majesty’s Fleet
(dated April let, 1887).

In acoordanee with the provisions of Her Majesty’s Order
in Council of April lBt, 1881, Fleet Surgeon Eugene- Victor
de Marie has been placed on the Retired List of his rank.

The following appointments have been madeSurgeon
Alfred T. Rime 11, to the Rattlesnake (to date from 28th inst.)
Fleet Surgeon Henry 8. Lander, to the Impregnable; Staff
Surgeon M. Fitzgerald, to .the Triumph, for Esquimaolt
sick quarters; Staff Surgeon O. P. Browne, to the Caroline t
and Surgeon C. D. D. E. Chamberlain to the Rattler,

Royal Naval Artillery Volunteers (London Brigade).
Edmund Distin Maddick, Esq., to be Honorary Surgeon (dated
April 20th, 1887).

Yeomanry Cavalby. —Oxfordshire: Surgeon Frederick
Taylor resigns his commission; also is granted the honorary
rank of Surgeon-Major, and is permitted to continue to
wear the uniform of the Regiment on his retirement (dated
April 27th, 1887).

Artillery Volunteers. —1st Caithness: James Leith
Waters, M.B., to be Acting Surgeon (dated April 27th,
1887).—8th Lancashire: Surgeon T. F. Morrish resigns his
commission (dated April 27th, 1887).—Newcastle and Sun¬
derland: Henry S. Baumgartner, M.B., M.S., M.R.C.S., L.S.A.,
to be Acting Surgeon.

Rifle Volunteers.— 3rd Cheshire: Theodore Fennell,
Gent., to be Acting Surgeon (dated April 27th, 1887).—
1st Volunteer Battalion, the Duke of Cornwall’s Light
Infantry': Acting Surgeon E. S. Angove resigns his appoint¬
ment (dated April 27th, 188p.—6tn Lanarkshire: William
Brown Moir, M.D., to be Acting Burgeon (dated April 27th,
1887).—1st Renfrewshire: Acting Surgeon T. Philip, M.D.,
to be Surgeon (dated April 27th, 1887).

The Volunteer Medical Staff Cobps.—T he London
Division: John Adam Watson, GenL, to be Surgeon (dated
April 2nd, 1887). /

THE VOLUNTEER MEDICAL SERVICE.

To the Editor* qf The Lajtcet.

Sirs,—I regret to be obliged to point out to you an alteration now
neceaeary in regard to a statement in your annotation in Thk Lancet
of a recent date on my paper on "The Volunteer Medical Service in
Peace and War.” ,

I have jolt been officially informed that the permission granted me
last November to join the School of Instruction at the Medical Stiff
Corps Depfltat Alderthot under the usual regulation* m to allowance* Ac.
has been reeotnded. and that mote permission will not In future be

E ted to regimental surgeona. bat only to Aurgeoni of the Volunteer
ical StanT I regret the matter the more because it <eems to me
one of the dlffleuttlee most strongly deprecated by the promoter* Of
the Volunteer Medical Staff Oorpe is now* riling by the drawing of a
moot Invidious distinction between the offioer* of that oorpe (and,
indeed, all other commissioned officers) and the surgeons oarrlea on the
Regimental Lists. I am. Sirs, yours faithfully,

W. P. llilH. M.D„
Burgeon, Tynemouth Artillery«v

Newcastle-oa-Tyne, April 26th, 1887.

Digitized by

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902 Thb Lancet,] THE MANCHESTER VERSUS TAB LONDON SCHOOLS OF MEDICINE. [Apart. SO, 1887.

Comspnittnu.

“ Audi alteram partem.”

THE MANCHESTER VERSUS THE LONDON
SCHOOLS OF MEDICINE.

To the Editors of The Lancet.

. Bibs, —In The Lancet of March 26th there is an editorial
annotation dealing with the question of degrees for London
medical students, in which the following remark occurs: “ It is
difficult to understand the position of the Colleges [of Phy¬
sicians and Surgeons] in patting into the foreground of their
claims the advantages and superiority of clinical teaching and
clinical opportunities in London, if some residential period
is not insisted on.” Beyond what appears in this statement
in your own columns, I must confess that I am ignorant of
any such claim to superiority haring been advanced in
favour of the London schools. Nor is the precise meaning
which the words are intended to convey to be found on the
surface. If it be that throughout the length and breadth
of London there are to be found clinical teachers and
material for clinical instruction which, if they could be
focussed and made available for the instruction of all
London students, would be superior to any to be found else¬
where, then we of the provinces can afford, with much
complacency, to admit that it is so. If, on the other hand,
it means that, as the London schools are at present consti¬
tuted and the teaching at present carried on, this same
superiority over provincial schools is to be recognised, then
i think it will be admitted that there are good grounds for
provincial jealousy being aroused and for a wish to hear
something further on the subject.

It happens that a few weeks ago I made some remarks at
the close of a clinical lecture which were curiously at
variance with any such idea, and your article thus imme¬
diately arrested my attention. Of other provincial schools
I cannot, of course, speak; but so far as that of Manchester
is concerned, as a teacher of clinical surgery in it, I feel
strongly disposed to controvert the alleged contention of the
Colleges in respect of every individual subject of clinical
study. I believe it would be possible to show that, whether
in the mere passing the tests of the examining boards, in
the competition lor prizes, or in general equipment
for the responsibilities of practice, the Manchester
student holds his own with the Londoner; and, further,
in respect of clinical opportunities, that there is scarcely a
school in London which can provide such a fullness of
material as our own, whether in general medicine and
surgery, or in the special departments of fever, insanity,
ophthalmology, or the diseases of women and children. It
would entail some little trouble, however, to go into this
fully, and, after all, I wonder very much whether any such
claim on behalf of the London schools as that referred to
has ever been seriously made. I can scarcely think it possible
that so much ignorance of the resources of Manchester as
this would represent really exists in the Councils of the two
licensing Colleges. I will therefore content myself at pre¬
sent with a few data which are at once accessible to me,
with a view to giving a little information to those con¬
cerned, whether that information be really needed or not.

Two allegations are contained in your article: firstly, that
the clinical teaching in the London schools is superior to
ours; and, secondly, that the clinical opportunities are like¬
wise superior. With regard to the first of these, it is per¬
haps difficult to adduce direct proof without making
references which might appear invidious. A fair test, how¬
ever, of the quality of the teaching may be found in the
achievements of the pupils, and probably the results of
competitive examinations would be as good an indication
as could be obtained did the students from the schools con-:
cemed enter for such examinations in equal proportions to
their total numbers, Tbe honours examinations of the
University of London would afford an excellent example for
our purpose, were it not that it is undoubtedly more a matter
of course for a London student to prepare for these than it
is for a Manchester st udent, and therefore a larger proportion
of the total number of the former probably enter uiktt of
the latter. Still, this is the only examination which seems
to give any indication of tbe required information, and as it
has been somewhat fashionable of taW'^ettk f ot d m ffeten to

read for the London degrees, 1 propose to accept this as the
test we are in quest of. For this purpose I asked Dr. ffm.
Thorburn, the surgical registrar of the Royal Infirmary,
himself one of our most distinguished students, to look out
for me the results of the honours division of the pass
examinations for the last Bix years. Unfortunately those
for 1886 are not yet published, but he has been good enough
to furnish me with those for the previous five years. I need
not give the several years separately, but will sum them up,
and the result appears as follows:—

Second M.B. Examination (Honours).

Medicine. Obstetrics. Forensic Medicine.

Man- All other Man- All other Man- All other
cheater. school*. cheater. schools. Chester. schools.
11 ... 77 . 3 ... 61 . <J ... 71

At this examination, during tbe same five years, fifteen
scholarships were given, of which Manchester obtained
three, and fifteen gold medals were given, of which Man¬
chester obtained six. At the B.S. examination in 1884, tbe
only one of these years in which honours were given in
surgery, Manchester obtained two out of six, and also took
both the scholarship and gold medal, no other men being in
the first division. At the M D. examination Manchester took
the gold medal in 1882. When it is borne in mind that the
total proportion of students in Manchester to those of
London alone is as one to eleven, I think it will be admitted
that this record is one that we may be fairly satisfied with.
How many of the London schools can equal it?

Then, with regard to the second allegation, that of
superiority of the Loudon schools in clinical opportunities,
a little trouble in the collection of figures would probably
show that very few of the Loudon hospitals can compare
with Manchester in richness of material. But knowing so
little of the circumstances under which the claim alluded
to has been brought forward, and therefore of the importance
to be attached to it, I am unwilling to engage in what is
always to me an ungrateful task. At the risk of appearing
egotistical, I therefore propose to limit myself almost entirely
to the work of my own wards, as illustrating the work of
the whole surgical department of our infirmary. Probably,
without entering into tedious statistics, a fair criterion
of the “ clinical opportunities” of a surgical hospital is to be
fouud in an examination of the operations performed in it.
My house-surgeon, Mr. Seville, has accordingly supplied me
with the following iufdrmation. Since I became full surgeon,
or rather since November, 1882—say, four years and a half,—
1034 operations have been performed in my wards, about five
every week. These were operations such as have usually
to be performed in the theatre, as distinguished from small
operations done in bed ; but as an indication of their nature
I will specify particularly those of tbe past month of March.
They were as follows:—Scraping of lupus (2), amputation
of leg, ditto of breast, excision of knee (2), ditto of hip,
ditto of lymphatic glands (2), ditto of cystic thyroid,
ditto of sebaceous cysts, ditto of necrosed bone (2), fistula
in ano, Dupuytren's contraction, aspiration of diver¬
ticulum of knee-joint, rhinoplasty, cleft palate (2),
compression for popUteal aneurysm, extraction of catheter
from bladder, division of adherent ulcer, resection of ribs for
empyema, suturing wounds of face, reduction of dislocated
hip, taxis for strangulated hernia, vesico-vaginal.fistula—a
good month’s work, but, happily, not encountered every
month of every year. Yet, at the same time, where there is
so much to be seen, one frequently meets with “runs’ of
eases affording excellent opportunity for teaching purposes.
For example* in my last? “aocident" take-in week we
admitted six cases of fracture of the femur, one of disloca¬
tion of tbe hip, and one of braise of the hip simulating
fracture of the neck. Again, some eighteen months ago 1
bad on one operation day five cases of possible amputation
in the thigh. Three were so amputated, in one excision of
the knee was performed, and one was declined (senile gan¬
grene). Once more, a short time ago one of my colleagues
bad three cases of lithotomy in one morning.

The above represents less, than one-fourth of the in-door
surgical work of our infirmary, for besides three colleagues
with the same number of beds as myself, tbe two assistaat-
aurgeopa have some beds at their disposal. Then, in addition
to all this, there is the “vast field of observation in the
out-patient and accident rooms, in which no fewer than
14,000 cases were treated during the year ending June, 1886.
The former of these departments, under the charge of

The Lancet,]

THE MEDICAL 8TAFP AND RANK.

[April SO, 1887. 903

assistant-burgeons, is, indeed, a mine of instruction and
experience to the student, of which the value can scarcely
be over-estimated. The simple fact is that in every depart¬
ment of the hospital there is always a plethora of material
for teaching purposes, and the veriest glutton, hungering
and thirstiDg after knowledge, can only partake of a portion
of what is daily set before him.

So much for surgical work only. Possibly, with your
permission, some further information may at another time
be given as regards our clinical opportunities in other
departments. The present instalment will, however, demon¬
strate on what substantial grounds we may contest the
claim adduced on behalf of the metropolitan schools.

I am, Sirs, yours truly,

Manchester, April, W7.____ __ JAMBS BARDIE.

THE MEDICAL STAFF AND RANK.

To the Editors of The Lancet.

Sirs, —Mychiof reason for now addressing yon is the under¬
lying inference of your recent annotations and the letter of
a recent correspondent that the medical staff in asking for
rank is departing from its proper status as a professional body;
and if you will allow me, I will try to make our views (or, at
least, those of a section) plain. The question is admittedly
not one of personal likes or dislikes, but rather what is
necessary to honestly and efficiently carry out the duties
entrusted to us. In itself we care nothing for military
rank, and to anyone so inclined it can be readied through
the ordinary portal for the combatant officer far easier
and .with less expenditure of brains and money than
through the doubtful and indirect mazes of the medi¬
cal staff; it is not that we regard our profession as
secondary to any other, but rather that, valuing it
highly, and seeing how, in developing, its threads ramify
through all the segments of the military machine, we dee ire
reasonable freedom and a defined position for our labours.
There are many among the older members (and 1 am myself
among the number) who viewed with personal dislike depar¬
tures ultra-professional taken step by step, until now we have
work to do identical with that of the oombatant officer; but
we cannot but acknowledge that this is the normal sequel
of unification, and the logical and necessary outcome of our
present duties is rank. If anyone suppose that, as at pr e se n t
placed, we are merely medical men charged with care of
sick, let him run his eye over the medical regulations of the
army detailing also sanitary work, charge of stored,
command of Medical Staff Corps, which embraces duties
as essentially military as any that a combatant officer
can be called upon to do. These are the dudes which
daring peace, and doubly so during war, call for a defined
status for die responsible individual; one not liable to dis¬
turbance through the jealousies of the combatant ranks, or
by personal interpretations of orders and warrants, and
whittlings and twistings to meet a given end. It was
utter absence of all trust and faith in the acts of the
military towards the medical staff which constituted the
motive power in the recent outcry over relative rank, and it
is this which now makee os look with more than doubtful
eyes over the proposed amendment of the paragraph which
almost word for word repeats the preceding paragraph on
honorary rank, while stopping short of the logical step of
granting the latter.

The present disturbance is not. our act, it has been thrnst
upon ns; and now that the Secretaryof State for War has told
us (much to our astonishment) that relative rank is ameaning-
less phrase, we cannot but see in our present-state a condition
fraught with misunderstanding and frictibn with other
segments, and with probable failure when next tested in
the field. We seem to have oome to the parting of the
ways; the better we are professionally the less we feel the
possibility of con tented ness; and what we now ask for is
that the War Office should know its own mind and give us
fair play. If our work is to be limited to purely profes¬
sional topics, we can regard our then position as medical
men in Government employ with complacency. What
suffices for tbe chaplains will suffioe for us, with stripping
of our trappings and gaudy uniforms, spurs, swords, and
salutes, the complements of different military ranks—all a
pure mockery to rankless men and an obstacle in attendance
on tick men. If, however, unification is to nctrmally evolve,
we cannot but be an integral part of tbe military machine,
and our status must be defined in it on the only recognised

method—rank; and experience has now shown that this
system carried out to its logical conclusions contains
elements of the greatest value to the Army, State, and even
also to tbe medical profession. It entails ultra-professional
duties, and necessitates a designation embracing them;
but the latter need not disturb our peace of mind,
as it already exists in three of our present grades.
Moreover, in a department complete in itself, some of us
think we see an escape from the blot, which you so
forcibly put forward in your issue of the 23rd instant—
award of honours for service centred in the military head ;
and you do us a kindness in giving it prominence. To speak
plainly, it is nothing short of a disgrace, it saps all loyal
feeling towards our departmental superiors, it stifles the
growth of all professional culture and progress. But will
not unity, strength, and proper recognition of os as military
medical officers performing multiform duties carry also
proper and due authority and influence of our head
among the other heads of the army sections, and a
dominant (if not sole) influence in the internal economy
of the department, including promotion as well as rewards’?
and will not division of our present work into professional and
ultra-professional, with outside men and officers to carry on
the latter, by so much deprive us of weight in the military
sphere, and equally reduce the influence of our head on the
points mentioned? The present blots are relics of the
past, of a time when our duties were more strictly pro¬
fessional than they now are, and when the head possessed a
lessened importance; and it seems to some of us that our
present position without rank and the misplaced power over
awards and promotion await the same solution—emancipa¬
tion from the unreasonable supremacy in our affairs of the
military caste. I am, Sire, yours truly,

April, 1887. One of Them.

*,* We have much pleasure in inserting the above letter
from a distinguished officer of the Medical Department*
though we cannot quite agree with the writer on some of
the points he advances.— Ed. L.

THE LUNACY BILL, 1887.

To the Editors of The Lancet. .

Sirs, —The new clause inserted on Feb. 22nd last into the-
Lunacy Bill of the present year, at the instance of Lord
Monkswell, to the effect that “ when any officer is trans¬
ferred from one county asylum to another his service in all
such asylums shall count for the purpose of computing the
pension or superannuation allowance," is good so far as it
goes. But there are officers who have served a sufficient
number of years to earn a pension whose service has not
been confined alone to county asylums, who have trans¬
ferred their servioes from one of the county asylums to one
of the borough or metropolitan district asylums, or vice versd.
Those gentlemen will naturally be of opinion that, in fair¬
ness, the operation of the clause in question ought to be
extended to them. It will not, I venture to say, be con¬
tended that the work in the borough or district asylums is
less anxious, onerous, and responsible than it is in the
county asylums, and, moreover, probably one effect of the
exclusion of the officere serving in them from this pension
clause would be to deter the best, men at present serving
in the county asylums from offering themselves for such
appointments in future.

I am, Sirs, your obedient servant.

Mailing Place, Kent, April 23rd. 1837. JAMES ADAM, M.D,

THE ERASMUS WILSON BEQUEST.

To the Editors of The Lancet.

Sirs,— I venture to think that the petitions whioh have
been lately presented to tbe Council of the Royal College of
Surgeons by persons desirous of the suppression of experi¬
ments on living animals place the question of the disposal
of the funds which have accrued to the Royal College of
Surgeons in a new aspect. Before these expressions of
opinion by a section of the public, any disposition of the
funds of the Erasmus Wilson bequest was a matter of
interest mainly to tbe body into whose hands they had
fallen, and in a secondary degree to tbe medical profession
in general. The decision most now lie between tbe opinions
of tiie leaders of the profession, as erpressed- in the largely

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904 The Lancet,]

THE CONGRESS OF GERMAN PHYSICIANS.

[April SO, 1887.

signed memorial presented to the College of Surgeons in
March last, and the opinions of that section of the public
which is opposed to experimentation on living animals
nnder any circumstances whatever. I have not any doubt
that the verdict which must be pronounced by the Council
of the College of Surgeons will be favourable to the interests
of suffering humanity, by affording increased opportunity
for the research into the origin of disease by properly
qualified experimenters. But the question has now come
to be the decision of a medical corporation as to the necessity
for experimental research; and should the decision be
adverse to what is believed by far the majority of medical
men to be essential for the advancement of medical science,
I cannot but think that a blow of the greatest force will
have been struck against the prosecution of experimental
physiology throughout the kingdom.

I am. Sirs, yours obediently,

Oxford, April, 1887. W. TYRRELL BROOKS.

PUNCTURING THE ABDOMEN IN PUERPERAL
CASES.

To the Editors of The Lancet.

Sirs,— Dr. Priestley raises the question of puncturing the
abdomen for extreme flatulent distension in puerperal
diseases. The following case came under my care

Mrs. W- (seen Nov. Cth, 1875) was confined to bed in

the seventh month of pregnancy, with vomiting, dropsy, and
albuminous urine (nearly one-half on testing). On Oct. 5th
she was prematurely confined; labour natural. Vomiting
persisted after confinement, and a severe febrile state fol¬
lowed, with flatulent distension of the abdomen as a chief
symptom. This increased during the next few days, and on
the night of the 12th, the distress being so great. I punctured
the bowel (Mr. E. Jackson being with me) with a fine trocar.
Flatus and some yellow fluid escaped. Relief was given,
and the patient, after some weeks of illness, recovered, the
albumen entirely disappearing. No inconvenience of any
kind followed the operation, and the patient has enjoyed
good health since. The distension returned after the
operation; but was not so extreme, and the puncturing was
not repeated. I am. Sirs, yours truly,

Manchester, April 25th, 1887, STEPHEN NeSFLELD, M.D.

TI1E CONGRESS OF GERMAN PHYSICIANS.

(From a Correspondent.)

The sixth Congress of German Physicians (Congress fur
innere Medizin) took place in the splendid rooms of the
Kursaal, Wiesbaden, on April 13th, 14th, and 15th. Amongst
the celebrities present were Virchow, Leyden, Gerhardt
(Berlin), Leube (Wurzburg), Curshmann (Hamburg), Binz
(Bonn), Filehne (Breslau), Hitzig (Halle), Kopbach (Jfena),
Nothnagel (Vienna), Liebermeister and Jiirgensen (Tiibingen),
Verstraten (Ghent), Xisch (Prague), and the late assistant
of the celebrated Cohnheim, Lichtheim, now professor at
Berne.

Leyden, as president, opened the meeting. Remarking on
the growing importance of the Society, he urged the neces¬
sity of a union of all physicians in view of the increasing
tendency towards specialism.

Dettweiler and Penzoldt spoke of the treatment of con¬
sumption, and both came to the conclusion that, in spite of
the great'hopes based on the discovery of Roah’a bacillus, we
are yet far from havina discovered a remedy for the dire
disease, and have still to rely on palliative .measures.
Kuehle laid stress upon the fact that tuberculosis i? far morq
often arigihated by direct infection from month to mouth
than is, usually believed, and he even went so far as to speak
of a " family tuberculosis ” in this sense of propagation.

■ Lichtheim made some very interesting and practically
important remarks on the etiology of pemipious
relating some cases in which there was a coincidence of
tabes and, this disease and an evident connexion with intes¬
tinal worms (bothriocephalus, filaria).

Rindfleiach of Wurzburg advanced a new theory with
regard to tabes dorsali* basing it on t very ingenious
experiment. According to this observer, the fchiokening of

the pis mater is the primary affection, having for its effects
the compression and degeneration of the posterior cords,
which are more liable to be compressed than the other ptrto
of the medulla.

Vogel (Munich) and Hagenbach (Basel) spoke of the
treatment of whooping-cough, and, reviewing the various
belauded remedies, they recommended a larger recourse to
morphia as an anti9pasmodic, besides quinine (as many
decigrammes as the child has years), and the local irritation
of the nose advocated by Michael of Hamburg according to
the experience of Hauek. But they regretted that in
statistics connected with the effects of remedies there is
not taken into due account the age of the child, the pro¬
gnosis in no disease being so much influenced by the ige
as in whooping-cough. So with regard to the mortality,
which, according to Vogel, is as follows: under one year
25 per cent.; from two to five 4 8 per cent.; and over five
years only IT per cent.

Nothnagel and Naunyn (KSnigsberg) were the exponents
of the difficult question of the localisation of brain diseases,
more especially with regard to the cortex. The latter
could confirm the observations of Wernicke and Kussmaul
concerning aph asia.

Litten (Berlin) laid stress upon the fact that diseases of
the stomach are very often associated with malposition of
the right kidney (seventeen out of his thirty-two cases), and
not exclusively in women. He considers the gastric dilata¬
tion as the primary cause, and has obtained excellent results
by washing out the stomach.

Adamkiewicz (Cracow) stated that he had cured several
acute cases of neuralgia (supra-orbit&lis) by employing a
combination of chloroform and the galvanic current, and
explained its immediate effects by the way of kataphoresis.
This experiment is certainly worthy of attention.

Very interesting were the observations of Finkler upon a
typhoid fever epidemic in a small town near Bonn, when
he could trace most accurately the path of the infection.
After this Professor Fraenkel of Berlin drew attention to
the long vitality of the typhoid fever bacilli of Gaffky in the
intestine, and he explained by this circumstance the occur¬
rence of late infection and of relapses. Rosebach made
some observations on chyluria and leucocytoeis. He also
exhibited a chair for the use of asthmatic* and patient*
suffering from emphysema (Athmunf/sstuhl), invented by a
patient of his, by means of which- the expiration is aided by
an elastic compression very easily manageable.

Cabn, assistant at Straaabnrg, denied the assertions of
Riegel that in the carcinomatoas stomach hydrochloric acid
does not exist, but proved that in certain cases there is
carcinoma with BCL, and yet the reaction of methyl violet,
or congo, or tropseolin may be wanting.

Of very far-reaching and undoubtedly also practical
importance will prove, the experiment of the young pro¬
fessor, von Mehring, of Strassburg, who produced diabetes
on fasting dogs by large doses of florhidein, an extract of
the roots of the plum-tree, and who expressed his conviction
that the sugar is formed solely by decomposition of albumen-
These researches and operations seem worthy of special
notice, os they are calculated to profoundly modify the
views held of this disease. Leube congratulated v«
Mehring, and gave expression to the hope that we might
now succeed in getting animals continuously diabetic.

Franz spoke of a question which is in Germany very much
discussed, and has, indeed, become a burning one since th#
suggestions of Oertel—viz., whether rest or exercise is tobe
recommended for patients with heart disease. Leyden took
part in the discussion, stating that many practitioners go
too far in their anxiety for the safety of such pati»t*,
and he referred to the reports of Sir Andrew Clark, who his
seen in his practice more than 600 cases of heart die*®® 8 *
without any bad symptoms during five years. In conclu¬
sion, Leyden expressed the hope that the next Congress*
which will meet again in the beautiful queen of German
watering-places, maybe equally well attended.

Weiatadcn, April, 1887. _

The German Hospital.— On the 27th inst the

forty-second anniversary festival of this institution, wh>»
is situated at Dalston, was held at the H6tel MStropd®.®*
Duke of Cambridge in the chair. During the evening
secretary announced donations and subscriptions
to £8409, including £200 from the Emperor of Genn*^ 1
£50 from the Emperor of Austria, £20 from the Chin®*®*
and £106 frpm the Corporation of the City of London*

Di.

O

THK LANCET,]

LIVERPOOL—EDINBURGH,

[April 80,1887. 905

LIVERPOOL.

{From our own Correspondent.)

HOSPITAL SATURDAY.

Saturday, May 7tb, is to be oar Hospital Saturday this
year, and two circumstances combine to give great interest
to this year’s collections. The first is the steadily growing
practice o£ making weekly collections among large bodies of
working men, the aggregate of which is realised on Hospital
Saturday. The second is the honest rivalry in this good
work which it is believed will be manifested this year
among the workmen belonging to the different trades. The
two circumstances will be enhanced by the improvement
which has been observed in some branches of trade, of which
it is hoped that the hospitals may feel the benefit.

THE LOCK HOSPITAL.

The hospital has been closed against all venereal cases, it
being required temporarily by the committee of the Royal
Infirmary, under whose management it is while the present
infirmary is being taken down and a new one erected. Mean¬
while many greatly needed repairs and alterations are being
effected, and when the new infirmary is completed the sur¬
geons of the hospital will be enabled to return to it with
mcreaaed comfort to themselves and their patients.

ANOTHER SWINO-BOAT FATALITY.

An inquest was held at St. Helens on the 25th inst. on
the body of a boy who was killed accidentally by a swing-
boat. It appeared that on the previous Saturday (23rd inst.)
he, with a large number of other children, were playing on
some land where were a number of whirligigs and swing-
boats. One of the occupants of a swing-boat which was in
motion having dropped his cap, the deceased ran to pick it
up, when he was' struck on the right side of the head by the
boat and picked up insensible vnth a fractured skull and
part of the brain protruding. He was attended by Dr. Reid,
but died the following day. The deputy coroner remarked
that “ accidents of this kind were so common that whereVer
swing-boats went coroners had to follow.” Some of the
jury suggested the putting of a rope or fence round the
boats, but the deputy coroner thought that the latter
should be suppressed altogether, in which opinion the jury
concurred.

8AD RESULT OF VIEWING A BODY,

A young man residing in Warrington went on the 24th
inst. to view the body of a woman which had been found
floating in the Saukey canal, under the impression that it
might be that of his mother, who had been from home for a
week attending to a sick relative. He was much excited
and impressed with what he saw, and, being somewhat
weak in mind, he became quite delirious and almost un¬
manageable. In spite of every precaution, he escaped from
the house, and subsequently was found drowned in a clay-
pit near.

A FATAL FOOTBALL ACCIDENT.

An inquest was held at Widnes to-day on the body of a boy
aged twelve, who died on Saturday last from the effects of
akick on the shin, received while playing football on the
llthinst. He did not complain until the following day,
and medical advice was not sought until the 19th inst.

Liverpool, April 86th._

EDINBURGH.

{From our own Correspondent.)

UNIVBBBITY GENERAL COUNCIL.

The statutory half-yearly meeting of the University
Council held last week was of a more than ordinarily in¬
teresting character. Of late there have been evidences that
this body, composed of the graduates of the University, is
increasingly anxious to assert its right of forming an in-
teRral part of the University polity, and of exercising such
powers as legally belong to it in shaping the course of
academic development. As it was understood that questions
affecting these subjects were to be discussed at the meeting,

the attendance was a large one; the professoriate in par¬
ticular, showing much greater interest than usual in the
proceedings, was largely represented. The first business of
the meeting was a communication to the Chancellor from
the Prince of Wales in regard to the Imperial Institute
scheme, placing its advantages before the members of the
University, and bespeaking their personal interest in its
support. A resolution was unanimously adopted that a
loyal address should be presented to the Queen, congratu¬
lating Her Majesty on the jubilee of her accession about to
be happily celebrated. The next business was the appoint¬
ment of an assessor to represent the General Council in the
University Court, the supreme, governing body of the
University. This office is now vacant through the lamented
death of Dr. Rutherford Haldane. Sir Alexander Christison
and Dr. Heron Watson were nominated for the office, and
a division was at once taken. There voted for the former
70, and for the latter 63; but the result of the vote was
challenged by Dr. Watson’s propoeer, who requested a poll of
the whole constituency. This was agreed to. After a dis¬
cussion on some proposed changes in the system of arts
graduation, an important question touching the representa¬
tion of the University in the General Medical Council was
raised, and very warmly discussed. It was contended, and
put in the form of a recommendation to the University
Court, that the Court should memorialise the Government
that the term “University,” as used in the Medical Act in
regard to the election of a representative on the General
Medical Council, should signify the “ Council,” including all
University graduates, and not the “Senatus,” as it has been
till now interpreted. A somewhat stormy discussion
ensued, in which Sir William Turner appeared as the
champion of the interests of the Senatus. In a somewhat
melodramatic scene, in the face of considerable dissent and
interruption, he iterated and reiterated the statement that
“ the Senatus Academicus is the administrative body of the
University under the Universities Act.” By a reference to the
mode of Representation of other bodies, he showed that all
analogy was in favour of the election of the representative
by the Senatus. Ultimately his amendment to the original
motion recommending to the Court the consideration oi the
sound interpretation of the Universities and Medical Acts
in the point raised was accepted by the Council.

THE COUNCIL A8SKS80RSHIP IN THE UNIVERSITY COURT,

Owing to the nomination of two candidates for this im¬
portant office, an active canvas in behalf of both is now
proceeding, and the voting papers have been already issued.
The election ends on May 10th, before which date the ballot
papers must be returned to the University registrar. Both
Sir Alexander Christison and Dr. Heron Watson are so well
known and widely esteemed, and each in many points of
view is so well qualified for the office, that the contest is
fraught with an unusual degree of interest, and public
opinion is strongly divided in the matter. The question of
general politics fortunately doee not enter into the contest,
nor is there any element of rivalry as between two of the
learned professions, as both candidates are distinguished
graduates in medicine; but the issue at stake is for the most
part one of the balanoe of power between two bodies in the
University, for Sir Alexander Christ! son is as closelyidentifled
by his antecedents and in his nomination and support with
theBenatus and an oligarchical system of university adminis¬
tration, as is Dr. Heron Watson by bis position as a suc¬
cessful extra-mural teacher and his advocacy of an expanded
system of professional education with the University Council
Association and with university reform. This issue is, of
course, one that has long been pending, and one in which in¬
creased interest has been from time to time developed bypass¬
ing events; but it is brought into special prominenoe at the
present time by the fact that the new Universities Bill is
now being drafted and will shortly be before Parliament,
whence the absolute importance to all parties of as strong a
representation as possible of their specific requirements at
the governing board of the University.

GOVERNMENT AID FOR SCIENTIFIC RESEARCH.

During a recent visit of Lord Lothian, the Secretary for
Scotland, to Edinburgh, he was interviewed by & deputa¬
tion of scientific men representing the Royal Society
of Edinburgh in regard to the position of science in this
country, ana the almost complete absence of Government
subsidies for its support. Sir William Thomson introduced
the deputation and spoke on the general question of Scottish

Digitized

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006 The Lancet,]

DUBLIN.

[Apetl 30,1887.

claims, pointing out the extraordinary inequality in the
grants under the present system as furnished to Scotland
and England. To put the matter practically, he suggested
that his lordship should claim an annual grant of £2000 for
Scotland, one-tenth of the sum annually administered in
London. He was supported by Mr. John Murray and Pro¬
fessor Chrystal, who drew particular attention to the
establishment of the Ben Nevis Observatory under the
auspices of the Edinburgh Royal Society, and to the unique
and valuable work that it has accomplished. Lord Lothian,
in reply, admitted the very reasonable nature of the request,
and he asked them to prepare a memorandum setting forth
their views on the matter, which might be of service to him
in approaching the Treasury on their behalf.

UNIVEBSITY GBADUATION CEBBMONIAL.

The Annual Graduation Ceremonial in the Faculties of
Arts, Law, and Divinity took place on April 20th, when,
after a number of honorary degrees had been conferred and
the new graduates capped by the Vice-Chancellor, Pro-
feesor Campbell Fraser delivered an address to the graduates
on “Recent and Prospective Reform in the Faculty of
Arte.” His historical sketch of the progress of the Univer¬
sity during the last quarter of a century was the tale of
one who has studied and largely aided in the unfolding of
each stage of the development that he now narrates. In
looking to the future, he trusts that the proposed commission
will inaugurate an epoch of still further development, and
he indicated ways in which this might be aided, in an
expansion of the Arte curriculum.

Edinburgh, April 26th.

DUBLIN.

( From, our own Correspondent.)

DUBLIN HOSPITALS COMMISSION BBPOBT.

This report has at last become public, and is a voluminous
one, extending to over fifty pages. It enters fully into the
constitution and management of a large number of the
Dublin hospitals. The annual Parliamentary grant amounts
to £15,850, and of this £7600 is allocated to the Richmond
Hospital. This sum was originally granted on the recom¬
mendation of a former commission, on account of its great
educational advantages, and because a medical school was
attached. The latter, however, has been removed, while
other hospitals now provide students with means of clinical
instruction. The Commissioners consider that there is great
urgency for providing additional accommodation for the
inmates of the North Dublin Union, and that in the event of
their recommendation with reference to the future appli¬
cation of the Parliamentary grant being adopted, the
Richmond, which would cease to be a State-supported
institution, should be appropriated for the purposes of the
Union. They consider Steevens’ Hospital to be well managed,
and the nursing arrangements to be exceptionally good. As
regards the Meath Hospital, the power exercised by the
physicians and surgeons to elect to vacancies on the staff
was only conferred formerly on the medical staff in con¬
sideration of certain rights which were relinquished, and
the hospital being a county infirmary, there should be no
distinction made between it and other county infirmaries in
this important particular of management. They also state that
the grant of £600 wae fixed by the Select Committee on the
condition that it should bo devoted to the support of fever
beds; and on tbese grounds they reoommand that the grant
should be withdrawn. The report speaks of the world-wide
reputation of the Rotundo Lying-in Hospital; but states
that the subscriptions, which are chiefly from the Protestant
portion of the community, might be capable of considerable
expansion if a larger proportion of Roman Catholics were
on the Board of Governors. They consider the limiting the
masters tenure of office to seven years as radically bad;
while they disapprove of the practice of exacting a fee from
the assistant master, which obliges him to purchase his post.
The charter of the Coombe Lying-,in Hospital limits the
governors to 21, and it appears that several members of the
present board do not subscribe anything to the funds of
the institution. Here, also, as in the Rotundo, the assistant
masters pay the master for the appointment. There is only
one assistant, the fact being, they assume, that there are very

few willing to pay the fee which the master requires. TheCom-
missioners do not think the grant will be continued to the
Westmoreland Lock Hospital, and observe that there are bus
two ways in which it can be supported by private charity
or local rates. They consider that the grant (£2600) to Cork-
street Fever Hospital cannot be defended from the point of
view from which the institution must be regarded ever
since legislation has imposed upon local bodies the respon¬
sibility of providing against the spread of infectious disease.
The Commissioners also consider that the grant to the Hos¬
pital for Incurables cannot be justified, as institutions of
the kind have no claim for support at the bands of tbe
general taxpayer. The purchase system for posts on the
medical staff which exists in Jervis-street Hospital is con¬
demned, and the nursiDg arrangements are not satisfactory.
In Sir Patrick Dun’s the arrangements for the isolation of
fever cases are very imperfect, but the general state of the
hospital is one of high efficiency. The purchase system
which exists at the City of Dublin Hospital is referred to;
while the nursing arrangements are stated to be admirable.
In reference to Mercer’s Hospital, the Commissioners 6tate
that tbe existing corporation has practically been confined
to the medical staff, who seem to have regarded the lay
governors as merely lay figures, as a result the purchase
system in its worst possible form exists in this insti¬
tution. The Commissioners do not consider in detail
the voluminous evidence to which they were obliged
to listen, because the replies which had been fur¬
nished to their queries had never been considered by the
board, and were often upheld by one witness and contra¬
dicted by another; while, in the next place, the evidence as
a whole presents such a melancholy picture "of the relations
subsisting between certain members of the medical staff, as
well as of the internal organisation of the institution, that
no good will result from making them more public than
they have been made by the evidence itself. I hope on
another occasion to refer to the conclusions of the Com¬
missioners, and the various suggestions put forward by
them in distributing the Parliamentary grant on more
equitable principles than those at present adopted.

LOYAL COLLEGE OF 8UBGKONS.

As'pointed out on a previous occasion, those candidates
going in for the First Professional Examination next July
have been very anxious to find out whether they will be
classed for examination under the scheme which has up to
this been in operation, or by the proposed conjoint scheme
between the two Colleges. It is not altogether the subjects
bat the curriculum that has puzxled candidates, for under
the conjoint scheme candidates require courses in practical
chemistry, practical pharmacy, and materia medica, none of
which are necessary under the ordinary scheme of tbe
College. The Council have seen this difficulty, and last week
passed a resolution recommending that students should be
admitted to the First Professional Examination next July, on
the present curriculum of the College. This must of neces¬
sity be ratified by the College of Physicians and the
Managing Committee of the two Colleges, but it is expected
that it will be carried out. I am informed that Mr. Austin
Meldon will be a candidate for the vice-presidency of the
College in June, 1888. Mr. C. H. Robinson, at present an
examiner in materia medica, has intimated his intention of
being a candidate for an examinership in anatomy at tbe
annual election of examiners, which usually takes place on
the first Monday in May.

BANQUET BY SIB WILLIAM 8TOKE8.

The banquet given in celebration of ner Majesty’s Jubilee,
by the President of the Royal College of Surgeons in Ire¬
land, on Saturday evening last, was in every way a decided
success. About 120 gentlemen sat down to a sumptuous
repast in the Albert Hall of the College, which was hand¬
somely decorated with flags and flowers. The various toasts
were given by Sir William Stokes with his usual eloquence
and good taste, and all present were charmed with the
manner in which be discharged the onerous duties apper¬
taining to the position of host. The mbiu cards contained
a portrait of Her Majesty and the arms of the College, and
were in every way appropriate to the occasion.

THE BOYAL UNIVF.BSITY.

A petition from tbe graduates and undergraduates to the
Senate, to allow this year’s Pass in honour of Her Majesty 8
Jubilee, will shortly be presented. It is, I believe, only in -
twrted for Alts Students, and as the University of Dublin

The Lancet,]

DUBLUf.—PARIS.

[April 30,1887. 907

has already granted this concession, it is felt that the Senate
of the Royal University may very fittingly agree to the
prayer of the memorialists. From the fifth report, which
has just been presented to Parliament, 1 learn that daring
the past year the total number of persona who presented
themselves for examination at the Royal University was
2983, or an increase of 43 over the previous year. Lady
students obtained various distinctions, 9 taking degrees and
4 honours. The Senate draw attention to the subject of the
maintenance of the buildings whioh have been partly pur¬
chased and partly erected by the State, and which they
consider ought not to be chargeable from the endowments
which are for certain academic purposes. Owing to failure
of revenues, the “ Dr. Hutchinson Stewart ” Scholarships
cannot be awarded this year.

ACADEMY OF MEDICINE IN IRELAND.

A meeting of the Fellows was held on Tuesday last, Dr.
McDonnell in the chair. It was resolved, by a majority of
fifty-four to three, that the title of the Academy should in
future be “The Royal Irish Academy of Medicine”; audit
was decided to present an address to Her Majesty con¬
gratulating her upon the celebration of her Jubilee.

FRACTURE OF THK SPINS.

At a meeting of the Surgical Section of the Academy of
Medicine in Ireland last week, Mr. Edward Hamilton exhi¬
bited two cervical vertebra which presented peculiar
characters. A young man had fallen over a wall of about
twelve feet into the soft mud of the river Liffey, and died
twenty-one hours after removal to hospital. On post¬
mortem examination the fourth and fifth cervical spines
were found fractured, and also the bodies of the same
vertebra in a vertical direction. That such extensive
injuries should have occurred by a fall from such a trifling
height on to soft, muddy ground appears unaccountable.
At the same meeting Sir William Stokes showed a girl who
had been operated on by lateral thryoidectomy.

Dublin, April 26tii.

PARIS,

(From our own Correspondent.)

ANTIPTRIN AS AN ANODYNE.

At a recent meeting of the Academy of Sciences, Pro¬
fessor Germain Sde made a communication upon “The
Treatment of Pain by Antipyrin.” This substance, which
was discovered by Knorr in 1384, was first employed, as its
name implies, for lowering the temperature, and it was
expected that it would prove useful in typhoid fever,
articular rheumatism, and other acute affections. It has
not, however, been as satisfactory in its action as was antici¬
pated, and if the- temperature can be by its use lowered at
■will, it does not seem to exercise much effect upon the process
of disease. But according to M. Germain S<5e, antipyrin
is the remedy, par excellence , for pain, and far superior in
every way to antifebrine. In fifteen cases of subacute
rheumatism, or hydrarthrosis, treated unsuccessfully by
salicylate of soda and ignipuncture, the pain and swelling
disappeared in a few days, and, the medicine being con¬
tinued, there was no relapse. The same effect was
observed in cases of acute gout, both primary and
secondary to chronic gout with chalky deposits. Antipyrin,
to the extent of from 60 grs. to 90 grs. a day, removed
both pain and swelling in from two to four days without
any bad effect either on the heart or kidneys. But it is,
above all, in nervous pain that its action is most remarkable.
A first group comprises four cases of facial neuralgia, one of
^mch was inveterate, six of migraine, with one failure, and
tour headaches, la a second series are classed five cases of
sciatica, one of simple neuritis, two of diabetic neuritis, and
two of neuritis with zona (one failure). Cases of lumbago and
muscular rheumatism make up a total of eighteen. The
third category relates to five cases of locomotor ataxia, in
^hicn the pains were removed by antipyrin. In
the fifth instance it failed, as did also antifebrine. The last
8toup comprehends those affections of the heart, aorta, and
? oro ?mry arteries iu which angina is a most painful symptom,
with* w ‘th cardio-aortic disease, and in three others

Jtth aneurysm, the painful manifestations disappeared eu-
ireJ y, Without any evil effect being caused by the medicine

on the strength or regularity of the cardiac pulsations.
The dose given by M. 8tSe is from three to six grammes daily.
If too much is given at one time, nausea and giddiness may
supervene, but when the whole amount is divided into
small repeated doses of half a gramme, no disagreeable
effects are observed. Antipyrin may be given and con¬
tinued for a length of time with but little risk. Antifebrine,
on the other hand, is dangerous when administered in doses
exceeding one gramme. It causes hemoglobin to pass into
the condition known as metahsemoglobin, and the blood
losing part of its oxygen becomes of &' chocolate colour,
cyanosis and collapse being the consequences. From labora¬
tory experiments it is found that reflex excitability - to
electricity is diminished by autipyrin, and the sensory
perceptivity of the cord is lessened.

TREATMENT OF DIABETES.

A few weeks back M. Martine&u created a sensation in the
medical world by the publication of the results obtained by
him with his “specific” for diabetes,and since then we have
all been prescribing arsenicated lithia water. Dr. Le Blond
now makes known a rival treatment, which, if not precisely
new, is novel in its mode of application, and from which he
has obtained some remarkable results. The administration
of oxygen in the form of peroxide of hydrogen has often
been tried, but, although it wouM seem theoretically to be
the ideal treatment for glycosuria, results have not been
sufficiently constant to popularise it. M. Le Blond has
reopened the question, and advises the administration of an
aerated water which has been manufactured In Paris for the
last few years, and which only differs from the familiar
siphon in that it is gaseous from oxygen instead of carbonic
acid. Three cases are reported, in whioh the treatment
caused the total disappearance of sugar from the urine; in
a fourth the partial failure was due to imperfect oxidation
from chronio bronchial catarrh.

m. pasteub’s treatment.

M. Pasteur has returned to Paris in good health, and was
warmly welcomed by his colleagues at the last meeting of
the Academy of Sciences. On this occasion a communica¬
tion was made concerning two stablemen in the employ of
M. Charles de Lessepe, one of whom had been licked by a
mad dog, and cured by auti-rabic inoculation. His fellow-
servant was bitten, and having neglected this precaution,
died of rabies. In my account of the case of Hamyau the
dose of pilocarpine given daily is reported to be fifteen
grains. This is a misprint for one-fifth of a grain.

MORPHTNOMANIA IN MONKEYS.

Experiments have hitherto tended to show that animals
did not acquire the so-called morphia habit. Rabbits to
which morphia is administered for months in enormous
doses, as much as eight grains per day, bfar the sudden sup¬
pression without any evidence of discomfort. But it would
appear from a memoir eent by Dr. Jammes of Cambodge to
the Academy of Scienoes that this is not the case with
monkeys. When these live with opium-smokers, and have
become accustomed to a medicated atmosphere, they acquire
a taste for the poiRon. One monkey, for instance, would
wait until its master had laid aside his pipe, and would then
take it up and smoke what remained. It not allowed to do
so for several days, it would fall into a state of depression
and stupor, which disappeared as soon as the stimulant was
supplied. I dare say some of your readers will remember a
monkey at the Zoological Gardens which had been taught
by the keeper to smoke tobacco.

TREATMENT OF GRAVE EPISTAXIS.

M. Verneuil, who, although one of our most eminent
surgeons, makes frequent incursions into the domain of
pure medicine, read a communication at the Academy of
Medicine upon the treatment of certain forms of epistaxis
by counter-irritation over the region of the liver. M. Verneuil
began by stating that be had at first thought that the
method was entirely his own, but from bibliographical re¬
search it turned oat that he had been anticipated to a certain
extent by Galen, who says that luge cupping glasses applied
to the hypochondria arrest nasal hemorrhage. In the first
case related by M. Verneuil, the epistaxis was probably
symptomatic of cirrhosis of the liver. Quinine, ergotine,
and digitalis had all been tried in vain. The hemorrhage
continued to recur at intervals. The second patient bad
suffered from nasal hemorrhage, which seemed to have
been caused by the shock of a kick from a horse. In this

LV_

908 The Lancet,]

ROYAL COLLEGE OF PHYSICIANS.—OBITUARY.

[April 30,1887.

case plugging had failed. The third was the subject of
chronic nephritis, with secondary affections of the heart
and liver, and the cavity of the nose had been plugged
without effect both with ergotine and perchloride of iron.
M. Verneail’s treatment, which was immediately and per¬
manently efficacious, consisted of the application over the
region of the liver of a large blister.

Paris, April 27th. _

ROYAL COLLEGE OF PHYSICIANS.

A Comttta of the College was held on Thursday last, the
28th inst., the President, Sir W. Jenner, Bart., in the chair.
The chief business was the election of new Fellows. The
following were chosen: —George Oliver, M.D. Lond., Harro¬
gate; Robert Cory, M.D. Cantab., Lambeth Palace-road, S.E.;
Henry Radcliffe Crocker, M.D. Lond., Welbeck-street, W .;
Frank Buszard, M.D. Lond., Northampton; Robert Saundby,
M.D. Edin., Birmingham; Charles James Cullingwortb,
M.D. Durb., Manchester ; ffm. Julius Mickle, M.D. Toronto,
Bow, E; George Allan Heron, M.D. Glasgow, Harley-
street, W.; James Anderson, M.D Aberdeen, Wimpole-
street, W.

There were also admitted as Members—D. Burgess, M.B.,
Jas. Calvert, M.D.,. Thos. Johnstone, M.D., and T. F.
Pearse, M.D.

Licences were granted to the ninety-two candidates who
had passed the recent examination.

Communications were read from students of the West¬
minster Hospital, of Charing-cross Hospital, and the London
Hospital, containing resolutions in support of the granting
of degrees by the Royal Colleges. These were referred to the
Committee of Delegates.

The text of the address to Her Majesty on the occasion of
her Jubilee was read and approved.

The Quarterly Finance Committee submitted their report,
which contained a recommendation that the stipend of the
Registrar be raised to the sum of 600 guineas. The proposal,
moved by Sir E. Sieveking, seconded by Dr. flare, and
supported by Dr. Quain and the President, was received
with much applause; and the President expressed the sense
of the College in stating that neither. money nor thanks
could repay the debt which the College owes to Sir Henry
Pitman. Sir Henry acknowledged the vote in feeling terms,
and took occasion to present the College with a volume
which he had compiled, to replace the only volume of the
College annals (viz., 1771 to 1781) that is missing from the
long series.

ALFRED MEADOWS, M.D., F.R.C.P.

We briefly adverted last week to the death of this well-
known obstetrician, which took place at the early age of
fifty-five, after a short illness. A familiar figure will be
missing from our midst. A name which designated a
physician especially esteemed by the public drops from
the roll of contemporary practitioners.

Dr. Meadows was born at Ipswich, and received his
medical education in King’s College, London, where his
energy and zeal in the study of his profession were early
recognised. He speedily took an advanced place amongst
the students of his year, and filled the office of resident
obstetrician at the hospital with distinction. He early
showed considerable literary ability, and as a student
edited the Transactions of the King’s College Medical
Society. He took the M.B. bond, in 1867, the M.D. in 1868,
and became F.R.C.P. in 1873. The appointments which he
held at various periods of his career were numerous, in¬
cluding that of physician-accoucheur to the St. George’s and
St. James’s Dispensary, assistant-physician for diseases of
women and children at King’s College, physician to the
Hospital for Women, Soho-square,and physician-accoucheur
to the General Lying-in Hospital. At the time of his
decease he held the appointment of physician-accoucheur to
St. Mary’s Hospital, an office to which lie had been elected
without competition on the resignation of the late Dr. Tyler
Smith. His death has occasioned a profound feeling of

regret amongst his colleagues at the hospital, who fully
appreciated his ability, and have reoeived a great shod
from his sudden and untimely end. Besides being an
honorary member of numerous foreign societies. Dr. Meadows
obtained a Commandership in the Order of Was a of Sweden,
and in his own country was made a justice of the peace for
the county in which he possessed a country house—Pojle
Manor, Colnbrook, Bucks.

Dr. Meadows was distinctly a man of exceptional ability.
Not only did he achieve a great success in the department
of practice which he had chosen whilst yet a student, but
in various directions he evinced power of no ordinary kind.
Early in his career he published a “ Manual of Midwifery,'
which has been widely read. This was followed by die
“Prescriber’s Pharmacopoeia,” a pocket oompanion of a
handy kind. About the year 1860 or 1861 he commenced to
edit a monthly journal of medicine called the London
Medical Review, which enjoyed a considerable success for a
few years. It was characterised by a great spirit of fairness,
and the articles, which were contributed by many old
friends and fellow-students of the editor, were in advance
of the more usual examples of critical composition.

Besides enjoying a lucrative practice, Dr. Meadows was
also, at least m the more recent part of his career, possessed
of good private means. This circumstance, far from inter¬
fering with his energy, appeared to intensify his zeal for
the profession to which he was passionately attached. With
a strong religious bias, he lost no opportunity of endeavouring
to forward the interests of the Guild of St. Luke, in the
formation of which he took the most prominent part. Dr.
Meadows was also well known as an energetic Freemason.
He was a past officer of the Grand Lodge of England, and
was connected with several private lodges. He took one of
the most active parts in founding the University of London
Lodge, and it was largely due to his influence that so many
members of our profession joined it. After Berving in the
Wardens’ chairs he became the Master of the Lodge, which
post he held at the time of his death. At bi3 country house
he showed great artistic taste in the decorations and fur¬
niture, whilst the completeness which distinguished all his
arrangements for comfort and elegance proved the untiring
energy which he was accustomed to throw into every
subject which engaged his attention.

Dr. Meadows had a good address. He was of kindly
nature, hospitable, strongly Conservative in politics, and
much attached to his patients. He was a good operator and
an ingenious mechanician. Unlike so many members of his
profession he was an excellent man of business, and as
chairman of a meeting he was unsurpassed by any of his
contemporaries in our ranks.

Dr. Meadows leaves a widow and a daughter. He was
buried on Saturday last at Colnbrook, his funeral being
attended by a very large concourse of friends.

CHARLES JAMES BRACEY, M.B.

We record with regret the decease of Mr. C. J. Braoey, of
Birmingham, which occurred on April 21st at the residence
of a relative near London, in the forty-ninth year of his
age. Mr. Bracey was the son of an esteemed Birmingham
surgeon. He pursued his studies at the Queen’s College and
General Hospital, Birmingham, and subsequently at Kings
College, London, and in Paris. He took the M.B. of the
London University in 1861, and carried off the University
Exhibition and Gold Medal in Surgery, taking in addition
high honours in Medicine and Midwifery. Returning to
Birmingham, he was medical tutor at the school for two
years, and afterwards house-surgeon at the General Hospital-
He subsequently became Professor of Anatomy in Queen*
College, surgeon to the Children’s Hospital, and surgeon to
the Hospital for Women. At this time no surgeon in Bir¬
mingham stood so well for attaining the first position as *
consultant, for which by education, by experience, and by
address Mr. Bracey was so eminently fitted. But the state
of his health, never very robust, warned him about ten
years ago that he must give up public work and the
anxieties and responsibilities of operative and consulting
practice. Mr. Braoey then devoted himself to his practice,
which was of the highest class, and even then he had to
recuperate by rest and frequent sea voyages.

The deceased gentleman had for the last eighteen months
suffered from retention of urine, due to prostatic disease,
and a few weeks ago he decided to go up to London t«
place himself under the care of his friend Mr. Page 01

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Diqitizec

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OBITUARY.—MEDICAL NEWS.

[April 30,1887. 909

Mary’s Hospital, who successfully removed a large
mber of proatatic calculi. The operation was most
isfactory,, and for three weeks he seemed to go on
ourably, and, the wound having healed, he was removed
m town and went to stay at the residence of a relative
iparatory to taking a voyage to the Canary Islands. He,
wever, suffered from increasing vomiting, which had been
>re or less troublesome since the operation, and sank from
iaustion nearly a month after its performance.

Che chajm of Mr. Bracey’s disposition and manner, the
Iture of his mind, and the tenderness of his heart will
long held in loving memory by the circle of friends
io knew him intimately—a circle limited by the require-
snts of his health only, for no professional man in
rmingham would have been more welcomed by every
.ss. By his professional brethren and by his patients he
is held in the deepest respect and closest affection, and
i early death has caused a blank in the profession in
rmingham. _

THE CHEVALIER FELICE GALLONE.

Tbtr Royal Household of Ttaly baa just lost an old and
listed medical adviser in Dr. Gallone, who died in Rome
l April 21st, in his seventy-third year. He qualified in the
3ummi in Medicina Honores ” in the University of Turin,
id at once devoted himself to the practice of his profes-
do. In 1854, when the cholera epidemic was numbering
any victims in the sub-Alpine capital, he exerted himself
ith so much courage, skill, and success, that the then King
ictor Emanuel decorated him with the Cross of SS. Maurice
id Lazarus, while he also received the gold medal for
good service in the cause of public health.” Following
le Royal household to Rome in 1870, he there continued
ie practice of his profession, winning the esteem of all his
^leagues and earning the gratitude of the august clientele
> which his official connexion with the Court introduced him.

IPK&intl ffefos.

Royal Colleges of Physicians and Surgeons of

DINBURGH AND FACULTY OF PHYSICIANS AND SURGBONS

f Glasgow. —At the April sittings of the examiners, held
i Glasgow, the folio wing candidates passed the final exami-
ation tor the triple qualification:—

Adle. Alfred A.. Glasgow- Kapadla, S. A., London.

Brodie, James, Edinburgh. M'Lean, Alfred Jos.. St. Helens.

Bowker, C. S., A^jpleby Magna. Marquis, A. F. 0., Glasgow.

Clark, George A., Southsea. Rutherford, V. H., Newcaitle-on-

Cooper, W. F., Birmingham. . Tyne.

Davis, George W., Liverpool. 8mlth, Henry, Glasgow.

Huntley, Edith Ara, St. Albans. ; Williams, W. A. G., Carmarthen.

Society of Apothecaries.— The following gentle-

oen, having satisfied the Court of Examiners as to their
mowledge of the Science and Practice of Medicine, Surgery,
nd Midwifery, received certificates entitling them to
iractise as Licentiates of the Society on April 21st:—
Hensley, Arthur Egerton, Parkham Rectory, Hldeford.
Harris-'Llaton, Llewellyn, Cambridge House, 8t. John’s.

)n the same day eleven others were admitted to exami¬
nation, of whom three passed in Surgery and seven passed
is Assistants.

The Prince of Wales has intimated his intention
)f visiting Great Yarmouth on the 18th prox., when the
ouadation stone of a new hospital is to be laid.

The annual Hospital Sunday demonstration of the
Irantham Friendly and Trade Societies has been fixed for
ihe 15th prox.

Westminster Hospital Medical School. —Hr.
-barlea Mercier has been appointed to give a course of
lectures on “ Neurology and Alienism ” at this medical school
m the winter session.

The foundation’stone of the Merthyr Tydvil General
. ®Pjtal is to be laid on June 21st, and the Marquis of Bute
will be invited to perform the ceremony.

the last meeting of the Hospitals Committee of
the Manchester City Council, it was resolved to accept a
tender for the erection of an infectious diseases hospital for
the sum of £13,937.

Presentation. —On the 16th inst. Mr. J. F. Little
was presented with an illuminated address and an oak
casket on the occasion of his leaving Ilkley for the south of
England.

The City Council of Worcester have adopted,' by
30 to 8 votes, a scheme of sewage disposal by means of
precipitation works at Diglee, prepared by Mr. Thomas
Hawkeeley. The estimated cost is about £40,000.

Legacies and Donations.— A legacy of .£50,
bequeathed by the late Mr. Joseph Borman, has been re¬
ceived by the treasurer of the Lincoln County Hospital.—
The late Mr. Benjamin Lancaster of Bournemouth, who
died on the 16th ult., has bequeathed £1000 each to St.
George’s Hospital and the Brompton Cancer Hospital, and
£500 each to the Middlesex Hospital, King’s College Hospital,
the Consumption Hospital, Brompton, and the Hospital for
Incurables, Putney.—Air. R. A. Newbon of Islington has

S 'ven £1050 to the Great Northern Central Hospital, with
e object of endowing a bed in the new establishment.
In order to complete the building a sum of £46,000 is
required; only £10,000 has as yet been subscribed.

At a meeting of the subscribers to the Dartmouth
Jubilee Cottage Hospital scheme on the 22nd inst., regret
was expressed at the smallness of the support afforded to
the project, but it was ultimately agreed to hire a building
and commence operations, the expenses of the hospital
-being limited to £160 annually.

The Abuse of Medical Charities. —The Glasgow-
Medical Charities Committee, appointed at the public meet¬
ing of practitioners in the Faculty Hall on the 30th ult.,
met on Friday, the 22nd inst., and, having appointed Pro¬
fessor James Morton, M.D., chairman, and Dr. Edward
McMillan vice-chairman, and the other office-bearers and
members of the executive, proceeded to consider the initial
steps of dealing with the whole question of the abuse of
medical charities. Professor Gairdner strongly advised a
conference with the Charity Organisation Society, as being
in possession of the beat possible information regarding the
abuse of charitable institutions and the most successful
means of dealing with it. Ho was of opinion that while the
out-door cases should be seen for the first time, the Services
of that Society might be obtained for the purposes of in¬
vestigation. Dr. Erskine spoke of the importance of intro¬
ducing the lay element into the committee, and it was
proposed to invite the managers of the various medical
charities to confer with the committee and become members
of it. Other important points were afterwards considered.
The Secretary (Dr. Robb, Carlton-place), who was desired
to obtain information from other towns in England and
Scotland where reform of charitable medical institutions has
been effected or is under consideration, will, we under¬
stand, thankfully acknowledge all suoh which may be
addressed to him.

The Levee. — The following members of the
medical profession were presented to the Prince of "Wales
at a letie held on the 25th inst. at St. James’s Palace
by His Royal Highness on behalf of Her Majesty:—
Surgeon-Major W. R. Brunton, 1st Surrey Rifles; Dr. T.
Vincent Dickinson; Dr. James Ellison, surgeon to Her
Majesty’s Household at "Windsor; Surgeon Alfred Thomas
Irvine Lilly, Army Medical 8taff; Dr. David Nicol-
son, superintendent of the State Asylum, Broadmoor;
Dr. C. V. Stanford; Sir James Sawyer; Surgeon W.
Henderson Starr, Army Medical Staff; Surgeon Walter
Tytheridge, 12th Middlesex (Civil Service) R.V. AIbo the
following members of the Naval Medical Service:—Surgeon
J. E. Coad, M.B.; Surgeon W. J. Colbome; Surgeon G. F.
Collins; Surgeon G. T. Collingwood; Surgeon C. Dickinson;
Surgeon E. Griffin, M.D.; Surgeon II. St. D. Griffiths;
Surgeon R. Bardie, M.B.; Surgeon J. D. Hughes; Surgeon
H. Holyoake ; Surgeon J. A. Moon ; Surgeon J. D. Menzies,
M.B.; Surgeon R. Miller, M.B.; Surgeon J. Moore; Surgeon
Charles Strickland; and Surgeon J. W. O. Underhill, M.B.
The following members of the medical profession also
attended:—Drs. James H. Aveling, Argyll-Robinson, T. B.
Christie, C.IJB., Grainger Stewart, C. A. L. Robertson, J.
.Wickham Legg, D. F. Phillips, P. Heron Watson, and
Messrs. Berton (Acting Surgeon) andT. J. Haran (Inspector-
General, R.N.). [The above list, though carefully compiled,
may possibly not be qnite complete. Any names which may
have been inadvertently omitted will, however, be published
in our next, if intimation be given to us to that effect."!

910 The Laxcet,] MEDICAL NOTES IN PARLIAMENT.—APPOINTMBNTS.—VACANCIES. [April 30,1887.

The Prince and Princess of Wales will open the
new buildings of the London Hospital at 6 o’clock on the
21st prox.

University Colleqe Hospital. —A public dinner
in aid of the funds of this charity was held on Wednesday
last, the Right Hon. Q. J. Goschen, M.P., in the chair.
After the usual loyal toasts had been honoured, Mr. B. L.
Cohen proposed "The Houses of Parliament,” and Mr. R. G.
Webster, M.P., responded. Mr. Goschen, in proposing the
toast of the evening, was very happy in his comparison
between the nation and the institution; both alike had
debts and liabilities, and an inelastic revenue. Dr. Russell
Reynolds proposed “ The Hospital and Medical Com¬
mittees,” whicn was replied to by Captain Douglas Galton
•and Dr. G. V. Poore. The dinner was successful, £1885
having been announced by Mr. N. H. Nixon, the secretary, as
the amount of subscriptions,

University of Oxford. —The following notice to
candidates intending to offer themselves for either of the
examinations for the degree of Bachelor of Medicine has

I ust been issued by the Regius Professor of Medicine, Sir
lenry W. Acland(1) The Pinal Examination to be holden
in Trinity Term next will by statute, and under the Medical
Act, 1886, be an examination qualifying successful candi¬
dates, first, for the degrees of Bachelor in Medicine and of
Bachelor in Surgery; and, secondly, for the registering of a
complete qualification in Medicine, in Surgery, and in Mid¬
wifery. (2) That the Pinal Examination tor the degrees of
Bachelor of Medicine and Bachelor of Surgery will begin in
the first week of Trinity Term—i.e., on Tuesday, May 31st.
(3) That an examination for the degree of Master in Surgery
will be holden during the same week. (4) That the First
Examination for the degree of M.B. will begin at a later
date during the Trinity Term—viz., on Monday, June 27th.
Also the Secretary to the Boards of Faculties has given
notice that, in accordance with the statute, names of candi¬
dates for the Second or Pinal Examination for the degree of
Bachelor of Medicine must be sent in to him not later than
May 14th; and for the First Examination for the same
degree not later than June llth. All candidates, in giving
in their names, are required by the statute to pay the fees
for admission and to produce the required certificates.

MEDICAL NOTES IN PARLIAMENT.

The Pistcur Treatment.

Ix the House of Commons on the 25th Inst., Mr. W. M'Laren asked
the Secretary of State for the Home Department whether It waa a fact
that a constable of the Nottinghamshire police, and two constables of
the metropolitan police, were sent to M. Pasteur for treatment last
year; whether any of them were sent at the public expense; whether,
considering the number of deaths that had attended M. Pasteur's
treatment, he would use his influence to prevent any more public
servants being subjected to it, or public money being spent upon it,
until the Buisson Vapour Bath system, which could be obtained in
England, had been thoroughly investigated ; and whether, as a Com¬
mittee had been appointed to investigate M. Pasteur's system, he
would appoint another Committee to investigate the Buisson Vapour
Bath system of preventing hydrophobia.—Mr. Ritchie, In reply, said
that the Nottingham constable was sent at the cost of the county rates,
and the metropolitan police at a cost to the public of £227. The report
of the Committee appointed to inquire Into the Pasteur system had not
yet been received. It was not proposed to ask the Committee to extend
the Inquiry to the Buisson system, or to appoint another Committee of
Inquiry.

Aberdeen Infirmary and Lunatic Asylum Bill.

On the 27th Inst, this Bill was considered and ordered for third
reading. _

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. ■ ■ —

Armson, Frank Greaslny. M.R.C.8., L.S.A., has been appointed
Medloal Officer and Public Vaccinator to the Yoxall District of
the Lichfield Union, vice George Chapman, M.R.O.9., L.S.A.,
resigned.

Barling. A. 8., L.K.O.P.Lond., M.R.C.8., has been appointed House-
Physician to the General Infirmary, Leeds.

Caret, Basil de B., B.A.Gautab.. M.R.O.S.. L.S.A., has been appointed
Clinioal Assistant to the Hospital for Consumption and Diseases of
the Chest, Brompton.

Carter, D’Arcy B., M.R.O.8., L.R.C.P., baa been appointed

Surgeon to the Shipley and BccjoahLll Distrletof the Great Northern
Railway.

Donaldson, David Gilbert. M.B., C.M.Bd.. has been appointed
Parochial Medical Officer and Medical Officer of Health for Donning.
Perthshire.

Ellls, William Henry, M.H.O 8., L.8.A., has been appointed
Surgeon to the Shipley and BecleehiU District of the Great Northern
Railway.

Forsyth. Robert. M.D.GIaa.. ha* been reappointed Medical Ofloor of
Health for the Blrstal Urban District.

Fox. George Martix, L.R.C.P. Lond.. M.R.C.S., L.S.A.. baa been
appointed Resident Medical Assistant to the General Hoepltaf,
Birmingham.

Grimsdalb, Thomas Babixotox, B.A.. M.B.Cantab.. M.R.O.S.. has
been elected Honorary Assistant Medical Officer to the Shaw-street
Hospital for Women, Liverpool.

Holloway. William G., B.A., M.B.. M.R.C.S.. has been appointed
House-Surgeon to tho Hastings. St. Leonards, and Bast Soaeex
Hospital.

Jones. Johx J., M.B.. O.M.Glas.. has been apnointed Medical Oflfioer for
the Laughton District of the Rotherham Union.

Lillky, James Harris. M.A.. M.B. C*nf*b.. M.R.G.S.. lute been
unpointed Medical Officer for the Burghlll District of the Hereford
Uoion.

Macphersox, Alexander, M.D.Aber., has been appointed Medical
Officer of Health for Itasllngden, Lancashire.

Milxkr, B. T.. M.A., M.B.Oxon.. has been appointed Resident Medical
Officer at the Convalescent Hospital In connexion with the Mao-
cheater Royal Infirmary.

Nkvins. Arthur E.. M.B.C.S.. L.B.O.P.Kd.. has been a poo in ted
House-Phvnicfan to the Middlesex Hospital, vice Hedley Bartlett,
L.R.O.P.. M.R.C.8.

Oldham, Montague Williams, M.R.O.S., L.R.C.P. Lond., L.8.A., has
been appointed Onhthalmio and Obstetric House-Surgeon to the
Queen's Hospital, Birmingham, vloe T. Emery, resigned.

Smart. David. M.B., O.M.Ed., B.Re., has been elected Honorary
Assistant Medical Officer to the 8haw-street Hospital foe Woman.
Liverpool.

Tomlinson, W. H.. M.R.C.8.. L.8.A., has been appointed House-
Surgeon to the Oldham Infirmary.

Williams. Lionel, M.R.O.S.. L.8.A.. has been appointed Auirt.nt
House-Surgeon to the York County Asylum.

fatalities.

In compliance with the desire of numerous subscribers, it has been dec i ded to
resume the publication under this head of brief particulars of Ckc various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
adoertieement. - •

Gaxcer Hospital, Brompton, 8.W. — Assistant Hoose-Sorgeoo.
Appointment for six months. Salary at the rate of £35 per annum,
with board and residence.

Cextral Loxdox Ophthalmic Hospital, OrevVtnn-road, W.C.—
House-Surgeon. Rooms, gas, and firing.—Assistant Surgeon.

Cheltenham Gkxeral Hospital.—A ssistant House-Surgeon. Salary
£40 per annum, with board and apartments.

City or Loxdox Lunatic Asylum. 8tone, near Dartford, Kent.—
Medical Superintendent. Salary £500 per annum, with residence,
coals, gas. washing, and garden produce.

County Asylum. 8tafIord.—Resident Medical Officer and Superin¬
tendent. Salary £500 per annum, with unfurnished residence
within the Asylum, and £200 In lieu of board.

Dorset Count r Asylum, near Dorchester.—Assistant Medical Officer.
Salary £120 per annum, with board Ac.

Fabrinodox General Dispensary and Lttxo-ix Chabitt, Bart let t's-
buildings, Holbom, E.C.—Honorary Physician.

Gloucester General Infirmary and Gloucester Btb Institu¬
tion.—H ouse-Surgeon. Salary £100 per annum, with board, lodging,
and washing.

Great Northern Central Hospital, Caledontan-road, N. — House-
Physician.

Infirmary for Consumption and Diseases of the Chest and Throat.
Margaret-street, Cavendish-square, W. — Honorary Visiting Phy-
ftici&n.

London Throat Hospital, Great Portland-strcet, W.—Dentist.

Madagascar Medical Mission. — Superintendent of Hospital. Ac.
Satary £150 to £200 a year, house, outfit, Ac.

Mason Science College, Birmingham.—Professor of Physiology.

National Hospital for the Paralysed aed Epileptic. Queen-
square, Bbomsburv. — Senior House-Physician. Salary £100 per
annum. Junior House-Physician. Salary £50 per annum. la
each case board and apartments are supplied in the hospital.

Boyal Albert Hospital. Deronport. — Assistant House-8nrg«n.
Board and lodging in the hospital, but no salary.

Sussex County Hospital, Brighton.— Assistant Surgeon. Assistant
House-8nrgeon. Board, lodging, and washing, but no salary.

York Friendly Socibtifj' Medical Association.—A ssistant Medic*!
Officer. Salary £150 per annum; part accouchement fee*; £30fa
cab hire.

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The Laxckt,!

BERTHS, MARRIAGES, AND DEATHS.—MEDICAL DIARY.

[April 30,1387. 9 LI,

■girth, Carriages, anir gratfrs. Stoical giarj for the ensuing H«k.

BIRTHS.

ACKttVD.—On the 20th irut., at Bideford, Devon, the wife of Charles
Kingsley Ackland. L.K.O.P.Lond., of a daughter.

Bkkhy.—O n the 21st in6t„ at IIornca6tle, the wife of J. B. Berry,
M.K.C.S.. of a daughter.

Oarter. —On the 21st inst., at Stamford, the wife of T. E. Carter,
M.B.Lond., of a daughter.

Cuke.—O n the 15th inst., the wife of Maurice Smelt Duke, M.R.C.S., !
of Keunington-park-road, London, of a son.

Fairbink.—O n the 28th inst.. at Moulsey House, Windsor, the wife of
William Pal roan k, M.K.O.S.Hng., of a daughter.

Fleck.—O n the 28th Inst., at Frogmoor Lodge, High Wycombe, the
wife of William Fleck, M.D., of a son.

Ooddard.- On the 25th inst.. at Wembley, near Harrow, the wife of
Charles Hrnest Goddard, M.U.C.S., L.R.C.P., of a son.

Jokes. — On the l»th lust., at Marylands-road, W., the wife of
J. Thorcsby Jones, L.R.C.P., M.H.C.S.. of a son.

McClemext. — On the 19th Inst., at Hnlies-strert, Merrion-square,
Dublin, the wife of P. MoClement, M.D., Staff Surgeon, H.M.S.
Active, of a son.

14 cM li.lk.v. — On the 14th Inst., at Brlxton-road, the wife of
W. McMullen. L.K.Q.C.P.I.. L.R.O.S.I., of a daughter.

Scott.—O n the 14th Inst., the wife of Alfred Scott, M.R.C.S., German-
place, Brighton, qf a daughter.

Scott.— On the 21st Inst. at Bladud-bulldings, Bath, the wife of
Richard J. H. Scott. M.R.C.8.. of a son.

Smith.—O n the 23rd inst.. at St. Austell, the wife of J. Snowden Smith,

M. R.C.S., L.H.C.F.. of a son.

STDxrr.-On the 25th Inst., at Pownall-gardens. Honnslow, the wife of
Henry Sydney, M.D., of a son.

MARRIAGES.

Athtold— Munx.—O n Feb. 18th. at the Cathedral. Shanghai, Charles
Arthur Arnold. M.B., O.S.Aber., of Nagasaki. Japan, to Mary
Isabella, only daughter of the late Captain H. O. Munn, 7th Royal
Fusiliers.

Bbodib— PKTTtonnw.—On the 19th Inst., at 17. Queen's-crescent, by
the Rev. John Isda'e. assisted by the Rev. James Douglas. M.A.,
John Ewan Brodle, M.D., to Mary Stuart, daughter of Matthew
Pettigrew.

Churchouse— Kino.—A t East Haddon. Win. Jno. Franklin Churchouse,
L.R.C.P.Bd.. to Kate Emma, second daughter of George King, Esq.,
of East Haddon, Northamptonshire.

Courtenay—Ap-Joux.—O n the 30th Inst., at 8t. Philip’s Church,
Kensington, W., Edward Maziere Courtenay, M.B., Limerick
Asylum, to AHoe, widow of the late George Atkins, Barristcr-
at-'law, and youngest daughter of the late Rev. M. Lloyd Ap-John,
of Linfield, and Rea tor of Ballybrood, co. Limerick. Ireland.

Davies — McLaren. —On Feb. 22ud, at All Saints’Church. Dunedin.

N. Z.. John Morgan Lloyd Davies, M.R.C.8.. to Jessie Maud, third
daughter of Robert McLaren, Baq., of Dnnedln.

FoTHKRtiiLL—W kathkheu..—O n the 21st Inst., at the Parish Church
of Elton, Notts, Thomas Prince Potherglll, M.D., to Eleanor Jane
(Nora), eldest daughter of the late Robert Weatherell, Rector of
Elton.

Macpherson—TAYLOR.— On the 20th last., at St. Chrysostom's Church,
Rverton, Francis Alexander Macpherson, L.K O.P, and L.R.C.8.B., to
Florence, elder daughter of the Rev. W. F. Taylor, D.D., Vicar,
Hon. Canon of Liverpool, and Rural Dean of Walton.

Paton—Austin.— On the 27th Inst., at 7, Moray-plaee, Edinburgh, by
the Rev. John 8tuart, D.D., Frederick Brtkine Paton, M.B., O.M.,
of Abergavenny, Monmouthshire, to Maggie, eldest daughter of the
late Rev. JohnMeln Austin.

Powell—Sanders. —On the 29th Inst., at Christ Churob, Lee. by the
Rev. Arthur Stevens, brother-in-law of the bride, assisted by the
Rev. L. A. Smith. Vicar, Lewis B. Powell, M.R.C.S.Eug., to Edith,

S oungest daughter of the late Thomas 8anders, of Wheatley,
'xon.

Woods—Heatley.— On the 20th Inst., at 8t. Andrew’s, 8.W., Frank
Woods, L.B.O.P. Load., M.B.C.S., L.8.A., to Eva Carlota,

youngest daughter of the late John D. Heatley, of Illghara Hill,
Walthamstow. •

DEATHS.

ChAtto.—O n the 19th inst., at Chapel-road, Nottlng-hiil, John Cbatto,
M.U.C.S., Librarian to the Boyal College of Surgeons of England,
aged 77.

CRorrs.—On the 25th Inst., at Church Oresley. near Burton-on-Trent,
William Carriek Crofts, M.K.C.S.B.. Ac., aged 59. No cards.
Guthrie.—O n the 18th Inst., at Brechin, N.B., John Guthrie, M.D.,
In bis 57th year.

Halket.—O n the 17th Inst., at sea, on his homeward voyage from
Australia. Laurence John Halket, L.H.O.P.Lond., third son of the
lade David Halket, of Newcastle-on-Tyue, formerly of Perth and
London. Australian papers please copy.

Hinoeston.—O n the 25th Inst., at Lyme Begts, William Hlngeston,
M.K.C 8.

Iliff.—O n the 25th Inst., at Kennlngton-park-road, 8.B., William
Tiffin IUff, M.D. Load., Medical Offioar of Hwlth for St. Mary,

Newington, aged 63.

Pater—O n the 21th inst., at Oxford-terrace, Hyde-park, William
Thompson Pater, M.R.C.8.. late Medical Superintendent of the
Countv Asylum, Stafford, aged 52.

Trevor— On the 25th Inst... at Beaumaris, N. Wales, Artbnr Tudor
Humphreys Trevor. M.R.C.8., L.R.O.P.Lood., formerly of Iqnlqne,
Wrat Coast of S. America, aged 42.

Yarf.nke. — On the 22nd Inst., at Kelvedon, Esiex, Ezekiel George
Varenne, M.B.C.S., aged 75.

M.B.—A fctafSt.it charged for tAs Insertion of Notiott of Births,
Marriaget, and Deaths.

Monday, May 2.

Royal London Ophthalmic Hospital, Moorfiklds. — Operations,

10.30 a m., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.— Operations, 1.30 P.M.,

and each day at the same hour.

Hospital for Women. Soho-smuark. — Operations, 2 p.m., and on
Thursday at tlie same hour.

Metropolitan Free Hospital.— Operations, 2 p.m.

Central London Ophthalmic Hospitals.— Operations, 3 p.m., and
each day in the week at the same hour.

Royal Institution.— 1.3o p.m. Annual Meeting.

Society of Arts.—8 p.m. Mr. J. M. Thomson : The Chemistry of Sub¬
stances taking part in Putrefaction and Antisepsis.

Odontolooical Society of Great Britain.—8 p.m. Mr. F. Henri
Weiss : On the Destruction of a Permanent Tooth Pulp by an
Alveolar Absoets attached to a Deokluous Molar.—Dr. St. George
Elliott will show a New Hot-air Motor.—Mr. B. Lloyd Williams will
exhibit a Hot-air Syringe.—A paper by Mr. Humphreys.—Mr. W.
Hern : Cocaine as a Local Anesthetic in Dental Surgery.—Dr. Geo.
Cunningham : The Physiological Action of Cocaine.

Medical Society of London. — 8.30 p.m.' Sir William MaoCormac will
deliver the Annual Oration, after which the President will hold a
Reception, and a Conversazione will follow. The String Band of th»
Royal Artillery will be in attendance.

Taeaday. May 8.

Guy’s Hospital.— Operations, 1.30 p.m. and on Friday at the same hoar.

Ophthalmic Operations on Monday at 1.30 and Thursday at 2 p.m.
8t. Thomas’s Hospital.— Ophthalmic Operations, 4 p.m.; Friday. 3 p.m.
Cancer Hospital.Bromptox.— Operations.2.30 p.m.; Saturday,2.30 p.m.
Westminster Hospital.— Operations. 3 p.m.

West London Hospital —Operations, 3-30 p.m.

St. Maby's Hospital— Operations. 1.30 p.m. Consultations. Mondsy,

1.30 P.M. Skin Department, Monday and Thursday. 9.30 a.m.
Rotal Institution.—3 p.m. Prof. W. B. Ayrton: Electricity.
Pathological Society of London. — 8.3o p.m. Report of Morbid

Growths Committee on Dr. Edmunds'Specimen of Horny Papilloma
of Hand.—Mr. Hutchinson : Destructive Arthritis of Knee without
Suppuration.—Mr. T. 8mith : 8enile Arthritis.-Mr. Hutchinson,
juu.: Sarcoma (?) of Knee.—Dr. Pitt: Carcinoma of 8plne and Liver.—
Dr. Ooupland and Dr. Pasteur ! Diffuse Sarcoma of Spinal Pta Mater
(two cases).—Dr. Maguire : Interstitial (Aneurysm of Inter-auricular
Septum.—Mr. B. W. Parker : Case* of Sarcoma in Children.—Mr.
Lawson Tait: Tubal Pregnancy.—Dr. Payne: Multiple Neuro¬
fibromata in connexion with Moilusoum Fibrosum.—Mr. Leopold
Hudson: Tumour of Prostate. Card Specimens : —Mr. Fenwick-.
Urinary Tuberculosis with Multiple Calculi.—Dr. Barlow: Renal
Sarooma in m Child.—Mr. Page (for Mr. Raven): Sarcoma of Dorsal
Vertebras.—Mr. Shattock : Tubercular Arthritis (six cases).

Wednesday, May 4.

National Orthopedic Hospital.— Operations. 10 a.m.

Middlesex Hospital.— Operations, 1 p.m.

St. Bartholomew’s Hospital.— Operations, 1.30 p.m.; Saturday,same
hour. Ophthalmlo Operations. Tuesday and Thursday, 1.30 P ol.
Surgical Consultations. Thursday. 1.30 p.m.

St. Thomas’s Hospital.— Operations. 1.30 P.m.; Saturday, same hoar.
London Hospital.— Operations. 2 p.m.; Thursday A Saturday,same hour.
Great Northern Central Hospital.— Operations, 2 p.m.

Samaritan Free Hospital fob Women and Children.— Operations,

2.30 P.M,

University College Hospital.— Operations, 3 p.m. ; Saturday, 2 p.m.

Skin Department. 1.45 P.M.; Saturday, 9.15 a.m.

Royal Fees Hospital.— Operations. 2 p.m., and on Saturday.

King’s College Hospital.— Operations, 3 to 4 p.m. ; Friday, 2 p.m.
Saturday, 1 p.m.

Children’s Hospital. Great Ormowd-stbeet. — Operations, 9 a.m.

Saturday, same hoar. „ . ,,, ,

Obstetrical Society op London.—8 p.m. Specimens will be shown
by Mr. Doran. Dr. John Phillips. Mr. Barton. Mr. Lawson Tait, and
others. — Dr. Matthews Duncan: Htemorrhsglc Parametritis.—
Dr. Lewer*: On the Frequency of Pathological Conditions of the
Fallopian Tubes as determined by Post-mortem Observations at the

London Hospital. Thursday, May 8.

8t. Georoe’s Hospital.—O perations, 1 p.m. Ophthalmic Operations,
Friday, 1.80 P.M.

Oharing-cross Hospital. —Operations, 2 p.m.

North-West London Hospital.— Operations. 3.30 p.m.

Royal Institution.— 3 p.m. Prof. Dewar: The Chemistry of the
Orgnnlc World.

Harvkian Society op London.— 8.30 p.m. Mr. Hogh Owen Thomas:
The Physical Signs of Disease and Recovery of the Hip-lolnt, with
a Demonstration of the Mecbsnlo&l Fixation of the Joints—Dr.
Stephen Maokenxle: Some cases of Hysteria.—Mr. A. Q. Sllcook j
A fatal case of Hysteria. ■

Ophthalmological Society or the United Kingdom. — 8.30 p.m.
Living and Card Specimens at 8 P.M. Messrs. Oritchett and Jaler :
(1) Guttate appearance of Fundus; (3) Peculiar Pigmentary De¬
generation of Choroid.—Mr. Ernest Clarke: Improved Artificial
Byes. Papers :-Mr. W. Lang: (1) A fatal case of Meningitis after
BxoLion of a Suppurating Globe; (3) On the Insertion of Glass
Globes Into Tenon’s Capsule after Excision of tho Eyeball.—Mr.
Nettleshlp: (1) Three oases of Night-blindness, with peculiar
Retinal Changes; (2) Two easesof Quinine Amblyopia.—Dr. Bratley:
Recurrent Choroldo-retlnltls in region of Macula, probablyau early
stage of "central guttate choroiditis."—Mr. Macktnlay: Complete
Self-enucleation of Eyeball.

Friday, May 6.

Boyal South London Ophthalmic Hospital.— Operations. 2 p.m.
Royal Institution.— 9 P.M. Dr. Brunton: The Element of Truth In
Popular Beliefs. Saturday, May 7.

Middlesex Hospital.— Operations. 2 p.m.

Rotal Institution.—3 p.m. Mr. R.Voa Lendealeld : Reoent Researches
on SpoDges.

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N0TE8, OOMMENTB, AND ANSWERS TO UORBBSFONDKST8.

[April SO. 1887.

METEOROLOGICAL READINGS.

(Take a daily at 8.50 a.m. by Steward'» Instruments)

The Lancet Office, April 28th, 1887.

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Bolts, jljwrt Comments, & §Lnsfocrs io
Cnrasjjoiiiknts.

It is especially requested that early intelligence of local event*
t\aving a medical interest, or which it is desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “To the Editors”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and adi'ertising
departments of Thb Lancet to be addressed “ to the
Publisher.”

We cannot undertake to return MSS. not used.

Election Expenses Fund of B. W. Richardson, M.D., F.R.S.
jy r Treasurer’s Account to April Hind, 1881.

252 Receipt* as per Counterfoil Receipt-book .£155 2 1

Cr.

Printing; .

Pottage .

Advertisements ...
Gratuity to Porter

... £68 12 6

... 52 15 1

... 32 19 0

... 0 15 0

- £155 2 1

Audited and found correct.

(Signed)

P. H. Alderson, M.D.. Hon. Treasurer.

Rout. J. Banning, M.D.,
Chas. Wells, M.D.,
Quebec Institute, Baker-street, W.

lion. Secretaries.

P.S. —The expenditure would have been somewhat larger had not
Dr. Ricliardaon defrayed some preliminary exfxmsea and Dr. Danford
Thomas kindly given £10 worth of stamps in addition to their sub¬
scriptions.

Mr. James Oliver.—the paper, if forwarded, shall have consideration.
.V.£.-No.

OBSCURE NERVOUS AFFECTION.

To the Editors of The Lancet.

Sirs,—C ould any of your readers assist me In a case that has resisted
all the ordinary forms of treatment for many months, and which is
getting worse, in spite of iodide of potass., bicarb, potass., brora. potass.,
colchicum, Donovan's sol. of arsenic, &c. The patient, a lad 3 - over sixty
years of age, is of a gouty family, but of active and very temperate
habits. Her general health is good. About four years ago she was
seized with numbness of the toes, which afterwards extended over the
whole sole of one foot. Then the ol her foot became affected in the same
way, and latterly the uppers of both feet as well as the soles. She feels
as if walking on soft cushions, not pins nnd needles. Her walk on rising
up is at first rather unsteady, and she kicks one foot against the other.
But the knee-jerk is perfect in both. and»he can walk or stand quite well
with eyes closed. Moderate warmth makes them easier; but cold, or
much heat, makes them feel more painful. Any hints ns to treatment
will be thankfully received by Yours truly,

April 20th, 1886. PUZZLED.

Registration and the new Medical Act.

In reply to numerous correspondents we may say that the new Act is
not retrospective, and will not therefore affect gentlemen in respect of
any qualifications already registered.

Massage is referred to an annouccment in our issue of April 16tb, p. 44 of
advertisement sheet.

Dr. A. A. Smith .—The instrument lies at our office.

Hospitals fob Infectious Diseases.

Mr. E. Turner (Stourbridge).—It has been held that one bed per thousand
of the population forms ample accommodation for the permanent
wants of a district. But In every case sufficient land shonld be taken
to admit of extensions, whether temporary or permanent, owing to
emergencies or to increase of population. This ertimst* is, of course,
only a general one, and the proportion of beds to population would
have to be varied according aaa large or small number of the inhabitant*
have such dwelling accommodation at admits of reasonable facilitlea
for isolation. The handbook relating to this subject is the Supplement
by the medical officer to the Tenth Annnal Report cf the Local Govern¬
ment Board—“On the Use and Influence of Hospital* for Infectious
Diseases.” This can be obtained as a Parliamentary paper. The first
forty pages of this Report contain a summary of the whole volume.
Another useful paper la one “ On the Planning and Construction of
Hospitals for Infectious Diseases,” by the Architect of the Local
Government Board, which Is contained in the Transactions of Use
Epidemiological Society, New Series, vol. il. (Shaw and Sons, Fetter,
lane). A copy of the diagram of an isolation pavilion, recently issued,
should also be procured by application to the Local Government Board.
Mr. J. Gowant.— Cassell’s Domestic Medicine would probably answer the
purpose.

•• EXTIRPATION OF RUPTURED UTBBU8.”

To the Editors of The Lancet.

Sirs,—R eferring to the very interesting case described in your issue of
April 23rd, in which Dr. Andrews performed abdominal sectioa to enable
him to deal with a rupture of the uterus and the hremorrhage consequent

thereon, allow me to endorse his comment that "such an operation.

gives a chance to an otherwise hopeless case, and that It should be under¬
taken without hesitation under such circumstances.” Dr. Andrew*
opened the abdomen, removed “a very large quantity of blood “from the
peritoneal cavity, dealt with the rent In the uterus by removing the
organ with its appendages, and completed the operation. Bat the patient,
barely survived the procedure, ami unquestionably, as Dr. Andrew*
observes, the “ hremorrhage was the fatal factor in the case.” My object
in venturing to address you Is to assert my belief that the fatal factor in
such cases as these may be absolutely obviated by injecting about a pint
of warm water (with or without the addition of a saline powder) into
the veins. If circamstanoes permit the transfusion of blood, so much
the more favourable will be the prognosis; but the Intravenous Injection
of water or of saline fluid at 100° F. may generally be trusted as an
efficient means of combating acute anxmla (the hemorrhage having
been arrested), in proof whereof allow me to refer to my paper on
“Transfusion for Hemorrhage in Military Surgery, published in The
Lancet of Jan. IStli, 1887.—I am. Sirs, your faithful servant.

Upper Brook-street, W., April 23rd, 1887. Chas. E. Jennings.

Languors Defence Fund.

A SUM of about £103 is still required to settle the costa incurred by Dr. J.
Wreford Langmore in defending this action, most unjustly brought,
against him. Further subscriptions are consequently needed, and
may be paid to Mr. George Bastes, M.B., 60, Connaught-street, Hyde
Park-square, London, W.

Third List.

Subscriptionsannounced£U8 8 6 I Dr. G. F. Blandford
Dr. Wilson Fox. 3 3 0 Mr. J. F. Churchill

Dr. S. O. Ha ben h on ...
Mr. Henry Morris
Sir Edwin Saunders ...
Dr. W. H. Allehin
Mr. J. Blsshopp.

2 3 0 1 Dr. G. C. Dole ...

2 2 0 Dr. Owen Pritchard
2 2 0 Dr. Harrington Tuke
1 1 0 Mr. M. J. Verdon
1 1 0 Dr. H. W. Webster

£1 1 O
1 1 O
1 1 0
110
llO
110
0 10 &

A Very Old Subscriber .— 1 The M-B. of Dublin University is not a licence
to practise surgery and midwifery. It is a qualification In medicine
only. The University supplements it with licences and degrees in
surgery and midwifery.

Inquirer had betteh apply to some large nurseryman.

Dr. McKee is thanked, but wo had already made arrangements for a
report.

MALIGNANT PUSTULH AND COMA.

To the Editors of The Lancet.

Sirs,—I have little ddubt that the convulsions and coma in the
remarkable case of coma due to malignant pustule, reported by Mr. Reilly
In yourlwur of April 33rd, resulted from cerebral meningeal haemorrhage.
There were at least two amongst the fatal cases of malignant pustule at
Guy's, In the year 1881, dnrlng the latter part of which I was acting as
surgical registrar, in wbloh death was preceded by convulsions and
coma. The necropsy in these cases revsaled extensive hremorrhage over
the cortex of the cerebrum beneath the arachnoid. Of oourse. in addition
to this, there were other lesions discovered characteristic of death from
malignant pustule. I do not think we ought to be surprised when we
meet with subarachnoid htemorrhage In these oases, considering bow
frequently we meet with extravasations of blood under other serous
surfaces, as the pleura, Ac.; lu fact, 1 should be inclined to look upon
meningeal htemorrhage, like cedema of the glottis, as not a very un¬
frequent complication which may directly Induce a fatal termination in
a case of malignant pustule. I Am, Sirs, yours faithfully,

St. niomas'Mtreet, April SCth, 1887. L. A. DONE, B.fi.

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Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [April 30,1887. 911

The late Dr. Carrixotox.

Yy. are asked to state that Mrs. Carrington and family desire to express
their gratitude to the very many friends who have sympathised with
them in their recent bereavement, and whom they find it impossible
to address individually.

It. Charles Williams.—We cannot learn that Schwartze's Aural Surgery
has been translated into English.

ir. Stratheam (Govan).—The address of the Secretary is 25, Wynne-
road, Brixton.

•• FRIENDLY SOCIETIES’ MEDICAL ASSOCIATIONS.”

To the Editors of Thb Laxcet.

Sins,—Tour correapond'-.nt, "M.O.. F.S.M. Assoc.,” who appears so
ontented with his lot, does not consider the bearing of his position with
I'gnrd to these monopolies in relation to the profession generally. Our
xperience in Loughborough is that the abuse of the “ medloal aid” is
nost flagrant. It includes professional men, tradespeople, the upper
lasses of artisans, and, in fact, makes a clean sweep of about 6000 people.
>ut of a population of 18,000 of all classes and conditions. For this
eason the medical men of the town have refused from the first to
o-operate with the medical ofBoer. An Institution which has for its aim
o obtain medical services at the cheapest rate, and whose payment of
heir medical man would compare unfavourably with that for servloe
inder the Local Government Board, In many instances, cannot command
mr support, when we consider for whom it partly, if not mainly, exists,
lot the poor of the labouring classes, but the thrifty and well-to-do
irttsans. the prosperous tradesmen (small and large), and professional
nen, not to mention a large number of the publicans. Your oorre-
ipondent may, from his commercial point of view, consider that his
ralitical economy is good, but I beg to suggest that the lowering of our
: ees to the rate of 2d., 3d., or id. for a consultation in the case of people
rach as I have indicated is not good either for the medical profession or
he general public. It is defrauding the really necessitous In the interest
>f the mean, who in their saving do not consider how they save. Than
this no subject, to my mind, is more urgent. We wish for equal titles
for medical men, and for conjoint examining boards, but the “ battle of
the shops ” is quite secondary to the question of whether general practice
is to be swamped in a co-operative medical store. If the Council would
tike up the questions of medical charity, provident and otherwise, and
friendly societies’associations, and make some effort to prevent tho great
ibuse at present existing, it would be doing more useful work than
dieting regulations as to preliminary education. And I believe that a
commission Instituted by The Laxckt to investigate these matters
would open the eyes of the profession to the snare which is gradually
being thrown around it. If these miserable oontraete beoome general,
we shall cense to be a liberal profession, the general practitioner will be
merged altogether in the “ olnb doctor," and will beoome more than ever
an over-worked and subservient drudge.

I am. Sin, your obedient servant,

Loughborough, April 16th, 1887. J. B. Pike.

To the Editors of Thb Laxcet.

Sirs,—T he medical officer whose letter appeared in yonr issue of the
16th Inst, is to be congratulated on his good fortune. The association I wasln
contained over 4000 members, and the committee were composed of work¬
ing men who appeared to have no respect whatever for the surgeons. The
work was heavy. The hours at the surgery were 9 to 10 a. sc., 1 to 3 and
6 to 8 p.m., and all know how patients rush In at the last and keep one at
work long after the time for leaving. Visiting was done between times.
One of the worst faults of this system is the liberty people with a
morbid faith in medicine have to oome and demand a bottle of medicine
whenever they like. For advice they care nothing, and the surgeon is
reduced to little better than a puppet. If "M.O., F.8.M. Assoc.” had
his members Increased to 4000 and the oommlttee of that peculiar
democratic character that tries to raise Itself by degrading others, and
with no increase of salary, he would form a very different opinion of such
places. The life of on assistant with a general practitioner is better, as
hr as social position goes. In au Association one’s social position is
sacrificed; but If abuses were cleared out, all fees given to the surgeon
Instead of to the committee, and patients taught to respect a surgeon
and his house, life would be vastly preferable there than In a position
where you have to please two parties—viz., the principal and the patients
—and be at the mercy of the whims of both. I cannot see sufficient
reason why all fees subscribed by members for the surgeon should go to
the committee, and only a portion be handed over to the surgeon. The
surgeon should receive all fees, supply drugs, and the clubs should pay
the expenses of management. The present olub system is disagreeable
and wrongly based, as members, when once a surgeon is chosen, are
brand to go to him, however much they may dislike him, or pay
another, and the surgeon is obliged to attend to many who he
knows would rather not have him. This makes club work
almost unbearable at times, and often leads to suoh bickerings and
quarrels that many surgeons look forward to the day when they can get
quit of dabs and others refuse to have them. A much better plan
would be for each club to have a list of surgeons willing to take club
Diembers, each member to choose for himself. A surgeon would receive
from the various clube his list of members. This Would give more
freedom to both parties and do away with three-quarters of the present
causes for bitterness qnd complaints.—I am, Sirs, yours sincerely,

April, 18*7. M.B.

The Food op Paris.

Thb last municipal report relating to the sale and consumption of food
in Paris contains an estimate showing the average consumption per
head of the population, and from this It would appear that each
Inhabitant eats 1891b. of meat, 9 lb. of ••triperie" (which Includes
calves’ head, tongue, kidneys, Ac.), 261b. of fish, 251b. of poultry, 8lb.
of oysters, 171b. of butter, 61b. of cheese, and 15 dozen eggs. The
report does not give the quantity of bread eaten by the population of
Paris, but the average price of it during 1886 was at nearly as possible,
allowing for the fractional difference of money, 3 \d. per lb. The total
quantity of meat consumed during last year in Paris was about
150,000 tons weight, this representing 302,894 head of cattle, 188,60&
calves, 1,979,526 sheep, and 352,001 pigs, while In addition to this
nearly 4000 tons of horse, mule, and donkey flesh were sold In the city,
at the average wholesale rate of 3<f. per lb. The quantity of fish said
was considerably in excess of the total for the previous year, the
increase being most marked in the oyster trade, the total weight being
greater by 1720 tons.

Sigma (Ostend).— The International Congress of Hygiene will be held
between Sept. 26th and Oct. 2nd at Vienna. The first day’s sitting
will be signalised by a paper on the Mode of Propagation of Abdominal
Typhus, by Dr. P. Brouardel, Dean of the Medical Faoulty of Paris.

Dr. Bell Taylor. —No.

PROPOSED ARCHITECTS AND BNOINBBR8’ REGISTRATION
ACT.

To the Editors of The Laxcet.

Sirs,—W ill you allow us to call the attention of your readers to an
important movement contemplated by the architectural profession ?
At the present time it is open to anyone, however ignorant he may be of
sanitary science and construction, to practise as an architect, to the
great danger of the general health of the public. In order to put an end
to this unsatisfactory state of matters, the Architectural Federation
Oommlttee (a body elected for the special purpose at a public conference
of architects held in April last) are endeavouring to obtain for tho pro¬
fession an Act of Parliament, such as the Medical Aot, for the compulsory
registration and proper education and examination hereafter of all
desiring to enter its ranks. The proposed Bill is now drafted, and a
public meeting is to bo held on Wednesday, May 4th, at 4 o’clock,, at
St. James's Hall, Regent-street, London, W., when the principles of the
Bill will be discussed. It must be well known to most of your readers
that a vast amount of illness which comes under their notice is caused
directly or Indirectly by badly-drained, ill-ventilated, damp or otherwise
faoltlly-construoted dwellings. It is hoped, therefore, that all who feel
the necessity of architects being properly educated, especially in matters
of sanitary science, of which so many are so utterly Ignorant, will
endeavour to attend.

We are. Sirs, your obedient servants,

Hugh Roumtex Gough, Chairman.
April 25th, 1387. Edgar Farmax, Hon. Secretary.

Mr. D. Donald .—The attention of the body from whom the gentleman

derives his qualification should be drawn to the matter.

“ INHALATION OF COAL-GAS AS A SOURCE OF DISEASE.”

To the Editors of The Laxckt.

Sirs.—T he action of ooal-gas on the throat and head has been under¬
estimated. I have had most nnplsasant experience. I live in an old
house, and although the gas fittings in the bedrooms were massive and
good still the gas escaped. I got a clever workman to come down from
London, and he told me that every joint wanted oiling; I found he was
quite correct, and the rooms are free from smell. He further said that
people expected the joints to remain tight for years without any
attention. Another great safeguard against escapes is to have the tap on
the fixed end of the bracket and not on the branohes, for then the
pressure of gas does not act on the joints in the bracket.

I am, Sirs, yours faithfully,

April 25th, 1887. Thos. CHRmr.

OBESITY.

To the Editors of Thb Laxckt.

Sirs,—W ould any of your readers be so kind as to inform a brother
practitioner as to what is practically the best treatment to bo adopted
la a case of exoessive obesity ? I have unfortunately bad no experience
In the treatment of such cases.—I am. Sirs, yours faithfully,

April 35th, 1887. A 8UBS0UBKB.

The Red Corpuscles.

J. G. S. (Barrow-in-Furness).— At the last sitting of the Realo Accademta
dl Lincel of Rome (the Italian equivalent to our Royal Society) the
following were among the "Note” presented for insertion in the
“Atti”:—(1) Cadaveric Alterations of the Red Corpuscles and the
Formation of the Coagnlnm; (2) Formation of Pus from the Red Cor¬
puscles of the Blood ; (8) How Leuoooytes are derived from the Bed
Corpuscles of the Blood; (4) Degeneration of the Red Corpuscles of
the Blood. The series of “ Note ” were all from the pen of Prof. A.
Mosso of Turin.

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914 Thb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[April 30, 1887.

Cipriani thb FuRk-ewAU-owBR.

Fifteen years ago, it may be remembered, Bgisto Cipriani, a journeyman
printer of Florence, as the result of a bet, introduced a fork down the
(esophagus into his stomach. Every method short of surgical inter¬
ference was tried to extract it, but in vain, Cipriani meanwhile being
from time to time so ill as to have to take to bed. Prof. Koeatl, the
eminent surgeon of Florence, has at length persuaded him to submit
to the operation of gastrotomy, the result of which will shortly be
made known.

Dr, James G. Robertson. —St, Thomas’s Home, In connexion with St.

Thomas’s Hospital, would probably receive the patient.

Homaopathist should send the documents to a journal devoted to the
advocacy of the system.

Dr. Aikman (Guernsey).—The article had been arranged for.

Mr. Steivart.— In an early number.

THB OPBN-AIR TREATMENT OF PHTHISIS.

To the Editors of The Lancet.

Sirs,—D r. Burney Yeo, in his most interesting and instructive lecture
upon Gaseous Rectal Medication in Pulmonary Affections (The Lancet,
April 16th. p. 761). alludes to a case which I noted In the British Medical
Journal, Dec. 1880, p. 1098. as illustrating the value of open-air treat¬
ment, of phthisis, many highly Interesting papers and cases of which
mode of treatment are quoted in Sections 695: 6 of the Medical Digest
and Appendix. Dr. Yeo, by his remarks, seems to infer that the vast
benefit derived by the open-air treatment of this case was really due to
the use of antiseptics. This I am not at all inclined to admit, for in two
other members of the same family antiseptic treatment alone was most
carefully carried out, with, alas, unsatisfactory results; whereas my
patient, living day and night in the open air, rapidly recovered, hi»
health being at the present time most satisfactory.

I am, Sirs, yours obediently.

Richard Neale, M.D. Lond.
Bonndary-road, N.W., April 27th, 1887.

Mr. J. Jackson (Sowerby). — Our correspondent appears to have been
rather hardly used.

Dr. Lewers.—fho paper, if sent, shall receive attention.

OojnftnriCATioNS not noticed ki our present number will receive atten¬
tion in our next.

Ookkueications, Letters. Ac., have been received from—Dr. Savage,
London ; Dr. Horrocks, London ; Mr. Blackett, London; Dr. Gale,
Guildford ; Dr. Blanc, Cannes ; Dr. Auld, Wick ; Dr. Lavers, Wands¬
worth; Mr. Nathan; Dr. J. Harris, Norwood; Mr. Prenslau, Liverpool;
Dr. N. W. Bourns; London; Dr. Urban Pritchard; London;
Mr. J. M. Mason, Glasgow; Dr. Rotenau, Wiesbaden; Mr. Reginald
Harrison, Liverpool; Mr. C. H. Robinson, Dublin ; Messrs. Gough and
Farman, London ; Dr. Aikman, Guernsey ; Mr. D. Lloyd, Newcastle
Bmlyn; Dr. P. Hood, London ; Mr. J. H. Morgan, Loudon ; Mr. J. T.
Little, London ; Mr. W. J. Nicholls, London ; Mr. W. H. R. Stewart,
London; Mr. C. E. Jennings, London; Dr. Robb, Glasgow; Mr. T.
Christy, London ; Mr. Villanueva, London; Mr. Cocks ; Mr. Malden,
Dorchester; Dr. W. P. Mears ; Mr. J. H. Hughes, Droltwlch; Mr. J.
Knight, Manchester; Mr. W. T. Brooks, Oxford; Dr. Nesfield, Man¬
chester; Miss Boor, Nottingham; Mr. Lenoey, Hltohln ; Mr. Allen.
Dulwich; Dr. Maynard, Eritii ; Mr. Ford, Devonport; Mr. Young,
Glasgow; Dr. Fraser, St. John’s, Newfoundland ; Messrs. Butterfield
and Co., Northampton; Mr. Blliott, Carlisle; Messrs. Burroughs and
Co., London; Mr. Gillander, Neweastle-on-Tyne; Messrs. Macmillan
and Co., Loudon; Mr. Greenwood, Liverpool; Messrs. Bromley and
Co., Lincoln ; Mr. Evans, Oswestry ; Mr. Kemp, Hull; Messrs. Blake

and Co., Leeds ; Mr. Hamilton, Monaco; Mr. Stewart; Mr. Marriott.
London ; Mrs. Brown, Bournemouth ; Mrs. Gray, Banff; Mr. Walker.
Glasgow ; Dr. Macnamara, Dublin; Mr. Das, Calcutta ; Messrs. Spring
and Co., London ; Dr. MacAllster, Cambridge; Mr. Horrooks, Pennsyl¬
vania ; Miss Aldridge, Rochdale; Mr. Medland,London; Mr. Wright,
Romford ; Mr. Birchall, Liverpool; Mr. Berthler, Paris; Mr. Blliott,
London ; Mr. Robertson, Edinburgh ; Mr. Rubcnsteiu, Liverpool;
Mr. Fairbank. Windsor; Mr. Hilliard, Aylesbury; Mr. Harrison, Port
Elizabeth ; Mr. Droonold, Carmarthen ; Mr. F. W. Clark, Thornton
Heath; Mr. J. Milner, Hayes; Mr. Banning, London; Mr. Marcos
Gunn, London ; Dr. Skelton, Downeikd ; Mr. J. Gowans, Broughtv
Feny; Mr. M. Coj)eman, London; Mr. A. Drysdale; Messrs. King
and Co., London; Mr. G. C. Stewart, London; Messrs. Griffin and
Co., London; Mr. Jackson, Somerby; Mr. Hope, London; Mr. T.
Cook, London; Mr. Chrismas, Hemel Hempstead; Messrs. Lee and
Martin, Birmingham; Dr. G. Macdonald, London; Mr. T. Walker,
Wakefield ; Mr. H. B. Wood, Cranbrook ; Mr. L. A. Dunn. London ;
Mr. D. Donald, Streath&m ; Miss Butterworth, London ; Mr. Mayo,
Yarmouth ; Mr. Wakefield, Barlswood; Mr. Grant, London; Mr. Amos.
Newcastle-oa-Tyiie; Mr. Howee, Stafford; Mr. Wiggles worth. Ashford;
H. S.; Amicus; No Humbug; . Surgeon ; L. M.; Melbourne; One
of Them;

Letters, each with enclosure, are also acknowledged from—Dr. Churton.
Leeds; Sir W. Dalby, London; Mr. Juler, Loudon; Messrs. Smith
and Co., London; Mr. Leiterschofen, Homburg; Mr. Manby, Sierra
Leone; Mr. Green, Hull; Mr. Smith, St. Austell; Messrs. Macfarl&a
and Co., London; Mr. James, Chorley; Mr. Davison; Messrs. Lang
and Barker, Edinburgh ; Mr. Douglas, Mlddlesbro'; Messrs. Slinger
and Son, York; Mr. Webb, Kingsbridge ; Mr. Smailes ; Messrs. Duncan
and Co., Edinburgh; Mr. McMahon, Hartford ; Messrs. Richardson
and Co., Leicester; Mr. Trestse, Burton-ou-Treut; Dr. Adam. West
Mailing; Mr. Botwood, Ipswich; Mr. Taaffe; Means. Loefiund and
Co., London ; Dr. Williams, Mold ; Dr. Kerr, London ; Messrs. Clark
and Co., York; Mr. Gant, London; Dr. Haberahon ; Messrs. Oliver
and Boyd. Edinburgh; Mr. Brockelbank, Islington; Mr. Mayo, Great
Yarmouth ; Mr. Lloyd, Lampeter; Mr. Bigg, London ; Messrs. Kllner
Bros., London; Mr. Wliateley, Birmingham ; Messrs. Pownceby and
Co., London ; Dr. Watkins, Newton-le-Wlllows ; Messrs. Deighton
and Co., Cambridge; Mr. Burgess, Manchester; Messrs. Isaacs and
Co., London ; Dr. Keay, Polton ; Mr. Cosbura, Newbury ; Dr. Tetley.
Keighley; Dr. Lindsay, Belfast; Mr. Hamilton, London; Mr. JojI--:>.
Workington; Mr. Curran, Bridgwater; Mr. Graham, Godalming;
Mr. Draper, Huddersfield ; Mr. Williams, Oxford ; Mr. Skrlrashirv.
Holt; Dr. Davies, Bridgend ; Dr. Leesou, Bridgend; Mr. Fysh, Liine-
bouse; Mr. Burns, Ipswich; Mr. Morton. Glasgow; Mr. Browning.
Manchester; Mr. Brown. York; Mr. Griffiths. Ennis; Mr. Brown,
Westgate-on-Sea; Dr. Partlow, Forest-hill; Messrs. B. Smith and
Co., London ; Miss Townsoa,-Chester; Messrs. Bowes and Co.. Herne
Bay; Mr. Mundy, Hampsteod ; Mr. Rideal, London ; Messrs. Hertz
and Co., London ; Mr. Afflick, Manchester ; Messrs. Bobbins and
Co., London ; Dr. Fleck, Wycombe; Miss Landal, Bath; Mr. Holden.
Folkestone; Mr. Cook, Lowestoft; Mr. Evans, Oswestry; Mr. Wilson,
Rastriok; Messrs. Bennett Bros., Salisbury; Messrs. Beal and Sons,
Brighton; Mr. Mawson, Bradford; A. B., Brighton; Medicos;
Cantab., Burton-on-Trent; Medicus, Matlock ; B., Lewes ; South
Coast; Surgeon, Mlnchlnhampton; J. E. B., Liverpool; B. A., Ben
Rhyddlng; A. B., Bridgend; M.D., Southsea; H., Ilfraoombe; Lady
Superintendent, Bath ; Matron, Bedford; Dr. H. F.; Medicos, Wood-
pan ; S., London; S. B. B.. Brighton; K., London ; Medtcos, Mile-
end; A. Z., Surgeon; C. B.; Matron, Rotherham; P., Hull.

Advocate of India, Gup's Hospital Gasette, Philadelphia Public Ledger.
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THE XJlNCET, Ma* 7, 1887.

%n ©ration

OS

ABDOMINAL SECTION FOE THE TREATMENT
OF INTRA-PERTTONEAL INJURY. ,

Delivered to the Medical Society of London, May 2nd, 1SS7,
By SIR WILLIAM MACCORMAC,

SUBCF.OX TO ST. THOMAS'S HOSPITAL.

Mb. 1'ttKBiDBNT AND Gentlkmhic, -The subject of
abdominal surgery is so wide that it may be said to possess
a literature of its own. The condition of the kidneys, in¬
testine, stomach, uterus, and spleen, which indicates surgical
intervention has been very fully considered, and lately
diseased states of the pancreas and liver. There is one class
of cases, however, which has received less consideration than
the rest—at any rate, in the light of our newer knowledge
and experience, and that is the treatment of penetrating
abdominal wounds and visceral injury. My attention has
been directed to the subject by the recent occurrence in my
own practice of two cases of intra-peritoneal rupture of the
bladder produced by external violence. In both of these
the abdominal cavity was laid freely open, the rent in the
bladder closed by suture, and the peritoneal cavity effec¬
tively purified. In each instance the patient completely
recovered, and two men, the subjecte of a heretofore fatal
injury, were restored to perfect health. Another case of the
same kind has been since successfully operated upon in a
precisely similar manner by Mr, Walsham at St. Bartho¬
lomew's Hospital. My colleague, Mr. Croft, has courteously
placed at my disposal the record of a case which, if
not in itself completely successful, points out how success
is to be realised. It is so interesting that I shall give a
brief account of it.

G. W-aged thirty-four, labourer, was admitted into

St. Thomas’s Hospital on Sunday, March Gth, at 2 o’clock.
Seventeen hours previously he had received an injury to
the abdomen in a public-house row. He stated that he had
been jumped upon. Ho had no medical advice before
reaching the hospital. During the night he was in great
pain and was sick two or three times. On admission the
patient’s temperature was 103', and he was thought to have
peritonitis. Mr. Croft was sent for. He decided at once to
explore the abdomen by median laparotomy. The operation
was performed eighteen hours and a half after the accident.
Three lesions were discovered. The ileum had been
ruptured trauversely to the extent of two-thirds of its
circumference at the junction of the lower and middle
thirds. The lower surface of the mesentery in the same
neighbourhood presented a laceration about an inch and a
half in diameter, and the omentum, above the level of the
umbilicus, had a considerable rent in it. There was ftecal
extravasation, and septic peritonitis had spread into the
iliac, umbilical, and hypogastric regions. Entororaphy was
debated, but postponed under the circumstances in favour
of artificial anus. The peritoneum was very carefully
irrigated and rendered aseptic with a warm solution of
borucic acid from 15 to 20 per cent, in strength. The edges
of the ruptured intestine were closoly attached to the
parietal wound, and. the rest of the incision closed in the
usual manner., The operation lasted an hour and a half,
and the nmn was kept during this time under the influence
of ether. He became much exhausted. . The pulse was very
feeble and the bands and feet cold. lie recovered satisfac¬
torily. The symptoms of peritonitis disappeared,. but a
sharp attack of bronchitis ensued. This yielded to treat¬
ment, but he, di4, not gftin strength or flesh, partly by the
irrepressible, escape,of i mtestina^ j^paUnts at, the artificial
anus and partly by. the local irritation established in the
abdominaT willthe contact at. the intestinal secretioa,
At the and.jet Mr..Cr^|tipi(x»^4^d tp close the

artificial anus. The nfficgfr fu pfapMed for, the operation,
which was B j gftwffl W ,pg,iAprfl fly .faie ntw fag rectal

feeding for alimentation by the month, and by local irriga¬
tion of the intestine and all parts immediately concerned.
The bowel was then separated from its parietal attachments,
the injured portion resected, and the cut surfaces carefully
united by twenty-six sutures of tine silk; twenty of these
were in one row, after Lambert’s manner of suturing. The
operation lasted two hours and a quarter, and the patient
was taking ether all that time, with the exception of b
quarter of an hour, when his circulation was so feeble that
the anaesthetic was discontinued and a brandy enema was
administered. The patient died on April 5th, thirteen hours
after the operation. The lungs were found very congested
and airless. The suturing had been perfect, and the peri¬
toneum was entirely free of any recent exudation or inflam¬
matory products. (Fig. 1.) Had the natural force of the man'
been a little greater he might have made a good recovery. '

Mr. MacKellar, in a case of gunshot injury of the sigmoid
flexure, recently opened the abdominal cavity, but found: it-
impracticable to apply Lembert’s suture to the intestinal
perforations caused by the bullet. The patient was in a
state of impending eollapse at the time of the operation,
and died twelve hours afterwards.

Again, Mr. Croft nearly achieved success in a case of
rupture of the spleen. The patient, a young man, had been

Fia. 1.

Appearance of the sutured port ion of the bowel after death.

run over by a cab, but no effective assistance was rendered
to him, and when brought to the hospital twelve hour*
afterwards the abdominal cavity was full of blood. Laparo4
tomy was performed and the ruptured spleen removed, the
peritoneal cavity being cleared of blood and purified; but the
patient never rallied from the state of collapse and died the
same evening. . . I

Cases such as these are somewhat closely connected. They
suggest many points of interest, and invite consideration to
the large question of abdominal injury, more especially in
regard to its treatment by operation. 1 weald urge tbs
propriety of a more freooeat resort to abdominal metaoa
and exploration of the aLdonimi Cavityandocm teats than
has beemheratoforo adapted in anas o£ injury in- 1. ineised
and punctured wounds of the abdomen implicating thesis*
testine or other viscera. 2. Abdominal gunshot wound*
chiefly as they affect the intestine. 3. Traumatic ruptgnQ of
the intestine and viseqra without external wookid. i
. Stab wovndt,of the abdomen.— These unay be either simpi*
penetrating wounds without injury ito any Of 1 the rontwinM
viscera, or accompanied by visceral injury, Simple j p eam
trating wound* of the abd omi n al cavity art very rarely
inflicted either by .sharp or blunt i Weapons oc by gunshot.
Them sso.upon record many apparent exceptions to this

916 Thb Lancbt,] SIB WILLIAM’ MAC CORMAC ON INTRA-PERITONJSAL INJURY.

[May 7,1887.

statement, but some of them may be explained by the
circumstance that the weapon or projectile has evaded the
abdominal cavity which it apparently enters, or when
traversing the cavity has produced an injury susceptible of
repair. .A sword thrust may traverse the abdomen, and the
bowel, subsequently prolapsed through the wound, be
found uninjured. During the American war an Apaebe
Indian prisoner, attempting to escape, was transfixed by a
bayonet and pinned with it to the ground. The weapon
entered the left bypochondrium, passed directly backwards,
and made its exit about two inches from the vertebral
column. No bad symptom followed, and the wound had
healed on the fourth day. An instance is recorded whese
an iron-headed arrow entered three inches to the right
of the fifth lumbar spine and emerged two inches to the
right by the ensiform cartilage. Circumscribed peritonitis
ensued, but the patient reoovered without other ill con¬
sequences. Hannan records the recovery of a soldier shot
through the abdomen with a ramrod at Badajos in 1812.
During the Ame ri can war in 1863 a ramrod entered the left
groin of Private Manypenny and emerged through the left
lumbar region. The surgeon records his diagnosis as “aram¬
rod driven plump through the guts.'' There was no serious
peritonitis, and the man returned to duty two months later.
Beck quotes seven cases of penetration of the abdomen by
bullets, without any apparent visceral injury, occurring in
soldiers of General Warder's corps during the war of 70-71.
Five of these recovered. In one of the fatal cases the bullet
entered anteriorly, and was found lying against the vertebral
column. The viscera were not wounded. In the other fatal
case several coils of uninjured intestine protruded through
a large wound caused by a mitrailleuse bullet. In the five cases
which recovered there were secondary lesions, such as fecal
fistula, so that they can scarcely be considered conclusive.
But such cases are very rare; the viscera seldom wholly
escape. Larrey, in his long career, only observed one instance
in which a ball penetrated the abdominal cavity without
producing immeoiatelpeerious results, and in this case the
intestine was afterwards found to have been contused.

Penetrating wounds, with visceral injury. —As I can only
deal with a limited part of so comprehensive a subject, 1
shall chiefly refer to wounds of the small intestine, since of
all the complications of penetrating wounds of the abdomen,
injury of the small intestine is the most frequent and most
fatal. Mr. Abemethy used to shake his head and say natnre
would have nothing to do with theee cases, but left them to
their fate. "In one short and general prognostic,” says
John Bell, “ we announce them to be fatal.” Fortunately
this is not absolutely true, but despite the exceptions, we
may take it that such injuries are very rarely recovered
from.

Punctured and incised wounds. —In time of war very few
sword or bayonet wounds of the bowel are met with; these
injuries occur for the most part in brawls, where the knife or
dagger is used. The intestine very rarely protrudes, and
hence, probably, suture of the wounded bowel has been but
seldom attempted, and although the result must depend to
some extent on the empty or collapsed condition of the
bowel at the time of injury, unless the puncture be very
small, there is no likelihood of recovery without suttfto.
When extravasation occurs, peritonitis almost necessarily
follows, although in a few instances a fortunate agglutina¬
tion of adjacent coils may prevent it and recovery ensue.

Diagnosis. —The diagnosis of wound of the bowel is of
primary importance, as upon the speedy determination of
this point and prompt consequent action most almost
altogether depend the suocesa of our treatment. When the
injured intestine is prolapsed through the wound, or the
oontents of the tube escape externally, the diagnosis is dear;
bat these oocntrences are the exception, and the presence of
a wound of the intestine in the early stage most be often mere
matter for conjecture. Tympanites and discharge of blood
per anum are valuable symptoms when present, hut neither
may appear directly after the injury. If the blood passed
feom the bowel be abundant and shows itself soon after the
injury, it is a very valuable symptom. Emphysema, when
it oocure in the wound neighbourhood, is said to be patho¬
gnomic. Shock and pain vary so much in degree as to
afford no usefnl guidance. The amount of shock is very
variable, and cannot be relied upon in any degree as
diagnostic. It is often described as very trifling; at other
times it may be severe* The amount of pain also off ere no
tree criterion. The suma who sees the case immediately
after the injury must often be in doubt as to whether the

intestine be injured or not, and as to the extent of the internal
damage. Probing these wounds has been very universally
condemned as useless for diagnostic purposes, and harmful to
the sufferer, by possibly disturbing the parts and giving rise
to fecal effusion. But this view can scarcely, meet with
the same consideration now in the fight of modern means
of treatment. If precautions be taken to exclude septic
influences, the thorough examination of the wound by the
probe may determine its direction and extent, and ii thia
fail to clearly establish the fact or otherwise of penetration,
the wound should be enlarged and explored to its termina¬
tion, either in the parietes or more deeply. The important
point to speedily determine is whether tne wound penetrates
the abdominal cavity, and this is perhaps the most effective
manner of ascertaining it. After a short interval the
occurrence of peritonitis will determine our diagnosis; tym¬
panitic distension of the abdomen, agonising pain, oeaselesa
vomiting, tendency to collapse, thready pulse, and clammy
surface make their appearance,' and a fatal issue soon
follows. When the diagnosis has been established in this
way the services of the surgeon am no longer called for.
8bould the abdominal oavity be penetrated, the question
arises as to whether the intestine has been wounded or
haemorrhage has taken place. In that event, the better
treatment will be at once to make a median incision in the
manner recommended for any other form of abdominal sec¬
tion, and not to trust to enlargement of the existing wound.
Of course where the bowel protrudes and no extravasation
has taken place in the interior, it will be sufficient to suture
the opening in the prolapsed pertion, excise after ligature
any damaged portion of omentum, and return the parts, if
necessary enlarging the external wound for the purpose.

Treatment,. —Although tiie abdominal cavity has been
traversed both by a bullet and sward without opening the
intestine, which is presumably thrust aside, this rendition
of things is not to be relied upon to guide opr. treetjPtifOL-

Enteroraphy is at the present time admittedly the best
method of treatment for all punctured and incised wounds
attended by protrusion, unless the parts are so damaged
that an artificial anus seems preferable. In oases of stubs
and gunshot wound unattended ky protrusion, the common
practice heretofore has been to arrest the p er istaltic move¬
ments with opium and enjoin absolute rest, in the hope that
adhesions may form to avert extravasation. Experience
proves that in the vast majority of instances oueh hopes are
illusory; ninety-nine times in a hundred extravasation
occurs, hyper-acute peritonitis follows, and after much
suffering death usually takes place within forty-eight hours.

Another practice commonly recommended is the formation
of an artificial anus by attaching the margins of the wound
in the gut to the skin; but where it is possible to avoid it
this course is in the highest degree undesirable, and cer¬
tainly unnecessary In those cases where the injury does not
extend more than half-way around the calibre of the tube,
or where the convexity of the bowel is wounded; probably
also in all cases where the mesenteric attachment is intact;
and the same may be said where the bowel is ruptured by
external violence. This practice gives the sur geo n a false
sense of security; he thinks if his sutures give way tbe
patient may still recover, bnt the evidenoe u very strong
that the risk of faecal extravasation is less when the wound
in the bowel is completely dosed and the gut at once
returned to the abdominal cavity. A different practice pro¬
perly obtains where the bowel is gangrenous in hernial or
other forms of strangulation. An artificial anus should then
be established in preference to immediate rese c t i on of the
gangrenous portion of bowel with suture of the divided
ends. In such cases the bowel is in an unhealthy condition.
We do not exactly know the limits of the gangrenous action
or of tbe zone of inflammatory infiltration beyOfld w-flad
therefore cannot precisely determine what amttimt ’ of
damaged bowel it is necessary to remove. In cases of
injury, however, we shall have but half accomplished our
work if we do not at once attempt to restore the continuity
of the intestine. Should the patient recover, a further
operation will be required to doee the faecal fistula, and this
procedure is often one of grant difficulty and serious risk.
Besides, should the original damage be in tbe t ip per portion
of the small intestine, there is a ririnnl il raalill pYniianfttlrif
tbe individual being either starved or so
escape of nutriment that he beoomee urifffiil
successfully to any operation whetevfe. J1 j teioBj/v

- Intestinal mtvre .-^There are Itrtto oBri g tftH U
ensure successful suture of the Intestine. 1. Two adequately

918 The Lancet,] SIR WILLIAM MAC CORMAC ON INTRA-PERITONEAL INJURY.

[May 7.1887.

manipulation. The intestines must be withdrawn, care¬
fully examined, and protected as far as possible by
warm cloths. The best way is to seek the caecum first,
and then trace the small intestine upwards for its entire
length ; in this way we shall be least likely to fail to find
the injury. All bleeding points must be secured and the
clots swept away. When several openings exist close
together, it is better to resect the portion of intestine in¬
volved. In some instances, when the bowel wall is seriously
compromised at one or more distant points, multiple resec¬
tions have been made. Ingenious clamps, such as those of
Rydygier, Treves, and others, have been suggested, but

(Pigs. 3,4,5), filled with connective tissue and blood veeeels,
between the layers of the peritoneal coat as it leaves
the bowel to form the mesentery. At this place the
needle must be passed deeply enough to include the mus¬
cular coat as well as the serous, otherwise extravasation
will result. Three sutures should be first introduced at the
mesenteric border in the manner insisted upon by Parkes.
A suture had then better be placed at the convexity of the
bowel, then one half-way down on each side, the others
following in order in the quadrantal intervals between.
Each suture should be introduced not lees than a third of
an inch from the divided margins, brought out just free of

Fig. 2.

Illustration of the appearance of the resected bowel with
ita edges much everted previously to the Introduction
of the sutures. In the margins or the separated portion
of mesentery four points of suture have been introduced
after the vessels were secured by ligature.

When a Complete resection of the bowel Is performed, the margins of
the opening in the gut should be divided in a slightly radiating or
Oblique manner, so as to remove rather more on the convex than the
concave or mesenteric border. When the Lembert's suture Is tied, the
ohannel of the united portion of the bowel will thus be straight*! - ,
and there is leas liability to Interference with the free passage of its
contents at the point necessarily narrowed by the suture. The meeentcrv
.should be cut through as close as possible to the intestine, and after all
•bleeding has been arrested, the two cut edges are sutured together.

the fingers are probably the best form of instrument to
preyent the escape of the intestinal contents after division of
the tube. The mesentery muBt be detached from the part of
the gut to be resected. When a large portion requires removal,
a triangular piece of mesentery may have to be excised,
taking care to secure separately every bleeding point. The
mucous coat becomes much everted (Fig. 2), sometimes
, seriously interfering with the introduction of the sutures

Mesentery, showing the di¬
vision of the serous layers
as they approach the In¬
testine .„

Triangular space filled with
fat, connective tissue,

vessels, and nerves .

Base of the triangle formed
by the muscular ooat of
Intestine ...

Serous cost .

Muscular coat.

Mucous membrane .

Fig. 3.

Artery.

Semi-diagrammatic section of the jejnnum (natural aize).
The muscular layer through which the sutures are
passed is comparatively thick.

And the accurate approximation of the surfaces of the bowel.
It should not be excised, as it gives support, and supplies
blood to tbe edges of tbe gut. In all the experiments
where it was cut off by scissors the sutures gave way
(Parkes). Care must be taken to insert the sutures at
the mesenteric border sufficiently deep to ensure complete
inversion of the intestine, and to bring the serous
surfaces fairly into contact. There is a triangular interval

Fig. 4.

Section of Ileum, from the same auhject (natural aize).

Fig*. 8 and 4 illustrate the comparative thickness of the wall of
these two portions of the Intestine, sad show how thin the muscular
layer la In the ileum.

the edge on one side, then reintroduced dose to the oppo¬
site edge, and made to include about the same width of
tissue. It should include only the serous and muscular
layers. In cases of complete resection of the bowel it is
best to include a considerable width of serous membrane.
It is more difficult to pass the sutures in succession one
after the other all the way round; the muoous membrane
is in the way, and the sutures are apt to be uneven. Fine
silk is the best material to employ, and a moderately curved
needle. Cremy’s double row is very tedious to apply, and
as it gives no better results than the single row, iDeluding a
sufficient width of tissue, it had better be abandoned on

Fig. 5.

account of the loss of time it entails, or, if used at all,
it can only be necessary along the mesenteric border. Tbs
condition of the solid viscera must then be examined
and any injury found in them dealt with according to
circumstances. This will, however, prove a very fatal
complication.

Abdominal injury without external wound .—Violent con¬
tusion of the abdomen may result in rupture of any of its
contained viscera, a condition for which laparotomy has been
very rarely pe rf o rm ed.

Digitized by

Google j

Thu Lancet,] DR. W. B. CHEADLE ON LARYNGISMUS, TETANY, AND CONVULSIONS. [May 7,1887. 919

Rupture qf the intestine. — In these cases an exact
diagnosis must always be very difficult, oftentimes quite
impossible to arrive at, as the symptoms are obscure and
common to several degrees and kind of injury. Serious
hesitation must always occur when we are called upon to
decide in the presence of each particular case what is the
beet line of treatment to adopt. One has seen many cases of
severe abdominal injury recover, while many very speedily
die. The most serious injury is sometimes unaccompanied
by any definite diagnostic symptoms.

Symptoms and indications for operation .—The chief indi¬
cations for operative interference are afforded by the mode
of action and severity of the violence, the presence of pro¬
longed and profound shock. The duration of the shock is
of greater importance than its intensity. A small and quick
pulse and hurried respiration, while the temperature remains
either normal or subnormal, associated with acutely severe,
persistent, and localised pain, increased on pressure, indicate
the Berioua nature of the injury. Bloody vomit or stool, rapid
tympany, the evidence of percussion, are inconstant signs,
and nelp us but little. The jejunum and ileum are the por¬
tions of intestine most frequently ruptured, and the rent
will generally be found juftt behind the part of the abdomen
which has been struck—a fact which can easily be verified
by experiment. In about 15 per cent, of the cases more
than one loop of intestine is damaged, and in that case
the injury generally occurs in super-imposed coils. It is
difficult at first to distinguish the syncope induced by
haemorrhage from the shock caused by a ruptured intes¬
tine. In the early period we shall have to arrive at a
diagnosis from the nature and violence of the injury
and the general condition of the patient When peri¬
tonitis is declared, an exploratory operation is urgently
indicated, a9 collapse comes on very quickly, sometimes
very suddenly, and a few hours’ delay may negative all
prospect of recovery.

Treatment .—Absolute rest has hitherto been the chief
indication for treatment. But cases do arise in which
abdominal section should be practised, and an attempt made
to discover and deal with the visceral wound, arrest the
bleeding, and clear away the clots and extravasaled blood.
We should interfere when we possess a reasonable belief
that the intestine is ruptured. AVe may in some cases pro¬
perly propose laparotomy as a means of diagnosis, and, indeed,
when intestinal rupture i9 suspected, the operation should
be performed at once to afford a good prospect of success.
Exploratory laparotomy has no very serious inconvenience,
and should be adopted in those cases where there are
reasonable grounds for believing the intestine has been
damaged, as in no other way can effective assistance be
rendered to the patient. At a later period we have not only
the ruptured intestine to deal with, but a septic peritonitis,
which produces the most profound depression, and often
necessitates an undue curtailment of some essential step in
the operation, or occasions the death of the patient before
its completion. Extreme collapse, a long interval from the
time of the injury, or severe coexisting damage to the
spleen, liver, or pancreas, of course contra-indicate operation.
The incision should be made in the middle line in all cases,
and at the level which will afford readiest access to the seat
of the injury. It is desirable to make it long enough to
permit the surgeon to reach without difficulty every part of
the interior. According to circumstances, we may then
decide to suture the intestinal wound, resect the injured
portion of the bowel, or make an artificial anus. The same
objections hold in regard to the latter that obtain in respect
of artificial anus after gunshot injury. AVhere it is at all
practicable, I believe it best to finally close the opening in
the intestine and also the external wound.

The Sewage of Manchester. —The Rivers Com¬
mittee of the Manchester Town Council have prepared a
report containing particulars of a scheme for dealing with
the sewage of the city. The scheme, which is that of the
city surveyor, comprises an extensive system of main drains
which will carry the sewage of the entire city to Davi-
hulme, where it will be dealt with by precipitation works
? Q t ^ le P rLnc *Pl e of those now in successful operation at
Leeds. The effluent water will pass into the river Irwell,
which stream, by the means to be adopted, will be relieved
of much of its impurity. The maximum expenditure to be
inc urred to cover works, 1 land, easements, and all other con¬
tingencies is Bet down at £500,000.

% Clinical lecture

OK THE

PATHOLOGY AND TREATMENT OF LARYN¬
GISMUS, TETANY, AND CONVULSIONS,

ILLUSTRATED BY CASES OP THESE DISORDERS IN'
CHILDHOOD, AND ALSO BY A CASE OF THE
TETANY OF ADULT LIFE.

By W. B. CHEADLE, M.D., F.R.C.P.,

SENIOR PHYSICIAN TO THE H08PITAL FOR BICK CHILDREN, OREAT ORMOND-
8TREKT, PHYSICIAN AND JOINT LECTURER ON MEDICINE
TO 3T. MART'S HOSPITAL.

Laryngismus, tetany, and convulsions are different
expressions of the same constitutional morbid state, are
associated especially with the first two years of life, with
the period of rickets, and with the period of dentition.
They are all distinguished by the occurrence of muscular
spasms. In the first by a transient spasm of the laryngeal
muscles, lasting only for a few seconds, and then ceasing
absolutely during an indefinite period of rest. In the second
by a persistent tonic spasm of the flexors and adductors of
the hands and feet, varying in degree, liable to exacerbations,
but never relaxing absolutely. When this is at its worst
the cramps are painful. There is also twitching and fibrillar
contraction to be obtained of the orbicularis and levator
anguli oris on stimulating the skin by scratching over the
pe8 anserinus 1 In the third the whole of the voluntary
muscles are usually involved, and there is loss of conscious¬
ness. There may be complete relaxation between the attacks,
or more or lees continued rigidity of certain groups—as the
flexors of the hands and feet, for example.

Laryngismus, tetany, and general convulsions are the
positive, comparative, and superlative of the convulsive state
m children. Convulsions no doubt ooour in special circum¬
stances apart altogether from laryngismus and tetany, and
the peculiar constitutional state with which they are, as a
rule, associated—as, for example, as a result of the irritation
of round worms in the intestine, of undigested food, of
irritation of the dental nerves; and in ursemiaand in menin¬
gitis. But in the vast majority of cases there exists as a
predisposing cause a special constitutional state, in which the
nervous system is in an extreme state of hyper-excitability
or mobility—a state of “ erethism,” as it is called; and in this
state slight causes of irritation which would be innocuous in,
a condition of stability set up the muscular motor spasm ofr-
laryngismus, tetany, or general convulsions. It is my object-
in this lecture to demonstrate as clearly as I can in what the
essence of this predisposing constitutional state consists, in*
order that the principles upon which these affections must
be treated may be fully recognised and understood; that I-
may warn yon against the erroneous practice which widely
prevails, and enforce safe and wise treatment of these
common serious disorders, with which in the course of
your career you will be frequently called upon to deal.

Let me illustrate the clinical features of the three phases
of spasmodic motor disturbance by one or two examples* _
and first a case of simple laryngismus stridulus.

Mrs. L-’s child, a boy of one year and seven months, was

brought to me in December 1883, suffering from frequently
recurring attacks of spasm of the glottis, from which it had
suffered for the past six months. At first the seizures were
merely occssional crowing inspirations, then after a time
more severe; the breath stopped until the child became black
in the face and was almost suffocated. Sometimes these
attacks recurred every half-hour, the child waking up in the
night with them; there was always a severe one on first
waking in the morning, but the most alarming seizures oc-
_- — —-- ■ 1

1 Tetanv must be distinguished from idiopathic tetanus; indeed,
there is little difficulty In the diagnosis. The fact that In the one case-
tetanus—the contractions commence In the jaws and the muscles of
expression, extend to the trunk, and only slowly and at last to the
extremities, while in the other—tetany—the contractions commence in.
the extremities, and only extend to the trunk In rare c ases afterwards,
and seldom occur In the extremities and trunk simultaneously, serves to
distinguish the two; moreover, the peculiar form of the contraction of
the hands and feet Is In itself pathognomonio—i.e., tetanoid contrac¬
tions as distinguished from tetanic.

Digitized by G00gle

920 Thb Lanort,] DR. W. B. CHEADLE ON LARYNGISMUS, TETANY, AND CONVULSIONS. [May 7,1887.

curred during the day, when the child was excited by laughter
or vexation or crying. The child was extremely rickety,
the forehead prominent, the fontanelle widely opened, the
ribs beaded, and the wrists enlarged, but the long bones
were not curved. It had great perspiration of the head at
night; frequent diarrhoea; the muscles were soft and flabby;
it could nob walk; it had two teeth only, whereas at this
age it should have had at least ten or twelve. There was
no tetany or spasm; the thumbs were not drawn in, nor
the toes flexed. The child had frequent attacks of crowing
inspiration as I examined it. The explanation of the
rickety condition was given by the history. It was kept
at the breast until thirteen months old; latterly the
mother had very little milk for it, and could give it the
breast twice a day only. In addition to this it had nothing
but nursery biscuits—no cows’ milk, no beef-tea. After it
was weaned, at thirteen months, it had a pint of cows’ milk,
Osborne biscuits, bread, and gravy. It had frequent diarrhoea.
Here was a child, then, brought up on insufficient animal
food; the imperfect nutrition was aggravated by frequent
diarrhoea, hence nervous instability. A source of irritation
increasing the motor nerve excitability was partly the in¬
testinal catarrh, partly perhaps the irritation of teeth slowly
making their way through the gums. The immediate cause
of each spasm was the emotional excitement of laughter, or
crying, or a breath of cold air. The invariable attack on
waking was probably set up,by the crying a child indulges
in so often then, or the greater activity of the reflex function
on the waking state. The treatment consisted in giving four
grains of bromide of potassium with one grain of chloral every
six hours, to relieve the spasm. During the attack cold water
was directed to be dashed in the face, or a hot sponge to be
applied to the throat. To improve nutrition and remove the
predisposing cause of tho convulsive seizures, two ounces of
raw meat pulp and wheat flour with milk; this to be the
sole diet. The baby was to be kept quiet—not played with,
crossed, excited, or exposed to a stream of cold air. The
child took the food well; the attacks at once grew fewer
and less severe, coming on only on waking or under special
excitement. The treatment by chloral and bromide was
omitted for a time by the parents, with the result of a return
of laryngismus and two severe general convulsions. After
this warning the treatment was steadily continued, and the
child got well without further relapse.

In the case I have related there was no tetany, but
larnygismus with general convulsions. In the next case the
laryngismus was accompanied by the tetanoid condition,
but there were no general convulsions.

In December, 18S3, I saw in consultation with Dr.-

a child of eleven months- a thin, miserable, white-faced
child, with flabby muscles, projecting forehead, widely open
fontanelle, pigeon breast, beaded ribs, and enlarged ends of
the long bones. It had no teeth ; at this age it should have
had four or five at least. It had, in fact, all the signs of
well-marked rickets. It had had repeated attacks of sick¬
ness and constant diarrhoea, no food seeming to agree with
it. It was anaemic, chill, its temperature subnormal. I
was asked to see it, however, chiefly on account of attacks
of spasm of the glottis. These were occasionally so severe and
prolonged ns to bring the child to the verge of suffocation.
They were brought on by the smallest excitement, but were
most intense on first waking in the morning, or when
induced by angry crying or by laughter—a feature of the
preceding case, and 1 think universal in this disorder. On
examining the child more minutely, the thumbs were seen
to be tightly drawn in to the palm, which was arched longi¬
tudinally, the fingers adducted and overlapping each other
—the typical so-called “ accoucheur’s hand ” of tetany. The
feet were arched and the toes flexed. The dorsum of the
foot was much swollen, as if dropsical, but there was no
actual oedema, the swelling being due probably to pressure
of contracting muscles, not sufficient to produce effusion,
acting just as a tight bandage does. The child was
constantly crying with the pain of this cramp when the
spasm was most intense. Twitching of the orbicularis and
levator anguli oris could he induced by scratching the skin
over the pes anserinus. The attacks of'laryngismus had been
increasing in intensity. The family history of the patient
was remarkable and highly significant. There had been
five children born alive, all strong, plump, and apparently
healthy; yet of these five three died. The first had general
convulsions at three months, and died in an attack of
laryngismus at six months. The second died at six months
and a half of diarrhoea and wasting; no laryngismus or

convulsions. The third is still alive and fairly well, but
she was weakly as an infant, and had two oonvnlaiorta
when teething. The fourth had “croup ” when four months
old, and died at the age of a year and ten months from
general convulsions. The fifth was the youngest, who came
under my observation in the condition I have described.
So that four out of the five children had convulsive seizures,
and the one who escaped convulsions had diarrhoea and
atrophy. What is the explanation of this remarkable pre¬
disposition to convulsions. Was it an inherited tendency ?
a congenital nervous hyper-excitability ? 1 think not. The
tendency had been acquired—developed by defective nutri¬
tion. The explanation lay in the fact that all these children
had been brought up by hand. The mother, closely engage
in business, could not give time to suckle her children
They were fed chiefly on corn flour, infants’ food made with¬
out milk, and arrowroot, with hardly any milk, for cows’
milk disagreed with all and caused vomiting and diarrhoea.
No other animal food was given to make up for this. The
only exception was the little patient. The parents rising
in circumstances, the mother was able to give time to
nurse the youngest, baby, but she found she had little-
milk to give. So this, too, had corn flour and all kinds of
things in the shape of bread-and-butter and farinaceous
food. Its appetite was ravenous. The bowels were always
loose, and it often had sickness. 1 advised that for the
immediate relief of the laryngeal spasm half a grain of
chloral and four grains of bromide should be given every
four hours, and that the diet should be chauged to
one of animal food chiefly, with abundant nitrogenous
matter; two ounces of raw meat, boiled milk diluted
with one-third water, and thickened with entire wheat-
flour thoroughly boiled; with this, half a teaspoonful of
brandy in a tablespoonful of food every four hours—a
valuable assistance to circulation in these chilled, feeble
children, and, moreover, a most useful nervous sedative in
early life. The fits at ouce declined both in frequency and
severity, and the tetanoid spasm of the hands and feet gra¬
dually relaxed. When I saw the patient again, in a week’s
time, the thumbs and toes were flexed, but the palms of ttfe
hands and soles of the feet were no longer arched or rigid.
She improved steadily, and escaped convulsions; the attacks
of laryngismus declined to two or three a week, and then
not severe, instead of ten or twelve a day as at first. Then
there was a relapse, when the bromide and chloral were
stopped, but the laryngismus quickly subsided, and there
were no more seizures. Cod-liver oil and lacto-phosphate
of lime were given; and when seen six months afterwards,
the child was stout, hard-fieshed, and robust in health, and
had got five teeth (at one year and five months).

It is very curious and instructive to compare tetany
in a child with what is called tetany in an adult. A
case of this latter kind came under my care at St. Mary’s
Hospital in the spring of 1884. The patient was a thin,
ill-nourished, anaemic girl of seventeen years of age. Her
condition was briefly this. Both wrists were Hexed, the
hand being drawn towards the ulnar side, the thumbs
firmly adducted and drawn across the palm of the hand;
the fingers were partly flexed at the metacarpo-phalangeal
joints, and slightly flexed at the phalangeal joints. Thus
the hand became narrowed into the characteristic conical
form. a Both hands were affected, the left being rather
worse than the right. There was pain in the wrists and
over the metacarpo-phalangeal joints. The skin over them
was exquisitely tender and red. There was liypenesthesia
generally of the back of the hand and the ulnar side of
the forearm. Any attempt to forcibly extend the fingers
caused intense suffering. The lower iimbs were fre8 from
contractions, yet as the patient sat up in bed to have
her chest examined cramp came on suddenly in the right
leg. The foot was forcibly extended by the spasmodic
contraction of the calf muscles, the pain causing her to cry
out sharply. When the patient resumed the recumbent
posture the cramp instantly ceased. It was found, moreover,
that no spasm was brought on if the patient kept her
legs hanging down over the side of the bed when
up, or by walking a step or two. So that the spt ^gna ws
clearly produced, not by the calf muscles being' brough'
into active contraction, 'but by passive stretching 0 f there.

* This form of contraction of the hand appear.; to be •_ fire r
notion of the adductor pollicis and flexor brevie pollicis, (2jf palmar inter
oesci hollowing the palm. (3) dorsal in to row I causing separation ■■■ t'
fingers as attack passes off. All supplied by ulnar nerve. r(Abercrombie:
Tetany in Children, p. 16.)

TiU* XiANCBT,]

MR. ANTHONY A. BOWLBY ON INJURIES OP NERVES.

[May 7 , 1887 . Q 2 X,

Generally there was observed to be hypenemia wherever
there had been pressure — as over the patella where the
bedclothes rested, over the spines of the scapul®, and at
the tops of the elbows. The tache c6r*5brale was readily
produced. No fibrillar contractions of the orbicularis pal-
ebrarum, or levator al® nasi, or levator annuli oris could
e induced by scratching the skin over the pes anserinus, as
observed in severe cases in children. ' We made out that the
contractions had commenced two days before, when the
right hand began to feel stiff. On the next morning
when she woke it was rigid, with the thumb drawn in as
described, and great pain localised about the styloid process
Of the ulna. The left hand remained unaffected until
the following morning, and soon became in the same
state as the right. But although the tetanoid spasms
had arisen two days before, they were by no means
the commencement of the illness. The cramps were
merely the sequel and outcome of previous disorder.
The girl had been ill three weeks. She had had pyrexia
and constant diarrhoea. An elder sister had just recovered
from typhoid fever; another sister was down with it.
The patient’s temperature was 100'5°; pulse 120; tongue
red; spleen enlarged and tender; no spots; stools not
distinctive. But there was no doubt the girl was just
recovering from & moderate attack.of typhoid fever. In her
history the following noteworthy facts appeared: In infancy
she had convulsions when teething, and had been especially
liable to croup and bronchitis. When twelve years old
she had chorea. At twenty she was a surgical in-patient at
SL Mary’s Hospital with abscess in the side from necrosis
. «f a rib, and had contraction of the muscles of the left arm,
with pain lasting only twenty-four hours. Six other
<;hldren, her brothers and sisters, had died, four of
■consumption, one of infantile convulsions, and one of
bronchitis. Ten grains of chloral were ordered every
•four hours. In three days the tonic spasm had disappeared,
stiffness and numbness alone remaining for a fortnight
longer. For six weeks, however, cramps could be pro¬
duced in the legs by forcible flexion of the ankle-joints.
But the spasm could never even at first be produced by
pressure on the brachial artery severe enough to blanch the
limb, which Trousseau affirmed to be a distinctive feature
of tetany. At the end of the six weeks she was well.

I think it is clear that the tetany in this case was
identical with the tetany in the child. The spasm of the
extremities in each was the typical contraction of tetany.
The chief differehce lay in the absence of facial irritability
and of laryngeal spasm in the young woman—features of
■the disorder so characteristic in a young child. The presence
•of these special signs in infancy is probably due to the
greater reflex nervous excitability notable in young
Children. If you toss a perfectly healthy baby into the air
it crows, catches its breath—i.e., has slight laryngismus or
spasm of the glottis. Some children, too, who are strong and
healthy in every way apparently, get spasm of the glottis
when in a violent fit of passion. The comparison of these
■cases of tetanoid spasm is interesting, and the question of
their identity important, because it throws light upon the
■causation. I lay stress upon it on account of tne bearing it
has upon the pathology and treatment of the disease, as I
shall show shortly, and also because it has been suggested
that the tetany of children is a different affection from that
described by Trousseau and others who had followed his
lead in this matter. 3 Trousseau appears to have drawn his
-description of the disease chiefly from adults, although he
mentions tetany a9 occurring frequently in infancy. Now
the disorder as we see it in this country bo commonly in
.children undoubtedly does not correspond absolutely with
the original description. Trousseau laid stress upon the
intermittent character of the spasms, and upon their being
excited afresh, at will, by pressure “ over principal nerve
trunks, or over bloodvessels so as to impede the venous or
arterial circulation.” But in the case of the young woman
these special characters Were wanting. The spasms were
not intermittent, and could not be reinduced at will by
pressure over nerve Or vessels; corresponding thus exactly

* Henoch, for exatnple, fcpeaktnjfof this condition, which lie terms the
Tdiop&thlo contractures of childhood, says: " This affection is classed
with tetany by many, tmt In toy opinion It Is well to separate the two
dtse ai c e entirely. ■ I .have never bean able .to detect the symptoms
regarded by Troufseau ss cbaractaristlc—v(i., production of the con-
Wactures by proisdrc on the artefy supplying the affected limb—in
tdlopatblo contractors* Of chfldeSn.” D*. 'Abercrombie, for Similar
reasons, expresses doubts as to tfcfe IdevMty of the tetany of children

with the case of the child, and agreeable to the observations of
Ilenoch and Abercrombib in children. I have never seen a case
in which the intermission of the contractions was complete.
There is always variation in the degree and intensity of con-'
traction, partial remissions, and exacerbations, but no absolute
cessation, often for weeks. So that in all cases of children,
and in the only adult which I have examined with regard to
these points, these two symptoms, so prominent in Trous¬
seau’s picture—viz., the intermittent character of the spasm
and its reinduction at will by pressure on nerve trunks or
vessels,—have been altogether wanting. You will remember,-
however, that in the case of the young woman spasm, of the 1
calf muscles was at once produced by stretching, and it is
significant that in children Dr. Abercrombie noted that
muscles became more rigid on handling. It is possible, I
think, that this phenomenon of hyper-excitability on pressure
of muscle or stretching of it may have given rise to the im¬
pression that the spasm was excited by pressure on nerve or
vessels, when it was in reality due to the stimulation of
rough handling or stretching or muscle.

Another curious point with regard to the history of tetany
is the fact before mentioned, that it has been described
chiefly m relation to its occurrence in adnlts, whereas it is
far more common in children. Of the seven cases given by
Trousseau six were in adults, one only in a child. Of twelve
cases I find in the medical journals (chiefly about 1870,
when the subject cropped up, I suppose in consequence of
the publication of Trousseau’s Lectures by the Sydenham
Society), two only were in children. Yet my friend and
colleague Dr. Abercrombie, who has given the most complete
account of the disorder in children in one year, met with
no less than fourteen cases in ■ children in this hospital. • I
have seen a very large number of cases in children, and
only three or four in adults in the whole of my experience
in this hospital, in a large general hospital, and in
private. The fact is that, in children, this condition,
when not extreme enough to be painful or obtrusive,
is constantly disregarded because it occurs in con¬
nexion with laryngismus stridulus and convulsions. The
minor is overshadowed by the major symptom, whereas in
adults tetanoid contraction is the most prominent feature.
Yet the peculiar spasm of hands and feet has been frequently
described by authors, under the name of carpo-pedal co ntrac -
tions, as one of the symptoms accompanying laryngismus:
Dr. Ley, Dr. West, Dr. Hillier, Meigs, and Pepper so describe
it. The flrst person to identify these carpo-pedal contrac¬
tions with tetany was Dr. Abercrombie, to whose excellent
paper on the subject I refer you for much useful information. 4

( To be concluded.)

Jtctam

ow

INJURIES OF NERVES.

Delivered at the Royal College of Surgeons ,

By ANTHONY A. BOWLBY, F.It.C.S. Eng.,

SVSQIOAL BEOffiTBAR AND DHMOXSTRATOR OP 8UBGICAL PATHOLOGY AT
ST. BABTHOLOJABW'S HOSPITAL, HUNTERIAN PROFESSOR OF THE
BOYAL COLLEGE OF SURGEONS.

LECTURE I.

{Concluded from page SOS.)

Union by first intention .—I have already said that the
usual result of nerve section is degeneration of the entire
peripheral end, and' the question at once arises whether
such a degeneration is invariable, or whether union by flrst
intention, independently of such degeneration, can occur.
As regards the fowl, Gliick has very clearly shown that if
the cut ends of a divided nerve are carefully sutured, de¬
generation may be entirely prevented; and although other
experimenters disagree with him, in my opinion his con¬
clusions are warranted. It is of course quite another
question whether union by first intention occurs in man,
for it must be clearly kept in mind that the results of
experiments on the nerves of animals cannot be directly

* Tetany In Young Children. Thesis lor the degree of M.D. at Cam
bridge; BailUSre and Co., Ktifg WlUlsm-street, 8trand.

Digitize)

922 Tax Lancet,] ME. ANTHONY A. BOWLBY ON INJURIES OF NERVE8/ , [*»*&

transferred to man. The subject is one on which there has
been much controversy, but I may say at once that from
clinical observations I have no doubt of the possibility of
primary union, although I think it is certainly very rare,
and in support of my opinions will quote the following
two cases.

H. H-, aged twenty-thr^p, was admitted into St. Bar¬

tholomew’s Hospital on Nov. 20th, 1881. He had fallen
with outstretched hands on to some sheets of loose glass
a few minutes before arriving at the hospital. On examina¬
tion I found a large lacerated wound about an inch above
the palmar surface of the right wrist, a dap of skin and
muscle being turned downwards towards the palm of the
hand. The whole of the flexor tendons of the wrist and
fiagers, except the flexor carpi ulnaris and the innermost
tendon of the flexor sublimis digitorum, were divided. A
small piece of bone was cut out of the radius, and the
pronator quadratus was torn. The radial and interosseous
arteries bled freely, and were tied; the arteria comes nervi
mediani, which was very large, was similarly treated. The
median nerve had been divided in two places, and the
intervening portion of it, nearly an inch in length, lay
loose in the wound, and was accordingly removed. I then
drew down and stretched the upper end as forcibly as
possible, and sutured it to the lower portion with carbolised
catgut, the cut surfaces being brought into contact with
some difficulty after extreme flexion of the wrist. As many
tendons as possible were similarly fixed, and the wound
dressed with carbolised oil, the hand being steadied in a
position of flexion by means of a splint.—Nov. 21st: Much
pain in the hand; no sensation whatever in the parts
supplied by the median. Temperature 103°.—22nd: The
edges of the skin have sloughed, but the deeper parts look
healthy. —Dec. 1st: Sensation has been tested daily, but
this morning, for the first time, he can tell which finger is

E ricked with a pin. No pain. A good deal of the wound has
ealed, and the part is granulating healthily. — 3rd: With
his eyes blindfolded he can now tell with certainty
which finger is touched with the handle of a pen; the prick
of a pin causes pain.- 7th: Sensation in the thumb, index,
and middle fingers is nearly perfect. He can feel the
slightest touch, and can localise it accurately. Is fully
sensitive to the prick of a pin, and can move the fingers
slightly. — 10th: nas much improved in the power of
flexion; can thoroughly oppose the thumb and pick up a
pin ; says he has still a slight sensation of numbness; the
fingers are all quite warm and fully sensitive to all stimuli.
—24th: The wound has healed except for a very slight
ulceration opposite the seat of injury to the radius; he
says that, except for some stiffness in the fingers, one hand
feels much the same as the other. Has increased power of
movement in the fingers and thumb.—Eight months later
this patient came to show himself at the hospital. He
could not quite bend the fingers into the palm, owing
to. the adhesions of the tendons to the scar; otherwise
there was no difference between the two handp, and the
man said he could work and feel as well with one as tne
other.

I am indebted to Mr. Menzies for the details of the
following oase, which appears to me to be of unusual
Interest, alike from the care with which it is recorded and
the rapidity with which the functions of the injured nerve
were restored.

Primary suture of the median nerve, with union by first

intention. —Jas. W-, aged fifteen, was admitted to the

West London Hospital on Nov. 29tb, 1884, having fallen on
a glass bottle and cut his wrist. On examination there was
found to be an incised wound an inch and a half long on
the anterior aspect of the right wrist. The tendon of the
palmaris longua was seen to be divided. The median nerve
was completely divided. There was hjemorrhage from the
arteria comes nervi mediani, and the patient had complete
anaesthesia over tbe part supplied by the median nerve.
The ends of the nerve were exposed and sutured with
three catgut stitches passing through the trunk itself.—
-Nov. 30th: Patient had a good night, but complains of pain.—
Dec. 1st: Wound dressed. He has tactile sensation, and
localises accurately in the parts which were previously
anmsthetic, with the exception of the last two phalanges of
the index finger. The prick of a pin causes pain. He can
distinguish the points of two pins one inch'apart. Sense
of temperature is uncertain, especially that of cold.—
Cth: Wound healing by granulation. Sensation is fully
established to all forms of stimuli. He can appreciate tbe

points of two pins half an inch apart, except on thefai^tei;

finger. —8th: Sensation returned in the index _ finger.-i*.
20th : The wound has healed. Sensation is equal to that of*
the other hand to all stimuli.—Jan. 20tb, 1885: He uses tbe-
band quite well; he says it is as good as it was before the
injury.—July 20th, 1885: The hand differs in no way fromi
that of the other side; tbe muscles are quite natural, but
they do not react to either faradism or galvanism.

As to the actual lesion, and the rapidity of the subsequent-
recovery in the first case, there can be no room for doubts
for the patient was seen both at the time of the accident
and during his convalescence by many competent observers*
and the conditions I have described were frequently verified.
Tbe case under the care of Mr. Menzies is, again, in my
opinion, quite undoubtedly one in which primary union,
occurred. In no other way than by actual union of the-
previously divided fibres is it possible to explain the pre¬
servation of such perfect sense of touch, pain, and tem¬
perature, and above all of muscular power. As to the
completeness and rapidity of the cure the patient himself
bore the strongest testimony, insisting that his hand wan.
not numbed for more than about a day, and that it was
“quite as good as the other in three weeks,” notwithstanding:
that there had been a considerable wound. In other case®,
that I have observed there has been noticed a rapid:
restoration of function after primary suture of various-
nerves, leading one to believe that some fibres at least had.*
undergone primary union; but the cases already quoted am
sufficient for my present purpose—namely, to establish the-
fact that “primary union” of recently divided nerves*
without any antecedent degeneration, is quite possible in.
man. For although up to the present no case has been
recorded in which a microscopic examination could be made*
of the nerve during the process of repair, yet the complete-
return of sensation and of motion is a sufficient proof of the
reality of primary union. Supposing that in any given case
primary union does not occur, the length of time required:
lor the restoration of the continuity of the nerve trunk is*
very variable. Paget considers that a year or more i»
requisite. LdtitSvant observed cases at the end of the
nineteenth and fourteenth months respectively. The time
required will necessarily depend on many circumstances.
If tbe ends are far apart, if the wound sloughs, if a large-
quantity of dense cicatricial tissue intervenes, and if the
cut nerve contracts adhesions to the surrounding musclea
and tendons, union will be long delayed. In connexion,
with this question the following two cases are of interests
the first.being an example of failure of primary union, due
probably to separation of the cut ends, followed by sub¬
sequent regeneration; the second showing very plainly that*
even when tbe best contact is maintained, primary union
may be interfered with by erysipelas and sloughing.

Mary Ann P-, aged nine years, was admitted into

St. Bartholomew’s Hospital in October, 1879, having sus¬
tained a deep cut above the wrist-joint on the palmar
surface. There was complete loss of sensation and motion
in the parts supplied by the median nerve, but the cut end®
could not be found. A few weeks later the patient waa
discharged unimproved and with some wasting of the-
muscles of the ball of the thumb. On July 24tb, 1882,1 bad
an opportunity of examining the hand and found it in the
following condition:—Scar neither painful nor tender. Hand
well nourished and plump, not at all atrophied. Finger®
straight; can bend them well, but does not make a very-
good fist. Movements of thumb quite normal. Sensation
perfect. No trophic changes. Suffers slight pain in the-
hand in cold weather. Her mother says that feeling
did not begin to return till a year after the child left the
hospital, but that since then motion and sensation have
steadily improved.

R. W-, aged forty-four, was admitted into St. Bar¬

tholomew’s Hospital on July Gtb, 1882,on account of a wound
on the inner side of the upper arm, which divided the bicep®
and a part of the median nerve. As the divided portions of
the nerve tended to separate from each other, catgut sutures
were inserted and the ends drawn together; the muscle waa
treated in a similar manner. On the 11th I found tbe wound 1
suppurating, and the patient complaining of a sensation
of numbness in all his fingers. The sensory condition was
as follows:—Thumb: Tactile sensation impaired over the
distal phalanx, both front and back; also sensations of pain
and temperature; no place, however, is quite anaesthetic..
Proximal phalanx normal. Index finger: No sensation of
touch, pain, or temperature over the whole palmar surface*

'5

Th* Lancet,]

DR. W. GARDNER ON EXCISION OF THE LARYNX.

[May 7, 1887. 925

which is the underlying cause, is one of exaggeration, con¬
gestion, and exhaustion, and these all disappear upon proper
.hygienic observances, conjoined to will training. The
weakened will itself is but part and parcel of the whole
nervous disorganisation, and will regain its normal standard
as soon as the other functions return to a physiological basis.
The nerve-supply of the female pelvis is not a distinct and
isolated department, but intimately connected with the
whole nervous system. So that disorganised function any¬
where, but the more especially in the brain and spinal cord,
may transmit its influence to the ovary. If we admit the
possibility of “maternal impressions” stamping themselves
upon the fcetus in utero, we must also admit that certain
States of consciousness',can impress themselves upon and be felt
within the uterus. This premiss seems reasonable by virtue
of the direct connexion between the mucous membrane of
the uterus and the chief mucous centres. Clinical evidence
of the influence of the brain upon the uterus is ample. A
prolonged unhealthy nervous influence would set up a
correspondingly unhealthy action in the organ reached and
affected by it. Not only directly through the filaments and
ganglions, but also by its effect upon blood-supply, will any
derangement of nervous function be sensibly appreciated by
other and remote organs. Either congestion or anremia
may result from prolonged states of cerebral excitement or
exhaustion. Arterial tension hinges largely upon states of
consciousness, and menstruation, which is one of its ex¬
pressions, is always regulated by the nervous condition of
the woman. I am not at all sure but that many of the
changes in the endometrium that occasion thickening,
hyperplastic proliferation, tumour growths, and malignaut
hyperplasia of the uterine glands are due first to nervous
influences, subsequent congestion, and generally altered
blood-supply. If this be so, we should address ourselves
first to a normal rehabilitation of nerve and bloodvessel,
and then seek to eradicate any local condition which would
•.Interfere with such treatment. Gynaecology has handicapped
itself with excess of detail, and, like all specialties, its field
of vision is limited. .The success of a few, who do little or
nothing else, has created a surgical epidemic, and whole
communities rush headlong into a strom, where experience
is partially learned at the cost of hundreds of lives sacrificed.
These habits of thought and medical crazes revolve in certain
well-known cycles. Already there is the faint flutter that
precedes the coming storm. We are on the eve of a change
in gynaecological practice, in which the scalpel will be the
bar sinister and conservatism the crest and crown of our
special coat of arms. Define the limits of abdominal surgery
to its narrowest confines, and then let those only practise
it who are educated to it and who devote their lives to it;
no others have the right to place a human life in jeopardy,
i have said that there are countless instances on record, where
epe ial surgery has failed to relieve general symptoms, and
of these ailments none is more common than neuralgia of
the trigeminus nerve, or so-called migraine. 3 The cry of the
trigemiuus is the echo perhaps of the uterine wuil, they both
eche synchronously with the pathological pain of the central
eystem, which is labouring to carry out its daily routine
under unnatural effort. The migraine and the “pain in the
•aide" (ovarian) are merely symptoms, and can bo best
reached, and only reached, so far as I know, by constitutional
treatment. You will not cure the migraine by extirpating
the ovary, and you will not cure the ovary-ache by resecting
the trigeminus, oven were one bold enough to attempt it.
One operation is about as sensible as the other. Take the
complex symptomatology of oophoritis (a most vague term,
rather a cloak of ignorance thau the expression of scientific
pathology), with its pain in the side, leg-ache, dyspepsia,
intra-menstrual peritoneal pains, and spasmodic action of the
gall-duct setting up an appearance of icterus. What
are we going to do about it? The ovary is suffering no
more as a primary cause than does the aching tooth of a
pregnant woman act primarily. The tooth does not ache
•from the presence of a cavity, but from sympathy. Now,
shall we turn the woman’s stomach into an apothecary’s
•shop, dosing her specifically for each disordered function,
•combining this with the routine local treatment; or shall we
go to work and find out what makes the ovary ache, and
then treat the cause ? In a rare percentage of cases I will
•admit that the terminal filaments from the inferior hypo¬
gastric plexus within the ovary, have, for some reason un¬
known to us, taken on diseased action, and have so transmitted

' Sec Moblus, Bed. Klin. Wochenschr., 1884, Nos, 16,17, 13.

their plaint. But such instances are rare, and when they
do occur there must be some reason for the nervous and
vascular changes. That reason cannot rest within the
ovary itself, but it does rest in the chemico-molecular
changes in the vessels sustaining its life. It may' be
objected that the train of symptoms that I have cited
belongs to catarrhal salpingitis, with enlargement of the
ovary, but I only say that which I know, and that which I
have seen I take as evidence of anything that I adduce.
Simple tubal disease, non-specific in the nature of its dis¬
charge, floes not call for the operation of Hep ar. Gonorrhoeal
salpingitis, when recognised, can be treated first by dilating
the tube with a catheter. If that fail, and the womams
condition is so unbearable that she demands it, then
Hegar’s operation is justifiable, but not until the full line
of treatment which I have often suggested is first given a
fair trial. There are a certain number of gynaecological
cases which will always demand the skilled hand and clever
brain of the surgeon ; but the number is not as large as is
generally supposed, while the surgeons multiply with
wonderful rapidity. I am sure that before long our whole
process of combating diseases of the endometrium •will
undergo radical change, for there cannot be inherent
potentiality in the mucous membrane of the uterus to
originate so many complex conditions. When we have once
found out the true nature of this mucous membrane, when
we know surely the role it plays in menstruation, we shall
then arrive at a knowledge of the prophylaxis, patho-
anatomy, and etiology of uterine myoma. Even now we
are finding out that many uterine myomata will yield to con¬
servative treatment which gynecology until very lately
maintained should be cut out.

Leipzig.

EXCISION OP THE LARYNX.

By W. GARDNER, M.D., CAL Glas.,

SOHO BOX TO TBK ADELAIDK HOSPITAL. AXJi LKCTUBBR OX 8UBOERY IX
TUB ADELAIDE UXIVKH8ITY.

James M-, aged sixty, shoemaker, living in a small

suburb of Adelaide, was sent to me by my friend Mr. Corbin
os a probable caso of malignant disease of the larynx, with
a request that I would examine him, and do what I could
to rid him of his trouble. On Oct. 9th, 1886, I admitted
him to the Private Hospital. For the following notes of his
previous history and present illness I am indebted to my
assistant-surgeon in the Adelaide Hospital (Dr. Ainstey
Giles).

“ The patient has been a healthy man all his life, and has
never suffered in any way except from an occasional cold.
He has always been engaged in the same trade, and has not
suffered from syphilis or been exposed to hardships of any
kind. His father died at the age of eighty, and his
mother at forty. He does not know the cause of
death in either case. His grandmother (paternal) died
at the age of ninety. There has been no disease of an
hereditary nature in the family. Two years ago he
lost his voice entirely, and it has never returned. Pre¬
viously to losing his voice he suffered from no throat
affection of any kind. The voice gradually became weaker,
till at the end of about four months he could not
speak above a whisper. He continued in this state until
four months ago, when he began to experience a sharp
gnawing pam over the larynx, for which he was treated in
various ways, but without the least improvement in the
conditions. 'He has had a long course of iodide of potassium,
with no result. With the increase of pain ho has been
rapidly losing flesh, feeling very weak, and during the whole
period (four months) has been unable to rest at night on
account of the pain, which wakes him up continually. Ho
never had any night sweats. He can take food fairly well,
but has no appetite, and swallowing causes slight pain.
There is no absolute aphonia.”

On laryngoscopic examination both true vocal cords were
found to be ulcerated away in nearly their entire length.
Irregular white papillomatous nodules were projecting into
the centre of the larynx from the Bides immediately below
the glottis. The false cords and the mucous membrane
above were very much inflamed and bulged out by a solid
growth underneath, more marked on the right side than on

Digitized by CjOO^Ic

g26 The Lancet,] DR. W. GARDNER ON EXCISION OP THE LARYNX. [Mat 7,1897;

the left. Arytenoid cartilages not swollen or abnormally
red; posterior commissure not thickened. The epiglottis
was quite free from the growth, and there was ho sign of
any disease above the larynx. There was nothing abnormal
to be felt externally in the neck, and the glands were not
enlarged. The larynx was quite free and movable, but some
pain was caused when it was pressed between the Angers. A
small piece of the growth was removed with laryngeal
forceps and sent to Professor Watson, who very kindly
examined it and pronounced it to be a “ cornifying epithe¬
lioma.” On examining the lungs the chest was seen to be
barrel-shaped. All over the front and back of toe right
lung the percussion note was fairly resonant.. Over the left
lung hyper-resonance was observed. No increase in the
vocal fremitus. Respiration harsher than normal all over
the chest, and expiration prolonged—more marked on the
right side than on the left. No rales, rhonchi, or accom¬
panying sounds of any kind to be heard. Vocal resonance
normal. Heart sounds normal. Pulse slow, full, and
regular. Arteries not atheromatous. The urine contained
neither sugar nor albumen.

On Oct. I2tb, at 3.30 p.m., the following operation was
performed. The patient having been put under the influence
of chloroform, the whole anterior part of the larynx was
exposed by making a free incision from the thyroid bone to
a point immediately below the second ring of the trachea.
The anterior jugular veins were tied in two places and
divided between the ligatures, as they interfered with a free
dissection. The muscles attached to the side of the thyroid
cartilage were thoroughly separated as far back as pos¬
sible, and the fascia attached to its upper edge was set
free without dividing the thyro-hyoid membrane. The
haemorrhage was- troublesome and very free, the bleed¬
ing from the crico-thyroid artery being very difficult
to arrest. Every bleeding point was carefully ligatured,
and pressure with hot sponges gradually reduced the
oozing. I. opened the trachea between the cricoid carti¬
lage and its first ring and at once inserted a well-fitting
tube, mode of lead, which effectually prevented blood from
entering the lung. A flexible rubber tube, about ten inches
long, was attached to this, and the administration of chloro¬
form was continued through it. Then, principally with the
handle of my knife, I separated the larynx from the oeso¬
phagus, divided the superior cornu of the thyroid carti¬
lage, cut through the thyro-hyoid membrane, and finally
divided the superior and posterior attachments of the
larynx, as close to the cartilages as possible, with a pair of
scissors, the epiglottis being cut through at its base. The
superior thyroid arteries bled profusely, but were at once
caught and ligatured. The patient took the anaesthetic easily,
bore the operation well, and showed no signs of collapse.
As far as possible throughout the operation' the parts were
separated by working with the handle of the knife. All bleed¬
ing points were ligatured with ohxomicised Wallaby tendons,
which make most excellent ligatures, being strong, safe, and
easy to apply. The wound was dusted over with iodoform
and covered with absorbent cotton-wool. The tube was
securely tied in with tapes passed round the neck and under
the axilla.—6.30 p.m. : Slight oozing of blood-stained saliva
took place from above the tube.—8 p.m. : An enema of beef-
tea and brandy administered, and carbolic acid spray used
for five minutes in the room. Temperature 98°.—9.40 p.m. :
one-sixth of a grain of morphia injected hypodermically.—
12 p.m. : Enema of beef-tea and brandy given. Carbolic acid
spray used in the room.

Oct. 13th.—Ordered an enema of beef-tea and brandy
every four hours; carbolic spray also used in the room.
Temperature 98 6°. Slept well through the night. Slight
cough. Pulse 88; respiration 28. Some blood-stained saliva.
Wound dressed with absorbent cotton-wool sprinkled with
iodoform laid above and below the tube. A piece of carbolised
gauze was placed over the orifice of the tube, and the patient
raised to a sitting posture. No oozing from the wound. Chest
- sounds over bases of lungs normal. At 4 p.m. a small red
rubber catheter was passed down the oesophagus from the
wound in the throat, and through a glass fonael about a
pint of milk and lime-water was allowed to flow into the
stomach.—9.30 p.m. : Temperature 98 6°; pulse 84; respira¬
tion 28.

.v 14tb.—Feeding by the oesophageal tube was continued,
sftnd also enemata of beef-tea and brandy. The tube was
/not kept in but was easily introduced each time that it
rfWaaconsidered seoeaaary to feed the patient. Temperature
98-4°; respiration 21; pulse 92. 8km cool and moist; no

pain. Lungs resonant all over back aud front; breath*
sounds normal. Great quantities of saliva r unning front
the wound. Wound dressed with iodoform and absorbent
cotton-wool. Tube keeps in good position and causes no
irritation.—3 p.m. : A pint of milk with brandy and lime*
water passed into the stomach through the oesophageal tube*
causing Blight vomiting and some feeling of discomfort.
Half the quantity was ordered to be given at a time for
the future. Cough troublesome.— 9 p.m. : Temperature 98 - 4°'-
pulse 84 ; respiration 22. ’"■*

15th.— Slept well throughout the night; cough easier.
Temperature 98° ; pulse 80; respiration 24.-2.45 p.m. r
Leaden tube replaced by a silver one of similar shape but
rather larger calibre.—9 p.m. ; Complains of thirst. Lemon-
water given to rinse out the mouth.

16th.—Slept fairly well. Cough rather troublesome. A.
quantity of thick phlegm was expectorated. Temperature?
98°; pulse 80; respiration 18. Wound almost healed above.
Copious flow of saliva.

From this date to the 19th the treatment was just the-
same,and the temperature continued normal, with;diminished
cough and lessened expectoration of phlegm. The little
finger was passed every other day upwards as far as the base?
of the epiglottis to keep the way open for the insertion oF
the upper tube of the artificial larynx afterwards. On
Dec. 3rd the patient was discharged, and returned to hi®
own home, wearing only the lower tube of an artificiaP
apparatus which had been made for me from the woodcut
in The Lancet, as used by the late Dr. Foulia of Glasgow,
and modified from Gussenbauer’s original apparatus by
Dr. Irvine. In this case, however, the straight tube coula
not be inserted, and I had the upper one altered so as to
assimilate it to Gussenbauer’s original apparatus.

On Jan. 17tb, 1887, the man re-entered the Private Ho#*
pital, and, under chloroform, the upper wound was reopened
sufficiently to admit the upper tube, and then the lower tube-
was passed through it, and the whole tied in with tapes round
the neck. The reed used was made of platinum, and, although
thenotewas rathertrumpet-like, his words could be distinctly
understood on his awakening from the anaesthetic. After
the insertion of the upper tube liquids were found to run
down whenever he drank, and recourse was bad to the soft)
rubber tube, which was passed down the oesophagus seven?
times a day for feeding purposes. Examination with the-
laryngoscope showed the silver tube appearing just below
the epiglottis, which was very cedematous. Tannic add*
spray was ordered, and no examination was made until
the end of the month, when it was discovered that there
was a small new growth on the anterior pillar of the fauces*
low down, with a small amount of glandular enlargement
of the neck on the same side. As it was evident that the
disease had returned, it was decided to remove the upper-
tube to prevent any irritation, and, as the epiglottis was
not acting, to enable him to take food again by the moutb-
by allowing the upper wound to heal, which it did very
rapidly, and on Feb. 5tb, being able to take both liquids
and solids well, he was sent home again. On the morning of
Feb. 11th I again saw the patient, and the growth had
increased markedly. He was wearing a tube which I ha<F
constructed of silver, like a tracheotomy tube, but with »
more abrupt dip into tbe trachea. This he found exceedingly
comfortable, and all he complained of was pain in the righo
ear. He seemed thoroughly well nourished, and exp reseed 1
gratitude for the temporary relief afforded him. ' *

Remarks .—This case is interesting as being only thetbftd
operated on in tbe British dominions in which the patient
has lived more than four months. The others were operated
on by the late Dr. Foulis and Dr. Newman, both of Glasgow.
It is not encouraging to find recurrence so rapid after
recovery from so formidable an operation, especially as there
was nothing to suggest that the disease had passed beyond
the confines of the larynx. Of the eighty-three case* which
Dr. J. B&ratoux has collected, death occurred in half of them
before the fourth month. 1 would draw attention (t) te
the ease with which the blood can be kept out of tbe trachea
by the rectangular tube made the full diameter of the normal
larynx, and inserted immediately after tbe division of the
trachea, thus lessening greatly the risk of septic pneumonia;
(2) that the " banging head ” position is also of immense
advantage; and (3) that it is probable, in the great majority
of cases, that Gussenbauer’s original artificial larynx is the
best, although the straight upper tube seems to have suited
the late Dr. Foulis’ case. In the method of operating I am
I indebted to the papers of Dr. Foulis and Dr. Newman, and

Vffli LANCBT,]

DB. P. HOOD: CABBONATE OP LIME IN CANCEBOUS TUMOUBS. [Mat 7,1887. 927

after consideration I decided to adopt the method of the
latter, aa being probably the easier and better plan. The
interesting discussion at the Clinical Society has induced
me to forward my case as a contribution to the subject. If
Mr. Butlin’s opinion that “ complete excision of the larynx
for carcinoma should be practised only in very rare in¬
stances, as the mortality from the operation is large and the
prospect of cure small, is ever to be altered, it must be by
attempts to ensure an earlier diagnosis, and in the meantime
I indulge the hope that this may be accomplished'.

Adelaida, South Australia.

ON THB

ADMINISTRATION OF CARBONATE OF LIME
AS A MEANS OF ARRESTING THE
GROWTH OF CANCEROUS
TUMOURS.

Br PETER HOOD, M.D.

Nbarly twenty years ago Thb Lancbt published a com¬
munication from me on the value of carbonate of lime in
the form of calcined oyster-shells as a means of arresting
the growth of cancerous tumours, and 1 am anxious once
more to call attention to the subject, and to urge upon those
who possess the necessary facilities that a more extended
trial should be given to this agent than it appears yet to
have received. My own opportunities of employing it in
suitable cases have not been large, but the results which
4 have witnessed have been sufficiently remarkable to justify
me in seeking for them a more extended publicity.

Iu the paper referred to I related in detail the case of a
lady nearly eighty years of age who was the subjeot of
.schirrus of the breast, and in whom the growth sloughed
away and left a healthy surface after a course of carbonate
>of lime, administered in accordance with a recipe which
was current in her family. She manufactured her carbonate
-of lime by baking oyster-shells in an oven and then scraping
off the calcined white lining of the concave shell. The
.substance thus obtained was reduced to powder, and as
much as would lie on a shilling was taken once or twice a
•day in a little warm water or tea. It was said that
^perseverance for at least three months was necessary before
any good result was to be expected. I presume that the
^powder would be almost pure carbonate of lime, but it
might possibly contain a small admixture of iodine.

The immediate cause of the publication of my paper was
s conversation with Mr. (now Sir) Spencer Wells, to whom
"I related the particulars of the case above mentioned, and of
one or two others which had fallen under my notice, and
who suggested that the beneficial action of the powder
’might be due to the lime which it contained. He told me
"that he had used lime largely in the treatment of uterine
"ffbroids and other tumours, and that he was convinced that
processes of atrophy and calcification resembling the
spontaneous change or degeneration sometimes observed in
them were often produced or promoted by its action. He
■added that he believed the change commenced in the coats
of the arteries bv which the tumours were supplied with
blood, and that these coats underwent first an atheromatous
and subsequently a calcareous degeneration, in either case
with a diminution of the calibre of the vessel and a lessened
capacity for the conveyance of blood. ; .1

After the appearance of my paper I was applied to by
several persons with an inquiry as to whether their cases
were suitable for the employment of the remedy but in
most of these instances I subsequently found that it bad
'been taken for only a few weeks, and then abandoned
‘because no result was apparent. I should not hope for
manifest benefit in any instance under three months of pet-
Agiatent treatment. A notable exception to the ordinary
want of perseverance was furnished by the wife of a phy¬
sician practising at Beading. This lady was the subject of
a well-marked schirrus of the breast, which 1 had myself
an opportunity of examining. After a fair and persistent
trial of the calcined shell powder for three months, her
bUsb&nd reported to me that M the tumour bad ceased
growing and that she suffered no pei*,” She continued to
take the powder for several months longer, and for several
■fears her husband paid -me an annual visit, always giving

the same account, “that his wife never suffered any incon¬
venience or pain from her disease, the progress of which
had been stopped.”

The ordinary history of true cancer is such a dismal
record of failure, that 1 think even a few instances in which
benefit has been derived from a harmless remedy should
encourage the profession to make trial of it in all suitable
cases. It would probably be inexpedient, generally speaking, 1
to disclose the nature of the medicine, and the public mind
is by degrees becoming permeated by the knowledge that
many important medical actions can only be gradually pro¬
duced. We have no difficulty in inducing patients to submit
to prolonged courses of mercury in the treatment of
syphilis, and there is no reason why they should not do the
same in a malady which, if possible, is even more formid¬
able. Up to the present time the narratives of cures of
cancer have been chiefly suggestive of errors of diagnosis,
and no assurance of the value of any proposed remedy can
be obtained until it has been used in a sufficient number of
instances to exclude the possibility of such errors having
been committed in the majority of them. Although the
experience of Sir Spencer Wells with fibroids points to the
probability of a beneficial action upon soft and vascular
growths, those which I should myself select for the purpose
of further investigation would be typical examples of
breast schirrus, adherent tumours of stony hardness,
attended by retraction of the nipple and lancinating pain.
About the nature of such it would seldom be possible to
entertain a doubt.

As au example of the uncertainty which may overhang
the true characters of growths which do not present the
symptoms above described, I may mention that 1 was once
consulted by a lady living in the north of England, who had
a swelling in her breast which bad been pronounced to be
cancer by her family medical attendant, and also by two
consultants called in from the neighbouring county town.
She was urged to submit to an operation, but, before con¬
senting, she came to London for further advice. 8be paid
separate visits to Sir James Paget, to the late Mr. Skey, and
to me. I was the first whom she visited, and I gave an
opinion that the tumour was a harmless one and might be
let alone. Her second visit was to Mr. 8key, who said with¬
out hesitation that it was a cancer, and advised removal.
Her third visit was to Sir James Paget, who said that the
growth was innocent. It was let alone, and the patient has
had no further trouble from it for twenty years.

Again, I was lately consulted about the case of a well-
known nobleman, who had a soft growth in the front
of his chest over the upper part of the sternum, which
quickly attained a considerable size, and was pronounced
to be malignant by eminent authorities. It disappeared
entirely under a course of small doses of the perchloride
of mercury.

It is therefore not in cases which admit of any reasonable
doubt of their nature that I would desire to urge a trial of
the lime powder upon the profession. There are hundreds
of instances of unmistakable cancer in which an operation,
if performed, may perhaps for a time diminish suffering or
may prolong lire, but in which it cannot afford any well-
grounded hope of restoration to health. For all such I
would say that the lime ought to be persistently and fairly
tried. It can do no poesible harm, it need not interfere with
.any remedies for the present relief of pain, its action can be
referred to a perfectly intelligible and probable hypothesis,
and it has been of unquestionable utility in a sufficient
number of cases to warrant us in reposing some confidence
in its use. We have a great hospital devoted to cancer, and
cancer words in others also; and I think the time has come
when this simple means should be fairly tested by the pro¬
fession. It is not long since we witnessed an extraordinary
eagerness to try the Chian turpentine, which was so much
extolled by Dr. Clay, and in support of which the primd-facie
case was nothing like so strong as that in favour of the
remedy to which! desire once more to call attention.

B«ymour-«tr»et, W.

Association of Sanitary Inspectors. — On the
23rd ult., at a well-attended meeting of public sanitary
inspectors at Liverpool, it was decided to form an associa¬
tion for the north-western district. A provisional committee
was formed to give effect to this resolution, and Mr. A.
Taylor, inspector of Wallasey, was appointed temporary
secretary and treasurer.

Dii

928 Tax Lancet.]

DR.J.G. BLACKMAN ON DIFFUSED INNOMINATE A NEURYSM.

[Mat 7.1887.'

DIFFUSED INNOMINATE ANEURYSM.

By J. G. BLACKMAN, M.D. Bbux., M.R.C.S., &c.

The great interest and importance attaching to aneurysmal
disease of the innominate artery, and its comparative rarity,
induce me to record the following case, which I think
particularly shows the impossibility of diagnosing the
actual limits of the disease in this class of coses, and the
risk in operating lest the available vessels be atheromatous.

William W-, aged sixty, shipwright, first came under

my care four years ago, suffering from hiemorrhoids. As he
was losing a rather large quantity of blood after each
stool, and wa 3 much weakened in consequence, I proposed
their removal to him, to which procedure he assented.
Upon examining his heart preliminary to the adminis¬
tration of an aneestUetic, a somewhat loud systolic bruit
was heard over the aortic area. To be on the safe side
it was decided to operate without ansesthesia, which was
accordingly done, and the patient made a quick recovery.

friends, who, with myself, deemed operative interference
unadvisable, considering the probable generall thseased
condition of his arteries, and also the possibility of its
being aortic. I prescribed a spare diet with absolute
rest and gave a mixture containing iodide of potas¬
sium with morphine. The second injunction he refused
to obey, and persisted, in spite of repeated warnings,
in taking long walks and occasionally doing a little
gardening. Under these adverse circumstances the tumour
steadily increased until about three months before his death,
at which period it began suddenly to enlarge very rapidly,
and at each visit I noticed a decided difference. The dimen¬
sions it attained are well shown in the accompany mg wood-
cut, which is from a photograph taken a month before death
bv Mr. Newby, F.R.C S. Eng. It will be noticed that the sur¬
face is very uneven, and appears, as it were, “ pointing m
several places, one of which (marked A) became very thin-
and developed a black crust on its summit, which eventually
came off leaving an ulcer, the base of which seemed to be
entirely composed of cellular tissue. This condition caused
me great anxiety! as it gave one the idea that the next
pulsation must burst the apparently thin tiMue. Fortu¬
nately this event did not happen, for although the ulcer
spread to the size of a florin and bled to a trilling extent, it
gradually became drier, and the poor fellow died from ex¬
haustion, and in part possibly from suffocation, on Dec. itli.
1886, having only taken to his bed during the last week ot
his long illness.

Necropsy .—The wall of the sac was of varying thick ness,,
being at the most not more than from three-eightbs t<>
half an inch, nnd in some places was extremely thin. The
arterial coats could not be distinguished and there wae
scarcely any attempt at lamination. A small clot of fibrin©
was found in the interior, surrounded with dark, semi-
coagulated blood. On tracing the sac, it was found to pass-
in all directions. To the outer side, it communicated with the
right subclavian artery, and upwards with the carotid artery
of the same side; whilst to the inner side it passed across the
trachea, oesophagus, left carotid, and subclavian arteries.
Downwards, it had passed over the clavicles and sternum,,
eroding the sternal ends of the former bones and the upper-
part of the first piece of the latter bone. Backwards, it
had pressed upon and displaced both the trachea and tbe-
cesophagus. The aorta was found to be considerably dilated
and atheromatous, the disease involving the whole of the
arch and the commencement of the thoracic portion. C r*
passing the finger along the interior of this vessel, one dis¬
covered the opening corresponding to the innominate artery,
which communicated directly with the aneurysmal sac; the
atheroma here appeared to be less marked. Iassing the
finger along still further, the openings of the left carotid and
subclavian arteries could be made out, the former being a
mere chink, whilst the latter was of natural size. Both
openings were, however, rigid, and surrounded by athero¬
matous calcification, and gave the impression of being fora¬
mina in bone. The coats of both carotids and subclavians
were more or less diseased. A further inspection was
not permitted by the friends.

Portsmouth. —

He. however, shortly afterwards again consulted me, com¬
plaining of obscure pains in the chest and back, which he
said quite unfitted him for his work; and in accord¬
ance with his wish the authorities of the dockyard
granted his superannuation. On examining his chest
again, I could discover nothing abnormal except the
bruit previously mentioned, and the subjective symptoms
seemed quite out of proportion to the objective. I was,
however, able to afford him some relief by the adminis¬
tration of anodyne drugs, and after a time 1 quite lost sight
of him. This respite was, however, not destined to last
long, for in November, 1885, he once more came to me, tins
time complaining of a swelling in the neck in addition
to his other troubles. On examination, 1 discovered a
pulsating tumour, the size of a large walnut, situated imme¬
diately behind the right stemo-clavicular joint. He did not
complain of much pain. The right radial pulse was full
and strong, while the left was small and weak. The right
carotid pulse was weakened. In spite of the anomalous
condition of the radial pulses, I felt sure 1 had to deal with
an innominate aneurysm, probably complicated with aortic
disease. 1 saw him in consultation with several medical

MALIGNANT DISEASE OF RIGHT LUNG
AND POSTERIOR MEDIASTINUM, PRO¬
DUCING COMPLETE PARAPLEGIA.

By FREDERICK J. SMITH, M.R.C.P., M.B. Oxox.*

MEDICAL REGISTRAR TO TRK LONDON HOSPITAL.

By the kindness of Dr. H. G. Sutton, under whose care
the patient was in hospital, I am enabled to publish the
following case, which presents somewhat rare and peculiar

features. - . . . .

r C_, aged forty-five, was admitted into the London

Hospital on June 1st, 1886, complaining of pain in the right
side and numbness of the legs. Family history very good,
ne has been engaged as stevedore and coal-porter all his
life, and until three years ago had always enjoyed good
health. Is a moderate drinker, never exceeding three pint,
of beer a day. Three years ago he had severe pain in the
chest and slight cough, and is said to have been treated for
pleuro-pneumonia. Ever since then he has had pain in tbt •

Die

DyGoOQl

Tsb Lancet ,]

right tide, and latterly, he says, the lower part of the
abdomen and lower extremities have felt numbed.

Condition on admission. —Looks well, but is of a melancholy
disposition, and cannot sleep on account of the pain. He
states that he perspires freely, but not on the right side.
Digestive system fairly good. Respiratory system: Has a
slight cough; physical signs normal, except at right base,
where there is dulness, deficient breath sounds, increased
vocul fremitus, and pain on movement. Vascular system
healthy. Nervous system: Knee jerks equal, and not re¬
markable; plantar and other superficial reflexes present, and
about normal in freedom. The patient does not seem fully
cognisant of sensations of heat, cold, and pain. Able to
walk, but not well.

The following is a short abstract of the daily notes from
the date of .the patient’s admission until his death:—
Juno 7th : Unable to pass urine; when drawn, found to be
alkaline; complains of much pain in the bladder; can¬
not stand without support.—lGtli: Passed a motion involun¬
tarily ; knee jerks exaggerated; unable to move either leg.—
21st: Entirely unconscious of lower extremities.—30th: Legs
contracted; commencing gangrene of right heel.—July
19th: Since last note, pam in right side and also pain re¬
ferred to leg3 have been the chief symptoms.—22nd: Gland
projects at inner end of right clavicle; a bedsore has
formed, and is extending rapidly; right leg very sensitive;
temperature very variable.—Nov. 1st: In this interval the
chief notes are a progressive loss of strength, and complaints
of pain in chest, together with a most distressing cough.—
29th : Pain of a girdle character and in left side very dis¬
tressing.—Dec. 14th: Troubled with “fits” and fainting.—
Jan. 12th, 1887: Continued to get weaker, and died quietly
without any further definite symptoms.

Necropsy.— Body much wasted. On opening the thorax, a
large mass was at once apparent, occupying the right upper
part of the posterior mediastinum. On further exploration
it was found' that the new growth had extended into the
base of the right lung in a downward direction; upwards,
it had infiltrated the glands of the posterior mediastinum,
thus producing the bulging above the right clavicle; back¬
wards, it was found to have softened and infiltrated the
bodies of two or three of the upper dorsal vertebra:, and to
have compressed the spinal cord to such an extent as to
have almost obliterated it opposite the fourth dorsal
vertebra, with complete softening above and below this
point for some little distance. The growth had apparently
begun in the neighbourhood of the right bronchus, as here it
had softened down into a mass of cheesy, purulent material.
The kidney showed acute pyelitis, and the "bladder evidence
of cystitis. The other organs presented only such charges
as might fairly be attributed to the mode of death. The
naked-eye appearances of the growth showed that it was
an encephaloia, or soft caiicer, with much juice and very
little fibrous stroma.

Remarks. —The above case is interesting from one or two
points of view. Primary cancer of. the lung (be it remembered
that so careful an observer as Dr. H. Sutton performed the
post-mortem examination, and found no other cancerous
deposit) is in itself a somewhat rare affection, and it must
be rarer still to find examples of a soft cancer in such an
important organ as the lung -Which took three years to kill.
I say three years, for unless we take the illness of three
ears ago to have been the commencement of the growth we
ave no other possible explanation of its origin. Clinically,
the case was one of extreme interest, owing to the diffi¬
culty of diagnosis. On admission the signs in the lungs
were such as to rive one no clue whatever as to the
dangerous nature of the case, nor did the nervous pheno¬
mena lend us much aid, for, though the paraplegia was
somewhat marked, the signs of spinal cord disease were
absent or ill-defined. After a week’s stay in hospital, how¬
ever, the signs of acute myelitis rapidly developed, and then,
indeed, the case assumed a most serious aspect. But still
the diagnosis was anything but absolutely certain, and not
till the end of July, when the enlarged gland appeared above
the clavicle, could an almost positive conclusion be drawn
as to the nature of the case. 1 can find no mention in
ordinary text-books of this particular cause of paraplegia and
myelitis—Le., growth from the lung. I presume the reason
W that such growths usually kill before spreading in that
direction. The growth appeared not to have infiltrated the
cord at all, but merely to have compressed it. I regret to
<ajr thata microscopical examination has not been made.

We»tr*tre«t, Flnabury-droo*.

m

% Utirror

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Holla aotem e»t alia pro certo notceudl via, nlai quamplurim&s et mor-
borum et disseotlonum historias, turn aliorum tum proprias collectaa
habere, et inter te oomparare.—MoRffAGXi De Sed. ft Cans. Morb.,
lib. iv. Frocemlum. -

HOSPITAL FOR SICK CHILDREN, GREAT
ORMOND STREET.

CASK OF SUPRA-PUBIC LITHOTOMY ; H-EMORRHAGST INTO
THE BLADDER; RECOVERY; REMARKS. ••

(Under the care Of Mr. J. II. Mona ah.)

Numerous instances of successful operation for the
removal of calculus by incision into the bladder above the
pubes have been recorded during the last few months. The
following case, however, is one in which an unusual com¬
plication occurred during treatment, and the account of it,
with the Remarks of Mr. Morgan, and his explanation of
the mode of occurrence of the haemorrhage, will be read
with interest. For the notes of the Case we ere indebted to
Dr. Penrose.

W. G-, a boy, aged six years and a quarter, of healthy

aspect, and with no history of previous illness, was brought
to the hospital on account of passing blood with his uruie,
and of pain in micturating. This had existed for two years.
Eight months previously he had been circumcised at another
hospital. The boy had always lived in London. The
mother’s family was gouty. The pain and blood followed
micturition, and both were worse after exercise. The patient
had to rise &t night to pass urine. The urine after admission
was slightly alkaline, without any albumen. A stone was
detected on sounding, which it was decided to remove by
the supra-pubic operation.

The patient having been placed under chloroform, a small
gum catheter was passed and the bladder emptied of urine;
it was then filled with a moderate quantity of boracic lotion,
the catheter plugged, and an indiarubber band placed round
the penis to avoid leakage by the side of the catheter. A
tampon was passed into the rectum and distended with air
until the bladder could be seen in outline upon the abdominal
surface projecting with moderate prominence. An incision
about an inch and a half from just above the symphysis was
made in the riiddle line and the dissection carried down to
the fat overlying the bladder, in which one vessel was tied
before division. The wall of the bladder being exposed, it
was incised, the finger passed in, and the stone immediately
detected. This was Of moderate size, i and was extracted
with the aid of forceps. The muscular coat of the bladder
was then sewn up by inserting a number of separate fine
catgut sutures, the mucous coat being avoided. The wound
in the abdominal wall was then united by silk sutures and
a small horsehair drain inserted at the lower angle. The
stone was composed of uric acid. The catheter was allowed
to remain in the bladder.

On the following day the wound, which was dressed anti-
septically, looked perfectly quiet. The boy was well, and
the temperature normal. Urine, slightly blood-stained,
passed through catheter. On the second day the catheter
was removed, as it was causing some urethritis, and urine
was passed per urethram. The drain from the wound was
also removed. On the third day the patient was restless,
and complained of paini The quantity of urine passed was
small, and was slightly stained with blood. More was
drawn off by catheter. There was a good deal of straining,
and, thinking that this might be due to constipation, an
enema was administered by the house-surgeon. Pain in¬
creased; no sleep. Ordered two minims of tincture of
opium. Temperature normal. On the fourth day after the
operation, the patient was pale, and the surface cold. The
bladder was seen and felt distended up to the umbilicus,
hard and tense, but not tender. To relieve this, which was
evidently due to the presence of blood, a catheter was
passed, and some warm boracic lotion injected. This was
repeated several times, the instrument when withdraw*
being filled with clotted blood, the fluid dribbling away mixed
with blood. The boy slept between three ana four hoard.

HOSPITAL MEDICINE AND SURGERY.

6

930 The Laxcbt,]

HOSPITAL MEDICINE AND SURGERY.

[Mat 7, 1887.

Daring the following night several ounces of blood-stained
fluid were passed, and the bladder became softer and less
distended. The injections were repeated, with the result of
bringing away much more fluid and some clots. The swell¬
ing of the bladder was much diminished. On the sixth day
the bladder swelling had disappeared, and a good quantity
of blood-stained urine was passed naturally. The wound,
which up to this time had looked firm and healthy, now
Showed some oozing, and there was marked tenderness in
the right inguinal region. Three stitches were removed,
and later in the day urine passed from the aperture. On
the seventh day almost all the urine, which was slightly
blood-stained came through the wound. The tenderness in
the inguinal region was less marked, but there was observed
a dark-coloured defined area of skin over the right pelvic
region and extending a short way below Poupart’s ligament,
which was evidently caused by extravasation into the
tissues of blood-stained urine. Boy improving. In a few
days this staining disappeared, and the amount of urine
passing from the wound began to gradually diminish as that
flowing from the urethra increased. Healing was complete
in the course of another four weeks, and the boy was dis¬
charged, but on coming to see Mr. Morgan a short time
afterwards he was reported again to have passed some blood
with the urine. This, however, has not recurred, and he is
now perfectly well.

Remark *.—Any contretemps in the progress of a case
which follows an operation which may be said to be still on
its trial deserves to be recorded, and the above case illustrates
two points to which attention has already been drawn. In
the first place, it is not desirable, at all events in the case of
children, to retain a catheter in the bladder after the supra¬
pubic operation. Although for the first forty-eight hours
the urine passed through the catheter, and was therefore
not allowed to remain in and thus distend the bladder walls,
the urethritis excited by the presence of the catheter was
probably the cause of the bladder subsequently becoming
distended, and so tearing apart the freshly united edges
of the incision and giving rise to the bajmorrhage into
the bladder which produced so much tension. It was this
also which caused the stitches in the bladder to give way,
and had they not been inserted the htemorrhage might have
made its way out by the wound in the abdominal walls and
the distress which followed the distension of the bladder
avoided. The staining of the tissues about Poupart’s liga¬
ment on the right side is an interesting feature, and shows
that a small amount of extravasation need not lead to any
bad results.

NEWOASTLE-ON-TYNE INFIRMARY.

JAW CASES.

(Under the care of Mr. Page.)

The cases were reported by Mr. J. P. Maynard, house-
surgeon.

CASE 1. Epithelioma of the lower jaw— Rebecca E-,

aged fifty-two, a woman with marked cachexia and much
run down, was admitted on May 22nd, 188b, with epithe¬
lioma involving the floor of the mouth. Three months
previously she had noticed a painful ulcer on the frcenum
linguae, which gradually spread rather rapidly over the
tongue and floor of the month, with much pain ana salivation.
Shortly afterwards a swelling appeared beneath the chin.

On admission the floor of the mouth and under sur¬
face of the tongue were found to be occupied by an
irregular ulceration, with uneven sloughy floor, indurated
margins, and binding the tongue down all round as far as
the first molar tooth on either side. It involved the lower
jaw to a similar extent. All the eubmaxillary glands were
much enlarged, but not adherent to the skin.

As the woman was suffering terrible pain, shooting along
both sides of the head, was emaciating rapidly from inability
to eat, and was willing to have anything done, Mr. Page,
under chloroform, split the chin to the hyoid bone, reflexed
the flaps, sawed through the lower jaw on either side by the
first molar tooth, and, after passing a silk ligature through
the base of the tongue, removed the whole tongue with
scissors and dissected the glands out. The linguals were
easilv secured, and the skin brought together with a fine
continuous catgut suture, the ends of the silk ligature, used
to hold the stump of the tongue, being brought out through
the bottom end of the wound and secured on the chest by
strapping; this kept the stump from falling back upon the

glottis, and was found useful more than once when that
accident threatened.

The woman recovered well from the shock of so severe an
operation, and the wound was kept sweet by washing it out
frequently with weak Condy. She was fed by enemata the
first three days, and by the mouth afterwards. Her recovery
was complete; the pain left her, and by degrees the divided
ends of the jaw came into apposition, so that she looked
like a person with a small retreating chin. She was kept
under observation, and on Nov. 1st the following note was
made:—“ Pain recommenced lately, shooting up left side of
face, and swelling appeared below the chin on the left side;
mouth healthy.—20th: Ulceration commencing on gum of
left half of jaw. Stump of tongue healthy; glands increas¬
ing. Some cough.—Dec. 10th : Woman bed-last; sinking.”

Case 2. Encephaloid cancer involving lower jaw— John

H-, aged fifty-six years, married, admitted Nov. 9th; a

hard drinker and smoker; no history of syphilis. Twice had
toothache ten years ago on the right side, accompanied by
swelling. Four months ago he found a small tumour grow¬
ing from the gum on the right side, with a pedicle. This he
removed frequently as it recurred, and then swelling began
below the right jaw, without pain, and has increased
gradually since. Losing flesh.

On admission the right cheek was found prominent, and
the swelling extending into the neck. Surrounding and
adhering to the right lower jaw, reaching from the lateral
incisor anteriorly as far back as the wisdom tooth, and
bulging up on the inner and outer sides of the intermediate
carious and loose teeth, was a mass of growth composed of
hard, lobulated, elastic material, looking like bunches of
large ripe cherries, bright-red in colour, smooth cm the
surface, and superficially ulcerated in a few places. Occupy¬
ing the submaxillary space were three large hard glands,
adherent to each other, but not to surrounding structures,
and passing beneath the sterno-mastoid muscle. The cheek
was free, so was the tongue and its movements, though the
growth invaded the floor of the mouth.

Mr. Page performed a preliminary laryngotomy, plugged
the pharynx with a sponge, and then making an incision
along the lower border of the jaw as far as the ear, and in
front not quite dividing the lip, he sawed through the jaw
by the lateral incisor tooth and turned the jaw upwards
and removed it at the joint, afterwards easily shelling oat
the glands. Hasmorrhage was easily arrested, and the wound
stitched with continuous suture of catgut, drainage being
allowed for at the angle of the jaw where bagging seemed
likely to occur. The wound healed well, some facial
paralysis that occurred passing off, as also slight cellulitis of
the face that followed. The laryngotomy tube was removed
the next day, and the wound healed well. It was intended
to keep the tube in and to plug the pharynx, but the sponge
excited vomiting and had to be stopped. The growth proved
to be encephaloid cancer.

Jan. 20th.—Patient stationary. The recurring attacks of
cellulitis (?) have left an “ elephantoid" thickening of the
cheek.

March 10th.—Growth returning.

Case 3. Epithelioma. — James C -, aged fifty-three,

admitted on Oct. 30th, 1886. He suffered from epithelioma
of the cheek in August, 1885, which wa9 excised. Ten weeks
previously to admission it returned, and has increased.

On admission, the growth involved the whole thickness
of the cheek at the angle of the lower jaw and the jaw itself.
It had recurred inside the cheek, and was making its way
to the skin, which was reddened. The mouth could only be
opened half an inch in front, when the inside of the chew at
the angle of the jaw was seen to be ulcerated. No enlarged
glands in the neck. On Nov. 17th the skin burst, after which
the growth seemed to diminish somewhat in size.

On Nov. 27th, at the patient’s urgent request, Mr. Page
operated, making a double elliptical incision extending
from the angle of the mouth nearly to the lobule of the
ear, and including the ulcerated surface. He sawed through
the jaw outside the canine tooth and across the ascending
ramus, removing the intermediate portion. In order to bring
the edges together without the tension there must other¬
wise have been, a curved incision was made about three-
quarters of an inch below, and parallel to the lower one pre¬
viously made, as in the principle of cheilo-plasty, and then
t.he two incisions sutured, three hare-lip pins being
The man did well, and, though two of the pins cut psrt'J
through, the wound healed up.

Jan. 26th,—There is no return of the disease.

Digitized byLjOOgle

Thb Lancet,]

PATHOLOGICAL SOCIETY OP LONDON.

[May 7,1887. 9^1

Fab. 16th.— Since going out the cheek has gradually
becombe oedematous and indurated (as in Case 2).

• April Gth.—The growth is recommencing inside the mouth
at tne old seat. The cheek still remains elephantoid. No pain,
and still eats well.

Cash 4. Sarcoma involving the upper jaw. — James S - ,

aged fifty-nine, young for his age and healthy, was admitted
on Oct. let, 1886. Six months ago he noticed a swelling on
the right cheek close to the nostril, the size of a pea. It grew
slowly without pain. Never bad any discharge from the nose.

On admission the angle between the nose and cheek on
either side was occupied by a swelling as large as two
walnuts, fixed, elastic, and attached to the superior maxilla
on the right side, not adherent to the skin or enaroaching
on the orbit. On raising the lip it appeared as an elastic
red swelling, distorting neither alveolus nor palate, it fills
up the right nostril, and its nasal surface is superficially
ulcerated, bleeding when touched. There are no enlarged
glands in the neck. On punoture a drop of blood escaped.

On Oct. 19th Mr. Page operated, raising the upper lip by
cutting through it into the right nostril. Sawing through
the upper jaw on either side beyond the lateral incisor tooth,
he forcibly removed the inter-maxillary bones with the
growth. The growth proved to be a round-celled sarcoma.
The case did we[l, and the deformity was nil, his voice
having a nasal twang, and occasionally fluids returning
through the nostrils while drinking.

On Jan. Slst, 1887, he returned with a recurrence at the
seat of removal and in what remained of the right upper jaw.
On Peb. 1st the upper jaw was removed, and the antrum was
found to be filled with the growth. The man had erysipelas
of the face and a mild attack of pneumonia (no preliminary
laryngotomy had been performed), and an abscess formed
subcutaneously in the left arm. He also had a purulent
discharge from both middle ears. These absoeeses gradually
healed, but his recovery was retarded by a fresh attack of
erysipelas lasting some days, and leaving behind it a thick¬
ened state of the cheek, as in Cases 2 and 3. On March 26th
he was discharged, with evidence of a return of the growth.

Cask 5. Encephaloid cancer , involving the upper jaio .—

Mary H-, aged fifty-nine, widow, was admitted on

Oct. 28th, 1886. Seven months ago she felt pain followed
by swelling over the right malar bone. It increased slowly,
spreading towards the orbit. No pain in mastication
(teeth all lost some years ago), and no discharge from nose
and mouth.

When admitted the right face was very prominent; akin
reddened and partially adherent. The upper jaw, malar,
and half of zygoma were covered by a hard growth, soft in
places, whicn displaced the eyeball upwards, filled the
temporal fossa (anterior half), and covered the maeseter
muscle (upper half), bulging into the mouth between the
upper teeth and cheek. No glands enlarged, and the patient
had been losing flesh.

On Nov. 6th, on the patient’s urgent solicitation, Mr. Page
raised the skin by the incision recommended by Mr. C.
Heath, and, after dividing the zygoma and nasal process of
the upper jaw with bone forceps, sawed through the alveolus
from the nostril and avulsed the upper jaw and mass entire,
dissecting up the orbital structures from the floor of the
orbit. The large chasm bled profusely, but soon stopped with
pressure, and the akin flap was brought down with a con¬
tinuous catgut suture. It healed well, and the woman went
home early in December. Her face, which previously had a
very anxious and pinched expression, assumed quite a cheerful
look. The growth proved to be encephaloid cancer. She
came up on January 15th, when there was no sign of any
recurrence, though the eyeball appeared in danger of dis¬
organisation. In the beginning of April the growth recom¬
menced at the seat of removal.

Case 6. Myxoma involving the upper jaw. —James M'K-,

aged seventy-five, was admitted on Oct. 30th, 18S6. Six
years ago he noticed a small growth like a raspberry pro¬
truding from the socket of one of the left upper molar
teeth. He used to remove it with his finger-nail, but it ;
gradually grew too firm and extensive for this. He is a
hale and hearty man, looking about fifty-five. There is a
growth about tbe size of a hen’s egg attached to the left
upper alveolus, red, elastic, and fairly soft. It consists of
two parts, the interval between them leading through the
tooth socket into the antrum. Under chloroform the growth
with a portion of the alveolus was removed. It proved to
be a myxoma.

Jan. 20th.—There is a small piece of the growth projecting
through into the mouth the size of a pea. He had no pain,
and it is uncertain whether it is returning.

March 20th. The projecting portion is not increasing, and
he suffers no inconvenience from it.

Case 7. —Sarcoma of the upper jaw. —J. R -, aged sixty-

eight, was admitted on Feb. 24th, 1887. Eighteen years
ago he had mucous polypi removed from the nostrils. Last
December he felt pain and swelling over the right cheek,
which had increased pretty rapidly. Has lost flesh. He is a
hearty, strong old man. The interval between the nose and
the right cheek is filled up with a swelling, which encroaches
upon the floor of the orbit above, passing over, not through,
the bone, pushing the eyeball upwards. Below, it bulges in
the angle between the cheek and the gum; and inside, it
presents in the nose as a red vascular surface. It is elastic
and tender; a needle draws off blood only. There are no
enlarged glands in the neck. The finger detects a hard
lobulated growth projecting through the posterior nares.
All organs healthy.

On March 1st Mr. Page removed the entire upper jaw.
The growth proved to be soft sarcoma, filling the antrum
and the right half of the nose. The patient aid well after
the operation, and on the 31st went home perfectly well.

Htt&iral Societies.

PATHOLOGICAL SOCIETY OF LONDON.

Destructive Arthritis of Knee without Suppuration.—Senile
Arthritis .—(?) Sarcoma of Knee.—Carcinoma of Spine
and Liver.- Diffuse Sarcoma of Spinal Pia Mater .—
Interstitial Aneurysm of Inter-auricular Septum.—Tubal'
Pregnancy.

An ordinary meeting of this Society was held on Tuesday
last, Sir James Paget, Bart., President, in tbe chair.

Mr. S. G. Shattock read the report of the Morbid Growths
Committee on Dr. Edmunds specimen of Homy Papilloma
of the Hand, from which it appeared that there was no
evidence of genuine malignancy. The necrosis had extended
over a period of two years; there were no lymphatic en¬
largements, and although the operation had been performed
twelve months ago, there were no signs of recurrence.

Mr. Hutchinson showed a specimen of Dry Arthritis in
which there had been an unusual amount of absorption. It
came from the limb of a head mistress of a large school,
aged forty-five, who had suffered from extreme pain for
some time. The tibia was displaced backwards and out¬
wards, but there was no real periosteal thickening. The
leg was amputated. The whole of tbe cartilage was
absorbed, and there was much wasting of the femur and
tibia without any suppuration, necrosis, or material soften¬
ing of bone, or, indeed, any fluid effusion. It was not a case
of Charcot’s disease; there was no evidence of locomotor
ataxy; rheumatism was out of the question.

Mr. Thomas Smith showed specimens of Acute Senile-
Arthritis of Tubercular Nature. The first came from a lady-
aged sixty-seven. She had suffered much from pain in the
ankles and knees. Last November she was suddenly seized
with severe pain in one knee, which rapidly filled with flnid
and the limb became deeply ecchymosed; the body tempera¬
ture fluctuated between 100° and 103°, and the pulse be¬
tween 150 and 160. The patient was most unmanageable. In
March amputation was performed and recovery followed.
The amputation was through the lower third of the thigh.
Over the joint surface subject to pressure the cartilage
was absorbed; the synovial membranes were thickened
and thrown into processes and fimbriae; there was no sign
of ulceration or suppuration. Mr. D’Arcy Power made a
microscopical examination, and found miliary tubercle, but
not bacilli. The family history showed a marked degree of
tubercle in many relatives. A second case occurred in a
man aged seventy. The wrist-joint had been affected for
two or three months with great swelling; open sinuses had
formed, and necrosed bone could be detected through them.
Theendoftbeulna was 1 aid bare and dead. A prof used isch arge
of pus flowed from the joint. Albuminuria (one-fourth) was
present. Amputation through the forearm was followed one
month afterwards by death from the effects of chronic heart

PATHOLOGICAL SOCIETY OP LONDON.

disease. The joint was much destroyed; the ligaments had
given away; the bone was much necrosed. The cases were
illustrations of senile struma as recognised by Sir James Paget
some years ago, though he gave no evidence aB to the micro¬
scopical presence of tubercle.—Mr. It. J. Godubb mentioned
the caseof an old man with extensive disorganisation of the
wrist joint, in which caseous material was discovered.—Mr.
P. S. Eve said that Dr. Lediard had shown a specimen closely

• resembling Mr. Hutchinson’s case.—Mr. M acnamara thought
there was clear evidence of the existence of degenerative
changes due to trophic nerve influence, and yet not a
genuine case of Charcot’s disease. He had published a case

• of distinct and definite tubercular disease of the joibt, but
there were no bacilli.—In reply to Mr; Smith, Mr. Uctohin'-
: SoN said that the chronic disease had lasted many years, but
the aCiite destructive disease only three or four months; a
' microscopical examination had not been made, but there wae
- no Evidence of tubercle. He had seen many cases of what

• he diagnosed as struma in people above the middle age since 1
the publication of Sir James Paget’s.

• ' Mr. Hutchinson showed a specimen of Tumour of;
(?) Syphflitic nature. A swelling appeared on the inner side;
of the left knee-joint of an officer in the Indian army. Thore
was a history of chancre, but no conclusive proof of syphilis.
Iodide of potassium failed to effect real improvement. The
skin over the tumour was healthy; no nocturnal pain. Mr.
Hutchinson thought it most probably was a syphilitic
gumma, and iodides of sodium, potassium, and ammonium
were given in large doses, and afterwards mercury to full
ptyaliam, but all without effect. Consultation with Sir
James Paget was followed by exploration, and finally
amputation of the limb, A soft opaque whitish structure
like a sarcoma was found beneath the vastus, and then muoh
grumous fluid was discovered and a bare patch of bone, but

( there was no ossification of the tumour. The knee-joint
was involved. The growth, the size of a fist, was attached,
above the inner condyle; a central cavity contained glairy
' fluid and extensive erosion of bone over a surface of about
three inches in diameter. Several weeks’ treatment with iodide
and mercury had previously failed to reduce the swelling,
' The growth was well defined by fibrous tissue, and to a large

• extent was made up of this, with collections of round cells
' at various points. Great numbers of vessels -were present,

• many of which were more-or lees obliterated by thickening
-of their walls. Some new formation of cartilage and bone
1 had occurred at the margin. The thickening of the vessel

walls by cellular infiltration, together with the erosion of
, bone, pointed to a specific origin; but the failure of treat¬
ment, the absence of any marked gummatous deposit (though
some parts were degenerated) were against this hypothesis.
.Mr. Hutchinson said that two cousins and an uncle had
; died of cancer. He had never seen a gumma having the
naked-eye characters of Che tumour in question, nor
. one which so persistently refused to be cured by specific
treatment.—Sir Jambs Paobt said that he had had no
serious doubt during life that the growth was a sarcoma,
even whilst bearing in mind that mistakes had been made.
He thought that tumours expressed themselves as surely
in shape and naked-eye characters as they did to the
microscope.—Mr. D’Abcy Power had dissected a similar
. specimen in a well-marked case of syphilis.

, Dr. G. N. Pitt showed a specimen of Primary Carcinoma
of the Liver, taken from a man aged forty-eight, who had
incontinence of urine for two years, and died with para-
’ plegia. There was a large liver weighing 120 ounces, and
section of it showed a large white growth of elastic con¬
sistence, with forty or fifty secondary growths around.
Deposits were found in the kidneys, lungs, and suprarenals,

’ As a unique occurrence, it was found that the eighth dorsal
! vertebra was entirely replaced by carcinoma. It was pro-
. bably of scirrhous nature, and primary in the liver, perhaps
originating in the bile duels. Several similar cases have
, been recorded in the Pathological Transactions. Numerous
‘ prostatio calculi were found, and possibly this was related
to 'the enuresis. There was also a mass of growth in
. Douglas’s pouch. Mr. Godlef. said that Mr. Kesteven had
I recorded a case of sarcoma, in which one vertebra was com-
. pletely replaced, - Dr. Norm an Moons had never seen a
vertebra so completely substituted.- -Mr. Lawson Tait
' related a case of papillomatous disease of the peritoneum,
. from which recovery took place—Dr. W. S. A. Griffiths
0 Mid Mr.„Thomioa and Mr. Doran had recorded similar

• PaSteur (oni behalf of himself and Dr. CoUFtiirt))

read a paper on two cases of diffuse sarooma of-the epfoal
pia mater. Case 1 was that of a female aged twenty-two,
whose illness began in June, 1886, with headaches and pain
in the right shoulder and arm. In September there waa
severe pain along the spine. On admission to the Middle¬
sex Hospital, on October 7tb, 1-885, there was impaired
memory, paresis of arms and legs, without lose of sensi¬
bility, abolition of knee-jerks, and severe paiu along the
spine and in the occipital region. There wae intense double
optic neuritis, impairment of vision, and complete paralysis
of both external rectus muscles, with simple diplopia. The
patient died eomatose on the second day after admission.
The spinal cord was found ensheathed in its wboleoxAent
by a softieh grey mass of new growth, meet developed <on
the posterior and lateral aspects. It was,situated beneath
the arachnoid and was inseparably united to the pia mate*.
In an upward directum it spread over the pons and medulla,
completely investing the sixth pair of cranial nerves, and
had extended in the form of isolated nodules to the panetes
arachnoid in several places. Downwards the growth had
invested the nerves of the cauda equina with thin translucent
sheaths, which at intervals expanded into small tumours.
The nervous tissues presented normal naked-eye appearanoee.
Microscopically, the growth consisted of closely ^aggregated
small round cells with a small nucleus enj bedded in a stroma
for the most part obscured by the luxuriance of the cell
growth. The growth invaded the white matter of the cord
at several points, mostly along thelines of the normal tyabe-
culfe. The nerve tissue of the cord showed no pathological
changes. Case 2 : A girl, aged four years and a half, under
the care of Dr. H. C. Bastion. Her symptoms dated from a

lastian. Her symptoms dated from a

fall down a flight of steps two months before admission to
University College Hospital. The chief symptoms were
strabismus, paresis of the legs and arms, and blindness
of sudden onset, fourteen, days before admission. There
was also severe pain in the back and marked weakness of
the trunk and muscles. Sensibility was unaffected. Death
took place by asphyxia seventeen days after admission,
without convulsion. The spinal cord was surrounded
thickish layer of new growth, especially developftdviillypbe
posterior aspect. The growth reached upwards roWunSar
surface of the cerebellum, which it invest «d and
to the depth of about half an inch. The middle Soe

cerebellum was almost entirely replaced by pejiL^nKh.
Microscopically, the growth presented appeaxa»to#
identical with the previous case, which were rare, mrd
seemed to form a group apart from other kinds of growth In
the spinal membranes. Only three cases ip which the growth
might be presumed to be primary in the spina^. pia m&tqr
were on record. The notable points in the group of cases
were; The extreme diffusion of the new grqwth, which in¬

volved the whole spinal pia mater; the type of tissue,
approximating closely to inflammatory tisspp,,hpt die tin-

four and a half, sixteen, and twenty-two,yearn respectively;
the brief duration oE the symptoms—about three months in
each case; the absence or impairment of knee-jerk and
other reflexes in connexion with the involvement of nerve
roots; the absence of convulsions; the. presence of con¬
stipation ; the presence of fundus changes in the two cases
in which the disease reached the brain. The-cause of death
in all the cases was interference with respiration.—Dr. J. A.
Ormeuod said that a somewhat similar ..case had been
recorded by Dr. Long Fox in the Bristol Medico-Chirurffical
Journal— Dr . Harden referred to some cases of a similar
kind published as chronic meningitis in the last volume of
the Pathological Transactions.

Dr. Maguire showed & specimen of Interstitial Aneurysm
of the Inter-auricular Septum. The aortic valve was
stenosed, and the cusps much thickened by inflammatory
growth and covered with fibrin, in which no micrococci
could be found. Anterior to and below the foramen ovale
a cyst filled with partly disorganised clot was found, which
turned out to be really an aneurysm. There was some
ulceration below the aortic valve, which communicated by
a narrow fissure with the cavity of the aneurysm. The pre¬
cise mode of origin was doubtfnl. As affecting a part of the
body rarely the seat of morbid changes, the specimen was
of much interest.

Mr. Lawson Tait communicated an additional note on
the Pathology of Extra-uterine Pregnancy. The theory of
i extra-uterine pregnancy which he advanced in 1873 has

Tech La scat,]

EPIDEMIOLOGICAL SOCIETY OF LONDON.

[May 7,1887. 933*

met with only one objection. His theory, based on the
belief that the rupture of the tube was caused by the
placenta, it was urged, could not be accepted because the
placenta was not differentiated until after the third month,
whereas these ruptures generally occurred between the
tenth and twelfth weeks. Carpenter said that “ the forma¬
tion of the placenta commences in the latter part of the
second month, and during the third the organ acquiree its
proper character.” In fact, according to Goodsir, the
changes upon which depend, in Mr.Tait's belief, the ultimate
rupture of the tube begins before the end of the first
month. He meant the immersion of the ffetal tips in the
maternal tissue and the formation of new vessels and the
great increment in size of those in previous existence. The
ultimate localisation of this immersion for the subsequent
differentiation of the placenta is evident loDg before the
completion of the eighth week. All the facts are com¬
pletely proved by two preparations of the Pathological
Series of the College of Surgeons Museum (4691 and 4691a).
In a post-mortem examination made in 1874, in which he
succeeded in perfectly injecting the uterus, ovaries, and
tubes, the enlarged maternal vessels at the edge of the
placental site were clearly the reason of rupture, and the
source of the fatal bsemorrbage. The difference in the
uterus and the Fallopian tube in the matter of a contained
fertilised ovum is that the uterus has the power of in¬
definitely increasing the thickness of its walls, whereas the
tube has no such power, or has it to a very limited extent.
The site of the placenta as a seat of active nutrition, wherever
it may be, becomes extremely vascular, as is proved by pre-

f iarations now exhibited. If the tissue in which this change
9 effected is also infiltrated by soft villi, naturally of a
kind easily torn, and if it does not increase proportionately
in strength, it must offer a feeble resistance to the pressure
of the rapid growth of the ovum. There are many other
preparations illustrating and confirming these points. Dr.
Hevwood Smith’s specimen was removed from the living
abdomen as a pediculated tumour, and the conditions were
such that it seemed that at last a case bad been found that
unhinged completely Mr. Tait’s theory of extra-uterine preg¬
nancy. This preparation wa9 submitted to a committee for
report, which read as follows: “ The specimen consists of a
foetus and placenta corresponding to the fifth month of
gestation. Also the Fallopian tubes, with the ovaries. The sac
containing the foetus and placenta is made up of involuntary
mosole fibre, and resembles in structure the Fallopian tube,
portions of which from the same case were cut and prepared
for the microscope, and compared with the sac wall. Sec¬
tions were also taken from an undoubted case of tubal preg¬
nancy which had advanced to the fourth month of gesta¬
tion. The sections from the two cases were identical. The
outer wall of the sac presents pieces of omentum, showing
that fairly strong adhesions had arisen between the dilated
tubes and tlie omentum. The Fallopian tube corresponding
tothesac,&c.,wa88carcelyrepre8entedexceptbylimbrue. The
corresponding ovary contains a large corpus luteum. There
is no evidence of rupture of the tube, and there can be no
doubt that the specimen is one of tubal gestation.”
What, then, is wanted now for the modification or destruction
of the author’s theory is a preparation of extra-uterine preg¬
nancy which is inconsistent with a tubal origin, or a case
of tubal pregnancy which has not ruptured either into the
peritoneum or into the broad ligament at or before the
twelfth week of ovum life. Dr. Berry Hart dissected a
specimen of extra-uterine pregnancy, and subjected it to the
process of freezing and longitudinal slicing. It is a case of
tubal pregnancy ruptured into the broad ligament, and
developed there until at least the eighth month—perhaps
longer. Unfortunately, nothing is known of the history, but
thefortunate sections cut by Dr. Hart absolutely prove beyond
all criticism what he (Mr. tait) had convinced himself of by
the facts observed by him iu operating upon these cases—
that they are originally tubal, and that they develop in the
broad ligament, pushing its layers and those of the peri¬
toneum upwards and backwards and towards the centre.
In operating on these cases, sometimes he opened the
peritoneum and sometimes not. The reason is made plain
by Dr. Berry Hart’s sections, where the uterus is central.
The growth of the pregnancy has stripped the tubal and
peritoneal layers and carried them upwards, but a moment’s
consideration will make one conclude that the peritoneum
could be Stripped off the posterior wall by the uterus only;
»t could not be shifted from the anterior wall of the uterus
and bladder, though these were pulled weli up. Bqt imme¬

diately on each side of the uterus the peritoneum has
been shifted off the transversalis fascia as far up as
the umbilicus, leaving a long conical tube of the peritoneal
cavity reaching down over the median line of the foetal moss
as far as, and corresponding in diameter to, the uterus.
In some cases the uterus was central, but in the majority it
was not. Dr. Berry’s Hart’s drawings showed why it was
that sometimes the peritoneum was opened and sometimes
not. When this peritoneal tube was central, it was opened;
when it was not, Mr. Tait missed it: so that these operations
were sometimes to be ranked as abdominal sections and
sometimes not. He submitted also sections of the tube in
early tnbal pregnancy, showing the immersion of the fcetal
villiin to the tissue of the Fallopian tube, and the conse¬
quent enlargement of the tubal vessels.

The following card specimens were exhibited:—Mr. E. H.
Fenwick: Urinary Tuberculosis with Multiple Calculi. Dr.
Barlow: Renal Sarcoma in a Child. Mr.Page for Mr. Raven :
Sarcoma of Dorsal Vertebras. Mr. Shattock: Tubercular
Arthritis. Mr. R. J. Godlee: Bones of Limbs, Skulls, and
Sternum, infiltrated with Sarooma.

EPIDEMIOLOGICAL SOCIETY OF LONDON.

The Pretence of Mould Fungi in connexion with Diphtheria.

At the meeting on April 13th (Surgeon-General John
Murray, M.D., Vice-President, in the chair). Dr. Michael
W. Taylor read a paper on the Presence of Mould Fungi in
connexion with Diphtheria. He gave the whole evidence
he possessed, which he had collected from many years’
experience of outbreaks of diphtheria, in support of views lie
had formerly expressed in the British Medical Journal,
July, 1881, on the fungoid origin of diphtheria. He had
ventured on a deduction from these observations, which he
laid down as a proposition to be worked oat—viz., that
some common mould fungi growing under oertain con¬
ditions may originate or transmit diphtheria. The first set
of cases comprised three children in one house, who took
diphtheria within a few days of each other; no exposure to
infection; absence of all evil extrinsic conditions, except
the state of the bedroom they slept in. The walls, in cou-
sequence of leakage, had become sodden with wet oo
July 12th. On July 22nd a fungus appeared on wet plaster.
On August 1st appeared the first case of diphtheria, rapidly
followed by two others, in the children who occupied the
. room. At this time the surface of the wall was covered
with aspergillus mould, besides which there was a sur¬
prising development of a pileate fungus, a coprinus, crow¬
ing on the wet plaster. Second case : Child with diphthe¬
ritic exudation on fauces, extending to larynx, and death
in three days. Leakage through walls of house some time
previously, from storms of wind and rain ; great develop¬
ment of penicillium moulds in.the apartment; a large quan¬
tity of recent skins of cats, covered with mould, stored in an
adjoining chamber. Third case: A young man, who had
diphtheria severely four days after having been engaged fora
whole day in cleaning out a loft in which a number of pigeons
were kept, which was full of mould growing on the exuviae
and debris; and rotten wood-work. Fourth series : A rapid
series of cases in four children in the same family, in which
the only insanitary condition known to have existed was
the presence of a quantity of fleeces of sheep’s wool, which had
been stored for two years within the house in an adjoining
room. Fifth series: Three outbreaks of diphtheria in a farm¬
house, one case in 1879, four cases in 1880, two cases in 1881.
Here also wool had been stored within the house, until there
had been an accumulation of six years’ clippings, and it was
kept in a room which had been successively used by these
children as a sleeping apartment. The author regarded the
evidence in these cases as pointing strongly to the storage
of wool, and to the mould spores and dust proceeding from
it, as being the exciting causes of three successive outbreaks
of diphtheria. After citing the observed phenomena, the
author proceeded to work out the probabilities of common
moulds being connected in some way as axjents in originating
the diphtheritic growths. The presence of fungoid organisms,
found in the exudations of diphtheria, were of pathogenic,
import. It was shown by researches of Oertel, Nasiloff,
Kbert, and others, that diphtheria is a true mycosis, and
that we are warranted in believing that it depends on the
implantation of fungoid material endued with virulent
power. Evidence was sought from analogy of what obtained

034 The Lancet,}

REVIEWS AND NOTICES OF BOOKS.

[Mat 7,1887.

in other fungoid parasitic affections infecting man and
animals; it was shown that many of these fungal pro¬
ductions were but conversions of elementary states of
nicillium and oidium. As maintained by Zopr, there may
a pleomorphism amid pathogenic micro-organisms, and
that there are stages of intermediate forms resulting
from the nature of the nutrient media. Common moulds
are capable of artificial growth in the bodies of animals;
the spores of aspergillus glaucus have been made to
germinate in the eyes of rabbits; and there is a ready¬
made experiment in the Madura foot disease, which arises
from inoculation with the spores of a mucor, growing
in the hot season in India. The innocent bacterium and
aspergillus may by special cultivation become pathogenic,
according to Griiwitz and Fepinger; the experiments in this
direction by Nagel e and Buchner were referred to; and also
Lichtein’s experimental inquiry on pathogenous mould
fungi. So the author claimed that this speculation from
bedside experience was sustained by the experiments of the
laboratory. He regarded the primary elements of zymotic
disease as dependent not on individual forms of germs, but
an affair of soil; and inferred that common moulds, both by
spores and mycelium, might originate diphtheria by growing
on noxious media.—In the discussion which followed
Surgeon-General Murray, Sir William Smart, Drs. Thorne
and Burns, and Messrs. Shirley Murphy and Paget took part.

WEST KENT MEDICO-CIIIRURGICAL SOCIETY.

A meeting of this Society was held on April 1st.

Mr. John Poland showed a patient after amputation at
the knee-joint by Bryant’s method, leaving the inter-articu¬
lar libro-cartilages and their fascial surroundings intact.
The stump was an excellent example of the result of this
form of amputation.

Mr. John Poland then read a paper on the Diagnosis of
Traumatic Separation of the Epiphyses. The chief points
in the diagnosis of these injuries were fully discussed.
Special importance was attached to the particular period of
age in which it occurred in particular bones. At this time
the separation was found to be of a simple character and
complete—that is, completely through the epiphysiary line
of cartilage. Above and below this age the detachment was
frequently incomplete or partial, and often very complicated,
defying the most skilled surgeon to give an accu¬
rate account of the precise anatomical condition of the
lesion. Separation of the epiphyses without displacement
was described as a most important practical point to be
constantly borne in mind, otherwise a number of these
injuries would be overlooked. Stripping up of the peri¬
osteum, and its subsequent inilammation, were found to take
place in this, as well as in the case of a complete separation,
but to a much less extent. The question of prognosis,
especially as regards the partial separation, was mentioned,
as well as the various dangers likely to be met with. Acute
joint disease, as in the hip, was often the result of a separated
epiphysis. The paper was illustrated by cases that had been
under the author’s treatment and by specimens from Guy’s
Hospital museum.

^Leblefcus aitlr ftotias of

The Treatment of Spina Bifida bu a Nero Method. By
James Morton, M.D., L.R.C.S. Ed., l’rofessor of Materia
Medica in Anderson’s College, lately Surgeon and Clinical
Lecturer on Surgery in the Glasgow Royal Infirmary,
Ac. With a paper on the Pathology of Spina Bifida by
Dr. John Cleland, Professor of Anatomy in the Univer¬
sity of Glasgow. London : J. and A. Churchill. 1837.

Dr. Morton has considerably enlarged his book in this
edition, and by the accumulated experience of the results
of his treatment of spina bifida is enabled now to speak
of it more confidently than before. The interest that
would otherwise have attached to the republication of this
brochure has been greatly lessened by the issue of the report
of the Committee of the Clinical Society of London on the
whole subject of the treatment of spina bifida. Not only
was this committee a strong one, but its investigations into

the clinical aide of the subject and into the pathology of th*
deformity, so far as they went, were so extensive and
careful, and their conclusions so well considered, that it
would seem os if but little were left in this field for any
other investigators just at present; and Dr. Morton relies
to a very large extent indeed upon the committee’s report
for the general facts in this essay. Of course he adopts
the committee’s view that his treatment is the beat
at present known, and he supplements it in three par¬
ticulars—1st, that the percentage of recoveries under it u
larger than that found by the committee; 2nd, that he
would not exclude from its application even the cases con¬
sidered desperate; and 3rd, that he would employ it at an
earlier date than the committee recommend. A large par;
of the volume consists of the detailed records of cases under
the care of Dr. Morton and other surgeons, and we wish a
good table of all the cases known to the author had been
appended, for in its present form the book is not well suited
for reference. Considerable interest attaches to the shor:
chapter on the Pathology of Spina Bifida, contributed by
Professor Cleland. Premising that/' it cannot be said tha;
the committee has placed the pathology of spina bifida in a
satisfactory position,” he points out that “ open spina bifida
without tumour” must be studied together with the
commoner variety of the deformity. Dr. Cleland argute
that the essence of spina bifida is a dropsical effusion in;o
the central canal of the spinal cord. The non-tumescent
form is not only often associated with bat is allied to
anencephalus, in that eacli is due to rupture of a dropsical
sac. Tumescent 6pina bifida he groups into metaneural and
perineural varieties in the former the effusion being
behind, and in the latter surrounding, the nerve roots. The
metaneural effusion Dr< Cleland believes to be syringocele.
or dropsy of the central canal of the cord, or an effusion
secondary to this-basing this contention on the frequency
of syringocele (three out of five specimens in William
Hunter’s Museum), and on the fact that in all cases the cord
extends down to the sac and does not undergo the usual
developmental retraction. Similarly, perineural effusion is
based on a burst syringocele in some instances, and mothers
is associated with an unburst syringocele. The conclusion
drawn is that “ spina bifida, in all its varieties, implicates
in the first instance the interior of the cord."

Rest and Pain. By the late John Hilton, F.R.S., F.R.C8.

Edited by II. A. Jacobson, B.A., M.B. Oxon., F.R.C.S,

Assistant-Surgeon to Guy’s Hospital. Fourth Edition.

London ; George Bell and Sons. Pp. 514. 1887.

The profession will welcome anew edition of this classical
work, which has lost none of the popularity and apprecia¬
tion bestowed upon it when it first appeared in print under
the personal supervision of its learned author. In his
editorial preface Mr. Jacobson states that he has made very
few alterations in the present edition, on the grounds tha;
since "the author’s death renders his name less and less
familiar to the generations that are rising, it has seemed
more right to leave his book without further changes.” We
entirely subscribe to this explanation. Mr. Hilton’s work is
facile princcpe of its kind in our own or any other language.
Its pages teem with facts—dry perhaps in themselves—but
rendered palatable, instructive, and interesting by reason of
the clinical and physiological interpretations that have
embellished them. No one can rise from a perusal of it?
pages without admiring the ingenuity of the reasoner and
the practised skill of the surgeon who, alas! is now lost to
science and humanity. Some of the arguments adduced in
support of preconceived opinions may seem fanciful and far¬
fetched when scrutinised by strict logical laws, but, for all
that, none can doubt the sincerity and enthusiasm of the
writer who gave an affirmative answer to the interrogation
contained in Divine writ, " Can these dry bones live?"

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The* Eajkcmt,]

BEVIEWF.—NEW INVENTIONS.

[MAY 7,1887. 0J5

It may be safdly said that the late Mr. Hilton touched no
subject -which be did not adorn; and bis pages now under
review will stand as his lasting monument. In Mr. Jacobson
the author of the work found a worthy disciple, and one well
fitted to take the responsibility of editorship. Wherever
Mr. Jacobson has altered the original text, or amplified it, it
hae been done with the purpose of rendering it more accu¬
rate and complete, and no one can deny that his task has
been successfully accomplished. The additions to the work
are chiefly in the form of foot-rnotes.so that the primary plan
and substance remain much as they were in previous editions
—a procedure far preferable to that which more commonly
obtains in excising and substituting, until by mutilation
recognition of the author's handiwork is all but impossible.

Practical Pathology; an Introduction to the Practical Study
of Morbid Anatomy and Histology. By John Lindsay
Steven, M.D. Glasgow: Jas. Maclehose and Sons. 18S7.
The thoroughness with which pathology is pursued in
the great schools beyond the Border is reflected in the
manuals that have been issued of late from two of the
Unfveraity towns. Dr. Steven's book is the less ambitious
of;the two, hot not less useful< and we oaa congratulate him
upon the manner and style of .its production. In the present
day our pathological departments ought to be so equipped
and conducted that no post-mortem examination should be
considered complete unless it included records of histological
as well as of gross anatomical appearances. This will not
be possible Until'a more generous recognition is given by the
responsible authorities to the pursuit of this subject, for it
\yould necessitate a greatly increased staff and outlay. Vet
it has always seemed to us that every effort should be made
to perfect our means of pathological investigation and in¬
struction. Much has been done of late years to facilitate
enteh studies, but theit value will not become appreciated
until examining boards take mors cognisance of real
practical knowledge. To the earnest student bent on seeing
for himself the facts of which he reads, such a manual as
that of Dr. Steven will be invaluable. It is not too diffuse
or too technical; and although it lacks illustrations, they
are not absolutely needed, for the best illustration is that
afforded by the specimen itself.

ftefo I’rtknturas.

A NEW SEWAGE PRECIPITANT. ,

Mb. Kinoxbtt, the well-known inventor, or we might,
perhaps more correctly say the discoverer of “ Sanitas,” has
patented a very simple agent for the precipitation and
utilisation of sewege. This agent is powdered coke. The
gWht value of gas coke as a filtering agent for water was
demonstrated, we believe, for the first time by Dr. Percy
Frankland, but Mr. Kiagzett is doubtless original in suggest¬
ing its use in the clarification of sewage. The powdered
coke is' first mixed with a certain proportion of clay, to in¬
crease the density of the precipitant, and is then well
mired .with the sewage. It is said.tbat the deposit can most
readily be pressed, and .that the cake has a certain, although
not great, manurial value. What is even more important, the
cate can be air-dried and used without nuisance as fuel, or
may be carbonised by heat and used again as a precipitant.
The suggestion is an interesting ohe, for every gasworks
tutus out: a.tjuantity of breeze or coke dust, which is sold at
ejeryJpw rate, and is often hard to sell at all. It certainly
seems jjossible that this breeze, more finely powdered, may
prove an economical sewage precipitant. We can express
nq decided opinion as to its sanitary value, but it promises
well, and we shall be clad to hear that it has been properly
tried. Mr. Kingzett, in his circular, does not tell us how
arach of his material would be required. Indeed, he does
not.seem tp have,gone beyond laboratory experiments. , ,

A NEW UVULATOME.

Uvulatomy gives very various results in the subsequent
degree of discomfort during cicatrisation, according to the
method tfnd skill of the operator. It was Bosworth of
New York who first pointed out the advisability of cutting
in a direction upwards and backwards, so that during
deglutition the bolus of food should not come iu contact
with the raw surface, lu order to effect this, he directs
that the uvula be seized with forceps, drawn forwards nnd
cut in the direction indicated, with ordinary scissors. That
the subsequent discomfort when this is satisfactorily accom¬
plished is infinitely less than when the wound is horizontal
I can assert from comparison of the two methods. But the
means he advocates are neither simple nor efficient. The
chief objection is the drawing forwards of the uvula with
forceps; for the loose union subsisting between the mucous
membrane and the muscular structures enables the former
to be drawn off the latter, and the operation inevitably
leaves the stump denuded of its coverings. And thus

\ Bo8worth’splan defeats its own ends.

With the object of avoiding this mis¬
hap, I have had a uvulatome con¬
structed of which the accompanying
sketches are illustrations. Essentially
it is a pair of strong curved scissors,
with a pair of forceps-blades lying
beneath and almost in contact. The

latter, while the scissors are still wide open, grasp tno uvuia.
The projecting arm at the end of one blade, which the artist
should have represented half as long again,prevents the uvula
from slipping back during cutting. IV ith the mouth wide open
and the tongue depressed, the patient is instructed to breathe
in and out gently through his nose, whereby the velum is
relaxed and the uvula brought into a verticaLposition. Ibis
is the more easily effected, since an elongated uvula is gene¬
rally accompanied by a semi-paretic condition of the soft
palate, both being probably dependent upon a chronic conges¬
tion of muscular tissue as well as mucous membrane. 1 he
instrument is then opened wide, and that portion of the uvula
which it is desirable to remove is carefully included in the
forceps-blades and rapidly cut through. If the operation has
been efficiently performed, we should be unable to see the
cut surface. It is scarcely necessary to add that no more than
the redundant mucous membrane should be removed.

036 The Lancet,]

REFORM OF THE CORONER’S COURT.

[May 7, 1887.

THE LANCET.

LONDON: SATURDAY,, MAY 7, 1887.

A Bill to Amend the Law relating to the Election of
Coroners has been brought in the House of Commons by
Mr. Wootton Isaacson. It also bears the names of
Mr. E. T. Gochlry, Mr. W. Ambrose, Q.C., and Colonel
Hughes. The opportunity is a favourable one for con¬
sidering it, together with the report (a condensed notice
of which appeared in The Lancet for March 12th last)
issued by the Manchester Medico-Ethical Association
as to the present inefficient working of the Coroner’s
Court, and the subject generally. The Bill is a short one,
containing only five clauses. Its provisions are briefly
to place the elections of county coroners upon the same
basis as those of members of Parliament. Thus, upon
receipt of the writ declaring the vacancy, the Sheriff
is to give fourteen days’ notice of his intention to proceed
to the election of a coroner. The persons entitled to
nominate and vote are to be freeholders whose nances
appear on the Parliamentary Register then for the county
or division, or part or parts thereof, in respect of which the
election is being held; and they alone will be deemed
eligible to vote. The nomination and poll are to be con¬
ducted, so far as circumstances permit, like those at
Parliamentary elections, under the Ballot Act, and subject
to the provisions of the Corrupt and Illegal Practices
Prevention Act, 1883. Provision is made specially for the
expenses of each candidate, which, if the number of free¬
hold electors does not exceed 2000, is to be £400, and for
larger numbers in proportion. In the event of a petition
being lodged against the return of any candidate, the
election judges are to appoint a commissioner to try such
petition, and if it be successful a new election shall
take place. The Bill is well designed to remedy most
of the evils of the present system, and deserves every
support.

It is to be regretted that the Manchester Medico-Ethical
Association made no allusion to medical coroners, but
merely expressed an opinion “ that the qualification and
position of a coroner should be those oE a stipendiary
judge, who should devote the whole of his time to the
duties of his office, and that his salary should in no case be
dependent upon the number of inquests.” Even if there
had been an overwhelming majority in favour of legal
coroners, it would have been just to have paid some tribute
to the many medical men who have filled the offices both
of borough and county coroners with credit to themselves
and to the best interests of the public. This would have
been more apparent to the latter than it is if medical
coroners had more fair play, and had been appointed in
anything like a just proportion to their legal brethren.
But out of 28G coroners in the Medical Directory whose
qualifications are stated, only 49 are medical, while 237
are legal coroners. And the experience of Lancashire is
negative, medical coroners being altogether unknown there,
which fact may be a possible explanation of their being so

ignored in a report issuing from Manchester. There is,
however, a still more weighty argument in favour of medical
coroners at the present day than there has hitherto been.
Judges have strongly condemned the committal of prisoners
on the coroner’s warrant alone, urging that there should be for
every criminal charge an inquiry before the magistrates and
a bill of indictment to lay before the grand jury. This would
imply what has always been contended for in The Lancet,
that tbe duty of the coroner is solely to inquire into the
cause of death, and this is obviously more the function of
a medical than a legal coroner. The more legal duties and
egal questions are eliminated from the office the better.
Such verdicts as “Found dead,” “Found drowned,” “Died
by the visitation of God,” are more suggestive of antiquated
formalities than modern records of the cause of death, and
they are verdicts generally recorded at “legal” coroners'
inquests.

The Manchester report, which is of a somewhat sweeping
character so far as its reforms go, further suggests “ that the
coroner should have no disc retion but to hold an inquest in
every case of death, sudden or otherwise, in which the cause
of death cannot be certified by a legally qualified medical
man.” This is scarcely practical, even with the qualifying
addendum; “It is not implied that the coroner should
be necessarily de barred from holding an inquiry, pro¬
vided there exists reasonable grounds for suspicion, because
a death has been certified by a legally qualified practitioner."
It is undoubtedly true that the discretionary powers of
coroners are at preeent far too great, and that they have
often been used very unwisely, especially by legal coroners.
But to give coroners no discretion whatever would be only
adding to the useless and formal inquests which are already
far too numerous. Many cases must be referred te the
coroner in which the want of a medical certificate is more
or less accidental, and yet where an inquest is wholly un¬
necessary; it is these preliminary inquiries, indeed, which
constitute a very important part of a coroner’s duties. This
discretion to be used wisely, and tbe conduct of these pre¬
liminary inquiries require a medical training, and can only
be properly left to a medical coroner. The report pro¬
poses to continue the coroner’s jury, but that it should
be a properly constituted one, of an improved social
status; it deprecates the present custom of “ viewing the
body” as objectionable and unnecessary; it advocates the
providing of mortuaries with proper appliances in every
coroner’s district. It also suggests that registrars of deaths
“ should have no option but to report to the coroner every
case of death brought for registration the cause of which
has not been duly certified by a legally qualified medical
man ”; and proposes an amendment to the present form of
certificate giving " the period of attendance of the medical
man.” It also raises again the importance of registering
still-births, urging “ that the registration should be made, as
in other cases, only under a medical certificate, which should
state that the certifier had attended the mother during hear
confinement or had inspected the body of the child within a
few hours after birth. Failing this that a coroner’s inquiry
should be necessary.” To meet objections on the ground of
expense to the poor, it is suggested that the payment of the
medical inspection might be charged upon the local autho¬
rities, All these suggestions are very good, and though

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THE TREATMENT OF INJURIES OF THE INTESTINE.

[May 7,1887. 937

somewhat in advance of the time, they are practicable and
mast sooner or later be adopted. The remaining portion of
the report we must reserve for consideration ontil next week.
-♦-

Sib William MacCormao is certainly to be congra¬
tulated upon hie choice of the subject of his Oration at the
Medical Sooiety on Monday last. “ Abdominal Surgery ” is
fast losing the charm of novelty, and the marvellous results
attained in this branch of the surgeon’s art are familiar to
all, and cease to excite the wonder with which they were
first received. Sir William Mac Cobmao wisely devoted
himself to a consideration of one branch of this great sub¬
ject, which has been the last to receive its meed of notice
at the hands of surgeons, and has indeed only been opened
up by the large experience now gained in the removal of
abdominal tumours, and of the many contingencies attending
it. The treatment of Injuries of the Intestine was the
theme of the Oration, and it is one well worthy of the
attention of Eaglish surgeons. Our American brethren at
present bear the palm in this region of operative surgery,
and it is to Bull, Dbnnis, and Sknn, among many other?,
that we are indebted for the best recent papers on this
subject, and the best cases illustrating the line of practice
they advocate.

Intra-peritoneal wounds of the intestine are certain to
lead to fecal extravasation, which is nearly always fatal
from intense septic peritonitis. Experience has shown that
wounds of the intestine can be safely sutured, and that
prompt and thorough cleansing of the peritoneum may
avert septic peritonitis. We are able now to follow out tLe
practice inculcated by Bbnjamin Bell, and Sir William
Mac Cqrm ac's Oration was but the enforcement and
exemplification of that great surgeon’s teaching. Intestinal
injuries may be easily classed into stab wounds, gunshot
wounds, and ruptures. The first great difficulty that besets
the surgeon in their management is that of diagnosis. We
doubt if there is anyone of large experience in surgery who
cannot from his own practice cite striking examples of the
misleading appearance of harmlessness these lesions often
present. As these lesions are so extremely fatal, the very
difficulty of diagnosis imposes the duty upon the surgeon
of clearing up the doubt and of determining with certainty
whether or not they are present. This is the first point that
needs to be made plain. To wait until the diagnosis is
certain is to miss the golden opportunity for treatment, and
to allow the onset of septic peritonitis to rob the patient of
nearly every chance of life. Hence, when the doubt exists,
it should be cleared up by a careful aseptic exploration,
first of the wound in the parietes, to see whether it is
perforating or not, and next of the abdominal viscera', to
ascertain whether and where they are injured. This may
be a difficult task, and, if undertaken at all, must be done
systematically and with the utmost precision. But it is
also the step at which some, perhaps many, surgeons will
pause. While quite ready to admit that when a wounded
intestine is known to exist it may be best to suture the
wound, cleanse the peritoneum, and close its cavity, they
will hesitate before they adopt the bolder step of seeking
out the injury when the symptoms do not indubitably
point to it. To some extent their scruples will be just.
While such an exploration may be urgently needed when

the intestine is wounded, it should not be practised when
only a suspicion of such an injury exists, and the surgeon
must weigh most carefully all the circumstances of the
case before adopting so grave a procedure as the systematic
inspection of all the abdominal viscera. Such a case is just
the one to test the mettle of a sargeon, and the practice
advocated, while good in the hands of the wise, may be
fraught with evil in the hands of the careless.

An intestinal wound having been discovered, the proper
line of treatment undoubtedly is to close it with the utmost
care by the Lembert suture, and, having cleansed the
peritoneum, to close the external wound. Such a line of
practice is not good in theory only. Already its results in
practice are encouraging, and likely to become more so
when surgeons are more familiar with such proceedings.
Of eighteen stab wounds so treated, success has been
obtained in ten. Among thirty cases of penetrating gunshot
wounds of the abdominal cavity, seven have been saved by
this means. There is, however, one feature in these cases
that must always militate against success. They are of the
nature of surgical emergencies. They do not permit of special
preparation, and the circumstances attending them often
tend to depress the patients and unfit them for a severe
operation. But in spite of all this, and of all the grave diffi¬
culties attending the subject both in diagnosis and treatment,
it cannot be doubted that the facts contained in Sir Wm.
Mac Cormac's address are evidence of another advance
gained by surgery, and the arguments deduced from the facts
are well deserving the careful consideration of surgeons.

■ ■»

Whatbvbr of scientific truth may eventually become
established concerning the reflex relationship of the cervical
region with the brain and bulb, now set forth by Professor
Bbown-8£quard, there can be no question of the remark¬
able suggestivenese of his conclusions. He showed some
years ago that puncture of a certain region of the floor
of the fourth ventricle, in close juxtaposition to the vaso¬
motor and cardiac centres, but not identical with them, has
the effect of reducing to the lowest possible ebb the nutri¬
tional changes of the organism, so that the blood in the
veins runs red as that in the arteries; for the protoplasmic
tissues neither absorb oxygen nor disengage carbonic acid,
being, in fact, in a state of suspended animation. But this
is not the only cessation of activity that may be brought
about as the effect Of puncture of the floor of the fourth
ventriole. The activity of the cerebral cortex may also be
suspended by a similar operation; and actual death may
also occur. To sum up in a few words the latest conclusions
of the distinguished experimental pathologist, we may state
that the skin of the neck covering the larynx has, like
stimulation of the larynx, though in a less degree, the power
of inhibiting the sensibility of the body, and, furtheT, that
mechanical irritation of the larynx, trachea, and perhaps of
their superjacent skin, possesses the power of causing
deatli, in the same way as though the bulb or medulla
oblongata were irritated. These are extremely important
conclusions, and it will be well to examine the evidence on
which they are founded. The following is the gist of
Professor Bbown-S6quabd’s communication to the Aca¬
demic des Sciences.

It has often excited surprise that suicide by cutting the

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938 Thb Lancrt,]

THE MORBID ANATOMY OF THE FALLOPIAN TUBES.

(May 7,1887.

throat should be carried out with such determination, and
apparently at the cost of enormous suffering, indicating an
almost superhuman courage. The surprise, however, would
be considerably lessened if it were true, as is now asserted,
that mechanical irritation of the akin covering the larynx, as
well as of the larynx itself, causes total analgesia, as Eeema
possible from the remarkable experiments Professor Brown-
Sk 2 UART> made some four years ago. After having made a
longitudinal incision through the skin of the middle line, or
transversely from one side to the other, in the anterior
cervical region, the Professor observed in a great number
of expariments, especially in dogs and monkeys, that he
could lay bare, cut, bruise, galvanise, and even bum the
various structures in the anterior two-thirds of the
neck without causing any great pain, and sometimes with¬
out appearing to cause any pain whatever. Such facta—
verified hundreds of times during the last five or six years
—prove that these structures have the inhibitory property
of causing general analgesia, though in a varying degree,
according to the precise structure stimulated—viz.: (1) The
maximum effect is produced by stimulation of the mucous
membrane of the larynx—i.e., of the parts supplied by
the terminal ramifications of the superior laryngeal nerves.
(2) In a less degree irritation of the trunks of these nerves,
and in a still less degree of the trunks of the vagi above
the point of emission of the superior laryngeal nerves,
causes the same result to appear. (3) A transient anal¬
gesia of variable completeness may be caused by ligature
of the trachea. (4) The minimum effect is caused by
the irritation of the skin covering the throat, and espe¬
cially of that over the larynx proper. Although incision
of the various structures is the most effective in bringing
about the analgesic effacts, it is not the only irritation that
possesses this property. The trigeminal and other sensory
cranial or spinal nerves in their trunks or ramifications do
not appear to be endowed with the special power that the
vagus nerves and the nerves of the cervical region posses?.
Surgeons performing tracheotomy during the asphyxia of
a patient may be incorrect in supposing that the asphyxia
confers immunity from pain, for doubtless the analgesia is
partly owing to the very incision of the skin of the front of
the neck. Other experiments on animals seem to show that
stimnlation of the anterior cervioal region, especially the
larynx, but also the trachea, and probably the superjacent
skin, has the power of stopping the heart, inhibiting the
respiration, and suspending consciousness. When Professor
Boown-Skward has killed dogs by cutting their throats, he
has found that nearly always, if not always, death occurred
without convulsions, without agony, in a state of perfect
syncope, permitting the protoplasmic tissues of the body to
preserve for a long time their special properties: the blood
running red from the arteries to the veins, and thus present¬
ing an absolute contrast to death due to asphysia, where
the arteries are filled with black blood.

An article descriptive of the morbid conditions in twenty-
live cases of tubal disease operated upon by Prof Martin,
is contributed to the current issue of Virchow’s Archvv by
Dr. E. G. Orthmann. It should be read with interest at
this time, when so much is being said regarding the clinical
aspect of the chKraic inflammatory changes to which the

uterine appendages are prone. Dr. Orthmann describes in
detail the histological characters of his specimens, and in
the first place draws attention to the normal structure of
the Fallopian tube. The wall of the tube is composed of
three layers—the mucous membrane, which, covered with
ciliated epithelium, is disposed in longitudinal folds, which
towards the free extremity become branched and divided,
ultimately forming the so-called fimbriae; the muscular
layer, greatly developed in the uterine segment of the tube,
and diminishing in thickness towards the abdominal ex¬
tremity; and the outermost eonnective-tissue layer. The
morbid conditions described fall under five heads, and each
case is related in full. Of catarrhal salpingitis there were
nine cases, six being unilateral. The disease is not limited
to the mucous membrane, nor does the ciliated epithelium at
first suffer, the change commencing with thickening of the
mucous membrane, and consequent irregular swelling of its
folds. The swollen folds coming into contact, the cells are
compressed, degenerate, and disappear. More or less cystic
cavities form between the thickened folds of mucous mem¬
brane ; and bloodvessels in the infiltrated submucosa may
rupture, giving rise to haemorrhage into the cavity of the
diseased tube. Such haamatosalpinx may result from a
closure of the fimbriro. The muscular and fibrous coats of
the wall of the tube may also be thickened, often with
atrophy of the muscular fibres themselves. In five cases the
“ ostium abdominale ” was occluded, partly by hypertrophy
of the mucous folds, partly by adhesive peritonitis. The
following varieties of catarrhal salpingitis are enumerated,
the term “ catarrhal ’’ being obviously used in a wide sense: -
(1) Salpingitis cat. simplex or endosalpingitis; (2) S. diffusa
or interstitialis, which comprises (a) S. hremorrhagica and
(/>)• S. follicularis. Of jmmlcnt salpingitis eight cases are
described. In seven of these the most careful examination
failed to detect any bacterial organisms—a negative result
which suggests either that the organisms were remarkably
scanty (as usual in chronic suppuration), or else that
they could not be manifested by the methods used; reference,
however, is made to the discovery by other observers of
tubercle bacilli and of gonococci in tubercular and gonorrhoeal
salpingitis, and Dr. Oethmann himself has quite recently
recorded an instance of the last-named variety. 1 In
purulent salpingitis only traces of the ciliated epithelium
remain where protected by the folds which are now converted
into wide septa between cavities filled with pus; whilst the
mucous membrane is more or less replaced by the granula¬
tion cells of the inflammatory process. In places the
muscular coat may he laid bare by the destructive process.
This coat may also be thickened by infiltration of round
cells, and the vessels will be increased. In six cases the
ostium abdominale was occluded, and of the others one had
a fistulous communication with an ovarian abscess. There
were two cases of hematosalpinx, m one of which there was
atresia of the ostium abdominale, the mucous folds were
stretched, and the wall somewhat atrophied. In the other
case the tube was occluded by a kink. Four cases of
hydrosalpinx are described, three of which were unilateral.
In all the superficial epithelium wis not much altered; in
one case the mucous folds were hypertrophied, but in the

1 Vide Burl. Klin. Woch., No. 14, 1887.

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TUE GENERAL MEDICAL COUNCIL.

[Max 7,1887, 939

teat they were dwindled, and the muscular coat was also
atrophied. Lastly, there were two cases of pyo&alpin.v, a
condition generally dependent upon atresia of the tube.
The walls were thickened and their vascular supply increased.
No microbes could be found in the purulent contents. Dr.
Ouxhman.n also gives a summary of these cases, from which
we gather that in the twenty-live operations there were three
deaths—one from collapse and two from peritonitis. Of these
cases twenty-one were simple salpingotomies (two deaths).
In two instances the patient underwent a second laparo¬
tomy. In one a right hydrosalpinx was removed seven
months after the extirpation of the left appendages; in
the other, a large htematoma of the right ovary had been
removed thirteen years before, The majority of the patients
had presented no disturbance of menstruation; in five cases
it had been of late somewhat profuse, in five there was
severe dysmenorrhcea, and in three menstruation was
irregular. The chief and universal symptom was pain in
the abdomen and groin, whilst in ten cases there occurred
haemorrhage and in seven marked uterine discharge. As to
tbs etiology of the cases, ten were ascribed to gonorrhoea,
these including six purulent cases, two catarrhal, and the
two cases of hydrosalpinx. Four were post-puerperal, but
in the remainder no definite cause could be assigned. Two
cases were associated with cancer of the uterus, one with
myoma, and one with an ovarian cyst. The ovary was
found diseased in all but two of the cases. In eight there
was chronic ovaritis, two being further complicated with
hsematoma of the ovary and one with hydrops folli-
culorum. In four other cases there was ovarian h;cma-
toma, and in three others hydrops folliculorum, without
other lesions. There were five coses of ovarian abscess,
which in two cases communicated with the tnbe by small
openings, and in one the tube and ovary were conjoined
in a common abscess sac. One case of catarrhal salpingitis
was associated with an ovarian cyst of the size of the fist.
Atrophy of the ovary occurred throe times, and parovarian
cysts in four cases; in three cases there was haematoma
between the ligaments, and in one an abscess. We have
called attention to this contribution because it seems to
us that the pathology of these conditions has yet to be
worked out, whilst the material is rapidly accumulating
for a thorough study of the subject.

-+--

During next week the General Medical Council will have
to decide whether the Apothecaries’ Society shall cease to
exist as an examining body, or whether, by the appointment
of assistant examiners in surgery, the special powers which
theypossoss for protecting the public against unqualified
practitioners shall be maintained. Of the issue there can be
little doubt, however greatly we must deplore the multipli¬
cation of licensing bodies. There has not been from the first
any question that the failure of the Colleges to unite with
the Society is due to the action of the former alone; but if
further argument were wanting, it is to be found in the
rebuff which the Medical Council have themselves received
st the hands of the Colleges, who have refused to comply
not only with the request of the Council, but also with that
of the greater number of their licentiates. We have no
hesitation in saying that the governing bodies of the two
Colleges have by their action lost the confidence of many of

the profession, and we anticipate that evidence will not
long be wanting of a determination to bring about the
change which has hitherto been sought in vain. Until
this is accomplished the Apothecaries’ Society will continue
to grant a separate licence to practise. By the appointment
of assistant examiners the Medical Council will themselves
be practically engaged in the duty of examining. A further
business, moreover, which will oooupy their attention is the
appointment of inspectors of examination, and this will
bring them still more closely into relation with this function
of the corporations. Indeed, it is not impossible that in
the future their powers in tliis direction may be increased
until they have placed upoo them a greater responsibility
than that of acting as the critics of other people’s work.
Already they have adopted a resolution that the visitations
and inspections shall systematically cover within stated
periods of time the pass examinations in all branches of
knowledge which the Council deem essential as qualifica¬
tions for licence. Their intention is, therefore, to perform
this duty in no perfunctory way, and although during the
present year they will not go beyond the appointment of
three inspectors, one each for medicine, surgery, and mid¬
wifery, it may be anticipated that it will not be long
before every branch of medical examination is represented.
The work of each inspector will be to attend the exami¬
nations of all the licensing bodies hi the United Kingdom,
so as to enable him to form an opinion upon and report to
the Council as to their sufficiency or insufficiency. Evidence
obtained in this manner will be the groundwork upon which
future changes will be based, and it may be accepted that
failure to protect the public from the entrance into the
profession of unskilled practitioners will lead to the loss
of powers to exercise this function. The selection of
inspectors is therefore a matter of the greatest moment
to the profession, and the Council may be trusted to
exercise a wise judgment in their choice.

Annotations.

Ne quid nlmU."

THE LATE DR. WILSON FOX.

Tue announcement of the death of Dr. Wilson Fox will
cause Avidespread grief in the profession. A physician has
passed away in the prime of working life whose knowledge,
judgment, and skill had won for him a degree of confidence
which few secure, and whose loss creates a void which can¬
not be easily filled. But this is not all. A man has passed
away who was far more than a skilled physician. Dr. Fox
combined in a degree rare in any calling moral elevation
and moral courage, spiritual ardour and self-devotion. No
consideration for his own interests warped his action from
the straight line of right and honour, or dimmed the clear¬
ness of his mental vision. His intense energy has been a
motive force in the profession of far wider iniluence than
appeared on the surface, for he was ever ready to efface
himself when the movement he had started had gained
inherent strength. He will be deeply mourned, not only in
the profession, but in a wide and ever-widening circle of
those who knew him, and, knowing him, could not help enter¬
taining towards him a feeling deeper than mere esteem, and
warmer than mere gratitude. We hope next week to give
some account of his life—a life of hard and earnest work, a

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TttE ACTION* OF* THE DIAPHRAGM.

[Mat 7, 1887.

940 Thw LANdKt,]

life of devotion and self-sacrifice, ending with the final
sacrifice of himself, where so many have laid down their
lives, on the altar of beneficence. To-day we give an
account of his last illness.

On Saturday, April 23rd, Dr. Wilson Fox was in his usual
health in London, and intending to proceed to his home in
Westmoreland in the afternoon. His doing so was pre¬
vented by a telegram informing him of the serious illness of
his eldest brother. He went into Somersetshire to see him,
and found him suffering from acute double pneumonia and
his case almost hopeless. He remained until bis brother
died on the following Wednesday, April 27th. During this
time he had suffered from lumbago and some slight feeling
of cold, but left for the north, stopping at Preston on his
way. He was quite well when in Birmingham, and walked
about there. At Preston he ate a simple dinner with
thorough relish, and retired apparently quite well. Early
in the morning he was disturbed, and sustained some chill
amounting to a slight rigor. His temperature was raised,
and he was seen by Dr. Brown of Preston, who found him
suffering from pneumonia, with extreme cardiac weakness.
During the day he was visited by Sir William Roberts, an
old college and intimate friend, who took a very grave view
of the case owing to the extreme cardiac weakness and his
depression, the result of the death of his brother. He rallied
in the after-part of the day. The temperature was never high.
His cough was troublesome, and expectoration characteristic,
not excessive. But very frequently there were recurrences of
extreme cardiac dyspnoea, which were relieved by treatment.
On Friday afternoon he was seen by Sir William .Tenner in
consultation with Sir W. Roberts, and the former remained
with him during the night. His condition on Saturday
morning was that which might be expected of pneumonia
running its ordinary and natural course, but about 10 a.m.
serious prostration (cardiac) reappeared, causing great
alarm. Dr. Russell Reynolds was telegraphed for to come
d >wn immediately, which he did, and found that he had
made some slight rally. The night of Saturday was passed
with more comfort, and on Sunday morning, although
suffering frem some pleurodynia aud lumbago pains and
rapid breathing, he appeared better. About midday, after
some intestinal disturbance, Dr. Fox became excessively
prostrate. He was perfectly aware of the danger of his con¬
dition and took leave of his family. During two hours and
a half death seemed imminent, but he occasionally rallied
for a few minutes under subcutaneous injections of ether
and the administration of stimulants and nourishment,
which he took easily. During all this time there was con¬
siderable cyanosis. Later in the day he was better and
passed a fair night, with some tranquil sleep, and on the
morning of Monday the improvement was maintained. About
midday, without apparent cause, his dyspnoea became most
urgent, and it was found that lie had mucous rales in the
small bronchial tubes of both sides of the chest, with ex¬
tension of lung congestion on the left side. From this,
although from time to time there were periods of some
relief, he did not rally, but occasionally, when dyspnoea
wa9 urgent, found great comfort from the hypodermic use of
ether. His breathing did not trouble him, but cyanosis in¬
creased ; he was perfectly clear in intellect, capable of under¬
standing his own condition; but he became weaker and
weaker every hour in spite of all that was done to aid him,
and exactly at 4 a.m. on Tuesday he breathed his last, with¬
out any struggle or sigh. He had spoken with clear intelligence
three minutes previously to Dr. Reynolds. Eleven years ago
Dr. Wilson Fox had an attack of extremely acute pneu¬
monia, and tills was obviously of a rheumatic character, and
extended to the pleura, pericardium, and endocardium. His
life was then in grave danger during two or three days, and
unfortunately both aortic and mitral valves were affected,
but after a certain time of rest his recovery to all except

those who knew the physical condition of his heart was
complete. In the spring of 1886 another attack of pneu¬
monia occurred after an accidental chill, when much de¬
pressed by the death of his mother, but the cardiac con¬
dition was again a source of extreme danger. From this he
recovered, and was able to attend to bis professional duties,
and to exhibit, as all those who met him knew, an extra¬
ordinary amount of energy inf work, mental and physical,
professional and social.

The Court Circular of Wednesday contains the foUowing :
"The Queen was much grieved to receive yesterday the
news of the death, after a few days’ illness, of Dr. Wilson
Fox, one of Her Majesty’s Physicians in Ordinary. Dr. W.
Fox had formerly been in frequent attendance on the Queen
in Scotland, and Her Majesty had a great regard for him.
The medical profession loses in him one of its most distin¬
guished members.” _

THE ACTION OF THE DIAPHRAGM.

In a memoir published in the just-completed volume of
Braune’s Archiofiir Anatomic und Physiologic, Haase gives
the results of his observations and experiments upon this
subject. He finds that the contraction of the muscular
fibres of the diaphragm causes a flattening and descent of the
diaphragmatic domes. The tendinous centre also descends,
and bocomes flattened by the traction exerted upon it from
every side by the muscular fibres. In deep inspiration the
descent of the diaphragmatic domes is al ways more consider¬
able than that of the tendinous centre. The contraction of
the muscular fibres of the diaphragm cause®, a9 was main¬
tained by Duchenne, an* expansion of the lower aperture
of the chest, owing to elevation of the ribs and of the
sternum. When contraction of the muscular fibres of the
diaphragm takes place, the muscular plane they form separates
from the long walls of the thorax, and consequently cause
an enlargement of the complemental space of the pleural sao;
and to so much the greater extent the greater the coincident
elevation of the thoracic cage. The descent of the diaphragm
augments the normal positive intra-abdominal preasniY,
whilst its ascent diminishes the pressure, though never tozero.
The changes of position which occur in the descent of the
diaphragm cause a corresponding change in the position of
the viscera lying subjacent to it—as the liver, stomach, and
spleen. The liver is consequently by no meane a rigid, fixed
organ, but varies both in form and position. When the
diaphragm contracts, the resistances to the flow of blood
through the liver and spleen are overcome, and the passage
of blood through them is rendered easier in proportion to
the freedom of the respiratory acts. Lastly, the movements
of the diaphragm are essential for the discharge of the bile,
and further the movement of the contents of the stomach
and intestines.

VACCINATION UNDER DIFFICULTIES.

Tuk Saltan of Turkey, it is said, has just had the
ladies of the seraglio vaccinated, and we are told that
the operation was attended with difficulties which fortu¬
nately arc unknown in this country. An Italian physician
who was employed to vaccinate the ladies of the harem was
not permitted to see the faces of bis patient?, from whom he
was separated by a screen. The operation, it is stated, was
performed on the patients' artne, which were in turn thrust
through a hole in the screen ; and on every occasion of one
arm being replaced by another, the physician was obliged to
submit to bis head being enveloped in a shawl, to prevent
any chance of his seeing the subjects of hi* operation. The
circumstances which permit the entrance of a man into *
harem must be of rare occurrence, and probably there aw
none under which he is more welcome than when he comes
to preserve the beauty oE the inmates. Whether the Saltan
has learnt by experience the necessity for vaccination, or

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THE DISTRIBUTION OF MIORO-ORGANISM8 IN THE ATMOSPHERE. [MaY 7,1887. 941

whether he is guided only by others, the fact remains that
female beauty is more indebted to Jenner’s discovery than to
any art to which the sex can have resort. It has often been
remarked that the portraits of ladies who were the English
Court beauties of former times give no very exalted idea of
the personal appearances which in those days merited
approbation, and that the originals only excited admiration
from tbe fact that they were among the few who escaped
the disfigurement which attends an attack of unmodified
small-pox. However this may be, we trust that the example
which the Sultan has set will have its effect in leading to
the more general vaccination of his subjects. There is
nothing which more strongly impresses the traveller in the
East than the large proportion of inhabitants who are
scarred with small-pox. _

THE DISTRIBUTION OF MICRO-ORGANISMS IN
THE ATMOSPHERE.

Thr Interesting paper read by Dr. Percy Frankland at the
Society of Arts on March 22ad will be found in the Journal
of the Society of Arts of March 25th. In it he reviewed the
history of the subject of atmospheric micro-organisms, by
reference to the experiments of Pasteur, Tyndall, Miquel,
and Freeudenreich. The introduction by Koch of solid culti¬
vating media had, he pointed out, greatly assisted these
investigations, and Hesse’s method by the use of a glass tube
coated internally with sterile gelatine peptone, through
which a given quantity of air can be drawn by aspiration,
had been largely used by Dr. Frankland. He pointed out,
however, that the accuracy of this method depends some¬
what upon the strength and direction of the air currents,
and he bad therefore devised a modification consisting in
the introduction of glass porous plugs to retain the micro¬
organisms, the plugs being transferred to flasks containing
liquid gelatine, in which, after cooling, the colonies resulting
from the microbes later develop. The estimation of the
abundance of microbes in the air is made by enumerating
tbe number of colonies obtained in a given quantity (ten
litres) of air thus filtered. Amongst the results stated may
be selected the fact that from observation on the roof of the
Science Schools at South Kensington the average number of
colonies per ten litres of air varied from four in the month of
January to 105 in August. On the top of Primrose-hill on
May 19th, 188(5, the average numberof colonies was nine; at the
foot of the hill it was twenty-four; at St. Paul's Cathedral
the number in the air in the Golden Gallery was eleven, in
the Churchyard seventy. In country places the air con¬
tained much fewer microbes than in towns, especially in
crowded thoroughfares—there being, for instance, as many
as 664 per ten litres in Exbibition-road on June 8th, 1886.
Fischer’s observations upon the gradually diminishing
number of microbes in sea air in proportion to distance from
land were shown to depend upon the direction of the wind,
with the general conclusion that the maximum distance to
which, under ordinary circumstances, micro-organisms
can be transported across the sea, “ lies between 70
and 1*20 sea miles, and that beyond this distance they
we almost invariably absent." Records were also given
of observations on the air of buildings, and upon tbe
number of micro-organisms falling upon one square foot of
horizontal surface in one minute. As to the nature of the
aerial micro-organisms, the moulds were found to be most
universally prevalent, being found generally in greater pro¬
portion to other forms at high altitudes in the open country.
. Numerous forms of micrococci and bacilli, especially chromo-
genoos species, have been identified in the air; but, as
regards pathogenic microbes, Dr. Frankland stated that their
detection in presence of the overwhelming number of
saprophytic organisms was almost hopeless. The air in &
hospital ward, provided it be undisturbed, contains very

few organisms, and tbe investigation points to practical
hints in the prevention of any aerial commotion daring
surgical operations, and the great importance of removal of
dust in a moist condition. _

THE MEDICAL REGISTER.

Thh Medical Register for 1887 has just been published.
Its appearance this year has been delayed by the adoption,
just before its final issue, of a suggested improvement,
according to which initial headings at the top of each page
enable the contents of each to be more readily seen. During
the past year the work has been subjected to more thorough
revision than in any previous year, circular letters of
inquiry having early in 1886 been sent oat to all prac¬
titioners, and in November voting-papers in connexion
with the election of direct representatives to the General
Medical Council. As the result of these inquiries, a
very large number of corrections have been introduced.
The statistical information contained in the volume will
be found very complete, and in addition to the numbers
being given of practitioners registered in the different
divisions of the United Kingdom, the information is
now supplied as to how many are resident in the three
divisions. In the introductory part of the work tbe new
Medical Act of 1886 has been printed, together with the
older Acts, for the information of the profession, and a
table of the qualificatious in sanitary science that become
registrable under the new Act is also inserted. Copies of
the volnme may be had, as in previous years, either at the
office ot the Medical Council or at the accredited publishers,
Messrs. Spottiswoode and Co., 54, Graceehurch-street, E.C.
The Medical Students’ Register and tbe Dentists’ Register
for the current year have also been issued, and may be
obtained at the same place.

MORTALITY AMONG RAILWAY SERVANTS.

Nearly seven hundred millions of passengers travelled
on railways in Great Britain lost year, and of these eight
were killed and 615 were injured in what are commonly
called railway accidents. Many other persons not in the
employ of the railway companies were killed or injured by
accidents connected with the railway service, such as falling
between carriages and platforms and the like; but, excluding
servants of the companies, the total number of deaths from
causes incident to railway travelling were only a trifle over
500, and of injuries only about 1500. Considering that
these numbers include a great many casualties due to
neglect of well-known precautions, we may conclude that,
as regards passengers and the public, railway travelling is
the safest mode of locomotion. But when we turn to
the servants of the railway companies, the picture is
not only less satisfactory, but almost appalling. We are
not informed of the actual number of hands employed in
the more dangerous kinds of railway work; but we
are told that, including the railway carriers as well as
the ordinary servants, there were last year 459 fatal and
5190 non-fatal accidents. Five men are killed on an aver-
rage in four days, and sixty injured more or less severely.
Whatever the number of workmen may be, this represents
a very grave amount of injury to life and health, and the
statistics prepared by the Board of Trade deserve the most
serious consideration. Doubtless a large number of the
casualties are due to the carelessness of the men. Familiarity
with danger breeds indifference, if not contempt, and we all
know by our daily railway experience how wilful plate¬
layers, porters, and pointsmen are in running totally
unnecessary risks. If a porter has to cross the line
he seems to delight in waiting until the very last
moment before the express dashes through the station,
and in the same way the carman seems to choose by

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942 Thh Lancet,]

FUNCTIONAL DYSPEPSIA AND ITS RESULTS.

[May 7 , 1887 .

preference a place exactly below the heavy weight whioh
is being raised by a crane. A party of plate-layers, apparently
with no one on guard, will continue their work with
scarcely a glance up or down the line until a whistle reminds
them that a train is close upon them, when they gather
their tools and move out of the way quite leisurely. These
things we have all watched with a feeling of irritable ner¬
vousness, and have, perhaps, from time to time admitted in
our hearts that railway companies cannot be held morally
responsible for the suicidal recklessness and stupidity of
some of their employes. But, recognising all this, we fear
that much real blame still attaches to the railway
companies for the loose supervision which they exercise
aver the lives and limbs of their servants. Men
constantly exposed to danger, even when, as often
happens, they are not excessively overworked, are sure
to become careless, and it is universally admitted that
it is a part of the duty of employers to enforce due care
upon their servants, ns well as to diminish, as far as possible,
the unavoidable risk they ruu. The protection of machinery
in motion, the regulation of coal mines, and the inspection
of ships, are all examples of the care which the State now
bestows upon those engaged in dangerous industries.
Economy of labour is probably, next to individual careless¬
ness, the chief cause of the so-called incidents. It would surely
be possible, without any great increase of expense, to arrange
that in every party of men engaged in any particularly dan¬
gerous work, such as the shunting of trains or the repairs
of the permanent way, one man, experienced and worthy of
trust, should have some responsibility for the safety of the
rest, lie would be a foreman, and if any disaster due to
negligence happened to one of his gang, a greater or less
degree of blame would attach to him. No doubt he would
individually do less manual work, but probably the work
would be better done, and at any rate, if sullicient authority
were, committed to him, he would in many cases save the
men under him from the results of their own ignorance or
indiscretion. When l’arliament linds time for domestic
legislation, we hope it will endeavour to minimise the risks
run by a useful body of public servants.

FUNCTIONAL DYSPEPSIA AND ITS RESULTS.

Dr. Jaworski has investigated, chiefly with respect to
the relative amount of hydrochloric acid secreted, the com¬
position of the gastric juice in 222 individuals who presented
symptoms of gastric disturbance, yet in whom there was no
evidence at all of organic disease of the stomach. His ob¬
servations have led him to differentiate five groups, or rather
stages, of functional derangement ( Wien. Med. Woc7t, 1886,
Separatabdruck). In the first, under the influence of
repeated irritation of the gastric mucous membrane, as by
brandy or condiments, the sensibility is imfreased to a degree
that during digestion there is developed an abnormal secre¬
tion of hydrochloric acid, which may give rise to subjective
gastric disorder as well as remote nervous symptoms. The
condition, he says, is readily recognised, and is declared to
be nervous dyspepsia, but it actually forms a prodromal
stage of more permanent derangement, for in the next
stage he finds that the acid is secreted continuously and
spontaneously even in the empty stomach, the quantity
increasing during digestion. These cases are marked by
gastralgia and vomiting, and the mucous membrane is,
one may say, subinfiamed. This condition may, under
Continued irritation, pass into a third stage, when the
acid secretion is extremely abundant, being as high in the
intervals of digestion as during the process. Often bile finds
an entrance into the stomach, and under the action of the
acid is converted into the characteristic greenish-yellow
flakes. The gastric epithelium is acted on, being shed in
masses and in layers. The condition leads, as may well be

imagined, to dilatation of the stomach, partly from weaken¬
ing of the walls, and partly from incomplete evacuation,
with fermentation of the food debris. The symptoms ars
those of intense gastric discomfort after taking food, with
retention of appetite. The excessive thirst can. only be allayed
by warm drinks. Ultimately an antomic state is developed.
The condition may be termed “ hypersecretio hyperacids coo-
tinua,” or “ gastrorr hce a acid a,” or, anatomically, add catarrh of
the stomach. It seems to accompany most oases of gastric olca
After this extreme condition of irritation has lasted a certain
time, there occurs a diminution of the secretion of hydrochloric
acid, and the mucous membrane gradually loses its sensibility
to stimuli. This the fourth stage (or type) of functions!
disorder is characterised by feebly acid or even alkaline
reaction of the gastric juice, and, anatomically.it is marked
by gastric dilatation. It is the condition which patient*
style “ a weak digestion,” and it is attempted to be corrected
or arrested by stimulating foods and drinks; but these efforts
often cause the case to pass over into the fifth or last stage of
the series. Here we have a total incapacity of the stomach to
secrete acid, and in great part also a loss of pepsine-forming
power. No .stimulus can excite the acid secretion. The
stomach contains a small quantity of mucoid, cloudy, mostly
alkaline fluid, of no peptonising power. Yet the patient.*
may be well nourished and not always amomic, intestinal
digestion still being in action. The condition, “ mucou*
catarrh,” is that which accompanies most cases of gastric
carcinoma. _

SMALL-POX AT CARDIFF.

Oca attention i9 drawn to the prevalence of small-poi at
Cardiff, and to the action which is being taken in conse¬
quence. According to the Western Mail, arrangement'
have been made that the public vaccinators shall attend *t
their own residences every evening at a certain hour, so that
the working classes may have an opportunity of securing
revaccinatioD, and that on receiving notice of the existence
of small-pox in any house, the public vaccinator for the
district shall proceed to that house, and there offer
vaccination or revaccination, as the case may be, to all the
inmates. On the part of some it is thought that further
action should be taken, and that a house-to-house inquiry
should first be made, this being followed by the offer of
vaccination at their homes to all who need additional
protection. The house-to-house inspection suggested is of the
utmost value,andithas on several occasions brought about the
best results—as, for example, in the St. Fancras outbreak of
1884. But as regards the expediency of taking vaccination
away from the stations where a proper supply of lymph from
infants is alone obtainable, except under such special emer¬
gencies as the existence of small-pox ia a house, gr&ve
doubts may be entertained. That some immediate go<d
would result we do not doubt, but, after all, it is the full
protection of the general population by efficient vaccination
that must be the main aim of the guardians, and not the
spasmodic gift of an inferior vaccination on a large scale at
moments of panic. House-to-house vaccination must neces¬
sarily be largely performed otherwise than from arm to arm,
and it is notorious that vaccination so done is, as a rule, les*
efficient than when the lymph ia taken direct from an
infant's arm, and that it tends in the end to bring vaccina¬
tion into disrepute. It therefore becomes a question
whether the main gain would come from a large increase in
the amount of vaccination irrespective of quality, or from a
limited amount having true protective qualities. Heh»"
looked at the memorandum issued by the Local Government
Board on this subject, aud we find it entirely supports the
view that the current work from arm to arm at the station*
should, even in moments of emergency, not be sacrificed to
sudden demands arising out of a previous neglect to secure
efficient protection.

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[Majt 7;1887. 943

.-CABBQLATE OF MEBOUBY IN SYPHILIS.

REGINA v. BAXTER AND POTTS.

On April 28th and 22th the trial of Mr. Baxter, an unquali¬
fied medical assistant, and Mrs. Potts, described as a midwife
and ladies’ nurse, for having 'procured illegal abortion on
Elizabeth Culling, aged twenty-two, took place at the Old
Bailey before Mr. Justice Stephen. The jury convioted the
prisoners, who were sentenced each to fifteen years’ penal
servitude. There was a committal by the coroner on the
capital charge, but this was abandoned by the prosecution,
and the prisoners were indicted only on the minor count of
felonious assault, as it was, considered doubtful if the
evidence would suffice to warrant a conviction on the
charge of murder. The facts of the case are already known,
so that it is not necessary to give them in detail. The
deceased, a single woman, ostensibly an assistant in a con¬
fectioner’s shop, but who appears to have led a “ gay life,”
resided at a private hotel in London-istreet, Paddington. As
alleged by the prosecution, she went to reside with the
female prisoner for the purpose of having an abortion
procured. The evidence went to show that she was
attended by Baxter, who was known as “the doctor”
and as the husband of Mrs. Potts, but, as a matter
of fact, he was neither one nor the other. Some days
after the abortion took place, finding deceased in an
apparently hopeless condition, one or both of them took
her to the Paddington Infirmary, where she died the day
after her admission. The acting medical officer of the in¬
firmary, together with his colleague, made an unofficial
post-mortem examination. From this they learned that
deceased died from, acute peritonitis and blood poisoning
consequent on a recent abortion. They also detected two
deep grooves or puokerings in the neck of the womb.
Subsequently, by order of the coroner, a further exa¬
mination of the body was made by Mr. Pepper, assisted
by Dr. Smith. These gentlemen ascertained that the so-
called pucKering in the cervix were two deep lacerated
wounds half an inch deep extending for the whole length
of the cervix. They were further of opinion that the rents
had been made some- days before death. A portion of the
placenta corresponding to a four months’ pregnancy was
still firmly adherent to the fnndus uteri. There were no
injuries to the body of the womb, nor to the vagina or
external genitals. No natural cause of abortion was dis¬
covered. At the fourcbette and for some distance up the
vagina were some “gonorrhoeal warts,” but no signs of
syphilis were to be seen. A few days before her death
deceased had been treated at the Lock Hospital for vaginitis.
The theory set forth in the prisoner’s defence was that the
abortion was a consequence of the death of the fcctus, and
that this was due either to syphilis or to inflammation
having spread from the vagina to the uterus, or to blood
poisoning from absorption of the vaginal discharge. The
medical men who gave evidence for the Crown admitted i
that these were all possible causes of abortion, and that i
syphilis was a very frequent cause. They further admitted
that natural abortion is a not unfrequent event from causes
other than those above enumerated, but they declined to
subscribe to any definite percentage of abortions in a given
number of conceptions. In this they were undoubtedly
right, as authorities on the subject differ very widely in their
estimates. Mr. Justice Stephen, who was of the same mind,
told the jury that, medicine being an inexact Science, it was
difficult to obtain absolutely trustworthy statistics on
account of the difficulty in Obtaining all the facts in the
inquiry. A point of some importance was raised concerning
the post-mortem evidence of syphilis. Mr. Pepper admitted
that it was just possible that a person might have been the
subject of the constitutional affection, and yet that at a
necropsy no conclusion of the existence of the disease might
be found. Mr. Bloxam deposed that, in his opinion, if

syphilis were present it would be discovered, ; since the
lymphatic glands remain enlarged so long as the patient
suffers from the disease. The. latter statement is no doubt
quite correct; but would one be justified, upon finding en¬
larged glands apart from other signs of syphilis, in con¬
cluding that the deceased waa the subject of. syphilis?
Whatever may be the surgical interpretation of the ques¬
tion, it was obviously safer to give the prisoners the
benefit of the doubt implied by the difference of opinion
expressed at the trial. Apart, however, from the medical
evidence, the collateral testimony-^circumstantial, and
direct—told strongly in favour of the guilt of the accused.
Before Justice Stephen passed sentence Mr. Poland informed
him that the Treasury were in possession of information
that the convicts had illegally procured abortion in other
cases. _

CARBOLATE OF MERCURY IN SYPHILIS.

Dr. Karl Shadrk of Kieff, being anxious to try the
effects of carbolate of mercury, which ha9 been strongly
recommended in syphilis by Professor flamberini, requested
M. H. Brandt, a pharmacist in Kieff, to prepare some for
clinical Use. This he did by precipitating a very dilute
solution of bichloride of mercury with a concentrated
alcoholic solution of carbolate of potassium. A yellowish
precipitate was- obtained, which, after being frequently
agitated with the liquid for twenty-four hours, assumed a
whitish appearance. It was filtered and washed with
distilled water till the washings showed no taraoes of
chloride. It was then transferred to a fresh filter paper
and dried under a-bell jar.- In this way a nearly white
tasteless amorphous Substance was obtained, which Was
scarcely acted upon or dissolved by cold, but was readily
soluble in boiling, hydrochloric aeid. The name given
to it by Dr. Shadek is “hydrargyrum carbolicum oxydatum,’’
and he has been using it in his private practice for
several months. At first he gave it.in the form of pills, one
of which, containing about an eighth of a grain, wasordered
three, or occasionally four, times a day. It was well borne,
and did not interfere with the digestion. In some esses the
treatment was continued for six or eight weeks, without
producing colic or other disagreeable symptoms. The total
number of syphilitic cases in which it was given internally
was thirty-five (twenty-six men, aix women, and three
young children). In five of these there was swelling of the
gams and salivation. Mercury was foupd in the urine after
the third dose. Its therapeutic value was especially remark-?
able in macular and tubercular syphilides and in syphilitic
psoriasis of the palm and the sole. Syphilitic rash and slight
relapsing forms yielded to the treatment in from two to four
weeks; in syphilitic affections of the mutous membrane,
and in papular and pustular eruptions, from four,.to pix
weeks were required. Multiple enlargements of glapds were
but little affected by iL In the case of children of from two
to four years old, doses of about the fifteenth of a grain
were well borne twice daily. .

THE DECAY OF BODILY STRENGTH IN TOWNS.

Othbrs besides Lord Brabazon most have remarked the
steady flow of population which has set in, especially of late
years, from the country districts to the towns, and must
have asked themselves, as they reflected on the changed eon-*
ditions, the high working pressure with intermissions of en^
forced idleness; and the unwholesome home life which
awaited many of those immigrants, how far in the end the
nation would be a gainer by the interminable process. Bo
long as our manufacturing and shipping industries continue
to maintain affair measure of prosperity there is little likeli-*
hood that the influx into the towns will be seriously checked.
Its influence for good or evil on the physical state of' our

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J)44 The Lancet,]

REPORT ON FACTORIES AND WORKSHOPS.

[May 7, 1887.

people must therefore greatly depend upon our securing for
them in their changed mode of life the surroundings Acces¬
sary for healthy development. It would be difficult to show
by precise statistics how far the work of degeneration has
progressed among our poorer urban population. For our
own part, we are not disposed to accept, without due
scrutiny, any random alarmist rumours as to a progres¬
sive shortcoming in the national vigour. It must, how¬
ever, be generally allowed that until a recent date little
care has been taken to protect the poorer inhabitants of
our cities against the evils of overwork, overcrowding,
mismanagement in household arrangements and in food and
drink, and other insanitary conditions to which they are
almost necessarily subject; and if this negligence be allowed
to continue, the logic of facts will not fail to convince us of
a suicidal error. There is therefore good reason why
schemes now on foot for the better housing of the poor, the
better allotment of working time, and plans which like
these tend to healthy living should not want substantial
support. We would also draw attention to the great im¬
portance of care in the physical training of children, by
rendering gymnastic exercises acompulsory part of education,
and we are reminded by another article in the Nineteenth
Century that sufficient attention has not been paid to the
necessity for leaving here and there in districts extensively
built upon open spaces for public recreation. Where common
land is not available, it might well become the Legislature
to order the allotment of certain portions of enclosed land
for this purpose. _

THE MEDICAL ACT, 1886.

Fhom the frequent inquiries that have been addressed to
us, there appears to be some doubt as to the effect the new
Act will have on practitioners whose names are now regis¬
tered. It may therefore be as well to point out that gentle¬
men whose names are now upon the Medical Register will
not have to re-register. Existing single diplomas not yet
registered—as, for example, the M.R.C.S.—can be registered
up to Tuesday, May 31st, after which date degrees and
diplomas cannot be registered, unless they have been con¬
ferred after a qualifying examination in medicine, surgery,
and midwifery, held expressly for the purposes of, and
under the conditions stated in, the Medical Act of 1886.
The Act, however, gives power to the Privy Council to
postpone “the appointed day” to any day not later than
the end of June—a power on the exercise of which, we have
reason to believe, the Medical Council is likely to be con¬
sulted at their meeting next week.

ANTISEPTIC MIDWIFERY.

In a report by Dr. K. Inoieffs of the work done in the
Lying-in Institution in connexion with the Golitsineki
Hospital in Moscow for the year 1886, the advantage of
antiseptic midwifery, which is strictly carried out there, is
evident, as out of 641 cases there were but 2 deaths. Some
of the statistics, which are very carefully kept, may be of
interest. The largest number of births occurred, as it is
popularly believed they do, at night, 145 taking place
between midnight and 6 a.m.; the numbers corresponding
to the remaining three-quarters of the twenty-four hours
being 131 from 6 a m. to noon, 107 from noon to 6 p m., and
144 from 6 p.u. to midnight. There were 14 abortions and
9 cases of twins; three births took place in the street. Of
the remaining 601, 478 were vertex presentations, 15 breach,
and 8 transverse. In 9 of the 14cases of abortion the ovum
was removed mechanically. When there was considerable
haemorrhage and the os was not dilated, a hot vaginal
injection of carbolised water was given which was, as a
rule, successful. Twice, a plug consisting of a long strip of

cotton-wool moistened with glycerine and iodoform vu
introduced by means of the speculum, as much as posable
being inserted into the cervical canal, and subsequently,
when the os was sufficiently patent, the finger was intro¬
duced and the uterine contents removed. In one care
there was a slight amount of perimetritis and in two
a single rise of temperature. In one case a spatula wu
cautiously used to assist the irrigation, and once th«
contents were removed with the help of a sharp hook.
Apart from cases of placenta prmvia and abortion, there
were 29 cases of haemorrhage, 6 of these occurring in
primipane; six took place during the first and second
stages of labour, the rest in the third stage and post-partm
The treatment adopted was, during the first stage, to ping,
and when the os was sufficiently dilated to rupture tb?
membranes. If there was rigidity of the os, narcotics were
given. When uterine atony was the cause, massage, tb-
application of ether to the abdomen, hot injections, and
(after the birth of the placenta) ergot were resorted to.
As to operations, episiotomy, or a double v-ehaped incision
of the perineum was performed five times, no sutures being
inserted afterwards. Twice the os uteri was incised; twice
the prolapsed cord was replaced; perineal sutures were
required in 20 cases. In the performance of the opera¬
tion the most careful antiseptic precautions were taken;
in 16 cases the union was complete. Retention of mem¬
branes required the introduction of the band into the
uterus once, but in 14 cases the placenta had to be arti¬
ficially extracted, being completely adherent once, and par¬
tially so thirteen times. Labour was induced prematurely
for contracted pelvis three times, twice by the injection of
water at 28° R. (95° F.) through a tube passed into the
cavity of the uterus, between the uterine wall and the foetal
membranes; in the third case it was induced by the intro¬
duction of an elastic sound into the uterus. Podalic version
was performed eleven times, and the forceps applied fifteen
times. Craniotomy was performed twice.

REPORT ON FACTORIES AND WORKSHOPS.

The annual report of the Chief Inspector of Factories and
Workshops is, as usual, of considerable interest. We are
pleased to note that it speaks encouragingly of a revival of
trade in nearly all branches of industry, which was particu¬
larly noticeable towards the end of the year. Of the many
industries in which an improvement is noted, we are glad to
find the linen trade is in a flourishing condition, as likely to
encourage the growth of flax in this country, a matter of
considerable importance to agriculturists in these depressed
times. The invention, too, of a new scutching machine, by
which 30 per cent, of fibre may be secured from the straw
instead of about 20, will also aid in this direction. But the
chief interest in the report, so far as we are concerned, is
contained in the information it affords respecting the
precautions taken in various industries to protect tie
workpeople from injury or loss of life or health. The
total number of accidents last year arising from machinery
alone amounted to no less than 6656, of which 316 wire
fatal—a formidable return, but one which, we are pleated to
find, is gradually diminishing owing to precautions enforced
and by improvements in the construction of the machinery
employed. Thus many aocidents occur from unfenetd
hoists, and these are generally serious; Mr. Meade King >n
the report deals at length with this, and introduces us to
several kinds of hoists which, whilst simple and inexp« n '
sive, protect the employed from accident and the employ* 1
from liability. Mr. Lakeman, another inspector, has devised
a saw guard, which is calculated to prevent those serious
accidents that so frequently occur from the use of tf*
circular saw. Mr. Lakeman has also induced Mr. Bockbih

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Thb Lahcbt,]

THE MEDICAL SOCIETY OF LONDON.—PYORRHffiA ALVEOLARIS. [May 7, 1887. 945

to perfect a system for stopping shafting and machinery
instantly, so that a person caught by machinery can
immediately be released. The ventilation of factories and
workshops receives considerable attention, and several
effective and simple methods suitable to small factories are
described. We regret to find that the enactments of the
Truck Act are still evaded in some districts. One of the
inspectors, Mr. Hoare, states the following as of recent
occurrence. “ A chain-maker informed me this week that
he paid his master 15s. for gleeds which he oould buy for
7s.” The enormous profits made by the employers by
selling gleeds enables them to sell common chains at cost
price, to the great injury of the workman, who, in addi¬
tion to his loss on the transaction, is fined if any
of the links are the least faulty. One wonders that
the workmen, in their own interests, allow such a
system to continue. But it is, in reality, a question of
work or no work, and any complaint on their part leads '
not only to their present discharge, but prevents their !
getting employment in the future. It is satisfactory to note
that the prosecutions for offences against the Factories and 1
Workshops Act are not for very grave breaches of the
law. Still, they are numerous enough to show that in the
absence of constant supervision very grave abuses would
speedily spring up. Fortunately, the character of this re¬
port assures us that the inspectors are keenly vigilant, and, 1
moreover, are themselves interested in the work and ready
to receive and to suggest anything that will improve the
conditions of health and add to the security of life and limb
in our workshops and factorise.

THE MEDICAL SOCIETY OF LONDON.

Thb annual Oration (which we publish in another part
of our present issue) was delivered by Sir Wm. Mac Cormac [
at the commencement of the conversazione on Monday last,
Dr. Hughlings Jackson, F.R.S., President, in the chair.
Sir Joseph Fayrer proposed, and Mr. Croft seconded, the
vote of thanks to the orator for his interesting address on
Abdominal Surgery. The conversazione was, as usual, a great
success, the music being provided by the string band of the
Royal Artillery. Specimens of art pottery, by Messrs. Martin
Brothers; recent etchings and mezzotints, by Mr. R. Dun-
thome; photographs of landscapes, by Mr. Vernon Heath;
Japanese screens, by Mr. W. Anderson, F.R.C.8.; oil paint¬
ings and water-colour sketches, by Mr. G. E. Cook; book of
engravings after Rubens and Vandyck, by Mr. Walter Pye,
F.R.C.S.; the Remington Standard Type-writer, by Messrs.
Wyckoff, Seamans, and Benedict; together with some old
books, including the MS. of the Rev. John Ward, which
contains the only authentic account of the cause of Shakes¬
peare’s death, besides other objects of interest, were provided
for the delectation of the Fellows and their friends. We
may add that the entrance ball, staircase, and rooms were
lighted by the patent safety lamps of Messrs. Defries, which
bad been lent for the occasion.

PYORRHOEA ALVEOLARIS.

Mb. Nbwland Pkdlby, F.R.C.8., read a paper at the
Odontologioal Society upon the above subject. Pyorrhoea
alveolaris is characterised by conditions as follows:—The j
mucous membrane, especially that adjacent to the teeth, is i
deeply congested, tumid and thickened, and detached from i
the necks of the teeth and from the roots. A thick fetid j
discharge may often be pressed up between the teeth and |
mucous membrane, which gives to the breath a very re- ;
pulsive odour. Later, the alveoli become absorbed, and at
times more or less denuded, whilst the fangs of the teeth
become coated with a layer of thin, hard, green-brown tartan 1 .
Ultimately, the disease progressing, the teeth, one after,

I another, drop out. The pathological changes which take
place are hypertrophy of the muco-periosteal fold around
the teeth, accompanied by dilatation of capillary loops, en-
j largement of the papillae, and rapid proliferation of epithelial
i cells. Later the gum becomes firm and contracted, and dis¬
plays increase of fibrous tissue. The changes which go on
in the socket have not been yet satisfactorily worked out, but
the examination of the jaws of some carnivora which were
apparently affected with pyorrhoea alveolaris would lead to
the supposition that there is osteitis of the alveolar process
spreading towards the apex of the socket. There are many
differences of opinion as to the causes: some maintaining that
it is of parasitic origin and due to a specific bacillus, but there
is no good proof of this; others that it is catarrhal, and an
extension of inflammation of the mucous membrane; others
that it is due to the irritation of small deposits of hard
tartar under the edge of the gum, but this is plainly not the
case, for the disease may be far in advance of the deposit,
and in some cases there is not any to be found. It is probably
dne to some constitutional condition, and the fact that it is
often symmetrical, and frequently hereditary, gives support
to this view. It occurs in the mouths of patients whose
health has been undermined by debilitating influences and
inj udicious habits of living; it is a common sequel of malarial
fever in America; young persons recovering from eruptive
fevers are sometimes subjectsof pyorrhoea alveolaris; and fre¬
quent pregnancies are a fruitful source of the disorder. Atten¬
tion has been lately drawn to the shedding of the teeth in
tabes dorsalis, but it does not by any means seem to be a
constant symptom. Mr. Bland Sutton has found that pre¬
mature loss of the teeth is a very common feature in cases
of rheumatoid arthritis in animals, and has also met with
it in mollities ossium and other wasting diseases. Magitot,
who views the alveolar-dental periosteum as a ligament,
and not of the same nature as osseous periosteum, calls the
disease symptomatic alveolo-arthritis, and mentions espe¬
cially as causes chronic Bright’s disease and glycosuria, in
whioh latter, he says, the phenomenon is absolutely
constant. _

I •

i THE POPE ON ALCOHOLISM.

Leo XIII., even more than his predecessor Pius IX, has
made the social amelioration of the masses an object of
i Catholic concern, mobilising the forces of the Church and
i even calling on public hygiene to assist in the philanthropic
crusade. The ravages of intemperance, particularly in the
United States of America, have just evoked from him a
strenuous charge to the clergy in that part of the world to
' continue their efforts for the removal of the scourge, and to
! make their flocks an example of moderation and sobriety to
all outside the fold. In a Brief addressed the other day to
Monsignor John Ireland, Bishop of S. Paul, Minnesota, he
congratulates him on the success which has followed the
organising of the Catholic Union for the observance of total
abstinence ( Unto Catholica perfects abstiruntia tequenda),
and adds that too much praise cannot be given to those
pastors in the United States who in the late plenary council
at Baltimore have formulated a “plan of campaign” against
the abuse of alcohol, with its bequest of disease and misery
to generations yet unborn. He commends the Bishop and
hie clergy for themselves reinforcing their precept by per¬
sonal practice, and charges them zealously to save their
Church and their native land from the innumerable calami¬
ties with which both are menaced by the vice of alcoholic
excess (i it tot calamitates ex eo vitio Eeclesia ipriqtie patria
impendentes strenue avertere contendant). The Gatholic
Union, to whioh the Pope alludes, now numbers over one
hundred thousand members, while it is at the same time
gratifying to hear that the co-operation of the medical pro¬
fession in what is nothing lees than a great movement,
sanitary as well as social, is also noted with commendation

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'946 Thh Ranch*,] THE INFLUENCE OF TEA, COFFEE, AND COCOA ON DIGESTION.

' (.May 7. M87.

at the Vatican. The Church, whether Catholic or Protestant,
in a cause so humanitarian, may always count upon medicine
and its practitioners for loyal and effective support.

MEDICAL OFFICERS OF HEALTH.

The Sanitary' Authority of West Ham had last week
under consideration the question whether they should
appoint a medical officer of health who should devote the
whole of his time to the district, or whether they should
elect a medical man who had other means of adding to his
income. The Sanitary Committee had recommended that
the former course should be adopted; but the Town Council
sitting in committee had not approved this recommendation,
and the corporation have now by a small majority rejected
an amendment that an officer be appointed who should
give the whole of his time to his duties. This decision
is distinctly unfortunate. In a district of the size and
population of West Ham there is abundant material for
the work of one man, and in engaging a partial service the
corporation are by no means doing the best for their borough*
There is only one reason for satisfaction' to be found in this
decision. If the feeling of the corporation is to be judged
from the statements of its members, the inadequate re¬
muneration of £300 a year would be given to the officer,
Who would be expected to devote a special knowledge of
preventive medicine and the whole of his time to the
health duties of West Ham. It is needless to add that this
sum ought to be, and would be, insuflicient to procure for
the corporation the services of anyone fully competent to
perform this important duty. West Ham should have
leamt by its own experience the necessity for active sanitary
administration, and it is to be regretted that the corporation
should now be prepared to leave the borough without the
aid of an officer of the best professional standing.

THE INFLUENCE OF TEA, COFFEE, AND COCOA
ON DIGESTION.

Dr. James W. Fraskr, in .the recent number of the Journal
of Anatomy and l'hysioloyy, has recorded the results of an
interesting series of experiments on the action of our
common beverages on stomachic and intestinal digestion.
The experiments have been most carefully arranged from a
physical standpoint, and give us some valuable hints on the
digestion of the chief alimentary principles, but they have no
bearing, it should be mentioned, on individual variations of
human digestion, or on the influence of the various glands
in preparing the gastric or intestinal juices. They are,
however, of much value in showing how standard prepara¬
tions of the peptic and pancreatic ferments are modiGed in
action when our ordinary daily beverages are allowed their
free action on the digestion of various articles of food. The
digestive processes were carefully investigated, and absorp¬
tion was imitated by a proper dialysing arrangement. An
artificial peptic juice, and afterwards an artificial pancreatic
juice, were employed, and the amount of nitrogenous
matter dialysed was most carefully estimated. The food
stuffs experimented on were raw and cooked serum and egg
albumens, raw and cooked myosin, syntonin, alkali albumen,
casein, gluten, starch, and oleine. The results obtained from
an exhaustive series of experiments and analyses show that
all the three typical infused beverages—tea, coffee, and
cocoa—retard the digestion and absorption of all the nitro¬
gen ieed proximate principles of dietetic substances when
peptic and pancreatic digestion are taken together, and that
they uniformly retard peptic digestion, although tea may
assist the diffusion of. peptones from the stomach. I’ancreatic
digestion is also uniformly retarded, ami diffusion thereafter
is bat rarely assisted, so that neither of them compare

advantageously with water as a standard beverage far
experimental investigations* A summary of dietetic advb
is added to Dr. Fraser’s observations, which will, in tht
main, agree with that which is now given by our be®
authorities in cases of dyspepsia; and we are glad tint
experimental inquiries afford so strong a bams of rapport to
empirical clinical observations

“ 1. That it is better not to eat most albuminoid food
stuffs at the same time as infused beverages are taken, for
it has been shown that their digestion -will in most cases le
retarded, though there are possibly exceptions. Absorption
may be rendered more rapid, but there is a loss of nutritive
substance. On the other hand, the digestion of starchy food
appears to be assisted by tes and coffee; and gluten, the
albuminoid of Hour, has bean seen to be the principle least
retarded in digestion by tea, and it only comes third
with cocoa, while coffee has apparently a much greater
retarding action on it. From this it appears that bread
is the natural accompaniment of tea and cocoa when
used as the beverages at a meal. Terhaps the action
of coffee is the reason Why, in this country, it is usually
drunk alone or at breakfast, a meal which consists much of
meat, and of meats (eggs and salt meats) which are not much
retarded in digestion by coffee. 2. That eggs are the best
form of animal food to be taken along with infnsed beverages,
and that apparently they are best lightly boiled if tea, hard
boiled if coffee or cocoa, is the beverage. 3. That the casein
of the milk and cream taken with the beverages isprobahlv
absorbed in a large degree from the stomach. 4. That the
butter used with bread undergoes digestion more elowly in
presence of tea, but more quickly in presence of coSee ot
cocoa; that is, if the fats of butter are influenced in a similar
way to oleine. 5. That the use of coffee or cocoa as
excipients for cod-liver oil &e. appears not only to depend
on their pronounced tastes, but also on their action in assist'
ing the digestion of fate.” _

A JUBILEE SUGGESTION !

Mfi. T. W. Rhys Davids has written to the Academy to
suggest that the Jubilee of the C^ueeu and the Jubilee of
the University of London may best be celebrated by changing
the present title of the University to that of the “ Imperial
University,” because it is an '• Imperial Examining Board.
And yet we are supposed to believe that the Academy is
a serious and severely critical paper, and that its corre¬
spondents pre really in earnest, even when they make such
an audacious proposal as this must seem to the authorities
that be. Surely the writer must be intent on indirectly
advocating a Teaching University for London, although we
do not find his name among those who support the move¬
ment. . _

BURIAL DURING A TRANCE.

Thb reading public have lately been startled by the
shockaag details of a reported case of burial during a state
of trance.. The history of this occurrence—which relates
how a Russian officer was interred in his family vault forty
hours after his supposed death, and how his body was found
a fortnight later turned with the back upwards in h«
coffin, the lid 6f which had been partly forced open, with
face torn, and hands gnawed and still bleeding appears too
horrible to be true. Instances of living burial have at
various times been reported. The authenticity of some such
has been vouched for on good authority, though even these,
it may be, have not reached us without the spectral halo of
an oft-repeated horror; Some others, which, owe their
apparent credibility t<> the Signs of mnvementdue to cramp¬
like spasms occurring after death, may probably be dis¬
missed at once as fictitious. We would fain hope that the
most recent and appalling case, to which we have referre.
ia one of those to which excited popular imagination has
added,asit is wont to do, particulars as dreadful os unfounded

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Tim LAwoffi,]

VALUE OF THB HJ3M0BBHAGfi -IN' THETBEATM2LNT OFi WOUNDS. [Mat 7,1887i MT

It is certainly somewhat difficult to understand how a human
being could live for a fortnight, shrouded, and in the con¬
fined space of a coffin, without nourishment of any kind,
without fresh air, in a state of trance, and awake at the end
of that time possessed of sufficient strength to struggle
desperatoly and to lacerate himself as this unfortunate
officer is said to have done.' As a matter of fact, moreover,
it is hardly conceivable that the eye of a careful and educated
observer should mistake the true meaning of the collective
signs,of death or fail to note their absence in a case of
stupor, however death-like to the ordinary onlooker,
i • -

ON THE VALUE OF THE HEMORRHAGE IN THE
TREATMENT OF WOUNDS.

Professor Tu*razza, in the Gaszetta rkgli Onpitali of
April 13th publishes a note showing that haemorrhage from
wounds, when not She to the lesion of large vessels or
carried to excess, is of small importance and does not inter¬
fere with primary union. He believes that the rule gene¬
rally laid down regarding thd first dressing of a wound—
viz., to secure complete arrest of haemorrhage and to apply
firm compression—thqugh excellent*is not,important. Pro¬
fessor Turazza relies on perfect disinfection of the bleeding
surface, as far as within reach, by mefcns of weak solutions
Of phenrc acid or corrosive sublimate. He then leaves the
cavity of the wound full of blood, without any donbt as to
primary union, the edges of the wound being very accu¬
rately sutured. As the result of his experience he for¬
mulates a new rale in surgery—“ that in wounds perfectly
disinfected and frse from foreign substances the effusion of
blood is not a source of danger, bub the reverse, for the
extravasated: blood fills up the cavity of the wound per¬
fectly, preventing the formation of empty spaces and ren¬
dering both compression and drainage superfluous,' and,
further, the organisation of the clot favours healing/’ Pro¬
fessor Tnrazza also expresses himself decidedly averse to
the use of the drainage-tube, because it increases septic
risks; and may remove from the cavity into which it is
inserted fluids which in an aseptie condition may be useful
by reabsorption. He advises the restriction within the
narrowest limits of the drainage-tube, and would deprecate
its use in even ovariotomy, hysterectomy, and amputation
of the breast, thinking it more dangerous than useful.

THE INCOME OF DOCTORS.

Ocr contemporary the Graphic, aooepting the estimate of
Dr. Ururstao in our columns, that the average income of
medical men does not much exceed £300, or, including
house-surgeons, ship surgeons, and assistants, even £200,
recommends as a—if not the only—remedy, combination.
This remedy is one that medical men are not fond of. There
is something in the very-nature, and property of. the pro¬
fession which deters its members from combining to
decline help to those in need. But it may be tempted
to tty the ways of less sensitive classes. There is so much
shabbiness in the remuneration of medical services. In
many people, and in some classes of the community, there is
such a determination to treat medical services ungenerously
that it would do good to combine. It would lead to a more
wholesome estimate of the value of medical service and
advice. It would correct the vulgar impression that people
have a sort of natural claim on doctors at any hour of the
day or night. No doubt it would cause some surprise, not
to say scandal, if the whole profession were to unite to
dedlne to Answer'tile call of those who see no necessity to
pay doctors, but thjiik doctors bound to attend them. But
a : fifctle reflection on, the part' of r’easonible people would
*°9n tfrem toa^more correct judgment. The difficulty
is, as our contemporary says, in getting combination among

medical men. There is so little organisation and so much
competition that the patient who owes a medical bill to one
doctor is only too sure of being able to secure tho services
of another, and, when he fails to be reckoned with, of a
third medical man.

THE COMPULSORY ISOLATION OF INFECTIOUS
PATIENTS.

A cask has just arisen at Gosport which illustrates a
difficulty that has more than ouce occurred in the admini¬
stration of the clauses of the Public Health Act which deal
with tho spread of infectious diseases. Under Section 124
of that statute it is enacted that, where a sanitary authority
have provided an infectious hospital, they may, by order of
a justice who acts under a medical certificate, remove to
that hospital any person who is suffering from any danger¬
ous infectious disorder. But amongst the conditions neces¬
sary to the procuring of the order it mu9t be showa that
the person in question is “ without proper lodging and
accommodation”; and it is the precise meaning of this con¬
dition that gives rise to difficulty. On the one hand, it has
been contended that since the statute deals with public
rather than individual health, and since the intention of
the section in question is clearly indicated by the heading
“Provisions against infection,” under which it is plaoed,
the quality of the accommodation referred to has to do
not so much with the welfare of the patient as with
the risk of danger to others. But, on the other hand,
ie is held that since the section'admits of the com*
pulsory removal, quite apart from the question as to the
quality of the accommodation in bo far as this may affect
others, in cases where the patient is in a room occupied
.by more than one family, or is on board any ship or vessel,
the reference to proper lodging and accommodation had to
do with the welfare of the patient, and not of the public,
apart from the two exceptional conditions specified. The
latter has generally been the customary ruling of magis¬
trates, and it was so in the case which has just arisen. A
young woman, who was a tailoress and who lived with her
mother, was found to be suffering from small-pox at Gosport,
and in the bouse were twelve pairs of trousers she had made
for the Marines. The danger to others was obvious, both
owing to the locality and circumstances under which the
patient was- placed and owing to the special nature of
her calling. But the magistrates, ascertaining that the
quality of the accommodation, especially as to cubic
space, which was available for the sick woman in
her own house was sufficient for her own prbper
treatment, decided that they had no power to order her
compulsory Isolation in the hospital tents provided by the
sanitary authority. This case indicates the legal aspect of
this compulsory removal clause; and, as far as we are
aware, there has been no appeal against the position which
the magistrates have taken up, either on this or on other
similar occasions. Fortunately, the isolation of the infectious
sick is but rarely dependent on the exercise of compulsory
powers. Where a really proper hospital, of a reasonable
attractive character and with good administration, is pro¬
vided, hundreds of persons are every year only too willing
to avail themselves of the advantages thus afforded to them.

THE MORTON LECTURES ON CANCER AND
OANCEROU8 DISEASES.

Sir James Pagkt, at the unanimous request of the
Council of the Royal College of Surgeons, has consented to
give the first lecture on Cancer and Cancerous Diseases atT'A
date to be announced later (in all probability towards ttib
close of the year). The lecture will be the first given! Oh
the above subject in compliance with Mr. Morton’s dohatidfl.

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943 Th* Lancet,]

THE SANITARY CONDITION OP CLERKENWELL.

[Mat 7.1887.

THE UNIVERSITY OF LONDON.

PARALYSIS OF THE SENSE OF TA8TE.

The annual meeting of Convocation of the University of
London will take place on the 10th inst., when the report of
the Annual Committee will be presented. Although the
scheme for the reconstitution of the University proposed by
the Special Committee of the Senate has been circulated as
an appendix to the report of the Annual Committee, there is
no resolution on the agenda in reference to it. It remains
to be seen whether the subject will be discussed at this
meeting. Probably some notice may be taken of the matter
on the motion to receive the report; but there is no doubt
that Convocation will have to be specially convened to con¬
sider so important a question. The chief resolutions on the
agenda relate to the initiation of local examinations by the
University. The election of graduates to 6erve on the Annual
Committee will take place at this meeting.

THE SANITARY CONDITION OF CLERKENWELL.

At a meeting of the Clerkenwell vestry last week orders
were given for the removal of twenty-live Greek gipsies
who had gained admission into a small house in the parish,
which the medical officer of health stated had long since
been condemned as unfit for human habitation. It may well
be asked how such a house, which we presume has been
reported under Torrens’ Act, has for a long time remained
in this condition. The vestry have ample powers to cause
the demolition or repair of such premises, and the neglect to
utilise them is a distinct reflection upon their sanitary ad¬
ministration. A member of the vestry present at the meet¬
ing drewattention to the generally bad condition of the courts
of the parish, as being small, ill-lighted, and ill-ventilated,
whilst the houses were dilapidated, with inefficient water and
other sanitary appliances; he stated that he thought all the
courts should be abolished. The medical officer added that
there were twenty-six courts that should be condemned, while
another vestryman expressed the opinion that all the courts
of the parish were a disgrace. The Mansion House Council
would be doing good service if they were to ascertain the
dates at which these courts have been reported by the
medical officer, and the steps which have been taken since.
It is now nearly two years since this parish was the subject
of inquiry by a commissioner appointed by the Home
Becretary, and it would be interesting to know if his report
contains the information which is wanted, and which would
be useful to those who desire to see the sanitary condition
of London improved. _

DEATHS OF EMINENT FOREIGN MEOICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announcedDr. W. Hack, Professor of Laryngo¬
logy and Dermatology in the University of Freiburg in
Baden, was last week found dead, apparently from heart
disease, upon his tricycle, which was standing still in the
middle of the road near Staufen in the Untermunsterthal.—
Dr. Max Geminger, Conservator of the Munich Zoological
Museum, and a well-known entomologist.—Dr. Joseph
Lercb, Extraordinary Professor of Zoology and Director of
the Zoo-chemical Institute in the German University of
Prague.—Dr. Vladimir T. Hbrschelmann, Privy Councillor, and
late holder of a high position in the St. Petersburg district,
Military Medical Staff. At the time of the Crimean war he
was senior surgeon of the Preobrashenski Regiment.—Dr.
Edward Meyer, who is described a9 the Nestor of Livonian
practitioner#, being at the time of his death eighty-two
years of age, and having taken the M.D. degree at Dorpat
in 1827.—Dr. Hellinger, one of the oldest and most resp ited
medical officials in the Rhine provinces.

Many observations point to the conclusion that uy
function of the living body may be annulled by the action
of some specific agent. The selective action of drugs is one
scientific reason for their employment in the rational and
the empiric treatment of disease. Some arguments could be
found to sustain the hypothesis that the treatment o!
symptoms is a real way of treating the disease, that sup¬
pression of all symptoms by the employment of vaiiow
agents would be equivalent to the suppression of the causes
of the disease. Doubtless this might hold good in some cases,
but probably not in all, and the present state of knowledge
gives us no warrant for asserting anything absolute on the
matter. It is known that the leaf of Gymnema sylvestre,
an asclepiad, has the property of abolishing the function of
tasting bitter and sweet things, of paralysing certain fibre
or nerve endings of the gustatory nerves; for there is much
evidence leading to the belief that there exist different seta
of fibres subserving the various sensory functions, not only
in the sphere of taste, but in the department of any other
general or special sense. _

POISONOUS BISCUITS.

Two children were recently successfully treated at the
Melbourne Hospital for symptoms of poisoning, and from
inquiries which were made it was supposed that th eir illne*
arose through eatiBg some biscuits, the colouring matter of
which was of a poisonous character. Similar biscuits to
those which the children had eaten were obtained and for¬
warded to the Government analyst for report. The analysis
showed that the green colouring matter on t’ae biscuits sub¬
mitted for examination was arseniate of copper. By the
direction of the President of the Cantral Board of Health,
the police in the various suburbs visited wit hout delay the
various establishments where biscuits are sold, and seized
aU tins containing any biscuits with green colouring matter
on them. In all, over eighty tins were confiscated, and by
the praiseworthy promptitude of the authorities a fertile
source of danger to the infant population of the colony h«»
been removed. _

MEDICATED WINES.

We think the Board of Inland revenue are right to place
some restriction on the sale of medicated wines. Many of
these preparations consist of ordinary foreign wine, often
Marsala or sherry, to which some med icin&l substance has
been added. It is to be feared that in some cases they have
been used in undue quantities for the sake of their alcohol,
while in others the consumers have not known that they
were drinking strong wine. In future a wine licence will
be required by every person who sells them.

THE TREATMENT OF MOR PHINOMANIA.

We have recently received two publications on the treat¬
ment of this important and increasingly prevalent com¬
plaint. The first, by Dr. Oscar Jennings of Paris, is “~ ur _
un Nouveau Mode du Traitement de la Morpbinomanis,
and is illustrated by nearly thirty sphygmographic tracing-’'
The other and smaller work, covering much the
ground, is entitled “ Considerations sur la Traitement de l»
Morphinom&nia,” and has beea prepared by Dr. Jennings to
conjunction with Professor Benjamin Ball, the well-kno"fl
alienist. The drugs chiefly relied on for the cure of tbe fe
patients are nitro-glycerine and sulphate of sparteine. Tj 1 '
former is given in tabloids or as a 1 per cent, alcohols
eolation, whilst the latter is administered hypodermic^
usually in doses of from two to four centigrammes. 8p»^
teine has hitherto been but little used in medicine, bat 1
action on the cardiac inhibitory ganglia is so marked tfi»

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MR. W. NORTH. OUST MALARIAL FBVHB8.

[Mat 7,1887. 949

it-seems not improbable that it has a brilliant future before
it. The effects on the pulse are admirably illustrated by the
aphygmographic tracings, and the success attending the
new method of treatment is especially gratifying..

TEA AMBLYOPIA.

Wk read in a contemporary that M. Molchanoff, a Russian,
who is reputed to be the wealthiest tea merchant in the
world, has arrived at Paris from Hankoy with the intention
of plaining himself under the treatment of Dr. Charcot and
on experienced •'French ophthalmic surgeon. The great tea
magnate Is suffering from amblyopia, which, it is said, is
the result of the prolonged practice of tea-tasting. It is not
unlikely that tea taken in excess might produce amblyopia
similar in character to those toxio amauroses which result
from the abuse of alcohol, tobacco, opium, and quinine; but
we are not aware that this form of amblyopia has been par¬
ticularly described. Wecker does not mention it in the last
volume of his large work just completed, and it is not men¬
tioned in-the Real Encyolopedie, nor in the Grftfe S&tnisoh
Handbuch. Tea is hardly indulged in in this country to a
sufficient extent to produce any marked effects upon the
nervous system, but it is undoubtedly a sedative and acts
powerfully upon the heart._

THE HEALTH OF THE HOME SECRETARY.

Wk learn that the absence from the House of the Right
Hon. H. Matthews has been caused by his suffering from
slight ulceration of the cornea of one eye, which necessitates
some temporary rest, but involves no serious consequences.
He'ie under the care of Mr. Brudenell Carter.

FOREIGN UNIVERSITY INTELLIGENCE.

Brussel*. — The students have presented M. Ernest
Rousseau, the pro-Rector, with his bust.

Cracow. —Dr. Anton Rosner, Extraordinary Professor, has
been elevated te the position of Ordinary Professor of
Dermatology and Syphilis.

Giessen .—Professor Schwarz is expected to succeed Pro¬
fessor Kaltenbach, who has gone to Halle.

Konigsberg. —Dr. A. Yossius has been appointed Extra¬
ordinary Professor.

Munich .—Professor Gietl is resigning his hospital appoint¬
ment, after fifty years of service.

Trieste .—The local legislative body has commenced to
take steps for the establishment of a university in which
Italian will be the language in which instruction is to be
given. _

Ths efforts which are being made by the authorities with
the view of stamping out rabies among the deer in Rich¬
mond Park have not produced the results which were
anticipated. On the 4th inst., the official veterinary in¬
spector reported at the Richmond Petty Sessions the
slaughter of six more animals since the last sitting of the
bench. Of 1500 deer in the Park over 130 have now been
killed, and it iB expected that many more will have to be
slaughtered before the epidemic comes to an end.

Mr. J. S. Morgan has withdrawn the condition attached
to his promise of £10,000 in aid of the funds of Guy’s .Hos¬
pital, and has made it an absolute gift. The fund now
amounts to £72,000. _

A VrRNNA firm has received a telegram from Buenos
Ayres, stating that cholera has broken, out afresh there.
Tkore have been, it is reported, twelve cases in Tucuman, in
the interior, and several in the city of Buenos Ayres itself.

Wk understand that Messrs. Henderson Bros., managing
owners of the Anchor Line, of steamships from Glasgow to
New York, have decided to offer to members of the medioal
profession desirous of attending the International Medical
Congress to assemble at Washington in September next
return tickets to New York for £20, giving the best accom¬
modation at this low rate._

Mr. C. R. Thompson of Westerham, Kent, was thrown out
of his carriage on the 26th ult„ and sustained such injuries
that he died on the 28th, never having recovered oonsoionn-
ness. At an inquest held on the 30th the jury- returned a
verdict to the effect that death was due to a fracture of the
base of tile skull and concussion of the brain.

Wk regret to record the death at Chenawan, in the Piuk-
Jaub, of Dr. G. J. Shand, of the Indian Medioal Service. The
deceased entered the service in 1881, find at the time of hte
death, which occurred on the 1st ult. from typhus fever,
held the appointment of superintendent of the Chenawan
Central Gaol. _

Professor Victor Horhlrt, F.R.S., will read a paper
“On the Operation of Trephining during the Neolithic
Period in Europe, and on the probable method and object
of its performance,” at the Anthropological Institute,
3, Hauover-square, on Tuesday, May 10th, at 8.30 p.m.

Mr. H. R. BARRAtm of Oxford-street has submitted to
us an excellent cabinet photograph of the late Dr. Alfred
Meadows. _

Dr. Hughlings Jackson has received the honorary degree
of LLJ). Glasgow.

ABSTRACT OF

LECTURES ON UAJJJEAL FEVERS.}

Br W. NORTH, B.A., F.C.S.,

LATE EKSJCABCH SCHOLAB Of TBS OBOCBUS' CO^IPAXT. ,

LECTURE II.

LOCAL CONDITIONS AFFECTING THBIR DISTRIBUTION A 8
STUDIED IN THE "PROVINCE OF ROME.

In the previous lecture the general relations of malaria .to
latitude, altitude, water, and climate have been shown to
hold good for a continent, for an individual country, and fdr
a province of that country. It remains to show how far
they hold good for much smaller areas. This involves
consideration in detail of localities, and with regard to each
the following points demand especial attention:—1. Local
conformation of the Boil. 2. Constitution of the soil. 3. Water.
4. Altitude. 5. Cultivation. 6. Population. 7. Drinking-
water. 8. Meteorology.

Local conformation of the soil .—The peculiar nature of the
Roman Campagna, and the fact that it is by no means a
plain in the generally accepted sense of the word, may be
illustrated by the following examples. The neighbourhood
of the Isola Farnese is exceedingly broken up by streams
running in valleys with almost precipitous walls, often fifty
metres and more in height. Of more undulating country,
but still very broken, the neighbourhood of Tre Fontane, to
the south of Rome, affords a good example. Here there are
valleys whose bottoms are not more than from 12 to 16
metres, and whose sides may rise to 60 or even 60 metres
above sea level. The streams which flow through these
valleys are, for reasons to be considered later, liable to fre¬
quent flood, and deposit an enormous amount of mud and
tilt. Of true plain, the valley of the Tiber, the Pontine

1 Delivered at the London Iajtltutloa, April 25th, 1887.

Digitized by

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950 The Lancet,]

PHARMACOLOGY AND THERAPEUTICS.

[May 7,18CT.

region, and the low land on the coast line may be cited as
the best examples.

Constitution of the soil .—It has been shown repeatedly
that geology has little to do with malaria, except in so far
as it affects the physical nature of the soil. The fact that
the greater part of the Roman Campagna is volcanic is of
material importance to the subject, inasmuch as it has a
great influence on the distribution of the water underlying
the surface soil. There is frequently an almost impervious
layer of lithoid tufa, full of eaucer-like depressions, which
hold water and render the soil with which they are filled
and hidden wet and boggy. In some cases these depressions
are crater-like and of large size, having once been, to all
appearance, volcanic lakes. These larger depressions are
found chiefly round the base of the extinct volcanoes of
Albano and Cracciano. The best example, perhaps, is that of
the Val d’Ariccia, below Albano, which is nearly a mile
across, exceedingly fertile, and very unhealthy. After heavy
rain the whole valley becomes a bog, there being apparently
no adequate means of escape for the water. This valley is
known to have been a lake, and to have been drained in
order that the alluvium which almost filled it might be
cultivated. The volcanic soil holds water like a sponge, and
only when it is saturated does the water issue from the
hill-sides as springs, and then chiefly because it has met a
layer of hard tufa which stops its downward course.
Good examples of this are to be seen near Tre Fontane.
Some idea of the water-holding capacity of this volcanic
soil may be gathered from the following facts. In 1876 the
water in the torrents in the district of Velletri began to
show an increase about Oct. 20th. The total amount of water
which had fallen over the drainage area since the first rains
of September was equal to a depth of 25 centimetres, and
represented a total of 31,000,000 cubic metres of water. In
1877 the flow did not begin till even later—viz., in the first
fortnight of November, after a rainfall of 17 centimetres or
a total volume of 23,000,000 cubic metres of water. The
Travertine area below Tivoli is very interesting as an
example of an exceedingly malarious district covered to a
varying depth with a calcareous stone excellent for building
purposes, and on the top of which the soil is often so thin
as to render cultivation impossible.

Altitude. —The general fact that malaria diminishes and
finally disappears as we ascend is undisputed. The remark¬
able fact about it is that a very small elevation above a
malarious soil affords a very efficient protection to the
inhabitants. The practice in such oountnes of building the
houses on poles, on the tops of tombs, and similar places,
is evidence of this; but it would also appear that there is an
undoubted difference, as far as the risk of acquiring the
disease is concerned, between a house at the bottom or one
of the valleys already described and one built on the top of
the hills which bound them--a difference in altitude often
not more than thirty metres. The neighbourhood of the
Basilica of San Paolo fuori le mura, to the south of Rome,
affords a very curious example of this.

Cultivation .—The ancient cultivation and the present
state of the Roman Campagna have been already discussed.
The relation of malaria to trees is of great interest, though
but little understood. The case of Cisterna will serve as an
illustration. In 1714 it was proposed to cut down a large
area of macchia which lay between the town of Cisterna
and the Pontine marshes. Lancisi, the Papal sanitary ad¬
viser at the time, resisted it, and successfully, on the ground
that these trees opposed a barrier or filter to the malarial
emanations from the Pontine region, this idea constituting
what is known as the prejudiziopalastre. Cisterna at the time
was very unhealthy, and had a rapidly diminishing popula¬
tion. About a hundred years later these woods were cut down,
and since that time the health of the place has improved
and the population almost trebled. The attempts made at
Tre Fontane to improve the locality by planting eucalypti
hardly admit of discussion. The plantations are too young
and too small to enable any decided opinion to be formed ;
still, there is considerable evidence that good has been done.
It may be seated generally that the effect of plantations
well kept and of suitable trees is to drain the soil and dis¬
tribute the water, whilst the macchia before mentioned near
Cisterna, consisting of stunted brushwood, undrained and
boggy, was rather a means of collecting stagnant water near
the town, and its removal exposed the soil to the light and
air, and so without artificial drainage what was practically
a hog was got rid of.

Population .—The condition of the moving population of

the Roman Campagna is a very serious question. They ire
ill fed, ill clothed, and worse housed, and generally in
jilaced in circumstances which render successful resistance
to the violence of the climate almost an impossibility.
Density of population undoubtedly drives away malaria,
and we need go no further than Rome itself for a conclusive
example. Since the entry of the Italians in 1870 the city
has extended enormously, and parts which at that time
were something more than unhealthy are now built over ind
fast becoming the fashionable quarter. The areas within the
walls, particularly on the south, near the Porta San Sebis-
tiano, which are still unbuilt on, have a very evil reputation.

Drinking-water— la the malarial infection capable of
being earned by water ? This is a question which is natu¬
rally of the very first importance. The evidence, such as it
is, would seem to point to an emphatic negative as tbs
answer. The healthiest parts of the city of Rome are sup¬
plied with water admittedly the best in the world, and
which rises—to take the Acqua di Trevi or Acqua Yergine
as an example—on unenclosed land in springs, which
bubble up and cover the surface in a locality so un¬
healthy tnat to pass several nights there in August might
involve risk to life, and certainly to health. Tnere seems
to be but little doubt that a supply of good drinking-
water is of importance in malarious localities, but it hu
yet to be shown that in exchanging pond and ditch
water for that of springs the inhabitants cease to takes
poison into their bodies. The evidence rather points to the
tact that by so doing they raise their general health and so
become less liable to the disease. At all events, proof ths
the malarial infection can be conveyed by water is wanting,
though very largely credited by the natives of countries
where the disease prevails.

Meteorology will oe considered in the next lecture in con¬
nexion with the circumstances under which the disease n
acquired.

It may be concluded from the above facts, and numberles
similar ones which might be quoted did space permit, that
the malarial infection is neither wind nor water borne, that
it is extraordinarily local and dependent upon local con¬
ditions for its intensity to an extent not readily believed,
and that the conditions which appear to favour its develop¬
ment are precisely those which affect looal climate.

|)jrannatoIop anb

METHYLAL.

Methylal, which was last year investigated from a
physiological and therapeutical point of view by Personili
(see The Lancet, Nov. 6th, 1886), has since been expen-
mented upon by Nicot, and more recently by two Russian
physicians—Professor V. K. Anrep and Dr. M. Motrokhin.
The results obtained by the latter of these observers ire
described in a “ preliminary communication ” in the Yrtv l
In frogs hypodermic injections of from 0’2 per cent, to
0’3 per cent, of the auimal's weight produced mors or !e«
profound anaesthesia, which, however, quickly passed away.
The lethal dose for frogs was found to be 0‘8 gramme. Reflexes
were weakened, and with large doses temporarily abolished.
Thus, after giving a frog 03 gramme of methylal, irritation
of the central end of tne sciatic nerve during the period
of complete narcosis produced no effect, but when the
animal was aroused some reflex activity returned. Irritation
of the peripheral extremity of the nerve showed that the
drug had produced no effect upon its reflex action. Warm¬
blooded animals are more susceptible to the effects o-
metbylal than frogs, a quantity equal to 0-25 per cent of &
rabbit’s weight throwing it into a deep sleep lasting from one
to two hours ; with larger doses, loss of coordination in the
movements was first observed, then the animal fell on
side, and remained in a state of narcosis for from thre0 .^
four hours, after which it quickly recovered. The
dose was 0‘45 or 05 per cent, of the animal’s weight. The
irritability of the cortex of the cerebral hemispheres
lowered both by hypodermic injections and by the inb&la-
tion of the vapour. Convulsions due to strychnine sn
picrotoxine in animals subjected to the action of a modersw
dose of methylal were diminished in violence, but when
the strychnine or picrotoxine was given in lethal dof*
death was actually accelerated by methylal. Methyls*

Digitized by GoOgle

Thu Lancet,]

THE ROYAL ACADEMY OF ARTS.

[May 7,1887. 951

on be employed in the form of vapour for inhalation,
r as a liquid for internal administration. When given
ypodermically in an aqueous solution of the strength of
in 3, it is very painful, and the skin is apt to slough near
he puncture. Dr. Motrokhin does not think methylal is
ikely to be of use in poisoning by strychnine and picro-
oxine, except when only small quantities of these poisons
ave been introduced into the system. Regarding inhalations,
wo ounces may be inhaled, and only produce in addition to
.naesthesia slight headache and dizziness. No experiments
eetn to have been made with a view to ascertaining the
'alue of methylal as a surgical anoesthetic, but it does not
eem to affect the heart’s action perceptibly. Prof. Anrep
loticed especially that the anaesthesia was more marked on
be upper part or the body.

FLUID BXTBACT OF VEBATBUH YIBIDE.

Dr. N. Chistovich, chief of Professor Botkin’s clinic in
3t. Petersburg, has just published an elaborate research on
;he physiological and therapeutical properties of the fluid
extract of veratrum viride root. He found that in warm¬
blooded animals the cardiac contractions were at first dis¬
tinctly diminished, but subsequently they were accelerated,
the primary slowing of the pulse depending chiefly on the
action of the drug on the centres of the vagus, causing an
increase in the irritability of its peripheral extremities. The
action on the inhibitory cardiac apparatus was manifested
when the accelerator nerves and the sympathetica of the
vagi were divided. The secondary acceleration of the
pulse was due to a paralysing effect on the central
and peripheral cardiac inhibitory apparatus, as well as
to a stimulating action on the central and peripheral
accelerator apparatus, this stimulation being partly ac¬
counted for by the direct action of the drug and
partly by the rise of arterial pressure, which was itself
due both to the increased force of the cardiac beats and to
contraction of the small arteries. The number of clinical
observations was much smaller than those conducted in the
laboratory. The doses given were usually from ten to
twenty drops of the 1 per cent, liquid extract. The cases
which were found to be benefited by this treatment were
those of cardiac disease when compensatory hypertrophy
had not been established. In these there was almost imme¬
diate improvement in the dyspnoea and anasarca, the secre¬
tion of urine augmenting considerably and the patients
feeling a great deal better. In two cases where the cardiac
disease was complicated by nephritis and in one where there
was pleurisy with effusion the veratrum did not seem to

P roduce any satisfactory improvement, but it was only tried
or a very short time, and no attempt was made to increase
the doses.

SULPHATE OF SPABTBINB.

M. Masius of Brussels, having been engaged in investi¬
gating the physiological effects of sulphate of sparteine, has
come to the following conclusions:—1. In small doses it
does not modify the carotid pulsations in dogs. 2. In
moderate doses it diminishes the irritability of the pneumo-
gastric, accelerates the pulsations, which decrease in
amplitude, and at the same time suppresses the periodical
respiratory variations. 3. In poisonous doses it induces
paralysis of the pneumogastric, also asphyxia, and, as a con¬
sequence of asphyxia, a change in the pulsations, which
become larger and less rapid, and then quickly smaller and
smaller, till they take on the characters of “ alternate pulse,”
and finally cease. 4. The blood pressure decreases only a
short time before death. 5. It exerts in the healthy subject
no effect on the urinary secretion. 0. In disease its effect
on the heart is uncertain, as well as its effects on the urinary
function and on the subjective condition of the patient.

COHHON SALT IN MIGBAINE.

Dr. R&bow, of Berlin, finds that half a teaspoonful or more
of common salt, taken as soon as the premonitory symptoms
of an attack of migraine begin to show themselves, will fre¬
quently cut it short in about half an hoar; similar treat¬
ment has also proved of service in epilepsy, as was remarked
some years ago by Nothnagel: the explanation being pro¬
bably in both cases that a violent reflex action is set up.

On the 9th ingt. an afternoon concert, conducted
«y Mr. Henry Leslie, will take place at Grosvenor House,
i of the Duke of Westminster, in aid of

the lands of the Hospital for Women, Soho-square.

THE ROYAL ACADEMY OF ARTS.

It is significant of the wealth of artistic talent in this
oountry that, although the present exhibition contains
no works by such masters of the craft as Watts, Vicafe
Cole, Burne Jones, Calderon, Poynter, G. Richmond, and
Woolner, it is nevertheless one of extraordinary merit and
interest. It would seem as though the financial depression,
which is naturally felt most keenly by the sensitive pro¬
fession of Art—a profession which is an appendage of the
luxuries, not the necessities, of life,—has incidentally served
to stimulate the energies of the painters to exertion, which
were not displayed, because possibly they were unnecessary,
in the piping days of commercial prosperity which pre¬
vailed some fifteen to ten years since. Notwithstanding
that we have passed through—if we have passed it—a winter
of exceptional cheerlessness and want of light, the keen
competition which the present position of Ait in England
renders necessary has served to produce an exhibition
abounding in works of merit. Our readers will find no small
recreation in a visit to this, the most popular of all the
exhibitions of the metropolis.

From a purely medical and professional standpoint, we
have not so much to point out as in many former years.
There are perhaps fewer than usual great notabilities of
our ranks who are immortalised on canvas or in marble, and
incidents of the works calling for criticism from the
anatomical or physiological side do not appear to be
numerous. We may, by the way, remark that there ia a
picture of extraordinary power by 8. J. Solomon called
“ Nature,” No. 603, Gallery No. 7., that should not on any
account be missed. It ia a huge canvas, and the story of
the hero when dispossessed of his locks by the crafty
Delilah falling a victim to the bonds of the Philistines is
admirably told—so admirably, that it may appear captious
to point out that the Philistine in front, whose leg is half-
flexed upon the thigh, would not in this position have the
vasti muscles (the extensors of the leg) standing out pro¬
minent and rigidly contracted. It is not so very uncommon
to find that painters who have studied the muscular system
have failed to seize a correct idea of the conditions under
which the muscles are contracted or relaxed, and, in their
anxiety to give as much anatomy as they can, portray a
contraction where it should not be found.

Amongst the portraits of medical interest is that of Dr.
Walter Fergus, by Wirgman, and Sir Rutherford Alcock,
K.C.B., by Arthur J. Foster. This latter, although placed
too high to be perfectly examined, is conspicuous by its
truth and power; it is an admirable likeness, and we would
especially note the dexterity and, at the same time, the C6n-
scientiousness of the painter in hie treatment of the sitter’s
hands. A landscape by the same painter hung on the line
in Gallery No. 8, called “ A Harbour at Low Tide,” is as
admirable bit of seaside painting, and a proof of the artist’s
versatility. Mr. Luke Fildes strikes new ground in two
portraits of great power; and Mr. Sargent's portrait of Mrs.
William Playfair will interest especially those possessed of
artistic sensibility. In Gtfllery No. 4 Surgeon - General
Maclean looks down upon us with his well-known amiable
physiognomy; and in Gallery No. 6 we find Dr. Edward
Waters immortalised by Frank Holl. In the lecture-room
there are good busts of Sir Henry Adand, by J. E. Boehn*
and of Dr. Cholmeley, by C. B. Birch.

THE qhosvbnob qalleby.

The GToevenor Gallery has been open for eleven yean,
and has suffered no falling off and no important defec¬
tions. The President of the Royal Academy does not often
contribute, and this year admirers of Mr. Alma Tadema
must content themselves here with works by his wife
and his daughter. Mr. Whistler has found a home of his
own at. the “British Artiste,” but most of those who have
made the reputation of the Gallery are faithful to Sir
Coutts Lindsay, to whom newer men also are not wanting.
Portraiture and landscape are undoubtedly the strong
points of English art at the present time, but it is on idem
work that the Grosvenor Gallery especially relies. This year
Mr. Watts sends a “ Judgment of Paris,” a vision of the three
goddesses bathed in a glory of light, which he has never
surpassed. Perseus shows to Andromeda the reflection of
the head of Medusa in Mr. Burne Jones’s chief-picture, the

952 The Lancet]

REPORTS OP MEDICAL OFFICERS OF HEALTH.

[May 7.1887.

other being a landscape with three figures—the garden of
Pan. Both are medievally conceived and treated, but in
landecape this is surely a retrogression, while the mystical
truth of the old Greek legend is finely presented, with
delicate colour and consummate drawing. Mr. W. Rich¬
mond’s Fiammetta is a beautiful ideal study of a girl,
much influenced by Leonardo and the Lombard School.
Mr. Hacker, however, has produced the picture which will
probably draw most attention, as t he striking work of a rising
artist—“Pkilammon watching Pelagia asleep in the Desert,”
from C. Kingsley’s “Hypatia,” a book which furnished
Mr. Mitchell with the subject for a painting which made a
sensation here two years ago. The large work by the
last-named painter in the east gallery, of the “ Resurrection
of a Saint at the Crucifixion,” shows a great falling off, except
in the fine figure of the mother. In landscape the exhibi¬
tion is not very strong, but we mu6t mention the “Loch
Awe” of Mr. Keeley Ualswelle, the works of Mr. Alfred
Parsons and Mr. J. W. North, the sea of Mr. Henry Moore, and
the sea genre pieces of Messrs. Bartlett and Napier Henry.
But in portraits there is full cooqieneation. Mr. Frank
Holl sends three, notably one of Lord Harlech ; Mr. Ilerkomer
also three, of which that of the late Professor Fawcett is
the best; Sir John Millais two, one of his daughter, the
other of Lord Esher, Master of the Rolls, in his robes, the
latter being especially warm and harmonious. Mr. Bume
Jones’s finest work is the portrait of a lady in blue, seated
with her back to a convex mirror, in which the influence of
the late D. G. Rossetti is very strong; the subdued power
and beautiful execution of this picture will appeal to many
to whom the painter’s allegories are unintelligible. Mr. W.
B. Richmond contributes four portraits of both sexes and
various ages, in his refined eclectic style and rich colour.
Of less known artists, we would draw attention to Mr. W.
Carter’s picture of Mrs. C. A. Fyffe.

WATER COLOURS.

The Royal Institute of Painters in Water Colours has
filled its rooms with pictures to the ceiling, but has not
made a very interesting exhibition in consequence. Several
leading members send no contributions, but the best work
belongs, nevertheless, to old members, who do not depart
from their established lines. There is plenty of work of a
high quality, though nothing of exceptional originality or
importance. The third room is perhaps rendered the most
striking by Mr. Langley’s “Betrayed,” and “The Miser’s
Death,” by Mr. Joseph Nash. .

THE ART JOKE.

- Mr. Harry Furniss, the versatile and amusing artist so
well known in the pages of Punch, has opened a “ Royal
Academy” of his own at the Gainsborough Gallery, 25, Old
Bond-street. This consists of a room full of large mono¬
chrome drawings, burlesquing the mannerisms of the
leading artists and tie artistic fashions of the day, not
without some cuts at the Academy itself, and popularity-
hunting and “ pot-boiling.” We have no space to mention
snore than the severely close rendering of “Cinderella,” and
the humour of the ** Modern Lady Godiva,” which disposes of
the question of the prude and the nude. Altogether the
exhibition must delight everyone who knows the originals,
end can do no harm even to its victims.

Sanitary Registration of Buildings. —On the
2nd inst. the second meeting of the Conference convened by
the Council of the Sanitary Assurance Association was held for
the purpose of considering the details of the Sanitary Regis¬
tration of Buildings Bill (down for second reading on the
22nd prox.), the principle having been assented to at the
first sitting. Sir Joseph Fayrer, M.D., presided. The bodies
•represented, besides the Sanitary Assurance Association,
■were the Royal Institute of British Architects, Public
Health Medical Society, London Sanitary Protection Asso-
•ciation of Municipal and Sanitary Engineers and Surveyors,
and Royal Institute of Architects of Ireland. The exclusion
k»f places of less than 2000 population from the Bill was
'amended by the insertion of a declaration that the Act
should next year apply throughout the United Kingdom. A
proposal to make the measure compulsory on all buildings
was rejected. The further consideration of the matter was
'deferred for a fortnight.

IpuMic |]raltfr aitb ^oor f ak

LOCAL GOVERNMENT DEPARTMENT.

reports of medical officers of health.

Kendal Urban District. —Mr. Charles E. Paget records tfe
death-rate of this borough during 1886 as 16 - 5 per 1006--
namely, 24 less than the mean for the quinquennion
1881-85, and it is held that this satisfactory result has bean
greatly brought about by the influence of the borough ami-
toriiim in controlling the spread of infectious diseases. la
1884 the authority saw the advisability of erecting a second
ward-pavilion, and on two occasions during the present year
the Coexistence of two separate diseases needing hospital
isolation has shown the wisdom of this course. Interesting
details are given as to several branches of the saniteiy
work carried out; and it is noted that the defective sewn
ventilation which, associated with a curious combination ol
meteorological circumstances, led to an outbreak of enteric
fever in the early part of 1884, has been largely remedied,
some sixty to seventy new ventilators having been put in.
But Mr. Paget gives cautionary advice as to the need for
constant watchfulness for evidences of such over-pressure of
sewer air as calls for legitimate relief through ventilakn
in all extensions of borough sewers.

Hanley Urban District.— The mortality of infants under
one year of age has for the past four years averaged some
19'9 per cent, of the births registered. In 1886 it was it
that rate, whereas the corresponding rate for the twenty-
eight large English towns did not exceed 16D per emit.
Neglect of infants by exposing them to cold, improper
feeding, and the use of narcotics and other deleterious drugs
are, in the opinion of Dr. S. Walker, responsible for tins
needless waste of infant life—a waste which is unfortunately
on the increase. In some towns Ladies’ Associations have -
as, for example, by the aid of the tracts issued by the
National Health Society- succeeded in educating their fellow
towns-women as to the proper precautions to be taken with
infants, and some such work would not be out of place m
Hanley. In regard of phthisis, it is most satisfactory to
note how steadily the death-rate from this disease m*
become reduced since the completion of the sewerage
system, until it stands at 1'4 per 1000, as opposed to +v w
London. The report, which deals mainly with statistics and
actual causes of disease, does not point out the sanitary
advice given, or the work needed in the future, or toe
circumstances under which the people are living, and which
tend to affoct health. But the inspector of nuisances supplies
a table of current nuisances dealt with.

Newcastle-upon-Tyne Urban District. —Mr. Henry At®"
strong’s annual report for 1S86 shows that the genenu
mortality was at the rate of 22'2 per 1000. Under the
Improvement Act of 1882, 1348 cases of infectious dise^
were notified, and of these 1004 were scarlet fever, J 1
enteric fever, and 73 diphtheria ; the report sets forth
in detail the circumstances under which the diseases
occurred and the remedial measures adopted. Amongst id
latter we find that in 108 cases removal to either the f^w
or the small-pox hospitals was effected, and in 19
orders of justices were obtained as to burial of corp- •
The construction of new dwellings during 1886 has
provision for 1158 families, at the rate oi 5 persons to
family; and plans for 837 new dwellings, of which wb con¬
sisted of flats, were examined by the medical officer

health. Amongst the details of sanitary work earned out,

we find that the bakehouses, dairies, cowsheds,
and slaughter-houses have been inspected, and th #t .
licensing of the latter is not granted exoept after such w -
as tend to ensure wholesome conditions for the storsg
human food. . _

Aylesbury Rural District. —Dr. Hilliard takes occaai
his annual report tor 1886 to point out how, on
occasions, early information as to occurrences of me ^
and scarlatina has enabled him to prevent the sp“
those diseases. In some parts of the district the .
ance of defective sanitary conditions shows itself by ^
breaks of preventable disease. ThuB, in the
Westcott. which is of all others worst off for water*
were twelve fatal cases of diarrhoea; and at Aston ’
where faults of water still prevail, typhoid fever conw"

Tub ToA-nchtJ

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[Max 7. 1887. 959

> recur. The death-rate for the district was 18'6 per
000. A. good deal of current sanitary work is carried out,
ae notices relating to such work numbering many hundreds
nder several separate headings.

Tunbridge Wells Urban District .—During 1882-86 the
lean death-rate for this district was only 15-1 per 1000 per
nnum, and in 1886 it was 14'4. The only noticeable mor¬
ality was that of nine infants from diarrhoeal affections,
nd Mr. Wm, Stamford is induced to attribute this mainly
o fermentative or putrefactive changes in the milk with
vhich infants are fed. Some scarlatina was checked by the
Lse of the infectious hospital provided by the sanitary
.uthority; and amongst a good record of sanitary work
:arried out during the year we note that the water-service
vae laid on to 142 houses.

EccleshiU Urban District .—Measles has been veTy preva-
ent in this district, and this, together with some diphtheria
ind diarrhoea, raised the death-rate for 1886 to 17 per 1000.
vfeasles was found to be difficult of control, especially on
iccount of many of the attacks being so mild that no
nedical attendance was sought. Hence Dr. Byles only
aeard of the caseB when serious complications supervened.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 6816 births
and 3647 deaths were registered during the week ending
April 30cb. The annual rate of mortality in these towns,
which had been 20'5, 20'9, and 21-6 per 1000 in the preceding
three weeks, declined aga in last week to 20'6. During the first
four weeks of the current quarter the death-rate in these
towns averaged 20'9 per 1000, and was 2-5 below the mean
rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 105 in
Derby, 14'6 in Brighton, 157 in Leicester, 16'3 in Portsmouth,
and 16'3 in Bradford. The. rates in the other towns ranged
upwards to 28 2 in Bristol, 30 8 in Blackburn, 31 - 3 in Hud¬
dersfield, and 35'4 in Cardiff. The deaths referred to the prin¬
cipal zymotic diseases in the twenty-eight towns, which
had steadily increased in the eleven preceding weeks
from 340 to 558, declined again last week to 529;
they included 261 from measles, 132 from whooping-
cough, 51 from scarlet 1 fever, 43 from diarrhoea, 26
from diphtheria, 15 from “fever* (principally enteric),
and only 2 from small-pox. No death from any of these
zymotic diseases was registered during the week in Preston,
whereas they caused the highest death-rates in Sheffield,
Norwich, and Oldham. The greatest mortality from measles
occurred in Manchester, Sheffield, Sunderland, Liverpool,
Salford, Oldham, and Norwich; from whooping-cough in
Newcastle-upon-Tyne, Cardiff, and Blackburn; and from
scarlet fever in Blackburn, Sheffield, and Oldham. The
25 deaths from diphtheria in the twenty-eight towns
included 16 in London and 5 in Liverpool. Small-pox
caused 1 death in Sheffield and 1 in Cardiff, but not one in
Greater London or in any of the twenty-five other large
provincial towns. Only 6 cases of small-pox were under
treatment on Saturday last in the metropolitan hospitals
receiving cases of this disease; no new case was admitted to
these hospitals during the week. The deaths referred to
diseases of the respiratory organs in London, which had
declined in the preceding five weeks, from 509 to 337,
were last week 838, and 49 below the corrected average.
The causes of 76, or 2'1 per cent., of the deaths in the
twenty-eight towns last week were not certified either by
a registered medical practitioner or by a coroner. All the
causes of death were duly certified in Nottingham, Ports¬
mouth, and in four other smaller towns. The largest
proportions of uncertified deaths were registered in Sunder¬
land, Leicester, Preston,, and. Bradford. ,

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
■which had been 237 and 224) per 1000 in the preceding
tWo weeks, rose again to 22’5 in the week ending
April 30th; this rate exceeded by 1'9 the mean: rate in the
same week in the twenty-eight large English towns. The
rates in the Scotch towns last week nidged frofin 9 7 and
15-1 in Perth and Leith, to 24'8 in Glasgow and 26'5 in
Paisley, The 663 deaths in the eight towns last week
mtewed an increase of 13 upon the number in the previous

week, and included 36 which were referred to whooping-
cough, 27 to measles, 8 to scarlet fever, 8 to diarrhoea, 6 to
diphtheria, 4 to “fever" (typhus, enteric, or simple), and
not one to small-pox; in all, 89 deaths resulted from these
principal zymotic diseases, against 91 and 95 in the pre¬
ceding two weeks. These 89 deaths were equal to an
annual rate of 3 6 per 1000; which exceeded by 0-6 the
mean rate from the same diseases in the twenty-eight
English towns. The fatal cases of whooping-cough,
which had been 36 in each of tlie previous two weeks,
were again 86 last week, of which 16 occurred in Glasgow,
7 in Edinburgh, and 6 in Dundee. The 23 deaths from
measles were within 3 of the number in the previous week,
and included 13 in Aberdeen, 12 in Glasgow, and 2 in
Greenock. The 8 fatal cases of scarlet fever showed a
further slight decline from recent weekly numbers;
4 occurred in Edinburgh and 2’ in Greenock. Of the 8 deaths
attributed to diarrhoea, 3 were returned in Dundee and 2 in
Edinburgh. Four of the 6 fatal cases of diphtheria, and 2
of the 4 from “ fever,” occurred in Glasgow. The deaths
referred to acute diseases of the respiratory organs in the
eight towns, which had been 126 and 124 in the preceding
two weeks, further declined last week to- 111, and were 12
below the number in the corresponding week of last year.
The causes of 70, or more than 12 per cent., of the deaths
registered in the eight towns during the week were not

certified. -

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which bad been 30 0
34'1, and 31'3 per 1000 in the preceding three weeks, was
again 31*3 in the week ending April 30th. During the
first four weeks of the current quarter the death-rate in the
city averaged 32 2 per 1000, the mean rate during the same
period being but 18'6 in London and 19*5 in Edinburgh. The
212 deaths in Dublin last week corresponded with the
number returned in the preceding week; they included
11 which were referred to measles, 4 to whooping-cough,
3 to “fever” (typhus, enteric, or simple), 3 to (fiarrhcea,
2 to diphtheria, 1 to scarlet fever, and not one to small¬
pox. Thus 24 deaths resulted from these principal zymotic
diseases, against 22 and 19 in the preceding two weeks;
they were equal to an annual rate of 3'5 per 1000, the rates
from the same diseases being 2*6 both in London and in
Edinburgh. The 11 fatal cases of measles showed a further
considerable increase upon recent weekly numbers, while
the deaths from the other zymotic diseases did not show
any material variations. The deaths both of infante and of
elderly persons showed an increase upon those returned in
the previous week, while those of persons aged between one
and sixty years had declined. Five inquest cases mid 6
deaths from violence were registered ; and 50, or mtfee than
a quarter, of the deaths occurred in public institutions.
The causes of 34> or more than 16 per cent., of the deaths
registered during the week were not certified. 1

THE SERVICES.

1 ...

Wab Office. — Army Medical Staff: Surgeon-Major
William James Wilson, M.D., to be Brigade Surgeon, vice
William Cherry, granted retired pay (dated March ,28jth,
1887); Surgeon-Major John Croker is granted retired pay
(dated April 30th, 1887). ‘

- . India OffiCBL—T he Queen his approved'of the'retire¬
ment from the Service of the following Officers of tbe Indian
Military ForcesBrigade Surgeon Henry Cayley, of the
Bengal Medical Establishment (dated April 29th, 1887);
Brigade Surgeon Cameron' Joseph Francis MocDowtUL of
the Bombay Medical Establishment (dated April 1st. 1687>;
Brigade Surgeon Henri Jules Blanc, M.D.,.- of the Bombay
Medical Establishment (dated April 2nd, 1887); Siirgeon-
Major Warwick Jackson, of the Bengal Medical Establish¬
ment' (dkted April 8th, 1887); and Surgeon-Major Robert
Reid, of the Bengal Medical Establishment (dated April 25th,
1887). •

The under-mentioned Officers have been granted a-step of
honorary rank on retirement:—Brigade Surgeon Cameron
Joseph Francis MacDowall, :of the Bombay MedicalEstab-
lishment (dated April lBt, 1887), and Brigade Surgeon Henri
Jutes Blanc, M.D., of the Bombay Medical Establishment
(dated April 2nd, 1887), to be Deputy SurgeonB-GenanaL
Admiralty. — The following appointments have beeta
made:—Fleet Surgeon Fleetwood Bookie, to the Umctm:

Digitized by GoOgle

954 The Lancet,]

THE PENGE CASE.

[May 7,1887.

Surgeon Hamilton E. L. Earle, to the Duncan, additional,
for disposal; Surgeon George A. Dreaper, to the Triton,
additional; and Surgeon Henry B. Beatty, to the Duncan ,
additional.

Artillery Volunteers.— 3rd Durham: Jas. Drummond,
M.D., to be Acting Surgeon (dated May 4th, 1887).—
•1st Kent: William Lindsay Chubb, Gent., to be Acting
Surgeon (dated May 4tb, 1887).—1st Newcastle-on-Tyne:
Surgeon R. Young, M.D., resigns his commission (dated
May 4th, 1887).

Rifle Volunteers. —2nd Ayrshire: Surgeon and Hono¬
rary! Surgeon-Major R. Dobbie, M.D., resigns his com¬
mission ; also is permitted to retain his rank, and to continue
to wear the uniform of the corps on his retirement (dated
May 4tb, 1887).

The Volunteer Medical Staff Corps.— The Maidstone
Division: Surgeon and Honorary Surgeon-Major David
Henry Monckton, from the 2nd Volunteer Battalion, the
Prince of Wales’s (North Staffordshire Regiment), to be
Surgeon (dated May 4th, 1887).

(loraspukiur.

••Audi alteram partem.”

THE PENGE CASE.

To the Editors of The Lancet.

Sirs,— Many of your readers will recollect that about
«leven years ago four persons were found guilty of murdering
Harriett Staunton by starving her, and were condemned to
death; but that to a large proportion of the public, and to a
larger proportion of the medical profession, the evidence that
was adduced did not seem to justify the verdict of the jury
or the sentence of the judge; and that subsequently the
prisoners’ punishment was commuted to penal servitude
for life, a result which was largely due to the action of
The Lancet, through whose agency a petition signed by
-over 700 members of the profession was presented to the
Home Secretary. Shortly afterwards one of the female
prisoners had a free pardon accorded to her; some five or six
years ago one of the brothers Staunton died in prison of
consumption ; and about three years ago Sir W. Harcourt set
«t liberty the wife of the deceased brother. One only of
the party still remains a prisoner. For my own part, I
believe the accused were innocent of intentional wrong.
But even granting what many of those who helped to save
them from death believed that they had been guilty of
gross, and even criminal, negligence, eleven years of penal
•servitude is a heavy and surely sufficient penalty to exact.
Considering, however, that two have already been pardoned,
it is certainly hard that the same grace should after so
many years of punishment be withheld from the last of the
number. Will you allow me to mention that a petition to
the Home Secretary praying for the release of Louis Staunton
is how in process of signature, and to invite some of those who
-signed the former memorial to attach their names to this?

I am, Sirs, yours faithfully.

Old Burlfngton-street W., May 1 th, 1887. J. S. BriSTOWE.

THE TREATMENT OF EPISTAXIS BY COUNTER¬
IRRITATION OVER THE HEPATIC REGION.
To the Editors of The Lancet.

Sm«,—I was much pleased to observe in a letter from
your Paris correspondent, dated April 27th, that at a recent
meeting of the Academy of Medicine M. Vemeuil read a com¬
munication upon the treatment of certain forms of epistaxis
-by counter-irritation over the region of the liver. In the
first case related by M. Verneuil, quinine, ergotine, and
digitalis had all been tried in vain. In the second, plugging
'had failed. The third hid been the subject of chronic
nephritis, with secondary affections of the heart and liver,
and the cavity of the nose had been plugged without effect
both with ergotine and the perchloride of non. M. Ternenil’s
•treat ment, which waa immediately and'permanently effective,
oonawted in the application ovar the Wgfan <*f the fiver of a
large blister. M.Vornetdlbad at Hm thought that the
.method was ectinQyfbin.owm ’bu f --*n bibliographical

research it turned out that it had been anticipated te i
certain extent by Galen, who says that large cupping glaw
applied to the hypochondriac region arrest nasal ham*
rhage. To me it is very satisfactory to learn that a modei
treatment practised by myself successfully for manyjeic,
and reported in The Lancet of Oct. 30th, 1886, with cue
in illustration, has also been advocated by so eminent u
authority in continental medicine, and, as far as he wu
concerned, independently of any euggeetion from another. 1
am quite sure that, in his case any more than my own, the
dictum of Galen had nothing to do with its origination. 1;
is of more importance that the remedy, which is undoubtedly
of the utmost value, should be more generally adoptee,
especially when its application is urged not upon merely
empirical grounds, but in accordance with accepted p&tho-
logical teaching. That your correspondent did not appetr
to be aware of my previous pronouncement on the sutjoc;
arose possibly from the fact that my publication did "no;
take the form of a monograph with specific beading, bat u
portion of a paper treating of congestion of the liver, and
protesting against the impolitic interference of modem sur¬
gery with the sanitary efforts of Nature when through the
medium of haemorrhage from the heemorrhoidal veins or ths
mucous lining of the nostrils she endeavours to lessen tie
turgescence of an important viscus. In illustration of my
views, I gave the particulars of a case of vicarious bleeding
from the under lip, which arose immediately after tie
deligation of hemorrhoidal tumours with excessive bleeding,
ultimately cured by blistering over the liver; of s second
example, in which dangerous and profuse haemorrhage from
piles was immediately cured by a similar remedy; and then,
in pursuance of my theme, appended the cases of three
young men suffering from epistaxis, who were instantly
relieved by blistering over the hepatic region. A remarkable
case, which occurred during the recent riots in Belfast will
further illustrate the subject: While paying my morningvist
to a straw lodge, a temporary barracks improvised for tie
members of the Royal Irish Constabulary, and accompanied
by one of the officers, I found one of the men in bed with a
handkerchief saturated with blood, which had flowed from
his nose during the greater part of the previous night On
satisfying myself of the nature of the illness, I painted the
man freely with the liquor epispasticus over the region of
the liver, prescribing no other remedy but rest in bed. On
our revisiting the man next day, he informed us that from
the moment the blister began to pain him the haemorrhage
declined, and left him altogether a short time after. To
quote from my paper: “ The frequent occurrence of epistaxia
in youth is evidently due to the excitement and hypenemic
condition of the liver and digestive organs during the
period of active growth and the constant demands upon its
functional activity. The liver at this stage closely approxi¬
mates to the condition in after-life, which is tbs cansa!
factor in the development of piles, and as such is equally
amenable to treatment in accordance with etiological pri“*
ciples; the derivative that cures the bfemorrhoiaal flu 1 u
certainly puts an end to the epistaxis, the outcome of hepatic
congestion.”—I am, Sirs, yours very truly,

Belfast, May, X887. ALEXANDER HarKIN, M.D., F.R.C.S.

ON THE NECESSITY OF OBTAINING POWEBS
TO DETAIN IN WORKHOUSES AND IN¬
FIRMARIES PATIENTS AFFECTED
WITH VENEREAL DISEASES.

To the Editors of The Lancet.

Sirs,— A few years ago our Government, swayed by the
twaddle of sentimental politicians and by a misguided and
ill-informed public, had the rashness to repeal the
tagions Diseases Act, and thus has engendered the spread
of venereal diseases not only amongst our sailors wd
soldiers, but throughout the community. I now wish
to call attention to the pressing necessity of acqniru^
powers to detain patients suffering from these disease
in our Poor-law and other institutions until well. “
some of our workhouses and infirmaries patients are lou^
suffering from the most fearful ravages of syphilis
from the most virulent forms of gonorrhoea, and many"
them insist on taking their discharge before they are cured.
Now, for such patients to have it in their power to leave tw
infirmary or workhouse before recovery is not only
unsatisfactory os regards the treatment of them, bat i t «

Thb Lancet,]

TANGIER AS A HEALTH-RESORT.

[May 7,1887. ftfifl

reading disease broadoast, and is likewise a grave in justice
> tbe ratepayers, upon whom is thrown the cost ot their
aintenance when ill. It is not my intention to discuss
ie merits of the Contagious Diseases Act, but I will say
vat its repeal, in addition to facilitating the spread of
enereal diseases, has a tendency to encourage seduction and
roetitution amongst a large class of girls and young women
•bo support themselves in an honest and respectable way.
5 appears to me to be the duty of medical men who are
iembers of Parliament, or otherwise possess considerable
iftuence, to try to introduce another Contagious Diseases
till, or, failing that, Borne measure giving powers for the
etention of these cases in our Poor-law institutions until
hey can be discharged cured.

1 am, 8irs, yours faithfully,

April, 1887. ABTHtm Fflintoff Mickxb, M.B.

TANGIER AS A HEALTH-RESORT.

(From a Correspondent.)

As a winter station and a pleasure resort Tangier is rapidly
acquiring considerable popularity. Many circumstances
combine to bring about this favourable result. Politically,
the range of modern artillery has Tendered Tangier a
military position second only to the Suez Canal. Without
attempting to discuss here all the complications that arise
from the necessity of keeping open the Straits of Gibraltar
and the efforts of English diplomacy to prevent any power¬
ful nation becoming master in Morocco, it is nevertheless
necessary to mention the existence of these grave political
questions in order to account for the importance now
attached to all that concerns the town of Tangier. Already
tbe Sultan of Morocco has been termed “the new sick man,
and it is evident to all politicians that the Eastern question
is travelling westwards, and may have to be fought out in
the Straits of Gibraltar as well as at the Dardanelles or the
Red Sea. Conjointly with these considerations, the develop¬
ment of trade at Tangier has been most marked. The
increase of exports and imports in 1885 was nearly equal
to a third more than the average of the previous five years.
Thus, either politically or commercially, Morocco is daily
becoming better known. Though within three hours’ sail
of the nigh degree of civilisation prevailing at Gibraltar,
Tangier still maintains primitive Oriental customs and
appearance. To those who thirst for a complete change,
who are tired of the ordinary resorts of the invalid or the
tourist, Morocco may be confidently recommended. The
need of such change is very generally recognised, especially
when dealing with those nervous diseases that are more
prevalent as the strain of our highly wrought civilisation
Womes greater. But the health stations of the Continent
grow more and more like each other; there is a wearisome
sameness about the hotels, the society, and surroundings,
which many would like to avoid. On the other hand,
a thorough change is generally thought to involve a
long journey, a sojourn m a country far removed from tbe
resources of civilisation, where some personal risks must be
incurred. Tangier, however, can be reached from London
in five or six days by the Forward line of steamers, and from
Marseilles in three days and a half by the Pacquet line. The
overland journey to Cadiz, Malaga, or Gibraltar brings the
traveller within a few hours’ sail of Tangier; and, when once
here, he can benefit by the wildest scenery, the most complete
change, while enjoying perfect personal security. In spite
of the barbarous aspect of tbe country, the European is safer
from robbery and aggression than in the streets of London
or Paris. The dread of the Moorish authorities lest any
complaint mode by a European should lead to an invasion of
theirconntry has brought about the application of theeeverest
and the most cruel measures of repression. Quite recently
a man was flogged to death because he was supposed to have
robbed a foreigner. Others are left to die of starvation in
prison when they are accused of owing money to persons
ifflder foreign protection. Whole districts have been most
cruelly oppressed, taxed, and half ruined to supply compensa¬
tion for some slight Jobbery committed in the neighbourhood.
Yet oil this, heinous as it is, has, on the other hand, the
result of terrifying those who otherwise might be guilty of acts
kMy to alarm intending visitors. Thus it is possible to
hre without fear or risk in a country of easy access from

England, and yet where there are no regular roads, no
carriages, no railways, no police, no inland post, no munici¬
palities, no ratesor taxes for Europeans to pay, no standing
army or drilled troops, no daily newspaper, no public
opinion, where, under the capitulations, there are thirteen
Christian and one Mahomedan constitutions having the force
of law, and where, in spite of all this, a sufficient amount
of material comfort may be enjoyed conjointly with the
benefits of a most genial climate. If it is change of life;
scenery, and climate that have been prescribed for the
patient, it would be impossible to find nearer home any¬
thing more thorough in this respect than Tangier. Even if
there were nothing else to say in its favour, this is enough in
Itself to show that it may render much service.

From time immemorial, however, Tangier has been
renowned for -its equable and salubrious climate. It was
much esteemed by the ancient Romans, who built here a
commercial town on the east and a military fortress on the
west side of the bay. Long before their time, before Rome
itself sprang into hfe, the exceptional position occupied by
Tangier had attracted various races and tribes, and it is
said that there are only two other towns in the world whose
existence can be traced so far back. A glance at the map
will show that Tangier is situated on a promontory running
northward from tbe mainland of tbe African continent, lb
is nearer to the Atlantic than to tbe Mediterranean. The
north-west, west, and sonth-west winds are all Atlantic
winds. Tbe north-east blows down the straits from the
Mediterranean, and tbe east and south-east also blow from
the Mediterranean over the Reef Mountains and across the
Bay of Tangier. Thus nearly all tbe winds that reach-
Tangier are sea winds, and therefore supply an atmosphere
of exceptional purity. Even the north wind, which comes
direct from Spain, is refreshed and purified by crossing tbe
Straits of Gibraltar. Tbe due south is alone a land wind,,
and, coming from tbe desert, might be extremely unpleasant.
Fortunately, this wind must first pass over the eternal snow
of the Atlas Mountains before it can reach Tangier. Thus
even in summer the climate is comparatively cool, while in
winter it is exceptionally warm. The better-known winter
stations on the French or Italian Riviera receive as many
land as sea winds. Those winds that do come over the-
water blow from the Mediterranean, and this sea does
not seem to agree with English constitutions so well'
as the Atlantic. Again, comparing Tangier with the
Riviera, it will generally be admitted that tnere is not the
game and dangerous difference between night and day
temperature. At sunset the thermometer falls much more
than in England, but less than on the Riviera. Froete are
extremely rare. This winter, which has been so excep¬
tionally cold throughout the west of Europe, brought onlv
a few flakes of enow, that melted as soon as they, touched
the ground. On the other hood, Tangier is not so dry ah
the Riviera resorts. While the record of the thermometer
is most favourable, the individual may nevertheless feel
chilly because of the dampness that arises at night. Extra
clothing, and perhaps a little fire in the evening during the
depth of the winter, amply suffice to cope with this dis¬
advantage ; but it is essential to take this local peculiarity
into account, or the patient will be unpleasantly surprised
to find that bis personal sensations do not harmonise with
tbe temperature marked on bis thermometer. Unfortunately^
there is no regular meteorological station at Tangier. Ob¬
servations have been taken here and there; the best are
those of the German Legation, but these statistics are not
compiled, and the summary of the results have not been
made public. Dr. Arthur iJeared, in his interesting work on-
“ Morocco and t he Moors,” gives statistics taken m a patio-
or courtyard, showingth&t during the year 1872themaximum
(reached in June) did not exceed 83° F., and the minimum
(attained in December) was not lower than 60° F. During
the six winter months tbe thermometer ranged from 66° F.
to 50° F. But these statistics are not sufficiently extensive
to warrant the formation of any definite opinion.

Perhaps, under these- circumstances, it would be safer to-
rely on the vegetation as the surest evidence of climatic
advantages. There are, it is true, comparatively few gardens
at Tangier; but if tbe necessary money were forthcoming
almost any plant could be grown here. The tropical and'
semi-tropical plants to be seen on the Riviera may also be
found in the neighbourhood of this town; but many, of
these have grown with more vigour and attained larger
dimensions. This ls< especially the case with respect to the
Egyptian and Mexican bamboos in the garden of tee Belgian

956 ThsLanobt,]

TANGIER AS A HEALTH-RESORT.

£Mav7,1«S7.

Legation and the Draceana drago at the German Legation.
This latter tree is one of the curiosities of Tangier. It is
probably more than 300 years old, and is considered the
finest specimen in the world. At the Canary Islands there
is one tree of this sort which is larger, but it is not so high
or so handsome. Close at hand the Datura shrub, which
is killed by 2° to 3° F. of frost, may be seen growing
to a height of more than twelve feet. Wild oleanders
abound in great luxuriance throughout the country. The
Delos crmbri , with its giant roots, and the Chamarops}'utmilit ,
the date palm, grow naturally—that is, in a wild state and
without cultivation. The cedars of Lebanon, the Laurus,
both terms and nobilie, the banana, the <S£reeur,the Magnolia
grandiflora, and many other plants that are only known in
the hot-houses of England, prosper here in the open air, even
when little care is taken to preserve them. But perhaps
the best illustration of the equable nature of the climate is
that of the Araucaria excelaa; for, while this fir can stand
but little heat, it is killed at once by the frost. If the heat
continued for a few days consecutively at 75° F. the leaves
would turn yellow; and it is extremely difficult to: find any
place where this tree, will grow. Yet at Tangier several
specimens have been successfully reared, notably under the
able surveillance of a German horticulturist, Herr Ferdinand
Neureuter, who is in charge of the gardens belonging to
Mr. Perdicaris.

The salubrious character of the climate is further demon¬
strated by the observations of medical men who. have
practised for some time in this country. Dr. Miguerea, who
has resided at Tangier some , sixteen years, acting in the
capacity of consulting physician to the French Embassy and
to the French Hospital, and who has had a most extensive
practice among the native and foreign population, declares
that many diseases which in other countries last from fifteen
to twenty-one days reach the convalescent state at Tangier in
from ten to twelve days. This is, of course, more particularly
the case with the natives or those foreigners who are
thoroughly acclimatised. Among the diseases that rarely
attain a malignant form may be mentioned typhoid and
scarlet fever, measles, and diphtheria. Though m England
there is such good reason to dread any outbreak of scarlet
fever, its occurrence here is very rare, and of remarkably
mild character. A fever, however, which in many respects
bears a. close resemblance to typhoid is of somewhat fre¬
quent occurrence. Infantile diarrhoea is also very prevalent,
and one of the principal causes of mortality. It is doubtful
whether the climate would be of any use in the more
advanced stages of phthisis. But the results attained daring
the earlier development of the disease are most encouraging.
These facts are confirmed by the records kept at the noe-
pital and by the local practitioners. i. ■> ; ■ tj

In spite of this favourable record, ft must be acknow¬
ledged, however, that the. sanitary state of Tangier is most
deplorable. Nevertheless, the Moors are, in one respect,
more advanced than the French and the municipalities of
many Spanish and Italian towns. They, at least, admit
direct drainage into sewers, and believe in the practibility
of small sewers. At Tangier there are two main sewers,
both sufficiently large for a man to enter. The principal
newer passes through the ravine—that is, the lowest portion
Of the town—and empties itself under the small landing
.stage in the bay. It is about a yard wide and a yard and a
half high; the roof is domed, and the invert but slightly
concave. This seWer runs a distance of a thousand yards,
and during heavy rains is often completely filled. It is said
to have been originally built by the Romans, but was probably
in part rebuilt daring the English or the Portuguese occupar
lion. The other mainsewer crosses the town more to the east,
et a somewhat higher level, and passes under, the British
legation. From ail the neighbouring small streets, innumer¬
able small sewers converge to these two main drains. These
little 1 serwert axe very badly constructed of rough masonry
end tiles. They ike often stopped up, and buret. They in¬
variably leak, and contaminate the surrounding soil, They
Act dbeb; enough in .the earth, and fail jtqfcQ the top
dkutead attamk/wie portion of;the main sewer.. Thus they
memvey badk feo the- housee the,gases aocumulat^d ua ^he
anafcxad n fe U—i n fe»hrsTyhriraiw. Aforharethe
Adsa.of

street. Also all the water used in Tangier.,_

house drain, and is not, ns. in France, wasted by
thrown into the gutter. AU the water used helps to
both the house drain and the public sewer. The Mooni^
their credit be it said, use a great deal of water, JS, tf
could only be induced to trap their closets, the i*

Tangier might compare favourably with many
towns, and would be preferable to Marseilles
Some of the worst houses in Tangier are those
Europeans, especially for the Spaniards. The
these have been carried further within the hpufep^
are not trapped. Other drains are opened in. tfafri .
the kitchen,;.thus the sewer poisoning iamopeqp^a
and more thoroughly distributed ever the entire ngqfg,
Anyone, however,,who settles in this ^oqnjry may tot
great extent protect, himself, efficaciously against ihejwp-
rounding bad sanitation. He will not be harassed bypefix
regulations that are opposed to the lAWs of hygiene. It
France, for instance, there, is a police ordinance,to the effect
that soil pipes must measure nine inches in diametavthoagk
experience has proved that the size should not exceed tiuree
or four inches if the pipe js .to be self-cleansing. Than a
cesspool or a tinette is imposed, and, as often .«
cesspool is built immediately under the house, so
thing like effective interception is impossible. A1
the whole of the drainage is sent to the sewer.

English plumber in the.town, with all the
appliances, and for a small cost, the. house
trapped and ventilated according to the mart
system. If the interior of the houses W in a bid 1
this is entirely the fault of the Owners br been
half the difficulty can be overcome. Nor would
Bible to obtain permission from the Sultan to aubsti
earthenware pipes, properly laid, for the mi^ei
tile-built drains, which so often burst and poison
sphere of the by-streets. Unfortunately, th^

Corps are not a body of sanitary xefermaw, ppr,.
possible for them to act in unison with^espeot.tq
whatsoever. The Moorish authorities, on thr
will not move except under pressure, and on:
from without. Anything like precaution qrf<_ ,
opposed to Moorish customs and beliefs. )tt u q
expostulating on the danger of epidemics. - If s'
arrives, it is the will of Allah, and it is neif’
possible to attempt any resistance. . But ov
sewers of Tangier cannot be rebuilt, the* foi
and it is easy to find villa accommodation
walls. So far as the hotels are couoapn*
prietor of the Continental Hotel, fpr instancy,
installed good English closets, but has fqg
Of the sewer passing along the street in f ropty
to be rebuilt. Thus,if the Moorish autbontigav
themselves, they do not oppose others Ukipgxh
■hand. Villas outside the town must of po'
cesspools; as the sewers do not go beyond
But land is still cheap, the villas are gene*
by good-sized gardens, so that, the cesspools n$a,
generally are, built at same.distance fromthe djwal,
the ordinary methods of trapping, ventilation, arid
tion can therefore be applied, and every precautiy mw
against the ingress of sewer gas. There frteutljEal sites
within a few hundred yards of the town -wberef/dustso
of villas and hotels could be built on the
ciples. No Government interference wo^dd
creation of a small Hygiea, where, perfect wtaw

unite with an almost perfect climate toi Qfo sti t Ufo . | yi *
health-resort. : i:» ■'5

. In the meanwhile, the town
-and, to some extent, dangerous >oo
free access of sewer gas into the Inferior
Streets outside are m a filthy state ;fer ( 'Wife*
scavenging. The water-supply„ at one '
good, is becoming more and more ex;

To the east of the town, the <distifet
Ma (the head of water) is

vpn>-

fenyards deep, j
flMViferaif fe**wn.of ehi

Ths Lancet,]

NORTHERN COUNTIES NOTES —DUBLIN.

[May 7,1887. 05 7 :

to the Marina after travelling a distance of 1400 metres.
This large canal or collector must have been most admirably
built to have resisted so many centuries of ill-usage. On
reaching the town there are two derivatives from the main
aqueduct; one goes to the Sultan’s mills, the other to the
Puente Nueva; but both these are now stopped np, and there
only remains in working order the principal canal, which,
passing under the large soko (or market) down the main
street, supplies the fountains of this street and the Mosque
at the further end. In its course through the town, the
water may be contaminated by the leaking sewers that pass
under it, over it, and by its aide. Also the Und at Haa-
el-Ma, formerly uninhabited,is nowdotted overby villas and
a cluster of huts occupied by natives. Not only do these
people to some extent contaminate the soil, bat the land
which is not built upon is being brought under cultivation—
that is to say, coveted with manure. It is true that a
sample of the water taken and analysed in 1882 stall
proved exceptionally pure, and-was compared for its ex¬
cellence with the water brought to Seville by the English
company; still it is evident that, ae the population increases
on this spot, the quality of the water gathered from the soil
will be impaired. Herr Meis Barger, an Austrian engineer
resident at Tangier, with the authority of the Govern¬
ment, investigated the whole condition of the water-
supply, and states that half the small drains which
bring the water from the soil to the aqueduct are novf
broken and useless. These he proposes to lay bare and recon¬
struct, and calculates that the whole work of restoration
would only cost £6000. Further, he would constitute a
large reservoir containing 10,000 cubic metres of water to
be delivered in the town through iron pipes. Thus, in dry
seasons a reserve supply could be drawn upon, and the iron
pipes would prevent contamination from the proximity of
the street sewers. By these means the water-supply could
be doubled, and giveeeoh in habit a nt of Tangier twenty-five
litres per day. Instead, however, of relying on the surface
supply derived’ fret* the sand; it would be preferable, as
there are no springs at hand, to dig artesian wells, and then
there would be no longer any reason to apprehend that the
growth of the town will endanger the purity of the water. At
present many persons drink only rain-water obtained from
the roofs of their houses. This is stored in large tanks under
the bouses, which are seldom oleaned with sufficient care, and i
which occasion a dampness in jurious to health. Others, in their
ignorance, avail themselves of the numerous wells in and
about the town, though the water is often highly charged
with organic matter. This is especially the case with
respect to some wells at a lower level than the cemeteries to
the west. Under these circumstances, it is necessary for
all visitors to boil and filter their drinking-water, and to
make it a duty to complain as lustily as possible, so that the
long promised waterworks may at last be taken in hand; in
fact, the European population, by united action, have it in
their power to mare Tangier one of the most; enviable
pleasure and health resorts within comparatively easy
accsss. ;■

• - -NORTHEHN COUNTIES NOTES.

(From our own Corretyondmt.)

- ; !•' TH* NEWCASTLE JUBILEE EXHIBITION.

ON the 11th of this month our exhibition is to be opened
by his Royal Highness the Duke of Cambridge, who is to be
the guest of our eminent citizen. Sir W. G. Armstrong, at
Cragaide, Roth bury. The full title of tie exhibition is the
Xeweastle-oa-Tyne Royal Alining Engineering and Industrial
Exhibition. I give it here, and hope it will not be necessary
to repeat it often. The exhibition will include a very great
number of objects of general interest, but it will also cover
many subjects of medical or sanitary interest, and of these,
so far as they are likely to prove welcome to your readers,
it will be my duty to write about from time to time in this
correspondence. I have (as your representative) received
an invitation from the Executive Council to join the private
inspection of the exhibition which is to take place on
Saturday next, the 7th; but as it is requested that no notice
of the exhibition is to appear in any paper until Monday next,
the 9th, I must reserve my remarks until then. TV e are to
have another great exhibition here during the coming
summer—namely, the Royal Agricultural - at which his

Royal Highness the Prince of Wales’has promised to bO"
present, so that our northern city is likely to attract a large
□umber of visitors this coming summer.

AN OUTBREAK OF TYPHUS IN NEWCASTLE.

There has been an outbreak of typhus fever in the east
end of Newceetle, confined to two or three of the poorer
streets, and densely inhabited by not the best class of
working people. Already about eighteen cases have been
admitted to the Fever Hospital, it is the opinion of our
medical officer of health, Air. H. E, Armstrong, that the
di s e as e has been imported into our city by some strangers.
I am happy to report that there has been no fresh case since
the 25th of last month. While on the eubjeet of fever, 1
may here allude to the facilities for its study which will be
afforded t» students at the new. and very complete hospital
just erected for the city at lbeafcw. Boeing that tbq study
of fever is not at all attended to by students in England ae
in Ireland, it is now recommended to. be taken up by .candi¬
dates for the licence in Bsaitary Science of the University
of Durham and for the M.B.

THE HARDY NORTHMEN.

All this spring, so for, we have experienced a good deal of
the dull grey weather which i» saw hy the poet to make
“ strong Englishmen.” This has been accompanied by cold'
east and north-easterly winds, very trying to all but the
very strongest constitutions. Nothing daunted, however,

! “ the bathing season,” we are told, set in yesterday, when,
the Tynemouth Amateur Swimming Club bad ,its first
“outing,” or first “inning” perhaps I should say, as it’
is stated that yesterday, after an appropriate * peach by
the mayor to an assembly of about sixty, “a rush” was
made by most of those present into the sea, where they
appeared to thoroughly enjoy themselves. Scarcely, much
behind us on the other side of the Tyne, the swiinming
folk of Shields took the water to-day, and before doing so
they were addressed by the president, the worthy Alderman
Nelson, J.P., who stated that he had bathed in the sea 105
I times this year already. Comment on this Is needless.

SUNDERLAND.

It la very pleasing to hear that the Sunderland Workmen’s
Exhibition during the month it was open made a profit of
about £500. This will be handed over to the funds of the
infirmary there, which is free and also well supported by
Sunderland artisans.

The vacancy in the staff for an honorary physician at
the Newcastle Dispensary is likely to be filled up by the
appointment of Dr. Beatley, of this city, who is the selected
candidate, and who previously held the office of Resident
medical officer with much satisfaction. ..,

Newcastle-on-Tyne, Hay 3rd.

DUBLIN. - ,,

{From our ohm CorretpOndmt.)

ROYAL COLLEGE OF StUlGEONS. ' ‘ .’

Tub annual election of office-bearers will take place on
the first Monday In Jane, andvoanvasatng for the Council
bad aitMNty cowmen tad, 1 have four hamee before me’Who
seek’election at-the hands Of the FejloWs-^tir., MeWrsJ
Kendal Franks, Houston, Norman, and Ward. Mr. Franks
made such a satisfactory attempt last year, being defeated
by only four votes, that I regard his success on this occasion
as assured. This will be Mr. Heuston’s first application, and
although it is extremely unusual for agentleman to obtain a
seat on the Council on bis first candidature, yet I think be
will be well supported, and dese rv edly so. As regards Mr.
Norman, who is resident medical superintendent to the
Richmond Lunatic Asylum, be will, I am informed, if elected,
devote special attention to matters affecting psychical medi¬
cine. Mr. A. II. Corley, vice-president, will succeed Sir
William Stokes as president, and the office he vacates will
be contested by Mr. Henry Fitzgibbon and Mr. H. Gray
Croly. Both these gentlemen will be well supported, and
the contest, I am convinced, will be a very close one.

THE VICTORIA JUBILEE HOSPITAL.

A committee was appointed last February for the purpose
of taking steps to commemorate Her Majesty’s Jubilee in a
manner which would include the inauguration of some

Digitized by CjOO^Ic

95 $ The Lancet,J

DUBLIN,-BBLFAST.-AUSTRALIAN NOTES.

[May 7,1887.

work of public utility, and which would especially benefit
the working classes of the county and city of Dublin.
After due consideration, it was decided that the foundation
of a hospital for consumption and diseases of the chest
would be the most fitting memorial. The committee state
that they were aware that persons suffering from consump¬
tion and other similar forms of lung disease cannot be
treated with a fair prospect of suocess in town hospitals,
and that in many cases it is inadvisable to admit such to
the general hospitals of the city. By the establishment of a
hospital of the kind proposed adjaoent to Dublin, many
patients may be successfully treated who at present end
their days in the Hospital for Incurables, and many others,
not absolutely curable, may be so alleviated as to enable the
sufferers to lead comparatively healthy and useful lives.
From the mortality returns of Ireland, it appears that over
one-tenth of the deaths are caused by consumption, and
about one-sixth by other diseases of the lungs; while in
the city of Dublin and its immediate suburbs the annual
Average deaths from consumption number a little over 1000,
from other diseases of the respiratory organs over 1800, the
two groups forming about one-third of aU the deaths which
take place in Dublin. It is gratifying to state that the
subscriptions towards the proposed hospital have already
reached a sum of £6640.

DUBLIN HOSPITALS COMMISSION.

In addition to the remarks made in last week’s issue
relative to this report, there are a few others to which
attention may now be directed. The commissioners, having
reviewed the circumstances of each institution, make some
suggestions which they consider will render them more
effective institutions for the advancement of medical know¬
ledge. They refer to the large number of small hospitals in
Dublin, which add largely to the “establishment cnarges,”
and by frittering away the number of beds among so many
hospitals, thus diminish the opportunities for clinical
instruction. They recommend a reduction in the number of
general hospitals, and believe that the total income of the
various hospitals, taken at an average of £65,000, would
suffice to support 1249 beds, the number maintained in
1884-5, if judiciously distributed among a few large institu¬
tions ; but under the present circumstances the withdrawal
of the Parliamentary grant would be attended with
disastrous consequences. They suggest that the annual
grants be commuted for a capital sum to be invested in the
hands of trustees, and that the interest be paid periodically
to a central board, to be distributed by them among such
hospitals as shall fulfil certain specified conditions, in my
opinion, it is extremely unlikely that these recommendations
•of the commissioners will be carried out; and, indeed, if
they were in their entirety, it might prove injurious to some
institutions which thoroughly deserve the grants they at
present receive.

ACADEMY OF MEDICINE.

By a clerical error it was stated last week that the title of
the Academy was intended to be “ The Royal Irish Academy
of Medicine ”; it should have been stated that it was re¬
solved to apply for permission to use the prefix “ Royal,” so
that it shall be called “ The Royal Academy of Medicine in
Ireland.”

THE “KENNEDY DEFENCE FUND.”

Allusion has already been made in these columns to the
groundless accusations brought against Dr. Kennedy, the
resident surgeon of Mercer’s Hospital. A committee has
been formed, who invite subscriptions from the profession
so as to express tbeir determination to support one another
when called on to meet charges arising out of the con¬
scientious discharge of their duties, and also to indemnify
the member of the profession so charged against law costs.

Dublin, May 3rd.

BELFAST.

(From our own Correspondent.)

THE BELFAST DIBTBICT LUNATIC ASYLUM.

In the fifty-seventh annual report of this asylum, just
Issued, Dr. Merrick, the able and courteous superintendent,
states that there have been 196 admissions daring the year,
wfcfeb, with those already in the aeylaxn at the end of 1885,
nftkes the total number under treatment 766; 130 have been

discharged, and 35 have died, leaving a total of 601 in residence
at the end of the year 1886. Of those discharged, seven were
unimproved or harmless, forty-two were improved, and
eighty-one recovered. One death occurred from suicide.
The general sanitary condition of the house has been most
satisfactory, and no case of infectious disease occurred. The
gross expenditure for the year amounts to £12,837, which
gives the cost per head at £2114s. 4$d., and is a decrease
of £1 4s. 4 id. on comparison with the cost of the preceding
year. Considerable cnanges in the personnel of the medical
staff have taken place. Dr. Purdon has been appointed
visiting and consulting physician, in place of Dr. Henry
MacCormac deceased. Dr. W. Graham, assistant to Dr.
Merrick, has been appointed medical superintendent of the
Armagh Asylum, and Dr. Samuel Graham has been appointed
in his place.

THE BOYAL HOSPITAL.

The summer session commenced on Tuesday, and the
medical dasses have also started at Queen’s College. At the
Royal Hospital Mr. John Campbell has gained the Coulter
Exhibition, while the Malcolm Prize has been awarded to
Mr. Quarry. Mr. Campbell has also won the Gold Medal at
the Belfast Hospital for Sick Children.

MEETING OF SOCIETIES.

At the last meeting of the Ulster Medical Society, instead
of the reading and discussing of papers, the evening was
devoted to the exhibition of patients, instruments, and
specimens. A large number of members of the Society were
present, and among the contributors were Dr. Whitla, Dr.
Esler, Dr. Dill, Dr. Sinclair, Dr. M’Caw, Dr. Browne, and
Mr. Fagan. At the meeting of the North of Ireland Branch
of the British Medical Association, held last week in Belfast,
papers were read by Dr. Burden, Dr. Byers, Dr. O’Neill, and
cases shown by the last-named gentleman and Dr. Esler.

AUSTRALIAN NOTES.

(From our own Correspondent.)

SANITATION (?) IN BRISBANE.

This town is in a very discreditable state, as far as health
matters are concerned. There is a Central Board of Health,
the members of which are Government nominees, who
(with the notable exception of Dr. Taylor, who not long ago
furnished the Government with a full report on the relative
merits of different sewage systems, and who does all he
can to stir the Board up) are content to do little bat meet
and take their guinea a sitting each. Certainly they have
ne powers entrusted to carry out any improvement, and
have recently failed even in getting the Arcade cesspits
removed, which are an acknowledged nuisance to the
neighbourhood, and have to be emptied fortnightly by men
going down into them and baling the excreta out in
buckets. There is no permanent medical officer of health
to the corporation, and the water supplied to the town by
the Board of Waterworks was so filthy recently that one of
the reservoirs had to be shut off on account of the general
popular outcry against it.

HORRIBLE ABORTION CASES IN NEW ZEALAND.

Dr. Russell of Christchurch (a coloured American prac¬
titioner), who has been in practioe in that town for some
years, is now on his trial for abortion in three cases. The
evidence goes to prove that be has been making a systematic
practice of this, and be seems to have kept a sort of abortion
hospital at a small boarding-house in the town, where he
regularly attended. One woman who bad been aborted by
him acknowledged to having been twice operated on by him,
and that on the former occasion the foetus was put on the
fire alive to destroy it. Another woman gave evidence that
she had been aborted twice by him, had had criminal intimacy
with him, and that the second pregnancy was by him. Ten
pounds seems to have been his customary fee for the business.
When arrested be endeavoured to commit suicide by taking
tincture of aconite, but a dose of apomorphia administered
hypodermically defeated his intention.

MEDICAL MEMBBR8 OF PARLIAMENT IN NEW SOUTH WALKS.

There has been a dissolution of Parliament in New South
Wales recently, and several medical men have obtained cents in
the new House; I will give you their names in my next, as the

oogle

The Lancet,]

ROYAL COLLEGE OP SURGEONS OP ENGLAND.

[May 7,1887. 969

elections are not ail concluded. Cnarlea Kinnaird AlcKeliar,
M.B., one of the ablest medical men in Australia, was given
a portfolio in the late Ministry as Postmaster-Genera),
and was also Minister of Mines. He was chief medical
adviser to the late Government, and I do not know where
tbe present Government will find one to replace him if he
goes out with the Ministry from that capacity.

SYDNEY AND ADELAIDE HOSPITALS.

The annual report of the Sydney Hospital shows that
2808 cases were admitted during the past year, 1091 being
accident cases. The directors are £10,000 overdrawn at the
bank, and a new building, estimated to cost £60,000, is con¬
sidered essential. The report of the Adelaide Hospital Bhows
1878 admissions during the year, with a daily average of
174; deaths 164. Expenditure for the year £9679. The
Government will expend £3000 in improvements and
alterations.

MEDICAL PBACTICE IN QUEENSLAND.

I see that a correspondent (a “ poitrinaire ”) asks what
are tbe prospects of practice in Queensland. Queensland,
like all the other Australian colonies, is pretty well as much
overdone as England with respeot to the supply of medical
men, and their ratio to the population is even more than the
English average. Thirty-one new men have started practice
in Brisbane in the last five years. Of course, a good man
does well in any town in Australia, but not better, I should
say, than elsewnere.

MELBOUBNE UNIVEB8ITY APPOINTMENTS.

At a meeting of the University Council in January, M|r.
Baldwin Spencer was appointed to the chair of Biology;
Dr. 8pringtborp« to that of Therapeutics, Dietetics, and
Hygiene; J. B. Kirkland, Demonstrator of Chemistry ; and
J. W. Barrett, Demonstrator of Histology. At the February
meeting the principle of admitting women to degrees in
Medicine was adopted and referred to the Faculty of
Medicine.

POISONING BY ANTIMONY IN NEW ZEALAND.

A man has just been condemned to death for poisoning
his father-in-law by antimony early in 1886. He was
sentenced to penal servitude for life for the attempted
murder of his wife, by tartar emetic long administered in
her food, And suspicions having arisen after bis conviction
ior that offence, the body of his father-in-law was exhumed,
and ample evidence was obtained by analysis that all the
•viscera were saturated with tartar emetic.

TYPHOID.

This is very prevalent in Victoria at present, but Queens¬
land usually tops the list for the mortality from this disease,
though with a much smaller population. Brisbane contributes
largely to tbe sum total of that colony. As writers in the
papers here freely point out, typhoid was almost unknown
in Brisbane. Now typhoid is the third largest cause of
fatality in Queensland. Last year a great many horses
suffered from it in Brisbane.

COOKTOWN (QUEENSLAND) HOSPITAL.

This hospital is now over-full, crowded out mostly with
fever and other patients from the Bloomfield Tin Mines, and
as most of these patients do not belong to the district they
are a serious strain on the finances of the hospital, which
is in very straitened circumstances.

HAILWAY AMBULANCE COBPS IN NEW SOUTH WALES.
This movement is being carefully and energetically
carried out under medical officers appointed by the Railway
(State) Medical Board, and at a recent meeting of the corps,
medals and certificates were presented to railway employes
for proficiency in “ first aid.”

SALE OP POISON8 ACT IN TASMANIA.

A new Act has just been passed in Tasmania to regulate
;he sale of poisons, which contains a sensible and practical
regulation, taken, I believe, from the Canadian Act. Every
)oison sold is to have a written or printed label containing
jarticulars of the antidote for such poison.

CONSUMPTION HOSPITAL IN MELBOUBNE.

A movement is on foot to start an institution of this
iature for Victoria, and undoubtedly it would be a boon on
ccount alone of tbe number of cases ordered out from
Ingland to be cured by the Australian climate.

A steamer from China (the Chingtu) has landed a small-
ox patient at Port Darwin in the northern territory. Be

is now convalescent, and the cargo, after being fumigated,
was released.

The Intercolonial Medical Congress is progressing well.
Dr. Verco having been appointed president and Dr. B.
Poulton honorary secretary.

March 1st, 1887.

ROYAL COLLEGE OF SURGEONS OF ENGLAND 1 ,

At an extraordinary meeting of the Council held on
Thursday, tbe 5th inst., the minutes of the last meeting
were confirmed.

It was referred to the Library Committee to report on the
filling of the vacancy caused by the decease of Mr. Cbatto,
librarian.

The President reported that Sir James Paget had con¬
sented to deliver Che first lecture on Cancer and Cancerous
Diseases.

It was agreed that diplomas be forwarded to those candi¬
dates who passed the recent examination in Surgery.

A report, dated April 2nd, 1887, from tbe committee of
delegates of tbe Royal College of Physicians of London and
of the Royal College of Surgeons of England, on the ques¬
tion of tbe grant by the two Colleges of degrees in Medicine
and Surgery, was read, and, after discussion, was referred
for further consideration.

A report, dated April 27tb, 1837, from the President,
senior Vice-President, and Mr. Marshall, on the purposes to
which the unoccupied ground on the Embankment Delong¬
ing to the two Colleges can be applied, was read, and referred
to the Committee on the Extension of the College Premises
to report thereon.

It was resolved that tbe Secretary be instructed to prepare
an official abstract of the petition for tbe new Charter, and
that the same, when completed, be issued to any Fellow or
Member applying for the same. Notice icill be given when
this is ready. The Council do not think it expedient to
convene a general meeting of the Fellows and Members of
the College to consider and discuss the proposed draft of the
Charter, the subjects to which it relates having already
been submitted to previous meetings of Fellows and
Members.

The picture of the Council in 1884-5, by Mr. H. J. Brooks,
was presented by Sir T. Spencer Wells, on behalf of the
subscribers to it, and accepted by the Council with thanks.

A letter of the 18th ult.., signed, on behalf of the students
of the London Hospital, by Mr. F. Howard Taylor, and
forwarding a resolution adopted by the students in favour
of the grant by the two Colleges of the degree of "M.D.
Westminster,” was read and referred to the Committee of
the two Colleges.

A letter of the 30th ult. was read from the Secretary to
the Science and Art Department, South Kensington, offering,
through tbe Secretary of State for Foreign Affaire, to furnish
to the Austro-Hungarian Government tbe name of any
delegate whom the Council may wish to nominate to attend
the International Congress on Hygiene to be held in Vienna
in September next; and Sir T. Spencer Wells was nominated
by the Council accordingly.

LEON GOSSELIN.

By the death of Professor Gosselin, which occurred on
the 29th ult., after a long and painful illness, French
surgery has lost one of its most eminent representatives.
M. Gosselin took his degree at the age of twenty-eight;
the following year he was successful at the concours de
I'agrfyation, and in 1846 became Director of Practical
Anatomy at tbe School of Medicine. Twelve months befpre
he had gained the position of Surgeon to the Paris Hos¬
pitals, in which capacity he was successively attached to
the Lourcine, Cochin, Beauion, La Pitid, and La Charity. In
1858 he was named to the chair of Surgical Pathology,
which he occupied until the death of Velpeau, whom he
succeeded in 1867 as Professor of Clinical Surgery. Elected
a member of tbe Academy of Medicine in 1860, and of
the Academy of Sciences in 1874, in the place of Ndlaton,

Digitized by GoOgle

960 The Lancet,]

OBITUARY.—MEDICAL NEWS.

[May 7, 1887.

Gosselin bad attained all the distinction which French
science has in its gift. But a crowning honour was reserved
for the close of his life, and a few months before his death
he was called by the Academy of Sciences to its presidency.
Professor Gosselin leaves a number of works upon medical
and surgical science. Amongst these may be mentioned
“L’Osteite Epiphysaire des Adolescents," “Lemons sur les
Hernies Abdominales,” the “Compendium de Cbirurgie,”
different memoirs on Septicasmia, Purulent Infection and
Urinary Fever, V-Fractures of the Tibia, Tarsalgia of the
Young, &c., but his c/tef-iTasuvre is his “ Clinique de l’Hopital
de 1& Chari to,” a work which ranks justly with Trousseau’s
** Clinique de 1’Hotel Dieu.”_

JOHN MOORE, M.D.

7th Surrey R. V., and surgeon to the Royal South London
Dispensary. His death took place on April 25th, after six
weeks’ illness, from extensive disease affecting the pylorus.
He was a skilful practitioner, and esteemed as the kind
friend of his patients as well as th6ir medical attendant;
and the poor of his district have lost a trusted and sympa¬
thetic helper, who was always ready to aid them in their
time of need.

At the meeting of the Newington vestry on the 27th ult.
an intimation was received of the death of Dr. Iliff. A
resolution was unanimously adopted recording the vestry’s
appreciation of the deceased gentleman’s services during
thirty-one years as medical officer, and expressing sympathy
with his family. __

It was with deep regret that the Belfast public learned
on Tuesday of the death of Dr. John Moore. The sad event
occurred on Monday, May 2nd, at the Strathearn Hydro¬
pathic Establishment, Crieff, Perthshire, under exceedingly
melancholy circumstances. For some months past the
deceased gentleman had been in very poor health, suffering
from mental depression; indeed, he seems never to have
recovered the shock of his son’s death, which took place
about a year back. A week since, acting under medical
advice, lie left town for a complete change to Crieff. On
Sunday evening, it seems, he retired to his room at his
usual time, and in the morning was found dead in bed.
The unfortunate gentleman had evidently committed suicide,
the instrument used being a penknife, which was found
beside him. During his brief stay at Crieff Dr. Moore had
become known to several of the other visitors in the estab¬
lishment, but, in spite of his very depressed condition, no
danger was apprehended. Dr. Moore took his medical
degree in 1851, being one of the first to graduate in the
Queen’s University. After this he was appointed dispensary
medical officer in Glenarm, co. Antrim, and after residing
there for several years he removed to Belfast, and was
ppointed one of the surgeons to the Royal Hospital, a post
he held for sixteen years ; and since that he had been a con¬
sulting surgeon to the charity. He was also a life governor.
He was surgeon to the co. Antrim Gaol, a post which is now
at the disposal of the Government. Dr. Moore was the
founder and first secretary of the North of Ireland Branch
of the British Medical Association, and, also, a few years
ago was president. He afterwards became the secretary, a
post he held at the time of his death. When, in 1884, the
British Medical Association visited Belfast, Dr. Moore was
one of the local secretaries. He was also on active member
of the Ulster Medical Society, of which at one time he was

? resident, and for a long time he was medical officer to the
yrone Fusiliers. He was among those who established a
centre in Belfast for the St. John Ambulance Association, and
for a time acted as secretary. The deceased took an interest
in all charitable and philanthropic movements. lie was one
of the members of the Throne Hospital Committee, and was
closely connected with the Young Men’s Christian Associa¬
tion (of which he was one of the oldest vice-presidents) and
the Prison Gate Mission. He was also local and honorary
secretary to the British and Foreign Sailors’ Society. Dr.
Moore leaves a widow, three daughters, and a son, with all
of whom sincere and oeep sympathy is felt in their very sad
bereavement, and especially with one of his daughters, who
accompanied him to Crieff, and who was placed in a most
sad and painful situation among those who were comparative
ctrangers. '

W. TIFFIN ILIFF, M.D. Lond. • ■

We record with much regret the death of Dr. William Tiffin
Iliff, who waa in practice for more than forty years—
succeeding his father. Dr. W. T. Iliff, in 1803 —at Newington-
butts, South London. He was appointed medical officer of
health for Newington in the year 1856, and retained the
office with perfect satisfaction to the Authorities until his
death (a period of thirty-one years). Bom at Newington
in January, 1824, his education was commenced, at Shrews¬
bury, whence he proceeded to Guildford, and afterwards to
King’s College, London. He entered at Guy’s Hospital about
1841, passed snccessfslly through his career, taking medals
See., became a Member of the College Of Surgeons and
Licentiate of the ApotbeCaite*’ Society in 1845, M.B; Lond.
.id 1855, and Mi), in 1856. ■ He was hon. surgeon to the

HtcVual fttfos.

Royal College of Surgeons of England. —The
following gentlemen having passed all the necessary exami¬
nations were at an extraordinary meeting of the Council on
the 5th inst. admitted Members of the College:

Labey, Julius. L.R.O.P.L.
Lankester, Francis J.. L.R C.P L.
Lawrence. Thomas Wm. Pelham.
Lumley, Charles Armstrong.
McLean, W. W. Laroche, L.S.A.
McLurg, John, If .1). Toronto.
McVety, A. F., M D. Kingston.

Andrews, Frederick William.
Arnison. W.Drewett. M.H.Dur.
Bacot, W. Rickwiird, L.S.A.
Baldwin. Harry.

Ballance. J.Desc:irriere9.L.li.C.P.
Barker. AUcyne, H., L.R.C.P.L.
Barr, Horace Carlos, L.R.C.P.L,
Barrett, F,dward Kniest.

Barton, Francis A., L.K.C.P.L.
Batchelor, Charles, L.It.C.P.L.
Bishop, Charles Rosser, L.S.A.
Blurton, John Frederick.

Bowden. Ernest Edward. L S.A.
Bower, William G., L.It.C.P.L.
Brackenbury, H. B., L.R.O.P.L.
Brook, William F., L.S.A.

Brooke. Charles Edward.

Browne, ltobley Henrv John.
Burke. II. Morton. L.R.O.P.L.
Burt, Ovrll Cecil Barron.

Ourter, "Robert James, L.S.A.
Caudwell, Eber. L R.C.P.L.
Chilcott. Arthur E.. L.R.C.P.L.
Clarke. A. B., L.K.Q.C.P.I.
Cockill. W. Baron, L.R.O.P.L.
Connolly, F. Glvnn, L.R.C.P.L.
Cox, A. "H. Lissant, L.R C.P.L.
Coy, W. Flltner, M.D. Kingston.
Dalgliesh, John W., L.R.O.P.L.
Dane, Robert. L.S.A.

Davenport, Cecil J., L.R.C.P.L.
Davies, Hughes Reid.

Klllaon, B. Henry. M.A., L.S.A.
Farrar. Reginald Anstruther.

Fox, George Martin.

Fox, S. C. Gundrv, L.R.C.P.L.
Gardner, Ernest F., L.R.C.P.L.
Garman, B. C., L.R.C.P.L.
Glddlngs, George Thomas.
“Goodman, Roger N., L.R.C.P.L.
Goodwin. F. C.. L.R.C.P.L.
Gowan, Bowie Campbell, L.S.A.
“Green, Conrad T., L.R.C.P.L.
Greig, Duncan Mcllean.

Hallilay, Richard Percy. L.S.A.
Hamel-Smith, Lionel. *
Harris-Liston, Llewellyn, L.S.A.
Harrison, Henry Leeds.

Hensley. Arthur Kgerlon, L.3.A.
Hitmen, Joseph Squier. L.S.A.
Hosegood. Samuel Price. L.S.A.
Hudson, Henry. L.R.C.P.L.
Mutton, John, L.R.O.P.L.

Iddon, Thomas Whittaker.
“James, Arthur WlIHam, L.R.O.P.
Jaqnes, John Warren, L.R.O.P.
Joseph. Arthur Hill.

Kerens, Felix.

Marston, Henry John, L.R.C.P.
Meggioaon. Mowbray.

Metzgar. Cltarles. L.R.C.P.L.
“Mlley, Miles, L.R.C.P.L.

Mould, William T.. L.K.C.P.L.
Naumann, John C. F., L.S.A.
Osmond. Edward B.. L.R.O.P.L.
Parry, Wm. T., M.D.Toronto.
Parsons, Charles O., L.R.O.P.L.
Paul. Arthur E-. L.R.C.P.L.
“Peake, W. Pemberton, L.R.O.P.L.
Penno, Francis F. L.. L.S.A.
Pitcairn, John James, L.R C.P.L.
Pratt, William Sutton. L.3.A.
Pullan, H. N., L.K Q C.P.I.

Pye, Thomas. L.K.C.P.L.

Rees, John Morgan.

Roberts, Shirley. L.K.Q.C.P.I.
Robson, H. Barker, M.B. Durh.
Rutherford, John V. Walton.
Sharman, J. S W. K.. L.R.C.P.L.
Short, James Joseph, L.S.A.
Shute, G. Sidney. L.R.C.P.L.
Sidebothsm, E. J., M.B.Cantab.
SkilL James Maurice.

Smith, Arthur H., L.R.C.P.L.
Smith, B. S.. L.R.C.P.L.
Somerset, Edward, L.S.A.

Stokes, F. Wm., L.K.Q.C.P.I.
Stuart, Thomas B., L.R.C.P.L.
Swyer, Robert, L.S.A.

Thompson. W. H.. M.D., Q.U.I.
Todd. H. B.. L.R.C.P.L.

Travers. A. Lindsay, 1,-B.CJX.
Tumbull. George Lindsay.
Turner, Brneat Blaker.

Tweed, E. R., L.R.C.P.L.

Venls, Walter, L.S.A.

Vinoent, H. E.. L.R.O.P.L.
Vinter, S. Garrett. L.R.C.P.L.
Waites. R.P., L.R.C.P.L.
Walker, Benjamin, L.S.A.

Wallis, Maurice B. Arnold.
Ward, John Alfred, L S.A.
Wedgwood. Wm. B.. L.S.A.
Wheeler, James Atkin.

Whlston, Philip H.. L.R C.P.L.
Wtgglesworth. V.. L.R.C.P.L.
Wight, John Cam. M.B. Ueii).
Williams, William. L.S.A.
Woods, Ninlan Wildridge.

King, Preston, L.S.A.

* Candidates under the Regulations of the Examining Board ic
England.

University of Cambridge.— At a congregation held
on the 30th ult., the following degrees were conferred : —
Bachelor ok MKDicnr*.—Frank Edward Nichol, GonvIUe and Calm;
William John Ilill, Jesus.

Bachelor of Surgery.— Frank Edward NIehol. Gonville and Cains.

Faculty of Physicians and Surgeons of Glasgow.—
At the April Examination the following candidate was
admitted a Licentiate :—

Barnes, Ernest W., L.K.Q.C.P.I., Liverpool.

The following candidate obtained the qualification in Public
Health;—

Kiddle, Walter, M.B. Dub., Surgeon, Mediae! Staff.

The following candidate having passed the full Exanu*

e

M

The Lancet,]

MEDICAL NEWS.

{May 7,1887. 961

nations for the Fellowship, was admitted a Fellow on the
•2nd inst.

Dalzlel, Thomas Kennedy, M.B., C.M. Edin., Regent-terrace,
Glasgow.

Royal College of Surgeons in Ireland. —At
reeent examinations the following were admitted Fellows of
the College:—

Curran, Francis G. Adye, A.M.S. | Sawyer, R. H. Stewart, A.M.S.

College of Physicians in Ireland. —At the
April examinations the following obtained licences in
Medicine and Midwifery of the College:—

Medicine. —Patrick Hallon Fox, Bartley Hynes Hopkins, Edward
Stewart I.ewer, Joseph Maguire, A. Kennedy Forbes McCutcheon.
Samuel McKee, Thomas Alexander Murray, Humphreys Robert
Penre, Michael Rlordan, Shirley Roberts, Nelson Camerou Solater,
William Thomaa Steele, James St.. Johnston, Jabez Davenport
Wardle.

MrDwiFKitY.—Edward Stewart Lewer. Joseph Maguire, Samuel McKee,
Humphreys Robert Peare, Shirley Roberts, William Thomas Steele,
and Jabez D. Wardle.

The under-named have been admitted Fellows: —

W. Beatty. | E. McDowel Cosgrove.

Alexander Duke.

Society of Apothecaries.—T he following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on April 28th:—

Bowden, Ernest Edward, Gorsefleld, Patrlcroft.

King, Preston, Barton-place, Bury 8t. Edmunds.

Rees, John Morgan, Machynlleth.

8hort, J. J., 8taortlanda, 8penoer Park, Wandsworth Common.

Somerset, Edward, Newbury, Berks.

Stephens, Richard John, Woodlands, Old Chariton.

Oxford University. — Dr. Brooks has been
appointed Lichfield Clinical Lecturer in Medicine, and Mr.
Horatio Symonds Lichfield Clinical Lecturer in Surgery,
each for two years.

The Levee.—J ohn Sherbum, Esq., M.B., C.M., in
his capacity of Sheriff of Kingston-upon- Hull, was present
at the levSe held at 8t. James’s Palace on the 26th ult.

The Royal Society.—A mongst the candidates
selected by the Counoil to be recommended for election into
the Royal Society are Dr. W. R. Gowers and Dr. J. T. Cash.

The proceeds of the recent ball at the Brighton
Royal Pavilion, in aid of the funds of the local Hospital for
Women and Children, amount to £81.

National Health Society.—T he annual general
meeting of the Society was held at 44, Berners-street, on
the 2nd inst. The report showed a great increase in the
number of health lectures given in poor districts in London
during the past year.

Medical Magistrate. —The Lord Chancellor, upon
the unanimous recommendation of the Town Council and
t he Borough Bench of Magistrates, has placed the name of
-Mr. Vincent Jackson upon the Commission of the Peace for
Wolverhampton.

Presentations. — On the 23rd ult. Mr. 0. B.
Shelswell was presented by the officers of the Holbom Union
Infirmary with an electro-plate tea and coffee service, on
the occasion of his resigning his post as assistant medical
officer at that institution, to take an appointment under the
same Board of Guardians, at their new workhouse at

Mitcham.-On the 26th ult., Mr. E. T. Ash was presented

by his colleagues on the staff of the Brighton Dental
Hospital with an illuminated address,* on the occasion
of his leaving England for South America.——In recogni¬
tion of Mr. H. B. Vincent’s services as a lecturer, the East
Dereham members of the various classes in connexion
with the St. John Ambulance Association have presented
him with a hall clock and some volumes of medical Htera-
ture, and the ladies of the Grbssenhall class have also pre¬
sented him with a handsome ivory paper knife.—“-At a
meeting of students of the Charing-croas Hospital, held bn
Thursday last, in the Board-room, a testimonial was pre¬
sented to H. Montague Murray, M.D., M.R.C.P., on the
occasion of hie marriage and in recognition of his services
us medical registrar during the last five -years* The testi¬
monial was presented by Mr. 0. P. Oliver, and Cock the
form of a dock of the time of Henry II., heing Copied from
the Catalogue of 'the Archaeological collection of Prirfce

Dr. Edward Palmer, the medical superintendent
of the Lincoln County Asylum, haying, after thirty-nine
years’ services, sent in his resignation, the Visiting Com¬
mittee have submitted a recommendation, to the Quarter
Sessions of Lindsey, Kesteven, Holland, and the Town
Councils of Lincoln, Stamford, and Grantham, to award him
a superannuation allowance of £600 per year.

Anniversaries of Belgian Medical Societies.—
The Antwerp Medical Society lias recently held a grand
meeting in honour of the fiftieth anniversary of the Society’s
foundation. The mayor of Antwerp and Professors Lefebvre,-
Van Beneden, Dumonlin, Boilde, and Thiry were present at
the banquet.—The Belgian Society of Public Medicine has
just celebrated its tenth anniversary, under th8 presidency
of M. Kubom. There was a theatrical entertainment and
meetings of various sections. At the grand final meeting
the King and his suite and the Minister of the Interior .were
present.

University of London. —The following Examiners
for 1887-88 were elected at a meeting of the Senate on the
27th ult.:—Chemistry: Prof. J. Emerson Reynolds, M.D.,
F.R.S., and Prof. W. A. Tilden, D.Sc., F.R.S. Botany and
Vegetable Physiology: Prof. Bayley Balfour, M.D.,’ D.Sc.,
F.R.S., and Prof. F. Orpen Bower, M.A. Comparative Anatomy
and Zoology: Prof. E. Ray Lankeater, M.A., F.R.S., and Adam
Sedgwick, M.A., F.R.8. Practice of Medicine: William
Cayley, M.D., and Prof. F. T. Roberts, M.D., B.Sc. Surgery:
W. Morrant Baker, Esq., and Prof. Christopher Heath.
Anatomy: Prof. D. J. Cunningham, M.D., C.M., FJR.S.E., and
Prof. John Cumow, M.D. Physiology: Prof. E. A. Schafer,
F.R.S, and Prof. Gerald F. Yeo, M.D. Obstetric Medicine:
F. H. Champneys, M.A., M.B., and John Williams, M.D.
Materia Medica and Pharmaceutical Chemistry: J. Mitchell
Bruce, M.D., M.A., and T. Lauder Brunton, M.D., D.Sc., F.R.S,
Forensic Medicine: Prof. G. V. Poore, M.D., B.S., and Thomas
Stevenson, M.D.

Queen’s College, Belfast. —The following is the
official list of the results of the medical examinations in
April:—Anatomy and Physiology: Third Year—J. M. Hall.
Second Year—S. A. Powell, B.A.; H. L. Atkinson, B.A.;
James Fulton; Robert Forsyth. First Year—John Jamison j
Douglas Maoonachie. Practical Anatomy: Third Year—
J. M. Hall; R. C. McCullagh, B.A., and D. C. Smiley, equal;
James Buchanan; C. E. Shaw, MA.; James Hunter.
Second Year—James Fulton; S. H.Withere; James M‘Connell
and Nathaniel Morton, equal. First Year—(J. S. B.
M'Murray, non. mat.); K. B. Barnett; James Adrian ; (W. A.
Collier, non. mat.). Medicine: Second Year—John Campbell,
M.A.; R. C. M'Cullagh, B.A. First Year—Robert Wilson
and M. H. Quarry', equal; Robert Thomson. Surgery:
8enior—John Campbell, M.A., and James Hunter, equal;
R C. M'Cullagh. B.A.; C. E. Shaw, M.A. Junior—J. M.
Hall; Robert Wilson; M. H. Quarry. Materia Medica;
Nathaniel Morton; W. II. Cox; H. J. Anderson; James
Fulton. Midwifery: D. C. Smiley; Robert Thomson;
Robert Wilson and C. E. Shaw, M.A., equal. Practical
Chemistry: John Jamison and E. W. M'Bride, equal;
Nathaniel Morton. Zoology: G. S. Hart; Andrew FuHerton ;
Thomas Jackson,

Scholarships and Prizes. —At the London Hospital
Medical College, the hospital scholarship, value £20, for
proficiency and zeal in clinical medicine, has been awarded
to Mr. C. R. Killick, and an honorary certificate to Mr.
Benjamin Walker; the hospital scholarship, of the value
of £20, for proficiency and zeal in clinical surgery, to Mr.
Evelyn Oliver Ashe, and honorary certificates to Mr. Owen
Meredith Jones and Mr. Benjamin Walker; and the Duck-
worth-Nelson prize in practical medicine and surgery, value
£10, to Mr. Benjamin Walker, and an honorary certificate to
Mr. Owen Meredith Jones. — At the Middlesex Hospital
Medical School, the Broderip scholarships, of the value of
£30 per annum and tenable for two years, has been awarded
to Mr. W. II. Vickery, and that of £20 per annntn, tenable
for two years, to Mr. E. E. Lewis.—At St. Thomas's Hospital
Medical School, the William Tite scholarship of £30 has "been
awarded to Mr. Henry Burden; the Muegrove scholarship,
of £42 per. annum, tenable for two years, to Mr. Arthur
Francis Stabb; the second tenure of the Peacock scholarship
to Mr. Francis Charles Abbott; the Mead medal to Mr.
W. W. Ord; and the Cheselden medal and the Treasurer’s
gold medal for. general proficiency and good conduct to
Mr. Frank Fawssett.

3 y Google

962 The Lancet,]

MEDICAL NOTES IN PARLIAMENT.—BOOKS ETC. RECEIVED.

[May 7,1887

Ophthalmological Society. —A special meeting of
this Society is to be held on June 23rd for the purpose of
collecting fact9 in reference to toxic amblyopia. Communi¬
cations, whether written or viva voce, which bear on the
subject will be acceptable. Facts in elucidation of the
following points are particularly desirable1. Coses of true
alcoholic amblyopia—i.e., failure of central vision in drinkers
who do not U9e tobacco in any form. 2. Cases of recovery
from any form of toxic amblyopia—e.g., from tobacco,
bisulphide of carbon, &c.—without complete discontinuance
of the toxic agent. 3. Cases of complete persistent pallor
of the optic disc consequent on a long-continued exposure
to any of these forms of poisoning. 4. Do second attacks
of central amblyopia ever occur, whether induced by the
original agent or by any other ?

Hospital for Epilepsy and Paralysis, Regent’s-

pabk.— The annual meeting of this institution was held on
Wednesday at the Eyre Arms Assembly-rooms. The report,
the adoption of which was moved from the chair by General
Maclagan, R.E., laid stress on the great need of funds
generally prevailing among the London hospitals, and con¬
gratulated the supporters that the debt had only increased
£60 during the past year. He expressed the hope that
the “ jubilee” which marked among the Jews a time for
“ setting free ” from bondage would be characterised by a
similar liberation of the hospitals from the “bondage of
debt.” The Right Rev. Bishop Perry seconded the motion.
The reappointment of the retiring members of the committee
was moved by Sir W. Magnay, Bart., who said that the
administration by his colleagues of the funds at their dis¬
posal was a far easier task than the collection of funds to
administer. Mr. R. B. Chapman alluded, as a regular visitor
to the wards, to the distressing nature of the diseases treated
in the hospital, and to the great need of such an institution.

BOOKS ETC. RECEIVED.

BAiiiifcHK. Tindall, A Cox, King William-street, Strand, London.

Brief Statement of the so-called “Salisbury Plans" of Treating, by
Alimentation. By J. H. 8alisbuiy. M.D. pp 64.

A Manual of Veterinary Hygiene. fly Fred. Smith, M-R-C.ViL
pp. 475, Illustrated.

Churchill, J. ft A., New Burllngton-etreet, London.

The Treatment of Spina Bilida by a New Method. By James
Morton, M.D., L.H.O.S.Bd. pp. 228, with 3 plate*.

Griffin, G., A Co., Exeter-street, Strand, London.

Yew-book of the Scientific and Learned Societies of Great Britain
and Ireland. Compiled from Official Sources. Fourth Annual
Issue, pp. 223.

Hughes, John, Pilgrim-street, Ludg.ite-hill, London.

The Principles and Practice of 8chool Hvgiene. By Alfred
Carpenter, M.D.Lond. pp. 368, with Illustrations.

Kegan Paul, Trench, A Co., Paternoster-square, London.

The Prevention of Consumption: a Mode of Prevention found**.*
upon a new Theory of the nature of the Tubercle Bacillus. By
C. Candler, Melbourne, pp. 210.

Lxwis, H. K., Gower-street, Loudon.

Photography of B icterla. Bv Edgar M. Crookshank, M.B.Lond..
F.K.M.9. pp. 61 . with 86 Photographs, reproduoed In antotype.

Trentment of Disease in Children, including the outline of
Diagnosis and the chief Pathological Differences between
Children atnl Adults. By Angel Money. M.D., M.B.C.P. pp.2se.

The Officinal Materia Medica. By F.'T. Roberto, M.D., B.Sc.„
F.R.C.P. Second Edition, pp. 543.

The Essentials of Bandaging. By Berkeley Hill, M.D.Lond..
F.It.C.9. Sixth Edition, revised*and enlarged, pp. 366, withi
Illustrations.

Congenital Club-foot, its Nature and Treatment. By R. W. Parker,
pp. lo5, with Illustrations.

Syllabus of Materia Medica. Bv Alexander Harvey, M.D., and
A. D. Davidson, M.D. Eighth Edition, pp. 64. '

LmNGSTONB, E. ft S., Edinburgh.

Anatomy of the Brain and SpiDal Cord. By J. R. Whittaker,
pp. 133, with Engravings, some coloured.

MEDICAL NOTES IN PARLIAMENT.

The Prevention of Babies and Hydrophobia.

In the House of Lord* on the 2.1th utt., Lord Mount-Temple called
attention to the regulations for the prevention of rabies and hydrophobia.
He considered the present method of muzzling bull injurious to the dogs
and inefficient for the purpose of preventing the spread of the disease.
The principle upon which he had proceeded in framing his Bill was to
place a responsibility upon the owner of the dog, who should have
presented to him such a statement of the premonitory symptoms
of rabies as were set forth In one of the Orders issued by the Agri¬
cultural Department of the Council. In addition to the present
regtster of persons who had paid the dog tsx and obtoinod a licence,
there ought to be a register of the dogs themselves as well as of
the owners. When the tax was paid, he proposed that there should
he given to the owner of the dog a badge bearing a number,
Which should be p’aced on the collar of the animal. This number being
registered, could always be seen; and if a dog was found wandering about
in the streets or roads without a collar, It would be primA facie evidence
that the animal was ownerless, when it might be token up by the
PoHce. The Bill did not propose to interfere with any of the existing
regulations, but placed It within the power of the authorities to add
the method of registration he had described and placing responsibility
npon the dog owner as an alternative for the muzzle.—Lord Craubrook
thought the ordinary powers only required to be put in force to stamp out
rabiee. In 1885 there were notless than seventy-five caaea of rabies in the
metropolitan area, and besides that twenty-eight people died of hydro¬
phobia In and close to London. Muzzling was enforced, and the number of
cases Immediately fell. The bestauthoritieswereof opinion thatthedisease
might bn stamped out altogether by a universal system of muzzling.—
The Earl of Kimberley hoped the authorities In the metropolis and
throughout the country would not be deterred by an v outcry that might
be raised against the muzzling of dogs from doing what was possible to
stomp out the disease.—The Bill was read a first time.

The Cold Bath for Lunatics.

In the House of Commons, on the 3rd Inst., Dr. Kenny asked the Chie
Secretary, with reference to the case of " Lamb v. Ashe," tried recenth
before the Recorder of Dublin, under what rule of Privy Council or orde:
of Lunacy Department the use of the cold plunge bath was permittee
a* a punishment for lunatics.—Colonel Klng-Hurman said the nsc of thi
cold plunge bath for curative purpose* had been sanctioned under a ml*
of tlicDundrum Asylum, but the Irish Government had now given order
for its discontinuance.

Impure Water-supply.

In reply to Mr. Norton. Mr. Forwood (toted that a long report ha<
been received with reference to the supply of Impure water to Hei
Majesty s ships at Malta, resulting In a serious ontbreak- of enteric fever
and that the tanks wore periodically tested and cleansed.

Public Sanitation.

r ‘ F. Powell gave notice that on an early date he would introduce i
Bill to amend and extend the Public Health Act of 1875, and to con
stMldate the statutes relating to the public health which had been passe*
since that year. ,

Leave to introduce the Temporary Dwellings Bill was obtained m
Wednesday. It has for its objects the education of gipsy and v*i
children and the bringing of sanitation into their home*.

Longmans, Green, ft Co., Paternoster-row, London.

A Text-book of Organic Materia Medica. By Hobert Bentley,
M.R.C.S., F.L.S. pp. 415, with many Illustrations.
Maclachlan ft Stewart, Edinburgh. Simpkin ft Marshall, London.
The Dissector's Guide: a Manual for the use of Students. By
D. J. Cunningham, M.D., As. Head and Neck. pp. 482. with.
57 Illustrations.

Macmillan ft Co., London and New York.

A Textrbook of Pharmacology. Therapeutics, and Materia Hedies.
By T. Lauder Brunton, M.D., D.So.. F.R.S. Adapted to the
United States Pharmacopuua bv F. H. Williams, M.D.Boston.
Third Edition, pp. 1261. with Illustrations.

New Sydenham Societt, London.

Lexicon of Medicine and the Allied Solenoes. By Henry Power;
M.B., and Leonard Sedgwick, M.D. Part 13. Her—11m.
Remington ft Co.. Henrietta-street. Covent-garden, London.

The Misuse of Marriage, or Hymen Profaned. A Voice, pp. 221.
Smith, Elder, ft Co., Waterloo-plaoe, London.

Post-mortem Handbook, or How to Conduct P.M. Examinations
for Clinical and for Medicolegal Purposes. By Thomas Harris.
M.D.Lond.. M.R.C.P. pp. 78, with Illustrations.

Neurectasy, or Nerve-stretching for the Relief or Cure of Pain.
Bradshawe Lecture. With Appendix. By John Marshall,
F.R.S., ftc. pp. 63, with Illustrations.

Vizktkllt ft Co., Catherine-street. London.

Dr. Phillips: a Maida-vale Idyll. By Prank Danby. Second
Edition, pp. 342.

Ward ft Downey, York-street, C oven t- garden, London.

Travels In the Interior; or the Wonderful Adventure* of Luke
and Belinda. By L. T. Courteney. Edited by a London Phy-
eioian. pp. 316, with Illustrations.

L’Hnselgnement actuel de 1'HvglSae dans lee Faculty* de M$declne er»
Europe; par le Dr. W. Loewenthal (Sondier, Paris).—How to Appeal
against your Rates; by A. D. Wilson, M.A. (B. Wilson, London).—The
Imperial Review, April (Melbourne). — The Jubilee Penny Cookery
Book (Simpkin and Marshall).—Index Medians (Index to Vol. VIII. .
—England as a Petroleum Power; by C. Marion (Andersen, Cockspur-
street).—Journal of the College of Science, Imperial University, Japan,
Vol. I., Part 1 .—Bibliographic des Sciences Medicalee (BaUliCre et Pils.
Paris).—Botany Notes, Parts I. and II.; by Alex. Johnstone, F.Q.S,
Us. —The Defence of Insanity in Criminal Cases; by L. F. Bvereri.
M.A., LL.D. (Stevens and Sons). 1*. 6d.— Scheme of Case-reporting -.
arranged by W. H. Allchin, M.B. &e. (Lewis). Is.—L'Enucleation c*u
Extirpation Intr&glandulaire da Goitre Parenohymateux; par le Dr.
S. Kesser (Schiller, Paris).—Notes on Chinese Materia Medica; by
ChA*. Ford, F.L.8.—Transactions of the Medical and Physical Society
of Bombay, No. IX. —Paracelsus-Forsciiungen; von Drs. B. Schubert
and K. Ludhoff; ersfees Heft.—The London Hospitals and the Jubilee .
by H. Nelson Hardy, F.R.C.8.Bd.—Index Medians, Vol. IX.. No. S.—
Magazines for May: Good Words, Sunday Magazine, Leisure Hour,
Sunday at Home, Boys' Own Paper, Girls’ Own Paper. Soribuer >
Monthly.—Die Diagnose dor Blasen-und Nlcrenkrankheiten mlttelst
der Harnleiterplnoette; von Dr. M. Tuohmann (Hirschwald, Berlin).

Th* Lancbt,] APPOIRTMESTS.—VACANCIES.—BIRTHS. MARRIAGES, AND DEATHS. [May 7, 1887. 168

Appointments:

fcrrrip*irf applicant* far Vacanetei, Secretariat of Public Institution!, and
otKert possessing information suitable for tbit column art invited to
forward it to The Lancet Office, directed te the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in

tko next number. _

R nT Theodore, B.A.. H.B.. B.Ch.Dob.. hat been appointed Medical
Officer to the Morchard Bishop District of the Gredlton Union.

e.iwwiH G. Altrsd. M.B. Lond.. has been appointed Reaident
Mediaal Officer to the Bvelina Hoepital for Children. vloa Albert
Martin, M.D.Lond., resigned.

Cook, Thomas D., M.B., CM.Olaa.. has been appointed Medical Officer
for the Torquay District of the Newton Abbot Union.

Dm, Bernard. B.8c., F.G.8., has been appointed Public Analyst for
the City of Truro.

Bnsor, Hknry 0.. M.H.C.*., L.S.A., has been appointed Burgeon to the
Oardiff Bye and Bar Hospital.

Pox. B. L.. M.A., MJB., B.C.Cantabs M.B.C.S„ has been appointed
Senior Hou»e-8urgeon to the Liverpool Children’s Infirmary, vioe
Francis Johnston, resigned.

GooDiix, John K.. L.R.C.8., L.B.C.P. Bd., has been reappointed
Medical Officer of Health for the Bolsover District of the Oheater-
fleld Union.

Oraht, Davyd. M.A., M.B.Bdin.. has been appointed Lectern- on
Materia Medico. Medical Botany, and Blementary Thampootios in
the University of Melbourne.

Green, B. W., M.R.C.S., has been appointed House-Surgeon to the
Leeds General Infirmary.

Babilit, Horace. M.R.O.S.. L.B.0.PJM., has been appointed Medical
Officer for the Workhouse and for the Stone District of the Stone

Union.

Nicholson, C.. M.B.C.S., has been appointed House-Surgeon to the
Leeds Infirmary.

Pam. John William. L.B.C.P., L.B.C.S.Bd.. L.P.P.S.Glas., has been
appointed Surgeon to the Bettisfleld and OoleshiU Collieries,
BagiUt.

Pun. Joseph. L.P.P.S.Glas., L.S.A., has been appointed Modloal
Officer for the Parish of Falkirk, sice Hadden, deoeas e d.

Peabcsy. James J. W., L.B.O.S., L-B.0.P.Bd., has been appointed
Medical Officer for the Howden District of the Auckland Union.

Price. Arthur. M.B.O.8., L.S.A., has been appointed Surgeon to Her
Majesty’s Prison at Wlnson-green, Bi rm i n gham, vice Waterton,
deceased.

Primrose, Alexander, M.B., O.M.Bdin., has been appointed House-
Surgeon to the PAddington-green Children's Hospital, vioe Leonard
O. Guthrie, M.A., M.B.C7S., L.S.A., whose appointment has
expired.

Soukts, William Lake. M.B.C.S., L.M., L.S.A— has been appointed
Surgeon to the Bradford District of the Great Northern Bail way.

Travers. William, M.D., P.B.C.8.. late Senior Assistant Phyiiclan to
the Chelsea Hospital for Women. Pulham-road, 8.W., has been
appointed Physician to that institution.

Warner, P. A., M.B.O.8., LBB.P., L.S.A., has been appointed
Surgeon to St. Gabriel's Hospital for Infanta, Chelsea, vioe
J. Cantlie, F.B.C.8., resigned; also Assistant Medical Officer to St.
John’s Lying-in Home, Gunter-grove, S.W.

Wilson. Francis, L.B.O.8., L.H.O.P.Bd., has been appointed Medical
Officer for the North Keighley District of the Keighley Union.

©acantus.

As etmphenot with Us deoiro of numerous eubocribort, it bat been decided te
resume tke publication under tbit head of brief particular! of tke various
Vacancies which are announced ia our advertising columns. For further
information regarding rack vacancy reference should be made te the

Blackburn and Bast Lancashire Infirmart. — Honse-Surgeon.

Salary *100 per annum, with board, washing, and lodging.
Cmarino-cross Hospital, Strand, W.C.—Assistant Burgeon. Medical
Registrar.

Hospital for Consumption and Disrasrs or the Chest, Hamp¬
stead.—Two Clinical Clerks for the out-patient department.
Hospital for Women. Soho-square, W.— Clinical Assistants. Fee for
course of three months. £6 os.

Lincolnshire Countt Lunatic Asylum. Braoebridge. — Medical
Superintendent. Salary and emoluments *400 per annum, with
furnished house, coals, (ptt, milk, vegetables, and washing.
Liverpool Infirmary for Children. — Assistant Honse-8nrge<m.
Board and lodging In lieu of salary.

Liverpool 8tanlet Hospital.— Senior House-Surgeon. Salary *80,
with board, to.

Madagascar Medical Mission. — Superintendent of Hospital Ac.

Salary *150 to *300 a year, house, outfit, Ac.

Mason Science College, Birmingham.—Professor of Physiology.

National Dental Hospital, Great Port land-street, W ■ — A ssis t a n t
Dental Surgeon:

National Hospital fob the Paralysed and BpnjtPTic, Queen-
square, Bl xmisburv. — Senior Houae-Physioian.- Salary *100 per
annum. Junior House-Phyaician. Salary *50 per annum. In
each cate board and apartment! are supplied in the hospital.

Bochdalk Infirmary and Dispensary.— Beaident Medical Officer.
Salary £80 per annum, board, Ao.

Boyal Albert Hospital. Devonport. — Assistant House-Surgeon.
Board and lodging in the hospital, but no salary.

Staffordshire General Infirmary, Stafford. — Assistant House-
Surgeon. Board and lodging, but no salary.

St. Mary’s Hospital, Paddington, W.— Physiolan In charge of out¬
patients.

St. Thomas’s Hospital Medical School.— Leoturer on Systematic
Physiology.

. Teignmouth, Dawlish, and Newton Infirmary and Convalescent
Home.— House-Surgeon and Dispenser. Salary *71 per annum,
with board (beer excepted), lodging, and washing.

Went Sussex, Bast Hants, and Chichester General Infirmary and
Dmpensart.— House-Surgeon and Assistant Secretary. Salary *100
a year, with board and rooms.

§irt|s, Ufarriaps, anb Jtatfrs.

BIRTHS.

Brown.-O n the 16th ult.. at Penang, the wife of Wm. Carnegie Brown,
M.D., of a son.

Ckipperfikld. —On the 31st nit., at Bloxam. the wife of Pearse
Chlpperfleld, L.B.O.P., M.B.C.S.. of a daughter.

Or nutwood.— On the 1st Inst., at High-street, Ctapham, the wife of
C. D. Greenwood, M.B.C.S., of a son.

Hadershon. —On the 1st inst., at Upper Wlmpole-street, W.,the wife of
8. Herbert Habershon, M.B.Cantab., M.B.O.P.Lond.. M.B.G.8.. of a
■on.

Milne. —On the 30th nit., at Aoarington, the wife of Thomas Milne.
M.A..M.D., of a son.

Pewfold.- On March 17th, at Sandhurst, Victoria, the wife of O. Penfold,
M.B.O.S., L.S.A., of a daughter.

MARRIAGES.

Carter— Jones.— On the 37th nit., at 8t. Peter’s Church. Bournemouth,
W. Fltxwllliam Carter, L.B.O.8.I.. L.B.C.P.Hd.. to Florence Archer,
daughter of John Averay Jones, Bsq., J.P.. of Vale House, Clifton.

Cotes—Allingham.— On the 80th nit., at St. George's. Han over square.
Charles B. Cotes. M.B.Cantab., to Blltabeth Christiana (Lily), elder
daughter of Wm. Allingham, of Orosvenor-street, W.

Davenport—Sievwbight. —On the 38th ult., at Holy Trinity Church,
Hobart. Tasmania. Arthur Frederick Davenport. M.B.Lond..
M.B.O.8., of St. Hilda, Melbourne, to Alllne, daughter of the late
Major Allan Sievwright, Boyal Artillery.

Frith— Farnoomb.—O n the 38th ult., at Holllngton Church. Baptist
Gamble Frith. B.A.. M.B., B Ch..to Georgina Anne, eldest daughter
of Edward Farnoomb, Bsq., of Asbbrooke-park, Holllngton.

GARS0N.-AflPiNALL.-0n the 30th ult.. at BcMngton Parish Church,
W. B. J. Garson, M.B., to Bmmeline. fifth daughter of Olarke Asplnall,
Bsq., J.P.. and Coroner of Liverpool.

Miles—King— On the 28th nit., at Melbourne. Victoria. Geo. B. Miles,
M.B.C.S.. L.B.O.P.Lond., to Ada Louise, youngeat daughter of the
Bev. Bichard King, formerly of Preatwioh.

PamloE— Hay.— On the 28th ult., at Holy Trinity Church, Worthing.
Henry Heath Parsloe. M.B.O.S., L.B.C.P., to Emily Ann, daughter
of Hesuy B. Bay, Heine-terrace. Worthing.

Show—Jarrett— On the 30th ult.. at St. Matthew's Church, City-
road, London, Lionel Mason Snow, M B.O.S., L.B.C.P. Load.,
to Jennie, eldest daughter of Bvaa Jarrett, Bsq., of Bamsbury-
park, N.

West—Jacob— On the 4th Inst., at St. Peter's Church. Dublin, by the
Bev. John Alexander Jacob, Sector of St. Saviour's. Bath, uncle of
the bride, assisted by the Rev. Canon Jellett. and by the Bev. H. B.
Moves M.A., Francis Robert Leighton, second son of the Bev.
William Wrst. Hector of Randalstown. Suffolk, to Florence Alice,
eldest surviving daughter of Archibald Hamilton Jacob, M.D.,
F.B.O.S., of 23, Bly-place, and "Lucerne,” Sandycove.

DEATHS.

Fox.—On the 3rd Inst., at the Park Hotel, Preston, Wilson Fox, M.D.

Halekt.— On the 17th nit., at tea. on his homeward voyage from
Australis, Laurcnoe John Halket, L.B.C.P .Lond.

Nolloth. -On the 29th nit., at 13, North-terrace, Camberwell, Mward
Nolloth, retired Fleet Surgeon, B.N., M.B.C.P., F.R.C.8., ei*thton
of the late John Nolloth, Bsq., of 1, North-terrace. Camberwell,
aged 73.

Thompson.— On the 29th nit., at WIntrrthn House, Westerham, Kent,
Charles Bobert Thompson, M.R.C.S-, aged 57.

VJB.—A fee of St. is charged for the TneertUn of Noticetgf Births,
Marriage*, and Death*.

Digitized by l^OOQle

ftn'LlXcAT,] : NOTES, COMMENTS, AND ANSWERS TO OOSEESPONDENTB.

[Mat?,.1887-

llU&ital giarj for % ensuing Heek.

Monday, May 9.

Bom London OphthaImic Hospital, MoohjteLds. — Operations,

10.30 a.m., and each day at the nms hoar.

Bom Wwmuiitm. Oramiuua Hospital.—O perations, L30 p.m.,
and each day at the Hone hour.

Chelsea Hospital fob Women.—O perations. 2.30 p.m ; Thuraday,2.30.
St. Mark’s Hospital.—O perations, 2 p.st. ; Tuesday, 2.30 p.m.
Hospital fob Women, Soho-square. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.sc.

Koval Orthopedic -Hospital—O perations, 2 p.m.

Obrtral London Ophthalmic Hospitals.—O perations, 2 pjc„ and
each day In the week at the same hour.

Koval Institution.—5 p.m. General Monthly Meeting.

Socwnr of Arts.-S p.m. Mr. J. M. Thomson: The Chemistry of Sub¬
stance* taking part in Putrefaction and Antisepsis.

Tuesday, -May lfb

Guv’s Hospital.—O perations, 1.30 p.m. ^nd on Friday at the hour.

Ophthalmia Operation* on Monday at 1.30 and Thursday at 2 p.m.
St. Thomas* Hospital.—O phthalmic Operations, 4 p.m. ; Friday, 2 p.m.
Cancer Hospital,Bbompton.—O perations,2.30p.M.! Saturday, 2.30p.m.
Westminster Hospital.—O peration*^ p.m.

West London Hospital—O perations. 2.30 p.m.

St. Mary’s Hospital.—O perations, II;*> p.m. Consultations, Monday,

1.30 p.m. Skin Department. Monday aod Thursday, S.3Q a.m.
Hotal iNHTmrrioN.— S p.m. Prof. W. r! Ayrton: Electricity.
Medico-Psychological Association. — 4 p.m. Quarterly Meeting.

Meeting of Council at 2.30. Dlsoussfon on thepfoposed Lunacy Law
Amendment Bill. .1. >

SocntV' of _Ahtb.— 8 p.m, Mr. B. J, Tarver: The Architecture of
London Streets.

Hotal Medical and Chdwrgical Society.—8.30 p.m. Mr. Arthur
B. Barker: A case of Intussusception or the Upper End of tW6
Rectum due to Obstruction by a New Growth, Excision of the Intus¬
susception, Suture of the Cut Ends of the Bowel, Complete Re¬
covery .—Mr, Stanmor* Bishop t Results of an Bxperimental Inquiry
as to the Best Method of Restoring the Canal after Removing
Portions of the Small Intestine (oonemunioeted by Sir Spencer Walls*

Wednesday, May 11.

National Orthopaedic Hospital,—O perations, 10 a.m.

Middlesex Hospital.— Operations, 1 p.m.

Bn. Bartholomew’s Hospital—O perations, 1 JO p.m. ; Satihdar. same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgical Consultations, Thursday. 1.88 pm.

Sr. Thomas’s Hospital—O perations, L30 p.m.) Saturday, same hour,
Xoedon Hospital—O pe ratio ns, 2 p.m.j Thursday* Satusday, same hour.
Great Northern Central Hospital.—O perations, 2 pja.

J30 T p 5 ^ HKB Hospital fob Women and Children.—O peration^,

■CniverSitv College Hospital—O perations, 2 p.m. ; Saturday. 2 p.m.

' Skin Department; 1.46 P.M.; Saturday, 9.15 a.m.

Botal Frkk Hospital.—O peratfoni, 2 p.m., aod on Saturday. •

3£Dra* Oollbgk Hospital.—O perations. 3 to 4 p.m. ; Friday, 2 Par.'

Saturday. 1 P.M. ,

Children's Hospital Great Ormond-street.— Operations, e a.m.
Saturday, same hour. .

8ocraTV of Arts.—8 p.m. Mrs. Ernest Hart: Cottage Industries in
Ireland.

Bom.M icroscopical Society. —8 p.m. Hr. Maddox: On the Dif¬
ferent Tissues found In the Muscle of a Mummy.

BPidkmtolooical 8ociett of London.—8 p.m. Hr. Arthur Ranspmc:

8ome Evidence respecting Tubercular Infective Areas.

BeTOsK GrtfMOOAoelCAL Society.— a .30 P.M. Speolmena will be shown
by Dre. Granville Bantock. Fancourt Barnes, Gtlgg, and others.—
Dr. Routh: On the Various Modes of Treatment to be adopted for 1
the Worst, Cases oi Uterine Flexions.

Thvtdny, May 18.

Sx. George’* Hospital— Operations, l p.m. Ophthalmic Operations,
PTlaay, 1.30 p..\r.

Charino-cross Hospital.—O perations, 2 p„M. 1

North- West Lon don Hospital.—O perations, 2.30 p.m.

Royal Iwtottioh.—3 p.m. Prof. Dewar: The Chemistry of the
Organic World.

METEOROLOGICAL READINGS.

(Taken daily at 8.90 a.m. by Steward* Instrument*.)

The Lancet Offioe, May 5th. 1887.

N. 42 I 4h

B. 44 43

B. 49 49

W. 6* 47

N.W. 51 48

Bolts, Sfwrt Comments, $ glisters ft
Comspoubeiits.

- -i

It it especially requested that earluintelligence of local eeshti
having a medical interest, or which it u desirable to bring
under the notice of the < profession, may be sent direct, to
this- Office. i&

All communications relating to the editorial busytessof the,
journal must be addressed “To the. Editors,” .; > . • \

Lectures, original article*, and report* should be Written ete

one side only of the paper. • . '

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the navies and
addressee of their writers, not. necessarily-for publicatitaK
We canhot prescribe Or recommend practitioners .' . „

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor. • - : ‘i > >

Friday, May 18.

Royal South London Ophthalmic Hospital— Operations, 2 p.m.

Clinical 8ociety of London.-s.30 p.m. Mr. God lee: Some cases of
Abdominal Cyst following Injury.— Dr. Vivian Poore: A case of
Spasmodic Torticollis, probably due to Cerebral Lesion.—Mr. Stephen
«get: A case of Suppuration in a Chronic Gouty Knee-jOint.—
"• "P®™ 5 ®* Watson : A case of Intra-capsular I mpacted Fracture of
the Neck of the Femur, with specimen. Living Specimens t— Mr.

, Glutton: Case of Osteitis Deformans in a Female, with.Lengthening
, of some of the Bones.-Dr. Percy Kidd: Case of Rheumatic?NoduleS
in an Old Woman.-Mr. Sydney Jones : (1> Case of Extirpation of i
Uterus for Fibroid, recovery (and the specimen) ; (2) A case of
Tumour of the Bladder removed, by Supra pubic Operation (and the
tumour).

Institution .—9 p.m. Prof. J. 8. Bordon Sanderson: Some
Bleotrical Fishes.

.a* • <• • ••today, May ML ..

Middlesex Hospital.— Operations. 2 p.m.

Botal Institution.— 3 p.m. Prof John W. Hales i Victorian literature.'

be marked and addrested te the Sub-Editor. •
Letters relating to the publication, sale, and advertising
departments of Thb Lancet to. be addressed "to the
. Publisher.” V, .-, '*'

We cannot undertake to return MSS. not used. ' r ‘ 1>

Ravages of Wild Animals and Snakes in Bengal -,

Tint total number of persons killed fejt. wild animals and v enantoda
snakes in the ten divisions of Bengal during tlje official year 1885-86 wap
the highest in the last five, years, and,amounted to 11.823. As is usual,
nine-tenths of these deaths were caused by snakes. But of 12.22R
!■ b nlf aje sa . oxsfa, -hdrscs( rfnd ponies ddtroyed In this manner, only 3J\
were killed by snakes. These annual returns do not take aoootxnt of
sheep, goats, pigs, and.monkeys, the destruction of which Is'very
kseg*. • Passing,over the most iormidsbte wild animals, it appears thgfc
548. persons Were killed ;hy jackals. 221 by orooodllsi or alligator*. 84 by
pigs, and 22 by elephants—whether wild or domesticated Is not
stated,—12 by buffatoesrind oxen, 1 by a hone, 1 by a deer, and 2 by
musk rats, the bite of thejatter havlqg been followed by morti¬
fication. Only 18 deaths wefep%t‘<fc$d (Jojrnaddogs, which is regarded
as a manifest understatement. Not a single death was caused by wild
animals in the town and subifrbs Of Calcutta, but 18 persons died from
snake-bite. • Tbo total amount Of 29,884 rofpees Was ^Aid for tbe
destruction of wild animals and venotnous'kwilres, as oompared frith
42,374 rupees In the preceding year. ' " i

II. M.— Our correspondent should consult tbe Medical Register; bat we
doubt in any event if he has a legal remedy.

Mr. J. H. Sykt* is referred to a general notice at the bead °f this ootamu.

STROPHANTHU9. ’ " -. j. f'"

1 Toths Baton of Ton ItssUMH'’-"'

Sms,—At this time, whan Professor Fraser's elaborate experiment*
with strophanthus are bringing It to the fore in therapeutics, it is Inter¬
esting to note that Dr. Idvingstone, in tbe account o( his 1S63 expedi¬
tion up the Sliire branch of the Zambesi river, mentions that Dr. Kirk,
w ho accompanied the expedition, owing to carrying his tooth-brush io
the same pocket with some of tbe kombi, or arrow poison used by the
Ajawa and Maoganja tribes, acciilentally experimented on himself, and
“ though the quantity was small, it immediately showed its power by
lowering the pulse, which at the time had been raised by a cold, and next
day he was -petfectly restored," and remarks that “ it is possible that the
kombi may turn out a valuable remedy.’’ This cose points to it* value
as a febrifuge. I am, Sirs, yours faithfully, _

Clifton, May 2nd, 1887. Clements Hailes, M.D., C.M.

Digitized by CjOO^Ic

Tu Lancht,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Mat 7.1887. 965

Emm Defence f ua». I Thk Cukiti of Colorado.

Tn honorary secretaries beg to acknowledge the following contribution*
to the above fund, which I* being raised to pay the legal expense*
incurred In refuting a cruel and groundless charge, particulars of which
will be fonnd In an advertisement in the present number of The
Lancet. The committee invite the oo-operatlon of all members of the
profession in promoting the defenoe fund, and request that subscrip¬
tions be forwarded to the honorary treasurer, Dr. If‘Veagb, 1, Butland-
tquare Bast, Dublin.

Sir Prescott G.Hewett,Bt.£S S 0 William Bruce, H.D. ... £1 1 0

Patrick Thompson, Bsq.... 5 0 0 J. Hawtrey Benson, M.D.,

Sir Joseph Lister, Bart. ... 3 3 0 F.R.C.8.I. ... .... 1 l 0

Sir James Paget, Bart. ... $ 3 0 Robert H. Davis, J.P. ... 1 1 0

Sir George Barrows, Bart. 2 2 0 Joseph D. Fisher, Bsq. ... 1 1 0

Sfr George Bdward Paget, Kendal Franks, M.D.,

K.C.B. 2 2 0 F.B.OB.1.110

Sir Charles A. Cameron ... 2 2 0 B. Dwyer Gray, Bsq., M.P. 110

Thomas A. Cusack, Esq.... 2 2 0 Nathaniel J. Hobart, M.D. 110

George H. Kidd, M.D., Richard J. Kinkead, M.D. 1 1 0

F.R.C.S.I. 2 2 0 Arthur V. Macan, M.D.... 1 1 0

P. B. Kirwan, Bsq. ... 2 2 0 John MoCarthy, Bsq. ...110
Charles Frederick Knight, Robert McDonnell. M.D. 110

M.D. . 2 2 0 Alderman John O'Connor,

Thomas Peter Mason, M.P.110

M.B., F.R.C.S I. ... 2 2 0 Joseph H. Redmond,

P.AlcockNixon, F.R.C.S.I. 2 2 0 F.K.Q.C.P.I.. 1 1 0

M. A. Ward, M.D., W. G. Ternan, L.R.0.8.1. 1 1 0

T.BJ3.S.I.... . 2 2 0 Robert Wade, L.R.0.8.1. 1 1 0

Sir Henry Wentworth J. Kellock Barton, M.D.,

Aoland, K.C.B. 110 F.R.C.S.I. ... 1 0 0

The Right Hon. the Lord Bdward Hamilton, M.D.,

Mayor of Dublin... ... 1 1 0 FJt.O.S.I. ... ...10 0

Lennox Browne, F.R.C.S. 110

Mr. J. <U Ccntrry Young (Bruthen).—We da nod see bow we can help our
correspondent.

.Beta.,-Theooorae of action is quite legal, but very unwise.

" INHALATION OF COAL-GAS AS A 8OUB0B OF DISBASB.”

, To the Editor* of The Lancet. i

Souii —AUeotiqa'has been lately caUed to the deleterious effects
produced an the human body by the inhalation* of ooal-ga* in small
quantities. The public, equally with the medical profession, are aware
of the dangers to health resulting from the presence in respired air of
this gas in sufficient volume to be appreciated by the sense of smell.
How great Is the sum of 111-health produced by this necessity of our
civilisation is perhaps hardly realised, both on account of the insidious¬
ness of the symptoms and the association of them often to causes other
than the right one. In an Introduction to Onr Homes,” entitled
*• Health In the Home,” written by Dr. Richardson, he tells how he him¬
self suffered from symptoms due to the adulteration of the air of his
library by carbonic oxide derived from the escape of coal-gas from faulty
pipes in miunte but toxic quantity. Nausea, giddiness, ooldness of the
body, and inaptitude for work led him at first to suspect stomach derange¬
ment. Noting, however, the similarity, of the symptoms with those
produced previously on himself while experimenting with carbonic
oxide; he was led at last to the real source of the mischief. I remember
soon after this article was published meeting a medioal man who com¬
plained to me of drowsiness and giddiness, oomblned with ooldness of
the extremities and this same inaptitude for exertion. His digestion
was excellent, his frame robust, and he was becoming seriously alarmed
at what be thought might be indication* of oerebral mischief. I told
him that I felt sure he was suffering from carbonic oxide poisoning, and,
to add weight to my words, gave him Dr. Richardson's article to read.
Then the secret came out. His symptoms were always aggravated
during the evening, after he had been sitting for some time In his dining¬
room, and his wife bad also of late shown a drowsiness which was foreign
to Her habit. In this room a short time previously an indiarubber pip*
had been fitted to the gaselier, to bring the gas down to a water-heating
apparatus on the table, which was always used at this time of the day.
The symptoms dated from the time of this fixture, and the oonaexion in
my mind between the two things was oomplete. The diagnosis was
rendered oertain by my friend, who at onoe dtdfaway with the apparatus,
telling me a few days afterwards that all unpleasant symptoms had
passed away, and that he bad never felt better In his llff. This pertinent
incident may help to call the attention of your readers still more to a
source of danger to health which I have long felt to ha as oommoo as it
la often unsuspected.—1 am. Sire, yours faithfully,

H. M. Btus, Staff Surgeon, R.N.
H.M.S. Valorous, Devonport, May 2nd, 1887.

Jhasenis should write to the Secretary of the College, who will doubtless
afford the Information required.

BBOWHT DHFBNCB FUND.

. .,, To the Editors of The Lancet.

Sue,—Kindly permit me to acknowledge the following:—Amounts
previously Motived, £13 Is. 8 d. Dr. J. Brevard Neal, 10*. 6 d .; Dr. M.
A* Ward (Dublin), £1 Is.; R. H. A.Hunter, Esq.,£1 Is.; Messrs. Roby
and Roby, £1 Is. I am, Sirs, yours faithfully,

o. sbaitikt Muhitxx.

Meadow Side, 23, Upper Richmond-read, Putney, May 4tb.

In reference to an inquiry recently Inserted in onr columns, Mr. T.
Laffsn of Cashel sends us a letter, from which we make the following
extract:—“I must say, from experience and a long residence in
Colorado and the adjoining territories, that the oil mate is unsurpassed.
To those suffering from incipient consumption, by proper attention to
exercise, snoh as hunting, fishing, he., there is no question but in a
short time all traces of the disease win disappear. I have known
young men who went there eight or nine years ago as hopeless invalids,
and after a few months' sojourn returned to their eastern homes ragged
and robust men. Those far advanoed in consumption will have a herd
time of it as regards breathing, owing to the extreme li ghtness of the
atmosphere. For such the equable temperature of New Mexico is
more suitable. As a resort I would recommend the San Louis Park;
It is a beautiful valley, extending several hundred miles, running
north and south from Del Norte Col to Santa F6, New Mexico, and
over twenty miles wide, between the Sangrd De Christo and Conejos
ranges of the Bookies, with an average of about 4000 ft. elevation
by sea-level. Game abounds, 'and fishing In the Rio Grande river,
which runs through the valley, is excellent. The winters are hot
quite so rigorous as in the mountains. I have seen men in that
country who were so emaciated physically that their life was not
worth a cent. Profuse expectoration appeared to trouble them most.
In a short time they became hale and hearty. Persons in an advanced
state or period of the disease suffer much; they even Meed from the
nose and mouth on the least exertion, lkls is owihg to the high
altitude and light air. Bnt the Mexican people say that by drinking
tea made from the mild mountain sago all traces of the disease are
eradicated; and no Mexican is troubled with consumption that Is to
be attributed to climatic influences.”

Cyclops. —We consider the charges very reasonable. The legal profession
would not consider itself remunerated on any such terms. Our corre¬
spondent would do well, however, to base his cliarges entirely on
professional attendance, throwing medicine in, or charging little more
than cost price.

<2.—A very full exposition of the subject of som* was published in the
number of Brain for January last, from the pea of Dr. Herder—an
article which is well worthy of perusal.

P. W. should oonsult his medical attendant. We do not prescribe.

•• 8IMILIA SIMILIBUS CURANTUR
7b Us Editors of The Lance*.

• Sins,—Sin that I hah ben ylogged In Hades mo than fdur hundred
ye res, I pray you to be patient wld me, thanne wol I tell ye sikerly that
which doth wirry me moche. Oerte*. ther is a very partite practisour,
ycleped Doctour Lauder Btunten, wel versed in ye causes of everioh
baaUdle and the working of dragges. Eire hath he shewed you that ye
oonsdls of Honxeoiathy be alway fnl of erronr, inasmuohel as they weren
enforced will lota by the auctorltee of a persons, hlght Hahnemanne.
Dooteles ther ne hath ben naught neoe under the Sonne; bat I a’sm
not desirous for to teche yonge men of hlr praotike. I wold only say
that phisieiens at.my daye wer used to sayn, "right as maladies ben
oured by hir oontrpries, right so shal man warisba werre,” the which
worden I ban writ in ye Tale of Melibee, as you mote se for youraelven.
if It so be that ye haa gotten my werkes. Touching my letter. I beseke
you of youre good will, for Iche n’am not mochel used to dite letters sin
I han ben here; and the postea gon selden time here abouten.

Youre servant In alle humblesse,

Geoffrey Chaucer
His (lost. .

C. T— The answer most be uaaertain. The body named will only be
able to grant a registrable qualification, after the date mentioned, in the
event <H Other bodies combining with it, or the Medioal Council
appointing examiners In surgery.

Mr. T. B. Oibtn will find the method described in The Lancet of
April 10th last.

A. B. W .—The book mentioned Is perhaps the best for the purpose.

OBSCURE NBNVOUS AFFECTION.—OBB8ITY.

To the Editors qf The Lancet.

Sirs,—I n reply to two correspondent* In yonr last issue, one signing
himself “ Puzzled ” and the other " Subscriber,'' I would suggest a trial
of massage In both the cases to which they respectively refer. The neuro¬
pathic condition developed by the patient of the former would, in ray
opteton, judging especially from the hhtory of the oase, be math
benefited. If not entirely cured, by such a prooess; and with regard to
'obesity, as referred to by the latter, one case has lately been brought
under my notice in whioh under a oourse of massage the patient lost
sevan ipatyw round Sha trips sad five ioehee and a half round the waist
tn three weeks.—I am, Sirs, youre faithfully,

i <tr i- ; R. A. DOUOtasLlTErtoW, LIU}., M.R.C.P.Bd., Ac.
Lowndes-street, S.W., May 8rd, 1887.

Digitized by GoOglC

966 Thb Lancet,]

, »> tkgj .1 ~r.T-T ■

NOTES, C0MMENT8, AM) ANSWKR8 TO CORRESPOND ENT 8.

[May 7,1887.

A Oun amoks Oum.

There are giant* and giant*. There atofcven giant* among giant* ; and
w« venture to *av that the Austrian giant new. to be *een in
Ixmdon U one of the*e. He is moat phenomenally tall. Though
twwty-two y«nc* old lie 1* thought to be still growing, and has
certainly grown an inch or more in the laat nine month*. Ue has
thn* sisters and one brother. Neither in them nor in his family
haa there been any inatanoe oft nndne height. It la said that he was
not unusually tall until the age of fourteen, when he began to shoot
upwards.

KtiipatU .—The rule mentioned cannot be always applied. The special
circumstances of the case most be taken into consideration, or Injustice
may unwittingly be inflicted.

M. IF.—Only graduates of universities are entitled to the prefix.

"DANGERS OF SWING-BOATS.”

To (As Editor* of Tan Labozt.

Sum.—I u Leicestershire a similar case to that rsoerdad In your last
is us came under my care last autumn, a young child having been struck
on the left side of the forehead by an irou screw-nut on the bottom of a
swing-boat. A portion of the frontal bone, about an inch long, was
firmly fixed Into the base of the skull, and two portions of convolutions.
were mingled with the debris. Unsuccessful efforts under chloroform
were made to extract the bane, and the whole treated with a weak
solution oft perchlorlde of meronry. The child lived fifty hours, and
until two houra before death, in spite of the gravity oft the Injury, there
was neither severe haemorrhage, paralysis, unnatural pupil, loss of,
speech, uor vomiting. Death was preceded by strabismus, convulsions,
and syncope. I am, Sirs, yours obediently,

Sklpton-in-Craven, May 2nd. 1887. C. W. Sessions Barrett, M.B. ,

Erratum.— In Dr. Nesfield’s letter published hut week, page 004, the
date of the prematura labour was lnaoourately given as Oct. Mb. It
should have been Deo. Mb.

CamM tntlCAJioaa not noticed in our present number will receive atten¬
tion in our next.

OoMMUWiCArious, Emms, A*., have been rece i ved from—Dr. Herkia,

1 Belfast; Dr. DeWettavUle, London; Dr. Bristo#e; SirW. Mac Oorraac,
London ; Dr. Hollis, Brighton; Dr. Fothergill, London; Mr. Lawson
Tait, Birmingham; W. G. Macdonald, London; Mr. Edmund Owen,
London ; Dr. Cheadle, London ; Mr. J. Startln, London ; Mr. Simeon
Snell, Sheffield; Mr. Tempest Anderson, Yortc; tor.'Weaver, South-
port; Mr. J. Olivqc. Lou<fc>m Mr. Graham, London; Mr. Marmaduke
8beild, London ; Dr. Sadler, Barnsley; Mr. C. B. Lockwood, London ;
Dr. C. H. Saunders; Mr. S. i. Bapty, Manchester; Mr. J. de Courcy
Young, Gipp's Land; Dr. L. W. Marshall. Nottingham ; Dr. Peter
Hood, London; Dr. D. Drummond, Newcastle-on-Tyne; Mr. Mayo
Collier, London; Mr. H. W. Robert*. Lewisham ; Messrs. Brady and
Newoastloon-Tyne; Mr. A. F. Mickle, London; Mr. Walker,
Spondon ; Mr. Barraud, London; Mr. Ellison; Mr. C. H. Robinson,
Dublin ft Mr. T.D. Bryce, Nottingham; Mr. Waugh; Dr. Blackman,
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Philadelphia; Mr. Tymr, London; Mr. Murray; Messrs. Shelley and
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Eudham; Mr. Ioffisn, Cashel; Mr. Best, Cheltenham ; Mr. 8 tret ton,
Kidderminster; Mr. Kelly, Hnnfscorthy; Mr. J. B. Clarkson, Boston,

' U.S.A.; Dr. C. F. Knight. Dublin; Mr. Lynd, London; Mr. C. B.
Lockwood. London; Mr. T. G. Horder, Cardiff; Messrs. Hopkinson
and Co„ Notts ; Mr. W. North, London ; Mr. Todd, Dublin ; Mr. A. S.

Morton, London; Dr. Llthgow, London; 'Messrs. Oppenhelmer and
Co., London; Dr. McBride, Philadelphia ft Mr. Wilkinaon, Melton
Mowbray ; Dr, T. S. Smith, iSittingbourne; Messrs. Miehnlikn and
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York; Mr. Bast, Lincoln; Mr. Blake, Dublin; Messrs. Reid
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London; Mr. Christison, Stonehaven; Dr, B. Squire, London; Mr. T.
Cooke, London ; Mr. Hume, Edinburgh ; Dr. Read; Messrs. Lumley,
Piccadilly; Mr. Moullin, London ; Mr. Aston, Barnetty; Mr. Owen,
Teignmouth ; Mr. Eastwood, Blackburn; Dr. Thurnan, Htghgate;
Dr.Wood, Pontypridd; Mr. Cornish, Manchester; Dr. Duggan,Caatls

' Eden ; Dr. Knight. Dublin; Dr. Colley, London; Dr. Macdonald,
Cork; Mr. Sacker, London; Mr. HiU, London; Mr. Marks;
Dr. Jacobs. Dublin; Mr. Burnett. Liverpool; Dr. Bahadbnrp,
Berlin; Mr. Stent, London; Mr. Stewart, London; Mr. Carter, Liver¬
pool; Miss Meyer. Holloway ; Mr. Hunter, Lowestoft; Mr. Sessions
Barrett, Skipton ; Mr. C. J. Bond, Leicester; Alpha, Bfrari ttg^iapi i
A Reader; C. T.; H. M.; A. R. W.; Secretary, Liverpool; MefllCU*.
Kensington;Superintendent; C. X„ London ; M.A. Cantab.; :

H. A. C. A

..a

Ljcttsbs, each with enclosure, are also acknowledged from—Dr. Seaton,
Sunbury; Miss Garrett, Winchester; Mr. Allen, Dulwich; Mr. Todd,
Carlisle; Mr. Bottomley, Ashton-under-Lype; Messrs. Bromley and
Oo..Lincoln; Mr. Godfrey, Northampton; Mr. Davison; Mr. Marsh,
Wigan; Mr. Macadam, Glasgow ; Mr. MOring, London; Mr. Dawson,
Leeds;,Mr. Walker, Durham; Mr.Hughes,Harry; Mr. Mulsh. Forest
Hill; Dr. Milne, Aocrington; Mr. Miiller, London; Me. Jnssyp,Great
Grimsby; Dr. Webber, Orewkerne; Mr. Ryan, London; Messes. Gab-
and Co., London; Mr. Beaman, Newton-Ie-Willows ; Messrs. Wyley
and Co., Coventry; Mr. Huhenstekx, Liverpool; Mr. Nnttman, Groat
Yarmouth ; Mr. Worslcy, Ryde ; Mr. Parry, Baglllt; Messrs. Wilson
and Co., Ipswich; Mr. Dumvine, St. Albans; Mr. Crassweller, Higb-
• bury; lb. Hodgson, London; Mr. Mills, Rochdale ; Messrs. Giles end
CO., Clifton; Mr.- Branthwalte, Twickenham ; Dr. Mayo, Groat
Yarmouth; Mr. Reid, Seacombe; Mr. Tayior, Leicester; Mr. Beach,
London; Mr. Beddoe, Hereford ; Mr. Lindsay, Belfast; Mr. Lee man.
Inverness; Mr. Whittaker, Derby; Mr. Telford, Bury; Mr. Grimsley,
St. Asaph ; Mr. Lang, London; Mr. Allen, Dulwich; Messrs. Bullock
*hnd Co., London; Mr. Woodward, Highbury; Messrs. Mottershead
and Co., Maucbester; Mr. St. Dalmaa, Leicester; Mr. Ware, South
Kensington; Mr. Stallard,Worcester; Mr. Baird, Bradford; Mr.Davis,
Worcester; Mr. Hine, Kcnniugton; Mr. Llnney, Hitch In ; Mr.Joslea.
Workington; Miss Harrison, Stafford; Mr. Wlutray, Scarborough;
Mr. Hendry’, Eastbourne; Mr. Hume, Bdinburgh; Messrs. Bell and
Bradfute, Bdinburgh; Mz. Marquis, Dundee; Mrs. TurraU. Hert¬
ford ; Mrs. Spreat, London; Mr. Leggatt, Woodgroen; J., Brixton;
Alpha, Manchester; Secretary, Glasgow ; Alpha, Stratford; M.D.,
Horncnstle; Meredith, York; D. M.; Medicos, Uppingham ; Alpha,
Manchester; H. O. 8., Beverley; P.; Medieus, West Kensington;
D., Bdgboston ; G. B., Hampstead; Z. Y. X.; M. Z.; Otone; Alpha.
Bourne; K., Gamden-town; Immediate, Han well.

Midland Tintes, Matt London Courier, Stratford J ixpress, Imperial
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An original and novel featam of "Tbb Lapanr General Adv erti ses” la a special Index to Ad^sriisetotots ompageg, which not only affords a
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Digitized by LjOOQle

THE LANCET, May 14, 1887.

% Clinical fttta

OK THK

PATHOLOGY AND TREATMENT OF LARYN¬
GISMUS, TETANY, AND CONVULSIONS,

ILLUSTRATED BY CASES OF THESE DISORDERS IN
CHILDHOOD, AND ALSO BY A CASE OF THE
TETANY OF ADULT LIFE.

By W. B. CHEADLE, M.D., F.R.O.P.,

SENIOR PHYSICIAN TO THK HOSPITAL FOR SICK CHILDREN, GREAT ORMOND-
STREKT, PHYSICIAN AND JOINT LECTURER ON MBDIOINK
to st. mary’s hospital.

(Concluded from pagt Otl.j

The next point of importance, and one of the first moment
to us as physicians, is the cause. What gives rise to
tetany and the allied conditions, laryngismus and convul¬
sions ? Let us take the case of adults first. Trousseau styled
the affection the rheumatic contraction of nursing women.
This arose from the fact that the first few cases which he
saw were all in women who were suckling; and he deemed
the affection rheumatic probably because of the pain and
swelling of the extremities, really due to the pressure
of muscular cramps, and because exposure to cold appeared
to be the exciting caose. Subsequent experience led
him to modify this view, and he acknowledged many
conditions as predisposing. Another antecedent supposed
to be almost invariable was diarrhoea. In Trousseau’s
cases diarrhoea was almost invariably present. He gives
one case, however, in which the bowels were obsti¬
nately constipated. In ten cases of adults I have found
recorded elsewhere, diarrhoea was noted in two only, as
absent in four, and in the remaining four not noted. Then
another point. In all nineteen cases together—Trousseau’s
and others—twelve were in women. Of these twelve, seven
■were suckling, two were pregnant, and one had had several
miscarriages recently. Four of these had diarrhoea, and two
menstruated while suckling. Tetany comes on in adults
also as a sequel to acute specific fevers, especially in cholera
and typhoid fever, in which diarrhoea is a prominent sym¬
ptom. In the vast majority of cases, then, if not in all,
tetany supervenes in patients whose nutrition is impaired
by drain or flux—that of lactation or pregnancy, or diarrhoea
or haemorrhage.

Let us take now the case of children, and see whether the
conditions which favour the occurrence of .the disorder in
them are in any degree similar. In the first place, the
affection in nearly every instance occurs in children under
three years of age—the period of rickets, the period of
dentition. In the second, in every instance which I have
seen the child has also had well-marked rickets. In every
one of the fourteen cases collected by Dr. Abercrombie there
was marked rickets. Further, in every instance which I
have seen the tetany was associated with the first spasmodic
disorder—viz., laryngismus. In all Dr. Abercrombie’s oases
there was likewise accompanying laryngismus. Now,
according to my observations, laryngismus is invariably
associated with rickets. 1 Again, the third spasmodic
disorder is associated with rickets—viz., general convul¬
sions 9 ; and a cdasiderftble proportion of these cases
of tetany and liryriglstaiis suffer from convulsions.
Therefore in children spasmodic disorder in these three
forms—viz., laryngismus, carpo-pedal contractions or tetany,J
and general eclampsia—ate essentially associated with the
rachitic conditiori. This is, indeed, the key to the subject.
The constitutional state in rickets in children, fruitful of
tetany and all Mods of convulsion, is closely analogous to the
constitutional stats in Which tetany is apt to occur in adults.
Rickets, remember, is ndt mere defective nutrition of bone,
bat defective nutrition of all Structures—of muscle and
nerve, as well as Of bone. It arises largely on a diet of
starchy food—ie^ not by thd eyH effects of starch and sugar,
but hecauSd the diet is deficient in animal albuminates and

* ».B»aie«riidthisfanlte*ffte.jrtekste‘-ti»48sqtof .

* S>^fb^M^nimnlf^raUomi^»<mbid609imtaoiUrjmglumm.

animal fats. It arises frequently, too, where nutriment 1#
drained off by frequent and long-continued vomiting arid
diarrhoea. Sometimes, again, in a condition closely allied
to it, as the result of the cachexia of congenital syphilis.
In the child, then, as in the adult, the constitutional state
which predisposes to spasmodic disorder is subnormal
nutrition. This state is, however, brought about in a
different way in the two cases. Children get into the state
which favours laryngismus, tetany, or convulsions when the
nutrient milk is not given, or its equivalent of animal
albuminates and fat. The nursing mothers get into the
state which produces tetany from loss of the same nutriment
in the milk they yield. In the case of children the fault of
insufficient supply is constantly aggravated by the drain of
diarrhoea or vomiting. In the case of adults the fault of drain
by flux of milk or diarrhoea is frequently aggravated by in¬
sufficient supply. The condition of nervous system which
renders it so unstable, this hyper-excitability, would appear
to be due to defective nutrition of motor cells. Their proto¬
plasm is as ill-nourished as we know the nitrogerious
element of muscle to be in like cases. Look at the myoidema
of wasting diseases. Muscle is hyper-excitable in this con¬
dition; nerve centre is hyper-excitable likewise. There is no
affection of th6 governing cerebrum, for thore is no affection'
of the sensorium, but an undue excitability of the motor
ganglia of the cord; probably no permanent organic change.*
This is perha s not all. There is an immediate excitihg
cause; the r;flex irritation of diarrhoea, or teething, or
exposure to 5 old, or indigestible food. But the constitu¬
tional defect is the essential antecedent, the predisposing
cause underlying all, rendering the nervous organism
morbidly sensitive to slight irritation. As in the stiychnia-
poisoned frog, tetanic symptoms may not be developed if it
remains quiescent, but the stimulus of a shake or jar brings
on a convulsive seizure. Now, gentlemen, I lay stress
upon these points of etiology and pathology, because they
bear so strongly upon treatment, and this is of vast im¬
portance. The disease, indeed, involves little risk to life
in the case of adults. 1 know of two cases only on record
in which the disease proved fatal. 4 With children, however,
the case is otherwise. They do not die of the tetany, but
they do die of laryngismus and convulsions, sometimes of
concurrent exhausting diarrhoea, or bronchitis, or catarrhal
croup. The majority get well, but now and again death
occurs. 8o long as the condition of excessive irritability
of the motor nervous system evidenced by the carpo-pedal
contraction and attacks of laryngismus remains, so long is
the child in danger from spasm of the glottis, fatally pro¬
longed, or the supervention of general convulsions.

Treatment. — In the olden time treatment was chieffy
divided towards relieving a supposed congestion of the
brain and cord. Trousseau relied upon bleeding for this
purpose in tetany, and claims great success for it. He also
gave quinine, opium, belladonna, and chloroform inhalations.
Yet his claim to success seems hardly borne out by the evi¬
dence. In the case of one woman who died, bleeding aggra¬
vated the symptoms, the muscles of respiration became
affected, and asphyxia appeared imminent. Twelve leeches
were then applied behind the ears, but before they had fairly
taken the patient succumbed. In the case of a man also who
had tetany In the most severe form, bleeding from the arm,
repeated several times, was foDowed on every occasion by
increased contractions involving the muscles of respiration
and threatening asphyxia. Cupping along the spine,
however, appeared to give decided relief, and the patient
recovered, possibly in spite of the treatment rather than in
consequence of it. But, indeed, bleeding, in persons
already exhausted by drain or deficient nutriment as these
patients are, would seem to be the very worst therapeutic
measure possible. We know, moreover, that loss of blood in
quantity tends to produce the convulsive state. Animals
bled to death die convulsed; animals starved to death some¬
times die convulsed. In the case of these poor debilitated,
rickety children, bloodletting, even in the mild form of

* In a fatal case of mine (examined by Dr. Abercrombie) the brain and
membranes were healthy, the medulla and cord seemed rather firmer
than usual, and the grey matter, if anything;, too pale. No other e fta tigb
In any organ. Langhaus (quoted by Abercrombie). In a fatal case in a
man aged forty, found some changes, especially iu the anterior irhlte com¬
missure of the cervical enlargement—vis., thickening of the tnnice adven¬
titia Of small arteries and veins, dne to the presence of lymphoid cell* in
the reticulated stroma. (Is this the result of congestion set up by odh-
vulsion P) The affection is transient; it is not a priori likely that It
depends on permanent organic changes.

4 Trousseau’s ease, ana that of langhaus noted by AbenttomtH*.

U

'3

9 66 Tkb Lancet,]

ME. ANTHONY A. BOWLBY ON INJURIES OF NERVES.

[May 14,1887.

leeching or cupping, is out of the question. The practice is
based upon a pathological error.* The condition of the nerve
centres is really one of aniemia already, not of congestion.

The objects to be sought in the treatment of tetanoid laryn-
gismal convulsive disorder of childhood are threefold—(1) to
relieve dangerous convulsive seizures when they occur, (2) to
ward off these attacks from recurring, and (3) to remove the
constitutional rickety state which predisposes to them. For
the first purpose:—In laryngismus, a dash of cold water in
the face, a hot sponge to the larynx, a finger in the throat to
induce the act of vomiting, are approved methods to unlock
the dangerous spasms. In general convulsions, the vapour of
chloroform may be given between the seizures, or ten grains
of chloral and twenty grains of bromide may be given by injec¬
tions into the rectum, or from one to three grains of chloral
in solution injected hypodermically in an urgent case. The
latter I have tried once only, but with an excellent effect.
It is often impossible to give medicine by the mouth, and a
hypodermic injection acts more quickly and more certainly
than one into the rectum. For the second purpose (i.e., to
ward off attacks) give chloral and bromide. Each good, but
best both together. They have a marvellous power, chloral
especially, in averting tetany and laryngismus, and probably
in preventing general convulsions. They must be given in
fairly full doses and at regular intervals of sufficient fre¬
quency, so that the system is kept constantly under their
influence. For a child of six months, half a grain of chloral
to one or two grains with three of bromide every four
hours. For one a year old, from one to three grains of chloral
with five grains of bromide every four or six hours, and so
on in proportion. Children bear chloral well. Dr. Wilks
gave to a boy three years old with tetany ten grains
of chloral three times a day with the best effect. Bouchut
gave thirty grains to children of two to five years, sixty grains
to children of seven years, to produce anaesthesia for opera¬
tion. I should not hesitate to give much larger doses than
those I have indicated should urgent symptoms arise. In one
case of severe tetany in a boy of two years, in which chloral
(two grains) and bromide (five grains) given every four
hours failed to produce improvement, I gave one-twelfth to
one-fifth of a grain of Calabar bean with good effect. With
larger experience I should try much larger doses of chloral
in a similar case before resorting to Calabar bean. Let me
give, however, this warning with regard to the free use of
bromide and chloral. Bromide in five-grain doses every four
hours for some days occasionally produces severe pustular
rupial eruption. Chloral at most induces drowsiness, there¬
fore rather push chloral than bromide in case of necessity.
This treatment by sedatives may have to be continued in
greater or less degree for weeks and weeks, until the tendency
to spasm permanently declines. Thus gaining time by keep¬
ing the nervous system in safe quiescence, you proceed to
treat the rickety state, the evil condition which underlies
and is the prime source of all. For this purpose give milk,
cream, or raw meat if milk cannot be borne, with the best
kinds of infants’ food, or entire wheat flour (rich in phos¬
phates and nitrogenous matter); later, cod-liver oil and syrup
of lacto-phosphate of lime or of lime and iron. Another useful
adjunct in increasing nutrition and aid in increasing blood
flow to the atucmic nerve centres in these cases is brandy,
half a drachm to a drachm, given in half an ounce to an
ounce of food every’ four or six hours. It has also another
advantage: it acts on children chiefly as a sedative and
narcotic, and produces no excitement. And I must enforce
the paramount importance of this full nutrient treatment,
because there is a common and grave error pervading
practice in these cases—viz., that of adopting a spare and
lowering diet, such as barley-water, weak broths, and arrow-
root. Such had been the medical advice given in the second
case which I related : a most pernicious plan, against which
I wish to protest as strongly as possible—the remnant of the
old idea that the morbid condition at the root of the disease
was one of plethora and active congestion, instead of debility
and antenna. Moreover, many confound a full nutritious diet
with an indigestible irritating diet. Raw meat, for instance,

' Experiments show that convulsive seizures and spasm (apart from
ori'.inie disease, such as meningitis, tumour, &c., or poisoning) are pro-
duoed by tiro causes chiefly: (1> carbon products in blood— venosity ;
(2) anosmia of nerve centres. Kussmaul and Tenner (see Stirling and
handols. vol. 11., p. 901) found the spasm centre in the medulla could be
excited by (a) suddenly producing a highly venous state of blood, either
by m pby si > or by compressing the v ein* coming from the head, or (4) by
sudden anxmla of the medulla, either in consequence of hicmorrhageor
ligature of the carotids and subclavian*. In all these cases the stimula-
latlon of the centre is dir to the sudden interruption of the normal
interchange of gases.

is not indigestible; it is most digestible as well os most
nutritious—i.e., the soft pulp scraped-free from the fibre ;
and so with cream. A spare, thin diet, such as veal broth,
barley-water, and arrowroot, is no more digestible, and in¬
finitely less nutritious. Let me repeat, then, that the food
should be as digestible and nutritious as possible, with a high
proportion of animal albuminates and fate. Then, again, tbie
evil of low diet in these cases is Constantly heightened by
the over-use of strong purgatives and depressant drugs:
aiding artificially the very condition of draining off of
nutriment and deficient vitality we know to be the prime
fault of the disorder. If the immediate exciting cause of
convulsion be the irritation of undigested food, a dose of
castor oil should of course bj given at once ; or if there be
obstinate constipation, sufficient doses of some simple
laxative, such as magnesia, may be given to relieve it, or a
single dose of calomel may be useful on occasion. But the free
and frequent use of strong purgatives does nothing but harm.
Lastly, if diarrhcea be present--and you will remember that
it is an almost constant accompaniment of the rickety and
tetanoid state—it must be controlled. For it is injurious
in two ways: (1) by draining off nutriment from the ali¬
mentary canal before there is time for it to be absorbed, and
(2) by the reflex irritation it sets up. For the relief of
diarrhcea bismuth is one of the best remedies. It should be
given in the form of the insoluble trisnitrate, and in full
doses; the doses usually given are far too small to be really
effective : four or five grains every four hours to a child six
months old, and more in proportion to age, and with it a
quarter of a drop of laudanum, or the castor-oil mixture of
the Hospital Pharmacopceia, one, two, or three drachms
every four hours, with a quarter to one drop of laudanum
accox-ding to age; or, if there be sickness with the diarrhoea,
from half to one grain of grey powder, with from a quarter
to half a grain of Dover's powder, according to age, may be
given every four hours; or a mixture of chalk and catechu
with hiematoxylum and small doses of tincture of opium, if
the alvine discharges are watery and profuse. But astringents
are less valuable than drugs like bismuth, chalk, and the
sedative opium. _

lectures

ON

INJURIES OF NERVES.

Delivered at the Royal College of Surgeoru,

By ANTHONY A. BOWLBY, F.R.C.S. Eng.,

SURGICAL REGISTRAR AND DEMONSTRATOR OF SITROICAT. PATHOLOGY A'
ST. BARTHOLOMEW'S HOSPITAL. Hl’XTERIAN PROFKSSOR OF THE
BOYAL COLLEGE OF SURGEONS.

LECTURE II.

TROPHIC CHANGES CAUSED BY NERVE INJURY.

Mr. President and Gentlemen,— In addition to the.
partial or entire loss of sensation and motion in the part*
supplied by the divided nerve, the various tissues are liable
to undergo changes wliich are chiefly of a degenerative
nature, though sometimes combined with inflammatory con¬
ditions. The extent to which these changes are dependent
on a want of nerve force will be left for future consideration,
and for the present it will be sufficient to study the morbid
processes themselves. The first authors to draw attention
to the altered nutrition of the parts supplied by a divided
nerve were Tlilton in bis lectures on Rest and Pain (p. 199’.
and Paget in the Medical Times and Gazette of March,
but since then they have widely occupied the interest of
surgeons, and it would be impossible to allude here to all
the writers on this subject, amongst whom the names of
Charcot, Weir Mitchell, and Hutchinson occupy the foremost
places. It must first of all be premised that many of the
changes to be described, which will be known once for all
as “ trophic changes," are not by any means the invariable
sequel of nerve section, but rather that, instead of such
conditions being the rule, some of them are the exception.

The skin.- The condition of the skin most characteristic of
nerve lesion is a smooth shiny-red appearance, generally
known by the name of “ glossy skin.' The description oi
Paget in the Medical Times and Gazette , already alluded

V»7

7 ftr-OTi

970 The Lancet,]

MR. ANTHONY A. BOWLBY ON INJURIES OP NERVES.

[May 14,1887.

nerves, in only one were the nails found to be “stumpy,
broken, and uneven on the surface”; while other English sur¬
geons have passed over the question in silence. Weir Mitchell,
Morehouse, and Keen, however, in some patients noticed
very considerable lesions. They say: “ The alteration in the
nail consists of a curve in its long axis, an extreme lateral
arching, and sometimes a thickening of the cutis beneath
its extremity. In other cases a change takes place which is
quite peculiar, and which to us at least was new. The skin
at that end of the nail next to the third finger-joint
becomes retracted, leaving the sensitive matrix partly ex¬
posed. At the same time the upper line of union of skin
and nail retreats into or under the latter part, and in place
of a smooth edge is seen through the nail a ragged and
notched border. The patient who presented these changes
in the most striking form had also luteral arching of the
nail, but no longitudinal curving. It was a oase of most
terrible suffering from a combination of burning pain in the
hand and neuralgic pain in the forearm. No deformity of
nails in tubercle at all approaches that which nerve wounds
occasion. Indeed, we think it would be possible for one
familiar with these cases to diagnose the existence of a
nerve lesion from the form of these protuberant and oddly
curved nails. When the nails of the toes have been attacked,
and they are very rarely so, the curving is less marked; but
a distressing ulceration is apt to occur at thedr angles, and
to break out again and again, despite of every care and
attention. In many cases of nerve wounds, where there is
only ordinary neuralgia, and not glossy skin and causalgia, I
have seen the nails clubbed in some places, and mothers dry,
scaly, cracked, and fragile. Occasionally they are very thin, so

as to be tender—atrophied, in fact.Even complete nerve

section does not prevent lost nails from being re-formed.”

In the above graphic description, however, the authors do
not mention in what proportion of cases they observed such
lesions, or whether they occurred as a rule in recent divisions
er in those of later date. It has appeared to me that after
nerve section there may be simply a diminution in the
rapidity of growth of the nail, combined with a stunted and
.• fibrous appearance, or else that changes of a more special
nature such as those described above may be observed. Of
.eleven cases of old injury which I examined consecutively,
in only one was there any stunted and fibrous appearance
. of the nails. The other ten patients exhibited no morbid
■changes whatever, and for the most part expressed their
opinions that the nails of the one hand grew as rapidly as did
those of the other. In ten consecutive cases of more recent
nerve section, within a year of the accident eight patients
showed no change in the nails, but in the two others the latter
presented a very strange and characteristic appearance, in
many respects resembling the description by Weir Mitchell.

The first patient was a boy aged fourteen, who had sustained
a division of the median and ulnar nerves nearly a year pre¬
viously. The nails of all the Angers were short, stumpy, and
broken, excessively arched both longitudinally and trans¬
versely, with transverse furrows and ridges running across
them, the latter being marked with a delicate longitudinal
striation, giving them a 44 toothed” appearance. The nails
were thick and not tender, and the surrounding skin was not
retracted from their bases. The patient said that they had
been in this oondition ever since a few weeks after the acci¬
dent; he thought they grew as rapidly as those on the
opposite hand.

The Eecond patient was a lad, aged seventeen, who had
divided the median nerve Ave months previously, and in
whom partial union had resulted, and was still progressing.
The nails of all the Angers and thumb presented conditions
very similar to those just described, except that the nails
were very long—a condition, combined with their extreme
curvature, which gave them a talon-like appearance. In this
Tespect the thumb nail differed from its fellow, being short
and only half grown; this was accounted for by the fact that
the nail had been painlessly shed from this digit a month
previously, and had not yet grown. The patient said that
all the nails grew rapidly, and their appearance certainly
warranted the statement.

These cases, and others that I have since seen, would tend
to the belief that trophic obanges in the nails appear soon
after the nerve injury, as might be expected from the time
at which similar lesions are found in other parts. Each
patient had lost one nail entirely, a loss which may fairly
be attributed to a more complete cutting off of trophic
inAuences from this digit than from the others. In addition
to the curvature, the most characteristic appearance was

found in the peculiar striated or toothed condition of tbe
transverse ridges, which was quite different to anything 1
had seen. In the lost patient perhaps the most surprising
fact waa that, although it was quite certain that only the
median nerve had been divided,- the nails on the fourth
and Afth Angers were quite as much affected as those of
other digits. This peculiarity I have seen in other cases.

Changes in the hair growing in parts deprived of their
nerve supply have appeared to me to be very common. In
most of the cases I have examined, tbe hair, when any bos
been present, has appeared short, stumpy, and brittle, la
some patients it was altogether absent, and, as has been
remarked by Paget and Weir Mitchell, especially in cases of
glossy skin. 1 have only once been able to obtain any
portion of skin for microscopical examination, so as to see
the exact conditions of the hair follicles, and found in it that
the absence of the hair was accompanied by a corresponding
degeneration of the follicle. In some rare exceptions, the
growth of hair after nerve wounds has been very excessive.
Weir Mitchell quotes several examples, but does not appear to
have seen cases himself, and none have come under my own
notice. Hamilton, however,* records a case in which a nerve
appears to have been wounded in the operation of vene¬
section, and in which symptoms of chronic neuritis ensued,
the arm being subsequently covered by a rich growth of
hair. The patient was a young lady.

The connective tissues deprived of their ne *ve supply usually
undergo atrophy, and the palmar fascia sometimes shrinks
and becomes indurated in a very noticeable manner. In
some patients there is developed a great tendency to cedemi,
a condition which is probably due to section of some of the
vaso-motor nerves. Weir Mitchell has described, in addi¬
tion, cases where hypertrophy of the connective tissues ws»
very marked, apparently the result of chronic oedema.

The secretion of sweat is in most cases more or less
affected. By most of the patients I have seen in whom the
injury was of some standing there was a tolerable certainty
expressed that the parts deprived of their nerve supply were
always dry. 1 examined some of them oa very hot summer
days, and in most of them the parts affected remained dry,
while the rest of the hand was moist, and this despite
energetic friction. In some cases, apparently those of partial
division complicated by neuritis, the secretion of sweat bos
been described as excessive, and Weir Mitchell records cases
in which it was very acid and foul-smelling..

Considering these facts by the light of recent researches
in physiology, it might olmost be said that such conditions
would be only just.what we might expect from nerve
section or irritation; but it is interesting to note that they
were observed before experiments had proved the dependence
of tbe secretion on nerve supply.

The temperature of the paralysed parts often differs con¬
siderably from that of the opposite side erf the body, of
contiguous digits, See. Immediately after section of a nerve—
e.g., the median—the distal parts become suffused with blood,
and appreciably hotter to the touch. Waller and Weir Mitchell
have both shown that a similar rise of temperature follows on
f reusing the ulnar nerve at the elbow, and the latter observer
has also demonstrated that this elevation does not occur if s
tourniquet has previously been placed on the brachial artery, 4
thus showing the dependence on the vaso-motor system. This
increased heat is well instanced in the following two cases

A man, aged thirty, divided his ulnar nerve on May 8th,
1885, and came at once to St. Bartholomew’s Hospital,
where the cut ends were sutured by the house surgeon,
Mr. Murray. Eight hours after the accident the tempera¬
ture taken between the fourth and Afth Angers was 100-2“,
between the Aret and second, 99°.

Between 4th and Between let and

6th finger*. Sad finger*.

May 10th . 99-0° . 98-0°

„ 11th . 99-6 98-2

„ 14th . 98-0 . 97 4

„ 16th . 982 982

„ 16th . 101-6 101-6

„ 18th . 100-6 99*6

„ 19th . 99-4 98-8

„ 20th . 98-0 97-6

„ 21st . 99-0 98-0

Speaking generally, the temperature of the paralysed
ADgers averaged about 1° higher than that of the others.

* Dublin Jonmel of Medical Science, 1888.

* Archlv of-Scl. and Prac. Med., New York, 1872.

The Lancet,]

PROFESSOR HUMPHRY'S ADDRESS,

[May 14,1887. 971

and this variation remained constant despite alterations in
the general body temperature.

In the next carte a woman, aged twenty-seven, divided
her median nerve at the wrist. The following day the
temperature between the index and middle fingers was 99°,
■whilst that between the ring and little finger was 96 6°;
the day after, the temperature between ■ the index and
middle fingers was 98'8°, that between the ring and little
fingers 97°.

The following case by Richelot® is a very remarkable
instance of the rise of temperature that may follow on
separation of peripheral parts from the nervous centres:—

Fracture of humerus followed by neuroma of median
nerve; resection of nerve followed by rise of temperature in
hand. —A man aged twenty-six was admitted to the hospital
of La PititS on Dec. 30th, 1882, on account of severe pains in
the right forearm. His history was that at the age of
seven years he had sustained a compound fracture of the
lower end of the right humerus, and that the arm had always
been in a weak condition and the elbow had been stiff.
On admission there was found to be on a level with the site
of fracture a small oval swelling the size of an almond,
situated apparently on the median nerve. Pressure on
the swelling caused pain referred to the thumb, index
and middle fingers. In these fingers also sensation was
much impaired. The muscles of the forearm and of the
ball of the thumb were much wasted, but were not com¬
pletely paralysed. The temperature of the hand on the
affected side was 4*5° below that on the opposite side.
On January 15th, 1883, Mr. Vemeuil removed the tumour
by operation, completely cutting out the portion of median
nerve from which it grew, and not stitching the cut ends,
but leaving them widely separated. The tnmonr itself was
found to be a fibroma, separating the nerve tubules, and by
its pressure destroying some of the nerve bundles. After ,
the operation the temperature of the hand on the side on
which the operation had been performed—i.e., the right—
was 34°, of the left 30°. The day after the operation the
temperature of the right hand was 85°, and of the left 25°.
Sensation was still further lost, but was nowhere entirely
absent. The further history of the patient is not given.

But although immediately after injury and for a varying
number of days there is an increase of temperature in the
peripheral parts supplied by the damaged nerve, yet in the
course of about three weeks there is a decided fall of
temperature, so that in by far the larger number of old
nerve wounds the peripheral parts are cold and livid. The
amount of loss of heat varies much. In one of Hutchinson’s
cases it was as much as 16° compared with the fingers of
the opposite side, in two others 10°; and, indeed, it may vary
between these and the normal temperature in a manner
which admits of no rule being formulated. In a case brought
before the Pathological Society,* the gradual restoration of
heat, coinciding apparently with nerve repair, is well in¬
stanced. The patient was a boy aged six years and a half,
who suffered division of bis ulnar nerve in August 1861. In
October of. the same year the temperature of the fingers
supplied by it was 10° lower than that of the others which
derived their supply from the median and radial. On
November 28th the difference was 5°. In July, 1862, the
same. In February, 1866, there'was only a difference of
half a degree, and the muscles had resumed their normal
bulk. Sometimes, however, even in cases of old injury,
instead of any loss being discoverable, there is a distinct
increase of heat, and Weir Mitchell found the tempera¬
ture raised one or two degrees in cases of what he calls
“ causalgia.” These cases seem comparable with those of
increased sweating.

The muscles in connexion with a divided nerve undergo
a rapid atrophy and degeneration, of a character which is
completely different to the simple decrease in size which
follows upon non-use. The final result of this process is a
transformation of the muscle into a mass of fibrous tissue,
firm and dense, neither contractile nor elastic, usually
mingled with a little fat. For some time after the nerve
lesion the muscle feels limp and flabby, the patient can
exercise no control over it, and the tendon into which it is
inserted no longer stands in relief under the skin; the muscle
has, in fact, lost tone. This condition is gradually followed
by wasting in bulk, and frequently by shortening of the
muscle in its long axis. Vulpian describes a redaction in

- ? BaU.etMem.de IaSoo.de Ohir.de Paris, 1883, p.438.
8 Path. Soc. Report*, voL vU.

the diameter of the primitive muscle bundles, with granulo-
fatty changes and complete disappearance of certain fibres:
“ in the early stage of alteration, the primitive fibres appear
to be segmented, the muscular substance persisting in some
places and being absent in others. At the same time we ob¬
serve the formation of a more or less considerable quantity
of fat-vesicles in the connective tissue which separates the
secondary bundles of fibres, and much more rarely between
the primitive fibres.” Multiplication of the nuclei of the
connective tissue of the muscle is also observed, while the
vessels suffer only a loss of calibre, without other changes.
The faradaic and galvanic excitability of the muscles is soon
lost, but at present I shall not further allude to the changes
in the electrical reactions, as I propose to treat of them at
greater length in the section on Symptoms of Nerve Injuries.

(To bo concluded.)

Delivered on May Gth, 1887, at the Meeting held for the
formation of an

ANATOMICAL SOCIETY.

By PROFESSOR HUMPHRY, F.R.S.

Gentlemen,—I fully appreciate the honour you have
done me in voting me to the chair on this occasion. The
reason for your doing so may be found in the fact that my
commencement of the study of anatomy dates from more
than half a century ago, during much of which time I have
been a teacher of anatomy, and it is therefore pretty certain
that I am the senior anatomical student as well as the
senior anatomical teacher here present; and though I have
now to a great extent relinquished the study and teaching
of anatomy, yet- it may be supposed that I still cast
lingering looks behind upon that field in which I for so
many years worked happily and earnestly, and, I hope, not
altogether unprofltably. I appreciate the honour, however,
more especially because I feel that this is an important
occasion—an epoch, it may perhaps be regarded, in the
history of anatomy, and an occasion of much importance to
the study of medicine generally. We are met together for
the purpose of elevating the study of human anatomy, and
placing, or endeavouring to place, the science oi human
anatomy on a level with, and in that proper relation to, the
other branches of natural science which I think it has not
for some time held, and which relative decadence is greatly
to be attributed to the fact that it has not advanced
pari passu with them. Since the time of Hunter, Cruikv
shank, Astley Cooper, and the Bells, human anatomy has
lacked its proper interest, and has not held its own with,
the other quickly progressing branches of natural science.
Hence it has come to be regarded as a merely practical,
subject, and its study to be merely a process of "piling fact
upon fact without due regard to the puiport oi the facts
and the suggestions to which they should give rise. Far
be it from me to disparage the value of anatomy as a
practical subject, seeing that in this way it confers the-
greatest benefits upon humanity, and has, and ever must
have, the first and chief claim to our regard. Nor would
I disparage the educational benefits resulting from the
acquisition of a cleat and accurate knowledge of the
structure of the body and the mental training derived
thereby, which is of so much value to those who are-
entering upon the pursuit of medicine. But I feel that the
study of anatomy should not be regarded from this point
alone, but that a wider and higher view should be taken of
it. The human body is undoubtedly the highest and most
perfect of created works, the last and most perfect outcome
of nature’s laboratory, the central one around which all the
rest of the animal world is grouped, to which all point, and
which all are calculated to elucidate. It is provided with
a surpassing mechanism, great results being produced by
slight modifications from the forms of other animals, and,
the resultant being such acuteness of perception, and such
variety, nicety, and precision of movement, as to give man
the mastery over all others, and enable him to bend all

ed by Google

972 Thb Lanckt,]

DR. THOMAS BUZZARD ON THOMSEN’S DISEASE.

[May 14,1887.

nature to his purpose. Moreover, its proportions, the
outlines of its form, and the power of expression of its
several parts in both sexes and at all periods of life,
are such, and present so much beauty and variety, that it
has formed subjects for the highest efforts of the greatest
artists of all times, from Phidias and Raphael to Leighton
and Millais. Further, in it the physical is worked up into
that complex and mysterious elaboration and process which
enables it to become the organ or agent of the mental and
intellectual, the seat of the soul, the abode of Deity. The
problems and conceptions, physical, artistic, and psychical,
arising out of and associated with this material frame of
ours, infinitely surpass in number and interest those of all
other existing forms. It may be regarded therefore as one
of the marvels connected with it, that the study of it should
come to be regarded as dull and uninteresting, and profitable
only for its direct practical relations with medicine and
surgery. Surely it needs only the proper impulses, such as
we trust will in part be furnished by the proposed Society,
to obtain for it a due appreciation and position among the
higher and educational sciences. It was this feeling which
urged me to contend strongly, and I am glad to say success¬
fully, for a place for human anatomy among the natural
sciences at Cambridge; and I am convinced that it would be
a benefit vibrating along the whole line of medical educa-
tion-if at the early stage of that education the student.were
accustomed to reflect upon what he sees and reads of in his
anatomical course, and to associate thoughts respecting the
mechanical and other relations of the structures which he
dissects. One of the greatest, perhaps the greatest, defpct
in medical education—I might say in all education more or
less, but in medical education especially—is the heaping
upon and oppressing the student’s mind with a load
of facts which he neither digests nor appropriates, and
which he therefore does not retain. His mind is like a
sack orammed with grain which there is little power to
fertilise or utilise. Far better would it be to lessen the
load and to substitute the habit and the ability to Teflect
and really digest and appropriate the remainder—to give
some opportunity for mental elasticity, and for that enjoy¬
ment of study which results from a real knowledge
and appreciation of what is learned. As a general
rule, we remember only — at any rate, we remember
best — that information the bearings of which we
have well understood, and which has consequently most
interested and impressed us, and which we have most
enjoyed. To make anatomy better remembered and a better
mental training, it must be made more interesting, more
attractive, and more thought-inspiring; and this is to be
done by giving to it its proper scope as a medium of infor¬
mation, and by imparting to its details, which are now too cold
and dry and sterile, the warmth and life and thought-budding
energy which should belong to them. I have spoken chiefly
of human anatomy because to it these remarlcs especially
apply, and because the human body is the subject of the
most serious and arduous study, and the manner in which it
is prosecuted is the most important and the most relevant
to our purpose. Not that the scope of the proposed Society
is to be limited to it, but that our greatest opportunities far
good will be in relation to it. Anatomy—the anatomy-
more particularly of the human body—is a very ancient and
dignified science; indeed, a royal Bcience. It was studied
ages and ages ago by the people on the banks of the Nile, from
wnom we have derived so much; and we were told the other
day at Cambridge by my learned successor in the chair of
Anatomy that the earliest writing upon it of which we have
any cognisance was by an Egyptian king who had passed
away long before the exodus took place. It is for us to
make it a royal science in a higher sense, and to give to the
human body its proper royalty of position in the animal
world, not merely by having regard to the paramount
practical importance of its study, but by considering it also
in relation to its mechanism or physical physiology, in its
relation to embryology, in its relation to the anatomy of
other animals, and also in its relation to the special structural
features which may be associated with the occurrence of
certain diseases. The attendance this afternoon shows a

f general interest in this movement, and augurs well for the
ormation and prosperity of the Society, which, I trust, will
prove long-lived add useful, f will occupy your time no
longer, for the relation betweedtfce brevity of life and the
.-length of art, and the in word as well as in

/ictfon, are becoming daily In the quickly

ihifUng scenes of this singularly ntoT w

TWO CASES OF THOMSEN’S DISEASE . 1

By THOMAS BUZZARD, M.D.,

PHYSICIAN TO THE NATIONAL HOSPITAL FOR THE PARALYSED AND
EPILEPTIC.

So far as I am aware, no case of the remarkable condition
to which the name of “Thomsen’s disease” has been applied
has yet been described as haying been observed in this
country. Examples have been reported from Germany,
France, Russia, Italy, Sweden, and the United States, whilst
the description given by Dr. Thomsen, of K&ppeln, Schleswig,
himself a sufferer and a member of a family largely affected
with the disease, is well known as the source of the name
which has been bestowed on the affection. I would refer
those interested in the literature of the subject to a digest
of it published by Dr. Paul Chapman in Brain (April,
1883), which has been continued up to date by Dr. Hale
White in the same journal (April, 1886). These two articles
contain an admirable summary of existing knowledge upon
the subject.

The patient, E. C. F-, aged twenty, engaged in a MBJ-

nercial pursuit, was sent to me by Dr. Izod, of Esher, bo
account of a peculiar difficulty in the movements of his
limbs. As long as he could remember he had always suffered
more or less trom this trouble, but it had been noticed
-(specially of late when he began to enter upon the duties of
his business. In his own words, “ before doing anything he
feels that he must get his muscles ready.” If he has been
at rest for a short time and goes to make, a movement the
muscles not only contract but remain contracted, so that a
very strong effort on his part is required to make a fresh
movement. He cannot run upstairs; after taking one step
he is not ready to follow it up with another. On seating
himself he is often unable to flex the knees, so that his legs
i«main for a time rigidly extended. And so, again, on wishing
to rise the muscles appear to be “set,” and it is only by
strong exertion that he can effect the necessary movement.
He has often fallen down upon a railway platform on alight¬
ing from a carriage, because he has been unready to take
the second step necessary to preserve his equilibrium.

It is characteristic of his condition that the difficulty
described is only temporary. After a few flexion and exten¬
sion movements of the knee the tendency to stiffness ceases,
and does not return until after he has rested for a few
seconds. Thanks to this peculiarity, he can ride a tricycle
very well after overcoming the stiffness which results from
the first attempts to move the treadles; but if an impedi¬
ment on the road should compel him to cease “ paddling"
lie encounters the old difficulty in recommencing. So,
likewise, he can play lawn tenms very fairly when he has
overcome the stiffness which obstructs His movements at
the beginning. In skating recently, he observed that if he
were stopped suddenly, as in a collision, he could not go on
again for a few seconds; and if he fell, he lay “ like a log,”
unable at first to move a limb. He feels difficulty in
lieginning to run, but after a little while goes on very well.
He can stop easily enough, but his limbs then grow stiff,
and he cannot start again for a few seconds. The difficulty
in beginning to move after rest, or in changing one move¬
ment for another, is intensified by anything producing
“nervousness.” If, for instance, he is called sharply, hs
finds his muscles more than ever unfit to obey the orders of
his will.

The patient is a sturdy-looking young man of middle
height, whose general health has always been excellent.
When stripped the thighs are found, to be extraordinarily
developed, so that one is reminded, as he stands, of the sculp¬
ture of Michael Angelo, the muscles being sharply mapped
out, and standing forth when in action in bold relief. When
contracted they reel firm and hard, but in a quiescent state
are perhaps inclined to be somewhat flabby. The actual
muscular force, as tested by the power of resisting passive
movements, is distinctly less than might be expected from
the bulk of muscle displayed; and the patient- himself says
that he is not very strong, and somewhat easily tired. Whan
seated and asked to extend the leg upon the thigh, it is only
after an interval of several seconds that he can do so. And

'* 1 The substance of a oomnranteatlon made to the Neurological Sochdf
of London at the meeting held On Jan. 27th, 1882, when the elder of the
two patients woe exhibited. - - —"-'’joia'

• r«r’«, 'J7KUU.

TJOI*AKOM,],

DB. THOMAS BUZZARD ON THOMSEN'S DISEASE.

[May 14,1887. 97a

te like manner, tie leg being extended, be is unable until
alter a similar pause to place hia> foot upon the floor. The ;
extensor, oruris muscular mass is felt contracted, and relates
oblj by slow degrees.. During tbs relaxation tie patient
feels pain of cramprliae character in the muscle. Except for
this there is not the slightest: sensory disturbance—no cuta¬
neous anaesthesia, numbness, or loss of muscular sense;,
and the muscles are not tender when handled. .If be lies
upon the floorythe difficulty experienced in rising to his feet
reminds one-to a certain extent of' that ■ shown by a patient
suffering iromDa«h«me’amyoscleros»(pew*Io-hypeitrophio
muscular paralysis), nod-the. hypertrophy of hu muscles-
-lends add fco thia general resemblance jbuVM will presently
appear, the electrical reactions are completely opposed to.
those which characterise that disease. The act of rising is
laborious^ and the help of the arms is much called upon.
Tha knee phenomenon is entirely absent in. each limb, even
when the Jendraarik method as employed for testing it.
“The cremaster reflex is present, hut weak) the plantar so.
imperfectly elhxtodas to leans soma doubt as to itepnesenoe.
Although tbe tehdency to a tetanoid condition .upon, volun¬
tary movement is by far the most strongly expressed in the
muscles of/ the .lower extremities, ibis not absolutely con¬
fined. to these; The patient describe* some unreadiness and
etiffness inthe use of his erms. His artioulatiou is peculiar,
recalling to-a slight extent that of a patient .with trismus;
and the > lower half of the face is a little suggestive of the
endOnio expression to be noticed in a ease of tetanus.
Occasionally his eyelids will become pertly fixed in a half- 4
open position^ so that .for an instant/he ean neither open
them further nor shut .them.,. • - • . ,

Examination elicits no signs of increased excitability to
mechanical' sttaratetioa i* the anterior crural nerve, i A
galvanic current of one milliampdre applied to this nerve
produced fro muscular contraction; with two miUiampterfls
there was evident contraction in the, vastus interims and
externns and K S Z < A 8 2; bat on a OsoozkL trial with? the
same strength of current, tha condition < was- reversed—i*
KSZ> ASZ. The inference was that the excitability of
the nertu to galvanism is not heightened. : i

As regards the mtiscle, a pushwitha Anger-point upon
the vastus interims causes a lumpy wave of contraction to
1 rise, which lasts for many
seconds after the Anger has
been removed, if this be
repeated, however, several
times hi rapid succession, a
normal condition is brought
about, so that the oon-
troctSotis following percus¬
sion subside with ordinary
quidknesa. If after thte the
-muscl# be left quiet for
fifteen or twenty seconds
add the finger then again
thrust into it, the pheno*
menon described is repro¬
duced. It is evident mat,
unlike that of the nervd,
the moehMfical excitability
of - the mutcle is greatly
heightened. The muscles re¬
spond to a normal strength
of faradaio current, and
there ife oentractioti of the
Vastus internes to a gal¬
vanic current of two milli-
. . v 1 ■’ ' ' ‘ ' - : snrpdree,' and KSZ=xA8Z.

f n the extensor oommunto digitorotn of the left foreiara this
’mtemiption of a galvanic i currant from four milttampdreo
m necessary to eause oontsectioii, and K8Z>A8Z. The
excitability to galvanism of the thigh muscle is therefore
apparently ccwiderably greater than that of the muscle of
theforeamtaL (The peeuttmr condition of the muscular system
•gives rise to a t rfl m a rka bla phenomenon. The contraction of
toe vastus internes muscle Allowing electric stidinlation
can be seen to persist long-after the irhebpbora has been
amoved, and on several occasions of examination an interval
oi twenty-flve ascends wOs required te the. gradual return
of the musoie to a stoto ef relaxation.

The above flghre hOoWn engraved from a photo*
255“ for mb 1 by . DT. Wifsott, resident medical

<"“<*r. National Hospital, Queen-square. It is intended to
exhibit the contraction of the vastus intern us remaining

long enough after removal of the rheophore to be photo¬
graphed.

A similar condition was noted in the sural muscles, and'
was also well seen in those of the thenar and hypothenar
eminences of the hand. The muscles of the arm and forearm
scarcely showed the peculiarity, and those of the face not at
&1L There was but little marked persisting contraction in
the muscles of the front of the leg, which thus presented a
considerable contrast to those of the calf, but it mast be
noted that the latter were considerably hypertrophied.'
When the rheophore—strong galvanic current—was drawn
over the skin covering the vastus internua, the wave of con¬
traction produced under it had not subsided ere another
arose, and the appearance thus presented was very remark¬
able. This phenomenon, with the others described, has'
been noted by Erb and other observers.

The effect of mechanical and electrical stimulation npon
the muscle is the same as that which accompanies volition,
and it is to the persistence of induced contraction that the
patient’s embarrassment of movement is due. In strict cor¬
respondence, again, with what takes place as & result of
repeated voluntary action, the exaggerated tonicity of the
muscles passes off after a few repetitions of the application
of alectnc currents, and then the contractions, are observed
to relax in normal fashion and in the usual time. After a
rest of ten seconds only the phenomenon can be reproduced.
The patient has no complaint to make as regards the action
of the sphincters or of the muscles of respiration, except
that he rather easily gets out of breath, but this he attributes
to being out of practice in exercise. The heart sounds are
quite normal.

E. C. F- is one of a family of sixteen children, his

father having married twice, and he "being the second child
Of the second family, which numbered sevezi. The first 1
child, a sister, has no trace of the affection, but a younger

brother, W. F-, aged sixteen, is affected like himself.

His muscles present the same remarkable development, and
his symptoms generally are so precisely similar to those of
the patient first described that it is unnecessary to enlarge
upon them. But in two respects there is an important dis¬
tinction. In the younger brother the vasti muscles show an
increase of excitability to induced currents, and the knee
phenomenon is preserved to a normal extent. No other
children of either family (except these two) present, as I
ato informed, any trace of the disease. The father is de-*
scribed as being of somewhat anxious temperament, and
so, it ia thought, is the mother; but the size of their family
must be remembered. The father has Buffered from gout
in the toe; the mother’s father also suffered from gout, but
died at the age of seventy-three. Nothing in the nature
of this peculiar affection is remembered as regards any
member of the mother’s family.

'.,lt has been reported that persons affected with this dis¬
order betray irritability of temper, suspiciousness, and
reserve. This doee not appear to be the case in the patients
described. Indeed, the elder has been singularly liberal in
affording opportunities for the observation of his symptoms,
and has evineed a most intelligent interest in the requisite
examinations; and the younger has cheerfully assented to
investigation of his condition.

The symptoms presented by the two brothers are very
characteristic of the disease, which has acquired its best
known designation from the physician whose description of
it in his own person and family first drew any particular
attention to it. The term applied to it by Striimpell,
44 congenital myotonia,” conveniently suggests the exalted
muscular tonicity which is apparently the immediate cause
of the symptoms; whilst 44 myotonic contractions,” which
has also been suggested, baa the advantage of avoiding pre¬
judice of the question whether the condition is always conn
genital, about which some doubt has been expressed. Allan
M'Lane Hamilton of New York, in an interesting article
(referred to by Dr. Hale White in his critical digest), is disr
ppasd to doubt whether the so-called Thomsen’s disease is a
distinct malady, and suggests that the muscle stiffness on
contraction is a frequent symptom in a variety of maladies.
But the microscopical examinations made by Erb and
<5. Fischer would appear to show distinct anatomical changes
in the muscular fibres—hardness and want of suppleness in
the muscular bundles, with marked thickening of the fibres
and changes in their transverse striation, together with
increase in the number of nuclei of the saroolemma.

I have never seen in any case of disease of the spinal cord
or peripheral nerves the peculiar condition observable in

O

974 The Lancet,]

MR. C. WILLIAMS ON TREPANATION OF THE MA8TOID PROCESS. [Mat 14,1887.

these patients, who, it mast be remembered, are, with the
exception of the exalted muscular tonicity, in perfect health.
There are no doubt remarkable tendencies to rigidity in
certain organic and functional •diseases of the nervous
system, but they differ, according to my experience, from
the state observed in Thomsen’s disease, which is quite sut
generis. In view of the fact that rapid repetitions of volun¬
tary or mechanically induced muscle contractions will
cause the abnormal tonicity of the muscle to disappear,
at least for the time, it seems to me difficult to refer
the peculiarity to the anatomical changes as a cause. One
would perhaps feel more disposed to conjecture that these
might be a result of a functional abnormality. But much
extended observation will be required ere we can usefully
discuss this point. I would refer incidentally to a circum¬
stance of peculiar interest. In the view of some authorities
the knee phenomenon depends upon locally induced con¬
traction of a muscle, the tonicity of which it is essential
should be well preserved. It would appear that the chief
characteristic of the disease under discussion is an exagge¬
rated tonicity of muscular fibres, and eeeteris paribus, if the
“ tonus” theory of the knee phenomenon were correct, one
would expect to find the response to a blow on the liga-
mentum patellae-more than usually well marked in such cases
as I am describing. But instead of this the knee pheno¬
menon is entirely absent in the elder of the two brothers.
At the same time the cremasteric reflex is very weak, and
the plantar only doubtfully present. In the younger patient,
as I have remarked, the knee phenomenon fa present. Ac¬
cording to the summary derived by Dr. White from a con¬
sideration of the various recorded cases, it is the rule that
the reflexes are normal. It does not seem that they are ever
exaggerated.

It is scarcely necessary to remark that in the absence of
any definite information as to the pathology of this affection
nothing satisfactory can be said in reference to its treat¬
ment. As it is seen that exercise of the muscles, either
by voluntary use or electric stimulation, conquers for a
time the tendency to persistent contraction, trial is being
made of the galvanic current, and regular exercise is
reco'mmended to the patients.

Groevenor-Btreet, W._

CASES OF TREPANATION OF THE MASTOID
PROCESS . 1

By CHARLES WILLIAMS, F.R.C.S. Edin.,

BURGEON TO THE NORFOLK AND NORWICH HOSPITAL.

Caries and necrosis are more common in the mastoid
than in any other part of the temporal bone. They are
more frequently met with in childhood than in adult life,
on account of the anatomical relations of the bone, which
are highly favourable to the retention and consequent
inspissation and putrefaction of the pus formed in suppura¬
tive inflammation of the mucous periosteal lining of the
mastoid cells. If during the inflammation ulceration
takes place, the bone, deprived of its periosteum, is very
soon involved in the molecular necrosis of the tissues, and
caries is the result. With caries of the mastoid process the
posterior wall of the meatus is almost always deprived of
its periosteum and perforated. ThiB condition was well
marked in two of the cases about to be related, as well as
in a specimen removed from a boy who died of absoess of
the brain. The specimen is interesting from the faet that
the mastoid abscess perforated the bone in three places.

The first case is that of William K-, aged forty-nine, a

coachman, who was admitted into the Norfolk and Norwich
Hospital under my care in May, 1883, suffering from severe
pains over the right side of his face and head; it generally
commenced behind the ear and shot upwards, and was of a
boring, grinding character; it made him feel very ill, and he
looked as if he were in great suffering. Occasionally he had
cold shivering fits, alternating with hot feverish attacks. He
had a furred tongue and a temperature of 101°. ne carried
his head on one side, nnd drawn to the right shoulder.
Behind the right, ear the parts were red and cedematous;
very tender when touched. Pus was being discharged from
the meatus; it was seen to issue from a small opening
behind the cartilaginous portions of the auditory canal on

its posterior and upper side; a small granulation marked
the spot. Hearing was most imperfect; the membran*
tympani doll and oonvex. The man stated that his affection
began four months before admission, after driving through-
a severe snowstorm, in which snow was driven into toe-
right meatus. The same night be experienced pain in the-
ear. This increased in seventy, and a month later the skin
behind had become swollen, tender, and inflamed. This state
of affairs gradually increased in intensity, besides extending
down the neck, nntil the day of his admission. Ten days later
he was placed under the influence of ether, and a straight-
incision made downwards over the mastoid process. As the
tissues were infiltrated with inflammatory products, the in¬
cision was carried to a considerable depth before the bone wse
fully exposed, the condition of which was softer than usual.
A small gouge soon penetrated it, and thick pus immediately
oozed up. The opening was now carefully enlarged, and its
connexion with the auditory tube followed up and also
enlarged. The parts were well syringed oat with carbolic-
water, a drainage-tube placed in the wound and drawn out
through the meatus, ana cotton-wool placed over all. A few
days later an absoees, which had been forming deeply in the
neck, opened into the wound and discharged very freely, h
month after the operation the wound had heeled, the
membrane tympani was in a healthy state, and his hearing
almost perfect. He was then sent to Yarmouth. In less
than a fortnight he returned to the hospital goffering from
an attack of erysipelas of the face and head, which rendered
him delirious for a week. Eventually he got quite well, and
I have seen him many times since. Even so lately as last-
week he expressed himself as being in exoellent health, and
his hearing good.

The second case was that of a young woman from whose
right ear thin fetid pus was constantly discharging itself.
There was a fistulous opening in the upper and posterior wall
of the auditory canal, and another over the mastoid prooess.
A probe could be made to pass from one to the other. She
came under my care in this hospital with the hope of being
relieved. She could give no account of the origin of her
trouble. The membrana tympani was absent. Whilst under
the influence of ether an incision was made over the mastoid,
which was softer than it is naturally. All the carious bone
was freely gouged away, and the opening extended into the
auditory canal, through which a drainage-tube was placed.
She recovered well, but had lost her hearing from disorgani¬
sation of the tympanum.

The third case was that of a schoolmaster in this city, who*
when I first visited him, was suffering great pain and un¬
easiness over the left mastoid; it was severe enough to keep
him in bed. No inflammation could be made out; no
oedema over the mastoid. The membrana tympani was
healthy, and hearing fairly perfect. For three months he
tried every known remedy, both externally and internally*
and failed to obtain the least relief; and, although there
was no external sign of an abscess, I proposed as a last
resource to cut down upon and open the mastoid process.
The patient readily assented to this. The periosteum wa»
found to be thickened, but not otherwise altered. This w&»
freely incised, and I now attempted to perforate the mastoid
with Hunter’s trephine. So dense and hard was it that 1
utterly failed to make the smallest impression on it. Nor
was I more fortunate with Marshall’s necrotome. I was
reluctantly obliged to close the wound from that day. My
patient suffered no more pain; the wound healed rapidly,
and at the present time—four years from the date of tbe-
operation—he is in perfeot health, and free from any audi¬
tory annoyanee.

Remarks. Voltilini is the only authority who has
directed attention to this peculiar affection, which b*
represented as a “ form of mastoid periostitis nndescribed by
otological authorities.” To him is due the credit of having
given a clear and detailed description of this disease. “The
ear," he observes, “ may remain intact, but may sometimes
in the course of the affection participate in the inflam¬
mation. The disease begins with severe tearing pains on
one or both sides of the head, which extend to the ride of
the face and teeth.” In three coses reported by.Dr. Voltilini all
were the result of cold and exposure. In one case, after the
use of leeches, which did not diminish the symptoms. »
long and deep incision was made over tbe mastoid. The
pain was almost immediately relieved, the patient slept
well, and made a good recovery. Dr. Turnbull 3 remarks:

1 A paper read before the Norwich MedlcoChfc-urgical Society.

* Imperfect Hearing. Philadelphia, 1SSJL.

Tra Ujtcbt,} DB. W. PASTEUR: PARALYSIS OF THE DIAPHRAGM AFTER DIPHTHERIA. [May 14,1887. 975

“ A study of these cases (one by Dr. Blake of Boston, one
by Dr. H. Knapp of New York, and my own) shows the
disease to be neither one of the auricle, the external auditory
canal, the tympanic cavity;, nor the mastoid cells, but one
that originates without, and not within, the ear, and one
that might progress inwards, but Would hardly penetrate
deeply.

The next case was that of a boy aged - seven years, under
my care in the Norwich Hospital, and very kindly transferred
to me by Mr. Cadge in December, 1885. He had an attack
of scarlet fever five years ago, and from that time has
suffered from otorrhcea of the left ear. Three weeks before
admission he complained of severe pain in the heed,"
■especially about the vertex; he had a peculiar way of
looking upwards, and generally carried his head on one
eide (the right); he used to walk against things as if be had
lost liis sight, aad had occasional attacks of vomiting. He
is fairly well nourished, of tight complexion; has a vacant
expression; was able to read and write,- but can do neither
new, the sight being so imperfect, sb much eo that he
cannot distinguish letters. The pupils are widely dilated
end act feebly. In walking he proceeds very cautiously and
elowly. Is doll and stupid. Has no paralysis, either facial or
lateral. There is a free offensive discharge from the left ear,
and a tender swelling behind. The membrana tiympani and
ossicles absent. On Jan. 8th, 1885, he was etherised, and a
long deep incision made' over the mastoid process. A good
deal of pus was found to be lyingUnder the periostedm. The ‘
surface of the boue was rough and carious. ■ This was
chiseled away, the mastoid cells freely opened, and a com*
nrunication made into the auditory canal. A drainage-
tube was passed into the wound and out through the
meatus. The wound was well syringed with boradc lotion,
and the ear covered over with earbolised 1 dressing. Two
months later the wound had healed, the discharge bad
ceased, the boy was less dull, could see well, and run about
without fear.

Remarks.—Of all cases within thedomain of surgery no case
is so likely to terminate fatally if left to itself as that of in*
flammation of the tympanum, whether it be acute or chronic;
and no case is so likely to end well as such a one if operative
proceedings are adopted early. An abscess in the immediate
vicinity or the brain carries with it grave dinger, and the
early opening of that abscess is the only protection against
the destructive effect of pent-up matter. Surgeons, as a
rule, hesitate too long in dealing with abscess of the mas¬
toid process; precious time is thus lost, irreparable mis¬
chief is sustained by the structures of the tympanum, and a
fatal termination from abscess'of the brain, meningitis, or
pyaemia is too frequently the result. On this point Hinton
observes: “I have never regretted making the incision, and
scarcely ever decided against making it without regretting
that I aid not.” Sir William Dal by soys: "No time should
ever be lost in providing an escape for pus. Pain and
tenderness over the mastoid process should always demand
immediate attention, and especially ‘when the tympanic
membrane is perforated. If, in addition, there should be
any redness or pitting upon pressure, it may be assumed with
great confidence that there is pus in the mastoid cells.”
At the same time, a word- of caution on one or -two
points in connexion with this operation may be useful,
ft is well to remember how near the lateral sinus is; it lies
immediately behind the mastoid process; and if this process
has become softened from the long retention of pas within
its cells, a condition results named by some "caseous
degeneration.” The trephine or chisel may readily slip
through this into the sinus. As a precautionary measure
the finger-nail or the point of the scalpel should be pressed
against the bone; ana if it does not yield we must proceed
to operate with the gouge or trephine. The form of trephine
I like best is that used in America, aad known as Dr,
Buck’s. It is a more manageable instrument than Hinton’s,
and more under control. I have had fitted to mine a m^ii
conical-shaped necrotome, which will be found of great use.
Having perforated the bone with the trephine, the necrotome
can be used to enlarge the opening; but should the bone be
soft, Yolkmann’s scoop is unquestionably the safest and best
Instrument with which to scoop away all carious bone.

At the annual meeting in connexion with the
Association of Public Sanitary Inspectors, on the 7th inst^
the President (Mr. Edwin Chadwick, C3> delivered an
address ort the Financial Value of Sanitary Science.

PARALYSIS OF THE DIAPHRAGM AFTER
DIPHTHERIA, WITH EXTENSIVE PUL¬
MONARY COLLAPSE; RECOVERY.

By W. PASTEUR, M.D. Lond., M.R.C.P„

PHTSTCIAX TO THE HOBTH-KA3TEB.X HOai’ITAI. FOB CHILDRKX, ETC.

J. H-,, five years of age,, ca me to the .out-patient

department of the North-Eastern Hospital on May 3rd,
1886,. with the following history. During feouvaleseehoe
from chicken-pox in March his mother noticed a
swelling (probably glandular) oU the right side of his
neck, but the child did not complain of pain or difficulty
in shallowing, and there was no regurgitation of liquids
through the nose. On April 26th the boy was in perfect
health, but shortly after this be began to languish and
became vapidly weaken Et was also noticed at this time
that ha began to walk'In a very peculiar manner. He reeled
intb- the out-patient room like a drunkard; his gait was
tnashecUy ataxic and unsteady. No obvious paralysis of the
soft palate could be made out, but the voioe had a nasal
"timbre.” The heart was acting strongly, the pulse being
lull and regular. The knee-jerk was absent on both sides.

The child was taken into the hospital a week later in the
following condition.' A fairly nourished, somewhat frail¬
looking boy, with a dry, cool skin, healthy lungs, and good
pulse, Nervous system. The intelligence is good, the ex¬
pression rather listless. There is no facial paralysis. The'
pupils are equal and active, and the ocular muscles healthy.
The tongue is protruded in the median line. The child
swallows slowly, but there is no regurgitation of food. The
voice is weak and nasal in quality. The movements of the
soft palate are very limited, but equal on the two sides.
There is marked paresis of the muscles of the trunk and
extremities. The child is Unable to sit up in bed without
assistance; the grasp of both hands is very feeble, and
When put upon his feet be begins to sway to and fro, and
would fall if not supported. Tactile sensibility, Os far as
can be ascertained, is intact. The knee jerk is absent on
both sides, but the superficial reflexes are all readily elicited,
and with one exception (the plantar) remained present
throughout the illness. There is no ankle clonus. Since the
beginning of this illness the patient has been troubled with
rather obstinate constipation. There is incontinence of
urine, which, however, existed previously. The 1 child has
a slight dry cough, but examination of the lungs does nob
reveal any abnormal physical signs.

Progress and termination .—The first sign of heart failure
appeared on May 18th, when the pulse became irregular and
increased iu frequency. On the following day paralysis
of both legs wes absolute. The plantar reflex wae a little
delayed, and tactile sensibility in the legs appeared to be
blunted. The patient was still able to take his food am)
stimulants by the mouth, though with some difficulty, and
an odour of sour milk was perceptible in the breath. During
the next few days there was a gradual increase of the para¬
lysis of the trunk and arms. The movements of the ribs
seemed to grow less day by day; the head rolled helplessly to
one side or other when unsupported; the child had lost all
power of movement over both shoulder-joints, but wae still
able to move the forearms and hands, though even here
muscular power was almost in abeyance. The voice mean¬
time had sunk to a whisper, and the cough was aphonic and
ineffectual, havingalmoet entirely lost its explosive character.
Up to this time the treatment had been of the simplest. The
child was placed in a curtained cot in a warm oonaer of the
ward, and strict orders were given that he should be moved
as little and as gently as possible. Constipation was relieved
by simple enemas as often as necessary, and small dose*
ot liquor strychnin were administered every four hours.
The diet consisted entirely of milk and beef-tea, with
an ounce and a half of brandy in the twenty-four hours.
At this period of the illness the most serious factor was the
great difficulty experienced in getting the child to take a
sufficient quantity of nourishment. Owing to the very Slow
and imperfect manner in which tbe act of swallowing was
performed, it was found impossible to give more than two
or three tAaapoonfols of food at a time, and this made the
total quantity for the twenty-four hours far below what one
would have wished the patient to take. During the last
forty-eight hours, too, the ingurgitation of food had givdn

970 The Lancet,] DR. W. PASTEUR: PARALYSIS OP THE DIAPHRAGM AFTER DIPHTHERIA. [May 14,1887.

rise to one or two severe paroxysms of coughing, which
greatly exhausted the child. It was accordingly decided to
make up the deficiency by giving nutrient enemata. On
the following morning (May 20th) an alarming train of
symptoms suddenly developed. Respiration became greatly
embarrassed and the lips and extremities cold and bluish.
Examination of the chest showed that the right side was
practically immobile, with the exception of the two or three
upper ribs. The percussion note was much impaired over
the right front and right base. At the right ape* in front
the breathing was loud and tubular in the upper spaces,
weak over the middle lobe, and almost inaudible at the base.
Behind, above the level of the scapular angle, the breath
sounds were fairly loud and bronchial. No crepitations or
rales could be discovered. (Morning temperature 99-4°;
evening 99°.) The quantity Of stimulants was increased to
three ounces per diem.

On May 21st the child was arach weaker. The front of
the chest was alone examined. These was weak tubular
breathing without rales and impaired resonance all over the
right front, with exaggerated breath sounds on the left
side. The heart was not displaced; its action was rapid and
feeble (144). The movement of the right half of the chest
in respiration was Just appreciable, and it was observed
that the epigastrium receded during each inspiration,
whilst it bulged very slightly during expiration and more
distinctly so daring cough, an indication of partial if not of
complete paralysis of the diaphragm. The cough was
ineffectual, very frequent, and much aggravated by giving
food, owing no doubt to a certain amount of leakage into
the air passages. The temperature was rising (100°), and
the puUe (144) becoming thready. The condition of the
child was critical; indeed, there seemed but little hope of
recovery. The oheet was wrapped in cotton-wool, and food
by the mouth entirely withheld, nutrient enemaa of pan-
creatised milk or beef-tea with brandy, three ounces every
four hours, being substituted. Further, the house-surgeon
was directed to give hypodermics of brandy and ether
(half a drachm of each) at intervals of a few hoars, if
necessary. Some half-dosen injections ware given in the
course of the following two or three days. The next day
there was no improvement in the patient’s condition. The
temperature was 102°, and the pulse, in spite of free
stimulation (brandy, four ounces), was wsaker and more
thready (156), )and only just perceptible at the wrist. On
May 23rd the temperature reached 102-4°, and the case
appeared quite hopeless. During the night, however, the
severity of the symptoms abated somewhat, and there was a
very slight but appreciable improvement on the morning of
the 24th. The return of movement in the right side of the
chest and a rapid disappearance of the signs of dia¬
phragmatic paralysis were amongst the moBt favourable
signs. Examination of the backs (first time) revealed the
existence of bronchial and tubular breathing at the right apex
and posterior apex of the lower lobe. At the extreme base
there was distant weak breathing, probably due to collapse.
Over the left back there was exaggerated breathing. The
child now continued to improve slowly. Swallowing soon
became easier, so that on the 26th he Was able to take seven¬
teen ounces of liquids by the mouth. (Nutrient enemas
reduced to three in the twenty-four hours.) On the 28th
every sign of diaphragmatic paralysis had disappeared, and
the two sides of the chest moved almost equally. The phy¬
sical signs at the right apex continued much the same
(dulness, tubular breathing, bronchophony, &c.). There were
• few coarse crepitations of doubtful nature in the right
axilla, which rapidly disappeared. The cough was still
troublesome, but had to some extent regained its explosive
character. The pulse rate had fallen to 108; the pulse
was of fair strength and regular. Temperature normal.
On May 31st the patient had regained some power over the
shoulder-joints, and there was evidence of a general, if slight,
recovery of muscular power. The knee jerk was still com¬
pletely in abeyanoe. Swallowing had so far improved
that the nutrient enemata were discontinued. A few
days later the last sign of imperfect deglutition—the
sour milk odour of the breath—had disappeared. Thera
was now harsh breathing, without rales, at the right
apex, with a little dulness at the angle of the scapula
and weak breathing at the base. On June 11th the
chUd was allowed to sit up in bed for the first time. The
voice had returned, but was still “ reedy." The movements
of the soft palate were normal. (Takes food and stimulants
well.) There was c< '-Table power in both legs, with

marked incoordination of movements. The plantar, reflex
was not obtained on either side; the other superficial re¬
flexes were normal. Physical sigus in chest quite healthy.
Heart strong and regular. From this date convalescence
was uninterrupted. The plantar reflex returned towards the-
end of June. In the first week of July the child began to-
walk with assistance. For some time his gait was very
ataxic as well as feeble. He was discharged cured oa
July 24th, but the return of the knee jerk was delayed for
several weeks longer.

Remarks .—The features of -this case which call for com¬
ment are (I) the paralysis of the diaphragm; (2) the nature
of the lung affection, and its relation to the diaphragmatic-
palsy. Paralysis of the diaphragm after diphtheria is of
sufficient rarity to deserve mention, and, as fax as 1 can
ascertain, recovery from this complication is very rare
indeed. Under any circumstances paralysis of this muscle*
is attended with very grave danger, and when it is borne
in mind that in the .present instance it occurred in a child
with all four limbs paralysed, with great enfeeblement of
the muscles of the neck and trunk, and with un m istakable
evidence of seveie heart disturbance, the recovery of the
patient furnishes a striking example of the extraordinary
recuperative power possessed by children, sod of the para¬
mount importance of leaving nothing undone in the way
of treatment on the plea that a oase is hopeless. The
extreme feebleness of the respiratory movements rendered
the signs of the paralysis leas obvious than usual. But the
superior costal type of the breathing, the complete lose
of inspiratory protrusion at the epigastrium, with pro¬
trusion during, but net before, attempts to cough, were
sufficiently marked to make the diagnosis a matter of
certainty. And if confirmation had been needed, it was-
furnished by the rapid return of normal physical signs and!
respiratory, movements, coincident with the disappea r ance
of the clinical signs of diaphragmatic paralysis. .

Of the exact nature ot the lung-condition it is not easy
to speak with certainty, but it is important to note in this
connexion that for two or three days previously there had
been evidence of slight leakage of fluids into the air pas¬
sages, and that the cough was powerless to clear the bronchi
of any obnoxious material—a condition of things favourable
to the production of collapse or bronchial irritation. It is-
just possible too that some temporary arrest or disturbance-
of function in the right vagus nerve was a factor in the
causation of the changes observed. The physical signs Were
those of collapse of the base (there was no pleural effusion),
with pneumonia or broncho-pneumonia arid collapse of the
remainder of the lung. The onset was unlike that of
croupous pneumonia. There was no rigor; the temperature-
rose gradually, reaching .the highest point (102-4°) on the
fourth day, with a morning remission each day. The respira¬
tions Increased from 24 to 48, and the pulse rose to 144.
There was & rapid fall of temperature and amelioration of
symptoms on the fourth day, which coincided with the
return of diaphragmatic movements. The speedy dis¬
appearance of the abnormal physical signs at the apex and
the almost oomplefce absence ot crepitation or rales from first
to last in every part of {Re affected lung would seem to
show that simple collapse preponderated largely over the
pneumonic element—if, indeed, this was ever present to an
appreciable extent. The limitation of the lung condition to
one side admits of two explanations: either the right half of
the diaphragm was more paralysed than the left, of which
there was no other evidence; or, which is more probable, there
was a temporary paresis of the right intercostal muscles,
especially in the lower interspaces. In conclusion, I would
draw attention to the powerful stimulating action of the
hypodermic injections of brandy and ether, without which
I dloubt whether the child’s life vfould have; been saved.

Queea-«tra«t, MayJtair. W.

Victoria Hospital for Children.—A festival in
commemoration of the twentieth anniversary of this charity
was held on the 6th List, the Duke of Cambridge presiding.
The main object of the festival was to provide funds for a
large addition to the hospital buildings which were opened
by the Prince and Princess of Wales in June, 1886. Last
year the number of in-patients was 661, and of out-patients
37,566; the aggregate number attended to since the founda¬
tion of the charity being 364,164. During the evening sub¬
scriptions and donations amounting to over £1200 were
announced by the Secretary.

Tire Lancet,]

DR. R. G. ALEXANDER ON PNEUMONIA.

[Mat 14,1887. 977

CANCER AND PHTHISIS AS COHKELATED
DISEASES.

By W. ROGER WILLIAMS, F.R.C.8.,

'SURGEON TO TUB WESTER* GENERAL DISPENSARY ; SURGICAL REGISTRAR
TO TIE MIDDLESEX HOSPITAL.

In consequence of the unity of nutrition existing Among
all the parts of every living thing possessed of aUy organic
solidarity, changes of nutrition affecting an individual part
necessarily react on other parts. This relation, which is
known 4s correlation, Was first clearly pointed out by
•Cuvier with regard to normal states, and it is equally
applicable to morbid conditions. Buch correlations are,
indeed, very numerous. They may be regarded as the out¬
come of a powerful synthetic tendency, which causes the
individual whole to be as much conditioned by its parts
as each part is conditioned by others. But why changes
in this or that part should be linked with this or that par¬
ticular correlation, whilst variations in other parts, appa¬
rently equally important, excite no such correlated
•changes, is for the most part beyond our ken. In
some instances the developmental history of the corre¬
lated parts gives ns a clue, as in the case of homologous
structures, such as teeth and hair, which are particularly
liable to vary together. But very often no such indication
can be discovered. We cannot say whether one part ,
governs the others, or whether all are governed by some
earlier synthetic tendency. Why, for instance, should
-colour and constitutional peculiarities go together ? What
connexion is there between deficiency in pigment and such
changes in the muscular and osseous systems and iu the
general constitutional condition as albinoes exhibit ? Why
should such individuals be weaker in body, more delicate,
and more feebly developed than others with pigment of
their own species ? Why, too, should the degree of develop¬
ment of pigment in the epidermis so greatly influence the
susceptibility to certain diseases and drugs ? How is it that
red-haired persons are more liable than others to melanosis ? :
Why are white cats With blue eyes nearly always deaf, and
why are white horses distinguished from their coloured
congeners by special liability to sarcomatous tumours ? A 1
similar question might be asked'With regard to the durious
correlations seen between quite distinct parts in many cases
-of monstrosity. In all of these instances no explanation is
possible in the present state of our knowledge. Indeed, the
subject has been but little investigated. In this wfde
uncultivated field rich harvests may be gathered.

I now propose to point out, in the briefest manner
possible, the correlation between cancer and phthisis. For
-detailed treatment of the subjeot I mast refer the reader to
the Middlesex Hospital Surgical Report for 1886. The
-following facts show that there is the most intimate con¬
nexion between the two diseases. The widespread belief
as to the incompatibility of phthisis and eanoer is attribut-
•able to the eroneous teaching of Rokitansky. That such a
grossly inaccurate statement should ever have obtained
credence shows the folly of blind submission to authority in
such matters. The chief evidence to be Cited may be
arranged under two heads

1. As to family history. — (a) Of 184 families subject to
breast cancer, one or more relatives, among the adults,
were known to have died of, or were subject to, phthisis in
■74, or 55-2 per cent. ( b ) pf 129 families subject to uterine
cancer, one or more relatives, aiUong the adults, were
known to have died of, or were subject to, phthisis in 60,
or 46-5 per cent, (c) Similarly, of 63 families subject to
cancer of the tongue and mouth , phthisis prevailed, among
tbe adults* in 17, or 82-per cent. Thus in these316oanneorous
families there was a history of phthisis in 161, or477 percent.
There was a history of both phthisis and oancer in the same
'family in 18 cases out of 134 families subject to breast
Cancer, and in 14 cases out of 129 families subject to uterine
Cancer. In a large proportion of the foregoing cases the
causes of death were unknown. If these had been eliminated,
the amount of phthisis would have appeared much greater, as j
may be judged from thefollewing statements in which this has
been don#. Thus, 40-9 per cant, of the fathers of patients with
ibreatt Cannes were of phthisical families, and 33-9 per cent;
of -We .mothfrs, Of the fathers; of patients with uterine
were of .phthisical families; and of the

mothers, 30 3 per cent. Of the fathers of patients with cancer

of the tongue and mouth, 29*4 per cent, were of ‘phthisical
families; and of the mothere, 6*8 per cent. With regard to
the prevalence of phthisis among these patients’ brothers and
eieters, in 88 families subject to breast cancer there were
one or more deaths from phthisis, among the adults, in 40;
in 81 families subject to uterine cancer, in 41; and in 62
families subject to cancer of the tongue and mouth, in 14.

2. As to the necropsies.—{a) Of 44 necropsies for breast
cancer, old arrested phthisical lesions were found in 4 in¬
stances ; and in 2 other cases the patients had died with
phthisis in active progress. (6) Of 88 necropsies for uterine
cancer, old arrested phthisical lesions were found in 12 in¬
stances. (c) Of 34 necropsies for cancer of the tongue and
mouth, in 5 cases old arrested phthisical lesions were found;
and 4 other cases had died with phthisis in active progress.
Thus in these 166 necropsies cancer and phthisis were found
associated in 27 cases, or 16-2 per cent.

PNEUMONIA.

By REGINALD G. ALEXANDER, M.A., M.D.,

CONSULTING PHYSICIAN TO THE BRADFORD INFIRMART, AND PHYSICIAN
TO THE HAIJFAE DOURMAKY.

Thb subject of pneumonia, at all times interesting, has
been specially brought before my notice daring the last
week, having seen a number of cases, brief notes of three of
which, occurring under different forms, by way of illustra¬
tion I extract from my note-book. By the perfection of
our modern diagnosis the physical signs of pneumonia are
perhaps more defined and certain than in any other, disease.
Conditions of weather and climate are no doubt chief factors
in its production, especially a climate which is variable and
damp; but all debilitating conditions of the system specially
predispose to the disease. The symptoms are too well
known to require enumeration. The prognosis is grave in
proportion to the implication of both lungs, rile number
of respirations, temperature, state of pulse, and nervous
system. In protracted cases the possibility of indurative con¬
solidation must not be overlooked, as in Case 2. In consider¬
ing treatment, we must recognise the fact that it is a general
and not a local affection with which we have to deal. The
heroic methods of the past, which caused great mortality-r
venesection, large doses of tartar emetic, &o.—had for its
aim the cutting short of a local affection. The great danger
in pneumonia is cardiao failure, and it is necessary to
husband tbe strength until the disease subsides. If hyper¬
pyrexia is the prominent symptom, the treatment by baths
adopted abroad is certainly justifiable, with the object of
diminishing the injury to the heart by tbe pyrexia, and it is
occasionally useful when, with a high temperature, great
dyspnoea threatens life. There is always a danger of falling
into routine treatment. Every case should be treated on its
own merits, as the disease requires different management
under different conditions. Pneumonia neither requires nor
will it endure the active. measures which were formerly
practised. We should have clearly before us what we intend
to acomplish by any particular line of treatment, and in. this
way, and in no other, will our success in the great majority
of cases be complete and satisfactory.

Cass 1.—1 saw with Dr. Windle at Ovenden on Sunday
night, Feb. 13th, a young man, previously healthy, suffering
from acute croupous pneumonia. His dyspnoea caused hint
to concentrate all his efforts on breath-getting. Respire-,
tion 72; pulse 130; temperature 104°. Sputa bright-red
blood; absolute dulness of left lung, anteriorly and dost
teriorly; bronchial breathing and bronchophony well marked.
Diagnosis: Pure pneumonia, second stage. Prognosis hopeful.

Cass 2.—On Feb. 12tb, and again on the 14th, I saw at
Southport a case, with Mr. Heath, of very different character.
A young lady at school, aged eleven, had been under Mr.
Heath’s care suffering from catarrhal pneumonia of the
left lung for three weeks. All had gone well, the only
unusual symptom being a temperature lokrer at night than
in the morning (evening temperature 101°; morning 102*6°),
The lujig had cleared up, with the exception of the lower
third of the base posteriorly, which was consolidated, and
at the line of healthy and solidified luBg marked bronchial
breathing and bronchophony existed. Tongue furred. Pulse
108, somewhat sharp; respiration only 18, Lung expan¬
sion elsewhere very good. The diagnosis was uncertain

978 The Lancet,]

DR. MACKENZIE BOOTH ON PERSISTENT PRIAPISM.

[Mat 14, It«7.

on account of the family history: chronic interstitial pneu¬
monia or tubercular deposit.—May 8th: The patient has
steadily improved, is still under Mr. Heath’s care at South-
port, and able to walk and drive out daily.

Case 3.—On Feb. 9th and subsequent days I attended a
lady aged thirty-seveD, married, with children, who for ten
months had suffered in consequence of domestic bereave¬
ments from complete anorexia, want of sleep, dyspnoea, and
eneral debility. The day previously to the attack she
ad exposed herself to inclement weather, and developed
acute croupous pneumonia of both lungs. There waj also
mitral insufficiency and excited loud bruit, with great
cardiac impulse. Respiration 76; pulse 150; temperature
105°, intermittent and flickering; clammy sweat. She was
apparently sinking. She was ordered mustard and linseed
poultices, eggs and brandy, alternating with port wine and
stimulants generally; drachm doses of steel wine and dilute
hydrobromic acid, with compound conium and morphia pill
(| gr.). The patient would bare died daring the night but for
the unsparing use of stimulants, which were continued for
several hours until the pneumonic symptoms had subsided.
On the 16th her condition had greatly improved, deeping
and eating well.

In simple cases of pneumonia, however, no stimulants
may be required, and an expectant plan of treatment which
does not interfere with nature’s efforts at a core is the plan
most desirable and efficacious.

Halifax.

ON A CASE OF PERSISTENT PRIAPISM.

By J. MACKENZIE BOOTH, M.L, M.D.,

pnrsiciax to the abkrdeex gexeral dispkxsary.

Cases of persistent priapism crop up in practice from time
to time, but their occurrence is rare enough and their causa¬
tion sufficiently obscure to merit a passing notice. Several
cases of this nature lasting from one to four months are re¬
corded in The Lancet in 1815, 1867, and 1873, in most of
which excessive coitus was the exciting cause. In a case
lasting for six weeks, which recently came under my
observation, no such cause was present, nor was there any
coexisting injury or disease of the spinal cord or nerve
centres to account for the condition.

The patient, W. S-, a seaman, aged fifty-five years,

was a married man with twelve children, most of whom
were grown up. Save for a dysenteric attack thirty years
before, which prostrated him for six weeks, he had always
enjoyed good health. He had always been of temperate
habits, and had never suffered from venereal disease.
While at sea on June 27th last, he awoke in the morning
with the penis erect and very painful, especially at the root.
He said that the day before he had been exposed to cold and
wet. Two days later, during which he was unable to sleep
for the pain, he came under my care. I found him lying in
bed with his knees drawn up so as to prevent the bedclothes
from touching the affected parte. The penis was erect, hard,
painful to touch, and bent backwards along the abdomen in
the middle line, and the scrotum was much relaxed. The
pain was most severely felt on either side of the crus, and
the parts there were found to be hard, swollen, and
exceedingly painful to touch. Otherwise he was quite well
and had been in robust health up to the time of this seizure.
There was no other disease of the urinary apparatus or rectum
discoverable, and the urine was normal and easily passed. A

K tive was administered, and half-drachm doses of the
de of potash ordered to be taken twice daily. This was
continued steadily for four days without the slightest
change in the affected organ. On the second night an
enema of a drachm of laudanum in two drachms of starch
was given, after which the patient had a few hours’ sleep.
On the fourth day ice was applied to the penis and continued
for over a week. Small doses of tartar emetic combined
with morphia were also administered at intervals, nausea
being occasionally induced. Still, the penis remained
as turgid as ever, and exceedingly painful to touch.
Daring the next four weeks, after consultation with
the late Professor Dyoe Davidson, everything that
we could suggest to relieve the painful condition was
tried. Oleate of morphia and other anodynes rubbed into
the penis and perineum, and morphia suppositories, gave
only temporary relief to the pain. Blisters were applied

over the perineum, and free leeching both over the perineum
and the penis itself, were resorted to, but without appre¬
ciable effect. The amount of turgescence varied slightly
from time to time, but was net materially reduced at the
end of the fifth week. During all this time, too, the hard¬
ness, swelling, and pain were most marked over the muscles
at the root of the penis, and there was total absence of
sexual desire throughout. In the beginning of the sixth
week he was ordered five-grain doses of the iodide of potash
in mixture, to be taken four times daily. From that time
there was a steady improvement, till in a fortnight’s time—
i.e., at the end of the seventh week—the penis bad wellnigh
regained its wonted condition, and thepatient wasable to don
his nether garments and walk about without pain. He shortly
afterwards resumed his seafaring life, and since then he has
had no recurrence of his troublesome malady.

In the above case the causation was different from that
of most of those previously recorded. In these the history
of injury of nerve centres or exosssive coitus generally
pointed to distant or reflex nervous irritation as the
main cause of the priapism, but here it was evidently
due to local inflammation about the muscles constricting
the bulb of the penis. The marked swelling, hardness,
and pain over these muscles, coming on a few hours
after exposure to cold and wet, and continuing while
the turgescence of the penis lasted, indicated continued
obstruction to the venous effiux as the chief factor in
its causation. The exhibition of the iodide of potassium
seemed to have a beneficial effect in hastening the recovery,
as up to the date of its administration the symptoms had
shown no sign of abatement, while immediately thereafter
gradual improvement took place, terminating m complete
relief in fourteen days. The perusal of a closely analogous
case reported by Dr. Mitchell Bruce in The Lancet (vol. L
1873, p. 90) led to its adoption. In that case also the
patient was a man of fifty-nve years, the priapism lasted
six weeks, and it subsided in twelve days during the
exhibition of the iodide of potassium.

Aberdeen.

% Utirm

HOSPITAL ^PRACTICE,

BRITISH AND FOREIGN.

Nulla antem eat alia pro oerto notcendl via. nlal qoamplurimaa et mor-
borum et dlsaeotionum hUtoriaa, turn alloram turn propria* collect**
habere, et Inter te oomparare.—MOROAGHI De Sed. et Cam. Mart.,
lib. Iv. Procemium. -

WESTMINSTER HOSPITAL.

PUNCTURED WOUND OP BRACHIAL ARTERY; ARREST OP
HEMORRHAGE BY PRESSURE ; SECONDARY BLEEDING
ON TWENTIETH DAY, WITH FORMATION OP DIFFUSE
ANEURYSM; LIGATURE OP YF.88BL; REMARKS.

(Under the care of Mr. A. Marmaduke Shxild.)
Wounds in the neighbourhood of the larger arteries are
always of importance, and cause much anxiety to the surgeon
until the danger of secondary haemorrhage is over and th«
wound healed. It is Often difficult to say from the character
of the haemorrhage and the colour of the blood whether the
loss is from artery or vein, and if free pulsation is felt in the
artery below the region of the wound the difficulty is in¬
creased. The following is a case in which the more serious
symptoms in connexion with the artery were developed
twenty days after the wound, probably from the sudden
giving way of the cicatrix in the vessel wall, due to the
severe strain received in falling.

A stout muscular man of intemperate habits, aged twenty-
seven, Was stabbed on the front aspect of the right arm,
near its lower third, by a penknife. He also sustained a
deep cut above the nose. These injuries were inflicted
during a drunken brawl on Dec. 14th, 1886.

On admission there was free bleeding of an arterial nature
from the wound, bat the pulse at the wrist was not altered
in force aDd volume. The hemorrhage was readily arrested
by bandage and eompress. The man was intolerant of
treatment or confinement, and left the hospital on Dec. I8tb
at his own request There had been no marked retain ef

The Lancet,]

HOSPITAL MEDICINE AND SUBGEBT,

[Mat 14,1887. 979

the bleeding. He attended irregularly as an out-patient,
the wounds on the bead and arm healed, and the haemor¬
rhage seemed to be permanently arrested. On Jan. 2nd the
patient resumed his avocation of grinding knives and
scissors, but his arm became so swollen and painful that he
had to desist. The next day, twenty days since the inflic¬
tion of the wound, he fell down while skating. Profuse
bleeding occurred from the wound again, and he was
brought in haste to the hospital and admitted under the care
«f Mr. Cowell, who kindly transferred the case to Mr. Sheild
for treatment. The patient, who had been leading during
Christmas-time a lire of continuous debauchery, was ill
and feverish. His tongue was coated and tremulous, his
limbs shaky, and he appeared to be on the verge of delirium
tremens. The right arm was enormously swollen, hard,
tense, and somewhat discoloured. No pulsation or bruit
could be detected over the swollen parts. The hand was
odematous and cold, the radial pulse completely absent.
The patient complained of terrible pain in the limb, and
«aid the hand felt “ numbifled.” On removing the temporary
compress, a jet of blood the size of a small quill issued in a
continuous flow from the punctured wound. This blood
■was venous in colour, and pressure on the artery above
lessened but did not check its discharge. The patient being
anaesthetised and Esmarch’s apparatus lightly applied, the
opening was enlarged, and the huger passed into a large
irregular cavity, full of soft, warm clot. This was freely
laid open by an incision some four inches in length along
the inner side of the biceps muscle, and a quantity of clot
sponged away. The parts were so disintegrated that the
source of the bleeding or the position of the main vessel
could not be accurately determined. A bent probe was
employed as a searcher, and this device was soon successful,
the end of the instrument passing into an opening in what
■was evidently the brachial artery. The aperture was
transverse and clean cut, and would have admitted the end
of a .No. 8 catheter. It was situated at the upper port of
the middle third of the vessel. The median nerve was
clearly seen, and held away, while the artery was tied
with carbolised silk above and below the wounded part.
The large cavity was then dusted with iodoform, and
Lightly packed with gauze, being left quite open. The
whole limb was wrapped in wool and bandaged evenly.

The after progress of the case was satisfactory, and can be
briefly related. A large amount of sero-sanguineoue dis¬
charge poured from the wound. The limb rapidly diminished
in size, and the constitutional symptoms of fever and pain
eoon subsided. The day after the operation the patient re¬
peatedly expressed his relief from its performance. On the
third day after the operation, when the wound was being
dressed, smart bleeding occurred. The source of this was a
email arterial twig obviously enlarged by the collateral cir¬
culation. A ligature was easily applied in the open wound,
and no further bleeding occurred. The hand felt numb and
powerless for several days, but the circulation was active,
and a radial pulse was established on the tenth day. The
ligatures separated on the sixth and fourteenth days. The
wound was practically healed on the thirtieth day after
operation, being gradually brought together by bandaging.
The incision, which seemed so extensive in the swollen con¬
dition of the parts, was not more than two inches and a half
long when the arm had resumed its normal dimensions.

Remarks .—The first point of interest in this cose is the
fact that the radial pulse remained unaffected, though the
brachial artery was badly cut. Most surgeons are familiar
with similar instances. Provided that an arterv be not
completely divided, a small portion of it seems sufficient to
guide the blood into the distal part of the injured vessel.
The sequence of events observed here hot uncommonly occurs
in wounds of the main vessels treated by pressure. The
orifice in the vessel is temporarily sealed by clot and the
pressure of surrounding tissues; some accidental movement
displaces the3e frail barriers, and fresh bleeding takes
place externally or into the tisanes of the limb. The latter
variety is much to be feared, for. in addition to the loss of
blood, the patient has to ombat the danger of gangrene
caused by the pressure of the extravasation, and the
surgeon may be misled by the absence of external bleeding.
This variety of haemorrhage reminds one of the concealed
©r‘‘occult 5 ’bleeding 6poken of by obstetricians. Still, the
fact most not be lost sight of that a considerable number of
cases of punctured wounds of the main vessels can be
perfectly treated by pressure. £>ut the surgeon who under¬
take this must. be careful pressure is applied

properly, and he must be assisted by quietude and tolerance
on the part of the patient. The colour of the blood when
the haemorrhage recurred was venous rather than arterial.
The plan of searching for the orifice into the artery, after
laying open an aneurysm or haemorrhagic cavity by a probe
or catheter, was very successful in the present instance.
The great use of Esmarch’s apparatus and the importance of
making a very free incision in these cases are well exemplified.
The course adopted in leaving this deep wound quite open
was justified by the free drainage of serum which took
place from its extensive cavity. Had the margins of the
wound been united, retention of inflammatory products and
tension, with its attendant evils, must have resulted. It is
an important consideration that in punctured wounds of a
limb the main vessels may be injured, and yet the wound
caused by the entrance of the instrument be far removed
from the known course of the vessels. Thus a stab on the
front of the lower third of the thigh may wound the
femoral artery near the adductor opening. In the present
case the knife hod passed obliquely from without upwards
and inwards through the biceps muscle, and its point had
notched the brachial artery in its middle third.

NORTH-WEST LONDON HOSPITAL.

STRICTURE OF THE URETHRA PRESENTING UNUSUAL
DIFFICULTIES ; REMARKS.

(Under the care of Mr. Mayo Collier.)

For the notes of this case we are indebted to Mr. Cedi
Cbri8topher8on.

Edward S-, aged thirty-one, railway porter, was

admitted on the morning of September 5th suffering from
retention of urine, ne had come from Leeds the day pre¬
viously, and since then a few drops of urine only had
passed. Four years ago be had a similar attack, and was
admitted into the Leeds Infirmary, under Mr. Jessop, who
with great difficulty passed an instrument. Since then he had
suffered from more or less inability to micturate. Fifteen
years ago he had gonorrhoea. The patient is a big, burly, mus¬
cular fellow, of fair complexion and nervous temperament.

Mr. Collier was not able to see the case until twelve
hours after admission. In the meantime hot baths and
opium had been administered freely, but without effect, by
tne house-surgeon, and on attempt bad been made with the
catheter, hut unsuccessfully. Owing to the delay the
bladder was extremely distended, and the patient was
suffering much from pain and nervous anxiety. He was
now removed to the operating theatre, and a careful and
prolonged attempt made with fine soft metal instruments,
still without success. Judging that further delay was
unwise, the bladder was aspirated with a long fine needle,
the precaution being taken to pass the instrument well into
the oladder in the direction backwards and downwards
before removing the stylet. By these means some fifty ounces
of urine were drawn off, with great relief to the patient.
A dose of opium was followed by a good night and no pain
or discomfort in the site of puncture. The temperature
was normal. Next morning, no urine passing and the feel¬
ing of discomfort recurring, a hot bath, chloroform, and a
second attempt with fine metal instruments was made!
Catheterism having failed, it was decided to again aspirate
and to relieve the madder entirely by aspiration for the next
few day?, leaving the stricture absolutely alone. During
five successive days the aspiration was repeated six times in
all, very little urine during this time escaping by the
urethra. On the fifth day chloroform was again adminis¬
tered, and after considerable delay and trouble a No. 1 metal
catheter was passed into the bladder, and twenty-five
ounces of fluid removed. The catheter was very tightly
grasped, and required considerable traction or pressure to
move it either in or out. The instrument was tied in and
left in situ for four days. Afterwards an attempt was made
to replace the No. 1 by a No. 2. The No. 2 would enter the
stricture, but could not by any ordinary pressure be made
to enter the bladder. No. 1 was now reinstated and left
in situ for a week. The patient was comfortable during
this time, and the temperature remained normal. ;lv .

Sept. 14th.—The patient’s temperature this morning at
8 a.m. was 100 6°. He seemed poorly. At 10'30 a.m. he
had a severe rigor, and the temperature rose to 104'4°.
Mr. Harper, the houBe-surgeon, attributing the rigor to the
presence of the catheter, removed it, end administered tea
grains of quinine.

ROYAL MEDldAL AND CHIRURGiGAL SOCIETY.

&80 The Lancet,]

I5th.—The patient can pass some urine with much straining.
Teels very uncomfortable. Temperature 102-6°.

; 16th.—Some pain and hardening was discovered in the
floor of the urethra, two inches from the meatus.

17th.—The patient is very uncomfortable and the bladder
full. Temperature 101-6°. After a hot bath and opium the
distension of the bladder was relieved naturally.

18th.—The swelling under the penis, which was very
painful and tender, was opened; pus came from the wound
and also from the meatus.

9th.—Temperature normal. Great straining to pass a
small quantity of urine; it mostly passes through the fistula;
the bladder, however, does not fill.

The patient was now left completely alone to Oct. 1st,
when a No. 1 silver instrument was passed with the same
difficulty as on the first introduction. At 11 p.m., eight
hours after the introduction, the patient had a rigor lasting
an hour and a half, the temperature reaching 105-2°. Acting
on instructions, the catheter was not removal by the house-
surgeon, but large doses of quinine and hot drinks were
administered.

Oct. 2od.—At 10 a.m. the patient had another severe rigor;
temperature 105-2°. Atr4 p.m. there was another severe rigor,
temperature reaching 106°. Mr. Collier removed the eatheter.

3rd.—No further rigor; temperature normal; patient com¬
fortable ; urine passed frequently, but in small quantities.

4th.—Just one month after correct, careful, and assiduous
treatment the* stricture would only admit No. 1 instrument
with difficulty, the introduction being invariably followed
by severe rigor. The stricture was now also complicated
by a penile fistula, through which most of the urine passed.

Mr. Collier now decided and explained to the patient that
further attempts to dilate with the catheter were inadmissible
and dangerous; that the proper course was to divide the
stricture if possible from the inside, and, failing that, to cut
through it from the outside. He fully understood the
gravity of his case, but refused an operation, and was dis¬
charged cn Oct. 14th and returned home. On Oct. 16th he
returned and requested an operation.

On Oct, 21st Mr. Krohne procured a very small urethro-
totoe of the Civiale pattern. After injecting the urethra
■with & 20 per cent, solution of cocaine, and subsequently
With olive oir, Mr. Collier introduced his left forefinger
into the rectum to the point of oonstriction, which could be
easily made out in the membranous portion of the canal.
With this finger the stricture was steadied. The urethro¬
tome was next introduced, and an endeavour made
to insinuate it into the stricture. By firm pressure,
assisted by a peeling action of the left middle finger, the
urethrotome was passed. The knife was now unsheathed,
and the stricture completely divided in a direction upwards.
The blade was again sheathed, reinserted, and again drawn
through any opposing bands. There was free hfemorrlinge.
A No. 10 soft catheter was at once introduced without tne
slightest opposition, retained, and a suppository of half a
grin of morphia placed in the rectum. No rigor or eleva¬
tion of temperature followed the operation.

The subsequent progress of the case was most satisfactory.
The fistula healed rapidly, and the patient left the hospital
on Nov. 6th, just two months after his admission, with the
Calibre of the urethra completely restored, and feeling, as he
expressed himself, “ quite well, but weak.”

Remark* by Mr. Collier.— This case is replete with
points of interest, but two stand out more prominently
than the rest. In the first place, six aspirations on five
successive days were the whole and sole means of emptying
the bladder of its contents. These tappings were not fol¬
lowed by the slightest pain or bad result. Aspiration of the
bladder, if properly performed, is seldom dangerous. I have
resorted to it on several occasions Without the slightest bad
effect. In. the second place, although the presence of a No. 1
catheter in the urethra caused an intense rigor, the free
division of the stricture was not followed by the smallest
had result. ''_ ; .

MANCHESTER ROYAL INFIRMARY.

PERINEAL AND 8CPBAPUHIO CYBTOTOMY COMBINED;

RHMARK8.

(Under the care of Mr. Whitehead.)

J. C- , aged fifty-seven, engineer, was brought by Dr.

Spearing, of 8haw, on Feb. 16tb, 1887, and admitted on tbq
following day suffering from severe; pain in the region of

the bladder, profuse heematuria, and incessant desire to>
micturate. The first indication of bis present iHnese
occurred ten months ago, when, without any warning or
pain, “he passed three pints of what appeared to him
pure blood. From that time the urine had almost con¬
stantly contained quantities of blood. He gradually became
thinner and more feeble, and at the time of his admission
he appeared in the advanced stage of malignant disease,.
The urine, on standing, gave a thick reddish-brown deposit,
which on microscopic examination showed transitional
epithelium, numerous fat-globules, red blood-oorpusclee,
lencocytee, crystals of uric acid, and oxalate of lime.

On Feb. 18th, an attempt was made, in the first instance*
to explore the bladder by a lateral perineal cystotomy, bah
owihg to the depth of the perineum the index finger only
reached the entrance, hut not the interior, of the Madder.
Bidigital counter-pressure—one finger in the wound and
the other hand above the pubes—demonstrated a solid
growth associated with the right wall of the bladder.
Suprapubic cystotomy was then performed, and the dia¬
gnosis which had previously been made of a malignant-
growth confirmed. No attempt was made to remove the-
tumour. The patient died on Feb. 24th, the sixth day after
the operation.

At the necropsy a tumour was found which occupied the-
right half of the bladder and deeply infiltrated the sur¬
rounding tissues. The surface of the tumour was exten¬
sively ulcerated. The right kidney was atrophied, its
parenchyma had almost entirely disappeared, whilst the-
pelvis was very much dilated. The corresponding ureter-
was much dilated, and its opening into the bladder impeded
by the growth. The left kidney was considerably enlarged,
but appeared healthy on section.

Remarks by Mr. Whitehead. —Sir Henry Thompson haa-
expressed his opinion that pain, and not hsemorrhage, is the
usual premonitory symptom of malignant disease of the
bladder; in this case, and in every other instance of malig¬
nant disease of the bladder coming under my personal'
observation, the reverse has been the case. The difficulty
found in introducing the finger into the bladder through a.
deep perineum is unfortunately a condition not unfrequently
met with. The obstructed ureter and atrophied kidney ara
an unusual result in malignant disease of the bladder, it
being generally found that the growth does not encroach*
upon the ureters to the extent of total obstruction. The
pain was considerably in excess of that generallj* met with
in malignant disease of the bladder, but was no doubt due-
to the bladder bemg adherent on the right side to adjacent
structures, thus preventing the muscles from exercising*
their contractile power, and causing the neighbouring parts-
to be dragged upon in the constantly recurring efforts to
micturate. The fixed condition of the bladder was also
responsible for another feature. The bladder was moderately
distended previous to the operation, but none of the fluid-
came away when the perineaJ incision was made, nor eveis
after the finger had passed through the prostate; but directly-
the bladder was opened above the pubes the fluid in ths
bladder rushed out of the perineal wound, as well as through
the wound above the pubes, illustrating in a graphic manner
the necessity and great advantage of counter openings whei»
free drainage is the object desired.

Mcbintl Societies.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Rectal Intussusception, due to a nee' growth; Eecision o f
Intussusception; Enterorajihi/; complete recovery.—Ex*
perimental Inquiry as to tne best method of Enteroraphy,

Am ordinary meeting of tine buuioly waekaki on Tuaedny
last, Mr. G. D. Pollock, F.R.C&, President, in the chair.

Mr. A. E. Barker communicated a ease of Intussnsoepturo
of the Upper End of the Rectum due to obstruction by a
new growth, in which complete recovery ensued, after ex¬
cision of the intussusception and suture of the cut ends
of the bowel. The case narrated is that of a married
woman aged twenty-eight, who for sixteen months had
noticed streaks ef blood with heir motions, and for eight
months had been conscions ef a foreign body in her
rectum. Two or three months before operation the lattsx

Tin? LAncht,}

ROYAL’MEDICAL AND"OHiRURGIOAL SOCIETY.

[M ay 14,1887. - 9^ 0

had begun to prolapse at each stool with copious bleeding.
There was much constipation, but there had never been
any diarrhoea. On examination of the rectum in June,
1886, a mass of new growth was found surrounding
nearly the whole of the apex of an intussusception of the
rectum. The reflexion of the rectal wall' could be felt
about three inches from the anus, so that the apex of the
mass belonged to a spot about six or seven-inches from the
latter. On J one 9th Mr. Barkerdrewdown tbeintussusception
and operated ae f olio wsThe left index Anger was passed well
into the intussusception and the two layers of. bowel were
pinched together beyond the growth between the Anger and
thumb. An ordinary sewing needle, carrying stout carbolised
silk, was then passed through the two layers from the in-
tussasoipient into the lumen of the intussusception and
returned, including about one-sixth of an inch of bowel
tissue. This loop was tied firmly, and another stitch was
similarly introduced, about one-sixth of an inch from the
first, and tied m the same way. By repeating this the whole
bowel was encircled with a row of stitches well above the
growth. When this had been done, a second row was
similarly introduced about half' an ineh higher up. The
'Whole intussusception was then cut away en masse imme¬
diately below the lowest row of stitches. Only one small
vessel bled, and was tied; the rest of the cut surface was
dry. The mass cut away cotasisted of a nodular mass of
adenoid epithelioma, taking' up about two inches of the
bowel, and with a margin of healthy tissue- above it. The
patient's recovery was rapid and uninterrupted. A large
motion was passed on the sixth day. The patient left the
hospital about four weeks after operation feeling quite well.
The rarity of intussusception of the rectum is dismissed and
some statistics are given. The rarity also of intussusception
of the lower bowel produced by cancerous growths is alluded
to, the author having only been able to collect eleven such
oases. These are briefly described, six of them being either
purely rectal or in the sigmoid flexure. Of these six, only
four were operated on; the first two by Verneuil, but both
with a fatal result. The next excision was performed by
Kulenkampff with an ultimately good result, but a loop of
small intestine had been opened in excising the intussuscep¬
tion and a provisional oolotomy had to be done. The case
Sow related is the fourth.

Mr; Stan mom Bishop’s paper on the Results of anEx-

S srimental Inquiry as to the best method ef restoring the
anal after removing Portions of the Small Intestine was
communicated by Sir Spencer Wells, Bart. The question
was discussed ae to what an' ideal suture should be, and
reference made to all those now in use; the suture devised
by the author was described. The results of some experiments
on animals were detailed. A perfect method of enteroraphy
requires: Absolute and perfect apposition. Restoration
of the status quo ante of tne calibre of the bowel. The sur¬
geon must not leave any unnecessary sign of his interference
behind him. The two serous surfaces must be brought face
to face together. The various methods of enteroraphy were
described and figured in a paper by Mr. S. Bishop in the
Medical Chronicle of 1886. —Mr. T. Houcks mentioned a
Case of intussusception in an infant which was constantly
recurring and being reduosd. The child died, and many
polypoid tumours were found in the intestine besides the
one that caused the intussusception.—Mr. Harrison Cripps
rather agreed with Mr. Holmes that cases of intussusception
of the kind in question were not rare. Perhaps one case
in six of annular malignant disease of the bowel was
attended with an intussusception, which, however, did not
advance and could not be pulled further down. Reference
was made to the oase of a lady in which the growth was
with difficulty reached; the posterior part of. the rectum
having to be divided, and then, after some dissection, the
whole growth, the size of a two shilling piece, was removed
With both layers of the muscular ooat, leaving only, the
peritoneum. He thought Mr. Barker’s operation was one
of extreme interest.—Mr. Christopher Heath Was quite
sure that any operation than that done by Mr. Barker
-Would not have been successful. Neither the suggestion of
Mr. Holmes nor of Mr. Grippe would have been sufficient,
for the growth was a large, ragged, sessile tumour, nearly
the size of the palm of the hand. He was agreeably sur¬
prised to find what an exoellent recovery had followed the
Operation. Such an. operation seemed to show that greater
HbSttiee might be taken with the mucous membrane of
fhti pdrt than had hitherto been supposed. Mr. Whitehead’s
method of treating piles also pointed to the aameoonclnriah;

How would Mr. Barker deal with a cate which could not be
drawn out of the anus? With a growth higher, up would
laparotomy or what operation be best ?— Mr. A. E. Barker
said the growth infiltrated the coats of the bowel, rendering
a mere excision of the growth impossible. To dissect on
the growth would be an unsatisfactory method in the case
of a malignaut neoplasm. It would be preferable to remove
the whole of the intussusception. In reply to Mr. Heath, he
said he should certainly perform laparotomy and excise the
whole mass of the intussusception. He would search for ’
the upper part of the intussusception and employ Czerny’s 1
suture for a row of stitches, and afterwards cut off the intugi,
susception, thus imitating nature’s method of sloughing.
He thought that there was a good deal in Mr. Bishops,
method ot suture.—Mr. jF. Treves said that Mr. Barker’s
case was the most deliberate, complete, and successful
operation of the kind on record. He made three classes of.
cases in which intussusception and cancer become com-'
bined. The first was an annular cylindroma forming'
an obstructing ring, and this forms a commencing intus-.
susception. The second kind was made up of cases of
chronic intussusception which develops into an epithelioma.'
The third class was composed of cases where an ordinary,
polypus, having produced ah intussusception, becomes a’
cancerous growth. Mention was made of the case of a
woman, aged forty, with chronic intussusception, in which
unsuccessful attempts to draw it down to the anus were
followed by removal with a .galvanic wire; the lumen was
restored, and the patient remained comfortable foi a while.
The return of obstruction was relieved by a lumbar
colotomy, and no less than eleven polypi were removed at 1
the operation.—Sir Spencer Wells thought that as Mt.
Bishop’s knots and suture did not irritate the peritoneum,
and when separated the stitches fell into the cavity of the
bowel, a great advance was made in abdominal surgery..
He considered that the result of Mr. Bishop’s experiments
was a oomplete argument to those who objected to the,
funds of the Royal College of Surgeons being employed for]
legitimate viviseotion.—Mr. Croft oompared the suture,
recommended by Mr. Bishop with that of Lembert, and
thought that it might have disadvantages, for the stitches
were so close together that the suture might amount to a
circular stricture of the bowel, and possible cutting off of
the blood supply. He would be sorry if everyone set
this suture down as an absolutely unobjectionable one.
The tissues operated upon were those of healthy dogs,
whereas in diseased men and women the tissues might prove
less tolerant of the suture. Whether the latter tell away
into or outside the* intestinal canal he considered was a.
matter of small moment. He admitted that the suture had
some advantages.—Mr. Treves had tried every suture on'
doge some years ago, and came to the conclusion that the
Czerqy-Lembert suture was the most suitable. Time, was a
great element in enteroraphy, and the old suture was readily
manipulated. The bowel of the dog was hard and tough,'
unlike the thin delicate bowel of the human being. If the
stitches were applied tightly enough to bring the bowel well
together, the danger certainly would exist of sloughing of
the margin of the bowel. Travers’ experiments were per¬
formed with string and coarse dressings, which sufficiently
explained bis disasters. — Mr. Knowsley Thornton said
that Mr. Bishop’s suture did not favourably compare .with
ijembert’s, for the knots within the bowel were favourable
to the absorption of septic material, abundance of oppor¬
tunity for which would exist, especially in the case of a dis¬
eased bowel. He agreed with the remarks of Mr. Treves.as tQ
the constriction of the bowel.—Mr. R. Barwbll had. em¬
ployed Lambert’s suture in a boy aged seven. The who le, of
the suture was neatly enveloped in lymph. ,-Mr. Barks®
asked how long the thread was which filled the needle.'
Passing so many times through the mucous membrane, thtf
thread must become very septic.- -Mr. T. Bryant asked 1»W
Mr. Bishop tied the last knots.—Mr. Charles JenNINg*
did not understand Mr. Treves’s objections to experiments
on living animals. He (Mr. Jennings) had used cylinders
of oocoa butter and gelatine, so as to maintain the lumen of
the bowel whilst the suture was being inserted. -Mr. Bishop,
in reply, thought the time of exposure of tbe bowel
more important than the mere duration of the operation.
Experiments could only b& satisfactory if performed 04
living animals. He did not use one thread for the whole
operation, but as many as might be necessary, and by reef-j
knotting the fresh thread on to one end of the single threads
of the suture.

982 The Lancet,]

OBSTETRICAL SOCIETY OP LONDON.

[May 14,1887.

OBSTETRICAL SOCIETY OF LONDON.

A meeting of this Society was held on Wednesday,
May 4th, Dr. John Williams, President, in the chair.

Uterine Appendages. —Mr. Lawson Tait showed a series
of specimens removed on account of inflammatory disease.

Malformation of the Fallopian Tubes. —Mr. Alban Dokan
exhibited this specimen, in which there was an accessory
ostium surrounded with fimbriae.

Spinal Meningocele. —Dr. John Phillips showed, for Mr.
Reginald Clarke, the head of a seven months fcetus, in
which there was dystocia, owing to a meningocele between
the axis and occipital bone. The child presented by the
breech.

libro-myoma of the Ovary. —Dr. Carter said that this
tumour, which weighed 10£ lb., had only been noticed for
six months. The patient had made a good recovery.

A pair of Midwifery Forceps were 6hown by Dr. Para-
more, for Dr. Haslam, with a lateral hinge in the handle of
the upper blade.

A Speculum was exhibited by Mr. Butler-Smythe which
folded like a tongue depressor.

Hcsmorrhagic Parametritis. — Dr. Matthews Duncan
related three cases of severe bleeding in patients with Para¬
metritic Abscess. In the first case the bleeding occurred on
opening the abscess, and was easily restrained; the woman
recovered. The bleeding was probably only a profuse
oozing. The second case ne did not see; the bleeding was
rapidly fatal and flowed through the bladder, the abscess
having spontaneously opened into that viscus. In the third
case, also fatal, the bleeding occurred in repeated flows
through the bladder, along with pus and sloughs. The
bleeding arose from gangrene laying largely open the ex¬
ternal and internal iliac veins at their junction. This case
he regards as one, not of ordinary parametric abscess,
but of progressive gangrene of cellular tissue. Of this latter
disease he has recorded a case in an appendix to his work on
** Perimetritis and Parametritis.”—Dr. Graily Hewitt
referred to the particulars of a case he had published, and
which Dr. Matthews Duncan had mentioned in his paper.
It waB entirely due to physical injury, and was not at all
analogous to the cases of Dr. Matthews Duncan.—Dr.
William Duncan had seen two cases in which, after
bursting of the abscess, there was oozing of blood for several
days from the pyogenic membrane lining the abscess cavity.
He thought that it would have been more correct if Dr.
Matthews Duncan had given the cases as hcemorrhage into
the sac of a parametric abscess, and de*precated the use of
the title “haemorrhagic parametritis.”—Dr. Galabin had
met with a case in which fatal haemorrhage into a pelvic
abscess occurred. The case was originally diagnosed as one
of retro-uterine haematocele. Suppuration occurred, and dis¬
charge through both bladder and rectum. After three months,
erysipelas occurred about the vulva, and fatal haemorrhage
into the abscess cavity. Extensive burrowing and sloughing
in the pelvic cellular tissue were found at the necropsy.—
Mr. Lawson Tait had never met with any such cases as
those described by Dr. Matthews Duncan, and thought that
they ought to be dealt with by abdominal section before
such disasters occurred. Mr. Tait thought the title of the
paper should have been “ Parametritis ending fatally by
Haemorrhage.”—Dr. Matthews Duncan thought that the
title was of no moment, whether haemorrhagic parametritis
or parametritis with haemorrhage. He knew no reason tc
regard extravasation of urine as the cause of sloughing, and
in a very large number of cases of these abscesses discharging
through the bladder he had never met with any evidence of
extravasation of urine into the abscess cavity. It might
occur, but he knew no evidence of it.

The Frequency qf Pathological Conditions of the Fallopian
Tubes formed the subject of a paper by Dr. Arthur H. N.
Lewers, and was the outcome of observations on the pelvic
organs in a series of a hundred cases in the post-mortem
room of the London Hospital, made with the view of assist¬

ing in the d
dilatation of
•ad

ablation of the frequency with which
’ * tubes- hydrosalpinx, pyosalpinx,

f Dfc Hang*'Ode,in his paper, “Is Disease of the
UmiriiMifcfrequent as it has been represented
rHjywft JflUHilM qf Obstetrics , June, 1886) said:

process iadjaaisd —ly by oM.fifctf
Mr. ti rtii

is far lass frequent than ft

dMaasliliBUlWrilM ftonswsMtti *4

; frequent occurrence. Casetf-iffcfcre the

contents of the dilated tubeB were not distinctly purulent,
or were not composed of blood, were classed by Dr. Lewers
as hydrosalpinx. Disease of the Fallopian tubes, restricting
the expression to pyosalpinx, bcematosalpinx, and hydro¬
salpinx, was met with in seventeen cases out of one hundred
examined. A detailed description of each specimen was
given in the paper, which included also a table classifying
the chief points -of interest in these seventeen cases.—
Dr. Galabin thought this communication was of very great
value as an addition to the evidence on the subject by Dr.
Kingston Fowler. He wished to ask whether the 100 cases
recorded were consecutive or selected, as he thought that
17 per cent, was a large proportion of cases of distension of
the Fallopian tubes. In 302 necropsies of women above the
age of puberty at Guy’s Hospital the pathologists had only
found twelve cases of distension of tubes, and two of these
were very trivial. This was a proportion of only 4 per cent.
There was only one case of pyosalpinx and a doubtful case,
the pathologist being uncertain whether two suppurating
sacs were tubes or ovaries; the ovaries could not be found.
There were fourteen cases of chronic inflammatory disease
about the Fallopian tubes withoufdistension. Of the whole
twenty-six cases, it was probable that in seven pelvic in¬
flammation was indirectly the cause of death through the
medium of general peritonitis, intestinal obstruction, or in
other ways. These included the two cases of pyosalpinx,
one of hydrosalpinx, and four of chronic inflammation with¬
out distension. Thus, in 302 cases there were of chronic in¬
flammatory disease about the tubes 9 percent, distension of
tubes 4 per cent., death indirectly in about 2 or 3 per cent—
Mr. Lawson Tait spoke in eulogy of Dr. Lowers’ paper.
He found the conclusions drawn from the post-mortem room
as regards causation, progress, prognosis, and treatment
identical with those which he had been preaching for about
ten years on the basis of clinical experience. He confessed
that it was somewhat a staggering thing to And 17 percent
of the women who died in the London Hospital suffering
from tubal disease, and this did not include those cases which
suffered the most, in which there were adhesions between
the ovaries and tubes to the surrounding viscera, more
particularly the peritoneal layer lining Douglas’s pouch,
resulting ultimately in complete retroversion of the uterus
with its appendages, and forming one of the most dreadful
conditions which the gynaecologist had to deal with. When
removed, it was difficult for an unskilled pathologist to see
anything the matter with them. Dr. Lewers bad not in¬
cluded such cases, and they must have been numerous. He
thought the explanation of the higher percentage at the
London Hospital aud the small group at Guy’s must be due
to locality, and that gonorrhoea was more common amongst
the poor at the East-end than on the south side of the river.
At the out-patient department at Birmingham 10 per oast
of the women who applied for relief suffered from chronic
inflammatory disease of the uterine appendages. All these
did not require operation. The most staggering conclusion
to be derived from Dr. Lewers paper was the enormous
fatality of these diseases. At the London Hospital tbs
death-rate was 24 per cent., while at Guy’s it would appear
to be 26 per cent. For years Mr. Tait had been arguing in
favour of operation in order to relieve suffering, but when
the pathologists at the London, Guy’s, and Middlesex
Hospitals showed a death-rate between 24 and 60 per cent,
the cry for relief by operation wae one which could not be
gainsaid. His own results showed that these cases could
be relieved by operation, with a mortality not exceeding
2 or 3 per cent The question as to the sterility caused by
these diseases might be settled by ascertaining the period
between the occurrence of death and the birth of the
last child. Mr. Tait agreed with Dr. Lowers that hydro¬
salpinx seems to precede pyoealpinx.—Dr. Horrocks was
surprised at the large percentage of disease of the Fallft*
pian tubes shown in Dr. Lowers’ table of cases.
found that in many cases the disease began in the pTWT
and glued the fimbriated extremity to itself, which
to pathological ebanges in the tubes. In sqm# OMM MS
affection spread from the vagina to the uterus and from tbs
latter to the tubes. In all his cases there

waa-

MrteruS so aftnotte j

Googl,

Ths Li.fr cbt,"]

OPHTHALMOLOGIC AL SOCIETY.

[Mat Ji, 1887. 988

not likely that it escaped through the ostium into the
peritoneal cavity, else hydroperitonenm would be more
trequent, as he had pointed out in his paper on Papilloma of
the Tube. The severe forms of tubal disease with
local peritonitis showed how the tubes were a highway
from the exterior into the peritoneum. Their fre¬
quency amongst the East-end women suggested that
they arose more from extension of neglected leucorrhoea
and gonorrhoea than from sounding or syringing. Disease
of the tubal mucous membrane waa more probably caused
by the passage of fluids upwards than by extension of ;
inflammation. Extension might occur, but mnoous inflam- ■
matioDS were generally localised in the genital aa in the
respiratory tract.—Dr. Imlach regarded Dr. Lowers’ paper as
important, and trusted the investigation would be continued,
and that pathologists would scrutinise the ovaries and tubes
as carefully as they did other organs. The gonorrbceal
origin of these diseases was often assumed. He had
examined a large number of women in the lock hospitals,
but had not found a single example of pyosalpinx
amongst them. The question of etiology was important,
and oould only be settled by clinical investigation
of a large series of gonorrhoeal patients.—Dr. Matthews
Duncan expressed his sense of the great value of
Dr. Lowers’ paper, but felt the want of further informa¬
tion regarding the cases. He wished for information
ae to the symptoms, if any, caused by the pathological con¬
ditions. It was probable that these pathological conditions
were obsolete and evidence only of long past disease. This
-view was confirmed by the ages of the patients. Mr. Tait
had said that in his practice the average was twenty-seven
to thirty, and Dr. Lowers’ cases were above forty on an
average, and many quite old. Dr. Matthews Duncan was
not astonished at there bring evidence of disease in 17 per
cent, of the post-mortems, for he had long known that evi¬
dence of past or present disease in the region of the uterine
appendages was a very frequent occurrence.—Dr. William
Duncan thought it most important that out of the
seventeen cases reported, fourteen were over forty years
of age, and in only one case were definite symptoms
of pelvic mischief given, while almost all died from
diseases not attributed to tubal mischief, showing the
fallacy of the view that most cases require laparotomy.—
Dr. Lbwers, in reply, said that the cases were as nearly
as possible consecutive, and that the inquiry lasted thirteen
months. There were many cates showing more or less ex¬
tensive old adhesions not included in his list. He did not
think gonorrhoea was more common at the East-end than
elsewhere in London, and many of the cases at the London
Hospital came from the ad joining districts. He thought
hydrosalpinx and pyosalpinx were stages of the same dis¬
ease, ana the cases in his table confirmed this to a great
extent. If further investigation should establish this view,
and that pyosalpinx has a mortality of 40 per cent., we
shall not be able to resist the conclusion that dilated tubes
should be removed. None of the seventeen esses of dilated
tubes came from the obstetric wards, though some of the
100 cases examined came from those wards.

OPHTHALMOLOGICAL SOCIETY.

FrcmkUris Spectacles.—Fatal Meningitis after Excision of
. Suppurating Globe.—Insertion of Artificial Globes into
Tenon's Capsule of ter Excising the Eye. — Night-blindness.
—Complete Self-enucleation of Eyeball,

An ordinary meeting of this Society was held on the 6fch
inst., Mr. J. Whitaker Hulke, F.R.S., President, in the chair.
The President announced that Dr. Samelson of Manchester,
had presented a volume of letters of von Graefe to the
Society.

Mr. Beudbnell Carter showed a pair of Franklin’s
Spectacles for use after Cataract Extraction. They were
made by cementing two small semicircular plano-convex
lenses upon an oval of plane glass. Thus, both near and
distant vision was afforded, and the spectacles were not
heavier than ordinary spectacles. Messrs. Baker, of 244,
High Hoi born, were the makers.

Messrs. Oritchxtt and JiT.br showed a case of Peculiar
Dotted Appearance of the Fundus of the Right Eye, whether
ohoroidal or retinal they could not say, nor whether it was
congenital or acquired ; syphilis was probably not opera¬
tise. There waa haziness of' the vitreous of the other eye.

They also showed a case of a young woman with a rare
form of Pigmentary Change in the Retina.—Mr. Nbttlbsbip
asked how long the condition had probably lasted in the
first case ?—Mr. Julkr said there was slight myopia, but no
history of special failure of vision.—Dr. Hill Griffiths
mentioned a case of minute dotted appearance of the fundus
about ths macula in a woman whose sight was defective
from abuse of tobacco, but as her sister had & similar
change in the fundus he regarded the laaions as of congenital
origin.—Mr. W. H. Jkbsop said there was pigment in front
of the large vessels in the second case, and therefore in the
retina.—Mr. Julbr admitted that the pigmentary layer was
much affected in places.

Mr. Adams Frost showed a case of Cystic Tumour in the
Orbit of a woman aged thirty-five. It was of two years’
duration, the eyeball bring merely prominent till six months
ago, when a soft swelling appeared at the upper and in ne r
angle of the orbit beneath the skin of the upper lid; the
cyst was punctured but yielded nothing.

Mr. Ernest Clarke showed a set of Artificial Eyes made
by Maw, Son, and Thompson, at the inexpensive cost of
3r. each. ...

Mr. W. J. Collins showed a case of Cholesterin in the
Vitreous in a man aged sixty-six, probably primary, the
right eye being alone affected. Such a condition might dis¬
appear according to von Graefe.

Mr. W. J. Collins also exhibited a living specimen of
Exophthalmos with Opacities of the Lens in a young woman,
with marked palpitation but no goitre, though a small one
had been present a year ago. Von Groefe’e and Strilwag’s
signs were absent—Mr. Nbttlbship said there waa slight
ptosis of right side, in which the disease began, the reverse
of what was usually seen.—Mr. Collins thought the ptosis
might be due to congestion, for it was variable in degree.

Mr. Lang read notee of a case of Fatal Meningitis follow¬
ing excision of a suppurating globe, and causing death in
forty-eight hoars. The necropsy revealed extensive sup¬
purative meningitis. .

Mr. Lang also read a paper on the Insertion of Artificial
Globes into Tenon’s Capsule after Excising the Eye. He had
employed this plan after finding that Dr. Mules’s operation
for evisceration and an artificial vitreous was unsatisfactory.
The operation consisted in inserting a hollow globe of glass,
celluloid, or silver into Tenon’s capsule, and then closing
the capsule by a set of deep sutures, and the conjunctiva by
a superficial set, both of silk; the deep ones were not
removed. A horse-hair drain placed under the deep sutures
and an iced pad to the lids prevented pain and swelling of
the lids and conjunctiva. In sixteen cases not one nad
suppurated; this waa probably due to the antiseptic pre¬
cautions which were taken—namely, to irrigate the conjunc¬
tival sac before excising the eye, again after the excision (and
this brought Tenon’s capsule plainly into view), and finally
when the operation was completed, lie advocated the
operation, as it had all the advantages of Dr. Mules’s opera¬
tion without any of its disadvantages.—The President had
never met with a fatal case alter excision of a sup¬
purating globe. Was extension of the inflammation
brought about by the application of a too firm com¬
press? Fluids in the orbit might conceivably in this
way be driven back. Would it not be better to treat such
a case as in an ordinary wound, and leave the orbit quite
free from pressure ?—Mr. NBTTLBSHn? remarked that the
meningitis might have preceded or accompanied the suppu¬
ration of the eyeball, and he therefore asked whether there
was any fever before the operation or other indications of a
similar significance.—Mr. Brudenkll Carter said that Sir
Wm. Bowman had thirty years ago condemned the extrac¬
tion of the capsule of the lens from the eye as a certain
cause of cyelitia &c. In operation on the eye he always
soaked his instruments in alcohol, a useful precaution
against septic infection, he believed. Following von Graefe,
he never excised an eye in acaee of suppuration.—Dr. Brajlky
was of opinion that evisceration was the best method of
treatment of suppurating eyeball. The occurrence of suppu¬
ration was,perhaps, not often due to inoculation with germs
on instruments, but bad more to do with the general condi¬
tion of the patient. He thought it was more reasonable to
suppose that a more beneficial effect and less chance of spread
of the suppuration to the meninges would be obtained if the
sclerotic were left, than if the capsule of Tenon was the only
barrier.—Mr. Adams Frost confirmed all Mr. Lang had said in
favour of his operation as compared withthatof Dr. Mules. His
own operation hod not been so successful as Mr. Lang $,

984 The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Mat 14,1887.

His plan was to unite the musolea with Tenon’s capsule and
the conjunctiva over the globe; the haemorrhage was some¬
times very troublesome. He thought that removal of the
sclerotic was an additional safeguard.—Dr. Mdlrs had had
upwards of one hundred cases of evisceration without any
cause for anxiety; the cases were kept in about twelve days.
There had been no sympathetic disease, nor had there been
any difficulty in cleaning out the interior of the globe.—
Mr. Jessop thought that the capsule of Tenon would get
worn away by the foreign body; the sclerotic (as in Dr.
Mules's operation) was the only tissue in the body of suffi¬
ciently low vascularity to withstand the irritation of a
foreign body.—Dr. Little said that he sometimes enucleated
and sometimes eviscerated; the latter when he had good
reason to believe that the back part of the eye was not in¬
volved in the disease. He did not use or advise the employ¬
ment of an artificial vitreous for fear of irritation resulting.—
Mr. F. R. Cross said that evisceration was a not altogether
successful operation, for it was uncertain whether a sinus or
fistula might appear after the introduction of the artificial
vitreous; and the thin conjunctival membrane between the
artificial vitreous and the glass eye would be sorely tried.
He concluded that the old operation was the best still,
especially if some means could be devised to keep the lower
eyelid firmly against the glass eye.—Mr. Brudbnbll Car¬
ter had performed Dr. Mules’s operation about twenty-five
times. He had seen difficulty arise from the wound not
uniting properly. He thought it an excellent and safe opera¬
tion. — Mr. Nbttleship had performed Mr. Frost’s opera¬
tion five times; twice successfully, but in one of these
the globe had become displaced.—Mr. Lang, in reply, said
the lens capsule was very tough and quite loose, and required
no force in its extraction. He did not believe in the absorp¬
tion of soft tissue by a foreign body. Gaping of the wound
was due to the use of too large a globe.

Mr. Nbttleship narrated four cases (in two families) of
Night-blindness of long standing, and apparently at present
not increasing, in which a number of very small, scattered,
white spots were present at and behind the equator of the
fundus, evidently caused by deposit, not by atrophy. In
none of them were there any of the appearances of common
retinitis pigmentosa, though there was pigment disturbance
of a somewnat different kind towards the periphery in some
of them. The patients were grown-up girls.

Mr. Mackinlay narrated a case in which a woman had
wrenched out her left eye with a meat-hook. She was
thirty-nine years of age at the time, and had had several
children in rapid succession. She was suckling a baby three
months old, and had been much depressed for three or four
days before the occurrence. The optic nerve had been
snapped off close to the commissure. She made a rapid
recovery. The only case he knew of was one recorded by
Mr. M‘Hardy in the last volume of the Society’s Transactions.

THE GENERAL COUNCIL OF MEDICAL
EDUCATION & REGISTRATION.

Tuesday, May 10th.

Sir Hbnry Acland, President, in the chair.

At the meeting of the General Medical Council on Tues¬
day last, the President delivered the following opening
address:—

At the close of the last session the Council did me the
honour of desiring that I should retain office until we could
with advantage meet to further consider the relation of the
Apothecaries’ Societies to the Royal Colleges of Physicians
and Surgeons in England and Ireland, and the con¬
sequences which would arise should they fail respectively
to combine for examination purposes. I find myself, there¬
fore, once more called upon by your favour to open
another session of the Council. In the discharge of that
duty I shall state very shortly the clrief business whieh
is before the Council. I shall offer a summary of the pro- 1
ceedings which relate to the action of the Colleges and the
Apothecaries respectively, and then, before I retire, shall
request you to permit me, as my last act, to join you in
-recording the sense we all have of the.blessings this country

has enjoyed during the eventful reign of the Queen and
Empress of this united empire. First, then, and briefly, as
to the business, exclusive of the combination question. Thu
is already for the most part set forth in the programme now
on the table. Through the activity of your committees,
their reports afford ample scope for prolonged attention, bat
also through the carefulness of the reports each subject
can be rapidly, as well as clearly, dealt with. It would be
an improper employment of time were I to give any account
of the several reports on procedure, income and expenditure,
or practical education, in the consideration of which I shall
be unable to share. The Council will doubtless desire that 1
shall pass at once to the question of the combination of the
three licensing corporations in England and Ireland respec¬
tively. First, I would ask that the several communications from
the four Colleges and the Societies of Apothecaries, which are
upon the programme, may be received and entered upon the
Minutes. I will offer such short commentary upon them as
may lay the whole case, as I understand it, clearly before
you. 1 will then report the little that it has been in my
power to do in furtherance of the Council’s wishes. First,
as to the case of England. The letter which was read to
you at the last meeting was forwarded to the four Colleges
on February 26th. Replies were received from the Royal
College of Physicians of London on March 23rd, and from the
Royal College of Surgeons of England on April 2nd. Bo
desire was expressed by either of the Colleges for an inter¬
view. It was clear from semi-official information which I
received that if an interview were obtained with the College
of Surgeons it would be useless for the object of the Council. I
did not therefore press it. With respect to the College of
Physicians the case was different. Having been for nearly
forty years a Fellow of. that, body, 1 was, in my judgment,
bound in that capacity to attend the meeting when the
subject would be discussed. Accordingly, on March 21st this
was done. What passed I am not at liberty to relate. Di*-
cussions are bald to be secreta colltgii. Sut I may just say
that it seemed to be a duty to endeavour to disabuse the
College of a charge which had been privately made to me,
that, in the judgment of many Fellows, the Medical Council
had gravely outstepped its duties by addressing the College
on the subject. As a Fellow, I do not hold that opinion;
whether it was largely entertained, I cannot say. That it
was held, by whomsoever held, on an imperfect conception
of the position of affairs, cannot reasonably be doubted.
Since the time when the Colleges declined to admit the
Apothecaries’ Society, that body had applied to the Medical
Council for examiners under the Medical Act, 1886. The
Council, as well as the Colleges, had at various times de¬
clared in favour of union between the licensing bodies in
England, inclusive of the Apothecaries’ Society. If there
was any chance still left of union, the Council was clearly
bound not to appoint the examiners and thus erect the
Apothecaries at once, and de noo<\ into an independent
licensing corporation. It was a case in which precipitancy
was to be with the utmost care avoided. We were deciding
upon a momentous education question of the future. The
answer which you have now received must be accounted as
final. A simple question therefore remains. The Apothe¬
caries apply again to you through a new motion (Programme,
No 12) for examiners. To this application a reply must now
be given. An endeavour will be made to traverse the direct
answer by means of a motion by Professor Struthere. This
motion makes it my duty to make certain statements for
the information of the Council. Very opposite opinions
have been pressed upon me sinoe- we last met—as, for in¬
stance; (1) That the Council should certainly refrain from
appointing the examiners, and should leave the onus of the
decision to the Privy Council. (2) That the Council is
bound, both in honour and by the principles of law, to carry
out the alleged intention of the Legislature by the Act of
1886 and to appoint examiners. (3) That it will be injurious
to the public interest that the Apothecaries should continue
to exist as an examining body, (4) That it will be s real
advantage to retain them side by side with the two corpora¬
tions and the .Universities, in order that excessive and
unnecessary scientific examinations may not be imposed on
every medical student. . I have noted that some who used
to wish the Apothecaries to be “ extinguished ” now hold
the opposite opinion. (6) That if the Medical Council do
grant the examiners, the Privy Council will certainly
override your descision. And, lastly, (6) that the Privy
Council will certainly, in the case of your refusal, dire®
you to appoint examiners, and, if you then decline, win

The Lancet,]

MEETING OF THE GENERAL MEDICAL COUNCIL.

[Mat 14,1887. 985

appoint them against your judgment. If this be so, the Privy
Council will be acting in the unquestioned exercise of its
powers under Clause 19 of the Act of 1886. In what pro¬
portion these opinions, and others which have been pressed
upon me, weighed with the English Colleges cannot be
stated, since they do not assign their reasons for not
consenting to form one Corporation Examining Board
for England, and in this simple way bring to a close
a long and tedious discussion. To you, therefore, or
to the Privy Council, is left the decision Whether
to perpetuate or to extinquish an examining body
which for seventy years has rendered the 8tate acknow¬
ledged services. I should not have ventured to trouble you
with these divergent and hearsay statements but as an in¬
troduction to what follows. Since we parted, it appeared
to me to be a duty to learn, as far as I could, the legal view
of our position—subject, of course, to the uncertainty of all
opinion not resting on judicial decisions in a court of law.
I gather that the Council would probably be advised
that they will fail in a statutory duty if they refuse to
appoint the examiners. It is true that underthe Act of 1886
the Council has power to refuse. “ It shall be lawful for the
General Council, if they think fit, on the application of (a)
corporation, to appoint any number of examiners to assist
at the examinations ” (Clause 5). But then, by Clause 19,
“ if it appears to the Privy Council” that “occasion has
arisen for the General Council to appoint assistant exa¬
miners,” “ the Privy Council may notify their opinion to the
General Council"; and if the General Council fail to comply
wit h any “ directions of the Privy Council ” relating to such
notification, the Privy Council may themselves give effect
to such directions. The Medical Council is therefore
powerless to prevent the appointment of examiners. Its
decision must rest, not on the question whether the new
examining board of the Apothecaries would be adequate or
inadequate, but on the general question of policy or vested
interests in respect to an old corporation. It is clear that
the Legislature has carefully guarded these interests by
giving a right of final appeal to the Privy Council. By re¬
fusing examiners, the Medical Council would propose a
policy, but that only provisionally. If it grant examiners,
it becomes the complete guardian of the examinations,
because it would both appoint the examiners and send its
inspectors. It cannot therefore be alleged that the Apothe¬
caries’ examinations will be inadequate, if they continue
to exist. It may be said they are unnecessary. The Legis¬
lature has implied that the Apothecaries have rights. If
we refuse these, they appeal to the Privy Council. That
body will, on a review of’the whole case, interpret, as it sees
fit, the intentions of Parliament by the Act of 1886. As
regards the Apothecaries in Ireland, the case may be more
shortly stated. A direct legal issue has been raised by the
College of Physicians. You have before you the statement
of the College of Physicians of Ireland (March 19rh and
21st,), the letter of the College of Surgeons (March 24th),
and recently a further letter from the College of Physicians,
dated April 26th, and opinions of counsel forwarded by the
Apothecaries’ Society of Ireland, dated May 6th. From these
documents three special conclusions may be drawn :—1st,
that it (the College of Physicians) uncompromisingly decides !
against any combination, alleging that the Apothecaries
cannot grant a licence in medicine, and therefore no body
can combine with the Apothecaries; 2nd, that they therefore
dispute the power of the Medical Council to grant supple¬
mental examiners to the Apothecaries; and 3rdly, that the
College of Surgeons, in its judgment, propose to incorporate
the Apothecaries with themselves for examination purposes,
without the Physicians, rather than that the Council should
give the Apothecaries a permanent and independent
position by granting the examiners. It is here necessary
to observe that the Council has before it the opinion
of the Attorney-General, the Solicitor-General, and Mr.
Muir Mackenzie, that under the Medical Act of 1886 the
licensing bodies can combine without the sanction of
tho Medical Council, and not, as heretofore, under con¬
ditions to be approved by you. By this opinion the
Surgeons and Apothecaries of Ireland can combine, if the
Apothecaries can combine at all, without your consent
or that of the College of Physicians. I cannot conclude
this sketch of an important subject without thanking the
Irish members of the Council for much assistance in this
matter. I need not longer detain the Council. There is
much to be considered during this session, and my medical
adviserj forbid me to share it. Indeed, I feel assured that,

in your interest, I should, for the last time and with deep
regret, bid you farewell. This I do with an earnest prayer
for the steady progress of the scientific, humane, and
national work which Parliament has laid upon you. I trust,
however, you will allow me, before I quit the chair, to pro¬
pose for your consideration a humble address to the Queen.
The two surviving members of the original Council may thha
join you in discharging a welcome and touching duty to a
Sovereign who is lull of sympathy for the sufferings we
have to prevent and to alleviate, and greatly beloved by all
her loyal people. (Applause.)

Mr. Marshall, in moving that the President’s address be
entered on the Minutes, said he was sure the members would
desire to express to him their extreme pride and gratification
as to the manner in which be had discharged the duties of
his office for so many years, and their deep regret that his
physical health should compel him to relinquish bis post.
The address which he had just delivered would be an excel¬
lent guide to the Council through the labyrinth of questions
which seemed to be pressing urgently for solution.

Sir William Gull claimed the privilege of seconding the
motion. He had known the President forty-eight years,
and he had never met with anyone who had so thoroughly
devoted hfmself to duty—to which, indeed, he had sacrificed
every other consideration.

The motion was unanimously agreed to.

Mr. Simon moved that the following address be engrossed
and presented to Her Majesty;—

To Her Mott Gracious Majesty Queen Victoria, Queen of Great Britain and
Ireland, Empress of India.

May it please your Majesty.—We. tho General Medical Council of
Education and Registration of Great Britain and Ireland, humbly tender
our loyal congratulation* to your Most Gracious Msjestv on the approach¬
ing completion of the fiftieth year of your Majesty'* reign. Haring
been appointed by Act of Parliament to take stops’ for euabling your
Majesty * subjects to distinguish between those who are, and those who
are not, qualified by education and diameter to practise medicine in
your dominion*, we have had the opportunity of noting the progress
which has been made during your Majesty’* reign In the science of
medicine, especially In it* bearings on the health of tho nation. The
progress of education and the improvement* in the practice of all
branches of medicine, civil and military, have been great during the
last fifty years. Town* have been rendered more healthy; rural dwell¬
ings have been improved; dac gerous occupations supervised; medical
officers of health and public analyst* appointed; excessive hours of
labour regulated; the treatment of the sick poor in our workhouse*
amended ; and aayluma for mental disease* carefully organised. In ail
these improvement* medicine and medical education have had a large
share. To these subjects the lamented and illustrious Prince Consort
gave earnest attention, as evinced by the Interest he took both In the
erection and administration of model dwellings and hospitals—Insti¬
tution* which have also been the objects of your Majesty's solicitude and
sympathy. We desire further to express our sense of the obligation
under which the nation lies to all the members of your Royal House,
who, treading In the steps of their Royal parents, hare oonstautly shown,
by numerous acts, their desire to promote the sound progress—scientific,
educational, and practical—of every department of rational medicine.
For these, amongst other reason*, bearing on the general welfare, wo
have special came to join our fellow-subject* throughout the empire In
thankfulness to the Almighty for the blessings of your Majesty’s reign.
We fervently pray for your Majeaty’s continued peace, well-being, and
haopiness.

We have the honour to be your Majesty’s dutiful and loyal subject*.

Dr. H. Watson seconded the motion.

Sir William Gull, in supporting the motioD, said that
Her Majesty not only deserved the respect and affection of
her subjects, bat she had special claims on the medical pro¬
fession, to which she bad ever been thoroughly loyal, never
countenancing quackery or anything leaning towards
irregular practice.

The motion was agreed to.

The President t hen retired from the chair, expressing bis
earnest desire for the progress and well-being of the Council
as long as it and England lasted.

Dr. Quain waa requested to oocnpy the chair during the
discussion on the election of the President. He said he wa*
sure that the Council would desire to pass a hearty vote of
thanks to the retiring President for his long and valued
services.

Sir William Turner seconded the motion. The late
President, he said, had always performed his duties in the
spirit of a kindly gentleman, never Once losing his temper.

Mr. Macnamara desired, as one who had perhaps tried
the President’s temper sorely, to support the motion, and
suggested that an address should be drawn up and pre¬
sented to him on his retirement.

This was agreed to, and a committee was appointed to
draw up the address.

Dr. Quain said that the duty now devolved upon the
Council of electing a president- from among themselves, us
c 3

O

986 Tni? Lancet,] MEETING OF THE GENERAL MEDICAL COUNCIL. [May 14,1887.

required by the Act of Parliament. There were no rules
given for tbe election, and the Council would have to decide
whether it should be by ballot or otherwise. A precedent
would thus be established to regulate future elections.

Strangers were then requested to withdraw, and the
Council deliberated in private on the subject of the election.

On the readmission of strangers. Dr. Quajn intimated
that Mr. Marshall bad been unanimously elected as Pre-
Bident of the Council.

Mr. Marshall, in taking the chair, expressed his thanks
for the distinguished honour conferred upon him. When he
remembered the names of his predecessors he felt the serious
responsibility of his office. He was now in the peculiar
position of being one of themselves, and it might be supposd
that, as the representative of a particular body, he might be
liable to swerve from the line of duty. He was quite sure,
however, that that body would feel itself disgraced if he
allowed himself to have nis Conduct influenced or modified
in the least degree by the circumstance of his connexion
with it. His duties would have relation chiefly to the mode
in which the business of the Council was conducted, and
the object of the president of any public body should be, on
the one hand, to protect individual members, and, on the
other, to maintain his own authority in the chair. It was
quite possible that those two conditions might be excellently
maintained; and it would be his endeavour not only to
throw his whole soul into the affairs of the Council, but to ;
conduct the business (according to the Celsian maxim with
regard to a surgical operation) cito, tuto, etjucunde.

Sir Wm. Turner was then appointed a member of the
Executive Committee in the place of Dr. Haldane, and Mr.
Wiieelhouse in the place of Mr. Marshall.

On a motion for entering on the Minutes the usual state¬
ment of the degrees, diplomas, and licences of the candidates
for commissions in the medical staff of the army, who on
February 14th and following days presented themselves for
examination,

Dr. McVail pointed out that the holders of English
diplomas appeared to have been much more fortunate than
the holders of Scotch and Irish diplomas, and suggested that
the circumstance might perhaps be accounted for by differ¬
ences in the examinations in the different bodies. He
thought it was desirable to ascertain from the Directors-
General of the Army and Navy Medical Departments what
conditions regulated the numbers in the column “qualified,
but not successful.” Last year, he said, it appeared that
out of six licentiates of the University of Edinburgh two
were appointed to vacancies and four were actually
rejected

Dr. Quain said that any body that considered itself
aggrieved could make application to the Directors-General,
but that it was not the duty of the Council to interfere in
the matter.

Sir Dyck Duckworth said that the holders of the qualifi¬
cations referred to must also have had other qualifications,
and that no definite conclusions could be drawn from
the figures given, unless they were carefully read. The
matter might be referred to the Executive Committee for
inquiry.

Sir Wm. Turnbr said that, as representing the University
of Edinburgh, he would bring the matter before that body,
but it was not a subject to be taken up by the Council. It
was satisfactory to observe that out of seventy-three candi¬
dates only three were rejected.

Mr. B. Carter said that Sir Thomas Crawford had told
him that the examinations of candidates for examination
during the present year had been exceptionally good, and
that, many more vacancies were filled in consequence.

Dr. Duncan said he sympathised with Dr. McVail’s views,
and thought it desirable to know what were the conditions
regulating the position of candidates’ who were passed as
qualified but not successful. He would move that applica¬
tion be made to the Directors-General for the desired infor¬
mation.

Dr. McVail seconded the motion, which, after some re¬
marks by Mr. Simon, Mr. Wheelhouse, Dr. Bruce, and Dr. H.
Watson, was put and negatived.

A communication was received from the Lord President
of the Privy Council enclosing an application from the
Society of Apothecaries for a postponement of the “ap¬
pointed day ” mentioned in the Medical Act, and asking the
opinion of the Counci! on the subject.

Dr. Haughton moved that the matter be deferred till
after the consideration of the motion by Mr. B. Carter for

the appointment of assistant examiners to the Society a!
Apothecaries.

It was pointed out by Mr. Simon, Dr. Quain, Sir W. Gall
and others, that when the matter was mentioned at the list
meeting of the Council it was understood that if the exten¬
sion of time was required it should be allowed.

Dr. Haughton’s motion was not seconded, and it fell to
the ground. A motion for the required extension of tine
was then agreed to.

Mr. B. Carter then moved :' “ That, in pursuance o!
the application made to the General Medical Council by
the Society of Apothecaries of London, by letter dated
April 12th, 1887, for the appointment of Messrs. W. J.
Walsham, G. II. Makins, and Andrew. Clark, to be
assistant examiners to the Society, under the provision*
of the Medical Act of 18SC, the Council hereby appoint
Messrs. Walsham, Makins, and Clark to be assistant
examiners accordingly.” He said that at the last meeting
of the Council in February the decision on the question wu
postponed in order that a representation might be made on
the part of the Council to the Royal College of Physician'
and the Royal College of Surgeons, in the hope that the
objections entertained by those bodies to a combination
with the Society of Apothecaries might be overcoat.
That representation bad been made, but unsuccessfully.
During the interval the Sooiety of Apothecaries had in tome
degree modified the terms of their application. They now
asked for the appointment of the three named gentlemen
as assistant examiners. The privileges of the Society of
Apothecaries with regard to the licensing of medical prac¬
titioners dated.originally from a charter conferred by King
James I., but for the purposes of the discussion he would
be content to trace them to various Acts of Parlii-
ment, some of them specially obtained by the Society and
bthers affecting the Society in common with other medio!
bodies. The first and most important of the special Acts
was that which came into operation in the year 1815. Tue
College of Physicians absolutely refused to undertake the
supervision and control of the medical education of the
general practitioners, and the work was therefore com¬
mitted to the Society of Apothecaries, which had ever since
carried it on in what he believed was admitted to bean
admirable manner. During the seventy years that had elap*d
the licence had been conferred upon more than 22,000 practi¬
tioners, and the number of licentiates was at this moment
about one-half of the whole medical practit ioners of England.
Of the thirteen gentlemen of English birth and English
medical education sitting around that Council table, he
believed seven held the licence of the Society of Apothecaries.
The estimation in which the Society was held by Parlia¬
ment was sufficiently shown by the faettbat it was retained
in the Act of 1886 as one of the bodies entitled to send a
representative to the Council; but the Act, while requiring
that no one should be admitted to the Register except aa
the result of au examination in medicine, surgery, and mid¬
wifery, did not give the Society any statutory right to
confer a surgical qualification. It could not therefore gran;
to its licentiates the right of entrance to the Register unless
it could combine with some other licensing body by which
its deficiency in respect to surgery could be made good. It
could hardly be expected that the Society of Apothecaries
would be able to combine with auy of the universities,
because those universities already possessed the power «
giving licences in medicine, surgery, and midwifery. The
only bodies with which the Society could combine prac¬
tically were the College of Physicians and the College of
Surgeons, and some years ago such a combination was very
carefully considered, and was at one time looked upon as
being practically settled. Lately, however, the Royal Colleges
had refused to carry out the arrangement which they once
made. It was under these circumstances that the Society now
appealed to the Council to carry out the intentions of the Act
of Parliament. He held that the Council had a certain
amount of discretion in the matter, but that discretion
must be exercised in a just and reasonable manner, having
due regard to the legal rights of the Society. What¬
ever their decision was, the Privy Council had absolute
power to review, confirm, or reverse it, and he was
strongly of opinion chat the action of the Privy Councu
would be almost entirely guided in the matter by tbe
grounds upon which the decision of the Council was
arrived at. If it appeared that it rested upon
weighty reasons of public policy, there could be
little doubt that an adverse decision on the part of we

Thk Lancet,]

MEETING OF THE GENERAL MEDICAL COUNCIL.

[May 14,1887. 987

Council would be supported by the Privy Council; but if,
on the other hand, they were influenced by sentiment, by
corporation rivalries or jealousies, the Privy Council would
reverse the decision. If any members of the Council were
opposed to the granting the Society examiners, he respect¬
fully invited them to Formulate the reasons by which their
views might be supported. His mind was perfectly clear
on the question that if he were not the representative of
the Society he should still vote in favour of the application.
The only assertion that he had heard as to the mischief or
evil that might arise from granting the assistant examiners
was, first, that those examiners would enable the Society of
Apothecaries to remain in competition with other licensing
bodies, and that such competition would be likely to be
disadvantageous. It could not surely be disadvanta¬
geous to the public, because the special function of the
Council was to exercise a supervision over examinations,
to see that they were adequate for the protection of
the public, and not unduly severe in their claims on the
medical student; and for the Council to say that the
existence of one or more examining bodies would tend to
lower the standard of examination was to admit at once
their own inability to discharge the functions which the
Act imposed upon them. His own feeling was that the
action of competition would be precisely the reverse, and
that nothing but good was likely to come from it. If there
was room for useful work for both the bodies, they would
survive and do the work; but if there was not room, the
fittest only would survive; and if the time came for the
Society of Apothecaries to be extinguished, it would
extinguish itself by a process of natural decay, of which,
however, he at present failed to see even the very earliest
indications. The idea that the Society would be likely to
use what had been called competition downwards was one
which had appeared to him no gentleman was justified in
gravely putting forward, because it was totally opposed to
the whole past history of the Society. He could quote in
defence of his position the professional authority of the
Royal College of Physicians of London, which was so much
impressed with the necessity or the desirableness of some
, competition in London that in the year 18G1 or 1862 it
established an organisation, and went oat of its way to
set up competition where none before existed, and by recent
decisions the College had shown how thoroughly it adhered
to what it had done. He asked the Council not to deprive
the public of the benefits of that system of competition
which the College of Physicians had made sacrifices to
establish, and which even within the last week it had
declared it would not abandon. The reason why three
examiners had been named was because the Act stated that
they should have the power to appoint on the application of
the corporation, and it was doubtful, therefore, whether the
, Council would have any power to appoint either more or
, fewer examiners than those that were applied for. The
gentlemen named were appointed examiners by the Society
of Apothecaries in 1884; they were gentlemen of the highest
surgical attainments and of great practical experience. The
Society put forward their names without any shadow of
hesitation as to their fitness for the work.

Mr. Simon seconded the motion. He said he did not
agree in the view that it was desirable to have competition
among examining boards, but the Council was now in this
dilemma that they must either have the two examining
boards in London, or must disobey the intentions of the
] law. It was on that ground that he seconded the motion.
The Act of Parliament was obligatory upon the Council
unless they had strong and definite reasons to the contrary.
They might refuse, but they could not do so unless they had
some reason which was not before Parliament at the time
of the passing of the Act. If Parliament had meant to
' extinguish the Society of Apothecaries, it would have done
so itself. That proposal was before Parliament, but was
withdrawn. Such a thing was never dreamed of in Par-
, liament as to give power to the Council to extinguish a
, body with vested rights against whom no complaint had
been levelled. If they had been at the present moment
before the. Privy Council with an accnsation against the
Apothecaries’ Company for having unfitly discharged its
duties, then without doubt they might refuse to entertain
the application, and probably the Privy Council would
support them. If there had been anything wrong in the
anamination, it was the duty of the Council to represent it
to the Privy Council, but in the absence of any such repre¬
sentation the examination of the Apothecaries’ Company

was supposed to be as good as that of the University of
Cambridge for all purposes of the law. If without any
justification of that kind they would refuse to do what the
Company asked them, they would place themselves in an
extremely embarrassing position. What wrong had the
Apothecaries’ Society done that they should be at the mercy
of the General Medical Council ? The Council was not
established on the Kilkenny cat principle, that some bodies
should be able to eat up others. He extremely regretted
the necessity of the vote, but he had not the least hesitation
as to what was his duty, and therefore he seconded the
motion.

Mr. Tealb said that the motion involved two separate
things: first, the granting of examiners; and, secondly,the
appointment of special persons.

Mr. Cabtbb said he was quite willing to alter the resolu¬
tion so that it should read: “That in pursuance of the
application made to the General Medical Council by the
Society of Apothecaries of London, by letter dated April 12th,
1887, for the appointment of assistant examiners to the
Society under the provisions of the Medical Act of 1886, the
Council hereby consent to appoint assistant examiners
accordingly.”

Mr. Tbalb regretted that it was necessary to establish a
second c >mpeting Board of Examiners in London, but he
agreed with Mr. Simon that they really had little optioi or
discretion in the matter. If Parliament had intended that
they should have the power to put an end to the Apothe¬
caries’ Society, Parliament would have done it itself. He
therefore did not see how they could avoid coming to the
conclusion to grant the request of the Society.

Permission was then given to Mr. Carter to amend his
resolution, and Sir Dycb Duckwobth moved the adjourn¬
ment of the debate.

The Council then adjourned.

Wednesday, May 11th.

Mb. Mabshall, Pbesidknt, in the chaib. ‘
Adjourned Debate on Mr. Cartels Motion.

A proposal by Dr. Aquilla Smith, seconded by Mr.
Whkhlhoitsk, to resolve the C >uncil into a committee for the
purpose of considering the application from the Apothecaries’
Society was negatived, and the debate was then resumed.

Sir Dycb Duckwobth said that at the meeting of the
Royal Cjllege of Physicians he was requested to state to
the Council what the policy was that lei the College to
act as it had done. When the courteous letter from Sir
Henry Acland was received it was accompanied by no fresh
arguments, and as the whole question had been fully and
maturely considered, both in committee and by the whole
College, the first decision was reaffirmed nem. con. The
College saw that it would receive no accession of strength
by union with the Apothecaries’ Society, that the
examination established by the Conjoint Board would
in no way be improved by the addition of such
examiners as the Apothecaries’ Society could send
to it from its own body, and that such being the case
no possible good could accrue to the public at large from
conjunction with that body. If the Apothecaries’ Society
took part in conducting the examinations of the Conjoint
Board, they would have to find their examiners from without,
and they would cease to issue diplomas upon their own
account, so that, in fact, they would be nothing more than a
trading company in the City. One point that had been lost
sight of was that the College of Physicians of London had
power to give a complete qualification in medicine, surgery,
and midwifery; so that it was really not incumbent upon
the College to seek an alliance anywhere. For the general
benefit, however, it was thought well that the College of
Surgeons should be nllied with it. At the time when there
were negotiations for an alliance with the Apothecaries’
8ociety all the universities of England negotiated too, but a
very different state of things prevailed now. The action
which the College took in 1861 in establishing a new order
of licentiates had been of great benefit to the profession,
and had improved the educational standard of general
practitioners. If that was to be regarded as competition, it
was at all events a competition upwards, but he was quite
sure that it was in no way intended to compete with
the examinations held every week in the Apothecaries’ Hall.
To those who knew the circumstances of the case it was
aimply ridiculous to talk of rivalry or jealousy. Speak-

Digitized by GoOgle

988 Thk Lanckt,]

MEETING Ofc’ THE GENERAL MEDICAL COUNCIL.

[Mat 14,1887.

ing simply as a member of the Council, and not as
a representative of the College of Physicians, he con¬
sidered that the Apothecaries were no longer wanted
in this country. They had done their wprk well, but
the need for them had passed away. That which they had
done at one time was now much better done by the trained
and examined members of the Pharmaceutical Society. The
only reason why the pupils at the schools wanted to take
a licence of the Apothecaries was because in some pro¬
vincial hospitals, aud in the bye-laws of various boards of
guardians, it was required that, whatever diploma any can¬
didate might possess, he must produce the licence of the
Apothecaries’ Society. It therefore happened that men
who were eminently qualified and held the diploma of the
College of Physiciaus and degrees of the universities, had,
perforce, to go to Blackfriars and obtain the licence of the
Society. The Apothecaries’ system had been a great draw¬
back to the profession of the general practitioner. It bad
been the means of spreading many mischievous ideas among
the public, and the nonsense of homceopathy in this country
was little more than a Nemesis following the apothecary.
It was not for one moment to be doubted that the require¬
ments of the two Royal Colleges were distinctly in excess
of those of the Apothecaries’ Society, and those who were
interested in the levelling up of the profession must look
askance at the reinstatement of the Apothecaries’ Company.
They h;d been threatened with an appeal to the Privy
Council; but was the Medical Council to be muzzled and to
be afraid to utter its opinions at a time like the present,
und to (lifer to the opinions of a body of laymen who, how-
over exalted and eminent, did not at present contain a single
member of the medical profession, aud who therefore were
not qualified to form an opinion for themselves unguided by
the Medical Council as to what was best for the highest
interests of the profession. It was the duty of the Council
to go forward boldly without any fear to do what it thought
best and right for the profession aud for the highest interests
of the public.

Dr. Sthuthkiis moved as an amendment: “ With refer¬
ence to the application made to the Council by the Society
of Apothecaries of London, of date February 12th, 1887,
received and entered in the Minutes of February 18th
(p. 127), and to the further application by the Society to the
Council, of date April 12th, 1887, that, in the opinion of the
Council, it would be contrary to the interest of the public
tfiat the Society of Apothecaries should, through Section 5
of the Medical Act (18SG), be enabled to grant a diploma
qualifying for admission to the medical profession.” At the
last meeting of the Council he had proposed a resolution in
favour of the Society of Apothecaries being admitted to the
Conjoint B >ard, ns he considered that the best way of get¬
ting rid of the difficulty which then existed was by process
of absorption. The present proposal, however, was to re¬
vivify the Apothecaries’ Society of Loudon and put it in a
position it had never before occupied—namely, that of being
empowered to give a complete qualification. lie opposed
that, proposal, feeling that the matter should be left with
the Privy Council. His amendment was not designed to put
an end to the Apothecaries’ Society, which under the Act
would in Rome respects come to an end in June, unless the
Medical Council gave ic a new lile. But it had other
functions to fulfil, and would still continue to supply
medicines to the profession or to anybody else, and
to prosecute quacks. Even if it ceased to do that,
it could still confer the distinction of LAC. on those
who chose to take it. In Ins opinion, it would be contrary
to the interests of the public that the Society should be
enabled to grant a diploma qualifying for admission to the
medical profession. That the Apothecaries’ Society should
cease to he a licensing body was no new idea, for in the
reports of the Select Committee in 1870-89 the opinion was
sometimes expressed. By the Bill introduced by the
Government of the day into Parliament in 1S33, the
Apothecaries’ Society was only to have one representative
on the Council, while the College oE Physicians was to have
three and the College of Surgeons three. When the Bill
went into committee the Irish Apothecaries disappeared,
and afterwards the London Apothecaries' Society was
deleted from the Bill. Then, again, in the Bill of 15531 the
Apothecaries’ Society was left out. All those who were
engaged on the Bill of 1886 knew very well that the Vice-
President, Sir Lyon Playfair, was very anxious to pass what
was passable, and to steer clear of all rocks ahead, lie got
qu : t of the dilliculty of the Apothecaries very cleverly by

putting it upon the Medical Council, and, if they did dm
settle it, leaving it to the Privy Council. If the application
of the Apothecaries’ Society were granted, the qualification
which they gave must be an iuferior one, and would lev:
to an inferior order of practitioners. At the last meet¬
ing of Council he was challenged by Mr. Carter when
he spoke of the licentiates of the Society as apothecary,
but he found in the well-known Act of Parliament of lili
there were constant allusions, not to a licence, but to a cer¬
tificate to practise as an apothecary, and the examiner'
were required to examine a man “ as to his fitness or quali¬
fication to act, ns an apothecary or assistant to an apothe¬
cary." If Mr. Carter’s motion were agreed to, what kind cf
students would go to the examination? The men about
whom there was something wrong might try for the certi¬
ficate, but others would uot. He did not think that any
qualification should be attempted below the diploma of the
Royal College of Surgeons. The profession was overstocked,
and it was the duty of the Council to elevate it, and no:
to lower it—not to make apothecaries out of them, but to
raise the members more and more. If the application were
granted, the Council would perpetuate the system of
supplying drugs. The competition of the universities wu
good, but the competition of the Apothecaries’ Society
would not be good. It was continually said that
Society ought not to be extinguished because it bad
done good work in the past. No doubt the Society put
on ah examination in medicine in 1815, but they ob¬
tained a monopoly along with it, and got the whole of th?
practice in England into their hands. An English apcr.br
cary was a thing that was not understood in Scotland or
anywhere else in the world. The Apothecaries’ Society used
their power against the Scotch and against the Irish. Tse
best educated man from Scotland or from Trinity College.
Dublin, was regarded as an illegal practitioner in England.
Formerly, if a Stokes or a Christison ordered a do* of
rhubarb, he would have got a lawyer’s letter, and have been
mulcted in .£20. No English Star Chamber ever used its
powers more constantly than the Apothecaries’ Society
did.

Dr. Quain said Scotchmen were not allowed to cross the
border to practise as apothecaries. The restriction did not
apply to surgeons or physicians.

Dr. Stbuthkrs said that the Apothecaries’ Society be¬
came a trades union, giving the Englishmen the monopoly
and keeping enterprising Scotchmen and Irishmen off tbe
soil. Au outburst of homceopathy took place in Edinburgh,
but it was like the seed that fell on stony ground, and tber*
was not now a pure homoeopath in Scotland; but owing to
the Apothecaries’ Society homceopathy nourished in England,
and, by teaching people to rely on nature and not trust .-o
much to drugs, had done more good for the science of
medicine than the Apothecaries’ Society ever did. Mr.
Carter had uot referred to it, but outside a good deal bad
been said about the power of prosecuting quacks. On tbn
matter, however, the report of the Medical Acts Commisaon
said: “We consider it undesirable to attempt to prevent
unregistered persons from practising, but at the same tuns
we think that they should be prevented from representing
themselves as being registered or assuming titles wind
would lead the public to believe that they are reguw
medical men.” It was not creditable to any body &
men at the present time to combine with another
on the ground of the power to prosecute quacks.
There were some things about the constitution of the
English Apothecaries’ Society which were not understood
even in England. The Master of the Society, when giving
evidence bef ore the Medical Acts Commission in July, f-' 1,
said that the Society touched none of the money that was
paid for the examinations, the fees going into afuud entirely
separate from the corporation, and being applied towards
the expenses, the twelve examiners receiving £1000 a year
between them, and the secretary of the Court of Examines
a salary of £200 a year. The Royal Colleges and university
had grand museums and magnificent libraries, but
Apothecaries’ Society had no such things. It was an an-i
quated body, having its livery aud its yeomanry, and u?i R
old phrases which dated back to the time when the surgeons
were in alliance with the barbers. The Society was
trading company, manufacturing and selling drugs
chemicals, not only by wholesale, but by retail, and dealing
likewise in goods which it bought from other traders.

Dr. Quaix said the Apothecaries’ Hall was a distinct toy
from the Apothecaries’ Society, and he protested againfi

iOOQ

o

The Lancet,] MEETING OP THE GENERAL MEDICAL COUNCIL. [May 14,1887. 9 89

time of the Council being wasted upon hearing an argument
which had no bearing upon the subject before them.

Dr. Stbuthkrs caused some amusement by handing to
the President a tincture, a powder, and a bottle of eau de
Cologne which he had bought at the Apothecaries’ Hall.

Sir Wm. Gull seconded the motion.

Sir Walter Foster said he was glad that Dr. Struthers had
recalled the minds of the Council to the humbler branches
jf the profession, which were doing good and useful work,
lie had, however, endeavoured to appeal to sentiment not of
:he highest kind, and to revive recollections and grudges
tgainst the Apothecaries’Society. There was nothing dis¬
graceful in shopkeeping when carried on in an honest spirit.
They were now placed in a position of great gravity, being
jailed upon to decide whether the competition between the
licensing bodies of London should continue on those lines
which the profession generaHy had condemned. If they
refused to grant assistant examiners to the Apothecaries’
Society it would appeal to the Privy Council, and it was
generally thought tnat the Privy Council would concede
them the right to continue by ordering the appointment of
examiners. He did not think that the Council should have
the power to destroy the Apothecaries’ Society under the
present condition of matters, unless they had a good
reason of their own for it; but in that event they
would not be acting in the interest of the public, but
from a narrower professional ground. If they refused
to allow the Apothecaries’ Society to have examiners
and were backed up by the Privy Council, they would have
growing up in the profession a new kind or practitioner.
A Bill was now befoie Parliament called the “Pharmacy
Act Amendment Bill,” which established for the Pharma¬
ceutical Society a curriculum of which materia medica
formed a part, which meant that pharmacists of the future
would enter upon a course of study embracing part of the
medical curriculum. The course of materia medica lectures
would include a good deal more than & knowledge of the
physical and chemical properties of drugs. It could not be
denied that in hundreds and thousands of cases patients
were prescribed for by chemists over the counter, and that
practice would continue until they supplied properly
qualified aid to the poor people. If the public were
denied the opportunity of consulting those practitioners
who were usefal to them, they would soon ask for
parliamentary powers authorising those practitioners to
prescribe for them, and he consequently believed that,in the
interests both of the public and of the profession, it would
be wrong to remove the power from the Apothecaries’
Society of giving qualifications for the practice of medicine.
If the Apothecaries’ Society failed to sustain its standard of
proficiency the Council would have power to control the
granting of its licences. He regretted that the matter had
come to its present position, and he laid the blame on those
Colleges which had refused their sanction to the proposal
that had been made. For himself, he was willing to give
his vote according to his convictions, which were that the
Council should declare that the Society should have ex¬
aminers, and,in the interest of the public, t hey should appoint
examiners to assist the Apothecaries’ Society in giving a
qualifying diploma for entrance on the Medical Register.

Mr. Whbelhouse said he thought the apothecary was a
necessity in England. He did not know how the poor in
many isolated localities could obtain medicine if the general
practitioner were not permitted to supply it. He had been
very anxious that the Apothecaries’ Society should be
absorbed by the two Colleges, and that there should be one
portal by which to enter the profession. If that could not
De brought about, there should be some means by which com¬
petition could be kept up to a certain extent. He was him¬
self a licentiate of the Apothecaries’ Society, and he felt that
he should be turning his back upon it if he were now to say
that it ought not to have the powers which it sought. The
Council would be able to keep up the standard of the Society’s
examinations, and he therefore hoped that the application
would be granted.

Mr. Mitchell Banks said he believed that there was a
strong desire on the part of the Council that an amalgamation
should take place between the Society of Apothecaries and
; he other bodies, but those bodies had declined, and the
( ">uncil ought not to have its judgment warped by that con¬
sideration. The fear of threatened consequences ought not
' o weigh on them for a moment. No valid argument had
been brought forward to prove that the request made ought
to be granted. It had been urged that it was necessary to

have a low class of practitioners, but he did not believe that
such a class was required. The question at issue was one of
vested interests, but whatever respect they might have for
such interests, they ought not to be allowed to override the
public good.

Dr. Leishman concurred in the interpretation given by
Mr. Simon to the words “if they think fit,” and said than
he was able to vote for Mr. Carter’s resolution, which left it
open to the Council to consider what number of examiners
should be appointed. He had no sympathy with the Society
of Apothecaries, but ho was bound to recognise its legal
claims.

Dr. Haughton said that he was now a complete convert
to Mr. Carter’s proposal, for which he intended to vote.

Mr. Simon said that the question of the fitness of the
Society of Apothecaries had been decided by Parliament,
and it was not for the Council to attempt to override that
decision. The Council had a legal duty to fulfil towards the
Apothecaries’ Society, and if they did not do it tbe Privy
Council would. If Dr. 8truthers’ amendment were defeated,
as he hoped it would be, he believed that in two years there
would be a conjoint board in London which would include
the Apothecaries’ Society.

Dr. Duncan said he could not accept the law as laid down
by Mr. Simon. When the Act used the words “if they
think fit,” it did not mean nonsense, but it meant what it
said. The prophecy of a one-portal system in two years he
considered a ridiculous one, and he believed that if tbe pro¬
fession were polled the general feeling would be expressed
that tbe system was the abomination of abominations. He
had great respect for the Apothecaries’ Society, and regretted
to have to vote for a proposal that might lead to its extinc¬
tion. Mr. Simon’s statement about the intention of the
Legislature in passing the Act was mere idle talk. That
intention could only be gathered from the Bill itself. He
had learned from the highest authorities in the College of
Physicians with which he was connected that the inten¬
tion was. that the Society of Apothecaries should be extin¬
guished if tbe Medical Council thought fit.

Dr. Bruce said that he thought Mr. Simon's argument in
reference to the words in Clause 14 was unanswerable.
Although he had at one time been an advocate for the one-
portal system, he believed that if that system were carried
oat it would lead to a dull uniformity, and that the best
thing w&s free open competition. It it had been the inten¬
tion of the College of Physicians when the Act was being
passed to extinguish the Society of Apothecaries, that view
ought to have been frankly declared.

The debate was adjourned.

(For continuation of Report see p. 1003.)

JERUSALEM HOSPITAL FOR JEWS.

The English Hospital for Jews in Jerusalem, in connexion
with the London Jews’Society, has been established for over
forty years for the gratuitous relief of the sick. It was the
first hospital founded in Jerusalem, though many similar
institutions have been established since then by the different
nationalities. The work of the institution lies amongst the
Jew8,of whom there are about 25,000 now in Jerusalem: but
Arabs are also occasionally seen. The hospital has twenty-
six beds. There appears to he some difficulty in respect of
tbe nursing, for which the managers of the charity have to
depend entirely on such aid as can be procured in the place.
Mr. Percy D’Erf Wheeler, M.R.C.S., L.R C.P. Lond., is both
physician and surgeon, and be is assisted by a proselyte
educated for the medical profession in Hungary. A dis¬
pensary is connected with the hospital, and all the drugs
and instruments are from London houses. Every kind of
case is admitted, and patients arrive from Persia, Armenia.
Circassia, Tunis, &c., many of them suffering from diseases of
tbe eyes. They say they prefer coming to an English hospital.
The sanitary condition of the city is stated to be deplorable,
and tbe services of the medical staff of tbe hospital are
found to be necessary not only in treating disease, but in
directing the minds of the people to the paramount import¬
ance of cleanliness and sanitation. Malarial fever heads the
list of diseases for which relief is sought. During the year
1886 the in-patients numbered 6052, and the total consulta¬
tions amounted to 37,018—a figure which speaks eloquently
of the good wor]c done in connexion with the institution.

O

990 This Lancet,]

THE FINAL EXAMINATIONS.

[Mat 14,1887.

THE LANCET.

LONDON: SATURDAY, MAY 14, 1887.

That there is something radically wrong in the present
Btate of medical education is a proposition which at the
first blush seems almost preposterous. That, with all our
boasted improvements in the art of teaching, with a
large body of teachers, never more zealous and devoted
than at present, the results of the Final Examinations
should be so deplorable as they confessedly are, surely
evinces an error in method somewhere. Dr. Glover, it
may be remembered, urged the point as evidence of a
lack of practical knowledge, and thought that a return
more or less to the old apprenticeship system would
prove a remedy. That in 1885, according to the oilicial
returns, no fewer than 66 per cent, of the candidates
were rejected at the Final Examinations of the Edinburgh
Colleges, 48'2 per cent, at the Royal University of Ire¬
land, and 44*1 per cent, at the College of ‘Surgeons of
England, are results which, to use Dr. Glover’s words, may
well be styled “ appalling" and “ very painful.” For it must
be remembered that the candidates are all men who have
completed the prescribed curriculum under all the ad¬
vantages now offered for a complete training, and it is
shocking to find so poor a result after so much labour. It
is hardly possible to attribute this solely to the causes
assigned by Dr. Glover, and it may be worth while to in¬
quire whether there may not be other and less remote
reasons for the high percentage of rejections.

The experience of the last few weeks of the examination
held by the College of Surgeons supplies an answer to this
inquiry, and clearly demonstrates that a large share must be
laid at the door of the examination itself. For the number
of rejections among the candidates at this Final Surgical
Examination has been considerably in excess even of that
given for the year 1885. There must be something wrong in
system and in method to permit of such a large percentage
of rejections, and we call upon the London teachers, who
are all interested in this question, to spare no effort in
determining the real cause of this regrettable state of things.

Much praise has been bestowed upon the examinations of
the College of Surgeons for their stringency; but an equal
amount of blame is due for their uncertainty. The personal
equation plays a prominent part, for owing to the system that
prevails, whereby the results of the written and those of
the oral examinations are kept apart,and the comparatively
high value set upon the few minutes’ oral examination, it
is obvious that the chances of success or failure must lie
largely in the demeanour of the candidate and in the fitness
of the examiner for his work. The rough-and-ready methods
of old days have their survival in the present, and the
student, who knows often as well as his teachers, and
certainly better than his examiners, the standard of his
fellows’ knowledge, comes to regard the passing of an exami¬
nation where the strong sometimes fail and the weak succeed
as a game of chance, and trusts that he may have the luck
to meet with a leniency which he may not'merit. It-is this

uncertainty, due almost entirely to deficiency in the “art
of examining,” that is doing a great deal to bring into
contempt examinations which we have perhaps been too
apt to praise for their practical and searching character.
That this is no new discovery may be gathered from the
outspoken evidence of Mr. Christopher Heath, given
before the Medical Acts Commission. Speaking of the
examinations at the College of Surgeons, he says:—

“ 4065. One man may be lucky. He may go to a man at
one table who is an easy examiner, and he will get through;
and his friend, who has got a more difficult examiner at a
table the other side of the room, does not get through. I do
not know, human nature being as it is, how it is to be
avoided.”

Again, a little later Mr. Heath makes the following
remarkable admissions:—

“4060. (Prof. Turner.) I have heard complaints as to
the examination of the Royal College of Surgeons of
England, as to its being so uncertain an examination. Do
you think there is any foundation for such a complaint?-
It is uncertain.

“ 4070. What you have said with regard to the different
standards at the different tables bears out the statement of
its uncertainty ?—Quite so.

“ 4071. So that I suppose you would not put forward the
examination of the College of Surgeons of England as a
model examination?—No, I think it might be modified with
advantage in some way.

“4072. And perhaps in some respects in the way of
diminished stringency and of less uncertainty ?—Yes."

Further comment is needless. The statements of 1831
hold good for 1887; and we maintain that the credit of
the College of Surgeons (ay, and the College of Phy¬
sicians, too, since it has become a partner in the Exa¬
mining Board) is at stake, for its reputation depend! on
the maintenance of a just uniformity in the performance
of its duties as a qualifying body.

In continuation of our remarks on the report of the
Manchester Medico-Ethical Association on the question of
the defects in the constitution of the Coroner’s Court, wa
proceed to deal with the most important part of the whole
document. We allude to paragraph 1 at the bottom of
page 10: “ The examination of the body upon which an
inquest is to be held should be made by a medical man
specially skilled in such matters, who should be designated
the Public Pathologist, and that for every coroner's district
there should be one or more such pathologists appointed
to conduct the examination of the body previous to tbs
inquest.” The second paragraph advises that the appoint¬
ment of the pathologist should be made by the Crown. Thu,
it may be remarked, is quite impracticable; the pathologist
should be not an officer appointed by the Crown, but an
expert witness called by the coroner. The third paragraph
provides for the calling in of further scientific experts for
analysis, Sec. The fourth paragraph is very important, and •«
this: “The duties of the public pathologist should not pre¬
clude the medical attendant in the case from giving evidence
as a skilled witness where necessary.” At present coroners
are compelled by the Medical Witnesses Act to summon the
medical attendant in the laBt illness, or, failing this, “ » D .'

legally qualified practitioner in actual practice in or near
the piece where the death happened.” He majority

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The Lancet,]

REFORM OF THE CORONER’S COURT.

[Mat 14,1887. 991

jurymen at such inquest may also call for the evidence of
such other medical witnesses as they may desire. From
this it will be seen that the present law is sufficiently
elastic to provide the requisite evidence without so sweep¬
ing a change as would be involved by the appointment of
public pathologists by the Crown. The employment of the
medical attendant or local practitioners by the coroner has
been the subject of ceaseless attacks, and it is somewhat
lamentable to read in the report under consideration that
tho medical attendant is not to be precluded from giving
evidence as a skilled witness when necessary! A large
proportion of the cases forming the subjects of inquests are
those of sudden illness, poisoning, and violence of all kinds,
in which the assistance of the nearest practitioner must be
sought. Should death occur and an inquest follow, he is
the only witness who can give evidence as to symptom?,
appearances, &c., and his evidence must, as a matter of
course, be necessary. Moreover, should a post-mortem
examination be requisite, and the medical attendant be
willing and desirous to undertake it, why should he be
requested to stand aside and give place to u pathologist ?
The Lancet has always appeared as tho champion of the
rights of general practitioners, and in continuance of this
course we must protest against the proposed shutting out
of the medical attendant as utterly unwarrantable. For
not only is it, as we have seen, unworkable so far as the
giving of evidence is involved, but it wholly ignores the fact
shown by past history, that the average general practitioner
in town and country has frequently shown himself to be as
competent to make a post-mortem examination and to face
with credit to himself a severe cross-examination in the
witness-box, as to attend a difficult midwifery case, to set a
fracture, or to perform any of the other numerous and mul¬
tifarious duties which fall to a general practitioner’s lot. In
1845 occurred the case known as the Tawell murder, in
which the deceased woman, Sarah Hart, died from poison¬
ing by hydrocyanic acid. The three local practitioners of
the rural district where the death took place (Messrs.
Champneys, Pickering, and Norislad) conducted the
necropsy.; and those who will refer to The Lancet of that
year will And that their report leaves little to be desired.
Moreover, so carefully were the stomach and its contents
removed, handled, and forwarded for analysis, that, though
the nature of the poison was not known, the analyst
(Cooper) was enabled to distil from the contents of the
stomach one grain of pure anhydrous hydrocyanic acid.
Could, a skilled pathologist have done better? Again,
when the Rugeley poisonings occurred in 1855, the late Dr.
Monceton, then of Rugeley (subsequently of Maidstone),
was entrusted with the examination of the exhumed bodies
of An.^ and Walter Palmer. He published minutes of
these in The Lancet of 1856, and they may he profitably
referred to now as models of how to proceed in future
inquiries of the kind. And numbers of similar cases might
be given* What is required is, not to shut put the medical
attendants or local practitioners, but to encourage amongst
them, the careful and practical study of forensic medicine.

But though anxious to guard the interests of the general
practitioner* it : is not to be inferred that the present mode
of conducting necropsies for coroners is in our opinion
aatiqUetory. Very far from it. In every case involving a

criminal charge against a suspected person there ought to
be a second medical examiner without waiting for this to be
asked for by the coroner’s jury. It is obviously undesirable
that all the important evidence afforded by a post-mortem
examination should be the solitary possession of one medical
witness, who might subsequently be unable to attend the trial
from illness or even death. This has not infrequently hap¬
pened, and the prisoner has thus been deprived of the advan¬
tage which might have followed a cross-examination of the
only medical witness. On thi3 account alone tho presence of
a secoud medical witness is most desirable, and this being
admitted, it follows naturally that he should be one well
experienced in necropsies and thoroughly acquainted with
all the appearances of the internal organs, both morbid
and healthy. The evidence of a skilled pathologist is
very valuable, but it is also desirable that the second
examiner should possess a competent knowledge of legal
medicine. In a leading article published in The Lancet
of March 7th, 1885, it was remarked that the position of
forensic medicine in this country was not what it ought
to be. It has not kept pace with physic, surgery,
ophthalmic surgery, obstetrics, or the other branches
of medical study. The cause is not far to seek. Though
for many years past attendance on one course of lectures
on medical jurisprudence and toxicology has been com¬
pulsory upon every medical student, the lectures, with
few exceptions, have not been of a nature to render
the subject attractive; in most provincial and some metro¬
politan schools the lectureship has been too often regarded as
a mere stepping-stone to some other more lucrative chair
—a condition of things disastrous both to lecturer and
students. Those who have attended the lectures of the
late Professor Swayne Taylor, his successor Dr. Thomas
Stevenson, Dr. Tidy, Dr. Ogston of Aberdeen, or Dr.
Littlejohn of Edinburgh, will know how deeply interest¬
ing and practically useful this course of lectures can be
made. In future care should be taken that the lecturer on
forensic medicine in every medical school should be able to
teach his subject practically as well as theoretically; and, as
a means towards securing this, he should be an experienced
pathologist. His aid should be sought by coroners and
medical practitioners in all necropsies of a medico-legal
character, the medical attendant and he making the exami¬
nation jointly. By this simple arrangement, which could
be brought about quietly, voluntarily, and without any
alteration of the law, the rights of general practitioners
would be respected, the latter would be afforded valuable
help at a time when it is much needed, a considerable saving
would be effected of scientific material now wasted, and a
great impetus would be given to the better cultivation of
forensic medicine. The various classes of this branch of
medical study commenced this month, and we would call
the serious attention both of teachers and students to
recent trials, especially those of the Oldham poisoning case
and the Hoxton murder. The first shows how important it
is for every medical practitioner to have his wits always
ready for any emergency, even in his most routine duties.
Poisoners generally work insidiously, and take full advan¬
tage of every circumstance likely to remove suspicion
from them. The Hoxton murder emphasises the excellent
advice given by Lord Deas at a trial in Aberdeen in

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992 Thb Lancbt,]

VACCINATION.

[May 14, 1887.

1855: “A medical man, when he 6ees a dead body,
should notice everything.” The same case also shows
the importance of making careful notes of all the post¬
mortem appearances for the purpose of refreshing the
memory at the trial. What made the lectures of the
eminent medical jurists to whom we have referred so
valuable and interesting was the number of cases which
they were able to give from their own experience. It is this
which made Caspar’s work so valuable a book of reference.
But London, Edinburgh, and Berlin do not possess a
monopoly of all that is valuable in forensic medicine. Every
coroner’s district may furnish its quota, and it is the duty of
all practitioners throughout the kingdom, while standing up
for their undoubted rights as afforded them by the Medical
Witnesses Acts, to give every assistance towards the practical
study and cultivation of forensic medicine and toxicology.

Of all the means which medical men possess for the
saving of human life there is none eo potent for good as
vaccination. The amount of sickness and death which is
prevented by this operation is almost incalculable, yet it is
no exaggeration to state that there are few subjects of
which the teaching is so lamentably neglected in our
medical schools. The fact that vaccination is regarded
as a trifling operation which can be performed by
anyone leads to large numbers of men who engage in
practice having the roost elementary knowledge of its
nature. The result is that vaccination is considered by many
to be the mere inoculation of vaccine lymph, without any
relation to the effects which will be produced in protecting
the patient against so fatal and disfiguring a malady as
small-pox. There is no question that comparatively few
realise the full importance of the duty they are under¬
taking when they vaccinate, or understand that upon their
method of operation depends the probability of their patient
being protected for a long or short time against attack or
even death from this disease.

A recent discussion by the Society of Medical Officers of
Health was the occasion of statements being made which
show that the want of knowledge of parents is often allowed
to influence the action of the operator to the distinct detri¬
ment of the child, and, as a result, vaccination is credited
with failure to sufficiently protect against small-pox, simply
because it has been inefficiently performed. So far as relates
to public vaccination, the Local Government Board have
endeavoured to raise its standard, and have, by the iesue of
instructions for vaccinators under contract, pointed out the
proper method of the performance of the operation and the
means of guarding against all risk of injury. It would be
well if the profession would understand that the instruc¬
tions are not less applicable to private than to public
vaccinators, and that it is their duty to protect as com¬
pletely as possible their patients against attack by small¬
pox. These instructions state definitely that at least four
separate good-sized vesicles, or groups of vesicles, should
be made, so that the total area of vesiculation on the same
day of the week following the vaccination should be not
less than half a square inch. This recommendation is based
upon an experience of many years, and upon the evidence
which every small-pox hospital afforde, that the Severity of
attack by small-pox subsequent to vaccination is inversely

I proportionate to the number of cicatrices. It should there¬
fore be clearly understood that any medical man vaccinating
less efficiently than is here indicated is guilty of an act of
injustice to the individual who has placed himself under hii
care for the purpose of being protected against small-poi.
It cannot be pleaded that vaccination of this sort exposes
the patient to greater risk than a less complete performance,
and everyone who neglects to comply to the fullest extent
with this requirement incurs a serious responsibility, which
it is impossible to evade.

There are reasons for the postponement of vaccination;
there are none which can justify its ill-performance. Of
the reasons for postponement may be mentioned thou
which are specifically stated in the instructions. The
patient should, at the time of vaccination, be in good
health, and, if an infant, should not be in any febrile state,
or suffer from any irritation of the bowels or any unhealthy
state of the skin, nor should he have been recently exposed
to the infection of measles or scarlet fever, or any chance of
risk from erysipelas which may happen to prevail in or
about the place of residence. There is only one dream-
stance under which this advice can be set aside—that u,
where there is definite exposure to small-pox, when the risk
of death from this disease will justify the infraction of
these rules.

As to the subjects from which lymph may be taken, the
instructions are equally specific. They must essentially b#
healthy children, of whom preferably the family history is
known, and they must be absolutely free from skin disease,
from any sort of sore at or about the anus, or other sign of
hereditary syphilis. Lymph must only be taken from
children vaccinated for the first time, and never from cases
of revaccination; and, again, only perfect vesicles without
conspicuous areola should be permitted to supply it, and
lymph contaminated with blood or by running over the
skin must be rejected, as well as that which is thin and
watery or not clear and transparent.

The precautions against septic injury are based upon
the maintenance of absolute cleanliness of instruments, of
subsequent dressings, and upon, as already said, freedom
from exposure to septic disease. The need for the instruc¬
tions as to cleanliness has unfortunately been strongly
emphasised by accidents due to neglect. Lancets, it has to
be remembered, are not the only instruments which are
capable of inflicting injury in this manner. Our readers will
not have forgotten the calamity at Norwich which led to
the inBtraction that ivory points and capillary tubes
should not be used a second time; we are induced to dwell
especially upon this recommendation for the reason that
the Local Government Board have just issued a report
by Dr. Airy on a death from erysipelatous disease after
vaccination, the operator having omitted to exercise the
precaution which is here enjoined.

By the loyal adoption of these recommendations, the
few accidents which now occur from vaccination would
be materially reduced in number, and an operation
which 6aves yearly thousands of lives would meet with
less opposition from those whose very existenoe is often
dependent upon its performance. It may be hoped that
in the future the General Medical Council may recogni*
the necessity for students being better taught in a branch

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ThS Lancet,] SUBSTANTIVE VERSUS HONORARY RANK.—THE MEDICAL COUNCIL. [Mat 14,1897. 993

of practice ia which they will all more or less have to
engage; but the absence of this teaching, which we lament,
makes it the more necessary that the instructions of the
Local Government Board should be c&refulfy studied by
private as well as public vaccinators.

-»-*—-

We had hoped that thet|ue9tion of the military status of
the medical officers of the army would have been settled by
the assurances given by the Secretary of State for War and
the alteration in the Royal Warrant which he intimated.
But this, it would appear, is not to be the case. An outcry
has been raised for the grant of honorary rank to the
medical officers, in the same manner as it is now given to
the officers of other departments of the army. We cannot
but think that this is a retrograde step. The wording of the
Warrant as proposed to be now issued appears to us, as we
have already pointed out (see The Lancet for April 23rd,
p. 836), to carry with it substantive military rank, for we
are unable to conceive of any more clear definition of sub¬
stantive rank to a medical officer than that his position and
powers are the same as those of the corresponding grade in
the combatant ranks, within the specified limits which
dearly mark out their several and respective spheres of
action. And for this substantive rank it is now proposed
to make a fight for honorary rank. It is certainly
rather amusing to find those who profess to be indig¬
nant at -befog placed in the same category [with the
officers whose duty i3 the supply and pay of the troops
claiming to be classed with these very officers by having
honorary rank given them. It is . asserted that the
abolition of the term “relative rank” has left only two
descriptions of rank in the army, substantite and honorary.
Surely of these two substantive is the more to be desired,
and if Her Majesty decrees that medical officers shall rank
as the corresponding grades of military officers, this mani¬
festly constitutes substantive rank. The movement, then,
would appear to involve a protest against the more desir¬
able rank, with a view to obtain in lieu of it that which
will associate the medical officers with those departments
whose duties are such as not to expose them to the same
dangers on field service as the so-called combatant and
as the medical officers. But we are afraid that below
he surface there is a desire on the part of a section of the
Department to have military instead of professional titles.
In our opinion the latter are the more honourable of the two,
and when, as it is now proposed, all the privileges of sub¬
stantive military rank, so far as they can be enjoyed by
medical officers, are conferred on them, it would be - indeed
“an undignified and false position” to lead the public to
believe that “ they need the support of purely military titles,
indicative of and appertaining to a profession to which they
do not rightfully belong.” If our view be correct—and we
firmly believe it to be so—that the Royal Warrant confers
substantive rank, the medical officers will be in a much
better position than if they were to obtain honorary rank.

In his opening address the President of the General
Medical Council placed clearly before its members the steps
which had been taken since the last session to prevent the
continued existence of separate licensing bodies in the
metropolis, Sir Henby Acland's action could not be
criticised by those who are most jealous of the dignity of

the Council, and the profession will remember with gratitude
the part he has played in proceedings which have unfor¬
tunately been unsuccessful in their result. The satisfaction
will always remain that the Council have used their best
efforts -to carry out the intention of the Act of 1886, and
the responsibility of failure must henoeforth rest alone
upon the Royal Colleges of Physicians and Surgeons.

The arguments in favour of amalgamation have so
frequently been discussed in these columns that it is un¬
necessary to repeat them; it is sufficient to state that the
position of the Apothecaries’ Society and their right to
continued existence were represented by Mr. Brcdbnsll
Cabteb, who again urged the Council to consent to the
application of the Society of Apothecaries of London for
the appointment of assistant examiners to the Society under
the provisions of the Medical Act of 1886.

Sir Dyck Duckworth has certainly failed to make clear
the grounds upon which the Royal College of Physicians
have refused to accept the advice of the Medical Council. 1
The College, he argued, had power to give a complete
qualification in Medicine, Surgery, and Midwifery; it could
receive no accession of strength by union with the Apothe¬
caries’ Society and, such being the case, no possible good
could accrue to the public at large from conjunction with
that body. Notwithstanding the possession of this power
to give a complete qualification, the College "of Physicians
have thought it well to combine with the College of
Surgeons “ for the general benefit.” If we have compre-,
hended rightly the intention of the Act of last year, the
general benefit was its ostensible aim, and it is difficult to.
understand that regard for the public interests should,
under these circumstances, have indicated the desirability
of combination with one body and not with the other. The
question has, however, passed this stage, and it only remains
for the Council to decide whether they will grant or refuse
the appeal of the Apothecaries’ Society.

In taking farewell of the Council, Sir Henby Acland
commended to their consideration the address which it was
proposed should be submitted to the Queen on the conclu-'
sion of the fiftieth year of her reign. The address properly
refers to the great advance which has been made in the
health conditions of the people, the appointment of a public
health administration, and the good results which have
accrued therefrom, as well as the progress which has been
made in every department of rational medicine; and it bears
witness to the support which the Queen has always given
to subjects which thus intimately promote the happiness of
those over whom she rules. In this last act of his official
life, the President will have the warm approval of every
member of the profession.

The appointment of Mr. John Marshall to the pre¬
sidential chair was unanimously agreed to by the Council,
and will give general satisfaction. It is right that the
body engaged in the control of medical education should be
presided over by a representative of the highest scientific
attainments, and no one is better fitted to undertake the
responsible duties of ths office than the newly-elected
President. The admirable service which Mr. Marshall
has already rendered to the Council directly indicated him
os the successor to Sir Henby Aclanp, and gives the best
promise that its increasing powers will be utilised for the
continued advancement of the profession.

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994 Thb Lancbt,]

QUALIFICATIONS UNDER THE NEW ACT.

[May 14, 1887.

11 Ke quid nlmla."

QUALIFICATIONS UNDER THE NEW ACT.

Thb new Medical Act recites:—“A qualifying examina¬
tion shall be an examination in medicine, surgery, and
midwifery held for the purpose of granting a diploma
or diplomas, conferring the right of registration under
the Medical Acts, by any of the following bodies —
that is to say: (a) Any university in the United
Kingdom or any medical corporation, legally qualified at
the passing of this Act to grant such diploma or diplomas in
respect of medicine and surgery; or (6) any combination of
two or more medical corporations in the same part of the
United Kingdom who may agree to hold a joint examination
in medicine, surgery, and midwifery, and of whom one at
least is capable of granting such diploma as aforesaid in
respect of medicine, and one at least is capable of granting
such diploma in respect of surgery; or (c) any combination
of any such university as aforesaid with any other such
university or universities, or of any such university or
universities with a medical corporation or corporations, the
bodies forming such combination being in the same part of
the United Kingdom.” With regard to the above-named
clause, we understand that the authorities of the University
of London consider that the M.B. degree will be registrable
apart from the B.S., because the examination for the former
includes the three subjects required by the Act. The wording
of the clause, however, seems to be very ambiguous and
difficult of interpretation; and it is not easy to see how far
“qualifying examinations” will entitle "the following
bodies” to place upon the Medical Register such higher
diplomas and degrees as the F.R.C.S., M.R.C.P., B.S.,
M.S., and M.D., which, although nearly invariably granted
after "qualifying examinations” have been passed, do
not in themselves fulfil the requirements of the Act. It
certainly seems not improbable that this unfortunate
piece of medical legislation may afford more benefit to
the legal than to our own profession. We trust the Medical
Council will take steps to inform the profession what is
really the true status, as far as registration is concerned,
of. the various degrees and diplomas. They are, it is
true, an executive body, but they can hardly carry out
their duties without knowing what is definitely re¬
quired by the Act. The L.R.C.P.Lond., although single, is a
complete qualification under the Act, but, owing to the
combination of the Colleges of Physicians and Surgeons, is
only Applicable to persons commencing medical studies be¬
fore October, 1884. Colonial MJJ.’s requiring a registrable
English surgical qualification must now take the L.R.C.P.
conjointly with the M.R.C.S.

THE NEW CHARTER OF THE ROYAL COLLEGE OF
SURGEONS.

Wb may not unfairly claim to have secured at least one
crumb of concession from the magnates in Lincoln’e-inn,
who rule so absolutely and so despotically in all matters
concerning the College of Surgeons. The concession, it is
true, concerns a matter of comparatively trifling import¬
ance. As we pointed out in a recent article* notwith¬
standing repeated and emphatic expressions of opinion by
large numbers of Fellows and of Members, the Council per¬
sists in its determination to apply for a new Charter which
ignores the Members of the College and leaves them un¬
represented on the Council, although they form nearly
nine-tenths of the entire constituency and contribute very
largely to the College funds. The concession we allude to
ia this:.The Cowmil have.decoded that an offloial abstract

of the petition for the new Charter shall be prepared and
issued to any Fellow or Member applying for the same.
They do not think it expedient to have another general
meeting to discuss the prepared draft of the Charter,
as the subjects to which it relates have already been snb-
mitted to previous meetings of the Fellows and Members.
We presume that an "official abstract of the petition"
will include the new parts of the proposed Charter; for.
after all, that is what is really wanted, and that is what tha
Association of Fellows asked for in the resolutions which
they addressed to the Council some time last month. The
Association of Fellows at the same time ordered a letter
to be sent to the Lord President of the Council begging
that the proposed Charter about to be applied for by the
College be not approved until the Association of Fellows
has had an opportunity, by means of a deputation, of stating
and explaining its defects. The Association of Members
would do well to address a similar request to the Lord
President. It is hardly necessary for us to urge on then
also the presentation of their petition. When this is done
they must be careful in the selection of speakers. It would
be invidious to name some in preference to others;
nevertheless, it should not be a difficult task to select the
very best men for the purpose, if the memory is allowed to
go back to the general meetings of the Fellows and Memtere
that have been held at the College. ' We shall be very
much mistaken and disappointed in our estimate of
the Lord President of the Council if the representations of
two such deputations—the one representing the Fellows, the
other the Members of the College of Sargeons—are entirely
without effect. In other words, we much doubt whether
the Lord President will sanction a new Charter, which is
promoted only, and not even unanimously, by the present
Council, and to which a very large proportion of the rest of
the body corporate is strenuously opposed. But we shall
soon see. We cannot but regret this continued antagonism
of the Council to the natural aspiration of the Fellows and
Members. So long as it continues, energy and thought are
being wasted, of which the corporation has need for purposes
of its development. A house divided against itself canDo*.
stand: the College of Surgeons will prove no exception to
the rule. The feeling of the Fellows and Member* is »
widespread, so well founded, and so reasonable, that sooner
or later they will succeed in carrying their points, provided
only they do not weary of the struggle, but continue to
fight in a legitimate manner until their demands are satisfied.

METASTASIS IN ERYSIPELAS.

An interesting contribution has been lately made to the
pathology of erysipelas by Dr. von Noorden (Abstr. by
Weichselbaum, Centralblatt f. Bacteriologie, No. 18). It b
bhsed upon a fatal case of facial erysipelas, in which there
was also suppuration in the sheaths of the extensor tendon?
of the right hand, parenchymatous nephritis, acute oopho¬
ritis of the left side, and acute swelling of the spleen. It
was concluded that this was an instanoe of secondary or
metastatic infection of erysipelas. The blood in the cardiac
cavities and the pus from the inflamed hand were found to
contain large quantities of a streptococcus, which neither
microscopically nor by cultivations could be distinguished
from S. erysipelatis or from 6. pyogenes. Inoculations o’
the cultures obtained from tha blood were made ia the ear
of rabbits. In throe instances only redness, without swell¬
ing or suppuration, occurred^ in one of these cases oo-y
isolated chains of cocci were found in the lymphatics of the
ear. In a fourth rabbit there was no local effect, but dest
followed in two days, and the blood was found to contain
numerous streptococci; whilst in the fifth rabbit redness o
the ear appeared on the sixth day, and numerous chains o
cooci ware detected in the lymphatios of the amputated e».

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Thus Lancbt.J-

MEDICAL JURISPRUDENCE, AT KIMBERLEY.

[May 14,1887. 995

yet on the twelfth day, when the animal died, no cocci were
found in the blood. These variable results led Noorden fo
conclude that animal experimentation was an insufficient
test of the species of streptococcus; and further that, con¬
trary to genernj opinion, the, erysipelas-coccus may under
certain conditions gain entrance into the blood. This infec¬
tion may, he thinks, explain the occasional occurrence of
secondary pneumonia; but Weichselbaum states that in such
cases the pneumonia is not due to the erysipelas-coccus, but
to the diplococcus pneumoniae, and that it is incorrect to
speak of an erysipelatous pneumonia. The case related by
Noorden was probably one of pyaemia, due to infection
by the streptococcus pyogenes.

MEDICAL JURISPRUDENCE AT KIMBERLEY.

On Nov. 21st, 1886, a man named Grattan was found dead.
He had been attended some time previously by a medical
man, who diagnosed “mitral disease of the heart.” The
brother of the medical man, also a doctor, was called to see
the deceased after he had been dead “apparently for some
hours.” Finding nothing in the history of the case or in
the surroundings of the body to cause him to suspect poison¬
ing, he, with the permission of a relative of the deceased,
opened the abdomen and examined the stomach, and, feel¬
ing satisfied with the negative evidence it afforded, certified
that death arose from natural causes. As in all hot climates
it is desirable for interment to take place without unneces¬
sary delay, Grattan was bnried on the day following his
death. According to Dr. Croghan, Mr. Robinson (Grattan’s
relative before referred to) informed the police of the death
within a quarter of an hour of the finding of the body.
Subsequently, on information received, the assistant
resident magistrate ordered an exhumation, and a second
and more complete necropsy was made by Drs. Harris
Grimmer, and Cumming. These gentlemen failed to
detect heart disease in any form, but discovered old
tubercular affection of one lung. Suspecting that poison
had been taken or administered, they placed portions
of the body in spirits of wine, with a view to pre¬
serving them for future analysis. In a letter to the Kim¬
berley Daily Independent , Dr. Croghan complains that
a preservative was added to the parts *to be analysed,
but on what grounds we fail to see, as not only was the
measure a justifiable one, but it was pursuant to official
instruction. The analyst at Cape Town detected prussic
acid in the body. This seems a remarkable fact, for Dr.
Croghan states that there was no odour of that poison in the
room in which deceased was found, either before or after
the body was opened. Had prussic acid caused the death—
and in the face of the report of the official analyst we are
not in a position to dispute it,—undoubtedly it ought to
have been discovered at the first necropsy, either by the smell
or by the glass plate test, which might have been then and
there applied. We have known cases in which this test has
succeeded when applied to blood taken from the heart two
or three days after death. We have many times expressed
the opinion that whenever a person is found dead, the coroner
or his representative should be informed of the fact. In this
*ay the medical man frees himself from all responsibility,
and shifts it on to the person designed by the law to bear
it. It was, of course, injudicious on Dr. Croghan’s part to
open the body without an official order, but having done so
■why did he not complete the examination, or at least satisfy
himself of the existence of the heart disease that his brother
had discovered during life ? Negative evidence as to the
cause of death is all very well as far as it goes, but it should
not be accepted where there is the possibility of getting
positive testimony. A wound was found on the wrist of
tijo deceased, which Dr. Croghan asserts was caused by the
bite of a dog, but which Dr. Harris says was inflicted by a

bullet. Surely such a discrepancy is discreditable to the
cause of sutgery and of medical jurisprudence. A skilled
observer could not fail to settle the point with certainty.
There are other matters in this controversy which ate
rather of personal than of public interest, and therefore
we decline to discuss them; but we may say that Dr.
Croghan received scant courtesy when he was not requested
to attend the official necropsy or informed of the time and
place of its performance. _

PRESENTATION DAY AT THE UNIVERSITY OF
LONDON.

The most interesting part of Lord Granville’s speech on
Wednesday last referred to the new scheme which is now
ripe for consultation between the Senate and Convocation,
and which will be laid before the latter body at an early
special meeting. We have already given an outline of these
changes, the chief effect of which will bring into the Uni¬
versity representatives of associated colleges and of faculties
as constituent elements. The maintenance of the high cha¬
racter of the University degrees and the Imperial nature of
its work were strongly insisted upon by the Chancellor,
his remarks being received with much applause by those
present. It is to be observed that Lord Granville failed to
refer to the real difficulty before the University. The time
of the authorities is already so occupied with the numerous
examinations at home and abroad, and the machinery of the
University is so entirely devoted to this object, that a suit¬
able constitution for a local teaching university cannot be
framed, such as is wanted in London, as well as an Imperial
examining board. It must surely be seen that the functions
of the two bodies are quite different, and that they require
separate and distinct organisations. The proposed scheme
only touches the fringe of the great educational question in
London which so urgently presses for a full and proper
solution. _

VIVI8EOTION IN 1886.

From the Home Office report, just issued, it appears that
the experiments on living animals made last year under
the provisions of the Cruelty to Animals Act numbered
1035. The total number of persons holding licences is
sixty-four (forty-eight in England and sixteen in Scot¬
land), and of these fifty-four have performed such opera¬
tions in twenty-one separate buildings, of which eight
are in London, eight in the provinces, add five in Scot¬
land. Notwithstanding that these experiments come under
the term “vivisection,” as commonly used, a compara¬
tively small proportion only were attended with pain
to the animals experimented upon. In 458 cases the use
of anaesthetics was dispensed with, on the ground chiefly
that, the operation consisting merely in the slight punc¬
turing necessary for inoculation, more distress and annoy¬
ance would be occasioned to the subject of the experi¬
ment by the administration of a narcotic than by the
operation itself. Of the remainder, 213 cases were subject
to the condition that the animal should be killed before
recovering consciousness, in which cases, therefore, no pain
at all was inflicted; while forty are reported as being
painful in character. Even in these instances, however, the
amount of pain inflicted was generally but small. ..Upon the
whole,the official record warrants the belief that the demands
of science have within the past year been reconciled with
the infliction of a very small total of pain and inconvenience
upon its victims. When our business and our sport come
to be conducted with equal consideration for the brute
interests involved, we shall be able to congratulate ourselves
on having deserved well indeed of the lower creation. One
passage in Mr. Erichsen’s report suggests a doubt Whether
the Home Office is wise in the latest addition to its code of

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996 The Lancet,]

THE METROPOLITAN ASYLUMS BOARD.

[May 14, 1887.

vivisection rules. “ It has been decided,” we read, “ that in
future, if after the main result of the experiment has been
attained pain be occasioned, the animal must be killed under
the influence of an antesthetic.” Surely this is a most ill-
judged regulation. If all that remains is to kill the animal,
the most expeditious must usually be the most merciful
method of procedure. To prolong a needless agony which a
single stroke might terminate, while narcotics are adminis¬
tered only for the purpose of killing under the influence of
an anaesthetic, seems to be the very pedantry of bumani-
tarianism. The fact is that rules cannot be framed to
supersede in every detail the head and heart of the operator.

THE METROPOLITAN ASYLUMS BOARD.

Again another week has passed without a single case of
small-pox being removed to the metropolitan hospitals, and
again at the last meeting of the managers was the cry
raised that the hospital 6hips ought to be closed. The
managers have, however, a very distinct duty to perform
the removal from London of all cases of small-pox that can
be removed; and the hospital ships essentially give oppor¬
tunity for this to be done. Later, when the managers have
learned how emall-pox hospitals may be built which will
not act as centres of infection, the natural course will be to
utilise those in London, but at present there is no alternative
but to adopt the course they have determined upon. The
guardians of Islington, who have no public health functions,
have protested against the expense of keeping open the
hospital ships. The managers have, however, become (not
of their own seeking, but because of the neglect of other
bodies) the hospital providing authority for public health
purposes; they must do more than house sick people—they
must keep in reaainesB the machinery for isolating cases of
infectious disease, -and thus aid in the prevention of epidemic
prevalence. The money spent in maintaining their hospitals
in a state of preparedness better serves the public interest
than the larger sum which would be required for providing
accommodation for numerous cases which would result if
small-pox were treated in London. The statement which
was made by the Islington representative, that every
small-pox patient costs £800, simply conveys to the minds
of those conversant with hospital administration the
smallness of the number of cases under treatment. The
letter of the Islington guardians has now been referred to
the Ambulance Committee for consideration and report;
their decision will be freely accepted by the ratepayers, for
no member of the board more thoroughly possesses the
public confidence than the chairman of this committee.

RABIES IN DEER.

Tin? recent outbreak of rabies among the deer in Richmond
Park will perhaps direct attention to the hitherto almost
entirely overlooked destruction caused by this disease in
other than the human and canine species, and afford an
additional reason for strenuous efforts to rid the country of
it once and for ever. Almost daily we receive reports of
heavy losses sustained among horses, sheep, and cattle,
through their being inoculated by rabid dogs; and this in¬
cident in Richmond Park is far from beine a novel one. In
Fleming’s “ Animal Plagues” and in his “ Rabies and Hydro¬
phobia” allusion is frequently made to the occurrence of the
malady in deer, as well as in foxes, wolves, and other fera
natura. It is well known that of all the animals in India
the one most liable to rabies is the jackal, and that it gene¬
rally is the medium of infection; as when rabid it has no fear,
and becomes extremely aggressive. It appears that in last
October, when rabies was prevalent in the suburbs of
London, a rabid dog was seen in Richmond Park, and it was
noticed that eomw of the deer were bitten by it. In the

course of time one or two of these creatures showed the
disease, the symptoms, however, being more of the paralytie
than the furious form, and were therefore at first misleading,
the presence of rabies not being suspected. Soon others
became affected, however, and both forms of the disease
were manifested, those which were furious biting and
butting their fellows. Whether the bites of the rabid deer
were productive of rabies in those bitten by them, or
whether all had been infected by the dog, cannot be clearly
ascertained; certain it is, however, that a large number of
them have died, or been killed because of being affected.
Some accounts report considerably over a hundred lost in
this way,'and measures of isolation and segregation have
probably prevented further mischief. That the disease
was rabies there is no reason to doubt, as inoculation with
portions of the brain and spinal cord of deer which had
perished from it has produced the malady in rabbits. These
experiments were carried out at the Brown Institution. It
is to be hoped that adequate prophylactic measures, and
notably the systematic adoption of muzzling of dogs, to
which we advert in another column, may be enforced, so that
in the course of a year or two we may hear no more of such
a terrifying scourge, which has been allowed free play far
too long. It now exists in at least six counties in Eogland.

SMALL-POX AND VACCINATION.

The determined opposition to the Vaccination Acta at
Leicester has led to a sad exhibition of violence in that
town. According to reports in the daily press, an auctioneer
was assaulted and driven into the police-station because he
had attempted to sell the goods of a man who had refused
to pay a penalty inflicted by a magistrate for non-
compliance with the Vaccination Act. Leicester will one
day have serious cause to regret the reckless wilfulness with
which it refuses to learn that vaccination, and vaccination
alone, will protect against small-pox. Not long since we
pointed out that the system of isolation which is rigorously
practised in Leicester is dependent for its efficacy upon
t.he vaccination and re vaccination of the hospital attendant*
Leicester, therefore, is obliged to rely upon vaccination;
but the time will certainly come when even the method
of removing to hospital, not only the sick but also
those who are exposed to them, as practised in tbit
town, will fail to protect sufficiently the population.
The story that comes from Marseilles might be studied
with advantage. This town resembles Leicester in so
far that there is no compulsory enforcement of vaccina
tion. It is now stated that the mortality from small¬
pox among the Marseillaise was last year greater than that
assigned to any other cause except diseases of the respiratory
organs, which bat slightly exceeded it. The total mortality
from small-pox was said to be over 2000 in a population o
375,000. _

HEREDITY.

Wr read in a contemporary that at the request of the
Crown Prince of Germany, Professor Virchow has endea¬
voured to trace in the long line of the HohenzoUern Prince*
persistent physiognomic peculiarities such as have °
observed in the Stuart*, Bourbons, Hapsberg, St. Aiwm*
family, and many others; and he is said to have foun
the physiognomic characteristics of the HohenzoUerns seen
to have split np into several types, which are in some ca*<-
strikingly apparent, and then disappear for some genera¬
tions. Evidence of a like kind might, we imaging■ »
obtained readily from any family that has long been .
in the same place, though in these days of change of low.
it is not always easy to trace family peculiarities for
than a generation or two.

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Thu Lancet,]

DENTAL DISEASE IN SAVAGES. —THE CIVIL WAB, 1643.

[May 14,1887. 987

THE CONJOINT COLLEGES AND A DEGREE IN
MEDICINE.

A PirrmoN has been sent in to the authorities of the
Royal Colleges of Physicians and Surgeons of London by
the teachers in the metropolitan medical schools praying
that earnest endeavours may be made to obtain the power
of granting a degree in medicine. There are four qualifica¬
tions or conditions in the petition, to one or more of which
each signer has testified his assent—viz., (1) that the degree
should be granted only to those who have received some
portion of their medical education in London; (2) that
some addition should be made to the present examinations
in arts; (3) that some additions should be made to the pre¬
sent examinations in science; and (4) that some addition
should be made to the present examinations in professional
subjects. The first of these conditions finds great favour
with the signers of the petition, and the other three are also
well supported.

ALMEN’S TEST FOR SUGAR.

Of all tests for sugar in urine, Fehling’s is undoubtedly
the most satisfactory. The only objection that can be
urged against it is the difficulty of preserving it a sufficient
length of time, so that unless recently prepared it may lead to
fallacious results, owing to stale solutions having a tendency
to throw down the euboxide of copper spontaneously when
heated. This of course is a great disadvantage to prac¬
titioners, who may be seldom called upon to use the te9t, aud
are at a distance from manufacturing chemists from whom
they may procure a fresh supply. To remedy this Professor
Almda of Upsala has improved the old bismuth test for sugar,
and has prepared a solution which has the advantage of
keeping unchanged for years, and being at the same time an
extremely delicate test for sugar in urine. It consists of a
solution of bismuth subnitrate, with eaustic soda and
potassio-sodium tartrate. In testing for sugar, the albumen,
if present, must be first removed by precipitation by beat
and acid, and one,part of the solution treated with ten of the
urine, when if sugar is present the bismuth will be deposited
in a metallic state. The test is sufficiently delicate to detect
sugar in the proportion of only '05 per cent. This test, as
we have already said, is chiefly valuable on account of its
preservative qualities, keeping well on board ship and in hot
climates, though we doubt if it will supersede the use of
Fehling’s solution, especially as the latter is now supplied in
hermetically sealed capsules whioh preserve tho test for a
considerable time. _

DENTAL DISEASE IN SAVAGES.

Dn. Whitney writing from Honolulu, describes in the
British Journal of Dental Science the bleached skeletons of
Kauai, and points out that it is a great mistake to believe
the "noble savage” enjoys an immunity from suffering due
to disease affecting his tepth; in spite of the simple nature
°f his food and his out-door life, he still has toothache.
Dr. Whitney found both superior aud inferior maxillaries,
but none had complete dentures. This does not take into
account the loes of the anterior lower and, less frequently,
n Pper teeth, which were knocked out to express their grief
at the death of a favourite chief, as was their universal
custom in those times. Rome had lost but one or two
teeth, others the greater portion of the molars; while not
infrequently the an teriora showed decay upon their surfaces,
or had left the traces of alveolar abscess. In several coses
traces existed of much suffering, caused by the eruption of
the inferior third molars, and in several by the superior.
One specimen Bbowed the ravages of salivary calculi, bnt,
as a general rule, there was but little tartar upon the
teeth. No instances of erosion were met with, but many of

the teeth were much worn by use. There was one case
of ankylosis of the jaw. Several had exostosis. The
effects of alveolar abscess were very frequently seen, some¬
times leaving but a small opening through the outer plate
of the jaw, in others the whole outer plate being gone.
Dr. Whitney found the antrum to vary greatly in size. On
the whole, the teeth were set in a regular arch, but there
were a few instances of irregularity. In uncovering two
skeletons lying side by side, it was 6een that both were
females, one much older than the other, and in them the
peculiar dental irregularity of the one was exactly repeated
in the other. _

CHOLERA IN SOUTH AMERICA.

Cholera is believed to have ceased as an epidemic in the
various parts of South America that have been attacked.
Its ravages in some districts have been very severe. Thus,
according to local information, there had been in Santiago,
up to about the end of February, a cholera death-rate equal
to 10,000 par million living, as compared with a rate of 24*22
and 913 per million during the epidemics of 1848-9 and 18. r >4
respectively in England and Wales. The city stands upon
an alluvial soil largely saturated with 9ewage matter, which
courses about in open drains, and its sanitary condition
generally is such as to serve as a strong predisposing cause
to the spread of such a disease as cholera. Having regard
to the wide extent of the infected area, and to the fact that
the conditions so largely favour the propagation of the
infection, there are strong grounds for fearing that with the
return of summer weather a recrudescence of cholera may
take place, and that the present abatement is due rather to
the winter period than to the adoption of proper precautions
in favour of improved healthiness. In Santiago, especially,
there is urgent need for a proper system of sewerage and
drainage, and it is to be hoped that the authorities will not
defer providing it until they have had another fatal lesson
in the form of a renewed cholera epidemic.

THE CIVIL WAR, 1643.

Historians have advanced from time to time many
conjectures to account for the slow conduct of tho war
between Parliament and the Crown during its earlier
stages. Some have thought that the leaders ou both sides
equally feared a decided success; others have attributed the
delays and failures iu strategy to the incompetency of the
generals or the undisciplined stale of the troops. None,
however, seem to have hit the real reason, which, never¬
theless, is graphically described by an eye-witness, the
celebrated Dr. Thomas Willis, who was with the King at
Oxford. According to Dr. Willis, neither party after the
siege of Reading were able to take the field for many
months, owing to the great morta'ity in both camps,
which “grew so grievous that in a short time after,
either side left off, and from that time for many months
fought, not with the enemy, but with the disease; as
if there had not been leisure to turn aside to another
kind of death, this deadly disease increasing, they being
already overthrown by fate, and as it were falling down
before this one death.” It is strange that this state¬
ment should so long have escaped the notice of historians,
especially in these days of minute research ; but, now that
attention is drawn to it, there can be little doubt that many
circumstances will be explained that have hitherto looked
suspicious in the conduct and action of some of the com¬
manders. Thu9, how could the Earl of Essex make a
vigorous campaign when the London apprentices, who
formed the bulk of his regiments, were dying so fast that,
as Willis distinctly says, he lost the great part of his
men, and had to remain pitched in camp on the bankB
of the Thames. The excessive mortality abo accounts for

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1

998 This Lancet,] EPITHELIOMA OF THE KIDNEY.—THE ADULTERATION OF PEPPER. [M * /14,1887 ‘

the surrender of Reading by the King’s officer, who has been j
generally credited with treason; yet it was during the siege j
that the camp fever first broke out, and the garrison on
their surrender carried the disease with them to the main 1
body of the King’s army, who suffered “not much less”
than Essex's camp on the Thames, which again accounts for
the supineness of the Royalists and their hesitancy in not
taking advantage of the condition of the enemy. For, as
Willis describes it, the foot soldiers (which it chiefly invaded)
being packed together in close houses in the villages, “they
filled all things with filthiness and unwholesome nastiness
and stinking odours, they fell sick by troops, and as it were
by squadrons.” Willis is particular to tell us that this great
mortality was due to typhus—a true camp fever, and not of
the nature of theplague; and that the epidemic did not spread
beyond ten miles of the infected camps, the surrounding
counties being healthy. _

EPITHELIOMA OF THE KIDNEY.

The proceedings of the Paris Anatomical Society (Progrks
MtAicaU April 23rd) make mention of the histological exami¬
nation by M. Cornil of a rare tumour of the kidney removed
during life by Dr. Pean. The portion examined included a
cyst filled with blood. This cyst bad a wall of new growth,
surrounded by the capsule of the kidney, beneath which
atrophied anatomical elements of the organ were seen. In the
new growth were seen haemorrhagic areas and calcified fibrous
tracts; and budding into the cyst were grey, semi-transparent
vegetations containing small ovoidal cavities,lined by a single
layer of clear epithelial cells, with nuclei near their base. The
lumen of the cavities was empty, and their wall contained
capillaries arising from vessels running mostly longi¬
tudinally. The resemblance to uriniferous tubules was
striking. In places there were cavities of larger size filled j
with red corpuscles, suggestive of intertubular haemorrhage. i
Some of the cells were filled with fat-globules, others with
fat-crystals; and the intermediate tissue contained fat or '
calcareous material. The cose is recorded as “ hremorrhagic
epithelioma”; and M. Cornil pointed out that it belonged
to the class described by Sabourin under the head of
“adenoma,” growths which, although structurally simple,
were clinically to be regarded as cancers. Nevertheless,
they generally remain confined within the capsule of the 1
kidney and undergo calcareous transformation.

THE ADULTERATION OF PEPPER.

The study of pepper adulteration has progressed consider- j
ably of late. Dr. Campbell Brown of Liverpool has described
an adulterant which has hitherto been little known. This is
the great millet (Sorghum vulgare ), one of the most important
of the Indian cereals. In Professor Church’s recent and
valuable book it is described as “ joar,” but several synonyms
are given as well as excellent illustrations. Dr. Campbell
Brown describes it as “dhoura,” which is perhaps the name
by which it is known in the English market. Of course, its
addition to pepper is a mere common fraudulent adultera¬
tion. Another valuable contribution to our knowledge is
contained in some articles which appeared last month in our
new contemporary, The Produce Markets Revieiv. In these
articles the fashionable adulterant miscalled poh'rctte is de¬
scribed, and its influence on the trade discussed. Poivrette is
obtained by grinding waste olive-stones, and is totally useless
as a substitute for pepper. The author concludes from a study
of trade statistics that some 600 tons a year of adulterants

which has accrued to a presumably 1 sir r . ° snn ^ en< j y
dishonest seed grinders, has on the ibove 18 ° J
amounted to £07,000. This ought t L stimuli® 11 ? public
analysts to increased exertions. The sr T “ect of long pepper,
to which we lately alluded, is alsc liscussed’in these
articles. Long pepper, it appears, 8( i for 6i«Z. a pound,
while white pepper costs ll^rf. As ^ before pointed out.
long pepper is more or less similar, though greatly inferior,
to true pepper. The temptation to use it for fraudulent
purposes is obvious. _____

DR. PEACAN’S TREATMENT OF CHOLERA.

Dn. L. Peacan of Buenos Ayres warmly recommends a
plan which he has for many years past pursued with much
success in the management of cholera. When a typical
case with vomiting and diarrhoea /jOmes before him, he
immediately applies a cautery behin the right ear over the
condyle of the lower jaw, with the j object of stimulating
the pneumogastric, and thus paral sing the action of the
sympathetic, on the abdomen. lie then administers six
centigrammes (sixth-sevenths of a grain) of calomel, which
dose is repeated every five hours. Half an hour after taking
the first of these powders a mixture is commenced consisting
of phosphoric acid, carbolic acid, tincture of opium, tincture
of ginger, chloric ether, and mint-water, which is supposed
to arrest vomiting and diarrhoea, to allay thirst, and to calm
spasm—being, indeed, he states, sufficient to cure mild cases
by itself. When the cramps are severe, ten drops of Battley's
sedative solution of opium is added; and when there is marked
prostration of the nervous system, tincture of coca. If the
diarrhoea continues, three grammes (forty-six grains) of
glycerole of tannin are given in coffee three or four times a
day, and forty centigrammes (six grains) of Dover’s powder
for three or four nights in succession. The patients are
allowed to have as much sulphuric acid lemonade as they
care for. In addition to internal medication, warm frictions
and sinapisms are applied, especially over the epigastrium.

THE ANATOMICAL SOCIETY.

The inaugural meeting of this Society was held on the
6th inst. Professor Humphry was elected to the chair, and
letters expressing approval were read. It was then proposed
“ That an Anatomical Society be formed, and that it be called
the Anatomical Society of Great Britain and Ireland.” Thi?
resolution was carried. Next, it was carried nem. con. “ Tnat
the scope and object of the Society be the anatomy, embryo¬
logy, and histology of man and of animals, in so far as they
throw light upon the structure of man.” Professor Humphry
was then elected president, and delivered an address, which
will be fouud in another part of our present issue. Mr. C. B.
Lockwood was elected lion, secretary, and a committee wx<
appointed to report upon the constitution of the Society.
The first meeting will be held at an early date and duiy
announced. _

DANGERS OF AIR-GUNS.

Aih-guns are dangerous playthings. Last week one
j of the gentlemen cadets at Woolwich aimed one of these
! weapons at a boy who was carrying a basket near the
1 academy, not thinking that the air-gun could carry fifty
yards, which was about the distance at which the boy
was. However, the little bullet, whioh was about the six?

1 of a swan-shot, hit the boy on the cheek and embedded
itself in the masseter, where it will probably do no grei:

have been used in the pepper for the last year or two. The harm. Had it entered the eyeball, the accident would
actual adulteration has, the author argues from good have been fraught with much more serious consequence
evidence, been effected by the wholesale grinders, and It is to be hoped that this will prove a warning to all
not by retailers, who were probably ignorant of it. persons who indulge in such dangerous toys not to point
the adulterant used was poivrette, the annual profit j them except at a target.

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EFFECT9 OF HOT-AIR BATHS 05 ASSIMILATION.

[May 14,1887 9 99

ST,]

.'^IMMORTALITY AT WILLESDEN.
bit. in his annual report on the health of

the'^Wri.esden Loi% Board District, draws attention to a
matter cC grave i: \ortance. He has on more than one
occasion directed Itice to a large infantile mortality.
During 1886 the nu. Joer of deaths under one year of age
amounted to 167 on every hundred births, and ill view of
this special inquiry was made into the matter. The result
has been to show that some very decided action is needed
under the provisions of the Infant Protection Act, and
that this fatality is in large amount brought about in the
case of infants born in a metropolitan lying-in hospital
where single as well as married women are received. During
1886 there occurred six deaths under two years of age in one
house, two deaths u-'.der three months in a second, two
deaths under one mc ot ,h in a third, and in each of seven
other houses a single ^ e ?ath occurred. In all these instances
the children were in s. me way or other connected with the
lying-in hospital referred to. In seven other cases of
infantile deaths the children came from elsewhere. There
is, of course, no suggestion that any hospital or other
authorities are in any way responsible for this fatality; but
it seems very obvious that a large number of so-called
‘nurse” children are sent into the Willesden district, and
that a very undue proportion of them die there. Dr. Branth-
w&ite very properly advises that the legal adviser to the
local authority should at once take such action as may be
possible in order to bring the many houses involved under
such control as can be brought to bear upon them. We hope,
in the next report, to see that some very decided action has
been taken in the matter. _

EFFECTS OF HOT-AIR BATHS ON ASSIMILATION.

In a paper by Dr. Garin of St. Petersburg on the effects of
hot-air baths on healthy subjects, and on those suffering
from kidney disease, it is stated, as the result of his re¬
searches, that the sudorific action of hot air produces an
increase in the quantity of the nitrogenous elements of food
assimilated. In healthy subjects it was found that after a
course of hot-air baths lasting for five days the nitrogen
assimilated was greater than before the baths, though less
than during their continuance. This, however, did not appear
to be always the case with patients suffering from nephritis.
Again, the ratio of the urinary nitrogen to the nitrogen
assimilated—that is to say, the nitrogenous metabolism—was
decidedly increased both during and after the baths, the
subsequent effect being more marked in the case of nephritic
patients than in that of persons in good health, though not
in either case so great as the effect observed while the baths
were in progress. _

THE REPUTED SUICIDE OF SCORPIONS.

A memoir upon this subject, of much interest and value,
has just appeared in the Proceedings of the Royal Society.

A statement has long passed current in works on zoology
-hat a scorpion when placed under such circumstances as to
preclude the possibility of escaping with life—such, for
ixample, as surrounding it with a ring of red-hot embers—
will deliberately sting itself upon its own back, and put an
:nd to its sufferings by destroying its own life. This legend,
which is believed to emanate from Spain, though denied by
some, has received the countenance of several respectable
luthorities. It has now been put to the proof and ascertained
x> be incorrect by the scientific investigation of Dr. A. Bourne,
; he Professor of Biology in the Presidency College, Madras.

It may be noted, in the first place, that there are several
species of scorpions, and, as Professor Ray Lankester
.who has himself made some experiments upon the point)
remarks, it is important that the species should be deter¬
mined, since one species may act in this way whilst v others

may not. The first question Dr. Bourne set himself to
solve was the power of the scorpion to sting itself at
all, and he found that the movements of the sting are
remarkably free—so much so, indeed, that if a dead but
still limp scorpion be taken, the last four segments of the
tail are about the only portions of the body where the
scorpion is incapable of stinging itself. Further, when a
scorpion is placed in very unpleasant circumstances it not
unfrequently lashes its tail about and causes actnal
penetration of its own integument. But numerous experi¬
ments performed, both by stimulating scorpions to fight
and by artificially injecting the poison, which is easily
obtained from the gland by pressure into the bodies of
these animals, 6how that the poison of a scorpion is
quite powerless to kill the same individual of the
same or even of another species. Experiments made in
the same way with other animals show that the poison
is very rapidly fatal to a thelyphonus, which is an animal
closely allied in form and poisonous faculty to a scorpion,
less rapidly to a spider, and much less rapidly to an
insect. On injecting the poison into the leg of a cock¬
roach or of a cricket the injured leg became paralysed, but
no pain appeared to be produced. The slow and compara¬
tively feeble action of the poison on insects Dr. Bourne
attributes, with great probability, to the very inefficient
circulation of the blood in that class as compared with
arachnids. When two scorpions fight, they may repeatedly
be observed to sting one another with little or no effect, and
the stronger kills the weaker by actually pulling it to pieces
with its chelicerse, and then proceeds to feast upon its victim.
On making experiments with heat-, as by concentrating the
sun’s rays with a burning-glass upon the animal’s back or
elsewhere, the animal lashes out with its sting and en¬
deavours to strike away the source of irritation. If placed
in water at 43° C., scorpions quickly die; and they.do not
appear to be able to stand a dry heat much above 50° C.,
falling into a kind of heat coma and becoming very sluggish.

“THE SPECTACLE MISSION.”

A provincial contemporary contains an account of a
new missionary enterprise—one for distributing spectacles
among the poor. This may seem at first sight a very
prosaic thing to do, but we recognise in it the very genius of
kindness. “ I was eyes to the blind” was one of the most
excusable boasts of Job in his moments of pardonable com¬
placency. Such may be the satisfaction of Dr. Edward
Waring of Maida Vale, who is credited with initiating this
piece of benevolence among the inmates of St. Giles’s work-
house and the Cleveland-street Sick Asylum years ago.
Such a service implies much trouble and time. It is of little
use to supply spectacles to the poor without much personal
trouble to suit the glasses to sight. We can only hope tha.t
Dr.Waring’s example will be fruitful, and that the intolerable
irksomeness of life in those who have the disposition to
work without the means of doing so will be extensively
mitigated. __

MASSAGE IN CATARRH OF THE BILE-DUCT.

Dr.Gopadze publishes in the Proceedings of the Caucasian
Medical Society an account of fourteen cases of catarrh of
the bile-duct in which massage proved of great service. The
symptoms were loss of weight, malnutrition, eructations,
tympanites, diarrhoea or constipation, admixture of blood
with the 8tools, loss of appetite, &c. In a week’s time from
the commencement of systematic massage a marked im¬
provement invariably took place. The author complains
that massage is as yet but very little practised in Russia,
and that its use is chiefly confined to surgical clinics. Pro¬
fessor Manaesein, the editor of the Vrach, replies, however,
that massage has been for some time past largely practised

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TIIE CENTENARY OP COLUMBIA COLLEGE, NEW YORK.

1000 The Lancet,]

in his own and many other medical clinics, and that the three
graduation dissertations which have treated of the subject,
one of them from the pen of Dr. Gopodze himself, were
all founded on work done in the physicians’ wards. Indeed,
though Dr. Gopadze may be inclined to underrate the atten¬
tion bestowed on massage in Russia, the back numbers of
the Vrach and The Lancet would show him that the
observations of himself and his countrymen on its value
in many different affections are recognised both in Russia
and abroad as worthy of attention.

Berlin for a period of nine years, owing to
with which the canine code is carried out - .ilorc
irrefragable proof of the general mode 9 * origin t apresd
of rabies, but is in itself a complete a r ament in iavcfur of
the adoption of a similar code.

THE CENTENARY OF COLUMBIA COLLEGE, NEW
YORK.

Last month Columbia College celebrated with appropriate
ceremonies the one hundredth anniversary of its revival
after the Revolution. In 1787 it was reorganised by an Act
of the State Legislature, which confirmed the Royal Charter
granted in 1754 for the establishment of a College in New
York, and also changed the name of the institution from
King’s College to Columbia College. The medical school
was first established in 1767, and strengthened in 1787 by
the appointment of a dean of the Faculty and several pro¬
fessors. In the beginning of the present century Dr. David
Hosack was professor of botany and materia medica. In
1818 the school was consolidated with the New York College
of Physicians, which remained entirely distinct from
Columbia College until I860, when it became formally
recognised as the medical department of the institution.
The number of medical students at present in attendance is
601, and the munificent Vanderbilt benefactions will with¬
out doubt eventually, if not sunk in bricks and mortar,
make the school the most completely equipped and exten¬
sively appointed centre of medical teaching in the United
States. _

INTELLECTUAL EVOLUTION.

“ Intellectual evolution, as represented by modern
civilisation, will, by overcrowding, the unequal distribution
of wealth, and social changes incidental to these two factors,
lead to an increase of the tendencies to disease, and there¬
fore to physiological dissolution,” writes Dr. F. W. Mott in
the Edinburgh Medical Journal of April, 1887. The writer
has tried to bring together facts tending to prove that a
“ racial ” existence, like that of the units of which the race
is composed, has periods of infancy, youth, maturity, old age,
and decay; and that the same factors which lead to early
decay and dissolution in individual organisms also tend
to the same result in the race. Dr. Mott throughout lays
stress on the necessary and simultaneous inter-action and
inter-relation, or mutual tension, between evolution and
dissolution, growth and decay, rise and fall, development
and degradation. _

PROPOSED SYSTEMATIC MUZZLING.

Theue seems now to be a more general recognition of
the advisability of the adoption in a systematic manner
of the muzzling order, and doubtless ere long we may
expect the re-issue of the edict from Sir Charles Warren’s
official centre; but this time the order should apply
to the whole of Great Britain, and should be put in
force in a thorough and rigid manner for a period of at
least six months. The necessity for the adoption of this
measure is based on the ground of an increase of rabies and
allied disorders, together with its consequences to human
beings, as proved by the published statistics; and the in¬
creasing confidence on the part of the public in the efficacy
of the muzzle, as well as in its real kindliness, will serve
to facilitate the administration of the police order. The
rare immunity from rabies and hydrophobia enjoyed by

THE QELICACY OF SPECTROSCOPIC REACTION
IN GASES.

At the suggestion of Sir Henry Roscoe, Mr. T. W. Be*
has made an interesting aeries of expettuaenta on this subject
which has recently been communicated to the Manchester
Literary and Philosophical Society. The author mixed the
pure and perfectly dry gases in eudiometers provided witl
aluminium electrodes, which were connected with an induc¬
tion coil and Leyden jar. The light of the discharge was
then focussed upon the slit of a one-prism spectroscope.
The only gases experimented upon were hydrogen, nitrogen,
and oxygen, but it may be hoped that others will shortly
be examined. When nitrogen is added to hydrogen at ordi¬
nary atmospheric pressure, the least quantity of the forme?
element that can be detected is 11 per cent. At the sans
pressure as little as 0 25 per cent, of hydrogen can be detects!
in nitrogen. This curious difference is also observed witi
mixtures of nitrogen and oxygen. As little as 0 - 8 pe
cent, of nitrogen can be detected in oxygen, whereas dr
less than 4 o per cent of oxygen gives a visible spectrum ii
nitrogen. At lower pressures tfie results are somewbe
different, the least quantity of nitrogen perceptible ia
hydrogen being at ten inches and a half 3 6 , and at th»
inches and a half 2 6 . The experiments are well wort
extending. The limits of delicacy with gases contain^
carbon would be very interesting.

ST. THOMAS’S HOSPITAL MEDICAL SCHOOL

Owing to the considerable increase in numbers of tb-
students attending the above school, it has been foucJ
necessary to enlarge the new laboratory in which the course
of practical physiology is conducted. Accommodation b»*
been provided for thirty additional students, and the lights
of the laboratory has been greatly improved. Two rooms haw
been fitted up, one as a lecturer’s room and the other as 1
workroom for the demonstrator and assistants. These altera¬
tions, with those made when the anatomical department w
enlarged and improved some eighteen months ago, haw
involved large expenditure on the part of the Medical Schoo.

UNDER ETHER.

The effects of ether and other drugs when administer*-!
as anaesthetics have been often and carefully studied by tfc<
usual methods of scientific observation, but we do no>
remember ever having Been such a detailed description d
the subjective impressions thus produced as that which h&-
been recorded recently by an American practitioner, P'
G. E. Shoemaker. In his case the anaesthetic u.sed wi'
ether, and it is curious to notice how the stage of stup*
seemed to form, as it were, a prolongation of the earii- -
stage of excitement, and how some trace of the latter see®-*,
always to persist as a partial wakefulness of intellef.
though without the sense of pain, till at last it drew hie
through a play of intoxicated fancy out of his torpor
back to the daylight of clear intelligence. His descriptirc
does, indeed, suggest a doubt whether the degree of an-
ffistheeia attained in this instance was as deep as usual. U
remarks that, though there was no pain, a most disagree
able sensation never left him. He seems also to have beet
dimly aware that something was being done to him whirl -
was neither right nor pleasant. A confused whinnne
sound and a visual Bense of oscillation were percent

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IMPORTANT DECISION AS TO SCHOOL CLOSING.

[Max 14,1887. 1QQ1

ad he could register mentally the beginning of the
it urn to .oonsciousness.. It may be doubted whether
iah & degree of intelligent, even though drowsy, per-
iption i« consistent with really deep etherisation. Had
lloroform been employed, it is still less probable that
le stimulant property possessed by the drug should so
ir have survived in the narcotism which it initiates as
i awaken or maintain any such distinct mental impres-
ons. Ether, as is well known, possesses this property in
greater degree than chloroform. It is this which consti-
ites at once its chief disadvantage as an effectual anses-
letic and its chief recommendation on the ground of safety,
robably the method of producing anesthesia most likely
> satisfy its claim to acceptance as compared with that
E its more powerful rival is its use in combination with
[lloroform, a practice now far from uncommon,

THE COURT PHYSIO!ANS.

Bra Wn/fttAM Btrct, being the senior Physician Extra-
rdinary to the Queen, succeeds the late lamented Dr.
filson Fox as one of the Physicians in Ordinary. Dr. Reid,
rho has been for some yean Her Majesty’s Resident
fedical Attendant, has been appointed one of the Physicians
Extraordinary. A odntemporary society journal states that
>ir William Jenner only attends the Queen when “Her
fajeaty is really unwell.” As a matter of fact, Sir Williatn
leepe at the Castle almost every Saturday night when the
hurt is at Windsor. _

IMPORTANT DECISION AS TO SCHOOL CLOSING.

In commenting in a recent issue on the annual report of
he medical officer of health for Barnsley, we drew attention
o the circumstance that one large elementary school had
ailed to comply with the notice to close which was
ssued by the sanitary authority on account of the pre¬
sence of scarlet fever. We have since then received
nformation from Dr. Sadler to the effect that the school,
hough a voluntarily supported one, received an annual
'rant from the Eduoation Department, and that the failure
o comply with the request of the sanitary authority was
irought under the notice of that department and also of
he Local Government Board. Some little time was allowed
o elapse before the sanitary authority heard again, but they
lave now been informed that the managers of the school
>ave been communicated with, and that in consequence of
heir neglect the Education Department decline to make any
pant to the school this year. In the ease of such a school,
his amounts to the imposition of a very substantial
pecuniary fine, and it is well that both sanitary authorities
ind school managers should know that the clause of the
Education Code which deals with this subject is intended to
>e acted .upon, and that any failure to comply with the
luthorised notice of the authority will be met by the loss
)f the Government grant._

TUBERCLE IN THE COW.

The cowkeepers and farmers of Hull have had their
attention drawn to the dangers of tuberculosis among their
Jattle by Dr. J. W. Mason, medical officer of health, who
Wivered an interesting lecture on the subject at a meeting
K dairymen last week. Dr. Mason urged upon them the
Importance of slaughtering all animals affected with this
“ease,- and stated that while in tile early stage the meat
■tald be eaten. In the later it was only fit to be destroyed,
r® discussed the risks to milk drinkers, and pointed out that
pill received 40,000 pints of milk per 4ay fromcows living
■ th# town, and an equal amount from cows outside, over
fhom the corporation had no authority, and he supported
®e view of Dr. Hime and the Bradford Corporation that

authorities ought to be able to exercise control over
neighbouring areas supplying the town population with
milk. Members of tbe Association who joined in the dis¬
cussion expressed their desire for legislation which would
enable infected animals to be seized and slaughtered, and
would add tuberculosis to tbe list of diseases dealt with
under the Contagious Diseases (Animals) Act. The subjedt
is obviously one of great importance, for although there is
much reason for thinking that human and bovine tubercle
are not identical, Dr. Creighton has adduced considerable
evidence, to show that man may suffer from the bovine
variety. Certainly tbe milk of tuberculous cows ought not
to be sold, and the only safe course is to {slaughter all
animals infected with the malady. '

THE REGISTRATION OF ARCHITECTS.

Architects have been slow to claim the rights whioli
have long since been accorded to other professions; but at
last a movement has been made which will in all probability
end in the granting of licences to practise to those architects
who are competent to perform the responsible duties whtah
devolve upon them. A large meeting was held at St. James’s
Hall on the 4th inst., which was called by the Architectural
Federation Committee, who-had drafted a Bill which in
principle resembles that of the Medical Acts. It is probable
that some modification of this measure will be required
before its acceptance is sufficiently general to enable it.to
become law. With the intention of the Bill we are entirely
in accord; there is reason for the public to be able to dis¬
tinguish between qualified and unqualified architects, as
there is also for them to be able to know the professional
position of medical men. It will doubtless bs necessary to
plaoe upon the register in the first instance many who
although now engaged in practice, have but scanty claim to
this position; but this is inevitable, and in course of time
the difficulty will be overcome. The intimate relation
which, it is now recognised, exists between ill-health and
imperfect house Construction renders the Bill deserving of
the support of the medical profession.

LUMINOUS PAINT IN THEATRES.

Herb Stehlb, the Government Inspector of the Royal
Bavarian Court Theatre, has, according to Iron, given high
testimony to the use of luminous paint as a safeguard
against panic in theatres. Any explosion or disaster with
gas leaves the exit passage of the theatre in total darkness,
and even if additional oil lamps were used, they would
probably be extinguished by the air concussion. In the
above-named theatre inscriptions in luminous paint are
suspended over the exit passages, which direct the audience
to the “way out” ( Auxgang). “These placards, in spite of
being exposed to the very poor light of the corridors in the
daytime and the gaslight in the evening, are so luminous
after the gas has been turned out that anyone can gain the
stairs in each corridor without diffioulty.” The precaution
is so simple and inexpensive that we wonder 1 it is net
immediately adopted in all theatres. Indeed, we see no
reason why its use should not be made compulsory. Surely
some provision of the kind might be included in the
Theatres Bill now before Parliament.

DEATHS OF EMINENT FOREIGN MEDICAL AND'
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announcedDr. Johann Anger, tbe well-known
Carlsbad “bath-physician,” at the age of teventy-two.r-
Dr. Fleitas y Lem us, Director of the Hospitale de Higieqe
in Havana.

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ACTION-OP CALOMEL ON BILE.

[Mat 14,1887.

1002 The Lancet,]

SURGICAL OPERATIONS ON THE BRAIN.

At the meeting of the New York Neurological Society,
held on April 6th, two interesting examples of “ cerebral
surgery ” were recorded. The first was the case of a man
forty-two years of age, who suffered from left lateral
hemianopsia, slight dilatation of the left pnpil, awkward
gait, and double optic neuritis. A large tumour in the right
oocipital lobe was diagnosed, and Dr. Weir proceeded to
remove iL The mass removed weighed five ounces and a
quarter, and tbe operation was attended with very trouble¬
some haemorrhage, for which the wound was plugged.
Unfortunately the bleeding recurred, and the man died from
it. The other case was one of unilateral (left) convulsions,
followed by paralysis of the left side of the face, then of
the left arm, and then of the left leg. A tumour was
diagnosed in the right motor area, and the skull was opened
and the brain explored with a hypodermic syringe without
any result. The patient died, and at the necropsy three
cysts were found lying close together in a line deep in the
white matter of the right hemisphere, and “in a position to
affect tbe face, arm, and leg centres.”

ACTION OF CALOMEL ON BILE.

An account of a number of observations made in tbe
laboratory of Professor Tumas in Warsaw, and published
in the Vrach, points to the antiseptic action of calomel
on bile. It was found that when fresh bile was mixed
with calomel and kept at the temperature of 12° R.
(69° P.) for several days its smell and its colour changed
but little, whereas another portion of the same specimen,
unmixed with calomel, kept under similar conditions,
rapidly became pntrid and turned to a reddish colour.
Again, a smaller admixture of calomel produced a partial
effect only. This antiseptic effect appears to be due to
tbe conversion of calomel in an alkaline medium into
suboxide of mercury, which converts bilirubine into biliver-
dine—thus, C ia H 18 N 5 O s + 2Hg,0 = C lfl H 18 N 2 0 4 + HgO + 3Hg,
mercuric oxide and metallic mercury being also formed. If
an experiment is made on alkaline bile by mixing it with
calomel a distinct deposit of metallic mercury is easily
obtained. _

EFFECTS OF WARM ABDOMINAL COMPRESS E8.

De. T. T. Levinson, who has been engaged in investigating
the effects of warm abdominal compresses under the direc¬
tion of Professor Manassein of St. Petersburg, finds that
they distinctly promote nitrogenous change in the body, the
quantity of urine passed and the amount of uric acid
excreted being also increased, as well as the assimilation of
the nitrogenous elements by the body.

THE COMPULSORY DETENTION IN WORKHOUSES
OF PATIENTS WITH VENEREAL DISEASES.

In our issue o? last week there appeared, on p. 964, a letter
from Mr. A. P. Mickle, M B., advocating the necessity of acquir¬
ing powers to detain until well all patiente suffering from
venereal diseases in our Poor Law and other institutions.
A correspondent calls our attention to the fact that, so far as
workhouses are concerned, such power already exists as to
syphilitic diseases, and presumably also to gonorrhoea. It
is the Act 30 and 31 Yiot., the Poor-law Amendment Act,
c. 106, s. 22, which provides for the compulsory detention in
workhouses of persons afflicted with contagious disease;
fihd the Royal Commissioners appointed in 1870 to inquire
into the Contagious Diseases Acts were advised that this
includes syphilis. The clause is vety complete and stringent,
b ohf atring ample powers on tbe guardians, the master, and
the medical officer of each workhouse to detain such patients

until the medical officer has certified as to their freedom from
disease. If from any reason this power has been permitted
to fall into abeyance, or has been exercised with laxity, it is
of the greatest importance that it should in future be
rigidly enforced. __ |

THE ELECTION AT 8T. THOMAS’S.

We understand that Walter Baugh Hadden, M.D. Lond,
M.R.C.P., and Theodore Dyke Acland, M.D.Oxon., M.R.C.P,
have been elected assistant-physicians to St. Thomas’s
Hospital. _

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin. —Dr. F. Renk of Munich ha9 been appointed to
take charge of the Imperial Sanitary Bureau, in succession to
Professor Wolffhiigel, who has gone to Gottingen.

Scdle. —Dr. Zopf, Privat Docent in Botany, has been
granted the position of an Extraordinary Professor.

Konigtberg. —Dr. Branco of Berlin has been offered the i
Professorship of Mineralogy and Geology.

Montpelier .—The Faculty of Medicine has recommended
M. Kiener, principal medical officer of the Military Hospital,
for the Professorship of Pathological Anatomy and His¬
tology, vacant by the death of M. Bator. In proposing
M. Kiener, who is not agrigi, the Faculty haa taken a new
departure, it being the rule hitherto that only those who
had the title of agrigS or assistant professor could hope te
obtain the higher post. _

Du. J. A. Mxestok, Deputy Surgeon-General, head of the
Sanitary Branch of .the Army Medical Department, is, in
consequence of the continued indisposition of Dr. De Chau.-
mont, at present discharging the duties attaching to the
chair of Military Hygiene at the Medical School at Netley.
We regret that we are unable to report any great improve¬
ment in the condition of Dr. De Chaumont.

On the 9th inst.. Princess Beatrice opened as a place
of recreation the disused burial-ground adjoining the
Church of Holy Trinity, Tredegar-square, Bow-road. The
whole cost of laying out the ground, which i9 about an acre
in oxtent, has been defrayed by the Metropolitan Public
Gardens Association. _

Mr. Condbe’s sewage process is said to be now at work
successfully at Chichester Barracks. A pamphlet haa besa
forwarded to ue in which the results obtained by its means
are represented as remarkably satisfactory, but no su ffi ci ent
details are given as to the mocha operandi. We are therefore
unable to express an opinion on its merits.

On the 21st ult. the death occurred of Deputy Inspector-
General J. G. T. Forbes, R.N., at Pitlochrie, N.B., after a
lingering illness, borne with exemplary resignation and
fortitude. The deceased, who had some time ago retired
from the service, obtained the licence of the Royal College
of Surgeons of Edinburgh in 1848.

As announced in our advertising columns the Annual
general meeting of the governors of the Royal Medical
Benevolent College will be held on the 26th insU, when, ia
addition to other business, several important alterations in
the bye-laws of the College will be proposed by the Council.

We are requested by the Director-General of the Any
Medical Department to state that no examinations for com¬
missions in the Medical Staff of the Amy will be bold in
August next.

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Tans Lancet,]

MEETING- OP THE GENERAL MEDICAL COUNCIL.

[Mat 14,1887. 1003

Wb understand that the new and commodious Physio-
igical Laboratories just completed at Bt. George’s Hospital
[edical School will be opened on Wednesday, May 18th, at
x*. m. An address will be delivered on the occasion by Mr.
eorge D. Pollock, consulting surgeon to the hospital.

The President of the Royal Medical and Chirurgical
ociety announces that the name of Dr. S. J. Gee has been
ominated by the Council as honorary librarian, to fill the
acancy caused by the much-regretted death of Dr. Wilson
'ox. _

Mb. Bland Sutton and Dr. Dudley Buxton have been
lected honorary members of the Odontological Society, in
cknowledgment of the distinguished services they have
endered the science of dental surgery.

Thb proposal to erect an Infectious Disease Hospital at
loreham is meeting with much opposition by the residents
f the town, and a memorial is to be presented to the Local
lovemment Board against the scheme.

Mb. Victor Horsley, F.R.S.,wilI give at the Royal Insti-
ution, on Tuesday, May 17tb, the first of a course of
hree lectures on the Modern Physiology of the Brain and
ts relation to the Mind. _

Dr. Graily HbWitt has been appointed a Vice-President
)f the Gynecological Section at the forthcoming Inter-
lational Medical Congress at Washington.

Lord Rayleigh, F.R.8., has been elected Professor, and
[)r. John Tyndall, F.R.S., Honorary Professor, of Natural
Philosophy at the Royal Institution of Great Britain.

MEETING OF THE GENERAL MEDICAL
COUNCIL.

{Continuedfrom page 989.)

Thursday, May 12th.

Mr. Marshall, President, in the chair.

8ir Wm. Turner moved that the following address to
Six Henry W. Acland be signed and approved by the
Council:—

To Sir Henry Wentnxrth Acland, K.C.B.

We, the members of the General Medical Council, desire td express to
you on your retirement from the presidential chair, to which you were
diectod in July, 1874, our warmest thanks for the Invaluable services
which you have rendered, as President, during the pass thirteen years.
We would record that you have with singular aevotedness applied your¬
self to the service of the Counoll. and that you have conducted Its
business with a dignity, ceurtety, and impartiality which have secured
for you the con&drnoe, regard, and affection of Its members. We would
also recall the fact that you have been a member Of the Council since Its
establishment by Parliament in 1SS8. and that your action during
that long period has had for its object the improvement of medical
education, the elevation of the status of the medical profession, and the
establishment and maintenance of harmonious oo-operation between the
Council and the several medical authorltiea of the United Kingdom.
We would also express the hope that yon may, in your retirement, have
the enjoyment of your well-earned leisure.

Dr. Quain seconded the motion, end suggested that
Sir H. W. Acland be requested to dine with the Council
next week.

The motion was unanimously agreed to.

The debate on Mr. Carter’s motion was resumed.

Dr. Humphry said the question was not one of sympathy
with the Society of Apothecaries, but a question of carrying
out the Medical Aof, the great object of which was to enable
the different medical bodies to combine in their examina¬
tions. A discretion was given to the Medical Council; and
it was net only to “think fit” on the subject, but was
bound to think fitly, and if it did not it was subject to a
mandamus from a higher power. It would be absurd for
the Medical Council to tell the Privy Council that it would

be “injurious to the interest of the public” to adopt the
course proposed without stating its reasons. None
of the reasons which had been given would have any
weight with a sensible body like the Privy Council.
He nad been astonished that they should have been
brought forward by two sensible Scotchmen. One reason
assigned was that competition would be injurious; but
Parliament had provided for that competition, and the
Council could not put forward such an objection. As to
the Apothecaries’ Society being a trading Sowety, that fact
was known by Parliament, and there was no reason why a
trading Society should not give a good examination. It had
been stated that the Society bad degraded the profession.
It had, however, commenced the examination of students,
and the Medical Council had extended that examination.
As to dispensing medicines, he knew many high-class
practitioners who had done the same thing without any
degradation whatever. The assertion that the Society of
Apothecaries had been the cause of homoeopathy was absurd,
and it was impossible to assign such a ground of objection
to the Society. There was only one proper ground of refusal,
and that was that a proper examination could not be given
with the aid of the Medical Council; and the question was
whether such a statement could be borne out. It was
admitted that the Society gave a good examination in ita
own department; and the Council had power to appoint
any number of examiners whose duty it would be to main¬
tain the required standard of examination. Could the
Medici 1 Council go to the Privy Council and state that it
could not make the examination an adequate one ? If it
could not, it had no valid objection to offer to the proposed
combination.

Mr. Collins said he understood the objection which many
entlemen might have to a mixture of trade and profession;
ut the Council was sitting as a judicial body, and ought to
act in that capacity, not simply carrying out the private
opinions of its members. One of the privileges conferred by
Parliament upon medical practitioners was that they might
charge for the medicaments they supplied. Physicians only
were prohibited from charging for medicines. As a judicial
body the Council was bound to carry out the law. When
the Apothecaries’ Society’s Act was passed, Parliament knew
that the members of the Society kept open shop, and yet it
gave the Society power to examine in medicine, thus mixing
trade and profession. As to the interpretation of the words
“ if they think fit,” if there was any doubt on the subject,
the Society of Apothecaries was entitled to the benefit of
that doubt. It was quite possible that the young man who
6old to Dr. Strut.hers the os. 2 d. worth of medicine at Black-
friars had the diploma of the University of Aberdeen in his
pocket. (Laughter.) If the licentiates of the Apothecaries’
Society were inferior men, the fault lay chiefly with the
teachers who gave them their certificates. The idea of
homoeopathy and hydropathy having been encouraged by
the Society of Apothecaries could not be substantiated,
other causes having contributed to the result.

Sir Wm. Gull protested against the notion that the
Council had no discretion in the matter. He maintained that
the Government would not interfere with the discretion of
a public body so long as it was exercised bond fide. His
duty as a member of the Council was to consider whether it
was desirable to have a Society of Apothecaries at all. He
contended that it was not, and that its existence was con¬
trary to the interests of medicine. People did not get well
by drugs. When the Prince of Wales was ill of typhoid
fever how many doses of medicine did he take? Not four.
The question was whether the profession should be set free
from the trammels of the past. Medicine was once given
even for fractures. It was the powers of nature that'
effected a cure of disease, and the duty of the medical man
was not to give drugs, but to see that nature’s powers were
not interfered with. He had nothing to say against general
practitioners, whom he respected and admired; but he
wanted to raise the general tone of the profession, and that
object would never be accomplished by maintaining the
8ociety of Apothecaries. There was no reason for appointing
examiners in surgery for the Society, seeing that the
College of Surgeons was willing to undertake the examina¬
tions. Whatever might be eaid of general practitioners,
there was a universal practitioner better than all of them—a
warm bed when you are tick.

Dr. Quain protested against being considered a pretender
in professing to cure dieeaee by administering remedies. He
had seen drugs of use in thousands of cases, and where they

Digitized by GoOgle

ldOU' ThETjANCKT,}

MR. St. 5GRTH 05 MALARIAL FEVERS.

failed, the fault was not with the drags, but with the
diagnosis.

Mr. Macnama.ua. was not going to discuss the merits or
demerits of drugs, but he believed it was the general feeling
that the request of the Society of Apothecaries should not
be granted. He differed from Mr. Simon as to the com¬
pulsory signification of the words “if they think fit.” Legal
opinions on the subject were of little value unless they were
delivered- from the bench. He maintained that the Act of
Parliament) had actually disfranchised the Society of Apothe¬
caries. Its qualifications were stated not to be registrable,
and it was for the Medical Council to decide whether they 1
should be made registrable. There was no adequate ground 1
for the adoption of that course, and he hoped that the
application for the appointment of additional examiners
would not be granted. It would, he believed, be to the
advantage of the profession and the public to prevent the
appointment of such examiners, which would, in his opinion,
be a retrograde step.

Dr. Glover protested against SirWm. Gull's statement
as to the uselessness of drugs, and said that his speech was
rather directed against physicians and the whole medical
profession than against drugs. It had been said that if the
virtue of cinchona had been discovered a little earlier the
life of Oliver Cromwell might have been prolonged for some
years. The action of the two Colleges was, in nis view, an
additional reason for granting the prayer of the Society of
Apothecaries. He had been for many years one of a number
of persons who had tried to diminish the number of licensing
corporations by the action of the Legislature. The Legisla¬
ture, however, had declined to reduce the number in the
way desired; and that being so, he now declined to be the
executioner of an old corporation that had done its work
well for seventy years. If it was disestablished, it should
be by the same Parliament that had called it into existence. 1
His experience agreed with that of Mr. Wheelhouse, that
low professional conduct was rarely exhibited by licentiates
of the Society of Apothecaries, who had always been dis¬
tinguished for their honourable behaviour as men and their
competency as practitioners.

Dr. Ch ambers supported the motion, and contended that
the Society of Apothecaries ought to be continued because,
among other reasons, it was the only English body to which
women could go for diplomas to practise; the curriculum of
the London University being unsuitable.

• Dr. Me Vail supported the motion for the appointment of
examiners. He said that in that case the Council would
become the examining body, and they could surely ensure
that the examinations were sufficient. It was utterly absurd,
therefore, to say that a number of inferior practitioners
would be appointed. The Act of Parliament gave the Council
no option whatever. It had been assumed that it was an
Act which extinguished the Apothecaries’ Society, and that
the Council was appointed the executioner, but from the
beginning to the end of the Act there was not a single word to
support that notion. It might have been that the College of
Surgeons found itself unable to give the fall qualification,
but was it to be said that therefore that College was to be
extinguished ? The past history of the Apothecaries’ Society
Was very honourable, take it all in all. Undoubtedly here
and there in the reports of visitation of examinations there
might be found observations not of the most complimentary
character on some part of the Apothecaries’ Company’s
examinations, but that did not apply to that Company alone.
He was sure that anyone acquainted with the medical prac¬
titioners of England would admit that the licentiates of the
Apothecaries’ Company had been as worthy members of the
profession a^ those of any other body in the kingdom.

Df. Ktdd asked whether the Council was prepared to
accept the responsibility of becoming an examining body.
Sdfcr as he was concerned, he was not prepared to accept
the responsibility. They were asked to set up an examining
body under their own control, and that body was to be a
competing body with the Colleges of Physicians and Sur¬
geons. That was a position that was altogether contrary
to the public welfare. If the amendment were carried, the
effect would be simply to refer tho matter to the Privy
Council; and if the Privy Council decided that examiners
must be appointed, it would take away the responsibility
fromthe Medical Connell.

Dr. Heron Watson said that no sufficient reason had
Advanced for refusing the crave of the Apothecaries’
Society. HU nOjWl It would not enter into the imagination
dfahy' of"tbo ttetnbers of Council, nor of the profession

generally, that they were really establishing a neWinstiftift,
setting up a new examination, and taking steps which
should enable a new university to be created at Blackfriars;
but he did most sincerely hope that the Council- would
grant the crave of the Apothecaries’ Society, would give
them what they required in tho way of an additional exa¬
miner, and so enable this most useful, valuable, and ancient
body to be perpetuated. Yi huT

Dr. AqoiLLA Smith supported the amendment. ,

Mr. Brudenkll Carter, speaking in reply upon the
question of statutory obligation, said he thought there was
a moral obligation upon gentlemen who accepted a certain
definite position, such as membership of that Council, to
fulfil the statutory duty which that position imposed upon
them, or to retire from their position. He referred t» what
took place in April last year when he formed one of a
deputation from the Society of Apothecaries to Sir
Lyon Playfair, the object being to point out that they
did not think they were sufficiently protected by the '
words “think fit,” which then carried no right of
appeal. Sir Lyon Playfair, in his reply, stated that
the clause was put in specially for the protection of the
Apothecaries’ Societies, because it was not thought desirable
that those Societies should be extinguished. Stress had been
laid upon the changes made in the statements in the medical
journals with reference to the Society of Apothecaries.
That change was only an indication that the Society had
improtad its position in the estimation of the profession. 1 £
The amendment was then put* as moved by De. Strut hers,
and was rejected by 19 votes against 9. One member of tho
Council did not vote, and two were absent. f "

The debate was then adjourned.

jI

lit) -B(f

ABSTRACT OF

LECTURES OX MALARIAL FEtoM*

By W. NORTH, B.A., F.C.&, -.n anoj

LATE RESEARCH SCHOLAR Of THE GROCERS' C OH PAST. ,j 0

- .... ... ,i)

LECTURE III.

RECENT researches INTO TIIEIIt etiology and PATHO¬
LOGY.-THE POSSIBILITY OP PREVENTION IN THE
INDIVIDUAL AND OP IMPROVING THH CONDITION OP
MALARIOUS COUNTRIES.

After considering the general and local distribution of
malaria and the conditions under which it exists, the next
question which arises is, How far may the symptoms which
characterise the disea».be regarded as the natural con¬
sequence of exposure of the individual to those conditions ?
Or is it necessary to go further, and seek their origin in some
poison whose growth and development are especially fostered
by these conditions. A simple uncomplicated attack of
malarial fever, as is well known, begins with a “cold stage,”
often accompanied, but not necessarily, with more or less
violent rigors; then follows a “ hot stage,” or condition of
fever, which terminates in profuse sweating—the “ sweating
stage.” It is possible for a patient to have such a train
of symptoms, and to recover and have no return of
them if he be promptly treated; but in most cases they
repeat themselves at varying but exceedingly regular
intervals, constituting what is known as quotidian, tertian,
and quartan ague. Farther, it is possible for an individual,
after an interval of immunity varying from days to years,
to have a recurrence of the symptoms, though not, as & rule,
with the same period of intermission, and in old cases the
regular intermission disappears. Further, these symptoms
may, and often do, reappear under conditions which render
it impossible that there should have been a fresh access of
poison; and an individual who has once suffered appears to
be more or less liable to returns of the disease as long as he
lives; and should he be attacked by any febrile disorder
whatsoever, a distinct intermission will generally be found
added, as it were, to the ordinary symptoms of his disease,
and this intermission will disappear under the treatment
usually prescribed for ague—viz., the use of quiniue, arsenic,
and the like, in addition to any drugs proper to the treatment
of the particular disorder from which he is suffering. If

i Delivered at the London Institution, April 98th, 1887.

byG00gl(

Thb LAngbt;]

ME. W. NORTH ON M A.LARI AL FEV ERS. •

[Max 14,.1807., K)0S

ltiperiodics be, not administered, the intermission will
aappear with the disease, and may not manifest itself
fain until the patient suffers from some other disease,
gain, in a person who has once had ague, an attack may
> provoked, by a number of widely different circum-
ances—e.g., fright, surgical injury, nervous and physical
ihaustion, sudden chill, &c.; and not only will these circum-
ances bring about an attack, but some of them are equally
ficacious iu cutting one: short which has just begum In
ie very grave forms of the disease known as “ pernicious ”
le fever is often continuous and frequently fatal. These
sea—in the Roman Campagna, at all events—are not very
immon, and, in the author’s opinion, are rarely, if ever,
first” attacks; and though a first attack may be severe,
lere is a very large amount of evidence to show that inter-
ittent fever, except perhaps in the case of persons of very
eble constitution, cannot be acquired by a few hours’ i
;posure in a malarious locality, and that there is some
>rt of connexion between the duration of the exposure and
is severity of the attack. This varies enormously in
.fferent individuals, and though it is exceedingly doubtful
hether such a thing as absolute immunity exists, there
-e certainly such differences in susceptibility as to render
at all events conceivable.

The pathological changes in the organs and tissues which
company the disease are somewhat obscure. In grave cases
lere is always a large amount of melanasmia, which mani-
:9ts itself in the liver, spleen, and kidneys, and especially
i the cortical substance of the brain, where the capillaries
»found to be loaded with minute black granules. The
)lenic trouble which is characteristic of most cases would
to point to some special interference with or alterations
i the functions of that organ; and it is not surprising,
lerefore, to find in the blood evidence of profound changes
i the red corpuscles and their pigment, and the production
! certain amoeba-like bodies, which, under the name of
Us modi um malarise, have been described by Drs. Celli and
archiafava as the cause of the disease, the transmisaibility
: which they claim to have proved by the intravenous in-
ction of the blood of a patient suffering from intermittent
ver into an individual who was said never to have had it in
s life. It is needless to remark that the experi mente are open
very grave objections—so grave as to deprive the result
almost all its significance. Dr. W. Osier has given a very
ill account of these so-called “ haamatozoa of malaria” in the
ritish Medical Journal of March 12th. Here it will suffice
; state that all attempts to discover an organism capable
: producing the disease in the air, soil, or water of malarious
calities have signally failed, though a number of organisms
ive from time to time been announced as such; nor have
ie attempts to cultivate the blood of patients produced
iy better results. The experiments of Dr. Silvestrini on
ie.subcutaneous injection of dew, water, and the water in
hich soil from exceedingly malarious localities had been
ashed, are interesting. Sixty-three experiments of this
ind yielded absolutely negative results, and, despite the
*8® amount of work which has been done in the search
v a pathogenic organism, a confirmation of the existence
: the peculiar changes in the blood above referred to
(presents the progress made; and proof that the disease has
s origin in such an organism, or that the bodies discovered
i the blood come from without and are not the outcome of
ranges in the corpuscles themselves, is still wanting.

There Is one other theory as to the cause of the disease
hich claims serious attention. The so-called "chill theory,”
xording to which the thermotaxic nervous system, in
*1 favouring to adapt itdelf to the needs of the body
(posed to the great and violent changes of temperature
ud to occur in malarious countries, breaks down and
scomes disorganised; that is to say, malarial fever is essen-
»Uy a disease of the nervous system caused by exposure to
imatic conditions. “ Chill ” is probably a wrong term to
M; for the break-down is more likely to be occasioned by
epoeureto excessive heat than to excessive cold, and, con-
dering'that we know* practically nothing of what occurs
i the body when exposed to a temperature above its own,
ie theory cannot be summarily rejected. It depends, how-
rer, on the supposed existence of these violent changes,
hich have not apparently been made the subject of accurate
nervation by those Who have urged this explanation of the
isease, ;

Frttm A large number of experiments made by the author
i exceedingly unhealthy, sites near Rome in the summer of
xo, it Wonkl appear—1. That the daily range'of tempera¬

ture in these places is very great. 2. That the changes are
sudden and violent. 3. That the characters of the curves
indicating temperature and tension of aqueous vapour pre¬
sent in the atmosphere present most marked differences in
localities barely 2U0 metres apart horizontally, and similarly
marked differences are found in the records of instruments
placed at different vertical heights above the soil. 4. The
connexion between these variations of temperature and
vapour tension and the malarious character of the localities
in which they were observed is such as to lead to the con¬
clusion that, if not in themselves the cause of the disease,
they must directly affect any organism to which such a
power could be attributed; and it would seem fair to con¬
clude that if these climatic conditions could be modified,-
the pathogenic organism which may be supposed to thrive
under them would disappear, and the localities in question
become healthy. Either as a sufficient cause in themselves,
or as controlling the growth of organisms, these phenomena-
undoubtedly have a most intimate connexion with the
disease, and it becomes pqssible for ue to understand
the real value of the precautions universally deemed
advisable in malarious countries: fire, food, and clothing;
the avoidance of low, damp ground for camps; the building
of huts on poles, residence in the top floors of houses, and
the like, it is difficult to, realise from mere figures what
these climatic phenomena really are, but one night spent in
the G'ampagua.in August would suffice to convince the most
sceptical of the necessity of protecting the body against
them, and to realise the wretched condition of the great
bulk of those who are most exposed: ill-fed and worse
clothed, they have to resist all day long a temperature often
104° F. in the shade, and to sleep in a damp wretched-
hovel, in an atmosphere saturated with moisture and a
temperature which just before dawn may have fallen to
38° or even 36°, to rise in three or four hours to 100° or
even more. A healthy person exposed for some time in
places where these conditions obtain, runs grave risk of
acquiring an intermittent fever, and one who has already
had the disease will reaJily relapse under them, and may be
attacked by one of the very grave forms. In both cases the
result may be attributed to access of poison; but the same
explanation will hardly hold in cases of relapse from exposure
to heat and cold in a non-m&larious country, and after years
of immunity. Either the organism, if such there be, has a.
wonderful power of lying dormant and of being recalled to
activity by exceedingly diverse conditions, or the thermo-*
taxic nervous system, having once been thrown out of gear,
readily breaks down again under strain. The recurrence of
attacks would seem to be, as it were, & vice rendered the
more easy by practice; consequently the anticipation of them
by drugs or other remedies is of great importance in treat¬
ment. Chronic cases in which all regular periodicity haa
been lost are notoriously obstinate, and difficult, if not im¬
possible, of cure. Much may be done, however, in all cases
by avoiding exposure to the above-mentioned extreme-
variations of temperature and the maintenance of “ tone” in
the nervous system.

The question of the care of a malarious country resolves
itself into the removal of the causes of these climatio
extremes, and this in turn into perfect control over subsoil
water. Drainage and the planting of suitable trees are the
well-recognised methods of effecting this; and the care
bestowed by the Romans on their woods, and the elaborate
system of drainage which they constructed in the hills
round Rome, would seem to indicate that they, at all events*
realised the vast importance of these things, it. is very
evident from the facts that malarial fevers have a most
intimate relation to the soil and to local climate. In the
case of the Roman Campagna it has been possible to so mo
extent to trace the spread and increase of the disease pari
passu with the depopulation and neglect of the soil, and
whether malaria be due to the direct influence of climatio
conditions on the individual or to a pathogenic organism,
there can be no reasonable doubt that these peculiar local,
conditions form an important factor in the problem of its
causation—and not only of malaria, but probably of other
diseases. The peouliar form of enteritis known as typho-
malaria exhibits a similar relationship to the soil, and in,
England infantile diarrhoea shows a connexion hardly less
striking. 0 ur knowledge of the relatione of soil and climate
to disease is sqanty and very general, and a careful study of
these local conditions would probably tend to throw greats
light on much regarding them/which is afr present obsewe
or almost inexplicable. , : -i_';

Digitized by GoOgle

1006 Thb Lancbt,]

UNIVERSITY OF LONDON.—WILLS OF MEDICAL MEN.

[May 14,1887.

UNIVERSITY OF LONDON: ANNUAL MEETING
OF CONVOCATION.

Thy annual meeting of Convocation of the University
•of London was held on Tuesday last, the 10th inst, Dr. Wood,
•the Chairman of Convocation, presiding. Mr. Henry E.
Alien, LL.B., B.A., was re-elected Clerk of Convocation. The
report of the Annual Committee was received on the motion
of Mr. Howse. The report contained the reply of Her Majesty
acceding to the petition of the University to grant it
the privilege of addressing Her Majesty upon the Throne
“ upon the occasion of the completion of the fiftieth year of
Her Majesty’s reign, and upon all future occasions in like
manner as is allowed to the Universities of Oxford and
Cambridge.” The Committee also reported that revised
regulations for matriculation had been framed by the
Senate, embodying many of the recommendations of
Convocation. The steps taken with regard- to the recon¬
stitution of the University were stated and the report of
the Special Committee of the Senate on the subject was
appended. The Senate had approved of the adoption
of a motto for the University in accordance with a
•resolution of Convocation, and had referred the con¬
sideration of its selection to the Committee on Exami¬
nations in Arts, Science, and Laws. The Annual Com¬
mittee desired that the subject of the expenses of Convoca¬
tion be again referred to them, and with respect to a
■resolution upon the regulations for the doctors' degrees,
•were not prepared to make any recommendation. The
report mentioned with regTet the death of Mr. William
Shaen, and stated that the vacancy in the 8enate occasioned
by the death of Mr. George Busk had been filled by the
Crown appointment of the Right Hon. A. J. Balfour, M.P.

On the motion of Dr. Weymouth, seconded by Mr.
Spratling, B.Sc., it was resolved that the resolution of
January 17th, 1887, in regard to the annual expenses of
Convocation, be again referred to the Annual Committee for
its further consideration.

Dr. Napier moved, and Mr. Mears seconded, the reception
of the interim report of the Special Committee for the con¬
sideration of the regulations for the examinations for the
degrees in Law.

Dr. S. P. Thompson moved, and Dr. Napier seconded, a
resolution, which was to the effect that in the voting for
graduates nominated by Convocation to serve on the Senate
the vote of each member should be restricted to one candi¬
date. It should be remembered that Convocation is required
to submit three nameB to the Crown, and that it has been
the custom for the choice to fall on the candidate who has
received the largest number of votes. It was urged that
under the present system the candidate thus chosen might
not represent the actual majority. After much discussion,
in which the resolution was opposed by Mr. Macdowall,
Mr. Tyler, Mr. Osier (who believed the proposed change was
ultra vires), Sir A. K. Rollitt, and others, and supported by
Dr. Weymouth, Dr. Nesbitt, Dr. Collins, and others, the
resolution was carried. A further resolution, to make the
nominations in rotation from amongst the Faculties of Arts,
Science, Laws, and Medicine, was moved by Dr. Thompson,
and seconded by Sir A. K. Rollitt. At present the selection
is made alternately from the combined Faculties of Arts and
Laws and those of Science and Medicine; mid it was urged
that this gave a disproportionate representation on the
Senate to graduates in the Faculties of Arte antTMedioine.
Sir Julian Goldsmid opposed the resolution, and in the
course of his speech referred to the "inchoate scheme” for
the reconstitution of the University now before the Senate,
expressing his belief that it would be long before it emerged
as a real fact. Several graduates spoke, and eventually the
resolution was lost.

On the motion of Dr. O'Reilly, seconded by Mr. Enright,
the meeting reaffirmed previous resolutions in favour of the
establishment of London local examinations by the Uni¬
versity; but a further resolution to initiate the undertaking
by means of a voluntary Permanent Committee, or 8yndi-

Weymooth, M.A„ moved, and Mr. Nesbitt, M.A.,
MMMbaJiriUsut Mfun the* Convocation cannot assent to any
. itl.f i »n fW«4M*Miebmenfcof f Faculties in which it wifi

i mm hoatf ist m iq i to « vote mi

The Annual Committee was appointed, the following
members being elected:—

Faculties of Medicine and Science. — M. Baines, M.D.; A.
W. Bennett, M.A., B.Sc.; W. L. Carpenter, B.A^ B.Sc.;
W. C. Coupland, M.A., B.Sc.; J. Curnow, M.D.; G. Eaatea,
M.B.; W. H. Holman, M.B.; H. G. Howse, M.S, M.B.; Sir P.
Magnus, B.A, B.Sc.; H. Morris, M.A., M.B.; R. Neale, M.D. ;
M. F. O’Reilly, D.Sc.; W. J. Spratling, B.Sc.; F. Taylor,
M.D.; S. P. Thompson, DJ5c., BA.; W. C. Unwin, B.So.

Faculties of Arts and Laws. —J. B. Benson, LL.D., B.A.;
J. W. Bone, B A,; M. P. Christie, B.A; J. Henneli, BA. ;
R. W. Hinton, B.A.; B. Kisch, M.A^ B.Sc.; W. G. Lemon,
LL.B., B A.; A. McDowaU, B.A, B.8c.; S. P. Moore, LL.B.,
B.A., B.Sc.; T. B. Napier, LL.D.; H. A. Nesbitt, M.A ; W.
Paice, M.A.; G. A. Smith, M.A.; E. S. Weymouth, UA;
R. F. Weymouth, D.Lit., M.A ; B. Whitehead, B.A

WILLS OF MEDICAL MEN.

Thb will and codicil of James Drummond, M.D, formerly
of Glasgow, afterwards of Richmond, and late of 6, Great
Cumberland-place, who died on Feb. 28th last, were proved
on the 16th ult. by George Skene Keith, M.D, the acting
executor, the value of the personal estate exceeding £52,000.
The testator gives his furniture and effects to his spouse
Mrs. Jemima Johnston or Drummond; and there are bequests
in favour of his mother and sister. The residue of hia real
and personal estate he leaves upon trust for his wife for life
or until she shall marry again, and then for his children.

The will of David Scott, M.D., late of 62, Camden-square,
Camden-town, who died on March 7th last, was proved on
the 18th ult. by Mrs. Emma Louisa Scott, the widow, James
Hamilton Wylie and Alfred Charles Preston, the executors,
the value of the personal estate amounting to over £31,000.
The testator gives all his household furniture and effects and
£1000 to his wife; £160 each to his executors, James
Hamilton Wylie and Alfred Charles Preston, and £1500 upon
trust for his son David Forest. The residue of his real and
personal estate he leaves upon trust for his wife for life, and
after her death to his said son absolutely.

The will of Robert Elliot, M.D., late of 93, Denmark-hill,
Camberwell, who died on February 16th last, was proved oa
the 4th ult. by Mr. Norman Bruce Elliot, M.R.G&, the aoa,
and Major-General James Mansfield Nuttall, C.B, the
executors, the value of the personal estate amounting to ova
£12,000. The testator bequeaths £26 to his executor, Major-
General J. M. Nuttall, to purchase a walking-stick or oriw
momento of him. The residue of his real and personal nsfsti
he gives to his son Norman Bruoe and to his three daughter
Janet, Caroline, and Charlotte Alice in equal shares.

The will of Robert Bryce GilJand, M.D., formerly of tfc
Berks County Asylum, but late of Fayremeade, Sevenoaki
who died on March 8th last, was proved on the 7th ult. 1;
John Bryce Gilland, William Taylor (physician), am
William Taylor (farmer), the executors, the value of A

f tersonal estate being sworn over £6000. The testator Ufa
saving sundry legacies to persons connected with the Bed
County Asylum, leaves the residue of his real and pecMM
estate to hie sister Ann Wilding Taylor absolutely.

The willof Charles Hutton, M.D.,lateof 26,Lowndee~afemf i
Belgrave-square, who died oa March 27th last, was wo w
ou the 19th ult. by Mrs. Henrietta Sophia Elisabeth HqMk
the widow, and the Rev. Edward Seymour, the nimatm
The testator gives all bis real and personal estate to Msxl
absolutely. .. .

The Scotch Confirmation, under seal of the commissariat)
Lanarkshire, of the deed of settlement, with two ood i s Om j
Ebenezer Watson, M.D., of Glasgow, who died on Deo. U
last, granted, to Mrs. Mary Ferrier Young or Wataoto# J
widow, Mr. James Ebenezer Watson, the eon, and Mr. Jii
Ebenezer Watson and Mr. Thomas Watson, the coushi%i
executors nominate, was resealed in London on tbs Undid
the value of the personal estate in England and Soatia
amounting to over £12,000.

The following legacies have recently been left to hospi!
and other medical institutions:— Miss Harriot Gun
Fordham, late of Melbourn, Bury, Cambridgeshire* M
to Addenbrooke’s Hospital, Cambridge; £300 to the ft
staaton Convalescent Home; £2Q0each to ibe R oy nt o mO sO I
Hospital, and the Hospital for Cfcildreawitk Hi p B ts u s

Tins Lancet,]

HEALTH OP ENGLISH AND SCOTCH TOWN8.

[May 14,1887. 1007

Sevanoaks.—Mr. James Chapman, late of Warminster, Wilta,
£250 each to the W'arminater Cottage Hospital and the Salis¬
bury Infirmary—Mr. John Clark, formerly of 34, Marischal-
street, Aberdeen, but late of 19, Royal York-crescent, Clifton,
Bristol, £'200 each to the Royal Infirmary of Aberdeen, and
tbe Hospital for Persona labouring under Incurable Diseases,
Aberdeen.—The Right Hon. Henry Edwyn Chandos, Earl of
Chesterfield, J.P., D.L., late of Holme Lacy, Herefordahire,
£100 to the Hereford Infirmary.—Mrs. Eliza Maria Beaumont,
late of Kenwood-park, Sheffield, £100 each to the Sheffield
General Infirmary and the Sheffield Public Hospital and
Dispensary.—Mr. Stephen Ponder Kennard, J.P., D.L., late of
17, Kensington-palace-gardena, £300 to the West London
Hospital, Hammersmith.—Mr. Benjamin Lancaster, late of
Sunnyside, Bournemouth, £1000 to St. George's Hospital,
Hyde-park-corner, £500 each to the Middlesex Hospital,
King’s College Hospital, the Consumption Hospital, Brompton,
and the Home for Incurables, Putney.—Mr. Moses Lea,
formerly of the Stock Exchange, and of 27, Clarendon-
gardens, Maida-vale, but late of 58, Mary land-road, St. Peter’s
Park, £1000 to the London Hospital, Whitechapel, £500 each
to the Jews’ Hospital, Lower Norwood, the Royal Ophthalmic
Infirmary, Moor fields, the Home for Incurables, Pntney, and
the Cancer Hospital, Brompton. The residue of his property
is to be divided between the London Hospital, Whitechapel,
and the Jews’ Orphan Asylum, Tender Ground.—Mr. William
We8tley, late of 24, Regent-street, £100 each to tbe General
Hospital and the Birmingham Dispensary; £200 to the
Cjnsumption Hospital, West Brompton.

VITAL STATISTICS.

HBALTH OF ENGLISH TO WHS.

hr twenty-eight of the largest English towns 5809 births
and 3701 deaths were registered during the week ending
May 7th. The annual rate of mortality in these towns,
which had been 21 6 and 20*6 per 1000 in the preceding two
weeks, rose again last week to 20 9. During the first five
weeks of the current quarter the death-rate in these towns
averaged 20 9 per 1000, and was 2*1 below the mean rate in
the corresponding periods of the ten years 1877-66. The
lowest rates in these towns last week were 160 in Birken¬
head, 167 in Bolton, 17'2 in Nottingham, and 17'5 in Hull.
The rates in the other towns ranged upwards to 27 2 in
Oldham, 27 8 in Huddersfield, 810 in Manchester, and 349
in Preston. The deaths referred to the principal zymotic
diseases in the twenty-eight towns, which had been 568 and
529 in the preceding two weeks, rose again last week to
548; they included 249 from measles, 160 from whooping-
cough, 15 from scarlet fever, 39 from diarrhoea, 32 from
diphtheria, 22 from “fever" (principally enteric), and
only 1 from small-pox. The lowest death-rates from these
zymotic diseases were recorded last week in Birkenhead
ud Wolverhampton; and the highest rates in Liverpool,
Manchester, 8a 1 lord, and Norwich. The greatest mortality
hom measles occurred in Liverpool, Manchester, Salford,
and Norwich; and from whooping-cough in Bradford, Liver¬
pool, Oldham, and Huddersfield. The 32 deaths from
diphtheria in the twenty-eight towns included 20 in
London-and 2 in Liverpool. Small-pox caused 1 death
in Cardiff, but not one in Greater London or in any of the
twenty-six other large provincial towns. Only 5 cases of
*mU-pox were under treatment on Saturday last in the
metropolitan hospitals receiving cases of this disease; one
uew case had been admitted during the week. The deaths
referred to diseases of the respiratory organs in London,
*hich had been 337 and 338 in the preceding two weeks,
father rose last wreck to 348, but were 9 below the cor¬
seted avenge. The causes of 81, or 21 per cent, of
we deaths in the twenty-eight towns last week ware not
certified either by a registered medical practitioner or by a
kroner. All the causes of death were duly certified in
Nottingham, Portsmouth, Brighton, and Wolverhampton.
The largest proportions of uncertified deaths were registered
w Sheffield, Halifax, Cardiff, and Newcastle-upon-Tyne.

BBAZ.ni OF SCOTCH TOWNS,

The annual rate of mortality in the eight 8coteh towns,
*hich had been 220 and 22 6 per 1000 in tbe preceding
tw ° week*, declined to 21-2 in the week ending May 7th;

this rate exceeded, however, by 03 the mean rate in the
same week in (he twenty-eight large English towns. The
rates in the Scotch towns last week ranged from 9 4 in
Leith and 13 0 in Perth, to 239 in Aberdeen and 26 0 in
Greenock. The 529 deaths in the eight towns last week
showed a decline of 34 from the number in the previous
week, arid included 31 which were referred to whooping-
cough, 25 to measles, 11 to diarrhoea, 2 to scarlet fever, 2 to
diphtheria* 1 to “fever" (typhus, enteric, or simple), and
not one to small-pox; in all, 72 deaths resulted from these
principal zymotic diseases, against 95 and 89 in the pre¬
ceding two weeks. These 72 deaths were equal to an
annual rate of 29 per 1000, which was 0*2 below the
mean rata from the same diseases in the twenty-eight
English towns. The fatal cases of whooping-cough,,
which had been 36 in each of the preceding three weeta,
declined last week to 31, of which 13 occurred in Glasgow,
8 In Dundee, and 3 in Edinburgh, in Aberdeen, and in
Greenock. The 25 deaths from measles showed a further
decline of 2 from the numbers in recent weeks, and included
12 in Aberdeen, 9 in Glasgow, and 3 in Greenock. The
11 deaths attributed to diarrhoea showed an increase of 3-
upon the low number in tbe previous week, but were one
below the number in tbe corresponding week of last year.
Tbe fatal cases of scarlet fever further fell last week to 2,
both of which occurred in Edinburgh. The 2 deaths from
diphtheria, also showing a further decline from recent
weekly numbers, were returned in Glasgow; and the single
death from “fever," occurred in Edinburgh. The deaths
referred to acute diseases of the respiratory organs in the
eight towns, which had been 126,124, and 111 in tbe pre¬
ceding three weeks, further declined last week to 106, and
were 2 below the number in tbe corresponding week of lash
year. The oanses of 57, or nearly 11 per oent.,of the death*
registered in the eight towns during tbe week were not
oertifled. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal
to 8P3 per 1000 in each of the preceding two weeks, rose
to 38*6 in the week ending May 7th, and exceeded the
rate in any previous week of this year. During the first
five weeks of the current quarter the death-rate in the city
averaged 32 7 per 1000, the mean rate during the same
period being but 18 6 in London and 19 4 in Edinburgh, The
248 deaths in Dublin last week showed an increase of 86*
upon the number returned in each of the previous two weeks ;
they included 6 which were referred to measles, 5 to
“ fever " (typhus, enteric, or simple), 5 to whooping-cough,
3 to scarlet fever, and not one to small-pox, diphtheria, or
diarrhoea. Thus 19 deaths resulted from these principal
zymotic diseases, against 19 and 24 in the preceding two-
weeks ; they were equal to an annual rate of 28 per 1000,
the rates from the same diseases being 27 in London and
18 in Edinburgh. The fatal cases of measles, which had
been 6 and 11 in the preceding two weeks, declined again
last week to 6; while the deaths referred to “fever,* -
whooping-cough, and scarlet fever showed an increase upon
recent weekly numbers. Tbe deaths of infants were within
one of the number in the previous week, while those of
elderly persons showed a considerable increase. Seven
inquest cases and 7 deaths from violence were registered ;
and 93, or considerably more than a third, of the deaths
occurred in public institutions. Tbe causes of 31, or more-
than 12 per cent., of the deaths registered during the week
were not certified.

Royal Institution of Obi at Britain.—T he annuafi
meeting of this institution was held on the 2nd inst., Sir
William Bowman, Bart., LL.D., F.R.S., manager and vice-
president, In the chair. The annual report of the Com¬
mittee of Visitors for the year 1886, testifying to the
continued prosperity and efficient management of tbe insti¬
tution, was read and adopted. The real and funded property
now amounts to above £83,000, entirely derived from the
contributions and donations of the members. Forty-eight
new members had paid their admission fees, and sixty-
three lectures and nineteen evening discourses had been
delivered. The books and pamphlets presented in 1886:
amounted to about 288 volumes, making, with 443
volumes (including periodicals bound) purchased by the
managers, a total of 731 volumes added to the library ha
the year.

D

IL

1008 ThhDanckt,] • THE RELATIVE RANK QUESTION, [May 14,1887.

Cflrresjjonltrmf.

*' Audi alteram partem."

THE RELATIVE RANK QUESTION.

To the Editors of Thb Lancet.

Sins,—I have no sympathy with those who have again
Toused a spirit of opposition in a department which craved
only one thing—viz., to be let alone, and not subjected to
constant changes, the reason for which they could not be
expected to understand, but the effect of which their
previous experience gave them every reason to apprehend.
The recent change involved a meaningless contradiction;
for if A is brought in relation to B in regard to rank and
position, that necessarily involves relative rank, if the English
language has any meaning. But if the authorities choose to
be so foolish as to state, what is evidently not the case and
cannot be the case, that relative rank is abolished, they can
only mean that the use of this term is to be discontinued, >
the thing meant by it is and must remain, and the War
Minister affirms emphatically and unequivocally' that not
only has no change been made in the rank and position of
any medical officer, but, in deference to the representations
of others about a dispute, the meaning of which he declared
to be simply inexplicable after the deputations had laboured
in vain to moke it apparent to him, he has offered to secure
the rank and position of medical officers as definitely and
precisely as human language can make it, by expressly
specifying that each grade in the medical service shall rank,
not with , but as the substantive military rank with which
it corresponds, in all and every respect within the sphere
which circumscribes and defines the position, functions, and
duties of the medical officer. To my mind the word “ as ”
not only includes, but is distinctly a stronger and more
satisfactory expression than either “with” or “equivalent
to.” It must be clearly understood that, as the medical
service forms a necessary' and integral part of the military
machine, it must be provided for and adequately recognised
and respected in every way. It would be undignified to
ask less; it would be absurd, as well as undignified, to ask
more. The professors in our medical universities and schools
are told, however, that they must shut their doors upon a
public medical service, and an enthusiastic opposition to
it is invoked. To what end ? To secure honorary rank in
substitution for that which medical officers now have; and to
get some distinctive combatant military title incorporated
with the medical one—such as captain, major, colonel, general.
I confidently appeal to the civil medical profession to do
nothing of the kind; and I claim to represent the views
and feelings of some of the very best men in the service—
men proud of their profession and emulous of getting on in
and by it, and not by grasping at military titles which would
only render them ridiculous in the eyes of those who from
a professional point of view had a right to them; men
whose professional knowledge is recognised, and who have,
in a quiet way, done much to merit consideration.

Is it possible that after about half a century’s con¬
tention to prove that, as we shared all the dangers, risks,
and hardships of combatant officers in the field, supple¬
mented by others in which combatant officers had no share,
we should have our due proportion of honours and rewards—
of C.B.’s, Y.C.’s, and so forth—we should now put forth a
claim for honorary rank — a rank bestowed upon officers
(we speak of them with all respect and esteem) whoee
duties are of a purely clerical kind, and may be from the
beginning to the end of a campaign performed in an office
far removed from all possible dangers of a fight, and all the
hardships of actual field service? It seems a monstrous
step backwards, which these very military medical officers
are pressing on the authorities! The medical officer
is, on the one hand, non-combatant in the sense that
the colonel commanding a regiment or an officer com¬
manding a field battery in action is combatant; but, on
the other, he is surely not to be put in the same cate¬
gory and on the same platform as the officer indenting
for rations or casting up a pay bill. A medical officer’s
rank is relative, and the relation to other ranks appears
to be better defin'd now than it ever was before, in
spito of the abolition of the form of words “relative
rank,” but the medical officers owe the War Office no

thanks for the change. I have no sympathy with that
small section of medical officers who are more military
than the military themselves. If they think that they
are to obtain greater respect—military or social—by the
titular military distinctions of Captain, Colonel, and Major,
they wi}l only find themselves, and not unjustly, very much
mistaken.

I have always understood that the sense of profes¬
sional trust and honour was so elevated and keen that,

to take an illustration, a physician would refuse to make
an experiment on a condemned criminal in order to
test the truth of any theory—such, for instance, as Koch’s
comma bacillus being the essential cause of cholera; he
would urge that it was his function to save human
life, not to destroy it. But now it seems that the highest
aim of a doctor is to gain the titles and be confounded
with the rank of those whose function it is to fight and
destroy life. But if so much value be attached to military
titles, it is natural to expect that the holders of them will in
consequence despise and depreciate professional ones. What
has been the main aim and object of the medical profession-
civil and military—of late years but to be welded more closely
together by ties of mutual sympathy, and of associated aims,
as members of a common profession with common interests?
The strenuous efforts now being made to obtain purely
military rank and titles must tend to create a very strong
impression that these are held to be altogether superior to
those arising from professional and academic distinctions.
Is that a wise, judicious, or dignified course to adopt?

Advocacy of a cause is one thing; a fair judgment'and
consistency another. The combatant officer is scarcely
tempted into the ranks of the service by the emoluments it
offers. Whether the view be right or wrong, wise or silly,
still there it is; he values military rank for the power of
command it confers and the social value he thinks it gives.
Honorary military rank has been bestowed broadcast among
other than purely combatant officers, and distinctly with
the effect of diminishing the value of such titles. Would
there be no ground for the combatant office’s jealousy and
dislike to the presence of a Surgeon-Colonel drawing the
much higher pay of a medical officer on the one hand, and
usurping a purely distinctive military title on the other?

The medical officer is now master of his own household ;
he has the responsibility of all that concerns the sick and the
hospital service, aud he has the power to command obedience
and enforce his behests within those limits. To secure
respect from others you must extend it to those within their
sphere of responsibility. If a combatant officer presumed to
interfere or to give advice inside the limits of a senior sur-
eon’s duties aud responsibilities he would have to pay
early for his temerity. Surely, with the indisputable rank
granted him by Her Majesty’s warrant, the medical officer
should have no difficulty' in maintaining his position and in
obtaining that respect from officers of other departments to
which he is professionally and socially entitled.

I am, Sirs, your obedient servant, A. M. I).

* # * The above letter, which, it will be seen, is strongly
confirmatory of the view expressed in our leading article
thi3 week, is from thd pen of a distinguished medical officer
on the retired list.—E d. L.

' ,, 'i ">■ i >' 1 nr xn**rf

GASEOUS RECTAL INJECTION IN
CONSUMPTION.

To the Editors of The Lancbt.

Sms,—I have read with much pleasure Dr. Burney Yeo'i
interesting lecture on a new method of treatment of con¬
sumption by gaseous rectal injections. During the last
winter I have applied this treatment in a few cases. At
first I used the apparatus described by Dr. Burney Yeo in
The Lancet, but lately I have preferred another (SehetV,
in which the gas is allowed to pass directly into tb?
rectum, the amount being regulated by a screw. The
pumping of the gas is done away with. The apparatus
works well, and the patient can carry on the treatment by
himself after he has been taught how to use it. I have
always prescribed the “ Eaux Bonnes,” being careful to ex¬
clude all bottles not containing a good supply of sulphuretted
hydrogen. At the beginning of the treatment two litres were
injected, gradually increasing to four, and after awhile thb
quantity was injected twice a day. In every case the gaseous

gitized by Google

The Lancet,] THE PULSE—RAGS AS CARRIERS OP INFECTION. [Mat 14,1887; 1009

injections were well tolerated. They never gave rise to
any local or general disturbance. They were very soon fol¬
lowed by a marked improvement in the general condition of
the patient. He gained flesh, the appetite increased, the
hectic lessened. In one case tubercular infiltration was
progressing rapidly, attended by a high temperature. It
ceased to invade the lungs a fortnight after the treatment
had been commenced. The patient is progressing favourably.
He is still making two gaseous injections daily. It is
nearly three months now since he began them. On the
other hand, in this as well as in other cases, the bacilli are
as abundant as ever; the cough persists, and is, perhaps,
more troublesome, a lessened expectoration being one of the
consequences of the treatment. Some of the cases left
Cannes before I was able to form an opinion as to the
ultimate value of this new method, and altogethe# my cases
are too few for me to pass judgment on it one way or the
other. I believe, however, that it has done some good,
certainly no harm, and with Dr. Burney Yeo I would say
that the remedy is worthy of a more extended trial, and
that “ something ” may oome out of it.

I am, Sirs, yours truly,

Ounm*. April 26tb, 1887. H. BlANC, M.D., F.R.C.P.

THE PULSE.

To the Editor* of The Lancet.

Sirs,—I have read Dr. Broadbent’s lectures on the Pulse
vqry carefully; but the good they would otherwise dome
is largely lost owing to a somewhat lax phraseology. In
the first place, we are told the pulse is not an expansion of
the artery, but simply an increase of pressure. Now there
are three typical variations in the calibre of an artery—
a maximum calibre occurring at the top of the pulse, a
minimum calibre at the end of the diastole, and a mean
calibre somewhat midway between these, corresponding to
the mean arterial pressure. If Pr. Broad bent denies that
the mean calibre or the minimum calibre is converted
into the maximum calibre during the pulse, of course be
denies the existence of varying calibres at all; and this
is apparently what he means, because his explanation of
the pulse is consistent with this view. Instead of varying
calibres, he substitutes, flattening of the artery, to account
for the pulse. I may not properly understand him, and am
in doUbt whether he means that an artery is only flattened
by and ddriBg the pressure of the finger on it, or whether
the natural condition of an. artery during the diastole
is one of more or less flattening. If the flattening only
occurs when we press with our Anger, then the pulse
does not naturally exist, for take away the pressure of the
finger and the pulse is non-existent. If, on the other hand,
an artery is naturally flattened during the diastole, this is
utterly inconsistent with 'that continuous pressure of the
arteries on the blood which maintains the circulation during
the diastole, for from the .moment the cylindrical form is
lost pressure is practically abolished. Then we are told
that tension and 1 distension art almost similar terms, and
meah the same thing. ' 1 flnd, to6, by reference to my dic¬
tionary, that distenaion ia given as one of 'the meanings of
tension, and that expansion and distension have the same
meanings attached to them.' Now, according to Pr. Broad-
bent, during the pulse" the pressure is increased, hut the
expansion of the artery Is hot increased.’ If this is So, then
the distension is not increased, neither is the tension; and
this implies that Dr. Broadbent does not Consider pressure
and tension &S one and the same thing. But, unfortunately,
in other portions of his lectures he talks ss if they were the
same thing; and between these two views those parts of his
lectures relating to arterial pressure are lost on me. - - -

* 1 1 remain, Sirs, yourt obediently,

* .BOSS Greenwich, April, 1687. ‘ ' W.NlCfiOLSON.

-BAGS AS CARRIERS OF' INFECTION.

To theEditor* of The Lancet.

Stna,—-I read the able article on the above subject which
appeared In your issue of the 30th ult., and, with your per¬
mission, would point out that uncleaned rags are Often
employed for making the flock of the flock , bed. In
Austria there art many flock-bed manufactories, and i. do
not know 6t 'one in ^hich the rags art washed or otherwise

cleaned before their conversion into flock. I am told that
in England “it does not pay ” to do more than “shake out ”
the dirt adhering to the rags before putting them in the
machine that converts them into that material which com¬
poses the soft beds of millions. Exceptions to this practice
doubtless exist, but I think medical authority should be
brought to bear upon flock-bed makers who neglect to
cleanse the raw material upon which they start.

I am. Sirs, yours truly,

R. W. E. MaoIvor, F.I.C..F.R.G.S., &c.,

H* 7 ,1387. Late Member of the Central Board of Health, Victoria.

LIVERPOOL. •

(From our own Correspondent.)

THE EYE AND BAR INFIRMARY.

Teh report of the Eye and Ear Infirmary, just published,
shows that in 1886 there were 6109 new eye cases and 2352
new ear cases treated; 68 cataract extractions were performed,
in 18 of which irrigation by Mr. McKeown’s method was em¬
ployed. This plan finds increasing favour with tha surgical
staff in esses of sticky cortex. In a considerable number
of unripe cataracts a preliminary iridectomy and artificial
maturation by stroking the cornea has been found to give
good results.

THE TOXTBTH PARK CASE.

A chemical examination of the stomach of the deceased
girl, and of such of its contents ap could be obtained, was
made by Mr. Edward Davies, F.C.S., of the Liverpool Royal
Institution, but with a negative result, none of the mineral
poisons being found, except a small quantity of bismuth
which had been given medicinally, The inference, there¬
fore, is that death resulted from natural causes.

THE CLINICAL STUDY OF SMALL-POX.

Dr. Hope, assistant medical officer of health, has been
appointed by the- City Council visiting physician at the
Park-hill Hospital. This will affoed facilities to the students
of the Medicad Faculty of the Liverpool University College
to become conversant with small-pox in its various phase a.
Dr. Hope, who is the lecturer on hygiene, being most anxious
that Such opportunities should not be lost.

HOSPITAL SATURDAY, r , . .

The 7th inst. being Hospital Saturday, boxes and cages
were freely displayed in, all parts of the city. -Out of over
1000 boxas only 112 bare been returned, • the contents of
which amounted to £397. There is every prospect of the
result being considerably in advance of thatobta in e fl l as byesr.

Liverpool) M*y 19*h. __. • r : ii

northern counties notes 1 ;'

^From our own Correspondent .)

. NEWCASTLE JUBILKH EXHIBITION,

On Saturday last I was, as your representative, privileged
to a private view of our Industrial Eihftitlpn, now all but
complete, and we can’,-In the Words of our local poet, Dfc
Hodgkin, in his very fine opening ode—_

“ Upon s bleak Northumbrian moor
Behold a palace railed."

For palace it is, regarded either as ,tq cost,: ^xtent, wealth,
or variety of exhibits; Much as I Was prepared to see
wonders from the articles in our daily press, I must say
that all my anticipations were far exceeded When in the
building; i Firat u to the mtei * It is in a park forming part
of ’ the Town Moor, and in the .northern suburbs of
our city. Iti is-, only one milsfrom the Central
Station, tramcars passing tbs building at very short
intervals. The space at the disposal of the Execu¬
tive Committee covers thirty-one and a half acres, or a
little in excess of that provided for the late exhibition at
Edinburgh. There is thus provided ample room and vergd
enough, not merely for the exhibition,.but,for the show of
the Royal Agricultural Society of England, which, for the
third time in its history will be held m the month of July
next in Newcastle. As regards the building, it is con-

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JO 10 TubLikcei,] NORTHERN COUNTIES NOTES,—EDINBURGH.-DUBLIN. [May 14,1887. J

atructed upon the systems adopted at the exhibitions at
South Kensington. It coatoins a theatre to. seat 1500
persons, art galleries, machinery in motion, and an internal
garden which covers two and a half acres, while around it
runs a pleasant verandah giving shelter from the sun
and rain. The band stand is surrounded by pleasant
walks and well-arranged parterres. The exhibits are full
•of interest, and many have a special interest for our pro¬
fession, which I shall notice in future letters.

NEW HOSPITAL FOB SUNDERLAND.

It is now more than four years ago since the pressing need
of a new hospital for lever at Sunderland was pointed out
in The Lancet’s sanitary report on the borough, and it is
only just now we read that a commencement is to be made
by the laying of the foundation stone, which is fixed to
take place next Saturday.

NEWCASTLE INFIRMABT.

At the last quarterly meeting of the infirmary, a grati¬
fying report was read, showing that the income bad
increased and the expenditure diminished. Dr. Philip-
eon moved the following resolution, which was carried
unanimously: *' That in consideration of the life governors,
the annual subscribers, and weekly contributors having
agreed to relinquish their privilege of recommending
patients, with the object of making the hospital accessible
to the public. Her Majesty the Queen be respectfully invited
to allow the institution in the future to be designated the
** Royal Infirmary.” It is as well to say that it is to be hoped
that the governors will not a'low their zeal for economy in
the management to extend so far as to deprive patients of
any necessary comfort. That there is a tendency that way
will be apparent when I mention that a governor took
fltrong exception to the amount expended on aerated waters—
about £12,1 believe for the quarter; indeed, he went so far
as to say aerated waters " were a great humbug,” and asked
why the patients were not given “cold water”; but if this
governor had the misfortune to suffer from surgical fever,
with irritability of the stomach, he would be in a better
position to appreciate the value of aerated waters.

NEWCASTLE DISPENSARY.

A curious dispute took place at the late meeting of the
special court of governors called for the purpose of electing
a physician. I told you in my last letter that Dr. Beatley,
the late resident physician, was the selected candidate,
canvassing being prohibited. The chairman ruled that, there
being only one name put forth by the Committee of Selec¬
tion, the election could not take place. There was a
good deal said about canvassing, and, although the letter of
the rule may have been adhered to, it was plain that the
spirit had been somewhat infringed. Candidates have
not canvassed, but the governors have been influenced by
friends, and of course the o&ndidate who gets the moet
governors’ influence is elected. As it was, the governors
present held that, as there was only one name before them,
there was no choice, and so the election was postponed.

TYNEMOUTH INFIRMARY.

At a meeting of the Building Committee of the Tynemouth
Infirmary, held in the Town Hall, North Shields, on Friday
last, the architect presented his plans for the new building,
and it was decided to ask the Dowager Duchess of North¬
umberland to perform the ceremony of laying the founda¬
tion stone on the Queen’s Jubilee day.

Newcaifcle-on-Tyne, May 9th.

EDINBURGH.

(From our own Correspondent.)

THE ROYAL COLLEGE OF PHYSICIANS.

Considerable interest in Edinburgh has centred in the
recent election of the representative of this College on the
General Medical Council, in the room of the late Dr. Ruther¬
ford Haldane. The election of Dr. Batty Take has been to
many a surprise, and it indicates clearly the direction in
which public opinion is now gravitating amongst the
Fellows. There can be little donbt that Dr. Tuke owes his
election to something approaching a declaration of inde¬
pendence among the younger Fellows, and that his return
shows a tendency to a new departure in the internal policy
of the College. He has frequently identified himself with

movements of a liberalising nature, and that he is the choia
of a majority of the electors shows that such changes in tta
direction of the College procedure would be received with I
large measure of satisfaction. In other respects also tfcd
College is to be congratulated on its choice, for Dr. Take i*
generally recognised as a man of exceptional ability in the
conduct of affairs, and his wide popularity with the prc-»
fesaion in Edinburgh can bat react favourably in the ini
terests of the corporation he now represents. J

THE COLLEGE OF PHYSICIANS’ LIBRARY AND J
LABORATORIES. j

I have had occasion in previous letters to notice thsj
splendid library equipments possessed by the College, anJ
the generous terms on which it placed these advantages
within the reach of medical men engaged in study anf
research. Gf late a rule of the College has been rigor¬
ously insisted on that indicates a reactionary feeling
on the part of the College OoundL All applicants for
the use of the library not possessing the privileges of
Fellowship are now refused access to the books unless
they are accompanied by a Fellow in proprid persona..
This results in the exclusion of many of our most diligent
workers from their only local sources of Information on special
points in medical literature, and the continuance of such s
state of matters must react very disadvantageoualy upon the
vitality of the Edinburgh school. This is not, as far u is
known, the result of any abuse of the previous generosity of the
College, but seems to Dave arisen from some increased sense
of jealous proprietorship almost inconceivable in a leading
medical corporate body. There are hopes thAt the College
will recognise the widespread feeling now abroad on this
subject, and will add the grace of liberality to the virtue of
loyally maintaining the present effectiveness of its library,
in respect to its Dew laboratories, the College merits tbe
highest praise for its efforts towards Creating a greater
earnestness in original research. The laboratories an
rapidly approaching completeness under the auspices of
Dr. Woodnead, who has handsome provision supplied him
for making the equipment of the institution complete in
every respect. The tariff proposed in relation to work done
is no less generous, as it is understood that medical men
are to be accommodated as workers free of charge and with
the ordinary laboratory necessities supplied at the expense
of the institution. In a few weeks these well-furnished
rooms will be open for the prosecution of research.

THE COUNCIL AS8ESS0RSHIP IN THE UNIVERSITY COURT.

On Tuesday the election of an assessor in the Uni¬
versity Court was concluded, and resulted in the return
of Dr. Heron Wateon by a majority of 587 votes, in t
gross poll of over 5000 in number.

Edinburgh, May 11th._

DUBLIN.

(From our own Correspondent.)

THE CARMICHAEL PRIZES.

A meeting of the Royal College of Surgeons waa held an
Monday last to bear the awards of the judges (Messrs.
Robert McDonnell, P. C. Smyley, and S. Chaplin) selected to
adjudicate the Carmichael Prize Essay. Sir William Stoke*.
President of the College, who occupied the chair, said
that however opinions might differ as regarded either
the wisdom or the utility of the design of the founder
of these prizes, yet it was satisfactory to learn that
the great majority of the essays sent in possessed very con¬
siderable merit. More especially was this the case with the
essay which had obtained the first place. It was a work
of exceptional merit, and the judges had stated that it
was one likely to be of great utility as a work of refer¬
ence. The first prize has been awarded to Mr. Walter
Rivington of London, for bis essay on "Every Man is a
Debtor to his Profession,” and the second prize to Mr. T.
Laffan, for his paper on "Aristides.” It is a circumstance
worth noting that on the last occasion when the Carmichael
prizes were awarded both these successful essayists respec¬
tively obtained first and second prizes.

MEDICAL STUDENTS’ ASSOCIATION.

A meeting of those interested took place at the Ledwich
School of Medicine last week to consider the proposed

,Google

Thb Linear,]

ROYAL COLLEGE OP PHYSICIANS.—OBITUARY.

[May 14,1837, 1011

changes in connexion with the Conjoint Examination
Scheme adopted last October by the Colleges of Surgeons
and Physicians. After some discussion it was resolved
to send a petition to both Colleges asking to be allowed to
continue their studies according to the regulations under
which they commenced their medical curriculum, making
only such alteration in the final or qualifying examination
as the Medical Act of 1886 required. It was pointed out
that, in consequence of the uncertainty as to what might be
required of them at the coming examinations in July and
October, they would find it most difficult to give their minds
to study, and that they feared it would be impossible to be
prepared for the conjoint e x a m ination at such short notice
should they have to enter for it. No postponement would
get them over the difficulty, as school and hospital instruc¬
tion would cease daring the summer holidays. It has been
arranged that a deputation of the students belonging to the
Association shall wait on the Joint Committee of Manage¬
ment in reference to the matter.

ZYMOTIC DI8BA8BS IN DUBLIN.

During the March quarter tbe number of deaths from

S motic diseases was 212, being 204, or 49 per cent., below
e average for the corresponding quarter of the past ten
years. As compared with the December quarter of last
year, the deaths from scarlatina show a decrease of 44, fever
of 8, and diarrhoea and dysentery of 61.

Dr. Aheam has resigned the post of medical officer for
Ballickmoyler and Newtown Dispensary; and his successor
will be appointed on the 20th inst.

Dublin, May 10th. ____________________

ROYAL COLLEGE OF PHYSICIANS.

At an extraordinary Comitia on the 12th inst., Sir W.
Jenner, Bart., President, in the chair, tbe following gentle¬
men were admitted to the FellowshipDrs. G. Oliver,
R. Cory, H. R. Crocker, F. Bustard, C. J. Cullingworth, W. J.
Mickle, G. A. Heron, and J. Anderson.

A memorial, signed by 270 medical officers and teachers
in London hospitals and schools of medicine, in support of
the proposal that the two Colleges should obtain powers to
grant a degree in Medicine, was read. It was referred to
the Committee of Delegates.

Notification was made through the Foreign Office that an
International Congress on Hygiene would be held in Vienna
in the month of September.

On the motion of Dr. C. T. Williams, seconded by Dr.
Julios Pollock, it was resolved to hold a conversazione in the
month of June.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At an ordinary meeting of the Council of the Royal Col¬
lege of Surgeons on Thursday last the Minutes of the
extraordinary meeting of the Council were confirmed.

An address of congratulation to the Queen on the com¬
pletion of the fiftieth year of her reign was read, approved,
adopted, and entered on the Minutes, and directed to be
sealed and presented in the proper quarter.

On the report of the Nomination Committee, Mr. Howard
Marsh was elected an Examiner in Anatomy for the Mem¬
bership, and Mr. Davies-Colley for tbe Fellowship.

Farther memorials from Mr. B. Brian were presented, in
opposition to that recently presented by Dr. Wilks.

The Council resolved not to appoint any separate Exa¬
miners in Medicine and Midwifery for the ensuing year, on
the ground that by the Medical Act of 1886 tbe diploma of
Member will not be registrable alone as a qualification for
practice.

The following resolution was adopted, and referred to the
CoUeges’ Land Committee for further eonsideratidn and
report“ That, in accordance with the proposals contained
in the report of the Colleges’ Land Committee dated the
13th Of December, 1888, it be recommended to the Council,
with respect to the report from the Prudent, setiidr Vice-
President, and Mr. Marshall, referred to the consideration of
the Committee, that the Council do agree with the Royal
College of Physicians thatthe vacant ground on the Embank¬

ment be occupied by buildings suitable for such scientific
purposes as may heieafter be resolved upon.”

The Council proceeded to the farther consideration of the
report dated April 2nd, 1887, from the committee of dele¬
gates of the Royal College of Physicians of London and the
Royal College of Surgeons of England, on tbe question of
the granting by the two Colleges of degrees in Medicine
and Surgery. This report included a recommendation
from the Committee of Delegates that the overtures made
on the part of the Council of University College and King’s
College, London, that the four Colleges should confer with
a view to obtaining powers to jointly get degrees in Arts,
Science, and Medicine,* should not be entertained; and it
was agreed to take the necessary steps to petition tbe
Crown to grant a new Charter to enable the two Collegi s
to give degrees in Medicine and Surgery.

A petition sent in by Mr. F. Treves addressed to tbe
Presidents of tbe two Colleges, and signed by representatives
of all the metropolitan schools, in favour of the grant by
tbe two Colleges of degrees in Medicine and 8urgery, was
received (see page 997).

The usnal resolutions with regard to the election of
membera of Council on July 7th at 2 p.m. were passed.
The following are the retiring members of CouncilMr.
Hutchinson, Mr. John Wood, and Sir Spencer Wells.

It was agreed, on the motion of Mr. Heath, that an extra¬
ordinary meeting of the Council be held, to be called at such
a time as the President shall determine, to consider the
disposal of the Erasmus Wilson bequest.

WILSON FOX, M.D., F.R.CJ’.L, F.R.S.

Wilson Fox was born at Wellington, in Somersetshire,
‘on November 2nd, 1831. His family belonged to the Society
of Friends, a large number of whom were more or less closely
related to him. His early education was at Bruce-grove,
Tottenham; but be became a student of University College,
London, in 1847. He studied in the Faculty of Arte, and
obtained bis degree of B.A. in 1850; he then entered the
Faculty of Medicine in the same College, and among
other honours obtained the Fellowes’ gold medal in
1853. He was clinical clerk and physician’s assistant to Dr.
Walshe. He took his degree of M.B. Lond. in 1864, obtaining
honours in Medicine, and proceeded to the degree of M.D. in
1885. He then studied in Edinburgh, where he was resident in
the Royal Infirmary for a year. After this be visited Paris and
its medical schools, on his \yay to Vienna, where he remained
for a year. Subsequently he went to Berlin, and for two-
years studied assiduously, under the guidance of Professor
Virchow. It was here, under the personal direction of
Virchow, that his great powers for anatomical investigation
were educed, stimulated, and developed. While in Berlin
he made an important observation with regard to the
degeneration of the gastric glands, Adding in them the same
kind of change that had been described by others in the
intimate structure of the kidney in Bright’s disease. Tho
results of this investigation were given alter his return to
this country.

Dr. Wilson Fox married, in 1869, Emily, (laughter of
Wesley Doyle, Esq., and not long afterwards was invited to
accept the poet ot physician to the Royal Staffordshire In¬
firmary. This 'invitation be accepted, and at once entered
upon a career of successful practice. His reason for going
there was that tbe hospital presented a large field for
continued medical and clinical research. After some time
his heslth failed, and be came to London to be nnd<r
medical care; but from this ill-health he entirely re¬
covered, and returned to Staffordshire. In 1861, upon the
strong recommendation of Professor Virchow, he was ap¬
pointed Professor of Pathological Anatomy in University
College, London, and not long afterwards assistant phy¬
sician to University College Hospital. "He was elec tea a
Fellow of the Royal College of Physicians in 1866, and in 1867
physician to the hospital, Holme Professor of Clinical Medi-

Diaitize

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1012 This Lancet,]

OBITUARY,

[May 14,1887.

cine, and also a Fellow of University College. He contributed
a paper in 1866 to the Philosophical Transactions of the
Royal Society on the “ Development of Unstriated Muscular
Fibre.” In 1870 he was appointed Physician Extraordinary
to the Queen, and became a Fellow of the Royal Society.
Soon after the marriage of the Duke of Edinburgh Dr. Fox
was appointed Physician in Ordinary to their Royal and
Imperial Highnesses. A most important paper was published
in the Transactions of the Royal Medical and Chirurgical
Society on the “ Origin, Structure, and Development of the
Cystic Tumours of the Ovaries”; also a remarkable contribu¬
tion to science in the Medical and Chirurgical Review on
“ Purpura,” giving the details of a‘fatal case, accompanied
by waxy degeneration of the muscles. In this paper
he gave full evidence of his great power as a micro¬
scopical observer. He contributed also various papers
to the Pathologioal Society, and was elected its vice-
president, an office which he held from 1875 to 1877. At
this time he became librarian of the RoyaL Medical and
Chirurgical 8ociety, and continued to perform'the duties of
that office until his death. In 1868 Dr. Wilson Fox delivered
a lecture before the Royal College of Physicians on the
Artificial Production of Tubercle in the Lower Animals,
which was afterwards published in Tan Lancbt, and re¬
published in a separate form. This paper contained in
clear and concise form the results of long-continued research,
and was a most valuable addition to our knowledge of the
etiology and pathology of tubercle. In 1871 Dr. Wilson
Fox originated in this country the treatment of hyper¬
pyrexia by cold affusions and baths, and, in spite of
apparently the most obvious difficulties and dangers, carried
his case through to a successful issue. He wrote the article
on “Diseases of the Stomach” in “Reynolds’ System of
Medicine,” which was subsequently re-published in a
separate form. He contributed also to the same work the
results of one of his most important researches in his
exhaustive article on “ Pneumonia.”

At the Pathological Society, in 1873, Dr. Fox opened a dis- -
eu89ion on the Anatomical Relations of Pulmonary Phthisis
to Tubercle of the Lung, occupying the whole evening in a
lucid exposition of the subject, founded chiefly on his own
work, but taking cognisance of all that had been done by
others, from Bayle to Niemeyer. Another important con¬
tribution to science was given by him to the Medical and
Chirurgical Society about the same time, on the Tempera¬
ture, Pulse, and Respiration in Phthisis and Acute Tuber-
culisation of the Lung, founded on eighty cases observed
by himself in University College Hospital. At the meeting
of the British Medical Association in Manchester (1877),
he opened a discussion on the Mortality of Pleurisy
considered in relation to the operation of paracentesis
thoracis, accompanied by most careful tables of mortality
from various sources. His great work on Diseases of the
Lungs is not yet published, but, we believe, is almost com¬
plete. It has .occupied him during the last fifteen or sixteen
years, and is accompanied by an atlas containing his own
microscopical drawings, and coloured plates, the latter pro¬
duced under his most careful direction.

Dr. Wilson Fox’s first wife died in 1870, leaving him with
three sons and three daughters. In 1874 he married Evelyn,
daughter of 8ir Baldwin Wake Walker, Bart., widow of the
late Captain Hugh Burgoyne, R.N., V.C., who survives
him. We have already given an account in this journal of
Dr. Fox’s last illness, and of its sad termination at 4 A.M.
on May 3rd, at Preston in Lancashire. The funeral took
place at Taunton in Somersetshire, on Friday, the 6th inst.,
where several of his nearest relatives had been buried. Mrs.
Wilson Fox and all his sons and daughters were present,
with a number of relatives and friends. The Queen was
represented by Dr. Russell Reynolds, Physician in Ordinary
to Her Majesty’s Household, who was entrusted with a
wreath to be placed by him on the coffin on Her Majesty’s
behalf. Attached to the wreath was a card, on which Her
Majesty had written the following words: “A mark of
sincere regard and esteem from Victoria R.” A very large
number of most beautiful wreath Syerosaes, and other tokens
of affection were Bent from sorrowing friends and relatives.
They were plaoed in. the ohapel, and then around thegrave.
The service was read by the Rev. Harry Jones, M.A., hon.
chaplain to the Queen, Prebendary qf St., Paul’s, an affec¬
tionate friend for many yeara assisted fey the Rev. F.
Baggalay, M.A., son-in-law of Dr. Wilson Fox.

In this endeavour to give aorqe slight sketch of Wilson
Fox’s life, whioh was so beautiful, an<r of his death, which

was so sad, we feel that but scant justice has been done I
the character of one so great and good; and we thereto
add the impressions that were made on us through fan
years of intimate acquaintance and most loving friendship

As a “student” Fox was industrious in bis work an
thorough in bis play. He enjoyed both, and one aa much i
the other. In the class of Professor Malden, he entered ini
the mirth of Aristophanes with intense pleasure and amu§4
ment, and his keen sense of humour enhanced to him tb
delight of hearing the ancient Greek author’s fun “ done ini
English” by the staid and learned.modem Professor. U
was the same in the mathematical course, and in oth<
classes in the Faculty of Arts; and when he comment
his career in the Faculty of. Medicine he was a mu
diligent learner in the classes, of Sharpey, Graham, an
Quoin; and, subsequently, in the hospital wards, under tb
direction of Walshe, Jenner, and Parkes. But, at the san
time, he gave himself healthy recreation in walking, ridim
cricket, racquets, aad music; and during vacation days i
mountain cUmbing, both in England and abroad. Wor
and play were duly balanced, and each helped thq other, an
each to him was a delight. He listened and observe
eagerly, assimilated rapidly and yet thoroughly, so tha
he could readily reproduce bis knowledge when callei
upon to do so.

As “physician to a hospital,” in both Newcastle and Tni
versity College Hospital, Dr. Wilson Fox exhibited the mos
admirable combination of qualities. He waa pai ns ta k ing ti
the very highest, degree in his study of each indiridtia
patient. To him the sufferer was a “human being,” and no
only a “ case” from which to learn, and so add his mite, a
he regarded it, to the sum of human knowledge. Hi
felt that he lja,d something to “do” as well as something ti
“ learn.” It was “ the man ” he had to investigate and treat
and the obvious disease from which he suffered was but i
part of-him. He coiild quickly make a diagnosis of th>
immediate source of suffering, anfi as readily give rdid
where such was possible. But he. was not content with an;
such routine work as that might be. He would trace disean
as far as could be, to its source, fie made it his busine>s t
know “ the man ” thoroughly, tb grasp facts that the stetbn
scope could not reach, and, while searching into the morbii
physical processes of • every organ in the body, kept i
view the heavy burden of the soul, which lay beoeat
and often was ‘the souroe of the greatest suffenni
This he did by inspiring utter confidence in his kind
ness, knowledge, sympathy, and power to help. Thes
qualities rendered him to his hospital patients, as wel
as to others, the successful physician, the wise in
steady counsellor, the beloved and trusted fries:
His great success as a “teacher” depended upon th
thoroughness of his knowledge of the thing he bad ti
teach ; his ready appreciation of the plane upon which hi
pupils were standing; his sympathy with them in the;
blameless ignorance, and in their desire to learn; In
peculiar lucidity of expression; his rapidity of illustrate
by analogy; hfis versatility and humour; and, most of all.
earnestness. Whether in college theatre or at the bcdadi
of patients, he would exhibit his ipastery of the minutrf
details, but would, at the same time, bring hie genius a?J
burning glass to gather all details to a focus, and place m t'j
strongest light the' primary and all important points tbal
needed observation, study, and recollection. In thus e»
centrating the facts or dogmas with which he dealt, £1
achieved a dpuble success, he presented the subject-matt--'
of his lesson in the best form possible, and concentrated ti
the same time the attention of nis pupils. The attention; i
had won by his skill he riveted by his enthusiasm, W
teaching was of the highest moral tone, everywh-w
and at all times; and although he would most kind?
give individual help to a dull \tudent who was struggle!
to advance, he could give him, with all good grace, a ft*.?
goad onwards; an idle and conceited man he would *
once put in his proper place, and perhaps “ treat
bitter banters” ; but “ a fool,” although he would be gsner
to him, he could not abide. His pupils, now scattered’*•
and wide, must be numbered by many hundreds, and tM
can be among them no one worthy or the name of stuc-v-
who will not sorrow deeply at the loss of him to wbom tM-
owe so much, nor fail to cherish with profound gntj 11 -'
the memory of their teacher and their friend. On his df-*''
bed he sent this message to his pupils: “ Tell rnyhoy^ ' E '
students of University College, how much I Jots t*f®
Tell them that the surest road to success is to hate a

}gle

fHB LANCET,]

OBITUARY.—MEDICAL NEWS.

[May 14,1887. 1013

indard of right and honour, and to adhere strictly to it.”
is message was given to Dr. Arkle, a former pupil, for
10 m he had a great regard, and for whom be had sent
len becoming ill at Preston, and who watched him with
roted attention to the last. It was communicated to the
tdenta by Dr. Gowers, who enforoed upon them the great
ample that Dr. Fox had set before them.

In his capacity as a “ worker in physiology,” pathology, and
idicine, Dr. Fox followed closely in the steps of the greatest
restigators of Nature’s Becrets. Their method was his—1«
jertam the facts by every means in his power, to see all
at was to be seen, to read all that was written in the
ok of Nature, and to “read between the lines” by I
stituting experiments, and so shifting the relations
tween materials and forces, both inside and outside th6
ing organism, as to anticipate the results of slowly
jumulated observations. His work was done in no
ldom way, but with distinct and careful forethought;
recorded faithfully, step by step, the facts that lay before
n; proving, and, indeed, id most over-proving, the conclu-
□8 to which he had arrived, advancing by a strict process !
induction, guided by acute selective faculty between the <
;at and small, (he relevant and irrelevant, or collateral, i
til he was convinced of the accuracy of the answers
.tore had given to bis inquiries, and then, and not till j
en, placing them as truth before those who wished to j
.ow now he had read her mysteries. His power of ob- ]
rration, innately good, had been sharpened to the finest,
euest edge by his long-continued studies in England,
otland, and Germany. He had great faculty for original
restigation, and an energy that was as untiring as it was
tient. But beyond these Qualities, which were his
bitual working tools, he was endowed with undeviating
votion to troth, and yet farther with most buoyant hope.
As an “author” Dr. Fox’s great qualities found worthy
pression, but only those who knew him intimately in his
)de of writing and of publishing can be aware of the great
st and enormous amount of labour he imposed upon him-
i in order to secure accuracy and fulness. Many years
o it was said by a great author that “no man should
'ite a book unless he could put into it all that was
lown until his time, and £0 add to it that there could be
thing to be said afterwards.” In the line of work which j
. Wilson. Fox had adopted the latter term was an impos-
•ility, but in so far as there was possibility he secured the
rmer. His reading of all literature, past and present, that
re upon his subject was wide, deep, and critical; and
8 pains which he took to verify quotations by one
thor from another, whether in monograph, contribution to
entific journals, in this country or elsewhere, was beyond
praise.’ His work was so elaborated that sometimes
fore he had reached the end of an article some fresh
pers came forth from the teeming press of France,
rmany, Italy, and America, and all that was worthy in
?se he felt bound to digest and introduce. This marvelfQUs
lustry, while it has given the greatest value to
i already published works, has yet delayed the pro-
ction of his “ Magnum Opus,” now nearly finished.

Regarded as a “member of the medical profession,”he was
jfoundly interested in all that affected its welfare. “ Order”
tl "Progress” were the watchwords of his lifo. He was
nest to preserve what was right; eager to make that
;ter; to remove what was wrong or unhelpful; to widen
d advance, by new methods and in every direction, its
lge of usefulness; and to secure thiB end, by reduction of
necessary work, and the addition of other modes of pro¬
lure which might, in his opinion, conduce to this end.
enly critical, he was no mere critic, but was always full of
Igestion and constructive genius. Having once made up
mind, he rarely swerved from his purpose, but maintained
ground by considerate courtesy to those who differed,
m him; by absolute intrepidity and perseverance in
ending all that he believed was right; and so he often
seeded by impressing upon those who heard him the con-
tion of the entire sincerity of Ms heart and judgment,
1 also by the eloquence and impetuosity of nis words,
ich made many feel that, in spite of obstacles, all things
re possible to him that believed. •>»«•-• -

n his dealing with'private’patiantahew&s all that has
>n said about him as hospital physician -, and there is little
re to add. He was entirely unselfish, truthful, and
lost infinitely tender. With their friends he was thej
ae; and if, sometimes, his eager, earnest look might have
en the feeling that be was over-anxious, those wno knew

him best knew also it was the outcome of his heart’s deep
feeling—neither alarm nor even fear, but—the unconscious
expression of his loving sympathy.

As a “ man,” Wilson Fox was a Christian gentleman in the
best, fullest, and highest meaning of those words. Ha lived
soberly, righteously, and godly. Careful in his living, for
the sake of others and himself, he was rigliteooato all with
whom he had to deal, and bis motives came from the highest
source; he was eminently a godly man. Free from Sec¬
tarianism as he was free from cant, he took great interest in
the Christian Association of his College, and often gave wish
words of counsel to its members.

As a “ friend,” only those who knew him best and loved
him most can feel how absolutely impossible it is to find, in
the poverty of words, any adequate expression of their
thankfulness for his life and their unspeakable sorrow at
his death. Many will feel, as with tear-bllnded eyes they
read this slight attempt, or any others that may be written,
to recount his life, and tell their grief that it has now been
taken from their earnest gaze, the full meaning of our great
poet* when he wrote—

“ I cannot see the feature* right,

When on the gloom I strive to paint
The face I kuow."

There are many, however, who will be consoled to know
that a few hours before his death, Wilson Fox said, In reply
to a question put to him by a member of his family, “My
only prayer is ‘ Thy will be done.’ ”

On the next morning, when obviously and consciously
dying, and after his eyes had been fixed for a few minutes
on the angle of the room, and as some grey streaks Df dawn
were entering it, he said suddenly—“ There is a great light,

agreat glare of light.I feel so strange.a glare of light.

TTnat is it, Reynolds?” The reply was—“ It is the peace of
God.” He grasped his friend’s hand firmly and said, " God
bless yon,” and m a few minutes after this

“ His soul to Him who gave it rose.,

God led him to his long repose.

His glorious rest.

And though the warrior’s sun lias set,

Its light shall linger round us vet,

Bright, radiant, blest.”

Yes,'dear Wilson Fox has gone into that light in which
be trusted all his life through; the light that knows nor
cloud nor shadow. This world is greatly poorer, but the
higher world is richer in receiving, with bright welcome, &
soul so strong, so loving, so good, so tender, and so true.

Royal College op Surgeons op England.—T he

following gentleman, having passed the necessary exami¬
nations for the diploma, was at au ordinary meeting of the
Council on the 12th inst. admitted a Member of the College:

Mitchell, Richard Pryce, St. Mary’s-square, Cardigan.

Royal College of Surgeons in Ireland.—A t
a recent meeting of the Court of Examiners the following
gentleman was admitted a Fellow of the College

O’Brien, John William, Melbourne.

University of Dublin.—T he following degrees
were conferred last week by the Vice-Chanoellor of the
University

Lickrtiate in Medicbt*.— Alfred Ruucll Darley.

Bachelor in SuhqkrY.— Armstrong Herbert Swifte Todd.

Bachelor in Medicine.— Walter Jamea Buchanan, Robert. WIlham
Henry Jacksoo, Henry Simpson Limn, William Movie O'Connor,
Perceval Cecil Ryan, Armstrong Swifte Todd, and John Henry Du
Bedal Wnalte.

Doctor in Mkdicins.— George Thomas Revington.

Society op Apothecaries.—T he following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on May 5fch:—

Jaquwi, John Warren, Tyndale-place, Islington,
i , Pott, Francis Hennr, Cortiwali-gardrijs.

Womill, Charles Lfovd. Buckfield, Leominster,
i Whicher, Alex. Hastings, Westcoihbo Park, Blackheath.

f Weld. Octavius. London, Canada.

Wooldridge, Arthur Tylee, Winchester, Hants.

On the same day four others passed the Primary Examina¬
tion, four the Surgical, and One for Assistant.

[The name of “Francis Forbes Lanyott -i f*fe*no ? ’ was Im-

j by Google

Digitize

1014 Thu Lancet,]

MEDICAL NEWS.—MEDICAL NOTES IN PARLIAMENT.

[May 14,18ST.

advertently omitted in the list of candidates who passed
their examinations on April 28th, and received certificates
to practise.]

Westminster Hospital Medical School.— Mr.
Edward Cullinan has been elected to the Natural Science
Entrance Scholarship.

Jervis-street Hospital, Dublin. — This institu¬
tion has received £500, being a bequest by the late Captain
Geary.

Portsmouth has spent nearly £ 150,000 in improving
its drainage. The new works were inaugurated on the
9th inst., with a pomp and ceremonial befitting their
magnitude.

Princely Donations.— Sir George Stephen and
Sir Donald Smith have given $500,000 each to found a Royal
Victoria Hospital for the sick and poor of Montreal, and that
city gives a fine site for the buildings.

King’s College Hospital.—O n the 10th inst.,
Princess Louise opened a grand bazaar in King’s College,
Strand, in aid of the funds of this institution. Tne hospital,
which was founded in 1839, relieves annually about 20,000
persons.

The French Hospital.—T he Queen has graciously
consented to be patron of the French Hospital and Dispen¬
sary, Leicester-place, Leiceater-Bquare, and has sent a
handsome donation towards the building fund of the new
hospital about to be erected on a site in Shaftesbury-
avenue.

Anderson’s College Medical School.—I n con¬
nexion with the reconstitution of Anderson’s College under
the scheme of the Glasgow and West of Scotland Technical
College, the Medical Faculty of Anderson’s College will in
future be carried on as a separate incorporation, under the
title of “ Anderson’s College Medical School.”

Meath Hospital, Dublin. —The following prizes
were awarded at the termination of the winter session:—
First Medical Prize: Harry P. Sloggett. Second Prize:
William Bagot. First Senior Surgical Prize: Thos. Galavan.
Second Prize: Alfred Bewley. First J unior Surgical Prize:
Oliver L. Robinson. Second Prize: George Hepenstal and
Ernest Hawthorne.

The Freeman Convalescent Home, Bath. — At a
meeting of the Royal United Hospital Committee, held last
week, the Mayor (Alderman Murch) presiding, it was de¬
cided not to accept the responsibility of the management of
the Convalescent Home on Lansdown, given by Mr. H. W.
Freeman as a Jubilee gift, towards the endowment fund of
which only £1700 has been collected.

The Committee of the Liverpool City Hospital,
Netherfleld-road, have accepted a tender for the erection of
a new administrative block, laundry, mortuary, and
boundary walls, together with additions and alterations to
the east pavilion, and the formation of a complete system
of drainage for the whole site of the hospital, for the sum
of £10,633.

Instruction to Volunteer Medical Officers.—
A course of lectures to Volunteer medical officers is now
being given by Dr. Walter Pearce at the headquarters of
the Volunteer Medical 8taff Corps. A lecture on Barrack
and Camp Hygiene will be delivered in the Parkes Museum
on Wednesday, May 26th, at 7.30 p.m. Dr. Farquharson,
M.P., will take the chair.

Glasgow University Club, London.—S ixty-five
of the members of this Club, with their guests, dined
together at the Holborn Restaurant on the evening of
Fnday, April 29th. Professor Gairdner of Glasgow was in
the chair. Amongst those who spoke after dinner were
the Marquis of Lothian, K.T., Lord Watson, Sir F. Sandford,
K.C.B., Lieut.-General Sir A Alison, Bart., K.C.B., Sir T. A.
Colt, Bart., M.D., and Professor McCall Anderson,M.D. During
the evening the chairman read a congratulatory telegram
sent to the Club by Principal Caird on behalf of himself and
the Chancellor and professors of the University of Glasgow.
The Club now numbers over 120 members. The honorary
secretaries are Dr. Heron, 67, Harley-street, W., and Mr.
Mcllraitb, 3, Fumival’s-inn, E.C.

Leith Hospital.—T he series of improvements
this hospital, which have been in progress for some tin;:,
have now been completed, several wards having been adta
to the charity.

Small-pox in Jamaica.—A ccording to the late-i
advices from Jamaica, the epidemic of small-pox which hu
prevailed on the island since March, 1886, shows but digl:
signs of abatement. Between March 13th and 27th liii
330 cases occurred, of which 19 were fatal. Since the con
mencement of the epidemic there have been altogether'll*!
cases and 690 deaths, of which 1990 cases and 353 destb
were in Kingston.

The Sanitary Condition of Warsaw.— Hitbera
the inhabitants of Warsaw have been drinking Vistula waw
drawn from where the river is polluted by the drainage tl
the town, and the sewage has been running through op?i
gutters, with which the streets are lined on both siu^
emitting pestilential odours. Important water and sewap
works, designed to rectify this intolerable condition a
affairs, are now approaching completion.

The Hospitals Association.—T he annual genen
meeting of members and associates will be held at the rocm
of the Society of Arte, John-street, Adelphi, on Wedneria;
the 18th inst., at 6 p.m., at which the President, Sir Andre'
Clark, Bart., M.D., F.R.S., will preside. On the evening *
the same day the Association will be held at the room* ■
the Medical Society of London, at 8 p.m., when a paper v.l
be read by Dr. Wm. Collier, on " The best means to prevtc
the Abuse of Hospital Charity.”

The Sanitary Condition of Poole.—O n the 11;
inst., a Local Government Board inquiry was held at P»a
into the application of the Town Council for leave to borr?;
£3000 for the erection of public baths. The inspector afM
tained that there was no system of sewerage inthetowi
and expressed the opinion that the Local Government Bos:
would not be justified in giving encouragement to ta
growth of an increasing town like Poole unless there *i
simultaneously carried out a thorough system of seweT*f
The mayor expressed the opinion that the death-rate of ■
town would increase if a system of underground seva
were substituted for the present cesspool system.

MEDICAL NOTES IN PARLIAMENT.

The Lunacy Board of Scotland.

05 tho 5th Inst., In the House of Lord*, the Marquis of WUw ji
•ented a Bill restoring to the General Lunacy Board of Scotland |>
to alter, enlarge, or restrict. In such manner as may be necesf^ -
present lunacy districts in Scotland. The BUI was read a first tin.f

Smoke Nuisance Abatement (Metropolitan) BUI.

On the 9th Inst. Lord Stratheden and Campbell formally
second reading of this Bill.—The Dnke of Westminster, in supp
the seoond reading, referred to the action of their lordships In 1 >*•
the same Bill was carried on a division, and concluded by »«ing ,
give a second reading to the BiU, on the ground that it would tew'
a boon on those who were constrained to pass the balk of thei
an atmosphere greatly contaminated by smoke. — Lord Monm-i •
commented upon what he termed the barbarous cireumstanw •••
London one-half of tho fuel used did not produce heat at all. bu‘• -
rose into the atmosphere, Irritating our nostrils and tbro»J
Inflicting enormous injury on buildings and everything. The it
ho thought, provide better machinery than at present, existed wtu |
the tame time, making any alteration in the law^and tncre^™
reason to beUeve
useful but a safe

Government could 1 — --- ... .

noble lord would allow sufficient time to elapse before the stage *• .
mittee to enable the metropolitan authorities to take oognisan^
Bill.—The Bill was ultimately read a seoond time.

Cremation.

On the 10th Inst., Lord Forbes moved for a return of the nun*^
cremations that had taken place In England within the last nrt .
and asked by what authority and under what regulation* mr ,
permitted.—The Marquis of Salisbury add that the ,

have been willing to give such a return if it had been In th« r I*
was impossible, however, for them to do so. because, oremauon ^
matter of Individual discretion, and not an official proe**'- 1
records were kept, or at least none that were accessible wuku
ment.—The motion was withdrawn.

Ventilation of the Vote Office. .

In the Honse of Commons on the 6th inst., in answer to Dr- *, i
Mr. Plnnket stated that he was afraid it was true that the ' ,
Inoonveniently small, and that at times when much, crowdrota j
tion is not very good, but he had not heard that the extotto* ,
menu have proved injurious to the health of the Officials in ;J
He feared there would be considerable difficulty In mending w*

Digitized by GoOgIc

5 Tub Lancet,] APPOINTMENTS.—VACANGIB^.—BERTHS/MAHRUOES, AND DBATB6. [Mat 14 1887. 1015’

©atmttus.

* but hs would oonault with Dr. Percy a* to what could be done aa to sub-
l ailtuting electric for g»* lighting. The difficulty wma that the plaut for
, the electric lighting was already strained to the utmoat.

The Vaccination Acte.

On the 8th inat., Ur. Charming asked the Secretary tor the Home De-
) part men t whether hla attention had been called to the otroumatanoea
, attending a recent execution of a dlatreaa warrant on a peraon realdlng
at Kettering for non-payment of a floe under the Vaccination Acta, and
whether he would make some representation to the loc tl bench of magis¬
trates to prevent any almilar occurrences.—Mr. Stuart Wortley aaidthat
be had received a report aa to the circumstances of this distress, but
would cause further Inquiries to be made in the matter.

Pteuro-pneumonia in Dublin. '

In answer to Sir J. Swinburne, Lord J. Manners said that Her Majesty's
Government had not taken any steps to prevent the landing In Great
Britain of cattle from any part of Ireland; but asm result of correspon¬
dence on the subject the Irish Government had passed an order with
the object of preventing the exportation of animals from certain dis¬
tricts in or near DaUlnlh which pleura-pneumonia waa Known to exist.
The correspondence woqld be laid before Parliament.

Female Labour at Collieries,

On the 9th Inst., lr\ reply to Mr. W. M’Laren, Mr. Stuart Wortley
stated that the Secretary of State would be pleased to receive a deputa¬
tion of those opposed to the prohibition of labour by women and girls at
the pit bauik. He would undertake that discussion on the clauses of the
BUI In committee shotUd be postponed for a week, but would avail him¬
self of the earliest opportunity to take the general discussion before
going into committee.

Army Medical Officer*.

In the Hoooe of Commons on Thursday, Dr. Clark asked the Secretary
of State for War whether, considering the great dissatisfaction that
exists amongst medical students and the medical profession generally at
fhe abolition of relative rank, which dissatisfaction may seriously
diminish the number of candidates for the Army Medical Servioe, he will
advise Her Majesty to issue a Warrant conferring honorary rank on all
medical offloers, and place them at least In ss good a position as the
officers In the Commissariat, Ordnance, and Pay Departments.—Mr.
Stanhope: I think I have told the House several times tbat the abolition
of relative rank will in no way alter the position or status of any
medical officer. I have no reason to suppose that these officers are
desirous of being called by titles which dissociate them from their duties.
—Hr. William Corbet asked the Secretary of State for War whether, in
view of the proposed alterations in the new Warrant with reference to
the medioal department of the army, the same privileges as enjoyed at
present by the Royal Engineers would be extended to medlonl offloers.
vis., “That an officer, placed on half-pay on account of ill-health Incurred
in an l by the servioe, may reckon time on half-pay, not exceeding one
year, towards promotion, towards voluntary retirement, and towards
retired pay.”—Mr. Stanhope: The general rule for aU departmental
offices Is not to reckon time on half-pay towards promotion or retirement.
Medical offloers come under this rule, in common with officers of aU
other departments. _

Irporotmntts.

&veessful applicantt for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to Xu Lancet Office , directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. —————

Baxbok, John. M.D., M.Ch. Boy. Upiv. Irel., has been appointed
Medical Officer for the No. 1 District of the Belfast Dispensary, vice
Barron, deceased.

Coplet. William Henry; M.R.C.S.,L.B.O.P.Lond., has been appointed
Honorary Surgeon to the North Cambridgeshire Hospital, Wlabeoh,
vice Wm. Boy, M.D.Bd., resigned.

Davies. Arthur moldsworth, L.R.C.P., M.H.C.8., has been appointed
Resident Medical Officer to the City Hospital; Netherfleld-road,
Liverpool.

Geiffitse, Ernest H., L.E.O.P., M.B.C.S., L.S-A.. has been reappointed
Government Medioal Officer and Vaccinator for Blayney District,
New South Wales.

Hull, Walter, M.B. Lond., M.R.C.S., has been appointed 8enlor
House-Physician to the National Hospital for the Paralysed and
Bplleptic, Queen-square. Bloomsbury.

Mackintosh, Angus, M.D.Glas., has been reappointed Medical Officer
of Health by the Obesterfleld Rural Sanitary Authority.

Metcalfe, James, L.R.C.P,. L.lLC.S.Bd^ L.M., has been elected
Dispensary Surgeon to the Bradford Infirmary, vice W. J. V. Harie,
resigned.

Millson, GROB6B. M.B.0.8., L.R.C.P. Lond., has been appointed
Temporary Medical Officer of Health for the Parish of Newington,
vice IUff. deoeased.

Newby, O. H., F.B.C.8.Bng., has been appointed Medical Officer
to Out-patients at the Royal Portsmouth, PorUea,and Gosport
Hospital.

Peek nvs, Whitfield, M.D.Dnr.. M.H.O.S., has been appointed Medical
Officer for the Fulboura District of the Chesterton union.

Risgx. Johjv A., M.R.C.8., L.R.C.P.Lond., has been appointed Medioal
Officer for the Hambiedon District of the Henley Union.

Gtewart, W. R. H., P.R.0.S.Bd.. has been appointed Aural Surgeon
to the Great Northern Central Hospital, vloe A. B. Cumber batch,
resigned.

Atmons, Joke, M.R.O.S., L.8.A., has been appointed Surgeon to the
West Cornwall Dispensary and Infirmary, vice Henry Grenfell,
deceased.

Valpt. Char. B., B.A.Oxon., H.B.C.3., has been appointed Junior
Houao-8vxrgeon to the Cancer Hospital, Brampton, vice A. C. Dove,
M.B., M.8.. M.R.O.8.. resigned.

Williamson, B. T., M.B., B.8. Lond., has been appointed Junior House-
Physician to the National Hospital for the Paralysed and Bplleptic,
Queen-square, Bloomsbury.

In compliance with the desire of numerous subscribers, it has been decided to
resume the publication under this head of brief particulars of thi various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should bo made to the ‘
advertisement. -

Birmingham and Midland Eye Hospital. —Dispenser. Salary £70
per annum, with dinner, or an equivalent.

Blackburn and Bast Lancashire Infirmary. — House-Surgeon.
Salary £100 per annum, with board, washing, and lodging.

Charing -cross Hospital, Strand, W.C.—Assistant Surgeon. Medical
Registrar.

Evelina Hospital for 8icx Children, Seuthwark-bridge-rood, S.E.—
Registrar and Ohloroformist. Salary £30 per annum, with additional

, £20 if the post is held for twelve months.

Infirmary fob Consumption and Diseases of the Chest aniv
Throat, Margaret-street, Cavendish-square* W.—Honorary Visiting
Physician.

Lincolnshire County LukaTic Asyluh, Bracebridge. — Medical
Superintendent. Salary and emoluments £100 per annum, with
furnished house, coals, gas, milk, vegetables, and washing.

Liverpool Northern Hospital. —Assistant House-Surgeon. Salary
£70 per annum, with residence and maintenance in the bouse.

Madagascar Medical Mission. — Superintendent of Hospital Ac.
Salary £150 to £200 a year, house, ontfit, Ac.

Newcastle-upon-Tyne Infirmary. — House-Physician. Salary £100
per annum, with board, lodging, and washtng.

Rotherham Hospital. — Assistant to the House-Surgeon. Rooms,
commons, and washing in lieu of salary.

Rural Sanitary Authority of the Staines Union.— Medical Officer
o£ Health. .Salary £75 per annum.

St. Thomas’s Hospital.— Librarian. 8alary £150.

St. Thomas's Hospital Medical School.— Lecturer on Systematic
Physiology.

Tawd Vale Colliery Sick and Accident Society. Skelroersdale,
Lancashire.— Medical man. Salary about £150 per annum.

Tkionmouth, Dawlish, and Newton Infirmary and Convalkscknt
Home.— Houae-Surgeon and Dispenser. Salary £71 per annum,
with board (beer excepted), lodging, aud washing.

University College, London.—Holme Professor of CHnical Medicine.
Professor of Pathology.

Victoria Hospital for Children, Queen’s-road, Chelsea.—Assistant
Surgeon In the out-patient department.

West London Hospital, Hammersmith-road, W.—House-Physician.
Board, lodging, and attendance. Two House-Surgeons. Board,
lodging ana attendance.

IjSirffjs, Parrhtps, aitir §.eai{rs.

BIRTHS.

Barlow.—O n the 4th Inst., at Wimpole-street, the wife of Thos. Barlow,
M.D..F.H.C.P.. of a daughter. _

Davis.—O n the 9th Inst., at West Hartlepool, Durham, the wife of
B. H. Davis, M.B.C.8., L.S.A., of a daughter.

Embleton.— On the 4th Inst., at 8t. Wilfrid’s, Bournemouth, the wife of
. Dennis C- Embleton, M.R.C.S.. L.B.O.P.Lond., of a son.

Gould.— On the 8th inat., at Queen Anne-stroet, W., the wife of

A. Pearce Gould, H.S., of a son.

Griffiths.— On Jan. 29th, at Blayney, N. S. Wales, the wife of Ernest

B. Griffiths, L.R.C.P.Bd., M.B.0.3. Eng., Government Medical
Officer, of a son.

Jones.—O n the 7th Inst., at Chesham-place, the wife of T. Ridge Jones.
M.D.,of a sou.

Lank enter.— On the 5th lost., at Elm-park-gardens, Sonth Kensing¬
ton, S.W., the wife of Herbert Lankeater, M.D.Lond., of a
daughter. _

MARRIAGES.

Adams—Kinchin.—O n the 5th Inst., at Emmanuel Churoh, Clifton,
James Alexander Adams, M.D.Glas., to Agnes Mortimer, only
daughter of the late John Coster Kinchin, of Clifton.-
Kibbt-Oollistkr.— On the 30th ult„ at 8t. George's* Hanover-square,
Albert Edward Kirby, M.R.C.S., to Marian, fourth daughter of
W. Oolllster, Esq., of Liverpool, and relict of the late James Fllnn.
Robinson — Goldfinch. — On the 27th ult., at St. Mary Abbott.,
Kensington, George Strickland Robinson, M.R.C.S., to Lavinla
Maria, youngest daughter of Bdwin Goldfinch, Esq.

TaIt— Batten. — On the 10th Inst., at St. Mary Abbott, Kensington,
Henry Brewer Tait, F.R.O.8., to Beatrice Brend. second daughter of
John Wlnterbotham Batten, of the Inner Temple and Airlle-
gardens, Campden-hilL _ ,

DEATHS.

Atwell.—O n the 10th Inst., at Portlaud-road. Stoke, Gregory Haines
Atwell, L.R.C.P., late of Altrincham, Cheshire.

Bannister. —On the 8th Inst., at Tottenham, John Henry Bannister,*
M.R.O.8., L.8.A., late of Keppel-street, RusselLsqnare.

Burges.— On the 4th inst.. at Fethard, co. Tipperary, Francis Carleton
Burges, L.R.C.S.I.. aged 72.

Lowes. — On the 25th ult., at his residence, Lexbam-fmrdens,
Kensington, W., and formerly of Anglesey, Hants, Frederick John.
Lowes, M.D. _

IJS .—A fee of 6s. is charged fbr the Insertion ef Notions/Births,
Marriages, and DesUht.

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1016 Tub LabOBt,] NOTES, COMMENTS, AND ANSVttfftS tO CORRESPONDENTS.

[Mat 14,18W.

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Tttb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [Mat 14,1887. 1017

Langmobk Diracs Fund.

A sum of about £90 is still required to settle the heavy bill of ooete for
legal expenses incurred by Dr. J. Wreford Langmore for his defence in
the recent action unjustly brought against him, ■which he, indeed,
gained completely, but the expense of which, In consequence of the
bankruptcy of the plaintiff, falls upon Dr. Langmore. The committee
in charge of the fund desire to close it soon, and will therefore thank
all gentlemen wishing to subscribe to send their donations at once to
Ur. George Eastes, M.B., 69, Connaughtstreet, Hyde Park-square,
London, W.

Subscriptions announced £136 16 0 I Dr. O. Ransford. £110

A Friend. 3 0 0 | Dr. 0. Koyston . 110

Dr. 0. T. Aveliog ... 1 1 0 j Mr. T. 0. White. 110

Mr. A. E. Cumberbatch 1 1 0 A Friend . 10 0

Mr. J. H. Drew. J 1 0 1 A Friend . 10 0

Mr. H. C. Lawrence ... 110 1 Mr. A. H. W. Ayllng ... 0 10 6
Dr. Isambard Owen ... 110' Mr. Rayley Owen ... 0 10 6

THE DISPOSAL OF LONDON SEWAGE.

To the Editors of Tub Lancet.

Sliu,—In your lsaue of April 30th there Is a most valuable note relating
to the proposed disposal of the sewage of the Thames district and of the
Lea district at Barking Creek and Crossness. Sir Joseph Bazalgette, the
engineer of the London Board of Works, seems to be quite satisfied with
the present plan of the Board, which treats the sewage at these outfalls
with chemicals In two underground reservoirs of about nine acres in
extent at Barking, and of about the same extent at Crossness. The
extension of the Barking reservoirs will. I hear, make the whole extent
at that spot of underground reservoirs about twenty acres; and, what
with cbemloals and steamers to ooayey. the chalk and Iron salts and
mineral constituents of the sludge down the river Thames, it is calcu¬
lated that the interest of ten millions sterling will have to be annually
met by the ratepayers of the metropolis. All this, too, will be totally
useless, and will certainly have to be undone in a few years. Meanwhile,
Paris, which took lessons from English sewage farms, and Berlfn, which
did the same, are both in possession of splendid sewage farms at Genne-
riUiersand roundabout Berlin. The latter city has purchased no less
than 19,000 acres of land, and is thoroughly content with her experiment.
Alt who understand the question will agree that the only real way of
treating sewage with effect is the physiological plan of passing it
through suitable soils, and allowing the organisms contained in all
pervious soils to split up the urea into ammonia, the food for plants.
If London sewage were oonveyed, as proposed by Col. Jones and Mr. B.
Denton, down below Tilbury, and then* pumped, up on the lands of
Essex, enormous amounts of rye grass and roots might be raised, and the
Thames thoroughly purified.

I am. Sirs, your obedient servant,

London, May 3rd, 1887. C. B. Drysdale, M.D.

Professional Attendance oh School Boys.

II. B. W. —The rate of remuneration for professional attendance on boys
at school varies very much In the same degree as attendance on the
different grades of society. At Winchester the medical officers, two in
number, are paid at the rate of two guineas per head. At Bugby the
medical officer, who has sole charge of the school, is remunerated at
the rate of about a guinea and a half per head. At Wellington College,
Charter-lionse, and some other schools of the same class, the medical
attendant receives one guinea for each boy. At Eton the older system
prevails of remunerating the medical attendant after the manner of
family practice. Each house-master selects his own medical
attendant, whose remuneration Is on a scale similar to that in
family practice. The same rule is observed at the majority of grammar
schools, as well as at most private boys’ schools and girls' schools. The
fee varies with the class of school—from five to seven shillings a visit.
It would be better for all schools to follow the example of the higher
grade public schools, and pay a sum per head for medical attendance,
either inclusive or exclusive of necessary medicines. It occasionally
falls very hard on parents who are struggling to give their children
tile beat education their means will afford to have to meet a heavy
doctor’s bill as an extra to the school charges, whereas a guinea a year
divided Into three-payments of seven shltHngs each school term would
be an easy matter. Medical men would, as a rule, be found willing to
attend schools at this rate where masters and parents were not need¬
lessly exacting, which, as a rule, they would not be.

Ur. Thomas Laffan is referred to an article In onr-preeent issue.

M'jllon.— No.

DB. KICHARDSON’S ELECTION FUND.

To the Editors of la* Lancet,

Sirs.— May I ask yon kindly to Inform your readers that the above
fund was dosed on April 23rd, and tbs audit published. I have since
received two subscriptions (one to-day), whioh I have returned with a
note of explanation; but as this involves trouble your insertion of this
letter will oblige.—I remain. Sirs, yoon truly,

Fredk. H. Aldebson, M.D., Hon. Treasurer.
Hammersmith, May.«th,I88fc •, ii . ..1 .h/*;. J. a.. ..

Suicide in Ancient Some.

This sombre, though fascinating, theme has usually been handled as If
a series of anecdotes of celebrated suicides sufficed to exhaust Its
interest; but Dr. Iglnlo Gentile of Milan, In am able memoir recently
read before the Clrcolo FUologioo of that city, adopts the more
scientific method of treating It in relation to the notions of death, as
these have been developed and embodied in the various philosophic
systems. Aristippus of Cyrene proclaimed the nullity of existenoe,
and sought to deprive death of Its traditional horrors; and Hegeslss,
by persuading the Greeks that the sum of pain exceeds the sum of
pleasure, caused so many to destroy themselves that hit “prelections"
were prohibited. Bpicums, shrinking from absolute pessimism, main¬
tained that the dread was as culpable as the desire of death, which, by
Itself being neither a good nor an evil, might yet become, according to
circumstances, either the one or the other. The next step in the
evolution of the notion of death was that of the Stoics represented by
Zeno, who placed the chief good in the pure repose of the reason, and
limited himself to considering death os a necessary evil, and suicide as
a rational mode of exit. These notions in the march of historical
development penetrating the Boman mind, so averse to philosophical
speculation, formed part of the groundwork of morals; and. In spite
of the protest of the older citizens, who hated this intrusion of Greek
subtleties, suicide received Its sanction (n the Latin “ mori licet out
viverenon placet ” (he Is at liberty to die who does not like to live);
so that self-destruction became oommon In the last years of tho Boman
Republic and in tho first of the Empire—a period'prolific in social and
political perturbations. When the Empire reached Its culmination,
while there were development and vigour In the provinoes, there were
corruption and decay In the City, where the new oonditlon of things
supplied new incentives to suicide, and voluntary death, refined Into a
philosophy, became the crown of the career of the Roman voluptuary.
It was in the upper olasses, the old Republican oligarchs, become
effete under the Empire, that this notion prevailed; but in the lower
strata of society. In the suffering masses, germinated the mystic ideal¬
ism that prepared the victory for advancing Christianity. Epictetna
and Marcus Aurelius represented the last phase of philosophy which
sanctioned voluntary death lu a mitigated form, while the “acta
urbls” (the daily journals) registered suicides every tweuty-four hours.
At last came the message of salvation, the new faith which preached
the comforting doctrine of man's duty to live. Dr. Gentile’s paper,
highly interesting tb its Milanese audience, may prove not less so to a
yet wider public.

THE HONOURS REGULATIONS AT THE LONDON UNIVERSITY.

To the Editors of The Lancet.

Sirs,—A s an Intending candidate for the 1st M.B. of London, might I
be allowed to express a student's views on tho recent honours regula¬
tions? I quite ilhderstand the reason of them—viz., to prevent every
man who obtains a pass trying for honours in every subject on " spec,”
which I believe used to be a favourite amusement. This certainly ought
to be stopped, as it simply meant extra and unnecessary trouble to the
examiner. But the regulations do more than that; they prevent men
trying for honours, and tempt men to read for the lower standard.
Oould not this be obviated by the following method ? Make each can¬
didate take the pass la each subject, and then if he obtains a sufficient
percentage in any subject, let him have the option of trying for honours
in that subjeot. The same regulations might also apply to the pre¬
liminary scientific. This method would effect a weeding out, and thereby
enable the honour* papers to contain purely honours questions—raising
the standard. As it Is, failure to obtain honours means possibly a
recommendation for a pass, possibly failure. This would entail a heavy
loss of time and money, that in most oases ran be ill afforded, whilst at
the same time there would be the irritation of feeling that one might
not have failed if one had been more modest, whence would come the
obvious moral—Don't read for honours again. Enclosing my card,

I am. Sirs, yours obediently,

May 9th, 1887. X. Y. Z.

Regulation of Minimum Fees.

Mr. Albert S. Morton complains severely of the low fees charged by some
medical men,and of the system at Guy's and other hospitals of charging
oub-patleuts a small pittance, and taking, and even advertising for,
in-patients at a guinea a week. Unless cases are carefully selected,
such conditions might easily operate Injuriously on patients and on
the profession. But It it of little use to expeot the Medical Council to
regulate fees. Its business Is to regulate medical education. Medical
men themselves, and amongst themselves, must regulate fees; and the
sooner it U understood that there it no power in any existing body or
authority to fix fees or prescribe scales of charges the better. Ottr
correspondent encloses a Bmall circular advertising a cheap medical
practitioner (M.D.St. Andrews and M.B.C.S.Eng.). He should for¬
ward this circular to the bodies from whom the gentleman in question
holds his diplomas.

' NMtaaLshOniA wri ps tn the- ge u b e fiaty of tbcOolfege.

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Diqitiz

1018 Thk LAJJOBT,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[May 14,1887.

Hutton Fund.

Titk secretary of the committee of the above fond request* the Insertion
of the following list of subscriptions, and hopee that this maybe added
to, so aa to oreate a luting provision for those who have so great claim
on the profession as the widow and daughters of Dr. HuttoD.

Second List.

Amount acknowledged . Bi36 17

0

Mrs. Lloyd .

£5

0

0

Mrs. C. La Motte

60

0

0

Mrs. Keyser .

r,

0

0

A Friend.

60

0

0

William Fuller, Esq. ...

6

0

0

Medical Benevolent

R. F. Crawsliay, Esq.

5

0

0

Fund .

25

0

0

C. F. Gore. Esq.

ft

0

0

The llev. W. Niven

25

0

0

A. Cox, Esq.

6

0

0

Dr. Herbert Watney ...

21

0

0

Mrs. C. .

ft

0

0

Baron Von Hiigel

21

0

0

Woolhouse Braine, Esq.

3

3

0

A. Sandeman, Esq.

21

0

0

Dr. Gibbons .

3

3

0

J. H. Hlekens, Ksq.

20

0

0

G. A. Macmillan, Esq...

:»

3

0

Per Fielding Nalder.Esq.

20

0

0

Mrs. Ponsonby ...

3

0

0

Dr. Kustaee Smith

10 10

0

J. J. Merriarn, Esq.

2

3

0

Thomas Smith. Esq. ...

10 10

0

Warrington Ha ward, Esq

2

2

0

Bernard G. Broadhurst,

Dr. Barnes .

2

2

0

Esq.

10 10

0

Dr. Blandford .

3

2

0

Dr. Arthur Farre

10 10

0

Dr. Gage Brown.

2

2

0

M. Van Raalte, Esq. ...

10 10

0

Mrs. Goetz .

3

2

0

Mrs. Coke.

10

0

0

Lady G. Fitzgerald

2

2

0

Walter Sandeman. Esq.

10

0

0

A. Curling Esq.

2

2

0

George Barnett, Esq. ...

10

0

0

James Tee van. Esq.

2

2

0

Mrs. Hutton (Burr) ...

10

0

0

Geo. Fitzroy Mundy ...

2

2

0

Hon. Mrs. Halford

6

0

0

Mrs. Sydney Scott

2

2

0

Miss Matilda Horsley ...

0

0

0

Miss Levy.

2

2

0

Sir James Paget.

5

5

0

The Bishop of Truro ...

2

2

0

Dr. Habershon.

5

6

0

Mrs. Cameron .

2

2

0

Hugh Macpherton, Esq.

5

5

0

Dr. Frank.

2

0

0

C. Du Pasquier, Esq. ...

5

5

0

W. J. Penny, Bsq.

1

1

0

G. W. Mackenzie. Esq. ..

5

fi

0

Mrs. 8Iyman .

1

1

0

Dr. Bowles-Folkestone..

5

ft

0

Mrs. J. F. Churchill ...

1

1

0

H. S. Trower. Esq.

5

6

0

Dr. A. 0. Key .

1

1

0

Adolphe Schloesaer, Bsq.

6

6

0

H.Crlppa Lawrence. Bsq.

1

1

0

Edgecombe Venning,

Dr. Sinclair Thomson ...

1

1

0

Esq.

ft

ft

0

Mr*. Owen Jonee

1

1

0

W. S. Steel, Esq.

6

5

0

Dr. Waggett .

1

1

0

John Wler, Esq.

5

5

0

Dr. de Havilland Hall...

1

1

0

Mrs. R. Stewart.

5

5

0

The Rev. Frederick Cox

1

1

0

H. Gerald Tudor, Esq....

5

6

0

F. H. Stewart, Esq.

1

0

0

Ladv Herbert of Lee ...

6

6

0

K.. .

0 10

6

Sir Oscar Clayton

5

0

0

B. J.

0 10

0

Miss Arnold .

5

0

0

—

—

—

Colonel Hume .

5

0

0

Total.

£974

4

6

Mr. L. Houghton .—To the Secretary of the St. John Ambulanoe Associa¬
tion, St. John’s Gate, Clerkenwell.

Dr. James Weaver .—One case is hardly sufficient to prove our corre¬
spondent's contention.

L.R.C.P., L.R.C.S. —St. Thomas’s amongst others.

Erratum. —In Mr. Sessions Barrett’s letter in our last issue, page 966,
for “ fifty hours " read thirty hours.

Communications not noticed in our present number will receive atten¬
tion in our next.

*

Communications, Lkttzrs, *o., have been reoelved from—Mr. Has lam,
Birmingham ; Dr. Good hart, London; Dr. Heron, London; Mr. F.
Treves, London; Dr. Jas. Bralthwalte. Leeds; Mr. Mackenzie Booth.
Aberdeen ; Dr. Dickinson, London; Dr. Steavenson, London; Dr. W.
Wilson, Florence; Professor Humphry, Cambridge; Dr. Percy Boulton,
London; Dr. W. Nicholson, Greenwich; Mr. Saxon Snell, London ;
Dr. Saunders, Bxeter; Dr. W. Pearce, London; Messrs. Whlteiegge
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.Hi C t • . I

ABSTRACT OP A

Clinical lecture

GUNSIIOT WOUNDS OF THE EYE.

. Br CHRISTOPHER JEAFFRESON,

n*K>K wMMk to >bb lownuWBUun). wimy, MDinffram
. . : tmuau jtt ««» wn«m ov to kth.

mj r . - -

• We hate now for another year entered

upon that qeason when the frequent use of firearms for
eporting purposes brings its almost inevitable crop of
iwcoidents.! Indeed,so-on wen— ateIheae heooariag that itis
rare for thh shooting season to pass withriut several such
cases coming under my notice. Wlthiq the last few days
my advice has been sought in two instances of this kind of
.injury. I am quite certain that these casualties are. now
.much more frequent than they used-, to be, and we- most
look for the seaeea.tooeveral different oivoamstanoee. In the
first piece, them are many more snorting men, or, I should
perhaps say, men given to sporting proclivities, than there
used .to be. Of these, many only take to the gun late in life,
when .the accumulation of sufficient means enables thum to
.indalge in pastimes to which they haye, never, been trained,
but which tor the sake of fashion they feel called upon to
pursue. These patrons of sport, however careful they may
,.*ry to be, are- always dangerous companions upon a moor
or in a cover. ,,Thpy always hwidJa..their weapons badly,
sire bad judges , of distance, and lack that calmness and
.{liberation which are only, acquired by a training com¬
menced in early youth. Unquestionably, too, tbe use of
breech-loaders has engendered a very rapid system of tiring,
'which encourages recklessness in young and excitable
.sportsmen; and, finally, tbe system of grouse* and of late
years partridgo, driving is responsible for no small number
of tbe casualties which occur. Not infrequently the butts
are much closer together than there is any necessity for,
.they are not uncommonly very.deficiently constructed, and
the rules with regard to lateral fi ri ng are not sufficiently
impressed upon each sportsman before the shooting com-
.mences. 1 find I have altogether notes of twenty-three
cases of gunshot wounds of the eye? and orbital regions;
to give them in, detail would, however, occupy too much of
your time and space. I - hall therefore only refor to them
.when necessary to illustrate certain points relative to
aymptoms, diagnosis, and treatment. And here (may say
that it is say intention in this lecture to confine ray remarks
chiefly tp those injuries which affect the globe, reserving for
.another occasion 1 ho more severe form of injuries, where, the
globe is destroyed together with parts of the orbi;. (
.Gunshot wounds of the eye do npt differ very materially
from injuries to the eyes which occur from the projection
with force of particles of metal .or other materials used in
'hhe arts and manufacturer but they are usually attended
with much more shock. Sometimes this, is peculiarly
.marked, Though the globe may have been only penetrated,

i globe of the eye possesses a power of drawing a shot:ant .of
its coarse. . v

. Shots may be “direot” or “rioqebeti” Risoobebcshot*
may take plaoe; at the, month peculiar; angles, and. the
possibility of a double ocoohet. must not be tojgottetn It
is,only by taking them into comideratiqa that we can
scepuot for some oases, in which the person, Wounded was
in a position where it seemed .almost an impossibility that
he could be hit. Ricochet shots are, lor, a given velocity,
much, more dangerous , than diwet onee, for the following
reasoni Their primary impactusooliy destroys their epheriaal
form, flattening them, nndi giving them rnn edga m some
case} almost as, sharp,as akmte, and -whicbpecahariy
facilitates their pwetration under a eompaMtively low
i velocity. The affeate produced by the impeot of a pellet
upon the globe, will naturally eery .with the velocity of the
shot and the angle at which it strikes, partly aleo npon
the varying thickness and resistance of the ocular tissues in
different individuals.. The cornea is much less resistant
than the sclerotic, and .may- be penetmfed at a greater
distance than tbe latter. From experiments I have con-

principal cavities ef the body. On one occasion I was
present when a young.gentleman was struck by a spent shot
<m the globe;. Jia Immediately .fainted, the faint being
accompanied hy general, convulsions, liis restoration to
consaiaugneps waa-twvc^,within an hour followed by similar
attacks* An eiaminatn?d of the eye showed only a slight
abrasion of the cornea,apd at the ead of forty-eight bourn
his general health and. the eye were completely restored.
Jlo doubt mantfl Influences play a great port in this form of
shock. The uncertainty of what has really happened, the
forebodings of future sufferings, and the exaggerated fean
of sudden ai

account fqr, t
•everal pellefA.1
the paiieftt-K
icequaucy that
po. ofteq does *

( future sufferings, and the exaggerated fean
.perpetualhkhdnega acting upon a person of
SfUgMy, nervous temperament are enough U
this condition, , Although not iofcequeatlj
^(drfka different, part* ,ot .the body at the time
sjnjured.-.atili ffj happens with remarkable
Athe globe is the only part struck. Indeed,
fUs happen that there m a popular, snpert
.WfPWDf of that class that the

i: ducted I think the penetration of the globe through the
I sclerotic i* rare, at a greater.distance than seventy-, juris,
although in the case of the cornea I believe it may-occur up
ninety yards; nndiin.one o*se where a No. 6
nfh«i/TPWPtrated at. thoi eoroeo-scleral junction, .1 was
, informed the distance of the injured pemon from the gun
, wap fully 100 yards. For con vewenee sake we may divide
these injuries into “ qon-peaet*»ting” and “penetrating”
wounds^ The fur sane may vary from trivial ecohymoses of
the conj unctiva, glmast unattended with, visual dijriurbftaoe,
to extensive extrsyawitionsi enboo^junctival and imtxaceular,
with detachments of. the retina, rapture,of the choroid, and
partial or complete djsplsceaaenD of. the lens. On ©He
occasion 1 found a shot in the superior .oonjunpkivai <ttl-.de-
sac; it had evidently struck the upper part of the sclerotic
at one angle arid glided under the lid.

In some cases there may be a momentary difficulty in
assuring oneself if the globe has hem penetrated J a diffi¬
culty which may be considerably increased if the patient
is not seen till some days after the accident and the
wound lies in the equatorial' regions of the. eye, away
from the plane of. the iris. The little wound, if- at
existed, may then have healed, or its site.may be nmafeed
by chemosis or extrsvasated Wood.. It. is usually to
be found if diligently sought for,, iIn, these doubtful
cases it is well to carefully efamine,:the teoHon of the
globe. A perforated globe generally shews. a very marked
diminution of tension oompared with the .healthy eye.
When the globe has been penetrated, more anteriorly the
wound is usually sufficiently.obvious, .the iris being inpp
gal or or displaced, and in many instance*/partially .paro-
lapaing, and the lens is seen to be opaque aqa swollen. In
other esses tbe whole of the deeper structural may be con¬
cealed by hmmoighage iptp tbs anterior chamber. In doubt¬
ful cases we should never omit to ball in to our aid. all the
points bearing upon the csae,*nd we Should meka a detailed
and minute .examination into the elroumstanoos of the
accident, having fully explained to Qe the relative position
and distances ot tbe parties engaged., The elasticity of tbe
sclerotic is such that Abe aperture made by a Nix; 6 shot
may sometimes require a good, deal of Marching -fox.
On one occasion, alter the .enucleation of a globe which
hod a most distinct and weUmteriMft. aperture,of entranoc
through the cornea, immediate dietaotien io£ J*e «ye failed
to find any shot iu the interior. - Ibis,<wna j very ptudding.
After a very minute and careful examination the opartur*
of exit was found close to the inner aide of the optic nerve
entrance, the shot having P Qoorplr*tiy>DaveTaeditheTglobe,
On examining tbe wound carefully, the pellet wee-found in
close apposition to the cut extremity of tbe nerve ami
removed. A very oblique. efaofc striking a very prominent
eye, may traverse it without lodging. There .will theft be
the appearance of two apertUQMS. Which might,mislead, the
surgeon into supposing tbefc,;two ahotq :&ad! pe netrated
instead of one. Again, there may be but, one. aperture In
the globe, and two shots mayihave.entered,,one following
exac tly in the footsteps of , the other. Buch a case ooaarwa
in W i practice .auum ye***, ago. The- case, is vividly
impressed upon my mind -from wcurious coincidqftOft • • c

1 surgeon brought, me.a awilamao who had euesmewed

1 surgeon brought, me. a genjlfoneo who had epesmewed
him ou account of a gunshet wound of bio right eye. : He
was of npmipnj. that a -ehot had penetrated tend: kdgefk

1020 Th* Laxcbt,] MR. C. fl. JEAFFRESON ON GUNSHOT WOUNDS OF THE EYE.

[May 21,1887.

whilst another medical practitioner held a contrary opinion,
and I was asked to determine the point. Upon examination
it was decided that the globe should be enucleated, and I
promised at a subsequent time to give the result of the
dissection of the eye after it had been prepared by
hardening in Muller’s solution. In a fortnight both gentle¬
men appeared, and were equally anxious to learn my con¬
clusions. Mr. A. said, “ Weil, was I not right—there was a
shot in the eye ?” I replied, “ No.” “ Then," said Mr. B., “it
was just as-1 expected—there was no shot in the globe.”
When I replied that he also was wrong, they both looked at
each other With astonishment. They then pressed me for an
explanation of this apparent inconsistency, and were much
•mused when I explained to them they were both wrong,
because there were two shots lodged in the injured organ.

It may seem somewhat paradoxical to say that a shot
may penetrate the globe without there being any visible
aperture or external manifestation of the occurrence. Yet
the possibility of this accident and its absolute fulfilment
are amply illustrated by a case which 1 shall relate, in which
it is more than probable that a considerable number of shot
entered the posterior part of the orbit through the pterygo-
maxillary fossa, producing blindness. The case, which was a
most interesting one from many points of view, happened
-as follows

A number of gentlemen out shooting were walking in
single file along the bank of a river, when a duck rose in
front of them. The leading sportsman put up his gun to
fire, as did also the one immediately behind him, and in the
excitement of the moment the latter discharged his piece.
The distance of the leading man oould scarcely have ex¬
ceeded five feet from the one immediately behind him, and
the greater part of the charge from the latter’s gun entered
the right side of the foremost gentleman’s head and shoulder.
He fell as though dead, and was promptly removed to a
neighbouring house. When 1 saw him some hours after the
accident he was in the following Condition. He was much
collapsed from haemorrhage and snook, but was sensible, and
there was no paralysis. The right temporal bone was
riddled bv shot, and considerable haemorrhage was still
going on from these apertures; the ear was much torn and
lacerated. The integuments over the temporal muscle were
ploughed into furrows, and the substance of the muscle was
a mere bag of ecchymosed blood and shot corns. Several
shots had completely traversed the base of the skull, and,
flattening themselves against the back of the teeth, had
been spat out of the mouth. The right eye was deeply
ecchymosed and somewhat prominent. With a little difficulty
I was able to make a very satisfactory ophthalmoscopic
-examination. The media were dear and perfectly trans¬
parent, but the retina was covered with large heemorrhagic
patches. These were particularly visible upon the temporal
-aids. Vision was completely abolished, -with the exception
of slight perception of light in the temporal half of the field;
the nasal half of the retina having evidently escaped with
less injury. I show you here, gentlemen, an enlarged
rough sketch which I took of the fundus at the time, and
1 think there can be no doubt that these ecchymosed
patches are the result of the impact of shot which arrived
at the back part of the globe through the pterygo-
maxillary fossa. The case proved a tedious and anxious
one. During the course of treatment something like 150
shot were removed from the facs\nd shoulder-joint, but
a large number, in spite of extensive suppuration, must
have remained lodged in the mastoid portion of the temporal
bone. Sight, it is needless to say, was permanently lost in
the right eye, but in other respects a perfect recovery took
place without much visible disfigurement.

1 previously mentioned incidentally the possibility of a
shot traversing completely the globe, and lodging eventually
in the deeper structures of the orbit. I may say that this is
by no means a very uncommon result, and I have met with
it on several occasions. Such an eye can rarely recover any
useful degree of vision, but it may nevertheless recover very
rapidly from the injury, and may thus belie the anticipa¬
tions formed, and perhaps expressed to friends and relatives,
of severe symptoms and prolonged suffering, which may have
been legitimately urged in justification of enucleation.
When a distinct aperture of entry is found in the globe, and.
on removing the damaged organ no shot is to be found in j
its interior, we should always Buspect that the globe has
been completely traversed, and make a minute examination
for the aperture of exit, which is sometimes very difficult to
see, and, if there is time, may possibly have closed. The

shot, too, should be sought for amongst the orbital tissue*,
bearing in mind the fact that it may be wiped away in the
sponges, these should be carefully looked after. Whether,
however, the shot be found or not is not a matter, surgically
speaking, of great importance, as it rarely gives rise to uy
mischief when left in the orbital tissues. Nevertheless, the
patient and his friends never seem perfectly satisfied unle**
it is produced.

What is the treatment we should adopt in oases of gunshot
wounds of the eye ? Of course this will very much depend
upon the nature and extent of the injury. In oases wham
there has been no penetration and the injury consist* of
ecchymoeia of the conjunctiva with extravasation to a
greater or lees extent into the anterior or posterior chamber,
we must use cold and evaporating lotions and do our
utmost to guard against all inflammatory reactiov. We
shall usually succeed in this with young and healthy p*wons
and in persons of more advanced years if then to an
absenoe of gouty, rheumatic, or other diathesis predisposing
to inflammation. In course of time the blood effused, will
be absorbed, and if the media regain their transparency sad
there has been no detachment of the retina, sight nay
eventually be restored to a useful degree. Are there say
external or internal remedies which promote the abeotptini
of extravasated blood ? I most confess personally I hare not
much faith in any, but I usually order locally a weak lotion
of lead and opium or belladonna, or, in cases where inflam¬
mation threatens, conium; and internally administer maU
doses of iodide of potass with tincture of jaborandL 1 tare
more faith in this drag than any other, and certitinly^tUtk
its administration either internally or by means ofl tab-
cutaneous injections in the shape of pilocarpine proMtai
absorption. \. *

In cases where a shot com has penetrated the globe the
case at once assumes a more serious aspect end roqmres%sre
radical measures. I must here only mention to oondtaaflv
attempts being madefy probes or otherwise to senich’Mfw
position Of the shot or ascertain its presence, frtare
seen such attempts practised, but they can lead to UO taod,
and may be productive of much harm by iUcrewIg
the risk of panophthalmitis and euppurativei inflamma¬
tion. There is only one condition, or rather oomhUlflre
of circumstances, under which I should contadarwneh
attempts justifiable (and then only when we had/ wMfltoflP
suppose the shot was close to the wound): that ia, ttimvta
patient has already from some other cause • lost the
the uninjured eye, or it suffers from such an ~“
amblyopia as to render it practically useless. *’
circumstances we can be influenced by
sympathetic mischief being developed, and e
should be made, and at all risk, to preserve
organ if it retains nothing more than a hie
light. This rule applies, I need scarcely
force to accidents occurring from other
than gunshot wounds. I bate known
mended, and in more than one instance
it was ascertained that the remaining

Organ, and I cannot too strongly impress u, _. a

sity of making ‘strict inquiry Defore yon roC0iioifitiff*|«*
proceeding. 1 have only once succeeded' iii* llJLtiiMiflta w
shot from a wounded eye. On that occaaiodr l ^lflwtf w<>
evidence of penetration abont three inches QUtaflW t*»
lowest part of the sclero- corneal junction, 1 Stiff* Itijpvim
of iris was protruding. The anterior chtfioMW' flti’ flnH of
blood, and there was no
the other eye was perfect." I recbm
organ should be enucleated; bat the
therefore excised the protruding ] *
cut it dose off, a small black spot
the wound. Touching it with the
be-a shot. I slightly enlarged ti
The patient recovered, but with nfi

The enlargement of the woiuM
necessary when a shot hah to be
of the Coraes'kofi sclerotic is sttdf
smaller than 'tire' body which
theta, when a shot has re ‘
tC M fedfefl 'there, Id
cne

m Afeottent
isparttied.
tbetttoti

. and the

Tn Loncwt,]

MB. ANTHONY A. BOWLBY ON INJURIES OP NERVES.

[May 21,1807. 1021

become encysted. In these cases, for a time the patient is
satisfied with his condition, and is apt to consider that the
advice tendered in favour of enucleation was unnecessary
and harsh. But the dangerous epoch for such an eye is sure
to come sooner or later. The encysting capsule becomes par¬
tially absorbed, under some violent exertion or shock to the
head or body the shot shifts its position, and severe sym¬
ptoms immediately set in. I have noticed that the train
of events above described is peculiarly liable to occur
when the patient is least able to bear it—that is, at
a time when some intercurrent disease has reduced his
physical powers, especially maladies which have a ten¬
dency to produce emaciation. In other cases the original
hopeful condition is only maintained for a short time, retro¬
gressive changes set in, and the whole globe undergoes a
process of phthisical wasting. In others, again, a subacute
inflammatory condition is developed with choroido-iritis or
perhaps ossification of the choroid, and the patient is
eventually glad to submit to the treatment which the
surgeon proposed to him from the first. " In by far the
majority of cases, however, if nothing is done, violent reac¬
tion takes place at once. Acute inflammation is set up with
great pain, and considerable constitutional disturbance and
a condition of panophthalmitis, or suppurated choroiditis,
is established, which in weakly and broken-down subjects
may give rise to grave anxiety.

In the event of a patient acquiescing to part with bis
eye, what operation should we perform ? Should we
enucleate the whole globe, or should we content our-
sekves with the ablation of the anterior segment and
clearing out the sclerotic cavity, an operation which
now goes by the euphemistic term of “ exenteration "? To
enter upon this question here would be to open up ground
which has lately been much controverted. Personally I believe
the disadvantages of enucleation have been very much exag¬
gerated, and the advantages of exenteration unduly extolled.
Its relative value as a preventive, or rather 1 should say
safeguard, against sympathetic ophthalmia, as compared
with enucleation, has yet to be determined. It is more
painful, is not less tedious in its performance than enu¬
cleation, and is followed at times by an amount of reaction
which, in my experience, is very'rare in enucleation. I
have not been overtaken by the fear of septic poisoning
following enucleation, which seems to have invaded
continental ophthalmic clinics and threatens some of our
own. It must have fallen to my lot within the last six¬
teen years to have enucleated as many eyes as most
persons; yet I have never lost a patient or seen one lost
by enucleation. I have seen cases in which slight symptoms
of septic poisoning were developed, but these occurred
almost invariably when enucleation was performed at the
height of acute suppurative inflammation—a practice which
I always personally condemn. The danger of this proceed¬
ing has, however, long been recognised; and it is in these
cases that, perhaps, the operation known as “ exenteration ”
may find a useful sphere for its execution; although I am
still doubtful if it has any advantages over a free corneal
incision with evacuation of the contents of the globe. All
the different operations which have for their object the
removal of an eye are as much an “opprobrium” to the
ophthalmic surgeon as an amputation is to the general sur¬
geon. They are as distasteful as arithmetic is to the school¬
boy, and, if we might be allowed to parody, we might say

” Bxent«r*tIon Ii vexation,

Abeclnion la u bad,

Neurotomy won't do me.

Though extraction drive* me mad."

St. Thomas's Hospital. —On Monday, the 16th
inat., the Dean, in the name of the students, past and
preeent, of St. Thomas's, of whom above one hundred were
present in the library, preaented Mr. Denison, the retiring
librarian, with a clock, a purse of 120 guineas, and an illu¬
minated engrossed list of the subscribers to the fund,
numbering 309. Dr. Ord briefly touched on the many ser¬
vices of Mr. Denison, the tact which he has shown in
advancing school matters, and his happy influence on many
generations of students. Mr. Le Gros Clark afterwards, in
a short address, emphasised the remarks made by Dr. Ord,
and expressed the deep feeling of friendship existing
between himself and Mr. Denison. The clock and purse
were then presented, and Mr. Denison briefly replied,
thanking bis friends present for their kindness at all times
during hie lengthy connexion with the school.

lottos

ox

INJURIES OF NERVES.

Delivered at the Royal College of Surgeons,

By ANTHONY A. BOWLBY, F.R.C.S. Eng.,

SURGICAL REGISTRAR AND DEMONSTRATOR OF SURGICAL PATHOLOGT AT
8T. BARTHOLOMEW'S HosPlTAU HUSTKRIAN PROFESSOR OF THE
ROYAL COLLEGE OF 8LBOSONS.

LECTURE II.

( Concluded from page 971.)

Thb trophic changes in the joints and bones next claim
attention.

With regard to the joints, the description by Weir
Mitchell must again be given the foremost place, for he was
the first to describe the conditions to which I am about to
allude. 1 He states that the arthritic lesions may appear
either early after the nerve lesion, or else at a later period,
when the more immediate symptoms have subsided. Under
the latter conditions, “we may then have one articulation—
and if only one, a large one—involved; or perhaps all the
joints of a finger, or every joint of a hand, or of the entire-
limb, may suffer. The swelling is never very great, the-
redness usually slight, and the tenderness on touch or
motion exquisite. This condition of things remains, with
little change, during weeks or months, and then slowly
declines, leaving the joints stiff, enlarged, and somewhat
sensitive, especially as to movement. A small proportion
of such cases find ready relief, but in many of them the
resultant ankylosis proves utterly unconquerable, so that
it is vain to try to restore mobility by manipulation or
splints.” Such is Weir Mitchell’s account, and I make no
doubt that cases such as he has described have been seen by
him. Yet it would be quite a mistake to consider that such
are at all common. It has been my fortune to observe for
some years past, and to keep constantly under my notice, a
large number of cases of nerve injury of most various kinds,
yet in none of them have 1 seen any joint affections so
extremely acute and painful as those described by Weir
Mitchell. On the other hand, I think that arthritic lesions
of a less severe and more chrtmic kind are amongst the most
common results of nerve injury. I have seen them over
and over again, and, for my own part, am inclined to con¬
sider them as an almost invariable sequel of nerve lesion.
It is difficult to understand how they have been missed by
many observers; I suppose because they have not been
looked for. f rom my own observations, I should say that
within a time varying from one to six weeks after injury
to a nerve, the joints will usually be found somewhat stilt.
The finger joints have seemed to me to be much more liable
to be affected than those of the wrist and elbow, and this
not only in cases of injury inflicted low down in the fore¬
arm, but also when the wound has been in the upper arm.
Usually, but not always, this stiffness has supervened
without causing the patient any pain, and, from the fact
that the affected parts are often both anaesthetic and
partially paralysed, theetiffening of the articulations not
infrequently escapes the notice of the patient himself. For
several weeks the stiffness increases, and the movements of
the joints, both active and passive, gradually diminish.
Finally, there appears to be a tolerably firm fibrous ankj-
losis. The future of the case depends to a great extent on
the condition of the injured nerve and on the patient him¬
self, for, if the hand be not used, the stiffness is likely to be
much more persistent than if resolute attempts are made to
overcome the fixation of the articulations. If the divided
nerve resume its functions, the joints are much more likely
to again become movable than in coses where no reunion
occurs. In many cases they entirely recover, but in others,
in spite of all treatment, permanent stiffness results. There
is much in the condition of these joints which is suggestive
of chronic rheumatism.

It is but rarely that an opportunity is afforded for an
examination of tne diseased articulations, and I am only
aware of one case in which the results of such an examina-

1 Injuries of Nerves, p. 169. . .. .

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MR. ANTHONY A, BOWLBI ON INJURIES OP NERVED

[MAX 31. MRr

tion have been recorded. The case I allude to is one by
Blum, 1 in which the joints of a man whose median nerve
had been divided several years previously were examined
after death. The cartilages were thinned and softer than
natural, and there was some cell proliferation. The articular
bone also was rarefied. In 1382 I had the opportunity of
examining the hand of a man whose median nerve had been
injured about eighteen months previously. An examination
of the hand after amputation showed that the nerve had been
wounded above the wrist joint, and that a fragment of wood
was still buried in its substance. The finger joints were one
and all much stiffened. On opening those of the middle
finger the capsules were found to be thickened, and the car¬
tilaginous surfaces of the most distal joint united by fibrous
tissue. The terminal joint of the ring finger was firmly
ankylosed, the union being by bone, and so firm as only to
yield to cutting instruments. Microscopically examined, the
cartilages were all thinned, and their normal matrix replaced
in part by fibrous tissue.

With regard to the bones, I have not myself met with a
case in which any definite change could be assigned as the
result of nerve injury. Instances have, however, been
detailed by Blum, Ogle, and Arnozan. 3 In the cases collected
by these authors the chief alteration appears to have been
a simple atrophy of the osseous tissue, such as might not
improbably result from simple disuse. Thus shortening of
the femur is mentioned as a result of injury to the sciatic
during childhood. In one of Ogle’s cases, however, there
was not only thinning of the bones of the hand in a case of
section of the median nerve, but also bony union between
the radius and ulna at their lower ends. Considering there¬
fore the paucity of information on the subject of bone lesions
due to nerve injury, I think it may be concluded that they
are of comparatively rare occurrence.

Such is a brief account of the various trophic changes
that may follow on nerve injury. Instances of them are
sufficiently numerous to allow'most surgeons to become more
or less acquainted with the more common of them, and
although I might quote in detail numerous cases in support of
the above descriptions, it is needless to enumerate them here.
What is of more importance is to inquire into the manner
in which section of a nerve trunk so affects the tissues to
which it is distributed; and on this point opinions are much
at variance. The following are the chief theories:—1. That
the changes are due to section of vaso-motor nerves, and
consequent irregularity of the blood supply. 2. That they
are due to non-use of the paralysed parts. 3. That they are
due to irritation of the oentrifugal fibres set up by the
injury. 4. That they are due to the removal of a special
influence exercised by the nerves on the nutrition of the
tissues.

The first of these theories lias been very extensively
supported, but may, I think, be disproved. The argu¬
ments adduced in its favour, have been mainly founded
upon incorrect views of the vaso-motor system, and
conclusions have been incorrectly drawn. It is well
known that section of vaso-motor fibres results in the
congestion and rise of temperature of the part to
which they are supplied, and it has been rather hastily
assumed that these changes may readily overstep their
bounds and pass on to inflammation and destruction of the
affected tissues. Tliese conclusions were drawn on the sup¬
position that the vessels of the part remained permanently
in a state of suffusion. Such is not the case. It has been
definitely proved by experiments on animals 4 that the
vessels of any part are not entirely dependent on their con¬
nexion with the medulla oblongata for their nerve supply,
but that local vaso-motor centres are present, which are
capable of regulating the calibre of the vessels after section
of all nerves connecting the latter with the brain and spinal
cord. The ear of a rabbit in which the cervical sympathetic
has been divided will gradually return to its normal con¬
dition, and the former rhythmical contractions of the blood¬
vessels may again be perceived. The temperature also
gradually approximates to that on the opposite side, and
subsequently the ear or else the limb of a vertebrate animal,
which after section of the main nerve wasmarkedly hotter than
its fellow, will gradually become colder by several degrees. It
will thus be seen that, while the trophic changes may last a

1 Those d’Ajjrc^ation.

* T)«s L£«ion* TropfilquM etm«4cunvf* ansi Maladies in SvitSme
Nerveu*.

* Lister: Phil. Tran* , 1668. GelU: Pfluger t Arcliiv, volt. viii. and

*L. 1875. '. ic a!*

considerable time, the condition which is supposed to give rise
to them gradually passes away. Again, while the vessels
are turgid and swollen the ear of the rabbit does not atrophy
or inflame. On the contrary, the hair grows more luxu¬
riantly (exactly, the reverse of that on an extremity whose
main nerve is divided) and the nutrition of the .whole part
is improved. So much, then, for the experimental evidence;
but that afforded by pathology is none the less clear in its
refutation of the claims made for the influence of the vaso¬
motor nerves on nutrition. If it can be shown that in
certain cases vaso-motor paralysis exists without trophic
lesions the independence of these two conditions might be
considered demonstrated. Now the first of these conditions
is undoubtedly present in a large number of cases of in¬
fantile paralysis. It has been shown of late years that the
seat of the lesion in these patients lies in the anterior horns
of the grey matter of the cord, and most probably in the
ganglion cells which are found in this situation. Further,
it is well known that many of the vaso-motor nerves leave
the spinal medulla by the anterior roots as low down as the
eleventh dorsal. These nerves, then, are a priori likely to be
affected by the lesion in the cord, and it is a matter of clinical
observation that the skin over the paralysed muscles is gene¬
rally congested and its temperature raised, although later on
it becomes cold and blue. But infantile paralysis is never
accompanied by changes in the nutrition of the skin, always
excepting chilblains. There are no subcuticular whitlows,
no herpetic eruptions, no loss of hair, and no glossy fingers.
Yet, were these lesions dependent on loss of a proper vaso¬
motor supply, we might fairly expect to find them present
in at any rate a certain proportion of these cases, whereas
they are conspicuous by their absence. And, on the other
hand, we have the testimony of the best authors to prove
that trophic changes may be present and the vaso-motor
supply still intact. On this point Weir Mitchell* * writes:
“If the vaso-motor nerves were alone responsible for the
existence of all the lesions which follow nerve wounds, it
would be reasonable to expect always to meet with some
rise or fall in temperature. Such, however, is not the esse,
and I have frequently met with profound trophic changes
unattended by thermal perturbations, and the same remark
has been made by other neuro-pathologists." , 5J

With regard to the second theory, that the wasting and
degeneration are due to non-use of the part, it will be well
to turn to the case of the muscles, and the claims made for
this explanation may be readily set aside. The moat dis¬
tinctive characters of the atrophy following division of a
motor nerve are the rapidity of the onset and progress, and
the fact that it is accompanied by “degeneration” of the
muscle-fibres, so that the affected muscle will not react to
faradism, but will do so to galvanism. Now, on the other
hand, we have innumerable cases of injury to the spinal
cord, of hemiplegia and paraplegia, in which, so long as no
destructive disease is in progress in the cord below the seat
of the lesion, the paralysed muscles maintain very nearly
their normal bulk and do not give the degenerative reactions
to electrical stimuli. Yet these muscles are equally powerless
as those whose motor nerve is divided, so that, were Hie
atrophy due to simple non-use, it ought to accompany the
one lesion as frequently as it does the other.

Both the third and fourth theories involve the belief in
the presence of a direct nervous influence over the process of
nutrition, and may be considered together. From an ana¬
tomical point of view, the distribution of the terminal nervous
filaments to the cells themselves of the different glands, to
muscle and connective-tissue fibres, Ac., would render it
extremely probable that they are intimately concerned both
with their functional and vital powers, and a well-known
experiment lends proof to this supposition. If the fifth
nerve of a rabbit be divided within the skull, the section i*
followed in about twenty-four hours by a cloudiness of the
cornea, and subsequently by a destructive inflammation of
the eyeball, frequently by ulceration of the mucous mem¬
brane of the lips, gums, and nose. Considering that division
of the fifth nerve necessitates an anaesthetic condition of the
corresponding Side of the face and of the parts involved in
the inflammatory process, it seemed at first quite probable
that the destructive changes occurring in the eye were the
result of an inability to perceive and remove any irritating
substances which might be lodged upon it. Snellen accord¬
ingly reinvestigated the subject, and expressed his belief
that, with due care in protecting the eyeball, the subsequent

£ Op.ciw

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MR. ANTHONY A. BOWLBT ON INJURIES OP NERVES'. [Mat 21,1897. '1003

inflammation might be avoided. Hia results have not, how¬
ever, been obtained by others, and more recent investiga¬
tions by Merkel have placed the matter in a rather plainer;
dght This observer states that the fibres, division of
which causes the inflammatory conditions above described,
are collected together in a small bundle on the inner side of
the fifth nerve. If they alone be divided, while the rest of
the nerve is intact, sensation of • the corresponding side of
the face it not lost, bat destructive changes occur as before;
and, on the other hand, if this bundle beleft, but the rest of
the nerve be divided, no trophic troubles follow, though
anesthesia of the face ensues. It is therefore assumed
that the small tract of fibres alluded to are essentially
"trophic."

‘ The numerous experiments bearing on the secretions of
saliva by the submaxill&ry gland also tend to prove the
reality of the trophic influence of nerves. When all of those
supplied to the above-mentioned gland are divided, and
a so-called “ paralytic ” secretion is set up, the gland tissue
ultimately degenerates. This degeneration is not due to
ca seation of function, for the gland continues to secrete so
long as it ie able. It may also be proved that secretion
(which is but a variety of nutrition) may be started by
stimulation of the nerve going to the gland, under the most
varied conditions of blood supply, or even in the entire
absence of any such fluid. It therefore appears that, in the
p r ese n ce of a copious blood supply and of a continuance of
the functional activity, division of the nerves will yet cause
an atrophy of the gland structure; while, on the other hand,
the presence of the nerves alone is sufficient for the tem¬
porary maintenance of tiie salivary secretion, or, in other
words, of the nutrition of the salivary gland.

The argument that the lesions of the skin are doe to
physical causes, such as pressure, beat, Ac., applied to an
snmtbetic part, cannot be maintained in its entirety. I
have already stated that in some of the oases which nave
come under my own notice, some external injury has been
the starting point of an ulcer or inflammation of the finger;
but this is not the case in all, and does not, indeed, apply te
many of the trophie changes, such as loss of hair, herpetic
eruptions, and others that might be mentioned. Again, in
these cases lesions occur while the patient is under observa¬
tion, and frequently while the extremity is bound up in
bandages, Ac., which obviate all external influences.
Lastly, ulcers, whitlows, Ac., are more particularly prone to
make their appearance very early after the date of the
nerve injury, whilst the aiuesthetic condition of the skin, to
which they are supposed by some to be due, is much more
permanent, and indeed exists under conditions such as
manual labour, &a, which might fairly be expected to pre¬
dispose to inflammatory conditions in a part insensible to
pain. Yet, as the anesthet ic co ndition outlasts the tendency
to trophic change, the latter can soarcely be said to be
dependent on the former. Many of these arguments have
already been need by Dr. roore in Tim Lancet of May 19th,
1877, and to his paper I am much indebted for many
suggestions.

Against the theory of the trophic influence of nerves, it
bar been argued that some tissues- e.g., cartilage and fat—
whose nerve supply is either very scanty or entirely absent,
get along very well under such conditions, and that there¬
fore nutrition -is independent of neurotic influence. Such
is by no means n ece ss a rily the ease, and, indeed, the changes
which occur in the above-mentioned tissues after nerve
section argue the contrary. Further, it is no argument to
say that because any tissue maintains its nutrition, although
unconnected with the nervous centres, therefore those which
ere supplied by nerves can afford to do without, rt is only
fair to suppose that the more highly developed a structure
the mere dependent ft is on the accurate working of every
component part.

All other theories failing, we are therefore driven back
to the conclusion that the nerves exercise a direct trophic
influence over the tissues. Where, then, is this influence
generated, and what are the conditions essential for its
integrity? These questions may be briefly answered by
st a ting that so long as any tissue is connected to a healthy
nerve centre by healthy nerve fibres ite normal nutrition is
preserved. Each tissue, then, has its own centre of nutrition
m the ganglion cells from which its nerve fibre springs, the
tisane, the fibre, and the cell being oonsidered as Dr. Poore
puts it—to be one nutritive unit. One question which offers
ttmlf for solution is whether the ganglion on the posterior
root acts as a centre for nutriti ve functions; bat the answer.

must bo that, though it may do so, yet all the trophic
impulses are oertainly not generated in it, as is proved by
the fact that many of them follow lesions of the cells in the
cord itself.

But it may be considered necessary to still further localire
the situation of the trophic cells of each fibre, and it only
remains to be shown that the latter are not situated higher
up the cord than the point at which each of the nerves takes
its origin. Simple section of the spinal cord, however, above
the point of junction of any particular nerve root, does not in
any way interfere with the nutrition of the parts to which the
same is distributed; whilst, on the other hand, buy lesion
involving the nerve cells, from which the fibres take their
origin, results in trophic changes in the peripheral ■ tissues.
Thus it has been shown by Charcot, in his “ Leyons sor lee
Maladies du Systems Nerveux,”thatinhemiparaplegia therp
results, on the same side as the lesion, atrophy and degene¬
ration of muscle with disease of the joints, and on the
opposite side anaesthesia with acute bedsore, and MM.
Dejtfrine and Leloir, in the Archives de Physiolegie tor, 188L,
have demonstrated that in cases of acute decubitus the
nerves themselves had undergone a degeneration, thus
placing the tissues to which they were distributed in a con¬
dition similar to that which results _ from_ nerve section.
Again, in infantile paralysis, a disease in which the cells of
the anterior cornu undergo destructive changes, atrophy
of the muscles is the most marked symptom, and there can
be no doubt that the nerve fibres also degenerate, for trans¬
verse sections of them show an increase in the connective
tissue and a corresponding diminution of nerve fibres. This
condition is evidently the result of a degeneration of the
motor nerves, their atrophied remains being seen amongst
the normal sensory fibres.

But, granting that the nerves exercise a special control
over nutrition, the nerve injury may be supposed to affect
the latter in one of two ways: first, by irritation of the
trophic fibres; and, secondly, by cutting off the permanent
trophic influence which is constantly supplied. Professor
Charcot is at present the most notable supporter of the first
view; others who formerly held to.it, foremost of whom
is Dr. Weir Mitchell, having given their adhesion to the
latter explanation. In this particular Charcot follows the
teaching of Samuel, who thus states his opinion: “The
sudden increase in the action of the trophic nerves beyond
their ordinary physiological action occasions a rapid de¬
velopment of all nutritive processes throughout the part!
to which they are distributed. Acute irritation of these
nerves gives birth to a series of abnormal products simply
because it stimulates’ to tbe highest degree the nutritive
processes. The tissues suddenly tumify, the cells increase
rapidly, they divide and multiply, and hence the forma¬
tion of new structures, which no longer resemble the
parent one. We are accustomed to name this tout
ensemble of phenomena inflammation.” Under this
belief Charcot states his opinion that muscnlar atrophy
occurs most frequently “after contusions, junctures,
and incomplete sections of the nerves — that is to say,
after traumatic causes which are most liable to produce
neuritis, or at any rate neuralgia”; and this is also his
opinion as regards other trophic lesions following nerve
injury. But this theory is in no way borne out by facts,
and I have no hesitation in saying that in by far the large?
number of nerve injuries which I nave examined, and which
have shown trophic lesions more or less marked, the section
has been complete, and there has been no reason whateve?
to suspect any neuritis or neuralgia. Moreover, in moBt of
the cases described by other writers similar conditions have
existed. This explanation of Samuel, then, is theoretical •
but even on a theoretical ground it falls through; for, ad
Vulpian has pointed out, the nerve fibres below the seat of
section or other injury rapidly degenerate. How, then, can
they convey the necessary irritative impulses? I think,
therefore, that it may safely be assumed that nerves do exist
which exert a direct trophic influence upon the tissues, and
that the currents which convey the same are constantly
passing. The only question that remains to be considered
is whether the existence of special nerve fibres is
necessary for the conveyance of trophic impulses, or
whether the ordinary sensory and motor tracts suffice.
It has been shown that there is nothing incongruous in the
idea that any given nerve fibre can convey currents either
centripetally or centrifugally, so that there is no primd facie
reason why the nervee of motion and sensation should not
be amply sufficient for the purpose. And, considering that

G

o

trophic disturbances very rarely, if ever, occur without
some interference with the sensory and motor functions,
there is strong probability that the same fibres are capable
of conveying the different impulses which are generated in
the centres. This point, however, requires further investi¬
gation. ■ , _

STRETCHING THE SPHINCTER IN
, APOPLEXY . 1

Br JOHN W. TEALE, MA.Oxon., F.R.C.S.

Ow June 8th, 1886, I was summoned by a gentleman
to see his wife, whom he had brought from the Midland
Counties to place under my care. The lady, aged sixty-four,
looked very ill, and. was in a highly nervous state. She had
a waxy, , yellow complexion, and. looked wan, anxious, and
careworn. She said she h ad suffered m uch from constipation,
bad had severe attacks of what she called “ angina pectoris,”
and that she lived in perpetual dread of having accumula¬
tions in the bowels, from which she had suffered. She was
clearly possessed of considerable intellectual powers, and
when she could forget her physical troubles she was bright
and animated. My routine treatment of mild alteratives,
stomachics, and aperients proved a complete failure. Mild
remedies were ineffectual; more severe ones produced vomit¬
ing. So after a few days of fruitless efforts to relieve the
bowel3,1 examined per anum, and found, as 1 rather antici¬
pated, a very tight sphincter. With considerable difficulty
I passed a finger through it into the rectum, which I found
distended and loaded with hardened fteces -the cause, no
doubt, of the straining, discomfort, and sense of weight.
In her feeble health, with shattered nerves, an irritable heart,
and albuminous urine, an operation seemed inadmissible.
Failing this, I could see no course open except by careful
and repeated castor oil enemata, &c., to gradually unload
the lower bowel and break down the accumulated mass.
For some days this was persisted in, with more or less
success. Several times a considerable quantity of old faeces
was removed, and often the patient had some gleams of
returning health and spirits. July 7th, however, proved
a very trying day. No relief could be obtained. In the

evening Mrs. E-, with her maid's assistance, gave herself

two injections, which were ineffectual, in spite of con¬
siderable straining. About 10 p.m. she became very restless
and excited, and almost beside herself, wandering from room
to room, scarcely recognising those about her, constantly
making attempts to relieve the bowels. About 6 a.h. on
July 8th, whilst on the night-stool, her maid noticed
her face twitching, and, on getting her into bed, she 6aid
that these twitch ings increased until they amounted to
violent convulsions, which continued at intervals. I was
sent for, and saw her with my friend, Mr. Beverley, at
6.50 AM. We found her with slight but well-marked
symptoms of paralysis of the left side of the face, which
gradually became more decided in character, extending to
the left arm and leg. The pupils were regular, somewhat
contracted, slightly sensitive to light. There was no i
stertor, but insensibility was complete. Every few minutes
there was a convulsive attack, commencing with twitchings '
of the left side of the face, extending gradually to tne
left arm and leg, and then becoming general over both sides 1
of the body, and gradually relaxing without pursuing any i
•definite order. A copious enema of soap and water and i
olive oil was given, which was retained. At 10 a.m. the ]
enema was still retained, the convulsive attacks continued .
every few minutes, were more frequent and violent, and ,
insensibility complete. On examining per anum, hardened
ffeces could be felt floating about in the enema fluid, though, 1
even in her insensible condition, so tight was the sphincter 1
that the finger could only be passed through it with diffl- ■
culty, nor would it allow a drop of fluid to escape.

Happy thought why not operate now ? In this insensi- 1
ble condition no ether would be required. Nothing could be
worse or more hopeless than the present state of things;
any change must be for the better. So I stretched the ‘
sphincter freely. Immediately the enema fluid poured out,
followed by a copious mass of offensive fasces of various
stages of antiquity. The convulsions continued as bejfore.

1 Paper read before the Leeds and West Riding Medlo-Cblrurglcal ’
noddy, Nov. eth, ism. . rA ■ |

-At 11 a.m. some beef-tea and forty grains of braonde
-were injected and retained. At 1 p.m. this injection mi
repeated. The urine was drawn off by catheter, and on
boiling was almost solid albumen; and ice was applied to the
head. The convulsive attacks continued pretty regularly
until 130, when they ceased after the second doee of bromidt,
and there were slight natural movements of the right side,
but none of the left. Temperature 103°;. pulse 120, small and
weak. In the evening there was another extensive actum
of the bowels; patient still unconscious.

July 9th.—Fair night; no return of convulsions; bowel*
again acted freely. Pulse 110; temperature 993°. Hu
slightly moved her left leg. Suppositories given at interval*.

9th.—10.30 a.m. : Patient can swallow sips of water;
seem8 to recognise her husband. Ioed water given to
moisten the lips.

10th.—When Mr. Beverley saw her at 6.30 A.M. she bad
passed a restless night; pulse very poor and scarcely
countable, about 200; respiration 40. She looked very like
sinking, but revived with some essence of beef, with a few
drops of brandy added, which she could now swallow.—
9 a.m. : False rallied, more regular, 110.—11.30: Suppoptpries
continued. Essence of beef and iced milk and soda given.
Gradual return of consciousness after fifty-four hour*. Look*
eagerly for fluid. . , r<

The urine bad to be drawn off by catheter forthenszt
three or four days, but the amount of albumen soon becaas
merely nominal.

Mrs. E-slowly recovered. For some days she pi*-

placed names and words. The right side of the hodysooa
regained power, the left more slowly, and still reaaiM
markedly weaker than the right. In about three weeks dm
returned home. She has again recently visited Scar¬
borough for two or three weeks. The bowels now set easily
and naturally without purgatives. She suffers much at
times from mental depression, but is clear and animated,
and can walk a mile with her husband, sit in a boat-jwkh
him whilst he catches codlings, and lives out in a fistk
chair the most part of the day.

P.S.—1 hear that Mrs. E-died at her home aboct s

month ago. During the early winter she was able toget
out in a Bath chair, and, except for fits of extreme despon¬
dency, was fairly well, and had little discomfort froartbe
bowels. I think the operation lengthened her life for
nearly a year, and also relieved her from sufferings The
fact that prolonged constipation from any cause is Pi im¬
portant factor in causing apoplexy, when the arteristPMts
are degenerated, has long been recognised—an argu m en t ,no
doubt, for the early and effectual surgical relief of affcatioua
of the rectum, where they are found to exist. > •- o
Scarborough. ' ! ' •

COCAINE DOSAGE AND COCAINB
ADDICTION . 1 '• '

a il! . * . i

By J. B. MATTISON, M.D. k ...

The recent sad story of the Russian surgeon’s suitfdtfam
sorrow or remorse due to his belief that a patient laiirfied
from an overdose of cocaine points a moral, the impact, of
which demands more than a passing notice. No ifiapl in
the therapeutic arena during the last decade kp bMi
attended with such varied and extensive claims for'flKtPor
as cocaine. Its marvellous effect in ophthalmic ktjigirj
roused a spirit of experimental research in other dlrec^P*
which has added largely to its well-proved power fOp, (gift;
but, as has been well observed, a potency for good iaffbM
potency for harm, and the risk impends of it* artmt
advocates being carried by over-enthusiasm * '

limit of a safe regard for the welfare of their
themselves, that may imperil an otherwise well
success. Surely it is high time to draw the
revoice a warning as to the use and abuse of th
but at the same time toxic drug, lest the roll of
dangerous, and fatal effects from its ignorant
tious use be sadly extended, and a reaction
by creating distrust within and without the
will damage its good repute, and binder its use
where it would be almost certain of serving ns —

The Lancet,] DR. J. B. MATTISON: COCAINE DOSAGE AND COCAINE ADDICTION. [May 21 1887. 1025

the need of this seems all the more called for in view of
opinions expressed during the past year, in certain quarters,
affirming the harmless character of cocaine—opinions-which,
I am convinced, are at variance with well-accredited facts,
and should not be allowed to pass uncontradicted.

Cocaine seems to have secured for itself a more than usual
share of attention apart from the professional press. One
metropolitan daily, in particular, has again and again given
its columns to a discussion of the topic, and in a somewhat
lengthy article not long ago an “eminent but unnamed
specialist”—Dr. Francke H7 Bosworth —was reported as
®»ying, “There is not a well-authenticated case on record as
yet where cocaine has effected injury.” In view of cases
cited in this paper, and others elsewhere recorded, such a
statement is no longer tenable, and any conclusion based
thereon as to the harmless nature of cocaine is misleading
and incorrect. And the evidence herewith presented weighs
even more heavily against an assertion by Dr. Wm. A. Ham¬
mond, at a recent meeting of the New York Neurological
Society, in the course of his “Remarks on Cocaine and the
so-called Cocaine Habit,”-when, after narrating his taking of
eighteen grains as a Subcutaneous dose, he asserted “ he did
not believe any dose that could be taken was dangerous.”
What might be the outcome of such an opinion put m prac¬
tice ? The Russian surgeon’s error of judgment, fatal to his
patient and himself, was largely due to his reliance on the
asserted use by other surgeons of large doses without ill
effect. Might not a like result follow an incautious depend¬
ence on Dr. Hammond’s disbelief in the toxic power of
cocaine? The Medical Record (New York) well said of
Professor Kolomnin’s case, “ The experience, though so sad,
may not be without its lesson,” and put a very pertinent
query as to whether “there are not other surgeons who could
report very serious if not fatal results from injudiciously or
ignorantly using too large a dose of cocaine/ Fifty cases
herewith noted attest a power in this drug on some patients
that warrants caution with all.

Germane to the subject of acute cocaine toxaemia is that
of cocaine addiction—these notes are preliminary to a more
extensive paper on cocaine inebriety, —the existence of which
Dr. Hammond denies. He took ha f a dozen doses, at intervals
of from one to four days, and says “he acquired no habit.”
But to argue from that that there is no danger of addiction is
absurd. Such evidence is worthless. Dr. Hammond might do
the same-thing with morphia; more, he might take morphia
subcutaneously daily-for a month or two without creating a
“habit”—albeit its ensnaring power is well admitted,—and
yet that would not prove its freedom from danger. Not at
all; it would merely show his exceptional strength to re¬
sist Many, under a like pressure, would surely succumb.
Supporting this opinion, I quote from the last report of
Dr. Orpheus Everts (Cincinnati Sanitarium), a gentleman
well known in alienistic circles, which report was kindly
sent me after my paper wa* written, who says: “ A distin¬
guished physician of New York has recently reported per¬
sonal experiences tending to discredit the claim that a
cocaine habit corresponding to the morphine habit is
acquirable. The judgment of this distinguished physician
is based upon the evidence of personal experience re¬
ported by niinself, he having failed to acquire the-*habit,
or any especial fondness for the specific effects of the
drug experienced by the hypodermic injection of one,
two, three, and finally eighteen grains of the salt, on
five or six different occasions in the evening before
going to bed. But for the great reputation of this phy¬
sician as' an author afid observer of facts, this denial
would have but little weight. The testimony is both bad
and insufficient. Bad, because reported by himself: the
testimony of an intoxicated person respecting his experiences
while intoxicated being proverbially untrustworthy; and
insufficient, because the experiment was not continued long
enough. Many instances might be cited of total failure to
establish the morphine habit or habitual drunkenness by
the use of six or seven doses of morphine, or six or seven
drinks of whisky, one a day, for six or seven days in succes¬
sion. It is often the case that such experiences end with
disgust for the drugs used, instead of a desire to continue
their use. There is also much and accumulating testimony
bv competent observers to the fact of such a habit as u
alleged respecting cocaine, which a single opinion will not
invalidate, nowever worthy of consideration.

, Cooainism is hot the outcome of using the drag at long
intervals. Its transient effect and the demand of an im¬
paired nerve status compel frequent taking—more than

alcohol or opium,—so that habitiUs have been known to .
take it ten, twenty, or more times daily; and ibisthia—
growing by What it feeds on—that tends to create and con- ■
tinne the disease. In the early days of chloral one point
claimed in its favour was a freedom from risk of “habit,” a ■
claim long ago exploded, as cases of chloralism well prove;
and yet I venture to assert that there are more cases of
cacaine taking in this country to-day—less than three years
since its arrival—than of chloral after a period more than
Bix times as long. Dr. Hammond says there may be in¬
stances of cocainism as rare as chronic tea taking, and of cases
with or after habitual alcohol or opium using; but, aafor giving
up the use of the drug, be believes every cocaine taker could
if he chose. The same opinion regarding opium obtains
among some medical men, and the only effective argument
against such a fallacy is to place those who hold it under
ower of that drug, and then have them prove their precept
y their practice. While admitting that most instances of..
cocaine taking are, for obvious reasons, in, those who have
been or are alcohol or opium habitues, especially the latter,

I maintain there are cases of pure, primary addiction, and that
the number is increasing at home and abroad. Foreign
writers have noted them, and they will figure in our records.
Notes of orfe such are here given; others are at command.
My experience with a number of cocaine cases makes to me
two things certain—there is a pernicious power per »e in
this drug, and it finds in the opium habitui a peculiar con¬
dition that specially favours its ill effects, making it, for
such patients, as has well been said, the “ devil's own device”"
to still further enslave. And this opinion is that of others,,
for it is the testimony, without exception, so far as I know,
of those who have had to do' with this disease, that as an-
intoxicant cocaine is more dangerous than alcohol or opium,,
and that inebriety resulting from its use is more marked
and unyielding than any other form. Dr. Shrady, in the-
Medical Record of Nov. 28th, 1886, says: “To some persons ,
nothing is more fascinating than indulgence in cocaine.. It
relieves the sense of exhaustion, dispels mental depression,^
and produces a delicious sense of exhilaration and well- .
being. The after-effects are at first slight, almost imper- .
ceptible, but continual indulgence finally creates a craving
which must be satisfied; tbe individual then becomes
nervous, tremulous, sleepless, without appetite, and he is at
last reduced to a condition of pitiable neurasthenia.” Dr. A.

B. Shaw, Physician to St. Vincent Asylum for the Insane, St.
Louis, asserts: “Once a man flies to cocaine for relief from * cares ; _
that annoy,’ he generally continues with such rapid strides'
towards such complete subjugation to its bewitching thral¬
dom as but few will ever be rescued from by any power oL
will which they may be able to bring to their aid.” ^Dr.
Everts writes: “ It is not only not an antidote to opium,
poisoning—or, more properly speaking, the organic demand,
for such drug effects as have been acquired by use,—but is,
itself a fascinating and dangerous intoxicant, tbe effects of
which may be more difficult to counteract and renounce
than are those of opium or its derivatives." Dr. Hughes,
declares it “a remedy to be used with extreme caution and
prudence internally, and the large doses reported as having,
been given are not ordinarily safe. It will bear watching.-
It crazes and kills quicker than opium. The possibilities
for immediate harm are only not great, bub the likelihood of >-
remote damage when tolerance is established is not small*
The cocaine habit, more pernicious than the morphine*
neurosis, is the certain entailment of its frequent admini-v
stration, and its thraldom is far more tyrannical than the
slavery of opium.” Erlenmeyer calls cocaine the third scourgs
of humanity, alcohol and opium being the first and second *„
and Erlenmeyer is right as to toxic neuroses. He says*
“Its characteristic effects are vaso-motor paralyeis, accele¬
rated pulse, profuse sweats, dyspnoea and syncope, failure of
general nutrition, eyes sunken, skin cadaveric, with mental
trouble that sometimes needs restraint”; and 1 am positive,
from cases under my care, that he is correct. I think it for
many, notably the large and enlarging number of opium
and alcohol habitude, the most fascinating, seduct ive, dan-,
gerous, and destructive drug extant; and while admitting its
great value in various disordered conditions, earnestly warn
all against its careless administration in these cases, and
especially insist on the great danger of self-injecting, a
course almost certain to entajl added ill. To tbe man who
has gone down under opium, and who thinks of taking to
cocame in the hope of being lifted out of the mire, I would
say, “ Don’t,” lest he sink the deeper, i have yet to lean)
of a single instance in which such an effort reached success,

- Digitized by G00Qle

1028 The Lancet,] DR. ANGEL MONEY ON TYPHOID FEVER AND MENINGITIS.

[May 21,1887..

but know of many cases where failure followed, or worse—
cocaine or coca morphia addiction. And the need of caution
against free and frequent use obtains in other cases, for
there may come a demand for continued taking that will
not be denied.

To summarise. Cocaine may be toxic, sometimes deadly,
in large doses. It may give rise to dangerous, or even fatal,
symptoms in doses usually deemed safe. The danger, near
and remote, is greatest when given under the skin. It may
produce a diseased condition, in which the will is prostrate
and the patient powerless—a true toxic neurosis, more
marked and less hopeful than that from alcohol or opium.,
Such being my belief, I regard Dr. Hammond’s statements
mistaken and his conclusions rash and dangerous.

Brooklyn, Now York. _ _

MANIPULATION WITHOUT INCISION AS A
POSSIBLE TREATMENT IN CERTAIN
CASES OF STONE IN THE
KIDNEY.

By WILLIAM II. BENNETT, F.R.C.S.

In connexion with the recent discussion on Renal Surgery
atrthe Clinical Society, the following ease—which, had time
allowed, I intended to have mentioned—presents, 1 venture
to think, some points of interest.

An unmarried woman, thirty years old, of a spare habit
and nervous disposition, came under my care as an out¬
patient at St. George’s Hospital in September last, com¬
plaining of symptoms which led me to suspect that she
was the subject of a calculus in the left kidney. At the
same time she presented several indications of “ hysteria,”
and stated that she occasionally suffered from fainting
attacks, which were quite unconnected with the symptoms
on account of which she applied for treatment. Upon
examining the abdomen, which was very thin, deep
pressure over the left kidney caused considerable sharp
pain and threw the superjacent muscles into rigid con¬
traction. The kidney could be distinctly felt and moved
with the hand, and seemed of the natural size and form.
Taking into consideration the hysterical tendency of the
patient, I was unable to decide, in the absence of any very
marked abnormality in the urine, with the exception of a
very slight deposit of mucus and pus, whether the case
was really one of renal calculus or not. Seeing, however,
the ease with which the kidney coull be felt, partly by
reason of the thinness of the patient, I determined, as drug^
afforded no relief, to ensure complete relaxation of the
abdominal parietes by the administration of an amosthetic,
and then manipulate the kidney as freely as possible, with¬
out previously exposing it by incision, with a view, if the
case were one of calculus, to disturbing the stone, and, if it
were not too large, perhaps bringing about its passage
down the ureter, or, in the event of the symptoms being
“hysterical," with the hope of producing a mental effect
upon the patient sufficient to relieve her distress. She,
however, declined the antithetic, and 1 was compelled to
attempt the manipulation without its aid. The patient
having been laid on her back upon a couch, the fingers of
my left hand were dipped deeply into the abdominal wall
over the kidney, the right hand being pressed forwards into
the loin. By a little management, the muscles being quite
flaccid from the patient having become faint, the kidney
could be felt quite easily between the two hands, and was
kneaded as thoroughly as the circumstances allowed. The
patient, although much discontented with the aching and
tenderness which the operation seemed to have caused, was
Well enough to walk away almost directly afterwards.

Two days later she reappeared at the hospital in a more
grateful mood, saying that, having suffered much discomfort
for the rest of the day after the manipulation, she was
seized as she was going to bed with a most acute pain in
the affected loin and side of the abdomen. The pain lasted
for about half an hour, during which she vomited twice. Ali
at once an uncontrollable desire to micturate occurred, and
the pain immediately ceased. No further pain followed,
and there can be little doubt that a small calculus had made
its way down the ureter into the bladder, although no
evidence of its having passed “per urethrara” was forth¬
coming. Moreover, it is quite possible that the tiaampula-

tion had moved the stone from its resting place in tbs
kidney, and thus brought about its expulsion.

' I am aware that an isolated case like the above cannot be
taken to necessarily provemuch, since the passage of the cal ta¬
lus may have been a mere coincidence; at the same time l am
strongly disposed to attribute the result to the manipulatioB.
This view receives some corroboration from a case which njia,
under the care of one of my colleagues, in which the kidnsy
was exposed and examined without the detection of a stoqe,
although shortly afterwards an attack of renal colic wu
followed by the expulsion of a very small calculus, whick
had probably been disturbed during the exploration.. Other
similar cases have, I believe, occurred. As bearing on the
same point, I may here say that it seems most probable
that when relief has followed the exposure and manipula¬
tion of the kidney without the detection of a stone, the
result has been due to an alteration in the porttKm
of the calculus produced by the kneading to intich
the organ has been subjected. That calculi of cotuiderebU
size may be overlooked both in the lumbar and comhued
abdominal and lumbar operation for exposing the kidney
when the organ is examined by the fingers only is certain,
and it is, I believe, from our experience at St. Georgs’!
Hospital, equally certain that only stones of the ama&t
size can escape detection when the kidney is thoroughly
explored by acupuncture an operation which has been at
present associated with risks which are hardly more than
problematic, and at all events less serious than the danger
which exists of overlooking calculi of no small sice When
digital examination is alone employed. Manipulation of
the kidney through the parietes without previous infflifoa
is possible in certain cases, the number of which is far l|iHt
than is generally supposed, when the abdominal wa&^i*.
not too much loaded with fat, and the muscles have pen
completely relaxed by the administration of an Hntwrtlidttv
Indeed, I believe the kidney to be, as a rule, far pin
movable and less fixed in the loin in the living sobjectjibla
it is usually described to be. In conclusion, I y
suggest that manipulation without incision i
ceeding worthy of trial as a treatment which
sibly prove of utility in certain caees of renal
not too far advanced, a9 a means of changing the „ ,

of the stone and perhaps effecting its expulsion—a p
sibility, to my mind, sufficiently strong to commend
process to the attention of physicians as an adjunc
the medical treatment of renal calculus.

Chesteriied-itreet, Mayfair, W.

WILL THE KNEE JERK DIVIDE TYPHOID
FEVER FROM MENINGITIS : |

By ANGEL MONEY, M.D., M.R.C.F,

ASSISTANT PHYSICIAN TO THE HOSPITAL FOB SICK CHILDREN AND 10
THE VICTORIA PARK Oil BBT HOSPITAL.

Dr. Hughlinqs Jackson asserted a month ago at ibe

Medical Society of London that loss of the knee jerk miffht
prove of service in the diagnosis of meningitis from typhoid
fever, for he had never known the knee jerk to be absent
in typhoid fever, whilst he had found it to be wan tang'll
cases which the necropsy ultimately proved to be meningijT
Our “friend in need,” the knee jerk, indeed, appears'
considering its apparent triviality of as much, if not
value than almost any other clinical phenomenon.

At the same meeting of the Medical Society at wl
Dr. Jackson’s announcement was made. Sir Dyce Do
worth seemed to put a damper on the President's sug]
by asserting that the knee jerk might be absent
doubted typhoid fever. Two years ago I recorded]
Thh Lancet my experience of the reflex actions and i
nervous phenomena in typhoid fever, phthisis, and >
continued fevers (pp. 843 and 1069, vol. ii., 1885), and I
only add that further experience does but confirm w‘
then stated to be the condition of the reflexes and mu
in these various diseases. The suggestion forces itself i
us that prolonged pyrexia with all that it involves, wl
in the way of direct deterioration of protoplasm by
fever heat, or of indirect deterioration of the same
collateral consequences of the pyrexia, is the causal
the very general exaggeration of the deep reflexes and m|
cular irritability to be found in the diseases mention#!.

1028 The Lancet,]

CLINICAL NOTE3.

The breathing now became deep and regular, and colour
returned to the cheeks and lips. He seemed to sleep until

7 A.M., when he roused and asked for some toys. At 7.30
there was an extremely severe seizure, caused apparently by
a sudden profuse secretion of mucus in the fauces. This
collection, after a tremendous effort, he swallowed. He
spoke of some water which he saw in a class standing on
the mantelpiece six or eight feet from him, but was not
affected by looking at it. Another attack threatening at
7.35, I again gave one-tenth of a grain of morphia. He
remained quiet, talking occasionally, and vomited some
brown fluid. At 7.60 he inquired whether I had gone away,
and then asked to be held so that he could see the gas. At

8 a.m, without loss of consciousness, there was a clonic
convulsion of the left arm and of both hands. Both thumbs
were flexed into the palms, but not firmly. Secretion in
fauces more and more profuse, but no spitting. Breathing
consisted of violent shallow inpirations, rapid expiration,
and long pauses. Vomiting of brown fluid continued, which
was now darker and contained altered blood. At 8.30 a.m.
a grand attack was imminent. Morphia was again given,
after which he dozed. No further violent spasms, but
constant starting and continual vomiting. Pupils slightly
contracted. At 10 a.m. come® muddy, and commencing
ulceration of lower external quadrant on left side. Pro¬
fuse muco-purulent discharge from conjunctive. Large
quantities of grumous fluid vomited. No further secretion
of mucus in the fauces occurred. He lay quietly in bed, dis¬
turbed from time to time by convulsion of the left side of
the body and face until now, when in a violent and general
convulsion he died.

I have detailed this case with what may seem tedious
minuteness; but while it falls to the lot of but few prac¬
titioners to observe any considerable number of cases of
hydrophobia, there are scarcely any opportunities for
observing the disease in infancy. This fact may be my
excuse. It is only in childhood that the course of the malady
is uncomplicated by the mental condition arising out of
knowledge of the inevitable termination close at hand; and
although this condition is often, if not generally, betrayed
by tut few outward signs, it cannot fail to influence the
psychical symptoms manifested.

Shanghai.

Clinical Hobs:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

A CASE OF HAEMOPHILIA.

By Hebbbbt W. Page, M.A. Cantab, F.R.C.S. Eng.,

LSCTURKR ON SUHGKRY, 8T. MART'S HOSPITAL. '|

The publication by Dr. Skelton of his “ Three Cases of j
Haemophilia in the same Family ” induces me to publish a
clinical note of a case recently under my care in St. Mary’s
Hospital) where the patient was a member of a family in j
which ten members, males and females, of three successive j
generations were hemophilic, and in which there was some
departure from the ordinary rnle of transmission.

A yoiing man aged twenty-two, tall, anemic, And thin,’
was admitted with an extensive swelling of the left thigh
reaching from the knee to the groin, andfrom its physical'
characteristics evidently dne to blood extravasated beneath;
the muscles. Seven weeks previously he had been laid up ;
with so-called rheumatism in bis left knee, which left it'
stiff; and five days before admission he had stumbled and'
fallen, and his leg was bent forcibly under him. It seemed to}
him as if “the flesh was being torn irom the bone”; he suffered'
gteat pain, and the thigh rapidly swelled. We very early}
suspected he was a bleeder, and learned from him that her
hwibad profuse hemorrhage at one time from, the extrac¬
tion of a tootb, that he was subject to epistaxis, had bled?
furiously some two years ego from the openiner of

abSceas, and three
weeks With a «we3
thought at first to
was an intra-artta
Stab constSSS
pofttf** the

the opening of

ITs before had been laid up for many
g of the right knee, which, he said, was
% sarcoma, but which in all probability
i hemorrhage. His high temperature,
^tenderness with some redness at one

iaiinNiPMVKppnratiofi mm

supervene; and as the necessity for making an incisimttop
above all things to be avoided, the limb was plaoOdvtt
perfect rest on a Macintyre splint, after having been
fully bandaged from toes to groin. He was soon easte^tl*
swelling at once began to diminish, and in seven weeks kfcd
entirely gone, some slight stiffness of the knee kiito
remaining when he was discharged at the end c£
month e. ‘’rh

His family history was very carefully worked oat bjr'iiy
dresser and friend, Mr. Davis; and although it was mr
possible for him to see the various members of the tud) ,
he nevertheless elicited the following facts. Patera*!
grandparents healthy ; maternal grandmother was isssliy
life a bleeder, though in what precise way it was not kho^a.
She and her husband were not related to each othafciBr
were her own parents. She bad eleven children, otwgkt
the first, second, fourth, sixth, seventh, and eigbfMift
males) are dead—a startling mortality; bat whether auJWM*
bleeders or not it was impossible to discover. As, howto,
the ninth, a living male, is a bleeder, it seems probahli ton
some of hie elder brothers may have been bleeder! Mb
One of these brothers had died in infancy, and
known to have died of haemorrhage. The third, c
tenth, and eleventh (females) are alive, and all are bkmto.
The third child, and eldest daughter, now aged sixty,i$Sk
patient’s mother, and some of her children alone, of taMM*
generation, are, so far, bleeders. Her family consists caffe
daughters and three sons. The three eldest are dan{MM>
all bleeders, if a history of severe epistaxis and tator
bleeding is sufficient to establish this fact. The fuiMl
the patient; then come a daughter and two sons, of totto
none are bleeders. It is true that these three, the yaM 1
brother and sisters of the patient, may perchance aflKMk'
have bad the opportunity of showing their diathesis, jgm
may be hoped that their immunity is an indication tflMto
hemophilia is tending to die out. What may hafton*
the original cause of tbe hemophilia in the first getMMP*
it is of course impossible to say; but this pedigree tfMto-
at any rate, a good example of a morbid diathesis betototo
rapidly developed to an extreme decree in tbe Wt 1
generation—so much so that the children were aflMN'
certainly from tbe third down to tbe very yotoli*
member (the eleventh) of ih j family; and possibly detinue
again, and it may be disappearing altogether, in tWtol!*
generation, the three youngest grandchildren not "Mag
affected. Of the fourth generation, there are two, 'ttoifr
and a female, children of the patient’s eldest sister, irifetoe
not bleeders. A noticeable feature, also, in this hiftowls
tbe fact that males and females seem to have been ajRto
in an equal degree, contrary to the supposed usual naHtot
the males alone or moet chiefly suffer, and that iMp
males inherit the disease it is through their motheBjHto
themselves remain unaffected. ■

ThbLancbt,]

CLINICAL NOTES.

[Mat 21, 1887. 1029

■tion, for visiting the patient, avoided touching him, and
-took a bath immediately after my visit. On our arrival
at Adelaide those of the passengers who had reached
their destination were placed in quarantine, and the
boat in which the patient WUs (who was now becoming con¬
valescent, the scabs commencing to fall off, showing well-
marked “pits”) lowered into the sea, and taken off to
a separate island to undergo his quarantine. We sub¬
sequently arrived at Sydney, where we were placed in
quarantine for three weeks, the time to date from our
arrival at Adelaide. All the rest of our passengers were
landed on the quarantine ground at Melbourne and Sydney.
Tue patient, who had never been vaccinated, had con¬
fluent small-pox, highest temperature 104°, never had any
delirium, ana made a good recovery. At the commence¬
ment of disease there was an uncertain history of vomiting
and pain in the back. The “ secondary fever" was well
marked. None of the passengers, officers, or crew subse¬
quently contracted variola. 1 believe the main factor in
preventing the spread of the disease was the early isola¬
tion of the patient. Variola, never easy to diagnose, is
rendered much more difficult in hot climates. 1 have seen
cases of “ prickly heat" closely simulating variola, and a
mosquito bite which has not been scratched has exactly the
bard, shot-like feel of a papule in small-pox. Of course
these cases will not have the constitutional disturbance
which variola usually has, though I have seen constitutional
symptoms iu bad cases of prickly heat, and these symptoms
in modified variola are sometimes, at any rate at the com¬
mencement of the disease, very slight. I can strongly
recommend the treatment of patients suffering from variola
in a bbat which is partly covered in, thus forming a tent,
provided the climate is suitable.

The Australians have a great dread of variola, yet vac¬
cination is not compulsory amongst the inhabitants. The
e&nitarjr authorities made a great point about the vaccina¬
tion of our passengers and crew. All who had not been
successfully vaccinated within two years had to undergo
the operation or remain in quarantine for an indefinite
period. Some of the quarantine regulations are very strict,
but in other matters the sanitary authorities are lax.

Ald-mey-street. 8.W._

CASE OF THYEOTOMY FOR EPITHELIOMA OF THE
LARYNX.

By W. R H. Stkwabt.

AURAL SURGNON TO THK GREAT NORTHERN CENTRAL HOSPITAL,
SURGEON TO THE LONDON THROAT HOSPITAL, ETC.

B. E-, aged forty-five, a chimney sweep, came under

my care in 1883. A slightly-made, delicate-looking man,
married, no children; does not remember bis parents; one
brother and two sisters living, all healthy; no history of
hereditary taint; had been a sweep from boyhood; had
suffered from difficulty of breathing for the last six months,
which was much worse lately; paroxysmal cough; had lost
fieeb. When first seen there were marked laryngeal stridor,
harshness of voice, and severe attacks of dyspnoea. There
were no enlarged glands in the neck. Laryngeal examina¬
tion revealed & rather large, irregular growth, springing from
below the right vocal coni, and projecting across the larynx.
A portion removed by laryngeal forceps and placed under the
microscope proved to be epithelioma. A preliminary tracheo¬
tomy was performed, and when the patient was sufficiently
recovered, the growth being large, thyrotomy was determined
)n. Ether having been administered and a tampon tube
nserted in place of the ordinary one, the superficial struc¬
tures were divided in the middle line, the thyroid cartilage
was then carefully cut through in its whole length with a
cnife (there was no ossification), and the alse drawn aside
with retractors. Through this small opening the tumour
was seen to be growing from the under surface of the right
?ocal cord, and involving the soft tissues around. It was
leized with forceps and as much as possible of the tumour,
with the voeal cord and adjacent structures, cut away with
imall curved scissors; the remains of the growth were then
>craped away with a sharp spoon, and solid nitrate of silver
ipplied. The haemorrhage was rather profuse at first, bat
◦on stopped. The alse were then carefully adapted and
>rought together with silver sutures, strapping applied to
he external wound, a drainage tube inserted, aud antiseptic
Lresaings need. The tampon tube was left in for twenty-

four hours, after which an ordinary tube was used for a
couple of days. The patient was entirely fed for the first
weelc by nutrient enemata. There was no sign of peri¬
chondritis, and the patient made an uninterrupted recovery.
At the end of the fourth week, when he left at his own
desire for domestic reasons, the external wound had com¬
pletely healed and the internal one was cicatrised over, but
up to that time he had not regained his voice. The cartilages,
however, having firmly united, would lead one soon to
expect a complete return. There was no sign of a recurrence
of the growth.

I unfortunately lost sight of the case, as I was obliged
soon after to leave England on account of my own health,
and subsequent inquiries have failed to find the man.
Where possible, either the above operation, or removal of
half the thyroid, as illustrated in a case recently published
in a medical journal, is, 1 think, preferable to the extremely
fatal one of excision of the larynx. I' strongly advise
preliminary tracheotomy with retention of the tube for
some days after the operation, and also feeding per rectum.

Devonshire-street, W.

' HERNIOTOMY IN A VERY YOUNG CHILD.

By J. Lionel Sthbtton.

H.G-,bom July28th, 1886; male child. OnAug.l6ih

a swelling was noticed in the right scrotum; this was found
to be a rupture, and was reduced by my assistant. On
Aug. 25th the rapture again appeared, and all attempts at
reduction failed. Faecal vomiting set in, and the child was
evidently losing ground. There had been no evacuation,
and, so far as the mother could tell, no passage of flatus
since the rupture appeared, thirty hours previously to my
seeing him. Under such circumstances I determined upo»
immediate operation. Chloroform was administered and an
attempt made to reduce the rupture; this failing, I made
an incision over the swelling about three-quarters of an inch
in length, and exposed the bowel, which was an exceedingly
difficult proceeding in such a small space. The stricture,
which appeared to be situated at the inner ring, was exceed¬
ingly tight, and required two or three nicks before the
bowel, which was in a healthy-looking state, could be re¬
duced. Silk sutures were employed and the wound dressed
with oiled, lint. Ordered half a minim of tiQCture of opinm
every four hours; the mother to continue suckling.—
Aug. 27th: Passed flatus last nigh*; no sickness since opera¬
tion. Temperature normal. Takes breast well. Wound
looks healthy.—28th: There wore two natural evacuation*
during the night. Child seems quite well. A little local
inflammation round the wound.—Sept. 1st: The bowels
have acted regularly. Sutures removed. Slight gaping.—
7th: The wound has quite healed; the child has gained
much in flesh, and appears to be quite well. There is no
bulging, even on violent crying.

Remarks .—This case is remarkable on account of the age
of the child, the immediate subsidence of all symptoms after
operation, and the rapid recovery. I have been unable to.flnd
any account of operation in so young a child; but when
I.take into consideration all. the disadvantages I laboured
under in this case I should not despair of success in even
younger subjects. He was the child of poor parents, and
was brought to my house for me to examine him, and know¬
ing that he was in better air and surroundings 1 operated
at onoe, and he was carried home in a blanket, and certainly
did not receive any skilled nursing afterwards, nor was it
possible to prevent the dressings being soaked in urine.

Kiddermln*t*r. _

A BARE COMPLICATION IN A CASE OF PLACENTA
PRJ5VIA.

By GbobqU D. Logan, M.B. & C.M. Ed.

.In July last I was called to see a woman who lived four
miles away, and who was said to be in labour and bleeding
to death. On arrival I found her blanched and in a cold
sweat. Her pulse was quick, irregular, and feeble. I was
informed by an attendant that the patient, who was a
primipara, had fainted twice, and that the pains were
neither so strong as they had been, nor so frequent. She

i030 The Lancet,]

HOSPITAL MEDICINE AND ’SURGERY.

£May 21,1887.

had an attack of bleeding about three weeks previously for
the first time, but it was not severe, and there had been a
recurrence of it on one or two other occasions. It was now
excessive. On examining per vaginam the placenta was
found presenting and slightly detached on the left side, but
the os uteri was not very dilatable. Considering this,
together with the facts that the liquor amnii had escaped,
and that I could not discover the foetal heart sounds, I made
up my mind to detach and extract the placenta, thinking it
would give the best chance of recovery to the mother.
After having detached the placenta, I could not, however,
extract it, but the bleeding was considerably diminished.
I now plugged the vagina with lint and administered ether
hypodermically, as the stomach rejected everything imme¬
diately after it bad been swallowed. On removing the plug
about half an hour later, the os uteri was more dilatable.
There was still considerable haemorrhage, so I determined
to turn and deliver the child. While passing my hand into
the uterus the latter suddenly contracted, and after this had

S assed off the uterine surface felt warmer than the placental,
ue no doubt to a renewed flow of blood from the uterine
vessels. After turning, the child was easily delivered, but
it was dead. It now became evident why the placenta
could not be extracted; it was intimately adherent to the
head of the child. As nearly as could be calculated, the
surface of attachment measured in diameter about two
inches and a half, and the situation of its centre was a point
a little below- the posterior fontanelle. The neck of the
child was very short, the head having the appearance of being
attached to the trunk, without neck at all. The forehead
receded very much, so that the supra-orbital ridges became
very prominent, as were also the eyes; the bridge of the
nose extended upwards beyond the eyes and separated them.
The cord was quite natural both at its origin and insertion,
and in every other respect the ohild, which was a male, was
well developed. The mother made a good recovery.

Heolefeoban, Dumfriesshire.

% lltirror

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nulla autem est alia pro oerto nosoendl via, nisi quamplurimas et mor-
fconitn et dlsseotlonum histories, turn aliorum turn proprias oollectas
habere, et later se oompemre.— Morgaqhi Dt Sed. it Cain. Morb.,
lib. Iv. Prommlum. -

: ST. GEORGE’S HOSPITAL.

A COMPLICATED CASE OP INTUSSUSCEPTION IN A CHILD;

OPERATION AFTER SEVENTY-TWO HOURS; DEATH;

NECROPSY; REMARKS.

(Under the care of Mr. Dent.)

The treatment of intussusception is a subject which has
occupied the attention of practical surgeons for years.
Whether to proceed immediately to the performance of
abdominal section on the failure of the injection of air or
fluids into the bowel, or to try again these methods even
though the patient is in extremis , has been, and still is in
many cases, a doubtful point with practitioners. There is
no doubt that an early abdominal operation is more likely to
be successful than one performed later, when the patient is
exhausted by vomiting and early peritonitis. Still, there are
cases in which the employment of injection of air or fluid
has succeeded when the intussusception has recurred after
reduction, and in which this treatment has ultimately
proved successful. The difficulty is to determine when the
case is one of incomplete reduction or of complete reduction
with recurrence of the original condition of intussusception.
.yt* would refer our readers to the remarks on this case.

Annie 0-, aged six months, was admitted on JatL 31st

30th, under chloroform, the same plan of treatment vu
again adopted. The tumour appeared to be to a great extent
though qot entirely reduced, for it still could be felt through
the abdominal walls. Next day the tumour came down u
low as before, and the child being worse she was sent to the
hospital for operation.

On admission there was evidence of rather severs abdo¬
minal pain and peritonitis. The vomiting was tolerably
constant and the obstruction complete. The tumour could
easily be felt through the wall of the rectum, low down in
the pelvis, but its extent could not be ascertained. In view
of the peritonitis it seemed highly improbable that the in¬
tussusception could be reduced, and it was decided to open
the abdomen at once under an anmsthetic. An incision two
and a half inches in length was made in the middle lino
below the umbilicus. As was expected, the distended coils
of intestine protruded immediately the peritoneum w&a
opened, and throughout the operation gave the greatest dif¬
ficulty. Search was made in the neighbourhood of the right
eacro-iliac joint for the obstruction. A double coil of empty
small intestine now came into view, and on being traced out
was found to be about fifteen inches in length and to pees
down to the left side of the pelvic cavity. Farther exami¬
nation revealed that this loop of gut was tightly constricted
by the sharp edge of a fold of mesentery attached to the
ileum, this portion of intestine being buried deeply down
in the pelvic cavity. The sharp constricting edge was cot
and the portion of small intestine forming the intern!
hernia released, though not without difficulty. The child
was now so exhausted that it was necessary to proceed with
the utmost rapidity. Attention was next tinned to the
intussusception, which proved to be ileo-colic as well M ileo-
cffical, and six or sight inches in length. The ctecom k;i>
the middle line opposite the first vertebra of the mcrom,
while the transverse and descending colon were dragged
down and stretched across the brim of the pelvis on the lef'>
side. The entering gut was pretty firmly adherent to the
intussuscipiens, and considerable traction was required to
draw out the intussusception. The peritoneal coat ww
slightly lacerated in two places in releasing the intestine-
The apex of the caecum, together with the vermiform
appendix, was also invaginated upwards into the aacendiBg
colon, the whole of the appendix being buried; this second
invagination was easily drawn down. The invaginated
bowel was dark, and patches of it were rough from lympb.
By hooking the fingers under the upper angle of the wound
and lifting the abdominal wall well up, the protruding intes¬
tine was easily reduced and the wound closed as quickly m
possible. The child, who was almost moribund after the
severe operation, rallied considerably after a while. T* 19
pulse returned, the limbs became warm, and she began to cry -
About rive hours later, however, she died very suddenly.

At the necropsy, the coils of intestine were found to l*
lightly adherent together. The lumen of the intestine mi
pervious throughout, but the coil of gut that had formed
the internal hernia was still empty and flaccid. The edg*
of the ileo-csecal opening was stretched and thickened, «d
the mucous membrane ulcerated. There was no blood in
the peritoneal cavity. The other organs were all healthy.

Remarks hy Mr. Dent.— No cause could be assigned for
the intussusception, and the child had previously been a
good health. In view of the condition of the parts fom>4
at the time of operation and at the post-mortem examine-
tion. it is hard to believe that the first attempt attadnchw
really relieved the obstruction at all. the internal hem*
Mo doubt, was a secondary affection, and resulted from

early. The noticeable points of the caSri art— (f) that t»
intussusception was ileo-colic as well as ileo^caecSl-' ^2)
complicated nature of the obstruction; and (8) that it vu
possible to reduce this completely by operation. Irt f ffrtei^
tusausception such as in this case, in which vomitingoecarr
early, abdominal section, to n^y mind, offert the rid?
jlpect of relief. After thirty hours f
diminishes. The case was from
romptly, and orthodox treatment ^viar

--MM

Tn Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Mat 21,1887. 1031

intussusception than in other forms of obstruction, and this
record may therefore prove instructive. The hope that the
invagination may slough and come away is a very delusive
one; for, as Mr. Treves has pointed out, only a small pro¬
portion of patients in whom this occurs actually recover.
Obviously in this case the obstruction would still have
existed, even though the intussusception had sloughed off.
The greater the number of cases recorded, the more will
knowledge advance; and the more knowledge advances, the
more will the principles that guide the treatment of internal
«nd external strangulated hernia tend to assimilate.

CROYDON INFIRMARY.

A CASK OF ACUTB INTERNAL STRANGULATION.

<Under the care of Mr. F. W. Clark, UR.C.P., MJLC.S.).

‘ F. B-a Polish Jew, aged twenty-nine, was admitted

into the infirmary on Tuesday, July 6th, 188G, at 5 p.k.
He was a fairly well nourished man, a painter by trade,
4*nd on admission he complained of great pain in the abdo¬
men and intense thirst. His face had a drawn and anxious
•expression; there was pallor of the surface; the tongue
dry and coated; and he lay in bed on his back with his
knees drawn up, and was evidently in great suffering. The
abdomen was distended and tympanitic, and was tender all
over, but especially so over the hypogastric region. The
pulse was small, hard, and rapid—“wiry,”—and the respira¬
tion thoracic. The patient dated the onset of his illness
•from the previous Saturday (four days), on which day he
had partaken largely of some tinned salmon, and since that
meal he had suffered from pain in the abdomen, which had
gradually increased. There was no history of vomiting, but
it was elicited that his bowels had not been opened since the
onset of the pain in the abdomen. There was no external
hernia. The patient asked repeatedly for a catheter; a
No. 10 silver English catheter was accordingly passed into
the bladder without any difficulty, and four ounces of clear,
high-coloured urine were drawn off, containing no traces
of blood. Turpentine stupes were at once applied to the
abdomen, and he was given a grain of opium by the mouth;
and was ordered two drachms of brandy every half-hour,
diluted with small quantities of warm water. During the
night the patient twice got out of bed to get to the night-
stool, and, with much straining, he passed abont two ounces
df very dark-coloured fluid blood. Vomiting set in at 8 p.m.
the patient bringing up at this time the brandy which had
been given him, and ho continued to vomit intermittently
until his death at 1 a.m., eight hours after admission, the
vomited matters not becoming stercoraoeous until within
an hour of his death.

, At the necropsy, made thirteen hours after death, a large
«nass of gangrenous small intestine was found lying in the
pelvic cavity, while the rest of the bowel was matted
together by recent lymph. The gangrenous bowel was
found to have been strangulated by a rounded fibrous
cord, about an inch and a half in length, stretching
between two adjacent coils of small intestine in such
a manner as to form a loop through whieh the strangu¬
lated bowel had passed. This band had evidently been
formed by the stretching of an old peritonitic adhesion of
the intestine.

liemark* by Mr. Clark.- Apart from the comparative
rarity of such cases of acute internal strangulation, this'
case, I think, presents several features which are of especial
interest. One is so apt to look upon frocal vomiting as in¬
separable from strangulation of the bowel, whether external
or internal, that the marked absence of this symptom in the
present case until the patient was in extremis, rendered
the cause of the peritonitis at first very obscure. The per¬
sistent reference by the patient of all his pain to the bladder,
coupled with the marked tenderness over the hypogastric
region, suggested a rupture of that viscus as the possible
oauae of the peritonitis, but the result of the catheterisation
completely negatived such a conclusion. Another feature
which adds an interest to the case is the nature of the
strangulating band. It is well known that fibrous adhesions
of adjacent segments of bowel, the result of an old peri¬
tonitis, will, under the influence of the peristaltic contrac¬
tion of the bowel, gradually elongate to form bands of
fibrous tissue stretching across the peritoneal cavity,
and these bands or cords may, as in the present
■case, occasionally prove the direct cause of an in¬

ternal strangulation. It is most probable that, had the
atient been seen earlier—for he bad been ill for four days
efore admission, yet had sought no medical advice,-—and
had the condition been correctly diagnosed, an abdominal
section, followed by the division of the strangulating band,
might have been the means of saving his life. Other point*
of interest in the case are: firstly, the fact that the patient
was a painter by trade, and so liable to attacks of Intestinal
colic; and, secondly, the suspicion of irritant poisoning,
which wag excited by the history that the symptoms dated
from the time at which he had partaken largely of some
tinned fish.

DORSET COUNTY HOSPITAL.

A CARR OF SUPRAPUBIC LITHOTOMY.

(Under the care of Mr. A. Ekson.)

For the following notes we are indebted to Mr. F. J,
Malden, house-surgeon.

R. W-, a quarry man, aged sixty, residing at Portland,

was admitted on Oct. 14th, 1886, with symptoms of stone in
the bladder. The symptoms had not been severe, but had
been present over a period of four years. It was only a few
days before he came to the hospital that he was obliged to
give up his work, on account of frequency of micturition*
hmmaturia, and pain after the act of micturition.

* At the time of admission the urine was alkaline, specific
gravity 1020, no albumen, muco-pnrnlent. The stone was
readily detected by means of a No. 8 sound with small
curve, and the ring heard distinctly. The stone, which
seemed to fit in the concavity of the sound, was situated in
the right lower part of the bladder. The attempt to pass
the grooved “staff” dn two previous occasions having failed
on account of the enlargement of the prostate, it was deter- 1
mined to remove the stone by the suprapubic instead of the
lateral method. The operation was performed on Jan. 11th,
1887. The rectal bag was first inserted, and twelve ounces
of warm water introduced with a syringe; the bladder was
then distended by means of eight ounces of carbolic lotion
(1 in 1000), and the penis tied with a soft rubber catheter.
An incision was now made abont three inchee long in the
midde line, coming well down oil to the front of the
pubes; after this the tissues were separated by means of a
director, handle of scalpel, and finger nail until the
wall of the bladder came in view. There was no heemor-
rhage to speak of, no vessel needing ligature. The hook
used in this case for elevating the walls of the Madder was
one found particularly serviceable (it was made by
Ferguson, and intended for cases of laryngotomy); on the
convex surface of it is a groove (like a miniature staff), into
which the point of the scalpel was inserted, and an incision in
the bladder wall made direct from the point of puncture of
the hook large enough to admit the finger. The stone was
easily felt, and removed by means of a small pair of
lithotomy fores ps. A drainage tube was inserted into the
bladder, but it slipped out during the night, and was not
replaced. No sutures were placed in the walls of the
bladder, but two in the upper part of the abdominal wound,
which was dressed with absorbent cotton wool.

On the day of operation the evening temperature was
101°; next day, morning 100 4°, evening 101°; the follow¬
ing morning 99 •0°, evening 100*4°. From this time the
temperature remained about normal. There was a free dis¬
charge of urine through the wound. No catheter was passed
until Jan. 25th, when a soft rubber one was tied in; this
after the second day, however, set up urethritis, and was,
discontinued. The after treatment consisted in placing the
patient alternately on one side or the other as much as pos¬
sible, to encourage drainage. The wound was dressed with '
boradc lotion (1 in 80), and tbs urine absorbed by means of
sponges and absorbent ootton wool. The patient’s progress '
was satisfactory, bat slow; the wound granulated, but
cicatrisation took place slowly. On Feb. 6th (twenty-
seven days from operation) twenty ounces of unne were
passed through the urethra, being the first time it had
flowed naturally since the operation. The abdominal wound
now began to contract more rapidly. The stone was a ,
mulberry calculus covered with phosphates weighing five
drachms. The handle of the scalpel used was made of
tortoiseshell rounded off at the end and bevelled to form an
edge, and was admirably adapted for separating the tissues
in this case.

PATHOLOGICAL SOCIETY OP LONDON.

[Mat 2T, 1887.

WOLVERHAMPTON GENERAL HOSPITAL.

MULTIPLE ANEURYSMS OF THE ARCH OF THE AORTA.

For the following notes we are indebted to Mr. Arnold
Evans.

R. L-, aged thirty-seven, grinder, having been seized

with sadden illness whilst at work, was brought to the
Wolverhampton General Hospital, bat on arrival life was
found to be extinct.

At the necropsy it was found that the pericardium con¬
tained about fifteen ounces of clotted blood. The heart,
with the aorta and aneurysms attached, weighed about
eighteen ounces. Apparently the aortic valve was com¬
petent, but its cusps were distinctly thickened. The ascending
and transverse parts of the aortic arch were enormously
dilated and thickened; and springing from the flrat part
of the artery immediately above the valve were three
aneurysms, each communicating with the artery by a narrow
orifice: one sprang from the anterior surface of the vessel,
and pointed downwards and forwards towards the origin of
the pulmonary artery overlapping the appendix of the right
auricle; the other two, each about the size of a walnut and
situate close together, projected backwards under the aortic
arch and compressed the pulmonary veins. One of these
last mentioned had ruptured into the pericardium, forming
an orifice which barely admitted the tip of the little finger,
and had ragged and attenuated edges. About an inch higher
up was a cluster of three aneurysms, each slightly larger
than those above described, but resembling them in that each
communicated with the artery by a narrow mouth; two pro¬
jected forwards and the third to the right. Another aneurysm
arose from the upper part of the arch; this was a little larger
than the others, and had thin walls; from its aide sprang the
brachio-cephalic and left carotid arteries. There were
several other small aneurysms in addition to those just
described. All contained a small quantity of laminated clot.
At the commencement of the descending part of the arch
the aorta resumed its normal oalibre, and in its onward
oourse contained only a few small atheromatous patches. The
mitral valve was competent, but its curtains were slightly
thickened. The hypertrophy of the left ventricle was by no
means great. There were no other aneurysms in the body.
The only other morbid change in the organs was an
cedematous condition of the lungs.

. The most interesting point in connexion with the above
case was the complete immunity (with the exception of a
slight cough for a few days) from any serious or distressing
symptom, until the time of the man’s sudden death.

ebiral Societies.

PATHOLOGICAL SOCIETY OF LONDON.

Multiple Neuro-fibromata and Mo Hus cum Fibrosum.—
Sarcoma of Pelvic Fascia. — Cerebral Hcemorrhage m
a Child with Thrombosis of Sinuses.—Fibrous Contraction
■ of Stomach. —Subpleural Lipoma of Diaphragm —Rickets

the patient could remember. There was also a tumour, tbw
size of a walnut, in the left axilla, formed on the brachial
plexus; it gave rise to much nerve pain in the arm. It went
on increasing in size, while the skin tumours varied, some
new ones being formed, while others wasted and almost-
disappeared. During the last few months of lire there was
a marked diminution in their number. The patient died in.
August, 1886, with symptoms of violent summer diarrhoea.
A partial necropsy only was possible, but all the chief organs
were found healthy. The left brachial plexus was removed,
and on dissection by Mr. Sbattock there were found,
besides the large tumour, a number of-smaller ones, vary-

■ _ AiMA /mam m nnmawla n«i womaiis vmafs

- the Parasitic Theory of Cancer.—Bones from Congenital
Syphilis. ' *

The last ordinary meeting of this Society was held on
Tuesday last, Sir James Paget, Bart., President, in the chair.

Mr. Charters Symonds read the report of the Morbid
Growths Committee on Mr. Hutchinson's specimen of Tumour
of. the Lower End of the Femur shown at the last meeting.
The committee came tothe conclusion that the morbid
process was of an inflammatory nature, and most probably
the result of syphilitic poison. Drs. Coupland and Payne
and Mr. Bowlby were the other members of the committee.

Dr. F. J. Payne showed specimens from a case in which
Fibro-Neurom&ta . co-existed with Mollitscum Fibrosuzn.
The patient, a woman aged forty-three, bad been under
observation fqr some years as a well-marked, case of mol¬
lusc um fibrosum. The surface of the body was nearly
covered with small, soft, fibrous tumours, from the sise of a
pin’s head to that of a hazel-nut—some pendulous, some
sessile, some umVr the skin. They had existed as long as

fibre-nsuromata, consisting of nucleated fibrous tissue, hi
the midst of which the nerve-fibres could be traced. It was
not possible to examine other nerves thoroughly, but the
right brachial plexus appeared healthy. The skin-tumours,,
which were seated chiefly in the corium, but some in the-
subcutaneous tissue, consisted of fibre-nucleated tissue, the-
larger ones containing broad fibrous bundles with, lacunae.
To ascertain the connexion of the tumours with the nerves
sections were made by Mr. Sbattock, and stained with oemic
acid, as well as with other dyes; but though nerve-fibres
were seen near the small tumours, none could be traced
entering them, and the fibrous masses contained no nervoua
struct urea At the same time, the possibility of the fibroua
growths originating in the sheaths of nerves, as in the in¬
ternal nerve-tumours, could not be disproved. These
observations, therefore, only partially confirm thoee of
Recklinghausen, who, in his classical memoir, ** Die Molti-
plen Fibrome der Haut” (1882), first noticed in two caser
the coincidence of fibroma molluscum of the skin with-
multiple fibrous tumours on the nerves, and explained the
former as being neuro-fibroma of the skin.

Mr. Leopold Hudson showed a Sarcoma of the Recto
Vesical Fascia. The patient was a man twenty-eight years-
of age. There was no family history of tumour. The first
symptom, seven months before his death, was pain on defe¬
cation, and on rectal examination a bilobed tumour feeling,
like an enormously enlarged prostate was found. Five-
weeks after its first appearance cutaneous nodules deve¬
loped. The tumour grew rapidly, filled the pelvis, and
extended upwards into the abdomen causing lancinating
pains and severe vomiting. There was no albuminuria,
and the constipation was overcome by purges. He died
emaciated. At the necropsy the tumour was found to
weigh seven pounds and a half, was distinctly encapsuled.
and originated apparently from the layer of recto-vesical
fascia which investing the vesiculm semin&les passes across
the space between the bladder and the rectum. Examination
proved the growth to be a small spindle and round-celled,
sarcoma, which had in part undergone development into a
myxomatous tissue, ana showed also areas of retrogression
with mucoid cyst formation.—Dr. Collier mentioned a case
in a young woman who, after a fall one month previously,
experienced severe pain in the left iliac region, where a.
swelling.formed, and there was considerable fever. In¬
flammation with cartes was diagnosed, and an incision wan
made and much blood evacuated from the pelvis. The tumour
proved to be sarcoma, and the specimen was shown. The
total duration of .the clinical course was apparently only ten
weeks.

Dr. Handford read a case of Cerebral Haemorrhage in w
boy aged five, following thrombosis of the venous sinuses..
Drawings of the brain and preparations of the vessels of
this case were shown. The chief symptoms had been head¬
ache, constipation, and frequent vomiting. There was no
dryness or discharge from the ears. The breathing became
stertorous three or four hours before death, which took place-
ten days after the commencement of the illness. There was-
no sign of head injury or disease of the ears. The veuoua
sinuses were thrombosed, the superior longitudinal and
lateral sinuses containing adherent decolourised clots. The
superficial cerebral veins were also.thrombosed, and felt like
whipcord. There were numerous hemorrhages on the
surface of both hemispheres; two of them —viz., those in
the left ascending parietal convolution and in. the right
temporo-sphenoidal lobe—being very extensive, and plough¬
ing up the brain substance to a considerable depth. There
was ground for supposing that the hemorrhage oc cur red'
only a few hours before death. No cause for the thrombosis
could be ascertained, neither could the raptured vessels her

Dii

ThbLancbt,]

PATHOLOGICAL SOCIETY OF LONDON.

[May 21,1887. 1033

found. The cause of the haemorrhage was assumed to be
Abe increased vascular tension from the thrombosis of the
sinuses; but whether the vessels that gave way were
arteries or veins was left an open question, though
Dr. Handford inclined to the latter view.—Dr. S. Wilks
had seen fire or six cases of thrombosis of the cerebral
mnusee in young women suffering from severe anaemia, and
an all there were hemorrhages: the cause was probably in
the blood.—Dr. Co up land bad seen one oase of thrombosis
■in the cranial sinuses in cancer, and he referred to Dr. Bright’s
{taper on the subject.—Dr. Obd had seen thrombosis of the
-cranial Minuses in a case of acute rheumatism, in which
.phlebitis developed in the neck and arm on one side. There
-was haemorrhage into the brain. Changes in the condition
ml the lining membrane of the vessels were perhaps opera¬
tive in the causation.—Dr.T. BARLOwreferred to the possible
source of the haemorrhage. In one oase of a child who had
.marked anaemia and cachexia from whooping-cough and
ulcerative bronchitis (bronchiectasis)—in all the cases he
■had seen there had been a long continued cachectic con¬
dition—there was a large haemorrhage which might have
proceeded from rupture of a large vessel, but there were
innumerable small punctas of haemorrhage in the oarebral
cortex, and the large haemorrhage was probably a great mass
of the small haemorrhages. Sir William Jenner had told
him that he considered the source of the haemorrhage was
the small venules, and was the result of the venous stasia

Dr. Chablkwood Turner showed a specimen of Stenosis
of the Stomach due to Fibroid Thickening; there was
chronic ulceration of the anterior wall, but the whole
•stomach was seamed all over by fibroid tracts.

Mr. F. W. Clark showed a Subpleurai Lipoma taken from
a woman aged sixty-five, in whom it had caused no
symptoms. It was a lobulated tumour (lipoma) springing
from the diaphragm and projecting into the right pleural
cavity, without adhesions. Normally there was a growth of
fat attached to the diaphragm on the right aide anteriorly,
and this outgrowth of fat from the diaphragm might go
d the physiological bounds.

Bland Sutton made a communication on Rickets in
Animals. The bones preformed in membrane were much
thickened, and the diptoe absent. The reverse of this pro¬
cess obtained in the cartilage-formed bones, they being very
much thinned. The lions of Manchester and Dublin did
not became rickety. Paraplegia developed in carnivorous
rickets as the result of the epiphysial plates of the vertebras
becoming greatly overgrown. The tentorium cere belli was
enormously ossified; instead of being a thin plate of bone, it
had become a veritable exostosis. Reference was made to
the case of a cub which at two months of age became
paraplegic. The tentorium was greatly ossified, and there
was great dilatation .of the cerebral ventricles as occurred
in the brain in hydrocephalus, and due to interference with
the circulation of cerebro-spinal fluid. Paraplegia was the
first sign; then the bead was drawn to one side and con¬
vulsions eet in. Afterwards oscillation of tbo eyeballs and
rhythmic movements in the head were observed. These
symptoms were parallel to those described by Hilton, Wilke,
mul Moxon in cases of hydrocephalus in children.—Dr.
Horrocks asked why London lions developed rickets and
not thoee in Dublin.—Sir Jambs Paget said that Dr. S.
diaoghton had found that if bones were given to ricketty
lions hi Dublin the rickets disappeared. Had this been tried
at the Zoological Gardens?—Mr. B. Button, in reply, said
that it was supposed that the constant use of home's flesh
was the cause of rickets, but even when goat’s flesh was
added and the bones could be eaten the rickets did not dis¬
appear. He ooold not offer any solution of the differences
■between lions in London and elsewhere. In reply to Sir
James Paget he said that the giving the lions bones cured
the cube of being boa with deft palates, but did not pre¬
vent their developing rickets.

Mr. Strphrn Pagrt read a paper on Suprapubic Absoeee,
and showed one specimen removed from a man aged sixty-
five, .who had had cystitis and other bladder troubles, with
a perforation leading obliquely into the cellular tissue of
the pelvis. Cases of suprapubic abscess were not very oom-
muii. Twenty cases were collected. Sixteen occurred in
yonng or middle-aged men who were generally healthy and
vigorous. Four occurred in women, after genital disease,
in the-males, eight under thirty and eight over this age. The
inflammation reselved without suppuration in the oa ses under
4he ige of thirty. Thoee that occurred after typhoid fever
suppurated. Malignant disease was not noted in any ease.

Mr. B allancb and Mr. Shattock exhibited the results of a
series of Cultivation Experiments made with New Growths.
The authors were led to experiment with malignant new
growths in this direction, since they were persuaded that
the essential pathology of these must (as so greatly insisted
upon by 8ir James Paget) be similar to that of the specific
diseases. Pieces of carcinomata of the breast removed im¬
mediately after operation and transferred to tubes of
solidified serum, agar agar, and Koch’s beef peptone gelatine,
were incubated at 100° F, for various periods — in one
case for thirty-three days. The authors compared the
pathology of cancer with that of tubercle, and considered
that cancer, like tubercle, might be either & purely local
disease, or the local manifestation of a “ diathesis, com¬
parable to that of the “ scrofulous,” the localisation in either
case depending upon a specific organism. The geogra¬
phical distribution of cancer was also noticed as an argu¬
ment in favour of its parastic nature. They met the
chief objection urged against the parasitic theory—viz.,
that in a case of columnar-celled carcinoma of the
rectum the secondary tumours in the liver resembled in
structure the crypts of the intestine—by observing that in
the normal process of development it is the epithelium that
determines the anatomical character of glandular formation,
the arrangement of vessels and connective tissue being a
secondary adaptation to this; and they conjectured that in
a similar manner a cell transported to another organ would
by its determinate hereditary tendency produce a structure
similar to that of which it primarily formed a part, the organ
itself furnishing the vessels and supporting tissue of the
new epithelial formation. They further remarked that tha
view of the parasitic nature of cancer sfforded a possible
explanation of the cachexia, which is at times not to bb
wholly accounted for on general principles, since all patho¬
genic organisms give rise, as a result of their activity, to dele¬
terious chemical products, and these passing continually into
the general circulation from the substance of the tumour
would exert an unfavourable influence on the general health.
The alleged antagonism of cancer and tubercle might be
explained on the well-known grounds of the interference in
growth which certain organisms exercise upon other's.
They concluded from their experiments that the parasite of
canoer must be unlike iu its life-history those already
known, in that it does not admit of cultivation in any of
the ordinary media. They commented upon the supposition
that the parasite was one of the protozoa, and thought that
the physiology of certain of the naked protozoa afforded
much interesting - material for speculation upon the
physiology of cancer; the spornlation of protozoa and the
rejuvenescence-by foaiou-were referred to as offering possible
modes of explaining the infection of the epithelium, the
abnormal growth and extension of which constituted the
characteristics of carcinoma. Having found that new
growths were sterile under the conditions of the experiments,
the authors experimented in a similar way with healthy
tissues, with the result that they were able to maintain
sterile at 100° F. portions of testicle, submaxillary gland,
kidney, muscle, and liver. In regard to.tha liver, they were
not prepared to state that the same holds good, since
in most cases the portions experimented with did not
remain sterile. These results acoord with Mr. Watson Cheyne’a

E revious work reported in the Society’s Transactions for 1879.—
>r. Coupland said that the late Dr. Grant believed that
white corpuscles of the blood were forms of the. lowest
protozoa—Mr. F. S. Bvb gave arguments against the
parasitic theory. He had repeated Leopold's experiment
and transplanted portions of epitheliomata of the tongue
into the anterior chamber of the eye of the rabbit, and
acute suppuration followed, although it was known that
this chamber was very tolerant of living tissues.—Mr.
Roger Williams also combated the parasitic theory.—Mr.
Felix Sbmon referred to the antagonism alleged to exist
between tube role and epithelioma. He bad seen the two
forma together in the larynx.—Mr. 8. Pagrt referred to a
paper in The Lancet of May 14th by Mr. Roger Williams.—
Sir James Paget said that he had known canoer almost
decay and shrivel up during the rapid development of
tubercle, and vice verm; neither lived in full force together.
He felt that he must have made a happy guess in early life,
and he thought that very likely the parasitic theory would
be found to give an explanation of the great difference
between innocent and malignant growths.—Mr. B allancb
said he oould not imagine any other result than suppuration
following the inoculation of material from any growth on

VjOOgl

1034 The Lancet,]

CLINICAL SOCIETY OP LONDON.

[Mat a r 1867.

any surface of the body. They did not believe that the
parasite was a bacterium.—Mr. Shattock, in reply, said
that he imagined that the transported cell was provoked to
multiply by the irritation of the contained parasite.

Mr. W. H. Battle showed specimens of Extensive Bony
Lesions from Congenital Syphilis and Rickets. The illegiti¬
mate child was three years and ten months old. One year
before admission the left elbow swelled, and afterwards the
right one, and then the right knee. Progressive emaciation,
sleeplessness, and great tenderness were the chief symptoms
one month before death. There was also considerable fever
—101° to 103° P. The necropsy showed broncho-pneumonia
and collapse of the lungs. There was separation of the
epiphysis from the diaphysis of the femur, the periosteum
was separated from the shaft over nearly the lower half,
and was much thickened and vascular, with slight new
formation of bone. The tibia showed a similar necrosis
with separation of epiphysis. There were similar changes
in the bones of the upper extremity, with signs of riokets in
the ribs and about the growing ends of the shafts of the
bones. There was marked “ bossy” growths on the skull,
which had a natiform aspect.

The following card specimens were exhibited:—Mr. Page,
ior Mr. Raven: Sarcoma of Dorsal Vertebra;. Mr. Sydney
Jones: 1. Tumour of Parotid, twenty-five years’ growth.

2. Papilloma of Bladder removed by Suprapubic Cystotomy.

3. Uterus and Appendages extirpated for obstruction of
rectum and bladder. Dr. Barlow : Renal Sarcoma. Dr. Pitt:
Pleura, two years after drainage for Empyema. Dr. Collier:
Pelvic Sarcoma, simulating Hiematocele during life. Dr.
C. Turner: 1. Bladder, Kidney, and Dura Mater, from a case
of Purpura. 2. Endocarditis, with Necrosis of Mitral
Valve. Mr. J. H. Morgan: Cystic Disease of Metatarsal
Bone. Mr. Fenwick: 1. Encephaloid Cancer of Apex of
Bladder. 2. Acute Tuberculosis of Bladder and Prostate.
8. Purpura Hsemorrhagica of Bladder. Mr. Bull, for Mr.
Rouse: Sarcoma of Clavicle. Mr. Mansell-Moullin: 1. Abscess
of Brain following Disease of the Ear; trephining. 2. Sac¬
culated Bladder, with Calculus impacted behind the Prostate.
Mr. Poland: Osteomyelitis of Scapula and separation of
Coracoid Process. Dr. Gulliver: Aortic Aneurysm opening
into Superior Cava. Mr. Targett: Bony Tumour of But¬
tock. Dr. Hebb: Quiescent Tubercle (a Disseminated
Fibrosis) of Lung. Dr. Horrocks: Uterus and Fibroids re¬
moved by Abdominal Section (reoent specimen).

CLINICAL SOCIETY OF LONDON.

Abdominal Cysts following Injury- Spasmodic Torticollis
due to Cerebral Lesion .— (.iouty Knee-joint with Sup¬
puration.—Intracapsular Fracture of Neck of Femur.

An ordinary meeting of this Society was held on the
13th inst., Dr. W. II. Broadbent, President, in the chair.

Mr. Goqlbe related three cases in which abdominal cysts
of large size followed the passage of a cart wheel over the
body of the patient. The first was a little girl aged four,
who sustained a rupture of the left ureter. A large cystic
tumour containing urine developed itself, which was first
aspirated and then tapped and drained. The kidney was felt
projecting into the upper part of the cavity when it was
opened. As the patient became liable to frequently recurring
attacks of fever, caused by accumulations of urine and pus
at the bottom of the wound, it was decided to remove the
kidney, which was accordingly done. The operation was a
difficult one, but the child made an excellent recovery. Tbe
sinus, however, has not completely closed, but still con¬
tinues to secrete a small amount of pus. ■ The second case
was that of a man aged twenty-three, who was run
over by a heavy waggon. A cystic tumour developed itself
on the left side, partly under the ribs, partly projecting
below them, causing considerable discomfort and vomiting.
After periods of improvements and relapses tbe tumour was
aspirated through the seventh intercostal space, and seven
ounces .of turbid fluid, containing a trace of urea with a
considerable amount of albumen, were drawn off. After
this tiie patient gradually recovered. It was pointed out
that, while the diagnosis of the case was very obscure, it
was probably a renal cyst resulting from a laceration of the
kidney. The third case was that of a boy aged seven, who
was knocked down by a van, but not run over. A month
afterwards, a tumour of considerable size, but the dimensions
of which apparently varied, was found in the upper part

of the abdomen on the left side. During the eleven months
after the accident the tumour gradually increased in sire,
and came to occupy the middle line of the abdomen,
pressing the stomach upwards. It was accordingly opened,
and the cyst wall was stitched to the abdominal wall. It
contained forty-three ounces of turbid whitish-yellow fluid,
containing five ounces of urea and a large amount of
albumen. The child made an excellent recovery. There
appeared to be no data for making a diagnosis in theciaa-
Mr. Golding Bird said that urea might be found in appre¬
ciable quantities in most of the tissues and fluids of the
body, so that its presence in minute proportions did not
necessarily indicate a connexion with the kidney. Hs had
found as much as • 2 percent, in ovarian fluids.—Mr. Babde
referred to a case of his own, published in The Lancet,
Jan. 17th, 1885, in which ’5 per cent, of urea was found.
This low percentage appeared to be due to reflex pressure o*
tbe kidney, for on opening the cyst the percentage rose to
more than 1 per cent. A second case was alluded to, in which,
the patient having been run over, the abdomen began to
swell greatly. After some months forty-five ounces of fluid
were withdrawn from a point three inches to tbe left of the
middle line; the fluid contained a considerable quantity of
urea. The case was probably a localised peritonitis, and not
a renal tumour. The presence of urea should not therefore
in itself suggest a renal origin for the cystic tumour.

Dr. G. V. 1'oorr read a case of Spasmodic Torticollis, pro¬
bably caused by Cerebral Lesion. The patient, aged thirty-
six, was admitted to University College Hospital on Aug. 5th,
1886, suffering from violent spasmodic torticollis of nesrly
six months’ duration. The head was twisted towards th»
right shoulder. At first the left sterno-mastoid muscle nu
mainly at fault, but after division of the sternal attachment of
this muscle the spasm was scarcely altered, the rotation of
the head being effected by the right splenius. This fact nuds
it probable that tbe lesion was central. On the left side of
the head, immediately over the situation of the posterior
part of the superior and middle frontal convolutions, was s
scar, the result of an injury many years previously, which
at the time had “ half-stunned him.” There was an un-
donbted history of syphilis, and the patient, prior to th*
onset of the torticollis, had suffered from headache, referred
to the neighbourhood of the scar, and from occasions!
attacks of giddiness. All things considered, it seemed pro¬
bable that the lesion (? meningeal thickening) would b*
found on the surface oi the brain beneath the scar on the
scalp—i.e., in the region irritation of which is said to
cause deviation of the head to the opposite side. The
propriety of trephining was considered, but prior to ita
performance it was deemed advisable to subject the patient
to a thorough course of mercury. This was done, with th*
result that the torticollis almost completely disappeared.-
Mr. B. Roth asked whether the spasm disappeared when
the patient Was under the influence of chloroform.—Dr.
Olovrr spoke of tbe extreme severity of the spasm. The
case showed the virtue of patience in pbyairaana before
calling in surgical aid.—Dr. S: Mackenzie mentioned Dr.
•Ringer’s case, shown to be associated with a lesion abent
the ganglia of the brain;' and also referred to tbe case oi
Mr. Campbell de Morgan, in which the spinal accessory nerve
was stretched with success. In other cases various opera¬
tions were undertaken without success, and the arm and
other parts of the neck were sometimes involved.—Dr.
Broadbent alluded to the hemiplegic lateral deviation oi
the head and eyes, and said that the cortical mechanism
must be similar in Dr. Poore’s case. The higher centre
calls npon and commands muscles on opposite side*
of the body, as in conjugate palsy of the eyeball*-
The deviation disappears as soon as communication t»
established with the opposite cerebral hemisphere. Per¬
manent deviations are present when there is a lesion w
tbe medulla. He had no doubt of the correctness of tbe
localisation, and the striking development of symptoms
during the waking state was very confirmatory, m also the
relaxation during sleep.—Dri Poore, in reply, said that the
difference observed during the waiting and sleeping state*
went to prove the cortical origin of the spasm, so be didnbt
give the patient chloroform, because natural deep sufficed-
He had made a bare recital of one isolated case, and bad not
weighted hie paper with literature. Cases which had pre¬
ceded or followed hemiplegia were well known, and a»*
that mercury bad relieved other cases. He considered “jx
trephining would be warrantable, for the danger of
operation was slight.

If HI* LAN'CRY,]

EPIBEMIOL'OGICAH SOCIETI OF LONDON.

[May21;186T. 3 036

Mr. Stephen Pagbt showed a. Knee Joint from the body
of a man, aged foyty-nine, who had suffered for seventeen
years from severe gout. The knee was suddenly attacked
by acute inflammation, and a very large abscess occupied
the joint and the thigh. It was aspirated, and perfectly
healthy pus was let out; later it was opened. Suppuration
extended up nearly to the trochanter and down mto the
calf; and several counter-openings were necessary. Ampu¬
tation was not advised, on account of the constitution
being broken down by disease. For some time he seemed
likely to recover, but at last bedsores formed, and he died
about eleven weeks after the invasion of the inflammation.
The specimen showed destruction of the cartilages and liga¬
ments, with rarefaction of the ends of the bones; no marked
lipping or eburnation. The synovial membrane was infil¬
trated and partly destroyed by suppuration. Mr. Paget
referred to a case published by Dr. Norman Moore of
purulent effusion into the knee joint in chronic gout, a case
of suppuration of the back of the hand and the wrist joint
published by Mr. Riving ton, and a case of suppuration of
the eyeball published by the late Mr. Critchett. In all these
cases the only common cause for the suppuration was chronic
gout, of very long duration and of great severity.

Mr. Spencer Watson read notes of a case of Intra-
capaular Ffacture of the Neck of the Femur, with specimen.
A gentleman aged sixty-nine fell from his horse, and on
attempting to rise found he could not support himself on
his right leg. There were no symptoms of fracture, beyond
the pain on attempting to move the limb, for a fortnight
after the accident, and measurements taken several times
during the period indicated no shortening. Three weeks
after the accident shortening of the right limb to the extent
of an inch and a quarter was discovered. No splint or
extension apparatus could be borne by the patient, who
got up and sat in a chair from the first week, and was
on crutches at the end of a month. He died seven
months after the injury, and the specimen exhibited
showed a fracture through the neck of the femur, intra-
.capsular, and at one time firmly impacted. The neck of
the femur was so much wasted that the head of the bone
rested on the space between the two trochanters, and was
kept in that position by interlocking splinters of the neck.—
Mr. Wm. Adams said that in intra-capsular fracture a
difference existed in the degree of mobility and shortening
in different cases, dependent on the kind and direction of the
fracture. If the fracture were oblique and irregular, a sort
of impaction might have taken place, and yet the diagnosis
of fracture be doubted. In the specimen shown the
periosteum had become folded in between the fragments,
and a neoplasia of fibrous tissue afforded a very fair fibrous
union.—Mr. Ohiustopskr Hrath said that measurement
might detest alight differences in the length of normal
limbs, and much importance could not be. attached to slight
differences as indicating fracture. If the patient could
raise the l^nb, then the fracture must necessarily be of the
impacted, sort.

tjie following living specimens were exhibitedMr.
Clutton: Osteitis Deformans in a woman. Dr. I’eroy Kidd :
Rheumatic Nodules in an old woman. Dr. de Havilland
Hall: Adhesion‘of Soft Palate to Posterior Wall of the
Pharynx. Mr. Mansell-Moullin: Elephantiasis of Right Leg.

EPIDEMIOLOGICA L SOC IETY OF LONDON.

Some Evidence respecting Tubercular Infective Areas.

At a meeting of this Society held on Wednesday, May 11th*
Inspector-General Lawson in the chair, Dr. Arthur Ran¬
soms read a paper on some Evidence respecting Tubercular
Infective Areas. He showed that there are strong reasons
for believing that whilst tubercle travels infectively through
the body, and is derived from infective particles contained
in air rendered impure by organic matter from human
breath or from ground air, yet it is very rarely directly
transmitted from person to person. It seems tndst probable
that for the active propagation Of the disease some increase
in the virulence of the organism most take plaoe outside
the body, in a' manner similar, to the infection of typhoid
1 fever or cholera. Although direct transference of the com-
■ plaint,is.probable, especially after previous injury and loss
of elasticity of the lungs, yet the evidence so far adduced
.would,, se^m to show that it is a very rare event—first,
because many medical men have never seen a case;

secondly, many of those recorded as cases of infection
would have taken place without infection, as Bhown' by
Dr. Longstaffs formula; thirdly, most of these cases of sup*
posed infection lived under conditions favourable to indirect
infection; fourthly, it is difficult to see why drainage of
the land and the sandy condition of a soil should affect direct
contagion, but it is easy to see why indirect infection should
be thus affected; fifthly, the frequency of one-Bided phthisis
was pointed oat Numerous instances of infected areas were
given from records of barracks, public institutions, ships*
&c., and cases of infected houses were given from private
practice from the Collective Investigation Record and from
other soarcea. In all of these the ontside conditions
as to ventilation, drainage,. soil, &C., wete favourable
to the intensification of the virulenoe of the morbific
agent. The mortality tables of certain districts in Man*
Chester and Salford had also been kindly given to
the author by . the medical office® of health, Mr.
Leigh and Dr. Tatbam; and maps showing the con¬
struction of the Salford districts had been furnished by
Dr. Tatham. An analysis of those showed that in certain
streets and courts, consisting of back-to-back houses, and
with no through ventilation, the disease was much more
common than in other parts; and that it occurred again and
again in the same house in these parts. In all, forty-ona
cases of such coincidence df death were detected, in flte
years in Ancoats in a population of 5600; and in Greesgata,
Salford, with a population of 2600, in six years, there were
twenty-nine such doable or treble deaths. Certain possible
sources of fallacy were dismissed. In the discussion which
followed, • Inspector - General Lawson, Brigade Surgeon
Striven, Surgeon-Major Pringle, Dr. Moir, and Messrs. Pagdfc
and Morphy took part._ • • •

MEDICO-PSYCHOLOGICAL ASSOCIATION. *

The quarterly meeting of the above Association was held
at Bethlem Hospital on Tuesday, May 17th, the ’principal
business being to consider a memorandum from the Par¬
liamentary committee of the Association containing obser¬
vations and suggestions in regard to the Lunacy Actfa
Amendment Bill. In the absence at first of Dr. Savage,
Dr. Rayner occupied the chair. A long discussion ensued,
in which Drs. Kingrose Atkins, Outterson Wood, A. R.
Urquhart, J. Murray Lindsay, S. W. D. Williams, llayes
Newington, Hack Tuke, G. H. Savage, H.Rayner, S. It. Ag^,
Robert Baker, and Evan Powell took part. In opening the dis¬
cussion, the chairman animadverted upon some observations
made by the Lord Chancellor in introducing the Bill, and to his
having made use of certain words, i.e., “ accused ” of lunacy,
“supposed” examination, &c, which, if lightly construed,
associated lunacy .with crime, and further implied per¬
functory work or laxity on the part of medical men in tpgfr
professional duties in connexion with lunacy. Suggestions
having been freely made on the various clauses of the Bui,
it was agreed that the memorandum should be circulated
among the members of the Association, now numbering
upwards of four hundred. A strong opinion appeared to

S revail that the magisterial intervention proposed by toe
ill should not be allowed entirely to override medical
opinion, and, further, that there should hen power of appeal
to the Home Secretary in cases of refusal or reduction (f
pensions. It was also urged that members of the A c sodi -
tion should seek to impress moat earnestly on members c f
the House of Commons with whom they were acquainted
that insanity is a symptom of disease, apd that the primary
aim and object of all legislation in regard to it should be tip
care and proper treatment of those suffering from it. . ^ .

- . -; (t

LEEDS AND TVEST RIDING MEDICO* :
CflIRURGICAL SOCIETY.

Empyema. - . ;

At the ordinary meeting on April 1st, Dr. Spottiswoode
Cameron, Vice-President, in the chair, a discussion tank
place on the above subject. * • . r

Dr. Chubton cited some remarkable examples of empyerop,
selected from seventy cases, in some Of which- the puq.wfts
difficult to find, and in others there had been, difficulties ip
the operation required. • He also described oases of double
and of fetid empyema, and of apparent empyema in which
the pus came from dilated bronchi.—Mr. Godfrey Cabtsb

O

1036 The Lancet,]

REVIEWS AND NOTICES OP BOOKS.

[May 21,188T.

described the case of a girl in whom symptoms of pneumonia
on the left side were followed by symptoms of dyspnoea and
rigm of fluid in the opposite side. Some days afterwards pus
was evacuated by incision, but no great improvement followed.
Three exploratory punctures were made in the first affected
side without effect; but in a month’s time, dyspnoea being
urgent, repeated exploration was made under chloroform,
and pus was found on the left side in the eighth space near
the spine. As the right side seemed nearly healed, and only
a few ounces of water could be injected, an incision was
made in the left side and a large quantity of pus evacuated,
with satisfactory result. — Dr. Wabdrop Griffith gave
statistics of thirty-three male and seventeen female cases
treated in;the Leeds Infirmary. I. As to age: Twenty-nine wore
in the first decade, seven in the second, and eight in the third.
Contrasting these with a similar number of cases of simple
effusion, there were ten in the first decade, sixteen in the
second, and nine between thirty and forty, against one only
of purulent effusion. 2. The right side was affected in nine¬
teen ; the left in twenty-six; both in one. 3. As to results:
Thirty-five cases recovered after incision. In four of these
there was certain or suspected phthisis; five cases, in addi¬
tion, were discharged with a sinus still open. 4. Six cases
were fatal, three from advanced phthisis. In one there was*
double effusion, and another was complicated by hepatic
abscess. 5. There was a history of injury in three
instances. In most case3 the fluid seems to have been
purulent from the beginning. Out of 151 cases of
simple effusion treated in the infirmary, of which mon
were tapped, only two became subsequently purulent,
suffering respectively from tuberculosis and erysipelas.
6. Physical signs: There was cedema of the chest wall in
one case only. In children there was great deviation from
the physical signs, vocal fremitus being frequently marked,
and considerable effusion being present. 7. The operation-*
were done mostly under ether, wnich the patients took well.
The spray was used, and the incision was made low down at
the back. No ribs were excised, although in two cases this
might have been done with advantage. In nine cases there
was pointing of pus, a spontaneous opening in four, and in
one case the pus pointed behind.—Dr. Clifford Allbott
held that resection of ribs was never needed if the operation
was done early enough. All effusions of any bulk should be
promptly and repeatedly removed. If the case were uncom¬
plicated, and the operation and drainage efficient, the tern-.
perature should never be raised. Injections were therefore
worse than useless.—Mr. McGill referred to a case where
a piece of drainage-tube remained in the chest four years;
it was removed post mortem.—Mr. Littlewood described
a case where he accidentally penetrated into the peritoneum.
The incision was made in the eighth space, extending as
far forward as the mid-axillary line. Omentum was seen
in the anterior part of the opening.—Dr. Eddison referred
to the statistics of forty cases under the care of Dr. Allbutfc,
Dr. Churtdn, and himself, which he had published three
years before. The largest proportion of his cases occurred
between the ages of twenty and thirty. In one case there
was reason to believe the effusion' had existed for three
years, in another for one year; both recovered. In one
case, where 160 or. of pus were removed, death ensued within
fifteen minutes. Cases with 62 oz. and 104 oz. removed
recovered. In no case did death occur if the lungs were
healthy. He had never seen a case where resection of the
rib was necessary. — Mr. Lawfobd Knaggs spoke against
the use of anaesthetics, preferring cocaine.—Dr. Tempest
Anderson recommended a double opening made with a
curved trocar.—Dr. Churton, in reply to Dr. Allbutt, said
he had known cases where the temperature remained high
for some days after operation in spite of perfect drainage,
but was reduced by five grains of quinine three times a day.

Pathological specimens. —Mr. L. Knaggs: Dermoid Cyst of
Broad Ligament. Dr. Allan: Rupture of tbe Bladder from'
Retroversion of Gravid Uterus, which had become occluded
by adhesions. Mr. Mayo Robson: (1)^ Polycystic Ovary;

of Uterus. Dr Braithwaite: Uterus with Cylindrical Cancer,
removed by Vaginal Hysterectomy. Dr. W.Grifflth: (1) Tho¬
racic Aneurysm, sbowing thick Laminated Clot; (2) Case of
Extreme Aortic Stenosis without Incompetence; (3) Micro -1
Mopic Sections of Tubercular. Tumour of tbe Qptic Tsaofc 1
o—sing Hemianopsia. Dr. E* Jacob: Section*-andjjfgtttft-
photographs of a Sporosperm of Coccidinm Ovijrttthfrom
the liver of a rabbity the,bile-dnets- bcip gjy Qif j f ^ ,g fl*tsd
-«atd a condition no a ifrh blkgencgphatoi* ajs^ng|lijpVPfq& •

mitfas antr ftotias of $ooks.

Pilocereus Senilis, and other Papers. By Walter Moxoh,

M.D., P.R.C.P. London: Sampson Low and Co. 1887.

This little volume consists of short essays contributed
to the Guy's Hospital Gazette under the assumed title
given above, together with three longer essays, two of
which are introductory or annual addresses. We have read
it through from oover to cover, and with much enjoyment.
No book more vividly recalls its author; his keen, eager
face, his eyes twinkling with humour, and his body with
its curious, sudden movements (we often wonder who was
tbe originator of the Guy’s Hospital gestures), rise up before
us as we read. The author being, in thia instance, identical
with his book, we may speak of either indifferently. The
prevailing element in his writing is humour searching,
keen, and critical, hut always good-natured. When he
incites us to laugh at an individual, he always invites the
subject of laughter to join with us; he says as plainly as
words can speak, “Let us all laugh together.” We have
heard that this habit of his sometimes gave dire offenee
to students, but no statistics are forthcoming as to the
part of the United Kingdom from which such individuals
sprang. Another element in his humour which adds greatly
to its value is his essentially reverent treatment of great
questions, which is very striking. We often seem to enter
quite suddenly from the light and glitter of clever banter
into the dimness and quiet of a sanctuary. The literary
effect of this is not inconsiderable, but its moral effect is
greater still. We can quite well understand that these
qualities, which charm those who are sympathetic, may
have narrowed the circle of his disciples; but even those
who failed to follow his meaning cannot have been entirely
unaffected by his purpose. .

The essays themselves are not, indeed, easy reading. To
read easily, the mind of the reader must travel with the
writer, and be not altogether unprepared for the nsxt sen¬
tence. For this to be possible the motion of the author
must generally be rhythmical, like tbe flight of a bird. Bert
in reading these essays we are reminded of nothing so much
as of a dragon-fly on a brilliant summer afternoon, glittering
with gold, and barred with stripes, which is seen fluttering
near; anon he has disappeared, and again reappear* some
distance off, and again he is gone. The glitter rivet* tbe
attention; the sudden darts cannot be followed, hot we
cannot but gaze and admire. Of the essays, we like to*
short ones best of all, where all are good, none more
than that with the Guy’s Hospital motto, Dare qua*
accipere. It is pleasanter to give than to receive medicine
prescribed in the surgery (why is it made so nasty.),
advice, and even money sometimes. The division oj
advisers (p. 11) into the sympathetic, apathetic, sad
antipathetic, is admirable. The first says, “ Let me help
you?”; the second, "Do as you like”; the third, <*»
thee and hang thyself.” The first, in the case of a badtoott.
will say: “Let’s see if stopping will do any good. Tfi#
second: “Now then, if you’re going to have it out ta
down.” The third drowns the enemy’s yells with
make that noise, it doesn’t hurt you.” “ The thought
of the heart” is another which is itself fall of thought.
Thoughts are not only of the brain, as physiologists say.
“The fact is, the brain is a sort of ^Eolian instrument
many strings, whereupon the several organa play (nocawj
those of the circulation—the heart), and so David
right.” “Special kinds of activity determine character.
Thu* are we creatures of our own activities, and he who nw
no special activity will have no character” We havei«
room for all the passages we should like to-quote; w®""
must select a few to whet our readers appetite, and
him long for more.

‘ Why cannot we combine .against

■ - •_••• * j,,.

Thb Lancet,]

BEVIEWS.—NEW INVENTIONS.

[May21,1«7. I0S7

up of unverified hearsay? Ingenious men with large
memories connect together various well-meant quotations,
until some far-away propositions, uncertainly drawn from
uncertain sources, go for the 'progress of medicine.’”
(Page 34.)

“ Did you ever see a caddis worm? When I was fishing
I never could stick a hook into a caddis worm. 1 never
contemplate a caddis worm without a certain feeling of
brotherhood. Nature is essentially too satirical in the way
she takes off one thing when she designs another. Every
one has, by nature, the faculty of picking up bits where¬
with to furnish himself according to the grounds be is upon
at the time, as the caddis worm dresses nerself in scraps of
green when she is upon leaves, and in bits of brown when

upon the stones.Most minds are like maggots dressed

in scraps, and all that is their own is just the glue the

scraps are stuck with...You mustn’t shake the scraps

much for fear you see the maggot.” (Page 42.)

“ With one man faith may be compared to wings support¬
ing him by his own brave effort where there is no ground
tb stand upon, and with another, faith is as a prehensile
tail, such as you see on those monkeys who, holding securely
by something they are not obliged to keep in view, have their
hands thereby the more free to pick nuts, &c. Let us not
think disrespectfully of any; to the born prehensile such a
tail is a requisite. We see how needful it may be at the
‘Zoo,’ and though nature gives the human form no such
outward and visible sign of dependence, it may be just the
same inwardly with men.” (Page 44.)

“ I have met the modem scientific and well-read youth,
who has studied chemico-physiological lectures upon texture
and its vitality until be thinks that the life is nothing more
than meat, and read Carlyle’s ‘Sartor Resartus’ until he
suspects ‘ nor the body than raiment,’ and who would call
the holding of such opinions ‘faith,’and then wonder at the
enthusiasm faith has aroused in the world.” (Page 46.)

“ No thought is ever strong and true which does not arouse
something into unexpected harmony.” (Page 70.)

“It (ther present classification of diseases—one a pain in
the leg, another a growth in the stomach, and another a
spider in the skin) is like trying to mix the solar spectrnm
and the key of C major with essence of peppermint.”
(Pape 89.)

“ Some day, you know, we shall be historic ourselves; that
is, the louder ones amongst us—a chastening thought, when
you reflect what sort make the most noise.” (Page 125.)

On page 138, treatment without drugs is compared to
religion without a creed. “It is very sublime, and suits
your inside nature so well that you try it on yonr friends;
but it does not suit them.”

“Patients do not drink medicine as medicine. They
swallow it as if to JSsculapius, and in the gulp their eyes
sparkle with all the old ineffaceable longing for help from the
unknown. The time-honoured potion carries with it the
undying power of the medicine-gods and medicine-man of
fairyland, and of the witches as real as ever.” (Page 147.)

A few pages further on the author discusses homoeopathy
excellently, but we have not space for all the quotations we
should like to make.

. “ The great fallacy of the age is the vulgar fallacy that
4 Knowledge is power.’ But not all knowledge is power.
Only the knowledge you have faith and aim to use is power.”
(Page 205.)

“The power of knowing is the fruit of knowing, and
the power of acting is the fruit of acting.” (Page 206.)

“ If we follow the biologist through his long story, what
does he do towards touching the mystery of genesis, or help
us to conceive how a little thing shaped like a frying-pan,
and so small that you can scarcely see it with the best
microscope, shall carry over the shape of the paternal nose,
the colour of his whiskers, and even his mode of thinking,
for sixty odd years?” (Page 216.)

“ We want less of such biology as takes all purpose out
of the universe and aims at professing a theology of high

apes.But Hunter’s back was towards all apes, and his

face to the future, because he did not make futile biology,
but took pains to bring in the knowledge of nature to the
help of man.” (Page 222.)

from the suggestive essay on “Alcohol and Individuality”
we have not space to quote.

The foregoing quotations sufficiently illustrate our author’s

aptitude for epigram, love of paradox, and humour. He strikes
us as the type of man who generally gravitates to the Bar*
Such powers fill the pocket better in the legM profession,
but their possessors are not always the better for such a
choice, and we are thankful for the choice made by Dr.
Moxon. Indeed, the profession oan ill spare such men, and
to his school his lose must be irreparable.

fUfo Indentions.

A NEW EYE SPECULUM.

The ordinary speculums are perfectly efficient in exposing
the eyeball, bat as they all have some part which enters
within the margin of the eyelids, their use is neoeesarily
attended with discomfort to the patient, which in slight
operations, such as removal of foreign bodies from the
cornea, or puncture of the cornea, is often more than the
pain of the operation itself. For each cases the author has
used the speculum shown in Fig. 1 for several years, and notr
brings it under the notice of the profession. It consists of

Fia.1.

a piece of stout wire bent into an oval ring at one end
and a handle at the other, as shown full size in the figure.
Fig. 2 shows on a reduced scale the mode of application for
removing a foreign body, the operator standing behind the
patient’s head. The nng is applied outside the lids and
near their edges. The Ude are then, if necessary, polled
more open by the fingers of the other hand. The pressure
of the speculum gives it such a good hold on the sun that

Fio. 2.

even the most intense spasm of the sphincter is powerless
to close the eye. The pressure to a great extent fixes the
eyeball, and also renders the coraea tense, which is a great
advantage, especially in puncturing the cornea. In removing
a foreign body it is usual and perfectly easy to hold a
magnifier in the same hand as the speculum, but this may
be dispensed with if preferred. Messrs. Wood and Co.; of
York, are the makers. Tempest Andbbbon, M.D..

Medical Officer, York By* Inrtttutkm.

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1038 Thu Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[May 21,1887.

THE GENERAL COUNCIL OF MEDICAL
• EDUCATION & REGISTRATION.

Friday, May 13th.

Mr. Marshall, President, in the chair.

Mr. Carter’s motion with reference to. the appointment
of examiners to the Society of Apothecaries was adopted
without further discussion.

In pursuance of the proposal made on the previous day,

Mr. Carter moved the appointment as assistant examiners
to the Society, of Apothecaries of Messrs. Makitas, Walsham,
and: Andrew Clark, and, referring to the point raised by.Mr.
MeVsil ; ns to whether the Council could appoint more
examiners than were asked for. by the Society, said he
thought they could not do so, though he admitted that those
who were nominated by the Council would carry with them
peculiar authority, and if they were of opinion that exami¬
nations were not properly conducted the Council would be
able to, interfere and make a statement to that effect to the
Privy Council. Irrespective of the legal aspects of the
question, he would suggest to the Council whether it would
not be better simply as a matter of courtesy to afford every
assistance that wa9 asked of’ them. The Society desired
that those gentlemen who had been appointed surgical
examiners in accordance with the recommendation of the
Council should be confirmed in their position, although it
was fully recognised that if the Council’s nominees were
accepted they would be empowered to exercise an influence
in excess pf that of the ordinary members.

The motion having been seconded by Mr. Simon,

Mr. Macnamara remarked that it had been stated
by Mr. Carter that it was necessary that the responsi¬
bility of examinations should rest entirely with the
body which he represented. What, then, became of
the Medical Council? The Act of Parliament had cast
the responsibility upon the Council, and by its action
on the previous day the Council had accepted that
responsibility. The Act distinctly stated that it-was the
duty of the examiners to maintain the standard of efficiency
in medicine, surgery, and midwifery,, and clearly there
ought to be an examiner to report to the. Council upon the
examinations on the last-mentioned subject. As show¬
ing the necessity 'of this, he might say that, though he
considered himself a very good surgeon, he had only delivered
two women in the course of his life; how, therefore, Cbuld
be -be- expected to sit in jndgment on midwifery exami¬
nations? Such an official would not exclude the Society’s
examiners, bat co-operate with them. The same observation
would apply to examinations in medicine and surgery; in'
facts,.he thoughtthe Counoil.might supplement the Society's
Court of Examiners by adding, if necessary, an examiner in
connexion with the subjects of shrgery, medicine, and mid¬
wifery. At any rate, if that was not the intention of the
Act it ought to have been. Mr. Carter’s resolution said
nothing about the statutory obligations created by the Act,
but the amendment which he intended proposing would
cover the whole ground. His amendment was, “that the
subject be remitted to the Executive Committee,” which, he
thought, would be the most competent body to decide upon
the merits of the question, composed as it was of English
scientists, from whom the examiners would be largely
drawn. ' It was quite open to the Society of Apothecaries to
offer any suggestions as to the constitution of the committee,
and he was sure that if they were made they would receive the
most careful consideration at the bands of the committee. He
therefore moved, “ That it be remitted to the Executive
Committee to appoint, under Section 5 of the Medical Act
of 1886, assistant examiners in medicine, surgery, and mid¬
wifery, to assist at the examinations conducted by the

believed that, it should simply, provide for a recognised
deficiency in the examining powers of the corporation,

Sir Wm. Turner having directed attention to the wording
of Sub-section 2 of Section 5 of the Act,

Sir Walter Foster observed that he could not vote for
Mr. Carter’s resolution because he feared that, if carried, it
would i in the future place the Council in a dangerous
position. Any action that they might now take would
become a precedent, and the question before them ought,
therefore, to be discussed with great deliberation. He
looked upon the Council as the supreme authority for the
regulation of medical examinations, and consequently it
was not in the power of any of the corporations to dictate
the course of procedure which it should adopt... The
Council had affirmed by resolution the principle that the
Society of Apothecaries was entitled to hold a qualifying
examination, but when the latter endeavoured to nominate
examiners the effect was to make the Council a body for
registering their degrees, and that position could net Of
course be accepted.. The Act of 1886 regarded the Sooetj,
as capable of holding an examination, not in surgery, but i
medicine and midwifery, and it gave the Council a <H*
cretionary power to remedy thi9 deficiency by appointing Off
number of examiners they thought fit in order to make earn
body complete in itself. It was not contemplated that the
Council was to send to the Apothecaries’ Society additional
examiners in medicine and midwifery, because those subject!.
were already admitted to the Register, so that there WU DO
necessity to interfere with what was already declared to he
right and proper; all that it was necessary to do wal (6
intervene in connexion with the surgery examination, end.
make it of such a character as to meet with the approval.
of the Council. Mr. Macnamara’s amendment sought to
authorise the appointment of examiners in three BUDjq&t,
and to that he (Sir Walter Foster) could by no means
sent, as it was not contemplated by the Act. . He
suggest that in order to enable the Executive Committee J5
report on the matter further debate should be postpone^
Hr. Pettigrew argued that the Council would not
out its duties if it simply appointed additional exanffnaqtia.
surgery, seeine that it was tneir province to maintain
standard of efficiency in medioine, surgery, and midwife*?/
Mr. McYail, after observing that if such a committor
had been proposed were appointed the difficulty ml *
perhaps be evaded, proceeded to point out that thsj
declared that certain universities were still able 1 to
qualifying examinations, and that if other bodies defii .
in such powers were unable to combine witfc ttwM that
were thus privileged they might join with the/QMldfl'
whose examiners would have the power of ooptrolling
examinations. The Council were now in a position, tp^
a union with the Apothecaries’ Society exactly w
College of Surgeons might have done had it been so 1
Such examiners, however, would not merely WteM
for surgery, but for medicine and midwifery AI«y
the Act expressly mentioned that this should "be
was imperative on the Council to carry out the j "
the statute, and it was useless to'attempt to
an obvious duty simply because it might bei
Act was badly drawn. -Mr. Carter had suopee^^,_,
his Society with the Council, and he onght
it, hut if his proposals .were accepted he would dO
[the Institution' with whieh he was cOnne
(render the Act a farce and a sbkpL He
'Walter Foster that it vroilld he better to de
cussion until they realised their exact pontion-
, Mr. Carter, said he was willing to with«a#^
but announced that he would vote'In fivpiff^lfji
jment which Sir W. Foster proposed tphrinj’
iference to supporting that which Mr. Ms
(submitted/ ’ *

I Sir W. GutL, after expressing'the
■being borii this side of the Tweed, ■
he had not much logic, he posaea
Me Vail had supplied them wit!
ended In Vina.' (Laughter.

'-k ** tbeft thu Society of Af
66,‘arid the]
eitiinl

THE LANCE*,]

MEETING OF THE GENERAL MEDICAL COUNCIL. [Ma¥ 21,1887. 1039

it naturally came to the Medical Council for the necessary
powers; but it seemed that if Mr. McVail could have hiB
way he would extend the provisions of the Act to all space
and time, even to the controlling of the movements of the
heavenly bodies. (Laughter.) With his old friend, Benjamin
Disraeli, he (Sir William Gull) could only say, “Thank God
we are not governed by logic.” (Laughter.) Mr. McVail
had said the Council was responsible for the entire examina¬
tion, although what it simply had to do was to appoint the
necessary examiners. Perhaps when he next spoke he would
assert that the Council was responsible for the issues of life
and death. He (Sir William Gull) should certainly vote for
Mr. Carter’s motion.

Dr. Lbishman heartily supported Mr. Macnamara’s amend¬
ment, because he was distinctly of opinion that the examiners
to be appointed should be responsible to the Council for every
detail of the examination.

Dr. Haughton could not vote for the motion, because he
was convinced that the Council had power to appoint
examiners in midwifery and medicine as well as in surgery.

Dr. Heron Watson suggested that, in order to avoid
further delay, the Council should itself go into committee
on the subject. The Apothecaries’ Society bad asked that
certain gentlemen should be appointed, and had thereby
exceeded their powers, inasmucn as the Act enabled them
only to apply for examiners, and not to nominate them.
He understood that the examination fee was six guineas,
and he should like to know whether it was sought to have
the Society rehabilitated in order to cheapen the process of
obtaining a licence in medicine, surgery, and midwifery.
The varying prices of diplomas were a melancholy fact, and
he thoughtit would be desirable that the Council should insist
upon a levelling up, not only as regarded the fees, but also
ae to the times of examinations. In conclusion, he said that
he should vote for the amendment.

Further debate was at this point discontinued, and the
Council adjourned for a short time, having unanimously
agreed in the meanwhile, on the motion of Dr. Quain,
seconded by Mr. Macnamara, to the adoption of the report
of the Pharmacopoeia Committee. When the Council re-
isaembled,

Mr. Carter said he should like to be permitted to witb-
Iraw his motion, and the Council having agreed to allow
iim to do so, Mr. Macnam&ra’s amendment became the
substantive motion, but this in turn was withdrawn in
iavour of Mr. McVail’s proposal, to the effect “ That a com¬
mittee be appointed to consider, with such legal assistance
is they may require, the number of assistant examiners that
thould be appointed to the Society of Apothecaries of Liondon,
:he subjects in which they should respectively examine, and
;he powers and duties which they may consider the Council
thould by order prescribe, also as to the remuneration of
;he assistant examiners, and to report to the Council at its
>resent session.”

Sir W. Foster then moved, as an amendment, “That
lending a full consideration of the best mode of carrying
>ut the resolution of the Council to appoint assistant
•xaminers to the Society of Apothecaries under the pro¬
visions of the' Medical Act (1886), and subject to further
^solutions of the Council under Section 5 of the Act, the
Council hereby appoint Messrs. Making, Waleham, and
Indrew Clark as assistant examiners for the Council for one
rear from July, 1887.” He said the matter was a very serious
me, but he could not see how daring the present session the
loancil could obtain all the requisite information for its
guidance. The Council might be compelled to act in a way
lot contemplated by the framers of the- Act, but before
ping to that extreme full time was needed for deliberation;
irhilst it was not unlikely that counsel’s opinion would have
o be taken and arrangements Made to confer with the leading
fficials of the Privy Council. The gentlemen named in his
esolution would be appointed, not at the dictation of the
ociety, bat because they were members of the profession,
nd had been introduced to the Council as lit and proper
ereons to conduct the examination. To add these examiners
o those on the Society would not in anyway prejudge
he question, and during the interval legal advice could be
btaiued as to future procedure.

Dr. Quain seconded the amendment on the ground that
; would be impossible to go into and present a satisfactory
sport upon the subject during the current session. To his
imd, however, there could not be any difference of opinion
s to whether the Council could appoint examiners in all
xbjeote oriaonly one, and he thought they ought to confine ■

themselves simply to what was asked for—viz., examiners
in surgery.

Dr. Lbishman suggested the appointment of an examiner
in surgery, medicine, and midwifery respectively, instead of
three in surgery.

Sir W. Foster thought that to do so would prejudge the
question, which would not result if his amendment was
adopted in its present form, because tbe gentlemen men¬
tioned therein were simply styled “ assistant examiners.”

Dr. A. Smith looked upon the amendment as jl mere sub¬
stitute for Mr. Carter’s motion, and he objected to this
attempt to obtain by a side wind what had been refused
when put in another form. The Council ought to possess
complete control of the examinations, but if they were to
accept Sir W. Foster’s amendment they would find them¬
selves shorn of their power to do so.

Dr. Bruch was in favour of the amendment. The Society’s
examination hitherto had been accepted as sufficient, and
the body ought not be unnecessarily interfered with; but it
was doubtless desirable that its standard of efficiency should
be raised, and, having regard to the words of the Act, he
thought it was the duty of tbe Council to supplement the
existing board by appointing assistant examiners in surgery,
medicine, and midwifery. It was only proposed to continue
the present arrangement for a year. Next year the Council
could consider tbe whole question, and see that the exa¬
minations were what they should be.

Sir Wm. Turner thought that Mr. Me Vail’s motion,
perhaps with some little modification, was the best that
could be adopted. He did not at present see his way to a
true interpretation of the words of the Act, and au authori¬
tative opinion was wanted upon the subject. For that purpose
it would be best to refer the matter to a committee. He could
not, howover, think that it was the intention of the Legis¬
lature to establish anything like a State examination. Sir
Walter Foster’s amendment appeared to him to be a proposal
to shirk the difficulty, at least for a year, and to sanction
the existence of the examinations of the Society of Apothe¬
caries precisely as they had been conducted.

Dr. Hauguton referred to the answers given by the
Attorney-General, the Solicitor-General, and Mr. Muir
Mackenzie on the points submitted to them. A question
had been raised as to whether, if a university were to give a
degree in medicine, another in surgery, and another in mid¬
wifery, the holder of them would be entitled to registration.
He understood the answer to be in the affirmative: “ Such
evidence can be either by diploma, or diplomas granted by
the combined body, or by a certificate, or in any other
manner that the General Council or Branch Council may
consider satisfactory.” He presumed that the conjoined
bodies or universities might send up diplomas or qualifica¬
tions without a special certificate. The Apothecaries’ Com¬
pany was already qualified to give a diploma in medicine
and midwifery; and the Council, in supplying an additional
examination m surgery, had placed the Society in the
position of a conjoint body, and bad not given it the right
to conduct a State examination. By tbe addition of surgery
the Society would be able to give three diploma?, the pro¬
duction of which would entitle the holder to be placed upon
the Register. He supported Mr. McVail’s motion. The
authorities in Dublin considered that it was absolutely in
the power of tbe Council to give directions to the Registrar
in the sdnse he had indicated.

Mr. Simon said the Council would be going beyond its
powers in agreeing to the amendment. The Act gave the
Council power to appoint additional examiners “ from time
to time/ and the present motion was to appoint them for a
limited time only. According to his reading of the Act the
duty of the Council was simply to supply a specific defi¬
ciency; it had not a general commission to improve the
examinations of the licensing bodies except by means of
inspectors, and by reporting when necessary to the Privy
Council. The two things ought not to be confounded. He
supported the amendment of Sir Walter Foster, which simply
accepted provisionally the arrangements in force at the
Society of Apothecaries for a limited period, and subject to
any further resolutions of the Council under Section 5. If
there were a reference at aU,it ought to be to the Executive
Committee.

.Dr. Duncan supported Sir W. Foster’s amendment, but
expressed his dissent from most of the speeches that had been
delivered in its favour.

Dr. Glover said tbe Medical C->»ine»l had an awkward .>
habit of postponing its duti°o He had himself found in

1040 The Lancet,]

MEETING OF THE GENERAL MEDICAL COUNCIL.

[May 21,1887.

private life that however difficult a thing might be to-day,
it was still more difficult if put off till to-morrow. Tnat
rule applied, he thought, to the present position of the
Council. They owed it to themselves and to the Society to
settle the business during the present session. It the
matter were postponed, the Society of Apothecaries would be
living for twelve months in a Rtate of suspended animation.
It was due to the Society that the Council should complete
its equipment as rapidly as possible.

Mr. Carter said that on behalf of the Society of Apothe¬
caries he cordially supported the motion of Sir Walter
Foster. As to the weekly meetings of examinations, the
fees paid, and other matters of the kind, they were all
settled by Act of Parliament: but the Society intended, as
soon as it was relieved from its present state of suspense, to
apply for an Amendment Act. so as to bring the arrange- j
ments more in harmony with present-day requirements. |
There was no intention on the part of the Society to dictate 1
to the Council. If the Amendment were adopted, there
would be ample time to consider the many difficult problems
requiring solution, and the ordinary work of the Society
would still be conducted in an uninterrupted manner.

Dr. otrutiiers said that, as he had foreseen, the letting
out of the waters had already begun. Sir Walter Foster’s
amendment was a very clever and ingenious way of getting
out of the difficulty ; but it certainly prejudged the question.

Sir W. Turner said it was the duty of the examiners
to take cognisance of medicine, surgery, and midwifery,
and he wanted no lawyer’s opinion upon the subject.
Indeed, the Council had no choice in the matter.

Dr. Kidd called attention to a statement in the report, of
the visitors that the examiners of the Society of Apothe¬
caries were not, bound to examine in any special subject;
but undertook the examinations for periods of live weeks.
It was, however, generally recognised at the present time
that all examinations should be conducted by experts.

Mr. Carter said that on the recommendation of the
Council the system lmd been altered.

Mr. McYaii. said that if Sir Walter Foster’s amendment
were adopted, the Society of Apothecaries in its present
state would be perpetuated for another year, and he main¬
tained that the Council had no power to bring about that
result. One consequence of it would be that when there
was the least difference on the part of any combining body
there would be a split up of the whole thing, and more
examining bodies would have to be appointed.

On a show of hands being taken for the amendment, 12
voted for it and 14 ag linst. For: Mr. Wheelhouse, Dr. Fergus,
Mr. Teale, Dr. Haughton, Mr. Collins, Sir W. Foster. Dr. Pyle,
Dr. Quain, Mr. Simon, Dr. Bruce, Mr. Carter, and Dr. Moore.
Against: Dr. St rut hers, S ; r Dvce Duckworth, Sir W. Turner,
Dr. Banks, Dr. Pettigrew, Dr. A. Smith, Dr. Lei.-hmnn,
Drl Take, Dr. Heron Watson, Dr. Kidd, Mr. Me Vail,
Dr. Glover, Mr, Muennmara, and Dr. Chambers.

Some discussion took place on a motion for the adjourn¬
ment of the debate. On a show of hands the motion was
negatived, but on the names being taken and the numbers
counted it was declared to be carried by a majority of one.

Saturday, May 14th.

Mr. Marshall, President, in the chair.

A communication was received, and ordered to be entered
on the Minutes, from the London School of Medicine for
Women, petitioning the Council that, in the event of their
appointing examiners in surgery for the Society of Apothe¬
caries of London, they would urge upon the Society the duty
of recognising the School and admitting its students to the
benefits of the Society’s examinations and licence.

Sir William Gull gave notice that he would call atten¬
tion to the subject at a future sitting of the Council.

The following ad interim report was received from the
Income and Expenditure Committee:—

The Committee appointed to consider the pa»t income aiul expendi¬
ture of the Council, and to report to the Council whether any. and if so
what, diminution c*n be tir.ule in the future expenditure of the Council,
and ala*' whether, and In what manner. Its Income may be increased,
make the following nd interim report.

The average annual income of the G-neral Council and of the three
Branch Couuel's for the past five years has been as follows

General Council.£.1«7ff 5 0 I Scotch Br. Council ... £103* 0 2

English Br. Council ... 4730 14 3 | Irish Branch Council 1276 4 0
The average vearly total Income (£8H77 14*. M.) of all the Councils for
the past five years —aa set forth in Table A—Include*, however, excep¬
tional receipts from the new edition ot the Pharmacopeia. If the
average yearly amount (£341 6*. 4<f.^ which has resulted from the sale of

Pharmaeopu-ias during the past five years be deducted, the averse
annual income of the General and three Branch Councils saow
nli.x'Lther to £7‘.tW m 24.-that is to say, In round numbers to ab ut
The committee are unanimously of opinion that there arv u
present no available means of increasing the income of the Gouoci..
It has been suggested that a registration fee might be charged w
medical students, but the committee are unanimously of opinion t-s.

this cannot be recommended. . . .. ,,_.

Tlie expenditure of the General Council and of the throe Branrti
Councils during the past five years is set forth in Table B. which shorn
the annual averages during that period to have been as follows :

General Council.& 0 I Scotch Br. Council ... £Ut 9 1

English Br. Council... 875 19 10 | Irish Branch Council 1S7
The expe.is.-s and balances of receipts of the three Branch Conne ll
for the past- live years are set forth separately, in detail, in Table C.
It results, therefor.-, that the annual average of the total income for»he
past live years of the General Couucl and otthe three Branch Countah
excluding, for pnrpuses of comparison the exeephonal ir««pU IhsJ
have, as before staled, arisen Hi connexion with the 11 harmacopn »
amount * t o £7** »«■ M -; «n«» that the expenditure has been
thus leaving a vearly balance in favour of income of £lJ»o UU. 6d. Tie-*
vearly balances have, from time to time, been invested in CotwU^-hr
Branch Councils, thus giving now ft total of lnrwt n ^ t, ° l f
This expenditure will, at the present rate of payment.heinoWed y
the enlargement of the Council: nnd the increase w '*'{" r Ul ?
exient of nearly one-fourth, the proportion in which the number <4
I Council members w ill be ultimately increased. It liecomesthiijnianjreit
that if the income and expenditure of the enlarged Coiincilareto W
brought into sat isfac-ory relation, and if there are no meansa^haW.fw
, increasing t he income, it will be nee-ssary to reduce ^ e e xpend' l u ..

Among the items of expenditure, those which arc attendant upon , if
meetings of the General Council have received the serious «mnstd«wM"B
of the committee, and the committee are of opinion ‘this expen,l>
tore should be reduced. But they defer making any P ro P^ “»®
met hod of effecting such reduction until the report, by the Procadu.e
Committee shall have been considered by the Council.^ ™ .,_. n
May 12th, 1837. G - M - Humphry, Chairman.

An opinion was read from the Attorney-General, th*

| Solicitor-General, and Mr. Muir Mackenzie, in answer to the
following questions: —

1 <„) Whether the sanction of the Council is

eruitj'p the medical bodies mentioned in the *ct of 1S*3 to eomWnr
i the purposes of the examinations therein mentioned ; or whether wx#

I bodies can combine without the sanction of or reference to the Uunn-
If counsel arc of opinion that the medical bodies can legally eoird,
without the sanction of the Medical Council, whether the OhwJ
Council or Branch Councils, t hrough their registrars. “hould m

I quire evidence, either from the diploma or diplomas granted by'** ■
j cunillined bodies, or from a certificate to accompany such d.plonu «

diplomas. | Imt the person receiving it or them has passed the neee_

, qualifying examination, and that the examination hasbeen eondo. nd
| by bndit s who have legally combined under the Act of 1**#.

The opinion was as follows:

(a) In our opinion, the sanction otthe General OouncBU^t nece^arr
in order to enable the medical bodies mentioned in the Medical AM. le •
to combine for the purposes of the examinations therein mentioned, si-

such bodies can combine without ? ‘VJ C n^.l PooneUorthe Bra"

, General Council. <h) In our opinion, the ' Of™** £

Council through tlieir registrars can and should be satisfied that *»-
I person who presents liimself for registration lias pawed the neons-ol
j qualifying examination, and that the exammaUon ha. b^n

'will, h ive entered into a valid combination, under tne a - ■
j can he afforded either ***«g™*

! illnlomns crarited by the combined tKslies. or by a certificate, or io an
! otilcrnirtimer that tfie General Council or Branch Council may cn»fc*
i satisfactory. R- D. WEB8TBB.

I Edward Clause.

1 The Temple, March 30th, 1887. M. MUIR MACKENZIE

A letter was read from the Lord President of the Fnyj
1 Council, together with a copy of an Order in Council of :

| 25th March last, declaring that Part 2 of the Medical Act ol

188 G shall apply to the colony of New Zealand.

Certain regulations were received for the diploma u
Public Health of the University of Aberdeen.

A communication was received from the Science and Ar.
Department with reference to the International Conference
on Hygiene to be held next September in Vienna, and statin*
that,‘should the Medical Council wish to nominate a dele¬
gate, the Secretary of State for Foreign Affairs had exprefetf
his readiness to furnish his name to the Austro-Hungmmn

Government. ..« ._ 4

The adjourned debate of Mr.McVail s motion with reference

to the Society of Apothecaries was resumed. .

Mr. Simon said that the motion as to the appointment a
1 assistant examiners referred to “ the subject in which they
should respectively examine.” He suggested that the won-i
should read “the subjects in which they should respectiv- J
or collectively examine.” The words proposed by -Mb
McYaii appeared to prejudge the whole point at issue.

Mr. Me Vail accepted the proposed modification.

Dr. Haughton moved as an amendment to omit tEf
. words ‘a committee be appointed,’ and to subrtitnte k*
) them • the executive committee be requested. The Councu
- had passed a resolution affirming the principle that it wouu
• supplement the Society of Apothecaries examination ty
r the appointment of examiners in surgery only.

The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[May 21,1887. 1041

■was no power to thrust on the Society an examiner in
medicine and midwifery, and if the Council did so he
believed that the Society might resist it in a court of
law. If the College of Surgeons were under considera¬
tion the Council would have to give them supplemental
examiners in medicine; and in the same way it lmd to give
the Society of Apothecaries examiners in surgery. The
principle of Mr. Carter’s resolution had been adopted by a
large majority, bat the Council appeared to be hopelessly
divided on the question of how to carry it out. There was
the same confusion among the members of the Council as
there would be among the judges of the Court of Queen’s
Bench if they tried to treat a case of fever. He did not
think that any committee would be able to settle the
question during the present session. Under all the circum¬
stances, he thought the best course was to refer the question
to the Executive Committee, who were accustomed to deal
with such matters. He believed that it was beyond the
power of the Council to appoint examiners in medicine or
midwifery for the Society of Apothecaries, and if it had the
power it would be unwise to exercise it.

Mr. McVail said that the Executive Committee was a
small body, and he believed that the members of it were all
of one way of thinking. He therefore objected to the question
being remitted to that committee; a larger committee should
be appointed on such an important ques'ion.

Dr. Haughton said he did not know who constituted the
Executive Committee, or what views they entertained.

Mr. McVail said he bad no objection to include in the
committee that would be appointed under his motion all the
members of the Executive Committee.

Dr. Haughton said that under those circumstances he
would withdraw his amendment.

Dr. H. Watson said he did not approve of the matter
being referred to the Executive Committee, and did not
desire that it should be relegated to another session. If the
Council did nothing more than appoint surgical examiners,
he did not think it would incur the opprobrium of setting
up a gigantic examining body; but be strongly held the
view that the Society of Apothecaries should be aided by
the Council by the appointment of such assistant examiners
as the Council thought tit, in order to make it an efficient
beard.

Dr. Quain moved an amendment to the effect that it
was unnecessary to refer the matter to any committee, and
that the Council proceed to comply with the request of the
Society of Apothecaries. He said he hoped the Council
would not commit itself to so false a step. There was not
a shadow of pretence for saying that the Council had any
other duty than that of appointing examiners in surgery
for the Society of Apothecaries. The Act of Parliament
stated that examiners should be appointed to the bodies
concerned “ on their application,” and the Society had only
applied for examiners in surgery.

Sir. B. Carter seconded the amendment. He said he had
no sympathy with the imaginary difficulties that had been
raieed by many speakers. The intention of the Act was
clear, although its language was in many respects defective
and involved. The great peculiarity of the case of the
Society of Apothecaries was that the inability was not a
real but only a technical one. They had the examiners,
although they had not the statutory right, and he asked the
Council to recognise the existing position of things. The
direct question which they had to determine had been lost
sight of. His willingness to consent to a reference to the
Executive Committee arose from the fact that that com¬
mittee consisted of gentlemen accustomed to transact busi¬
ness expeditiously, and he knew that when they went to
the law officers of the Crown the contentions raised about
the responsibilities the Council was going to assume would
be scattered to the winds. He could not, however, agree to a
reference to a committee ad hoc.

Mr. Simon said that if the proposed committee were to
take legal advice of a quality sufficient to satisfy every
scruple of every member of the Council, the proceedings
must occupy considerable time. The opinions of solicitors
and attorney-generals could not be obtained in a day. There
might be a difficulty in the selection of the memhers of the
committee, and would it not be better that the Council
settled the matter itself? He had no right to go back on
the amendment which was rejected yesterdav afternoon,
but it was. rejected by an accident, after the Standing
Orders had been suspended, and when one or two of those
who were In favour of it were absent. Would not the

simplest way of dealing with the matter be to invite Mr.
Muir Mackenzie to attend and answer any questions that
might be put to him ? Some of them dissented from the
principle of what they were doing, but if his suggestion
were adopted they would be able to take part in the con¬
sultation, while gTeab embarrassment would arise in the
appointment of a committee. If they did it in full Council,
with the assistance of the legal adviser, he thought they
could not go very wrong, and much time would be saved.

Sir W. Turner said, although Mr. McVail’s motion to a
large extent met with his approval, he thought that under
the circumstances in which they were placed Mr. Simon’s
suggestion would better meet the most important of their
difficulties. He would a*k Dr. Quain to withdraw his
amendment and allow Mr. Simon to substitute for it one
expressing in terms the suggestion that he had made.

Dr. Heron Watson considered that the solution of the
position suggested by Mr. Simon was really the only pos¬
sible one. He could not, however, coincide with the pro¬
posal to have legal advice. So far as be had seen, the advice
which they had of late received from the solicitor and
oounsel had rather tended to darken judgment than to clear
it up.

Dr. Quain consented to Sir Wm. Turner’s suggestion.

Sir Wsi. Gull could not see why the Council should not
proceed to do their duty. He could see his way elear
enough. He had no doubt that it was his duty to help to
appoint assistant examiners, and in his opinion it should be
done at once. Metaphysics and logic and theory bad been
indulged in ; but the Council had its work to do, and any
plain Englishman could in ftve minutes do all the work
which had taken three days.

Dr. Duncan said he did not quite agree with the views
expressed by any of the previous speakers. The Council
had settled that they were to proceed with the appointment
of the assistant examiners to the Apothecaries’ Society, and
the point that was not decided would not be settled by
Mr. M’Vail’s resolution or by Dr. Quain’s amendment.
Underlying all other matters was the question whether the
Council were to take charge of the entire examination by
the Apothecaries, or whether they were nr rely to do what
the Act prescribed—namely, to appoint assistant examiners.
When that was settled the whole question would proceed
easily. Was the Apothecaries’ Society in future to be a mere
creature of the Council, or was it to be, as it bad hitherto
been, a body of independent examiners, with assistants sent
to them by the Council ? Mr. McVail and his supporters;
hoped to establish the principle that the Apothecaries’Society
should in future exist, not in reality, but merely virtually ;'
that as an examining board it should be a mere creature of
the Council, and that the Council itself should examine in
all branches through the Apothecaries’ Society. No one
could read the Medical Act and suppose that that wan the
intention of the Legislature. The word “assistant” was
enough to settle the whole matter. He would suggest
another amendment, which would not require legal advice:'
“ That the assistant examiners about to be appointed are to
be such as are required by the Apothecaries’ Society, with a
view to the completion of the board of examiners under the
Act of 1886.”

Dr. Heron Watson. --That does not clear up thedifflculty.

Mr. Macnamaha thought the difficulty would be solved
if the legal adviser attended at two o’clock next Tuesday.

Dr. Quain’s amendment was thereupon withdrawn in
favour of the following, moved by Mr. Simon, and seconded
by Dr. Quain : “That the Council will on Tuesday next, at
two o’clock, consider in committee the steps by which to
give effect to its resolution of May 13th for the appointment
of assistant examiners to the Society of Apothecaries, and
that a request be made to Mr. Muir Mackenzie and Mr<
Ferrer for their attendance on that occasion.”

Mr. M'Vail said that after discussing the subject for
nearly a week the Council had now got into a position of
grave legal difficulty, and the time was very short before
June 30th. In the interest of the Apothecaries’ Society the
matter should be quickly settled. It was therefore advis¬
able to refer it to a committee to prepare for the discussion
next Tuesday, and to lay before the legal advisers the
difficulties which the Council felt, and which they were
incapable of settling. Evidently Mr. Simon meant to
oppose to the death the views of some members of the
Council. By motion after motion obstructing the inquiry
he showed that he was determined that his view of the
duties of the Council should bi carried. . j

1042 T&B LANCET,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[May 21,1887.

Mr. Simon said such personal imputations were contrary
to the practice of the Council, lie could not more clearly
show that he was not pressing any persona view on the
Council than by asking that their legal advisers might

Mr. Me Vail sa^d he did not impute any personal motive
to Mr. Simon, who was simply acting according to wbat he i
considered his duty, but he opposed the inquiry by amend- ,
meat after amendment, and was conducting lus opposition
with a degree of persistency that was unusual in the
Council. The opinion of the committee might come before
a committee of the whole House, and it was extremely de¬
sirable that then the legal advisers should be present, it
the Council declined to proceed with the matter until
Tuesday, they would either have to sit an absurdly long
time, or would have to be called together again before

June 30th. , . , |

Dr. Banks heartily supported Mr. Simons motion, as he •
considered it the only practicable way of getting out of the
difficulty. If the discussion were continued much longer,
he thought the power ought to be conferred upon the i
President, which was exercised in another place, to put a

8t °Dr t KiDD thought that the different views might be har- j
monised. There were certain duties laid down by the i
statute which Mr. Simon’s amendment did not cover, ine
Council had to fix the time of the examinations, to decide
how the standard of education and examination was to be
maintained, and to consider the powers and duties to be ,
conferred on them, as well as the remuneration. It would |
probably meet the views of the Council if the motion ran : |

“ That a committee be appointed to consider, wit h such legal
assistance as they may require, the number of assistant i
examiners that should be appointed to the bociety ot
Apothecaries of London, the subjects in which they should
respectively examine, and the powers and duties which they
may consider the Council should by order prescribe, and
also as to the remuneration of the assistant examiners, and
to report on Tuesday at two o’clock, when the legal adviser
should be requested to attend.”

Dr. Bruce said there appeared to be an attempt to put
the cart before the horse. The first thing the Council had
to do was to make up its own mind. Referring the matter
to a committee was a silly proceeding; it was passing away
their responsibility to a committee. The right and proper
thing to do was to first settle the legal question, and then
they might appoint a committee.

Dr. Glover wished to ask the older members of the
Council if they ever remembered a question of such magni¬
tude being settled without the previous appointment of a
Committee to draw up a careful statement, and then to
come to the Council with the best basis they could arrive ,
at. With regard to the legal construction, he thought it
would be shown that their duty would be limited to the
appointment of surgical examiners, but the question wou d
come out in the report of the committee, who would certainly
be very much fortified by having a lawyer present at their
meetiug. He would appeal to Mr. Carter, after the irieudly I
vote of Thursday and the disposition shown by the majority i
of the Council to treat the Apothecaries with great faith tut- |
ness and justice, to give the members credit for wishing as
well to the Society as he did himself. _

Mr. Simon said that, to the best of his recollection, there
had never been a case of this kind before. There were
groups in the Council holding fundamentally different .
opinions on a point of law, and a settlement could not. be i
arrived at by a Committee. After bearing Mr. Muir Mac¬
kenzie's opinion each member of the Council would be able
to satisfy himself as to the construction of the law and to
put questions to counsel. . . ,

Sir W. Turner said that the presentation of the amend¬
ment by Mr. Simon had put the question in a very different
aspect, because it now appeared that all parties m the
Council were of opinion that additional advice was needed
before the matter was dealt with. He did not consider that
a special committee was needed. Every member of the
( uincil had the points in dispute clearly in his mind, so
that it seemed to him that Mr. Simon’s suggestion was the
more practical. If it were agreed to, then the Council,
before it parted on Tuesday afternoon, would be able to ao
wbat they were advised to do.

|)r. St RUTH HRS could not agree with Sir YV. Turner. Jie
thou >ht the motion and amendment might be worked in
together - the point of law, there were a number of

other matters to place before counsel, and if that were done,
then on Tuesday they might come to a decision. ....

Mr. Me Vail slid he was willing to adopt Dr. Kidds
amendment if Mr. Simon would do the same.

Mr. Simon would not consent to this course.

Dr. Quain said, in answer to Dr. Glover, that the usual
way had been for the President to communicate to the
solicitor the question under discussion, and, no doubt, that

course would be followed in the present case. _

Mr. Simon’s amendment was then voted upon, and carried

by 21 to 5. . .

On its being put as a substantive motion, .

Dr. Kidd moved the amendment wkich he had previously

r6 j) r- Pettigrew eeconded the amendment, but it was lost

k^Tho President said that he regarded it as his duty, in
the present crisis, to prepare a case and a senes of queMions
to be submitted to the lawyers before Tuesday. *Jecon-
gratulated the Council on the failure to carry Mr. Mc\ wl s
motion, because it had struck him all along that the words
•‘such legal assistauce as they may require involved an
exceptional and altogether wrong power. The committee,

if appointed, would have been able to go outeuie the 1 <sgal
advisers of the Council and obtain opinions from Scotland
or Ireland.

Mr. Mu Vail—C ertainly.

Mr. Simon’s motion was then agreed to nem. con.

The Apothecaries' Hall of Ireland.

Mr. Collins moved: “That inasmuch as the King and
Queen’s College of Physicians and the Royal Co!lege of
Surgeons in Ireland have declined to comply with the
request; of the Medical Council of Feb. 16th, i^T- that the
Colleges should combiue with the Apothecaries Hall of
Ireland for the purpose of holding qualifymg ^xammations
in accordauce with the provisions ot the Medical Act (l-No .
and the Governor and Court having made application to the
1 Medical Council for the appointment of assistant examiner?.

I the Council do now appoint such summers accordingly.

* In doing so he said the Registrar of the College of r hy i
had sent him a statement, with the request that he
carefully consider it. He had done so, and he thought there
were certain portions of it calculated to produce an erroneous
impression upon the members of the Council. The Ant of
1791 was “ for the more effectually preserving the health of

His Majesty’ssubjccts, for erecting on Apothecaries Hail in the
city ot Dublin, and regulating the profession of an apothecary
throughout the kingdom of Ireland. The
liameiit who passed it knew very well what the meaning ot
the word was, but the contention of the College of Physicians
of Ireland was that the licence of the Apothecaries Hall was
only a licence in pharmacy. If that hid ton^the inbenuon
of the Irish Parliament the words would have been for
regulating the practice of pharmacy in Ireland. It should
bo known that the College of Physicians was at that tun.
just as much opposed to the idea that the apothecaries of
, irelaud should practise medicine as they were at the present
' time- Id one part of their statement it was said that in
I 1791 there were no apothecaries in Ireland properly eo calleu.
1 but the Act was passed “at the request of the master,
i wardens, and commonalty of the corporation of apothecary
! a ud other apothecaries of the city of Dublin. There*' 1 *
there were apothecaries at that time because the Act wa
passed at their request. He at once acknowledged that t.*
| Hall mixed up trade with profession, and the Irish Parhamec.

and the English Parliament intended that they should do »

1 There was not a single word in the Act directing the appeUan.
examiners to confine their examinations to materm medic*.

by 8 the J A?t, h wid P That"it would"be"an anomaly to give th-
appeal to the College of Physicians without expecting thy
tn examine in the practice of medicine. M hat made th»
perfectly certain was this: they had, as a board of examine*
So institute examinations for apprentices, and to give eli¬
minations to assistants, and then the final1 examination f
licence to practise as an apothecary. Now_an apprenti.
and an assistant, if three times rejected, had an appy
to the General Council of the Hall, but an
cary was allowed to appeal to the College of I h
simons because they had to examine himi t. « it »
he was not unfairly rejected by the examiners of i

’8

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MEETING OP THE GENERAL MEDICAL COUNCIL.

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Hall either in pharmacy or in the practice of medicine.
The Act left the Hall perfectly at liberty to examine in
every subject from time to time. The Apothecaries’ Society
of London were obliged to have an examination every week,
but there was no such limitation in the Irish Act, which left
the Hall at liberty to make changes from time to time as
circumstances and the progress of knowledge might require.
Dr. Kidd had said that the College of Physicians baa not
declined to comply with the request of the nail, but in his
opinion an offer based on impossible conditions was the
same thing as declining. The condition was that the Hall
should take some kind of case to the Queen’s Bench at
Dublin and have it decided at their own expense, for the
satisfaction of the College of Surgeons and the College of
Physicians, before they were admitted to the conjoint
examinations. He had asked Mr. Purcell whether the
College of Surgeons could be satisfied in that way—by
bringing a sham friendly case into the Queen’s Bench ; and
the answer was that there was no way of doing it until
the Hall had an independent position, or until they joined
with the College of Surgeons, and then, if the College
of Physicians chose to go to law, the question might
be brought into court. The efforts to bring aoout a Conjoint
Scheme in Ireland went on for three or four years—from
1871 to 1875. First, the two universities ana the three
corporations endeavoured to combine; afterwards, the Univer¬
sity of Dublin and the three corporate bodies tried to form
a Conjoint Scheme; and, finally, the three corporate bodies
alone formed such a scheme, but it came to nothing because
the two colleges could not agree upon pecuniary matters.
It was said that efficient examiners could not be obtained
among the existing directors of the Hall; but of the sixteen
examiners, only two held the qualification of the Hall alone,
six had double qualifications, and seven had triple qualifica¬
tions. It had been stated that only one of the examiners
was a licentiate of the College of Surgeons in Ireland, but
there were four. He himself had kept up his knowledge of
medical and pharmaceutical chemistry to the present day,
and in reality the examiners were all experts. When the
visitors from the Council attended at the examinations, the
Hall came off just as well in the reports as any of the other
bodies that were visited. Of coarse some fault was found,
but not more than was found with the College of Physicians,
and Dr. Gairdner was astonished at the admirable examina¬
tion in hygiene. The Hall, too, was complimented by the
visitors on the examination in midwifery.

Pour o’clock having arrived, the debate was adjourned.

Monday, May 16th.

Mb. John Marshall, President, in the chair.

On the motion of Mr. Wheelhodse, seconded by Dr.
Struthbrs, a communication from the Parliamentary Bills
Committee of the British Medical Association, requesting
;he attention of the Council to the provisions of the Phar¬
macy Acts Amendment Bill, was received and entered on the
Minutes.

The Practical Education Committee, which was appointed
1) to consider the best methods of increasing the practical
dement in medical education, as by a system ot limited
mpilage with a registered practitioner, and (2) by in-
listence on more clinical, therapeutical, and patho-
ogical teaching and work in medical schools, now re-
>orted that it had had under its consideration the large
>roportion of rejections at the final examinations of many
>f the medical authorities, together with other facts
vhich seemed to show a deficiency in the knowledge of
>ractical subjects on the part of candidates. It was of
•pinion that such deficiency was, primarily at least, the
oncera of the medical authorities, and that they were best
ble to make such changes in their curriculum and examina-
ions as would effect the improvements to be desired in
nedical teaching. On the question of pupilage, the com-
nittee was of opinion that, in some way, the advantage to
>e derived from personal instruction was of too great value
o be altogether sacrificed, and suggested that a period of
lot less than six months should be spent in personal
'upilage—not necessarily six consecutive months, but six
a all; that personal pupilage should imply not only the
'•udy of the routine of medical life and its accessories, but
Iso, at some period of its duration, the responsible charge
f patients under efficient supervision. They also recom-
lended that the six months should be taken during the
)og vacation, and after the examinations in anatomy and

physiology had been passed. On the subject of school and
hospital study, the committee drew attention to a resolution
which had already been before it, and which stood recorded
in its Minutes—viz.:

•‘That It be a recommendation to the licensing bodies that In
admitting candidates to professional examinations care be taken tha*
attendance on courses of study prescribed for any second professional
examination shall qualify only If made after the first examination has
been passed, and generally that attendance prescribed for any subsequent
examination must be made after passing the Immediately preceding
examination.”

In conclusion, the committee offered the following sug¬
gestions:—

1. That the Counoil, with a view to Increasing the practical elements
in medical education, should circulate a recommendation to the
examining bodies to make the practical part of examination in medicine,
surgery, and midwifery more extended and more searching than It has
hitherto been, so that it may form a surer guarantee of the possession
by the candidate of the required skill for the safe practice of the above-
named arts. a. That it be a recommendation to the examining bodies,
in their clinical examinations, to give more prominence to the
recognition and treatment of common diseases; and to facilitate the
extension and searching power of these examinations, the "final" or
qualifying examination should be divided into two parts, of which the
ultimate should consist maiuly of clinical work and the personal
application of diagnosis, prognosis, and treatment to set cases, leaving
to the penultimate the testing of the knowledge possessed by the can¬
didate of the other subjects contained in the currioulum of senool work.
3. That it be also reoonynended that there should be an interval of at least
twelve months between tne two parts of the final examination, and that
this Interval should be passed In such occupations as will involve the
charge of patients under the supervision of competent persons recognised
by the authorities of the school at which the candidate has been
educated, which authorities should be responsible for the genuineness
of the evidence afforded of the candidate’s diligence and care of such
number of cases of medicine, surgery, and midwifery as tha examining
body shall deem expedient.

On the motion of Mr. Whbblhousb, seconded by Dr.
Struthbrs, the report was received and entered on the
Minutes.

The report of the Procedure Committee, appointed “ to
consider under what rules of meeting and procedure, and
with what appointment and authorisation of standing
committees and subcommittees, the Council may best pro¬
vide for the regular, effective, and economical discharge of
its statutory duties, the committee to report to the Council
at its next meeting, and to propose for consideration of the
Council the draft of any new Standing Orders which it may
deem desirable,” was received and entered on the Minutes.

Visitation and Inspection of Examinations.

The Council having referred to the Executive Committee
the arrangements to be made in regard to inspectors of
examinations, the committee now presented an interim
report stating that it had passed the following resolutions:—

(a) " That it be an instruction to the inspectors on the present occa¬
sion that they give special attention to the quality of the practical
examinations, and to the sufficiency of the means and appllanoes which
are in use in them for testlngthe qualifications of candidates." (6) "That
each inspector, within the period of twelve months from the date of
his commission, inspect, as regards his subject matter, the qualifying
examinations of all the licensing bodies, and report thereon to the
Council.”

Adjourned debate on the application of the Apothecaries'
Hall of Ireland.

Mr. Collins, in continuing his address in support of his
motion, proceeded to deal with the contention of the King
and Queen’s College of Physicians that the Apothecaries’ Hall
had no legal status beyond the appointment of pharmacists,
referred to various Acts of Parliament passed during the
last century, in which apothecaries were appointed in the
same category as physicians and surgeons to attend the
county gaols. The present Apothecaries’ Act was passed by
the Irish Legislature in 1791, and contained provisions for
the education and examination of apprentices, assistants
and licentiate apothecaries. To show the kind of education
given, he stated that when he passed the Hall in 1826 he was
examined in Greek, Latin, and English, the subjects being
the first two books of Sallust, the first six books of the
^Eneid,and the first two books of Homer. Having passed that
examination, he was bound to an apothecary, and after a
certain time, wishing to become an assistant, had to undergo
an examination in materia medica, chemistry, and pharmacy.
Acts of Parliament passed in 1817 and 1823 stated that
persons might be admitted into hospitals on the certificate
of a certified apothecary or snrgeon, and defined the term
“medical officer,” as meaning a physician, surgeon, or
apothecary. By an Act of 1841 the certificates of two
“ apothecaries” were made equally valid with those of two
physicians or surgeons with reference to the reception or
detention of any person in a lunatic asylum; and by a

1044 Thb Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[May 21,1887.

aeoond Act it was provided that no ship carrying a certain
number of passengers was to proceed on a voyage without
having on board a *• physician,surgeon, or apothecary.'’ He
contended that the Apothecaries’ Hall had fullided its
duties, and had given its licentiates such an education aud
examination as would tit them, in some respects at
all events, for the important positions they had to
occnpy, and for the practice of medicine as well as
pharmacy. He referred to the hostility which the
Hall had met with from the College of Physicians,
although he was not aware that it had done any thing to
provoke it. Since 1791 it had licensed about 4000 prac¬
titioners and was still in a state of vitality, yet the Medical
Act of 1880 placed all the various bodies in a new position.
The Apothecaries’ Hall mu9t come up to that position and
undertake the responsibilities, and his colleagues were fully
prepared to do so. It was a mistake to say that there were
only 387 licentiates of the Hall, for at the present time
there were between 900 and 1000 in Ireland. If there were
only 800, that would be one-third of the medical practitioners
of Ireland, and till 1851 the majority of the practitioners in
Ireland were licentiates of the Apothecaries’ Hall. They
were recognised as medical practitioners not only by the old
Acts, but also by the Act or 1858 and the Act of 1836. He
relied on the justice of Englishmen, Scotchmen, and Irish¬
men to aid the Apothecaries’ Hall.

Dr. Bbucb seconded the motion. The Council, he said,
had recognised the Eaglish Society, and in all fairness they
ought to recognise the Irish Apothecaries’ Hall.

Mr. Teals felt that the Council had no other course open
to it than to accede to Mr. Collins’ motion. As they had
decided in favour of the Apothecaries’ Society of London, he
did not see how they could refuse the request of the
Apothecaries’ Hall of Ireland. By the Act of 1858 they had
been obliged to register the licentiates of the Hall, and that
arrangement was not disturbed by the Act of 1886.

Dr. Stbuthebs had no objection to offer to admitting the
Dublin Society of Apothecaries to the same privileges as the
London Sooiety. Still, it must be remembered that the
Council were threatened with an action at law by the
Dublin College of Physicians. Opinions had been obtained
in Ireland in favour of both sides of the question. The
College of Physicians contended that the Apothecaries’ Hall
had no legal power to grant a licence to practise medicine;
and the opinion of counsel was “that the Apothecaries’ Hall
has no power to grant a diploma or licence to practise medi¬
cine.” On the other hand, Mr. Purcell, Q.C., said: “I am
dearly of opinion that the General Medical Council has no
power to exclude the holders of such diploma from regis¬
tration.” He would therefore move—“That, inasmuch as a
legal question has been raised by the King and Queen’s
College of Physicians in Ireland as to the right of the
Apothecaries’ Hall of Ireland to have assistant examiners
appointed for them, to enable them to separately hold
qualifying examinations within the meaning of the Medical
Act 11886), or to enter into a combination with the Royal
College of Surgeons of Ireland for that purpose, the General
Medical Council decline to appoint assistant examiners for
the Apothecaries' Hall unless directed to do so by the Privy
Council.”

Dr. Duncan inquired whether the licentiates of the
Society of Apothecaries were refused admittance to the
army, the navy, or the Poor-law boards of Ireland.

Mr. Collins said they were not. The licences were
recognised as a qualification in medicine.

Dr. A. Smith said that the mere licence of the Society of
Apothecaries was not held to be sufficient.

Mr. Collins said it of course required a surgical qualifi¬
cation, just as did the licence of the College of Physicians.
Both were in the 9ame position.

Dr. Kidd seconded the amendment. The best solution of
the question would have been to admit the Society of
Apothecaries into the combination, but the question had
now entered on a new phase. The College of Physicians
had threatened to bring the Council before a court of law if
it granted assistant examiners or registered men qualified
by the College of Surgeons and the 8ociety of Apothecaries.
It was necessary, therefore, to obtain a legal decision on the
subject, and that could be done by an appeal to the Privy
Council. There was really no analogy between the Eaglish
and the Irish Societies. The Society of Apothecaries were
distinctly directed by the Act to examine in medicine, but no
•uch direction was given to the Apothecaries’ Hall of Ireland,
the preamble of whose Act distinctly defined their duties as

compounders of medicine. The question now was whether
the Hall came within the definitions of the Act of 1886. In the
opinion of LordO'Hagan and Mr. Justice Lawson the Apothe¬
caries’ Company were not entitled to grant a diploma in
medicine, and if so they could not combine with a surgical
corporation. It was necessary for them to prove their title,
and the amendment afforded them the opportunity of doing
so by an appeal to the Privy Council. The College ot
Surgeons had expressed their willingness to combine if the
Apothecaries’ IIoll had the power to enter into a combina¬
tion, and if the Privy Council decided' that they had that
power the Medical Council would be relieved from the
difficulty as to the question of examiners. The point in
dispute was a legal one, and ought to be decided by a court
of law.

Mr. Simon said that the Privy Council, in the sense of Dr.
Struthers's proposal, was not a court of law, but a branch
of the executive government. The Act of 1858 enacted that
a person holding the licence of the Apothecaries’ Hall was a
qualified practitioner. The Council could not legally refuse
the application of the Hall.

Dr. Lrishman thought it would be beneath the dignity
of the Council to be influenced by the threat of the King
and Queen’s College of Physicians. He frankly owned that
he considered it a mistake that the Act of last year did not
extinguish the London Society of Apothecaries, and the
same observation would apply with still greater emphasis to
the Irish Apothecaries’ Hall. There could not, however, be
any doubt that the Apothecaries’ Hall was & medical cor¬
poration, and the Council therefore had no right to refuse
their request, particularly after the decision that had been
come to with regard to the London Society of Apothecaries.

Mr. Me Vail said it was beyond dispute that the Act of
1858 made the licentiates of the Dublin Society of Apothe¬
caries medical practitioners. The Society was therefore a
medical corporation, and he could not see any ground for
doubting what was the duty of the Council in this case.

Dr. Banks could not vote for giving examiners to the
Apothecaries’ Hall until the legal question was decided in
their favour.

On the motion of Mr. Macnawaba the debate was
adjourned. _

Tuesday, May 17th.

Mb. John Mabsuall, Pbbsident, in the chaib.

The Council at once resolved iteelf into committee, and
stringers were requested to withdraw.

On the read mission of the public,

Mr. Macnamara resumed the debate on the request of
the Apothecaries’ Hall of Ireland. The case, he said, was
not on all fours with that of the English Apothecaries’
Society. That Society’s Act clearly laid it down that'they
should examine in mediciue, but no suoh words were to bo
found in the Acts relating to the Irish Hall. That Hall
simply had to examine as to the knowledge of the
candidates of the art and mystery of an apothe¬
cary. Neither was the case on all fours with the
decision come to by the Council in 1863. At that
time the Council’s decision was final, and there was
no appeal; but now there was an appeal. The Council
was not only a Council of Education, but was also a
Council of Registration, and they were now placed in the
position of having to say whether they would or would
not set up a body capable of conferring registrable quali¬
fications. At present there were in Dublin two universities—
one requiring a complete course of arts, and the other
requiring a most satisfactory general education. There were
also the Royal Colleges of Physicians and Surgeons, who
were prepared to qualify for the Medical Register. The
Council was now asked to set up a fourth body in that city.
He knew that it would be most destructive to education in
Ireland to give the Apothecaries’ nail the power of granting
the qualification in medicine. It was not a question of
corporate jealousy or a battle of the shops, but the opinion
of the profession in Ireland had been deliberately pronounced
upon the subject. In 1881 the Irish Medical Association,
which included nil ranks of the profession, stated before the
Medical Acts Commission that the Apothecaries’ Hall of
Ireland could not be considered anything more than a
body for the licensing of pharmaceutists, and that it
had no more claim than the Pharmaceutical Society to be
represented at the General Medical Council. It was a
trading company, and was now so diminished in importance

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MEETING OP THE GENERAL MEDICAL COUNCIL.

[May 21,1887. 1045

as not to be entitled to the privilege aaked for it. Mr. Collins
had said that in severs! claims for joint examination the
Apothecaries’ Society was included, but that was antecedent
to the year 1879, from which date onwards the Colleges had
steadily refused to have anything to do with the Apothe¬
caries’ Society. It might be true that the public services
recognised the qualifications of the Apothecaries' llall, but
they also recognised non-registrable qualifications such as
the licence of the Coombe Lying-in Hospital and the
Rotundo, and those hospitals might as well call upon the
Council to recognise and register their qualifications in
midwifery a3 the Apothecaries’ Hall might call upon them to
JHgister its qualification in medicine. Mr. Collins had argued
that the lioentiates of the Apothecaries’ Hall were of great
value as general practitioners because they were enabled to
supply medicine to their patients; but the licentiates of the
College of Physicians were not interdicted from supplying
medicine, though they were from keeping an open shop for
the sale of medicines. The pharmaceutical chemists had
entirely taken the place of the apothecaries in Ireland. The
Council, before conferring the powers sought for, should see
that there was an urgent necessity for doing so, especially
when they bore in mind that their decision was not the
final one. For these reasons he supported Dr, Struthers’
amendment.

Dr.QuAiN said that, inasmuch as Parliament had recognised
the Apothecaries’ Hall as one of the examining bodies, the
Council m,uet do the same or be prepared to take the respon¬
sibility of refusing, for the Privy Council would be guided
by law, and not by sentiment.

Sir W. Foster said that the question now before the
Council was one of dry law, and not of sentiment. The

K ciple had already been practically decided. He acknow-
ed that the Irish Society stood on a different footing
from the English Society, but still it was a body which had
the power to put a man on the Register, and it was not t.he
rovince of the Council to deprive them of it. As the Hall
ad not been able to combine with other bodies, it was the
duty of the Council to fill up the deficiency by appointing
examiners. He considered that the case made out was
strong enough to induce a majority of the Council to comply
with the request.

. Sir Wm. Gull stated that he should exercise his discretion,
aad vote against granting the demand of tiie Apothecaries’
Society.

- Sir Dyck Duckworth also expressed his intention of
voting against the application.

i• Dr. Humphry said there was no question of setting up a
pew examining body. The Apothecaries’ Hall existed as
the examining body under as good authority as any in the
United Kingdom, and since the passing of the Act of 1858 it '
held a legal position on a par with all other licensing bodies i
in the country. By that act its licentiates were to be |
entered on the Register, and whoever was on the Register !
was a qualified practitioner in medicine and surgery. Iu
his opinion there could not be any legal doubt as to the duty
of the Cotmcih and what had been done in regard to the
English Apothecaries’ Society should also be done in regard
to the Irish Society.

The amendment was then put to the vote and lost by 21
to 8, after which Mr. Collins’ motion was carried by 21 to 8.

A motion by Mr. B. Carter, seconded by Mr. Simon,
^tas agreed to : “That the assistant examiners to be appointed
for the Apothecaries’ Society of London be examiners in
Surgery.”

Mr. B. Carter moved, “That these assistant-examiners
be three in number.”

“ Mr. Simon seconded the motion.

Mr. McV ail objected to the motion, because no intimation
Whatever had been given of the number of students to be
examined, or any information as to the mode of carrying out
?he examination.

' Mr. Simon said that for two years the Society had found
that three examiners were sufficient.

Dr.M. Duncan asked what was the number of candidates.
Mr. B. Carter said there were 250 annually, and the
#xaraihatiope were held weekly.

. Mr. Me Vail said that the Council were suddenly asked,
■tHtbout any in![orxn6tion of a definite kind, to determine on
fhe number of examiners. In his opinion three surgical
^xaminepa ^ould not be sufficient for 250 candidates; and
before arriving at a decision he wished for information with
regard to the examinations—hotv the written examinations
were QpnductM.,^Whether there were any clinical examina¬

tions and who conducted them, and were the same three
men to carry out the written, the oral, the clinical, and the
operative examinations ? It might be said that the average
number of candidates was only five per week, but it would
be a marvellous circumstance if that were the uniform prin¬
ciple throughout the year. Under these circumstances be
would move as an amendment, “ That the Council, instead
of proceeding to adopt this motion, postpone action until it
has received information regarding the methods of carrying
out the details of the examinations, written, oral, clinical,
and operative, and the numbers of students on the different
days of examination throughout the year.”

Dr. Kidd seconded the amendment, considering that tbe
number three was either too many or too few.

Dr. Bruce 6aid that the Council, through its inspectors,
would learn how the examinations were conducted, and
until their report was received it would be prudent not to
interfere too much with the Apothecaries’ Society.

Sir W. Foster considered that the whole discussion arose
from the fault of those who persisted in defeating his
amendment on Friday last, when he asked the Council to
wait for twelve months in order to give the Apothecaries’
Society time to equip itself as a body capable of giving a
complete qualification. In hie opinion three examiners
were sufficient to examine five candidates per week, and be
hoped that the Council would carry the resolutions it had
previously passed to their logical conclusion.

Dr. Struthers said the recommendations required that
two examiners should be present at every examination, but
he would offer no further opposition to the Apothecaries’
Society getting whatever they wanted.

Dr. Heron Watson said, as the Council was about to
establish a precedent, they should carefully consider the
wise and prudent coarse to adopt under the circumstances.
It would be very heavy labour for three examiners to deal
with 250 or 300 candidates in the year. The number was
too few to invest the written examinations with a sufficient
degree of variety, and those gentlemen who prepared
students for examination would soon become acquainted
with the style of questions, so that the surgical part of the
examination might come to be regarded as a matter about
which the students need not distress themselves.

Mr. Brudknbll Carter said that during the last five years
the Society had passed an average of 250 men annually. It
wa9 quite impossible to foresee what number of students
would present themselves, or in what proportion medical
students would be attracted from them by the conjoint ex¬
amination of the lloyal Colleges. This being the case, his
proposition was merely this—that, inasmuch as for tbe last
three years the surgical part of the examination had. been
conducted by gentlemen of the highest character and ability;
who had not found themselves overworked for the present
for the space of a year, it should remain in static quo,
though probably the examiners would feel it necessary to
widen the field of examination, and if possible to conduct
it with greater strictness than had been found necessarv
when the surgery was & mere accidental appendage with
the qualification the Society was able to give. If the
number of candidates increased, no doubt the Society would
ask for a further addition to its strength, but at present such
a step would be premature.

The amendment was negatived by 21 votes to 5.

The motion was then put and carried.

Mr. Carter moved,“That each of these assistant examiners
be paid an annual stipend of £100.”

Mr. Simon seconded the motion.

Mr. McYail said the idea that 250 students were to ba
examined in surgery for .£300 reduced the whole thing to
an absurdity. Was it supposed that men would be found
capable of doing the work who would give themselves up to
it for that pay. Such a proceeding would make the whole
examinations a sham. He moved, as an amendment, “That
the question of remuneration be postponed.”

Sir W. Gull thought that £L00 was not such a despicable
sum. lie objected to bringing tho matter cown to one of
trade measurement. There was a question of honour in the
matter. It was an honourable position that a surgeon should
be responsible for surgical knowledge, and in such a case
the honour was to he looked at, and not the mere money
reward. It was going on very unprofessional ground to say
that it would be a sham to get men to examine for £1U0 a
year in surgery.

Dr. Strutheus. from the Scotch point of view, thought
the proposal a very handsome one.

O

1046 The Lancet,J

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Mat 21,1887.

Dr. IIaughton said that at Trinity College some of the
surgical examiners were not paid at all, but those who were
paid received on an average £1 a head. He therefore con¬
sidered £300 for examining 260 candidates very fair remu¬
neration. He entirely concurred with Sir ffm. Gull’s idea.
It was not requiring surgeons to turn out machines as they
would steam-engines, but there was also the honour of the
position to be considered, which would be worth more to
the man than the sum he received.

Mr. Carter said it was the intention of the Apothecaries’
Society to apply to Parliament for power to increase its fees.
They felt that that which might be an adequate payment
for a licence in one part of the profession was inadequate for
a licence in all parts of the profession, and that the examina¬
tions must necessarily be more expensive. When that was
done, then the payment to the examiners might be increased ;
in the meanwhile he hoped the existing arrangement would
be permitted to stand.

The amendment not being seconded, the motion was put
to the Council and carried by 20 votes to 1.

It was moved by Mr. Carter, seconded by Mr. Simon,
and agreed to: “That, for a term of one year, from
July 1st next, and subject to the orders of the Council,
Messrs. Makins, Walsham, and Andrew Clark be appointed
by the Council to be surgical examiners to assist the
Apothecaries’ Society of London in its conduct of its
qualifying examinations.”

Sir Wm. Gull said a communication had been received
from the London School of Medicine for Women, petitioning
the Council that, in the event of their appointing examiners
in surgery for the Society of Apothecaries of London, they
would urge upon the Society the duty of recognising that
school and admitting its students to the benefits of the
Society’s examinations and licence. He should be sorry if
the application was passed over in silence. They could not
do what they were requested, but he thought it would be
right to pass a motion such as he had prepared—viz.: “ That
although the General Medical Council has no power to urge
the duty of examining candidates, male or female, upon any
examining body, and therefore cannot do more than receive
the communication from the London School of Medicine for
Women (Minutes, vol. 24, pp. 214-216), the Council are not
unwilling to express the hope that examining bodies may,
if within their powers, find it desirable to admit women on
equal terms with men to the privilege of examination.” He
had no particular interest in the education of women, and
had resisted it as long as he could in the University of
London. But they had now come to the time when further
resistance would be faction.

Dr. Banks seconded the motion, and pointed out that,
although women were not wanted as doctor* in England,
there was a very large opening for them in India.

Dr. Quain objected to the Council being asked to appeal
to the Colleges with th« knowledge that that appeal would
certainly be refused. They had had a very recent lesson in
that respect in regard to the appeal of the Apothecaries’
Society to be admitted to the conjoint scheme. He moved
the “previous questioo.”

Mr. Simon seconded the “ previous question,” which was
put to the Council, and carried.

The Council then adjourned.

WKDNK8DAY, MAY 18tH.

Mr. John Marshall, President, in the chair.

Nearly the whole afternoon was occupied in appointing
committees and arranging rules of procedure.

On the motion of Mr. Wheelhouse, seconded by Dr.
8truther8, the Executive Committee was empowered to take
the necessary steps for carrying into effect the clauses of
the Medical Act (1886) relating to the registration of the
diplomas of colonial and foreign practitioners.

A communication from the Parliamentary Bills Committee
of the British Medical Association, relating to provisions of
the Pharmacy Acts Amendment Bill, was referred to the
Executive Committee.

Mr. Macnamara proposed: “That in compliance with
the request contained in the last paragraph of the com¬
munication from the Science and Art Department, dated
April 30th, 1887 (Minutes, vol. xxiv„ pp. 229-230), the names
of the medical bodies which have authority to give regis¬
trable diplomas or certificates, for proficiency in 8anitarv
Science, Public Health, or State Medicine, be returned to
•he Science and Art Department as being ‘genuine sanitary

authorities,’ which might wish to send delegatee to the
International Congress on Hygiene.”

Dr. Heron Watson seconded the motion.

Sir Dyck Duckworth said that so far as the College of
Physicians was concerned they refused to send delegates to
such congresses because the Government would not pay the
expenses.

Dr. Glover thought that the Council might itself send a
direct representative.

The President said that any gentleman so sent would
have to pay his own expenses.

The resolution was agreed to.

The Council then resolved itself into committee to con¬
sider the report of the Procedure Committee, and resolutions
were passed to the following effect: That the Council should
meet each year on the fourth Tuesday in May, and, if neces¬
sary, again on the fourth Tuesday of November, unless the
President for reasons of public emergency should think
otherwise; but other matters may be called on a written
requisition signed by eight members and addressed to the
President. That the Executive Committee should consist of
eight instead of six members, four for England, two for
Scotland, and two for Ireland, five being a quorum; and fouT
meetings be held in the year on the Mondays before the
fourth Tuesday in February, May, July, and November.
Two new standing committees are to be appointed, the
Education Committee and the Examinations Committee,
each of which should consist of nine members, three for
each division of the kingdom, to be annually elected on the
nomination of the Branch Councils at the May meeting of
the Council. It was also resolved that all the committees
should be appointed annually at the meetings in May.

The Council having resumed, the resolutions passed in
committee were agreed to, and to the Executive Committee
was delegated the task of revising the Standing Orders, so
as to bring them into harmony with the resolutions of the
Council.

Mr. Macnamara hoped that the Council would before the
present session terminated appoint visitors to the examina¬
tions, as he expected that in July examinations under the
Conjoint Scheme between the Royal Colleges of Ireland
would be held.

On the motion of Sir Wm. Turner, seconded by Dr.
Haughton, it was resolved, “ That the General Council in¬
struct the Branch Registrars to register, after the appointed
day prescribed by the Medical Act (1886), graduates of uni¬
versities who have passed a qualifying examination in
medicine, surgery, and midwifery, either on the production
of a diploma or diplomas in respect of medicine and surgery,
or on the production of an authorised list of such graduates,
duly certified by the University.”

The Council then adjourned.

(For continuation of Report ace p. 1056.)

“PLACENTA PR/EVIA.”

To the Editors of The Lancet.

Sirs,— La9t year I recorded in your pages a case of entire
placenta prasvia which eventuated most happily to mother
and child through the careful temporising measures
adopted. That case was the last of four occurring in my
obstetric praotice during the last thirty years. I was, how¬
ever, much struck by the perusal of your late article on this
subject, and the aphorism you summed up the proa and
cons with, and resolved, the next opportunity, to personally
test its value. Strange to say, that chance was afforded me

on the evening of May 6th. Mrs. W-, of this parish, was

found on the floor in a state of collapse from very profnse
hffimorrhage. This haemorrhage had occurred at short
intervals, but sparingly for three weeks. This, however,
bad not alarmed her or her friends much until this utter
collapse occurred. I learned that she was about eight
months pregnant. After giving some brandy and beef-tea
and medical restoratives, I sent for my son (in practice
about eight miles off at Sherringham), and whilst I gave
the patient the A.G.E. mixture, he introduced his hand
within the os uteri, detaching all the placenta adjacent
thereto, pushing the rest to one side, and tbus, after ruptur¬
ing the membranes, placing the head in situ. Labour was
rapid, and was expedited with short forceps. The child
was dead, but the mother has done well.

I am, 8irs, yours faithfully,

Cley-next-Sea, Norfolk. W. SUMPTER, M.D,

Ths Lancht,]

THE GENERAL MEDICAL COUNCIL.—THOMSEN’S DISEASE. [Mat 21,1887.

THE LANCET.

LONDON: SATURDAY, MAY 21, 18S7.

In the second edition of our issue of last week, we were
able to announce that the General Medical Council had
determined by a large majority to consent to the application
of the Society of Apothecaries for the appointment of
assistant examiners to enable the Society to hold “ qualifying
examinations” in medicine, surgery, and midwifery. This
decision will meet with the warm approval of the profession.
8uch opposition to it as was based upon the unwillingness
to create multiple examining bodies had our cordial
sympathy, for we have throughout recognised the dis¬
advantages attending upon the existence of more than one
licensing authority in London. There were, however, other
considerations involved, and the Council have doubtless
properly appreciated the obligations imposed upon them by
the Legislature in complying with the request of the Apo¬
thecaries’ Society, who, through no fault of their own, had
been unable to combine with the other corporations. The
Council, having arrived at this conclusion, encountered great
difficulty in determining the steps which should be taken
to give effect to the resolution they had already adopted.
The whole question of the Council’s position with reference
to licensing examinations was raised, and it was held by
some members that the responsibility which the Council
was about to incur necessitated the appointment of assistant
examiners in every branch of professional education.
Motions were followed by amendments, which in their turn
became substantive motions, again to be rejected by sub¬
sequent amendments which were proposed. The questions
at issue were undoubtedly of extreme importance, and it is
well that each aspect which they presented should be duly
considered, but the conduct of the discussion, and the time
which it occupied, gave but too clear evidence of the widest
differences of opinion amongst the members of the Council.
The question is certainly complex, and the Act is so drawn
as to enable an interpretation to be put upon it which leaves
room for doubt as to whether the Council have been well
advised in the course they have adopted. The Medical Act
of last year deals with two separate and distinct subjects.
In the first instance a qualifying examination is defined as
an examination in medicine, surgery, and midwifery for the
purpose of granting a diploma, and this examination may
be conducted by any corporation already possessing this
right, or by a combination of two corporations, one of
'Which is capable of granting a diploma in surgery, and
the other of granting a diploma in medicine. Further,
the Act puts upon the Medical Council the duty of
maintaining the standard of proficiency required from can¬
didates, and for this purpose empowers them to appoint
inspectors of examination, who will make reports to be
nsed subsequently for compelling the examining bodies
to improve their method or for depriving them of their
rights. When, however, any corporation is unable to enter
into a combination for the purpose of holding a qualifying
examination, notwithstanding that it has used its best

endeavours, an entirely different course is adop
General Medical Council are then authorised to ftp*,
examiners to assist at the examinations which are held by
such corporation, and it becomes the duty of the assistant
examiners to secure at these examinations the maintenance
of such standard of proficiency in medicine, surgery, and
midwifery, instead of the inspectors, whose services appear
by the wording of the Act to be limited to watching
the qualifying examinations conducted by the bodies
mentioned in Section 3. It is therefore not an un¬
reasonable contention of Mr. McVail that the Council
under these circumstances should take part in examination
in the three subjects. The Council have, however, deter¬
mined to limit their action to supplementing the wants
of the Society of Apothecaries by the appointment of
examiners in surgery only, and, whatever may be the
intention of the Act, it is undoubtedly wise to interfere
as little as possible at this moment in the Society’s
examinations. It may, indeed, be anticipated that the
Society will wholly rearrange its examinations, and will
strengthen its staff by the addition of men competent to
deal with the various subjects. Should it fail to maintain
a sufficient standard, the course of the Council is obvious;
but interference in anticipation of failure would lessen the
prospect that the Council and Society may usefully be em¬
ployed together to the advantage of the profession.

Of other work which has engaged the attention of the
Council may be mentioned the report of the committee on
Dr. Glovkr’s proposals for amendment of medical educa¬
tion and the application of the Apothecaries’ Hall of
Ireland for the appointment of assistant examiners by
the Council. To the former we shall hope to refer later;
of the latter it may be said that there was no material
difference between the position of the Irish and English
Societies. The Council have, indeed, taken this view,
and have agreed to comply with the application of the
Apothecaries’ Hall.

With reference to our remarks last week regarding the
higher qualifications of the Universities and the Colleges, it
is interesting to note that the Council resolved to “instruct
the Branch Registrars to register, after the appointed day
prescribed by the Medical Act (1886), graduates of univer¬
sities who have passed a qualifying examination in medi¬
cine, surgery, and midwifery, either on the production of
a diploma or diplomas in respect of medicine and surgery,
or on the production of an authorised list of such graduates,
duly certified by the University.”

Last week we published an account of two cases of
Thomsen’s disease, with remarks on the nature of the
affection by Dr. Buzzard. An interesting paper by
Dr. Jacoby on the same malady is contained in the March
number of the Journal of Nervous and Mental Disease.
The disease is undoubtedly rare, and far more common in
some countries—Germany and Scandinavia—than in others,
though it is possible that slight cases may be of not
unfrequent occurrence, and, not being very obtrusive, may
have escaped the attention of the medical profession. So
far as is known, Dr. Buzzard’s are the first cases of the
kind that have been seen in England. Erb has given a
very thorough account of the disease in a monograph

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1048 The Lancet,]

THE SPREAD OF RINGWORM.

[Max 21, 1887.

published at Leipzig last year, and entitled “ Die Thom-
rensche Krankheit” (Myotonia congenita). Good summaries
of all the literature have been given in Brain in 1883 by
Dr. Paul Chapman, and in 1886 by Dr. Hale White.
But for all this literary abundance, our actual knowledge of
the true nature of the disease remains obscure, and though
most authorities are inclined to regard the conditions as
dependent entirely on muscular change, yet this view
eannot be said to be altogether satisfactory. Tonic spasm
catching the voluntary muscles as they are about to be put
into action is the most characteristic symptom. The spasm
may prevent altogether, or interfere but slightly with, the
voluntary action; there appear to be all shades of diffi¬
culty of voluntary movement. But one point comes out
very clearly, and that is that the spasm subsides after a
variable period measured sometimes by seconds and some¬
times by minutes, and then no further hindrance exists
to voluntary movement until after a period of actual
repose. The patient will have a difficulty in starting the
pedals of, a bicycle, but once he has thoroughly begun
he may continue for hours without experiencing any
impediment to the “ paddling” action. Let him but stop
for one brief rest, and the spasm will recommence with
his fresh attempt at action.

According to most authorities the disease is necessarily
congenital and hereditary, though it may not be manifested
till very early youth, and generally is not very pronounced
till adult life. In Jacoby’s case and in others the evidence
of heredity was wanting. The muscles themselves are appa¬
rently splendidly developed, but there does not appear to
be any actual increase of strength, so that though pseudo-
hypertrophic paralysis may be suggested by the size of the
muscles, yet the possession of fair strength and the reten¬
tion in the vast majority of cases of the knee jerks are
features sufficiently striking in contrast. Changes have
been detected in the muscles in Thomsen’s disease, and
chiefly in the direction of great enlargement of the
muscular fibres themselves, together with increase in the
number of nuclei beneath the sarcolemma; and some assert
that the connective tissue (perimysium of the muscles) is
*lso augmented in amount. Jacoby says, “ there can be no
doubt that this disease is a congenital malformation of the
muscular fibres,” but it is surely open to belief that the
muscular changes are secondary effects of the frequent
tonic spasms. The influence of emotion in increasing the
tonic spasm, and the prolongation of the same produced by
energetic action of the will together with the inability
quickly to relax the muscles by voluntary effort, whilst they
could be equally explained on the muscular theory, might
also point to a participation of central influences in the
qausation of the malady. The behaviour of the muscles to
mechanical and electrical stimulation also differs from that
which obtains in health. These changes were well marked
in Dr. Buzzard’s cases. The prolongation of contractions
artificially induced, as by percussing the muscle, is the
most noteworthy change. Indeed, it would seem that any
stimulus to the muscle tends to set up an almost tetanic
spasm, and. so far as these facts go, there would thus be
much reason in ascribing the essential characteristic of the
disease to the muscular apparatus alone. Although the
disease is thus fairiy characterised by its chief symptoms^

yet many cases have been recorded which do not fully ex¬
hibit all the symptoms necessary to establish the diagnosis.
Erb therefore classes the recorded cases in threegroups: the
first containing only purely typical cases, the second those
which have a great similarity, and the third those which
only show the myotonic disorder, but are complicated with
other symptoms of nervous disease, it being essential to the
diagnosis of Thomsen’s disease that all other functions of
the body and nervous system should be perfectly normal.

-4-

Ringworm of the scalp is a disease of no great importance.
it does not threaten life or even health, and there are plenty
of remedies—so think many who have not had experience of
it. The medical man who has had to treat it, however,
regards it in quite another light; he knows well that in
undertaking a case of ringworm of the scalp he will go
through some anxiety in using active remedies and con¬
trolling their effects; that despite his best efforts with new
remedies and methods, the disease will probably spread;
that he will have difficulty in getting instructions efficiently
carried out; and, finally, that the parents, becoming impatient
at the long-delayed cure, will most likely seek further advice.
He has, however, the consolation of finding that the results
obtained are not much more brilliant than his own, and
that the time expended in the “cure” leaves it doubtful
whether this is due to remedies or the natural course of the
disease. Parents who have had ringworm in their families
look back on the time with a shudder; they think of the
hair-cropping and shaving, the never-ending head-washing,
the poulticing, the malodorous applications, the irritation
and disfigurement of the child, the interrupted studies, and
the long tedious isolation (often extending over a year or
more) from playmates. Ringworm is equally trying to the
poorer classes. They have to send their children to Board
schools, where they contract the disease; during the earlier
hair-falling stages, when it is easily recognisable, the patients
are brought to hospitals, often in families, the poorest having
to spend time and money'in accompanying them; then, after
attending some months, the hair crops up again, the disease
drifts into the well-known chronic stage, in which only a
few hair stumps and scales remain to betray the presence of
the fungus; the children are thought to be well, and' under
renewed pressure by the Board-school authorities they
return to school and spread the disease to others. This is
going on every day at hospitals where such cases are
treated. Of the thousands attending in the course of a
year, probably not 3 per cent, are seen to their complete
recovery. The time and trouble expended by doctors and
patients, to say nothing of remedies, are little better than
thrown away. Here, then, we have an exceedingly
annoying disease, practically incurable in chronic stages,
not difficult to diagnose, not depending on some obscure
diathetic cause difficult to remove, but simply on the con¬
tagion of an easily recognisable parasitic fungus. With
this knowledge we have allowed the disease to spread until
it has gained such a hold on the population that it is to
be met with amongst all classes and at every turn. Surely
the time has come to make some organised stand. It
may bo suggested, with deference, that it is of the first
importance that the appearances in the more chronic
forms of ringworm of the scalp should be readily reco-

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Xp Lancet,] THE UNIVERSITY OF LONDON AND ITS RE-CONSTITUTION, [May 21,1887. 1049

gnised. That this is not always the ca9e at present is 1
proved by the fact that children still suffering with the
disease ere frequently being certified as well or cured.
It Is these unsuspected chronic forms which are met
With in families, at lodging-houses, at children’s parties,
and, above all, in schools. Medical men would do
■well to advise parents to send their children to schools
where proper medical supervision is in force. For a
reasonable fee any medical practitioner in the neighbour¬
hood could act as referee; all fresh scholars should pass
through his hands, and, most important, all scholaro should
he examined by him on their return from holidays. No
scholar who had had ringworm should be permitted to
return without a certificate. But all such effort will be of
little uso unless the Sohool-board authorities will consent
to give their help. No doubt there are difficulties in the
way, but while no efficient means are taken may we not
ask if it is fair to the poorer classes that they should be
compelled to expose their children to contagion, or if it is
fair to the community that Board schools should be per¬
mitted to become centres of infection?

At the presentation-day on the 11th inst., Lord Gran-
vt'llb, in making his annual speech as Chancellor of the
University of London, touched full lightly on the educational
questions which have been so thoroughly discussed in pro¬
fessional and academical circles, in the past year. The
Chancellor is apparently unaware that there is in existence
an Association for the promotion of a Teaching University
m London ; that University and King’s Colleges are pro¬
foundly dissatisfied with being annexed to a University
which requires no professional curriculum in Arts and
Science, and so reduces these bodies to an equality with any
go-sty led college of a year’s existence; that the Royal
Colleges of Physicians and Surgeons are Beekiog a toint
Charter to confer degrees in Medicine and Surgery, and are
basing their petition on the fact that the present University
only recognises the metropolitan medical schools as author¬
ities to sign certificates, as in the case of provincial and
Colonial degrees, and gives them no power in the University
pf London,. The opinions as to the proper functions of a real
University expressed by Sir Lyon Playfair fifteen years
ago are now held much more absolutely than they were
then, as the letters of Professor LankksTxb and Sir
tfEORGE Yooxc* in The Timet of the 18th inBt. dearly
^how. It i$ now almost taken as all axiom that a
university and an examining board have essentially
different functions to perform, and, unless the latter
is made subordinate to the former, that they require
different organisations for their work. We regret to find
that the Chancellor has not appreciated these differences in
their full force. London requires a local university, such
as exists in most provincial and colonial centres, and the
fact that in London an Imperial examining board has
.been placed makes this necessity none the lees urgent.
The duties of the two bodies are as dissimilar as can
possibly be imagined. A university has an assemblage
of teachers for Its rule and guidance; a purely examin¬
ing board knows nothing of teachers, and only guarantees
yB yipjn. Both are valuable, but they cannot work side
by sidftr The University of London has chosen the

examination role, and it is impossible for it now to change
its function. The modifications foreshadowed by the,
Chancellor will damage its present position, and not satisfy
the desires of those who are anxious for a university on the
old model. It is, indeed, very doubtful if Convocation will
pass the new scheme, and anyone who is conversant with
the attendance and debates in Convocation will readily see
that a large university scheme for the metropolis should not
be dependent on the casual attendance and votes of such a
body. Important interests are at stake, and Convocation is
not the body from which a fiat should issue. In the whole
controversy two very different questions are intermixed—
viz. (1) the beat general teaching in Arts and Science in the
metropolis, and how this is to be attained; (2) why
medical students in London should not obtain degrees oa
the same conditions as elsewhere, eVen if the University of
London persists in barring the way. A strong Royal com¬
mission would bring the numerous factors into a clear
light, and in the present position of domestic legislation
would probably be -a necessary preliminary to settling the
claims of the numerous bodies who are anxious to present*
or to oppose, the petitions for Charters which are being
prepared for the Privy Council.

^rauMuras.

“ We quid nlmli."

THE MEDICAL ACT, 1886: EXTRA PASS
EXAMINATION.

It has been decided to hold an Extra Pass or Final Exami¬
nation on Friday, the 17th of June ne*t, for the licence of
the Royal College of Physicians of London and for the
membership of the Royal College of Surgeons of England
under the old regulations, in order that candidates who
have completed the required curriculum of professional study
may have an opportunity of obtaining the licence ©f the
Royal College of Physicians or the diploma of Member of the
Royal College of Surgeone in time to register under the con¬
ditions now in force, before the new Medical Act comes intq
operation (June 30th). Those candidates who were referred
for three months in April last and those referred in January
for not more than six months will, we are informed, be
specially allowed to present themselves for re-examination
on June 17th. Candidates should bear in mind that they
must give fourteen clear days’ notice in writing, stating the
subject in which they desire to be examined, and whether
for the licence of the College of Physicians or the member¬
ship of the College of Surgeons, to the secretary, Examina¬
tion Hall, Victoria Embankment, London, W.C.

ALTERATIONS IN THE EXAMINATIONS OF THE
. UNIVERSITY OF LONDON.

The calendar for the year 1887-88, which has been recently
published, contains the mtmeroua alterations in the exami¬
nations to which we referred when they were sanctioned
by the Senate. Revised regulations and a revised syllabus
for the Matriculation Examination will come into foroe in
June, 1888. As a result of these changes, the length of the
examination will be slightly reduced, one language only in
addition to Latin and English will be demanded instead of
two as at present, a separate paper in Mechanics will be set;
and an option given between Chemistry, Heat and Light*
and Magnetism and Electricity. But even more important
alterations are to be introduced into the medical exaxmna-

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1050 Thb Lancbt,] EPIDEMIC MEASLE8 IN LEEDS.—ADULTERATION OP DRUGS.

[May 21,1887.

tions. At the examination for the M.B. degree, a practical
examination of surgical patients at a hospital or at the
University •will for the future always form a part of the
examination—in deference, we suppose, to the severe com¬
ments of the visitors from the General Medical Council.
But in the changes introduced into the Intermediate
M.B. Examination, the Senate has taken no advice, either
from these critical visitors, from the examiners, or from
the metropolitan teachers, and the result is a series of
innovations which are universally condemned. In future,
every candidate at the July examinations will have to
choose between a Pass and an Honours paper in each subject;
at the January examinations he will only be examined for
a pass. If in July a candidate takes the honours paper,
and cannot satisfactorily answer it, he will endanger his
passing; and if he takes the pass paper, he shuts himself
out from all chance of distinction. The only reasons for this
proceeding which have Ire ached us are that many candidates
who have no chance for honours now send in papers, and so
waste the time and patience of the examiners, and that the
system works well at the Preliminary Scientific M.B.
Examination. But we question if the examiners have
recommended this change, or even been consulted about it.
It was, we believe, in the pass examination that the exami¬
ners complained of the severity of the work, and this has
been materially lessened by the appointment of assistant
examiners, who obviously cannot be employed in deter¬
mining honours. Again, at the Preliminary Scientific M.B.
Examination honours are of but little value to medical
students, whilst at the Intermediate M.B. the subjects are
strictly professional, and the obtaining of honours in any
given subject may materially affect the whole of the after
career of a student. In every way these changes are most
unfortunate, and show how far the authorities of the Univer¬
sity can lose sight of the candidate in drawing up new
regulations, and how necessary a Board of Studies is, so
that a body in touch and sympathy with students may at
least be consulted. As if in further emphasis of these
remarks, the Senate has published a time-table for the coming
examinations, which we should have thought impossible
if it were not before us. The examination is to begin on
July 11th—that is to say, before the medical session has even
begun to draw to a close, and whilst lectures and practical
classes in the subjects of examination are at their most im¬
portant stages; and will finish on Aug. 4th, a period of nearly
four weeks, during which time the student’s physical
energy will be taxed to the utmost and his mind be on
the rack. A fortnight of this will be spent, not in the
examination-room, but as an interregnum devoted to medi¬
tation on mistakes made in the papers, and in “ cramming ”
for the vivd voce. A more deplorable arrangement for the
schools and the teachers, or one more trying to the can¬
didates, could not have been devised. In January the same
break of sixteen days has been introduced into the continuity
of the examination, with a similar absence of reason.

EPIDEMIC MEASLES IN LEEDS.

Mbasi/bs has recently shown exceptional general epidemic
prevalence, ahd it appears from the recently issued Qaarterly
Return that the death-rate from this disease in England and
Wales during.the three months ending March last was
higher than in;the first quarter of any year since 1874.
Leeds is one of the towns that has suffered most severely.
The disease first became prevalent in this town about the
middle , of September last, and caused 230 deaths before
Christmas; 137 more fatal cases were recorded in the first
quarter of this year, and 15 more were returned in the first
five weeks, of the currant quarter. Thus 382 deaths from
measles have occurred in Leeds since the commencement of
the epidemic in September last. The fatality of the present

outbreak is the more remarkable, since the disease vu
severely epidemic in the borough so recently as the early
part of 1884. The present epidemio of measles in Leeds ha*
been more fatal than any since 1870, when the Registrar-
General first began to issue mortality statistics for the large
provincial towns. The recent exceptional fatality of the
disease may be in great measure due to the unseason¬
ably cold weather that prevailed during February and
March, but relatively high rates of mortality from any of
the principal zymotic diseases should always suggest special
inquiry as to the sanitary condition of the suffering popula¬
tion. As regards the general death-rate in Leeds, it may be
noted that in 188G the death-rate, after correction for sex
and age differences of population, was 234 per 1000; and
that the town occupied the seventeenth place among the
twenty-eight large English towns ranged in the order of
their corrected rates of mortality from the lowest. The
rate of infant mortality in Leeds that year, measured by the
proportion of deaths under one year to registered births,
was 181 per 1000. Tried by this test, Leeds took the
twentieth place among the twenty-eight towns last year.
The death-rate from the principal zymotic diseases in Leeds
last year was 343 per 1000, against 2-88, the mean rate
in the twenty-eight great towns, and, measured by this
standard, Leeds took last year the twenty-first place
among these towns, ranged in the order of their zymotic
death-rate from the lowest. The mortality in Leeds from
measles, scarlet fever, “fever” (principally enteric), and
diarrhcea considerably exceeded the mean rate in the
twenty-eight towns. Especially noteworthy is the fact
that scarlet fever has in the last six years been nearly a*
fatal in Leeds as it was in the preceding ten years, whereas
in other large towns, and in England and Wales generally,
the decline has been most remarkable. These are among
the considerations which point conclusively to unsatis¬
factory sanitary condition in Leeds requiring investigation
and action on the part of the ratepayers and their sanitary
authority. It may readily be proved that the health of
Leeds, jndged by its mortality statistics, has materially
improved in the last twenty years; but it is fully as evident
that, in comparison with other large towns, Leeds has in
recent years been losing ground in the fortunately now
general struggle for sanitary progress.

ADULTERATION OF DRUGS.

Wb observe with satisfaction that Lord Coleridge and
Mr. Justice A. L. Smith have decided, on appeal, that it is an
offence against the Food and Drugs Acts to sell tincture of
opium which differs materially in strength from that de¬
scribed in the British Pharmacopoeia. It had been proved
before the magistrate that the strength of the tincture sold
was one-third less than that of the British Pharmacopoeia,
but the magistrate declined to convict. Many strange
decisions have been given by magistrates in regard to the
adulteration of drugs, and it appears evident that for this,
as for many other reasons, the law requires amendment. It
is unnecessary to insist on the extreme danger to public
health which arises from weak or impure drugs. The effects
of the most skilful treatment are often lost through the
inertness of the drugs; and although we fully recognise the
care and skill with which the great majority of pharmaceu¬
tical chemistsdo theirwork.it is necessary to guard the public
against the dishonest minority. Moreover, the dispensing
chemist, however careful and skilful he may be, is to a great
extent at the mercy of the manufacturer, so that the public
runs a double risk. Even the medical practitioner who dis¬
penses his own medicines is exposed to the latter danger,
lie is often puzzled by the action or non-action of the medi¬
cine he is prescribing, when the fault lies entirely in the
drugs. We hope to return to this subject before long.

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8ANITARY AUTHORITIES AND THEIR DUTIES.

[Mat 21,1887 1051

A “PALACE OF DELIGHT.”

The realisation of Mr. Walter Besant’s beneficent idea of
a “Palace of Delight ” in the East-end of London, set apart
for the amusement and improvement of the toiling multi¬
tudes of that densely crowded district, is in itself a suffi¬
ciently notable event to claim a place in the chronicles of
the capital; but when to this are added the felicitous facte
that the opening of the Palace has been so timed as to con¬
stitute the commencement of the celebration of the Jubilee
of Queen Victoria’s happy and prosperous reign, and that
Her Majesty herself performed the inaugural ceremony there,
the event supplies material not only for the theme of the
Court newsman, but for the hearty congratulation of every
loyal subject of the crown which has been worn gracefully
by a Sovereign who has laboured graciously for the good
and contentment of her people for fifty years. The func¬
tion on Saturday was all that could be desired, and, even by
those cynics who do not believe in the spontaneity of
reverence, and even affection, for a Monarch, it must be
ungrudgingly conceded that the proofs of joyous emotion
penrading the “ masses ” were not only abundant, but incon¬
trovertible.

There is always great difficulty in forming an accurate fore¬
cast of the practical value and ultimate measure of success of
any effort for the public good which is made for the people
instead of by them. Whether this “ Palace of Delight”—thing
of beauty as it undoubtedly is, in many senses—will prove a
joy for ever remains to be seen. We know how many well-
conceived schemes have failed, at least in the full fruition
of their expected results. It is needless, and might be
invidious, to particularise; but the fact is beyond question,
and the lesson it teaches ought to be submissively learned.
The moral seems to be that there should not be overmuch
management in the endeavour to meet the needs of the
masses. Better far let taste develop itself, and then culti¬
vate its growth. Attempts to “ force ” desired qualities in
human nature generally fail, and not unfrequently more
harm than good is done by the endeavour. Speaking
generally, the scheme of the promoters of the “ Palace of
Delight” is an admirable one. It is satisfactory to find that
the scheme of this new venture—which it would be most
regrettable to ruin by any wrongheadedness—is sufficiently
broad to include gymnasia and swimming baths. It might
with advantage go further. Mr. Walter Besants idea not
only comprised, but made a feature of, dancing. Good might
result from a reperusal of this gentleman’s admirable and
entertaining book. We commend the suggestion to the “ o’er
gude,” who may, with the best intentions, frustrate the
beneficent working out of this scheme, as they have marred
many others. So far everybody is to be congratulated, and
the event of Saturday last is one around which none but
loyal and grateful recollections can cling.

THE BOILING POINT OF OZONE.

Ozone, according to the recent careful observations of
Dr. Olszewski, boils at a temperature of - 106° C. This
curious substance—the nature of which was so long a
mystery, and about which so many conflicting hypotheses
have been devised—is now becoming well known to us. For
the sake of those of our readers who have not been able to
follow the details of recent research, we may in a few words
summarise the present state of our knowledge. Ozone is a
denser form of oxygen. Its specific gravity is 24, that of
common oxygen being 16, and that of hydrogen 1. . It is
highly probable that its molecules contain three similar
oxygen atoms. In the concentrated state it is a powerful
irritant poison, and it is very unstable, decomposing with
explosion and with evolution of heat, and exerting a most
powerful action on oxidisable materials. For some time

past it has been known that it liquefies under the influence
of combined cold and pressure. The liquid is indigo blue,
and its vapour in a tolerably concentrated state has a colour
which can only be compared to that of an Italian sky.
OlezewBki has now succeeded in liquefying it at the ordinary
atmospheric pressure by exposing it to the intense cold of
boiling oxygen ( - l8l° C.). When cautiously heated the
liquid began to evaporate, and when heated to - 106° C. it
entered into active ebullition. It is a very dangerous sub¬
stance to work with. _

SANITARY AUTHORITIES AND THEIR DUTIES.

A painfci. occurrence has taken place at Ince, near Wigan,
in Lancashire. The authorities of Ince have had constructed
lately an infectious disease hospital, and from the evidence
given at the inquest on a child which was overlain by its
fevered mother it appears that the nurse is sixty years of
age, and she with her husband, who is fifty-five years of
age, have charge of the institution. Mr. BriRhouse, the
county coroner, held an inquest on the child, and he, con¬
sidering that the body was lying kt a fever hospital and that
many of the jurors were married men with families, dispensed
with the practice of viewing the body. It came out in evi¬
dence that a case of typhoid fever was admitted into the
hospital on a Saturday night, late, and that early on Sunday
morning the patient gave birth to a child, which was the
subject of inquiry. Dr. Hall, jun., who was acting for
the medical officer of health during temporary absence from
illness, and also the assistant of Dr. Hall, ordered the child
to be removed from the woman. The father was appealed
to, but he could not take it. The nuisance inspector and
the clerk to the board, and also the relieving officer, were ap¬
pealed to, but in vain, and, as might have been expected from
bo young a babe being left with a fevered mother, the child was
found next morning overlain. The coroner, in summing up,
stated that “the evidence, however, had disclosed a very
unfortunate state of affairs. The woman in charge of the
hospital was practically by herself, and this meant that for
seventy-six hours she was kept awake nursing and attend¬
ing to the wants of these people without any help. All the
while communications were being made to the nuisance
inspector and the clerk to the local board the woman was
left by herself, and no provision Bee me d to have been made
for clothing the child, who had been wrapped up in towels
for want of something better. The whole case seemed to
have been surrounded with neglect, and two questions to
be considered by the jury were, first, as to whether the
death was accidental, and then as to whether the manage¬
ment of the hospital was in any way to blame. The jury
found a verdict of accidental death, and desired to say t e
hospital management was bad, and that “ the authonties
should reconsider the question of the management of the
hospital so as to preserve life in the future. This s
certainly an unfortunate case. Here we have a sanitary
authority providing a hospital for infectious diseases, no
doubt at the strong request of the Local Government
• Board, yet it is inefficiently equipped. Sanitary authonties
» will spend two or three thousand pounds in budding a
1 hospital, but, from a penny wise and pound foolish policy,
3 will begrudge a couple of hundreds for furnishing it, and
r will grumble at the expense of a few pounds yearly for its
> proper maintenance. This case will probably teach the ad-
9 joining authorities that it is their duty not only to provide
1 a hospital, but to see that it is properly administered, or how
f can poor people be expected to enter it? Nothing brings
s sanitary authorities to a sense of their duty so much as a
r misfortune like this, or a severe epidemic which slaughters
1 hundreds. We would advise all medical officers of health
ti either to have their infectious hospitals efficiency quipped
t or to have nothing to dcTwith their management. We know
e the difficulties of providing and maintaining hospitals in

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1052 Thk Lancrt,]

AN UNUSUAL METHOD OF PROPAGATING INFECTION.

[May 21, 1887.

small local board centres and small towns, but 6urely a
combination of adjoining places would always keep a
hospital in use and enable one to be provided worthy of the
name and maintained with proper efficiency.

AN UNUSUAL METHOD OF PROPAGATING
INFECTION.

Dn. A. Tkpliashin describes in the Vrarh (No. 17) a
curious epidemic of syphilis affecting the eyes of eight
persons who came under his care in the hospital of the
Glazoveki district of the Yiatski province. The conjunctiva
was more or less inflamed and the edges of the lids thickened
and hardened, with in some cases mucous patches in the
neighbourhood of the eyes and mouth. In all cases mucous
patches were found on the genitals or round the anus, but
the patients entirely denied impure intercourse. As all of
them came from two villages, it was evident that some cause
must be in existence in their locality to account for this
curious epidemic. At last jt was discovered that a certain
“wise woman” there had, in the exercise of her profession,
which is one much esteemed among Russian peasants,
treated all these patients for real or imaginary afFections of
the eyes by licking them with her tongue ; this woman had
syphilis, which it was interesting to learn had been com¬
municated to her in the same way by another woman. The
habit of licking out as much of the conjunctival sac as can
be reached by the tongue is very common, Dr. Tepliashin
says, in his province, and he is surprised that it does not
oftener lead to evil results; but though he has been there
during the last eight years, and has seen about 10,000
ophthalmic cases, he has not previously met with any syphi¬
litic affections due to the habit. From subsequent observa¬
tions made on the spot, it was found that no less than ten
males and twenty-four females belonging to these two
villages had been infected by the “ wise woman.” In order
to combat the evil as far as possible, a temporary dispensary
has been opened in the neighbourhood.

LONDON SEWAGE.

At the meeting of the Metropolitan Board of Works, on
the 13th inst., some further information was vouchsafed to
the public in regard to the system of sewage disposal to
which the Board has at last committed itself. Little is told
which is new, and nothing which is likely to reconcile sani¬
tarians or the public to the scheme, or induce them to accept
it as a Anal solution of the problem. It is now settled that
the whole of the London sewage is to be treated at Barking
and Crossness, in spite of the very strong adverse opinion
expressed in the reports of the Metropolitan Sewage Dis¬
charge Commission. The precipitation method adopted is,
we think, a good one. It consists in treatment with lime
and protosulphate of iron. The precipitate subsides in an
hour or two, and a fair effluent is said to be obtained. The
experiment, originally tried on a small scale at the Grosvenor-
road station, was continued with much larger quantities at
Crossness during last year. Nearly a thousand million
gallonB—that is, about nine million gallons a day—were
treated. This yielded 30,614 tons of wet sludge, which on
further settlement was reduced to 18,191 tons. Of this
16,747 tons were exposed to pressure in filter presses, and
were thereby reduced to 5310 tons of sewage cake, two-
thirds of the water being removed by the presses, about
the usual proportion. It is said that about 3000 tons
of the cake were taken without payment by farmers and
others for manorial purposes. The rest, we presume, has
accumulated. To all this we have only the old objection
to make. The proposed system q^nnot produce a proper
wrification of the river. Even if ft turtoa put that this is

■e best^f aR'posalble puriflcation, schemes, that the effluent

is “ fairly clear/’ and that the sludge and. cake will produce
no local nuisance, it still remains afact that the situation of
the works is utterly unsuitable. It 6eems to us doubtful, to
say the least of it, whether chemical and mechanical opera¬
tions upon the sewage of four million persons can be con¬
ducted without serious local injury, or at least annoyance;
and we are certain that the effluent water, although much
less objectionable than raw sewage, is unlit to be thrown
into the Thames at the existing outfalls. At present,
according to the Royal Commissioners, who had ample
evidence before them, the river is polluted with sewage
almost up to Teddington. The pollution will now be
of a less disgusting character, but still it will remain
a disgraceful pollution, to wbioh the people of London
ought not to submit. We have always maintained that the
proper place for the treatment of London sewage is in Sea
Reach, where there are large tracts of land for sewage irri¬
gation, low lands to be raised, no houses to be incommoded,
a large volume of water, and close proximity to the sea. To
this remedy we shall surely come sooner or later, and then
it will be found that the vast expenditure for works and
steamers now lightly incurred by the Metropolitan Board of
Works will have been absolutely thrown away. To those
who wish for further information on the subject we commend
the remarks of the Royal Commissioners.

FASTING AND POISONS.

Tuf. advance of rational therapeutics will be characterised
by increased precision in instructions as to the mode of
taking medicaments, their relation to food, their state of
dilution, difference of action according to temperament, and
so forth. Fasting is already known to exercise an important
influence on the effect of certain substances, and M. Riger
has further investigated the influence of the state of himger
upon the power of animals to resist the poisonous action of
alkaloids. It was found that such alkaloids as quinine,
atropine, or nicotine, were only four-fifths as toxic if intro¬
duced during fasting into the peripheral venous system of a
rabbit, as compared with their action when introduced whilst
digestion is in progress. But if introduced into the portal
venous system during digestion the toxicity is only half
that during fasting. It is assumed, then, that fasting dimi¬
nishes the power of the liver to arrest the alkaloid, and this
coincides with a diminished power of glycogen formation.
Sugar given to the animal three hours before experimenta¬
tion causes the liver to recover its functions.

PIT WOMEN AND THEIR WORK.

It is to us very satisfactory to learn that any necessary
improvement in the condition of women employed in
collieries is likely to be effected without entailing upon
them the loss of their employment. The evidence afforded
by the deputation of pit women which waited on the Home
Secretary a few days ago is worth noting in this connexion.
As far as its members were concerned, any detriment to
health attributed to colliery labour appears to be imaginary,
though we would not be misled by accepting these few selected
examples as average types of their class. In the matter
of domesticity, also, it is said that they and those whom
they represent will stand favourable comparison with their
sisters employed in factory work; while their working dress,
if not conventional, is not indecent, and it is as womanly as
the circumstance'’ of their occupation allow. The hours of
labour are not long, and a reasonable interval is allowed at
meal times. In this respect, indeed, a9 well as the possession
of a purer atmosphere and a somewhat higher scale of
wages, they seem to be more fortunately situated than the
majority of factory women. In one particular the wotoen
themselves admit that the work is unsuitable to them •*

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Tint Lancet;]

EDINBURGH UNIVERSITY CLUB, LONDON.

[May21,1887j 1053

namely, their having to move railway waggons, a dangerous
proceeding, which will probably hereafter be left in the
bands of the men. With this exception they are well satisfied
with their lot; and if no stronger evidence than has already
been produced be forthcoming to prove their incapacity, the
question of who shall work at the pit and who shall not can
hardly, we think, be dealt with otherwise than by the pro¬
cess of natural selection.

EDINBURGH UNIVERSITY CLUB, LONDON.

Sm Alexander Christisox, Bart, M.D., presided over
the last quarterly dinner of this Club, held at the HoJbom
Restaurant on Thursday, May 13th. Forty-one members
and thirty-nine guests were present. The toast of “The
Colonies, - ’ gracefully proposed by the Marquis of Lothian,
K.T., Secretary for Scotland, was received with the utmost
enthusiasm, and most eloquently responded to by Sir Saul
Samuel (Agent-General for New South Wales), Sir Graham
Berry (Agent-General for Victoria), and Sir Patrick Jennings
(late Premier of New South Wales). Sir Dyce Duckworth
proposed the health of the chairman. A specially interesting
feature of the meeting was the presentation by Sir Edward
Sieveking, M.D., on behalf of the Club, of a handsome silver
candelabrum to Dr. J. B. Potter, on his resignation of the office
of honorary treasurer, which he has held for a period of ten
years, and in which his labours have been indefatigable and
eminently successful, the Club being now in so satisfactory
a financial condition as to be able to give a triennial prize
of twenty guineas to the University of Edinburgh. Dr.
Potter is succeeded in his important post by Dr. J. J.
Pringle. Excellent vocal mneic was discoursed at intervals
by Dr. Lavies and a party of friends. The Club now numbers
nearly 400 members, and it is felt that this number might
easily be increased. The honorary secretaries are Henry
Rutherford, Esq., barrister-at-law, 2, Harcourt-buiidings,
Temple, E.C., and Surgeon-General W. Gerard Don, M.D.,
Janior Army and Navy Club, St. JamesVstreet, S.W., either
of whom would doubtless be glad to hear of Edinburgh
graduates anxious to join the Club.

SMALL-POX IN AUSTRALIAN PORTS.

The Board of Health of New South Wales have issued a
report prepared by their President (Dr. H. N. MacLaurin) on
the occurrence of small-pox, and the consequent quarantine
measures which took place in connexion with the arrival at
Sydney of the North German Lloyd’s steamship Preuwcn on
December 2Gth last. The steamer having embarked 544
steerage passengers as emigrants at Antwerp, called at Port
Said on November 18th, and, although sm&ll-po* was pre¬
valent amongst the Arabs there, the passengers were freely
allowed to go ashore. The Preussen left Port Said on the
22nd, and on December 5th a passenger named Pryce
sickened of small-pox. Early on December 15th the vessel
arrived at Albany, but the health officer of that place refused
to land the patient. So far as can he judged, no other person
on board had up to this date contracted the disease, but,
having regard to the history attaching to the vessel, all the
passengers were landed and moved to the quarantine ground
on her arrival at Sydney on the 26th. Small-pox showed
itaelf amongst them on the following day, and there is every
reason to believe that it was all contracted after passing
Albany. The arrangements on shore appear to do credit to
a quarantine station, for the patients can he at once
thoroughly separated from those who do not sicken, and
measures are taken to make the compulsory 5 stay of twenty-
one days as little irksome as possible. During this stay
seventy-nine attacks occurred, and thirteen deaths resulted.
The report deals specially with the circumstance that
nearly all this disease would have been avoided if the first
patient had been landed at Albany, and the President presses

strongly for united action on the part of the several Austro- 1
lion colonies in the matter of quarantine- detentions. That'
which readers quarantine measures necessary for small-pox
in Australia is evidently the habitual neglect of vaccination,
and some hope is expressed to the effect that the oolonyi
learning how narrow has been its escape, will not negleet
this precaution any longer. The lesson is a serious one, for
out of nineteen of the passengers who had never been vac¬
cinated, fifteen had small-pox, nine died, and one lost her
eyesight; whereas, out of fifty-four said to have been vac¬
cinated and some revaccinated, only four were attacked and
none died. Of those who had previously had small-pox,
three were attacked, but without death. We learn that the
vaccination stations in Sydney and in the country districts
are all but deserted, and the youthful population is described
as “ practically unvaccinated.” We very much fear that the
lesson which this incidentshouldteach will largely be thrown
away on the population. Experience in Europe has shown,
whatever the disease to be dealt' with may be, that trtte
preventive measures are far more neglected in countrier
resorting to quarantine than in those who do not enforce it,
and the extent of neglect may often be largely measured by
the tenacity with which the quarantining of sick and healthy
alike Is maintained. The position of the Australian health
authorities is admittedly a difficult one. They are powerless
to enforce the true remedy against the spread of small-pox,
and are hence thrown back upon the enforcement of a
detention which affects large bodies of people not suffering
from the disease, and which may at any moment, owing to
error of diagnosis or otherwise, break down as a preventive
measure. _

TOXIC EFFECTS OF LEAD.

Mr.Wyxtkr BLYTHhas had an opportunity of examining
portions of the bodies of two out of five persons who have;
at different times died more or less suddenly from, as it is
believed, the effects of lead poisoning. In one case be
separated about a third of a grain of sulphate of lead from
the liver and about a thirteenth of a grain from one kidney,
besides finding lead qualitatively in the brain. In the'
other he was able to examine the brain with more minute¬
ness, and estimated that here the cerebrum contained about
a grain and a half and the oerebellum about a quarter of h
grain of sulphate of lead. Mr. Blyth went on to remark, in
the paper he read to the Chemical Society of London on these
investigations: “ There has hitherto been no reasonable
bypotheeis to explain the profound nervous effects of the
assimilation of minute quantities of lead, but if it is allowed
that lead forms definite compounds with essential portions
of the nervous system, it may then be assumed that in effect
it withdraws such portions from the body; in other words,
the symptoms are produced nop by poisoning in the ordinary
sense of the term, but rather by destruction—a destruction -
it may be, of important nerve centres.”

THE TEMPERATURE OF THE SKIN.

Thb experiments of Davy long ago demonstrated irre 1 *
futably that the temperature of the interior of the body
varied little in man with race, climate, or season ; yet it is '
familiar to all that the temperature of the skin varies con¬
siderably in different parts—the extremities, for example,
and those parts of the skin in which the circulation is feeble
being cooler than other parts. Quite recently some in¬
teresting experiments to determine these variations of the
surface have been made by Professor Kunkel at Wurzburg.
Taking the skin of the face in the first instance, he finds that [
in men from twenty to thirty years of age it varies from 85 a
to 89° F., with an approximate average of 88°. The skin of
the more exposed parts of the body, as the tip of the no3e and
the lobules of the ear, in which the circulation is slow attd y J

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1054 Tub Lancet.]

THE QUEEN’S JUBILEE.—GUY’S HOSPITAL.

[May 21,1687.

feeble, exhibited a lower temperature, not exceeding in
many instances 75°, or even descending as low as 71*5°. The
skin covering the muscular portion of the body is warmer
than that over the bones and tendons. Contraction of the
muscles caused the temperature Of the superjacent portion
of skin to rise one degree or more. The decrease of tem¬
perature from the skin to the outer covering in a room at a
temperature of 63° was as follows: on the skin 88°, on the
linen shirt 82°, on the vest 75°, and on the coat 72°. The
highest temperature was found to occur in men in the full
vigour of life. As a singular fact, Dr. Kunkel states that
children otherwise in perfect health showed a much lower
degree of surface temperature--from 77° to 84°—than
adults. He does not appear to have followed out Professor
Lombard’s observations on the temperature of the head.

THE QUEEN’S JUBILEE.

On the 16th inst. the Queen held a Court at Windsor
Castle, at which, amongst others, addresses were presented
by deputations from the University of Edinburgh and the
University of London. The deputation from the former
body consisted of Principal Sir William Muir, K.C.S.I.; Pro¬
fessor Campbell Fraser; Mr. T. Graham Murray; Dr. P.
Heron Watson; the Eight lion, the Lord Advocate, C.B.,M.P.;
Sir Dyce Duckworth; Professor Sir William Turner; Pro¬
fessor Grainger Stewart; Professor Armstrong; and Mr.
Taylor lanes. Sir William Muir, Professor Campbell Fraser,
and Professor Sir William Turner had the honour of kissing
hands. The University of London was represented by Earl
Granville, K.G., Chancellor; Sir James Paget; Dr. Wood;
Sir John Lubbock, M.P.; Sir William Gull; Dr. Quain;
Dr. Weymouth; Dr. Baines; Mr. Osier; and Mr. Arthur
Milman, Registrar. Earl Granville, Sir James Paget, and
Dr. Wood had the honour of kissing hands.

GUY’S HOSPITAL.

The Graphic , in its issue for the 14th inst., publishes a
descriptive account of Guy’s Hospital. The article, which
is profusely illustrated, commences with a brief sketch of
Thomas Guy, the founder of the charity, and traces the
progress of the institution down to the present time. The
illustrations are, on the whole, judiciously chosen, and com¬
prise, amongst others, portraits of Guy and Hunt, the chief
entrance, the chief clinical, Mary, and Doroas wards, the
founder’s tomb, the old staircase, and the women’s surgery,
this last named indicating a tendency towards realism in art
which we trust will not be allowed to go to such lengths as
to rival the “ pictures of horrors ” of the Paris Salon. The
publication of this brief history of the charity, and its labours
by our contemporary cannot fail to attract support to the
hospital in its attempt to retrieve its failing fortune.

PYO-PNEUIVIOTHORAX SUBPHRENICUS.

The condition simulating very closely a pneumothorax of
the right side, but which is due to an abscess between the
liver and diaphragm, was first thoroughly described and
differentiated by Professor Leyden. A record of such a case
has just been made by Dr. Pusinelli of Dresden ( Bcrl. Klin.
Woch., No. 20), who points out that the condition is mostly
due to perforation of a gastric or Intestinal ulcer, and that
the diagnosis depends upon the occurrence of abdominal
symptoms at the onset, the absence or complete suppression
of pulmonary symptoms, the sharp transition from normal
vesicular breathing at the apex of the lung displaced upwards
by the diaphragm to amphoric breathing on deep inspira¬
tion, and the absence of hepatic dulness with marked dis¬
placement of the liver downwards. If the diagnosis,be
correctly made, it is urged that treatment might be directed

to abdominal section, the discovery of the ulcer, and its
excision. Duodenal ulcers, as the case he details shows, often
run their course without symptoms, and may be so little
adherent that a slight injury, as a fall on the abdomen, may
detach them and cause perforation.

BAD DRAINAGE AND LANDLORDS’ LIABILITIES.

Both in England and in Scotland it is being made clear
to landlords that they will be held responsible for letting
houses the drainage of which is in eucb a state as to induce
injury to health amongst the tenants. The letting of a
house for human occupation should necessarily imply that
the house is held to be'fit for occupation, and substantial
penalty should be required of a landlord who fails to fnlfil
his part of the contract. In the case of Gurney v. Stroud,
tried the other day before Mr. Justice Cave aud a common
jury, the judge informed the jury that if a house was let
furnished, then there was an implied contract by the land¬
lord that it was fit for habitation, and the tenant having
shown that soon after he came into possession liis wife and
children became ill, two of the latter dying, he was awarded
compensation to the extent of .£175. And in a somewhat
similar case which came before Mr. Sheriff Lees at Glasgow,
i,'150 was awarded to a parent as compensation for the loss
of a child eight years of age, and for illness in other
members of his family, owing to the defec'ive drainage of
the house which he occupied.

PERFORATING ULCERS OF THE AORTIC VALVES.

Fob a few years past much attention has been given to
the cardiac complications of tabes dorsalis, and every kind
of view has been stated as to the possible connexion between
the heart lesion and the spinal degeneration. Before the
Soci6t6 Nationale de Mddecine de Lyon, M. Teissier exhibited
a series of photographs designed to indicate the dimensions
and nature of the perforations of the aortic valves observed
in ataxic patients. These perforations are accompanied by
an extreme thinning of the valve, such as is not met with
either in atheroma or syphilis. M. Teissier considers it to be a
genuine trophic change, a veritable perforating ulcer of the
valves. Moreover, these lesions are found in conjunction
with visceral perforations, also attributed to the tabetic in¬
fluence—e.g., perforation of the trachea and of the oesophagus.
In one of his cases of valvular perforation, M. Teissier ob¬
served an intestinal perforation the size of a franc piece.
The holes in the aortic valves give rise eventually to all
the signs of aortic regurgitation.

LIFE INSURANCE.

A case recently decided in the Court of Chancery may
serve as a warning to any who purpose insuring their lives,
and also as a caution to medical examiners. The defendant
was alleged to have made a misstatement in having denied
that he ever had rheumatism or heart disease, from both of
which , conditions he had suffered some years previously,
and he consequently forfeited his policy and the premiums
already paid by him. We do not now enter into the
question as to how far a history of rheumatism or ite
cardiac effects ought to influence the acceptance of a
life. Every case must be judged upon its own merits,
though undoubtedly a rheumatic taint must often con¬
stitute a grave disqualification, notwithstanding the fact
that since the introduction within recent years of im¬
proved methods of treatment, the dreaded cardiac com¬
plication is a less real danger than formerly. It is possible
that the full moaning of the perversion of facte may not
have been apparent to the offender, but the misstatement
could not be condoned on that account. This kind of
offence, though perhaps not common, might.be illustrated

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The Lai? get,] . DISPENSARIES AND PROFESSIONAL ETHICS.—TYPHUS IN FLINT. [May 21,1887. 1055'

by more than one example. We have heard of a case of
such downright dishonesty as the production by an albu¬
minuric subject of a fluid other than his own for examina¬
tion. There is therefore need both for the stringency of
companies and for shrewdness on the part of their medical
representatives in dealing with the question of life in¬
surance among a certain class of applicants.

DISPENSARIES AND PRbFESSIONAL ETHICS.

A greatly lauded panacea for the evils of gratuitous
medical advice, we all know, is the establishment of provident
dispensaries. At this very moment an influential committee,
appointed by a public meeting,' is considering the best
means by which they can be established and encouraged in
London; and we ourselves "have always been anxious to
«ee such institutions supported by the working classes. Bat
great care is necessary to prevent their being worked in
unprofessional ways. And__we are constantly .receiving
circulars, handbills, &c., announcing these institutions and
their arrangements and charges. The names of the members
■of the staff are often included. The general offect of the
fthole is not to convey a high idea of the value of medical
services, or of the methods of competition in the medical
profession. We invite expressions of opinion as to the
best way of avoiding these evils. We all want to promote
thrift and diminish the amount of gratuitous medical relief.
The problem is to do so without degrading the medical pro¬
fession and the popular estimate of medical services.

TYPHUS IN FLINT.

We regret to learn that the outbreak of typhus fever in
Clnfl; still oontinues, and that it has been found necessary,
owing to a sudden increase in the number attacked, to con¬
vert the assembly room at Flint Castle into a hospital. The
circumstances attaching to this outbreak are very unfortu¬
nate. Typhus is so rare that it was hardly recognised as
each in the first instance, and hence the disease tended to
spread. Dr. Tegid Evans, the medical officer of health, we
greatly regret to say, in the performance of his duties,
contracted the disease and died. Since.then Mr. Spear,
of the medical department of the Local Government Board,
has visited the town, and has advised the mayor and the
corporation as to the action which should be taken to
stay the spread of the infection. Fourteen fresh caees are
reported to have recently occurred.

OEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

'The deaths of the following foreign medical and scientific
then are announced:—Dr. Bernhard Studer, formerly Pro¬
fessor of Physics and Geology in Berne, at the age of
ninety-three.—Dr. Ludwig Rohden, director of the recently
established Sea-bathing Infirmary at Norderney, at the early
age'erf forty-eight, suddenly, at Gardone, Riviera, from the
bursting of an aneurysm into the bronchus. — Dr. Ilohl,
Extraordinary Professor in the Science Faculty of Tubingen,
•Lthe age of eighty-one. __

THE BOWER AND KEATES CASE.

Tff* profession will learn with satisfaction that there is
some hope of its soon hearing the end of this case, which
Veil illustrates the delay and the costliness of law. The
nonuhittee charged with the duty of administering the funds
wisSd to pay the legal expenses of Messrs. Bower and Keates
mefc'at ftli* William Jenner’s oh Tuesday night, and reported
the termination of litigation.. A full statement of the
psincjpal facts, wil} shortly be laid before the subscribers,
who will be asked tp empower - the committee to distribute

the balance which remains, after paying expenses by con¬
tributing to the expenses of similar cases or to charitable
purposes within the profession. Roughly it may be said
that over .£1700 were raised in little more than a week, and'
that a balance of about £500 is left after the payment o#*
expenses. __

SPECIALISM IN EXCELSIS!

We have received a programme of the first annual m^et- 1
ing of the "Association of Genibo-urinary Surgeons,” which 1
is being held this week at the" Laurel-House, Lakewood, N.J.
The establishment of this Association • has been attended
with so much success, and commends itself so thoroughly to
the more enlightened members of the profession, that many-
similar ones are shortly to be inaugurated! Among those’
more immediately to be promoted are associations of
“Umbilicologists,” of “ Rhinoiogiafee,” of “Tenotomists,” of
“ Depilatory Surgeons,” and of “ Skin-grafters.” The only
reason-we can perceive why this list should not be in-,
definitely extended is that surgery as an art would, by such
differentiation, speedily be resolved into its constituent
elements, and its professors broken up into repellent groups
-of solemn deliberators on the utility and beauty of the
segregation of parts. *

VICTORIA UNIVERSITY AND THE YORKSHIRE •
COLLEGE.

On the 12th inst. the Yorkshire College made a formal
application to the Court of Governors of the Victoria
University to be admitted as a College of the University,
and the application was referred to the Council for report
in accordance with the provisions of the Charter. A further
step has therefore been taken towards the fusion of the
three colleges of Manchester, Liverpool, and Leeds into one
great university, and we hope that no time will be lost by
the Council in taking action towards the furtherance of the,
desired union. _

THE BRUSSELS SCIENTIFIC CONGRESS.

The Surgical Section of the International Congress of
Science and Industry, which is to be held in Brussels next
year, has given notice that instruments and apparatus of
the following descriptions will be specially acceptable:—

(1) Apparatus for the treatment of spinal curvature;

(2) materials for dressings; (3) gynecological instru¬
ments ; (4) instruments for diseases of the urinary tract;.
(5) instruments for the treatment of glandular enlargements,
in the pharynx; (6) laryngological apparatus; (7) apparatus
and dressings for antiseptic operations on the eye ; (8) appa¬
ratus for the measurement of the acuteness of hearing. ,

THE PENJEH SORE.

At the instance of the inspector of the military medical-,
district of the Caucasus, a special commission has been
appointed to proceed to the neighbourhood of Penjeh for ther
purpose of studying the etiology and characters of the
so-called Penjeh sore. Dr. Rapchevski of St. Petersburg-
has been selected as director of the expedition. Some ob-,
servations on this affection made by Dr. Suski, and com¬
municated by him to the Vrach, were mentioned in THk
Lancet of April 10th, 1886. This paper was subsequently.
(June 12th) referred to by Surgeon Pierson, who pointed
out the identity of the Penjeh affection with the well-known-
Delhi toil, &c.; and, again, by Dr. J. Hickman (The Lancet,
Aug. 94th), who mentioned that he had also pointed out
this identity in am Indian journal, and referred to a fall
geographical account to be found in Hirsch’s Geographical.
Pathology, and also to an article by himself in the
.Practitioner of Jan. 1886. - , ' -'t *i

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1056 The Lancet,]

MEETING OP THE GENERAL MEDICAL COUNCIL.

[Mat 21,1887.

THE APPOINTMENTS AT GUY’S HOSPITAL.
Thk following are the Assistant-Physicians at this hos¬
pital Dr. Hale White becomes Senior Assistant-Physician;
and, at a recent meeting of the governors, G. N. Pitt, M.A.,
M.D. Cantab., M.R.C.P. Lond., late Fellow of Clare College
and present Demonstrator of Pathology at Guy’s Hospital,

L. C. Wooldridge, M.D., D.Sc. Lond., M.R.C.P. Lond., late
George Henry Lewes and Grocers’ Research Scholar, late
Croonian Lecturer at the Royal Society and present Demon¬
strator of Physiology at Guy’s Hospital, and E. G'. Perry,

M. A., M.B. Cantab., late Captain of the Sohool at Eton,
Fellow of King’s College, Cambridge, and Senior Classic for
1880, and late Demonstrator of Anatomy at Cambridge, were
elected to the three vacant Assistant-Physiciancies.

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin .—The Medical Faculty are about to create a new
Extraordinary Professorship of Laryngology in connexion
with a Polyclinic for Throat and Nasal Affections, for which
room has been taken in a private house in the Luisenstrasse.
The first occupant of the chair will probably be Professor
Bernhard Frankel. A series of vacation courses intended
for practitioners is being arranged. These are to begin on
Sept. 26th, and will continue till the end of October.

Bordeaux. — M. Poueson, agrtgl of the Faculty of
Medicine, has been appointed Surgeon to the hospitals pf
Bordeaux. M. le Profeeseur Viand has recently read an
important paper advocating considerable changes in the
system of medical instruction, whereby the theoretical lec¬
tures would be given by the agrSgSs and the clinical instruc¬
tion by the professors.

Cadiz .—Don Manuel Bernal has been appointed Professor
of Medical Pathology.

Giessen. —Dr. Max Hofmeier, first assistant in the Royal
Gyntecological Clinic in Berlin, has been appointed Pro¬
fessor of Midwifery and Gynaecology. Dr. Hofmeier has
just married the eldest daughter of the late Professor
Scbroeder.

Halle .—Professor Olshausen’s former pupils and assistants
propose to erect his Statue in the Gyntecological Clinic,
which has been under his care for the last twenty-five
years, as a mark of their affection for and gratitude to
their old master.

Madrid— Don Gabriel de la Puerta y Rddenas, Professor
of Pharmacy, has been appointed a member of the Council
of Public Instruction, in the place of the late Don Manuel
Rioz y Pedraja.

Moscow.—Dr. Hugenberger, having completed his term
of office as Director of the Moscow Lying-in Institution,
has now retired. His successor will be Dr. Sutugin, privat
docent in the Military Medical Academy, and one of the
Medical Officers of the Duchess of Edinburgh’s Hospital in
St Petersburg.

8t. Petersburg .—Professor Wenzel Gruber, who has held
the Chair of Anatomy for forty years, has resigned.

Wunburg .—One of the recently made Doctors of Medicine
is, or was, a “ poet director,” a captain, and a jurist, his age
being fifty-six. _

Thb death is announced from Paris of the eminent French
chemist, M. Joseph-Dieudonnd Boussinganlt. The deceased,
who was born in 1802, occupied the chair of Agriculture in
the Paris Conservatoire of Art and Ind ustry. He was named
Commander of the Legion of Honour in 1857, and promoted
to the rank of Grand Officer in 1876. M. BoussingauTt was
the author of a large number of papers on physics and
chemistry, and of treatises on “ Chemistry and Physiology
in Agriculture,” “Studies on the Transformations of Iron
and Steel,” Ac.

An influential committee of the inhabitants of the Royal
parish of St. Martin-in-the-fields is appealing for snbecrip-
tions towards the suitable celebration of the Queen's
Jubilee. The money received will be devoted, either by-
direction of the donors or at the discretion of the committee,
to any one or all of the following objectsEntertainment
to children and old people; the purchase of a site of free¬
hold land for the extension of Charing-cross Hospital; a
memorial window in St. Martin’s Church; the Imperial
Institute; and the Church House. A first list of subscrip¬
tions has already been published, and each of the above
objects seems to be meeting with hearty support.

The Editor of Land and Water has succeeded in in—
during M. Pasteur to undertake an investigation into the
cause of grouse disease, and aaks thorn interested to co-operate-
with him in obtaining for the French savant the necoemry
specimens. _

At the last meeting of the Aldershot Military Medical
Society, Surgeon-Major Scott, C.M.G., who has recently
been studying the Pasteur system in Paris and Naples, gave
an account of his investigation.

We are asked to announce that all drawings to illustrate
papers in the Pathological Society’s Transactions most be
sent to Dr. Conpland, hon. sec., before May 31st.

Nbws has been received from Vienna of the serious ilhMIse
of Professor Billroth. _

The Cape de Verde Islands are stated to be now expe ri encing
an epidemic of small-pox.

MEETING OF THE GENERAL MEDICAL
COUNCIL.

(Continued from page 10^6.)

Thursday, May 19th.

Mr. Marshall, Phbsidbnt, in thb chair.

The Pbesidbnt read a letter from Sir Henry Acland
acknowledging the receipt of the address from the Council
on his retirement, expressing his gratitude for the kindly
feelings embodied therein, and adding that he should
always take the warmest interest in all the future proceed¬
ings of the Council.

A communication was received from the Privy Council,
stating that the Lords of the Council had yesterday passed
an order for postponing until June 30th next the “appointed
day ” named m the Medical Act of 1886, and that the order
would be forwarded as soon as printed.

Dr. StrutHBR8 proposed the re-telection of the existing-
members of the Executive Committee.

Dr. Banks seconded the motion.

Mr. Simon hoped that the members of the Executive Com¬
mittee would be elected in the ordinary way by ballot,
seeing that tbe Council had been strengthened by the election,
of five new members.

Dr. Fergus said all that was necessary was to elect
two new members, the existing members holding office
till June. -

After some.disonssion tbe motion was agreed to. A ballet
was then taken for two new members of the committee, one
for Scotland and one for Ireland, and the members-elected
were Dr. Heron Watson and Mr. Macnamara. 1 Tbe Business
Committee, the DentaL Committee, the Pharmacopoeia Com¬
mittee, and the Finance Committee (to which Dr. Humphry
was added) were re-elected. The Education Committee and
the Examinations Committee were also appointed.

Dr. Quain said that the available' funds of the Couaril
were exhausted, and there was nothing wherewith to ps>
the members for their attendance unless the En g lish Branch

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The Lancet,]

MEDICAL ATfENDANCE ORGANISATION COMMITTEE.

[May 21,1887. 1057

Council advanoed it. They were willing to do so, but on
condition that, the Scotch Irish Branch Councils made a

remittance at an early period.

Mr. Simon moved, “ That the Council delegate to the
Executive Committee to exercise the powers aud discharge the
duties of the Council so far as the Executive Committee
shall, in the absence of the Council, find necessary or ex¬
pedient, except as followsFirst, as to making representa¬
tions or reports to Her Majesty in Council or to the Privy
Cpunoil; secondly, as tp making general rules or recom¬
mendations ; and thirdly, as to deciding, under Section 29 of
the Medical Act (1858), whether any medical practitioner
has been guilty of infamous conduct in a professional
respect.”

Dr. Haughton seconded the motion.

Dr. A. Smith thought that all the offences under Sections
28 and 29 should be included in the exception.

Mr. Simon thought the Executive Committee should
have the power of removing from the Register persons who
had been convicted of felony; but doubtful cases would
probably be referred to the Council for decision.

, Mr. Me Vail saw no reason why the Executh e Committee
might not make “ recommendations.”

Dr. Duncan suggested that the motion should be deferred
till the next meeting of the Council, considering the far-
reaching nature of the change proposed.

Dr. Humphuy hoped that the matter would not be
deferred. The Executive Committee should not have power
to interfere with the general principles on which the Council
acted, and that was sufficiently provided for in the excep¬
tions named in the motion. It was important to enable the
Executive Committee to decide many matters of business
ordinarily undertaken by tbe Council. If that were done
-it was possible that one meeting of the Council in the year
might be saved.

Dr. Bruce supported the motion, and urged the impor¬
tance of saving tbe time of the Council. Dr. Banks, Mr.
Carter, and Dr. Heron Watson also supported the motion.

Dr. Pettigrew thought the matter should be delayed in
■order that it might have more consideration.

8ir Dtcb Duckworth supported the motion, which was
then put, and agreed to.

Dr. Haughton moved, in behalf of the Irish Branch
Council: “ (a) That this Council do appoint two assistant-
examiners to the Apothecaries’ Hall of Ireland. (i) That
these examiners do examine in surgery, (c) That for a term
of one year, from July 1st next, and subject to tbe order of
the Council, Sir William Stokes and Mr. Edward Hamilton
be appointed. ( d) That the fee to each assistant-examiner
at tne stated quarterly examinations shall be five guineas.
<«) That, in the event of any vaoanoy occurring among the
assist ant-examiners appointed by this Council, it be re¬
mitted to the Branch Council in the division of the kingdom
in which the vacancy has arisen to appoint an ad interim
examiner or examiners.”

Mr. Collins seconded‘the motion, which was agreed to.

Mr. Macnakara moved: “ That tbe Council now proceed
to appoint Inspectors of Examinations from the following
•list of persons suggested by the Branch Councils:—By
English Branch Council: In Medicine—Dr. Coupland, Dr.
Finlay; in Surgery—Mr. McGill, Mr. Peppor; in Midwifery
—Dr. Mahne. By Scottish Branch Council: In Medicine—
Matthew Hay, James A. Russell; in.Surgery—Joeeph Bell,
J. D. Gillespie, D. N. Knox; in Midwifery—A. H. F. Bar-
hour, R. Milne Murray,* W. L. Reid, James 8tirton. By Irish
Branch Council: In Medurino—John Magee Finny; in
Bwgery—E. H. Bennett, E. D. Mepother; in Midwifery—
F. W. Kidd, T. M. Madden.

•Dr. Barren seconded the motion, which was adopted.

The Council then proceeded to the appointment of in¬
spectors in private, strangers being requested to withdraw.

On the readmission of strangers the Prnsidbnt announced
*het the following gentlemen had been appointed:—For
Medicine; Dr. Finlay; Surgery, E H. Beanett; Midwifery,
A. H. F. Barbour.

'Dr. Glovbb called attention to the late appearance of
ue Medical Register, which be said was not published till
"pril 29th. The Medical Directory appeared before tbe end
■of Hie previous year. In former years the Register appeared
•t various dates in February and March, but never so late
as this year, No doubt the circumstances were somewhat
exceptional, and.certain improvements had been introduced,
he still thought that the appearance ought not to have
bft * a so late, and hoped that it would be earlier in future.

He waa.quite sure that the fault did not lie with the Registrar,
who took great pains to have the work done not only accu¬
rately but promptly.

Dr. Quain said that many changes bad been required in
the Register, and there were great difficulties in bringing out
so large a volume. There had also been some delay in the
Stationery Office, where the book was printed at a very cheap
rate, so that it was impossible to put too much pressure
upon them. •

Dr. A. Smith regretted that the matter had been brought
before the Council, aud thought that the* attention of the
Executive Committee ought to have been called to the
subject. He also thought that there was an undeserved
imputation of neglect on the part of the Registrar.

The Registrar said that the work of the Register had
materially increased of late years. Some delay had arisen
in consequence of the useful addition of dictionary head¬
ings, which necessitated another revise. The work was done
at a much cheaper rate than it would be done by an ordinary
printer.

Bir Wm. Gull thought that there ought to be a general
expression of entire confidence in the Registrar. He had
often been surprised at the admirable manner in which his
work was done.

Dr. STRUTHBB8 expressed his concurrence in the remarks
of Sir W. Gull. They ought to take no notice of the pellets
of the penny-a-liners of the anonymous London press.

Mr. McVail said he thought that Dr. Glover was entirely
justified in the course he had taken.

Dr. Glover said be thought that he had carefully guarded
himself in regard to their obligation to Mr. Miller, the
Registrar.. He still, thought that he had brought an im¬
portant matter before the Council. He was not quite satis¬
fied that tbe late appearance of the Register was unalterable;
and if it did not appear sooner next year he should feel it
his duty to make the same complaint.

Dr. Struthers, who had given notice of a motion for the
consideration of the interim report of the Executive Com¬
mittee and the suggestions of the Branch Councils in regard
to the appointment of inspectors of examinations, said that
it had been rendered unnecessary after the motion of
Mr. Macnamara. He would only refer to one of the recom¬
mendations of the committee, that tbe inspectors should
have their attention specially called to the quality of the
examinations, and also to the sufficiency of tbe means and
appliances for testing tbe qualification- of the candidates.
There was another matter to which special attention should
be called—viz., the quantity of tbe examinations, that being
a point in which they were deficient. There ought alao to be
a reference to the previous reports of visitors.

Dr. Haughton withdrew a motion of which he had givep
notice, with reference to the 'maimer of entering on the
Register the names of British physicians and surgeons
bolding foreign diplomas in dentistry.

This concluded the business of tbe Council.

The President said be thought that the Council might
congratulate itself on having settled some very important
and difficult questions in such a way as to economise time
and labour in the future. Though the session had been a
long one, he did not regret the time that had been spent,
because be thought that great economy and other advan¬
tages would be the result.

MEDICAL ATTENDANCE ORGANISATION
COMMITTEE.

The eleventh meeting of the above committee was held
at 5, Lamb’s-conduit-street on Tuesday, the 10th inst., Sir
T. 8pencer Wells in the chair. There was again a good
attendance of the committee. The following resolutions
were considered:—

1. “ That it be an understanding that the resolutions
passed on this branch of the subject—namely, relating to
the hospitals—are intended as a basis for a conference with
hospital authorities previous to the general report being
submitted, and not as a final settlement.” This resolution
wss carried unanimously.

2, “ That in the opinion of this committee hospital
authorities should be requested to consider the propriety of
requiring all applicants for relief in the out-patient depart¬
ments to sign a declaration that, in the case of single

105 h The Lancet]

: REPORTS OF' MEDICAL OFFICERS OF HEALTH.

[MiT 21,1887.

persons, their average wages do not exceed £1 per week;
and, in the case of a family, their joint earnings do not
exceed 30s. per week/’

To this resolution the following amendment was pro¬
posed:—“ (1) That in the interest of hospitals, provident and
other dispensaries, and of the poor themselves, it is desirable
that an agent, well trained and thoroughly conversant with
the locality, rates of wages, See., be employed at general
hospitals and free dispensaries to fulfil the following duties:
(a) To ascertain whether the patients should receive advice
and treatment gratuitously; (A) to make inquiries on the
plan now in force at the London Hospital; (c) to refer
persons ineligible for free medical treatment to local prac¬
titioners, provident dispensaries, or relieving officers.
(2). That this proposal be adopted, on the understanding
that all patients are eligible for first treatment, and also
that those cases which are vouched for by the medical men
as of special interest be retained at the hospital."

- There was considerable discussion on the resolution and
amendment, after which the amendment was carried by a
large majority.

The following proposed alterations in the out-patient de- :
partments of hospitals was then moved by Mr.T. Holmes:— 1
“1. That both the number of out-patients received each
•day and the hours for seeing them be limited, so that not
-more patients be received than can be deliberately attended
by the stated officers of the hospital (and used for clinical
instruction ia hospitals having schools attached), and also
that the present abuse of keeping patients waiting for a
great part of the day be reformed. 2. That out-patients be
not received (except in the casualty department) without a 1
-recommendation from some medical authority, whether a
dispensary or private medical practitioner, so as to ensure
that only persons are received whose medical condition fits
them for out-patient treatment. 3. That out-patients be
received only tor consultation, and not for prolonged treat¬
ment, unless the latter be recommended both by the medical
authority who sends the patient and by the out-patient
physician or surgeon of the hospital. 4. That the casualty
department be strictly limited to accidents find street
emergencies, and that only accidents attend more than
once.” .

It was resolved that these resolutions should be considered
separately at the next meeting of the committee On Tuesday,
the 17th inst.

TESTIMONIAL TO MR. FURNEAUX JORDAN.

A meeting of subscribers to this fund was held on the
12th inst., in the library of the Birmingham Medical Tnsti-
. tute, to present Mr. Furneaux Jordan with a Testimonial on
the occasion of his retirement from the surgical staff of the
Oueen’s Hospital and from'professional life. Mr. J. St. S.
Wilders presided, and a large number of the practitioner of
Birmingham and the Midlands attended. The presentation,
towards which 134 old pupils and friends contributed, took
the shape of two large portraits of> Mr. Jordan, which were
.specially prepared at the wish of the subscribers—one to
be bung in the. Queen’s > Hospital and the other in the
Birmingham Medical institute; and also a handsome
library of books and a cheque for .£217. The chairman,
in making the presentation, alluded to Mr. Jordan’s high
renown as a surgeon and a teaoher, and to the services
he had rendered to his hospital and the profession.
Sir James Sawyer, Mr. T. H. Bartleet, Mr. Chas. Sims, Mr.
,Yii)cent Jackson, and Mr. F. Underhill also added com¬
plimentary remarks; the latter, on behalf of the general

? iractitioners, for whom he spoke, said that they had always
ound in Mr. Jordan the higheet type of a consultant. Mr.

, Jordan, in replying, expressed his grea,t appreciation of the
kindness which had prompted the testimonial. He bad been
impelled to retire by considerations of health, as pro¬
fessional work could only be carried' on-by a strain too great
'for his endurance. He urged his professional brethren to
consider whether it was worth while dying in harness,—
■whether they should not look forward to a short period of
test and enjoyment. Retrospectively, he observed that when
he began life he was ambitious to take up the-philosophical
side of the profession, but' he could not succeed in doing
anything of the kind. He found practical surgery—the
easing of the troubles and pains and anxieties of one's
fellow-creatures—much more pressing.

SANITARY LEGISLATION CONFERENCE.

Tub third meeting of the Conference convened by the
Sanitary Assurance Association, to consider and report upon
the Sanitary Registration of Buildings Bill, was held on the
ICbh inst., the President of the Association, Sir Joseph
Fayrer, presiding. At the first two meetings the principle ol
the Bill was unanimously approved, and six oat of the seven¬
teen sections of which the Bill consists were with amend¬
ments agreed to. At the last meeting Section 7 was agreed
to as follows:—The Local Government Board or corre¬
sponding authority shall issue licences in sanitary practice
to the following persons and corporations—that is to say,
(1) members of the Royal Institute of British Architects,
members of the Institution of Civil Engineers, members of
the Royal Institute of Architects of Ireland, members of the
Association of Municipal mid Sanitary Engineers, and sur¬
veyors and members of the Surveyors’ Institution who are
registered in accordance with this Act as qualified in
sanitary practice; (2) architects and civil engineers who
have been in practice three years at the passing of this Act,
and who shall prove their practice has been a bond fide one
and hae included the designing and carrying ont of con¬
structive sanitary works; (3) sanitary associations incor¬
porated by licence of the Board of Trade, provided that their
certifying officers be registered as qualified in sanitary
practice, in accordance with this Act; (4) medical practi¬
tioners registered as qualified in sanitary science; (5) persons
who are medical officers of health at the passing of this
Act; (G) persons who at the passing of this Act hold
appointments as engineers or surveyors under the Public
Health Acts, provided they are members of one of the institu¬
tions mentioned in Subsection I. of this section ; (7) stich
other persons as the Local Government Board or cor¬
responding authority may consider qualified after examina¬
tion. Considerable discussion took place on the eighth
and ninth sections, but they were agreed to with merely
verbal alterations, and the Conference then adjourned until
the 23rd inat.

public Dealt!] atttr |paor ITafo :

LOCAL GOVERNMENT'DEPARTMENT. .

REPORTS OP MEDICAL OFFICERS OP .HEALTH.

Reading Urban District . 1 —The borough of Reading has
increased between 1881 and 1886 front a populatfCn of 80

to 48,280, the persons per acre having risen frbm 20'S to
to 23 0. But the death-rate has fortunately fallen, and last
year it stood at 168 per lOOQj a «ubs(Mtial reduction ha*
also taken place in the zymotic cate: and', in the infantile
death-rate. Ail these points arabnought out in considerable
detail by Dr. Shea, who is also able to advert-to soma of
circumstances which have led to this comparative prosperity
in health. The water sapply is.kept- underconstant and
vigilant supervision, and improvements are steadily being
effected in the method of its service. There is a sanatorium
for small-pox, and a separate fever cottage. The notifica¬
tion of infectious diseases is ■ also carried out uadeor aa
Improvement Act, and-the information so obtained has
materially, assisted the efforts -to deal ■ with these diseases.
Bakehouses, cowsheds &c., slaughterhouses, and offensive
trades am kept under supervision, and a'code •£ bye-larti is
-now ready for application.. Some occurrences of typhoid
fever led- to the water supply, being suspected by asess
inhabitants of the district. . Dr. Shea does, not tbink the
suspicion well'founded, but be presses the importance'of
efforts to secure the diversion of .all sewage about the
intakes of the Reading Waterworks.

’ Reading Rural District .—This district is also under Dr.
Shea’s medical supervision.-' It had in 1886 a death-rate df
only 12*2 per 1000, and the amount of infectious disease was
unimportant. When any occurred, such action as was avail¬
able was adopted to secure permanent improvement in the
sanitary circumstances. The local water supplies are cared
for, especially where dairy farms are concerned, and a
system of scavenging has been adopted in one of the more
populous localities.

3 y Google

Tot Lancet,]

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[>Uy 21,1881 (106$

Taunton Urban District .—In his annual report on this
district Dr. Alford points to the improvements that have
been effected in the water service, and which will soon be
completed by the construction of a storage reservoir suffi¬
cient to ensure a constant service. Referring to complaints
as to enforcing closure of wells, he states in answer that*
whereas typhoid fever was once common in the district, it
has now well-nigh disappeared. Much has also been done
to improve the system of sewers and to secure adequate
•means of flushing. The corrected death-rate for 188(3 was
17 per 1000, and the zymotic rate was only 14; infectious
diseases being controlled by voluntary notification, isolation
in hospital, and subsequent measures of disinfection. The
sanitary hospital received 60 patients, the total admissions
since its opening having been 593. Of the 60, 4(3 came from
the urban district and 14 from the rural district, and, apart
from two cases dying within forty-eight hours of admission,
only two instances of death occurred. This hospital has
always been worked satisfactorily, and a glance at the
year’s financial statement with regard to it shows that
repayment by patients of the costs incurred is not allowed
to stand in the way of the prime consideration of
securing isolation in the interests of the health of the
public.

Taunton Rural District— In this district Dr. Alford has
complaint to make as to the absence of proper means of
drainage and as to defects in existing sewers, and he states
generally that although good sanitary work has been carried
out yet much remains to be done. The death-rate for 1836
was 15 9 per 1000. Bye-laws are needed to regulate the
construction of new buildings, and power should be sought
by the authority to make them.

Wokingham Urban District .—Here Dr. Shea reports a
death-rate of 19 - 3 per 1000, but the zymotic rate was 6nly
l'l per 1000. Small-pox was the only disease that gave rise
to anxiety, and the authorities are reminded that the Poor-
law hospital is not properly available for sanitary purposes.
■The water supply is carried, into houses heeding it, the
sewage farms work well, and bye-laws have been pro¬
visionally adopted.

. Wokingham Rural District .—This district is also in Dr. ;
Shea’s area os medical officer of health, and the report is in
the main a record of sustained sanitary work. Nine cases
of enteric fever occurred in three houses, and a detailed
account is given of their sanitary circumstances, the result
being that these did not sufficiently account for the ;
occurrence, which in point of causation remained somewhat
obscure. The general death-rate during 1886 was 15 3 per
1000.

Whitechapel .—The death-rate for this district in 18SC
■was-22-5per 1000, and Dr. Loane holds that it is consider-,
ably influenced by the- number of common lodging houses
.within it. These tend at times to become suddenly filled by
persons who are certainly not in the best state to with¬
stand disease. Thus, early in the year when liberality was
-being dispensed at the Mansion House, there was a special
influx of people into Whitechapel lodging houses from all
<parts, of tbn Conakry, and they ware people who, whilst
adding but little to the birth-rate, tend eaormooslyto increase
:the aiok and death rates. Indeed, whilst the common lodging-
house births eqnal 1*3 per cent..of the total district births,
<atad 38*4;par cent, of the births in the Union infirmary, the
-deaths in.these registered houses equal 119 per cent, of the
.total dishrieiideaths, and 64-5 per oent. of the total infirmary
deaths. In this connexion it is interesting to note that in the
-Wbiteehapel district there are buildings constructed under the
Artisans and Labourers’ Dwellings Acts, and also by private
•enterprise, which accommodate some 6432 persons. These
give a mortality of.16-0 per 1000, and contribute only 6 3per
oent. of the total deaths, or about half that which the
common lodging houses contribute. And the contrast is
'the greater when it is remembered how large a proportion
of young children to adults there is in the artisan class of
•dwelling. _

VITAL STATISTICS.

OTALTH OF ENGLISH TOW^S. ,

, In twenty-eight of the largest English towns 5703 births
pad 3494 deaths were registered during the week ending
(May 14th. The annual rate of mortality in these towns,
which had been 21-6, 20 6, and 20 9 per 1000 in the preceding

three weeks, declined last week to 197, and was lower
than in any previous week of this year. During the first
six weeks of the current quarter the death-rate in these
towns averaged 207 per lOtH), and was 21 below the mean
rate in the corresponding periods of the ten yedrs 1877-86:
The lowest rates in these towns last week were 107 in
Bolton, 12-8 in Derby, 14 9 in Leicester, and 15 3 in Sunder¬
land. The rates in the other towns ranged upwards td
26-2 in Newcastle-upon-Tyne, 26-4 in Manchester, 26 9 in
Liverpool, and 29 0 in Huddersfield. The deaths referred to
the principal zymotic diseases in the twenty-eight towns,
which had been 558, 629, and 548 in the preceding three
weeks, declined last week to 500; they included 235
from measles, 136 from whooping-cough, 47 from scarlet
fever, 33 from “fever" (principally enteric), 27 from
diarrhoea, 20 from diphtheria, and only 2 from small-pox.
No death from any of these zymotic diseases was registered
during the week in Wolverhampton; whereas they caused
the highest death-rates in Sheffield, Huddersfield, and
Norwich. The greatest mortality from measles occurred itt
Sheffield, Manchester, Salford, Newcastle-upon-Tyne, and
Norwich; from whooping-cough in Huddersfield, Birming¬
ham, and Blackburn; from scarlet fever in Hull and
Oldham; and from “fever” in Liverpool. The 32 deaths
from diphtheria in the twenty-eight towns included 9 ixl
London, 3 in Huddersfield, 2 in Liverpool, and 2 in Brightofi.
Small-pox caused 1 death in Portsmouth and 1 in Cardiff,
but not one in Greater London or in any of the twenty-
five other large provincial towns. Only 7 cases of small 1 -
pox were under treatment on Saturday last in the
metropolitan hospitals receiving cases of this disease
3 new cases were admitted during the week. The deaths
referred to diseases of the respiratory organs in Londoq,
which had been 338 and 348 in the preceding two weeks,
declined last week to 291, and were 48 below the cor¬
rected average. The causes of 74, or 21 per cent., of
the deaths in the twenty-eight towns last week were nqt
certified either by a registered medical practitioner or by p.
coroner. All. the causes of death were duly certified in
Portsmouth, Cardiff, Bolton, and in four other smaller towns.
The largest proportions of uncertified deaths were registered
in Sheffield, Salford, and Liverpool, ,

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 22*5 and 2T2 per 1000 in the preceding
two weeks, rose again to 21*5 in the week .ending May 14th •„
this rate exceeded by 1*8 the mean rate,in the same week
in the twenty-eight large English towns. The rates in
the Scotch towns last week ranged from 10 8 and I46 ip
Leith and Perth, to 23li in Glasgow and.237 in Edinburgh.
The 53b deaths in the eight towns last Week showed an
increase of 7 upon the number in the previous week, and
included 36 - which were refeped'to whooping-cough,. 15
to measles, 12 to scarlet fever, 7 tOfdipbtheri*, 6 to .“feyer”
(typhus, enteric, or simple), .3 to dian-hoea, and not one tp
small-pox; in all, 78 deaths resulted from these principal
zymotic diseases, against 95, 89k and 72- in the preceding
three weeks. These 78 deaths were eqnal to an. annual
rate of 31 per 1000, .which exceeded by 0*3 the mean
rate from the same diseases in the twenty-eight English
towns. The fatal cases : of whooping-cough, which
,had been 36 and 31 in the preceding two weeks, rose,
again last week to 36, of which ,18 occurred in Glasgow;,
.7 in Dundee, and 6 in Edinburgh. The 15 deaths from
measles showed a further considerable decline. from
,the numbers.in recent weeks, and included 10. in Glas¬
gow and-5 in Aberdeen, The fatal casespf scarlet-fevpf,
on the other hand, whioh hod declined in. tbs five,pre¬
vious weeks from 11 to 2, rose-again last week to 12, of
which 6 occurred in Glasgow end 3 in Aberdeen. The 7
deaths from diphtheria also exceeded recent weekly num-
.bers, and included 4 in Glasgow and 2 in Paisley. Of the
5 deaths referred to “ fever, 2 occurred in Glasgow and S
in Aberdeen. The 3 deaths attributed to diarrhoea werp
10 fewer than those returned in the corresponding week of
last year. The deaths referred to acute diseases of the re¬
spiratory organs in the sight towns, which had declined ip
the preceding four weeks from 126 to 106, rose, again last-
week to’120, and exceeded the number in the corresponding
week of last year by 17. The causes of 56, or nearly 11 per
cent., of the deaths registered in the eight towns during the
week were not certified.

Digitized by

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1060 The Lancet,]

THE DUBLIN DEATH-RATE.— 1 THE SERVICES.

[May 21,180T.

7 HEALTH or DUBLIN.

The rate of mortality in Dublin, which had been equal
to 31-3 and 36 6 per 1000 in the preceding two weeks,
declined to 24*4 in the week ending May 14th, and was
lower than the rate recorded in any previous week of this
year. During the first six weeks of the current quarter the
death-rate in the city averaged 313 per 1000, the mean
.rate during the same period being but 18'4 in London and
201 in Edinburgh. The 165 deaths in Dublin last week
showed a decline of of no fewer than 83 from the number
in the previous week; they included 7 which were referred
to measles, 4 to whooping-cough, 3 to diarrhoea, 2 to scarlet
fever, 2 to “fever” (typhus, enteric, or simple), and not
one either to small-pox or diphtheria. Thus 20 deaths
resulted from these principal zymotic diseases, against 24
and 19 in the preceding two weeks; they were equal to
an annual rate of 3 0 per 1000, the rates from the same
diseases being 2 3 in London and 1'4 in Edinburgh. The fatal
.cases of measles, which had been 11 and 6 in the preceding
two weeks, rose again last week to 9; the deaths from
whooping-cough, “fever,” and scarlet fever, on the other
-hand, showed a decline in each case. The deaths both of
infants and of elderly persons showed a considerable de¬
cline from recent weekly numbers. Four inquest cases and
6 deaths from violence were registered; and 48, or more
than a quarter, of the deaths occurred in public institu¬
tions. The causes of 19, or more than 11 per cent., of the
deaths registered during the week were not certified.

THE DUBLIN DEATH-RATE.

The Registrar-General for Ireland, in a recent address,
stated that, whilst a remarkable reduction in the death-rate
'had taken place in the English towns during the ten years
which had elapsed from the passing of the English Public
Health Act, no corresponding reduction had been noticed in
Dublin dnriDg the ten years which had passed after the
-enactment of the Irish Public Health Aet in 1874. This
statement attracted the notice of the Dublin Town Council,
and they adopted a resolution drawing the attention of Sir
•Charles Cameron, the medical officer of health, to the matter,
and requesting^ him to report to the Council on the subject
as soon as possible. That gentleman has accordingly drawn
up a report, in which at the outset he states that since the
corporation have been provided with adequate means for
the purpose, they have, apparently with remarkable success,
■laboured to reduce the high rate of mortality which has so
long prevailed in Dublin. It appeare to him that a most
sinous factor in producing the high death-rate in Dublin is
the poverty of a large proportion of the population. Another
-cause of the higher death-rate is the crowding into the city
from the country of worn-out and decayed persons who end
their days in the hospitals and workhouses. It is a remark¬
able fact that Dublin, with only one-twentieth of the
•population of Ireland, contains about two-fifths of all the
hospital beds in the country. A fact showing the poverty
•of tne people is that, while 15 per cent, of the deaths in the
‘English towns take place in the workhouses and charitable
’institutions, in Dublin it amounts to 30 per cent. The
returns of the Registrar-General for Ireland show that the
death-rate among certain of the poorer sections of society is
•very great, while among the well-to-do classes in Dublin
the mortality is the reverse of excessive. For example, in
1886 the death-rate was only 173 among the 30,129 persons
-composing the “professional and independent classes.” Sir
•Charles Cameron thinks it probable tbit the stagnant con-
-dition of the contents of the city sewers operates injuriously
upon the public health. It may not, he remarks, be
■generally known that tbe mouths of the sewers are closed
ior about twelve hours daily by the rise of tidal waters in
•the river; therefore, during this time all the sewage of tbe
■city is impounded in the sewers, except the portion which
is pumped out at tbe two pumping stations. Until tbe be¬
ginning of 1879 the corporation of Dublin were un-
-provided with funds for the purpose of effecting needful
sanitary reforms, and the following are the chief
measures which since then have been taken to improve
the sanitary state of the city. In 1880 £15,000 were ex- (
‘pended in making and improving street sewers; a loan'
Of £100,000 was obtained for paving the streets, and fol¬
lowed by a supplementary one of £13,000. In 1881 1 a loan
Of £28,000 was procured for domestic scavenging: and the
'following year the daily cleansing of the yards and Sanitary
Accommodation of tenement bouses was tftrriSd cut.' This

service costs £3000 a year; and in 1882 an abattoir was
established, at a cost of £16,000. Last year tbe eecond of
two unhealthy areas was cleared, at a cost of £56,700; while
public baths and wash-houses have been erected at a coat
of £11,000, and a loan of £20,000 obtained for the erection
of dwelling-houses for tbe working classes. Among minor
sanitary loans may be mentioned £3000 for improvement of
the sanitary accommodation of tenement houses, £2000 for
the ventilation of sewers, and £3000 for pumping works in
connexion with sewers; while three new streets have been
formed since 1883, at a cost of £90,200.

THE SERVICES.

Surgeon-General W. S. Murray, M.B., has been appointed
Principal Medical Officer with tbe troops in Egypt, vice
Surgeon-General J. O’Nial, C.B., who will be placed on the
retired list next month under the age clause or the Medical
Warrant.

Surgeon U. J. Bourke has been appointed Medical Officer
at the Royal Arsenal, Woolwich.

Deputy Surgeon-General J. Landale, M.D., has been ap¬
pointed to the medical charge of the Sirhind Division.

Deputy Surgeon-General R. W. Meadows has been ap¬
pointed Principal Medical Officer of the Western District.

India Office.— The Queen has approved of the follow¬
ing promotions among tbe Officers of the Indian Military
Forces, made by the Governments in IndiaSurgeon-Major
William Smyth Fox, of the Madras Medical Establish¬
ment (dated Jan. 4th, 1887), and Surgeon-Major Abraham
Nickson Hojel, of the Bombay Medical Establishment (dated
April 2nd, 1887), to be Brigade Surgeons.

Admiralty— Staff Surgeon John JoRifle has been awarded
the Greenwich Hospital Pension of £50 a year for Fleet and
Staff Surgeons, R. N., vacant by tbe death of Deputy Inspector-
General F. J. G. T. Forbes.

In accordance with the provisions of Her Majesty’s Order
in Gouncil of April 1st, 1881, Fleet Surgeon Gerald Molloy
has been placed on the retired list, with permission to assume
the rank of Deputy Inspector-General of Hospitals and Fleets
(dated May 15th, 1887). ’

The following appointments have been madeFleet Sur¬
geon Astley Cooper, to the Dadalus; Fleet Surgeon William
D. Longfleld, to the Indus ; Fleet Surgeon Godfrey Goodman,
to the Royal Adelaide; Fleet Surgeon James D. Smith, to
the Rupert ; Surgeon John L. Bsgnall-Oakeley, to the Royal
Adelaide ; Surgeon John D. He wood, to ibe-Minstaur ; Sur-

J eon Edward J. Biden, to tbe Plymouth Hospital; Surgeon
, D. Trevor Roper, to the foxhound:- Surgeon R. Hickson,
to the Dolphin; Surgeon W. G. Axford to the Lion; and
Surgeon F. J. Burns, to the Pembroke, additional.

Yeomanry Cavalry.— Suffolk: Robert Harry Lucas,
Gent., to be Surgeon (dated May 14tb, 1867).

Artillery Volunteers. — 1st Cinque Ports: Acting
Surgeon Thomas MacQoeen, M.B, resigns his appointment
(dated May 14tb, 1887). • -

Rifle Voluntehrb. — 2nd ’Volunteer Battalion, the
Gloucestershire Regiment: Surgeon C. F. Garrett resigns
his commission (dated MayMth, 1887).—6th Lanarkshire:
James Wylie, M.B., to be Acting Surgeon (dated May 14th,
1887). 1 —1st Suffolk : Surgeon G. S; EUiston is granted the
honorary rank of Surgeon-Major (dated May 14th, 1887).—
1st West Ridingof Yorkshire: Acting Surgeon T. Deriile, MJD*
resigns his Appointment (dated May 14th, 1887).' ■

The Volunteer Medical Staff Corps. — Tbe Man¬
chester Division: Acting Surgeon William Henry BrownWil
Crockwell, from the 16th Lancashire (3rd Manchester Rifle
Volunteer Corps), to be Surgeon (dated May 14th, 1867),

The Pharmaceutical Society held its annual soiree
on Wednesday, in the galleries of the South Kensington
Museum. The company were received hy the President,
Mr. Michael C'arteigh, and members of Council. A selection
of music was played by the hand qt the Royal Horse Guards,
and a concert of glees and madrigals were given under the
direction of Mr. and Mrs. Winn. The attendance was very
numerous, and a very agreeable evening was spent.

The annual Court of Governors of the Bath
Minerkl Water Hospital was held on the 2nd inst., when
satisfactory genera), medical, and financial reports were
presented and adopted.

Di.

Thb Lancet,]

THE COLLEGE OP SURGEONS’ EXAMINATIONS.

[May 21,1887. 1061

Csmsjrankmt.

“And! alteram partem.”

THE COLLEGE OF SURGEONS’ EXAMINATIONS.

To the Editor t of Thb Lancet.

Sirs, —As my name is prominently mentioned in your
leader of last week upon the examinations at the College of
Surgeons, perhaps you will allow me to reply.

I do not retract one word of the evidence 1 gave before the
Royal Commission, and 1 still say that “ one man may be
lucky,” &c.; and that “ I do not know, human nature being
as it is, how it is to be avoided.” Of oourse, with a com¬
paratively small number of candidates, as at Cambridge in
former years when I examined there, it was possible for the
whole of the candidates to pass before my surgical colleague
and'myself, who read all the papers and examined alter¬
nately vivd voce. Buoh a method is impracticable at the
College of Surgeons from the large number of candidates, as
it is also at the University of London, where my surgical
colleague and I divide the papers and candidates, and both
of ns only read all doubtful papers and examine vivd voce all
doubtful candidates, so that no man- may be rejected by a
single examiner. At the College of Surgeons the Court of
M ten examiners of surgeons” is divided into five “tables,”
and the candidate whose paper goes, say, to A (where it is
read and marked by both examiners), goes to B, C, D, and E
for his vivd voce , and so on. Hence each candidate appears
before the whole Court, and no section knows what marks
the others have given until they are called out at the end of
the examination. It is, no doubt, much to be regretted that
the rate of “ pluck ” has been so high lately—viz, 60 per
cent, in January and 51'6 in April; but this is partly due to
the fact that in January last 65 men were up for the second
time, 23 for the third time, 7 for the fourth time, 2 for the
fifth time, and 1 for the sixth time; while in April 60 men
were up for the second time, 24 for the third time, 7 for the
fourth time, 5 for the fifth time, 1 for the sixth, and 1 for
the seventh time—making altogether 28 reappearances
out of 246 candidates in January, and 96 out of 289 in
April.

Although “ the statements of 1881 hold«good for 1887,” a
good deal has been done to improve the College of Surgeons’
examination, with the object of gaining “ leu uncertainty,”
and even “in the way of diminished Stringency.” The
former has certainly been attained to some extent by
increasing the time allotted to the clinical and practical
examinations respectively from ten minutes to a quarter of
an hour, so that neither candidate nor examiner may be
hurried. At the April examination, too, the experiment
was tried of taking the two parts of the vivd voce on different
evenings, and thus a candidate had twenty-four hours to
“ pull himself together ” after his first “ heat.” The rule has
been established that the “tables” are rearranged every six
months, bo as to prevent colleagues getting into ruts; and
A great deal of care is taken by the College officers in
arranging the tables so as to counterbalance any recognised
proclivities of certain bxaminers. Lastly, the practice of
referring for only three months candidates who have failed
by only one murk of the required fifteen (out of a possible
thirty) has been introduced into tbe College of Surgeons’,
and through ite representatives into the College of Phy¬
sicians’, examinations. As a set-off we have now the power
to refer grossly ignorant candidates for nine and twelve
months, and the following figures may be of interest:—In
January 35 were referred for three months, 82 for six months.
4 for nine months, and 2 for twelve months; in April 43
Were referred for three months, 79 for six months, 7 for nine
months, and 9 for twelve months.

In conclusion, may I say that tbe Court of Examiners are
but the servaute of tbe Council, which does not hesitate to
oust an incompetent examiner. The examinership is not
now a life-long office, but is restricted to ten years’ tenure,
and at the present moment every member of the Court is in
■otive practice as a surgeon and teacher! I could wish that
mme Fellows of the College wonld avail themselves of their
undoubted privilege to attend the examinations and see
how tiie work is done.

1 am, 8im, yours obediently,

1887. Christopher Heath.

“SUBSTANTIVE VERSUS HONORARY RANK.”

To the Editors of The Lancet.

Sirs,— Your article, and the letter of “ A. M. D ,” in The
Lancet of the 14th inst., on the question of the rank of
medical officers of the army, place this most unwise and
undignified agitation in a true aud proper light. Surely
the medical staff has a substantive rank of its own. This i»
defined in such grade by the clear statement of the Secre¬
tary of State for War, that medical officers shall rank as the
corresponding grades of military officers. What could be-
more explicit ? To what end, then, can honorary raok be
desired? Is it possible that physicians and surgeons,,
graduates of universities. Fellows and Members of Roy at
Colleges, seek to obtain incongruous military titles as pre¬
fixes to their names ? If there be medical officers who desire
such an anomaly, they have lost sight of the respeot due to
themselves as members of a learned and recognised pro¬
fession, and they fail to appreciate the position that pro¬
fession holds in the esteem of all cultured men. Medical
officers may, 1 think, congratulate themselves that only a-
very few of their number are so stroogly imbued with the
love of playing at soldiers that they would carry the
mimicry into the serious work of life; and it is fortunate
that Mr. Stanhope’s replies to questions on tbe subject am
so definitely negative that no fear need be entertained tbat-
tbe few will succeed in placing the many in a very ridiculous-
position. I am, Sirs, your obedient servant,

May 17th, 1807. _ BRIGADE SURGEON.

To the Editors of The Lancet.

Sirs, —Your issue of April 2nd, has just reached me. In
it, atp. 701, is a letter by “ F.R.C.P.” That communication
- doubtless written with the best of intentions- only too-
well illustrates the absolute ignorance on the part of our
civil brethren of the peculiar position which we army sur¬
geons bear in regard to wliat are two distinct professions—
namely, those of arms and medicine. 1 can well understand,
the difficulty which “F.R.C.P.” finds in appreciating the-
unanimous outcry of the army medical staff against the
abolition of relative rank. When I first entered the service,
some four years ago, the auestion of rank was often dis¬
cussed among the medical officers. In those days no stronger
opponent than myself existed against the tendency to ask
for real or honorary rank. I took my stand—as “ F.R C.P.”
does—on the inherent position which that of surgeon
gives to a man, and scouted all ideas of, or pretensions to,
purely military titles, as being expressive of an undignified
and false position for members of tbe medical profession. A
few years of actual experience in tbe army has convinced
me of the folly of my original views. 1 stand second to.
none in my. respect aud love for my profession, and have
consistently and strenuously endeavoured to do my work as
a good medical officer abreast of his times. In the army
that is not enough to hold one’s own, although it goes some¬
way towards it. Onoe in the army,- and mixing with army
men, the value of military rank asserts itself. Let a map be
ever .so good a doctor, ever so goad a gentleman (in its
fullest sense)* without rank—I mean military rank, and
called by military terms—he is- as no one. “If you go to-.
Rome, you must do as Rome does.” In tbe army you must-
be known by army terms and bold army rank.. I write in
no captious spirit; on tbe contrary, I may say I almost
regret (being a surgeon) to write so. But tbe plain term sur¬
geon or doctor is valueless in the army. Whether it is. the-
reflected light from our civil rank and file, I know not, but
surgeon as surgeon carries no weight. It is true we army
surgeons are not soldiers in the sense of engaging directly
in the operations of war, but we are an integral and>
important part of an army. On service we undergo the
same hardships as the regimental officer; we run. similar
risks; our duties involve equal dangers to life and limb. We
command our own men; we acquire the babits and qualities-
of the soldier. We. have to .combine units into disciplined
bodies for the purposes of esneerted action, and at the same-
time fulfil the offices and show the talents and judgment of
experts. In a word, we are two professions roUed tato one-
I fail to imagine any higher role than that, of. the army
surgeon. Hess at onoe a commander,of men, an. organiser,,
and a guardian of man’s most precious gift— life. The last
few years have eeen a steady increase in the ranks of the>

1062- ThbLancbt,]

A DOCTOR’S INCOME.

[May 21,1887.

army medical staff of well-trained, well-educated profes¬
sional men --men not only adepts in their technical work,
but at the same time men of varied talents; men not
drawn exclusively from Ireland and Scotland, but men from
the English schools. This last step of the War Office will
check this popularity of the army as a career for able and
educated surgeons. An inferior class of men only will enter.
No man with any respect for himself or his profession could,
or will, enter the army so long as his position is defined as
being non-military, and as such secondary to each and every
person whose rank is military. We want no blinking at the
question, and hazy definitions of position and rank as given
in Clause 125 a of the last Warrant., If not actual, we want
honorary rank in the army. The questioh is important, far
more so than many of our civilian brethren think. We in
the army know where the shoe pinches.

I am. Sirs, your obedient servant,

B.A. Oxon., F.R.C.S.Eng.,

' Punjab, India. Snrgeon, M.8.

%* We fully sympathise with our correspondent in his
opinion that a definite military rank is essential in the case
of an army medical officer. As we have repeatedly said,
the medical officers form an integral part of the army, and
are entitled to, and must have, a distinct and clearly defined
military rank. But we differ from him in this, that we
believe the Warrant, as it is to be modified, will secure
that well-defined position. The Royal Warrant in its
amended form appears to us to grant a substantive
military rank to each grade of military officers. If it should
turn out—an event which we consider almost impossible—
that the military authorities on any occasion call in question
this rank, and the Secretary of State declines to carry out
the assurance he has repeatedly given in his place in the
House on the subject, we shall be found amongst the strongest
supporters of any course which may seem calculated to
secure to the medical officers that position to which they are
clearly entitled. But, believing as we do that the War
Minister will in good faith carry out the views he has
expressed, we are of opinion that the positions of the medical
officers will be well secured, and beyond the reach of question,
under the modified Warrant.—E d. L.

A DOCTOR’S' INCOME.

To the Editors of Thk Lancet.

’ Sirs,—T he letter I wrote you regarding the income of
doctors has excited so much interest that I hope you will
allow me further to discuss the possible remedies for the
present deplorable state of things.

1 One of your contemporaries has suggested that 10,000
•doctors should emigrate. But how can men emigrate who
have no practical knowledge useful in that line of life, who
have sunk their capital in their education, who have, per¬
haps, delicately nurtured wives and young children unfitted
to roagh it in the bush ? 'I venture to assert that there is
no overorowding in the profession. There is one doctor to
every 1650 people, which is none too many. The disease
which blights so many, of us is not want of work, but want
of pay. Too -many people evade paying the doctor, or pay
him such fees that he cannot live decently. At shilling fees
1650 people ought to give a doctor over £800 a year, whilst
I showed before that the gross income even of those who
have practices scarcely exceeds £600. Surely this proves
that the evil is not. overcrowding, but underpayment.
Can we remedy this ? I will venture to offer some sug¬
gestions, though I fear they will be much opposed.

■ Taking fees in detail, we must own that be. a visit and
Upwards Are adequate payments for doctors. I think quite
10 per cent, of the population pay such fees. We will there¬
fore disregard these. The next grade pay fees which range
between 2s. 6d. a visit and 5«. These are as much as
middle-class people can afford, and enable a doctor to make
a fair honest livuw. These, too, may therefore be fairlyset
aside. I think they may be reckoned as cohstitutisg
another 10 per cent, of the population. ■ The remaining 80
nfcr cent, pay, as a rule, such fees that no doctor can possibly
live as an educated gentleman may claim to do, on these
fees alonet ' The union, chib, and dispensary patients pay.

as I showed before, about 6 d. or 7 d. a visit, and the rest of the
poor look on these as typical payments, and resent paying
more. I will illustrate, by an actual case, the working of
the present system, ex uno discs omnes. The wife of a
retired tradesman joined a medical club, and fell ill. The
doctor attended her. Her case was chronic and obscure.
The doctor’s visits fell to one a week, which the patient
considered inattention. Another doctor was called in.
This doctor charged la. 6<f. a visit (surely a modest ram
for half an hour of an educated man’s time). This was
considered too heavy an expense. The woman obtained a
letter for the local hospital and attended as an oat-patient
for some time. Becoming too weak and ill to go on as an
out-patient, she reverted to her club doctor. Finally, she
became an in-patient of the hospital, and, I believe, died
there. She was attended throughout a long illness, with
the exception of one short period, for the sum of five
shillings! She did not expect a butcher to give her meat
or a baker to give her bread for nothing, but that she should
expend money on medical attendance seemed monstrous
when two doctors were willing to see her for nothing, or
next to nothing. Now why were these doctors willing to do
this? The dispensary doctor was driven by sheer com¬
petition to acoept these ludicrous payments or actually
starve. The hospital doctor attended her for nothing,
because his connexion with the hospital gave him status^
and this enabled him to command higher fees from
his private patients. But the system which makes
the hospital doctor breaks hundreds of his less fortu¬
nate brethren. I would begin, then, by reforming the
country hospitals. Let the general practitioner follow his
cases to the hospital, and let him receive for se doing exactly
the same fees as he would have received for attending this
patient at his own home. Let the honorary staff be truly
a consulting staff. Let them have the honour which they
(rightfully) seek, but do not let them do general practitioners’
work without pay. Let them meet general practitioners in
consultation in the hospital over difficult or obscure cases.

Then we come to the present system of paying the holders
of union and club appointments a fixed sum per annnm.
This has many ruinous effects. In the first place, the large¬
ness ef the total conceals from the patients the poorness of
the pay. In the second place, it-enables the doctor to mass
several appointments and keep , an assistant (often, ala*,
unqualified), almost always worse paid than any curate, to
do the bulk of the work. In the third place, it often com¬
pels men to seek these appointments in order to exclude
opponents, who would otherwise divide an already scanty
income. Why should .not payment be by result in ail
these cases? Suppose the fee were fixed at Is. a visit
and 6d. per bottle of medicine, with extras for mileage
and nightwork. Let all members of clubs or parish
patients be free to go to any doctor they chose who
was willing to attend them at the fee fixed. In the case of
clubs the patient might be required to pay a portion of each
fee out . of his own pocket, to guard against excessive
visiting. In the great majority of cases union patients
could similarly pay a portion of the fee and the parish the
rest. I venture to say this system would not merely add
largely to the present income of doctors, but would effctually
disabuse the public mind of the idea that they have a moral
right to a doctor’s services for nothing. My arguments
may have seemed to be all for the doctors, and none for the
public. They are not so really. It cannot be to the advan¬
tage of the public that any trade or profession should wqrk
for nothing. Such a trade or profession would be lean ktne
eating up the fat A:me—that is, the profits made by their
fathers in other lines of life. A death-rate of-1122 in the
medical, as compared with 842 in the legal and 656 in the
clerical, shows an undue waste, which must injure the
whole body politic. There is much actual lloss, too, from
scamped work. For instance, a club patient grew seriously
worse through his doctor failing to visit him for four days.
He then called in another doctor, who cured him in a few
hours. Meanwhile the man had lost five days’ work, of the
value of 18*. 6 d .—as much as he had paid his club doctor in
tjie past five years probably.

Now, Sira, how are these reforms (or any others that may
be thought better) to be brought about? General prac¬
titioners are like amoebae—structureless, without differen¬
tiated hrain or mouthpiece. Their nominal leaders really
belong to a different profession, for consultants are to
family doctors almost precisely as barristers are to solicitors.
Where are we to look foi leaders ? Our next question will

Digitized by GoOgle

The IiANCBT,]

The society op apothecaries.

be to form a combination such as has never yet been
attempted by the profession. If that were once accom¬
plished there would be no difficulty left. The union and
club authorities would be obliged to accede to any reform
demanded with anything approaching to unanimity by the
profession. But there is the rub. We are not sufficiently
organised to effect combinations. I fear, therefore, reforms
are not likely, and that the present system of hard work
and poor pay will probably flourish for many a long day,
until, in fact, it has become so intolerable that there is a
great dearth of candidates for the profession.

I am, Sirs, your obedient servant,

E. Paget Thurstan, M.D.

Bouthborough, Tunbridge Well*, May, 1SS7.

To the Editors of Thb Lancet.

Sirs,— Kindly allow me to make a few remarks upon the
letter of Dr. Paget Thurstan in The Lancet erf April 23rd,
1887. He says, “Such is the state of things; what is the
remedy?”

There is and will be no remedy unless medical men hold
more together. Why do we not have a society similar to
the Incorporated Law Society, and determine amongst
ourselves not to take any appointment without a meet¬
ing of medical men likely to be invited to undertake any
appointment, consider the amount of work to be done, flx
their own salary, not allowing the steward or secretary to
say we give our surgeons “ so and so,” and then, throwing
the result into the hands of the members, to ballot for the
surgeon, each one honestly refusing to make any attempt
to win over voters ? Can there not be sotne interference on
the part of the Medical Council to limit and determine the
difference between medical men and chemists as to their
several provinces ? Numbers of the people, both rich and
poor, consult chemists, and never send for a doctor until
the eleventh hour, to save any difficulty with regard to
the death cectMaateu Until tins is done I fear there will
be no remedy for the general practitioner.

I am, Sirs, yours obediently,

May, 1887 . _ MJL Cantab.

THE SOCIETY OF APOTHECARIES.

To the Editors of The Lancet.

Sms,—The decision of the Medical Council in reference to
the Apothecaries’ Society will.give general satisfaction to
medical practitioners throughout the country, and they
Cannot but feel very satisfied at the action of their represen¬
tatives. The important discussion previously to the division
will open the eyes of the medical world. Never was a speech
made more damaging to the speaker, or more likbly topoteon
the ignorant mind, than that of Sir W. Gull. One benefit,
I trust, will arise from Mr. Brudenell Carter’s able advocacy
of the weak against the strong—namely, that now the Fellows
and Members of the Royal College of Surgeons may hope to
have his energy and ability directed towards obtaining for
them their just rights and privileges from their own College.
The Hall has now nothing to fear; and if in the future it
sends out as good men as it has done in the past, the public
and the profession will have no cause for complaint.

I am, Sirs, yours faithfully,

May, 1887< _J. WlCKHAif B ARNES.

THE COMPULSORY DETENTION IN WORK-
HOUSES OF PATIENTS WITH VENEREAL
DISEA8E.

To the Editors of The Lancet.

. 8ibs,—I n reference to the above subject, you state in last
'week’s issue that a correspondent calls your attention tothe
fact that, so far as workhouses are concerned, such powers
already exist, and are to be found in Act 30 and 31 Viet, the
Poor-law Amendment Act, c. 106, 8. 22. Now, when I wrote
you fourteen days ago, 1 was quite familiar with Section 22,
*nd, certainly, one might very well argue that: it gives
the necessary power; but 1 find there is considerable un¬
certainty as to whether it really applies to oases of venereal
duease. It is therefore desirable to have a definite and
authoritative opinion on the matter, and, if that be
adverse, then some other measure must be obtained.
<ln support of what 1 say, I may mention that quite

fMAY'21,1887. 1068

recently' a deputation of influential gentlemen from
eleven unions or boards of guardians in .the prin¬
cipal naval and military centres had an interview with
Mr. Ritchie, President of the Looal Government Board, with
reference to the repeal of the Contagious Diseases Acts. In
his reply, Mr. Ritchie referring to Section 22 of the above-
mentioned Act stated : “ Well, a question then arises as to
what is the meaning of the words ‘contagious diseases’ in
this Act. I have no doubt it might be argued, and argued
with very great force, that the disease in question is a con¬
tagious disease under this Act; but I understand there is a
very considerable element of doubt upon the point as to
whether or not medical officers who are.really responsible
would be justified in certifying that a certain poor person is
suffering from a contagious disease under the Act and
ought to be detained.” This really being the case, Mr,
Ritchie proposed.to submit the question to the law officers
of the Crown, so that at present the matter is subjudice.
Even when we obtain power to detain patients in Poor-law
institutions, there still remains the large number of cases in
lock hospitals and other hospitals with lock wards. Surely
something should be done in order to deal more satisfactorily
with these. I am. Sirs, yours faithfully,

M*y 17th, 1887. ARTHUR FlINTOFP MlCKLB, M.B.

THE UTILITY OF DRUGS IN THE TREATMENT
OF DISEASE.

To the Editors of Thb Lancet.

Sirs,—I am a general practitioner, and am glad to be able
to add have bgen a successful one for the past thirty years.
1 desire to make a comment or two on the speech of Sir
William Gull at the last meeting of the Medical Council, as
reported in The Lancet of the 14th inst. I am referring
particularly to his expressed disbelief in the utility of drugs
in the treatment of disease, and his belief in the all-
sufficiency of guarding the patients from any “ interference
with the powers of nature,” and keeping him in “a warm
bed.” Sir william Gull, referring to the share which be bore of
the responsibility of conducting the treatment of the Prince
of Wales’ attack of typhoid fever, stated that during the
whole illness his Royal Highness did not take four doses of
medicine. Typhoid fever, all properly educated medical
men know, requires, as a rule, little or no active treatment.
But what if the Prince's illness had been rheumatic fever or
malarial fever caught in India (supposing his Indian tour to
have taken place): would Sir William stm have withheld all
treatment by drugs—salicylates in the one cast, quinine in
the other ? I will do him the justice to say 1 do not believe
he would. But is it a fact that the treatment of the Prince
consisted entirely in guarding him from interference with
the powers of nature, and in keeping him in a warm bed ?
Was not alcohol freely administered ? I do not know; but
this I do know, that Sir William regards a full dose of
alcohol, two ouncee or-even four ounces of brandy if neoesn
sary at bed-time, as the beet sedative for the nocturnal rest¬
lessness accompanied by delirium which occurs in typhoid;
end I would ask what is alcohol administered in this way
but a drug ? I am, Sirs, yours truly,

May, 1887. A GENERAL PRACTITIONER. .

REPEATED ASPIRATIONS OF THE BLADDER.

To the Editors of Thb Lancbt.

Sirs, —The case of repeated aspiration of the bladder
recorded by Mr. Collier in last week’s Lancet is like one
published in V Union Midicale, Feb. 26th, 1876. The patient
was a man seventy years old, who bad retention from
enlarged prostate. The bladder Was aspirated with a Potain’s
aspirator sixteen times in nine days, and then at last an
instrument was passed. He did well, and no harm came of
the repeated punctures. “ Yet who would baye thought the
old man to have had so much blood in him” !

Your obedient servant,

Wlmpole-street, W., May 17th. 1887. STEPHEN PaGBT.

Two entertainments by amateurs are to be given at
the Novelty Theatre on the 3rd and 4th prox., under the
patronage of the Prince and Princess of Wales and other
members of the Royal Family, for the benefit of the Great
Northern Central Hospital.

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1084 The Lancet,]

MANCHESTER.—NORTHERN COUNTIES NOTES.

[Mat 21 , 1887.

JLEEDS INFIRMARY POST-GRADUATE CLASS.

(From a Correspondent.)

The concluding lecture of a most successful course was
•delivered on Friday last by Dr. Bans, on Albuminuria, after
which Dr. Griffiths, the house-physician, gave a very inter¬
esting demonstration in urine tests. The value of this course
to the hard-working country practitioner, and, indeed, to
others whose time for reading is limited, and whose oppor¬
tunities are necessarily restricted, will be at once seen by
the subjects taken, which were as follows:—Coma and
its Causes, by Dr. Clifford Allbutt; Common Deformities,
by Mr. T. Pridgin Teale; Some of the Common Diseases of
the 8tomach and Liver, by Dr. Eddison; Intestinal Obstruc¬
tion, by Mr. Jessop; Pulmonary Therapeutics, by Dr. Churton;
Glaucoma, by Mr. Nunneley; Common Diseases of the
Uterus, by Dr. Braithwaite; Gunshot Wounds, by Mr. E.
Atkinson; Causes of Retention of Urine, by Mr. M’Gill;
Common Diseases of the Larynx and Pharjnx, by Dr. Jacob;
Diseases of the Anus and Rectum, by Mr. A. Mayo Robson;
Common Ear Diseases, by Mr. Hewitson; Injuries of the Head,
by Mr. Brown; Syphilis, by Mr. Ward; and Albuminuria,
by Dr. Barrs. After each lecture, demonstrations in the
wards and in the post-mortem room have been a most
valuable, practical, and useful part of the course. Imme¬
diately after the lecture a meeting of the members was
held, presided over by Dr. 8cott of Ilkley, for the pur¬
pose of discussing the desirability of a second course,
the subjects to be treated upon, the remuneration of
ithe lecturers, the desirability and practicability of ad¬
mitting qualified men to clinical studies and operative
surgery by payment of fee rather than by sufferance (this
was introduced by one member, but voted out of order by
the chairman), and other matters relating to the success of
a future course. The meeting unanimously resolved that
another course should be commenced, and that Drs. Barrs
and Roberts, the honorary secretaries, who had so satis¬
factorily framed the last course, should work out and
arrange the practical details of the future one, which is to
commence on the second Friday in October next, when Mr.
Wheel house is expected to give the introductory lecture.
Although the late class was a comparatively large one
< forty-one), there was a general belief expressed that many
more gentlemen in the town and surrounding towns and
district would take advantage of the next course. It was
stated at the meeting that since the formation of the class
it had lost two of its members: one by the sudden and
lamented death of Dr. Murray of Burley-in-Wharfedale; the
other by removal to London of Dr. J. Fletcher Little, late of
Ren Rbydding, who, by his characteristic indefatigability,
was largely instrumental in the formation of the class.

Before the meeting closed a vote of condolence with the
widow of the late Dr. Murray was feelingly proposed, and a
-resolution passed that the class fee (£2 2s.) should be returned
to his widow as a mark of respect to his memory. Very
cordial and grateful votes of thanks were unanimously and
venthuaiaatically accorded to the staff, specially including
Dr. Griffiths, the house-physician, and to the honorary
secretaries for their valuable services.

MANCHESTER.
(from our own Correspondent.)

HYDROPHOBIA,

There is some ground for fearing that rabies is on the
increase in Manchester and surrounding districts. A fort¬
night ago two boys, who had been bitten by a supposed
mad dog at Sale, were sent to Paris for treatment by
M. Pasteur. It is satisfactory to note that yesterday, at the
county police-court, steps were taken for putting in force
the provisions of the Dogs Act throughout this division of
the county.

BUILDING BYE-LAWS.

It was a short time ago stated here that the Sanitary
Association was directing its attention to the unsatisfactory
condition of the building bye-laws of the Corporation. A
conjoint deputation from the Association and from the
Architects’ Society recently waited upon the mayor, urging

their amendment in accordance with modern requirements,
and there is ground for hope that this matter will now soon
receive the attention of the City Council.

NEW SEWERAGE SCHEME.

The River Committee of the Corporation has just presented
their report upon the new sewerage scheme for diverting the
sewage from the river. It provides for a large and extended
system of new sewers, by means of which the sewage will be
taken some few miles below the city, and there treated with
chemicals to precipitate the greater part of the solid mattes*,
the effluent being still farther purified by filtration through
soil.before it is allowed to flow into the river or into what
will by that time probably be the ship-canal. When
Manchester has thus set its own house in order.it will be in
a position to call upon other offenders to cease polluting the
river in its higher courses. The cost of these new works
will be something like half a million of money.

ISOLATION IN INFECTIOUS DISEASE,

At the meeting of the City Council last week exception
was taken by some members to the expenditure of £7500
for the isolation of patients suffering from infectious disease.
The opposition was based upon two grounds: First, that
with the exception of small-pox the sending patients with
fever to hospital had in no way diminished the prevalence
of these diseases; and, secondly, that it was wrong in
principle to vote such large sums of money over the expen¬
diture of which they had no control, as the fever hospital
was under the management of a. charity subject in no way
to the supervision of the Corporation.

OWENS COLLEGE.

Owens College has come out very well from the recent
pass examination of the College of Surgeons, and the per¬
centage of plucks has not been large. Some few years ago
it was the custom to institute a preliminary test examina¬
tion (as is done in most of the London schools) before
allowing men to go up for this examination, but during the
late dean’s (Dr. Gamgee) time this rule was abolished. The
results do uot appear to have been detrimental to the college
successes. Owens College has lately benefited to the extent
of -£5000 under the will of Mr. Thomas Jones, who died
at Bournemouth, but who formerly' lived in this city.
He has also made bequests to the Royal Infirmary, tbe
Eye Hospital, the Southern Hospital, the Consumption
Hospital, and to most of our local charities, amongst them
to one that seldom receives recognition in this way —i.e., the
Manchester and Salford Sanitary Association, to which be
leaves £200—a most acceptable bequest, as the funds of
this Society are not at all commensurate with the work it
attempts to do.

THE SCARLET FEVER EPIDEMIC.

This epidemic appears to be slightly abating from the
returns published weeklv, but the wards of the fever
hospitals are still very full of patients suffering from this
disease, and measles prevails to an extent almost alarm¬
ing. In the Chorlton Union alone last quarter 146
! deaths were reported, and during the past month 85
deaths occurred in Gorton township. In other parts of
the surrounding districts it is equally prevalent.

May 17th. _

NORTHERN COUNTIES NOTES.

(From our own Correspondent.)

NEWCASTLE JUBILEE EXHIBITION.

This Exhibition, which was opened here on the 11th insf.
by H.R.H. the Duke of Cambridge, under the most favour¬
able auspioes, may be said, as is often said here, “ to have
never looked behind it since.” The registered attendance of
visitors passing the turnstiles up to yesterday for the firs
days was 76,296, but as it was impossible to use the turn¬
stiles completely on the first day, and many thousands
were admitted otherwise and without counting, it is .quite
certain that already over 80,000 persons have been ad¬
mitted. The firework display on the 11th was rather
marred by the damp weather, but this has been more
than made up for since by tbe brilliant illumination of
the courts and grounds every night, in tbe exhibits
several London houses are represented. In the stand of
Messrs. R. McQueen and Son, surgical instrument makers,

pri bv

Thk Lancet,]

DUBLIN.—BELFAST.—PARIS.

[May 21,1887. 10S5t

of Newcaetle-on Tyne, I noticed‘a respirator designed for
the use of lead workers, by our townsman and late mayor,
Mr. Henry Newton, surgeon. Mr. Newton has had much
practical experience in the diseases common to lead workers,
having been for a long time medical attendant to some
of our largest works. The respirator is formed of wire
work, with a filtering material capable of being changed
with, facility. It is distinguished by simplicity ana economy
in use, and it is therefore no wonder that the chief inspector
of factories states “ that it is the best thing of the kind he
had seen, as it entirely obviates the objection to all other
respirators—that of becoming so readily clogged." If Mr.
Newton has been so fortunate as to devise a respirator to
prevent lead poisoning he will become a public benefactor,
tor the destruction of health and life in white-lead works
here and elsewhere is much to be deplored.

THK NEW FEVER HOSPITAL AT SUNDERLAND.

The foundation of the new Fever Hospital for the borough
was laid on Saturday last. The site and building together
will cost about £19,000. I will in a future letter give you
a general description of the building, which is to contain
every modern improvement.

POISONING BY NITRIC ACID.

Last Wednesday the wife of an umbrella maker at South
Shields swallowed half an ounce of nitric acid mixed with
quicksilver and water at seven o’clock in the morning. She
received immediate attention, but died in four hours. The
acid solution was used by her husband in plating umbrella
handles. At Carlisle also a child has died after twenty-
four hours’ illness from swallowing nitric acid. The father
of the child explained that he had the acid in the house to
cutb some disease in poultry, it having been recommended
for that purpose by some newspaper.

TYPHUS IN THE BAST END OF NEWCASTLE.

Since I last wrote of fresh invasion three cases have
occurred m 1 one family and one single case‘in two other
families; all these were removed to the hospital, with one
exception (a case dealt with in private practice). One of
the cases removed to hospital was the eighth and last
member of the family affected. Two cases of undefined
type, but strongly suspected to be typhus, have also been
removed to hospital. In all of these cases disinfection
has been fully carried out. Most of the oases have occurred
in the City-road and Sheffield district.

Newc*stIe-on Tyne, May 19th.

DUBLIN.

(From our own Correspondent.)

DUBLIN HOSPITALS COMMISSION.

It is very uncertain whether the various recommendations
and suggestions of the commissioners will be adopted. It
is a report which will please but few people, and it was a
great oversight, as has already been pointed out, on the
part of the Government not to have selected at least one
medical man as a commissioner, or at all events any
important member of the committee connected with the
Dublin Hospital Sunday Fund. The truth seems to be that
the Commission was appointed to recommend a consolida¬
tion of certain of the Dublin'hospitals, and also the redis¬
tribution of the annual Government grant, the words of the
Wari-ant directing the inqniry to be held naturally leading
< to these suggestions. This being granted, no great surprise
can be felt that the members of the Commission have re¬
ported m the way they have done.

VIVISECTION IN IRELAND IN 188G.

A return has just been issued relative to the number of
, experiments on living animals made in Ireland last year.

It appears that the total number of persons holding licences
. *ere three, all being medical men, and that all the experi¬
ments were carried out in a painless manner. The experi¬
ments were seventeen in number, and were directed to the
elucidation of diseases of the vascular and nervous systems
j sad to blood poisoning.

I HEALTH OF IRELAND.

> During th^March quarter the births registered numbered

",051,and the'deaths 26,392, the latter repreeentingan annual

rate of 20 9 per 1000. The birth-rate for the quarter was 1 G
under the average rate for the corresponding quarter of the-
past five years; and the death-rate shows a decrease of 1*2.
Compared with the returns of pauperism, furnished by the-
Local Government Board, for t.he corresponding quarter of-
1886, there was a decrease of 1073 in the average number of
workhouse inmates, on Saturdays during the quarter, and-
an increase of 2346 in the average number of person* on.
out-door relief.

The ooncert recently given in aid of the “ Nurses’ New-
Home,” connected with the Adelaide Hospital, has realised
a sum of over £50, which will be expended in furnishing
the Home.

The salary of Dr. Oaksboot, assistant resident medical
superintendent of Cork District Lunatic Asylum, has been,
increased by £25 a year.

J. Cardiff, M.D., has been elected coroner for South Wexford..

Dufcliu, Hay 17th.

BELFAST.

(From our own Correspondent.)

THE COUNTY ANTRIM GAOL.

The Lord-Lieutenant of Ireland ha9 appointed Mr. J.
Camac Smyth medical offi jer of the county Antrim Gaol,
in room of the late Dr. John Moore. Mr. Smyth waa
for soms time house-surgeon at the Royal Hospital,
where, owing to his kindly disposition and skill, he was
a great favonrite. For some time be has been acting as.
locum tenena for Dr. Moore at the gaol. The appointment-'
is worth about £200 per annum.

BELFAST CHARITABLE SOCIETY.

I understand that at the last meeting of the hoard of thi»
Society, one of the oldest charities in Belfast, a resolution was
passed approving of plans for a new dining-hall, laundry,
and other additions to the present buildings of the Society.
The cost of the extensions will be about £3900. The Pre¬
sident (Sir John Preston) stated that the board, while able
to carry oh this valuable work without an appeal to the-
public, would not forget that the constitution of the 8ociety
must be kept up by subscriptions, and he trusted the com¬
munity would continue as hitherto to contribute to that-
charity.

BELFAST DI8PENSARY COMMITTEE.

At the last meeting of this committee there was a very-
large attendance, as the principal business w&s the election
of a medical officer for dispensary district No. 1, rendered 1
vacant by the death of Dr. James Barron. There were eight
candidates. After several polls the contest lay between Dr.
John Barron and Dr. Taylor, the former of whom received
42 votes and the latter 35. The successful candidate is a<
brother of the late medical officer of this dispensary, who
died some time ago of typhus fever.

Belfast, May 17th. __ , ,

PARIS.

(From our own Correspondent.)

M. VULPIAN.

The death is announced of Professor Vulpian, who is said
to have fallen a victim to septic pneumonia, resulting from
an anatomical inoculation. M. Vulpian was born in Paris
in 1826. In 1854 he took the degree of Doctor of Medicine,,
and was then attached to the Museum, where he faded
Flourens in his researches upon the nervous system. In
1860 he was successful at the agrlgation with a thesis upon
Infectious Pneumonia. Shortly afterwards he became
one of the physicians of the Salpetridre. The chair of
Pathological Anatomy becoming vacant at the Faculty,.
M. Vulpian offered himself as a candidate, and, notwith¬
standing the opposition of M. Maret, dean of the Faculty
of Theology, who denounced him at the Conseil Aca-
ddmique as an Atheist unfit to direct the education of
the young, he was elected by a majority of one vote.
A little later his adversaries carried the question to>

L

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1066 Thb Lancet,]

PARIS.—VIENNA.

[May 21, 1887.

the Legislature, laying a petition against bis doctrines and
teaching before the Senate. In spite of these attacks he
remained one of the most popular professors at the
School of Medicine, and after having been promoted in 1872
to the chair of Comparative and Ei peri mental Pathology,
he was elected in 1875 Dean of the Faculty. Already a
member of the Academy of Medicine, the Academy of
Sciences admitted him to their number in 1876, and only
last year he was elected to the post of Perpetual Secretary,
one of the highest honours to which a scientific man can
aspire. As a physician M. Yulpian was not one of those
practitioners who owe part of their reputation to public
caprice. Of somewhat brusque manner, he was quite the
opposite of the fashionable doctor, and his opinion was

f enerally sought in obscure and difficult cases. It was
I. Vulpian who was called to Frohsdorf for the late Count
de Chambord, and it was not until his assent had been
obtained that M. Pa6teur ventured to inoculate the human
subject in rabies. M. Vulpian leaves a large number of
works upon medical science. Amongst these may be cited
his “Lemons sur la Physiologie Generate et Comparde du
Systeme Nerveux,” his “ Lemons surl’Appareil Vaso-moteur,”
his “ Clinique Mddicale de l’Hopital de la Charitd,” and, lastly,
his magnificent “Maladies du Systeme Nerveux,” beyond
doubt the most original contribution to the subject in the
French language.

DR, FLORAND ON AMYOTROPHIC SCLKR0SI8.

Most neuro-pathologists recognise lateral sclerosis as a
distinct systematic disease. Leyden of Berlin, however,
maintains that the cases of amyotrophic sclerosis Tecorded
by Charcot and others are merely varieties of progressive
muscular atrophy and bulbar paralysis, which, in his opinion,
are essentially the same disease. In a recent Paris thesis,
prepared under the auspices of the eminent professor of the
Salpetriere by Dr. Antoine Florand, the objections of Leyden
to the recognition of amyotrophic sclerosis as a noso-
graphical variety are discussed and combated. Con¬
cerning the proposition that amyotrophic sclerosis is
merely a variety of bulbar paralysis, M.Florand maintains—
and this is the chief point of his thesis- -that labio-glosso-
laryngeal paralysis is one, and sometimes the only,
symptom of lateral sclerosis. He thinks, moreover, that in
the cases where Leyden did not note spasmodic symptoms
these had either passed away or were yet to come ; and he
considered the muscular rigidity alone sufficient to establish
the spasmodic character of these cases. Leyden’s objection,
that “ for the lesion to be considered systematic it is neces¬
sary that it should be traced above the pons,’' is disposed of
by a reference to recent researches bv Kahler, Pick, Kojew-
nikoff, Charcot, and Marie, who have been able to follow the
lesion of the pyramidal fasciculi through the pedunculi into
the hemispheres.

ACTION OF THK LIVER ON POISONS.

M. G. H. Roger publishes the results of his researches with
Professor Bouchard on the action of the liver on poisons.
Having verified and confirmed the assertions of Heger and
Schiff on the modifications which the alkaloids undergo in
the hepatic parenchyma, M. Roger shows that the liver
transforms also the normal poisons of the organism, includ¬
ing both the products of disassimilation, and the toxic
principles which arise from intestinal fermentation. The most
interesting and novel point is that the action of the liver on
organic poisons only takes place in the presence of glycogen.
This is established clearly in the different experimental
diseases of the liver, particularly in animals in a state of
inanition, where the gradual ana parallel decrease in the
two functions can be followed day by day. On the
other hand, when hypersemia of the liver is arti-
flcally induced by the injection of irritants into the vena
porta, both functions are exaggerated ; more glycogen
is present and a larger quantity of poison is transformed.
M. Roger thinks that the glycogen, changed into glyooae,
combines with the alkaloids, or with ammonia, to form new
and less toxic products, such as he has obtained, outside the
body, by heating mixtures of glycogen with alkaloids or
ammonia in closed tubes. These experiments lead to various
clinical deductions, which are reserved for a future memoir.

gkrlixb’s disease.

M. Haltenhoff, of Geneva, made a communication at the
Academy of Medicine upon a new neurosis termed vertiqe
paralyzant, first observed by MM. Gerlier and David in
agrieultural labourers and shepherds residing in the vicinity

of Geneva. This affection is characterised by attacks of
paralysis of the muscles of the nape of the neck and
extremities, with vertigo, lancinating pains, and ptosis. It
occurs in persons living in hot and ill-ventilated stables,
and is cured by a change of surroundings.

foreign body in the pleura.

At a recent meeting of the Anatomical Society of Pari*
M. Leudet showed a preparation of the pleura of a patient who
had been operated upon for empyema eight years previously.
It contained an indiarubber tube a yard and a half in length.

Farit, May 17th. _

VIENNA.

{From, a Correspondent.)

THE FHYSIOLOGICAL CONNEXION BETWEEN THK HEART
AND THE LUNGS.

Prof. Ernst von Fleischl, the well-known Vienna
physiologist, has recently put forward an ingenious view
concerning the influence of the heart beat on the respiratory
changes in the lungs. His theory is based on a very in¬
teresting, but hitherto unknown, physical phenomenon he
had occasionally observed. If a liquid containing an ab¬
sorbed gas be exposed to negative pressure -to a vacuum-
only a small quantity of the gas absorbed can be extracted,
ascending in visible bubbles through the liquid; but if the
liquid had been shaken by a single blow or impact just
before commencing the exhaustion process, nearly the whole
of the gas absorbed is rapidly set free, the liquid assuming
a froth-like appearance. The quantity of gas thus exhausted
is one hundred times larger than that withdrawn without
impact. This action of the impact on solutions of gases in
liquids is, as I believe, somewhat analogous to the well-
known phenomenon of rapid solidification of water cooled
below the freezing point, or of instantaneous crystallisation
of hot saturated and then slowly cooled solutions of Glauber's
salt, alBo initiated by a sudden impact. At a recent meet¬
ing of the Vienna Society of Physicians I had an opportunity
to see some of Professor von Fleischl's experiments, which
can easily be repeated by means of a hypodermic syringe
furnished with a stopcock. By a slow upstroke of the
piston the lower portion of the syringe is filled carefully with
water which has been exposed to the air for a short time;
the orifice is then closed by turning the stopcock. The piston
is now drawn upwards as far as possible, and then released
slowly and cautiously until it touches the water again. Bv
tliis exhausting action some gas bubbles are formed, which
are to be expelled by opening for a moment the orifice and
inverting the syringe. Then the liquid is shaken by a single
blow exerted against the piston, or by releasing it suddenly.
If a short time (half a minute) after the concussion of the
liquid the piston is drawn upwards again as far as possible,
the previously clear liquid becomes rapidly white, like an
effervescent mixture, by the froth formed by the sudden
and copious escape of the gas. In explanation of this
phenomenon, Professor von Fleischl saggests that by the
.impact the physical connexion of the molecules of the
gas and of the liquid is altered, and that the real solution
;of the gas in the liquid is transformed into what he calls a
“ molecular mixture,’’ wherein the gas molecules, previously
closely connected with the molecules of the liquid, are
lying free in the interspaces between the molecules of the
liquid, from which they can easily be withdrawn if the
liquid is exposed a short time after the impact to a vacuum
or to the .process of diffusion. Now, the blood is also a
liquid containing absorbed gases. The entr&nca of oxygen
can be easily explained by the properties of the coloured
blood-corpuscles, but the exit of carbonic acid has till now
received no elucidation, for the rate of pressure of the
alveolar air is not sufficient to secure the diffusion of the
gas from the blood serum wherein it is dissolved into the air.
The Professor assumes that the diffusion of the carbonic
acid of the venous blood into the air of the alveoli is only
made possible by the action of the impact imparted to the
blood in the pulmonary artery by the systolic contraction
of the right ventricle of the heart. By this impact the
physical condition of the blood entering the alw f jolar capil¬
laries of the lungs is changed, the solution of r J yubonic acid
in the serum being converted into a “• molecular mixture

Google

Tkb -LANCBT,}

OBITUARY.—MEDICAL NEWS.

[May 21, 1887. 1067 r

from which the gaseous carbonic acid can diffuse freely
through the alveolar walls into the air. He believes also that
cyanosis is due to a wreak action of the heart muscle, which
cannot impart to the blood an impact sufficient for preparing
itrfor diffusional exchange, so that its carbonic acid cannot,
hp fully discharged. This view of the action of the heart
on the respiratory changes seems also to be supported by
f^cts of comparative anatomy. , .

. CHARLES ROBERT THOMPSON, M.R.C.S., L.S.A.

Wk announced a fortnight since the death, after a carriage
accident, of Mr. Charles Robert Thompson, of Westerham,
Kent. Such practitioners as Mr. Thompson was are not so
rpre in country districts as many imagine, but they are far
too good to be allowed to disappear from the scene of their
labours without a few words in memoriam. Those who
knew Mr. Thompson even slightly, or who had had the
pleasure of even casual relations with him at Westerham,
saw quickly that he was a man of the greatest value to the
neighbourhood in which he lived. His sound judgment, his
large' experience, his surgical readiness, and his kindly
manner at once made themselves felt, and must be deeply
missed by the community which he served so well,
and that , in succession, to an honoured father who had
practised in Westerham for over fifty years. Such histories
are the very strength and glory of our profession. They
constitute an influence in the surrounding country. Mr.
Thompson served his generation in various public ways,
notably as a churchwarden and as chairman of the Qas and
Water Company. He was born at Westerham in 1830. He
was educated at Romanoff School, Tunbridge Wells, and
afterwards at St. Barth olome w’s Hospital, where he took
the Bartley Scholarship. "His qualifications were those of
the College and Hall, taken respectively in 1850 and 1851.
He invented the tube trocar, now so much used in para¬
centesis. Mr. Thompson had suffered at times from attacks
of angina pectoris. He leaves a widow, a sod, and two
daughters to mourn their loss. They may find satisfaction in
reflecting on his life and character.

EDWARD NOLLOTH, M.R.C.P., F.R.C.S.,

RETIRED FLEET 9UKOEOR, R.N.

It is with regret that we record the death of Mr. Nolloth,
which occurred on the 29th ult. at his residence at Camber¬
well. The deceased was the sixth son of the late John Nolloth,
formerly Assistant'Secretary of the Navy Board, and latterly
of Portsmouth Dockyard. He was the first to be appointed
on the staff of the Royal Naval Hospital, Malts; the second
appointment being Mr. (now Sir Spencer) Wells. He was
surgeon of H.M.S. Victor Emmanuel (eighty guns) during
the whole of 'th6 Russian war, for which he obtained the
Crimean and Turkish medals and Sebastopol Clasp, 5th Class
Medjidie. He was buried in Nunhead Cemetery.

®ttriral Ihbrs.

Royal College of Physicians of London.—T he
following gentlemen have been admitted Licentiates of the
Qollege:—

Adams, Gerald. Wheatley.

A die, Alexander James.

Barker, Alleyue Hayward.
Barling, Arthur Stanley.
Barton. Francis Alexander.
Batchelor, Charles.

Blomfield. George Wills.

Bower, William George.

Brown, Frank Manson.

Brown. Lewis Henry.

Barke, Harry Morton.

<lapea, Robert.

Charlsswprth, George Henry.
Chilcott, Arthur Edward.

Cook son. Begin aid George.

' { Approved by the

Comber, Arthur Wandesforde.
Davenport, Cecil John.

Davies, Frederick Mark.

De Carvalho, Alberto Pedro.
Dcwsnap. William Frederick.
Fox, George Martin.

Fox. Stephen Charles Qundiy.
Frost, Francis Turner.

Gar-man, Edwin Cornelius.
Gardner, Ernest Frederick.
Gooddy, Edward Samuel.
fGoodman. Roger Neville.
Goodwin. Frederick Charles.
Qowan, Bowie Campbell.
tGreen, Conrad Theodore.
Examining Board.

Green. William.

Henderson, James Therapland.
Holt, Joshua.

. Hood. Charles John Jacomb.
Hosegooil .Samuel Price.
Howse. Neville Beglnuld.
Humphry. Ernest.

Hutton, John.

Jaques, John Warren,
tJames. Arthur William.

James, John Angell.

- Kelly. Thomas William.
Kirkpatrick, Randolph.
Kitct'lng, John Lea Walton.
Lankester. Francis John.
Lawson, Hugh.

Lewis, John Nicholls.

MscLean. W. W. Laroche.

Mac nab, Allan James.

Malpas, James.

Mars ton, Henry John.

Meizgar, Charles.
tMUey, Miles.

Mortson. Frederick William.
Nott, Arthur Holbrook.
Oldham, Montague Williams.
Oliver. Franklin Hewitt.

Oliver, Stuart.

Osmond, Hdward Hart ram.
Parsons, Charles Octavius.

Paul, Arthur Edmund,
tPeake, William Pemberton.

t Approved by the

Pitcairn, John James.

Preston, Frederick.

Pye, Thomas.

Sansom, Hairy Arthur.
Scudamore, Charles Edward.
Sen, Chandl Chavan.
Sheilawelt, William Arthur.
Shute, George Sidney.
Simmons, Harold.

Slmson, Francis Taylor.

Smith, Arthur Henry.

Smith, Edmond Symonds.
Solly, Ernest,

Spurrier, Alfred Henry.

Stuart, Thomas Edmund.
Thompson, Edward Kgglngton.
Thompson, Wilberforce.

Tinker. William.

Todd, Henry Banaall.

Tonks, Henry.

Vincent, Herbert Edmund.
Waites. Richard Foulstone.
Walker, Joseph Eaglaud.
"Ward, Charles Walton.
Warlters, Walter Soott.
Watson, William Robert.
Whiston. Philip Henry.
Wiggles worth, Vincent.
Wilkin. Griffith Charles.
Williams. John T. Oreswick.
Young, William Archibald.

Examining Board.

University of Cambridge.—A t a congregation held
on the 12th inst., the following gentlemen were appointed
ExaminersState Medicine: Dr. Francis S. B. F. de C'bau-
mont, Edinburgh ; Dr. Alfred Carpenter, London; Dr. Hubert-
Airy, Trinity; Sir Charles A. Cameron, Ireland. The follow¬
ing degrees were also conferred : —

Doctors of Medicine.— Francis Murray Haig, Trinity; William
Arthur Bond, St. John's.

Bachelor or Mehicike.—E dward Noel Nason. Downing.

Bachelors ok Surgery.— Francis Murray Haig, Trinity; William
Arthur Bond, St. John's.

Society of Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on May 12th

Brodrlclt. H. E.. M.R.C.S., Badwcll Ash Hall. Bury St. Edmunds.

Crew. Henry Charles, 8haw-roa<l, Dudley, Worcester.

Danvers. Herbert, Cape Colony.

Rutter. George Herbert, Lady Margaret-road, N.

Scott, Walter Frederick. 8t. Helen s Gardens. Notting-hill.

Stratum. Samuol Alex. Kenny, Berry Wood. Northampton.

Waites, RIcluird, Foulstone, The Grove, Ealing.

The new premises of the City Provident Dispensary
were inaugurated on the 16th inet.

King’s College IIospital.—T he bazaar in aid of
the funds of this hospital has resulted in a net profit of
nearly £1200.

Medical Magistrate.—D r. E. Sparshall Willett of
Ielewortb, has been recently sworn in as one of the Justices
of the Peace for Middlesex.

Vaccination Grants.—T he following gentlemen
have received the Government grant for successful vaccina¬
tion:—Mr. P. Swales, Sheerness (eighth time); Mr. J. W.
Hayward, Whitstable, Blean Union (third time).

Hospital Saturday at Birmingham.—T he amount
collected on Saturday, the 14th inst., reached the gratifying
sum of £6125 10«. 3a., being contributions from the many
workshops and warehouses of the town.

At the sixth general meeting of the members of
the Hospitals Association, held on the 11th inet.. Sir Andrew
Clark, Bart., President, in the chair, a paper was read by
Dr. William Collier on “The Best Means to Prevent tha
Abuse of Hospital Charity.”

• Devonshire Hospital.—T he report of the Com¬
mittee of Management of this institution for the past year
states that 2459 in-patients were admitted and 2238 6ent
away as improved, 49 as no better, 24 at own request, 8 had
died, and 121 remained on the books.

At a meeting held at Plymouth on the 13th inst.
it was decided to signalise the jubilee of the Queen’s
aocession by the reduction or removal of the debt on the
South Devon and East Cornwall Hospital. A committee
was appointed to take steps to give effect to the resolution.

Digitized by LjOOQle

1068 The Lancet,]

MEDICAL NEWS.—MEDICAL NOTES IN PARLIAMENT.

[May 21,1887.

Royal Hospital for Children and Women.—
On the 11th inst., at St James’s Hall, Mr, G. A. Sala delivered
a lecture on “ What I saw in Australia and New Zealand,’’
the proceeds of which are to be placed to the credit of the
above hospital.

St. John Ambulance Association.—O n May 14th
Mr. Stephen Nockolds and his assistant, Mr. MacPhee, of
West Cowes, were each presented with a handsome photo¬
graph album, by the members of the East Cowes Class, as a
token of the esteem and regard in which they are held.

'St. Mary’s Hospital: Ophthalmic Department.—
We are informed that the eye department at St. Mary’s will
in future be open on Tuesdays, Fridays, and Saturdays, at
9 A.M. ; Fridays being specially devoted to operations and
•elected cases.

On the 15th inst., a procession of Friendly and
Trade Societies in the North-western district was held in
aid of the University College and the North-west London
Hospitals. A service was held at St, Pancras Church, Dr.
Spence, Dean of Gloucester, preaching an appropriate
sermon.

Hospital at Damascus.— Dr. Macinnon, of the
Scottish Medical Mission, has recently opened a hospital for
poor patients at Damascus. The fanaticism of the Moham-
medan population has forced the Government to close it,
and Sir W. White is now making representations to the Porte
to grant the hospital its protection.

A new Sword Handle.— Prof. Braune of Leipzig,
after a thorough investigation of the mechanism of the
hand, has constructed a new sword handle on anatomical
principles, which exactly fits the hand, and can be held with
absolute security. It is expected that this improved sword
handle will be found very useful, especially by cavalry.

Bacteriological Laboratories in Siberia and
Russia.— The Medical Society of Irkutsk, the capital of
Eastern Siberia, will soon have a bacteriological station in
this city of 40,000 inhabitants. The Kharkov Medical
Society has received from the Kursk Government Assembly
1500 roubles to establish a bacteriological laboratory in
Kharkov, and will receive 700 roubles yearly to support the
establishment.

Sunderland new Infectious Diseases Hospital.
The foundation stone of this institution, which is situated
on an isolated site about twelve acres in extent, was laid on
the 14th inst. The building about to be erected includes
the administrative block, the laundry, and disinfecting
establishment, mortuary, and two fever pavilions. The cost
of the building is to be £14,796, and the price paid for the
site was £5000.

West London Medico-Chiruroical Society.—
The annual dinner of this Society was held at the “ Criterion ”
on Wednesday, the 10th, Dr. Alderson, President, in the
chair. There . was a large and representative gathering of
the members, in addition to numerous guests of eminence
in. the profession and others. This Society, which was
founded but a few years ago, has amongst its members many
names well known in the profession, and has done good
work during the session which is now passed.

Queen s College, Cork. —The following prizes
and exhibitions have been awarded at the sessional examina¬
tions in. the Faculty of Medicine:—Exhibition in Practical
Medicine: William Kelleher. ExMblfeioti Ha Practical Sur¬
gery: William J. O’Meara.- Practical Anatomy: Third
year—James Jackson and J. V. Ryan, equal (1st): E. Jenney
and J. Wolfe, equal (2nd). Second year—Wm. O’Donnell
(let); J. Hennessy (2nd). Anatomy and Physiology:
Third year—James Jackson (1st); J, Smith and E. Jenney,
equal (2nd). Second year—W. O’Donnell (2nd); J. Tracey
(3rd). Practical Physiology and Histology: J. Jackson
(1st); J. Smith (2nd); J. Macpherson (3rd); J. Wolfe (4th).
Surgery: E. Jenney (1st); J. Smith' (2nd). Practice of
Medicine: W. O’Meara (1st); W. Kelleher and J. Ryan,
eousl (2nd). Materia Medina: J. Hennessy (1st); W.

(2nd); J. Tracey (3rd). Medical Jurisprudence:
W. QMeara (1st): J. H. Wilson (2nd). Midwifery: G.
Jenney (1st); C. Porter (2nd); J. Smith (3rd). Practical
Chemistry: J. Hennessy (1st); J. Ambrose (2nd); J. Tracey
(3rd).

Middlesex Hospital. — The festival dinner on
behalf of tbis hospital,' announced to take place on tbs
18ili inst., has been postponed.

City of London Truss Society. —The 80th annua)
festival in connexion with this Society was held on the
17th inst.,-the Lord Mayor presiding. During an existence
of more than three-quarters of a century the charity has
relieved over 425,000 of the suffering poor—9394 in 1886,
men, women, and children. In the course of the evening
the secretary announced subscriptions amounting to £610.

Great Yarmouth Hospital. —On tbe 18th inst.
the Prince of Wales laid, with Masonic rites, the foundation
stone of a new hospital at Great Yarmouth. The building,
which will cost about £8000, is being erected on the site of
a former hospital, and will consist of a central block of
buildings, with north and south wings. Accommodation
will be provided for forty beds.

North-Western Association of Medical Officers
of Health. —At the monthly meeting of the members of
this Association, on the 12th inst.,a discussion took place os
the regulations for dairymen and others under tbe Con¬
tagious Diseases (Animate) Act, 1886, and the Dairies.
Cowsheds, and Milkshops Orders of 1885 and 1886. Several
suggestions were made, and it was decided to forward them
to the London 8ociety, with the view of getting them
incorporated in the new regulations.

The London Hospital. —To-dsy (Saturday) the-
Prince and Princess of Wales, accompanied by thsir
daughters, will open tbe new Nursing Home of tbis insti¬
tution and the new buildings of tbe London Hoapitak
Medical College, the cost of the latter being about £15,000.
The Home, which has cost upwards of £10,000, provides
separate sleeping accommodation for 100 day nurses snd 50
night nurses, and is probably the most complete establish¬
ment of the kind in existence.

MEDICAL NOTES IN PARLIAMENT.

. Registration of Dogs in the Metropolis Bill.

Ik tbe House of Lord* on the 17th lnet. Lord Mount-Temple. in movinj?
the second reading of this Bill, said the muezle was generally regarded,
as a failure, and the object of the Bill was to provide that there should be
a complete register of all persons who took out licences, each dog having a
number to be worn on Its collar.—Viscount Cranbrookdld not opposethe-
second reading of tbe Bill, but suggested that further progress should be
postponed until after thureruxt of a oommiselon on the subject, and In¬
vestigation by committee. The noble lord said there were difference* of
opinion as to the origin of rabies from Irritation and other cause*.—Lord
Belper stated that rabiee. which had prevailed in Notts, had been checked
by muzzling, but in a neighbouring oounty a poor boy waa bitten by a
mad dog and died. It was tlieretore desirable to give power to extend
provisions against rabies beyond county bordert.—The Bill was read a
second time.

On the motion of Viscount Cranbrook It was subsequently resolved*
that a delect Committee be appointed to inquire into and report upon
the subject of rabiee in dogs and the laws applicable thereto.

Monaghan Lunatic Asylum.

In the House of Commons on the 16th lnet., in reply to Mr. P. O’Brien.
Colonel King-Harman stated that arrangements are being made to have
the necessary improvements carried out at the Monaghan District
Lunatic Asylum. Diphtheria has not reoeotly broken out. and one of
the inspectors who visited the asylum toward* the end of last March
found the sanitary condition of the patients so satisfactory that only-
four out of the entire number of 485 were oonfined to bed.

The Army Medical Service.

In consequence of the lateness of the hour at which Dr. Clarke pot hie
question on this subject on the 13th inst.. in our last issue we were
unab'e to give Mr. Stanhope's reply in fall. The following, however,
were the words used by the right hon. gentleman:—** I have said
many times that tbe abolition of relative rank has not in any way-
altered the position or status of medical officers, and I have no reason
to ,suppose that these officers are desirous of being oalled by title*
so'thseoolated from the duties of their honourable profession as those
ofoolonei. major, and captain. These titles are. however, neoeesajy la
the oase of other departments, whose officers, unlike those of the Medical -
Department, do not belong to a recognised profession.'*

Poor-law Officers.

In answer to Mr. Waddy, Mr. Ritchie said that district medical offleare-
and relieving officers are. speaking generally, appointed for life, subject,
of course, to the proper performance of their duties, and their salaries
cannot be reduced without their consent. It is not the oase that there
has been, on the whole, a great decrease In the number of paupers during
the last few years, although, no doubt, in particular instance* this h*«
been so. Neither was it the case, in his opinion, that many of these
officers are receiving salaries out of proportion to the duties they have
to perform. He could not undertake to suggest that the Royal Commis¬
sion on the Civil Service should extend their inquiries to the salaries of
Poor law officers, as this would be entirely beyond the scope of tbeb-

TUM Lancet,] BERTHS, MARRIAGES, AND DEATHS.—APPOINTMENTS.—VACANCIES. [May 21,1867. 1060

Ubourt; but the question of the power* which ihould be possessed by
Boards of Guardians with respect to their o(floors would reoelve con¬
sideration In connexion wfth the County Government BUI.

Typhus at Fort Burgoyne.

On the 17th hist., In answer to Mr. Bruoe, Mr. Northcote stated that
.examinations have been made both by the Medical and Bngineer De¬
partments without discovering any cause which will account for the
reoent cases ol typhoid fever at Fort Burgoyne. Arrangements have,
however, been made for an Independent examination by an expert of
the Local Government Board, which might, he hoped, result in the dls-
■coverr and removal of any insanitary conditions. Three companies of the
2nd Battalion Bast-Kent Regimept were quartered In the fort until the
12th Inst., when the battalion went to Lydd for training. It is intended
if there be no objection on the part of the Medical Department, to
accommodate the 4th Brigade of the Scottish Dlv.slon Royal Artillery
in Fort Burgoyne, so far as its construction will permit, the remainder
ef the corps being encamped close at hand.

The Status of Medical Officers .

On the l»th Inst. Mr. William Corbet asked the Secretary of State for
War whether he could state why army medical offloers are placed no a
footing with departmental or non-oambatant offloers, and disqualified
'from reckoning time on half-pay towards promotion or ret irement, in
view of the fact that they are required by the Regulations to go under
fire, and. In time of war, do so.

The Secretary for War: There are several- reasons why medical
officers do not count time on half-pay towards promotion or retirement.
In the first p'aoe, there is in their rase no compulsory retirement (as In
the case of oombatant officers) at a comparative! v early age, for it is de¬
sirable to retain the service# of trained medical officers aa long as possible.
Moreover the retiring pav of medical offloers is on a more liberal scale
than shat: of combatant officers. .

iPtoiages, anir

BIKTH&

Biirt.—O n the 13th Inst., at Queen’s-road, Watford, Herts, the wife of

F. Hayoraft Barry. M B.Loud., M.B.C.S., of a son (stillborn).
Brewer,—O n the 17th lost., at “ Oaira," Richmond-road, Hackney,

the wife of Hampton Brewer, L.R.C.P.Lond., of a son.

De’Ath.—O n the 12th inst., at Buckingham, 'be wife of George
Hanby De'Ath, L.R.C.P., M.R.C.8., of a daughter.

OsnUM.- On the 14th ult., at Bindjey, Sumatra, the wife of John
Campbell Graham, M.D., of a son.

Howsx.—On the 11th inst., at 69, Brook-street, W., the wife of Henry

G. Howse, M.8., P.R.C.8., of a daughter.

Johnson. —On the 12th inst., at Mickleton, Campden, Gloucestershire,
the wife of J. Bovell Johnson, M.D., of a daughter.

Kidd.—O n the 7th lrtst., at Brook-street, the wife of Percy Kidd, M.D.,
F.B.O.P., of a daughter.

Mkrson.—O n the 8th inst., at De-U-Pole, near Hull, the wife of John
Merson, M.D., of a son.

Steel.—O n the 10th inst.. at 11, Nevlll-street, Abergavenny, the wife of
William Dvtte Steel, M.D., of a son.

MARRIAGES.

Burrell—Sparse.—O n the 14th inst., at the Parish Church, Mansfield,
by the Bev. Canon Paver, John Burrell, eldest son of the late John
Merchant, of Hertford. Solicitor, to Marion Guyse, second daughter
of Geo. Whftefleld Sparke, M.R.C.8.

Hollingsworth — Cooper. — On the 14th inst., at Sonthend-on-Sea,
Thomas Smith Hollingsworth, Deputy Surgeon-General, retired, late
of the 62nd Regiment, to Rebecca Page, third surviving daughter of
Joshua Vernon Cooper, of Stoke Newington-green.

Xeathak—Rawaox. — On March 22r\d, at St. Maty’s Church, New
Plymouth. New Zealand, Henry Blaokbura Leatham, M.R.C.S., to
Mary Louisa, youngest daughter of Mr. District Judge Rawson.

Jf asht-Pebcaval. — On the 13tta inst., at the Parish Ohurefa. West
Haddon, Northamptonshire, William Gunner Nash, M.R.C.S..
L.8.A.. to Loulka Gertrude, second daughter of Charles Perelval
Bsq., of Fox-hill, West Haddon.

DEATHS.

Bkglkt.—O n the 11th ult., at 8t. Peter's-square, Hammersmith,
William Chapman Begley, M.D. Trln. Col. Dnb , F.R.C.P.. late
Superintend out (Male Department) of the County Asylum at
HanyreR, in hta 85th year.

■Crowfoot.— On the 18th inst., at Beooles, W. K. Crowfoot, J.P.,
F.B.C.S., aged 80.

•Hutson.—O n the 14th Inst., at Brlegh, Whiteknigbta, near Beading,
Henry Hutson, M.R.C.S., of Demerara, in his 69th year.

Mexzibs.—O n the 30th nit., on board the P. and O. steamship Valetta,
between Colombo and Aden, Alexander Menxlea, M.B., O.M., in his
36th year.

Tiffbn.—O n the 13th inst., at The Limee, Wlgton, Cumberland,
Robert Tlffen, M.D., aged 63.

Troutbeck.—O n the 17th lost., at hit residence, Flnsbnry-park (of
acute inflammation of the lungs), James Troutbeck, M.B.Hd..
L.B.O.S., aged 41.

Woods. — On the 12th inst., at Heene Villa, Worthing, Francis
Benjamin Woods, M.R.C.S., aged 77.

foe of is. is charged forth* Insertion ef Notiessef Births,
Homages, and Deaths.

^pointmtnts.

Successful applicants for Vacancies, Boor starts* of Public Institutions, and
others possessing information suitable for this column are invited to
forward it to The LANCrr Office, directed to the Sub-Editor, net later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. -

Armsox. Fa axe G., L.S.A., has been appointed Medical O(floor for the

Youali District of the Lichfield Unton.

Bratlet, W. A:, M.A.. M.D.Cantab.. M.R.O.8., has been elected
Consulting Surgeon to (be Cardiff Bye and Bar Hospital.

Doxxellax, Patrick S., L.U.C.8.I., L.K.Q.C P.I.. has been appointed
Medical Officer to the Anchor Line s jt. City of Rome.

Doughty. David.Somerville, M.B., C.M.BX, has been re-elected
House-Surgeon to the Dumfries and Galloway Boval Infirmary,

Dowdino,. Alexander W. W.. M.D. Durb., M.R.O.8.. has been
appointed Medical Officer for the Fourth District of the Stow
Union.

Hkslop, W. J.. F.R.C.S.Bd., has been appointed Medical Officer of
Health for the Stretford Rural Sanitary District, vice Geo. Poitlnger,
deceased.

Kerb, James, M.B.. C.M.Bd., has been re-elected Surgeon to the
Dumfries and Galloway Royal Infirmary.

Kilham. Charles S., M.R.C.S.. L.R.C.P.Lond.. has been appointed
Medical Officer for the Fourth District of the Beoleahall Blerlow
Union.

MacDonald, Alex. Dill. M.D., O.M.Bd., has been re-elected PhysicUii
to the Dumfries and Galloway Royal Infirmary.

M'Leod, P. B. H-. M.D., C.M.Aber.. has been reappointed Medical
Olllcor by the Parochial Board of New Deer, Aberdeenshire.

Manx, Alfred, M.B., C.M.Bd., has been appointed Visiting Surgeon to
the dbester General Infirmary.

Ma|<k, Leonard. L.R.O.P., M.R.C.3., has been appointed Surgeon to
the Chelsea, B romp ton. and Belgrave Dispensary.

Marshall, William, M.D.St.And., L.F.P.S.Glas., has been re elected
Physician to the Dumfries and Galloway Royal Infirmary.

Mitchell, Andrew, M.B.. C.M.Aber., has been reappointed Medical
Officer by the Parochial Board of New Deer, Aberdeenshire.

Moxham. M. Camplin. M.R.O.S., L.R.C.P., L.S.A , baa been appointed
House-Surgeon to the Central London Ophthalmic Hospital, vice
G. Barker, M.K.C.S., resigned. (

Perry, R. Cooper. M.A., M.B.Cantab., has been appointed Assistant
Physician to Guy's Hospita'.

Pitt, G. M.. M.A.. M.D.Cantab.. M.R.C.P.Lond., has been appointed
Assistant Physician to Guy's. Hospital.

Scott, William, M.D.Bd., L.R.O.S.Bd.. hu been reappointed Con¬
sulting Surgeon to the Dumfries and Galloway Royal Infirmary.

Smtth, James Camac, L.R.C.3., L.B.C.P., has been appointed
Medical Offloer to the County Antrim Prison ; also Medical Officer
to the Brookfield and Bdenderry Spinning Mills and Factories,
vice John Moore, M.D., deceased.

Thomson. Alexander, M.D., L.F.P-S.Glaa., has bean re-elected Surgeon
to the Dumfries and Galloway Royal Infirmary.

Wooldridoe, Leonard C., D.Sc., M.B.Lond., M.B.O.P., baa been
appointed Assistant Physician to Guy’s Hospital.

faaucies.

In oemplianee with the desire of numerous subscriber^, it has been decided, to
r esum e the pubUeation under this head of brief particulars ef the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. -

Brighton, Hove, and Sussex Throat and Bar Dispexsart.—H ono¬
rary Dental Surgeon.

Bvelina Hospital for 8ick {3kildrej, 8outhwark-bridge-road, S.B.—
Registrar and ChloroformUt. Salary £T) per annum, with additional
^ A30 If the post Is held for twelve months.

Kildurn, Maida Vale, and 8t. John's Wood General Din-
pens art.—H ouse-Surgeon. Salary £100 a year, with ooals, gas, and
attendance.

Liverpool Northern Hospital. — Assistant House-8urgeoa. Salary
£76 per annum, with residence and malntenanoe.in the house.

Newcastle-upon-Tyne Infirmary. — House-Physician. Salary £109
per annum, with board, lodging, and washing.

OxsAg Uxioe, Bssex.—Medical Officer and Public Vaoclnator. Salary
‘ £75 per annum, with the extra medloal fees prescribed by the Con¬
solidated Orders of the Local Government Board and other addi¬
tional charges In respect of lunacy and vaccination. *■

Rotherham Hospital. — Assistant to the House-Surgeon. Booms,
commons, and washing In lieu of salary.

Royal Alexander Hospital fob Sick Children, Brighton.—Assistant
Physician.

Rural 8anitary Authority of the Staines Union.—M edical Officer
of Health. Salary £76 per annnm.

Staffordshire General Infirmary, Stafford. — Assistant House-
Surgeon (unqualified). Board and lodging, but no salary.

Tawd Vale Colliery Sice and Accident Socnmr. 8kelmersdale,
Lancashire.—Medical man. Salary about £150 per annum.

University College Hospital. London.—Resident Medical Officer.

Victoria Hospital for Children, Qfieen’s-road, Chelsea.—Assistant
Surgeon in the out-patient department.

Wilton Union.—M edloal Officer and PabUo Vaccinator. Salary £100 a

f ear (Inclusive of all midwifery and surgical fees); vaccination
ees to be paid In addition.

Digitized by Google

1070 Thb Lanobt,] NOTES, COMMENTS, AND 'ANSWERS to OOiRRESPONDENTS. t Hay 21, 1887.

Htt&ical giarj far % muhtg

Monday, May 23.

Botal London Ophthalmic Hospital, Moorpiblds. — Operations,

10.30 A.M., and each day at the same hour.

Botal Westminster Ophthalmio HospItal.—O perations, 1.S0 F.M.,
and each day at the same hoar.

Chelsea Hospital for Woken.—O perations, 2.80 p.m; Thursday, 8.30.
8 t. Hare’s Hospital.—O perations, 3 p.m. ; Tuesday, 3.80 p.m.

Hospital tor Wo.vm, 8oho-square. — Operations, 3 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospitai _Operations, 3 p.m. '

Royal Orthopedic Hospital. —Operations, 3 p.m.

Ceetral London Ophthalmic Hospitals.—O perations, 3 p.m., and
each day in the week at the same hour.

Society of Arts.—8 p.m. Mr. J. M. Thomson: The Chemistry of Sub¬
stance* taking part in Putrefaction and Antisepsis.

Tuesday, May 24.

Guy’s Hospital. —Operations, 1.30 p.m. and on Friday at the same hour.

• Opht h al m ic Operations on Monday at 1.30 and Thursday at 3 p.m. ,
St. Thomas’s Hospital. —Ophthalmic Operations, 4 p.m. ; Friday, 3 p.m. ,
Cancer Hospital, Brompton. —Operations, 3.30p.m.5 Saturday, 3.30p.m.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

8t. Mary's Hospital.— Operations. 1.30 p.m. Consultations, Monday,

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.h.
Eotal Institution.— 3 p.m. Professor Victor Horsley: The Modern

Physiology of the Brain and Its Belation to the Mind.

Society or Arts. — 8 p.m. Mr. Walter Crane: The Importance of the
Applied Arts and their Relation to Common Life. - .

AethbopolooicalInstitute of Great Britain and Ireland.—8.30 p.m. ■
Dr. George Harley : Comparison bel ween the Recuperative BodUy .
Power of Man In Rude und In Civilised Life.—Mr. G. L. Gomme:
On the Evidence for Mr. M" Lennan’s Theory of the Primitive
Human Horde.—Mr. Samuel Gatoti: On the Dieyerie Tribe of South
Australia (communicated, with notes, by Mr. J. G. Frazer).

Botal Medical and Ghirurgical Society.—8.30 p.m. Dr. Haig:
The Relation of a certain form of Headache to the Bxcretlon of Uric
Acid. —Dr. Finlay: Three cases of Alcoholic Paralysis (Multiple
Neuritis).

Wednesday, Hay 26.

National Orthopedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew’s Hospital —Operations, 1.30 p.m.; Saturday, same •
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 p.m.
Surgical Consultations, Thursday, 1.30 P.M.

Bt. Thomas’s Hospital.— Operations, 1.30 p.m. ; Saturday, same hour. ;
London Hospital. —Operations, 2 p.m. ; Thursday A Saturday, same hour. ;
Great Northern Central Hospital.— Operations, 2 p.m.

Samaritan Free Hospital fob Women and Children.—O perations,

2.30 p.m.

University College Hospital.—O perations, 2 p.m. ; Saturday, 3 p.m.

Skin Department, 1.45 p.m.'; Saturday, 9.15 a.m.

Boyal Free Hospital. —Operations, 2 p.m., and on Saturday.

King’s College Hospital. —Operations, 3 to 4 p.m. ; Friday, 2 p.m. :
Saturday, 1 p.m.

Children’s Hospital, Great Ormond-stbebt.— Operations, 9 a.m.;
Saturday, same hour.

British Gynecological Society.—8.30 p.m. Specimens will be shown
by Dr. Grigg, Dr. Edis, Mr. Lawson Tait, and others. Dr. Booth:
On the Various Modes of Treatment to be adopted for the Worst
Cases of Uterine Flexions (adjourned discussion). Council at 8 p.m.

Thun day, May 26.

Bt. George’s Hospital.— Operations, 1 p.m. Ophthalmio Operations,
Friday. 1.80 p.m.

Chahix o -cross Hospital. —Operations, 2 p.m.

North-West London Hospital.—O perations, 3.30 p.m.

Botal Institution. —8 p.m. Professor Dewar: The Chemistry of the
Organic World.

Friday, May 27.

Botal South London Ophthalmic Hospital.—O perations. 2 pjt.
Society or Abtb.—8 p.m. Mr. J. Berry White: Indian Tea.

Qubeett Microscopical Club.—8 p.m. Mr. Underhill : On Spiders.—
Mr. B. T. Lowne: On the Larva of Musca Vomltoria.

.OunoAL Society of London—8.30 p.m. Report of the Committee on
Joint Disease In connexion with Locomotor Ataxy. —Dr. Robert
Maguire: Cases illustrating Acute Dilatation of the Heart produced
by Alcoholism.—Dr. H. Handford: Caae of Endemic Hematuria due
to the presence of the Diatomum HamatoMnm. — Dr. Dawtrey
Drewltb: Case of a Child with a Patch of Lnpus, which has been
Ueated partly by Scraping and partly by Salicylic Add.-Mr. Wra.
Anderson: Caae* of Hammer Toe. Living Specimensi—Dr. Arthur
: ^ ca5 ° ^ytbraical Tremor* affecting One Limb only.—
Mr. George Bastes: Chronic Spasmodic Affection of Inspiratory
Muscles, with loud Crowing Inspiration.

Bot al Institution.—9 p.m. Dr. Edward E. Klein i Etiology of StarJet
Ferer.

Saturday, May 28,

HDDunz Hospital.—O perations, 2 p.m.

Botal Institution .—a p.m. Prof. John W. Hale* i Victorian literature.

METEOROLOGICAL READINGS.

(Taken daily at 8.30 a.m. by Steward '* Instrument*-J

The Lancet Office, May MW.

■ais.

Barometer
raduoed to
Bsa Leva!
saiSTT.

Dlrao-

tloa

of

Wiad.

SSL

Wet

Bulb.

Solar

Radis

la

Vaeao.

Max.

Temp.

aa«A«

Mia.

Tap

Beta

fall.

SJOsjs.

May 13

30-22

N.B.

46

43

91

63

43

-04

Cloudy

14

30-37

N.B.

47

43

100

59

40

■01

Cloudy

., 16

30-37

N.B.

66

<8

101

63

39

Cloudy

„ 16

30-21

B.

62

47

97

62

47

Cloudy

17

30 04

N.B.

60

47

67

57

47

Overcast

„ 18

29-88

W.

66

49

83

61

49

■oi

Overcast

.. 19

29-89

8.W.

60

47

47

•05

Dklnlnj

ftotts, j%rt Comments, # §,itsfotrs In
Corasponknis.

It is especially requested that early intelligence of local events
having a medical interest, or which it is desirable to brine
under the notice of the profession, may be sent direct tv
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors."

Lectures, original articles, and reports should be written on
one side only of the paper .

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not neoessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publioation, sale, and advertising
departments of Thh Lancet to be addressed “ to the
Publisher.”

We cannot undertake to return MSS. not used.

The late Db. Wilson Pox.

We are asked to state that Mrs. Wilson Fox feels deep gratitude to a
large number of members of the medical profession for kind letters W
sympathy and condolence which have been addressed to her and other
members of the family. She begs the writers, at the present time, to
accept her thanks, and to understand that owing to the largeness of this
expression of sympathy it hits been, as yet, impossible to tend indi¬
vidual replies. We may take this opportunity of supplying an omission
inadvertently made last week in our obituary notion of Dr. Wilson
Fox—vir., that he held the office of Physician in'Ordinary to the
Queen. An obvious typographical error occurred also in the date
given as that at which he took his M.D. degree, 1865 being mis¬
printed 1885.

No . iSO . —Our correspondent wishes to apply.to the regulations generally
an answer which was given to a question on one specific point. Thh
is, of course, inadmissible.

Observer has apparently omitted to notice onr comments on the caw,
which appeared in our Impression of the 7th Inst.

Viator has not enolosod his card.

COCAINE IN AURAL SURGERY.

To the Editors of The Lancet.

Sirs,—N ot having seen mentioned the use of oocslne during the
removal ot polypi from the middle ear, I should like to state that I bare
found the operation a painless one after having applied two or three
times , a ten-per-oent. SoLatlon of the hydrochlorate on a probe tippel
with cotton wool, the cocaine also acting as a slight tuemootatlc —id
effect similar 1 to Which I have* noticed when applied to bleeding and
irritable ulcere of lip prior to cauterisation.

I am, Sirs, yours faithfully,

Burntisland, May 16tli, 1837. C. Batten Gbacie.

UVULATOMBS.

To the Editors of The Lancet.

Sirs,—M y attention has just been called to a uvulatome, described m
The Lancet of Mayrfth, by. Dr. Q rev lire MacDonald. Permit roe fe>
say that Mathlm of this city made for me an identical Instrument in its
year 1865, and that a plate of it, with a slight modification, has appeared
in his annual catalogues ever ilooe that date.

I am, 8jrs, very respectfully yours,

Paris, May 17th, 1887. Bdward Warren-Bet, M.D, C.M, LL.D.

Digitized by CjOO^Ic

Tax Lancet,}

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. • [Mat 21 , 1071 .

Thb Moxoh Memorial Fund-

Pjunuoxim Sit William Jennet, Bart* M.D., K.O.B., FB.B. A* it I*

iwliiiil iimit- rTm'V WhcriHlw Itrtj ~7r--—

on bating »hoakl forward their sabscrlptioos without delay to the
honorary treasurer, H. Clement Loom, B.S.,' F.B.O.S., Id, F l nsb u ry-
sefuare, B.C., by Fhom they will be acknowledged. Cheques iherald be
crowed ** City Bank."

Subscriptions announced £5M
F. Wallace, Esq. ... 8

T. A. EVitlOy, Bsq. .... Z

W.-ft-H. HuntJS^. ... 3

F, Fprnk, M.D. ... 3 2 0 J. 0. Stasle. M.D. ... 1, 1 0

Slf Henry Achmd ... 2 2 0 J. Bwart, Bsg. :. J. 1 0

bTF: Stephen*; Beq. ...• 2 2 0 H. Blatherwfck, Bsq. ... 1 t 6

Au L. Qalabln, M.D. .... 3 2 0 : 9. 8. Pilklngtou, Esq-.. 0 10 «

H. W, Strahan. 2i 2 0 F. Ak Hine, Bsq. 0 10 8

A. Q. Osborn, Esq. ... 1. 1 0 i

£rriUua.—The name of Dr. W. B. DaJa i* appeared in the iarft Bet at

",at;C. Datum.?. ■■ .

Doubtful,— Eitbesoourae ], permissible, though the-flrat-mentioned ie
perhaps the-more advisable.

Mr-H. ThutletAt-ayta^Ilje flrst-natied ie practically an hritonrt dagteW.

Dr'. IFkrfe/aw'Bsurni.-—Yes, shortly. " ■ 1

>* .; • •• * ^uicfur or dcOR-mirk* 1 \‘; •;;

' ,, To the kiitorr of root Lancet.,", t

8fR5f—If yqawUl do moths favpur of looking into.voh x*l., p. 328, of
Mature, yon ylfl, I think, find that Dr. Bourne’* experiments- •* three
creatures have been Iqng slnqe substantially discounted by-me. I did
not, however', base any memo# or other essay on these. I djd not,
indeed, think the' game' wprth the candle; and my ohjeot In making
them at til Wat to test Goldsmith's" assertion that if “a scorpion is placed

inthemidat of a circle of homing charcoal.It stings itself on the

back of the head, and in thla mitiner the uutiaanted Suicide instantly
expires. 9 It doesrnoUdng etthaBSt -iAa to Byre o’* more glowing
description avepteodw- . \i . .-I’

: ns. ■ • "Tito miodthat toaoda 6’et suIRy wows :

1 ,-e . i feUkwihaaeoeptetf girt by fits.v: >

*t s.l. .»; •

i; ;. One,aad.ands(ffb rriirishe kttows— ■ t. r ...

. . Th e stipa shopourlshed for her foes, j jr .,•

' ' Whose venom, never ]jret Was vain,

• : ‘”QTvet bot oneVirtgidd cureaall pain,

■ And dart* into her desperate brain;” • 11

4 0 8 B. InnesNUbett, Bsq....
8 3 0 W. B. Grove, M.D. ...'
Z 9 0 J. Poland, F.B.O.S.

8 2 0 G. P. Barr, Ad,...

2 2 0 J. 0. Steele. M.D. ..,

2 2 0 J. Ewart, Bag. :.

2 2 0 H. Blatherwfck, Baq....

‘"GTvet bnt one'pang
■ And darts into her I

• >.i< </ ; And darU-into her desperate brain• 11 ■('•'

and so, It would appeal, ahudles off the mdrtal ooil, along with all its
throes knd Woes,.again I say It doCs nothing of the Wad. On
the contrary, atyd a# thb outcome of hundreds of these experiments—
e x pe ri me n t s -that'were carried out by me Ih the presence Or with the
<XHJperdtl<>h bf-a- Score or more bf still living q(peers, not Only kt the
JaoniAri basil practice ground at Oawnpore, but also In sundry hill and
cholera torripe elsewhere ia : India—‘Icame to the conclusion that this
MM or sn perttltlon was entirely eA&rtdbe. I eatbe to the farther com
elusion. flMb it* poison was all toot more, not only on Itself, but also ofi
small birds, toes, Ac.» add as to ttscWnlndlrfddalhehavlorir-ln preeenofe
of Am, It ww* beAh .atopid add oosSasdlyK It sStos i slfaak'ewray into any
comer it oeuld either make or fln<k or, mertog Sbqut Mbdasidy within
this olrylen it either peflshadin the same ,er diSAwithout making any
sign inside It. . I am. Slra, yonrobedic*rt.**rv*t. ,

Anripl-mad, W., kfoy,l«tb. 1887. W. Otmuar,

THB SHOVEL SHOE. . .

, . ToiA# Lsncrnw.

8um.—Y ou and some of your readers may recognise the signature at
th e foo t o f this letter as that of one yh o has a "craze for orl pplM," or,
topotfl anoSicr way, of one* Who has busied himself In Italy and
England for the last eight (fIpvlslon of Beaufort arms

and legs ^or the orlpplpd pppr. Those who know the Beapfort foot will
recollect , thgf to savb expense the inventor got rid of sm ankle, joint by
adopting, a ,foot with a curved, sole. This -item of. thn Ifn CUiaauHli e
back so nee lor^Fjfclw*—so I leamfrom the Count de Beaufort. The
otherday, Whito driving in Borne, I saw a mole yoked to h eart, Wfijch,
havink aft 1 sWkyloeed• pastern joint, was shod with''a curved Iron shoe.

I was po trtuCh struck 1 with the arfKngeihCnt that I iriade an appointment
with the ’eaftef 'to briijg. his o^rf and mula to pay me a visit. I made
skptches, pf fhlft I send yoo,cpplee.. Xdo not.think euoh a system eau>
have ever 'prevailed In England; for a horse with a stiff pastoral joint
woaWswnely he shot. The application of the eenwdeote tothe moje is
vsey Impeeftot r *or tbs wear 1 on (he specimen thovtfshoe ("ferrn a
paletta ’’) before me appears only from the point to a little short of mid¬
way of the curve. The result was a deplorable limp. After due Inquiry,

1 ^ «td that the

inventor must remain for ever unknown. Similar drawings to those !-
tP,tfm-Cp*u4 daBnaafurt,' Hie:only-rttnmk'.tav
“ H#w strange thit this plan shool^ hifrjy t^rind ni> snjiaia se lent
^ t h a f .i^ t a* f o rty yenatopWVn — ji-'

sto.o l.j- •r-.wt-ly lekVdUSiyewra lsB bdsUy* -c. y. -* 5 i

Hkrbt H. Msxwkzx,

Boom, May 3th, 1887. .ah*? .nUtaoiAeDCtaHraft&B^Hl'LKskiUkyt^n

QuauncATioRS fob Practice nr Tax Charjkl Iblaxds.

Accord ixa to the last law—that of 1876—an English diploma will entitle
Ite possessor to practise in the Ch&nnel Islands; but he must prevlooa|y
obtain the permission of the Royal Court. ,

Dr. Jamet Weavrr .-*-We regret, that we are unable to afford spaoe far the
series of cases promised, and advise our correspondent to nboUt' hie
fact* and propositions to (he judgment of a medical society, Where
they might be adequately dfsenssed.

Ur. Freemen (Bath),—The paper will appear shortly.

» MKUIQAA ATTBNDAJfCE OH THE POOB.* .

To ihi Editor* if Tbs LxlKnrtr.'

Sirs,—I have read with some amusement Dr. Alderaon’a letter on the
above subject, in, your Issue of the 30th ult.‘ He must Indeed be a
fortunate general practitioner if he can afford to attend persons with an
income pf £312 a year as *.* plub" patients, an Income which, according to
Dr. Thnrstab’s letter, exceeds that of the average medical man f It is a
little remarkable that men who have made their fortune^ by consulting ,
practice, men who charge fees from one to two hundred guineas and up-
wards, should begrudge the general practitlonerapoorhalf-a-crown fee. So
anxious do some appear that the British public should not be over-charged,
that I believe thqy would have all medical attendance (except tljat dona
by themselves) given con antoro. Perhaps they will extend their
philanthropy still further, and surest some rneans of assistance to the
new class of paupers they are trying,to, raise from the , general practi¬
tioners and. their families. Some of the people are, however, beginning
to find thit the cheapest Is not klways the best, evep in medical matters.
The good labourer Is always worthy of his hire. And they cannot have
their oases carefully gone Into by well-qualified men for a fee ranging
from twopdttat to sixpence; , I know Several cheap turghrt**'and dis¬
pensaries where the patients fro habitually attended by men who have
never seen the inside of a medical school. There are many dispensaries
that have ab toedknl man'enmkeoa «heAb<*. fDHswatorwMM# kafttty
unq>MriBea psnctltieners, prote ct ed by tome bf war twedtoen. Thtoie a' 1
pnbMb matter-that-’should be Inquired Mo by government, hot, the
much-abased Apothecaries' Hall appears to be the only proteetor ef pro-
fesslonal tntdrtouaftd the pubUo health. Yhe Colleges and DatvarflUea ^
Should prohibit their, graduates from establish big branches that they
cannot personally superiutonA .: lam.,filrs v :youi> ohodiontly,

May 12th, 1887. F. T. S.

Medical Stajf.—Wo do not agree, with our evrreepondsnt. In the twe
Instanoes, yioted, the military officer was wrong, and It the caeca, hed
been brought to the notice of the authorities we have qo doubt ha
| : would have been properly instructed on the subject—probably to the
| I shape of a reprimand. ^ , ,

Mr. ltdwards.—Too late for this week. /,

THB LATH DB. WILSON FOX. ' ' ■ '

To the Editors of The Lahcet.

. ffraa,—1 think yanr re a ders wohM! Uke tn know that the lafe Dr.-WHsea '
Fox was In the habit of placing his beautiful house at Bydal at Ske dls-

ktndaosSj and dsMto sy AvlthWhleh- this was done will M Understood %
aU who knew torn, i Ope might ,ne* spSalS«t <m« wkBe tal .wtoiUvtag;
bat now that he Is gone* Ifiis Impossible 4o witbhold this fast^rointbe
record of his goodness. I am, Sirs n yooss faithfully, ,

Mlleend, E., May,,1887. , Os* of the Cu3«r.

Alpha.— We rqgrst that our correspondent shook! hare.received tto
Impression to which he*Aef#fs in his private note. Hals entirely
wrong on that point, ant) we oannotibub thin k that a aaraful perusal ef
the various articles In The Lancet bearing on the interests of the

we happen to differ from < ^(9i < P i: ?W90dU3
Mr. B. Walker (Spondon).—Yes. , f ^

<"• EieiSHW <W 0HANUBBS. .

‘ - 1 >■ To the Editors of The LlKCET. 1 . ^ ‘ ^

Snta,—I see In your joumalofr Feb! 19th a notice that imlrehio*
claims t A'hive '^htli'ely' eradicated the syphJUClo virus By excinzig the
primary sore. I. tried the plan myself to Hovbatoee » hot basideSdlaMrig
I carefally cauterised the- wasind toth istrong nlttic arid.-. K tow AIM >
patient some three months afterwards, and could find bo: taeb ofc
syphljis on him- l am^ Sirs, yqnrs/s lt h fnllyrf ,' ,, - ,k

Nagasaki, Japan.' ' , C. Arthur Arnold, M.B-, C.M.,

- - BBOWN DBFBNCB FUND.

f ■■ ■ TP 1M Editor*^Of 'Tfflfc' fiilft)»±.^obihe r,/.

WIO you kindly allow me to acknowledge the cepqipE tffjthe’
totlowhig' additlonill subscriptions towards the above fuout,, ^kmqant
'trtrC^dy'attctKlwledged. £ld 15*.,; Sidney'Jones, Esq., £1 *». j' dl. I-
MSfeatftfriei 1 Dtmtnr, «1 1*.; It: Quinton BdWn, Hid., 10*. W. 1

U* .li -ita, Bfr^fotthfntiy ftiM; ' ,a - \ ‘ .

• . -u. Motaur.M.D.

Digitized by LjOOQle

1072 The Lancbt,] NOTE8, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Mat 21,1887.

TREATMENT OP MASTITIS.

To tfa Edilort of Tax Lahcxt.

Sirs,—P ermit, me through your pages to call attention to a method of
treating this affection, first brought before the notice of the profession
about nine years ago by a practitioner In the south of England, whose
name, I regret to say, I cannot recollect—a method which, if I may
judge by the fact that no reference has been made to it In the various
artioles which have appeared from time to time In your journal, has not
reoeived that attention which my own experience leads me to consider
it deserves. The gentleman to whom I refer treated this disease first by
a ten-grain dose of quinine, and then by a two-minim dose of tincture of
aconite, every ten minutes for the space of four hours, contlhuiug the
same dose afterwards onoe every (our hours. At the same time extract
of belladonna liquefied by glyoerlne In the proportion of one part to
eight was applied locally. Since that time I have always used this
method of treatment, latterly without the quinine, and In almost every
instanoe have found It cut short the affection at onoe, nipping in the
bud this painful and troublesome disease. I have found It far more
reliable, and at the same time less troublesome, than any other mode of
treatment, and I have not seen any alarming consequences from the
action of the aoonite on the heart. In one case only did the pulse
become slow and Intermittent, and In this case, a delicate woman, strict
confinement to the recumbent posture was maintained for a day or two,
and she made a good recovery. AU my other cases have led me to
consider that Httle, If any, danger need be apprehended where the heart
is sound and there is much pyrexia. Lately I have given the tincture
of aconite only once In a quarter of an hour with good results.

I am, Sirs, yours truly,

Botherh&m, May Uth, 1887. Wx. Oxlkt.

COMPLETE SBLF-KNUOLBATION OP AN EYEBALL.

To the Editort of Tax Lakckt.

Bibs, —As reported In your last issue, I reoently brought before the
Ophthafcmologioal Society the details of a oase of self-mutilation in
which a woman completely enucleated one of her eyes. If any members
of the profession have, had any oa ses under their observation, and will
kindly favour me with particulars, I shall be greatly obliged to them.

I am. Sirs, yours faithfully,

15, Stratford-plaee, W., May 176h, 1887. J. Gbosvkxor MioxmtT.

I>r. A. Hvtchiton (Loughborough).—Our correspondent can refer with
advantage to “ Rlbot on Heredity,' and to Galton’s work, “English
Men Of Sciencealso to the chapters on Heredity In the “ Dictionnalre
des Sciences Mddioales.' We do not know of any detailed account of
the Stuart family.

Mr. J. A. Jontt (Tir Caradoo). —Ths matter shall have consideration.

Dr. H. Leffmann (Philadelphia) Is thanked.

Mr. C. J. Bond (Leicester),— Yes.

Commukioatiohs not notlood In our present number will reoeive atten¬
tion in our next.

CoxximcATiajra, Litters, 4c., have been reoeived from —Dr. Hale
White, London; Mr. C. Heath ; Dr. FothergtU, London; Mr. Bennett
May, Birmingham ; Mr. W. Curran, London t General Maxwell;
•Mr. J. Walters, Re I gate j Mr. A. Wilkinson, Shaftesbury; Mr. Lauren oe
Humphry, Cambridge; Dr. Hamlll, Manchester; Messrs. Maclehose
and Co.. Glasgow; Mr. B. D. Sinclair, Glasgow; Mr. Turnbull, North
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Gehevk; Hr. Dewhurst, Lambeth; Dr. Branson.SheSeld; Mr. Jacob,
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and Oo., London; Dr. Rayner, Hanwell; Messrs. Hopkinson and
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1 and Co., Glasgow; Dr. W. Sumpter, Oley-next-the-Sea; Mr. A. F,
, Mickle, London; Mr. J. W. Teate, Scarborough; Mr. C. S. Jeaffreson,
Newcastle-on-Tyne; Mr. StradUng, Watford; Dr. B. Warren-Bey,

I Paris; Dr. Mohro, Pengs; Mr. J. Brown, Ual va d ei e; Mr. Loekwood,
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; Handsworth; Dr. Garages, St. Leonqcde-en-Seet Mr. Reynolds. Hew
Cross; Mr. Lemon. Glasgow; Dr. Bland, Kensington; Mr. Mnrray.
Walworth; Miss Williamson, Scarborough; Mr. Masters, Weston-
| super-Mare; Mr. Affleok, Manchester ; Mr.'Davis, Brighton; Mr. R..

Klmptou, London; Mrs. Holloway, Worcester; Mr. J. A. Jones, Tir
i Caradoo; Mr. Bailey, London; Dr. Oolguhoun, Dunedin ; Mr. G. H.

, Maktas, London ; Mr. J. Atkinson, Crevre; Mr. D. C. Trott, Hamilton.
Bermuda; L.B.O.P.; 0. H.; L.K.Q.C.P., 4).; Alpha; A General
Practitioner; One of the Clergy; No. 420; B.AOxon., F.B.C.S.Rng.,
Surgeon M.S.; A. C. B., Pontypool; Beta, Hull,
ixmaa. eaeh with eadeswrs, are also acknowledged from—Dr. Steele.
Abergavenny; Mr. Immlsch, Kentish-town ; Mr. Marshall, Bury-
St. Bdmunds; Mis. Howlets, Westgate-on-flsa; Messrs. Woolley and
. Co., Manobester; Mr. Gilchrist, .Bgremont; Messrs. Burgoyne and
Co., London; Mr. Bssex, London; Mr. Jeesett, London ; Mr.

Glasgow; Miss Garrett, Winchester j Miss Mason, Lohdon; Dr. Tata.
Notts; Mr. Hillier, Kennlngton; Mr. Wood, Pontefract ; Mr. Blake,
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London; Mr. Davies, Bath; Dr. Kidd, London; Mr. Robinson. Berry
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. and Co., London; Mr. Forrest, Cambridge; Mr. Jelly; Dr. Davies,

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, Leeds; Mr. Pinner, Broughton j Mr. Bond, Leioester; Messrs. Santttn
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1 Manobester; K. J.; Medic us, Hall; Forceps; Medicus, Pentonvflle;
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Liverpool; Matron, Barnsley; Dragon; Clerical, Manchester; Sister
■ Bona, Kensington; George; Ozone ; Beta; Roma; Spes; Medicus.
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Digitized by GoO^lC

THE E&NCJET; Mi>.^; ,r 1887. ;

Clinical ^Cotes

' OX '

STERILITY.

Bt GRAILY HEWITT, M.D., F.R.O.P.,

TtortasO R or wn>wrr**t xst> mska<<ks ok wo* nr, mm-msm-

ooixaas ; osbtotiuc pwnucixir to thx hospital.

AtTiioroK It cannot be denied that in a certain number
of cases sterility in the woman ia due to what may be
termed general causes or condition* in other ways unfavour¬
able to the occurrence of conception, yet what is known on
the subject of the cure of Sterility is consistent with the
idea that interference with patency of the passage of the
uterine canal constitutes the most common cause of sterility.
Hence interest chiefly attaches to the question, What are the
. abnormal conditions of the cervix uteri and its tower and
■ upper inlet which may interfere with the patency neces¬
sary for insemination ? Abnormal conditions in the ovaries,
in the Fallopian tubes, in the body of the uterus, may cause
8terility,but these irregularities are less open to recognition,
whereas the oervioal canal readily admits of examination.
The success which has followed various methods of dilata¬
tion, incision, and enlargement of the passage of the cervical
canal with the view of curing sterility, amply justifies the
amount of attention which has been directed to this part of
the uterus in the endeavour to deal with the evil.

One of the latest writers on sterility, Dr. Matthews Duncan,
admits the frequent success of treatment of dysmenorrhcea
by enlargement of the cervical passage, and the occasional
success of the same treatment in curing sterility. Hut be
denies that the enlargement of the passage is the cause of
the cure, because, as he contends, the passage is already
open. The mechanical dilatation seems “ in some mysteri¬
ous way” to exert a generally beneficial influence under such
circumstances. He dwells, however, on the presence of
rigidity of the cervix as an important factor in these oases,
That dilatation under such circumstances is removal of a
mechanical obstruction it seems reasonable to suppose, but
Dr. Matthews Duncan denies this. He is in favour of the
view, which was, I believe, first suggested by Coste, that the
orgasm of coitus tends to produce a patent condition of the
cervix. This appears to be the fact, out it follows also that
a rigid condition of the cervix would be likely to interfere
with this increase in the cervical patency, and would there¬
fore constitute an obstruction.

Although the influence of flexion of the uterus in pro¬
ducing obstruction of the uterine canal has been vehemently
denied, clinical facts appear to me to indicate that obstruc¬
tion may be and is frequehtly thereby brought about. So
far as the question of sterility is concerned, the facts, 1
believe, are as follows:—Obstruction of the cervical canal at
and near the internal os uteri is liable to bo produced by
marked flexion of the uterus. Under these circumstances
the uterine canal becomes flattened out, and the anterior
mH posterior walls brought into apposition. Such coapta¬
tion of the opposite walls of the uterine canal, and affecting
the canal for upwards of half an inch according to the
acuteness of the bend, more or leas, will constitute an
obstruction to the oocurrence of insemination. The condition
of the tissues of the cervix- and of the walls of the canal, in
fact—will also materially affect the patency of the canal, for if
the uterus has for a long time been in a state of flexion, and
hat become hardened and consolidated in that shape, the
obstruction to insemination will bo likely to be greater than
in a case where the flexion is of recent origin. There will
be “ rigidity ” of the cervix also to a greater or less degree.
When the uterus is found doubled upon itself and the
greater part of the canal, constituting a curve of an ellip¬
tical shape, which is the condition in many cases of acute
uterine flexion, there will arise a tendency to coaptation
a«d virtual closure of the canal. This does not necessarily
prevent passage of the sound into the uterus, whence it has
been azgual, but most erroneously as I believe, that there is
no obstruction present. In a sense the canal is open, no
doubt, and probably in the early stages of the cose, the
ute» retaining its flexibility and no "rigidity” of the

Ho. 3326.

tissues of the cervik present, no obstructive effects may
arise, because the organ » still capable of straightening
itself during the orgasm produced by coitus. The occur¬
rence of straightening separates the wails of the tnbej and
for tbe_ time obstruction is removed.i .When later on the
uterus is both rigid and flexed, as frequently happens in
long-standing cases of flexions, the case is different,
and a practically impermeable condition' of the iseovipal
canal, at and near the .internal os, supervenes. There
are. no doubt,.many cases in . which the uterus.ia flexed,
and the canal more or leaf decidedly curved, but in
which, nevertheless, pregnancy occurs. The presence of
flexion of the uterus does np& necessarily imply .persistent
interference with tbo patency of the canaL But when the
degree of flexion is pronounced and the uterus.has become
hardened and fixed in that particular shape,,tben in a-con¬
siderable number of cases the patency,of the, canal may be
so affected that conception is prevented, from occurring.
Thus the degree of flexion is probably not so important a
factor as its irreducibility. If the utesus is firmly Set in its
flexed shape, the coaptation of the anterior and posterior
walls of the canal, which is liable to be present at and near
the internal os uteri in such, cases, persists, and an obstacle
is thus interposed such as may effectively prevent insemi¬
nation. The induration of the tissues of the cervix, due to
sclerotic contraction, which is liable to be observed in long¬
standing cases, renders the straightening of the canal more
and more difficult. If my interpretation of the phenomena
observed in such cases is correct, the cure of sterility* so far as
the cervix and os uteri are concerned, will be found to be neces¬
sarily associated with measurescalculated to remove the source
of difficulty, and to thus restore the patency of the uterine
canal. Numerous records published prove that conception
is far more likely to occur when steps have been taken to
improve the state of the uterus in ,tbis particular then
when these steps have been omitted. Forcible dilatation
of tho cervix by bougies is one of the methods by which
this object caa be secured, and is more or less applicable in
different cases.

It is disputed by some authorities that mere straightening
of the canal is of assistance in regard to improving its
permeability. This idea is. certainly not borne out by my
experience, nor is it supported by the facts adduced by
those who rely on dilatation alone for the cure of sterility.
When the cervix is dilated it is also straightened. Unques¬
tionably, the patency is improved by dilatation, hut mas-
| much as the procedure in question has the effect also of
, straightening the canal, it may be doubted whether the
benefit is derivable from the dilatation or from the straight-
. ening. The simplest case illustrative of the bearing of this
question is that in which the uterus is markedly retro flexed.
Here the patency of the canal is interfered with, M I sup¬
pose, in consequence of the compression of the cervical
canal in the antero-posterior direction, - whereby it ia
flattened and its calibre diminished so long as the bending
of the organ remains. Now it is possible, as clinical facta
show, that the sterility arising in such a- case may be
cured cither by raising the fundus uteri, and thus doing
away with the flexion, or by dilating the uterine oanal.
But if the mere elevation of the fundus is effeotual, what
becomes of the argument for the necessity for forced dilata¬
tion ? It is, in view of this fact, more reasonable to attri¬
bute the success of the dilatation to the straightening, of the
uterus, or at least it ia very unreasonable to deny the
efficacy of the dilatation qua the straightening which is its
inevitable concomitant. I do not intend to dispute the
efficacy of dilatation, but to show the incorrectness of
deductions which have been drawn from that success ha
regard to the remedial power of straightening per at, and

dealing with sterility which have been above alluded to.

Ia illustration of the foregoing remarks I propose to
subjoin the following series of cases, which came under
notice daring a period extending over eight years, and
ending about eight years ago. They were not all treated for
sterility, but in most of them the absence of procreation was
a noteworthy part of the case. In some the sterility was
what may be termed “ primary in others the sterility was
“ secondary,” there having been one or more children bora,
followed by a cessation of child-bearing. It will be noted
that the method of treatment adopted in these eases was
limited, except in about three of them, to straightening of

1074 Thb Lancet,]

DR, GRAILY HEWITT ON STERILITY.

[M ay 28,1887.

the canal and maintenance of the proper position of the
uterus by a pessary, so that the cases offer evidence of a
favourable character in regard to the beneficial influence of
this method of dealing with such cases.

Cash 1.—Mrs. J-, aged about twenty-three, from the

west of England, married one year and a half, has had
dysmenorrhcea for nine years, which came on first after a
day’s hunting. Latterly the pain continued the whole of the
period. Walking produoes exhaustion. Uterus severely
retroflexed. Treatment by a combined Hodge and stem
pessary. Cure of tbe displacement, and pregnancy followed
with a satisfactory result in the birth of a mature child.

Cash 2.—Mrs.-, aged nineteen, was sent to me from

Yorkshire. She had been married fourteen months. Men¬
struation profuse, spread over too long a period, lately pain¬
ful, accompanied with sickness. A pessary has been tried,
but found not to answer. It appears that four years before
marriage the patient had an attack of scarlet fever, as the
result of which she did not walk for one year, being so weak,
and then was obliged to use crutches. Has had occasional
hysterical attacks since the scarlet fever. The os uteri was
found soft, and it was thought just possible that she was
pregnant. After waiting a little, however, this proved not
to be tbe case. Uterus found retroflexed. A modified Hodge
pessary was adjusted. The pessary was worn for a consider¬
able time. I subsequently learned that the patient became
pregnant two years after I had seen her, and delivery took
place at term.

Cask 8. —Mrs.-, aged twenty-eight, the wife of an

officer in the army, had been married four years; no preg¬
nancy. 8he first felt pain in the groin four years ago, with
dragging pain in back and in legs, which prevented her
standing or walking long at a time. Menstruation regular,
a little painful; leucorrhcea. Complained also of a burning
heat in the head. The uterus is severely retroflexed, the
cavity half an inoh too long. Reduced easily, but at once
returns to flexed state on withdrawing sound. Uterus is also
very low in pelvis. Was formerly accustomed to walk four
or five miles at a time, even during menstrual periods. The
patient underwent treatment, consisting of the use of a
pessary, aided by rest and occasional use of sound. The
restoration of tbe uterds to its proper shape occupied some
time. One year and eight months after first consultation she
became pregnant, and was delivered naturally at full term.

Cash 4.—Mrs. M. G-, aged twenty-two. Married two

years. Has been abroad in a warm climate, and had a mis¬
carriage (probably) just after marriage. Had dysmenorrhcea
much since marriage. Exertion and walking very produc¬
tive of discomfort. Was treated by a pessary before mar¬
riage (ring pessary). Has also worn it lately, but it is found
to slip. A Hodge-shaped pessary was accordingly intro¬
duced, the uterus being found retroflexed. 8be went away
and had a child two years and three months after the com¬
mencement of treatment. Seen again two years after birth
of the child, it was found that she was wearing a ring pessary.
The uterus had again become retroflexed, and was now large
and heavy.

Cash 5.—Mrs. L-, married one year. Had an abortion

eight months ago from horse riding. Uterus retroflexed
acutely. Treated by a Hodge-shaped pessary. Pregnancy
occurred about a year later; result satisfactory.

Cash 6.—Mrs. C-, aged thirty-two. Had four children,

last one year ago. Uterus retroflexed. Patient a great in¬
valid. Treated by Hodge-shaped pessary, rest, &c. The pessary
was worn for a considerable time (nearly three years), at the
end of which she was found to be four months pregnant and
the pessary was removed. Result good.

Cash 7. —Mrs.-, aged twenty-two, was sent to me

from the west of Eogland. 8be had been married early,
and had two children, the last fonr years ago. Since that
time she had suffered from “ ulceration.” Had formerly a
specific affection of the milder type. Buffers from some
degree of prolapsus, bearing down, See. Menstruation
occurs every ten or fourteen days; is scanty and painful.
Walking causes great pain. Soffers from nausea. Uterus is
retroflexed, easily replaced. A pessary on the Hodge
principle adopted. Four mouths later she was again seen;
uterus now in good position, although she has been without
the instrument for the last three weeks. It was thought
best for her to have a pessary a little longer. This
patient had another ohild shortly after the above treatment.

Gash 8.—Mrs. ——, aged twenty-eight, the wife of an
'Ottoer,<u iad^'from the north of England. Had had two
children, the kst four years before. ShshSd been HI for two

years, suffering from prolapsus. Previously to that time had
much to do, and exerted herself too much. Uterus in a state
of acute retroflexion, lying very low in pelvis. She was in
a state of great prostration, excessively weak and thin, and
a complete m valid. The uterus was much hypertrophied. Tbe
treatment consisted in careful reposition of the uterus and
adjustment of a pessary, with assiduous attention to dietary
&c. At first a rather large pessary was required to keep
the fundus from descending posteriorly, and it was some
time before the patient see Died to make progress, though
the discomfort ceased quickly. After about three months
she was able to get about, but continued to wear tbe pessary
much longer. Four years afterwards this patient had
another child; she had worn the pessary almost con¬
tinuously, it having been found impossible to dispense
with it.

Cash 9.—Mrs.-, aged thirty-three, sent to me from

Norwood. She had had five children, the last five yean
before; and since that two miscarriages, the last six months
ago. Uterus found to be much thickened, and large uni¬
versally. Much retroflexed; reduction not difficult; retains
to flexed state at onoe. There is not muoh pain felt in using
the sound. The patient was treated by rest and the use of a
pessary of modified Hodge shape, but covered with india-
rubber, and the pessary rather thick (ten millimetres). She
continued to wear this pessary, feeling quite well, and four
ears later came to me stating that she was then pregnant,
found her still wearing the pessary, and removed it. She
was nearly five months pregnant.

Cash 10.— Mrs. - , aged twenty-three. Has had one

child, about two years ago. Suffers from cough and trouble¬
some uterine symptoms. Uterus retroflexed. A Hodge

S issary was applied, and the patient had a second child
ter on.

Case II.—Mrs.-, aged thirty-three, married nearly two

years. Took much walking exercise after marriage. Suffers
from severe menorrhagia. Is now unfit for exertion and gene¬
rally ilL Uterus found to be acutely anteflexed, half an inch,
too long, and fundus enlarged. At first it was considered to
be a case of fibroid growth in the anterior uterine wall, and
the uterus was dilated in order to gain access to this. But
it resolved itself into a case of acute anteflexion. Pregnancy
resulted shortly afterwards, and ended favourably.

Case 12. Mrs. T-, aged twenty, married seven months

when first seen. Suffers much, and is very weak and in¬
competent for exertion. Uterus much anteflexed. Amenor-
rhoea. Patient treated for some time by general measures;
later on treated by a stem pessary, and subsequently by a
cradle pessary. Pregnancy occurred first three years after
marriage. Later on the symptoms recurred, and the pessary
was again employed, with result of a second pregnancy
and this sequence of events was again observed. The
uterus was in this case apparently thin walled, and tbe
organ became flexed. It is noteworthy that in this case, at
a still later period, the patient again applied for relief, and
it was then found that the uterus had become retroflexed,
and a Hodge pessary was required to place her in a condition
of comfort.

Case 13.—Mrs.-, aged twenty-seven, married six

months. Suffers from menorrhagia and dysmenorrhcea,
also pain after walking. Uterus acutely anteflexed. Treated
by cradle pessary. Eleven months after first seen was
found to be three months pregnant; still wearing pessary,
which was then removed.

CASH 14. —Mrs. -, aged twenty-seven, married seven

years. Suffers from dysmenorrhcea and a very sensitive
condition of the uterus. Acute anteflexion. Treated by a
cradle pessary and use of sound. Treatment continued for
about six months. Pregnancy occurred one year and a half
later.

Cask 15.—Mrs.-, from the United States. Had been

married for six years, and had been under treatment for
uterine disorder tor four years. Principal complaint, dys-
menorrboea, which existed from first menstruation. Lately
an operation had been suggested. 1 found the uterus acutely
anteflexed, but tbe flexion was very high up, and the top of
the fundus seemed to be enlarged. Entrance of sound
difficult at the seat of the flexion. The patient objected to
any operation, and the use of a cradle pessary was advised.
By means of a cradle with a rather high bridge the flexion
was controlled, and the patient made much easier. 8b«
continued to use the pessary (removing it at night) for a
considerable time, and I saw ber occasionally at intervals of
two or three years. The passage of the sound finally

Tot Lancbt,]

DR. GRA1LY HEWITT ON 8TEB1LITT.

[Mat 28,1887. 1075

became easier, and nine years after I first saw her, and after
fourteen or fltteen years ef married life, pregnancy for the
first time occurred. The occurrence of pregnancy after so
long a continuance of the sterility is especially noteworthy.

Cask 16.—Mrs. -, aged twenty-six, a lady who had

been married nine years, bad been under treatment for some
time when she consulted me. There had been no pregnancy.
Suffering consisted chiefly of a continual severe backache.

I .found the uterus considerably swollen and much ante-
flexed. The fundus uteri was very low down in front, end
it was exceedingly difficult to raise it from this position.
Inquiry appeared to trace this position to a very severe fall
in early childhood. The nterus was gradually elevated, and
a cradle pessary employed. This occupied much time, and
afterwards the uterine canal was periodically dilated by a
two-bladed dilator. These measures were finally sacceasral,
and pregnancy occurred, followed by a natural delivery
three years after I first saw the patient.

Cask 17 —Mrs.-, aged forty-two. Has been married

eleven tears; no pregnancy. Menstrual periods too often,
smd frigntfally painful almost always. The uterus appears
to be enlarged anteriorly, se if by prsne aes of a tumour.
The sound cannot be introduced move than a sheet distance.
Farther exa m ination proved that the case was one of severe
anteflexion, and the sound was fully introduced. The cervical
canal was then dilated from time to time, and a cradle
pessary was employed. Nine months afterwards this patient
became pregnant, and was seen by me when eight months
sad a half advanced.

Cask 18. —Mrs.-, aged twenty-nine, was sent to me

from abroad. Had been married ten years and had several
miscarriages, the last two years and a half ago. Mens¬
truation very irregular. Has had much travelling of a
fatiguing nature. The uterus is markedly anteflexed; the
canal very sensitive at internal os. Treated by cradle
pessary, with great relief from uterine symptoms. This was
removed after some months, but resumed after a long
interval. Finally she became pregnant while wearing the
pessary, went to her full time, ana was deli vend of a living
child five years after first consulting me and after sixteen
years of married life.

, Cask IV. -Mrs.-, aged thirty-two, married seven

months. Seen in consultation with my friend. Dr. Murray of
Newcostle-on-Tyne. Has suffered from backache severely
fa; some years. Leads a very aotive life. Menstruation in¬
termittent. Uterus anteflexed, large, congested; the bend of
the uterus is high up; sound pretty readily introduced.
The patient wore a cradle pessary and the uterine canal
was dilated by Dr. Murray. Pregnancy occurred not long
afterwards.

Cask 20. Mrs. S-, aged thirty-five, seen with Dr. Burton.

Married six years; no pregnancy. Has bad treatment for
uterine displacement for one year. Buffers from pain and
leucorrbcea. Uterus found anteflexed, large; tissues of
uterus soft; sound enters pretty easily. Was treated by a
cradle pessary. The patient became pregnant, and had a
miscarriage five months afterwards. The pessary was dis¬
continued for a time and then again employed. A second
pregnancy followed, and there was a threatening of a mis¬
carriage, but this went off and the patient hod a living child
at foil term.

Cass 21.- -Mrs. T-.aged thirty-four. Has been married

four years. It is thought there was a miscarriage last year.
For the last five months she had frequent micturition.
Uterus much anteverted, pressing on the bladder. She was
treated by a cradle pessary, the uterus being large and heavy.
Pregnancy occurred while wearing the pessary one year and
a half afterwards, and, I believe, ended satisfactorily.

Cash 22.—Mrs. L-, aged twenty-seven. Had a mis¬

carriage eleven months ago, due to over-exertion. Uterus
low down, anteflexed to left side. Os uteri soft; sound
difficult to pass. Treated by a cradle pessary. Six months
afterwards the patient proved to be pregnant, and with, I
believe, a satisfactory termination. The pessary was worn
up to about the time of quickening.

Cask 23.—Mrs. —aged twenty-six. Has hod one child
three years ago, since which she has suffered much from
backache. Menstruation irregular and painful. Uterus
much anteflexed. Wore a pessary for some time. Oae year
loUr, reported to be pregnant.

Cash 24.—Mrs. -, aged twenty-seven. Had had two

crnlfften, the lost two years previously. There hod been one
miscarriage also previous to first chila. Some little time ago
she strained herself in catching a box, and is now not able

to walk; she suffers also from hysterioal attacks after
exertion. Uterus anteflexed; the anterior lip much elongated.
Use of sound a little difficult. A cradle peaeary was employed,
which enabled her to walk easily. Pregnancy occurred again
in three months.

Cass 26.— Mrs.-, aged twenty-five, the mother of one

child nearly three yean old. States that she walked too
much after her confinement, and has not been well sinoe.
Suffers from pain on rising, also from nausea. The period*
are long apart. She can walk a little in the afternoon.
Uterus acutely anteflexed. Sound very difficult to intro-
dace. Tr e a te d at first by an air-boll pessary, then by a
cradle pessary. Six mouths later pains relieved. The pess ar y
continued to be worn for some time, altered in shape occa¬
sionally, as much difficulty was eaoounteeed in maintaining
proper position of the uterus. Two years and a half after
commencement of the treatment pregnancy again ooouned,
the patient having worn a pess a ry up to that time.

Cask 26.— Mrs.-, aged twenty-eight. Has had three

children, lost two years end a half ago. Hod a miscarriage
eight months ego. Suffering from great depression and
hysterical symptoms. Uterus large ana much anteverted; os
uteri far book. Treated with a cradle pessary for six.
months. Pregnancy followed shortly afterwards.

Cask 27.— Mrs. —-, aged about thirty-two, the wife of a
medical man. Has bad two children, the first twelve yearn
and the last three years ago. Suffene modi from dyamenor-
rbtBO, menorrhagia, and leuoorrhcea. Uterus anteflexed and
to the right side; os uteri muoh congested. General remedies
were at first tried, without result. A cradle pessary was
then employed. Great relief obtained. Patient Wi another
child soon afterwards. Subsequently the displacement
recurred sad became very troublesome. The pessary was
again successfully employed.

Cass 28.— Mrs.-, aged thirty-one. Hod two children,

and two miscarriages since. Menstruation profuse. Has a
constant sensation of bearing down. Five months ago she
was confined to her bed for a week with pains so severe
as to resemble labour pains. Much leocorrboea and- sickness
during the lost three months, especially in the morning-
Feeling of numbness in the tower part of the body. Uterus
much anteflexed ; it is easy to straighten it, but the flexion
immediately recurs. A cradle pessary was adjusted. Six
months later she became pregnant. She was advised to be
vary careful, and the result wee good. I saw this patient
again five years afterwards. She had had another mis¬
carriage one year otter the third child was bom, from which 1
infer that the uterus afterwards resumed its anteflexed shape.

Cam 29.— Mrs. ——, aged about thirty. Hot had two,.,
children. A year ago bod a miscarriage at three months.
The ovum, or a port of it, was retained for a month, and
puerperal fever occurred. This was in India. Now suffers
from pain in the right side, fain tings, and general illness.
Uterus anteflexed and soft to the touch. A cradle pessary
was employed. The patient reoovered, and had another
child later on.

Cash 30.— Mrs.-, aged thirty. Had two children, lost

two years ago; also miscarriage a year ago. Since that time
not so well. Has had almost continued loss during last four
months. Periods painful. Has had leucorrbcea. Walking
very painful. Uterus anteflexed; anterior lip elongated;
os crescentic in shape; Nabothian follicles enlarged. A
cradle pessary was employed, together with other general
treatment. Patient pregnant one year later, the peesary
having been removed six months. Nowsuffering from sick¬
ness owing to the pregnancy. Cradle pessary again used to
relieve the sickness.

In order to estimate the bearing of these cases on the
question of the value of treatment in cases of sterility, the
cases must be classified aocording os they were cases of
primary sterility or secondary sterility. Regarding primary
sterility, a further division is required into (a) coses where,
no pregnancy had occurred, and ( b ) cases in which preg¬
nancy nod occurred but ended in abortion. Respecting the
retroflexion cases related, it will be found that three were
cases of primary sterility without previous abortion, that in
two the patients hod had abortions, and that the remaining
five were eases in which secondary sterility hod existed for
a number of years, and was relieved by ouring or amelio¬
rating the flexion, which was the assigned cause of the
secondary sterility. Regarding the anteflexion cases, nine
were instances of primary sterility without abortions, cured
by treatment; three were cases in which the patient hod
been pregnant before, but followed by abortion; and eight

1078 ' Thx LAircirr,] , Mil. S. M. COPKMAN: THE BLOOD IN PEENICHODS ANAEMIA.

[Mat 28,1BW7.

ware instances of secondary sterility, relieved by straighten¬
ing or partially dilating the cervical canal.

Some of the cases mentioned were instances of primary
sterility of very long standing. Thus in Case 3 the duration
of the sterility was four years, due to an obstinate retro¬
flexion. In Case 8 there was secondary sterility from retro¬
flexion of four years’ standing. In Case 9 secondary sterility
of six years from a similar cause. Of the anteflexione, in Case 14
there was primary sterility of eight years and a half’s dura¬
tion ; m Case Id—a remarkable one—the sterility (primary)
was of upwards of fourteen years’ duration; in Case 16 the
patient had been married without issue for twelve years;
in Case 17 the patient first became a mother at the age of
forty-two, after a married life of eleven years’ duration; in
Case 18 the patient had had several miscarriages and been
married sixteen years when she became a mother ; in Case 20
the sterility (primary) was of six and in Case 21 of four
years’ duration; in Case 25 secondary sterility was of three
yean’ duration when treatment commenced.

It will be obserted that the occurrence of abortion is
noted in some of the cases above related. Sterility is not
seldom witnessed in women who are liable to abortions. The
fact is one of great importance. Some women are apt enough
to conceive, but the pregnancy ends in abortion, and this
may occur repeatedly. It is certain that in many such cases
the abortion is due to distortion of the uterus, which inter¬
feres with the proper exp ansi on of the organ as the ovum grows
and expands within it/ Abortions may oocur primarily, but
mom commonly it is observed that the subjects of thetn
have had one or more children, and that there is established
subsequently a liability to abortion. These latter are oases in
which the uterus has become distorted after parturition and
has settled down into a confirmed state of flexion, which
has not been sufficiently severe to prevent conception, but
sufficient to prevent healthy growth of the ovum. Hence,
arises secondary sterility. In these latter cases the cure of
the sterility by treatment of the flexion is an important
argument in favour of the view that the confirmed severe
flexion is the cause of the liability to abortion and associated
sterility.

The principle of treatment which was adopted in dealing
with the above cases was to improve the patency of the
cervical canal by straightening it, and the method of pro¬
curing this increase of patency, which was most par¬
ticularly and uniformly carried out, was the elevation
of ihe fundus by employment of a suitable pessary. This
latter procedure was the sole treatment carried out in
several of the eases, but in some of them other methods
were adopted. A stem pessary was used in two of the oases
mentioned; in several of them the uterine sound was used as
on assistance to the pessary in unfolding the flexion, and
thus increasing the cervical patency. So far as these cases
go, they prove chat the method of treatment adopted was
a successful One, and bear testimony to the efficacy of the
principle of treatment carried out in these instances. In
only two of the cases was dilatation of the cervix sys- ■
tematieally carried out, and in these the dilatation was
employed to a slight extent only, and not so fully as has
been adopted by practitioners of repute during the last three
or four years. The above cases were treated by me some
years ago. Judging from more recent experience, I conclude '
that a more extensive adoption of the dilatation method
than was carried out in the above series would be profitable,
and probably the list of successful instances of the cure of
sterility during the period of my practice covered by the
above oases would have been longer bad ‘dilatation treat¬
ment been more largely carried out. The experience above
recorded exhibits the utility of mere straightening and
rectification of the positions of the uterus. Dilatation has
the effect of straightening and replacing the uterus, and it
offers the further advantage of getting nd, for a time at all
events, of that rigidity of the cervix which is probably a
great obstacle to the occurrence of pregnancywhen associated,
as It so frequently is, with a chronic long-standing flexion.
It may be considered, possibly justly, as superior to mere
straightening and maintenance of the proper position of the
uterus on account of the greater rapidity with which the
result is effected; but judging from cases whioh 1 have
thus treated, the use of a supporting mechanism after
dilatation will be found advisable if the permanent restora¬
tion of oervical patency is aimed at. For in long-standing
oases the uterus may, after full dilatation, return in a few
months to its abnormal "foxed condition, andthfc potency of
the oerVir is'liable to be again dihaiurfttairt. >

THE BLOOD IN PERNICIOUS ANiEHIA . 1

Bt S. M. COPEMAN, M.A., M.B. Cantab.,

DEMONSTRATOR OF PHYSIOLOGY, ST. THOMAS'S HOSPITAL ; LATE SCHOLA1
OF CORPUS OHRISTI COLLHGB, CAMBRIDGE.

Pernicious or idiopathic anaemia has been recognised as
a distinct disease since Addison first described it in 1855, 1
but Dr. Byrom B ram well appears to have been the first to
call attention to the peculiar changes in tht blood which are
Characteristic of this affection. Subsequent observations
have in the main confirmed his descriptions, although on
certain points there has been considerable difference of
opinion; and accordingly when, lost year, four cooes of
pernicious amentia were admitted into the words of
St. Thomas’s Hospital, under the care 6f Dr. Briatowe
(curiously enough, all at about the same time), I seized the
opportunity of examining the blood on a number of.
different occasions, with the results narrated below. The
clinical history of these oases is briefly as follows
Cask 1.— A single woman, aged twenty-Seven, who eleven

? eara previously to admission into hospital had suffered
rom rheumatic fever and pericarditis. For nine months
jaundice had been coming off, although the faeces remained
normal in colour. The catamenia had not appeared for the
same length of time. The patient was very anaemic, the :
skin being yellow and moist.' The area of cardiac dulness
was somewhat increased, and at the base the second
sound was reduplicated on the left of the sternum. There
was considerable pain in the right hypochondrium. The
b tools contained an abundance of bile, and there was no
trace of bile pigment or acids in the urine. From the time
of admission onwards there was an evening temperature
averaging 101°, and never falling below 99-2°. After a
month in the hospital there was a sudden rise to 103°,
accompanied by much pain in the cardiac region, and a
faint systolic murmur was found to have developed at the
apex. About six weeks after admission the eyes were
examined by the then house-physician, Mr. Hutton, who
found optic neuritis present in both discs, which were
reddened, swollen, and hazy. There were also a number of
retinal haemorrhages. The blood was pale, and coagulated
rapidly; the red corpuscles numbered only abont 36 per
cent, of the normal quantity, and on drying a thin layer
of the blood the corpuscles broke down, and crystals of
haemoglobin were formed. The patient was put on liquor
arsenicali8 (ten minims three times a day), and Improvement
commenced at once, the patient feeling better, although for
a time the anaemia seemed even more marked. Before
another month had elapsed the retinal haemorrhages were
becoming rapidly absorbed—those seen, four or five in
number, being very ill defined and pale. The blood was
laleo much improved. The red corpuscles (which now
reached 60 per cent, of the normal number) ho longer broke
down, and consequently no crystals could be obtained. The
patient went out three months after admission, having made
steady progress towards recovery from the rime that she
was put upon arsenic.

Cask 2.—A leather finisher, aged thirty-two,' was ad¬
mitted in February, 1886, with a history of rheumatism
five years previously, and frequent attacks of epistaxis for.
the past lour years. The skin was of a pale yellowish
colour; the conjunctiva very antemic, but apparently not
jaundiced. There was a blowing systolic murmur at the
apex, conducted into the axilla, and a faint double murmur
at the base. Temperature 100°. On examining the eyes
the optic discs were very pale; there was marked red and
black stippling of the choroid but no haemorrhages. The
blood was much impoverished, the red corpuscles being pre¬
sent to the extent of 48 per cent, of the normal number
only; they were under-sized, light-coloured, and did not
run into rouleaux. A number of small highly coloured
corpuscles about 2 n in diameter were seen. Many of the
larger corpuscles were of an oval or pyriform shape; they
did not tend to break down, but their colouring matter was
extruded in an amorphous form. At several subsequent
examinations similar appearances were observed. Tbs
patient gradually improved, and was discharged on May 1st,

i * Abstract of paper read before the Medical and Physical Society d
• St. ThotBMM'i H capital on February 17th, 1887.

ThmLancbt,]

MB. S. M. COPE MAN: TH.B BLOOD IN PERNICIOU8 ANAEMIA. [May 28,1887. i07f

bat has recently been readmitted in about the same state
as before.

Cash 3. —The patient was a woman, aged thirty-three,
who had never been well since her confinement nine years
previously. Her chief complaint was of almost continuous
pain in the flanks, sometimes causing vomiting, and of
shortness of breath. Though very anaemic she appeared
fairly nourished; both the liver and spleen were enlarged
and tender, but no enlarged glands were found. The
ophthalmoscope showed marked red and black stippling of
the choroid in both eyes, while in the left several patches of
haemorrhage were seen. The house-physician notes: “ The
blood is pale and thin; no increase of white corpuscles; the
red are irregular in shape; for the most part oval or pyriform,
and are smaller than normal, but there are some even larger
than those found in health. In parts the colouring matter
seems to have separated out from the corpuscles and to lie
in red lines between them.” I found the red corpuscles to
be 47 per cent, of the normal number. Temperature 1006°.
Later on some oedema of the face and eyelids was noticed,
followed by swelling of both legs, which, however, gradually
passed off, and under the administration of arsenic the
patient improved greatly in colour and appearance, the
change for the better in the state of the blood also being
very noticeable when she was “ presented” after a stay of a
couple of months in the hospital.

Case 4^- A brewer’s man, aged fifty-seven, admitted in
February 1886, complaining of severe diarrhoea. He had
suffered from rheumatism some time previously. He was
pale, emaciated, and aged-looking, the skin being very pale
and dry. No eruption. Temperature 100°. Several retinal
haemorrhages were noticed in the eyes, and on examining
the blood the red corpuscles were found to number only

known that the number of the red corpuseles in severe cases
is largely diminished, the individual corpuscles being both
smaller and paler than in a normal state. Dr. Bramwell
observed, in addition, that their shape was li&blo to great
variation, the normal change being from circular topjrilorm,
this doubtless being dne to a diminished consistence of the
stroma. He also mentioned the presence of nucleated red
corpuscles, which have also been noticed by other writers.
But in all probability the nucleation is only apparent, being
due to the fact that the heemoglobin has become accumulated
towards one part of the cell, as a very similar appearance can
be produced artificially in human blood by the action of
tannic acid. The size of the red corpuscle is diminished
often to a great extent, the diameter usually ranging
between 4 u and 7 as although occasionally there are seen
some which exceed in diameter the largest of those found in
health, the measurement in exceptional cases being even as
much as 14 n. Dr. Hermann Eichorst notes the presence of
corpuscles of a very small size, not more than 3 n in
diameter, which differ from the others in that they are
globular, instead Of the usual biconcave form, while they
are also of a much deeper red than normal. Dr. Bramwell
admits the presence of these minute corpuscles, but has
failed to observe their deeper colour, in connexion with
which statement it is curious that I rarely failed to find
them. The number of red corpuscles present is much
reduced, the hsemocytometer showing an average of from
35 per cent, to 45 per cent, of normal. The corpuscles
are also apt to change their form as noted above,
becoming pyriform or spindle-shaped. When the con¬
sistence of the stroma is thus altered, the colouring matter
tends to leave the corpuscle, as mentioned in the notes of
the cases; but at the same time does not necessarily

Tabular View of Cases.

No.

Sex.

Age.

Occupation.

Supposed

cause.

General

appearance.

Retinal

! haemorrhages.

8

1

Q

! Vomiting, i

Fever. 1

Complications.

1.

F.

27

| Single 1

Rheumatic 1
fever i

Jaundiced ; no
emaciation

Ye§

j No

Yes

Yes

1

[ Epistoxis ; pain in long bones;
systolic murmur.

3.

M.

32

Leather !
finisher j

Rheunlatism 1

Very anjemic. with
yellowish tint;
no emaciation

No

No

No

Yes

EpLstaxls; paroxysmal cough ;
systolic murmur;
albuminuria. '

3. j

M. ;

57

Brewer's

man

Rheumatism 1

Emaciated, pale, 1
and aged-looking:

Y«

Yes

Yes

Dry cough ; pain in long
bones.

4. j

F. |

1

33

Married |

Pregnancy

i

Pale, brownish-
yellow ; no
emaciation

Yes

No

Yes

Yes j

; (Edema of legs; pain In long
bones.

6. '

M. j

47 |

Policeman

Malaria Very aniemte ; no
! emaciation

Byes not 1

examined

Yes

Yes j

i

Yes ^

Profuse sweating; pain in long
bones; hesmic murmur.

about 40 per ednt. of the normal quantity. They were very !
irregular in shape, and pale, although some which were very i
minute were dark-coloured. On drying the blood on a slide ;
by spreading it out with a needle, the corpuscles broke down i
into a uniformly granular-looking mass, which, when the .
slides were examined the next day, seemed to have die- '
appeared almost entirely, while in its place were seen j
numberless acicular crystals of haemoglobin. In parts where
a few corpuscles had persisted entire the crystals were
seen to be directly derived from them, and by good fortune
I was able in some instances to watch the gradual change i
into perfect crystals, which in these cases were larger than
those derived from the broken-down material. The patient
went out about a month after admission by his own desire
on finding that he had not increased in weight during the
previous week. He was not quite so aammic in appearance
as when admitted, and had gained considerably in strength
during his stay.

In a fifth case, that of a policeman who came into the
hospital some time before the others, the disease appeared
to ensue on an attack of malaria, contracted in the Kentish
Marshes where he had been sent to prevent prize fights.
The blood presented similar appearances to those noted in
Case 2, the masses of amorphous pigment being very
numerous and exceedingly obvious from their large size,
while the corpuscles were few in number, pale, under¬
sized, and irregular in shape. (See Table.)

In connexion with these, cases there are two points to
which attention should particularly be directed, the first
being the pathology of the blood, and the second the effect
produced primarily on the blood, and so on the patient, by
the treatment pursued.

First, as to the condition of the blood. It has long been

become dissolved in the blood plasma, at all events entirely,
some of it remaining in amorphous masses. This appear¬
ance, which was seen in two of the cases, has not, 1
believe, been observed before. It is also worthy of note
that the corpuscles do not form rouleaux, but appear
to cohere by their edges, sometimes even appearing to
become partially fused with one another. The colour of the
corpuscles is much less intense than in health, if those of the
small globular variety be excluded; the eolourifle intensity
of the blood, as determined by the hfemoglobinometer,
being often found to be much less than can be accounted
for merely by the diminution in number of the corpuscles.
Eichorst describes the liquor sanguinis as being of a serous
amber colour, and state# that it ccpgulates with difficulty,
but this has not been borne out in these cases; neither can
I agree with him that the colourless protoplasmic granules
found in normal blood are completely absent, as in each
case they were noted as being, if anything, more numerous
than usual.

In three of these cases it was found that on rapidly dry¬
ing a specimen of blood taken from the finger, the red
corpuscles readily broke down, sometimes diappearing
entirely, while sometimes a coarsely granular appearance
was left. These specimens showed after a time, in place of
the corpuscles, an aggregation of rhombic crystals of
haemoglobin, the spontaneous appearance of which in
anaemic blood has not apparently been previously noticed.
The fact of their appearance in this manner without special
| preparation is the more curious when it is remembered that
under ordinary circumstances it is practically impossible to
obtain htemoglobin crystals from normal unman blood.
'From the blood of some of the lower animals crystals may
be obtained with the greatest ease, notably from the guinea

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Dii

1078 The Lancet,] MR. 8. M. COPEMAN: THE BLOOD IN PERNICIOUS ANJ2MIA.

[Mat 28, 1887.

pig and rat or mouse; but human haemoglobin, being soluble
in a much greater degree, is consequently much more difficult
to obtain m the crystalline form, the order of solubility,
and so of facility of crystallisation, being given by Gautier in
the following order for various animals—(1) rat, guinea-pig,
equirrel, and then, with a great interval, (2) cat,dog, horse, and
man. In two of the cases described above, in which the cor¬
puscles persisted, no crystals were developed, but amorphous
masses of brown pigment were seen scattered among the cor-
uscles, the difference possibly being that in the one case
(smogiobin and in the other bseraatin only wan extruded, the
globulin then being retained in the stroma. That bsematin,
which is non-crystallisable, and globulin should be capable
of dissociation thus is borne out bv the presence in old
blood clots of pigmented crystals of hsematoidin, which is
apparently identical with iron-free hsematin. In two

my specimens have deteriorated considerably einee they
were first prepared. The only description of crystals occur¬
ring in the blood in disease is apparently that of Cbareor,
who speaks of small lenticular crystals, named after him,
as having been noticed in the blood in leucocythsemia.
Gowers states that they are a post-mortem phenomenon, and
also adds that they are not peculiar to this disease. These
crystals, which Charcot considers to be of a proteid nature,
differ in every respect from those just described, one im¬
portant point of difference being that in these cases of
pernicious aneemia the destruction of the red corpuscles waa
a necessary antecedent to the appearance of the cry stair,
while in Charcot’s cases it was not so.

It is necessary to add a word or two on the treatment of
this disease, since the appearanoee described seem to have a
bearing, if only a negative one, on this point. In all the

Fig. 1.

Fig. ?.

Showing oryitali starting from red corpuscles. (Case 3.)

instances the specimens of which were taken from Case 3,
the crystals were seen to be directly derived from the red
oorpuscles (Figs. 2 and 3;, and their formation was watched
from time to time. An exactly similar appearance is described
by Dr. Lionel Beale as having been witnessed by him in the
case of hoemoglobin crystals obtained from guinea-pig’s
blood, the crystals being comparatively large when spring¬
ing from an entire corpuscle—smaller when arising from
the portions of one which has partially broken down.

Considerable difficulty is experienced in preserving spe¬
cimens of haemoglobin crystals as permanent objects. The
beautiful cry stale from guinea-pig’s blood are readily obtained,
but, in whatever way they may be mounted, generally lose
brilliancy and the sharpness of their angles after a time.
Consequently, it waa to be expected that human haemoglobin,
being so exceedingly soluble, would not be very permanent,
and this unfortunately appears to be the case, as many of

Fig. 3.

Fig. 4.

Ciy«UU from red corpuscles of guinea-pig's blood. (After Beale.)

cases arsenic was prescribed in the form of liquor arsenical is,
and with the best results. To Dr. Byrom Bramwell we owe
not only some of the earliest descriptions and the first real
investigation of this disease, but also the use of this drug in
treatment, in support of which may be mentioned the not
uninteresting fact that in the cases in which crystals of
haemoglobin were at first obtained none could be found after
the patient had been for a few days under the influence of
arsenic, even though the blood did not at the same time show
any very considerable change in the number of corpuscles
or in the amount of haemoglobin present, while in two or
three subsequent cases in which the drug had been adminis¬
tered before the patient was examined, but in which the
htemocy tome ter showed a percentage of corpuscles as small
as that in the caseR in which crystals were obtained, none
were ever found. These facts appear to show pretty distinctly
that arsenic has a very immediate action lor good on the
blood in this disease, especially as all the patients, notes of
whose cases have been given,
relieved, if not absolutely cured.

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left the hospital greatly
One of these, it must be

The Lancet,]

MB* F. B. JES8ETT ON MYELOID SARCOMA

[May 28, 1887. 1079

stated, has lately been readmitted, and it is poasihle that the
disease may reassert itself in all of them after a time, as, it
seems, is not unfrequently the case; still, the effect of this
drug, at any rate for the time, appears to be little short of
marvellous.

In conclusion, my best thanks are due to Dr. Brie to we, to
whose kindness I am indebted for permission to make use of
the notes of the cases that have been quoted.

Tork-road, S.B.

CASE OF MYELOID SARCOMA, INVOLVING
BOTH SUPERIOR MAXILLARY BONES,
TOGETHER WITH THE HARD AND
SOFT PALATE;.

REMOVAL OF GROWTH WITH 1HE GREATER PART OF
BOTH BONES; RECOVERY. 1

By F. BOWREMAN JESSETT, F.R.C.S. Eno.,

8UBOKOK TO THE CAXCKJt HOSPITAL.

S. G. B—- , a married woman, aged thirty-five years, was
admitted into the Brompton Cancer Hospital on Oct. 31st,
1886, with a large growth involving the whole of the hard
palate, and projecting into the mouth to the line of the
teeth on both sides. . The patient’s grandfather died of
epithelioma of the lip; no further.history of cancer in
the family; father and mother both living and healthy;
no history of phthisis or syphilis. She first noticed a
lump in the hard palate twenty-one months ago, which
grew rapidly until it attained the size of a bantam’s egg
and projected considerably into the mouth, interfering with
mastication and speech. Six months after first noticing the
growth she went to Guy’s Hospital, where she was operated
upon by Mr. Clement Lucas, through whose courtesy I have
obtained from Mr. Targett, the surgical registrar of Guy’s
Hospital, the following particulars:—“ She was admitted
into the hospital on June 11th, 1885, under the care of Mr.
Clement Lucas for a myeloid sarcoma of the hard palate
which had existed about six months. On June 16th, 1885,
Mr. Lucas excised the tumour with scissors, and then
scraped the base, applying tannic acid to stop hsjmorrhage;
no portion of the hard palate was removed, and on June 28th
she was discharged, the wound having granulated nicely.” In
June. 1886, she was admitted into St. Thomas’s Hospital, under
Sir W. MacCormac, with extensive recurrence of the disease.
On examination it proved to be a very vascular sarcoma,
with definite myeloid cells and spicnla of bone. 8he noticed
the edges of the opening in her palate, the result of the
removal of the tumour, swollen and tender about three
months after she left Guy’s Hospital, and from that time the
growth extended rapidly.

State on admission .—There is an irregular mass impli¬
cating the whole of the hard palate and the inner aspect of
the gums on both sides, as far forward as the first molar
tootn ; the soft palate is also infiltrated with the disease to
within a quarter of an inch of its posterior edge; the growth
extends upwards into both nostrils, but more so on the
left, where it is seen protruding for some considerable dis¬
tance, presenting much the appearance of a large polypoid

g rowth. The patient cannot breathe through either nostril.

y digital examination of the pharynx, the tumour is felt
pressing back upon its posterior wall, and it is impossible to
ascertain how high it extends posteriorly. The patient
suffers comparatively little pain from the growth, but com¬
plains chiefly of the difficulty in eating, the movement of
the tongue and capacity of the mouth being limited by the
growth (which is the size of a large lemon) projecting into
it. There has never been any hasmorrbage. The tumour
feels hard but elastic to the touch, is firmly fixed, and appears
to extend deeply into the antrum on either side. There is
a slight fulness over the left antrum, but the teeth on both
sides are very good, and in no degree loosened.

At the urgent request of the patient, l consented to
endeavour to remove the growth, although at the time I
feared I should not be able to do so without removing the
whole of both the superior maxillary bones; but I determined
in the first place to endeavour at any rate to leave the in fra-
orbital plates in tact if possible, and I hoped to* be able to

i Bead befor* the Modioal Society of London.

accomplish this, as from the history of the case it appeared
clear that the growth commenced 6olelv from the hard
palate or from the alveolar process. On Nov. 9th the
patient being placed fully under the influence of an ames-
thestic 1 made a most careful examination of the tumour,
but could find little more than I had done previously. The
growth, however, exteaded so far back and appeared so
firmly fixed that I had some misgivings as to the result of
the operation.

Operation.—I made two incisions, extending from either
angle of the mouth, upwards and outwards towards the
inner angle of the oroit; I then reflected the flap thus
formed, which included the nose, upwards over the
forehead, and in this manner thoroughly exposed the whole
of the front of the growth and superior maxillary bones.
1 next, with a fine jncision saw, divided both bones about
half to three-quarters of an inch above and parallel
to the alveolar processes through their whole extent, and,
with a raspatory used as a lever, separated this portion of
the bones from the upper and remaining halves. Having
thus loosened this poitinn of the bones with the tumour
attached, I seized it with tbe lion forceps, and at the same
time introduced the index finger of my left hand into the
pharynx behind the growth, and in this manner was enabled
gradually to remove the whole of tbe disease, with the
exception of that portion which had grown into the antrum
on the left side. This, however, was quite detached, and
was subsequently easily removed by means of Volkmann’s
spoon. There was scarcely any haamorrhage, and the disease
appeared to have been entirely limited to the portion of
bone removed, having grown from thence upwards and
insinuated itself into tbe antrum and between the ethmoidal
spongy bones. The skin flaps were next brought together
with harelip pins and one or two horsehair sutures, and
tbe whole surface dusted over with iodoform. Tbe patient,
who stood tbe operation remarkably well, was returned to
bed. She was fed for the flr.it twenty-four hours with
nutrient enemata, after which time she took food by the
mouth from a feeding-cup with a piece of indiarubber
tubing attached, sufficiently long to pass over the root of
the tongue.

Nov. 10th.—Patient has passed a good night. Tempera-^
ture normal.—12th: Patient still doiiig well. Tbe mouth is,,
kept washed out with a solution of boro-glyceride; there is .
very little discharge; takes nourishment well.—15th: Two .
of the harelip pins removed. Wound healthy; no pus.—
16th: The remaining harelip pin removed. Wound quite
united. The patient from this point made an uninterrupted,
reco very, and is now (February 24th, more than three months.,
after the operation) quite well. Her speech is peculiarly
good ; in fact-, with the exception of a few letters, she speaks
well. There is little or no deformity. She is now being,
fitted with a plate, by which means itj is hoped to enable
her to masticate fairly well.

Remarks —This case represents well one of those rare
cases in which the practice of removal of the greater part-
of both the superior maxillary bones may be practised with.,
advantage. In performing the operation I preferred adopt¬
ing the primary incision as suggested by Heyfelder, as, from.,
the size of the growth and the uncertainty of its deep,
attachments, 1 thought these incisions would afford the
greatest possible amount of room for the removal of .the.
tumour, and also in case of deeply seated haemorrhage,
occurring daring or after its removal these incisions would
enable me to obtain the best view of the d- ep parts.
After having fully axpoeed the tumour by reflecting the.
flaps upwards, instead of attempting to pass a chain
saw through the spheno-maxillary fissure, which in this case
would have been impossible to accomplish, I preferred to
saw through the maxillary bones from the front, and
then by inserting a chisel into the divided bone to separate
tbe alveolar processes and lower part of tbe bones from the.
upper. By this means I avoided woundiqg the growth,,
which was very vascular, and I was enabled to remove it
with its attachment entire. Had I persevered and thrust
the chain saw through the spheno-maxillary tissue and sawn,
through the bone from behind forwards, it is evident that
I must have divided the growth as well, and in all proba-.
bility met with very considerable haemorrhage. By adopting-
tbe method of dividing tbe bones, I was enabled to preserve,
the pterygoid processes of the sphenoid bone intact, which
is of very great importance. Had the disease extended,
deeper than it did, bjr removing the lower portions of the
bone by this method it would have been easy by means of

1080 The Lancet,]

MR. S. P. MURPHY: PREVALENCE OP WINTER DIAERHffiA.

[Mat 28,1887.

the gouge or gouge forceps to remove as much more as
might have been necessary. Doubtless, this method of
proceeding has been adopted by other surgeons, but I have
been unable to find any case so operated on recorded. A point
of interest about the growth is its character. The original
growth when removed at Guy’s Hospital is reported to be
myeloid sarcoma. Again, when the patient presented herself
at St. Thomas's Hospital the growth was described as a mye¬
loid sarcoma. The appearance of the tumour now, however,
has appeared to have undergone a change, for there are only
a few myeloid cells to be seen, while the bulk of the tumour
seems to be made up of a firm fibrous stroma interspersed
with a large number of small round cells. Another interest¬
ing point is that when Mr. Lucas removed the growth in
June, 1885, he did not remove any of the hard palate. Now,
however, the whole of the hard palate is absorbed, having
been destroyed by the tumour. There is no doubt the growth
commenced in the periosteum of the hard palate, for Mr.
Lucas is reported to have scraped the base, after removal
of the growth with scissors, and from its point of origin the
tumour grew upwards and right and left, absorbing the
bony structures as it extended, at the same time pushing
its wav outwards into the cavities of the antra, and
upwards bet ween the ethmoidal spongy bone.

Upper Wimpolc-street, \V.

A FEW FACTS CONCERNING THE RECENT
PREVALENCE OF WINTER DIAllRIKEA . 1

Br SHIRLEY F. MURPHY,

LBCTL'OKR OS HYGIEXF. AND PUBLIC HEALTH, ST. MARY'S HOSPITAL.

I have thought that our Society might well have before
it a few facts which I have been able to glean concerning
the recent prevalence of diarrhoea during the winter months.
The subject was first referred to in a paragraph in The
Lancet of Feb. 5th, which also contained the following
week a letter from Mr. C. H. Taylor of the West London
Hospital, stating that diarrhoea was prevalent in Fulham,
Chiswick, and Hammersmith; and the British Medical
Journal of the same date published a communication from
Dr. Norman Kerr telling the same story for the neigh¬
bourhood of liegent’s-park. Later, other correspondents
bore witness to the existence of epidemic diarrhoea in
St. James's, Bayswater, Marylebone, Clapham, Lewisham,
Penge, Kingston-on-Thames, Kent, and even as for from
London as Lancashire and Aberdeenshire. The reports of the
symptoms from which the patients suffered fairly well agreed.
In all cases there was diarrhoea, in the majority abdo¬
minal pain, vomiting, cramps in the limbs, great de¬
pression, and a symptom of particular interest — high
temperature. In a few the fact was noted that the patients
also suffered from hemorrhage from the bowels. In many
instances the sufferers were attacked in the night, and often
in groups, suggesting community of cause. W a may assume
therefore, in the first instance, that the epidemic, wherever
it manifested itself, was of the same nature, and that Borne
of the symptoms to which it gave rise were those not usually
met with in ordinary diarrhoea, and that, regarding it as diar¬
rhoea, the disease occurred at an unusual period of the year.
We are led, moreover, to conclude that, notwithstanding the
area which its operations covered, it is in the highest
degree probable that the cause in each locality was the
same. And 1 may go further, and say that this cause was
not related to any climatic condition; for, if we examine the
dates of outbreaks in public institutions situated near to each
other, and therefore subject to the same climatic conditions,
we do not find that these dates exactly correspond.; and,
farther, some institutions also in the neighbourhcwd of those
which were invaded escaped altogether. The cause must,
nevertheless, be one capable of operating over large extent*
of country.

My own opportunities for learning some particulars of this
illness were practically limited to its behaviour in a special
hospital in Central London, which I first visited for that
purpose on Jan. 27th. I was informed by tile senior house-
surgeon, who had taken great interest in tha matter, that
half the inmates of the institution about two months before

1 Bead «t a meeting pf the Society of Medical Officer* of ficalth,
May 30th, 13S7. '

had been attacked suddenly with diarrhoea, the patients
alone suffering and the staff altogether escaping. On
Jan. 25th the incident repeated itself, nearly fifty persons
on this occasion being attacked. The distribution of the
disease in the hospital is of importance ; for again, on the
second occasion, the patients were, with trifling exceptions,
the only sufferers. The patients are resident in wards
situated on three floors; those on each floor taking their
meals mostly together. On the first floor are beds for thirty
women, on the second floor beds for forty men, and on the
third floor twenty-six beds, twenty-one of which are occu¬
pied by men and the rest by children. Of the patients
resident in the hospital at the time of my visit, I found thst
on the first floor there were attacked on Jan. 24th (Monday),
in the morning one, in the evening three; on the 25th
(Tuesday), in the morning two, in the evening six; on the
26th (Wednesday), in the morning one. On the second
floor there were attacked on Jan. 24th (Monday), in the
evening one; on the 25th (Tuesday), in the morning
eighteen. On the third floor there were attacked, on
Jan. 24th (Monday), in the evening• five; on the 25th
(Tuesday), in the morning six.- Or, considering those on the
different floors together—on Monday, Jan. 24th, ten were
attacked; on Tuesday the 25th, thirty-two; nod on
Wednesday the 2(>tb, one; the majority of the attacks
occurring while the patients were in bed at some period of
tbe night.

The most striking circumstance in the outbreak is the
almost complete immunity enjoyed by tbe staff. Of twenty-
two persons engaged either in attendance upon the eick or
in domestic duties, but two suffered from diarrhoea, and these
were nurses, both of whom were attacked in the early morn¬
ing of Tuesday, Jan. 25th.

To enable the exact incidence of the disease upon tbe
patients to be determined, and for the purposes of farther
inquiry, I ascertained the condition of health of those who
had been discharged from the hospital for some time pre¬
viously, and in this manner elicited information that no
patient who left the hospital before Jan. 24th was attacked.
On Thursday, Jan. 20th, three patients were discharged, and
on Friday, the 21st, three; on Saturday, the 22nd, six: none
of whom suffered. On Sunday, the 23rd, no patients were dis¬
charged ; on Monday, the 24th, six patients were discharged,
three of whom were attacked early the following morning
at their own homes. Whatever cause, therefore, gave rise
to diarrhoea probably came into operation after the patients
left on Jan. 22nd—i.e., after midday dinner on that day. Of
patients newly admitted into the hospital, three admitted on
Jan. 20th were each attacked; of two admitted on the 21st.
one was attacked; and of three admitted on the 22nd, t wo
were attacked. None were admitted on Sunday, Jan. 23rd.
Five were admitted on Jan.24tb, all of whom escaped. Two
were admitted on Jan. 25th, both of whom escaped. The
cause of the outbreak therefore probably ceased to be
operative before the patients were admitted on Monday*
Jan. 24th--i.e., the cause was operative only some time
between midday on Saturday, Jan. 22nd, ana midday on
Monday, Jan. 24th.

It becomes important, therefore, to ascertain tbe effect of
this cause upon the patients who were in the hospital at this
particular time, changes by admissions and discharges having
taken place before my visit. There were sixty patients in
the hospital between Jan. 22nd (Saturday), midday, and
•Tan. 24th (Monday), midday, of whom forty-three were
attacked with diarrhea, either within the hospital or
immediately after their return home, giving a percentage of
76 6. Of the staff I have already said there were twenty-
two, of whom two were attacked, or 9 per cent. This
difference is so great that I was compelled to regard the
condition causing the diarrhoea as one with which the
patients must be specially related, and this view was
strengthened by the fact that the two affected members of
the staff were nurses who may likely enough have come
into accidental relation with this condition.

At this period I was not aware that the disease was pre¬
valent in other parts of England, and I was led to examine
the incidence of attack upon patients taking milk, water,
and other articles of food. Of those who drank unboiled
water at their meals there were thirty-three, of whom
twenty-five were attacked, or 757 per cent., being practically
identical with the general average. Of those who drank no
water exoAit that which they bad in their tea, and which had
therefore been boiled, there were twenty-six, of whom
twenty-one were attacked, or 807 per cent. Drinking water

Tk* Lanokt,] DR. A. G. WILLIAMS: DEATH FROM IMPACTION OP GALL-STONES. [May 28,1887. 1081

or abstaining from water did not therefore affect the proba¬
bilities of attack. Again, ferty-four patients drank uncooked
milk instead of beer, and of these thirty-four were attacked,
or 77'2 per cent., a proportion equal to the general average.
■Of fifteen patients who took no milk except in tea, thirteen
were attacked, or 86*6 per cent. Drinking or abstaining
from milk cannot therefore be said to have affected the
probabilities of attack. Nevertheless, the large proportion of
■attacks among patients, and the immunity enjoyed by the
staff, strongly indicated some article of food as responsible
for the occurrence. The senior house-surgeon was good
enough to prepare for me a complete list of all the
articles of food consumed in the hospital. I may at once
•eliminate from further suspicion the following: — Milk,
because the supply was common to staff and patients,
because of the evidence already adduced, and also because
the same farms supplied milk to another large hospital, which
(remained free from disease. Water, because it was con¬
sumed by staff and patients, and because of the evidence
-already adduced. The possibility that the local contamination
of a cistern was responsible for the outbreak may be set aside
by consideration of the fact that separate cisterns supplied
the different floors. Tea and salt may be eliminated, because
the supply was common to staff and patients. Meat and
potatoes, because the supply was common to staff and
patients. Beef-tea, because it was only consumed by a few
patients. Beer, because those who did not drink beer were
also attacked. Bread and sugar, because the same articles
■consumed by the patients were also supplied to the servants,
none of whom were attacked. Rice, because no fresh supply
bad been received for a long time previously, and the children
bad been eating rice daily without injury. I may also refer
to the fact that other institutions and other parts of the
country were invaded, having different milk, water, and
meat supplies.

There is but one article of food I am unable to exculpate,
and to the possibility of this being the cause of a widespread
•outbreak 1 would desire to direct the attention of the
Society. I refer to butter, which in the method of its dis¬
tribution in the hospital in the first instance raises a pre¬
sumption that it may have been concerned in producing
this carious disease. Three qualities of butter were supplied
to the institution— (a) that provided for the medical officers
and matron, (A) that provided for the nurses and servants,
and (c) that provided for the patients. The patients’ butter
is received on every weekday at 10 a.m., and is used for tea
and supper the same day and for breakfast the following
■day, on Saturdays the supply being increased to last until
breakfast on the following Monday morning. If we assume
that the butter received for the patients on Saturday,
Jan. 22ad, possessed purgative properties, there is ample
•explanation of the illness of all the patients who suffered
from diarrhoea. That all were not attacked at the same
time, and that some escaped, may be due to some unequal
distribution of the active principle throughout the butter, or
perhaps to some difference in the quantity consumed. There
remain the attacks of two nurses, who, it may be men¬
tioned, suffered less severely than the patients from this
malady. I have no other explanation to offer on this
point than that they must have eaten some portion of the
bread-and-butter not required for the patients. Those who
■are intimate with hospital life will know that this is no
unusual event. Thus far as to this particular hospital. The
■difficulty which stands in the way of the acceptance of this
theory is the fact that other institutions—many persons
not living in institutions, and other parts of the country
Also shared in the prevalence of diarrhoea.

. English butter is made upon the farm on which the milk
*s produced, and the few pounds which each farm is able to
contribute could not be sufficiently widely distributed to
give rise to an occurrence such as that we have under con¬
sideration. But the butter which I have been led to suspect
w&s that provided for the patients, and low-priced butters
? orn ® lar g e, y from abroad. In Other countries butter
th j,, a * Wa y 8 manufactured on the farms on which
*9 produced, but large numbers of farms send
v,®" to central depdte, where, I am told, the milk of
““nawda of farms is mixed together, made into butter, and

, ounn 8 matter added, which always gives to it a uniform
°^ r aa<i flavour. This is sent over in enormous quantities
JLr® EngHsh middle-man, #ho distributes it to local
man from ^bom it reaches the consumers. In this
n ““ er ® n y capacity which the milk from any farm might
v css to cause diarrhoea Would, if due to an organism, have

the possibility of being multiplied by admixture of this milk
with other milk, and thus its effects might be felt in many
places. Or perhaps the method of treatment of the butter
in some central depot might be concerned in conferring
upon it this power, or possibly by the development of some
chemical poison it might have acquired this special property.
The symptoms of the sufferers, indeed, remind us of the
observations of Dr. Victor C. .Vaughan of Michigan concern¬
ing the effects of a ptomaine he found in cream. It is, under
any circumstance, conceivable that butter which possesses
this property might be distributed through different
channels over a large area of country, and thus induce
diarrhoea in one district or institution at one time and in
another at the same or at a different time.

I have not had the opportunity of extending my inquiries
sufficiently to enable me to thoroughly sift the evidence
that could be obtained outside the institution with which I
was concerned. I therefore prefer to leave the subject
where it is, but I may mention incidentally that one large
hospital which also suffered heavily received its butter from
the same source as that which came under my own observa¬
tion, and that another suffering very partially require4
the patients to supply their own butter, thus giving
opportunity for it to be procured from many sources, of
which perhaps one only was identical with that under
suspicion. This difference in the method of supply may
perhaps account for the smallness of the number of
persons affected in some institutions. I do not wish
now to do more than urge—1st, that the nature of the
epidemic of which we have recently had experience points
to an article of food as the cause; 2nd, that the facts learnt
at one institution, where they were carefully observed,
point especially to butter; and, 3rd, that any objection to
this theory, which is based on the method of distribution of
butter made on English farms, falls to the ground when the
distribution of foreign and of artificial butters is considered.
In conclusion. I would desire very cordially to thank Mr.
E. Treacher Collins, whose active assistance has enabled
me to ascertain the facts upon which this story is based,
and to whose accurate observation I am very greatly
indebted.

DEATH FROM IMPACTION OF GALL-STONES.

By A. GLOVER WILLIAMS, M.D., M.R.C.S.,

SCROEOJT TO THE URIXTOX DISPKXS1RV.

Ox October I3th, 1886, I was called to see Mrs. B-»

She was a woman of dark complexion, with rather an anxious
expression, and was markedly jaundiced, the conjunctivas
being df a deep yellow. 8he wa9 fairly well nourished. I
was told that three months ago she was seized with pain
below the right ribs, which gradually became intense; it
was more or less paroxysmal in character, accompanied by
violent sickness, and followed in a day or two by yellowness
of the skin. A medical man was called in, who said she was
eaffering from the passage of gall-stones. She suffered from
the pain and sickness at short intervals until three weeks or
a month ago, when the pain left her; but the sickness
increased, notwithstanding, until she could keep nothing
down; the jaundice also deepened. Her friends told me
that ebe had been somewhat addicted to drink. She was
under my care from October 26th to November 12th, 1884,
and was then suffering from symptoms of gall-stone colic—
viz., acute pain in tne right hypochondriac region, with
sallowness of the conjunctivas, which did not amount to
jaundice; the urine contained some bile, and the/aaces wore
pale—i.e^ clay-coloured; the motions were searched for
gall-stones, but none were found. In July, 1886, she again
came under my notice with the same symptoms. There was
no actual jaundice on this occasion, and no gall-stones were
found in the frooes. In March, 1886, she had a similar
attack, but on this occasion she was jaundiced; the pain
then left her suddenly, but her recovery was gradual. She
says that her father had some operation performed on his
lip, but she does not know what for.

The patient’s present condition (Oct. 13th, 1886) is as
follows: She has lost all pain, but suffers from constant sick¬
ness. She retains nothing; even the medicine is returned.
The vomit is of a dark-greenish colour, almost wholly fluid,
and about the consistence of thin gruel. The bowels are

Gooq

O

1082 Tkb Lancrt,]

DR. A. T. SLOAN ON GOITRE IN ANIMALS.

[Mat 28, 1887.

open, somewhat relaxed; motions greyish-white in colour.
She is very restless, and gets but little sleep. The urine is
very dark, and contains bile. The liver is felt below the
ribs; the upper line of dulneas is lower than natural (at
seventh rib) owing to increased lung resonance, so that the
liver dulness only measures vertically three inches in the
nipple line. At the junction of the umbilical and right
lumbar regions, and about three inches from the edge of
the right ribs, a hard mass about the size of a large walnut
is felt on deep pressure; it is somewhat tender and quite
immovable. Ordered iced milk, milk and soda-water in
small quantities with brandy, and a mixture containing
bismuth, hydrocyanic acid, and opium.

Oct. 16th: Sickness somewhat less. Has kept a little
down. Medicine has not been returned.—17th: Not so well;
sickness is worse; has not been able to keep anything down.
Ordered nutrient enemata of beef-tea, egg and brandy, three
times a day.—19th : Sickness still continues; is very rest¬
less ; cannot sleep at night. Ordered white of egg by mouth,
as well as the enemata, also a pill containing half a grain of
opium every four hours.—20th: No diminution in sickness.
Ordered an effervescing draught, with hydrocyanic acid and
opium.—21st: She is much worse, and in a semi-unconscious
condition, from which she can be routed to a certain extent.
No Bickness since 3 a.m. ; pulse frequent and very feeble.
Ordered two drachms of brandy every hour. From this
condition she never rallied, but, becoming more unconscious,
died at 6 p.m.

Necropsy.— Body fairly well nourished; skin and con¬
junctives intensely jaundiced. On opening the abdomen,
a good layer of fat was noticed in the abdominal wall. The
liver was seen to project about an inch below the edge of
the right ribs; it was somewhat larger than natural, and
the increase was most marked in the Toft lobe. On section,
the central zone was well marked, the outer being pale.
The gall-bladder was small, and adherent to the under
surface of the liver; its walls were much thickened. On
opening it, it was found to contain about a tablespoonful of
thick greenish fluid, and thirteen or fourteen gall-stones,
varying in size from a small pea to that of a hazel-nut; most
of the stones were marked by facets. The cystic duct was
much dilated, and contained two gall-stones about the size of
small hazel-nuts. The common bile-duct was much dilated,
and was at least as large as a man’s thumb. At the point of
entrance into the duodenum three large gall-stones were im¬
pacted in a triangular fashion, two being in front and one
behind; they completely blocked the opening into the duo¬
denum,wereof the size of large hazel-nuts,angular, and marked
by facets; the remainder of the common duct contained three
stones, rather smaller than these. The hepatic duct was
dilated, and contained two 6tones, which were angular and
marked by facets., The duct from the left lobe wal much
dilated, and contained one stone about the size of a large
pea; the duct from the right lobe was not much larger than
natural, and contained no stone. The spleen was congested
and very friable. The kidneys were slightly puckered, and
the capsules somewhat adherent. The glands in the lumbar
region lying to the right of the bodies of the vertebr®, and
behind the duodenum and head of the pancreas, were con¬
verted into a hard calcareous mass about the size of a
walnut. There was no bile stain on the mucous membrane
of the duodenum.

Remarks.—' The rarity of death from impaction of gall¬
stones uncomplicated by other disease alone makes this case
interesting, only two cases being quoted in Murchison’s
*' Diseases of the Liver,” and these do not occur in his own
experience. The diagnosis was in some degree complicated,
owing to the small tumour felt at the function of the
umbilical and right 1 umbar regions. This, which proved to be
a calcareoas mass of glands, suggested some malignant disease
of thepylorus,duodenum,orheadof pancreas; but the charac¬
ter of the pain, the interval between the patient’s illnesses,
and the freedom from symptoms, together with the fact
that there was comparatively very little loss of flesh, pointed
to gall-stones as the chief element in the case. Another
point of interest was the cessation of pain for so long a
period before death, without any improvement in her other
symptoms. Then there was no enlargement of the gall¬
bladder, owing to the obstruction of the cystic duct—a
pbint which usually helps the diagnosis. As to the immediate
cause of death, it was no doubt due to eholmmla and the
exhaustion consequent upon the continued sickness. BUe
had evidently not entered the intestines for some time. In
conclusion, could anything have been done in the way of an

operation (cholecystotomy) in this case ? In my oprnica
decidedly not, as the gall-bladder was small and flimlj
adherent to the under surface of the liver.

Brlzton-hill, 8.W. ______________

GOITRE IN ANIMALS.

By ALLEN THOMSON SLOAN, M.D. Edik.

Thb question of goitre among animals appears to have
been little studied, and it is difficult to get any literature
on the subject. For my present information I am indebted
to the works of St. Lager and Baillarger, and also to the
kindness of Principals Williams and Walley of the Veteri¬
nary Colleges, Edinburgh, whose opinions, however, are
rather opposed to each other. According to St. laager, the
thyroid gland exists in all mammiferous animals, birds, and
reptiles. Is is wanting among many fish—such as the perch,
mackerel, salmon, herring, turbot, and sole; but it exists in
the carp, sturgeon, eel, and shark. In many mammals—as
the camel, alpaca, nylghau, hartebeest, dog, wart hog.
porcupine, and kangaroo—the isthmus is wanting, and the
two lateral lobes are quite disconnected; whilst in the female
carnivora the isthmus is very small in relation to the size o3
the lateral lobes (Turner). . „

Naturalists have wrongly applied the term goitre to
the enlargement of the throat seen in certain reptiles—such
as the chameleon, iguanas, lizards, and some species of
toads. Among these the skin of the neck hangs down in
projecting folds. The term “ goitre ” has also been applied
to the swollen necks found in certain birds—such as
the pouter pigeon, the cormorant, the pelican, and somo
vultures, all of which have enlargement of the throat quite
distinct from the thyroid gland. Aristotle, Pliny, Galens, and
.Etius have remarked that pigs are subject to swellings of
the glands of the neck. Galen expresses himself thus-
“ Graeci strumas appellant x 0L P a ^ (i a porcisin quorum guttuie
adenosi quidam tumores reperiuntur.” Paul D'Egine said
that thet-e referred to scrofulous tumours, but Pliny, in bis
Natural History, says positively that pigs are subject to goitre
owing to the bad water they drink. Vegece, in his “ Treatise
on the Veterinary Art,” speaks of scrofulous tumours of the
parotid, and goitres which are seen sometimes in mare*.
Goitre has been seen in dogs and pigs in many parts of
Switzerland by various observers. It has been noticed in
sheep and cattle in Switzerland, Wurtembuxg. the valley o.
the Danube, in the Himalayas, in Siberia, in Brazil, and the
United States. Rudolp and Rupp have seen hymna*
goitrous. Gustave Rudd<5 has seen in Siberia, near the
Chinese frontiers, antelopes with goitre. He thought av
first they formed a new species, and called it “antelope
gutturiosa"; but as he only saw them in districts where
goitre also affected man, and not in those where it wa»
absent, be came to the conclusion that it was pathological.

In Russia, Central America, the United States, and in the
Canton of Geneva horses have been seen goitrous. M.
B&illarger, in a paper read before the French Academy oi
Sciences, 1 gives the result of his researches undertaken u»
the departments of the Savoy and of the Isere. In maav
localities in Maurienne, St. Jean, and St. Michael, he foimC
among mules hypertrophy of the thyroid gland in much
greater proportion than among man. In a stable of Modane,
out of twenty mules nineteen had goitre. In the depart¬
ment of Isere, out of thirty mules employed in the mining
works no less than twenty-three had goitre. In the norma,
state the thyroid gland of mules is about the size of a
chestnut, but in these cases it had attained the size of a ben*
or turkey’s egg. As a rule, the goitres were very movabir
and caused no pain; but in three cases they compreaaad tbe
trachea, and produced breathlessness during strong muscular
effort, causing the animals to kick. The hypertrophy
affected both lobes of the gland, or one only, and in the
latter case more often the left. At Allevaru, Dr.
Niepce confirmed these observations. The existence
among mules of a special tendency to hypertrophy oi
the thyroid seems to be placed beyond doubt, and doe*
not exist to the same degree among other domesu;
animals. Horses are often attacked with goitre, but the
proportion is much less. In certain condit ions, howe ver.

i Sur le Goitre dee Animaux. Compte Benda, Aosddmle dee Science*

1869.

Thb Lancet,] ME. A. GRE8SWELL: ABNORMAL GROWTHS IN MEN AND ANIMALS. [Mat 28,1887. 108a

the frequency is very great. At St. Jean de Maurienne four
out of seven horses of the gendarmes were affected with goitre
after a residence of less than two years in the place. This
case was all the more remarkable because these horses were
well fed, carefully groomed, and kept in a well-lighted and
well-ventilated stable. After horses, dogs are most liable
to hypertrophy of the thyroid. Finally, one finds it in cats,
cows, sheep, goats, and pigs. It is impossible not to attach
goitre in animals to the same endemic causes which produce
it in man. Among a great number of these animals in
Swiss localities, it was rare to find a thyroid of normal size.
Professors of veterinary medicine have considered goitre
excessively rare among animals. I believe this rarity only
exists in healthy localities, but it is otherwise where goitre
and cretinism are endemic. It is difficult to account for its
special prevalence among mules, but it is interesting to note
its occurrence among sterile animals, when sterility is one
of the characters of cretinism. In regard to cretinism few
observations have been made. Reynard has seen in goitrous
dogs a stupidity C5mparable to idiocy, and Rougieux has
observed the same degradation in dogs and horses. St. Lager
asked several persons who possessed goitrous animals in
Savoy, Switzerland, and Piedmont, and all have assured him
that the hair becomes rough and coarse, the voice hoarse,
and the memory obliterated. They become lazy, and finally
reach a state of torpor which it is quite justifiable to
compare to cretinism. Moat interesting are the above
observations when viewed in the light of the recent experi¬
ments of Mr. Victor Horsley, who, in showing the relative
value of the thyroid gland iu different animals, demonstrated
how its removal produced sooner or later grave nervous
effects in the donkey, pig, cat, and dog, according to the
functional importance of the gland in each. 3 Alibert says
chat sheep and calves not unfrequeiitly die from the effects
of goitre.

Observers in India confirm the fact that goitre affects
animal8 in those countries where it is endemic. Thus Mr.
Greenhow * says: “ At Hi sea ur pore, a village on the Sarjoo,
about twelve miles distant from Seerora, dogs and other
animals are affected with goitre. Mr. Bramley 4 noticed the
same curious circumstance in Nepaul, for he mentions, “ on
one occasion s goat brought forth a kid with a goitre as large
as its head.” Puppies of a month old, bred from English
dogs, are very frequently affected by it, as are also lambs.”
in 1824 he observed this tumour in camels at Purneah, and
crows are likewise said to be affected with it at the Bame
place. Dr. Campbell * has seen horses and lambs goitrous
on the borders of Gunduk, and also many animals in Nepaul,
among others buffaloes. Dr. MacClelland reports its occur¬
rence among dogs and cats in the Himalayas. While Mr.
Brett, in bis “Surgery of India,” says: “ Bronchocele is
congenital in animals in Nepaul; almost the moment the
mimal is born it expires”—a fact noted also by Dr. Campbell.

Principal Walley of the Dick Veterinary College, Edin¬
burgh, is of opinion that goitre in animals is an extremely
'are disease, and that the cases reported have been generally
nistaken for struma. In horses especially it seldom occurs,
ind these also are very free from struma. The only typical
:ase of goitre be has seen was in a horse belonging to the late
Smperor Napoleon, which was bought by Mr. Pender, M.P.
r or Wick. Owing to the enlarged thyroid the animal was
ifflicted with “roaring,” so its removal was attempted.
During the operation, however, the horse in its struggles
>roke its back, and bad to be killed. Mr. Walley thinks
hat true cases of goitre do occur among pigs, and these
>f all domestic animals are most commonly affected with
icrofula. He considers it rare in dogs and cattle. 1 have
lever seen a case of goitre in an animal, but it is interesting
o note that in Cumberland, where it exists as endemic
lisease among man, that cattle are notoriously subject to
crofulous enlargements of the glands of the worst type.

Principal Williams, of the New Veterinary College, Edin-
>urgb, informs me that goitre is prevalent m horses, sheep,
ind cattle in Derbyshire and some parts of Wales, where
nagnesian limestone prevails, but that he has seen it pretty
»>mmon in places quite independent of this. In his practice
ound about Edinburgh he finds it occasionally occurring in
.’oung foals, which fact he associates with bad ventilation,
t is sometimes congenital; in one case a mare of his own
rave birth to a. foal that was goitrous. It is more rare among
ogs, though it sometimes affects young ones, disappearing

* Brown X«ctur«*. The Lahcet. Dec. 18th, 1888.

* Indian Annals of Medical Science, rol. xll.

* Calcutta Medical Tran*., 1833. * Ibid, 1835.

as they grow older and under treatment. About twelve
years ago an epidemic of it affected Lord Polwarth’s lambs
at Mertoun, Berkshire. In his “Principles and Practice of
Veterinary Surgery,” he writes thus: “ Cysts in the thyroid
body constitute bronchocele; they are said to be caused by
the water which the animals drink, and that if the water
be changed they will disappear. But I have some doubt as
to the truth of the statement that bronchocele is solely
caused by the presence of magnesian lime in the water, as I
have seen well-marked cases in young foals and in large
flocks of lambs where this could not possibly be the cause.
Doubtless, it is found most abundantly on the magnesian
limestone formations; but it cannot be denied that low
situations, or a damp atmosphere upon elevated situations,
will act as causes of bronchocele.”

Both these professors have several times seen the thyroid
completely destroyed by inflammation and suppuration, and
the animal remain afterwards perfectly well. Neither of
them have had any experience in regard to removal of the
gland, as cases necessitating this operation are hardly ever
met with.

Artificial production of goitre in animals .—Various ex¬
periments have been made upon animals with the view of
artificially producing goitre, but without any trustworthy
results. According to St. Lager, both he and Baillarger
administered preparations containing carbonate of lime and
magnesia to dogs for a period of six months, without any
enlargement of the thyroid gland ensuing. The same writer
gave dogs and guinea-pigs sulphuret ana sulphate of iron
and other metallic salts for some months, but with negative
results. One day, however, in his own house, he caught a
mouse, and to his astonishment it had A goitre, which he
thought might have been caused by its eating cinders of a
certain coal which contained aulphuret of iron. Accordingly
he experimented on a dozen mice, giving them sulphuret
and sulphate of iron, baryta, fluorine, and natural bitumen.
At the end of three months three only had enlargement of
the thyroid perceptible both to sight and touch. These
three had added to their food sulphuret aud sulphate of
iron. Many doctors of Lyons are reported to have seen
these animals, but the experiments can hardly be said to be
trustworthy or at all convincing. The salts of iron have beeh
long administered in medicine, and for the last few years not
only the sulphate but the sulphide of iron have frequently,
and for lengthened, periods, been given in the treatment
of anaemia, with none other than a beneficial effect.

Edinburgh.

GENERALISATIONS REGARDING THB

PATHOLOGY OF ABNORMAL GROWTHS IK
MAN AND ANIMALS, AND THEIR EXPLA¬
NATION ON THE EVOLUTION THEORY.

By ALBERT GRE3SWELL, B.M, B.A.Oxon., M.R.CS.

No branch of comparative pathology has received more
careful study than that which deals with the mode of growth
and variations in the histological structure of the various
tumours, malignant and benign. In these short notes 1
propose to restrict myself to a cursory survey of the
etiology of abnormal growths, not criticising views which
are generally held, and not dealing with the actual or
immediate cause, but suggesting a general basis which
may be regarded as the ultimate cause to which such
abnormal manifestations may probably be traced. In order
to clearly explain my meaning and to illustrate it more
fully, some remarks of my brothers, Dr. A9tley and Pro¬
fessor George Gresswell, may, in the first place, be mentioned.

It may be said that all new formations, as instances of
which the enchondromata may be taken, are characterised
by the preponderance of cellular elements. These are, of
course, variously modified. They may fibrillate, and, further,
may be at length calcified; but very rarely, if ever, do they
develop into the highest forms of tissue, the muscular and
the nervous (Buhl). This latter fact is only to be expected,
since the tissues of most important specialisation must
necessarily be those which are produced, so to speak, with
greatest difficulty. It is a familiar fact that all the
tissues of organisms are to be regarded as having their
origin in celle. Similarly, too, new formations in man and

1084 The Lancet,] MR. P. H. M. BURTON ON OSTEOPHYTES OP THE ARACHNOID.

anim&Ia are also traceable to the proliferation of cells.
Necessarily, the cells become more or less modified so as to
become almost, if not quite, indistinguishable from their
parent cells. New formations of all varieties are, I hold,
to be looked upon as reversionary in nature, and are clearly
traceable to a remote ancestral condition, when the primary
importance of cells as units not greatly modified, distinct and
uncombined into aggregates or but imperfectly and incom¬
pletely combined, was far greater in the respect of individual
power than it can be, where each cell is dependent on the
activities of other units, with which it is combined as in the
higher forms of life.

As illustrating my theory, let me briefly consider some
points regarding the enchondromata. Enchondroma myxo-
matodes presents structural features such as are met with
in the notochord of the vertebrate animals. The cells of
some enchondromata are stellate, their processes uniting
into a network. A like condition of cellular structure is
met with in the Selachii, which may be regarded as the
root forms of the vertebrates. Again, enchondromata are
most common in the limbs, and especially in their distal
extremities; and, since the original condition of the verte¬
brate limb is represented in the selachii as a multitude of
cartilaginous rods arranged in a definite manner (the rods
increasing in number towards the distal extremity of the
pro-pterygium, the meso-pterygium, and the meta-ptery-

? jutn), we are perhaps justified in looking upon these
acts as showing to us homologous relationship. Corro¬
boration is seen in the frequency with which cartila¬
ginous bodies develop in connexion with certain joints
of the limbs in man and animals. These bodies are either
single or multiple, and they are of all sizes up to that
of a small apple. Cruveilhier figures a number of rounded
cartilaginous bodies in the elbow joint. Mr. Smith removed
over 200 loose rounded cartilages from the knee joint
of a man at St. Bartholomew’s Hospital. He also operated
on a woman, aged twenty-eight, who had for six years

f iresented a tumour in the upper third of the right arm,
mmediately beneath the skin. The tumour was pyri¬
form, tapenng towards the axilla. It was three inches and
a half long, and two inches in diameter at its thickest part.
It was encapsuled, and within the capsule there were found
one large mass of cartilage and twelve or more detached
lobulated bits of cartilage. There were also similar detached
nodules of cartilages in the axilla. The limbs, in fact, of
the higher animals may have therefore dormant germs of
the ancestral rods of cartilage; indeed, cartilage cells
have been found in the synovial tufts of some joints.
From such centres some of the above-mentioned
cartilages had apparently developed. Supernumerary
fingers have been referred to the multifid condition of the
rays of the selachian fin. New formations of capillary
vessels are generally congenital, aud they are much com¬
moner in the skin of the head and neck than elsewhere.
These facts might suggest the possibility that they bear
homologous relations to the vessels which develop about the
epiblastic involutions lining the visceral arches of the lower
vertebrate. Dr. D. A. Gresswell recently saw a nmvus, the
distribution of which seemed to afford some corroboration
for such a speculation concerning the homology of n®vi.
It extended in a snake-like form down the right side of the
neck; it was distinctly raised, and it passed with a tapering
extremity into the external auditory meatus, down which
it extended for a considerable distance.

It will be seen that the view which Dr. D. Astley Gress¬
well pointed out, and which we now wish to lay stress upon,
is that one of the primary properties of cellular organisms ;
was that of multiplying by processes of fission and gemma¬
tion. This characteristic, originally possessed by inde¬
pendent units, is still, in greater or less degree, a feature of
those units which, when combined in various ways, make
up the tissues and organs of higher forms of life. At times,
and under special circumstances, which, in the present state
of our knowledge, in many instances can only be roughly
traced, this ancestral tendency of the cells to divide aud
multiply on their own account shows itself once more with
something of its old vigour, and then new formations of
various kinds result. When the bloodvessels are invaded
by Dathogenio micro-organisms, may it not be that, as
previously pointed out, a kind of warfare, so to speak, goes
on between the blood cells and the vegetal germs, and that
when the latter gain the victory the man or the animal dies:
whereas in cases where the blood-cells possess the power of
strong resistK- : h« sufferer also withstands the deadly

[Mat 28,1887

effects of the foe ? In some instances, then, the fertility of
cells in the way of reproduction would be highly service¬
able to the man or animal, while in others such power of
multiplication is manifestly most destructive. Is it not
a great question if we should not, in our investigations
of disease, search most diligently into all those conditions
which would enable us both to control and to- facilitate,
the growth and multiplication of cells?

Louth, Lincolnshire.

CASE OF

OSTEOPHYTES OF THE ARACHNOID:

By F. H. M. BURTON, M.8. Dcbit., M.R.C.S.,

aURQROa, ARMY MEDICAL ST AFT.

On Nov. 28th, 1886, W. R-, a private in the 1st Battalion

of the Royal Welsh Fusiliers, aged twenty-seven, who had
served for a period of six years and three months in India^
was detained in the Bhamo Field Hospital, suffering from
ague. During his service in Barmah he had been twice in
hospital for simple continued fever, and in May was invalided
to Darjeeling from Mandalay, returning to duty in Bhamo-
early in November.

On admission, the patient was treated with quinine and
a saline diaphoretic. He remained in bed during the day,
and at 6.30 i\m. took some beef-tea. At about 9.30 p.m. a
comrade’s attention was attracted by his loud breathing and
attempts to vomit. When I saw him he was lying on his-
back. On speaking to him he appeared to follow me with hi*
eyes, but was otherwise unconscious. His pupils acted to-
light, and the conjunctivas were sensitive; the teeth were
tightly clenched, the right forearm was flexed at the elbow,
and the fingers flexed on the hand, the right arm, forearm,
and hand all being in a state of tonic rigidity, and tbe left
arm and both legs in a state of flaccidity ; occasionally both
arms were jerked up in a spasmodic manner. Temperature
101-4°; pulse regular and good; breathing slightly stertorous ;.
skin perspiring profusely. He had vomited a little bilious
fluid.

On the morning of Nov. 30th, at 7.15 a.il, when I again
visited the patient, he was suffering from clonic convulsions

Drawing exact size of oeteomati.

of the muscles of the head, neck, trunk, and arms; the righc
leg was affected at intervals. Temperature 101-6°; skin
perspiring profusely; quite unconscious. The clonic con¬
vulsions lasted considerably over two hours, and became
very violent, the head being drawn to the right; and once
the man uttered a shrill cry when the convulsions were
most violent. As nothing could be given by the month, an
enema of bromide of potassium was administered. At
11.30 A m. the convulsions had ceased, and the patient lay
passive in bed. Temperatare 107*4°; pupils contracted t-e
the size of a pin’s head and fixed; breathing stertorous:
pulse irregular and rapid. The temperature afterwards fell
to 106-6°, there was loud stertorous breathing, the pulsation
gradually ceased, the pupils became dilated, seminal omis¬
sion occurred, and death ensued at 2.16 p.m. The patient
had been altogether fifty-three hours and thirty-five minute*
under observation.

Necropsy .—General aspect of body: A well-nourished
man, but decided malarial cachexia. Cadaveric rigidity
well marked in lower extremities, passing off in the upper
part of the body. Brain and membranes: On removing the
skull-cap, some half-dozen small osteomata, from the size of
a pea downwards, were found symmetrically arranged on
either side of the groove for the superior longitudinal sinus,
and growing as excrescences from the inner surface of the
frontal bone, composed of compact bone (see accompanying
drawings); owing to the close adhesions in this sitaation
the dura mater was torn in taking off the skall*-oap. After-
opening the superior longitudinal sinus from the cristi
galli of the ethmoid to the torula Heropbili, the
falx cerebri were detached from the crieti galli, and
the dura mater and the parietal layer of the arachnoid
stripped off from before backwards. Immediately behind
, the fissure of Rolando of the left hemisphere, and over the

O

Thb Lanckt,]

tipper part of the ascending parietal convolution, the visceral
and parietal layers of the arachnoid were strongly adherent;
there was a small patch of freshly effused lymph on the pia
mater, and flat osteophyte (made up of two pieces closely
hound together side by side) of the size of the thumb-nail,
one-seventh of an inch thick, growing from the arachnoid
-and pressing upon the brain, its under surface being very
rough and having several spiculso. An inch and a naif in
Iroat of this growth was another three-quarters of an inch
long, one-tenth of an inch thick, and one-flfr,h of an inch
broad, with sharp needle-like extremities, curved down wards;
-this was situated at right angles to the falx cerebri.
^Between the two growths the membranes were much
thickened and there were signs of old inflammation. A
similar set of growths (three in number), in the same position 1
as the first one described, were found growing in the arach¬
noid over the right hemisphere, but extending over about
twice the surface occupied by those on the left hemisphere,
and having several very sharp and needle-like spicuhe, all
-curved down on to the pia mater. The visceral and parietal
layers of the arachnoid were adherent in the situation of
the growths, as on the left side, but there was no sign of
recent or active inflammation on this side of the brain. The
apper surface of the dura mater was normal. There was
no fluid in the subarachnoid space or ventricles of the
brain, and no other signs of inflammation of the membranes
-or of t^e brain. The superficial veins of the right side of
the brain were somewhat congested, and the right lateral,
-superior and inferior petrosal sinuses were full of dark
tarry blood. Thoracic cavity: The right lung was firmly
'bound everywhere to the chest walls by old adhesions.
There were some old tubercular deposit in the upper part
of the pleura. The lung itself was codematous, but other¬
wise healthy. The left lung was cedematous, and some old
tubercular deposit existed in the upper part of the pleura;
-otherwise healthy. Heart normal. Abdominal cavity: Gall¬
bladder full of thick reddish bile. Spleen enlarged and soft.
Pancreas normal. The stomach contained some ounces of
thick bile, and the mucous membrane was covered with
thick, stringy, sticky mucus. Duodenum full of thick bile.
Jejunum normal. The ileum contained much bilious faecal
matter. Colon and rectum normal. Kidneys normal.

Remarks. —The growth of osteophytes from the arachnoid
is a sufficiently rare pathological condition to justify the
publication of the above case. There was no history of
syphilis; there were no symptoms by which cerebral disease
could be diagnosed till the fatal attack, when the symptoms
of pressure on, and irritation of, the cortex of the left hemi¬
sphere of the brain were well marked. In my opinion the
fever suffered from was malarial, and merely caused an.
-exacerbation of the chronic disease, and determined the
fatal irritation and inflammation.

Bbamo, Burmab,

FOREIGN BODY IN TIIE AIR PASSAGES.

By CHARLES BOYCE, M B., C.M.Edi*.

Thk following case is interesting as showing the length of
time which a foreign body of the size shown by the accom¬
panying diagrams may remain in the air passages without
producing any untoward symptoms.

On October 20th last F. C-, aged twenty, whilst driving

'home on a very dark night through a narrow lane smoking
a briar pipe with a vulcanite mouthpiece was thrown out of
hie dogcart and rendered insensible, the pipe he was smoking
being lost. For some time he lay insensible, and became
•cold and wet from the reetoratives used by the surgeon who
saw him at the time. When he recovered consciousness he
vras carried borne and seen on the following day by my
-assistant, Mr. Macartney, and myself. His condition was as
follows: There was considerable ecchymosis of the face and
-eyes, slight nasal catarrh, but no difficulty of breathing or
■impairment of expansion, resonance, or respiratory sounds,
vesicular breathing being apparently equal over both lungs
at repeated examinations. Examination of his throat showed
oothing beyond relaxation of the fauces and elongation of
the uvula. No laryngoscopic examination was made. There
was no cough or shortness of breath; no pain or uneasiness,
except on lying down in bed at night, when the breathing
became whistling. This was the reason of my careful ex¬
amination of the lungs, as I feared the development of some

[May 28,1 887. 1085

inflammatory trouble. As no improvement occurred in his
condition, I advised him to go to Brighton for a change of
air, cautioning him against going out at night or exposing
himself to cold. When he had been some time there, one
morning (Dec. 13th), whilst eating his breakfast, he swallowed
a email fishbone, which caused a violent fit of coughing,
during which he brought up part of the vulcanite mouth¬
piece of the pipe he was smoking at the time of the accident,
the shape and exact size of which are figured in the dia-

LongitudIn.il View. Largecnd. SmnUend.

-Thicknm.

■ ■ ■ ■ D*pt h at smal l end.

-DuptU at large end.

-— Length through centre.

grams. At the time of the convulsive cough a deep-seated
pain at the sternal end of the right clavicle was experienced.

Remarks .—The most notable feature in this case was the
absence ot any serious symptoms; in fact, it was only
whilst in the recumbent posture that any symptoms occurred
pointing to the presence of a foreign body, and as the
patient was quite unaware of what had happened to the
mouthpiece of his pipe, the real condition was never sus¬
pected. I should be inclined to say that the foreign body
lay crosswise in the trachea at its bifurcation, and that
whenever he assumed the horizontal posture its position
became slightly altered, so os to project more or less into the
bronchi, causing the whistling breathing, and the pain at the*
right sterno-clavicular articulation which was felt at the
time of its expulsion. Had it been in one of the bronchi,
we should have expected far more serious symptoms from
the size of the body, and the dyspncei which was observed
only on lying down would have been difficult to explain.
The termination of the case was most fortunate for the
patient, especially when we consider the size of the body
expelled. Mr. Durham in Holmes’ “ System of Surgery”
(3rd edition) gives the results of a number of cases
of foreign bodies in the air passages, from which it
appears that of those In which no operation was performed
death resulted in about 40^4 per cent.

Miknicue.

OVARIAN TUMOUR FOLLOWING INJURY;
OPERATION; RECOVERY.

By JAMES WILSON, M.D., F.R.C.S. E.vo.

Miss L-, aged eighteen, gives the following history:—

About three years ago she struck her left side against a door,
felt faint, hod severe and continuous pain for two years, and
thought she could feel a lump at the seat of injury. About
a year ago the swelling began to increase, with oomplete
cessation of the pain. Bowels costive ; menstruation irre¬
gular, periods varying from a fortnight to two months. She
consulted a medical man, who treated her for indigestion
and flatulence.

On examination the chest was found to be normal. Urine,
free from albumen. Slight oedema of feet and ankles^
Family history of phthisis. Temperature normal; pulse 130
per minute. On examining the abdomen, it was found ex¬
ceedingly enlarged, with distinct fulness on left aide. Os

E rcussion, dulness extended from the pubes to the sternum,
sonance in flanks, but more marked on right side. Dis¬
tinct wave of fluctuation in every direction. Per vaginam
the uterus was normal, save that it was markedly depressed.

On March 3rd, under the A.C.E. mixture, ovariotomy was
performed. The abdominal walls were thin, tense, ana free
from adipose tissue; hremorrhage slight. On opening the
abdomen the tumour was found to be non-adberent. It was
tapped and about two gallons of fluid withdrawn, when a
dense flbro-muscular tumour, weighing about 2J lb., was
removed with the cyst wall. The pedicle was tied with
China silk. The other ovary was found enlarged and cystic,
and was also removed. The abdomen was cleared of a little
ascetic fluid with sponges. The abdominal wound was

MR. C. BOYCE: FOREIGN BODY IN THE AIR PASSAGES.

Digitized by ^jOOQle

1086 The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[Mat 28,1887,

stitched with silver wire, and iodoform powdered over the
surface. No spray was used. The patient recovered from
the anoesthetic in an hour after the operation. There was
slight sickness, but no pain. Ice was given. Tempera¬
ture 100° in the evening.

March 4th.—The patient has slight headache and pain.
About two drachms of blood passed by Fallopian tubes.
Natural sleep. The only unpleasant symptom was suppres¬
sion of urine. Temperature 100'5°. Ordered milk, ice, and
champagne in teaspoonful doses.—5th: Patient comfortable;
temperature 99 - 2°, pulse 100. The napkin had a urinary
odour.—6th : Patient slept well the previous night, and at
7 a.m. one pint of urine was drawn off by catheter. Wound
healthy, and apparently healed. Temperature 99 - 2°. —
7th: The patient has slight bladder irritation, and passes
urine without the aid of the catheter. Temperature normal,
pulse 98. Takes milk and champagne freely.

The case had an uninterrupted recovery, except that the
bowels were obstinate, and there were severe griping pains for
several hours on the eighth day. Three weeks after operation
the patient was perfectly well, and able to move about freely.

Haverfordwest.

% lltirar

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nulla autera eat alia pro oerto noscendl via, ntai quamplurimaa et mor-
borura et diweotionum historlas, turn alioram turn propriaa oolleota*
habere, et Inter ae oomp&rare.—M oruahsi De Sed. at Catu. Mori).,
lib. iv. PnxBmium. -

MIDDLESEX HOSPITAL.

THREE CASES OF SARCOMA COMMENCING IN CONNEXION
WITH THE SCAPULA, THE THIGH, AND WITH THE
FEMUR; RESULT.

(Under the care of Mr. J. W. Hulks.)

Whilst cancer (anatomically defined) is not often seen
before the end of the third decade of life, sarcoma does not
observe such restrictions, but attacks alike the young and
persons in advanced age. But this statement is subject to
the limitation that the melanotic variety rarely occurs before
middle life, and glioma (regarded also as a variety of
sarcoma) in its most frequent seat—the retina—has a strong
predilection for infancy and early childhood. Youth and
early adult life furnish a large proportion of cases of sarcoma
originating in connexion with the motor apparatus, and
under the circumstances incidental to these life-phases the
disease usually runs a rapid course and manifests great
malignancy. In the first and second of the following cases
exarticulation at the shoulder and hip joints, ensuring a
more complete removal of the tumour, would have offered a
prospect of longer immunity from recurrence; but in neither
instance would the patient accept this measure. The occur¬
rence of secondary tumours within the skull, noticed in the
third case, in which the primary tumour was in the thigh, is
well illustrated by two preparations in the Middlesex Hos¬
pital museum taken at an interval of a couple of years from
the same patient, a ^oung adult: one a persistent sarcoma
of the tibia, for which the leg was amputated; the other
preparation a part of the brain, with five sarcomatous knots
in the pia mater.

Case 1. Sarcoma originating in connexion with the struc¬
tures attached to the coracoid process of the scapula;
excision; recurrence; a second operation: some months later ,
death.— In July, 1885, a milliner aged twenty-four, an
anmmic blonde with flushed cheeks, was admitted for a
swelling lying below the outer third of the left collar bone.
It had a roughly hemispherical outline ; its consistence was
firm, yet elastic; it was evidently beneath the pectoralls
major muscle: it was not attached to the clavicle or to the
humerus; it moved with the scapula, with the coracoid

S rocess of which it appeared to be closely connected. No
ifferencesin respect of force, volume, and time were notice¬
able in the wrist pulses. No loss of muscular power and no
Impairment of sensibility of surface were observable in the
limb. She complained of a dull aching pain in and about
the swelling. The patient, a native of a northern county,

said that she had been in London about a year, in ti»
course of which her health, good before, had failed; dre!
had become delicate, liable to faint, subject to palpiutix
and nervousness, and for the last three months had nr.
menstruated. Nearly at the same time when her couiw
stopped, whilst washing before a mirror, she first notice!
the swelling. A few days later she showed it to i
doctor, who, regarding it as glandular, directed her to
paint it with iodine. This had not, however, any cun-
tive effect; the swelling continued to enlarge, and tier,
pain supervening, she was advised to enter the hospital
The swelling was manifestly not of an inflammatory niton.
There were not any grounds for considering it guarantee*.
Its rapid growth, its elasticity, its connexion apparently
with bone, together with the woman’s age, concurred in
suggesting sarcoma. On July 20th the tumour was eipoeai
by an incision following the interval between the pectonlii
major and deltoid muscles. When the borders of there
were retracted, it became apparent that whilst a small part
of the tumour cropped out above the upper border of the
pectoralis minor muscle, the chief mass of it was corere!
by this muscle. The latter was therefore divided; the
axillary vessels, which were found displaced inwards by tie
mass, were drawn aside, and the deep connexions of the
mass, which were found to be, as had been suspected pre¬
viously, with the fibrous structures, attached to the coracoid
process, bemg next divided, the removal of the mass xi?
accomplished. The patient quickly recovered, and on
Aug. 11th was able to be sent to a convalescent homed
Sussex. When next seen, on Nov. 16th following, she con-
plained of a slight uneasiness about the upper end of tbe
scar, but nothing palpable was discoverable there. (ft
Feb. 22nd, 1886, she returned, complaining then of serere
pain in the shoulder and down the back and the inner tile
of the arm. A mass of some size could now be felt
beneath the scar, but not implicating it, lying deeply
beneath the axillary vessels, which it displaced inw&rd*.
The left radial pulse was weaker than the right. Txo
days later (Feb. 24th) the tumour was laid bare by u
incision following the inner border of the scar. Its principal
mass was found wedged in between the chest wall, tie
neck of tbe humerus, and the scapula. The axillary vessel#
and the brachial plexus ran through a groove in its anterior
surface; the circumflex nerve pierced its substinct
During the extrication of tbe axillary vessels and tire
nerve cords, a thin fascial capsule which enclosed the
tumour was ruptured, which rendered the clean and entire
removal of it less certain than it might otherwise hare beer..
By March 15th the large wound had cicatrised, she left her
bed, and by the 22nd appeared convalescent, 8he did no',
however, recover strength, was low spirited, and she often
complained of pain about tbe shoulder. On March 30 :t
some hasmoirhage was detected in the neighbourhood of tbe
coracoid process. She went for a few days into tbe country,
and on her return on the 22nd of April a recurrence of the
sarcoma was unmistakably present. A large ill-defined ma?--
projected forwards the pectoralis major muscle, filled tire
armpit, extending thence upon the dorsal aspect of tire
scapula, and upon the back of the upper arm. She had
much severe pain in the arm and in the shoulder, and ft-
complained of some shortness of breath. The left side of
the chest was now found less resonant and the respirator
sounds feebler than on the right side—changes which
Dr. Cayley, who made this examination, regarded i‘
suggestive of implications of lung by the new growth. Til £
visceral implication placed tne case beyond farther
surgical aid; she therefore returned home, where fh?
lingered until the end of February of this year, death
occurring about twenty-eight months after tbe fir'
recognition of the swelling. Mr. R. Williams, the bospit-
pathologist, reported that the primary tumour and the
recurrent mass both exhibited the fine structures characte-
istic of sarcoma.

CASE 2. Sarcoma in the upper third of the thigh; erring-
death from chest implication some months later.— A book¬
seller’s assistant, aged twenty-four years, was admitted mb'
the hospital on Jan. 1st, 1884, with a swelling in the upp^
part of the front of the thigh, reaching very near to tk
groin, evidently involving the adductor muscles, and di¬
placing outwards the superficial femoral vessels. Its ficrcre
was tabulated; its outline seemed definite. It was not tin* ;
to the femur. He had been very active, and much addict*
to football playing. For about eighteen months he had bad
pain in the thigh, which had been attributed to a sprai*-

The Lancet,]

HOSPITAL MEDICINE AND SURGERY.

[May 28, 1887. 1087

One doctor had told him it was due to muscular rheumatism,
and another had pronounced it to be sciatica. About thirteen
months after the first occurrence of pain the swelling
appeared. Its increase had been rapid. The diagnosis was
sarcoma. On May 7th the tumour was exposed by an incision
nine inches long down tbe front of the thigh. The super¬
ficial femoral vessels were first disengaged; they ran in a
groove in the outer aspect of the mass, and the separation
of the vein was rendered difficult owing to the close
adhesion of the paravenous connective tissue to the new
growth. The saphena vein, the upper end of which near
its termination was expanded into a large sinus, and also
closely adherent to the tumonr, was clamped with two pairs
of pressure forceps and the intermediate adherent part
excised. In the dissection required to liberate the
deep aspect of the mass, it became evident that this
was wedged in between the superficial and the deep
femoral vessels. The tumour appeared to have begun in the
adductor longus muscle. After its removal the deep femoral
artery was seen exposed in nearly its entire course. The
extensive and very irregular wound was washed out with
a chloride of zinc solution (twenty grains to the ounce);
two long and -wide drainage tubes were inserted, and the
9dges brought together with silk sutures. Iodoform was
freely applied. A compressive pad of boric-acid charpie
with an outer gauze completed the dressing. All movement
of the thigh was prevented by a Liston’s long splint. The
subsequent course was marked by absence of fever. By
June 19th the large wound had quite closed, and a week
later he left the hospital. The pathologist, Mr. R. Williams,
reported the tumour to present the structure of sarcoma.
The patient died at home in the following autumn of a
chest affection, which the doctor in attendance said was due
to the occurrence of tumours in the lungs.

Cask 3. Sarcoma of the upper part of the thigh spreading
into the pelvis ; secondary tumours on and in the skull and
orbit ana in the lungs . —On Aug. 26tb, 1885, a clerk, aged
twenty-five years, was admitted on account of an affection
of the right thigh. The upper third of the thigh was very
obviously swollen; its girth exceeded that of the left thigh
by three inches. The swelling was caused by a deeply
situated mass which implicated the upper part of the thigh
bone. Below, it subsided so gradually that its limit in this
direction could not be precisely defined. Above, its boundary
was irregular. At the inner side of the thigh in the
adductor region the mass appeared to be connected with the
body and the symphysis of the os pubis, external to which
it dipped beneath Poupart’s ligament into the iliac fossa,
forming there a rounded knob. Yet more externally it
passed below the anterior superior iliac spine into the
buttock, involving the gluteal muscles and concealing the
great trochanter. Behind this last-named process was an
aid scar, as of a former abscess. The thigh was kept flexed
on the trunk at about 80°. Flexion could be carried much
further without discomfort, but extension gave pain and it
caused rotation of the pelvis. The patient stated that in child¬
hood he had been an in-patient under the care of the late Mr.
C. De Morgan for hip disease; that he had recovered, retaining
a useful limb, having fair mobility of the thigh; and that he
had remained well until about eighteen months previously,
when he began to suffer severe paroxysmal pain in the thigh,
which he had himself attributed to a fall occurring some
six months before. For some weeks be was treated for
sciatica, without relief. The characters of the swelling,
together with its history, were thought to indicate sarcoma,
probably periosteal, originating in the femur. The extension
if the new growth into the pelvis forbade exarticulation at
ihe hip joint.

Indisposed to regard his condition as being beyond the aid
if surgical operation, he left the hospital on Oct. 9th. One
week later he was readmitted, being then much weaker and
?reatly worn by the increasing intensity of the pain in the
swelling. This latter also had become larger. Three days
later (Oet. 19th), on waking in the morning, he found the
fight of the right eye imperfect, and his eyeball appeared to
be very slightly more prominent than the left. A few days
ifter this proptosis was unmistakably present. He lingered
antil Dec. 15th.

At the examination of tb^, body, made on the following
lay, Mr. R. Williams found a large sarcomatous tumour
imbracing the upper part of the femur. It displaced but
lid not otherwise implicate the large femoral vessels,
t involved tba brim of the pelvis, and secondary masses
vere present upon the front of the lumbar part of the

vertebral column. A single nodule of sarcoma was found in
the base of each lung. A thin diffuse layer of sarcoma
existed beneath tbe scalp over the apex of the lambdoidal
suture, and two masses were present within the skull —one
beneath that just mentioned, the other anterior to it in
relation to the coronal suture. These intra-cranial masses
apparently arose in the cerebral membranes; there was not
any gross perforation of the bones of the vault of the skull,
and by the unaided eye no continuity between the extra- and
the intra cranial masses was discernible. A nodule of
sarcoma of the size of a walnut was discovered in the middle
fossa of the skull, from which it passed into the orbit sur¬
rounding the optic nerve, and displacing forwards the
eyeball. _

NORWOOD COTTAGE HOSPITAL.

MULTILOCULAR OVARIAN TUMOUR, WITH UMBILICAL
HERNIA, COMPLICATED WITH STRONG PELVIC
ADHESION; RECOVERY.

(Under the care of Dr. John H. GAlton.)

E. S-, aged fifty-four, was admitted on Nov. 29th,

1886. She had been married for twenty-five- years; no
children or pregnancy. No family history of tumours
Eight years ago she first noticed a swelling in the middle of
the abdomen (umbilical hernia). Six months ago general
swelling of the abdomen was first perceived. She has now
a large ventral hernia lust above the umbilicus, which is
included in its walls. It measures fifty-two inches and a
half round the hernial protrusion, and forty-nine inches and
a half above it. Dulness and distinct fluctuation are present
all over the abdomen, except in the right hypochondriac
and umbilical regions, where it is resonant. On internal
examination, there is a small fibroid on the anterior lip of
the uterus, a large mass in front, and a smaller behind in
the posterior uterine wall; slight coffee-coloured uterine
discharge, not offensive. For the lost six months she has
been unable to keep down solid food.

On Dec. 2nd, at noon, chloroform was administered by
Mr. S. Sidney-Turner, and Drs. Miller and Iletley and Messrs.
Gandy and Plimmer assisted. The abdomen was opened by
an incision five inches long below the hernial protrusion,
through very thick and fat abdominal walls. On passing
the hand into the abdomen upwards, some c ils of intestine
were found adherent to the cyst and forming the ventral
hernia. On separating these, the cyst wall gave way, and
some of the clear fluid contents were discharged into the
abdomen and externally. The cyst was then tapped with
Spencer Wells’s trocar, and drawn gradually outside the
abdomen, anterior omental adhesions being separated. After
tapping several secondary cysts and freely opening them
with scissors, the tumour was found to be held to the right
brim of the pelvis by a strong and thick adhesion.. This
was torn through, upon which copious haemorrhage imme¬
diately followed, filling up the pelvis and pouring out of
the abdomen. A large sponge was firmly fixed upon the
pelvic brim, the tumour drawn out, and the pedicle trans¬
fixed and tied with silk ligature. An adhesion on the
posterior wall was then tied with catgut, two pieces of
bleeding omentum were tied and cut away, and, after much
difficulty, the vessel in the pelvic adhesion was secured and
tied with silk. The uterus had a fibroid of the size of a
walnu,t on the anterior wall, and another of the size of a
mandarin orange on the posterior wajl. The pelvis and
peritoneum having been well sponged out, the wound was
closed by four deep thick silver wire sutures and four super¬
ficial thin silver wire, and dressed with green protective
and carbolic gauze, secured by strapping and flannel
bandage over the whole. The quantity of fluid was five
gallons, the weight of solid 3 lb. 4 oz. The operation lasted
two hours, one of which was occupied in searching for the
bleeding vessels. At 2 p.m. the pulse was 81, and tbe tem¬
perature 95 8°. She was ordered twenty minims of tincture
of opium every three hours. At 8 p.m., pulse 104; tempera¬
ture 96-8°; slight hiccough ; ordered ice to suck.

Dec. 3rd.—Pulse 106 ; temperature 99°. In twenty-four
hours nineteen ounces of urine were drawn off. Quite free
from pain. At 12 o'clock the patient was ordered a tea-
spoonful of kreochyle every hour (she cannot take milk).
At 8 p.m. the pulse was 110; temperature 100'4°. Has
passed urine naturally once.

4th.- -Pulse 104; temperature 100°. Passed a good night;
no pain; the tincture of opium repeated every six hours.

ignze y

1088 The Lancet,]

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

[Mat 28,1887.

Ordered a teaspoonful of kreochyle every two hours; beef-tea
one ounce every two hours.—8 p.m.: Pulse 104; temperature
100 - 6°. Beef-tea causing nausea, the patient was ordered
one drachm of an extract of beef, to alternate with the
kreochyle.— 3p.m.: Passed flatus freely; urine thirty-five
ounces in twenty-four hours.

6th.—Pulse 94; temperature 98-2°. Changed outer flannel
bandage, as urine had been passed in sleep. Abdominal walls
move freely in respiration.— 8 p.m.: Pulse 100; temperature
100'8°. Passed forty-two ounces of urine in twenty-four
hours.

6th.—Pulse 84; temperature 99°. Bowels acted freely
under her. Ordered raw meat sandwiches and rice soft-
boiled in beef-tea.— 8 p.m. : Pulse 104 ; temperature 100 2°.
Ordered onedrach m of brandy every two hours. Passed thirty-
five ounces of urine in twenty-four hours.

7th. — Pulse 84; temperature 982°. Was sick this
morning after eating bread-and-butter. Ordered whiting,
and one ounce of brandy every three hours. Dressed
wound; all united; no discharge at any part. Good
abdominal respiration, but much swelling (flatulent) at the
upper and right side of the abdomen. Passed twenty-five
ounces of urine in twenty-four hours.

8th. — Pulse 84; temperature 98‘8°.—8 p.m.: Pulse 96;
temperature 99'4°. Passed thirty ounces of urine in twenty-
four hours.

9th.—Removed all deep and superficial sutures, applied
strips of plaster, pad of dry lint and bandage. Passed thirty
ounces of urine. Ordered fowl and ale.

From this time the progress was uninterruptedly good so
far as the abdomen was concerned, but a troublesome bed¬
sore had formed. The slough separated on Dec. 19tb, and
disclosed a large and deep wound, which slowly healed, and
she was discharged cured on Jan. 22nd, 1887.

RemarJcs.—One point of interest in the case was the reso¬
nance of the umbilical hernia mass with the dulness over all
the rest of the abdomen. This was explained at the opera¬
tion by the collapsed state of the afferent and efferent por¬
tion of the intestine which led to the coils in the sac.
The strong adhesion of the back of the tumour to the pelvic
brim did not admit of ligature before division, but the fact
that it rested upon bony structure and not upon bowel
admitted of its being torn forcibly, without other risk than
the severe haemorrhage which followed.

HERTFORD GENERAL INFIRMARY.

A CASE OF BEMOVAL OF THE COCCYX; REMARKS.

(Under the care of Mr. William Odell.)

Fob the notes of the following case we are indebted to
Mr. H. G. Shore, house-surgeon.

A housemaid, aged twenty, was admitted on March 3rd
with the following history. Last July she fell and injured
the bottom of her spine. She had also a second fall on the
ice last December, and the coccyx was again injured. Since
July she had felt pain at each catamenial period, but for the
last five weeks the pain had been excessive and continuous
when in the sitting position; there was also slight momentary
pain on coughing. The pain and distress of Tate became so
great that the patient begged to have the bone removed.

On examination per rectum, the coccyx was found to be
bent at a right angle, in-curved, and pressing upon the
rectum. It could be straightened at its lower pant, but
would not remain in position. On March 9th, the bowels
having been previously freely relieved by a dose of castor
oil, followed by an enema, tBe patient was placed on her
left side and ether administered. An incision was then
made from the end of the sacrum over the coccyx to its
extremity, the parts being divided down to the bone, from
which all ligamentous and muscular structures were then
removed. The coccyx was separated at its junction with
the sacrum, to which it had become ankylosea at an obtuse
angle. There was rather copious haemorrhage at one time
during the operation, but it was controlled by applying
gponges soaked in very hot water. A piece of gutta-percba
tissue was put in for drainage, the wound closed with silver
sutures, and dry boracic lint applied. In addition to the
ankylosis with the sacrum—the result of previous fracture—
the coccyx was found to be broken about an inch from its
extremity, the lower part being freely movable. To avoid
moving the dressing the urine was drawn off until the lltb,
when the patient passed it herself by turning upon her face
Half a drachm of laudanum was giv- ’■ night, and the

bowels kept from acting until the 14th, when a dose of
castor oil and a soap enema were given. The gutta-percha
tissue was removed on the 13th and the sutures on the 15th.
The wound healed almost by first intention; the patient mad»-
an uninterrupted recovery, and was discharged cured on
April 7th.

Remarks by Mr. Odell. —From the time of the opera¬
tion until May 2nd the patient was entirely free from pain
or even inconvenience when sitting, all the distressing
symptoms which rendered the operation necessary bad dis¬
appeared, and there was no pain or difficulty in defecation.

UtoiraL Sorutus.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

The Relation of a certain form of Headache to the Excre¬
tion of Uric Acid.—Alcoholic Paralysis.

An ordinary meeting of this Society was held on Tuesday
last, Mr. G. D. Pollock, F.R.C.S., President, in the chair.

Dr. Alexander Haig communicated a paper on the
Relation of a certain form of Headache to the Excretion of
Uric Acid. Previous papers by the author on the influence
of diet in this headache, and its clinical relationship to gouL
are referred to. An investigation of the urine was under¬
taken with a view of testing the relationship to gout. Meat
and cheese were taken with the object of bringing on a
headache, for purposes of experiment. The relation of this
headache to the excretion of uric acid at first appeared
equivocal, but definite results were obtained on separating
the urine excreted during the headache from that before
and after. There appears to be retention of uric add before
the headache, excessive excretion during the headache, and
diminished excretion after the headache. The excess during:
balances the diminution before and after; there is no absG
lute excess of uric acid; hence the previous equivocal results.
During a headache there is little or no alteration of the
excretion of urea. The relation of the uric acid to the urea
is important, and is greatly altered during the headache.
When, as the result of plus exercise, there is a large excretion
of urea and uric acid (though in their normal relation ),
headache is not far off; and if anything causes the uric
acid excretion to fluctuate, headache will be present
during its excess and absent during its diminution.
This fluctuation in the excretion of uric acid does not
affect the urea, is temporary and transient, and there
is proof that urates may accumulate, while the kidneys
are quite sound. The theory which best explains everything
in this connexion 1 b that of diminished alkalescence of the
blood. Does gout consist in a diminished power of forming
ammonia to neutralise acids, resulting in a permanent
diminution of the alkalescence of the blood ? The influence of
meat diet and beer in this respect, and the well-known con¬
nexion of fourpenny ale with gouty deposits, are referred to.
A dose of acid, either introduced from without or formed
internally, may cause temporary retention of uric acid, and
so lead to headache. Beer will do this. Retention possibly
does not explain everything, as the excess during the head¬
ache appears to exceed the previous retention. There may
be temporary excessive formation as well, hence the good
effect of salicylate of soda, which diminishes the formation
of uric acid. The good effect of a meal on this headache i?
due to the fact that it increases for a time the alkalescence
of the blood. Hence also the good effects of a somewha:
vegetarian diet and alkalies in its treatment. The relation
here shown between the headache and the excretion of uric-
acid has an important bearing on the pathology of gout and
other diseases connected with uric acid, in demonstrating
the way in which temporary retentions of uric add may
be occasioned, and in supporting tbe theory of diminished-
alkalescence of tbe blood, as a cause of these retentions.—
Mr. G. D. Pollock related bis personal experience of head¬
ache. Tbe urine passed during the attack was always pale
and clear. Bilidus vomiting used to terminate the attack.
Calomel soon afforded relief.—Dr. Chbadlk congratulated
Dr. Haig on his valuable paper. He doubted, however,
whether irregular excretion of uric acid would explain all
headaches. Women who were not large meat eaters suffered
from this headache. After railway journeys or anything

Digitized by GoOgle

THB LANCET,]

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.

[May 28,1837. 1Q80

causing vibrations the headache could hardly be due to faulty
excretion of uric acid. He knew a boy who journeyed from
Ireland to Eton and always had a prostrating headache, the
result of this journey. The scent of strong flowers—e.g.,
hyacinth—also caused a headache. lie (Dr. Cheadle) also
suffered from megrim if for one hour he remained in an ill-
ventilated room. A good dose of wine would sometimes
cause megrim to disappear, and this seemed to militate
against the views advanced.—Sir Dyce Duckwobth referred
to the two classes of large eaters and drinkers, and those
who could not eat or drink to excess without suffering soon
from headache and other symptoms. This latter class had a
smaller margin for the disposal of excess of food, and he
supposed that Dr. Haig belonged to this class. He thought
that the author deserved great credit for so painstaking au
investigation.—Dr. Pbhcy Kidd was conscious of at least
two sorts of headache: one for which no remedy is useful;
the other brought on by obvious causes, and easily re¬
lieved by stimulants and other means.—Dr. Wabd thought
there were three sorts of headache, in his own experience.
Tiny little chalk stones from the joints of the hands were
obtained at the age of foorteen, when the real' megrim began.
The nervous headache was probably quite distinct in its
causation from that which arises from inspecting a picture
gallery or from excitement. This latter kind may be
relieved by a dose of strychnine. Other headaches expe¬
rienced by him were amenable to sal volatile. Bottled beer
is less liable to cause headache, owing to the soda added. A
specific gravity of 1030 was also noticed, followed by a
copious deposit of urates. Sometimes a decided exaltation
of spirits preceded the severe form of headache.—Dr.
Hingston Fox inquired as to the method of estimating uric
acid best adapted for clinical work.—Dr. Haig bad noticed
the light colour of the urine, but this seemed to have no
relation to the amount of uric acid. He explained his views
of the relation of diminished alkalescence of the blood as
causing a retention of uric acid.

Dr. David W. Finlay read a paper on three cases of
Alcoholic Paralysis (multiple neuritis). The three patients,
all married females, came under the care of the author in
the Middlesex Hospital in the course of last year. Tho first

case, E. F-, aged twenty-eight, a confirmed drunkard, had

suffered from weakness in the knees for more than a year.
To this succeeded difficulty of walking, and numbness in
the hands and arms, soon followed by paralytic symptoms.
In the hospital she lay helpless in bed with the legs flexed,
rambled in her talk, and had delusions. The muscles of the
arms and legs were much wasted, and she had double wrist
drop and foot drop, with much pain on pressure or passive
movement, and abolition of plantar and patellar reflexes. She
had complete control over the bladder and rectum. Abundant
large and small rales were heard over both lungs, and the
epigastrium receded during inspiration. The liver was
enlarged. On electrical examination the muscles of the legs
and arms generally showed the reaction of degeneration. The
optic discs were normal. She gradually got worse and died
on the seventeeth day after admission. The urine was nor¬
mal, and the temperature hectic throughout. Post mortem,
the lungs were found to be the seat of tubercular disease,
and the liver was large and fatty. On microscopic examina¬
tion the cord and spinal roots were normal-; all the nerves
examined showed advanced degenerative changes, and the
extensor carpi radialis longior muscle was crowded with
connective tissue nuclei and round cells. The second case,

M. J. P-, aged twenty-eight, had a history similar to the

other, and the symptoms were much the same as regards the
nervous system. There was less degenerative reaction, how¬
ever, and less wasting. The temperature was seldom above
normal. The liver was enlarged, but the lungs were not
diseased. At the post-mortem examination the brain and
its membranes appeared normal; the cord on section seemed
somewhat atrophied in the grey matter, but no other change
was noted. Under the microscope the cord did not present
such a typically healthy appearance as in the former case.
The greater number of the large Cells in the anterior cornua
were shrunken, the branohing processes were less clearly
defined, and many had dropped out of their places, leaving
holes in the : section; but the results were probably due
to comparatively unsuccessful preparation. Most of the
nerves examined showed changes similar to those found in
the other case, but these were less strongly marked, except in
the anterior tibial nerve. The spinal nerve roots were sound.

The third case, E. C-, aged forty-three,, resembled the

other two as regards the history and many of the rfininal

phenomena, differing, however, in result, slowly progressive
recovery having taken place. She has regained the use of
her limbs, can now walk and dress herself without help,
and has lost her delusions. The reflexes, however, have not
yet returned, and her feet and legs have lately become
cedematoue. Reference was made generally to the clinical
and pathological history of the disease, and particularly to
the history of the individual cases os excluding the idea of
causes other than alcoholism being concerned in the pro¬
duction of the symptoms. The frequent coexistence of
tubercular disease was also discussed, and reference made
to a recent paper by MM. Pitres and Vaillard in this
connexion. The paper concluded with a few remarks
upon the treatment of the case which hud recovered.
Microscopic specimens and drawings were shown. — Dr.
Hale White said that the cases bore out a clinical
observation he had made, that the alcohol concentrated its
action on one set of tissues, and those chiefly where the
inflammation commences. The vessels were thickened
secondary to perivascular changee. The change in the
muscle was peculiar. In syphilitic and alcoholic neuritis
he had observed no secondary influence on the skin. The
bladder and the rectum were usually not affected, and this
was rather to be surprised at.—Dr. Hadden remarked on the
legs being not very uncommonly in a state of flexion, and
was glad to find this observation corroborated. Cutaneous
hypersesthesia was not marked, and as a rule he bad not
found tenderness of the nerves. Perforating ulcer, cedema,
erythema, falling off of toe-nails, bullous eruption, and other
trophic lesions he had observed in alcoholic paralysis. In five
fatal cases he had examined the spinal cord was normal. In
four there was phthisis also. Lancereaux had detected a
slight sclerosis in the antero-lateral columns of the cord.
The tendency to label all cases as alcoholic should be
deprecated; other causes might cause the same grouping of
symptoms.—Sir Dyck Duckwobth bad had four cases in
women during the last six months. The history of alcohol
was not always easy to elicit. He bad no doubt that
alcohol did pick out certain tissues and act in certain
lines. The condition of the muscular fibre was new to
him. Muscular hyperrestbesia was to bo observed, and he
had noticed tenderness of the peripheral nerve trunks.—
Dr. Obmkbod had noticed tenderness of the nerve trunks,
and also one case at least of cutaneous tenderness.
The muscular tenderness might be ascribed to an
inflammatory condition. The infiltration of leucocytes
coaid hardly be explained on the degenerative theory of the
nervous changes. He had also observed the flexion of the
legs. It would be important to have a guide to prognosis.
The mental condition was an important point, was often
characteristic, and might serve to differentiate cases of
peripheral neuritis. The patient possessed great aptitude
for giving circumstantial accounts of occurrences that have
never happened. Mistaking the identity of places --
e.g., supposing that the hospital was Newport Market—
was also a feature in the mental condition.—Mr. Jessop
referred to the state of the optic nerves. If alcohol
gives rise to amblyopia, these were the cases to inves¬
tigate. The French ascribed the central scotoma, to
alcohol, and the English to nicotine. A case of central
scotoma for red and green in a woman, who, however,
smoked, was mentioned.—Dr. Finlay said the vision was
normal. The perineuritis might lead to degeneration by
shrinkage of connective tissue, causing degeneration by
pressure. He had satisfied himself that there was nerve
tenderness. ___

WEST LONDON MEDIOO-CHIRURGICAL SOCIETY.

A meeting was held on May 6th, Dr. Alderson, President,
in the chair.

Clinical Cases.— Mr. KAbtlby showed a case of Excision
of Epithelioma of the Fauces, affecting the adjacent parte
of the palate, tongue, and maxilla, with previous ligature of
the external carotid; Mr. Edwabds, a case of Recent Suture
of the Patella; Mr. Wainwhight, a case of Suture of the
Patella; and Mr. Dunn, a case of an Albino.

Some of the Rarer Forms qf Rectal Fistula. —Mr. Edwabds
read a paper upon this subject. He first drew attention to
the difference of opinion existing between surgeons concern¬
ing the question of dealing with the sinus which extends
upwards by the side of the bowel from the internal opening

1090 Thb Lancet,]

ACADEMY OP MEDICINE IN IRELAND.

[May 28,1887.

of a complete fistula. lie considered that the treatment
should depend upon the position of the sinus to the muscular
coat of the bowel; if submucous it should be laid open, but
if submuscular it is better to leave it, thus avoiding the risk
of incontinence due to division of the fibres of the internal
sphincter. A cure may be looked for after the frequent
injection of the sinus with tincture of iodine. After touch¬
ing upon some of the more frequent errors in diagnosis
and operative treatment, the author pointed out that there
seemed to be a definite relation between the internal and
external orifices of a fistula. For fistulse liaviDg their
external orifices situate behind a plane passing trans¬
versely through the centre of the anus usually have their
internal aperture in the middle line dorsally, while those
with their external orifice in front of this plane generally
terminate in an internal opening immediately opposite,
thus forming a simple, straight, complete fistula. The author
then spoke of horseshoe fistulse, which he defined as
being a fistula with one or more external orifices on either
side of the anus, with an internal one in the middle line
behind. He said that not only were the descriptions of this
form unsatisfactory, as found in most special works on the
rectum, but the operative measures, when mentioned, left
much to be desired. 8urgeons of the present day when
operating upon horseshoe fistulse either slit up the sinus
on both sides of the gut, thus dividing the sphincter in two
places, or they content themselves with the division of one
sinus, hoping that the other may heal of itself, with or
without the insertion of a drainage-tube. The operation
recommended in these cases, and for which the author said
he had to thank his colleague and friend, Mr. Goodsall, was
as followsComplete division of the sphincter in the
middle line dorsally, laying open the abscess cavity and
internal opening, and the subsequent slitting up of each
lateral sinus from the external orifice to the central dorsal
incision. By this means the whole of the fistulous track would
be laid open and the sphincter would only suffer one division,
and this m the most favourable manner—viz., at right angles
to its fibres, thus avoiding all risk of subsequent incon¬
tinence, which so often happens after the operation as usually
practised. In conclusion,the author related two interesting
and rare cases: one of fistula completely encircling the bowel,
and the other of fistula originating in the pelvi-rectal space—
i e., between the bowel and levator ani muscle.—Mr. Whit¬
more referred to that form of incomplete internal fistula
which was associated with phthisis, and remarked that
rectal fistulas should always be operated upon early.—
Mr. Kektlby related the case of a married lady from whom
he removed a growth the size of a Spanish nut from the sub¬
mucous tissue of the rectum; the operation was followed by
a fistula, which was treated by division of the sphincter,
and a complete cure resulted.—Mr. Bf.nham narrated some
cases of rectal fistulaj which he had treated with success by
injecting carbolic (1 in 20) solution.—Mr. 8. Benton made
some remarks upon the blind internal horseshoe fistula,
which he said Mr. Edwards had not mentioned.—Mr.
Chapman had used pure carbolic successfully in three cases ,
of rectal fistula.—Mr. Edwards, in reply, said that no 1
reliance could be placed upon the cure of a case with car- ;
bolic injections. The experiment could be tried, but division
of the sphincter was usually called for. In phthisis the
patient derived benefit by having bis rectal fistula operated
upon.

Some Points in the Selection and Administration of
Anasthetics. —Dr. Hewitt read a paper upon this subject,
and said that he wished to limit his remarks to the con¬
sideration of the following points:—1. The best method of
administering nitrous oxide and ether, either in succession
or in combination. 2. The prevention of vomiting during
or after the administration of an anaesthetic. 3. The danger
of inducing general anao-thesia in persons so suffering from
obstructive dyspnoea. 4. The possibility of dangerous
symptoms occurring from the administration of opium or
morphine prior to chloroform, ether, or other anaesthetics.
He exhibited an apparatus which he had used for three
years in hospital aDd private practice. It consisted of a
Clover’s portable ether inhaler fitted with a special form of
face-piece, and with a bag capable of holding two gallons of
gas. By means of this apparatus any desired combination
oFnitrous oxide and ether could be given. The amount of gas
in the bag was always sufficient, when administered with
the face-piece shown, to anaesthetise a patient before
gradually admixing the ether vapour; and the whole
apparatus was portable and qiuld be changed before entering

the room in which the operation was to be performed. By
means of this apparatus tbere was no sudden transition from
nitrous oxide to ether as when face-pieces were changed
during the administration. YomitiDg could be prevented by
rapid and deep anaesthesia. In a large number of cases he
had given half a grain of cocaine in half an ounce of water
shortly before the administration of an anaesthetic. This
was done with the object of lessening the sensibility of the
gastric mucous membrane. Vomiting after anaesthetics wm
best prevented by keeping the patient upon bis Bide, and by
moving him aslittle as possible. Thedangerof inducing anaes-
i hetic sleep in persons suffering from obstructive dyspnoea was
then considered. Patients in this condition were dependent
for their existence upon an increased activity of their respira¬
tory mechanism, and failure of respiration was very likely
to ensue under chloroform or ether.—Mr. Lloyd showed an
improvement in ether inhalers, which consisted in a beg of
very fine indiarubber, the cost of which would be found to
be so immaterial that one could be used for each patient
anaesthetised. The bag would, of course, take the place of
the ordinary bag as used at present, and would be destroyed
after use; thus the ether apparatus could not become a
source of infection by either the tubercle baciUns or any
infectious disease.—Mr. Davis said that chloroform was the
best anmstbetic in ovariotomy.—Mr. Mackinlay remarked
that he always insisted upon a patient being deeply under
the influence of an anaesthetic before dividing the optic
nerve in enucleation of the eyeball. Partial ansest-heaia.
he thought, was in such cases fraught with some danger.—
Mr. Alderton related the case of a man who died under
ether, who had been admitted for a small operation upon
the mouth. Hedepiecated the custom of admitting patient*
into hospitals, and hurriedly operating upon them wilhoat
preparing them.—Dr. Hewitt replied.

On the Association of Mitral Stenosis with Gout and
Granular Kidneys- Dr. G. N. Pitt read a paper on this
subject, upon which it was not possible for a discussion to
take place, owing to the shortness of time.

Mr. Dunn showed the following pathological specimens:
(1) Sarcoma of the Os Uteri; (2) Sarcoma of the Dura
Mater; (3) A Kidney and adjacent parts, showing a large
Extravasation of Blood into the Peri-renal Tissue of the Left
Side.

Mr. Benton showed a Pedunculated Growth removed from
the rectum of a man forty-six years of age.

ACADEMY OF MEDICINE IN IRELAND.

Maliynant Disease of the Stomach, 8 ( C . — Fibro-Sarcoma of
the Orbit.—Trephining for Epilepsy.

At the meeting of the Pathological Section held on
March lltb,

The President showed specimens of Malignant Disease of
the Stomach, Pancreas, Liver, Kidney,&c .taken from a young
man aged twenty. The patient was admitted into Sir Patrick
Dun’s Hospital on Jan. lltb, and died on Jan. 22nd. Two years
previously he was attacked with heartburn, retching and
vomiting, and epigastric pain. At the post-mortem the
stomach was found to be greatly distended; pylorus con¬
stricted, and its walls dense and white; a mass of new
growth in edge of falciform ligament, and one or two nodules
on the liver; walls of gall-bladder invaded by the neoplasm;
cavity small, containing green mucus; cystic duct occluded;
dense mass of new growth, involving stomach, pancreas,
right kidney, &c., and extending back to the spine. Left kid¬
ney healthy on section; right kidney invaded by neoplasm;
portal vein pervious; abdominal aorta constricted by sur¬
rounding mass of new growth; right upper surface of
diaphragm studded with white nodules. An immense
number of round, flattened nodules all over each lung, and
also internally, radiating from root. Heart and pericardium
normal.

Mr. Swanzy exhibited a Fibro-sarcoms, about the size of
an ostrich’s egg, which be had successfully removed from
the orbit of a boy, aged eleven years, and which bad a
history of four years and a half. The eyeball had become
dislocated upwards under the upper lid, by which it was
completely covered, and sat on the top of the tumour, but
retained its consensual motions to a slight extent, notwith¬
standing its very abnormal position. Owing to the presence
of the tumour, the orbit had become much increased in size,
measuring 7 cm. vertically, 65 cm. horizontally, and 4 5cm.

Tub Lanoht,]

ACADEMY OP MEDICINE IN IRELAND.

[May 28,1887. 1091

in depth. The patient, who was exhibited, made a perfectly
good recovery.

Mr. M’Ardlb read a paper on Sarcoma, detailing cases
which showed the deterioration of the different tissues of the
body, apparently as a result of the disease. He noticed in
all his cases a great diminution of the red corpuscles of the
blood, and a slow and incomplete coagulation of that fluid.
In these cases he met with spontaneous fractures, and on
examining the bones he found them brittle, and the red
marrow in a state of fatty degeneration. In seeking an
explanation of the decrease of red corpuscles in the blood,
he concluded that the destruction of the red marrow of
the bones led to a diminution of their manufacture. He
explained the emaciation of the patient by the lessened
oxygenating power of the blood, which, in some of the
case*, looked like serum, so poor was it in corpuscles.

Mr. W. 1. Whkblbe gave a description of a Calvaria and
Brain after Trephining for Epilepsy, and exhibited speci¬
mens.—Mr. Story asked what was the use of trephining
for epilepsy if the seat of the affection were, as Mr. Wheeler
had said, the medulla oblongata or the pons. Epilepsy was
interesting from an ophthalmic point of view. It was
known that after epileptic seizures the patients frequently
had either transitory or permanent affections of their Held
of vision, and it was a curious fact that these affections
took the form of concentric limitations of the fields of vision
of both eyes. It was well known to those present that when
a patient suffered from a lesion at one side of the brain,
whether caused by a tumour or otherwise, his visual appa¬
ratus waB damaged, but the effect produced was that there
was a loss by both eyes of one half of their field of vision,
the halves lost corresponding to the visual centre on the side
of the brain affected. But atter epileptic seizures the limi¬
tation was concentric, though also affecting both sides; and
the explanation of this which had been put forward assumed
that the seat of the epilepsy was not in the medulla or the
pons, but in the cortical centres.

Secondary Suture of Ulnar and Median Nerve*.—Excision
of the Knee Joint.

At the meeting of the Surgical Section held on March 18tb,

Mr. J. H. Scott read a paper on Nerve Suture. The subject
was a young man, aged twenty-one. He sustained an injury
to tbe palmar surface of right forearm, about an inch and
a half above the wrist joint, by putting his band through a
plate of thick glass. The accident occurred four mouths
prior to admission into the Adelaide Hospital. There was
distinct evidence, from tbe condition of the hand, that the
ulnar and median nerves had been completely divided,
without any attempt at regeneration. On April 16th, 1886,
eighteen weeks subsequent to the injury, the ulnar nerve
was sutured, three catgut ligatures being introduced to
bring the freshly-cut surfaces together. Five davs after tbe
operation sensation had markedly improved. The patient
returned to the hospital in the following August, being
desirous of having a similar operation performed on the
median nerve, on account of the success of the former
procedure. The median nerve was consequently sutured on
Aug. 31et, almost ten months having elapsed since the
injury. Three weeks after operation the patient could dis¬
tinguish the touch of a pin’s point anywhere in the area of
distribution of the median nerve. Mr. Scott stated that the
result so far has been very satisfactory, nutrition of parts
becoming rapidly normal. J udging from present appearances,
there is every hope that the hand will become perfectly
restored to usefulness.—Sir William Stokks recalled a
Similar operation by Mr. Wheelhouse of Leeds, who related
the details at the meeting of the British Medical Asso¬
ciation in Bath. A man, having fallen accidentally on the
sharp edge of a scythe, sustained a deep wound on the
back of the thigh, followed by paralysis both of motion and
sensation. About eighteen months after the accident Mr.
Wheelhouse cut down on the sciatic nerve, which he found
completely divided, and brought tbe ends together by
sutures. There had been extreme muscular atrophy; but
sfter the operation the man was soon enabled to return to
his ordinary avocation as a field labourer. Thus was proved
the efficacy of the operation, despite the lapse of a long
interval since the injury. Dr. Scott’s case was a further
U u trat i° n ^ great importance of nerve suture.

fa ^ H0HNLKY Stoker read a paDer on some Elements

Success in Excision of the Knee Joint. He considered
that the results of excision of the knee had been too favour¬

ably stated, and that many cases recorded in their early
history as having been cured, had later on shown a return
of disease. Age had been over-estimated as an influence for
good or evil in this operation. Three things were to be
regarded as of superlative importance in the prospect of
success in excision of the knee—(1) complete removal of all
diseased structures; (2) relative permanence of dressing;
and (3) thorough fixation of parts. With regard to the
first, he laid great weight on the careful removal of diseased
synovial membrane, the commonest seat of tubercular foci,
and the most troublesome to extirpate. In speaking of the
second, he dwelt on the necessity for all oozing to have
ceased before the dressings were applied, and argued against
the use of Esmarch’s bandage. He advocated the use of
dry dressings, and the performance of the first dressing two
or three weeks subsequent to operation. Speaking of the
third point, Mr. Stoker recommended the use of Dr. Heron
Watson’s splint as modified by Mr. Thomson, and opposed
the use of plaster-of-Paris as a retentive apparatus. He
described the method of “ dowelling ” which he had devised
as a means of securing the bones, and which he had found
most satisfactory.—Sir William St. kes said the plan of
fixation of the bones devised by Mr. Tbomley Stoker should
be welcomed by every operating surgeon as superior to any
other method of bone suture. Speaking of dowelling from
the experience of his cases, he negatived the production of
irritation or of suppuration in the part operated on.—
Mr. Franks, taking seriatim the three points raised in
Mr. Stoker’s paper, said, with regard to the first, he con¬
curred as to the removal of the synovial membrane, failure
being mainly due to leaving foci of diseat e either therein or
Tn the tissues round the joint. As to the second, the dry
dressings were of inestimable value in keeping the part at
rest without the discomfort of repeated dressings. He him¬
self provided drainage by turning in little tongues of skin
at the angles of the wound and stitching them to the back
part of the soft tissues, without leaving any foreign body in
the wound except the silver wires. As to the third point,
he employed the dowels in one case, which afterwards tailed
from other causes. At the same time, the dowels kept the
bones in good apposition, and brought about satisfactory
union. Still, while the fixation of the bones was satis¬
factory, he was not prepared to say that the dowels were
better than the wire sutures.—Mr. Croly, Mr. Lentaigne,
Dr. Kennedy, and Mr. Thomson also spoke.

Prevention and Treatment of Disease.—Latent Typhoid
Fever fatal through Cardiac Thrombosis.

At a meeting of the Medical Section held on March 26th,

Dr. C. F. Knight read a note on the Prevention and
Treatment of Disease. A fever may abort at any time—
spontaneously or by the administration of therapeutic
agents. Acute articular rheumatism may be treated by one
of seven plans—viz., alkaline, quino-alkaline, mint-water,
salicylic acid and salts, salicin, chalybeate, and eclectic.
Advantages of alkaline treatment: First, rapidity of action;
second, absence of cardiac complications; third, rapid defer¬
vescence. Quinine, an antipyretic and antiseptic, must be
given with greater regularity, and in sufficient doBes to
produce satisfactory results. A tolerance may exist. In
1883 the author gave tbe largest quantity of quinine
ever recorded to one patient—vix., in twenty-four houra,
131*25 grains; five grains subsequently produced cincboniem.
Temperature analogous to septictemia. Quinine may fail
to reduce temperature; alkalies rarely do. The author
believes that mint-water, salicylic acid and salts, and salicin
influence the disease, because they are antiseptics. Cases
where rheumatoid fibro-ankylosis of vertebrre and joints
exists are well treated with small doses of salicylate
of sodium, assisted by massage. As to tbe pathology
of acute articular rheumatism and other diseases, the
manifestations may be due to organisms in the blood,
which are destroyed by antiseptics, and cannot live in a
strongly alkaline medium. Source of organisms: 1. Outer
world, through ingests, or by gases inhaled. 2. May
arise in digestive or respiratory tract, as by germs intro¬
duced, or coalescence of organisms, which separately are
innocuous. Do normal digestive ferments ever give nee to
morbid processes? Means of combating disease, dietetic,
hygienic, and therapeutic; farinaceous food causes a rise in
temperature in febrile affections. Therapeutic agents to
include - 1. Abortives. 2. Inhalation of gases. 3. Antiseptics,
as turpentine, in acute croupous pneumonia. 4. Rectal in-

1092 The Lancet,]

MIDLAND MEDICAL SOCIETY.

[May 28,1887.

tlations of medicated vapours, which was advocated as a
means of combating disease, fuvere, phthisis, and cholera in
1878. 5. Atomised liquids, a spray of a solution of cuch-
lorine, cooling and grateful in fevers, and where thirst is a
prominent? symptom. The best abortive for diphtheria,
croup, mumps, and the exanthemata is red iodide of mer¬
cury, prescribed in hospital in these diseases since the com¬
mencement of 1884; dose, one-sixteenth of a grain thrice
daily in the form of pilules, first dose a double one. Children
bear this treatment well. In adults it may cause colic ; if
so, allay with an opiate, which increases action of mercurial.
Opportunity for trying this treatment now offers in the
present epidemic of scarlatina. The author requests phy¬
sicians to adopt this plan, and to communicate the results of
their observations to the Academy.—The President ex¬
pressed his dissent from Dr. Kuight’s views ns to the
superiority of the alkaline over the salicylate treatment of
acute rheumatism, and drew attention to the fact that some
patients in rheumatic fever continue to suffer from the pains,
no matter what drug is administered, until milk is excluded
from their dietary.—Dr. Knioiit, in reply, urged the desir¬
ability of resorting to therapeutic agents, which appeared to
act as abortives, instead of trusting solely to isolation. There
was a distinction between salicylic acid and salicylate of
soda, and he spoke of cases treated with the acid and not
the salt.

Dr. A. Montgomery read a case, communicated by Surgeon-
Major R. Harman, A.M.S., of latent Typhoid Fever, which
proved suddenly fatal without the disease having been
recognised during life. The patient, a dragoon of splendid
physique, aged forty, was admitted to hospital for slight
eczema o £ the left leg, which readily yielded to treatment
He never complained of any symptoms, abdominal or other¬
wise, except a slight cough, lor which the usual remedies
were applied; the temperature was taken on several
occasions, both morning and evening, without finding any
rise above normal. However, on the sixteenth day from his
admission, after being up and about as usual, he vomited
about a pint of iluid resembling coffee grounds, and expired
immediately afterwards, being quite conscious and free
from pain to the last. A post-mortem made three hours
after death revealed a dense fibrinous clot, of a pale amber
colour, occupying the right auricle and ventricle, firmly
adherent to the endocardium and tricuspid valves, and ex¬
tending into the vena cava and pulmonary artery. The
parietal and visceral peritoneum was covered with thick
masses of recent lymph, and the peritoneal cavity contained
about two pints of semi-purulent serum. Just above the
ileo-cfccal valve, the ileum, on the anterior free surface of
the bowel, presented an oval open gangrenous ulceration,
about three inches in length and half the circumference of
the bowel in breadth, destroying all the coats of the bowel;
and although opening freely into the peritoneal cavity,
there was no extravasation of the intestinal contents.
There was another gangrenous patch about six inches higher
up, and Peyer’s patches exhibited every stage of the disease.—
Dr. Finny said the case brought forward by Surgeon-Major
H&rman was one of great interest and rarity. In enteric
fever, until the post-mortem examination was made, it
was difficult, if not impossible at times, to give an accurate
diagnosis, and sometimes during life the ulcerating process
may advance unnoticed until marked by a gush of hremor-
xhage. Tbe present case revealed an interesting clinical
fact, that the patient had marked pathological lesions of
several hours’, if not days’, duration, without having pre¬
sented any subjective symptoms. There was no evidence
that death was caused either by thrombus of the heart
or embolus of the pulmonary arteries. The action of the
peritoneal inflammation, as it became developed, produced
weakness in an already fatty heart; and the clot found
in tbe right ventricle was really the result of a failing
heart in the death agony, and not the oause of death.—Dr.
John William Moore concurred in the conclusion that
the pathological appearances in the intestine were those of
enteric fever.—Dr. Ddffey said that his reading of the
case was that death was dae to simple collapse, the result
of perforation of the intestine—a view which was borne out
by the history of the case. There was nothing in the lung to
suggest that death should be attributed to pulmonary throm¬
bosis. Cardiac thrombosis was an uncommonly rare lesion.—
Dr. Knight said the case presented the characteristics of
-general septic* mi a, of which enteric fever might be re-

S rded as a variety; bat the enlargement of the viscera and
e intestinal ulceration did not constitute sufficient evidence

of its being one of true septicaemia. In gynaecological cases
adhesions were found without any history of severe attacks
of pain or serious inconvenience to health.—The President
said that he considered this case one of typhoid fever, but
it was rare indeed to have such a normal temperature and
an entire absence of severe symptoms before the fatal ter¬
mination.—Surgeon-Major Harman, in reply, said the
temperature was taken by the ward master, an intelligent
non-commissioned officer, about a dozen times, by means of
the ordinary clinical thermometer, in the axilla, and it wt*
never above 99°. There was softening of tbe mesenteric
glands. The clot found in the heart was of a pale colour,
and firmly adherent to the endocardium.

MIDLAND MEDICAL SOCIETY.

A meeting was held on April 13tb, Mr. Lloyd Owen
F.R.C.S.I., President, in the chair.

Talipes Calcaneus.— Mr. Edward Freer showed two
cases of Talipes Calcaneus that he had treated by teno-
section at the Orthopedic Hospital. The section was msde
obliquely, and the tendon sutured by kangaroo-tail tendon,
as suggested by Mr. Walsham. The results in both cams
had been highly satisfactory, no signs of relapse having
occurred after a period of six months from the operation.
This was performed with antiseptic precautions, the feet
being extended to their utmost and retained there by plaster
and an anterior interrupted splint. Mr. Freer pointed out
the necessity of ascertaining hefore operating whether there
was sufficient nerve power in the paralysed limb to prevent
a recurrence, and also the advantages of galvanism and
massage for some time after.

• Ruptured Brachial Plexus.— Mr. Morrison showed a
man, aged forty-six, who was admitted into the General
Hospital, under Mr. Bartleet, on Dec. 27th last. lie had fallen
a distance of forty feet upon some loose bricks, and had
sustained fracture of the right upper ribs, right clavicle,
and lower jaw, together with rupture of the brachial plexus,
and probably laceration of the inner coats of the axillary
artery, on the same side, with occlusion of the vessel. There
was emphysema of the chest wall, neck, and right upper
limb as low as the wrist. For about ten days he remained
in a critical condition, with collapse of the right lung,
bronchitis, and delirium; but eventually he convalesced and
became an out-patient; the upper limb, however, remaining
paralysed, both as regards motion and sensation in the area
of distribution of the brachial plexus. The limited move¬
ments that remain appear to be imparted by the trapezium.
Anaesthesia of the limb is complete, excepting in the part
supplied by the intercosto-humeral, descending brandies of
the cervical plexus, and possibly also by some filaments of
the circumflex. Pulsation in the axillary artery ceases
abruptly below the clavicle. The right pupil has remained
persistently smaller than the left, indicating lesion of the
sympathetic in the neck. Massage and galvanism are being
used to the limb.

Dr. Suckling showed a woman aged forty, who presented
the appearances of Myxoedema in a typical form. He also
introduced a patient who had been successfully treated by
trephining for Jacksonian Epilepsy. Dr. Suckling also
exhibited a number of Sphygmograms.

Mr. John Taylor read a paper based on a series of
twenty-three consecutive cases of Abdominal Section.

NOTTINGHAM MEDICO-CHIRURGICAL SOCIETY.

A meeting was held on Friday, April 15th, Mr. Hatherly.
President, in the chair.

Dr. Handford showed the following cases .-—Neuritis of
the Ulnar Nerve following typhoid fever; Empyema in a
man aged forty-one, cured by opening and drainage;
Aneurysm of the Arch of the Aorta, with Paralysis of Uft
Vocal Cord, in a man aged forty-three; Aneurysm of the Arch
of the Aorta, with Panlysis of Left Vocal Cord, in a mu
aged fifty-six.

Dr. Handford also showed a case of Aneurysm of the
Aorta for Dr. Ransom.

Mr. Andebson reported a case of Bullet Wound of tn»
Brain, and showed the specimen.

The President read a paper on Infant Feeding for D*-
Marshall.

O

The Lance*,]

REVIEWS AND NOTICES OF BOOKS

[May 28,188T. 10V3

'Qtisiths atto ftsiim of ^oofes.

A Text-book of Medicine for Students and Practitioners.
By Dr. Adolf StrCmrell. Translated from the Second
and Third German editions by Herman F. Vickery,
A.B., M.D., and Philip Coombs Knapp, A.M., M.D., with
Editorial Notes by Frederick C. Shattuck, A.M., M.D,
London: H. K. Lewis.

The readiness with which our American confreres under¬
take the translation of the best German works deserves to
be widely recognised. Had it not been for their enterprise
and devotion many such writings would have remained
praotically unknown to the English practitioner, who has
derived so much instruction from their perusal. One in¬
voluntarily calls to mind the work of Niemeyer, which on
its first appearance fascinated the medical world. There
was a thoroughness of treatment and a freshness of style
about that book which could not fail to impress the reader,
and which gave the work a widespread popularity; but
text-books are apt to fall behind the times, and require in
these rapidly progressive days to be constantly renewed
and re-edited if they are to retain their popularity; and
they are apt to lose their original uniformity and spon¬
taneity of expression by being refurbished at the hands of
others. If only therefore as an exposition of modern
medicine from the heart of “young Germany,” we should
welcome this edition of Dr. Striimpell’s admirable text¬
book. Its publication will, however, increase considerably
the difficulties of choice before teachers and students by
adding another text-book upon medicine of high merit
to those already in existence.

So far as it has been possible for us to judge. Dr. Strum-
pell’s work will bear favourable comparison with others
of the same class. It is not the mere compilation of an
industrious student, but it bears ample evidence of the
independent observation and thought which add so much
to the force of an author’s teaching. The author, too, is
already well known in clinical medicine. His contributions
to neurology are widely known and acknowledged, and
this fact must render the chapters in the present work
dealing with diseases of the nervous system especially
valuable. They form, indeed, an admirable treatise in
themselves, covering a wide field in a masterly manner.
Nevertheless, Dr. Btriimpell shows that his attention has
not been wholly engaged by this department. The rest of
the work is written with as much evidence of personal
knowledge as that dealing with diseases of the nervous
system. That he is thoroughly imbued with the importance
of modern researches into the etiology of disease is evident
in the chapters which deal with the acute specifics. “ The
cause of typhoid fever must be sought,” he says, “in
some specific organised pathogenetic poison,” and he con¬
siders that the bacillus discovered by Koch and Bberth
is apparently that poison; erysipelas is “a disease of
the skin excited by the presence of a specific patho¬
genetic micrococcus” (p. 57). “ Beyond a doubt the diph¬
theritic poison is organised” (p. G2); but the difficulties
of its isolation are admitted, and the proof of its presence
w said to be as yet inconclusive. Even more dogmatic is
the following statement with respect to cholera, which
would hardly be subscribed to by Dr. Klein. Dr, Striimpell
(P'73): “ Some time ago it had become evident that the
***1 cause of cholera consists in the infection of the system
hy a specific micro-organism. Koch was, however, the first
to succeed in the search for the poisonous agent”; and after
giving Koch's views upon the comma bacillus, he goes on to
M y. “These statements have beau since confirmed by all
competent investigators, while the various alleged refutations
° ffi 00 ^' 8 re8aita have all proved erroneous.” These extracts
suffice to show the spirit in which the author writes, and

there is something to be said for the adoption of clearly
defined views upon the etiology of specific diseases such aa
are afforded by bacteriology. An English author would,
however, have expressed himself more cautiously—though
perhaps not to more advantage in imparting clear ideas
to the student. The fact is that upon this vast qnestion
of etiology we have arrived at a period when opinions and
facts are strangely commingled, and we have to break away
from old ideas before we can place ourselves in a position to
assimilate the new.

The system employed In the description of diseases is
orderly, and the arrangement of facts is good. It is a
novel, but decidedly beneficial, departure to find the
symptomatology of such a disease as typhoid fever, for
instance, described side by side with descriptions of the
anatomical lesions. Some of the subjects also are intro¬
duced by chapters giving a general survey of the anatomical
and physiological facts underlying the morbid conditions
subsequently dealt with—a plan which is followed to the
fullest extent in the section of diseases of the nervous system.

We have little doubt that this work will be favourably
received in this country, as it has been in Germany, where
within a few years it has ran through three editions. Its
value has been decidedly enhanoed by the pains taken by
the editor, Dr. Shattuck, who has made several additions—
particularly in the subject of “ Treatment," and elsewhere—
that contribute to its completeness. The translation has been
well executed, and the book produced in a single well-
printed volume. We have no hesitation in recommending It
to students; whilst there must be many practitioners who will
be glad to have the opportunity of becoming familiar, through
its pages, with the present standpoint of scientific medicine.

Nervous Diseases and their Diagnosis. By H. C. Wood,

M.D., LL.D. Philadelphia: J.. B. Lippinoott and Co.

1887. . ‘ _ ■ ’

Diagnosis of Diseases of the Nervous System. ' By <7. W‘.

Suckling, M.D., M.R.C.P. London: H. K. Lewis. 1887:

Notwithstanding the abundance of works and books oil'
diseases of the nervous system, we think that good reasons
may be found in both the present books to justify their
existence. The chief excellency of ' Dr. Wood’s book is
its suggestiveness, and of Dr. Suckling’s its conciseness.
We shall illustrate our remarks in commenting on the books
before us by selecting for special treatment one subject in
each, taken not at random, but as fairly representing the
general character of each work.

Dr. Wood is perhaps best known in this country for his
work on Chorea, and we shall examine his article thereon.
The first statement is not one to which we can attach any
importance: Acute general chorea is usually due to St.
Vitus's dance. Whatever is, is. In the definition of St.
Vitus’s dance, Dr. Wood says “there is often a distinct loss of
muscular power.” Our own way of writing this sentence
would be, “there is always loss of power of volitional move-*
ments.” Dr. Wood thinks enough evidence may be adduced
to prove the existence of reflex chorea. In our belief, in
most cases of “reflex” chorea the special irritant—e.g., in»
testinal worms—is but one of many causes of the chorea,
the main cause being the irritable state of the motor
centres. We concur in the statement that "an acute
chorea may be intimately associated with minute cerebral
embolism, and also with other lesions of the brain,
amoDg which lesions may be especially mentioned the
peculiar alteration of the ganglionic cells of the brain, noted
by Meynert as pervading the whole organ in a case of
chorea.” At the same time, we cannot but think that chorea
may coexist with defects in the “motor” cells, without
these being recognisable by any means of research at present
known to us. Indeed, a page or two further on Dr. Wood
clearly states the case. Chorea of pregnancy, hysterical

^6bgle

Die

1094 Tm Lanctht,]

REVIEWS.—NEW INVENTIONS.

[Mat 28.1807.

chore a, electric chorea, rhythmical spasms, local choreas,
chorea of stamps, chorea in internal inflammations, and habit
choreas are other varieties recognised by Dr. Wood, and it
is in thus boldly naming various varieties that we see the
suggestiveness which is the leading feature of the book.
We cannot, however, agree with all that the author states
under these various headings, and are inclined to think that
his shots are often wide of the mark. For example, we can
fee no striking analogy between the chorea that may accom¬
pany internal inflammations and that twitching which goes
by the name of paramyoclonus multiplex. Our recommenda¬
tion of Dr. Wood’s book cannot be to students, but to those
who have already acquanted themselves with neurology it
will doubtless afford much interest and some instruction.

Our selection from Dr. Suckling’s book is the chapter on
Diseases of the Peripheral Nerves, consisting of thirty-one
pages, and there is a great deal of information imparted in
this brief space. “ Qualitative electrical changes are always
present in severe oases, the faradaic response being lost and
the reaotion of degeneration present,” is not sufficiently
elearly put for a student to understand; it would have been
better to say that qualitative electrical changes are always
present in well-marked cases, the reaction to faradaism
being diminished or lost, the reaotion of degeneration being
usually present (see p. 144). Bearing in mind that we look
for faults as well as excellences, we cannot but object to
the looseness of such an expression as the “ myeline and axis
cylinders being broken up ” (p. 203), though we may admit
that in the space occupied a better description could scarcely
be expected. But the truth is, we look in vain for ground for
any serious criticism of Dr. Suckling’s little book, and we
feel bound to give it the warmest reception; our only doubt
about its fulfilling all the demands likely to be made upon
it by the student or practitioner is that it may not be so
clear and lucid to them as it is to neurologists, for of course
one versed in any subject is apt to see more in a simple
Statement than another who has no previous knowledge
of’ it. To students and practitioners who have read
other works this production will prove extremely valuable
in time of need: to the former just before examination; to
the latter in every-day practice.

Tumeura de VOmbilic. Par le Dr. Francis Viliar, Ancien

Interne des Hdpitaux de Paris. Avec 7 Photogravures.

Paris: J. B. Bailliore et Fils. 1886.

Cbitios of specialism and its abuses have often prophesied
that some day a surgeon would rise up and take the
umbilicus under his special care, and devote all his energies
to the treatment of the maladies, real and imaginary, of this
square inch of the human frame. The essay before us shows
that such a forecast was by no means an impossible exagge¬
ration. Dr. Villar has written a very interesting acoount of
the tumours of the umbilical cicatrix, excluding hernia,
and anyone who will read it will be likely to admit that
his time has not been misspent. The classification of
these tumours is simple and useful. The distinctions be¬
tween the two kinds of fungous tumours or polyps of tbe
umbilicus met with in infants are clearly drawn. The
commoner variety is a mass of granulation tissue arising
subsequently to and in connexion with
the separation of the cord—a lobulated
growth, secreting pus, sometimes curable
by caustics, and not containing any special
structure. The rarer form is an adenoma,
a truly congenital growth developed from the omphalo¬
mesenteric duct, discharging mucus, and being very thickly
studded with tubular glands—a growth only to be cured by
excision. Cases of dermoid and sebaceous cysts, of fibroma,
papilloma, myxoma, and sarcoma—all of them very rare—are
recO&ed, topi a large part of the «say is devoted to a study
Of tUOioer. Dr is shown that primary cancer of the umbilicus
^ fetolr at#hya epithelioma, while secondary cancer is as
d&aandmy carcinoma. The primary form has a marked
tittfiUnoy to tavnde the peritoneum and spread in a

mushroom-like mass over the inner surface of the abdominal
wall. On the other hand, carcinoma of the abdominal wall or
of any of the abdominal viscera has a special tendency to
infect the umbilicus, so that in any case of cancer of tbe
umbilicus other malignant growths should always be looked
for. These and many other interesting and important facts,
together with details of diagnosis and treatment, are well
discussed, and a bibliography completes the whole. Like
many of his countrymen, Dr. Villar is not well acquainted
with the medical literature of this oountry, from which he
could have collected additional cases and observations.

The Asclepiad. No. 14, Vol. IV.

Da. Richardson, writing on the phenomena of Palpita¬
tion, with and without intermittency of the Heart and
Circulation, believes that all persons who suffer from inter¬
mittent pulse have occasional attacks of palpitation, but
that some persons have palpitation who are not liable to
ntermittent action. Speaking of the causes of palpitation.
Dr. Richardson thinks that “ the worst mischief of all is the
practice of carrying to bed the anxieties and annoyances of
the labours of the day.” He believes that more than half
the cases of palpitation of the heart occur from this one
mistaken and foolish practice. The practice is, we grant,
foolish and mistaken, bnt it should not be forgotten that the
practice itself may be due to disorder of the chief organ of
mind. Tbe clinical aspects and relations of palpitation
and intermittenoy, as studied with the sphygmograph and
cardiograph, are dealt with in a very interesting manner.
The article on Winter Palaces of Health and Camps of
Health at Home forms the subject of some editorial obser¬
vations on another page of our present issue. “ John
Arbuthnott, M.D., F.R.S., the Medical Scholar,” is the subject
of tbe biography and portrait—an autotype from an oil
painting by Jervas, in tbe possession of the Royal College of
Physicians. The f&c-simile autograph of John Arbuthnott
has been reproduced from the Register of St. Andrews Uni¬
versity, where it was inscribed on Sept. 11th, 1696. This
number contains the third chapter on “ Practical Biometry,
or the Measurement of Life in Health and Disease," and
treats of the relationship to insurance of life. If we cannot
altogether subscribe to the distinctions drawn by Dr.
Richardson, we can at least admire his originality in
classes according to particular external characteristic* :
{a) the atheromatous, (6) the alcoholic, (o) the areas —ilw
expressions. The fourth chapter deals with the various tem¬
peraments in relation to the measurement of life for insurance.

ftrfo Jnfentimts.

BRYANTS TORSION FORCEPS.

Almost any kind of artery forceps may be used for
twisting the end of an artery, whether it be spring
forceps provided with a spring catch or sliding bolt,
or pressure forceps with the usual scissors handle. The
spring forceps, however, in whatever manner they may be
made to close, are apt to let the artery slip—a contingency

which is avoided in using the pressure foroeps, which are
made on the principle of a lever. The latter, however,
owing to the scissors-shaped handle, are not convenient for
twisting. By the direction of Mr. Bryant, Messrs. Krohne
and Sesemann, of Duke-street, Manchester-square, have con¬
structed for him the forceps (of which the accompanying
woodcut is on illustration) on the lever principle, to which a
handle is centrally attached. At the end of the lever is placed
a bolt, which is readily governed by the thumb for opekrfng
and closing the forceps, The h and le permits of easy rel ati on .

Thu Law cut,]

PRACTICAL EDUCATION AND PUPILAGE.

[May 28,1887. 1095

THE LANCET.

LONDON: SATURDAY, MAY 28, 1887.

Ws regret that the committee which was appointed by
the General Medical Council to consider the best methods
of increasing the practical element in medical education
should hare made a report without taking any evidence
from practitioners, pupils, and teachers. If some further
time and consideration had been devoted thereto, we are
sure that the report wonld have been more complete and
satisfactory, and would have had greater weight with
the profession than it can now have. The question of
pupilage with a general practitioner is far too important to
be dismissed with the mere opinion that the advantage to
be derived from personal instruction was of too great value
to be altogether sacrificed: an opinion held, without doubt
we should suppose, by every member in the profession,
and which reads as a truism so obvious that it was surely
almost unnecessary to solemnly record it in a report. But
what does the committee suggest for its being carried into
practical effect? A term of six months spent in per¬
sonal pupilage is suggested, not necessarily six con¬
secutive months, but six in all, and that the six months
should be taken during the long vacation, and after the
examinations in anatomy and physiology have been passed.
Such a suggestion as this is so very crude that, if a little
more consideration had been bestowed upon it, it would
never have been put into a report from so important a
body as a committee of the General Medical Council,
Pupilage is worth something or it is not. If worth nothing,
let it pass away, as it is now doing throughout England;
it has never existed to any great extent in Scot¬
land. But if it secures a something of importance in
medical education, surely the suggestion of six months in
long vacations being devoted to it is insufficient. Personal
instruction in “ the routine of medical life and its acces¬
sories” is valuable in proportion to the earliness of the time
in the piupil’s education that it has taken place. It is the
moulding and forming of habits, manners, and modes of
observation and thought that should be secured by such
routine, as well as the knowledge of common diseases and
their treatment, and these must be secured early or not at all.
Pupilage, to mean anything of value,' must mean a pupilage
of at least a year under a practitioner’s guidance and
tuition, and that year must be the first year of medical
study; and this is distinctly reoognised by the Royal
College of Burgeons of England, which permits a student
to begin his professional education as a pupil of a legally
qualified surgeon holding the appdintment of surgeon to a
hospital, general dispensary, or union workhouse, or where
such opportunities of practical instruction are afforded as
shall be satisfactory to the Council. The only objection to
an imperative instead of a permissible pupilage is that it
must lengthen the time devoted to professional education,
and so increase its cost; for we cannot seriously take into
consideration as a worthy substitute six odd months in vaca¬

tions in the latter half of the student’s curriculum. Moreover,
he only gets two long vacations between his second and his
final examinations; and if he is, as he should be at this
time, a clinical clerk or dresser to in-patients, he will pro-/
bably get a freedom from his duties for only a week or ten >
days consecutively; for hospitals know no long vacations,
and even visiting physicians and surgeons must find their
substitutes when they take their month’s holiday. If a
student can afford an extra year, it can be well spent with
a good general practitioner, who has patients among all
classes, and this is the best way, perhaps, of commencing a
professional education; but, at the same time, a know-'
ledge of chemistry, physics, and more especially of tha
biological sciences, must be secured. These are very
important parts of the medical curriculum, and may,'
along with a routine knowledge of common diseases and
their usual remedies, be acquired early.

- 4 - , ,

Iw the last number of th eAscUpiad Dr. B. W. RichaudsoN
advocates a great national effort for establishing in our own
islands a system of Winter Palaces of Health and of Camps.
of Health at home. The first part of the idea is not new, >
for he proposed it in 1866, in a memoir whioh he then
wrote on the Medical History of Bath, but he now adds
another suggestion for utilising the high grounds of the
country into what he calls “ Camps of Health.” The .
argument in favour of this new project is stated in a vary-*
simple manner. The library of the writer, a room eighteen
feet square, has been kept, he tells us, during the whole of
the past winter well ventilated at all times with fresh air
warmed to 64° F. What can be thus effected on a small scale
can be extended to any required degree; it is all a mere
matter of engineering skill, the details of which are well
understood and easily mastered. His proposal is to ex¬
tend the plan by erecting in suitable localities a series of
palatial residences which shall include, in a closed square;
magnificent grounds covered in with glass, and fitted with .
playgrounds, tennis courts, subtropical gardens, and every- >
thing that can contribute to the health and pleasure of the.'
invalids who require a resort from inclement seasons in a
genial and Bummer climate at their own doors. The pro- '
portions are supplied for one of these Palaces of Health on >
a minor scale, so as to afford one hundred residences in fifty
substantially built houses of two storeys surroundipg a square
of gardens and grounds accessible by four grand entrances..
Each of the houses, divided into an upper and a lower flat,
would be sixty feet deep from the front, twenty-five feet
wide, and fitted with every convenience for the residence...
of an invalid, with every room and part at an equable,
and adjustable temperature. The two sets of resi- .
dences would accommodate at least one hundred in¬
valids comfortably and luxuriantly, with their attendants.
and friends. On the roofs would be four galleries or >
terraces, covered in glass and laid out with flowers, each ,
gallery twenty yards wide and about one hundred yards
long, in all a promenade of nearly a quarter of a mile.
The square, covered at a great height with an arch of glass* i
like the Crystal Palace, would be the inner garden, kept
always at an equable temperature, and arranged for exercises
of every kind suitable for the sick. Add to the whole a
library, a reading-room, a lecture-room, a concert-room or

Digitized by CjOO^Ic

1098 Tfiu Lancet,] WINTER PALACES OP HEALTH AT HOME.—THE MEDICAL COUNCIL. [Mat 38,1887.

theatre, a gymnasium, the most approved baths, including
the Turkish bath and the swimming-bath, with a pump-
room at which the different artificial or imported mineral
waters could be obtained, and it must indeed be a fastidious
invalid who could not for health’s sake spend the months
of December, January, February, March, and April in euch
a Palace of Health. In this palace it is urged there need be
no monotomy, nor one whit less of good exercise, than is
obtainable at foreign resorts, while the immense advantage
Would be secured of entire freedom from treacherous winds,
and the other accidents of atmospheric variability which
the best climate within easy reach of Great Britain fails
altogether to secure. How these advantages are to be had
is next considered, and it is contended that in the palaces
foreshadowed, we could in these days “ command climate.”
In such a palace we oould make our own electric suns to
shine, if we wished them, by night as well as by day; we
could filter the air from every kind of impurity, and by the
effect of electric discharges set at defiance fog, cloud, and
storm. By the same means we could make the air what we ;
pleased in respect to its physical influence on the life of
man and on vegetation. We might even utilise an east wind
for the value of the oxygen it contains, whilst we might take
out of it its fatal sting, and turn it into any quality of
wind we liked so soon as it had entered our territory. We
might make it dry or moist, keen or soft, bracing or relaxing,
as we wished.

Dr. Richardson still suggests that Bath is the centre in
whioh this advancement should first be established. The
climate and position generally are favourable to the experi¬
ment, and the history of the city as a health city is very com¬
mendable ; but most important of all is the flood of heated
water from the springs, which now flows away into the Avon,
and which would be priceless as a means of helping to sustain
the summer climate of the Winter Palaoe and Garden of
Health. There are, however, many other sites in England,
in Scotland, and in Ireland, in which Palaces of Health
could be constructed on a much grander scale; sites in
which valleys of great extent ready for roofing, if we may
so say, and for being laid out in a vast expanse into Winter
Palaces, wait only the hand of man “ to become in all their
natural beauties gardens of perpetual summer, with miles
of park verdure and pleasance.” For Camps of Health at
high levels, Dr. RiCHABDsbN suggests the utilisation of
certain of the old Roman encampments whioh form such
striking points in the history of our country. These, he
shows, are ready for immediate transference into his
design. Into this matter we cannot now enter, but
we offer the idea generally as a “practicable ideal” for
our readers to con over. It would afford good work for
the profession were it realised; but, above all, it would,
as its proposer says, be patriotic in its bearing, by
encouraging native labour, creating a wholesome diversion,
and inaugurating a new era of national progress.

- -*>--

Wb have already referred to the means at the disposal of
the General Medical Council fbr maintaining the standard of
proficiency to be required from candidates at qualifying
examinations, and we pointed out that the Medical Act of
1880 requires the Council to appoint inspectors of examina¬
tions for those bodies which were before the passing of the

Act legally qualified to grant diplomas in respect of mcdi-
cine and surgery, or which have since entered into combuu-
tion with other bodies for this purpose. We stated, mon-
over, that when, in the absence of such combination, tie
Council has appointed assistant examiners, these exuninen
were required to secure at the examinations the main¬
tenance of such standard of proficiency in medicare,
surgery, and midwifery as is required from candidate
at qualifying examinations. As yet the Council have only
appointed examiners in surgery to assist the Society of
Apothecaries, and presumably they intend to send to the
examinations of the Society the inspectors in medicine and
midwifery whom they have recently appointed; it remains,
however, a matter of grave doubt whether they have fully
complied with the intentions of the Act in adopting this
course. The point will probably not be raised at the present
time, but it would become of much importance if tbeCoundl
were at any time to receive from their inspectors a report tbit
the examinations were insufficient. If the Council ere satis¬
fied with the accuracy of this report, they must of naeeasty
communicate their views to the Privy Council, who an
empowered to deprive the examining body of its right to
conduct f urtherqualifyingexaminstions. The question would
then undoubtedly be raised whether the Medieal Council
had themselves fully exercised the powers they poaaea
for securing the maintenance of a standard of proficieney.
It is lamentable that the position assumed by the Boytl
Colleges has created another complete qualification in
London; it is some satisfaction, however, to observe that
the undesirable element of cheapness will not be held oat
by the Society of Apothecaries as an inducement to
candidates. The Society propose to apply to Parliemat
for power to increase their fees on the ground that the
sum which might be an adequate payment for a licence
in one part of the profession was inadequate for a licence
in all parte of the profession. The granting of tits Hcoce
of the Society will therefore we trust, be independent
of -competition based upon pecuniary considerations. The
future alone can show whether the allianoe of the Society
with the Medical Council will sufficiently enhance the nine
of the qualification to make it acceptable to the profosnoo.

The appointment of committees, which finally engsged
the attention of the Council, gives rise to matter fbr com¬
ment. In their codstitntion sufficient regard has not bees
had for the relative population of the profession in the
three kingdoms. Both in the Finance and Education Cosj*
mittees England only shares equally with Ireland and with
Scotland; and, again, in the strengthening of the ExeentiTt
Committee an Irish and Scotch representative only were
added. The proportion of direct representatives assigned to
the three countries must be regarded as some indication of the
relative influence which it was intended should be exercised
by the different countries in the work of the Council, sod
certainly in the constitution of the committees England bis,
therefore, been left somewhat at a disadvantage.

The delay in the publication of the Medical Register
the subject of some discussion at the close of the session.
The early appearance of the volume is undoubtedly very
desirable, but it deserves to be stated that there is no room
for criticism of those who are engaged in its oonpii*'
tion. It is, indeed, bat right that we should nfirtotfce

Digitized by Google

The LAncbt,] THE AIR OP DWELLINGS.—RAGS AS DISSEMINATORS OP DI8EASE. [MAT 28,1887. 1097 J

ndebtednees of the profession to the Registrar, Mr. W. J. C.
Jillek, whose admirable services have contributed in a large
legree to the efficiency of the work of the Council.

The progress made in hygienic researches by the applica-
ion of bacteriological methods has been nowhere better
exemplified than in the investigation of air. Dr. Percy
<'ranbxand has pursued the subject in this country with
nuch profit, and there has lately appeared in the Philo-
ophical Transactions a paper by Professor Carnellbt, Mr.
Ialdanb, and Dr. Anderson of Dundee, which should be
;arefully studied by sanitarians. The investigations here
lescribed consisted in the analysis of the air of dwellings as
-egards carbonic acid, organic matter, and micro-organisms,
he carbonic acid being estimated by the method of
’ettbnkofeb, the organic matter by that of Carnblley
ind Mackie, and the micro-organisms by that of Hesse. As
egards dwellings, their inquiry involved a comparison
jetween houses of from one to four rooms and upwards, and
be composition of the air within these tenements with
bat without. As an example we may cite from one of the
mmeroua tables the following flguree, which represent the
tverage quantities in one-roomed houses, relatively to those
n houses of four rooms and upwards (which are taken as 1):
jubic space per person, 0‘11; carbonic acid, 2*0; organic
matter, 4‘4; micro-organisms, 67 (bacteria 6-9, moulds 3 0).
The carbonic acid, organic matter, and micro-organisms all
diminish in quantity as the oubic space per person increases
from 100 to about 1000 cubic feet; but beyond this capacity
there is a slight increase in these impurities, which is attri¬
buted to inadequate ventilation of the larger rooms. An
nstructive comparison is made of mortality statistics with
be composition of the air of these dwellings—the death-rate
increasing in proportion to the rise in impurity of the air,
there being a very rapid increase in the death-rate among
young children, and the mean age at death being very
greatly lessened. The death-rate from phthisis is lower in
those living in one- and two-roomed houses than in those
living in three rooms, but this anomaly is readily explained
when the early mortality of the former from other
diseases is ooheidered. Thus the death-rate per 10,000 from
(1) diarrhoea, acute bronchitis, bronebo-pnenmonia, and
meningitis is—for dwellers in four rooms and upwards 19 6,
for those in three rooms 27‘6, for those in two rooms 39 7,
and those in one room 69 8; from (2) phthisis the rates are
respectively 13 0, 27’6, 24-4, and 14 - 6. The - inquiry also
showed the effect of impure air in promoting pulmonary
disease; and ae 1 regards infectious disease the mortality
from measles and Whooping-cough seemed distinctly con¬
nected with the class of house, whilst, contrary to expecta¬
tion, no such relation held for diphtheria. The memoir also
enters fully into the subject of the composition of the air
of schools, of mills and factories, and of the Royal Infirmary,
Dundee, and proves that the determination of carbonic add
alone is not a sufficient indication of the purity of a sample
of air. We ca n only mention the very exhaustive study of the
conditions which influence the excess of organic matter and
micro-organisms, and the proofs of the superiority of
mechanical over natural ventilation, but may state that the
authors fP ve as “standards of purity” the occurrence of 10
toIs. of oarbonicadd per 10,000 in the air of dwelling rooms,

and of 13 vols. per 10,000 in that of schools—or an exes88 over
outside air of 6 vole, in the one case, and 9 vols. in the other.
These limits should not be exceeded. Nor should the excess
of organic matter within the house over that of the air out¬
side be equivalent to more than 2 vols. oxygen per 1 , 000,006 f
and the excess of micro-organisms should not he more than
20 per litre. Of these three classes of impurities, the carbonic
add (in the amounts mostly present) is the least deleterious
to health, being compensated for by increased frequency of
respirations; but the “ organic matter” probably has a great
effect in lessening the health predisposing to disease ;
whilst micro-organisms, apart from specific infection, may
be responsible for bronebo-pnenmonia, so frequent and fatal
a complication of the prevalent bronchial catarrh and'
other affections. The paper ooncludes With suggestions of
remedies—especially the adoption of mechanical ventilation
in the Board schools of Dundee, and improved ventilation
by means of open grated windows in landings in block’
tenements; other recommendations, such as the avoidance
of keeping lamps burning at night, the adoption of cleanli¬
ness, attention to frequent renewal of air as of more import¬
ance than the size of the rooms, and the construction of
windows so that they can be freely opened at intervals to
allow a good current of air to be sent through the rooms,
afe such as will commend themselves to everyone.

Ws drew attention in our issue of April 30th to the ques¬
tion of the dissemination of infection through the agency
of rags, as it has been met with in the United States. In
this country the subject has been fully dealt with in the
reports of the Medical Officer of the Local Government
Board. The report for 1881 contained an account by
Dr. Parsons on the influence of cotton and linen rags in
this respect, and there is now issued in pamphlet form 1 an
account of the danger of such dissemination by means of
woollen rags. These rags come mostly from abroad, being
mainly landed at the ports of Goole, Hull, London, and
Liverpool, and they largely find their way to the “ shoddy ” ‘
manufacturer, by whom they are ultimately used for weaving
into cloth or into “linseys.” Pure woollen rags, unless dyed,
undergo no process which can be held with certainty to
destroy infection; but rags of mixed cotton and wool are
exposed either to sulphuric acid, or are treated in a stove in
an atmosphere of hydrochloric acid gas in such a way that
thp cotton fibre is destroyed. Bat no real trust, as regards
disinfection, can be placed in these methods of dealing with
the rags. In the process of flock-making various kinds of
woollen rags and carpets with a backing of hemp are used.
At times exceptionally filthy rags stained with blood and
excrement are used, and in some cases hardly any attempt
at cleansing or purification is resorted to. On the other
hand, an attempt has been made to deal with them effec¬
tually by disinfection under steam pressure. Inquiry on a
wide scale as to the possibility of mischief resulting to
those engaged in the various processes of manufacture to '
which these rags are subjected brings out certain valuable
information. In the first place, the occupation, like others
of a dusty character, was found to affect some workers
so generally that the illness they suffered from acquired

1 Byre and Spottiawoode, East Hardlnf-street. B.C.; A. and C. Black.
Edinburgh; Hodges, Plggla, and Co., Dublin.

Digitized by

Google

lO08 Thb Lahoict,]

A TEACHING UNIVERSITY IN LONDON.

[Mat 38,1887.

the definite name of “flock fever.” But infection seems
rarely to have been brought about. A few cases of small*
pox amongst those who bad been handling woollen rags in
the making of “shoddy” were heard of, but Dr. Pabsons
referring to the common belief that woollen articles are more
likely to retain infection than cotton or linen ones, shows
th^t this does not apply to the prooeases of manufacture of
these several classes of rags; whereas it is well known how
commonly calico rag sorters at paper mills are affected with
small-pox. Indeed, the latter articles in the form of sheets
and underclothing come into closer contact with the bodies
than woollen articles, &c,, and are hence more likely to
receive infection; and it is the sorters of white rags for the
best class of writing papers that suffer most. Still, certain
cases of infectious disease were heard of amongst woollen
rag sorters, upholsterers, and users of rag waste as manure,
which were believed to be due to retained infection in the
rags. The precautions suggested are as follows: Every rag-
worker should be efficiently vaccinated and re vaccinated.
Avoidance of dust should be aimed at, especially in the
direction of improved cleanliness and ventilation of premises.
A moist heat of some 220° F. should be applied to the rags.
This process should preferably be carried out in the bale, and
the beet methods of effeoting it have been fully indicated in
Dr. Pabso^s’s report on methods of disinfection in a recent
report of the Medical Officer of the Local Government Board.

^imotations.

“ No quid nlmli .”

A TEAOHING UNIVERSITY IN LONDON.

It is evident, from the activity displayed by the various
bodies affected by the movement in favour of establishing a
Teaching University in London, that the crisis in its history
is not far off. The Special Committees of the Senate and Con¬
vocation of the University of London have recently met
and exchanged their views on the proposed reconstitution
scheme, so that we shall soon expect to see Convocation
summoned for its discussion. Many of the graduates will
strongly oppose the formation of Faculties composed of
representatives of affiliated colleges, and, even should they be
unsuccessful in their resistance, the powers of these Faculties
are so limited that they cannot satisfy those who think that
teachers should have practical control in a university. The
scheme may not be passed by Convocation, or, if passed, it
will only make some minor, but in our opinion necessary,
changes in the University. It solves neither the general
university question for the metropolis nor the special one
of degrees for average medical students, as in other centres
of medical education. The proposals of the Association for
promoting a Teaching University for London must find
greater favour with those interested in metropolitan educa¬
tion. A university which aims at providing for the student
in all the subjects included in its Faculties the best attainable
teaching, with the necessary aids and appliances, which
requires attendance on a definite course of teaching as a
necessary preliminary to graduation, and which secures to
the teacher a direct and adequate representation in its
councils and share in its administration, cannot fail to
enlist the sympathy of the teachers in the metropolis.
University and King’s Colleges have now formally agreed by
their Councils to petition for powers to form (with any
other efficient college in the metropolis) such a university on
the lines of the Victoria University, and we understand that,

jas a result of this decision at University College on the 2tit,
Lord Kimberley has resigned the office of President of tk
College. Lord Kimberley is also a member of the Senate d
the University of London, and had therefore to choc*
between his University and his College. Powers will be
asked to grant degrees in the Faculties of Arts, Science, and
(Medicine, and to add other Faculties. The difficulties of tin
(medical degrees question are referred to in the petition, and a
(union with the Royal Colleges of Physicians and Burgeoned
England, with a due recognition of the medical schools of
London, is suggested as the proper means for overcoming
(these difficulties. Meanwhile, the Royal Colleges are engaged
jin preparing a charter and petition, asking for powers to
grant degrees in Medicine only, and have declined to pay
any attention to those who deprecate the severance of pro¬
fessional degrees from general academic influences, and
think that the conferring of degrees should only be under¬
taken by a real university. Certainly the present time
seems favourable, by a judicious combination and a little
mutual forbearance, for the formation of a true metropolitan
university. _

EXTREME FREQUENCY OF PULSE AFTER
PARACENTESIS.

An interesting case in which extreme frequency of the
pulse followed puncture of the abdomen for ascites, it
reported and discussed in the St. Petersburger Medicmitdt
Wocheruchrift by Professor Dehio of Dorpat. The patient
was a man aged fifty-six, with cirrhosis of the liver. In
addition to a considerable degree of ascites, there was
general oedema and an old-standing hernia, but no heart
mischief could be detected, and the pulse was 86, regular,
and of moderate tension. Immediately after the opera¬
tion the man felt better and was able to breathe more
easily, and a alight rise of the pulse was then noted. The
next day the face was pallid, and the patient complained of
giddiness and prostration. The radial pulse had become
162, thready, and weaker; the second sound of the heart
could scarcely be heard. This condition continued without
any great alteration for five days, the pulse rate varying
from 180 to 150. No rise of temperature occurred, and the
respiration was about 24. At Professor Kobert’s suggestion
two milligrammes of corooilin were introduced sub¬
cutaneously, which was shortly followed by a reduction of
the pulse rate to 80. A few hours later, however, it rose
again to 182. The next day, without any repetition of the
coronilin, and indeed without any assignable cause, the poise
sank to 84, and did not again rise to any remarkable extent.
From this time, however, the patient’s general condition
became worse, and he died eighteen days later. The necropsy
showed fatty degeneration of the heart and general diffused
arterio-sclerosis. There was some hremorrhagic pachymenin¬
gitis and a good deal of clear fluid in the ventricles of the
brain, the cerebral substance being of moderate consistence,
without any softening and containing less blood than usual.
The cerebellum and medulla were in the same condition.
The cause of the extreme frequency of the pulse was evi¬
dently not the disease of the heart and vessels, as this still
existed at the time of death, or eighteen days after the poise
had resumed its normal rate. It most be looked for in the
ansemia of the medulla, which doubtless followed the opera¬
tion. Dr. Dehio proceeds to discuss the question whether
this anaemia affected the heart by stimulating the accelerator
(sympathetic) centre or by paralysing the inhibitory (vagus)
centre, and strongly inclines to take the latter view, quoting
Nothnagel, who, in a recent article, says that when ao
extreme frequency of pulse is found associated with regu¬
larity of the intervals between the beats, a weak cardiac
impulse, and an absence of other symptoms, or the existence
of such as point to an incomplete emptying of the ventricles

Digitized by GoOgle

Th 4 Iuuron.J

HOSPITAL WEEK OP THE JUBILEE TEAR.

[May 28,18#. 1009

i&ralysis of the inhibitory apparatus is indicated. Exactly
hese conditions existed in this case, as shown by its
listory and the sphygmograms obtained, which were of a
lyperdicrotic type. Traube has also described a case of this
are condition. An old man, with phthisis, was unable to
it up in bed from the extreme frequency of pulse produced
>y the amwmia which the upright posture caused in the
nedulla, which, according to Traube, induced paralysis of
he inhibitory apparatus, “ the action of which is more easily
inspended than that of the respiratory and vaso-motar
tentres.” Another reason given by Dr. Dehio for the view
le takes is that it is hardly possible that stimulation of the
coolers tor apparatus should have been kept up for so many
lays without any sign of the eentre becoming fatigued, the
nterval between the pulse beats not having altered at all.
’he fact was that when the abdomen began to refill the
uedolla became engorged with blood and the vagus resumed
ts proper functions. Nothnagel has pointed out the analogy
>etween the sudden loss of regulating power of the vagus,
ind the sudden loss of consciousness in epilepsy and fainting
vhich is produced by very slight interference with the blood
listribution. _

HOSPITAL WEEK OP THE JUBILEE YEAR.

Thu mere list of speakers who have promised to take
part in the public meetings is enough to show how deep is
Che interest taken in Hospital Sunday. These meetings will
be held in various parts of the metropolis. The speakers
include Sir Wm. Plowden, K.C.S.I., Mr. Spurgeon, the Bishop
jf London, Sir Andrew Clark, the Lard Mayer, the Prime
Minister, Rev. Dr. Allon, Mr. Henry Irving, the Duke of
Argyll, the Duke of Westminster, Mr. Richard Chamberlain,
Che Dean of Westminster, Cardinal Ma n ning, Lord Randolph
Churchill, the Duke of Cambridge,•and the Rev. 6. S. Reaney.
A cause which can command advocates so varied and so
distinguished should have great success. The list of places
at which the meetings are proposed to be held, with the pro¬
posed date and hour of the meeting, will be duly advertised.
We urge upon all our readers to do their part to make the
meetings effective. When the Prime Minister of England
can steal half an hour from Ms toils to plead the cause of
hospitals, and when some of the busiest men in the city can
And time to organise such a set of meetings, it is the least
that any benevolently disposed perton can do to aid to
every possible way to make them a success. Many fear
that the Jubilee year will interfere with thiB great collection.
This is to pay a poor compliment to the Jubilee, which can
have no worthier memorial than the doubling of the sum
usually raised for hospitals on Hospital Sunday.

POLYMORPHISM OF THE FUNGUS OF THRUSH.

OtrtmvAfWD in gelatine, M. Aftdry finds that the fungus
of thrush gives rise, at the end of five or six days, to a large
number of small secondary masses, white and tea arm i Ha ted,
in Juxtaposition to the original growth introduced. On
igar-agar at a higher temperature the vegetation is more
rapid, but the mammillated aspect is less ebvtous. The
multiplication is MB! m4te rapid when glycsriaed agar is
employed, and on ■potato it# growth is also snooetsfml. In
these virions cultivations no spores were found, but oells
of oval form, of greater or less dimensions, arranged in a
chain, in the angles of which secondary ceUules may arise
in mycelial expansions, altogether similar to yeasts. But
sown in bouillon there organisms turn the liquid turbid at
the end of two or three days, and a sediment of whitish flakes,
const ting of agglomerations and mycelium of cellules—
the true oidiaa albicans,—is found. In wine the mycelial
growth flourishes; an acid medium f av o ur s their mnltiplic**
tion, which barer prevents. The fman of bacterium aoeti
has not been dfeootored ih those miltnree, Ttuptbe pstho*

genic organism of Mugnet develops in two different fashions.
In liquid bouillon it throws out profusely mycelial expan¬
sions, and is in the heyday of its vigour; it is then a
saocharomyces. In a solid medium, on the other hand, it
retains its condition of an oidium, being bnt slightly different
from certain fungi; in this state it may be regarded as the
spore of which the myoelium has remained in an embryonic
state. _

PENSIONS TO MEDICAL MEN AND THEIR WIDOWS.

All men should insure their lives early. All medical men
especially should do so: first, because they should set a good
example; secondly, because their lives are a little more pre-
oarious than other men’s lives. But for all men early life
insurance is a good thing. It implies some forethought. It
can be done for a moderate sum, and it is a thing well over.
We confess to something like shame at the frequent recur¬
rence of painful cases of want of foresight and forethought in
medical men who have allowed themselves to live and die
without making any provision for those whom they leave
behind,—apparently content that they should appeal in
formd panperia to the pity of those who have their own
burdens to bear mid their own families to provide for. There
is something almost mean in tins conduct, especially in days
when it is comparatively easy to make some provision. It
is not for us to indicate or select the particnlpr method.
Medical men in London and the neighbourhood are almost
without excuse in this matter with the Widows and Orphans
Fund to subscribe to. For others there are the multifarious
systems of the different offices for life insurance, some of
them on very easy and favourable terms. Lastly, there is
what is called the Non-forfeiture system advocated by Mr. E*
C. Garland of Yeovil, and worked by the Edinburgh Life
Office, by wMch by a Certain annual payment a man may
receive a certain sum at sixty or at death; and by which,
further, in the event of his ceasing to pay premiums at any
age, be will still, it appears, receive at sixty a larger sum than
he has paid in premiums. Particulars of tbis system may be
obtained fa any individual'case by application to the secre¬
tary, Edinburgh Life Office, 11, King William-street, E.C.
But we repeat our contention, that a man who is living con¬
tentedly without having made provision for his family fa
the event of his death is acting discreditably.

MUROER OR HOMICIDE.

Thb practice of criminal abortion in a Mod of villapy the
enormity of which we have no wirii to landmine. To take
away the life of an undeveloped infant, unless it be to sari*
the mone important life of the mother, is in iteelf an Imp
cusable piece of wiaksdness. To risk the metherk safety fa
doing so dearly aggravates the crime, and there are etoemn*
stances in which each an offence may even be regarded as
murder. It is rather, however in most oases, one of those
misdeeds which lie just on the borderland between homicide
and murder, and its exact significance must often be difficult
to define. Tn a case recently tried at Warwick Assizes
two persons were sentenced to death, though With a
recommendation to mercy, for having caused the death
of a young woman by procuring abortion. Here thd
evidence available seems to have amounted to proof of
murder; yet it is, we confess, somewhat difficult for ua
to reconcile our ideas to such a supposition. Murder
implies either a design to MR or the employment against
the person of means capable of killing, with a reckless dis¬
regard of their worst possible effects. It is, we should say,
virtually impossible that two persons desirous of hushing up
a scandal by causing abortion should directly contrive the
death of a third, the subject of this operation. When we
oome to the question Of reckless procedure, the mere fact of
the operation undoubtedly goes far to prove * criminal die--

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BOARDING OUT OP

regard of consequences, and is in itself, highly illegal.
Nevertheless, we have still considerable difficulty in accept¬
ing the view that this in itself is enough to prove a
graver crime than culpable homicide. It is at least
doubtful whether some concession should not in such
cases be allowed to the criminal on the ground
that, while doing wrong, he has blundered through
unskilfulness beyond his intention, or even his apprehen¬
sions. He goes about his malpractices, it is true, with
his eyes open both to its dangers and its illegality, yet he
must in his own interest endeavour to prevent the worst
consequences. These are, as a rule, not impossible of pre¬
vention, whatever the uncertainty and difficulty of arriving
at such a result. If it were otherwise, induction of abortion
in any case would be impossible. Consequently, the abor¬
tionist, bad though he is, must in many cases be excused from
such utter recklessness as would render him distinctly guilty
of murder. We should remember, too, that the subject of
his unscrupulous attempt is usually a consenting party, not
a mere victim. These considerations have, doubtless,
weighed with the jury in recommending the prisoners above
mentioned to mercy; and, though we do not know of any
injustice in the sentence, we are disposed to think that they
may very fairly be urged as a plea for its commutation.

PATHOGENY OF GASTRIC ULCER.

The precise pathogeny of chronic ulcer of the stomach is
one of those undetermined questions which have led to
considerable speculation, with comparatively little profit.
The position, form, and nature of the ulcer have done more
than any positive demonstration of the vascular lesion to j
favour the current doctrine of its dependence on arterial
blocking. But everyone knows the difficulties in the
acceptance of this view, not the least being the comparative
frequency of the disease in the female sex, and the great
preponderance of cases where the ulcer is solitary and seated
on the posterior surface near the lesser curvature. Dr. Decker
of Wurzburg has the last word on the subject (Berl. Klin.
Wochenschrift, No. 21), and he advances evidence in support
of the initial lesion being traumatic, or rather thermal.
Thus, he believes that the contact of hot thickened fluids
with the gastric mucosa excites hyperamia, which becomes
localised, and may lead to venous stasis and haemorrhage in
a limited territory, with all the subsequent necrotic changes.
He supports his view, not only by reference to the clinical
history of cases of gastric uloer (he points to the great pre¬
valence of gastric ulcer among cooks, who habitually test the
flavour of their dishes when very hot), but by two experi¬
ments on dogs into whose stomach food heated to 60° C. was
introduced. In one of the animals a patch of hyperemia, with
hemorrhage between the gastric mucosa and muscularis near
the lower curvature, was found; in the other, a deep ulcer j
of characteristic shape and position had been produced.

BOARDING OUT OF PAUPER CHILDREN.

Some recent statements as to the condition of children
boarded out at Denmead by the St. Pancras Board of
Guardians seem, at first sight, calculated to discredit that
mode of bringing up pauper children. At one place, it was
stated, four children were found sleeping in one room with
a thatched roof. A woman named Sylvester had six children
of her own, two from Mr. Bernardo’s Homes, and one from
the St. Pancras guardians. These boys were described as
sleeping three in a bed, and “ covered with festering sores.”
Pour were in a deplorable state, and had no doctor attending
them. An old man with six shillings a week had four boys
boarding with him—two from Mr. Barnardo’s Homes and
two from St. Pancras. When visited, the boys were standing
at their dinner round a table one eating out of a broken

PAUPER CHILDREN. [Mat 28,189.

gallipot and another out of a broken basin. The only fool
which they were seen to have by the visitor consisted 4
pieces of pork rind and of bread and potatoes. The vrfcu
family used one towel, which did not seem to haw
been washed for two month a These statements hat*
however, been very largely disputed or refuted, ki
Bernardo has had the boys from his school brought -J
to be inspected, and he declares that they are quite wU
and free from sores, save one boy who has oocsb
tutional eczema, and even he is much better than who'
be went away. The agent from Mr. Bernardo, making i
surprise visit on the very night the statements were pub¬
lished, found the beds and clothing clean. All the childr.:
appeared to have had ample food. The vicar of Detune*
Mr. Greene, describes the reports as grossly exaggerated, tai
attributes the eruptions noticed to children affected wifi
itch sent down from St. Pancras. But Mr. Clarke, the medi¬
cal officer, denies that any child with the slightest indieatks
of disease has left St. Pancras, and his carefulness is vouched
for by Mr. Mill ward, clerk to the St. Pancras Board, in u
interview with the representative of the Pall Mall Gazetu
It seems right to conclude that a system which has beer
found on the whole to work well should not be condemned
on such doubtful statements as have gone the round of tt*
press. Bat it is evident that the system requires dose
supervision, either by the guardians themselves or by amt
one person or number of persons in whose vigilance sad
wisdom they can place confidence. Mr. Mill ward tpckt
favourably of the system, and said the St. Pancras guardian 1
had nine districts in various parts of England to which they
sent children to be boarded out.

THE MICROBES OF PNEUMONIA.

Pbofessob Weichselbaum of Vienna, in the course
of a review of the discoveries made concerning the
etiology of acute pneumonia ( Centralblatt f. Bacteriolog.
Nos. 19 and 20), refers to his own researches, which
are of much interest. Dealing with material from 12-
cases, which comprised not only primary croupous pneu¬
monia, but also lobular and secondary forms, he dis¬
tinguished four kinds of bacteria. The most common was &
diplococcus, mostly of an oval shape, sometimes occurring
in small chains, and having a capsule which stained
faintly. Its cultures had some resemblance to those of
streptococci; and when injected into the pleural cavity of
rabbits caused a fatal result in from one to two days, with
bilateral lobar or lobular pneumonia, pleuritic exudation, and
often also peritonitis and pericarditis. This microbe is
identical with Frankel’s pneumococcus, but differs froB
Friedlander’s, which does not affect rabbits, but does affect
guinea-pigs. It was found ninety-four times in the 129 cases,
seventy-eight times in genuine croupous pneumonia, but also
in secondary and lobular pneumonia. A second variety, far
less frequently present, was the streptococcus pneumonic,
distinct from other forms of streptooocci, and occurring in
secondary (lobar or lobular) pneumonia when the primary
disease was excited by a streptococcus. It was also me;
with in other forms of secondary pneumonia, and even in
primary lobar pneumonia, associated or not with the diplo¬
coocua. Less frequently still (viz., in nine cases only) did be
meet with an organism identical with Friedlauder’s pneumo¬
coccus, which Weichselbaumstylea" bacillus pneumoniae.’’ He
found this not merely in lobar croupous pne umon ia, but eree
in lobular pneumonia, and three times in association with
the diplococcus pneumonia and a streptococcus. Lastly, the
staphylococcus pyogenes aureus was found In five cases,
either alone or in company with the diplococcus, and always
in secondary inflammation. In several observations these
various microbes were also detected in the exudation of
inflammatory processes complicating the pnwunom a-a s

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LONDON WATER SUPPLY.

[May 28,1887. 1101

>leunsy, pericarditis, peritonitis, meningitis, &c., and once
n the blood and splenic palp. Weichselbaum concludes
root these facts that genuine croupous pneumonia is in
noat cases caused by the diplococous pneumoniae; but
indoubtedly in a few the bacillus pneumoniae seems to be
he sole agent. Clinically, he observes in a footnote, these
atter cases seem to run an exceptionally malignant course,
icute lobular pneumonia, and the pneumonias (lobar or
obular) which are secondary to other infective diseases,
nay be due to either of the four above-named organisms,
iither alone or combined. Therefore the pneumonic virus is
lot a single entity, but, just as in acute inflammations of
ionnective tissue, several kinds of bacteria may be the cause
jf the morbid process. _

LONDON WATER SUPPLY.

Tan report of General A. de C. Scott, the water examiner
for the metropolis, gives an account of the chemical com¬
position of the different waters, which still contain a large
amount of chlorine, and discusses the methods of collect¬
ing water adopted by the different companies, mentioning
that the Grand Junction atad other companies have con¬
structed in the beds of gravel and sand which overlie the
London clay, in the bottom of the river valley, open-jointed
distributing and collecting conduits, the former being used
to convey the river water to the gravel or ballast beds,
and the latter placed at a lower level to collect the
water after it has passed through the ballast, and convey
it to the well of a pumping engine, by which it is lifted
into the reservoirs for ordinary filtration and distribution.
At Hanbury, near Sunbury, a brick-lined tunnel, 1550 feet
in length, has been driven through the clay underlying
the gravel, and from the tunnel vertical pipes lead to the
base of the gravel, from whiob pure water flows into the
tunnels. The gravel beds in this locality form, General Scott
says, a valuable source of eupply, the importance of which
should be recognised. It must, however, he adds, be borne in
mind that this, like all shallow sources of water in porous
subsoils, is liable to become fouled by extension of popula¬
tion over the surface; and if houses with a system of cess¬
pools were built on the gravel area adjoining the works of
the water companies, the purity of the supply therefrom
might become seriously endangered.

ACTION OF HYOSCINE ON THE EYE.

Dr. 0. Walter of Dorpat has published a series of obser¬
vations on the action of hyoscine on the eye. This body
produces some toxic effects very similar to those produced
by atropine—viz., dryness of the throat and dilatation of
the pupils—but, unlike atropine, it causes drowsiness and
languor; it also sometimes causes nausea and giddiness,
Until lately little has been known of the effects of hyoecine
on the eye, but within the last few months two other
Dorpat students, working under Professor K-obert’e direction,
have paid some attention to the subject—one of them,
Dr. Sohrt, having published a paper on the general, thera¬
peutic, and physiological effects of hyoscine. ilirochberg
end Emmett had, however, remarked the mydriatic action
of this subject. Dr. Walter experimented on animals by
instilling hyoscine into one eye and atropine into the other,
end found that a drop of an exceedingly attenuated solution
produced distinct dilatation, acting both on the pnpil and
on the accommodation much mere rapidly than atropine.
The dilatation passed off more quickly than that produced
by atropine, but the paralysis of accommodation persisted
about as long as that produced by an equally strong solution
of atropine. No decided effect was remarked on the intra-
ocular pressure, but in patients with chronic glaucoma the
regular application of hyoscine certainly produced an im¬
provement in the sight and -an enlargement of the field of

vision. Slight toxic symptoms were produced by two drops
of a 1 per oent. solution. The author recommends repeated
applications of a weak solution in preference to a single,
application of a strong one._

THE HEALTH OF THE GERMAN CROWN PRINCE.

The news that Dr. Morell Mackenzie bad been hastily;
summoned to Potsdam to see the Crown Prince has attracted
the attention of English readers to bis Imperial Highness’s
illness, and naturally excited some alarm, which we hope
may be groundless. It appears that for some time the
Crown Prince has suffered from hoarseness and laryngeal
irritation, which a stay at Ems did nothing to mend. A
laryngoscopic examination revealed the presence of a growth,
from one of the vocal cords, and it was feared that it was
malignant in nature. Under these circumstances Dr. Morell
Mackenzie was summoned to the illustrious patient, and he*
to solve all doubts, removed a portion of the growth with
laryngeal forceps, and submitted it to Professor Virchow for
microscopical examination. We are glad to see it stated
that his report was to the effect that the growth is not
malignant. This has allayed the grave fears that had been
entertained in some quarters. .

ALLEGATIONS AGAINST THE HOVE SANATORIUM.

It is a great pity that persons who evidently do not
properly understand the general principles on which in¬
fectious hospitals ought to be established should publicly
condemn a hospital which, in their own district, has been,
erected in order to protect the population against infection.
But this is what has been done at Hove. We, of course, do
not refer to complaints a9 to such matters as dampness of
plaster, ill-fitting doors, &c. These are at times noticeable
in new buildings, and where sea-sand is used on walls the
former condition is by no means uncommon. Such faults
should obviously be remedied; but the work can be done
quietly without, wholesale condemnation of the hospital.
The more important matters complained of are such as, if
wrong, cannot easily be remedied, and to these we would
draw attention. The alleged defaults, it was stated, had
led to the institution being the very reverse of what it
should be. First, complaint was made of the distance of
one block from another, which rendered the passage of atten¬
dants difficult. We cannot assume that an ordinary atten¬
dant, properly clothed, could not be expected to pass from
one block to another; otherwise how can tradesmen, doctors,
and other people who have to go to the hospital face such
weather as is supposed to exist in what is admittedly a
breezy spot ? Apparently it was considered that nurses and
attendants should be running to and fro between the ward
blocks and the administrative building. But that is pre¬
cisely what ought to be hindered. A nurse, when told off
to her ward duty, should remain in her ward until her time
for duty is over, and then, putting on such out-door clothing
as may be necessary during cold weather, she should return
to the administrative cottage, which is her home. She will
thus suffer no more than if she dressed for a walk in the
same breezy place. So, also, the food supplies should three
times a day be brought in a properly covered apparatus to
each ward block by a suitably clothed person. What is
wanted is, above all things, to prevent communication
between ward blocks containing different infectious fevers,
and to keep the several buildings aerially quite distinct.
Another objection raised is that the nurses must take their
food in the infected wards. They certainly have no need,
and the place must be badly administered if they are
allowed to do so. A proper administrative building baa
been provided where the nurses are expected to live when
off duty, to eat, and to sleep. Then, again, it is said there
are no rooms or conveniences for an attendant in the isolat

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THE EDUCATION OP CHEMISTS.

[Mat 28,1897.

tion block. A special room for a nurse is no more needed
than in the case of a nurse who is looking after a private
case in a house, and, what with the separate rooms and
conveniences for nurses in the administrative block, we do
not see what more could be wanted. Enough has been said
to show how unfortunate this publicity has been. Some
details of repair apparently want seeing to; but before such
hospital provision is condemned in public again, it would be
better that those who criticise it should visit other modern
infectious hospitals built on approved systems, and learn
what their experience has been.

TRANSPLANTATION OF HUMAN BONE IN A CASE
OF UNUNITED FRACTURE.

On March 28th M. A. Poncet of Lyons read a paper before
the Acad6mie des Sciences on a case in which he had
transplanted a piece of bone for ununited fracture of the
tibia. The patient, aged nineteen, had sustained a com¬
pound fracture of the tibia about the middle of the shaft
thirteen months previously; this had been followed by
necrosis. On Jan. 19th half of the first phalanx of the big
toe, measuring about one inch in length and half an inch in
width (the articular ends having been removed), from the
recently amputated limb of a healthy man aged forty-three*
was inserted between the fragments after having been
soaked in sublimate solution for three minutes. Antiseptic
precautions were taken and the graft did well, but at the
end of two months the tibia was still movable, and
M. Poncet decided to resect the fibula and tibia. It was
then found that there had been very little loss of substance
on the part of the graft, which was united firmly to the
lower fragment of the tibia by fibrous tissue, but was
separated by about a quarter of an inch from the upper
fragment by weak fibrous material.

PROFESSOR BILLROTH.

We regret to learn that the distinguished Vienna surgeon
is dangerously ill, and that his condition excites the
anxious fears of his friends and medical attendants. He is
suffering from a severe attack of bronchitis; this in itself
would not occasion serious alarm in a man of his age—fifty-
eight—and robust nature. Unfortunately, it is complicated
with weakness of the heart, which adds to the gravity of
his condition. Our Vienna correspondent, however, as will
be seen by his letter, printed in another column, mentions
the publication of a bulletin which favours the indulgence
of a hope of the recovery of the great surgeon—a hope
which will be shared by surgeons all over the world.

A MEDICAL PRACTITIONER A CO-RESPONDENT-
On Saturday last, in the case of Pittis v. Pittis and Wiley,
in the Divorce Court, we regret to note that a member of
our profession was the co-respondent. The respondent, Mrs.
Pittis, was the wife of Mr. Richard Roach Pittis, a solicitor
and the town clerk of Newport, Isle of Wight. They were
married in 1881 and lived happily until a year or two ago.
In 1883 Mr. Thomas Ormsby Wiley came to Newport as an
assistant to another medical man, and afterwards succeeded
him. Mr. Wiley became the medical attendant of Mr. and
Mrs. Pittis, who had no children till 1886. It was not till the
year 188o that the petitioner had reason to think that Mr.
Wiley’s visits to his wife were too frequent and of something
more than a professional character, and not indeed till a
much later period that he doubted the behaviour of his wife.
Then, however, evidence was unmistakable, and when the
cause came into oourt the case against Mr. Wiley was so com¬
plete that he did not appear, and no defence was attempted.
It was proved that he bad taken advantage of his profes¬

sional position and encouraged an interchange of visits with
the respondent for which there was no excuse. These riaiu
were at such times and in such circumstances as to
inconsistent with the innocence of either party. The jadge
spoke in the highest terms of the conduct and bearing of
the petitioner, and in a very different way of the conduct c:
the medical man. The jury agreed to a verdict without
leaving the box, and awarded damages to the amount of
£1200, and the judge ruled that the petitioner should have
the custody of the child. It is humiliating to think that >
medical man should be found in such a position. While it l*
our part to defend medical men who in the discharge of their
duties are exposed to the slander of the malicious and the
extortionate, it is not less our duty to denounce in the
strongest terms those who do not demean themselves ini
manner consistent with the character required in the mem¬
bers of a profession where purity and high minded nets ue
so essential to the public welfare.

MEMORIAL PORTRAIT OF SIR WILLIAM JENNER.

BART., K.C.B., M.D., &o.

Numerous friends and many former pupils of Sir William
Jenner have, for some time past, desired that there should
be an enduring memorial of one so generally and so highly
esteemed, and who has attained to so distinguished a
position in his profession. With this object a prelimimu
meeting has been held, and Sir William Jenner has consent
to eit for his portrait to Frank Holl, Esq., R.A., to be pre¬
sented to Sir William by the subscribers; a replica to fc-
presented to the Royal College of Physicians, and to l'Di¬
versity College, London.

In order that as many as possible of Sir William Jenner'?
friends and former pupils may take part in the memorial, it
has been decided that any sum, however small, may be sub¬
scribed, and that the names only, and not in any case th*
sum subscribed by each, be published. A committee is in
course of formation, and anyone desiring that his name be
added thereto should signify the same without delay to on--
of the following:—Dr. C. J. Hare, 15, Manchester-squire,
W.; G. D. Pollock, Esq., 36, Grosvenor-street, W., bon. trea¬
surers; Dr. J. Russell Reynolds, 38, Grosvenor-street, W.; Sir
Henry Pitman, M.D.,28,Gordon-square, W.C.,bon. secretaries
to any one of whom subscriptions may be paid.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announcedProfessor Carl Friedlander, a brief
account of whose labours will be found in another column.--
Professor J. E. Areschoug, the well-known Swedish botanist,
in his seventy-seventh year.—Dr. A. de Waal Malefijt, a dis-
tiuguished Haarlem surgeon.—ProfessorCastorani,tbeNapl^
ophthalmologist. _

THE EDUCATION OF CHEMISTS.

Thebe can be no doubt as to the benefits which haw
accrued from the Pharmacy Acts of 1852 aad 1863. A®*
there can be no reasonable objection to an extension of the.-?
Acte in the direction of giving power to enlarge the educa¬
tion of chemists, so long as the distinction between it and
that of medical men is kept clearly in view. It is vain to
charge the Medical Council and eighteen or twenty su -
ordinate bodies with the duty of upholding the standard
medical education if Parliament with its other hand sanc¬
tions a quasi -medical education in chemists. truS "
therefore, that care will be taken in the Pharmacy Act n°«
before Parliament to give no such sanction, and to eliminate
from the curriculum of chemists such subjects as are ' i
proper study of medical men. We have good reason to

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THE “TEAR” OF PUBLIC LIFE.—INNERVATION OF PYLORUS. [Mat 28,1887. 1103

alieve that the best teachers of pharmacy appreciate
ie limitation of their duties, and, while giving the clearest
istruction as to the nature and character of drugs, most
irefully avoid disquisitions on their medical uses and
lerapeutioal properties. _____

THE “TEAR” OF PUBLIC LIFE.

Burbly the sort of life lived by members of the House of
ornmons just now is tear, not wear. The worry of it all
i bad enough, but the wretched squandering of energy in
U-night sittings, which has come to be the role rather than
he exception of late, is little, if at all, short of suicidal,
nless there be an entire change of tactics shortly, there will
e a hideous roll of mental and physical wrecks to chronicle,
'he “ tear ” is already telling very seriously on many valuable
ves, and before long the mischief in progress will make itself
lanifest. We think it in no way beyond our province, as
n organ of the profession whose business it is to advise the
ublic on matters of health, to warn those whom it may
Tgently concern that there is a real and instant peril that,
nless something be speedily done to spare Ministers and
aembers of the House of Commons the fearful and prolonged
train to which they are now, and have been for some time
>ast, subjected, there will be a catastrophe which men of all
tarties and ways of thinking and acting in politics cannot
ail to regret. _

INNERVATION OF THE PYLORUS.

The state of the pylorus has been observed under various
irlificial conditions by M. Dobbert, who has employed bags
>f caoutchouc filled with air and introduced within the
>yloric ring of rabbits; the variations in the movements of
he pylorus were written on a kymograph, with which the
'.aoutchouc bag was put in communication by means of
;ubes and tambours. M. Dobbert finds that the pylorus is in
\ state of continual tonus, and at the same time may exhibit
inder certain conditions movements of further contraction
ind dilatation, apparently induced in a' reflex manner,
iocal an.-emia and electrical excitation of the vagus and of
lie spinal cord at the point of origin of the tenth dorsal pair
:ause increased tonicity of the pylorus, whilst local asphyxia
md electrisation of the upper part of the spinal cord have the
opposite relaxing effect. The tonus is sometimes increased,
sometimes diminished, by excitation of the splanchnic.

ST. MARY’S HOSPITAL.

On the 19th inst. Sir E. II. Sieveking was elected Con¬
sulting Physician to St. Mary’s Hospital, and Dr. J. Braxton
Hicks Obstetric Physician. Dr. Lees, the senior out-patient
physician, fills the vacancy caused in the staff of in-door
physicians. Mr. Edmund Owen was formally re-elected
Surgeon to the institution, and Dr. Walter Pearce was
appointed Assistant Physician.

PNEUMONIA IN THE HELDER GARRISON.

Db. H. A. Jansen, a Dutch military surgeon, reports an
interesting series of cases of croupous pneumonia occurring
during his term of duty at the military hospital of Helder.
Though in five years he only saw three cases in private
practice, the number admitted into hospital with this affec¬
tion was forty-seven. The cases came exclusively from two
rooms in the barracks, the occupants of the other parts
of the building and of the married men’s quarters, which
vrere close by, entirely escaping. The climatic influences
and the exposure on sentry duty were of course shared by
the whole garrison alike; so that it is very difficult to
account for the apparently exceptional susceptibility of the
occupants of the two rooms, the hygienic and other con¬
ditions being at least as satisfactory as in other parte of the

barracks. It should be remarked that a large proportion of
the cases were far from typical, some of them presenting
several of the appearances of enteric fever. As a rule,
however, the symptoms were not very severe. Two out of
the forty-Beven died. In the rare instances in which the
pyrexia was very marked antipyrin was given, with satis¬
factory results. Other cases were treated with an acid
mixture, together with brandy, musk, and camphor where
there was much prostration.

PROFESSOR HYRTL.

The illustrious Vienna anatomist, Hyrtl, who has for some
time been suffering from cataract, has had the right eye
operated on by Prof. Fuchs, apparently with great success.
The left eye is also affected, and will shortly have to be
operated on. Prof. Hyrtl is seventy-five years of age. He
has the sympathy and good wishes of medical men in
every country, who have all, probably, whether they are
aware of it or not, profited more or less by the excellent use
to which he put his organs of vision in his earlier days.

SEA WATER FOR STREET WATERING.

On the 12th inst. at Bournemouth an important inquiry
took place at the instance of the Local Government Board
with respect to an application from the Bournemouth
Commissioners for sanction to borrow £9000 for works
of street watering and sewer flushing. The scheme was
opposed by the local Gas and Water Company, no objection
being raised by the ratepayers. Evidence in favour of
the proposal was given by the Bournemouth surveyor,
the borough engineer of Portsmouth, the borough surveyor
of Great Yarmouth, the consulting analyst for the county,
and Mr. Kinsey-Morgan, medical officer of health for Bourne¬
mouth ; and a shareholder in, a director of, and the secretary
to the Water Company, opposed it. The Local Government
Board will shortly come to a decision on the matter;
we have frequently supported the suggested use of sea
water for such purposes, and cordially hope that the London
Board’s decision may be in favour of the promoters of the
scheme. _

THE WIDOWS AND ORPHANS OF MEDICAL MEN.

The admirable Society for the Relief of Widows and
Orphans of Medical Men, whose generous rules leave every
medical practitioner in the metropolitan district without
excuse for not providing something for his own widow and
orphans if need be, and for not lending a helping hand to less
fortunate practitioners if there be no such need, will soon have
completed a century of useful existence. Next year will be
the centenary of its foundation. We are glad to hear that
its officers propose to celebrate the event in a manner
worthy of the great and good objects of the Society. We
shall welcome the occasion, and trust that it will excite
much attention on the part of medical men to the subject of
provision for widows and orphans.

CHEMISTS AS MEDICAL ADVISERS.

Mb. William; Carter lately held an inquest on the body
of a woman who had died without medical attendance, and
with only the advice of a ehemist. He said it was a great
pity that persons should consult chemists instead of medical
men. He said the evil was increasing and it was time
something should be done to lessen it. It caused a great
number of unnecessary inquests and much expense to the
country. This is a serious view of the matter; but it is the
least serious one. There can be but little doubt that
many such deaths might be obviated by proper medical
care and attendance, which can be had in every parish

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TITE LONDON HOSPITAL.' •

[Mat 28,1887.

for nothing if the patient is too poor too pay. The
coroner's remarks are opportune at this moment when a
Pharmacy Bill needs to be amended in such a way as to
preserve a broad distinction between the education of
medical men and that of chemists.

GASEOUS RECTAL MEDICATION IN PHTHISIS.

A FBE 81 I series of observations by M. Perret appears to
result in conclusions in general harmony with other recent
trials of the method. He states that the gaseous injections
have no microbicidal action ; they can modify the bronchial
phenomena And diminish expectoration, also influence nutri¬
tion for good, especially in the apyretic forms, like other
medicaments, and hence are of value in relieving particular
symptoms. The outcome of this appears to be that they are
as good as, but no better tli&n, other bronchial remedies.

FOREIGN UNIVERSITY INTELLIGENCE.

Basic.— Dr. M. Gottschau, Professor of Topographical
Anatomy, has resigned.

Berlin. —Dr. B. Fraenkel has been raised to the status of
Extraordinary Professor lecturing upon laryngology. Dr.
Jurgens, first anatomical assistant in the CharittS, has been
appointed Curator of the Pathological Institute. His post
as first assistant will be filled by Dr. 0. Israel. Dr. Matthias
Schulz, director of the Royal Vaccination Institute, has been
appointed to assist Professor R. Koch in giving instruction
to all the students in vaccination.

Buda-Pesth. —Dr. 0. Portig has qualified as privat
docent.

Prague (Bohemian University).—The names of Dr. Sch wing
and Dr. Bubesca have been selected for the vacancy caused by
the death of Professor Strong.

Tubingen.— Dr. Walcher, privat decent, has been ap¬
pointed to the post of Superintendent and chief instructor
in the Stuttgart Midwives’ School, in place of Dr. Fehling
recently appointed Professor of Midwifery at Basle.

Thb members of the Society for the Prevention of Hydro¬
phobia and Reform of the Dog Laws are preparing for
submission to the Government a comprehensive Bill intended
to abrogate all existing laws affecting dogs, and place
their hygienic control and general management upon clear
and well-defined lines. The co-operation and advice of all
interested in this question are invited by the secretary of the
Society, but the fact that the Duke of Beaufort is its pre¬
sident, and that several professors of the Royal Veterinary
College are on it* committee, is sufficient proof that the
true interests of dogs are being cared for, as well as the
public protection. __

Wk regret to hear that throughout the county of Lincoln¬
shire petitions are being signed protesting against the
proposed pension of £600 to Dr. Palmer, who has for many
years acted as medical officer to thelCounty Lunatic Asylum;
Gainsborough having taken the initiative, the other boards
are following suit. The reason given for the protest is the
present depressed condition of agriculture, but it is to be
hoped that Dr. Palmer will not be deprived of the reward
of his tang and faithful services to the county.

Wr understand that the restriction which has been
hitherto imposed upon the President of the Medical Board
at the India Office with respect to practice in the case of
sick offioemor employes of the Indian Government on the
active list has-now been withdrawn by the Secretary of
State for India in Council, this decision having been officially
communicated tp Sir Joseph Fayrer in a letter bearing date
-

Thb charges of criminally assaulting two female patients,
brought against Mr. Ralph. Hodgson, a medical practitioner
of Lewisham, were investigated at the Central Criminal
Court on the 24th and 25th inst. In the first case the jury
returned a verdict of not guilty, a decision which was
received with applause; and in the second, no evidence
being offered, a formal verdict of acquittal was recorded.
We congratulate Mr. Hodgson on having succeeded in
vindicating bis character from a charge which of all accusa¬
tions is the most difficult to disprove, and most fatal to
those against whom it is made.

The death of Mr. H. F. Gisborne is announced as having
occurred, in his seventy-ninth year, at his residence in
Derby on the 25th inst. The deceased was a justice of the
peace for the county and borough, and consulting surgeon
to the Derbyshire General Infirmary. For upwards of fifty
years Mr. Gisborne was intimately associated with public
affairs in Derby, and was the ninth member of his family
who, during the last 200 years, had filled the civic chair.

Thb Cavendish Lecture will be delivered at the West
London Hospital on Friday, June 3rd, at 8.30 p.»r., by Sir
Andrew Clark, the subject being, “ On a frequently suc¬
cessful and speedy Method of treating Hay Fever.”

The dignity of Knight Commander of St. Michael and
St. George has been conferred on James Hector, M.D.,
Director of Geological Surveys aud Curator of the Colonial
Museum for the Colony of New Zealand.

Mb. F. Bowbeman Jessett, F.R.C.S. Eng., has been
elected one of the vice-presidents of the Surgical Section of
the International Medical Congress to be held at Washington
in September next. _

Mb. Edoab M. Crookshank, M.B., has been appointed
Lecturer on Bacteriology at King’s College, London.

THE LONDON HOSPITAL.

Last Monday the first lecture of a course on Chemical
Pathology, arranged to meet the requirements of fourth
year’s students, or those Who have recently qualified, was
given at the London Hospital by Dr. Ralfe. The lecture,
which was introductory to the course, dealt with the
Relations of Humoral Pathology to Therapeutics. The
history of humoral p&tholdgy was traced back to the teach¬
ings of Galen, and the domination of the idea of black and
yellow bile, and their respective influence on the fluids of
the body. The general distrust of the Galenic doctrines,
or, rather, disgust at their dogmatism, was then alluded to
as Betting in at the end of the fifteenth century, as pre¬
paring the way for the acceptance of the teaching of the
latro-chemioal school in the sixteenth century. The rise of
the two great schools—the anatomical and tne chemical—
was then described ; how at first there was a hearty union
between them, and great anatomists like Sylvius, Willis,
and Vieussene, who were also great chemists; how the schools
became rivals, and at last deadly enemies. It was interest¬
ing to observe, said the lecturer, that the more specu¬
lative school—the chemical—was from the firet associated
with Germany, whilst the more practical—the anatomical—
found its chief adherents among the Latin races. He de¬
fended the iatro-chemical school against the charges
brought against it. The real cause of its failure was it*
being unable to verify its factp, neither chemistry nor
physics being sufficiently advanced to render assistance.
Having drawn attention to the importance of applying
chemical analysis to animal physiology, the iatro-enemista
could do no more than wait till chemistry was sufficiently

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The Lancet,]

8T. GEORGE’S HOSPITAL.

[Hay28,1887.' 1105

advanced to afford further assistance. Although patho¬
logical chemistry was eclipsed for more than a century and
a half, it did not die. It wa3 fortunately preserved by the
Dutch School of Medicine, which during the whole of
the eighteenth century exercised a potent influence over
medical thought. It was this school that first made patho¬
logical anatomy a science, and took the anatomist from the
dissecting-room to the deadhouse. Dr. Cullen, who was a
pupil of Boerhaave’s at Leyden, was next to see that scien¬
tific chemistry, advanced as it was by that time, might play
the same part to pathology that anatomy was then doing,
and from that time chemistry, no longer attempting to
dominate medicine with its speculative views, consented
to work as a servant, and chemical pathology has,
in consequence, become a recognised science based on
experimental facts. “ Ckymia cgregia anciila medicinrc, non
alia pejor domina." One great result of Cullen’s teaching was
the creatiou of a school of medicine at Edinburgh, which
soon distanced its Dutch rival, and became at the com¬
mencement of the century the leading school of medicine in
Europe. Dr. Ralfe then proceeded to enumerate the chief
results obtained by this union of scientific chemistry with
practical medicine during the present century, and remarked
that everything was tending to a new alliance with the
anatomical school, to unite in work for the common good.
After paying a tribute to the work done by Prout, Golding
Bird, Bence Jones and others, the lecturer eulogised
Dr. Garrod as the Nestor among the humoral pathologists of
the day. Chemical pathology owed him much, not only for
the brilliant discoveries he had made and their practical
utility, but for the cautious manner and sobriety with which
he had advanced his generalisations, and which had con¬
ferred such credit on the young and rising school.

ST. GEORGE’S IIOSPITAL.

A very successful gathering took place at this Hospital
on the occasion of the opening of the new physiological
laboratories and class room. On May 18th, in addition to
the present Btudents, there was a very large attendance of
old St. George’s men and other friends of the hospital. An
interesting address was delivered by Mr. G. D. Pollock, in
which he reviewed the various changes and improvements
he had witnessed, both in the medical profession generally
and in the hospital in particular, during the past fifty years.
Congratulating the medical school on its good fortune in
having secured the services of Dr. DelSpine as lecturer and
general superintendent of the physiological department,
Mr. Pollock referred at length to some remarks which
Dr. Deldpine had made to him with regard to this depart¬
ment, over which he now presides: “For a number of
years physiological facts have been taught in the form of
dogma, the student remaining in ignorance of the simplest
methods of demonstrating facts. Hence the facts and the
theories arising from them were received on the mere
authority of the discoverer, this being taken as equivalent
to actual demonstration, and the result was but too often
erroneous teaching.” Great stress was laid by Dr. DelSpine
upon the fact that this new laboratory is so fitted and
arranged that any student with proper industry can work
out for himself all questions which fall within the
curriculum, and that it is independent work of this kind
which is so profitable. Mr. Pollock then proceeded to give a
sketch of the hospital as it was when he entered the Medical
School, and dwelt, amongst other advantages which the
present student enjoys, upon the fact that house-surgeons,
dressers, &c., held their appointments free of charge, an
inestimable boon in the case of the house-surgeon or house-
physician, who holds his appointment at St. George’s for
twelve months. Mr. Pollock then introduced the question
of increasing the number of house-physicians and house-
surgeons in order to meet the daily augmenting work of
the hospital. Such a plan for adding to the resident staff
would, Mr. Pollock said, receive his hearty support, as con¬
ducing alike to the welfare of the patients and the better
education of those who are to form the rank and file of the
nwdical profession. Mr. Pollock concluded an instructive
•ddresa with a few words of advice to the students, and a
graceful compliment to the dean of the school. Dr. Wadham.
Those present, at the reqosst of the dean, then proceeded to

inspect the new laboratory, where Dr. Del6pine made a few-
physiological experiments with a view of showing the
capabilities of the building for the purpose for which it was
intended. A subsequent adjournment to the museum for
refreshments concluded the meeting, which had been agree¬
able and satisfactory to all concerned.

MEDICAL ATTENDANCE ORGANISATION
COMMITTEE.

At a meeting of the above committee, held on Tuesday,.
May 24th, the following resolutions were carried unani¬
mously:—

1. “ That it is desirable that hospitals should enter into
arrangements for co-operation with provident dispensaries
in their neighbourhoods, and that a subcommittee be
appointed to prepare a scheme defluing the relations that
should subsist between them.” The following were ap¬
pointed as a sub-committee to consider this resolution: Sir
Spencer Wells, Drs. W. Ord, Gilbart Smith, W. E. Steavenson*
J. Grey Glover, Walter Smith, F. H. Alderson, and J. C.
Steele; Mr. W. G. Dickenson, Mr. W. Bousfield, Lieut.-Col.
Montefiore, and Mr. W. G. Bunn (secretary).

2. “ That the governing bodies of hospitals be requested to
consider the advisability of attaching a provident branch
to the out-patient departments.” This resolution having
been passed, it was also resolved that the chairman (Sir
Spencer Wells) should select a subcommittee to consider
the best means to carry it out.

The next meeting of the committee will be held on
Tuesday, June 14th._

Dealt! aitb |]oor fak

LOCAL GOVERNMENT DEPARTMENT.

REPORTS OP MEDICAL OFFICERS OF HEALTH.

Jarrow Urban District .—Under the Jarrow Improvement
Act 140 notifications of infectious disease were heard of
during the past year, and much useful work wm done by
excluding scholars from houses infected. One section of the-
Act contains a useful prohibition. It enacts that no person
shall cease to occupy any house within six weeks of the
occurrence of a case of infectious disease therein without
having the house disinfected to the satisfaction of a medical!
practitioner, or intimating the nature of the disease to the
owner; and breach of this provision led to the infliction of
a fine during the year. Typhus was twice imported, but it
did not spread, and Dr. Muuro attributes the low “fever ,r
death-rate of the town, even in such a period of privation
as has been gone through, to the considerable sanitary
improvements which have been brought about. Amongst
the more prominent additions to the sanitary defences of
Jarrow is the completion of an excellent _ hospital for
infectious diseases. During a previous year it was found
that the bye-laws as to drainage for new buildings had not
been observed, and the method of dealing with such cases
gave rise to much discussion. As a matter of fact, in any
town where much building is going on it is nearly the work
of a single officer to see that building bye-laws are duly
observed, for constant sujiervision during the process of
building is imperatively necessary. ,

Bristol Urban District. —Dr. D. S. Davies, who during the
last six months of 1886 held the post of medical officer of
health in succession to his father, gives an excellent sum¬
mary in his annual report of the various sanitary circum¬
stances existing in Bristol. On many points details are-
given which must be of great local value. As regards the
water-supply, it is stated to be, in point of quality, above
suspicion; but it is to be regretted, in connexion with a
special charge which the company have the power to make
as to each closet flushing apparatus, that the majority of the
out-door closets throughout the city are dependent on hand
flushing. As regards the sewers, Bristol is a city without
sewer ventilation, and Dr. Davies supports our contention
that roadway ventilators are injurious. Much is being done
in the direotion of efficient house drainage, but additional

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HEALTH OP ENGLISH TOWNS.—HEALTH OF DUBLIN.

[May 28,1887.

powers are needed, under bye-laws, as to securing proper
foundations for bouses. In one respect we regret to see so
little advance in Bristol. Scarlet fever caused no less than
eighty-nine deaths last year—a fatality which indicates a
vast amount of sickness. There is a fever hospital,and yet the
admissions numbered nine only. It is difficult to understand
the grounds on which this hospital is administered as it is,
■for one of the regulations for admission not only reminds
.patients that a charge not exceeding fl & week will be
•demanded of each such patient, but it goes on to add that
this payment “ will be enforced ” in all cases where such
patient or person is able to pay. Anything more calculated
to prevent the use of a hospital built and maintained at the
cost of the rates, professedly for the public protection, it is
■almost impossible to conceive, and it is, we assume, largely
owing to this statement as to the enforced payment of a
• comparatively paltry sum of money that so little is done by
way of isolation to stay the spread of a disease so fatal and
•so costly to the community suffering from it. Happily,
authorities generally understand that the public interests
demand isolation at almost any reasonable cost, and the
-question of procuring repayment is rarely entertained to
any noteworthy extent.

Spilth;/ Rural District .--In connexion with an account of
the infectious diseases which have come under notice during
■the past year, Dr. F. J. Walker refers to the advantages of
•notification, isolation, and disinfection. As regards isolation,
he believes that the plan hitherto adopted, of taking cottages
ns hospitals as occasion may require, will still answer the
purposes of the district; and it would appear that disinfec¬
tion is limited to such work as can be carried out in the
absence of an efficient dismfecting apparatus. The general
description of the several localities in the district affords
indication of action needed in the direction of providing
proper water, sewers, privies, &c., and of the want of action
ns regards houses that are a nuisance from dampness or
otherwise. The death-rate for 1886 was 17 - 45 per 1U00.

Bedford Rural District. —Dr. Prior calculates the death-
rate of this district at 16'27 per 1000 for 1836, and he then
proceeds to give some account of the infectious diseases that
•have prevailed during the year. Small-pox has been held
at bay during ten years, and it is earnestly hoped that,
oven with the risk of fresh importation, this disease may soon
become extinct in the district. Diphtheria was to some
-extent prevalent in Kempston, and owing to the absence of
a hospital belonging to the sanitary authority one cas9 was
isolated in the Poor-law small-pox building in the work¬
house grounds. Dr. Prior presses upon the authorities in
■the Bedford Union the necessity for some central hospital on
the block system, and adapted to serve the requirements of
■their districts.

Wem Rural District. —Dr. Giles reports that scarlet fever
was widely prevalent in the district during the last six
months of 1886, and he refers to the need for notification of
•such diseases. He points to the strange anomaly that if a
farmer can trace the los9 of one of his pigs to the fact that a
neighbour has failed to give notice of the existence of in¬
fectious disease on his premises the latter is subject to a
■heavy fine, but if the farmer only loses one of his children
from a similar cause there is no penalty. In Wem itself
good results have followed from the new arrangements as
to the removal of town refuse. In Shawbury the need for
a proper supply of water i9 pressing. Throughout the
•district the death-rate was 18 9 per 1000.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5701 births
and 3591 deaths were registered during the week ending
May 21st. The annual rate of mortality in these towns,
which had been 20 9 and 19 7 per 1000 in the preceding
two weeks, rose again last week to 20*3. During the first
•seven weeks of the current quarter the death-rate in these
towns averaged 20 6 per 1000, and was 1*9 below the mean
rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 12 3 in
Wolverhampton, 14-2 in Leicester, 14-9 in Sunderland, and
15'2 in Halifax. The rates in the other towns ranged
upwards to 281 in Preston, 288 in Oldham, 29*2 in
Norwich, and 811 in Manchester. The deaths referred to
■the principal zymotic diseases in the twenf-v-pi cht towns,

which had been 548 and 500 in the preceding two
weeks, rose again last week to 532; they included 237
from measles, 158 from whooping-cough, 48 from scarlet
fever, 47 from diarrhoea, 22 from diphtheria, 19 from “fever*
(principally enteric), and only 1 from small-pox. No death
from any of these zymotic diseases was registered daring the
week in Wolverhampton; whereas they caused the highest
death-rates in Newcastle-upon-Tyne, Norwich, Salford, and
Oldham. The greatest mortality from measles occurred in
Newcastle-upon-Tyne, Manchester, Oldham, Salford, and
Norwich; whooping-cough in Birmingham, Oldham,'and
Blackburn; and scarlet fever in Preston, Salford, Halifax, and
Blackburn. The 22 deaths from diphtheria in the twenty-
eight towns included 12 in London, 2 in Liverpool, 2 in Sal fold,
and 2 in Oldham. Small-pox caused 1 death in London,
but not one in any of the twenty-seven large provincial
towns. Only 5 cases of small-pox were under treatment
on Saturday last in the metropolitan hospitals receiving
cases of this disease; no new case was admitted during
the week. The deaths referred to diseases of the respiratory
organs in London, which had been 348 and 294 in the pre¬
ceding two weeks, further declined last week to 289, and
were 25 below the corrected average. The causes of 79,
or 2 2 per cent., of the deaths in the twenty-right towns
last week were not certified either by a registered medical
practitioner or by a coroner. All the causes of death ware
duly certified in Bradford, Cardiff, and in four other smaller
towns. The largest proportions of uncertified deaths were
registered in Hull, Halifax, Sheffield, and Huddersfield.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal
to 31 - 3, 3G 6, and 24 - 4 per 1000 in the preceding three weeks,
rose again to 25 4 in the week ending May 21st. During
the first seven weeks of the current quarter the death-rate
in the city averaged 30 4 per 1000, the mean rate during
the same period being but 18’5 in London and 19 5 in Edin¬
burgh. The 172 deaths in Dublin last week showed an
increase of 7 upon the number in the previous week; they
included 8 which were referred to measles, 6 to whooping-
cough, 5 to scarlet fever, 4 to “ fever " (typhus, enteric, or
simple), 1 to diarrhoea, and not one either to small-pox or
diphtheria. Thus 24 deaths resulted from these principal
zymotic diseases, against 19 and 20 in the preceding two
weeks; they were equal to an annual rate of 3 5 per 1000,
the rates from the same diseases being 2 o in London and
2 4 in Edinburgh. The fatal cases of measles, which had
been 11, 6, and 9 in the preceding three weeks, were 8 last
week. The deaths from scarlet fever, whooping-cough, and
“ fever,” on the other band, showed an increase upon recent
weekly numbers. The deaths of infants corresponded with
the number in the previous week, while those of elderly
persons showed a further decline. Three inquest cases and
5 deaths from violence were registered; and 51, or nearly
a third, of the deaths occurred in public institutions. The
causes of 17, or nearly 10 per cent., of the deaths registered
during the week were not certified.

ZYMOTIC DISEASE IN AUSTBIAN TOWNS.

We recently called attention to the high rates of mor¬
tality that prevailed during last year in the Austrian towns,
having a population exceeding 10,000 persons. The forty-
nine towns embrac-d by this return had an estimated aggre¬
gate population of rather more than two millions and a half
in the middle of 1886; and the mean death-rate in tbs
year was equal to 31*7 per 1000, against 20 9, which was th#
mean rate in the twenty-eight large English towns, with an
estimated population of more than nine millions. Thus the
average population of the forty-nine Austrian towns was
little more than 50,000, while the English towns had a mean
population more than six times as great. A comparison of
the mortality from the principal zymotic diseases in the
Austrian and English towns throws considerable light upon
this marked difference of mortality. The deaths from
the principal diseases of this class caused a mean death-
rate of 5 11 per 1000 in the Austrian towns, whereas
in the English towns it was but 283. Small-pox
caused 1015 deaths in the Austrian towns, equal to
0 38 per 1000, while only 70 deaths from this disease occurred
in the twenty-eight English towns, giving a rate of but
0-01. The rates from measles and scarlet fever in the
Austrian towns differed but slightly from the rates in the

ed by Google

The Lancet,]

TIIE COLLEGE OP SURGEONS’ EXAMINATIONS.

[May 28,1887. 1107

English towns; while that from “fever ” was 033, against
0'23in the English towns. The death-rate from whooping-
cough, however, which was 0'53 in the English towns, did
not exceed 0 - 21 in the Austrian towns. Diphtheria and
croup caused 2233 deaths in the Austrian towns, equal to a
rate of 0 83, which was more than five times the rate in the
English towns. It should be borne in mind that in the
disease classification now used in England croup is not
classed with diphtheria, but, after due allowance for this
cause of difference, diphtheria mortality is undoubtedly very
much greater in Austria than in England. In Trieste and
in sixteen other smaller towns the death-rate from diph¬
theria in 1886 exceeded 1 per 1000; and in a smaller town,
Drohobncz, with a population of 18.896, the death-rate from
this disease exceeded 3 per 1000. The mortality from diar-
rhceal diseases also accounted for a considerable proportion
of the excess of mortality in the Austrian towns. The
mortality from these diseases, which did not exceed 116 per
1000 in the English towns, was equal to 2 62 in the Austrian
town8: it should be noted that 0 22 was referred to cholera;
but if this be excluded, the diarrbceal rate in Austria was
ynore than double the rate in the English towns. The
Austrian return also shows a remarkable excess of mortality
from inflammatory diseases of the respiratory organs and
from phthisis, the rates from these diseases being equal to

3 75 and 6 38 per 1000 respectively. The Registrar-General’s
Annual Summary does not give similar information for any
Of the large English towns except for London, where the
rate from diseases of the respiratory organs last year was

4 41 and that from phthisis 2 01 per 1000respectively. Thus
inflammatory diseases of the lungs and phthisis caused a
death-rate in the Austrian towns greater by 871 per 1000
than the rate in London. The return also affords conclusive
evidence of a marked excess of infant mortality. It may
therefore be safely assumed that the startling excess of
mortality last year in the Austrian cities was mainly due to
high rates of zymotic and infant mortality, and to excessive
fatality of diseases of the respiratory organs and of phthisis,
thus affording conclusive evidence that the excess may be
attributed to defective sanitary condition, such as pre¬
vailed in most of our largest English towns less than half a
century ago.

Cnmsjfintirmt.

“ And! alteram partem."

TIIE COLLEGE OF SURGEONS’ EXAMINATIONS.

To the Editors of The Lancet.

Sihs,—T he very large proportion of failures at the
examination in Surgery at the Royal College of Surgeons is
too important a matter to be allowed to drop from the
notice of the profession, and it is to be hoped that the
prominence you have given to it will be the means of
eliciting the opinions of those best able to judge. I do not
propose to ask whether the fault lies at the door of the
students, of their teachers, or of their examiners, although it
is doubtful if the teaching of surgery were ever carried out
with greater care and thoroughness than now, while the
students of to-day are certainly not less industrious than
their predecessors. Having often availed myself of the
privilege of Fellows of the College to be present at the
surgical examination, I will ask to be allowed to mention
one or two feature* of the examination which, I believe,
account in some measure for the distressing proportion of
failures.

I think all examinees will admit that viva voce examina¬
tion is more trying and embarrassing to a candidate
than is a written paper, and the fact that the paper only
carries one-third of the total of marks at the College of
Surgeons makes this examination an unusually severe test.
I am aware that very strong arguments are urged in support
of the present system, and I do not suggest that it should
be altered; but l submit that every care should be taken to
diminish the evil of the system, and to eliminate from
the vivd vocc. examination the elements of chance which
all must admit are very prone to characterise it. Special
pains ought to be taken to put a candidate at his ease by
commencing the examination with some simple questions.
It is obvious that a “ time limit ” introduces a special

difficulty, and it seems to be a pity that there are no means
by which the examiners can prolong the examination of
elow students or shorten that of obviously quick and
proficient ones.

Another difficulty that candidates have to contend with is
the low ecale of marking. Itmustoftenbeimpossibletodecido
whethtr a given candidate should have two or three or four
out of a possible five, and for the simple reason that twenty-
five or thirty-five out of fifty really represent the value of
his answers. This is a matter that might be easily altered,
and I cannot help thinking that it would tend to make the
examination more satisfactory. But, Sirs, these are, after
all, minor points, and 1 would submit that the main requisito
is, as you mention in your article, greater attention to the
art of examining. It Bhould be more generally recognised
than it is that it is not an easy matter to examine well and
so to frame questions as to at once show the examinee their
purport. So far as my experience goes, the main complain)
of candidates at the College of Surgeonsis that they mistake
or quite fail to understand the meaning of examiners’
questions, and I am confident that there is much that is just
in this complaint. If examiners would prepare for the
examination with a tithe of the care they demand of the
students, I should confidently anticipate a marked diminution
in the percentage of “plucks,” and a fair approximation of
the result of the examination to the actual state of the
students’ knowledge.

1 should like to add, in reference to Mr. Heath’s letter,
that his statement that the standard of the examination has
been lowered of late is quite contrary to the general im¬
pression in metropolitan medical schools, and is quite
opposed to the confident opinion of at least one of his
colleagues in the Court. Mr. Heath’s explanation of the
large percentage of failures in the recent examinations i»
hardly satisfactory, for, of course, the number of reappear¬
ances is dependent upon the number of men “plucked” at
previous examinations.

I am, Sirs, your obedient servant,

May 24th, 1887. _ A. PEARCE GOULD.

To the Editors of The Lancet.

Sirs,— Your leader of May 14th has, I am sure, been read
with pleasure by many who are interested in the welfare of
the College of Surgeons, and especially by those who have-
had a practical experience of its late final examinations.
Having undergone this experience on four occasions (the
fourth only being a “lucky ” one), a few remarks from a
candidate’s point of view may be of service, if taken together
with the letter from the pen of Mr. Christopher Heath, con¬
tained in The Lancet of last week. Credited with two-
years profitably spent under the old apprentice system at a.
county infirmary—twenty-one months of provincial and
fifteen months of metropolitan hospital attendance on tho
one hand, against three rejections at the Royal College of
Surgeons’ final examination on the other, -I have, needless
to say, long since come to the conclusion with Mr. Heath*
that at this examination “one man maybe lucky, &c.”; but;
many will not agree with him when he goes on to say that
he fails to see,“ human nature being as it is, how it is to b&
avoided.” Again, Mr. Heath writes that “a good deal ha»
been done to improve the College of Surgeons’ examination,
with the object of gaining less uncertainty, and even in the
way of diminished stringency.” Yet in the preceding para¬
graph he tells us that (notwithstanding these improve¬
ments) the rate of “pluck” was in Januory 60 percent.*
and in April 516 per cent.—a percentage which he attributes
to an unusually large number of “ reappearances” in January
and April. But why should a man who has the misfortune
to be referred, and has spent that term of reference in honest
work at his hospital, be more likely to fail than one who
has never experienced the examination, especially when
a second appearance is so common ? The obvious conclusion
to be drawn from these statements seema to be that, what¬
ever improvements have been made, they have not remedied
the evil. Your leader above referred to, I believe, rightly
attributes the uncertain results of these examinations to thw
“comparatively high value set upon the oral examinations,”
and especially to the fact that the "personal equation playo-
a prominent part” in the result. To this may be added the
different standards which exist at the various tables, and
the fact that in the clinical examination one candidate may
be given six or seven or even nine cases to diagnose, whilst

oogle

1108 The Lancet,]

THE TREATMENT OP RINGWORM.

[May 28,1887.

another is kept daring the same time at two. He who
makes a correct diagnosis in four out of seven cases has an
advantage over his more unfortunate fellow-candidate who
succeeds only in one of two cases. When there is more
uniformity, not only in the number of clinical cases allotted
to each candidate, but also as regards the nature of the
questions in the oral examination, and above all in the
method of marking in that department, then, and not till
tQen, may we expect uniform results. By all means let a
high standard of proficiency be maintained, but if this can
-only be done by the sacrifice of justice, the sooner means
are. taken to remove what is becoming a cause of reproach
to the College the better, not only for the College, but for all
who have the honour to hold its diploma.

I am, Sirs, your obedient servant,

May, 1S87. _ M.R.C.S.

ON THE ADMINISTRATION OF CARBONATE OF
LIME AS A MEANS OF ARRESTING THE
GROWTH OF CANCEROUS TUMOURS.

To the Editors of The Lancet.

Sirs,—D r. Hood’s interesting paper in The Lancet of
May 7th encourages me to communicate some details of a
■case under my own observation which, I think, are to a
great extent corroborative of his testimony as to the pro¬
bable value of lime in cancer.

Rather more than four years ago, my late partner. Dr.
Wilson lies, performed an amputation of the left breast
for scirrhus of unusually rapid growth. The patient, an
unmarried lady aged forty-two, was stout and of florid
complexion. I was not present at the operation, but I
chanced to look in just as the tumour was beiDg examined,
-and although 1 had no reason at that time for taking special
notice of the matter, 1 distinctly remember the characteristic
•“ apinoid ” section as the mass was laid open. A prepara¬
tion of this was made, but it has unfortunately been mislaid
■or lost. I discovered, however, amongst Dr. lies’ microscopic
■slides one which exhibits some large diptycbal cells, which,
'if I am not mistaken, came from the 6ame specimen. Not
the least doubt, as far as I know, was entertained as to
the nature of the tumour, but 1 had no personal connexion
with the case until two years later, when I was consulted
by the patient, after long delay and hesitation on her part,
about the other breast. This presented a tense, incom¬
pressible, lobulated enlargement at the lower and outer part,
■deeply attached, the skin partially adherent and the nipple
iretracted, with dilatation of the superficial veins and indura¬
tion of the axillary glands. There was no ulceration and no
pronounced constitutional cachexia, but the expression was
careworn and anxious. She complained of acute lancinating
pain, radiating from the nipple, and it was only to obtain
such temporary relief from this as would allow her to sleep
-at night that she appealed to me, since she declared most
positively that nothing would induce her even to listen to
the suggestion of another operation. Neither she nor I
doubted for a moment that the cancer had recurred, though
from the increased rapidity of its growth, as well as from
•certain sensations elicited by palpation, I was led to suspect
that it was rather of an encephaloid than a scirrhous
character. I prescribed a little chloral and sundry anodyne
applications, which were varied from time to time, being of
■little or no effect. For several months I had no conversation
with the patient, but I judged from her physiognomy that
the disease was making its usual hideous progress. Shortly
■after this, at a meeting of the West Herts Medical Asso¬
ciation, I heard from Dr. Hood of the calcined oyster-
shells. Greatly impressed with the desirability of affording
so simple and innocuous an agent a trial, I sought out the
lady, and, disregarding her prohibition ever to mention
the subject, I told her that there was a remedy which
might cure her if she would steadily persevere with it for
at least a year, which might fail, but which could not
possibly in either event do her any material harm. Obtain¬
ing her promise to take this regularly without further
question, I supplied her with a quantity of dried carbonate
■of lime, adding thereto 2.J per cent, of the phosphate, to
imitate the product of the shells as nearly as possible. I
have since been told by Professor Attfield that the true pro¬
portion should have been about 1 per cent. Of this she
was to take as much as would lie heaped up on a sixpence
three times daily, in a dessertspoon!ul of milk; stirred up

in a larger quantity of fluid, a great part of the powder
settles before it can reach the lips, and is apt to be
overlooked at the bottom of the cup, while a dessert¬
spoon is introduced bodily into the mouth and the milk
hides the disagreeable appearance of the lime. Last
week I examined the breast for the second time. The
lime has been administered now for nineteen months,
with very rare omission of the daily doses. During
that time I have purposely avoided any allusion to the
matter, and have congratulated myself on the patient’s own
reticence. But I have remarked that her countenance has
been more placid and content during the past year, and that
she has long since ceased to write to me tor soothing lotions
or liniments. The growth of the tumour is undoubtedly
arrested. I do not like to say positively that its bulk is
diminished, because 1 took no actual measurements, and two
years is a long time to retain a mental impression which
may be relied upon for comparison, but I am decidedly of
opinion that it is smaller. Whether this and the result
generally proceed from simple mechanical diminution of
vascularity, or more remotely by alteration of nutrient
innervation, 1 do not pretend to know; but there is certainly
a healthier aspect of all the surrounding tissues. The impli J
cation of the skin and retraction of nipple still persist, of
course, but no tenderness remains, or the slightest appear¬
ance of any proneness to ulceration. I should add that there
is no apparent evidence of calcification.

It is somewhat curious that burnt and powdered oyster-
shells are held in great estimation as a remedy for various
ailments and injuries in many parts of the world. Certain
tribes of South American Indians make pills of this sub¬
stance, which they swallow as a preventive of hunger on
long journeys, and it was thought at one time, like chopped-
up hair, to augment the sustaining virtues of pemmican.

I am, Sirs, yours truly,

Watford, May lith, 1837. ARTHUR STOADLINO, M.R.C.S.

THE TREATMENT OF RINGWORM.

To the Editors of The Lancet.

Sih 8,—During the early part of my medical career, I
served the time-honoured apprenticeship of five years. The
family consisted of the usual number of adults and two
little children. These children were unfortunate enough to
catch ringworm of the scalp (nobody knew how), and not¬
withstanding the application of every known or suggested
remedy, they managed to keep the disease for nearly three
years. It was with peculiar pleasure, derived from old
reminiscences and experience, that I read your recent lead¬
ing article on the subject, which so accurately detailed all
the troubles incident upon that nasty disease. Now the
nature of the disease is well known, and you will think I
make a bold assertion when I say that the disease is to
be cured with one application, and without the unsightly
shaven head.

In the first place, the remedy must be in the hands of the
medical attendant alone; secondly, procure a rough brush
of the prescribed pattern, best represented by a penny gum
brush with the bristles cut very short; then take a sufficient
quantity of pure glacial carbolic, warm and liquefy it in a
watch glass, and then rub it into the roots of the hair until
all is thoroughly touched and no further application is
necessary; but the head may be washed from time to time,
when necessary, with a lotion of sulphurous add. The
principle is to destroy the spores of the fungi which cause
the disease. Have clothes disinfected.

I am, Sirs, yours truly,

Leamington, May, 1887. F. E. WILKINSON, M.D.

RANK OF MEDICAL OFFICERS IN THE ARMY.

To the Editors of The Lancet.

Sirs, —Although the subject of the rank of medical officers
in the army has been lately well ventilated in your columns,
perhaps you will kindly let me trespass very briefly on your
space to endorse most thoroughly the views so clearly and
tersely put forward last week by “ Brigade Surgeon.” I
have recently had opportunities of discussing the question
of honorary rank with many senior officers of the depart¬
ment, and I am glad, for our credit’s sake, to find that one
and all scout the notion of purely military titles being throat

ized bv

I

Thb Lancet,] THE UTILITY OP DRUGS ‘IN THE TREATMENT OP DISEASE. [May 28, 1887. U0»

on ns* Speaking, then, for many of my brother officers, I
say, we do not wont to be captains and colonels; we do not
want to sink our profession by adopting titles utterly incon¬
gruous; we do not want (putting it plainly) to become the
laughing stock of the army. I should like to assure students
and others who contemplate entering the medical service
of the army that they need not tor one moment be dis¬
suaded from doing so by this question of rank. If a medical
officer is a gentleman in the true sense of the word, as well
as a careful, painstaking professional man, he is sure of the
respect and esteem of his military brethren; his status and
rank as an army surgeon are accorded him, and he need
never wish to sail under false colours. This is my experi¬
ence after twenty-five years happily spent in Her Majesty’s
service. I am, Sirs, yours obediently.

May 24th, 1887. _ABMY SUBGBON.

THE UTILITY OF DRUGS IN THE TREATMENT
OF DISEASE.

To the Editors of Thb Lancet.

Srns,—As a general practitioner, I cannot allow Sir Wm.
Gull’s remarks, made at the meeting of the General Medical
Council on May 12th, to pass unnoticed. For a man of
his position, thought so highly of by the public as he is,
to make the statements that “ people did not get well by
drugs,” and that “it was the duty of the medical man
not to give drugs,” was, to say the least, injudicious, not
to use a stronger term. It would be absolutely wasting
the space of your valuable paper to argue against such utter
nonsense, as the value of drugs in certain diseases is beyond
all question. Sir Wm. Gull said that the Prince of Wales,
when suffering from typhoid fever, did not have four doses
of medicine; but we know that, of all severe diseases,
typhoid fever is the one above all others that requires little
or no medicinal treatment. Sir Wm. Gull also considers a
warm bed when you are sick better than all the general
practitioners. It would be interesting to know whether he
considers a warm bed when you are sick better than all the
consulting physicians, because, if he does, it is quite evident
he has found a panaoea for all ills—viz., a bed and a warming
pan. I am, Sirs, yours truly,

Streatham, 8.W., Hay Mtfa, 1887. Geo. STEELE PBHKIN8.

ENTERORAPHY.

To the Editors of Tint LanCbt.

Sms,—I should not have ventured to trespass on your
space, after your full account of the meeting at the Medical
and Chirurgical Society, had not the time at my disposal
for replying to the discussion been so limited that 1 was
forced to omit, or pass very rapidly over, points which
deserved much more notice. I shall be glad if you will allow
me the opportunity of making these clearer. And, first, the
objection raised as to the respective length of time taken by
the performance of Lembert’s and my own suture. Is it
reasonable to compare the time taken to use Lembert’s
stitch by a surgeon accustomed to use it with the
time taken by the same surgeon in using mine, to
which he is not accustomed? Moreover, the risk to the
patient in these operations is not so much in the length
of time which the entire operation absorbs, although
that is important, as in the length of time during which
the bowel is outside the abdomen, and exposed. This dan¬
gerous time I claim to be far shorter during the use of my
stitch than with any other, for whilst my own can best be
done with only the cut ends exposed at the level of the
skin wound, tiie whole of the rest being reduced, no other
stitch can safely be used in this position; in which case the
bowel wall lying outside is further irritated by the constant
friction produced by the removal and replacement of warm
towels, sponges, &c. r to say nothing of the ever-varying tem¬
perature to which it is thereby sub jected. With regard to the
total penetration of the bowel liy the stitch, as opposed
to the partial one of Lembert, 1 should like to point out that
sutures are useful for two reasons, the latter of which appears
1 to be overlooked: first, as a means of approximating tissues
designed to unite; and, secondly, as a means of exciting
plastic inflammation in those tissues, and thereby securing
their union. Union of the intestine has two distinct stages,

in each of which distinct tissues are involved; in the choice
of a method of snture regard should be had to both. The
first epoch is occupied by the union of the peritoneal sur¬
faces; this is apparently immediate, or almost so, but
temporary. During this period the plastic lymph effused
covers in any sutures which may be used; but the point)
here is that, in so far as stitches and knots irritate a peri¬
toneal surface, so far and so much adhesion from effused
lymph is to be expected. Now, whilst this is wanted
between the opposed surfaces of divided ends, it is not
wanted between these and the peritoneal surfaces of viscera
and abdominal wall around, where adhesion would be harmful.
It will readily be appreciated that whilst the knots in
Lembert’s stitch are outside the bowel, and so tend to excite
such production of plastic lymph on the neighbouring sur¬
faces, forming subsequent adhesions, which will be more or
less permanent iri proportion to the length of time during
which these sutures remain th situ, in my stitch the knots
and threads are separated from the new-formed peritoneal
sac by the whole thickness of the bowel, and therefore can
have no such action. Inasmuch as all sutures pass at last
into the lumen of the bowel, and not into the peritoneal
cavity, it is unnecessary to speculate whether or not they
could do any harm there. But the secondary or permanent
union takes place by connective tissue formed partly from
the cellulo-flbrou8 layer of Gross, and partly from the sub-
serous layer. Gross himself, in describing his experi¬
ments on animals and their results, pointed out that the
main permanent union was due to the action of the cellulo-
fibrous layer, and-the microscopical sections shown by me
demonstrate perfectly this' fact, as well as the share taken
by the subserous layer. Now, bearing in mind the second
reason for the use of sutures, is there not an advantage in
the passage of the suture through both these layers inthe
production of a firm and satisfactory result? The com¬
parison bet wean, the ligature around an. ovarian stump and
these sutures is manifestly no parallel at all. The conditions
are absolutely different. In the one a stump is left which
is no longer to have any further office to perform in the
ecohomy; and the more thoroughly this is bound down
by adhesion, so long as no band is formed under which
a loop of bowel may be caught, the better. In the
other, an attempt is made to restore the status quo ante
in an organ, one great essential in the efficiency of which is
its complete freedom of movement; in proportion as this is
obtained will the operation be really successful. It will be
seen at once that this comparison will not hold water.
Moreover, in any case in which symptoms of sudden obstruc¬
tion appeared, would not the fact of a previous ovariotomy,
other things being equal, lead the surgeon to suspect internal
strangulation under a band resulting therefrom ?

This letter is already too long, or I should have liked to
answer also the objection to operations on dogs; but doubt¬
less such answer is perfectly apparent..

I am, Sirs, yours truly, ______

G. Stanmobb Bishop, F.R.G.S. Eng.

Manchester, May, 1887.__

FORK SWALLOWING.

To the Editors of The Lancet.

Sms,—Cipriani, to whom you referred in a recent number,
while imitating the exploits of a juggler in swallowing a
-fork, some sixteen years ago, allowed it to paes into his
cesophagus beyond his control. After various attempts at
extraction, made by himself, his friends, and his wife, he
was, on the following day, transferred to the Ospedale de
Santa Maria Nuova, where also all efforts at removal were
unavailing. Several ingenious instruments were invented
for the purpose, but failed. He remained in the hospital for
five weeks, suffering more or less inconvenience, moral as
well as physical, for the public were divided in opinion, some
proclaiming him only a fool, others an impostor. A year or
so afterwards, having produced severe pain, hemorrhage,
and other untoward symptoms, it was ascertained t-hat the
fork had effected itsexit from the stomach, and passed into the
intestines, accompanied with a relief to the more urgent phe¬
nomena ; motion, however, occasioned severe suffering. He now
wandered from place to place, a subject of interest to some, of
ridicule to others, till three or four weeks ago he was attacked
by acute pleurisy of the right side, terminating in effusion,
and was admitted into the Ospedale di San Giovanm di Dio.
Recovering from this, attention was again directed to “ the

Digitized by GoOgle

i 110 The Lancet,]

A SUGGESTED IMPROVEMENT IN ETHER INHALERS.

[May 28,1887.

fork,” which wag discovered ia the right iliac fossa, pointing
obliquely upwards to the left side. It was evidently fixed
in tois situation, for palpation effected no change in its
position, and considerable enlargement could be detected in
the immediate neighbourhood. After long hesitation, he
consented to an operation, which was performed by the dis¬
tinguished surgeon. Professor Kosati, aided by his skilful
assistant, Dr. Catani. An incision was made extending from
an inch and a half below the umbilicus perpendicularly
down to the pubes, and after considerable difficulty tho fork
was extracted from the ascending colon, the blunt end point-
ingupwards. Therehad been long and constant inflammation,
as was proved by the great thickening of the bowel, adjacent
tissues, and the firm adhesion of the colon to the abdominal
pariet ee. Thebowel was opened, the edges secured to the abdo¬
minal integuments, and the wound dressed in the usual way.
The fork measured twenty-two centimetres, and presented
but little erosion; for though the plating had disappeared,
the extremities retained their original defined outlines. The
time could not be calculated wbich it had taken in reaching
its ultimate destination, but probably many years, judging
from tbe condition of the surrouuding textures. The patient
bore the operation well, and was very anxious to secure pos¬
session of the fork as conclusive evidence against his detrac¬
tors. There has been no fever or unfavourable symptom,
and the wound is nearly healed, there remaining only a small
fistulous opening communicating with the intestine. I will
«ot take up your space by any remarks on this strange
history of tne journey of a fork.

I am, Sirs, yours truly,

Florence, May 9th. 1837. WILLIAM WlLSON, F.R.C.P. Lond.

A SUGGESTED IMPROVEMENT IN ETHER
INHALERS.

To tho Editors of The Lancet.

Sms,—The object of this letter is to call attention to the
fact, as it appears to me, that the arrangement of anaesthetic
inhalers has not kept pace with discoveries in medicine, at
all events of the bacteriological branch, and to suggest one
Temedy which seems to me successful so far as Clover’s
ether inhaler (than which I know none better) i9 concerned.
Almost as soon as I commenced to administer ether, it struck
me that for patient after patient to respire air from a bag
•which in the meantime had not been cleansed was certainly
an indelicate proceeding. If patients were aware that they
were doing so, many ot them would object to Submit to it.
But it was not until I was one evening listening to a discus¬
sion on tubercle at the West London Medico-Chirurgical
Society that it occurred to me that this repeated use of the
same bag was also possibly injurious, for most believe now
in the tubercle bacillus, and practically there ip, it seems to
me, every facility for its getting into the air-bag of an ether
inbaler, such as Clover’s, supposing the patient using it to be
suffering from phthisis, possibly undiscovered. Again,
patients may be amesthetised while developing infectious
zymotic disease, and I am not sure that in this way such
diseases may not have been propagated. If these premisses
are conceded, what is the remedy ? I am informed by an
eminent physiologist that the ether would not render the
bacillus or germ inert. Well, then, the apparatus should be
cleansed. This is not difficult, except as regards the air¬
bag, and the improvement I wonld suggest is an india-
rubber bag the same size as that now in use, but of as thin a
material as possible (it could scarcely be made too thin), so
that it may be of so little cost that there would be no hesi¬
tation in throwing it away after use, a new one being used
for each patient. Messrs. Maw, Son, and Thompson, of
Aldersgate-street, have been very kind in preparing samples
of the proposed bag for me. It would be possible to keep,
say, half-a-dozen of the ordinary bags going—turning them
inside out after use, cleansing and drying them before use
again ; but this would be less certain and more troublesome
than renewing the very much cheaper bag which I have
described. I am, Sir, yours obediently,

Rickard W. Llotd, M.R.C.S,

Anrothetlst to tho We«t London Hospital.

Hnsaoll-road, Kensington, W., Mxy. 1887.

Vaccination Grant.—M r. T. H. Tidswell, of
Moreoambe, Lancaster, has received tbe Government grant
tat successful vaccination (fourth time).

LIVERPOOL.

{From our own Correspondent.)

TUB ASSIZES.

Thb criminal business of the Spring Assizes for South¬
west Lancashire has just concluded, having been of nearly
three weeks’ duration. The medical officers of H.M. Prison
at Walton will have a considerable addition to their already
large experience of corporal punishment, Mr. Justice Day
having ordered the punishment of the “ cat ” in many cases,
combined with a comparatively short term of imprisonment-.
There werenoconvictions for murder, but two very aggravated
cases of manslaughter: one in which a man set his wife on
fire; another in which the prisoner kicked his wife to death.
Among the other cases was that of a man charged with
throwing a stone at a policeman, which struck him in the left
eye. He was taken to the Royal Southern Hospital, where
he was attended to by Dr. Dixon, and subsequently on his
discharge from the hospital by Mr. F. W. Lowndes, surgeon
to the police, and Mr. E. A. Browne, of the Eye and Ear
Infirmary. The worst effects of the injury were observed
posteriorly, the choroid and retina being torn across. Very
little sight remains, tbe officer being only able to distinguish
night from day. The prisoner was acquitted.

HOSPITAL SATURDAY.

The total amount advised to the treasurer up to May 21st
was .£2132. More returns have still to be made, and it is
expected that this sum will be considerably increased.

THB WBATHBR.

The unseasonable weather which has prevailed elsewhere
has been especially marked here. It may be donbted
whether any predecessor of this merry month was ever
celebrated with so much influenza, winter clothing, and fires.
It has influenced the mortality Teturns, as might have been
expected, elderly people suffering severely from the effects
of so unseasonable a spring after a long and trying winter.

Liverpool, May 2"»th._

NORTHERN COUNTIES NOTES.

{From our own Correspondent.)

■ NEWCASTLE EXHIBITION.

Although the weather has been anything but favourable
for our Exhibition, the attendance for the past week was over
76,000. There is one circumstance acting adversely—namely,
the great strike in the coal trade, which has gone on now
for nearly seventeen weeks, causing a cessation of employ¬
ment to over 20,000 persons; but at last there appears a
prospect of this great dispute beiug arranged. Very little,
1 fear, is thought of its effect on the medical profession, bat
it is a heavy loss to all having colliery appointments, as of
course there is no pay, and the doctor has more to do, with
the exception of accidents, than when the miners are work¬
ing. Among the models at the Exhibition of interest, I
might mention the model dwelling erected under the super¬
intendence of the Model Dwelling Banitary Committee, to
illustrate principles of design, construction, sanitation,
decoration, and furnishing—an example of a healthy, con¬
venient, comfortable, and complete detached residence.
The model -of tbe floating hospital on pontoons lately
described in this correspondence and constructed for the
Tyne Port Sanitary Commission, is also fall of interest as
regards hospital sanitation, and is itself the best hospital
model I have ever seen. •

THE PRUDHOK CONVALESCENT HOME.

Toe annual meeting of this Convalescent Society has just
been held at its noble home at Whitley. Drs. Philipson and
Baumgartner read tbe reports, which showed that the
number admitted during the year had been 1469; of that
number, 446 were from Northumberland, 486 from Newcastle,
529 from Durham, and the remainder from Yorkshire and
Cumberland. Of the whole number, 1272 were cured, 149
were greatly relieved, 15 were somewhat better, 29 were fit
statu quo, and;4 died. It is pleasant to add that, although
the expenses of this benefloent institution had been very

The Lancet,]

E l) INBUBGH.—DU BLIN.

[Mat 28,1887. till

heavy, the financial year had closed with a substantial
balance in the hands of the treasurer. Dr. Philipson may
well be proud of the position of an institution to which he
has devoted years of labour.

DEATH CERTIFICATES : A CAUTION.

At the Newcastle police court last week, Mr. W. Hardy, a
gentleman in practice here, was summoned by the super¬
intendent registrar of Newcastle and district for making
out a certificate contrary to the Registration of Births
and Deaths Act of 1874. It was shown that Mr. Hardy
had not seen the deceased during his life, but he was
attended for him by his assistant. It was pleaded that,
although there had been some irregularity, it was the
practice of some practitioners, when their assistants
attended, to sign the certificates, and that the deceased did
actually die from the complaint stated in the certificate.
The bench, however, held that it was a very irregular prac¬
tice, and inflicted a fine of £2 and costs. But it should be
remembered that often great pressure is put on practitioners
by the poor to give them certificates, which are often granted
out of pure good nature without fee or reward. Medical
men here will, however, do well in future to protect them¬
selves from beiDg placed in a false position and undergoing a
very troublesome prosecution.

MEASLES IN THE NORTH.

There is a pretty extensive epidemic of measles at Seaham
Harbour. Many adults have been attacked also at Morpeth,
where the infant mortality is said to be so severe os to have
become a subject of pulpit reference.

Newcastle-on-Tyne, May 2Uh.

EDINBURGH.

(From our own Correspondent.)

PRESENTATION TO DR. JOSEPH BELL.

Last week Dr. Joseph Bell was presented with his por¬
trait at a large meeting of his frionds and admirers. The
presentation was made in the hall of the Royal College of
Surgeons, which was well filled, and the meeting was of an
enthusiastic character. In opening the proceedings, Dr.
Littlejohn referred to the family name borne by Dr. Bell as
a household word in the history of surgery in Edinburgh,
and spoke of the services rendered to the school and to the
public by him during his thirty years’ connexion with
the Royal Infirmary. This connexion was inaugurated in
1856, when Dr. Bell entered the institution as a dresser, and
ended last year, when he retired with the rank of senior surgeon
on theactingsfaff. Mr. Fleming spoke of the warm enthusiasm
and respect with which the students regarded their old
teacher, and of their appreciation of his great powers as a
clinical lecturer. The portrait was then unveiled amidst
great applause, and was formally presented by Dr. Argyll-
Robertson, President of the College of Surgeons, who
presided. Dr. Joseph Bell then expressed liis thanks in a
few happily framed sentences. The picture is an excellent
likeness painted by Mr. J. Irvine, and bears the inscription :
“ Presented to Joseph Bell, M.D., F.R.C.S.E., on the termina¬
tion of his appointment as surgeon to the Edinburgh Royal
Infirmary, by numerous students of the School of Medicine,
and by many professional friends in town and country.
1887.”

POST-GRADUATE courses.

A meeting of the committee that arranged the series of
post-graduate courses held in September and October of last
year was summoned for Monday last, when the programme
tor the course for the coming autumn was discussed and
provisionally settled. The demonstrations which were so
nighly appreciated last year are to be repeated, and their
scope in some instances considerably extended. A number
of additional courses not included in last year’s programme
will probably be added to this year’s list. The arrangements
for the course will be finally completed and published at the
end of the present month. The time selected is the same as
that adopted last year—viz., the last week in September and
the first two weeks in October, a period previously found
most fitting the convenience of the lecturers and of those
attending tDeir demonstration?.

Edinburgh, May 24tb,

DUBLIN.

(Fi-om our oxen Correspondent.)

THE QUEEN'S BIRTHDAY HONOURS.

In celebrating Her Majesty’s Jubilee, it is sincerely to-
be hoped that the profession in Ireland will not be over¬
looked in the dispensing of birthday honours, and that botli
the medical and surgical branches may receive that recognition
from Her Majesty’s advisers which they are undoubtedly
entitled to. Successive Governments have treated the leadero
of the medical profession in this country in a niggardly and
ungenerous manner, and no excuse can any longer be mado
for the systematic ignoring of their claims to State honours.
Scattering distinctions broadcast in England, and to a less
extent in Scotland, while Ireland has been markedly
neglected, can scarcely be regarded with equanimity by tho
members of the profession in this country. Confining my
remarks at present to the surgical branch, there is one—a
leading member of it—possessed of the highest surgical
talent, gifted with great eloquence, and in every respect well
fitted to receive a mark of Her Majesty’s favour. Need I
mention the name of Sir William Stokes, the President of
the Royal College of Surgeons in Ireland, whose term of
office has been filled in an exceptionally brilliant manner,
and who has well deserved thd highest honour which the
Fellows of his College have conferred upon him. His claims
for recognition cannot be disputed, and I am confident they
will be favourably considered by Her Majesty’s advisers.

ROYAL UNIVERSITY OF IRELAND.

The medical degrees obtained by the successful candidates
at the spring examinations of this University were conferred
last week by the pro-Vice-Chancellor, Sir Robert Kane.

ROYAL COLLEGE OF SURGEONS.

A meeting of the Fellows will be held on Saturday,
June 4th, to receive the report of the Council for the past
year; and on the following Monday the annual election of
office-bearers for the ensuing year will take place. In
addition to the names of candidates already mentioned for
a seat on the Council may be added that of Mr. William
Frazer, for many years a member of the Court of Examiners
of the College.

THE QUEEN’S JUBILEE : BANQUET BY THB INCORPORATEI>
LAW SOCIETY.

Sir William Stokes, President of the Royal College of
Surgeons, responded to the toast of “The Medical Pro¬
fession ” at the banquet given by this Society on Monday last
in honour of Her Majesty’s Jubilee. He said that it was
deserving of recognition, not alone on account of the fact
that its great aims and objects were the alleviation of
suffering, but also because it furnished an arena for the
eultii a ion of all the sciences which might directly or
indirectly tend to promote human good ; and there was
another reason—because it counted among its ranks so many
who are devoted to works of mercy and of charity, and who-
are and had been true citizens and loyal men. It was a
subject of congratulation to him that his tenure of office as
President of the Royal College of Surgeons had been con¬
temporary with two great events—the Jubilee year, and tho
union recently formed between the two great medical cor¬
porations, the King and Queen’s College of Physicians and
the Royal College of Surgeons. This union he looked upon
as an official recognition of the fact that the barrier which
had been erected years ago by foolish men, separating
medicine and surgery—a barrier productive of much mis¬
chief, which tended to promote division, and which kept
the two professions powerless and weak —had been
shattered by the unerring artillery of common sense. Now
that this union had been effected, they might look to the
realisation of that which was their great aim and object—
this mutual overlapping of their work, which would lead to-
unity in medical science.

MEDICAL MAGISTRATES.

Brigade Surgeon T. Barnwell, retired A.M.D., has been

? laced on the Commission of the Peace for co. Dublin.

. J. Stafford, M.D., of Tangier, Boyle, has been appointed to
the Commission of the Peace for oo. Rosoommon.

Dublin, M*y 2lth.

1112 The Lancet,]

BELFAST.—VIENNA.

[May 28,1887.

BELFAST.

(From,our own Correspondent.)

QUERN VICTORIA CONVALESCENT HOME FOR CHILDREN.

A short time ago the committee of the Children’s Con¬
valescent Home in connexion with the Belfast Hospital for
Sick Children made a request, through Mr. Wm. Ewart, M.F.,
to Her Majesty the Queen, soliciting her patronage and per¬
mission to use her name in connexion with the Home. An
answer has now been received to the effect that Her Majesty
has been graciously pleased to command that the said
institution shall be known as “The Queen Victoria Con¬
valescent Home for Children.” The amount required to
build and endow the home is £3300, and already the sum of
£1240 8*. bd. is announced a9 received or promised. A
pleasing feature in this movement is that the working men
are co-operating with the committee, and have arranged to
have collections in the various manufactories in and around
Belfast.

ACCIDENT TO MR. STEWART OF GLASSLOUGH.

About three weeks since, Mr. Stewart of Glasslough sus¬
tained a fracture of the leg in the neighbourhood of the
ankle joint, and, after an attempt at saving the limb had
been made, it was found necessary to amputate. Mr. Hall
and Mr. Young of Monaghan, Mr. Palmer of Armagh, and
Mr. Huston of Tynan have been attending him, and I
understand he is doing well. About the time the accident
occurred arrangements were being made to present him
with a testimonial, a sufficient indication of his popularity
in the dispensary district of Glasslough, and this has now
been done.

DBLFAST ROYAL HOSPITAL.

From the report presented at the quarterly meeting held
on May 23rd, we learn that during the past three months
there were 499 in-patients, 233 medical and 21G surgical;
while during the same period 32G0 out-patients received
treatment. The expenditure of the hospital up to the end
of April has been £5938 Os. 3d , and this added to the debt at
the closej>f last year of £1048 8*. '2d. makes a total expendi¬
ture of £70S6 &?. 5d. The receipts from all sources have been
£9804 4s. 4 d., but of this sum the bequests (£3500) have been
invested, so there remains an excess of expenditure over in¬
come at the end of April of £682 4s. Id. Tbe board state that
the hospital is in all its departments in a most efficient
condition. As explained before, one of our merchant princes,
Mr. Foster Green, has offered to build a wing for the treat¬
ment of consumptive coses on condition that a sum of
£15,000 is raised to endow the hospital, so that this depart¬
ment would not be a drag on the institution. Between
£7000 and £3000 have been raised, and it is hoped that
before the end of the year, the time up to which Mr. Green’s
offer extends, the remainder will be subscribed.

Belfast, May 21th.

VIENNA.

(From our own Correspondent.)

THE ILLNESS OF PROFESSOR BILLROTH.

The state of Professor Billroth, who is suffering from
bronchitis capillaris and pneumonia catarrhal is, was very
serious on Friday last. There was considerable debility of
the heart’s action, and a catastrophe was feared. But after
inhalations of pure oxygen the patient had rallied by the
next day. The bulletin just published is confirming the
hope of a speedy recovery of the illustrious surgeon. He
felt himself greatly relieved, the appetite was good, and he
slept soundly for some hours.

THE VIENNA H08PITAL QUESTION.

A great deal of public excitement was recently caused by
a speech of an Austrian deputy, Herr Pemerstorfer, on the
bad condition of the Vienna General Hospital. An endless
series of grievances relating to the bad hoarding and nursing
of the patients wa9 animadverted upon. The Government
wai induced to order an Inquiry on 'the state of the affairs,
and the physicians of the General Hospital have been
examined by a commission consisting of officials of the

Government (Stattkalterei). So far as I can gather, the
statements made by Herr Pemerstorfer on the mismanage¬
ment prevailing in tbe General Hospital seem to be proved
by the evidence obtained from the physicians of tbe hos¬
pital. The examinations are continued daily. By a decree
of the governor of Lower Austria the introduction of a book
of grievances in all public hospitals has been ordered. Bui
it is hoped that this impracticable measure will soon be
withdrawn. The director of the hospital, Herr Hofrath
Hofmann, has not as yet asked to be relieved of bis duties,
as had been reported by the daily newspapers, but having
suffered some time ago an apoplectic attack, he obtained sick
leave for Baden, near Vienna.

NEW TREATMENT OF GRANULO-FUNGOUS IN FLAMMAT IONS.

In the clinical wards of Professor Albert I bad recently
occasion to see some cases exhibiting very favourable results
of a new method for treating granulo-fungous inflamma¬
tions, which seems to deserve the attention of medical prac¬
titioners. By theoretical considerations and by experiments
made on animals, Dr. Gustav Kolischer, one of the pupils of
Professor Albert, has been induced to try the local applica¬
tion of phosphate of lime in cases of fungous disease.
The results obtained by this treatment were in all cases
highly satisfactory. The medicament, which is prepared
by adding phosphoric acid to the water in which the
phosphate ot lime is dissolved, Was administered by injec¬
tions into the diseased parts, or by dressings impregnated
with the salt. The majority of the patients treated with
phosphate of lime were children between six and twelve
years of age. There were two cases of white swelling of the
elbow, with ankylosis, fever, and pain; after six weeks they
were cured, with perfect freedom of movement. In anoihn
case of fungous disease of the knee with pain, the mobilitv
was partly restored after four weeks’ treatment. With
similar results some cases of caries manus in children and
adults were treated. The most remarkable case was that of
extensive destruction of the knee joiut by gTanulo-fungotu
inflammation in a boy twelve years of age, with hectic fever,
severe pains, necrosis, and large cavities in the bones. The
cavities having been stuffed with phosphate of lime gauz?,
recovery proceeded quickly; after three weeks the cavity
was filled with fair granulations up to the surface, and the
fever and pain ceased. The use of phosphate of lime proved
also very efficacious in a cose of tuberculous fistula of the
rectum, which resulted in perfect recovery. But this remedy
has some disadvantages. It exerts a slightly irritating efFrcr,
and causes pain, which continues during the first six hours
after its application, and is followed by fever, whioh lasts a
day or two.

A NEW AUSTRIAN PHARMACOPOEIA.

As nearly twenty years have elapsed since the Austrian
Pharmacopoeia was revised, the Minister of the Interior
has appointed a commission of physicians and pharmacolo¬
gists to prepare a new (seventh) edition. Among the new
remedies to be recognised in this edition will be acid, pyro-
gallicum, amyliumnitrosum, the bromine salts, antipyrinun,
chrysarobinum, cocainum, hydrargyrum tannicum, cortei
condurango and C. quebracho, lithium carbonic.,mentholum,
naphthalum /3, naphthalinum, physostigminum salicyL and
sulf., thymolum, vaselinum, pilocarpinum hydrochl.

Vienna, May 22nd.

SCIENCE EN FETE: THE CONGRESS OF HYGIENE
AT FLORENCE.

(From our own Correspondent.)

As if sensitive to the charge of a distinguished compatriot
that “the Italians are a carnival people,” the Florentines,
amid the gay and imposing ceremonies that have made
their city the resort of the artistic world for half the month
of May, have introduced a scientific foil to the festive
monotony, and in a “ Congress of the Hygienic Societies of
Italy ” have at once relieved and heightened the enjoyment
of the brilliant commemoration of Rossini and Donatello, of
the historic cortege and tournament, and of the crowuine
solemnity of all—the unveiling of the facade of th-ir
glorious cathedral, the Santa Maria del Fiore. On Sunday
the 8th, in the Hall of the Istituto di Studii Superior*,
the sanitary associations of- the peninsula held their fi**
Congress, and its promoters have every reasm to **

Digitized by v^ooQle

TEB UtNGBT,]

OBITUARY.

[May 28,1887. 1HS

gratified with the success they have earned. The ball
itself, almost severe in its purely academic aspect, was
adorned with the insignia of the leading hygienic
societies of Italy—those of Breseia, Padua, Turin, Palermo,
and Florence herself being conspicuous in the trofeo.
A numerous and distinguianed audience, including many
ladies, more than filled it, as the President, Professor
Paoli, opened the proceedings, indicating the signal services
vouchsafed to the common weal by a sound and well-
organised hygiene, and dwelling on the advances Italy has
yet to make if she intends to assume her proper place in
the State system of Europe. The usual congratulatory
speeches and telegrams having been heard from the various
representatives of the Government and of the learned
societies, the audience rose to visit the •* Esposizione d’lgiene”
—a splendid assortment of sanitary apparatus and appliances,
for which the spacious rooms of the Palazzo Fenzi had been
hospitably thrown open. Mucja interest was taken in the
mechanism of Profeseor'G. Roster for the analysis of atmo¬
spheric air, a series of experiments being performed to
illustrate its efficacy; while attention was equally attracted
by the various systems of domestic convenience, from
latrines to filters, devised by Italian officers of health.

In tb6 afternoon sitting Professor G. Pacchiotti, who
represented Turin, read an elaborate paper on the“ Yaccina-
zione Anti-rabica ” of Pasteur, in which he described the
methods pursued by the French pathologist, reviewed the
results, favourable and unfavourable, on the patients, and
concluded by giving a guarded estimate of the system,
maintaining that on the whole the good achieved was more
than the risk incurred. An Animated and discursive con¬
versation ensued, in which Professors Ruata, Calovolo, and
Luciani took the chief part.

Monday’s proceedings included a discussion of the prin¬
cipal clauses of the New Code of Public Hygiene submitted
to the Senate of the kingdom by the Prime Minister Depretis ;
after which the topics ranged from Italian sanitation in
general to that of Florence in particular, and concluded with
an interesting conference on tlie dispensary doctore of Italy,
their qualifications and responsibilities, and the need for a
higher remuneration of their services, especially in the
remoter communes. The demand for a Minister of Public
Health was urgently represented by the confcrenziere, Dr.
Benizzardi of 'Brescia, and the discussion received important
contributions from Dr. Faralli of Florence and Professor
Pacchiotti, the latter urging the claims of duly qualified
lady doctors on the recognition of the State, and arguing
that their possession of a diploma in medicine or surgery
entitled them to the same offices and remuneration as
similarly qualified men. The “ Free Exercise of Pharmacy
was auother keenly canvassed topic, ending in an almost
unanimous consensuain favour of the exclusive rights of the
pharmacists. In the evening a great banquet was held in
the Sain Comelio, at which a series of toasts, all tendiug to
the fraternisation of the hygienic societies throughout the
peninsula, were eloquently given and heartily acknowledged.

On the 10th, Dr. Bonizz&rdi, representing Padua, opened
the day’s business by demonstrating a method of his own
for “The Easy Distinguishing of the Carcases of Animals
■dead from Epizootic Disease.* He was followed by Dr.
Busi, representing Palermo, on “ Cremation as practised in
Florence,” and by Professor George Koster on the “ CaTbonic
Acid of the Soil and Air Of Florence;” after which a visit to
Professor Roster’s laboratory and observatory and to the
Ophthalmological Clinique of Professor Paoli (President of
the Congress) closed the proceedings for the forenoon. In
the afternoon* interesting papers were read by Dr. d’Ancona
on “Rural Dwellings”; Dr.Bdnizzardi on the “ Drainage of
Cities'”; and 1 by Dr. A. Bianchi c*n the “ Selection of Troops for
Service in Tropical Africa.”' ’ This last led to a very keen
disdussion, in which Professor Pacchiotti took an able part.
4 '0rdeWof the day* (as is usual in continental congresses)
were thereafter moved and carried, and with a few appro¬
priate remarks* Professor Paoli declared the Congress dis-:
solved— the second to beheld at' Brescia in the autumn of 1888.

T H ^ TAo<HNATK>^.Actrs.—Thq Gloucester Board of
Guardians haft' after a. long discussion, decided, by 20
votes to 18, that nineteen persons who were reported for not
having, their children vaccinated should not be prosecuted,
and that in future the vaccination officers spall not take
proceedings in eaae of default/without the direct sanction of
the board, * 4 . -

©Iritttarjr.

JAMES TRODTBECR, M.B.

Wb recorded last week the death of this gentleman, who
was stricken down by pneumonia when apparently enjoying
most robust health. James Troutbeck was a Cumberland
boy, and as such was educated at Appleby Grammar School.
After completing his school education there he commenced
his medical studies at the Edinburgh Infirmary, and supple¬
mented them by a great deal of work at the Carlisle Infir¬
mary for three years. Here he was a great favourite with
all; his kindness aud gentleness endeared him to the
patients, and his diligence and cheerful disposition made
him an excellent servant of the institution. He subsequently
came south and entered upon general practice at Bushey, and
for some years worked laboriously at it. Leaving there,
he recently took a practice at Finsbury-park. On Saturday,
May 14th, he was in his usual health and retired to bed
early. During the night he was seized with severe pain in
the chest, and remained in-doors on a couch all Sunday*
On the Monday he went into the City and saw his solicitor,
and then consulted a surgical friend under the impression
he had injured his ribs. It was found, however, that there
was pneumonic consolidation of his left lung, and from his
general condition grave fears were entertained, which were
only too quickly realised; for during the next night he
became unconscious and died at midday on Tuesday. His
frank generous nature and his unvarying kindness had
endeared him to a large circle of patients and friends.

RARL FRIEDLANDER.

At Meran, in the Austrian Tyrol, in his fortieth year, has
just died this able pathologist, leaving behind him a high
reputation for what he did, and a still higher one for what
he was expected to do. Beyond the strictly scientific
“inner circle” he was little known; lie was never in pro¬
fessional practice; he was a pathological anatomist pure and
simple. A native of Brieg, in Silesia, he graduated as
Doctor in Medicine in 1869. In 1874 he was assistant in the
Pathologico-Anatomical Institute at Strasburg under Pro¬
fessor Friedrich ron Recklinghausen—a post which he held
for five years. In 1879 he removed to Berlin, where,
in the Friedricbshain Hospital, he filled the modest
position of assistant superintendent of post-mortem
examinations. In the academic scale he never rose
higher than a privat docent, and only a few months
ago obtained the title of Professor, without, however,
an official chair. He published from time to time the results
of his investigations, his best known book being his
“ Mikroskopische Technik,” a favourite manual with the
beginner and even the proficient in microscopy. His other
publications include “Researches on Local Tuberculosis”
(1873); on “ Lupus * (1874) ; on “Epithelioma and Carci¬
noma ” (1877); and on “ Hypertrophy of the Heart” (1881).
In the recent investigations into micro-organisms he took
an energetic part, his special contribution to the subject
being his discovery of a micrococcus, for which be claimed
a distinct pathological role in pneumonia, and which be
first described in Virchow’s Archiv. (1882). This minute
germ integer is now referred to in the nomenclature of
bacteriology as “ Friedlander’s coccus.” In the fortnightly
Fortschritte der Median he continued his microscopic work
with equal energy and ability, and raised that periodical
(published by Fischer, in Berlin) to the front rank among
German,scientific journals. The last number was published
the day after its editor’s death, which is announced by a
few touching words of regret by Dre. Fiirbringer, Hahn,
Gottstein, and Rornfeld. Mult is tile bonis flebilis occidit.

SAMUEL E. MOREWOOD, A.B., M.B. (T.C.D.).

We regret to have to announce the 'death of this gentle¬
man, which took place on May 26th after a short illness,
Mr. Morewood for the past eight years has been medical-
officer of the Dispensary, Draperstown, co. Derry, and
medjeal attendant of the constabulary. Mr. Morewood was
a licentiate of the Royal College of Surgeons of Ireland

O

2114 Thb Lancet,]

THE SERVICES.—MEDICAL NEWS.

[May 28,1887.

and a graduate in Arts and in Medicine of Trinity College,
Dublin. He succeeded his father, who for thirty-two years
■was medical officer in Draperstown, and it is worthy of note
that the same appointment was held by his grandfather for
a period of twenty-seven years, so that for the greater part
of a century members of the family have been in practice
in Draperstown. Mr. Morewood’s death, occurring at an
early age (thirty-five), has caused very deep sorrow in the
neighbourhood where his family have been so long held in
the highest respect, and universal sympathy is felt for
Mrs. More wood and the members of hie family. The funeral
took place on Wednesday.

THE SERVICES.

Deputy Surgeon-General D. A. C. Fraser, M.B., the Prin¬
cipal Medical Officer of the South-Eastern District, has
joined the Southern District for duty at the Royal Victoria
Hospital, Netley, in succession to Surgeon-General W. S.
Murray, whose appointment to Egypt we noticed last week.

Deputy Surgeon-General T. Tarrant, M.D., has handed
over his charge at Bangalore and joined in Madras for duty.

Artillery Volunteers.— 3rd Volunteer (Duke of Corn¬
wall’s) Brigade, Western Division, Rojal Artillery: John
Quick, Gent., to be Acting Surgeon (dated May 21st, 1887).—
1st Forfarshire: Robert Boutar, M.B., to be Acting Surgeon
(dated May 21st, 1887).—1st Dorsetshire: Surgeon C. W.
Parkinson resigns his commission; also is granted the hono¬
rary rank of Surgeon-Major, and is permitted to continue
to wear the uniform of the corps on his retirement (dated
May 21st, 1887).—5th Durham: Richard Brown, M.B., to be
Acting Surgeon (dated May 21st, 1887).

Utibiral Ifcfos.

College of Physicians in Ireland. —At the
May examinations the following obtained licences in
Medicine and Midwifery of the College:—

Mkdici.ve.—J ohn Theodore Abbott. Alfred William Bewley, William
Ground* Booth. Charles Edward Boyce. William Mitchell Branson,
Thomas E. Burrowea. Frederick Norris Burwell, Harry Cartmell,
Edward Joseph Cotton, Charles Edward Dawson. Robert Harper
Dickson, William Dunbar, Julius Martin Ehrhardt. Cornelius Gerald
Fitzgerald. Robert Alexander Flynn, Arthur Goff, William Robert
Grave*. Henry Bertram Greene, Robert William Harley. John G.
Harrie*. Joeeph Thoma* Harty. John Henry Lister, George John
Lough. Charles John Lyon*. William McGeagh, James Magauran,
James Hastings Morgan. Oliver Norris, Joseph Edward O'Meara.
Andrew William Orr. Pierce Hugh Power, Hugh Roberta, Henry
Harlow Sales. Harry Paynter Sloggett, John Edwin 81ott, Harry
William Smith, Timothy Thaddeus Teahan, George Thorpe. John
Westwood, and Thomas Owen Willinnis.

Midwikerv.—J ohn Theodore Abbott. William Grounds Booth. William
Mitchell Branson. Harry Canmel, Robert Harper Dickson, Cornelius
Gerald Fitzgerald, Robert Alexander Flynn, Arthur Goff, William
Robert Graves. Joseph Thomas Harty, George John Lough. Charles
John Lyons. Arthur Kennedy Me Cutcheon, James Magauran, James
Hastings Morgan, Oliver Norris, Harry Paynter Slogyett, John
Edwin Slott, Harry William Smith, and Thomas Owen Williams.

Society of Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on May 19th :—

Baxendoll, Arlliur, Rose Hill, Denton, Lancs.

Clark. Percy John, Margaret-atreet.

Cockerton, Herbert, 8t. George’R Hospital.

Crowther, Astley Brodie, Laun-1 Bank. Luddenden, Manchester.

Date, W. Horton, St. Leonard's-place. Moseley, Birmingham.

Elias, James. Essex-road. Sale. Manchester.

Ewbank, William Withers. Hilgrove-road, Hampstead.

Wood. Frederic Charles, Hutton. Brentwood. Essex.

King’s College Hospital. —The annual festival
dinner in connexion with this Hospital was held on the
23rd inst., the Lord Mayor presiding, when a list of dona¬
tions amounting to ,£1786 was announced by the secretary.

Metropolitan Convalescent Institution.— By
the permission of the Duke of Westminster a meeting in
support of the interests of this institution was held at
Grosvenor House on the 23rd inst. During the forty-seven
years in whioh the charity has been in active operation more
than 100,000 patients have been admitted to its benefits, the
number last year being 4500.

The Hospital Sunday collection at West Hartlepool
was held on the 22nd inst.

Victoria Hospital, Bournemouth. —At a meeting
of the Hospital Committee a few days since it was announced
that the subscriptions to the fund being raised for tbe erec¬
tion of a hospital in celebration of tbe Queen’s Jnbilee hid
amounted to about £5000, and there was a like sum available
for the same purpose from the old Dispensary Committee.

The sum of -£1000 having been offered by Mr. John
Geddes towards tbe building of a new infirmary for South-
port, a committee has been Appointed to report upon the
character, convenience, and structural arrangement of the
present infirmary, which is said to be very inadequate to
the demands made upon it.

Children’s Hospital, Great Ormond-stbbt.—
At tbe children’s service on the 22nd inst. at Berkeley
Chapel, Mayfair, the offertory, which amounted to consider¬
ably over £100, was collected on behalf of the children's
Jubilee tribute for the erection of a new wing to this insti¬
tution, of which Her Majesty is patron.

At the forty-second annual meeting of the
governors of and subscribers to the Birmingham and Mid¬
land Ear and Throat Hospital on the 23rd inst., it was re¬
ported that during the past year the income had amounted
to £615, a sum which exceeded the expenditure byXth).
The total number of cases registered at the hospital during
the year was 3243.

Devon and Exeter Hospital. —At tbe annual
meeting of tbe governors of this institution, on the 19tb
inst., it was reported that during the year 1391 in-patients
and 1932 out-patients had been treated. The ordinary
income amounted to £7159, as compared with £7252 for the
previous year, and the expenditure to £7908, as compared
with £8106.

In an action recently brought in tbe Loughborough
County Court by two medical practitioners for the recovery
of fees for professional attendance, the question of tiw
reasonableness of the charges was submitted to Dr. Banfield.
of Leicester and Dr. Paul of Loughborough. The arbitra¬
tors ruled that the charges generally were exceedingly
moderate, and one or two items having been struck out,
judgment was accordingly given for the plaintiffs.

Hospital for Epilepsy and Paralysis, Reoest's
Park. —At St. George’s Hall on Thursday evening, in aid of
this hospital, a grand variety entertainment waa giro-
Not the least interesting part of the varied programme ww
a gavotte, danced, in costumes of the period, by four ladies
and four gentlemen. The entertainment was the first of *
series which the friends of the hospital are promoting, with
the object of raising a fund of £2500 for the purchase or
the lease and the extinction of the debt with which theho?-
pital has for some years been burdened. The hall was well
filled, and the performances much applauded.

The British Medical Temperance Association.-
The eleventh annual meeting of the British Medical Tempe¬
rance Association was held at 11, Chandos-street, Cavendisb-
equare, on Tuesday last; in the unavoidable absence of the
President, Dr. Norman Kerr took the chair. The annu*!
report stated that there are at present 350 members (w
total abstainers), and 72 associates (abstaining medittj
students). Dr. Kerr read an account of the work of
Dalrymple Home for Inebriates since its establish®*:
three years and a half ago: 103 cases had beem admitted,
of whom 86 have been discharged, and of these 35 u»
known to have done well. Dr. Walter Pearce read ap»P*
on a case of acute cardiac dilatation due to alcohol.

Ridge also showed experiments proving that quantities «
alcohol under 2 per cent, promote the growth of bsct**
in decomposing fluids, while the same quantities 1®“
been proved to be injurious to the growth of constructs*
protoplasm. — The annual meeting of the Central iri»
Branch of the Association will be held in the Royal ColWP
of Surgeons, Dublin, on Tuesday, June 7tb, at 4.30 p.m.
chair will be taken by tbe President of tbe Branch, DcP 0 *?
Surgeon-General F. L. G. Gunn. Brigade 8orgeon r.t-
McFarland (President of the North of Ireland Brana>.
Dr. T. Collins, Dr. Lonn, Mr. R. Morton; F.R.C.S., and * r -
Learson will speak. The meeting is open to all member
of the medical profession

Thj Lancet,]

MEDICAL NEWS.

[May 28,1887. 1115

London Hospital.—T he ceremony of opening the
f urging Home and new library and other college buildings
t this hospital was performed on the 21st inst. by the Prince
nd Princess of Wales, in the presence of a large and in-
luenti&l assembly.

The Association for Preventing the Adulteration
f Butter in Amsterdam has offered a prize of 1000 florins
or the best means of detecting any foreign elements in
latural butter made from the milk of the cow.

Tottenham Hospital.—T he new wing (Samuel
forley Memorial Wing) of the above institution will be
ormally opened by the Princess of Wales at 3 o’clock
his day (Saturday). This recently completed part of the
ospital contains two children’s wards, with fourteen cots
ach; sisters’ dining-room; on the first floor, wards for paying
latients in separate rooms, and “cubicals”; on the second
oor, the operating room, which is reached by a hydraulic
ift.

Parses Museum.—O n June 1st and two succeed-
ag Wednesdays, Dr. B. W. Richardson will deliver a course
if lectures at the Museum, Margaret-street, on the Medical
md Scientific Aspects of the Temperance Question. A very
uccessful series of sanitary demonstrations to the medical
•rofession has just been held in the Museum. The closing
emonstration was given on the 23rd inst. by Mr. Percival
lordon Smith, of the Local Government Board, which
elated principally to the construction and ventilation of
louses. On the 19th inst. a lecture was delivered by Major
.amarock Flower, C.E., on “ The River Lea,” in which he
jave a description of the geology of the watershed area
md of the navigation of the river from the Danish epoch
ill the present time.

The French Hospital.—T he Prince of Wales was
)resent on the 23rd inst. at au assault-of-arms at Willis’s
looms, given in aid of this institution. In the twenty
rears that the hospital has been open it has given relief to
WOO in-patients and over 100,000 out-patents. A new
milding, to accommodate double the number of patients,
s to be erected shortly in Shaftesbury-avenue, ana to this
the Queen has given her patronage and a handsome sub¬
scription to the building fund. The entertainment on the
23rd was under the patronage of M. Waddington, the
French Ambassador, and the company present included
many of the leading French and Italian residents in London.

Royal University of Ireland.—T he following
Honours have been awarded to candidates at the recent
examinations of the University:—Second Examination in
Medicine: Second Honours, Eleonora Lilian Fleury and
Thomas Jones; Second Class Exhibition (£20), Eleonora
Lilian Fleury. M. B. Degree Examination: First Honours,
Ambrose Edward Birmingham; Second Honours; Edmond
Joseph M’Weeny and William Westropp White. First Class
Exhibition (£50), Ambrose Edward Ignatius Birmingham;
Second Class Exhibition (£26), E. J. M’Weeney. M.Cb.
Degree Examination: First Honours, John Wallace Watson;
Second Honours, William Baird M’Quitt.y. M. A. O. Degree
Examination: First Honours, William Westropp White and.
William Baird M’Quitty; Second Honours, Eaton William
Waters, Edmond Joseph M’Weeney, and Jerome Barry.
Doctor of Medicine: Second Honours, W. W. White. Bachelor
of Medicine: First Honours, Ambrose Edward Ignatius
Birmingham; Second Honours. E. J. M’Weeney. Master of
Surgery: First Honours, J. W. Watson; Second Honours,
W. B. M’Quitty. Master of Obstetrics: Honours, 1st Class,
W. W. White and W. B. M’Quitty; Second Class, E. W.
Waters, E. J. M’Weeney, and Jerome Barry.

The Levee.—A t a lev6e held on the 21st inst. at
SL James’s Palace by His Royal Highness the Prince of
Wales on behalf of Her Majesty, the following amongst
nther presentations were made:—Surgeon J. F. Henry
Dottrel!, Volunteer Medical Staff Corps; Surgeen-Major
George R. Barnes, 3rd Surrey Rifle Volunteers; Surgeon
Robert HippUley Cox, Coldstream Guards; Surgeon Herbert
G?*‘\ er . M.D., Royal Naval Artillery Volunteers; Surgeon
William Collingridge, M.D., Volunteer Medical Staff Corps;
ktaff Surgeon A. G. Delmege, on appointment to Royal
yacht Onbome; Surgeon A. P. H. Griffiths, Medical Staff, on
vJ 8 return from active service; Dr. J. de Burgh Griffith, of
Surgeon Charles it Hsrtt, Volunteer Medical
bfca “ Corps; Surgeon Henry St. George Standish Hore,

Medical Staff; lion. Surgeon Edmund Distin-Maddick,
Royal Naval Artillery Volunteers; Mr. Alexander O.
Mackellar, chief surgeon to the Metropolitan Police Force;
Surgeon George Hutchinson Milnes, R.N.; Inspector-
General D. M'Ewan, M.D., R.N., on promotion and appoint¬
ment as Honorary Physician to t he Queen; Deputy Inspector-
General H. F. Norbury, C.B., R X., on promotion; Surgeon
Herbert Innes Pocock, Medical Staff; Dr. Smith, Vice-
President of the Royal College of Surgeons of Edinburgh
and Surgeon Dentist to the Queen in Scotland; and Sin
William Stokes, President of the Royal College of Surgeons
of Ireland. Amongst those present at the levde were the
following members of the medical profession:—l)rs. M.
Baines, Brodie, Ii. M. Chester, W. M. Collins, Fleming, Ralph
Gooding, Lowe, William Moore, Minter, J. D. Macdonald,
Poore, W. S. Playfair, Henry J. Strong, Quain, Mark Tanner,
Thorne Thorne, George Wilks, Shapurji Aspaniarji Kapadia,
Rastamji. Dhanjibhai Sethna, and Mr. Xavoroji Manekji.

Victoria Hospital for Children.— The twenty-
first annual Court of Governors of this institution at
Chelsea was held on the 18th inst. Mr. Martin R. Smith,
the chairman, remarked that the new out-patients’ wing
bad been completed nearly a twelvemonth, and that about
58,000 children had been treated during the past yeai.

The offertory at the special jubilee service held at
St. Margaret’s Church, Westminster, on the 22nd inst.,
which has been forwarded to the treasurer of the West¬
minster Hospital, amounted to £123.

Poplar Hospital for Accidents. —The thirty-
second annual festival in aid of the funds of this institution
was held on the 20th inst., Mr. Sydney Buxton, M.P.,
presiding. The committee desire to extend the Samaritan
Fund for assisting patients who have left the hospital
and require medical appliances, and also to establish in
connexion with the hospital convalescent homes where
patients can be sent. They are anxious, too, if possible, to
obtain sufficient funds to sever the in-patient department
from that for out-patients. At present, in consequence of
insufficient accommodation, the out-patients have to be
seen in the basement of the building. Over 9000 patients
were treated during last year, the number having nearly
doubled in five years. During the evening subscriptions
amounting to £1405 were announced by the secretary.

Society for Relief of Widows and Orphans of
Mbdical Men. —The annual general meeting of this Society
was held at Betners-strset on May 18th, Sir James Paget,
Bart., President, in the chair. The annual report for 1888
was read by the secretary, from which it appeared that the
number of members was 343 (twenty less than in 1885);
only five new members had been elected, sixteen had died,
and nine resigned or ceased to be members. The Society had
lost two vice-presidents during the year by the deaths of
Mr. Cooper Forster and Dr. Harvey Kempton Owen. The
number of widows receiving grants was sixty-four—the
same as in 1885; but the number of orphans had been
reduced from nine to six, and there were three orphans
receiving grants from the Copeland Fund. Five widows had
been elected and one orphan. Five widows had died or
become ineligible for further assistance, and three orphans
had ceased to receive relief, having reached the age of
sixteen. The amount distributed in grants had been £2750.
and the expenses had been £243. Owing to the want of
funds the directors had not been able to make any present
to the widows and orphans last Christmas. Two legacies
had been received—one of £50, from the executors of Miss
Anne Lyne, per Dr. Stokes; another of £300, from Dr. Harvey
K. Owen, V.P. The funded property had been increased by
the purchase of £140 Metropolitan Consolidated Stock. Mr.
Mould was elected a vice-president in the place of Dr. Iliff,
deceased, and the following gentlemen were chosen directors
in the place of the six senior, who retired by rotation—viz.,
Dr. Birkett, Dr. H. M. Duncan, Mr. Langton, Dr. J. M. Bright,
Dr. F. de Havilland Hall, and Mr. Malcolm Morris; and Mr.
Ware, Dr. Quain, Dr. John Clarke, and Mr. Fuller were elected
trustees of all the funded property of the Society. A special
grant of £26 was made to one widow. Votes of thanks to
the editors of the medical journals were carried unanimously,
for their kindness in assisting in making known the objects
of the Society. It was resolved that the centenary of the
Society should be celebrated next year by a dinner. A vote
of thanks to the chairman closed the proceedings.

1110 rnK Lancet,]

BOOKS ETC. RECEIVED.—APPOINTMENTS.—VACANCIES.

[Mat 28, 1887.

BOOKS ETC. RECEIVED.

Baillterk, Tindall, & Cox, King William-street, Strand, London.
Stricture of the Urethra, its Diagnosis and Treatment facilitated
by the use of new aud simple Instruments. By K. Distin-
Maddick, F.R.C.S.Ed. pp. 151, Illustrated by Original Wood
Engravings.

Inoculation for Babies and Hydrophobia. By Surgeon-General
C. A. Gordon, M.D. pp. 127.

Churchill, J. & A., New Burlington-street, London.

Abdominal Surgery. By J. Greig Smith. M.A., F.R.S.B. pp.
006. Illustrated.

Practitioner’s Handbook of Diseases of tho Ear and Naso-pharynx
(Third Edition of the “ Aural Surgery”). By H. Macnanghton
Jones, M.D.. M.Ch. pp. 176.

The Student's Guide to the Diseases of Children. By Jas. Frederic
Goodhart. Second Edition, pp. 692.

Fischer G., Jena.

Lehrbuch der Allgemeincn und Spec'ellen Pathologi9chen
Anatomle. Von Dr. Ernst Zeigler. Zwei B&nde. S. 499—
1020, mit 1099 Abbildungen.

Fiissu A Co., Zurich.

Bud St. Moritz im Oberengadin. Von Dr. C. Veragnth.
S. 161.

Griffin, C., A Co., Bxeter-strcct, 8trand, London.

A Practical Treatise on Diseases of the Eye. By Dr. E. Meyer.
Translated by Dr. Freeland Fergus. M.B. pp. 637, with
numerous Illustrations and three coloured Plates.

Hamilton, Adams, A Co., Paternoster-row, London.

What can a Mother do to Preserve her Children’s Teeth f By
H. C. Quinby, L.D.S.B.C.S. pp. 59, with Illustrations.

Hogg, J., Paternoster-row, London.

Tho Cookery Primer, for School and Home Use. By Agnes C.
Maitland, pp. 156. Price Is.

Johnson, O. J., Chicago.

A Manual of Weights and Measures, with Buies and Tables.
Bv Oscar Oldberg, Pharm. D. Second Edition, revised, pp.
2i6.

Kroan Paul, Trench, A Go., Paternoster-square, London.

Three Lectures on the Anatomy of Movement. Delivered at the
Royal College of Surgeons. By Francis Warner, M.D. Ac.
pp. 135, with Illustrations.

IdtwiS, H. K., Gower-street, London.

Indigestion, Biliousness, and Gout, in its protean Aspects.
Part I.: Indigestion and Biliousness. By J. Milner FothcrgiH,
M.D. Second Edition, pp. 323.

Manual of Bacteriology. By Edgar M. Crookshank. M.B.Lond.,
Ac. Second Edition, revised and considerably enlarged,
pp. 439, Illustrated with Coloured Plates and Wood
Engravings.

Longmans, Grrbw, A Co., Paternoster-row, London.

8ocial Arrows. Bv Lord Brabazon. Second Edition, pp. 414.

The Health of Nations t a Review of the Works of Edwin
Chadwick. With a Biographioal Dissertation. By B. W.
Richardson. In Two Volumes, pp. 377—410. price 23s.
Murray, John, Albemarle-street, London.

Letters from a Mourning City (Naples, 1884). By Axel Munthe.
Translated from the Swedish by Maude V. White, pp. 289.
Phntland, Young J., Edinburgh.

BlemcntS of I’harmaoologv. By Dr. Oswald Sohmledeberg.
Translated under tho Author’s supervision by Thomas Dixson,
M.B. pp. 223.

Diseases of Women. By Dr. F. Wlnckel. Translated by Dr. J. H.
Williamson. With an Introduction by Theophilus Parvln,
M.D. pp. 674, with Illustrations.

The Principles and Practice of Operative Surgery. By Stephen
Smith. A.M.. M.D. New and thoroughly revised edition,
pp. 877, Illustrated with 1006 Woodcuts.

Putxam’s Sons, New York and London.

Sphvgmograptav and Cardiography, Physiological and Clinical.
By A. T. Keyt. M.D. Edited by A. B. Isham, M.D., and M. H.
Keyt, M.D. pp. 220, Illustrated.

Rkdway, Gkorgb, London.

Ambulance Sermons: being Pooular Essays on Medical and allied
Subjects. By J. A. Austin, M.D. pp. 884.

Swan So.xnbnsokkin, Lowrby, A Co., Paternoster square. London.
The Fungus-Hunter's Guide. By W. Delisle Hay, F.R.G.S.
pp. 157, with Illustrations.

TbUbhrr A Co., Ludgate-hill, London.

Carlsbad, its Thermal Springs and Baths, and how tjo use them.
By J. Kraus, M.D. Third Edition, revised and enlarged, pp.
138.

Unwin. Fisher, Paternoster-square. London.

The Massage Case. By Cyril Bennett. Two Vols. pp. 240—-
. 228.

.Wbkhkn, F.. Braunschweig; Wii.lu.m8 A NoRGatl, London.

Lehrbuoh der Kioderkrankhclten. Von Dr. Adolph Baginsky.
Zweite nerbesserte und verinehrte Auflage. S. 902.

-Zur Geschlehte der Phosphomekrose. Eine Streitschrift von Dr. F. RIs in
Kloteu (Scheuchzer, Biitach).—Transactions of the Olistetrieal Society
of London, Vol. XXIX.—Die Massage in der Gyniikologie ; von Dr. P.
Profantcr (Braumiiller, Wien).—The Carbonic Acid, Organic Matter,
aud Micro organisms in Air. more especially of Dwellings and Schools;
by Professor Thomas Carnelley, D.Sc., J. 8. Haldane. M.A.. M.B., and
A. M. Anderaon, M.D. (Trttbner).—Index Medicos, Vol. IX., No. 4,—

Tho Hunterian Oration ; by W. S. Savory, P.R.8.—State attaint
nostro Oonoscenze aulla Natura della Malaria ; nota del Sodo Comb
Tommasi-Crudelii.—By Win. Hunter, M.D.Ed.: The Durations U
of Red Blood-corpuscles after Transfusion; Intra-peritoneal Tran Jq :
of Blood and the Fate of Absorbed Blood.—New Commercial Pfc'j
and Drugs, No. 10; by Thoe. Christy, F.L.S., Ac.—Notes tm Bee*
Work; by Arthur Brinokman (Palmer). — Aetiologtscha '.fc
Anatomlsches fiber Lungenochwindaucht; von Dr. Johannes Orth.-
De la Jugulation de la Fifcvre Typholde au Moyen de la Quinine 6 >
Bains tiOdes ; par le Dr. G. Pecholier.—Observations on Milk
tina; by Prof. Brown; and Report on a Disease in Oowi In la
Relation to. the Scarlatina Epidemic in the N.W. District of Lcxriosa
1885; by Prof. Axe.—Magazines for June: Good Words, Sun-is;
Magazine, Leisure Hour, Sunday at Home, Boys’ Own Paper. CL-i
Own Paper.—Mr. Punch’s Victorian Era : an Illustrated Chronicle d
Fifty Years of the Reign of Her Majesty the Queen (Bredbuiyi&o

Appointments-

than 9 o'clock on the Thursday morning of each vsteh for psbhcatM a
the next number. _

Bailey. T. Ridley. M.B.Ed., has been reappointed Medical Oflkr-'d
Health to the Bilstou Union.

Bishop. William, M.E.C.S.. L.K.C.P.Ed.. has been appointed Meta
Officer for the Fifth District of the Bridge Union.

Butter, John Kbrb, M.D.. C.M.Aber.. has been appointed Main)
Officer for the Cannock District of the Cannock Union.

Cant, William Edmund, M.D., F.R.C.S., has been appointed Asslit;
Surgeon to the Central London Ophthalmic Hospital.

Carl ess, Albert, M.B.. lias been appointed Opht ha l mic Cumai
Assistant to King's College Hospital.

Cox. A. H. Lissant, M.R.C.S.. L.H.C.P., has been appointed ILm*-
Surgeon to King’s College Hospital.

Galloway, Walter, L.h.C 8.. L.B.C.P.Bd„ has been sppoiH"
Medical Officer for the Birtloy District of the Chester-t-Scm'-
Union.

Hknsley. A. E., M.R.C.S., L.S.A., has been appointed Assistant Hk*
Physician to King’s College Hospital.

Jkpson, Edward Cane, F.H.C.S.Eng.. L.S.A;, has been •PP* 11 -'' 1
Medical Officer to the Durham Union Workhouse, rise Boj®.
resigned. .

Kerr. William Smith, M.D.Glas.. L.R.C.S.Bd. (and not James mu-
M.B., C.M.Ed., as stated in our last issue), has been rodefie-.
Surgeon to the Dumfries and Galloway Roval Infirmary.

Lton. Thomas M. M., M.B.. C.M-Bd., has been appointed
Officer for the Ford District pf the Glendale Union.

Mac.nak, Allan J., M.R.C.S.. L.R.C.P.. has been appointed Hoo*-

Surgeon to King’s College Hospital.

Mair, R. S.. M.St.And., F.H.O.S.Bd.. has been appointed Phyawsa'•
hts Highness Prince Malcom Khan and the Persian Embassy. ;r
Vincent Ambler. deceased. ’

Mariktte, Ernest P.A.. M.R.O.S.. L.S.A., has been appointed House
Aocoucheur to King's College Hospital.

Owen, J. V., M.R.C.8., L.S.A., has been appointed HoosedfergeMi>■
King’s College Hospital. , ., .

Pedlky, It. Denison, L.D.S., M.R.C.S., has been appointed

Dental Surgeon to the National Dental Hospital, Great PortiU-
street, W. . .

Phillips. John. M.R.O.S., L.8.A., has been appointed Medical owe
for the Llanboidv District of the Narborth Union. . „ ...

for the Llanboidy District of the Narberth Union. .

Reynolds, H. 8.. L.R.C.P., F.R.C.S.Ed., has been appointed
Officer for the Codnor-park District of the Basford Union.

Sanders. Charles. M.B.Lond., M.R.O.S., has been appointed

Officer of Health foe the Borough of West Ham, vice um
resigned.

Shelly, William, B.A.. M.D. Q.U.I.. L.R.C.S.Bd.. has been appouw

• Medical Officer for the East District of the Poplar Union.

Stephrns. H. J.. L.8. A., has been appointed Assistant House- Aooonct -
to King's College Hospital. , . . .. ..

Wheatley. James. M.U.C.cL, L.S Jo., has been appointed H-
1’nysiclBn to King’s College Hospital.

iatanrits.

in compliance with the detire ofmtmeroHi subscribers, it hat been ******
resume the publication under this head of brief part indart oftAt tvf
Vacancies which arc announced in our advertising columns, f or fvr>
inform ilion regarding each vacancy reference should be **
advertisement. _____

AncOATS HosJhtal. Manchester.—Junior Visiting Surgeon. Ssb? -
per annum, with board and laundry service.

Camherwell Provident Dispensary, S.E.—Four Medical Omctn.

Chelsea Hospital for Women, Fulham-road, S.W.—AniwUieW.

HastiioURnk Union.—D istrict Medical Officer. Salary £85 per an
with tile usual extra fees. . » r -

Evbmna Hospital for Sick Children, Soothwark-bridge-rcan.- »
Registrar and Chlorofonnist. Salary £30 per annum, withEM-*--
£20 If the post is held for twelvemonths. .

Grove Hall. Bow, B. — Assistant Medical Officer to largr P"
asylum. Salary at the. rate of £180 during the first y«ar; after
of£l'i0. Board, lodgiug, aud washing. ,

Hospital for Consumption and Diseases of The Chest, Bromp-
Resident Clinical Assistant.

Google

'ns Lancbt,]

BIRTHS, MARRIAGES, AND DEATHS.

[May 28 , 1887 . 1117 r

krpool Northern Hoomtal.— AiiMut House-Surgeon. Salary
£70 per annum, with residence and maintenance In the house.
tropolitan Free Hospital, Kings land-road, Shoreditch, E. —
Dental Hospital. '

llbe Hospital and Botal Knott Dispensary, Greenwich-rood,
8.B.—Senior Resident Medical Offioer. Salary £60 per annum, with
furnished apartments, board, attendance, and washing. — Junior
Resident Medical Officer. Salary £30 per annum, and like accom¬
modation.

sab Umov, Esse*.—Medical Officer and Public Vaccinator. Salary
£75 per annum, with the extra medical fees prescribed by the Con¬
solidated Orders of the Local Government Board and other addi¬
tional charges In respect of lunacy and vaccination.
ken's College, Birmingham. — Co-Professor to sham the duties of
the Chair of Surgery.

fAL College of Surgeons of England.— Professors and Lecturers.
r*L Westminster Ophthalmic Hospital, King William-street,
West Strand, W.O.— HousoHurgeOn. ,

tal United Hospital, Bath. — Resident Mcjlial Offioer. Salary
£100 per annurq. with board and lodging.

Mart’s Hospital, - Paddington, W.— Secretary. Salary £300 per
annum, with board'and residence, or £360 without.
tett ok Apothecaries, London.—Twelve examiners.
inks Union.— District Medical Offioer. Salary £65 per annum,
exclusive of the authorised fees for surgical and midwifery cases.
lmfoed Hill. 8tokk Newington, Ac., Dispensary. — Resident
Medical Officer. Commencing salary £106 per annum, with an
allowance of £60 fer fuel and light.

n> Vale Colliery Stck and Accident Society. Skelmercdale,
L a nca s hi re.—Medical man. Salary about £150 per annum.
toria Hospital fob Children, Queen’s-road. Chelsea, 8.W.—
Resident Medical Officer. An honorarium of £20 for the first six
months, and £30 for the second six months, will be given, and
board and lodging In the hospital provided.

1TKHATKN AND WEST CUMBERLAND INFIRMARY. — House-Surgf cm.
Salary £120 per annum, and £80 a year for dispensing, with
furnished apartments and attendance.

$irt[rs, iitarraps, anil

BIRTHS,

Ru. — On the 21et Lust., at Glenavon, Stoke Hewiogton-
oommon, N., the wife of Thomas Furze Clarke, M.B.O.8., of a
(laughter.

(N.— On the 13th Inst., at Churchill Court, Worcestershire, the
wife of Brneat Harr-old Penn, Surgeon, Grenadier Guards, of a
sen.

—On the 22nd Inst., at Gay-street, Bath, the wife of Arthur B. W.
Fox, M.B.. F.H.C.P.B., of a daughter.

ebtson. —On the 18th Inst., at Roeharapton, 8.W., the wife of
A. Milne Robertson, M.D., of a son.

MARRIAGES.

tlky—Fenwick.— On the 21st Inst;, at the Cathedral, Newoaatle-on-
Tjme, by the Lord Bishop of the Diocese, assisted by Canon Lloyd

Tyne, by the Lord Bishop of the Diocese, assisted bv Canon Lloyd
and the Rev. G. Fenwick (brother of the bridge). William Crump
Beatley, M.D., to Frances Mary, daughter <Jf J. Q. Fenwick, J.P.,
of Moorlands, Goeforth, Newcastle-<m-Tyne.

^wood— McCann.—O n the 20th ult., at 8c. Mary’s -Church, Aston,
Roger Alan Bird wood. M.B.Cfcmb., M.R.C.8.. to Agnes, youngest
daughter of the late Hugh McCann, of Birmingham-
■lkr—Wacher. — On the 19th last., at the Parish Church, Herne,
Walter Fowler, M.A., M.B., B.C.Cantab, F.R.C.S.Bng., to Alice,
fifth daughter of WQlkun Wacher, Bsq„ of Bddlngton, Herne.
tCHANT — Spares. — On the 14th Inst., at the Parish Church,
Mansfield, by the Rev. Canon Pavey, John Burrell, eldest son of
the late John Mat-chant, of Hertford, Solicitor, to Marion Guyse,
second daughter of Geo. Whitefleld Sparke, M.R.C.S.
sr—Edmonds.—O n the 17th Inst., at St. John’s toe Divine,
Richmond, William Henderson .Starr, M.R.C.S., L.R.C.P.Lond.,
Army Medical Staff, to Helena Mary, danghter of Henry Bdmonds,
if Kew. .

, DEATHS.

Mil.—On the 20th Inst., at Stanhope-gardens, Queen's gate, S.W.,
Patrick Gammie, Surgeon-General, aged 78.

cbson. —On the 13th Inst., at Ballsera, India (of fever), W. White-
>ide Paterson, M.B., C.M., M.R.C.S., youngest aon of the late
Andrew Paterson, of Carston, Ayr, In his 25th year. (By telegram.)
krs. —On the 13th inst., at South Kensington, William Hinds
Sogers, M.R.C.S., of Yealmpton, South Devon, aged 64.
ell.—O n the 30th ult. (of septicemia), at Lahore, India, Blla
llary Tlckell, aged 23, eldest daughter of Henry J. Bock, L.&.G.P.,
M.R.C.S., of Clapton-common, London, the beloved wife of Charles
rickell, Beq., Q.8., of Mardan, Punjab, India, youngest son of the
ate Lieutenant-General Tlckell, O.B., of Cheltenham. Deeply
amented.

kn. — On the 12th Inst., at The Limes. Wlgton, Cumberland,
tobert Tiffen, M.D., aged 63; also on the 15th inst., Ann, his wife,
ged69.

ik a.—On. Urn 18th lnst v very suddenly, Thomas Aubrey Turner,
tf.RXI.SJi., 6f 8, Alex a n dra-rood, Finsbury-park, eldest son of the
ate Rev. T. B. Turner, of Kingston, Jamaica, aged 42. B.I.P. ,

METEOROLOGICAL READINGS.

(Taken daily at 8.S0 a.m. by StnaanCt tnstnanentt.y

The Lancet Office, May 26th, 1887.

IRxrgmeter Dtreo-
redaced to flos Dry
. «fx LotsI of Bulb.
1 and M*F. Wind.

£9-35 W.
2978 W.

29-81 I W.
30 06

Trap 1 B — rtn ea

OV-." Temp LUL 8J0 xj«.

93 55 45 I *33 Raining

99 I 57 39 'll Fine

87 65 40 '15 Cloudy

99 62 41 -03 Cloudy

80 61 48 ... Fine

88 69 46 *02 Cloudy

Itirfts, Sjwrt Cmnmtnts, # |,nsfers ta
Corrtsjmt&tuts.

It is especially requested that early intelligence of looalevente
having a medical interest, ot tonich it ts desirable to bring .
under the notice of the profession, may be seat direct to
thts Office.

All communications relating to the editorial business of the
journal must be addressed ' 1 To the Editors .”

Lectures, original articles, and reports should be written on.,
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be _ authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing ‘reports or news-paragraphs should .
be marked and addressed to the Sub-Editor. >

Letters relating to the publication, sale, and advertising
departments of Thb Lancet to be addressed "to the
Publisher.”

We cannot undertake to return MSS. not used.

•f Births,

Blbnkosrha<ha.

R. J. it. (Belfast).—A suodnet study on the etiology and treatment of
this disorder Is given by Dr. Ullsse Maluaardl In the Ga;:etta Medica
<U Roma of May 1st. His conclusions, set forth as the result of special
clinical experience, are these;—1. Gonorrhoea (or blennorrhagla, as ho
prefers to call it) is a specific local affection, the principle of which
eonsiats invariably in the preseooe at a parasite (gonococcus) in the
secretion. 2. This Infective principle of blennorrhagla with its paraattfq
basis must be constantly treated from the beginning with antiseptic
remedies. 3. Injections of hydrochlorate of oooalnc are the sovereign
antidote to nocturnal erection or ohordee. 4. The use of warm baths,
even prolonged. Is not contra-indicated, as It materially allays the
patient’s sufferings and facilitates resolution. 5. Incomparably the
most powerful and least hazardous antiseptic is corrosive sublimate in
doses increasing from 0*5 per oeot. to i per cent., after the action of
iodoform has been proved to be inefficacious. 6. In the local sequels,
of blennorrhagla advantage Is eften derived from tin use of the sulphate ■
of rinc, combined with that of corrosive sdbUmxte. Tobacco is net-
forbidden in such cases by Dr. Malusnrdl, who, on the contrary, agrees
with tho French specialists in “ never having repented of allowing
its use."

M.O .—The method referred to Is not one to be commended. The proper
course would have been for the gentleman to send a card to each of
his patients announcing the removal.

J. M. L. la referred to a general notice at the head of this column.

NON-SACCHARINE ALCOHOLIC DRINKS.

To the Editors of The Lancet.

Sirs,—I t occurs to me that you may by an annotation or a short
artiele make known a want and get it supplied. The want I refer to la
an alcoholic drink which does not contain sugar. This is especially
needed for diabetic and gouty persons; and, except unsweetened gin, which
Is unpleasant to many, I know of no form of alookol which Is free from
sugar. Unsweetened whisky would be cspeabdly valuable, and it Is
almost impossible to get any. Sugoroandy, or sugar in some form, la
added to nearly all whisky,, to give it rou nd a — and mellowness.
Brandy contains a good deal, and even claret a small quantity. I am
afraid my letter alone will do no good; bat if you recognise the want,
and make it known it will oeaae to exist.

Believe me. Sirs, yours truly.

May Slat, 1887. F.R.C4L

Google

l\]8 Thk Lancbt,] NOTES, C0MMENT8, AND ANSWERS TO CORRESPONDENTS. [Mat 28, l&I,

Leeches.

J. H. C. (Leeds).—The first to employ leeches was Them! sod, a physician
of Laodicea and contemporary of Pompey. He was also the founder
of the sect of the Methodic!, and Is often cited as an authority,
especially by Caellus Aurelianus. Dr. Greenhlll distinguishes him
from the Themison satirised by Jurenal (x., 221), who, it being then
the custom with artists of every kind to assume the name of celebrities
~tn the same walk, no doubt called himself after bis distinguished pre¬
decessor. This assumption of names is one of the many difficulties
besetting the historian of anolent medicine.

W. P. F. —We fear that the universities named are, under the circum¬
stances, all practically closed to our correspondent. Casas such as his
show very clearly and very painfully the disadvantages under whioh
the London student at present labours.

J. C. should consult one of the old-established firms of surgical instru¬
ment makers.

Sir. Larehin. —Dr. Morrell's book.

THE POLLUTION OP THE THAMES.

To the Editor! of The Lancet.

Sra,—The Metropolitan Board of Works profess that at last they are'
shout to run a satisfactory effluent into the Thames. They carefully
avoid, however, to state on what grounds they consider it satisfactory,
and it is only by supplementing the figures which they have published
by one or two more whioh their chemist, Mr. Dibdin, has communicated
to the Institution of Civil Engineers, that it Is possible to ascertain
definitively what they now propose to do. Mr. Dibdin states the strength
of the sewage now turned into the Thames at 87 grains of foreign matter
per gallon. Captain Calver stated it in his report at 285 50 grains, at two
hours after high-water, and 189 0 grains at two hours before low water.
But let us take Mr. Dlbdln’s figures, and also his statement that the
“ pressed oake," which Is the most unobjectionable form into which the
matter removed from the sewage Is converted, contains 58 per cent, of
water. It Is easy on these data to calculate that the treatment described
in the recent report of the Finanoe Committee of the Board of Works
removes 31 grains per gallon of foreign matter from the sewage, and
and thus turns into the Thames an effluent containing 56 grains of im¬
purity per gallon, which is, in foot, only a .very slightly diluted sewage.
Indeed, out of 20 grains of organic matteT in solution only 2‘6 grains
are removed by precipitation. As the result of this very mlnnte im¬
provement, 30 tons 13 cwt. of foul sludge are produced from each million
gallons of sewage. Tanks are erected, at a cost of £106,000 for the north
of the river alone, to allow this sludge to subside ; by which process it
Is reduced to 18 tons 6 cwt, of drier and thicker sludge. It is this
product which it is now proposed to boat away to sea. Its amount, on
a daily outflow of 100.000,000 gallons of sewage, is 2928 tons. The total
solid matter removed from the sewage it under two tons per million
gallons. This is increased by the method now accepted by flfteenfold,
and by more than ninefold after the cost of a second subeidenoe. If this
is aktisfactory to the Metropolitan Board of Works, the satisfaction will
hardly be shared by the frequenters of the Thames, or by the rate¬
payers of London. I am. Sirs, yours obediently,

May 20th, 1887. M.Ikst.G.B.

A DOCTOR’S REAL HOLIDAY.

To the Editors of The Lancet.

Sirs,—A ny middle-aged practitioner must have met with many men
who havo gone on for years practising until they have at last broken
down from worry, work, and ennui. Why do not some of our worn and
weary brethren copy the clergy, and go far away for three or six months'
complete change t I have known more than one doctor work on till
compelled to give up practice, and then linger on in misery to himself
and a trouble to his friends through years of invalidism. A local clergy¬
man was worn and done up; he left for fourteen months, returning
well. I have often known a clergyman go away for six months, and
hundreds of the clergy, even in these days of poverty and anti-tithe
agitation, go off for two months. But our medical brethren, who have
so much worry and night-work, so few holidays, so little society, are
just the men who cling to work till the last, and yet many doctors have
good private means, and some have lucrative and easy enough practices
in addition. There are hundreds of middle aged and experienced men,
who would do the kind of work I am alluding to. I am sure that dfee of
fifty guineas would secure for three or four months a competent locum
tenons, glad to look after a first-class practice and to do full justice to it.
Such a course of action would add years to many a weary practitioner’s
life, and secure that holiday for him that he of all men most needs.

I am, Sirs, yours truly.

May, 1897. 8. U. M.

NEW SOUTH WALES.

To the Editors of The Lancet.

Siks,—I shall feet muoh indebted to any of your readers who are con¬
versant with New South Wales if they will give me any information as
to the diseases whioh are moat prevalent there. Also, if drugs and
instruments are to be easily obtained at any of the large towns; or what
drugs and surgical instruments it would be advisable to takeout, and
any other hints and suggestions will be thankfully reoeived by, .j

Yours faithfully,

■ay 33rd, 1887. Viator.

"Da. Pkacan’s Treatment ot Cholkbi*

In our Ibsuo of the I4th Inst, we published an annotation on this idjec.
Our attention has since then been called to the fact that, exerpu,-
some surplusage In after-medication. Dr. Peaoan’t method of tasted
of cholera is In principle, and also in practice, identical with the pi:
proposed some years ago, and commented on by us at the tin*
Dr. Alexander Harkin of Belfast. To thia latter observer, who is w
published a paper read by him In 1884 before the Ulster Kato.
Society, in which his theory of the causation and cure of the dhos-
is expounded, must be ascribed the merit of originality. Dr. Pesos
success in cholera treatment being a striking proof of the soundue*
Dr. Harkin’i views tested in a different hemisphere.

Etiquette should receive the visit of the neighbour alluded to vithx
prejudice. Time will show if his delay in calling arises from unfm» >
or discourteous motives.

Surgeon will find in The Lancet of Dec. 6th, 1884, p. 1030, a letter *t
will inform him on the points he mentions. Appeal should be da.-
to the commissioners.

THE BROWN DBFENCE FUND.

To the Editors of Thk Lancet.

Sirs,—W e, the undersigned, crave yonr permission for a few rwmrt
in oonnexlon with the above oase. Having allowed a fair Urns to **
since attention waa called to the matter by the letter of Dr. Bum
D r. Broadbent, and Mr. Sydney Jones in your issue of April M. c>
finding only an Inoonslderable response to the appeal, we thick « aifs
invite further notice to the oase. Up to the present date the sum d
£20 9*. 6 d. has been received, which goes a short way Indeed
defraying the law oosts, amounting to over £160. Mr. Brows tea,’
personally known to us, we believe we can confidently state ttat t*
became Involved in the matter through no indiscretion or tmprsder
on his part. Indeed, his position was one in whieh any member de-
profession might find himself at any moment, and as heeanilliSri
to be at-such a serious lose, we solicit help on hb behalf. As wt bo*"
many of bis professional brethren would contribute s smell %*>-•?
where they cannot spare much, we desire to make it known that we r -
gladly receive any contributions, however small, as it is apparent^
that if even a limited number of the medical practitioners of the eoM' r
would each give half-a-crown, or even less, the whole sum reqo-".
would be paid off many times over. In conclusion, we might
(should it be wished by those contributing) that the donon will *
acknowledged without the amount being specified. Hoping « l! »-
not make this appeal In vain, and thanking yon for the inUrat
have shown In the matter and the oourtesy you have extended to m.

' We remain, 8ir», faithfully yonrs,

Robey & Robet, 129 A143. St. John’s-hlll. New Wsndjwxti

J. H. T. Connor, 49. 8t. John’a-hlU. S.W.

R. F. Frazer, 185, Lavender-hill, 8.W.

M. O. Biggs. 101, Northcote-road, S.W.

Mabtx Read, Claph&m Common-gardens, S.W.

J. T. Boyd. 73, St. John’a-hlll, S.W.

James B. Lawrence, East-hill, S.W.

T. A. Ives Howell, 14, High-street, Wandsworth, 8.W.

O. Stanley Murray, Meadow-aide, Putney.

Richd. R. W. Oram, Cremvll, Wandsworth Common.

R. H. A. Hunter, Clifton House, Battersea.

May 23rd, 1887.

To the Editors of The Lancbt.

Sirs,—K indly Insert the following .—Amount already scknowlolF-
£19 8*. 6 d.; Arthur Ivee Howell, Esq., £1 1*.

I am, Sirs, vours faithfully,

G. 8TANLET MOBUT, M.P-

23, Upper Rlchmond-road, Patney, May 23rd, 1887.

MEDICAL ATTENDANCE ON THE SICK POOR. NOT

PAUPERS: A CORRECTION.

To the Editors of The Lancet.

Sirs,—I f " F. T. 8." will kindly refer to an annotation in The U*-*
of April 23rd, he will find at p. 791 that you mention In your nollor of c
paper on the medical attendance of the sick poor: “ One fe at 0 " ' *
Alderson’s views is the suggestion of a graduated acale of payment «•
ing from 6*. to 80 s. per year for single persons, or 30*. to £* per 7* f '
families; ’’ and if “ F. T. S.” would refer to the original pamphlet
should be pleased to send him one), he would read st p. 9. "* I*; t _
whose Income is £150 a year could easily pay out of it from £3 to »
medical attendance.” There is no all osion to an Income' 1 of £312. ^

at a much increased rate on the principle of health Insurin'*-“ !
mentioned in my pamphlet on “ The Wants of the General Prsctiti J ■.
I wonld even attend patients of a much higher sodal position b*
larger incomes. The £6 per week which has caused your cormpf^ -
“ F. T. S.” “some amusement” Is a clerical error. What I
have written was that I was willing to attend a patient » ’•

for £6 per year, whose wagee averaged £3 per week. I noticed th '
directly I read my letter in print, but the mistake appeared to
obvious that I did not care to trouble you by asking a oorrwtw®- ' _
I am now anxious to do, for it is this class, who«e inoome is under
year, that requires aid in providing medical skill when illne«* 0 '' e
Its members. I am, Sira, your obedient servant.

May 21st, 1887. Fhkd. H. AU*» j

ioogle

!*hb Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [May 28, 1887. 1119

MEDICAL PRACTICE IN THE NEW WORLD.

Tb the Editort of ThK Lahcet.

ibs.—I n the expectation that lome one nearer home would be able to
e the information asked for by “ A Conttant Reader" in your lwne of
roh 19th, I have refrained from writing; bat as Thk Laxckt for
rll 9th has just come to hand without anyone giving the desired
irmation, I will endeavour to help him.

.s regards the Western States, there are many good openings in them,
in Washington Territory, Oregon, California, Colorado, Ac. In all
hem British diplomas entitle the holder to registration. Drugs can
>btalned with little or no difficulty in almost any part of the oountry.
regards the climate, tome sections of the oountry, as California and
orado, salt certain oases of long disease admirably. Near the ooast the
ct is bad on cases coming to the country, though natives of the place
not suffer much from chest affections. In British Columbia, before
amendng practice a new-comer mutt present himself before the
dioal Connell, produoe a degree from a recognised oollege or university,
s an examination in all the primary and final branches, and pay a fee
B30 and an annual fee of £3 10*. These regulations apply to all alike,
mattter what qualification they hold. In this provinoe, moreover,
tnings are rare, the proportion of doctors to population Is about I to
, while in tome places, as Victoria and New Westminster, the pro-
■tion Is as low as 1 to 000, or lest. The climate Is not particularly
table for lung diseases, exoept some osses which do well in the
tin tains. I am, 8irs, yours sincerely,

W. A. Dk Wolf-Smith, M.D.
few Westminster, British Columbia, April 36th, 1887.

G. T.—l. The holder of a real American or continental degree Is
rarranted in nalng the title attaching to the degree on his plate, Ac.; but
t is not a sufficient title in cases of medical certificates. The mere
ise of It after other and recognised British titles Is not necessarily
Uegal.—3. We know of no means of ascertaining whether any given
wnen la possessed of any degree which be professes to have than by
nqulry of the authorities or Inspection of the rolls of the university.

R. C.P. would probably obtain much of the Information he desires by
ipplying to Messrs. Moore and Co., Houndsdttch.

AN U RGB NT CASE.

To tht Editort of Thk Liitcit.
iiss,—About five years ago you were kind enough to allow the late
. A. P. Stewart and myself to make an appeal In your columns for two
lies, sisters, who have had to maintain for about twenty years their
>tber, Mr. Charles Gaffney, who practised at Buntlngford before he
s overtaken with insanity. The oaae Is well known to the benevolent
ieties of the profession, and has repeatedly been generously assisted
them. But it still continues In all 1U hard facts. The brother has to
maintained from home, and the sisters, to support him and them-
ves, have to keep a boarding-house. Their increasing age and the
rdness of the times have landed them in straits whioh I do not like to
tcribe; but they are still holding np. Their account of the help of
•nds, including some who had little to give them. Is reviving reading,
ey are extremely needy and equally deserving. I shall be pleased to
the medium of any sums which any of your readers can spare for
:m, and to acknowledge the same in your columns.

I am, 81rs, your obedient servant,

S, Highbury-plaee, N., May, 1887. James Guy Glovkb.

locator (Norwich).—Dr. Pietro Canails, assistant in the laboratory of
jeneral pathology in the University of Turin. His paper, entitled
• Contribution to the Study of the Development of the Experimental
Ethology of the Supra-renal Capsules, with six Illustrations," was
recently presented by Professor Blzzozero to the Royal Academy of
Sciences of Tnrin, in the “ Atti ” of which it will shortly be published.
'• D. C. Trott .—It would be better, we think, to address the com¬
munication to the editor of the journal in which the correspondence
■eferred to appeared.

Pierrepoint .—The letter is of the nature of an advertisement.

HERNIOTOMY IN YOUNG CHILDREN.

To the Editori of Thb Laxobt.

’ IR3 .—In your last issue, psge 1029, Mr. Lionel Stretton reports a case
which he successfully performed herniotomy In a ohlld four weeks old,
d states that he has •• been unable to find any account of operation in
young a child." A moment’s reference to Sections 961:3 of the
;<ilcal Digest and Appendix will point to a case by Mr. Macnamara In
19, aged three weeks, and to another by Mr. Haziewood in 1881, also
ed three weeks, both reported in your valuable journal.

I am, Sirs, obediently yours,

Bcondary-rd., N.W., May 31st, 1887. Rickabd Nbalk, M.D. Lond.

THREADWORM.

To tht Editort of Thb Laxctet.

Su».-WUl any of your readers kindly suggest a mode of treatment
• an obstinate case of threadworm in an adult, all the usual remedies
ving failed, Including many changes of climate ?

,, I am, Sirs, yours obediently,

17th, 1887. M.R.C.B., Ac.

SWXATXXa OW TKK PSKT.

A Sufferer. —The question has been repeatedly noticed In our columns.
The following is the reply mads to a correspondent In our Issue ef
July 7th, 1877, p. 87 1 —"The complaint is not lastly cured. The
patient in question should not walk so much as to Indooe these foot-
sweats. Tonlo doses of quinine with mineral acid and well-regulated
dress should be recommended. Great relief is sometimes afforded by
a foot-wash made by adding half an ounce of solution of subaoetate of
lead, dilated with water enough for a foot-bath. Hebra recommend*
an ointment oompoeed of equal parts of lead plaster and linseed oil
spread on linen, and wrapped roond the feet, renewing the application
every third day for nine days. Laced shoes are preferable to boots.’’

Dr. Ridley Bailey.— There are several good filters In the market, amongst
which it is not easy to indicate the best. The ease with which the
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are of course the chief points to be kept in view in purchasing a
filter.

Hertford.—Yft know of no other societies of the kind at present In
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A WARNING.

7b the Editort of Thb Laxcbt.

Bibs,—I shall be glad If you will allow me through Thk Lakckt to
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alms representing himself to be Mr. Wm. Ashton Patchett, late of Shaw,
and stating that he is a widower with two children, and entirely destitute.
To confirm his statement he produce* some original testimonials from
Sir W. Roberts, Mr. B. Lund, Ac., whioh were given to me when I was a
candidate for a hospital appointment seventeen years ago, and whioh by
some means he has obtained possession of. I have come to the con¬
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few days some time ago, and Who stole not only tbe testimonials, but a
number of my medical books also. I am informed that in London be
has only too successfully imposed upon several benevolent medical
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extortions. I am. Sirs, yours faithfully,

Shaw, May 18th, 1887. W. A. Patchktt, M.R.O.S.Bng., L.S.A.

L.K.Q.C.PJ., L.M.—We are not prepared to reoommend the particular
steps to be taken; but it Is obviously right that In pubUo papers,
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would be justified in objecting to the description and title given as
Inaccurate. In answer to the third question, our correspondent, with
the qualifications mentioned, can recover in medical and midwifery
cases, but not in surgical ones.

R. —Our correspondent should consult bis legal adviser. A great deal
might turn on the details of the course taken In the past by the
respective parties.

INTESTINAL OBSTRUCTION CAUSED BY IMPACTED
GALL-STONE.

7b tho Editor ! of Thb Laxckt.

8res. In your issue of April 80th Dr. Allen reporta a case of operation
for intestinal Obstruction caused by Impacted gall-stone, and states that
be oan find no such oase on reoord. I beg to refer him to a similar case
published by me in The Laxckt for 1881. A previous case by Mr. Bryant
Is also on reoord. Both of these were fatal. I think also one or two cases
have been published since, but do not remember the particulars of them.

I am, 8!rs, yours truly,

Belgate, May 13th, 1887. J. Waltkbs. M.B., Ac.

CHRONIC RHEUMATIC ABTHRITI8.

To tho Editon of Thb Laxckt.

Bibs,—O an any member of the profession kindly inform me what
drug he has found most efficacious for relieving pain and promoting
sleep in a oase of chrooio rheumatic arthritis ? An elderly person has
had this affection for the past two years, and now suffers a good deal at
night from pain in the joints and sleeplessness. A great variety of
medicines have been tried, including potass, lodld. and potass, bromld.,
but latterly with very little effect. Morphia cannot be given owiDg
to the patient having a weak heart.—I am. Sirs, yours truly.

May 34th, 1887. Medicus.

Dr. Haddott (Melrose).—We shall be glad to receive the paper, and to
give it onr attention.

TREATMENT OF TiENIA SOLIUM.

To tho Editor! of THB Laxukt.

Bibs,—I should be much obliged if you would Insert this letter in yonr
next issue, on tbe chance that some of your numerous readers might
be able to help me. I have a patient suffering from tsenta solium, and
have tried all kinds of remedies, but fall to do more than get rid of small
quantities. I have used kousso In full doses, extract of male fern, and
pelleterin. Any hints would oblige—I am, Sirs, yours very truly, £
May. 1887. Puexled.

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THE LANCET, June 4, 1887

%tdms

on

INJURIES OF NERVES.

Delivered at the Royal College of Surgeons,

By ANTHONY A. BOWLBY, F.R.C.S. Eng.,

SURGICAL REGISTRAR AND DEMOIWTRATOR OF SURGICAL PATHOLOGY AT
ST. BARTHOLOMEW'S HOSPITAL, HUNTERIAX PROFESSOR OF TUB
ROYAL COLLEGE OF SURGEONS.

LECTURE III.

SYMPTOMS OF COMPLETE SECTION OF A. NERVE TRUNK.

Mn.PaESii?BNTANDGfiNTLEMEN,— The symptoms of nerve
injuries of all kinds have much in common, but considering
th&t those caused by bruising, pressure, partial division,
&c., possess some points of difference from cases of simple
division, I shall at present treat of the latter alone.

The pain caused by division of a nerve trunk does not
appear to be very severe, for, judging by the accounts of
patients, no further pain than that caused by the skin
wound seems to attract attention in at any rate the larger
number of coses. Numbness and tingling frequently cause
more anxiety than does the actual pain.

The shock following on an injury to a nerve trunk is not
a very noticeable feature id patients met with in civil
practice, though Mitchell records many cases of gunshot
wounds in which it was present.

The loss of muscular power and of the sense of touch are
symptoms of far greater import than either of the foregoing.
With regard to the former, it may be said at once that the
muscles supplied by the divided nerve become absolutely
powerless, and remain so as long as the divided nerve ends
continue ununited; their functions may be to a certain extent
supplied by surrounding muscles, as insisted on by Ldtidvant,
but they themselves undergo a rapid atrophy and degenera¬
tion, which is the cause of many deformities, and which
affords a sure evidence of the injury that has been sustained.

Sensation may be affected in many ways; there may be
loss of sense, of touch, of pain, or temperature, and of
weight, anaesthesia, hyperesthesia, and various abnormal
sensations, such aa pricking, tingling, numbness, &c.

The thermal sense is generally lost in proportion to the loss
of the sense of touch and over the same area; in very to any
cases, however, in which complete anesthesia is not present,
there is no power to discriminate between heat and cold.
The amount of loss may be easily determined by making
the patient dip the fingers into water of different tempera¬
tures, or else by touching the skin of the affected part with
6ome steel implement which has been heated to a certain
degree in hot water.

The dneesthesia which follows nerve section is generally
to the patient the most obvious result of the injury he has
sustained, but the exact extent to which it is present
requires an immense amount of time and care to estimate.
The best mode of estimating the acuteness of the tactile
sense in different parts of the body is to measure the dis¬
tances at which the two points of a pair of compasses can be
detected as such, but, in addition, tne power of localisation
must be duly noted. For general purposes it is beet to try
roughly to find the presence or absence of anaesthesia over
a given area by means of lightly touching the skin with the
point of a pencil or penholder, and then proceed to map out
the exact amount of anresthesia with a pair of compasses and
a rule. The patient should always be placed in such a position
•that it is impossible for him to see tne hand of the surgeon
or the area which is under Observation; he should not be
allowed to move the finger or other part touched, for thereby
the muscular sense comes to the aid and falsifies observa¬
tions; the impact of the instrument used should be very
light, for, as L6ti6vant has shown, a patient can frequently
discern friction on an anesthetic surface by means of
vibrations carried by the tissues to surrounding healthy
nerves. The distances at which the points of a pair of
compasses can be detected as such have been given approxi-
■ tnately by physiologists, but are almost valueless in testing
1 N* 6 3^ tt0XX °* the hand °* ft working man, in whom the

cuticle is so thickened and homy as to be insensible to slight
contact of any kind. It most also be remembered that the
distance at which the two points of the compasses can be
distinguished varies according to whether they are applied
in the long or transverse diameter of a digit.

The readiness with which a patient can recognise friction
when applied to an anaesthetic finger requires more than a
passing notice, for it is liable to become a very fertile source
of deception. I have often seen the sensory power of a pre¬
sumably anaesthetic area tested by rubbing the part with
the finger while the patient’s eyes were averted, and almost
always with the result that the stimulus was correctly per¬
ceived, and that a returning sense of touch was diagnosed
by the investigator. Such a conclusion is entirely erroneous,
for, as L<5ti6vaut has pointed out, any person can perceive
friction applied even to the finger of another person when
held between the bases of two fingers of his own hand ; ie.,
the vibrations are conveyed to, ana appreciated by the nerves
of the surrounding digits. How much more must this be
the case when, as in the case of median division, healthy
nerves exist on the same finger to which the friction is
applied. Friction should therefore never be used as a test
of sensation. For the same reason, the part whioh is being
examined should never be pushed, or thrust away from the
position in which it lies. This, I think, needs no farther
explanation.

If, then, the parts supplied by the terminal branches
the divided nerve be tested with every care, it will befrj
quently found they are not completely anaesthetic eveni
cases of complete section of the trunk. A careless examina¬
tion in such a case might readily lead to the belief that
the nerve had not been divided, and that such operative
measures as might otherwise have been considered advisable
were no longer necessary. The merit of first drawing atten¬
tion to this condition is due to M. Richet, in a case observed
by him in 1867, and since that date the theory of nerve
“anastomosis” has been so largely accepted that some
authors—e.g., LdtiSvant, Arloing, and Tripier, and others
have applied it to explain symptoms, many of which were
undoubtedly due to true regeneration. Now, in far the larger
number of cases it becomes very difficult to say for certain
whether the power of distinguishing touch is really due
to regeneration or to nerve anastomosis, and only an
examination of the divided ends can set the matter at
rest. In others, where the section has been very recent, and
the distance separating the upper from the lower end pre¬
cludes the possibility of union, any tactile sense must be
referred to the influence of nerve anastomosis. On the other
hand, in many cases a careless examination will lead the
surgeon to the conclusion that all sense of touch is absolutely
lost, and that the part is completely anesthetic; conse¬
quently, there are not a few who deny the presence of any
tactile sense in the paralysed part, and who therefore
discredit the theory of “ nerve anastomosis.” From my own
observations, I can have no doubt that in many cases of
neurotomy a complete arruesthesia is certainly present, and
that there are all grades of gradually increasing sensation,
till we reach a point at which it becomes exceedingly
difficult to say for certain that the tactile sense is not due
to a regeneration of the divided nerve. The extent to which
this supplementary sensation is developed varies acoording
to the nerve divided, and even then is by no means constant.

There are now recorded a sufficient number of cases to
render it certain that very acute sensibility may be retained
after section of nerves supplying definite skin areas, and I
will only mention that on the Continent unequivooal in¬
stances, verified in some by post-mortem examination, have
been detailed by Richet, Leudet and Delabost, Baudens and
Israel. Two other cases quite as interesting have been
recorded in England by Savory and Batlin, and these 1 will
venture to quote in greater detail.

In The Lancet of August 1st, 1868, Mr. Savory describes
a case of neuroma in which he excised a considerable por¬
tion of the muscnio-spiral nerve with the tumour. The
following is his description of the state of the parts after
the operation: “ From the time of the operation the muscles
of the back of the forearm were paralysed, and the hand
dropped forward from the wrist. But when testing the
sensibility of that portion of the skin of the hand which is

S lied by branches of the radial nerve, we were not a
astonished to find that it was but slightly impaired.
When the skin upon the outer part of the back of the hand
or over the back of the thumb and forefinger was slightly
z

tized by Google

1122 Thb Lancbt ]

ME. ANTHONY A. BOWLBY ON INJURIES OP NERVES.

[Junk 4,1887.

pricked, the man cried out sharply. He could distinguish in
the same region two points of contact, when they were not less
than an incn apart, both in the long and tranverse axis of the
hand. When they were closer than this, on any part of the
back of either hand or forearm, he confused them, and,
indeed, in comparing the sensibility of this region with that
of the inner portion of the back of the hand and two inner
fingers, or with the corresponding part of the opposite hand,
no very striking difference could be detected. All portions
too, of the back and sides of the middle finger appeared
equally sensitive. He could distinguish also between the con¬
tact of hot and cold bodies in this region as well as in other
parts. He always remarked the distinction between the
touch of a cold steel sound and one that had been previously
dipped in hot water. When desired to experiment on him¬
self by touching, scratching, or pricking the different parts,
he repeatedly declared either that he could perceive no
difference of sensibility or that the radial portion of the
donum of the hand was rather more sensitive than the
other half. These observations were carefully repeated in
various ways day after day, with a uniform result; indeed,
the man at last got tired of them, concluding, no doubt, that
the existence of acute sensibility had been abundantly proved.
It need hardly be said that in many of these experiments the
man was blindfolded and otherwise prevented from forming
any idea of what we did except through the sense of touch.
Now, what is the interpretation of this remarkable fact ?
All anatomists will agree that, so far as ordinary dissection
goes, the skin on the outer half or thereabouts of the back of
«he hand, and of the back of the thumb, forefinger, and outer
portion of the back of the middle finger, is supplied only
by branches of the radial nerve; and when any variation
is witnessed in the distribution of this nerve to the back of
the hand, it is almost always that it supplies more than the
usual portion of integument, going on sometimes to the ring
finger. I cannot doubt, therefore, that in this instance the
parts in question were supplied in the usual way, only
through the branches of the radial nerve. But then how
oould these parts retain sensibility after the removal of
some inches of the nerve trunk ? I can only account for it
thus: We know that in the forearm just above the wrist
some 8mall branches of the external cutaneous nerve com¬
municate with the radial, and it may be that at this junction
the radial receives filaments from the external cutaneous
which so pass down to be distributed with the filaments of
the radial even to the skin of the hand. This seems to me the
most probable view of the matter—indeed the only reasonable
one."

The next case was reported by Mr. Butlin in vol. xxv. of

the Pathological Society’s Transactions“ D. D-, aged

-thirty-two, was admitted into St. Bartholomew's Hospital
with a broken back, in June, 1873, of which he died three
or four days after admission. There was noticed on his left
arrm, three or four inches above the wrist, a long oblique
scar, apparently the remains of a tolerably deep and severe
•wound; the ring and little fingers were exceedingly con¬
tracted, the little finger especially drawn in towards the
palm. Neither of them could beat all straightened; the skin
covering them was tense and glased. The musoles of the
ball of the little finger were atrophied to an extreme degree,
and contracted. The interossei and abductor indicia, the
abductor pollicis, and the inner head of the flexor brevis
polliofa were in the same condition. But, so far as could
be ascertained by careful examination, there was no loss
of sensation, feeling being as complete in one hand as in the
other. The history which he gave of this (for he was in
complete possession of his faculties until shortly before his
death) was as follows:—Fourteen years previously his fore¬
arm- was wounded, and he was in the hospital for fourteen
weeks. At the time of admission, and for some time after¬
wards, the hand was ‘numb’on the inside. He regained
feeling in it before he went out; his fingers became drawn
'down afterwards. A post-mortem examination showed
■that the ulnar nerve had been completely divided about
' three inches and a half above the wrist; the upper portion
was firmly united to the anterior surfaoe of the tendon of
“the flexor oarpi ulnaris; the lower portion was united to
tftesame tendon, bat to its posterior and external aspect.

‘ Nooommunication whatsoever oould be discovered between
the extremities of the divided nerve, which were not only
•fit* apart, but also on a totally different plane. The upper
1 -perilon showed very little atrophy, even when examined
’with thamdoroscope. About three-fourths of an inch above
its point of union with the tendon was a large bulbous

swelling, similar to the swelling found at or about the ends
of nerves in stumps. The lower portion of the nerve wm
exceedingly atrophied. Sections examined microscopically
showed that it was composed almdst wholly of connective
tissue, but here and there could be seen small points which
had deeply coloured with carmine, and which resembled
axis cylinders.”

The manifest care expended on a thorough investigation
of the recorded cases, and the high reputation of many of
the surgeons under whom the patients happened to be
placed, leave little or no room for doubting the reality of
the retention of a certain amount of sensation in the ana
supplied by the divided nerve. The more care, then, is
necessary in arriving at the conclusion that in the case of
any injury regeneration and reunion of the divided ends
have occurred; for if the surgeon disregard the possibility of
a supplementary nerve supply, he is apt to refer any signs
of returning sensation to a reunion of the nerve, and not to
its true cause. In addition, then, to testing the tactile
power and amount of anesthesia, it is necessary to note thi
presence or absence of paralysis and of trophic changes. If
coincidentally with a gradually returning sense of tench
the nutrition of the part improves, if previous trophic
lesions pass away, ana if—what is most important-ihe
atrophied muscles resume their normal bulk, their reaction
to faradaiem, and their contractile power, it may fairly be
considered proved that a reunion of the divided nerve hu
occurred. But in the absence of these additional symptoms
of regeneration, a simple return of sensation does not afori
sufficient proof of new nerve formation.

With regard to the extent to which this supplementary
sensation (, sensation tupplie of Ldtidvant) may be pr e —it ,
Ldtfavant writes: “ These supplementary sensations are very
imperfect; but, in proportion to the length of time which hu
elapsed since the section, they undergo by use a greater de¬
velopment. They are modified by certain local pathological
conditions. Thus, after certain nerve divisions practised
chiefly for neuralgia, there is produced a sort of local stupor
which masks the supplementary sensibility for a few days.
Sensibility is restored as this stupor is dissipated." With the*
remarks, my own experience would lead me to agree, and I
would only add that in other cases the supplementary sen¬
sation appears to be most marked immediately after the
nerve section, and that it subsequently disappears. The
manner in which this supplementary sensibility is kept up
is thus stated by Eichet: “ As both the loops and filaments
which end in the touch corpuscles are compound, contain¬
ing fibres from the median, radial, and ulnar nerves, eeetioc
of one of these trunks is powerless to deprive of sensibility
the corpuscles, which are the essential organs of touch.
This is a propos of a division of the median. Arloing and
Tripier in the Annales de Mid. Vit., 1876, express moch
the same opinion, and state that after division of three out
of the four collateral nerves on the toe of a dog, sensibility
still remains, but is destroyed by dividing the other Berra
This, however, is certainly not applicable in its entirety to
the human subject, as there can be no doubt that fa many
cases—e. g., after division of the median at the wrist—the
fingers are in parts frequently entirely ansBSthetic. Israel
in the case quoted by him is inclined to ascribe the cause of
the supplementary sensation to a chance union of the
proximal ends of the injured nerves with another nerre
which was yet intact; this condition, however, is not esees-
tial for the presence of supplementary sensation. Jk
Savory, with more probability, refers this condition to whet
I may call the “coarse anastomoses” in contradistinction to
Eichet’s explanation; and in the case of injury to the
musculo-apiral, on which he bases his arguments, instance*
thq union of small branches of the external cutaneous with
filaments of the radial nerves. No difficulty need be fousd
in accepting either Richet’s or Savory’s exp l anation. It wa
been proved that the nerves can transmit currents eqiwff
well in either direction; and considering the oomporatiTwJ
small bonds of union which exist, and the fact that tier do
. not enlarge as do the collateral vessels after ligature o f m
artery, the imperfections of the supplementary sensaaots
will not excite surprise. .

In addition to simple inability to perceive the contact «
various bodies with the skin, there is often found a wa nt»
power to localise correctly the exact spot touched. Fre¬
quently a patient will perceive that some part of the n«»
is being touched, but on being asked to name the jj*l* ®
spot of contact he makes mfat&es. Thus, on pricking®®
back of the finger he fancies that it fa the fimt Wmc* ■

1124 The Lancet,]

MR. LAWFORD KNAGGS ON INTUSSUSCEPTION.

[Jtnru 4,1887.

to St. Bartholomew’s Hospital. I have found that in cases
of nerve section in man the faradic excitability of the
paralysed muscles has disappeared with much greater
rapidity than in animals, for, whereas Erb states that it
gradually fades and finally disappears in the third week, I
have found absolutely no reaction to the strongest currents
as early as the third or fourth day. In one case only
excitability persisted until the eighth day.

With regard to the galvanic current, there is, again, a
marked difference between the conditions in men and
animals. In the latter the galvanic irritability of the
muscles is said to become greatly increased at the second
week, and in the third week the excitability is so great that
contractions are excited by the current evolved from only
two or three cells. Such is not my experience. I have
never seen but once, and then it was doubtful, the least
increased excitability. On the contrary, I have found that
the galvanic irritability diminished rapidly, so that in two
or three weeks, at a time when theoretically excitability
should be at its height, strong currents produced but slight
fibrillar contractions, which were also very slow and wavy.
And, whereas by experiment the date of the final disappear¬
ance of galvanic excitability has been fixed at about eight
or ten weeks, I have found it to vary in man from about the
third to the sixth week.

With respect to the alterations in reaction to thekathodal
or anodal closure currents, my own observations are in
accordance with those of others. In about a week or ten
days I have found that the anodal closure contraction was
either equal to or greater than the kathodal closure con¬
traction. This reaction is of great value from a diagnostic
point of view, and is also most reliable. Considerable
care is nevertheless requisite in investigating the affected
muscles.

The next point for consideration is the permanency or
otherwise of these altered reactions. Supposing that at the
end of a few weeks all electrical excitability has disappeared
in the paralysed muscles, when must we look for its recur¬
rence, and in what way does its absence influence the
prognosis ? To this it may be answered that, if the divided
nerve does not reunite, the electrical irritability will not
return; but that, if it does reunite, voluntary power will
return before electrical excitability. The first sign of repair as
regards the muscles must not, then, be looked for in the
electrical reactions, but in tbe return of function; and the
continued absence of electrical irritability is not to be looked
upon as sufficient ground for a bad prognosis. Voluntary
power often returns many months or even a year or more
before electrical excitability—a fact which is difficult to
explain, but of which I cannot have the slightest donbt.

Does faradic or galvanic excitability return first? I
cannot answer this question quite so definitely as some of
the others. In some cases both have returned at the same
time; in others the muscles have contracted to the faradic
current whilst yielding no response to galvanism. I have
never seen galvanic irritability return Wore faradic. In
most of the cases I have observed, the galvanic reactions,
when they first reappeared, were normal in quality; but in
one case, where they did not return until six months later
than the faradic reaction, the reaction of degeneration was
well marked. The following notes of cases illustrate most
of these points.

Case 1.—James D-, aged thirty-four, divided his ulnar

nerve on April 7tli. 9th: No reaction to faradism of ulnar
muscles; good reaction to galvanism of ditto. 14th: No
reaction to faradism; very slight reaction to galvanism.

Cash 2.—Geo. H-, aged thirty, divided his ulnar nerve

on May 8th. 11th: Muscles supplied by ulnar nerve react to
faradism; galvanic current, A.C.C. = K.C.C. 13th: Com-
lete loss of faradic contractility in all muscles supported
y the ulnar nerve; very slight reaction to galvanism.

Cash 3.—Emile M-, aged forty-seven, divided his ulnar

nerve at the elbow on Feb. 22nd, 1884. 26th: Faradic current;
no reaction of muscles supplied by ulnar nerve.

Case 4.—John S -, aged thirty, divided his ulnar nerve

at the wrist on Feb. 23rd, 1885. 24th: Faradic current;
all muscles react. Galvanic current, K.C.C. > A.C.C.; no in¬
creased irritability; ulnar muscles paralysed. 2Cth; Faradic
current; slight reaction of interossei. Galvanic current,
A.C.C. = K.C.C.; no increased irritability. 27th: No change.
28th: Faradic current; marked diminution of excitability.
Galvaniccurzent in third interosseous muscle, A.C.C. > 1LC.C. ;
other interossei as before. March 1st: Faradic current, only
the falntbet contraction. Galvanic c VC.C. > K.C.C.

4th: No reactions to faradism. The faintest tremor to gal¬
vanism.

Case 5.—Henry B-, aged forty-seven, divided his nhar

nerve on Feb. 6tb. 20th: Complete loss of both faradic and
galvanic contractility.

Case 6. — Annie B- , aged twenty-seven, divided b*r

median nerve at the wrist on September 27tb, 1885. On
account of her band being entirely covered with antippoc
dressings I was unable to examine the condition of tbe
muscles until the third week; On October 20th there vie
found to be no reaction to faradism in either the opponent
or abductor pollicls. The same muscles gave the reaetkn
of degeneration to the galvanic current (A.C.C>K.C.C.), bet
instead of there being marked excitability there was great
loss of galvanic irritability, and the contractions wen slow
and wavy. Oct. 30th: The muscles supplied by the medkn
nerve require eighteen more ceils to cause a contract**
than do those of the other band, and then scarcely react

it will thus be seen that after nerve section the paralysed
muscles usually fail to contract to the faradic aura:
after the third or fourth day. That at the same tint
tested by the galvanic current, A.C.C. = K.C.C., andlawr
on A.C.C.>K.C.C. In from three to six weeks there is com¬
plete loss of all electric exoitability.

In support of my statement that voluntary power returns
before electric excitability I append the following extracts
from cases I have observed:—

Cask 1.—J. 0 -, aged seventeen, divided his musculo-

spiral nerve on March 25th, 1883. On April 28th the open*
non of secondary suture was performed. On July 27th
there was some return of power m the previously paralysed
extensor muscles, but no return of electric excitability. Ou
Nov. 16th there was almost perfect restoration of power, but
no reaction to galvanism or faradism. On March 25th, 1&4
one year after tbe injury, there was complete restoration of
voluntary power, but stall no electric excitability. 0cL9th,
1884: Wrist extensors and extensor ossis metacarpi polte
react to faradism and galvanism, but the extensors of tba
phalanges of tbe fingers and thumb do not react.

Cask 2.—T. M-, aged twenty-four, divided his medial

nerve on July 20th, 1882. On May 5tb, 1883, the divided
ends were sutured. Nov. 28th, 1883: Return of power in
opponens and abductor pollicis. No reaction to galvanism
or faradism. March 28th, 1884: Muscles quite asgo odmoa
other hand; very slight reaction to a strong faradic current.
Sept. 22nd, 1885: Reactions normal to faradism •and gxl-
venism.

Case 3.— W. W - , aged nineteen, divided his ulnar nerve

at the wrist. Seven months later the divided ends woe
sutured. In five months there was a return of voluntary
power in the interoesei and muscles of the ball of the little
finger. A year later this hand was quite well, bnt there wit
yet no reaction to electrical stimuli.

Case 4.—C. R-, aged eleven, divided her ulnar nene

in the forearm. Three months later secondary suture wa»
performed. Muscular power began to return in
eighteen months. Six months later the muscles supported by
the ulnar nerve reacted to faradism, but not to galvanise-
After an interval of another six months galvanic irrita¬
bility was restored, but the reaction of degeneration wm
well marked.

RESECTION OF AN IRREDUCIBLE AND
GANGRENOUS INTUSSUSCEPTION.

WITH A CONSIDERATION OF THE TWO CHIEF METHODS 0?
TREATMENT: INFLATION AND ABDOMINAL SECTION.

Bv LAWFORD KNAGGS, M.A., B.C. Cantab., F.R.CA Ess.

The patient, aged five years and a half, a strong healthy
boy, had been suffering from a cold for a week. His *PP*
tite had been small, and the bowels had not acted satis*
factorily, a scanty evening motion taking tbe pl»w °-
the usual morning one. On November 9th he came don
to breakfast, looking pale and complaining of stom*£ -
ache. A domestic aperient was administered, and *“«-
breakfast he vomited; but the bowels being moved only
twice, and very inefficiently, a second aperient was
and immediately vomited. The pain continued,

' i Head before the Lcetfa and West Elding Sfedloo-Chlnirftcol See* 5 '
February 4th, 18S7.

^oo^le

Tech LIitoet,]

MR. LAWFORD K.NAGQS ON ENTUBSUSORPTIQN./

[Juror 4,1887. 1133

ubaequentty described as of a spasmodic character, but
lot very severe. The vomiting became frequent, and any
attempts to take food caused retching. I saw him in the
ivening. The vomited matter was white and frothy. In the
ight iliac fossa could be felt what seemed to be thickened
,nd solid coils of intestine, unlike anything elsewhere. The
pot was tender, and to it he referred bis pain. As I was
nanipulating these coils something seemed to move under
uy Angers, and I was unable afterwards to distinguish what

had previously felt. The manipulation gave pain, and
a used retching. Temperature 08°; pulse 90. I concluded
hat what I had felt was probably an intussusception which
lad resolved under manipulation, and I ordered four minims
>f tincture of opium in one drach m of water every four hours;
10 food to be taken by the mouth. I saw him again later,
md, the vomiting and pain continuing, I substituted sub-
:utaneous injections of morphia with atropine for the opium.
The tumour had not reappeared.

Nov. 10th. —Vomiting stopped after the subcutaneous
njeotions, and he had slept fairly during the night. There
vas now a lump on the right side below the umbilicus, dull
in percussion, somewhat pear-shaped, with the stalk sloped
owards the right flank. It could not be indented by pres-
mre; it was tender. There was no action of the bowels,
>ut flatus had been passed. The rectum was empty. A
■ery small quantity of urine had been voided. Tongue
noist. Temperature 98°; pulse 100-110, good. The dose
if morphia and atropine was increased, and he was kept well
inder its influence throughout the day, being allowed beef-
ea by the mouth, but fed regularly by the bowel. In the
ivening he vomited some brown-looking fluid not unlike
leef-tea—not offensive. The lump remained unaltered, and
ihowed through the rectus as a prominence.

11th.— Passed a good night; pulse 120; tongue moist; no
.’omiting. Tumour less aistinct, but perceptible and dull.
Che A.C.E. mixture was administered, and the bowel inflated
vith Lund’s insufflator. Air could be felt under the fingers
ilaced upon the tumour; this disappeared gradually, and the
ibdomen became generally distended and resonant, but there
vas no feeling suggestive of resolution having taken place,
’n the afternoon Mr. Teale and my father saw the case with
ne. All doubt as to the nature of the tumour had been set
it rest by the passage of a pint of fetid dark-brown liquid
;cces, having a reddish tinge due to blood. It was thought
o come from above the obstruction, and, in the absence of
.ay distinct tumour, to indicate that probably partial or
:omplete reduction had resulted from the inflation. The
iteration therefore was to be repeated in the morning.

child passed an easier night under the morphia and
.tropine,. but woke every half hour, complaining of “that
wful pain.” Two motions of the same dark fetid character,
>ut now containing mucus as well as blood, were passed.

12th.—He is evidently worse. Pulse 140, compressible;
onguedry, slightly brown, and covered with sordes; features
linched. inflation was repeated, but with no more satis-
action. With a view to operation, he was now fed by
he mouth; so that with nutrient enemata, each containing
me drachm of brandy, every three hours, and champagne,
irandy-and-water, calves’ toot jelly, chicken broth, and
ssence of beef by the mouth, he had taken a considerable
mount of nourishment and stimulants before he was again
een by Mr. Teale at 7.30 p.m. His condition then was much
mproved, but his pulse was 146, his temperature 994°, his
ongue dry, and he was incoherent and rambling. He had
lassed another liquid motion containing more blood and
nucus than the previous ones, and much more offensive.

It was now thought that the risks were greater if no
aterference was attempted, and so it was decided to operate,
nd if it became necessary to remove the intussusception to
ttach the open ends to the abdominal incision in order
o economise time, and so tend to lessen the shock. With
Ir. Teale’s assistance, my father givipg the anaesthetic—
-C.E., for which ether was eventually substituted,—I opened
ho abdomen by a median incision three inches long, and at
uee found the tumour lying rather deeply on the right side,
'here was considerable difficulty, in getting it to the surface
without undue traction, and when this was accomplished
othiog could be made out until the whole mass was drawn
utside the abdomen. It was nearly a foot in length and
urved, and proved to be an intussusception into the small
atestine, in which it was very tightly strangled, the outer !
lyer being arranged around the upper part in collar-like rolls,
'he intussusception passed through the ileo-cascal valve, and
ar three or fourinches into the large intestine. It was quite

loose here, and for two or three inches in the adjoining part
of the ileum, and it could be easily pushed back at this part,
but the mass was so tightly gripped above, that prolonged
and steady traction, both at the upper and lower ends of the
tumour, had not the least effect upon it. Moreover, there
were several dark-coloured patches upon the outer layer,
where the pressure was greatest, suggestive, either of
gangrene or blood beneath. The attempt to reduce the
invagination was abandoned, and the intestines protected by
lint wrung out in carbolic lotion. Following a suggestion
of Mr. Teale’s, with the object of saving as much bowel as
possible and avoiding a subsequent union of small with
large intestine, I made a transverse opening in the ileum
three inches above the valve, and through this pulled ont
the lower part of the invagination. A ligature was applied
to it high up and the free end removed ; it was black and
offensive. 1 then found that there was a small perforation
about an inch below this incision through which blood and
mucus could be squeezed from inside, so I made the section of
the gut an inch nearer the colon than I had intended. Before
doing this I clamped the bowel above and below the invagina-*
tion with Treves* clamp, and ligatured the mesentery to the
tumour half an inch from the bowel with five Or six ligatures.
The tumour was thep removed between the clamps and its
attached mesentery cut through. At this stage the patient’s
state became very serious, and it was deemed advisable to
conclude matters as quickly as possihle. The upper end
Was attached to the abdominal incision by deep sutures
passed through the abdominal wall, and the peritoneal
and muscular coats of the bowel, and by superficial ones
between the skin and the mucous membrane. To do
this the clamp had to be removed, and tbe open end
was held by a pair of Knowsley Thornton’s pressure forceps*
an instrument that proved extremely useful, completely
closing the gut and allowing it to be manipulated quite out-
of the way of my fingers. On removing it to put in the
superficial sutures, a small pieoe of Bponge effectually pre¬
vented any escape of faeces. The lower end was then fixed*
the incision dosed, a dressing applied, and the child put bade
to bed. He was then pulseless, but soon came round from
the ether, and after stimulant had been administered by the-
bowel and under the skin, a small pulse could be felt. He
was very restless, never rallied, and died about an hour and.
a half after the operation.

The success that has attended inflation in oases of intus¬
susception has been so satisfactory that it is not surprising
it has now become recognised as tbe first operative pro¬
cedure which should be attempted. ’ The ease with which it>
can be carried out, the simplicity of the means for its pei*-
formance which can be so readily extemporised, are likely
to render it a very popular method with practitioners, who
may be so situated as to be beyond reach of the ordinary
hospital requisites needed for serious operations. A clear
appreciation of the dangers to which any operation is
subject by no means makes it less useful, but rather
enhances Its value by ensuring a more thoughtful intelligence
in its performance. I feel therefore tempted to try to
bring out clearly the dangers to which forcible distension of
the bowel by air or water is liable; the more so because of
the usual text-books Fagge’s “Medicine” is tbe only one
in which I have found special reference to them, and I
believe that there exists a very general opinion that if
inflation- does no good, at least it can do no harm. The
following eight cases show that there are two great dangers
in the operation: injury to tire bowel, even to the point of
rapture, and shock j—

Cask 1. (Mr. Bryant.)—Boy, aged six months. During
inflation the abdomen became generally distended; no air
escaped per rectum. The child became almost pulseless.
Post-mortem: Faecal extravasation. "The left half of the
transverse colon and splenic flexure were constricted and
perforated.” A seooad opening Was found lower down in
the sigmoid flexure. (HarvedSn Lectures, 1884. This is
probably tbe same case as that alluded to by Dr. Fagge and
Mr. Howse in the Med. Cbir., Trans,,, vol. lix.)

CasX 2". (Mr. Symonds.)—Bdy, aged five months. During
inflation the abdomen became suddenly distended, and when
opened brownish mucus was found inside the peritoneal
cavity. Perforation had occurred in a portion of the in-
▼aginated bowel, which was easily reduced. (Not published.)

Casb 3. (Mr. John Thomas.)—Boy, aged five months. The
tumour could be felt per rectum. About nine ounces of
water were injected, when a rambling noise was heard in
the abdomen. No air returned. Post-mortem: In the pelvis

1126 Thb Lasobt,] ME. H. A. LATIMER: CHEST DISEASES AMONG COPPER WORKERS. [June 4,1887.

was half a tumblerful of water. (Thb Lancet, Dec. 25tb,
1886.)

Case 4. (Dr. Tyson.)—Case where oil was found in the
abdominal cavity after death. {Brit. Med. Jour., Dec. 3rd,
1881.)

. Case 5. (Dr. Moxon.)—Child, aged seven months. After
inflation and enemata the colon had partially given way in
several places. (Med.-Chir. Trans., vol. lix. Probably the
same case is recorded by Mr. Bryant in the Harveian
Lectures.)

Case 6. (Mr. Bryant.)—Boy, aged seven months. The
bowel between the intussuscepted portion and the sigmoid
flexure was partially ruptured in many places. The peri¬
toneal covering was cracked, and turned out, and in the
aacculi the longitudinal muscular fibres were torn and the
transverse separated. (Harveian Lectures.)

Case 7. (Mr. Bryant.)—Child, aged seven months. The
bowel was inflated, and the child became collapsed, convulsed,
and died. (Harveian Lectures.)

Case 8.—Dr. Fagge and Mr. Howse mention a case of an
adult in which a large injection of seven pipta injudiciously
administered was supposed to have caused the death of the
patient. (Med. Chir. Trans., 1876, vol. lix.)

In one only of these cases was the age not stated, but of
the remaining seven it is interesting to note that in all
three cases in which rupture occurred the age of the patient
was only a few months; that the two in which the bowel
was seriously injured were only a month or so older; and
that six of the seven in which harm resulted were children
less than eight months old. Admitting the greater frequency
of invagination in young children, these figures pointstrongly
to the conclusion that the intestines of infants are not well
suited to bear great distension. Nor is this astonishing
when we bear in mind their thinness and delicacy.

What bearing have these facts upon the question of the
.administration of an anaesthetic during inflation ? In adults
anaesthesia is dispensed with, that the operator may obtain
^information from the sensations of his patient and regulate
the continuance of the operation by them; but in infants
insensibility is usually deemed advisable to ensure the proper
. application of the method, and by the abolition of spasm to
•improve the chances of its success. Admitting that a
surgeon is not likely to obtain much information from
the intelligent co-operation of a conscious child forcibly
subjected to inflation, yet if it is ansosthetised there is
the very obvious danger that the distension may be carried
to too great an extent in consequence of the inability
of the patient to feel, or to express any discomfort.
Now it has been pointed out that to employ inflation when
sloughing of the invaginated gut is in progress is sure to
result in disaster; but in considering the applicability of
this method to any particular case, it is necessary to bear in
mind that the only certain sign of sloughing is the passage
of portions of gangrenous gut, that acute symptoms do not
mean the onset of gangrene, but probably the commence¬
ment of conditions which will end in gangrene if the patient
survive long enough, and that in cases in which gangrene has
been supposed to exist the facts have as often as not been found
to belie the supposition. The operation, then, is only contra¬
indicated in those cases in which there is certain evidence of
sloughing in the passage of portions of gangrenous intestine.
Sometimes, quite distinct from gangrene ot the invaginated
intestine, there are other conditions of the tumour, or
having some connexion with it, which predispose the
atient to suffer injury from forcible distension of the
owel. Such conditions are gangrene, ulcemtion, and per¬
foration of the outer layer from outward pressure of the
tumour, or ulceration of a neighbouring part of the bowel,
a not very uncommon accompaniment of intussusception,
and which is sometimes thought to be the exciting cause,
and at others may be produced by the invagination. The
following instances will illustrate these conditions:—

Case 9. (Dr. Charlewood Turner’s case.)—There was found
ulceration of the csecum, into which the apex of the tumour
had passed. (Path. Soe. Trans., 1881.)

Case 10. (Mr. Henry Morris’s case.)—On the sixth day the
outer layer of an intussusception of the small intestine was
found gangrenous from pressure, and almost perforated in
three or four places. (Path. Soc. Trans., 1877.)

Case 11. (The case reported above.)—On the fourth day a
minute perforation existed in the outer layer at a place
where the tumour was easily reducible, and several places
vary suggestive of commencing gangrene where the invagi¬
nation was tightly grasped.

Though perforation in Dr. Turner’s case did not take plug
till three days after the employment of large injections hid
been discontinued, yet their existence must have rendered
forcible distension a very hazardous proceeding, and I fed
that it was a piece of good fortune that no harm resulted in
my own case. (To bt conclude!.)

ON THB

CHEST DISEASES AFFECTING WORKMEN
AT COPPER WORKS . 1
By H. A. LATIMER, M.R.C.S., L.S.A.,

SCBOKOH TO THE SWANSEA HOSPITAL. THE MORFA AND PORT TEIJiTT
COPPER WORKS, <fcO.; PRESIDENT OP THE SWAHSXi
.MEDICAL SOCIETY.

I hope I shall meet with approval in bringing before the
notice of the profession a diseased oondition with which muy
practitioners are brought into occasional contact, and whitb
forms a large part of the practice of others who, like myself,
are engaged in attendance on persons who labour in one of
the special industries of this country. I allude to the chest
complaints set up in those who are employed in the mm-
facture of copper and yellow metal—staple industries of tbs
town of Swansea and its neighbourhood. I am compelled
to adopt a somewhat indefinite nomenclature for the title of
my paper, because, by the very nature of the pathologiol
changes induced in the chest primarily, and in the generil
system secondarily, I am prevented from giving a definite
title to the matter under consideration. Thus, for instance,
I should be failing in my purpose were I to speak of chrome
bronchitis, or of chronic interstitial pneumonia, and to on,
when dealing with the matter at issue; for either of the*
diseases, alone or together, form only links in the chain ot
morbid conditions which are set up by the pulmonary
irritations caused by the oft-repeated inhalations of norioci
substances, whether gaseous or mechanical, which act ns the
irritants and disease-producers amongst the workman who
labour under such exposures. Indeed, for many yearn put
I have been in the habit of alluding to the cases which fora
the subject matter of this paper as examples of “coppermtoj
chest,” a title which perhaps tails to convey to the uninitiated
any sense of pathological entity, but which is sufficiently
comprehensive to carry with it to the minds of students i
knowledge of what condition the sufferer is in. I venture
to say that no practitioner who has the care of workmen
engaged in the manufacture of copper will disagree with
me in thus denominating a class of disease with which he u
brought into familiar contact.

What, then, may one expect to find in the “ copperman*
Chest” ? Two things will always be found, at least; and tbes
two things are bronchial disease and interstitial pulmonary
change, both more or less pronounced in character. A*
time progresses other organs than the lungs become affect*^
and the sufferer presents a very storehouse of symptoms
the consideration of his medical attendant. I think I sha
best deal with the matter by a description of a patient o.
mine who is now under my treatment, as his case is a *ery
typical one and well adapted for my purpose. .

S.T-is now fifty-six years of age, and has been engage

in copper works since eight years old. He has always wen
& very steady and abstemious man. He started as a labourer i
help, became a labourer engaged in discharging coal and w,
moved on to be a furnace-man, then worked in the refinery
and finally became what is known as a “ gaffer” or foremw
His family history has a well-marked phthisical tamt in
At different periods he contracted colds like other peop •
and the colds always affected the chest; but there ’
nothing notable about this circumstance until the a-
ten years or so, since which time he has been more *
a sufferer from oough and shortness of breath. Item .
this period his colds would take the course to wm
I am now well accustomed in men of his class—vi*^ •
would be characterised by chronicity of process mw •
resistance to ordinary remedies for that class of ai.■ ■■
For some years past he has never been free from some sn
ness of breath and cough. For the past twe lve m
he has been quite unable to wor k, as he has sunersQ

i A paper read at the Swansea Medical Society on October

Thb Lawcbt,] MB.H. A. LATIMER: CHEST DISEASES AMONG COPPER WORKERS. [Jura 4,1887. '1127

increasing shortness of breath with dyspnoea on exertion,
.from asthmatic attacks, from drenching perspirations by
day and by night, from great disinclination for food and
inability to digest the same, and from constantly increasing
weakness as a result of those troubles. The heart beats
feebly and frequently in its efforts to pump the blood
through the lungs, and, under the presence of constantly
increasing resistance there, has become overloaded, so that
its right side has failed to empty itself, and there is venous
regurgitation. The stomach and other abdominal viscera,
being overloaded with retarded blood, and so passively
congested, are affected with catarrh, and the kidneys are
with difficulty excreting a scanty urine, whioh is loaded

with albumen. S. T-’s case is on all fours with many

others that I have witnessed, and, in reply to my frequent
advice that he should shift his quarters and his employment
at an early period in treatment, I have been told, “ What
can I do, sir ? I am too old now to start afresh, and my
state of health is not such as to commend me to any other
employers of labour than those for whom I have worked
for many years past.” And so it happens that the sufferer
drifts into the condition of confirmed and fatal disease.

I have said that all the cases present at least two con¬
ditions—viz., those of bronchitis and chronic interstitial
pulmonary changes. There is a wide variance, however,
in the type of the former complaint. With many persons
the bronchitis remains to the end the main morbid condition,
and loud rhonchi—sonorous or mucous in character—indicate
the chief foci of disease. This bronchitis becomes chronic,
and, emphysematous changes occurring, in the lungs, the
tubes yield here and there, aud form large bronchiectatic
cavities, from which great quantities of offensive sputum are
discharged at different times. The condition is one winch is
prone to mislead inattentive observers, who are apt to regard
the bronchiectatic cavities with their surrounding layers of
condensed lung tissue as being vomicae caused by the
ravages of tubercular phthisis. But the extensive character
of the morbid condition, as well as the duration of the
disease, and the concomitant conditions of emphysema and
cardiac trouble, are sufficient to negative such a view of the
case, even if we exclude the information given us by careful
physical examination of the patient. One such patient as I
have now been describing died under my care last year. For
many years past he had Been confined to the house in the
winter months suffering from dyspnoea, gastric catarrh, and
all the bronchial disease just spoken of. With the first
cold winds of the year he would be affected, the breathing
at once becoming much obstructed, the cough gaining
rapidly in force and frequency, and the attacks of dyspnoea
becoming more and more severe, until orthopncea would
declare itself and he would have to pass the greater part of
the twenty-four hours in a sitting position. Here, as with

S. T-and all my other patients affected with the disease,

the heart became more and more affected with incapacity
to pass the current of blood through its chambers, and so
there ensued venous engorgements and dropsical affections.
This heart failure plays a most important part in the later
stages of illness, and in by far the greater number of those
under my observations has been the immediate cause of
death, through asthenia and syncope.

I -will now deal with the question of the alterations in the
lungs proper, which at all times are to be found in these
cases. I would premise that the changes in these organs
are not secondary to inflammatory attacks there, either as
lobar or lobolar pneumonias, but that they are from the
first a prominent feature in the chest symptoms complained
of by the sufferers. In the early stages of illness, occurring,
for most part, many years before the patients are reduced
to a condition of permanent invalidism, one finds on.
auscultation marked increase of duration in the expira¬
tory breath sound, with a lessening of the volume of the
respiratory murmur generally. It is very evident that the
normal elasticity of the long tissue is impaired. This
impairment, once produced, remains as a permanent condi¬
tion, and it needs only a catarrhal influence, whether
atmospheric or irritant, to throw the whole - breathing
apparatus out of gear. I know a number of workmen who
are sure to appear at my surgery on the first frost or pre¬
valence of east winds, suffering from severe cough with
difficulty of breathing, and these men are the ones affected
in the way I hove just described. Under the influence of
these miserable circumstances the sufferers become, as a
rule, despondent and bad-tempered. 1 am not disposed to
regard this despondency as due altogether to their actual

sufferings; on the contrary, 1 attribute it largely to the
functional disorders of their digestive organs induced by
the vascular disturbances there to which I have already
adverted. . Moreover, the very nature of the complaint,
coupled with the fact that those affected are compelled
to continue under the adverse influences by which it
was contracted, are sufficient to account for much that is
unsatisfactory in the results of treatment. When the
bronchitis predominates, very satisfactory results often
follow one’s attendance, bat in the long disease proper
drugging yields bnt very poor returns.

So far i have not spoken of the exciting cause of this
chest mischief, and I will how deal with this matter. I find
that the parts of the works which seem to be most injurious
to those engaged in them are the calcining and the yellow
metal departments. In the process of calcination or roasting,
the rough copper ores which are in combination with
different proportions of other metals, such as iron and
sulphur, tin and arsenic, together with earthy matters, are
heated in an appropriate furnace to such a pitch that the
volatile ingredients are disengaged in the gaseous form,
“ whilst the metals that possess a strong affinity for oxygen
become oxidised.” Much dust also is flying about, and
so a calcining furnace and its neighbourhood is a very
rough comer of the works. The yellow metal workers
suffer still more than the calciners, for the place in which
they are working becomes at the moment of casting quite
enveloped in fumes and particles of volatilised metal, which
are necessarily drawn into the lungs when breathing. I
may remark in passing that I have met with well-marked
cases of “ brasstounders’ ague ” amongst those yellow metal
workers. But the injurious influences of the works are not
limited to the calcining and the yellow metal departments;
on the contrary, the whole range of furnaces at which the
metal is smelted, and the mill in which it is rolled, all
contribute to the general fund of irritation.

Now I come to the question of the duration of life in those
affected with “copperman’s chest.” This is by no means
short, although most of those who are sufferers by their
occupations become prematurely old. It is no exception for
men to live up to a good age, having been troubled with
the various ailments I have spoken of for thirty years and
onwards. The thing varies in degree, and although many
men die at a comparatively early age from acute chest
attacks grafted on chronic disease, a great many go on from
year to year, suffering each winter from distressing coughs,
shortness of breath, cardiac and gastric disturbances, &c^ to
such an extent that life is more a harden than a pleasure to
them. I suppose the very conservatism of the; pulmonary
changes which form the product of the constant irritation to
which they have been exposed serves than in good stead, and
.is a great bar to sudden and severe inflammations which
would have the effect of terminating life. The keynote of
the pathology of the subject is evidently irritation; and we-
all know what results when mechanical irritation affects,
the lungs and bronchial tubes; the former become affected
with “a progressive fibrosis,” whilst the latter take on
dilatation and ulceration. The lung fibrosis becomes
more and more confirmed; the “flbro-nucleated tissue [I
now quote from Green] which constitutes it is developed
from the walls of the alveoli, from those of the bronchi, and
from the interlobular tissue; which new growth, as it in¬
creases, and from its tendency to contract, gradually replaces
and obliterates the alveolar structure.” Hence ensues per¬
manent dyspnoea, aggravated at times and under various
irritations into attacks of asthma. The very density of the
lung, now occupied largely by fibrous tissue, is a bar to the
presence of much- blood in the parts, the capillaries being to
a very great extent obliterated. Following this obliteration
comes imperfect aeration of blood and all its concomitant
troubles; whilst, on the theory of *• collateral fluxion,” the
blood present in the body has to find some new channel of
distribution other than its ordinary one, or submit to cur¬
tailment. We shall see that this last fact is well worth
noticing, with a view to treatment directed against sym¬
ptoms arising in consequence of it.

I have drawn special attention to the cardiac disturbance
in these eases, It shows itself in the form of rapid and*
irregular action, and, in the later stages, by manifest in¬
competency t<o carry on the current of the circulation. On
examining the poise, it will he found to be irregular in
force and rhythm—circumstances due, I take it, to dis¬
turbances of the vaso-motor nervous system. One can
easily understand that the . heart disturbance and inoom-

1128 THE Lancsst,J MES8R8. HARRISON AND CROSS t SLOUGHING OP SCROTUM.

[June 4, 1887.

potency are due to failure in coping with the extra difficulty . the
it finds in propelling the retailed blood through the pul- ver
juonary capillaries, and that, just as in kidney cirrhosis, but how
in a different way, it is disturbed in its function. In kidney moi
disease, hypertrophy of the heart often ensues; in these vey
cases of interstitial pneumonia, due to copper smelting, the was
force of the heart’s action ie not augmented,Jout its frequency on 1
is, whilst the rhythm of its contractions is disturbed or rais
■ abolished. May not the fact of the aeration of the blood sigr
being interfere! with, and, through this disturbance of thai
aeration, the general functional health of the body, have as wd
mnch to do with enfeeblement of nervous control and heart stat
contraction as the mere mechanical difficulty in propelling goii
a.blood current with an orgah of ordinary capacity has? I com
cannot remember ever, having met with a case of hyper- littl
.txOphy of the heart where there has been pronounced stni
ooppennan’s chest”; on the contrary, in the majority of past
. cases, I have found the condition of debility prevailing to dr&'
which I have just drawn attention. tot

.. One can easily see, from the foregoing, that there is no som
, royal road to treatment in the complicated state of “ copper- tine
man’s chest.” To my mind, susceptibility plays a very the
important part here as. in other diseases. I believe the -Twt
majority of oases originate during the existence of a catarrh, whi
and that the irritations have not much power of doing sprt
permanent njischief when the breathing apparatus is in pree
a i^ealtby condition. Acting on this theory, I do what I' .nrir
can to keep workmen affected with recent chest. troubles Pou
at home, and on the funds of their clubs, as I regard 1 Ji
an abstinence from work at such a time, in such an atmo- is n
sphere as obtains in copper smelting, as & prophylactic pen
measure of the first value. 1 cannot say that 1 have found 6th
any one drug to prove of especial value in treatment. I had den
hbped much from iodide of potassium, but have been die- spre
Appointed... Belladonna, morphia, ipecacuanha, cod*liver oil, Ord<
ana digitalis are .all serviceable in their turn, when indicated, wit]
The treatment, in fact, resolves itself after a while very ; ture
much into one of cotnbating symptoms; 'and the main to 1
point is to keep the patient as jealously guarded from i sion
adverse atmospheric influences as is possible. As with all also
people affected with organic visceral disease, chilling of the batl
surfaces, whereby blood is diverted into the deeper-seated pols
parts, is to be carefully guarded against; and it is a of t
erne qud non in bad oases that the patient shall be pub
kept in-doors during .the prevalence of the cold or 101 c
.changeable seasons. The patients are most sensitive baro- pert
meters, and, just as the column of mercury in a weather has
glass runs up and down with the varying atmospheric pule
pressure, fl0 they continually alter under the same influences, all
Box them up ever so much in comfortable quarters, they) (wil
will still respond to the weather outside. The one special side
point in treatment is to act freely on the bowels occasionally, bo it
This gives marked relief, not only to the discomfort of .cuti
flatulence from which they are prone to suffer, but to the encl
very breathing itself. In bad cases where attacks of .dyspnoea den
harve prevented sleep, and when brotnide and other soporifics I .tun
have failed to give relief, a timely dose of jalapine or of occi
white mixture has often proved a veritable sleep-inducer by sect
tranquillising the system and allowing repose. It is well to Eve
bear this matter in mind, for the purgative often, gives 1 of t
relief when not directly indicated. fori

Swansea. brai

. ldtl

CASE OF SLOUGHING OF THE SCROTUM,
UNCONNECTED WITH URINARY
, . EXTRAVASATION.

By G. E. HARRISON, M.B. Lone., F.R.C.8.,

' . SURGEON-STATOR, GRENADIER GUARDS I ' I1 ? Tl1

•. . and : the

l’ /;•'; H..R’. 0. CROSS, M.R.C.8., L.R.C.P. Ed., Ju1 :

iuRGioir, oKKNAbrzR guards. 0411

■' ,v; is _ -wei

connexion with the oases published by Mr. Morrant
Baker under the above heading in The Lancet of July 25th,

•1885, and also of June 5tth, 1886; thefolloWing notes may be
ttf interest. ' - y '

'Private J. P—-> aged foartfc-biie; ' admitted Into JjJ*
■Soopital on the morning of June 4th,1885, At the time of P
■Admiss i on there was considerable swelling of the. scrotum
-and perineum, with a dark thin V of discolouration on ten

. the anterior .surface of the scrotum. The appearance ms
very suggestive of extravasation of urine. The aerotua,
however, was not tense, though much increased in sue; the
movements of the man’s body as he was lifted into bed ooa-
veyed a tremulous motion to the oedematoms scrotum. Thar
was fulness in the perineum, which was rather more tease
on the left than on the right side. Pulse 120; temperaum
raised. Tongue clean; cardiac sounds clear, and the phyenl
signs of the lungs normal. The urine contained rather dob
. than a trace of albumen. The patient is a atroogly btuh,
well-nourished man, bnt has been a rather hard drinker. He
stated that he had a fall on the buttocks on June 2nd whilst
going downstairs, and that on the following day the scrotum
commenced to swell. He had since then, he stated, hsd a
little difficulty in passing urine, but there was no history of
stricture. A medium-sized catheter (Sir H. Thompson 1
passed into the bladder without difficulty. This was with¬
drawn and No. 11 passed readily. It was thought advisable
to tie in the catheter for a time. He was ordered to hiv»
some warm fomentations applied to the scrotum, and to Ub
tincture of cinchona with dilate nitro-bydroehloric acid. In
the evening it was evident that the scrotum would skmgfc.
-Twelve or fourteen incisions were made in the scrotum,
which was tenser than in the morning. The cedems xw
spreading to the penis, where an erysipelatous blush wm
present. A large amount of serum, perfectly free from uj
. urinary odour, drained away. Temperature 104-5°; pulse 121
Poultices applied to scrotum.

June 5th: Temperature 103° ; pulse 105. The pens
is more involved. Several incisions made. Evening tem¬
perature I03'2 9 ; pulse 114. Fresh incisions neceesuy.-
6th: Temperature 1036°; pulse 112, rather small. Ten¬
derness felt on pressure above the groins, i nfl am m tioa
spreading to the subcutaneous tissue of the abdomen.
Ordered one grain of opium, to be repeated in six boun,
with strong beef-tea, eggs, and brandy. Evening temper*
ture 103'4°; pulse 112. The patient showing a tender?
to be very drowsy, the opinm was not repeated. An ind-
:sion has been made above the right groin, and ukssom
also into the subcutaneous tissue of the penis. Warm hip¬
baths with Condy’s fluid ordered.—7th: Temperature 1017;;
pulse 106. Patient’s aspect improved. Portions of the skin
of the penis have sloughed. Evening temperature 102V - ;
pulse 112. Charcoal poultices applied.—10th: Temperate
101°; pulse 100. Yeast poultices ordered. Evening tem¬
perature, which has been lower for the last two dap.
has risen to .103°; pulse 107.—11th: Temperature 1016';
pulse 112. Patient’s general condition improved. h’etfly
all the sloughs have come away, comprising the scrotum
(with the exception of a fringe of tieeue on escb
side, which much resembles in its shape and irregular
border a cock’s oomb), the septum scroti, and the loose sub-
,cutaneous areolar tiseues of the perineum. The two testicle*,
enclosed in their coverings of fascia, hang down completely
denuded of cutaneous ana dartoe tunic. Evening temper* -
.ture 102-9°; pulse 120.—12th: A little arterial hmmoitbagt
•occurred from a vessel at the back of the wound, which ^ai
secured with a ligature. Temperature 101°; pulse W
; Evening temperature 10V4 C ; pulBe 80.—13th: The surface
of the wound is becoming clean, and looks healthy. Iodo¬
form is now dilatedoVertne surface. A liberal allow« 01
brandy and light nourishment ordered. Temperature wl' - '
19th: Temperature still raised slightly at night. ThediecbarF
from the wound is decreasing. The incision above the ngw
in having dosed, there is now some accumulation of Pi*

Tv* JsAhcmxJ, DR. N. W. BOURNS ON PUERPERAL APOPLEXY. [June 4,1887. 1129

two granulating surfaces have united. A triangular surface
is leu covered with granulations between the edges of these
fringes of skin.—«Wth: Two skin-grafts applied to the
granulating surface. The testicles are now gradually
coming down into the newly formed scrotum.—Sept. 14th:
The wound is healed with the exception of a square half¬
inch.-30th: The patient was discharged from hospital, and
shortly afterwards returned to duty.

At the present time (August, 1886) the man is in his usual
health and performing his duties as a soldier. The urine is
found on examination to be free from albumen.

Wellington Barracks, S.W.

PUERPERAL APOPLEXY IN A YOUNG
WOMAN;

(in MAINTAINED FOR FOURTEEN HOURS BY ARTIFICIAL
RESPIRATION.

By N. WHITELAW BOURN8, MJ>.

- Mbs. E-, aged thirty, engaged me to attend her in her

first confinement, which she expected about the end of
March. She was a rather thin, aneomic-looking woman,
and a great sufferer from chronic rheumatic arthritis, caus¬
ing distortion of the finger joints. She informed me that
the articular trouble had been much better daring her
pregnancy; she otherwise enjoyed fairly good health. At
-&30 a.m. on February 18th I was called, and told by the
hosband, a medical man, that aha appeared in her usual
■health up to midnight, when she retired to her bedroom,
having entertained some friends during the evening. Her
husband joined her abont 1 o’clock, and found her
•complaining of pain in the epigastrium, for which she took
-a little bicarbonate of soda. The bowels had acted before

f ring to bed, and urine had been passed freely. About
30 a.m. she complained of constant pain over the abdomen,
and was given a grain of opium in a pill; but the pain con¬
tinuing, a vaginal examination was made by her husband,
and as he found the os externum dilated to the sire of a
shilling, he thought it well to send for the doctor and nurse.
The patient was then begging for chloroform to relieve the
continuous abdominal pain. I reached the room at 3.45 A.M.,
mad found her quite unconscious, lying on her back, rather
high in bed, with her left hand apparently supporting her
head. On examination I found the os slightly dilated,
and with some difficulty made out a vertex presenta¬
tion. There was no vaginal discharge. Poise abont 90, and
regular; respirations natural; pupils equal, not contracted,
reacting to light. I carefully watched her for some
little time, and saw that she continued in the same state,
with occasional uterine expulsive pains, daring which she
held her breath, and moved her legs np and down in bed.
As the urine voided before going to bed had been thrown
•way, 1 passed a catheter, and found the bladder empty;
but upon withdrawing the instrument, a couple of drops of
■deeply blood-stained fluid escaped from its eye. Feeling
Alarmed at the condition of the patient, I sent for Dr. Clement
•Godson, and shortly afterwards found the pulse much slower
—not more than 00 to the minute—and rather full; pupils
equal, slightly dilated, and not reacting to light. Noappear-
anoe of paralysis of the muscles of the face. The breathing
-for a few respirations was inclined to be stertorous, and at
•<1.15 a.*, she gave a couple of sighing inspirations, and then
stopped breathing. No pulse at the wrist. The heart could
toe felt over the pnecordial region, but the action was very
■feeble. I at once set up artificial respiration, and the heart
■soon began to improve, so that when Dr. Godson arrived,
soon after 7 o'clock, he was able to count the pulse
dn the radial, and made it 96 to the minute. We dis¬
continued the artificial respiration, but within two minutes
•the patient became markedly cyanosed and the pulse almost
imper cepti ble. Artificial respiration was again started;
hypodermic injections of ether and enema of brandy given,
ana the galvanic battery freely used. The fcetal heart was
listened for, bat coaid not be heard. Dr. Godson passed a
catheter and drew off about three drachms of dart blood-
coloured fluid; he found the os dilated to the size of a two-
ahilling piece. Enemata of peptoniaed beef-tea was given,
and the respiration kept up Dy a staff of neighbouring
medical men, who kindly lent their services. No change

took place in the condition of the patient np to 2.30 p.m.,
when we had the advantage of a consultation with Dtp, 1
Playfair and Godson, and the diagnosis of cerebral b®mor-
rhage was maintained. However, artificial respiration was
continued until past 8 o’clock, when reluctantly we had
to admit that the case was hopeless, and on discontinuing
our efforts life was soon extinct.

For the following post-mortem report I am indebted to
Mr. Colby of St. Bartholomew’s Hospital. Examination nine¬
teen hours after death:—Rigor mortis well marked. Heart:
Some excess of pericardial fluid, a patch of recent lymph as
big os a shilling over the front of the ventricles near the
apex. No valvular disease; no atheroma of the aorta. Lungs:
(Edema of both lower lobes. Liver: Capsule stripped off
easily in the neighbourhood of the right kidney. Kidneys:
Some irregularity aud thinning of the cortex. Surface
smooth. Capsule of right came off very easily, and the
organ was engorged. Ureters free. Bladder empty. Brain:
Under the meninges and on the surface of the left hemisphere
was a clot as large as a crown piece, covering the upper end
of the fissure of Rolando; on the parietal region of the right
hemisphere a similar but smaller clot. In the left hemi¬
sphere was a clot as big as a duck’s egg, continuous with
that on the surface, and lying outside the external capsule,
but compressing both the basal ganglia and the convolutions.
The right haemorrhage was superficial.

There are, I think, several points of interest in con¬
nexion with the case. Had parturition actually set in
before the h®morrbage occurred P Again, were the uterine
efforts in any way owing to the cerebral clot? I am inclined
to think that, considering the aspect of the case before the
loss of consciousness, and the condition of the . 09 , the
first step in the case was commencing parturition. Next
as to the diagnosis; this was admitted by all to be a point
of great difficulty, as the age and appearance of the patient,
the onset of the attack, the absence of any paralysis* facial
or ocular, and the fact of the catheter drawing off only a
little sanguineous fluid, all point to other than cerebral
causes. Lastly, the length of time Hfe was maintained by
artificial respiration is, I think, very interesting, if not
unique, as there cannot be the least doubt that any inter¬
ruption of artificial respiration between 6.15 a.m. and a
few minutes past 8 p.m. must have resulted in immediate
death. It would also be interesting to know how long life
wonld have been maintained if sufficient relays of medical
men could have been procured to continue artificial respira¬
tion. In conclusion, I may say that both Dr. Playfair and
Dr. Clement Godson look upon the case as a most unusual
one, and well worthy of being placed on record.

West Brompton. _ _

A CASH OP

OVARIOTOMY, FOLLOWED BY SECONDARY
INTRA-PERITONEAL HAEMORRHAGE; RE¬
OPENING OF THE ABDOMEN; RECOVERY . 1

By HENRY W. FREEMAN, F.R.C.8.I., LJLC.P. Lond.,
stnwaoa to m botas drud rosktal, bath.

Lizzie D-, aged twenty-two, a fine, tall, young,

single woman, the eighth child of a family of nine, was
admitted into the Royal United Hospital, Bath, on July 21st,
1886, with an abdominal tumour. She had menstruated
painfully far five years, the menses having ceased four
months before admission. Bhe stated that a swelling on
the right side of her abdomen had been noticed for
fifteen or sixteen mouths, and it had gone on increasing
solidly towards the left side, accompanied by some oedema
of the legs. Her general appearance, however, was that of
a healthy woman, and, bat for the mechanical weight in
carrying abont the tumour, she had Httle to complain of,
and had done her work as a domestic servant up to the
day of her admission.

On examination, the abdomen was found to be occupied by
a smooth, bard, semi-elastic growth, a little uneven at its
upper margin, and extending from the Itft side of the pelvis
to four inches above the umbilicus; dull all over on per-

1 Bead at the Bath and Bristol Branch of the British Medical Associa¬
tion. Dec. 9th, 18-9S. ...

Digitized

MR H. W. FREEMAN’ ON OVARIOTOMY.

[June 4, 1887.

i

H30 The Lancet,]

guaaion, with no definite fluctuation anywhere. The flanks
were resonant, and the fingers could be carried between the
tumour and the pubic rim. The abdominal circumference
measured thirty-five inches and a half. Her excretory
organs were healthy. The cervix uteri was pointed and
pushed backward in the direction of Douglas’s pouch; the
uterus was fixed, the sound passing in to the extent of an
inch and a half only. A rough, harsh friction sound was
heard over the right lobe of the liver, and an extensive
adhesion was diagnosed.

On Aug. 10th the patient was operated upon, under ether
and antiseptically, and a large single solid cystoma was seen
on opening the abdomen. An extensive adhesion was found
over the right lobe of the liver, which was broken down
and ligatured with chromic silk. The tumour was solid
and unyielding, and before it could be raised from its bed
free incisions were made and quantities of semi-solid
gelatinous matter got away. Other small adhesions were
treated in the usual way. The pedicle which involved the
left ovary, not the right, was broad, thin, and so short that
it was strained upon when the solid growth was moved in
the abdomen. The pedicle was transfixed with the Stafford¬
shire knot, clamped, and subsequently cutoff with a bistoury.
The peritoneal toilet was carried out by the aid of a Leiter’s
irrigator with warm water, and much sponging for cleaning
out the abdomen was consequently avoided. An eight-inch
Keith’s glass drainage tube was inserted through the lower
angle of the wound down into Douglas’s pouch, and guarded
antiseptically. Chromic acid sutures for the abdominal
parietes were used as usual, and the patient was put to bed
in an apparently satisfactory condition, with but little shock
or collapse. Four hours afterwards, on visiting my patient,
although the nurse reported favourably of her, a glance on
removing the dark window-blind told me all was not
right: the face was pale, pulse rapid, and the surface of the
body was getting cold and clammy. On examining the
tube and dressings no discharge was seen, but on carrying
the rubber tube of a suction syringe through the glass
tube straight into Douglas’s pouch an ounce and a half
of pure venous blood was brought up. Dr. Cave (tbe
resident physician) quickly joining me, it took but a
few seconds and a whiff of ether and chloroform to re¬
open the abdomen, when, to my dismay, we found the
intestines were swimming in blood, and tbe whole abdomen
filled with fluid and clot. Brandy was quickly injected into
the rectum, the cavity rapidly cleared out, the pedicle seized
and inspected, and the tied adhesions examined closely,
but we could not make out the bleeding spot. When the
stump of the pedicle was raised no venous oozing could be
detected ; when it was dropped back again into the abdo¬
men oozing took place again and again into Douglas’s pouch,
but the blood came not from the' stump. The pedicle was
found securely ligatured; nothing came from it. On carrying
a light into the pelvis, blood was seen to ocze from a small
valvular rent m that portion of the left broad ligament be¬
tween the stamp and fundus of the uterus, but only when the
pedicle was in a dependent condition and lying in the pel vis;
it stopped at once as soon as it was raised and held up. Evi¬
dently a rent bad been made in the pampiniform plexus of
the left broad ligament, and it was at last picked up, trans¬
fixed in two places, and tied in halves. The abdomen was
again minutely cleaned out with the irrigator, the wound
closed, and the tube replaced; but the patient was pulseless
and apparently moribund. Alargewash-nandbasinfulof blood
and clot had been cleared out of tbe abdomen. Iced cham-
pagno and peptoniaed milk with brandy, a teaspoonful every
twenty minutes by the mouth, and nutrient enemata and
suppositories by the rectum, were ordered, and in two hours,
although blanched and restless, the pulse was felt beating
feebly 16S to the minute, and she asked for sips of hot tea.
Three hours after this vomiting set in, with thirst of course,
but no headache or gaping. She dozed at short intervals
during the night, and secreted four ounces of urine. Dr.
Goodridge saw her with me at noon. Pulse 150; temperature
normal. Strong doses of digitalis were advised. Retching,
with constant vomiting, compelled us to abandon drugs by
the month for a few hours; but on the morning of the second
day, the pulse having gradually fallen daring the night to
120 , we gave her small doses of calomel and extract of opium
by the mouth frequently, which brought away some bilious
stools on the evening of tbe same day; ahe passed flatus
freely, and expressed herself as feeling more comfortable. She
took and retained her nourishment now. The rectum was
washed out periodically to avoid tenesmus and septic®mlc

---■-

absorption. Her pulse fell on the fifth day to 108, the tem¬
perature not exceeding 100°; the glass drainage tube wan
emptied of about an ounce and a half of pure sweet serum,
and on tbe sixth day it was withdrawn ana the wound closed
with stout silver wire. The parietal sutures were removed
on the tenth day, except the silver one at the site of drainage*
and she was then practically convalescent, with a pulse of
100, and temperature normal. Only one parietal suture
suppurated, and that was due to the China twist not being
prepared. She subsequently did well, sat up at tbe end of
the month, add left the hospital five weeks after the opera¬
tion. She menstruated six weeks after the operation and
monthly since, without discomfort. The tumour weighed
101 b.

Remarks .—It perplexed me very much at the time to
explain how that small rent took place in the left broad
ligament which caused all this haemorrhage; and I believe
when the solid weighty tumour was lifted out of its bed,
tbe pedicle being thin, short, brood, and ribbon-like in
structure, it'was pulled upon and split before the ligature
was applied. The clamp succeeded tbe ligature, it will
be remembered, as previous clamping might have caused
the rupture when the ligature knot was being tied.
The ligature stump when dropped down bled, and when
held up stopped, giving us the impression it was the cut
pedicle that bled; but it was not so. A vein of the
left ovarian or pampiniform plexus had been opened
obliquely, and Bivington in the Journal of Anatomy has
shown that these veins of the broad ligament communicate
freely with the uterine plexuses and sometimes have
imperfect valves; but on the left side it is commonly absent,
the valve being found in the left renal vein, about a quarter
of an inch from the entrance of the former vessel; and
further, Bland Sutton, in demonstrating the remains of the
meso-nephroe or Wolffian body, in his splendid work on
the Evolution of Pathology, points out, that this curious
plexus of veins called the pampiniform plexus, are, in
reality, the dilated tortuous venules, which originally
administered to that very curious structure the paroophoron.
The bleeding was entirely venous, but the coagula were
fragmentary, small, and thin, contrasting markedly with-
uterine clot in parturition. How far the interference with
perfect coagulation is due to a closed serous cavity or to the
lymph spaces of the peritoneum with their open stomata S
am not prepared to say. We closely examined the right
ovary that remained, and it was found shrivelled up, and
atrophied like a piece of old wash leather; yet the patient haa-
menstru&ted freely several times since the operation, which
leads one to consider how far the Fallopian tube plays an.
active part in this phenomena.

Now, as to the character of this semi-solid tumour. Bland
Sutton has so recently arranged his facts that it is difficult
to dispute the origin of parenchymatous ovarian cysts from
corpora lutea, ana he describes them as arising in this way
from infancy up to the end of sexual life, and ripe follicles
are frequently present in the ovary before birth. In
vol. xxxvi. of the Pathological Society’s Transactions lie
describes the transverse section of a mare’s ovary, showing
a corpus luteum, the interior having broken down into two-
small cysts, and this explains tbe origin of many of thoso
cysts so common in the ovaries of full-grown mares. It is *
curious fact, and I have seen it often during the past ten
years, that nearly all mares, after they attain the age of ten
or twelve years, have cysts present in their ovaries, which
probably arise from corpora lutea. You may demonstrate-
this statement more commonly even in cows than horses,
and the primitive condition in the former animals of the
ducts of Gaertner, tbe analogue of the vas deferens in the-
male, explains the frequent presence of cysts about the
upper portion of the vagina. I have a strong impression the
colloid tumour of this woman arose from a corpus luteum.
Again, what becomes of the ligatured pedicle after the
operation? It becomes encysted, we admit; lymph or clot
forms on its surface; but how is it nourished, or does it slough?
I shall risk the view that the everted peritoneum above the
ligature bends downward, and joins the nearest point belour
the ligature, and so maintains its vitality. In Sir Spencer
Wells’s statistics we find that in his first 500 operations there
were no deaths from haemorrhage, but twenty from ex¬
haustion, while in the second eeries of 105 there were only
eight from exhaustion and two from haemorrhage; but he
adds the probability that some of the first series of deaths
were also partly due to bleeding, but the fact was not
established by examination. Keith’s mortality from shock

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Tax Lancet,}

CLINICAL NOTES.

[June 4,1887. 1131

and hemorrhage was 3'6 per cent. Lawson Tait does not
mention any deaths from hemorrhage in his later statistics.

I wish to draw attention towards the use of the glass
drainage tube in all abdominal sections, and I am aware
that in the hands of Mr. Lawson Tait drainage is never
used if the abdomen can be properly cleansed and dried.
Keith still places great reliance on nis Koeberl<?s drainage
tubes. Spencer Wells doubts their success, although I am
under the impression he drained the peritoneal cavity in his
earlier operations. Mr. Knowsley Thornton considers them
only necessary in 2 per cent, of cases done antiseptically,
-and 10 to 16 per cent, of cases without antiseptics. Quite
recently, however, Mr. Lawson Tait has pointed out how
remarkable is the influence of the drainage tube in arresting
■hemorrhage into the peritoneal cavity: for if the cavity
is kept dry by frequent withdrawal of the blood, the
bleeding, as from tom pelvic adhesions, will stop; but
if drainage is not kept up the bleeding will probably
prove fatal. This is a strong point in favour of the tube,
fn my own cases of laparotomy I have been struck with the
little irritation produced by the glass tube in the abdomen.
It has been kept it in for eighteen days in an hysterectomy
end for a week in an ovariotomy; but care must be taken that
■the end drops easily into the bottom of Douglas’s poucb, and
is not displaced above the promontory of the sacrum. In
the case recorded the glass drainage tube saved the patient,
by immediately confirming the suspicion of secondary
haemorrhage, and minutes meant in her case her existence.
Sn complicated cases with purulent cysts the utility of the
thing is admitted; but for the beginner in abdominal sur¬
gery, we would venture to say, Use Keith's drainage tubes,
and always do so if in doubt. It will be a safeguard to
your patient and a comfort to you for the first hours after
the operation, as it brings the doings of the peritoneal cavity
within touch of your special senses.

Bath. 1

Clinical Units;

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

CASE OF CHRONIC INTERSTITIAL NEPHRITIS. 1
By C. H. Robinson, F.R.C.S.I.,

MEMBER OF THK COURT OF EXAMINERS OF THE ROYAL COLLEGE OF
SURGEONS IN IRELAND, LECTURER AT THK LKDWICH
SCHOOL OF MEDICINE, ETC.

The lady, aged fifty-five, whose case is described in the j
following brief notes, was under my observation for years, I
•the signs of the malady from which she suffered commencing j
with hypertrophy of the heart, followed by albuminuric
retinitis, epistaxis, and finally cerebral haemorrhage, which
terminated fatally last November. In the autumn of 1886
the sight of her eyes became considerably affected, and on
-examination by the ophthalmoscope haemorrhagic retinitis
of botn eyes was found to be present. At this time the
urine passed was copious in quantity, pale in colour, of
■specific gravity 1006, and on one occasion only was I able to
detect any albumen, and then only the merest trace. At
various intervals it was carefully examined, with a nega¬
tive result. Under appropriate treatment (which included
the administration of the perchloride of mercury in com¬
bination with the iodide of potassium, the bowels being
kept open by occasional doses of Friedrichshall water
and a spare dietary enforced), the sight after several
weeks was restored, and the specific gravity of the urine
gradually became normal. In January, 1886, I was sent
tor in consequence of a severe attack of epistaxis, which
was arrested by plugging the anterior nares and applying an
iee-bag over the cardiac region. In October of the same
year I attended her for uraemic vomiting, and in the follow¬
ing month she called at my house about three o’clock, and
when leaving complained of a numbness in the right leg.
She wished to proceed into town, where she had some
business to transact; but I persuaded her to go into the
waiting-room, and in a couple of minutes there was com¬
plete anaesthesia as high as the knee. She remarked that

1 Bead before the Medical Section of the Academy of Medicine in
Ireland.

she had dreaded this, and expected to be paralysed. I had
to leave her for a few minutes, atid then found the right arm
paralysed as well as the leg, also the face on the same side.
Her articulation now became impaired, but she could put out
her tongue, which was directed to the right side. I had
her removed to her own house, where, on arrival, although
unable to speak, she appeared to be in a semi-conscious
state. About seven o’clock the same evening she was
perfectly unconscious; the pupils contracted ; pulse 78 ;
temperature 95°; respiration fairly quiet, occasionally
stertorous. During the night she exhibited Cheyne-Stokes’
respiration; the pulse gradually got higher; the tem¬
perature went up to 100°, then to 102°; while the face
and neck were greatly congested. The eyes, which were
now dilated, had that peculiar fixed stare so characteristic
in serious attacks of cerebral htcmorrhage. The right arm
was very rigid, but gradually relaxed. Death took place
about thirteen hours after the first seizure, being preceded
by a violent trembling.

Some, perhaps, might regard the fatal result in this case
as due to uremia, in which occasionally hemiplegia has been
shown to occur; 3 but the absence of convulsions and the
rapid increase in the temperature would, I believe, show
such an opinion to be erroneous. Albuminuria may exist, it
is well known, without nephritis, but the converse of this is
comparatively rare. Where no trace of albumen can be de¬
tected in the urine, but the general symptoms point to
interstitial nephritis being present, the test recommended by
Feltz and Ritter, as modified by Prof. Bouchard, it is said
will decide the matter. 3 The urine of a healthy person when
introduced into the circulation of the rabbit by injection into
the veins of the ear kills the animal in the proportion of
50 grammes per kilogramme of weight. But that of albu¬
minuric subjects can be tolerated in much larger doses, and
in one case mentioned by M. Dieulafoy a rabbit of two
kilogrammes, for which a toxic dose of healthy urine
would be 100 grammes, exhibited no discomfort until 260
had been injected, and even then recovered.

Dublin. ___

NOTES ON A CASH OP

ILEMOPERICARDIUM FROM RUPTURED CORONARY
ARTERY.

By J. W. Battebham, M.B. Lond., F.R.C.S.

On March 9th, 1887,1 was called to a lady who had died
suddenly. The following was the only history obtainable
from the friends of the deceased. She was seventy-five
years old, and had suffered for “sometime” from “slight
fits,” in which she “ struggled” and lost consciousness for a
few minutes. These fits were usually preceded by Bickness.
About noon on the day of her death she complained of pain
in the left mammary region, and took a Gregory's powder.
She then had lunch, which consisted only of a little beef-tea.
Her servant coming into the room about an hour after lunch
found her Bitting in a chair dead. The deceased’s face
was pallid. She appeared to have vomited just before death,
as some brownish fluid containing gritty particles (ap¬
parently the beef-tea and Gregory’s powder) was seen stain¬
ing her chin and the front of her dress.

The necropsy, performed twenty-four hours after death,
showed the heart enveloped in about four or five ounces of
dark clot. There was no rupture of the heart or great
vessels. On the posterior surface of the heart was a slight
subpericardial ecchymosis, covering an area about the size
of half-a-crown, situated on the interventricular groove
about an inch from the apex of the heart. A fine aperture
with ragged edges was discovered in the pericardium
covering the centre of this eochymosis. On vertical section
through this aperture, a few small clots were seen in the
muscular substance of the hypertrophied left ventricle. The
largest was about the size of a small pea, and was situated
imm edia tely beneath the minute aperture in the pericardium
above described. The coronary arteries were tortuous and
thickened, their coats containing numerous calcareous plates.
On dissecting out these vessels, the left, after running
down the anterior interventricular groove and turning
round the apex to the back ef the heart, was found to
terminate in two main offsets, which surrounded the area of
hemorrhage. Two small twigs we re traced into the clots,

» Bevue de MAdtcine, Nov. 1885. The Lancxt, 1887, p. 703.

1132 Thb Lancet,]

but were of too small size for any rupture of their walls to
be detected. These, I imagine, were the chief source of the
haemorrhage. The heart weighed 12| oz. Its muscular
tissue was ftrm, and of good colour. The thickness of the
right ventricular wall was one-eighth of an inch, that of the
left (at its thickest part) half an inch. The valves were
normal in appearance; the aorta was healthy. The other
thoracic and the abdominal viscera were normal, with the
exception of the kidneys, which were small, red, and
granular, and showed a marked diminution in the cortical
substance. The head was not opened.

From the post-mortem appearances, it may, I think, be
concluded that the “fits” from which the deceased had
suffered were probably of urremic origin. The pain in the
chest felt for a few hours before death may have been due
to the rupture of fine branches of the left coronary artery
into the myocardium, while the perforation of the peri¬
cardium and subsequent haemorrhage into the pericardial
sac, resulting in fatal syncope, may have been induced by an
act of retching.

Hmmopericardium is not a very uncommon condition.
References to between eighty and ninety cases may be found
in the first thirty-five volumes of the Pathological Society’s
Transactions. The most frequent causes are rupture of the
heart or aorta, occasionally from violence, but more commonly
the result of disease. Seven cases due to rupture of an
aneurysm of a coronary artery are referred to in vol. xxii. of
the Transactions. Scurvy has also given rise to hromorrhage
into the pericardial cavity. On reference to Neale’s Digest, I
find that a case of haamopericardium arising from a ruptured
coronary artery is narrated in the Medical Times and Gazette
for 1862 (vol. i., p. 317). In this instance the patient, a
woman aged sixty, lived six days after the appearance of the
symptoms, of which praecordial pain, dyspnoea, a email, fre¬
quent, but regular pulse, and coldness of the extremities
appear to have been the chief. A case of purulent pericar¬
ditis in which a rupture of a coronary artery was found is
quoted in Banking’s Abstract for 1861 (vol. ii., p. 85).

St. Leonard!.

OTITIS MEDIA HEMORRHAGICA.

By K. B. Bullbl, M.D.

Casks of pure and simple otitis media haemorrhagica I
think, are rare. Dr. Roosa mentions two cases, and Burnett
only makes a passing allusion to the disease in his work on
Diseases of the Ear. This is in itself a sufficient inducement
to me to place the followihg case before the profession.

Mrs. C-, aged forty-two, mother of nine children, and

in a fair state of health, was placed under my treatment for
an acute attack of pain in the left ear. Previous history:
She had been Buffering from the pain in the ear for the past
ten days. The pain at first was of an intermittent nature
and confined to the ear only. For the last two days it had
been very severe, constant, and radiating all over the left
side of the head and face. She complained of a feeling of
fulness and acuteness of hearing on the affected side. The
act of mastication and deglutition aggravated the suffering.
The parts were very sensitive to touch. There was occasional
paroxysmal aggravation of the severity of the pain. Along
with these symptoms there were pyrexia, restlessness, and
insomnia. On examination I found the left tympanic
membrane uniformly congested and slightly bulged at the
anterior and inferior quadrant. The right membrane was
slightly in-drawn, and the naso-pharynx congested. The
severity of the pain and a bulged appearance of the mem¬
brane induced me to suggest the operation of paracen¬
tesis, with a hope that that would relieve the suffering of
the patient. The operation was performed at once. To my
surprise, there was a gush of blood through the puncture in
the membrane and the side of the nose, and nearly two
drachms flowed freely. The intensity of the pain and sense
of fulness were immediately relieved. From this time until
complete recovery of the patient, which took nearly a week,
not a drop of blood or muco-purulent matter escaped
through the puncture in the membrane; the latter healed up
in five days. Subsequent examination of the urine showed
no trace of albumen in it. It is nearly four weeks now, and
on examination of the ears I find no trace left as to where
the membrane was punctured. In my opinion this case can
be called a pure and genuine “otitis media hiemorrhagi ca.”

BombSy.

[June 4,1887.

CASE OF PLACENTA PREVIA.

By B. Walker, L.R.C.P.Ed.

Elizabeth B——, aged thirty-three, has had seven
children, of whom two only survive, the rest having died
in infancy, at ages varying from two weeks to three years
and a half. Two of these were born at the eighth month.
There was no history of syphilis, and no haemorrhage hid
occurred at previous labours. She had reached the seventh
month of pregnancy, which had advanced normally. She
went to bed as usual, and on awaking at 1 a.m on April loth
found the bed very wet. A neighbour was called m, and l
was with her in half an hour after her awaking. I found
her in a pool of blood on the bed; she must have lost about
a gallon, for it had sunk through the mattress and deluged
the floor, and her nightdress was saturated up to the armpits.
On examination, the vagina was found to be filled with
clots, and blood was flowing freely. The os was about the
size of half a crown, and complete placenta previa wu
present. Introducing the hand into the vagina and detach¬
ing the placenta, a vertical presentation was found, and with
two Angers in the uterus ana the right hand on the abdomen,
combined version after Braxton Hicks’s method was quickly
and easily performed, and a foot brought down, thus plugging
the cervix and causing the hemorrhage to cease, the whole
being done in five minutes. The woman was left comfortable
on the bed, a dose of ergot and strychnine having bees
given, for there had been no expulsive pains hitherto. At
9 a.m., as far as labour was concerned, things were in dot *
quo. On calling at 1 pal I found the woman delivered
(child stillborn) and the placenta expelled without any
haemorrhage. The woman made an uninterrupted reeoverj.

This case is very like the one recorded by Mr. Taylor in
The Lancet of April 30th (p. 875). The only object in
adding this is to call attention to the long time (nearly
twelve hours) before delivery was effected after version.
After bringing down a foot, and the haemorrhage having
ceased, it seemed much safer to leave nature to finish the
delivery than by traction on the child to empty a uterus
which had shown no signs of physiological action—to empty
it, and possibly to reawaken the haemorrhage. In some
cases the life of the child, though only at the seventh month,
may be a consideration, but in this instance the mother s
safety was of paramount importance, and would be in most
cases, and entitled to the first place. The patient bed.
besides, an interesting history. In October, 1882, she had
the lower half of the left scapula removed for a sarcomatous
growth (her mother died at the age of thirty-seven from
“internal tumours”), leaving her an arm little impaired for
use. (See Thb Lancet, vol. L, 1886, p. 203.) About three
years ago, on becoming pregnant, a large ulcer—or rather
two—and fungating growths, larger than an orange,
attacked the outer side of the right call They healed
quickly when she was put to bed. When pregnant again,
seven months ago, another deep ulcer formed outside and
behind the external malleolus. This lasted through the preg¬
nancy, but is now reduced to one-half its size, and healing
rapidly; besides this, an ugly sore formed over the sternal end
of the right clavicle, which healed after a time. On each occa¬
sion it was feared the sarcomatous growth was reappearing,
but the termination of pregnancy has hitherto been followed
by the quick disappearance of the sores. The growth
removed oonsisted of round cells with one large or two
smaller nuclei, and of unipolar nucleated cells.

Spondon. ______

NOTE OF A CASE OF SUDDEN DEATH FROM PUL¬
MONARY APOPLEXY.

By W. Henry Kestevbn, M.R.C.S., L.SA.

R. F-, aged sixty-five, was found lying on his left ride

on a staircase, with his head crashed against the wall and
bent upon his right shonlder. . At an examination of the
body, made seventy-five hours after death, the brain was
found to be healthy, though somewhat congested. The
heart was healthy, and contained a small quantity of fluid
blood in the left ventricle; none in the right. The lungs
were adherent to the walls of the chest, and extensively
infiltrated with tubercular deposits. The trachea aid both
bronchi contained blood. The source of this blood ww

CLINICAL NOTES.’

by Google

The Lancet,]

HOSPITAL MEDICINE AND SUEGEBY.J

r [J unb 4,1887. ,1133

found to be in the left lung, the whole of the interstitial
tissue of which was charged with extravasated blood. No
distinct cavity or large clot was found in the lung, nor was
it possible to find the vessel which had given way, though
several branches of the pulmonary artery were traced. Tne
bronchial tubes and tubules were full of blood. No blood
had escaped from the trachea into the month or into the
pharynx.

The case seems to be one of those described by Niemeyer
as causing death suddenly, before haemoptysis can occur,,
by blocking up the bronchi with blood and so suffocating
the patient. It is recognised by the author just named
as a very rare form of disease.

Holloway-road.

% llfcrar

or

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nulla autem eat alia pro certo noaceudl via, nUl quamplurlmas et mor-
iorura et dlaaectlonam hlatorlat, turn allorom tarn propria* oollectaa
habere, et inter ae oomparare.—MoRoaon D* SttL ft Qua. Mori.,
lib. lv. Procemlum. -

VICTORIA HOSPITAL FOR CHILDREN.

TWO SUCCESSFUL CASKS OF OPKEATION FOB CLEFT PALATE
IN CHILDREN QF TWELVE MONTHS OF AGE ; HE MARKS.

(Under the care of Mr. H. H. Clutton.)

The age at which operations for the cure of cleft palate
should be undertaken has caused considerable discussion in
the past, and there is still much diversity of opinion about
it. The operation has been performed on a child of only
four, days old, bat unsuccessfully, and it is not often j
ittempted osi children of twelve months old, and could only |
se successful in such cases as are here recorded. We agree
with Mr. T. Smith’s remarks: 1 “None but very general
rules can be laid down as to the best time for operating,
since each case most be judged on its own merits, and every'
surgeon will be guided by the results Of his own experience.”,
We would refer our readers to Mr. Clutton’s remarks-on the
:ases.

The first case (for the notes of which we are Indebted to
Dr. Moline, the medical registrar) wks a girl of twelve
nonths old. Who was admitted in August, 188G. She was a
lealthy-looking, well-nourished baby, brought up by hand,
is she could not take the breast. The cleft involved only'
he soft palate, and there was no other abnormality. On
5ept. 2nd, the infant being under chloroform, the edges
vere pared and brought together with fine silk sutures. A
ateral incision, chiefly through the pillars of the fauces, was
aade on each side to relieve tension. On Sept. 8th a few of
he sutures were removed under chloroform. On the 15th
he remaining sutures were removed in a Similar maimer,
lie palate was entirely healed ahd closed, with the exception
f a small aperture near the hard palate. She left the
ospital a few days afterwards. When seen again a few
Wnths later this opening had closed, and the line of
nion was scarcely perceptible, the nvula even having
a natural form. The mother also said that the babyK
ry had a much more natural sound than it had before the
peration.

The second case, for the notes of which we are indebted to
t. Wills, the house-surgeon, was a boy of eleven months of
je, who was admitted on Jan. I7tb, 1887. This was not
ich a healthy-looking child as the last, and was therefore
Jpt in hospital on careful diet for a month before attempting
*y operation. With care the inf wit could take the bottle,
6 the food easily returned through the nose. The Child
jd no other deformity, nor was there any history of this or
y other abnormality in the family. The cleft involved the
p palate and a very small portion of the hard. The two
Bves seemed fairly thick, and not too far apart. On
B>. 10th, the.child being under the influence of chloroform,
I. Clutton pared the edges, and, finding that part of the
Jpt which involved the posterior edge of the hard palate

p 1 Heath’* Dictionary of Surgery: art- (Heft Palate.

too fixed to be successfully brought together by the simple
operation, made a lateral incision on each side close to tne
gum, and raised a muco-periosteal flap from the bone, by the
method generally known as L&ngenbeck’s. The whole cleft
was then very easily united by fine silk sutures. The pillars
of the fauces were partially divided with a pair of curved
scissors, as in the previous case, to relieve tension, and the
operation was concluded on Feb. 20th. The sutures were all
removed under chloroform, when the palate was found per¬
fectly united from one end to the other.

Remarks .—It is obviously a great advantage, if the voice
is to obtain its natural sound, that the operation should be
done at as early an age as possible. If, however, it fails, any
subsequent operation is made more difficult. It is, therefore,
of great importance that only the simplest cases should be
undertaken at this early age; and even amongst these
success will greatly depend upon the thickness of the
divided' palate which iB to be united. A healthy child at
twelve months of age may have the simplest cleft in its
palate, involving only the velum, and yet the tissue* on
each side may be so thin as to give a very poor prospect of
success after operation. The circumstances which induced
Mr. Clutton to operate at so young an age in these two cases
were—the simple character of the cleft, the abundance of
the tissue on each side, which would afford a thick bond of
union, and the healthy condition of the children. The
nursing after the operation which the child is likely to
obtain has also to be considered, for with constant crying
success Is impossible. These two children were scarcely
out of arias during the ten days succeeding the operation,
and the success that was thus obtained speaks volumes for
the care and trouble which was devoted to them by the
nurses at the Victoria Hospital.

. LEEDS INFIRMARY. .

RUPTURE OF BLADDER; OPERATION; DEATH FROM
PERINEAL HAEMORRHAGE;

(Under the care of Mr. T. PridgIn Ybalh.)

Frederick S-, aged twenty-five, was admitted on

Dec. 6th, 1883, having been violently assaulted two hours
previously. He had been kicked in the abdomen and peri¬
neum during aquarrol, and when admitted complained of
.pain in the lower part of the abdomen and of inability to
pass urine. There was tenderness of the abdominal wall,
with tension of muscles, bat no visible braising at other
seat of injury, and the -patient was under the influence of
alcohol. The retention was relieved by a No. 10 catheter,
a few drops of blood preceding the flow of urine. The
oatheterismwas repeated twice at intervals of sis hours.
There was, moreover, such an absence of collapse ok altera¬
tion of look, pulse, or temperature, that the nature of the
case was not suspected by the resident staff. On the fol¬
lowing morning he was seen by Mr. Teale, who, observing a
tympanitic hbdomen, with dillness of the flanks, and being
told that the more recent catheter-ism had only drawn
off an ounce or so of uriha, suspected rupture of the
bladder.

At midday, after consultation with his colleagues, who
agreed in the diagnosis' of ruptured bladder, Mr. Teale
operated. Having first opened the perineum in the median
line and introduced into the bladder an indiarnbber drainage
tube, out short at the wound, and stitched to its edges, Mr.
Teale opened the abdomen between the umbilicus and pubes.
A large quantity of pale straw-coloured fluid was found, in
which the intestines floated freely, and without any trace of
inflammation or congestion. At first the rent could not be
seen or felt, owing to the collapsed state of the bladder, but
on injecting through tfie penneal drainage tube a weak
solution of carbolic acid a vertical rent was detected in the
posterior surface of the bladder, not far from the apex, and
folly an inch in length. The rent was dosed by six fine
catgut sutures, so inserted as to bring the peritoneal surfaces
into contact without perforating the mucous surface, and
the abdominal wound was dosed without the insertion of
any drainage tube. Thera was more oozing of blood from
the peritoneal wound than usual, and shortly after Mr. Teale
left the hospital Mr. Robson was called to the patient, who
expiated and then plugged the perineal wound. Some hours
after there appeared to be some fresh oozing of blood, and
the man became alarmingly antemic from loss of blood, and
died the next morning at seven o’olock. '

At the post-mortem examination, the rent in the bladder
igi ize y c > 1

1134 The Lancet,]

HOSPITAL MEDICINE AND SHEGEET.

[June 4,1887.

was found to be perfectly water-tight, and there was no
peritonitis.

Remarks by Mr. Tkalb.—T he haemorrhage from a simple
median perineal wound was so unusual that one can only
look upon it as an unfortunate coincidence, possibly the
result of the kick in the perineum, of which no visible
bruising gave warning. In another case of ruptured
bladder, I should not think it necessary to insert the perineal
tube, partly because the recent experience of others shows
that such a course is not needed, and partly because it is
a question whether on the whole suprapubic drainage
would not be more satisfactory.

SAMARITAN HOSPITAL FOR WOMEN,
NOTTINGHAM.

OASES OF ABDOMINAL 8BCTION; REMARKS.

(Under the care of Dr. Truman.)

Case 1. Parovarian cyst. —Jane S-, aged twenty-four,

was admitted on May 19th, 1886. The menstrual periods
commenced at the age of fifteen, and were painless until
the last four or five years. The nature of her work requires
frequent exercise of her strength in lifting heavy weights.
Owing to pain in the lower part of her body she has been
unable to go to work for the last six weeks.

On examination per vaginam, there was found a rounded
swelling in the right lateral fornix, the size of a cocoanut,
perfectly resistant and unyielding to pressure. Uterus
pressed against the os pubis; its cavity not lengthened. The
swelling felt solid, ana it was suggested that it was due to
a pedunculated myoma. In reference to this, Dr. Walter
mentions the close resemblance of the physical signs, in a
case of parovarian cyst, to those caused by a myoma
attached to the posterior wall of the uterus. In the present
case, however, the normal length of the uterine cavity, the
absence of metrorrhagia, &c., pointed rather to the existence
of a small ovarian cystoma.

An operation was performed on June 15th. In the right
half of the pelvic cavity, and not at all rising above the
brim of the pelvis, was a unilocular cyst, perfectly un¬
adherent, and with a long narrow pedicle crossing over to
the left side of the uterus. By aspiration were removed
twenty fluid ounces of a perfectly dear and white liquid,
of specific gravity 1006, containing neither fibrin nor albu¬
men, but abounding in chlorides. The cyst was then drawn
out, and the pedicle, three-quarters of an inch in diameter,
secured by the Staffordshire knot and divided, when it was
seen to spring from the left broad ligament, the cyst having
fallen over into the right half of tne pelvic cavity. The
ovaries were healthy, and were not removed.

The patient made a good recovery, and was discharged
on July 10th. She is in full work, and menstruation has
been painless since.

Case 2. Dysmenorrhea. —Mary H-, aged thirty-two,

was admitted on July 21st, 1886. The menstrual period
began at fourteen. She has had severe dysmenorrhoea for
eight or nine years, and was latterly dismissed from one of
the metropolitan hospitals as incurable. The periods are
regular, lasting seven days, with great loss, small clots being
frequently observed. The pain never ceases in the intervals,
but is intensified at the periods. The patient has great
difficulty in walking a hundred yards, and this always in¬
creases the pain. She has been unable to work at all for the
past two years, and is thus, much against her will, depen¬
dent on her friends for support. The situation of the pain
is the left ovarian region, and this pain is increased it she
lies on the left side.

On examination, the uterus was found slightly retrofiexed.
In the situation of the left broad ligament was a swelling
the size of a walnut, freely movable, and exquisitely tender,
nausea being caused when it was pressed between the two
index fingers, one internal and one external.. There was no
tenderness. In the right ovarian region there was no pain
except in the above-named spot.

On July 24th an operation was performed. The appen¬
dages were removed on both sides; the left ovary was
enlarged and becoming cystic.

The patient was discharged cured on Aug. 24th. After a
time spent in recovering her streogtb, she returned to work.
She can now walk a couple of miles, and can work, if
necessary, for fourteen hours a day. Although both ovaries
were completely removed, there is a discharge of blood every
month unaccompanied by pain.

Case 3. Bcematosalpinx (?).—Mrs. H-, aged thirty-two,

was admitted on Dec. 7th, 1886. Has had four children; no
miscarriages. First labour ten years ago; forceps were
applied for five hours and a half. She was in bed for two
months afterwards. Ever since has bad more or less pain
in the right iliac region. Has also had four attacks pre¬
viously to the present one; these attacks came on suddenly
and kept her in bed for three or four months. Her Iasi
child, fourteen months old, is at the breast. For the last

eight months Mrs. H-has menstruated regularly, and the

periods have been longer than usual. A month ago she had
sudden pain in right nip and pubic region, with vomiting
and faintness; has been in bed since. Has had great difficulty
in emptying the bladder.

On examination, the cervix was found jammed close to
the pubic bone; the cervix was that of an unimpreg¬
nated uterus, but with a deep laceration. The right
half of the pelvis was occupied by a tense, fluctuating
tumour, continuous with a swelling above the pubes.
This tumour stretched over to the left side, but the
left half of the pelvis was not so closely filled up as the
right. There was great tenderness to touch externally and
internally. Temperature 100-2°. An operation was urgently
needed on account of the partial blocking up of the urethra.
This, howeVer, had to be deferred; the woman was suckling,
and the sudden weaning of the child made her very feverish.
Pain was considerable, and had to be combated by opium.
On re-examination on Dec. 29th, it was seen that the abdo¬
minal swelling was larger, and that, in addition to steady
increase since the 7tb, it had rapidly increased during the
past forty-eight hours, and the woman was losing colour.
There was marked dulneea in the hypogastric region, and
that mostly on the left side. The swelling feit per vagiaam
when first seen was principally on the right side; it was now
on the left; and to the extreme left of this elastic swelling
was felt a more resistant body.

The diagnosis was not very dear, but seemed to be one of
three things: an ovarian cyst, with twist'd pedicle, and
consequent haemorrhage into its cavity; an extra-uterine
fcetation; or a hcematosalpinx, the latter accounting the
more readily for the history of four preceding attacks, if
small haemorrhages be supposed to have taken place. It was
evident that haemorrhage was actively going on at tht
present time, and the operation was performed on Dec. 30th,
The pelvic cavity exhibited the following condition of
things. The left naif was occupied by a large swelling, con¬
sisting mainly of blood clot. The uterus was enlarged
about three-quarters of an inch in all three dimensions.
Between it and the rectum was the tumour, semi-fluctuant,
and from three to four inches in diameter; by its upper
surface it was free, but by the other surfaces it was adherent.
The wall of the tumour was formed of (1) a strong, thick,
fibrous investment, so firmly adherent to the bowel that it
had ultimately to be separated by the knife, and passing
upwards to the left cornu of the uterus, where it showed a
large, ragged rent, and (2) of a layer of plastic lymph, which
limited the contents of the tumour. This layer broke
down with a touch and blood clot escaped. The finger
was passed round the tumour and adhesions were
pretty easily broken down. The solid part of the tumour
sprang from the left cornu, and apparently was the left
ovary; it was ragged and torn, and contained a cavity two
inches across. The rest of the tumour consisted of blood
clots and dark fluid blood. The blood clots were of two
kinds, fresh and red, and old and decolourised (fresh blood
coinciding with fresh pain and swelling on the 28th and
29th). In these clots were found a membranous cyst, very
thin, and about three-quarters of an inch in diameter, ana
two small bean-shapea bodies half an inch to three-eighths
of an inch long. The clots were cleared away, and the part of
the growth springing from the uterus tied and removed.
That part of the fibrous investment that was adherent to
the bowel was tied and divided, leaving a margin half an
inch deep attached. The posterior surface of the uterus
was left freed, but covered with a rough layer of lymph.
A glass drainage tube was inserted to the bottom of the
posterior cul-de-sac.

The case went on well. The drainage tube was removed
on Jan. 3rd, and the patient discharged on Feb. 1st.

Remarks by Dr. Truman.— A question arose whether
this might not have been a case of early tubal Dregnancy. Dr.
Handford, physician to the Nottingham General Hospital, most
kindly examined the relics for me. He says: “All the tissues,
besides the dot, are so infiltrated and sodden with bleed

Digitized by GoOQle

Tub Lancet,]

CLINICAL SOCIETY OF LONDON.

[June 4,1887. 1135

that it is unusually difficult to recognise the parts. I have
made some sections, but the nature of the material is very
unfavourable for making good sections. In the first place,
1 have failed to find anything fcetal, unless the small sac,
■which you suggest formed the envelope of the embryo, is of
that nature. 1 would suggest that a sac that size could not
be part of an ovum more than from four to six weeks old, and
that the outer surface should be most distinctly shaggy and
■villous from the villi of the chorion. I do not think that at
that early period the amnion would separate from the chorion
so as to form a smooth surface. But if it is not a foetal
■envelope, I cannot say at all what it is. The two bean¬
shaped bodies are undoubtedly not fcetal. They con¬
sist, in greater part, of blood clot; there is no
trace of the cellular structure which makes up the
whole of the early embryo, and there is a small quantity
■of adult adipose tissue which finds no place in the embryo
till much later. The large mass with the peritoneal cover¬
ing, and large cyst with an irregular mass projecting into
it, 1 take to be explicable as follows :---The irregular mass
projecting into the cyst seems to be an ovary much torn up
and damaged by interstitial hemorrhage. I cannot find
any Graafian follicles, so that I cannot t>e sure; but at any
irate, 1 can say that the tissue is adult, and not fcetal. There
is much fibrous tissue, both white and elastic, and a con¬
siderable number of non-strip9d muscular fibres, with many
large bloodvessels. 1 think I can trace going to it the round
ligament, and the Fallopian tube, the extremity of which
has, I conclude, taken part in forming the cyts into which
the ovary projects. 1 would suggest as not unlikely a
tubo-ovarian pregnancy, rupturing at about four to six
weeks. At this time the ovum would be very small, and
the embryo, being entirely oellular, would easily become
disintegrated.'’

Case 4. Ovaritis.— Mrs. T - , aged thirty-one, was ad¬

mitted on Jan. 7th, 1387. Has always been regular, and the
periods were painless up to her marriage,three years previously.
Has never been pregnant. Three weeks after marriage had
severe dysuria and white discharge; this lasted three weeks,
fiver since then has had, a week before the period, swelling of
the breasts, with secretion of clear liquid. This goes off
when the menses appear. Periods since marriage have
■come on every three instead of four weeks, but the duration
has gradually decreased. Has had ovarian pain also, and
this dm much increased in the last twelve months. Has
never done a day’s work without pain since three weeks
after marriage. Pain in lower part of the abdomen was at
■first relieved by lying on the abdomen, or by elevating the
knees; but this is not the case now. For the last twelve
months she has been unable to do her household work; any
slight jar, such as walking, brings on the pain. Sexual
intercourse is most painful, and she is unfitted for all her
■duties. There is an adenoma of the left breast, and in both
breasts there is an abundance of clear serous fluid, in which
colostrum corpuscles may be seen under the microscope.

On examination, in the left lateral fornix was a solid,
movable tumour, the size of a chestnut, very sensitive; in
the right half was a thickened and sensitive spot, but no
movable tumour. In Douglas’s pouch was an enlarged
fiallopian tube.

An operation was performed on Jan. 20th—ovaries and
tubes removed on both sides. On left side, the ovary was
loosely adherent to the part surrounding it; on right side,
the ovary was much freer. The left ovary contained a false
corpus luteum. The right ovary was healthy, but the
Fallopian tube was blocked up and distended. The free
surface of the appendages was everywhere covered by flakes
of organised lymph. There was a good deal of bleeding, and
a drainage tube was used, which was removed on the 25th.
The case was discharged cured on Feb. 12th. This was
evidently a case of chronic ovaritis following gonorrhcea.

Remarks.— The operations were done with strict antiseptic
precautions, but without the spray. In the second case the
temperature roae on the first and second days to 100-6°, and
«u the ninth to 102°. With these exceptions, the tempera¬
ture never rose above 100° in any of the four cases.

On the 31st ult. a Local Government Board inquiry
was held at Higbgate respecting an application by the
Hornsey Local Board to borrow £76fl3 for works of sewerage
and public improvement. There was some opposition to the
scheme, bnt ultimately the inspector intimated that he
ahoold report favourably upon the application.

Ute birai ikri etks,

CLINICAL SOCIETY OF LONDON.

Acute Cardiac Dilatation from Alcoholism. — Endemic

JIamaturia.—Lupus treated partly by Scraping and

partly by Salicylic Paste.—Hammer Toe.

Tub last meeting of the session was held on the 27th ult.,
Dr. W. H. Broadbent, President, in the chair. Tho report of
the committee on Charcot’s Joint Disease and of that on
Myxoedema have been completed, and will be published in
the ensuing session.

Dr. Robert Maguire read a paper on Acute Dilatation
of the Heart produced by Alcoholism. Alcoholism produces
acute changes in the nervous and circulatory systems. The
latter are not usually of serious moment, but may occasionally
be important, as shown by the two cases here given. The
first patient (aged twenty-three), when applying for treat¬
ment, showed oedema of the legs and some ascites. The
pulse was small, weak, and of low tension, beating at the
rate of 140 per minute. The heart beat was diffused, apex
outside nipple not lowered, and epigastric pulsation exces¬
sive. Cardiac dulness was extended vertically and laterally.
The cardiac sounds were short, weak, and spaced, and a slight
systolic murmur was heard. There was dyspnoea, but no
abnormal pulmonary sounds. The urine was excessive in
quantity, and of low specific gravity. There was no history
of rheumatism or of previous cardiac symptoms, and, after
excluding all other causes, it seemed clear that the dilata¬
tion of the heart was produced by alcoholism, of which
the patient gave a pronounced history. Under treat¬
ment by cardiac tonics the symptoms and the enlarge¬
ment of the heart entirely disappeared. The second
patient, aged forty-three, when first seen, had oedema of the
legs, tremor of tne tongue and hands, and complained of
nervousness and want of sleep. The pulse was small, feeble,
and easily compressible. The after-beat of the heart was
outside the nipple line, and was somewhat diffused. The
transverse dulness of the heart was increased in extent.
The cardiac sounds were short and sharp, but no murmurs
were to be heard. As in the previous case, no cause could
be found for the dilatation ot the heart, other than acute
alcoholism, of which the history was clear. Under treat¬
ment the symptoms entirely disappeared. The mechanism
by which alcoholism produces the dilatation is probably
not by increasing the peripheric resistance, bnt by poison¬
ing the heart muscle itself, so causing it to give way
before a normal, or even & reduced, arterial tension. - -
Dr. Broadbent said the subject of the paper was novel to
him, but it was not easy to understand how the dilatation
was produced, unless it were aided by the imbibition of
large quantities of alcohol without food, thus increasing
peripheral resistance.—Dr. Ohmbrod asked what form of
alcohol had been taken, for Leyden had noted similar
conditions to follow beer-drinking.—Dr. Stephen Mac¬
kenzie said that he agreed with the view taken by
Dr. Maguire, though pyrexia should be borne in mind as a
cause of myocardial dilatation; also actual myocarditis may
occur under various circumstances.—Dr. Ewart said that
beer-drinking, though very common, could hardly be the
explanation, unless combined with other causes. He had
not observed dilatation to commence in the left ventricle,
nor considered that it was due to toxic effects. With dila¬
tation of the heart or of any of the cavities he would expect
to find an increased (and enfeebled) rate of the heart’s
setion, and this might not correspond to the pulse rate.—
Dr. Hingston Fox remarked that a single testing for albu¬
minuria would be Insufficient to exclude it.—Dr. Maguire,
in reply, said gin was the alcohol consumed. The urine had
been carefully examined. Also, be had been careful to
eliminate any possibility of peripheric resistance being
operative in tne causation of tbe dilatation, and even after
recovery arterial tension was not in excess.

Dr. Handford communicated a case of Endemic Hema¬
turia that he had had under observation for a year and
three-quarters. The patient was a fresh-complexioned,
healthy-looklng man, aged twenty-four. He had gone to
Natal at the age of twenty-one, and had remained there for
three years ana a half. He first passed blood in the urine on
the voyage home. While in Natal he enjoyed good health,
except for two attacks of dengne. When first seen in

Di.

d

[June 4,1887.

1136 The Lancet,] ACADEMY OF MEDICINE IN IRELAND.

November, 1885, he complained of pains in the loins,
occasional discomfort in micturition, and the passage of
blood in the urine. Numerous ova and embryos of the dis-
tomum (bilharzia) haematobium were discovered in the
urine, and are still to be found, though in much smaller
numbers, at the present time (March, 1887). The following
were the points of chief clinical interest raised:—1st. Can
the parasite multipy within the human body, or is an “ inter¬
mediate host” necessary? 2nd. In the latter case, and in
the absence of reinfection (and the conditions for reinfec¬
tion are not known to exist in this country), what is the
“ expedition of life ” of the parasites, and may the host
reasonably expect to outlive his guests? 3rd. Is any para¬
siticide treatment useful? 4th. What is the method of
infection ? What precautions should be recommended with a
view to prophylaxis?—Dr. Sharkey had examined speci¬
mens from Cairo, showing ova in the kidneys, lymphatic
glands, and even in the skin.—Dr. Coupland had observed
them in specimens, sent by Dr. Kartuliz, in the lungs.—Dr.
IIandford said in this country it would be a waste of time
to try to discover the (probable) intermediate host.

Dr. Drewitt read a paper on the case of a child in
whom a patch of Lupus had been divided for treatment
into two parts, of which one part had been treated with
salicycle acid and creasote, and the other by scraping. An
unusual opportunity was thus offered of comparing the two
methods. There had been altogether eight applications of
Unna’s plaster of salicylic acid and creasote during one
month, each application having been preceded by washing
the patch with a solution of cocaine. At the end of that
time the granulation nodulgs had all suppurated out, leaving
little pits surrounded by unhurt, healthy skin. There had
been no return of the disease in either part. Unna claimed
for the salicylic acid treatment that it removed old bands.
This it had failed to do in this case—in fact, some new, thin
bands had been formed; but still the scars left by the sali¬
cylic acid were smaller and less hard, and had less tendency
to contract, than those left by scraping, and, judging from
this case alone, there is distinct evidence in favour of the
salicylic acid treatment of lupus. The case was shown with
a drawing.

Mr. W. Anderson read a paper on a case of Ilammer
Toe, with-some remarks upon the deformity. The patient,
a youth aged nineteen, had been suffering from hammer
toe, presenting the usual characters, and affecting the
second digit of the right foot. The history showed that
the condition hod been noticed from early infancy, and that
an aunt and two cousins on the parental 6ide had been
similarly affected. The deformity was treated by removal
of the head of the first phalanx, which was exposed by a
longitudinal incision through the integuments and extensor
tendon. The toe was straightened, and healing took place
by first intention. The following points with reference to
the disease, as illustrated by an analysis of twenty cases,
were then brought forward: 1. The complaint is peculiarly
one of early life, the period of commencement, in genuine
examples, appearing to range between infancy and the
age of twenty-one. 2. The lesion is almost always limited
to the first phalangeal joint of the second toe, but occa¬
sionally appears on the metatarso-phalangeal joint of the
great toe (which developmentally must be regarded as
belonging to the interphalangeal series). The cases described
as “hallux flexus” by Mr. Davies-Colley a few weeks since
are of this nature. 3. True hammer toe is often bilateral,
but when this is the case one foot is commonly attacked
several years before the other. 4. A history of an inherited
tendency to the disease may often be obtained. 5. The
development of the complaint does not appear to be affected
by either sex or class, or to be connected with any special
constitutional diathesis. 6. There is no good reason to
believe that it is caused by ill-made boots. There is, of
course, no doubt that the distortion is sometimes associated,
probably os a mere coincidence, with evidences of the
habitual use of misshapen foot covering, but in many cases
the normal form of the foot is preserved, and there is no
reason to believe that the shoemaker has ever been at fault.
7. The essential pathological lesion is a contraction of the
plantar fibres of the lateral ligaments and of the glenoid
plate, probably the result of a peculiar form of chronic
inflammation. Secondary Changes of form occur in the
articular surfaces, particularly in the cartilage, and may
lead to a trigger-like action of the affected joint during,
forcible flexion and extension. The muscles, tendons, and
fascia: take no part in the etiology, but may be secondarily

affected. 8. The treatment recommended is removal oi tin
head of the first phalanx in the manner described. Twc
specimens, one lent by Mr. Shattock, and some drawing
were shown to illustrate the pathology of the affection.
Mr. W. Adams said that a study of the dissections wou! -
show that it was the fault of the lateral ligaments. Divisioc
of these ligaments should be practised, not amputation,
between the ages of twelve and eighteen. Mr. Anderson
suggestion was a very valuable one. The pathology stL
remained obscure.—Mr. Nunn considered that a defectiv
development of the spinal cord was the cause of th-
deformity. A case of a lady with a hammer toe had a -
who did not develop the condition till thirteen years of ag-
—Mr. R. W. Parker had 6een many cases in young childre
even infants, so that the foot covering was not a cause, i:
was difficult to see why accidental causes should affect
second toe so frequently. Removal of the toe was hi
practice.—In reply to Mr. Broadbent, Mr. Andbrson sa;
that he did not know whether the condition was mor-
common in town or country children.

The following living specimens were shown:—Dr. Arthu
Davies: A case of Rhythmical Tremors affecting only tl
Right Arm. Mr. George Eastes: Chronic Spasmodic Affec¬
tion of Inspiratory Muscles with Loud Crowing Inspiratio:
Mr. Bernard Pitts: Congenital Scoliosis with other Malfor
mations. Mr. Battle: Osteotomy for Congenital Talipes
Mr. Black: Double Congenital Dislocation of Hip.

ACADEMY OF MEDICINE IN IRELAND.

Exhibition of Specimens.—Treatment of Vtsieu-oiufuiai an.

Vesico-uterine Fistula.

At a meeting of the Obstetrical Section, held on April lo

Dr. Alfred Smith exhibited an Encephalocele. Ti
interesting point was the enormous size of the child, which
was 21 in. long and 11 lb. in weight. This was perhaj
because the brain had ceased to require food, and th-
additional supply went to the other parts of the body. T-
child had come to its full term.

The Prf.sident exhibited a Multicular Ovarian Cj.
which was peculiar in consisting of two very large cy
and one smaller one, which were all connected by a commuu
isthmus, so that at the operation he first thought it was a
case of double ovarian tumour. A large quantity of the
cyst fluid escaped into the abdominal cavity, which was
therefore washed out with very weak carbolic acid solution.
The woman’s urine for some days contained a very large
quantity of indicon, but she made a typical afebrile con¬
valescence.

The President also exhibited a Malignant Growth which
had been removed from the cervix uteri by Schroeder's
operation. The patient was a strong, stout, healthy, florid-
looking woman, and the only symptom was menorrhagia,
which had lasted for eight months. The old method of
removal was by putting an t?craseur round the base of
the tumour. The woman had a perfectly afebrile con¬
valescence.

Dr. More Madden read a paper on the Treatment of
Ve6ico-vaginal Fistula;. In the present communication the
writer confines himself to those more difficult and excep¬
tional cases of vesical fistula consequent on parturition.
Amongst these Dr. More Madden includes all cases of vesico¬
vaginal or vesico-uterine fistula in which the loss of tissue
or the position and character of the rupture are such as to
preclude the restoration of the former structural integ?
of the parts, and in which either new vesico-vagina
vesico-uterine walls must be built up by plastic operatt
or else a new condition of the parts must be establish'
In most of the instances of vesico-uterine fistula that hav
come under Dr. More Madden’s observation the patients
been delivered instrumentally, and, moreover, were plurip_
in whom the uterine walls had been previously softei
and disintegrated by imperfect involution. In the la
cases there are, as a rule, but three courses available in t
way of operative treatment—viz., tracheloraphy in the fl»-
instance, followed by a plastic operation ob the d -
ruptured vesico-uterine walls; secondly, closure of th
uteri, so as to convert the uterus into an appendix to th
bladder; or, thirdly, the same result may be obtained in so r
cases by turning tne cervix into the vesical wound, witl
the closed walls of which it may be included. In this con
nexion Dr. Mote Madden refers to a case in which, after th

TbebLancet,]

NOTICES OP BOOKS.

[June 4; 1867. 1137.

normal aperture of the uterus was thus closed, nevertheless
the patient subsequently again became pregnant. In some
exceptional instances, however, of destruction from slough¬
ing of the entire vesico-vaginal septum, none of the repara¬
tive operations usually recommended are feasible or effectual,
and,in such cases the advisability of closing the vaginal
orifice, so as to thus afford a possible restitution of retentive
power, becomes a question for consideration. Against Simon’s
operation for this purpose must be recognised the consequent
liability to fatal renal disease which Dr. Emmet holds to be
an inevitable result of its performance. Nor should it be
lost sight of in this connexion that in some instances the
most extensive vesico-vaginal fistulas may in course of time
become cured without any operation by the occurrence of
senile atresia of the vagina—a fact of which two cases have
come under Dr. More Madden's observation.—Dr. Roe said
it was the experience of most of them that in all cases that
occurred Of vesico-vaginal fistula the deliveries had been
effected by instruments. But it would be wrong to let it
go forth as the opinion of the Section that the instruments
were the cause of these fistulas. He believed that in the
majority of cases the flstulee were the result of sloughing.—
Dr. Horne said that Dr. Madden, in his paper, had divided
fietulm into two great classes. As regarded the first of these,
they were all agreed that where the bands of adhesion were
not very great, and the edges of the denuded surfaces could
be. <easily brought together, there could be no hesitation
about performing the operation. The great question was
whether it shoidd be performed when the loss of tissue
at the base of the bladder had been so great that,
whether the bands Were divided or not, it was not
possible to bring the edges of the wound together*—
The President said, when they looked back upon the
history of vesico-vaginal fistula, it was extremely interest¬
ing to find that a disease which at one time was considered
almost incurable could now, except in the worst cases, be
cured with absolute certainty ; and they should never cease
to hope that some day even the severer cases should be
brought within the power of the gynaecologist. No person in
modem times, with the exception of Marion Sims, had done
so much to show them how this disease ought to be treated
as the late Professor Simon. It was most desirable to draw
the attention of young men to the conditions be had laid
down as necessary for the cure of these cases. First of all,
broad freshened surfaces were required; secondly, all tension
should be taken off the edges; lastly, the edges should be
brought accurately together by plenty bf stitches. Dr. Roe
had opened an interesting question as to the etiology of those
cases. When he (the President) was first studying them he
was under the impression that it was in cases of first child¬
birth that vesico-vaginal fistula occurred most frequently.
But he had not found that most of the cases of the disease
that came from the country were cases of first birth; on the
contrary, the maj ority of the women had borne children before;
and he thought the occurrence of the disease in them was to be
explained by the tediousness of their labours. These con¬
siderations point to the fact that it was not great pressure
but'prolonged pressure that caused vesico-vaginal fistula.
Dr. Horae had drawn attention to the circumstances under
which stone was likely to form in the bladder. When the
bladder was in its normal condition it was emptied from the
lowest point, and then its contents could be always cleared
out. But in some cases the opening between the bladder
and the vagina was high up in the former, and the result
was that there was a pocket up to the level of where the
fistula was, which was constantly full of unchanged urine.
The salts of that urine were then deposited, and stones
formed.—Dr. More Madden replied. .

GLASGOW OBSTETRICAL AND GYNAECOLOGICAL
SOCIETY..

The eighth ordinary meeting wa* held on May 25th, in
the Faculty Hall.

. Dr. Robert Pollok exhibited a small Pediculated Polypus
which he had removed from the os uteri of a patient who
had been supposed to be suffering from prolapsus and
bad been wearing a pessary, and afterwards read “Notes
of Difficulties occurring in eleven years’ private Obstetric
Practice (2000 cases), with the Treatment- adopted.” The
difficulties alluded to include adherent placenta, funis pre¬
sentation, anencephalic foetus, dystocia from obstructing
tumour, placenta previa* post-partum htemorrhage, puer¬

peral eclampsia, aad extra-uterine pregnancy. A discussion
followed, in the course of which the diagnosis in the laitter
case was called in question by Dr. Abraham Wallace, and
the author’s views as to treatment were freely criticised.

Ifatim of §ooks.

The Essentials of Bandaging, with Directions fbr
managing Fracture* and Dislocations, for administering
Ether and Chloroform, and for using other Surgical
Apparatus. With a Chapter on Surgical Landmarks. By
Berkeley Hill, M.B. Lond., F.R.C.S., Professor of Clinical
Surgery in University College, Member of the Court of
Examiners of the Royal College of Surgeons of England.
Illustrated by 144 Engravings on Wood. Sixth Edition,
Revised and Enlarged. London: H. K. Lewis. 1887.—
This is a deservedly popular book, so much so that a sixth
edition has been called for. The whole has been revised,
and to some small extent the book is enlarged; but on
looking through it we notice some few points in which
further improvements could easily have been introduced.
The descriptions of bandages and splints are practically
unaltered, but we are glad to notice that Mr. Hill gives a
caution as to the danger of sloughing following the use of
the graduated compress in the treatment of a wound of the '
palmar arch, and recommends the enlargement of the wound ■
and double ligature of the vessel instead. He might have .
added that if the bandage affixing the compress is loosened
Rafter twenty-four boon without displacement of the com¬
press, the danger of sloughing is obviated. Mr. Tweedy has
written a short account of Retinoacopy, and Dr. Poore has
added a description of Catheterism of the Larynx. We are
surprised that no account of the many convenient uses of
the triangular bandage is given; we miss also a description
and proper illustrations of the various simple slings for the
hand and arm. The old account and woodcuts of redac¬
tion of dislocations of the hip by pulleys are still
left in, and considering that this mode of reduction
is now rarely, if indeed ever, used by an educated surgeon,
it would have been more useful to replace these diagrams-
by others of the modes of reduction by manipulation. A
still stranger instance of "survival” under many revises,
is the account of the mode of administering a hypodermic
injection. We should suppose that there-was hardly any
room for difference of opinion as to the best way 1 of
performing this trifling operation, and that everyone did it
by gently pinching up a fold of skin and thrusting in the'
needle parallel to the surface. But Mr. Hill recommends the
surgeon to choose the arm (not the forearm), and to steady 1
the skin “by putting it on the stretch with the left thumb
and fingers, while the point of the cannula, held ah' right
angles with the surface, is thrust quickly, with a slight VOta-
tary motion, completely through the skin. We must add otte
further criticism, and it is in regard to the application of
Scott’s dressing to a joint. The ointment is called “ mercurial
ointment,” and there is no allusion to the fact that it should'
be a special preparation of mercury and camphor.

Congenital Club-foot: its Nature and Treatment t ' idith
especial reference to the Subcutaneous Division of the Tarsal
Ligaments. By Robert William Parker, Surgeon to the
East London Hospital for Children, and to the GrosvenOr
Hospital for Women and Children. London : H. K. Lewis.
1887.—Mr. Parker has, in conjunction with his friend and
co-worker Mr. Shattock, studied the pathology of Club-foot, 1
and the present brochure is an amplification And jjrabttCffi
application of the paper already published in the Trains^
actions of the Pathological Society. Mr. Parker’e View
are the outcome of painstaking study of the anatomy Off
club-foot, and are worthy of the most careful considerations
Put briefly, his teaching is that the cause of congeniti!

1138 Thb Lancet,]

EOYAL MEDICAL BENEVOLENT COLLEGE.

[Jims 4, 1887.

club-foot is malposition in utero, preventing the proper
developmental changes in the foot; that not only are muscles
at fault, but bones and ligaments too; that in severe cases
the shortened ligaments offer great and, it may be, insuper¬
able obstacles to the correction of the deformity, and are the
cause of the frequent relapses after tenotomy; that tenotomy
should be often supplemented or replaced by division of
the shortened ligaments—syndesmotomy as it is called. We
believe that Mr. Farker has made a valuable addition to our
knowledge and our means of surely remedying one of the
commonest of deformities. The book is, however, weak on
its clinical side. The pathological argument is complete,
but not a case is given to show the practical value of the
treatment recommended. We are well aware that the load¬
ing of brochures with accounte of cases is a vulgar device of
unsoientific writers, but none the less is it to be wished that
Mr. Parker had recorded one or two of the cases in which
he has practised syndesmotomy. The book-is excellent, but
it needs a clinical appendix.

Druitt's Surgeon's Vade-Mecum; a Manual of Modem
Surgery. Edited by Stanley Boyd, M.B., B.S. Lond.,
F.R.G.S. Eng., Assistant-Surgeon and Pathologist to the
Charing-cross Hospital, and Surgeon to the Paddington-
green Hospital for Children. Twelfth Edition, with 373
Wood Engravings. London: Henry Renshaw; J. and A.
Churchill. 1887.—This is an old friend, but in its new form
shows none of the decadence of age, but all the vigour of
youth. Mr. Stanley Boyd has amply justified the con¬
fidence placed in him by the publishers, and we most.
heartily congratulate him upon the success of this, which,
we believe, is hie first literary effort of an important kind.
Every part of the book shows signs of careful and judicious
revision, and while the well-known characteristics of
Druitt’s book, which have been appreciated by many gene¬
rations of students, are preserved, all the chapters have
been brought well up to date. The most important altera¬
tion made in this edition is the incorporation of a good
acoount of antiseptic surgery in all its branches, and of the
changes introduced into pathological views by the.recent
discoveries of the important role played by micro-organisms
in many morbid processes. The arrangement, the illustra-
trations, and the size of the book have been improved, and
it is in every way a trustworthy text-book. The twelfth
edition ought to do more than maintain the reputation
Dr, Druitt earned.

A Treatise on Chemistry. By Sir H. E. Roscob, F.R.S.,
and C. Schorlemmer, F.R.S., Professors of Chemistry in the
Victoria University, Owens College, Manchester. Vol. III.
Part III.: The Chemistry of the Hydro-carbons and their
Derivatives, or Organic Chemistry. London: Macmillan
and Co. 1886.—This, the third part of the third volume of the
great work which the Manchester professors have in hand,
is, after all, only another small instalment, and leaves almost
any amount to be completed. The present volume “com¬
mences the consideration of the complicated but most
important series of bodies known as the aromatic com¬
pounds”; in fact, it deals with benzene and its simpler
derivatives, including, of course, the phenol and aniline.
It is quite equal in value to the preceding volumes, which
is saying a great deal. The section on benzene itself is a
model of scientific writing; it is eminently practical, with
good working directions and clear illustrations, and yet the
scientific idea is never lost sight of throughout. As in the
previous volumes, unusual prominence is given to the history
of each important compound. It is not universally reco¬
gnised that such history is essential for the true comprehen¬
sion of the present views. We trust there will be as little
delay as possible in the issue of the remaining volumes. The
book will remain a landmark in the history of Eaglish
chemistry. It is unnecessary to praise it, for every chemist
in England knows and values it.

Brain: a Journal of Neurology. Edited for the Neuro¬
logical Society of London by A. de Wattevillb. Part 37.
April, 1887. London: Macmillan and Co. 1887. — This,
which is the first number of Brain since it has been
converted into the organ of the Neurological Society, is
almost wholly occupied with an elaborate paper by
Dr. Bastian, read before that Society, upon the Muscular
Sense, its Nature and Cortical Localisation. It would be
impossible, within the space of a brief notice, to detail the
points laid down by Dr. Bastian, whose argument is directed
largely against the doctrines enunciated by Dr. Farrier.
The interest of the subject is heighten9d by the publication
of the full text of the discussion which followed upon the
reading of the paper, and was joined in by Dr. Ferrier,
Mr. Sully, Dr. Ross, Sir J. Crichton Browne, Dr. Hughlingg
Jackson, Professor Horsley, Professor Hay craft. Dr. Merrier,
and Dr. de Watteville, and the reply of Dr. Bastian to the
criticisms of these gentlemen. Beyond this subject, the
journal contains a Critical Digest on Peripheral Neuritis by
Dr. Pierson of Dresden, and an abstract of a paper by
Landouzy and DdjSrine on Progressive Atrophic Myopathy
involving the Face.

The New Sydenham Society's Lexicon of Medicine and the
Allied Sciences .—The thirteenth part of this dictionary,
which is edited by Henry Power, M.B., and Dr. Leonard
W. Sedgwick, has just been issued. It extends from “Her'
to "11m," and its publication is another step towards the
completion of a work that will in the future be of immense
value to those who are fortunate enough to possess it.

Pen and Pencil. Glasgow: Maclure, Macdonald, and Co-
Several numbers of this recently established illustrated
weekly newspaper have been forwarded to us. Each part
contains eight pages, and with several a supplement is also
issued, of high class illustrations and interesting letter¬
press. As a means of implanting and encouraging the love
of the beautiful and refined we are glad to afford it a
hearty welcome. ___

ROYAL MEDICAL BENEVOLENT COLLEGE

At the annual general meeting of the governors of the
Royal Medical Benevolent College at Epsom, held on May
25th, Mr. Hird, who has filled the office of treasurer for
many years, resigned in consequenoe of giving up practice
in London. He was unanimously elected a vice-president,
and received a moat hearty vote of thsnks for his service*.
Dr. Holman, of Reigate, on the recommendation of the
council, was elected as the new treasurer. He is well
known in the profession, and has been an earnest supporter
of the College for a lengthened period.

The aid given by this institution to the aged and helpless
by pensions, the education free of all cost afforded to the
children of the less prosperous members of the profession,
•and the really first-rate education given to sons of any
medioal practitioner for £55 a year, are all so many reasons
why every member of the profession should support the
College, and yet we are grieved to say not one-fifth of onr
□umber give anything. It is not, perhaps, sufficiently known
that the College has several good scholarships to the univer¬
sities. It has seven free medical scholarships to the metro¬
politan hospitals, besides numerous other minor exhibitions
With Dr. Jonaon, Sir Edward Sieveking, Mr. France, Sir
Joseph Fayrer, Sir Trevor Lawrence, M.P., Mr. Jlorrant
Baker, Mr. Page, Mr. Malcolm Morris, Dr. Frederick Taylor,
and Mr. Propert, the son of the founder, on the Council, we
cannot but hope that the new treasurer and his colleagues
may receive a generous pecuniary support to enable them
to carry on the charitable objects of the institution with
no niggard hand, and, at the same time, to be shown such
confidence by sending pupils there as may secure atriumphant
success for their efforts to place Epsom College in the front
rank of the schools of tlie country.

Digitized by GoOgle

Thu Lancet,]

THE RELATION OP SCARLET PETER TO DISEASE IN COWS. [Junk 4,1887. 11 $9

THE LANCET.

LONDON: SATURDAY, JUNE 4, 1887.

This lecture delivered by Dr. Klein lost week at the
Royal Institution placed before the public the complete
evidence upon which is based the opinion that the infection
of milk with the virus of scarlet fever may result from a
disease of the cow. Although the papers which have from
time to time appeared in the reports of the Medical Offloer
of the Local Government Bjard have indicated the in¬
sufficiency of the more commonly acoepted methods of
milk infection to account for this infection, and although,
therefore, it was seen that some condition of the cow
herself might be responsible for this occurrence, it was
not until the publication of Mr. Powbb’s investigation’ into
scarlet fever caused by milk coming from a farm at Hendon
that evidence was obtained that the disease was due to a
particular affection of this animal.

It will be recollected that the appearance of scarlet fever
among tine drinkers of milk from one and another shed on
this farm coincided with extraordinary exactness with the
appearance of a disease among the cows inhabiting these
shells, and that-further proof that the cow and the human
disease were related was afforded by Dr. Klein, who dis¬
covered in certain sores on the udders of the affected cows a
streptococcus which, when inoculated into calves, caused
the same disease as that from which the cows at Hendon
suffered ; and that, farther, the changes in the visoera of
these animals resembled those which are found in the
human subject after death from scarlet fever, and that the
same micrococcus was discovered in their blood and tissues
as was found m the Hendon cows.

Since tbis time an outbreak of scarlet fever at Wimbledon,
again duo- to milk, gave opportunity for Dr. Klein to extend
his inquiry. A monkey, one of the milk drinkers and a
sufferer from its infective properties, had died, and an
examination of its body by Dr. Klein left no doubt that
the cause of death, was scarlet fever. From the blood
of this monkey he obtained by cultivation the same
micrococcus as that found in the Hendon cows. Again,
some tins of condensed milk whioh were under suspicion of
having produced scarlet fever in a number of persons who
had partaken of it were forwarded to Dr. Klein, with
the result that among other organisms the same micro¬
coccus was distinguished. The action of this microbe was
tested on animals, and communicated to them the same dis¬
ease as that observed at Hendon. Dr. Klein finally directed
his attention to persons suffering from scarlet fever, and
discovered in the blood of the general circulation a species
of micrococcus which, on cultivation in nutritive gelatine,
agar-agar mixture, blood-serum, and other media, proved to
be in every respect identical with that obtained from the
Hendon cows.

The identity of the human and the animal organisms having
been thus far established, both were tested on animals and
the results compared. Mice, especially wild mice, when
inoculated or fed with the streptococcus, both animal and

human became affected exactly in the same manner. The
majority of them died between seven and twenty days
afterwards, the post-mortem examination revealing great
congestion of the lungs and congestion of the liver, spleen,
and cortical part of the kidney. From the blood of these
mimidii, taken directly from the heart, cultivations were
made, and the existence of the same micrococcus proved.
For the remaining experiments calves were employed. Four
being fed and four being inoculated with cultivations from
eases of human scarlatina, all eight animals developed the
disease, both cutaneous and visceral, identical with that pro¬
duced in the calves that had been infected last year with
the micrococcus from the Hendon cows. And, lastly, from
the blood taken from the heart of calves thus inoculated
with human scarlatina, was recovered by cultivation a
micrococcus possessing all the characters of that of the
Hendon cows and of the cases of human scarlatina.

The evidence is therefore complete, and we may accept
as an assured feet that the conclusions to .which Mr. Power's
investigations of last year pointed were absolutely correct.
It is impossible to exaggerate the importance of these
observations, both in the saving of human life which they
will ultimately effect, and in the security they will give to
the interests of agriculturists when further knowledge of
the bovine disease enables it to be more easily recognised*
and its nature-to be better understood. Unfortunately it
may yet be some time before the practical lessons which,
are taught by Mr. Power’s and Dr. Klein’s work aTO
turned to useful account.

While Dr. Klein has been thus engaged in the completion,
of this chain of evidence, another department of the State,
the Agricultural Department of the Privy Council Office, has.
been employed in the production of a document which will
excite considerable surprise. The Privy Council had ordered an
inquiry into the subject matter of Mr. Power’s report, but
the investigation proved abortive, for we learn from a letter
addressed to the Privy Council by Professor Brown that,,
owing to the alarm which was occasioned among dairy
farmers by the publication of the report of the Local
Government Board, it was found impossible to obtain
any information from them of the existence of the-
disease among their herds. Nevertheless, the department:
appears to have felt the necessity of publishing a report,,
and they have therefore issued one by Professor Axn r
who inspected the Hendon cows at the instigation of
the Jlritish Dairy Farmers’ Association, but arrived upon
the scene at a time when, to use his own words, “the
eruption on the teats and udder, which was the charac¬
teristic feature of the complaint, had in the majority of case*
altogether disappeared.” Professor Axe has therefore based
his description of the malady also upon “ information ob¬
tained from the farmer and his herdsmen, as well as from
other dairymen to whose herd the disease spread.” It is
obvious from this statement that Professor Axe has from the
beginning assumed that the malady of the Hendon cows
was identical with that of other herds, which, he stater,
without giving his source of information, had been asso¬
ciated with those introducing the scarlatinal disease upon
the farm; these other herds do not appear Co have been
seen by Professor Axe at the time of their illness, and
the description must be, therefore, based upon his own

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1140 Th* Lancet,]

THE ANTIrVIVISECTlON SOCIETY.

[June 4,1887.

limited experience of the Hendon malady, and upon the
observations of dairymen of the ailment or ailments of
other herds, which may have been suffering from one or
more of the vesicular diseases which attack the udder of
the bovine animal, and which are perhaps affections totally
different from that with which Mr. Powsa was ooooemed.
Subsequently Professor Axe proceeded to ascertain whether
the milk of these other herds had communicated scarlet
fever to the drinkers of their milk; and, foiling to find
evidence of this occurrence, he appears to have con¬
cluded that the malady of the Hendon animals was
not responsible for the scarlet fever which Mr. Powjsb
investigated.

So serious a conclusion needs to be supported by evidence
which will enable some opinion to be formed of its
accuracy, but, strangely enough, although adopted by a
department of the State, no opportunity is given for such
judgment to be arrived at. In the first instance, it is most
important to know how far we may trust the observation
of the dairymen upon whom Professor Ax* relies for
information as to these other herds, and we are not even
told when inquiry was made of them, and, therefore,
whether dependence is being placed .upon the memory of
these people long after the event. In the second instance,
no information is given which would enable anyone to
judge of the sufficiency of the inquiry as to the effects of
drinking the milk of these herds, nor even is the statement
advanced as to the period when inquiry into this branch,
of the subject was made. There is, indeed, much reason for
believing that these steps were not taken until more than a
year after the termination of the Hendon outbreak, when
all clue would likely enough be lost, and, if so, the publica¬
tion of this paper sadly needs justification.

£tnee the publication of Dr. Buchanan’s official report
and Dr. Klein’s lecture at the Royal Institution, the subject
is, so far as its scientific position is concerned, outside the
region of controversy. The evidence conclusively establishes
that the cow malady caueed human scarlatina.

The Anti-vivisection Society of London is still so far
alive as to have its May meeting, which was held last week;
but. it would seem from the report of the proceedings
that there is not much animation about it. The chief
object of the speakers seemed to be to convince themselves
and their audience that the great majority of medical men
are against this practice. If by this as meant tha^ the
sentiment of humanity in the medioal profession is strong,
and is painfully touched by the necessity for experi¬
ments on animals, we readily admit and accept so just
a compliment. We have never erred from the line of a
regretful admission, of the necessity for, and the undoubted
value of, experiments on animals, with a strong request that
as fidr as possible they should be rendered painless. The
late. Editor of this Journal was. known for his love of
animals, and his in tolerance of anything but kindness to
and consideration for them; and in this, as in So much else,
ho represented accurately the profession. In this sense,
than, we will allow that the medical profession feels
strongly on the subject of vivisection, but only in this
sense. To represent the profession as . longing for an
overwhelming expression of public opinion—to say as

Mr. Hawbis did, that it is difficult to get at the real
opinions of medical men, or, as Dr. Hauohton did, that
doctors, even of the highest eminence, are afraid to express
views which happen to be in opposition to those of the
medical profession, is to make statements which are in¬
accurate, and which refute each other. The medical pro¬
fession is a liberal profession; it is bound by no creed; it
swears by no master; it.is confronted daily and nightly
with enormous suffering, which enters neither into the
imagination nor tlie experience of ordinary men. Not only
has it to face this suffering, but it is expected to mitigate,
if not to abolish it. It is this which makes the m**d»c *l
man tolerant of what is called vivisection, which in his
hands is a merciful business. What is it that permit* men
to abuse vaccination so glibly, and clamour for its abolition ?
Chiefly the fact that by the very beneficence of the operation
they disparage they never see small-pox. Experience of
this terrible disease would send the race of anti-vac¬
cinators to the nearest vaccination station. So with anti-
viviseotionists, they do not see disease, and are not
responsible for its treatment. But medical men are. They
know, moreover, the solidarity of men and animals in the
matter of disease, and that their pathology is so far common
that discoveries which benefit men will also, in most cases,
benefit the lower animals. These animals, indeed, so far
have been large gainers by the discoveries made Witl^ the help
of experiments on animals, as in the case of anthrax. To read
the speeches and the books of anti-viviaectioniste, one would
think that animals had no diseases, and no interest in the
progress of the art of medicine. No assertion could be mare
at variance with truth, or even with the Scripture which
tells us that the “ whole Creation groaneth and travaileth in
pain.” Let the enormous mass of disease in animals be
realised, and it will appear but fair to them, as well as to
men, to make them parties to those great discoveries by
which disease is to be averted. We will not depart from
that studied moderation of language which has characterised
British men of science in urging for the right to perform
careful and, wherever possible, painless experiments on
animals, with & view to & deeper knowledge of life and of
the things that destroy it and save it respectively. We
confess to finding it .hard sometimes to preserve this mode¬
ration and to be perfectly cool with an opponent who may
be willing to shoot an animal and thereafter to eat it, but
who objects to the physiologist or the physician performing
an operation that may save herds of aaimalB and thousands
of human beings. But moderation has its reward, and in
regard to this very subject has had its reward already.
We may respect the motives of men who object to an
experiment on a dog even if it is to save the life of
a man, but we eannot admit their sense of proportion
or their intelligent interpretation of Holy Writ, which
very clearly indicates the different value of the life of
man as compared with that of animals.

. ■■ - -

Since the true nature of the tubercular virus,was revealed
by Koch, there has been a constant endeavour to bring the
accepted facts of clinical observation into harmony with
that discovery. The range of tuberculous disease has been
widely extended, and especial prominence given to that
farm which in its abundance far exceed a ail o there—we

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Thu Aasom,]

HEREDITY IN TUBERCULOSIS.

[Jun* 4,1881 1141

mean pulmonary phthisis. According to the knowledge
gained of the invariable coincidence of the bacillus of
tubercle and of phthisis, we are bound to include the lung
affection in the same pathological category as that of other
tubercular disease in any part of the body. When, therefore,
we speak of the etiology of phthisis, we mean the etiology
of tuberculosis; and when we indicate the fact of inherit¬
ance as one of the most striking of the etiological factors in
phthisis, we must add the liability to the transmission of
any one of the servers! forms of tubercular disease. This is
so obvious that it barely needs to be pointed out, and yet we
venture to think that it is sometimes lost sight of. It is not
the pulmonary disease that is inherited, but the tuberculosis,
of which the pulmonary affection is but one manifestation;
and the fact that we habitually speak of ** inherited phthisis"
is merely because that is the most common of all tubercular
disease. If, therefore, we seek to discuss the influence which
the bacillary doctrine has hod upon the problem of the
inheritance of phthisis, we must embrace in our view the
whole range of tubercular disease. The question, then, is
whether tuberculosis, like syphilis, can be directly trans¬
mitted from parent to offspring; and if the answer is in the
negative, we must be prepared with a satisfactory alterna¬
tive to explain the undoubted influence of heredity in the
etiology of the disease.

The subject is surrounded by difficulties, and we oan hardly
wonder that the medical world is divided in opinion upon it.
Professor Obzth has recently drawn prominent attention to
it, 1 but current literature abounds with references to it. It
is simple and easy to evade the question by implying, as
v'ibohoW did thirty years ago, that it is not tuberculosis
that is transmitted, but only a special vulnerability of tissue
nr organ; and this explanation may probably be the true
>ne, unsatisfactory as in some respects it is. Still, before
iccepting it we are bound to see how far it can be supported
)y facts, and how far it harmonises with the central fact of
ill—via., the organised virus, the baoillua. The analogy
vith syphilis, in many particulars so striking, is hardly
K>rne out in this question of inheritance. That the parent
mpsrts the syphilitic virus to his or her offspring, either
[irectly from the germ or sperm cell or through the medium
>f the placental blood, is absolutely proved by the existence
f congenital and fcetal syphilis. Now, in tuberculosis
here is hardly a single well-authenticated case on record
f the disease being present in the foetus or the new-born,
he one or two instances of foetal tuberculosis are not
eyond suspicion of being examples of syphilis with wide-
pread visceral lesions, and perhaps the only indubitable
ase is that of a calf which John* records. But even if
here were more cases to be substantiated, it is plain that, as
ompared with syphilis, they would form but an infinitesimal
roportion in the whole number of cases of inherited tuber-
ulosis; and the possibility of accidental infection inutero
ronld be quite a legitimate explanation for such a rare
ccurrence. At any rate, it would be more legitimate than
ie endeavour to clench the analogy with syphilis by
a miming that inherited tuberculosis is always latent, and
bat what is the exception in the former disease is the rule
i the latter. The positive arguments in favour of direct

1 Aetioloffiaches unci Anatomlsches liber Lungenschwindsucht.

fetttn; HlrsobwaM. 1867.)

transmission are mainly based Upon such facts as th’ott
adduced by Landouzy— viz., the detection of bacilli in the
vericulse seminales of tubercular subjects, without actual
disease of those organs, and the experimental inoculation of
tuberculosis in guinea-pigs by the injection of the spermatic
fluid from a tubercular subject. In face of the transmission
of syphilis, it cannot be contended that it is impossible for
the sperm cell or germ cell to be primarily infected; but the
proof of such infection is wanting in the case of tuber¬
culosis, or is at least so meagre as to be unimportant. In
his very suggestive work just published, Mr. Candlkb,*
who adopts the malarial doctrine of tuberculosis, saysi
“In syphilis the microbe is in the blood from the begin¬
ning to the end of its parasitism, in phthisis the irruption
of the bacillus into the blood is the first scene of the
last short act in its career as a parasite in the one host;
Hereditary syphilis therefore, in addition to its being clearly
established, may be readily apprehended, but hereditary 1
phthisis in the sense implied would appear to be a physical
impossibility.”

Nevertheless, in spite of the absence of evidence of con¬
genital tuberculosis, and the fact that inherited phthisis
delays its appearance mostly till puberty has been passed,
the occurrence of infantile tuberculdsis is by no means so
rare as is generally believed. In a paper read at the'
Copenhagen Congress, Dr. Hklleh, showed that whereas outr
of a total of 1800 post-mortem examinations in infants and
children he had met with only one case of tubercular
disease as early as nine weeks of age, yet the pro¬
portion increased with considerable rapidity as the age
advanced, even in the first years of life; and M. Landouzy
has contributed from his recent experience at the Tenon
Hospital, Paris, details of no fewer than seven fatal
cases of tuberculosis in infants ranging from six weeks
to twelve months, among twenty-three cases of death
during the first quarter of this year.® It may be
admitted that infantile tuberculosis is common (although
infantile phthisis is exceedingly rare) without necessarily
concluding that the disease has been directly inherited—that
is, that it is congenital. There is always a possibility of
post-uterine infection by the milk of a tubercular mother
or by exposure to the vitiated surroundings of a home
inhabited by infected parents. It is more reasonable to
admit acquired disease than to assume that during fcetal
life and for a few weeks subsequently the disease remained
dormant. From these and other considerations, we are
almost impelled by the bacillary doctrine to believe that
the old assumption is tbfe true one—viz., that inheritance of
phthisis (and of tuberculosis in its widest sense) is not an
inheritance of the disease itself, but of a special proclivity
of tissue to the disease. It is the soil that is suitable for'
the growth of the bacillus, and not the bacillus, that is
transmitted. As Koch says, “ hereditary tuberculosis is
explained most naturally by supposing that the infectftvn
germ itself is not inherited, but rather certain pecuHarities'
favourable to the development of germs which may later!
on come into contact with the body; in fact, it is the
predisposition to tuberculosis which is inherited.” The
same conclusion is reached by Professor Obth, and it

* The Prevention of Consumption. (Kegan Paul and Trench, 1887.)

3 Bev. do UM. May, 1887.

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1142 Thb Lancet,]

PRACTICAL EDUCATION AND PINAL EXAMINATIONS.

[Juwk 4 , law.

is the one which is most in consonance with experience;
but, as Professor Obth remarks, it by no means gets rid
of the fact that the disease is infective.

--

In our last issue we referred briefly to the recommenda¬
tions of the Practical Education Committee of the General
Medical Council on the question of pupilage, and pointed
out how inadequate was the suggestion of a six months’
pupilage taken in the long vacations after the passing of
the examinations in anatomy and physiology. We regret
that the part of the report which deals with the final
examinations is equally unsatisfactory. Its recommenda¬
tions are unworkable. It is suggested that the extension
and searching power of the clinical examinations would be
facilitated “ if the ‘ final ’ or qualifying examination were
divided into two parts, of which the ultimate should
consist mainly of clinical work and the personal application
of diagnosis, prognosis, and treatment to set cases, leaving
to the penultimate the testing of the knowledge possessed
by the candidate of the other subjects contained in the
curriculum of school work. It is also recommended that
there should be an interval of at least twelve months
between the two parts of the final examination, and that
this interval should be passed in such occupations as will
involve the charge of patients under the supervision of
competent persona recognised by the authorities of the
school at which the candidate has been educated, which
authorities should be responsible for the genuineness of the
evidence afforded of the candidate’s diligence and care of
such number of cases in medicine, surgery, and midwifery
os the examining body shall deem expedient.” We have
every eympathy with attempts to make the qualify¬
ing examinations as thoroughly practical in medicine,
surgery, and midwifery as is possible, and should have
welcomed and supported any proposals which would have
really secured this object, or even tended towards this end*
For example, the committee might have pointed out that
those examining bodies which only require a certificate of
attendance on six cases of labour were doing very little to
secure an efficient practical knowledge of obstetrics, and
this is the less pardonable because everyone must recognise
the impossibility of a really practical examination in
this branch of the medical art. In Ireland the regulations
of the examining boards on this question are more stringent
than in .England, where attendance on twenty cases at
least is insisted on by all the present authorities; but in
Scotland only six cases are required by any qualifying body,
whether University or Faculty. Practical midwifery is at a
M inimum ; theoretical midwifery has to be cultivated to its
highest point of excellence by the unfortunate pupil. “ Two
courses of midwifery of fifty lectures each are reckoned
equivalent to one course' of one hundred lectures, provided
they embrace different departments of obstetric medicine.”
Again, it would have been worthy of consideration whether
operations on the dead subject should not be made com¬
pulsory in every surgical examination, as well as the appli¬
cation of bandages and the marking out of the surgical
landmarks on the living body. In medicine, should not every
candidate be compelled to go through a strict examination
both at the bedside and in the out-patient room, and thus
hare his knowledge tested both of sew ™ and common cases

of disease? And could not his therapeutical knowledge b*
readily and thoroughly examined into at the same time I By
such suggestions the practical element in medical education
would quickly be increased, for every student is keen enough
on learning what he knows will be required of him by tb*
examiner. But the recommendation of a twelve month*
interval between two parts of a final examination is quite oat-
side the practicable. There is now a compulsory two yean’
interval between the second and the qualifying examination
at the Conjoint Board, and this interval would, by the
adoption of the recommendation referred to, be extended to
three years between passing the second examination and
obtaining a licence to practise; for if the penultimate part of
the examination into the theoretical knowledge embraced i>
the later part of the curriculum is of any value whatever, it
cannot take place until after the present interval of two
years. Theoretical surgery and medicine, midwifery,
forensic medicine, and pathology, to say nothing of hygiene
and mental diseases, cannot be studied under two years, and
adding another year compulsorily to the curriculum u
impossible, both on the score of time and expense. Another
year devoted to medical study is the most valuable booa
that can be given by the parent to his son, but his exami¬
nations must be finished for him to obtain the greatot
benefit from it. His time can then be wholly devoted to the
practical element, and he can follow with every advantage
the special departments of his hospital, where he oan aee say
number of common diseases, whether of the eye, ear, throat,
or skin, gynaecological or exanthematous, and quickly
become skilled in their diagnosis and treatment. A year
spent thus might not be less profitably employed than in
the charge of patients under the supervision of com¬
petent persons recognised by the authorities of the
school at which the candidate has been educated. More¬
over, how could the authorities of a school guarantee tbs
thoroughness of any supervision exercised by practitioner*
outside their own body? We cannot hope that any im¬
provement in the practical element of medical educatioi
will be the outcome of this report, and we are sorry tin;
the committee did not more fully consider the queetioos
involved before they drew it up and allowed it to be
entered on the Minutes of the Council.

Snuofatitms.

" He quid Blais.”

THE SUPPLEMENTARY CHARTER.

Elshwhbbe we publish an abstract of the petition c.'
the Royal College of Surgeons to the Queen for & Supplemen¬
tary Charter. We have practically discussed all the poio^
contained in it so often that it is needless to do so again oc
the present occasion. We cannot refrain, however, froi
pointing out a feature which appears to have been recently
introduced by the Council apparently for the purpose c-
keeping control to some extent over the election of tl-
Couhcil. In the last clause it will be noticed that tb
Council desire to obtain the power to compel a certain num¬
ber of Fellows to be present in proprid persond in order
legalise the election by voting papers, this number
Fellows to bo such “as the Council may from time to tin-
think fit to direct.” It is clear that, if election by votiag

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TheLawcep,] UNIVERSITY COLLEGE AND A TEACHING UNIVERSITY POE LONDON. [Jttnk 4,1887. 1143

paper is to be legalised by Charter, it should be unconditional
of any such absurd regulation as the Council appear anxious
to introduce. Such a restriction con serve no useful pur- j
pose; if it do serve some special purpose, not obvious to
outsiders, then the number of Fellows who are to attend
personally should be fixed by Charter, and ought not to be
allowed to depend on the pleasure of a body like the present
Council, who have so persistently ignored all the representa¬
tions which have been made to them from time to time by the
body corporate. There is one other point we may briefly
allude to—viz., the proposal to empower the Council to elect
annually to the Fellowship ten Members instead of two, as
under existing rules. Unless a very different class of men
are to be elected to the Fellowship from those originally
contemplated, this rule will be useless; for the Council have,
so far, not always availed themselves of their present power
of electing two Members to the highest grade. We view
with disfavour any plan which, on the one hand, tends to
depreciate the intrinsic value of the Fellowship, or which
gives the Council the means of bestowing, at all largely, a
qualification which should be reserved strictly for those who
have rendered special service to surgery in one way or
another. For the latter purpose, the powers already pos¬
sessed by the Council seem quite adequate. It would be a
waste of time, under present circumstances, to discuss at
greater length the abstract in question. We must wait the
course of events, and trust to the outspoken wishes of the
Fellows and Members, and to their respective deputations
which are to wait upon the Lord President of the Council
for the purpose of laying them properly before him.

UNIVERSITY COLLEGE AND A TEACHING
UNIVERSITY FOR LONDON.

The arguments which we have so frequently put before
our readers as to the advantages which would be obtained
by medical students if a Teaching University were founded
in London, were well summarised in the speech made by Sir
George Young at the distribution of prizes at University
College on the 1st instant. The inefficient character of the
changes suggested by the Senate of the University of London,
and the necessity for the establishment of a local University
in London as well as an Imperial Examining Board, were
ably pointed out. It is obvious that the movement for
establishing a Teaching University in London will go on, and
that University and King’s Colleges must take the chief, if
not the entire, responsibility for forming the Faculties of Arts
and Science, and the other medical schools must combine
with these to form a Faculty in Medicine. Such changes
cannot be foreshadowed without exciting the jealousy of the
University of London, which can hardly be expected to look
with equanimity on the secession of its two largest and
oldest London Colleges so soon after that of Owens College.
It is therefore not a matter of surprise that several members
of the Council of University College, closely identified with
the existing University, have followed the example of Lord
Kimberley, the President, and resigned their seats on the
Council.

METROPOLITAN ASYLUMS BOARD.

An interesting report by the Chairman of the Metropolitan
Asylums Board has been published, giving an account of the
work performed during the fifteen months ending March 2bth
of the present year. Mr. Galsworthy is able to congratulate
the managers on the comparative absence of small-pox from
London, and properly claims that some portion of this free¬
dom from disease is due to the existence of opportunities for
the isolation of infectious persons. He comments upon the
endeavours of the managers to acquire the legal recognition
of the position which it has involuntarily assumed in pro¬

viding hospital accommodation for all classes of the popula¬
tion. Deputations to successive presidents of the Local
Government Board on this subject have, he says, only resulted
in the adoption of incomplete measures, in consequence
of which the Metropolitan Asylums Board has been called
upon to do the work of vestries and district boards, but
without any legal recognition of responsibility. The pro¬
posal that the sanitary authorities should enter into con¬
tracts with the Asylums Board for the purpose of the
treatment of all classes of the infectious sick has led to no
other result than the passing of the Act of 1879 giving per¬
mission for this purpose—a permission which.it is needless to
say, has not been acted upon. This class distinction between
those who are paupers and those who are not leaves London
in an unfortunate position with regard to the provision of
hospital accommodation; Mr. Galsworthy’s suggestion,
therefore, that the Local Government Board should intro¬
duce a Bill into Parliament with a view to putting an end to
these difficulties is one which should receive general support.
Among the important arrangements made by the managers
during the past twelve months in connexion with the
treatment of infectious disease are the adoption of a regula¬
tion whereby the services of medical superintendents and
assistant medical officers appointed to any infectious hospital
will be available for any other hospital of the managers,
and the appointment at the hospitals of duly qualified
medical men to act as clinical assistants. The first is
obviously needed in the interests of the public service, for
without such power of transference of officers the managers
are compelled to retain a staff at institutions which are for
months absolutely empty; the second is necessary to enable
medical men to study more thoroughly the diseases which
are to be found in the hospitals of the Metropolitan Asylums
Board. We note with pleasure that a committee has been
appointed by the Board for the purpose of increasing the
value of the statistical information which is obtained from
every institution. Small-pox and vaccination statistics
I specially need to be carefully recorded, and an improvement
j of the methods adopted will lead to valuable results.

ABSENCE OF FREE HYDROCHLORIC ACID IN THE
GASTRIC JUICE.

The diagnostic value of the absence of free hydrochloric
acid in the gastric juice in cases of malignant disease of the
stomach is discussed at some length in a recent paper by
Dr. Y. G. Necbaieff of St. Petersburg. For the detection of
free hydrochloric acid no less than thirteen different tests
have been proposed. Of these he considers the following to
be the most useful1. A solution of tropeolin in water, as
proposed by Edinger; this has of itself a yellow colour, but
when brought into contact with a solution containing
001 per cent, of HC1 it becomes a dark cherry red
2. Methyl violet becomes blue on the addition of
0*025 per cent, of HC1. 3. Congo paper shows a blue tinge
on being immersed in a solution containing 0*025 per cent,
of HC1. 4. A mixture of three drops of liquor f erri perchloridi
with the same quantity of carbolic acid in twenty cubic
centimetres of water shows the presence of lactic acid or
its salts by becoming yellow; but if free hydrochloric acid is
also present the reagent becomes colourless. This is there¬
fore an excellent test for free hydrochloric acid, when lactic
ac^d or the lactates are present. Dr. Necbaieff advises that
all these tests should be applied in each case. He found
that in cases of carcinoma of the stomach, and apparently
in carcinoma of the oesophagus, absence of free hydro¬
chloric acid constituted the rule and its presence the excep¬
tion, and is disposed, therefore, to think that its absence
affords a practically useful diagnostic sign in cases where
cancer of the stomach or oesophagus is suspected. Thus, in
, seven cases of carcinoma of the pylorus, though 142 ex ami-

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1144 Thu Lahcbt,] CERTIFICATES OF DEATH.—THE GENERAL MEDICAL COUNCIL.

[Jonh 4,1887

nations ware made, free hydrochloric acid was never found,
though lactic acid invariably existed; and, again, in 105
examinations of four patients with carcinomatous stricture of
the oesophagus no free hydrochloric acid oould be detected.
In a case of cancer of the rectum, however, the presence of
free hydrochloric add in the contents of the stomach was
very distinct. _

CERTIFICATES OF DEATH.

lx a recent annotation respecting the Toxteth-park
poisoning case, it was suggested that all cases in which, from
the sudden character of the death or other suspicious cir¬
cumstances, the medical attendant had a doubt as to its
being a death from natural causes, should be referred by him
to the coroner of the district. No doubt a difficulty is created
by the wording of the 20th section of the Births and Deaths
Registration Act of 1874, which is as follows

“ In the case of the death of any person attended during
his last illness by a registered medical practitioner, that
practitioner shall sign and give to some person required by
the Act to give information concerning the death a certifi¬
cate, stating, to the best of his knowledge and belief, the
cause of death.”

A correspondent wishing to know whether he or any other
medical practitioner could refuse to give a certificate, com¬
municated with the Registrar-General, from whom he
received, through the secretary, a reply of which the follow¬
ing is an abstract. After quoting the section of the Act
just given, the letter adds:—

“ The duty of the medical practitioner is thus very clearly
explained by the 20th section of the Act, which admits of

no other interpretation.The medical practitioner under

the circumstances described in the Act has no option in the
matter; he cannot withold the certificate. He can of
course, if he sees fit, himself communicate with the coroner
or polioe with regard to any suspicious circumstances which
may have come under his notice when in attendance during
the last illness of the deceased; but he may safely leave this
duty to the registrar, who in his * Regulations’ is directed to
report to the coroner (on a form provided from this office)
all deaths caused directly or indirectly by violence, or which
have been attended by suspicious circumstances, as well as
sudden deaths, and every death the cause of which is stated
to be unknown.”

It is unfortunate that the Act takes no cognisance of
those cases in which it is very difficult, if not impossible, to
give a certificate, and in which it would be, medically
speaking, much better not to give one. For instance, a
practitioner might be in doubt as to whether the cause of
death were due to “ English cholera” or “ irritant poisoning.”
How is the certificate to be so worded as to induce the
registrar to refer the case to the coroner without prejudice
to the medical attendant should his suspicions be unfounded?
We are by no means so assured as the Registrar-General
would appear to be of the safety of leaving this discretionary
power to the district registrar. Corbnershave frequently com¬
plained, and with too much reason, of the delay which often
occurs before they receive information of a death in which an
inquest has to be held. This delay must bo increased, if not
caused,by presenting for registration a certificate useless for
that purpose, and which must bereferred to the coroner—more
especially if these officials reside in country districts far from
each other. The question is not without its difficulties, but
these will be more easily surmounted by meeting them
once, and not shifting them on to the shoulders of others.
It will surprise many readers of Thk Lanckt to learn that
they cannot refuse to give & certificate of death, even when
such can only be a merely formal one to be passed on by the
registrar to the coroner. The obviously better course would
befOT the m e dic al attendant hinmalf to refer to the coroner
every oase in which he had doubts as to the propriety of

giving a certificate—not necessarily because an inquest was
called for, but because the coroner is the authority to whom
all such cases ought to be referred, and who is the official
responsible for making full inquiry and for the results
thereof. _

THE GENERAL MEDICAL COUNCIL.

ImcBDiATBLT after the termination of the session of the
General Medical Council, the printed Minutes of the Council,
of its Executive Committee, and of its English Branch
Council, including the Transactions from Feb. 25th to
May 20th, were published. The volume contains information
of the greatest value to the profession and to those
interested in its government. In it will be found, in addi¬
tion to the President’s address, all the communications
which have taken place concerning the appointment by the
Council of assistant examiners to the Apothecaries’Societies of
London and Ireland; also a statement of a case and opinion
by the Attorney-General and the Solicitor-General in regard
to the combination of licensing bodies under the new
Medical Act, as well as the proceedings relating to the
appointment of inspectors of examinations. Among other
documents of interest is the report by a committee on
practioal education, to which we referred at length in our
last number. The early appearance of this volume, with
an excellent index, will be appreciated by those interested
in medical education. _

OXYGEN AS AN ANTIPYRETIC.

At the last session of the Royal Academy of Medicine of
Madrid, the President introduced an innovation by allowing
Senor Don Dr. Francisco Valenzuela, a non-member, to read
a paper. The subject was “ The Effect of Oxygen of High
Tension upon the Animal Organism,” and the amount of
original investigation reported in it may well serve to justify
the President of the Academy in departing from the time-
honoured custom of confining the papers and speeches to
academicians. Don Valenzuela began his researches by
submitting rabbits to pure oxygen at various pressures. No
effect on the temperature was produced at a lower pressure
than 700 mm., or five times the ordinary tension of the
oxygen in the atmosphere. Under this, however, a rabbit
whose initial temperature was 387° C. after an hour’s
sojourn in the chamber presented a temperature of 37 - 9° C.
At still higher pressures of pure oxygen greater falls of
temperature occurred. The highest tension at which experi¬
ments were made was 1520 mm.; this reduced a rabbit’s
temperature in-an hour from 38 - 4° to 32*2°. The general
effect on the animals of oxygen at the higher tensions was
to produce a temporary torpor, and they came out of the
chamber covered with moisture; in a very short time, how¬
ever, they entirely recovered their ordinary condition.
Some experiments were also made on the effect of oxygen
of high tension on the febrile state, by inducing septicaemia
in rabbits and comparing the course of the disease in
those which were subjected to the action of oxygen with
that in others kept under ordinary atmospheric con¬
ditions, with the general result that pyrexia appeared
to be reduced by the sojourn in the oxygen chamber.
In one case two rabbits were each inoculated with a
cubic centimetre of serous fluid with a putrid smell from a
dead body. One of them waa then subjected for two hours
to the action of oxygen of a tension seven times higher
than that which it has in the air. Four hours subsequently
the temperature showed a reduction of 17° C., the tempera¬
ture of the other rabbit at the same time being 3° C. higher
than the normal. The next day the body heat of the first
rabbit was 1*6° C. and the second 31 C. above the normal.
The first was replaced in the oxygen chamber under the
same pressure, and for the same length of time as before,

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THE CROWN PRINCE OF GERMANY.—ANTI-VACCINATION. [Junb i, 1889. 1146

which reduced the temperature 2'2°—that is to aay, to
0'7° below the normal. On the third day it waa only 1° C.
above the normal, while the aecond rabbit died. No further
treatment waa resorted to, and on the fourth day the first
rabbit had regained its normal physiological condition. It
was found in the various experiments made that when
a small quantity of septic matter only waa introduced, a
single session in the oxygen chamber was sufficient to
destroy the effect of the virus, but that if a high degree of
sepsis waa induced the poison was only partially destroyed
by a single session. Dr. Valenzuela then made some observa¬
tions on patients. A young man was attacked by pneu¬
monia, affecting both lungs, on April 26th. On the morning
of the 27th the temperature waa 89'6° C., and in the evening
404°. He waa then put into the pneumatic chamber con¬
taining pure oxygen at a pressure of 950 mm., or six
times the ordinary tension of atmospheric oxygen, for
an hour, after which his temperature was 1'7° C. lower. The
next morning it was 39 , 2°. A second session in the chamber
produced no immediate reduction, but four hours later the
temperature was 39-0°. That evening it was 39 - 5°, and it
gradually returned to normal, though no further sessions in
the oxygen chamber were ordered. The man made a rapid
recovery. Dr. Valenzuela likewise mentioned some other
cases of pneumonia and tuberculosis on which the oxygen
treatment appeared to have a beneficial action.

THE CROWN PRINCE OF GERMANY.

Wb are glad to be able to give in fuller detail this week
an account of the Crown Prince’s illness. It appears that
in January his Imperial Highness began to suffer from
slight hoarseness, and early in March Professor Gerbardt
discovered a warty growth attached to the left vocal cord,
which he treated by touching with the electro-cautery.
Its size having been reduced by this means, the Prince
was advised to go to Ems, where he remained about six
weeks. On his return he was found to be no better as
regards his hoarseness, and the growth had somewhat
increased in size. Professor To bold was then called
in, and after a consultation with the Emperor’s and
Crown Prince’s physicians, Von Lausr and Wegner, it
was thought that the growth was of a malignant
nature, and at their request Dr. Bergmann’s opinion was
sought. He was inclined to confirm the diagnosis. It was
decided that an external operation was necessary, but
whether it was to be excision of the larynx or thyrotomy
was not settled definitely. In consequence of the strong
.feeling at Court that this operation ought not to be done
unless absolutely unavoidable, on account of its attendant
danger to life and great impairment of voice, even if
successful, Dr. Bergmann declined to take the responsi¬
bility as the operator, nnlees the impossibility of the
removal of the growth by inter-laryngeal methods was
confirmed by Dr. Morell Mackenzie. Immediately on
arriving in Berlin on Friday, May 20th, a consultation
was held, at which Dr. Mackenzie met all the medical
men above mentioned. On making a laryngoeoopic exami¬
nation, Dr. Mackenzie found a sessile growth about the
size of a large split pea, but in shape more elongated,
attached to the posterior portion of the left vocal cord
on its inner and upper surfaces. He urged that the
more serious operation should not be performed before a
portion of the growth had been removed for microscopic
examination. This had not been done because it was con¬
sidered impossible owing to its small size and sessile
character. The following morning another consultation
vraa held, at which Dr. Mackenzie succeeded in removing
’rith forceps a piece of the growth about the size of a tare.
Professor von Virchow, having examined microscopically
portion taken away, pronounced it to be a benign

growth. He said that the epithelial cells were increased
in size and number. He further stated that, as the portion
removed included a complete section of the growth and the
surface of the vocal cord beneath, as clearly demonstrated
by the presence of some of the longitudinal elastic fibres of
the latter structure, he considered that there was no reason,
to suppose that any remaining portion of the growth was of
a cancerous nature. Professor von Virchow also said that
he thought the thickening was the result of chronic inflam¬
mation, which accorded with the history of the case. Dr.
Mackenzie leaves London for Berlin on Sunday night,
and we shall hope to hear that he has been successful in
removing the entire growth, which is the source of so much
trouble to his Imperial Highness and of so much anxiety to
others. _

TERRIER’S NEPHRECTOMY.

Thb last word has not yet been said upon the relative
advantages of the lumbar and the abdominal methods of
nephrectomy. Each has its merits and its demerits, and
M. Terrier has attempted to combine the merits of each
without the corresponding demerits in a new method of
operating. It consists in making a vertical lateral incision
over the front of the kidney through the abdominal wall,
The peritoneal cavity being opened, the diseased organ and
the opposite one can be explored; and if the surgeon decides
to proceed with the operation, he makes a clean vertical cut
through the peritoneum over the kidney on the outer side
of the colon, and strips up the serous membrane from the
front of the kidney. By carefully suturing the cut edges of
this visceral peritoneum to the edges of the abdominal
wound, the field of operation is completely shut out from
the general peritoneal cavity. Before doing this, the
surgeon proceeds with the removal of the kidney. The
vessels having been secured, the cut edges of the peritoneum
are united as described above, and the meter can fan taught
out at the lower end of the wound, which is then partially
closed, a large drain being left in. The advantages of this
method of operating are the facilities it affords for deter¬
mining the condition of the opposite kidney, abundant
room for extracting the kidney, ease in dealing with the
pedicle, satisfactory drainage of the wound, which is ren¬
dered extra-peritoneal, and the freedom from risk of con¬
taminating the peritoneum by the divided ureter. Terrier
records the two cases in which he has practised this opera¬
tion in the Revue de Chirurgie for May. One of them, in
which there was hydronephrosis of the organ, was successful;
the other, a case of malignant disease, waa fatal. This
method of operating certainly deserves further trial.

ANTI-VACCINATION.

Thb article which we published recently on the instruc¬
tions to public vaccinators issued by the Local Government
Board ia the subject of a letter in the Echo by Mr. William
Tebb, a prominent leader of the anti-vaccination party, who,
referring to our statement that “ the amount of sickness and
death which is prevented by this operation (vaccination) is
almost incalculable,” proceeds to say: “ No evidence is pro¬
duced to establish the truth of this wonderful salvation, for
the very sufficient reason that there is none to produce, aa
all the available evidence both from England and the Con¬
tinent points in an opposite direction.” The anti-vaccina¬
tionists know too well that an assertion such as this appear¬
ing in the public press and left unoontradicted must have
its effect amongst those persona who would never think of
learning the lessons taught by every small-pox hospital, by
the Registrar-General, by the Local Government Board,
and by the State Departments of other countries. We have
no reason to anticipate that any Government would deprive
the country of the benefits seeulting from the a dministr a tion

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1146 The Lancet,]

PARALYSIS OP CONVERGENCE IN TABES DORSALIS.

[June 4,1887.

of the Vaccination Acta; but the efficiency with which these
Acte can be carried out is largely dependent upon the
willingness of the people to protect their children by vac¬
cination against small-pox. Under these circumstances, it
becomes a serious question whether greater effort should
not be made to combat such false statements as that to
which we refer, and to enlighten the public as to the dangers
of small-pox, and as to the immunity from this disease
which is conferred by vaccination. It is indeed lamentable
that a few anti-vaccinationists should be permitted to poison
the public mind by assertions absolutely devoid of truth.
The press, which publishes the letters of anti-vaccinationists,
is not less open to those who are cognisant of the enormous
saving of life which is effected by vaccination. There is no
class of men who could better undertake this duty of the
education of the public than medical officers of health, and
no better service could be rendered by these officials than the
constant delivery of lectures in their districts, which would
thus enable the information, now too much confined to
official publications, to be generally known. The Society of
Medical Officers of Health are now considering changes in
the constitution of their body which will add to its power
of usefulness, and we would venture to suggest that the
course we have indicated is one which they might readily
adopt. They would be able to make clear to the public the
absurdity of a story told in the same number of the Echo,
that an unfortunate baby, who subsequently to vaccination
suffered from diphtheria and whooping-cough, did not con¬
tract these diseases from its vaccination, and they would
thus prevent the growth of an opinion based upon these
fallacious statements. We do not doubt that if this method
had been earlier adopted, we should have found the death-
rates from small-pox much lower than they have hitherto
been. _

PARALYSIS OF CONVERGENCE IN TABE8
DORSALI8.

An interesting case of paralysis of the movement of
convergence of the eyes occurring at the commencement of
tabes dorsalis, in a man aged thirty-six, has been placed on
record by Dr. de Watteville in the Ncurologitchcs Central-
blatt (No. 10), and the facts of the case are also vouched for
by Dr. James Anderson, whose examination corroborated
the loss of knee jerk, loss of the light-reflex of the pupil, and
the presence of accommodation, lateral and vertical move¬
ments of the globes, with perfect action of the eyelids. Loss
of this function of converging the eyelids has been recorded
as an isolated symptom, and as complicating Basedow’s
disease. Dr. de Watteville states that he knows of no
observation in which this loss of convergence has been
chronicled during the early stage of tabes, but he quotes
Dr. Gowers’ Manual, vol.i., p. 298: “ Rarely there is loss of
tiie movement of convergence associated with loss of accom¬
modation, although the internal recti may act in the move¬
ment towards one side.” ______

“WAKING NUMBNESS.”

The author of this communication to the American
Journal of the Medical Sciences (April, 1887) proposes as a
convenient designation for the “ hitherto undescribed neu¬
rosis ” the name of “ narkophypnia,” a suggestion which we
trust will not receive general support. There is, he states,
nothing but the sensation of numbness in these cases, no
paralysis of motion or sensation, no change in temperature
of the affected part, the surface is not blanched or mottled,
and there is no tenderness on pressure. One case has been
under observation six years; the patient, a professional man,
aged forty-three, wakes up with a sensation of numbness
which may involve both hands, arms, shoulders, thorax, and
tongue. The sensation lasts no longer than one minute.

—

1 THE GORDON MEMORIAL.

Evkbyonb who wishes well to the youth of the country
will have learnt with satisfaction that the Gordon Boys'
Home has, during its short but useful past, fully justified
its claim to a continued existence. In the report submitted
last week to the Council of this institution it was shown
that the accommodation hitherto provided at Fort Walling-
ton is fully occupied—a sufficient proof that the benefits
afforded within its walls have been appreciated. Order, at
one time somewhat difficult to establish, is now satisfactorily
maintained, and, in spite of a considerable necessary outlay,
self-help and economy have materially reduced the amount of
working expenses, while the assets of the Home derived from
funded property have largely increased. Just at this time,
however, a large additional expenditure will be required for
building purposes in connexion with the formation of the
permanent establishment between Bagshot and Woking.
This work has already been begun, and it is hoped that by
next winter 160 boys will be in occupation of the new
quarters. It is hardly requisite to remind our readers that
the means at the disposal of the Council are still limited.
They do not suffice to meet the whole cost of this scheme of
extension. A greater sum than the available yearly inoome,
indeed, is required to maintain the educational machinery
in a thoroughly efficient state. The public are therefore
invited to contribute in aid of this very deserving project.
We cannot do better than advise them to accept the offer,
and thus to prove at once their sense of what is really most
practical in philanthropy, and their esteem for the memory !
of one who freely and most worthily spent his all and him¬
self in their service. We note with particular interest that
the new arrangements include the erection of a small
detached infirmary, and for this purpose £1000 will bs
required. No part of the contemplated changes is more
clearly desirable or even essential to the success of the
scheme as a whole. No school of this kind can possibly be
complete without its hospital, and the fact that this will
be a separate building in the new Home is an additional
guarantee that the management of affairs is in careful hands.

A POULTRY DEALER’S DEN IN THE EAST-END-

The sanitary inspector of the Whitechapel District
Board of Works has discovered a house in Spitalfielde
where the floor, bed, tables, and chairs were bespattered
with filth due to the killing, drawing, and plucking
of ducks and fowls. In the yard, in cages that did ns:
seem to hate been cleaned, there were a number of live
poultry. The occupier of the house was a foreign Jew who
deals in poultry. The odour of the rooms is described as
most sickening, and the drainage arrangements as in a truly
horrible state. Other rooms in this house were sublet and
greatly overcrowded. Poverty, overcrowding, and defective
drainage are bad enough of themselves, and too often
characterise the houses where foreign Jews crowd together
in the East-end of London. In this case, however, we have
an additional grievance; and, at first sight, it seems difficult
to explain how, under such unpropitious circumstances, a
trade in poultry can possibly be established. Why about!
purchasers patronise this overcrowded and ob&axkxu
private house instead of going to the market or to a dean
shop? A ready explanation, however, can be given. It
is a question of "Kosher” meat. The Jew must not eat
poultry killed in the ordinary manner, and this poultry
dealer buys live stock only, which he despatches in accord¬
ance with the rules laid down by the rabbi, and thus is able
to trade with the Jewish community. The grievance may
therefore be referred to the Jewish Board of Guardians and
the Sanitary Committee they appointed shortly after the
revelations we published concerning the sanitary c ondi ti on

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CHARGES AGAINST MEDICAL MEN.—LONDON WATER SUPPLY. [June 4,1887, 1147

of the sweaters’ dens in the East-end of London. The
Jewish laws affecting the slaughtering of animals for
human food were conceived with a view to the preservation
of health. The poultry dealer in question may have observed
the letter of these laws; but surely the condition of his
house as described by the sanitary inspector is not in keep¬
ing with the spirit of the law. This obvious fact will
commend itself to the more educated section of the Jewish
community; and, for the health and credit of their race,
measures will doubtless be taken by the Jews themselves to
abate the nuisance. _

THE FIELD OF VISION IN NEUROSES AND
DURING THE MENSTRUAL PERIOD.

Db, Ii. Finkblstbin has drawn attention in a recent
work to the effect of various neuroses and of menstruation
upon the functional activity of the organs of sense, especially
of the eye. Thus he found, from a large number of obser¬
vations taken in Professor Merzheievski’s clinic for nervous
diseases in St. Petersburg, that in epilepsy, hysteria, neuras¬
thenia, delirium tremens, and during menstruation the field
of vision is perceptibly diminished in a concentric manner.
In epilepsy the internal radius of the field is usually most
affected. This diminution in the field of vision commences
before the fit, simultaneously with the premonitory giddiness,
headache, &c. The greatest diminution is, however, observed
immediately after the fit; by the next day the field has
always resumed its normal extent, no permanent effect
having been detected in any of the cases examined. The
field of vision for colours presented various anomalies, the
diminution being most marked in the case of green, less for
yellow and red, and least of all for blue. With regard to
menstruation, it was found that the field begins to diminish
from one to three days before the period, reaching its
extreme limit on the third or fourth day of the flux, and
returning to the normal about the seventh day. It varies
in degree direotly with the general condition of the woman
and with the amount of blood lost. Here the diminution of
the field of vision for different oolours does not appear to
vary, as in the case of epilepsy.

CHARGES AGAINST MEDICAL MEN.

It is to be hoped that the almost uniform unsuccess of
actions brought against medical men charged with offences
against women, said to be committed in the course of the dis¬
charge of their professional duties, will lead women to be more
careful in bringing such charges, and hysterical moralists to
be more chary of stimulating women to fancy themselves
injured. We would not say a word calculated to diminish
carefulness on the part of medical men. Rather would we
advise double caution in their professional relations with
women. For example, we think it highly indiscreet in a
medical man to administer an ansBsthetic to a female patient
without the presence of a third party. Also we think it
very inconvenient and unfit that a medical man should have
a habit of seeing patients in his bedroom. Such indiscretions
perhaps show only the oonfldence of medical men in their own
uprightness; but they are not to be approved for all that.
Still, when all care is taken, our profession, from its very
nature, will be exceptionally exposed to such attacks and
actions as those under notice. The presence of third parties
is a desirable condition of all consultations, but it is mani¬
festly often impracticable, and the main stay of the profes¬
sion must be on its own character and the delicacy of its
own sense of honour and purity. Fortunately, there is a
widespread confidence in the profession—a belief that it
realises its responsibilities and appreciates the obligations
imposed on it by the very interests with which it is trusted.
This confidence is shown not only by the verdicts of juries,

but by the observations of judges, and by the generous and
respectful tone of articles in our lay contemporaries called
forth by recent cases. We have been very much struck with
this tribute to the profession, which may well lead every
medical man to be doubly careful not to do anything that
will lower the high standard of professional honour and
morals, and it may well lead the medical bodies to deal
boldly in expelling those who discredit their diplomas. The
rarity of the necessity for such action on the part of the
medical bodies is the best proof that the profession is still
sound at heart and true to its great ethical traditions,
which embrace “whatsoever things are true, whatsoever
things are pure and of good report.”

LONDON WATER 8UPPLY.

A Contempobabv, commenting on the machinery for
the prevention of injury to health from London water
supply, observes that, now there are half a dozen chemists
and a Government water examiner engaged in this duty, if
anything goes wrong the fact is not likely to escape notice.
We have no doubt these gentlemen will do all in their
power, but the staff is deficient in the one officer who could
render most signal services to London; there is ample need
for the employment of an engineer and of analytical
chemists, but the subject which requires the most serious
study is the effect of water upon the health of its drinkers.
A medical man, skilled in sanitary science, is alone com¬
petent to undertake this duty, and Londoners should not
rest satisfied until their interests are protected by the
strengthening of the staff in this direction. The risks to
London from the present methods of supply deserve to be
immediately investigated, and every fact conoeming them
known; it will be little satisfaction to water drinkers if
this should only be undertaken after a repetition of the
calamitous experience of the year 1866.

COVERING WOUNDS WITH PLASTER.

At an inquest held in the Southwark Coroner’s Court last
Friday a point was brought out which is of some import¬
ance as bearing on the treatment of recent wounds. A
schoolboy running out of the school gates fell and cut his
forehead. The wound was strapped with plaster, and
everything appears to have gone well for four days. Then
shivering came on, and was followed by drowsiness deepening
into insensibility, and death resulted two days later. After
a post-mortem examination, it was decided that the fatal
issue was due to blood-poisoning brought on by neglecting
to cleanse and dress the wound, the plaster never having
been removed from the time of its application. In com¬
menting on cases of this kind one naturally allows
somewhat for the possible effects of shock occasioned
by the primary injury, which, without amounting to
any gross lesion, might yet materially influence the
flual result. Be this as it may, however, enough has been
shown in evidence to enable the coroner to assign to the
death in question a more direct connexion with the wound
itself. The practice of plastering over recent cuts is very
usual; it is also one which in numerous instances has proved
injurious. Apart from any question of blood-poisoning,
indeed, the mere tension of retained discharges is an
inevitable source of mischief where this custom is adhered
to. The simple rule in surgery which provides for the free
escape of pus where such is likely to form is one of which
we need not remind any qualified practitioner. Accidents
due to neglect of this rule are chiefly liable to occur when a
wound has been treated either by the injured person himself
or by a practising chemist. In such cases plaster is the first
resource, and is apt to be used rather well than wisely.

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1148 THB Lancet,] _ ADULTERATION OF OIL AND LARD, [JtrN* 4, 188T|

NEALE’S MEDICAL DIGEST.

The second edition of this work, the first edition of which
formed the seventy-fifth volume of the New Sydenham
Society’s publications in 1877, affords a means of ready in¬
formation regarding such discoveries, new doctrines, and
different methods of treatment in each department of
medical science as are likely to be of interest to the practi¬
tioner. An appendix to the work has now been published,
including the years 1882-3-4-5 and the early part of 1888.
Originally intended for the daily and hourly use of the busy
practitioner, there is hardly a case that one is called upon to
attend in which valuable suggestions cannot be obtained
by a simple glance at the pages of the Digest. We have
already noticed Dr. Neale’s work, but are induced again
to call our readers’ attention to the work for this reason:
weekly, nay daily, we receive from correspondents queries,
the answers to 99 per cent, of which are contained in this
volume. All of us are conscious of valuable time having
been lost in searching back numbers and wrong volumes
of periodicals for what, after all, will most probably be
missed, and to obviate such loss we can recommend to our
readers no better method than reference to the Digest and
its first Appendix. _

SEASONAL RELATIONS OF CHOREA AND
RHEUMATISM.

In his paper on a partial study of the seasonal relations
of chorea and rheumatism in the Medical News of Nov. 13th,
1886, Dr. Morris J. Lewis finds that while the chorea
tracing shows a strong tendency to keep pace month by
month with the irregularities in the storm tracing, that of
rheumatism, while also strongly resembling the latter, may
be seen to be exactly one month later, looking as if the
effect of the meteorological changes was immediate in the
case of chorea—as it is now acknowledged to be in some
varieties of neuralgia —and preparatory only in cases of
rheumatism. “ Prom the close relationship known to exist
between these two diseases one might be led to suppose
that the rheumatism tracing would precede, or at least
accompany, that of chorea, instead of following it, as this
study seems to show." _

ADULTERATION OF OIL AND LARD.

Olive on, is adulterated extensively, and lard is also
adulterated. These are among the latest discoveries of
the daily papers, and for a day or two they have
attracted some feeble indignation in the public mind.
“ n ° w fraudulent—how disgraceful! ” say a few, and then
pass on to some other novelty. Of course, oil and lard are
adulterated. No one who knows anything of the trades
doubts it. Dishonest vendors are making profits freely
by their dishonesty, but nothing noxious is sold to
the public, and as for the fraud, who cares? Cer¬
tainly not the Government, who are too busy to think of
such things, and certainly not the public, who are too
apathetic to care about anything that does not come
before them with a flourish of trumpets. The British consul
at Leghorn has recently made some strong remarks on the
barefaced frauds now openly perpetrated in Tuscany and
England. Not only is olive oil freely adulterated with the
cheaper oil of cotton seed, but the well-known flasks and
cases are now sent empty to London to be filled with cotton
seed oil and sold in England as olive oil of fine quality. It
may well be asked, Is there no possible remedy for such
audacious swindling ? Of course there is; the remedy is
simple enough. The adulterations of olive oil can easily be
detected, and fraudulent vendors might easily be punished
if it were not for the absurd difficulties which are engendered
by our English law. Give us a more stringent Adulteration
Act, which shall not only confer greater power ttpofi local

authorities, but compel them to exercise it, and such frauds
would soon become matters of history. At present, however,
there seems little chance of such an upheaval of commercial
morality.

LEUCOCYTOSIS AND NEW GROWTHS.

Almost any sudden or rapid change in the organism
appears to be attended with an increase in the white blood
corpuscles. In fevers, inflammations, and especially sup¬
purations, a leucocytosis may always be detected.* A careful
paper on this subject was communicated to the Royal
Medical and Chirurgical Society by Mr. T. P. Goatling two
years ago. Hayem has recently read a paper on the lenco-
cytosis accompanying the development of neoplasms. A cubic
millimetre of blood should yield normally 6000 white blood
corpuscles, but the numerical fluctuations are greater for
white than for red blood corpuscles. Hayem, assisted by
M. Alexandre, draws the following conclusions:—Scxzrhua
and encephaloid cancers are accompanied by a slight increase
in the number of white blood corpuscles. The leucocytosis
is much more marked with osteo-sarcoma and lympho¬
sarcoma. Epithelioma has the least influence in imtnmwg
an increase in the white oorpuscles. Hayem believes that
the leucocytosis may prove of diagnostic service, and
mentions a case of doubtful epithelioma of the foot in which
M. Alexandre counted 14,000 white globules per cubic
millimetre; it was thought during the life of the patient,
from this circumstance and from the absence of inflam¬
matory complications, that the disease might be cancerous.
The case terminated fatally after operation, and the necropsy
revealed several visceral neoplasms of encephaloid structure

ANOTHER DEATH ON A TRICYCLE.

Closely following the death of Prof. Hack of Frsibmg
on a tricycle, a well-known inhabitant and parochial
official of Plumstead has met with a similar end. On the
Queen’s birthday he rode out into the oountry, and after
having ascended a hill near Hidonp, and while going steadily
along a level road, smokiDg according to his usual practice,
he was seen to fall from the machine. The bystanders
appear, unfortunately, to have attempted to raise him into
a sitting posture against the bank, and he died in a few
minutes. According to the published report of the inquest,
the medical evidence was to the effect that “ all the organa
of life were healthy, and that death had been the result of
syncope produced by over-exertion after a hearty meal.”
The deceased was fifty-five years of age. Healthful aa
cycling is for those who are young and strong, with aa
unimpaired condition of the circulatory organs, it becomes
a dangerously severe exercise for persons who, besides being
somewhat advanced in life, have any cardiac or arterial
mischief, and if indulged in to the point of riding up hills
immediately after a heavy meal fatal oonsequenoM may vary
easily ensue. _

THE LATE8T CURE FOR CONSUMPTION.

The recent observations of Dr. Kolischer upon a new
method of treating tuberculous disease of joints, which were
described by our Vienna correspondent last week, appear
to have excited considerable attention. The method, based
on the fact that tubercle deposits do sometimes undergo
spontaneous “ cure ” by calcification and fibroid changes, was
an endeavour to excite such retrogressive change artificially.
The results obtained in the few cases at present thoroughly
treated were certainly striking, and were declared by Pro¬
fessor Albert to surpass any other plan of treatment yet
in vogue. It is now said that Dr. Kolischer contemplates
applying the same method to the treatment of visceral
tubercle, and [once more the world is agitated by the

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lHX IiANCBT,]

A CASE OP HYDROPHOBIA.!—INFANTILE DIARRHCEA.

alleged discovery of a “ cure for consumption.” We would
counsel a little patience before accepting even the possibility
of being able to artificially arrest the progress of pulmo¬
nary phthisis by the administration of acid phosphate of
lime or any other salt. At the same time, we would by no
means discountenance a fair trial of any plan which, as in
this case, is based on rational grounds. Perhaps between
the varied efforts to discover germicidal agents on the one
hand, and drugs to render the tubercular neoplasm obso¬
lete on the other, we may one day arrive at some panacea.
There is not much, however, in the recent history of the
treatment of phthisis to render us very sanguine of such a
result being attained. _

CLINICAL SOCIETY.

At the list meeting of the Clinical Society a vote of
thanks to the Committee for its report on the connexion of
joint disease with locomotor ataxy was proposed by Dr.
J. G. Glover, seconded by Dr. Ormerod, and agreed to with
acclamation. The President said that the report was a most
valuable one, and would reflect great credit on the whole
Society. The names of Sir James Paget (chairman of the
committee) and of Mr. Bilton Pollard (the hon. sec., on
whom it is understood a considerable amount of work fell)
were specially mentioned in the vote of thanks. Mr. Bilton
Pollard thanked the Society on behalf of the committee, and
said that the report comprised the results of observation
of a large series of cases of joint disease in locomotor ataxy
and of ordinary osteo-arthritis, and, so far as the cases
Allowed, he thought the report went far in the direction of
settling points raised in the debate.

VACCINATION IN NATAL.

The precautions necessary to be observed against small¬
pox epidemics appear to be sadly neglected in Natal. At
the last half-yearly meeting of the Vaccine Board it was
stated that forty-eight births had been registered in the
Newcastle division during the latter half of last year, and,
as far as could be ascertained, not one of these children had
been vaccinated. _•

A CASE OF HYDROPHOBIA.

A cash of hydrophobia was admitted into St. Thomas’s
Hospital on May 16th. The boy, aged six, was bitten by a
dog over the left eye two years ago; the wound was not
treated in any way; he was quite well until the evening of
the 15th ult., when he was observed to be rolling on the
floor, and soon refused food and drink. He was admitted
on the evening of the 16th, the symptoms then being a
peculiar jerky inspiration with a condition of great terror
and excitement. He soon developed well-marked symptoms,
having general convulsions on attempting to drink, and
constantly ej acting saliva from his mouth. He was quiet and
sensible between the paroxysms, complaining of toothache
on the left side. He died on the evening of the 17th from
cardiac and respiratory paralysis.

NO MEDICAL EVIDENCE.

Air inquest was held on May 24th by Mr. William Carter,
at York-street, Lambeth, touching the death of Sarah Clara
Watson, aged fifty-one years. From the evidence, it appears
that the deceased had been addicted to habits of intemperance
for twenty years. On the day of her death she called up
her son, and complained of feeling ill. A glass of wine was
given to her, and immediately afterwards she fell prone
on to her bed, and appeared to sink into ° a sotlnd sleep.”

[Jpns A,188T. 114$

Two hours later it was discovered she was dead. No medical
man was sent for, nor was any medical evidence called
for at the inquest. The deceased appears to have mani¬
fested some delusions shortly before her death, and it is not at
all improbable that she had delirium tremens, and that she
died from sudden failure of the heart’s action—an issue hot
very uncommon in that affection. Moreover, long indulgence
in alcohol is calculated to produce fatty degeneration of thd
heart’s substance, and this may have conduced to the fatal
event. At the same time, we cannot but think that a medical
man should have been summoned when the deceased warf
found to be dead, or apparently dead, and that the case w mi
one in which a post-mortem examination should have been
made. In every case of sudden death, where the cause is
not obvious, the jury should have something more than pro¬
babilities to guide them. _

NEPHRO-LITHOTOMY IN AUSTRALIA.

Dr. W. Gardner, surgeon to the Adelaide Hospital, reporta
a successful case of nephr’o-Jithotomy, which is of special
interest as the first case in which this operation has been
performed in Australia. The patient was a man twenty-
three years of age, who dated his troubles from a fall, which
was immediately followed by hasmaturia. For three years
he suffered from pain in the left loin and testicle, haamaturia,
and frequent micturition. There was marked tenderness of
the left kidney. Dr. Gardner cut down on to this organ from,
the loin, found a stone in it, and removed it., The calculus
was composed of oxalate of lime. The patient made a good
recovery. It is satisfactory to find that the value of this
operation is appreciated in our far-off colonies, and that
they are supplied with surgeons so alive to the advances
made in Europe, anfi so well qualified to give their patients
the benefit of them._ ,

INFANTILE DIARRHCEA.

The latest recommendation for the treatment of the
“green diarrhoea” of infants is that of M. Hayem, who
has tried with much success the hydrochloric and lsctio
acids, the latter being preferred. A teaspoonful of a 2 per
cent, solution of lactic acid , is given after each -stool, as
much as from forty to sixty centigrammes a day being
taken by the infant. M. Lesage has investigated the stools
and has discovered a microbe, which will probably receive
more attention. The activity of this microbe is diminished by
acids, hence the explanation of the value of the above treat-'
ment.

MR. LUND, F.R.C.S.

We. regret to hear that Mr. Lund, whilst engaged last,
Saturday in his duty as an examiner in the Final Fellowship,
was seized with a slight attack of an apoplectic nature. We
are very glad, however, to be able to state that he is now so
far recovered as to be able to leave his bed, and will after a
few days’ rest probably be able-to resume his professional
duties. _

DEATHS OF EMINENT- FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announced:—Dr. Emil Huber, Extraordinary Pro-’
feasor and First Assistant in the Leipsig Pathological
Institute.—Dr. Ferdinand Hauska, Emeritus Professor of
Medical Jurisprudence in Vienna.—Professor Hamernik, of
Prague, in his seventy-seventh year.—Dr. Jewell, Professor
of Neurology and Mental Diseases at the Chicago Medical
College.—Dr. Alexander Ecker, Professor of Anatomy in
Freiburg—Dr. Francois Vleminckx, secretary of the Brussels
Medical Federation. •

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1 ] 50 The Lancet,]

University college, London.

[June 4,1887.

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin .—Profeasor Senator has succeeded Professor Henoch
in the charge of the clinic for children’s disease, Professor
Henoch being obliged to retire on account of ill health.

Buda-Pcsth. —Drs. Jendrasaik and Moravcsik have qualified
as Privatdocenten; also Dr. Pertik, Prosector of the new
City Hospital.

Leipsig. —Dr. Winkler, of the Freiburg Bergakademie, has
been appointed Professor of Chemistry, with the charge of
the physico-chemical laboratory, in succession to Professor
G. Wiedemann. _

Messes. Longmans and Co. announce as almost ready
for publication the following amongst other new books
and new editionsA Text-book of Elementary Biology, by
R. J. Harvey Gibson, M.A., F.R.S.E., Demonstrator of Biology
in University College, Liverpool; Modern Theories of
Chemistry, by Professor Lothar Meyer, translated from the
fifth German edition by Messrs. Bedson and Williams; a
new edition of Huth’s Marriage of Near Kin; Electricity for
Public Schools and Colleges, by W. Larden, M.A.; and
Elements of Physiological Psychology, by George T. Ladd,
Professor of Philosophy in Yale University.

It is satisfactory to learn that the Home Secretary has
advised Her Majesty to commute the sentence recently
passed upon the two prisoners at Warwick Assizes for
having caused the death of a young woman by procuring
abortion. As we remarked last week, heinous as is the
offence of criminal abortion, there are yet certain features
in connexion with this oase which seem to show that justice
will be satisfied with a less penalty than the highest the law
can inflict. _

On Wednesday, at the French Academy of Medicine,
Sir T. Spencer Wells was elected Corresponding Foreign
Member, “« la prctquc unanimity des suffrages"; and last
month he received the diploma of Honorary Fellow of the
German Society of Surgery, conferred at their sixteenth
Congress. _

We are requested to inform subscribers to the Jacob
testimonial that the presentation of the address and purse
of 600 sovereigns will be made at 6 p.m. on Monday,
June 6th, at the Royal College of Surgeons, Dublin.

Me. A. Maemadcke Sheild, M.B., B.S. Cantab., F.R.C.S.
Eng., assistant surgeon to Westminster Hospital, has been
elected an assistant surgeon to Charing-CToss Hospital.

The ninth annual congress of the American Laryngological
Association was held at New York on the 26th ult. and two
following days. _

UNIVERSITY COLLEGE, LONDON.

The distribution of prizes by the Faculty of Medicine of
the London University College took place on Wednesday,
when Sir George Young, Bart., presided. There was a large
attendance of professors and students. After the reading

of the report by the Dean of the Faculty and the presenta¬
tion of the prizes,

The Chairman addressed the students. lie congratulated
the recipients of the prizes, and after referring to the past
work of the College and the loss sustained by the death of
Dr. Wilson Fox, he alluded to the establishment of the
Victoria University, its general objects, and its effects on the
London University College. He pointed to the fact that a

number of medical students in London were in the habit
of going to the provinces to qualify by residence at
some other school for the attainmeht of the degree
which the authorities of the school bad power to give.
Admitting that there were teachers elsewhere as eminent
as those in London, why should he hesitate to say, when it
was universally acknowledged, that there was no medical
school in the kingdom which could claim a higher tradition
of successful teaching than their own, that the general hos¬
pitals of London with their eleven medical schools afforded
a field for study which it was ridiculous should be deserted
for other fields under the stress of artificial regulations?
Not only were medical schools dependent upon hospitals,
but hospitals were dependent upon them. Each school
had to provide not merely the clinical teaching which the
hospital wards supplied, but scientific instruction of a
multifarious and costly character. When a school was a
constituent of a general college the instruction was ready
to hand, but elsewhere it was too often improperly pro¬
vided. Most of the lesser schools had lately acknowledged
their insufficiency', and had entered into an arrangement vnth
the Government School of Science at South Kensington
to get that part of their work done for them. To that
arrangement the Council of the College took exception on
account of its exclusive character. A remedy for the existing
evil was needed which should put an end, not to wholesome
emulations, but to the mischief which proceeded from their
excess, which would enable other schools, without fear of
losing ground, to permit their students to come to the
London University College for scientific instruction, and
which should bring together the teachers and administrators
of the schools to concert, on equal terms, on a common
platform, with the University, means for the improvement
of medical education. Considerations of that nature bad
led to the movement for a Teaching University in and for
London, which bad now been brought to a practical stage
of definite proposals and .a formal programme. They asked
that the same privilege which had been conceded to the
country colleges through the Victoria University should be
conceded to them. They wanted a degree giving authority,
in which their administrators and teachers should have their
due share of influence. They wanted a new institution^
a federation of the University colleges and medical schools in
the London district—whereby measures might be arranged,
in concert, for the promotion of university education.
They could not go to Manchester, or so far give up
their position and history as to apply for admittance
to the offspring of their offspring. To do so would
be to accept a position in a university of an imperfect
type, when the perfect type of a localised university
was open to them. If the population of this vast
metropolis was not sufficient to support a university,
what population was? The last report of the Senate
Committee of the London University had been carefully
considered by the College, but its proposals did not amoant
to the foundation of anything analogous to a Teaching
University for London. They were limited to the admission
on the Senate of eight representatives of bodies called
Faculties, which were again to be composed of the repre¬
sentatives of the teaching institutions throughout England
sending up students to the University examinations. There
was also a provision for Boards of Studies, and there
was to be an addition to the preamble including among
the purposes of the University “ the promotion of regular
and liberal education throughout Her Majesty’s dominion?,
and especially in the metropolis and its neighbourhood.'’
There was, finally, a proposition that the University was to
be at liberty to found professorships and lectureships pro¬
vided they were not of a kind likely to compete with the
University College. The proposals, however, were of a very
meagre character: nothing was done for the organisation of
university education in London. The Boards of Studies, the
Faculties, and the new members of Council did not belong
to London, but to England at large, and they could not meet
the evils that had been pointed out. They tended to inter¬
fere with the position of impartiality which the University
was bound to maintain. By mixing up the system of an
Examining University with the system of a Teaching
University they ran the risk of spoiling the work the
University was doing, and they were quite certain not
to do well the work that was waiting to be done.
The real work of a Teaching University was not merely to
provide for, but to commend to its students, the beet methods
of study under the best teachers; in the Examining Carver*-

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BOYAL COLLEGE OP SURGEON8.—HEALTH OF ARMY HORSES. [June 4,1887. 1151

nty the degree was only the mark of attainment. The two
systems were not compatible. But if mutually destructive
when blended in one institution, there was room for them
both. There was plenty of room far an Examining Univer¬
sity in the British Empire. Even though a certain proportion
of its candidates from London institutions were withdrawn,
[.here would still be plenty of candidates for its degrees,
and plenty of honour attaching to them. But why should
institutions like the London University College be lor ever
debarred frota the right to confer, under proper guarantees,
the honour of a public degree ? They asked that a charter
to confer degrees upon all persons who had undergone a
regular course of study in a college or medical school of
the University, and had passed the required examina¬
tions, should be granted to a suitable governing body
upon which the governing bodies of University College,
ot King’s College, and of the teaching staff, not merely
3f those Colleges, but of other medical schools, should
be represented. To this end they sought an alliance
with the Royal Colleges of Physicians and Surgeons,
thus offering guarantees to other medical schools that their
interests would be respected. It had been objected that the
degrees of the London University having been kept at a
high standard, the degrees of the new University would not
be kept as high. He did not deny that it was one of their
Dbjects that degrees should be more easily obtained by
London medical students. There was always some work
thrown away in preparing for the best of examinations, and
in preparing for an examination against which great
objections were urged, which was arranged independently
of the teachers who prepared for it, the amount of friction
md wasted work was considerable. Assuming that a
London degree represented higher attainment than an
Edinburgh or a Cambridge degree, that was an excellent thing
for the University and for those who attained its degrees, but
it was a bad thing for the much greater number who gave up
all hopes of a degree, but who might have been stimulated
to meritorious exertions for a prize which was within
the reach of effort. It was a still worse thing for youths
who ran away to Newcastle, because they foresaw that in
xmntry practice they would be at a disadvantage beside
the Newcastle men. The next objection was that the pro¬
fessors wanted to “ brand their own herrings,” that the
iefects of their teaching should be concealed by the
Government stamp, which was placed in tbeir own power
to confer. That accusation was a mistake. The University
system to which more than any other the accusation
applied was that of the University of London. Again, it
had been urged that the establishment of a new University
with power to confer degrees with a licence to practise was
objectionable as increasing the number of bodies con¬
ferring such licences. The remedy would be easy if a
cordial alliance could be established with the Royal
Jollejjes. There would be no interference with their pre¬
rogative and no addition to the number of licensing bodies.
There was at present a movement on foot at the College of
Physicians for a single Faculty university in London, or an
nstitution in the nature of a university to oonfer medical
legreea alone. That movement appeared to tbe London
Jniversity College to be part of its movement. Regarding
t as a separate movement the College could not look upon
t altogether with approval, as it would be fatal to its
nedical school; but if tbe movement of the Colleges of
’hysidana and Surgeons could be brooght into line with
hat of the University College, then, indeed, they would bave
ibtained a very large part of what they sought. No doubt
here were great difficulties to be encountered. Some of
heir number, including their President, and others who
lad held high office, had thought it their dnty to with-
Iraw from the Council of the College. They had. how-
ver, encouraging assurances from influential quarters
f sympathy with tbe movement, and they would, no
oubt, soon be in a position to All up satisfactorily their
epleted ranks. Those who remained were not discouraged ;
hey were now unanimous amongst themselves; they had
he unanimous support of the professors; they had tbe
nanimous voice or King’s College, once their rival but now
heir cordial ally; they had friends in tbe press, in every
ledical school in London, and every university in England,
'hey believed in tbe f utore capabilities of tbe institution, and
hey desired to make it greater than it was at present, more
plendid, more efficient, and in that aim they expected to suc-
eed, because they were not labouring only for their own
ggnuuUsement, but towards the foundation of a university

which would be of incalculable benefit to the cause of
education in the mighty metropolis in which they lived.
(Loud applause.)

On tbe motion of Mr. Ebichsbn, a vote of thanks was
passed to Sir G. Young for his address.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

Wb have received from the Secretary of the College for
publication the subjoined abstract of the petition to the
Queen for a Supplementary Charter. Copies may, we
understand, be obtained on application by Fellows and
Members of the College.

The following are the purposes for which the application
is about to be made:—

1. To enable tbe College to hold “ lands, tenements, rents,
and hereditaments” of an annual value not exceeding
£20,000, instead of £2000 as by present Charter.

2. To enable the Council to determine by rules and regu¬
lations, instead of, as at present, by bye-laws, the conditions
of admission to tbe Fellowship by examination; and to
determine by bye-law, instead of by Charter, the fees payable
for such Fellowship.

3. To empower the Council to elect to the Fellowship
Members of twenty years’ standing, not exceeding ten
(instead of two) in each year, on the payment of the same
fee as required for the Fellowship by examination.

4. To authorise the election by the Council of any number
of persons, not exceeding two in each year, whether a
Member or Members of the College or not, having, in the
opinion of the Council, to be ascertained and expressed in
each manner as the Connell may from time to time think
fit and direet-, rendered distinguished service in the ad¬
vancement of surgery or the sciences allied thereto, such
persons to be and be called Honorary Fellows. Such Hono¬
rary Fellows not to pay any fee, and to be ineligible to vote
for the election of members of the Council.

5. To provide that Fellows may vote in the election of the
Council either in person or by voting papers, each papers to
be signed, authenticated, and delivered in such manner as
the Council shall from time to time think fit and direct.
No election of members of Council to be valid unless there
shall be present at the meeting for the purpose of Buch
election such number of Fellows as the Council may from
time to time think fit and direct.

6. To render Fellows of ten (instead of fourteen) years’
standing eligible for election as members of Council, and to
abolieh the restriction in regard to their practising as
apothecaries.

7. To simplify tbe mode of nomination of Fellows, candi¬
dates for election to the Council, by requiring in each-case
only one nomination paper to be signed by three Fellows.

8. To dissolve tbe Midwifery Board.

9. To enable tbe Council to increase the number of members
of the Board of Examiners in Dental Surgery, and to require
that those members of the Board described as “ persons
skilled in Dental Surgery,” wbo shall in future be elected,
shall be persons registered under the Dentists Act of 1878.

May 23 rd, 1887. Edvtabd Tbimmbb, Secretary.

HEALTH OF ARMY HORSES.

The annual statistical and general report of the principal
veterinary surgeon of the army, for the year 1886 has just
been issued, and is of a very satisfactory character. The
mean strength of the army horses at home was 12,393; the
admissions on the sick list during the year were in the pro¬
portion of 628 per 1000; the deaths from all causes were
18 - 8, of which 12 - 5 were the result of disease and 6 3 were
destroyed for various causes. The proportion cast and sold
amounted to 87'5, and the constantly non-effective from
disease and injury to 38-0 per 1000 of the strength. Compared
with the preceding year’s results, the admissions wereslightly
higher, thedeathsand constantlynon-effective were identical,
and there was a slight decrease in the number cast. TbO Royal
Engineers furnished the highest proportion of cases, amount-

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1152 The Lancet,]

ARMY MEDICAL STAFF DINNER,

[J UIIS 4,1887.

ing to 825, and the Life Guards the lowest, being only 428
per 1000. The highest death-rate (25 - 3) was in the Heavy
Cavalry, and the lowest (14-4) in the Field Artillery. The in¬
crease in the admissions has been chiefly from diseases and
injuries of the locomotive apparatus, particularly contusions,
sprains, and diseases and injuries of the feet; there has also
been an increase in diseases of the digestive apparatus,
especially colic, and in strangles and epizootic fever. Only
one case of glanders occurred; it was in a remount of the
13th Hussars at Colchester, which had just joined from
Ireland, where, it is believed, the disease was contracted.
The 2nd Life Guards in Regent’s-park Barracks had 65
cases i of epizootic fever, being in the ratio of 247 per
1000 of the strength, and nearly half of the admissions
from this cause in the whole force. The only other stations
at which it prevailed to any extent were Canterbury and
Aldershot, which respectively had 20 and 45 cases, or 537
and 21*9 per 1000 of strength. Dr. Fleming does not assign
apy reason for this outbreak in the 2nd Life Guards, but he
remarks: “It will be noted that the Regent’s-park Barracks,
London, continues to be by far the unhealtniest of all the
stations for mounted corps in the United Kingdom, the
average sickness from zymotic diseases being 2471 per cent.,
the next highest being Canterbury, with 5 37 per cent., and
the next Aldershot, with 219 per cent.” Previous reports,
however, do not quite bear out this statement about the
Regent’s-park Barracks, and it is noteworthy that in every
year in which they havo been recorded as furnishing such
cases they have been occupied by the 2nd Life Guards. The
immunity of the lstand liability of the 2nd Life Guards to these
diseases is a subject worthy of investigation. A case of rabies
occurred in a horse of the 1st Life Guards three months after he
had been bitten at Wormwood Scrubbs, although cauterisation
of the wound had been immediately resorted to. The highest
annual ratio of admissions occurred among the four-year-
olds, and the deaths among them were twice as high as at
any age up to seventeen—results in accordance with those
of previous years.

The proportion of horses cast has been lower than in
any of the preceding four years, but their average service
has also been lower, having been only sevjn years and seven
months, while in previous years it has usually been a little
over nine years. Nearly one-third were cast for “ old age.”
The average price received for them was £10 0«. 9<f., which,
although a trifle higher than in 1885, was considerably under
the prices of preceding years.

In addition to the information respecting the horses in the
United Kingdom, the report contains, for the first time,
returns of the horses, mules, and camels in charge of the
veterinary officers in Egypt and in Natal. The results for
the animals in Egypt are shown in the following summary:

fifth was returned as asthenia and exhaustion. Surely there
must have been gross neglect somewhere to permit of such
results. Of 209 camels which died or were destroyed, 178
are accounted for under the head of asthenia mwi exhaus tion.
On this disgraceful state of matters Dr. Fleming prudently
refrains from comment.

The strength of animals employed by Government in Natal
is stated at 732 horses and mules, but the number* of each
are not given separately. The cases among them amounted
to 759, and the total mortality to 1420 per 1000 of the
strength. Of the ninety-one animals which died, sixty-one
were returned under the head of anthrax, and seven of in¬
testinal calculus caused by the horses eating sand. Of
“ anthrax ” Dr. Fleming says that “ in some parts of the
most fertile portion of the Gape and Natal colonies it is im¬
possible to keep horses during the summer season, nearly all
perishing from this plague.” Of seventy-one army horses
and mules attacked during the year under review, only ten
recovered. The Government has sent out a veterinary
officer, who has gone through a special course of training, to
investigate the nature of the disease “ and to attempt its
suppression by the adoption of the method of protective
inoculation with attenuated or modified virus, introduced
by Pasteur and others so successfully in the case of European
anthrax.” We shall look forward with much interest to the
result of these experiments.

In addition to the information on the subject of the health
of the army animals at home and abroad, the report gives
an interesting account of the good work going on in the
Army Veterinary School at Aldershot. The instruction
given in it is not confined to the veterinary officers, but is
open to any officers of the garrison who may choose to avail
themselves of it. A considerable number have advan¬
tage of it, and there can be no donbt that the knowledge
thus acquired may prove moet useful in a campaign and in
the colonies. The school is also turned to account in training
a body of farriers to act as veterinary assistants or sab-
ordinates—a system which has already been found to work
advantageously on service in Egypt and South Afriea.
Dr. Fleming has given some details of hie proposed farriery
reorganisation, which appears calculated to diminish the
labour and increase the efficiency of the department; and
also a short but interesting article on winter shoeing, which
we recommend to the attention of all who require to use
their horses in winter, whatever the weather may be. The
careful manner in which the report has been drawn up, and
the practical character of the suggestions it contains, are
worthy of Dr. Fleming’s reputation, • and the satisfactory
state of health of the army horses reflects credit upon the
department over which be presides.

The admissions of horses were not excessive, considering
the circumstances under which they were employed; two-
thirds of the cases were of injuries and diseases of the
locomotory apparatus and surgical disenses and accidents.
Digestive diseases, chiefly 'colic, were next in frequency,
and then general diseases, of which more than half were
returned under the heads of anfemia and asthenia. The
most fatal diseases were those of the digestive apparatus,
causing eleven deaths, of which four were from colic and
four from enteritis. The colic “was, in many• instances,
due to the horses eating sand, usually with their food.”
There were only nine cases of glanders, which were, of
course, at once destroyed. Considering the great pre¬
valence of this disease in Egypt, the army horses appear to
have been very fortunate.

The mules furnished a very low ratio of cases and of
deaths. The diseases from which they suffered were much
the same as those of the horses, but they had only two
o^ses of .glanders.

Thje history, of the army camels, as shown, by these
returns, is a very melancholy one. The proportion of cases
and of deaths wa9 extremely high. Of the former, two-
thirSa were cases of flore back from the saddles, and one-

ARMY MEDICAL STAFF DINNER.

The annual dinner of medical officers of this depart¬
ment was held at the Hoi born Restaurant on June 1st,
Sir Thomas Crawford, K.O.B., in the ohair. The following
officers and guests were present:— Inspectors- and Surpeonf-
General: Lawson, Balfour, Gordon, C.B., Ker lanes, C.IL,
Sir T. Longmore, C.B., Massy, C.B., Manifold, Fraser,
Mackinnon, C.B., Irvine, Handley, CJ3., Ekin, C.B,
Muschamp, and Fuller. Deputy Inspector a- and Surpeons-
General: Swettenham, Laing, Fox, Fraser, Reads, C.B-,
Marston, Roberts, Veale, Watts, Sly, and Don. Brigade
Surgeons: Ashton, Herbert, Wade, Inkson, Warren.
Prescott, Gribbon, Maunsell, Wright, Leask, Mackinnon.
Lloyd, Adoock, Tomlinson, Clarke, and Anderson, 0.1 JL.
Surgeons-Major: Lane, Churchill, Hensman, Staples,
Maunsell, Scott, C.M.G., O’Dwyer, McNalty, Nash, Beattie,
Johnston, Macartney, Morgan, McSwiney, Macrobin, Frazer.
Roe, Oiery, Williamson, Ash, Donovan, Buake, Altin,
Miller, Gormley, Scott, and Powell. Surgeons; Ligert-
wood, Penn, Ryan, Tuthill, Kirkpatrick, Seymour, Clark.
Flood, Harwood, MaoNeece, Baker, Twiss, Sloggett, Porter,
Johnston, Reade, Semple, Carte, Sheldrake, Zimmerman,
Bostock, Hale, and Min niece. Guests; Sir Charles MeGrigor,
Bart., Sir J. W. Reid, K.C.B., Sir William Mac Ctormac,
Inspector-General Dale, Dr. Glover, and Messrs. Pollock,
Holt, and Hart.

-The health of the Diraotor-General of the Department was
proposed in very warm terms by Sir William Mac Germae.
In reply, Sir Thomas Crawford said that he was smtnfinim

hydrophobia and thb Pasteur institute. •

[Jfore 4i 1887. 1158

Thb Lancxt,]

mainly to effect two results—first, to hold high the standard
of professional efficiency and character in the army, and,
secondly, to approximate more and more the military and
the civil branches of the medical profession.

Smith, and Mr. Wm. Thomas were added to the directorate;
Mr. Bartlett and Sir James Sawyer were reappointed trea¬
surers, and Dr. Thomas Savage was re-elected honorary
secretary. The members afterwardsdined at the Grand Hotel,
under the chairmanship of Mr. A. P. Evans.

HYDROPHOBIA AND THE PASTEUR INSTITUTE.

WILLS OF MEDICAL MEN.

According to the report of the late Dr. Vnlpian, the secre¬
tary, the number of persons subjected at the Institute to the
Pasteur treatment during the fourteen months from the end of
October, 1886, to the end of December, 1886, was in all 2682.
Of this number 2164 had been bitten by animals known for
certain to have been mad at the time of biting, and the
remaining 618 by animals suspected to have been mad. Of
the 2164 bitten by animals undoubtedly mad and treated
according to Pasteur’s method, 29 persons died, representing
a proportionate mortality of 1*34 per cent. Of the 618
bitten by animals presumed to be mad, and subjected to
Pasteur's treatment, only 2 died—i.e., 0-36 per cent. The
statistics of rabies before the discovery and application of
the Pasteur method give the proportion of mortality from
that disease among the persons affected by it as at lowest
16 per cent. If, then, this, percentage be correct, the cases
of mortality amongst the 2164 persons in the state described,
had they not been treated by the Pasteur method, would
have been, not 29, but 346. With respect to the most dan¬
gerous cases, the report states that there were 48 persons
bitten by mad wolves, 186 persons bitten on head or race by
animals known to be mad, and 28 bitten on head or face by
animals presumed to be mad. Of the 48 in question 7 died—
ie., a mortality of 14 per cent. The mortality in similar cases
before the Pasteur method is ascertained to have been 60 to 80
per cent. Moreover, in three of the 48 persons symptoms
of rabies had actually appeared before the application of
the treatment, and their deaths may therefore be left out
of account, thus reducing the mortality of this class under
the Pasteur treatment to 8 per cent., as against 60 per
cent, to SO per cent., without this treatment. Of the 186
above specified, the number of persons who died was 9, or
4*83 per cent., as against 88 per cent, without the Pasteur
treatment. That is, out of the 186,163 would have died but
for this treatment, whereas under its employment only 9
died. Lastly, of the 28 above specified, only 1 died—i.e., a
mortality of 3*57 per cent. For some months past M. Pasteur
has modified his method, and in the most serious coses has
applied, not simple, but intensive treatment. And whereas
out of the 136 specially serious cases in which the simple
treatment was applied 9 died, in 60 specially serious cases
in which intensive treatment was applied no mortality
whatever is stated to have followed.

BIRMINGHAM MEDICAL BENEVOLENT SOCIETY.

Thb sixty-fifth annual general meeting of the Birming¬
ham Medical Benevolent Society was held on May 27th,
Dr. James Johnston in the chair, there being a good at¬
tendance of members. Dr. Thomas Savage, hon. sec., read
the annual report of the directors, which stated that during
the past year the Society had accomplished its usual amount
of work in a quiet, unostentatious manner. The invested
funds at the end of 1886 amounted to .£10,978. During
the year fifteen annuitants had received grants varying in
annual value from £10 to £40. The roll of benefit members
contains 272 names, the total receipts dnring the year reached
£616 2 8. 4«£, and grants bad been made to the amount of
£466. A new annuitant, a member of the Society, had been
added to the list, and a grant of £40 a year had been made..
The widow of a deceased member had also been made an
annuitant. Since the commencement of the present year
the widow of a deceased member had died. She was in
receipt at the time of her death of £25 a year, and had
received a total of £837 10«. from the funds of the Society.
Hot husband had paid as a member of the Society seventeen
goineas. Twelve new members had been elected, and six
Saddled. Mr. Alfred P. Evans (West Bromwich) was appointed
president; Dr. Charles Warden, president elect; Mr. Arthur
Oakes (Birmingham) and Mr. J. Arthur (Henley-in-Arden),
▼use-presidents; Dr. Marriott (Leamington), Mr. Priestley

Thb will of Surgeon-General William Rutherford, M.D.,
C.B., honorary physician to the Queen, late of 326, Vaux-
hall-bridge-road, who died on March 24th last, was proved
on April 27th by Mr. Peter Ronaldson and Mr. George
Ronaldson, the executors, the value of the personal estate
in the United Kingdom amounting to upwards of £49,000.
The testator bequeaths £600 to the Dublin Lying-in Hos¬
pital, and numerous legacies to relatives and others. The
residue of his property he leaves between the children of
his late first cousin Thomas Shirreff Rutherford, and three
of the children of his late first cousin George Rutherford.

The will and codicil of Dayrell Joseph Thackwell Francis,
M.D., F.R.C.P., formerly of Northampton,and lateofWethersell
Grange, Cranleigh, were proved on April 26th by Herbert
Howard Keeling, Mrs. Marian Howard Francis, the widow,
and the Rev. Edward Howard Francis, the son, the executors,
the value of the personal estate accounting to over £30,000.
The testator,'after giving legacies to sons and to bis trustees,
leaves all his real estate and the residue of bis personal
estate upon trust for his wife for life or widowhood, and
then for his children.

The will of John Jackson, M.D., a retired offieer of the
East India Company in their Bengal establishment, late of
5, Brunswick-terraoe, Brighton, who died on March 31st
last, was proved on Apru 23rd by Mr. Herbert William
Fisher and Mr. Charles Nottige Macnamara, the executors,
the value of the personal estate amounting to over £15,000.
The testator gives all his household furniture and effects
and £500 to nis wife, £60 to each of his executors, and
several legacies to brother and sisters. He also leaves
£10,600 upon trust, to pay the income to his wife for life,
and, after her death, upon the trusts of the marriage settle¬
ments of his three daughters. The residue of his property
he bequeaths to his wife absolutely.

Letters of administration of the personal estate of Thomas
Allen, M.D., late of II, Keppel-street, Rus sell-square, who
died on March 21st intestate, were granted on April 28th
to Mrs. Emma Allen, the widow and relict, the value of the
personal estate amounting to upwards of £14,000.

The will of Mr. George Curme, late of 9, Oomhill, Dor¬
chester, surgeon, who died on January 2nd last, was
proved on March 10th by Mr. Decimus Curme and Major-
General Joseph Hanwell, the executors, the value of the
personal estate amounting to £8600. The testator bequeaths
all his household furniture, wines, &c., and under hie
marriage settlement gives bis houses in Comhill and £3600
consols, to his daughter; his surgical books and instruments
and his Ross’s microscope, with all the fittings, to hie
nephew, Mr. Decimus Curme; and legacies to servants. Hie
estate at Whitchurch and the residue of his personal estate
he leaves upon trust for his daughter for life, and after her
death, subject to certain conditions, to Decimus Come and
bis sons. ___

The following legacies have recently been left to hospitals
and other medical institutionsMr. George Henry Johnson,
late of 10, Addison-crescent, Kensington, £106 each to the
Chelsea Hospital for Woman, Queen s Elm, Brompton; the
Metropolitan Free Hospital, 81, Commercial-street« St.
George’s Hospital, Hyde-park-corner; the West London
Hospital, Hammersmith; 8t. Mary’s Hospital, Paddington ;
the North London or University College Hospital, Gowei-
street; and the Middlesex Hospital.—Mr. Robert Cocks, late
of Wilby House, Ladbroke-terrace, Netting-hill, £200 to the
Gloucester Hospital.—Mr. 1 John Bowie, late- of the Beacon,
Exmouth: The testator gives and bequeaths all. such pasta
of his personal estate and property as may be (lawfully
bequeathed for charitable purposes to the treasurer for the
time being of the Brompton Hospital for Consumption and
Diseases of the Chest.—Mrs. Margaret Round, late of East-
hill House, Colchester, £100 to the Colchester Hospital.—
Mrs. Maria Newen, of 1, Hyde-park-terrace, £300 each to the

1154 Thb Lanokt]

REPORTS OP MEDICAL OFFICERS OF HEALTH.

[Jot 4,1887.

Brompton Hospital for Consumption; St. Mary's Hospital,
Paddington; and the Cancer Hospital, Fulham.—Mr. John
Marsden, late of Whitebanks, Chesterfield, Derby, .£100 to
the Chesterfield and North Derbyshire Hospital and Dispen¬
sary.—Mr. T. E. Jones, late of Whitefield House, Wilmslow,
Chester, and of Manchester, £600 to the Montgomeryshire In¬
firmary at Newtown; £300 each to the Manchester Southern
Hospital, Clifford-street, the Royal Eye Hospital, St. John’s-
etreet, Deansgate, Manchester, and the Homeior Consumption
and Diseases of the Throat, St. John’s-street, Deansgate; and
£200 to the Manchester Institution for Diseases of the Eye,
Byrom-street; the residue of his property he gives to the
Manchester Infirmary.—Mrs. Margaret William Tryon Cum¬
berland, of Enham Lodge, Lillington, Warwickshire, £300
•each to the North-West London Hospital and the Samaritan
Free Hospital, Seymour-street, and £100 each to the Hospital
for Women, Soho-square, and the Wameford Hospital,
Leamington. _

public Pealtjr anit fak

LOCAL GOVERNMENT DEPARTMENT.

BBPOBTS OF MEDICAL OFFICERS OF HEALTH.

Derby Urban District. —Mr. Iliffe, in his annual report for
1886, draws a comparison between the state of the borough
of Derby, as regards its appliances for improving public
health and the prevention of disease, in 1877 and the year
now reported on. The additions made to the security of
the borough have been substantial, and they have, of course,
not been made without a corresponding cost. But whereas
the death-rate in 1877-81 was 21 per 1000, it has been 18 - 2
for the period 1882-86; the scarlet fever deaths per 1000
have fallen from 43 2 to 10‘5, and the diarrhoea deaths
from 37 - 2 to 320. Enteric fever has unfortunately had
its downward course checked by the milk epidemic of
1884, a calamity for which it is held that the sanitary cir¬
cumstances of the borough were not responsible. Un¬
fortunately the experience of 1886 does not quite bear out
this view. Derby was one of the districts inspected under
the survey instituted by the Local Government Board in
view of the cholera prevalence in Europe, and it is
gratifying to note that Mr. Iliffe found material advan¬
tage from the co-operation of Mr. Bpear in the task of
improving such conditions as specially called for amend¬
ment. These related essentially to sewers, house drains,
and midden privies; and, naturally enough, water supplies
from local wells in such a place as Derby came under con¬
demnation. Enteric fever was far too common in Derby in
1886, and, after a somewhat exhaustive consideration of the
•conditions leading to it, the conclusion is arrived at that it
was mainly due to the contamination of the air by means of
the deposits in midden privies. Under such circumstances
any epidemic beginning with milk has its spread favoured.
During the year a total of 336 cases of infectious diseases
was notified; and the authority made final arrangements for
-erecting a new infectious hospital in the place of the wooden
one heretofore serving almost exclusively for small-pox.

Wavertree Urban District. —Although the death-rate
•during 1886 was not excessive in Wavertree, having been
16’0 per 1000, yet the list of infectious diseases given by
Dr. Harvey shows how much an infectious hospital is needed.
Typhoid fever of a bad type occurred; scarlet fever often led
to two, three, and fonr cases in the same house; and eleven
cases of diphtheria occurred. Dr. Harvey recommends a
•email hospital in or near the district. Preferably, it should
be in the district. There is too much tendency to profess to.
make use of hospitals in adjoining districts; whereas, as a
matter of fact, the mere existence of the hospital elsewhere
than in the district it is intended to serve often tends to
prevent its nse. Unless Wavertree can find such a hospital
dose to its own boundaries, it had better bnild a small one
within its proper limits.

Rutioom Rural District. —Dr. Adams tabulates at length
the instances of infectious disease occurring in hie distriot,
and the action taken with regard to each. An outbreak of
typhoid fever at the Overton Grammar School House at one
time caused anxiety, and led to a strong condemnation of
the prevailing sanitary conditions. These were, however,
fully remedied. Muob of the action taken, in this direction
*ttd*eHaHy ttftiiitatwl by-the eaMy nsdttoaUon of disease

which is given by an increasing number of medical practi¬
tioners. Great difficulties are experienced as to the wa f er
supply of Frodsh&m, and the blame for this is thrown an
the central authority who, it is alleged, oppose every scheme
submitted to them. The last attempt to deal with the
subject has again been opposed on the ground that the
supply in question was precarious in quantity and doubtful
in quality—a decision in which Dr. Adams does not concur.
In this he is supported by the county analyst, and by the
result of experiments as to the quantity of water available.
The death-rate for 1886 was 17 05 per 1000.

Friem Barnet Urban District. —The sewerage system does
not appear to be as yet in working order in this district.
When it is, it may be hoped that the complaints as to
sewer emanations from ventilators, and as to which char¬
coal trays are admitted by Mr. Stott to be no proper remedy,
will cease. Foul ditches should then also be done sway
with, the more so as At present they are associated with
the prevalence of diphtheria and pneumonia. Some time
since, Hornsey proposed to erect an infectious hospital close
to this district. Opposition came from Friern Burnet, but
now that the hospital is to be erected, joint action with
Hornsey is suggested. The general death-rate for 1886 was
13 0 per 1000 living, but the symotic rate was as high as
21, diarrhoea, due to defective sanitary conditions, Doing
a cause of the excess.

.Middlesex and Herts Combined District*.— In his pre¬
liminary report on this combined district, Dr. Saunders
refers to the fact that the repressive measures for the
purification of rivers has been a conspicuous failure, and ha
is inclined to attribute this to the circumstance that
attempted and actual legislation has been based on the
assumption that trade pollutions were of the greatest can-
sequence, and should be the first point of attack; whereas
such pollutions are not nearly so serious as those which are
brought about by the discharge of sewage into streams. And
he next urges that, if our rivers are ever again to be clean,
work must be done in their tributaries and in the sewer
ditches which so often exist in rural and semi-rural districts.
On the entire district the death-rate during 1886 was 16 4
per 1000, and the infantile deaths amounted to a rate of 116
under one year of age to every 1000 registered births. In the
detailed descriptions of the several districts, attention is
drawn to their most pressing sanitary wants. At times, as
in Barnet, scavenging by the authority is urged ; in other
cases the need for keeping filth out of ditches the water of
which is used for domestic purposes is dealt with. In the
Watford rural district a serious epidemic of enteric fever
took place in the London Orphan Asylum, the cause of the
disease being set down as due to milk. In the Hendon rural
district diphtheria at Little Stanmore again drew attention
to the need for eewering the village; and at London Colney,
in the St. Albans rural district, the school closets are reported
as being in a scandalous state. This latter is a matter which
should be brought under the notice of the Education
Department, who can bring pecuniary considerations to bear
upon school authorities. In Rome of the districts substantial
improvements have been effected, some of these being of a
permanent character; and we are glad to notice that the
Albury Hospital, belonging to the Berkhampsted- rural
authority, has again served its intended purpose of prevent-
ingthe spread ot infection.

Epping Rural District.— The work done in connexion
with infectious diseases is well set out in table* by Mr.
Fowler, the action taken in each case being duly recorded.
Diphtheria has been a serious cause of mischief in this
district for some years past, and Mr. Fowler feels sure that
it has not been due to any one specific cause, but that,
having once been introduced, it has been spread by a variety
of favouring insanitary conditions. Progress is fortunately
being made as to water provision, and some good work
has been done in the matter of drainage. The sanatorium
has only been used for small-pox, no special .demand having
oocurred for isolation in other cases. The death-rate to
1886 was 16-2 per 1000.__

VITAL STATISTICS.

HEALTH OF ENGLISH TO WEB.

In twenty-eight of the largest English towns 5787 Hrtfcf
and 3621 deaths were registered during the week ending
May 28th. The annual rate of mortality in theea town*
which had been 107 and 20 3 per 1000 in the preceding

The Lancet,]

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[June 4,1887. 1155

two weeks, further rose last week to 20"4. During the first
eight weeks of the current quarter the death-rate in these
towns averaged 20 - 6 per 1000, and was 17 below the mean
rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 15 7 in
Sunderland, 16*1 in Wolverhampton, 16 3 in Portsmouth, and
17‘1 in Leicester. The rates in the other towns ranged
upwards to 25 7 in Halifax, 260 in Preston, 29 5 in
Huddersfield, and 32 3 in Manchester. The deaths referred to
the principal zymotic diseases in the twenty-eight towns,
which had been 500 and 632 in the preceding two
weeks, were last week 522; they included 251 from
measles, 143 from whooping-cough, 52 from scarlet fever,
31 from diarrhoea, 23 from diphtheria, 22 from “fever" (prin¬
cipally enteric), and not 1 from small-pox. No death from
any of these zymotic diseases was registered during the week
either in Wolverhampton or in Halifax; whereas they caused
the highest death-rates in Salford, Manchester, and Norwich.
The greatest mortality from measles occurred in Sheffield,
Newcastle-upon-Tyne, Birkenhead, Salford, Manchester, and
Norwich; from whooping-cough in Newcastle-upon-Tyne,
Plymouth, Nottingham, and Preston; and from “fever” in
Cardiff and Derby. No death from small-pox was registered
either in London or in any of the twenty-seven large pro¬
vincial towns. Only 4 cases of small-pox were under
treatment on Saturday last in the metropolitan hospitals
receiving cases of this disease; no new case was admitted
during the week. The deaths referred to diseases of the
respiratory organs in London, which had been 294 and 289
in the preceding two weeks, rose last week to 333, and
exceeded the corrected average by 44. The causes of 79,
or 2*1 per oent., of the deaths in the twenty-eight towns
.last week were not certified either by a registered medical
practitioner or by a ooroner. All the causes of death were
duly certified in Brighton, Preston, Norwich, and in three
other smaller towns. The largest proportions of uncertified
deaths were registered in Huddersfield, Sheffield, and Hull.

HEALTH OF BCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 21*5 and 21*3 per 1000 in the preceding
two weeks, rose to 22*6 in the week ending May 28th ; this
rate exceeded by 22 the mean rate during the same week
hi the twenty-eight large English towns. The rates in
the Scotch towns last week ranged from 18*0 and 20*1 in
Leith and Edinburgh, to 24*8 in Aberdeen, 25 - 9 in Perth,
and 27'4 in Greenock. The 664 deaths in the eight towns
last week Bhowed an increase of 32 upon the number in
the previous week, and included 43 which were referred
to whooping-cough, 19 to measles, 10 to diarrhoea, 6 to
scarlet fever, 4 to “fever” (principally enteric), and not
one either to small-pox or diphtheria; in all, 82 deaths
resulted from these principal zymotic diseases, against 78
and 72 in the preceding two weeks. These 82 deaths were
equal to an annual rate of 3 3 per 1000, which exceeded by
0 4 the mean rate from the same diseases in the twenty-
eight English towns. The fatal cases of whooping-cough,
which had been 31, 36, and 42 in the preceding three
weeks, further rose last week to 43, of which 14 occurred
in Glasgow, 7 in Edinburgh, 7 in Dundee, 5 in Greenock,
4 in Leith, and 4 in Perth. The 10 deaths attributed to
diarrhoea also showed an increase upon recent weekly
numbers, and exceeded by 2 the number in the corresponding
week of last year. The fatal cases of measles, which had
declined in the live previous weeks from 30 to 10, rose again
last week to 19, of which 15 occurred in Glasgow and 3 in
Aberdeen. The 6 deaths from scarlet fever corresponded
with the number in the previous week, and included 2 in
Glasgow, 2 in Edinburgh, and 2 in Aberdeen. Of the 4
deaths from “ fever,” 2 were returned in Glasgow and 2 in
Aberdeen. The deaths referred to acute diseases of the
respiratory organs in the eight towns, which had been 106,
120, and i26 in the preceding three weeks, declined again
last week to 109, but exceeded the number in the correspond¬
ing week of last year by 23. The causes of 71, or nearly 13
per cent., of the deaths registered in the eight towns during
the week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal
to 24*4 and 25*4 per 1000 in the preceding two weeks,
declined again to 241 in the week ending May 28th.

During the first eight weeks of the current quarter the
death-rate in the city averaged 29 7 per 1000, the mean
rate during the same period being but 18*6 in London and
19 6 in Edinburgh. The 163 deaths in Dublin last week
showed a decline of 9 from the number in the previous
week; they included 17 which were referred to measles,.
3 to “fever” (typhus, enteric, or simple), 3 to whooping-
cough, 2 to diphtheria, 2 to diarrhoea, and not one either to
small-pox or to scarlet fever. Thus the deaths resulting
from these principal zymotic diseases, which had been 1$
20, and 24 in the preceding three weeks, further rose last
week to 27; they were equal to an annual rate of 4'0 per
1000, the rates from the same diseases being 2 9 in London
and 2 2 in Edinburgh. The fatal cases of measles, which
had been 9 and 8 m the previous two weeks, rose last week
to 17, and exceeded the number in any previous week of
this year. The deaths from both “ fever,” and whooping-
cough showed, however, a decline from the numbers in the
previous week. The deaths of infants and those of elderly
persons were also fewer than those returned in the previous
week. Three inquest cases and 3 deaths from violence were
registered; and 46, or more than a quarter, of the deaths
occurred in public institutions. The causes of 25, or more
than 15 per cent., of the deaths registered during the week
were not certified. _

HEALTH OF STOCKHOLM".

In the Registrar-General’s recently issued Annual Sum¬
mary it was shown that in twenty-four of the largest-
European cities, having an estimated aggregate population
of more than ten millions of persons, the mean death-rate-
during last year was equal to 27 2 per 1000, and exceeded
the mean rate in the twenty-eight large English towns by
no less than 6 3. It appears that the rates in these
European cities ranged from 21 4 in Christiania, and 21*9
in Stockholm, to 33 0 in Prague, 35 0 in Marseilles, 37 8 in
Buda-Pestb, and 38 0 in Trieste. The medical officer of
health for the city of Stockholm has just issutd a summary
of the mortality statistics in 1886 for that city, and it may
not be without interest to note a few figures bearing upon
the mortality of one of the European cities showing for last
year the lowest death-rates. The estimated population of
Stockholm in the middle of last year was 213,762 persons.
The birth-rate was 30 6 per 1000, and 2 7 below the mean
rate in the twenty-eight English towns. More than
26 per cent, of the births were illegitimate, whereas the
proportion in London does not exceed 4 per cent. With so
high a rate of illegitimacy it is not suiprising to find a rate
of infant mortality out of all proportion to the death-rate
at all ages. The return before ns shows that the death-rate
under one year was equal to 342 per 1000 living at this age;
measured in another way, the deaths under one year were in
the proportion of 218 per 1000 of the registered births,
whereas the mean rate in the twenty-eight English towns
did not exceed 169 per 10Q0. This high rate of infant
mortality, in conjunction with the low death-rate at all
ages, shows that the rate of mortality among adults in
Stockholm was very low. The mortality from the principal
zymotic diseases in this northern city was not on the
Whole high. No death from small-pox and only one
from measles was registered, and the deaths from whoop¬
ing-cough, scarlet fever, and enteric fever do not yield
a high rate. The death-rates from diphtheria (including-
croup) and from diarrhoeal diseases showed, however, a
considerable excess, compared with the mean rates in the
English towns. The aggregate deaths from the principal
zymotic diseases gave a death-rate last year of 37, against
2'9 in the English towns, more than the whole excess in
Stockholm being due to the greater fatality of diarrhoeal*
diseases. Diseases of the respiratory organs and phthisis
were somewhat less fatal in Stockholm last year than in-
London; while the death-rate from violence considerably
exceeded the mean rate in tbe English towns. It is evident
that, but for the terribly high rate of infant mentality, due
to the markedly excessive proportion of illegitimacy*
Stockholm would take a still higher place among the
healthiest cities of Europe.

On the 28th ult. the Princess of Wales, accompanied
by the Prince of Wales and the Princesses Louise, Victoria,
and Maud of Wales, opened the “Samuel Motley” memorial
wing of the Deaconesses’ Institution and Hospital at
Tottenham.

1156 The Lancet,]

THE COLLEGE OF SURGEONS’ EXAMINATION.

(Junk 4,1887.

Cflrrespnhnte.

“ Audi alteram partfltn.”

THE COLLEGE OF SURGEONS’ EXAMINATIONS.

To the Edit or8 of The Lancet.

Sibs,—I n the concluding paragraph of my letter to you
last week I made a reference to Mr. Heath’s statement
“that the standard of the examination has been lowered of
late.” Mr. Heath has written to me to say that he “ can
find nothing in his letter to justify ” such a reference, and
to assure me that he has “ never said so,” and that he does
41 not believe or wish it.” Mr. Heath’s ipaiimma verba in
his letter to you were: “ A good deal has been done to im¬
prove the College of Surgeons’ examination, with the object
of gaining ‘ less uncertainty,’ and even ‘ in the way of
diminished stringency.’ ” 1 was under the impression that

this expression “diminished stringency” implied that it
was easier to pass the examination now than formerly, but
Mr. Heath informs me that he referred to the practice of
rejecting candidates for three months only, and he is anxious
to have this stated in your columns. But this “diminished
stringency” has what Mr. Heath calls the “set off”—that
the examiners haye.npw the power to refer candidates for
nine or twelve months.

I am, Sirs, your obedient servant,

May 31st, 1887. _ A. PeABCE GOULD.

To the Editors of The Lancet.

Sms,—“Audi alteram partem” is your motto, and I should
be glad if you could find space in your columns for a letter
dealing with the large “referred list” from a candidates’
point of view. An ounce of fact is worth a pound of theory,
and I believe I can lay before you some facts which may'
throw a little light on the problem.

Of the candidates for the recent examination for the final
Fellowship of the College of Surgeons, four— whom I know
personally—came before the same examiner at one of
the pathology tables. Three out of the four were referred—'
a result which will, I think, not be wondered at, when you
consider how their examination at that table was conducted.
No. 1 was examined for the whole twenty minutes on con- i
cussion and compression of the brain. No. 2 was questioned
about syphilis of bone, and then about hip-joiilt disease.!
No. 3 was questioned the whole twenty minutes on fractured |
base of the skull, and No. 4 was asked precisely the same
subject as No. 3. With regard to the actual questions asked
of these candidates, I am able to reproduce only a few. |
No. 2 was asked, “ How do you classify hip-joint disease ?”
Answer: “ Arthritic, acetabular, and femoral.” “ Ob, non¬
sense,” replied the examiner, “ I never heard of such a 1
foolish classification.” The candidate then used the phrase
“rarefactive osteitis.” It was not accepted, the examiner
remarking, “ Why do you use such long words ?” No. 4 can¬
didate was questioned on the treatment of fractured base,
and replied, “Perfect rest and slop diet,” “What slops ?"
was the next question. “Milk, and beef-tea.” “Yes; how
much 7” “ Oh, four or five ounces every two or three hours.”
“That is, twelve meals of five ounces; why you would
bring about the very mischief you are trying to avert—viz.,
meningitis.”

Now, Sirs, these facts give rise to several questions. 1. I
would a&k. Is it fair that a candidate should be examined
during the whole time at one table on one subject only 7
1 submit that if the examiner found Nos. 3 and 4 weak
on fractured base, he ought to have given them no
marks (if he liked) for that subject, and then to have
passed to other matters, to give them a chance of
making up.: 1. submit that every man has a weak point,
and I assert it is unfair, when an examiner has found that
weak point, that he should press the candidate on it to
the total exclusion of all other subjects. 2. What is a can¬
didate to do who is not allowed to use a classification of
diseases found in what is admittedly the best text-book?

And how

ithe science of ,to-
ScieutJ^c Ian-
fora
sely

then bring out a total which is obviously absurd, sad
couple it with the remark quoted ? It would seem u
though he were beat on making the candidate appear u
foolish as possible; and were trying to find bis weakness
instead of his strength. Making the worst possible case
from a candidate’s answer is not the proper wsy to
examine.

This letter can, I am aware, have.no possible influence on
the fate of the three unfortunates; but I hope it may hare
some little influence in drawing attention to some stumbling-
blocks in the path of the candidates which, by very little
consideration on the part of the examiners, can be moa
easily removed.—I am, Sirs, your obedient servant,

London Hospital. May. 1887. _ FEED. J. SMITH,

To the Editors of The Lancet.

Sibs, —Few of us can look back upon our student days
without recalling personal instances of the “ luck * of
examinations. The subject is by no means new, bat, os
the contrary, is a source of perennial discussion and com¬
plaint, unfortunately with but little or no improvement.
It seems to me that the method of selecting examiners from
the ranks of successful practitioners is far from satisfactory;
it is not always the most successful surgeon or mt*
brilliant operator that makes the best examiner era is
surgery, much less in anatomy or any allied branch. I cm
see no tbeoretical objection, at any rate, to the creation of a
special class of examiners, who should spend the wkolt of
their time in making examinations which should be man
frequent and more thorough. It would then be possible for
the examiners to go from school to echool as a board of
inspection, or even to conduct the primaries at the schools,
so as to take account of the school records and inspeot the
actual work of the candidates. The latter, aithoogb
examined more frequently by the College authorities, wonH
save, at any rate, by a diminution of the class examinations
for which at present they.get.no credit at the College.

1 am, Sirs, your obedient servant,

May 29th, 1887. _ M.D., MJhCA

THE TREATMENT OF RINGWORM.

To the Editors of The Lancet.

Sibs, —While most cordially agreeing with your article
and the first part of Dr. Wilkinson’s letter on the above
subject, I cannot allow such a statement as he has made to
go unchallenged by one who has also seen a little bf this
troublesome complaint). I refer to the following: “ I make
a bold assertion when I say that tbs disease is to be cored
with one application”; and then the one application is said
to be warmed glacial carbolic acid. Surely Dr. Wilkinson
would not advise this treatment for all varieties ai ring*
worm, both recent and chronic, and at any age: ffingworm
constantly spreads over half or even two-thirds of tbesdlp—
would Dr. Wilkinson use glacial carbolic acid to a large
portion of the head or to a young child ? I trust none of
your readers will attempt such an experiment. Of course,
carbolic acid is a well-known and good application for small
places of recent ringworm if used with care; but I want
everyone against using it to a large surface, as it may cause
unpleasant resul ts and even scarring. Secondly, I cannotagwe
that one application of carbolic acid always, or genertllji
cures even recent ringworm. What would be the use-**
Dr. Wilkinson suggests -of washing the head from
time with a lotion of sulphurous acad (an excellent remed y )
if the one application of carbolic had already destroyed
all the fungus? I do not even suggest what is the b«J
treatment for ringworm; but I do think that, when such
a strong application as glacial carbolic afeid is advised in your
columns for such a common complaint, there should u*>
be given full directions with regard to the size of the place*
and the variety of the disease it is to be applied to; wfrxb®
for recent or chronic ringworm, and if for chronic, whette*
for patches only, or for that most troublesome. voiety
where there are no distinct bare places, but only stum p *
groups of stumps. Such disseminated cased ondonWeaiy
often remain uncured, in spite of the application of ev«J
known remedy, even for years. Each variety of this
requires special treatment, and every treatment req®*’*
special instructions to be given with it. ApriJcaw** t 641
would be jnost proper and perhaps sue

y Google

ECONOMY IN THE WARDS.

[Junf.4,1887. 1157

The Lancet,]

small patch of recent ringworm, would be both useless and
unjustifiable if applied to a large surface of chronic ring¬
worm or to the disseminated variety. I do not for a
moment think I can cure ringworm more quickly than
other men; but I do maintain that no end of cases are raid
to be cured when the disease is only in its most ordinary
chronic form. Thus the doctor who certifies such cases to
be well gets the credit of quickly curing ringworm ; while
those who refuse to certify if there are any diseased stumps
remaining (and it is often most' difficult to detect them) are
thought not to be able so successfully to cope with the
disease.

I cannot close without a few remarks upon your most
excellent leading article, especially about the fact that
“ probably not 3 per cent.” of hospital cases “ are seen to
their complete recovery,” if it ever take place before puberty;
and thus, to poor people, ringworm is M practically incurable
in ohronic stages/ It is, as you remark, “of the first import¬
ance that the appearances in the more chronic forms of ring¬
worm of the scalp should be readily recognised.” There is
no doubt whatever that children still suffering from this
iisease are frequently sent back both to public and private
schools, even with medical certificatee. After a long ex¬
perience with regard to “certificates,” I most fully endorse
ivery word you ray. Scarcely a week passes but I examine
children for admission into private schools who have
obtained, certificates from medical men that they are free
from ringworm, but who are Still suffering from it in a most
chronic form. Medical men of the highest professional
standing often make the .mistake of thinking ringworm is
cured because the hair is growing freely on the affected
places. There is no greater fallacy, for the most obstinate
forms of this disease are those where the hair has grown
again on the places, but where a few diseased stumps are
still to be detected with a lens among the long hairs. The '
diagnosis of chronio ringworm is easy enough provided the j
medical man knows What to look for. My advice is to take,
no special notice of scurf, or whether the long hairs are
growing firmly or not. Scarf may exist in patches and
long hair may come out easily without ringworm being
present; and, again, there may be severe chronic ringworm,
and yet the long hairs On the patches may be quite firm and
but little scurf may exist. The only diagnostic sign of any
value is the presence, or the absence, of short broken-off
liseased hairs called stumps. Ringworm rarely exists (ex¬
cept in the earliest stages) without a few broken-off hairs
being visible; and certainly if there are any left the case is
not cured, and the child-may give the disease to others.
Diseased stumps can generally be easily recognised, without
the aid of the microscope, by noticing whether they break
off on attempted epilation with a pair of forceps. If the
stumps break off easily, leaving the root part behind in the
follicle, there ia but little doubt the case is one of ringworm;
but if they come out with the roots entire and atrophied,
it may be alopecia Only: the microscope will settle the
question.

I trust my long experience with this most troublesome
and often intractable Complaint will excuse these somewhat
iogmatic remarks.—1 am, Sirs, yours obediently,

Christ’* Hospital. May 27th. 1867. ALDUS SMITH.

ECONOMY IN THE WARDS.

To the Editors of Ivor Lancet.

Sirs,— The embarrassed condition of the funds of many hos¬
pitals, large and small, has led to all sorts of expedients for
jutting down working expenses. Reform in our expenditure
a becoming a favourite cry, and the shifts that many institu-
ions have had, perforce, to resort to for some time past will
become almost universal. There is one department in which
l am sure great saving with a little care might be effected,
md that is in connexion with the materials employed in
mtiseptic dressings. I was brought up at the feet of
iamaliel, so to speak, under a master who enforced tbe.mast
Tpd attention to every detail of Listerism, and woe betided
me unfortunate dresser who omitted the smallest portion of
.he mystic ceremonies that were pursued at every bedside—
mch washings, and purgings, and sealdings, and sprayings,
-hat one left the hospital daily with, one’s hair and skin im¬
pregnated with pungefit odours, that were ineffaceable, and
'yhich were carried out to the theatre or dinner party, to
-he disgust of One’s nWghbdur and the discomfort of one¬

self. On leaving London I became house surgeon to a
country infirmary, where sepsis and poultices were the order
of the day, and stinking stumps and. fetid fractures rendered
the wards almost unbearable. By the courtesy of the visit¬
ing staff I was allowed to act the part of the proverbial
new broom, and certainly I did make a clean sweep of some
of the smells. But when the bills came in for the gauze and
the salicylic wool, thepounds-shillings-and-pence argument,
came into play with the board, who could not be made to
understand the abnormal rise in their expenses. Our
finances were limited, and I had to cast about to
see in what direction a raving could be made. In fear
and trembling, I first discarded the salicylic wool, sub¬
stituting ordinary waddrng, with no evil results; then,
in a rash moment, I dispensed with the gauze, using instead
Gamgee tissue, but without the wounds becoming septic;
then the green “ protective ” went the way of the gauze,
and a strip of carbolised oiled lint took its place; and,
lastly, to the intense relief of my cracked and frozen fingers,
I abandoned the spray. In fact, I gradually threw over¬
board every detail of Listerism as then practised, without the
least bad result. Accidents of the most serious kind were
frequent.it being a great railway centre; and, with com¬
pound fractures and tolerably frequent injuries requiring
amputations, the test was ample and sufficient. I can un¬
hesitatingly affirm that with a preliminary cleansing with
a solution of carbolic or corrosive sublimate—of course,
seeing that all the instruments were carefully cleaned—
amputations were performed without the spray, the wound
covered with iodoform powder, two or three thick pads of
Gamgee tissue applied, outside that a quantity of oakum
with a common calico roller, and the results were as
uniformly satisfactory, and perhaps more so, than we had
before under the more complex and certainly far more
expensive system of prepared dressings; in fact, the simpler
the dressing used the better the wounds seemed to do.
I could quote a dozen cases of the most serious in¬
juries where it was of vital importance to exclude sup¬
puration, and where, with no more precaution than
careful ablution and a sufficiency of soft absorbent
material for dressing, primary union took place without
a rise of temperature or the least discomfort to the patient.

I found wood-wool by far the best dressing; its cost
was very little, and pads of it covered with old
linen formed an all-absorbing covering. The raving to
the hospital was immense; indeed, we could not have
afforded Listerian dressings as then practised. I am not
advocating a return to the old days of water dressings, &c.;
I firmly believe in antiseptio dressings, but I am perfectly
sore that in our hospitals, daily ana weekly, pounds are
wasted in precautions that conld be dispensed with. 1 have
carried out the same treatment in private practice, and with
the aid of iodoform, common lint, and ten ax, have secured
as good surgical results as we used to do with layer on layer
of gauze, protective^, prepared wools, and special bandages.
The hospital I speak of was not in a particularly healthy
town, and onr sanitary arrangements at one time were very
bad. I know it is said that these insults cannot be obtained
in London. That that is erroneous is shown by some of the
remarkable results achieved by men who use far lees pre¬
cautions than I did. Of course, where economy is no object
(and I judge that there are very few hospitals where that
could be said), or in those where a certain formula for
wound dressing is obligatory, this economy of dressings is
not to be expected; bat I am sure that, were the actual
cost of the materials employed in some of our wards during
a year published, the figures would astonish the natives and
foreigners alike. I am, Sirs, yours obediently,

June, 1867. «L G. Marshall, M.B. Cantab., M.R.C.S.

THE UTILITY OF DRUGS IN THE TREATMENT
OF DISEASE.

7b the Editors of The Lancet.

Sirs,—I n my green and salad days I, like many others,
fell away from the scholastic belief in the utility of drugs,
my apostasy to a great extent being due to a blind hero-
worship and following of the investigations of 8ir William
Gull into the treatment of rheumatic fever. Does he
still hold that the temperature in this fever cannot be
lowered by aalicina, and that it matters not to the resalt
whether we use this valuable and certain antipyretic or gitfe

1158 The Lancet,]

THE CONTAGIOUS DISEASES ACTS IN INDIA.

[June 4,1887.

mint-water ? Must we now shut our eyes to the brilliant
investigations of Brunton, Murrell, Frazer, Rutherford,
Fothergill, Garrod, and a host of other recent writers, who
without doubt show that this epoch in the history of prac¬
tical medicine is more remarkable than any other for the
unbounded and intelligent faith which scientific prac¬
titioners have in the utility of drugs in the treatment of
disease ? Is this warm bed to replace the surgery, and the
warming-pan the hypodermic syringe? Everyone must
admit that it is bad to give too mucn medicine, but what
is worse than the trade mark on the prescription is the taint
of empiricism. This, we hope, is passing away.

We now know how quinine cures neuralgia; how the
bromides and chloral give sleep; how digitalis may be given
so as to act on the kidney, strophanthus on the heart, amyl
on certain peripheral blood areas, pilocarpine on tbe sweat
glands, ergot on the arterioles of the lungs and uterus, &c.
By the light of this more exact and fuller knowledge we
have come, by slow but sure steps, to believe more implicitly
than our fathers did in the action of remedies, and to ignore
■that panacea of ignorance, “expectancy” Our drugs are
purer and more elementary, our prescriptions simpler and
more scientific; and, with his hypodermic syringe and the
long array of accredited alkaloids, the physician not only
trusts more to the action of his remedies, but even dares to
look forward to the time when his art will be based on
scientific certainty. It may or may not be true (for it is
still sub judicc) that vaso-motor pathology justifies Sir
William’s beautiful theory of arterio-capillary fibrosis; but
no one can deny that to vaso-motor therapeutics the general
practitioner owes much of that calm faith and comfort at
the bedside which is the aim of all true rational medicine.
I am a general practitioner and dispense my own prescrip¬
tions, but I claim as high a platform as any consultant, be
he who he may, who is content to ignore the light which is
now flooding the field of therapeutics.

I am, Sirs, yours truly,

Jambs Mobs, M.D.

Hothwell, Northamptonshire, May 29th, 1837.

THE CONTAGIOUS DISEASES ACTS IN INDIA.

To the Editors of Thb Lancbt.

Sibs,—I n your issue of April 16th, page 792, you furnish
e few remarks on this topic. The following facts emphasise
in a remarkable degree the gist of your observations. Lock
hospitals were introduced into India in 1866. Following
their establishment the ratio of venereal disease in the army
fell in a most remarkable manner, so much so that in 1873
the ratio per mille was 1667; from then till 1877 tbe reduc¬
tion was stationary. From 1877 to 1884 there appeared a
steady increase in the ratio. This increase was made the
reason for a determined onslaught on the existence of lock
hospitals. It was chiefly in consequence of the discredit
thrown on these institutions by the late Sanitary Com¬
missioner with tbe Government of India, in his yearly
statistical comments, that an experimental reduction in their
number was ordered to take effect from the early part of
1885. It was then that we saw a truly marvellous increase
in the venereal ratio. The excess of the 1885 rate over that
of the preceding ten years was 192-0 per mille in the experi¬
mentally unprotected stations and 61-2 in the protected.
The outcome of this experimentally closing of some of the
lock hospitals in 1884-5 was that 130 8 per mille of the troops
in cantonments where the lock hospital was closed con¬
tracted disease; the same, bad the hospital been left open,
would have escaped. So conclusive have these facts been
that tbe Government of India have recently reopened all
the lock hospitals which had been experimentally closed.
It is probable that several causes exist tor the relative in¬
crease of venereal disease in the Indo-European army apart
from the closure of some lock hospitals. They appear to
be—(1) a larger proportion of young men in the ranks;
(2) a larger number of inexperienced men; (3) a lesser
number of married men; (4) the increase of cold weather
manoeuvres; (5) the improved general health of the army,
which is consistent with greater prevalence of sensual
desire. Factors though these may be, their existence in no
way vitiates the value of lock hospitals in the cantonments
of India, but rather points to the necessity for the continued
establishment of every precaution against venereal risks.

I am. Sire, yours faithfully,

R. H. FrBTH, F.R.C.S. Eng,

Dagthal, May 2nd, 1887. Surgeon, A.M.S.

MR. WARRINGTON HARVARD'S CASES OF
TRANSFUSION.

To the Editors of Thb Lancet.

Bibs,—I n a recent number of The Lancet there appeand
a communication from Mr. Warrington Haward, describing
a method of transfusion which he had successfully employs!
in a case of bmmorrhage. Mr. Haward is evidently under i
misapprehension as to the authorship of the method in
question. In June, 1883, my friend, Mr. J. M. Cotterill, ww
good enough to perform transfusion on a patient of mine.
This he did, with complete success, by the method which
Mr. Haward has carefully described. Recognising the great
merits which this method possesses, Mr. Cotterill strongly
recommended it to other surgeons here, who, like himself,
have since frequently performed it with marked succesA
While Mr. Anaandale, Mr. John Duncan, and many other
surgeons, here and elsewhere, who have since that date per¬
formed transfusion by Mr. Cotterill’s method, have testified
to its ease and safety.it is here well recognised that the
credit is due to Mr. Cotterill for having brought the method
under the favourable notice of the profession.

I am. Sirs, yours faithfully,

Edinburgh, May 34th, 1837. J. GBAII AM BaOWN, M.D.

“A DOCTOR'S INCOME,’

To the Editors of The Lancet.

Bras,—Dr. Paget Thuratan, in his letter of May 21?t,
suggests that county hospitals are one of the causes which
contribute to the under-payment of the great mass of It*
medical profession. With this suggestion I entirely agrt-,
but altogether dissent to his proposed remedy. Dr.Thur«in
suggests that the general practitioner should be allowed to
follow his cases to the hospital, and should receive for si
doing exactly the same fees as he would have received for
attending the patient at his own home. He forgets that s
large proportion of the inmates of our hospitals aw mo,
and that their families, deprived of the weekly wage*, ha^
great difficulty in providing the daily loaf, and would t*
quite unable to pay a doctor remunerative fees. Again.»
large percentage of the patients are drawn from the ear-
rounding villages, makiDg it impossible for the country
practitioner to drive often several miles to the neighbours/
town, quite out of his usual round, to visit his patient in
the hoepital. It is not tbe in-patient departments of
our county hospitals which injure tbe general practi¬
tioner, but the out-patient. In the present day the
wives and daughters of small farmers, tradesmen, and
well-to-do wonting men are most frequently allowed
to attend the out-patient department without any questions
being asked them. They have learnt and are teaching others
to seek their county hospitals when they are well enough
to make the journey, and to fall back on the country prac¬
titioner when they are too ill to leave their own homes. Tt»
remedy lies with the medical profession. Throughout tbe
kingdom we have our medical societies, ■which meet U
various intervals during the year. Why should not tbi*
question of hospital abuse and other similar questions aflecc-
ing the profession at large be freely discussed at such meet¬
ings? If this were done, hospital physicians and surgeon*
would realise more fully than they yet have the gros
injustice they inflict on the general practitioner by tresua?
in their own out-patient rooms at the hospital, withe-’
making any kind or protest, patients who are well able t<
pay their own doctor moderate fees which would remuneritf
him for his services. I would further suggest that it ww®
be a good opportunity, now that the subject iaeidtiug 1
great deal of interest, to arrange for a discussion of
question at the next annual meeting of the British iledic*-
Association in August.

I am, Sire, yours truly,

Wm. Colltbb, M.D.,

May 34th. 1887. Hon. Phyildan, Radcllffe Infirm try. Oil" rt -

To the Editors of The Lancet.

Bibs, —The happy idea of Dr. Paget Th are tan in briofiax
out so lucidly the inner life of the profession deserve
praise. But there is a point not brought out fully in *
letters to The Lancet. I mean the estimate put by tb*

Google

D

The Lancet,]

NORTHERN COUNTIES NOTES.—EDINBURGH.

[J unb 4,1887. 1159

ublic generally, and those classes who are addicted to the
abit of visiting the oat-patient rooms of hospitals par¬
ticularly, upon the value of a doctor’s services. A case
occurs in my practice just now which deserves publica¬
tion. Nearly three months ago I was called from dinner to
assist a brother practitioner at a confinement by the
husband of the patient, with the request that I would be
prepared to administer chloroform, and go at once. The
man seemed to resent the slightest delay, and scarcely
allowed me to walk. It was a difficult case; great foroe
'was required to bring the head into the world with the aid
of forceps, and the patient was under chloroform a long
time. Last Thursday I called and reminded the husband
that I had received no remuneration for my trouble and
care, and requested him to send at his convenience half a
guinea. Last evening I received a note to this effect: He
did not acknowledge his liability. His wife had contracted
with my friend to be attended for a guinea. He had fetched
me at the request of their doctor, and I must look elsewhere
for the’money, adding, “ as for 10s. 6d., I should have thought
£s. Gd.” The man is in good business and dresses well.
Comment is not needed.—Very faithfully yours,

Klng*Und-road, May 13th. 1887. GEO. LoCXE, M.R.C.S.

To the Editors of The Lancet.

Sins,—I have read Dr. Paget Thuratan’s letter in your
issue this week with interest, and I may add a suggestion to
those already made—i.e., hospital physicians and surgeons
attached to schools should be kept to their own special
work (consultation), not only in the out-patient department
but also in a private capacity. Loud outbursts of indigna¬
tion are heard should some indigent general practitioner in
a semi-starved condition, and driven to his wits end for the
needful, issue to the denizens of his local slums a circular
that he gives advice and medicine for 6 d., and competes
with hospitals and chemists; but would anything be
said should a Consultant publish bulletins in The Times
newspaper as to the state of an illustrious patient’s health ?
Where is the line of advertising to be drawn? Under
the present condition of things the medical profession is
divided into two classes by the so-called higher and lower
standard, which division is only with regard to fees, not
practice, and is as wide as the gulf which separated Dives
from Lazarus; for since there is no chance to rise from
one status to the other except’by the Chinese fallacy
examination, interest, and money, why should we of the
lower grade be robbed and ruled by an oligarchy who will
not allow us to have a voice in the management of our own
institutions ? It is an old saying that “ Charity begins at
home,” and while there are so many of our poorer brethren,
it seems hard that all remuneration should go to the
fortunate few. 1 am. Sire, yours &c.,

May 23rd, 1887. ___ M.R.C.S.E,

ACTION OF HYOSCINE ON THE EYE.

To the Editors of The Lancet.

Sms,—In an annotation in your issue of last week
(May 2Sth) under the above heading, you mention some
recent observations of Dr. 0. Waller of Dorpat and others
on this alkaloid. In The Lancbt of Dec. 4th, 1886, Mr.
Tweedy, in an article entitled “ On the Mydriatic Properties
of Hydrobromate of Hyoscine,” described some comparative
experiments which I made for him between hyoscine and
atropine, and in which all the facts noted by Dr. Waller
had been observed. I am, Sirs, yours truly,

E. TREACHER C0T.LIN8.

Boy*I London Ophthalmic Ho*pltal, Moorflelds, June 1st, 1887.

Collegiate Lectures. —Dr. Leonard Charles Wool-
ridge commenced his course of three lectures on “Physio¬
logy of Nutrition”in the theatre of the Royal College of
Surgeons on the 1st inst., and will be succeeded on the
8th inst. by Professor Christopher Heath, F.R.C.S. Bng., who
will deliver three lectures on “Certain Diseases of the Jaws.”
The annual course of lectures will be brought to a dose by
Professor Henry Power, F.R.C.S. Eng., who will deliver
three lectures on “The Relations of Ophthalmic Disease
to Affections of the General System,” commencing on
June ,17th. The lectures will commence at 4 p.m. precisely
each day.

NORTHERN COUNTIES NOTES.

{From our own Correspondent.)

NEWCASTLE EXHIBITION.

Oca Exhibition continues to increase in popular interest,
and, notwithstanding gloomy and at times wet weather, the
attendance is upon the whole very satisfactory. Yesterday,
being Whit Monday, 45,000 .passed in, making the total
attendance since the opening on May 11th over 250,000.. I
should not omit to mention the model of the new infeotious
diseases hospital for the borough at Heaton, and now nearly
complete. Last week a deputation from the Corporation of
Nottingham, with Dr. Whitelegge, their medical officer of
health, came over to see the hospital. They were received
by the Sanitary Committee of our Corporation and the
medical officer of health, Mr. H. E. Armstrong. They
expressed themselves as being well rewarded for the trouble
of the journey by the inspection of the building. Visitor®
to Newoastle should by no means omit to see the museum
of the Natural History Society, which is a few steps from
the Exhibition and on the same road. It is well known to
be one of the best collections of natural history objects in
the kingdom, and is frequently visited by foreigners. It has
lately received some interesting additions, including a line
specimen of the echidna, porcupine ant-eater. This animal,
which is peculiar to Australia, greatly resembles the hedge¬
hog, but a little examination shows that it differs much from
the spiny hystrix. The echidna is about a foot in length,
and its body is covered tilth strong spines. The head
consists of a long tapering shout, like the bill of a bird,
from which it protrudes its long slimy tongne, and captures
its food in the same manner as the great ant-eater. The
limbs ere short and strong, and the forelegs are armed
with large and powerful claws, with which the animal
burrows into the ground very rapidly. It is very apathetic,
and tries to get out of sight quickly. It also rolls itself
like a hedgehog, and in this way defends itself from attack.
Another late addition, which, though not perhaps of great
importance from a scientific point of view, possesses an in¬
terest peculiarly its own on account of its association with
a name dear beyond Northumbria, Grace Horsley Darling.
It is a collection of shells, Crustacea, and birds’ eggs, gathered
on the Faroe Islands by Grace Darling and her father, and
was bequeathed to the museum by her sister, Miss Thomasine
Darling, who lately died at Bamburgh.

FEVER IN NEWCASTLE

At a late meeting of the Newcastle Sanitary Committee,
the medical officer of health, Mr. H. E. Armstrong, reported
that during the past fortnight there had been 1 case of
small-pox, 7 of typhus fever, 14 of enteric fever, 1 of con¬
tinued fever, 27 of scarlet fever, and 2 of diphtheria—a
total of 52 coses. As regards the outbreak of typhus in the
east end, it appears that there have been altogether 38 cases,
all of which, with the exception of one, have been removed
to the Fever Hospital. The solitary patient, who refused
to go, caused a good deal of trouble by his obstinacy, and
was the means of infecting two or three people who nursed
him, each of whom had to be token to the hospital.

NewcMtle-cm-Tyne, M»v Slat.

EDINBURGH.

{From our own Correspondent.)

THE VOLUNTEER MEDICAL SERVICE.

Such has been the success attending the formation of an
ambulance corps amongst the students of the Edinburgh
School, that it has now been decided to proceed farther in
this invaluable movement, and to raise a corresponding
company from amongst the citizens of Edinburgh. The
students’ company, raised two years ago in response to
the earnest appeals of Surgeon-Major Evatt, and commanded
by Mr. C. W. Cathcart ana Dr. Sims Woodbeod, is constantly
kept at its full strength; it has received official recognition
and a definite status at the War Office, and it now takes part
in all the movements carried out by the Volunteer regiment®
to which it is attached, in which both officers and privates

Digitized by GoOgle

1160 Thb Lancet,]

EDINBURGH.—DUBLIN.—PARIS.

[Joke 4, 1887.

display much enthusiasm and devotion to the work they
have undertaken. Although the new citizens’ company will
not possess the technical knowledge of the medical students
that makes their corps so specially effective, it will pro¬
bably be largely recruited from men who have taken some
interest in the ambulance classes held in Edinburgh during
the last three years; and starting on this basis some careful
training in their work and frequent practice cannot fail to
make the new corps a valuable addition to our Volunteer
establishment.

THU ETIOLOGY OF SCARLATINA.

The announcement of Dr. Klein’s discovery of a microbe
that bears a causal relation to scarlatina has been received
with great interest in Edinburgh ; the more so since it has
been known for some months that an elaborate research on
the same subject was in progress towards completion in the
laboratory of Professor Chiene. The matter was taken up
by Dr. Jamieson, of the City Fever Hospital, early in the
course of the recent epidemic in Edinburgh, and he and
Dr. Edington, assistant to the Professor of Surgery, are
reported to have isolated the materies morbi in the form of
a small bacillus, whose life-history, physiological and
pathogenic characteristics they have accurately defined. I
hear that their paper has been for some weeks in the bands
of the publisher, and that its immediate appearance is
anticipated. There is a general curiosity here to know
whether their results and those of Dr. Klein will be found
to agree.

THE ROYAL INFIRMARY.

By the will of the late Mr. Archibald, of Edinburgh, a
sum of £ 1000 , free of all duties, has been left to the general
funds of the Royal Infirmary.

ST. ANDREWS AMBULANCE ASSOCIATION.

A demonstration of ambulance work, under the auspices
of the Scottish Association, is announced to take place in
“the Waverley market next week, and elaborate preparations
are in course of completion, which should give it great
interest in the eyes of the public. Recent cases of street
accidents and of disasters in large manufactories have
clearly shown the value of the work done by the Associa¬
tion. In particular, the Portobello police force have been
of late complimented for their efficient treatment of a com¬
pound fracture that was found admirably treated on “first
aid” principles on its arrival at the Royal Infirmary.

Edinburgh, May 31st.

DUBLIN.

(From our oum Correspondent.)

THE QUEEN’S BIRTHDAY H0N0UR8.

Last week I drew attention to the paucity of State
honours doled out to the medical profession in this country
by successive Governments. I now wish to add that, as
regards the medical branch practising in Dublin, there is a
leading physician whose claim ought in no way to be for¬
gotten. I refer to Dr. William Moore, a physician of the
highest eminence, who has filled numerous important
positions in a manner not to be surpassed, and who ie
regarded with the greatest esteem by his professional
brethren. Dr. Moore also holds the high position of
Physician in Ordinary to Her Majesty in Ireland. These are
considerations which ought to have due weight with Her
Majesty’s advisers.

HEALTH OF DUBLIN FOR 1886.

The death-rate in the city of Dublin for 1888 was 28 4 per
1000, while in 1886 it was 30'69, and in 1884 it was 29 96.
The deaths due to zymotic diseases amounted to 823, or a
decrease of 188 as contrasted with the year preceding. It
appears from the annual report by Sir Charles Cameron, the
efficient medical officer 1 of health for Dublin, that one of the
most serious factors in the Dublin mortality bills is pul¬
monary consumption. This malady caused 984 deaths in 1886,
988in 1886, and 999 in 1884. it is remarkable that while the
general and zymotic death-rates are declining, the mortality
from constitutional diseases shows no decrease. It is satis¬
factory to learn that a substantial reduction in the death-
rate of Dublin has taken plaoe within the last six years, and
the reduction has been mainly in the mortality caused by

infectious diseases—those which sanitation can mor.
effectually deal with. With our present underfed, poorly-
clothed, and badly-boused working population, we c&a
hardly expect that the death-rate from all causes can U
reduced to that of the prosperous cities of England. It is,
however, some consolation to refieot that in 1886 we bad the
lowest mortality since registration of deaths commenced in
Dublin, that our zymotic death-rate was well below the
average in English towns, and that our general mortality
was less than the average general mortality of the chid
continental cities. The mortality due to constitutions]
diseases is, however, still excessive in Dublin; but the
measures for lessening it must be sought for in the domain
of political economy as well as ir that of hygeia. As Sir
Charles Cameron points out, just in proportion as the people
are well fed, well clad, and well lodged, will they, by reason
of their higher vitality, be able to resist the assaults of both
constitutional and infective diseases.

M. PA8TEUR’8 TREATMENT OF HYDROPHOBIA,

The guardians of Thurles Union some time since sent to
Paris a youth named Hayden, who had been bitten by a mad
dog, to undergo treatment by M. Pasteur. Attenuated Tiros
was daily injected on twenty-nine occasions, and Haydn
was to leave Paris on 4 certain day for home. On April 19th hf
arrived at the institute, and on May 17th arrange me at* wen
made that he should return to Ireland. The day after be
left the institute the boy went out for a walk, sad on his
return to his lodgings he complained of pain in tbe stomach,
which was followed by vomiting and convulsions, death
taking place thirty-six hours afterwards from hydrophobia.

ROYAL COLLEGE OF BURGEONS IN IRELAND.

A meeting of the Fellows is to be held to-day (Saturday],
to receive the annual report of the Council, when the
following motion by Sir Charles A. Cameron will be under
consideration “ That the College regret the failure of tbe
attempt to unite the Colleges of Physicians and Surgeoai
and the Apothecaries’ Hall for the purpose of holding exami¬
nations. The College is of opinion tnat a fresh attempt w
effect this tripartite combination should be now made-tbe
Medical Council having recognised the Apothecaries’ Hallu
a medical corporation; and ahonld such an attempt acah
fail, the College considers that tbe Council should, if poasblt.
form a combination with the Apothecaries’ Hall.”

Dublin, May 3lit. _

PARIS.

(From our oum Correspondent.)

CURABILITY OF LOCOMOTOR ATAXIA,

M. Babinski related at the Society of Biology the
cases of several ataxic patients who had been cnnd.
One of these patients, after having suffered for tan yen?
from violent lightning pains, which prevented bin fn®
undertaking any kind of employment, at least three tints
a week, has been cured for the last five years. In another
case the symptoms set in with violent pains, dissemintted
anaesthesia, and urinary and faecal incontinence. During t®
years the disease steadily increased, then grew grado»Ei
less severe, and for the last four years the patient h**
been quite well. The third observation is, _ho*e^
the most interesting, inasmuch as the anatomical pr»
of the recovery from previous disease was obam*
The patient was a woman whose symptoms comprised
degeneration of the optic nerve, lightning pains,
crises, and abolition of reflexes; no incoordination. *
Charcot has frequently shown this woman at his lectn»f
as a typical example of tabes fruste. The pains, after ex«|
iag for twenty-five years, completely disappeared. 1 "
patient died five years later 01 pneumonia. The p'*"
mortem examination of the cord showed unmistakable I<* ; ®
of locomotor ataxy; but, with the exception of blin -n*
recovery had taken place from all their consequence
Dr. Brown-Sdquard said that he had long been connncw
of the possibility of 6 uch recoveries, but he was n*?w
to find the evidence brought forward by a k -* 1
opposed to his doctrines. It proved conclusively, *•’
had always taught, that lesions of the nervous
do not give rise to symptoms, as destructive

Thb Iujvcht,]

PARIS.—EGTPT.

[June 4i 1887. 1161

>ut by an inhibitory action on other parts. In reply
o a question, it was stated that one of the patients had
>een to Lamalou ten Tears in succession, and had always
■eturned improved. The others had been treated by revul-
uvea. Dr. Brown-SiSquard observed that it was important
o apply revulsive treatment, not to the back, as was gene¬
rally done, but to the lower extremities. The cord is acted
lpon in this way by all the sensory nerves, and the effect
jreatly increased, lie quoted the case of a medical man,
who was cured of locomotor ataxy by circular blisters
iround the leg and thigh. The same treatment is also of
;he greatest value in epilepsy with aura,

TREATMENT OF INTESTINAL OBSTRUCTION.

An interesting discussion has been provoked at the
Socidtd de Chirurgie by a paper by Professor Vemeuil on
the Treatment of Intestinal Obstruction. The practical
conclusions would seem to bat hat if the course of events does
not give rise to immediate anxiety, medicinal means, such
as purgatives, enemata, rectal douches, and electricity, should
be tried in the first instance. These means should not, how¬
ever, be relied upon too long, as thereby time is lost and they
exhaust the bowel. M. Marc SOe’s case of recovery by the use
of rectal douches forty-five days after the onset of the
symptoms is entirely exceptional. A surgical operation
being decided upon, two choices are open, each having its
special indications—laparotomy or artificial anus. When
the diagnosis is easy and the obstruction is known to result
from chronic disease, such ss cancer, there is no question as
to the treatment to be preferred. An artificial anus must
be made, either on the right, as advised by M. Le Dantu, or
at the iliac, flexure* as counselled by Professor Vemeuil.
When the symptoms have set in acutely and there is good
reason to believe that they depend upon an obstacle that
can be removed by reasonable exploration, laparotomy should
be resorted to. In a great many instances of acute and sub¬
acute obstruction of the bowels the Society recognised that
a diagnosis was impossible, notwithstanding the opinion of
M. Despr&s. that it ought to be made ninety-nine times out |
of a hundred. Opinions were divided as to the best treat¬
ment. M. Vemeuil would treat symptoms and make an
artificial onus; MM. TnSlat and Le Fort prefer laparotomy;
and if a short exploration prove fruitless, the operation
should be transformed into enterotomy.

THE INSTITUT PASTEUB.

It is said, that M. Pasteur, has once more modified his
method of anti-rabic inoculations. For simple wounds he
has returned to the first system of mild attenuated virus.
For bites about the face and head, and severe bites about
the body, more virulent meduUee are used, but these do not
attain the virulence indicated by M. Pasteur in his last
communication. The last three deaths are: Ph. Hydram,
aged fifty-eix, bitten on October 6th, and treated from the
10th to the 21st of the same month; died on April 21st of
rabies. J. B. Gacbet, twenty-five years of age, bitten on
April 4th, treated from the 10th to the 20th, and died on
May 2nd. J. Hayden, aged eight, bitten on April 16th,
treated from April 22nd to May 16th; died on the 18tb.

THE BURNING OF THE OPERA COMIQUE.

It is to be hoped that the catastrophe at the Opera
Comique will lead to some practical improvements in the
Paris theatres. This is a subject which comes up every
time a large and fatal fire takes place; but like the periodi¬
cal typhoid fever score, it is forgotten as soon as the
balls for the benefit of the sufferers are over, and the persons
who fatten upon charity organisations have closed the
accounts of the transaction. It is somewhat ghastly that
one of the official medical advisers to the administration
of the Opdra Comique should ,be the Professor of Public
Health at the School of Medicine. Perhaps this calamity
■will prompt him to ascertain whether there are any
other duties attached to the post than those which
consist in applauding the actors once or twice a month,
and occasionally prescribing orange-flower water for a
lady of the troupe Buffering from her netfs. The
papers publish a note upon an examination of the blood
cf the victims, said to have been made at the Morgue by
M. Brou&rdel, and which would show that death occurred
in three different ways-^(l) from fright; (2) from asphyxia
by carbonic acid; (3) by asphyxia from carbonic oxide.
Apparently noon© was crushed to deaths which is scarcely

HYPNOTISM IN THE PARIS HOSPITALS.

Although hypnotism is not practised here on as large a
scale as at Nancy, there are some cases which medical men
visiting Paris should see. MM. Charcot, Luys, Dumontpallier,
and Mesnet have the most interesting subjects at the present
moment, the last-named gentleman having a woman under
bis care in the Salle St. Martine at the Hotel Dieu who was
confined without consciousness daring the hypnotic sleep.

Paris. Juno 2nd.

EGYPT.

(From our own Correspondent.)

BABIES AND HYDROPHOBIA.

These diseases are almost unknown in Egypt, but the
fact that the police in Cairo have during the last eight
months destroyed 5233 street dogs has been construed by
some lay journals into a belief that a large number of
persons had been bitten by rabid dogs, and had died of
hydrophobia. Pariah dogs, which act as scavengers in the
native quarters of the town, are destroyed in considerable
numbers every year, and the extra energy of the police
during the past winter was only caused by various com¬
plaints of householders who were kept awake at night by
sleepless mongrels, which had become far too numerous.
Griesinger, Larrey, Watson, and many other writers say that
rabies and hydrophobia are quite unknown in Egypt, but
Fleming notices that .travellers have asserted the presence
of rabies here. Most of the cases reported during the last
five years have been very doubtful, though some have been
observed by European doctors in Cairo and Alexandria. An
argument employed to prove the existence of the disease is
that the Bedouins have a well-known remedy for bite*,
consisting of a hard pointed root, which certain of their
“ medicine men” thrust into the fire and then cauterise with
ifr the wounds of the bitten.

Case 1.— In December, 1882, a Swiss doctor near Cairo
was called hurriedly to see an Egyptian gardener, whom he
found lying on the ground, much excited, foaming at the
mouth, and being held by three men. lie had occasional
convulsions, during the intervals of which be bit the doctor
in the back of the hand while his pulse was being felt, and
within half an hour he died, ana was buried without a
necropsy. The doctor then heard that twenty-eight days
previously the man had been bitten in the forehead by a cat,
and for the last three days had been unable to drink. Until
three days before he had been quite well, though formerly
troubled with asthma. The cat was killed after it had
bitten a soldier through his trousers, and its body was not
examined. The doctor and the soldier have never suffered
from their bites. The man apparently bit the doctor to show¬
ing hatred of a Christian. In May, 1886, twelve women and
children were bitten by a wolf in the early morning near
Cherbin. The wolf was seen standing over a small child
gnawing at its head, and the child died fifteen days after
from its injuries. It was proposed by two native inspectors
to return this case ss hydrophobia, but their opinion was
rightly overruled by an English veterinary surgeon. The
other eleven bitten people recovered satisfactorily.

Case 2.—Again, in May, 1886, a cat in Upper Egypt bit two
xiatives, who were Bent to Paris to be treated by M. Pasteur.
This case rests on the evidence of M. Piot, an able French
veterinary surgeon, who disinterred the cat two days after
burial and inoculated two rabbits from it. The two rabbits
died from either rabies or septicaamia.

Case 3.— In August, 1886, an authentic case of dumb rabies
was certified by English veterinary surgeons as occurring in
a suburb of Cairo in a terrier belonging to the Army of
Occupation. The terrier was kept under observation, but
unfortunately escaped one night, and was found dead in the
desert the next day.

Case 4.— In October, 1886, three Syrian children in Cairo
were bitten by a dog, of which nothing is known. Six
weeks later, Dt. Grant, was called to Bee one of these
children, aged six, who had a scar from the bite at one
angle of his mouth, and was then complaining of fever and
of a burning sensation in the. throat. The medicine
.prescribed could not be swallowed, and the child passed a

1162 Thb Lancet,]

MEDICINE AMONG THE MOORS.

[Junk 4, 188 !,

very excited night, leaping incessantly in and out of bed,
and refusing to drink a chloral draught. Early next
morning the boy -was seen, with a frightened harassed air,
sitting at the far corner of a large bed, like a monkey, and
again complaining of his burning throat, his temperature
being still raised. He trembled all over when water was
called for, but had no convulsion until it was brought near
him. He was thirsty, but absolutely refused to try to
drink, though after some shuddering he could extend two
fingers at arm’s length, touch the water, and then apply his
fingers to his tongue. An attempt at hypodermic injection
induced so many convulsions that it was abandoned. The
same night the boy was seen again by Dr. Grant, two col¬
leagues, and a French veterinary surgeon. The boy was then
extremely excited, and could only be kept on the bed if his
mother sat upon it with him. When a light was brought he
dodged round hu mother to avoid it. A touch of the hand
induced convulsions, and each of the doctors singly tried, but
failed, to inject morphia. The boy died the following morning,
but there was no necropsy. The other two children were
then sent to M. Pasteur for treatment, and have remained
well.

Case 5.—In January, 18S7, the dog of an Austrian woman
bit her in the nose, and she has undergone M. Pasteur’s
treatment with success. The dog died presumably of rabies.
From the pons Varolii of the dog's brain two rabbits were
inoculated in the eyes by Mr. Littlewood, and cerebro-spinal
fluid was further injected under the skin of their thighs.
Fourteen days after one rabbit died without symptoms of
rabies; the lungs were very congested, but there were no
other important facts noted at the necropsy. The second
rabbit on the fifteenth day suffered from marked photo¬
phobia, hiding itself from the light, facial paralysis, and
convulsions of the whole body. Death occurred six hours
after these symptoms were first seen. AU the organs were
found deeply congested and the bladder was full of urine.
Mr. Littlewood believes that this second rabbit died of inocu¬
lated rabies. Unfortunately, no thermometrical observations
were made to test the rapid loss of heat which seems patho¬
gnomonic of the Pasteurian inoculations.

Case G. —On Feb. 15tb, 1887, an Egyptian was bitten by a
wolf, of which nothing is known, in a village near Tantah.
Thirty-seven days later, on March 24th, a Greek doctor cer¬
tified that this man had died of hydrophobia. He complained
of headache and was delirious, and refused to drink for two
days before death, and on the day preceding death he fell
down some steps, but without injuring his head. At the
necropsy, the lungs were found gorged with blood and in¬
flammation in the membranes of the brain. The larynx, ;
pharynx, intestines, and kidneys were normal. From the j
brain of this man two rabbits were inoculated, as in the last
case. They were fed on bran instead of clover, and both
became thin and wasted, one of them dying of starvation.
At the necropsy great atrophy was seen, but no congestion
of the organs. The second rabbit was then returned to a clover
diet, at once improved in health, and is now perfectly well.

The Sanitary Department now dpes all that it can to
encourage bitten people to bring the dogs to be watched,
instead of their being at once Silled. Since October last
more than a dozen dogs have been kept under observation
for periods exceeding one week, and, so far, in every case
the dogs have proved to be healthy. The above record of
six cases, including doubtful ones, represents all the returns
of hydrophobia in Egypt during the last twenty years.

BBLAP8INO FEVER.

Occasional small outbreaks of this fever have been re¬
ported this year by native doctors in Lower Egypt, but
they have not been verified by any skilled observer.
During March and April there were eight cases reported
from an overcrowded prison at Damanbour, of which one
died.

ELEPHANTIASIS.

M. Innes, Curator of Museums at the Medical School,
believes that he has recently discovered a bacillus which is
special to the erysipelatous elephantiasis of the Arabs. The
bacillus, coloured blue by methylene and not affected by the
Ehrlich method for colouring the leprosy bacillus, occupies
in masses the connective tissue which forms the scrotal or
other tumour. Under a microscope of 1200 diameters it
appears straight, slightly swollen at its middle, and tapering
at both ends. But this investigation will require much
subsequent confirmation. The eggs of the filaria sanguinis
hominis are rarely found in case? 'mntiasid in Egypt

BLIND AND DEAF SCHOOL IN CAIRO.

This school is deserving of praise because it is entinh
under native direction, and because the houses and all tha*
contents are scrupulously clean. Of the blind, there are no?
thirty-one boys and twelve girls, who learn reading, writing
arithmetic and geography, besides mat and chair making
silk weaving and carpentering. Most of the children to?
suffering from extreme corneal opacities after granular lid-.
On the deaf and dumb side there are nine boys and eigt'.
girls being taught by deaf teachers.

Cairo, May 21at. __

MEDICINE AMONG THE MOORS.

(From a Correspondent.)

The mantle of Avincenna or Adul Axis has not fallen <a
the shoulders of the modern Moorish doctor. The leaden oi
scientific research and progress during the dark ages hr*
not advanced, but, on the contrary, they have materially
retrograded. Superstitions have gained ground; srieatiik
precepts have been forgotten; astrology is still asaodated
with medicine; and for the little skill occasionally displayed,
and a few good local remedies, we have, as an offset, u
appalling prevalence of crude ignorance and savage rape-
stition that can scarcely be exceeded, even in the nor.
barbarous parts of the world. The Moorish “ medicine mu"
—we can hardly call him doctor—certainly display? k>*
skill in couching for cataract. He has also an originai
method of curing irritation of tha eyes due to the present*
of foreign bodies: with much skill he passes his tongue over
the open eye of the patient, and thus, without irritating,
removes the sand, grit, &c. For cupping, the Moor also
makes good use of his mouth: a cow's norn is plsced ct*
the part, and from a hole at thepoint of the horn the open-
tor sucks out the blood &c. But the Moor who Tentar*
on such treatment will, with equal confidence, prescribe
gold dust, or the scrapings from the horn of a rhinoceros, u
an emmenagogue; and will give an idle man ants to eat, or
suggest that a coward should try and procure for his meal
a Tittle lion’s flesh. The fumes of the burning bodies oi
animals are supposed to be a good remedy for anaemia

In such matters the Jews of Barbary, who form an im¬
portant section of the population of Morocoo, are aa super¬
stitious as the Moore with whom they live. Though
naturally a gifted and highly intelligent race, the Jew ia«
prone aa the Moor to attribute bis ailments to the interra-
tion of evil spirits. If a man is ill, it is customary to place
a dagger under his pillar so as to intimidate the evil one.
At the birth of a obild, the father, if he is a Jew, takas
big and sharp sword with which he cuts and alubee about
the room in the hope of destroying the evil spirits that
may be seeking to retard his wife’s convalescence or tha-'
menace the child’s future. Should this be considers!
insufficient, the pots and pans are violently struck together,
and everyone helps to make an alar ming noise under the
impression that ft will frighten illness awsy. This die*
turbing method of warding off the dangers of the situatioo
is continued till the seventh day, or the time of drcnmdfw*
When, on the other band, there is no family, the empir*
practitioners of this country have propagated the very con¬
venient belief that a sapphire, an emerald, a pearl, and son*
coral ground into powder and mixed with alcohol, con¬
stitutes an effective drug for the core of barrenness. It»
needless to say that the patient is not allowed to grind up
the precious stones herself, but must confide them to tee
care of her medical adviser.

Nevertheless, by the side of these absurdities there am
some good remedies employed. The Moors, for instance, u*
the actual cautery, and, by freely applying red-hot irons to
the skin, often succeed where in more civilised practice the
mustard poultice or the blister fails. Excellent syraps u*
made for coughs and colds by simply boiling figs, date*’

raisins; while the huge, thick, primely pear leaf, when cot

in two and heated, is a very good substitute for the lmsew

K ultice. The same leaf, put on a plate and covered witb
jwn sugar, will make a very good cough lozenge when tw
sap oozes out and mixes with the sugar. For fracture, w
limb is dressed with splinters and tow soaked in honey
The honey, of course, attracts a multitude of flies, “>■ l *®

Thk L*anobt,]

THE SERVICES.—MEDICAL NEWS.

[June 4,1887. 116(3

Augments the annoyance the patient has to endure; but,
nevertheless, some skill is sometimes shown in the dressing
of wounds. A plant, vulgarly known among Europeans in
Morocco as the "donkey’s fig,” and called by the Arabs the
“ Feghouz elhmir,”is much used in jaundice. Cut in two
and held to the nose, it will cause a violent irritation of the
nasal mucous membrane, followed by a copious discharge,
which it is thought relieves jaundice.

The henna sold for staining the heels of the foot and the
nails of the band a bright orange red, which among Arab
women is a favourite method of ornamentation, is also
employed as an astringent for eruptions on the heads of
infants. The root of the wild grenade, or assouak, is effective
as an astringent for the lips and gums, and it imparts a
marvellous whiteness to the teeth. For the purposes of a
purgative the Arabs generally resort to a decoction of senna
and honey. The “kuol,” or sulphate of carbon, with which
the women black their eyelids, is used not only from
motives of coquetry, but to help to cure slight ophthalmia.
This latter reason is said to account for the fact that men
also occasionally paint their eyes. It is strange, however,
that this painting is especially prevalent on festive days,
notably during weddings. Is it only when their powers of
vision are more or leas affected that Moors make up their
minds to inour the pleasures and dangers of matrimony?
Such a supposition is not a complimentary reflection on the
personal appearance of Moorish women; but, nevertheless,
men even in Morocco do not care to admit that they paint
merely to satisfy their personal vanity.

Undoubtedly the fatalist theory of the Mahomedan religion
is chiefly responsible for the deplorable ignorance prevalent
on all medical matters. The Moor considers it more or less
wicked to avail himself of the science of the Christian. For
instance, at Tangier the Minister of Foreign Affairs has been
urged over and over again to have some false teeth. He,
however, invariably replies that, if God has thought fit to
deprive him of his teeth, it is not for him to set at defiance
the will of the Almighty by putting in false teeth. In the
same manner, the actual Governor or Bashaw of the Province
of Tangier obstinately refuses to avail himself of the advice
of any European practitioner, though his health is in a very
precarious condition. This fatalistic resignation has been
combated with much energy by the Bashaw’s European
friends, as they greatly value bis life, and fear it will be
difficult to find a successor equally energetic in putting
down abuses. Nevertheless, the Moors will very rarely
follow the advice of European doctors. With the excep¬
tion of a few rough remedies to relieve pain, they generally
prefer to trust in Allah, or else reeort to necromantic practices.

THE SERVICES.

Deputy Surgeon-General Jas. H. Thornton, C.B., I.M.S.,
has been awarded an Indian good-service pension from
Dec. 8th, 1886, in the room of Col. Sir F. B. Norman, K.C.B,
Bengal Staff Corps.

Admiralty. —In accordance with the provisions of Her
Majesty’s Order in Counoil of April 1st, 1881, Surgeon Robert
Arthur Simpson, M.B., has been allowed to withdraw from
Her Majesty’s Naval Service with a gratuity.

The following appointments have been made:—Fleet Sur¬
geon William Graham to the Unicom : Fleet Surgeon Henry
A. Clone, to the Durham (to date from May 28th); Staff
8urgeon Matthew F. Ryan, to the Tamar: Staff Surgeon
Henry Beaumont, to the Invincible (to date from May 28th);
Staff Surgeon Michael Roman, to the Rover (to date from
May 28th); Surgeon Alexander N. French, to the Agincourt;
Surgeon James Rogers to the Pembroke; and Surgeon
Charles F. Newland, to the Invincible (to date from June 2nd).

Royal Naval Artillery Volunteers (London Brigade).
Alex. Stewart Brown, to be Surgeon (to date from May 28th,

Hospital for Sick Children, Great Ormond-
strext.—T he thirty-fifth anniversary festival of this insti¬
tution was held on the 26th ult., the Marquis of Ripon
presiding. Since the establishment of the hospital in 1864,
400,000 out-patients and 24,000 in-patients have been treated,
the numbers last year being 16,000 and 1100 respectively. A
list of subscriptions and donations amounting to upwards
of £1500 was during the evening announced by the secretary.

Utebinil fkfos.

University of Cambridge.—A t a congregation held
on the 26th ult. the following degrees were conferred;—
Doctor of Medioisk.—H enry Lewi* Jones, Gouvllle and Caiua.
Bacheu>b of Surgrbt.—J anies Kerr, St. John's.

• Royal College of Surgeons in Ireland.—A t
recent meetings of the Court of Examiners the following
obtained the Fellowship of the College

Thomas Higgins. | John H. Scott.

Society of Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, 8argery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on May 26th:—

Dean, Henry Percy, Anson-road, Tufnell-park.

DeRenzl, Arthur Castriot, The Chaplain's House, H.M. Prison,
Wandsworth.

Clark, Calvin Worcester Day, Regent-square.

Harris, Worsley John, Bennatt-park, Blackheath.

Johnson, Harold Joese, Blahopsgate-street.

Mansell, H. Rosser, Lynchmere, Maberiey-road, Upper Norwood.

Read, Henry George, Finsbury-squsre.

Servses, Francis Charles. Northern Hospital, Liverpool.

Thomas, John Lewis, Brynmowr, Breconshire.

White, Charles Tereival, Furnlval's-inn, Holbora.

Vaccination Grant.— Mr. Julios Ctesar, Minster
in Sheppey, has received the Government grant for successful
vaccination (first time).

The War Department has granted a piece of land
at Woolwich for the erection of a hospital in commemora¬
tion of the Queen's Jubilee.

On the 26th ult. the Metropolitan Counties Branch
of the British Medical Association held a highly successful
conversazione at the South Kensington Museum.

The Danish corvette Dagmar, which has been
on a cruise in the North Sea with cadets, has put into
Sheerness Harbour with three cases of diphtheria on
board. The patients were admitted to Melville Hospital,
Chatham.

The Sale of Poisons.— Cases are occurring almost
every week which show the urgent need of reform in the
Sale of Poisons Act, and of the greater stringency in the
enforcement of the provisions already in existence.

Bequests.—T he late Mr. G. Woods Maunsell has
left £50 to the Adelaide Hospital, Dublin. Mr. Wm. Magrath
has bequeathed £500 to each of the following institutions—
viz., Mater Misericord!®, Vincent’s, and Jervis-street
Hospitals.

East London Hospital, Shad well.—T he annual
court of governors of this institution was held on the
31st ult., when it was reported that 16,012 patients had
been attended during the year, making 178,644 since the
opening of the institution in 1868. The receipts for the
past year amounted to £7053, against £6699 during the
preceding year, and the total expenditure was £6803.

Association of Public Sanitary Inspectors.—-
On the 28tb ult. the second provincial conference of the
members of this Association was held at Eastbourne. Papers
on health, drainage, and sanitary questions generally were
read and discussed, amongst those present being Dr. A.
Carpenter, Mr. G. A Wallis, Mr. Toms, and Mr. Walter
Grant. After the conference the Association visited the
places of interest in the town.

Presentations.—D r. Lawton Roberts has been
presented with a copy of Keith Johnston’s “ Royal Atlas of
Modern Geography,” a case containing an inkstand, a pen-
stand, and a pair of candlesticks by the men employed at
the Plaskynaston Collieries, in recognition of his services as
medical officer, and with an electro-plated tea and coffee
servioe by the members of the ambulance classes for his

services as instructor.-Dr. Davidson of Wartle has, on

the occasion of his golden wedding, been presented with a
marble timepiece and a purse of 100 sovereigns as a mark
of the esteem and respect in which he is held throughout

Digitized by V^OOQle

fl64 fa Jt Lancet,]

MEDICAL NEWS.—VA0ANC(E8.—APPOINTMENTS.

fjTTN* 4,1887.

the district.——Mr. John Blackburn of Barnsley has been
presented with a silver dnnking-cnp by the police of
the Staincross Division of the West Riding of Yorkshire in
recognition of his services as teacher of the ambulance
Class.—Mr. Charles Sanders has been presented by the
members of his ambulance class with a handsome edition of
the worksof Charles Dickens.-Mr. W. Jenner Reid has. on the
occawon of his leaving Esher, been presented with an illumi¬
nated address and a purse of over fifty sovereigns by the in-
habitants of that village, as a token of their regard and regret
at his departure.-On the 28th ult.Mr. JordanLloyd was pre¬
sented, as a wedding present, with a cheese dish and a butter
cooler bv the sisters and nurses of the Birmingham Queen’s
Hospital, and also by the past and present resident officers
of the institution, who bad been associated with him in
the work of the hospital, with a silver salver and an
illuminated address.

The Jubilee celebration of the National Hospital
for the Paralysed and Epileptic (Albany Memorial), Queen-
Square, will take place on July 7th, when the Duchess of
Albany will open the wards hitherto unoccupied, including
the ward for children which bears her Royal Highnesses
name, thus raising the total number of available beds to
a r ,T roees “ d °ther flowers by Paul and
bon, of U altham-cross, with additional attractions, will be
provided.

On the 27th ult. an alarming and destructive fire
occurred at the private asylum known as Brooke House,
Clapton High-road. One of the inmates was, unfortunately,
burned to death. An inquest was held on the body of the
deceased, and the jury, who returned an open verdict,
appended a nder to their verdict complimenting Dr. Adams,
the proprietor of the asylum, and the members of bis staff
for the promptitude they had displayed In endeavouring to
extinguish the flames.

London Temperance Hospital.—T he annual public
meeting of the supporters of this institution waaheldon
the 27th ult, under the presidency of the Rev. Canon
Ellison. During the twelve months ending April 30tb, the
number of in-patients treated was 737, the deaths amount¬
ing to 57, or 8-4 per cent. During the 14 years in which
■° e J’, oap ‘ tal has bejm in existence more than 4000 in- and
2b,000 out-patients have been received. The income for the
year was £5075, leaving after payment of expenses a
f ala ^J, Q ha f d ot .P 8 - ^he debt on the hospital amounts
to £0500, and until this is paid it is not considered pru-
dent to open to the public the whole of the 120 beds which
the building contains, of which 60 only are at present in

Royal College of Surgeons in Ireland.—T he
following Examiners have been elected for tbe ensuing
year:—Anatomy: J. Barton, P. A. Nixon, W. T. Stoker,
R. L. Swan. 8urgery: C. B. Ball, E. S. O’Grady, W.
Thomson, A. F. Tobin. Physiology and Histology: E. D.
Mapother, J. A. Scott. Medicine and Therapeutics: M. A.
Doyd, ft. A. Hayes. Chemistry, Physics, and Medical Juris¬
prudence : J. D. Pratt, S. H. Webb. Midwifery and
Gjnwcoiogy: J. J. Cranny, S. R. Mason. Ophthalmology :
A. H. Benson, H. A. Swanzy. Diploma in Midwifery : J. J.
Cranny, H. Croly, W. Roe. Public Health: E. Flinn, E.

'w £ arry ’ H. Tweedy. Preliminary Education:
P. Davys, R. Morton, H. C. Tweedy.

Instruction to Volunteer Medical Officers.—
On Wednesday. May 25th, the last of a course of six lectures
to volunteer medical officers was delivered by Dr. Walter
Pearce in the Parkes Museum. Dr. Paenuharsou, M.P.,
occupKjd the chair, and there was a large attendance of
medical officers and of members of the Volunteer Ambulance
Department. Surgeon Stewart, M.D„ Middlesex Yeomanry
Cavalry, moved a vote of thanks to the Chairman, which was
weonded by Surgeon Stokes, London Rifle Brigade. Dr.
Parquharson, in reply, said that he took much interest in
the subject of the lecture, especially in tbe fralions of the
•warnr. He hoped that ample-opportunity would be given
t? r the discussion of the Army Medical Estimates in the
House of Commons, and that he should be ready to
pnt .forward the grievances of the Volunteer regimental
surgeons, and their deprivation of pay and allowances
instruction at the Medical Staff Depdt at

fcanries.

I* compliance with the desire of numerous subscribers, it has been to

resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be maA* to the
advertisement. _____

Ancoats Hospital, Manchester.—Junior Visiting Surgeon. Salary Bb o
per annum, with board and laundiy service.

Biogleswadk Union, Bedford.— DUtrlot Me<lla*l Officer. S*l*rv £130.
with extra medloal fee*. as allowed by the Local Government
Board.—Medical Officer for the Union Workhouse and Infirmary.
Salary £10 a yeir.—Medical Officer for the Contagious Disease*
Hospital. Salary £10 a year.

Baot London Hospital for Children, Shad well. H.—Resident CUnleal
Assistant. Board and lodging are provided free of coot, but Umn la
no salary attached to the post.

Queen's Hospital, Birmingham.—Honorary Surgeon.

Koval Alexandra Hospital for Sick Children, Brighton.—Assistant
Physician.

Royal United Hospital, Bath. — Resident Medical Officer. Salary
£100 per annum, with board and lodging.

Botal Westminster Ophthalmic Hospital. King William-street,
Weit Strand, W.C.—House-Surgeon.

Staines Union.— District Medical Offioer. Salary £#5 per annum,
exclusive of the authorised fees for surgted and midwifery oases.

Township of Toxtbth-park. Liverpool.—Assistant Medical Officer for
the Workhouse and Infirmary. Salary £100 per annum, wills
rations of a first-class officer and separate apartments.

Victoria Hospital for Children, Queen's-road. Chelsea, 8.W._

Resident Medical Officer. An honorarium of £30 for the 8nt ilx
months, and £30 for tbe second six months, will be given, »»*
lodging in the hospital provided.

Westminster Hospital. S.W.—Assistant Surgeon.

Whitehaven and West Cumberland Infihmart. — House-Surgeon.
Biliary £130 per annum, and £30 a year for dispensing, wltt»
furnished apartment* and attendance.

Successful applicants for Vacancid, Secretaries of Public Institutions, tout
ethers possessing information suitable for this column art incited to
forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
the next number. _

Barnard, Arthur Joynson, M.R.O.S., L.B.C.P.. has been ap nointcx*
Senior House-Surgeon to tbe Royal Albert Edward Infirmary,
Wigan, Lancashire, vice John Buchanan, M.D., resigned.

Bidwkll. L. A., M.K.C.S.. L.S.A., has been appointed Assistant House-
Surgeon to St. Thomas's Hospital.

Bond, W. A., M.A., M.D., B.CT.Oantab., has been appointed CUnleal
Assistant la the Throat Department of 8ft. Thomas's Hospital.

Bowbn-Jonkn, L.M., M.B.C.S., L.R.O.P.Lond.. lias been appointed
Physician to the Carmarthenshire Infirmary, Carmarthen.

Brook, W. F., M.B.O.S., L.S.A., has been Appointed Assistant House-
Surgeon to St. Thomas's Hospital.

Brown, C., L.R.C.P., M.R.C.S.. has been appointed Clinical Assistant!
in the Ear Department of St. Thomas's Hospital.

Bplstrodb, It. T., L.R.C.P., M.R.O.S., has been appointed CUnleal
Assistant in the Throat Department of St. Thomas • Hospital.

Calvert. J. T., L.B.C.P.. M.B.O.S., has been reappointed Clinical
Asslstnntln the Skin Department of St. Thomas's Hospital.

Clarke. Thomas. L.R.C P.Bd., L.P.P.S.OIas.. has been reappointed
Medical Offioer of Health for the Pawsey Rural Sanitary District.

Duncan, H., L.lt.C.P.. M.B.O.S., has been appointed Oliniool Assistant*
in the Skin Department of St. Thomas's Hospital.

Edwards, William Lloyd, M.R.C.S., L.R.C.P.Lond., has been
appointed Physician to the Carmarthenshire Infirmary, Car¬
marthen.

Bllis. Donald M., M.R.C-.S., L.R.0.P.Rd., has been appointed House-
Surgeon to tlie Teigniuouth Infirmary and Convalesceut Home, vice
A. D. Owen. M.R.C.S., L.S.A., resigned.

Hall, H. S., M.U.C.S., L.R.C.P., has been appointed Junior House-
Surgeon to the Royal Albert Edward Infirmary, Wigan,
Lancashire.

HARMS. Arthur W-, M.R.O.S.. L.S.A., has been appointed
Medical Officer to the Infirmary of the llolbom union.

Hawkins, H. P., M.R.C.S., L.S.A., has been appointed Resident House-
Physician to St. Thomas’s Hospital.

Heslop. William John. L.K.Q.C.P.I., F.B.O.S.Md., has been appointed
Medical Officer of Health lor the Stretford Urban Sanitary Districts
vice Pet linger, deceased.

Hecnkll. J. S., M.R.C.S.. L.S.A., has been appointed Ophthalmic
Clinical Assistant to 8t. Thomas’s Hospital.

Hutton, J. S., M.B.Lond., L.B.OP., M.R.O.S., has been reappointed
House-Surgeon to St: Thomas's Hospital.

Jhiraa. H. S.. L.R.C.P.. M.H.O.8., L.8.A.. has been, appointed Oltalcal
Assistant in tbe Ear Department of St. Thomas's Hospital.

Leslie. W. MLit ray. M.B.7 C.M.Ed., has been appointed Public
Vaccinator to the Popfaf Union.

Marinor, H. J., L.K.O.P.. M.R.C.S.. has been appointed Reddest House-
Physician tp St. Thomas's Hospital.

Mackintosh, Anols, M.D.. L.F.P.S. OIrs., has been reappointed
Medical Officer of Health for the Chtsterfleld Rural Saoltarv
District.

The Lancet,]

BIRTHS, MARRIAGES, AND DEATHS.—MEDICAL DIARY.

[June 4, 1887. 1165

McLean, Charles J. B., M.B., O.M-Bd., has been appointed Medical
Officer of Health for Yeadon. near Leeds.

Mastermax, Qeokoe Frederick, L.K.Q.C.P.I., M.B.O.8., liaa been
reappointed Medical Officer of Health for the Stour port Urban
8anitary District.

Nqbkt, J. Tawse, M.B., C.M.Ed., has been appointed Honorary
Assistant Medical Officer to the Liverpool Infirmary for Children.

Sab so*, H. A., L.R.C.P., M.R.O.S., has been appointed Assistant House-
Physician to St. Thomas's Hospital.

Smyth, H. J., L.R.C.P.. M.R.O.S., has been appointed Non-Resident
House-Physician to St. Thomas’s Hospital.

Solly, B., L.B.C.P., M.B.O.S., L.S.A., has been appointed Resident
Accoucheur to St. Thomas's Hospital.

Staple, James D., M.K.C.S., L.S.A., has been appointed Assistant
House-Surgeon at the Stockport Infirmary, Stockport, vioe A. J.
Turner, M.D.Lond., M.R.C.8., resigned.

Stavelxy, W. H. 0.. L.R.C.P., M.R.O.S., has been appointed House-
Surgeon to St. Thomas’s Hospital.

Stevessox, Robert, L.R.C.S., L?B.C.P.Bd., has been appointed Medical
Officer for the Third District of the Hunslet Union.

Sutton, Thomas ’ 8 ., M.B.O.S., L.S.A.. has been appointed Medical
. Offloer for the Second District of the Bridge Union.

White, Brxest William. M.B.Lond., M.K.C.P.Lond.. M.R.C.S., has
been appointed Resident Medical Superintendent of the City
Lunatic Asylum, Stone, vice Jepson, resigned.

Wirfield-Roll. G.. M.B., B.C.Cantab.. L.R.O.P., M.R.O.S.. has been
appointed Ophthalmio Clinical Assistant to St. Thomas’s Hospital.

girths, Carriages, aitEr

BIRTHS

Bigger. — On the 2Sth ult., at Queen Vpark-gardens, S treat ham-
common, the wife of W. G. Bigger, M.B., M.Ch.Roy. Unlv.Irel.,
M.R.C.S., of a daughter.

Crawshaw.— On the 25th ult., at 22, Trafaigar-sqnare, Ashton-under-
Lyne, the wife of S. Crawshaw, M.R.C.S.Eng., of a son.

Chitchktt.— On the 29th ult., at 21, Harley-street, W., the wife of
Anderson Critchett, of a daughter.

Davies.— On the 22nd ult., at Delabeche-street, Swansea, the wife of
W. T. F. Davies, M.B.. B.S.Lond., of a son.

Gilbart-Smith.— On the 22nd ult., at Harley-street, W., the wife of
T. Gilbirt-Smith, M.D., of a son (prematurely).

Baw. — On the 23th ult., at Rutland House, Oakfleld-road. Anerley,
S.K., the wifeof William E. St. M. Raw, L.R.C.P., M.R.C.S., L.S.A.,
of a daughter.

Biyingtox.—O rrthe 21st ult., at Plnsburv-sqaare, the wife of Walter
Bivington, BA., M.B., M.S.Lood., P.R.C.S., of a ton.

Stkavhrsor.—O n the 27th ult.. at 89. Welbeck-stroet, Cavendish-square,
the wife of W. B. Steavanson, M.D.Oantab., of a son.

Tweedy. — On the »»fch ult.. at Gardiner’a-row, Dublin, the wife of
H. C. Tweedy. M. D„ of a son.

Whittle. —On the 30th ult., at 65, Dyke-road, Brighton, Elizabeth,
wife of Ed. Geo. Whittle, M.D-Loncf., of a daughter.

MARRIAGES.

JTbnyox— Law.— On the 26th ult., at St. Matthew's Church, Cheltenham,
John Bdwand Kenyon, F.R.O.8., to Georgina Elizabeth, eldest
daughter of the late Rev. Henry Law, Vloar of Chepstow, Mon¬
mouthshire.

Lloyd— Hampsok-Simpsor. — On the 1st Inst., at Bdabaston Parish
Church, by the Rev. Cresswell Strange, M.A., Vicar, Gordon
Lloyd. M.8., F.R.C.S., of 22, Broad-street, Birmingham, to Marian
(Minnie), eldest daughter of Mercer Hampson-Simpson, Bsq., of
Priory-road, Bdgbaston.

©TOCkkr—Hodokirsor. —On the 2nd Inst., at St. Luke's, Westbourne-
park. by the Rev. R. J. Knowles, M.A.. Viear, George Bertram,
youngest son of the late James Stocker, Esq., of Guy’s Hospital, to
Alice Mary,, eldest daughter of the late Lieut.-Col. Cadman
Hodgklnson, 23th Regiment, Bombay Native Infantry.

Stcrridok—Hamer.—O n the 2nd Inst., at Wallasey Church, Cheshire,
by the Rev. A. E. P. Gray. Peter Frederick Sturrldge, M.R.C.S.,
L.H.OJP., of Kendal, to Mary Ada, second daughter of Charles
Marshall Hamer, of Lisoard, Cheshire.

DEATHS.

Cheese.— On the 30th ult., at The Terrace, Harilngbam-lane, Fulham,
Frederick Cheese, M.R.O.S., aged 47.

Coates. — On the 29th ult., at Dunedin, Bournemouth, Gilbert
Herbert, seventh son of the late W. Martin Coatee, aged 31.

Cook. —On the 28th ult., at Chepstow-place, Bays water, John Henry
Cook, M.D. (formerly of the Mlnorles).

Gammie.— On the 20th ult., at Stanhope-gardens, Queen’s-gate, S.W.,
Patrick Gammie, M.R.O.S., Surgeon-General, aged 73.

Milre.—O n the 27th nit., at Bridge of Allan, N.B., Henry Milne, M.D.,
late of Banff, N.B., in his 76th year.

Pritchard. — On the 21at ult., at Hastings, George F. Pritchard,
L.K.Q^C.P.1., M.R.O.S., of Bruson House, Teynham, Kent,
aged 47.

Vooar.—O n the 24th ult., at St. Mary Hlms, Ipswich, after a short
illness, Emma Jane, the beloved wife of James Norman Yogan,
F.R.C.8., in her 22nd year.

H.B .—A fat of it. it ckaryd for tit ZnttrMon tf Notiom tf Sirtfu,
„ , Marnagtt, and Dtatkt*

Utoital |}rary for % muing MttL

Monday, Jane 6.

Royal Lordor Ophthalmic Hospital, Moorfields. — Operations,

10.30 a.m., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.—O perations, 1.30 p.m..
and each day at the same hour.

Chelsea Hospital for Women.—O perations, 2.30 p.m; Thursday,2.30.
Bt. Mark's Hospital.—O perations, 2 p.m. ; Tuesday, 2.30 pji.

Hospital tor Women, Soho-square. — Operations, 2 p.m., and on
Thursday at the same hour.

Metropolitan Free Hospital.—O perations, 2 p.m.

Royal Orthopaedic Hospital.—O perations, 2 p.m.

Central London Ophthalmic Hospitals.—O perations, 2 p.m.,
each day in the week at the same hour.

Anatomical Society of Great Britain and Ireland. — 6 p.m.
Meeting! at the Medical Society of London, Chandoe-street.
Cavendish-square, W. Report of Committee and Election 6f Officers.
Odontological 8ociety of Great Britain.—8 p.m. Mr. F. Henri
Weiss: On the Destruction of a Permanent Tooth Pulp by an
Alveolar Abscess attached to a Deciduous Molar. — Mr. Storer
Bennett: (1) Dental Abnormality in a Lower Jaw from a subject
who is supposed to have lived In the Stone Age; (2) Extraordinary
Bxample of Perverted Tooth Development.—Mr. Bridgman: Case
of Irregularity.—Prof. Victor Horsley: Epileptiform Neuralgia of
the Fifth Nerve treated by Avulsion of the Nerve.

Tuesday, June 7.

Guy's Hospital.—O perations, 1.30 p.m. and on Friday at the tame hour.

Ophthalmic Operations on Monday at 1.30 and Thursday at 2 p.m.
St. Thomas's Hospital.—O phthalmio Operations, 4 p.m. ; Friday,3 p.m.
Cancer Hospital.Bromptor.—O perations,2.30 p.m.j Saturday,2.30 p.m.
Westminster Hospital.—O perations, 2 p.m.

West London Hospital.—O perations, 2.30 p.m.

St. Mary's Hospital.—O perations, 1.30 p.m. Consultations, Monday.

1.30 p.m. Skin Department, Monday and Thursday, 9.30 a.m.
Royal Institution.—5 p.m. Rev. J. P. Mabaffy: The Hellenism of

Alexander’s Bmplre—Macedonia and Greeoe.

Wednesday, June 8.

National Obthopaidio Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, I p.m. *"

8t. Bartholomew's Hospital.—O perations, 1.30 p.m,; Saturday,same
hour. Ophthalmio Operations, Tuesday and Thursday, l.w p.m.
Surgloal Consultations, Thursday, 1.80 p.m.

St. Thomas's Hospital.—O perations, 1.30 p.m.; 8sturday. same hour.
London Hospital.—O perational p.m.; Thursday A Saturday, same hour.
Great Northern Central Hospital.—O perations, 2 p.m.

Samaritan Free Hospital fob Women and Children.—O perations.

2.30 p.m.

University College Hospital.—O perations, 2 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 p.m. ; Saturday, 9.15 a.m.

Royal Free Hospital.—O perations, 2 p.m., and on Saturday.

King’s College Hospital.—O perations, 3 to 4 p.m. ; Friday, 2 p.m. ;
Saturday, 1 p.m.

Children’s Hospital, Great Ormond-strket. — Operations, 9 a.m.;
Saturday, same hour.

Royal College of Surgeons of England.—1 p.m. Prof. Christopher
Heath : Certain Diseases of the Jaws—Cystic Diseases of the Jaws.
Royal Microscopical Society.—8 p.m. Mr. G. Massec : Monograph
of the Genus Lycoperdon. — Profs. T. Rupert Jones and 0. £>.
Sherbom: Remarks on the Foramlnifera, with especial reference bo
their Variability of Form, illustrated by the Crlstellarians.
Epidemiological Sooikty of London. — 8 p.m. Annual General
Meeting. Dr. George Turner: Diphtheria.

British Gyh.soologioal Society.—8.30 p.m. Specimens will be shown
by Drt. B. T. Smith, Bdis, Granville Bantock. and others.—Mr. Lawson
Tait: The Principles of Flap-splitting In Plastlo Surgery.

Thursday, Jons 9.

St. George's Hospital.—O perations, 1 p.m. Ophthalmio Operations,
Frldsv, 1.80 p.m. r

Charing-cross Hospital.—O perations, 2 p.m.

North-West London Hospital.—O perations, 9.30 p.m.

Royal Institution.—3 p.m. Rev. J. P. Mahaffy: The Hellenism of
Alexander's Empire—Egypt.

Ophthalmolooical Society of the United Kingdom. — 8.30 p.m.
Living and Card Specimens at 8 p.m. :—Mr. W. J. Collins: Exten¬
sive Hemorrhage into Blind Bye with Coarctation of Retina.—
Mr. Higgens: Unusual Form of Coloboma of Iris.—Mr. G. B. Walker:
(1) Sequel to case of Exophthalmos ; (2) Sequel to case of Cyclotomy
in Glaucoma. —Mr. Story: Experimental Demonstration on thW
Pathology of Glaucoma.—Mr. Silcock: Sequel to case of Central
Choroidal Hemorrhage. Papers:—Mr. Story: Case of Complete
Blindness of Bight Bye with Temporal Hemianopsia of Left Eye.—
Mr. Hill Griffith: On the Permeability of the Suspensory Liga¬
ment by Organised Substances.—Mr. Brallev : Recurrent Choroido-
Retinitis in region of Macula Lutea.—Mr. Nettleshlp: Two cases of.
Quinine Amblyopia.

Friday, Jane 10.

Royal South London Ophthalmic Hospital.—O perations, 2 p.m.
Royal College of Surgeons of England.—1 p.m. Prof. Christopher
Heath: Certain Diseases of the jaws—Tumours of the Jaws.

Royal Institution.—9 p.m. Mr. Thomas Hodgkin: Aquileia the Pro.
cursor of Venice.

Saturday, Jane 11.

Middlesex Hospital.—O perations, 2 p.m.

Royal Institution.—3 p.m. Rev. J. P. Mahaffy 1 The Hellenism of

Alexander's Empire—Syria.

[Jtrani 4,1887.

116 6' Thb Lancet,] NOTES, COMMENT8, AND ANSWERS TO CORRESPONDENTS.

METEOROLOGICAL READINGS.

(Taken daily at 8.30 aan. by Stewards Instrumentt.)

Thb Lancet Office, June 2nd, 1887.

Data.

Barometer
reduced to
8ea Level
aadsr>P.

Dlreo-

tlOB

ol

Wind.

a

Wet 1
Bulb.

1 Solar i
Sadia
la

Vacuo.

Mas.

Temp.

Shads.

Min.

Tamp

Rain

Remarks at

8 JO lm.

May 27

29-97

N.

47

40

54

45

•17 !

Batnlng

„ 28

2992

N.

52

50

78

58

47

•10

Overcast

„ 29

29'M

N.H.

52

49

83

59

46

•04 ,

Overcast

„ 30

30-01

E.

63

61

75

62

47

•02 1

Overcast

!. 81

30 08

B.

56

54 1

111

70

51

... 1

Cloudy

June 1

29-96

B.

66

53

93

65

50

•02

Overcast

.. 2

29-77

E.

52 ,

50

50

50

...

Overcast

ftotes, S&art Comments, $ ^ttshicrs to
CoraspmtkRts.

It is especially requested that early intelligence of local events
having a medical interest, or which it ts desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication.

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating' to the vubliccetion, sale, and advertising
departments of Thb Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

Medical Students and the Juiiu.be.

On the occasion of the recent celebration of tije birthday of the Emperor
of Germany the students of Berlin turned out In force to show their
loyalty to their sovereign. In a few days we shall be oelebratlng the
completion of our Queen’s fifty years' reign t but as yet we have not
heard that the medical students of London, a large and Important
part of the community, are making any attempt to take formal part
In the celebration. Our attention has been called to this omission by
two correspondents, who suggest that a congratulatory address be
drawn up and signed; that the students of all the hospitals should
turn out In evening dress, with white flowers in their button-holes,
and should march In procession to Her Majesty, drawing up outside
the palace; and that a deputation oo us La ting of one representative
from each hospital should present the address, the whole tone, on the
return of the deputation, giving three cheers for their Queen. It
anything of this sort is to be done, there is no time to be lost. What
Is done must be done promptly. The Idea is worthy of consideration.

Justice. A medical man nnder promise not to practise as a surgeon and
apothecary within ten miles of a given centre is dearly also prevented
from practising as a physician, a term which does not now bear the
restricted meaning which It had fifty years ago, but embraces a great
part of the cases of ordinary practice.

Seta .—The qualifications mentioned are sufficient for the recovery of
midwifery fees, either singly or combined.

Junior .—Nothing Is definitely known on the points mentioned.

THE INOOME TAX.

To the Editors of The Lancet.

8ms.—I wish to get Information cm the following point, and perhaps
some of your readers may be able to help me. I took over a practioe in
the autumn of last year, but did not take the book debts with it. Not¬
withstanding this, the surtoyor of taxes required me to pay half my
predecessor's income tax) but I refused to do sol He then called upon
meto give a statement of ray book debts, though my bills cannot be sent
out till midsummer, and on this return, when he gets It. he proposes to
bMN^ bis assessment. I should say my actual receipt* for six months
ending March 31st are less by £10 than the working expenses. Can I be
required to pay on debts that have not yobbeen claimed, but on which
when paid I shall have to pay laoome tax for the year following p What)
isthebest odtuedto tabeP—1 am. She, yours obediently.

May, 1887. A ■‘TB^ftuemiwntR.

The Ojue or Mr. Oharlks Oarmr.

Da. Glover begs to acknowledge the reoeipt of the following sums

towards helping the Misses Gaffney in maintaining their brother:—

J. G. G., 2s. ■, J. A., £1 is.; H. S. H., £1 It.; Omega, 10s.

Mr. G. Schofield (Bournemouth).—The appointment Is not a public one.

TREATMENT OF TJJNIA SOLIUM.

To the Editors of Thb Lancet.

Sirs, —In answer to “ Puzzled,” I beg to forward the following obeer- "
rations :—

During my stay in South Africa I treated many oase s , myself included,
and always with success. The great point in the treatment of tape-
worm is to expose the head, which is attached to the Intestine by Its
booklets. So long as the head be covered with ffeces no medicine wiB
do much good. My treatment is as follows: —The day before giving the
worm medietas I allow no food of any kind exoept plain beef tea, «r
other very thin soup, and very little even of these. The first morning I
give one drachm of compound jalap powder, which generally operates
three or four times during the day, and effectually clears out the bowels,
bringing away at the same time large portions of the worm. The patient
of coarse, keeps quiet in the house. On the second morning, on
an empty stomach, I give a draught consisting of from two to three
drachms of oil of turpentine and one drachm of oil of male fern la
sweetened emulsion. After an hour or so I give a dose of castor oil. It
will not be long before the whole of the Worm with its head will have
passed.- Which will be found 1 on proper examination of the stools. The
patient can then take his usual diet, and the following day will be well.

I have never known this treatment" to tall. The above doses, of oourae,
are Intended for adults. The frequent failure of the oil of male fern as
an anthelmintic Is, I believe, attributable to the smallness of the does
exhibited, less btmandraahm for an adult being useless. I may bus 1
state that I believe every native In South Africa to be infected with one
or two tapeworms. I am, Sirs, yours faithfully,

Cheltenham, Mny,T887.' Fred. A. A. Smith, M.D.

To the Editors of Thb Lancet.

SiRfl.^In reply to “ Puzzled" I write to say that It Is useless to rabyl
upon any of the reputed remedies for tapeworm, unless the patient Is in
the first place well purged, and afterwards properly dieted. The plan J
have adopted, and which I have never found to fall, Is, supposing the
patient to be an adult male, to give an ounce of castor oil; this e lsaw
the intestines, so that the worm has nothing to hold on to. For the
next twenty-four hours feed the patient on beef-tea, gruel, raw eggs,,
allowing neither milk nor anything solid. Than give one drachm of
oil of male fern emulsified with yelk of egg and a little syrup and gum,
eight hours after whleh give another doee of oastoroil. This removes
the parasite without distressing the pattenfe. Shmdd the dose of rials
fern be vomited, before repeating It apply a mustard and linseed aeeal
poultice to the epigastrium. By,the above treatment I r ec en tly cgeoMRl
a tenant of nine years' residence.—I am, Sirs, yours obediently.

May 30th, 1887. H. W., L.S^. hm.

To the Editors of Thx Lancet.

Bibs,—I n reply to the letter in your Isawe of May 28th regarding the
non-sucoeos of the various remedies for Uenia solium prescribed by
“ Puzzled,'’ permit me to recommend my prescription and after-treat¬
ment for the entire expulsion of tsenia with its head. The patient, an
adult, Is to take the following draught on awakening about 4 o’oionk
In the rooming i—Six drachms of castor oil, one drachm of oil of male
fern, fifteen minims of llq. potass®, and ten minims of spirit of
'peppermint. For breakfast a small plate of Sootoh porridge and a eup
of hot tea. By following this treatment twice a week he will suooeed
after the third or fourth draught In expelling the worm with its bead-
I am, Sira, yoars obediently,

Manchester, Jane 1st, 1887. H. K. H. Pearr, L.K.Q.GJU., due.

To the Editors of The Lancet.

Sirs,—Y our correspondent, •• Puzzled,” should starve his patient for so
many hours, say seven. Kill the worm at bedtime with a full dose of
fresh male fern—a drachm. Empty the bowels next morning with a
large dose of castor oil. Allow the patient to drink tea without milk and
sugar till the bowels have well acted. Afterwards, in four hours, sanction
a plate of mashed potatoes. Repeat this twioe daring three days. After
a short interval of a few days repeat again, and if n e cess ar y again. ThA
plan I have on several occasions found to be a certain remedy; but ft
must be carried out most rigidly. It is what all praotiesd physioiaa*
would reoommend. I am, Sire, yours faithfully,

Boschurch, May 29th, 1887. J. F. Bb«»r.

To the Editors of The Lancet.

Sirs,—I n Dr. Lionel S. Beale's work “ The Microscope In Medicine” there
i» a section headed •• Means of Procuring the Head of the Tapeworm.” 1
followed these directions closely, while I bore In mind the caution given
by Dr. T. Spencer Cob bold in his book on “ Worms,” where be says:
“The important thing Is tb be sore that yoor pharmaceutical prepare*
ttons are the very best that can be made. Inferior drugs will cause yon
much disappointment.” I had my oil of male fern freshly made by one
of our best chemists, and administered in this case two drachms, with
the dmired result. I am, SIM, yours very truly,

, Brighton, May 28th, 1887. F. J. Spears**.

Digitized by Cj OOg 1C

Thh Lancet,]

NOTES, COMMENTS, AND ANSWEBS TO OOERBSPONDENTB. [June 4, 1887. 1167

HOUSE SANITATION.

Mr. R. Fitxroy Benham call* attention to the existing method of con¬
struction of houses which allow smells to pass from the basin of the
wateroloeet when it la used, beneath the seat, and travel along the
joists Into other parts of the house, and he suggests the rim of the basin
being provided with an indiarubber lining which would effectually
block up the space intervening between the seat and the rim.

JDr. J. JB. Uacnaughton. —The coroner certainly acted within his legal
rights in ordering another medical man to make the post-mortem
examination. We are inclined to think that whenever the death seems
not improbably due to violence, it is well that the responsibility should
be shared by two medical men, especially as the gentleman In charge
of the case during life might be charged by unscrupulous or careless
persons with having acted in other than the best Interests of the pat ient.
We advise our correspondent to view this caae in a philosophical spirit.
One of them. —As the Medical Begister was published on April 29th,
clearly not “ one of them "—new members of the College of Surgeons—
in the list of May 7th could appear.

NBW 8O0TH WALES.

To the Editort of In Lancet.

Sirs, —In reply to the questions asked by “Viator" In your Issue of
May 28th, I beg to state that there are no peculiar endemic or epidemic
diseases in New South Wales. Nearly all the diseases prevalent in Great
Britain are met with in practice, but the general mortality is low.
Typhus fever and small-pox are unknown, except when accidentally
introduced by immigrants. Sydney had a short epidemic of small-pox
lately produced in this way. Typhoid fever is rather prevalent, and
there have been various severe epidemics of scarlatina and measles.
Diphtheria is relatively common, Respiratory disease la dealdsdly less
frequent than in Great Britain, whereas diseases of the nervous and
digestive systems exoeed the home average. Parasitic disease, especially
hydatids, is common. Snake-bite is, perhaps, the only unfamiliar
affection which the practitioner is called upon to treat. The mortality
from it is low compared with the number of accidents reported. The
chief towns are well supplied with all the requisites of practice, but the
prioes charged are high. Your correspondent would do well to go out
thoroughly equipped with the usual armamentarium, but no special
selection of drugs or instruments need be made. The conditions of
practioe vary much aooordlng as the practitioner settles in one of the
large towns or in a rural district. In the former case medical life and
practice do not differ materially from the experience of the home
country. In the latter ease the practitioner must oarry with him such
accessories of civilisation as may be necessary for comfort and medical
practice. I am. Sirs, yours faithfully,

Belfast, May, 1887. James Alex. Lindsay, M.A., M.D.

In reference to one part of “ Viator’s" query, Meesrs. Mayer and Meltzer
of Great Portland-street write that they have a branch establishment
in Melbourne, where surgical instruments of all kinds may be obtained.

PLA01NTA PRJ2VIA.

To the Editort of The Lancet.

Sms,—Mr. Logan's case In The LaeCkt of May 20th has Induced me
to send yon the following, should you deem it of suOelent interest for
Insertion.

On April 28th last I was oalled to a prlmipara aged about twenty-six.
On arrival I found the patient In bed, looking and feeling remarkably
well. I was told that the contents of the uterus had been expelled. On
examination I found the vagina perfectly free from blood clot; In foot,
my digit was not even stained with blood. The vaginal wmi was
somewhat tightly contracted. In the ohamber vessel there was a foetus
between four and five months old, with the placenta attached to
the vertex. The head was exceptionally large. There was a
very slight aanlona discharge for two or three days after this.
I ncay mention that the menstrual discharge had been always very
scanty and that three weeks previously to the miscarriage the patient
fell into a small brook; the accident, however, gave rise to no unpleasant
symptoms more than the shock at the time. As the peculiarity of the
attachment of the placenta and the entire absence of hesmorrhago
at birth were unique In my experience, I thought the case might be of
interest to the profession.—I am. Sir, yours faithfully,

Wadebrldge, May 28th, 1887. P. G. Stewart, M.R.C.S., L.8 .A.

THREADWORM.

To the Editort of Tar Lae on.

8 irs, —In the case of your correspondent, “M.R.C.8.," perhaps the
vagina Is a nidus for this worm, the oxvuria vermicularis, presuming
the patient to be a female. If so, the vagina should be washed with a
cerboUe lotion, any uloeration of the oe uteri treated with AgNO*. the
pwtaeum anointed with a carbolic or mercurial ointment, as a poison to
these migratory creatures, and a rectal injection of Iron, salt, quassia, or
oekhark employed, coupled with the administration of Iron and bark
latoanally and an occasional purge. The diet to be regulated. Such
vegetable# as greens are to be avoided.

I am, 8ira, yours faithfully,

Basohurch, May 29th. M87- J.V.BUsooe.

Chiba Medical Missionary Journal.

The Medical Missionary Association of China has commenced to issue a
quarterly journal, which, if we may judge by the first number, will
oontaln a good deal of valuable scientific matter, connected especially,
of course, with the Oriental aspects of disease, in addition to articles of
missionary Interest. The columns of the journal are, we are glad to
note, by no means confined to missionaries, but are equally open to all
qualified practitioners in China. A space is also reserved for articles la
the Chinese language. From a list given there appear to be at present
seventy-nine medical missionaries in China, Corea, and Siam, belonging
to twenty different societies. The majority are Americans, but thirty-
three are British subjects. Fifteen ladies, thirteen of whom are
Americans, are included in the list. The Bev. L. U. Gulick, M.D., of
Shanghai, may be addressed for further information concerning the
association.

Pour y Parvenir, and A—Application should be made to the Directors or
Commissioners of Prisons, and the appointments are in the hands of
the chairman. Sir E. Du Cane.

Ur. T. L. Horner. — Heath's Operative Surgery; Stephen Smith's
Principles and Practice of Operative Surgery.

THB COMMEMORATION OF THB QUBBN’S JUBILEE BY THH
MBDICAL PROFESSION.

To the Editort of The Lancet.

Sirs,—I have been waiting to see if any of the leading members of
our profession would begin some movement to commemorate the jubilee
of Her Most Gracious Majesty the Queen, and that would also at the
same time have the effect of benefiting the less fortunate members of
the profession to which we belong, but up to the present time I have
seen no sign of anything being done In that direction. I know that
it is from no want of loyalty that the members of the medical profes¬
sion have so far not taken combined action to mark their high regard
for the jubilee of our beloved Queen In some practical and solid way,
but I believe it Is because they are waiting for someone to Initiate a
movement that would recommend Itself to their approval for that pur¬
pose. There is scarcely a week passes but that an appeal is made to tha
profession for assistance on behalf of some “ object of charity ~
belonging to our body by reason of old age, sickness, misfortune, or
death, and knowing this, and seeing that the various sections of the
community are vielng with each other to oelebrate the Queen’s Jubilee
in some substantial form, I venture to ask you to lend your aid and
influence to bring about such a movement that will be creditable to our
profession and a great gain to those who have particular claims upon
our sympathies, and who look to us to smooth somb of the rough places
of this life, and aid them in procuring the creature oomforta to make
life bearable. When we take into account the number of members
(16,000) belonging to the medical profession in this oountry, and know
the great want there is of help for the sick and needy amongst them and
their families, I cannot but think that it onlv requires your help
In pointing out the duty of our members to do something worthy
of our noble profession to alleviate the wants of our less fortunate
brethren In order to secure Its accomplishment. We sec what can be
done by united action in raising money by such examples as those of
the committees of the “ Women’s Jubilee Offering to the Queen”; and I
think we liave sufficient men of influence amongst ns who might be pre¬
vailed upon to act as a central committee, and to oall meetings of our pro¬
fessional brethren in every town throughout the kingdom In order to raise
subscriptions for the purpose I have indicated; and 1 believe if that were
done the results would be most satisfactory. Whan we see the number
of almshouses that are empty at Bpsom solely through the want of
funds, and that the number of applicants for pensions, ho., 1s to much
iu excess of the funds that are at the disposal of the Medical Benevolent
Society in connexion with the college at Epsom, I think it is quite time
we were up and doing. If the matter is thoroughly taken in band, I
feel sure that before many months are past we should be in a position to
go to the head-master of the college at Bpsom and ask his advice as to
how to expend a sum of £10,000.

I now, Sin, leave the matter in your hands, and ask your
powerful aid In furthering this much-needed object; and there can be
no doubt that the snooess of such a movement would not only be a wise
and beneficent act to testtfy our loyalty and appreciation of the blessings
conferred upon our countiy during the reign of our gracious Sovereign,
but would also be an honour to ear profession and a means of rendering
assistance and conferring comfort and happiness on many. I shall be
glad to give ten guineas towards any fund that may be begun In con¬
nexion with the Medical College at Bpsom.

I am. Sirs, yours faithfully,

■Irion Honse, Crewe, May 18th, 1887. James Atkinson.

“ CHRONIC RHEUMATIC ARTHRITIS."

TO Ms Editort of In Lancet.

Sirs, —I would recommend your correspondent who signs hhmtff
“ Medlcus" in The Lancet of to-dny to try the following treatment in
the case he mentions:—Five-drop doses of tincture of iodine three times
a day, and oooa wine at night to promote sleep. 1 have found coca wine
vary useful in oeaes where opium is eootra-1 ndmated.

I am, Sire, yours truly, {

Bridgend, May 28 th, 1887. W. BdmUNd-Thomas, L.R.C.P., Ac.

1168 Thb Lancet,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[June 4, 1887.

Want of a Chinese Medical Dictionary.

A WART has long been felt of a dictionary of medical terms for all China,
the words employed In one part of the empire often conveying no
meaning to those living in another part. Thus a Chinaman from the
north 1 b said to have hunted all over Canton and Hong Kong for
iodide of potassium without being able to make anyone understand
what he wanted.

Jfr. A. E. Barker.—A. proof of the paper will be forwarded in the course
of a few days.

Dr. McClure (Cromer). — The paper has been received and will be
published shortly. The other case mentioned may be forwarded.

CONVERTIBLE CARRIAGE.

To the Editors of The Laxcet.

Sins,—I have lately had a carriage built which presents some
peculiarities which may be interesting to your readers. By various
alterations it can be turned into a brougham, single seated; a
victoria, with hood; or a park phaeton, each complete in itself. The
alteration from victoria to park phaeton can be accomplished in about
two minutes, and that from victoria to brougham in a little longer
•pace of time. The advantages gained are, of course,—(X) that for the price
of one oarriage I have three; (3) that no more room in stable is required
than for one carriago; (3) that I can vary my vehicle according to the
weather, and either drive myself In the park phaeton or bo driven in the
victoria or brougham; and (4) only one tax for three carriages. There is
nothing in the victoria or park phaeton that looks different from the
ordinary carriages of this type. In the brougham the only discernible
difference is that the wings are retained. I shall be happy to show any
of your readers tho metamorphosis, which I can atronglv recommend
for medical men, especially for those whose Income is not in proportion
to their desires. 1 am, Sirs, jroors faithfully,

A. George Bateman, M.B.
Longridge-road, 8. Kensington, May 30th, 1837.

A Guy's Man cannot be blamed for not going to a case against the wish
of the parent*.

B.-It Is better to follow the custom heretofore observed In the place.

“A NEW UVULATOMB.”

To the Editors of The Lancet.

Sras,—I have only just been able to procure a copy of Mathlm’s
Catalogue, In which Dr. Warren says is depicted a uvnlatome Invented
by him In 1855. and precisely similar to that clatmel as my invention in
The Lancet of May 7th. His instrument sppears to be constructed on
the principle of flower-scissors, with a slight curve downwards, thereby
exposing a wide cut surface anteriorly. This is exactly what my
Instrument would avoid.

I am, Sirs, yours faithfully,

Greville Macdonald, M.D. Load.

Upper Wimpole-street, W., May, 1887.

Mr. E. B. Williams will see by a general notion which appears weekly In
our oolnmns that we do not undertake to return MSS. not used.

“SWEATING OF THE FEET.”

2b the Editors of The Lancet,

Sirs.—" A 8ufferer "asks, In your last Issue, for a remedy for the above.
Presuming that there Is no obvlons cause for the sweating, and that it is
confined to the feet, your correspondent will derive considerable benefit.
If not absolute cure, from the use of digitated wool socks and felt clotli
I am, Sirs, yours faithfully.

May 30th, 1887. Bernard O'Connor.

Communications not noticed In our present number will roodve atten¬
tion in oar next.

Communications, Letters, Ac., have been received from—Mr.
London ; Sir W. Mac Cormac. London; Dr. L. Marshall, Nottingh-'n
Dr. J. W. Ogle, London; Sir G. Young, London; Mr. E. Treac. -r
Collins, London; Dr. Alder Smith, London ; Mr. C. B. Harris;.;.
London; Dr. Lediard, Carlisle; Mr. Trimmer, London; Dr. Harr
Campbell, London; Mr. N. Porrit, Huddersfield ; Dr. G. Maodona! 1
London ; Mr. Pearce, Manchester; Messrs. W. A F. Thorn, Land;; ;
Mr. F. G. Stewart, Wodebrldge; Dr. W. Pearce, London ; Dr. Betf;
Rake, Trinidad; Mr. T. L. Horner, Malta; Messrs. Shillingford a: i
Co., Bicester; Dr. F. A. A. Smith, Cheltenham ; Messrs. Toeplitj ;
Deuticke, Vienna; Mr. Firth, Dagshal; Mr. Spranger ; Dr. Dorat..
Hormusjie, London; Mr. J. F. Briscoe. Baschurch ; Messrs. Bar: a
and Co., Congleton ; Mr. W. E. Thomas. Bridgend ; Messrs. WiL* -j
and Darter, London ; Mr. Ralph. Burton-on-Trent; Messrs. Warner
and 8ons, London; Dr. Lindsay, Glasgow; Mr. Morrison. Biib-
Auckland; Dr. J. B. Macnaughton. Deptford; Messrs. Madacfala i
and Co., Edinburgh; Dr. W. Ilitchman, Liverp>ol; Messrs. Coo-lr
and Co., London; Dr. F. J. Smith, London ; Dr. Jas. More, RothwrU•
Mr. A. G. Bateman, London; Mr. Gorancb, London ; Dr. Portae*
Fox, Strathpeffer; Mr. C. B. Westwood, London ; Messrs. Hooper \~.i
Co., London ; Dr. C. F. Knight. Dublin ; Dr. C. Holman ; Mr. F.
Humphreys, London ; Mr. II. MIchle. Nottingham ; Messrs. Boa;- j
and Paul, Norwich ; Dr. T. Savage, Birmingham; Messrs. Fl«f-.,r
and Co., Holloway ; Mr. Macklnlay, Stockton-on-Tc's ; Mr. Freeruia.
Bath; Mr. Barrett, London ; Mr. Laudon, Birmingham; Dr. Tav:..r.
Windermere; Dr. Purcell, London; Mr. Legge, Aberystwyth ; M:. B.
Eelton, Rugby; Mrs. Spreat, St. John’e-wood; Mr. Moulding, Liver¬
pool ; Dr. Hioka, Hendon; Mr. Allen, Liverpool; Mr. TunnldiJ*.
Hanley; Mr. Chapman, Bostock; Miss Terrell, Bsmet; Mr.Lanrond.
Glasgow; Mr. Orewes, Truro; Dr..Young, Manitoba ; Mr. Kirkby,
Leeds ; Mr. Dawson. Bangkok; Dr. Gerrard, London; Mr. Mackilila T,
London ; Mr. Smith, Kennetty; Mr. Davis, London ; Rev. A. Tooth.
Croydon; Mr. Evans, Biggleswade; Mr. Shroster; Messrs. Lee and
Nightingale, Liverpool; Mr. Baron. Manchester; Messrs. Hopkiotn
and Co., Notts; Mr. Groves, Dorchester; Mr. Pike. Longhboroogh;
Mr. T. Cook. London-, Mr. Knightley, London; Dr. J. F. Wklkrr.
Spilsby; A Town Councillor; C. D.; Physician. South sen; Justice •
M.D., M.R.C.S.; R. B. W.; J. W. W„ Leicester; E. W., L.S.A.;
Fluorine.

Letters, each tenth enclosure, are also acknowledged from—Dr. Wise.
London; Mr. Tunmer, Harrogate; Mr. Forster. Leigh ; Messrs. R« 1
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THE LANCET, June 11, 1887.

<£akatnslj lecture

OR A

SPEEDY AND SOMETIMES SUCCESSFUL
METHOD OF TREATING HAY FEVER.

Delivered before the West London Medico- Chirurgica l
Society,

By SIR ANDREW CLARK, Babt., M.D., F.R.S.,

XKKRmrS PROnOSOR OF cumoAi medicirb TO THJt IOKDOX
HOSPITAL.

Mb. Pbbsidbnt and Gkntlkmt.n,— It £as been sometimes
said by way of reproach that the scientific workers in
medicine, although eager in the pursuit of knowledge for
its own sake, were careless of its practical applications to
the treatment of disease, if at any time this reproach was
a just one I do not know, bat beyond all manner of doubt
it would not be a just one now, for in almost all countries,
and in nearly every school in every country, you can see,
not only the earnest pursuit of knowledge, but the most
zealoas efforts to force it into fruit for the uses of men, and
in the study of no subject could you find a better proof of
this than in the study of hay fever, of which I am about to
speak. From Blackley of Manchester to Mackenzie of Bal¬
timore you will find a succession of inquirers whose efforts
to discover the nature of this malady have been accompanied
by efforts equally earnest and persevering to discover its
most appropriate treatment; and from America, the most
earnest and persevering of all countries at work, we have
received the largest and best fruits of this double pursuit.
To-night the plan of treatment of hay fever which I
shall have the privilege of submitting to your consideration
is entirely founded upon a physiologioal study of the
disease. It is, however, with the results of this study only
in so far as they bear broadly and directly upon treatment
that 1 propose to occupy myself. With minute discussions
as to the nature of hay fever, its physiological and patho¬
logical relations, and the causal agencies engaged in its
evolution, I shall have to-night only an indirect concern.
Nevertheless, as I wish to set forth the true grounds for a
rational treatment of this malady, suoh discussions cannot
be passed over entirely.

Before proceeding farther I wish to pause for a moment
and advert to the name by which this malady is known.
From nothing has medicine suffered mom than from hypo¬
thetical naming. What may seem to to the correct and
adequate hypothesis of to-day may become tbs inoorrect
and inadequate hypothesis of to-morrow; and when the
true nature of a malady is discovered, the diffusion of the
discovery is hindered, if not prevented, by the retention of
a name which, established by'custom and 1 continued from
convenience, conoeals the truth and perpetuates error. 1
could advance few better illustrations of this than the
naming of the disease under consideration. The epithets of
“hay fever,” 44 hay asthma,” “ pollen fever,” 44 rose cold,” and
“peach cold” are widely open tothis objection. They withdraw
tne attention from internal states, and they tend to narrow
our ideas of causality within the limits of outward things. It
is true that the pollen of certain grasses is the most common
exciting agent of the paroxysm of hay fever, but it is also
true—for it has been demonstrably proved—that the
paroxysm can be excited not only by other external agents,
snob as light and heat and dust, but also by local affections
Of the noee and throat, by irritations propagated from
distant parts, and by influences degenerated de novo in some
part of the 1 Centra! nervous system. It is only of late, and
through researches made for the most part in America, that
We have come to a knowledge of these facts. Even there,
however, the tendency to hypothetical naming continues,
atod the term proposed by Mackenzie of Baltimore, to
whom We 0*0 so' ranch of what is beta in our recant
- knowledge bf this subject, is not free from grave objections.

, No.8828.

He calls the disease “periodic vaso-motor coryza,* but in
this designation there is involved an hypothesis which
to-day may be doubted and to-morrow disproved. Nor
are tne epithets proposed by myself— 44 periodic specific
coryza” and “ periodic nervous coryza”—free from just and
grave objections. We are thus in need of a proper name
for oar malady. No one can be rightly framed except out
of its commoner physical characteristics, and no one can be
safely used unless it shall imply no hypothesis and be
capable of remaining always the same, however much our
theories of the disease may change.

Of the innumerable persons exposed, in similar if not
identical conditions, to the exciting causes of hay fever,
only a few are affected with the disease, and of those few
there are, strange to say, scarcely any among agricultural
labourers and gardeners, who are habitually exposed to the
pollen of grasses believed by some authors to be the sole
causal agents of the development of the asthmatic paroxysm.
It seems therefore only fair to conclude that in the evolu¬
tion of the malady some other agent than the external
exciting cause must be directly concerned. Further in¬
vestigation proves this conclusion to be correct. Prom
experimental examination we learn the existence of a
second factor which resides in the mucous membrane of the
noee, month, pharynx, and eyes, which mainly concerns the
nerves of these parts, and which manifests itself in all their
histological constituents by a peculiar irritability of reaction
to certain excitants. Furthermore when, in cases exhibiting
this peculiar local irritability, we pursue our inquiries into the
characters of the constitutional state associated with it, we
discover certain baarre symptoms of disorder which belong
exclusively to the nervous types of organisation, and which
stamp the organism exhibiting them as specifically and
pathologically nervous. Lastly, if, pursuing our investiga¬
tions still further, we institute an analysis of the differentia
distinguishing the nervous constitution in this disease from
the nervous constitution of cognate affections, we are led to
the conclusion that they reside for the most part in the
respiratory and vaso-motor centres and in the ganglia con¬
necting and connected with both. In this way we discover
reasons for believing that there are three great factors con¬
cerned in the evolution of hay fever: the nervous constitu¬
tion, the irritable local state, and the exciting cause. As a
general rule, to which there are some remarkable exceptions,
all these factors, although in varying degrees, co-operate in
the development of an attack of hay fever. Concerning
each of them I have to offer a few observations which will
make plain the ground upon which a rational treatment of
this malady can be based.

The nervous constitution associated with hay fever is
sometimes inherited and sometimes acquired. For the most
part inheritance oomes from the arthritic and the nervous.
When acquired, it is acquired most easily by those who lead
laborious sedentary and intellectual lives, as well as by those
who, avoiding the difficulties and discipline of life, seek
luxury with ease, by those who prefer excitement to duty,
and by those who become weak through failure to exercise
their strength. And when once hay fever appears, it
exhibits still further the olosenees of its relationships to the
nervous system by choosing the man before the woman, the
educated before the ignorant, the gentle before the rude, the
courtier before the down.' Some of the more general
affinities of hay fever are harder to be understood, it pre¬
fers the temperate to the torrid zone; it seeks the city
before the country, and out of every climate which it visits
it chooses fdr its subjects the Anglo-Saxon, or at least
English-speaking race.

And now, conoerniug the seoond factor in the evolution
of hay fever, the condition of the mucous membrane of the
nasal cavities and parts adjacent, we have divers and some
diverse views. All observers are agreed that there is some
pathological condition of the affected parts, but no two of
them do agreed ae to its exact nature. For my own paxt^L
conclude from the investigations which I have panned lain
the matter that there is one funda me ntal condition which
reconciles all these varied and sometimes opposing views.
This condition it one of irritability, and the irritability Is of
a tort which involves the nervous vascular lymphatic and
cellular constituents of the affected parts, and when excited
disturbs the chemical morphological and secretory changes
taking place therein. When this local irritability is provoked
into action there arise a series of local structural changes
which are all but characteristic of the paroxysm of hay
.▲A

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1170 Thk Lancbt,]

SIB ANDREW CLARK: TREATMENT OP HAY FEVER.

[Junk 11,1887.

for or. (The erectile tissue becomes distended, the bloodvessels are fou
ah) gorged with blood, groups of lymph oells fill the lymphatic irritabil
spices, !tbe mucosa is crowded with migrating leucocytes,- practise
yOengpr epithelial cells are vacuolating and proliferating, Daly of
Seeeatiop as increased, in quantity and.altered-in character Baltimo
and composition, sensation is sharpened, altered, or be- But as
ru*jnbpt],,and the whole metabolism of the affected region, is cient to
profoundly disordered. These local changes are always form, of
pilesbnt in the paroxysm of hay fever, and whenever they of the i
aonohr and co-operate it may be safely said that hay fever chief ofc
is present. When this local irritability exists in an extreme treatme
degree, -almost any exciting agent—an odour or vapour, the pre
dust, a touch, light, or heat—will quickly call forth the cedurea
whole Series of structural changes already deacribed as The fi
almost exclusively characteristic of the paroxysm of hay hay fev
fewer.* mucous

•;' Andtnow let me speak shortly of the third factor engaged to achie
Lb tha aroiution of this malady—that is, of the external the tree
entiling or determining causes to which it is commonly several
ascribed. Authors in general, from Gordon in 1839 to Mac- atropini
lanzie in 1685, advocated the view that the paroxysm of the resi
hay'fevar is due in persons of a oortain idiosyncrasy ex- ina gnifl
dusively to the action of the pollen of grasses or of flowers so disag
apoa the mucous membrane of the nasal cavities and tion. 1
adjacent parte. In support of this view, it is contended employ:
that'the disease occurs only during the season when oertain re-open
geafiaeemnd flowers are in blossom, that it may be artificially success
ipdasedby the application of pollen to the nasal mucous immada
membrane, and that it may be prevented from occurring, or frequen
■myt be cured when present, by dwelling oik board ship at mucous
aea»l Where no pollen is to be found. Now, whilst it most the use
iei adnflteed that these contentions am in soma. degree just, using it
and tb&t toe most common exciting cause of the hay fever disagree
lies in. the action of the pollen of certain plants upon the but i v
nasal■ rimoous membrane, it cannot be denied that they ground*
require qualiicathea, and that they are inadequate to a althoug
obiiplete explanation of all the facte which make up the cocaine
history of this disease. For on this side it may be con- overrat*
tender lias proved that the malady is leas common among agri- is troub
calturafl labourers and gardeners than among other persona, venieno
that sometimes it occurs at other seasons of the year than 1 am-of
in the hay season, that it has bean induced by local irritants from is
hi Which pollen did not exist, that it has occasionally arisen careful
huoonsequence of irritation in a part with which the nose ways oi
■a hk sympathy, and that the mare action by itself of pollen it may
upon the nasal mucous membrane is insofluriant to provoke nasal be
S'ooniplete paroxysm of hay fever. in strpr

j . For myself, I am co m pelled by my inquiries to adopt the interior
view that in tbe evolution of almost every attack of this means a
malady 1 the thiee factors already mentioned are at-work— shank i
the nervous constitution, the local irritability, the external form of
exciting cause; and that whilst this last is most commonly hydrocl
tipCUeb acting more in virtue of its physical characters andglye
than of its intimate nature, it may be any other agent lag to t
Capable of calling into notion the irritability of tbe parts employ*
fldnieoned in the muaohs membrane of the nose. And now, efficient
when wa consider these facte sad theories of hay fever With Many t
the view of framing a rational plan of treatment, we find that tfci
•twelves beset on every side with difficulties. Theoreti- the nan
the objects to be achieved by treatment are the ] with wi
soothing and strengthening of the general nervous system, allaying
the allaying of local irritability, and the removal of tbe thalnle
enejtJAg cause. To remove the exciting cause, or rather, the eye:
Speaking >oonectly f to remove the susceptible person from dale, to
itj» to prevent the cm-eoming of the disease; and< if yott of this 1
•end him to sea, or to the summit of some Alpine height, show al
you will assuredly succeed. There are, however, many who meets v
oamadt follow this oounBel, and who must remain under the I cot
influence of the exciting cause of the malady. What can local tri
bedoie for the patient in such circumstances? We may does.no
•taive^to strengthen by tonics the weak and irritable nervous irritabil
Constitution; and Morell Mackenzie has had.some Success that it.
tadth yaleriapate of zinc and aasafeetida, whilst Blackley has whethe:
iaried with every drug which he has tried. By Common place tt
Confession, general treatment, although not useful, ianevfir most to
-by itself successful. > structet

• < Wo sVe therefore Compelled to turn to the study of local modera
breatmsnt as 'the chief mode of relieving'or coring the axeraiad
dteeaee. There are three plans of local treatment. .The first

are found, or believed to be, the seat of the pathogenic
irritability. This third and most r&dicChplap oftreatment is
practised for the most part in -Atndric&^And'ia the hands of
Daly of Pittsburg, Roe of Rochester, and - Mackenzie of
Baltimore, it has been followed by lasting and signal success.
But as there are not as yet at our disposal materials sufl-
cient to form a critical estimate of the relative value of this
form, of treatment, as 1 have myself no personal' experience
of the practice of it, and as in this imperfect lecture my
chief object is to submit to your consideration the plan of
treatment designed and practised by myself, I dismiss for
the present from further consideration all operative pro¬
cedures of this radical kind.

The first plan of treatment proposes to prevent or to care
hay fever by allaying the pathogenic irritability of the
mucous membrane. This was theobjeot which I endeavoured
to achieve when I began my therapeutical experiments in
the treatment of this disease. From trials extending over
several years no remedies of this sort except aoottkitiaa and
atropina returned me any results'of the smallest value, asd
the Result returned by the Use of these (alkaloids was so
insignificant, and the effects of hollowing it were sometimes
so disagreeable, that I abandoned my inquiries in this direc¬
tion. The introduction of cocaine, however, and its recent
employment'in the treatment of hay fever, induced me to
re-open my experiments in this direction. At first my
success was considerable, for three out of five cases were
immediately relieved, and the relief was maintained by the
frequent renewal of the application of cocaine to tbe nasal
mucous membrane. But when last year my experience of
the use of this drug somewhat increased, my success in
using it diminished. In one case the application failed asd
disagreed. Tn another case it neither disagreed >ncr failed,
but i was quite unable to discover in toe patients the
grounds of -this difference of aotiop; Nevertheless,
although it appears to me that the success of
cocaine as a local remedy in hay fever has been
overrated, although the necessity of frequent application
is troublesome, and although its use is-not free from incon¬
veniences which might eventually prove something worse,
I am -of opinion that its success and its Comparative treedon
from injurious consequences are sufficient to justify with
careful watching a longer and larger trial. There are three
ways of using cocaine in the local treatment of hay fcver;
it may be used in the form of a solution, of a spray, or of a
nasal bougie. Personally, I prefer to use a solution varying
in strength from 6 to 16 per oent., and I apply it to the
interior of toe nose and toe book of the soft palate bj
mPMiH of a large camel-hair pencil attached toan aluminium
shank and bent at an appropriate angle. For use in thfl
form of nasal bougies, from a quarter of a grain or more of the
hydrochlorate of cocaine is dissolved in a mixture of g otitls s
and glycerine,and made of different.wtightesmdabapsMoaorl-
ing to'the peculiarities of the esse on which they an to be
employed. Fur using cocaine in toe form of spray, seas
efficient and ingenious spray producers have been invented.
Many of them are furnished with noszles, so constructed
that toe spray can be applied directly to almost aaynait of
the nasal and pbrayngeal cavities. These spray pewbeera,
with weak cocaine solutions, are sometimes very useful in
allaying tbe small but still troublesome irritation which, in
tha intervals of> the hay fever paroxysms, are ut to arise in
the eyes and mouth. By the great kindness of Mr. Martin-
dale. to whose pains, intelligsnee, and accuracy in matter*
of this kind we are all so muoh indebted, I am enabled to
show all these -preparations of- coeaine and all tty instzn-
ments wherewith they are used.

I come now to consider tbe second plan proposed for tbe
local treatment of bay fever. The objeot of this plan, which
does not exclude constitutional treatment, is to snbdns the
irritability of toe nasal mucous membrane to such an extent
that it shall no longer resot to special or common irritants,
whether prileo. or dust, in a pathogenio manner. In their*
place the patient is put upon such a regimen as will oonda®
most to toe improvement of hi* general health. He is in¬
structed to have a simple but liberal dietary, to be e xt w i ly
.moderate in toe nse of alooholio s t imulan ts, to hays dsuy
exercise, to follow early hoars, and to oostinne, if tost ba
.possible, even at the cost of suffering hjsordknry oeonpatiom.

three «r mm

Thb Lanckt,}

DR. S. FENWICK ON FUNCTIONAL DISEASES OF THE LIVER. [Junk 11,1887.

tincture of nux vomica, and a solution of arseni&te of soda.
In some cases I think that I have seen great benefit follow
the use, thrice a day, of five grains of sulphate of quinine,
dissolved in citric acid and given in effervescence with
carbonate of ammonia.

For the strictly local treatment there are required a ,
common laryngeal brush and a carbolic mixture. This
mixture is composed of glycerine of carbolic acid one ounce,
hydrochlorate of quinine one drachm, and a thousandth part
of perchloride of mercury. Heat will be required in order
to dissolve the whole of the quinine, for without heat Mr.
Martindale informs me that the glycerine of carbolic acid
will dissolve only half the quantity prescribed.

Let me now describe the method of procedure to be
followed in applying the carbolic acid mixture to the mucous
membrane of the nasal cavities. If there is much mucus in
the nostrils, cleanse them by means of a douche of warm
water containing boroglyceride, 1 in the proportion of an
ounce to the pint. Dip the laryngeal brush in the carbolic
add mixture, and see that the brush is full but not over¬
flowing. Place the left hand on the left side of the forehead,
and the thumb on the tip of the nose, with the shank of the
brush between the thumb and two forefingers of the right
hand, and the brush itself directed upwards, push it gently
but firmly into one of the nostrils, carry it as high as you
can without inflicting injury, move it about so as to bring
the mixture in contact with as much as possible of the
interior of the upper part of the nostril, and then withdraw
it. With another brush filled with the carbolic acid mix¬
ture, or with the same brush washed, dried, and re¬
plenished, you complete in the manner following the
two operations required for each nostril. Having the left
hand in the position already described, and the right hand
holding the laryngeal brush, with the hair pencil directed
forward from the body of the operator, push the brush
along the floor of the nostril into the pharynx, and after
insuring free contact with the adjacent parts, withdraw it.
If during the operation the brush is over-full, some of the
carbolic mixture will fall into the throat and excite cough¬
ing or some other discomfort. When you have thus finished
the treatment of one nostril, and carefully removed any of
the carbolic acid mixture which may have been spilt upon
the no3e or lips, you will proceed to treat the second
nostril in exactly the same manner as you have dealt with
the first. During the performance of these manoeuvres
great assistance will be obtained from the left hand of the
operator being placed over the left side of the forehead and
face of the patient. With this hand the operator can
adjust the patient’s head to the various movements of the
laryngeal brush, and with the same hand placed on the tip
of the patient’s nose the opening of the patient’s nostril can
be adjusted to a convenient size and shape. When the
local effects of a paroxysm are severe, and have extended to
the back part of the soft palate, it will be desirable to intro¬
duce through the mouth into the pharynx the laryngeal
brush moderately filled with the carbolic acid mixture, and
there, by a manoeuvre easily acquired and practised, to brush
the posterior surface of, the soft palate and the adjacent

S arts. The immediate effects of these manoeuvres differ in
ifferent persons, and in the same person at different times.
In all cases the effects are more or less disagreeable, and
last from half an hour to half a day. Sometimes a little
blood-stained mucus is discharged from the nose and
throat; sometimes there is a slight frontal headache; some¬
times there is a trivial cough, and occasionally you will
have developed all the local phenomena of a paroxysm of
h ay f ever.

When advising a patient with hay fever to submit to this
plan of treatment for its relief, I have found it expedient to !
warn him beforehand of the disagreeable effects which
sometimes follow the application of the carbolic mixture,
and to assure him that they are both brief in duration and
devoid of danger. When this warning is withheld, some
patients will grossly exaggerate their sufferings, ascribe all
sorts of injurious consequences to the application, and cover
the physician with undeserved reproaches. Sometimes a
single application of the carbolic acid mixture is sufficient
to prevent for a whole season the return of the tray fever
paroxysm, and four times within my own knowledge it has
never reappeared. Usually two or three applications are
necessary to ensure a full chance of success. The length of

the interval between the applications must be determined
by the character of the immediate effects. If these are mild,*'
tne application may be renewed on alternate days; but if’
severe, at least three days should elapse between succeeding - -
applications. *

Of the measure of success which has followed this treat- -
ment of hay fever, now practised over twenty years, Leim
unable to speak with exactitude. Patients when relie^bd 1
seldom, and when unrelieved never, return to record their
experience, and I have been unable to get at the subsequent
histories of more than a third of the number of persona
whom I have treated. It is, however, my conviction that
of this roughly estimated third whose cases I have been;
able to follow, a half has been cured for the season, and f<ntr
persons have been cured “for good.” This, you will say
justly, is not a success of which to boast. Quite so. But
if you will compare the results of this treatment with the
results of every other treatment, Hot excepting the cocaine
treatment, which is its closest rival, you will have to confess;
that, however small the measure of success, it is not one'
which you can afford to despise. At any rate, a communi¬
cation of this kind is entitled to your indulgence, inasmuch 1
as it is an honest, although a very humble, endeavour to
press pathology into practice, and to take away the
reproach which has been cast upon us of ignoring or of 1
repudiating the natural and just alliance which should'
unite in closest relationships the science with the art of'
medicine.

Clinical fctto

? Before the latrvdua&lon of boroglyceride I employed
solution of chlorate of potash, which wm lna efficient.

a five-grain

FUNCTIONAL DISEASES OF THE LIVflR.

Br SAMUEL FENWICK, M.D., F.R.C.P., ’

PHYSICIAN TO THE LOWHON HOSPITAL.

I

Gbntlkmkn,—W e know perhaps less of the functional
diseases of the Kver than of those of any other structure ini
the human body of equal, importance. The organ is popularly •
supposed to be very frequently deranged; but, from the
changes its secretions undergo before they come beneath
our notice, we have no means of proving how fax such aa.
opinion is correct. ‘

Many years ago I commenced some inquiries in order'll
ascertain if any of the secretions afforded a means of test¬
ing the manner in which the hepatic functions are per-'
formed. For this purpose I first examined the colouring,
matters of the urine, but was unable to arrive at any de*-
finite conclusions, although no doubt fas many oases there is
a close connexion between the state of the urine anti tije-’
condition of the liver. Observing the yellow coating which,
is so frequently present on the tongue in affections of the
biliary system, I separated the colouring matter from the*
saliva in cases of jaundice. The material thas obtained
seemed to be a derivative of the bile; but it was only present 1
under certain conditions, and I was forced to abandon, th#
hope that it oould be employed as a test for the quantify pr
quality of the hepatic secretion. t -

You are aware that a bitter taste in the mouth is occa*-
sionally complained of by patients suffering from jaundice,,
and also sometimes by those who are only what is teemed,
“ bilious.” 1 failed in various cases of jaundice to obtain,
evidence of what has been often surmised--viz:, that the.
bitter taste is the result of the excretion of the biliary salts*
by the salivary glands. However, an elderly medical man>
consulted me, whose only complaint was an intensely bitten
taste in the mouth. He never had suffered from jaundice,)
and he believed himself in other -respects to he in pefcfect
health. He found the taste increased, after taking alcohol
in any form, but no treatment he had adopted: had relieved
him. I received from him a considerable quantity of saliva,,
and obtained from ib the ordinary indications of the presence,
of biliary salts. On thinking over his ease, it seemed t« mfl
that if the salivary glands were capable of separating the
biliary salts, perhaps some material derived from these
[might be a normal constituent of their secretion, ,119 m

vVjUUV VC

lira Thb Lure**,] DR. S. FENWICK ON FUNCTIONAL DISEASES OF THE LIVER.

[Jurm 11, 1887.

sulphocyanide suggested itself to my mind, and I deter¬
mined to ascertain, if possible, whether the quantity of this
substance varied in different persons, and under what cir¬
cumstances such variations occurred. The estimation of
the aulphocyanide was, however, a matter of no small diffi¬
culty, for it is normally present in so minute a quantity
that any attempt to isolate it appeared hopeless. You are
aware that the addition of a persalt of iron to saliva gives
the blood-red colour of sulphocyanide of iron, and it ap¬
peared to me that the simplest way would be to compare
the depth of the colour thus produced in the salivas of those
suffering from disease with that of persons in a state of health.
The saliva of each person examined was therefore collected
as it flowed from the mouth for about two minutes, and
seven drops of a solution of half a drachm of perchloride of
iron to one ounce of water were added, and the colour thus
obtained was compared with a scale of colours prepared in
the following manner:—A quantity of saliva was collected
from a number of healthy persons, and the tint produced by
the addition of the perchloride of iron was taken as the
normal amount; a portion of the same saliva was then
evaporated to one-quarter, and another to half, its bulk, and
the colours produced in these respectively were assumed to
represent four times and twice the normal amount of sulpho-
cyanide; whilst two other portions diluted with water to
twice and four times their amount were taken as represent¬
ing half and a quarter of the normal quantity of the salivary
salt. These were then oopied in colours by an artist, so that
there should be no variation in the tints.

In this way I examined during the course of many years
the salivas of numerous persons who consulted me for
different maladies, recording also the symptoms of which
they, complained, and in most cases the results of the
treatment adopted. These observations were so numerous
(probably many thousands) that I selected for analysis only
those in which the amount of the sulphocyanide was much
below or much above the normal. I have described these in
this lecture as “private cases” whenever I have found
it necessary to quote them. In order to check these
observations, I requested Dr. Needham, at that time house-
physician to this hospital, to examine in the same way the
salivas of a number of patients who were under treatment in
the wards, and two years afterwards a similar inquiry was
carried on by Dr. Bedford Fenwick. The cases thus obtained,
numbering between 200 and 300, were analysed togother,
and I have quoted them as “ the earlier hospital cases.”
Although the conclusions from both of these sets of cases were
generally in accordance with each other, there were numerous
discrepancies which could not be explained. I therefore com¬
menced a fresh series, in the following manner:—A solution
of aulphocyanide of iron was prepared of definite strength,
and was graduated by successive dilutions, so that each
was only one-quarter of the strength of that above it. These
were placed in the small flat bottles used by spectroscopists,
each bottle being of equal thickness. I took my own saliva,
which agreed in colour with that formerly taken as normal,
as the normal standard, and the bottles were labelled + or -,
according as they differed from N. Each of the salivas, when
examined, was mixed with a definite quantity of the tincture
of perchloride of iron, filtered through cotton wool, and
boing placed in a spectroscopic bottle of equal thickness
was carefully compared with the graduated strengths of the
sulphocyanide of iron.

In this manner I examined week by week the salivas of
500 patients admitted into my wards, carefully recording
the depth of colour at every observation, but not looking at
the notes of the cases in the hospital books. After all these
persons had been discharged. I compared the state of the
saliva of each in every week of his residence with his con¬
dition at the time his saliva was obtained. The results of
these observations form the facts from which I have
drawn most of the conclusions I am now about to lay
before you, and I have quoted these as the “ later hospital
cases.”

Before commencing our inquiries it is necessary to deter¬
mine what is the normal amount of sulphocyanide in the
saliva of healthy persons. No doubt this must vary con¬
siderably according to the circumstances of the individuals
examined, but I thought we should obtain the best standard
for reference if the observations were conducted upon

{ tersona of the same class as our hospital patients. I there-
ore procured the salivas of forty-three persons, most of the
females being hospital nurses and the males either hospital
porters or patients suffering from some trifling local malady,

such as gonorrhoea. The following table showB the results
of this inquiry:—

Table I. — Showing the Colour of the Saliva of 43 Healtkj
Persons.

Colour of saliva.

Males

Females.

Totals.

- H

i

1 0

1 'll

1

-1

2

! ^

4 - 6

— i

1

0

1 1

— I

4

! fi

9 ■]

— T

2

; o

2 1 |

N

12

l 4

16

11

+ 1

1

0

1 ,

2

1 1

3 J

+ i

0

: o

0 il

1

+1

2

0

2 1

l

i

3 1

f

+ 3 .

1

0

- Totals. |

29 |

J

13

You will observe that the largest number of the 8 »Ktu
presented the depth of colour we before took as the norms!
standard, but that most of the females were half belov it,
and that thirty-one out of the forty-two were within hiif
below or above that amount, only five being above and six
below. It will be necessary that this should be borne in
mind when we afterwards discuss the diseases to which
persons apparently healthy, but in whose salivas the
sulphocyanide varies greatly from the normal point, are
especially liable.

In commencing an analysis of the cases in which the
amount of the sulphocyanide in the saliva was determined,
let me first direct your attention to the patients who were
admitted suffering from typhoid fever. Thirteen are re¬
corded in the “ later hospital cases,” all of whom recovered,
and in each, as soon as convalescence was established, there
was a sudden rise in the amount of the salivary Salt, which
either increased or was maintained at about the same
strength until the patient was dismissed. This is seen in
Table II., in which are placed in the first line the average

S tities of the sulphocyanide in each week before and
the commencement of convalescence, and in the second
the number of cases from which the averages were obtained.
The date of convalescence was in each fixed at the day on
which the temperature permanently fell at or below the
normal point, and you will observe that in the second week
before this period the average amount of the salt was
only +%. But during the febrile condition there is a very
scanty secretion of saliva, so that the quantities we were
able to obtain were very small, and consequently in a state
of great concentration. It is evident, therefore, that the
amount of the sulphocyanide daily excreted must have been
very minute whilst the fever was going on, but as soon aa
this began to subside the average rose to +2, and remained
high until the seventh week after the commencement of
convalescence. Let me remind you that the figures in this
table are averages, for in some cases the quantity rose
to + 4, and in some instances to seven times the normal
amount.

The degree of increase of the salt seems to depend on toe
length oi the febrile stage. In Table III. I have included
in the first line all those in whom the fever lasted le«
than twenty-one days, and in the second those whose
febrile stage exceeded three weeks In duration. It would
appear from these figures that in cases in which the fever
has been of short duration the increase of the salivary
salt takes place more slowly, but the duration of the
convalescence is longer than in those in which the febrile
stage has been more prolonged. It is also worthy of remark
that t,he greatest amount of secretion was reached earlier in
the latter than in the former, the maximum being in toe
third week in the second group, and in the fourth week m
the first group. If further investigations should confirm
these conclusions, we shall have £ the quantity of the
sulphocyanide during the first week of convalescence *
means of ascertaining the probable length of the pene d
during which the patient is likely to regain his
health and strength. The augmented quantity secreted is
not the result of an increased supply of food, for, as you «re
aware, the patients are confined to a liquid diet for
or ..three weeks after.convalescence haS be«a qrtablisbed. J*
isafto wotfitfy of observation that in
to increase before the fever has quite subsided, so that tie

Thb Lancbt,}

DB% & FENWICK ON FUNCTIONAL DISEASES OF THE UVJHfc [Jvwe IM&ft M7»

state of the saliva may be of value as an indication that the
febrile action is about to terminate.

Let us now ask ourselves what are the chances that occur
during the progress of typhoid fever. Every day’s observa¬
tion shows you that there is a rapid loss of flesh and strength;
the muscles quickly waste and the fat is absorbed, so that
in a case of long duration the patient is reduced almost to
the condition ofa skeleton. As soon, however, as the fever
disappears nature begins to repair the damaged structures,
the appetite becomes keen, the digestive organs are stimu¬
lated into a state of unusual activity, and the patient day
by day increases in weight and strength. What, then, I wish
to draw your attention to is the fact that along with this
unusual activity of the organs engaged in nutrition we And
an excessive quantity of the salivary salt—a fact sufficient
to indicate that, instead of its being a mere accidental result
of local decomposition, as some have supposed, the sulpho-
cyanide is in some way dependent m>on the action of the
digestive or assimilating structures. But, in addition to this,
Table III. seems to point out that there is probably some
relation between the quantity of the sulphocyanide secreted
and the degree of activity of these organs, for it will be
remarked that in the group in which convalescence was
most rapid the amount of the salivary salt was the greatest.

A similar state of the saliva may be occasionally observed
when from other causes there is a sudden demand made on
the nutritive organs. In some cases of haemorrhage occur-

Is there not a necessity for an increased aotion of the.
assimilating organs in typhoid from the first moment when
the patient is smitten with the fever ? Certainly there is j
but the nutritive organs are incapable of responding to the
demand, for they themselves rapidly waste and lose their ’
functional powers. Thus in four cases that had died of-
typhoid fever I carefully scraped off the whole of the
mucous membrane of the stomach and found that the
average weight was only 580 grains, whilst the average
weight of the gastric mucous membrane in seventeen malee.
who had died of other diseases was 1035 grains, showing,
that in this malady the stomach loses nearly half its bulk.
Nor is there merely a loss of bulk; there is also an im-.
pairment of functional activity, for in seven oases .It.
made an artificial gastric juice with the mucous membrane
of the stomach, and found that the average amount of.
coagulated albumen dissolved was only one grain, whiles ,
the amount ordinarily dissolved by the mucous membrane of
the stomachs of persons dying from other disorders-was four >
grains. In two of the typhoid cases the albumen was quite
unaffected by the artifloial'gastrio juice, and in one a small
quantity only was dissolved. It is therefore probable that
in typhoid the general wasting of the body is the result not
only of an increased destruction of tissue, but that it also
arises from the inability of the digestive organs to supply
sufficient nutriment to compensate For the augmented waste;
and, as we have already seen, along with the diminished .

Tabu IL —Showing the number of Cates of Typhoid Fetter examined, and the average amount of the Sulphocyanide

m each week.

v : '

Weeks before |
Convalescence.

- ' . . 0

Weeks after Convalescence.

!' , •

2nd. |

1 st.

3 !

e '

1

7 - r -

Average 1 amount of sulphocyanide .

+ 2

+ 2J

Numbfer of esses examined ... _. ....

3

1

Table l\l.—Showing the Differences in the Weekly Quantity of the Sulphocyanide in Typhoid of short and long duration.

Weeks after Convalescence. ,

; 1

3

3

4

&

0

7 •

Within 31 days at fever

Average amount of sulphocyanide ...

.. i +i

+ 2*

+ 2*

+ 3

+ »i

+ 3

+ 2»

Number of cases.

2

3

4

3

4

3

1

Beyond 21 days of fever -

Average amount of snlpbocyanlde ...

+ 3-80

!

+ 3-02

+ 8-17

+ 3-71

+ 4-08

-

—

Number of eases ... .. .

3

. 3

3

2

X

"

---i_

ring in persons whose digestive organs are not impaired the
salivary salt will be found in increased quantity, ac the same
time that the loss of blood is being rapidly replaced. Thus
a woman, about thirty years of age, was admitted into the
hospital in a very exhausted condition. A few days pre¬
viously, when she appeared to be in perfect health, she had
suddenly fainted, and shortly afterwards had vomited a
large quantity of blood, the htemorrhage being repeated
twice in the next few hours. There was no return of the
bleeding from the stomach, but the general nature of the
malady was shown by haemorrhages being present in the
retinse. Two weeks after the attack the sulphocyanide
was + 2£, next week +3, and in the successive weeks +3,
+2£, and + If, at which latter date it is noted in the case¬
books that she had quite regained her strength and colour.
One month afterwards she was again attacked in the same
manner, and was readmitted in a very blanched condition;
the amount of the sulphocyanide was remarked to be + 2,
and continued at that amount until she regained her colour
and left the hospital.

The conclusion that seems fairly to follow from these
facte is that an unusual amount of the sulphocyanide
presents itself in the saliva whenever the necessities of the
system call for an increased activity of the digestive organs;
and this is supported by the circumstance that persons who
are unusually stout and well fed ordinarily secrete a saliva
having an excess of this salt. But you will naturally say,

activity of these organs there is a decreased quantity of the
sulphocyanide in the saliva. As soon, however,- as the blood-
making organs are restored to activity the salt reappears in -
the salivary secretion in an increased amount.

it will be obvious that, if the above conclusions are
correct, we should find the quantity of sulphocyanide below
the normal whenever the digestive organs are unable to
supply nutriment sufficient to meet the requirements of the
system. Let us, then, test this by the condition of the saliva
in maladies attended with rapid loss of flesh. Perhaps one
of the best diseases we can select is pulmonary phthisis.
Seventeen cases are recorded in the “ later hospital records,”
of which ten died or were removed from the hospital in a,
sinking condition, and seven were dismissed much improved.
Of those who died, the average amount of sulphocyanide.
was only -1'27, and in some no colour at all could be pro¬
duced by the addition of the solution of iron to the saliva,
so that in these we may assume the secretion of the salt had
ceased. In only two of these was the amount above the
normal—in one it was +£, in the other +T; but in all the.
others it was much below the ordinary quantity. In eight
of them the weight of the body was regularly recorded;-
in five there was a diminution of weighty and these exhibited
an average of - 1 - 15 of the sulphocyanide. You must not,
however, suppose that this condition of the saliva is an
indication of the existence of tubercular disease; it is only a
concomitant of a failure of the^ general nutrition, for the .

Digitized by GoOglc

1174 Thb Lxncbt,] DR. S. FENWICK ON FUNCTIONAL DISEASES OF THE LITER.

[Jm»B II, 1887.

average of those who improved in the hospital amounted to
+1-; only two exhibited a deficiency of the salt, and all
the others showed an amount above the normal. In three
there was a weekly gain in weight, and in these the average
quantity of the sulphocyanide was above the normal. The
above facts are supported by the “earlier hospital cases,"
from which it appears that the diminution of the salivary
salt increases with the duration of the malady. Thus
twenty-six cases of phthisis are reoorded, of whom 25 per
cent, had a deficiency of the sulphocyanide when examined
within six months of the beginning of the illness, whilst
68 per cent, of those between the sixth and twelfch months,
ana no less than 87 per cent, of those above twelve mouths’
duration, presented the same condition.

A similar deficiency of the salivary salts is usually ob¬
served in the later stages of malignant diseases. In almost
all of those in which the stomach was the seat of cancer the
sulphocyanide became deficient at an early period, and re¬
mained so until the termination of the case; thus I find
eight cases recorded of this disease, and in all the amount
was very small or was entirely absent. When other organs
were affected by cancer, the period at which the sulpho¬
cyanide sank below the normal varied with the rapidity of
the growth, the organ involved, and the more or less rapid
inroad made upon the general health of the patient. This
fact may perhaps prove useful in the diagnosis between
cancer and simple ulcer of the stomach. It is rare to find a
deficiency of the sulphocyanide in the latter, for the power of
digestion usually remains good, and in cases of haemorrhage,
as we have before seen, there is often a sudden increase in
the quantity; whereas in cancer the amount early falls
below the normal from the loss of digestion with which it is
accompanied. But you may ask. Why is there such an early
failure in the general nutrition in gastric cancer ? ' In every
case that I have examined microscopically changes of an
important nature have been found in the mucous membrane
of the stomach, although it often appeared normal to the
naked eye, and the parts examined wera at a distance from
the seat of the tumour. The peptic glands were either closely
adherent to each other or were in a state of atrophy, and an
infusion of the mucous membrane exerted only a slight
power of dissolving coagulated albumen. In addition to the
structural changes, the patient’s strength is sapped by the
more or less constant discharge of blood, by frequent
vomitings, or by an obstruction to the passage of the food
into the intestines.

From the above facts, we are bound, I think, to conclude
thut whenever an unusual demand is made upon the
nutritive organs of the body by the necessities of the
system, and the patient gains’ flesh and strength, the sulpho¬
cyanide in the saliva is found to be increased in quantity;
but when, on the contrary, a person rapidly wastes from
some. general disease the amount of the salt is diminished.
An increased quantity of the sulphocyanide, therefore,
under such conditions, manifests an excess of the income
over the expenditure, whilst its diminution points to an
excess of the expenditure of the system over its income.

We before found that when, as in convalescence after
typhoid fever, an increased activity in the cell growth of
the whole body took place, there was an unusual amount of
the sulphocyanide in the saliva, and we attempted to
explain this by supposing that the necessity for repairing
the previous waste of the tissues stimulated the blood-
forming organs into increased activity, the augmented
amount of the salivary salt being only an indication of
their increased action. But if there is a relation between
the necessities of the system and the activity of the blood-
making organs, we should expect that an increased local
cell growth would act in the same way as when it is general,
and would stimulate the functional activity of the nutritive
organs, and that consequently, under such circumstances,
the amount of the sulphocyanide would be also augmented.
Let us, then, test the truth of this anticipation by the exa¬
mination of the saliva in persons who were suffering from
increased local cell growth—in other words, from malignant
or inflammatory affections.

We have already seen that in most of the cases of cancer
the salivary salt has been below the normal, but in these
the local malady had made great inroads upon the general
health. Where, however, either from the position of the
t umour or the slowness of its growth, there was no marked
cachexia, the sulphocyanide was above the normal. Thus,
in a case of sarcomatous tumour of the ribs the amounts
registered each week wero-+2$, +3J, +2J, +3}, +3j, and

the patient left the hospital with no loss of weight or
strength, although the size of the mass bad greatly increased.
I have met with the same circumstance in some cates oi
cancer of the liver, where the disease was in an early stage,
and where the growth was rapid, although there wis in
some of these also jaundice, probably resulting from com¬
pression of the smaller bile-ducts. In the earlier stages of
phthisis there is usually an increase in the salivary salt, sod
it is not until the patient has been reduced by diarrhct,
vomiting, or loss of appetite that the diminution we before
observed presents itself.

But you may naturally object that in typhoid the increase
of the sulphocyanide was only observed after the cessation
of the fever, whilst in cancer and phthisis it takes plsce
during the progress of the disease. This is easily explained
when you remember, wbat was before stated, that in typhoid
there is but little digestive power, so that the blood-makug
functions cannot respond to the demands of the system until
after convalescence has set in ; whilst in the local maladies
we have been just considering the digestive functions appear,
in the earlier stages at least, to be intact.

In moet cases of acute inflammation there is a rapid local
cell growth. What, then, is the state of the saliva under
these circumstances ? Let us first look at acute pneumonia,
of which disease there are nine instances recorded in the
“ later hospital cases.” The average amount of the salivary
salt in these was only + *95; they were examined after
convalescence had set in, for unfortunately I have no record!
of the state of the saliva during the acute stage. The small¬
ness of the increase is what might have been anticipated.for
everyone must have observed how little flesh the patient
loses in an ordinary attack of acute lobar pneumonia, and
how rapidly be regains his strength. This is supported by
the fact that the more severe the case was, the greater wu
the amount of sulphocyanide during convalescence. Thus
five were dismissed within three weeks, and their average
was 4- ‘70; four required a longer residence to regain their
strength, and their average was +1*27.

Bronchitis, when uncomplicated with heart and kidney
disease, seems to have no effect on the production of the
salivary salt, for in eeven cases which were examined from
week to week the average did not exceed the normal.

In acute pleurisy there is a considerable cell growth, and
consequently we find a marked difference in the amount of
the sulphocyanide from that in bronchitis. There were
thirteen observed in the “later hospital cases," four of which
presented only the physical signs of “dry pleurisy in
seven there was exudation of fluid, and most of these were
treated by aspiration. In the cases of dry pleurisy the
average of the salivary salt was +109; in those accom¬
panied by effusion it reached +145. A similar result is
afforded by the “ earlier hospital cases for of nine cases,
four were examined within one week of the commencement
of the illness, and three of them presented an excess of the
sulphocyanide, while in one it was normal; three were
examined between the second and third week, of whom two
had an excess and one was subnormal; after the third week
two were examined, and both were below the normal. It is
therefore evident that the amount of the salivary salt is

G reatest where there is most local cell growth, and it often
alls below the normal in the stage of absorption. There
were two cases of empyema in the “ later hospital case?,
both treated by drainage, and the examinations of their
salivas are very interesting. The weekly amount of the
salivary salt was in one + 2£, in the other + 3£; but in each
at the twelfth week of the illness it fell suddenly—in the
one to - 4, in the other to - and in each it remained in
amounts varying from -l’to -+ -4- till the termination ci
the illness.

Observation teaches us that a local cell growth, whe'
malignant, tubercular, or merely inflammatory, will dis¬
continue for a length of time without perceptibly reducing
the strength of the patient, the undue loss of material being
supplied by an increased action of the nutritive organs; but
that when a certain point is reached the general health
rapidly deteriorates. This point -probably that at which
the expenditure exceeds the income of the body—seems to
be accurately marked by the sudden diminution in tbr
quantity of the sulphocyanide.

Two cases of “ granular kidney” were admitted suffering
from uriemic convulsions; both improved under treatment,
and the amount of the salivary salt increased in proportion
to the improvement. One had, on his admission, +L which
increased to +3, at which figure it still stood on his leaving

Tct Lancbt,]

MR. A. E. BARKER- ON CEREBRAL ABSCESS.

[J own 11,1887. 1175

the hospital at the end of eight weeks. The seoond had
only -1 at first, but it had risen to + 2$ on the fifth week
of treatment. In another case it waa normal on admission
and remained so the next week, bat ten days afterwards he
died with uraemic symptoms, no other observation being
recorded izf the meanwhile.

In chronic tubular nephritis, there must be a large demand
upon the nutritive organa to supply the waste caused by
the abundant cell growth and the drain of albumen from
the diseased organs. Consequently 1 have generally found
that in the early stage the amount of sulphocyanide was
above the normal, and remained so until the patient’s
strength began to fail. In one case of this kind it was
+1£ on admission, but it rose to +2£ the next week, and
remained high until he left the hospital much improved.
Two cases died; in one the quantity was at first normal, but
it sank next week to - 2, and remained at this point until
death ; in the other it was at first +11, but it had fallen to
-1 on the last observation recorded before his death.

(To be continued.)

REMARKS ON

CEREBRAL ABSCESS DUE TO DISEASE OF
THE TEMPORAL BONE, AND ITS
TREATMENT . 1
By ARTHUR E. BARKER, F.R.C.S.,

l RGEON TO UNIVERSITY COLLEGE HOSJ'ITAL AND TEACHER OF PRACTICAL
SUHUEKY AT UNIVERSITY COLLEGE.

If surgeons were only called upon to deal with cases of
abscess of the brain when physicians had determined their
locality, our position would, in my opinion, be clear, and our
task, as a rule, a light one. For I am one of those who
hold that in these days of aseptic surgery those areas of
the brain in which inllamm&tory foci are most commonly
met, and which are well known from experience to be
wondrously long-suffering, may be as freely dealt with
almost as the structures external to the skull. But far
more than mere operative treatment of these conditions
is demanded of the surgeon now, and he cau only be really
useful And reliable when he has studied the whole subject of
the pathology and clinical symptoms of cerebral abscess
with as much care as that of the details of surgical procedure

The mode, however, of approaching this study must be
very different to that hitherto adopted before we can hope
for much practical result from it. No one who at the pre¬
sent day reads through the abundant (literature of cerebral
abscess can fail to be struck with the tendency there has
been in the past to consider abscess in the brain as one
disease, whereas in reality it is only a sequela or accident
occurring in the course of a long series of totally distinct
ailments. Cases have been grouped together which have
no possible affinity, and the result nas been much confusion.
What possible pathological relation, for instance, is there
between an abscess due to commotio cerebri and one the
result of septic phlebitis from middle-ear disease ? and yet
we find in those collections of cases which have hitherto
been appealed to for information on the subject results
produced by these and other most widely-differing causes
grouped together as if they all belonged to the same disease
because they affected the same organ. Let me enumerate
some of these causes of abscess in tne brain produced with¬
out external breach of surface to help diagnosis. 1. Bruise
of the brain under a spot of the skull which has received a
sharp blow, but where the bone is uninjured. 2. The spread
of inflammation into the brain along a vein leading from a
portion of bone damaged by a blow. 3. Commotio cerebri,
the result of contrecoup. 4. Secondary infarcts in general
pyaemia. 5. Disease of the lungs. 6. Hepatic inflamma¬
tion. 7. Caries of the hones of the nose. 8. Disease in the
middle ear.

Now, as long as cerebral abscess was considered an in¬
evitably fatal condition, and the only questions involved
were tne diagnosis of its presence and the prognosis, such
» wholesale method of dealing with the subject may have

„ * at the diicuision on Cerebral Abscess at the Medico-Chlrarglca)

Bocletj 0 f Glasgow, Feb. 11th, 1837.

seemed to some sufficient. But now that the brain has
been brought within the reach of operative surgery by the
perfecting of antiseptic methods much more is demanded,
and above all knowledge to enable us to fix the locality of
the inflammatory focus. For this knowledge ih the case of
that class of cerebral abscess to which I shall confine my
remarks—namely, that due to disease of the temporal bone—
1 am afraid we shall have to wait a long time if we rely
solely upon special clinical symptoms. It appears to me
that wo are likely to learn far more facts available for
localisation and treatment from a careful study of their
pathology, macroeoopic and microsoopic, than from a search
after special nerve symptoms. But if this is to be true, one
of the most indispensable conditions of our research into
their nature must be kept in view—namely, that we shall
separate and keep apart those abscesses which depend
upon totally different exciting causes and study each
for itself according to its own special etiology. Strongly
impressed with this idea, 1 shall confine my remarks
to matters relating to one particular form of cerebral
abscess which is of relatively frequent occurrence, and
for which surgical treatment will probably be most fre¬
quently necessary for a long time to come. 1 refer to abscess
depending upon inflammation of the temporal bone. Thus
limited, the field is still a large one. 1 find, by combining
Rudolph Meyer’s tables with those of Dr. Ogle, that we have
101 cases of abscess of the brain classed as to cause, and 18
unclassed. Of these 101 classed, 29 were due to disease of
the temporal bone following upon suppuration in the middle
ear. Traumatic causes followed next, with 27 cases; then
suppuration in the lungs and liver, with 20 cases. Among
the remaining 24 cases pyaemia was credited with 7, the rest
being made up in various ways. Now, although 1 should
not like to rely too much upon these statistics, which were
compiled twenty years ago, when pathological observation
was not so accurate as now, 1 believe they are sufficiently
accurate to enable one to estimate roughly the relative fre¬
quency of abscess due to ear disease as contrasted with those-,
from other .causes. And 1 think, from a study of the tables
referred to and of other cases as well, that a revision of the .
question would now lead to ear disease being credited with
a still larger relative number of cerebral abscesses than,
above, and that 30 per cent, of all causes would be below
the mark. It would probably be nearer 60 per oent.,
pyaemia having now become a relatively rare affection, and
fractures of the skull, or suspected fractures, being now
treated by antiseptic surgeons in such a way as greatly
to reduce the number of traumatic abscesses of the brain.
At the same time, I question strongly whether a corresponds*.
ing improvement in the treatment of suppuration in the
middle ear has yet taken place generally to largely reduce the.
mortality from ear disease. It is to this large group, then,
and to it alone, that the remarks 1 have to make refer.

The pathology of encephalic abscesses due to ear disease is.
not very abstruse. They appear (broadly stated) to be pro-*
duced in two different ways, of which it is hard to say
which is the commonest. In the first place, we find a septic
phlebitis extending from the walls of the tympanio cavity
into the substance of the brain by a longer or shorter route,
and there setting up an inflammatory process in the white
substance. Here the dura mater of the petrous bone may
show but few signs of disease, and the serous covering of
the encephalon Ira perfectly normal to the naked eye; there
may even be a considerable thickness of sound cortical
brain tissue between the arachnoid and the cavity of the
abscess. The course of the veins along which the inflam- .
mation extends is liable to considerable variation. In the
case of the brain they usually pass from about the middle
of the temporo-sphenoidal lobe either into the superior
petrosal sinus or to the dura mater about the roof of the
tympanum, or to the petroso-squamosal suture. The abscess
in the brain consequently is set up by “a retrograde
phlebitis.” The next mode of origin is that of simple ex¬
tension of the inflammation from the middle ear to the
dura mater, and from this to the cortex of the brain directly-
through the medium of a more or less localised septic lepto¬
meningitis. This la9t mode of origin is, 1 think, more often
met with in the case of the cerebellum, the last in that of
the brain. Both may start from the same form of inflamma¬
tion in the middle ear, with or without caries of its walls
and with or without subdural abscess. It is obvious that
the last mode of origin is associated with the gravest looal
condition. In the first place, septic meningitis has a great
tendency to beoosoegeneral; and, next, such an inflammation

Digitized by G00Qle

1176 TH» IilNOBT,]

MR. A. E. BARKER ON CEREBRAL ABSCESS.

can hardly spread backwards towards the cerebellum without
involving the lateral sinus and producing more or less septic
phlebitis in it, with or without general pyremic infection.
Moreover, subdural abscess may produce grave symptoms.

But though the pathology of encephalic abscess from
disease of the temporal bone maybe a comparatively simple
study in the dead body, in the living the study of the process
is fraught with difficulty. For it is plain that the same
form of disease in the bone may produce at least five distinct
conditions of grave disease. These are (1) general septic
meningitis; (2) plastic phlebitis of the sinuses; (3) pyaemia,
generally associated with phlebitis of the sinuses; (4) abscess
of the cerebellum; and (5) abscess of the cerebrum. More¬
over, each of these may be met with not only alone, but
grouped together with one or more of the others. Here,
then, is the great obstacle to our dealing with abscess in the
brain or cerebellum by operation—viz., the difficulty of
differentiating them during life. For to operate on an abscess
of the brain or cerebellum where general septic meningitis or
pyaemia is present would be almost hopeless; and to open an
abscess in the cerebellum while another is left untouched
in the brain, or vice verm, would not be successful surgery.
Again, to leave uurelieved a condition of the temporal bone
which has started and is keeping up a phlebitis of the lateral
sinus, and may at any time end in general septic infection,
while the accidental brain abscess is opened and drained, is
not likely to lead to good results. There is a sixth condition
which has much in common with those last mentioned, both
in pathology and clinical symptoms. This is the simple
accumulation of pus in the middle ear, due to blocking of
the external m°atus by swelling or polypoid granulations.
Now, any or all of these six conditions may follow upon the
simplest attack of suppurative otitis media. Is it possible
to distinguish them clinically one from the other? I think
it is to a large extent, to anyone who has studied the
pathology of this whole group of affections as a whole,
commencing with the initial inflammation of the tympanum,
and has closely watched their course in the living. It will
not do to know all about intracranial abscess and the varieties
of meningitis and neglect the study of the initial affections
of the middle ear, which require just as close attention.

For brevity’s sake I will now venture to sketch roughly and
without argument the method l should pursue in a case where
suppuration in the middle ear was followed by grave consti¬
tutional disturbance, arousing a suspicion of brain disease. In
doing so I shall endeavour to embody in the sketch the rules
I have found useful in dealing with a large number of such
cases. If called to treat a patient who, having recently had
severe pain in the ear for the first time, had begun to suffer
from violent headache on that side, drowsiness, rise of tem¬
perature and quickening of pulse, with or without rigor and
delirium, thq surgeon, knowing that the commonest cause
for these symptoms is pent-up pus in the middle ear, would
at once examine the latter with a speculum and a good
light. If the membrana tympani were seen to be bulged
outwards by a quantity of opaque white pus, he would
incise it from top to bottom behind the malleus and trans¬
versely below the latter. If pus ran out freely, the sym¬
ptoms would probably all shortly disappear, if they did
not do so after the tympanic cavity had been freely drained
and cleansed, but the headache became worse and the
temperature and pulse remained high, while further ex¬
amination disclosed optic neuritis, and the patient began to
have the “cephalic cry ” and so-called cervical opisthotonos,
acute meningitis would be suspected. If after iucision of
the membrana tympani and thorough drainage the head¬
ache and dulness disappeared, but the temperature kept
oscillating between the two extremes without any approach
to regularity, while occasional rigors developed, we should
suspect and probably soon recognise pyremin with its
secondary manifestations. In neither of these cases would
there be any probability at the outset of abscess either in
the brain or cerebellum. After such recent, acute attacks,
while meningitis and pyremia are not uncommon, abscess in
the encephalon is almost unknown. Subdural abscess and
plastic phlebitis are also unlikely to occur in these cases of
early acute disease. But if a discharge from the ear had been
present for a long time, and had lately ceased with the onset
of the above acute symptoms, the most common cause would
be blockage of the meatus with polypoid granulations or
oedema of the passage. In the first case immediate relief ought
to follow removal of the growths. In the second, if marked,
or, should the symptoms persist after removal of the polypi,
an opening should at once be made into the mastoid antrum.

[Jpot 11,1887.

and the middle ear be drained from this until the meatus
had been rendered again pervious. This operation ought
always to be done in doubtful cases as an aid to diagnoMs.
It is as simple and devoid of risk as it is useful. Moreover,
as a preliminary to graver operations on the brain or
cerebellum, it has the great advantage of enabling us to
cleanse the foul infecting focus in the middle ear, and to
continuously drain it. But though by this drainage of the
middle ear we should have eliminated one source of un¬
certainty, the symptoms might still persist. If so, in a
chronic case, we should have to consider the possibility of
the presence of encephalic or subdural abscess, or phlebitis
of the sinuses, even though meningitis and pyremia had been
already excluded.

Now as to subdural abscess. Is it possible to diagnose its
presence in an early stage? I think hardly with certainty,
unless by exploratory operation, though there may be good
grounds for suspicion from general considerations. In the
first place, subdural abscesses are, as a rule, only found in
very chronic cases, and in those where matter has been
pent up in the temporal bone, not where the discharge has
been free. They are usually heralded by a single rigor, with
rise of temperature, which does not oscillate much if un¬
complicated by pyremia. The patient will be heavy and
dull, only complaining of aching in the temporal regioa
The pulse will be rapid, unless the abscess be large enough
to produce compression, which is not common. It seems
probable that this condition may produce optic neuritis
but further observation is required on this point. An
examination of the mastoid and squamosal portions of the
temporal bone may reveal more or less tenderness and tedenu,
which will, if present, persist even after free drainage of the
middle ear as above. These symptoms all point to an inflam¬
matory focus close by, probably pent-up matter, and, as our
preliminary operation has shown that it is not in the
middle ear or mastoid antrum, we must look for it under
the adjacent dura mater. But at what point is the pus to
be looked for? The study of the disease in the post-mortem
room teaches us that it will be found either over the roof of
the tympanum clos9 to the squamoso-petrosal suture, or on
the posterior surface of the petrous bone—i.e., in the groove
for the lateral sinus. In some cases it extends from one to
the other of these spots. If in the first situation, it ii
reached by cutting cautiously through the bone layer by
layer with a gouge at a point about half an inch above
and the same distance behind the centre of the bony
meatus of the ear. If in the second position, the col¬
lection is found half an inch directly behind the centre
of the meatus. With due care the dura mater can be
exposed in both situations with very little risk, "e
cannot be certain of the non-existence of a subdural
abscess until both spots have been examined, but the higher
operation should be done first, then the lower. The state of
the bone, too, in both situations must be very carefully
examined as it is cut away. If pus underlie it, it is usually
spongy, and the matter will begin to ooze through its porea
before the abscess is actually reached, as was found in two
of my cases. If no pus be found, and the high temperature
and other symptoms persist for many hours after the opera¬
tion, the case will probably turn out to be one of phlebitis
of the sinuses with septic absorption or saprremia os
distinguished from pyre mi a or general septic infection,
which is almost certain to be accompanied by rigors, »
greatly oscillating temperature, and secondary suppurations
in distant parts. For this condition little can be done
beyond what has been already effected by the exploratory
operations—namely, thorough cleansing and drainage of the
initial focus of suppuration; but this is a great deal. ”
actual thrombosisof thelateralsinus and internal jugularbave
taken place, there may be a flush on the same side of the fart
and injection of the conjunctiva, together with deep-seated
induration over the track of the internal jugular vein. This
could be well felt in one of my cases. Optic neuritis msy
also be well marked in cases of phlebitis of the lateral sinus,
as was seen in two cases on which I operated for what I
believe to have been this condition. Both patients *T
improved after operation, and are now well, all traces of t-S
optic neuritis having disappeared.

1 have briefly traced these four consequences of midli?
ear suppuration in the order of their frequency and P n! ': ’
logical sequence. It is necessary to be thoroughly fumiiw
with them and the way to eliminate one after the offr.
before we can hope for anything approaching a 5*- 9
diagnosis of abscess in the brain or cerebellum.

The Lancet,]

MB. LAWFORD KNAGGS ON INTUSSUSCEPTION.

[Jura 11, 1887. 1177

Taming now to the latter conditions, our first ques¬
tion is: What probability is there of their occur¬
rence? It is quite plain, in the first plaoe, that abscess
of the encephalon is far lees common than the other
•affections just described, the symptoms of which so
■often arouse the suspicion of the presence of the latter
-condition. I feel sure, from personal observation, that
pyaemia, meningitis, phlebitis of the sinuses, and subdural
abscess are, broadly stated, ten times more common than
-abscess of the encephalon. Then, again, the more extensive
the destruction of the walls of the tympanum the more
likely is the latter to be produced. This is almost as much
-as to say that the more chronic the bone disease the more
likely a brain abscess, but not quite. It is better to say,
the more imperfect the drainage from the middle ear In
-chronic cases the greater the probability. For disease lasting
a year or two, in which the meatus has been bloakea
by granulations or swelling will be far more likely to
lead to abscess of the brain than the same amount of disease
lasting twenty years where free drainage existed. The
history, then, of a case of otitis media p'urulenta will help
us much in estimating the likelihood of the presence of
cerebral abscesB. Again, it requires far more extensive mis¬
chief in the walls of the tympanum to produce a cerebellar
-abscess than one in the cerebrum. Here, again, the history
of the case and an exploratory operation are of the greatest
assistance. From an analysis of cases which I have made
it appears that abscess of the brain is a much more common
eequela of disease of the tympanum than abscess of the
cerebellum. I find that out of forty-five cases only twelve
of abscess in the cerebellum were found against thirty-three
<in the cerebrum. This is but a rough calculation, but
from personal observation and reading I feel sure it is near
-the truth. The brain is about three times as liable to abscess
as the cerebellum.

Now, what does pathology teach us as to the region of
the brain in which these inflammatory foci are found. This,
namely, that they are most usual in the middle or posterior
part of the temporo-sphenoidal lobe ? I think that nine-
tenthe of them would be found to lie within a circle with a
three-quarter inch radius, whose centre lay an inch and a
■quarter above and the same distance behind the centre of
the bony meatus of the ear. This, then, might be described
■as the dangerous area, and as it fortunately also includes
the spot indicated above as most likely to be the seat of
subdural abscess, from the same cause an exploration for the
latter would be a necessary preliminary to a trephining
operation for cerebral abscess. As to the position of abscess
an the cerebellum, it is, I believe, always found at the outer
and anterior part of the lateral lobe which rests against the
petrous bone. If these conclusions be justified, we have much
•valuable evidence to go upon as operators. We know in the
case of the brain where to look for abscess, a point we are
not likely to learn from any special symptoms, inasmuch as
in collections of ordinary size the affected tissue would be
•quite outside the motor areas, and would belong to a part
of the brain very tolerant of stimulation, and whose func¬
tions are still obscure. This last point was well illustrated
in the case of cerebral abscess in which I operated. Neither
the movements of the silver drain tube within the temporo-
sphenoidal lobe nor the injection of the cavity therein
with boracic lotion seemed to have any effect upon the
patient, even when he was perfectly conscious; nor did the
scraping of the cortex during the operation produce any
nerve symptoms. But though there may be no special nerve
symptoms to guide us, there are other general clinical signs of
great value. I need not enumerate these in detail to a society
such as that I have the honour to address, but I should like
to indicate briefly those which appear to me of special value.

First, there is the feeling of malaise and drowsiness with
slow pulse terminating in a sudden great rise of temperature
with a single rigor. Next, the gradual fall of temperature
■to subnormal, without perhaps any subsequent rise, tne pulse
remaining slow and full. There is one point in regard to
this subnormal heat, which I noted in my own case, to
which I should be glad to specially direct attention, as
I do not find it anywhere alluded to. It may or may not
prove of value in the future. It iB this: the subnormal
temperature was most marked in the evening. This is so
unlike what we are accustomed to see with pent-up septic
matter in other situations where an evening rise is considered
characteristic, that it may have some special significance in
cases of abscess of the brain. I have noted the same point
in other oases.

Another symptom also noted in other cases of cerebral
abscess was strongly marked in that under the care of Dr.
Gowers and myself. This was the sluggish but perfect cere¬
bration. When asked a question, for instance, the patient
appeared to take no notice for several seconds, until one
thought he could not have heard, or bad forgotten that he had
been addressed. But presently he would begin to answer
slowly and deliberately, but with perfect intelligence. It was
the same with his movements. This condition lasted for some
days after the opening of the abscess in our case, and we
noticed that after considerable improvement had taken
place there was a relapse into slow talking, which appeared
to coincide with an imperfect drainage of the abscess, the
latter having been left undressed for a longer period than
usual, and tne drain tube being then found outside the skull
altogether.

As to optic neuritis, I venture to think we must be
cautious in relying on it as a sign of cerebral or cerebellar
abscess. It certainly may be present in an intense degree
where extensive disease of the middle ear exists without
abscess in the brain or cerebellum. For instance, I have
seen it in two cases (intense in one of them) in which open¬
ing up of the middle ear through the mastoid bone was
followed by its rapid disappearance and the complete and
permanent recovery of the patients. The condition here
was probably phlebitis of the lateral sinus with subdural
abscess. But of course, taken with other signs, optic
neuritis is a valuable symptom.

Harley-etreet, W. _

RESECTION OF AN IRREDUCIBLE AND
GANGRENOUS INTUSSUSCEPTION.

WITH A CONSIDERATION OF THE TWO CHIEF METHODS OF
TREATMENT: INFLATION AND ABDOMINAL SECTION.

Br LAWFORD KNAGGS, M.A., B.C. Cantab., F.R.C.S. Eng.

(Concluded from page 1126.)

From the facts before mentioned it is impossible to avoid
coming to the conclusion that forcible distension of the
bowel, whether by air or water, is an operation never
entirely devoid of danger; that in very young children it is
one of very considerable risk; and that in all cases it should
be employed with great judgment and care. But when
rupture does occur, to open the abdomen at once is obviously
the only hopeful course to pursue. The injury is by no
means necessarily situated in gangrenous bowel, and, other
things being satisfactory, there is no reason to despair of a
successful result. In Mr. Symond’a case, to which he has
very kindly permitted me to refer, this was done and the
rupture sewn up. The child, however, was too exhausted to
rally from the operation, but at the necropsy the sutured
bowel was able to resist successfully very considerable dis¬
tension with water. To be of any avail operation should be
immediate, and therefore it would be well, whenever pos¬
sible, to have the necessary requisites at hand, in case
inflation should prove disastrous or fail to effect reduction.
The desirability of being able to recognise that reduction
has taken place after inflation is obvious; for if a doubt
exists, and further time is allowed to Alapse, the dangers
are very materially increased if reduction has not been
accomplished.

What are the signs by which we can recognise successful
reduction after inflation ? To what fallacies are they open ?
Are they so sufficiently certain as to leave no reasonable
doubt as to the result? Mr. Clement Lucas 1 publishing a
successful instance, puts them down as follows; 1. The
tumour gradually sinks away under the hand and is lost.
2. A gurgle of air is felt and often heard. 3. This is followed
by sudden and uniform distension of the abdomen, which
becomes tympanitic. But the history of cases shows that a
tumour may not infrequently disappear after inflation,
whilst its early reappearance proves that its reduction has
not been complete. Dr. Goodhart has shown 2 that in con¬
sequence of the greatest congestion and swelling taking
place at the apex of the invagination—the portion that is
the last to be reduced—the final part of the reduction may
be the most difficult, or even impossible. This fact no

1 The Laxckt, Jan. 16 th. 1S86.

* Fagge't Principles and Practice of Medicine, yd. U., p. 196.

o

llt& J Tub Lancet,]

MR. L.WFORD KNAGGS ON INTUSSUSCEPTION.

[Jcnk II, I88X.

doubt explains some of these cases, the invagination being
reduced to so small a size as to escape detection, and
the swollen state of the abdomen after inflation adding
to the difficulty of the search. Other cases may perhaps
be explained by the tumour becoming buried beneath
distended intestine. If an invagination has reached the
descending colon, it is obvious that the distension that
occurs must be at first local, and as reduction goes on the
swelling will mark the course of the descending and
transverse colon. When the colon is entirely unravelled
the swelling will become general, for I believe, and this
case supports the view, that considerable distension of the
colon is quite sufficient to produce uniform distension of
the abdomen. Post-mortem evidence confirms this, for the
small intestines may be quite concealed by a distended
large bowel. If the intussusception is of the ileo-crecal
variety, or of the large intestine only, the chances are greatly
in favour of reduction having occurred when this general
distension takes place; but if the small intestine is the seat
of the invagination, the disappearance of the tumour will
probably only mean that the distended colon is pushed in
front of it. The gurgle of air is not, I think, a symptom of
great importance. If this reasoning is correct, cases will occur
in which these symptoms will present themselves and the
invagination still remained unreduced. Such a case is the
one I have reported. In a case in which inflation recently
proved successful in the hands of Dr. R. W. Brogden of
Ipswich, with whom was associated Dr. Carrington, there
was “ an alteration from distinct hardness and contour to
comparative softness and want of definition in the shape of
the mass,” but doubt existed as to the success of the treatment
till it was set at rest by the disappearance of the other sym¬
ptoms. The experience of other surgeons would, I believe,
show that such doubts as to the success or non-success of
inflation are by n6 means rare. When, as in Dr. Brogden’s
case, they are solved satisfactorily, all is well; but when, on
the other hand, lapse of time proves the operation to have
been futile, as in mine, what an amount of harm may have
resulted, and how largely may the patient’s chances have
been prejudiced. 1 conclude, therefore, that cases will occur
in which at the time of inflation the operator, if sure of the
exact nature of the invagination, may feel certain that re¬
duction has been accomplished. Yet there will be others in
which doubt must exist os to the result until the disappear¬
ance or continuance of the symptoms, or the reappearance of
the tumour, settles the matter.

The position of the tumour is a point of considerable
importance in considering the probability of inflation prov¬
ing successful, or in estimating the amount of good that it
has effected. If it is in the descending colon, the invagina¬
tion is almost certain to be one of the large intestine, or of
the ileo-csecal variety, and in the large majority of the
instances of the successful employment of inflation or
enematatbat I have met with the tumour was stated to
have been situated on the left side or felt per rectum. 3 If,
however, the tumour is on the right side, or near the median
line on the right side, there must exist considerable un¬
certainty as to its variety, and therefore disappearance of
the tumour with distension of the abdomen must leave it
doubtful whether the tumour has been disinvaginated or
only obscured. Before leaving this part of my subject it is
well to p-int out that sudden uniform distension of the
Abdomen is the mbst obvious sign that rupture has occurred.
The expansion is so immediate and eo general, so different
from the more gradual uniform distension that takes place
so long as the air is within the intestines, that it is impos¬
sible to remain in doubt as to the accident that has taken
place.

There is no longer any question as to the desirability of
opening the abdomen in these cases, but the time when it
should be done can hardly he said to be generally agreed
upon. In the hope of throwing eome light upon this point,
I have collected from American and English records thirty-
seven cases in which abdominal section has been performed
for intussusception. I am indebted for twenty-one of these
to a paper by Dr. Sands in the New York Medical Journal
(1877). and to Mr. Jacobson and Mr. Symonds for permission
to include four cases that have not been published. In the
first three ancpossf al oasas,tjiedqtails are somewhat incom-

patient and the duration of
- tbs aafc&ft&probable, in the absence of any

i hr. r. Taylor,

direct statement to the contrary, that the operation mi
performed either before or very soon after acute symptoms
had appeared. In the next four this is more definitely stated.
In two acute symptoms never developed, and in two tbe-
operation was performed twelve and eighteen hours respec¬
tively after they had set in, whilst in the last a successful
result was obtained after four days’ acute symptoms, wheo
the pulse had reached 200 in the minute, and when the chili
appeared so much exhausted that the operator “ was doubtful
whether much should be attempted for its relief.” The moral
of these cases is plain. Success is more certain to be obtained
if operation is undertaken before acute symptoms set in, or.
if they have set in, before many hours have been permitted
to elapse. The last case is an eloquent encouragement to
persevere when the prospect seems hopeless. (See Table 1.)

Table I .—List of Cates of Intussusception successfully
treated by Abdominal Section.

No.

Names of J
observer*.

’Sex and age.

Duration of
symptoms.

Other points.

1

Velse. 1784

F., 50 years

Not stated

_

2

Ftischiua, 1820

M68 years

10 days

—

3

Wilson, 183d

,M., a,' years

17 days

—

4

Uutchinsou, 1873

F., 2 years

1 month

Symptoms new
acute.

6

Marsh, 1876

M., 7 months

14 days

Acute symptom D
hour* before
operation.

6

Howse, 1878

F., 33 years

18 days J

Acute symptoms
not developed.

7

Sands, 1877

F., 6 months

18 hours

Amite symptom
from the first.

8

Godlee, 1883 |

— 9 months

4 days

Acute from the first.

The duration of tbe acute symptoms in the list of unsuc¬
cessful operations (Table II.) bears a marked contrast to
their duration in the successful cases. Where I have been
able to state it definitely, they have existed, with one excep¬
tion, from three to seven days ; and, could I have ascertained
it in the remaining instances, I believe the contrast would
have been greater. But an inquiry into the cause of death
is likely to help us as much as a comparison of the duration
of acute symptoms. I assume, where 1 have found no causa
of death stated, and where the patient hassuocumbed within
a few hours after the operation, that exhaustion increased by
the shock of the operation has been the chief cause of death.
In those case8 in which peritonitis existed, probably trace¬
able to the operation, it would be but a small factor com¬
pared with the other two, and but for them might have been
recovered from. Out of twenty-seven cases, no lees than
twenty-three died within twenty-four hours (twenty within
twelve hours) from exhaustion and shock ; and two others,
though surviving into the second day, might possibly be
included under this heading. Two only can fairly be ex¬
cluded—one in which the child died of purulent peritonitis
the result of the operation, and the other where a man sur¬
vived nine days after an abandoned operation with a rup¬
tured intestine and general peritonitis. If we are to improve
our results we must eliminate shock and exhaustion. Where
success has been attained, it has usually been when acute
symptoms have lasted only a very short time, or before they
have set in. Where operation has failed, acute symptoms
have been in existence for some time. The exhaustion they
produce has been often very marked, and in numerous
instances the condition of the Involved parts has necessitated
either the abandonment of the operation or tbe performance
of a purely palliative one, or the more severe but more
scientific undertaking of removal of the damaged intestine
The more acute the symptoms, the more rapidly does ex¬
haustion supervene; the greater the damage inflieted upon
the bowel, the worse does the patient's state become.

To open an abdomen under ordinary conditions is not now
regarded as an operation of very great gravity. It is done
every day for conditions that are trivial compared to this
form of intestinal obstruction, and its results become more
encouraging with increasing experience. But to allow as
intussusception to continue is a matter of most serious
moment, and usually fatal. Notwithstanding this, our pre¬
sent attitude, whilst recognising that operation is the only
measure that is sure of giving relief, is to wait until nothing
seems left to us but operation; to wait until exhaustion »
advancing at an increasing pace, and shock is almost certain
to prove too great for success; to wait until to a steals
abdominal section must be added the abeplute ntaiantj

Tm* Lajtott,]

MR. LAWFORD KNAGGS ON INTUSSUSCEPTION.

[June 11* 1887. r 1T7&-

of reeecting irreducible or gangrenous gut; to wait until
we know that the shock will be the greatest possible,
*nd the patient’s powers of resistance the least possible.
And We do this because we hope that the invagination may
#o back under simpler treatment, or because we are afraid
lest we may by operating take away our patient’s last
-chance. Our position is well summed up in the line—

“ Fain would we ollmb but that we fear to fall.”

This waiting policy, this surgery of hope, has so far been a

tion was abandoned for a variety of reasons, or in which
an artificial anus was established and an irreducible or
gangrenous invagination left inside the abdomen, or in
whioh reduction was not completed. In five others (Nos.
13, 14, 25, 26, 29) removal of the whole or a part of the
invagination was performed, and it is worthy of note that
in not a single instance did success follow this proceeding.
I do not wish it to be inferred that this serious measure is
one that should on no account be undertaken. When the
occasion for it arises, the choice must lie between leaving

Table II .—List of Cates of Intussusception in which Abdominal Section was performed unsuccessfully.

Ho.

Names of observers.

Sex and age.

Duration of
symptoms.

Time of death
after operation.

Cause of death.

1

Ohle, 1817

M., 50 years

11 days

13 hours

General peritonitis, with
gangrene of invagtnated
gut

a

Oerson, 1838

M., 13 weeks

Not stated

In a few hours

-s

Haul, 1843

M., 36 yean

4 or 6 days

9 days

...

A

PtrogoC. 1863

M„ 16 yean

Considerable

time

4 days

Soon after

*

Wells, 1863

— 4 months

5 hours

•A

Laroyenae, 1878 '

...

...

...

...

1

s

•9

J O
11

Johnstone, 1873
Weinllcher, 1873
Duncan, 1874
Hntohinaon. 1876

Bell, 1876

Infant

F., 6 months

— 6 months

— 6 months
M., 18 months

3 (lays

4 day*

6 days

In a short time

6 hours

34 hours

8 hours

7 houn

Inflammat ion

Acute peritonitis
Syncope

Universal peritonitis

19

Brit. Med. Jour., 1876

— 9 months

7 days •

A few hours

Collapse

13

Morris, 1877

H., 13 yean

7 days

18 houn

14

Howse, 1876

— 5 months

1 month; not
acute

A few hour*

■

15

18

17

Currier (Hutchinson, Med.-
Ohlr. Trans., vol. 57, 1874)
Page (Med.-Chlr. Trans., 1878)

Hulke (Clin. Trans., 1879)

M., 33 years

M„ 6 years

F.; 16 yean

15 days

Acatc8dayB,foI-
lowlng chronic
3 months

5 days’ acute
symptoms

7 hours

-9| houn

36 hours

MnUon; commencing
peritonitis

Hxhaustion; peritonitis

18

19

God lee (Clin. Trans., 1883)

Godle* (Clin. Trans., 1888)

M„ 7 months

—14 weeks

3 days’ acute
symptoms
Not known

U days

8 houn

Pnmlent peritonitis, pro¬
bably result of operation
Exhaustion; shock

.SO

21

22

23

Warrington Haward (Clin.
Trans., 1888)
Davies-Colley (Bryant,
Harvelan Lectures, 1884)
Symonds, 1884 (not published)

Symonda, 1884 (not published)

M.,i7 months

U., 32 yean

M., 5 months

F., 6 znont hs

5 days’ acute

5 days’ acute

7 days' acute

todays

Several hours

2 days

9 hours

Several hours

Bxhanition; peritonitis

k

Exhaustion; early
peritonitis

Exhaustion; shock; com¬
mencing peritonitis

at

Kendal Franks (Brit. Med.
Jour., Dec. 6th, 1884)

Man

Few hours

23

Mayo Robson (Brit. Med.
Jour., Oct. 3rd, 1885)

F., 33 years

7 days

2j houn

Shock

£6

Fox well (Brit. Med. Jour.,
June 5th, 1886)

Boy

10 days

-

Exhaustion

97

Jacobson (not published)

—11 months

34 hours

34 hours

-

£8

20

Jacobson, 1886 (not published)

Lawford Knaggs

M., 5 months

M., 5J years

3weeks; not
acute

4 days’ acute

At close of
operatlou

1J hours

8hock

Other points.

Operation abandoned because of
ruptured gangrenous intestine,
and Arm adhesions rendering
reduction impossible.
Adhesions firm; Intestine ruptured;
operation abandoned; general
peritonitis existing at time of
operation.

Invagination found gangrenous;

artificial anus established.
Nearly moribund when operation
was begun.

Diiluvagination could not be
affected owing to adhesions.

Invagination Irreducible; artificial
anus established above tumour.
Post-mort.: Peritoneal adhesions;

hemorrhage into mesentery.

At operatlou there was peritonitis
and escape of fieces from upper end
of tumour. The invagination was
resected, and the ends of the In¬
testine fastened to the abdominal
wall.

The Intestine ruptured under
traction; fdurlnches were resected,
and the Intestine above and below
joined.

Seduction impossible; artificial
anus established.

Pulseless and collapsed when
operated ou.

Tumour Irreducible; artlfidil anus
made above it; peritonitis fit opera¬
tion ; condition of patient bad.

Patient much ooilapsed at time of
operation; part of tumour not
reduced, and some sloughing of
cum had taken place.

Condition of patient before
operation had.

Patient was the subject of general
tuberculosis.

Part of gut almost gangrenous, and
peritoneum had given way in
several places.

Four feet of gangrenous jejunum
resected, and the ends of intestine
sewn together.

Death occurred during tbeattempt
to resect the intussusception, which
was gangrenous; pnrnlent peri¬
tonitis exited.

Operation abandoned in hope that
cure might occur from sloughing;
the Intussusception irreducible,
and too large to be resected.
Child much collapsed at time of
operation.

Resection of irreducible and par¬
tially gangrenous Intussusception.
State of patient good, but after
resection completed desperate.

<Usmal failure. Nor should we forget that in all cases that
last chance is far too poor to be relied npon for permanent
anocess, and that in infants it practically does not exist.

To attempt to draw any comparison between the numbers
of successful and unsuccessful cases would be manifestly
'unfair, I have included in the second list no less than nine
oases (Nos. 2, 3, 4,6,11,15,17,19, 27) in which the opera-

an irreducible and probably gangrenous mass in situ and
establishing an artificial anus above it on the one hand, or
making a clean sweep of the offending parts on the other.
In the former case all hope is practically abandoned, and
the patient is left to die unless he proves so miraculously
fortunate as to survive the shock, to part with the gangrenous
mass, and psss safely through dangers attendant upon its

MR. H. C. GILLIE8: 'A' SIMPLE CASE- OT PLEURISY.

[Jins 11, UK

1‘180' Tis La’ncist,] *

elimination. In the latter the probability is that the patient
will die; but we are justified in hoping that he may over¬
come the difficulties in front of him. What might have been
the result in HauPs case, where the patient survived nine
days with peritonitis, had the operation been carried to a
conclusion? Here, at least, the shock might have been
survived. But it is to be hoped that in the future
resection will not often be required to be resorted to in
these cases. It will, I believe, be rarely recovered from.
If the necessity for it arises, the patient will usually be in a
most serious state, and the terrible shock entailed by it will
almost certainly prove more than he con stand. But if the
importance of immediate operation, inflation failing, becomes
generally recognised throughout both branches of our pro¬
fession, the necessity for it will rarely occur, i ust as we
must hope to abolish shock and exhaustion as a cause of
death by being beforehand with them, so must we hope to
eliminate cases of abandoned operation, incomplete opera¬
tion, and resection, by dealing with all cases before their
natural progress compels us to entertain these measures.

It will generally be admitted that in cases of this nature,
even when pursuing a more chronic course, an operation of
such gravity as abdominal section should not be performed
without proper consultation, whether in hospital or private
practice; and it is even more deeirable in acute cases, where
a child in robust health one day is brought within an ace of
death’s door the next, from causes which are neither apparent
to nor understood by its friends, and who will rarely be
found to appreciate to the full the perilous condition,
of the patient. Now consultations are not usually sought
until the surgeon in charge has already consumed some
time in ineffective treatment, or has himself decided that
operation is desirable, and the loss of time that in this way
occurs at critical periods of this disease, especially in
country practice, adds very materially to the dangers of the
case. It cannot be too clearly understood that the successful
treatment of intussusception will to a large degree depend
upon promptitude in diagnosis and vigorous and immediate
action. When once the nature of a case is ascertained, a
consultation should immediately be sought, at which in¬
flation should be first employed, and, in the event of t his
method failing to effect redaction, the abdomen should be
opened then and there. If this were adopted as a routine
practice, I am persuaded far more cases of intussusception
would recover than do now, and this increased success
would be contributed to both by inflation and by abdo¬
minal section. Lastly, where the diagnosis remains in
doubt these are urgent cases for exploratory incision.
If the diagnosis halts between intussusception and faecal
accumulation—a not unlikely possibility—it is quite as
justifiable to settle the point in this way, when life seems
certain to pay the penalty of a mistake, as it is to decide
upon the possibility of removal of an abdominal tumour by
the same means when the prospect of death is not nearly so
imminent. Any operator who finds that he has opened an
abdomen for a lump composed of fteces under the impression
that it was an intussusception will undoubtedly receive a
severe shock, and the fact may be rightly described as a
“ surgical calamity”; but he is not in- such a position as the
surgeon who opens the abdomen and finds that lie cannot
remove a tumour. The former can assist his patient by
trying to break down the mass, and the information he has
gained may prove of the greatest value to his patient; but the
latter can only close the wound—a sadder and a wiser man.

Huddersfield.

A SIMPLE CASE OF PLEURISY: THE
INTERPRETATION OF DISEASE.

By H. CAMERON GILLIES, M.B.

In the spring of 1884 I used to meet a neighbour, whom I
knew well, going to his business. I noticed that he was not
looking well; and in reply to my “ How do you do ?” he
generally answered, “ Well, 1 don’t feel quite the thing, but
there is nothing particularly the matter.” Things went on
in this way for some weeks ; still nothing particularly the
matter, yet day by day looking worse, losing colour, flesh,
elasticity and force, until one morning Iwaa sent for to see
Mr. B—r~ urgently. 1 wm& and found- ttoase was now, at
any rata, somsthmg fJm 'matieH - He Was down

with some violent dfsekefc^ttotf was Apparent. It was an

extensive pleurisy of one side, attended by all the niul
symptoms, with marked prostration and high few. Be
got exceedingly low, bat wae well nursed and recovered
well. After a few weeks’ tafliday he, in his own words,
“ felt a new man.”

This was as simple and ordinary a case of pleurisy as it
could be. There ‘was nothing in the symptoms or k the
pathological conditions worthy of note. The reason why 1
record it is that it has been for my mind the starting-point
to indulge ih certain speculations that have been to myself
of no little interest, and perhaps not altogether wanting in
practical Usefulness. I beg to submit them to the generous
consideration of the profession in somewhat the same order
as they occurred to me.

What was the patient suffering from? As I stood by
that bedside I could not help asking myself: Is that rasa
suffering from pleurisy ? Is this pleurisy a specific thing,
the roots of which have extended a month or more back
into the man’s life ? Or is this pleurisy a mere accident in
the course of the real disease that has told so plainly on the
man’s frame during the past month or so ? Am 1 to take
the local inflammation, the occurrence of the past few hoars,
to determine my coarse of treatment against my know¬
ledge of his declining condition for weeks past ? Am 1 to
treat the pleurisy and to forget the man ? That was the
beginning of my curiosity and interest in the matter.

Some short time after that I met another neighbour. H»
did not feel at all well; if he did not get better he would
have, as he said, “ to look me up.” I was quite sure from his
expression, and from what J knew of his assiduous labours,
that he would very soon have to “ look me up.” In a week
or two I had a note wishing me to call to see him. 1
examined him carefully, but could make nothing of him.
He had the usual “premonitory symptoms” of scats
disease, being feverish, generally upset, and very unwell.
He was an intelligent man, and I had no difficulty in ex¬
plaining to him that I could not give a name to his disease
till perhaps the following day. I found him then distinctly
set for acute rheumatism.

Initial depression in acute disease. —Prom these observa¬
tions I determined ever after to inquire, in all cases of acute
disease, whether this initial state of depression held good,
and in every case and every form of disease it has. To me
it has been most interesting and instructive to hear even
powerfully built persons, who may have been taken with
acute pleurisy or pneumonia, nephritis, peritonitis, &£-,
declaring, in their own valuable phrase, “ It has been work¬
ing on me for a long time.” Sometimes it is difficult to
elicit the fact, but perseverance will in every case find that
“I have gone off my food,” “I have had no heart in my
work late!v,” “ I have been lary—disposed to lie about," “1
have not slept well for some time bade,” give the indication
and the necessary proof. I shall attempt to explain this
further on.

A modern writer of ability has declared that nothing is
more urgently required in our day than is “ the rejuvenescence
of the commonplace.” Let that be my apology if oa this I
write some things that everybody knows. There ia DOt
anywhere, as far as I know, in our modern medical literature,
any positive assertion that this initial state of depression is
an essential in acute disease; though in almost every one of
our better writers we meet with prophecies and indications in
this way. Mr. Simon 1 says that “weakness in the sense of
readiness to die is the prime cause of local inflammation,
and constitutional influence only influences inflammation
according as it leads to local weakness.” This is the truth;
but is it the whole truth ? Local “ readiness to die ” is by
this a condition precedent and, I take it, a condition essen¬
tial to inflammation; and this may be produced by consti¬
tutional influence. I would ask now otherwise can it be
produced ? for 1 consider that here constitutional influence
means the effect of our environment working by and
through the constitution, and not anything in the constitu¬
tion per se. Mr. Bimon has given us some of the best
chapters in our literature, and it is for me a pleasure to
acknowledge indebtedness to him for much that u valuable.
His theory of idiopathic inflammation enunciated in the
same work, and to which I shall have to refer, is admirable.

Dr. Hurobiaon^ states that “persons in good healt h {n ot
apparently 60 » but strictly so) are little liable to inflamma¬
tion.” Even of cancer he says, “In a largepixmootam of
cases it will be found that the first symptoms auaampomtma
have been preceded by protracted periods of grief or «**» *?»

1 Holmes* Surgery. » Disease* of Uw Llvw.

' 9 " Ze V O

TH* LANcht,] MR. RUTHERPOORD: RARE CCttTmWQII'OI'.VRftNS IN VAGINAL WALL. [Jxrcra 11, 1887. U8I

whether or not the family taint exists." This is going pretty
siear the troth in a cautious, perhaps doubting way. The
observation is a purely clinical generalisation, and as such
•from such a man it is of much value. My humble opinion
in that persons in strictly good health are so little liable to
inflammation that—they never have it.

Anstie 3 says: “ The general body energy is low when the
attack (of neuralgia) occurs.” And In his own sterling honest
way he elaborates the fact at considerable detail, but be does
not anywhere get nearer the general truth—that the fact is
•ae true of every other form of disease as it is of neuralgia. .

£riehsen says: “ Old age, anything that interferes with the
-qaality of the blood or its supply, anything that enfeebles
the heart’s action, predisposes to inflammation. Thus opera¬
tion wounds are more prone to inflame after a loss of blood
and in patients weakened by fever or want of food.” But
this, again, is only part of the whole truth. All these con¬
ditions, any thing that produces “weakness in the sense of
readiness to die,” not only predispose to, but make inflam¬
mation absolutely certain in some form or other.

Graily Hewitt, 4 in referring to cellolltis, says: “ The diet
should be liberal; most patients are weakly and prostrated,
■and there is reason to believe that this is an initial condition,
and had it not been for the general weakness the patient
would not in the,majority of cases be afflicted with cellulitis
•at alL” The quotation is so apposite that I have italicised
it. He sees in his own special sphere what others have
observed in theirs. His large experience of cellulitis leads
him to a truth that Simon, Murchison, Anstie, and Erichsen
■had arrived at by studies in other directions. It all points
in one way.

But this is not a modem discovery, nor can we say that it
has been arrived at by any ingenuity of our better methods.
St is the outcome purely and simply of clinical experience
end observation. John Hunter was clear upon quite as
much. “Weakness,” he writes, “is seldom or never an
immediate cause of disease, but it often becomes the pre¬
disposing cause, many diseases not taking place but when
weakness is an attendant, as agues, scrofula, nervous, &c.”
Hunter was troubled with the definition of weakness. He
found it applied to so many various conditions that he could
mot have written more precisely than he has as to its place
and value and meaning in disease. Disease was to him an
■entity, a thing distinet from its predisposition, in every
instance siu generis. But we can readily believe that if he
had Mr. Simon’s neat, complete definition of weakness as
■** readiness to die,” he would have greatly modified many of
his expressions, and his opinions would be found quite up
■to our modern attainments in this respect.

Abernathy's work on the “ Constitutional Origin of Local
Diseases ” is the high-water mark of rational medicine. His
charge, that “ the connexion of local disease with the state
of the constitution in general is either not sufficient! v under¬
stood or not duly regarded by this generation of practi¬
tioners,” holds quite good even in our later and more learned
■day. Addison says of this work: “It has extraordinary
merit and originality. The substance is that locftl diseases
are rather symptoms of a disordered constitution than
/primary and independent s themselves. This is a beautiful
theory, and I am not disposed to deny it a large share of
truth.” This is very generous criticism, yet it is not
sufficient; for, not only is this theory not to be denied a
large share of truth, but it must be granted wholly true over
the whole ground to which Abernethy applied it. And if
our present-day practice and our interpretation of the
phenomena of disease are not very wrong, this theory has
more of truth in it and a possibility of a wider and fuller
application than even Abernethy himself probably foresaw.

John Brown, of Edinburgh, was certainly a remarkable
man. Perhaps no “ideas” have been so often and so com¬
pletely “exploded” as his, yet somehow they turn up from
time to time. There was some life in this Brown. He was
in effect banished from his native land, yet he made himself
•quite at home abroad more Scottico , and now he is showing
himself to some extent after being “exploded” constantly
for a century. This is how he puts the matter: “A great
•criterion by which general diseases may be distinguished
from local ones will be found in this single circumstance—
that general diseases are always, local diseases never, pre- !
•ceded by predisposition.” And he explains: “ Predisposition
ia & middle state between health and disease; the powers
producing it are the sarneas produce disease.” That is perfect.

1 Stimulant*, and Narcotic*. . * Disease* oi Women.

Nothing in our modern literature approaches that fine
gene r alisation—that health, malaise (predisposition),disease,
and death are in one and the same straight line. We must
be clear that he uses predisposition in a sense different from
that of modern usage. Our present-day teaching puts pre¬
disposition among the causes of disease, end even our clearest
thinkers put it as, at any rate, a condition precedent; but
Brown says, “ Predisposition to disease and the disease are
the same.” The initial depression is the disease, says
Abernethy, and it is produced by a remoter disorder of the
constitution, and the pleurisy is only a symptom of that
disease. Tha initial depression (the predisposition) and the
pleurisy are one and the same disease, says Brown, and the
cause or causes producing the one produces the other also,
and is antecedent to and concurrent with the disease while
it exists.

Perhaps the rejuvenescence of so much that may appear
commonplace required an apology; but it is necessary for my
purpose of endeavouring to show that disease itself, at any
rate in its acute idiopathic forms, is a manifestation of the
determined lawB of the conservation of physical energy.
This. I will attempt in my next paper on the Meaning of
Initial Depression in Acute Disease,

\ Brookley, S.B.

A RARE CONDITION OF VEINS IN THE
ANTERIOR VAGINAL WALL.

Bt H. T. RUTHERFOORD, B.A., M.B. Cantab., &c.

Mbs. A. D-, aged sixty-five years, married forty-six

years, mother of ten children, the last pregnancy occurring
twenty-six years ago; has had one miscarriage thirty years
since; menstruation ceased at forty-five years of age. The
patient presented a pale, sallow, rather cachectic appear¬
ance, reminding one somewhat of the cachexia seen in
patients suffering from malignant disease, but she stated
that she was perfectly well and of good colour until a few
days before seeing me. Her history was that she had never
suffered a day’s illness until January 10th, 1887, when she
met with an accident during the frosty weather pre¬
vailing at that 'time. As she was stepping off the pave¬
ment to cross the road she slipped and fell heavily on
the pavement. She was helped up-, and on starting to
cross the road felt something trickling down her thighs,
like water or blood. She returned home at once, and found
she was flooding severely. As this was the first appearance
of blood from the vagina for twenty years she was consider¬
ably frightened. The flooding continued for four days,
becoming profuse on coughing or attempting to walk about
her room; but she had to do a certain amount of work each
day, as she was alone in the house and had no friends to
help her. On Jan. 14th the haemorrhage ceased, but began
again on the following day, and continued off and on till
Feb. 1st, when she came to see me. Physical examination
showed there was a slight varicose condition of the labia
majors; the vagina was small, the entrance having atrophied
somewhat. Just beyond the ostium vaginae the examining
finger came upon a soft oval tumour projecting into the
vagina. The cervix was Bmall and atrophied. A small-sized
Ferguson’s speculum was passed, to ascertain if the haemor¬
rhage came from the uterus, but no blood was seen escaping
from the os uteri externum, which was quite healthy. On
gently withdrawing the speculum, the haamorrhage was ob¬
served to come from a valve-like opening in the right and
anterior part of the tumour, which was tne size of a large
walnut, havingat its anterior extremity a beak-like pro jection.
The apex of this projection was about a quarter of an inch
behind the urethral orifice. The tumour was of a dark-
bluish colour, its surface irregular and divided by many
shallow sulci, and on touch felt like a varicocele. It was,
in fact, a mass of dilated veins, projecting posteriorly into
the vagina and anteriorly into the urethra, narrowing the
lumen of that passage at one point in a slight degree. The
treatment consisted of applying the strong solution of
perchloride of iron externally over the valve-like opening,
and applying pressure to the whole tumour by means of
pledgets of cotton wool. A strong saline purge was
ordered, and absolute rest in bed enjoined. Tne patient
at the same time was instructed how to apply pledgets
of cotton wool over the tumour, the pledgets to be ap-

1182 ThkLanubt,]

CLINICAL NOTES.

[Juznc 21, MKT.

plied every day. She returned in a week, said she had
followed out my instructions as to rest and the daily
application of pledgets, with the result that for the last one
or two days she had been going about the house without
being troubled with haemorrhage. She had gained flesh and
colour, and was in every way stronger. The tumour, though
present, was certainly diminished. She has been seen by me
once or twice since, and says she feels quite Well, has had
no more haemorrhage, is doing her every day work, and does
not intend to see a doctor again unless a fresh haemorrhage
attacks her.

Remarks .—Varicose and enlarged veins in the region of
the vulva and in the vagina are of oommon enough
occurrence during pregnancy, and at times give rise to
serious haemorrhages during or after parturition; but I have
never seen, nor can I find recorded in any volume of obste¬
trics or gynaecology with which I am acquainted a similar
condition of dilated veins in a subject sixty-five years of
age, who was, as far as one could judge from examination,
perfectly healthy, and who certainly presented no other
signs of varicose veins in any other part of the body. No
tumour was found in the pelvis, either per vaginam, per
rectum, or on abdominal palpation, which might have
accounted for this varicosity, and I must confess I am at a
loss to explain its occurrence. The rupture and consequent
haemorrhage are easily accounted for by the extra pressure in
the venous system, acting on what was evidently a weak
part in the wall of the dilated vein. The sudden haemorrhage
with the almost cancerous cachexia presented by a patient of
her age, the mother of ten children, might easily have led
one to suspect malignant disease of the generative organs.

Queen Anue-»treet, W.

Clinical ftoics:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

A PROPOSED MODIFICATION OF MOORE’S TREAT¬
MENT OF ANEURYSM.

By W. E. Steavbnson, M.D. Cantab., M.R.C.P.,

KI.ECTRICIAX TO ST. BARTHOLOMEW’S HOSPITAL.

Thu papers read before the Royal Medical and Chirurgical
Society on April 12th on the Treatment of Internal
Aneurysms by the Introduction of Steel-wire into the Sac,
and the subsequent discussion thereon reported in Tin?
Lanckt of April 16th, have suggested the following modifica¬
tions and additions to the operationThat the wire used
should be soft iron wire, instead of steel, of No. 29 gauge
according to the Birmingham scale. That the introduction
should be accomplished by means of a perforated needle
fitted to a handle similar to that used for the operation of
staphyloraphy, as suggested by Mr. T. Smith. That the
wire should not, as in the latter instance, be previously
wound upon a reel or bobbin, but ehould be paid out from a
tolerably large coil or skein so as to reduce the chance of
kinking. The amount of wire to be used will vary in
accordance with the size of the aneurysm. That the perforated
needle should be a straight one made of ivory, and much
longer than those ordinarily employed for cleft palate. 1
That the needle should be introduced to such a depth that
the point would be well within the aneurysm. When
sufficient wire has been introduced, it should be cut off
near the hank or coil from which it was paid out; the
handle detached from the needle; the needle left in the
aneurysm with the end of the wire protruding from it.
That the wire should then be connected with the positive
pole of a strong galvanic battery; a sponge, or tin and'
amadou plate electrode, moistened in salt-ana-water, should
be attached to. the negative pole and placed on some
indifferent part of the body. That the circuit should be
closed, and a current of from fifteen to twenty milliamperes
passed through the aneurysm until it became consolidated,
or for thirty minutes. The pad connected with the nega¬
tive pole should be moved to different parts of the
body when found necessary, so as to avoid any parti¬
cular spot becoming blistered or sore. That at the con-

1 Meaart. Ooxeter, of Qt*fton-ctreet, hare made me mAh U needle.

elusion of the operation the re m a ini ng piece of iron wire
protruding from the needle should, if not already de¬
tached by the decomposition which had taken place in
the sac, be pushed through the perforated needle by a blunt
trocar into the anenrysm, and the small puncture hole
closed by a piece of strapping. The introduction of soft
iron wire into the sac of an aneurysm would be a gnat
additional advantage in the employment of electricity over
the usual method ot galvano-puncture. When attached to
the positive pole of a battery, coagulation would be
encouraged within the aneurysm, and the wire itself would,
undergo decomposition with the formation of chloride sod
oxide of iron, which would, in addition, exercise their ova
specific coagulating properties.

It was mentioned by Dr. Pringle in the discussion already
alluded to that the clot resulting from electrolysis is dis¬
tinctly softer than an ordinary dot. If this be so, it is 10
doubt partly due to its rapid formation, and it would no
doubt shrink and consolidate, and possibly become as firm
as any other clot when of a similar age. In the operation,
now suggested, the clot produced by electrolysis would have
a long and extensive origin, and be entangled in innumer¬
able positions by the coils of the iron wire. Another
probable reason why the coagulum formed by electrolyna
“appears very frequently not to be stable, but to'be liable
to melt down again into the blood stream,” 3 is because
needles attached to both poles, or to the negative pole, bare
been used. Around the negative pole the blood is coagulated
into a yellow friable alkaline mass, composed to a gnat
extent of gas bubbles, which very quickly breaks down.
Around the positive pole the clot is smaller, firmer, and
darker in colour, and has an acid reaction. From the
physical laws of electrolysis, and from the experience
already obtained, it would seem probable that a com¬
bination of Moore’s treatment of aneurysm with that by
galvano-puncture, as here sketched out, would offer a
very fair chance of a successful result.

Welbeck-itreet, W. _

ASPIRATION OF THE URINARY BLADDER.

By A. Wilkinson, M.D.

Having seen Mr. G. Buckston Browne’s letter in your
issue of Feb. 26th, also the report of and discussion on a
paper read by Mr. W. H. Bennett at a recent meeting of the
Medical and Chirurgical Society on a case of rupture of the
urinary bladder which terminated fatally as a direct result
of aspiration above the pubes, I am induced to send you the
notes of a case in which the bladder was aspirated by this
method sixty-nine times in immediate succession by myaelf
and assistant alternately.

The patient, a large fat man, aged sixty-seven, had been
an invalid three years owing to bfain mischief, and during
that time was gradually getting worse. His intellect waaeofar
impaired that none of his statements could be credited, but.
as far as could be ascertained, he had had some difficulty in
micturition, but no actual retention till 8ept. 3rd, 18S5, the
date of my first visit. The history, condition, and sym-

toms — aphasia and paresis — pointed to cerebro-spinal

isease; but an enlarged prostate, fully the size of a tennis-
ball, undergoing some active change, probably inflammatory,
was the immediate cause of thb retention. The bladder to
greatly distended, and the urethral passage narrow, tortuous,
and painful. With considerable difficulty a No. 5 gum-
elastic catheter was passed, and about thirty ounces of unne
drawn off. This was repeated on the 4th and again on the
5th, but from the latter date to Oct. I6tb, as no catheter
could be passed, supra-pubic aspiration was resorted to.
sometimes once a day, more often twice. The punctures
were made with a fine needle corresponding in size to No. ly
wire. The natural route to the bladder was still occluded,
and aspiration having been performed fifty-four times, on
Oct. 16th 1 punctured above the pubes with Pearce’s troar
and cannula with the view to establish a permanent outlet.
The cannula was tied in, but owing to the patient’s inter-
ference, he twice pulling it out, that course was abandonee-
The aspirator was again brought into use, and continued
until tne 25th, when I succeeded in passing a No. 3 soft
catheter, to which an exhaustor was attach ed, and t he

* See Mr. Timothy Holmes’ Lectures on the Surgical Tr*atm«l ^
Aneurysm. (The Lahczt, Shpt. 7th, 18W, p. SM).

TUB LANOet,]

HOSPITAL MEDICINE AND SURGERY.

[Juw 11,1887. U83.

urine -drawn off. Tbe catheter wm tied in, but removed
by the patient in his demented condition. On the morning
of the 27th about a teaspoonful of pus suddenly gushed
from the urethra, and on passing the- catheter about
four ounces came through it, fairly conclusive that
prostatic absoess had been the cause of the retention.
Oatheters gradually increasing in size were passed from day
to day, until No. 10 could be easily introduced even by the
patient’s attendant. In this case tbe urinary bludder was
aspirated above tbe pubes sixty-nine times in succession.
All the punctures were made within an area about the size
•f a crown-piece, the most recent being as far removed as pos¬
sible from the previous one. Small subcutaneous shot-like
indurations followed the punctures, but soon disappeared,
leaving no ill effects. The urine, which at no time con¬
tained sugar, after three or four aspirations became exces¬
sively large in quantity, being secreted at the rate of five
-ounces an hour, often more, and subsided to its normal
-amount when the aspirations were discontinued. The
^patient residing at a distance of nearly four miles, and the
nrine being so large in quantity, over-distension was not an
-unfreqnent occurrence, bnt notwithstanding this unfavour¬
able circumstance the bladder maintained its own fairly well
throughout, the urine only becoming slightly turbid toward
the last. The patient so far recovered that his attendant was
enabled to relieve him by a soft catheter when necessary.

Shaftesbury, Dorset. _____

A REMARKABLE CASE OF FIBROMA MOLLUSCl’M.

By Francis W. Clark, L.R.C.P., M.R.C.S,

Thk following notes of a case of fibroma molluscum will,
1 think, be of interest from the exceptional rarity of certain
of the features presented by it.

The patient, a man aged seventy, is covered from head to
foot with a number of subcutaneous tumours of various sizes,
-some of them being pedunculated, while others are sessile.
These tumours are of very soft consistence, and there is an
entire absence of that lobulation which iB so characteristic
•of subcutaneous fatty tumours. The largest of these tumours
is one which forms a complete anklet around the left ankle.
One of the smaller pedunculated growths was removed
for further examination, and on section it was found to
-consist of a gelatinous translucent material, which under the
microscope was seen to be composed of a very fine reticulum
•of fibrous tissue, containing in its meshes a transparent
.gelatinous material -myxo-nbroma. The patient dates the
onset of this condition from a fright he received thirty years
ago, when he happened to be a spectator of a severe railway
accident. He states that since that time these tnmonrs have
gradually appeared, most of them developing daring the
£ rst twelve months subsequently to the fright. It is a curious
feature in the case that the patient’s daughter, who was bom
«ome twelve months after the appearance of the tumours,
is also covered with similar growths, though thev are less
numerous. The case was shown for me by my friend, Dr.
J. Kingston Fowler, at the Clinical Society of London in
February last, and was then considered to be unique.

Croydon Infirmary. _

DISLOCATION FORWARDS OF THE HAND. *

By Charlks Aitkkn, M.B.

The following report of a dislocation of rare occurrence
may be of interest:—

In July last W -, a boy aged sixteen, was brought to

my surgery with the history that he was sent up a tree to
fasten a rope to one of its branches, so that it could be
puUed down in a certain direction. While the boy was
among the branches his master cut away at the stem, and
the boy fell. He was not sensible for a few minutes after
falling, and on becoming conscious thought that his arm
was broken. Neither dia he remember whether he fell with
the p&lmar or dorsal aspect of his hand facing the ground.
On examining him, I found that he had a dislocation forwards
of the right hand on the arm and almost compound on the
palmar aspect. The ends of the radius and ulna could be
felt distinctly on the back, and there was a rounded swelling
on the front. On pulling the hand away from the arm the
dislocation was reduced with a loud snap. There was some
awelliDg for three months over the carpal bones in front,

but that has entirely disappeared and the boy's arm is now
as well as usual. On referring to the surgical dictionary by
Heath, and to Holmes’ and Hulke’s Surgery, I see it is men¬
tioned that the above dislocation is a very rare one indeed.

St. Mawe*. Cornwall. ______

ABSENCE OF THE OCCIPITAL BONE AND SKIN IN A
NEWLY-BORN INFANT.

By William Fbasbb, M.B. T.C.D.

I recently came across a curiosity which will no doubt
be of some interest. Among the books at my command
(including Dr. Neale’s u Digest,” Sydenham Society, 1877), I
cannot find any mention of a similar case.

About 3 a.m. on Nov. 20th I was asked to go to Mrs. W-,

living about eight miles away, who was in labour with her
third child. On my arrival there was a mysterious silence
and glances which betokened that the baby was stillborn,
but the afterbirth was retained. Having seen to the mother,
I turned to the child, and the mystery was then explained.
I found a female infant of about seven months and a half
(though the mother says she did not expect to be confined
until the end of December). The body was fairly nourished
and well formed, the head flattened in its antero-posterior
diameter, the eyes large and protruding; a black mass on
the back of the skull proved to be the cerebellum exposed tc
view, with complete absence of the occipital bone and the
skin covering it. On loosening the cerebellum and lifting it
up I could see the base of the skull, and was able to push a
piece of wood down tbe spinal canal. No cause could be
assigned by way of fright or anything else.

Ashburton, Devon.

% lltirror

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Nollaaotem e*t alia pro oerto noacendi via, nlti quamplurlma* et mor-
borura et diuectlonum hUtorlaa, turn allorum turn propria* oolleotaa
habere, et Inter *e oomparare.—MoBoaeiri Dt Sed. it Caul. Morb.,
lib. Iv. Procemlum. -

MIDDLESEX HOSPITAL.

CASKS OF SARCOMA IN CONNEXION WITH KNEE, FOOT, AND
EAR; RESULT.

(Under the care of Mr. Hulke.)

The cases of sarcoma reported in our impression of
May 28th (p. 108G) illustrated the occurrence of this form
of new growth in young adult life, evincing in its progress
clinical features as malignant as those exhibited by any
carcinoma. The first case of the present series exemplifies
the same facts; it illustrates local recurrence after excision,
and infection of remotely situated viscera manifesting itself
at a date long after amputation of the limb. But this case has
an additional interest in the illusory resemblance presented by
the primary tumour in its clinical characters, in its apparent
seat and connexions, and in its naked-eye appearances after
removal to a mnltilocular ganglion. The deception was occa¬
sioned by tbe presence of the myxomatous elements, which
simulated the structureless colloid contents of a common
ganglion. The second case illustrates the occurrence of
melanotic sarcoma in middle life in a form which, as regards
the primary tumour, deceptively resembled epithelioma, and
which led to its being mistaken for this--a mistake not
unlikely to occur where the melanotic constituent exists in
a minimum qn&ntity in the original tumour, and only
attains considerable development in the larger secondary
masses, a by no means uncommon circumstance. The
frequent development of melanosis in moles is too well
known to need more than passing mention. The sole and
the clefts between the toes would seem to be tbe favourite
situations for this form of sarcoma, possibly because in these
situations any little, apparently trivial, tegumental disorder
is more exposed to pressures and to other kinds of local
irritation. The third case is an instance of melanotic
sarcoma occurring at an unusually early age, and in a very

.oogfe

Diqiti:

1184 The Lancet,]

HOSPITAL MEDICINE AND StJRGERY.

[June 11,1887.

unusual situation. Here also the tendency to rapid local
recurrence was very strongly pronounced. It is to be
regretted that the entire auricle was not in the first instance
excised, but the mutilation thus involved was regarded by
the patient as so likely to prevent his continuing to obtain
employment in his ceiling that he was averse from enter¬
taining the recommendation to submit to it.

Case 4. Myxosarcoma; primary tumour simulating
multilocular ,ganglion; recurrence in liver after excision;
amputation; death from recurrence in lungs about four years
and a half after the first operation. —A milliner, aged eighteen,
a blonde, apparently in the enjoyment of excellent health,
was admitted into Regent ward on Jan. 13th, 1880, for a
swelling of the left knee joint, latterly accompanied with so
much pain as to render walking very difficult. The swelling
was about the size of a pigeons egg; it was firm, yet some¬
what elastic; its consistence suggested that it might be a
very tightly distended cyst. When the leg was extended,
the swelling seemed fixed to the femur just above and
slightly behind the extomal condyle; but when the leg was
flexed a distinct mobility of the swelling upon the femur
was recognisable. It was in close relation to the tendon of
the biceps muscle, which passed behind and internal to it.
The patient stated that about four years previously she first
began to suffer pain in the knee, which was regarded as
rheumatic; the pain gradually increased, and this latterly
to such an extent that the limb was nearly disabled. The
swelling was first noticed about one year before she entered
the hospital. The diagnosis was a ganglion connected with
the bicipital sheath, tightly distended. A few days later the
swelling was exposed and dissected out. Its rough characters
were those of multilocular cyst, the spaces of which were
filled by a jelly-like substance. The wound healed well,
and the patient went home on Feb. 26th.

On Aug. 26th, 1881, being about nineteen months after the
first operation, the patient again sought admission into the
hospital. A note of her condition at this time states that
there was at the outer and posterior aspect of thekneeasub-

f lobular nodular swelling, three inches in diameter, crossed
y the scar of the former operation. Its consistence was
not uniform, being mostly firm, but in some situations so
soft and elastic as to occasion the idea cf fluctuation. The
mass was plainly now attached to the femur. The patient
was unable to fix the date of the reappearance of the tumour,
but she thought that it was not very long after she left the
hospital. She attached so little importance to it that it did
not deter her from marrying. Amputation was proposed
by Mr. A. Clark, then in charge of Mr. Ilulke’s ward, but it
was declined by the patient, who left the hospital.

On Nov. 4th following the patient returned, looking thin,
anxious, and worn. The tumour had in the interim con¬
siderably increased. The limb was removed by a circular
amputation at the middle of the thigh. The femoral artery
was secured by torsion. The stump suppurated and healed
slowly, so that she did not leave her bed until Jan. 4th, 1882.
At the middle of the month she was allowed to return home,
having gained flesh, and feeling stronger and looking much
better than before the amputation. The tumour proved to
be a myxo-sarcoma, springing apparently from the perios¬
teum of the outer condyle of the femur. The preparation
is preserved in the Middlesex Hospital museum, No. 644,
catalogue.

The patient was not seen again until the autumn of 1885,
when she entered a medical ward for intense dyspnoea,
under the care of Dr. Cayley, who referred it to sarcomatous
infiltration of lung.

Death occurred suddenly. At the necropsy, Dr. Fowler
found the upper lobe of right lung compressed by a sarco¬
matous mass, a portion of which intruded into the right
bronchus. From this a detached nodule of the size of a
walnut had escaped into the trachea and caused suffocation.
The middle lobe of the right and the lower lobe of the left
lung each contained a small knob of tumour. Its histology
was that of spindle-cell sarcoma.

Case 6. Melanotic sarcoma; primary tumour in the sole
of the foot, simulating epithelioma ; recurrence after eircision,

and wide dissemination of secondary tumours. —E. W-,

aged fifty-four, an extremely fat woman, was admitted into
the Regent ward on June 26th, 1880. In the middle of
the sole of her right foot was an ulcer of the size of a
shilling. Its edges were abrupt, raised and slightly
averted, and its base was, warty* Waa trader and p&in-
fpl, aofLpteraited hej watog,., Stojjtatel, % tort
had begun about one year previously In a Small mole Which

she picked because it itched. The circular outline of the
ulcer was not unlike that of a perforating nicer, bat its
situation was in the hollow of the sole, and not is a part
subjected to pressure, as the balls of the toes or heel, situa¬
tions for which perforating ulcer would appear t» exerrias
a selection. The edges of the ulcer were everted and not
undercut, and the base was warty, both of which eireum-
stances were unfavourable to the supposition of its bring a
perforating ulcer. The absence of all symptoms of tabes
dorsalis, with which malady perforating ulcer so fre¬
quently concurs, was also against this view of its nature.
The probabilities were considered to be in favour of its
being an epithelioma. On June 30th it was very freely
excised. Cicatrisation proceeded very slowly. This was
attributed firstly to the little extensibility of the tegument
in the sole. On July 27th, the wound having almost closed,
and appearing healthy, she was allowed to return home. A
few weeks later, when she next presented herself at tbs
hospital, there was evidently a renewal of the growth st
the seat of the operation, and now, first, enlargement of the
inguinal and also of the lymph glands along the course of
the external iliac vessels was deteoted. This extenrire
glandular implication barred further operative measures.
She was seen at intervals in the course of 1881-84; is the
latter year she died. Large tumour masses appeared is
the leg and thigh, upon the right shoulder, and in the
neck. They were bossy and elevated, and imparted to the
attenuated skin covering them the bluish-black appearance
characteristic of melanosis.

Case 6. Melanotic sarcoma of auricle; excision; re¬
currence : second operation ; recurrence. — A footman,
aged twenty-three years, was admitted into the hospital on
March 2nd, 1883. In the lobe of the left auricle and on the
posterior border of the helix, at its lower end, he had two
small rounded swellings of a violet-bluish colour, overrun,
with dilated capillary bloodvessels. The upper of the two
swellings was of th? size of a small grape; the lower was
slightly larger. They were not tender or painful, tfo
enlargement of the cervical lymph glands or other swellings
were discoverable. He said that the upper swelling had
been first observed about five years previously, being then
as large as a “ pea.” He had noticed the existence of the
lower swelling about one year. The appearance of the
upper swelling wa3 slightly suggestive of hasmatoma, but
this is commonly an incident in perichondritis of traumatic
origin, being of not very infrequent occurrence in pugilists.
Here, however, there were not anv circumstances pointing
to injuries of the external ear, and there was an absence of
tenderness and of heat; besides, hfcmatomata are limited to
the cartilaginous part of the auricle, and here the lower
swelling was seated on the lobe. The diagnosis of hrematmna
was also rebutted by the duration for five years from the
first appearance of the upper swelling. The appearance of
the swellings was very suggestive of melanotic sarcoma, but
the duration threw doubt on this supposition, and tbe in¬
frequency of such new growths in the auricle, and the
patient’s age, tended to confirm this doubt. He would not
permit more than the least possible mutilation of the ear
consistent with the removal of the swellings. These were
therefore excised. Their naked-eye appearances and histo¬
logy were those of melanotic sarcoma. - On March 10th he
returned home with the wound apparently soundly healed.
In the following August he returned with & recurrence of
the melanosis in the scar and in the neck. Mr. Lyell, then
in charge of Mr. Hulke’s wards, freely excised the masses in
the ear and neck. The wounds healed, bat before long such
extensive recurrence occurred in the neck as placed the
patient beyond further surgical aid.

HERTFORD GENERAL INFIRMARY.

A CASE OP HYPERTROPHY OP THE 8PIiE*N; DEATH;

NECROPSY.

(From notes by Mr. H. G. Shore, House-Surgeon.)

E. T-, aged twenty-eight, married, came to the out-*

patient room on April 4th, having walked two miles and a
half. She was evidently suffering great pain, and was con¬
siderably exhausted, so she was sent into the ward at cm*.
when her temperature was found to be lO^S 0 . Tbe patien*
has had five children, the youngest two years and thus
months old. Catamenia normal. She says *he baa hiria
tumour in the abdomen since 1 la* August, but bar trjra"
say she has been looking ill for two years. 8b*Mr*»**

THB LaNCBT,]

OBSTETRICAL SOCIETY OF LONDON.

[Junk 11,1887. 1186

pain during the last fortnight, bat has not consulted any
doctor. She says the tumour was first noticed just above
the left anterior superior spine of the ilium, and has been
getting larger for the last four or five months. There was
no hietory of malignant disease, of syphilis, or ague (?).
Urine : sp. gr. 1020; acid; no albumen.

On examination, a tumour was found occupying the whole
of the left side of the abdomen, with a well-defined inner
and lower edge, it being just possible to get one’s fingers
between the lower margin and the ilium. Percussion did
not give an absolutely dull note. The tumour felt hard, and
extended right back into the lumbar region. The patient
was in considerable pain, which was, however, relieved by
hot fomentations with laudanum sprinkled thereon.

April 5th.—The patient slept about six hours after the
hypodermic injection of morphia (gr. $), and atropine
(gr. riv)- Temperature 104 2°. Systolic murmur audible
at the base of the heart. Nothing remarkable about the
lungs, excepting loud breathing over the right back. Uterus
normal.

0th.—Temperature 103°. The pain still continues, but is
relieved by laudanum fomentations and by an anodyne
mixture containing fifteen minims of tincture of opium.
Urine: sp. gr. 1020, albuminous, and contained pus and
blood. Faces dysenteric in character, and apparently con¬
tained pas. Farinaceous diet ordered, with beef-tea, soda-
water, and brandy (two ounces). There was some difficulty in
obtaining the urine, and poseibly the specimen was not pure.

8 th.—The patient seemed somewhat better yesterday, was
in less pain, and the temperature 102°; but this morning she
is in great pain, temperature 103-8°, lips purple, and appa¬
rently some interference with circulation. An exploratory
puncture was made, and two ounces of sanious serum drawn
off by means of the aspirator.

9th.—In less pain; tongue not so furred; tempera¬
ture 102° ; pulse 120, soft, or fair volume.

10th.—Tongue dry; sordes about teeth; very exhausted;
pulse 124, not feeble. Exhaustion shows itself principally
in shallow respiration, &c. Veins of right iliac region very
distinctly visible. Less peritoneal distension. Wound of
uncture healed; tumour unaltered iu appearance. Noon:
he patient became cyanosed. A subcutaneous injection of
ether (twenty minims), to be repeated in an hour, was
administered. Took nourishment well, but died at 5 p.m.

Necropsy. —Thoracic viscera perfectly normal, with the
exception of rather an excess of fluid in the pericardium.
On opening the abdominal cavity, an enormous spleen was
found filling up the whole of the left side from the
diaphragm to the iliac region; it appeared perfectly normal,
except that the capsule at the posterior border, about the
centre, showed signs of inflammation; on section, the organ
was quite natural in appearance. Weight of spleen 5* lb.
The liver was greatly enlarged and fatty; kidneys normal, but
left ureter distended; bladder and uterus normal. There
was evidence of enteritis, but to no very marked extent.

The enormous size of the spleen is so remarkable as to
justify the case being published. Unfortunately, the acute
pain and high temperature prevented any large operative
measures being attempted.

STAMFORD, RUTLAND, AND GENERAL
INFIRMARY.

CALCULUS VB8IC.E ; SUPRAPUBIC OPERATION; HEATH ;

NECROPSY.

(Under the care of Mr. Greenwood.)

N. R-.male, aged four years and & half, a well-nourished,

healthy-looking child, was admitted with the following
history. The symptoms of calculus had been noticed for
six months, and had been worse for the last two months.
No blood had been seen in the urine and no albumen was
found, but considerable phosphatic and mucous deposit.
There waa no phimosis, but the prepuce was adherent to the
glans to some extent. On sounding, the instrument struck
and passed over a calculus lying to the right side, and the
impression was that it was a large one.

On Oct. 18tb, 1886, under the influence of ether and
chloroform, an elastic bag was passed into the rectum and
partially distended; but the bag seemed rather too large for
this case. A gum-elastic catheter was passed, and three
ounces of boracic acid lotion injected into the bladder. The
catheter was withdrawn, and an elastic cord tied around

the root of the penis. The rectal and vesical distension
were not sufficient to throw the outline of the bladder into
prominence. The abdomen was opened in the mid-line by
an incision two inches long upwards from the symphysis
pubis, it was not easy to feel the bladder at first, as it
eluded the Anger, falling over to the right side. Two silk
sutures were passed through the bladder wall, and between
these the bladder was opened. The stone was then felt
lying transversely in the bladder, which was contracted on
it, the fluid contents having escaped. The position of the
stone was changed with the nail of the forefinger, and then
it was extracted with fine lithotomy forceps. The atone,
which was flattened and oval in shape, weighed 3 drs. 6 grs.
A drainage tube the size of a No. 8 catheter, with two aide
openings at the lower end only, was introduced for two
inches and fixed in place to the abdominal wall by two horse¬
hair sutures; it extended for six inches outside the abdo¬
minal wound. No sutures were placed in the bladder. Deep
catgut sutures and superficial silver ones were used for the
upper part of the wound. The dressing was iodoform and
Gamgee’s cotton-wool tissue, through which the drainage
tube passed. The child was placed on his left side in bed,
and urine began to drain through the tube in half an hour
without a stain of blood. The dressings were renewed every
morning, and urine continued to drain off through the tube
until the fourth day, when it was removed, and two hours
afterwards half an ounce of urine was passed per urethram.

Oct. 31st (thirteenth day).—Has been kept on milk diet,
and at no time has there been any rise of temperature.
About half the urine passed per urethram (an ounce at a
time), the rest per abdominal wound, which is granulating
from the bottom and looking well.

Nov. 4th (seventeenth day).—Yesterday evening he was
sick after taking some milk, but no rise of temperature was
noticed, and no change in the local conditions, hut at 7 a.m.
to-day he became collapsed and died in twenty minutes.

At the post-mortem examination the bladder wound was
united, except at one point admitting a fine silver probe.
Bladder contracted, with half an ounce of urine in it, and
with hypertrophied walls. No escape from the wound into
the abdomen could be detected, and the kidneys were
healthy.

What was the cause of death ? The child was quite well
up to the attack of sickness.

U tokal Soci eties.

OBSTETRICAL SOCIETY OF LONDON.

A meeting of this Society was held on Wednesday,
June 1st, Dr. John Williams, President, in the chair.

It was unanimously agreed that an address should be pre¬
sented from the Society to Her Majesty the Queen on the
occasion of the completion of the fiftieth year of her reign.

Microscopic Sections of a Human Embryo. —Mr. Lock-
wood exhibited a series of sections showing absence of
spinal medulla with arrest of the development of the spinal
column and retroflexion of the lower limbs. The embryo
was eight millimetres loDg, and had reached about the sixth
week of intra-uterine life.

Foetal Membranes were shown by Dr. Bluett in which
two tumours were found. The labour had been natural and.
delivery took place at full term.

Spontaneous Gangrene of Cervix Uteri and Base of
Bladder.— The parts were shown by Dr. Herman, who said
they bad sloughed away spontaneously from a woman who
had not been pregnant for eight years.

Hydatids from the Mesentery were exhibited by Dr.
Malins; a Fibroid of the Ovary by Dr. John Williams; a
Fibro-cyst and a Solid Fibroma of the Ovary by Mr. Mere¬
dith ; and a Fibroma of doubtful origin by Mr. Malcolm.
These four tumours and Dr. Bluett’s specimen were referred
to a committee.—A Sloughing Fibroid Polypus was shown
by Dr. W. Duncan.

Ctesarean Section .—Dr. C. J. Cullingworth gave an ac¬
count of this case. A rachitic dwarf, aged thirty, 4ft. 2 in-
in height, was sent at full time to the author. The pelvis
was generally contracted and flat, the estimated conjugate
vera being two inches and a quarter. The child was alive.
There was great albuminuria, with oedema of the abdominal

Digitized bTCbogTe

1186 The Lancet,]

ANATOMICAL SOCIETY.

[June 11,1887.

wall, labia, and lege. Labour began spontaneously, and
when the 03 uteri was as large as a florin Caesarean section
was performed with full antiseptic precautions. The child
weighed 61b. 9oz., and was extracted by one leg; it was
partially asphyxiated but soon recovered. After clearing
the uterus of the placenta and membranes, its lower segment
was constricted by an elastic ligature. The loss of blood
was trifling. The uterine wall was united by four deep silk
sutures, and the peritoneal edges by six finer superficial silk
sutures. The patient died twenty-nine hours after opera¬
tion, the temperature remaining under 100° F. until two
or three hours before death, when it rose to 100'8 o F.,
pulse 140. At the post-mortem there was no sufficient cause
of death found except acute parenchymatous nephritis.—
The President wished to know if the kidneys and urine
had been examined microscopically, arid the quantity of
urine passed after delivery. The low temperature was
characteristic of urasmia, and he thought there was fear of
carbolic poisoning where the kidneys were badly diseased.
—Dr. Horrocks thought death was probably due to shock,
and that the elastic ligature compressing the plexuses of
nerves as they enter the uteruB would increase this.—Dr. J.
Phillips asked by what sign the seat of the placenta was
determined, and why the uterus had been brought outside
the abdomen before extracting the child?—Dr. W. Duncan
considered that it was better to place the elastic ligature
around the cervix before opening the uterus.—Dr. Lewrbs j
thought that, although improved results in Cesarean
section had been reported from abroad, such success had
not been met with in this country, and he preferred the
old rule of delivery, when possible, per vias naturalcs.
In the case under discussion this was possible.—
Mr. Meredith though that the Porro operation might
have been preferred with a view to ensuring against
the possibility of a future pregnancy.—Dr. AIatihews
Duncan said that neither he nor perhaps anyone in this
country had large experience of Cfesarean section, and that
it was to Germany that we must look for the guidance of
experience and such wonderful success as that of Sauger,
Leopold, Cred4, and Gusserow. It was such success alone
that should and would lead us in the great practical ques¬
tion, and their cases showed at present a less mortality with
Caesarean section than with Porro’s operation. Both opera¬
tions had a place in obstetric surgery, and he thought
Dr. Cullingworth had rightly selected Csesarean section;
while in the case to whifch Mr. Meredith had alluded,
as there were several large fibroids, Sir Spencer Wells
had wisely selected Porro’s operation. No amount of
eloquence about the abolition of craniotomy would
help forward that much-to-be-desired resulr. There
had been much of such talk. Nothing but success in
som9 alternative operation would do the least good.—Dr.
Matthews Duncan approved of the course adopted by
Dr. Cullingworth, and thought the renal disease was pro¬
bably the chief cause of death.- Dr. Ciiampnets said that
the seat of the placenta could not be diagnosed by uterine
souffle, and that often there was no sound at the seat of
implantation, while it could be heard after the removal of !
the placenta, and in cases where there was no placenta, as
in fibroid tumours. It could not be too strongly urged that
the uterine souffle was no guide whatever to the placental
site. He thought the tracing was typical of a generally
contracted flat pelvis, and that, although four or five years ago
Caesarean section would not have been justified, improved
methods and antiseptics rendered it the proper practice as an
operation of election.—Dr Cullingworth replied.

On the Mechanism of the Third Stage of Labour: the
Separation and Expulsion of the Me?nbra7tes. —Dr. F. II.
Champneys reviewed the literature of the subject, and the
various views expressed. These amount to four: (1) the
peelingoff of the membranes by the traction of the descending
placenta; (2) separation by effusion of blood; (8) wrinkling
of the membranes by uterine contraction and retraction ;
(4) separation of the lower pole of the ovum by retraction
of the lower uterine segment. The author dismissed No. 2
on the ground that the quantity of blood lost in an ordinary
labour is too small to produce this result, and that, with the
usual excentric implantation of the placenta, this mechanism
would fail of its purpose. He criticised the expression
“weight of the placenta,” as having influence on the mecha¬
nism in the recumbent attitude, and also the expression
“ leaving (the process) to nature,” as applied to its course in
the recumbent, attitude. He explained the natural process
as follows ; (1) Separation of the lower pole of the ovum by

retraction of the lower uterine segment during the
“premonitory” stage of labour. This requires a coa-
plete “ bag of waters.” (2) Wrinkling and partial separa¬
tion of the membranes by diminution of the internal
surface of the uterus. This requires some escape of the
waters. (3) Peeling off of the membranes by the traction of
the descending placenta. This requires the evacuation of
the uterus. The rupture of the membranes at the proper
time is an integral part of the normal process. The first
stage in the process seems calculated to prevent a very com¬
mon defect—viz., the adhesion of the membranes round the
lower uterine segment.

Tubo-ovarian Cysts — Dr. W. S. A. Griffith, in a paper
on this subject, referred to the scanty literature of the
subject, and gave an abstract of all recorded cases obtained,
numbering nineteen. The literature of tbe subject is com¬
prised in the original papers by Adolphe Richard, and is
recent ones by Olshausen and Burnier. The specimens were
divided into two groups, a small group of four in which the
ovarian portion of the cyst is multilocular, the tube com¬
municating with one loculus, and a group of eighteen is
which the cyst is unilogular. The question of uniloculsr
cysts of the ovary was discussed, and these were identified
with tbe larger unilocular cysts described by Olshauses
Tbe subject of the formation of tubo-ovarian cysts was sub¬
divided, and received the following answersThat the
dilatation of the tube, and the formation of the ovarian
cyst, are usually secondary and not primary factors in the
formation of tubo-ovarian cysts. That the application of
tbe tube to the ovary is physiological or possibly accidental.
That the permanent adhesion of tbe two is effected by ad¬
hesive inflammation. That the communication between the
two is generally either a primary occurrence or takes place
at a very early period in the formation of the cyst.

The discussion of these two papers was deferred till tbe
next meeting.

ANATOMICAL SOCIETY.

A meeting of the above Society was held on the6thinit,
when the following propositions of the committee were
adopted:—“ That notices than four meetings be held in each
year. That the officers of the Society shall consist of a
president, three vice-presidents, a treasurer, a council of
twenty, and three secretaries. That the officers be elected
by ballot at each annual meeting. That as far as possible,
in the election of president and vice-presidents, there shall
be two representatives of England, and one each from Scot¬
land and Ireland. That there shall be a secretary for
England, one for Scotland, and one for Ireland. That the
Council shall, from amongst their number, select six mem¬
bers to form, together with the president, vice-presidents,
treasurer, and secretaries, a committee of management.’

It was announced that the next meeting would bebeMon
July 7th, at which papers would be read by Professor
MacAlister, F.R S, Dr. Brooks, and J. Bland Sutton; and
specimens &c. exhibited by R. J. Godlee, Dr. Brucs CJaAe,
James Berry, and Dr. W. J. Collins.

The following is a list of the officers elected President:
George Murray Humphry, F.R.8. Vice-President*: J-
Strutbers, M.D.; John Woo$, F.R.S; and Daniel John
Cunningham, M.D. Treasurer: Charles Stewart. Secre¬
taries: C. B. Lockwood (England); David Hepburn, M.D.
(Scotland); and William Thornley Stoker, M.D. (Ire¬
land). Council: William Mitcbell Banks, John Camow,
M.D., J. N. C. D&vies-Colley, Edward Bellamy, Frank
Beddard, John Cleland, M.D., G. B. Howes, John Langton,
Henry Morris, Edmund Owen, Thomas Pickering Pick.
Johnson Symington, Robert Reid, M.D., George D. Thane.
Sir William Turner, F.R.S., Frederick Treves. Alexander
Macalister, F.R.S., Bertram Windle, Alfred H. Young, »nd
Arthur Thomson.

LEEDS AND WEST RIDING MEDI00-
CHIRURGICAL SOCIETY.

At the ordinary meeting held on May 6th,' Dr. S. C. Smith-
President, in the chair, the following papers were read
Diphtheritic (?) Slough of Vagina. —Dr. BLACK
to the case of a girl suffering from feverish
slight swelling of the neck. Nothing else yeas cwnpm®* 0

Thh Lancet,}

BSVIEWS AND NOTICES OF BOOKS.

[Jonb 11,1887. 1187

of but a slight itching of the genitals. Examination showed
an acute gangrenous condition of the vulva, with ashy
sloughs, resembling a diphtheritic inflammation. Later there
were suppurating gianda in the axilla covered with slough,
and the gums were red and spongy. Under general medicinal
treatment and the local application of iodoform recovery
took place. There was no subsequent paralysis. No history of
infection could be made out. The theory of diphtheria was
put forward as a possible hypothesis.—Dr. Churton related
a case where there was extensive sloughing of black colour
in the soft palate of a man, causing death from hemorrhage.
No kind ot infection could be discovered.—Dr. Cameron
thought the case could hardly be diphtheritic, from the
character of the ulceration and the fact that diphtheria was
seldom solitary.

Fracture of Thigh in a case of Paraplegia. —Dr. Black
described a case where a man who bad been paraplegic for
thirty years, from an accident to bis back when a boy,
fractured his thigh. It was set without pain or spasm, and
healing was rapid and complete.—Dr. 8. C. Ssiitit had seen
a similar case, healing with good results.—Dr. Cameron
had seen a fracture of the thigh in a case of locomotor ataxy,
which was rapidly fatal.

On the convenience of estimating the amount of Urine
voided by its Weight— Dr. Spottiswoode Cameron spoke
of the difficulty in private practice of obtaining exact
measurements of urine passed, owing to the absence in most
houses of measures less than half a pint. Weights, however,
down to half an ounce, were always at hand, and it was
easier for a patient to weigh the urine than to measure it.
To simplify the calculation required, the following method
was accurate enough for ordinary amounts of urine: write
down the weight of the urine in ounces and decimals;
multiply this number by the last two figures of the specific
gravity, placing the product beneath and three places to
the right; the difference is the bulk of the urine in fluid
ounces.—Dr. 8. C. Smith said people had an objection to
using ordinary measures for urine, and this plan was free
from objection.—Dr. Griffiths spoke of the necessity in
estimating the urine passed of beginning with an empty
bladder, the first morning’s urine being disregarded, and
measurement being begun from that time; this was the
plan now adopted in the infirmary.

Emmett's Operation. —Dr. Braithwaitb described four¬
teen cases in which this operation had been performed. As
operations, eleven were successful, two imperfect, and one
a failure ; but as relieving the symptoms complained of by
the patients, six were successful, four unsuccessful, and two
were complicated with other affections, which rendered the
result difficult to estimate. The lacerations generally
occurred in multipart, and the symptoms varied according
to the amount of cicatricial tissue in the angle of the
wound.

Therapeutic Memoranda: Ergotine; Hgdriodate of
Hyoscinc. —Dr. Allan spoke highly of ergotine in the treat¬
ment of cough, whether phthisical or bronchitic. Given in a
nightly draught in doses of form ten to twenty grains, it was
sate, and seemed to greatly relieve cough and promote ex¬
pectoration, without any disadvantages, in children be gave
from four to six grains. lie had tried also sclerotic acid in
doses of from one to two grains, lie recommended also
hydriodate of hyoscine as a cerebral sedative where morphia
or chloral was unsuitable, giving one-hundredth of a grain
subcutaneously as an average dose. He had found it
very useful in delirium tremens.—Mr. Oaklry preferred
the hypodermic use of ergotine, and samples varied
greatly. He never used a sample for this condition until he
had tested it by its effect on the uterus in a case of mid¬
wifery.—Dr. Churton had given hyoscyamine largely, but
had eeen alarming symptoms when the respiratory centre
had been weakened, as in cases of pneumonia.—In reply to
queries, Dr. Allan said he had found ergotine of most use
when the cough was violent and persistent, but it was of
limited value in very acute cases either of bronchitis or
phthisis.

Adenoid Vegetations in the Naso-pharynx.— Dr. Bbonnbr
read a paper on the treatment of this condition. He
related the history of the discovery of these growths,
and^ showed the instruments used in their removal. He

C erred operating without any anicsthetic but cocaine, and
found Dalby’s “ steel nail ” very convenient. Several
tubes filled with the removed growths were shown, and cases
described.

Dr. J. Gibson showed the original form of Dr. Bergeen’s

apparatus for injecting gases into the rectum. He had
been using carbon disulpnide in several cases of phthisis,
and he showed a patient who had derived considerable
benefit from the treatment.

Aneurysm of Thoracic Aorta, with Asthmatic Symptoms .—
Dr. Churton showed this specimen from a man aged fifty.
Although no physical signs existed, the presence of an aneu¬
rysm bad been inferred from the fact that the attack of
dyspnoea always came on if the patient moved about
much, even in bed. The aneurysm, which was small,
sprang from the third part of the arch, and was in oontact
with the bifurcation of the trachea.

licim&js attir ftotias of |Wks.

Prelectiones Anatomies Universalis. By William Harvey.
Edited, with an Autotype reproduction of the Original, by
a Committee of the Royal College of Physicians of
London. London: J. and A. Churchill. 1886.

The restorer of scientific anatomy was Andreas Vesalius;
the inaugurator of a rational system of physiology,William
Harvey. The discovery of the circulation of the blood is
the cardinal fact which separates modern from ancient
medicine, and in this discovery both Vesalius and Harvey
took important though unequal.shares. To the former un¬
doubtedly belongs the credit of initiating that series of
observations, experiments, and reflections from which the
theory of the circulation was educed; to the latter belongs
the glory of combining them and completing them by a
scientific induction. Until the publication of Vesalius’
memorable work, “ De* Humani Corporis Fabrics,” in 1543,
the authority of Galen in anatomy and medicine had reigned
supreme for more than thirteen hundred years. It was
acknowledged by Oribaeius in the fourth century, Aetius in
the sixth, and Paulus .Egineta in the eeventh; it dominated
the Arabian physicians, both in the East and the West, for
more than half a thousand years, and it prevailed in all the
schools of Southern Europe from the twelfth century on¬
wards. Avicenna, the greatest of the Arabian physicians in
the East, and their most prolific writer, took the greater
portion of his anatomical descriptions from Galen; and
Albucasis of Cordova, the boldest surgeon of the eleventh
century, and the best, laid special stress upon the necessity
of surgeons being acquainted with anatomy as it had been
taught by Galen, ** uti illam tradidit Galenus.” Even
Mundinus, who at the beginning of the fourteenth century
publicly dissected and demonstrated the human cadaver at
Bologna, followed Galen only too closely; and the account
of anatomy given two hundred years later by John de Vigo
is mostly taken from Galen, the “ prince of physicians,” aa
De Vigo calls him.

It was Vesalius who first deliberately challenged the
authority and supremacy of Galen, and it is noteworthy that
among the errors which Vesalius detected in Galen was one
which proved the starting-point of the discovery of the
circulation. Vesalius denied the existence of the perfora¬
tions through the cardiac septum. To fully appreciate the
importance of this observation, it is necessary to call to
mind the views which had hitherto prevailed respecting the.
functions of the vascular system.

The only complete theory of these functions which has
come down to us from ancient times is that of Galen.
According to the earlier Greek anatomists the vascular
system consisted of two kinds of vessels—namely, veins
(<p\lp(s) or bloodvessels proper, and arteries (aprrjplai), the
conveyers of “air” or “spirit” (irveufia). The veins were
thought to arise from the liver and to be connected with
the right side of the heart, and the arteries to be connected
with the left side of the heart. The anatomists of the School
of Alexandria taught that the veins received from the liver
the blood, enriched by the products of digestion, and dis-

Digitized by GoOgle

1188 Thb LAJfOBT,]

REVIEWS AND NOTICES OF BOOKS.

[Jusb 11,1887.

tributed it to all parts of the body by means of the superior
&n4 inferior cavse, and to the lungs by means of the pul¬
monary artery. The arteries, on the other hand, arising, as
the aorta, from the left ventricle, were also directly con¬
nected with the bronchi by means of the ramifications of
the pulmonary vein within the lungs. By these channels
the external air drawn into the lungs by inspiration had
access to the left ventricle, being converted into pneuma in
its transit through the lungs. From the ventricle the
pneuma passed through the aorta into all the arteries of the
body. Erasistratus (fl. B.C. 300), however, held that though
in health the arteries were ftlled with pneuma only, they did
contain blood in morbid states or when divided. But Galen
showed by reasoning and experiment that arteries always
contain some blood, which is thinner, brighter, warmer, and
more spirituous than venous blood. Adopting the tenets of
the Alexand rian School, that co mm unications existed b£t ween
arteries and veins in the substance of the tissues, he argued
that an interchange took place between the contents of the
two sets of vessels, some of the pneuma of the arteries
passing into the veins and some of the blood of the veins
passing into the arteries. lie maintained, however, that
these communications were not free enough or numerous
enough to account for the great gushes of blood which
occurred whenever an artery was wounded. He assumed,
therefore, that a direct communication existed between the
right and left ventricles by means of fine perforations in
the cardiac septum. He admitted that these perforations
Were imperceptible—at all events, in the left ventricle.
Notwithstanding this, no one questioned the existence of
these hypothetical perforations, or the passage of blood
through them, for nearly fourteen centuries. Mundinus
believed in them, and so did Berengario da Carpi. But
VesaUus maintained that, although depressions were to be seen
on both sides of the cardiac septum, none of them, so far as
the senses could determine, passed through; nor could any
channels whatever be found by which the septum could be
made pervious.

A few years after Vesalius had published his description of
the structure of the heart, his ingenious but erratic contem¬
porary, Michel Servetus, hazarded a happy surmise concern¬
ing its mechanism. In a theological work—" Christianismi
Restitutio,"published in 1553—Servetus alleged that the com¬
munication between the blood in the right and left sides of
the heart did not, as generally believed, take place through
the septum, but by a circulation through the lungs. This
was the first distinct expression of the so-called pulmonary
circulation.

The discovery of the valves of veins was the next most
important contribution to the observations and arguments
that prepared the way for Harvey's crowning discovery.
Though valves had been occasionally seen in veins
by earlier observers, they were first recognised as proper
constituents of the veins by Harvey’s teacher, Fabricius
ab Aquapendente, in the year 1574, and were systema¬
tically described and figured by him in “ De Venarum
Ostiolis,” published in the year 1603. It is true that
Fabricius misinterpreted the purpose and significance of
the valves, but his descriptions greatly influenced Harvey,
who was then studying at Padua. Some years later the Hon.
Robert Boyle asked Harvey what were the things that had
induced him to think of a circulation of the blood. Harvey
answered that it was a consideration of the position and
distribution of the valves of the veins, which were so placed
as to give free passage to the blood towards the heart, but
Opposed tbe passage in a contrary way. What use Harvey
made of these and other contributory facts, and what were
the merits and characteristics of hie method, and what the
final form of his exposition of the doctrine of the Circulation,
•re sufficiently familiar to every edneat4&'haan,-bf ought to
be. The poHt of special fnttfett jtfft Ww V* that by a

happy accident we have now an opportunity of seeing the I
doctrine in its earlier and more tentative shape. |

In August, 1615, Harvey was appointed Lomleian lactam I
at the College of Physicians. The office was then held for
life. He began his first course in the month of April of the r
following year, and there have always been grounds for
supposing that he first announced his views of the circu¬
lation in that course, though he did not publish his opuuou
to the world at large till twelve years later. A small
manuscript volume, bearing the date 1616, and containing
rough notes and memoranda for his lectures, was known to
have existed, and to have been in the British Museum in
1766, when Dr. Lawrence wrote the Life of Harvey, prefixed
to the College of Physicians’ edition of Harvey’s works. Thu
manuscript, with another volume, also in Harvey’s hsnd- [
writing, formed part of the collection of Sir Hans 81oane,
which became the property of the nation in 1753. Some |
time after it had been examined by Dr. Lawrence the volume
was missing for many years. In the year 1877 it was found
among the printed books in the Museum, and was rettored
to its proper place among tbe manuscripts. In the same
year it was described in the Ilarveian Oration by Dr. (now
Sir Edward) Sieveking, who read several extracts from it,
and exhibited an autotype of one of its most important
pages. Dr. R. Willis, in his Life of Harvey, published in the
following year, referred to it and to Sir Edward Sieve-
king’s labours, and asked, “ Would it not be worthy of the
Royal College of Physicians of London to have tbe entire
volume deciphered and published ? ” This suggestion has at
length been carried out.

Sir Edward Sieveking continued his investigations, and
at his suggestion the subject was brought before the Royal
College of Physicians on March 30th, 1885. The result iathe
handsome and interesting volume whose title stands at the
head of this notice. The manuscript is, as Dr. Willis truly
said, “a jumble of Latin and English with ever-recurring
abbreviations,” and written "in a hand so cramped and
scratchy as here and there to try the beat skill 9 f tbe
decipherer.” Mr. Edward Scott of the Manuscript Depart¬
ment of tbe British Museum has, however, succeeded in
making a transcript of the whole, “ a work of great labour
owing to the extreme obscurity of many pages of Harvey s
writing.”

The volume abounds with interest, historical, bibliogra¬
phical, and personal. It gives us an insight into Harvey’s cha¬
racter ; it lets us see his method of work; it tells us the books
he read, and shows us the uses he made them serve. There
is, however, one page, the interest of which is pre-emineot.
It has already been published by Sir Edward Sierekiag in
his Harveian Oration, but as the earliest known expression
of Harvey’s views is worth repeating. Harvey has himself
marked it with the initials “ W. H.,” as indicating its origi¬
nality and its importance:—

“ W. II. Constat per fabricam cordis sangninem per
pulmones in Aortam perpetuo traneferri, as by two clacks
of a water bellows to rayse water. Constat per ligatuna
transitum sanguinis ab arteriis ad venas. Unde A perpstaum
sanguinis motum in circulo fieri pulsu cordis? An ? hoc gratia
N utritionis, an magis Conservationis sanguinis et Membrorom
per infusionem calidam viciasimque sanguis calefariens
membra frigifactum a corde calefit.’’ (Page 80.)

Sir E. Bieveking renders it:—

“ W. H. By the structure of the heart it appears that tbe
blood is continually transferred through the lungs to the
aorta—as by the two clacks of the water ram for raising
water. It is shown by ligature that there is a perpetual
motion of the blood from the arteries to veins. Whence Ait
is demonstrated that there is a perpetual motion of tbe blood
in a circle, effected by the beat of the heart. Query: I*
for the sake of nutrition, or rather for the preservation <* u»
blood and the members by the infusion of heat; th e bleed
coolod by wanning the members being warned i* tarwby
the heart?"

Here is the promise; the ■ Exerritatio anafofhidAflfr** 0

Tsoi Uukwt,]

REVIEWS—ANALYTICAL BBCOBDS.

[Jtnnrll; W8T. 1186

3 rd is et sanguinis in aaimaMbus” of the year 1628 is its
llfil meat. Well may the editors declare, “ The manuscript
t to be regarded with veneration as one of the most precious
f the archives of English science.” It is but justice to add
hat the form and style in which it is presented are creditable
3 everyone concerned in its production—to the College,
he editors, the printers, and the publishers.

Might we suggest that, as the authorities of the Royal
Allege of Physicians and of the Royal College of Burgeons
ave purchased or guaranteed the cost of two hundred copies,
; would be a useful and graceful act to present a copy to
he library of every medical school in England.

being no less an authority than Sir R. Cbristison, who
asserted from his own experience that its effect in removing
physical exhaustion is remarkable. ' >

ANTISEPTIC WALL PAPER. ;

(Sinclair A Brows, Virginia-strket, Glasgow.)

This paper is described as containing an antiseptic com¬
pound which is calculated to destroy the activity of infective
matters npon the walls of dwellings. We separated the
antiseptic, which has but little odour, and can therefore
confirm the main statement of the inventors. There ip
merit in the idea, and we hope that experience will demon¬
strate the utility of the invention.

DB MIBL’S PERFHOT HBALTH BISCUITS.

Veurectasy: the Bradshaw Lecture of I88S. By John
Marshall, F.R.S. London: Smith, Rider, and Co. 1887.

It is with much pleasure that we announce the new
idition of Mr. Marshall’s Bradshaws Lecture, to which
s appended by the author, and dated March, 1887, an
appendix, and twelve illustrations by Mr. Victor Horsley.
To the last-named gentleman medical and physiological
icienae is indebted for the discovery of the nervi ner¬
vorum. Figures 8 and 9 represent longitudinal sections
>f human nerve stained with osmic acid, drawn by Mr.
Horsley. The first figure shows a branching nervus vasis,
.mproperly described by Sappey and Krause as a nervus
nervi accompanying a small bloodvessel. The seoond figure
ihows two true nervi nervorum arising from a branch
if a primitive bundle, and running onward in the epineu-
.•ium, doubtless to end in a tactile corpuscle or sensory nerve
juding. Mr. Marshall says that Mr. Horsley “ has proved
neyond doubt the existence of sensory nervi nervorum, so
that the conjecture I offered in my lecture on the existence
of such nerves, and their relation to certain neuralgic
pains, may now be regarded as having been completely
verified.” We may give Mr. Marshall’s conclusions as
to the practice of neurectasy or nerve stretching in his
own words: “An regards its severity and its therapeutical
results, nerv« stretching, may, speaking generally, be said
to occupy an intermediate position between neurotomy and
neurectomy, being more complicated in its effects on a nerve
and more efficacious as a means of treatment than the
former, but less decided and lets radical than the latter.
This general statement justifies the opinion that, as a rule,
nerve stretching should be tried in a given case, if possible,
before neurectomy; it nevertheless demands some further

qualifications.It is not only useless, but it is dangerous,

and should be prohibited in all cases of serious central
disease, such as confirmed ataxy, myelitis, fully established
tetanus, pure epilepsy, and paralysis agitans. In reflex
forms of epilepsy, in an ascending neuritis bringing about
epileptiform seizures, in the early stages of a distinctly
traumatic tetanus, provided that in any of these cases the
peripheral source of irritation can be clearly localised and
the affected , nerve or nerves be accurately defined, nerve
stretching may be serviceable, if employed soon enough.”
In peripheral disturbances of sensibility and motility the
operation is certainly beneficial, but it appears to be less
successful in spasmodic than in sensory or purely neuralgic
peripheral disorders. _

|,naljiiral $£a>rb$.

COCA WINB. (TOR FATIQUB OF MIND OR BODY.)

(Armbrecht, Nelson, A Co.. Duke-street, Grosyenor-squark,

London.)

Thbju samples of this wine have been examined by us.
One was sparkling, and had the flavour of a fairly good
dry champagne; another was a Burgundy, and the third
a Madeira. By analysis we easily isolated the cocaine,
showing that the wine is really prepared with active leaves
of the wail-known Eryikrtxylon eooa. Various statements
of its value have been made, one of its strongest supporters

(The International Patents Association, Nicholas-luce, London;)

These biscuits are well made from genuine wheat flour.
The sample examined by us contained 6 33 per cent, ash, of
which the greater part consisted of phosphates. We failed
to find fluorine. They are very good biscuits, but we cannot
see that they present any feature of novelty.

OARNRIOK’S LIQUID PBPTONOIDS: CONCENTRATED BBBF
AND MILK. WITH GLUTEN, PERFECTLY DIGESTED.

(The Maltixe Manufacturing Company, Limited.)

This is a clear, faintly acid liquid, which mixes easily with
water. It yields a white precipitate of phosphate with
ammonia, but is unchanged by acetic acid even on boiling.
On distillation a liquid smelling like oil of doves and con¬
taining some aloohol is obtained. When evaporated a great
deal of syrupy residue is left which contains much nitrogen,
and on ignition exhales an odour like burnt bread and leaves
a white ash in which a large quantity of phosphate is found.
We consider the preparation to be a very valuable condensed
food.

CARNRIOK’8 PBPTONOIDS i WINB AND IRON. COMBINATION

WITH PYROPHOSPHATE OP IRON IN BEST SHERRY WINB.

(The Maltirb Manufacturing Company, Limited.)

The basis of this preparation resembles the last, and fc
probably identical with it. It is a clear and agreeable wine,
which mixes freely with water, is not precipitated by acetie
acid even on boiling, but yields a distinct precipitate with
ammonia. The iron is readily found by ordinary methods.
It is a very powerful and agreeable tonic and stimulant.

EAUX MINfiRALBS NATURBLLBS DB VALS: ST. JEAN.

(W. Best A 8ons, Henrietta-street.)

This is a very interesting natural water. The sample we
have examined contained 219*6 grains per gallon of solid
matter. It is an aerated water, and its chief constituents
are the bicarbonates of sodium, potassium, lithium, calcium,
and magnesium. Sulphates and chlorides are present in
small quantities, and iodfne in very notable quantity*.
All these we have found by analysis. The flavour of the
water is agreeable, but there seems to be somewhat more
organic matter than is desirable. Close attention should be
bestowed upon the surroundings of the spring for some
dark flakes were found in suspension in one sample,
which were at least unattractive.

OZONE PAPBR. (POR THB IMMBDIATB RBLTEP OP ASTHMA>,
CHRONIC BRONCHITIS, AND BRONCHITIS-ASTHMA.)

(R. Huggins, 199, Strand, London.)

These papers, in which chlorate of potassium is readily
detected, deflagrate readily when ignited, and are very con¬
venient. All our readers know how valuable the remedy is
in certain cases. We think, however, the title requires
some qualification.

SUNLIGHT SOAP.

(Liver Brothers.)

This is a good neutral soap, which gives a perfectly dear
solution with water, and yields an excellent lather in cold
water. We found no caustic alkali in it, but some glycerine,
which is an improvement. It is soft and pleasant in use.
The pamphlet which accompanies the soap contains some
excellent directions for washing in lukewarm water. If
laundresses would only follow them, they would save
themselves labour, and the goods would last much longer. .

U0 O TssLahobt,]

OVER-PRESSURE Of ELEMENTARY SCHOOLS.

[Jon* 11.180T.

THE LANCET.

LONDON: SATURDAY, JUNE 11, 1887.

Rathbr more than two years ago we urged upon the
Government the appointment of a Royal Commission to
inquire into the subject of over-pressure in elementary
schools. After a year's delay the Commission issued
direoted the Commissioners to inquire not only into over¬
pressure, but generally “into the working of the Ele¬
mentary Education Acts (England and Wales),” and the
first instalment of the report appeared last year. The
evidence then published, however, was chiefly collected from
offloial witnesses, and was directed rather to inquiries into
the working of the law and the efficiency of the existing
machinery than to the discovery of over-pressure, and of the
causes to which it might be due. On these points the public
has had to wait for the second report, which was issued only
at the end of last week. The witnesses whose evidence is
nere collected are for the most part teachers and managers
in actual and daily contact with the children of the schools,
from whom, therefore, the most important facts respecting
over-pressure might be elicited, and to whose testimony
accordingly the public will look with the liveliest interest
for information on this profoundly important subject.

Upon the preliminary question, whether over-pressure
does exist at the present moment, the opinion of the great
majority of the witnesses was unmistakably that the fact is
eo. Out of forty-two who were interrogated on the point,
twenty-six said distinctly “ Yes,” eleven said more or less
distinctly “No,” and five answered equivocally. Upon the
whole, therefore, there was a strong preponderance of
opinion in favour of the affirmative view, and in fact the
set of opinion was even more distinctly in this direction
than this mere summary analysis would indicate. For in
most cases “ No ” meant only that instances of over-pressure
had not come under the witness’s own observation, and they
do not in the least, therefore, conflict with the “Yes" of
other witnesses whose less happy experience had made them
acquainted with over-pressure, occasionally in very grievous
measure. It never, of course, has been suggested that over¬
pressure existed in every school, and it is only neces¬
sary to recall the guarded language used by Sir J.
Crichton Bbownb in 1885 to perceive that the net result
of the opinions now collected is to establish to the
letter what he then said. His conclusion was that
“4G,par cent, of the children attending elementary schools
in the poorer districts of London suffer at certain masons
from .habitual headache,” in part attributable to over-pressure
in the course of their education. No doubt the public
attention was largely directed, in the discussion which
ensued, upon those extreme cases in which nervous disorders,
originated or promoted by the strain of education, had
resulted actually in death. But these cases are obviously
.exceptional. The mischief, more serious in the aggregate
than these occasional instances of entire collapse, against
which it is especially necessary for the directors of juvenile
e&tefction to be upon their guard is manifested rather by

the slighter ailments, which are convenient!y grouped under
the symptom of habitual headache.

The evil having been thus clearly indicated, it might
have been expected, perhaps, that the Commissioners would
be careful to make a large collection of facte, from which
any competent person might draw bis own conclusions.
This, however, they have, strangely enough, entirely failed
to do. In view of the remarkable deficiencies of the report
in this respect, we can but regret that no medical man
was included in the Commission. As matters stood, there
does not seem to have been anybody engaged about the
inquiry who could indicate to the witnesses what were the
specific points and special symptoms to which they might
most usefally speak. The question was generally put in
some such form as this: “ Do you think there is any over¬
pressure in such and such a school?” It is obvious that the
answer to such a question would depend quite as muoh cm
the witness as on the facts. The inquiry, as we think,
should have been conducted in a wholly different manner.
Questions suggested by medical experience would no
doubt have revealed the fact that many of the ladies and
gentlemen who expressed to the Commissioners very de¬
cided opinions had no adequate foundation for their views,
and, on the other hand, they would have elicited a large
body of facts which are to this moment undisclosed. How
large and bow valuable these facts would have been, if only
the Commissioners had known how to set about collecting
them, may be gathered from one or two observations
which fell in the course of the inquiry from some
exceptionally clear-headed and well-informed witnesses.
One gentleman, for instance, a manager of a village
school in Sassex, found ocoasion, when replying to the
question “How do you define 'over-pressureP* to observe
“Before every examination I hear complaints from parents
of children talking in their sleep, or that they cannot sleep,

or that they walk in their sleep . but then I must say

that in my own school the children are all excessively
anxious individually to pass; they take a very desperate
interest in it, and it is considered a direful disgrace to the
whole family if they make a failure, and they never hear the
last of it.” Another, the vicar of Islewortb, said: “I saw a
new form of it [over-pressure] the other day. I heard of some
girls who did not come in the afternoon because they were so

pressed in the morning.Their parents.have been in

in the habit, when their children came home tired after morn¬
ing work,of keeping them away from school in the afternoon.’
Even in these instances the inquiry was not followed up,
and the witnesses were not asked to indicate the actual or
proportional number of the children to whom their remarks
applied. This is much to be regretted; yet, imperfect as
they are, a handful of such facts is worth a houseful of
generalised statements and mere expressions of opinion. We
are sorry to add that it is to this latter category that almost
the whole of the evidence in this branch of their inquiry
collected by the Royal Commissioners must be referred.

Upon the whole, then, the report of the Royal Commission
is a distinctly disappointing document. Much very valuable
matter has no doubt been put together, but upon the impor¬
tant question in which the medical profession is chiefly
interested the result -attained is almost a cipher, and the
feeling forces itself upon us that s splendid opportunity of

Digitized by vjOOviL

Thb Lancbt,]

THE SPREAD OP INFECTION FROM RAGS.

LJttnb 11,-1987. l f l^l

collecting facts has been sadly wasted, for want, not of
will, bat of scientific qualifications on the part of the
Commissioners engaged in the inquiry.

W» have on two recent occasions drawn attention
to the question of the spread of infection through the
agency of rags, and We have now before us a farther
report from the medical department of the Local Govern¬
ment Board, in which the occasion of a small-pox
prevalence in connexion with some paper-mills at Ivy-
bridge in South Devon is taken to deal in a somewhat
exhaustive manner with the whole subject and with its
treatment in this and in foreign countries. We do not
propose to discuss that poirtion of Dr. Parsons' report
which deals with this special small-pox occurrence; but as
regards general considerations as to rag infection at paper-
mills, we may state that although cases of infection by
means of rags do occasionally occur, yet they are, con¬
sidering all tbs ciroumstanoes, only of infrequent occurrence.
This infrequency is to some extent due to the fact that it is
essentially the white rags, from which the finer class of
paper is made, that are most risky, because they have
formed articles of underclothing, which come into
actual contact with the bodies of persons. The great body
of rags are coloured ones, and with these the amount of
manipulation needed is much less than with those required
for the superior class of manufacture. Then, again, in this '
country at least, the 126th section of the Public Health Act
docs deter people to some extent from trafficking in rags
known to be infected; and, apart from the law as to the
matter, a large number of people take certain precautions
in their dealings with rags which have run the risk of being
infected. RagB before reaching paper-mills have also been
several times sorted and exposed, and it is often some
before they reach the cutter’s hands. And, lastly, it
is only those who are engaged in dealing with rags daring
the preliminary stages of the manufacture that run much
risk; the boiling and chemical treatment to whiah rags are
submitted after catting must practically render them
innocuous.

Reviewing all the available precautions against infection
by means of rags, Dr. Parsons lays down the following
rules. Against small-pox, vaocination and revacciuation
should, in the main, be trusted to. Since infection doubt¬
less takes place mostly as the result of inhalation of “ dust”
during the processes of manipulation and cutting, such dust
often consisting of matters whioh have dried into and on the
surface of the rags, ventilation is an important considera¬
tion, and fans to draw off the dust would be eminently
useful. Where it is known that disease prevails in a locality,
rags from that plase should, if possible, be prohibited from
importation. This is done in the case of cholera, but it is
hardly practicable with our current infectious fevers.
Finally, disinfection of rags should be aimed at. The pro¬
cesses that asem at all applicable are: (1) Chemical disinfec¬
tion by gases, as sulphurous acid or chlorine; but unfortu¬
nately the gases would not penetrate bundles or heaps of rags,
(2) Disinfection by heat, especially in the form of steam.
This latter system works well, and a report made to Dr.
Santa of New York is quoted as te the opinion of an ex¬
perienced Mg inspector to the effeot that the market value of

the rags is in no way impaired by the process. The difficulty
of dealing with rags by disinfection is to determine who is
to bear the expense of it. The original responsibility rests
on either the person who sells the rags, or the rag merchant,
who buys them regardless of the source whence they come;'
and, as Dr. Parsons says, it would hardly seem fair to require
paper manufacturers to atone for the omission of others by a
comparatively expensive process of disinfection. The ques¬
tion may be raised in future eanitary legislation, and it may
be that the public authorities will, in the interest of the com¬
munities they represent, themselves undertake the task of
disinfecting such articles as rags. One of the most valuable
parte of Dr. Parsons’ report is contained in a series of
Appendices giving a summary of the principal outbreaks
at paper mills, and an abstract of information obtained
through the Foreign Office as to the measures taken in
a large number of foreign countries with regard to this
question of rag infection. For these reasons’ alone we are
glad to see that the report is placed on sale. 1

No less than four Bills having for their ostensible object
the repression of adulteration are now before Parliament.
For the purpose of scientific argument these Bills may,
however, be reduced to two, of which one deals with beer
and one with butter. There are, it is true, two similar Beet
Bills and two similar Butter Bills, but in each case the dif¬
ferences are of minor importance. In the Beer Bills &
definition is attempted which would render the punishment
of adulteration a simple matter if the offence were proved.
Adulterated beer is “ any beer brewed frbm or containing
any ingredients other than hops or ["and” in one of the
Bills] malt from barley.” If any other ingredients are used
by the brewer or publican, " conspicuous notice ” must be
given to the public in the bar or other place where the beer
is sold or offered for sale. This is simple enough, and Would
evidently prohibit the sale without special description of all -
beer in whioh sugar, rice, or maize had been used instead of,
or in addition to, malt; or any hop Substitute, Such as
quassia, instead of, or in addition to, hops. This somewhat
pedantic phraseology 1 b essential to a comprehension of the
difficulties with which the question is surrounded.

In the other Bills which propose to deal with butter, ft
definition which in this case is attended with less difficulty
is enunciated. The definition differs slightly in the two
Bills, but, taking the wider and more sensible, it is “ the
substance usually known as butter, made exclusively from
milk or cream, or both, with common salt, and with or
without additional colouring matter.” The only adulterant
named or aimed at in either of the Bills is margarine or*
oleomargarine, which in the better drawn of the two Bills is
defined to include “ all substances, whether compounds or
otherwise, prepared in imitation of batter, and whether
mixed with batter or not.” The Bill in either form would
require considerable revision before it could pass into law*
but, as its objects are simple ftnd easily attainable, it may
for the moment be postponed, although it will be necessary
to discuss it at a later stage.

With these important proposals before Parliament, it is
not surprising that the small but vigorous Society of Public

1 Eyre and Spottiswoode, East Hardlng-street, E.O.; Adam and Chaa,
plack, Bdlnburgh; Hodges, Figgis, and Co., Dublin.

Digitized by vjUUV Lv_

1192 Thb Lancet,]

THE REPRESSION OF ADULTERATION.

[Jcwa 11,1887.

Analysts, which includes among its members nearly all the
best public analysts of Great Britain, should have taken
prompt action and summoned a conference to consider the
general questions involved. The meeting on May 11th was,
in fact, a conference. Several letters from absent members
and some original papers were read, and a good discussion
took place, which turned almost exclusively upon the use
and detection of hop substitutes. The only notable exception
was the side issue raised by Mr. Otto Hehnbe as to the
relative positions which public analysts and the Government
chemists of Somerset House would occupy if any of the new
Bills passed into law. It is well known that ever since the
passing of the Food and Drugs Act, 1875, some jealousy of
the powers then entrusted to the Somerset House chemists
has existed among the public analysts, who have fancied
themselves slighted by the appointment of an independent
court of inquiry. Repeated complaints, sometimes couched in
language of unnecessary acrimony, have been made of the con¬
duct of the Government chemists, and in a recent letter to an
evening contemporary, Mr. Allen of Sheffield, an able chemist
who holds the position of President of the Society of Public
Analysts, has brought charges against the official chemists
which are, in part at any rate, charges of incompetency.
To us as to the public, the question is one of subordinate
importance. Provided that adulteration is exposed and
properly punished, we care very little whether the work is
done by the officers of a public department or by analysts
appointed by local authorities. On the whole, we should, if
suitable modifications were introduced, prefer the present
system, because we believe it might easily be made efficient
and satisfactory. No one can assert that it is just now either
the one or the other. The Government chemists laid it
down as their line of duty that they would never certify
that a sqmpie was adulterated unless their own analyses
proved the adulteration. To that line they have most pro¬
perly adhered. Doubtless they have made mistakes at
times, but we do not think they have ever caused the
punishment of an innocent man; and it surely cannot be
denied that in the investigation of a charge of fraud the
accused ought to be held to be innocent until he is proved
to be guilty. In regard to this matter some of Mr. Allbn’s
complaints seem somewhat unreasonable. Thus, speaking
of cases of doubt, he says, " If they cannot speak with
certainty, they might speak of probabilities.” We can but
ask what would be the use of that ? Fancy a toxicologist
employed to test for arsenic reporting that he could not find
the poison, but that probably it might be there 1
We may now consider the proposed alterations of the law
in regard to beer. It must be premised that some very
important alterations have already been effected by the
Customs and Inland Revonue Aot of 1885, which is worked
by the Inland Revenue Department. This Act is .in some
respects extremely vague, and is apparently intended, as so I
many pthers have been, mainly for the protection of the
revenue. Its definition of beer is about as loose as possible.
Beer is a liquor “ which is made or sold as a description of
beer, or as a substitute for beer, and which on analysis of
a sample thereof shall bs found to contain more than 2 per
cent, of proof spirit.” It would seem as though adulteration
after such a definition was an almost impossible offence—
except, of course, adulteration with noxious ingredients,—

and yet the Act specifically and by name prohibits adultera¬
tion, and many convictions have already been obtained
under it. As Mr. Hehnbb puts it, “ beer, as permitted to be
brewed, is a nondescript article, of no particular composi¬
tion and of no particular strength.” And yet ite adulteration
is made a penal matter, and it has even been held to be as
offence to blend one kind of beer with another, an opentiaa
which is practised every day with whiskies. No doubt the
law is intelligible to the lawyer, but to the layman it is
certainly puuling.

In strong oontrast with the vagueness of the Act of 1885
stand the Beer Bills now before Parliament, the hard and
simple definitions of which we have already noticed. Cm
liquor brewed with hops and malt from barley only is in
these Bills defined to be pure beer. No other beer is genuine.
It may, indeed, be sold, but only with a sufficient waning
to the purchases. This last proviso is tantamount to as
admission that bear may be innocuous although other ingre¬
dients than barley-malt and hops have been used in its assn-
facture, for surely no one would propose to legalise the sale
under any conditions of a noxious beverage. Looking closely
into the matter, we think it cannot be denied that the cry lot
pure beer is mainly a, political cry. It is not pretended that
1 malt substitutes or hop substitutes are necessarily or area
commonly injurious to health. Other graina besides barky
can be added to malt in brewing: notably nee, which, u it
contains less nitrogen, often improves the beer. Glucose also,
which is, after all, but an altered form of starch, may, whea
of good quality, be safely added to the wort before farmea-
i tation. So with the hop substitutes. It was stated by all
| speakers at the reoeat conference that quaaaia, gentian,
j chamomile, and chiretta were not inferior to hop as vegt-
i table bitters. Wby, then, should these substitutes far malt
| or hops be prohibited ? It is admitted that they an ham-
! less; the fact that they are used shows that they an obeap;
and as for the flavour, the public is the bast judge of that
The beer-drinker who wants “ pore bear” can always ask for
some well-known brand. If he gets an inferior article he ia
defrauded; the fraud should be severely punished, and doubt¬
less the great brewers would be willing enough to help ths
purchaser. But if he simply aaka for a glass of ale, it i*
enough that he should be protected from drinking & noxious
beverage. If be does not like it he must go somewhere eks.
Many branches of this important subject still require dis¬
cussion, but they must be reserved for a future article.
-“♦>-

Thb Council of the Royal Agricultural Society had
last week under discussion Professor Axes report on *
disease in cows in its relation to the scarlatina epidemic is
the north-west district of London, and it was resolved to
address a letter to the Privy Council, asking that ti#
Agricultural Department “ should undertake further inves¬
tigations into the subject, with a view to making it dear
whether it was possible that scarlatina could, ae alleged, be
communicated direct from the milk of diseased cows.” Ike
President, Lord Eoibton of Tat ton, suggested that eftorte
should be made to determine whether the oow oould suffer
from scarlet fever; and Mr. Cops, veterinary inspector of
the Agricultural Department, after referring to the evidrace
Dr. Hunt and Professor Axb had adduced, stated that
when an opportunity was afforded by,an outbreak of “tkis
Digit,zedTVjOOgle

COW DISEASE AND SGARLHrFEVBR.—Tffit H08PITAM ANNIVERSARY. [jOTrell,1887i H#3

eruptive disease appearing among the cows of this country,”
the Agricultural Department had instruction* from the
Government to make any inquiries that might be neces¬
sary. In the report of the proceedings we note the
words “ this disease,” as if it were an assured fact that the
assumption that the Hendon cows suffered from the same
malady as ceitain other herds, the milk of whioh did not
give scarlet faver was correct. Jt deserves to be borne in
mind that Professor Ax*, after visiting the Hendon cows,
addressed a letter to the British Dairy Farmers’ Asso¬
ciation, in which he stated that at the time of his
visit nothing of the disease remained but a few scabs and
superficial ulcers on the teats to mark its former presence;
he was therefore “ quite unable to say what may have been
its precise nature." We refer to this because there are
certainly several vesicular diseases of the udder of the cow
which do not appear to be sufficiently differentiated, and if
the Agricultural Department are guided in their selection
of the malady they propose to study by the description
Professor Ax* has published of a disease the precise nature
of which is unknown to him, they will not improbably
fall into serious error, which in its results would be
disastrous to human life. If the Agricultural Department
make it their business to study the natural history of all
vesicular diseases which affect the udder of the cow, they
•will undertake a valuable piece of work, and one which
•would not be less useful to the agriculturist than to the
milk consumer. A lesson to be learnt from recent investiga¬
tions is the need for the further study of some animal
diseases in the interests of the public health, and for this
purpose the staff of the Local Government Board should be
strengthened by the addition of a skilled veterinary surgeon,
and the Board would be doing good service in undertaking
the clinical Btudy of these maladies.

The name of the month of June in the year of Her
Majesty’s Jubilee sounds sweet, and we are glad to think
that it even more than usually suggests many facts which
tend to make the human mind less careworn and more
happy. Some great sicknesses have gone out of human
knowledge. We know them only as we know stage
coaches, and not so well. Others have become less
terrible. A case of typhus was received into a great
hospital in the centre of London a few months ago, and
it was referred to and treated as a rarity. The Registrar-
General has been telling us that in only one week out
of the last five weeks has there been > death from small¬
pox in London, and that in twenty-five or more out of
twenty-eight of the big towns there has not been one such
death. The disease is so completely under human control
that some thoughtless people have come to disparage the
very discovery which protects them. These are very sig¬
nificant facts. But let nobody imagine that our Hospitals
ere a superfluity yet. The millennium has not arrived.
The condition of the people will have to be very different
from what it is before hospitals can be dispensed with.
Disease still counts for much in the life of the working
classes. Defective food, inadequate clothing, mental and
physical depression from want of work, poor and insanitary
homes, create much and many kinds of sickness whioh it
is hopeless to relieve at home. In addition to this, there are

the accidents whioh befall working men in larger proportion
than in other classes—fractures, bums, sprains, heroi®,
wounds,—for the treatment of which there is simply no con¬
venience in a poor man’s house. Let any of the comfortable
classes remember what grave sickness has meant in their
experience or in that of their relatives: the beBt advice, a
variety of opinions—all of them of the beat,—a skilled nurse*
choice and convenient food, and, when the wont was over
and hope again in the ascendant, a reviving holiday at the
seaside or the country. Such amenities deprive even sick¬
ness of half its terrors. The human mind in its divine
moods has devised an institution which goes far to put
such amenities within the reach.of the poorest. The insti¬
tution in question is no other than a Hospital, where poverty
and sickness are the only conditions of entrance, and where
the latest discoveries of medicine tod thd last improvements
in nursing, food, and appliances can be had, and in some cases
the patient can be passed on even to a convalescent home.
This is the very crown of charities, which no civilisation yet
reached supersedes, and for the absence or starving of which
no adequate excuse oan be formulated by a Christian or,
indeed, by any other community. We shall not say more
to-day. The following meetings'are to be held in every
part of London in the coming week preparatory to Hospital
Sunday:—On Monday, the 13th, at 8.30 p.m., Newington
Parish Mission Hall, Kenningtoa-road, S.E. t on Tuesday^ at
3 p.m., Mansion-house, E.C. i on Wednesday, at 8 p.m., St.
Andrew’s Hall, Newman-street, W.; on Thursday, at 4 p.m.,
Kensingtob Town Hall; on tile same day, A 8 P.Jfc, Welling¬
ton Hall, Islington; on Friday, at 4 p.m>, Westminster Town
Hall; on the same day, at 8 p.m, Stratford Town Hall; on
Saturday, at 3 Ip.m, the People’s Palace, Mile-end-road.
It is devoutly to be hoped that no sensational politics and
no exceptional excitement will interfere to, prevent a full
appreciation of the wants of these great but quiet institu¬
tions, and. of the strong arguments which appaal to the
favourable consideration of the highest authoritiesia Ctarsh
and State, including Lord SAustnmr, who, to hie great
credit, has engaged to speak at the Mansion House on
Tuesday in this cause. We shall, as is our custom, refer
at greater length in our next issue to the unparalleled
claims our hospitals have on “ sweet charity.”

^.nuotaiiras.

•• lie quid nlmia.*

THE CONTAGIUM OF SCARLET FEVER: JAMIESON
AND EDINGTON’S RESEARCHES.

Tub remarkable chain of evidence whereby Dr. Klein has
been enabled to substantiate the results of Mr. Powar’s
investigation upon the transmission of scarlet fever direct
to man from the cow seems to leave little room for scep¬
ticism that in the streptococcus met with by Dr. Klein we
have the effective agent in the etiology of this disease; snd,
scanty as prior observations are, imperfect as many of them
have been, it is noteworthy that hitherto the scarlatinal
microbe has been described as a micrococcus. Coze and
Feltz found micrococci in scarlatinal blood; Comil in the
urine in scarlatinal nephritis; Babes describes streptococci
in post-scarlatinal inflammatory products; and Pohl-Pinous
found " very minute micrococci adhering to the scales of
Digitized by ' L^oogr

re

f19 4 ftttUifdw,)

DEATHS IN THE MIDST OF FlBfc8.

[Jotcb 11, 1887.

the desquamating epidermis in scarlatina” (von Klein:
14 Micro-organisms,” third edition). The isolation, cultiva¬
tion, and successful inoculations practised by Klein, how¬
ever, far outweigh all such partial observations. But, as in
the case of diphtheria, so here, it would seem that other
observers have arrived at the conclusion that the scarlatinal
microbe is a bacillus, and not a micrococcus. Drs. Jamieson
andEdington of Edinburgh University have completed a series
of observations, which arrive at this result: their plan of
procedure being to examine tbe blood of scarlet fever patients
as early as possible, to sterilise an area of skin and protect it
from contamination till desquamation occurs, and then to
examine the desquamated epithelia for organisms. They
found a bacillus in each of these media, and succeeded in
reproducing a disease like scarlet fever in calves and other
animals inoculated with pure cultivations of this bacillus.
Further tests by examination of tbe blood of the inoculated
animals and pure cultivations therefrom also yielded
positive results. Until the details of their research are
published it would not be fitting to attempt any critical
comparison between them and those obtained by Dr. Klein.
The fact that the blood of scarlatinal patients has been
frequently examined without result makes it at first sight
more probable that tbe minuter organism-has been over¬
looked; but much also depends upon the technical skill
of the observer, and bacteriological methods are daily being
perfected. It is curious that a disease so obviously con¬
tagious as scarlet fever should hitherto have baffled the
attempts made to isolate its virus, and that almost simul¬
taneously investigations should be in progress with this
object, and with such apparently conflicting results.

DEATHS IN THE MIDST OF FIRES.

Teb usual outburst of emotional carefulnees has been
called forth by the catastrophe at the Opdra Comique in Paris.
The deplorable destruction of that place of entertainment,
with the serious loss of life it involved, must be regarded
as a catastrophe , for the preceding history of the construc¬
tion and general arrangements of the Op<5ra Comique cul-
minates methodically in what seems to have been pretty
generally anticipated and has at last occurred. It is only
natural that we as a people, and particularly the people of
London, should be agitated to a considerable extent by the
Calamity. We cannot be ignorant of the dangers that beset
our own enjoyment of theatrical performances, and which
indeed, as is beginning to be recognised, threaten the
visitors to Exeter Hall and the worshippers in crowded
churches or chapels scarcely less urgently than playgoers.
Already the excitement, which has been less than usual
amongst ourselves, is subsiding, and in another week or
two the affair will, doubtless, be forgotten, except by those
who have been personally affected by it. Meanwhile, it
may be well to point out that, although the idea of being
" burned to death ” in a crowded place of assembly is a very
hideous one, in all probability the experience is, like most
other modes of exit from this wonderful life of ours, less
agonising than it appears. Practically, the burning seldom
occurs in these cases until after death, or, at least, insensi¬
bility to pain, has been produced. Except under very
peculiar conditions the victim is asphyxiated—that is,
rendered faint and pulseless—by the carbonic acid gas or by
the carbonic oxide, before tbe Are reaches his body. Any¬
one who has been in a burning house will know that the
heated and smoky atmosphere speedily induces a feeling
of powerlessness and at the same time of indifference to
what ia going on around. It is generally this stupefying
of the cerebrum, with subsequent paralysis of tbe nerve
centres, that prevents judicious means bring taken for
escape; and unless tbe sufferer baa the pretenoe of mind
to stoop almost to the aground «e as to keep his head

below the level of the smoke, he is almost sure to sink
without much feeling in the midst of the lire instead
of pushing forward. It is well to know and bear in
mind this fact, both for the sake of precaution, and to
mitigate some of the acute grief which must be experienced
at the loss of friends by fires such as that which h&i
just occurred in Paris. We do not, of course, deny that
there may in some exceptional instaaoes be a certain
amount of suffering iu the case of persona so dying, hot we
doubt whether the proportionate amount of pain in dsatlu
amidst fires is actually greater than that endured by those
who die from ordinary disease. There is the element of
time to be considered. In place of days, or perhaps week*,
of pain, the whole experience is over in a few minutes at
most, without either expectant misery or prolonged con¬
sciousness of the approaching end, and, so far as aoenc*
can determine, it is by no means probable that the intensity
of the agony is greater than that of an ordinary death; pos¬
sibly, even, owing to the rapid generation of the ga*«,
it may be lees. This is a view of the case on which it is
more pleasant to dwell than that which thrusts itaelf im¬
mediately on the attention when such appalling events is
those to which we refer are brought under notice. If the
facts were present to the minds of those who now madly
rush out of a burning house, to the very great diminution
of their chances of escape, perhaps they would induce a
little more composure, and thus help to render the lew of
life lees extensive. __

THE METROPOLITAN ASSOCIATION’S IMPROVED
DWELLINGS.

Tfi£ Metropolitan Association for Improving the Dwellings
of tbe Industrious Classes has just issued its forty-third
annual report, for presentation to the shareholders at the
approaching annual meeting. This Association has the dii-
tinction of having led the way in the invaluable movement
for improving the dwellings of the working classes, which
is slowly but surely effecting incalculable benefit on the
housing and sanitary and social condition of the Load cm
poor. Compared with the operations of the Peabody Trust,
and one or two; of the larger companies carrying on this (
work, those of the Metropolitan Association are moderate in
extent, but the report tells us that the buildings of tbe
Association, situated in fourteen localities, had, during
the year ending with March last, an average populi-
tion of 0115 persons. This was rather less than a third
of the population of the Peabody buildings at the end of last
year. It is stated that 97 deaths were recorded in these
buildings during the year, equal to 16 9 per 1000 of the
population, which the report points out is 4 per lOOObelow
the general rate for the whole metropolis. It must, however,
be remembered that no correction is made for deaths recorded
in the workhouses, hospitals, and lunatic asylums of the
metropolis, a proportion of which should be debited to this
population. The deaths in public institutions in London
during last year were equal to 4-1 per 1000 of the populi-
tion. If we debit the Metropolitan Association Dwellings
with their full share of these deaths (probably in excess of
tbe true proportion), the corrected death-rate would but
slightly exceed the general rate in London, and the rate is
the Peabody Buildings last year. This corrected rate wouM.
moreover, still be a most satisfactorily low rate for i
working-class population such as that which inhabit?
both the Peabody and Metropolitan Association Improved
Dwellings. The Metropolitan Association report also state*
that the rate of infant mortality in those dwellingi wu
equal to 164 per 1000 of the registered births, against K-3
in the whole of London and 149 in the Peabody Building?-
It is worthy of note, however, that the birth-rate in the
Metropolitan Association Dwellings is stated to have bees
only 32-9, whereas in tbe Peabody Buildings it wai 43 i

Digitized by VjOO glC |

The Lancet,]

THE BOARDING OUT OP PAUPER CHILDREN.

[June II, 188?v 119(1

Unless the age distribution of the Metropolitan Association
population differs very remarkably from that of the Peabody
population, it appears probable that the birth-rate in the
former is understated, the effect of which would be to over¬
state the rate of infant mortality. After full allowance for
all possible defects in the vital statistics of the Metropolitan
Association’s report, there can be no doubt of the beneficial
effects of these improved dwellings upon the health of their
population, or of the important reduction in the death-rate
of many parts of London that would result from the further
extension of the operations of this and of other companies
for the improvement of the dwellings of the working classes.

THE BOARDING OUT OF PAUPER CHILDREN.

The case of the St. Pancras children boarded out at Den-
mead does not greatly alter the public opinion as to the merits
of the boarding-out system. In some respects it confirms the
belief that the system is preferable to that of huge pauper
schools. The report of Mr. Clarke, the medical officer of
the Leavesden Schools, who was sent by the guardians to
examine the children and inspect the homes in which they
lived, leaves on the whole a favourable impression. The
children were better than when they went to the country,
and they were happier—at least they had no wish to leave.
They one and all said most distinctly they would not like
to return. So strong a human liking for them had taken
possession of some of the foster-parents that they refused to
give the children up, even if the guardians should with¬
draw the 4 $. a week for their support. Some of the houses
were clean and comfortable and all that could be desired.
There wa», it is true, another side to the picture. Some of
the foster-parents were old and infirm or in ill-health ; one
in particular was dirty ; another kept a sort of old-clothes
shop. The sleeping accommodation in several homes was
insufficient; while in seven of the ten homes there were
more than two children boarded out—and, it appeared, some¬
what promiscuously,—and some of the children looked dirty
and neglected. On the top of these drawbacks Mr. Clarke
adds: “ notwithstanding all this, the children bad improved
since they came to Denmead.” The fact appears to be that
there has been a want of care in the selection of fit houses
and foster-parents, and that the local committee of super¬
vision has been a little too formal in its duties and trusted
too implicitly to the foster-parents. One other point strikes
us: that the sum allowed is not such as can compensate the
foster-parents for adequate treatment of the children.

MEDIOAL OBJECTIONS TO VACCINATION.

Uitobr this heading a contemporary publishes a letter
figned by persons holding medical qualifications, in which
it is argued that there is no ground for olaiming that the
reduction in the death-rate from small-pox is due to
vaccination, because leprosy has also disappeared from this
country without any special means having been resorted
to for its prevention. The writers omit to mention that
the evidence with regard to vaccination is based upon the
behaviour of small-pox among vaccinated and unvaccinated
persons respectively, that the latter suffer from small-pox
us severely and as fatally as heretofore when they are
attacked, and that it is only the unvaccinated who enjoy
the benefits of more recent times. What are ♦e to think
of persons with medical qualifications who make a statement
such as that to which we refer to a public consisting of
many who have no means of judging for themselves, and
who are likely enough to be misled by such teaching ? For
the ignorant we oaa feel regret; but a terrible responsibility
devolves upon all who- by mistaken edvioe may—unin¬
tentionally of course—be the means of introducing disease
and d ath in many a family.

GYMNASTICS AT SCHOOL.

The honorary secretary of the National Physical Recrea¬
tion Society gave some interesting evidence lately before
the Royal Commission on Elementary Education, and it had
the advantage over much of the other matter collected by
that body of being statistical in large measure. Speaking
of the work done by the Liverpool ‘Gymnasium for the
treatment of spinal curvature, he stated that some 3000
cases had come under his own observation there, of which
2500 were cases of children between the ages of eight and
fourteen years, 2000 of these beinggirls. There can be no doubt,
we think, that deficient physical exercise, if not the only
or even perhaps chief cause of this very common deformity,
is highly calculated to promote it; and, even apart from
any specific evil, a well-considered and systematised plan
of training for the muscles is undoubtedly a most valuable
regimeD, and eminently adapted to preserve and benefit the
general health. But it is of the highest importance, in follow¬
ing out tbi9 object, to avoid pernicious exercises, which may
do irreparable mischief to the growing organs and unbraced
body of a child. The following instance is very much in
point; “The care-taker commanded them all (like children
of an elementary school) to keep their knees stiff and touch
their toes with their hands, and while he kept them in that
position be proceeded to give them an impromptu discourse
upon the benefit of physical training. When the children
rose up you could tell from the hectic colour of their cheeks
that they were evidently suffering at that moment from
palpitation of the heart caused by leaning down in this
extraordinary position.” Equally sound appears to us tl^e
following Comparison between the horizontal and thle
parallel bars: “In the case of the horizontal bar, or any¬
thing pendent, children naturally jump up and get on with
their hands together; that is a position of contraction; thp
chest is contracted and the shoulders brought forward,
unless they have a very painstaking instructor, who will
make them widen out their bands and change frequently.
In the case of the parallel bars, the ordinary position of a
child upon it causes expansion of the chest; the very move¬
ment of resting upon the parallel bars is one of expansion,
without any teaching whatever.”

“ ACROMEGALY.”

Another example of the curious and rare condition of
acromegaly of which an account was first given by Dr.
Marie (The Lancet, 1886, vol. i., p. 1060) last year, has been
recorded by Dr. Minkowski (fieri. Kfin. Tf'och., 1887, Np. 21).
The case occurred in the medical clinic at Konigsbezg, the
subject being a musician, thirty-eight yean old, who for
some years past had experienced a gradually increasing size
of the hands and feet, so that be could no longer play the
violin. The nose and ears also became thickened, and the
whole form of the face altered. He had suffered much from
headache, and bis vision had become gradually impaired; he
bad also become somewhat deaf. He was a man of medium
height. The bands were strikingly enlarged in width and
thickness, the fingere especially, the thickening involving both
bones and soft p&rts. There was no oedema. The forearm was
disproportionately enlarged. A parallel Increase in tbe size
of the peripheral parts was seen in the lower limbs, where the
leg and foot were greatly enlarged, as well as the individual
toes, tbe great toe being “ gigantic.” The patella was
notably enlarged. As to the face, the nose, lips, and chin
were manifestly hypertrophied, the septum as well as the
tip of the nose being much thickened. The lower jaw was
thickened and projecting, the zygoma mad the orbital
margins prominent. Tbe bead had a long oval shape. The
ears were large, and their cartilages thick. The eyes ware
prominent, the tongue was large, and the bnocal mucous
Digitized by Li

it fife Thk Lancet,]

THE NATIONAL HEALTH SOCIETY.

[Jmts 11’ M8T.

membrane hypertrophied. The laryngeal cartilages were
-voluminous, the thyroid body apparently atrophied. The
muscles were ill-developed. Intellect was normal, but
bearing impaired, speech slow, and visual field contracted.
Marie’s case also had symptoms of polyuria and polydipsia,
hut otherwise resembled the present one. Dr. Minkowski
refers to the opinion of Klebs, who had recorded one of
the cases collected by Marie, that the condition was
due to a morbid proclivity to excessive vascular de¬
velopment, affecting chiefly the peripheral parts. It is
noted that in the coses as yet examined after death the
pituitary body has been found much enlarged ; in one case
(Henrot’s) it was of the size of a hen’s egg; in another
(Brigidi’s) it had caused enlargement of the sella turcica and
compression of the optic nerves. The thyroid has been
found in some cases atrophied, in others greatly hyper¬
trophied. One case has been recorded as myxcedema, but
the resemblance between the two conditions is only super¬
ficial, the osseous changes and the absence of cutaneous
lesion in acromegaly, together with the wholly different
physiognomy, sufficiently marking the difference. In
Virchow’s leontiasis ossea there is no such disproportionate
enlargement of the extremities, and in Paget’s osteitis
deformans the loDg bones and cranial bones are chiefly
affected, whereas in acromegaly the facial and not the
cranial bones are involved, and the distribution of the
changes in the limbs is invariably symmetrical.

THE NATIONAL HEALTH SOCIETY.

Tax fourteenth annual report of the National Health
Society is published. The work of the Society consists
chiefly in providing for the delivery of lectures on subjects
more or less connected with personal and national health.
Among the lecturers were Mr. Shirley Murphy,Mr. Malcolm
Morris, Mr. Frederick Treves, Dr. Greenwood, and Dr. Bar¬
nard O’Connor. The last-named gentleman, at the request
of Canon Cromwell, gave a course of lectures on the Laws
of Health, at St. Mark’s Training College, Chelsea, for the
instruction of young men training for schoolmasters. The
Society, whose office is at 44, Berners-street, is glad to
receive applications for short courses of lectures for district
visitors, mission women, cottage mothers, &c. We think
such a society likely to do a great of deal good, if it keeps
to sound lines and does not attempt too much.

THE CHILDREN’S FETE.

Tan 21st of June will be marked by many noteworthy
signs of rejoioing in different parts of the country. Perhaps
none of them will afford Her Majesty a more appropriate
tribute of congratulation on the completion of the fiftieth
year of her reign than the colossal assemblage of London
school children in Hyde-park. Of all the changes that have
come to pass during that long and prosperous period, none
is more Bigniicant of the growth of our national life or
more fall of hope than the formation of our system of State
education. We therefore wish all sucoess to the intended
demonstration. If, at the same time, we point out some of
the difficulties which belong to so great an undertaxing’, it
is only because we desire to ensure its success, and to pre¬
vent the chance of regrettable consequences. The plan of
transit may be safely left in the hands of those who will
organise the practical details of the scheme. What chiefly
conoerna us is the condition and surroundings of the children.
It is to be hoped that in making the selection of those who will
attend the gathering due regard will be paid to the subject
of health. Not prominence in class work but fitness

for the journey Bhould be taken into consideration. Weather
irani uncertainty which nmafcalao be reckoned with. These,

perhaps, may seem to be mere commonplaces, though they
are important trifles. Scarcely so obvious, but even non
pressing, is the necessity that no child should atttend in tie
park about whom there lingers a trace of infectious diseu*.
This year has seen an unusual prevalence of measles awl
whooping-cough among the urban poor. Is it neoesrary lor
us to add the caution that the person and home of each of
this multitude of children should be certified as free frar
any taint of infection? It may prove calamitous for
many of the children if this matter does not receive th»
strictest attention. _

MEDICAL ASPECTS OF THE MISSION TO DEEP-
SEA FISHERMEN.

The annual meeting of the Mission to Deep-eea Fuher-
men was an interesting one from a medical and bamu»
tarian point of view, Sir Andrew Clark occupying the ch&ir,
and addresses being given by him and by Mr. Frederick
Treves, F.R.C.S., who had himself personally inspected tha
work in the North Sea and had seen the great need existing
among the 1200 fishermen there for the medical andeurgial
aid now as far as possible supplied by the mission smacks,
which are provided with a medicine chest and variosi
surgical appliances, and which carry a skipper and samtn
who have gone through a course of instruction by Dr.
Schofield, so that a man who meets with a lacerated wound
or a fracture of the arm whilst conveying fish boxes in a
little boat from his smack to the steamer running between
the fleet and Grimsby can be, if a mission smack ii
near, promptly and pretty efficiently treated. A great
want, however,, is still unsupplied, and that is a
floating hospital, neither the mission nor the other
smacks having berths suitable for sick or injured men.
Another great advantage of the mission smacks is that they
have to a large extent driven the “copers," with their vile
and unwholesome spirits and tobacco, and their still more
vile literature, off the seas, they themselves selling good
tobacco, warm woollen mittens, “ helmets,” and other clothing,
and pure healthy literature, but no alcoholic liquors. A
magnificent gift of a steam yacht has just been received by
the Deep Sea Mission. This will be just the thing for the
work, and a few sick berths might well be fitted up in ha.
She might even “carry a surgeon," hut unfortunately the
society is so pressed for funds that it is quite uncertain
whether the yacht can be even manned and put to sea.

ACUTE GRAVES’ DISEASE.

An apparently well-authenticated case of Graves’ disease,
having a total duration of six weeks, and accompanied by
remarkable emaciation, is recorded by Dr. Michell Clarke in
the Bristol Medico- Chirurgical Journal, No. 15. It *u
that of a girl, aged eighteen, a native and resident ri
Chepstow, whose family history was good, and who had
always enjoyed perfect health till 1885, when she experience
headaches occasionally, with slight feeling of fulness at tha
throat; and again in June, 1888, during a menstrual period,
violent palpitation, severe frontal headache, pain in tha
prmcordial region, and nausea with vomiting in the morning
but this group of symptoms disappeared, and the neri
menstrual period was completed without the occurrence d
any abnormal symptoms. She remained well ns* 11
Aug. 4th, when the palpitation returned, and the symptom
of exophthalmic goitre appeared, together with anaealvok’-.
slight cough, and rapid emaciation. On admission, u*
notes show great mental exoitability and slight chowifora
movements of limbs. Von Graefe’s symptom was
marked. Toward# the end of the case fiiarrhm*
vomiting .ware remarkable symptoms. The patient died »
Sept. 14th. Dr. Michell Clarke observed that thethynw

Digitized by Cj OOg lC

Thb Lawcbt,]

OVERLAIN CHILDREN.—CATTLE DISEASES IN GREAT BRITAIN, ptartfll, 188 *- 119^

was very large, as in two instances of exophthalmic goitre
recorded by Hilton Fagge; the liver and pancreas were very
small; tLe thyroid very large; the exophthalmos had dis¬
appeared; microscopic sections of the central nervous
system and the cervical sympathetic revealed nothing
abnormal. _

OVERLAIN CHILDREN.

When a coroner tells ua that he has observed more than
200 cases in which children have been overlain and suffo¬
cated by a parent, we are tempted to ask whether this
accident has always resulted from mere carelessness. A
misf ortune so simple in its causation may doubtless easily
happen in the overcrowded homes of the poor where a
number of children are huddled into one or two small rooms.
Nevertheless when one finds it repeats itself so frequently,
and even occurs more than once in a single family, the con¬
viction that there has been gross neglect cannot but carry
with it some suspicion of design. Infantile insurances, end
the poverty of hard times, are pressing inducements which
might suffice to justify in the minds of unscrupulous parents
the wilful contrivance of such an accident. Coroners and
insurance companies alike will therefore do well to inquire
with particular closeness into the details of any case of the
kind which may come before them, and every motner who
would merit the reputation of even ordinary care should
take the advice of Dr. Denford Thomas and allow her infant
a separate cot. _

CATTLE DISEASES IN GREAT BRITAIN.

Pbob. G. J. Beown, in his annual report for the year 1886
of the Agricultural Department, Privy Council Office, states
that the last reported outbreak of foot-and-mouth disease
occurred in October, and that it may be concluded that the
disease has ceased to exist in this country. Respecting
pleuro-pneumonia the report is less encouraging, there
being slightly fewer outbreaks in England than in 1885, but
more cattle were attacked; whilst in Scotland the outbreaks
extended in area, and the cattle attacked were more than
twice as numerous as those affected in 1885. Many of these
outbreaks were traceable to Irish cattle, and the subject of the
possible conveyance of the disease from Ireland is being
considered, os well as the measures to be taken to deal
with it. Mr. Brown discusses the measures for the extinc¬
tion of pleuro-pneumonia, and declares that nothing short
of the stamping-out system is efficacious. Protective inocu¬
lation, which had been advocated in Scotland, is objection¬
able from the probability that infected cattle may be
inoculated with great risk to.the spread cf the disease, and
be states that no country has been yet successful in getting
rid of pleuro-pneumonia by inoculation. Swine fever
appears to have been very prevalent in various parts of the
year, the variations being attributable more to the amount of
trade carried on with these animals than to the enforcement
of restrictive measures. This disease was made the subject
of a Parliamentary report last year, one object being to aid
in the discrimination of the disease from other diseases of
swine; and experimental inquiry into protective inoculation
is in progress, but it is pointed out that the ordinary methods
of attenuation of virus could not be applicable, since it
would be necessary to have the power to inoculate a herd
from the infective matter of the first case arising in it.
Perhaps the desired result might be attained by diluting
the virus through admixture with certain chemical agents.
Anthrax, which by order of Council was last year brought
under the operation of the Act of 1878, forms the subject of
some interesting paragraphs in the report. The wide pre¬
valence abroad, especially in France, as compared with this
country, is noted; and the possibility of its introduction
through infected wools, skins, fodder, litter, and manure

is illustrated by a reference to the occurrence of wool-
sorters’ disease. It is pointed out that it would be
practically impossible to prevent the importation of in¬
fected wool. Anthrax is generally limited to the farm
on which an outbreak occurs, and, owing to the rapidfty
with which it kills, nothing would be gained by adopting
the stamping-ont system with a view to its eradication.
The importance of avoiding any effasion of blood of the
diseased animals is emphasised, post-mortem examination
being unnecessary for diagnosis, which can be at once
effected by microscopic examination of a drop of blood.
Protective inoculation has not been as yet needed in this
country, but it is encouraging to learn that experiments ar©
being made t,o test the value of certain chemical agents in
modifying the activity of the virus or rendering the animal
insusceptible to its influence.

THE CHURCH BELL GRIEVANCE.

We are sorry to be unable to endorse the opinion that the
question of church bells “is one for judicious compromise,”
though we agree that it “should be approached without
anything like temper on either side.” It is confessedly
difficult, to the extent of being impossible, to preserve any¬
thing like equanimity when a dear friend has been seriously
injured, perhaps hurried into a state of cerebral excite¬
ment which has ended in death, by the ringing of belle in
churches. We cannot designate the church bell question one
of nuisance; it is more than that, for direct injury is done;
and, for ourselves, we should certainly advise practitioners
who have patients suffering from this annoyance to refuse
certificates in the event of death being hastened by this
wanton noise-making. We entirely agree with a corre¬
spondent of one of the daily newspapers, who thinks that
the question mu9t be fought out by strong contention. As
a matter of law, we are decidedly of opinion that church
officials are, in strictness, only entitled to ring or toll bells
previously to “morning” and “evening” prayer and for
funerals, and that all extra ringing previously to sacramental
and other occasional services, now so numerous, are abso¬
lutely without warrant of statute or custom.

MEMORIAL TO THE LATE DR. WILSON FOX.

A desiee has been widely expressed that there should
be some memorial to the late Dr. Wilson Fox. It has been
thought by some of his most intimate friends that the
memorial should be personal, and that the most appro¬
priate form would be a portrait, to be presented to Mrs.
Wilson Fox. It is proposed, if the amount of the contribu¬
tions permit, that replicas shall be made for the College of
Physicians and for University College. For this object a
committee has been formed, consisting of Sir William
Jenner, Dr. Russell Reynolds (treasurer), Mr. Erichsen, Mr.
George Pollock, and, as secretaries (to whom contributions
can be sent), Dr. Gowers, 50, Queen Anne-street; and Dr.
Barlow, 10, Wimpole- street.

PLACENTA PR/EVIA.

Bayeb, in the Centralblatt fur Gynekologie (No. 26),
discusses the relations of the lower segment of the uterus to
placenta prsevia as held by different observers. He thinks
that the condition of the uterus in this affection is often
similar to that in premature labour—i.e., that in both
the supra-vaginal portion does not undergo the usual
changes, and that the internal os remains dosed till labour.
According to this view, no hemorrhage occurs during
pregnancy except when a part of the placenta actually
covers the internal os, and even then only when the internal
os dilates during pregnancy, which it does not always-del

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1106 Tkb XO.NGBT,] HEALTH OP CALCUTTA—SMALL-POX. HOSPITAL EXPHND1TUEE. [Jxtnb 11,1S87.

Bayer recommends tbe following classification of cases of
placenta prsevia: 1. Cases in which the placenta covers the
os, and in which tbe expulsion of the supra-vaginal portion
occurs at the usual time. In these there will be haemorrhage
during pregnancy, and secondary changes will be found in
the placenta. 2. Cases of placenta praevia in which the
cervix continues intact right on to labour. No uterine
haemorrhage occurs during pregnancy, and consequently no
secondary changes will be found in the placenta.

HEALTH OF CALCUTTA.

The death-rate in Calcutta for the first quarter of the year
was 2711 per 1000, being about 1'5 per 1000 above that of
the same period in the preceding year, but lower than in any
other year of the decade. The principal causes of mortality
were fevers, by which the deaths were 7'51 per 1000 of the
population, dysentery and diarrhoea 3-55, and cholera 3 47.
The deaths from cholera were only 77 in January and 82 in
February; but in the first week of March they experienced
a sudden increase, and the total for that month amounted to
216. The latter number corresponds very closely with the
average for the month of March during the last decade. Dr.
Simpson, in his report, gives the details of an investigation
into the probable cause of two special outbreaks of cholera,
one on board the ship Ardcnclutha in the river, and the
other in Howrah. They were pretty clearly traced to the
milk supply, which had been contaminated by being diluted
with water from a tank which had been fouled with the
excreta of a cholera patient. In a special memorandum on
the reorganisation of the health department of the munici¬
pality, Dr. Simpson has brought under the consideration of
the authorities two very important subjects—the appoint¬
ment of qualified inspectors charged with the duty of making
periodically a house-to-house visitation to ascertain the real
sanitary condition of the dwellings, and the imperative need
of an increase to the numbers and reorganisation of the
duties of the staff of the health officer. We sincerely trust
that these subjects will meet with the consideration they
deserve from the sanitary commission.

SMALL-POX HOSPITAL EXPENDITURE.

Thk Islington guardians have expressed sympathy with
their representative who, at a recent meeting of the
Metropolitan Asylums Board, showed that every small-pox
patient had during the last six months cost £31 per head
per day, and urged the closing of the hospital ships. It is
impossible to tell how long London will remain free from
small-pox, but to close the ships would be to expose London
to a definite risk ; it does not need the aggregation of more
than a few cases of small-pox in hospitals situated in a
populous neighbourhood to give rise to an outbreak, and
though this would undoubtedly have the effect of reducing
the cost per head, the total expense would necessarily be
greater. We doubt if this result would be satisfactory to
the Islington Board of Guardians or to any other of the
London local authorities. The Metropolitan Asylums Board,
acting in the interest of the ratepayers, regard themselves as a
sanitary authority, and hold that they are doiDg a more useful
work in preventing disease than in merely providing hospital
accommodation for those who suffer from it. Dr. Edward
Seaton has recently urged that the Metropolitan Asylums
Board are justified in advocating tbe means for preventing
the infection of persons for whom it would be their duty to
provide accommodation if they were attacked with such
illness. No doubt the interests of the ratepayers, both as
regards the saving of life and tbe expenditure of money, will
be best ensured when these two functions are in the hands
of one administration. One of the greatest of London’s wants
is a central sanitary authority.

THE MEAT SUPPLY OF GIBRALTAR.

The authorities at Gibraltar propose to abolish the in-
portation of meat from Tangier. This decision has ilreedr
occasioned loud protests. It is urged that a great number o!
persons derive their means of existence solely from slaughter¬
ing cattle and preparing meat for the garrison and population
of Gibraltar; that it is easier and cheaper to take meat than
live cattle across tbe Strait. In considering this matter, it
must be born in mind that the all-important fortreei of
Gibraltar derives the greater part of its fresh meat supply
from Africa—that is to say, from Tangier. The distance acre*-
the Strait is thirty-eight miles, and the sea is often vert
rough. Nor is there any port at Tangier; the steamer* mo?
anchor in the open bay, and the cattle are brought to them ia
flat-bottomed barges and then swung on board after mneb
labour and trouble. In the face of these circumstances, i:
is much more simple to kill the bullocks at Tangier ud
send the meat over. Thus the trade in meat ha* bea
developed; and not only does it supply work foragret:
number of persons at Tangier, but the sums paid for the u&
of the slaughterhouse go in part to defray the cost of varioa*
charitable institutions. Finally, the town imposed t shilibz
tax on every head of cattle killed, and this pay* th-
wages earned by the scavengers who, at rare intern!',
are sent out to clear the streets. In spite, however, of ii!
these arguments, it is impossible not to approve the actim
of the authorities at Gibraltar. 'The elaughterhouie* at
Tangier, both the Jewish and the Moorish, are indescribably
filthy. In England such establishments would atone*be
closed by the police. They are a standing nuisance and
gravely endanger the public health. No attempt is made to
drain the slaughterhouses. The blood runs away in u
open ditch down to the beach, and falls into tbe sea ckw
to a spot generally selected for bathing. The ditch u
so foul with blood that horses and mules are some¬
times afraid to step over it. Perhaps, now that the in¬
habitants of Tangier find they are about to lose a loov
tive source of income, the necessity of building a props
slaughterhouse and imposing regulations in keeping with
the laws of hygiene will at last be admitted. In any esse,
and in self-defence, the authorities at Gibraltar have done
well to bring euch wholesome pressure to bear. Gibraltar
is intensely overcrowded. At Tangier there is any amount
of vacant space, and the climate is better and the air purer.
It would therefore be preferable that the cattle should be
slaughtered at Tangier; but only if this can be done und*
proper sanitary control, in slaughterhouses with cemented
and well-drained flooring, where the most perfect ventilation
and cleanliness are maintained.

- t

SHEFFIELD MEDICAL SCHOOL.

It will be remembered that the need for fresh premise-
for the Medical School at Sheffield was brought prominently
before the public last October, when a meeting was held a:
Firth College, at which the Archbishop of York and sir
Andrew Clark were present. The amount required wi>
£6000, and the appeal for assistance has been so we!
received that the Council now feel justified in proceeds
with the erection of the new premises. A site containmc
about 550 yards, situated in Leopold-street, opposite Fir-
College, has been secured, and Dr. Bartolomd, president oi
the school, is expected to lay the foundation-stone abou.
the 16tli or 17th inst. The plans which have been prepaid
give the school a handsome outward appearance, and pro¬
vide all the accommodation needed. The main elevation «
entirely of stone, and the treatment a sort of free Class*
Benaissanoe, which will cause the building to harmonise
with the surrounding property. The contractors expert to
have the premises completed by next March.

Thb Laron,]

HERPES IN PHTHISIS.—THE IPSWICH INQUEST.

[Jems 11,1887. 1199

THE IRISH EXAMINING BODIES.

Thk College of Surgeons of Ireland have not abandoned
11 hope that the Irish medical corporations may still com¬
ine to form one examining body. At a meeting held on
aturday last the Fellows of the College adopted a motion
f Sir Charles Cameron to the effect that a fresh attempt
hould be made to procure the much-needed combination,
be General Medical Council having recognised the Apothe-
aries’ Hall as a medical corporation; and, further, they
xpresaed the opinion that, should an attempt again fail,
tie College considers that the Council (we presume that of
he College) should, if possible, form a combination with the
apothecaries’ Hall. The proposal was seconded by Dr. Kidd,
nd carried. We sincerely trust that the Apothecaries’ Hall
vill agree to this course. There is not, we fear, much hope
hat the College of Physicians of Ireland will at this stage
eizs this excellent opportunity of proving that their interest
a the welfare of the profession is so great as to make them
lepart from their previous decision, but the Apothecaries’
fall have before now shown their willingness to combine.

. HERPES IN PHTHISIS.

An interesting paper in the Gazette Midicale dee HGpitaux,
Vo. 9,1887, by E. Barid, brings together much information
m a rare condition met with in tubercular subjects, and
iormulates the following conclusions. Zona is a rare com¬
plication of chronic pulmonary phthisis, usually affects the
;horacic walls, but may occur in the neck, face, loins, upper
ind lower extremities, and even the perineo-genital region,
rhe eruption, sometimes accompanied by motor and thermal
lisorders, has been set down to vaso-motor perturbations
>ossibly of reflex origin, but this explanation is insufficient,
rad the zona of tubercular subjects may be connected with
i tuberculous meningo-myelitis, or more often with a
>arenchymatouB peripheral neuritis.

THE IPSWICH INQUEST.

Thk unfortunate death of Bertha Wall, aged sixteen, a
pupil at the Ipswich High School, has been the cause of
serious differences between the coroner on the one hand,
rad the jury and representatives of the press on the other.
It may be remembered that the body of the deceased was
:'eund in a pond near Akenbam. The evidence went to show
;hat death resulted from drowning; the jury ultimately
■etumed an open verdict. From information received, the
:oroner, Mr. Yulliamy, in the exercise of his discretion,
lecided to proceed with the inquiry with closed doors. The
ury and certain members of the press took umbrage at this,
rad resented it, to the extent that the former refused to
lerve unless the reporters were admitted, and the latter on
beir part insisted on being present. After several adjoum-
nents the case was investigated in private, the Lord Chan-
:ellor having adjudged the coroner within his legal rights in
ixcluding the press. This decision is founded oh statute,
vhich empowers the coroner to conduct his inquiries in
public or private as he may deem fit. Whilst regretting
he exclusion of reporters, we are bound to admit that if
he responsible judicial authority is of opinion that matters
vill transpire the nature of which will be likely to shock and
hjure decency and morals, he is acting wisely in refusing ad¬
mission to the general public. In the present instance no one
leems to have disputed the point that some extraordinary reve-
ations would be made at the inquest—revelations the result
if which it would be difficult to foresee as regards their indi¬
vidual and collective application. We fully acquiesce in the
contention that guilt should be visited with its just reward,
wen to the extent of public exposure, providing public morals
ire not abused thereby. There is a duty to the living as

well as the dead, and no demand can be more urgent than
that which calls for the protection of the mind'of youth
from the exposure of revolting details. Prior to the com¬
pletion of the inquiry the coroner committed a member of
the press for contempt of court, in that he openly advised the'
jury not to be intimidated by the ooroner. The same even¬
ing a writ of habeas corpus was obtained from Mr. Justice
Grantham in the terms asked for—via., that the prisoner
should be admitted to bail pending an application to quash,
the warrant of commitment. The incident was terminated
by the coroner ordering the release of the prisoner, the
latter having apologised for any remark he might have
made constituting contempt of court.

UNIVERSITY COLLEGE, LONDON.

Da. William Ramsay, Principal of, and Professor of
Chemistry in, University College, Bristol, has been appointed
to fill the ohair of chemistry in University College, London,
vacant by the resignation of Dr. Williamson. Dr. Sydney
Ringer, F.R.S., has been appointed Holme Professor of'
Clinical Medicine, in succession to the late Dr. Wilson Fox.'
Mr. Victor Horsley, F.R.S., has been appointed Professor of
Pathology, in succession to Dr. Bastian, resigned. The first
award of the Slade Travelling Scholarship (value £150 per
annum for two years) has resulted in the election of
Mr. Harrington Mann of Glasgow.

PROFESSOR BILLROTH.

A Russian daily paper of the 11th (i.e., the 23rd) of May
announced the death of Professor Billroth, whose work, it
remarked, had been the text-book of the majority of Russian
students. Happily, so far is this statement from/being
correct, that the condition of the eminent surgeon has
greatly improved, and he is now considered completely out
of danger. Dr. Hacker, who is doing his duty for the present,
announced to the class last week that it was hoped that
their great master would himself be able to resume charge
of the clinic after a rest of eix months.

THE APPROACHING COLLEGE ELECTION.

We understand that Messrs. Willett, Brudenell Carter,
George Cowell, and James Rouse are likely to be candidates
for election to the Council of the Royal College of Surgeons.
The retiring members are, Sir T. Spencer Wells and Messrs.
Jonathan Hutchinson and John Wood, of whom the two
former at least will probably seek re-election. Nomination
papers must be sent in before J uly 13th.

CEPHALIC VERSION IN PLACENTA PREVIA.

Dh. Kufferath, Professor of Midwifery at the University
of Brussels, in a clinical lecture on cephalic version, ex¬
presses an opinion that it is bad practice to resort to this
operation in cases of placenta prsevia; we cannot hope,
be says, to arrest hremorrhage by changing a malpresenta-
tion, for the head, in cases where cephalic version is still
possible, will not plug the bleeding surface.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announced:—M. Henri Issartier, Senator of la
Gironde and Mayor of Monslgur. M. ' Issartier had long
given up the practice of medicine, and had devoted himself
to horticulture and scientific agriculture. He published a
treatise on the Cultivation of Fruit-trees and a Course of
Agriculture.—Dr. A. U. Giubner, a well-known Russian
military surgeon.

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1200 The Lancet,] MEDICAL LEGISLATION IN BELGIUM.

[June 11,1807.

THE ILLNESS OF THE CROWN PRINCE.

Dr. Morbix Mackbnzib has again visited the Crown
Prince, and on Wednesday last he removed another portion
of the growth on the vocal cord by laryngeal forceps. The
Crown Prince will travel to London next week, and after
the J a bilee festivities it is expected that a long stay will
be made in the Isle of Wight, so that Dr. Morell Mackenzie
may conclude the treatment of his Imperial patient.

successful. The total deaths were twenty-four, 345 ctw
being stated to have been completely cured. Dr. Schlenngs
concludes that in pyosalpinx, hydrosalpinx, or Inem&tr-
salpinx laparotomy is the only possible resource, and thu
generally speaking, though it is by no means necessary u>
look upon this operation as a dernier ressort, it should bt
performed a9 rarely as possible.

NEW TEST FOR MILK.

PHARMACEUTICAL CONFERENCE.

Amongst other subjects upon which the secretaries of the
Pharmaceutical Conference, wltich is to be held next
August, invite papers, are the following:—The alkaloidal
strengths of narcotie extracts compared with that of the
fresh juice ; the quality of cacao butter ; the application of
dialysis to pharmaceutical processes; the strength of
tinctures and liquid extracts; the cause of the variations in
the value of salicylate of sodium; the active principles of
ergot, senna, colocynth, jalap, aspidium, felix mas, lactu-
carium, senega, taraxicum, and buckthorn.

MEDICAL LEGISLATION IN BELGIUM.

Thk Belgian Legislature has just had before it a new Bill
concerning university examinations and academic regula¬
tions. The proposals to re-establish the arts degree as
obligatory for medical students and a final State examination
for a licence to practise did not meet with much favour.
Some changes were, however, voted in the programme of
medical studies; thus, the special course of embryology is to
be abolished, and this subject included in the course of
genera% and special histology; also the elements of pharmacy,
together with the course on pharmacognosis, are to form part
of the programme for the first Doctorate. The necessity of
a better acquaintance with legal medicine and toxicology
has been recognised, but no fresh examination has been
imposed. Som9 of these changes will doubtless affect the
numerous British practitioners who, under existing circum¬
stances, resort to Brussels for the degree which is denied
them in London. Another regulation has been made as
the result of the representations of Belgian medical men,
Avho have for a long time been complaining bitterly
of the competition to which they have had to submit
from foreign practitioners, especially at Ostend and other
watering-places, for English and German practitioners have
hitherto been able without much difficulty to obtain a licence
to practise in Belgium upon the strength of their existing
diplomas. Now, however, all foreigners will be obliged to
pass an examination and obtain the recommendation of the
central jury before permission to practise in any part of
Belgium can be obtained. _

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin.- -The number of university teachers of all grades
is now 290, of which 104 belong to the Medical Faculty,
including three teachers of odontology.

Vienna —The vacation short courses of practical instruc¬
tion for medical men, which have been held for many years
past during the months of August and September, are about
to be stopped. The prospectus of these courses, numbering
more than fifty, had already been published when this
decision was arrived at.

A new test for water—that is pump water—in milk his
recently been proposed by Herr Szilasi. This depends on tin-
fact that sulphate of diphenylamine is coloured blue by tk
action of an exceedingly dilute solution of a nitrate. As
well water always contains more or less nitrate, its present
in milk can be detected. The test is carried out thoi:
Twenty minims of sulphate of diphenylamine is placed in i
small porcelain vessel and a few drops of the milk which ii
to be examined added to it. If this contains even 5percent,
of average well water, a blue tinge will gradually distinctly
appear. Sulphate of diphenylamine is easily procunbL-.
and only costs about sixpence an ounce, so the test miy br
readily tried. _ .

Thf. Jubilee number of the Illustrated London J«*ii
accompanied by a coloured plate of Her Majesty, in State
Robes, standing near her throne. The work is of the
highest finish, and the delicate flesh tints are copied with
the greatest accuracy. The number itself contains i pic¬
torial history of Her Majesty's reign, and can be wiraly
recommended to all who desire to become possessed of suc.
a souvenir of the event we shall all celebrate on the 2b".
inst.

In Scrifmcr's Magazine for July, Professor D. A. Sargent.
M.D., of Harvard College, will publish, as the fruit of min;
years' practical experience, an article on “The Physiol
Proportions of the Typical Man." In it the author will give
a standard of physical measurement based on the measure¬
ments of 10,000 individuals.

A Reuter's telegram from New York announces that
yellow fever has broken out at Key West, Florida. The
Government has ordered the mails between Key West Md
Cuba to be fumigated, and a strict quarantine is enforced
the northern ports. _

The J ubilee offering of a Royal Standard made by the
young ladies of Reigate to the Royal Medical Benevokm
College at Epsom has been most gratefully acknowledged
by the authorities. _

At the last meeting of the Epidemiological Society I>f-
Thorne Thorne was elected President for the next seeaon.
Mr. R. D. R. Sweeting succeeding him in the office of
treasurer. _

The formal opening of the Exhibition of Articles of Food
and Drink will take place at Amsterdam on the 16th in*
The Exhibition will remain open till the end of September.

We are glad to be able to state that Mr. Lund i? ha¬
proving in health, and progressing rapidly towards recovery.

SCHLESINGER ON LAPARO-SALPINGOTOMY.

Dr. Schi/e singer, chief of Prof. Slavianski’s clinic in
8t. Petersburg, publishes statistics of 274 cases of laparo-
aaJpingotorayfor diseased conditions of the Fallopian tubes.
Only four of them seem to be by Russian surgeons, two by
Prof. Slavianaki and two by Dr. Sutugin, all of which were

Tynemouth Infirmary.—A t a recent meeting 01
the Building Committee of this institution, it having W*
intimated that the Dowager Duchess of Northumboii**
would be unable to perform the ceremony of laying ^
foundation stone, it was agreed that the stone mould!*
laid by Mr. R. M. Tate, president of the committee.
ceremony will take place on the 21st inst.

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HB LAlfGBT,]

THE MANX CLIMATE.

[Junb 11,1887* 1201

THE MANX CLIMATE.

By Alfred Haviland,

JOB OF "CLIMATE. WEATHER, AND DISEASE." “ THE <1KO<<RAPHICAL
DISTRIBUTION OF HEART DISEASE, CANCER, AND PHTHISIS
IN ENGLAND,” ETC.

[Ayr there are who will for a loDg time remember the
!, frosts, and snowstorms of the winter, which we all
e has at length left us, although the snows of April and
fogs of May have combined to keep it fresh in the
oories of the Londoner and of many an invalid in what
been called the sunny south. There is an erroneous
resaion deeply engraven in the public mind that the
;her one goes north the winters become colder and
summers less genial. As a general proposition there
be no doubt that this is true; but the climates of the
•Id are made up of factors, which, whilst obeying the J
nutable laws of nature without exception, are neverthe-
80 interdependent the one on the other as in no two
jes on the face of the earth to be found in exactly the
le combination, and therefore identical in results. Our
it oceanic currents are grand secondary factors in both
general and local climates of the earth, and all of
3e we know to be influenced by the present con-
iration of the great continental areas, their initial
jctinn having been originally determined either by that
powerful and constant air currants (prevailing winds),
iy differences in the temperature between equatorial and
ar waters, or by both causes combined. Let the reader
suit the admirable map of oceanic currents in the
hyeical Geography ” of the late lamented Keith Johnston
lose young life was so recently sacrificed to his devotion
geographical exploration), and he will see the course of
south equatorial current from the S.E. to the N.W.
jcted by the north-east coast of South America until it
shea the Gulf of Mexico, where the land turns it back, so
t after its emergence from this inland sea it is diverted
rply to the N.K. by the south-east coast of North
erica, and, continuing in the same direction, sweeps by
British Isles and the north-west coast of Norway far
ond the Arctic Circle, carrying with it the genial warmth
h which the south-westerly or anti-trade winds load
inselves in their passage over it, and then disseminate
oughout Western Europe; Cornwall, Ireland, the Isle of
n, and the western isles and coast of Sootland enjoying
he fullest extent, from greater proximity to their source,
3e warm air currents m all their nascent parity; the
lit being, as described by Sir A. C. Ramsay in his
lysical Geology and Geography of Great Britain,”
t, where these genial influences are first felt, certain
den plants grow through the winter, and even in the far
th-west of Scotland, which the winter cold of Middle-
kills. “ 1 have seen,” he says, “ fuchsias growing all the
r round on the shores of Loch Erribol in Sutherland.”

[ow, the Isle of Man enjoys all the genial influences
ribed to climates begotten of the Gulf Stream to the
eet extent; it therefore will no longer be a matter of
ider that when the befogged and befrosted southerner
led on her shores last winter, or even during this spring,
began to think that the learned Dr. John Maccullocb, in
ting to Sir Walter Scott, was somewhat hasty in his
demnation of. the opinion of “ the author more pro-
nd than all his predecessors,” who firmly believed that
na was the Elysian plain of Homer, “where ocean
ays sends forth the gentle blowing breezes of the west
id," for had he not just emerged from the Cimmerian
kness of foe-capped London, or just been dug out of a
w drift ? With a mind filled with such late experiences,

. impressed with the notion that the winters increase in
erity as one goes northward, we ought not to be surprised
iis giving in his adhesion to the Elysian theory when he
nd, on landing, no trace of winter, no snow, no fog, and
y the history of a brief frost, and when the self-registering
rmometere and the sunshine recorders told him of the
.t and light enjoyed in Mona at a time when he was
ding his morning letters in London by gas-light, or
og driven in tandem cabs, at extraordinary fares, over
Janches through its streets. This is no exaggeration,
, on the contrary, a tame picture of what was ex-
ienced by hundreds of visitors last winter and thi9 spring,
many a winter and spring before.

The Isle of Man suffers from the ignorance of the public
on two subjects—climatology and geography. The former
is not taught in medical or any other schools in England,
and the average Londoner and Southron gets sorely puzzled
when asked to define the geographical position of Manx-
land ; he generally has no notion whatever about Mona,
and if he has somewhere or somehow heard of her, she is
generally inextricably mixed up in his mind with the Ialo
of Wight or Iceland, or in the poetico-geogjaphical mind
with Ultima Thule; although some learned Londoners will
tell you that the peculiarities of its fauna—to wit, the
taillessness of its cats and poultry—“differentiate” Mona
from Vectis; this is a grand peg on whioh many memories
are hung. This ignorance is strange when we consider
how much interest this lovely island of grand mountain,
sea-cliff, and glen scenery has created in times gone by; but
perhaps people were then more learned and less “ crammed ”
than they are nowadays in this age of competitive examina¬
tions.

The learned Dr. J. F. Berger, who visited this island in
1811, when he examined its geology, took the temperature
of its springs, and measured its mountains, in company with
Mr. Thomas Scott, the brother of the “ author of Waverley,”
tells us that it was in the Isle of Man that the first attempt
was made to use the barometer to determine the altitude
of a mountain in Great Britain, and that this experiment
was first made by the good Bishop Wilson on Snaefell, by
which he approximately ascertained its height; the original
experiment, pointed out by Pascal, having been first per¬
formed by Terier (his brother-in-law) on the Puy de Dome,
September 19th, 1648. Bishop Wilson came over to the Isle
of Man in 1698, where during his long residence he made the
experiments that led him to the elevation of Snaefell, which,
according to the latest survey, equals 2034 feet. It is also
interesting to note that during his stay in the island
Dr. Berger took “the temperature of several springs (thirty-
one) in all parts of the Isle of Man, to deduce by approxi¬
mation the mean temperature of the climate of that island,”
and that he concluded from these experiments “ that the
mean annual heat in the Isle of Man ” was 49’99°.
Mr. Alexander Buchan, M.A., F.R S.E., and secretary to the
Scottish Meteorological Society, from observations ranging
over a period of twenty-tbree years (1857-1880), makes it
49 00. For Dr. Berger's interesting observations I must
refer the reader to the Transactions of the Geological Society
of London. Following the Bishop’s example, Dr. Berger
measured the altitudes of seventy-seven mountains and
other heights, twenty of which ranged from a thousand to
nearly two thousand feet above the sea level. __ These heights
he determined by the barometer, and in hiis calculations
made use of Professor Leslie’s sliding scale.

From the past I will now proceed to the present. During
the exceptionally cold winter quarter of 1886 there actually
occurred in the Isle of Man, to the astonishment of most
Manx men, a snowstorm which will be long remembered as
a most unusual occurrence, like the only too historical
snowstorms that have occurred at Melbourne since 1849—
namely, those of August 29th, 1849, and July 26th, 1882.
As the Isle of Man suffered from the effects of the
exceptional winter of 1886, it will be well to see how it
came out of the ordeal by comparing the Manx and the
south coast winter quarters of that period, Douglas repre¬
senting the Isle of Man, and Tfuro, Plymouth, Torquay,
Ventnor, Eastbourne, Osborne, Southboume, and Brighton
representing the south coast of England. The mean monthly
temperatures were as follows:—

Jan. Feb. Mar. Mean.

Douglas. Isle of Man . 38 9° ... 38-8° ... 39-2° ... 38-98°

South Coast (eight stations) 38 5° ... 36-1° ... 39-»° ... 38-38°

Temperature at Douglas. *0 - 4* ... *2 4° ... t0'7° ... - 072°

•Excess. t Defect.

These figures speak for themselves, and prove how well
Douglas holds its own while the southern health resorts are
arrayed against her, even during such an exceptional winter
quarter as that of 1886.

I will now give Mr. Thomas Keig'a report of his observa¬
tions made during the three meteorological winter months
(December, January, and February, 1886-7) for Douglas
Dec. Jan. Feb. Mean.

Mean Maximum ...* 42-89° ... 44-48° ... 48 03° = 43 13°

Mean Minimum . ar96° ... 37-34° ... 42 06° = 38-13°

Mean Temperature . 38-92° ... 40 91° ... 42 01° = 40-62°

Such are the results of two exceptional winters. The
Manx winter is, however, remarkable for its mildness, its

O

1202 Thh Lanckt,]

THE HOSPITAL 8UNDAY FUND.

[Juris 11,1887.

mean temperature .mounting to 4210°, whtoh i« Mgbartj.au on
five out of the six south coast counties—namely, Kent^39 J . Lf
Sussex 4O0 c ; Hants, 407°; Dorset, 40 9 ; Devon, 42 0 ; and w
Cornwall, 44‘8°; the last being the only county the mean M
temperature of which exceeds that of the Me of Man; the se
mean temperature of these six counties being 413 , or17 w
colder. Added to the mild temperature and comparative
freedom from snow and frost, which characterise the Manx y,
winter, the visitor should remember, when hesitating 0(
between going abroad and going to the Isle of_ Man, that u yy
the latterhe Heed not fear either the cholera,thetattnl^or jj
A arthnuMbes and that in sunninees it ranks next to tne jj
■C hannel Islands, which are the sunniest partsoftbe British j
as shown by Mr. A. W. Moore, M.A., in ms tl

“Manx Note-book” Let him remember, too. that the 0
Isle of Man lies within 54° lat. N., or more than three H
degrees further north than the south ooast, and he will p
then be prepared, after what has been said, to purge his u
mind of P the fallacy that the winters must ii

become colder and the summers less genial the further c

one travels from the south to the north. a

_ c

t

THE HOSPITAL SUNDAY FUND. J

On the 6 th inst. a public meeting was held at the Lambeth J
Palace Library in support of the hospitals and medical t
charities in Lambeth participating m the Hospital Sunday t
Fond. The meeting was the first of a series of public meet- ]
ings to be held during the next fortnight in eight different
districts of London for the purpose of ^smg pubhc
interest in the pecuniary needs of thfe hospitals The chair ,
was occupied by Lieutenant-General Fraser, M.P., at the (

‘MMa w-asTi

importance of maintaining the hospitals and medical
charities in the utmost efficiency. In furtherance of this
S 1 M.POM the clergy and the ministers of religion
?o 3 point out^the advantage of giving to the Hospital
Sunday Fund, owing to the nominal cost of so collecting
funds for hospitals, and to make an earnest appeal to the
people to so increase their coajnbutionsasi toMguwthat the
whole sum collected shall not be less than X100.0W). The
■Rev Arthur Jephson seconded the resol utiou, and the Rev. Her¬
mann Gallaney, speaking on behalf of the Hebrew community
SwSth supported it. The resolution having been carried,

Mr Henry’ C. P Burdett, chairman of the Executive Com¬
mittee mfved the second resolution -.—“That this meeting
regrets to learn that the expenditure and liabilities of the
h„?ntol. . n d medical charities in this district in Ithe year
1886 exceeded the ordinary income by more than £ lOfiOO,

and pledges itself to increased exertion ^th^view of

preventing any like deficiency during the current year.
&V .0 Rev Newman Hall seconded this resolution, and the
Chairman having supported it, it was earned unanimously.
A vote of thanks to the Archbishop of Canterbury for pre¬
siding and granting the use of the library for the purpose
of the meeting brought the proceedings to a close.

On the 7th inst. a meeting was held at the Paddington
vwlw iT«n the Rev W. Abbott in the chair. Amongst
CholTpSt wefe B„ocFerdiaand da Rothschild, Mr,
Rnrdett Hon. Henry Noel, and Mr. E. Parker ^ oung.
AfteTsoine introductory remarks from the chairman, Baron
•Ferdinand de Rothschild, in a very able speech, setting forth
♦h« needs ob welt as the merits of our general hospitals,
SSeSft “ Ihow bow very email was the.proportion of
thTamounts collected from year to year in aid of the
Hospital Sunday Fund (£40.000) in so large and wealthy a
Si as London, and contrasted the enormous amount
in pleasure and fancy articles of dress, especially

the second resolution proposed on the 6th inst. at the
Lambeth meeting, and which was unanimously adopted,, ii i
was also a vote of thanks to, the chairman and to Mr. |
Michelli, secretary of St. Mary s Hospital, and Mr. Byu,
secretary of Queen Charlotte’s Hospital, the hon. secretane*.
who had been at the trouble of organising the meeting. ,
On the 8th inst. a meeting was held at the Hampstaid
Vestry Hall, Haverstock-hill. Lord William M. Comptm
occupied the chair, and was supportedl by S* Sydney71,
Waterlow, Sir Joseph Fayrer, the Rev. Sherrard B. Busto.
M.A (vicar of Hampstead), the Rev. Dr. Kennedy. Mr R f.
Horton, M.A., Mr. J. S. Fletcher* J.P., Mr. G. H.Powsm,
J.P., and others. The receipt of letters wasannomic^froj
the Marquis of Lome, Lord Cranbome, Lord Blades, ud
others, expressing regret at inability to be present, in
Rev. S. B. Burnaby moved the first resolution, whua
pledged those present to use every endeavour to arrow Ua
inhabitants of Hampstead and north-west London to tf
importance of maintaining the hospitals and °Aer m«haj
charities in the utmost efficiency, and called on tbsi cl«g
and other ministers of religion to earnestly &ppe»j to tlwj
congregations to assist in securing a collection of notjes
thaa £100,000 for the Hospital Sunday Fund, sgMj
the £40,390 collected last year. Sir Sydney Wattdo*
seconded the resolution, and it was
Sir Joseph Fayrer moved, and Mr. R. F. Horton
a resolution pledging the meeting to increased setmtf
behalf of the local hospitals and dispensaries, which w
also carried unanimously, and a cordial vote of thuikJ.
Lord W. Compton for presiding terminated the meeting.

A meeting was held on the 8th inst, at the Rmk Hd.
Blackheath, Mr. Henry Green in the chair. Mr
M.P., Sir- Edmund Cume, Admiral the Hon. t. Kgwt*
Mr. G. C. Whiteley, the Rev. Rhodes Bristow, D. Hath t#

: C. Wilson, and Mr. Burdett being the speskera Rw
pointed out that the south-eastern[district, with upwsrk^
1000000 inhabitants, contained but 486 hospital befli
which only 374 were occupied in 1886 owing to swaU
; funds. The apparent deficiency between
' expenditure amounted to £2800, but the
> was quite £8000. The crowded districts of
1 Deptford, and Bermondsey, with Greenwich and Lem^
' were very inadequately supplied

! tion and the necessity of increasing the nseofth« JBl J

Hospital was idmbwju ,

Reith urged that if Birmingham, which h«f
seventy places of worship, could collect £5000
Sunday, then London, with 2000 contributing coogre*
tions, was able to raise on the same average at *•
£150,000 every year. Mr. Burdett, referring M Co¬
operation and presence of Lord Salisbury, the Du
bridge, Lord Rosebery, the Archbishop or CsnJjJgjJ
Randolph Churchill, and other eminent men, regretw»
the lockl members of Parliament for OwjawgJ gj
district did not apparently care enough fo* (

suffering of south-east London to follow so ««e!W
example as that set them by their leader the Prime MuuJ
He was glad to see Mr. Whiteley at the meeting, ari to bt«
to report that in every other district ofi Londojtttj*
members of Parliament were doing their utmost to WP
hospitals/ There was a statement made bv Mr. RnM
the local press to the effect that Hospital Sunday ]
the Royal Kent Dispensary and wasnot an
to the hospitals. This was not the fact, for where*
Royal Kent Dispensary received on an wngej_r
annum from church collections in the ten ye« P ..g
the establishment of Hospital Sunday, during th 5

years of the fund the grant to the dispensary
£ 130 , and during the last three a*

annum. As to its effect on the hospitals as a wh «, ^
been shown by the production of the actual &#***
allowing for the increase in population for
circumstances. Hospital Sunday had benefited
hospitals to the extent of £ 20,000 per annum, by
the voluntary incomes of these institutions _had
daring the years it had been established in tee
In otheT words, wfiereas the expenditure of

hbLancwt,] REOPENING OP THE PUMP ROOM AND BATHS AT LEAMINGTON. [Junk 11,1887. 1205

3YAL COLLEGE OF SURGEONS IN IRELAND.

. meeting of the Fellows, presided over by Sir William
kes, was held on Saturday, the 4th inst., to receive the
ual report of the Council, and for the consideration of
:aiu notices of motion by Mr. Thomson and Sir Charles .
aeron.

'he tenure of office and election of vice-president was
t discussed, consequent on a resolution of the Council
sed last March, and a motion that it should be adopted
the College was proposed by Mr. W. Stoker. At the
gestion of Mr. Chaplin, however, it was resolved that the
retary to the Council should be instructed to call the
mtion of the in-coming Council to the matter, and that
teeting of the College should be called to consider the
Dlution.

lr. Thomson’s notice of motion then came on for discus-
i. It was as follows“ That, having regard to the
jrests of medical education in Dublin, it is desirable to
linish, as far as possible, the number of proprietary
ooI f, and that, with a view to carrying out this principle,
e an instruction to the Council to take such steps as may
necessary to effect, in the first instance, an amalgamation
ween the College School and the Carmichael College of
iicine.” In the course of his speech Mr. Thomson stated
willingness to withdraw the word “ proprietary ” in his
>lution. There was a debt of £6500 on the Carmichael
lege, the interest of which it was intended should be
ally defrayed by the professors of both medical schools.
Kidd thought if amalgamation took place the teachers
ild be better paid, and the classes of students in at-
dance better looked.after. He moved that the words
(uitable terms” be added to the motion, which was
uiesced in. Mr. Bennett spoke against the proposal and
sidered that the fusion of the two schools named could
be carried out with advantage. Mr. Macnamara thought
Grange that in the report of the proceedings of the Council
Fellows did not receive the information they were
tied to in respect to this matter. There was, he said, a
ority of the Council against the scheme, and a protest
been made against the proposed amalgamation by a large
ority of the professors of the College itself. It was also
trary to the Supplemental Charter to bring in a great
ly others connected with a school outside the College
If. Mr. Barton declared his opinion that it would
% mutual advantage to both schools to become amal-
lated. The increase in the number of professors would
gradually reduced in course of time. Mr. W. J.
ter, Mr. Jacob, and Mr. Fifrgibbon also spoke in favour
he motion. Mr. Hamilton asked why the Fellows
he College should force upon the professors of the
ege the burden of debt of £6500. He was always
Daed to amalgamation. Three years ago the scheme,
n brought before the Council, had been negatived, and
, second occasion a similar result had occurred. He had
red, if a majority of the College professors were not
)$ed to the scheme, not to take any action in the
ter; but if otherwise, he resolved to throw himself heart
soul into the opposition. He thought if the competi-
from the extramural schools were removed it would
.end to the advantage of medical edncatioD. He believed
reason the College school fell away was because the
nders ” and demonstrators bad been discouraged; but
ad not the slightest doubt of its ultimate success. A
don took place, and on the votes being counted a slight
onderance was shown on the side of those objecting to
motion, and by request the names were taken down,
re. Robinson and Jacob were appointed by the President
jrutineere, and as a result it was found that 27 voted
ind 30 against Mr. Thomson’s motion, which was
rdingly declared lost by the President.

■ C. Cameron’s motion, in consequence of the lateness
ie hour, was adjourned to Monday, when it camo on for
deration. The motion was—“ That the College regret
itilure of the attempt to unite the Colleges of Physicians
Surgeons and the Apothecaries’ Hall for the purpose of
ng examinations. The College is of opinion that a
attempt to effect this tripartite combination should be
made, the Medical Council having recognised the
hecaries’ Hall as a medical corporation ; and should an
apt again fail, the College considers that the Council
[d if possible, form a combination with the Apothe¬

caries’ Hall.” Sir C. Cameron pointed out that the Apothe¬
caries’ Hall was now a legal licensing body, and showed
that a moderate fee, some £10, would be the cost of their
diploma. They were capable of giving a registrable diploma,
which was eligible for Poor-law vacancies and for the
services, &c. It was extremely unlikely that the College of
Physicians would join with the Apothecaries’ Hall, and it
was therefore of great importance in the interests of medi¬
cal education that the College of Surgeons should form
a combination with that body. Dr. Kidd seconded the
motion, which was opposed by Mr. Chaplain, who moved
as an amendment that the last clause in the resolution
be struck out. This amendment was seconded by Sir George
Porter, but on being pat to a division it was lost, and Sir C.
Cameron’s motion was adopted.

THE REOPENING OF THE PUMP ROOM AND
BATHS AT LEAMINGTON.

On the 1st inst. the Royal Pump Rooms, Leamington,
which had been closed for several months for purposes of
repair, improvement, and renovation, were formally re¬
opened by the Right Hon. A. W. Peel, Speaker of the House
of Commons. The proceedings commenced with a luncheon
at the new Town Hall, at which upwards of 300 wero
present, including a large number of representatives of the
medical profession from the neighbourhood and various
midland towns. After the luncheon a procession was
formed from the town hall to the Pump Rooms, where there
was a large assembly of spectators to witness the opening
cerfsmony.

The Speaker, who presided, in opening the proceedings
spoke of the pleasure it gave him to take part in that large
gathering, and said he trnsted that the reopening of these-
baths would greatly contribute to the prosperity of the
borough. Having alluded to the curative properties of the
Leamington waters, he expressed the hope that those per¬
sons who were in the habit of recruiting their health by
having recourse to the continental spas would not forget
that they might procure as much benefit by the use of the
waters at home.

On the motion of Dr. T. W. Thursfleld, a hearty vote of
thanks was given to the members of the medical profession
who had come from varions parts of England to assist in the
proceedings. The compliment was Acknowledged by Dr.
Garrod, who argued at considerable length that the most
beneficial results often followed the judicious employment
of saline baths and drinka.

Mr. Oliver Pemberton combated the popular idea of
sending patients away to foreign spas while there was
adequate provision at home. Dr. Burney Yeo also responded.
Dr. Eardley Wilmot proposed a vote of thanks to the
visitors. The motion was adopted, and the High Sheriff
and Sir A. Hodgson responded. On the proposal of the
Mayor of Leamington, a cordial vote of thanks was given to
the Speaker for his attendance that day, and the Speaker
having acknowledged the compliment, the proceedings closed.

In the evening the bathe were thrown open for pnblio
inspection, and were visited by many hundreds of th»
inhabitants of the town.

IJaMic ai its fak

LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF THB INSPECTORS OP THIS MEDICAL DEPART¬
MENT OF THB LOCAL GOVERNMENT BOARD.

Diphtheria in the City of Winchester, by Dr. Parsons.—
Winchester has more than once been inspected by officials
from the Local Government Board. But it is satisfactory'
to note that, whereas when Mr. Power visited the city in'
1877, on account of the prevalence there of fatal diarrhoea,
water was derived partly from wells, there was no system,
of sewers, cesspools being in general use, and cesspit privies,
were discharging into drains, Dr. Parsons now reports that a
sewerage scheme has been carried out, that cesspools bare
been abolished, that the Water Company’s service- is all bub

Digitized by GoOgle

1204 Thb Lancet,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[Jen 11,1887,

general, that an infectious hospital, disinfecting stove, and
mortuary have been provided, and that a great improve¬
ment has been effected in the house property. Winchester
has certain defects which attach to the locality in which it
is placed. Much of the city stands on an alluvial flat, the
alluvial deposits containing an impervious bed of peat, upon
the configuration of which subsoil water is held up as in a
cup. But the disease which has recently been under investi¬
gation seems to have had no connexion either with these
special physical circumstances or with any of the remaining
sanitary defects. The diphtheria, which, together with
suspicious sore-throats, attacked eighty-three persons be¬
tween April, 1880, and March, 1887, was scattered in all
parts of the city, the high-lying chalky slopes suffering in
common with the low-lying alluvial bed; the attacks were
found at each extreme of the social scale; and in many
of the houses attacked there was no obvious sanitary defect.
In nineteen of the thirty-nine houses attacked, the first case
was a child attending day-school, and in several instances
there was in the street opposite the house affected a sewer
ventilator which was stated to have caused offensiveness.
No such defect was, however, detected at the date of Dr.
Parsons’s inspection. Milk could be set aside as the cause of
this disease, and, after careful investigation, it appeared that
the spread had been mainly brought about by reason of
contact with a number of ill-defined attacks of sore-throat,
which, though from a clinical point of view they may not
be described as diphtheria, are yet etiologically Of the same
nature. A number of these cases are given, one group show¬
ing that the paralysis of the muscles of accommodation in
the eye was the only symptom apparent, and that the cases
were sufficiently numerous to have led one schoolmistress to
imagine that the eye affection itself was of an infections
character. In a case of three adults it was found that One
man with sore-throat was given some drink in the same
mug with two other men. Both of the latter were, within
two or three days, attacked with genuine diphtheria, one
having paralysis of the soft palate.

The Sanitary State of the Okehampton Rural District,
by Dr. Blaxall. —The sanitary state of this district was
inquired into in connexion with the administration of the
Public Health Act in the locality. Many of the dwellings
were found to be of a very inferior character, having stone
floorings, and otherwise affording evidence of dampness.
Water supplies, except in certain specified places, are
exposed to excremental pollution, and in some instances
supplies still remain in use, although they have brought
about enteric fever, and are derived from sources which
continue to be open to suspicion. Certain towns and
villages have sewers, but even in these cases such
matters as ventilation and flushing need attention. Pig¬
keeping and excremental and other nuisances also obtain
to a considerable extent in the district. In April, 1888,
parochial committees were appointed by the sanitary
authority, but Dr. Blaxall could not learn that any action
had resulted from this step. Neither the work of the
medical officer of health nor that of the inspector of
nuisances is held to have been what the sanitary circum-
etances of the district should have demanded; and the
remuneration of the former is held to be altogether in¬
adequate to secure such services as are called for. On the
whole, this district does not bid fair to do much towards
removing those conditions of ill-health which so freely
obtain throughout a large portion of its area.

Spilsby Rural District. —The death-rate for this district
during 1886 was 14*83 per 1000. The rate quoted in our
issue of May 28th was th§ average of the preceding twelve
years._

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 4861 births
and 3452 deaths were registered during the week ending
June 4th. The annual rate of mortality in these towns,
which had been 20*3 and 20*4 per 1000 in the preceding
two weeks, declined last week to 19*5. During the first
nine weeks of the current quarter the death-rate in these
towns averaged 20*6 per 1000. and was 1*5 below the mean
rate in the corresponding periods of the ten yean 1877-86.
The lowest rates in these towns last week were 12*8 in
Derby, 13'2 in Portsmouth, 13*7 in Brighton, and 16 3 in

Leicester. The rates in the other towns ranged upwuG
to 25*9 in Newcastle-on-Tyne, 26'4 in Blackburn, 271) ■
Norwich, and 30*6 in Manchester. The deaths referred to th
principal zymotic diseases in the twenty-eight towns, whirl
had been 632 and 622 in the preceding two weds
further declined last week to 621; they included 252 fna
measles, 143 from whooping-cough, 44 from scarlet fey*
34 from diarrhoea, 26 from diphtheria, 22 from “fevrr
(principally enteric), and not one from small-pox. S|
death from any of these zymotic diseases was registers!
during the week in Derby, whereas they caused H
highest death-rates in Birkenhead, Norwich, and
chaster. The greatest mortality from measles occurred k
Brighton, Sheffield, Liverpool, Oldham, Salford, Newcuth-
upon-Tyne, Birkenhead, Norwich, and Manchester; and fna
whooping-cough in Birmingham, Bolton, and Plymooti
The 26 deaths from diphtheria in the twenty-eight ton
included 15 in London, 2 in Liverpool, 2 in Manchester, ud
2 in Oldham. No death from small-pox was registered a
London or in any of the twenty-seven large pro mat
towns. Only four cases of small-pox were under treat emt.
on Saturday last in the metropolitan hospitals recerin
cases of this disease; one new oase was admitted duriu
the week. The deaths referred to diseases of the reqi-
ratory organa in London, which had been 289 and 333 a
the preceding two weeks, declined again last week to 26*.
and exceeded by one the corrected weekly average. TV
causes of 84, or 2*4 per cent., of the deaths in the twenty-
eight towns last week were not certified either by t
registered medical practitioner or by a coroner. All tV
causes of death were duly certified in Bristol, Portsnoctfi
Brighton, Preston, and in six other smaller towns. TV
largest proportions of uncertified deaths were registered it
Leicester, Nottingham, and Salford.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch town
which had been 21*3 and 22*6 per 1000 in the precedut
two weeks, declined to 19*8 in the week ending June kt
this rate exceeded, however, by 0*3 the mean rate dura*
the same week in the twenty-eight large English tcvu
The rates in the Sootch towns last week ranged from lo¬
in Aberdeen and 17*8 in Perth, to 21*2 in Greenock ud -
in Leith. The 495 deaths in the eight towns last wee
showed a decline of G9 from the number in the prenoe
week, and included 32 which were referred to whooping-
cough, 5 to scarlet fever, 4 to measles, 4 to diarrhoea, J •
diphtheria, 2 to “fever” (typhus, enteric, or simple), •*
not one to small-pox; in all, 60 deaths resulted from tW
principal zymotic diseases, against 72 and 82 in the pre¬
ceding two weeks. These 60 deaths were equal to u
annual rate of 20 per 1000, which was 0*9 below the men
rate from the same diseases in the twenty-eight Engiii
towns. The fatal cases of whooping-cough, which h-
steadily increased in the preceding four weeks fra
31 to 43, declined again last week to 32, and incluA
11 in Glasgow, 10 in Edinburgh, 5 in Dundee,

4 in Leith. The deaths from scarlet fever, measles, die-
rhoea, and “fever,” showed a considerable decline fro:
recent weekly numbers. Three deaths from measles and
from diarrhoea occurred in Glasgow; and 2 of the fau
cases of scarlet fever were returned in Edinburgh. TV
3 deaths from diphtheria included 2 in Glasgow. IV
deaths referred to acute diseases of the respiratory orgi»
in the eight towns, which had been 126 and 109 in the pre¬
ceding two weeks, further declined last week to 102, fcf
exceeded the number returned in the corresponding week *
last year by 12. The causes of 64, or nearly 13 per ceaM*
the deaths registered in the eight towns during the ***
were not certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been eq* 1
to 26*4 and 24*1 per 1000 in the preceding two wed*
farther declined to 21*4 in the week ending June 4t-
Daring the first nine weeks of the current quarter tV
death-rate in the city averaged 28*7 per 1000, the wu
rate during the same period being but 18*6 in London
196 in Edinburgh. The 145 deaths in Dublin Isst w
showed a further decline of 18 from the number* In t>
previous two weeks; they included 10 which were refar*
to measles, 4 to scarlet fever, 3 to " fever ” (typhus, ent**-
or simple), 3 to whooping-cough, 1 to diarrhoea, and non*

Ti» Lancbt,] 1

THE HEREDITY’OP TUBERCULOSIS.—PLACENTA PRJ2VIA. [June II, 1887? 1-206'

ther to small-pox or to diphtheria. Thus the deaths re¬
nting from these principal xymotic diseases, which had
creased in the preceding four weeks from 19 to 27, do¬
med again last week to 21 j they were equal to an annual
te of 31 per 1000, the rates from the same diseases being
9 In London and 21 in Edinburgh. The fatal cases of
eaales, which had been 8 and 17 in the previous two weeks,
iclined again last week to 10. The deaths from scarlet
ver exceeded the average numbers in recent weeks; while
>ose from “fever’' corresponded with the number in the
■eceding week; The deaths of infants showed a consider.-
>le increase; while those of elderly persons were fewer than
1 any previous week of this year. Five inquest cases and
deaths from violence were registered; and SO, or more than
fifth, of the deaths occurred in public institutions. The
meet of 24, or, more than 16 per cent., of the deaths
igiatered during the week were not oertifled.

THE SERVICES.

WajbP Officb.— Army Medical Staff: Surgeon-Major
rank Pout is granted retired pay, with the honorary rank of
rig&de-Surgeon (dated June 4th, 1887); Surgeon-General
rchibald Henry Fraser has been granted retired pay (dated
[ay 18th, 1887); Surgeon-Major William Taylor, M.D., has
sen seconded on appointment ap Surgeon to his Excellency
le Cottimander-in-Chief in India (dated Dec. 26th, 1886).

Admiralty. —The following appointments have been
lade:—Inspector-General of Hospitals J. Breatky, to Haslar
lospital; Staff Surgeon B, Bensbaw, to the Sylvia; Staff
urcfeon E. W. Williams, to the Defiance; Surgeon W. E.
piller, to the Duncan; Surgeon N. H. Atock to the Nelson;
ad Surgeon John F. Bate, to the Sealark .{dated May 23rd).

Royal Artillery Militia— 9th Brigade, North Irish
ivision: Surgeon-Major A. Skipton resigns his commission
la ted June 4th, 1887).

Rifle Volunteers.— 2nd Ayrshire: Acting Surgeon R.
irvan, M.D., to be Surgeon (dated June 4th, 1887); Surgeon
Girvan, M.D., is granted the honorary rank of Surgeon-
[ajor (dat^d June4th, 1887).—1st Dumbartonshire: John
fylie, ME., to be Acting Surgeon (dated June 4tb, 1887).—
et Volunteer Battalion,the South Staffordshire Regiment:
cting Surgeon Thomas Edgar Underhill, to be Surgeon
la ted June 4 th, 1887).—6th (West) Suffolk: Edgar George
Arnes, M.D., to bd Acting, Surgeon (dated June 4tb, 1687);
ad Arthur Worlledge Alazigb, to bo Acting Surgeon (dated
une 4th, 1887). __

Comsptthntt

“Audi alteram partem.”

THE HEREDITY OF TUBERCULOSIS.

To the Editors of The Lancet.

Sirs,— The leading article on this subject in The Lancet
if last w eek induces me to offer the following remarks:—

The breeds of domesticated animals afford the best oppor-
unities to trace the working of heredity, both physio-,
ogical and pathological. The practice of breeding in-and-in
s the one chief reason why heredity is so marked in cattle.
Vithout entering on the abstract differences between an in-
terited disease and an inherited liability to fall into disease,

; shall state an unambiguous case of inherited tubercle that
lappened lately within my experience. Being in the
iorth of Scotland last Christmas, I went one day to see
l relative who has a farm. He happened to mention
hat if I bad come a day earlier 1 might have assisted
Lt the post-mortem examination on a diseased calf. From
vbat I learned on inquiry, I was led to request that the
jody might be dug up (it was merely buried temporarily
inder a mound of earth owing to the intense frost in the
ground), and I was rewarded with a spectacle of bovine
.ubercle such as I had not seen before. All the serous
mrfaees of the abdomen were thickly studded with enormous
lee&ile and stalked masses of rounded and flattened tubercles,
ike thick spelter buttons, with reddish lines of vessels on
:he grey surface. The calf was eight months old, and had
ie ver thriven, although it had lived through the best season

of the year. The new growths, which were like flat sarco¬
mata of dense texture, or like fibromata, as bovine tubercles
often are, had every appearance of being a slow or Chronic
formation. The evidence of heredity was conclusive. This
calf, as well as four others on the farm, was after a short¬
horn bull, which had begun to waste in like manner, and
had been destroyed in hie third year; and my informant
assured me that the interior of the carcase presented just
the same appearance as in the calf at that moment under,
our eyes. The bull had been purchased, when a calf, at the
annual sale of young stock by a breeder of short-horns well
known in the county. The four other calves by the earn©
sire were in good condition; one of them had shown ‘ some
joint weakness, which is occasionally 1 an early indication of
tubercle. The. dam ef: the diseased calf, a short-horn cow
without pedigree, did not appear to be ailing in any way.
There is nothing unusual in this case, which came under my
notice quite casually; veterinary surgeons are constantly meet¬
ing with facts of the same kind, and they seem to regard the
tuberculous diathesis as part of the strain or breeding of sueh
animals. Those of them who practise in breeding districts are
well aware that the complete dispersal of a pure-bred herd is
not unfrequently owing to the subtle invasion of hereditary
tubercle among the stock from in-and-iii breeding, and to
the impossibility of eliminating it without a general
clearance. Such of us as have not assented to Dr. Koch’s
upsetting doctrine of the parasitism of tubercle, do not
find any great difficulty in dealing with the facts of
heredity, or in finding a place for them‘in our synthetic
judgment of the disease as a whole. I would respectfully
ask those who are still uncommitted by any declaration on
the point in question to consider once more on how
slender a thread of experimental evidence Dr. Koch’s allega¬
tion of “pure culture” of the tubercle bacilli rests. The
New Sydenham Society has done a great service to the
English profession in including Dr. Koch’s memoir in the
volume of essays recently translated under Mr. Watson
Cheyne’s editorship. Dr. Koch remains, I believe, still the
only experimenter who has parried eut the whole procedure
from first to last, including the separation of tne bacilli
from the tuberculous substance in which they occur, and
the inoculation of animals with the parasites in a state of
purity, as he thinks. The evidence is thus to be found
within narrow limits, and the crucial part of the evidence
is all contained in a few sentences of the volume above
mentioned. I am, Sirs, your obedient servant,*

London, June 0th, 1837.__ C. CrEIQStON.

“PLACENTA PR^EVIA.”

To the Editors of The Lancet.

Sirs,— The case of “ Placenta Prasvia” recorded in The
Lancet by Dr. B. Walker is another interesting illustration
of the true physiological treatment which I have advocated
for the last forty years, and which abundant clinical
experience has substantiated. “Blood was flowing freely,
and complete placenta pnevia was present. Introducing the
hand,” says Dr. Walker, “ into the vagina, and detaching the
placenta, a vertical presentation was found, and with two
fingers in the dterus and the right band on the abdomen,
combined version, after Braxton Hicks's method, was quickly
and easily performed and a foot brought dbwn, thus
plugging the cervix and causing the hemorrhage to cease,
the whole being done in five minutes. The woman was left
comfortable. The delivery was completed spon¬

taneously after twelve hours.”

I submit that the just commentary upon this case is that
the haemorrhage ceased because the placenta was detached
from the lower or dangerous zone of the uterus, which
allowed the os and cervix to expand; that the subsequent
bipolar turning, although the case ended happily, was not
clearly the cause of the arrest of hsemorrhage by plugging;
that unless the uterus contracted to force the breech upon
the lower segment of the uterus the breech could not act as
a plug, since it was not kept in contact with the bared
surface by being dragged down upon it; and that experience
amply proves that, if there be contraction, this is enough to
arrest the hsemorrhage.

Dr. Walker holds, as Sir James Simpson held, that the life
of the child was of secondary importance. In this I quite
agTee. But was the child’s life incompatible with saving
that of the mother? When the head presents, it is surely
better to dilate the cervix with my hydrostatic bags, which

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THE HOVE INFECTIOUS HOSPITAL.

[Jmia 11,1887-

plug even better than the child’s breech, provoke uterine
activity, and give the opportunity either for spontaneous
-delivery by the head or by the forceps, either of which
gives a much better chance of saving the ohild without
•compromising the safety of the mother. The combined
method of turning comes in admirably in some cases, but it
is only an application of this proceeding. It cannot be
regarded as constituting by itself the rational treatment of
placenta prsevia. I am, Sirs, yours truly,

Hurley-street, June 6th, 1887. ROBERT BaRNKS.

“A SUGGESTED IMPROVEMENT IN ETHER
INHALERS.”

To the Editors of Thb Lancet.

8irs,— Under the above heading, Mr. Rickard W. Lloyd,
in an interesting communication in your issue of May 28th
•calls attention to a possible danger of Clover’s ether inhaler,
and he suggests that the ansesthetieer should possess and use
a number of indiarubber bags to minimise tbe risks of trans¬
mitting disease from one patient to another.

Mr. Lloyd, as, I believe, all who administer ether will
allow, has put his linger upon the weak part of Clover’s
inhaler, which is the bag. Unless the apparatus is in con¬
stant use the bag gets out of order. In hospital practice,
and in the practice of surgeons who have much operating,
it is tolerably easy with care to maintain the bag in good
order; but even then holes will mysteriously and unaccount¬
ably appear in it. But tbe general practitioner, who has to
let his apparatus lie on the shelf for an unknown length of
time, too often finds, when he requires it on an emergency,
that the bag has stuck together, and can only be opened up at
the cost of tearing, or has already several perforations in
it, and then sticking plaster or other tinkering expedients
have to be used to render the apparatus temporarily work¬
able. Regarding the carbonic poisoning which tbe bag of
■Clover’s apparatus causes in greater or less degree, I refrain
from expressing an opinion, as I have heard it condemned
on the one hand as a danger, and extolled on the other as
a virtue, by competent authorities. I would, however, ask
•those who approve this carbonic acid poisoning if, supposing
they were about to inhale ether, they would give instruc¬
tions to the ancesthetiser to allow their own blood to become
•carbonised, or whether they would not, on the contrary,
prefer that their blood should be as free as possible
from this noxious gas, and consequently the action of
the right side of the heart be impeded as little as possible ?
Deaths from ether are unfortunately not unknown, and it
behoves us to adopt every measure to render its administra¬
tion safe as well as effective. For some time I have been
making trials with an apparatus which Messrs. Mayer,
Meltzer, and Co. have constructed to my order, which,
whilst doing away altogether with the bag, retains all the
useful features of Clover’s apparatus. The patient never
re-breatbe8 expired air, and the danger pointed out by Mr.
Lloyd cannot therefore occur. My trials and experiments
are not yet complete, but I hope that the firm mentioned
may soon be able to offer to the profession an efficient and
handy inhaler which will surmount Mr. Lloyd’s difficulties
evon more satisfactorily than his own suggestions do.

I remain, Sirs, your obedient servant,

Norman Porbitt,

May 31*t, 1837. Hon. Surgeon, Huddersfield Infirmary.

and concerned in hospital government. At the present tia»!
I am one of the house committee of the largest boi-
pital in London. Therefore, feeling ourselves qualified to
form an independent opinion, we ventured to criticise tk
report of the local medical officer, who stated that “all tk
requisites of an institution of the kind were all that eu
be desired.” I have no intention of giving in detail tk
deficiencies to which we ventured to direct attention; i:
will be sufficient for me to say on this occasion that
we complained of defects in tbe arrangements (owii*
to the peculiar site on the downs), of defects ia tk
condition of tbe building, and of deficiencies as Kgufc
certain sanitary appliances. We are confidant that tbe*
defects would be admitted by competent and indepen¬
dent sanitary authorities. We are anxious only for tk
truth as to the facts and for efficiency as to the hoapitai
and we desire competent inspection, and fully believe tin;
we shall thereby obtain confirmation of our criticisms. We
have a duty to our constituents which we are aazioui to
fulfil. A large sum of public money has been expended oa
this hospital; out constituents are rated for its repayment
They deserve an efficient hospital for their outlay, and, coe-
scientiously believing that at the present time the hospital
is not in a satisfactory condition, we ventured to nise on
voices against the optimistic report of the medical often,
feeling sure that the public attention thus aroused vwH
ensure the removal of the defects of which wt bed
complained. In conclusion, I may add that the cost of
remedying these defects would only amount to so iseea-
siderabie snm of money. Under the circumstances, 1 tn*
that you will regard our oonduct as deserving of praise id
not of blame, and that yon will assist us and not add to o®
difficulties in rendering this hospital thoroughly efficien t
I am, Sirs, yours truly,

Brighton, June, 1887. ALFRED Q. HbWRIQCB.

We took no exception to a mere endeavour to remedy
such defects as may exist in this hospital, but we do ns
admit that some of the conditions which were alleged to
indicate defects are faults at all. Mr. Henriquee brought
forward statements calculated to damage the hospital is tk
minds of tbe general public, and thus to hinder the ven
object for which it was erected. He is also reported to 1 »r
objected to its ventilation, to have said that M tbe smoge

ments.were the very reverse of what such an inatitatk*

should possess”.and “ were as bad as they could be"; mil

he spoke of its “fatal objections.” We deny thesoearaq
of such statements, and, in answer to them, we would quote
the following authorities, who have at least equal know¬
ledge with Mr. Henriquee as to what are the reqairwwnti
of an infectious hospital. Dr. Ewart, chairman of tk
Brighton Sanitary Committee, says: “ The ventilation i*
excellent ”; and he adds that ** with proper care and manage¬
ment.your building.will prove a great bessfit to tk

town.” Dr. Kelly, medical officer of health to West Kent
says: “ On the whole, the building seems to have been (aw¬
fully planned, and to be well adapted for use as an infeetiou
hospital.” Such statements alone suffice to show how unvi*
was the wholesale condemnation of the hospital which vii
made pnblic last month.— Ed. L.

TnE HOVE INFECTIOUS HOSPITAL.

To the Editors of Thb Lancbt.

Sirs,— As it is your practice in all disputed cases to give
facilities for “the other side” to obtain a hearing, I trust
that you will permit me, as one of the laymen whom you
condemn in your article of May 28th for directing public
attention to the alleged defects at the Hove Sanatorium
or Infectious Hospital, to offer a few remarks by way of
explanation. In the first place, these “laymen,” whilst
claiming no great or extensive sanitary knowledge, have
had considerable experience in hospitals and hospital
management. General ShnteL C.B., both in the Crimea and in
India, learnt much practical knowledge in field and other
hoepitala, and, without,“expert,” now possesses
valuable experienoa -c»,JpffflTOeqfc I am no novice in
xwmiM py years been interested

THE VALUE OF DRUGS.

To the Editors of Tub Lancbt.

Sirs,— -The remark of Sir William Gull at tbe na* 1
meeting of tbe Medical Council has elicited consider***
correspondence on the value of drugs in the treatment»
disease. 1 have no doubt he never intended that his re®* 1 *
should be taken literally, but only that it should be aRroef
blow at the system of empirical treatment pursued pns-
cipally by dispensing chemists over the country.
medical practitioner must have noticed how much faith
uneducated place in a bottle of medicine, and must also”
aware how some dispensing chemists and all quacks pa»w
to this taste. There is in this way many a shiUing»*?*:.
in medicine that might have been well spent in a good «*•
steak or coal for the fire. Medicine is seldom ths ■o**®'

. portant*part in the treatment of disease, and it is »

I utmost importance for us at aU times toimpress this0?®°“

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THE COLLEGE OF SURGEONS’ EXAMINATIONS.

[Jlmk 11,1887* 120?

•ient 8. I expect that few men give the large quantities of
dicine that was common some years ago, and the simplicity
prescriptions is an important step in the right direction,
r these things the profession and the public are indebted
men, such as Sir William GulJ, who advocate a rational
*de of treatment, and who have done so much to abolish
at system of rough treatment now even dying out of the
terinary profession. 1 have no doubt Sir Wm. Gull will
ieve in the use of medicine properly administered as
icerely as any of us, but it is only leading men like him
10 can take a stand with general advantage for truth and
mmon sense.—I am, Sirs, yours faithfully,
lawlck, June 6th, 1887. JOHN R. HAMILTON, M.D., &C.

3YAL COLLEGE OF SURGEONS: THE PETITION.

To the Editors of The Lancet.

Sirs, —At last the draft of the petition of the Council of

6 Royal College of Surgeons (Eog.) has appeared, and, as
as to be expected, it contains none of the reforms demanded
th by Members and by a considerable proportion of the
illows of the College. There is no provision made for an
Lnual general meeting of Fellows and Members, and none
r the admission of Members to the Council or to a share

its election. After nearly 6000 Members of the College
we expressed their opinion that such alterations as those
e have just cited are desirable, and after their petition to
at effect has been presented to the Privy Council, it seems
»ite impossible that the College Council can obtain such a
laurter as that for which it is now petitioning. At all
eats, the Members having, over a month ago, lodged their
»titiQn with the Privy Council, and having asked to be
*ard in this matter before any new Charter is conferred,
e,can assure the Council of the College that every endea-
>ixr will be made by the Members to secure the reception

7 the Privy Council of an influential deputation in their
ihalf. We are, Sirs, your obedient seiwants,

W. C. Steele, V Hon. Secs.,
Jane, 1887. W. A. ELLIS, J ASSOC. M.R.C.S.

THE PROFESSION AND THE PEERAGE.

To the Editors of The Lancet.

Sms,—There is- a proud self-respect in our profession
hich forbids us, individually or collectively, claiming any
xblic recognition of our efforts to promote the public good,
irtue is, no doubt, its own reward; but the area of useful-
iss frequently bears some proportion to the power and
ifluence of those desirous of being useful, and social power,
ke any other force, does not lose in momentum by having
> fitter through all strata of society from an exalted
Dsition. The immediate object of this metaphorical state-
ient is to give utterance, through the influential medium of
our journal, to a notably widespread feeling in the pro-
‘ssion that something should be done to call attention in
ie proper quarters to the desire of many of its members
a at, in the celebration of the Jubilee of our gracious
overeign, a medical peerage ehoald not be conspicuous
y its absence. It will not be fruitful to inquire why
3is country should be singular in excluding from the
inks of its nobility a body of citizens who cannot on any
rounds be considered socially inferior to many of those who
re periodically raised to the Upper House. Nor is it need-
nl that the services medicine and surgery have rendered to
tie State and to mankind during the last fifty years shonld
e enumerated at length. They are well known and reco-
niaed by the Faculty, and the State and individuals have
o excuse for ignoring them. 1 feel sure that I speak for
lany when I say that no honour would be appreciated
lore highly, or received more enthusiastically by the pro-
sesion, than that which could be done it in the person of
ne or more of its representative members, by their being
ained to the peerage of the United Kingdom. I trust
n at your influential and judicious advocacy may render a
medical peerage one of the essential features of the Queen’s
ubilee. I am, Sire, yours truly, •

Jane 6th, 1837. _ AfiCLEPIAD.

To the Editors of The Lancet.

Sibs,—A n opportunity for Her Majesty is afforded by the
pproaching Jubilee to snow her appreciation of the valuable
er vices rendered by dur profession to herself, to the members

of the lloyal Family, and.to all classes of Her Majesty’s sub¬
jects, including the very poorest. It would be a moat grace¬
ful acknowledgment of suah services for special honour, and
that honour a peerage, to be conferred on the chief repie-
sentatives of the meaical and surgical professions.

I am, Sirs, yours truly,

June, 1887. A COUNTRY Sl'RGBON.

THE COLLEGE OF SURGEONS’ EXAMINATIONS.

To the Editors of The Lancet.

Sirs,— I have no desire to increase the terrible ink-shed
with which Mr. Heath's strictures on the College of Surgeons’
examinations have deluged your columns. Bat, as one who-
has just emerged from the fiery ordeal of the combined
examinations, I trust you will permit me to state the case
from the successful candidate’s point of view.

The cases cited by your correspondent, Mr. F. J. Smith
are only such as constantly occur within the experience of
every student. The “ good men ” sometimes go down like
ninepins, and the "duffers” are successful. Why? Simply
because the latter answer the questions which the former
are ignorant of. Granted that a good man is now and then,
plucked, my own experience shows that in nine cases out of
ten he well deserves his fate. If, as Mr. Smith says, every
man has his weak point, he should do his best to remedy it,
or else not complain if he is given six months in which to
do so. The examiners can only judge of him as they find
him. Mr. Smith appears to think his third and fourthcasea
have been hardly used. But I submit that if a man who is
shaky on such a sub ject as fracture of the base is allowed
to write “ F.R.C.S. Eng.” after his name, the diploma wilt
soon cease to be regarded as the highest surgical qualifica¬
tion in the world. On the first occasion on which I pre¬
sented myself for the final M.R.C.S., I was referred for six
months, and, as is usual and quite natural, thought myself
very unfairly treated. But, on reviewing the various inci¬
dents of the examination during the period thus afforded
me for mature reflection, I was obliged to own that I had
been asked straightforward questions, to which I could only
return unsatisfactory answers. Curiously enough, I also
came a cropper over cranial fractures, or, as Mr. Smith
would put it, “ the examiner had found my weak point, and
had pressed me on it'to the total exclusion of all other sub¬
jects.” I have heard of a man who was never able to pass
because the examiners would ungenerously persist in ask¬
ing him the very things he did not know. For my own part, I
have always felt that the gentlemen who did me the honour
of examining me were the heads of the profession which I,
a raw recrui% was endeavouring to enter. It would be in¬
vidious for me to mention the names of individual exami¬
ners, but I may say that, treating them with respect, 1 have
ever received kindness and consider anion. I say empha¬
tically, after two experiences, that 1 consider the final
M.R.C S. examination to be honestly and fairly conducted ;
and, in conclusion, that 1 have never known a so-called
“good man” to be referred unless, by hie own admission, he
had been guilty of some breach of that submission which-,,
as a student, it was his duty to accord to his examiner.

I am, Sirs, your obedient servant,

June 4th, 1887. __L R.C.P., M.R.C.S,

MANCHESTER.

(From our oxen Correspondent.)

OWENS COLLEGE.

On Saturday last the members of the professorial staff
of the College, with members of the Council and other
friends, met at the College to do honour to Sir Henry Roscoe,
who has lately severed his connexion with it as a teacher
after having for so many years presided over and brought the
chemical department to its present efficient state. Unfortu¬
nately Sir Henry Roscoe was prevented by severe indisposi¬
tion from leaving his house on that day, so that the ceremony
of presenting an address and unveiling a portrait of their
late colleague subscribed for by the professors was somewhat
shorn of its interest. , Professor Greenwood gave an appro¬
priate address, briefly reviewing the work of Sir Henry
during his thirty years connexion with the College, and
unveiled the portrait, which was then presented in tha

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1208 The Lancet,]

MAN C HESTER.—LIVERPOOL.

[Jura 11,18?:

name of the professors to the Council, being received
by Mr. Oliver Heywood on behalf of the fatter body.
Amongst other matters which Sir Henry has recently been
inquiring into during his recent Bhort stay here has been
the question of the sale of butterine, making himself
familiar by personal inquiry and investigation with all the
trade details of the same, with a view to the proposed
legislation on the subject. Amongst “ the trade ” of the
district much adverse criticism has found its way into the
public press concerning the provisions of the Bill now
before Parliament, dealers asserting that the article known
as butterine is a good and wholesome food, and that the
Adulteration of Food and Drugs Act provides ample pro¬
tection to purchasers if properly put in force.

JUBILEE EXHIBITION.

The Jubilee Exhibition opened last month by the Prince
and Princess of Wales is proving a great success. The
chemical, sanitary, and dietetic exhibits are of considerable
interest from a medical point of view, and a short description
of some of them will find a place in the near future in these
columns. Amongst “ the machinery not in motion,” a rail¬
way invalid carriage will no doubt attract the notice of the

S rofeseion. It is sent by the Lancashire and Yorkshire
auway Company, and is fitted up with every convenience
for the removal of a patient with the least possible amount
of discomfort. A small fixed bedstead is in one corner, with
movable table, rests, and supports, a small ante-room for
friends or attendants at one end, and a lavatory, &c., at the
other.

HOSPITALS.

The proposed extension of the Fever Hospital belonging
to the Royal Infirmary is meeting with considerable
opposition, and the Newton Heath Local Board, in whose
district the hospital is situated, at their last meeting
peremptorily called upon the infirmary to suspend all
further building operations until such time as the plans, &c.,
had been approved by them, which plans they at present
decline to pass. The neighbouring borough of Salford at
their last council meeting had a discussion on the following
proposition: “That by way of commemoration of Her
Majesty s Jubilee, the council be recommended to assist the
Health Committee in the erection of a new hospital for
infectious diseases, to be called the Victoria Hospital.” It
was suggested that a town’s meeting be called to consider
the subject, but the motion was eventually lost. It is
thought that the proceeds of the old fever hospital in
Cross-lano—i.e., .£21,000—should provide a new hospital
without any special appeal.

HEALTH BEPOBT FOB 1886.

The officer of health for the city has just published his
annual report for last year. Again Manchester shows an
exceedingly high death-rate, it being 24 G9 per 1000 per
year. The mortality from scarlet fever was double that of
the previous year, 188 deaths being recorded from it, not¬
withstanding the removal to hospital of a large proportion
of the sufferers. From small-pox no death occurred. The
officer of health devotes some considerable space to the
question of air impurity, and considers that the Health
Committee should now devote much of its energies in
endeavouring to render the air more pure, in the crowded
streets and alleys alike, and the inside of many of the
worst dwellings, where proper ventilation is impossible and
eubic space per occupant sadly deficient. At the present
time both scarlet fever and measles are exceedingly pre¬
valent. The death-rate for the first quarter of the present
Y e ” * rom . fbe seven common zymotic diseases was equal
to 3 - 8 per 1000 per annum.

June 7th.

City Obthop.edic Hospital. — The thirty-sixth
anniversary festival in aid of the funds of this hospital
was held on the 8th inst., the Duke of Grafton presiding.
Since the institution has been in existence 62,000 cases of
deformities have been treated, the number of patients who
received relief during last year being over 3000. In the
course of the evening the seoretary announced subscriptions
and donations amounting to between £900 and £1000.

The annual festival dinner in. aid of the funds of
the North London Consumption Hospital will be held on the
i nst » at the Laugham Hotel, under the presidency of
Mr. F. D. Mocatta.

LIVERPOOL.

(JProm our own Correspondent.)

A SATUBDAY NIGHT AT THB BOYAL SOUTHBBN H08PITL

This hospital is situated in the midst of what isknorj
as Toxteth-park—a great misnomer, being composed lirar
of streets, many of which are of a character the iar
reverse of sanitary, and tenanted by a very low cli-
of inhabitants. As a consequence of this, Saturday ni£i
is always more or less a busy night at the hospitil. ix
Saturday, June 4th, was one of the busiest ever bcr
since the hospital was opened. From early on Satur-i:
night till early on Sunday morning about fifty cases w*r
admitted and treated, two proving fatal: one wu tir
of a man who fell down in the street in a fit, was foo>:
lying insensible by a policeman, and on reaching the boqi i
was found to be dead ; the other was that of a child ton
months old, which was taken to the hospital by its moth.::,
expiring in her arm on the way there. In addition to tb«r.
a woman was admitted with a wound in the thigh, a ac
with a fractured leg, a woman suffering from severe bunai
woman with serious injury to the back, and * man r
severe injuries to the head.

BEQUESTS TO LOCAL HOSPITALS.

Under the will of the late Mis. Anna Maria Hejroo!
widow of the late Mr. John Pemberton Heywood of th
city, the Royal Infirmary and the Northern Hospri
Liverpool, each receive legacies of £1000. It is exjxo
that the local medical charities will benefit largely
the will of a former wine merchant in this city, who tt-
bequeathed the bulk of his estates, amounting to a re-
large sum, to local charities.

HOSPITAL SUNDAY AND SATUBDAY.

It was recently proposed to change the date of Hoapb
Sunday from the second Sunday in January to some Sunk'
in May. Endeavours were made to ascertain the opim::
of the clergy and ministers of all churches and cbs;»
wherein collections had been made as to the desirability
a change of date; and in the event of the change bic.
deemed advisable, then as to which month the oollefli:
should be transferred to. The replies were so evenly balan
that it was thought safer to leave matters as they r
The Hospital Saturday Fund already exceeds £2000, -s
more contributions have yet to be announced.

THE LATE BISHOP OF SODOB AND SIAN.

The announcement of the death of the Right Eev. I'
Rowley Hill, Lord Bishop of Sodor and Man, was recei'
in this city with much surprise. The late Bishop wu&iu
of very great physical strength, and up to within a It' 1
days of his death presented the appearance of a mu ini.
prime of robust healthy manhood, his age being fifty-i*
For some days before his death he had been mdifpo-
which had induced him to give up engagements in Sht£
as well as in the Isle of Man and to remain in London.
Friday, the 27th ult., he suddenly grew worse, became unc^
scious about noon, and died the same evening. The repr
as to the cause of his death differ. It was at first state:
be congestion of the liver; another and later account in
Isle of Man Tbnes states that “ he had for some tu
Buffered from kidney disease, and a few days before dr*
there were evidences of the presence of diabetes. The it?
immediate cause of death, however, is considered to
been extravasation of blood on the brain.” His m- t-
powers would appear to have been unaffected almost u[
the last, and he preached in the very church where only
fortnight later his remains were taken previously to inv
meat.

POISONOUS BEFU8B.

From time to time cases occur of wholesale poisonx

---- . poisonous -- -

years ago a number of children were poisoned by e*tu
Calabar beans, one boy dying. Within the last few dv
a number of children were taken to the Royal South:'
Hospital suffering from symptoms of poisoning in coi-
quence of their having eaten some nuts which they found
a heap of rubbish. The nuts were stated to be croton
nuts. The children suffered from acute pains in the etoci
accompanied by nausea and vomiting, but recovered.

Liverpool, June 7th.

, y Google

The Lancet,]

E DINBUB6H.—DUBLIN.

[June 11,1887. 1209

EDINBURGH.

(From our own Correspondent.)

ALBUMINURIA IN THE APPARENTLY HEALTHY.

At the last ordinary meeting of the Royal Society of
Edinburgh a paper on the Discharge of Albumen from the
Kidney in Healthy People was read by Professor Grainger
Stewart. The paper contains the results of an extensive
research carried oat in relation to varied classes of the
jommunity. Professor Stewart comes to the conclusion that
in the community generally the average of those who have
ilbuminuria is about SO per cent.; in military life the pro¬
portion is larger than amongst civilians, and with advancing
rears there is a marked increase in the proportion. In all
Haases he finds an increased number showing albumen after
nreakfast, as compared with what obtains before that meal.
While healthy moderate exercise, as in the weekly march-
out of the garrison, decreases the number in whom it is
present, excessive muscular exercise, as seen in fatigue duty,
argely increases the proportion of men showing albu¬
minuria. Several other phases of human activity have
oeen investigated in the same way, and yield most interest¬
ing results. Some of the general conclusions at which
Professor Stewart arrives are the followingThat there is
no sufficient proof that albuminuria is a normal condition in
;he human subject, but that it is a much more frequent
phenomenon in the apparently healthy than was formerly
supposed; that it increases in frequency as life advances,
and is more common in those who lead laborious lives than
m others; that moderate exertion decreases the phenomenon,
whilst excessive work produces an increase, as does also cold
jathing in certain individuals; and, Anally, that the exist¬
ence of persistent albuminuria is not per ae a sufficient
ground for the rejection of a proposal for life insurance.
Phe paper, which was richly illustrated by tables, giving a
complete analysis of the results, was very favourably
•eceived by the Society, and its author was congratulated
lpon the comprehensive and valuable nature of his research.

THE presence op bacteria in fish.

At the same meeting of the Royal Society a paper on the
•xistence of Bacteria in Living Fish was presented on behalf
>f Professor Ewart. A variety of species of micro-organisms
are constant inhabitants of the majority of fresh-water and
ea Ash alike, the skate, dogfish, and some other species being,
lowever, exempt. A considerable number of organisms may
>e present in the blood, lymph, and peritoneal cavity with¬
out any apparent interference with the vitality of the animal.
Jnder a variety of depressant conditions the number of these
jacilli increases: thus starvation, confinement in aquaria, and
l rapid, though moderate, rise of temperature produce this
fleet, and the increase, if considerable, is accompanied by
ymptoms of languor and, in many cases, the death of the
iab. The exact species of bacilli discovered have not as yet
ieen classified; experiment shows, however, that they are
lot of ordinary putrefactive varieties, while the clinical
vidence equally excludes them from the group of patho-
;enic microbes.

THE MEDICO-CHIRURQICAL SOCIETY.

At the recent meeting of this Society some interesting
aaes illustrating the condition of word-blindness were
xhibited by Dr. Byrom Bramwell, who gave a valuable
linical demonstration of the main symptoms in two of his
'&tients. Mr. A. G. Miller showed two patients who made
n excellent recovery after operations for the relief of intra-
ranial suppuration. Dr. Foulis exhibited a new and useful
pparatus for the irrigation of the bladder, and a new form
f obstetric forceps. A paper was read upon some Poisonous
roducts of an unusual nature present in Human Food, de¬
filing the results obtained by Drs. Philip and Hare in a
joetit case of poisoning that occurred in Carlisle. Dr.
hilip succeeded in separating from some ham, the material
uspected,'an extract poisonous to frogs, and producing
ymptoms in the human subject suggestive of irritant
oieoning, and resembling those observed in the large
umber of patients who suffered after the ingestion of por-
ons of the ham in question. Microscopic examination
lowed the presence of micrococci in the ham, but no bacilli
'ere discovered resembling those present in the Wellbeck
ise which occurred in 1880, where poisonous ham was
mnd to be the cause oi the outbreak. A special meeting of
iis Society is to be held early in July, to discuss the subject

of scarlet fever in relation to the recent epidemic in Edin¬
burgh, and specially with regard to questions of the etiology
of the disease now exciting such great interest.

Edinburgh, June 7th.

DUBLIN.

(From our own Correspondent.)

ROYAL COLLEGE OP SURGEONS.

The contest for the vice-presidency of the College which
took place on Monday last excited unusual interest, as it
was known that it would be a close one. Mr. Fitzgibbon,
the successful candidate, polled 126 votes, against 102
obtained by his opponent, Mr. Croly. As regards the Council,
all the outgoing members who offered themselves were re¬
elected, with the exception of Mr. Story; while two new
members have been added—viz., Mr. Frazer and Mr. Kendal
Franks. More than a month since, when writing on this
subject, I mentioned Mr. Franks as certain of success, and
the result has justified my expectation. An unusual com¬
pliment was paid Mr. Frazer by electing him on his first
attempt, and he will, I am convinced, prove a formidable
opponent to Mr. Meldon in the contest for the vice-pre¬
sidency next year. The votes at the meeting last Monday
were the highest ever recorded, and numbered 230. At the
annual meeting of the College on Saturday an animated dis¬
cussion took place in reference to the proposal for amalga¬
mation between the Carmichael College and the College
School. The matter is referred to more fully in another
column, and 1 only allude to it here to remark that
the debate would not have suffered by the admixture
of a larger proportion of the elements of courtesy and
toleration on the part of some of the speakers than was
manifested on the oocasion. By the recent rules of the
Council the examiners in anatomy and surgery, who were
appointed on the 31st nit. for the ensuing year come under
different arrangements as regards their emoluments, which
has caused considerable dissatisfaction to those most in¬
terested in the matter. Previously the eight examiners in
these subjects received equal remuneration, but now two
examiners only in anatomy and two in surgery will as a
rule be actually employed. The two other examiners in
these subjects, whom I shall style assistant examiners, are
only expected to act during tbe sickness or absence of the
others, and to examine candidates for fellowship. It follows
that almost all tbe fees from candidates will go to the acting
examiners; and, on the other hand, the assistant examiners
will neither have much honour or profit. For, taking the
average annual number of Fellows admitted to examination,
the remuneration of each assistant examiner will probably
not exceed from £10 to £16 per annum. 1 believe it is not
at all improbable that one, if not more, of these assistant
examiners will shortly resign his post.

DUBLIN HOSPITALS COMMISSION.

It is authoratively stated that no steps will be taken
by the Government, at least for this session, to carry out
the recommendations of the Dublin Hospitals Commission.
This is a result which probably will not cause much surprise,
a feeling existing to a very general extent that such would
be the case.

HOSPITAL FOR INCURABLES.

An appeal is being made by the governors for funds to
carry out a design formed to extend tbe usefulness of this
excellent institution. It is contemplated to add a new wing
for the treatment of patients suffering from cancer ana
phthisis. It will be called the “Victoria Jubilee Wing,”
and I am in a position to state that his Royal Highness
Prince Albert Victor, on bis approaching visit to Dublin,
will lay the foundation stone of this addition to the hospital.

THE JACOB TESTIMONIAL.

An address with a purse containing £500 was presented
to Dr. A. H. Jacob at tbe College of Surgeons on Monday
last. Tbe address was read by Dr. Mapother, and Dr. Jacob
having made a suitable reply, the proceedings terminated.
Tbe address, it may be mentioned, was signed by over 400
medical practitioners.

I am informed that Sir William Stokes and Prof. Edward
Hamilton have been appointed coadjutor examiners in
Surgery for the Apothecaries’ Hall of Ireland.

Pubjin, June 7tli. .

1210 Thk Lancet,1

PARIS.—AUSTRALIAN NOTES.

PARIS.

(From our own Correspondent.)

PARALYSIS FROM EARTHQUAKE ELECTRICITY.

A complete account of the effects of the Nice earthquake
from a medical point of view has yet to be written. In the
meantime, facts of the highest interest are recorded by
different observers. I have seen several cases of pul¬
monary disease which had been progressing satisfactorily
up to that time, and in which the agitation attending the
disturbance indicted an irrecoverable shock to the nervous
system. One lady has come under my care whose menstrual
period, just commencing when the first shock occurred, was
immediately checked. A month later the catamenia were
restored by uterine faradisation, the discharge, which had
not been preceded by the usual premonitions, occurring
within a few hours of the application. Similar pheno¬
mena have been recorded by others. Dr. Ouimus re¬
lates a case of nervous disturbance (Society de Bio-
logie) of unusual interest. The Subject was a strong
vigorous man, not easily impressionable and incapable of
deceit. He was at the time in charge of a fort. There
were, it will be remembered, three distinct commotions, the
strongest at six, another Boon after, and a third, much
weaker,at nine o’clock. The patient was sending a telegraphic
message, and, happening to have two points in contact with
the metal of the transmitting apparatus, felt a violent
shock, and lost consciousness for ten minutes. During the
remainder of the day be felt giddy and weak, but has no
recollection of phosphines at the occurrence of the shock.
Two months later he complained of constant headache
and fibrillary contractions in the muscles of the limbs.
The right arm was paretic, and the extreme weakness was
confirmed by the dynamometer. Besides tremor and painful
localisations along the median nerve, there was a consider¬
able decrease of sensibility, the finger-tips scarcely reco¬
gnising a separation of twelve millimetres between the
points of the compass. The paralysis of the face was on the
left side, and consisted of ptosis, accompanied by blepharo¬
spasm. This crossed or alternate paralysis is what is seen
constantly as a result of a powertul electric shock ; but in
this case the symptoms have been more serious and per¬
sistent. At the present time there is little if any improve¬
ment. The reappearance of Dr. Onimus, whose communica¬
tion was received with the greatest attention, was hailed
with pleasure by the .Society, the more so as it has been
reported of late that the health of the eminent electrician
had been failing.

EPIDEMIC PNEUMONIA.

M. II. Rondet of Lyons has given particulars of two
epidemics of fluxion de poitrine that have come within his
experience. The first occurred at Fleurien-sur-Saone, a
little village about ten miles north of Lyons. The disease
made its appearance on March 29th, 1882, the weather being
cold and misty, and the epidemic was confined to the in¬
habitants of a house jointly occupied by the school teachers
and rural police and their visitors. Of ten patients attacked
four died. The second outbreak was at the vagrants’ depot
at Albigny, which comprises a population of from 630 to
650 individuals, divided into two categories, those who have
entered voluntarily and those who have been sentenced to a
short imprisonment for begging or vagrancy. The epidemic
lasted five months, and was extremely fatal, fifty-nine deaths
occurring in seventy cases. An attentive study of the
conditions of development of the disease showed that its
intensity and duration were in proportion to the vitiation
of the atmosphere and the defects of the sanitary surround¬
ings. The contagion was most dangerous in the dark,
unventilated apartments, and there was no doubt as to the
infectious nature of the disease.

ACUTE GLANDERS.

Dr. Dhoste, the medical officer of the steamer St. Germain,
'running between St. Nazaire and Vera Cruz, states that
one of the passengers, a Spaniard, who embarked in perfect
health at Havannab, began to show symptoms of acnte
glanders five days later. No treatment was of any avail,
and the patient was landed in a dying condition at Santander.

8 A NIT ARY PRECAUTIONS FOR MARSEILLES.

The town council of Marseilles has passed a resolution
that it is desirable for the troops returning from Tonkin

[June 11,1887.

and other colonies where epidemic diseases are consume |
be landed at the quarantine stations of Port Cros uiJ
Bazan, instead of Marseilles. It is probable that the differ -1
ent administrations concerned in the matter will acqnun]
in this view, and disembark the men, in the first instance,a'
some point in the ieland of Ilyeres.

GASEOUS RECTAL INJECTIONS.

At the congress of the delegates from the learned societw
held last week at the Sorbonne the question of gveou
enemata came under discussion, M. Lamallerta tud this,
judging from his own personal experience, gaseons injec¬
tions were inefficacious when there existed cavities, but is
other stages of the disease (phthisis) they were useful. To
be successful no precaution should be neglected. The im¬
provement obtained consists m suppression of the few,
sweats, and oppression; the general health becomes non
satisfactory, and the stethoscopic signs are modified. M.
Laraallerde stated that he had been able to infect chicken
with tubercle by mixing the expectoration of bacillary
phthisis with their food, but not when the sputa came from
patients under the treatment. In other diseases of tin
lungs this method gives rapid and durable results.

Paris, June 8th. _

AUSTRALIAN NOTES.

(From our own Correspondent.)

MALPRACTICES IN NEW SOUTH WALES.

As a sequel to the case of Dr. Russell of New Ze&lux'.
which 1 referred to in my last letter, I have two mare
cases in New South Wales to relate. Encouraged apparent’
by the very easy way in which abortion-monger tug i>
regarded in the colonies, this crime seems to be increasing
in frequency. A case of the kind has recently occurred c
Redfern, a suburb of Sydney, where a Dr. Sabatowski
a German degree) had operated on a young single wobb.
and made a laceration of the uterus six inches in lew-
death ensuing within twenty minutes of the operation. T>
person in question escaped terrestrial justice bycommituo:
suicide, taking poison out in the bush, where his boa;
was subsequently found. Another man, this time with*
a qualification, has introduced a novelty in gynacologici
science by performing craniotomy with “ a chisel, a sere*;
driver, and a pair of pincers, borrowed from & blacksmith
The woman died, but as the “ obstetrician” charged col;
30^. for the operation nothing more could reasonably h»u
been expected. No inquiry was held, and reasons hare b«
asked from the coroner for such non-action by the Minute-
of J ustice.

A QUEENSLAND UNIVERSITY.

The first steps towards the formation of a university wr
inaugurated by a meeting of gentlemen summoned by t-
Chief Justice to consider the question, when it wasdecw^
to draw up a petition to the Government to be signal <
doctors, clergymen, lawyers, corporations, schoolmaster
&c.— to take steps to carry out that object by the necessa-"
grants, &c.

QUEENSLAND BOARD OF HEALTH.

This board have been trying to make the public bilk”
they are an energetic body, by going as a deputation to u-
Colonial Secretary and asking for executive power* ta
granted to them, as they at present only possess the
of “making recommendations." The Minister, howe™-
pointed out to them that they had made such very httk «•*
of what power they had, that he did not feel incline!
recommend their being granted any more. As a fact,. i> ^*
decrepit and useless board, and would be most
replaced by an experienced, scientific, well-psid nwciri
officer of health imported from England, with special ^
tary knowledge; and this is what will eventually h»« •*
be done.

TOWNSVILLE (QUEENSLAND) HOSPITAL.

The authorities of this institution h ave recently dead* ■-
appoint a resident surgeon-superintendent, in pj*« °
paid visiting surgeon. This, as the metropolis of the to.
colony of “Northern Queensland” (the separation of w»-
is bound, in common justice to the North, to ensue), u
important town and the centre of a very large tr*£>‘
country, the hospital thus offering great advuit*g*
practice; and I expect the appointment will bi w»r*-
competed for.

gitized by CjOO^Ic

THU IiANCET,]

AUSTRALIAN NOTES!—MBD1CAL NEW3.

[Juira 11,1887. 1-211

8YDNEY tTNIVEBSITY.

The following gentlemen have been appointed examiners
Tor the third examination for the degree:—In Medicine:
U. M'Kwv, M.D. Surgery: A. Renwick, M.D. Midwifery:
3. K. M'Kellar, M.D. Medical Jurisprudence: H. N. M'Laurin,
M.D. Psychological Medicine: Sir A. Roberts, M.R.CJ5.

SYDNEY HOSPITAL.

This hospital is still in a most unsatisfactory condition.
Cite present wooden structure was put up as a temporary
ouildwg ten years ag<?, and has long been condemned as
utterly dangerous in case of fire. The Tate Premier, in a note
which he left for his successor at the late dissolution, spoke
of the patients in it as liable to “ wholesale destruction ” in
such an event. The new site is considered by the Govern¬
ment unsuitable; hence the delay.

DEATH FROM CHLOBOFOBM.

A man died in the Sydney Infirmary recently whilst
being operated on for a crushed hand, under the influence
of chloroform. Three drachms were used in about five
minutes, administered by means of a perforated leather
mask containing a piece of sponge. One minute after the
inhaler had been removed the heart stopped. Hypodermics
at ether and galvanism were resorted to,’but without avail.
Dr. Kaaggs, President of the New South Wales branch of
the British Medical Association, said that, in his opinion,
fatty degeneration of the heart was the cause of death.
POISONING BY ORNAMENTAL BISCUITS IN MELBOURNE.
Several children have suffered from all the symptoms of
irritant poisoning lately after eating ornamental biscuits.
These were found on analysis to contain arsenic and copper
in the colouring matter, end the manufacturers, at the
instance of the Central Board of Health, were fined £20 and
costs.

In Melbourne two hundred and thirteen cases of typhoid
were reported frtm March 1st to 24th, of which fifty-eight
were fatal.

THE NEW ZEALAND POISONER.

Hall, who was convicted of the murder of his father-in-
law on the clearest evidence, has escaped capital punish¬
ment by a legal technicality. The conviction for murder has
been quashed on appeal, on the grounds that part of the
evidence on which he was convicted of the murder of his
father-in-law had been used at the previous trial, when he
was convicted of the attempted murder of bis wife, and. was
there feme inadmissible. Thus, by a legal quibble, a scoundrel
has escaped justice, than whom no more cruel or . cold¬
blooded Briavilliers ever existed. What little consolation
there is to be got oat of this case lies in the fact that his
“life ” sentence for the attempted murder of his wife stands
good, and no Minister of the Crown is ever likely to com¬
mute his sentence.

BBISBANE MORTALITY.

Out of 120 deaths for the month of February seventeen
were from typhoid. As Dr. Thomson pointed out at the last
meeting of the Board of Health, the mortality among young
children in Brisbane is abnormally high. Of course the late
weather has been against them, for the rains have been
continuous for the last three months, and floods have
occurred everywhere.

Dr. A. Ross has been returned for Molong at the general
•election. Dr. W. C. Wilkinson for The Glebe, and Dr. W. R.
Cortis for Bathurst. Of course, Drs. M'Kellar and Creed
still hold their seats in the “ Lords.”

The Hon. C. K. MacKellar, M.L.C., has just left Sydney on
a visit to the old country, and (if he finds it possible) to
America. He has done well, professionally and politically,
out here, and is worth welcoming as a very creditable
representative of the profession in Australia.

The medical men of Launceston, Tasmania, have unani¬
mously protested against the sewage being drained into
the river. Typhoid is prevalent there.

March 31»t.

The Deer in Richmond Park.—O n the 8th inst.
It was reported to the Richmond magistrates that there had
been no further slaughter of deer in Richmond Park, and
that the district was free from contagious disease. There is
every indication that the epidemic of rabies among the deer
is now being fast stamped out. The number of animals
killed is estimated at nearly 200.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

At an ordinary meeting of the Council held on Thursday,
June 9ch, the Minutes of the Library Committee on the
18th ult., as the report from that committee, were read; and
it was agreed that, as recommended by the Library Com¬
mittee, the vacant librarianship be filled up by the appoint¬
ment of a librarian specially educated for such office, and
that the vacancy in the office be advertised, and candidates
invited to send in their applications by a given date ; also
that the salary of the librarian be £400 per annum, to be
increased, after one year of service, to £600 per annum,
provided the person appointed shall perform his duties to
the satisfaction of the Council.

The third report, dated the 2nd inst., from the Committee
on the Extension of the College Premises, relating to an
addition to the building of the library and the appoint¬
ment of a pathological curator, was read, approved, and
adopted, subject to further consideration and discussion at
the extraordinary meeting of the Council, which is to be held
on Monday, June 27th (when the motion as to the disposal
of the Erasmus Wilson bequest comes on for consideration).

A letter from Mr. Lund, resigning his position as member
of the Court of Examiners was received, and bis resigna¬
tion accepted, with an expression of great regret at the
illness which was the cause of it. The election of examiner
to fill the vacancy will take place at the Council meeting
on Juue 27th.

A letter, dated the Gth inst., from Mr. John Marshall,
reporting, as the representative of the College, the proceed¬
ings of the General Medical Council during their late
session, was read, received, and entered on the Minutes,
and the best thanks of the Council were given to Mr.
Marshall for his services as the representative of the College
on the General Medical Council.

The following gentlemen were nominated for election in
July as professors and lecturers to the College: Messrs.
Bryant, Hulk©, Stewart, Warner, Lockwood, Jessop, E.
Nettleship, Marcus Gunn, Sutton, J. Priestley Smith, W.
Arbuthnot Lane, and W. Watson Chevne.

The President stated to the Council that he had received
from Mr. J. Talfourd Jones of Brecon a portrait of Jenner,
which he offered to the acceptance of the College. This was
accepted, with the best thanks of the Council to Mr.
Talfourd Jones for the same.

A letter of the 14th ult., from Mr. James Bankart of Exeter,
a Fellow of the College, was read, enclosing a memorial to
the Council on the subject of the new regulations of the
Examining Board in England* and their influence on sutdents
at provincial hospitals. This was referred to the Committee
of Management to report to the two Colleges.

Three further memorials forwarded by Mr. Benjamin
Bryan, and received on the 2nd inst, in opposition to the
proposals contained in the memorial forwarded bv Dr. Wilks
relating to the disposal of the Erasmus Wilson Fund, were
acknowledged.

A motion by Mr. Macnamara, “ that it be referred to the
President and Vice-Presidents to consider and report to the
Council as to the propriety of rearranging the lectures
annually delivered in the College, and of making them
more serviceable to the profession,” was agreed to.

Mr. Hutchinson gave notice of the following motion
“ To arrange for the delivery, by members of the Council or
others, of special lectures, expository of the pathological
preparations in the museum of the College.”

Hitofral ftefos.

Royal College of Surgeons of England.—T he
following Members, having passed the Final Examination
for the Fellowship on the 26ch, 20th, and 27th ult., were, at
a meeting of the Council held on Thursday last, duly admitted
Fellows of the College: —

Carr, J. W., M.B. Lond., Bloo anbury-square; diploma of Member¬
ship dated Oct. 24th, 1884.

Hadley. Wilfred J., L.S.A.. Oavondlsh-rd., Clapham: Nov. 10th, 1883.

Hare. Evan Herring, L.S.A., Mortlake-road, K.ew; August 2nd. 1870.

Hatch. W. Keith, M.B. Aberd., Pall Mall; August 3rd, 1870.

Heatherlev, Francis, Newman-street; January 28th, 1885.

Hewkley. F., L.S. A., Cazenove-rd., Stoke Newington; Nov. 21st, 1881.

Hughes, Bdjpu- Alfred, Ouslow-gardens; January 2ith, 1884.

Digitized by GoOglC

1B12 ; TttR LANCET,]

MBDICAL FBWS.

[June 11,1887.

Jame*. David Philip, L.R.C.P. Lond., Tonbv, South Wale*; Nov. 16th,
1*71.

Lawrence, Laurie Asher. L.S.A.. ilansfield-gardens; Jan. 22nd, 1964.

Lund, H., M.B. Cantab., Whalley Kan^e, Manchester; July .loth, 1886.

• Richmond, C. B., L.6.A., The Infirmary, Warrington i Jan. 28th, 1876.

Robinson, H. Betbam, M.B. Lond., York-creaoerrt, Lower Norwood,
July 20th. 1883.

Spencer, Walter G„ M.B. Lond., St. Barthol. Hosp.; Ang. 3rd, 1888.

Tubby, A.H., L.K.C.P.Lond.,Studley-rd., Clapham; July 29th, 1884.

Four other candidates passed the examination, but being
under the legal age ( twenty-five), the grant of their diplomas
was postponed. Thirteen candidates failed to reach the
required standard, five of whom were referred for six months
and eight for one year.

At the same meeting the following Member, who passed
the Final Examination in May, 1885, was also admitted a
Fellow:—

Braddon, W. Leonard, Upton-ou-Severa; diploma of Membership,
dated April 23rd, 1884.

The following gentlemen, having passed the necessary
examinations for the diploma, were at a meeting of the
Council on the 9th inst. admitted Members of the College:—

Cockcrton, Herbert, Cambridge Lodge, Lower Tooting.

Dean, Henry Percy. Dromore. Anson-rood, Tufnell park.

De Renri. A. Oast riot, Chaplain’s House. H.M. Prison, Wandsworth,

Harris, Worsley John, Bennett-park, Blaclcheath.

Johnson, Harold Jo*s6, BUhopagate-street.

Kirkpatrick, Randolph Femhlil. Bollngbroke-road.

Westbrook. Richard Talbot. Guv’s Hospital.

Whicher. Alexander Hastings. VVestcombe-park.

White, Charles Perclvsl, FurnivalVlnn.

Socnrrr op A pothecarles.—T he following gentle¬
men, haring satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on June 2nd:—

Cotes, Dlgby Francis Baynes, Purton, Swlndonj Wilts.

Morris, Edward Walter, Southern-hill, Reading

Pcschey, George Oharlee, Albany-street. Kegents-pork.

White. Thomas Dawe, Wallerton-road, W.

On the same day the following gentlemen passed the Primary
Examination

Atkins. Sidney Bmest, St. Bartholomew's Hospital.

Best. William Jenner, Londou Hospital.

Jessop, Arthur Rowland, Guy’s Hospital.

The examination in Arts of the Society of Apothecaries was
held in the hall of the Society on the 3rd and 4th inst.,
when there were 201 candidates. The class lists will be
published, it is understood, early next week. The third
examination in Arts of the Society of Apothecaries for this
year will be held on the 2nd and 3rd days of September
ziext, and the fourth examination in Arts is fixed for the 2nd
Rnd'3rd days of December next.

The Jubilee Extension Fund in connexidn with
the Aberdeen Royal Infirmary amounts now to upwards of
£22,924.

-/Esoulapian Society.—T he annual dinner of this
Society took place on Friday, June 3rd, in the Holbom
Restaurant. The meeting was a very successful one.

, Vaccination Grant.—M r. ‘William Rowlands, of
the Sephton District of the West Derby Union, has been
awarded the Government grant for successful vaccina¬
tion.

Mr. J.- O’Donovan, F.R.O.8.I., of Mount Haigh,
Kingstown, has been placed on the Commission of the Peace
for co. Dublin.

Royal Society.—T he second soiree, of the season,
that to which ladies ore admitted, was held on Wednesday
at Burlington House. There was a large and distinguished
company present.

On the 2nd inst. an athletic festival, in aid of the
building fund of the Great Northern Central Hospital, was
held at Tufnell Park, its organisers being the police / of
the Y Division and tradesmen of the district.

Cremation.— The Geneva Town Council is
agitating for the institution of a crematory furnace for the
Canton, on the scale of that so successfully worked at Milan.
M. Empeyta, the chief mover in the matter, has put forth a
defence of the practice against common objections. Mineral
poisons, he maintains, are as easily detectable after crema¬
tion as after burial, while premature cremation is avoided
At Milan by sending the corpse to the ustrinum not sooner
than eight days after death.

Hospital Saturday.—T he street collection on behalf
of the London hospitals takes place to-day (Saturday).

An Oriental bazaar in aid of the funds for building
a wing for the accommodation of out-patients at the East
London Hospital for Children at Shad well was opened on
the 2nd inst. at the Westminster Town Hall by the Duchess
of St. Albans.

Sanitary Institute of Great Britain.—A t an
examination, held on June 2nd and 3rd, seventy-seven can¬
didates presented themselves—nine as local surveyors and
sixty-eight as inspectors of nuisances. Of the former class
four satisfied the examiners, of the latter class forty-four
were approved.

The epidemic of measles at Grantham, which has
now reached the workhouse children, is supposed to have
been brought into the town by travelling hawkers who
attended the recent fair. The Town Council are discussing
the advisability of inspecting the vans Of these persons
beiore again allowing them access to the town.

Consultative Relations between Hospitals and
Providbnt Dispensaries. — The Medical Attendance
Organisation Committee has appointed a sub-committee to
consider a piac for bringing “ hospitals and provident dis¬
pensaries into consultative relations.” The sub-committee
consists of Sir T. Spencer Wells, Bart., Dr. F. H. Alderson,
Mr. W. G. Dickenson, Dr. J. Grey Glover, Dr. W. M. Ord,
Dr. Gilbert Smith, Dr. J. C. Steele, Dr. Walter Smith, Dr. W.
E. Steavenaon, Mr. W. Bousfield, and Lieut.-Col. Monteflore.

The Water Supply of the City.—A t the last
meeting of the City Commission of Sewers, a report of the
Streets Committee, recommending that a tender of £1750 be
accepted for constructing an artesian well at the artisans’
dwellings in the City, was adopted. The work, it will be
remembered, is being projected by way of an experiment to
ascertain whether pure water can be cheaply supplied to
the City independently of the water companies, whose
charges have been the subject of complaint.

Royal Collhge of Surgeons in Ireland.—A t a
meeting of the Fellows on Monday last, the following
office-bearer* were elected for the ensuing yearPresident:
Anthony H. Corley. Vice-President: Henry Fitzgibboo.
Secretary: William Colles. Council: G. F. Kidd, William
Colies, Sir Charles Cameron, Edward Hamilton, Robert
McDonnell, Sir William Stokes, William J. Wheeler, Sir
George Porter, J. Kelloek Barton, B. H. Bennett, Philip
Crampton Stnyly, W. Stoker, Rawdon Macnamara, A Meldoa,
William Elliott, William Carte, 8an»uel Chaplin, William
Fraser, and Kendal Franks.

Deeds and West Riding Medico-Chiruroical
Society.—T he general meeting of the members of this
Society was held on. the 20th ult., when the fourteenth
annual report was read and adopted. During the past year
nine meetings, with an average attendance of forty-five, have

been held, twenty-onenew members have been elected, twelve
have resigned, and the Society now numbers 214 mem¬
bers. The library hA8 been considerably increased, and
three additional microscopes have been purchased. The
financial report was satisfactory. The following were
elected office-bearers for the ensuing year:—President, Mr.
Edward Atkinaon; Vice-Presidents, Dr. Cameron and Mr.
McGill; Treasurer, Dr. Clifford Allbutt; Hon. Secs., Dr.
Jacob and Mr. Edward, Ward; Librarian, Dr. Bam; and
Auditor, Dr. Braithwaite.

Tiie International Congress on Alcoholism.—
At Antwerp, which in 1S85 was the scene of the last Con¬
gress on this great question of public health, it was arranged
that the next should be held this year at Zurich on Sept, ikb
and 10th. The permanent committee are organising for the
occasion an exposition, of everything bearing on alcoholism.
For example: tables and diagrams of different countries*
indicating .the consumption of alcohol per head of the
population ; the proportion of persons annually undergoing
imprisonment pbr 100,000 of'the inhabitants; the annual
proportion of suicides and of lunatics; the annual outlay
on alcoholic drinks compared with that incurred for articles
of prime necessity; plans of asylums for inebriates: speci¬
mens of non-intoxicating beverages; and comparative
regulations of the various temperance societies, with
, statistics of their working, ■

ed by Google

D

Tttr Lancet,] APPOINTMENTS.—VACANCIE8.—BniTnS, MARRIAGES, AND DEATHS. [Jew* II, 1887. 1213

Iw honour of Her Majesty’s Jubilee, it has been
decided by the promoters that the procession annually
organised in the East-end of London on Hospital Saturday
shall this year be conducted on a more extensive scale than
usual.

Exhibition at Wiesbaden.—A scientific exhibi¬
tion will be connected with the GOth Congress of German
Naturalists and Physicians to be held in Wiesbaden from
the 15th to the 24th of September. It will be strictly
scientific, not mercantile, and its purpose will be to show
at a glance tho latest and most perfected instruments
and apparatus which have been placed at the disposal
of science and medicine in the last few years. The fol¬
lowing groups will form part of it: -Surgery, physical
diagnosis and therapeutics; ophthalmology, gyntecology;
laryngology, rbinology, and otology; orthopaedics, dentistry,
chemistry, instruments of precision, with subdivision for
microscopy; instruments and apparatus aiding instruction
in natuml history, geography, equipment for scientific
travel, photography, anthropology, biology and physiology,
hygiene, electro-therapeutics and neurology, and pharma¬
cology.

MEDICAL NOTES IN PARLLV.ilENT.

ftn liter .

Iw the House of Common* on the 7th ln»t., in reply to Mr. Bonsor,
the Chancellor of the Exchequer stated that since the deputation
eighteen samples of t>eer. purchased of various publican* ohoaen by the
hon. member tor Suffolk (Sudburv Division), had been carefully analysed
at the laboratory at Somerset House, and lie was able to inform the
House that In no single case had any adulteration, nbxlous or otherwise,
been detected, but, on the contrary, the been were genuine and of high
alooholic strength. This statement fully corroborated the correctness
of the view maintained by the Board of Inland Revenue.—Mr. Qullter
asked whether the right hon. gentleman could inform the House If the
samples analysed had been obtained by the oUlcer* of excise of the
district, who would be presuombly well known to the publloana, or were
purchased over the bar by some of the public In the ordinary coarse of
business.—The Chancellor of the Exchequer understood that tho
■ample* had been arranged for by the hon. member himself.—Mr. Bonsor
wished to state that he had nothing to do with procuring the samples,
except to indicate the localities, fie believed that they wen 1 procured
through the officer* of excise.—The Chancellor of the Exchequer said
that. If the boa. member wished It, further inquiry should be made.—
Mr. Qullter hoped that tha right hon. gentleman would ascertain
whether or not t hese samples were obtained by the officers of excise.

Ilpotetmtuts.

Suemetfnl applicants Per Varmnet. Ne er et ar iee of PuhHe fnsHhttims. and
ether* possessing wftrmaticm statable fee this column an incited to
fon o ar d it to III Lancet Office, directed to (As Sub-Editor, not later
than 9 o'clock on tho Thursday morning of each toeek far publication in
tho next number. _

pAtrLKNER, W. Cooke, M.B.. C M.Ed., has l>oen elected Medical Officer
to the 8econd District ot the Bastbonrne Union.

Gelston, John S.. l.KIJC.P.I., L.B.O.S.T.. ha* been appointed
Medical Officer for tho Hapistem District of the Thetford Union.

Oovmrr. Graham P.. L.B.C.8., L.B.C.P.Bd., has been appointed
Assistant Medical Offioer for the Workhouse of the Sheffield
Union.

Habrmox, Walter, D.M.D. Unlv. Harv.. L.D.S. Roy. Col. Surg. Eng.,
hat been appointed Honorary Dental Surgeon to the Throat and Bar
Dispensary. Brighton, vice W. Lloyd Poundall, resigned.

Howard. Wilfred. M.R.C.S.. L.li.O.P. Bd„ has been appointed
Medical Officer for the Third District of the Depwade Union.

Huorc-s, Bimias A., M R.O.S.. L.R.C.P.Loml., ha* been appointed
Registrar and Chlorofomdst to the B\e]lna Hospital for Sick
Children, South wark-bridgw-rnad, 8.B., vice O. A. Carpenter,
resigned.

Kerr, Daniel 0., M.B.. O.M.Bd., has been appointed Medical Offioer
for the Kealby District of the Cats tor Union.

Kraoos. Francis H., M.B.C.8., L.R.C.P.. has been appointed
8urgeon to the Gloucester General Infirmary and Gloucestershire
Rye Institution, vice Anthony J. Bathe, M.R.C.S., LK.U.E L.8.A..
resigned.

ICExrH. Jas. Thomas, L.R.C P.Kd.. L.F.P.S.OIa*., L.M., has been
appointed Surgeon to the Oswestry Dispensary.

Power. IFARrY. M.A., M.B.Oxon.. P.B.C.8. Eng., has been elected
Assistant Surgeon to the Victoria Hospital for Children, Queen'*-
road. Chelsea.

Thomas. Frederick, U.R.C.S., L.R.C.P. Load., has been appointed
Medical Officer for the Upper Yalradyfodwg District of the
Pontypridd Union.

Thomas, Q. H. Wakrkn, L.R.C.P.Lond., M.R.C.S., list been appointed
Medical Officer and PubUo Vaccinator to the Tclgumouth
District. Newton Abbot Union, vice Robert Gibbs, M.R.O.S.. L.S.A..

resigned.

Turner, Alfred, M.B..O.M.M.. has been appointed Assistant Medical
. Offioer ft> Mm Dorset County Asylum.

©araitcks.

In compliance icith the desire of numerous subscribers , it has been decided to -
resume the publication under this head of brief particulars of the various
Vacancies which are announced i» our advertising columns . For further
information regarding each vacancy refere nce should be made to tho
advertisement . __

Bi<.glk.swadk Union. Bedford.—District Medical Officer. 8alary£12Q,
with extra m dies I fee*, as allowed bv the Local Government
Board.—Medical Officer for the Union Workhouse and InArawury.
Salary £40 a year.—Medloal Officer for tha Contagious Diseases
Hospital. Salary £ 10 a year.

Bikmlm.h.im Gkm hal Honpital.— Assistant House-Surgeon. Resi¬
dence. board, and washing will lie provided, but no salary.

Clink al Hospital for Womkx and Children, Park-place, Man¬
chester.— House-Surgeon. Salary £80 pci annum, with apartments
■ and board.

Durham Courtt Hospital. — Honse-Sorgeon. Salary £100 a year.

with board and lodging.

Hospital for Women. Sono-squnre, W.—House-Physician. Salary £75
per annum, with hoard Ac.

Liverpool Dispensaries. —Assistant 8urgeon. Salary £80 per annum,
with apartments, board, and attendance.

Liverpool Loyal Southern Hospital. — Ambulance Surgeon. .
Board, lodging, and washing provided, but no salary.

Manchester Hospital for Consumption and Diseases of the
Throat.— Honorary Assistant Physician.

Midhurit L'nicx. Sussex.— Two Medical Officer*. 8alariee £85 and
£15 per annum, with extra medloal and vaccination fees.

Paddington Provident Dispknsart, pear Bdgware-road, W.—Medical
Officer. Usual *ratuity £50 a year.

Prison Comm wnioxbrs for Scotland.—H eaident Surgeon. Salary
£200, with an increment of £50 after five years, and a further
increment of £50 after ten years, to a maximum of £300, with,
residence, or allowance in lieu, and medicines. '■

Queen's Hospital, Birmingham.—Honorary Surgeon.

bT. Pancrak and Nortiurr Dwpensarv, Bu»ton-road. — Resideat
Medical Officer. Salary £105, with realdenot.—Honorary Phy¬
sician.

Township of Toxtkth-park, Liverpool.—Assistant Medical Officer for
the Workhouse and Infirmary. Salary £100 per annum, with
rations of a lirat-class officer and separate apartments.

I'siVLltsiTT Collluk. London.—Professor of Medicine.

|Sirt{rs, Hfcirriaps, aitEr

BIRTHS.

Barton.— On the 1st Inst., at Searle Lodge, Market Essen, the wife ot
B. Bartoo, M.D„ of a ton.

Morton.—O n the 1st Inst., at Wellesley-vlllas. Croydon, the wile of
Shadforth Morton, M.D., of a son.

Phmiott.—O n the 0th Inst., at Telgnmonth, South Devon, the wife of
¥. Cecil H. Piggott, B.A., M J.. B.C. Cantab., M.H.O.S., L.S.A.. of
a daughter.

Raw. — On the 28th nit-., at Rotland House. Oak field-road. Aneriey,
S B., the wifeof William E. St. M. Kaw, L.B.C.P., M.B.O.8., L.8.A.,
of a daughter. _____

MARRIAGES.

Allwrioht — Lunnon.— On the 1st inst., at Si. Nicholas', Hodsor.
Bucks. Frederick William Allwrlgbt, M.D., to Dorothy Mary (Dora),
only daughter of the late Thom is Lunnon, Esq., of Bourne Bank,
Bourne end. Bucks.

Grimsdalk — Jevons. — On the 2nd inst.. at the Ancient Chapel of
Toxtcth-park. Liverpool, Thomas B. Grinisdolc, M.B., to Helen,
dan^hter of Henry Jevons, J.P., of Liverpool.

Holt — Cooper. — 'On the 4th Inst., at 8t. Jamee'a, Clap ham.

. H. Lyttleton Holt, M.K.C.S.. L.B.C.P.Bd., to Caroline Bmiljr
Cooper, elder daughter of William Cooper, of Olapham.

Moib— Bonamv.—O n the 8th inst., at St. John's the Bvangelist, W.C.,
Byre* Molr, M.B., to Bvelyn, daughter of the late Lieut.-Gol.
J. Colling* Bonamy. of Guernsey.

Toller—Mackat.-O n the 1st Inst., at Langton-bv-Wragby, Lincoln¬
shire. Charles William Bdward Toller. M R.O.8., L.R.O.P., to

Florence Heaton, second daughter of the Rev. Sween MacDonald
Mackey, M.A., Vicar of Langton.

Wilks—McGacukn -On tlie 1st lust., at St. Martin’s Chnrob, Fenny
Stratford, Buck*, by the Rev. A. H. MacGaohen, brother of the
bride, assisted by the Rev. A. H. Barrow. Vicar of the Parish,
Frederick William, youngest son of the late William Wiles, of
Wottoo-under-Edge. Gloucestershire. to Sophia Buphemfa Anld,
younger daughter of the late Her. J. D. Mctlachen, Vicar of
St. Bartholuniew's, Bethnal-green.

Wright—Gwvks.—O n the 1st inst.. at Emmanuel Church, Clifton,
John Frederick Wright. M.K.C.S., to Bthel Gwendoline, third
daughter of the late John Crowther Gwynn, of CUfton. Solicitor.

DEATH.

Oliver.—O n the 7th Inst., 8amurl Oliver, M.R.O.8., L.B.C.P.Bd., of
Buckingham Palace-road, and Enfield, Paignton, South Devon, in
his 53rd year. ______

B.B .—A foe of Be. it charged for the Insertion ef Notices ef Births,

Homages, and Deaths. ^

Digitized by v^ooQle

• The Lancet,] NOTES, COMMENTS, AND ANSWERS TO 00BRESP0NDENT8.

[June 1L, 1887.

METEOROLOGICAL HEADINGS.

(Taken daily at 8.80 dm. by Steward7s Instruments.)

THE Lancet Office, June 9th, 1887.

fists.

RsrorsoMT

rodased to
8e* Level

and Swy.

Direc¬

tion

of

Wind.

J2k.

Wet

Bulb.

Solar

Kadi*

In

Vacuo.

Mnx.

Tntrrp.

rtkado

Min.

Temp

Rain

fail.

Remark* si

Juue 3

29-63

N.B.

56

55

57

61

•43

Overcast

.. 4

29-95

W.

55

53

107

71

49

•73

Cloudy

.. *

30 05

S.W.

61

60

106

72

53

Hazy

„ «

3013

W.

60

57

109

69

65

Hazy

7

30-06

S.W.

63

68

95

71

55

Cloudy

.. 8

30-12

S.W.

63

59

116

76

68

Cloudy

„ 9

30-09

w.

60

65

62

•06

Fine

litotes, Sljsri Comments, $ Rustem te
Corosporttrenis.

It is especially requested that early intelliyenoe of local events
having a medical interest, or wnich it is desirable to bring
under the notice of the profession, may be sent direct to
thus Office.

All communications relating to the editorial business of the
journal must be addressed 1 'To the Editors.”

Lectures, original articles, and reports should be written on~
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication
We Cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “ to the
Publisher.”

We cannot undertake to return MSS. not used.

Physicians in Ancient Rome.

R. C. L. (Newcastle-on-Tyne).—The status of the profession in Anclest
Some was first recognised by Cal os Julius Crcsar when he came to
wield absolute power. “ Omnee medloinam Soma professos," says
Suetonius, " et llberullum artlum doctores, quo llbentlus et ipsi urbem
Jncolerent et ceterl adpetorent, civltnte donavlt. (He vouchsafed the
right of citizenship to all who in Some professed the healing art, and
who'gave lessons in liberal education, in order that they themselves
might the more willingly settle in the City, and that others similarly
qualified might repair to it.)

Dr. L. Marshall .—We fear the communication is too lengthy for pub¬
lication.

Mr. Kendrick .—The specimen Is nnder examination.

“SWEATING OF THB FEET.”

To the Editors of The Lancet.

Bibs,—T o cure the moisture of the feet every effort should be made to
secure rapid evaporation. From personal experience this end, I find, can
best bt obtained by the use of sanitary clothing, porouB throughout and
made exclusively of animal material, which is a non-conductor of
heat or electricity. So far as the feet are ooncerned, the sock or
stocking is made of pure an! Inal wool, free from all dyes or colouring
material. The separate division given for each toe, as for a glove, keeps
the foot cool by preventing the accumulation of sweat. We should soon
suffer with our hands if gloves were made of one piece, holding the
fingers tightly together, ns the toes In a boot. The true sanitary boot
should be made of woollen cloth or very porous leather with oioth
uppers. It Is lined -with pure woollen lining. There Is a hole In the
upper part of the heel, and the inner soles or layers of leather are per¬
forated. Each step Is supposed to pump air in and out of the boot.
However.this may be, the fact in any oaae remains that the foot is kept
atonoe warm and yet cool. There is no sense of stuffiness or closeness.
The foot does not swell. Whatever moisture arises at onoe evaporates.
The fob* therefore remains dry and warm, but is nbver over-heated and
offensive^ The bod odours that vegetable llnlngand socks—cotton socks,
to wit—retain are thrown off by nature’s clothing—I.e., animal wool.
This Is a fact I have particularly wotioed when travelling In hot oountrles.
My cotton socks soon became obnoxious, even when constantly changed,
though my feet were In a healthy staW; but now that I wear sanitary
beots Itfwer suffer any Inconvenience. My woollen soaks keep my feet
pleasantly cool and dry and free from all odour.. Bstolfe-is no use
wearing woollen socks with a boot that., has cotton or Un4rfttnibg. the
foot most be revered throughout wi th por ou a a nhaaby ptmls^.

Jane, 1887. 4 4 “ •"**' Adolphe Bum.

1 “ Winxs» Palaces of Health at Home.”

R&febbinq to Dr. B. W. Richardson’s suggestion, as noticed In oar
issue of May 28th, Mr. Richmond Leigh writes:—“In the Crystal
Palace wa have a spacious winter-garden. In which suites of rooms for
Invalids and delicate-chested individuals oould be put up at a reason¬
able outlay and let at a fairly moderate charge. The Palace also
possesses the great advantage bt a Large and' varied selection at amuse¬
ments, besides schools of art, Ac., to occupy the minds of the rt sMntl i
and prevent ennui. It is conveniently near to London, whence, tt
may be presumed, it would draw Its largest contingent of patrons, and
would also allow friends residing iu the metropolis to visit the invalids
frequently, the locality is of little import under glass. The eot»-
talned vegetation, another advantage already lu action at Hie Mace,
would preserve the purity of the air, and little ventilation would be
required, while dampness need not be apprehended. The luxuriant
growth of the bananas and palms in the Crystal Palace is the tort of
Its climate, and the proof of its suitability to phthisical and other
invalids.”

M.B.—l. If A entirely ignores the work of his Poor-law appoint mint,
he is decidedly infringing the regulations of the Local Govai naaaat.
Board; and in regard to his vaccination appointment the same rale
holds good with greater force. — 2. We should reoommenJ " 1LB.*
to live within his disCIftt, and leave otHttS to report to the Oratcml
Board his opponent’s non-complianoe with the!^regulations.

Boston .—The Morton lectures will bs delivered by Sir James Paget at
the Royal College of Surgeons of England. The date has yet to be
announced.

M.R. C.S .—Scarification with a very cold scalpel, the skin being fasten,
has been successful (see The Lancet, March 23rd, 1878, p. *21).

THE NEW MEDICAL ACT AND STUDENTS.

To the Editors of The Lancet.

Bibs,—I should be very grateful if yon would Insect this letter in
your next Issue, ns, if the Councils of the Colleges of Surgeons and
Phytioians would make the concession I plead for, many students
would benefit by it. Tne student who registered on Oct. 1st, 188A is
seriously affected by the New Medical Act, as he began his mndlrn
thinking that he could take either the diploma of K.B.C.S, or
L.R.O.P.L , and register It alone; and being thirteen days short of
forty-five months he Is unable to present himself at forth c o min g crrs n l -
nations, kindly held by both Colleges in order that many of those whs
entered, thinking they were entitled to register and practise with ei t her
one degree, may have sn opportunity of presenting then— el res wtttaneisw
to doing so. As he Is now obliged to take both, I would plead Mae* he
may be allowed to presen t, hims elf far examination at whichever College
he was preparing for two years after patstng first subject of primary,
instead of two years from completing It, *nd for the following reasons : —
First, If a student passed hi anatomy, sod was referred for six months
in physiology, no one wbnld. I think, suggest that he could rend that
subject alone during the whole pe ri od; and what he really do— is to
attend various out-patient departments and the post-mortem room, and
read up the referred subject la early morning and evening. S e con dl y,
it is not usual for a student to present himself at both College* (or th*
finals held In the same month, so that two years would have been sprat
probably in hospital practice, from the time of oom pie ting the primary,
before he had obtained both diplomas; and even if that were made a
condition. It would be a great boon to many students. At the time of
passing the first part of the primary he would then make np his mind
which be Intended to go in for first, and give greater attention to it for
two years from then, afterwards spending the re m a i n d er of the time
from the passing of the last part of the primacy till two y—us bad
expired, preparing for examination in the remaining subject or satgsets.

I am. Sirs, yours obediently.

May 31st, 1887. A 8TCDUT.

Mr. W. Longboitom. —Dr. KoUsehSr has not, we believe, completed kb
Investigations on the subject. We shall probably be in a pos i tion to
publish farther particulars shortly.

Jfr. G. W. E. Russell will see, by reference to an annotation in another
column, that the subject of our correspondent’s letter is eagagiag
attention.

INCISING THB TONSILS.

To the Editors of THE Lancet.

, Snri.—I attended lately a woman Who was suffering from tonsHSth.
there being even more than , the usual tumefaction. Upon vixtting
hbr one day tn the course of the disease I was anxious to incise Use tonsil
1st once, and not having a bistoury with me at-the time I did so with an
Ordinary blunt-pointed dressing scissors, and with the best runt ts. It
struck me upon thinking over the matter afterwards that psttsp it
would be better to use a blont-pcfnbed scissors in-6 very similar ease, B»
danger of wounding an artery Is altogether obviated, there t* nodMStelty
Whatever in getting a good grip with the scissors upon the swollen tOEsfl,
sad the preliminary preparation of a bistoury with Unt, which is wrappe*
rotradlt. Is avoided. I admit that there Is very little danger of m uiEHftaf
an artery with a bistoury used Tn the customary way; still it laMbw
to have no danger at all than a littiq.—Yo—sreSpeetJuUy,

, Deptford, S JB., May 28th, 1887, , JAB, fllfl

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NOTES, COMMENTS,'AND AlfSVTRKg ’TO COfiMESPONDKNTS, fjttm U, 188T. 1235

' '■ ■ i^^oxopi rr i._ / f'"

K. sum a little more than £90 14 still tecfylred to defiWy -the heavy
bill of cost* for legal defence Incurred by Dr. J. Wreford Langmore
In the recent groundless action brought against him in consequence of
bis having signed a lurfafey'hWtftaoffiepiiaKompUance with a magis¬
trate'* order. The oonuhlttee desire to close the fintd, and Will thank
all gentlemen wishing to subscribe to send their donations at dHce to
Mr. George Bastes, M.B., 69, Connaught-street, Hyde Park-square,
London, W., the hostossty seers tary to the fund. The donations
already acknowledged amount to £161 4a. Thus* Deceived daring the
last three weeks are the fe Ho wing i-r-

“A Friend In the Pells”... £2 .2 0 • Mr. fc. i. Godlee , .£1 1 0

Proprietors of Thk Lancet 2 2 0 j Mr. T. A. Rogers . 1 1 0

Mr. John Morgan . 3 2 0 Dr. John Williams .. ..1 1 1 0

Dr. J. Russell Reynolds... V 2 0 < Mr. B. P. Yonng . 0 10 6

Dr. J. P. P. Staples. 2 2 0 ' Dr. Maurice Davis . 0 10 0

Dr. A. B. Qarrod ... 1 1 0 '? Dr. J; O. Thorowgood ... 0 6 0

“ TREATMENT O# TANIA. SOLIUM.”

To tJm Editor* of TH£ XuprcKT.

Sins.—Being an old resident In Sooth Africa, I oan fully confirm the
assertion of your correspondent. Dr. Fred. A. A Smith, as to the fre¬
quency of worms among the natives—so much so that you will seldom
see a Kaffir's necklace without tome places of root among the ehsrms,
some probably of the male fern, as they know of that retnwiy. I have a
piece of root still in my poss e ssion which was given to me by a Kaffir
man, and of which I wrote at the time from his dictation: “ The root
umfissd, or nmfdzfi. The fiower they call ‘eenjlganjysmbo.’ A most
valuable medicine. The plant (I understand) attains no mare than six
Inches In height.” To this is appended the man’s directions for use in
the case of worms. Does Dr. Smith know the colonial remedy for worms
often used among the Boers—the Inner bark of the root of the pome¬
granate? The rind of the fruit Is used by them in dysentery.

I am, Sirs, yours faithfully.

Doughty-street, W.C., June, 1887. M. Caret-Hobson.

Fouxnuxos i» Italy.

Db. B. Raskri, Of the Italian Bureau of Statistics, has recently Issued a
valuable report on the subjeob of Illegitimate births and foundlings in
Italy. Of 187,555 Illegitimate children bom in the 8200 communes of
the kingdom of Italy during the three years 1S79,1880, and 1881,122,782
were recognised by one or both of their parents, while the remainder,
64,773, were brought to the civil offices, each by a stranger (midwife,
aoeoocheur, Ac.), with the declaration that the mother did not wish
to declare the proper name of the child. In the years In question
(1879-81) the Infants found exposed were 40,296 alive, and 600 dead.
Of these 32/093 were found in the turning boxes intended for thrir
recaption, 541 of them dead, and 6823 were found on the public roads,
under staircases, in churches, Ac., 79 of these being dead when found.
Out of a total of 227,851 Illegitimate children and foundlings in all
Italy daring the three years 1879-81 publio oharity took charge of
only 106,461, the greater another reengnlted by their parents, having
bean provided for by them, or having died before the owmmunea con¬
cerned had time to take measures In their behalf.

Scot .—Is our correspondent quite sore of the accuracy of his diagnosis ?
Iodide of potassium might be tried.

THB L.S.A AN A DOUBLE QUALIFICATION.

To Ou editor* of The Lancet.

8ras,—According to tbs decision of the General Medical Connell the
licence of the Apothecaries’ Society, London, will be a lieenoe to practise
surgery, as well as medlolne; after July 1st, 1887. ShOnld not those men
who have already p a s s ed tha examination In surgery (conducted by the.
same examiners—Messrs. Maklns, Walsh&m, and Andrew Clark—as were
recently appointed by the General Medical Council) be also recognised
by tha General Medical Council as possessing a licence to psactiso
surgery ? I am. Sirs, your obedient servant,

June, 1887. L.R.C.P.

%* The question asked by our correspondent is a very reasonable one.
Unfortunately, law and reason do not always coincide, and there
may be a difficulty in the Society acting on any examination retro¬
spectively. W# command the letter, however, to the consideration of
tha Society.—Bn. L.

isrsju should refer to a letter whloh appeared in our issue of Deo. 6th,
1864, p. 1036.

TO PASTUBH8 NBW.

To ths Editor* of Thb Lancet.

Bus,—I am a physician, Ac., with Indifferent health and a small
private income (about £120 a yea?). I am anxious to emigrate, but do
not know where to go. Perhaps tome ofyonr readers would kindly give
me some hint* on the subject. I am a bachelor, and fond of ootratry
life and sport. Any good oHtnato, with a chance of £100 a year, would
•alt ns; and for Information t Shriulfiborery grateful.

I am. Sirs, yours faithfully,

June 4th, 1887. .. f i.' - * ,71 ' IxmUM,

- ■ MVjirEBqoifeV TnElB n -C' T hi Tw k VIlto. J

The Viennk school'hits been investigating this subject, and bas arrived
at conoluifona of importance for all countries where, like Austria, the
edible fungi *re a common food. The traditional view has been that
mushrooms, are equal in nutritive value, tp butcher’s meat, and
physiologists, like Lorluser in bis work on “The More -Important
Fungi” (Vienna, 1883), have urged, in the interests of the poor,-the
mono frequent ¥»«of an aliment so easily procurable and so sustaining.
Do. 8 trOmerof Vienna has, however,after reposted and carefully checked
lnvwstigatkms, teoabud tbs following result* :—1. The fresh, aanahiwom
differs widely if rom Chet dry mushroom,-the dormer containing WOiper
cent, of water and only feem k to 3 per seat, of albumen. while the
latter contains 28 percent, of albumen. Moreover, the- different parts
of the mushroom contalh more 1 or less albumen, the “hat,’”for
instance, having twice"as ranch as the sterti. 2. The fresh : mnshrOom
contain* 2"5 per bent, of cartion hydrates, while the dry contains
24 - 5 per cent, of them. Experiments conducted on Stutzer’s method
give the following results as to the digestibility of mushrooms :- ; -Oat
of 4"7 per cent, albumen in the boletus edulis there was digested 79 per
cent., of 5 6 per cent, albumen contained in the “ hat" there *vaa
digested 80 per cent.,: while of 2*7 per oent- albumen contained in tha
stem there was digested 75 per cent. Compared with other aliments
this means difficult digestion. Black Viedua bread contains 1*2per
oent. albumen, and of-this, in the-same time, 86 per cent, was
digested ; bean-meal contains 3-6 per cent, albumen, and of fills,
also In the same time, 91 per cent, was digested ; pease-meal,
with 3 9 per oent. albumen yielded 95-9 per cent, to digestion,
raw ham 98 per cent., and grated butcher's meat as mneh as 99-25
per cent. Results, the same to a fraction, Were reached by Sdltel
of Amsterdam and Moraer of Upsal. Dr. Stromer concludes: I. Mush¬
rooms possess small nutritive value, their heavy charge of water
reducing to very little their quantity of nutrient substances, ^nd,
above all, the albumen, which is difficult of digestion. 2. Dry mush¬
rooms are not much better, because they absorb s great deal of water
Inoooklng. a. Mushrooms approximate In nutritive value to vegetables,
part tool arly to cabbage, and, being oheap and easily procurable, deserve
pro ta*to the attention of the poor. -

Ur. J. Peter*.—As far as w*e can make out, the case is still sub judtee ,*
we therefore refrain from comment.

“SPECIALISM IN BXOBLSIS.”

TO the Editors of Thk LaNCNT.

Sirs,—I n reference to your amusing paragraph with the above
heading In a recent issue of The Lancet, it may interest some of your
readers to hear that the ancient Egyptians, althengh they may not
have had an “ Association of Genlto-urlnary Surgeons,” appeared to
have practised specialism in exeelti*. For we learn, on the authority of
Herodotus, that eaeh single disease had its special phytiolan(De Bello
Portico, 2, 84).. They, however, seemed to have drawn the. line at the
bell}-, which, with it* contents and all below it, was given In charge of
one man. I am, Sirs, yours obediently,

Brighton, June 5th, 1887. W. A H.

Thk Vienna International Congress op Hygiene.

G. A. P. (Birmingham).—In July next the Working committee/of'this
great gathering will be in a position to issue to all members a detailed
programme, Inolndlng the topios entered for discussion. I* le etlU
receiving numerous announcements of intending pertfelpmte'Hi its
business, not merely from medical men, but from' members of other
more or lest cognate professions. The programme will be found to
include every mihjeet .bearing directly or indirectly on public health.
The Dutch, the Swiss, and the Saxon Governments have each nomi¬
nated their representatives. The exhibition of hygienic appllancee
will be unprecedentedly rich, thanks to the contributions aiready
received or promised from the various European and Transatlantic
States. All members of the Congress will be presented with a
“ Hygienic Guide to Vienna,” having a plan of the city annexed, and
indicating every object of sanitary interest within its gates. The
Austrian railway* are In treaty with the French and Belgian lines,
as well as with the Triester-Idoyd and the Danube" Steam Navigation
Company, to reduce their fares by 66 per cent, for all members'Of the
Congress. • • .

J. W. Black, F.R.C.S .—The subject is one of some delicacy; but we feel
very strongly With our eorre*i>ondttit.

THB BROWN DBFBNCB FUND. ,

To t/u Editor*of Ths Lahcwt.

Sirs.—K indly Insert the following r—Amount already acknowledged,
£20 6s. M.; the Proprietor* of The Lancet, £2 2*.; A Fellow Bhfferer,
£1 lr. ; small sums, 0*.

I remain, Sire, yeum faithfully, i-.

G. Stanley Hti1tfr;ilA
22, Pppee Blah BIO ad-road, fidUtey JbA«nfc> 1887.

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1216 Thb LancmtJ .XQTB8, COMMENTS, AND ANSWKBS TO OOftEESPONDENTS.

yes* 11,1887.

Communications, Letters, Ao., hav* been received from—Sir Andrew
Clark, London; Prof. T. B. Fraser, Edinburgh; Ur. J. B. Godlee,
London; Mr. Lockwood, London; Dr. Gowers, London; Ur. Bland
Sutton, London; Dr. Cullingworth, Manchester; Messrs. M&ggs and
Son, Yeovil; Major Cooper, London ; Dr. Porter Smith, Shepton
Mallet; Dr. Mallns, Birmingham; Mr. Barrlnd, London; Mr. Arnold
Bvans, Wolverhampton; Mr. Aloan, Paris; M. de PonrlUe, Paris;
Mr. Travers, Sotton; Mrs. C. Stone, Freshwater; Messrs. Boulton
and Paul, Norwich ; Dr. J. V. Shoemaker, Ghloago ; Messrs. Fletcher
and Oo., Holloway; Mrs. Adams, St. Leonards-on-Sea 5 Dr. Percy
Boulton, London; Mr. T. D. 0. Barry, Netley; Messrs. Manlachlan
and Co., Hdinburgh; Dr. J. H. Hamilton, Hasrick ; Messrs. Blake and
Co., Leeds j Mr. Peters, London; Mr. Speed, London; Mr. Stanley
Bovd; Mr. Dereutb, London 1 Mr.V. Richards, Goalundo; Mr. Mayo
Bobeon, Leeds; Dr. Goodridge, Bath; Dr. B. Neale; Mr. Blohmond
Leigh, London; Lieut.-Col. Paris; Dr. T. J. Mays; Messrs. Arnold
mil Sons, London; Mr. J. M. Caw, Woolwich; Messrs. Hopklnson
and Co., Nottingham; Mr. Henriques, Brighton; Mr. B. Bardley
Wilmot; Dr. Jacobs, Leeds; Dr. Jas. Cameron; Mr. Mahoney, Bast
Grlnstead; Dr. Byers, Belfast; Mr. KIdeal, London; Messrs. Maythorn
and Son, Biggleswade; Mr. Longbottom, Sheffield; Messrs. Weiss and
Son, London; Mr. Crookshank, Edinburgh; Messrs. Francis and
Co., London ; Mr. N. Dobson, Clifton ; Dr. O'Connell, Calcutta;
Mr. St. Dalmas, Leicester; Dr. Hilliard, Aylesbury; Mr. Lancaster,
London; Mr. Bussell, London; Mr. Gumer, London; Mr. Hodgson,
London; Miss Fox, London; Mr. Cowan, Glasgow; Mr. Dewburst,
Lambeth ; Mrs. Blore, Leeds; Dr. La flan, Cashel; Mr. Martlndale,
London ; Mr. Bergo. Oxford; Mr. Hatchett, London; Mr. Panduran,
Bombay; Mr. Fuge, Taunton ; Mr. Fox, Wellington ; Mr. Hawkings,
London; Mr. Silcocks, Bath; Mr. Fox, Birmingham; Dr. Stanley
Murray, Putney; Dr. J. Farrar. Gainsborough; Messrs. Danlellson
and Co.; Dr. Wolfenden, London ; Dr. Creighton ; Messrs. Steele and
Bills, London ; Dr. B. Barnes, London ; Dr. J. W. Fraser; Dr. Carey
Hobson, London; Dr. Caiger, Llndfleld ; Mr. Page. London ; Mr. A. B.
Barker, London; Rev. G. F. Prescott, London; Mr. Frankel, Clan
William ; Mr. Duntberne, London; Mr. 3. M. AUender; Mr. Hayles,
Bveaham; Mr. Latimer, Swansea; Mr. Mllle, Hanley; Mr. Cooper,
Durham; Mr. Highmore, Liverpool; Dr. Cooke, London; Rev. A.
Tooth, Croydon ; Mr. Hunt, Manchester ; Mr. Bast wood. Blackburn ;
Mr. Bvans, Oswestry; Mr. Teague, Manchester; Mr. Byrnes, Dor¬
chester; Mr. Stretton, Kidderminster; W. A. 11.; M.U.C.S.; Scot;
Inquirens; L.R.C.P., M.B.C.S; ; II. V., Aylesbury ; PJdIo PIlo; A
Country Surgeon; L.R.C.P. ; A Genera! Practitioner ; Ambulance.

LETTERS, •acK witK tndoturt, are also adkhowledged from — Dr. Hoyle,
Jersey; Mrs. Walinsley, Liverpool ; Mr. Sackef. London ; Mr. Pryoe,
Pontypridd; Mr. Hogg, London ; Messrs. Grace, Bristol ; Dr. Jones.
Pontardawe; Mr. Mackinlay, Stockton-on-Tecs ; Messrs. Harrison
and Brass, Elgin; Mr. Bjurly, Pertsea ; Mrs. Brown, Loudon ; Mr. H.
Sargent, London; Mr. St«i>hens. St. Austell ; Mr. Huggins, Great
Malvern; Mr. Thomson, Luton ; Dr. Johnstou, Sheffield ; Dr. Piggott,
Teignmouth; Mr. Davidson, Manchester; Messrs. Benjamin and
Son. London; Mr. Legge, Aberjstwlth ; Mr. Bastes; Mr. Bffernan,
Bootle; Mr. Johnson, Leicester; Mr. Gayley; Mr. Williams, Aber-
tlllery ; Mr. Stenhouse, Glasgow ; M., Manchester ; Medicus, Stoke
Newington; Physician, London ; L., Leicester; Celsus; Btatim, New¬
castle ; T. 0., London ; Locum, Rverton ; M.D., l’angboume ; Beta.
Brockley; Beach; Natural Science; Doctor; M.A. C.; Unfortunate;
K. V., Leeds; A. H„ Woodley;. Transfer, Hanley; L., Bristol; M.,
Ramsgate; Australian, Lurdan; W. S.. Manchester; Aneroid; lady
Superintendent, Canterbury; Medicus, Lantford; M. N.; Epilepsy,
Knights bridge; X. X. X.; J. N. D.; G. B„ Keatish-town ; H. N. T,

Ltamington Spa Coterier, Melbourne Ago, Carpentaria Timm, Ltamington
CkronicU, Kentish GastUe, Ac., have been received.

Htfc&iral .Siarjj fur % mixing Muk

Monday, Jane IS.

Royal LonoR Ophthalmic Hospital, Hoovkum. — Op—Unas.

10.30 A.M., and each day at the same hour.

Rotal Westminster Ophthalmic Hospital.—O perations, 1 JO p.m.,
and each day at the same hour.

Chelsea Hospital for Women.—O perations, 1.90 p.m ; Thursday.* JO.
St. Marx's Hospital.—O peration*, 3 PJt. ; Tuesday, 8.30 p.m.
Hospital fob Women, 8 oho-s<j 0 arn. — Operations. 3 p m., and os
Thursday at the same hour.

Metropolitan Purr Hospital.—O perations, 3 p.m.

Rotal Orthopedic Hospital.—O perations, 3 p.m.

Cxktkal London Ophthalmio Hospitals.—O perations, 3 p.m., and
each day in the week at the same hoar.

Rotal College or Subgkosb or England.—4 p.m. Prof. Christopher
Heath: Certain Diseases of the Jaws —Diseases of the Temporo-
Maxillary Articulation and Cloture of the Jaws.

Tuesday, Jtfte 14.

Gut's Hospital.—O perations, 1.80 p.m. and on Friday at the same boor.

Ophthalmio Operations on Monday at 1J0 and Thursday at 3 p.m.
8 t. Thomas's Hospital.—O phthalmio Operations, 4 p.m. ; Friday, 3 p.m.
Cancer Hospital, Bbompton.—O perations. 3 JO p.m.; Saturday, 3.30 p.m.
Wrstminstrr Hospital.—O perations, 3 p.m.

West London Hospital.—O perations, 3 JO p.m.

St. Mart’s Hospital.—O perations, 1.30 p.m. Consultations, Monday,
1 JO p.m. Skin Department, Monday and Thursday, 9.30 a. m.
Rotal Medical and Chibuegioal Socuctt. — 8.30 p.m. Mr. J. D.
Malcolm 1 The Condition and Management of the Intestine, after
Abdomiuol Section, considered In the light of Physiological Facts.—
Dr. Radcliffe Crocker: Dermatitis Gangrenosa Infantum. —Mr.
Hutchinson: On a form of Chronic Inflammation of the Lips and
Mouth which sometimes ends fatally and is usually attended by
tome disease of the Skin.

Wednesday, Jane 16.

National Orthopedic Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.m.

St. Bartholomew's Hospital—O perations, 1.30 p.m.; Saturday,«m«
hour. Ophthalmic Operations, Tuesday and Thursday, 1 JO pot.
Surgical Consultations, Thnreday, 1.80 p.m.

Bt. Thomas's Hospital.—O perations, 1.30 p.m.; Saturday, same hoar.
London Hospital.—O perations, 3 p.m.; Thursday* Saturday,same hoar.
Great Northern Central Hospital.—O perations, 3 p.m.

Samaritan Free Hospital tor Women and Children.—O perations.

2.30 p.m.

Cntvrrsitt College Hospital.—O perations. 3 p.m. ; Saturday, 3 p.m.

Skin Department, 1.46 P.M.; Saturday, 0.16 A.M.

Rotal Fere Hospital.—O perations. 3 pjt., and on Saturday.

Kino’s College Hospital.—O paattons, 3 to 4 pj t.; Friday, 3 p.m. ;
Saturday. 1 P.M.

Children’s Hospital. Great Osmond-street. — Operations, 9 A.M.;
Saturday, same hour.

Thursday, Jana 18.

St. George's Hospital.—O perations, 1 vat. Ophthalmia Operations,

Friday, 1 Jo p.m,

Charing-cross Hospital.—O perations, 3 p.m.

North-West London Hospital.—O perations, SJ 0 p.m.

Friday, June 17.

Boyal South London Ophthalmic Hospital.—O perations, 3 p.m.

Saturday, Jana 18.

Middlesex Hospital.—O perations, 3 p.m. ,

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THE LANCET,

Clinical fcctnrc

OH

FUNCTIONAL DISEASES OF THE LIVER.

By SAMUEL FENWICK, M.D., F.R.C.P.,

PHYSICIAN TO THU LOS BOS HOSPITAL.

(Continued from page 1175.)

In what way can we explain the sudden change from an
excess to a deficiency of the salivary salt that we have seen
occur, not only in phthisis and cancer, bat also in many
cases of long-standing inflammations? I think the most
probable hypothesis ie that the nutritive organs are at first
stimulated to unusual activity in order to supply the
materials for increased growth, and that we then find the
snlphocyanide in excess; bat that this augmented func¬
tional activity is after a time succeeded by a corresponding
depression, in accordance with the law that an excessive
exercise of any organ is followed by a diminution of its
functional power, and that when this occurs the patient
exhibits the proof of it in his loss of strength, flesh, and
colour, as well as in the deficiency of the salivary salt.
We have before seen that an increased growth of struc¬
ture, whether local or general, must be accompanied by
a sufficient power of digestion, in order that the eulpho-
cyanide should present itself in increased amount; it will
be therefore necessary to inquire into the state of the
salivary salt in various diseases of the digestive apparatus
when there is no demand made upon them for unusual
exertion.

In the earlier stages of stricture of the oesophagus and of
the pylorus the amount of the salivary salt is generally either
normal or above the usual quantity, so long as sufficient
food can be taken to maintain the nutrition of the bodv;
but as soon as this ceases to be the case the quantity sinks
below the normal. In cancer of the stomach, as I have
before mentioned, the amount generally soon becomes sub¬
normal. In gastric catarrh it is usually above the normal,
probably because this condition is so often associated with
acute congestion of the liver. In atonic dyspepsia, on the
contrary, the amount is ordinarily subnormal; in fact, this
is by far the most frequent cause of a deficiency of the
sulphocyanide, for 39 out of 111 “private cases,” in which
the amount was below the average, were instances of this
disorder. They were all very severe cases, the appetite being
bad in all; in many the sensation of hunger was totally
absent, or was replaced by a loathing of all food. It is
probable that feebleness of the stomach is a common cause
of a_ deficiency of sulphocyanide in various chronic maladies,
for in 84 persons presenting this condition the appetite was
stated to oe bad in 55, moderate in 12, and good in only 17
of the whole number.

Vomiting is a common accompaniment of a deficient
amount of the sulphocyanide, but this has only been
observed where the rejection of the contents of the stomach
-was frequent and complete. It ie not the case in the so-
called "hysterical vomiting,” and the condition of the
saliva might possibly be of value in the diagnosis of this
latter condition. In phthisis vomiting assists in enfeebling
the patient, and also in producing the small amount of the
salivary salt we have before seen is common in the latter
stages of that disorder. But it is only fair to remind you
that in vomiting there is generally an increased flow of
saliva, and we may doubt whether the deficiency of the
sulphocyanide may not be due, in certain cases, as in gastric
cancer, to exhaustion of the salivary glands, arising from
their undue action. This objection is, however, disposed of
by the fact that in some of the cases of gastric cancer where ,
the vomiting was relieved by the regular washing out of the
organ, there was no increase thereby produced in the
quantity of the salivary salt.

An occasional attack of diarrhoea or the exhibition of a
purgative does not seem to affect the quantity of the sulpho¬
cyanide ; but if dysentery or diarrhoea has been oontinued
long enough to diminish the general nutrition, it then falls
below the normal amount. Thus 23 per cent, of the cases

No. 3329.

June 18 , 1887 .'

observed in the “ private cases,” who presented a decrease of
the salivary salt were suffering from one or other of these
conditions. It is of course possible, if the saliva be examined
only after the cessation of the dysentery, that you may find
an . excess instead of a deficiency of the sulphocyanide, as
an unnsual demand may be made on the digestive organs in
order to repair the loss occasioned by the undue waste.
Thus, a patient was admitted on Oct. 27 th, 1883, with a
sharp attack of dysentery which had commenced on that.
day; the discharge of blood and mucus entirely ceased on
the 31st, and the saliva then was + 4. It remained at the
same point two weeks longer, when it fell to + 2±, and
finally in the sixth week to +1, when he was discharged
cored.

From a consideration of the effects of long-standing diar¬
rhoea, we might have conjectured that any cause that pre¬
vented the absorption of the digested food from the intestine
would be followed by a change in the saliva. I had not,
however, thought of this. I was therefore much surprised
to discover a marked alteration produced by the tapping of
persons suffering from ascites arising from cirrhosis. The
saliva of a man affected with this complaint, whose abdomen
was tensely distended with fluid, was examined on May lltb,
and found to be - 3‘; on the 14th be was tapped, and three
dayB afterwards the sulphocyanide bad risen to +2£; on.
the 28th it had again fallen to -1*, but on that day
470 ounces of fluid were removed by aspiration; and on the
31st it had risen to +2J, after which date it gradually
declined each week to +2, +1£, +N, subsequently to
which there are no records. In a second case the
sulphocyanide was only -3-on November 15th; on the
20th tapping was performed, and on the same day it rose to
+ i; on December 28th it was only -1', when aspiration waa
again practised, but the patient sank a few days afterwards.
Three cases Of this kind are recorded, each being tapped
twice; the average quantity of the sulphocyanide was - I B

I nst before the operations, and +1*04 shortly after them,
'his is not due simply to the removal of an obstruction from,
the general circulation; for no alteration in the amount of
the salivary salt was observed after aspiration of the pleura,
nor did it occur where the distension was only moderate, as
yon will see in a man suffering from ascites dependent on
cirrhosis at present in the wards. In this latter case the
fluid had been collecting for three years, and although there
was a considerable quantity of liquid in the peritoneum*
there was no great amount of internal pressure. He was
tapped at his own request, and the saliva was not below the
normal point before the performance of the operation. On the
other hand, the sulphooyanide may be below the normal in
ascites arising from other causes, not from the pressure of
the fluid, but from imperfect digestion, and in this case the
tapping does not alter the amount. For example, a man
suffering from cancerous tumours of the abdomen waa .
admitted, whose peritoneum also contained a considerable
quantity of fluid. On Nov. 14th the saliva was normal;
tapping was employed the same day in the hope of relieving
his pain, and on Nov. 21st the quantity of sulphocyanide
was - i ; on Nov. 28th it was - i, and he was aspirated en
Dec. 1st; on Dec. 6th it had sunk to -3°, and he died from
exhaustion on Dec. 8th. I think, then, we may conclude
that when the amount of the salivary salt falls much below
the normal in persons suffering from ascites arising from
cirrhosis, tapping is indicated; and that where there is a.
rapid increase in the sulphocyanide after the operation, it is
probable that the farmer condition had resulted from pres¬
sure on the portal vessels, and not from oausee immediately
impairing the digestive organs.

On commencing these inquiries I suspected that the
presence of the sulphocyanide in the saliva would be found
to depend on a decomposition of the biliary salts, and that
an increased amount would be observed in all cases of
jaundice. On the contrary, in one instance of jaundice
arising from duodenal catarrh in the “ later hospital cases ”
the salt was - 2 in the first week of the illness; in the next,
in which the yellowness of the skin was much diminished.
and the colour of the stools improved, it rose to -1*; and in
the third, when the patient was dismissed, it amounted to
+2-. In a second case it was - 2- on admission; three days
afterwards it was normal; on the tenth day, when the
patient had greatly improved, it was + 1-; and he was
dismissed cured on the nineteenth day. Taking tbe “ earlier
hospital cases,” where the variations of the sulphocyanide
were lees minutely recorded, I find that of twenty-three

B B

1218 Thb Lancet,] DR. 8. FENWICK ON FUNCTIONAL DISEASES OF THE LIVER.

[Junk 18.1887.

affected with Jaundice the salivary salt was deficient in
eighteen, and in some of them not a trace of colour could be
obtained by the addition of the perchloride of iron. In two
the quantity was normal, but one of these had so far
recovered as to have been placed on fall diet, and in the
other poet-mortem examination proved the jaundice to have
resulted from the rupture of a hydatid cyst into the ducts
of the liver, the opening of the common duct being only
partially obstructed, and bile being present in thedoodenum.
In three cases the quantity was above the normal, and in
one of these there was canoer of the liver; the histories of
the others oould not be obtained. From these observations
it would seem probable that in order that the salt shonld
appear in the saliva the bile must be able to enter the
duodenum, and this seems to be supported by the fact
that in two cases admitted into the hospital, where large
quantities of bile were expectorated, probably from per¬
foration of the lungs by hydatid cysts of the liver,
scarcely any colour could be produced in the saliva
by the addition of the solution of iron. Supporting the same
conclusion is the circumstance that in some cases of jaundice
the depth of the colour varies always with the amount of
the salivary salt. Thus a lady had suffered for three weeks
from jaundice arising apparently from hypertrophic cirrhosis;
the skin and urine were deeply tinged, the stools white, and
the saliva free from sulphocyanide. She was treated by
perchloride of mercury, and in three weeks the stools became
partially coloured, and a slight tinge was produced in her
saliva by the addition of iron. In two weeks afterwards
diarrhoea occurred, the stools being deeply stained with bile,
and although the skin and urine remained yellow the saliva
contained an abundance of the skit. Again, a gentleman had
been for three months deeply jaundiced, the saliva being - 2\
In two months afterwards the jaundioe had greatly lessened,
the stools were brown eolonred, and the saliva was+2. Two or
three weeks afterwards he had a severe attack of pain in
the abdomen, with an increase of jaundice, and the sulpho-
cyanide again became deficient. When I last saw him he
was much better, and the salivary salt was again +2’. In
severe cases of jaundice the deficiency of the sulphocyanide

S unless canoer be present, greatest at the commencement
the ease, for I found in the “ earlier hospital cases" there
was, on the average, twice the quantity in the saliva of thoee
examined five weeks after the onset of the disease that
there was in those who came under observation in the first
week of their illness. This rule, however, does not hold
good for the temporary cases following severe pain of the
abdomen, and usually referred to the passage of gall-stones.
In two instances of this kind the saliva was normal, even at
the commencement, and the jaundice passed away in a few
days. Although there are other circumstances that modify
the conclusions that seem necessarily to arise from the
above facte, we may lay it down as a general rule that a
deficiency of the salivary salt in the first week of jaundice
is unimportant, but that when it persists after many weeks'
duration it is of evil omen, as pointing either to an insuper¬
able stricture of the oommon duct or to some malignant
growth that is sapping the strength of the patient.

In every case of lead oolic the sulphocyanide was absent,
or present in diminished quantity, until the urgent sym¬
ptoms subsided, after which an excess was usually observed.
Let me quote to you one or two instances from the “ later
hospital cases.” A man, aged twenty-four, was admitted
into the wards with lead colic of six days’ standing on
July 13th, and his saliva was noted as -2\ The bowels were
freely moved by medicine, the pain and vomiting were
relieved, and on the 17th it was +1*. A man, aged thirty-
six, was admitted with lead colic of two daW duration on
Julv 16th; on July 19th the pain of the abdomen was lees
and the bowels bad acted, but he complained of pain in the
epigastrium, and the saliva was -1*; on July 26th he had
no abdominal pain, and the saliva had risen to +1$; on
Aug. 2nd he was still free from pain, and the saliva was +2*.
A man was admitted on Oct. 1st with lead colic; on Oct. 4th
the saliva was - J, and on Oct. 11th, when the pain had

a left him, it had risen to +2. The cause of this
ution in'lead colic is, however, susceptible of explana¬
tion on the supposition that, as the saliva was always very
thick and tenacious, the lead might have acted directly
as an astringent upon the salivary glands. I therefore
stimulated the secretion by the application of tincture of
pyrethrum to the tongue, but, although the quantity of the
fluid was increased, there still remained a deficiency of
colour on the addition of perchloride of iron. I therefore
came to the conclusion that the alteration in the amount of

the sulphocyanide was not due to a mere local causa. Bat
however we may explain the diminution of the salivary
salt in lead colic, the fact may be of great use in diagnosis.
We see occasionally symptoms of peritonitis, of gastric
ulcer, and other abdominal disorders in persons who have a
blue line around their teeth, and in such instances it is
difficult to determine whether the symptoms are due to
the absorption of lead or. not. The state of the saliva may
settle the point, and thus indicate the treatment that should
be undertaken for the patient’s relief.

In all cases where the symptoms and physical signs have
pointed to acute congestion of the liver arising from the
abuse of alcohol, overfeeding, or indolence, I have remarked
the amount of the salivary salt to be above the normal amount.
In chronic congestion of any organ, as we see exemplified
in congested kidney resulting from disease of the heart, its
functional activity is lessened, and it is not able to resume
its normal powers of secretion until the pressure is removed.
Let us, then, ascertain the state of the saliva in heart disease,
and see if any Similar change occurs.

In eases of aortic regurgitation, as you are aware, pressure
upon the general venous system only occasionally takes

S ace, so that we should not expect to find much alteration
the saliva. In six cases of tins kind the average amount
of sulphocyanide was only + ’43, and the following table
shows that there was very little change when they were
examined each week during the period of their residence
in the hospital.

Tabu* IV.— Showing the state of the Saliva each week in
Cases of Aortic Regurgitation.

—• .

Number of week* in hospital.

1 |

3 ,

3 ]

4 J

6

Avenge amount of sulphocyanide ...

Number of cate* examined . 1

1

+•60 |
a !

+•13

4

+1-25

1 1

i

+ -66 |

. 3 j

+ 11

1

Now, although in the above figures you will observe the
amount is greater in the fifth than in the first week after
admission, there is no evidence of a regular increase; for in
the second week it is smaller than in the first, and in the
fourth it is very little above what was remarked in the first.
We may conclude, then, that if the quantity of the salivary
salt is an index to the activity of the digestive powers, these
suffer but little in regurgitation through the aortic orifice.

Now let us examine cases of dilatation of the heart and of
mitral disease in which pressure upon the venous system ia
sooner or later developed. Here the difference is most strik¬
ing, as there were eight cases in which either the patients
died or were removed by their friends in a dying condition,
and of these five presented on their admission to the hospital
an average of - '95. In two cases it was on admission above
the normal amount, but in each, as time went on, there was
a gradual decrease in the salivary salt. Thus in one it was
at first + 2J, next week + U, after which no further exami¬
nation is recorded; in another it was at first + 2j, then it
fell successively to +2 and + £, which was quickly followed
by death. On the contrary, wherever there was a steady
improvement there was a weekly augmentation in the
quantity of the sulphocyanide. To illustrate this I have
added the following table.

Table Y.—Showing the Weekly Amount qf Sulphocyanide n
the Casts of Mitral Disease that improved in the
Hospital.

Week* in hoepltal.

B

D

3

B

fl

Pi

Average of Sulphocyanide

+•«,

+w

+•66

Number of casee examined

12 ]

13

13

6

If you look at this table, you will remark that, although
there is a decrease in the third as compared with the second
week, the rise week by week in all the periods was gradual,
marking, we may suppose, the diminution in the pressure
on the venous system, and thus allowing the digestive
organs to regain their normal condition. Bat yon will
naturally ask. How it is that heart cases during convalesces**

O

Thb Lanokt,]

DR. S. FENWICK ON FUNCTIONAL DISEASES OF THE LIVER. [Junb 18,1887. 1219

should show such an increase of the salivary salt? It is, I
suspect, because during the illness the general nutrition has
suffered, and the system calls, as after typhoid, for an aug¬
mented quantity of new material, and consequently the diges¬
tive apparatus is stimulated to unusual activity. Rut in heart
disease we should remember that the respiratory functions
are as much or more disturbed than the digestive. May
not the variations in the saliva, then, be due to the pul¬
monary congestion, and not to that of the liver? I think
this is not the case, because in the later stages of phthisis
we found the salivary salt was always much below the
normal point, although difficulty of breathing is a marked
feature in that stage of the disease. • But, however we
may explain these facts, there is no doubt, if their accuracy
ehould be confirmed by future researches, that the condition
of the saliva places in our hands a valuable aid in the pro¬
gnosis and treatment of diseases of the heart. When there
is a gradual increase in the amount of thesulphocyanide, we
may hope that the pressure on the venous system is dimi¬
nishing and the digestive organs are regaining their func¬
tions ; whilst when the quantity sinks week by week, we
-can only look forward to a decay of the vital functions and
to a fatal termination of the case. I have only examined
-one case of acute yellow atrophy of the liver. A woman
was admitted with jaundice of two or three weeks’ dura¬
tion, and there were no symptoms indicative of this fatal
-disorder. On examination of the saliva, the ordinary colour
produced by the addition of the perchloride of iron was
absent, but it had a brownish tinge, and I remarked to
the students present that in all probability, although
the case was an obscure one, it would prove dan¬
gerous or tedious. Delirium set in suddenly, the space
of the hepatic dulness rapidly diminished, and she died in
two or three days. I have been informed by Mr. Hurry
Fenwick that he has remarked a brown colour in the saliva
-on addition of iron in cases of pytemia, but I have not :
myself verified the observation. It is, however, worth
while to bear this in mind as various modifications of the
■sulphocyanide may perhaps be discovered in different
-diseases. If we should find that the ordinary salivary salt
is always absent in cases of acute yellow atrophy of the
liver, it may enable us to suspect the presence of this
formidable malady where there are no other indications of
it. I have found that the quantity of the salivary salt
occasionally differs to a considerable extent from the normal
in those who seem to be in good health, and it therefore
becomes a matter of interest to inquire whether persons
who present this condition are more prone to disease than
others, and if so, to what maladies they are especially
liable. At an early period of these inquiries I was
struck with the unusual quantity of the sulpho-
•cyanide secreted by persons suffering from acute rheu¬
matism, and this fact was confirmed by both the
gentlemen who so kindly assisted me. Of thirty-six cases
of this disease reoorded in the “ earlier hospital cases,” all
but one, whose saliva was normal, showed a marked excess
of sulphocyanide, the amount varying from eight times to
twice the ordinary quantity. As I before explained to you
the depth of the colour in the earlier observations was not
-*o carefully estimated as afterwards, so I shall now confine
myself to the results obtained by the later and more accurate
inquiries. Fifty-five were recorded in the “ later hospital
■cases,” which are grouped in the following table according
to their stay in the hospital, but these include a considerable
number of subacute and gonorrhoeal cases, in which the
quantity of the salivary salt is usually small, and conse¬
quently the average quantities are much less than you
might expect from the former statement.

'Vablx VI.— Showing the Amount of Sviphocganide in Cate*
of Rheumatic Fever grouped according to their
duration in the Hospital.

Period of residence in hospital.

■

m

7 to

38 to I

Above

38 days.

56 days. I

1

Mdays.

Average depth of oolour.

+•33

+•91

+-1-7

+ 2-62

Number of oasea examined ... 1

3

36

22

i

4

. You will see by the above figures that there was a gradual
rise in the amount of the sulphocyanide in proportion to the

length of time required to afford permanent relief to the
patients. Those included in the first column were either
relapsed or doubtful cases of rheumatic fever, but I thought
it was more fair to include everyone who was admitted with
the diagnosis of acute rheumatism, even if the correctness of
the diagnosis Was doubtful. I need not tell you that acute
rheumatism does not run a regular course; it consists of a
succession of febrile attacks attended with articular inflam¬
mations, and you will be able therefore to nndawtimH that
the smaller the quantity of the salivary salt, the less is the
tendency to the recurrence of these attacks.

But the state of the saliva affords also a measure of the
severity of the attacks—that is, of the number of joints that
are simultaneously affected,—for when many joi nts ar e i a-
plicated the patients are obliged to apply to the, hospital
earlier than those in whom only one Joint is painful, or
where the pain is so slight that they can continue at' their
employments. In the following table the cases are grouped
together according to the length of time the pains bad been
felt before their admission.. ’

Table VII.— Showing the Cates of Rheumatic Fever grouped
according to the duration of the illness before
admission into the Hospital.

■ -Duration of pains Before admission.

Average depth of colour ...

+ 1-65

+ 1-31

+1-18

Number of cases examined... j

33

24

8

It may, of coarse, be objected that other causes besides
the severity of the attack influence the early application of
the patients for hospital treatment, bat that this is the
chief reason seems to be borne out by the experience of
Dr. Hilton Fagge at Guy’s Hospitalfor he remarks: “ A
point which comes out clearly from the last column is that
a comparatively long duration of the disease after admission
is by no means peculiar to patients admitted at a very early
period of the illness. On the other hand, it may be noticed
that the cases which subsided most rapidly whilst in the
hospital had already been running on for three weeks; and
I am not sure that this is a mere accident, for on tabulating
ten other cases which have since occurred at Guy’s, and in
which rapid recovery has taken pkioe without treatment (or
under treatment which I believe to be ineffectual), I And
the average duration of the disease before admission was
13 7 days.’* But you may say that, as it has been already
stated that in all inflammatory disorders there is an increase
of the salivary salt from the demand made upon the organs
engaged in nutrition, why may not this be the reason or the
excess in acute rheumatism ? For the simple reason that
there is no difference to be remarked during the period when
the joints are affected and the intervals when they are free
from inflammation; and also because, even when the attacks
have subsided, and the patients are able to leave the hos¬
pital, tbe excess of tbe salivary salt has still been observable.
To show this I have constructed a table. (See Table VIII.)
Yon will remark that in each group the depth of colour
was nearly the same in the week when the patients were
dismissed as when they were admitted, so that, notwith¬
standing the pains were relieved, tbe excess of tbe sulpho¬
cyanide remained. It is also worthy of observation that no
effect appears to have been produced upon the saliva by tbe
treatment. Nevertheless, after the patients left the hos¬
pital the excess of the sulphocyanide seems to have dis¬
appeared. Thus, four patients were readmitted on account
of return of pains in tne limbs; one on his first admission
presented a colour of +3J, which fell to +2, and he was
readmitted with + lf; another had a colour of +8£, which
had fallen to +2$ when discharged, bat when readmitted it
was only +1£; another on his first admission presented a
colour of +2-,it was +2$ when ha left the hospital, but it was
-1 when readmitted; a fourth returned one month after
leaving the wards with a colour of -3. In all of these tbe
pains on re admission were slight, there was scarcely any
rise of temperature, and they were quickly again discharged
cured. Bat there is another objection that has probably
occurred to your minds. May not the exoess of the sulpho-

i The Principles and Practice of lledMUe. By Dr. HUtxm Fagge*
Vol. ii., p. 638.

12&0 Tffs Lancet, J

ME. F. J. GANT ON LITHOTRITY AND LITHOTOMY.

[June 18,1887.

cyanide in acute rheumatism and in all the febrile diseases
hitherto examined be due to the increased temperature of the
body, and be therefore merely an indication of the augmen¬
tation of the destructive processes by the fever, or of the
inspissation of the saliva accompanying it? Table IX.

sutphocyanide was in the cases in which the avenge
temperature was 98° to 99°, and that it lessened u the
average amount of heat increased, so that there is no con¬
nexion between the quantity of the salivary salt and the
increased retrograde processes that are believed to occur

Table VIII.— Showing the Depth of Colour in each Week of ^Residence in Hospital qf Cases of Rheumatic lever.

Weeks in hospital.

B

n

3

4

6

6

7

8

9

10

11

13

Dismissed

( Average colour .

+•33

_

_

,

_

_

within

8 days.

1 Number of cases .

3

—

—

—

—

—

—

—

—

_

—

-

Dismissed,

1 Average oolour .

+•8

+•8

+ •9

+ 1-75

—_

_

_

_

_

_

_

8 to 29

days.

( Number of cases.

20

20

13

2

—

—

—

—

-

Dismissed,
26 to 56
days.

I Average oolour .

+1-8

+ 1-72

+1-5

+ 1-25

+1-6

+21

+ 1-75

—

-

-

-

( Number of cases.

It

20

16

15

13

7

•

1

-

-

-

-

Dismissed,

above

58 days.

j Average colour .

+ 2

+1-87

+ 225

+ 1-87

+ 3-12

+ 281

+ 316

+ 8-76

+ 2-25

+ 2-

+3-

( Number of cases ...

a

2

a

2

2

4

3

3

2

1

1

has been prepared to test the truth of this objection, and
was formed by calculating the average evening temperature
of each case during its residence in the hospital; the whole
of the cases being then grouped according to the tempera¬
tures thus obtained.

Tabus IX — Showing the Cases of Rheumatic Fever grouped
according to their average Evening Temperatures.

—

No. of
observa¬
tions.

Average
depth of
colour.

Average evening temperature below 98°.

6

+ 1-10

„ „ between 98° A 99°

98

+ 2-25

.. ,, „ 99° A100°

42

+ 1-93

„ „ „ 100° A 101°

22

+ 1-5

„ „ above 101°.

11

+ 1-43

It will be remarked that the highest quantity of the

ON LITHOTRITY AND LITHOTOMY.

By F. J. GANT, F.R.C.S.,

SETIOR SIT BO BOX TO THK ROYAL FREE HOSPITAL.

Having recently had occasion to operate on two patients
in succession for stone in the bladder—the one by lithotrity
and the other by the lateral operation of lithotomy,—this
unusual coincidence led me to reconsider the relative merits
of these two operations, and that of the suprapubic method,
for the removal of vesical calculus; at the same time re¬
viewing the various accidents which may befall each such
operation, the difficulties which may have to be encountered
in their performance, and the dangers which may follow the
footsteps of these procedures. I will first briefly narrate
the two cases which suggested this critical survey.

Cabb 1. Lithotrity — Joseph D-. aged twenty-eight,

had suffered from symptoms of stoqe in the bladder for
about eight months previously to his admission to the Royal
Free Hospital on March 4th, 1887. On sounding him, I
found a calculus lying in the fundus of the bladder, which
gave a dull sound, and was attended with an alkaline and
mucous state of the .urines The diagnosis pointed to the
presence of a phospbatic calculus, and that, judging from
the extent of surface over which the convexity of the sound
traversed, it seemed to be of large site, while the resistance
offered to movement by the sound gave some estimate of its
weight. The act of sounding was painful, and excited
some spasmodic expulsion of urine. Operation was there¬

in fever. In acute rheumatism the saliva is alwm
abundant, so that there is no reason to suppose the
augmentation in the amount of the sulphocyanide is the
result of an inspissation of the secretion.

But it may be said, Is not the temperature a measure of
the intensity of the disease, and ought not, therefore, the
elevation of the thermometer to correspond with an augmea-
tation of the sulphocyanide? But the average evening,
temperature does not represent the severity of the
illness, for the highest temperature in each ewe
usually occurs during the first four days after the patient's
admission, and in short cases, where there is no re¬
currence of the fever, the patients sue quickly dismiss*!,
and consequently the average temperature is high. But
where there is a frequent succession of attacks, attended
with a moderate rise of temperature, the patients remain
loog in the hospital, and the average height of the thermo¬
meter is not much above the normal. Now it is in these
protracted cases that the sypbocyanide is in the greatest
excess, and consequently the saliva furnishes us with a most
valuable indication in respect to the prognosis of the disease.

(To be concluded.)

fore postponed for a few days until the vesical irritability
had been allayed by rest and recumbency in bed.

On March 12th lithotrity was performed. The patient
having been amesthetised, and the bladder moderately dis¬
tended with warm water, the calculus was readily caught by
the lithotrite, and measured nearly one inch and a ball in
its long diameter. It broke readily into pieces, and the
fragments were successively crushed. In the process of
pulverisation, the pieces were not sought by any exploration
with the instrument; but, by fixing the female Made in the
fundus of the bladder, and gently sliding the male blade
backwards and forwards, the disturbance of the water
sufficed to bring some fragment between the blades. By a
half-rotatory movement of the instrument from side to side,
other fragments were readily caught, lying beyond the
middle area. When a quantity of detritus bad accumulated,
it wa9 evacuated by a No. 15 evacuating catheter, the orif.ee
of the urethral meatus having been incised to admit of the
introduction of this instrument. Crushing and evacuation
were repeated a second and a third time, the operation
lasting an hour and a half, when I deemed it advisable to
leave the remainder for another sitting. But it is worthy
of note, that the water in the receiver of the aspirator
is scarcely blood-stained throughout the operation. A

f ;entle nee of the lithotrite, in the manner explained, eten
or a long period, is better tolerated, and especially by an
irritable bladder, than that by a more active use of the
instrument, lithotrity should be finished in half the time.
The patient suffered not the slightest after-symptom of any
kind, feeling as comfortable as if nothing had been doct.
and passing urine only three or four times daily. The man
was kept in bed only on account of the acute east winds.

Digitized by v^ooQie

Thz Lancet,]

MR. F. J. GANT ON HTHOTRITT AND LITHOTOMY.

[JmrB 18,1887. 1221

Three-quarters of an ounce of phosphatic calculus had
been thus removed without any inconvenience.

In a few days the operation was completed; with a final
exploration of the bladder, which still remained irritable,
even under the influence of anaesthesia. T cvo days after¬
wards, the patient being quite well, he got up at his
own request. He continued under observation for a fort¬
night, daily taking exercise; then, no fragments having
been found on carefully sounding the bladder, and being
entirely free from stone symptoms, he left the hospital
in good health. The total amount of phosphatic detritus,
so tar as it could be collected, was over an ounce in
weight, and the original size of the calculus one inch and
.a half.

Case 2. Lithotomy {perineal) by the lateral operation .—

William P-, aged eighteen, had experienced symptoms of

•vesical calculus for a period of ten years. When admitted
to the hospital (March 7th, 1887), sounding at once touched a
-stone, lying in the fundus of the bladder; it rang with a sound
as if metallic, and was distinctly tnberculated under the point
of the instrument, the stone measuring about one inch from
before backwards, as indicated by the passage of the sound
over its surface. I concluded that there was a hard mul¬
berry calculus, and of more than average size. The bladder
and urine were quite healthy. In this case the operation
of lithotomy, and by the lateral method in the perineum,
leaving the suprapubic operation out of the question, would
be far more suitable than lithotrity.

On March 12th, after the previous case of lithotrity, I
erformed lateral lithotomy in the usual manner. But,
aving made the prostatic incision and seized the stone with
•some little trouble, os it slipped from the grasp of the
forceps, I experienced a real difficulty in extracting the
stone without bruising the neck of the bladder. Accord¬
ingly, I had recourse to an expedient which I strongly
•advocate in such cases. Passing a blunt-pointed scalpel
along the inner blade of the forceps, held in the prostatic
.incision, I made a second rectangular or transverse incision
outwards in the right half of the prostate, sufficiently to
extract the stone with ease. This modification of the
operation was seen to be necessary, not only from the size of
the calculus, but owing to the projection of its rough
surface beyond the blades of the forceps.

The after course of this case was noteworthy only on
• account of the absence of any unfavourable symptoms. No
suprapubic pain ensued os from pelvic cellulitis, and the urine
passed freely through the wound about six times in the
twenty-four hours for the first two days. Thus, on the
second day—usually a critical time—The report states:
April 14th: urine from wound at 10 a m., 2 p.m., 6 p.m.,

' 8.30 p.m., 10 p.m., and 6 a.m. On the following (third) day

urine was passed through the urethra and through the
wound, and so on, alternating until the fifth day. Subse¬
quently the urine again passed more and more through the
wound; but from the eighth day onwards entirely per
urethram. The perineal incision healed up from within,
without any tenderness or fulness, and had completely
closed in a fortnight. Recumbency still seemed advisable,
to render the perineum firm and unyielding, the wound
having been known to reopen in consequence of the patient
being allowed to get up at too early a period ; but the young
man took gentle walking exercise in the quadrangle of the
hospital for a few days, and then left quite well. The stone,
a fine specimen of black mulberry oxalate of lime calculus,
looked like a round rough piece of iron slag, and weighed
nearly an ounce.

Choice of operation: lithotrity or lithotomy; lateral,
median , or suprapubic.— Before proceeding to remove a stone
from the bladder, certain clear and definite views must be
‘held as to the conditions which should determine the kind of
operation, seeing that the circumstances which lead to this
selection will obviously affect, for better or worse, all the
contingencies of difficulty and adverse consequences which
are associated with the particular method, but which are
referable rather to the questionable fitness of the case, and
thence the prior judgment of the operator. In connexion
with the relative merits of lithotrity and lithotomy, what¬
ever method be adopted,no question can have more practical
significance than with regard to the size and the density of
the calculus, coupled with the state of the bladder and urinary
1 -tract throughout—the combination of factors which shall
be more favourable for the performance and after safety of
the one or the other of these operations. The wide difference
1 of results in the hands of experienced operators may be

thus explained, more than by circumstances incident to the
individual skill of the operator.

Bigelow’s method of rapid lithotrity has done much to
place the crushing operation on equal terms with the cutting
operation of lithotomy for the complete removal of stone
from the bladder; but, if rightly interpreted in its full
bearings on the question, this method has done even more
to demonstrate the circumstances which should determine
the surgeon’s choice. The complete evacuation of Btone
from the bladder by a single operation of crashing, pro¬
longed perhaps for an hour or more, as compared with the
former method, by repeated crushings, each lasting only a
few minutes, may be read in the light of a crucial experi¬
ment to test the tolerance of the urinary bladder for the
free use of instruments or for the continued presence of
stone fragments. The evidence in favour of prolonged
instrumentation has not only reversed the judgment
formerly held as to the supposed intolerance of the bladder
for this kind of irritation, but has elicited the equally
significant fact that stone chips remaining in the bladder,
followed speedily by cystitis or aggravating the previous
vesical innammation, is the immediate cause of death
after lithotrity. The choice of operation for the removal
of stone must, therefore, be centralised in the kind
of calculus with which the surgeon has to deal. In
lithotrity, a hard calculus, ringing as if metallic when
sounded, yields fragments more angular and irritative
than those of a soft calculus—more provocative of cysti¬
tis. Unless the bladder can be most assuredly emptied of
all such fragments, a hard calculus of uric acid or oxalate
of lime had far better be removed by lithotomy. Of course
the size of the stone is also an important consideration, but

? uite subordinate, I should say, to that of density, as a
actor in lithotrity. According to my judgment, the crushing
of an earthy phosphatic calculus, measuring by the Iitho-
trite an inch and a half, would entail less ladder liabilities
than the crushing of a flinty mulberry calculus of only half
that Bize. The one squashes readily into grit as the opera¬
tion proceeds; the other gives way with a sort of bang,,
falls into angular pieces, and then breaks into Bimilar frag¬
ments. Any remaining chips which had perchance escaped
evacuation would induce cystitis more surely than the
whole amount of pulverulent matter into which the phos¬
phatic stone bad crumbled, mixing with the water into a
mortar-like puddle in the bladder.

With relation to lithotomy, the size of the calculus is the
element in the question which mainly determines the claims
in favour of lithotrity. The dimensions of a stone may
render it ill-fitted for extraction by any cutting operation.
In lateral lithotomy, the extraction of a stone beyond a
certain size, is attended with such bruising of the neck of
the bladder as will almost inevitably be followed by spread¬
ing cellulitis around. On the other band, a more than
limited prostatic incision backwards might trespass beyond
the fascial investment of the prostate, and lead to urinary
infiltration, with the same result. But contusion of the
vesical neck is more frequently responsible for a fatal issue.
The median operation can offer only a limited access to the
bladder, and allowing the extraction of a proportionately
small stone, this method of cutting is out of the running, in
comparison with lithotrity. Looking at lithotomy only from
a stone-extraction point of view, it is here assumed that in
either the lateral or the median way of approaching the
bladder the path is well known, with its relations, and the
operation skilfully performed. Suprapubic lithotomy pro¬
vides for the removal of a large stone, of such size as could
not be removed by lithotrity, however prolonged or repeated.
But, having regard to the pathway of operation, experience
has shown, and quite recently, that the bladder cannot
be entered above the pubes always, without wounding the
peritoneal reflexion, even when the bladder is raised by the
fullest distension, almost to the point of bursting, and
propped up from below by an equally distended Petersen’s
rectal bag. Then, again, the known nsk of urinary infiltra¬
tion has proved to be a not uncommon after-consequence of
the suprapubic incision, and certainly should not be an
after-thought in the mind of the surgeon who is about to
operate by this route.

Apart from the kind of calculus, as determining the choice
of operation, of less direct importance may be reckoned the
state of the bladder and kidneys, cystitis depending far
more on the continued presence of stone fragments after
lithotrity than arising from this operation. The complete
evacuation of the bladder would place the rapid method on

12^2 Thb Lancet,] MB. REGINALD HARRISON: A MEDIAN LITHOTOMY.

[Jcn» 18,1887.

a level with any operation of lithotomy. So, likewise,
nephritis or pyelitis, whether due to the extension of vesical
inflammation up the ureters, or occurring from reflex vaso¬
motor influence on the kidney, is alike the expression of vesical
irritation. The symptoms betokening. renal irritation, by
rigors, lumbar pain, with unemic blood-poisoning, proceed
from the bladder, and all the significance of kidney mischief
is lost in the prior question of entire removal of the calculus
from the organ below.

But when, in any case, the hardness of a calculus would
be adverse to lithotrity—unless the operation can be com¬
pleted, and the bladder be certainly emptied of all frag¬
ments, and when the size of the calculus places it beyond
lithotomy, otherwise than through the perils of the supra¬
pubic adventure,—can the old lateral operation of lithotomy
be modified and adapted for,the removal of a stone, whose
dimensions may require further space than usual for its
extraction, without any untoward consequences? The
perineal incision itself will, of course, be sufficient; and
the prostatic incision may be safely extended backwards to
the very neck of the bladder, notching the elastic riDg, but
within the boundary of the fascial investment of the
prostate; the incision, thus limited, admitting readily of
enlargement, by a tunneling dilatation with the finger,
without dividing or rupturing the elastic ring. But the
opening thus formed by this well-defined incision and
dilatation may be further enlarged to twice the size
by a rectangular incision from the middle of the first
towards the other side of the prostate. In a prostate of
average dimensions the usual lateral incision may be one
inch, admitting of the extraction of a calculus which
shall weigh an ounce and a half; and the rectangular
incision, in the middle of the right half of the pros¬
tate, having nearly the same extent—another inch,—
will provide the additional space for the extraction of a
stone double the size, should the necessity arise in this
stage of the operation. The valvular opening thus formed

f fives, therefore, ample room for the passage of a calculus as
arge as may be met with. This rectangular incision is not
the incision which was practised occasionally by M&rtineau
and Liston, who divided the right side of the prostate down¬
wards towards the right ischial tuberosity, forming, with the
similar section of the leftside, a double lateral section of the
prostate. The objection to that direction of the second incision
to the right is the liability of wounding the rectum, now
that the prostate is not held up by the 6taff, and
the bowel protected also by the finger, as when in the act of
making the ordinary lateral incision alone in the left half
of the prostate. The semilunar prostatic incision, by the
“bilateral operation”of Dupuytren, has obviously a different
shape, and the downward direction of the section on either
side, in using the covered double-blnded lithotome, is very
liable to touch the vasa deferentia or the seminal vesicles,
and emasculate the patient. Notching the margins of the
ordinary left lateral incision, obliquely, above and below the
“ quadrilateral section ” of the prostate, advocated by Vidal
de Cassis, is a procedure which involves no 6uch risk; but
nickings with the knife in those situations, to ease the for¬
ceps for the extraction of a large stone, might readily cut the
fascial investment of the prostate above or the rectum below.
The additional space afforded by the rectangular section
passing transversely across the right half of the prostate
is fully equivalent to that which is given in either of these
ways, and is entirely free from any danger. It is easily
accomplished. When, in the extraction of a large stone,
the forceps is found to be fixed somewhat firmly in the
ordinary lateral opening in the prostate, the second cut
can be made by sliding a blunt-pointed knife along the
convexity of the inner blade, and carrying it outwards, not
downwards, in the middle of the right half of the prostata
If there be any doubt as to the bearing of the blade, a little
traction with the forceps will make the prostate bulge
forwards sufficiently to bring that part actually into view
in a perineum of the ordinary depth. By this second
transverse incision bruising of the vesical neck is prevented,
the risk of urinary infiltration from a too free left lateral
incision in the backward direction is avoided, and the
extraction of the stone is effected without fracture and
splintering in the bladder, or in drawing it through thb
prostate.

By the operation of lithotrity large stones of the hardest
kina have been pulverised, and the bladder completely
emptied. That operation may be credited in Freyer’s prac¬
tice with having thus got rid of calculi formed or uric acid

and oxalate of lime, each weighing more than three ounces.
But these are quite exceptional cases, and in the hands
of an exceptional lithotritist. Success in crashing and
evacuating such calculi might well place some other opera¬
tors in mourning. The average lithotriti6t, tackling either
of those hardened sinners, would certainly have left some
portion of the enemy in the bladder; ay, and even after a
second attack, an angular fragment or two might still be
lodged. When the surgeon, who is about equally apt in
crushing or cutting, has to encounter a big, brazen mulberry
calculus, or its almost as formidable uric acid rival, instead
of spending an hour and a half or longer in lithotrity,.
without then clearing out the bladder, I would recom¬
mend him to try lateral lithotomy, with the additional
rectangular incision of the prostate to the right side, and
capture the enemy in a few minutes.

1 may take another opportunity of referring to the diffi¬
culties and dangers pertaining to lithotrity and lithotomy
in the various methods of operation.

Connaught-»quare, W.

A MEDIAN LITHOTOMY.

By REGINALD HARRISON, F.R.C.S ,

SUROEOIt TO THE LIVERPOOL ROYAL IH FIRM ART.

Thb recent movement to revive the suprapubic operation
for stone in the bladder, under somewhat altered circum¬
stances, has been doubtless prompted with the view of
diminishing the mortality connected with the removal of
those stones from the bladder which cannot be effected by
crushing, and of substituting an operation which is free
from the difficulties and risks which, either rightly or
wrongly, have been associated with lateral lithotomy. That
there are grounds for possessing an alternative is evident
from a study of some statistics and records of the latter
operation. That the lateral method for stone in adults has
been found to be a proceeding attended with a considerable
degree of fatality,, reaching in some instances, it is stated,
to a death-rate of 36 per cent., there can be no doubt.
Further, records of this operation show that the mortality
has arisen very largely out of complications having an
evident relation to the difficulties with which the operation
was performed. For instance, a well-executed lateral
operation where everything is straightforward is about
the safest operation of any magnitude in surgery;
and in proportion with the degree of deviation from the
standard that circumstances render inevitable may its
fatality be measured. In proof of this let me mention the
chief early causes of death after lithotomy. Haemorrhage,

? rimary and secondary; cellulitis and peritonitis arising
rom damage done by the knife, as when the latter is
allowed to miss or leave the staff and to pass behind or
through the bladder, not mentioning the rectum; rupture
of the urethra and failure to enter the bladder, as when
these parts are telescoped by the finger of the operator;
and, lastly, sepsis. With the exception of the last-mentioned
cause, which is largely determined by the nature of the
incisions made, probably all the others are avoidable, and
seldom occur save in connexion with an operation the
doing of which might be improved upon. Apart, however,
from these difficulties and contingencies, there is a necessity
for carefully considering our means of removing stones from
the bladder by the frequency with which recurrences take
place after lithotrity, even when the operation haa been
ractised by experienced hands. Such recurrences have
een recently stated as amounting to about 13 per cent.

When we consider the rarity of stone relapses after litho¬
tomy, as compared with lithotrity, we have the best reason
for critically studying the former operation with the view
of rendering it simple and efficient. I think it will be
generally admitted that the easiest and simplest method of
entering the bladder 1 , say for the purpose of exploring it
with the finger, is that known as median perineal urethro¬
tomy, or incorrectly as median cystotomy. By this plan
the finger may be readily passed Into the bladder without
risk. As I have now practised this operation for the relief
of cystitis, for the exploration of tumours of the bladder
and prostate, for prostatotomy and prostatectomy, a very
considerable number of times, I think my experience has

by Google

D

1224 The Lancet,]

MR. WALTER WHITEHEAD ON SUPRAPUBIC LITHOTOMY.

[June 16 1887.

to determine what was best to be done, especially baying in
view the probability of his kidneys and ureters being also
involved. A free median incision into the bladder, such as
I have described, seemed to offer the best solution with the
least risk. Further, should the strictured urethra prove
such as to render a permanent median perineal opening
desirable, this could be provided for by the median operation.
On March 29th, Dr. Paul Rodet, of Vittel, and Dr. Wilson, of
Boston, U.S.A., being present, the patient was etherised, and
the stricture divulsed so as to allow the passage of a
medium-sized grooved staff into the bladder. He was
then placed in the lithotomy position, when 1 per¬
formed a median urethrotomy, and extracted a uric acid
calculus about the size of a cobnut, which was wedged in
behind the stricture. I then slit up the floor of the
membranous urethra, including a mass of cicatricial tissue
which constituted the stricture. Passing my finger on into
the bladder, I then divided the somewhat large prostate
directly backwards with a curved probe-pointed bistoury
from within outwards, completing my incision to the utmost
limits of the prostatic capsule by the pressure of my index
finger. In this way 1 had made an opening into the bladder
in the median line which would readily admit my three
fingers. Forceps were then passed into the bladder, and I
extracted two calculi, one uric acid and the other phospbatic,
about the size of cobnuts, and in addition a considerable
quantity of soft, putty-like phosphatic incrustation. No
vessels were tied, and the patient certainly did not lose an
ounce of blood, an object which I was desirous of obtaining.
1 could have removed through this opening, with ordinary
lithotomy forceps, a hard stone of at least six ounces in
weight. As a precaution against any bleeding following, a
large double drainage tube was introduced, and the wound
in the perineum above and below it closed with sutures so
as to make the tube fit with some tightness. The patient was
then removed to bed, the whole of the proceedings only occupy¬
ing a few minutes. The patient’s convalescence has been un¬
interrupted, and on April 10 th he commenced to get up and
move about. The urine for the first eight days was passed
incontinently by the wound, the drainage tube being
removed on the third day. On April 14th he was able to go
out for exercise, as control over the urine, though almost
entirely passed by the perineal wound, had in a great
measure returned. I think it is extremely probable that the
perineal opening will have to be retained as a permanent vent
for the urine, as the condition of the urethra in front, from
long-standing stricture, is unpromising. A medium-sized whip
bougie is passed daily along the whole length of the urethra.
Apart, however, from this consideration, the case may be
taken as fairly illustrating this method of operating ana the
circumstances under whi<Hi it might be undertaken. Here
it was the only way of getting over the difficulties I had to
face without exposing the patient to far more serious risk.

As already stated in the columns of The Lancet,* 1 have
no reason whatever to find fault with the operation of
lateral lithotomy. I have now practised it considerably
over one hundred times, with no mortality in children, and
with a death-rate in adults of about one in twelve. On the
other hand, understanding why lateral lithotomy can never
be regarded as universally acceptable, I think it is desirable
that we should be provided with efficient alternatives.
Liverpool.

THESE CASES OF

SUPRAPUBIC LITHOTOMY.

By WALTER WHITEHEAD, F.R.C.S.E., F.R.S.Edin,

BUBSEOX TO THJt MANCHESTER BOTAL INFIRMARY, LECTURES OX
CUBICAL SUBOKRY AT OWENS COLLEGE.

Foa the purpose of contributing to the number of modern
cases of suprapubic lithotomy, I have written out the
following notes, and added a few remarks suggested by my
experience.

Case I.—J. H-, aged fifty-one, a publican from

Oldham, was sent to me in June, 1884, by Dr. Lacey, suffer¬
ing from stone in the bladder. He declined operation. The
following month he again called and produoed a small
calculus which had been expelled per urethram, stating that
all his symptoms had immediately disappeared. Albumen,

» April 10th, 188®. v

which had been present in the urine formerly, was now
absent. I neither saw nor heard anything of him again
until Jan. 29th of this year, when he was again sent to me
by Dr. Lacey. I observed a very marked change in his
appearance. From being a fine, stout, and powerful man,
he had become flabby and feeble, short of breath, and
affected with a hacking troublesome cough. He bad all the
characteristic symptoms of stone in the bladder, with
almost constant desire to micturate. He was admitted into
the Surgical Home, Greenheys, on Feb. 3rd. 1886, and three
days afterwards an unsuccessful attempt was made to crash
the stone; for although the calculus was easily and fre¬
quently grasped by the largest and most powerful lithotrite,
it was evident that the instrument was not constructed for
so large a stone, as the screw gear did not come into action
when the blades were fully separated. It was decided to
postpone any further operation for some days, and in the
meantime decide between the merits of perineal and supra¬
pubic lithotomy. On the evening of Feb. 9th, he contracted
a chill whilst returning to bed after a hot bath, and on the
following morning when we (Mr. Southam, Dr. Lacey, Dr.
Thorburn, and myself) assembled to operate, his temperature
registering 102'4°, a further postponement of the operation
was naturally our first determination, but this was finally
abandoned. Suprapubic lithotomy having been decided
upon, the operation was conducted in the following
manner:—The patient was placed on the table in a hori¬
zontal position and the A.C.K. mixture administered. The
pubes were shaved. A No. 12 silver catheter was introduced
into the bladder and the urine withdrawn; twtlve ounces
of a weak solution of borocic acid were injected into thv
bladder and the catheter withdrawn, and the base of the
penis ligatured with a soft No. 8 elastic indiarubber catheter.

An indiarubber bag, capable of holding sixteen ounces of
fluid, well lubricated with vaseline, was introduced into the
rectum above the sphincters and injected with twelve
ounces of water. An incision was made in the median line
of the abdomen, commencing three inches above and termi¬
nating at the upper border of the symphysis pubis. A dis¬
section was made between the recti, and through the transver-
salis fascia down to the perivesical fat, and this separated, the
handel of a scalpel being principally used for this purpose.

At this stage of the operation some doubt was entertained
as to the identity of what was supposed to be the bladder,
which had in reality ascended into the wound and over¬
lapped the Bymphysis; this, however, was immediately |
corrected by the reintroduction of the catheter, without
allowing any fluid to escape, and by projecting the beak
above the symphysis. The catheter was removed, and the
ligature again tightened. The bladder was then punctured,
without, unfortunately, first takihg the precaution of
securing it, either with a pair of forceps, or, still better
perhaps, with two ligatures passed at suitable intervals
through the entire thickness of the presenting surface. This-
was an oversight which ought never to have taken place, as
all the fluid commenced to stream out and the bladder to
collapse and sink out of sight, and it was with no little
uncertainty the bladder was again picked up and the
puncture found. Had the finger instead of the eye been
relied upon under the circumstances, it is conceivable that
lamentable results might have ultimately followed through
detaching the cellular tissue surrounding the neck of the
bladder in the endeavcur to recover the lost opening, which
would have afforded every facility for the infiltration of
urine. Having recovered the bladder and secured the*
opening with artery forceps, scissors were introduced, and
by expanding the blades the incision was enlarged longi¬
tudinally, sufficiently to admit one and then a second finger.

The stone was at once felt and easily removed by means of
an ordinary pair of lithotomy forceps. After the bag in ths
rectum had been removed the operation was completed.
Nothing further was done or required, in a surgical sense,
during the nine days the man lived. The urine, which was
copious, escaped through the wound and was absorbed by
pads of absorbent wool conveniently arranged below the
wound. No excoriation followed or threatened. _ No urine
passed by the penis, and neither catheter nor drainage tubs
was used after the first few hours. The patient, who wai
almost doomed to succumb from the commencement, died
from double pneumonia, which was evidently in the incipient
stage prior to the operation. The stone was composed of
uric acid. It weighed 3£ oz., and measured 2j in. by 2 ia,
or 7£ in. in circumferenoe.

Case 2.— J. W -, male, aged forty-two, was admitted to

The Lancet,] MR. WALTER WHITEHEAD ON SUPRAPUBIC LITHOTOMY. [June 18,1887. 1225

— ; ' U ■ .

the Manchester Royal Infirmary on Doc. 8th, 1884. lie is a
healthy-looking but slightly made man, and gives a good
account of his family history and general health up to
twelve years ago. Since then he had frequent attacks of
renal colic, which had, however, usually yielded to ordinary
methods of treatment. Eighteen months ago he first expe¬
rienced pain at the end of the penis, and he passed some
{gravel. Since then there have been occasional attacks
of renal colic, and he has passed gravel on several occasions.
Ale has also been troubled by frequency of micturition,
which often disturbed him six or seven times in the night.
Mis pain has al ways been aggravated by any shaking. Daring
«he last nine months he has often had hasmaturia. There
have been no symptoms of cystitis. On admission, he com-

? lained of the above symptoms. The urine was acid; sp. gr.

015; it contained no albumen and no deposits. The bladder
waa explored by a Thompson’s sound, and a stone was found,
the longest diameter of which appeared to be about three-
quarters of an inch. On Dec. 12th, 1884, the operation of left
lateral lithotomy was performed in the usual manner, the only
■difficulty encountered being in the extraction of the stone,
which was oblong in shape, being about | in. long and J in.
broad. No tube was introduced into the wound. The only
incident in the progress of the case was that the wound
became filled with blood clot, remaining in this condition for
some forty-eight hours, and necessitating the use of the
-catheter to relieve the bladder. On the second day urine
commenced to flow through the wound, and thereafter con¬
tinued to do so. The wound healed well, and when the
■patient went home on Jan. 5th, 1385, was almost healed,
although a small quantity of urine still came through it.
This soon ceased after his return home, and he remained
well. He was readmitted on March 31st, 1886, complaining
-of shooting pains in the glans penis and perineum, especially
at night or during exercise, this pain being most intense for
about five minutes after micturition. During the act of
passing urine there was frequently sudden stoppage with
ain, but the flow soon recommenced. Exploration of the
ladder showed the presence of a stone, and on rectal exa¬
mination there was found considerable enlargement of the
(prostate. The patient was much weaker than when last
admitted, and looked thin and worn. On April 2nd I
attempted to perform the operation of suprapubic lithotomy,
.in the presence of Mr. Chiene of Edinburgh, Mr. Lund, and
the members of the surgical staff of the Manchester Infir¬
mary. On attempting to pass a catheter into the bladder
with a view to injecting it, the instrument entered a false
passage, and all attempts to introduce it proved futile.
Being unwilling to abandon the operation, I placed one of
•Sir H. Thompson’s bags in the rectum, which was distended
with ten ounces of water. A vertical Incision, three inches
long, was now made in the linea alba, over the pubes, and
the structures being dissected down to and through the fascia
. between the recti, the bladder was sought for. As, however,
it was found impossible to define th is organ without running
•a great risk of injuring the peritoneum, the completion of the
operation was postponed, the wound being thoroughly dusted
with iodoform and left open. The wound continued healthy,
but the patient suffered much from pain in the bladder,
■owing to his cystitis, for which was prescribed a mixture
of hyoacyamus, buchu, and liq. potass®. The pulse was very
rapid, irregular, and so weak as to be at times scarcely per¬
ceptible. On April 10th, eight days after the first attempt,
'the patient was again placed under chloroform, and an at¬
tempt made to introduce a catheter into the bladder. This
-again failed, but after some trouble a ferret was passed, and
•a catheter, having an eye at the extremity, was slipped in
•over it. The bladder was then injected with six ounces of
boracic lotion, and the rectum distended as before. The
-divided structures being held aside, the bladder was now,
without difficulty, seen presenting in the wound, and was
i -secured by passing through it on each side a ligature held
in a handled needle. Between these the bladder was
i opened with a knife and a director, and the finger and
then a pair of lithotomy forceps introduced, and the stone
grasped and extracted without difficulty. The wound was
i left open, dusted with iodoform, and plugged with ab-
i sorbent cotton wool, which was changed every half hour.

I No catheter was placed in the urethra, nor a tube in the
! wound. The wound remained absolutely healthy-looking, the
i urine which came through it being absorbed by the cotton
wool. The patient’s weakness, however, increased, the
pulse being always rapid, weak, and irregular, often imper-
i ceptible. Stimulants were administered a week after the

operation; then a low form of delirium set in, with much
restlessness. This delirium continued almost constantly for
a month, but eventually passed off entirely. Urine came
away entirely by the wound until May 1st, three weeks
after the operation, when, for the first time, some passed per
urethram. After this the wound began to close up rapidly,
and was entirely closed by May 16th. On the 27tn the
patient was discharged well, and has since reported himself
as in good health.

Case 3.—J. M-, male, aged fifty-three, came under my

care about the end of April, 1886, giving the following
history. In August of last year he had several rigors,
followed by the discharge of dark brown urine with frequent
micturition and pain at the umbilicus. He was then attended
by Mr. Cartmel. Occasional h®maturia continued, and
especially After any jolting there was pain at the umbilicus
and passage of blood in the urine, but never any pain in
the bladder or penis. On one or two occasions there was,
during micturition, a sudden stoppage in the flow, causing
much straining and pain. When I saw the patient I found
a stone in the bladder, and attempted to perform lateral
perineal lithotomy, but without success, owing to the depth
of the perineum rendering it impossible to reach the
calculus. With a view to performing suprapubic lithotomy,
I admitted him to the Manchester Royal Infirmary on
May 22ad. On admission he presented the same symptoms as
before the first operation a week previously, ana he had, of
course, an opening from the perineum into the urethra. The
general condition was very good. The operation was per¬
formed on May 23rd. On examination the bladder was
found to be unusually large, dulness extending to within
two inches of the umbilicus. Neither the bladder nor the
rectum was distended. A staff was introduced into the
bladder (through the perineal wound) and its point rendered
prominent just above the pubes. An incision 2£ in. long
was then made in the middle line above the pubes, and
carried down until the bladder was exposed on the end of
the staff. It was here torn open, and the small opening
thus made enlarged by stretching with the fingers. There
was then no difficulty in introducing two fingers and seizing
and extracting the calcifiuB, which was encysted in a pouch
in the anterior wall. The stone was uric acid, oval in
shape, flattened on the sides, and about If in. long by £ in.
wide. The wound, which gaped considerably, was left open
and painted with a mixture of compound tincture of benzoin
and an ethereal solution of iodoform, then dusted with
iodoform and stuffed with iodoform gauze. The patient
was allowed to lie on his back, the whole of the lower part
of the abdomen being covered with absorbent cotton wool,
which effectually soaked up the urine as fast as it came
through the wound, so that no irritation of the skin was
caused. On June 4th urine ceased to flow through the
perineal opening, but still came freely from that above the
pubes. On June 9th the urine was found to be alkaline,
and there was a phosphatic deposit on the surfaces of the
wound, which gave some trouble, and which was met by the
internal administration of ammon. benzoae, with local use
of dilute hydrochloric acid. From this date the patient’s
condition became gradually worse. The urine remained
alkaline, and he developed the “typhoid” symptoms of
surgical kidney. During August he complained ot pain in
the left shoulder, probably py®mic. The temperature was
high and irregular. To the end all urine passed by the
wound, the flow per urethram never being re-established.
The patient died on August 31st.

Remarks .—The fact that two out of the three cases of supra¬
pubic lithotomy recorded proved fatal must not be regarded
with undue prejudice against the operation. I am satisfied
that in Cases 1 and 2 the patients would have died whichever
operation had been selected. The size of the stone in the
first case left no alternative, and in the third case suprapubic
lithotomy was only resorted to after perineal lithotomy had
failed. A practical lesson can be learned from Case 2. The
man had undergone perineal lithotomy two years previously,
and his recovery was complete in nineteen days, whereas after
suprapubic lithotomy forty-eight days were required to gain
convalescence. The three cases illustrate three conditions
which render suprapubic lithotomy the only operation
available: the large size of the stone in one case, an impedi¬
ment to the introduction of a staff in another, and an encysted
calculus in the third. During the last two years I have had
an unusually large number of patients suffering from stone
in the bladder, and these are only instances in which I have
felt warranted in adopting the suprapubic operation, as I am

1226 Thb Lxkcbt,] DR. GOODEIDGE: RE8ULTS OF CICATRISING PROCESSES. [Jmf* 18,1887.

at present quite satisfied with the success which I have had
during twenty years’ practice from perineal lithotomy and
litholapaxy. I regard rectal distension as quite unnecessary,
and not unattended with danger; in Case 1 the use of the
rectal bag was followed by profuse haemorrhage and
subsequent muco - purulent discharge. Pending much
stronger evidence than that which has hitherto been
advanced in favour of the high operation, I shall continue
to crush all stones capable of being crushed both in males
and females, either in youth or adult life. I shall perform
perineal lithotomy in cases not amenable to crushing, unless
associated with some complication rendering it impossible to
complete that operation, and I shall reserve suprapubic
lithotomy for sucn cases, and for stones estimated to exceed
three ounces in weight. These conclusions will, I believe.be
generally shared by surgeons who have had large experiences
m the various operations for the removal of vesical calculi.

Manchester. _

RESULTS OF CICATRISING PROCESSES IN
THE NEIGHBOURHOOD OF THE
PORTAL FISSURE.

By HENRY F. A. GOODEIDGE, M.D., F.R.C.P.,

SKMOB PHYSICIAN TO THE BOYAL UNITED HOSPITAL, BATH.

It is well known that structures which derive their blood
supply from vessels that pass through a cicatrix, or that
traverse the area of a cicatrising process, are liable to
undergo atrophy, and that this is due to the contractile
property of the cicatricial tissue causing narrowing and
diminution of calibre of the supplying vessels. The
facts have been observed on the surface of the body, and,
indeed, have been turned to good account in some instances
in the practice of surgery. But it is not so generally reco¬
gnised that similar secondary results mav under certain
circumstances follow cicatrisation occurring in internal
arts, and prove eerious drawbacks to the healing process,
he events that take place here, and their relation to one
another, are Out of the sphere of direct observation, and the
opportunity of tracing them by other methods is compara¬
tively rare. Conceiving that the two cases about to be
related afford such opportunity, I propose in this paper to
invite attention to the subject, ana to submit some patho¬
logical considerations in connexion therewith.

In the case of a small superficial ulcer of the stomach,
the loss of mucous membrane at the spot with a trifling
scar remaining is about the worst evil that can ensue. But
it is far otherwise with a large, deep, and long-standing
ulcer occupying the usual situation of the “ chronic ulcer of
the stomach.” Besides stenosis of orifices, deformity of the
organ is commonly noticed by writers as resulting from the
cicatrisation of such an ulcer; it is rather with indirect,
but not less important, results of the same that we are now
concerned. It has happened to me in the course of my
hospital practice to have a case of the latter class repeatedly
under my care during a period of nine years extending
from the first commencement of symptoms to the fatal
termination, and then inspection of the anatomical con¬
dition was obtained. The following is a summary of the
clinical history.

The patient, A. M-, was a lady’s maid, aged thirty in

January, 1866, when she was first admitted into hospital.
She was moderately tall, of slender figure, and of pale com¬
plexion ; sho had two phthisical brothers, but said that her
own health previously had been good. She had been suffer¬
ing for three weeks from constant and severe vomiting after
food, and from pain at the epigastrium, which was relieved,
but not removed, by the vomiting; there was tenderness on
pressure in the same locality. Her pulse was Small and
weak, her tongue pale and moist, her bowels sluggish, and
her catamenia scanty. Under absolute rest, restricted diet,
and nitrate of silver In half-grain doses, with a blister
to the epigastrium, and an occasional enema, the symptoms
speedily subsided; and with the substitution of iron and
hydrocyanic acid, and a more liberal but still regulated diet,
she made good progress, so that in the April following she
was discharged “ convalescent.” In September, 1868, she
was readmitted. She stated that shortly after she left
the hospital she had a return of the symptoms, had to
give up her situation in consequence, and nad not been

well since. The epigastric pain was very severe, and dis¬
turbed her sleep. Her catamenia had been absent for three
months. She was put upon similar treatment. 8he vomited
only two or three times during her stay, the pain subsided,
the catamenia reappeared, and she was discharged conva¬
lescent in the ensuing December.- She now had some
months of comparative, though not entire, freedom from
complaint, and resumed domestic service. In the autumn of
1869 she caught cold at a catamenial period, whereupon this
function became completely suppressed. The epigastric
pain returned, and she soon began to lose flesh and strength.
She attended as an out-patient, but, no benefit accru¬
ing, she was admitted into the wards again in May, 1871.
She was now in a much more pronounced state of anaemia
than heretofore. Epigastric pain, increased after food and
disturbing her nignte. was still her chief trouble, and
there was the local tenderness on pressure as before.
Omitting on this occasion the nitrate of silver, she had iron
given her at once, and solution of sulphate of atropine was
used hypodermically as an anodyne. She soon responded to-
this treatment, gained nearly a stone in weight in six weeks,
and went out convalescent in July following. In February,
1872, she returned, stating that three weeks previously she
had vomited blood to the amount of one pint. She was
very anaemic, and there was marked exacerbation of the old
symptoms. Her catamenia had now been absent for sixteen,
months. The sickness increasing, in spite of the treatment
which succeeded on the preceding occasion, she was given
nitrate of silver again in half-grain doses, and with
good result. On resuming the iron, flying blisters were
applied to the epigastrium and dressed with morphia oint¬
ment. Although bad fits of epigastric pain not unfrequently
recurred, and she had now and then sickness, her appetite
increased, she began to get up a little, she improved con¬
siderably in looks, and in April following was discharged
relieved. Her history for the next two years and upwards
was one of attendance off and on as an out-patient. 8he
was admitted into hospital for the fifth time in September,
1874. Her condition at this date was urgent; her pallor
and emaciation were both alike conspicuous. She bad bad
a short, time previously a recurrence of vomiting of blood
her pain in the epigastrium, increased after food as before,
went right through to her back and interfered greatly with
her sleep; she generally vomited after her meals, though at
various intervals, and this brought a little ease. The
existence of considerable dilatation of the stomach was now-
detected, and the vomited matters were found to contain
sarcin®. There was no response to treatment that formerly
succeeded, nor to some other that was tried. Hypodermic
morphia as an anodyne, with or without atropine combined,
gave but very temporary relief. She was almost incessantly-
harassed with pain and sickness. On Oct. 16th she vomited
dark grumous matter in which red blood discs were
abundant. There were some little fluctuations in her con¬
dition afterwards, but on Oct. 30th she had similar hemor¬
rhagic vomit with melsenic stools, and, this persisting, she
gradually became exhausted, and died on Nov. 1st.

Necropsy, thirty-three hours after death.— The stomach
was found occupying the area traced out upon the abdominal
parietes during life. It had several adhesions. First, it wi»
inseparably adherent at the small curvature to the under¬
surface of the right lobe of the liver by dense opaque neo¬
plastic tissue, which occupied for the most part the small
omentum. Another adhesion was to the pancreas and
duodenum in its inferior transverse portion; and a third
was to the left kidney, where also a very dense fibro-carti¬
lage-like layer was present. There were slight adhesions to
the spleen and to the diaphragm. The stomach at the
same time exhibited a well-marked hour-glass contraction.
The effect of the latter, as appeared on laying open the
interior, was to convert the pyloric segment into a separate
sac, which was entered by a quasi-orifice of about the sice
of a crown-piece. A large irregular stellate cicatrix- was
discovered at the spot near -the small curvature where
externally was the dense adhesion to the liver; two or three
small superficial ulcers were present near it. The muoons
lining of this part was much puckered. At the fund os
corresponding to the kidney adhesion was a large somewhat
oval-shaped ulcer; it was between four and five inches in
length; its floor was constituted of the peritoneal coat,
bbreddy d6bris of muscular fibre, and some vessels traversing
it. Its margin showed no trace of any reparative action,
nor did that of any of the smaller ulcers present. There
were several little deposits of melanic pigment in the vicinity

google

Th* Lancbt,]

DR. A. MANTLE ON MENORRHAGIA. AND METRORRHAGIA. [Jowb 18 r lS87. 1227

of this ulcer, with some increased vascularity of the mucous
surface, and sundry small ulcers and erosions. The pyloric
segment, which, asDefore observed, formed a separate com¬
partment, included the right half nearly of the great curva¬
ture, and was the healthiest portion of the organ, being quite
free from ulceration. The pylorus was normal. The total
capacity of the stomach was greatly augmented; it was gene¬
rally in a state of chronic catarrh, and it contained some of
the melsenio matter which was vomited during the last days
of life, but no coagula. The duodenum was considerably
dilated and contorted, the adhesion of the stomach to it just
at its termination having apparently produced some con¬
striction of the gut there; it also contained melesnic matter.
The liver bad some slight adhesions of its oonvecc surface;
its texture was so friable that it broke under the smallest
pressure—indeed the organ could not be handled without its
giviDg way; the texture was also dry and granular. It
weighed 32£ oz. There was little or no bile in the gall¬
bladder. The spleen weighed 7 oz., and was pulpy. Except
an old adhesion of the upper lobe of the left lung, there
was nothing noteworthy elsewhere. On closer examination
of the gastro-hepatic adhesion, it was found that the
hepatic artery and some branches of the coronary artery lay
very much in the focus of the dense neoplastic tissue, and
the hepatic artery was distinctly observed to undergo an
• abrupt diminution in its calibre.

Proceeding now to remark on the pathological events in
the foregoing case and to trace their connexion, the cicatrix
found in the patient’s stomach is obviously the first thing
to claim attention. The characters of this cicatrix clearly
denote that the pre-existing ulcsr was a large one, and that
in its extension in depth and progress outwards, having set
up adhesive inflammation in the peritoneum, ie came to
have a thick floor of new tissue, if, indeed, it did not actually
invade the contiguous portion of the liver. From the clinical
record it is hardly less evident that the ulcer was one of long
standing, and in the process of its healing underwent inter¬
ruptions and relapses. The marked hour-glass deformity of
the organ itself attests the magnitude of the lesion and the
abundance of contractile cicatricial tissue. Secondly, we
observe that, although there were several small ulcers else¬
where in the stomach, and one pretty large one, there was
no appearance of reparative action in any of them; whence,
I think, we may infer that these several ulcers were not
in existence when the one above referred to cicatrised, but
most have originated at a later period. Thirdly, we find
that the hepatic artery and certain branches of the
coronary were for a portion of their course involved
in the dense neoplastic tissue which united the stomach
and liver together in the site of the same cicatrix,
which occupied, in fact, the small omentum. In seeking to
understand bow this came to pass, we must, I think, bear in
mind that, besides the cicatricial fibroid tissue repairing the
breach in the gastric wall, there were the products of the
inflammatory process excited in the adjacent serous mem¬
brane, and rekindled with every relapse, of ulceration; so
that, with exuberant plastic material, the ultimate result,
when at length reparation was consummated and the con¬
tractile property of the new tissue had come fully into play,
would be a lumpy mass in which the normal relation of
parts would be very much disturbed and the anatomical
detail difficult to make out. The hepatic artery, however,
was unmistakably identified, and it was found to be
abruptly obstructed. Assuming that the liver is dependent
upon this artery for its common nutrition, its condition
corresponded ; it was much under weight, and its texture
was so friable, its cohesion so impaired, that it oould not be
handled without giving way. But, in reference to the
secondary ulcers observed on the mucous surface of the
stomach, and which showed no reparative action, may we
not oonclude that they owed their origin, in part at least,
to a similar constriction of the branches of the coronary
artery causing impaired nutrition in the sphere of their dis¬
tribution ? Our next point would seem especially to favour
this conclusion. Fourthly, the portion of the stomach in¬
cluded within the pyloric sac (as, for convenience sake, we
may call it) was found to be entirely free from ulceration;,
it Was the healthiest portion of the organ. Now, this, we
know, is just the portion that receives its blood supply, not
from the coronary artery, but from the gastro-duodenalis,
a branch of the hepatic artery, given off before this latter
-enters tbe small omentum, and therefore in the present in¬
stance before it was subjected to any constricting influence*

(T§ be concluded).

THE OCCURRENCE OF MENORRHAGIA OR
METRORRHAGIA DURING THE
FEBRILE STATE.

By ALFRED MANTLE, M.D.

In bringing before the notice of the profession the subject
of menorrhagia or metrorrhagia as occurring during a febrile
attack, I may at the outset say that my purpose in doing so
is for the consideration of the treatment of such cases when
the circumstances of some demand treatment. It is necessary
to make this proviso, because most certainly the majority of
cases of menorrhagia or metrorrhagia occurring during a
febrile disease require no treatment; for the loss of blood
may be considered to have a salutary effect upon the disease,
and nature is probably doing what the practitioner of a
generation ago considered the right course of treatment in
all febrile diseases.

It is not an infrequent occurrence for zymotic diseases to
be ushered in with haemorrhage. This is frequently observed
in the young when scarlatina or measles is making its
appearance, at which time the haemorrhage is most ofWn
seen to take place from the nasal mucous membrane. In
older patients epistaxis or hasmatemesis is occasionally
observed at the outset or early in the course of the fever;
whilst in others—and this is particularly the caee with
measles, scarlatina, small-pox, typhus, typhoid, yellow, and
intermittent fevers, and sometimes m pneumonia—the
haemorrhage shows itself from the mucous membrane of the
uterus. In some cases this may mean nothing more than
the normal process of menstruation taking place, whioh
may or may not have been hastened a few days by the
pyrexial attack, and the amount of blood lost may not
necessarily be in excess; but in the strong and plethoric,
and particularly in small-pox, typhus, typhoid, and yellow
fever, the loss may sometimes be excessive and perilous,
demanding active treatment. In other instances the haemor¬
rhage is quite unassociated with the normal menstrual act,
when such cases may be said to be ordinary cases of
uterine haemorrhage or metrorrhagia induced by the
febrile condition. I believe, however, that by far the
largest number of cases of uterine haemorrhage occurring
during a febrile disease take place at or near the proper
menstrual period, the circumstances being favourable to
an excessive loss of blood. In considering what condi¬
tions are favourable to the development of menorrhagia or
metrorrhagia during such an attack, we should remember
that in the early stages of fever we have a quickened
pulse with increased arterial tension. Incidentally, I may
remark that in normal menstruation we have increased
arterial pressure with slight pyrexia. In the uterus we
have an organ with an unusually good blood supply, and,
moreover, it is the only organ in the body from which blood
escapes normally as a physiological process. With an in¬
creased vascular tension, it is only what we might then
expect for blood to escape more freely from the mucous
membrane, which probably feels and is most influenced by
the increase of arterial pressure. A yet stronger factor,
however, is probably at work in the causation of hremor-
rhage in the febrile state, and it is the alteration in the
character of the blood. What these alterations consist of
we know as yet little or nothing; bnt whilst it has been
said that in some fevers there is an increase in the fibrin-
forming constituents of the blood, undoubtedly in others
there is a deficiency in these elements, and consequently
a marked fluidity and want of coagulability is observed. ‘I
believe this to be the case in many of the zymotic fevers. _

That the want of the properties of coagulation in uterifre
hiemorrhage is not explained by its being menstrual blood,
and due possibly to the action of the acidity of the vaginal
mucus, is proved by the fact that blood coming from the
intestinal mucous membrane, or which has been abstracted
by the operation of venesection, has the same, character^.
Trousseau, when speaking of intestinal hicmorrhage during
enteric fevers, says,* “ At the necropsy of persons who have
died of enteric fever, we often find bare mesenteric vessels
at the bottom of the intestinal ulcerations. Hence it bright
be supposed that these bjemoirhages are attributable to the
rupture of a mesenteric vesse l during the process by Which

i Clinical Medicine, vol. U., p. 388.

1228 Thx Laucbt,] DR. A. MANTLE ON MENORRHAGIA AND METRORRHAGIA.

[Junk 18,1887.

the furuncular core is eliminated. Still, for the most part,
if not always, this is not what occurs. Blood is exuded by
the mucous surface exactly as it is in btematemesis and
epistaxis, as well as in many other similar circumstances.
The immediate cause of this sanguineous exhalation is an
essential change in the blood, which is in a dissolved state—
a fact you can verify by examining the blood abstracted

from patients in our hospital wards..This particular

condition of the blood is seen in a very high degree in the
haemorrhagic putrid fever, and in yellow fever. In scarlatina,
diphtheria, measles, and small-pox the blood is aleo generally
in this dissolved state, and to it are attributable the intes¬
tinal, renal, and nasal haemorrhages met with in them. So
far is ulceration of the intestine from being a condition
essential to the production of haemorrhages, that they often
come on at a period of the disease very far removed from
that to which ulceration belongs.”

The difficulty and sometimes impossibility of stopping
bleeding in fevers was frequently experienced in the days
when venesection and the application of leeches were much
resorted to in their treatment. Only three years ago 1 was
called into consultation with a practitioner of the old school,
who, having applied ten leeches to the chest of a child suf¬
fering from pneumonia, produced haemorrhage which was
quite uncontrollable, and proved fatal. In these changes of
the normal characters of the blood, together with the in¬
creased arterial tension, lies the explanation of the profuse
menstrual discharge, or the occurrence of haemorrhage apart
from menstruation, during a febrile attack. If the normal
menstruation has not taken place recently, and should it not
appear during the earlier stages of the fever, in all proba¬
bility it will not take place during the after progress or con¬
valescence of the disease; and if it should, the arterial

S ressure being then lessened, the loss of blood may be
iminished rather than increased; but occasionally uterine
haemorrhage, either as menorrhagia or metrorrhagia, does
appear as a sequel to fevers, when we may consider it as
probably due to the changes in the blood alone.

1 shall now briefly relate particulars of two cases of
menorrhagia which occurred respectively during typhoid
fever and small-pox, and which, I may add, are the only two
cases I have witnessed requiring treatment.

In October, 1884,1 was called to attend a lady, aged forty,
the mother of five children, who had been particularly
strong and healthy. She had been at a picnic eight days
before, when she got her feet very wet. She had since had
a good deal of shivering, and for three days previously had
suffered with severe neuralgia, for which I was consulted.
1 found her pulse very quick, and was convinced that the
neuralgia was only a symptom. It was evening, and the
temperature was 105°. There was a slight pleuritic rub
heard on the left side, and pain was complained of; the
abdomen was somewhat distended and tender, and there
were some ill-defined lenticular spots of a rose colour, but
no diarrhoea. Next day the bowels were very loose, the
stools being of a pea-soupy character. The morning tempera¬
ture was 104 6°, and the evening 104'8°. I diagnosed the case
to be enteric fever. Three days afterwards I was informed
that menstruation had taken place. 1 had been consulted by
this lady two months before with reference to the menstrual
loss being more than usual; and finding great regularity had
ersisted for five years, since her last child was boro, and no
istory of miscarriage, whilst other symptoms were com¬
plained of, I considered the haemorrhage due to the meno¬
pause. The following day (being, as far as 1 could judge,
the twelfth day of the disease) the morning and evening
temperature were nearly alike; the diarrhoea had ceased,
hut I learned that the discharge of blood was considerable.
There was low muttering delirium almost constantly. Next
morning, finding the patient considerably weaker, I became
anxious about the loss of blood ; and, seeing the enormous
quantity of dark liquid blood which, according to my orders,
had been saved, having been wrung out of the diapers, I
determined to administer haemostatics. Pull doses of ergot
and gallic acid were given at frequent intervals, also
champagne and nourishment. Mv evening visit found the
patient’s temperature slightly lower, the pulse greatly
softened, but the bsemorrbage quite as free. I was anxious
for someone to share the responsibility of the case with
me, and at the friends’ wish I asked Dr. Gibb to consult with
me. Next morning, finding the usual haemostatic measures
<Jf ho avail, tincture of digitalis was given every three hours,
fidJd applications were applied to the vagina, and 1 remained
with my patient most ef-the day* Eventually I was com¬

pelled to plug the vagina, after which no bfemarrhage
ensued. My patient, however, sunk into a collapsed state;
a clammy sweat covered the body, which was cold. I stayed
with her the whole night, and, by applying warm bottles
and bricks around the body, and administering s timulant*
and food very freely end frequently, the temperature was
recovered. A good reaction taking place, and no recurrent*
of beemorrhage, she gradually improved, and, with the best
of skilled nursing, made a good recovery. I should scarcely
like to estimate the amount of blood lost, but it consisted
of several pints of a dark liquid blood, which did not
coagulate. The difficulty in this case was, in the first place,
to know when to take active measures to stop the haemor¬
rhage ; and, secondly, to find remedies to accomplish this,
for all save that of plugging seemed useless.

The only other severe case 1 have met with was that of &
woman, the wife of a respectable tradesman, who had small¬
pox. She was at the time suckling an infant. On seeing
the nature of the disease, I ordered her to cease doing so.
Four days afterwards menstruation, which had been abeent
during lactation, came on. The patient was a strong woman
and in robust health when seized with illness, and the
small-pox was confluent in type. 1 was not particularly
anxious about the menstrual loss, and, learning that it was
not excessive, I did not interfere. I unfortunately could
Dot get a trained nurse, and had to put up with a par¬
ticularly bad one of the charwoman type, who evidently
considered self-protection was the first object to be attained
—the means adopted being to saturate herself with whisky.
I was misled by this woman as to the quantity of blood
actually lost. At my next visit the patient showed
signs of anaemia in the mucous membranes, and the puke
was greatly weakened. I discovered the loss was very coe-
siderable, and though active remedies were adopted she
died. It is probable that if active measures had been takes
to stop the haemorrhage sooner—which, unfortunately, was
of a far greater extent than was anticipated—the result
might have been different.

As regards the management of such cases of menorrhagia or
metrorrhagia, in many instances, as 1 have already stated, we
may consider the loss of blood, if moderate, as beneficial, sad
we are right in not interfering with it. The uterine mucous
membrane may be considered to be acting as a safety valve,
and good effects may possibly result by lowering the Wood-
pressure and the temperature. But wo must be very watch¬
ful and cautious not to let the haemorrhage continue too kag
lest it become almost uncontrollable. I am convinced tin:
we take too little notice of the occurrence of menstruation
during a febrile attack. We may or we may not be casaally
told that our patient is menstruating, and if we are we treat
the remark almost with indifference. In other cases we may
not hear of it, the nurse or friends of the patient considering
it a natural occurrence and of little consequence. I imagine
that in the old days of bloodletting our fathers wen
accustomed to inquire and take into consideration more
than we do the loss of blood by menstruation, far the
simple reason that a lowering of the blood-pisasnze was
a part of the treatment in all febrile diseases; and it
is, 1 think, probable that nature’s loss frequently saved
the operation of venesection. In considering how far the
haemorrhage is beneficial in such cases, we should be greatly
guided by the general bodily condition of oar patient. W«
should consider what loss of blood she is capable of ausfcain-
ing, and be careful to ascertain the former perform anna of
the uterine function, and also learn if our patient is of a
hemorrhagic diathesis. When we have decided that the
loss of blood must be checked or stopped, it is not always
easily accomplished; the marked fluidity and want of
coagulability of the blood in some cases rendering ordinary
hemostatics almost inert, our treatment then must be very
active, and, if necessary, plugging of the vagina moat be
resorted to.

In conclusion, let me suggest that, as careful practitioners,
more attention be paid by us to the occurrence of meaetraa-
tion during a febrile attack; and let us ascertain whether
we have menstruation or uterine basmorrhage to deni with,
bearing in mind that the former is a common term for a£
forms of uterine bsemorrbage with the laity. It is JoS
possible that by an oversight of this kind we may Uni, too
late perhaps, that a physiological process has stolen a mmtet
upon us and insidiously become converted into .a patho¬
logical and maybe a therapeutical difficulty, sad Chat a
beemorrhage which, bad it occurred from the nose,
stomach, or bowel, would have received every attention at

Digitized by G00<?le

The Lancet,]

CLINICAL NOTES.

[Junk 18,1887. 1229

our bands, because it has arisen from an organ which
periodically bleeds has been deemed unimportant, and not
calling for special attention. It may occasionally happen
that in such a neglect lies the explanation of the tardy con¬
valescence or fatal termination of some cases which other¬
wise seem difficult to understand.

Stanley, Durham. _

Clinical Holes:

MEDICAL, SURGICAL, OBSTETRICAL, AND
THERAPEUTICAL.

A CASE OF COUPLE EHYTHM OF THE HEART.

By W. J. Collins, M.D., M.S., B.8c. Lond., F.R.C.S. Eng.

“ Couple RHYTHM ” was the name first given by Dr. Hyde
i Salter in 1871 to a rare and curious abnormality of the
i rhythm of the heart beat which he had observed in three
cases. The subject did not appear to attract the attention
of any observer until 1882, when Dr. Henry Cook of Bombay
J published three cases he had observed in India, and added
a sphygmographic tracing. Recent medical treatises and
dictionaries of medicine do not contain any account of this
( curious phenomenon; and as the cases are very rare, it may
be interesting to publish the notes of one that I have had
' under my observation. Before doing so I may say that the
; peculiarity consists in the cardiac systoles going in pairs or
! couples, the pause between the two being much lees than
1 that, which separates one couple from another. It is not a
1 reduplication of both sounds, as is proved by the pulse,
j the sequence of events being lubb-dup, lubb-dup, pause,
'• lubb-dup, lubb-dup, pause. It is neither an intermittence
1 nor an irregularity, as Dr. Hyde Salter pointed out. It is
rather an intermittent irregularity than a regular inter-
* mittence, and the irregularity is singularly regular. All

> three of Dr. Salter’s cases had valvular disease of the heart,
so had two of Dr. Cook’s cases, while the other was suffering

i from malarial fever.

1 J. R-, aged nineteen, a footman, was first seen by me

i in January, 1882. He complained of palpitation, which
i became distressing upon exertion, and was getting worse
i every year; it had troubled him altogether about five years.
i He had never had rheumatism, had had measles and
’ whooping-cough, with subsequent bronchitis, at three years

> old, but since then had enjoyed fair health, The apex beat
i was in the normal situation, the cardiac dnlness not
i increased; on auscultation, what first of all sounded like
i reduplication of both sounds was heard, but on listening
i more cautiously, tbe couple rhythm described above was

very distinctly audible. The pulse, too, exhibited the
i usual anomaly in these cases. The rate was 48 per minute,

! and the radial pulse synchronised with the first of each
. couple. On coughing or exerting himself—e.g, lifting a
i chair,—tbe pulse rate was immediately doubled, the second
i systole of each couple being then also appreciable at tbe
; wrist, giving 96 pulsations per minute. A sphygmographic
, tracing gave an ocular demonstration of the anomaly,
exhibiting the paired rhythm of the pulse, and the first of
i each pair being a more powerful systole than the second,
i There was a short systolic bruit, most distinct at the left
i base, and presumed to be htemic in character and causation,
j It was very remarkable to observe the pulse while the
, transition from the rapid rate to the exact half of that rate
i took place; every alternate beat weakened down, until at
, last it was no longer appreciable to the finger, and sank
, into the pause. Urine: specific gravity 1026, acid, no
l albumen. No other physical signs or symptoms beyond
considerable anaemia were observed.

, _ I saw the patient once or twice again in 1882, and each
time observed precisely the same phenomena. Then I lost
, sight of him until April, 1885, when he came complaining
of a severe cough which he had had two months, with occa¬
sional haemoptysis; and at the right apex were observed
increased vocal vibrations and crackling crepitation, while
, at the left apex were coarse breath sounds. The couple
i rhythm was still present, but less marked than formerly—
j that is to say, the pause between the members of a couple
approximated to that between two couples. As an oppor¬
tunity to go to Australia presented itself, he left England in

August, 1885. I heard from him in December last from
Lithgow (New South Wales). Alas! the voyage had appa¬
rently aggravated his lung trouble, and he entered Sydney
Hospital on landing with both lungs seriously diseased.
Quite recently I have been informed of his death.

In the absence of any better explanation of this rare and
striking phenomenon I would suggest as its cause a
rhythmic rise and fall in the activity of the medullary
cardio-inhibitory centre, akin to the rhythm which we
know to exist in the respiratory and vaso-motor centre;
this would produce an alternate reining up and relaxation
of the heart’s spontaneity, and so occasion the symptom
described. _

ON THE TREATMENT OF HYDATIDS.

By Arthur Senxbtt, M.D. Aberd., &c.,

FORMERLY HOUSE-SURGEON, LONDON HOSPITAL.

In The Lancet of Jan. 15th, 1887, Mr. Laurence Humphry
describes a case of hydatid cyst of the liver, in which
collapse and an urticarial eruption followed as the result of
puncture with a hypodermic needle, and which was after¬
wards cured by evacuating the cyst. I believe this method
is generally adopted, the aspirator or trocar and cannula being
used, and the cyst completely emptied. In this country,
where the disease prevails, such is the general practice; and
1 have operated on about a hundred cases in this manner,
with a fair percentage of recoveries. My notes do not
extend over afl the cases, but about ten deaths out of the
hundred would be nearly, if not exactly, correct. The con¬
clusion, however, has been forced upon me that this treat¬
ment is not the best, and during the last year I have treated
each case by puncturing, using a large hypodermic syringe
with two needles, drawing off about two drachms of the
fluid, and then injecting a similar quantity of a weak
solution (two grains to the pint) of perchloride of
mercury. The result of each case has been satisfactory; no
suppuration has resulted, and the cyst has gradually con¬
tracted. The generally accepted principle that collections
of fluid in the internal parts of the body should not be
suddenly evacuated is thus not violated. The action of the
perchloride, even in such minute quantities, is sufficient to
destroy the vitality of the echinococcus, which is never
great, and the spontaneous method of cure is simulated as
nearly as possible. That many cases do get well spon¬
taneously is shown by the fact that in fully one-tbird of the
necropsies I have made at the Hamilton Hospital on men
who have lived in the bush for a length of time, and who
have been accustomed to drink any water that they might
meet with, a shrunken cyst has been found. I am not aware
if the above method of treating this disease has been pre¬
viously described, nor have I opportunities of referring to
the literature of the subject. It seems to me to meet the.
indications and to be based on scientific principles.

Hamilton, Victoria. _

FRACTURE OF ASTRAGALUS; SUBSEQUENT NECROSIS,*
REMOVAL OF CARIOUS BONE; RECOVERY.

By Arthur E. Salter, M.B.

On August 3rd, 1886,1 attended a child (S. C-), aged

four years and four months, with an injury to her left ankle
joint, caused by her falling from the top of a heap of house
studs, some of the timber falling on the ankle. When I saw
her Bhe was in great pain, the accident only having just
happened. There was no bruising, but the foot was displaced
a little outwards, and there was a large effusion of blood
beneath the skin on the inside. She was in intense pain.
Having chloroformed her and examined the joint, there was
crepitation distinctly below the joint, the inner malleolus
was broken. Believing the fragments would unite well, I
put up the limb in a splint, guarding against pressure over
the effused blood, and in this way it was left for a few days,
at the end of which, as great pain was complained of, the
splint was removed. The limb having been again put up, it
was left for three weeks, when a plaster splint was applied
and kept on for another three weeks, after which, the pain
commencing to be great, the splint was removed, where¬
upon some signs of approaching suppuration were visible.
In this position it was left without any splint, and on

ed by Google

123d Thr Lancet,]

CLINICAL NOTES.- HOSPITAL MEDICINE AND SURGERY.

[Junh 18,1887.

Sept. 29fch an abscess below the inner mallecilus was opened
under chloroform, and pus evacuated; on this occasion the'
opening made with the knife was probed and dead bone dis¬
tinctly felt, The child took chloroform very badly, requiring
a large quantity to produoe anaesthesia, and boon regaining
her sensation if not kept very deeply under the influence of
the drug. On Oct. 4th, under the influence of chloroform,
the opening into the diseased bone was enlarged, a small
Scoop introduced, and a ‘considerable quantity of carious
bone in a softened state removed, the cavity so made being
•Well syringed with caTbolic water (1 in SO). The bone was
still disinclined to heal, and on Oct. 81st the cavity in the
astragalus was again scooped out, and more bone in a dis¬
integrated and decomposed state removed. From this date
onwards the joint proceeded well. Subsequently a piece of
the internal malleolus came away, and the patient was able
to walk about,'having as a result some enlargement of the
joint and ndt good mobility. I believe the mobility will con¬
siderably improve as time goes on, the patient being so young.

Thursday Island. Queensland.

PUERPERAL PYREXIA.

By R. J. Callender, M.R.C.S., L.R.C.P.L.

The following case may prove interesting and useful to
some of the readers of The Lancet :—

Mrs. P-was safely delivered of a female child on

March 26tb. The placenta came readily away and firm con¬
traction of the uterus ensued.- March 27th: Feels quite
well. Has taken a quantity of food (slop diet). Discharge
abundant. — 29th : Slight headache, which she attributes to
not having had her bowels relieved since her confinement.
Ordered castor oil.—81st: Called at 8 a.m. to see the patient.
She complains of excessive heat, restlessness, headache, and
thirst. Temperature 103° ; pulse 130. Lochia very scanty.
Slight pain in the abdomen on the left side. Slight soreness
qf throat. Ascertained that her bowels luid been moved four
times. Had been out of bed on the 29th and 80th, while bed
was made, and had complained of shivering. Did not sleep
lie preceding night. Ordered turpentine and hot poultices to
be applied to the abdomen, and a mixture containing solution
of acetate of ammonia and tincture of opium. I went back
at 10 p.m. and found her still very restless. She had had no
sleep. Temperature 104°; pulse 140. Lochia very scanty,
but not offensive. The uterus was washed out with warm
water and Condy’s fluid.—April 1st: Has had no sleep.
Temperature 105°; pulse 140. Lochia almost ceased.
Slight tenderness over abdomen. Ordered a draught con¬
taining fifteen grains of quinine, with twenty minims of
hydrobromic acid. Called two hours later. She was then
sweating profusely, had noises in the head, and was very
deaf. Sne seemed quite under the influence of the quinine.
At 10 p.m. the temperature was 104° and the pulse 13).
Ordered a quarter of a grain morphia pill, as patient had
had no sleep for three nights.—2nd: Temperature 103A 0 ;
pulse 120. Lochia much more abundant; pain gone. Has
slept well. Gave fifteen grains more quinine. At 10 p.m.
the temperature was 100’2°, and the pulse 95. She felt milch
better. Lochia profuse. Better able to take the nourish¬
ment ordered (half an ounce of brandy, with yelk of egg,
every four hours, and beef-tea).—3rd: Temperature 99 , 1°;
pulse 90. Patient has had a good night’s rest, and seems
inclined to sleep. Ordered a small dose of castor oil. From
this time the patient made a good recovery.

' I consider the quinine has in this case proved most useful,
bringing down, the temperature quickly and causing the"
interrupted lochia to come freely away.

BorthumberUnd.

REMOVAL OF ADENOMA OF THE BREAST: USE OF
COCAINE.

By E. F. GntN, M.R.C.S.

I desire to give a brief account of the removal of «h[
adenomatous tumour of the breast under the influence of’
cocaine, no other anmBthetic being used. The tumour, about,
tie sire of a walnut, had Existed for ahonfcoix months. The
pkthsdt, a highly intelligent lady residing at Putney, was
extremely anxious for its removal, but had groat; objection
to taking either ohlorofonn or Ether. Under these circum-
stanoea it was determined to remove the tumour with;

cocaine only, the ether being at hand in case of neoeaeity.
Dr. Wood house kindly assisted in the operation, which wu
conducted in the following'manner:—The breast was fim
smeared with a 5 per cent, solution of oleate of eocaine, which
absolutely deadened the pain of the hypodermic needle; them
a mixture of a saturated solution of cocaine with the hypo¬
dermic injection of morphia (B.P.) was injected over the two
extremities of the tumour. In five minutes all sensation
had disappeared over an area of about three square inches.
An iqcision about, two inches long’was now made, the raw
surface painted with satarated solution of cocaine, and the
tumour gradually dissected out. Two arteries were tied, and
the wound stitched together, but It had to be reopened to tie
another small artery. The whole operation lasted about an
hour and a half. Tbe patient was continually asked during
the operation if she felt pain; she stated that ehe felt no
pain whatever. This is the first case in which a tumour of
the breast has been removed under the influence of cocaine.
The patient has since made a most satisfactory recovery.

Putney._

PUERPERAL ECLAMPSIA; CRANIOTOMY.

By Bbavbn Rake, M.D. Lond.,

GOVERNME.NT MEDICAL OFFICES, TW5LDLD.

On April 10th, 1887, about 7 p.m., I was called some miles

into the country to see B-, a Hindu aged about twenty.

I learnt that she had been in labour about twelve hours,
and that it was her second child. 1 found her deeply coma¬
tose, lying on her back, her face very sunken, and her
pulse 130, very weak. She was said to have been in this
state for some hours. The head was at the brim and the os
the size of a shilling. There were no pains. I examined
the abdomen carefully, but could detect no fcetal movement
or heart sounds. Her critical condition seemed to call for
immediate emptying of the uterus. After drawing off
about half a pint of urine with the catheter, 1 dilated the
os digitally without chloroform, as she was too weak to
make any resistance. I then tried to put on tbe forceps.
One blade slipped on easily enough, but the head was so
high up that I had not room to get on the second blade.
These attempts produced clonic spasms, especially marked
in the right upper extremity. Her pnlse also became eo
weak that I feared the result of any more such irritation
of the uterus. Feeling also that tbe child was probably
dead, I perforated and completed delivery with tbe forceps.
Tbe child was small, and appeared to be about eight months.
There were no further convulsions, and the uterus con¬
tracted well. The woman died four days later. She
never recovered consciousness.

Trinidad.

% Piror

or

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

I Nulla an torn eat alia pro oerto noaoeadi via, n!d qnamplariraaa et naor-
borum et diaaectioouin hiitorias, turn alio rum turn propriaa rollrctai
habere, et inter ae oomparare.—M obgaoki Dt Sai. at Comm,

Tib. lv. Prooemium. ■ ■

GUY’S HOSPITAL.

POPLITEAL ANEURYSM TREATED BY DIGITAL OOMPRRSSIOX
FOB TWENTY-TWO HOURS ; CURB AFTER PREVIOUS
FAILURE OF ESMARCH’8 BANDAGE AND
ELECTROLYSIS BEFORE ADMISSION.

(Under the care of Mr. Bryant.)

The first of-the following two cases is an example of
the value of digital compression of the femoral artery ia
popliteal aneurysm. The great advantage which it preseau
over other methods in the majority of instances is eo well
known, that few Burgeons fail to avail themselves of it* use
when the patient can be treated under conditions favourable
to its successful employment. It would be interesting to
have fuller details of the methods employed before the
patient came under the care of Mr. Bryant. In the second
case, it would appear that tbe prolonged suppuration and

Digitized by GoO^lc

1932 The Lancet,]

HOSPITAL MEDICINE A2TD SURGERY.

[Jotb 48,1*7.

by the stricture. After this operation all symptoms of ad
irritable bladder entirely disappeared, and he was from this
time perfectly relieved. On Sept. 16th straight silver catheters
were again passed to ensure the perfect dilatation of the
stricture. As Noe. 6 and 7 were not held tightly, still larger
sizes were tried, and it was then found that Nos. 9 and 10
could be passed, but the latter wm very tightly embraced
by the stricture. He suffered in no way from this operation,
and left the hospital on Sept, 22nd.

Remarks.— The rupture of the urethra Was probably not
complete, or the symptoms would have been more urgent
after the accident. There was no evidence forthcoming as
to the possibility of a fractured pelvis, but it would appear
as if tne rupture had been produced by direct external
violence. Another interesting point is the size to which
dilatation of the urethra was carried. The penis was of
quite the normal proportions for a child of this age, and yet it
readily admitted a catheter of the size of No. 10 English
scale. This was done for the purpose of thoroughly stretch¬
ing the stricture, but it proves that a small lithotrite and
evacuating tube could be introduced at this early age if
lithotrity were necessary.

, BRISTOL ROYAL INFIRMARY.

THREE CASES OS IMTUBATION OF THE .LARYNX.

'(Udder the care of Drs. Shtngleton Smith and Waldo.)

Fob. the following account we are indebted to Mr. James
Swain, house-physician.

CasB 1.—E. W——, aged two years and four months, was
admitted on April 16th, under Dr. Shingle ton Smith. Then
was marked dyspnoea, as shown by the recession of the
epigastrium and supra-clavicular fossa during inspiration;
tne lips were rather blue, and there wae a harsh croupy
cough. The fauces generally were red, and the tonsils
slightly swollen. Temperature HXX'6°. By three hours,
after admission the dyspnoea had become so urgent that,
intubation (after (/Dwyer's method) wae performed. This ,
was followed by a slight attack of coughing, which lasted
about half a minute, and then the child breathed quite
calmly, the relief being perfect. Throughout April 17th the
patient continued comfortable, the temperature ranging
between 100° and 102 8°. The slight rough, which stiH
continued, was almost aphonio. — 18th: Tube removed,
after remaining fa’position about thirty-seven hours. After
removal, in consequence of gradually increasing dyspnoea,
the tube was again inserted abont three hours after removal.
This time, however, it remained in only for a few minutes,
being ejected during a violent attack of coughing. From
this time the Child improved, the temperature gradually
lowering until it became normal on April 23rd. The
voice continued to be rather hoarse for upwards of a week
after the removal of the tube. A slight attack of broncho¬
pneumonia supervened, but this did not appear to be in
any way connected with the process of intubation.

Case 2.—R. B-, aged live years, was admitted on

April 24th, under the care of Dr. Waldo. The mother stated
that the child bad been ill a week with symptoms of catarrh,
a rough of harsh character, andgradually increasing dyspnoea,
with occasional attacks of greater severity but compara¬
tively short duration. On admission, the child’s face had
a leaden hue; there was great restlessness and dys¬
pnoea, although little epigastric recession ; cough of croupy
character; fauces slightly reddened, but no membrane
visible. Urine concentrated, and containing a trace of
albumen. Temperature 101*2°. The symptoms of dyspnoea
gradually increased, although temporary relief was obtained
by the action of an emetic powder, and intubation was
resorted to during a severe attack of paroxysmally
augmented dyspnoea early in the morning of the 25tn. This
was followed by marked relief, but not so oomplete as in the
foregoing case.—April 20th : Cough rather severe. Child is
able to 6peak, but the voice is not loud. Urine still albu¬
minous. In the evening, about thirty-six hours after its
introduction, the tube was expelled during a severe attack of
coughing. Two hours after tne ejection of the tube the ehild
coughed out a piece of false membrane about three-quarters
of an inch long. The temperature ascended to 104°, but
in all other respects the patient seemed better. A gradual
improvement took place, and the temperature reaehedthe
normal line on April 80th. On May 1st, however, an in¬
crease in the amount of albumen in the urine occurred, and
the temperature rose to 102*. It continued elevated for a

few days, and then the child began to oenvaleeee. Bn
albuminuria disappeared finally on May 6th. The child’s
voice was hoarse up to the time of her discharge from the
infirmary on May 13th.

Case 8.—J. M—aged three, was admitted on May 10th,
under the care of Dr. Smith. The patient had only beea ifl
one day with rough and difficulty in respiration. 0a ad¬
mission no abnormal appearanoe about the fauces, but croupy
rough and slight dyspnoea. Temperature 99°; urine tad.
no albumen.—April' lltb: Dyspnoea getting worn, bat
was slightly relieved by emetic powder.—12th: Ptiimt
has had several paroxysmal attacks of dyspnoea dunag
the night. The face is livid, and there is marked epigas¬
tric recession. Hie administration of an emetic powder
caused no diminution in the symptoms. Very little air
is now entering the chest. The pulse is small aad feeble,
and the child seems exhausted. Intubation wes per¬
formed at 6.15 p.m m and was followed by instant relief.—
18th: The child ooo tinned perfectly comfortable until
5 A.if., when it was found that the string by which the
tube bad beea fastened to thB cheek bad beea gnawed
through and the end attached to the tube had disappeared.
AS the tube was not found tn situ and had not bare
ejected, it was concluded that it had bean dislodged
during the act of coughing. hnd had been swallowed. By
9 a.m. the patient had again become so dyspnosic that in¬
tubation with a larger tube was performed; this, bowenr,
was ejected in three-quarters of an hour. The breath is*
continued fairly easy far a few hoars, and than the
child again became dyspneeie. Temperature 994V
Aprll 14th: Intubated again at 12.30 a.m. Again followed
by instant relief. Ehoachu* over Umgs behind. Slink
diarrhoea. Temperature ranging betwean 99*8° and W2V
Aprii 15th: The child seems rapidly getting weaker. Psln
172; respiration 44; temperature gradually aa ca n fa g.
103° at noon. Air seems to enter the chest fairly freely;
no moist sounds; rhonchos over back of the longs occa¬
sionally; Death occurred at 4 p jc, the temperature in tbs
groin being 106'4° just before death, and 109*4* in the
rectum immediately after. At tha necropsy the trachea
and bronchi showed marked signs of scute inflasnaatlna, i
slight amount of frothy fluid could be squeezed oat of each
lung, there were a few patches of pulmonary collapse, and
emphysema was markedly present in, the right and slightly
so m the left lung. The tube which the child had swallowed
was found in the caecum, to which it had travelled without
doing any apparent injury.

Remarks by Drs. Smith and Waldo. —The subject «f
laryngeal intubation has been more or less freely diseased
in recent medical publications, but in Eng l and, at all tim%
this comparatively new operation is now on its probation,
and cases thereof have been sufficiently few to ioatify us in
pointing out any practical lesson which has been gained
from the above cases without any attempt at theoretical
speculation as to the merits or demerits of the operation ii
general. In introducing the tube, it seems best to hsya the
child sitting on the nurse’s lap with the head slightly
inclined forwards towards the sternum. The tip of the
Anger which is passed into the child’s month, after
passing over and hooking up the epiglottis, nearly
always impinges on the . top of the arytenoid cartilage*,
and the tube, when introduced, can be felt is facet
of one’s Anger passed into the lower part of the pharynx
behind the upper opening of the larynx. From want of
familiarity with the operation, we deemed it advisable in the
above cases (except tbs last intubation of Case 3) to fasten the
string which is attached to the tube during its introduction
to tbs cheek of the ohild by means of strapping. Thu a
we an convinced, a mistake, for it irritates the child, and
by the movements of the tongue under the string the tube
is apt to be dislodged, because the outer end, which »
fastened, te necessarily a fixed point. The tendency of the tuts
seems rather to be ejected from than to be drawn into the
larynx, and Cose 3 shows how the tube may be dislodged «n
swallowed in spite of an attempt to secure the tube. Tha
process of removal of the tube is, moreover, a oompartfamy
easy one. The acute tracheitis and bronchitis which occurred
in Case 3 we feel almost bound to attribute directly to the
operation; for the intensity of the inflammation va*
greatest in the upper part of the trachea and diminished •*
it went down the respiratory tract. Whether the insertion
of a tube which was presumably rather large (for theohw
bad swallowed the tube which corresponded to the ^
its larysx) had an increased effect in the causation of tut

L)

Tas LfNCBT,)

ROYAL MEDICAL AND CHI SURGICAL SOCIETY.

[June 18.1887.

inflammation we cannot say, but no doubt there is a tendency
to the occurrence of laryngitis, as Indicated by the hoarse¬
ness of voice which persisted in the other cases some
time after the removal of the tube. It is, perhaps, interest¬
ing to note that the tube which passed so harmlessly through
the pylorus and ileo-crecal valve measured two inches in
length. We cannot enter upon the question of the relative
value of tracheotomy and intubation, but it is right to state
that in each of the above cases we should have been
absolutely compelled to perform tracheotomy had not the
process of intubation been substituted. Our object is
rather to show that intubation of the larynx is in some
cases attended with perfectly satisfactory results, but vet
has dangers of a somewhat more serious character than
some recent writers would lead us to suppose.

U toiral Soci eties.

ROYAL MEDICAL & OHIRURGIOAL SOCIETY.

Dermatitis Gangrenosa Infantum.—A form of Inflammation
of the Lips and Mouth, usually attended by some Dis¬
ease qf the Skin.

The last ordinary meeting of the session of this Society
•was held on Tuesday last, Mr. G. D. Pollock, F.R.C.S., Pre¬
sident, in the chair.

It was unanimously agreed, on the proposal of Sir Dyck
Duckwojith, seconded by Dr. Crawe-orb, that an address
be presented from the 8ooiety to Her Majesty the Queen
on the occasion of the completion of the fiftieth year of her
reign.

Dr. Radclifke Chockkb read a paper on Dermatitis
Oangrenos* Infantum. Four groups of cases were described.
In the first there was no evidence of varicella antecedent to
the gangrenous or ulcerating eruptions, and in moat it was
-distinctly negatived. In the second group are cases in which
varicella has preceded the sloughs or ulcers, which either
-developed immediately upon the varicella pustule or occurred
as a sequela beginning in independent lesions. In the third
group vaccination was the immediate antecedent. In the
fourth group axe placed certain cases of local gangrene
resembling cancrum oris; but the individual lesions began
in exactly the same way as the independent eruption which
followed varicella, and there was a tendency to generalisa¬
tion,, or, at all events, to extension beyond the region in
which it started in some of the cases. A general account of
the disease was drawn up from an analysis of the preceding
-and other cases, and it was shown that there is great
difference in the severity of the eruption. In some the
gangrenous patches were so numerous and extensive as to
lead to the death of the patient in a'few days, while at the
other end of the chain are cases of so mild acharacter that there
were only superficially ulcerating pustules, which came out
in crops, thus protracting the disease as a whole for a con¬
siderable time, aud generally accompanied by intense
pruritus; these milder cases appear to correspond with Mr.
Hutchinson’s varicella prurigo. Between the two extremes
ire cases of all grades of severity. Comparison was made
between the local and general gangrenous eruptions, and,
among other things in common, it was shown that they both
attack girls more than boys, and occur at about the same
ages. The conclusions arrived at were—that the gangrenous
eruptions are pathological accidents, so to speak, which in
young children, especially when of tubercular constitution,
might supervene upon any pustular eruption, although no
doubt such a condition is much more common after varicella.
Secondly, that the determining factor is probably a micro¬
organism derived from without-, though cultivation and in¬
oculation experiments could alone prove the truth of this
theory. Thirdly, that the initial lesions, both of the local and
general gangrenous eruptions, present the same characters.—
Mr. Jonathan Hutchinson said that he never doubted
that other eruptions than vaccinia and varicella could be
follow'ed by, gangrenous changes. The various specific
animal poisons had the power of altering the condition of
the patient and rendering him liable to gangrene of the
skin and other,parts. He had seen many cases of cancrum
oris in children who were in excellent health till the measles
or other specific fever had overtaken, them. There were cases

also in which.no known antecedent cause could be made
out—neither syphilis, nor scarlet fever, nor vaccinia or
varicella, &c. He distrusted the view that tuberculosis as
a constitutional tendency was liable to set up gangrene of the
skin. He thought this was very highly improbable; He
thought that we must receive with caution the statement
that no evidence existed of the previous occurrence of
varicella, for it may be easily overlooked, having occurred
in a sporadic form. Infection may occur in individual pus¬
tules which are not of varicellar origin; these are not
extensive and not symmetrical, but irregular in distri¬
bution, and resulting from injury are succeeded by the
formation of pus and absorption of the same. He congra¬
tulated Dr. Crocker heartily on the value of bis paper.—
Dr. Radcliffe Crocker was gl^d to find that Mr. Hutchin¬
son did not differ so very much from the position assumed in
his paper. In one case at least the evidence was of the
strongest character that the vesicular eruption was not df
varicellar nature, and yet gangrene supervened. As to
tuberculosis, if well marked and attended with high fever,
he thought that it offered a genuine predisposition to the
development of gangrene.

Mr. Jonathan Hutchinson contributed a paper on &
form of Inflammation of the Lips and Mouth, which some¬
times ends fatally, and is usually attended by some disease
of the skin. The paper contains the description of a disease
(not, it is believed, previously recognised) in which super¬
ficial ulcerations ocour in the lips and in various parts of
the mouth, followed sooner or later by some form of skin
disease and tending to a fatal termination. The form of
skin disease may vary, but the bands and feet are the parts
usually affected, and the nails are especially prone to suffer.

> in some instances the eruption may consist of bullae which
are followed by free papillary outgrowths. The patients
attacked are usually in fiddle life, or in early senile periods.
No special antecedents can be alleged as the probable cause
of the malady. Unless checked by treatment the disease
appears to run its course in about six months, producing
death by exhaustion. There seems reason to believe that
opium given in repeated doses will cure it, and that there
is, at any rate in some cases, no tendency to relapse after¬
wards. All the best marked cases as yet observed have
occurred in males, but iu several milder ones tbe patients
were women. Of the most characteristic, two were
master tanners, one was a farmer, one a clergyman,
and one a gentleman of ’no occupation. All these
resided in the country. Careful inquiry has failed to
support the suspicion that the disease might perhaps
be doe to contagion from animals. Of these five cases, two
ended fatally and three in recovery. The patients who died
were those first observed, and since the discovery of the
signal efficacy of opium no case has ended in death. Hie
observation as to thfl efficacy of opium was simultaneously
made by the President of the Society, Mr. Pollock, wad by
the author, two different patients being at the same time
under their separate treatment and recovering under this
drug. Since that every case has yielded. uose of

opium were sufficiently pushed. In one, however, the
disease did not yield quickly and for more than a tnonth
seemed likely to end in death. As regards permanency of
cure, in one case the patient is known to be quite well four
years after his recovery, in another there is reason to believe
that such is the fact, and in a third a period of two years
has elapsed. In two of the milder cases, occurring In
younger patieifte, the disease has repeatedly relapsed. A
great variety of remedies had been tried without benetltbefore
the use of opium was resorted to. In no single casehas there
appeared to be any tendency to spontaneous improvement.
In all the cases the inflammation of the lips and month took
definite precedence of the skin symptoms, and in some the
latter were very slight. It is not known tnat any case has
as yet been obtained amongst the poorer classes of society.
The author desired to abstain for tbe present from express¬
ing any detailed opinion as to the canses or nature of the
malady. He would, however, venture to suggest that it is
allied to other forms of disturbed health attended by skin
disease and occurring in early senile periods, such as certain
peculiar varieties of psoriasis, pemphigus, lichen planus, and
pityriasis rnbra.. In confirmation of this suggestion, and as
an appendix to the paper, a case is narrated (with a portrait
in illustration) in which an elderly lady had a kind of
spreading eczema-psoriasis of tbe hands and scalp. She
lost her nails and all her hair, and was rapidly failing in
health in spite of various measures of treatment, but finally

1234 The Lancet,]

ACADEMY OP MEDICINE IN IRELAND.

[Junk 18,1887.

recovered quickly and completely under opium. Her case
does not belong to the group described in the paper, because
she never at any time had inflammation of the mouth.—
Mr. Pollock referred to the value of opium in all cases of
ulceration of the skin. In cases of phagedsena occurring many
years ago opium, in his hands, had proved of singular value,
lie never used any kind of caustic. We were very much
indebted to Mr. Hutchinson for the interesting clinical
grouping of cases brought forward in the paper. -Mr. Mac-
nauaka referred to the case which had been under his care.
There was no apparent reason for the ulceration and in¬
flammation of the mouth which supervened on the sufferer’s
return home from India. The spleen and liver were some-
wh&t enlarged. Emaciation and cachexia were already
advanced, and although opium was ordered, it was probably
not taken as prescribed, and therefore had not bad a fair
trial.—Dr. Radcufek Crocker said that so far as the mouth
part of the disease was concerned the condition was ne w
to him. He testified to the value of opium in chronic
.progressive skin affections in old people. Was the affno¬
tion related in any way to the pemphigus vegetans of
Neumann ?— Mr. Hutchinson, in reply, thought the affec¬
tion might be so related.

ACADEMY OP MEDICINE IN IRELAND.

Malignant Disease of the Tonsil.—Excision of the Wrist
Joint.

At a meeting of the Surgical Section, held on April 22ad

Mr. Hknby Gray Cboly read a paper on Primary
Sarcoma of the Tonsil, and detailed the history of two
cases. The first case, Michael D—-, aged seventeen years,
was admitted into the City of Dublin Hospital on April
22nd, 1886, suffering from a tumour involving the left
tonsil and soft palate. The boy was in excellent health
until six weeks previous to his admission into the hospital.
The disease commenced like ordinary tonsillitis, and so much
. did the swelling resemble tonsillar abscess that an explora¬
tory incision was made by the medical gentleman who first
saw the case; no pus escaped. The patient snffered from
. dyspnoea and dysphagia. A glandular swelling subsequently
formed in, the left digastric space. Sir James Paget, who
was in Dublin at the time, kindly saw the patient with
Mr. Croly, and concurred in hie view of the case and in the
proposed treatment—viz., preliminary tracheotomy and
, removal of the growth from within. Tracheotomy was
performed on May 4 h. The patient experienced much
reJieL The tonsillar and palate swelling and the digastric
tumour disappeared almost entirely after the broochotomy,
but soon reappeared. Mr. Croly excised the tumour from
beneath the ancle of the jaw on May 18th, and subse¬
quently removed the tonsillar and palate growth by means
of the "benzoline cautery. The tonsil and digastric tumours
were round-celled sarcoma. The disease returned very
rapidly in the digastric space and afterwards in the palate.
The patient got drowsy, and suffered from violent head¬
aches; the glands in the neck enlarged. He returned to the
country, and died in October—Bix months from the com¬
mencement of the disease. The second case occurred in a
man over fifty years of age. The sarcoma was confined to
the tonsil, and so much did it simulate tonsillar abscess
that an incision was made into the tumour. Mr. Croly de¬
clined operative treatment in consequence of extensive in¬
filtration of the cervical glands. The patient returned to
the country, and died from exhaustion caused by repeated
luemorrhages.—The President said that the case was one
of great clinical interest and of exceptional rarity. Thongh
the operative measure was not attended with success,
yet that procedure was eminently justified, and at an
earlier stage might have had a different result.—Mr.
Thomson asked whether Mr. Croly had succeeded by
this method in getting away the whole of the tonsil with
the cautery; because if there was only a spouting mass
removed and a portion left behind, the after-history was
intelligible. Although he never saw a case of the kind, it
occurred to him that the external operation would give
increased facility for getting at the structures to eradicate
them. The difficulty of operating through the mouth on
the tonsil was the uncertainty of removing the whole
gland.—Mr. W. Thornley Stoker said he approved of the
thermo-oautery, and used it freely and frequently; but this
was one of the otaee in which he would be alow to rely

upon it as being an instrument of dangerous facility in
finding its way, and therefore if he sought to do more than
remove the surface of the gland, especially where malignant
disease existed, he would adopt the apparently more heroic
operation of dividing the cheek and jaw, and enucleating
the gland from its attachment by means of an instrument of
less facility.—Mr. Kendal Franks concurred with Mr.
Stoker in his objection to the thermo-cautery, not only
because the surgeon might travel into undesirable parts,
but also because of the increased difficulty which
cauterisation created of seeing the limits of the disease.
He thought Mr. Croly was right in taking It from the in¬
side, and that the surgeon need not be afraid of going close
to the carotid artery, there being a good depth of tissue
between the tonsil and that artery to avert danger. - Mr.
Croly replied. Hie first idea wae to relieve the patient by
tracheotomy from the sense of choking, having no wish to
cut out the tonsil either from inside or outside. His ex¬
perience of those growths had been, unfortunately, that the
operation would only give temporary relief. Hence he
asked Sir James Paget what be woqld do if be had the case
in London, and that eminent surgeon replied that he would
perform the preliminary tracheotomy and cut out as much
of the tumour through the mouth as he could. In fact,
in this instance, unless he cut off the boy’s head he
could not have cut out the disease, and therefore it was
immaterial whether he made an external or an interna)
incision, although he reflected on the hazardous proceeding
of cutting within from without. He regarded the case as
one of malignant disease occurring with great rapidity, and
it was a question whether, m a similar case, he would do
anything bat tracheotomy to relieve the patient. The
external growth was completely encapsuled, and came out
.as a nut would out of the shell. The wound healed by
primary union, but the disease returned with great rapidity,
being in the boy’s blood. Wbat proved of greatest interest
to bun was its likeness to tonsillar abscess.

Mr. Wheeler read a paper on Etcialon of the Wrist
Joint.—Mr. Hamilton asked why Mr. Wheeler retained
Esmarch’s bandage in this particular excision and objected
to it in others. He himself disliked it in almost all excisions,
particularly of the knee, owing to the increased amount of
blood lost. The President said there was a tendency to
run down Esmarch’s bandage, which he was not inclined to
endorse from his own experience. In bis case, where
secondary haemorrhage ensued, he believed it was due to the
faulty application of the bandage, perhaps with too great
firmness; but he looked upon It ai one of the greatest
improvements in modem surgery.—Mr. W. Thornley
Stoker expressed his unqualified objection to the use of
Esmarch’s bandage in any excision of a joint; but he would
be sorry to object to its use in many other forms of opera¬
tion- -for instance, the removal of necrosed bone, where,
without it, the snrgeon saw nothing but a pool of blood.
In excision of joints, however, there were two great
objections to its use: First, troublesome hemorrhage,
which some attributed to want of skill in applying the
bandage; but he believed it could never be applied in such a
way as to empty the limb of blood without being followed
by troublesome haemorrhage. The second objection was
that it altered the appearance of the bone so much that the
surgeon could not form a proper estimate as to whether the
bone was truly healthy or diseased.—Mr. Corley said in
excision of the wrist the question of the case being scrofu¬
lous was a serious item for consideration, having regard to
the probable return of the disease, and therefore the necessity
of amputation in the end. Thus Mr. Wheeler’s, judging
from the ages of the patients, were not strumous cases, and
the chances of success were fair. In that view the question
of Esmarch’s bandage was one of minor importance.—Mr.
ToDiNwas surprised to hear early passive movement in such
cases recommended, except where there was likely to bt
stiffness. Mr. Wheeler, in reply, said the splint he used
was similar to that employed t>y Lister, but a little more
elevated at the heads of the metacarpal bones. Having
put in a drainage tube, he bandaged the hand to tbe
splint, putting T nicks at each side, so that he need not
remove it. The wrist was steady on the splint, while
each finger was moved separately. He had deprecated the
use of Esmarch’s bandage in excision of joints, for in excision
of the "knee he had secondary and sometimes intermediary
haemorrhage, and if that occurred whilst the limb was in a
fixed apparatus of plaster-of-Paris it would be necesaary to
take off the plaster-of-Paris to stop the haemorrhage. He

byGoOglt

Diqiti

THB LANCET,]

CAMBRIDGE MEDICAL SOCIETY.

did not, however, condemn Esmarch’s bandage in suitable
cases where there was considerable oozing, and it was
necessary to see the parts; for instance, he used it when
removing the cuboid bone. Having used the bandage both
ways, with the rubber and elevating the limb, he found
that by putting the band round above the seat of operation,
and not using the rubber, he had an almost bloodless opera¬
tion. The best time to begin passive movement was on the
second or third day folowmg the operation, the metacarpal
bone being held steady. _____

Chronic Interstitial Nephritis.--Ideal Paralysis.— Calculous
Pyelitis, followed by Albuminoid Disease.

At a meeting of the Medical Section held on April 29th,

Mr. C. H. Robinson read a paper on a case of Chronic
Interstitial Nephritis, which was published in Tub Lancet
! of June 4tb.

! Mr. W. Bernard of Londonderry read a paper on Ideal
Paralysis; and another on a case of Neurosis of the Viscera,
ending in dilatation of the stomach. He also exhibited
macroscopic and microscopic specimens of the latter case.—
Mr. Conolly Norman said the first case detailed in
Dr. Bernard's paper exemplified the extreme difficulty
| attending the diagnosis of apparent physical affections in
the insane. Instances of absolute silence for years had
also some affinity. He remembered a case recorded in
one of the German journals, eight years ago, of a man
who had been found wandering in a village and was
committed to a lunatic asylum, where he remained for
years and never spoke, being silent probably through
a delusion, so that his identity was not discovered.—
Mr. Fitzpatrick mentioned the case of a girl, aged twenty,
admitted into St. Vincent’s Asylum, suffering from hysterical
mania, and she exhibited delusions assuming a variety of
diseases. At one time she fancied her arm was paralysed,

1 and after long persuasion that it was not so she got the
use of the arm again. At another time she remained with¬
out speaking for months. During these delusions she took
1 her food ana gave no trouble to the attendants. At length,
in January last, after twenty years of intermittent delusions,

' she had an attack of epilepsy, followed by paralysis of the
1 right side, and she never spoke from that time to her de itb.

Two months ago she was attacked again with epilepsy,

> followed by paralysis on the left side. She was then in a
state of general paralysis. He never had a second opinion
1 bnt that there was structural disease in the brain, and his
1 prognosis was verified after twenty years. Dr. Bernard’s
case would, In all human probability, develop in an attack
of disease.—Mr. Cox said that he had had himself, in the
country, a case of ideal paralysis. A strong healthy man took
to his bed, suddenly paralysed, but on examination he came
to the conclusion that it was only a case of ideal paralysis;
he considered that the man would become paralysed if be re¬
mained in bed. His opinion, however, was not accepted. Some
time afterwards this man was driving, and the wheel coming
off his trap,he was forced to get out,and he walked home.—
Mr. Moloney asked if there were any history of hereditary
insanity or of intemperance in Dr. Bernard’s case.—The
Pbbsidbnt doubted whether surgical interference would be
useful where the stomach was so enormously dilated, as in
the present case, because, even if a fresh pylorus were con¬
structed by the skill of the surgeon, so long as the stomach
remained dilated it would form a receptacle for decomposing
matters, alimentary and secreted.— Sir. Bernard replied
In the first case the patient had a motive for lying in bed—
namely, to get his mends to pay more attention to him;
and his pretending to be paralysed went on so long that
really he could not walk. The case had nothing in common
with that mentioned by Dr. Fitzpatrick. There was no
hereditary tendency to insanity whatever. He regretted
not having washed out the stomach twice instead of once in
the twenty-four hours. Power was never lost over the
rectum and bladder.

Dr. J. W. Moore read a paper on a case of Calculons
Pyelitis, followed by Albuminoid Disease. The patient, a
porter, aged seventeen, was admitted into the Meath Hoe-
pitul, under his care, on Thursday, March 24th, 1887. He
was exceedingly ill—wasted, blanched, and weak. On
being: questioned as to the duration of his illness, he said
that hie lege began to swell a fortnight previously, when
sdeo seven pain m the left groin set u>. His appetite was
had.: !fhe first touch of'the liver suggested theprobahle
existence jof alhuRURoW change in the organ. At’the same
time it Iras ascertained that tne spleen was certainly not to

[June 18,1887. 1235

. i ■_ .a*.- , .. '

any extent enlarged. The urine, however, was found to be
highly albuminous, showing on microscopical examination
a few hyaline tube casts, but no pus-oorpnseles or blood-
cells ; it was acid in reaction, and its specific gravity Was
only 1010. There was moderate anasarca of the lower
extremities, and the left leg was flexed, as in hip-joint
disease—vital ankylosis. The patient died on April 16th.
At the necropsy, the lungs and heart were found to be
practically healthy. The liver was greatly, yet uniformly,
enlarged. It weighed 71b., was very firm and hard, ahd
yielded a pink colouration with aniline bine. The pancreas
and spleen were inseparably welded together by old
adhesions ; they weighed jointly 13£ os. The spleen Was
slightly congested; ite -capsule was thickened, and pre¬
sented appearances of former perisplenitis. It showed the
characteristics of the “ sago spleen ’’ of albuminoid disease.
The pancreas was firm, almost cartilaginous, and the neigh¬
bouring glands were enlarged. But the interest attaching
to the examination attained its climax 1 when the kid¬
neys and their environs were reached. The left kidney,
or what remained of it, was embedded in a mass of
dfense, cartilaginous-looking connective tisane. On catting
through this, the organ itself was found almost entirely
destroyed, converted into a multilocular cyst with inter¬
vening bands of chondroid connective disease. The cysts
contained a horribly fetid urino-purulent fluid, and branch¬
ing calculi were found in some of them. The pelvis of this
kidney was obliterated, as the result of old-standing cal¬
culous pyelitis, and the ureter also was thickened and
widely dilated down to a point about 2* inches above its
entrance into the bladder, where it was completely occluded
by a smooth oval calculus. This was of a bluish-black colour
(from deposition upon it of a sulphide), so resembling a piece
of limestone rounded by the action of the sea. Passing down¬
wards from the tunica adiposa and invading the sheath of
the left psoas muscle, a fetid perinepbritic abscess had
tunnelled, eo Causing the pain and stiffness in the left hip
Joint. The presumption is that during the dosing weeks or
the patient’s life this abscess had partly evacuated itself
by the bowel, but a careful examination with a catheter
failed to discover any opening—valvular or otherwise—into
the intestine. The absence Cf pus la the urine was satis¬
factorily explained by the complete occlusion of the left
ureter, as above described. The left kidney and its sur¬
rounding connective tissue weighed 6 6z ; but the right
kidney weighed more than twice ae much—14£oz., or
between three and four times the normal weight of the
viecus. It had evidently undergone compensatory hyper¬
trophy to a very marked extent; bnt in time ite fate also
overtook it, and at the moment of death it was the seat of
albuminoid disease, only in a less degree -to the liver.' A
histological examination confirmed tits widespread existence
of albuminoid disease.—The Pbbsidbnt said the case illus¬
trated the difficulty attending the diagnosis of renal mis¬
chief. The quantity of urine passed was an important
element in disease of the kidney. The morbid specimen
bad not the very pale colour and consistency for Which the
genuine albuminoid liver was distinguished.

CAMBRIDGE MEDICAL SOCIETY.

At • meeting on April 1st the following communications
were made :—

Dislocation of Lens.— Mr. DBioflTON showed a patient
with complete dislocation backwards of the lens of more
than twenty years’ duration. There was no history Of a
blow or fall: T = + ?, vision only central; with +11 D.
V = |$. With the ophthalmoscopic mirror the lens could
be seen freely movable in thrf vitreous, and of an opSaue
bluish-white appearance. Examination 6f the fuhaus
revealed extensive patches of superficial and complete
atrophy of tbe choroid. The optic disc was cupped. Dust-
like opacities were present in the vitreous, vision in' the
other eye was The patient had suffered severely from
syphilis.

Puerperal Never — Mr. WfcBBfcT gave a report of On
important outbreak of Puerperal septic*mi* in Bedford,
Gsmlingay, and seven villages around. There wert st leant
twenty deaths occurring in the practices of seven different
medical men. The outbreak at Gamlingay was especially
mentioned: cases occurred from November, 1884, to August,
1885. There were thirteen cases of fever and nine deaths.
There was one esse of sudden death. The patient expressed

1236 Thb Lutckt,]

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

[JCN* 18,1887.

herself u feeling perfectly well, had a good appetite, and
went downstairs. Her temperature was never below 108°,
nor her pulse under 120. One week after confinement, while
partaking of tea in bed, she fell back dead. An incident
illustrating the condition of some of the houses in regard
to overcrowding and the method of propagation of the
poison by the patients and their friends was also related.

Sanitation qf the Lying-in Chamber. — Dr. Boxall, in a
paper dealing with the above subject, pointed out that much
of the illness following delivery was essentially of a pre¬
ventable nature. It is not the mortality alone which should
be taken into account. Those minor ills of the puerpera,
the outcome of less fatal attaoks, must be also included.
Septic poison can only be produced within the passages
where air is permitted to enter, or any decomposable material
is left behind; for both the proeence of air and a suitable
nidus are essential to decomposition. A special liability,
however, exists of the poison, ready made so to speak,
finding an entrance from without. Dr. Boxall urged the
importance of inquiring into the antecedents of the nurse,
with a view to ascertain if ahe had been nursing or other¬
wise brought into oontaot with any person suffering from
septicaemia or pyaemia, burns, abscesses, or acute specifics.
If exposure have occurred, he advised a complete change of
clothing, and a general carbolic or iodine bath. He regarded
as the most important element in antiseptic midwifery the
thorough washing of the hands with soap and. water, in¬
cluding the use of the nail-brush; but he further advised
the soaking of the hands and wrists in strong antiseptic
solution (sublimate 1 in 1000, or carbolic acid 1 in 20) im¬
mediately before making any examination, performing any
obstetric operation, or touching the gonitals of the patient.
Second only in importance to this was the thorough washing
and subsequent disinfection of all instruments and utensils
employed. The abolition of sponges, and the employment
of cotton wool or tow in place of napkins, he thought
beneficial in every way. Special inquiries should be made
into the source of all artioles passed on from one patient to
another, such as binders and mackintosh sheets. Pariah bags
in use among the poor should always be regarded as likely
to contain assorted samples of infection. The condition of
the drains should be carefully ascertained, and any defects
remedied long before the expected date of the confinement.
Too little attention was frequently paid to this point, and
also to the subject of ventilation. A fire should be kept
burning in the grate, and one window at least opened a few
inohes at top. With regard to the choice of antiseptic agents,
he urged the advisability of employing one of universal
applicability rather than several, more especially when in¬
compatibility exists. Sublimate is incompatible with soap
(henoe the hands must be well rinsed before they are
immersed in the solution) and with oils (hence sublimated
glycerine or vaseline should be substituted for carbolic oil
or lard, as a lubricant); carbolic acid is incompatible with
Condy’s fluid, which, again, is decomposed by soap, while
iodine enters into combustion with the alkali contained in
it. These are points which are frequently overlooked.
Whatever antiseptic be used, the strength should invariably
be measured accurately, for if the proportion be merely
guessed at, not only may the solution be so weak that its .
sepsis-destroying properties become much deteriorated or *
are quite destroyed, but, on the other 1 hand, it may be so ;
strong that great danger may result, either locally to the
living tissues or generally by absorption, especially when
the more powerful agents are employed, in the form of
douche after delivery. Far the hands and instruments he
advocated the invariable employment of corrosive sublimate
(1 in 1000), or carbolic acid (1 in 20): solutions of the same
strength to douche the vagina in every case during the first
stage of labour, and after labour subsequently to douche the
uterus also, where any intra-uterine interference or foul dis-
charge from the cervix specially indicated such a proceed- I
ing.. But after the first douche the solution might usually 1
be reduced to half the strength. Tfie sublimate douche
frequently administered was not unattended with danger,
and he would never advise, itense unless the patient were
under constant observation. In ordinary cases, when the
douohe waa given as a routine practice, he considered Condy
(colour of claret) or ooracic acid (saturated solution) of
sufficient potency. While be invariably advocated the
douche (given morning and evening till tlie lochial dis¬
charge ceases, at from 110° to 115 e F.) as a routine practice
when the eervieee ef a competent nurse are.available, be
felt stare that Ita the hands of an ignorant woman more

harm than good might ensue. In such a case it was
advisable to trust to the more simple details necessary to
ensure thorough washing and disinfection of the hands and
instruments, the exclusion of all sources of infection and of
decomposition from, and free ventilation of, the lying-in
chamber, and to limit the employment of the douche to the
labour, unless special circumstances dictated its subsequent
use, and then it should be performed by the doctor in person
or under his immediate supervision. Intra-uterine irriga¬
tion should never be entrustedbothe none, however efficient
she may be.- -Dr. Inqlh thought Dr. Boxall must have
selected an unusual season or place for the statistics given.
He did not think the experience of private practitioners
would furnish anything near such an estimate, but rather
evidence wholly to the contrary. Effort after such sanita¬
tion as had been described by Dr. Boxall might be of service
in lying-in institutions, with trained skill and careful
medical oversight; but in general practice he thought it
undereirable that much interference with the parturient
should be encouraged other than great cleanliness. Injec¬
tions of vagina, except specially needed, were rather to be
discouraged as involving many risks.

SHEFFIELD MEDIOO-ORIRURGICAL SOCIETY.

A meeting was held on April 14th (Mr, W. A. Garrard is
the chair), of the prooeedings of which the following is an

abstract:—

Malignant Tumour of (J'jwphagus. —Dr. J. D. Wthx*
showed an (Esophagus which was involved in a cancerous
mass for about six inches from just above the root of the
lung downwards, greatly reducing the oalibre of the tube
below. The patient was aged seventy-nine, and for about a
year suffered from occasional dysphagia, which became
worse during the last three weeks Of life, so that eventually
all food waa rejected. The tumour Was a typical aoixrhua.
It was interesting to note that during life the patient had
complained of no symptoms of heart disease, but had a load
mitral systolic murmur, and at the post-mortem the mitral
valve waa found to be roughened and very much dilated,
the left auricle also being greatly dilated and the left
ventricle hypertrophied.

Pemphigus Neonatorum.- -MV. JurruiY* related this case,
occurring in a child five days old. It was not spedfte;
bailee existed on the face, chest, back, abdomen, arms, and
legs ; confluent, some being as much as three inches in din-
meter. The case was treated successfully with opiates and
arsenic, the body being washed occasionally with bran
water and anointed with purified vaseline.—-Remarks were
made by Mr. Jackson, Dr. Dyson, Dr. S. Roberts, and
Dr. Keelmg.

Sarcomatous Tumour of Anterior Lip of Uterus, com¬
plicating Labour. —Mr. Jeef*bt 8 also related this oaee.
The patient was in her second pregnancy. Barnes’ bogs were
employed and forceps applied. There was considerable
haemorrhage. After the birth of the child the tumour
descended to the vulva, and was found to be a rounded mass
of about two inchee In diameter, attached to the uterus by
a thin pedide. It was removed by transfixing the pedicle,
applying a siik ligature, mad cutting it off with a pair of
scissors. Satisfactory recovery resulted. Dr. Galabtn had
kindly examined the tumour, and called it a fibro-sarooma
of the Cervix uteri. The time elapsed was too brief at pre¬
sent to discuss the question of recurrence of growth.

Dr. W. R. TnoMAS related a case of Paralysis of both
Arms from severe exertion.

Mr. Snell Introduced a patient with Right Homonymous
Hemianopsia.

Birmingham Hospital Saturday Fuivd. —>A meet¬
ing of the subcommittee appointed for the purpose of
considering a scheme f6r the distribution of the proceeds of
the local Hospital Saturday collection was held at Birmfng-
on the 8th inst. The total sum received up to the preseat
time exceeds £6800—more than £100 in excess of last
year’s collection. It was decided that £.%O 0 be divided
amongst the medical charities of the town, the apportion¬
ment to be conducted on the plan adopted in previous
years--namely, in propbrtion to the ordinary current ex¬
penditure of each institution, as stated in the last published
or audited report.

^HB IiAJioirr,]

BBVia W9 AND NOW018 OF BOOKS;

[JtnrB'18,1188X 323?

f^rieta anJr |totkcs of ^ooks.

deplores the practice of medicine, as being merer or lead a
hindrance to the advance of pathology. Yetis it not true

Die AUgetneme Pathologic, oder die Lehre von dem Ureachen
unddem Weoen der Kremkheiteprocesse. Von Dr. Edwin
K i.EDS. lira ter Theil: Die Krankheitsursachen ; Alige-
meine Pathologische Aetiologie. ( General Pathology, or
the Doctrine of the Causes and Nature of Morbid Processes.
By Edwin Klbbb. Part I.: Causes of Disease; General
Pathological Etiology;) Jena: Gustav Fischer. 1887.

Tiibrk are few writers better qualified to produce 4 work
-of the scope indicated in the above title than the well-
known Zurich Prof asset. His nime has for many years
stood in the foremost rank of scientific pathologists for his
abundant original researches and for his admirable “ Hand¬
book of Pathological Anatomy,” which seems to have been
destined, like the classical treatise of Virchow upon Tumours,
never to be completed. Nevertheless, it iemains as a monu¬
ment of industry and genius, and, since its appearance, it
has been succeeded by other text-books, which may have
replaced although they have not surpassed it. We trust, how¬
ever, that a different fate is in store for the present work, and
that it will be speedily completed. Professor Klebs is him¬
self sanguine of being able to publish it all within twelve
months, and, if his anticipations are fulfilled, we shall soon
be in possession of a treatise that may mark an epoch in
the history of pathology. For, as he points out in the
preface, the sphere of pathological science has greatly
changed. It has no longer to confine itself within the
limits of morbid anatomy, but has to determine in what
manner the anatomical lesions are brought about. Etiology
has become an integral part of pathology, and disorders of
function have to be dealt with as thoroughly as those of
structure. Cohnheim recognised this extension of the patho¬
logical domain, but even he failed to grasp it in its entirety.
For in the main Cohnheim’s work was limited to the eluci¬
dation of disease by reference to normal physiological action,
whereas Klebs considers that the external agencies operating
to induce disease should also receive full treatment at the
hands of the pathologist. It is not enough, he says, to em¬
ploy pathological research merely to explain the symptoms
of disease, nor, on the other hand, simply to detect the
various modes in which the diseased organism differs in its
action from the healthy. The first is too superficial, and is
inadequate to solve many problems of disease; the second is
misleading, for it is based on the assumption, too often
erroneous, that physiological and morbid processes are
similar in their operation. We can thus understand why
Professor Klebs was always opposed to accepting the cell
doctrine of pathology as a final explanation of disease, and
why he was among the earliest to recognise the intervention
of micro-organisms in morbid processes. We doubt if full
justice has been rendered him in this regard. Though,
like many pioneers in other fields, he may have allowed
his conceptions to overstep legitimate bounds, yet in ths
main his contention was trim. Day by day Ire are
learning its truth, as we meet with proofs of the origin of
disease through parasitic agencies, and note how mock of
whatwe term predisposition is the permanent effeot upon
the individual, and even on the race, of the changes wrought
in the organism by previous disease. Cellular pathology by
itself is incapable of explaining these things, nor con bacte¬
riology. by. itself do so. • It Is the combination, of these two
—the straggle between cell life and bacterial life—which
entera so hugely into oi$r conceptions of disease at the
present, dayy and is destined doubtless to stall further de¬
velopments in the future.

Such are the ideas which appear to have dominated in
the mind of the author when he determined to write this
b°ql^--tfluqh he intends should treat'of general pathology
aa a science nvdtsalf, without-regard- to the aims, of the
^berapeuti^, .Jje.is. so pardy.a pathakogist that he almost

that pathology must be worked oat on its oW*n lines and its
fruits be gathered before they can be utilised in the treat¬
ment of disesse ? Treatment must perforce remain in great
measure am pi n ed, for medicine has not yet attained to the
certainty of a science. We deceive ourselves when we talk
so largely about “ rational therapeutics,” and there is no
shame in acknowledging that treatment is largely based on
experience, without any reference at all to pathology, If
we may venture to look forward to the future position of
practical medicine, we should anticipate that it will he cqn-
ceraed for the most part in efforts to deal with the causes of
disease, and that prophylaxis will than be as much a part
of therapeutics as symptomatic treatment is at present,
Pathology then will hold the field, for it is to that
science that we must look for the solution of problems
as to the causation as well as the nature of diseases. No
longer will the “mere pathologist” be regarded as un¬
practical ; rather he will have tt}e keys of all the science of
medicine in his hand, and will reveal to him who seeks the
mysteries of disease and the methods for its subduaL If
this be so—if, indeed, the medicine of the future is to be
based upon the facta of pathological research—we may
gladly welcome the attempt to mark the position at which
pathology has attained in our day, so as to gather therefrom
what hope we may of the near approach of this millennium.
Professor Klebs has undertaken to do this, and the first of
the three parts into which he has divided his work is that
now before us. This volume deals with etiology, the next
will treat of pathological morphology (in other words, the
structural changes in tissues and organs induced by disease).,
and the third with pathologioal physiology (the derange¬
ments of function).

The first chapter in the present volume discusses the
Nature (das Wesen) of Disease, from which it appears that
our modern knowledge has not advanced beyond tho old.
conception of an ens morbi, the only difference being a
substitution in terms. Professor Klebs holds that the varied;
manifestations of disease depend more upon variations in
the nature of the etiological factors than in ,the morbid,
process itself; but he is careful to make a distinction-
between the processes and the conditions or states of disease.
The former imply activity, and consist in a series of
orderly phenomena connected together in time or seat*
and are often referable to one and the same cause; the.
latter are permanent local changes, material lesions, or
functional derangements, such as may be imparted by,
inheritance or initiated by mechanical causes. He holds,
that these “morbid states "are to be regarded as disease,;
although often it may be difficult to mark the point where
the permanent lesion passes into the active outbreak of
disease. A general disquisition upon Etiology forms.thq
basis of the next chapter, where the operation of external
agents, combined or not with internal peculiarities or pro¬
clivities, is especially dwelt upon. The doctrine tljat ia
many diseases the Causes are multiple and not single is one
that is apt to be disregarded practically. The internal causes
or tendencies to disease, as exhibited,by heredity or other¬
wise, are then dealt with, the , Sub jest being illustrated
by reference toatriking gehealogioal diagrams of mtay
inherited affections. The light throwd on this subject
by Darwinism is fully reoognised, and the Chapter to a
most instructive one.- But the main bulk ’of the volume 1
is concerned with those etiological agencies 'which tnore than
any other h*ve- rivetod"tho attention of the pathological
world. These pathogenic organisms 1 havej ■ thanks to thO'
labours of biologists as well as of pathologists, been now- se
dearly, differentiated that their recognition is end of the’
ordinary pooceaebe df pathological inquiry. They are dis-
oussed heaeviwwevwr bo t simply from their taoryhdogidel

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1238 Tub Lancxt,]

REVIEWS AND NOTICES OF BOOKS.

[June 18, 1087.

side, but with considerable detail in respect to the changes
they initiate in the tisanes and organs of the body. Professor
Kleba brings all his vast experience to bear upon the eluci¬
dation of these great questions, and his work will serve to
enhance the interest which attaches to the subject; whilst
for purposes of reference the book will prove invaluable.
There are many coloured plates and illustrations in the text,
upon which we would fain dwell longer did space permit.

Photography of Bacteria. By Edgab M. Cbookshank, M.B.

'London; H. K. Lewis. 1887.

The application of photography to microscopical inves¬
tigation has, in spite of its difficulties, made considerable
advances of late. That it entails very great advantages
cannot be seriously doubted, since it entirely does away
with the intervention of the draughtsman in depicting the
characters of a microscopical specimen. Desirable as it may
be in histology, the adoption of photography in bacteriology
is even more to be wished for; and there is no saying how
important it may prove in correcting observations and har¬
monising conflicting statements concerning such minute
objects, where the liability to misinterpretation on the part
of the observer is enhanced by the conditions under which
the observation is made. Mr. Crookshank should therefore
be congratulated in his successful attempt to popularise the
employment of photography in bacteriological research in
the face of discouraging opinions as to its value put forward
by high authorities. A study of the numerous reproductions
of his photographs which are contained in this work shows
both the weakness and the strength of the procedure. Some are
as elearly defined as could be wished; others suffer from lack
of definition and lose their characteristic features, without,
however, any interference with their general grouping. It will
be noticed that the “enlargements” of negatives are those
which present the least satisfactory characters; but even in
spite of the additional difficulties encountered in procuring
good impressions of such enlargements, no more successful
results could be desired than those representing Proteus
Zenkeri (Plate iv., figs.1 and 2), Bacillus anthracis (v., 2 ;
vi., 1 and 2; viii.), Bacillus tuberculosis (x., 2), Bacillus
alvei (xi., 2), Spirillum Finkleri (xiii., 1), Spirillum cholera;
agiatice (xiii., 2), Spirillum Obermeieri (xiv., 2), Spirillum
vdutans (xv.,l),and the cover-glass impressions of Bacillus
figurans (xvL). The photographs from which these enlarge¬
ments were made are all included, so that the reader can
compare the results. These plates will form an excellent
addition to the descriptions of such text-books as the
author’s manual of bacteriology. The technical description
of the method of photomicrography pursued by the author
is so clear and detailed that it will prove of the greatest
service, and will, we trust, impart a stimulus to the study of
an interesting and useful subject, which there is good hope
may do a great deal to impart precision and accuracy to
microscopical investigations.

The Diagnosis and Treatment of Diseases of the Kidney
amenable to Direct Surgical Interference. By W. Bbccb
C r.ABKB, M.A., M B.Oxon., F.R.C S., Assistant Surgeon
- to, and Senior Demonstrator of Anatomy and Operative
Surgery at, 8t. Bartholomew’s Hospital; Surgeon to the
West London Hospital. With Illustrations. London:
H.K. Lewis. 1886.

The volume before us is to all intents and purposes tbe
essay to which the Jac k so ni a n prize was awarded in 1886.
The fact that it was considered worthy of this reward by
the Council of the College of Surgeons is the best guarantee
of its merit that can be adduced. It bears evidence of
having feeen written because tbe subject was chosen for
this prize, and we miss in it the signs, of. the mastery of a
subject that we are accustomed to find when an author is
writing upon a branch of surgery that he has made his own

by long study and thought. The book will commend
itself to many readers by its brevity and the nnmber of
illustrations it contains; but for fulness of detail and
thoroughness of description it is no rival of Mr. Henry
Morris’s work on the same subject, and in 'amplitude of
references and statistical information it falls short of
Brodeur’s recent thesis. It contains, however, a plain state¬
ment of the main facts in this branch of surgical pathology,
and a very brief and simple description of the various
operations on tbe kidney.

OUR LIBRARY TABLE.

The Principles and Practice of School Hygiene. By Alt bed
Cabpbntbb, M.D. With illustrations, pp. 368. London :
Joseph Hughes. 1887.—We are informed in the preface
that this volume was “ primarily written for students in
training for educational work, as well as for those occupied
in preparing them for their future duties.” It consists of
two parts: the first relating to the construction and fitting
up of schools, and the general management of the pupils
considered fiom a sanitary point of view; and the second to
the accidents and injuries incidental to school life, the more
common diseases which oocar among the pupils, and tbe
measures which should be taken to prevent their spread.
The first part contains much useful information, but might,
we think, have be»n j adicioualy curtailed, especially as regards
construction, considering the object with which the book was
written. The chapters on dormitories, physical exercise,
time allotted to study, and school desks and seats, are well
deserving of study. The second part partakes much of the
character of ambulance lectures and “ first aid to injured,”
and, viewed as such,* is too long and enters too much into
detail. It would, in our opinion, have a strong tendency to
induce masters to undertake too great a responsibility in
the treatment of cases of disease or injury, and lead to
serious results from delay in sending for professional
assistance. We regret that Dr. Carpenter does not point out
more forcibly the importance of obtaining skilled medical
advice in the early stage of illness, or in injuries, particularly
those involving joints. The mischief arising from delay
is often very great, and is not, we fear, generally appreciated.
The book has the advantage of a good index.

Veterinary Science: a Sketch. By Gbobgx Fucking.
LL.D., F.R.C.V.S., Principal Veterinary Surgeon to the Army.
Pp. 16. London : Uazell and Co., 1887.—This paper, whieh is
a reprint from tbe Veterinary Journal, gives an interesting
account of the progress of veterinary scienoe from the
period of the formation of tbe first veterinary school in
1761 to the present time. On tbe advice of Bourgelnt, an
advocate at Lyons, Bertin, tbe prime minister of Loois XV.,
was induced to establish a veterinary school and school of
equitation at Lyons, of which Boargelat was appointed
director. In 1766, under the auspioes of the prime-minister.
Bourgeiat founded a second school at Alfort, and a ’ third
was subsequently organised at Toulouse; all three are still
flourishing. Shortly after the formation of the school at
Alfort one was established at Vienna by order of Maria
Theresa, and the example thus set was quickly followed by
Prussia, Denmark, Italy, Sardinia, Saxony, and Hanover.
Ia 1791, through the efforts of the Odiham Agricultural
Society, the first veterinary school in this country was
established in London, under the title of the Veterinary
College of London, and M. St. Bel, who bad been trained at
Alfort, was appointed the first professor. Tbe college,
under the superintendence of Professor Coleman, who
succeeded M. St. Bel on his death in 1793, received much
valuable aid from some of the most distinguished members
of oar profession, of Which be was himself a member, in¬
cluding,- among others, Sir Astley Cooper, Sit Charles Ball.
Dr. BaWngton, Dr. Bright, and Sir Benjamin Brodie. la

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Tub Lancet.)

REVIEWS.—IRISH MEDICAL ASSOCIATION,

1819 a veterinary college was established in Edinburgh
by Professor Dick, who, at his death, in 1866, left a con¬
siderable sum of money to the college, vested in the Lord
Provost and Town Council as trustees. In 1814 the veteri¬
nary surgeons obtained a charter of incorporation under the
title of the Royal College of Veterinary Surgeons, of which
Dr. Fleming is at present the President. In this historical
sketch the author directs attention to the valuable lessons
which may be learned in our profession from the study of
comparative pathology, and “the advantages which human
medicine must derive from careful observation and investi¬
gation of the diseases of animals.” The great importance |
to the nation of sound veterinary science and skill may be j
estimated by the fact that “ two exotic bovine diseases alone
(contagious pleuno-pueumonia, or lung disease, and foot-and-
mouth disease) have been estimated to have caused a loss
during the first thirty years of their prevalence in the
United Kingdom of 5,549,780 cattle, roughly valued at
£83,616,854 : while the invasion of cattle plague in 1865-66
has been calculated to bare caused a money lose of from five
to eight millions of pounds.

A Systematic Handbook of Volumetric Analysis. By
Fbancis Sutton, F.C.S., F.I.C., Public Analyst for the
County of Norfolk, &c. Fifth Edition. London: J. and A.
Churchill. 1886.—Another new edition of a book so well
known and so universally esteemed among scientific men as
Sutton’s Volumetric Analysis scarcely requires notice. The
author has evidently spared no pains to incorporate all the
more important of the additions which every month brings
to our analytical resources. Among the additions in the
new edition may be mentioned some newly devised and
simple methods of gas analysis, and a synopsis of the
valuable researches of Mr. R. T. Thompson on the indicators
used in alkalimetry. These are merely quoted here as
samples of the new matter with whicli Mr. Sutton’s industry
has enriched a book which is essential in every laboratory,
and for which every chemist feels grateful.

The Qa» Engineer's Chemical Manual. By J. Alfred
Wanklyn, Hon. Fellow of the Chemical Society of the
University of Edinburgh, &c. London: The Scientific Pub¬
lishing Company (Limited). 1886.--Mr. Wanklyn has, as
usual, produced a good, and in some respects an original,
little book. It is not without faults, but it will pro-
1 bably be more useful to the gas engineers, for whom it is
: designed, than a more elaborate scientific treatise. The
i methods of analysis described are within the range of skill
i commonly found in gasworks, and if the author prefers
i methods of his own devising, who shall blame him? The
i book is short, simple, and handy. New ideas and new
systems are hardly touched upon, with the exception of the
coal-liming process of Mr. Cooper. Qas engineers ought
certainly to be grateful to Mr. Wanklyn.

The Organic Materia Medica of the British Pharma-
copeeia. By W. Southall, F.L.S. Fourth Edition. Lon¬
don: J. and A. Churchill. 1887.—We are glad to find that
this unpretending little volume has reached a fourth
edition. It contains a great deal of useful and practical
information, not only on materia medica, but on pharmacy
and pharmacognosy. The author has not confined bis
attention to the British Pharmacopoeia, but has consulted
other works of reference. The articles are well arranged,
and are thoroughly reliable. The book is intended for
medical and pharmaceutical students, and will be found
useful.

The Year-book of Pharmacy for 18S6. By Louis
Sixbold, F.I.C., F.C.S. London: J. and A. Churchill. 1887.
It is always a pleasure to record the appearance of this
well-known Year-book pf Pharmacy, which contains not
only the transactions of the British Pharmaceutical Confer¬
ence, bnti also abstracts of a number of valuable papers and

[Junk 18, 1887.

articles relating more or less to materia medica, chemistry,
pharmacy, and pharmacology. The present volume contains
a great deal of useful information respecting lanoline,
kairine, terebene, acetophenone, urethane, and other new
drugs. Mr. Siebold has performed his editorial duties with
his usual care, and the work is thoroughly trustworthy. . -

IRISH MEDICAL ASSOCIATION.

The forty-eighth annual general meeting of the members
of this Association was held at the Royal College of Sur¬
geons in Ireland on the 6th inst., presided over by Dr.
Kinkead. The report of the Council referring to the Medical
Acts Amendment Bill of 1886, which has now become law,
considers its provisions disappointing, inasmuch as they fail to
protect the profession against practice by unqualified persons,
and perpetuate an excessive and unnecessary number of
licensing bodies granting qualifications to practise, of diverse
educational grades, and without any settled standard of
competency. In a recent report the committee of Council
expressed a hope that a Bill to amend the Superannuation
Act would soon be introduced into Parliament; but after
considerable discussion it was agreed that it would be useless
to ask the Government or any private member to introduce
a measure of the kind unless the opposition of the Irish
members could be overcome or their support counted upon;
and that support, it was considered, could not be obtained,
in view of the facte that the Irish members chiefly repre¬
sented the interests of the boards of guardians, which were
generally hostile to allowing any powers to be taken from
them, and lurther, that several of the Irish members h^dmost
strenuously opposed the Bill to amend the Superannuation
Act previously put forward in Parliament. The Council
had pleasure in stating that further cases of successful,
applications by medical witnesses at Court had been made for
more equitable fees and expenses than Were allowed by the
rules of the committee of judges authorised to fix them. In-
opposition to the attempts made daring the past year by the
guardians of some districts to reduce the salaries of their
medical officers, the Council were successful, the Local
Government Board having refused to sanction the proposed
reductions. An amendment to the report was adopted in refer¬
ence to that portion of it bearing on the superannuation of
medical officers, to the effect that the leaders of all parties
in Parliament should be consulted to ascertain t.heir views
as to the terms of a Poor-law Superannuation Bill, which
would receive their co-operation. The following resolutions
were adopted:—

“That it would be but simple justice to the medical
officers holding Poor-law or other medical appointments,
and would tend towards increasing the efficiency of the
service, that they ahould be entitled to a reasonable period
of leave of absence in each year, as in the case of civil
servants, and that provision for the same should be made at
the public expense

“ That this Association requests the Council to avail them¬
selves of the first favourable opportunity of introducing
to the notice of Parliament a suitable measure,, with
a view to reasonable amendment of the law relating to
superannuation of Poor-law medical officers.”

The President stated that the result of the scrutiny of the
voting papers showed that Mr. H. Gray Croly had been
elected to the poet at president of the Association for the
ensuing year. The members and their friends dined together
in the evening in the Albert Hall of the Royal College of
Surgeons. 1 _' _■

Birmingham and Midland Skin and Lock Hospital.
The report presented at the sixth annual meeting of the
overnors of this institution on the 9th inst. showed that
wring the past year the number of new oases had been
2038—an, increase of 41 on the number of the previous
year. The finances .are in a satisfactory condition, the
balance of income over expenditure being £466. The
building fund, far which a total of £6000 is needed,
amounts to £4000, bnt it was decided not to com¬
mence the work until the remaining £2000 has been
subscribed. 1 ‘ ‘

oogle

1*240 1 Thu IajJcet,] HOSPlTAli SUNDAY.-' PEERAGES FOR MEDICAL MEN.

THE LANCET.

LONDON: SATURDAY, JUNE IS, 18S7.

After the meetings of the last two weeks, rich in
speeches by the beet men in every denomination and by
leaders in the City and in the State, a common excuse for a
poor collection to-morrow will not hold. It will not do any
longer to say that an inadequate collection arises from igno¬
rance of the case. The support of hospitals has been an affair
With which the run of people, even kindly people, have been
apt to think they had nothing to do. It was supposed to be
secured by the piety of ancient founders; as if the gene¬
rosity of one century could do the work of the generosity of
another, and as if the piety of a man like Gnr was to super¬
sede the benevolence of whole future centuries. It is true
of Guy that he actually did, with some assistance from
another man of benevolent nature, supply for more than a
century the magnificent accommodation to the sick for
which Guy’s Hospital has been famous throughout the world.
But experience shows that men like Guy are of rare occur¬
rence, and that the wants of the sick and the poor of
any one generation must for the most part be met by
tljeir more fortunate contemporaries. Wc cannot rely on
ancient endowments for the urgent work of relieving
the sick that are about us to-day. Even Guy’s itself is
asking for help, and has a large part of its beds out of
uBe for Want of funds. The one good thing abOut the im-
pecunioaity of Guy’s is that it tends to rouse attention to
a• lamentable failure of public charity. The failure is to
the' extent of £100,000 a year—i.e., the excess of the
expenditure and liabilities of the medical charities of
London last year exceeded the ordinary income by £100,000.
Tills sounds a large sum; but it could easily be put into
the collection to-morrow without there being a dinner party
ldss in London or the curtailment of summer holidays by
one day. Anyhow, there it is staring us in the face. The '
ministers of religion have a rare opportunity to-morrow.
By a Bort of providential arrangement they have the Sunday
before the great Jubilee day, when the feeling of national i
and metropolitan gratitude may be expected to require
religious and substantial expression. They will not make
light of the opportunity. The care of the churches is on
their .shoulders, ahd this presses heavily enough. But, as
the Bishop of London said at the Mansion House, we,
cannot pretend to be Christians while we make light of the
claims of the sick. The very note of thC Messiahship was
that the sick were healed, the lame made to walk, and the
blind to see. Such services are rendered every day in
Lofadon hcapitals.' As far as the' Serviced are' medical, thby
are mainly gratuitous. All that the public and the chinches
are asked to do As to . find beds and maintenance and
surgical instruments, while the beneficent work of medi¬
cine is , being done. The Rev. Dr, Allon justly traced
this sentiment of humanity further back, even to the
earliest traditions of religion and the scriptures Of the ' Ofd :
Testament—a view confirmed by the fact that in this great
anniversary Jew and Christian co-operate heartily together,

[Juke 18,1887.

and the Chief Rabbi is as earnest as the Archbishop of
Canterbury. At one of the hospital meetings it was esti¬
mated that if the Loudon churches gave in the same numbers
and on the same scale as those of Birmingham the sum raised
would be nearer £200,000 than £40,000. Surely the metro¬
polis should not be beaten by a provincial town—even though
it be Birmingham, where Hospital Sunday was first insti¬
tuted. T wo churches in London supply nearly a twentieth of
the whole collection, and Dr. Allon showed that the average
Rum raised by the London Congregations is £20 each. He is no
mean authority on the power of churches, and of what
he called at the Mansion House the “ voluntary principle.”
But he did not speak as if he thought that the churches had
done all they could or should do, and he very powerfully
contrasted the pleasure of giving to hospitals out of kindness
and being made to give by a municipal or parliamentary
rate. We heartily emphasise this difference, and recognise
on behalf of the medical profession the pleasure of co¬
operating with the public in a divine and charitable wor k .
There is no abuse in hospitals which does not admit of
correction, and no correction of abuses will diminish the
amount at present wanted for dealing with urgent cases.
In fact, thousands of urgent cases are kept out of hospitals
for want of funds. Every medical man knows this. Came
have to be turned out of hospitals prematurely, either to
undergo a slow convalescence, or to die in the straitened
homes of the uncomplaining poor. Thousands more are
never admitted that an ampler charity would admit and
greatly benefit. The life of hundreds is handicapped by
chronic sufferings that might be alleviated or removed by a
few weeks of hospital treatment, which in the present state
of hospital funds' cannot be given. These facts scarcely
come out in statistics. They have to he ascertained by
personal experience of the life and death of the poor, and
must be taken on testimony. Bub they are facta all the
seime, which a very slight exercise of the imagination will
make obvious to those who have hearts.

We must leave preaching to ministers. We must, from
our point of view, state mainly the medical side of the case.
But it is very strong. With all the labours of philanthropists
and political economists, life is still hard, and there is still
much disabling disease among the .poor. Of all uses of
wealth none is better than the support of institutions for
the mitigation of pain and disease. If we cannot all do as
much as Puy did. We can aTl do work of the same kind :
and in doing it we shall do muoh to hold society together
and to make the poor feel thankful to God for the existence
of the richj Active measures are in contemplation for
eliminating all abuse from hospitals and leaving them free
to deal with grave and urgent forma of disease.

---

1 Not a little confusion has occurred, and much misappre¬
hension has been occasioned, by the misuse of the term
*' medical peerages,” instead of " peerages conferred upon
medical men.” We do not think it has ever entered the
head of shy sane member of our professioh to propose the
institution of medical peerages properly so-called. Until
quits recently there were no Special peerages. Even the
fact that certain prelates of the 'Established Church had
seats m the House, of Peers did not make their peerages
spiritual in a technical sense, although they were “ lords

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A NEW ADULTERATION ACT*

iMJj

spiritual.” There are now constructively a few legal peer¬
ages, but it would be preposterous to ask for the creation
of peerages which should be medical, No such desire
exists. All we wish, and the profession as a whole demands,
is that -the reproach which certainly attaches to the
fact that, no medical man has ever yet been considered
worthy of a peerage, and that 'therefore it would seem to
he b«lA;ithat chare is something ia the calling of, or pro¬
fession of, the art of healing which is incompatible with
the dignity ,of high sodal rank, should be wiped away.
Rarely,-it is not true that physicians and surgeons, as
such, are incapacitated for social distinction? We cannot
briiev* that such a notion prevails in. the highest circles.
It would be mouetrous in these days, when success of almost
every, port is recognised as a claim to honour, that-the attain-
mentof a prominent position in the service of humanity in the
mattec.of health should be held to specially disqualify a man
for distinction. It has, indeed, been contended that the posi¬
tion of the physician and surgeon is so peculiar that it .must
be regarded- as. infra dig., he being, as it ware, a personal
attendant on the sick; but, this view, if it were ever actually
entertained, must have been so at a time and among persons
wheat and by whom the nature of scientific medicine and
surgery- and the character of their practitioners were
strangely misunderstood. It is no .idle pretence to affirm
that,-taken as a body, the medical profession is not either
leas well educated, or less able to bear the dignity of
seeing some of its members raised to the peerage than other
professions. The Church, the Military and Naval Services,-!
and the haw, are sot intrinsically more honourable ox of
greater service to mankind than are Medicine and Surgery. 1
It if hardly worth while to argue the point. Every unpre- :
judiced person must, we think, agree that such rank as
is- freely-accorded to ecclesiastics. soldiers, sailors, lawyers^
men, of -letters) artiste, and a host, of successful merchants
and manufacturers, cannot be reasonably denied to medical
nwp«—at least on the ground of their calling.

- We have not the slightest wish to take up a narrow class
position on this subject., If there be any solid reason why
mediefd men should not be made peers, we are perfectly
willing) and even anxious, to hear and recognise it, We
oan r only,say that as yet we have utterly failed to dis¬
cover any such reason. It will probably be admitted that
there i? no rational objection to the elevation of medical
men to the peerage. Then how does it come to pass that no
memtieE of i the, profession has. ever been, endowed with ,a
coronet?,; Will it ha alleged-that no medical man has ever
4<me anything tp,deserve so high an honour? Are there nob,
DOW living ,memberapf^-pur profession whose servioes to the
SCater»ftd the -people,-whose contributions to the, prosperity
of the,nation* have at least equalled those rendered .by some
uourtnedioal .ppreonrwho h*M* bean ennobled? It would be
mock, .modoaty and argue a very , inadequate sense pfiself-
were to hesitate i one instant in making the
unqualifodiassertion that the jpwits,,ofi medical, men,,a*
** tangible as thoaa of membora- .hfi other
calling* whiebhave been duly honoured. Again, we may be;
toW that medical men -arenas,* rids, too poos to,be;made
Maw* Possibly that .objection may,:though ,wa do not say
it eu^r eouW,hava he«;held to be,a good <m*in past tinner
but kx*mg[ to,the;,way. in;which peerages have been dietrin

buted during the last twenty years, ,° r more,it cannot.hq,
seriously contended that groat wealth ia an absolutely-,
indispensable qualification for, membership of the. House p^,
Peers. There are, .if we mistake not, some among us who
are sufficiently provided with the means pf maintaining the,
dignity of a peerage.! Indeed,.we can. confidently state, that,
there are at least three leading members .of the profession
who are possessed of an income of not leas than *£10,000 a
year from invested property.

We would respectfully but firmly submit to;those who.
advise Her Majesty in this year of jubilee that the occasion,
is one which offers an excellent opportunity for the redress
of what is felt to be a grievance, in the nature.of a,great
.slight, by a section of the community which is considerable,

I both in point of numbers and social position and influence.,
By conferring a peerage on some ope or more of the leading
members of our profession, Her Majesty would create a,
worthy precedent, and. do a just and generous action. Wa,

; do not for a moment suppose any living physician or surgeon
desires to be ennobled; we do not even know that anyone,
i would accept the offer of a coronqt; but the offer might be
imadet -so that, at least, the profession may know that
,it is not wholly given over to social neglect.. That goqd
iwould result from the presence of one or twp medical,
men in the Upper House cannot be doubted. The need
of a direct representation of the claims of health on,
the State is daily ; becoming more apparent, Moreover,,
it would tend generally to raise the status and tone of
the profession as > a whole if its claims to well-deserved
honours-ware recognised more generously. ‘

I i , : \ TT?—♦ 1 ‘-.. . a

,{Hast weekwe,commented on the Bills purporting to deal .
With Adulteration which are now before Parliament, and qq-
the .complaints of some of . the. public analysts in regard
the present jand future position of the. Chemical Depart,
mentof the Board of-Inland Revenue. But the subject iq.
too extensive to be discussed in a single artiole, and there
are still some remarks which in the public interest it is qu£,
•duty to make. We do so with all freedom because we have
no bias on quo side or the other, and are only anxipu* that,
to use a phrase[ common,in Acta of Parliament, the beat,
practical means shall be adopted for the suppression of the
trade fraud s-which are atfll rampant, in spite of the valu&bjp
work accomplished under the, Sale of Pood and Drugs Act,
of 1§7*>., ■ Happily the more noxious kind of adulterqtioq.
which, was ao-rife in 1851, whan we.undertook our inquiries,,
has to a great extent been suppressed, qnd. has for, thje. moat :
part becorqe too dangerous to tempt the unscrupulous,
trader. We cannot say that it has entirely disappeared,,
because the existing, Acts are so irregularly ,administered
that certainty is impossible, but it has undoubtedly been
v^ry greatly reduced. The other kind of adulteration*,
howevef> by, which the purchaser, thpugh not poisoned, js.
chaatjed, fs stjill so commoq that some alteration of tt^q lawi*.,
imperatively called for. Xn respect of some articles,indeed—,
as,.for example,pilk amf drugs—trade frauds involve a very,
serious danger to publiq health, and have exercised a pre-j
judfqial effect qpon it, The child fed on watered milk ia
fed on |eqd of unknown,, and therefore in maqycasea of,,
inSuffioiqqt,^^ng^h._. '■] , r . v «.„. , , „i

, The Bill*, porr befpre fParBaxuent dqal-with two artiolg*.

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1242 The Lancet,]

A NEW ADULTERATION ACT.

[Junb 16,1887.

only—beer and batter. We bare already stated our views
in regard to the first of these. No false description of or
deleterious addition to beer can in any case be tolerated,
and the revenue must of course be protected; but subject to
these conditions, we see no reason for limiting the materials
used in the manufacture of so artificial a beverage. Com¬
petition will regulate the price, and any artificial restriction
would only add one more to the sumptuary laws which have
in all ages proved failures. The case of butter is somewhat
different. There can be no difference of opinion as to what
in popular acceptation constitutes butter. It is a semi¬
solid, prepared from milk only, but containing naturally and
unavoidably a considerable quantity of water. The addition
of salt and of a minute quantity of some harmless colouring
matter is justifiable; but foreign fats, such as are grouped
together under the names of butterine and oleo-margarine, are
not butter, and their sale therefore as butter is apalpable fraud.
But even to this apparently simple story there is another
side, which must not be forgotten. It seems certain that
these butter substitutes are as wholesome and fit for food as
butter. They are much more palatable than the cheaper
kinds of genuine batter, and they can be sold at a profit at
a cheap rate. But for prejudice they would be asked for
and used freely by thousands of families, and but for their
illicit use butter would be much dearer than it is at present.
It is freely admitted that their sale under the name of butter
ie at present a fraud, but nevertheless it is a fair question
whether it might not be better to destroy the fraud by
legalising it. Popular prejudice is entitled to some Con¬
sideration. We know perfectly well that it will be long ere
a housewife can be induced to ask boldly for a pound of
oleomargarine. She may suspect that the very cheap fresh
butter she buys, pleasant though it be in taste, cannot trace
an unbroken lineage from the cow; but she naturally clings
to the name with which she is familiar, and would shrink
from the idea of offering her children bread and oleo¬
margarine. Would it not be better to respect her sentiment,
and to leave the price of butter, like The price of beer, to be
settled by the ordinary laws of trade competition ? It would
be easy to protect those who want, and are willing to pay
for, genuine milk butter. Let a new word be introduced,
and let everyone be warned that if he objects to substitutes
he has only to ask for “ milk butter," and he will either get
it or be egTegioualy cheated. The detection of foreign fats
in butter is now so easy, thanks to the labours of the public
analysts, and above all to those of Mr. Otto Hehner and
his former confrere, Mr. Angel, that adulteration of butter
sold as milk butter could easily be made too dangerous to
pay.

Of much greater importance is the question of drugs.
The patient is practically at the mercy of the dispenser, and
the dispenser depends on the merchant, who may or may
not be tbe manufacturer. - The manufacturer commands the
situation, for the dispenser cannot analyse every drug
which he receives. So it happens that, although most
manufacturers and dispensers are honest and careful, any
individual patient runs the risk of losing all the benefit of
medical treatment through the imperfection of the drugs
administered to him. The only standard! that caii bte ifet up
is evidently that of the British Pharmacqpcfeia, and even
tbls'fataat be used Vrith dttttetion, forstate drugs are ‘so

unstable that it is impossible to keep them for any time
without deterioration. It would be for tbe public b enefi t
that all important drugs should be frequently analysed by
some impartial chemist, but in many caves a warning
instead of an immediate prosecution would satisfy Justice.
The adulteration of qninine is one thing, the defective
strength of hydrocyanic acid quite another.

The real remedy for the present uncertainties and irre¬
gularities of the law can only be found in a new and effiefeat
Food and Drugs Act, framed on the basis of the pr es en t.
We are prevented by limits of space from stating in suffi¬
cient detail our ideas of the Act as it sboold be. Bat a few
of the salient points may be sketched. The Act should
be not less wide than it is now, and ought to inchide in
its purview all adulterations of food or drugs, whether
noxious or merely fraudulent. The powers of the central
authority should be considerably strengthened, and it should
be able to compel the enforcement of the law. A large
number of local authorities do their duty thoroughly, and
it would be unwise to interfere with them ; but others do
nothing, or next to nothing. In many places no analyst is
appointed, and in others no work is found for him to do.
Such authorities must be coerced if the public is to be
protected. Opinions will differ as to the best way of
securing the administration of tbe law, but one way is
obviouely possible. Having compelled the appointment of
efficient public analyst* in every district, the Local Govern¬
ment Board might have power to insist that a sufficient
number of properly selected samples should be sent for
analysis. If this duty were systematically neglected, tbe
Board should be able to appoint their own inspector, and
to charge the offending district with tbe expense. Tbe
regulations for the collection of samples require thorough
revision. We quite agree with Dr. Bell of 8omerest
House that the inspector should have the power to enter
premises and select his own samples, dividing them into
portions, and paying for them as at present. Sometimes, as
in the case of beer, large samples are required, and there is
in all cases a risk that the vendor, knowing tbe inspector
or his envoy, or guessing at the object of the purchase^ may
substitute a pore for an adulterated article. All articles of
food and medicine should be included under the Act, whether
subject to excise duty or not. There need be no conflict
between the public analysts and the excise chemists. The
main duty of the latter is the protection of the revenue; but
an analytical department is neoessary for this purpose, end
we see no reason why the Government chemists should not
continue to act as they do now as referees in disputed eases.
Their power* should he more accurately defined, sad some
arrangement should be made with regard to perishable
articles, such as milk, tbe analysis of which can never be
quite satisfactory unless made upon a fresh sample.
Finally, the new Act should contain a carefully drawn
schedule in which tbe principal articles of food and drags
were defined, and limits of purify assigned. With regard to
drugs this oah easily be ddne by retorting to the British
Pharmacopoeia as A Standard. Food will occasion more
difficulty, bat none that need be insuperable alter tbe
experience that has been gained ha the last few yettra.
Milk, bdttety and beef ire the articles wbtoh have gNue
rise to most ton trim*?. ' In this add tor Hurt weelcto

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Thx Lancet,]

SANITARY CONDITION OP INDIA.

[June 18,1887. 1343

article, we have considered the last two, and we have often
stated onr views in regard to milk. To the public analyst
is at present assigned the impossible task of ascertaining
how much water has been added to or how much cream
removed from milk, and as milk is sometimes naturally very
poor, he is compelled to take a low standard of purity. The.
Act might properly provide that milk should be held to be
adulterated if it did not contain as much as 3 per cent, of
fat and 9 per cent, of solids not fat, or if it. contained any
substance foreign to milk. The offences of watering and
skimming oonld then be detected with,certainty, and the
public would be secure of getting good if not very rich
milk. At present the limits used by moat public analysts
are per cent, of fat and 8j per cent, of solids not fat,
which represent a very poor milk.

The question of the sanitary condition of India has
been brought prominently before the British public by
the publication in The Timet of a letter try Mr. Justice
Cunning-ham, a judge of the High Court of Calcutta, and
by a leading article in that journal. Our readers must
be well aware that this is qo new subject to us, as we have
repeatedly brought it under their notice in our reviews of
the annual reports of the Sanitary Commissioner with the
Government of India, and of the Health Officer of Calcutta.
We rejoice that thid important question has been raised
by so high an authority as Mr. Justice Cunningham, and
backed by the powerful advocacy of the leading journal,
because it cannot fail to conduce to some more active
measures of improvement than have hitherto been in
operation. But to some of the statements which have been
made we feel bound to take exception, believing, as we
do, that nothing tends so much to retard sanitary improve¬
ments as an exaggerated representation of the need of them
and of the benefits to be expected from their adoption. Thus,
we are told that, “according to Frofessor Maclean, from
tiie time of the commencement of our occupation until
about 1860 the mortality of the English troops ' oscillated
round’ the enormous figure of 79 per 1000; and this
frightful death-rate was, within a few years, reduced to
reasonable proportions by the adoption of the recommenda¬
tions of the Royal Commission of 1859-60. In 1882 the
EagHsh military death-rate was only 13-07 per 1O0O from
all causes.” Now, this comparison is entirely mislead¬
ing, as it refers to two bodies of troops serving under
totally differed!; conditions. In the first period the
British troops consisted„of men enlisted for service in
India, who remained there, unless invalided home as unfit,
until they died or had completed twenty-one or twenty-
four: years’ service ; while in the later, period they were men
of the regular army, Who were retained in India only ten
years, and for the invaliding of whom, if their health broke
down, much greater, facilities existed than formerly. Those
onjy.wbp have studied tbe influence of age and of length of
reektenon^pon mortality in India will be ^We to, appreciate
the important part this change has played in the reduction
of tiie death-rate. We by no means undervalue tbe. influence
of sanitary measures upon the health of the troops or of the
population. but we believe they wilt carry more weight
,ppre ,of,fMlpptiQn when (jarefully and correctly

Mr. Justice Cunningham in his letter calls attention to
the valuable work being done by the Public Health Society
of Calcutta, in its endeavours to popularise sanitary know¬
ledge, and to bring forcibly to tbe notice of Government
the evils of the existing state of things, and the improve¬
ments necessary for the introduction of efficient sanitation.
But we are disposed to think he has not done justice to the
sanitary commissioners and health officers, who were work¬
ing zealously in this direction before the Society was formed;
nor to the late Lieut,-Governor, Sir Bivaas Thompson, for
his firmness in enforcing sanitary measures in Calcutta; and
those European residents, of whom Mr. Justice Cunningham
himself was one of the most energetic, who pressed upon
the Government the necessity for active intervention. 1 The
letter of Mr. Cunningham points out forcibly the failure
of the Municipal Corporation of Calcutta, apparently from
want of knowledge of, and belief in, sanitary science, to
carry out to a sufficient extent the measures necessary to
ensure the health of the population; for, though they have
effeoted some improvement, much yet remains to be done.
“ While cholera has raged in the insanitary portions of the
city—the cholera mortality in some wards attaining for
some weeks ratios beween 18 and 36 per mille per annum—
the properly conserved portions of the town have enjoyed
practical immunity from the disease.”

The measures proposed by Mr. Cunningham for the
improvement of the sanitary administration in India are—
1. The creation of a body possessed of sufficient knowledge,
and armed with sufficient authority, to superintend and
control tbe municipalities in the performance of their duties,
aad to enforce that performance in the case of persistent
negleot or contumacy. 2. A recurrence to the system of Govern¬
ment itself lending tbe necessary funds to municipalities
who have to borrow in order to carry out structural arrange¬
ments. 3. The creation of a branch of the Public Works
Department whose special duty it shell be to assist munici¬
palities in important projects of drainage or water supply,
and to test the soundness of projects. 4. The creation of a
staff of officials, sufficiently strong in numbers, ability, and
resources, to conduct scientific investigations into disease
with the precision end completeness that such inquiries
necessitate, and which their importance justifies. He
comments, with much justice, upon the inadequate and
niggardly arrangement at present existing for scientific
inquiries into sanitary questions, which appear to devolve
upon “a single official, who receives an honorarium of £30
a month for devoting to microscopic research the small
leisure left by his other professional duties. Even this
scanty provision is intermittent.” We most sincerely trust
that the Government may see it* way. to a,prpper adjust¬
ment of the administrative machinery necessary for the
promotion of the health of the. people by the adopfcionof
well-considered and .efficiently worked sanitary measures.
It is a matter which may involve a considerable outlay, but
an outlay which we have no doubt will be more than repaid
by its results. Tbe improvement of the health of the people
is. an imperative duty of the Government, and one wi^h
which no paltry question of reduction of expenditure should
be permitted to interfere. A liberal but judicious expendi-

l See The LaScet of August 9th arid 23rd, 1884.

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1244 fine LiwoAt,] LEGAL ASPECT OFTggSBft^lCB&QFlflityjXLEFIED ASSISTANTS. [Jpa» lMfiBrj

Wire foi suCh & purpose would prove ultimately to be true
economy, tending M promote the prosperity of India and
the moral and physical well-being of its population.

' The custom of using unqualified practitioners, especially
id branch practices, and in situations Where the assistant
cannot have any guidance dr supervision from the principal,
has had many severe discouragements of late 1 , but hone,
perhaps, more so than one involved in a judgment in the
Queen's Bench by LoTd CoLbEidgb and Justice Denman in
the case of Howabth v. BheaElky, reported pretty fully
itt The Time* of June 13th. The question raised by the
case was -whether for services rendered by an unqualified
assistant employed by a registered medical practitioner the
principal or his representatives Could recover in a court of
law. The case was begun in an action in the Salford court
by the assignee of Mr. Pitzmaurick, a qualified medical
practitioner at Bury, to recover from a person near there
stan'of £16 12 *. for medical attendance and medicine forft
period from 1880 to January last. It was admitted that
the actual attendance was by an unqualified assistant','
Mr. lYrzMAtmicfc himself taking no part. At the first
trial it was objected that under the 21 & 22 Vic., c. 90,
the plaintiff could not recover, as the attendances'were’
by an unqualified person. The judge took this view, and
directed a nonsuit. On the present occasion there was an
application to the Court of Queen’s Bench by way of appeal
from that decision. There was a sharp difference of opinion;
or, at least, of argument, sustained with mueh liveliness,
between Mr. Willes Chttty and Lord Coleridge. Mr.
Chitty maintained that the attendances in law were by the
principal. He admitted that there was no personal attend-
ance on the part Of the principal, but maintained that
through the agency of the assistant, who lived at a branch
bouse, he attended the patient'. He admitted that the
unqualified assistant could not recover for this, but conM
tended that the principal could. Lord CoxeRidob, with
filuch animation, controverted this view, Which, he said,
Would defeat the wbble object of the Act, which is to
prevent unqualified person* from acting. This is,- perhaps i
rather too absolute a way of putting it. If the Act
of' 1858 had been expressly designed to prohibit unquali¬
fied practice, it would have been very different in its
penal clauses from what it is.' But it certainly gives
such persons no power of recovering fees. It does not
Recognise their right to make charges, and if pro¬
hibits the false use of medical titles, and in bhie way it
discourages unqualified persons from practising; but it
does not absolutely prohibit them. Lord Ooxswim* was
decided, however, in his view. He entirety supported the’
fiidge below who had directed' k nonsuit.’ The tnedtoat
than Whose representatives suSd Lad hot Tendered the
service shedTbr, and he eorlldnot recover; and therefore tire
nonsuit was right. Mr. Justice Henman wAs equally strong
in supporting the non-Suit. Me' said i “The Medical man
here did not show that he had rendered the services sued
for, and so he could nOt recover.' Theservioss sued fur wezei
tendered by another person, whd was unqualified; without
iky 1 consultation with him. If wm "urged that this persons
acted as his servant; but a qualified practitioner could not
thus authorise an unqualified person to act for him in

jniedloal cttemliface. it Wobkl irt a mockery to apply-tfew
dOctriae of master* and seiVant <to Sach a case; and-i* Would
entirely defeat theintehiion and object of the Act. 71 Thu
appeal was accordingly dismissed; • 7

' This judgment*'wilt«dear>tha mat a good dcaSJ Soma-
previous cases stem to bavh -bean 'decided in an fippqMte
sense, dr at leist lti a- daubtfid senee; But the opinion of
Lord OoLBElixjE and Mr. Justice Dhnman, given withim
much (dearness, as 'likely 'tb (settle this question. And.
indeed, anyj other view of the base, would be as duntow to
the profession m if would be absurd; If a mediate maa
were at liberty to offloer half a doseirbranch houses oc dis¬
pensaries with as' tnahy unqualified assistants and to
enforce payment for their services in a court of- low; the
1 practice of unqualified persons: aright be indefinitely ia-
1 creased and encouraged totW great Injury of the public.
Such a doctrine would not" Cifly cover conduct which the
1 MediCal Council hSs eeVCrbl^ Condemned, but h Would
legalise ft. Weare tnuch gratified, therefore, at the
deCisibn given in the High GoUrt, from wfciCb ft fallows
that 1 charges ToF ail ServicfeS Tendered -by unqualified
' assistants "Slone cannot be 'reCoVEMd. 11

li'jl.'-... .Ill 1 , I

* KaqnM nfaals.**

THE APPROACHING COLLEGE ELECTION.

Tuffi following genttememake aandadetes for the ueucui
on the Council of the Royal College of, Buggpons caused,
by the, annual retirement of, members; Mr. ; Johq Cooper
(Memb. 1859; Feli. 1861), of the London Hospital; Mr.
Alfred Willett (Memb. 1859; Fell!,1862), Of St. Bartholo¬
mew’s Hospital • and Mr. Brndenell’Carter (Memb.‘t85l; FVB.
1864). Sir T. Spencer While, Bart., and Mr. Jonathan Hutehha-
son, two of the rhambera retiring imrotetibnyseek fre-electuat
but Mn John Wood will noti again come forward, The last
day for the reception of. nomination paper* was Mqnday
last, June 13th, and no \>July 13th, as was accidentally stated
in our last issue. The voting takes place oh July 7th, at
2 p.m., in the library of the College.

SUCCESSFUL REMOVAL Pf > TUMOUR FROM

.[ : „ ;I v :i: TfiE SPJNAL CANAL.

1 On Thursday, June 9th^Mr.,Victor Horsley removed a
tumour from the spip^l p&nalof a gentleman aged forty.
T^e diagnosis of compression of the, spinal cord by a morbid
growth was made by Dr. Gowers, who saw the patient with
Dr. Percy Kidd. 1 The patient was Suffering' from paraplegia.
WhiCfc trtmmeirted gradually siE ortntbS dgo/and from pate
sgand Uffe vchest? ‘cf (ftalgiyssrr^» ShWation- - Bir Wilhaxa
Jennet afterwards jmu* the patient, .end ood firmed the
diagnosis- , Dr, an attempt should

be, mpd^to xpmdyer.the, growth, . Fr 9 m the history of
severe neuralgic pain in the back and along the Course
of the left Sixth 'doikal flerVe Which preceded the pan-
plEgih,- ibWhs tohsWeTetf p«ri»kSte <ihrte 1 tl»b‘ga>Wth ooa i -
menoed ift ibe'Tpohmricr cental'*heas r* a; a nd after w awte
produced prtesate on the acncL -The operatic* waaperfaraiflri
by a leqg iooi wo n im -the mid-line of the, back, having its
Centre, about .the fifth dorsal, down to the spines of the
vertebrae., The muscles were cleared off from the laminae
and retracted. The spiheflW^e tbdJbVea' by bdne fokoep^
and then 11 thb lamiiMeWas mate'

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ttffl LiNrttT.i EXPERIMENTAL NEURITIS.—THE HOVE INFECTIOUS HOSPITAL. [Joro 18,1887, JB4&

through the membranes and the cord examined, a tumour
about the’ size of the tip of the little finger being eventually
found on the posterior root of the' .nerve about the level of
tie third dorsal vertebra. This had pressed the cord for¬
wards and to the right, producing a deep depression in its
substance. It was removed with the nerve to which
it was attached. The incision through the membranes,
which was at least three inches long, was not sutured;
the wound in the soft parts was closed with sutures
and drained. Strict antiseptic precautions were taken at
the operation. Since’ the operation there has been no rise
of temperature, and the paid has diminished. The painful'
spasmodic action of the muscles of the lower extremities
from which the patient suffered has diminished, and there
has been less rigidity of the legs, but the paraplegia con¬
tinues. ' The growth, which was of a pinkish colour, elastic
and vascular, has not yet been submitted to microscopical
investigation. _

EXPERIMENTAL NEURITIS.

Hypodermic injections of ether are now so frequently
employed,, and with such good effect, that we are apt to
forget that occasionally nervous lesions result from their
use. Cutaneous anaesthesia, disorders of motility, and even
serious trophic lesions have been observed, and the experi¬
mental researches of Amozan and Salvat proved that the
mechanism of these lesions was a peripheral neuritis.
MM. Pitres and Vaillard find, however, that some of the
peculiarities of the action of ether on the peripheral nerves
must have escaped the attention of the last-mentioned
observers. 1 We reproduce the salient points of this in¬
teresting communication. When an injection of half a
cubic centimetre of sulphuric eth^r is made deeply into the
cellular tissue which separates the muscles on the back of
the thigh of a guinea-pig, there always results'a paralysis
of sensation and motion in the parts of the limb situated
below the level of the injection. Generally the anaesthesia
OccUpiee the two outer toes and the outer aspect of the leg,
biitlfe miay sometimes afleot alt three toes and the whole of
the skin offehe teg, probably because the injection has
tesveSSedi the'moBealbr-interstices and tattaeked the crural
nerve. • After a few days these phenomena may be accom¬
panied by cedematoos swelling of the foot, ulceration of the
toee and tangus*falling off of the nails, &c. The anaasthesia and
the paralysis are manifested immediately after the injection,
add in a Short time they have reaohed their fullest extent,
and, odes developed, they persist for several weeks or even
months without either increasing or decreasing in severity.
In ordet^ to' study the meehtraism of the notion of ether,
MJf. Pitres sad Vaillard have made a hUbologioal examina¬
tion of tho segments ofi the nerye situated above, below, and
at the level of the injection of ether, and these examina¬
tions have been made on the aoiatiq nerve from animals after
a survival Of asms hours, days* or.several weeks. Above
thersoneof rejection the nerve; has always appeared abso¬
lutely, normal) nothing lika anascending neuritis; has been.
oh s rtra d* JhLtbe level e£ injection -the-alterations varied,
aeoofcdiaig to ithe length of survival p£ the animal When,
tbs darvQ was examined some hours tnly, after the injection,
the nerve,.being teased after,numeration for : twenty-four
hours im a- splufitan oC cnmia acid, and coloured by piaro-,
lanliiiiei'eosintv.or h*emuto»yloii,^tbe: myelin© is found to
buvb -become: blackened,,nod rather-,different,..from the
bhriSh-Wacktintof Q 4 KUMf ,norvn.fibre*. ’Farther,' the
hddrnLffssnies ire<noi4ongeri to, beseeu, the .axis cylinder
an&nunfefciof'jthe intennnabr segments ami,not distinct,
and it seems as though the,nervous element* h#d become
attend in their •ohendoal composition. .41 the auimtl be
MUnd' six; eight; or ten day#i aftqp *he, ; ex periment, the

segment of aff^pted nerve .shows sapid, changes; it is
only after the fifteenth day that the altered fibres begin to
undergo notable modifications: the myeline breaks up, and
is slowly absorbed. Below the level of the injection the
nervoiis tubules proceeding from the nerve trunk affected
by the ether undergo the Wallerian degeneration, which is
well marked on, the fourth day. The ether is therefore,
regarded as causing an immediate necrosis of the nerve
trunk at the site of injection. This was also shown by an
experiment in which the nerve was first divided at its exit
from the pelvis, and on the same day ether was injected
into the lower part of the thigh of the paralysed leg.
Wallerian degeneration was found eight days after in the
nerve, between the point of section and that of injection,
and also below the latter, but in the area of injection the
nerve had not undergone degeneration; the myeline was
continuous and confounded with tbe axis cylinder, and there
were no traces of nuclear multiplication. Other experiments’
showed that an injection of the sulphuric ether could arrest
the Wallerian degeneration at any point in its career. The
same facta hold good with nitric and acetic ethers for'
guinea-pigs, rabbits, and cats. Hydrochloric ether has less
severe effects. Formic and valerianic ethers have caused
considerable local swellings and gangrene, thus preventing
a proper examination of their action on nerves. The authors
suggest that, in cases in which neurectomy or neurotomy i's
needed, injection of ether in the neighbourhood of th6 nerve
trunk might serve equally well. ‘

THE HOVE INFECTIOUS HOSPITAL.

■ We have deceived a further communication fnm Mr.
Henriques as-to the Hove Infectious Hospital. We do nob
publish it because it Ho longer deals with the defects
referred to previously; it merely brings forward a fear fresh
points of objection, to. the institution. One relates to the
use of earth-closets, it'being Allied "thkl^the contents are
not buried'“at' anything approaching'10 a sufficient depth
to be safe. 1 * Surely such a trivial point of local admini*&rsM<
tion can be altered by-an order that the man in charge is. to.
dig deeper. Then it is stated that there is no system of
drains. Tbe drains themselves we believe.to be well and pro*,
perly laid, but we agree with Mr. Henriqnee in eo far aS tho
absence ef a proper system for disposing of their contends is!
concerned. There is ample ground for this* and here amend¬
ment is certainly Wanted. Then the water supply i« com¬
plained of. The supply is derived from a neighbouring
public reservoir, and, owing to.the levels, it has to be stored:
in a second reservoir on the hospital rite, and to be pumped'
by horse-power into the hospital cisterns. We are sorry
that, owing to the position of the buildings, such an expense
should be necessary, but we fail to see why 1 suoh ! a matter
should be held Hp as an objection 1 to the hospital itself i
“Stordd •water,” we now learn, “is never pure,” and it
lt may n become contaminated. These are not grounds of
objection which merit the publicity which this question 1 hlA
received. In < every way we regret the 1 action taken by
Mr. Henriques add his supporter General" Shuts* add in enb
respect'it has been scarcely courteous. Thus,‘the latte*
publicly asserts that Our ooaimente were inspfred by winds >
partisan, and hence to quete tfiem in fevour of the views Of
the medical officer of health ae to the hospital is * simply
gfving the public credit for being idiots.” And Mr. Henriqnee^
referring to the suspicious eharectetof certain dates, fegatdd
out knktrieeteaa “inspired abextr*? We may state that
our comments bave been tbe result of si personal 1 Visit tel
this partial hospital provision for infectious diseases ‘to
Hove, and of a kwowtedgo as to the principles property
govefntng such provision—which, wo believe, is not inferior
to that poeseesed by those, who have done so muehto Wring
the institution: into pubiio disrepute, n- .'..t',!' ! ii

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1246 Th» Lancet,]

CHOLERA FORECASTS.—EPSOM COLLEGE.

[Junk 18,1887.

THE LATE DR. WAKLEY.

Tub Executors of the late Dr. James Goodchild Wakley
request us to note that he devised his freehold residence
at Longcro88, Chertsey, Surrey, with its stables, out¬
buildings, gardens, and pleasure grounds, about eight acres
in extent, to University College, London, as a memorial to
his late father, Thomas Wakley, Esq, M.P, and in com¬
memoration of the establishment of Thk Lancet, of which
the late Dr. Wakley was for so many years the Editor and
part Proprietor. The expressed object of the devise was
that the premises might be used by the College as a
Home for the reception and treatment of Convalescent
Patients in connexion with University College Hospital,
to be called the "Wakley Convalescent Home.” He also
bequeathed to the College the pictures and prints in the
house, to be kept there for the amusement of the patients;
and a pecuniary legacy of £1000, to be expended in the
maintenance and support of the Convalescent Home at
the rate of £200 per annum for the five years next suc¬
ceeding his death. The Solicitors of the Executors inform
us that the premises, with the pictures and prints, have
been handed over to the College, and that the legacy has
been paid. The late Dr. Wakley also made several other
charitable bequests, all of which have been paid or set apart
Notably—to the Hospital Sunday Fund (which, in so far as
London was concerned, was initiated by the late Doctor
in his capacity as Editor of The Lancet), £1000, in
addition to two previous donations of a similar amount;
to the poor of Sunningdale, £200 ; to the poor of Chobham,
£500 ; to the Bisley Refuge Farm School, £500. And pro¬
vision was made by the Doctor in his lifetime for the con¬
tinuance for some years of the religious work among the
poor in the neighbourhood of his residence which he had
for long superintended._

CHOLERA FORECASTS.

Whether or not the German journals are warranted in
anticipating a return, in greater force, of the cholera invasion
that hovered round ifayence last autumn, they cannot cer¬
tainly be blamed for treating June and July as the test
months for the reappearance of the epidemic. A dry spring
like that which heralded the cholera raids on Munich in 1836,
1854, and 1863 has no doubt been absent this year, but the
suddenness of more recent explosions of the malady has
lessened the importance to be attached to that condition. A
vigilant prophylaxis, therefore, is all the more justifiable—
a prophylaxis not guided by the worn-out traditions of
French or Italian sanitation, but by the counsels of that
sagest of hygienic strategists. Max von Pettenkofer. " Zum
Gegeuwartige Stand der Cholerafrage” (“On the present
Aspect of the Cholera Question”) is the title of a series of
papers just concluding in the Archio fur Hygiene (Munich :
Oldenbourg), from the pen of that great authority, and the
wholesome truths they inculcate must, if well, acted on,

M place Germany in as unassailable a position hygienically
as her War Office headed by von Moltke has placed her in
strategetioally.” Readers of The Lancet will remember
that von 1’ettenkofer, even after the second cholera con¬
ference at Berlin, saw no reason to modify his non-
oontagkmist view of the origin and spread of the disease.
While recognising with M. Koch a cholera bacillus, and
ex hypothesi accepting that micro-organism as the parasitic
basis of the malady, he denies the conclusion sought to be
deduced from this theory that cholera is communicated by
the ooniagium of tbs bacillus Kochianus. Malaria, he con¬
tends, ha* also a bacillus or a germ (vegetable or animal) for
its basis, but it does not infect the human subject by .oon-
tsgium; it passes from the sOilinto the air, whence it reaches
she organism through the longs. Kpidemiologically con¬
sidered, cholera does not effect its foothold in localities by man -

to-man contagium. Lyons, Innsbruck, Salzburg, the asylums
to which cholera patients by the thousand have fled, have never
contracted the disease; in fact, for really contagious diseases
□0 localities can ever be called exempt, as these cities hare been
from cholera. It is, thinks von Pettenkofer, to the malarial
group of epidemics that we must turn for the true analogy
of the origin and spread of cholera, and the prophylaxis
which that analogy prescribes—attention to the conditions
of subsoil when operating in connexion with season —will be
found to cut at the root of the outgrowth and spread of the
disease. Contagionism with its isolation, its sanitary cordons,
its quarantine, its disinfectants, has achieved nothing but
fiasco. Witness 1884, when cholera, non-existent in Egypt,
non-existent in Europe, exploded in France, and almost
simultaneously, at Toulon and Marseilles, all M. Fauvel's
contagionist machinery notwithstanding; witness the same
year and the year following in Italy, where every con¬
tagionist precaution was enforced with fanatical strictness,
and where nevertheless the malady had everything its on
way in the frightful outbreaks. Yet so wedded was M. Fauvel
to his contagionist theory, that on his death-bed he solemnly
declared that the epidemic that bad decimated Tonlon and
Marseilles could not have been Asiatic cholera because it
proved intractable by his contagionist preventives! The
practical lesson deduced from von PettenkofeFs findings is
this: vigilant attention to the subsoil as to drainage, vigi¬
lant attention to water supply, such as within the next
decennium Germany relies upon to make her as exempt from
cholera visitations as her frontier is from attack. “ Fore¬
armed hygienically against the one and strategically against
the other,” she reiterates her claim to look on both with
equanimity. _

EPSOM COLLEGE.

The alterations in the by-laws of this College which
were proposed and carried at the last annual meeting
establish the institution on a new baair. Hitherto Epsom
College has been a class school confined almost entirely to
the sons of medical men. A few day-boys were admitted,
and only a small percentage of sobs of others than medical
men were among the boys. This limitation of Kpeom
College has done much to obeok the development and exten¬
sion of the school. Parents have long since recognieed tint
to limit a school to a particular class tends to curtail a boy 's
intellectual powers, and lessens his social advantages in
after-life. Thus, other pubHo schools—notably Wel¬
lington College and Marlborough—have expanded from
the strictly military foundation of the one and the
clerical foundation of the other into large general public
schools. This should have been the object at Kpeom. From
the foundation of the College the disposition has been to
make the medical benevolent feature of the foundation tco
conspicuous. The Epsom boys had at all times before them
a not very encouraging emblem in the form of aged pro¬
fessional pensioners located in ahnshoneee adjoining the
College. These are found to be a mistake, for the occupants,
if given choice, prefer their email pension and rwrideme
elsewhere to the precinct* of Epsom Collage. Thus the alma-
houses are being gradually vacated, and are becoming utilised
for school purposes. It would be to the interest of the
College, and not to the disadvantage of the pensioner* if
the whole of the almsbOuees were diverted to sobooi
purposes, and the proceeds arising therefrom directed to
the benefit of the aged pensioners resident elsewhere.
Hitherto the College, like some other public schools, fans
been weighted by a heavy debt. On his retirement from
the treasurersbip Of the College, it must have been a great
satisfaction to M!r. Francis Bird to have been able to
announce that during Bis period of office this debt had been
entirely wiped out. Dr. Holman of Beigate succeeds Mr.

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ZIEMSSEN ON GOLD WATER TREATMENT OF TYPHOID.

[Jor* 18,1887. 1247

Hird as treasurer to an institution now unembarrassed and
commencing a new era in its existence. Epsom College
henceforth is to aspire to be a great public school, fitting boys
not only to enter the medical profession, but other professions
and the universities. Dr. Holman, on entering office, pledged
himself to the governors present at the annual meeting that
the sons of members of the profession should reap the full
advantage of any extension of the school, and this,, too, at
only a fraction above the prime cost of their education. We
place on record this assurance of Dr. Holman in order that
it may not be lost sight of in what we hope will be a suc¬
cessful phase in the history of Epsom College. Each
member of the profession is as much interested in doing for
Epsom what he can, as military men have been in Welling¬
ton and clergymen in Marlborough. At these schools
masters have been found ready to build boarding-houses
for boys, and the same has been done at Charterhouse and
Winchester. Epsom College may be extended in the same
way, to the Advantage of the foundation. Eat to this end
scholars must be forthcoming from outside the profession,
and at a rate of remuneration such as shall be a source
of profit to the institution. The present happy position
of Epsom College cannot but be highly gratifying to the
members of the family of the late Mr. Wakley who are now
conducting this journal, of which he was the founder. It
will be remembered that a large memorial fund, subscribed
after his death in 1882 by members of our profession, was
presented to Epsom College, to establish a scholarship
which should bear his honoured name.

ZIEMS8EN ON COLO WATER TREATMENT OF
TYPHOID.

The Journal of the American Medical Association for
May 14th contains a full abstract of a lecture on Antipyresis
and Antipyretic Methods by Professor Ziemssen, director of
the Medical Clinic of Munich, especially in regard to typhoid.
The lecture is very interesting and earnest. It claims a
high value for the treatment by baths, and expresses a hope
that after the favourable results of active antipyresis phy-
sicans will not lapse again into the therapeutic indifference
of the Vienna School. Of all antipyretic measures Ziemssen
considers hydrotherapy the chief: first, because it com¬
bines in itself all the attributes of a remedial measure; and,
secondly, because its action on the fevered organism may be
varied to any degree. The benefit of such treatment is not
confioed to typhoid, but is also to be noticed in other febrile
diseases, such as pneumonia, erysipelas, and aeute phthisis.
The cold and lukewarm baths act, he thinks, by cooling the
blood at the periphery, the vital fluid being returned to the
internal organs with an indescribably pleasant as well os
beneficial effect. Sleep is favoured. There is an improvement
in digestion, so that the patient can be fed better. On the
circulation the effect is to contract the peripheral vessels,
the heart works more slowly, the vessels show an improved
tension, dicrotism is decreased, and the elasticity elevation
returns. The respiratory apparatus is excited by the peri¬
pheral irritation to deeper and slower movements, cough is
more effective,and in this way bronchial obstruct ions and con¬
sequent atalectasis and catarrhal pneumonia are better avoided
than by the impracticable advice to turn a fever patient on his
side. Ziemssen gives two or three statistics to show the
effects of the cold and the lukewarm bath treatment respec¬
tively. He takes his illustration of the strictly cold bath
from Vogl, physician to the Garrison Hospital at Munich.
He gives (with a rectal temperature of 102-2° F.) a cold bath
at 68-5°, lasting a quarter of an, hour, about every three hours,
winter and summer, in unheated rooms, with windows open
day and night. This is bold treatment, and for soldiers (for
the most part with young and picked lives) does well.
There wen only 62 deaths in 610 cases, or 6-4 per cent.

Murchison gives the mortality of typhoid in the London
Fever Hospital, after deducting cases which died within
forty-eight hours of admission, as 15'82per cent. Ziemssen
compares Yogi’s practice with strict cold water treatment
with Naunyn’s in a civil hospital, who, with an axillary tem¬
perature of 1031°, taken every three hours, gives usually
eight baths in twenty-four hours, generally between noon
and midnight, at a not lower temperature than 72*5 9 . He
divides baths into cold (72'6° to 816° F.; duration, five
to ten minutes), luktwarm (from 81-6° to 90-6°, ten to
fifteen minutes), and warm (90 6° to 95°). The warm are
given in the later stages in very active delirious patients
with great restlessness and muscular weakness. By this
treatment Nannyn lost 10 of 146 cases, or 6'9 per oent,

“ certainly a favourable percentage.” Ziemssen himself says
that for twenty years he has recommended, for private prac¬
tice, the gradually-cooled bath. The patient is placed in a
warm bath of 90 6° or 86°. The water is continually poured
over him with hands or sponge. While this is being done,
cold water is very slowly poured in at the foot of the bath
tub, and the water reaches gradually a temperature of 77°
or 72 5°, until the patient’s teeth chatter, or he declares he
can stand it no longer. He is then taken out and placed in
a blanket previously warmed, and wrapped in it without
being dried. In this he remains in the greatest oomfort for
fifteen minutes, is then rubbed dry, and allowed to sleep.
Ziemssen, like a wise physician, reoommends the study of
the peculiarities of individual cases. While lauding the
bath treatment, he speaks respectfully of antipyretic drugs.

8TATI8TK58 OF SUICIDE.

Thb Chronicle, an enterprising journal in New York, has
made a very painstaking compilation of statistics relating
to suicide, culled from the daily press of America over a
period of five years. In this way a large number of cases
has been brought together, and although the sources of
information are not always the best or the channels through
which it flows the most trustworthy, yet the result presents
many interesting features, and well repays the compiler’s
trouble. Among the most striking of the facts brought out
is the very obscure influence of the season of the year
upon the prevalence of suicide. It would be a curious
experiment to poll a constituency of ordinary people
for opinions on this point. We much suspect that
autumn or winter would commonly be credited with
being best adapted to develop and foster suicidal ten¬
dencies. In America it would seem that summer enjoys
this unenviable pre-eminence. And not only so: the summer
months all rank high—the highest in the year; but, actually,
the highest of them all is " the flowery month ” of June.
On merely psychological grounds, it would seem quite un¬
intelligible that suicide should be at its maximum just as
spring is making way for summer. ' The reason must be
sought elsewhere—in the organism and its environment;
and possibly the circumstance that a very large proportion
of the suicides are agriculturists affords a practical explana¬
tion. At least, this is the season of the year, just before
harvest, when a farmer is likely to find himself most hardly
pressed for money. The demand for money for agricultural
purposes, which is so well known in our own money market
as a regularly recurring feature of that season of the year,
bears testimony to the existence of*A state of things which,
indeed, may be seen by the help of merely d priori con¬
siderations to lie in the natural and necessary course of
events. It is very conceivable that this pressure In
a country like agricultural America, where banking faci¬
lities, compared with ours, are very limited, may be
pronounced enough to affect quite appreciably the suicide
record of the agricultural class. This explanation does
not seem, however, to be fully Adequate, for, giving to

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*24# ThhLanobt,] THE PHYSICALLY DETERIORATING INFLUENCES Off C1VII43ATION. [Joan 18.1687.

it the fullest weight possible, we still ere face to face with
the anomaly that a special circumstance is made to ex¬
plain a very general feature of the figures given. It is
probable that the truth lies deeper still in the nature of
things and men, and must await for its full disclosure the
more complete analysis of the relations between mental
states and pathological conditions, and again between these
latter and the season of the year. In the meantime these
seasonal figures, being among the piost reliable, presumably,
that our contemporary has put together, are of sufficient
interest to warrant reproduction.

Distribution in seasons of S22G American Suicides.

Spring. Summer. Autumn. Winter.

March ... 649 June ... 833 . Sept.... 781 ...... Dee.... 027

April ... 067 __ July... 710 . Oct. ...681 ...... Jan.... 318

May.7>'0 . Aug.... 8o7 . Nov. ... oix> . T'cb.... -171

Total, Total. *380 Total. *00* Total, 1736

and tramp life, and also from domesticated animals, such as
the sheep, the ox, the horse, and the dog, in all of which
species high breeding was shown to conduce to a marked
diminution in the bodily recuperative capacity. The speaker
further maintained that man universally had naturally a high
standard of bodily recuperative power inherent in his consti¬
tution, anid that the present higher bodily recuperative
capacity shown to be possessed by all men living in a rude
state, whether in the form of savages, like the South A fri can
Kaffir or the North American Eed Indian, or the gipsy or
tramp wanderer among ourselves, arises from the face that
the refining influences of a higher civilisation materially
diminish the animal recuperative capacity; and further that,
although all men are of the same flesh and blood, their
different modes of life and different social habits have
induced in them very varied degrees of nerve se ns ibility,
as well as of recuperative bodily power.

Of the suicides brought under review, nearly 6000 have
been classified under causes. The results thus brought out
agree more nearly with one’s expectations. Insanity, of
course, heads the list. Family trouble comes next, while
business trouble, dissipation, and disappointed love rank
almost together for the third place. So far all is common¬
place, but the list contains, as would be supposed, some
eccentricities. The refusal of a pension might easily sug¬
gest suicide to a severely logical mind, but it is passing
strange that self-destruction should be chosen as arefagefrom
asssssinatibn, yet two such cases are recorded; while in one
instance a source of trouble is assigned so utterly trivial as a
/nmple on the nose ! But more striking, upon the whole, are the
results brought but by classifying according to occupations.
Strangely enough, farmers contribute by far the largest
quota. Possibly the number is not disproportionate to tbe
numerical strength of the farmer class in America—for
these proportions are not worked out,—but it is singular to
find them outnumbering the saloon-keepers, merchants,
labourers, and clerks put together. Yet so it is. Among
other classes, that of courtesans is sadly and suggestively
conspicuous. For the rest, the list, though long and varied—
for no condition is free from the occasional temptation to
suicide,—contains nothing of special interest or in any way
peculiarly noteworthy. The problem of the seasonal varia-
tion, however, appears likely to reward careful examination.

THE PHYSICALLY DETERIORATING INFLUENCES
OF CIVILISATION.

At the meeting of the Anthropological Institute on the
2-fth ult. (Mr. Francis Galton in the chair), Dr. George
Harley, F.R.8., gave a discourse on the “ Relative Recupera¬
tive Bodily Powers of Man living in a rude, and Man living
in a highly civilised, state,” in which he brought forward
a number of hitherto unpublished, though mostly well
known facts in support of his contention that the refining
influences of civilisation had not been altogether an un¬
alloyed boon. Cases were cited by the speaker in support
of. his view that, while man’s physique as well as his
mental powers had increased during his evolution from
a barbaric condition into one of bienstance (his stature
and his strength, as well as his length of days, having
been increased pari passu with this improvement gra¬
dually), he has deteriorated in his bodily power, either
to resist the lethal effects of injuries, or to recover
from them as rapidly and as well as. his less favoured
barbaric ancestors. Nay, more: the cited illustrative cases
showed it apparently to be a fact that all tbe appliances p£
civilised life which most potently minister to-human com¬
fort and human enjoyments have a deleterious enervating,
effect on the animal frame, as wan demonstrated <said
Dr. Harley),toth by striking ample* drawn from gipsy

EXTREMES OF TEMPERATURE.

' It is not without cause that Englishmen so ceaselessly
grumble at the weather. There is no stability, no modera¬
tion about our climate. It is either very cold or very hot; or
if the general atmosphere be fairly comfortable the bitter
north-east wind makes us miserable. At this moment the
delicate have barely recovered from the sufferings inflicted
upon them by a cruel season, which had no legitimate
claims to be called Spring, when they are assailed with the
plague of summer heat. There is really no rest or peace for
any save the strongest In this “tight’’but ungenial “little
island” of ours. It is vain to preach caution. How can
the' most careful of mortals at'oid draughts when the
ordinary temperature in-dOStt la between 70° and 80° F. ?
Windows must be thrown open, and the air will rush in, which
is relatively, if not absolutely, of such lower temperature as
to give the sensation and do the deadly work of cold
draughts. So with clothing. In the sweltering heat it is
impossible to wear wraps which are nevertheless necessary to
protect the susceptible from those currents of air that rush
up side streets and round comers. If, regardless of comfort,
the weakly consent to endure these wraps, they cannot do
more than in a very moderate way defend themselves against
exceptional perils. Perhaps the wisest — certainly tbe
happiest—are those who have never, by pampering their sus¬
ceptibility, rendered themselves the creatures of conditions
in the presence of which it seems impossible to be either
contented or safe. .

SANITARY WORK IN PETERBOROUGH.

A iikport Which was presented to the Town Council of
this city by the inspector of nuisances in March last shows
a very discreditable state of things as regards refuse
removal. Wo are informed that house refuse is periodically
removed from 332 houses in a city which in 188L had a
population of 21,212, and it is added that great difficulty
is experienced witli occupiers of small tenements who allow
their ashpits to be filled to overflowing before they will
have them emptied. We are bound to infer that the
inspector is here speaking of houses other than the 332 as
to which periodic removal is in force; and we can only
wonder what else could be expected than the grave result
which he deplores, and ,which ensues “in the thickly
populated and poorer parts of the borough." It is a primary
duty of a sanitary authority to see that such refuse is
periodically removed from the neighbourhood of all dweliiags
within their jurisdiction, and this at very short intervals.
Occupiers should never be held to have a voice in dat arrafa t¬
ing the frequency of such removal unless they have a piece
of garden ground on which subh refuse can be properly
deposited at least onoa in every wuekt Where, as in Peter¬
borough, this is not possible, it is the obvious duty of ths

Digitized by vj ooQle

Tn* r LAkdBT,} ' r DEATH fEOM OVERCROWDING. ' ^' ■'T [jfllni-18, : 188% 124$

>anitary authority to undertake this duty themselves; and it
should he remembered that it is precisely the poor (who can
leither pay nor arrange for the frequent visit of a scavenger,
rad who prefer "to wait until there is a good load of stuff to
remove) who most need the intervention of the authority in
3uch a matter. Whatever the system or want of system is
hat prevails -in Peterborough, it is evidently one that
favours the retention in the vicinity of dwellings of the
r&ry materials which a sanitary authority should aim at
getting rid of at the shortest practicable periods.

COCAINE AND ITS USE AS A LOCAL ANES¬
THETIC IN DENTAL SURGERY.

Cocaine having now taken a place in the Dental Pharma¬
copoeia for various uses, it was desirable that some rigunU of
the literature of the subject, especially with reference to the
injection of the drag for producing an tee thesis, should be
made, and Messrs. Cunningham and Hern are to be congratu¬
lated upon the exhaustive character of their respective
communications to the Odontological Society. Both papers
cover much the same ground, and the conclusions arrived
at are very similar.. With regard to the physiological action of
cocaine, much experimental research has been performed by
von Anrep, Mays, Biggs, Hughes Bennett, and others; and
although the results recorded are not quite uniform, yet
these discrepancies are readily explained by the different
methods of investigation, and the varying degree of suscep¬
tibility to the drug of the individual animal or person,
‘Generally, it may be concluded that cocaine produces the
following effects:—On respiration it first increases the
number' of respirations, then decreases them; in larger
doses d^ath ensues from paralysis of respiration. On
the heart it has a depressant action,. reducing the force
and frequency of the pulsation, finally arresting the
auricles and. ventricles in diastole. In small and large
doses it. produces at first . constriction of the blood¬
vessels, ifith a rise of blood pressure, succeeded by a
considerable fall. Locally applied, cocaine also produces
contraction of the small arteries On the nervous system,
small doses increase the reflex irritability of the cord; large
doses reduce it considerably. On nerves, small doses
heighten the irritability of the sensory fibres, but exert no
effect on the motor fibres; larger doses completely paralyse
-sensory filaments and greatly diminish the irritability of
motor. Salivary secretion is markedly deficient in many,
and the temperature raised in some cases. A careful
examination of the very jarge number of cases of cocaine
injection now collected has led both Mr. George Cunning¬
ham q®d, Mr. Hern to express very much the same views, i
which we quote in the latter’s words, “In judging of the
practicability of the employment of cocaine as an anaesthe¬
tic for extractions, one has to weigh the advantages and
disadvantages of its employment, and compare it with
those agents for the production of general anaesthesia now
in i|se. After doing 8o tj I am led to the following con¬
clusion—via., that as an agent for general use in extrac¬
tion i—l. Ths physical barrier to injection which the bony
alveolus interposes. 2., The pain, however slight, due
to thft ptprcfeurq of the, syringe, 3. The ,mental suspense
due ,tp. thej necessity of waiting several minutes between
the injection apd operation.,. \ The. full consciousness
.un4er ^hicb tbe operation is performed. 5. The varying
idioayuftrasy; of .paints, [with^ eference t p the drug. <3. The
1 iucoustanay o£,pr<$ncrion. of; conaj^te; myesthesia. 7. The
1 °*oe^ty-^f 4o3P. W tb&t.pnly one part of the

> mouth, can be,safely yWaffiatbetjapfi, 8ame patient at a
giveaitime^nnd, that allow of. one, or at

4BO8 MF0t-teeth,, ; being ^ramayejL, .ail,' combine to

yafegatft.tba, to_a, PSP°adaryposition,

leaving nitrons oxide in the possession of the field ast

facile princeps for the va^t majority of such operations.
Other than for extraction there are various operations lh
which cocaine can be beneficially employed" - ”

THE HEALTH OF THE CROWN PRINCE OF “
GERMANY.

On Wednesday, June 8th, Dr. Morell Mackenzie, in the
presence of the Crown Princess and Dr. W. Wegner, removed
a second piece from the growth in the left vocal cord of
Hie Imperial Highness.. At a consultation held the following
Friday Professor Virchow read a most fully detailed report
of his examination of the growth, which he described ass
“pachydermia verrucosa.” He stated that the portion sub¬
mitted to him showed a great increase in the number and
size of the epithelial cells, some of which were empty,
whilst others contained-collqid matter, also that the papillae
were larger and more numerous' than 'in normal mucous
membrane. Numerous bloodvessels' and nerves were found
in the growth, but we believe no morbid producte ware
present in the submucous areolar tissue. Professor Viroho#
gave a most favourable prognosis. In View of Professor
Virchow’s statement there is reason to hope that the Grow*
Prince will in time be entirely cured, though it must not
be forgotten that recurrence is a characteristic feature of
these papillary growths. At the urgent request of Dk
M ackenzie the Crown Prince has ordered a detailed report
of Professor Virchow’s examination to be published, and'Dr;
Virchow has informed us that this report will appear in full
in this week's issue of the Berliner KUnisehe Wochenedhrift 1 .

DEATH FROM OVERCROWDING.

Although overcrowding is pretty general in manu¬
facturing towns, we seldom hear of a death from, this causa.
A case has, been recently investigated by Mr. Rowbottom,
the coroner for .Wigan. It transpired at the inquest that
the deceased, a young mam of twenty-two years of age, was
a labourer at some ironworks in the neighbourhood, and rer
tired to rest on the night of the 6th inst. in bis usual health.
He was called early next morning to go to his work, big
stated he Would not go that dap. The other occupants of the
room (lodgers) Went to /their work, and he was left alope. At
9.80 a.m. he complained to the landlady that his threat was
sore, and she applied a poultice. At 12.80 noon she sent for
Dr. Btadyt who 1 at once went to the man. and found the
atmosphere of the room in which he was overpowering. The
window was opened, and, after ex a mi n in g the man, he came
to the conclusion that he was suffering i from the effects of
mephitic gases; his throat wae of an intense purple eotaua
the neck slightly swollen, his general appearance indicated
inefficient aeration of blood, and there were spasms at times
of laryngismua stridulus. Dt .Brady gave directions aa to
treatment and left the house. The man died shortly after¬
wards. Hp made. an> attempt to vomit, fell back in. bed,
and died aaif dobing, Dr. Brady refused a certificate and
communicated with the coroner, dearing a second medical
m4n at the < postmortem.' The Coroner ordered a, post¬
mortem, ^ and'> baked .Mr. Berry,, tq be present witik
Dr. BradyJ > i The post-mortem' appearances were those
of poiaqning f by/ carbonic arid gas. The trachea was
intensely congested* se were also the bronchial tubes.
The right side bfi the heart was filled with :tvery
dark fluid bloisd; the tang* and kidneys Were oobgestnd,
and dark in cblbur. Thetaucous coat of the stomach Wste
in appearirace aU ir itainbd with port Wind lees. ^All the
Organs were healthy, with the exception of 1 this vetooti# iott 1 -
gestipn. There Was dpthing else to account' fbf dUath." It
was shown at the lnquest thot in this hohse, Wite ‘tWb
rooms above and two helpw (and these - small rodrhs),
eleven persons lived—a man, his wife, five children^

y Google

/

1260 The Lancet,]

THE NATURAL HISTORY OF WELL WATERS.

[Joke 18, 1887.

{oar grown-up men lodgers. In the room in which Dr.
Brady saw the man on his visit, were three beds. The room
was 7 ft. high, and 10 ft. 9in. by 11 ft. 8 in.: making allow¬
ances for recesses, and deducting space occupied by furniture,
a cubic space of 842 ft. Seven persons had slept in the room,
but the belief was that a larger number occupied it. The
landlady stated that the deceased had slept in the adjoining
room, which was a little less in cubic spaoe, and contained
two beds for the lodgers. The jury found a verdiot that the
deceased died from asphyxia caused by overcrowding. In
manufacturing towns like Wigan persons occupy houses
and take in lodgers, but, not having these registered,
they evade the Lodging Houses Act, and thus escape in¬
spection. The sanitary authority, however, should strive to
get houses like this one under its control.

THE NATURAL HISTORY OF WELL WATERS.

Another important contribution to science comes to us
from the celebrated laboratory and experimental farm at
Rothamsted. Sir J. B. Lawes and Dr. Gilbert, whose labours,
spread over a long period of time, have done so much for
agricultural chemistry, did wisely when a few years ago they
took Mr. Robert Warington into their scientific partner¬
ship. The present research stands in the name of the
younger worker only, although he carries on the work and
has doubtless been aided by the counsel of his distinguished
eonfrhre*. Mr. Warington's paper occupies more than fifty
pages of the current number of the journal of the
Chemical Society. It will be studied by all interested in
sanitation or scientific agriculture, and it contains such a
mass of facts and tables that it is not possible to give any
adequate idea of it in a narrow compass. Moreover, there
are as yet no great generalisations to record, but chiefly a
mass of statistical evidence which grows more detailed and
accurate, and therefore more valuable, every year. Fair
inductive reasoning is, however, applied to the facte. The
first section deals with the rain water of Rothamsted,
which has been systematically collected and measured since
1853, and which is evidently the basis of the whole inquiry.
The average proportion in one million parts of this water
is of chlorine 2-01, of sulphuric acid (S0 3 ) 2 52, of ammonia
035, and of total combined nitrogen 0 67. The last item is
equal to about 4-4 lb. per acre per annum. Then comes a
consideration of the drainage water. Ever since 1870
several isolated patches of prepared soil, consisting of
loam and flint resting on a clay subsoil, supported on
perforated iron plates and protected laterally by im¬
pervious walls, have been kept free from vegetation and
manure. The beds are respectively twenty, forty, and
sixty inches thick, and the drainage water is collected,
measured, and analysed. The thickness of the bed was
found to make no important difference, and the results
on the five-feet bed are taken as typical. Of 31-04 inches
of rain which fell on this soil, 17-09 inches evaporated and
1395 inches percolated below fire feet. In the drainage
water the chlorine was found to be the same as in the rain
Water, but concentrated by the evaporation; while the
nitrogen, as nitrates, was on the average 10 7 per million—
the process of nitrification being most active during summer,
while the principal discharge of nitrates was daring autumn.
The influence of vegetation is next studied. The conditions
at Rothamsted are remarkably suitable for experiment.
One celebrated field has grown wheat oontinnously since
1843, and one portion of it has never been manured. The
drainage water from each is carefully collected, measured,
and analysed. Vegetation, especially during its active stage,
increases enormously the surface evaporation by transpira¬
tion of water through the plant, and in our climate during
summer drainage is entirely suspended by the action of a
vigorous crop. Interesting details are given as to the quan¬

tity and composition of the drainage water at vancci
seasons of the year, especially with reference to the pceceu
of nitrification and the absorption of nitrogen by growing
crops. As to evaporation, the results seem to show that, ia
round numbers, about one-half the rainfall of the year
percolates through bare soil, and about one-third through
unmanured soil cropped with wheat. This, of course, is
only true under the conditions prevailing at Rothamsted.
Armed with these valuable factors, Mr. Warrington has, with
laborious skill, investigated the well waters of the neigh¬
bouring village of Harpenden—somo of which are uncon-
taminated, while others are certainly contaminated. We
must refer to the original paper for the very interesting
observations which the author has mads upon these work*
and their apparently eccentric contamination. He does no:
profess to explain all the anomalies, but, knowing and
using as a basis the composition of the uncontaminated
waters of the district, lie has been able to throw light upoa
some of them. The effect of season, variation of rainfall,
and local circnmstauoee upon the composition of the well
waters is amply illustrated, and the large quantities of
ealcinm, magnesium, and sulphuric acid in the polluted
waters is both interesting anl important. From the whole
study we gather the general inference, by no means new to
the experienced chemist, that it is very unsafe to give ■
definite opinion on the quality of a water without a greater
knowledge of its source than can be gained by a man
analysis. The analysis is essential, but it can only be
interpreted by what in medical practice is known ss the
family history of the case. _____

PROF. GAYET ON OPHTHALMIA NEONATORUM.

Db. Gayet, Professor of Ophthalmic Surgery in Lyons,
nrges his pupils, in a clinical lecture on Ophthalmia Neona¬
torum, published in La Pro vines Midicale, to search diligent! j
for the gonococcus of blenorrhagia in all cases of ophthalmia
occurring in very young infants. It does not, he says, require
any extraordinary skill, and can be accomplished in as ah or.
a time as the ordinary examination of urine for albumen.
A particle of the pus is placed on a glass slide and spread
out by means of a second slide; the two are then separated,
furnishing two preparations. They are stained by dropping
a mixture of an alcoholic solution of methyl blue with
an equal volume of water on them, allowing it to remain
for two minutes. They are then washed with plenty
of water. On microscopic examination each of the
leucocytes will be seen to have two, three, or four
nuclei, this being a special character of the disease,
the increase in the number of nuclei heralding the approach
of the gonococci, which will be observed as intensely blue
spherical bodies in the interior of some of the leucocytes.
If only one leucocyte so invaded is discovered, the diagnasi*
of blenorrhagic inflammation is rendered certain. With
regard to treatment, the child most be watched “ like milk
on the fire,” the visits being more than one per diem. Three
indications present themselves: 1. To clear away the agent
of infection. 2. To prevent its development. 3. To destroy
it where it is. To fulfil the first, frequent and careful
washing oat is requisite. The eyelids should be everted, the
mucous membrane stretched, and all the folds of the con¬
junctival sac thoroughly syringed oat with a ball syringe;
the eyelids should then be replaced, well nibbed on
the outside, again everted, and the syringing repeated.
In this way all the pus will be removed, bat it is
a somewhat difficult and tedious operation. In order to
destroy the microbes which have already penetrated fat*
the substance of the conjunctival mucous membrane, they
must be pursued and attacked by the soKd mitigated xrttnte
of silver, a solution of common salt being afterwards em¬
ployed to neutralise any superabundance of caustic. Ike

Digitized by GoOgle

TsoiLAircM,}

THE NATIONAL MEDICAL C0NGRE8S OP ITALY.

[JtntB 16,1887. 1201

mother should be directed to wash the eyes with a solution
of corrosive sublimate (1 to 6000), and to keep small com¬
presses wet with iced water on them. When the disease
appears to be cored it is necessary to be on the look-out for
a return; the microscope should therefore be in constant
requisition in order to detect microbes, even after all appa¬
rent discharge has ceased. The most favoured prophylatic
measure by Dr. Gayet is the employment of a vaginal douche
with a 1 to 6000 corrosive sublimate solution at the com¬
mencement of all labours, especially when the woman suffers
from leucorrhoea, in which case the child should not be
allowed to remain too long in tbe passage.

THE NATIONAL MEDICAL CONGRESS OF ITALY.

Ocra Rome correspondent writes:—“The Italians are
possibly ‘over-doing if’m the matter 6f congresses, but
considering how jealously public meeting used to be
restricted even on purely scientific subjects, the error is a
venial one and quite on the right side. On the 1st insh
tbe National Medical Congress opened its sittings here
in the great ball of tbe Senatorial Palace in the
Capitol. Three hundred medical men from all parts of the
peninsula were present, and on the presidential platform
Signor Crispi, Minister of the Interior, represented tbe
Government, tbe Dnke, Torlonia the Municipality, and a
number of well-known physicians and surgeons the various
medioo-ohirurgieal associations of the city and provinces.
T*w feature of interest was the eloquent speech of Crispi,
who claimed a morn than official—a personal—interest in
the Sanitary' Cods of the late Dr. Bertani, brought before
Parliament by the Prime Mini*ter, Depretis. Bertani, tbe
surgeon-in-ehief of Garibaldi’s patriotic campaigns, whose
premature decease some thirteen months ago was com¬
mented on in Th* Lancet, abandoned a brilliant academic
and civic career to minister to the wounded red-shirts, and
after their common goal was won devt ted himself heart and
soul to a department of medicine ooa paratively unfamiliar
to him—public health—that he might render physically and
morally sound and strong the nations! life he had helped to
unify. Orispi’a Slope qt his friend was in his happiest vein,
and seemed to infuse a genial spirit into the more formal
speeches thatcaUae after. The progra nme of the Congress,
an extensive one, in harmony with the sentence of Cicero,
inscribed in imposing characters ove r the entrance-portal,
"Hominam Vitro et Saluti Coasuleudum,” will doubtless
give ocoaeion to discussions of interest, not only for Italian
medicine, bat far that of other States.”

EARLY DIAGNOSIS OF PHTHISIS.

As an original contribution to the Revue Internationale
dee Scienaet MSiiealet, No. 6, Dr. E. Martel, writes on the
, early diagnosis of pulmonary phthisis by an examination
of the larynx. We cordially concur in the statement that
to diagnose pulmonary tuberculosis as soon as possible is of
tbe highest importance in tbe treatment of this affection,
but far more evidence than has yet been adduced will be
required to sustain M. Martel’s principal proposition, to
the effect that a “ paralysis or a paresis of a vocal cord, with
or without derangement of phonation, indicates in nearly
all cases an incipient pulmonary phthisis.” In other words,
the discovery of an imperfection in the action of one vocal
cord is equivalent to proving that tbe patient so affected will
eventually develop unmistakable signs of phthisis, and this,
too, in the lung of the same side as the impaired vocal cord.
The impairment of the action of the vocal cord may precede
the development of physical or other certain signs of phthisis,
even by aa long a period as four years. M. Martel’s own words
may Be quoted, as they are so very remarkable and emphatic:
“I have always examined thelarynx even when there wereno

signs pointing to mischief therein, and I have been surprised
at the number of ‘ lame’ vocal cords which it has been my lot
to examine; but we ought not to say, as soon as the dis¬
covery of a weakened vocal cord is made, that the apex of
the left lung will become tubercular in a nearer or more
remote future; there are exceptions, and aneurysm of the
aorta, tracheo-bronchial adenopathy, and tumours of the neck
may lead to functional troubles of the vocal organ.” Never¬
theless, in the next paragraph, M. Martel avers that in all
cases of examination of the thorax or neck we shall find
the cause of the vocal paresis; whilst in incipient phthisis
the long will appear to be healthy to physical examination
of all kinds, and yet the lameness of the voo&l cord alone
will suffice for ns to assert that something abnormal is
taking place on tbe same side of the respiratory apparatus

(Jong). •_,

MEANS OF ISOLATION AT SALFORD,

In view of tbs contemplated purchase by a rail way company
of tbe existing infectious hospital for Salford, Sr. Tathamhas
submitted to his . sanitary authority an able and exhaustive
report on the principles which should govern them in the
provision of a new hospital Care has been taken to study the
whole subject, and Dr; Tatham has interviewed tbe depart¬
ments of the Local Government Board in order to. elicit from
them any expression of opinion formed since the last official
publications were made an the subject. As a result of these
steps, Dr. Tatham recommends that 200 beds- at the rate of
one bed per 1000 inhabitants—should be provided as the
permanent accommodation for the borough, and he enters
into details as to the plan on which these should be arranged
in different pavilions. The subject of tbe isolation-of small¬
pox patients in urban communities is for the moment net
dealt with, because the Mousall Hospital, affiliated to tbe
Manchester Royal Infirmary, is available for the reception
of eases of that disease. But this;’ it is'adhiUted, if not
likely to be a lasting arrangement} and when it comes to an
end this very difficult problem will .have to be faced in
Salford. Dr. Tatham’a report is so complete that its perusal
would well repay those authorities and officers who have
the provision of infectious hospital accommodation in
contemplation. , _,

ACUTE INFECTIOUS MYOSITfS. ’

Thu subject of myositis which Mr. Treves brought under
tbe notice of the Clinical Society last year has been further
illustrated in a paper read by Dr, Jackson at a recent meeting
of the Massachusetts Medical Society. 1 The case was that of
a woman aged thirty-six, who had. been seen by Dr. Jackson
when in Strasburg. The illness began with malaise, sore
throat, and a red papular eruption on tbe face, which dis¬
appeared in a week’s time. Then occurred swelling, accom¬
panied by pain, in the shoulders, legs, and sacral region.
There was moderate fever, except at the close, when the
temperature was high and pneumonia occurred. There
was alight cedema of the face and extremities, the
muscles of the limbs being fixed and rigid, exten¬
sion causing pain. . There was paresis of the soft palate,
diminishe d electrical reaction, and absence of refluxes., The
patient died a week after admission. Professor Kussmaul,
who .had charge, of the case, diagnosed a diff used myositis,
and said the. case reminded him. clinically of, one in which
thousands of miliary aneurysms were found all oyer the body.
Trichinosis was at first thought of, but was eliminated by
the history and the absence of gastro-intestinal prodromata.
The post-mortem examination was made by Professor von
Recklinghausen, and it was found that the musolas through¬
out the body, especially in tbe extremities, the trunk, and
the face, were p&le and moist, many had small haemorrhages

1 Boaton Medical and Surgical Journal, 1887, No. 31.

Digitized by boogie

1262 Thr I^ngst,]

THE LOCAL DISTRIBUTION OF PHTHISICAL LESIONS.

[June 18, 1887.

in thou sheaths, whilst their fibres were waxy and granular,
and the interstitial tissue was infiltrated with round cells.
In the discussion on the paper, Dr. Fitz remarked on the
liability of the muscles to participate in infective processes,
and suggested that in the case related by Dr. Jackson
diphtheria may hove been the primary source of the infective
inflammation. _,

AMBULANCE ARRANGEMENTS FOR THE JUBILEE
PROCESSION.

Wk are glad to be able to state that Colonel Sir Charles
Warren, Commissioner of Police of the Metropolis, in
view of the probability of accidents which must neces¬
sarily oocur on an occasion when large masses of people are
gathered together, and of the possibility of cases such as
sunstroke, syncope, &c., due to the present 'sultry
weather, has taken the precaution of arranging with
the Chief Surgeon of the Metropolitan Police for ambu¬
lances to be stationed at various points along the
route over which the procession will pass. The actual
stations of such ambulances will be notified in the police
orders. We farther understand that in addition to those
possessed by the police a certain number of ambulance
vehicles will be supplied by the Order of St. John of
Jerusalem, and that if the permission of the General Com¬
manding the Home District be obtained the services of the
various companies of the Volunteer Medical Staff Corps will
be available at their respective hospitals or at any point
along the route where their presence may be deemed
desirable. It may be interesting to add that in the ranks of
the police are a large number of men who have previously
served in the Army Hospital Corps, and who have been
therefore selected for apodal duty on this occasion.

THE LOCAL DISTRIBUTION OF PHTHI8ICAL
LESIONS.

In a memoir upon the pathology of pulmonary diseases
{ZeiUchrift f. Klin. Med., abstracted by Sahli in Forteckritte
der Medicin, No. 11,1887), Dr. A. Hanau suggests that the
reason for the preference of the apex of the lung for the
initial lesion of phthisis is to be found in the comparatively
weaker expiratory power of this part of the organ. In
support of this he cites the frequency with which anthra-
cotic and chalicotic processes we to be met with at the apex
or a short distance below, corresponding to the sites of tuber¬
cular foci. Being unsupported, the apex of the lung can be
fully expanded by inspiration, but it is less under the influ¬
ence of expiratory forces than the lower parts of the lung.
As a consequence, in forced breathing the air is very likely
to stagnate in the apex; and, as Mendelsohn showed with
respect to emphysema, there may even be a reflux of air
from the normally acting lower parts of the lung into the
upper. The comparative immunity from tubercular phthisis
enjoyed by the subjects of spinal curvature, by those whose
longs have become cirrhotic, fcs coal miners, or the emphy¬
sematous, may in each case be attributed to defective power
of inspiration possessed by the apex or the whole lung in
such conditions. The selection of the middle lobe and lower
part of the upper lobe for the occurrence of eeeoadary foci
due to the aspiration of the contents of cavities which have
escaped into the bronchi is also explained. Usually the
areas of broncho-pneumonia arising from aspiration of
noxious matter are to be found in the lower and posterior
parts of the lung. This is due to the dorsal decubitus of most
of the patients in whom this complication supervenes. But
it is otherwise in phthisis when the subject is not confined
to bed, for the regions next to be involved to the apex, and
infected secondarily from it by means of aspiration, are the
middle lobe and contiguous part of the upper lobe. These

regions are the most liable to be fully distended in coughing,
and the products of the apical vomicte will be more readily
pressed in their direction by the backward current of air.
Hanau also ascribes the frequently rapid extension of
phthisis in women after childbirth to the aspiration of the
contents of cavities into previously healthy parts or the
lungs following on the extraordinary respiratory efforts
made during parturition. Aspiration as a factor in the dis¬
semination of tubercular lesions is not perhaps as fully
recognised as it should be, but it certainly serves to explain
the matter in a plausible way, and is in absolute harmony
with the doctrine of the local infectivity of tubercular
products, which is so admirably illustrated in the distribu¬
tion of the lesions of uro-genital tuberculosis.

THE MATHEMATICAL TRIPOS, 1887.

The list of Mathematical Honours for the current year
exhibits some rather interesting features. In the first place,
it is remarkable that four names are bracketed together for
the post of “ senior” in the Tripos, Trinity and St. John’s
equally dividing the honour. Of the thirty wranglers,
Trinity claims nine; St. John’s end Christ’s, four; Ring’s
College, three; Emanuel, Pembroke, and Sidney, two each;
whilst Peterhouse, Jesus, Corpus, and Queen’s each supply
a single wrangler. Caius College, winch in farmer days
furnished so many senior wranglers, and nearly always had
a candidate high up in the list, this year supplies no
wrangler. It would be interesting to inquire whether
this decline in the mathematical honour list is exceptional
and due to accidental causes or to failure in drawing
mathematic talent to the College. Caius College has been
the foremost in providing handsomely far the requirement*
of natural science teaching, and its success in that direction
has been very marked; it is just possible, therefore, that
some of its best scholars have been attracted in that direc¬
tion, and have sought for honours in the Natural Science
instead of the Mathematical Tripos. If such should prove
to be the case, we may regard the present decline of this, sail
might almost be called, Medical College as regards its position
in the Mathematical Tripos with equanimity, and indeed
with satisfaction, as showing that the medical profession L
attracting some of the best intellect at the College to tbe
scientific training necessary for its successful cultivation.
Among tbe successful Colleges this year in the Tripos,
Christ’s certainly deserves the palm; though considerably
smaller than 8t. John’s College, it furnishes an equal number
of wranglers, three of whom ace in the first thirteen. This,
again, is another instance of a change of tradition, since in
former years Christ’s was regarded more as a classical than
a mathematical college.

FREE LIBRARIES AND CONTAGION.

No public institution is so fortunate as not to he liable to
misuse. It is not, therefore, to be wondered at that the free
library, notwithstanding the benefits it undoubtedly oonfens
has been found to have its disadvantages. A complaint has
been laid against it that it may, and sometimes does,
become the means of carrying infection. A correspondent,
writing a few days ago, quotes what seems to have been a
oase directly in point. A child obtained from the library &
book which had just come from a house in which there was
scarlet fever, and two days later was taken ill with this
disease. The period of incubation in scarlatina is somewhat
variable, but it is not incompatible with the view that tbe
book was here the medium of infection. Whether the
disease could not have been traced to any other possible
source is uncertain, but, at all events, this case indicates a
danger which appears to be inseparable from the free
library system. The only possible safeguards are to be

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Tba Lancrt,]

THE NEWINGTON MEDICAL OFFICBR OF HEALTH.

[Jcnb 18,1887. 1268

found—firstly, im a compulsory notification of infectious
disease to the librarian, and secondly, the subjection of
every returned book about which there is any doubt on the
score of contagion to a process of disinfective fumigation.
In this connexion reference may be made to an incident
recorded in a Russian periodical. Typhus fever has recently
been very prevalent ill Sebastopol, and it is stated that its
ravages were to some extent controlled by the judicious action
of the librarian of the town library, who appealed earnestly
to the subscribefs to cease temporarily from changing books
in case of the fever appearing in their respective families.
In this way the frequenters of the library and the readers of
the books lent out, as well as tlie staff of servants and
librarians, have been saved from infection.

A NEW AND IMPERVIOUS DRESSING.

Photoxylin, a substance in use amongst photographers,
was recommended some time ago by Dr. Erysinski as a
Suitable material for mounting microscopic specimens, and
more recently still it has been utilised by Prof. Wahl of
St. Petersburg as a substitute for collodion in surgical
practice. A 5 per cent solution in equal parts of alcohol and
ether he finds preferable to collodion, as it adheres more
firmly to the skin, not being so easily rubbed off in washing.
It is Absolutely imperv ious to liquids, and exerts a perfectly
even compression on the tissues. In out-patient practice
Prof. Wahi fitds that, after small operations such as the
extirpation of glands, the application of phoboxylin solution
enables him to dispense entirely with voluminous antiseptic
dressings; also in plastic operations on the face, and in
operations in the neighbourhood of the male congenital
organs, such as those for the radical cure of hernia and
castration, where it is very difficult to prevent the urine
soaking through antiseptic dressings. Prof. Wahl, after
carefully arresting all hemorrhage, closes the wound with
sutures and gelatine plaster, and then covers the whole with
a thin layer of wool soaked in a solution of photoxylin.
This, it is stated, will remain eight or ten days, entirely
resisting all the effects of moisture. Even in laparotomy,
extensive dressings may, he believes, be dispensed with
by painting a solution of photoxylin over the wound with
a brush, or by the application of . a layer of cotton wool
soaked in the same liquid. Photoxylin appears to be unknown
in this oountry. It was introduced by Messrs. Mann of St.
Petersburg. '

THE NEWINGTON MEDICAL OFFICER OF HEALTH.

Wk regret the action which has been taken by the
Newington vestry in connexion with the office of medical
officer of health, which has become vacant by the death of
Dr. Iliff. ' The bye-laws of the vestry are specially contrived
to prevent vestrymen from taking paid offices, and to secure
the election of the best available persons. Thus, “no
vestryman shall be eligible for nomination or election to any
paid office or place under the vestry, and no person shall be
nominated or elected to any such paid offloe within six
months after he shall have held the office of vestryman.”
And further, the mode of election by selection from amongst
candidates is provided for. In the face of this the resigna¬
tion of Mr. G. Millson, L.R.C.P., a vestryman, was accepted at
the first vestry meeting after D*. Iliffs death ; Mr. Millson’s
offer “ to discharge the dutiea of medical officer of health
gratuitously until such time a* the vestry see tit to elect a
permanent officer ” was accepted; and it was decided “that
the appointment be reviewed not made—* 4 at the expira¬
tion of six months.” In our judgment nothing could have
been contrived which would more completely frustrate the
intention of the bye-laws than the steps which have been
taken,

REG. v. THE GENERAL COUNOIL OF MEDICAL
EDUCATION AND REGISTRATION.

Wb publish in another column an. important judgment
delivered in the Queen’s Bench Division in regard to the
power of the Medical Council to remove the name of dentists
from the Dentists’ Register in cases in which the qualifications
on the strength of which registration had been effected had
been withdrawn by the medical authorities granting the
said qualifications. The questions raised by this decision
are so important, and the report reaches us so late, that we
defer comment till next week. It will be seen that judg¬
ment is given in favour of Mr. Partridge, who held a
diploma in dentistry from the Royal College of Surgeons
of Ireland, which Was withdrawn on account, as alleged,
of. his advertising to attract business. The Council, with¬
out an independent examination of the facts, merely on
the ground of its duty to keep a correct Register, erased his
name. The mandamus, ,o* application on behalf of the
Medical Council, will no( be drawn up for. A week.

DRINKING TROUGHS AND GLANDERS.

At a recent meeting of the Commission of Sewers, the
Streets Committee advised the non-erection of a drinking
trough in Farringdon-street on the ground that it was
likely to serve as a means of disseminating glanders. This
is a serious indictment, and it is said to be supported by the
observations of several veterinary surgeons. It would be
interesting to learn on what precise statistics it is founded,
and the mere assertion made on such authority justifies an
inquiry into the subject. In consideration of the un¬
doubted benefit which these troughs confer upon travelling
cattle, the sufferings of which in hot weather would often
without them be very great, it is to be hoped that the Com¬
missioners will not aocept the recommendation of their
committee unless it is fully fortified by proof, but it would
certainly be well for them to consider the alternative
proposal made by one of tbeir number, that the drinking
trough should be so constructed that the water within it
any be kept running, and thus be constantly renewed.

DEATH OF DR. OXLEY OF LIVERPOOL.

Dr. Martin G..B. Oxlby, senior physician to the Liver¬
pool Infirmary for Children, died at Llandudno shortly after
midnight of the 13th inst. The deceased was a student
of King’s College, became M.R.C.S. Eng. in 1862, and later
on M.K.Q 1 &PX and 'M.ILSt. And; Borne year* ago he
suffered from mitral disease of the heart, for which he
was attended by Dr. Glynn of LiverpooL He rallied from
this, and.after some months’ rest resumed practice. But he
had several re lapses and recently went to Llandudno, where
he hoped 1 to benefit by the sea air and change. He was
attended by Dr. Dalton, and it was hoped that he would
recover. But a change for the worse occurred, and at
12.30 a.m. on the 14th inst, be expired. He leaves a widow
and two sons to mourn their loss, as well as a large circle of
professional and lay friends, among whom he was extremely
popular. _

FEVER AT STAPLEFORD.

Staflbford, in Nottinghamshire, is under the jurisdic¬
tion and mismanagement of the Shardlow rural sanitary
authority, and the Local Government Board having apparently
failed'to : induce the authority to do away With the condi¬
tions periodically leading t6 fever prevalences in the pl*ce,
have at last reminded them of the frequency with which
the water supply, has been condemned as dangerous, of the
faulty systenp of midden-privies and the lack of drainage,
and have finally thrown upon them the responsibility,£qr

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] 254 Thk Lancet,]

EUSTACHIAN OBSTRUCTION IN DIABETES.

[Junk IS, 1887.

such further disease and mischief w may result. In such
cases the Local Government Board have no power of
enforcing the adoption of proper sanitary measures unless
definite complaint is made to them of default under
Section 299 of the Public Health Act, 1875. The matter
must, therefore, now rest with those who elect the authority
and reside in the district. .

CONVERSAZIONE AT THE ROYAL COLLEGE OF
1 SURGEONS.

A very successful conversazione was given by the
President, Mr. W. S. Savory, F.R.C.S., at the Royal College
of Surgeons on Wednesday evening last, nearly twelve
hundred ladies and gentlemen being present, including a
large number of nurses from St. Bartholomew’s Hospital,
whose dresses lent picturesque variety to a brilliant scene.

DR. DE GROOTE ON HOT CLIMATES.

In a work on "The European in Hot Climates,” recently .
published by a Belgian naval surgeon, Dr. de Groote, Central ■
Africa irt general and tbte Congo in. particular are dealt
with. With regard to the.Congo, the authpr considers the
climate more healthy than those of Brazil and the
English and Dutch Indies. A good deal of practical valuable
advice is given to travellers, emigrants, and colonists, for
whom the work is mainly intended. The directions given
for the immediate treatment of medical and surgical
affections when out of the reach of professional aid will
also prove valuable to this class of persons, and in the
opinion of Dr. Thiriar, of Brussels, who has reviewed it in
La Clinique, the amount of information given under this
head is just what is required.

EUSTACHIAN OBSTRUCTION IN DIABETES.

Writing in the Revue Mmsuelle de Laryngologie, fyc., '
No. 6, on the troubles of hearing sometimes coitoplatned of
by diabetics, M. Miofc comes to the conclusion that the
swelling, with oedema of the Eustachian tube, is a compli¬
cation of diabetes which does not yield to ordinary treat¬
ment, but is amenable to- the -continuous current, which
diminis hes the congestion of the mucosa and allows of the ;
introduction of bougies, as well as the employment of
galvano-caustic agencies. The last-mentioned means appears
to be the most efficacious and rapid method of restoring the
functions of the canal._

HONORARY DEGREES OF DUBLIN.

It is probable that several members of the British Medical
Association will receive the degree of M.D., honoris causd,
at the hands of the University of Dublin on June 30th—Sir
James Paget, Sir Spencer' Wells, Mr. Simon, Professor
Gairdner, and Dr. Edward Waters. It is intended to confer
the degree of LL.D. on Prince Albert Victor on the same day.

THE PASTEUR COMMITTEE.

Wb learn that the report of the Government Committee
appointed to inquire into the efficacy of the Pasteur method
is revised, and will be signed in a few days when sent round
to the members of the committee. • It Will probably be in
the hands of Mr. Ritchie by the end of the week, when he
will, no doubt, lay it on the table of the House.

DEATHS OF EMINENT FOREIGN MEDICAL AND
SCIENTIFIC MEN.

The deaths of the following foreign medical and scientific
men are announcedM. le Dr. Rochas, General Secretary
of the Rhone Medical Association.—Dr. L. K. Wagner of
Kharkoff.

THE MEDICAL DEFENCE UNION.

The Transactions of the Medical Defence Union are before
ua in pamphlet form, and give an account of the position of
the Union in respect of membership and the action of the
executive. The members amount to about 554. As regards
action, some disappointment may be felt that it approaches
so nearly to inaction. But this feeling will be modified on
a careful perusal of the statement. For one thing, it seems
quite candid and complete, telling the reader the various
cases in which the action of the Union has been invoked,
and the reply of the Union, with its reasons, which are
generally sound and sensible. We do not think the worse of
the Union for not proceeding heroically and sensationally,
and it will take a stronger position if it acta slowly and
wisely. 1_

DR. GRAILY HEWITT.

After twenty-two years of service, and in consequence
of the pressure of private and other engagements. Dr. Gnilj
Hewitt has resigned the chair of Obstetrics and Gynaecology
in University College and his post of physician to the hos¬
pital. In accepting this resignation, the Council of the
College passed a resolution expressing their high appre¬
ciation of the very eminent services which Dr. Hewitt has
rendered to the College and hospital during the long period
he has held the chair._

CONSULTATION FEE8 IN RURAL FRANCE.

The bureau of the Haute Garonne Medical Asso ci ati o n
has been informed that sometimes a general practitioner
calling iR a consultant expects to be given a portion of his
fee—in fact to receive a commission on the transaction,
in the way In which commercial men remunerate others
who introduce business to them. The bureau, being
asked to express an opinion on this matter, had no
hesitation in characterising any transaction of the kind
amongst medical men as highly undignified. It added
that the general practitioner is entitled to a consultation
fee as much as the consultant, and that it would be a
desirable practice to intimate this to the patient.

SIR FREDERICK ABEL.

We regret to learn that Sir Frederick Abel, chemist to
the War Department, has had an attack of doable pneu¬
monia. He is at present at Woolwich, and is considered by
hia-medical attendant, the medical officer of the Arsenal, to
be' convalescent. The eminent chemist appears to have
“caught a chill” while attending a public ceremonial.

GRANTS FOR SCIENTIFIC RESEARCH.

Wb may remind our readers that the Scientific Grants
Committee of the British Medical Association will shortly
meet to consider applications for grants in aid of medical,
surgical, and collateral research, to which purpose £300 i*
annually devoted. Applications should be forwarded to the
office of the Association, 429, Strand, where particulars may
be obtained of the conditions under which the grants are
allotted. _

HENLEY REGATTA.

We have ascertained that, after all, there is as yet no new
regulation in force to prevent the befouling of the London
drinking-water supply by the house-boats that will gather
together in such large numbers at Henley during the
regatta week. The new bye-laws framed to prevent the
contamination of the Thames still await the Royal assent.
We shall deal more fully with this important question in
I our next issue.

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TH» Lancet,]

FOREIGN UNIVERSITY INTELLIGENCE.

[Juris 18,1887. 1256

. SCARLATINAL KIDNEY^.

The interesting contribution to the Pathological Anatomy
and Histology of Scarlatina, appearing in the pages of the
Birmingham Medical Review, from the pen of Dr. George
Crook, whilst confirming the general troth of Klein’s histo¬
logical observations on the changes in the arteries and
arterioles, states that the hyaline change is Hot met with so
frequently or so well marked as Klein described. “ Intersti¬
tial changes are undoubtedly rare in the first week, but in
two cases their presence in the form of cellular infiltra¬
tions around the glomeruli, and in patches along the vessels
ill the labyrinth, could not be overlooked.”

FOREIGN UNIVERSITY INTELLIGENCE.

Berlin .—Professor B. Fraenkel has just commenced work
in his newly established University Policlinic for Nose and
Throat Diseases.—Dr. Thom, assistant medical officer of
Professor Olshausen’s University Gynecological Clinic, has
been appointed to succeed Dr. 'Ilofmeier, who has gone to
Giessen.

Buda-Pesth — Professor Jos. Wagner, Director of the
Second Medical Clinic, having held the professorship for
forty years, is about to retire.

Dorpat. —Dr. Weil, Professor of Special Pathology and
Therapeutics, who has been away during the winter endea¬
vouring to recruit his health in the south, not having derived
as much benefit as was anticipated from the climatic change,
is now unfortunately obliged to relinquish all hope of
returning to his work, and is therefore resigning his chair.

Kief .—The medical library of the late Professor E. E.
Mir am has been presented to the University.

Prague (Bohemian University).—Dr. Karl Pawlik of
Vienna has been appointed Professor of Midwifery and
Gynaecology.

St. Petersburg— Mdme. Auer, daughter of the late Dr. E.
V. Pelikan, has given her father’s valuable library te the
Military Medical Academy.—Drs. Hertsenstein, Gendenreicb,
Oy dak off, and Sirotinin have been recognised as privat-
docenten. _

It is officially announced that the Dean of Westminster
has received the Queen’s permission, and also the sanction
■of Her Majesty’s First Commissioner of Works and of the
Lord Chamberlain, to repeat the Jubilee service in the
Abbey on Wednesday, 22nd inst, at 3 p.m. The service,
which will include musical additions, will be held for the
benefit of London hospitals. One third of the proceeds will
be given to the Hospital Sunday Fund, which this year will
lose the annual collection in the Abbey, one third to West¬
minster Hospital, and the remaining third wlH be divided
between the Hospital Saturday Fund and the Western
Dispensary. Tickets, at prices ranging from one pound to
half-a-crown, will be issued by the Secretary of West¬
minster Hospital, to whom alone .application should
be made. _

' The recent inquiry into the charges made against the
Health Committee of the Manchester Corporation by the
elective auditors has resulted in the finding that no charges
of fraud have been sustained against any member of the
committee or the committee’s responsible officers, and that
6hA shortcomings were no more than might be discovered
id any other concert, public or private, of equal siie.

At a meeting of Convocation of the University of Oxford
on the 9th inst. a gipant of £100 a year for three years fbr
thA purpose of providing instruction intnateria medici and
pharmacy was carried by 38 votes tip. 4j9,.

We regret to announce the death of Mr. J. Beswick
Perrin, M.R.C.S. E., of Leigh, Lancashire. Mr. Perrin was
for some years Demonstrator of Anatomy in King’s College,
London, and afterwards at Owens College, Manchester, and
will be remembered by many old friends and pupils as a
most able dissector, an ardent anatomist, and an excellent,
teacher. After leaving Manchester, he settled in practice at,
Leigh, and soon became extremely popular and muck,
respected in the district. In his earlier days he wrote many,
interesting and valuable anatomical papers in the Medical,
Tunes and Gazette, the Journal of Anatomy and Physiology,-
and the Transactions of the Zoological Society.

Thb eleotion of an Assistant Physician to the Royal
Alexandra Hospital for Sick Children, Brighton, took plaoe
last week, there being six candidates, all of whom were
highly qualified. Mr. W. C. Chaffey, M.B. Lond., late regis¬
trar to the Great Ormond-street Hospital, London, was
elected by the Committee of Election, who had no personal
knowledge of him; he was chosen purely on the ground of
merit. The elections at this hospital being carried out
by an Election Committee, canvassing either directly or
through an agent disqualifies candidates.

The borough of Oldham is about to receive a charter as
a quarter sessions district, which will entail the appoint¬
ment of a borough coroner. The only medical candidate
is Dr. George Thomson, his opponents so far being all
members of the legal profession. Our views of the ques¬
tion of medical coroners are well known, and we wish Dr.
Thomson every success in his candidature.

Another outbreak of diphtheria has occurred on the
Danish corvette Dagmar, which recently left Sheerness to
resume her training cruise in the North Sea. The patients
have been admitted by the naval authorities to the in¬
fectious wards of Melville Hospital, where three of the
Dagmar s crew have been confined since the 29th ult.

At the last meeting of the Royal Medical and Chirurgical,
Society, Profe9Bors W. H. Flower, Michael Foster, and Sir
William Turner were elected Honorary Fellows, and Pro-'
feasors John S. B .llings, Frederick Esmarch-, and Richard'
von Volkmann, Foreign Honorary Fellows of the Society;
Dr. S. J. Gee was elected Honorary Librarian. '

The Queen has been pleased to appoint James Patrick'
Tulloch, M.B., colonial surgeon for the Island of Tobago,
to be an official member of the Legislative Council of that
island. . _

A severe epidemic of measles is raging at Winaford,
Cheshire. The whole of the schools in the town are closed.

Testimonial to Mr. Godart.— It is proposed to
present a testimonial to Mr. Godart upon the occasion of
his departure for Sydney after thirty-seven years’ service as
pathological and anatomical draughtsman in the Medical
School of St. Bartholomew’s Hospital. A meeting will be
held in the anatomical theatre on Saturday, July 2nd, at
1 P.M., to determine the form which the testimonial shall
take. Subscriptions may be sent before that date to Mr.
b’Arcy Power, Curator of the Museum, 26, Bloomsbury-
equare, W.C.

A Physician attacked by Robbers in Havana.—
Dr. Vincente de la Guardia, a much-esteemed physician in
Havana, was recently attacked and robbed in or near the
city. He defended himself with vigour, but was unfortu¬
nately wounded ,

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1256 Thb Lancet,]

PHARMACOLOGY AND THERAPEUTICS.

[Jpnh 18,1887.

Iptemmtologg anir ®|cragnitit3.

TERTIABY ALCOHOLS.

Db. B. M. Shapibofp has made a number of observations
on the physiological action of tertiary alcohols, and especially
on that of dimetbyl-etbyl-carbinol, a tertiary amyl alcohol
obtained by the action of chloride of propionyl on zinc
methyl. In its pure form this substance is a clear oily liquid
■with a strong odour. The melting point is 12° C.; the boiling
pomt is 102-6° C.; and the specific gravity at 0° C., 0-828. On
oxidation acetic and propionic acids are formed. When 0-001
to 0 005 gramme is injected under the skin of a frog, the first
effect is to cause stupor—i.e., depression of the cerebrum;
after which paralysis of the spinal cord is induoed, evidenced
by the arrest of the lymphatic hearts, the centres for which
are, according to Veliki, located in the cord. No direct
effect is produced on the hasmic circulation. In warm¬
blooded animals dimethyl-ethyl-earbinol diminishes the
blood pressure, paralysing the vaeo-motor centres, but does
not exert any direct action on the heart. On the tempera¬
ture it produces a decided effect, lowering it in a marked
degree. The action of trimethyl-carbinol is very similar to
that of the compound containing a molecule of ethyl, but
less marked and slower. In general, according to the
author, the tertiary alcohols, though they may have the
same composition as primary alcohols, exert a very different
physiological action, the latter class of bodies being general
stimulants, while the former act as depressants.

Another Russian observer, Dr. Shumobo'i-Simanovski has
published some recent observations (Ejenedelnaia Klini-
chetkaia Gazeta, No. 11) on trimethyl-carbinol, which, he
says, was obtained first by Butleroff by the action of zinc
methyl on oxychloride of carbon, and also by its action on
chloride of acetyl. It is sometimes described as tertiary
pseudo butyl alcohol. As long ago as 1807 Danielevski
reported at the first Congress of Russian Naturalists that
this substance had the property of allaying irritability of the
psychic centres without causing any preliminary excite¬
ment. Dr. Simanovski, from observations recently made on
both warm-and cold-blooded animals as well as on patients,
is now able to confirm the views of Danielevski, and also
those of Thierfelder and Mering, who found that tertiary
alcohols exerted a soporific effect on rabbits. The dose for
an adult of trimethyl-carbinol is from ten to twenty drops.
Given to two patients in Professor Botkin’s wards suffering
respectively from perinephritis and pleurisy, with a high
degree of habitual and long-standing insomnia, it produced
in both instances areally good night’s sleep. There appeared
to be no objection to repeating the draught on several suc¬
cessive nights.

ANTIPYBIN AND ACETANILIDE IN PHTHISIS.

In comparing the effects of antipyrin and antifebrine or
acetanilide in phthisis, Dr. Jablovski finds that acetanilide
exerts a much more decided effect on the pyrexia. He
remarks that by taking acetanilide such patients exhibit far
less variation between the morning and evening body weight
than under ordinary circumstances. The same is true with
regard to antipyrin, but the effect is less marked. The loss
by the skin and lungs is increased by antipyrin and very
greatly diminished by acetanilide. Dr. Jablovski publishes
a senes of tabular results obtained during a long and
painstaking investigation conducted upon patients in the
Helsingfors Military Hospital.

HtJAMANBIPA.

The plant known by the name of buamanripa amongst the
natives of Peru is made use of by them in cases of bronchitis,
catarrh, and slight haemorrhages. It has been recently
examined by Dr. Zapater, who employed an infusion made
of 25 parts of the leaves to 1000 of water. In small doses it
quickens the cardiac pulsations and augments the secretions,
especially the saliva. In larger doses It produces vomiting
and sweating, and diminishes the cardiac beats, the respira¬
tion, and the temperature. In cases of pleurisy and pneu¬
monia it appears to exercise almost a specific action. It is,
besides, an excellent sudorific.

A demonstration of amalgamated temperance
societies took place on tbe 12th inst. in a : d of the North
London Nursing Association.

THE HOSPITAL SUNDAY FUND.

On the 11th inst. the sixth of the fourteen public meetings
to be held in support of the Hospital Sunday Fund was held
in the Shoreditoh Town Hall. The chair was taken by the
Bishop of Bedford, supported by the Marquis of Larne.
Mr. J. Bigwood, M.P., Sir Sydney Waterlow, Sir Edmond
Hay Currie, the Rev. Septimus Buss (vicar of Shoreditch.’,
the Rev. Prebendary Billing (rector of Spttalflelds), the
Rev. W. Cuff, and others. The following is a list of the
institutions comprised in the Shoreditch district whieh
benefit from the Hospital Sunday FundCity of Loodon
Hospital for Diseases of the Chest, German Hospital, North-
Eastern Hospital for Children, Poplar Hospital, East London
Hospital, Metropolitan Free Hospital, London Dispensaries,
and City of London Lying-in Hospital. The expenditure
and liabilities of these institutions in 1886 exceeded the
income by £30,000. The Chairman, In opening tbe pro¬
ceedings, said that if there was one charity which more than
another was free from the danger of doing more harm than
good it was the Hospital Sunday Fund. At present, how¬
ever, neither the supply of hospitals nor the support of
those existing was, in his opinion, sufficient. He should be
very sorry if the hospitals had to become a department
of the State or to be supported out of the rates, but
if the necessary funds were not otherwise provided they
might come to that. Centralisation of management was
never very efficient, and the hospitals would suffer very
greatly from it; besides, the public would be robbed of one
of tbe most healthy and pure channels of benevolence that
were open. The Marquis of Lome moved the first resolu¬
tion—“That this meeting pledges itself to use every
endeavour to arouse the inhabitants of this district of
London to the importance of maintaining the hospitals aid
medical charities in the utmost efficiency. In furtherance
of this object it urges the clergy and the minister* of
religioa to point out the advantage of giving through the
Hospital Sunday Fund, owing to the nominal cost of so
collecting funds for the hospitals, and to make an earnest
appeal to the people to so increase their contributions as to
secure that the whole sum collected shall not be less than
£100,000.” Ha said that the grave condition of the hospitals’
finances ought not to be allowed to continue. In the Eist-
end, and the more densely populated districts of London,
medical and surgical aid should be near at hand, and every
well-considered attempt to provide more extensive accom¬
modation in these crowded districts ought to be welcomed.
The Rev. S. Buss seconded the resolution, which was
unanimously carried. Sir Sidney Waterlow then moved
the second resolution—" That this meeting regrets to learn
that the expenditure and liabilities of the hospitals and
medical chanties of this district in the year 1886 exceeded
the income by £100,000, and pledges itself to increased exer¬
tion, with a view of preventing any like deficiency during
the ourrent year.” He said that the public of the metropolis
did not fully comprehend the duty and responsibility which
rested upon everyone of maintaining the hospitals in a
state of efficiency to rolieve the sick poor. As chairman of
the Distribution Fund, he could assure the public that the
money contributed to tbe fund went directly, with the
smallest possible deductions, to tbe objects for which it was
intended, the management, collection, and distribution of
the fund only costing 3 per cent. The Rev. Prebendary
Billing having seconded the resolution, it was carried with
only one dissentient: The Rev. W. Cuff then proposed a vote
of thanks to the Bishop of Bedford for presiding, and toth*
Marquis of Lome for his attendance. Sir Edmund Bay
Currte, in seconding the resolution, said he wished to
disabuse people of the idea that the money being naked foe
was for tne establishment of new hospitals, though these
were needed badly enough. The existing hospitals worenot
doing anything like the work they might do simply because
they had not enough funds, and the money asked for was U>
carry them on efficiently; £40,000 was oollected on Hospital
Sunday, and though this might sound a large sum, it was
perfectly unworthy of such a great city as London, for it
did not amount to £15 for every place of worship. Tbe
resolution was carried by acclamation, and the proceedings
came to a close.

On the 13th inst. a meeting was held as St. Mary’s
Newington, Parochial Hall, Kennington Park-road. Tbe
Newington district includes all London south of the Thar**

Yhb Lanobt,]

THE HOSPITAL SUNDAY FUND.

[Jckh 18,1887. 12fi7

And contains nine hospitals and eleven dispensaries partici¬
pating in tbe fund. During 1880 these institutions accom¬
modated 7594 in-patients and relieved 92,025 out-patients,
and in the same year their total income was £41,349, while
their expenditure amounted to £44,190. The chair was
token by Sir Wm. Plowden, M.P., who was supported by the
Rev. C. H. Spurgeon, the Rev. G. T. Palmer, the Hon.
Conrad Dillon, Sir Sydney Waterlow, the Rev. J. Guinness
Rogers, and Mr. H. C. Burdett. The Chairman, in opening
the proceedings, said that from returns which he had re¬
ceived he found that in Birmingham, where the Hospital
Sunday movement was initiated, seventy contributing con¬
gregations raised a sum of £5000 for their hospitals. In
London and the suburbs there were no less than 2000 con¬
tributing congregations, and if they gave to the same extent
as those in Birmingham they would raise a sum of £150,000,
instead of the £40,000 which they did actually contribute.
The deficiencies of the London hospitals were stated at
£100,000, but this estimate did not take note of the fact
that there were also 2000 beds available, but unoccupied
■for want of adequate means. If the hospitals were to work
at their utmost efficiency a sum of 200,000 would be re¬
quired. Sir Sydney Wateriow then moved a resolution
pledging the meeting to use every endeavour to arouse
public interest in the needs of the hospitals, and urging the
clergy to make an appeal to their congregations so as to
■secure that the total sum collected should not be less than
£100,000. The Hon. Conrad Dillon seconded the resolution,
which was carried unanimously. The Rev. G. T. Palmer then
moved a resolution expressing regret at the fact that the
expenditure and liabilities of tne hospitals in the Newington
district exceeded their income by £2800 in the year 1886, and
pledging the meeting to increased exertion to prevent any
like deficiency during the current year. The Rev. C. H.
Spurgeon, in seconding the resolution, said that the hospitals
would have inevitably growing needs. But while their
■liabilities were increasing their incomes were decreasing.
People must therefore rouse themselves to make up the
deficiencies which had already appeared, and which would
continue to appear in greater proportions in the future.
"From the constant growth of the population of the metro¬
polis more hospitals would be required, and if the tending
of the sick ana needy could not be properly undertaken by
voluntary institutions, the indispensable work would have
to be done by Government. He hoped that outsiders would
be awakened to the urgency of the case; for it was not only
as Christians, but as men, that they contributed to the fund.
In giving to the hospitals there need never be any fear of
■doing injury, for to relieve sickness and suffering must be
good. The Rev. J. Guinness Rogers supported the resolu¬
tion, declaring that the collections hitherto mado on Hospital
Sunday were not worthy of London’s wealth, her humanity,
or her Christianity. The resolution having been unani¬
mously carried, the proceedings terminated with a vote of
thanks to the Chairman.

On the 14th inst. a meeting was held at the Mansion
House. The Lord Mayor, who presided, was supported by
Sir S. H. Waterlow, Bart., Alderman Sir W. McArthur,
K.C.M.G., M.P., the Bishop of London, the Rev. Dr. Allon,
Sir Edmund Hay Currie, Canon Fleming, Dean Vaughan of
the Temple, Rev. — Simpson, Mr. Wakley, Mr. H. N. Custance
■(secretary), Mr. Burdett, and others. The Lord Mayor
mentioned the receipt of letters from the Bishop of Bedford,
the Bishop of Ripon, Lord Strafford, and the Rev. Dr. Wace,
and announced that he had received from Mr. Henry Irving
a contribution of fifty guineas. In opening the proceedings,
the Chairman said that the promoters of the Hospital Sunday
Fund endeavoured to excite in the public, and particularly
in tbe wealthy, feelings of gratitude and thankfulness for
the health and proeperity they enjoyed, and as a result to
make a special endeavour to support the institutions which
^rere established chiefly for the benefit of those not so
fortunate and not so well off as themselves. This year, and
this time of the year, when so many of them were spending
Iwge sums of money to gratify their feelings of loyalty,
-curiosity, or enthusiasm, in connexion with Her Majesty’s
-conspicuous jubilee, was particularly suited to be signalised
by special liberality in this respect. The Bishop of London
then moved a resolution identical with that proposed at the
"meeting on the 11th inst. by the Marquis of Lome. It was
not anything new, he said, to plead for hospitals in tbe
city where suoh institutions hod been liberally supported
■from the earliest times. There were no institutions which
appealed more strongly to Christian hearts than those which

were designed to carry on the work in which their Master
had so often engaged, that of relieving and mitigating the
sufferings of the sick and afflicted. It was a blessed thing
indeed to be permitted to be able to carry on such a work,
and it was in truth the very best mode of preaching the
Gospel. The Rev. H. Allon, D.D. (Islington), seconded the
resolution, and pointed out that the claims of the Fund hod
been already demonstrated far beyond the need of argument.
Experience had proved the need and the value of hospitals
ana dispensaries, and their core must now be one of prac¬
tical effort to apply principles that were universally admitted.
Referring to the discussion os to the desirability of a Parlia¬
mentary grant, the speaker said that money was not the
most important thing—sympathy was a necessity, and the
need of it had often rendered their Poor-law boards the
reverse of what they should be, and had earned for the
Charity Organisation Society the unpopularity for which it
was notorious. Mr. J. B. Martin, treasurer of Cbaring-cross
Hospital, at this stage attempted to deliver himself of a long
and rambling statement os to the refusal of four hospitals
to assist the Fund, but was ruled out of order by the Chair¬
man. The motion having been carried unanimously, Sir
S. H. Waterlow moved the seoond resolution, which was
similar to the one proposed by him on the lltb inst. Like
the first one, it was carried without dissent, and a vote of
thanks to the Lord Mayor having been passed, the meeting
broke up.

On the 15th inst. a meeting was held in St. Andrew’s
Hall, Newman-8treet, W. The St. Marylebone and West
Central District, on behalf of which the gathering was
held, comprises Marylebone, St. John’s Wood, Bloomsbury,
Holborn, &c., and contains twenty hospitals and seven
dispensaries benefiting from the Hospital Sunday Fund.
In the year 1886 these institutions relieved 8980 in-patients
and 158,955 out-patients; their income for the same year
wa9 £74,274 and their expenditure £84,451. The chair was
taken by Major A. H. Ross, M.P., who was supported by
Colonel Duncan, M.P., Mr. A. A. Baumann, M.P., and Mr.
H. L. W. Lawson, M.P. The Chairman opened the proceed¬
ings with a brief speech, in the course of which he pointed
out that, taking fourteen of the principal hospitals in
London, it was found that their annual average receipts
from subscriptions and the Hospital Saturday and Sunday
Funds for the past three years amounted to £105,000, while
their average expenditure in the same time was £220,000,
Colonel Duncan, M.P., then moved a resolution pledging tbe
meeting to use every endeavour to arouse public interest in
the needs of the hospitals, and urging the clergy to point
out the advantage of giving through the Hospital Sunday
Fund, owing to the nominal cost of collection, and to make
an earnest appeal to tbe congregations in order to secure
that tbe woole sum collected should not be less than
£100,000. Mr. A. Baumann, M.P., in seconding the resolu¬
tion, said that nothing less than the £100,000 mentioned in
the resolution would suffice if tbe hospitals were to be
relieved from their present financial crisis. The question
now was whether the London public preferred to support
the hospitals by their voluntary contributions or to submit
to having another 2d. or 3d. added to their ratee. In his
opinion, it would be a deep reproach to Londoners if they
allowed their poorer fellow-citizens to be thrown upon the
cold and unsympathetic relief provided by the State in the
time of sickness and pain. This resolution having been
carried unanimously, Mr. H. L. W. Lawson proposed another
expressing regret at the disparity during 1886 between the
incomes of the metropolitan medical charities and their
expenditure, and pledging the meeting to increased exertion
to prevent a like deficiency in the present year. Mr. Arthur
Marshall seconded the resolution, which was carried without
dissent; and a vote of thanks to the Chairman brought the
proceedings to a close.

On the 16th inst. a meeting was held at the Kensington
Town Hall. The Duke of Argyle presided, and was sup¬
ported by, amongst others, Sir A. Borthwick, M.P., Rev. the
Hon. E. Carr Glyn, Mr. Brudenell Carter, Rev. Mr. Graves,
and Mr. Burdett. The Chairman, in opening the proceedings,
expressed the pleasure be had in presiding over a meeting
which had for its object the increase of the Hospital
Sunday collection. He observed that in no other country
and in no other age had there been such a vast aggregation
of people as at present residing in London; throughout
Christendom there was no other city nearly approaching
the population of the metropolis. Provision for sickness

Digitized by GoOgle

1258 The Lancet,]

SANITARY LEGISLATION CONFERENCE.

fJtTNB 18,1887.

and disease, while absolutely necessary, was one of the most
difficult problems of modem times. Such provision cannot
be left to individuals, it must be met by organisation,
voluntary, municipal, or State. That it had hitherto been
imperfectly performed was proved by the fact that the
hospitals of London and the country were living
fiom bond to mouth, and that many of them had had to
dose some of their wards. The deficit last year in the funds
of the medical charities comprised in 'the Kensington
district amounted to about .£18,000, and the question was,
how was this deficit to be met? He deprecated State
assistance, which would, if resorted to, assuredly put an
end to voluntary contributions. In Glasgow organised
appeals to the industrial classes had proved highly success¬
ful, and he advocated systematic and organised appeals to
the working classes of London, believing that if this plan
were adopted the deficit in the funds of the metropolitan
hospitals would cease to exist. The first resolution, which
was in exactly the same terms as the corresponding one at
the previous meetings, was moved by Mr. Brudenell Carter,
who dwelt on the universality of the claim of hospitals
for support. He also opposed State aid, such institutions
requiring in their management not red-tapeism but flexi¬
bility. Sir A. Borthwick, M.P., seconded the resolution, and
announced his intention of endeavouring to organise such
an appeal to the working classes as had been suggested by
the Duke of Argyle. The motion having been carried
unanimously, Mr. Burdett moved the second resolution,
which was also identical with the one passed at previous
gatherings. He earnestly advised those present to visit the
hospitals to see the working of them, and to become per¬
sonally acquainted with the good they do. The Rev. Carr
Glyn seconded the resolution, and advocated not only
appeals to tho working classes, but also house-to-house
collections among the middle classes and the well-to-do.
A vote of thanks to the Chairman was then carried with
acclamation, and the proceedings terminated.

SANITARY LEGISLATION CONFERENCE.

Tms Conference held its fifth meeting on Tuesday last
at Argyll-place, Regent-street, when Mr. C. C. Lacaita,
M.P., Dr. Farquharson, M.P., and Dr. Cameron, M.P., who,
with 8ir W. Guyer Hunter, M.P., and Sir Henry Roscoe, M.P.,
have charge of the 8anitary Registration of Buildings Bill in
the House of Commons, were present. In the absence of the
President of the Conference, Sir Joseph Fayrer, Mr. H.
Rutherfurd, B.L., occupied the chair, and explained that the
object of the present meeting was to confer with mem¬
bers of Parliament on the subject of the second reading of the
Sanitary Registration of Buildings Bill. Mr. Lacaita,
M.P., said the present Bill was to some extent a
compromise with an uneducated public opinion. The
clauses of the Bill had been framed more or less on the
principle that registration should be compulsorily enforced
in those cases where the actual residents bad not got it in
their power to ascertain the sanitary state of houses in
which they lived. There was one very grave omission
from the Bill in that respect: the great class of tene¬
ment buildings often exhibited conditions inimical to
health, but the promoters of the Bill and the Confer¬
ence bod considered this class to be dealt with in this Bill.
Supposing the Bill became law more or less in its present
shape, there would be little difficulty in extending its pro¬
visions in modifying circumstances to tenement buildings.
The principle of the Bill obviously was that inspection
should not be conducted by public officers as such, but that
it should be in the power of every owner, lessee, or occupier
to go to any licensed practitioner in sanitary science just as
he would go to consult any doctor he chose about bis own
health ; bat, on the other hand, that the public authorities
should be responsible for the registration of the certificates
when given, and for the competency of persons who were
to certify, they had the guarantee of the Local Government
Board or the other responsible bodies mentioned in the Bill.
The Bill was down for the second reading on June 22nd.

General Sir Peter Lumsden proposed that a petition from
the Conference be presented in support of the second reading
of the BUI. Dr. Farquharson seconded the resolution,
which was passed unanimously; and it was resolved to

leave the convening of the next meeting of the Conference
in the hands of the president, vice-presidents, and ban.
secretary. _

THE SIXTH INTERNATIONAL CONGRESS OF
HYGIENE.

The sixth gathering of sanitary reformers, representing
almost every civilised nation in the world, promisee to be in
exceptionally brilliant affair. It should have taken place
lost year, for these congresses are held every two years,
and it will be three years next autumn since the Con¬
gress last met at the Hague. The exact cause of the post¬
ponement is not given, but doubtless the cholera epidemics
are not foreign to this delay. In any case, everything has
been done to moke up for loss of time, and the organisers
have certainly succeeded in drawing up a most attractive
programme. His Majesty the Emperor of Austria and
Hungary has granted a subvention to the Congress, and
the Crown Prince, Archduke Rodolpbe, is its patron. The
highest functionaries of the empire, the leading ministers,
notably the President of the Council and Minister of the
Interior, Count Taaffe, are honorary presidents of the Con¬
gress. All the ministries have appointed special delegates,
as also the Diets of Upper and Lower Austria, of Carinthia,
Bohemia, Moravia, Silesia, and Galicia. Subventions hive
also been granted, so that the whole empire will be thoroughly
represented. The various leading towns and mn ni cipal i tM#
have likewise joined the movement, and the Austrian railway
companies, together with the Danubian navigation com¬
panies, have granted a reduction of 50 per cent, on all
lares charged to members of the Congress.

A preliminary meeting of the members of the Congress
will be held in the evening of Sept. 25th, and a solemn
opening ceremony will take place on the morningof the 26th.
In the afternoon there will be an excursion to Kahlenber&,
The Congress will sit throughout the week, with the excep¬
tion of Thursday, when an excursion will be made to Hollen-
ttaal, Semmering, and the water intake of Kaiserbrunnen.
Numerous receptions are to be held, a club will be provided
for the use of the members of the Congress, all institutions
of interest at Vienna are to be visited, and facilities given
for attending at the theatres. On Monday, Oct. 3rd, a
special boat will take the members of the Congress who
choose to remain after the debates are terminated down
the Danube to Buda-Pesth, where an official reception is
announced. After visiting the principal objects of interest
in the capital of Hungary, the excursionists are to return on
the following day to Vienna, it is probable that from twenty-
five to thirty nationalities will be represented, and we are
pleased to note amongst those already announced to retd
papers the names of Professor W. II. Corfield. Mr. Shirley
F. Murphy, and Dr. Franklin, from England; together with
Dr. Brouardel, Dr. Proust, Dr. Jacques Bertillon, and many
other eminent Frenchmen; Dr. Oorradi and Dr. Pini, from
Italy; Professor Max von Pettenkofer, from Germany;
Professor Gruber, from Vienna; Professor Hauser, from
Madrid; Dr. Bambas, from Athens; and Dr. A. Beaujon,
from Holland. Several doctors from Switzerland, Sweden,
Belgium, and Denmark have also promised papers. The
subjects selected are of a thoroughly practical character,
and the Congress promises to be fruitful in good results.
Could not the seventh International Congress of Hygiene be
held in London?

North London Hospital poe Consumption.—T he
annual festival in connexion with this institution was held
on the 15th inst. at the Langbam Hotel, Mr. F. D. Mocatu
presiding. Since the foundation of the hospital in I860.
170,000 patients have been treated. Last year 318 in-patient?
were received at the hospital at Hampetead, while 2700
out-patients attended at the branch in Tottenham-court-
road. In the course of the evening subscriptions to the
amount of about .£2500 were announced, including a con¬
ditional donation of £1000.

The foundation-stone of a new College of Science,
affiliated with Durham University, was laid on the loth inst.
at Newcastle-on-Tyne by Sir W. G. Armstrong. The sire
covers two acres of ground, and the college will cost, whea
completed, £20,000.

lv_

• Thb Lancet,]

MEDICAL TRIAL.

[June 18,1887. . 1269

MEMORIAL PORTRAIT OF

SIR WILLIAM JENNER, BART., K.C.B., M.D.

The following is a list of tbe Committees up to June 14 th

General Committee.

Sir George Burrows, Part., M.D.. Chairman.
Sir Jamea Paget, Bart., Vice-Chairman.

of'D C »*q'; } H “- Trea. ure r.,

?;■ }“»»•

Adams, Win., Esq., Begent’s-park-
road.

Alkln, C. A., Esq., Cliftou-place.

Andrew, Dr. James, Harley-street.

Baatian, Dr., Queen Anne-street.

Beck, Marcus, Esq., Wimpo e-st.

Best, Palemon, Esq., J.P., Louth.

Blrkett, Dr., Euasell-square.

Bond, Dr.

Brodie, Dr. G. B.. Cheaterfleld-st.

Brunton, Dr. T. L.. Welbeck-street.

Buchanan, Dr. G., Nottingham-
pLaoe.

Champneys, D., GreatCumberland-
place.

Clark, Sir Andrew, Bart., M.D.,
Cavendish-square.

Corfleld, Dr. W. H., Savile-row.

Coupland, Dr., Weymouth-street.

Crawford, Sir T.. K.C.B., Director
General, Army Medical Depart¬
ment.

Cribb, Dr. A. J., Highbury.

Duckworth, Sir Dyce, M.D.,
Graf ton-street.

Dukes, Dr. Clement. Eugby.

Duncan, Dr. J. Matthews, Brook-
street.

Brichsen, John, Esq., Cavendish-
place.

Fairbank, Wm„ Esq., Windsor.

Fayrer, Sir Joseph, K.C.S.I., M.D.,
Wim pole-street.

Peamsids, Henry, Esq., Kensing¬
ton.

Frank, Dr.

Garrod. Dr. A. B., Harley-street.

Gee, Dr., Wim pole-street.

Gowers, Dr., Queen Anne-street.

Greenfield, Dr. W. S., Edinburgh.

Greenhow, Dr., Reigate.

Gull, Sir Wm., Bart., M.D., Brook-
street.

Harley, Dr. G., Harley-street.

Hewitt, Dr. Graily, Berkeley-«q. |

Hickman, Wm.. Esq.. Dorset-sq.

Hill, Berkeley, Esq., Wlmpole-st.

Holderness, W. B., Esq., Windsor.

Hughes, H. Spencer, Esq.,
Bromley.

Ingham, Dr. Amos. Haworth.

Jaokson, Dr. J. H.. MsncliesUr-sq.

Jackson, T. V., Esq., Mayor of
W olverhampton.

Jessett, Fredk. B., Esq., Upper
Wimpole-street.

Jones. Dr. T. Ridge, Cbesham-pl.
Jones, Dr. J. Talfourd. Eastbourne.
Knapton, Geo., Esq., Southport.
Legg, Dr. J. Wickham. Green-st.
Lister, Sir Joseph, Bart., Park-
crescent.

Marsh, Howard, Esq., Brutoo-st.
Marshall, John, Esq.. J.P., Dover.
Marston, Dr. J. A., Army Medical
Department.

Martin, Dr. B., Queen Anne-st,
Martin, A. H.,Esq., Evesham.
Merriman, John, Msq.. Kensington.
Money, Dr. Angel, Harley-street.
Monro, Dr. Henry, Upper Wim-
pole-street.

Moore. Dr. W. W., Brighton.
Oliver, Dr. George, Harrogate.
Patten. C. A., Esq.. Ealing.

Pary, Dr.,, Grosvenocstreet.
Phllipson. Dr., Newcaatle-on-Tyne.
Playfair, Dr., George-street, W.
Poore. Dr. G. V., W impole-strret.

| Potts. Wm.. Esq., Albert-terrace.
Powell, Dr. R. D., Wimpole-street.
Qualn, Dr. Richard, Harley-street,
Kigden, Walter, Esq., South Ken¬
sington.

Ringer, Dr. Sydney, Cavendish-
place.

Roberts, Dr. F. T., Harley-street.
Royle. Arnold, Esq., Army Medical
Stuff.

Saunders, Sir Edwin, George-st.
Scot t, Dr. H.. Upper Woburn-pl.
Semple, Dr. H. H.. Torrlngton-sq.
Sewell, Dr. C. B., Cavendish-sq.
Snow, Dr. H. L., Bayswater.
Squire, Dr. Wm., Orchard-street.
Stone. Dr., Sanctuary.

Thompson, Sir Henry, Wlmpole-
street.

Thompson, Dr. B. 8., Cavendish-
square.

Thompson, Joseph, Esq., Notting¬
ham.

Waagett, Dr. John, Bournemouth.
Wallace, Dr., Southsea.

Whiting, Dr. H. Townsbnd.
Williams, Dr. John. Queen. Anne-
street.

Wood, Dr. Wm., Harley-street.

Executive Committee.

Sir Henrv Thompson, Chairman, 35, Wimpole-street, W. •

Adams, William, Esq., Tower Lodge, 2, Begent's-park-road. N.W.
Dr. George Vivian Poore, 30, Wimpole-street, W.

Dr. Chas. J. Hare, Berkeley House, Manchester-"J

George*David Pollock, Esq., 36, Grosvenor- ( Hon ' Treasurers.

street, W. )

Dr. J. Russell Remolds. 38, Grosvenor-street, W., \

Sir Henry Pitman, 28, Gordon-square, W.C. / Mon ' ° cca '

Anyone desiring to have his name added to the General
Committee should signify the same without delay to either
of the Honorary Secretaries.

Subscriptions may be sent to any one of the Hon.
Treasurers or Hon. Secretaries.

June 14th, 1887. _

MEDICAL TRIAL.

RESTORATION OF A DENTIST’S NAME TO THE
REGISTER.

BEG. T). THE GENERAL MEDICAL COUNCIL.
Judgment was delivered on Wednesday last by Mr. Justice
Mathew in this case, which was an application on behalf of
Mr. H. F. Partridge for a mandamus ordering' the- General
Council of Me&icAl Education of the United Kingdom to
'restore the name of Mr. Partridge to the Register of Dentists

kept under the Dentists Act, 1878. The rule was argued
last sittings before Mr. Justice Mathew and Mr. Justice
A. L. Smith.

Mr. Justice Mathew now delivered the judgment of the
Court. His Lordship said the applicant had, since 1867,
practised in the metropolis as a dentist, and it was admitted
that when the Act passed he would have been entitled to be
registered as a dentist if an application had been made by
him in accordance with the provisions of Section 7. He had
not, however, applied for registration in respect of this
qualification. In 1878 he obtained from the Royal College
of Surgeons, Ireland, a diploma in dentistry, and as a
licentiate of this body, which was one of the medical
authorities referred to in the Act, be applied for and
procured registration under the statute (Section 6). The
diplamb had been granted on the terms that the holder
should not seek to attract business bv advertising or
by any practice considered by the College unbecoming,
and that the diploma might be cancelled on its being
proved to the satisfaction of the President and Council
that he had done so. In the year, 1883, the Royal College
of Surgeons of Ireland, upon the ground that Mr. Part¬
ridge had advertised for business, cancelled his diploma,
and thereupon the General Council directed his name to be
erased from tbe Register. Section 11 contains provisions
as to the corrections to be made from time to time in the
Register, and it was argued for the General Council that,
where the original qualification do longer existed, the
Council were bound to correct the Register and erase the
name. It was argued for the applicant that the name of' &
person qualified either by practice or diploma. and once
pioperly placed on the Register could only be erased in
the manner and upon the grounds specified in the statute
It was urged that the mere fact that tbe diploma had been
cancelled by the medical authority which had granted it.
was not a ground upon which tbe General Counoil was
justified in disqualifying the applicant or exposing him
to the penalties imposed by tbe Act upon unqualified
practitioners. We are of opinion that the contention of tbe
applicant is right and that he is entitled to have his name
restored. [His Lordship here read Section 13, and also
referred to Section 15.] It appears to us that, in such a case
as the present, the Medical Council possessed no further
powers of dealing with the Register than those conferred in
the sections referred to. It was admitted that the Council
had not decided that Mr. Partridge had done anything to
justify the removal of his name under Section 13, but bad
considered that they were bound to erase his name when
the determination of the medical authority granting the
diploma had come to their knowledge. This is a course
which, it seems to us, they were not entitled to adopt,
otherwise where a medical authority has withdrawn a
diploma on the ground, for instance, that a particular
theory of dental surgery had been adopted or discarded,
the name of the bolder must be struck from tbe register.
But this is a ground upon which the General Council
under Section 13 are expressly prohibited, from erasing a
name. The third clause of Section 13 appears to show that
the Council was not intended to be bound by any determina¬
tion of the medical authority, even with respect to tbe
grounds for erasing a name specified in Section 13, but was
required to adjudicate independently. This view is
strengthened by an examination of tbe provisions in the
last clauses of Sections 13 and 14. The Act appears to be
carefully framed to restrict the right of the General Council
to interfere with registered dental practitioners in the
practice of their profession to the cases where there
are the grave reasons for disqualification specified in
Section 13.

The rule for a mandamus was accordingly made absolute,
but, on an application on behalf of the Council, was ordered
not to he drawn up for a week.

Mr. Finlay, Q.C., and Mr. Lyon were for the applicant;
and Mr, Kennedy, Q.C., and Mr. Muir Mackenzie for the
Council.

The Lord Chancellor has received a memorial from
the laity of the Church of England praying for a limitation
to be imposed by authority on the publication of obscene
and unnecessary details of divorce and criminal cases. The
memorial was signed by 124 ' peers, 46 medical men, y(>
officers of the army and 'ntivy, and 44 solicitor^, there being
altogether 4000 signatures. ’

d by Google

Die

1260 Thb Lancbt,]

HEALTH OF ENGLISH AND SCOTCH TOWNS.

[Junk 18,1887.

"VITAL STATISTICS.

HHAI.TH OK ENGLISH TOWNS.

In twenty-eight of the largest English towns 6237 births
and 3340 deaths were registered during the week ending
June 11th. The annual rate of mortality in these towns,
which had been 20 , 4 and 19‘5 per 1000 in the preceding
two weeks, further declined last week to 18 9, and was
lower than in any preceding week of this year. During the
first ten weeks of the current quarter the death-rate in these
towns averaged 20*3 per 1000, and was 1*5 below the mean
.rate in the corresponding periods of the ten years 1877-86.
The lowest rates in these towns last week were 11*3 in
Leicester, 13*2 in Portsmouth, 13*3 in Bristol, and 13 9 in
Derby. The rates in the other towns ranged upwards
to 246 in Newcastle-on-Tyne, 27*6 in Oldham, 28 9 in
.Manchester, and 29*4 in Birkenhead. The deaths referred to
the principal zymotic diseases in the twenty-eight towns,
which had been 532, 522, and 521 in. the preceding three
•weeks, further declined last week to 489; they included
227 from measles, 127 from whooping-cough, 55 from
•scarlet fever, 31 from “fever” (principally enteric), 29
from diarrhoea, 17 from diphtheria, and only 3 from
small-pox. No death from any of these zymotic
diseases was registered during the week in Leicester or in
Derby; while they caused the greatest mortality in
Manchester, Salford, Oldham, and Norwich. The highest
death-rates from measles occurred in Brighton, Birkenhead,
-Sheffield, Newcastle-upon-Tyne, Salford, Oldham, Man¬
chester, and Norwich; from whooping-cough in Liverpool
and Norwich; from scarlet fever in Birkenhead; and from
diarrhoea in Preston. The 17 deaths from diphtheria in the
twenty-eight towns included 9 in London, 3 in Oldham, and
2 in Bradford. Small-pox caused 2 deaths in Sheffield and
1 in Birmingham, but not one either in Greater London or
in any of the twenty-five other large provincial towns.
■Only one case of small-pox was under treatment on Saturday
last in the metropolitan hospitals receiving cases of this
disease; and no new case was admitted to these, hospitals
during the week. The deaths referred to diseases of the
respiratory organs in London, which bad been 333 and 264
an the preceding two weeks, further declined last week to
259, and were two below the corrected weekly average. The
-causes of 70, or 2'1 per cent., of the deaths in the twenty-
eight towns last week were not certified either by a
registered m ed i cal practitioner or by a coroner. All the
■causes of death were duly certified in Leicester, Nottingham,
Portsmouth, and in six other smaller towns. The largest
.proportions of uncertified deaths were registered in Old¬
ham and Sunderland.

HE ALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 22*6 and 19*8 per 1000 in the preceding
two weeks, rose again to 21*9 in the week ending June 11th;
■this rate exceeded by 3*0 the mean rate during the same
week in the twenty-eight large English towns. The rates
in the Scotch towns last week ranged from 18*7 and 192
in Leith and Greenock, to 22*7 in Perth and 27*3 in Paisley.
The 646 deaths in the eight towns last week showed an
increase of 51 upon the number in the previous week, and
included 35 which were referred to whooping-cough, 12 to
diarrhoea, 9 to scarlet fever, 8 to “fever” (typhus, enteric,
■or simple), 8 to measles, 4 to diphtheria, and not one to
small-pox; in all, 76 deaths resulted from these principal
zymotic diseases, against 82 and 50 in the preceding two
weeks. These 76 deaths were equal to an annual rate
of 3 0 per 1000, which was 0*2 above the mean rate from
the same diseases in the twenty-eight English towns.
The fatal cases of whooping-cough, which had been 43 and
•32 in the preceding two weeks, rose again last week to 35,
■and included 11 in Glasgow, 9 in Edinburgh, 6 in Dundee,
4 in Greenock, and 4 in Leitb. The deaths from each of the
•other zymotic diseases also showed an increase upon the
-low numbers in the previous week. The deaths attributed
to diarrhoea exceeded by 6 the number returned in the
corresponding week of last year. Of the 9 fatal cases of
scarlet fever, 6 occurred in Glasgow and 2 In Dundee;
while 6 of the 8 fatal cases of measles alab/bccurred in
Glasgow. Five of the 8 deaths referred to “rater,” and 3 of
the 4 fatal cases of diphtheria, were attb fcMttned in Glasgow.

The deaths referred to acute diseases of the respiratory
organs in the eight towns, which had been 126,109, and lif-‘
in the preceding three weeks, rose again last week to 109,
and exceeded the number returned in the corresponding
week of last year by 19. The causes of 72, or more than 13
per cent., of the deaths registered in the eight towns during
the week were not certified.

HEALTH 07 DUBLIN.

The rate of mortality in Dublin, which had been equal
to 24'1 and 21*4 per 1000 in the preceding two weeks,
rose to 31*2 in the week ending June 11th, consider¬
ably exceeding the rate in any recent week. During th6
first ten weeks 'of the current quarter the death-rate in
the city averaged 29 0 per 1000, the mean rate during
the same period being but 18 - 4 in London and 19 8 in
Edinburgh. The 211 deaths in Dublin last week showed
an increase of no less than 66 upon the number retained
in the previous week; they included 18 which were referred
to measles, 3 to “fever” (typhus, enteric, or simple), 3 to
scarlet fever, 2 to whooping-cough, 2 to diarrhoea, 1 to
diphtheria, and not one to small-pox. Thus the deaths re¬
sulting from these principal zymotic diseases, which had
been 27 and 21 in the preceding two weeks, rose last week
to 29, and exceeded the number returned in any previous
week of this year; they were equal to an annual rate of
4 3 per 1000, the rates from the same diseases being 30 is
London and 2*8 in Edinburgh. The fatal cases of measles,
which had been 8,17, and 10 in the preceding three weeks,
rose last week to 18, and exceeded the number in any
previous week of this year. The deaths from the other
zymotic diseases scarcely differed from those returned in
the previous week, the 3 deaths from “fever” correspond¬
ing with the number in each of the preceding two weeks.
Compared with the numbers in the previous week the
deaths of infants showed a decline, while those of elderly
persons had considerably increased. Three inquest cases
and 4 deaths from violence were registered; and 55, or more
than a fourth, of the deaths occurred in public institutions.
The causes of 25, or very nearly 12 per cent, of the
deaths registered during the week were not ce r tified.

THB SEBVI0E8.

Brigade Surgeon Ramsden and the Officers of the Army
Medical Staff at Alexandria entertained Surgeon-General
O’Nial, C.B , at dinner at the Mobamed Ali Club, prior to his
departure for England by the Messageries Mari times mail
steamer.

Surgeon-Major F. W. Trevor has assumed the medical
charge of the military prison, and of the officers, women,
and children in the North Camp, Aldershot, relieving Sur¬
geon-Major J. W. Morgan, whose time of appointment has
expired.

Brigade Sargeon J. Paxton, Colchester, has been appointed
officiating Principal Medical Officer, Eastern District, during
the absence on leave of Deputy Surgeon-General T. W.
Fox.

India Office. —The Queen has approved of the follow¬
ing promotions among the Officers ot the Staff Corps and
Indian Military Forces, made by the Governments in India:—
Surgeons to be Surgeons-Major (dated March 31st, 1887):
George Spiers Alexander Ranking, M.D, Robert Davidson
Murray, Dennis Wood Deane Gamins, Patrick Fenelon
O’Connor, James Moran, M.D, William Beatson, William
Allason Simmonds, Roderick Macrae, Thos. El wood Lindesay
Bate, and Shibram Borah, of the Bengal Medical Establish¬
ment; Surgeon G. Tucker Thomas (dated March 31st, 1887),
Surgeon Arthur James Stunner (dated March 31st, 1887),
and Surgeon Archibald Adams, M.D. (dated March 31st, 1887).
of the Madras Medical Establishment; and Surgeon Arthur
Henry Coles Dane, M.D. (dated March 31st, 1887), Sargeon
John Philip Greany M.D. (dated March 31st, 1887), Surgeon
John Edward Ferguson (dated March 31st, 1887), Surgeon
George Edward Elton Burroughs (dated March 31st, 1887),
and Surgeon James McCloghry (dated Match 31st, 1887),
of the Bombay Medical Establishment.

Admiralty. —In accordance with tbe provisions of Her
Majesty’s Order in Council of April 1st, 1881, Fleet Surgeon
Walter F. Cope Bartlett has been placed on the retired list.

The Lancet,]

PASTEUR'S METHODS.—PLACENTA PREVIA.

[June 18, 1887. 1261

with permission to assume the rank of Deputy Inspector-
General of Hospitals and Fleets ^dated June 9th, 1887).

The following appointments have been made:—Fleet
Surgeon James Flanagan, to the Cotter; Fleet Surgeon
Edwd. Meade, to the Cambridge; and Fleet Surgeon George
Mair, to the Iron Duke.

Correspotthettce.

"Audi alteram partem. 1 *

“PASTEUR’S METHODS.”

To the Editors of The Lancet.

Sins,—Will you kindly permit me to offer some remarks
in reply to “R.J.P.S.,” who writes on the above subject in
your issue of the 23rd of April. Your correspondent says
that while expressing my anxiety that the dangers of
M. Pasteur’s prophylactic treatment for hydrophobia should
be recognised, 1 seem somewhat to ignore the much greater
danger of untreated bites from rabid animals. But as in
my humble opinion, M. Pasteur’s methods when they are
1 not hurtful are inefficacious, I submit “ R. J. P. S.” begs the
! question. If M. Pasteur’s intensive method is attended
1 with the risks indicated by M. Peter clinically, and by von
Frisch and others experimentally, it surely introduces an
1 additional danger, since in no case can we be certain that
the victim of a bite has been inoculated with mbic virus,
1 though according to M. Pasteur all cases must be dealt with
1 on the assumption that infection has occurred. Here, then,
1 in addition to the danger which is involved in the bite, we
have that which may follow the intensive treatment. Your
i correspondent admits that some of the deaths which
i have occurred during the present year “veiy possibly”
1 resulted from the treatment: that being so, I think the
concession ought to follow that the experimental test—
which M. Pasteur admits to be crucial, and by which he
obtained results which neither von Frisch, nor Renri, nor
Amoroso could obtain—should be as expeditiously as possible
carried out openly in the presence of those who are opposed
to him, and that in the meantime M. Pasteur should revert
to his former method, which is comparatively, if not quite,
harmless. Your correspondent holds that “it is largely a
question of statistics.” No doubt that is so, but not of
statistics founded on possibilities which are to be accepted
as facts. Now, if he accepts M. Pasteur’s figures and the
1 deductions which he and his partisans draw therefrom, he
will find that cases of hydrophobia in France and Algeria rose
1 suddenly and unaccountably, and without any corresponding
increase of rabid animals, from about 50 to 308, omitting all
i notice of those deaths which occurred outside M. Pasteur’s
i practice. Thus, taking their estimate of 16 per cent, as the
incidence of hydrophobia in rabid animal bite cases, and the
number of French and Algerian patients treated by M. Pasteur
in 1886 at 1929, 1 we have 308. Trousseau told his pupils
that hydrophobia was a disease which very rarely occurred
in the human subject, and that in France, with a population
of more than 36,000,000, only 20 to 25 cases of the disease
occurred annually. More recently the average has been
fixed at 30. Now, allowing 20—an excessive estimate—for
, Algeria, we have 60. Then again, how are we to account
for the extraordinary circumstance that, notwithstanding
M. Pasteur’s method, the average annual mortality from
i hydrophobia in France has not Deen reduced, but, on the
contrary, according to French authorities, it has increased
nearly one-third ? I have recently submitted to the Govera-
i ment of Bengal a report, founded on the returns of animal
i bite treated at the dispensaries in Bengal with the local
application of potassic permanganate, as advocated by me
in 1881, and here furnish some statistical information which,
\ to my mind, is most significant as illustrating the un¬
certainties of infection with rabic virus in animal bite. I
must premise that as a test of the efficacy of the
treatment I regarded the returns as unsatisfactory. A
reference to your issue of January 29tb, 1887, will show that
of the forty-eight persons supposed to have been bitten by
rabid wolves, seven died. This gives a percentage of 14-58,
not 14 0, as M. Grancher has it. Now, the returns with which
I had to deal showed forty-two cases of supposed rabid

. \ } M. Grancher'* figure*, Thk Lancbt, Jan. 39th, 1887.

jackal bite, with six deaths, or 14"28 per cent., 0'30 per cent,
in favour of the cases in which M. Pasteur’s method found
no place, and this, too, after eliminating some cases in
which the animals had attempted to carry off infants from
hunger, and in which no mortality had occurred. Here the-
jackal takes the place of the wolf, and so far as is known,,
with the exception of the circumstances mentioned above,,
it never attacks except when rabid. The fact is, that
statistics dealing with methods in cases of doubtful infec¬
tion are very unsatisfactory, as the data are often of a most
erratic character. Take for instance, the following example r
At Chumparun twenty-four persons, consisting of ten men,
eight women, and five boys, and one of whom no informa¬
tion is afforded, were attacked in one evening by a rabid
jackal. This occurred in the beginning of the year
1886. Twenty-three of these people came under the treat¬
ment of the assistant-surgeon, but although potassic-
permanganate was applied, my instructions were not
strictly observed. Four of these people died, but, strangely
enough, not a single one of the ten men was affected, the
victims being three women and one boy. Then again, L
found that, after eliminating clearly unsatisfactory caees in
which there was no death, of twenty-seven women who
were bitten and treated, seven, or25-9 per cent., and of twenty-
four children, four, or 16U per cent., died ; while only two
of the 123 men, or 1-6 per cent., succumbed ; and that out
of twenty-four men bitten by rabid jackals, only one,
or 4T per cent., died. Who, may I ask, is justified after
this in relying upon statistics alone as proof of the value
of his methods of treating esses of this kind? Surely it is-
not unreasonable to demand that the following question
shall be definitely answered and demonstrated by M. Pasteur:
Does his method prevent rabies in the dog after it has
been infected in the only natural way that infection takes-
place—namely, by inoculation with the saliva ?

In conclusion, allow me to point out a significant fact,
and one that should be noted as evidence of M. Pasteur’s ever-
changing tactics. A medical man in India imagined him¬
self to have been bitten by a rabid dog which had bitten
three others, who, so far as we are informed, still remain
unaffected, and submitted himself to M. Pasteur’s treatment.
In his own words I give the description of treatment
adopted in his case: “I bad to go and be inoculated,
morning and evening for six days; then every morning for
five days. I was finished last Friday, but they asked
me, if not inconvenient, to stay in Paris for five or six days-
more, and then report myself, when a few more inoculations
might be necessary. After that they said, * You can go with
the most perfect confidence.’ They begin with virus four¬
teen days old, and go on up to that only five days old r
they don’t use any stronger than that, but virus under seven
days -will infallibly give a dog rabies.” 3 Assuming tbis to be¬
an accurate description of his treatment, who, with the
words of MM. Pasteur, Grancher, and Yulpian ringing in bis
ears, is not justified in exclaiming, as to M. Pasteur's
“ methods ”— Credat Judeeus apella !

I am. Sirs, yours truly,

May 14th, 1887. _VlNCBNT RICHARDS*

“PLACENTA PREVIA.”

To the Editors of The Lancbt.

SrB8,—Dr. Barnes’s criticism on my case of Placenta
Prteviain The Lancet of Jane 4th, is not quite clear to¬
me. He approves of detaching the placenta, but not of the
version and plugging the cervix with the breech. Does he
appreciate the conditions of the case? I went to it not-
knowing its nature, and, not possessing his hydrostatic bags*.
I had to resort to other methods. Having detached the
placenta from the whole of its attachment, ruptured the
membranes, and the liquor am mi having escaped, a foot was
brought down, which I fondly imaginea did efficiently com¬
press the placental zone of the uterus and stop the hemor¬
rhage ; but Dr. Barnes objects to my propter hoc, and says this*
was due to the detachment of placenta only. Would he, if-
called to a similar case, without hie hydrostatic bags, have
been content to detach the placenta, put on a binder, and
leave the case to nature after such sudden and alarming-
hamorrhage? The child had virtually no claim to con¬
sideration at the seventh month, of a delicate mother, and
two generations’ heredity of a fell disease; but had it been

* Indian Medical Gazette for April, 1887.

1262 The Lancet,]

TUB BATH WATERS AND ARSENIOUS ACID.

[Jura 18,1887.

nn expectant heir, I should still have turned, but completed
the labour, having used more oxytocic agents, and dealt
with post-purtum haemorrhage as it required. I have just
refreshed my knowledgo of this subject by reading Dr.
Barnes’s clinical lecture on Placenta Praovia in The Lancet,
voL i M 1861. The third case there related has many points in
common with mine. The woman at 4 a.sx. was found faint
and anaemic from loss of blood; placenta quite over centre
of os, which was the size of half-a-crown ; no bleeding and
no pains at time of examination; but delivery was urgent
from exhaustion; eo the placenta was detached from the
lower zone of the uterus, a bag applied, and the cervix freely
expanded in about five minutes, but no pains. “I was,
however, enabled to pass my hand by the placenta and

reach the membranes, which 1 ruptured with a skewer.

head was presenting. A foot was easily seized. I ascertained
that neither cord nor heart was pulsating.Child ex¬
tracted.premature and stillborn. Uterus made to con¬
tract by pressure.the placenta was speedily cast and

withdrawn. No haemorrhage followed the labour. The
patient recovered well. In this case, had I not -possessed
the caoutchouc dilator, I should have been compelled to
stretch open the cervix with my fingers at the risk of injury,
or to encounter the alternative risk of renewed flooding and
a lingering labour, with exhausted uterine power. If the
uterus still remain flaccid, and if haemorrhage continue,
or generally xohere the patient is much exhausted, so
that effective muscular contraction cannot be roused,
artificial aid is called for in order to accelerate delivery.”
He then advises version, if the cervix can be easily expanded
(as in my case), or, if undilated and rigid, to use the bags.
There was no need to dilate either with bags or fingers, and
version was accomplished with the greatest facility and
with a happy result. Would Dr. Barnes have completed
delivery at once, without uterine pains, or would he have
waited? I am, Sirs, yours truly,

Spondon, Derby, June 13th, 1887. B. W AI . KK Xt.

TERRIER’S NEPHRECTOMY.

To the Editors of The Lancet.

Sirs, —In your issue of June 4th you give a leading
article under the above heading, and in referring to a paper
in the Revue de Chirurtjie, by II. Terrier, speak of the
method as a new one. Two years ago I removed a large
diseased kidney by an operation which seems to me essen¬
tially like the one you describe. After opening the abdomen
over the site of the tumour, I incised the visceral peritoneum
vertically over the kidney, enucleated the diseased organ,
and carefully stitched the edges of the visceral peritoneum
to the margin of the wound, thus completely shutting out
the peritoneal cavity from the field of operation, and espe¬
cially from the cut ureter, the wound being drained to the
front. This operation I have since seen performed by one
of my colleagues. At the time I did not think there was
anything new in the operation, supposing that what seemed
to be such an obvious method of shutting out the peritoneal
cavity and draining the wound must have been followed
out by others. It is my intention in my next nephrectomy
to perform the operation in an exactly similar manner;
but, instead of draining forward, to push a trocar through
the loin, and through the opening so made to pass the
detached ureter, together with a, celluloid or some firm
drainage tube, and afterwards to completely close the
anterior incision. A9 the question has now come to the
front, I will take an early opportunity of giving a detailed
report of the case. I am, 8irs, yours truly,

Leeds, June 6th, 1867. _ _A._W. Mayo ROBSON.

TRANSFU8ION.

• To the Editors of The Lancet.

Sirs,— In your issue of June 4tb,,Dr. J. Graham Brown
has pointed out that, in a paper on a case of Trans¬
fusion which appeared in The Lancet of April 16th I
erroneously attribute the method there described to Mr.
Aunandale, whereas it was really introduced by Mr. J. M.
Cotterill. I beg to be allowed to thank Dr. Graham Brown
for making the correction, and to at once acknowledge and
express my Tegret for the error into which I was led by the
fact that the leaflet of instructions famished by the instru¬
ment maker with the apparatus described the method as

“Mr. Aunandale’s.” In reply to a letter of inquiry from
me, Mr. Cotterill has most ccairteouely furnished me with a
succinct statement of the facts of the matter, which I shall
esteem it a favour.if you will allow me to quote:—

“ 1. The fact that phosphate of soda solution prevents
coagulation of the blood nas been known for many yean.
2. Dr. Braxton Hicks is reported (Bryant's Surgery’) to
have suggested its use in transfusion, but whether he
actually used it or not I do not know. 3. I performed the
operation, as described in the leaflet, in 1883, and taught it
to my class of practical surgery as the best method. 4. Two
years subsequently Dr. John Duncan, of Edingburgh, per¬
formed the operation upon mv very strong recommendation,
and by the same method. He repeated it frequently, and
made some further suggestions, which he published in the
British Medical Journal of Jan. 30th, 1886. .j. Mr. Lawton
Tait read a paper before the Midland 8ociety on the eabject,
in which he connected Mr. Annandale’s name with the
operation. No contradiction of this was made, and it is
probable that he was led into the mistake in the same way
as yourself. 6. Mr. Annandale has authorised me to state
that he has had no connection with the introduction of the
method, though he has performed it upon several occasion*."

I am. Sirs, your obedient servant,

Savile-row, June 10th, 1887. WARRINGTON HaWARD.

THE BATH WATERS AND ARSENIOUS ACID.

To the Editors of The Lancet.

Sirs,— In a letter on the above subject, which appeared in
your issue of January 8th this year, I gave expression to the
belief that in the certain discovery of areenious acid in the
Bath thermal waters an explanation was obtained of their
behaviour under certain conditions which hitherto had been
inadequately accounted for. Since then further very careful
experiments have been made for me by my friend, Mr. Gate¬
house, with the result that we are in a position to state that
a gallon of the waters in question contains as nearly as
possible tJu gr. of AS,O s . Can this amount be held respon¬
sible in any way for the “marvellous efficacy” of these
waters in the diseases for which they are extolled? We find
that even in the case of resident patients, in whose cure
change of air can have had no share, chlorosis succumbs
very readily to the waters, taken internally. M&y not the
arsenious acid be the cause here? The amount of iron
present per gallon is only £ gr. —therefore the ratio of the
amount of water that contains an ordinary dose of iron to
the amount that contains an ordinary do6e of arsenic is that
of five to four. From this it will be seen that, small as the
amount of arsenious acid present may be, the share it takes
in the action of the waters is probably great. The amount
of arsenic eliminated from the salts of bismuth in the
purifying process is small, but there is a great difference
between the actions of the purified and unpurified salts.
From this it appears that the action of arsenic when
in a natural compound is much more marked than its action
when given in a prepared form. I am 6trongly disposed to
thiok that certain reagents—among which I would class
arsenic—are specially efficacious when administered in their
so-called natural state, as obtains in natural springs, both
cold and hot.—I am, Sirs, yours truly,

Bath, June, 1887. T. PAGAN LOWE, M.R.C.&, L.B.C.P. Ed.

THE CONTAGIUM OF SCARLET FEVER.

To the Editors qf Thh Lancet.

Sirs, —In your issue of last week you noticed in an anno¬
tation the most recent work that has been carried on in
respect to the materies morhi of scarlatina, and, in stating
the general conclusions arrived at in that research, you in¬
dicated the attitude of guarded reserve in which they must
for the present be regarded. Dr. Edington’s paper has in
the meantime been printed, and a careful survey of its
contents seems to me to fully justify the spirit in which
your remarks were made.. Attention has already been
fully directed to the observations of Dr. Klein, and the
conclusion arrived at by him based on results of the mo6t
unequivocal nature. His conclusion is directly and
diametrically opposed to that now under consideration.
The issue thus raised is fortunately a direct and limited
question of fact; it is, moreover, satisfactory to find
that Dr. Edington’s statement is sufficiently explicit to

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This Lancs*,]

THE PRACTICAL ELEMENT OP MEDICAL EDUCATION.

tJ une ltf, 188?. 12013

render it readily susceptible of confirmation or disproof.
Amongst many organisms found by him in Bcarlet fever
blood and desquamation, the description of which is
a distinct addition to our knowledge of the disease, is
a small bacillus 04 u in breadth and 14/i in length, which
be describes as the specific virus of the disease. This
organism is found in the blood of patients up to the third
day, and in the desquamation on and after the twenty-first
day : in the intermediate period of eighteen days it cannot
be demonstrated in any of the tissues examined. Obtained
as a pure cultivation in nutrient media it has distinctive
specific characteristics in its mode of growth, and if inocu¬
lated into calves, guinea-pigs, or rabbits, it produces a disease
closely resembling scarlatina, and ending in a desquamative
stage. Closely associated with this organism is a micro¬
coccus form, of frequent occurrence in the blood and desqua¬
mation, but without pathogenetic effects if inoculated.
It is noted, however, that in cases where a vivid and
general rash is observed, this organism is a constant
concomitant of the so-called “bacillus scarlatinas”; and,
supposing the observations to be as careful and accurate as
their mode of presentation to the public would lead us to
infer, this point may well call for further investigation, for
it must strike everyone at all acquainted with the history
of such researches that the life history ascribed to this
“ bacillus scarlatinas” is strange and unnatural. A solution
in the continuity of its demonstrable presence extending
over eighteen days is, to say the least of it, a very sus¬
picious point in its behaviour; and it will necessitate a very
strict scrutiny of the conditions associated with its reap¬
pearance in the desquamation, to establish its identity
in its two manifestations, and to exclude tbe possibility of
aerial contamination under an aseptic dressing three weeks
old. Although there are strong points in its technical
arrangement which commend this research to favourable
consideration, there are some grave omissions in the detailed
account before me. The bacillus as found in the blood is
not figured, nor are we told whether it is readily demon¬
strable from its large numbers, or only found in isolated
scarcity, in that medium. Neither is any hint given as to
the manner of its disappearance from the blood. Jt does
not appear to have been found in the urine, and although
spore formation is mentioned, it is neither figured nor
described. The suggested rationale of its disappearance as
due to an exhaustion of its special pabulum is obviously
but an obiter dictum. There is also a lack of control experi¬
ments in regard to organisms normally present in the skin.
Until-these points are more fully elucidated.it is not
possible to accept this bacillus as tbe materies morbi of
scarlatina.

In view of the interest at present attaching to the question
of the zymotic origin of the disease, it may not be out of
place to refer to some of the best known recent publications
which have appeared upon the subject. I need not refer to
the statement of Dr. Klein’s results, already detailed in
The Lancet of May 28th, nor repeat the facts observed by
Mr. Power, but refer to some prior investigations of which
Dr. Klein’s paper affords confirmation, and to which it adds
the conclusiveness they themselves lacked. Coze and Feltz
(“ Maladies Infectieuses,” 1872) described a diplococcus
in connexion with the disease which they looked on as
a causal agent in its production. Pohl-rincus ( Cen -
tralblatt f. d. Med. WissenscJiaft, 18S3) described a similar
organism in the desquamation, on the skin surfaces, and on
those of the palate and pharynx. Crooke (The Lancet, 1883)
described a large bacillus in the last of these situations; but
in a subsequent paper from Eberth’s laboratory (Fortsckritte
der Median, 1885), he recounts the results of a long series of •
experiments in which micrococci were found, chiefly in the 1
tissues of the neck, and more rarely in distant internal
organ?. He does not appear to have examined the
blood in these cases. In a few very severe cases bacilli
blade their appearance at the end of the second or
the beginning of tbe third week, but they were not seen in
ordinary cases, and be does not ascribe any pathogenetic
significance to their pre s e nce. Bokaiof Buda-Pesth (“Orvosi
Hetilap,” 1885) found micrococci single and in chains
in the post-scarlatinal joint affectioup. A negative result
is recorded by Cornil and Babes (“ Les Bactdries,” 1885), who
examined the desquamation for the presence of organisms.
The organisms'normally present on the human skin are no
less important in their relation to tbe present question; j
they are d escribed by Bizzozero (Virchow's Archiv, Bd. 98 I
iii-. 1884), and by Bdrdoni-Uffreduzzi {Fortsckritte der \

Median , 1886). The latter describes five varieties of micro¬
cocci and two of bacilli as' normally present. His descrip¬
tion of one of the latter, B. epidermis, so closely resembles
that given by Edington of his B. scarlatinse, as to suggest
their identity. I remain, Sirs, yonra obediently,

June 15th. • _ M.D.

THE PRACTICAL ELEMENT IN MEDICAL
EDUCATION.

To the Editors of The Lancbt.

Sibs,—R equiring an assistant lately to help in my surgery,
1 engaged a gentleman who said he had bean taught prac¬
tical pharmacy at a large London Hospital. Finding him
very slow in dispensing, 1 made inquiries. He tells me he
was never allowed to make up a prescription for a patient,
or even to compound a stock mixture. He had never made
a pill, and did not know how to spread a blister. He was
simply shown the drugs and told to learn their composition
and uses, and for this he had to pay four guineas, lie then
goes to the College of Physicians and passes his examination
in materia medica, the chief questions being the action
of tbe alkaloids on -the system, and all this before being
taught to compound medicine. Six W. Gull may deprecate
drugs, but the large majority of medical men, as well as
their patients, believe in their efficacy, and what is wanted
is to teach tbe student the real practice of the medical art,
such as he will heed in his after professional life. I do hope
that the appointment of Dr, Glover’s committee will lead to
some form of tbe old apprenticeship being made compul¬
sory. It would be more useful than attending routine
lectures, which most students hate and would gladly dis¬
pense with. I am, Sirs, yours truly,

June, 1887. A GENERAL PRACTITIONER.

NORTHERN COUNTIES NOTES.

(From our ovm Correspondent.)

THE NEWCASTLE EXHIBITION.

Last week must be considered a most successful one for
our Exhibition, as nearly 120,000 visitors went up to the
Moor. The weather was very dull on Saturday, but
towards evening it underwent a favourable change, which
has still continued. An accidental circumstance has given
a variety to the throng of excursionists in our city. A few
days ago the Chinese steamer Toon an came into the Tyne,
with nearly 700 “ Celestiol ” sailors on board. They have
come to take charge of some Chinese war ships now fitting
up at Sir W. Armstrong’s. These sailors crowd the streets,
and create no little curiosity as they go about in their
picturesque groups.

SUNDERLAND.

Mr. A. E. Harris, medical officer of health for Sunderland,
is to be congratulated on the present sanitary condition of
his borough. During the past week the death-rate was
only 15-7, being the lowest point indicated in the list of
the twenty-eight great towns. The epidemic of measles,
which for some time bad assumed so alarming an aspect,
appears now 'to'be practically suppressed. A few years ago
Mr. Harris, on his appointment to the borougb, found a vety
serious state of matters, and the way he had to grapple
with many sanitary abuses before be coaid effect their
removal would have tried the patience of many less
determined officers. He is now rewarded, however, for his
up-hill work in the present sanitary state of Sunderland.

GATESHEAD.

A letter has been received by the Gateshead Town Council
from the Lord Chancellor's secretary, recommending the
appointment of new magistrates. Many of your readers
will be glad to hear that Dr. George Douglass of Gateshead
is included in the list.

HEXHAM .

Lieut.-Colonel NicbolSon, who died at his seat, HalHwell
Dene, Hexham, on Friday night last, in his sixty-eighth
year, was formerly a member of cmv profession, having
served his time to the late Dr. Jefferson of Hexham,
and on becoming qualified practised’ fat a few years
with much success in this ancient abbey town, but about

1264 The Lancet,]

EDINBURGH.—DUBLIN.

[Jtnra 18,1887.

twenty years ago he was enabled by fortunate circum¬
stances to exchange the life of a practitioner for that of a
country gentleman. He joined the Volunteer movement at
its commencement, and rose through its offices until, on the
death of the late Earl of Durham, he was further promoted
tp the command of a battalion, from which position he
retired about seven years ago, and was allowed to retain the
honorary rank of lieutenant-oolonel. He was active in all
that pertained to the welfare of Hexham and its dis¬
trict, and retained to the last a warm feeling for his old
profession. The writer was present a couple of years since
at a meeting presided over by Dr. T. Stainthorpe of Hexham,
-when this gentleman (whom I am glad to say is still hale
and bearty) attained his jubilee in practice at Hexham, and
the manner in which he alluded to his old companion in
practice, and to his old profession, did equal honour to his
heart and mind. In politics the deceased gentleman was a
Conservative; he was widely known and respected by all
•classes. He leaves a widow and daughter, and two sons,
the eldest of whom is practising as a solicitor in Hexham.

Newcaitle-on-Tyne, June 7th.

EDINBURGH.

(From our oum Correspondent .)

ST. ANDREW AMBULANCE ASSOCIATION.

A demonstration of ambulance work was given by
members of the Scottish Ambulance Association, in the
Waverley Market Hall last week, under the presidency of
Sir Thomas Clark, Lord Provost of Edinburgh. The hall is
■a capital place for such purposes, being capable of con¬
taining 30,000 people. On the present occasion about 4000
of the general public were present, ranged round a central
area in which the manoeuvres were carried on. These con¬
sisted of the resuscitation of the apparently drowned, of
those suffocated in conflagrations, and the treatment of
street accidents. Twelve squads of trained men, repre¬
sentative of the police, the tramway company, the railway
companies, and several manufactories and works in Edin¬
burgh, gave an admirable demonstration of stretcher drill
and of bandaging and “splinting” in cases of injury. The
Edinburgh fire brigade added greatly to the interest of the
proceedings by an exhibition of life-saving apparatus, and
succeeded to admiration in rescuing two victims from a
supposed fire in the lofty rafters of the hall. One of their
number demonstrated the safety of leaping into a stretched
sheet from a height of over forty feet, coming down un¬
harmed, amidst the enthusiastic applause of the audience,
who had awaited the denouement with breathless anxiety.
Improvised stretchers and surgical dressings made from
articles of ordinary costume were also demonstrated, and
the excellent hand and waggon ambulances kept by the
Association for the benefit of the citizens were fully exhibited
in action. A statement was made of the work done by the
Association, which shows it to be in a flourishing condition,
and places to its credit a great deal of most useful activity.

THE EDINBURGH CITY JUBILEE OFFERING.

A meeting was held lately to consider the form to be
taken by the Jubilee subscriptions now being raised in
Edinburgh. After several consultations of an informal
■nature, it was decided that a medical charity should be
inaugurated for the benefit of consumptives. At the public
meeting convened to settle the question, it was decided that
the charity should take the form of a permanent fund for
supplying consumptives with medicines and delicacies at
their own homes; not for building a consumption hospital,
as was recently announced in a contemporary journal. The
reasons assigned for deciding against the hospital were that
the Edinburgh climate is such as to render such an institu-
<tion of comparatively little service, whilst it is thought
that the fund applied as above may be a source of great
benefit. Bailie Russell, who is chiefly responsible for this
•decision, said at the meeting that this opinion largely
obtained amongst the medical profession in the city. It is
doubtful, however, whether it is so unanimously held as he
seems to think, and it is not improbable that a plebiscite of
the profession here would have shown a directly opposite

THE JUBILEE DAY.

The city of Edinburgh hold its jubilee holiday on Pridty,
the 17th; the chief illuminations, including a moaner
bonfire on Arthur’s Seat, will, however, be postponed till
the 21st, when the University also will celebrate the
auspicious event. A torchlight procession of unprecedented
grandeur is to be held by the students in the evening.
During the day a commemoration service will be held in
St. Giles’ Cathedral, at which the University authority* vill
be present in robes of office, and at which the other leading
corporate bodies of the city will attend.

Edinburgh, Jane 14th.

DUBLIN.

{From our own Correspondent.)

ROYAL COLLEGE OF SURGEONS.

The Council, at a special meeting held last Monday, the
13th inst., passed a resolution that delegates from tha
Council should be appointed to confer with delegates from
the Apothecaries’ Hall, in reference to a conjoint scheme of
examination between the two bodies. If the combination is
carried out, the question naturally arises. What will the
College of Physicians do under the circumstances? Will
they retire from their present alliance with the College of
8 urgeons or not ? There are many who say that if the Col¬
lege of Surgeons join the Apothecaries the Physicians will
retire from the scheme between the two Colleges; but 1
differ altogether from this opinion, and believe that the Col¬
lege of Physicians will not be inclined to dissociate them¬
selves from the College of Surgeons. And the reason may
briefly be stated : because they can join no other body; and
if they refuse, it is probable that coadjutor examiners will
not be granted them by the General Medical Council, and if
so, they will very soon disappear from the list of licensing
corporations in Ireland.

RICHMOND LUNATIC ASYLUM.

The report of Dr. Conolly Norman, resident medical
superintendent, for the past year is a very important one.
and will well repay perusal. The admissions during the
year amounted to 438, a number considerably higher than
the average for the last ten years. The deaths numbered
159. A severe form of dysentery occurred during the later
months of 1886, and up to the date of the report still con¬
tinued to prevail in the institution. Dr. Norman, who was
appointed to the asylum only last September, is of opinion,
from an examination of the death registers of the asylum,
and also from the prevalence of diarrhoea and dysentery
during his year of office, thst these zymotic diseases appear
to be endemic in the institution. These diseases and
erysipelas, which is rarely absent from the house, are usually
due to defective sanitation, and he states that the sanitary
condition of the asylum is deplorable. He adduces ample
proof of this statement; but as the main points have
some months since been already referred to in these
columns, I shall not go into details. Several months ago
I mentioned the chief defects in the sewerage; and <t
will be impossible, now that public attention has been
directed to the matter, for the governors to shirk the subject
any longer. The defects which undoubtedly exist must
be rectified, and that without delay. I believe I am correct
in stating that a very eminent sanitary engineer has in¬
spected the institution and reported fully to the Board of
Governors,and that he has corroDorated in the fullest manner
the statement of Dr. Conolly Norman as to the sanitary
defects of the Richmond Lunatic Asylum.

ROYAL MEDICAL BENEVOLENT FUND SOCIETY OF IBEIAKP.

The annual meeting of this Society was held last week,
and from the report of the Council it seems that its financial
state cannot be regarded as satisfactory. At the meeting
the sum of £1154 was awarded for distribution, of which
£110 was to medical practitioners,£946 to widows, and ^ to
orphans. The Society obtained a sum of £55 15a., which
was handed over by the Council of the Royal College of
Surgeons, in accordance with a proviso in the will of the
late Mr. Richard Carmichael.

A CENTENARIAN.

A widow named M’Ananev died last week at Enniekerry.
co. Wicklow, in her one hundred and ninth year.

oogle

Thr Lancbt,]

PARIS—OBITUARY.

[Junk 18,1887. 1265

THR RBGI8TRAR8HIP OF BIRTHS BTC. IN CRU8HKEN DIS¬
PENSARY DISTRICT: HNWIS UNION.

Dr. W. H. Hynes, medical officer of Crusbeen dispensary
district, was the registrar of births for his district, but some
weeks since he was removed by the Registrar-General for
Ireland for the alleged reason that he delayed answering his
communications. A successor was appointed without any
protest from Dr. Ilynes, as, from a monetary point of view,
the office was of little value; but, on Consideration, he con¬
cluded that the question of his removal by the Registrar-
General was one of very great importance to dispensary
medical officers in Ireland. The gentleman appointed having
resigned, Dr. Ilynes applied for the post, and this application
was received by the guardians some few weeks since.
Having heard his explanation, the guardians unanimously

g assed a resolution to the effect that they considered the
egi8trar-General had exercised high-handed authority in
removing Dr. Hynes in such a summary manner, and that,
before such a course had been adopted, the matter should
have been referred to them. They further asked the
Registrar-General to reconsider the matter and reappoint
Dr. Hynes, stating, at the same time, that the “ unanswered
communications” complained of by the Registrar-General
were addressed to Dr. Hynes during his absence on leave.
I am informed that the Registrar-General has refused
to appoint Dr. Hynes, and that a person whom be
selected for the appointment has declined to accept it.
An official from the General Register Office, under these
circumstances, was sent down from Dublin, where for
the past ten days he has tried to get the registrarship
accepted, but without success. So tne matter stands, and
at present there is no registration going on in the Crusheen
district, which is rather a serious matter. Dr. Hynes and
the guardians complain of the want of courtesy in not con¬
sulting them on the subject, and refusing to endorse their
recommendation of Dr. ilynes as a competent official. If,
as alleged, the appointment of registrar according to the
Act of Parliament is vested in the local authority, T cannot
see how the Registrar-General can make the appointment.
The salary of the post is only about £4 per annum I
Dublin, June 14th. _

PARIS.

(From our oum Correspondent.)

MASSAGE IN FRACTURES.

Dr. Georges Berne made an interesting communication
to the Socitftd MSIicale de l’Elysde on the treatment of certain
fractures by massage. After showing the importance of a
good venous and lymphatic circulation in fractured limbs,
he insisted npon the necessity of keeping the joints in the
neighbourhood movable and supple. It is particularly in
fractures of the radius and fibula that massage is useful, the
inferior epiphyses being supported as it were by natural
splints in the shape of the contiguous bones. Where there is
not displacement, extensive centripetal effleuragc, commenced
early in the treatment, will promote the absorption of the
blood extravasated around the fracture. Von Mosengeil has
shown that massage displaces effusions through the lym¬
phatic network of the cellular tissue, and the same thing
occurs when centripetal pressure is applied above the seat of
fracture. The rapid retraction of the tendinous sheaths of
the fingers when they are immobilised is a matter of common
experience. Dr. Berne maintains that this accident, almost
inevitable with the usual treatment, may be obviated by
massage. He states that he was the first to investigate this
point in the treatment of fractures of the fibula, which he
has treated with complete success by massage for the last
three years. In 1881 a patient with a fracture of the lower
end of the fibula without displacement was treated by Dr.
Coupard and himself in the following manner:—Massage
was employed from the very first day, the limb being placed
in a plaster ffouttibre, from which it was removed every two
days for this purpose. After each sitting of a quarter of an
hour the apparatus was reapplied. From the fifteenth day the
apparatus was laid aside, and the pationt was able to walk
without difficulty. The limb was in no way atrophied, and
all the movements of the tibio-tarsal and tarsal articulations
were natural. The temperature was normal. Other cases

in the wards of M. Duplay at the Lariboisiere Hospital have
shown that there exists no better treatment of fractures of
the fibula than relative immobilisation in a movable plaster
bandage and periodical massage. The mean duration of the
treatment by this method is from fifteen to seventeen days,
instead of thirty, an important point, especially in hospital
practice. Dr. Berne is also an advocate for massage in
fractures about the elbow and patella, but he urges the
necessity of caution whenever there is displacement or
wound of the integument. In all cases, however, he main¬
tains that manipulations should be performed bv an expert
scientific masseur, never by tbe so-called medical rubber.

SWEATING SICKNESS.

An epidemic of suette miliaire has reigned for some time
past in several districts of the department of Vienne, princi¬
pally in that of Montmorillon, but it has now spread to the
surrounding country. At BussuJre-Poite-Vinne, a village
near Mezi&res, there are 250 cases amongst 2300 inhabitants,
and more than twenty deaths have already occurred, some
of them with extreme rapidity. A commission, consisting-
of MM. Cbantemesse, Tboinot, and Descoust, has been sent
by the Government to investigate the matter, and M. Brou-
ardel has also gone for the same purpose.

PA8TBUBIANA.

The Bulletin Midical publishes a letter addressed by
M. Pasteur to the Imperial and Royal Society of Vienna
with reference to Dr. von Frisch’s strictures on his method,
and the comments thereon of Professor Billroth. M. Pasteur
points out that the experiments performed by Dr. von Friscb,
the results of which were unfavourable to his method, were
made chiefly upon rabbits. He discusses their value, and
concludes that “ these facts not only rain the experiments-
in question, but shake all confidence in tbe whole work,
of Dr. von Frisch. We must conclude either that Dr. von
Frisch is a bad operator, or else that he allowed tho
virus, which he obtained in Paris, to become deteriorated.”
At the last meeting of the Vienna Society, reported in tba
Semaine AfSdicale, Dr. von Frisch went over the same ground'
as in his previous communication. He maintained that
M. Pasteurs reply was not a refutation of his objections,
and said that be wan confident the future would decide in
his favour., M. UUmann, on the other hand, submitted threfr
provisional conclusions to the Society, which were as
follows: 1. Animals do not become rabid by inoculation
with the preventive virus. 2. Some animals can be made
refractory to rabies by the preventive inoculations. 3. The
statistics of the preventive inoculations made (by M. Ullmann>
in man appear favourable to Pasteur’s method.

Paris, June 15th. '_

©bitnarj.

W. A. B.. McCABE, F.R.C.S.

Wb regret to record the death of this promising young-
surgeon. which took place at Sydney on April 18th, at the
early age of twenty-five. He was bom in Jersey, and
received his early education at the Victoria College, St.
Heliers. In 1879 he entered in the Faculty of Science of
University College, London, and a year later, after passing
the Preliminary Scientific Examination with honours, he
commenced medical study. After a successful career as a
student, he obtained the poet of house-surgeon to Uni¬
versity College Hospital in 1885, and at the commencement
of the following winter session he was appointed Assistant
Demonstrator of Anatomy in the College. This post he was
obliged to relinquish on account of failing health after
holding it for one year. As the winter advanced the sym¬
ptoms of phthisis became more marked, and he was advised
to take a voyage to Australia. Unfortunately severe haemo¬
ptysis came on when he was near the end of the voyage, and he-
landed at Sydney almost in a dying state. Mr. McCabe was
characterised in all he did by a conscientious and honest
desire to do his best, and to nis unsparing devotion to his
duties may in part be attributed bis early death. He was a
good anatomist and a popular teacher. His genial character
endeared him to all who knew him, and his abilities and
enthusiasm gave promise, had his life been spared, of a.
brilliant career in tne profession he had chosen.

Digitized by GoOgle

1266 Th* Lancet,]

MEDICAL NEWS.

[June 18,1887.

llUiriotl |ttfes.

Royal College of Physicians of Edinbuegh.—
The following gentlemen have recently passed the exami¬
nation for the licence of the College:—

J. J. Jackson, L.R.C.S. Irol. | A. J. Tomkins, M.R.C.S.Bng.

B. F. McArdle, L.U.C.S. Irel.

The Duke of Portland will preside at a festival
dinner, to be held at the Hdtel M6rxopole to-day (Friday),
in aid of the funds of the West End Hospital for Panlyoi
and Diseases of the Nervous System.

At the annual general meeting of the subscribers
to the Queenstown General Hospital on the 7th inst satis¬
factory financial and general reports were presorted and
adopted.

College of Physicians in Ireland. —At the
June examinations the following obtained licences in
Medicine and Midwifery of the College:—

Medic raE.—Patrick Joseph Barry, Bdward Joseph Brady. Stafford
Mourltz Cox, John Smyth Crowe, Bdwtn Tyrrell Cummings. Albert
Edward D.vas, Richard Langford Fitzgerald, John Alexander
Foreman. Henry Gel!, Albert William Gray. Herbert Leonard
Hudson, Edward Julian Jacob, Augustus Grayaon Johnston, Joseph
Christopher Lavertlne, Francis James McArdle. Patrick Joseph
Molony, John Brooke Moore, Neal Nelson, Richard Pennefather,
Horatio Edward Rawlings. Edmund Boys Russell, John Stewart,
Francis James Spilsbury. Bbenezer Telchelmann, William Hall
Torbock, Patrick Joseph Ward, Edward Henry Wheeler.
Midwifery. —Patrick Joseph Barry, Edward Joseph Brady. John
Smyth Crowe, John Alexander Foreman, Henry Gefl. AlbertWilliam
Gray, Augustus Gravdon Johnston, Neal Nelson, Richard
Penaefather, William Hall Torbock, Thomas Torney, and Edward
Henry Wheeler.

A special examination will be held on the 24th inst. and
following days.

XJniversity of Cambridge. — At a congregation, held
on the 9ch inst., the following gentlemen were appointed
examiners:—

Medici**. — Dr. Norman Moore, St. Catherine's; Dr. Donald
Mac Alister, St. John’s ; Dr. W. H. Bro&dbent, London.

Midwifery.—D r. A. L. Galabln, Trinity; Dr. W. O. Priestley,
Edinburgh.

Surgery.—M r. G. E. Wherry, Downing; Mr. Charles N. Macnamara,
P.R.C.S., Mr. Alfred Willett, F.R.O.S. ^

Also the following degrees were conferred:—

Master of Surgery.—H enry Walter Pigeon, Christ's.

Bachkmrs op Memoirs.—R oger Neville Goodman, Hugh Richard
Jones, St. John’s; Henry Alfred Havlland, Pembroke; James
Black, Sidney Blake Jolly. Gonvlllo and Cafus.

Bachelors of Surgery.—H ugh Richard Jones, 8t. John's: Charles
Silvester Evans, Clare.

Society of Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
practise as Licentiates of the Society on June 9th;—

Bonce, Frederio Herbert, Lancaster-road. Notting-hlll.

Bloomer. Frederick William, Russell-street, Wednesbury.

Carter, John George, Brixton-road.

Clifford, Thomas, Thomhlll-terraoe, 8undertand.

Cocklll. William Baron, Trittiville-gardens, Uxbridge-road.

Dodd, George Herbert, Rush-court. Wallingford.

Raby, Leonard, Southwold-road, Clapton.

Richards George Frederick, The Firs. Beckenham-road, Penge.

Sandoe, John Worden, Bodmin, Cornwall.

Wakefield, Robert Clark, Ladbroke-grove-road, Nottlng-hili.

The annual distribution of prizes to the students of
the Bristol Medical School took place on the 7th inst.

Vaccination Grant.— Mr. F. M. D. Swallow, of
the Silkstone District of the Penistone Union, has teen
awarded the Government grant for efficient vaccination.

Bequests. —TheCJityof Dublin Hospital has received
under the will of the late Mr. William Bannon, and
ilOO from Mr. Richard Kemmis.

The prizes gained duiing the past summer and
winter session at St. Thomas’s Hospital were distributed to
the successful competitors by Sir Henry Acland on the
15th inst.

At the fourth annual meeting of the supporters of
the Paddington Children’s Hospital on the 10th inst., the
&atisfacto°n the charity was reported to be very

Vaca-itons of Resident Medical Officers.—
The administration of the Assistance Publique in Paris
has ordered that the internet (house-surgeons and house-
physicians) of the various hospitals shall not take their
holidays at the same times as their respective chiefs.

Presentation. — Thomas Lament Macartney,
L.R.C.P. and L.R.C.8. Edin., has, on his leaving Worthen,
0ee u presented with a magnificent dining-room marble
elode and figure, an illuminated address, and a parse of
gold by a few of his friends and grateful patients in and
around that district.

The Water Committee of the Sheffield Corporation
have come to an arrangement with the directors of the
local water company under which the Corporation will
take possession ot the reservoirs, &c., next January.

The Liverpool Marine Biology Committee hu
received a Government grant of £25 towards the expense!
of the exploration of Liverpool Bay and the determimtioa
of its flora and fauna.

Medical Magistrate. —Colonel Pearson R. Cress-
well, F.R.C.S., commanding the 2nd Glamorgan R.Y, tad
Chief Surgeon to the Dowlais Iron Works, has been placed
upon the Commission of the Peace for the County of
Glamorgan. _

EXAMINING BOARD IN ENGLAND BY THE BOTAL
COLLEGES OF PHYSICIANS AND SURGE058.

FIRST EXAMINATION.

Part I.-OHBMISTBY, INCLUDING CHEMICAL PHT8I0S.
Candidate* mutt answer at least four question*, and not more tie* i ix. A
least one question in each Section must be answered. Candidates untbU's
answer four questions must report the fact to the Presiding Examine,
and are not allowed to proceed with their examination.

Section /.— 1 . Explain dearly the construction of the ordinary wm-
curiat barometer. Why doe* the mercury fall on ascending heights?
What Is understood by the term "boiling-point," and what 11 the con¬
nexion between the boiling of liquids and the atmospheric pnwurri

3. What is understood by “conduction"and “Insulation"as appliedU
electricity ? Describe an electrieal machine for frictional eleetmty.
and make clear the objects of oonduotion and Insulation In the machine.
How would you proceed to electrify a person with positive electricity 1

Section If. — 3. 8how by equations the result of the action of sul¬
phuretted hydrogen upon the following bodies In solution: chlorine,
sulphurous acid, ferric chloride, sulphate of copper, and am mono.

4. Give two methods for the preparation ot sulphur dioxide, and explain
the bleaching effect of this add and that of chlorine. 5. A piece of pure
silver is dissolved in nitric add. Describe the preparation from thU
solution of lunar caustic, of ohloride, and of oxide of sheer. Glee the
properties and formulae of these bodies.

Section III.— 6. How may urea be prepared from the urine? Whit is its
composition and its formula ? How do you account for the presence of
carbonate of ammonium In stale urine? 7. Describe different methods
by which starch can boooaverted Into grape-engar. How it this sugar
distinguished from cane-sugar, and how is it detected in s solution’
8. Describe the preparation and composition of ordinary aldehyde.
What are Its leading properties? Howls chloral hydrate prepsrsd?
What is Its composition, and how is It related to ordinary aldehyde?
Part II.-MATBBIA MBDIOA AND PHARMACY.

1. Give an amount of the action of digitalis. What ars the doses of
this drug and of its preparations ? 3. What are the officinal compounds
and preparations containing arsenleum? Give the strength of the
preparations and the doses of all. What Is the action of arseuloos add ?

3. Give the preparations of ergot, colehicum, and ipecacuanha, and ths
composition of the pul vis Ipecacuanha: composltus and plluls ipectranhr
cum scilUL Mention the composition, strength, and dose ot tbs hypo¬
dermic injection of ergotin. 4. Give a description of (a) chloroform.
(A) Iodoform, and an account of the action of each. Enumerate thrlr
preparations, and mention the doses of those used Internally. 5. Describe
the action of the following sulphates : sulphate of iron, magnesium,
quinine, sodium, zinc; and give the dose of eaoh. 8. What Is the scare*
of pilocarpine ? Give an account of its action. How would you administer
It, and In what dose?

Part III.—ELEMENTARY PHYSIOLOGY.

1. How would you recognise under the microscope (a) the varieties «!
muscle, (6) a meaullated nerve-fibre? 2. How does plasma differ fmn
serum, and how may each be obtained from blood ? 3. What is the com¬
position of the atmosphere? How does expired differ from Inspired sir?
What are the chief changes produoed in the blood by respiration ’

4. What are the chief constituent* and uses of the gastric and pancreatic
juices ? 5. In starvation the body temperature Is reduced. Explain
this. 8. What is meant by (a) afferent nerve, (A) efferent nerve,
(c) nerve centre ? Give Instances of their use.

SECOND EXAMINATION.

ANATOMY.

Candidates must answer at least four questions.

1. Enumerate the bony surfaces which form the anterior fowt of the
base ot the skall. What markings and foramlns are there in this tom.
and what do those foramina respectively transmit ? 2. Give the origin,
oourse, and distribution of the external popliteal nerve and lte branches.
3. Describe the origin, oourse, and distribution or the arteries whl-t
anastomose In the fossa of the soapula. 4. Describe the dissection o! thr
anterior part of the perineum down to the superficial layer of the tn-
augular ligament. 5. Give the position, relations, connexions. sec
arterial supply of the stomach. 6. Give the origin, Insertion, and nerve
supply of the following muscles: (a) levatorangull scapular. (S)net*
aublimta dlgitorum, (c) rectus abdominis, (d) adductor magma.

zed by Google

THB LANCET,]

MEDICAL NOTES IN PARLIAMENT.—APPOINTMENTS.

[June 18,1887. 1267 -

PHYSIOLOGY.

1. Desorttw the tab of deglutition. Including It* nervous meabanlsro.
2 . Describe the mucous membrane of the uterus. State the changes
which occur at the menstrual period and during gestation. 3. Explain
the effects of the respiratory movements on the circulation of the blood.
4. State and explain the effects of exercise on the excreta. 5. Describe
the structure, action, and nervous median ism of the iris. 8. Give thS
structure of adipose tissue. What is the chemical composition of the
fats oontalned in it ? From what constituents of food may fat be formed?

ROYAL COLLEGE OF PHTSICIANS OF LONDON.

EXAMINATION FOR THE LICENCE.

(Third Part #r Final.)

PRINCIPLES AND PRACTICE OP StJBGEHY.

1. Cancer of the tongue: give the Symptoms, diagnosis, and treatment;

2. Give the symptoms, the possible results, and the treatment of lyphilitic
iritis. 3. Describe a case of congenital talipes varus, and give in detail
t he treatment that may be adopted. 4. What symptoms may be pro¬
duced by the presence of a foreign body in the trachea or bronchus?
How would you treat such an accident ? 5. Senile gangrene what are
its causes, its usual course, and termination ? What methods of treat¬
ment may be adopted ? 6. Describe the symptoms and treatment of
villous tumour of the bladder.

PRINCIPLES AND PRAOTICB OP MEDICINE.

1. Describe the course of the transverse aorta. Give its anatomical
relations, with special reference to the physical diagnosis of diseases of
that portion of the arterial system. 2. Enumerate the symptoms usually
met with in the third week of a case of typhoid fever, as they occur from
.lay to day. and the remedial measures that you would adopt for their
relief. 3. What are the signs of a pleural effusion on the right side, ,
rising to the level of the third rib? What symptoms would make you
come to the conclusion that the fluid was purulent? and, in the latter
case, what treatment won Id you adopt? 4. Describe the pathology,
■symptoms, and treatment of infantile paralysis. 6. Describe the course
of a case of unmodified small-pox, with its possible complications,
especially noting its period of incubation (including its prodromal and
eruptive stages), results, and proper treatment. 6. What are the sym¬
ptoms of cancer of the stomach ? Indicate the principal differences that
would result from varieties of site In the morbid growth. How would
you treat such a case ? Write in full the prescription you would give.

MIDWIFERY AND DISEASES OF WOMEN.

1. Describe the chorlpn up to the end of the second month of gestation.

3. What are the causes of total death in the last two months of gesta¬
tion ? 3. Wbat are the chief methods employed for the induction of
premature labour, and what are the circumstances which would deter¬
mine the choice? 4. State fully what means should be adopted to
prevent the occurrence of puerperal fever In obstetrio practice. 6. De¬
scribe the varieties of cancer of the cervix uteri, with the diagnosis and

pathology. 6. B-. aged thirty, was confined two years ago of her

second child. She did not suckle the infant, and the catamenia re¬
appeared one month after delivery. The periods, which were somewhat
profuse, appeared regularly until a year ago, when the patient had a
severe flooding. This recurred at irrregular intervals until the time of
her admission to the hospital a montli ago. On examination, the uterus
was felt to be slightly enlarged and the os uteri closed. What are the
various conditions which may give rise to these symptoms, and what b
the treatment?

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

DIPLOMA OF MEMBER.

PRINCIPLES AND PRACTICE OF MEDICINE.

Candidates must answer three of the four questions, including Question No. 4.

1. Give a full account of [cancer of the stomach, including its orifices.
Describe the oausea, diagnosis, and treatment of hsemoptysis.
-1. Under what conditions is excessive elevation of the temperature uf
the body met with ? What temperature is to be deemed dangerous, and
what are the means whereby it may be reduced? 4. Give the com¬
position. physiological action, medical uses, and doses of decoctum aloes
com poei turn, ferrum red actum, lithiic oltras. liquor morphinte hvdro-
chloratls, apomorphinie hydrochloras, piiula saponls composita, pul vis
glycyrrhlzas compositus, syrupus chloral.

MIDWIFERY AND THE DISEASES OF WOMEN.

1. Describe the passage of a child through the pelvis with the breech
presenting, with the sacrum to the right sacro-iliac synchondrosis.
2. State the circumstances In which convulsions come on In the puer¬
peral state, and how would you distinguish between them ? 3. State
the means yon would adopt with a view to prevent the infection of
parturient smd puerperal women. 4. A patient three weeks after labour
“ painful fixed swelling in the left iliac fossa, with febrile symptoms.
What la the probable nature of the swelling, and what oourse will it run ?

SURGICAL ANATOMY AND THE PRINCIPLES AND PRACTICE
OF SURGERY.

Candidates must answer at least four (including one of the first turn) of the
fix questions, and are strongly advised to answer all six questions.

'■ Describe the shape, position, and relations of the thyroid body.
Mention particularly the points which would require attention in an
operation for its removal. 2. Describe the arches of the foot, and the
stmetores by which they are maintained, with especial reference to the
deformity known as ••’flat-foot," 8. Name the most frequent disloca¬
tions and fractures occurring at the elbow-joint. Give their differential
signs. 4. Describe the surgical treatment of empyema under its various
conditions. 5. How may the production of lymph as the result of In¬
flammation be accounted for? Describe Its physical and chemical
Properties, and mention the changes it may undergo. 0. Describe the
tr <M?* nent 10 ** adopted in a case of punctured wound of the cornea
with prolapse of the iris. Mention the consequences which may ensue, .
ami the proper modes of dealing with them.

MEDICAL NOTES IN PARLIAMENT.

Dog Owners Bill.

In the House of Lords on the 10th Inst. Lord Mount-Temple moved
the second reading of the Dog Owaers Bill, the object of which was to ■
provide that the owner of a dog shall be liable In damages for any
personal injury done by such deg to any person, and It shall not be
neeessary for the person suing for the recovery of damages for any such

^ jury to show a previous mischievous propensity, in such dog, or that
e owner knew or had notice of such mischievous propensity, or that
tbs ihjurv dompkUned of was attributable to any aegltgehce oa ths')
part of the owner at thedog.ln toe.keeping or management of each
dog.—The Lord Chancellor opposed the Bill, and the second reading
was negatived.

Rabies in Dogs.

j On the 14th inst., on the motion of Viscount Gmabrook, the following
wpre Dominated as the Select Committee on. rabies in doga The Lord,
President (Viscount Cranbrook), the Duke of Beaufort, tho Earl of
Coventry, the Bari of Carnarvon, the Earl of Onslow, the Earl of
Zetland, the' Earl of Kimberley, Lord Walstngham, Lord Hibbleedale,
Lord Poltimore, Lord Belper, Lord Mount Temple.

1 Sanitation in India.

In the House of Commons on the 13th inst., in reply to Mr. Kenyon,

f ir J. Gorst said, that the sanitary condition of towns and villages in
ndia was constantly under consideration by the Government of India
and the Secretary of State, and that every effort had been, and would be,
made to Introduce from time to time such Improvements as may bn
practicable.

Scarlatina Infection.

i Lord John Manners stated, in answer to Sir U. Kay-Shuttle worth,
that the investigations which the veterinary officials of the Agricultural
Department had been Instructed to make Into Dr. Klein's theory of
scarlatina infection from the milk of diseased oows were still being
carried on, and the report would be laid before Parliament.

Successful applicants for Vacancies, Secretaries of Public Institutions, and
others possessing information suitable for this column are invited to
1 forward it to The Lancet Office, directed to the Sub-Editor, not later
than 9 o'clock on the Thursday morning of each week for publication in
1 the next number. _

Bxatlky, Wm. Crump, M.D. Durh., M.R.G.S., has been appointed
Honorary Physician to the Newcastle-upon-Tyne Dispensary, vloe
B. Young, M.A., M.D., resigned.

Black, Robert, M.D.Lond., M.R.C.S.. has been appointed Assistant
Surgeon to the 8ussrx County Hospital, vice Uhthoff, resigned.

Bradbrook, WIlltam, M.R.C.S., L.S.A., has been appointed Medical
Officer for the lnkberrow District of the Alceater Union.

Caldbr, Augustus B., M.B.. C.M.Ed., has been reappointed Visiting
Medical Officer to the Perth Infirmary.

Clarke. Arthur C.. L.K.Q.C.P.I., L.R.C.S.I., has been appointed
Medical Officer for the Chipping Warden District of the Banbury
Union.

Evans. O. W.. M.B.Lond., has been appointed Medical Officer of Health
to the Bakewell Urban Sanitary Authority.

Gillard, Richard, M.R.O.S., L.S.A., has been appointed Medical
Officer for the Ugborough District of the Totnee Union.

Gowahs, W. Bruob, M.B., C.M.Ed., has been appointed District and
Dispensary Surgeon to the Perth Infirmary, vice Hunt, promoted
Visiting Medical Officer.

Graham, J. T.. M.D.Glas., M.R.O.S.. has been reappointed Visiting
Medical Officer to the Perth Infirmary.

Heqabty,. Andrew, M.D., M.Oh.Q.U.I., has been appointed District
Medical Officer for the Drapers town Dispensary, vice Morewood,
deceased.

Honntwill. Alfred O., L.R.C.P.Bd.. L-B.C 8.Bd.. has been appointed
Medical Officer to the Lea Hall Branch of the Essex County Asylum,
vice W. T. Davert M.D.. M.B.C.S.. L.8.A.. deceased.

Hughes, Alfred W„ M.B., C.M.Ed., M.R.O.8., has been appointed
MedloRI Officer for the Flint District of the Holywell Union.

Hunt. Leigh. M.B., O.M.Glas., has been appointed Visiting Medical
Officer to the Perth Infirmary.

J Epson. Edward, M.R.O.S., L.S.A., has been appointed Medical Officer
for the Workbonseof the Durham Union.

Kkllt. Michael F., L.F.P.S.Glas., L.A.H., hat been appointed Medical
Officer for the Heworth District of the Gateshead Union.

Kelson, W. H., M.R.C.S., has been appointed House-Physiol an to the
London Hospital.

Mklson, George Hyde, M.B.Lond., M.R.C.S., House-Surgeon to the
Queen’s Hospital, Birmingham, has been appointed House-Physician,
vice Wm. Richards, M.B.Bd., resigned.

Morgan, William V., M.B., C.M.Aber., has been appointed Medical
Officer for the First Distriot and the Workhouse of the Narberth
Union.

O’Neill, J. Gower, L.R.C.P.. L.R.O.S., lias been appointed Assistant
House-Surgeon to the Rotherham Hospital.

Pooley, Thomas A., has been appointed Analyst for the Liberty of
Havering.atte-Bower In the County of Essex.

Richards, William, M.B.. C.M. Ed., has been appointed Resident
Surgeon to the Birmingham General Dispensary, vice T. E. Gordon,
M.D., M.B.C.S., resigned.

Roberts, Gkorgk A. E., M.R.C.S., L.S.A., has been appointed Medical
Officer for the Fourth District of the New Winchester Union.

Ship-ton, Arthur, F.R.C.S.Bd., L.S.A.. has been appointed Medical
Officer for tho Buxton District of the Cliapel-en-le-Frith Union.

Thomas, John, M.R.O.8., L.R.O.P. Lond., ha* been appointed House-
Surgeon to the London Hospital.

Thompson, Maitland. L.R.O.P.Ed., M.R.C.S., has been appointed
Medical Officer for the Fifth District of the Lincoln Union.

Googl

1268 The Lancet,]

VACANCIES.—BIRTHS, MARRIAGES, AND DEATHS.

[Juice 18,1887.

©axancus.

METEOROLOGICAL READINGS.

(Taken daily at 8.SO a.m. by Steward"t Instrument*.)

In compliant* with the desire of numerous subscribers, it has been decided t*
resume the publication under this head of brief particulars »f the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement, _

Clhicu Hospital for Women and Children. Park-plaoe, Man¬
chester.—Houae-Sargeon. Salary £80 per annum, with apartments
and board.

Coventry and Warwickshire Hospital. — House-Surgeon. Salary
£100 per annum, with board (exclusive of beer, wine, and spirits),
lodging, and attendance.

Durham County Hospital. — House-Surgeon. Salary £100 a year,
with board and lodging.

Hospital for Sick Children, Great Ormond-etreefc, W.C.—Assistant
Physician.

Hospital for Women, Soho- square, W.—House-Physician. Salary £75
per annum, with board Ac.

Liverpool Dispensaries. —Assistant Surgeon. Salary £80 per annarn,
with apartments, board, and attendance.

National Dental Hospital and College, Great Portland-street, W.—
Anaesthetist.—Lecturer on Operative Dental Surgery.

St. Luke's Hospital. — Resident Clinical Assistant. Board and
residence.

Westminster General Dispensary, Gerard-street, 8oho, W.—Hono¬
rary Surgeon.

Westminster Hospital, Broad Sanctuary, S.W.—Surgical Registrar.
Salary £40 per annum.—Assistant Surgeon.

Western Ophthalmic Hospital, Marylebonc road, W.—Dispenser.

HirtfjS, ^ferriages, attir $3tatjrs.

BIRTHS.

Dawson.—O n the 14th Inst., at Hesthlands, Southboume-on-Sea, the
wife of Yelvertou Dawson. M.D., of a daughter.

Mackenzie.— On the 14th inst., at Finsbury-square, E.C., the wife of
Stephen Mackenzie, M.D., F.R.C.P., of a ton.

Scanlax.—O n the 8th Inst., at Springfield, Pembroke, the wife of
Surgeon-Major Seanlan, Army Medical Staff, of a son.

Scouoal.—O n the 13th Inst., at Brooklands, Gledholt-road, Hudders¬
field, the wife of E. F. Scougal, M.A., M.B., of a son.

Skipper.— On the 13th inst., at Tollington-park, N., the wife of Edward
Skipper, M.D., of a daughter.

MARRIAGES.

Allen—Mair.—O n the 11th inst., at Holy Trinity Chnrch. Hastings.
Surgeon-General F. F. Allen, C.B., and Q.H.P., to Florence Mary
Jane, third daughter of George J. J. Mair, Esq., F.8.A., of Upper
Bedford-place, Russel 1-square, London.

Archer—Commerford.— Un the 14th inst., at 8t. John's. Hackney,
by the Renter, the Rev. A. Brook, M.A.. Launoelot Archer,
M.R.O.S.. of 38, Vincent-square. Westminster, eldest son of Thomas
Archer, Bsq., of Clapton, to Susie, only daughter of N. W. Commer
ford. Esq., of C'apton-square.

Hatch—Homan. —On the 4th Inst., at St. Marylebone Church.
William Keith Hatch, M.B., P.R.C.8.. Bombay Medical 8teff. to
Clara Catherine, third daughter of 3. A. Homan, Bsq., Deputy
Surgeon.GeDeral, Indian Army (retired).

Mackenzie —Christie. — On the 15th inst., at St. Mark’s Church,
Surbiton, by the Venerable Archdeacon Burney, assisted by the
Rev. A. H. Murray, Surgeon A. W. Mackenzie, 6th Punjab
Infantry, Punjab Frontier Force, to Jessie Thomson, eldest daughter
of the late John Christie, of Forth-bank, Stirlingshire.

Miles—Kino.— On April 28th, at All Saints’ Church, 8t. Kilda, near
Melbourne, Victoria, by the Rev. J. H. Gregory, Incumbent,
assisted by the Rev. Horace Tucker, Incumbent of South Yarra,
Melbourne, George Edward Miles, L.H.C.P., M.R.C.S.. of Callan-
park, Sydney, N.S.W.. to Ada Louise, youngest daughter of the
Rev. Richard King, of Hampstead, late of Prestwich, Manchester.

Preston — Sadler. — On the »th inst., at St. Mildred's Church,
Canterbury, by the Rev. J. Parmiter. Rector, assisted by the
Rev. R. N. Qandv, Rector of St. Andrew’s. Canterbury, and the
Rev. T. Preston, Vicar of Swaffham Prior, Cambridge, father of the
bridegroom. Henry Octavius Preston, M.R.O.S., to Dora Mary
Sadler, only child of Henry George 8adler, of Oswald House,
Canterbury.

DEATHS.

Cameron.—O n the 11th ln«t., at Morefleld, Aberdeen, William Hecto
Cameron, M.R.C.S., late Staff Surgeon, B.N.

Glover.— On the 8th inst., at St. Thomas’s Hospital, John Philli
Glover, M.R.C.S., L.B.O.P., M.D.Lond., late of Quarndon, Derby
shire, aged 41.

Lauder.—O n the 4th inst., at Comely Bank, Tayport, Fife. Bober
Scott Lauder, M.D., aged 43.

McCabe^O n April 18th, at Sydney, William Alexander Bowes McCabe
F.R.C.8., aged 25.

Oxlet.—O n the 14th Inst., at Llandudno, Martin Gay Black Oxley
M.D., aged 46.

■•B-—-A fmofds.it charged for the Insertion Notices of Births,

Marriages, and Deaths.

The Lancet Office, June 16th. 1BBT.

Date.

Barometer
reduced to
Sea Level
and S3* F.

Direc¬

tion

of

Wind.

Wet

Bulb.

Solar

Radia

1s

Vacuo.

Max.

Temp.

Shade

Min.

Temp

Hal*

fell.

Besutin

-

June 10

30-39

N.B.

60

64

112

71

54

Cloudv

., 11

30 41

W.

60

53

116

77

51

...

Bright

,. 12

3021

W.

65

57

120

80

5i

Bright

„ 13

30 TO

w.

06

58

120

84

54

Bright

.. 14

3024

N T E.

70

60

98

81

60

Bright

., 15

30-31

W.

71

62

122

87

57

...

Bright

.. 16

30-37

E.

67

60

112

79

66

Harr

ftuits, j&jwrt Comments, # ^nsfoers to
Corresponktits,

It if especially requested that early intelliyence of local events
having a medical interest, or which it ts desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed “ To the Editors .”

Lectures, original articles, and reports should be written on
one side only of the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses qf their writers, not necessarily for publication

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and a deer t isin §
departments of Thb Lancbt to be addressed “ to the
Publisher."

We cannot undertake to return MSS. not used.

Sites for Infectious Hospitaia.

Mr. G. L. Purchase.—In answer to an inquiry involving the question a»
to what is the proper area for the site of an Infectious hospital, we
would point out that for the permanent requirements of an ordinary
district arrangement should be made for so placing beds, at the rate cf
1 per 1000 of the population, on the site that the number of beds shall
not exceed twenty per acre. It may not be deemed requisite to make
all the permanent provision at once; but, on the other band, it is of
the greatest advantage to acquire a site exceeding the present require¬
ments and admitting of such temporary hospital extension as an
epidemic might necessitate. In placing the buildings on the site an
unoccupied zone of not less than forty feet in width abould be pro¬
vided between all buildings intended to receive infected persons and
things and the boundary wall or fence. The administrative building
ought to be kept free from infection, snd it is customary to erect :t
near the boundary of tbe site in such a way that entranoe to the
premises may be effectually controlled from It. Other points relating
to the selection of hospital sites will be found in the Supplement by
the medical officer to the Tenth Annual Report of the Local Govern¬
ment Board on the Use and Influence of Hospitals for Infectious
Diseases.

Dr. G. Thornton (Oldham).—A list of ooroners, medical and legal, will be
found In Churchill’s Medical Directory.

Mr. W. Habgood.— Such clothing can be obtained at 44, Fore-street, E.C.

” TO PASTURES NEW."

7o the Editort of The Lancet.

Sirs. —It should not be difficult to meet the modest requirements of
your correspondent, ‘'Emigrant.” He desires simply a good climate,
an out-door life, and the chanoe of making £100 a year. He has for¬
gotten, however, to indicate the nature of his ill-health, which would tv
a material factor in modifying the advloe to be given him. He caa
hardly be far wrong, however, in selecting one of the Australian colonies,
and, apart from any personal considerations to guide his choice, probably
Sydney affords about the best locale at present. If your correspondent
dislikes heat, he might try Dunedin in New Zealand. The oohtain
afford the certainty of a good climate, and a fair prospect of a com¬
petency to nn active man who can take the rough with the smooth. TT r
sport, however, to which your correspondent alludes Is not very fireg¬
rate in the colonies, as their legislators have omitted to oopy one of cur
Rational institutions—viz., the Game Laws.

I am, Sin, yours obediently.

Belfast, June 13th, 1887. 3. A. L.

Digitized by CjOO^I^

Thh Lancet,]

NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS. [June 18,1887. 1269

A Worm nr an Boo ?

Messrs. A. Kendrick and Co.— The specimen «u in so dried n state when
received that a precise determination of its nature could not then be
made. We hope, however, to be in a position to report next week. Mean¬
while it may suffice to say that there is no primd facie Improbability
against the entranoe of intestinal parasites into an egg; tor they are
Vnown to wander into the oviducts of birds. We may refer to The
Lancet, 1849, vol. 11., p. 386, where a correspondent forwarded us a
specimen of ascarls lumbrlcoides which had been found in a newly
laid egg.

J>r. McWalty. —Most of the treatises on surgery discuss the subject. Our
correspondent might refer to the article “ Nwvus ” in Heath’s Dictionary
of Practical Surgery.

Mr. Harvey (Ottawa).—We cannot exchange.

“SWEATING OF THB FEET.”

To the Editors of The Lancet.

Sim.—I have seen only two cases of sweating of the feet. The first
was a gentleman who bad some years before suffered from syphilis.
He was accustomed to the morning tub and other necessary sanitary
customs of society, but a few days’ hard walking on pavements had
rendered his society intolerable owing to the offensive smell from his
profusely perspiring feet. His sufferings were enhanced by the raw
state this condition had induced. I ordered his socks to be changed
night and morning, and the feet to be first washed in cold water with
carbolic soap and dried, and next swabbed all over with a lotion made
by adding a drop of llq. atropla: to an ounce of liq. hydrarg. perchlor.
This to be allowed to dry on by evaporation. In thirty-six hours I found
him quite well, and making preparations to go into camp, he being a
volunteer. He has slnoe, I believe, had no return of the annoyanoe.
The second case was that of a servant girl. Her feet were less offensive
than were those of the gentleman in the former oase, but very painful.
.Similar treatment quickly cured her.

I am. Sirs, yours faithfully,

Skipton-ln-Cmven, June 11th, 1887. O. W. Sessions Barrett, M.B.

The Medical Profession and Jubilee Honours.

A correspondent, under the nom de plume of “ Brackenthwaite,” has
sent us a communication in favour of the granting of a peerage to a
member of the medical profession, and the bestowal upon the Army
Medical Staff of honorary rank. The fact that our correspondent’s
letter has already appeared in a contemporary, above the signature of
“ B,” prevents us allowing it to appear in our columns.

Mr. 11. Sounder ton. —The title “ physician” attaches to an associate of a
College of Physicians, and cannot be olalmed or used satisfactorily on
the strength of the qualification mentioned in our correspondent’s
letter. A L.S.A. or L.A.H. is a licensed and qualified medical prac¬
titioner.

Mr. E. F. Le Souef.— So far as we are aware, the gas has not been
employed in the way and for the purpose named.

CHINBSB PHARMACOLOGY.

To the Editors of The Lancet.

Sirs,—I n my “ Contributions to Materia Medlca and Natural History
of China” (1871, Triibner) I have endeavoured to provide something like
an Anglo-Chlnese dispensatory. Dr. Dobson, in his “ Medical Vocabulary
in English and Chinese ” (Shanghai Mission Press, 1868), on page 69.
gives several “ names of medicines,” and I have followed him as much
as possible. The terms and names have had to be manufactured, and I
have endeavoured to oonvey by sense and sound some Idea (to the
Chinese) 6f the thing indicated. Iodide of potassium I have called
hai-tien tha, literally, “sea-lndigo salt.” Iodine is, of oourse, obtained ,
from the aahes of sea-weed, and the colours are near enough to each
ether. I should be happy to associate myself with any Chinese scholar,
in order to bring about uniformity in the use of medical and pharma-
■ceutloal terms in Chinese.—I am, Sirs, faithfully yours,

Shepton-Mallet, June 8th, 1887. F. Porter Smith.

The Diuretic Action of Mercurials.

G. B. (Paisley).—The most recent authority on the subject Is Rosenheim
of Berlin, who has worked in oonoert with Fiirbringer. He finds that
calomel is oontra-lndicated in parenchymatous nephritis, while, on the
other hand, it has a safe diuretic action in interstitial nephritis. Of
the other preparations of mercury, the yellow Iodide has also given good
results in this form of renal mischief, but not so invariably as calomel.
The bichloride of mercury, like the grey mercurial ointment, produces
diuresis, but comparatively slight and of brief duration.

Dr. Bow (Basutoland).—Aooordlng to the last published returns of the
Registrars-general for the several parts of the United Kingdom, the
proportion of males to females born in England and Wales was 103 9
to 100 in the year 1886; In Scotland the proportion was 105*4 to 100 In
1883; and in Ireland it was 106*3 to 100 in 1885.

Qn*rtns.-^ The question is still undecided.

Chemico-leoal Analyses in Cuba.

The Royal Academy of Scienoes of Havana has presented a memorial to
the Governor General of Cuba, calling his attention to the extremely
unsatisfactory and expensive way in which chemical analyses for
medloo-Iegal purposes are now carried out in the island, and praying
that steps may be taken to establish an institute of ehamioo-legal
examinations similar to the institutes recently established In Spain.
The memorial states that the chemical examinations, which are now
mostly conducted by pharmacists acting under the authority of the
magistrates, cost the State at least about 890,000 annually, and that as
the number of analyses required is rapidly increasing, there is no
doubt that the sum of 8190,000 will very soon be absorbed. This
Immense sum, while acting as a heavy burden on an already
impoverished treasury, does not afford any guarantee that the ana¬
lyses are conducted in a trustworthy manner, many of the analysts
having a very imperfect acquaintance with chemistry, and the good
faith of a certain number of these so-called experts not being above
suspicion. It is suggested that for the sum of about $12,000 annually
a really efficient institute could be maintained, under the charge of a
competent chemist with a salary of $3000, and two assistants—a phar¬
macist and a medical man—each with 83600. An attendant would
receive $500, and the cost of materials is estimated at $3600. Certainly,
if the state of forensic chemistry is as unsatisfactory as the Royal
Academy believes, it is high time some better system were adopted;
and the proposed institute, which would be a sort of Somerset House
laboratory, seems a fair method of meeting the want.

Junta.— We think the statement one of the most incredible we ever read,
though, of course, we receive it on the strength of our correspondent’s
authority. The duty of the lady and her husband was peremptorily
to stop and decline such obtruded services, and to make the prao-
titloner understand that his visits would not be allowed.

Surgeon— The office of the Crown Agents for the Colonies, Downing-
street, 8.W.

TREATMENT OF POISONING BY CHOKE-DAMP.

To the Editors of The Lancet.

Sirs, - Reoently a serious accident happened at, or near, Hamilton,
and the following is taken from the report of the accident, which
appeared in the Scotsman of May 30th :—“The more seriously injured
were carried into sheds and other places at the pit-head, where
Dr. Robertson, who was at that time alone, attended to them. Fifteen
of them required his attention for the effects of choke-damp, they being
more or less asphyxiated, some of them, indeed, to an extent that was
exceedingly alarming. Half a dozen small pits had been dug by the
medical officer’s orders, and the men were laid with their heads just over
the edge of these, in order that as the poisonous gases were exhaled from
the luDgs they might be absorbed by the fresh earth, whloh possesses a
sufficient quantity of oxygen to ohange their character. In one or two
cases artificial respiration was also deemed necessary.”

Many of your readers would no doubt be glad of an explanation of the
above treatment. I am. Sirs, yours truly,

June, 1887. Ambulance.

THB BROWN DEFENCE FUND.

To the Editors of The Lancet.

8irs.—K indly insert the following:—Amount already acknowledged,
£34 Is. 64.; Messrs. Oram and Bead, £1 Is.; Dr. A. W. Thomas, 10s. 64.;
Dr. B. Adams (Liverpool), 5s.

I remain, Sirs, yours faithfully,

G. Stanley Murray, M.D.

33. Upper BIchmond-road, Putney, June 14th, 1887.

Calculus in China.

The China Medical Missionary Journal asks : " Is stone in the bladder
anywhere so common as In Kwangtung, where, sinoe the first lithotomy
by Dr. Parker at the Canton Hospital in 1844, to the end of 1885, no
less than 1057 cases have been operated upon by lithotomy and
llthotrity, exclusive of a large number of urethral and preputial cal.
cull extracted? Is it so prevalent in Corea as reported some time
slnoe ; and what is known of the potent dissolvent of the native
physicians there, which potion * relieved in a few hours, after long
and terrible sufferings,’ the French Missionary Bishop Ferreol, about
I860?”

Errata.—O wing to unavoidable delay in the return of the proof of
Sir Andrew Clark’s Cavendish Lecture two or three errors escaped cor¬
rection :—In line 16 of second paragraph the “ 1 ” was omitted from
the word ‘‘causality’’; para. 6, line 4, the name “Morell” should
have preoeded “Mackenzie”; para. 7, line 20, for “assuredly” read
probably; same para., line 38, for “ useful ” read useless; para. 8, line 13,
after "followed” insert “it is said”; para. 9, last line, for "where¬
with ” read whereby; para. 10, line 15, for “ arsenic hydrochloric” read
hydrochlorate of arsenic; para. 11, line 4, for “ a thousandth ” read two-
thousandth.

Digitized by v^OOQLe

[Jtma 18,18*7.

1270 Thk La-nckt,]' NOTES, COMMBNTO. AND ANSWBE8 r I ( O CX)RRE8PC>NDKNT8.

Communications not noticed In our present number will receive Atten¬
tion in our next.

Communications, Lirmi, Ac., have been received from—Sir H, Pitman,
London t Ur. W. 0. Maonaughton, Glasgow; Messrs. Sampson Low
and Co-. London; Mr. Bhlrtllff. Kingston-on-Thames; Dr. Stanley
Murray; Mr. Howell, Houghton-le-8pring; Dr. Loon Petit ; Mr. W.
Blvington, London; Dr. Elder, Nottingham ; Dr. MoHalty j Mr. C.
Day. London; Mr. A. H. Allen, London j Mr. G. L. Purchase; Dr. G.
Thomson. Oldham ; Dr. Robertson, Brlxton ; Dr. Hubbell, Buffalo ;
Mr. Dunsford, London Mr. H. C. Gllllss, Brocklsy; Mr. T. Phgan
Lowe, Bath; Mr. Maynard. NewoeaUe-on-Tyne ; Messrs. Oaseell and
Co., London; Dr. Gibeon, Edinburgh; Mr. Saonderson; Mr. Sidney
Harvey, London; Mr. C. W. S. Barrett, 6kipton; Messrs. Bates and
Co., London ; Mr. Patten, Ealing ; Mr. E. R. Williams ; Mr. D’Arey
Power, London; Mr. T. P. Baveu, Broadstairs ; Messrs. Fannin and
Co., Dublin ; Mr. Ash, London ; Dr. B. Walker, Spondon; Mr. Victor
Horsley, London; Dr. Cullingworth, Manchester; Messrs. Christy
and Co., London ; Mr. F. Lott. London; Dr. McClure, Cromer; Mr. Vi
Wyatt, London; Mr. W. 3. Bell, London; Dr. M. A. Boyd, Dublin;
Mr. Mansell-Moullln, London; Mr. W. M. Jones, Swlnton; Mr. J. B,
Pike. Loughborough ; Mrs. Thompson, Loughborough ; Mr. LeBduef,
London; Dr. A. G. Auld, Wick; Mr. Stump, London; Mr. Logan, |
Glasgow; Mr. Page, Tsuwton ; Mr. Lewis, Waketeld; Dr. Davies,
Denbigh; Mr. Hyde, Northampton; Mr. Dicks, Totton; Mr. Manton,
Loudon; Dr. Benthal, Southsea; Mr. Pike, Taunton j Mr. Byecleyj
Portsmouth;. Messrs. Takata, London; Dr.,ScougaL Huddersflieldl
Mr. llomcastle, London; Mr. Thompson, Oldham; Dr. Sanctuary,
Kensington; Mr. Juler, London; Mr. Freeman, Epsom ; Mr. Godfrey,
Northampton ; Mr. Hotmosjie, Kensington ; Messrs. Livingstone,
Edinburgh; Mr. Hope, London; Mrj Brown, Weitgate ; Messrs. Auk! a
and Son, St. Ires; Mr. Thompson, Manchester; Messrs. Wright and
Co., Bristol; Mr. Scott. Manchester; Mr. Burchell; Messrs. Thoma*
and Co., London ; Dr. Siloeau, Paris ; Mr. Laffnn, Cashel; Mr. Evans,
Oswestry; Mr. Wood, Bromsgrove; Mr. Farquhar, lLu-rogate ; Reea.
Brecknock; Junta; Brackenthwaite ; C. H.; M.D.; M.D., Haughley;
J. A.-L.; Spes.

Letters. each with endoture, are also acknowledged from — Dr. Harris,
Philadelphia; Mr. Bay, Durham; Mr. OrAtswoiler; Mr. Bustotnjec
Frommurte, Kurraehec; Mr. Kelly. Nottingham; Messrs. Hutton
and Co., Bootle; Mr. Townson, Chesterfield; Messrs. Fawcett and
Co., Leeds; Mrs. Inman, Sodburgh ; Dr. Humphreys ; Messrs. Mills
and Co., Hanley; Mr- Hutton, London; Mr. Blythe; Messrs. Arber
and Co., London ; Mr* Breman, Bristol; Mr. Lister ; Messrs. Blake and
Co., Leeds; Mr. Saunders. Dublin; Mr. Anderson, York ; Dr. Heaton.
St. Asaph ; Mr. Hoysted. Gibraltar; Miss Huat, Dublin ; Mr. Kussall,
Liverpool; Mr. Clifford, Sunderland; Mr. Clarke ; Mr. Parkinson,
Manchester; Mr. Lathner, Swansea; Mr. Adams, St. Leonards-on-
Sea; Mr\ Tarleton, Ashton ; Mr. Whiling, Bodmin ; Miss Thomson,
Loughborough ; Mr. Stephens, Aestell; Mr. Hyde, Earls Barton ;
Dr. Bradford ; Surgeon, London ; S. E. M.; Locum, Hvcrton ; Nemo ;
Matron, Middiesbroogtr; T. W., Oldham; Alpha, Brockley; Hope,

' Smnllhc.ath; Francis, London; Tomkin, London; Ethuold, GntcsHeadr
on-Tyne; J. F. J.O., Dublin; Dr. A. N- London ; Surgeon; Alma,
Manchester; T. If. X. F., Dawlisb ; Victor, London ; Sister ; Sigma.
London; Cantab., Brixton; X. Y. 7.., Birmiugiiom; Matron, Brad¬
ford ; Surgeon, Brighton ; M.A., Cambridge ; Country; Medious,
Hackney.

Farm, Fiell, anil Fireside, WaUhamstenc Cuarrliirn, Paisley Daily Express,
Oriental Adrertiser, Worcestershire Echo, Denbijh Free Press, Ac., have
been received.

i ■/

Pfbiral §i:trj fur % ensuing HJetfe.

Monday, Jane 20.

Boy ax London Ophthalmiu Hospital, Moobfields, — Operations,

10.30 a.k» and each day at the same hour.

Boyal Westminster Ophthalmic HOSPITAL. — Operations, 1.30 pji,
and each day at the same houT.

Ohelssa Hospital fob Women.— Operations. 2.30 pji ; Thursday,2JO.
St. Mabk's Hospital.— Operations, 2 p.m. ; Tuesday, 2.30 p.m.
Hospital for Women, Soho-square, — Operations, 2 p.m., and oo
Thursday at the same hour.

Mktropolitax Free Hospital.— Operations, 2 P.X.

Boyal Orthop.cdic Hospital.'—O perations, 3 p.m.

Central Loxdox Ophthalmic Hospitaia.—O perations, 2 p.m., and
each day in the week at th e same boor.

Tuesday, Jane 21.

Gut's Hospital.—O perations, 1.30 p.m. and on Friday at the same hour.

Ophthalmio Operations on Monday at 1.30 and Thursday at 2 P.M.
St. Thomas's Hospital.— Ophthalmic Operations, 4 p.m.; Friday,3 p.m.
Caxcbr HospITaL. Bromptox.— Operations, 2.30 p.m.; Saturday, 2.30 pji.
Westminster Hospital.— Operations, 2 p.m.

West Loxdox Hospital.— Operations, 2.30 p.m.

St. Mary's Hospital.—O perations, 1.30 p.m. Consultations, Monday,

2.30 P.M. Skin Department, Monday and Thursday, * JO A.M.

Wednesday, Jnae 22.

National Orthop.cdic .Hospital.—O perations, 10 a.m.

Middlesex Hospital.—O perations, 1 p.H.

St. Bartholomew's Hospital.—O perations, 1.30 p.m.; Saturday, sams
.hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 pji.
Surgical Consultations, Thursday, 1.30 p.m.

St. Thomas’s Hospital.— Operations, 1.30 p.m.; Saturday, same boor.
Loxdox Hospital.— Operations, 2 p.m. i Thursday A Saturday, same boor.
Great Northern Central Hospitai — Operation*. 2 p.x.
Samaritan Free Hospital fob Women and Children.— Operations,
2.30 P.M.

University College Hospital.—O perations, 3 p.m. ; Saturday, 2 p.m.

Skin Department, 1.45 p.m. ; Saturday, 8.16 AJ€.

Boyal Free Hospital.—O peeation#,3 P-M.. aod on Saturday.

Kuo’s College Hospital.— Operations, 3 to 4 pji. ; Friday, 2 pji. ;
Saturday, 1 p.m.

Children's Hospital, Great Ormond-street, — Operations, 9 a.m.;
Saturday, same hour.

British G yn.ecological Society.—S.30p.m.—S pecimens will be shown
by Dr. Francis Imlacli, Or. Fancourt Barnes. Mr. Lawson Tait. and
others.— Dr. A. V. Johnstone (Danville, Kentucky) ■ The Bndo-
wetrtum ia the Cycle of the Hut, Council at 8 p.m.

Thursday, Jane 23.

St. George's Hospital.—O perations, 1 p.m. Ophthalmio Operations,
Friday, 1.30 p.m.

CHARrxo-cRosx HosprfAL.—Operations, * p.m.

North-West London Hospital.—O perations, 2.30 p.m. .

OPHTILALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. — 8 P.M.
Mr. Lockwood t Specimens Illustrating the Angtoyiy of the Capsule
of Tenon.—.s.;w p.m. Collection of Kvineuce regarding Toxic Ambly¬
opia. Commuincn' bins will be made by Messrs. Nettlestilp, McHiniy,
Bdgsr Browne. Hill Griffith, Frost, Juler, Sheers, Morton, Gunn,
mud others,

Friday, June 24.

Royal South London Ophthalmic Hospital.—O perations, 2 pjc.

Saturday, Jane 25.

] Middlesex Hospital.—O perations, 2 p.m.

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,T THE lancet,

Clinical fccturc

ox

FUNCTIONAL DISEASES OF THE LIVER.

By SAMUEL FENWICK, M.D., F.R.C.P.,

PHYSICIAN TO THK LONHON HOSPITAL.

(Concluded from page lilO.')

You are aware that the condition of the system producing
acute rheumatism has been a fertile subject for discussion,
■ and that numerous attempts have been made to discover it
both by chemical analysis and by experiments on animals.
Now, it will naturally occur to you to ask whether we may
, not have hit upon the cause of the disease in the excess of
! the sulphocyanide present in the saliva of such cases. I
: fear that we are unable to answer this question in the
affirmative; for, as we have before seen, the salivary salt is
augmented in various other conditions that are unattended
J with articular inflammations. Besides, if the cause of the
rheumatic fever were dependent on the presence of this salt
in the system, we should expect to find it in greater quantity
4 when the disease was hereditary that when it occurred in a
single member of a family alone. To ascertain if such is
‘ the case I have added the following table.

, Tab lb X.— Showing the average amount of Sulphocyanide in
. persons hereditarily predisposed to JVieumatic Fever.

Average
amount of
sulphocyanide.

Ino. Of

oases.

History of parents liable to rheumatic fever ...

+ 1-4

16

„ other members of family than 1

parents liable to rheumatic fever.J

+l-«6

i*

Persons who had no history of rheumatic fever

+ 1-4

31

You will see by the above table that a hereditary pre¬
disposition has no effect in increasing the amount of the
salivary salt, or consequently the severity of the attacks, for
the average amount is the same in those whose parents had
suffered from the complaint and in those from whom no
history of hereditary predisposition could be obtained. It
is also curious that previous attacks do not seem to increase
the quantity of the sulphocyanide, for of twenty-four who
had a history of former attacks the average was +1*4,
whilst in twenty-eight who were suffering for the first time
it was + 1 * 8 .

As there is a close connexion between the severity of the
complaint and the state of the saliva* I would advise you in
every case to watch the amount of sulphocyanide, and,
whenever you find the salt in excess, to keep your patient
on low diet and guard him carefully from oold and every
other circumstance likely to provoke an attack. It is pro¬
bable that those who have habitually a large amount of the
sulphocyanide in the saliva are more liable to local rheu¬
matism than other persons; for amongst the "private
cases” 40 per cent, of those who had an excess had suffered
from peins of the limbs or joints. This is sot, however, so
constantly the case as in acute rheumatism, for I have met
with cases of lumbago and rheumatic arthritis in which the
amount was below the normal.

The occurrence of chorea in rheumatic subjects has long
been recognised, and has given rise to much speculation as
to the connexion between diseases so very dissimilar. I felt
anxious, therefore, to ascertain whether the examination of
the saliva would throw any light upon this question. I find
nine cases of chorea are recorded in the “ later hospital cases,”
and of these, at the first observation, six presented an amount
cf sulphocyanide below the normal,some as low as -3; two
were normal; and only one was above the normal—viz., +•£.
One developed acute rheumatism, which affected both ankles,
but lasted only one week, the evening temperature being
100° and 108°. The saliva for three weeks before the rheu¬
matism occurred had risen to + 2 , +f, and +J, being +1
during the articular affection. Two other cases had a
No. 3380.

June 25 , 1887 , • '

systolic mitral murmur, and in both the salivary salt Was
in excess; one was admitted with +$, but next week it
rose to + 2 ^, + 2 , and + 2 ^; the other, on first observation,
showed - i, but next week it was + 2 $, then in the two
following weeks +3 and +2£. None of those whose saliva
remained below the normal had either rheumatism or
mitral murmur. It is worthy of remark that the chorea in
those in whom the excess presented itself yielded rapidly
to treatment, whilst where it continued below the normal
the complaint was very obstinate. Thus the two presenting
an excess were dismissed on an average in thirty-seven
days, whilst the three with a deficiency remained on the
average seventy-seven days under treatment. It is strange
that in chorea, unlike the diseases we have hitherto
examined, there is always a tendency to great variation in
the quantity of the sulphocyanide from week to week, very
few of the cases showing the same quantity in any two
successive observations. I have observed the same varia¬
tion in the weekly amounts of sulphocyanide in some cases
of hysteria, and suspect it may arise from an imperfect
action of the nervous centres.

It is always unsafe to draw general conclusions from
small numbers of facts, but, if future inquiries should con¬
firm these above stated, it would appear that there is no
necessary connexion between chorea and rheumatism, but
that the latter is apt to arise whenever the imperfect
nutrition which accompanies chorea is suddenly replaced
by an excessive amount of vitalised nutriment. The long-
continued subnormal amount of sulphocyanide is associated
with a long duration of the nervous disturbance, and would
seem to indicate that the treatment adopted was ineffectual.
In one such case I lately omitted the arsenic the patient
was taking, and substituted cod-liver oil and hypophosphite
of soda. In a few days the salivary salt increased, and the
patient so rapidly improved that she was soon discharged.

Cases of gout usually exhibit an increase of the salivary
salt, but not to such a marked extent as those liable to acute
rheumatism. In seventeen that were observed in the
“private cases” the amount was above the normal, and none
of them at any time presented a deficiency. When, however,
out has been complicated with phthisis or kidney disease,)
ave met with a subnormal quantity; so that the state of the
saliva is clearly not the result of the articular inflammation,
but is only an accompaniment of that over-action of the
nutritive organs which most practical physicians are in the
habit of recognising as predisposing to the complaint.

The sulphocyanide is usually in excess In the saliva of
persons who suffer from eczema, as this is so often asso¬
ciated with gout; but such is not invariably the case, as the
disease also presents itself in persons who are in an imper¬
fect state of nutrition, and under these circumstances the
salivary salt is below the normal.

I have never seen a severe case of urticaria in which the
sulphocyanide was not in excess, and the severity and
obstinacy of the malady may be generally measured by the
amount of colour produced by the addition of iron to the
saliva. As an illustration let me quote to you the case of a
gentleman aged thirty-one. He was stout, and was affected
with this troublesome complaint to such an extent that he
was in the habit of amusing his friends by writing on his
arm beneath the table with a match or pencil, and then
exhibiting the letters marked in bright and elevated lines
upon his skin. His saliva was +3 - , but after six weeks
treatment it was reduced to + J; bilious headache, to which
he had been formerly subject at least every week, dis-

complaint to which those having an excess were liable, and
the so-called "bilious headaches” constituted 25 per cent,
of the whole number of the "private cases” where this
condition of the saliva was present. Persons suffering in
in this way usually belonged to families of which other
members had been victims to gout or rheumatism; the
attacks of headache were periodical, and were often followed
by a temporary improvement in health. One-tenth of those
presenting a deficiency of sulphocyanide also complained of
“ bilious headaches,” but there was usually ne gouty history,
no relief was afforded by the attack, and the pain seemed to
be of a purely neuralgic character. The importance of such
a distinction in a practical point of view need not be pointed
out, for it will be obvious that symptoms connects! with
such opposite conditions of the nutritive organs cannot be
successfully treated in the same manner.

c c

ed by GoO^lc

[Jems 26,1887.

1272 Thb Lascmt,] DR. S. Jfl&TWBDK ON FUNCTIONAL DISBABEB OF'THB LIVER.

A great excess of the sulphocyanide, when it occurs in
elderly persons, is often indicative of a dangerous condition
of health, and may be for some time unaccompanied by
apparent disease of any important organ of the body. After¬
wards, however, changes in the vascular system usually
declare themselves, and the patients eventually die of
apoplexy or become the subjects of disease of the heart or
kidneys. As an instance of this, a gentleman, aged fifty-
nine, first complained in 1877 of irritability of the bladder,
the urine being very acid, but neither albuminous nor
saccharine. This soon passed away, and in the following
year he suffered from shooting pains of his arms ana
shoulders, although he had never had gout or rheumatism
previously. In 1881 he had bronchitis, and his saliva was
then recorded to have contained a great excess of sulpho¬
cyanide. In the same year he suffered from intense mental
depression and dyspepsia, the saliva still presenting a great
excess. Towards the end of the year it was +4, and a
diastolic murmur was first noticed over the aortic valves.
This was followed by a slight paralytic attack. The loss of

E ower soon passed away, the saliva rose quickly to +8, and
e complained of general weakness and depression. In
1882 the saliva was +6, there was no paralysis, the diastolic
murmur was still audible, but the urine proved to be slightly
albuminous. He remained in this condition for a few
months, when he was carried off by a sudden apoplectic
seizure.

Cases like the above are by no means uncommon, and are
subjects of great anxiety to the physician on account of the
indefinite nature of the symptoms from which the patient
suffers. They are generally said to arise from “ suppressed
gout,” but I suspect that atheroma of the arterial system
takes place from the abnormal nutrition, and produces
changes in the blood supply of various important organs.
I know of no test for such a state but the excess of the
sulphocyanide, and I have found this almost always to be
the case under such circumstances.

A deficiency of the sulphocyanide is much less common
in persons enjoying a moderate share of health than the
opposite conditions. It chiefly shows itself in females, and
especially in those who are thin and feeble in muscular
power. They seem to be especially liable to neuralgic
affections, and as these also often arise from gout, rheu¬
matism, or malaria, in which the sulphocyanide is in excess,
an examination of the saliva will often throw light on the
nature of a case otherwise hopelessly obscure.

We may now ask whether the foregoing facts and the
conclusions we have derived from them throw any light
upon the uses of the sulphocyanide in the saliva. Does
this substance perform any beneficial purpose in the mouth
or throat, or is it only an excretion, removed on account of
some deleterious effects it might produce upon the system ?
Again, what is the material from which it is separated, and
is this material broken up by the salivary glands, or is the
sulphocyanide only an ultimate product of the action of a
number of organs associated together in function? In
answer to the first of these inquiries, we may assume that
the sulphocyanide must be of use in assisting the functions
of the upper part of the digestive tract, for we can scarcely
suppose that any deleterious substance would be excreted
in a part where there is a certainty of its being rapidly
resorbed into the system.

Before attempting to settle the remaining questions, let
us first examine two suggestions that have been made by
physiologists to account for the presence of the salt in the
saliva. It has been stated that it is the result of decomposition
set up by the presence of decayed teeth, and that it is not
therefore a normal constituent of the secretion, but is merely
a pathological product. In order to test how far such an
opinion was founded upon facts, careful inquiries were
made into the state of the teeth in eighty-seven cases in the
hospital, and with the following results. The teeth were
quite perfect in 18 per cent, of those whose saliva contained
a normal or excessive amount of sulphocyanide, and in only
14 per cent, of those in whom it was deficient. One or two
teeth were carious in 47 per cent, of the former and in
44 per cent, of the latter; whilst many were decayed in
42 per cent., of those in whose saliva the Bulphocyanide was
below, and in 35 per cent, of those in whom it was normal
or excessive. It is evident, therefore, as the salt presents
itself in excessive quantities where there is no decay of the
teeth, and is as often deficient as superabundant where
many are carious, the opinion before mentioned must be
incorrect.

Others have attributed the presence of the sulphocyanide
to the smoking of tobacco, and the habits of two hundred 1
and thirteen patients in the hospital were investigated m
to this point. As the greater number had been confined to
their beds in wards in which smoking was not allowed, only
a few of them had latterly enjoyed the opportunity of ustag
tobacco. On analysing these cases, it appeared that, of those
whose saliva contained an excess of sulphocyanide, 6 per
cent, had only latterly smoked; of chose presenting a normal
quantity, only 2 per cent.; whilst of those in whom there
was a deficiency, 8 per cent, had latterly consumsd
tobacco, and one represented himself as an excessive smoker.

It is therefore evident that no material influence is exerted
by the use of tobacco, although my own impression before
analysing these cases was that the salt is usually present
in greater quantity in the saliva of those who smoke than
of those who abstain from tobacco.

From the facts we have before considered, it is plain that
an excess of the sulphocyanide is present in the saliva when¬
ever the nutritive functions are in a state of unusual activity,
and that a deficiency of this salt coincides with a defective
supply of new material. As, however, a number of different
organs co-operate in the preparation of the materials for
the growth of the tissues, to which of these can we attribute
the formation of the salivary salt? At first sight we might
suppose it was the result of some chemical change connected
with the gastric digestion, for its diminution in cancer of
the stomach, stricture of the oesophagus or pylorus, atonic
dyspepsia, and even frequent vomiting, seems to point in thii
direction. But, on the other band, this will not explain its
deficiency in cases of cirrhosis attended with nacitee, or it*
sudden increase directly the pressure had been removed from
the portal vessels by tapping, nor does it show why the
quantity should be so often below the normal amount in
jaundice.

A full supply of albuminous food is, however, necessary for
a free secretion of bile, aud for this purpose the conditions
both for its digestion and absorption must be favourable. We
before found that chronic diarrhoea and dysentery lessened
the amount of the salivary salt, and it is interesting to
observe that Dr. Rutherford, when reviewing the results of
his experiments on the Becretion of bile in don, states that
"we have, however, found several drugs that have an
indirectly depressant action; thus, when the intestinal
glands are excited to secrete, there is an indirectly depres¬
sant effect on the liver, whereby the bile secretion is lessened.
We invariably observed that while slight purgation by a
purely intestinal irritant scarcely, if at all, depressed the
secretion of the bile, powerful purgation produced a very
marked effect.” 1

I have before pointed out that the sulphocyanide is
either absent or in very small quantity in the saliva of
persons affected with lead colic, but that as soon as the
symptoms are relieved it reappears. Now, if we turn again
to the experiments of Dr. Rutherford, we find the following
remarkable statement: “ It cannot fail to strike the reader
as a remarkable fact, that while in the long list of drugs
whose hepatic effect we have investigated we have found
so many tnat stimulate the liver, there is only one—acetate
of lead—which appears to have a directly depressant,
effect.”

Physiologists are generally agreed that the main portion
of the fat of the animal body is the result of tbe breaking-
up of the albuminous material of the food by tbe liver, and
in reviewing the “ private cases ” in which tbe condition of
the saliva was tested, I find that only 6 per cent, in
whom there waa an excess of the sulphocyanide were
thin; 20 per cent, were moderately stout, and 74 per cent,
are recorded as fat. On the contrary, of fifty-three
cases where the sulphocyanide was below the normal
amount, forty are stated to have been thin, three
as moderately stout, and only ten as stout. In some of the
latter tbe deficiency of the salivary salt was only temporary,
and of tbe remainder four were stated to have been losing
flesh when tbe saliva was examined. But if we thus find
the same circumstances that tend to promote a free secretion
of bile also acoompany an increase of tbe sulphocyanide.
and tbe circumstances that lessen tbe formation of bile also
diminish or suppress that of the salivary salt, and if we dis¬
cover the condition of the body present in those whose
8 alive presents an excess and diminution of tbe salt such a?

* Professor EutUcrford oa the Action of Drugs on tbs Secretion a!
bile. p. 170.

u

Thb Lanott,]

DK. 8. FENWICK ON FUNCTIONAL DISEASE8 OF TAB LIVER* [Jura *6,1887. 1273

ire might expect from an increased or lessened activity of
the liver, I think we are justified in connecting the presence
of the salt in the saliva with the action of the hepatic cells.

I need not remind you that the bile is a complex secretion
containing colouring matters, cholesterine, and biliary salts;
now from which of these may we suppose the sulpho-
cyanide is derived ? Clearly not from the cholesterine, for
this is excreted ; nor from the colouring matters, for they
also pass out of the body, and if they were the source of
the salt in question, we should always find it in excess in
cases of jaundice, as they are in that disease retained in the
circulation. The remaining constituent of the human bile,
the t&orocholate of soda, seems to be the most likely source
of the salivary salt, as it passes from the liver into the
intestine and is resorbed into the circulation; for I think
we can only account for the absence or diminution of the
sulphocyanide in jaundice by supposing that the material
from which it is produced passes in the normal state from
the liver into the duodenum. This view is supported by
the fact that in all the cases of dyspepsia accompanied by
eructations of sulphuretted hydrogen gas which I have
examined there was an absence of the sulphocyanide. In
' such instances, we may suppose that the biliary acids are
decomposed in the duodenum into sulphuretted hydrogen,
instead of undergoing their normal decomposition.

But a difficult question now meets us. The albuminous
materials of ‘the food absorbed from the digestive canal
undergo certain changes which fit them for the purposes of
nutrition, and the greater part of these are again broken up
into urea and carbonic acid, without entering into the
composition of any of the organs of the body. Is, then,
the substance from which the sulphocyanide is derived
(? taurocholate of soda) the produot of the chemical changes
connected with the conversion of the peptones into the
circulating albumen, or is it the result of the decomposition
of the vitalised material? If the latter were the, case we
should find the amount of the salivary salt bear some rela¬
tion to that of the urea in the urine, and I have not, unfortu¬
nately, a sufficient number of cases recorded in which the
quantities of these two substances were simultaneously
determined so as definitely to settle the question.

In non-febrile conditions I have generally found that an
excess of the sulphooyanide corresponded with a high
specific gravity of the urine, but this probably arises from
the fact that the introduction of an undue amount of
nutriment into the system is quickly followed by an
increased metabolism, whereby the surplus nutriment is
broken up and eliminated. But during the course of a
febrile disorder the quantity of the salivary salt is not
increased, as you will see in the case of typhoid fever,
although the am ount of urea eliminated is excessive, and
it is not until the fall of the thermometer and the renewal
of the functions of the stomach and liver that the quantity
of the sulphocyanide is augmented. Pointing in the same
direction is also the fact that, as was before observed, the
quantity of the salivary salt in acute rheumatism is not in
proportion to the average height of the fever, so that from
the data we possess we nave no reason to conclude that the
material from which the sulphocyanide is derived results
from the destructive processes of the system. In addition to
this, let me remind you that in the oases of granular
kidney admitted with uraemic convulsions there was
no large amount of sulphocyanide, but it increased as
the patients improved in health; showing there is no
connexion between the retention of the albuminous
materials in the state of retrograde metamorphosis and the
quantity of the salivary salt. 1 think, then, as far as we
can at present see, the facts we possess seem to point to the
conclusion that the sulphooyanide is derived from some
substance separated from the peptones absorbed into the
system from the digestive canal, and produced during the
process (of the exact nature of which we are ignorant) by
which these are converted into material fitted for the pur¬
poses of nutrition. This substance we have before seen
reason to suspect is the taurocholate of soda, which is
secreted by the liver and forms one of the constituents of
human bile.

But if the sulphocyanide is only the ultimate product of
the action of a number of secreting structures, such as the
liver, duodenum (? pancreas), and the salivary glands, are
we justified in expecting that its quantity can be accepted
as a measure of the activity of -the first of these alone? There
can be no doubt that, as in the case of dyspepsia accompanied
by sulphuretted hydrogen, an abnormal action of any of i

these structures may alter the amount of the sulphocyanide;
and it is from feeling the foroe of this objection that I
have trusted to averages rather than to isolated observation*
By so doing, the statements have lost much in force, but they
are, I think, more trustworthy for the purposes we have in
hand.

The saliva of a person in good health varies but slightly,
as regards the quantity of the sulphocyanide, at different
times of the day, or from day to day. If secretion is very
active, the colour with the iron is a little less deep; if, on the
contrary, there is much dryness of the mouth, it is necessarily
somewhat deeper, from concentration. It has appeared to
me to be increased in persons in the habit of using alcohol
in any form, and especially in those who consume malt
liquors. Whenever, therefore, the salivary salt has been in
abnormal quantity, ! have advised these to be given up; and
iu most instances where the amount was deficient I have
recommended either wine or some other form of alcohoQc
stimulant. In cases of excess of the sulphocyanide, I usually
lessen the quantity of the animal food, and forbid soups and
all fatty materials; when the opposite condition of the saliva
is present, I prescribe as liberal a diet as the patient is able
to digest. I have been often greatly assisted in the choice
of an appropriate diet by the examination of the salivary
secretion.

As regards the action of drugs, lead is the only one that
has appeared to me directly to check the secretion of the
salivary salt, but I have seen a temporary decrease produced
by citrate of caffeine; but as the administration of it had
been followed by nausea and vomiting, it is doubtful
whether the change in the saliva may not have been pro¬
duced by the sickness. The quantity of the sulphocyanide
is always lessened by a long course of aperients, especially
by salines, calomel, and podophyllin; but a single purga¬
tion, however brisk, seems to nave little effect in this way.
The alkalies, iodides, and bromides, in like manner, reduce
the salivary salt; but all tonics, such as iron, quinine, and
the vegetable bitters, have the opposite effect, probably by
increasing the appetite, and thus augmenting the supply of
albuminous material. Cod-liver oil seems to be especially
efficacious in increasing the quantity of the sulphocyanide,
but it rarely agrees where this is in excess of it.

The most accurate method of ascertaining the amount of
the salivary salt is to obtain all the saliva the person is able
to secrete in five minutes, adding to it the tincture of per¬
ch loride of iron in the proportion of one drop to a drachm,
filtering this through a little cotton wool, and then to
compare the colour with solutions of sulphocyanide of
iron carefully graduated. The bottles containing the tests
and those to be compared with them should be of exactly
equal sire, and those used by speotrosoopists are best fitted
for the purpose. I found that 320 milligrs. of sulphocyanide
of potash added to 300 cc. of water containing 24 cc. of the
tincture of perchloride of iron produced a colour eight times
the strength of that which I adopted as the normal. This
plan has, however, the disadvantage of requiring the tests
to be replaced every six or eight weeks, as in that time the
colour begins to fade. A batter method is therefore a great
desideratum. For ordinary use in practice I have been in
the habit of using my own saliva as a test, and guessing
the amount of increase or decrease as compared with it. In
bringing before you this interesting subject, I must remind
you that the facts I have adduced and the attempts to
explain them are on a very different footing. The facts yon
can easily verify or disprove—only, in doing so, be careful
to use the necessary precautions to avoid errors, and do
not too hastily condemn the results of many years' ex¬
perience. I cannot expect to have solved all the diffi¬
culties of such an intricate subject, for, as in the case
of the thermometer, varieties must occur from the tem¬
perament of each person and the circumstances by which he
is surrounded. As regards using the facts for practical pur¬
poses, let me remind you that, although the nutrition of a
patient is a most important matter, it is not the only thing
to be attended to, for circumstances may force yon for a
time to put aside its consideration and direct your attention
to other structures, the abnormal condition of which are
threatening his existence. '

As regards the explanations of the facts we have been
considering, they seem to me to be the most probable I can
offer you, but it would be absurd of me to say they ahe
necessarily correct. Let me remind you that physiology has
as yet not offered even a plausible conjecture as to the
occurrence of the sulphocyanide in the saliva, the ases it

1274 Thb Laitobt,] MB. E. M. CBOOKSHANK: THE ETIOLOGY OB gOAELBT FEYER.

[J.

r farms, or the material* from which it is derived. Nor
more known of the changes that the inflowing tide
of nutriment undergoes before it is fitted to perform its
part as a portion of the living animal, although we
are sure a knowledge of this subject must be of the
greatest interest both to the physiologist and to the
investigator of disease. Physiology should ever precede
and guide inquiries into all disordered functions, and it is
only when it fails that pathology may venture to cast its
nlore dubious light upon the darkened path. If 1 can be
the means of attracting the attention of those better fitted
than myself to elucidate the difficulties environing the
whole of this intricate subject, I shall consider the labour I
have expended upon these inquiries as amply repaid.

THE RECENT RESEARCHES IN CONNEXION
WITH THE ETIOLOGY OF SCARLET
FEVER.

By EDGAR M. CROOKSHANK, M.B.,

LKCTUHEH OX DACTKKIOLOOT, KIXO'S COLLEGE, LONDOX.

The last link in the chain of evidence in favour of
believing that the Hendon cow disease caused human
scarlatina was afforded by the researches of Dr. Klein—that
is to say, when it was taken for granted that these researches
could be accepted without question. Indeed, assuming this
evidence to be correct, and attaching it to the cogent
arguments brought forward by Mr. Power, such a strong
case was made out that the subject appeared to be almost
beyond the region of controversy. The researches of Drs.
Jamieson and Edington, of Edinburgh, which have just been
published, have thrown a cloud of doubt over the evidence
adduced by Dr. Klein. The Edinburgh research carries with
it the weight of considerable authority, and, though some¬
what incomplete, appears so careful that it cannot be over¬
looked. On the contrary, an impartial criticism is called
for of the evidence brought forward on both sides.

In the Eighteenth Annual Report of the Local Govern¬
ment Board (1885-86, pp. 90-99) Dr. Klein describes in
detail the course followed in his investigation. The effect
of direct inoculation with the matter of the ulcers of
tiie diseased cows first claimed attention. No result was
obtained by inoculating ten guinea-pigs. In one out of
four dogs an ulcer resulted, which healed on the tenth day.
In four cows the places of inoculation became swollen,
tender, and spreading; the marginal part showing vesicula-
tion, and the centre formation of a crust. In from nine
days to a fortnight these uloers healed.

From these experiments Dr. Klein concluded that this
disease of the cow was directly communicable from animal
to animal. The question then arose as to the existence
of any specific micro-organisms. Cover-glass preparations
were made from the matter expressed from an ulcer: cocci,
diplococci, and streptococci were discovered which did “not
dinar from those described in connexion with foot-and-
mouth disease.” In sections the same diplococci and
streptocooci were found in the contents of the superficial
cavities as well as the depth of the epithelium. From
the deeper parts of an ulcer tubes of nutritive gelatine
were inoculated. In these media a growth of strepto¬
coccus resulted, which was “very similar to that pre¬
sented by the streptococcus of foot-and-month disease."
In gelatine tubes the streptococcus of foot-and-mouth
disease is a little faster in its growth, and the component
granules are a little more distinct. Nevertheless, Dr. Klein
adds that in some tabes of both kinds of' organisms in
gelatine and in agar-agar the general appearances could
not be easily distinguished. Only by one test can the
organisms be readily distinguished—namely, by the dif-
Iccent result obtained by cultivation in milk. In form,
mode of division, branchings of the chains, in the
presence here and there in the chain of a large element
amongSe the smaller ones, the organisms of the Hendon cow
disease are admitted by Dr. Klein to hardly differ from the
desc ripti on he was preparing of the streptococcus of foot- |
and-month disease. These points are entered into in detail to j
And of all correct an idea, which is very prevalent. , that the |

so-called streptococcus of scarlatina is an _
in its morphology and characters on cultivation,
markedly in these particulars from other
viously described. This idea has doubtless
interpreting the statement of Dr. Klein that
of scarlatina “ in its mode of growth on nutriti
on agar-agar mixture, on blood-serum in broth s
proved very peculiar and different from other
micrococcus hitherto examined.” 1

The next stage in the inquiry involved the st
effect of inoculating these artificial cultivate
calves were inoculated; one died and the other
In neither of these cases was a “ real uloer"
the post-mortem appearances recalled to Dr.
human scarlatina. In the blood from the heart
calves a few diplococci and streptocooci could l
and cultivations were made from the blood in
taining nutritive agar-agar. A growth, it is
obtained of a streptococcus which was in a
identical with the streptococcus that had been e
inoculation. We are not informed in what pc
the tubes the streptococcus grew, or whether
organisms appeared in any of the tubes. Ho
the statement that only diplococci and a few
were observed, we may fairly conclude that the
microscopical examination of thebloodand of the
was to reveal the fact that only diplococci and
were to be found in the blood of an animal inoc
the Hendon cow disease. No plate-cultivations
have been made to ascertain whether the dipl<
be grown apart from the streptococcus, or wh
only a phase in the life-history of the strep!
Klein apparently takes this for granted, and o
these experiments that the streptoooccos is
the virus of the cow disease. From the exj
dance, we may conclude safely that this strepi
mately associated with the disease in cows, but
that tiie same organism was responsible for the
human scarlatina lacked at this time any t
corroboration. The inoculation of a known milk
into the human subject was necessarily
there was obviously no distinct proof, so far,
Hendon streptococcus oould produoe scarlatina i
Let us now examine the experiments which
to for supplying some further evidence in
theory just mentioned. An account of
meats will be found in the Proceedings of the Ro;
vol. xlii, March 3rd, 1887. Dr. Klein here
suits obtained in the attempt to prove that h
was dependent on the Hendon streptooooous; th
this streptococcus, when obtained from the h
was capable of producing in the bovine species
ease as was observed in the Hendon cows and in..
experimented upon. The experiment consisted at;
cultivations in nutritive gelatine, nutritive
serum, and other media, from the blood ■
human scarlatina. Out of eleven acute cases,
positive results. In these four cases “ several d
were used after the customary methods,
very small number of these tubes revealed, after
tion of several days, one or two colonies of the str
There is no record of any control tabes being
from the blood of persons in health and kept
same conditions of incubation. This may no
essential, but if it had been done and no H
cocci had occurred in them. Dr. Klein would
himself from the criticism that the scanty
tubes inoculated from scarlatinal blood
attributed to aocidental contamination in the
There is, however, another poseihle exp
appearance of only a scanty growth in so
oaatage of the tubes—namely, that this si
only occasionally associated with scarlatina;
fact, possibly be identical with the etrept
lorum, which was reflated by Loffler from
diphtheria, and subsequently encountered by &
Bahrdt in post-scarlatinal suppuration. Thu
inoculation in the lower animals was found
rash, and to .be very closely allied, if not
streptococcus which Fehleisen believed to be
telaa,

farther support of his ooodnsioM, Dr.

V ErvoeMDnm of the Boy»l Society, ]farob.fcd^MB7t

TH

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ME..IL BASWRLL ON LATEaAJL CURVATUBE Off THS SJPIJfB. [Junx 25,1887.

atraounead the factmcj c i thh Hendoa streptococcus in
condensed milk which was suspected of having caused an
outbreak of scarlatina. Tide organism appears on inoculation
to have produced a similar disease to the disease of the
Hendon cows. Again, in the tissues and blood of a monkey
which died, it is said, from drinking suspected milk, the same
streptocooeus was found. Bat the conclusion that the animal
died of scarlatina was merely speculative, and the omission of
any experiments with scarlatinal blood or with the culti¬
vated streptococcus, to prove that a healthy.monkey could
suffer from scarlatina with the reappearance of the strepto¬
coccus, is a very grave one. One must admit, then, that the
experiments with scarlatinal blood ere not sufficient and
complete enough to justify the belief that the contagium of
scarlet fever is a streptococcus which will produce in cows
the Hendon disease. And yet this is the key to the conclusions
that have been arrived at, and it will therefore only be
when Dr. Klein's experiments have been extended and
confirmed that we shall be justified in saying that the cow
disease is distinctly proved to be a cause or human scarlatina.
Without this we are only justified, from a purely bacterio-
tagieal paint of view, m ooncduding that Dr. Klein
has isolated and cultivated a streptococcus whioh is in¬
timately associated with a peculiar eruptive disease of the
udders and teats of cattle. That the oontagium of scarlet
fever may be conveyed by milk is an accepted fact, but
whether this disease in cows is a source ef the contagium is
another question altogether.

Let us now pass on to consider the Edinburgh re¬
searches which were alluded to. In the latter end
of October, 1886, Dr. Edingtan reoeived instructions from
Professor Chiene to make investigations into the de¬
squamation and blood in human scarlet fever. These inves¬
tigations were carried out with every possible practical
precaution, especially with respect to avoiding contamina¬
tion of cultivations. Several different organisms were
isolated and studied. Two of these appeared to be especially
important—the provisionally named diplocaoatts scarlatina
saruruxnis and bacillus soarlatma. The dipiocooci occurred
in 45 per cent, of the inoculations from the skin; the bacilli
in 30 per cent, of the tubes inoculated from the blood, and
in every case, with the exception of one tube acci¬
dentally broken, in the tubes made from the desquama¬
tion—i.e., if taken after the termination of the third week
and never before this; the bacilli also occurred in every
tube made from scarlatinal Mood if taken before the third
day of the fever. These bacilli measure from l‘2/».to l*4p
in length, and ‘4/tin width. They readily grow in nutiritive
jelly, and rapidly liquefy it, hut without producing any
ch&ractarstic appearance. The bacilli are, according to Dr.
Edingtan, to be seen in ccrver-glaes preparations of scar¬
latinal blood. Inoculation of the bacilli produced in rabbits
erythema and hue desquamation, in guinea-pigs erythema
and coarser desquamation, and in calves febrile symptoms
and a rash followed by desquamation. Further, blood
direct from a case of scarlatina injected into a guinea-pig
produced also erythema and desquamation. It was an
unfortunate omission that the direct inooulation of blood
was not also made in a calf, as we should have been able to
Compare the results with the Hendon disease.

As another omission in this research I may mention the
absence of any control experiments with the bacteria found
on the skin m health. It may be urged that these have
already been studied by Biszctzero and by Bordoni Uffre-
dhui. The latter found several ooaoi, a bacillus, and a
(Mprogenic bacterium. The bacillus epidermidis measures
5m M to 3 n in length and 3 n in width. It grows but
scantily in nutritive gelatine, and pure cultivations inocu¬
lated into rabbits and guinea-pigs produced no effect. This
bacillus obviously differs very markedly from the bacillus
scarlatina, but nevertheless it would have been much more
satisfactory if these experiments had been, repeated with a
▼lew especially to ascertaining whether there might not be
another bacillus, though not met with by the Italian in¬
vestigators, which would prove on cultivation and inooula-
ttarto be identical with tne bacillus credited with being the
oontagium of scarlet fever.

Thus we have brought fhce to face independent observa¬
tions on the contagium of scarlet fever, with the per¬
plexing result that neither of the observers finds the special
organism described by the other as the speeific one. Dr.

methods.* A lack of knowtod^ofthese ordinary methods
Ma hardly be supposed on the port of Dr. Ediagton, which

might account for his overlooking the streptococcus. On
the other hand, it is evident that Dr. Klein nqvw
encountered in his researches the Edinburgh bacillus.

We must bear in mind, in connexion with this subject,
that saprophytic organisms may occur in man, both in healiA
and in disease, which produce very characteristic symptoms
in the lower animals.

If they gain access to the circulation through some surface
lesion, they may, in an advanced state of disease especially,
escape disintegration and be detected in the blood and m
the organs after death. Thus they may readily be mistaken
for the specific organism, if there be one, of the disease iq
question. We may also find more than one organism
associated with a-dueaae as the result ot a double infection.
Kassowitz and Hochsinger found in the organs of children
which had died of congenital syphilis streptococci, whicn
were regarded as the result of Mischinfection. It is interest¬
ing also to,recollect how commonly streptococci have been
met with. In addition to those 1 have already mentioned,
we must bear in mind the streptococci in purulent inflam¬
mations found by Ogston, Rosenbach, Krause, Garre, Hoffs,
and Biondi, the streptococci found by Weichselbaumin acute
pneumonia, the-streptococcus isolated by Nicolaier from
earth, the streptococci found by Emmerich in the air, and^J
may add, the streptococci found by Babes in the liver and
kidney in java -cases of yellow fever; in the liver, kidney,
and spleen in a case of fibvre typhoids bilieuse, and in inflam¬
matory products consecutive to scarlatina, by Bokai and by
Babes in joint affections after scarlatina, and by Charrin
in septicaemia consecutive to anthrax in rabbits. In con¬
clusion, it is obvious that the experiments which have been
analysed must be repeated and extended before a definite
opinion can be expressed ; and as in addition to its patho¬
logical interest the inquiry involves a question of national
importance, it is to hoped that a commission will be
appointed. By testing the result of inoculating blood from
human scarlatina direct into the calf and the monkey, and
by repeating and extending the experiments of Dr. Klein and
Dr. Edington, there ought to be no difficulty in dispelling,
the present contradictions.

ON LATERAL OURVATTIRE OF THE SPINE.

By RICHARD BARWELL, F.R.C.S.,

SENIOB SUBQBOK, CHARLSO-CR09S HOSPITAL.

Lateral curvature of the spine is, it appears to me, a
subject of increasing importance; because, if I am to judge
by my own considerable practice in this branch of surgery,
the victims of that condition are yearly increasing in
numbers. The fact is in part to be ascribed to the greater
pressure of school work, more and more carried on in
writing, to which young girls are now subjected. Before,
however, discussing the etiology and treatment of spinal
curvature, it will be necessary to give some few explanations
and definitions.

Lateral curves receive from the direction of their con¬
vexity the name of right or left, and they are termed dorsal
or lumbar according to the region they affect. Most curva¬
tures are double or S~ 8 h a ped; but in some cases tfib
upper, in others the lower, bend is the original evil, and W
named primary dorsal or primary lumbar; the other curve,
called secondary or consecutive, is an addition forced upon
primary curvature probably by the necessities of balance;
Other varieties, however, are not uncommon. Thus thh
whole spine may be bent either to the right or left
in one long curve from top to bottom; and we occa u
sionally meet with multiple curvatures—i.e., cases in
which the spine is bent in a series of three or more sharp
short curves, alternately to right and left. Combined with
the bend of the spine is always rotation of vertebra, 1 in
such sense that the anterior faces of the vertebrae always
look towards the convexity, and the tips of the spinous
processes towards the concavity of the curve. This connotes
that the transverse processes of thh lumbar, those processes
and also the ribs in the thoracic region, project abnormally
backward on the convex side, and are too little prominent

i The contention ot Niooladoni end Hiiter, that rotation aa seen
clinically and In the akeletoa la merely an ocular delusion, U quite

dvG0

1276 The Lancet,] MR. R. HARWELL ON LATERAL CURVATURE OF THE SPINE.

[JUKE 28,1887.

on the concave side of the curve; also that the muscles—
more especially do I here refer to the erectors—no longer
act symmetrically on each side of the mesian line, but
unilaterally and in a false direction. But although it is
true that in all cases of scoliosis the vertebra which has
deviated most from the straight line is also that which has
most rotated, curvature and rotation do not in different
cases bear the same proportion to each other; but, on the
contrary, the one or the other may be the predominant
deformity in any given instance.

Theories as to the causes of these deviations are very
numerous—more so, indeed, than can be here specified.
Rather more than twenty years ago, when the first edition
of my work on lateral curvature was published, I named
most of them, and pointed out where they failed to account
for the phenomena; also I showed that all these curves, and
perhaps some examples of rickety scoliosis, are produced
by one-sided muscular action. This view has, of course,
met with a certain amount of adverse criticism, chiefly
from those who assert that lateral curvature is due to
certain postures. Such contention, as opposed to the theory
of asymmetrical muscular action, is, however, a mere
logomachia, for it must be evident that postures, except
those assumed in recumbency, are the results of muscular

Fig. 1.

Fig. 2.

acts. Therefore, even after studying and giving full atten¬
tion to the various objections that have been made, I again
assert the correctness of my theory, including in the terra -
predominant action of muscles on one side of the body—
any and every peculiar posture which such habitual pre¬
dominance may maintain. Thus, in a young subject any
one-sided predominance, be it respiratory, be it postural
(either from mere habit or occupation), or be it from
difference in the length of the lower limbs, may, and
often does, produce a lateral curve and twist of the
spine, which at first is an affection of soft ports only, but
which after a time produces certain deformations of the
bones. The exigencies of small available space will not
allow me to go thoroughly into the many changes which are
thus produced in the vertebras; but, to place the matter as
shortly as possible, I will ask the reader to picture to him¬
self a rapidly growing girl between the ages of seven and
fifteen, who has from one of the above causes acquired a
constant, or nearly constant, side twist of the spine. It is
evident, firstly, that the ligaments on the convex side will be¬
come lengthened, thoseon the concaveside shortened, binding
the vertebra* still more fixedly in their false posit ion. More-
over, since the bones are still growing, more especially from
the junction-lines of the epiphysial plates and from the
neuro-central suture, it happens that the growth of that

Fig. 3.

aide upon which more weight is thrown will be HhnhiU^
of that upon whioh less weight is thrown in creased; there¬
fore the vertebral bodies become after a time wedge-shaped-
tbicker, that is to say, on the convex, thinner on the ooncsre
side of the curve; the pedicles also, and to a less axtsat the
laminae on the concave side, are shortened and gmenilj
stunted; in bad cases they are changed in direction, aa m
also the articular processes and their facets. Later on both
the transverse and the spinous processes also are deflected
and misplaced. The condition is now very different froc
that first described: the habitual curve has Scorns what it
termed permanent. I need hardly point out how modi nun
grave is this latter condition, nor how important it thoe/an
is to correct the earlier phase, while still merely habitual
One of the most. common forms of curvature whoa
etiology is the most simple is lumbar curvature, and this
perhaps rather more commonly to the left; it oririnsta
in the vast majority of instances from pelvic obliquity
—i.e., from one side of the pelvis lying on a lower level
than the other, which means of course that the sacrum
also slopes, and that the basis on which the spinal oolnai
stands is awry. Therefore the column itself, in order
to preserve its and the body’s balance, must be deflected
or, in other words, the spine must curve. Pelvic obhqoity
may result from unevenness in
length of the two lower limbs—
a condition constantly arising
from disease or injury, but very
often found when no such causa¬
tion can be traced. Such un¬
provoked inequality is much
more common in girls than in
boys, and usually, though by no
means always, tbe right limb is
the longer one. Fig. 1 is from a
lad whose left limb is short,
probably from early and transient
infantile paralysis. An extreme
case has been chosen in order to
•bow more clearly the oblique
position of the pelvis and the
curve of the loins therefrom re¬
sulting. While Fig. 2 (which
will be reverted to again in
the subject of treatment) shows
how a block under the foot com¬
pensating tbe shortness of the
left limb will restore the hori¬
zontal position of the pelvis; and
since this device straightens the
spine, it also shows now long
even an extreme habitual curve
may by judicious management be
kept in that phase. But pelvic
obliquity is not always tbe result
of uneven limb growth. It some¬
times is produced by a mere trick
or habit, such as many young
girls acquire, of standing on one
leg and letting tbe other fall loose with bent knee; end
unfortunately the habit is to thus use always the same
limb; the result is tbe same as though one were sharia
than the other—viz., pelvic obliquity, as shown in Fig. 3.

Another condition has, I am convinced, considerable
influence on the production of curvatures, especially si it
occurs at a period of life when growth is rapid, when
muscular development is in progress, and while yet the spinal
epiphysial junctions are soft and active. This condition is
due to tbe increased and increasing study now forced on
girls chiefly through the medium of writing, and is in all pro¬
bability the chief cause of a greater prevalence of lumbar
curve to the left, which, as stated in my opening sentence
I have observed during the last ten years. Writing, of
course, has no evil influence on the spine provided the popu
sit square and even on the chair and before the table, bat
very many sit so as to support the weight on the right
ischium and right arm, the spine being bent (convexity to
l?ft) chiefly between the last lumbar and tenth dcrasl
vertebras. Some girls even exaggerate this evil posture by
lushing the chair book from the table and bending the body
still more over.

^Doubtless certain other more recondite causes of lumbar
ctttve exist, such es constantly crossing, during sitting, the
lift leg oy*r the right;, also certain uterine and orsrisa

>s l

Tff® Lancxt,]

DR. GOODRIDGE: RESULTS OF CICATRISING PROCESSES. [Junb 25, 1S87. l*7f

conditions causing uneasiness, for which relief is sought in
some faulty posture of standing, sitting, lying, or all three.
These are, however, exceptional* and rarely produce other
t-hun slight curves. In all curvatures primarily lumbar
rotation plays a less prominent part than in dorsal curves.
In certain cases it is very slight, in others more marked
in proportion to the deviation, but is never so con¬
siderable or so important as it is in most cases of dorsal
curvature. In another paper I shall describe the dia¬
gnosis and treatment of loin curvature.

Wlm pole- street, W. _.

ON SOME

RESULTS OF CICATRISING PROCESSES IN
THE NEIGHBOURHOOD OF THE
PORTAL FISSURE.

By HENRY F. A. GOODRIDGE, M.D., F.R.C.P.,

SENIOR PHYSICIAN TO THK ROYAL UNITED HOSPITAL, BATH.
(Concluded from p. 1217.)

Thb second case exhibits cicatrisation bringing about in
the same way a different result; as will be observed, it has
an additional connecting link with the first case.

J. T-, aged eighty, was admitted on May 25th, 1875.

She stated that through the whole of her life up to the last
winter but one she never had any illness; she then had
what she called “the cold shivers” with slight cough. Her
present attack commenced between four and five weeks
previously with pain over the region of the liver, shooting
through to the right shoulder blade; at the same time
she became jaundiced. Her bowels were confined, the
stools being light-coloured: and her urine was very dark.
She had vomited three or lour times during the last week,
and her appetite had failed. On admission, she exhibited
marked jaundice, but the pain had pretty well subsided.
Her temperature in the axilla was 97°; pulse 68, radial
artery senile; respiration 32; and tongue moist, but coated
with whitish fur. Her bowels had not been open since the
23rd, when the stool, it was said, was pale; the urine was
acid, sp. gr. 1017, very, dark, and on testing showed the
presence ot bile pigment. She had some itching of her skin.

May 26th: She had slept well. The bowels had acted
slightly, the stool being clayey. Her temperature was 97 - 4°,
pulse 64, and respiration 28. The liver extended to near
the umbilicus; it did not feel hard, and presented no
inequalities of surface except at the extreme right, where
there seemed to be a small hard nodule on the convex
surface; it was near the edge, which could be distinctly
felt all along, but was not thickened or rounded. There
was apparent distension of the ascending colon, a feeling as
of a firm tube extending vertically under the right rectus
muscle.—28th: She had had good nights, and her appetite
was improved. When she had taken a little wine that was
ordered she said it gave her pain in the stomach. She
vomited once in the evening.—June 1st: Sbe had had no
further sickness, and had no pain whatever. She was
sleeping well and taking her food well. Her temperature
was 97°, pulse 56, and respiration 24. A little brandy-and-
water, which was substituted for the wine, she said she
could not get on with.—15th: She had had some bronchial
catarrh the last few days. Her bowels were open about
once daily; the stools had continued clayey, but were now
ot a slate colour. She passed upwards of thirty ounces of
urine in the twenty-four hours. The jaundice was much
as before.—20th: She had vomited several times to-day.—
25th: There had been no return of vomiting. Her cough
had continued troublesome. She had no pain. Her tempera¬
ture was 96°, pulse 72, and respiration 32. Her bowels
were open daily, the stools being still slate-coloured. The
jaundice was much as before.—26th: About 3 A.M. she
began to vomit black coffee-ground-like matter. At 9
thu had amounted to upwards of two pints. 8he had no
pain, but felt exhausted; her pulse was 116 and very feeble.
There was a little tenderness on pressure in the epigastric
^gion, none elsewhere. In the vomited matters were
numberless red blood-discs. The patient became much
collapsed and died the same evening.

ro P*yif or ty-f°vr hours after death.—On opening the
•Wanes* the liver presented nothing remarkable, except

near the margin of the right half of the right lobe, in tbe
situation where was observed the hard nodular feel during
life. Here the convex surface exhibited an opaque yellowish
white puckered look; in fact, the appearance of a large
cicatrix with some amount of central depression. The tex¬
ture was dense and indurated, and this condition was felt
to extend through the entire thickness of this part of the
organ. Underneath was a thick, tough, and pretty extensive
adhesion of the transverse colon, so that only by the knife
could the intestine be separated. Its lumen was slightly
diminished in consequence, and on opening it there was
found some puckering of the mucous surface, but no ulcer¬
ation. On making a section through the indurated portion
of the liver here, the same cicatricial character was observ¬
able. Corresponding somewhat in situation to. the gallr
bladder was a small cyst-like cavity that would contain
about one fluid drachm ; a little mucoid matter was in
it; there was no trace of duct. The opaque tissue
gradually and in a somewhat radiating manner passed
into the surrounding hepatic texture. The capsule could
not be separated over this part. There were also some
diaphragmatic adhesions and thickening of the capsule, but
nowhere else in the organ was there any appearance similar
to that described. The hepatic duct, as it issued from the
liver, was quite pervious; so also was the common bile duct
at its entrance into the duodenum, but even a No. 1 catheter
would not pass through the latter. The liver weighed 40 oz.;
its parenchyma generally was coarse. No gall-stone was
found anywhere. The stomach was considerably dilated. It
contained a quantity of thin melanic fluid like what had
been vomited during life. Near the small curvature on the
posterior wall, but not so near the pylorus, was a largish
ulcer, which reached to the peritoneal coat, and was dis¬
tinctly terraced. Just within its margin, which presented
no thickening, was the open mouth of an artery, evidently
a branch of the coronary. The kidneys were somewhat
granular; the two together weighed 6 oz. Nothing impor¬
tant was found elsewhere.

Now, the cicatricial appearances in this woman’s liver had
primd facie very much the characters of a syphilitic lesion;
I was disposed, however, to think that they were due to an
old suppurative inflammation of the gall-bladder, perhaps
connected with gall-stones, which had discharged by a fis¬
tulous opening into the transverse colon. Be that as it may,
the origin of the cicatricial tissue does not so much concern
us as ica presence, and its presence in quantity, in the sub¬
stance and on the under surface of this part of the organ;
though here, as in the case of A. M-, tne products of ad¬

hesive local peritonitis were clearly more or less blended
with it. Caught apparently in one part of its course within
the fibrous bands of this contracting tissue, the common bile
duct became constricted, and jaundice ensued. As to the
ulcer in the stomach, we may remark in passing that pos¬
sibly it owed its origin to arterial degeneration, which is
recognised by authorities as a cause of gastric ulcer in old
people. The same condition might also explain how it was
that the heematemesis was not of that florid and instantane¬
ously fatal character that the size of the gaping artery would
have led one to expect.

The products of adhesive inflammation have been above
referred to as having had a share in bringing about the
pathological events under consideration. These products
and cicatricial tissue, we know, are histologically closely
allied forma of fibrous connective tissue, and they possess
alike the property of contraction. In the cases before
us the share taken by the inflammatory products was a
subordinate one; but in some instances, as, from the facts
just noticed, and from our acquaintance with the operation,
of such products on a larger scale elsewhere, we might well
anticipate, they show themselves capable per se of inducing
similar results. 14 Now and then the fibroid tissue developed
in the portal fissure from the products of inflammation pro¬
duces constriction of the bile duct or portal vein.” 1

It is not unimportant, I think, to discriminate between
cases snch as we have been considering and those where
vessels, ducts, &c., are compressed by the gradual stuffing
by adventitious products of the spaces wherein they run.
Thus, in a case of lymphadenoma of the retroperitoneal
glands under my care, “ the disease had attacked also the
portal glands, and a considerable mass was found deep
between the liver and stomach, in which the vessels in the
porta! fissure were embedded. On cutting transversely

i Murchison on Disessso of the Liver, 3rd edition, p. 310
C C 2

CnOO

gle

1278 Thb Lancet,]

DR.08CAR JENNINGS: RELIEF OF MORPHIA CRAVING.

[Jmns 25,1887.

through the mass, the common bile duct, the hepatic artery,
and the portal vein were divided, their mouths being quite
patulous and their calibre undiminished.” 3 The tissue here
possessing no marked contractile property, the vessels,
though embedded in the same, did not suffer. At a further
stage of the growth, of course, compression would ensue,
with narrowing or occlusion of one or more vessel", accord¬
ing to the resistance they might respectively offer. But
then the modus operandi would be that of a pretty uniform
constriction, oomparable to the slow tightening of a ligature.
Not so, however, in the class of case dealt with in this
paper. We use the terms contraction and constriction in
■discussing the same, but, as has been pointed out, the con¬
traction of cicatricial tissue in cases of this kind is, strictly
speaking, a concentric retraction, a shrinking which takes
place in all dimensions, and is directed in radial lines
towards a centre or centres which are determined by the
conditions of the original lesion, and the foci, one or more
as the case may be, of tissue destruction. Hence the effect
-on vessels, ducts, &c.» traversing the area of cicatrisation, is
rather an irregular traction or torsion than a uniform con¬
striction as in the former instance. And hence also it
happens, that in the same cicatricial area, while one vessel is
implicated, another is not at all so, or only in a minor degree.

Bath.

THE RELIEF OF THE MORPHIA CRAVING
BY SPARTEINE AND NITRO GLYCERINE.*
By OSCAR JENNINGS,. M.D., M.R.C.8 .,

BLXOTBICAl PHTSICLAX TO THK CUITIQUB OF ST. AXNK.

In a note on the Condition of the Pulse in Morphinomania
presented by Professor Ball and myself at the French Academy
-of Sciences, 4 we discussed the mechanism of the morphia
craving, and showed that during the period of privation there
is ischromia of the general circulation. An injection of
morphia administered at this time causes a disappearance of
•the psycho-somatic suffering which constitutes the craving,
-and is followed by a restoration of the pulse. In a second com-
•muttication to the Academy of Medicine® we stated that we
Tiad found, moreover, that the morphia craviDg can be
appeased by the use of other medicines having the property
of restoring the pulse in a similar manner. We liad experi-
<mented extensively with two agents of the kind on patients
at Laennec, St. Anne, and in our private practice. The first
of these is sparteine. “We thought it would be preferable
■ to try heart tonics, and strengthen the action of this organ
in moments of weakness. To this end we have employed
•sulphate of sparteine, which fulfils most of the conditions,
andean easily be administered by hypodermic injections.
We watch for the moment of weakness as indicated both
by plateau in the sphygmographic tracings and by the
intimate sensations of the patient. At this moment we
administer an injection of from two to four centigrammes,
which may be repeated when necessary, and at the expira¬
tion of a few minutes we see the pulse strengthen and the
craving disappear. To use the words of one of our patients,
‘the .medicine gives heart.’ This expresses in familiar
language a physiological truth of which the sphygmograph

confirms the absolute exactitude.Another medicine which

procures a passing relief of the symptoms is nitro-glycerine.

. Its effects, very similar to those of sparteine as regards the
point in question, are at the same tune much more rapid
and much more ephemeral.”

Since the preceding lines were written I have adminis¬
tered sparteine and nitro-glycerine repeatedly in fourteen
. different cases, and 1 feel convinced that in these agents,
properly administered, we possess a means which will enable
any morphia habitui earnestly desirous of leaving off his
intemperance to carry the process of weaning to a success¬
ful issue. All morphia haoituis have from tune to time a
maudliqg hysterical desire to give up the practice, but this
vanishes at the first feeling of discomfort. For such cases
there can be no suppression without restraint, and a result

s Extract from the post-nioi+em note*.

> Read at th* Society Medicate deVBIjaSe of Pavla.

* Dea Madifteattani ,du Fouls dan* la Morphiaomanle. Comptea
Rendu* de t'Academic des Science*. March, 188..

s Considerations «ur le Traltcment dc la Morphlnomanle. Bulletin*
de l’AcadSmid de MSdldnC. Match, 1897.

so obtained is very unsafe for the future. Deprived of their
morphia in an asylum, patients are not thereby cured of the
craving. They have been forced by a compulsion, which ha*
provisionally taken the place of their will, and a marphino-
maniac is no more cured of his passion by this forced
deprivation than is the dipsomaniac by abstinence Iran
alcohol during a certain time. A relapse generally occurs si
soon as the patient has recovered his liberty. But then
are morphia habitues who honestly loathe thkr thraldom,
and who would do anything short of the impembk
to break through it. Very few medical men seem to
realise the nature and intensity of the suffering which
accompanies the privation from morphia, and upon which
they are occasionally called upon to advise. A gentleman,
whose case 1 related in the Enotphale of March, ls^T,
and who was cured of the habit by inhibition of the craving,
was informed by some of the consultants he had sees
that the confirmed habit of morphia was incurable. I
believe it is the writer of the section on Morphinism in
Ziemdsen’s Cyclopedia who is responsible for this uftaion.
But the greater number Of his previous advisers had ten of
opinion that all that was necessary to core him of the habit
was for him to “ throw away bis syringe and solution, and
just make up his mind not to get any more.” ,

Now, the truth lies between these extremes of theoretical
error and practical ignorance. Some morphia habitui* would
have sufficient resolution to wean themselves of the practice
of the terrible distress resulting from privation if this could
be alleviated in a certain measure; and it is to the* that 1
refer when I say that those who are earnestly derirouj of
breaking off the habit can be enabled to do so by thahdp
of sparteine and nitro-glycerine. To be properly adsanu-
tered the remedies mentioned must only be used whe n pall y
needed, and should not therefore be at the.patient's
ThS only results I have ever Been of giving succedaasa to
morphinomaniacs has been to complicate the first disease by
a second, and very often a much more dangerous, intem¬
perance. And just as I have seen morphia habitufs acquit
on additional craving for alcohol, chloral, cocaine, and other
drags of the kind, so I think it quite possible that tbs reck¬
less and uncontrolled administration of _ the medkines I
recommend may give rise to an artificial desire jot
them—a possibility foreshadowed by Dr. Murrell in hu
work on Nitro-Glycerine in Angina Pectoris. Given at
the right moment, and in suitable doses, sparteine ant.
nitro-glycerine, either separately or together, form an ad¬
mirable means of relieving the morphia crating, and the
only modification I have to make in the statement quoted
above is with reference to the intensity and duration of tr¬
action of nitro-glycerine. Further, experience has taught
me that the* effect of nitro-glycerine is most satisfactory
and persistent in those cases where there is a predominant
of the “ yearning” over the “craving"—that is to ■ay.”’
which the psychical symptoms are more distressing that
those of a 9omatic order. When, on the other hand, there i*
more physical craving than morphine-nostalgia, as I
termed it, the use of sparteine, which is a tonic to tfc*
circulation, gives better results than nitro-glycerine alone
which I take to be nervo-inhibitory. What, however, I would
especially insist upon in the present note, is that, in tne
simultaneous administration of the two drugs, the oae by
subcutaneous injection and the other placed upon the
tongue, we possess a perfect remedy for the morphia oravuu:
in its double psycho-somatic modality. 8ome patients, a.*
would naturally be expected, say that one or both srec'
fail to give them relief; but, as far as my experience
these are persons who have no real intention of giriag
their morphia. Indeed, all they desire is to be allowed:
indulge vrabout interference in their vice. But those wb?
have retained sufficient will to resist the first prompting? c.
a capricious impulse will find that the true morphia hung::
can be entirely appeased by sparteine and nitro-glycera-
takenwhen there is a genuine necessity. The snbjome:
sphygmographic tracings show better than a length®*
desenptron the relative values of the two remedies;

Tracings Nos. 1 and 2 were taken from a patte 1 *
I.aennec, whose case is partially reported in my littjgwflr.
on Morphinomanifl," No 1 being before, and No. - By. *-*
injection of morphine ; the first shows the state of Jpvu~
the second that of satisfaction. No. Sis a trncingWt.
same pulse after a hypodermic injection of spurt eineJjwfM-
of morphine. The patient having stated that t he spgtei c-

e De la Morph inomanie, 2nd edition. BaUHSra, Tindall. *nd<)ltt.l*'

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1280 Thb Lutobt,] MR. E. M. FENWICK ON CANCKB OF THE KIDNEY. [Juhb 28, UR.

“ gave her heart," the morphia was suppressed, and she was
given two grains per day of sparteine instead of half a grain
of morphia, to which she had decreased from eight grains,
to which she had been accustomed for seve n years.
Thanks to the sparteine and occasional faradisation, she got
over the craving in three weeks.

Nos. 4, 5, and 6 are the sphygmograms corresponding to
different degrees of morphia hunger in a young medical
man, who hod taken morphia for inimni* »i« years pre¬
viously, and had become accustomed to twelve grains per
day. The whole suppression took less than a month, and
fifteen days after the last injection of morphia his pulse
kept up by nitro-glycerine was as in No. 7. A few days
later he was entirely cured, and took no substitute what¬
ever. In a letter to me on the effect of the different medi¬
cines employed, he says: "Antipyrin congested the brain
the first time. At the third nr fourth trial it produced no
further effect. Its action diminished progressively. As to
any relief it procured, it was very trifling. What did pro¬
cure me the greatest relief, and which replaced by its effects
the morphia, was without doubt nitro-glycerine. In a state
of craving, at the time of my worst sufferings two or three
drops, taken every three or four hours sufficed to remove
all agitation and restlessness, and perhaps also perspiration.
1 will not be positive about this last point, as I only re¬
marked it once. As regards the nitro-glycerine, its action
increased progressively. I tried the tablets of nitro¬
glycerine, which had the same effect as the solution, and at
the present moment it suffices for me to take a single tablet
to congest the brain, and so procure a mild and pleasant
intoxication resembling that of morphia."

The next three tracings relate to a woman whose pulse
during her cure at St. Anne presented the truncated appear¬
ance which constitutes the plateau of morphia craving. The
administration of sparteine had enabled her to’be weaned of
morphia without difficulty. Six weeks after the cessation
of the treatment I took her pulse with a view to ascertain
whether her habit, which was of ten years’ duration, had left
any permanent injury to the vascular tonicity. The tracing
No. 8 indicated that the circulation was unsatisfactory, and
with very little persuasion the patient told me that she felt
uncomfortable about the heart, and would certainly be
obliged to resort to morphia when Hhe recovered her liberty
unless she could brace herself up by sparteine. I suggested
that she should try nitro-glycerine instead, and placed suc¬
cessively four drops of the 1 per cent, solution on her tongue.
Five minutes afterwards she said she felt much more com¬
fortable, and the pulse showed an improvement as in
No. 9. She still maintained, however, that something more
was needed to keep her away from morphia, so I injected
two centigrammes of sparteine, with the effect seen in
tracing No. 10, the patient expressing herself perfectly
satisfied.

The last three sphygmograms forip an int eresti ng contrast
to the three preceding. The pulse tracing on the day before
having been found by the clinical clerk to present my
plateau, Professor Ball had ordered sparteine. The pulse at
10.30 was as in No. 11; but notwithstanding tha satisfactory
condition of the circulation, the patient was in a state of
restlessness and enervation, unable to keep still, and crying
hysterically. I gave her two drops of nitro-glycerine solu¬
tion. The effect upon the circulation was greater than in
any case I have seen; but although the hyperdicrotism made
me feel a little uneasy, the patient was thoroughly com¬
fortable and became quite cheerful. I remained with her an
hour and a half, during which time she was calm and
tranquil, and before leaving took a tracing, which showed
that the arterial tension was entirely restored. (See No. 13.)

The last two cases are extremely instructive. The patient
whose symptoms were associated with a condition of the
circulation shown in Fig. 8 has a bodily malaise depending
partly on an embarrassed action of the heart. Her urine con¬
tains albumen. Here the nitro-glycerine was insufficient, and
it was not until the condition of the heart was modified by
sparteine to that shown in Fig. 10 that she expressed herself
relieved. The woman whose pulse is recorded in Fig. 11,
on the other band, was not, as far as physical investigation
could discover, suffering from the effects of ischfemia, and
yet her distress was painful to witness. Here the successful
remedy was nitro-glycerine.

To sum up, the morphia craving is a complex suffering,
at the same time cerebral and peripheral, each factor of
which can be relieved by appropriate treatment. The
organic distress may be soothed by sparteine, which recovers

the heart in the same way as a hypodermic injection of
morphia. The cerebral craving (or yearning), often the more
painful of the two, corresponds to a want of habitual con¬
gestion. This can be arrested by nitro-glycerine, which
gives rise to the same kind of sensation in the morphia
habitat deprived of his stimtfftet as the hypodermic injec¬
tion. It acts probably by inhibition d distance rather than
by essential sedation of the nervous centres.

Paris.

CORKAGE OF THE URETER WITH CLOT
IN CASES OF ADVANCED CANCER
OF THE KIDNEY . 1
By E. HURRY FENWICK, F.R.C.S.,

aflSMTAirr-flDB&ao* to tbm iahidom -Hoew»Afcr-#in»eoN in ranv-
LOGIST TO 8T. PETEB’S HOSPITAL FOB -CBIHAB? DtSEUL

I havA long been strongly impressed with the necessity
for adopting some measure, other than excision, in the treat¬
ment of cancer of the kidney. The statistics of nephrectomy
show the futility of removing a kidney thoroughly attacked
by carcinoma. Cases such as these are often met with in
practice, but sometimes there is superadded a profuse and
ungovernable- hrematuria—a hematuria which prostrates
.our patient, defies our remedies, and which slowly, always
surely, reduces that short term of life allowed by the disease
to a minimum. In casting about for some oonsemtive
measure to arrest the haamorrhage, without attempting to
remove its source, I bethought me of the skilful manner in
which the ureter is sometimes spontaneously plugged with
clot, obstructed by growth, or pressed upon and render*-!
impassable by the enlarged lower segment of the kidney .-
the haemorrhage being thereby suddenly and permanently
arrested. Post-mortem examination of these cases shows
the pelvis to be distended with a large firm blood clot, and
the canal to be impervious. It seemed to me to be within the
range of possibility to imitate this, by inducing dottage
of the blood in the ureteral canal, and it did not seem
beyond the range of probability that the mere pressure of
the distended pelvis upon the renal vessels would restrain
slightly the flow of nourishment to the neoplastic growth,
and thus reduce its rate of increase. The course I propo-*-!
to myself to adopt in a suitable case was to introduce into
the bladder some form of instrument which would allow nf
the vesical orifice of the ureter being nipped between it
and the compressing finger in the rectum. The instrument
I decided upon was my ureter aspirator/ 4 which can bemade
to embrace either ureteral orifice without trouble. Although
a good many cases of heematuria pass through my bonds
every year, yet it was not until 1885 that a case came under
my care at St. Peter’s Hospital which seemed to justify
such an attempt being made. I submit this case not for
criticism, for I regret to say it is incomplete; although its
clinical aspect is strongly in favour ot the concloaons I
have drawn being correct, yet its pathological history is
wanting, and without post-mortem evidence its accuracy
is questionable and its value greatly diminished.

J. L-, aged fifty-three, had hefen healthy up to July,

1884. On the 31st or that month he received a severe blow
upon his chest which caused him an hour afterwards to pa#
much blood in his urine. From that time he continued
passing blood in large quantities and at irregular intervals
tor thirteen months. The heematuria was often apparently
causeless in its origin, always painless in its course, and
generally beyond tha control-or drags. It used to step
gradually, only to reappear suddenly in a few days tinii.
Thirteen months after its onset he applied for relief at
the out-patient department of SLJeteFaJIqMutal, bringing
with him a bottle of scarlet hfematuria. He was at tbr
time suffering from some pain in the right kidney, sal
had lately lost flesh and strength. He was very anffinU.
There was no renal tumour to be felt, although paia
was experienced on pressure in the region of the hgfc*
kidney. No vesical or prostatic cause for the hemor¬
rhage was found. I explained the case to him, wl«
finding the heematuria unaffected by drugs, I advies.
attempting to close the right ureter with a' clot, and failing

1 Abstract of a paper read before tbe Medical Society.

8 Vide The Lancet, September 18th, 1886, p. 529.

Tun Lahcht,]

DR. M. HAND JTBLD-JONBS ON INVERSION OF THE UTERUS. [Juwk 25* I88T.

this to e*dse the kidney. He oonrented to the former
operation. After carefully washing out ate bladder I in¬
jected two draahms of a 20 percent* solution of cocaine.. I
then introduced my right-sided meter aspirating catheter,
and turned it a quarter Of a revolution on its long axis, bo
that the lateral eye of the instrument overlay the orifloe of
the right ureter. I now made a little counter-pressure per
rectum with my left index finger, and exhausted the air in
the catheter by means of its evaeuator ball. On removing
the catheter ten minutes after 1 found a large white clot,
which I believed had been socked from the ureter into the
eye and shaft of the instrument, and I concluded that more
of the same clot was collected in the lower third of the
ureteral canal. Had I plugged the canal ? With theexcep-
tion of a little bleeding that night, which I believed came
from the bladder instrumentation, he,had no recurrence of
the hemorrhage up to the date of hie death six months after;
and this although the haemorrhage for the previous fourteen
months had been recurrent and profuse. The patient now
rapidly picked up in health, weight, and strength. In three
months’ time, however, he relapsed, and I found, what I had
often examined him for—viz., a right-sided renal tumour.
The pain in the same region became worse, and in a month
or two he wasted considerably, and finally died exhausted
six months after my interference.

I had the opportunity of examining the patient shortly
after the operation with Dr. B. Ward Richardson, and.
although there was no disagreement as to the site of the
hemorrhage, our opinion as to the nature of the lesion
differed. This we expected to reconcile by post-mortem
examination, a privilege which was, however, most unfortu¬
nately denied us. The case, therefore, must stand upon its
clinical merits, but sinks in value in comparison with the
question of the advisability and possibility of closing the
ureter in cases of which the foregoing is an example. If it
be possible, is it surgical ? The answer to that question is
ready but not complete. The interference is imitative, and
is based upon pathological ground. It has the advantage
of being painless, and though palliative it is strictly con¬
servative. Its probable objection rests iri the formation of
a renal blood tumour, for there is but little renal substance'
left to form a hydronephrosis. Usually the haemorrhage is
directly into the pelvis, and the fibrous wall of the pelvis is
rarely attacked, so that its integrity will generally prohibit
the formation of a large blood collection.

Old Buflington-itreet, W.

'! r-.iJu • TWO CASHS OP

ACtn?£ COMPLETE INVERSION - OP THE
, UTERUS AFTER DELIVERY.

MONTAGU HANDFIELD-JONES, M.D. Lojro.,

OBtTSTRIC PHTSICIAIf IX CHARGE OF OUT-PATIKXTS TO ST. MART’S
HOSPITAL, AXD LBCTURRR OX MIDWIFBRT AYD DISEASES OV
M * WOMBS AT ST. MART’S MEDICAL SCHOOL.

■» 4 ., ---

CAOTS of acute complete inversion of the uterus are
fortunately rare, and recovery after this accident is by no
means constant: the notes, therefore, of the following cases
may prove interesting, especially as they illustrate two
varieties in the cassation of this obstetric complication. The
report of the second case has been kindly forwarded to me
by my friend Mr. Ambrose Fairies, in whose practice it
occurred. .

Gash 1. —Mrs. I -, aged twenty-four, has been married

three years, and has passed through two normal confine¬
ments. Naturally delicate, her health lately has been much
depreciated by trouble and scanty feeding. In the present
instance labour was attended with severe vomiting and
diarrhoea and great exhaustion, bat the birth of the child
took place without farther complication. The midwife
states that, as after ligature of the cord and the removal
of the infant the placenta was found to be lying in the
vagina, she removed it at onoa, using for this purpose two
Angers in tbe passage and gentle traction on the funis. "A
tew minutes” after removal of tbe placenta the patient com¬
plained of feeling unwell, and then fainted; free hsemor-
-hage occurred at tbe same time. Both tbe midwife and
;he mother of tbe patient were positive that no force was
lsed in extracting the plaoenta, also that the sudden onset
>f alarming symptoms took piaoe some minutes after the

removal of the secundines. Oq arriving an hour later, the
patient was found in-* state of intense collapse (though
brandy with ergot had Heeir freeljradministered), and the
uterus was completely inverted. In restoring the organ, no
difficulty was encountered while. replacing, the lower
segment; this- unrolled easily mne rssamea hi normal
position, but the fundus gave great trouble:, as last as one
portion was pushed up into position with the finger tipe
and then left in order to deal-with another section, so
certainly did the part last replaced rmnvert. At length,
under persistent pressure with the whole of the upper part'
of the right hand, the fundus reinverted with a distinct
snap, and the uterqa.at once retracted* expelling the hand.
Relief was immediate, and the symptoms hr collapse disap¬
peared with striking repkttty. > The pattens waanp an inn
tenth day, and has'lttety passed through another confine¬
ment without mishap. ':i

Case 2.—Mrs. E--, aged thirty-four, the wife of an

agricultural labourer, has passed through four confinements
without any mishap. In -the present labour everything
went smoothly at first: thevertex presented, the pains wUra
strong, and labour was rapid. A*> soon as the hsad had.
cleared the perineum, the body of the child followed with-
out delay, and then immediately the plaoenta appeared at,
the vulva, still adherent to the fundus uteri. The cord nregr.
sured fifteen inches in length, and was unusually thick and;
strong. The shock to the patient was intense, as evidenced
by the collapse, fainting, and death-like pallor. ReCognisrhg 1
the nature of the complication, Mr. Fairies at once tied sad
divided the cord, and then, having quickly peeled off Hie
placenta (a proceeding attended with maoti bnmazrhagn),
prepared to return the inverted uterus. Having grasped/
the mass of the fundus with the hand, no difficulty was
experienced in pushing it upwards; but when the - process
was a little more than half completed, tbe fnndus suddenly
left tbe operator’s hand and with a distinct snao resumed its
normal position. As soon ss tbe fundus had oeeaccestaxed
the patient rallied, And expressed herself as feeling immensely
relieved. No further difficulty ensued, and recovery waa
rapid and complete. ’ 1

Causation .—The cause of inversion in this latter case is
sufficiently evident:-Hie plsoenta remaining adherent, th«
shortness of the eord rendered inversion of the uterus on
snapping of the funis inevitable. In tbe-first case the
reason for tbe accident is more difficult to assign; there'is
no ground for supposing that it -was in any way due-to
unskilful removal of the secundines, as this was accom¬
plished with great care, and as, moreover, serious symptoms
did not Set in hhtil some minute# bad elapsed* The most
probable explanstibn is the folio whig. 1 The ti t ree s of the
patient, exhausted by starvation, diarrhoea. Sad vomiting,
were in a toneless, flabby condition, and the uterus 1 wav
thus prepared for inversion after the 1 method described by.
Dr. J. E. Taylor; which consists in a -foiling out of > the
cervix with gradual implication of Hie body and fundus*
As long as the plaoenta remained in the-vagina tbe- lowers
uterine segment was to some degree supported, bet with
the removal of the afterbirth all obstruction to the com¬
pletion of the aooident was taken away, and in a few
minutes complete inversion had become established; * >

In Case 1 the fundus was the only part which proved dim-,
cult to replace; it seemed t6 be the only part 1 of- the uterus
which maintained a degree of retraction; and th» existence
of this latter is an argument against the -hypothesis that
the process of inversion could have commenced at the
fundus. In Case 2 one feature is full of interest-—vis., the
readiness with" which-the fundus revttdetted ytseif after
once Mr. Fairies had started the process. Cases-of spa**
taneeus restoration of a completely inverted utmos have
been observed by various physicians, and the behaviour of
the viscus during reposition in Case 2 goes far to confirm
the correctness of such observations.

Montagu- square, W. • • ■ ‘ 1 ’

At the annual meeting of the governors of the 1
Dundee Royal Infirmary on the 13th inat., satisfactory
reports were presented and adopted. .

- Thb members of the medical staff of Jervie-street
Hospital, Dublin, on the 18th inst. entertained s number ofc
the friends and supporters of the hospital toigsakfaat. iTha
visitors were afterwards conducted over the instriufcidDe^iiii

1382 The Lancet,]

HOSPITAL MEDICINE AND 6DEGEBT.

[Jinn 2fi, 1887.

xrrur

HOSPITAL PRACTICE,

BRITISH AND FOREIGN.

Hollsaatem Mt ill* pro oerto noaoandi via, nil! qoamphirlmai et mar-
bo rum et diwaotlomun hiitoriu, turn allorum turn propria* oolloctal
habere, et Inter m oomparare.—M oboaoW D* Sed. tt Cam. Aforb.,
lib. iv. Procemiam. -

ST. MARY’S HOSPITAL.

A CAM OP GALL-STONES Ilf THU CYSTIC DUCT; CHOLR-
CY8TOTOMY; RECOVERY.

(Under the care of Dr. Broadbent and Mr. Page.)

The operation of cholecyetotomy has not yet been per¬
formed in so many cases as to deprive of considerable
interest the record of a successful case. The following
is an example of the operation in which, after previous
tapping of the gall-bladder, with only temporary relief and
with no ill effect to the patient, stones were removed from
the cystic duct which without surgical aid could not have
been passed. The after progress of the case was all that
could be desired. For the notes we are indebted to Mr. P. A
Lloyd, house-physician.

8 . W-, aged thirty-three, was admitted under Dr. i

Broadbent on Jan. 24th, 1887, complaining of a tumour in
the region of the gall-bladder. In April of last year she
had an attack of what appears to have been biliary colic,
though she had no jaundice, and did not pass a gall-stone
per rectum. Shortly after this attack the swelling was first
noticed, though it caused no inconvenience till Christmas,
when the patient began to feel a dragging pain in the right
side, especially after exertion. No farther history of colic, nor
any history of jaundice, could be obtained, but the patient
said she was subject to “bilious attacks” from time to time.

On admission, there was a swelling in the region of the
gall-bladder, about the size of an orange, which was smooth,
hard, and freely movable. No enlargement of the liver
could be discovered.

On Feb. 13th six ounces of slightly opaque fluid were
drawn off by aspirator. The fluid was faintly alkaline,
sp. gr. 1008, and contained about one-tenth albumen. No
hooklets or echinococci could be discovered on microscopic
examination. After the tapping the tumour could no longer
be felt, and the patient left the hospital ten days later, free
from all symptoms. On March 17th she was readmitted, as
the cyst had again filled; she had felt the pain in her
side during the previous week. On March 31st the tumour
was again aspirated, and eight ounces of fluid were drawn
off, of a pale green colour, faintly alkaline (sp. gr. 1010),
and containing mucin and about one-sixth albumen. Micro¬
scopic examination showed only a few blood-corpuscles,
small masses of yellow pigment, and a few epithelial cells.
On April 3rd the cyet had once more refilled to its former
size. Dr. Broadbent now considered that the tumour was a
distended gall-bladder, and not a hydatid, as had at first
been suspeoted. Mr. Page was therefore asked to perform
cholecyetotomy.

On April 9th, chloroform having been administered,
Mr. Page made a vertical incision two inches long, com¬
mencing half an inch below the ninth costal cartilage on
the right side and extending down to the level of the
umbilicus. The abdominal walls having been divided j
immediately external to the rectus, and the peritoneum I
opened, the gall-bladder and the edge of the liver were seen.
There were some slight recent adhesions between the gall- i
bladder and the parietal peritoneum. The cyst, having been
carefully examined, was then aspirated, ana ten ounces of
purulent fluid drawn off. The empty gall-bladder was now i
seized with forceps and incised; its cavity was wiped dry
with .sponges and then explored by the finger. A stone
about the size of a walnut was felt in the cystic duct, and
removed with a pair of small lithotomy forceps. Two
minute calculi were afterwards detected, and were removed
on a sponge. There was no discharge of bile-stained fluid
after the removal of the calculus. The walls of the sup¬
purating cyst (Le., the distended gall-bladder) were now
fixed by catgut sutures to the abdominal wall, and a
large drainage tube was passed as far as possible towards

the cystic duct. Wood-wool pads formed the drewiog, ta)
perchloride Of mercury was the antiseptic used. The fluid
removed bad a specific gravity of 1012, was alkaline, tad
contained a large quantity of pus. When the pui hid
settled the supernatant clear fluid contained about hill
albumen, and gave Gmelin’a and Pettenkofer’e testa far
bile-pigments and acids.

The wound in the gall-bladder healed in five days, ud
that in the abdominal walls in about five week*. Than
was neither pain nor rise of temperature after the operation,
and no bile was discharged through the wound. The patient
left the hospital on May 17tb, witn no trace of tumoar, and
quite free from abdominal disoomfort, and there has been no
reappearance of the swelling np to the present time.

HAMPSTEAD HOME HOSPITAL.

CHRONIC RENAL ABSCESS; ABDOMINAL NEPHRECTOKI;

RECOVERY.

(Under the care of Dr. Heath Btbanoz and
Mr. Edmund Owen.)

E. M-, widow, aged thirty-seven years, a domestic

servant, was admitted Feb. 15th, 1886. Her father and
two of her brothers had died of phthisis. As a young
woman she had been the subject of hramatoria, and daring
married life her urine had contained blood from time to
time, but from 1877 to 1886 the urine had been, so fir
as she knew, quite normal. Twelve months before admit-
sion she found that she got easily tired after exertion;
although the urine was normal, she had frequent desire to
pass it. The chief cause of her coming into the hospital
was the pain which she had in her legs (which weir
much wasted). Sbe complained also of great debility—
indeed, she was unable to stand. Dr. Strange obserred i
tumour in the left side of the abdomen, which, the pities:
said, had increased rapidly in size. It appeared to be about
the size of a cocoa nut, and was evidently renal in origin.
She bore physical examination well, but fomentations bad
to be occasionally applied over the region of the tumour for
the relief of pain. Sne lay prostrate in bed. She pamed be
urine but twice in the twenty-four hours; it averaged twenty-
eight ounces, specific gravity varying from 1010 to 1028; tt
contained neither pus, blood, nor albumen; in fact,daring
her stay in hospital it was normal, but scanty.

The diagnosis was made of oystio disease of the kidney,
and removal of*the tumour by abdominal section wi*
advised; it seemed too large to be brought away entire by
the post-peritoneal or lumbar operation. There wwe two
unfavourable elements as regarded prognosis: the woman
was in a very feeble state of nealth, and the other kidney,
though not tender, was evidently larger than natural. Sir
Spencer Wells — one of the consulting surgeon* to the
institution—saw the patient with Dr. Strange and Sir.
Owen, and agreed that the tumour should be re mo Ted by
abdominal section; he kindly arranged also to be present w
the operation, which was performed on May 18th by Mr.
Owen, Dr. Strange and Dr. Percival Cockey assuring, and
Dr. Pidoock administering the ansestbetic. Tbs abdomnuJ
cavity was opened through the lef t linea semilunaris, tw
posterior layer of the peritoneum being opened on
side of the descending colon, so that the kidney might w
reached without interference with the branches or the infenor
mesenteric artery. The renal vessels were so small tbit
it was at once evident that they were supplying as wys*
unusually poor in vascular tissue. Their size confirm* tw
diagnosis of cystic disease. Had they been associated witt
a malignant growth they would have been larger tins
normal. They were tied with car bo Used gut, which w
then cut short. The ureter was tied in two pi*** ““
divided, and as the section showed a drop of pus, me Iuum
of the tube was scraped clean and touched with iodme- n r
bed from which the tumour was removed was warned on.
with a warm and weak solution of mercuric chloride,*
the laceration in the posterior layer of the peritoneum *«>
closed with sutures of fine gut. No drainage tube wu
The abdominal wound was also sutured with gut, andAre*** 1
with thick pads of sublimate wool and a flannel binder.

For eight days after the operation the temperature re¬
mained at normal, but after thie it was raised
days, on one occasion reaching 101 °F., but it descended w-
mediately after a small collection of blood and eema "
dislodged from the wound; and until she left the ho^^

Tot Lxnott,]

OPHTHALMOLOGICAL SOCIETY.

[Junb 26,1887. 1283

on July 3rd, the chart was not marked above the normal
line. After leaving the hospital she was so well and strong
that she was able to enter domestic service again as a cook.

The tumour consisted of the thickened fibrous tissue of
the kidney, in which were a number of large and small
cysts which contained ten ounces of creamy pus, of a pale
green tint; it was not examined for bacilli. Before opera¬
ting, the tumour seemed too large to come readily by the
loin; but when it was exposed it was evident that the
retro-peritoneal operation would.have served; the cyst
walls, moreover, were so tough that they probably would
not have burst during the extraction. It was about the
size of a very large fist.

The patient was afterwards admitted into St. Thomas’s
Hospital under the care of Dr. Harley in May last, and we
are indebted for the report of her oondition at that time to
Mr. H. J. M. Montague, house-physician. She complained
of a tumour in the right side, whioh pained her very much
on movement, becoming much more painful after she had
been walking about for some time; she also complained of
pain in the left lumbar region. On examination, a scar was
found in the left linea semilunaris, at the seat of which
there was a hernia. In the right lumbar region was a
smooth rqunded body, quite movable, and slipping under
the liver on manipulation; tender to pressure, but not
causing nausea when pressed upon. Diagnosis: Healthy
movable kidney; urine of high sp«aflc gravity, with a large
deposit of urates, no albumen. Uric acid crystals were seen
under the microscope. The other organs were healthy.

The kidney became lees painful, and the patient left the
hospital wearing an abdominal belt.

. General hospital, Birmingham.

CASKS OF OVARIOTOMY.

• jL '- (Under the care of Dr. M alins.)

CIsb 1.—A. H-, aged thirty-five, married. Admitted

on Feb. 4th, 1886. Multiple cyst of left ovary, with fluid of
varied consistence. Weight 240 oz. Adhesions to anterior
abdominal wall and to right broad ligament and Fallopian
tube. Right ovary enlarged to about four times its normal
size, with numerous cysts; removed also with corresponding
tube. Pedicles transfixed and tied with silk. Keith’s drain¬
age tube used. Recovery.

Case 2.—J. T-, aged forty-four, married. Admitted

on March 2nd, 1886. Multiple cyst of right ovary. Large
«yst containing porter-like fluid and papillomatous growths
inside. Adhesions to anterior wall of abdomen. Pedicle
short; transfixed and tied with double silk dose to uterus.
Use of Keith’s drainage tube; removed on the evening of
the 4th. Recovery.

Cash 3.—E. P-, aged forty-three, married. Admitted

on May 27 th, 1886. Multiple cyst of rightovary, One large cyst
containing twenty-seven pints.of brown viscid fluid; solid.
Weight 85 oz. No adhesions. Good pedicle, transfixed and
tied with double silk. Quantity of ascitic fluid. Keith’s
drainage tube employed; removed on the 30th. Subse¬
quently, continued sickness and quick pnlse; average tem¬
perature 1004°. Later, some tympanites. Died on June 7th
from peritonitis.

Cask 4.—C. G-, aged forty-nine, married. Admitted

on Sept. 2nd, 1886. Multiple cyst of left ovary. Very thick
walls, undergoing myxomatous degeneration. Weight of
liquid contents, 180oz.; solid, 37 oz. Fair pedicle; trans¬
fixed and tied with double silk ligature. Recovery.

Cash 5.—M. W-, aged fifty, married. Admitted on

oept. 30th, 1886. Dermoid cyst of left ovary, containing
hair, bone, and two teeth. Pedicle sessile; transfixed and
tied with silk. Weight of cyst, 10$ oz.; of contents, 36 oz.
Opposite ovary enlarged; also removed. A fibroid tumour at
nght angle of uterus; transfixed and tied with donble silk
ligature and removed. Weight 6$ oz. Keith’s drainage tube
employed; removed on the morning of Oct. 2nd. Recovery.

Cask 6.—C. H-, aged thirty-six, single. Admitted on

October 21st, 1886. Multiple cyst of .left ovary. Weight:
fiuid, 120 oz.; solid, 42 oz. Papillomatous growths inside.
l“ght -ovary irregularly shaped, enlarged about three times
the normal size; filled with pellucid cysts; removed. Some
pelvic adhesions. Pedicle of first sessile; transfixed and
tied with silk. Pedicle of second longer; transfixed and tied.
Peritoneum velvety and vascular; some ascitic fluid. Keith’s
ir *hiAge-tube used; removed on the 28th. Recovery.

Cask 7.—E. P-, aged forty-four, married. Admitted

on November 4th, 1886. Large multiple cyst of left ovary,
undergoing interior degeneration. Some adhesions to small
intestine. Good pedicle; transfixed and tied. Drainage,
tube used. Recovery.

Cask 8 .—J. H-, aged thirty-three, married. Admitted,,

on November 13th, 1886. Large unilocular cyst, containing
206 oz. of clear, slightly viscid fluid. Some solid matter at
base. No adhesions; short pedicle; transfixed and tied with
silk. Recovery.

Cask 9.—J. P-, aged twenty, single. Admitted on

December 30th, 1886. Dermoid cyst of left ovary; globular; .
containing a quantity of hair and about 12 oz. of oily liquid
at temperature of body, solidifying in open air. Weight
of cyst, 4$os.; thick walls; base tied in two parts with
silk below cyst. Recovery.

Remarks.— The above cases represent the number of
ovariotomies performed in the year 1886 at the General
Hospital as they were admitted, without selection. The.
one death was in a feeble emaciated woman, who made a .
good struggle for life, but succumbed to peritonitis twelve
days afterwards. The tumour was very large, and the
health much impaired before admission. Keith’s drainage .
tube was used in the majority of cases, being removed when .
the fluid drawn through it became clear and free from
blood. The operations were done singly in an isolated
ward with special nurses, no precautions beyond stringent.
cleanliness being observed. The peritoneum was washed
out when there had been fluid in it with a solution of
boracic acid in warm water, with a glass tube, and glass.
funnel connected by a piece of indiarubber tubing, as little
handling or sponging as possible being always observed.

HfleMtal Societies.

OPHTHALMOLOGICAL SOCIETY.

Uniocular Optic Atrophy and Temporal Hemianopsia .—
Permeability of the Suspensory Ligament bj/ Organised
Substances. — Choroido-retinitis.—Cyclotomy in Glaucoma.

An ordinary meeting of this Society took place on the
9th inst., Mr. J. W. Hulke, F.R.S., President, in the chair.

Mr. Stoby read a case of Optic Atrophy in one eye, with
Temporal Hemianopsia in the other, occurring in a young,
woman, a dressmaker, who gradually lost her eight in one.
eye, and partially in the other. The menses were irregular.
As had been observed in similar cases of tumour of the
pituitary body, the patient grew much Stouter. Headache
and giddiness were complained of, but the sight improved,
and though the optio atrophy remained, she was enabled to
follow her occupation.—Mr. Nbttlxship remarked that a very,
similar case had been recorded in the Society’s Transactions,
and in that instance, after death, a tumour was found in the
pituitary fossa. Other similar cases had been published,
and he had lately seen a case at St. Thomas’s Hospital where
the same train of symptoms had been produced in the same
way.—Dr. Hill Griffith said that he had placed on record
a case identical with that of Mr. Story. Cessation of mens¬
truation and sleepiness had been present in his case; and
in several cases that he had seen the patients had com-
lained of getting stout.—Dr. James Anderson briefly
escribed the case oe had published, which closely agreed
with that of Mr. Story. He said that it was the ride in.
pituitary tumours that the patient should get very stout .—%
Dr. Coupland mentioned also the concurteace of an increased
development of tissue in conjunction with disease or enlarger
ment of the pituitary body—a condition known as “ aero-,
megaly” (vide Thk Lanobt, p. 1196). •

Dr. Hill Griffith read a communication on the Permea¬
bility of the Suspensory Ligament by Organised Substances
He mentioned several cases of keratitis punctata without
any iritis, but with recent patches of choroido-retinitis, and
also two cases of retinal gliomata, with separate nodules
free in the anterior chamber, and showed naked-eye and
microscopical specimens. He endeavoured to show from
these two groups of coses that solid particles were carried
by riie nutrient currents through the zonule at the circum-
lental space.—Mr. Jassop mentioned a case of an old opaque
lens, in which, on opening the eye, a gush of choleatenae

Digitized by GoOgle

1284 Thb Lancet,]

ACADEMY OP MEDICINE IN IRELAND.

[Jchh 13,1187.

spangles came from above behind the iris, and fell to the
lower part of the anterior chamber, taking up a triangle
with the apex upwards. The cholesterine was so large in
quantity that it must have come from the vitreous.—In
reply to Mr. Marcus Gunn, Dr. Hill Griffith said that in
his case there was evidence of choroiditis, gradually passing
into atrophy of the usual description.—Mr. Lanq, who
showed a specimen, with the suspensory ligament in situ,
said that he was much interested in the association of
solitary patches of choroiditis with keratitis punctata, and
he thought that the two conditions were always asso¬
ciated ; the cases were more frequent in young women,
but occurred also in young men. The etiology was obscure.
The vision was not much affected when the cases were first
seen.—Mr. Nbttlbship partly agreed with Mr. Lang as to the
presence of isolated patches of choroiditis in alarge numberof
cases of keratitis punctata. Opacities of the vitreous were
often present, and were sometimes found even when there
was no choroiditis, and in some only the keratitis punctata
could be seen. The dote on the back of the cornea could
only be explained on the hypothesis that there had been
migration through the suspensory ligament. — Mr. J. B. Story
could not accept this view, as it would not explain those
cases where there was no keratitis punctata. He thought
it was very difficult to exclude the theory that there was
some cyclitic deposit.—The President thought another
explanation was possible apart from the mechanical transfer
theory. There might be an inflammatory process, and
cyclitis or choroiditis, or both, expressive of some general
conditions. Some of the spots were only flocculent precipi¬
tates or coagula lying loosely; some might be due to pro¬
liferation and disintegration of the epithelium. The
anatomical difficulties in regard to the mechanical convection
theory appeared to him to be very great.—Mr. Silcock men¬
tioned the case of a lady in which a punctate appearance
at the back of the cornea was associated with opacities in
the vitreous, but without choroiditis.—Mr. Mackinlay
observed that he was unable to detect the spaces in
the suspensory ligament, even with powerful lenses.—
Mr. Hutchinson, jun., argued that a transmission of
particles might take place in a direction the reverse
of the ordinary, as there was reason to believe happened
in cases of secondary infection from axillary tumour.—
Mr. W. J. Collins suggested that particles might pass
along the canal of Stilling, and thus the necessity for sup¬
posing that they traversed the impervious hyaloid membrane
would be obviated.—Dr. Hill Griffith said he was much
gratified by the excellent discussion that had taken place,
ft would not be necessary for him to take notice of all the
points mentioned. He had, like Mr. Nettleship, seen cases
of descemetitis without iritis, in which he had failed to
mako out choroiditis, the cases he had recorded were only
made out to support the proposition contained in the head¬
ing of the paper, and were but put forward as examples of
the most usual conditions met with in descemetitis. To
Mr. Story’s objection that choroiditis did not always pro¬
duce descemetitis, he would reply that cystitis was not
always followed by that condition. He would not accept
Mr. Hulke’s explanation of a coincident cystitis to account
for his cases, for here, as in diseases of the nervous system,
we should avoid a “double lesion” if one be sufficient to
account for all existing symptoms.

Mr. Brailey narrated a case of successively occurring
Isolated Spots of Choroido-retinitis affecting the yellow spot
region of an independent gentleman, aged forty-one, who
had been under observation seven months and a half, during
which period he had five times experienced the development
of a small relative scotoma at or near the centre of the
field of vision of the right eye, which was wearing its full
correction (+3-50 sph. and +1 D, cylinder). His left eye
had been absolutely blind from glaucoma for twenty years,
and was still hard, though painless. The scotomata, as
appreciable by him at eighteen inches, varied in size from
two to six inches square. Each appeared as a round or oval
disc of dim and troubled vision, surrounded by a bright,
glittering edge. At first the disc was well marked with
annoying dimness and distortion of objects, which appeared
materially darkened when embraced in its area. Printed
letters appeared diminished as well as huddled together.
J Distant vision, though it might be diminished even to one-
1 half in a moderate light, was not much affected with bright
•I light, whether natural or artificial. All colours, except per-
| haps green, were dulled as if dashed with grey. Soon
.Jj the spot began to amend, and was more translucent,

i

Distribution of Phthisis and Diseases oj
Organs in Ireland.

At a meeting of the Sab-section of State Ms
on May 19th,

Dr. T. W. Grimshaw (Registrar-General for 1
a paper on the above subject. The total number t
in Ireland daring the decade was 966,745, of
phthisis caused 103,528, or more than one-tenth; <
of disease of the respiratory organa 142,991, or

irii

giving to his sight the impression of an imtacpoM tjmol
neutral tinted glass whose sharp edge slightly gUitared in
places. Each spot had resulted in almost perfect rostwEn
of vision, as estimated by test types, though thaapftW-
moscopic appearances still persisted to some degree. «hth>l-
mosoopically, each scotoma corresponded to a imiil'rt—hi,
isolated, not well defined spot of dull greyish coifa^'EaU
of them were in close relation to, though daszif saafemr
level than, the retinal bloodvessels, which wen * '

cidedly larger than usual. The optic disc was
at its margin, but of normal colour. An
drawing showed three of the spots--one
and two in process of fading.—Mr. Wakes Say
the case in some respects unusual, and said '*
must have been damaged.—The President
being an artist, the patient could observe and
great accuracy. . - : j«- -i

Mr. G. E. Walker read the sequel to-
Cydotomy in Glaucoma. He also showed a
pulsating exophthalmos in process of core,
shown at the November meeting, when the ~
much more marked. The disease had been
dowa some cellar steps on to a flagged floor
1886; this produced insensibility for. three d
awakening, the boy found he had a swishing
head. No ocular symptoms became manifest
when engorgement of the right eye a;__
night later, of the left. In a day oar two
appeared, and the proptoeis of the right took
increasing, he had proposed to tte the carotid
as be believed a true aneurysm of the artery, where
up from the cavernous sinus, had been produced,
account of the opinion of two gentlemen who ’
was not true aneurysm, but an opening of the <
the cavernous sinus, the operation was not perfori
October to the end of January the general
appeared to be stationary, but at that time (J
was much frightened by being caught in a
theatre, and soon afterwards found the bruit
The extrusion of the eye, its engorgement and
first were considerably increased, but afterward*
at first rather quickly, and since then very
contended that, although in this case a happ
been brought about by an accident, it would
future case to tie the carotid, and not to trust to
of accidents; and he gave a short account of
which he had performed the operation with
storation of the use of the eye, although at
operation it was lying on the cheek, thrust out from]
the lids, and with mere perception of light.

The following living and card specimens were
Mr. Silcock: Kerato-iritis in a woman probably '*
of congenital syphilis. The peculiarity of the *
in the presence of a number of minute dots ail
on the surface of Descemet’s membrane or in
layers of the cornea, and arranged in the form of
which corresponded in position with the pup:'"
of the iris. The affected cornea also presei
characteristics of interstitial keratitis. The
other eye was not affected. Mr. Cross: (1) Tin
probably sarcomatous, in connexion with which
mentioned a case which he treated by shaving
free application of nitrate of silver, with the
which had sa far not been followed by a ret
case of Opaque Nerve Fibres, limited to the Pa]

J. Collins: Extensive Htemorrhage :into
Coarctation of Retina. Mr. L&wford:
complete Anteversion of the detached
Mr. Story gave an experimental demonstration
the Pathology of Glaucoma.

ACADEMY OF MEDICINE IN IRELANI

j

fcr» Lancet,] NOTICES OF BOOKS. [June 25,1887. 1285

sixth—the two groups taken together causing more than
one-fourth of the total mortality of Ireland. Lung disease
was, therefore, the most important element in considering
questions connected with the health of the people of Ireland.
The main conclusions arrived at by Dr. Grimshaw were that
the lees civilised portion of the population of Ireland ware
less affected by phthisis and lung disease than the more civil¬
ised portion of the community; that not only was phthisis
more prevalent among urban than among rural populations,
but that essentially rural populations near large towns
suffer more than those in remote districts, thns pointing to
infection as a means of spreading the disease. Comparing
the distribution of phthisis-with the physical configuration
of the country, it was found that, as elsewhere, the low
levels suffered more thin the high levels. The bogs do not
seem to specially favour the prevalence of phthisis; indeed,
they seem rather to counteract the disease. There was no
constant relation between the prevalence of phthisis and
other forms of disease of the respiratory organs. In many
cases there is an absolute contrast between the prevalence
of phthisis and the other forms of lung disease. There did
not appear to be a close relation between the general dis¬
tribution of the geological formation - and the prevalence of
either phthisis or other forma of lung disease, except in so
far as geological formation influenced elevation, &c,—Sir
Charles Cameron said the subject opened a vast domain
for investigation to those interested in the etiology of disease.
It was remarkable that there seemed to be a greater pre¬
valence of the diseases in question on the eastern than on
the western seaboard;. Dubl i n occ u p i e d -a bad position of
eminence in the order of mortality—exceeding, as it did,
even Belfast, where, on account of the flax manufactures,
diseases of the respiratory organs might be expected
to abound. The death-rate would be a means of
comparing the salubrity of the different districts.—
Dr. Charles Moore, referring to Hr. Grimshaw’s observa¬
tion that sudden change was apt to produce bronchitis, said
there was no country where there was greater suddenness
of change of temperature than Egypt, and yet it was a
common thing to send people to Egypt to be cured of
phthisis. The drainage question was important in Dublin,
where the subsoil waiter had greatly increased since the
disuse of pumps. Many yrfars ago Sir William Wilde drew
attention to the prevalence of phthisis round the coast of
Ireland. The Bog of Allen and other bogs in the centre of
Ireland were factors which favoured phthisis. So also did
crowded populations. In the Zoological Gardens, Phoenix-
park, phthisis prevailed amongst the monkeys.—Dr. Cos-
srave adverted to the observations of Dr. M'Keill, medical
officer erf the Gesto Hospital, Isle of Skye, as indicating that
^oraumptiom was communicable from onepereon to another.—
The Chairvian pointed out that the rule that large cities
favoured the prevalence of consumption found a remarkable
exception in London, where the disease was below the
iveraee, except in the eastern districts. Turning to Ireland,
-here could be no doubt that the large towns acted as foci
rom which pulmonary phthisis seemed to spread. He agreed
vith Dr. Grimahaw that rainfall had very little to do
rith the matter as regards Ireland. He did not agree with
)r. Charles Moore as to the pernicious effect of the Bog of
Glen. His opinion was, on the contrary, that large peat
listriets perhaps tended to control phthisis by acting
mtisepticaily. The distribution of bronchitis in the south of
rel&nd was most puzzling, and he was at a loss to explain it.—
)r. Grimbhaw, in reply, said, with regard to Kilmallook, it
vas curious the mortality from bronchitis appeared to in-
licate rather a healthy condition of tbe population. The
lumber of old people who died there from bronchitis was
xtraoTdinary, and the great majority of the bronchitis caste
vere returned as from the Exlmallock Workhouse. Ths
isease was not, in fact, strictly speaking, bronchitis, but
he bronchial effusion of. old age; Of ooums that .depended
n how the certificates were given. The effect of drainage
vas well known in diminishing phthisis, cholera, and
yphoid fever. It was, however, always * question as to
rhether drainage diminished the phthisis death-rate. For
is own part, he was inclined to think that it acted in-,
u-ectly by improving the general health of the people,
nd by diminishing <.tbb prevalence of pneumonia, which
vas one of the principal foundations of phthisis, and
lao by diminishing the prevalence Of typhoid .fever,
he drainage of towns was Cot a question of the drying
r«oilB so much as. tbe gettihg 'rid of dirt and sewage
latter. How mtfoh was duct to the drying, of the . sou

itself, or how much to getting rid of dirt, it was impossible
to say, or to explain which was the main factor of disease.
With a perfect system of sewerage in Dublin and the dirt
kept out of the Liffey, and a clean gravel bed In the centre,
the public health would improve. When cholera prevailed
in Pembroke township district there wae practically no
cholera in R&thmines, the reason being that Bathmines wae
dry, while Pembroke was waterlogged, having a gravel bed
with the clay below it like a sponge In a basin. Sir William
Wilde had mentioned that the prevalence of phthisis along
the eastern coast was specially referable to the general con¬
ditions of life. Unfortunately, when he made his observations
he had as reliable data very few facts, there being then no
machinery for registration, and the only evidence being hear¬
say. As to the bogs, be was of opinion that a bog wae a totally,
different thing from a marsh, so far as the health of the
community was concerned. The most familiar example in
proof was that ague prevailed in the marshy lands of
England, but it never occurred !n a marshy bog. What the
antiseptic property of peat was he did not know, but that it
was antiseptic there was no doubt. Many examples of the'
antiseptic properties of bog had been observed. The pre¬
sence of phthisis in the animals in the Zoological Gardens
was due, he had no doubt, to their eating tuberculous food.

Helices of looks.

The Treatment and Utilisation of Sewage. By W. H.
GorRibld, MjL, M.D. (Oxon.), Fellow of tbe Royal College
of Physicians, London; Professor of Hygiene and Publio
Health at University College, London, &c. Third Edition.
Revised and enlarged by the Author and Louis C. Parses,
M.D. Cert. Public Health Lend. London: Macmillan and
Co. 1887.—A third edition of this well-known and vain-
able work was much needed, and it has been satisfactorily
executed. The first edition appeared in 1870, and the second
in 1871. Much additional experience has since been gained,
and many elaborate inquiries have been carried ont, but
it is to be feared that very little real progress has been
made. The obstinate persistence of the Metropolitan Board
of Works in their erroneous treatment of the sewage of
London has indeed produced a searching and satisfactory
inquiry by a Royal Commission; but as the Board still per¬
sists in disregarding the most important of the recommen¬
dations of the Commissioners, the great problem cannot at
present be solved in London. In evidence of the little real
advance made in our knowledge, we find that the summary
with which Prof. Corfleld concluded his first edition is now
reprinted entire and without addition, the present authors
remarking that they see no reason to alter it. It must not,
however, be supposed that the bulk of the book is left un¬
altered. On the oontrary, all the experience gained in
England and abroad during the last sixteen years is well
chronicled. Thus we have the Croydon experience in regard
to the ventilation of sewers, an account of the Lieraur
system, the Beriier system (partly adopted in Paris), and
the Scott system tried at Ealing. We have also critical
descriptions of the many precipitating schemes which have
from time to time been tried, and a full account of the
results of the labours of the Royal Commission on Rivera
Pollution and on Metropolitan Sewage Discharge. Alto¬
gether it will be seen that the book well maintains thq
reputation of the author. It is in fact essential to every
sanitarian.

Gnmdriss der Bdkttriekkxmde Von Dr. Med. Carl
Fbaenkbl. Berlin: A. Hirschwald. 1S87.—The author erf
this handbook on bacteriology can claim to speak with
authority, since in his capacity erf assistant in the Hygienic
Institute of Berlin University he has frequently had the
conduct,of those monthly courses of instruction which
Professor Eoch has so successfully established. The book is
intended-to furnish all the. details necessary to be borne in
mind in laboratory work* but it .include*, mere than ad^j

' DMizedbvGoode

o

1286 Thk Lancet,]

[Jure 25, usr.

NOTICES OE BOOKS —ROYAL SOCIETY.

scription of technical methods. These form about one-half
of the volume, the remainder being descriptive of the
morphological and physiological characters of micro¬
organisms. The absence of illustrations is compensated
by the clear descriptions given by the author, and as the
book is one especially for laboratory work, there is no
absolute necessity for elaborate illustration. The subject
matter is most systematically arranged, and presented in
the form of lectures, or rather demonstrations with oral
exposition. They will doubtless serve as a model for
bacteriological instruction in similar institutions.

What can a Mother do to preserve her Children's Teeth f
By Henry C. Quinby. Liverpool: G. G. Walmsley.—
The above is the title of a useful pamphlet designed to
take its place amongst the books on domestic medicine.
The author gives clearly and in a popular form the
reasons for the necessity of attention to the health of the
deciduous teeth, a subject which has been frequently men¬
tioned in these columns. With regard to patients seeking
professional advice for their children, it seems to be a fre¬
quent occurrence that they do not expect to pay a fee
unless some operation is performed; and he rightly urges
that this temptation should not be put in the way of the
dentist, and that, in fact, advice is quite as valuable; nay,
more so, than taking out a temporary tooth or putting in a
dressing. There is a good deal of useful information cited
such as the deformity that may be produced by thumb¬
sucking, and the mistake so constantly made of believ¬
ing the six-year molar to be one of the temporary set.
Most of the views expressed are those generally accepted
by the profession, although exception must be taken
to some of them; for instance, Mr. Quinby objects to
any tooth-brush the bristles of which are harder than
horsehair; also he does not advocate the filling of tem¬
porary teeth of which the pulps are dead, thus leaving
fetid food traps with the almost certainty of decay of
the contiguous teeth. He, however, goes a little too far with
amateur doctoring when he expects a mother not only to
diagnose between toothache due to an inflamed nerve and
that caused by periostitis, but in the latter case to drill
into the pulp cavity to let out its fetid contents.

Travels in the Interior. By Luke Theophilus Courteney.
Edited by a London Physician. London: W ard and Downey. —
“ A London Physician,” in the preface to this book, states
that he found the above story in manuscript on his table
one morning after the departure of his patients. Thinking
the method of teaching physiology ingenious and finding no
owner, he resolved to publish it. The plot may be given
briefly. Belinda Courteney, her brother (who is a M.R.C.S.),
and a friend accompany the uncle, Captain Courteney, to
Trebizonde, where they purchase in the bazaar a box of
pills capable of reducing them to the smallest dimensions
from an old woman * who repeats a rhyme to them to
the effect that in order to regain their natural size it is
necessary to place a grey hair between the teeth. They
have scarcely time to reach the room where the uncle sits
before they become almost microscopic, and are whisked
up by him with his eye-glasses, and fall thence into his
mouth. This they explore fully, afterwards passing into
the throat and climbing into the Eustachian tube.
The description of this is picturesque, the cilia being
compared to ripe corn waving in the summer breeze. Phil,
the brother, advises Belinda always to breathe through her
nose, and remarks that when on night duty in his hospital
ward he counted two hundred patients sleeping with
their mouths open; a large proportion of these patients
suffered from lung diseases. The three young people
next pass into the stomach and observe the digestive pro¬
cess. Finally, they ascend by the thoracic duct and are
introduced into the venous system. They then work up
a small vein and emerge through a pimple. Placing a
grey hair between their lips, they return to their normal
size There is a curious slip near the beginning of
the book, where Phil (a M.R.C.S.E.) is described as a lad of

eighteen. The interior is seen by means of a portable
electric lamp, and Phil is supplied with numerous unknown
inventions for the maintenance and comfort of life. Tbe
book is ingenious and amusing, and may serve to impress
some of the leading facts of physiology on non-protons'
readers.

Variations of fortune. Illustrated by sketches of some
old towns of Italy, and those who influenced them. London:
Sampson Low, Mars ton, Searle, and Rivington.—Those who
travel in Italy, either for health or pleasure, may find some
interest in the above book. It is quietly and thoughtfully
written, and contains an account of Miguel de Molina, the
famous Quietist, who was condemned by the Iaquinti® to
perpetual imprisonment. A curious method of payment to
a doctor is related in an old Italian document. The family
of Signorelli, the painter, were ill of the plague, and about
this time an agreement was made between the doctor and
the painter “ that for services received, and for those which
Luca Signorelli hopes to receive from Dr. Luigi de Butane,
a Fr enchman settled in the town of Montone; he hid
painted a picture gratuitously for a chapel built by the
doctor, and dedicated to Santa Christina in the church of
S. Francisco at Montone, the Baid Luigi de Rutame
promising to attend without fees on Luca Signorelli, or sny
of his family, when ill in the future.”

ROYAL SOCIETY.

Note on the Functions of the Sinuses of Valsalva and Anri r
lar Appendices , with some remarks on the Mtekami
the Heart and Pulse.

On Thursday, the 16th inst., Mr. Mayo Collies reed
on the above subject a paper which may be thus sum¬
marised. The object of the paper was to disprove the
present apparently accepted idea that the onuses o.
Valsalva are mere bulgings of the arterial wills, i°nsw
by a reflex current, induced by the sudden clo sures
the semilunar valves. The existence of a reflex can®
was shown to be impossible, and the theory of the sudden
opening and closure of the semilunar valves ws* ap¬
proved. The presenoe of the sinuses of Valsalva was shows
to be an absolute essential to the mechanism of the i««'
action. The paper then treated of the action of thssure*
and the part played by the auricular appendix, the lutt* 6 ® 1 *
considered as the only part of the auricle that sennbJvs^
vigorously contracts. The causes of the first sound of the
were next alluded to, and the theory thatthedoeuresndntrri-
tion of the tricuspid and mitral valves assist m its
tion was refuted. The mitral and tricuspid valves do. tt-
close suddenly, and anything like an audible vibianon £
these structures, or the chord® tendineee, was shown w re
impossible. The action of the ventricle and the mode ou
injection into the aorta were dwelt upon at some ]. »■
latter part of the paper was devoted to the medusa® ot»
pulse, mad an explanation was given of the so-called <bcrotua
The following is a summary of the chief points ot we a
elusions arrived at1. The sinuses of Valsalva «»
essential to the mechanism of the heart s action. L tw m
ouli papillares serve the same purpose for the atmemo-rwir
cularvalvee as do the sinuses of Valsalva for the sort*.
auricular appendices complete the distension ot we
tricles without appreciably altering the general t®**®
the auricles. 4. The first sound of the heart is not
icr influenced by tbe cloeure or tension of the tiw
nd mitral valves. 6. The semilunar valves open
radually, the second sound of the heart beu ^ d “? t! '.
he sudden difference of pressure on the two matt «
-alves at the. moment of commencing diastow o
rentricle, causing them to vibrate. 6. At each «y*t“ .
lontents of the ventricle distend only a segment oi
ength of the aorta* the force of the ventricle
nlluence directly on the general arcak^am,_ but maiw^
>y the elastic recoil of the aorta. 7. That the P™*
o a wave of dilatation and recoil, which wannto
lingle. 8. That when the arterial tension is below »or
standard one or more secondary pulse wares eta a
juently felt, due to a redistension of the
lection and its consequent repeated recoil.

by Google

Thi Lancrt,]

MEDICINE DURING THE REIGN OF VICTORIA.

[Jtjnr 26,1887. 1287

THE LANCET.

LONDON: SATURDAY, JUNE 25, 1887.

No class or section of Her Majesty’s subjects rejoices with
greater sincerity, or better reason, in the fruition of a happy
and illustrious reign than does the medical and surgical
profession. Under the benign influence of that progressive
peace and domesticity which, in spite of many regrettable
interruptions, have characterised the administration of
State affairs in this country since Victoria, came to the
throne, the eminently peaceful arts of medicine and sur¬
gery have flourished exceedingly; they have attained a very
high development, and, which is more important, they have
been consolidated and securely based on the cognate sciences
with which It may be confidently affirmed they are now
indissolubly associated. It cannot be doubted that the
scientific arts to which we as a profession are devoted, in
common with the arts of peace in general, owe much to the
providential fact that, the crown of England devolved on a
female Sovereign at the particular conjuncture when
Victoria came to the throne, and that its'wearer has been
a woman in whom the highest virtues have been combined
with the purest and truest love of home and family
happiness which has been manifested in the life of
any monarch that ever sat on the English throne. The
spirit of our national life has been one of quietness, albeit,
as we hhve said, there have been painful outbreaks of those
baser passions and that greed of conquest which lie beneath s
tad the long spell of comparative tranquillity we have
enjoyed has given space for the growth of that peaceful and
peaceable stability on which the permanent prosp e r ity of
every nation must in the long run depend.

We have no thought of reviewing the progress of medi¬
cine during the reign of Victoria. To do this in the most
cursory way would require much greater space than we are
able to devote to the subject. Meanwhile, there are one or
two reflections which it may be worth while to offer for
the consideration of our readers in this week of jubilee.

The profession may be congratulated on the immense
progress which has been made in developing the sciences
of medicine and surgery, and especially in the develop¬
ment of two almost new bmnehes of knowledge during
the last half cen tury . Turning to the Stndehts’ Number
of Thh La w crt for 1838 we find this significant remark:
“ In the medical department of rim .London University ”
(which was at that date a teaching university in Qower-
street), "the student will find there are two subjects
engaging the attention of two celebrated Professors which
are not taught in the other academical establishments; we
allude to the lectures on Comparative Anatomy by Professor
C- rant, and those on Morbid Anatomy by Professor Carswhll.
—We have nelected for especial notice the lectures of Pro¬

fessors Grant and Oarswria, as we find that comparative
and morbid anatomy are subjects which do not appear to be
entitled to the notice of the rulers in our chartered Colleges
and Halls.” To the “University of London” (which we now
know as “ University College”), be it remembered, the pro¬
fession owes the development of these two branches of
knowledge as special subjects of study; and who among us
can fail to perceive that out of the study of comparative and
morbid anatomy has grown that physiology of medicine and
surgery which is the distinguishing feature of the art of
healing as we know it to-day? Physiology, properly so
called, could have no real existence apart from com¬
parative anatomy and morbid anatomy. Not merely struc¬
ture but function is elucidated by the study of organic
development in the light of comparative anatomy. And
the inferences derived inductively from the study of de¬
velopment could only be corrected by the study of such
departures from the normal type of structure as are found
associated with disease, whether as causes or as effects. We
have repeatedly, called attention to the fact that mistakes
may be very readily made if morbid anatomy be scrutinised
without carefulness to distinguish between changes which
may have been the effects of abnormal function and those
which were clearly-the Causes and not the consequences of
error in the working of the organisms wherein they are dis¬
covered ; but the avoidance of this class of error is to be
sought and may be found in the combined light of compara¬
tive anatomy and morbid anatomy. Therefore, we say that
the debt which medicine and surgery owe to the then London
University, in giving these two subjects an individual exist¬
ence among ue cannot be overrated. A re-perusal of the
introductory lecthre delivered by Prof* Grant at the opening
at his course in 1833 would well repay the trouble. We
venture to think that if a careful digest of all that has
been achieved in medicine and surgery during the last fifty
years were made and just conclusions drawn, it would be
found that the progress achieved has been not only notably
but almost , exclusively due to the development of the two
branches of knowledge especially inaugurated at the period
named,

, It is very interesting to note in this connexion how much
we owe to the great and energetic race with which the
family of our Sovereign very closely links ns. We have no
reason to be ashamed of our indebtedness as a nation to
the infusion of that love'of; home life wMoh dominates the
German people, and Which -Ins dime much to foster and
strengthen our own peaceful 1 disposition as a community
of islanders. Nor need we try to veil or qualify the fact
that to the medical eavante of Germany we are under obli¬
gations of the largest and most practical description fbt
contributions to the sum of medical knowledge, and ill
many respects for the formulation of the fundamental laws
of our science and art. Her Majesty’s beneficent reign has
been of the highest value to medical science, as we believe
it has been to our national life as a whole. Medicine has
gigantio strides between 1837 and 1887, and its progress

Digitized by ViOO^ LC

1288 The Lancet,]

THE <X>NTA«1UM OF, SCARLET FEVER.

[JinwISkWr.

has been sensibly aided by—we will not say the patronage,
bub—the encouragement extended to its professors by the
occupant of the throne, and conspicuously by the opportunity
for advancement which has been afforded to all the sciences
and the arts by the peaceful and enlightened influences of
a period passed under the pure and happy auspices of a
8overeign who is not less loved than she is revered by a
loyal and affectionate people. God save the Queen.

It is natural that the recent researches into the nature of
the oontagium of scarlet fever should excite attention—
both those prosecuted, on the one hand, by Hr. Klein in his
investigations upon the relation between the Hendon dis¬
ease of cattle and milk scarlatina, and, on the other, by
Dr. Edington in an attempt to test the value of the hypo¬
thesis on which Dr. Jamieson had based a line of successful
prophylactic treatment of scarlet fever. The disease is so
common, its characters are so well marked, and its contagious¬
ness is so striking, th at it cannot be surprising to find bacterio¬
logists keenly alive to the solution of the causes of its
contagion. Nor was it likely that the researches referred
to should have escaped criticism by those qualified to pass
an opinion upon what is indeed a bacteriologist’s question;
as is to be found elsewhere in Mr. Cbookshank’s paper,
which we publish to-day, and which was unavoidably held
over last week. There is, we fear, a tendency to take
sides in this matter; for it is plain that if Dr. Klein’s
conclusions be accepted as universally true of the materies
morbi of scarlet fever, then Dr. Edington’s must fall, and
vice versd. We may remark here that a statement made in
this journal a fortnight ago, which has been not unnaturally
criticised, was not intended in the wide sense in which it
was liable to be taken in consequence of the inadvertent
omission of the word “ such ” before the ward “ con¬
troversy ”—an omission which was overlooked in proof. We
should be the last to cloee the door to scientific inquiry
on Any subject, especially one of this grave importance.
There is nothing in common between the two series of
results referred to, although, etiologically speaking, there
is a far graver and wider issue presented in the one case
than in the other. Perhaps one ground for their divergence
is to be found In the distinctly different lines upon Which
the inquiry proceeded in each case.

Taking them in chronological order, we have first thfrtu-
markaWe chain of evidence adduced by lb. Pbwxfc to p*dve
that certain epidemics of scarlet ferver tareoeable to infeo-
tion through milk were directly related to, disease inthe cows
yielding the milk, r The facte in support of. this doctrine
have been slowly accumulating; and it may be remembered
that some years ago Mr-Po web drew a somewhat similar
conclusion in the study of the etiology of an outbreak of
diphtheria.- Mr, Powbb has 1 therefore 4or some y time had
his mind prepared for the contingency that such diseases as
scarlet fever and diphtheria may be communicable from
animals to man. The duty that fell to Dr. Klein was to
establish, if possible, the identity of the human and bovine
disease. In this task, we think, as we have previously
intimated he was successful. The streptococcus which
he detected in the sores on the udders of the affected
Hendon cows, and by the inoculation of which he was
enabled to reproduce in calves a fatal diffuse that resembled

in its morbid anatomy the lesions of scarlet fever, eopphed
one link only in the chain of reasoning that led bin to thb
important ••onchision, and • taken by itself could sot, i»
Mr. Cboohshank points‘out,-be held as direct evident that
the Headcm disease was ideetioal with human sari e th m.
Dr. Klein was satisfied of the identity of the ongineUtapo-
coccub and that which oocurred somewhat epartalyiatk
blood and tissues of the inoculated animate; end hf kaovn
skill as an expert in these matters should go fir tweak
ensuring acceptance of the accuracy of his itatemot, Hie
real crux of the matter lies, however, in the later gageiof
his inquiry, which were communicated to thehojil'Bocietj
and detailed at the Royal Institution. His extmfcftttaiaf
scarlatinal blood proved the difficulties of the taqaby.ial
is in remarkable contrast with the same exsoiastiMfoo-
dneted by Dr. Edington, who seems to have badtaUctle
trouble in obtaining from the hlood in the earfy *fasaf
the disease the bacillus which he holds to be ohii*M»rir
of it, whilst at later periods there were found (hpkowiuii
streptococci, which appeared to replace the badlfas lathe
blood. There is, of course, considerable cogency it the
argument that so scanty a growth of streptomd «
Dr. Klein obtained from scarlatinal blood may have
been dne to accidental contamination, espsbhDy »
no mention was made of any oontrol etpadneau.
But this view is outweighed by the faith* jwufo
adduced by Dr. Klein as to the identity in MlaN'toms
the streptococcus of the Hendon cows, that fowl is th
specimens of condensed milk connected with as fStJpaV of
scarlatina, and that found in scarlatinal blood ,, It flay te
possible that the scarlet fever due to milk confonh ia fa i*
specifically distinct from other cases, but unlese wa^a pn-
pared to go so far we do not see any mode of snap fr®
the conclusion to which Mr. Power’s aad'lfelfci®’ 5

investigations have led them. ..

" It is well, however, that se Important a’sfibJeciHhceW
be thoroughly viewed on all sides, aad
a fortunate circumstance that Dr. EDiNGrotfs^rs*****
should have been so far completed as to allow.■o M M f pfr
lication whilst attention was stiH being jMKffclM*
subject, through Dr. Klein’s inquiry. Mop {9/0*1 *
this important, since Dr. Edington Q® 1 ®

different lines, and devoted his main efforts tojAijt 103
isolate the specific cohtagium, of' tfas existence Swbk*
in the desquamating epidermis there is fitfla^St** Ik
Jamieson had succeeded in preventing
toarietfever bfr* timt&tttoS flitodWWrt N

bathing and antiseptic inunctiefa-diieowd
dasquaxhatios as tobcnagxt Beamed iMMPWtaf *

this that be sought ProfesSar.-fiStraarfSflOiapsmtiflf
a thorough: bscteriotogiotl anhmiiRatjpbjnid^ rttw ^
inquiry was placed in t heft t a rts

it with great ardour, and his report

large number of micro-organisms whj
desquamation and in the blood, wt
precaution against contamination. Ml
seem to have been innocuous, for wit]
lations of animals produce any
was a bacillus, which occurred in el
(an exception being in the case of a tu|
before the organism had time to d«

e

°°8

The Lancet,]

THE LUNACY BILL.

[June 25, 1887. 1289

the products of desquamation, and also in those obtained
from the blood taken before the third day. Babbits and
guinea-pigs inoculated with this bacillus suffered from an
erythema followed by desquamation; and of two inocula¬
tions made in the calf, one was fatal, and the lesions found
after death were declared to be similar to those in man in
the early stage of scarlet fever. There are, however, some
weak points in the reasoning in favour of this being the
scarlatinal germ, which have been pointed oat in these
columns by Mr. Cbookshank or “ M.D.” One is the close
resemblance it bears to other non-pathogenic organisms
that exist normally on the surface of the body. Then
we have the curious association of this bacillus with
other forms, most of which are indubitably little more
than ectophytic parasites, and with one, which is not of this
class (the diplococcus scarlatinas sanguinis), the inter-rela¬
tion is singularly dose. That the bacillus should not be
found in the blood after the third day, nor in the cutide
till after the end of the third week is, as u M.D.” remarks, a
singular feature in the life-history of such organisms.
Lastly, there is a possibility of contamination here also, as
in the case of Dr. Klein’s experiments.

Irreconcilable as these two series of researches are, they
are both very suggestive, and point the-way to further
discovery. For whether the contagium of scarlet fever
be a bacillus or a streptococcus, it has at any rate been
demonstrated that it can be conveyed through milk, and
transmitted thereby from the bovine to the human organism;
and it has also been shown, as much by Dr. Jamieson’s treat¬
ment as by Dr. Edinqton’s bacteriological study, that it is
contained within the desquamating cutide, and that it
may be directly attacked and rendered impotent by reason
of this fact. It is, of course, impossible for the subject to
rest here, on public as well as on sdentific grounds. The
grave question of the transmissibility of the disease from
cattle to mankind is not to be dismissed with contempt like
that in which the Agricultural Department of the Privy
Council would seem to hold the results of Mr. Poweb’s
inquiry into the Hendon disease; nor, on the other side, can
Dr. Edington’s circumstantial and elaborate reports of his
discovery be set aside without an attempt to verify or
refute them. Bacteriology has achieved many successes
hitherto, but as great a triumph as any remains for
it if it can demonstrate without dispute the specific
organism which few can doubt underlies one of the most
contagious of human diseases. Mr. Cbookshanx’s sugges¬
tion of a Commission is deserving of note, but hitherto we
have not gained so much from bacteriological committees of
inquiry as to make us sanguine of a satisfactory result.

It is surprising that anyone interested commercially

the private asylum system should object to the Lunacy
Bill introduced by the Government. Practically that mea-
8Qr ® creates a monopoly, and the proprietors of “licensed
houses " existing at the date of the passing of the Act will
he able to command their own prices for the establishments
to their possession. Of course the legitimate and only
rational way of settling the question would have been to buy
°nt the Owners or lessees' of these houses. If the existence of
Wyluma Whereih lunatics are received and retained as a
Paying business is really opposed to the public welfare—in

short, so opposed to it that Parliament deems it wise to
prevent any extension of the commercial enterprise,—surely
the system ought to have been at once abolished. Either
there should be no limitation to the trade or it should be
interdicted. Anything more monstrous, from an economic
point of view, than the paltry and time-serving expedient
which a spirit of parsimony and the influence of red-tape
have combined to embody in this measure it would be
difficult to conceive. This is the common-sense and only
honest view of the matter. Meanwhile, as we have said,
the proprietors of existing licensed houses have no cause to
complain, and it is strange, indeed, that they should help to
throw obstacles in the way of the passing of a measure so
greatly to their advantage as the Bill now waiting the con¬
venience of the House of Commons to be engrossed on the
statute book. It is impossible to conceive that any obstinate
opposition will be offered to its progress by those who have
nothing to lose, but, on the contrary, much to gain when it
shall become law.

There are doubtless some good features in the Govern¬
ment Bill: for example, that which—at least professedly
—provides for the appeal of the alleged lunatic to un¬
official and presumedly impartial judge; but even as
regards this provision, meagre as it is, so much is left to
“discretion” that we doubt whether anyone erroneously
charged with being insane will be able to prove his sanity.
If the Parliamentary Committee of the Medico-Psycho¬
logical Association should have its way, the last vestige
of hope in this direction will be dissipated. The committee
would fain place the judge under the direction of the doctor
signing the certificate. If this were done, the whole pro¬
ceeding would be converted into a mere farce. Practically,
the function of the lay judge or justice, as the Bill now
stands, is to take the place of a guardian, and watch over
the personal interests of the alleged lunatic, protecting him
from all other persons as a parent should protect a child.
When once the decision has been arrived at that the case is
to be placed under treatment in an asylum, the doctor will
be free to make his diagnosis and to cany out his treatment
without interference. The generally admitted objection to the
law of lunacy as it stands is that the preliminary question
whether a man is or is not so ill as to necessitate his removal
to an asylum is placed at the sole disposal of the doctor;
and the mere fact of a decision that he is in need of such
treatment puts an end to the liberty of the subject, and by
a stroke of the pen destroys his claim to the right of self-
control. This is held—-and we think rightly so—to be a
grave fault of the law.. This Bill has for one of its objects
to give the person thus placed an appeal to the decision of
a lay judge before being removed to an asylum.. If any¬
thing whatever is done to limit that appeal, or to embarrass
the alleged lunatic in its ifse, for anything we can see
the Bill will be waste, paper, and ought to be abaddotted.
We have therefore no hesitation in expressing a hope that
the committee of the Medico-Psychological Association will
either withdraw its suggestion on this point, or that the
Government will disregard it. Other objections urged—for
example, that levelled against the judicious resolve., ^hat
the medical practitioner who signs an urgency certificate
shall not also sign the certificate on the subsequent peti¬
tion—having for their purpose to baffle the endeavour tb
Diaitized bvC jjOOQLC

1290 Thb Lancet,]

VACCINATION AND SMALL-POX.

[Junb 25,1887.

free an alleged lunatic from the toils of any scheme laid
for him, strike us as equally absurd and inexplicable.

Again, why should the endeavour to relieve medical prac¬
titioners from business which is in no sense professionel
be opposed ? The treatment of mental disease is one of
the very highest departments of scientific medicine; the
trade in lunatic boarding and keeping is purely a busi¬
ness. Let there be no misapprehension as to what,
precisely, we mean by these remarks. It cannot be
supposed that we cherish any of the exploded theories
about the inferiority of trade as a vocation. The man
who employs his skill and acumen as a man of businets
in the keeping of boarding-houses for the insane is no lees
to be respected than the man who makes a profit by his
skill as a scientist and practitioner of the art of healing,
but the two vocations are no more compatible than would
be the teaching and preaching of religion and the keeping
of religious houses in which converts were to be retained at
a profit. The labourer is always worthy of his hire, but he
must not engage in two branches of industry the one of
which plays—or may be made to play—into the hands of
the other. It is a worthy enterprise to cure the insane,
and it is a worthy enterprise to care for the insane; but
inasmuch as the profits made by keeping asylums are capable
of being increased by tardy treatment and slow cure, the
two vocations are distinctly incompatible. Let us never
•forget the dictum of the founder of The Lancet on this
point: “ If you say to a doctor, ‘ Sir, I will give you £300
a year so long as my liver is diseased,’ what is the chance of
liaving it cured T It is useless to fly into a passion of vir¬
tuous indignation if we are suspected. We can only quite
clear ourselves of suspicion by putting it out of the power
of anyone to suspect us, therefore we protest that the pro¬
fession of medicihe ought to clear itself of the poaaibility of
any suspicion with regard to the care and cure of the
insane. The opposition to this really very meagre Bill fills
us, we confess, with astonishment. We heartily hope it will
pass: not because we think it effective; it is very far from
securing thorough reform. Nevertheless, as the best we are
likely to get, it is a duty to urge the Legislature very
earnestly to pass the measure.

Op the several important papers contained In the volume
of the Transactions of the Epidemiological Society which
has Just been issued, there is none which merits more
serious attention than that presented by a Committee of the
Society on the subject of vaccination. It is now many
years since the Society put itself in communication with
the profession, and collected evidence which was largely
instrumental in bringing about legislation which has
conferred untold benefits upon the kingdom. It was
right, therefore, that after a lapse of years further
inquiry should be made and a Committee appointed to
report on the evidence which the present state of medical
knowledge supplies as to the conditions affecting the pro¬
tection afforded by vaccination against death by small-pox
occurring in persons contracting that disease. This Com¬
mittee, after seeking information from small-pox hospitals
and from many practitioners, collected together the facts as
to nearly ten thousand cases of this disease, and the results
which are now published form the latest contribution to

vaccination and small-pox statistics. Speaking generally
these statistics fully substantiate the opinions previously
held as to the protective value of vaccination, but when
considered in detail they teach lessons which have not
hitherto been fully understood. In previous papers on this
subject it has been assumed that the appearances of vac¬
cination marks are not altered as the result of time;
the Committee, however, have been led to adopt a different
view, and the grounds upon which their opinion is based
appear to be sufficient to warrant the conclusion at which
they have arrived.

When the death-rate from small-pox among unvaccinated
persons is studied, it is found that there is a greater
tendency to death when this disease attacks young
children under five years of age than during the next
quinquenniad ; from ten to fifteen years the death-
rate still further decreases, but after this period it in¬
creases again. For persons possessing fovested cicatrices,
the result of vaccination in infancy, the lowest death-rate
is during the first five years of life; but as the protective
'effect of vaccination wears out, the fatality increases in
each successive age period. For persons, however, with
unfoveated cicatrices at the time of attack by small-pox,
the story is altogether different. After the first five years
of life this kind of vaccination appears at first sight to
become more largely protective than is to be accounted for
by any lessening of mortality due to increased age, and the
Committee explain this circumstance by attributing it
to the disappearance of foveation in some persons whose
scars previously possessed this character, leading to their
inclusion with others who had never at any period had
other than plain cicatrices, thus giving at a later age
an apparent protective value to plain cicatrices which
is greater than they deserve. This opinion is supported
by the fact that when another class is considered,
those who at the time of attack by small-pox have no
vaccination sdars, although they are stated to have been
vaccinated, the same circumstance is observed; but the
diminished fatality referred to does not occur until a later
age period, leading to the conclusion that a longer period
is required for the complete disappearance of a scar than
for the loss of its foveation. This point is of so much
interest that it deserves to be finally decided by direct
observation of the changes in the appearance of vaccination
scars in children; and those who have charge of the young,
either in families or in schools, would do well to record
any alterations observable after periods of time. The
importance of foveation, and especially of permanent
foveation, is emphasised ; and certainly the kind of
vaccination which produces scars of this character is that
which should be aimed at.

In discussing the effect of quantity of scars, the evidence
collected by the Committee shows the urgent necessity for
the production of the larger number of vesicles, and it may
be hoped that a perusal of the report will lead every
vaccinator not to rest content with a smaller number of
vesicles than that recommended by the Local Government
Board.

The period of life at which revaccination should be
performed must necessarily depend upon the character of
the primary scars; but, under any circumstances, the

Digitized by

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The Lancet,]

THE INFLUENCE OP SCARLET FEVER HOSPITALS.

[June 25,1887. 1291

statistics show that even where vaccination has been well
performed a greater interval than fifteen years should not
be allowed to elapse between the primary and secondary
operation. Indeed, we are reminded of the conclusion of
the German Commission, of which an excellent account is
given in the same volume, that the duration of the pro¬
tection afforded by vaccination is on the average ten years.

The small-pox hospitals have supplied the Committee
with the most positive evidence as to the immunity from
small-pox conferred by revaccination upon attendants on
the sick. Of 734 persons thus employed, 79 had previously
had small-pox, leaving 655, of whom 10 were not revaoci-
nated; all but these ten persons escaped small-pox, and all
these ten were attacked. This should entirely dispose
of the oft-repeated but erroneous statement of anti¬
vaccinationists that small-pox attendants escape disease
from the fact that they are recruited from those who have
already passed through an attack of small-pox. It is,
indeed, impossible to read the evidence adduced on this
point without understanding that it is within the power of
every person absolutely to protect himself from all attacks
of this disease.

Some of the difficulties of the Committee in obtaining
information may well be taken to heart by those who have
the control of small-pox hospitals. It is upon the evidence
these institutions afford that we must mainly rely for
teaching the public the value of Jennbb’s discovery, and
the want of a uniform system of recording statistics at
once becomes apparent when any attempt is made to
utilise them. The Statistical Committee of the Metro¬
politan Asylums Board will, it is to be hoped, in the future
ensure that the records of their own institutions will be
free from this objection; for others we must rely upon the
interest which all medical men take in so important a
means for preventing disease.

An interesting contribution to the literature of the subject
of the influence of infectious hospitals on houses in their
neighbourhoods is contained in the last annual report on
the health of the Hackney district. Dr. Tripe, having
convinced himself of the injurious influence which followed
on tbe aggregation of small-pox patients in the Homerton
Hospital, set himself to investigate the effects following tbe
use of that hospital for the purpose of isolating cases of
scarlet fever. In dealing with this disease in a district where
compulsory notification is not in operation, greater diffi¬
culty is met with than is the case as regards small-pox, and
this because the cases of the former disease reported to the
health officer are not so numerous as in respect of the latter
class of disease. But doing the best with the materials
which were available, Dr. Thipe marked out the district
around the hospital in circles having quarter-mile, half-mile,
three-quarter mile, and one mile radii, in the same way as
bad been done with small-pox, and during 1886 he obtained
the following results. In the quarter-mile area 44 out of
283 houses were invaded; that is to say, 15*5 per cent, of
the cases occurred there against 61 per cent, of houses
in the whole district. Between the quarter-mile and half-
mile radii there were 112 houses invaded, or 39 6 per cent,
amongst 15 per oent. of the total number of houses.
Between the half-mile and three-quarter-mile radii there

were 35, and between tbe three-quarter-mile and one-mile
radii 31 houses invaded, making a total of 23'4 per oent. of
cases amongst 31*5 per cent, of the total houses, and outside
the one-mile radius 61 houses were invaded, or 21*5 per oent.
of all infected amongst 47‘4 per oent. of the total number of
houses.

These figures might be regarded as indicating some
injurious influence of the hospital on the population, but a
glance at the map which illustrates the report goes to show
that any such influence could not have been aerial, as m
the case of small-pox, but that it might have been induced
by personal contact, as during traffic, the disease existing
chiefly in tbe streets which form approaches to the
hospital. And not only so, but tile disease attacked one
group and spared another in the same area, and this
although the inhabitants of the area having immunity
were poor, and were certainly not in the enjoyment of
sanitary arrangements of a better sort than were their
neighbours in localities infected. Then, again, there is an
absence of that constancy which marked the influence of
small-pox hospitals. The returns for scarlet fever in 1882,
being submitted to a similar examination, are quite different
from those for 1886, and they would point much less conclu¬
sively to any mischievous effect. Having regard to the
total result of the inquiry set on foot, Dr. Thipe gives his
opinion to the effect that his statistics as to scarlet fever
“ show that it is not at all likely to spread from a hospital
in the way that small-pox has done, and that, whilst it is
almost certain that hospitals for small-pox in London have
proved injurious, those for scarlet fever tend to reduce the
spread of that disease.”

We should hardly have gone so far as to draw this con¬
clusion from tbe facts to which this report is limited; but
we And that it is at least in accord with previous experience
in this respect. When Dr. Thohne Thobnb published bis-
official report on the influence of hospitals for infectious dis¬
eases, he, with the aid of Mr. Shiblby Murphy, then resident
medical officer to the London Fever Hospital, set oat in a
tabular and diagrammatic form the history of houses sur¬
rounding that hospital with regard to scarlet fever and to
several other infectious fevers. The result was that over
a series of years the number of attacks from scarlet fever in
houses immediately surrounding the hospital happened to
be slightly less than that which might have been expected
to have occurred in a similar group of bouses situated else¬
where than near an infections hospital. Very similar
experience was obtained at Sunderland and Warrington,
where the infections hospitals were situated in close
proximity to tbe houses of the labouring classes. As yet
the investigations into this subject have noc -beenof the
precise character that have marked the similar ones as to
small-pox hospitals, and hence we think it wise not to
draw any very definite deductions from them ;'but we dan
at least assert that, apart from spread of disease under
conditions of personal contact, which should not be allowed
in a properly administered hospital, scarlet fever hospitals
have never been shown to have any bnt a beneficial effect
on the communities providing them.

It is understood that the Medical Council will appeal
from the deoision of the Court of Queen’s Bench in the eaa

Digitized by Google

1292 Thb Lancbt,]

THE MEDICAL COUNCIL AND THE DENTISTS’ REGISTER.

[Jmra 28 ,l».

of Reg. versus the General Medical Council. The case, our
readers will remember, was an application on behalf of Mr.
H. F. Pabtbidgb for a mandamus ordering the Medical
Council to restore his name to the Register of Dentists, from
which it had been removed under the Dentists Act, 1878.
The name was erased in the following circumstances. Mr.
Pabtbidgb, though entitled to be registered under the
Dentists. Act in virtue of being in practice before it was
-passed, elected to be registered in virtue of a diploma in
Dentistry which he held' from the Royal College of Surgeons
of Ireland, subject to the condition that he should not seek to
attract, business by advertising or by any practice considered
by tbe College to be unbecoming. In 1883 the Royal College
of Surgeons of Ireland withdrew or cancelled his diploma on
the ground that Mr. Pabtbidgb had attracted business by
•advertising. Mr. Pabtbidge’s diploma being withdrawn,
his loom standi in the Register seemed to cease; and ac¬
cordingly the Medical Council in February, without any
independent examination of the case, ordered the Registrar
to erase his name from the Register. The Dentists Act
differs in an important respect from the Medical Act. It
does not contain a clause like Clause 28 of the Medical Act,
.which provides that Colleges or bodies exercising the power
of striking off the names of any of their Members shall
signify the same to the General Council; and that the
■Council may, if they see fit, direct the Registrar to erase
from the Register the qualification derived from the College
or body in respect of which such member was registered,
always provided that the name of no person shall be erased
on the ground of his adopting any particular theory of
medicine or surgery. This provision is not repeated in the
Dentists Act; and Mr. Finlay, Q.C., with much skill, argued
that it must have been present to the framers of the later Act,
and been by them intentionally omitted. From this position
jbe went further, and argued that it was dearly not the in¬
tention of the Act to give the Medical Council.power to erase
except under Clause 13. The Court of Queen’s Bench
endorsed this view, and laid down that the Council are not
entitled to remove a dentist’s name from the Register, even
under Section 13, merely on the report of any College or
body that it had removed a given name from its list of
members, except after an independent inquiry and proof
that the person affected bad been guilty of certain
offences specified in the clause—viz., of infamous or dis¬
graceful conduct in a professional respect.

This decision may be a very sound one in point of
law, but it leads to some curious consequences. The
Council is required to .publish from time to time a correct
copy of the Dentists’ Register. Obviously a Register is
nothing if it is not correct. Is it possible for even the
Queen’s Bench to require the Council to publish a Register
t^at is incorrect f Clearly we think not. How, then, con
the, Court order the Council to register the possession of a
qualification which has been cancelled? It may be said
that Mr. Pabtbidgb was entitled to be registered in virtue
qtbeiag in praotiee befow 1878. So he was, but this title
tp (lapsed after.the first/day of Augusta 1£79.

The consideration of s u c h fop f e& righbto-re gitrti w Mflri nilfiM

It is difficult to see in what sense Mr. Pabtuks ck
be registered under this decision. His name may befpiM,
it is true; but what is a name in a Medical W/jMri
Register without the facts or letters which injtigfr the
nature of the right to be there ? The advantage of nek i
registration would be very doubtfuL It could nat exeite
anything but inquiry, and such inquiry would aftfe fie
fact that the only qualification once possessed hasten
withdrawn. The case is one of the many whfi^ p la
prove that the Medical Acts are drawn withj^plh
carelessness, and are more calculated to benefit *->*1
than the medical profession or the public,
curious to see if the Court of Appeal will ejufeu i
judgment which leaves both the Council and thepifcr h
such an unsatisfactory position, to say notinag.,«! its
tendency to encourage modes of attracting ** bushaTstei
we can only regard as derogatory to the dental p fffenka
and as militating against the interests of the public.)

^notations.

. • U •

•• No quid nimlj.”*

■ i 0 !#•

THE VACANCIES IN THE COUNOIL OF VIC
COLLEGE OF SURGEONS* * *

On former occasions we have sought to isltfM«
prospective action of the Fellows in their yrtlfcfpiA»
view to secure such new members for the Ooutf^nald
be most suitable for the attainment of those afcMRNfiltfee
policy of the College that are so much BoughfoftfiV the
profession at large. On this occasion mattfl^fW gett»
changed, and nothing that we can now say lM.bt 71
any influence on the immediate action or pdOnM# the
Council, directly or indirectly, seeing that tftawfcafcD,
for good or for evil, and notwithstanding 4fis44l0nt
introduction among them of men more « Me
to reform, have rejected all overtures made V,® 6 ®
by their constituents. For the Counoil have JNff F**
sented their petition for a new Charter whimTwtfk
embracing considerable changes, some
to the wishes of the Fellows and Mefoq&jggfcfr
ignores the three great desiderata as lurmUlali lEjljj
annual meetings of the College and oanaedtybvtMMW
majorities. Nevertheless, it is desirable that all
really wish to see the Council reformed sknull JW 8 *
their efforts, and should vote only foe
for seats as will be likely to keep Up aA
the reform element which already exists, t lmPS* *
minority at present. A few weeks *

brief abstract of the changes sought by VtfFGNMpf**
the risk of seeming wearisome, Wemay ranUrtVWP 1 ^* 1
that these changes leave untouched tb* jp ff*
posals made at and passed by the anaualmedM^ni.
(1) that the Council shall present a repptt
print of the Minutes of their
discussion by the annual meetih^n
tion in the Constitution, fit
College, or in any of its bye-law* QCjqVtttoltoSia WI*^*
effected without the oonsent-cd tto JEstjFWj **

convened to discuss the same,-
Members, under certain
shnJl take part & thb

(Midi. Th6sb"faMktoentol ll MM8 raMV

mu iiUiLSHKg|

The Lancet,]

THE CONJOINT COLLEGES.

[June 25,1887. 1293

with a non, po&mmus, and are now seeking for what will
practically amount to the endorsement of this policy by the
Privy Council. It remains to be seen with what success.
The two Associations of Fellows and Members respectively
have done, and we hope are still doing, their utmost to
have their views represented in any new Charter that may
be granted. It will indeed be strange in these days of
general representation if the wishes of a large body of the
Fellows and the petition of some six thousand carefully
educated Members of the College of Surgeons be entirely
ignored in matters of such obvious common sense as those
in dispute. Besides the three great questions just alluded
to, there are continually cropping up questions in which the
general practitioner is largely and chiefly concerned, and in
legislating on which it is quite clear that his practical
knowledge will prove of real service.

THE CONJOINT COLLEGES.

Thk following report on the utilisation of the vacant
ground adjoining the Examination Hall on the Thames Em¬
bankment will be laid before the respective authorities of
the two Colleges at early meetings:— 1 “ 1. That a central
theatre for lectures and demonstrations should constitute a
part of the proposed additional buildings. 2. That the
central theatre should be built so as to contain seats for an
audience of about 250 persons. 3, That the plan submitted
by the architect be, in its general arrangements, adopted,
and recommended to the two Colleges, it being understood
that the theatre shall be constructed to contain about 250
persons, and that the side wings be proportionately enlarged.
4. That, subject to the approval of the above resolutions by
the two Colleges, a subcommittee be appointed to investi¬
gate and report upon the best arrangements at present .exist¬
ing in scientific institutions in the construction of a lecture
theatre and laboratories. 5. That the appointment of the
subcommittee be left in the hands of the two Presidents of
the Colleges, and that the subcommittee be requested to
report within four months.”

POLICE AMBULANCE ARRANGEMENTS ON
JUBILEE DAY.

The ambulances Consisted of six horse-ambulances and
various bearer sections. The horse-ambulances were posted
as followsOne in Scotland-yard, one in Dean’s-yard, one
at King-street Police-station, one at Buckingham Palace,
one in Cleveland-row (at the bottom of St. James’s-street),
and one at the entrance to Spring-gardens, opposite the
Union Club. The bearer sections occupied positions at
Scotland-yard, Parliament-square, the Abbey, King-street
Police-station, Hyde-park-comer, top of St. James’s-place,
bottom of St. James’s-place, Piccadilly-circus, Waterloo-
place, Spring-gardens, Charing-cross, and the Embankment
end of Northumberland-avenue. Three of the horse-ambu¬
lances, fully equipped and with an efficient pertonnel , were
kindly placed at the disposal of the police authorities
by Mr. John Furley of the St. John Ambulance Asso¬
ciation, whose name has been so long and honour¬
ably before the public in connexion with ambulance
work both in civil and military practice. Mr. Furley per¬
sonally superintended the working of his ambulances, and
Mr. S. Osborn, as the surgical representative of the Order of
St. John, was in charge of the horse-ambulance in Dean’s-
yard. The permission of the General commanding the
Home District having been obtained, the Volunteer Medical
Staff Corps, under the command of SuTgeon-Major Norton,
furnished three strong detachments, consisting of about
160 men. The police ambulances provided eight bearer
sections, the men being specially selected for this duty from
thoee who had previously served in the Army Hospital

Corps (many of them wearing the medals of two or three
campaigns), and from those who had obtained certificates of
proficiency and efficiency in ambulance duties, ^he equip¬
ment, stretchers, haversacks, and water-bottles were kindly
supplied by Surgeon Lees Hall, A.M.D. (adjutant of the
Volunteer MedicalStaff Corps), whose services were extremely
valuable. The various ambulance contingents paraded at
Scotland-yard at 8 a.m. on the morning of Tuesday, when
after a few words of address from Sir Charles Warren, they
marched off to their allotted positions. Medical men were
posted in various parts of the Abbey. Dr. H. G. W. Mackenzie
and Mr. Battle of St. Thomas’s Hospital were in the Triforium,
Dr. Hawkins in the Peers’ Gallery, Mr. Farr at the north door,
Dr. Marsden Low at Poets’ Corner, and the Chief Surgeon of
the Metropolitan Police at the Royal entrance. Fortunately,
their services were not called into requisition. The acci¬
dents and casualties treated by the ambulances were
rather numerous than serious, and consisted mainly of
individuals fainting and crushed by struggling in the
crowd, fits, contusions, wounds, and injuries and frac¬
tures of limbs. At Piccadilly-circus so numerous at one
period were these minor casualties that Dr. Kemp, the
divisional surgeon in charge, felt himself compelled to
utilise the Vine-street Police-station as a temporary hos¬
pital. All the details are not to hand, but it is roughly
computed that between 600 and 600 were treated in the
streets. The serious cases, fortunately few in number, in¬
clude a fracture of skull, admitted into St. George’s Hos¬
pital; concussion of brain and severe injuries of chest,
resulting from a kick from a trooper’s horse, which shortly
proved fatal. Dr. A. E. Hardy, house-surgeon to Charing-
cross Hospital, has kindly sent us the following list of cases
treated at that hospital on the 21st. Contusion 1, sprains 6,
various wounds (slight) 31; fractures, of the radius 2, fore¬
arm 1, leg 1; dislocation of shoulder 1, alcoholism 5, syncope
2, hysteria 1, epilepsy 7, sunstroke 2, brought in dead 1,
trivial cases 11. Ten cases were admitted: severe con¬
tusions 3, concussions 3, epilepsy 2, apoplexy 1, delirium
tremens 1. Altogether about 98 cases required attention.
This is a fair example of the kind of cases treated during
the day chiefly at the hospitals along the line of route—viz..
Charing-cross, St. George’s, and Westminster. Every
assistance was given by the police, and the numerous cases
were rapidly transported to the hospitals or to their homes.
The arrangements, which were, we believe, made but a few
days before, were admirably carried out, and Sir Charles
Warren, the Commissioner of Police, and Mr. MaoKellar,
F.R.C.S., Chief Surgeon, are entitled to the highest credit,

HYDROSTATIC PRESSURE IN INVERSION OF THE
UTERUS.

Phofbssob Max Rungb of Dorpat, having a case of
inversion of the uterus, caused by a midwife pulling on the
cord which had been allowed to remain without medical
advice for nine weeks, made several fruitless endeavours to
effect reduction by manipulation and by distension of the
vagina, by means of Braun’s colpeurynter, which consists
merely of an indiarubber ball with thin walls, provided, like
Barnes’s bags, with a tube and stopcock. He then bethought
himself of a plan recommended and practised successfully by
Krukenberg—viz., the application of considerable hydro¬
static pressure to the vaginal canal, with the view of
dilating the os uteri and of softening the inverted uterus
itself. Professor Max Runge sprinkled the colpeurynter
well with iodoform, and again introduced it, conn e cti ng it
with a vessel of water hung at the height of about
3 ft. 8 in. above the bed. Communication between the
colpeurynter and the water-vessel was kept open, the stop¬
cock not being turned off, and so a high degree of hydrostatic
pressure was continually exerted, distending the vagina
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Dii

1294 The Lancet,] CONTAMINATION OP THE THAMES BY THE HENLEY 'REGATTA.

and the os and Compressing the body of the uterus. Next
morning the pain caused by the apparatus became un¬
end urable,'and the patient pulled it away from her. Upon
examination, it was found that the fundus had retreated
within the os, which was widely distended; there was still,
however, a partial inversion, which was readily reduced with
the finder. The uterine cavity was then washed out with a
carbolic solution, and a tampon of iodoform wool intro¬
duced into it. The mucous membrane of the vagina
showing signs of sloughing, it was well powdered with
iodoform; ergot was also given. The parts were carefully
dressed for some days, and the patient made a rapid recovery.

DEGREES IN MEDICINE AND SURGERY FOR
LONDON MEOICAL STUDENTS.

An extraordinary meeting of the Fellows of the Royal
Cdllege of Physicians has been summoned for Monday next,
at which a report from the delegates of the two Colleges on
the granting of degrees in Medicine and Surgery will be
submitted for approval. The chief features in the report
are the refueal to undertake united action with University
and King’s Colleges in the formation of a new University to
confer degrees in Arts, Science, and Medicine, and the recom¬
mendation of an application for a charter and power to grant
degrees in Medicine and Surgery by the two Colleges acting
jointly, but independently of any other bodies. We under¬
stand that the charter will suggest a governing body of forty-
eigjjt persons (twenty-four from each College), and that
power will also be soaght to confer degrees on those who
have already passed the examinations for the membership
of the College of Surgeons and for the licentiateship of the
College of Physicians. _

CONTAMINATION OF THE THAME8 BY THE
HENLEY REGATTA.

When last year we published a special report on the
contamination of the Thames at the Henley regatta, the
matter was brought before the House of Commons. To a
question put by Mr. H. S. Wright, the President of the Local
Government replied that the Thames Conservators, acting
according to the Act passed in 1885, had drawn up bye¬
laws which would enable the owners of house boats to be
prosecuted if the drainage of these vessels went into the
Thames. The bye-laws only awaited the approval of Her
Majesty in Council. With this assurance the public was
lulled into a sense, we regret to say, of false security. On
inquiry we find that even at this, tbe eleventh hour, the bye¬
laws in question have not yet received the Royal assent.. The
Henley regatta will be held on June 29th, 30th, and July 1st,
and the owners of house boats, steam launches, and other
craft are still at liberty to drain their sewage into the chief
drinking-water supply of London. This scandalous state
of affairs seemed so inexplicable that we at once proceeded to
inquire at the Thames Conservancy office as to what were the
causes of such a dangerous delay. We were then informed
that immediately after the publication of our report on the
contamination of the Thames at the Henley regatta, the
Thames Conservancy drew up a set of bye-laws calculated
to put an end to the grievance. These, according to the
law in such matters, were extensively advertised and
objections invited. Such objections were entered, but they
did not relate to the clauses protecting the Thames from
contamination. It was the rules concerning the marking and
numbering of the boats which elioited the opposition of many
of tbe persons concerned. Nevertheless, thedelay waeeffeotive
uu retarding the whole measure.. The bye-laws bad to be
drawn up ogam in a modified form and once more advertised.
A few objections were raised to this second project, but we
bate good r e aa o u to believe they were not of a serious

nature, so that there is now no valid reason for witijllMhg
the Royal assent. This may be obtained at any
perbaps, we were informed, in three days, or in threeVstb,
or in three months. We would earnestly urge that tike it
not an hour to be lost. Tbe Thames Conservator thh
commendable energy, have drawn up and printed fe rinkfe,
which they will send to tbe owners of every boos Ibdftth
moment the Royal sanction to the new bye-laws Mm.
This circular points out that by Clause 9 of the nefrafgali-
tions in question, a penalty will be inflicted on thtfcvbo
“cast or throw into or upon, or place or cause or saffirtflfil
or flow into or upon any of tue places specified in Sclfetial
of tbis bye-law, any se wage, rubbish, or other offeMMfculM
or thing.” But till this bye-law is approved, cwtiAtaf
established, allows the drainage of boats iat6 tifcnntv
on which they float. Rubbish, sand, and ballast a^Mtk
thrown into the river. Tbis is forbidden by the Utb sad
28th Victoria. And the 29th and 30th Victoria pievgdi She
drainage of houses into the Thames; but the Tha^i ■Con¬
servators do not consider that these Acts empowtfUlBto
interfere with the construction of waterdoeet* (Srtgiri
vessels, even if these navigate the Thames above Aifetrin
for the drinking-water of London. On the other
seeing that the Royal assent will probably not bMfMwd
in time to prevent the mischief and danger eaMdfyfti
large concourse of crafts at Henley daring thengMlM,
the Thames Conservators, at their own cost, hcvVttffad
our suggestion and appointed two scavenging baq# Tbai
will pass up and down the course both morning sMMhg.
so as to remove the contents of night-stools IM wl Ua
garbage and refuse. It is to be hoped that tbs VlMBYill
profit by this new facility placed at their dispoiilflilkiB
not throw overboard anything likely to befool wmfct
Nevertheless the bye-laws should have receivedtMINMry
sanction before this, and eo important a maUK Wp la^ to
have been left to mere voluntaryeffort. It i»h riyy<ts°
late; and we still hope to see this error of negMIpNtilri
befare the Henley regatta week. 1 - '

_. ^hr»»

INCREASE OF ALCOHOLISM IN FRANOlfc

A special commission appointed by the FrtlilflMti*
to investigate the above-named subject has dwP#*
regular impeachment against the trade ‘in ilBOMW PMN
the laat ten years the consumption of
has increased from 970,000 to 1,000,000
however, only represents the officially
the fraudulent and clandestine trade in
be estimated, though it is oonsiderablein
the liquor thus vended must be vile in qs
number of suicides attributed to excessive
of alcohol has multiplied sixfold during the
question—1874 to 1885. There were formerly 13
per annum; there are now 868. In those de
there has been a notable augmentation in tbe sale <
the number of recruits who have proved unfit
service has increased fourfold. Criminal assaults!
largely multiplied in these same counties,
tion of patients suffering from insanity due
received in public asylums has, on an average, i
; 9 to 16 per cent, during the last ten years. Ia
partments, out of the total number of insane from i
the proportion given of those who are victims of i
reaches the enormous figure of 21, and even, in i
28 per cent. During the last five years
have been 51,000 insane received in the public i
of these no less than 7400 cases are said to bare been j
the excessive use of alcohol. Among the i
recorded, no less than 20 per cent, are attributed to<
ness; and the birth-rate has also notably <
parts of the country where the use of alcohol

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Tmi Lancbt,]

A 0UR10US VERDICT.—THE PATHOLOGY OF FATIGUE.

[Jttwh 28,1887. 1295

increased. Yet all these are bat official figures, and the
case would be even worse if it were possible to record all
the facts that escape the control of the public authorities.
Nevertheless, the indictment is strong enough as it stands,
wd the Commission of the Senate have not failed to express
(heir serious alarm and concern. To remedy the evil, it is
proposed to increase the tax on alcohol, aud to impose more
jtringent regulations with respect to wine shops. This,
however, will scarcely meet the case. The phylloxera is
undoubtedly in a great measure responsible for the increase
of drunkenness in France. Given cheap and pure wine, there
would probably be butlittle alcoholism. Drunkenness is almost
unknown in wine-growing countries; and intemperance in
France prevails principally in the northern departments,
where the vine cannot grow. What is more particularly
wanted is the stringent application of laws against the sale of
bad aloobolics and adulterated wine, combined with facilities
of transit, so that pure wine may be brought within reach
of the poorer olasses. When once the palate is accustomed
to natural and wholesome wines, the intoxicants that do so
much barm will be considered too coarse to be drunk with
any sort of pleasure. A Spanish peasant from the vineyards
of Andalusia, accustomed to the unsophisticated Manzanilla
or the Montill a of his native country would find the schiedam
drunk in Northern Europe inexpressibly nasty. It is
difficult to prevent drinking by Aot of Parliament, but the
Legislature may seek to check fraud and adulteration.

A CURIOUS VERDICT.

An inquest was held at the Crowndale Hall, Crowndale-
road, on June 15th, by Dr. Wynn Westcott, deputy coroner
for Central Middlesex, touching the death of a man aged
fifty years. Deceased had been in pecuniary difficulties, and
on one occasion, some three months ago, he stated that had
he not been relieved be would have poisoned himself with
the contents of a packet he produced from his pocket. About
a fortnight before his death he disappeared from his home
and was not heard of for a week, nor was his whereabouts
subsequently traced. When he returned home on June 7tb
be appeared very ill, and was suffering from symptoms ol
gastric irritation. During the week he confessed to his wife
that he had taken poison, and directed his son to the con¬
tents of bis coat pocket. Two packets, each of which had
been opened, were there found. They bore labels marked
“ Oxalic acid,” “ Poison." One packet was nearly empty, and
s small quantity of the acid had been taken from the second
packet. The chemist who supplied the acid deposed that
each packet originally contained half an ounce, bat that he
had no knowledge of the purchaser, as the poisons falling
under Schedule B of the Sale of Poisons Act, it was not
necessary that it should be signed for. Dr. Mac Larty, of
204, Camden-road, was called to deceased on June 9tb, whom
ie found suffering from vomiting, pain in the stomach, and
ether symptoms of gastric irritation. Medicines were pre-
icribed for the alleviation of the patient’s troubles, but death
rom exhaustion ensued on June 11th, two days later.
Vlthough the wife of deceased knew that her husband had
idmitted taking poison, she did not tell Dr. Mac Larty of the
:ircumstance; consequently, in the absence of other evidence,
•here was no indication for other than symptomatic treat-
nent. Very promptly, but unfortunately, an alkali was ad-
ninistered ; just the last drug one would think of giving in
. case of oxalic acid poisoning, on account of the solubility
>f the eodic and potassic oxalates, compounds practically
•s poisonous as oxalic acid itself. There was no evidence,
lowever, to show that any acid had been taken after deceased
eturned home—that is, within three days of Dr. Mac Larty
eeing him. The necropsy was conducted by Mr. Pepper on
une 14tb, the day before the inquest. The stomach was found
o be acutely inflamed, the whole surface presenting a bright-

red appearance, varied by black arborescent markings due to
coagulated blood in the veioe of the submucoea. There
was no corrosion. The lower half of the oesophagus was
affected in much the same manner as the stomaob, and
there was slight corrugation of the mucous membrane at the
cardiac end. The mucous membrane of the small intestine
was much congested. In reply to the coroner, Mr. Pepper
said be bad no doubt that an irritant poison bad been
taken, and that analysis showed this was not metallic, nor
was it a mineral acid or caustic alkali. The condition of
the stomach might possibly have been caused by a large
quantity of strong alcohol, but it was more consistent
with poisoning by oxalic acid. He doubted if oxalic acid
would be found in the stomach five days after it was
exhibited, as it was soluble, and would be farther got rid-of
by vomiting and diarrhoea. The lungs were extremely
congested, bat there was no hepatisation. There was
nothing abnormal about the brain. The viscera generally
showed signs of degeneration incidental to* age, but were
not so diseased but that life might have been considerably
prolonged nnder ordinary conditions. Dr. Westcott advised
the Jury tbat a further analysis would probably disclose
nothing more of importance, and that it did not seem
necessary to adjourn the inquiry. The jury, after consulta¬
tion, returned a verdict of “Death from natural causes,
accelerated by alcohol,” whereupon the coroner pointed out
that the medical evidence went to show that the stomach
had been acted on by some irritant poison, and tbat there
was an entire absence of recent alcoholism. At his sug¬
gestion the verdict as registered ran, “ Death from syncope,
consequent on inflammation of the stomach and gullet, but
r.hat how the latter was caused there was no direct evidence
to show.” _

THE PATHOLOGY OF FATIGUE.

Phofbssob Angblo Mosso of Turin, with the aid of
coadjutors in his laboratory, has for some years been working
at the physiology of fatigue, and now he has turned his
attention to the pathological manifestations of that physical'
condition. Fatigue carried beyond the moderate stage, ftt ;
which it is decidedly beneficial, subjects the blood to a
decomposing process through the ioflltratioQ into It of 1
substances which act as poisons—Substances which, ^hen
injected into the circulation of healthy animals, induce
nalaise and all the signs of excessive exhaustion.' The
researches which seem to Justify this finding are embodied
'nan elaborate paper recently submitted to the Acdademiadei
Lincei, and shortly to be made accessible in its printed Trans¬
actions. Fatigue, according to Prof. Mosso, when incurred'
within limits regulated by the resisting power of the subject, 1
has its pleasures and even joys—these being the expression
of the organic consciousness that the active destruction of 1
tissue is normally balanced by its reconstruction, a prooees
yielding the sense of reinforcement and exhilaration. It'
was on the soldiers of the Italian army tbat Mosso’i experi¬
ments were made, and be has convinced himself that he
has arrived at practical regulations as to the amount 6f
exertion to be put forth on the march, as to the best distri- 1
bution of the halts and of sleep, and as to the lightening of
the weight each soldier has to Carry. The tent, for instance, 1
which the Italian linesman has to take in bis knapsack
might, he thinks, be advantageously dispensed with. Again,
the vexata quattio of the comparative strength of the much-
extolled Roman legionary and his modern counterpart has
not been neglected by Professor Mossd, who has even'
traversed the archaeological field in order 1 to settle it. He
baa examined the richly-furnished museums of antttyoe
Roman armour and impedimenta scattered through the
Italian cities, and he comes to the conclusion’that in peitrt-
of stature and bodily powerthe modem soldier is in no way
inferior to the ancient. The Roman armiee under the ablest-

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MORTALITY IN MANCHESTER.—MERCURIAL INJECTIONS.

[Junh 26,1887.

disciplinarians had their stragglers and their physically dis¬
tressed upon the march; while the treatment available for
their wounded on the battlefield and the ambulance-tent
was comparatively rude and ineffective. And yet they were
the conquerors of the then known world.

MORTALITY IN MANCHESTER.

Thk high death-rate that has prevailed in Manchester in
recent years, and the still higher rate that has been recorded
there since the beginning of this year, seem to call for more
local attention than has yet been given to the matter. The
recorded death-rate in this city appears, from the Registrar-
General's returns, to have averaged 26 5 per 1000 in the five
years 1881-5; it was 26 3 during 1886, and in the first
twenty-four weeks of this year the annual rate has been
equal to 30 7 per 1000. Now the mean death-rate in the
twenty-eight largest English towns during the five yea-s
1881-85 did nob exceed 2T5 per 1000, and was 20 9 in 1886;
in the first twenty-four weeks of this year the mean annual
death-rate in these towns was 21*2. These figures show a
striking excess in the Manchester death-rate compared with
the mean rate in the twenty-eight towns, an excess which
has prevailed continuously during the past six years, and
has been more strongly marked since the beginning of this
year. In each of the last six years Manchester has
been placed last, or last but one, in the list of these towns
ranged in the order of their rates of mortality from the
lowest. If the recorded death-rates in these twenty-eight
large towns be corrected for differences of age and sex dis¬
tribution, as is done by the Registrar-General in his annual
summary, the result shows that the recorded and uncorrected
death-rate in Manchester considerably understates the excess
of mortality in the city. The age and sex proportion of
Manchester is so exceptionally favourable to its mortality
that the recorded death-rate in 1886 (26 3 per 1000) is raised
by the Registrar-General’s method of correction to 29 4
before it is fairly comparable with the corrected rates in
the other large towns, and the general rate in England
and Wales. The corrected rates in these twenty-eight
large towns last year ranged from 17 6 in Brighton, 18 9 in
Derby, 19 - 5 in Hull, and 200 in Bristol, to 261 in Liverpool,
27'8 in Blackburn, 29‘4 in Manchester, and 31'4 in Preston.
AU the four towns at the bottom of the list are Lancashire
towns, to which may be added Bolton and Oldham,
which stand next to them, with rates very little lower
than the rate in Liverpool. The Manchester sanitary
authority has, we believe, asserted that the Registrar-
General under-estimates the present population of the city,
and thus overstates its death-rate. So far as we know,
however, no serious attempt has been made to prove the
probability of this assertion, by furnishing returns of in¬
habited houses on the rate-books of the city. The numbers
of births annually registered in the city since 1881, more¬
over, do not afford evidence of increase of population since
the last census much exceeding the small rate that prevailed
within the present boundaries of the city between 1871 and
1881. We do not propose on the present occasion to discuss
the causes of the long-continued high death-rate in Man¬
chester. It should, however, be noted with reference to
the death-rate in 1886, which was almost identical with the
rates in 1884 and 1885, (1) that the mortality from the
principal zymotic diseases was considerably above the mean
rate in the twenty-eight towns, and that the excess was
especially marked in the mortality from scarlet fever and
“fever,” which in most other towns shows a striking
reduction resulting from improved sanitary organisation;
and (2) that the excess of mortality is conspicuous at all
ages, infant mortality being 183 in Manchester, against 169
in the twenty-eight towns, the death-rate among children
and adults between one and sixty years was 16 0, instead of

11‘8, in the aggregate population of the large towns, sad the
rate among persons over sixty years of age was 10H per
1000 living at those ages, against a mean rate of 77‘1. Such
facts as these should engage the serious consideration of the
sanitary authority and of the ratepayers of the city of
Manchester. _

MERCURIAL INJECTIONS.

A discussion has recently been taking place in the
Brussels Medical and Scientific Society as to the relative
advantages of mercurial injections and inunctions combined
with internal medication. Dr. Thiry prefers the latter
method, as he thinks injections are attended with serious
risks and inconveniences. M. Ed. de Smetb, on the other
hand, practises injections largely—in fact, always—when
mercury is indicated in syphilitic patients. At present
there are in his wards 24 such cases in which no less than
900 injections have been given without any socident
occurring; and M. de Smeth thinks that, a*, apart
from his own practice, M. Martineau has reported a
series of 180,000 injections without any accident, Lewis
300,000 with 20 absoesses, and Paikert 6000 without any,
it cannot be said that this form of treatment is more liable
to inconveniences than other forms. He points out that there
is a great difference between injecting insoluble salt*, as
calomel and the yellow oxide, in the way recommended by
Scarienzo, upon which method M. Thiry’s experience of injec¬
tions was mainly gained, and injecting soluble salts, which is
the plan he himself prefers and follows. Here, he says, the
only objection to the injections is that the patient must be
regularly seen by the doctor, which in private practice is
sometimes inconvenient. Of course care must be taken that
the syringe is perfectly clean and that the liquid is well
filtered. In order to illustrate the occasional importance of
the rapid action which can only be obtained by the method
of injecting soluble salts of mercury, M. de Smeth mentions
a case of syphilitic laryngitis of so urgent a character that
it was thought that laryngotomy would be needed. How¬
ever, by means of hypodermic injections repeated five or six
times during the course of twenty-four hours all danger was
averted. _

CORSETS AND TIGHT-LACING.

It has always seemed to us to be somewhat of a satire on
the work of nature that the female form should be thought
to require the support of a corset in order to make it grace¬
ful. We observe therefore with satisfaction that ladies, and
even young ladies, are here and there to be found who hare
with equal courage and good sense dispensed with this un¬
necessary article of dress. Among the majority who con¬
tinue to wear it there are also signs, though less pronounced;
of the same healthy tendency. Tight-lacing is viewed with
much less favour than formerly. Women as well as men art-
coming to see that artificial slenderness is no beauty,
and indeed the sham and unreason apparent in a figure
wantonly contracted must create in all thinking person*
a feeling of repugnance which effectually prevents the
possibility of admiration. Victims of this hurtful prac¬
tice and grievous error in taste are still, however, not un¬
common. Only a few days ago an inquest on the body of
an elderly female revealed the fact that death was due to
the direct consequences of her having the stays too tightly
laced. This is by no means the first instance in which the
coveted fineness of waist has been thns dearly purchased
It is, in fact, impossible that this custom can but injure
health, for what are its effects? By tight-lacing, which
forces together the elastic ribs and narrows the space within
the thorax, free action of the lungs is obviously rendered
impossible, the liver and heart are displaced, and the great
bloodvessels unnaturally stretched. The organa placed at a

The Lancet,]

TUB VEEERINART PROFESSION AND PUBLIC HEALTH.

[June 26,1887. 1297

ower level are hardly lees affected, and the pressure tells
aore or less on every important structure between the
ollar-bone above and the pelvis below. The unfortunate
worshipper of a false ideal thus loses with free respiration
he due effect of the most powerful force which aids the
e&rt in driving its blood through the body—the force of
horacic suction. Displacement of the heart, moreover,
an only result in palpitation, or severer cardiac troubles,
hus it comes to pass that every organ and tissue is under-
ourished, digestion is little more than a meaningless term,
nd healthy life in any part of the body is unknown. This
my seem to be forcible language, but it is nevertheless the
othing of facts which it does not merely envelope, but in
iany cases fits with a strictness not incomparable to the
rm embrace of the most fashionably strait corset.

THE VETERINARY PROFESSION AND PUBLIC
HEALTH.

A well-known veterinary surgeon has, in a letter to
he Times, protested against certain recent statements
dculated to reflect on the attitude of the veterinary pro-
eaion towards the scientific study of animal diseases
hich are related to the health of man. We are convinced
i at it would be unfair to attack the whole profession because 1
rtain of its members have recently appeared less willing to
due scientific observation than we think should have been
>e case. As matter of fact, however, diseases of the lower
lim&ls have hitherto been considered rather in relation to
eir effect upon these animals than to the health of man.
)r this no possible blame can attach to veterinarians; it
is been necessary in the first instance for the importance
these maladies to be recognised; but we are sure, now that
me have assumed unexpected prominence, they will meet
Ah all the consideration they deserve. The scientific study
disease, whether of man or of the lower animals, has
come more possible during the last few years owing to
o better opportunities which exist for its investigation,
d a more definite knowledge is now expected than here-
Tore. No public health department is complete without
3 aid of those skilled in animal diseases, and we anticipate
3 need for services of this kind will not less stimulate the
luiries of veterinary surgeons than it has members of our
n profession. It is not many years ago that human infec¬
ts diseases were not properly differentiated; it will pro-
bly not be long before those of animals are as well under¬
od as are now human maladies of this kind. With the
ssibilities of experimental inquiry which are open to the
erinary profession, it may, indeed, be expected that the
owledge of animal diseases will soon be more precise
m that of human maladies.

DAIRY SCHOOLS.

'OB future of dairy farming in this country is a subject
iseesed of no small interest for the whole population.
i importance of fat in food, alike as a sustainer of mus-
ar energy and of the body heat, is now better understood
n formerly. The daily and universal need of milk, the
Icultyin many quarters of obtaining it unadulterated,
well-founded accusations levelled at it of late years as a
rier of disease, not to mention many other matters
‘ting to the quality and cost of dairy produce in general,
st therefore commend themselves to us as cogent reasons
y education should have more to do than it has bad
h teaching the best methods of conducting this great
ustry. We hear on all hands complaints of foreign com-
ition, and it is not remarkable, nor on the whole to
regret tad, that other nations compete with us in this
artment -of trade. The public is better fed in con-
ience. It is not certainly any measure of protection we

would ask for in the interest of. home producers; but
nothing can be more reasonable than the proposal that
dairy schools should be established in conjunction
with dairy factories in various rural districts. This would
strengthen the competition on our side, and would go
far to ensure a general supply of sound produce and the
correction of existing abuses. A suggestion has been made that
such a scheme should be instituted with thehelp of amoderate
Government grant. It would certainly be better, however,
if the project could be worked without applying to the
national exchequer; and it seems to us that farmers, by
combining for this purpose, especially when assisted, as they
must be, by the proceeds of the factories, might make the
system work, and even pay, without aid from the State.
If, however, a small grant or loan were necessary to start
with, it should be easily possible to refund it within an
appointed time. _

CARBOLIC ACID AS A SAFEGUARD AGAINST
INSECTS.

Man* people do not know how easily they can protect
themselves and their children against the bites of gnats and
other insects. Weak carbolic acid sponged on the skin and
hair, and in some cases the clothing, will drive away tbe
whole tribe. A great many children and not a few adults
are tormented throughout the whole summer by minute
enemies. We know persons who are afraid of picnics and
even of tbeir own gardens on this account. Clothing is an
Imperfect protection, for we have seen a child whose foot
i and ankle had been stung through the stocking so seriously
that for days she could not wear a leather shoe. All this
can be averted according to our experience, and that we
believe of many others, by carbolic acid judiciously used.
The safest plan is to keep a saturated solution of the acid.
The solution cannot contain more than 6 or 7 per cent., and
it may be added to water until the latter smells strongly.
This may readily, and with perfect safety, be applied with a
sponge. We have no doubt that horses and cattle could be
protected in the same way from the flies, which sometimes
nearly madden them, and it even seems possible that that
terrible scourge the African Tsetse fly, might be kept off in
the same manner. __

DEATH FROM CHLOROFORM AND FEAR.

An inquest recently held at University College Hospital
on tbe body of a woman forty-one years of age opens, up
two important questions bearing upon the administration
of volatile narcotics under special circumstances of disease*
The patient had suffered from pleurisy, followed by-effusion
of serum into the left pleural cavity, and the. operation to
which she was subjected was that of tapping the chest in
order to draw off the fluid. The needle was inserted, but or
the fluid did not flow it was proposed to tap at a point
lower down. To quiet the anxiety of the patient, who had
become nervous, and who asked for chloroform foe.[the
second puncture, chloroform was administered, but before
the quantity put into tbe inhaler—about two drachms—vpaa
used up, the pulse stopped and death followed. In order to
give a chance of recovery, the fluid was drawn off from the
chest, and the other usual means of restoration were supplied,
but without avail. The post-mortem showed the heart to be
fatty and empty, and death was returned as from syncope
under chloroform. The two practical questions in con¬
nexion with this untoward event are: (1) Is.it extra
hazardous to administer an anaesthetic when a pleural
cavity is charged with fluid ? (2) Is it extra hazardous to
administer an anaesthetic like chloroform after a patient
has expressed.fear or anxiety during an operation? La
answer to the first question, we should infer—although the
matter has, we admit, been little argued—tfiat in all eases

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1293 Tm Lxxcnrr,]

JUBILEE HONOURS TO MEDICJAL MEN.

[inti St MB,

where the capacity of the chest is reduced by effusion of
fluid or other cause there is some extra risk, and that in
such cases local anaesthesia is the safest method. On the
second question we have less doubt. We believe, as we
before expressed in these columns, that it is always an
extra risk to administer chloroform when a patient is be¬
coming faint or nervous from fear. Chloroform acts on the
heart like fear, and had better be avoided when nervous
trepidation leading to faintness is present. We do not for
a moment say that this patient would not have died under
any other method of anaesthesia, or that she might not
have died if no anmsthetic had been employed. But in the
future it may perhaps be preferable, guided by the experience
here afforded, not to administer chloroform under any
persuasion of the patient, when, with reduced capacity of
respiration from mechanical impediment, there is nervous
shock and threatened syncope from fear.

THE HEALTH OF THE CROWN PRINCE

His Imperial Highness the Crown Prince of OttooT
continues in excellent health, and the appearance oi it-
larynx is quite satisfactory. There is now no oosgotia
though the ventricular bands are slightly relaxed. At ti-
Crown Prince could not possibly manage to keep Ten
quiet during the past week, Dr. Morell Hackenrie hu n
yet thought it desirable to perform another operation. E-
has, however, applied a solution of perchloride of in:
on several occasions, and it is probable that Mae a*,
of the growth will be removed early next week. P:
Norris Wolfenden has, by desire of Dr. Mackenzie, be-;
added to the resident medical staff in attendance on :t*
Crown Prince at Norwood, in order that he nay mit
applications to the larynx and report to Dr.Miokeuiex
those days on which he does not examine the illaitnut
patient himself. _

JUBILEE HONOURS TO MEDICAL MEN.

The Gazette published on the eve of Jubilee Day did not
chronicle the fact of a peerage having been allotted to any
medical man. Well, the most we can say is that an oppor¬
tunity has been allowed to slip. The fact remains that no
member of our profession has ever been raised above tbe
rank of a baronet. We are not disposed to magnify this
grievance, but it is undoubtedly felt to be one, and it would
have been au act of grace in this year of jubilee to wipe
away the reproach that the practice of medicine disqualifies
a man for very high social position. For the rest, the honours
conferred on the profession, though scanty, are of a nature
to be approved. Professor Garrod, always supposing he did
not care to accept a baronetcy, is clearly entitled to knight¬
hood. Mr. MacLeod will wear his new hono *r v ith credit.
The other honours have been appropriately conferred. As
a whole, the Gazette is a meagre one; but while many
aspirants will be disappointed, there is nothing to be urged
against the little that has been bestowed.

SPAYING FOR FIBROIDS.

Dtt. G. ZvoBYKtiv has collected statistics of nearly 300
cases of spaying ( kastrateia) for uterine fibroids. A large
proportion of these are from English and American sources;
seven, however, are contributed by Russian surgeons, six by
Dr. Zvorykin’s chief, Professor Lebedeff, and one by Dr.
Salman off. Two of them are described as interstitial, three as
multiple interstitial, one as interstitial cavernous, and one as
cubserous multiple interstitial. In all these seven cases, both
ovaries, »nd in three of them more or less of the tubes, were
removed. The haemorrhage from which all the patients had
suffered- ceased, and no bad symptoms occurred. Dr.
Zvorykin compares spaying with myotomy, and believes the
one th be as devoid of danger as the other. Spaying, he con¬
siders, U indicated in cavernous fibromata; in retro-cervical
Or inter-ligamentous tumours, where myotomy would be
attended with danger; in all interstitial fibromata, especially
faa small ones where menorrhagia is the-chief symptom; in
snbberous fibromata of large sire,- if they give rise to menor¬
rhagia; and in 1 cases where the patient has beoorae so
anaemic and weak that the loss of blood necessarily attendant
on the operation of myotomy would be likely to affect her
condition seriously. Spaying he considers contra-indicated
in SUbSetous fibroids With long pedicles which can easily be
removed; to Urge interstitial fibroids canting symptoms of
■WeigfiH and ; bearing down, but unattended With ttbnore
rbagia; in flbro-cys'ic tumours; in young subjects in
whom fertility may be restored after myotomy; and, lastly,
in cases where the ovarieB are enclosed in a mass of false
membranes, and their removal ia consequently attended with
great difficulty.

THE CEREBRAL CENTRES FOR QA3THC
MOVEMENTS.

Db. B. A. Hlabko, of Dorpat, has recently Mowed n;
some researches of Oppencbowski, Knant, and Dehtatupx
the mode in which the stomach is affected ky cotta
influences. His experiments were conducted a no le
than seventy-six dogs, by stimulating different npm s
the brain by tbe faradaic current. He finds tbsttbssm**
for the contraction of the cardiac extremity of tkedoav
are situated in the corpora quadrigemina, and ttat tb
nerve fibres connecting these centres with tbs CBtiocpu
in part down the spinal cord, bat more especially “
pneumogastric. The centres for contraction rftkstido:
the stomach are likewise situated in the eMpM<P*d:
gemina, the impulses travelling mainly throsgb tie
cord. The centre for the dilatation of the ostili
origin of Oppenchowski’s “ dilator nerve at tbe cafdu'-'
situated at the junction between tbe 1—fimrtsr nuejs
with.the anterior inferior extremity of the cads**** 1 '
close to the anterior commissure. Hie vagus k Uw c '
medium of communication with the cardia. BA cards-
dilator fibres found by Knaut in the spinal eoriUpp*-
originate from some other not yet known osnti* !*•»(*
or brain. From these researches Dr. Hlaskoii bafc*!
doubt the existence of a single “ vomiting centra’** * '
believed in by many. He thinks that the dlflgati«c*
on the stomach and the abdominal and reepirawy
which are ooncemed in the act of vomiting mpro^'
each governed by a different centra.

METROPOLITAN ASYLUMS BOASJfc

The report as to small-pox prevalence in tbs
which was presented at the meeting of ..the A«yl sd*fr*
on Saturday continues to be satisfactory. In tbs I*** 5
fortnight not a single patient had hgan nAMftdL ***
had been discharged, and one only tWaainsd Ipm*
meat. When the site of London is a—Mswfrl***
complete abeence of this disease is in every Un yptiw*^
Scarlet fever however, has basn. dinting
many aa 482 oases being in the homltVr.ti JA* **
together with five patients suffering
from enterio fever. The Amtal
reported that so long as the buspiinl jfelps;
for the reoeption of patients^nofdather
could be made with due ic g aad. t P
ambulance, service; and avail ib the4
'he staff would have t» be as
fication for the -protection^
observe with satisfaction
has received the honour id
the

Diqiti2

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Thb Lancrt,]

THE HOSPITAL SUNDAY FUND.—DYSACUSIS.

[June 25,1887. 1299

which are rendered to London by the hospital-providing
authority for infectious diseases will give satisfaction to
those who are cognisant of the difficulties against which the
managers have to contend. It is indeed time that the com¬
plaints of other authorities as to the board’s expenditure
should cease. That there have been carelessness and extra¬
vagance in the past there is no matter for doubt; but
London is dependent, as are other communities, upon hospital
provision for the prevention of disease, and we congratulate
Sir Edwin Galsworthy and his colleagues upon the estimation
in which their efforts are held by Her Majesty and her
responsible advisers. _

THE JOHN LUCAS WALKER STUDENT IN
PATHOLOGY.

Dr. Wm. Hunter, M.D. Edin., F.R.SJ5., &c., has been
elected the first holder of this studentship. After a brilliant
university career, culminating in the Ettlea Scholarship,
Dr. Hunter took his M.B. degree at Edinburgh in 1383.
He then acted for six months as assistant to Prof. Rutherford,
and for the following six months as one of the resident
physicians in the University wards of the Edinburgh Royal
Infirmary. Since that time he has been engaged in original
work on pathology at Vienna, Leipzig, and Edinburgh. His
graduation thesis for the degree of M.D. on “ The Physiology
and Pathology of Transfusion and tbe Fate of Extravasated
Blood ” was awarded a gold medal. Other papers giving an
account of his researches—chiefly on the pathology of tbe
blood—have appeared in tbe Journal of Anatomy and
Physiology and elsewhere. Dr. Hunter’s past success as an
investigator of pathological problems, and the opportunities
which he has had of becoming acquainted with experimental
work as well as with morbid anatomy and histology, render
him extremely well qualified to occupy worthily the post to
which he has been elected._

THE H08PITAL SUNDAY FUND.

It is too soon to take any accurate view of the success of
the Hospital Sunday Fund this year, and of the dis¬
cussion of the merits of our hospital system which
has taken place in connexion with the Hospital Sunday
anniversary, wide and important beyond precedent. We
shall not delay a week in acknowledging the earnestness
and energy of all helpers, lay and clerical, but we shall
defer oomment till we have more data in our possession.

DY8ACU8IS. j

M. Lannois has contributed to tbe Lyon Midioal, No. 24,
an interesting article on hyperacusis in facial paralysis and
on the influence of mastication on the acuity of bearing.
Amongst some individuals a very notable diminution of the
faculty of hearing may be detected during mastication, and
this diminution may even amount to actual deafness, so
that on addressing the masticating individual not a syllable
reaches his consciousness. In some cases of facial paralysis
a distressing sensation in the ear of the paralysed side may
be experienced, and this has gone incorrectly by the name
of hyperacusis. The tensor tympani or internal muscle of
the malleus receives its nerve supply through a small branch
from the otic ganglion on tbe third part of the fifth nerve.:
It is held, therefore, that in paralysis of the facial nerve the*
auditory phenomenon is due to concomitant paralysis of the
stapedius, which is believed to be supplied by the facial nerve,
but this nerve does not supply the tensor tympani. The
diminished auditory capacity observed in some individuals
during contraction of tbe masseter and other muscles sup¬
plied by the motor part of the fifth nerve is the result of a
simultaneous but too energetic contraction of the tensor
tympani, which is innervated motorially by the fifth nerve
also.

MEDIOAL RELIEF IN GLASGOW AND THE CHARITY
ORGANISATION SOCIETY.

For some time past the families of the able-bodied poor
have been attended by a medical practitioner appointed by
the above Society for this purpose, and paid by it. The
Society considers this provision essentially temporary, and
now seeks to throw the duty of medically attending tbe
able-bodied poor on the various medical charitable agencies,
notably on the Glasgow Medical Mission, as “admirably suited
for affording suitable attention to that class of the poor."
The Charity Organisation Society will still investigate the
cases. Tbe question is a difficult one, the only thing clear
being that society at large should pay for this attendance,
and not throw it on the gratuitous services of the pro¬
fession. _

THE H08PITAL 8ATURDAY FUND.

The results of the recent Hospital Saturday collection, as
so far announced, are still very unsatisfactory. The sum
collected in factories was £6675 5s., and by ladies in tbe
streets £145 la. 6 d., a total of £6820 6a. Qd. t against
£6702 9a. 3d. last year. There will be no adequate success in
this matter till the committee of the Hospital Saturday Fund
takes into its serious consideration the methods practised
by similar committees in Birmingham, Sheffield, Sunder 1
land, and other provincial towns.

DEATH8 OF EMINENT FOREIGN MEDICAL AND
SOIENTIFIC MEN.

Thb deaths of tbe following foreign medical and scientific
men are announced;—Dr. Eduard Heymann, Geheimer
8anitilt8ratb, of Berlin, at the age of seventy-one. — Dr.
Gustav Hauck, Gebeimer Sanitiitsratb, of Berlin, at the age
of seventy-six. — Dr. D. Jaime Vilar y Colom, editor of the
Spanish medical journal, La Lanceta, published at Bar¬
celona.—Dr. T. R. Pasternatski, docent of mental diseases in
Warsaw, at the age of thirty-nine.—Dr. A. Zagumeni of Bt.
Petersburg, having after many fruitless endeavours failed
in obtaining a professorship of chemistry in Warsaw, Kieff,
or St. Petersburg, poisoned himself with prussic acid. He
was forty-two years of age, a Doctor of Medidne, Master of
Chemistry, and “ Laborant ” of the Academy of Sciences.

THE REMOVAL OF A SPINAL TUMOUR.

Wx are glad to be able to report the continued good
progress towards recovery of the patient from whom the
tumour was removed from the .spinal canal on J une 9th, a
short account of wbioh we gave in our issue of the 18th
(p. 1244). Comparatively little improvement in the condi¬
tion of the lower extremities has as yet been noted, and there
is much discharge of cerebro-spinal fluid from the wound,
but tbe temperature indicates an aseptic course, whilst the
general condition of the patient is improving.

OXIDISING ACTION OF TURPENTINE ON ALCOHQL.

In the method of preserving biological speouaens.propoeed
by Mr. M'Alpine of Melbourne, which consists in abstracting
their moisture with alcohol after hardening in chromic acid,
and then placing the specimen in turpentine lot some time,
great discrepancies are found to arise according as the
aloohol is or is not allowed to evaporate from the specimen
before dipping it into tbe turpentine. An explanation of
this discrepancy has just been suggested by some recent
experiments of Mr. 8 teed man of Victoria, who finds that
dilute ethyl alcohol becomes oxidised to acetic acid in pre¬
sence of air and turpentine. Tbns a clear glass 16-ox. bottle
oofctai&iag two drachms of aloohol oxtadraohmof turpentine,

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1300 The Lancbi,]

SINE CURRICULO DENTAL EXAMINATIONS.

[June 25,1887.

and one ounce of water, corked securely, and left exposed to
a temperature averaging about 80° F. for three months, was
found to contain a liquid which was decidedly acid from the
presence of acetic acid._

SINE CURRICULO DENTAL EXAMINATIONS.

Ax last the Royal College of Surgeons of Edinburgh have
given notice that they will close their doors to sine curricula
men for the dental examination after the end of next year,
and we sincerely hope that the Irish College and the Faculty
of Physicians and Surgeons of Glasgow will do the same.
It is now nine years (less one month) since the passing of the
Dentists Act: surely that is sufficient time for any man in
practice to prepare for and pass the Licentiateship in Dental
Surgery. Not only can no good accrue either to the dental
profession or to the general public by the examining boards
admitting men who have not had a hospital training, but
they lay themselves open to the charge of being actuated
by pecuniary motives._

QUEEN’S COLLEGE, BIRMINGHAM.

Ax a meeting of the Council on the ICth inst., Mr. Bennett
May, F.R.C.S., B.S., surgeon to Queen’s Hospital, was elected
to the chair of Professor of Surgery, to till the vacancy
caused by the resignation of Mr. Fumeaux Jordan.

DIPHTHERIA IN ONTARIO.

Great prominence is given in the last annual report of
the Provincial Board of Health of Ontario to the history
and causes of diphtheria, that disease having prevailed
during 1886 in the area under the Board's jurisdiction to an
extent unprecedented and unequalled in the history of the
province. The death-rate reached 0 - 76 per 1000 of the popu¬
lation, the total deaths having been 1470. The etiology of
the disease is discussed at considerable length, and the
views of German, English, and other authorities are referred
to. Regulations as to the prevention of the infection, such
as have been drafted by the Provincial Board, are also set
forth in detail. Dr. Chas. W. Covemton, chairman of the
Board, also deals with the subject in his introductory
chapter as to the matters which have occupied the atten¬
tion of the Board during the year reported on.

DRY HOT-AIR BATH8 FOR SYPHILITIC PATIENTS.

Db. Stbpanoff of Moscow has contrived a plan of treating
patients suffering from syphilis which has resisted mer¬
curial and iodine treatment. He has had a box or bath con¬
structed with an iron bottom lined with thick felt, in which
the patient is placed. The bath is heated to about 170° to
190° F. by means of two Bunsen’s lamps, each consisting of
Ave burners. After the patient has been “ baked” he is put to
bed and covered with blankets, so as to prolong the sweating
process commenced in the bath for an extra half-hour.
After this he is allowed to dress and go into the ward to his
dinner. By means of these baths the mercury is rapidly
eliminated from the system and the patient’s condition
greatly improves, and after a course mercury is found
to act quickly and energetically.

THE CHEMICAL EQUIVALENT OF ZINC.

Lieut.-Col. Rhinolds and Pbofbssob R amsax have com¬
municated to the Chemical Sooiety the result of a series of

twenty-nine experiments, conducted with great care, with
the object of determining the exact equivalent of zinc. The
zinc used was prepared by electrolysis from sulphate of zinc,
the liual sample being so nearly pure that dilute acid
would scarcely act on it. The equivalent arrived at was
65-4787 + 0016135.

FOREIGN UNIVERSITY INTELLIGENCE.

Dorpat.— Dr. Friedreich Schultze, Extraordinary Profs**:
in Heidelberg, has been offered the chair of Special Patho¬
logy and Therapeutics, vacated by Professor A. Weil oo
account of ill health.

Kasaru— Dr. Bogoluboff, Professor of Clinical Surgery, i*
about to retire in consequence of ill health. The I'ri .i
understands that the chair will be given to Dr. V. T. Bun-
mov8ki, privat docent for Operative 8urgery in the same
University.

Leipsig. — Professor de Bary of Strasburg has be«a
appointed to the Professorship of Botany.

Madrid— Notice has just been given that a concnrto i-
be held immediately, for the selection of the directors of. at
assistants in, the medico-legal laboratories of Madrid, Bar¬
celona, and Seville, which institutiona were established, on
paper at least, about a year ago.

Poitiers. —M. le Dr. Buffet-Delmas has been appauud
acting Professor of Anatomy and Physiology.

Prague .—A memorial which has recently been presenttd
to the Berlin authorities, requesting that study in Prague
might be recognised in the case of students of German
nationality has not been acceded to.

St. Petersburg (Military Medical Academy).—Dr. Tire-
netski, Prosector of Anatomy, has been appointed to th*
Professorship of the same subject, vacated by Professor v.
Gruber. Professor T. T. Nasilofl was also appointed to
the chair of Surgery lately held by Professor EoImbdip.
deceased. _

The repetition of the Jubilee service in Westminster
Abbey on the 22nd inst. was attended by a large con¬
gregation. As we announced in our last issue, the admis¬
sions were in great part by ticket, given in consideration of
donations for hospital assistance. A third of the receipts go¬
to Westminster Hospital, whose secretary has sustained th:
chief burden of the arrangements; a third to the Ha-pits
Sunday Fund; and a third to the Western Dispensary and
the Hospital Saturday Fund jointly.

We learn that the report published by an evening e x¬
temporary a few days ago, to the effect that measles
very prevalent amongst the boys in Winchester Coll**:-’
was exaggerated. There are a few cases of German mea&«-
in the school sanatorium, but, contrary to what had been
stated, the cricket match between Winchester and Eton has
not been postponed, but commences this day (Friday).

Mb. F. J. Williamson, of Esher, has been entru-- ■*
with the commission of executing the marble 6tatue of i--
Queen, which the Royal Colleges of Physicians and Sorgt r-
have resolved to place in the Examination Hall to ctkbrs:;
the Jubilee of Her Majesty’s reign. It is to be finished bj
June of next year and will be placed on the half-Undin;
facing the entrance to the Hall.

A genebal meeting of the Zoological Society of Lo ti- *
was held on the 16th inst., on the lawn of the Society •
gardens, which was reserved for the occasion. Profec--~t
Flower, the president, delivered an address in which ‘
reviewed the history of the Zoological Society from
foundation in the year 1826,

Cholbba is stated to be again spreading rapidly c
Tonkin. Th© circumstance is all the more imporur
because it was from Tonkin that oholera was first tapori*
into the military port of Toulon, whence resulted 2*
serious epidemic of 1884-86.

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The Lancet,]

JUBILEE MEDICAL HONOURS.

[June 25,1887. 1301

JUBILEE MEDICAL HONOURS.

THE HOSPITAL SUNDAY FUND.

The Queen, on the occasion of Her Majesty’s Jubilee, has
been graciously pleased to order the following appointments
and promotions to be made:—-

Knit/fits.

Dr. Garrod.

G. H. MacLeod, Esq., Queen’s Surgeon, Edinburgh.

Dr. Aitken, Netley Hospital.

Obdeb of the Bath.

Ordinary Member of the Military Division of the
Second Class , or Knights Commanders.

Surgeon-General John Harrie Ker Innes, C.B., Honorary
Surgeon to the Queen.

Additional Members of the Military Division of the
/Second Class, or Knights Commanders .

Inspector-General of Hospitals William Mackenzie, M.D.,
C.B., C.S.I., Indian Medical Service, Honorary Physician to
the Queen.

Inspector-General of Hospitals and Fleets James Jenkins,
C.B., Royal Navy.

Knights Commanders (Civil Division).

John Simon, Esq., M.D., C.B., late Medical Officer, Privy
Council Office.

Dr. Arthur Mitchell, M.D., C.B., Lunacy Commissioner,
Scotland.

Ordinary Members of the Military Division of the
Third Class , or Companions .

Inspector-General of Hospitals and Fleets James Nicholas
Dick, Royal Navy.

Surgeon-General Herbert Taylor Reade, V.C., Medical
Staff.

Deputy Surgeon-General Jeffery Allen Marston, M.D.,
Medical Staff.

An Ordinary Member of the Civil Division of the Third Class,
or Companion.

Professor W. H. Flower, British Museum.

Obdeb of St. Michael and St. Geobge.
Ordinary Member of the Second Class, or Knight Commander

James Alexander Grant, Esq., M.D., of Ottawa, in the
Dominion of Canada.

Companion,

Sir Oscar Clayton.

The Queen has been pleased to give orders for the appoint¬
ment of the undermentioned officer to be a Companion of
the “ Distinguished Service Order ” :—

For Operations in Burmah.

Fleet-Surgeon Thomas D’Arcy Bromlow, M.D., Royal Navy.

The Queen has been graciously pleased to confer the
decoration of the Royal Red Cross upon the undermentioned
Nursing Sisters under the provisions of Clause 5 of Her
Majesty’s Warrant, dated April 28rd, 1883:—Miss Louisa
Jane Mackay, Army Nursing Sister; Miss Christina
Fergusson, Army Nursing Sister; Miss A. B. Holland, Army
Nursing Sister; Miss Edith King, Stafford-house Committee;
Miss Emma Durham, Stafford-house Committee.

The following members of the Veterinary profession have
also participated in the distribution of honours

Knight

H. L. Simpson, Esq., Mayor of Windsor, President of the
Royal Veterinary College.

Ordinary Members of the Civil Division of the Third Class
or Companions of the Order of the Bath.

Principal Veterinary Surgeon George Fleming, Head-
Quarters Staff of the Army.

Professor Brown, Agricultural Department of the Privy
Council.

A Me D. 0. Mills has given 80,000 dole, for the
purpose of erecting a new building on the grounds of
Bellevue Hospital, New York, which will be used mainly as
a training school for male nurses.

On the 10th inst. a public meeting in aid of the Hospital
Sunday Fund was held at Wellington Hall, Islington. The
Islington north and north-west district contains eleven hos¬
pitals and six dispensaries benefiting from the fund. In
1880 these institutions relieved 0243 in-patients and 105,841)
out-patients; their total income was £52,581 and their total
expenditure £60,346. The chair was taken by the Rev.
H. W. Barlow (Vicar of Islington), who was supported by
Sir A. K. Rollit, M.P., the Rev. Canon Hurst, the Rev. Dr.
Alton, the Hon. Conrad Dillon, and others. The chairman
having briefly opened the meeting, Sir Albert Rollit, M.P.,
moved the first resolution, insisting upon the importance of
maintaining the hospitals in the utmost efficiency, and
urging the clergy to earnestly appeal to their congregations
in order to secure that the whole sum collected on Hos¬
pital Sunday should not be less than £100,000. He said
that the great deficiencies which had arisen in the funds
of the hospitals were a breach in the continuity of the
history of the century. At the beginning of the century
there were only 51 of these institutions, and at present
there were 496 scattered over the United Kingdom. This
was a thing to be proud of, and was characteristic of the
humane spirit of the age. The Hon. Conrad Dillon seconded
the resolution, pointing out that the sanitary education
given by the hospitals was very great. The motion having
been carried, the Rev. Canon Hurst moved the second resolu¬
tion, regretting that in the year 1886 the deficit of the
hospitals in that district amounted to £8000, and pledging
the meeting to increased exertion to prevent a repetition of
the deficiency. Dr. Glover seconded the resolution. He
said that the hospital accommodation of London at present
was barely sufficient to meet the cases of urgent necessity,
while cases of chronic disease had to suffer in consequence.
The expenditure of the hospitals was very narrowly watched
nowadays by business men, and extravagance was almost
impossible. The resolution was carried, and the meeting
terminated with a vote of thanks to the chairman.

On the 17th inst. a meeting was held at Stratford Town-
hall. The Stratford and East-end district contains seven
hospitals and five dispensaries benefiting under the fund.
In 1886 these institutions relieved 14,190 in-patients and
189401 out-patients; their total income was £78,565 and
their total expenditure £109,399. The chair was taken by
Mr. John Meeson, Mayor of Stratford. Lord Rosebery
moved the first resolution, which was similar to the one
moved by Sir Albert Rollit, M.P., at Islington on the 16th
inst. He said that if we are to continue facing a deficit
every year with regard to hospitals, the natural result would
be that they must come upon the rates. This he was not
in favour of, for two reasons—one being that the rates are
high enough already, and the second beoause he believed
that the best of all energy and of all motive powers is
voluntary effort. Zeal cannot be bought. Again, where
subscriptions are voluntary the subscribers look out very
closely to see that their money is well spent. Lord Rose¬
bery expressed the opinion that this was not the case
with rate-supported hospitals, and alluded to the recent
disclosures respecting the management and expenditure of
the Eastern Hospital. Canon Scott, Sir Edmund Hay Currie,
Mr Forrest Fulton, and others also addressed the meeting.

In the afternoon of the same day another meeting was
held at Westminster Town-hall, the Dean of Westminster
presiding, and resolutions were passed similar tOrthose
passed at all the previous meetings.

On the 18th inst. the last of the series of meetings was held
at the People’s Palace, under the Presidency of the Duke of
Cambridge. Among those present were the Right Hon. C. T.
Ritchie, (M.P.), Sir Edmund Hay CUrrie, the Bishop of
Bedford, Mr. J. H. Buxton, Mr. H. C. Burdett, and Canon
gcott. The chairman, in opening the proceedings, referred
to the great and useful work carried on by the hospitals.
More especially, he said, were those institutions deserving of
liberal public support in the East-end, for it was there that
their assistance was most essential. He concluded by mov¬
ing the usual resolution. Mr. Ritchie, M.P., in seconding
the motion, said that he trusted that t he public would do
awav with the scandalous State of things under which the
hospitals were spending £100,000 a year more than they
received. The resolution having been supported by the

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1802 Thb Lancbt,]

THE CROWN PRINCE OP GERMANY.

[Jura 26,1887.

Biebop of Bedford, it was carried unanimously. Sir
Edmund Hay Currie then moved a second resolution, re¬
gretting that the deficit in the accounts of the hospitals of
East London amounted to £30,000 in the year 1886. He
said that there were no fewer than 2100 beds unoccupied in
the eastern hospitals. Mr. J. H. Buxton seconded the resolu¬
tion, which was also carried unanimously. A vote of thanks
to the chairman having been carried with acclamation and
briefly acknowledged, the meeting terminated.

On the 19th inst. the annual collections were made at
nearly all the churches, and other places of worship in the
metropolis. The congregations were as a rule good, espe¬
cially in the West-end, the large number of visitors in town
for the jubilee festivities having a marked effect upon the
ordinary attendance.

The following is a list of the principal contributions
which have up to the time of our going to press been re¬
ceived by the secretary of the fund:—St. Michael, Chester-
square (Rev. Canon Fleming, B.D.), £1023 ; 8t. Jude’s (Rev.
D. Forrest), £800; St. Paul’s Cathedral, £232; Holy Trinity,
Kilburn, £81; St. John the Evangelist, Penge, £85; St.
Peter’s, Brockley, £69; St. Matthew’s, Brixton-bill, £70;
All Saints’, Blackheath, £75; Dulwich College Cbapel, £50;'
8t. Marylebone Presbyterian Church, £56; Barnes, Surrey,
Parish Church. £54; Amelia, Countess* of Lauderdale, £50;
St. Mark’s, North Audley-street, £146; St. Saviour’s,
Pimlico, £52; St. Mark’s, Reigate, £84; Brixton Unitarian
Church, £58; St. Paul’s, Forest-hill, £66; St. Andrew’s,
Wells-street, £114; St. John’s, Clapham-rise, £61; Trinity
Church, Hampstead, with St. Cuthbert’s, £91; St. Michael’s
Parish Church, Highgate.£66; All Saints’, Margaret-street,£70;
Metropolitan Tabernacle (Rev. C. H. Spurgeon), £250; St.
Matthew’s. Denmark-hill, £56; St. Matthew and Holy Trinity
Missions, Upper Clapton, E, £100; Mr. James Carnegie,£50;
the Temple Church, £273; St. Stephen’s, Wandsworth, £60;
City Temple, £58; Clapton Park Congregational Chapel,
£100; Christ Church, Highbury, £113; All Saints’, Ennis-
more Gardens, £357; St. Mark, Hnmilton-terraee, £295;
St. Paul’s, South Hampstead, £104; St. Paul’s Pres¬
byterian Church, Westboume Grow*, £63; Hampstead
Parish Church, £70; Westminster Abbey (afternoon ser¬
vice at St. Margaret’s), £58; St. Stephen’s, Ealing,
£129; Christ ChaTcb, St. Marylebone, £62; St. Paul’s,
Clapham, £50; St. Peter’s, Dulwich Common, and St.
Dunetan’s, £51; St. James’s, Kidbrook, £141; 8t. John’s
Presbyterian Church, Forest-bill, £87; Clapham Parish
Church, £58; 8t. James’s, Piccadilly, £132; Holy Trinity,
Sydenham, £120; Brixton-hiil Wesleyan Chapel and Schools,
£79; St. James’s, Paddington, £189; Trinity, St. Maryle¬
bone, £84; Lewisham Hieh-road Congregational Church,
£67; 8ir W. B. Gurdon, £50; St. Mary’s New Church, Stoke
Newington, £68.

The secretary of the Fund baa also received £820, being
tbe third, less expenses, of the receipts derived from the
repetition of the Jubilee service in Westminster Abbey on
the 22nd inst.

According to tbe last reports received previous to our going
to press t he sum total of the subscriptions up to that time
amounted to over £12,000.

THE CROWN PRINCE OF GERMANY: NATURE
OF THE LARYNGEAL GROWTH.

Tins following is a translation of the report (published in
the Berliner Klinischc Wochenschrtft, No. 25, June 20th, 1887,
and forwarded to that journal by the physician to his Imperial
and Royal Highness the Crown Prince, General Physician
Dr. Wegner) “ of Privy Councillor and Professor Dr. Virchow,
upon fragments of a swelling in the larynx which have been
removed by Dr. Morell Mackenzie from his Imperial and
Royal Highness the Crown Prinoe by means of avulsion
( Zangeneperatim ).” The report runs as follows:—

Tbe two specimens delivered yesterday by General-
Physician Dr. Wegner exhibit, on macroscopic inspection,
the appearance of a coarsely granular papillated tumour.
Their convex surface had a glandular, bluish-white, slightly
transparent, glistening aspect, in si far as they retained
their natural conditions • large portions, indeed, which bad
bean acted upon by catechu showed a dull, brownish, some¬

what crumbling character. The cut surfaces were somewhat
retracted, and concealed by the turning up of the margins ;
they consisted of a soft, slightly flbrillated tissue, rrwn
which projected some shreds of various lengths. Tbe larger
of the two portions was 3 mm. in height, and had a
diameter of 2*5 mm.; the smaller was about 2 mm. in
diameter. However, these measurements conld not have
quite corresponded to the conditions daring life, for by
the retraction and infolding of the cut surfaces after
extirpation they must have undergone a diminution.
Microscopical examination confirmed tbe diagnosis made
by the naked-eye inspection:—1. Tbe surface everywhere
consisted of a very firm and thick layer of stratified
squamous epithelium. Large colloid granules appeared in
many of the cells. Here and there lay a nest of con¬
centrically laminated cells. Internally there occurred a
similar stratified layer of cylindrical cells (without cilia),
which were seated directly on the connective tissue.
2. The connective tissue layer of the mucous membrane was
furnished on its surface with long papillary outgrowths,
which contained large vascular loops besides the con¬
nective tissue elements. Each such papilla corresponded to
a granulation on tbe surface. Otherwise tbe mucous mem¬
brane showed scarcely any changes; even proliferation of
nuclei and cells were only sparsely detected. The blood¬
vessels were moderately dilated. Both sections have been
made deeply into tbe mucous membrane, and through this
into the submucosa. Hence there are found, besides con¬
nective tissue with numerous fine elastic fibres, a large
number of small nerve-trunks (from four to six fibres) and
their branches, as well as small arteries and veins; in seme
places are seen also collections of lobules of tbe mucoos
glands. Although it is thereby proved that tbe operation
had reached tbe deep parts underlying the mueoos mem¬
brane, yet in spite of tbe most careful examination of these
deeper parts, especially at the cut surfaces, no single por¬
tions could be found altered in an appreciable degree. All
such changes were confined to the surface. They charac¬
terise the lesion as an epithelial growth combined with
papillary offshoots (misnamed papilloroa)—pachydermia
verrucosa. In no part conld an ingrowth of this epithelial
formation into the mucous membrane be detected.

The foregoing statement is an important advance upon
the statement of tbe 21st of May. in tbe specimen then
examined changes resembling those now present were only
very scanty in comparison with irritative changes, bat all
such appearances were limited to the periphery of the
lesion. Now, on the other hand, a more central portion of
the growth has apparently been obtained. Although this
portion is very much diseased, yet the healthy oondition
of the tissue on the cut surface allows a very favourable
opinion to be formed as to prognosis. Whether such an
opinion would be justified in respect to tbe whole disease
cannot be ascertained with certainty from tbe two portions
removed. However, there is nothing present in them which
would be likely to excite the suspicion of wider and
graver disease. (S'gned) Prof. Dr, Rob. Virchow.

Berlin Pathological Institute, June 9th, 1887.

LOCK HOSPITALS.

That part of tbe report of the Dublin Hospitals’ Com¬
mission which refers to tbe Westmoreland Lock Hospital is
of great importance not only to all concerned in tbe working
of the hospital itself, but also as it bean upon the important
question of hospital accommodation for patients with
venereal diseases. It may appear to medical readers some¬
what late in the day to be raising such a question, but, as
we shall see, it is not only still a question, but a veritable
vexata quaetio, surrounded with difficulties which
appear to be almost insuperable. The commissioners first
allude to the reports of a former Commission and Select
Committee, both of which recommended that, as tbe Weat-
in oral and Lock Hospital received assistance from the State,
students should be admitted for the ^purpose of receiving
clinical instruction, which recommendation, however, baa
not been complied with. The reasons for thia are
next dealt with. The governor* of tbe hospital, who
were responsible for the carrying out of this as at Am
other recommendation*, wore against the ad mi sA on of

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LOCK HOSPITALS.

[Juwn 25,1887. 1803

student*. Dr. Donnelly, the resident surgeon of the hos¬
pital, while admitting the importance of students having
clinical instruction, expressed his opinion that it would not
be practicable, and would deter the women from entering.
Dr. Henry Fitzgibbon did not go quite eo far as this; but
Mr. Reginald Harrison, surgeon to the Liverpool Royal
Infirmary, was enabled to give the commissioners important
evidence on this point from the experience of the Liverpool
Lock Hospital, which is a part of the Royal Infirmary.
There it was found that the ad mission of students did deter
women from entering, and when the former were excluded
from the female side some years ago there was a marked
increase in the number of female patients. In spite, how¬
ever, of thip, and of the fact which was also given in evi¬
dence that the examining medical authorities do not require
certificates of attendance upon such institutions (i.e., lock
hospitals), the commissioners report as follows:—

“ Having regard, however, to the fact that this hospital
‘does noV to quote the words of the select committee, * afford
medical instruction,’ we are clearly of opinion that it has
forfeited its claim to participate any longer in the Par¬
liamentary grant in its present form; wnile it is clear
that, if our recommendation should be adopted, it will
he excluded from any share in the newly created fund
so long as it abstains from affording this instruction; and,
further, thatevenifit were to comply with thecondition upon
which alone any hospital in Dublin will in future obtain an
allotment from the fund, the amount to be allotted to it
must inevitably be too small to admit of its continuing to
exist without support from other sources. We are therefore
brought face to face with the question as to how this hos¬
pital is to be supported in the almost certain event of the
Parliamentary grant in its present form being discontinued.”

There is, to say the least, a want of reasoning throughout
the whole of this paragraph, which is very remarkable in so
important a document, upon which such very weighty issues
depend. To disestablish and disendow a hospital, which is
admitted to be well managed, and which fulfils the object
for which it was founded, because it does not afford clinical
instruction, which the examining bodies do not require, and
which comparatively few students would seek, is illogical in
the extreme. But with the evidence before them, that the
governors would not sanction the admission of students, and
the great probability that this would deter patientB from
entering, the paragraph becomes worse than illogical—it is,
indeed, wholly unjustifiable. Should the Westmoreland
Lock Hospital be closed for this reason only, it would be
nothing short of a scandal. The commissioners evidently
feel this for they proceed :—

“ That Parliament will again consent to place the Look Hos¬
pital in Dublin in the singular position of being the only hos¬
pital of the kind which is supported by moneys charged on a
vote included in the estimates for Civil Services, is in the

highest degree improbable.How, then, is this hospital

to be supported in future ? It is plain that there are but two
ways in wbicb it can be done—the one by private charity,
the other by local rates; but it seems to be generally admitted
that an appeal to the public would be in vain, and if this
view be well founded, it is certain that the hospital must be
olosed unless it can be supported oat of the rates. That this
will be the ultimate solution we can hardly doubt, and we
believe that it will in various ways be attended with great
benefits, moral and material, to the community at large.”

With the exception that Dr. Thomas Myles was secretary,
the Commission appears to have been wholly composed of
laymen. Had the Commission been a medical one, its mem¬
bers would probably have congratulated Dublin on posses¬
sing so valuable an institution as a lock hospital supported
by Government, and have suggested, not its abolition nor
its diiendowment, but its initiation in other towns and
cities, especially such as, like Dublin, are garrison cities and
seaports. The commissioners righCy conclude that the public
are not likely to take up the duty of supporting this hos¬
pital after the Government have given it up, but the sug¬
gestion that the ratepayers should beoalled upon to support
the hospital does not indicate the same amount of knowledge
of the world which, might have been expected of them.
What reason have they to assume that the public will do
compulsorily as ratepayers that which they will not do
voluntarily as individuals and philanthropists ? It is true
that destitute persons suffering from venereal diseases are
admitted into workhouses, but they are admitted because they
are paupers; and it is only as suoh that they are admissible
at alL Thirty yean ago the late Mr. Acton made a proposal

somewhat similar to that suggested by the Dublin Commis¬
sion, of the reception of which he gives a brief and plaintive
description: “My so-styled ‘preposterous idea’ that the
overtaxed ratepayers—many of them hardly able to support
themselves—should be called upon actually to search out
and then maintain in idleness a parcel of invalid harlots,
thus qualifying them for fresh campaigns against the public,
was duly sifted over and ridiculed, and its unlucky author
was dismissed to keep the company of other visionaries.”
By the repeal of the Contagious Diseases Acts the Govern¬
ment Lock Hospitals at Kildare (Curragh Camp) and Cork
have been closed. Should the Westmoreland Lock Hospital
be also closed, as appears only too probable, Ireland will be
without any look hospitale at all—a great disaster, since the
look wards of its geoeral hospitals are so few, so far be¬
tween, and contain so few beds as to be a mere “ drop in the
bucket.”

Let us turn to London and see what has been done there
in the way of lock hospital and lock ward accommoda¬
tion. The London Lock Hospital was founded in 1747 in
Grosvenor-place, and removed to Westboume-green in 1846;
the hospital for male patients being opened in Dean-
street, Soho, in 1862. In spite of this ancient history,
the patronage of Royalty and of the nobility, and the fact
of its being the only hospital of the kind in London, its
very existence has from the first been one continued
struggle; and but for the almost superhuman exertions of
the late Lord Kinnaird and the partial support of the Govern¬
ment, it must long ago have been closed. As it is, the
withdrawal of the Government grant will affect the hos¬
pital finances very seriously. Passing on to the lock wards
in the general hospitals, it appears that in six hospitals—
those of Guy’s, King’s College, the Royal Free, 8c. Bar¬
tholomew’s, St. Thomas’s, and the Middlesex, there bas been
a reduction in the beds for females of 97. Thus Guy’s Hos¬
pital had formerly 30 beds, King’s College 6, the Royal Free
30; now there are no beds for females with venereal
diseases in any of these hospitals. Again, the beds in
St, Bartholomew’s Hospital have been reduced from 60.to
14; in St. Thomas’s, from 30 to 28; in Middlesex, from’8 tb 7.
The London Hospital has 8 beds for female venereal cases. In
all the other London Hospitals—Charing-cross, St. George’s,
St. Mary’s, University College, and Westminster' Hospitals,
lock wards are conspicuous by their absence. ’ The Lock
Hospital has 36 b«ds made np for females, which, if the funds
permitted, could be increased to 68. The lock wards in all
the other London hospitals contain an aggregate of $7 beds;
thus 93 is the total number of beds available in the whole
of London for tbs many females who must at any given
time be more or less afflicted with these diseases.

Passing on to other parts of the kingdom, we find the
same deplorable dearth of lock hospitals and lock wards.
There is the Glasgow Lock Hospital, for females only, with
60 beds available, which could be increased to 81. -Man*
cheater has a female lock hospital, with 20 beds made up
and a capacity for 60. The Liverpool Lock Hospital of the
Royal Infirmary (now temporarily olosed) had 26 male and
26 female beds. The Bristol Look Hospital, for females only,
has 16 beds. There are lock wards in the Aberdeen Royal
Infirmary (8 beds). Edinburgh Royal Infirmary (16 beds),
Queen’s Hospital, Birmingham (7 beds), Devon and Exeter
Hospital (6 beds), Newcastle-on-Tyne Infirmary (12 beds),
and Stafford Geoeral Infirmary (2 beds)—a total of 51 beds
for females in six large and important hospitals. The same
hospitals contain male wards with a total of 35 beds,
increased recently by new male lock wards in the Edinburgh
Royal Infirmary.

All this shows very conclusively that, unless a very great
obange takes plaoe in public opinion, lock hospitals and
lock wards will never be supplied or supported by tbs
public in anything like a reasonable proportion to their
necessity. Whether they will receive any share of the
flow of charity during this Jubilee vear remains to
be seen, but it is very doubtful. When such, great
difficulties are experienced in raising funds for hospitals
and other institutions for the most deserving inmates, it
is obvious that, these difficulties are increased when the
patients are either dissolute men or common prostitutes. And
though it hss been frequently shown that married women
infected by their husbands form a proportion of the patients
in lock hospitals and wards, this does not seem to enhance
the latter in public favour. The truth is that it is another
illustration of the old saying, “ What’ is everyone’s business
is nobody’s b u s in ess. ’ * The medical pro f ession ought long

1304 Thu Lancet,]

WILLS OP MEDICAL MEN.

[Joint 26,1887.

ago to have demanded through the examining bodies the
compulsory practical study of, and examination in, these
diseases; until this is done the public will not be convinced
of the necessity of lock hospitals and wards. The male
wards should be open to clinical instruction. Female wards
cannot be so open to students; there are obvious diffi¬
culties in the way which need not be discussed. But
under stringent regulations advanced students previously to
their final examinations might be permitted to witness the
examination of a few female patients, which is all that
would be required. The arrangements of the Liverpool
Lock Hospital, which were described by Mr. Harrison to the
Dublin Commission, possess many advantages, notably
those of economy combined with isolation. The patients
are in a separate building, with its own surgical and adminis¬
trative staff, but under the management of the committee of
the Royal Infirmary. Before it is again proposed to support
lock hospitals out of the rates, it is well that we should
know what are the present arrangements in our existing
workhouses. A return showing the average annual number
of paupers admitted with venereal disease, whether they
are admitted into special or general wards, and other
details, would be of great interest, and we hope that such
a return will be moved for.

MEMORIAL PORTRAIT OP

SIR WILLIAM JENNER, BART., K.C.B., M.D.

The following is a list of names of members of the General
Committee additional to those already published

Aclacd, Sir Henry, K.C.B., Oxford.
Bagihawe. Dr., St. Leonard*.
Ratten. Dr.. Gloucester.

Beale, Dr., Grosvenorstreet.
Church, Dr. W. T., Harley-street.
Cooper, Alfred, Esq., fienrietta-
•treet.

Critchett, J. A., Esq., Harley-street.
Palls, Dr., Bournemouth.

Fincbam, Dr., Belgruve-road.
Fowler, Dr. J. K., Clarges-street.
Glover, Dr. J. G., Highbury.
Grigg, Dr., Ourzon-street.
Hnberahon, Dr.. Brook-street.
Jackson, Dr., Notting-htll.
Johnson, Dr. George, 8avile-row.
Lawrence, Dr.H.C.,Oxford-terrace.
Manifold, Surgeon-General, Cath-
cart-road.

Matterson. Dr., York.

Millington, Dr., Wolverhampton.
Morlson, Dr. A., Highbury.

Odllng. Dr., Oxford.

O'Neill, Dr.. Lincoln.

Ord, Dr.. Upper Brook-street.
Palmer, Dr., Bast Sheen.

Potter, Dr. J. B., Qeorge-street.

Priestley, Dr., Hertford-strcet.
Pye-Smtth, Dr.. Harley-street.
Roberts, Sir William, Manchester.
Savory, W. 8., Esq., President,
Royal College of Surgeons, Brook-
street,

8awyer, Sir James, Birmingham.
Soott. Dr. John, Chandos-street.
Semple. Dr. C. E„ Torrington-
square.

8lbley, 8. B . Harley-street.

Smith, Dr. B„ George-street.

Snow, Dr., Bournemouth.

Tlrard, Dr., Weymouth-street.
Tamer, Halifax.

Wakley, Thomas, Esq.. Redcllffe-
gardens.

Wakley, Thomas, Jun., Esq., Red-
clifTe-gardens.

Warner, Dr., Harley-street.

Welter. Dr. H., Grosvenor-street.
West, Dr. Symcs, Croydon.
Whipham, Dr.. Grosv’enor-Btreet.
WHIoock, Dr., Manderville-strvet.
White. Dr.. Weymouth-street.
Williams, Dr. C. T., Brook-street.

WILLS OF MEDICAL MEN.

The will of Edward NoIIoth, M.D., M.R.C.P., F.R.C.S., a
retired Fleet Surgeon, R.N., late of 13, North-terrace, Cam¬
berwell, who died on April 29th last, was proved on May 11th
by the Rev. Henry Edward Nolloth, one of the executors,
the value of the personal estate amounting to upwards of
£16,000. The testator gives £6000 and bis furniture, plate,
and household effects to his brother, Peter Brames Nollotb,
£20 to his executor, and the residue of his property to his
brother, Henry Ovenden Nolloth, and his two sisters in equal
shares.

The will of Alfred Meadows, M.D. Land., F.R.C.P., late of
27, George-street, Hanover-equare, who died on April 19th
last, was proved on May 11th by Mrs. Sara Stirling
Meadows, the widow, the value of the personal estate
amounting to over £15,000. The testator gives all his
household furniture and effects to his wife. The residue of
his property he leaves upon trust for his wife for life, and
then to his daughter Anna Gertrude absolutely.

The will of Mr. William Tiffin Iliff, M.D., medical officer
of health for St. Mary's, Newington, late of 37, Kennington-
park-road, Surrey, who died on April 25th last, was proved
on May 20th by Miss Louisa Susanna Iliff and Mise Ellen
Agnes Iliff, the daughters, and Mr. Edward Chester, the
executor, the value of the personal estate exceeding £6000.

The testator gives legacies to his. executors, servant, and
Mr. Alfred Long, his faithful friend and invaluable assistant.
The residue of his property he leaves to his seven children,
Louisa Susannah, Ellen Agnes, Fanny, Eveleen, Lillian,
Jessie Marrian, and Percy.

The will of Mr. Ralph Beardshaw, late of 2, De Grey-
terrace, Leeds, Yorkshire, surgeon, who died on March 2nd
last, was proved on May 11th, at the district registry,
Wakefield, by Mr. Henry James Harrison and Mr. John
Beardshaw, the executors, the value of the personal estate
amounting to upwards of £3000. The testator leaves all
his property upon trust to pay the annual income thereof
to his three daughters, Mrs. Mary’ Helen Benham, Mrs.
Harriet Dawson, and Margaret Ann, in equal shares, and
after their death to their respective children.

The will of William Frederick Scores by, M.D, late of
Wawarsing, in the county of Ulster and State of New York,
who died on November 17th, 1884, was proved in London on
May 14tb, by Mrs. Grace Ada Scoresby, the widow, John
Frederick Scoresby Eastgate, the nephew, and George
Halstead Smith, the executors, the value of the personal
estate exceeding £3000. The testator gives the third share
of his house and furniture to his wife for life, and all his
medical books and instruments to his nephew, John
Frederick Scoresby Eastgate. The residue of his real and
personal estate he leaves upon trust for his wife for life, and
at her death to his sisters, Mary Eastgate and Louisa Sher¬
man, in equal shares.

The will, with a codicil, of Mr. George Bacon Sweeting,
surgeon, late of King’s Lynn, Norfolk, who died on March
25th last, was proved on May 12th by Mise Alice Helena
Cox, the niece, and Mr. Charles Bagge Plowright, the
executors, the value of the personal estate exceeding £2000.
The testator gives £100 each to his nephews, Frederick
Gould and George Gould; as to the residue of bis pro¬
perty, he leaves one moiety to Mrs. Mary Ann Palmer
Cox, and the other moiety to Mary Ann Elizabeth Sweeting
and Robert Charles Sweeting, the children of his deceased
brother, in equal shares.

The will, with a codicil, of Mr. William Henry Thornton,
surgeon, late of Margate, Kent, who died on March 20th last,
were proved on May 17th by Mrs. Ann Thornton, the widow,
and Bertram Thornton, the son, the executors, the value of
the personal estate amounting to over £5500. The testator,
after bequeathing a legacy of £200 to his wife, leaves the
residue of his real and personal estate upon trust for her far
life, and after her death to his children absolutely.

The will of Geddes McKenzie Scott, M.D., late of 16, Stone-
bridge Park, Willesden, who died on April 11th last, was
proved on May 19th by Mr. Thomas James Scott, the
nephew, and Mr. Walter Brodie, the executors, the value of
the personal estate in the United Kingdom amounting to
£900. The testator gives legacies to grandchildren, and the
residue of his property to the daughters of his son in equal

Bh&F66(

The will of Vincent Ambler, M.D., late of No. 14, Colville-
square, Bayswater, who died on February 6th last, waa
proved on May 13th by Mrs. Helena Ambler, the widow, the
value of the personal estate exceeding £700. The testator
leaves all his property upon trust, to pay the income thereof
to his wife for the education sad maintenance of his fire
children till they attain the age of twenty-one years, after
which the principal is to be divided equally between bis two
daughters; his three sons, having a good education, will
participate in other moneys. The testator leaves the piece
of plate presented to him by the Duke of Cambridge, and
the gold watch presented to him by his Excellency Prince
Malcolm Khan, the Persian Ambassador, to suck of his sons
as his wife thinks most deserving.

The following legacies have recently been left to hospitals
and other medical charitiesMrs. Elizabeth Ann Forest,
late of Uplands, Winchester, £100 each to the Brompton
Cancer Hospital, the West Kent County Hospital and tha
Royal Hants County Hospital.—Mr. Benaiah Gibb ths
younger, late of 1, Dartmouth Villas, Lewisham, £100 to ths
Seamen’s Hospital Greenwich.—Mr. James Bigwood, of
Bristol, £100 each to the Royal Infirmary, General Hospital,
and Children’s Hospital, Bristol.

The Cottage Hospital which has been erected at
Bnrslem in connexion with the Haywood Charity waa
opened on the 20th inst.

Digitized by

The Lancet,}

HEALTH OP ENGLISH AND SCOTCH TOWNS.

[June 26,1887. 1305

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns 5799 births
and 8262 deaths were registered during the week ending
Jane 18th. The annual rate of mortality in these towns,
which had been 204,19*5, and 18-9 per 1000 in the preceding
three weeks, farther declined last week to 18*4, and was
lower than in any preceding week of this year. Daring the
first eleven weeks of the current quarter the death-rate in
these towns averaged 201 per 1000, and was 16 below the
mean rate in the corresponding periods of the ton years
1877-86. The lowest rates in these towns last week were
12-2 in Derby, 13 4 in Birmingham, 13 8 in Halifax, and 141
in Norwich. The rates in the other towns ranged up¬
wards to 24-3 in Huddersfield, 26*0 in Blackborn, 26-2 in
Newcastle-on-Tyne, and 28*6 in Manchester. The deaths re¬
ferred to the principal zymotic diseases in the twenty-
eight towns, which had declined in the preceding four weeks
from 532 to 489, were last week 601; they included 226 from
measles, 132 from whooping-cough, 41 from scarlet fever,
49 from diarrhoea, 26 from diphtheria, 27 from “fever”
(principally enteric), and not one from small-pox. No death
from any of these zymotic diseases Was registered during
the week in Wolverhampton; while they caused the greatest
mortality in Brighton, Blackburn, Birkenhead, and Man¬
chester. The highest death-rates from measles occurred in
Sheffield, Oldham, Salford, Norwich, Brighton, Manchester,
and Birkenhead ; from whooping-cough in Plymouth, Brad¬
ford, and Nottingham; and from scarlet fever in Blackburn.
The 26 deaths from diphtheria in the twenty-eight towns
included 16 in London and 2 in Huddersfield. Small-pox
caused no death either in Greater London or in any of the
twenty-seven large provincial towns. Only two cases of
small-pox were under treatment on Saturday last in the
metropolitan hospitals receiving cases of this disease; one
new case was admitted to these hospitals during the
week. The deaths referred to diseases of the respiratory
organs in London, which had been 333, 264, and 259 in the
preceding three weeks, further declined last week to 213, and
were 23 below the corrected weekly average. The causes
of 78, or 2-4 per cent., of the deathB in the twenty-eight
towns last week were not certified either by a registered
medical practitioner or by a coroner. All the causes of
death were duly certified in Birmingham, Bristol, Sunder¬
land, Nottingham, and in three other smaller towns. The
largest proportions of uncertified deaths were registered in
Huddersfield, Halifax, 8alford, and Sheffield.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,
which had been 19-8 and 21-9 per 1000 in the preceding
two weeks, declined again to 19 3 in the week ending
June 18th; this rate exceeded, however, by 0'9 the mean
rate during the same week in the twenty-eight large
English towns. The rates in the Scotch towns last week
ranged from 9 - 7 and 12-4 in Perth and Aberdeen, to 22-2 in
Paisley and 23 0 in Dundee. The 483 deaths in the eight
towns last week showed a decline of 63 from the number
in the previous week, and included 48 which were referred
to whooping-cough, 13 to measles, 10 to scarlet fever, 10 to
diarrhoea, 6 to “fever” (typhus, enteric, or simple), 4 to
diphtheria, and not one to small-pox; in all, 90 deaths
resulted from these principal zymotic diseases, against 50
and 76 in the preceding two weeks. These 90 deaths were
equal to an annual rate of 3-6 per 1000, which was 0 7
above the mean rate from the same diseases in the twenty-
eight English towns. The fatal cases of whooping-cough,
which had been 32 and 35 in the preceding two weeks,
further rose last week to 48, and included 16 in Glasgow,
14 in Dundee, 8in Edinburgh, 4 in Greenock, and 4 in Leith.
The deaths from measles and scarlet fever also exceeded the
numbers in recent weeks; measles caused 11 deaths in
Glasgow, and scarlet fever 6 in 'Glasgow and 3 in Dundee.
The 10 deaths attributed to diarrhoea showed a decline of
2 from the number in the previous week, but exceeded those
returned in the corresponding week of last year by 2. Of
the 6 deaths referred to “ fever,” 3 occurred in Glasgow. The
deaths referred to acute diseases of the respiratory organs
in the eight towns, which had been 102 and 109 in the pre¬
ceding two weeks, declined last week to 76, and was 17
below the number returned in the corresponding week of

last year. The causes of 76, or nearly 16 per cent., of the
deaths registered in the eight towns during the week were
not certified. _

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal
to 21-4 and 31’2 per 1000 in the preceding two weeks,
declined again to 26*7 in the week ending June 18th.
During the first eleven weeks of the current quarter the
death-rate in the city averaged 28*8 per 1000, the mean
rate during the same period being but 18-3 in London and
196 in Edinburgh. The 181 deaths in Dublin last week
showed a decline of 30 from the number returned in the
previous week; they included 18 which were referred to
measles, 6 to scarlet fever, 5 to “fever” (typhus, enteric,
or simple), 3 to whooping-cough, and not one either to
small-pox, diphtheria, or diarrhoea. Thus the deaths re¬
sulting from these principal zymotic diseases, which had
been 21 and 29 in the preceding two weeks, further rose last
week to 32. and exceeded the number in any previous
week of this year; they were equal to an annual rate
of 4-7 per 1000, the rates from the same diseases being 2 9 in
London and 1*8 in Edinburgh. The fatal cases of measles,
whioh had been 17,10, and 18 in the preceding three weeks,
were again 18 last week. The deaths from scarlet fever and
“ fever ” showed an increase upon recent weekly numbers.
The deathB both of infants and of elderly persons were fewer
than those returned in the previous week. Two inquest
cases and 2 deaths from violence were registered; and 57, or
nearly a third, of the deaths occurred in public institutions.
The causes of 24, or more than 13 per cent., of the deaths
registered during the week were not certified.

Cormpnitbrnt.

" And! alteram partem. 1 '

“THE DOCTOR’S INCOME.”

To the Editor $ of The Lancet.

Sins,—Dr. Paget Thurstan is doubtless right in saying
that his letters on the income of doctors have excited much
interest. It is surely interesting, though not encouraging,
to learn how poor we most of us are, and how unequal is
the distribution of what wealth there is amongst us. What
strikes me as of chiefest interest, however, in his letters and in
other communications from other pens, is the tacit assump¬
tion that the hospital doctor is largely and mainly answer-
able for all the woes and the poverty of his non-hospital
brethren. And. yet not a tacit assumption only, for after
detailing the case of a patient who ultimately reached a
hospital, where she was treated for nothing, ana then died,
her whole medical expenses throughout a long illness having
amounted to five shillingt, he says: “But the system
which makes the hospital doctor breaks hundreds of his less
fortunate brethren.” If the hospital doctor is made in
the country by his hospital connexion— made, that is,
bolh as to professional status and pecuniary comfort—
and we will not deny that it is a vast help to him towards
success in life,—it is far different with his hospital brother
in London. The hospital doctor in London may derive a
certain position from his hospital appointment, but no
greater delusion exists than that it is tne means of bringing
him professional income. I doubt if the profession has the
shadow of a notion as to the pecuniary difficulties which
beset many a hospital doctor in London. Doomed for years,
it may be, to the monotony of out-patient practice, by
which he is supposed to be qualifying himself for the
treatment of in-patients in the remote future, and, so far,
too inexperienced for consulting work, forbidden by custom
to earn a living by general practice, and compelled to have
a respectable house in a respectable quarter—Harley-street
or Brook-street, for example—that he may look, at any rate,
as if he were a prosperous man, it is neither more nor less
than the truth that, unless by some lucky chance or other
he has an independent income to maintain himself, has a
lucrative appointment, or a wife with a dowry, has property
of his Own, or enjoys an allowance from his parents, he has
to pass the best years of his life—perhaps nis whole life—
oppressed by the load of pecuniary want. The public has
little idea that the doctors alone of the staffs of the hospitals

Digitized by GoOgle

] 306 The Lancet,]

REFERENCE CASES UNDER THE SALE OF FOOD ACT.

[Jtm* 26,1887.

do their work without remuneration or reward, and general
practitioners are many of them so slow to seek or encourage
consultative advice that true consultations are extremely
rare. Hence it happens that, with a few solitary excep¬
tions, the men who thrive pecuniarily and are satisfied are
those who know best how to appeal to the public, and who
best cultivate the art of advertising themselves, even though
it be at the risk of some distrust on the part of their own
brethren. The profession does not hear much of this side of
hospital doctors’ lives in London, for where is the man who
will openlyfell you that heisnot getting on,orwbo will boldly
admit that be has not taken a single fee for many months ?
Could the truth be told, the profession would stand amazed
at the insignificance of the purely professional incomes of
hospital doctors here in London, and at the utter inadequacy
of their incomes, even for the bare necessaries of life.
Cutting sections and showing fragments of your departed
patients at the Pathological Society may do much for
scientific progress: neither pastime does much for bringing
in the means of living. When, therefore, Dr. Paget
Thurstan and others write and speak of a system which
makes the hospital doctor and breaks his less fortunate
brethren, they do so in ignorance of the real pecuniary con-
dirion of one important branch of the profession, the so-
called pure consultants in London, supposed to be ever
nourishing on the plethora of their guinea or two guinea
fees. No, it is not the hospital doctors who break the
general practitioner; and if the general practitioner desires
to raise his income, let him look for and find the means of
improving it nearer home. If combination be necessary'
towards this end, by all means combine; but, above all, do
away with tho practice of underselling each other, which
cauuot be otherwise than harmful to the whole profession.
Let >t not, be forgotten, moreover, that the system of hard
/cork and no pay which prevails in this rich metropolis
amongst hospital doctors demands as much reform as the
s\stem of “hard work and poor pay” against which
Dr. Paget Thurstan has raised his voice. “ Consultants,” he
sayp, “ are to family doctors almost precisely as barristers are
to solicitors.” There is much aptitude in this comparison.
The briefless barristers who swarm in the law courts have
their exact counterpart, in the feeless consultants who herd
together and who look so cheery and contented in the
regions round about. Cavendish-square.

I am. Sirs, yours truly,

Juno 15th, 1387. _A Hospitax Surgeon.

To the Editors of The Lancet.

Sms,—Dr. Paget Thurstan has sent you a letter, very
valuable in pointing out some great abuses, but ending in
so miserable and hopeless a manner that it becomes simply
a jeremiad. To me the very blackness of the present
condition of general practice is the most hopeful of signs.
It is always darkest just before the dawn, and it is the
monstrous nature of the abuses to which we are subject
which will infuse energy and method into the amoeboid
mass of general practitioners, and show that they have both
brains and mouths, not to mention pens. The most powerful
agent, at our command is the press, and I believe we shall
always find the medical journals more especially willing to
aid us in gaining proper respect for the position and re¬
muneration for the services of the medical practitioner.
We must have combination. Cela va sans dire. We do not
require a trades’ union which shall fetter individual dis¬
cretion, but combination to protect us from the encroachment
of gratuitous treatment and the contract system as applied to
people able to pay ordinary fees. That is the question in a
nutshell. Hospitals, clubs (including friendly societies’associa¬
tions), and dispensaries, freeor provident, must beregulated in
theintere8t.s both of the general publicandtheprofession. The
Council and Corporations will do for us absolutely nothing
unless by means of pressure from without. Like Coriolanus,
“alone we must do it,” but “alone” for us means an army
of over 10,000. We want leaders in this reform, and you.
Sirs, with your influential organ, which can both form and
lead the opinion of the profession, ought to be our leaders.
Free ns from the nightmare of the clubs and hospitals, and
we can protect ourselves. Dr. Thurstan says the upper and
middle classes pay fairly. Some of them do—some of them
are club pa'ients. ‘ It ought not. to be possible that they can
obtain medical advice for a shilling a quarter.

The chief requisite reforms seem to be:—1. Tha*- -’mis¬

sion committees shall investigate the circumstances of all
patients receiving gratuitous advice, or semi-gratuitous
advice, by means of provident dispensaries, clubs, and friendly
societies’ associations. 2. That a certain scale shall be fixed
from time to time to guide these committees in the exer¬
cise of their duties. 3. That amongst the working-clame*
the ready-money system should be encouraged by a system
of email fees. 4. That provident dispensaries should be
instituted over the whole country by a national move¬
ment for the poor of the working class. 6. That for parish
appointments some uniform system of payment should be
provided.

1 cannot agree with Dr. Thurstan as to payment by
shilling fees for paupers. It would involve a heavy burden
upon Hie ratepayers in populous districts. Parish patients
are (or ought to be) destitute, as far as means of proconng
medical advice is concerned ; and if it be necessary to pro¬
vide for the class above them by provident dispensaries, it
would be palpably unfair to tax tbe local rates with fees for
their attendance which would be in excess of the average
obtained from tbe provident patients.

If the above five reforms were insisted on, the medical
profession would become more honourable and unselfish in
its internal dealings, as well as in Ds relation to the public.
The Lancet has the 1 power of passing these or similar
messures by bringing the subject, persistently and repeatedly
before the profession and the public, and to The IiAKCW 1
trust chiefly to accomplish this very desirable result.

1 am, Sirs, yours truly,

J. B. PlKK,

May 23rd, 1837. Mod. Officer. Loughborough DiUriet

and WorkbouM.

REFERENCE CASES UNDER THE SALK OF
FOOD ACT.

To the Editors of The Lancet.

Sins,—Suppose a man to be accused of rape, and the
medical examination of the woman to have been made
promptly. Suppose in t.he course of some weeko tbe case
to have come before the court, and the medical man who
made the examination to state his decided opinion that
a rape had been committed. Then suppose some doubt to
be raised as to the accuracy of his opinion, and that the
court in consequence order an examination of the woman
by some higher authority. Suppose the referee were sub¬
sequently to come into court and state that be “coaid not
affirm that the rape had been committed,” and declined to
give any further explanation. Would not the whole of the
medical profession be up in arms against such evidence as
one-sided, and calculated to frustrate the ends of justice?
Why could not the referee state that, owing to tbe length
of time which had elapsed since the crime was alleged to
have been committed, his examination was worthless for
the intended purpose, and that he could not. form an opinion
worth having, either one way or the other?

Now I will ask you in the light of this parable to rend the
following condensation of tbe complaint formulated in my
letter to the St. James's Gazette, on which you comment in
an article in The Lancet of the 1 Ith inst.

The Somerset House chemists who are appointed referees
under the Act are placed in a very disagreeable and invidious
position. Thus they are required to certify whether the
condemnation of a sample by a public analyst was c o rr e ct,
when it very frequently happens that they are not in a
position to certify either one way or the other; but
instead of stating this, the wording of their certitWroe
has commonly been that they were “ unable to affirm
that the sample in question was adulterated,” thus leaving
the magistrates to imagine that they affirmed it to be
unadulterated, whereas the fact has been that from de¬
composition or other circumstances thev could form no
positive opinion on the matter. That this is frequently
the case is evident from the. fact that, it, has often been
or six weeks before the sample in dispute has reached their
hands. Naturally, under such circumstances, no reliable
analysis of tbe milk has been possible, and although tbe
referees have attempted to avoid tbe difficulty by making
an allowance for change in the milk according to the number
of days it has been kept, it is evident that without a know¬
ledge of the circumstances and temperature under whieh it
has been preserved any such corrections are of a wholly
worthless character. I may point out also, with every

Tint LANCET,]

A SUGGESTED IMPROVEMENT IN ETHER INHALERS/

[Jew* 25,1887. 1307

personal respect for the Somerset House chemists, that the
assumption that they are bound to give the benefit of any
doubt to the defendant is not in accordance with their
position as impartial referees. It is their duty to state
fairly the result of their analysis, and whether from it
they believe the milk to have been adulterated. If they
cannot speak with certainty, they might speak of pro¬
babilities, and if they cannot make up their minds at all
they should say so, and leave the course of giving the benefit
of any doubt to the court in the usual manner, and not
exercise the prerogative of mercy themselves. I would
further point out that the example of testing for arsenic
is by no means a fair parallel with that of examining
milk for water. It is not the analysis that is the actual
determination of the constituents of the milk which is
difficult, but the interpretation of those results, with due
regard to the variable composition of natural milk, and
to the fact that, the rate of decomposition of milk by keep¬
ing is extremely variable. If arsenic were a body liable to
a certain range of variation in its characters, and liable
to considerable change by keeping, a toxicologist might
be quire justified in saying that be was not certain if
there had been arsenic originally present, but be thought it

S robable. The toxicologist might with advantage add that
is opinion under the circumstances was necessarily of very
little value as compared with that of the man who bad
examined the material under much more favourable condi¬
tions. No one suggests that the Somerset House chemists
should certify that a sample was adulterated unless their
own analysis proved the adulteration. My contention is
that when, from decomposition or other circumstances, they
know their analysis to be worthless they should state so
candidly, instead of contenting themselves with the state¬
ment that they are “unable to affirm the fact of adultera¬
tion.” The fact is that it is unfair to the Somerset House
chemists to place them in such a position. The remedy is a
simple one, and consists in adopting the plan which has
been in use with great success for several years past in
Derbyshire, for the southern division of which county Mr.
Otto Hehher is the analyst, while I am the similar officer for
the northern division. In the case of either of us having
a sample of milk believed to be adulterated, he sends it
without delay to the other, who also gives a certificate oil
it, so that there are two independent analyses made of the
fresh, or nearly fresh, milk. This course practically pre¬
cludes all chance of error on the part of the analyst, and is
a far more satisfactory way of checking him than by send¬
ing the milk to Somerset House when five or six weeks old,
and when, r herefore, it is quite impossible to make any trust¬
worthy analysis of the sample.

I am, Sirs, yours truly,

Alfred H. Allen, F.I.O., F.C.S,
President of the Society of

Sheffield, June 13th, 1387. Publlo Analyrta. ,

THE IRISH MEDICAJL ASSOCIATION AND THE
PRACTICAL ELEMENT IN MEDICAL
EDUCATION.

To the Editors of The Lancet.

Sms,—The annual meeting of the above body was held
the other day, and though I previously invited the secretary,
Dr. Chapman, to refer to the various matters of interest po
provincials which I have ventilated in your columns and
in those of the medical press during the year, yet no refer¬
ence whatever was made in their report to them. I trust
to be able to attend the annual meeting of that body next
year, and I will then and there raise the question of
grievances which it is the interest of the metropolitan knot
who at pretent pull all the wires in that association to
stifle. I was very much struck the other day with a re*-
mark of Montesquieu, to the effect that the father who
Rives his art to his children has left them a fortunp.
J'ow this is what the physicians and surgeons of former
generations were able to do, and what numbers Of
nearly every calling of the present day (our own excepted)
can do. Metropolitan folk, by abolishing apprenticeship,
have contrived to make us an exception to every other class
in the community. It now costs us as much to induct our
sons into the profession as if their fathers were the veriest
strangers to it. I hope that the approaching meeting In
Dublin will witness the establishment in Ireland of a brandh
of the English General Practitioners' Association. 1

The mouse whiob the committee of the General Medical
Council on the practical element in medical training brought
forth as the result of the labours of the mountain is an
insalt to common sense and to the whole of us, and the
public have a right to ask for a strict account of the part
taken on that occasion by each of its elected representatives.

1 am, Sirs, yours truly,

June. 1887. THOMAS LACTAM.

%* Mr. Laffan writes as if the Council had disposed of
the “ practical - element - in - medical - education ” question,
which is quite a mistake. The report of the committee is
still sub judice, and has been referred to an Education com¬
mittee. And that report contains the nucleus of most im¬
portant suggestions with regard to pupilage, an improved
midwifery course, and more attention to practical subjects
and common diseases in the final examinations.—E d. L.

“A SUGGESTED IMPROVEMENT IN ETHER
INHALERS.”

To the Editors of The Lancet.

Bibs,—I think that most anesthetists who have read the
recent letters in your journal under the above heading will
agree with the criticisms passed on that class of ether
inhalers in which a bag for the inhalation of a mixed
atmosphere of ether and the products of respiration is an
essential part of the apparatus. With the view of inducing
anaesthesia by the inhalation of ether unmixed with respi¬
ratory product#, I designed some years ago a simple apparatus,
a description of which appeared in your columns on July
5tb, 1884. Continued experience with this inhaler fully
endorses the remarks made on that occasion, and I have
only to add that the patient does not foul the instrument,
and that it is always ready for use. It was constructed
for me by Messrs. Erohne and 8esemann, London.

I am. Sire, yours truly,

P. Blaikib Smith, M.D,

Physician, Ute Anaesthetist, Aberdeen Royal Infirmary.
June lfltb, 1887. ^________

LIVERPOOL.

(From our own Correspondent .)

MEASLES epidemic.

The medical officer of health reports that the epidemic of
measles, which has been prevalent for the past three or
four months, is now subsiding. The number of new cases
reported daily by the school officers has undergone a more
marked diminution than the recorded deaths, which doing
the last eight weeks have been as follows:—

April 23rd ... 49 deaths. May 21st ... 26 deaths.

„ 30th ... 89 „ „ 28th ... 16 „

.May 7th ... 38 „ June 4th ... 26 „

„ 14th ... 30 „ „ 11th ... 17 M

The deaths are still considerably above the average. Dr.
Taylor has repeatedly urged the necessity for the provision
of hospital accommodation if threatening epidemics are to
be grappled with, and it is sincerely to be hoped that the
city council will give the matter their caref ul consideration.

THE wnArmen.

The change from the almost wintry weather which pre¬
vailed here during the last month to the intense heat of
this month has been most remarkable, and in some instances
has been attended with serious results, several oases of
sunstroke having occurred.

BURIAL REFORM.

A meeting of the Church of England Burial, Funeral, and
Mourning Reform Association was held here on the 7th
inst. The Lord Bishop of the diocese presided, and advo¬
cated the use of perishable coffins and simple burial in the
earth. Mr. Clarke Aepinall, the city coroner, who seconded
the first resolution, defended burial clubs as a prudent pro¬
vision, without which there might otherwise l» frequently
very serious difficulties; but he deprecated the popular idea
that the whole of the club money should be spent upon the
funeral. Mr. F. W. Lowndes, who seconded the second

,oogi

1308 Thb Lancet,]

LIVERPOOL.—NORTHERN COUNTIES NOTES.

[Junr 25,1887.

resolution, condemned the practice of washing the body, as
also that of standing bareheaded at funerals, urging that
the health of the living must always be preferred to any
wish to do honour to the dead.

ALLEGED TRIPLE MURDER BY A MOTHER.

A woman has been committed for trial for the murder of
her three children, a son and two daughters. The boy was
taken to the Stanley Hospital, where Or. Arthur Wood, the
resident surgeon, found him suffering from a gaping wound
in the throat about four inches long and two inches broad ;
the windpipe was nearly severed, being cut in two places.
A silver tracheotomy tube was inserted, and the child lived
for sixteen hours, subsequently dying from haemorrhage.
The pupils of the eyes were strongly contracted. The two
other children were seen at their own home by Dr. Robert
Gordon, who found them both dead on his arrival. One of
them had a wound almost three inches in length, extending
to within an inch of the left ear and half an inch of the
top of the breast bone. The windpipe was half divided
between the second and third rings. The left internal jugular
vein was also severed. The other child had apparently died
from suffocation. It was shown in evidence that the
prisoner had sent a girl eleven years old for twopenny-
worth of laudanum, which had been supplied. The
magistrate remarked that the Poisons Act required amend¬
ment. When arrested, the prisoner admitted having given
the children laudanum to quiet them.

THE LATE DR. OXLEY.

The remains of this much-lamented gentleman, whose
death occurred at Llandudno on the 14th inst., as noticed in
last week’s Lancet, were brought home for interment in
St. James’s Cemetery, which is within a very short distance
of the house where the deceased resided. The funeral was
of a very simple character, the body being carried on a
hand bier to the cemetery and buried in a grave. It was
largely attended by his medical brethren—some from a con¬
siderable distance—as well as a number of friends, with all
of whom the deceased was extremely popular. Though so
young, being enly in his forty-seventh year, he had suffered
from heart disease more or less for some years past, and
could probably have only lived to suffer even more than he
had. He will be greatly missed.

JUBILEE CELEBRATION AT THE ROYAL SOUTHERN
HOSPITAL.

A special service was held in the chapel of the Royal
Southern Hospital at 10.30 a.m. to-day, when jubilee hymns
were sung, and a short address was delivered by the chaplain.
After this, a distribution of medals took place to the number
of nearly 350, each medal being attached to a blue ribbon,
stamped with the name of the hospital and the date. A band
of music was stationed on the bridge commanding the two
wings of the hospital, and all the inmates of the hospital
who were sufficiently convalescent, together with the medical
and nursing staff, and some visitors, were present while a
programme of music was excellently performed. Oranges
and other refreshments were provided for the patients, as
well as an extra good dinner.

BEQUESTS TO HOSPITALS.

Under the will of the late Mr. John Bacon (late of Liver¬
pool and of Clwyd Hall, Llanyelian, Denbighshire), ship¬
owner, the following medical charities receive £1000 each :
Liverpool Royal Infirmary, Northern Hospital, Royal
Southern Hospital, Stanley Hospital, Bootle Borough Hos¬
pital, and Denbigh Infirmary. The Convalescent Institution,
Woolton, near Liverpool, receives £300.

JUBILEE DAY AT THE LIVERPOOL NORTHERN HOSPITAL.

The patients at the Liverpool Northern Hospital were
entertained with a cheering repast, and each was presented
with a medal, the gifts of two ladies, Mrs. Harmood Banner
and Miss Johnson. The male patients were permitted to
smoke, pipes and tobacco being given them. A concert
was given in the evening, Dr. Fisher pres i ding at the piano,
assisted by Drs. Thomson, Servaes, Has well, and Ross.

Liverpool, Juno Slat.

On the 19th inst. the eleventh annual demonstra¬
tion of the friendly societies in aid of the funds of the
medical charities of the borough was held at Middles-
borougb.

NORTHERN COUNTIES NOTES.

(From our own Correspondent.)

ILLNESS ON BOARD THE CHINESE TRANSPORT “TOO SAX'

Some uneasiness in the public mind here was lately
caused by the report of serious illness on board the Chine*-
transport Too Nan, now lying in the Tyne. The vessel k*i
only been a day or so in the river when two of the crew,
which numbers nearly 700, became so seriously ill that they
had to be removed to the Newcastle Infirmary, where they
died soon after their arrival; a third died on board before h»
could be removed. It appears also that two of the crew di*i
at sea on the voyage to the Tyne. Dr. Slater of this city
has been called in to attend the sick on board, and he found
as many as fourteen suffering from that obscure Orient*,
disease known as beri-beri or kakkd. Like most other
general diseases, beri-beri appears to assume an acute an 1
chronic form. In the former, there are general angari a and
dropsy, severe pain over the cardiac region -and a feeble
tottering gait, with speedy death, either from syncope
or from blood-clots in the right side of the heart or pul¬
monary artery. In the mild or chronic form recovery ri
frequent, and Dr. Slater’s present cases fortunately belon?
to this class. The treatment, as might be expected from Ut
symptoms, consists in stimulants, iron and quinine, wixl
nourishing diet; but it is to be hoped that Dr. Slater wu
send you a detailed account of this outbreak of a curiou
disease, so rarely observed in European ports.

SUNDERLAND.

As a result of the representations of an influential depu¬
tation which waited on the Ecclesiastical Commissioners la*?
week relative to the new Hartley wing of the Sunderland
Infirmary, the Commissioners have decided to increase their
donation from £250 to £500. Air. A. E. Harris, medica
officer of health, writes to say that the registered deaths
for Sunderland last week were 37, and not 67, as stated uj
mistake in the Registrar-General’s returns, which hrinc=
out the death-rate as 14 9, and not 22-9, as published in tt-
official returns. Some interesting vaccination returns have
been published for Sunderland, which show that the toul
number of births for the past year had been 5603; of the-*
4929 had been successfully vaccinated, 488 died before
vaccination, 55 were postponed on medical authority, anl
128 had removed to other parishes, which had been com¬
municated with by the vaccination officer. Only three ca.--^
of the whole had not been vaccinated, and the parents c;
these had been summoned.

MEASLES IN NORTHUMBERLAND AND DURHAM.

Dr. Duncan, medical officer of health for Chester-le-Street.
says that the outbreak of measles at Birtley is the woiv
that has occurred at the union for many years. A lare-
number of deaths have taken place at Birtley sad Parto-
bello, and the officer had personal knowledge of ov-r
300 cases. At Jarrow, too, the disease has been rife, an
has become a subject of discussion in the Town Coonc:.
At Killing worth and Morpeth the disease continues. New¬
castle and Gateshead are comparatively free, hat fears ar-
expreseed that the coming jubilee festivities may giv-
rise to a recrudescence of the disease.

Newcaatle-on-Tyne, June 30th.

EDINBURGH.

(From our own Correspondent.)

PROFESSIONAL COMPLIMENT TO DB. HERBERT ASHDOWN

On the 16th inst. Dr. Herbert Ashdown was entertained f
a complimentary dinner and presented with an address b?
his professional brethren in this city. The occasion cha~?
was that of his departure on a visit to Canada, there beiu;
a strong feeling that this juncture offered an appropn*:-
opportunity for expressing the wide-felt symptit-
awakened by the difficult and painful position which be hw
recently been compelled to occupy through no fault of hi 4
own. Between forty and fifty gentlemen attended tlx
dinner, which was presided over by Dr. Georg© A. Gibsot

Digitized by G00Qle

THB LANCET,}

EDINBURGH.—ABERDEEN.—DUBLIN.

Secretary of the Royal College of Physicians, and the pro¬
ceedings were throughout of the most enthusiastic
character. Numerous apologies for absence were intimated
from prominent members of the Edinburgh. School,
expressing sympathy with the object of the meeting. In
proposing the toast of the evening the chairman referred to
the warm esteem in which Dr. Ashdown is regarded, and
to the faithful and efficient services he has rendered in the
University Medical School. Throughout a long career in
Edinburgh he had comported himself with the dignity and
integrity of a Christian gentleman, and should he at a
future period return amongst us he might depend on aU the
sympathy and support that warm hearts and strong hands
can give. He then presented the address, which was read
by Mr. C. W. Cathcart, and is as follows:—“To Herbert
H. Ashdown, Escj., M.B., F.R.S.E., late Senior Demonstrator
of Physiology, University of Edinburgh. Wo, the under¬
signed, members of the medical profession in Edinburgh
and of the teaching staff in the University, desire to take
this opportunity of testifying to the high esteem in which
you are held amongst us, and oar sympathy with you in the
difficult position which recent circumstances have com¬
pelled you to occupy. Your brilliant career as a student, and
your success as a teacher, both of anatomy and physiology,
m the University of Edinburgh have earned for you the
respect of all with whom you have been brought in contact,
whole your high scientific attainments have been recognised
by a wider circle of fellow-wofkers. Your published writings
have reflected credit on the school with which you have
been long and honourably connected. Personally, your
geniality of disposition, your sympathetic nature, your
devotion to duty, and your stainless oharacter have attached
to you in close friendship a large number of the best men
among your contemporaries. The feelings they entertain
towards you afford the strongest testimony to your worth.
In conclusion, we heartily assure you of our constant interest
is your welfare. We anticipate for you a bright future, and
feel certain that this is guaranteed by the possession of
those qualities which have already gained for you so dis¬
tinguished and honourable a place.” This address was
signed by [ninety-eight [names, representing aty phases of
professional interest in Edinburgh, and a number of
additional names have since been appended. The address
is handsomely engrossed on vellum. Dr. Ashdown accepted
the gift amidst enthusiastic applause, and replied to the
compliment in very cordial terms. The toast fist included
"The University of Edinburgh ” and "The Edinburgh Medical
School,” the whole proceedings being of the most harmonious
and congenial nature.

THB CONTAGIU1C OF SCARLET FEVER.

At the last meeting of the Edinburgh Medico-Chirurgical
Society specimens of the organism discovered by Dr.
Edington in scarlet fever were demonstrated under the
microscope. On the proposition of Professor Chiene, a com¬
mission was appointed to inquire into the results of Dr.
Edington’s research, and to bring a report to the Society at
its special meeting next month, when the subject of
scarlatina is to be discuseed. The following gentlemen were
appointed members of the Committee:—Prof. Grainger
Stewart (convener), Prof. Greenfield, Drs. Carmichael,
Philip, and Woodhead, and Mr. Hare. It is hoped that they
will be in a position to give some opinion on the subject at
the meeting which is fixed for July 20th.

RESEARCH SCHOLARSHIP.

Dr. William Hunter, F.R.S.E., has been appointed to the
John Lucas Walker Scholarship in Experimental Pathology
in the University of Cambridge. Much regret is felt in
Edinburgh at the loss of this careful and successful
observer, whose work on the blood has won him an honour¬
able position among physiologists and pathologists. It is
hoped, however, that his transference from this school tb
that of Cambridge may not be of a permanent character,
bat that the credit he is certain to reflect on his alma
mater may in the future be associated with work done on
her native soil.

THE JTTBILEE OHLFBRATtOWS.

The 21st of June Was observed as a University hoTiday.In
the evening the students assisted in adding to the picturesque*-
ness of the civic illuminations by holding a torchlight pro¬
cession. About 600 torchbearers mustered in the University
Quadrangle at 10.30 a.m., and traversed many of the chief
streets of. the city; „ Enormous crowds filled the streets, and

[June 25,1887. ^0?

collected on the various eminences in the city to watch
the beacon fires which flashed out from the hills on ail

sides. No casualties are reported. . . .

Edinburgh, June !}2nd. ‘

. v.i , - rages .ggsea; a jil .-. >■ • -m

•'t l .•» .* 'ABERDEEN. •: ~ - . ,, - p

(our ■own 1 Correspondent,) • ! • ' A

1 ' > _ > • •• 'll

■ • ' •••■*. ’ ’ • ' I. . ' - 1 T

THB BOYAL INFIRMARY. . :-.r

The quarterly meeting of the managers of the Aberdeen
Royal Infirmary wSs held on Monday, the 13th inst., vbeh
the Lord Provost, who presided, intimated that the Jubilee
Fund for the extension and reconstruction of the infirmary
amounted to nearly* £23,600. Ib was therefore resolved to
proceed as soon as possible- with the erection of the we*
pavilion, in which there is to be accommodation for 108
surgical cases, 12 beds for eye diseases, 13 for "lock patients,"
and 7 for diseases of women. The east pavilion is to be
built afterward^ and is to be the medical side of the
hospital, affording accommodation for 84 inbdical cases and
8 beds for cases of erysipelas. When the new buildings
are completed there will be 233 beds, the space allowed tot
each being 90 superficial feet and 1400 cubic feet.

At the same meeting it was resolved to appoint a third
resident medical officer, and to give each of the residents a
honorarium of £25 a year. Professor Hamilton wa§ appointed
pathologist' to the institution, and permission “was given
him to appoint a duly qualified practitioner to act as his
assistant. ! • •

HEALTH OF THE CITY. ...

The measles epidemic has played itself out, and although
there are several cases of scarlet fever and a few of typhus,
still the health of the city, as compared with what it has been
for a few months, may be considered satisfactory. The
death-rate has fallen from 37 6 in March to 19 08 at present.
Unfortunately, however, we are threatened with an out¬
break of small-pox. The first individual affected is said to
have been a ragworkeo 1 , and it seems some time elapsed
before the true nature of the disease was detected, and in a
short time fourteen individuals became affected. They have
all been removed to the city hospital, &hd it is to be hoped
that the prompt means taken to isolate the cases will
prevent the disease becoming epidemic. One of the
town councillors at their meeting yesterday, when this
threatened epidemic was uhder consideration, made the
extraordinary statement “that there were four or fivb
medical men in Aberdeen who did everything they- pos¬
sibly could to thwart the sanitary officials, refusing or de¬
laying to report cases of zymotic dise'ase until, such time a#
an outbreak like the present occurred ! ”

Aberdeen, Jane Me t.

DUBLIN.

(From onrxntm Correspondent.)

UNIVERSITY OF DUBLIN*

At the annual meeting of the Senate, to be held on
Wednesday,'June 22nd, the following graces from the
Provost and Senior Fellows will be submitted.: That the
degree of Doctor of Medicine be conferred (honoris causd)
upon William Tennant. Goirdner of Glasgow; Sir James
Paget, Bart., F.RJ3. ; Sir Thomas Spencer Wells, Bart., M-D.;
Sir John Simon, K.C.B.; and Edward Waters, M.D. That the
degree of Doctor utriusguejuris be conferred (honoris, ca^sd)
upon His Royal Highness Prince Albert Victor Christian
Edward o£ Wales.

THE QUEEN'S JUBILEE. .

; The executive committee of the Queen’s Jubilee Memorials
"Association have decided to make a considerable grant to
the Hospital for Incurables, in aid Of the establishment of
the new wing for the treatment of patients suffering from
cancer and consumption. , This arrangement, it is to be
feared, will do away with the erection oi the Hospital^for
Consumption and other Chest Affections which it; was

suggested, should be established at Killiney, and wfricfa lflib

1 »/** •_ <7:.. .. . ,. .‘in r ... . , i- . ’ r j t*i -..si m

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1316 The Lancet,1

BELFAST.—PARIS.

[ J unk 25,1887.

urgently needed. Hie Royal Highness Prince Albert Victor
will formally open the Royal Jubilee Wards in the National
Children’s Hospital, Dublin, on Wednesday, the 29th inst.

EOT AX COLLEGE OP SURGEONS: BEQUEST BY THE LATE
DR. JOHN BARKER.

The College of Surgeons has had a sum of more than
£1000 transferred to its credit, being a legacy by the
late Dr. John Barker, formerly a Curator and Examiner of
the College. Dr. Barker wished the money to be expended
in prizes for the best dissections sent in by medical students,
the prize to be awarded by the Curator of the College, the
President, and the Professor of Anatomy in the University
of Dublin. The sum of £10 was to be given to the
Curator to entertain, in the College if possible, the successful
stndent. Counsel’s opinion was obtained as to whether this
money could be utilised for general College purposes or for
prizes for dissections, and as a result the Council were in¬
formed that they should follow the directions of the
testator’s will, unless they could not be carried out.

CORK-8TREET FEVER HOSPITAL.

From the eighty-third annual report of this institution, I
learn that of 709 cases treated in the hospital during the
year, 59 died, or 10 31 per cent. Were it not for a prolonged
epidemic of scarlatina existing in the city, the total number
of zymotic diseases would have fallen far short of those
treated during previous years. There were only sixty-two
cases of typhus fever under treatment during the past year,
a number below any previous record in the hospital. The
mortality from scarlatina was only 8*72 per cent.

Deputy Surgeon-General R. Webb has taken over the
duties of principal medical officer for the Dublin district.

The late Mr. Richard Kemmis has left £100 respectively
to the Adelaide and Meath Hospitals, Dublin.

Dublin, June 21»t.

BELFAST.

(From our own Correspondent.)

THE ULSTER MEDICAL SOCIETY.

At a meeting of the members of this Society, held last
week, it was decided, upon the motion of Professor Dill,
seconded by Dr. Gibson, that an address be forwarded
to Her Majesty the Queen on the occasion of her Jubilee.
The address was then adopted, in which attention is drawn
to the interesting fact that the Ulster Medical Society is
one of the oldest medical organisations in Ireland, having
witnessed Her Majesty’s birth, coronation, and happy reign
of half a century.

DEATH OF THE PRESIDENT OF THE ROYAL HOSPITAL.

I regret to have to announce the death of W.T. B.Lyons.D.L,
President of the Board of Management of the Royal Hos¬
pital, which took place under exceptionally sad circumstances
on May 4th. The deceased gentleman was suddenly seized
with illness while presiding at the weekly meeting of the
Hospital Board of Management. He was removed to the
superintendent’s room, and thence to his daughter’s residence,
where, a few hours after his sudden seizure, he succumbed,
his death being due to cerebral haemorrhage. Mr. Lyons
was one of the warmest friends of the Royal Hospital, and
as chairman of the Board of Management he always displayed
great tact, judicial wisdom, and kindness. No one has as
yet been appointed as his successor.

THE CHAIRMANSHIP OF THE PORTADOWN TOWN
COMMISSIONERS.

At a special meeting of the Portadown Town Com¬
missioners held last week Dr. George Dongan was re-elected
chairman for the ensuing year, having already occupied
that position for the past two years. Dr. Dougan had come
to the meeting determined not to hold office any longer;
but so unanimous and cordial was the request of his brother
commissioners that he would again preside, that he ulti¬
mately acceded to their wish.

EPIDEMIC OF BOTHELN.

During the past two mohths Belfast has been visited by
a very widespread epidemic of German measles. The type
of the disease, As a rule, has been mild, bat adults have

suffered much more when attacked than children. In some
of the public schools its spreading has been much facilitated
by the fact that parents have in some cases, from the mild¬
ness of the attack, allowed their children to go on attending
classes. I have not heard of any fatal cases. The enlarge¬
ment of the glands at the back of the neck has been a marked
feature in the epidemic.

THE ULSTER EYE, EAR, AND THROAT HOSPITAL.

In the printed report of this hospital I find that
Dr. McKeown gives a very interesting tabular statement of
forty-nine cases of cataract for the year 1886. In all except
three the new operation by injection was done, a method
which was first introduced by Dr. McKeown in 1884, and
which has the advantage that by it patients need not wait
until the cataract is ripe, but can be operated upon more
speedily and with greater ease and certainty than formerly.
This is the second series of cases published by Dr. McKeown.

Belfast, Jane 21st._

PARIS.

(From our own Correspondent.)

PROPHYLAXIS OF SYPHILIS.

At the two last meetings pf the Academy of Meffidne,
Professor Fournier read the report of the commiaaion
appointed to inquire into this question, and the importance
of the document may be understood from the fact that the
first instalment takes up nearly thirty pages of the Bulletin
de VAcadbnie. The best rtsumS of it is given by the
Gazette Hebdomadairc, which sensibly moderates the
eminent professorV. somewhat undue redness of descrip¬
tion, at the same time weeding out some of the mare
questionable neologisms—eg., to quote but a single ex¬
ample, such expressions as the hybrid “polymortality’
This report is the basis of the propositions submitted by the
commission to the Academy in order to be transmitted to
the Government with the view of showing to what extent
syphilis is a permanent danger to the public health, and
what means should be taken to remedy this danger. The
disease, says the reporter, is, indeed, disastrous and dan¬
gerous through its multiple consequences, individual,
social, and hereditary. It is, with alcoholism, one of the
gravest social evils of the present time. It is looked upon
in society as the result of a series of successive contamina¬
tions rather than the consequence of a single contagion,
and it is therefore supposed to be evidence of an ill-spent life
of debauch. This view is erroneous. Syphilis ia contagious,
like all other contagious diseases—Le., it results not from
repeated infections, but from one alone. There are numbers
of people who acquire the disease from what Professor
Fournier terms “ moral virtuous,” or purely accidental, con¬
tagions, but syphilis, both deserved and undeserved, has a
common origin. The infection of a virtuous wife and the
contamination of a child may most often be traced back to
disease of a prostitute; hence the consequence that to com¬
bat syphilis in the latter is to protect both the virtoou?
wife and child. Public interest requires that such an evil
should be repressed by general measures capable of reaching
it at its source. These measures are of three kinds: I. The
extension of the disease may be restrained by administrative
or police regulations to prevent provocations in the public
thorough fares, by what is called the inscript ion or registration
of prostitutes, which brings them under police and sanitary
supervision, by the inspection of those establishments which,
under the names of taverns and drinking bars, are in reality
nothing else than houses of assignation. 2. Syphilis may
be checked, in the second place, by treatment by hospital¬
isation— i.e., by extinguishing its germs of contagion.
3. It may be combated not less efficiently by teaching
the rising medical generation more thoroughly than has
hitherto been done all that concerns the symptom of this
disease in its different forms, its social dangers, and its
treatment. As regards measures of administrative pro¬
phylaxis, the Commission was unanimous In declaring that
prostitution constitutes a public danger by the contagion
which it disseminates in the population. It is therefore in¬
dispensable, both on hygienic and moral grounds, that i:
should be supervised, and, if necessary, repressed by the
public authorities. The measures proposed for this purpose

Thb Lancxt,]

paeis.—obituary.

[June 26,1887. 1311

by M. Fournier are briefly aa follows: In the first place
public provocation should be considered as a misdemeanour
(delit ). This measure, entirely in accordance with public
opinion, would have the effect of removing habitual
prostitutes from the arbitrary jurisdiction of the police.
Those convicted of the offence should be inscrites, and
subjected afterwards to periodical examination. Special
hoepitals for the treatment of venereal diseases should be
created for the large centres of population, and the medical
direction given to specialists, who should engage to remain
in charge for at least five years; but in respect to the army,
the Commission proposes that lectures on syphilis should
be delivered to the soldiers to make them understand the
dangers of contagion; that the men should never be punished
for having contracted venereal disease; and that treatment
should be continued after the soldier has returned to duty.
Professor Fournier’s final recommendation is for the benefit
of society at large. Henceforth no wet nurse should be
allowed to receive an infant without a medical certificate
that the parents are free from syphilis.

LA SUETTE MILIA IBB.

The Bulletin Medical gives the following particulars con¬
cerning the epidemic mentioned in my last letter. Towards
the end of April and the beginning of May an epidemic of
jneasles of exceptional violence broke out in a little village
of the arrondissement of Montmorillon, and during the first
days of May the {miliaria was seen at MontmorDlon con¬
currently with measles. Under fifteen years of age all the
deaths occurred from measles. Above that age the cause of
death was always la suette. Measles and suette killed in
two days at the outside, and the latter sometimes in a few
hours. From Montmorillon the epidemic spread to the
neighbouring villages, the order of invasion being always
the same, measles in the children, miliaria in the adults, the
first preceding the second chronologically. In the same
house all the children would be attacked with measles,
•whether they had had it before or not, and the adults by the
sweating disease. The measles was peculiar in that it always
began by a sweat. In some instances the extension of the disease
was more rapid than in others. In one place there were 63
pupils attending the school. The first day 26 of these were
suffering from the disease; on the second, 38; on the third,
46; and on the fourth the school was closed. A short time
afterwards the master had the suette and one of bis children
the measles. The symptoms of this pseudo-rubeola and of
the suette, which are essentially the same disease, were as
follows. The patient was generally seised suddenly at night
or in the evening. A profuse sweat then occurred, “ running
down as if water had been poured on the head.” At the
-same time a feeling of extreme anxiety, resembling
angina pectoris, was complained of. The sweats and
suffocations would return bv paroxysms, and these sym¬
ptoms would be accompanied by an eruption of sudamina.
In fatal cases death took place by syncope, preceded
by delirium and slowing of the pulse. After the first
five days the worst was generally over, although even
during convalescence there was still danger, death occurring
occasionally at this period with strange nervous symptoms,
such as anomalous pains, feelings of suffocation, irregularity
of the pulse aud of the cardiac contractions. Death was
sometimes preceded and often followed by nasal and buccal
haemorrhages, and the post-mortem decomposition was
very rapid. During convalescence there were polymorphous
desquamations, resembling those of measles, scarlatina, and
even psoriasis, sometimes with patches of purpura, and the
patients remained for some time profoundly cachectic, with
tremulation of the tongue and falling of the lips. The
suette may be sporadic endemo-epidemic or pandemic, but
it does not appear to be contagious, or, at all events, in-
oculable. Its miasma does not seem to be carried by the
wind, the progress of the disease having been hitherto, in
the Vienne, in the opposite direction.

Paris. June 31st.

Lofromvrtr in Russia.—A woman named Sophia
Masluchendff has just died in Kharkoff at the age of 122.
Up to the time of her death she enjoyed good health, and
had an excellent memory.—A medical man practising at Novo
Baiarzet writes to the Fraek that there is a pea s ant of the
name of Mamed in the village of Beiok Masra who is new
about 122. He has good health and very fair eyesight. He is
an exceedingly good walker. In his mouth are five sound teeth.

HENRY MILNE, M.D. Aber., &c.

Dr. Hbnry Milne died on the 27th ult. at Bridge of Allan
in his seventy-sixth year. In him passed away one of the
finest specimens of a country surgeon and general prac¬
titioner that the north of Scotland has known during the
last half-century. He was bom in 1812, and came of a
family that had been connected with Banff for about 300
years. Mr. John Milne, his father, had eleven sons, of whom
nine grew to manhood, and to all of whom he gave a uni¬
versity education. Alumni of King’s College, Aberdeen, Dr.
Henry Milne and an elder brother took their whole medical
curriculum at Edinburgh University under Abercrombie and
Alison. After a voyage to India be took the degree of M.D.
at King’s College, Aberdeen, in 1833, and almost immediately
succeeded to bis brother’s practice at Banff on his premature
death. From that date till his retirement in 1861 nis native
district and county were the field of his ever-widening
labours and success. His singular ability as a litbotomist
and surgical operator very soon made itself known among
his brethren and the public beyond his own county. The
late Dr. Keitb, the well-known litbotomist of Aberdeen, his
contemporary, bore frequent testimony to his unrivalled
skill, and had only one fault to find—that Dr. Milne would
not publish bis coses. Conducted as they were before the
days of antiseptics, had he cared to do so, bis would have
been a proud boast that he had forty-two or forty-
four consecutive cases of lithotomy without a deatn;
and it must be remembered that many of these were
undertaken in distant Highland glens and under con¬
ditions and surroundings that the operator of to-day knows
nothing of. Bat it is the belief of those who remember him
in his early days that this marvellous success and facility
in resource were but a small portion of what struck his
patients. Inhere was a gentleness, a courtliness, and yet
withal a quiet concentration about him that carried con¬
fidence ana regard wherever he moved. To the few that
knew him intimately he unbent freely, and showed a fund
of humour and sly wit that at first was little suspected.
The toilsome life he led slowly impaired a naturally healthy,
but not vigorous, constitution. Gouty dyspepsia made itself
known, and at last compelled him to retire at the early age
of forty-nine. Dr. Milne married, in 1839, Miss Keith of
Netherthird, and is survived by Mrs. Milne and their only
child, a married daughter. He never mixed in public matters,
though on one occasion pressed to accept the honour of the
Frovostabip of Banff. Foj some time after his retirement
he resided in the neighbourhood of this town, but in later
years spent his life mainly at Bridge of Allan, Bournemouth,
and Harrogate. His last years were passed in very pre¬
carious health, cardiac troubles rendering him much of an
invalid and often a great sufferer; yet no weight of years
or sickness ever dimmed the brightness of bis intellect or
narrowed his sympathies: true to the chief characteristics
of his life, helpfulness and unselfishness. Even early and
large success never spoiled the natural goodness of the man,
for be was ever at the command of the poor man as well as
the rich, and gave ungrudgingly.

JOHN PHILIP GLOVER, M.D. Lord.

Dr. J. P. Glover was bom at Derby on July 4tb, 1846.
At the age of sixteen he went to Australia, where ho
was engaged with a friend in hard and exciting work as a
squatter until the great drought which caused the rain of
so many farmers.' He then returned to England and entered
the office of his uncleat Derby, where, by working alone
and unaided in his spare moments, he qualified himself for
passing the matriculation examination of the London Uni¬
versity. After a year spent at the Derby Infirmary he
entered St. Thomas's Hospital in 1879; ■ he quickly passed his
first college examination and preliminary scientific (in tho
first class), and gained distinction in the medical school.
After he had obtained his diplomas at the Royal Colleges of
Physicians and Surgeons, he was appointed house-surgeon,
to the Cheltenham Hospital, which appointment he held for
twelve months. He then passed the M.B.Lond. examination

iS'lS The Lancet,] OBITUARY.— MEDICAL News. ficNT? 25,1887.

Htthkal pteing.

with honours in medicine. Afterwards he was house-
surgeon to the West London Hospital, and then became a
surgeon in the Orient Company’s service for some months.
Only last year he passed the M.D. Lond. examination, and
showed no signs of the disease (tuberculosis) from which he
died' until about two months ago, when an attack of
pleurisy developed, which was followed by symptoms
indicating a general dissemination of the disease. Those
who knew him well admired him very much not only for
his Cleverness, but also for his indomitable perseverance.
He was a man of retiring disposition, and made few friends,
but those were true, appreciating to the full his many
fnerits. _

JOHN TOPHAM, M.D. Lond.

Ora profession has lost an amiable and accomplished
member by the death of Dr. Topham, whose life came to a
eloie on June 17th, after a long and painful illness, endured
With great fortitude and resignation.

Dr. Topham was a son of the late Rev. John Topham, for
many years vicar of Droitwich. His professional education
was received at University College, London, where he took
a high place amongst the students, and secured many dis¬
tinctions in the class competitions. He graduated in the
University of London, taking the degree of M.B. in 1843,
End gaining a scholarship in surgery at the examination for
honours. He spent some time in Paris, took the degree of
M.D. in London in 1846, settled in Wolverhampton, and was
virtually the founder of the South Staffordshire Hospital
in that town. A threatened development of lung disease in
his wife compelled him to leave England, and he removed
to Rome, where he resided and practised from 1860 to 1870.
He was highly esteemed by and had many friends amongst
Che Anglo-American population of that city. Mrs. Topham’s
better health warranting his return to England, he took up
his abode in Torquay, and lived there for some years ; but for
a considerable time his home has been in London. Endowed
with an ample fortune, he gave up practice after his removal
to town, and indulged his love for science and music, ne
was one of the most constant frequenters of the Royal
Institution and of the concerts of the Philharmonic Society.
He became an extra-Licentiate of the College of Physicians
in 1848, a Member in 1861, and was elected to the Fellowship
in 1880.

THB SERVICES.

Was Office. —Army Medical Staff: Surgeon Arthur
Maher Kav&nagh, from the seconded list, to be Surgeon
(dated June 13th, 1887). *

India Office.— The Queen has approved of the retire¬
ment from the service of the undermentioned officers of the
St^ff Corps and Indian Military ForcesBrigade Surgeon
Jas. Champion Penny, M.D., Bengal Medical Establishment
(dated June 3rd, 1687); Brigade Surgeon John Cruickshank,
M.D h Bombay Medical Establishment (dated April 1st, 1887);
and Surgeon-Major George Moncrieff Go van, M.D., Bengal
Medical Establishment (dated March 3rd, 1887). The under¬
mentioned officers have been granted a step of honorary
rank on retirementBrigade Surgeon John Cruickshank,
M.D., of the Bombay Medical Establishment, to be Deputy
Surgeon-General (dated April 1st. 1887); and Surgeon-Major
George Moncrieff Govan, M.D., of the Bengal Medical Estab¬
lishment, to be Brigade Surgeon (dated March 3rd, 1887).

Artillery Volunteers. — 2nd Northumberland (the
Percy)Adam Scott Purves, M.B., to be Acting Surgeon
(dated June 18th, 1887).

Rifle Volunterrs. — 3rd Cheshire: 8urgeon Thomas
Moretoa is granted the honorary rank of Surgeon-Major
(dated June 18th, 1887).—4th Volunteer Battalion, the Nor¬
folk Regiment: Surgeon J. R. Clouting resigns his com¬
mission (dated June 18th, 1887).

, Under the will of the late Mr. Fox, of Aberford,
who died about a year ago, the treasurer of the Leeds
Hospital for Women and Children has just received a legacy
of £1000, and the treasurer of the Leeds Infirmary one of
.£6000.

The memorial stone of the Merthyr General
Hospital was laid on the 20th inst.

University of Durham Faculty of Medicine.—
At the recent examinations for degrees in Medicine and
Surgery the following candidates were approved:—

Degree or Doctor in Medicine for Practitioners or Firms
Years' Standing.

Counsellor, William Parkinson. M.U.C43., L.K.Q.C.P.I.

Goldie, Robert William, M.R.O.S. Eng., L.8.O.P. Bdin.

Goude, Herbert. M.R.O.S.. L.S.A., F.K.C.S. Bdtn.

Lloyd, Albert By too, M.R.O.S. Eos., L.R.C.P. Rdln.

Degree or Doctor nr Mrdicinb (Rnay)

Alnsley, Tbomaa George, M.B.. MJt.0.8.

Oowdun, Reginald Treacher. MJB.. M.R.C.S., L.S.A.

Clowe*. Herbert Alfred. M.B., M.8.. L.K.C.P., M.R.C.S.

Hubbard, Arthur John, M.B., L.B.C.P., M.R.O.P.

Morgan, Llewellyn Artiiur. M.B., M.R.C.S.

Willis, Charles Fanoourt, M.B., M.R.C.S., L.R.C S. Rdln.

Final Examination for the Degrkb or Bachelor
nr Medicine.

second class honours (in orsrb or merit).

Murray, G. Alfred Everitt, L.R.C.P„ M.R.O.S.. St. BartboL Heap.
Wholey, Thomas, L.R.C.P., M.R.C.S., L.S.A., London Ucapital.
Pass List.

Bailee, Lewi* Lamb, B.A., Coll, of Med., Newcaitla-oa-Tyne.
Baker, J. Barrington, M.R.O.S., L.R.C.P. Bdin., Ohartng-eroM
Hospital.

Bird, Matthew Mitchell, St. Maiy's Hospital.

Blight, William Lyne, L.R.C.P., M.R.C.S., Guy'* Hospital.
Blurton, John Frederick, M.R.O.S., Queen’s Coll., Birmingham.
Boot!man, John Smith, College of Medicine, Neweastla-on-Tyns.

B redin, Howard Albert, M.R.C.S., L.S. A., Liverpool Boy. Infirm.
Drodrick, Harry Bdw., M.R.C.S. L.S.A., Liverpool Roy. Infirm.
Clo*e, John Borrlll, M.R.C.S., L.S.A., St. Barthol. Hosp.
Edridge-Green. Frederic WlUlam, St. Barthol. Hosp.

Ksaery, William Joseph, King’s College.

Evans, O. Conrad Peurhys, L.R.C.P., M.R.C.S., St. BarthoL Hosp.
Gibbon, Ernest Henry, Coll, of Med., Newcastle-on-Tyne.

HaUted, Harold Ceoll. L.R.O.P., M.K4J.S.. St. Barthol. Hosp.
Herring, Herbert Thomas, University Coll. Hosp.

Lodge. Samuel, Coll, of Med., Newcastle-on-Tyne, and Leeds Med.
School.

Lund, Theodor, Coll, of Med., Newcastle-on-Tyne.

Metcalfe. George, Colt ofjMod., Newcastle-on-Tyne.

Morton, Thomas, Coll, of Med., Newcastle-on-Tyne.

Nlhill. John Edward, L.R.C.P., M.R.C.S., St. J&rthol. Hosp.
Norton, John, Westminster Hospital.

Nott, Arthur Holbrook, L.R.O.P., M.S.C.8.. Queen's ColL, Hrm.
Pridtnore, Walter George, M.R.C.S., Middleeex Hospital.
Robinson, Louis, M.R.OIS., L.S.A., St. Barthol. Hosp.

Steeuberg, Charles William, Coll, of Mod., Newcastle-on-Tyne.
Stokes, John, Coll, of Med., Newoastle-on-Tyns, and Sheffield Med.
8cbool.

Turtle. Frederick Wen man, M.R.C.S.. Guy's Hospital.

Walker, Benjamin, M.R.C.S., L.S. A,.London Hospital.

Watson, John, Westminster Hospital.

Wheeler, Humphry John. L.R.C.P., M.R.C.S., St. Georgs'* Hop.
Wllbe, R. Hayuock Wlffin, L.R.C.P.. M.H.C.S., St. Barthol. Heap.
Wilde. Leonard, St. Thomas's Hospital.

Degree or Master nr Surgery.

Openshaw, Thomas Horrocks, M.B., B.S., F.R.O.S„ London Hosp*
Degree or Bachelor nr Surgery.

Bird, Matthew Mitchell, 8t. Mary's Hospital.

Bredln, Howard Albert, M.R.C.S., L.S.A., Liverpool Roy. Inlra.
Edridge-Green, Frederic William, St. Barthol. Hosp.

Herring. Herbert Thomas, University College Hospital.

Lazenby, James Matthew. M.B. Coll, of Med., Newcastle-on-^ne.
Lodge, Samuel, Coll, of M.d., Newcastle-on-Tyne, and Leeds Med.
School.

Metcalfe, George. Coll, of Med., Newcastle-on-Tyne.

Nlhill, John Edward, L.R.C.P., M.R.C.S., St. Barthol. Hosp.
Prldmore, Walter George, M.R.C.S., Middlesex Hospital.
Steenberg, Charles William, Co LI. of Med.. Newcastle-on-Tyne.

Society of Apothecaries. —The following gentle¬
men, having satisfied the Court of Examiners as to their
knowledge of the Science and Practice of Medicine, Surgery,
and Midwifery, received certificates entitling them to
pract ise as Licentiates of the Society on June 16th :—
Barton, George Pigott, Lympstone, Exeter, Devon.

Benson, Alfred Hugh. Marchlands. Stoke Bishop, Bristol
Best, Norrys Dewes, Lime House, Walsall.

Brewis, Andrew Seymour, Bskdalc U-rraoe, Newcastle-on-Tyne.
Hill, Edward Brereton, Longfleet, Poole. Dorset.

Mallard, Fiauk Reginald. Eoeondale-road. West Dolwioh.
Saunders, Henry, High-street, Eton.

Sbemmonds, John Oulcy, Cam bridge-road, Kllburn.

Wheddon, Frederick Jean, Stoukport-road, Manchester.

We are informed that the Final Kxaminations at the
Society of Apothecaries will no longer be held every week,
as hitherto, but once a month—viz., on the third Monday,
Wednesday.and Thursday. The Primary Examinations will w
held only once a quarter, of which due notice will be given.

On the 21st inst. the foundation stone of the new
Victoria Hospital, at Bournemouth, was laid amid great
rejoicings. The estimated cost of the building is £7000.

ioogjc

Tasf LAwem,]

MEDICAL NOtftaWPXSWJ^SNT^aPPOlK'PiTKN'PS.

[I»MI'«V 188?. 4M&

The seventh animal meeting,of the Zeifana Medical
College was held at Exeter Hall on 'the 16th inst., ^hen a
satisfactory report was presented by the secretary and
adopted.

London Fever Hospital. — A loyal and con¬
gratulatory address has been forwarded by the nurses of this
hospital to Her Majesty the Queen and very graciously
accepted.

Presentations. —On the 13th ihst. Mr. J. G. Symes
was presented by the officers and staff of the Dorset County
Asylum with a handsome embossed silver bowl on an ebony
stand, on the occasion of his retirement after more than
thirty-two years’ service as medical superintendent of thht

institution.-Mr. Waldy has been presented with two cases

of surgical instruments by the students of the Newoastfe^
on-Tyne Infirmary, on the occasion of his retirement from
the position of house-physician to that institution.

Queen’s College, Cork. —The following class prizes
have been awarded in the Faculty of Medicine:—First
Year: Practical Anatomy—1st, Daniel O’Driscoll; 2nd,
W. J. Prendergast. Second Year: The following have been
awarded, in addition to those already published: Anatomy
and Physiology—Thomas Jones. Practical Anatomy—3rd,
Thomas Jones. Practical Chemistry—2nd, Thomas Jones.
The exhibition in Practical Midwifery has been awarded to
William J. O’Meara.

Illegal Practice in France Punished.— A bone-
setter at Aubervllliers, being applied to by a man with a
nasal polypus for advice, covered him with blisters from
head to foot, and, by dint of promises to cure him, and
threats about le grand Albert and le Dragon-Rouge , ex¬
tracted 500 francs from his credulous patient. His illegal
practice, however, was not allowed to go unpunished, for a
French coart sentenced him to three months'imprisonment,
and his wife, who had been assisting him, to fifteen days’
imprisonment.

Volunteer Ambulance Corps. —On the 18th inst.,
the non-commissioned officers and men trained as an
ambulance for the 1st Volunteer Battalion, South Wales
Borderers, were presented with the Geneva Cross and
certificates of proficiency, as a bearer company, by Mrs.
Somerset, wife of the Rev. B. Somerset, chaplain. The
examining offioer, Surgeon-Major Barrow, Army Medical
Department, expressed himself in complimentary terms as
to the high state of efficiency to which the men had been
brought by Acting Surgeon Hill, who ia in charge of the

North-Eastern Hospital for Children.— The
annual meeting of the subscribers and friends of this in¬
stitution, w hi on is situated in the Hackney-roari^was held
opt the 17th inst. From the report which was prssnsited by
the secretary, and subsequently adopted by these present, it
appears that although the hospital had been closed for a
month during the past year to in-patients, the number
treated, 618, was larger than in any preceding year. There
had been 14,083 new cases in the out-patients’ department,
with 50,170 new attendances, as compared with 13,801
patients and 46,164 attendances in the previous year.

Metropolitan Free Hospital. —On the 14th inst.,
at a special general meeting of the governors of this chanty,
it Was decided that the word “Free" he ofliitted in"the
title, and that the institution be in future knpwn as the
Metropolitan Hospital. The following, resolution was also
adopted“ That henceforth the institution be eonduotedon
provident principles, no letter of recommendation to be
required for any patient, and all cases of accident and
urgency to be seen at once. The provident priaetpie is that
every patient shall - contribute in health and sickness to
the oost whilst under treatment, and that, it bo Defeqrs£
to the General Purposes Committee of Msnagepen^ ,to
make provision and rules for carrying this prmg.plmto
DWtice,” ..... . . . V. :

11 U N i v E R grrr College, London.—A statement) has
been dr a wn up and signed by Lord Kimberley,presWwrt,
Lord Justice Fry, late vice-president, Sir Jnlfatt GbMfftrfd,
M» treasurer, and four members of the Cbuhofly for the
p u rpoee of laying before the members of tha College the
reaso ns which caused them to resign their seats 'on fie

Council. This step they have Jmen compelled to take
because they cannot cpiduT With' the resolutions passed by
the Council on March 5th and May 21st in the present year
with regard to the promotion of a,Teaching University fqr
London. They object to the proposal that the protestors
and teaohera should confer degrees upon their own students;
they object also to making attendance on a regular course
of instruction in the College a condition of obtaining a
degree; and, thirdly, they are : convinced that' the only
prudeut course for the College to. adopt in the present
crisis is to endeavour to maintain cordial relations with
the University of London, and to seek for a more intimate
union with it.

MEDICAL NOTES IN PARLIAMENT.

Smoke Nwtance Abatement. ( Mebropolie ) Bill.

Iirthe House of Lords on the 30th tost., on the order of the day for
going Into ooremittee on this Bill, Lord Stratheden and Campbell com¬
plained of the sudden opposition which bad sprang up on the part of
Her Majesty's Government to this msasnre. He trusted that the BlQ
would be allowed to pass'Into oommittee or be referred to a select com¬
mittee.—Earl Brownlow moved that the House do resolve Itself fnto a
domrattteeon the BUI that-day three mouths.—Bert Granville-having
expressed his disappointment at the west of action on the part of the
Government, the Karl of Harrowby said that the time had come when
some steps should be taken, as the present state of things was a scandal
to our civilisation.—The Duke of Westminster hoped that the Govern¬
ment would consent to refer the BUI to a select oommittee. After some
further discussion, in Which Lord Mount Temple and Visoonnt uranbrook
took part, this suggestion was adopted, and the Bill was accordingly
referred.

Vaccine Matter.

In the House of Commons, on the 16th inst., Mr. Burt asked whether
the vaoolne now In use was obtained by the Inoculation of the cow with
matter from tbe human subject in small-pox ; whether such variolous
veooloation was declared to be contrary to law by the Irish Loenl
Government Board In 18T9; and whether the Local Government Board
agreed With that declaration.—Mr. Bltohle said.tbe vaoolne now in use
was obtained by the inoculation of the cow with matter from a human
subject.

Coal Mine* Regulation Bill.

■ On tbe-20tfa last. Mr. Matthews moved that Hie House go Into Com¬
mittee on this Bill.—Mr. Burt said that tbe Bill was a step in the right
direction.—MrvGtAveley Hill asked the House to be very careful before
they took away from the pit-brow women the power of earning their
livelihood. Several members having spoken in support and criticism
of the Bill, the debate was ultimately adjourned.

Ilpoiittamita.

forward it to Th* Laxcxt Office , directed to the Sub-Bitter, not later
than 9 o’clock on the Tkortdetg morning of oath woek for pu blimtifn in
the neat number. ■ .... > • -----

BaioxsTV W ith am , M.B., B.S., late Assistant Medical Officer to
Dunston Lodge Asylum, has been appointed House-Surgeon to the
N<n*cattteK>n-Tyd* IdSrmtry. •••■'

Daunt, GKoRgk, L.B.O.8., L.R.C.P.Bd., has been appointed Moiical
Officer for tbe Thtrd Districts of the Yeovil Union.

1 Davuss, Hugh Hugh*?, L.K.Q.C.P.I., has been appointed Hedtaal
Officer for the Western District df th® Oorwen Union.

Minnow, B. W. TAYtoR, M.B., C.M.Glas., has been appointed Resident
1 Medical Officer to the Stamford Bill, Stoke Newington. Ac. Dis¬
pensary, viced. A. James, M.B.G.S., L.R.C.P.Lond., resigned* :•

HAji lock. Harry, MAC S.,. L.R.C-P.Lond., has been appointed
! Medical Officer for this Singleton Dlitriet of the Westhampnett
' ' Union. •• :*i .

HxpBiiKTKWACTW.. Hanoi®. , M.R.C.B., hXJu,- has been appointed
, Medical Officer.of Health for Burley-tn-Wharfedale, York*. • > ■ ■

. Hutchihsojt, Jbax H., M.R.C.S., L.S.A., has been ajj-pointwL Medical
j Officer for th* Oatterlok District of tbe Richmond union
Low. John H.. M.B.. C.M.Glas., has been appointed Medleift Officer
for the Appleby District qf the East Ward Union.

MXV, Bkktett. F.R.C.3., has been elected jbfnt Professor of
Surgery in the Queen’s College, Birmingham, viceFurneaux JorijfJg
resigned: " ' j .,

Palin, HrasYV- M.B., C.M-Bd., has been appointed Medical. Officer
forth® FlrM District of the Wrexham Union. ....

Skxttlx, Harry Wyntkr, L.ir.G.PrEd., M.K.C.8.. has been appointed
Assistant Surgeon to the . Royal South Hants Infirmary, South¬
ampton, vice A. B. wad®, M.B.; C.M., M.R.O.8., appointed
') 1 *• 1 .!

Tabgbtt, .Jambs HbKBY, M.B^ B.S.Lond., F.B.O.B.Bng., laile Surgical
Registrar to Guy’s Hospital, has been appointed Sfib-Ourafcor of the
Mnseum and Assistant Demonstrator of Pathol® gV At Guy’s
Hospital* „

WaM. AjccWu*E jtkxhoir, 'MvBu C.M.,- M.R.C.ffi, hds been apbbihted
Surgeon to the Royal Sentb Bhinti‘JnflrtnaW, Southampton, “vice
. GemieMtoS.M^K MAaS^deeetoed. ; „ ~

WHmoir. Dahih Flockto m . M J 1 .0.8., L.R.C.P.Lbnd?, 11 Has'Teen
a^p<dnted| ^Houy-Surgeon to the Rooh^ale Infirmaty^ A.

Googl

1314 The Lancet,]

VACANCIES.—BERTHS, MARRIAGES, AKD DEATHS.

[ Jmra 25.18T.

©antrum

in compliance with the desire of numerous subscribers, it has been derided to
resume the publication under this head of brief particulars of the various
Vacancies which are announced in our advertising columns. For further
information regarding each vacancy reference should be made to the
advertisement. _

Coventry AKD Warwickshihjs HOSPITAL. — Houje-Surgeon. Salary
£100 per annum, with board (exclusive of beer, wine, and spirits),
lodging, and attendance.

fiAST Suffolk and Ipswich Hospital.—H ouse-Surgeon. Salary £100
per annum, with board, lodging, and washing.

Hospital for Sick Children, Great Ormond-etreet, W.C.—Assistant
Physician.

Kent County Lunatic Asylum, Ohartham Downs, near Canterbury.—
Second Assistant Medical Officer. Salary £120 per annum, with
furnished apartments, board, and attendance.

Liverpool Dispensaries.—A ssistant 8urgeon. Salary £80 per annum,
with apartments, board, and attendance.

Mason College, BirminghamProfeasor of Physiology.

Hoyal College of 8uroeons of England.—L ibrarian.

University College Hospital, London. — Assistant Physician.—
Assistant Surgeon.—Assistant Obstetric Physician.

Wandsworth and Clapham Union. — Dispenser. Salary £80 per
annum, rising £5 annually to a maximum of £100 per annum, with
dinner and tea daily.

WEST-fiiDtNG Lunatic asylum, Wakefield.—Resident Clinical Assistant.
Ho salary, but board, apartments, Ac.

Parmges, attir Jtatjrs.

BIRTHS.

w Downlng-street, Famham, Surrey, the
wife of Wm. Htig Brodie, M.B.Kd., of a ion.

Brownrigg.—-O n the 17th lost., at Hill House, Gravesend, the wife of
J. Annesley Brownrigg, M. A.. M.D., of a daughter.

Orip^ f!eSo?»»“ Stratford-plaoe, W., the wife of HarrUon

DouGHTY.-On the 21st Inst, the wife of W. Doughty, M.B.C.S., Friem
Lodge, Lordship-lane, Dulwich, of a daughter.

Julkr.—A t 77, Wlmpole-street, W., the wife of Henry Juler, P.R.C.S.

oi a BOD. *'

Shore -On the 21st Inst., at Crouch-hill, N„ the wife T. W. Shore,
a.l;., 15.ho., of a son. *

THURLAND.-Outhemh lust., atl84, Aldersgate-street, B.C., the wife
daughter* 1 * Branc 5 ® dward Thurland, M.B.C.S., L.S.A., of a

Trewman.—O n the 18th Inst., at Portedown Lodge, Hants,Tthe'wife of
w r 8 eon G. T. Trewman, Medical Staff, of a daughter. *“
WA ^^ C ^°n DT -J . th ® afc Lewisham High-road, S.B., the

wife of C. van Waterschoodt, M.D., of a daughter.

MARRIAGES.

CLOSE-S^OAR-On the 18thinU., at St. James’s Church, Norlands,
W., Henry A. Close, Fleet Surgeon, H.M.S. Durham to
daughter of the late Mark Seager, of Palermo. ’

Drew-Brady.—O n the 14th inst.. at H.B.M. Legation, at Berne End
jub^uentlyatthe B.O. Chapel. W. B. Dre^Staff-Surge^BN
gJT’ dMghter of Henry Brady, of Tfaurireton Lodge,’

th . e mh at St. Thomas’s Church,

L C p^^ 1 ’Sf a ^lM^th Cheete^, i 0 5 ,1 SoyniourGelston, L.B.C.S.I.,

ta RgS7SSr WA 21rt , ! “*:v mt pbrfrt Church. Plymouth,
rih.fuL , ,,B - M.A., «*l*ted by the Hev. W. B. Kooroe B A
Charles Alfred James, M.K.C.S., L.R.O.P.Lond., D.P HKC^ *a''

jgaaaiycv sssssrs.t

asaa

MacDonald—SIMM.—O n the 16th inst., at Bradford Pewm.il

Bev. B G. Watson, Bector of All mSL^Sm! K Se

■’ £ K 0 .^ Keotor 01 Bradford PeveroU, iSTw.IIiI
^* edlca | Superintendent of the Dorset Count?
Asylums to Lydia Josephine Squire, eJdret daughter of Josenh

^d e ^anHH Med h.° al S V P l ria , t€ndent Dorset Co^y
Orewkeme * grandd * u « ht ® r ‘he late Beer Admiral Symes, of

Marshall—Chamberlain. — On the 18 th inst at st

M*B < oS te ^ J l°J h iu G ’ M y* hall V B A -“ B., CUre Coh CamEridg^
uin. of 'B^iHe)* 7 d * a « bU * o( the M»wer Chambfr*

DEATHS.

Lnr ^dZ'w°WillUm 1 r j ^ pneumonia), at Clifton-road, Maida-

VKAn*. Lindsay, M.D., in his 40th year.

MRn's°i«i V th '“fK** Uhetaea, George Henry Hentwoh

o££i' oSO^SaS ' M-di<ml ind

Topham.-—O n the 18 th inst., at OolHnghasn-road, South Koulnwtorr
John Topham, M.D., F.B.C.P., aged £ * OUW, liBn * Jn « toBr '

Wl *S!SfS TO?* 1Bth tMt ” ** Alfred Wlllmott,

MM^AfeeafSe. ie charge^

METEOROLOGICAL READINGS.

(Taken daily at 8 JO a.m. by Steward's Instruments )

The Lancet Office, June 23<4, UO.

DaU.

Raromoter
reduced to
Sea Level
and 82 " F.

Direc¬

tion

of

Wind.

a

Wet

Bulb.

Solar

Radis

In

Vacuo.

Max.

Temp.

Shade.

Mia.

Temp

Rain

fall.

Ranartis;

MO m

Junel7

30-37

E.

68

60

117

77

57

Pine

18

3027

E.

06

60

116

79

55

Hair

.. 19

30-26

E.

69

62

124

85

56

„ 20

30 32

K.

60

55

112

74

55

.. 21

30 35

E.

61

54

119

74

47

Pine

.. 22

30-33

K.

57

52

112

74

52

ft -3

30-27

E.

58

55

55

...

0 retain

Ibtts, Sfwri Comments, $ gmskrs la
(krrasyontattts.

It i« especially requested that early intelligence of local emit
having a medical interest, or which it ts desirable to bring
under the notice of the profession, may be sent direct to
this Office.

All communications relating to the editorial business of the
journal must be addressed u To the Editors."

Lectures, original articles, and reports should be written «
one side only cf the paper.

Letters, whether intended for insertion or for private in¬
formation, must be authenticated by the names and
addresses of their writers, not necessarily for publication

We cannot prescribe or recommend practitioners.

Local papers containing reports or news-paragraphs should
be marked and addressed to the Sub-Editor.

Letters relating to the publication, sale, and advertising
departments of The Lancet to be addressed “to the
Publisher.”

We cannot undertake to return MSS. not used.

A Curious Advertisement.

The following is a curious advertisement “ To Surgeons. —Wanted. %
middle-aged single man or widower, who must be of good address, to
attend for consultation daily at a patent medicine vendor’s, to dense
his whole time to the praotioe.—Address, in strict confidence,

•alary required, and with all particulars, to-What can to tie

need of a surgeon in the patent medicine department, where corenlto-
tlon is superseded and the medicines fitted by the patent to all mm
and comers? It looks, too, as if the qualification of .ingt— or
widowershlp were of more importance than the “ ordinary qnsHfies-
tions.” We cannot commend the appointment to any of our raiders.
Ignoramus. —The 30th of June is the day after whioh such application
should be made. Our correspondent wiH ascertain the fee on inquiry
of the registrar, 209, Oxford-street.

Quintu.— Most treatises on obstetrics supply the information.

. TOWN SANITATION.

To the Editors of The Lancet.

8lRs,—Some years ago in the town in which I reside the publii
slaughterhouse was removed to another part of the borough. Th* old
building was then coaverted into four tenements, which have bees Boot
continuously occupied by poor families. Neither of three tri .m—ti
has a back outlet, the privies are In small courtyards close to tto
entrance doors, and there is no proper drainage from them. A short
time ago the sanitary committee of the Town Council requested tto
medical officer of health to Inspect and report upon them. He pw-
nounore them to be in a " perfect sanitary condition.” As U» com¬
mittee hold • contrary opinion, and are anxious to have the ootteges (?)
removed, oaa you suggest how this is to be done in the hoe of tto
medical offloer’s report ? I am, Sire, yours truly.

June, 1887. A Town Codsclllox.

V Proceedings can be taken by the sanitary authority under Seotioa
of the PubBo Health Act. which deals with houses unfit for hsMtsttoo.
but it may be a question whether the court would be satisfied to art
without medioal evidence. Such evidence is, however, not neoesssry
under the section. The proper remedy in such a case Is to to (a
possession of an efficient code of bye-laws as to new buildings. Sack
bye-law* would oome into operation, under Section 160 of the Putt*
Health Act, on “ the conversion into a dwelling-house of any building
not originally constructed for human habitation.” The dirr** 1 * 1
Model Code of Bye-laws of the Looal Government Board sU>»s wtot
should be required under such clrcumstanoes.—E d. L.

Die

oogl

Th* Lancht,]

BOTES, OOMUBNT8, AND ANSWERS TO 00RRR8PONDENTS. [Jnira 25, 1887. 1315

Unqualified Assistants and th* Jubtux.

Sjtts.—Orir correspondent think* the Jubilee ought to bring ad rentage
to unqualified asalitanU, a* well as to other unfortunate people, and he
suggests how It might be so used. He proposes that within a given
time each unqualified assistant be registered, and that on certain con¬
ditions of character and service be should be admitted to a vivd voce
examination and qualification to practise as an assistant surgeon only,
' and that at any subsequent time he should be allowed to present him¬
self for examination at the conjoint examination of the Boyal Colleges
or other similar bodies sine curriculo. The idea is that ten years’ servioe
as an unqualified assistant Is or should be oonaidered equivalent to a
curriculum. We believe that neither the Medical Council nor the
medical bodies would agree to such proposals, which would neither be
fair to the practitioners and students who go through the expensive
and laborious system of medical education, nor to the public, which
believes that in a reoognised medical man they have one who has gone
through this process. In the case even of the legal profession, though
ten yean’ service as a managing clerk to a solicitor reduces the term
of articles from five years to three, the three yean’ man has never¬
theless to pass his Intermediate and final examinations.

Ur. J. B. Edwards .—We are of opinion that the coroner was quite right
not to pay our correspondent the fee. In fact, we believe he would
have rendered himself liable to refund the guinea on Its being disallowed
by the magistrates. Our correspondent must look for payment to the
person employing him.

J. Q.— The subject Is discussed in our issue of April 10th.

THB HUTTON FUND.

To th* Editors of Tan Lascar.

Sms,—May I again appeal to your kindness, and ask you to insert the
enclosed list of subscriptions ? The list will be kept open until Friday,
July 15th, up to which date Dr. Cumberbatch, 25, Cadogan-place,
Belgrave-square, will be glad to receive and acknowledge contributions.

Already acknowledged.. £908 19 0

Mrs. Tnexton . 16 0 0

Mrs. Benson . 10 0 0

Hon. L.Vesey Fitzgerald 8 0 0

Matthew Arnold, Beq... 6 6 0

W. Wickham, Bsq. ... 6 6 0

Nalder Hollyer, Bsq. ... 5 5 0

John Muir, Bsq. 6 5 0

Mrs. Bosworth. 5 0 0

Charles Gore, Bsq. ... 5 0 0

T. Ridge Jones, M.D.... 6 0 0

Mr. Agg Gardiner ... 5 0 0

W. Denman Benson, Bsq. 6 0 0

Lord De Saumares ... £5 0

A Friend. 5 0

Edwin Uumby, M.D. ... 2 2

Mr*. W. Wood . 2 1

Miss White . 2 0

W.Wightman Wood, Bsq. 2 0

Mrs. G. F. Prescott ... 2 0

E. L. Webb, M.D. ... 1 1

J. Rushforth. Esq. ... 1 1

W. 8. Falls. M.D. ... 1 1

Lady Vavasour. 0 10

£1071 10

I sun. Sin, your obedient servant.

0

0

0

0

0

0

0

0

0

0

0

0

June 20th, 1887.

W. Howship Dick inso it,
Secretary to the Committee.

Th* Nkw 8anitabt Cod* for Italy.

Th* sanitary Interests of the Italian kingdom will henceforth be
superintended by a Supreme Connell of Health, to consist of a cabinet
minister who will be preaidant; the procurator-general ef the Court of
Appeal; a jurist; six doctors In medicine and surgery, specially qnalifled
in public hygiene; a chemist; a pharmacist; a veterinary surgeon; three
engineers, experts in sanitary architecture; a medico-sanitary inspector
for the Army and a similarly qualified functionary for the Navy; the
directors-general of the statistical bureaux and mercantile marine. Of
these, six at least must be resident in Beene. In every provincial
capital there will also be a council of Hesdtb, consisting of the prefect,
the public prosecutor, a jurist, two doctors of medicine and surgery, a
chemist, a pharmacist, a veterinary surgeon, and a sanitary engineer.
For each district within the provinces there will be a similarly con¬
stituted Board of Health.

New Zealand. —Oassell’s Domestic Medicine would probably answer the
requirements of a person resident in a distant colony when beyond the
reach of medical assistance.

Invalid should consult his medioal attendant.

HBALTH OF THB “WILD WBST."

To the Editor* ofTwa Lancet.

Bias,—A rumour has been spread by some mall ohms person or persons
that an outbreak of scarlet fever bad occurred In the camp. We beg to
state that, with the exoeption of accidents and one oase of pneumonia
(since recovered), there has been no case of illness, and the camp is and
has been in a perfectly healthy state. It Is open at all times to the
inspection of the medical officer of health for the district.

Kindly Insert this letter In your valuable journal, and oblige
Yours truly, ,

J. B. W. Bidlack, M.D.Phil.U.S.A..

Medical Director of the American Exhibition,

* B. J. Maitland Coffin, F.B.C.P.Bd.,

Medical Officer in charge of the Wild West Camp.

Weat Brampton, June 22nd, 1887.

Novelists and th* Medical Profession.

1* that clever and intereating novel by Maxwell Gray, “The Silence
of Dean Maitland," which, though bearing this year's date, has
already reached a fourth edition, there Is a graceful allusion to
. the medioal profession, the members of which receive but scant
justice from novelists k> general:—“ The medical profession, strangely
enough, has never been popular, skill in the healing art being usually
attributed by the unlearned to the favour of the Evil One; a clever
physician is prized and feared, but rarely loved. Even among the
cultured there still lingers a faint repulsion for the man who is the
only welcome guest in the day of sickness and peril, and society lr
only just beginning to honour the cultivated intellect and reoognleo
the social value of the doctor." The real hero, and certainly the finest
character In the book, Henry Bverard, is a young surgeon, and when
asking his clerical friend, Cyril Maitland, the future dean, for the
reason why clergymen were more popular than doctors, received a
reply In whloh the truth Is somewhat satirically given: “Clergymen,
are of no use save at two or three august moments of life—when a man
dies, gets married, or is born ; therefore they Inspire popular reverence
as belonging to the ornamental and superfluous portion of existence.
Its fringes, so to speak. Doctors, on the contrary, cannot be dispense#
with; their servioe* are needed and obtained on the most homely
oooaslons, and men never reverenoe the Indispensable. Bread an£
cheese are taken as a matter of course, bat the champagne of festivals
is thought much of." The book will well repay the reading.

Mr. A. C. Cocks .—Our correspondent has a right to complain that he
was not Informed previously to Ills patient receiving a visit from the-
offlcial medical adviser of the stores.

Mr. J. Harris Jons* (Wilkes Barre).—We shall be pleased to receive the¬
re ports, and to give them our attention.

Dr. Birmingham (Dublin).—id, Fore-street, B.C.

REMOVAL OF BREAST TUMOUR WITH THB AID OF COCAINB.

To Vis Editor* of Th* Lanckt.

Sirs,—D r. B. F. Gnin, in yoar issue of the 18th Inst., publishes a case
of removal of a tumour from the breast with the aid of cocaine, in which
be confidentially asserts that “ this is the first case In which a tumour of
the breast bas been removed under the influence of cocaine," but he
neglects to give the date of his operation. I do not wish in the least to*
deprive him of any honour In being the first, but on May 29th, with the-
assistance of Dr. Stanley Ward, I removed with cocaine a much larger
tumour, it being almost the size of a human kidney, together with a.
second growth nearly as large as a walnut. The Incision was necessarily
longer than in Dr. Griin's case. It was almost four Inches in length.
The parts were painted with a 20 per cent, and injected with a 10 per
cent, solution in two places. It was not considered advisable to nsa
chloroform from the condition of the heart. The patient felt a little,
pain, particularly when the final stitches were being inserted, probably
from the effect of the cocaine passing off, but it must have been very
slight, as she never moved even her arm during the operation. The
wound healed by the first intention, the temperatnre did not rise above
100 °, and within a week she was able to go ont. 1 should not have
thonght of publishing this case, deeming it nothing exceptional, bad.
not Dr. Griin made an assertion that his was the first case, which, of
oourte, It still may have been, as he omitted to give any date.

I am, Sirs, yours faithfully,

Haverhill, June 21st, 1887. B. L. Tandy.

Alpha .—The coroner is bound to subpoena in statutory form. If our cor¬
respondent is not summoned, be must use his own discretion as to
whether he will attend the Inquest or not. It is certainly desirable
that friction should be avoided between coroners and the medical
re p res en tatives of large public institutions. In the ease mentioned, ous
correspondent appears to have understood that his attendance would
not be required, when in reality it was. A little give and take ought to
have removed the misunderstanding. It is clear from the coroner’e-
reply that he was cognisant of the fact that legally he was bound to-
oommand by * ubpeen a the attendance and ev idenoe of our correspondent.
Mr. A. J. Dalton — In an early number.

Mr. Walter Grtene .—The paper Is marked for insertion.

BNOBPHALOCELH 0% •

To the Editor* of Th* Lanc*t.

Sirs,—F our weeks ago I delivered a woman of a female child at fulfc
term. Labour was natural. After birth, the child was fohnd to havo a
bilobed tumour behind and below the occipital bone. The tumour, 1
believe, contains the cerebra; it Is the size of two oraDges joined
together, and Is covered by a thin membrane, which gave way some
days after birth and discharged a milky fluid. The dlscliarge has slnctf
ceased. The usual prominence of the frontal region is absent. The
cranial bones ate more than usually ossified, no fontanelles being pre¬
sent. The child is strong and healthy, and takes the breast well. May
I inquire how long such a child Is likely to live, and what is the usual
cause of death ? I am. Sirs, yours truly,

Jane 21st, 1887. r A. B.

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1316 Thb Lawobt,] NOTES, COMMENTS, AND ANSWERS TO CORRESPONDENTS.

[Jura 26,188R

Doctors' I e comes.

Mr. D. Lloyd.—fit regret to say that we think oar correspondent’s pro*
posals unpractical. Nobody who studies the Inability of Parliament to
<lo its own proper work can fall to see the impossibility of Its doing
what our correspondent proposes. The profession most rely on itself,
and certainly not on Parliament, to secure proper remuneration for
Its eerrioee.

Dr. Van Watersckoodt.— We do not know of an Institution which would
meet the requirements named.

Mr. Slerccs .— The letter is too long for Insertion,

Dr. Heaven Baht Is thanked.

Brrata. —The remarks attached to the case of intubation of the larynx,
published on page 1232 in our last number, were by mistake attributed
to Drs. Smith and Waldo; they should have been credited to Mr. James
Swayue.—The name ol the recipient of a presentation, of which a
notice was given on page 1161, should have been printed W. Jenner
Clarke, not Held.

Communications not notloed In our present number will receive atten¬
tion In our next.

Communications, Lome, Ac..have been received from—Dr.Wm.Budd,
Exeter; Dr. Diokineon, London; Ur. B. Owen, London; Prof. Boy,
Cambridge; Mr. K. Mlllican, London ; Mr. H. Travers; Dr. P. Blailde
Smith, Aberdeen; Rev. T. Dixon-Spsin, Brlesdene ; Dr. A. Thompson,
Uiverstone; Mr. J. P. Gray, Halifax; Dr. Brett, Watford ; Mr. B. L.
Tandy, Haverhill; Mr. Bennett May, London; Mr. A. Wood; Mr. R.
Jones; Dr. Lewers, London; Mr. T. J. Bernardo, London; Mr. T.
Ta ffan, Qashel; Dr. Dunlop, Jersey; Mr. Bonham, London; Dr. Percy
Kidd, London ; Mr. J. H. Jones, Wilkes Barre; Dr. Andrew Smart,
Edinburgh ; Dr. A. H. Hsssall, Lucerne ; Mr. Llttlewood, Leeds ;
Dr. Feamslde, London; Mr. P. B. Hill, Crlckhowell; Mr. Lennox
Browne, London ; Mr. R. B. Cooke, Scarborough j Messrs. Frecth and
Co., Vauxhall; Mr. N. B. Davies, Sherborne; Messrs. G. Masbn and
Co., London; Mr. D. G. Marshall, Edinburgh ; Surgeon-Major Briggs,
Madras; Mr. Lyson. Bnrmahj Mr. Logan, Glasgow; Messrs. Isaacs
and Oo.; Mr. A. J. Dalton, London ; Mr. Moore, Aden; Mr. Barlow,
Birmingham ; Mr. Jas. Swain, Bristol; Mr. Pease; Dr. MeMnrray,
Liverpool -, Mr. Henriqnes, London ; Mr. J. Meroes, London ; Mr. G.
Barling, Birmingham; Mr. Raw, Newcastle-on-Tyne ; Messrs. Savory
and Moore, London; Mr. Armstrong, H&rpurhey; Mr. Skrimshlre,
Blaenon ; Mr. Graham, Bristol; Mr. Fox, Manchester; Mr. Hawkins,
London; Dr. Baker, York; Mr. Linsey, Mansfield ; Mr. Symes, Dor¬
chester; Mr. Ladd, Canterbury; D. Pressland, London; A Locum;
H. D. F.; Coventry; Alpha, Clapham; M.D., Manchester; M.D.,
Suffolk; Francis; Ignoramus.

Lrrms, each with enclosure, are also acknowledged from—Dr. Squire,
London; Dr. Joler, London; I.adyLambton; Messrs. Thomae and
Co., London; Mr. Crewes,Truro; Mr. Lowther, Hull; Messrs. Morgan
and Co., Morrlston; Dr. Thompson, Oldham; Messrs. Hankin and
8on, St. Ives; Mr. Simpson. Oydh; Mr. Evans, Oswestry; Mr. Rees,
Brecknock ; Mr. Fitke, Dawllsh ; Dr. Shore, Hornsey ; Messrs. Blake
and Co., Leeds; Mr. Lewis, Wakefield ; Mr. Chadwick, Lancaster;
Mr. Williams, Richmond ; Mr. Bunbage, Coventry; Mr. Williams,
Abertillery; Dr. Connon, Blackburn ; Mr. Marsh. Wigan ; Mr. Christie,
Southsea; T. S.,lalon ; P. K., Winchester; Alpha,Bverton; Dragon;
Medlcus, Liverpool; Alpha; X.; Assistant, Hull; Surgeon, Liver¬
pool ; X. Y. Z., London ; Surgeon, Brsdfsrd-on-Avoa.

Orvoii Ilcti Sremle, Newcastle Daily Chronicle, Liverpool Evening Express,
Scotsman, Scarborough Post, Glasgow Herald, SfC., have been received.

Hitouul for % ensuing Meek,

Monday, June 27.

Rotal London Ophthalmic Hospital, Moorfiblds. — Operations,

10.30 a.m., and each day at the same hour.

Royal Westminster Ophthalmic Hospital.— Operations, 1 JO p.m.,
and each day at the same hour.

Ohbutea Hospital for Women.— Operations, 3.80 p.m; Thursday, 2J0.
St. Mark’s Hospital.— Operations, a pj(. ; Tuesday, 1.30 p.m.
Hospital toe Women, Soho-sqdasb. — Operations, a pj»., mmI m
Thursday at the same hour.

Metropolitan Free Hospital.— Operations, 3 pjl
Royal Orthoprdic Hospital.— Operations, a p.m.

Central London Ophthalmic Hospitals.—O perations, 3 p.m., sod
each day in the week at the same hour.

Tuesday, June 28.

Gut's Hospital.— Operations. 1 JO p.m. and on Friday at the same boor.

Ophthalmia Operations on Monday at 1.30 and Thursday at 3 pjl
8t. Thomas's Hospital.— Ophthalmic Operations, 4 p.m.; Friday, 3pjl
Cancer Hospital, Brompton.— Operations, 2.30 p.m.; Saturday,2J0r.it.
Westminster Hospital.— Operations, 2 p.m.

West London Hospital.— Operations, a JO p.m.

St. Mart’s Hospital.—O perations, 1.so p.m. Oonsnltatioaa, Monday,

3.30 p.m. Skin Department, Monday and Thursday, 8.30 ajC.

Wednesday, Jus 29.

National Orthopedic Hospital.— Operations, 10 a.m.

Middlesex Hospital.— Operations, 1 p.m.

St. Bartholomew's Hospital.— Operations, 1.30p.m.; Saturday,same
hour. Ophthalmic Operations, Tuesday and Thursday, 1.30 pjt.
Surgical Consultations, Thursday, 1.30 p.m. ’

9t. Thomas’s Hospital.— Operations, 1.80 p.m.; Saturday, same boor.
London Hospital.— Operations, 3 p.m.; Thursday 4 Saturday, same hour.
Great Northern Central Hospital.— Operations, 2 p.m.
Samaritan Fens Hospital nob Women and Children.— Operations,

2.30 p.m.

University College Hospital.— Operations, 3 p.m. j SatunUy, 3 pjc.

Skin Department, 1.45 p.m. ; Saturday, 9.16 A.M.

Royal Free Hospital.— Operations, 2 p.m., and on Saturday.

Kino’s College Hospital.— Operations, 3 to 4 pjc. ; Friday, 3 pjf.j
Saturday, 1 p.m.

Children's Hospital, Great Ormond-strKet.— Operations, 8 a.n. ;
Saturday, same hour.

Thursday, June 30.

S*. George’s Hospital.— Operations, 1 p.m. Ophthalmic Operations,
Friday, 1 JO p.m.

Omabing-cross Hospital.—O perations, 3 pjc.

North-West London Hospital.—O peration*, 3.30 pjc.

Friday, July 1.

Royal South London Ophthalmic Hospital.—O perations, 3 PJC.

Saturday, .July 2.

Middlesex Hospital.—O perations, 8 p.m.

SUBSCRIPTION.

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Th* Lanckt,]

INDEX.

[Junk 25,1887. 181 7

INDEX.

Abdomen, ballet-woond of the. 37; puncture of
the, (or extreme flatulent distension in
puerperal cases, 718, 800, 848, *04
Abdominal aorta, rupture of, out- of, 374

-compresses, warm, effects of. 1003

-cysts following injury, 1034

-disease, acute, surgical treatment of, 118

-explorations, 880

-nephrectomy in a chronic renal abscees,

un

-section, oases of, 1134; the mere presence

of blood in the peritonenm not a reason for,
290; one hundred consecutive cases of, Ms,
666; large omental lipoma successfully
treated by, 830

-and thoracic aneurysms, treated by the

Introduction of steel wire into the sac, 7»5

-tumour, floating, 218

Abel. Sir Frederick, 1251
Aberdeen. corres|>ondence from, 49, passim
- Sick Cbllareu's Hospital, 552
Abnormal growths In men and animals and
their explanation on the evolution theory,
pathology of, 1<i«3

Abortion, 126; the sharp spoon In, 897; criminal,
687

Ahsoesa, evacuated without any resulting dis¬
figurement, 217; chronic renal, abdominal
nephrectomy, 1282
Acetanilide, or antlfebrine, 41
Aclaod, Sir H., opening address at the General
Medical Council, 984

Acne, some points In the treatment of, especially
of the face, M
Acromegaly, 1195
Actinomycosis homlnis, 813
Adam, Dr. J., on the Lunacy Bill, 1887. 903
Adams, Dr. F. E., on the surgical treatment of
pulmonary cavities, SU 0
Addison's disease, 373; case of, necropsy, 676
Adelaide University and medical education, 37
Adenoid brunchooete, case of, 37 4
Adenoma from mammary gland of rat, 177
Adulteration Act, a new, 1241

-of Food and Drugs Act, 194

-, the repression oL 1191

Advertisement testimonials, 390
Air-guns, <Ungers of, 998

Air-passages, estheterism of the, 383; foreign
body In the, lngfl

Airy and Tar lor, Messrs., on the sanitary con¬
dition of New Windsor, 409
Altken, Dr. L., obituary notice of. 105

-. Mr. C., on dislocation forwards of the

hand, 1188

-. Prof., testimonial to, 488

Alabone, Mr. E. W„ 487

Albuminuria, experimental, 444 ; Intermittent,
In children. 6-19

Aloock, Mr. N., on the Influence of altitude on
phthisis, 567

-■, Sir R„ on hospital support and the

jubilee, 631

Aloohol, diminishing use of, 742; as medicine,
148

Alcoholic paralysis. 1088

Alcoholism, the Pops on, 945; the International
Congress on, 1212; acute cardiac dilatation
from, 1136; in Prance, Increase of, 1294
Alderson, Dr. F. H-, on inequality of the pupils
In various diseases, caution In the administra¬
tion of salicylic acid, 341, 619; on medical
attendance on the poor, 886, 1118; on Dr.
Richardson's election fund, l'»i7
Alexander, Dr. B. G„ on pneumonia, 977

-, Dr. W„ on purulent enceplialltls in a

pregnant woman, 169

Allbult, Mr. H., and the Royal College of
Physicians, Edinburgh, 707
Alien, Dr. R. H„ on oase of intestinal
obstruction from impaction of a gall-stone In
the ileum, 869

-, Mr. A. H„ reference oases under the

Sale of Pood Act, 1307

Ailing ham, Mr. H„ on a new method of
•Mating the knee joint, 196
Almfa'e test for sugar, 997

Althaus, Dr. J„ Some Phases of Cerebral
Syphilis (review), 783
Alveolar sarcoma, 624

-ulceration and general tuberculosis, 777

Ambler, Mr. V., obituary notice of, 346
Ammonia, piorato of, the treatment of malarial
diseases by, 366

Amputation, a sixteenth century, 63
Amyl, nitrite of, for relief of after pains, 608
Anirmla, pernicious, 272; entozoa and, 231
Amrstheiica, some points la the selection and
administration of, 1U90

Ai»xltocal Records.—B anger's peptonlsed
chicken jelly, 29—Oarnrieks liquid pepto-
noids with coooa, lb.—Finest Monlng Glenelg
tea, 1884-85, lb.—Voltmer'e artificial human
milk, ib.— Kola paste, 683 — Maltlne with
casoara sagrada; malto-vlbnrnin j malto
carrageen, ib.— Bxtractum pancreatli (Pair-
child); panoreatlc tablets (3 gr.); peptonlsing
powders in glass tubes (5 gr.), ib.—Tarasp, lb.
—Deodorine, lb.— Dry sparkling ooooa wine,
ib.—Bragg's pure flour of Egyptian lentils ;
Bragg's prepared baked flour iof infants and
Invalids. Ib.—Condy's powder, lb.—De Jong's

F iure and soluble ooooa, lb.—The Germains
mproved apparatus and powder for disin¬
fecting and fumigating, 888 — Moult la, or
potash liquid soap, ib.—Bokdl: a Norwegian
preparation of malt, lb.—Kentish sauce, Ib.—
Liq. podophyllin (Ifockln), Ib.— Van Abbott's
beet-tea, ib.—Raphael tannin wine, lb.—Ooca
wine, 1189—Antlseptlo wall paper, lb.—De
Mlel’s perfect health biscuits, ib.—Oarnrick’s
liquid peptonoids (beef and milk), ib.—Cam-
rick's peptonolds (wine and Iron), Ib.—Baux
mln6rales naturelles de Vais, 8t. Jean. Ib.—
Ozone paper, ib.—Sunlight soap, ib.

Anatomical Society, 744, 899, 996,1136; address
at the, 971

Anderson. Dr. T-. on a new eye speculum, 1037
Anderson • College medical school, 1014
Andrews, Mr. R. 0., on extirpatiou of ruptured
uterus, 830
Animal lymph, 388

Animals, genito-urinary disease In, 268
Annandale, Mr. T.. on displacement Of the
loterartloular cartilage of the lower jaw, and
its treatment by operation. 411
Anosmia, 658, 75i

Anthrax, epidemic of, 347. 453, 839; the pre¬
vention of, 484

Anthropometric Apparatus (review), 783
Antlfebrine In typnoid, 191
Antipyrln and acetanilide In phthisis, 1256
Anti-vaccination, 1145
Anti-viviscctlou Society, 1140
Antrum, removal of foreign body from, 822;
sarcoma of the, 1231

Aorta, multiple aneurysms of the arch of the,
1032

Aortlo aneurysm, rupture of. Into the peri¬
cardium, 315
disease. 681

-valves, perforating ulcers of the, 1054

Aphasia following a depressed fracture of the
left side of the head, 116
Aphonia due to subglottlo growth (? con¬
genital), cure, 521

Apoplexy, stretching the sphincter In, 1024
Apotheoaries' 8ociety, the, 1163, 1212; and pre¬
scribing chemists, 285; and the Colleges, 631,
699, 701

Appendix vermiform Is, suppuration In the, 99,
149

Arachnoid, osteophytes of the, ease of, 1064
Architects and Engineers’ Registration Act,
the proposed, 913, 1001

Arch l v fur Pathologisebe Anatomic and
Physiologic (review), 582
Arm and part of scapula, removal of, for
sarcoma, 20

Army, recruiting for the. In 1886, 60S; health
of nones In the, 1151
-Medical School, Netley, 336, 786

Army medical service, 585, 836; promotion to
the, 84, 148 ; rank in the, 1108

-medical staff dinner, 1152

-warrant, the real interpretation of ther

new, 482

Arnold, Mr. C. A„ excision of chancres, 1071
Arsenic and aoonite, an antidote for, 142
Arsenious acid, Bath water and, 100
Art joke, the, 952
Arterial pressure, 98, 147. 238
Asclepiad, The (review), 422, 1094
Ash. Mr. B. T., presentation to, 961
Ashby, Dr., on the Contagious Disease*
(Animals) Act, 1886, 23

-, Mr. H., on the Children’s HospItaL-

Manchester, 496

Ashdown, Mr. 11. H., on the University oi
Edinburgh, 396

Ash’s method of sewer ventilation, 505
Ashton-in-Makertleld, health of, 545
Aspergillus nigricans, 580
Asphyxia of viscera, local, S3
Astragalus, fracture of, subsequent necrosis, re¬
moval of carious bone, recovery. 1229
Asylums board and their medical superin¬
tendents. 330

Athetosis, 830; and aphasia in a child, 171
Atkinson, Dr. J„ presentation to. 107 ; on the
commemoration ot the Queen's Jubilee by
the medical profession, 1167
Atkinson’s ** perfect truss," 833
Australia, consumption in, 896
Australian notes, 908, passim
Austro-Hungarian army, the vaccination of the,.
39

Automatic purifying etoset, 886
Avian tuberculosis, 281
Avonmoutb. the sanitary state of, 741
Axillary glands, cancerous, 538
Aylesbury district, health of, 952

Baber, Mr. E. C„ on a case of rhlnollth, 772
Backache, on the Cause and cure of a form of, IT
Bacteriology, a practical course of. 898
Hihust islands as a health resort, the. 691
BaiUv. Mr. H. F„ on pregnancy complicated
with ovarian tumours, tapping, delivery, and
subsequent removal of cysts, 122
Bakers, dental carles In, 187
Balfe, Mr. J. H„ on vaccination and re-vaccina¬
tion, 706

Balfour, Dr. T. G„ honorary pbyslolan to the
Queen, 896

Baatock. Dr. G. G„ on Liiterlan and nnn-
Llsterlan ovariotomy, 339; on abdominal
section, 518,568

Balzer, Dr. P„ on Wiesen as a health resort for
phthisis, 810

Barford, Mr. J. G„ on suppuration In tho ap¬
pendix vermiformls, 99

Barker, Mr. A. E., ou treatment of cerebral
abscess, 1175

Barnes, Dr. B.. on the theory and treatment of
placenta pravla, 700,1205 ; on puncture of the
abdomen for extreme flatulent distension in
puerperal esses, 800

-, Mr. J. W., on the Society of Apothecaries,

1063

Barnsley dlstriot, health of, 900
Barr, Dr. T., on separation br necrosis of the
osseous labyrinth of the right ear, aud its re¬
moval as a sequestrum from the external
auditory canal, 212

Barraclough, Dr. U. W., on degrees for London
medical students, 100

Barrett, Mr. C. W. 8„ on dangers of swing
boats, 966

Barron, Dr. J., obituary notice of, 805
Barry, Mr. 0., on submaxlllary calculus, 366
Barwell. Mr. B., on surgical treatment of
hydatid oysta of the liver, 340; ou lateral,
curvature of the spine, 1275
Basdon's chloride of ammonium Inhaler, 313
Bossing boom, diphtheria at, 187
Bateman, Mr. A. G.. on jubilee suggestions,
656; on a convertible carriage, 1168
Bath United Hospital, 847

Digitized by v^.ooQle

1318 The Lancet,]

INDEX.

[Juh* 25,1807.

Bath water* and arsenlous acid, the, 1362
Batterham, Mr. J. W., on hamopericardlum
from ruptured coronary artery, 1131
Battle. Mr. W. H., on partial enterocele (Irre¬
ducible) associated with double hernial sac,
413, 596

Beach, Si' Michael Hicks, 535
Beckett, Dr. J., the Margaret-street Infirmary,
848

Beclard, Professor, obituary notice of, 399
Bedford urban dlstrist, health of, 797, 1106
Beer, what Is it ? 788
Begging children, 91
Belfast, correspondence from, 103, pat rim
Belgian Medical Federation, petition of the,
329 ; medical societies, anniversaries of, 981
Belgium, remedies for professional overcrowd¬
ing in, 141; medical legislation in, 1300
Bellamy, Mr. B., on case of symmetrical gan¬
grene, following varicella, 730
Belper district, health of, 900
Bel viderc Hospital, Glasgow, 602
Benham. Mr., on urethral calculus, 681
Bennett, Dr. F. W., on pyrexia, 800

-, Mr. W. H., on manipulation without

Incision as a possible treatment in certain
cases of stone in the kidney, 1026
Benthall, Mr. A., on coaine, 109
Benzoin resin in ulcers, 41
Bequests to hospitals, 1163
Berl-berl in the Dutch Indies. 40
Berlin, the new Reichstag buildings at, 39
Berry, Mr. G. A., on acute cerebral cases with
ocular symptoms. 272

Bert, M. P., First Year of Scientific Knowledge
(review), 783

Berthold, Dr. M. A., on transport of Infectious
patients, 454

Bethnal-green, insanitary, 793
Bey, Dr. B. W.,on uvulatomes, 1070
Bigelow, Dr. H., on psychto and nervous In¬
fluences In diseases of women, 921
Biggs, Mr. M. G., case of haemorrhage during
pregnancy, probably due to separation of

S lacenta. 469

e, action of calomel on, 1003
Bile-duct, massage in catarrh of the, 999
Biiharzia htematobla, 875
Biliary calculi, 75
Billroth, Prof., 1102, 1199
Btlston urban district, health of, 515
Binlodlde of mercury as an emmenagogue,
250

Birkenhead, health of, 96; amputation case,
the. 385

Birmingham, correspondence from, 239, pattitn

-and Midland Skin and Lock Hospital,

1239

-Hospital Saturday fund, 1286

-Children's Hospital, 248

-Medical Benevolent Society, 1153

-Medical Institute, 763

-Medical Review (review). 783

Bischof, Mr. G., on Dr. R. Koch’s bacterio¬
logical water test, 728
Biscuits, poisonous, 948
Bishop, Mr. G. S., on enteroraphy, 1109
Bishop's patent disinfectant distributor, 30
Blsley, health of. 698
Bismuth subiodide, 391
Bisulphide of carbon, poisoning by. 85
Blackburn, Mr., presentation to, 200, 704
Blackman, Dr. J. G., on diffused innominate
anenrysm, 928

Blackpool, fever* and fires in, 635
Blackwood, Mr. H. H., on the warming of rail¬
way carriages, 850

Bladder, on the cause of marked hypertrophy
of the anterior wall of the, 338 ; epithelioma
of, 22 ; successful removal of indiarubber
tubing from the, 121; hypertrophy of, 173 ;
rupture of the, 269, 539; certain conditions
of, in children, 576; tnmour of the. treated
by suprapubic cystotomy, 629 ; aspiration of
tne, 1063, 1182; rupture of, operation, death
from perineal haemorrhage, 1133
Blanc, Dr. H., on the medical aspect of the
earthquake at Cannes, 495 ; on gaseous rectal
medication In consumption, 1008
Blondln, M., 189

Blood, the white corpuscle of the, lfli; the
presence of. In the peritoneal oavity, 342.897;.
effusion of. Into the knee joint, 6*3; in
health,the variations of the specific gravity
of the. 636

Bluestone as a toxic agent, 591
B .

on diffused innominate

Bourns, Dr. N. W., on case of puerperal apo¬
plexy in a young woman, 1129
Bovine, contagious pleuro-pneumonla, protec¬
tive inoculation for, 191
Bowels, obstruction of the, 883
Bowlby, Mr. A. A., on Injuries of nerves, 863,
921. 968, 1021 ; on Injuries of cases of, 1131
Boxall, Dr., on nbortion, 126
Boyce, Mr. 0., foreign body in the air passages,
1085

Bracy, Mr. C. J., obituary notice of, 908
Bracnial artery, punctured wound of, 978

-plexus, the minute anatomy of the, 538 ;

ruptured, 1092

Braden, Mr. J. G., on maternal impressions, 55
Bradford Fever Hospital, 487, 704
-Infirmary ana Dispensary, 400

“ Brain,” A Journal of Neurology (review), 745,
1138

Brain, tubercular tumour of the, 269 ; anatomy
and physiology of the, 320; cholesteatoma at
base of, 525 ; surgical operations On the, 1002
Bralthwalte, Dr. J., does laceration of the oer-
vix uteri more commonly occur In first
labours or in subsequent ones ? 448
Bramwell, Dr. B.. Practical Medicine and
Medical Diagnosis (review), 735
Bread-making, 658, 708, 756
Breast, melanotic tumour of, 72
Bredtn, Mr. J. N., on case of melanotic sar¬
coma, 367

Brentford, health of. 797
Bright’s disease, the genesis of, 767
Briscoe, Mr. J. F., on treatment of tenia
solium, 1168; on threadworm, 1187
Bristol district, health of, 1106; proposed mater¬
nity hospital at, 235

-Medical School, 87

Bristowe, Mr. J. 8., on thePenge case, 954; on
cases of gall-stones, 361
British Medical Benevolent Fund, 157.192

-Medical Temperance Association, the,

453, 641,1114

Broadbent, Dr. W. H., on the pnlse, 607, 656,
709

Brodeur, Dr. A., Del'Interventlon Chlrurglcale
dans les Affections du Rein (review), 881
Bromidla, 190

Brompton Hospital, the Prinoese of Wales at
the, 691

Bronchial glands, dyspnosa from pressure of
enlarged, 23

Bronchitis, what is it ? 757
Bronchus, a calculus In the, 184
Brooks, Mr. W. T., on the Brasmus Wilson
bequest, 903

“ Brougham hansom,” a new patent, 423
Brown, Dr. J. G., on Mr. W. Howard's cases of
transfusion, 1158

-, Mr. G., on medical defence, 109

-, Mr. J., on medical bursaries, 56

-. Rev. T. A.. 8ketch of the Life and Work

of Dr. A. Wood (review), 629

-defence fund, 809, 861, 965, 1071. 1118,

1215, 1269

Browne. Mr. G. B., on aspiration of the urinary
bladder, 447

Brown-Sequard, Professor, on the pathology of
the laryngeal vagus, 937
Brnnton, Dr. T. L., and homesopathy, 341,
397, 788

Brussels, infectious diseases In, 842 ; Scientific
Congress, 1056; Maternity, perineal ruptures
In tne, 791

Bryant's torsion forceps, 1094
Buckmaster, Mr. G. A., Elementary Animal
Physiology (review), 783
Bu6e, Mr. W. U., what Is bronchitis? 757
Buildings, sanitary registration of, 952
Bullel, Dr. K. £., on a case of otitis media
hemorrhagica, 1132

Bullock, Rev. 0., The Man of Science, the Man
of God—Sir J. Y. Simpson (review), 832
Burdett, Mr. H. C., on hospitals, the sick poor
and all England. 290

Burdett's Official Intelligence (review), 682
Burial, premature, 138 ; reform, 539
Burmah, 499

Burmese, midwifery among the, 176
Burnle, Mr. W. G., treatment of diphtheria,
404

Burroughs, Dr. H., presentation to, 653
Burton, Mr. F. H. ft., case of osteophytes of
the arachnoid, 1084

Buxton, Mr. A. 8 .. Vision and Vision-testing
with Practical Tests (review). 581; on the
inequality of the pupils in tubercular menin¬
gitis. 596

Bnztard, Dr. T., on two oases ert Thomsen’s
disease; 972

Cadet, death of a, atWoohricb, 188

Caesarean section, 1189

Oafictdou* pyeHUs, followed by albuminoid

Callender, Mr. R. G., on puerperal pyrexia, 1830
Camberwell, infirmary accommodation at, IK
Cambridge, university of, 586; the flnatvial

K iition of, 139; Medical Graduates’ Club ad
udon medical degrees, 222, 232
Cameron, Dr. M., presentation to. 753
Cancer, and its treatment, 175; cultivation
experiments with new growths and healthy
tissues, and the parasitic theory of. 10S3;
and phthisis as correlated diseases, 677

-Hospital, Brompton, 400

Canoeroos tumours, carbonate of Itme as a
means of arresting the growth of, 967,1106
Cannes, medical aspect of the earthquake at,
495

Cannon, Mr. R., oh a case of strongylos gigs*.
264

Cant. Mr. W. B., on the induration of
Hunterian chancres in the female, 313
Canterbury dispensary, 154
Carbolic acid as a safeguard against insects, 1367
Cardiac thrombosis, latent typhoid few f a tal
through, 1062

Carlisle, wholesale poisoning at, 184; health of.
645

Carmarthen inquest case, the, 741
Carpenter, Dr. A, the Principles and Practice
of School Hygiene (review). 1838

-, Mr. G. A., on case of aphonia doe to sob-

glottic growths, cure, 521
Carr, Mr. J. W., on degrees for London nasdtal
students, 196

Carriage, a convertible, 1168
Carriage tax. the, 40. 640

Carrington, Dr., on recovery from 1 nbnonlsi
meningitis, 72; on successful t re a lm so t of
hyperpyrexia, 471

-. Dr. B. E., death of, 591; obituary nottoe

of, 653

Cascara pastils, 42
Case-making, the plan of, 55
Casual wards, 896

Catalepsy in a mother and child, 486
Cataract, treatment of, 26; picture faUsd
after extraction of, 577; Induced by tlxs vaca¬
tions of tuning forks, 691
Catarrhal jaundice, treatment of, 648
Catgut holder, an improved, 630
Cattle diseases In Great Britain, 1167
Oattlln, Mr. W. A. N., obituary nodes of, MB
Caxton and St. Neots, health of, 767 ,
Centenarians, deaths of, 946
Centralblatt fiir Bacteriologie dU FyaittM-
kunde (review), 589

Cephalic version In placenta previa. 1199
Cerebellum, excision of tumour of, 7 68, 69 ;

cyst of, enolosed In fourth ventricle, 889
Cerebral abscess, 1175; trephining fas. 474;
due to otitis media, 616

-cases, acute, with ocular symptom. 873

-embolism following parturition termi¬
nating in hemorrhage Into lateral vanddtfa,

necropsy, 19

-oentres for gastric movements, 1108

-- haemorrhage in a child with throMMs

of sinuses. 1039

-lesions, ollntaal and pathnloghmlBIcCta-

tlons of. 12, 64

-meningitis and abeoees, 177

-syphilis, random symptoms from, 680

Cerebro-spinal meningitis, rec o ve r y. 871
Cervical catarrh, different methods of trsetta,
190 .

-emphysema, following part«rlUdB.akiss

of, 122 '. .

Cervix uteri, laceration of the: dees It Bases
commonly occur In first labours or iaNBse-
quent ones ? 448
Ceylon, medical history of, 140
Chalky district, health of, 846 \

Chancres, excision of, 390,1071
Chapoteaut’s morrhnol, 549
Character, anatomy and physiology III. M , _
Charbon, Seven Consecutive oases of, treats*
successfully by excision, 367, 416 • ,

Charcot, Dr. J. M., Lepons sur les MslelWqlk
SystC me Nerveux (review), 681 . , d _ mt

Ohavasse. Dr. T. F., on renal mxrgtrf, MB . ''
Oheadle. Sr. W. B.. on pathqlogy ami (Mo¬
ment of laryngismus, totsny. eeo twfri^t.
slons, 919, 967 ’ r. jl.

Cheek, primary Hunterian Ohanerefif U»4,6M'
Cheese, poisonous. 486 .

Che vers. Dr. N., a Commentary on th i TMk s#si
of Tndla (review), 489 . _

Chemist, a, censured for medlaalnnidtS*,9
Chemists, the education of. liat; ttadtfM
advisers, 1103

Cheshire, anthrax In, 638 * •

Chest, bullet wound of. wound of long. SfcMtfBI
of bpllet.reoovery,266 .."' . .

•«-■********»

Chit
OW1
Oh

Thb Lanckt,]

LXDEX.

[Jcma 26,1887. 1810

Children's fftie, 1196

-Hospital, Great Ormond-*tract, 1114

-teeth, 796

Chinese pharmacology, I960
Chloral, ratable after taking a dose of, 109,166
Chloride of ammonium, the dm of, aa an in¬
halation in dfceaaee of the reaplratory tract,
167

Chloroform, deaths from,401
Chlorosis, pulverised spleen In, 191
Choke-damp, treatment of poisoning bv, 1269
Cholera, the progress of, 40; In (mill, 91; in
Europe during 1686,190; fungus, a new, 228,
397; statistics, 326; In Austria-Hungary. 444,
995; Intelligence, 486; treatment of, In Buda-
Peeth, 539; In Sicily. 541.692; precautions, 643;
in Booth America, 286, 997; forecasts, 1249
Choleraic diarrhoea with ool lapse, 468
Chorea, school-made, 112, 134, 196; posthemi¬
plegic, 680 ; seasonable relations of, and rheu¬
matism, 1148

Choroidal haemorrhage, 271
Ohoroido-retinltis, 1284

Christian Theocracy and the Dynamics of
Modern Government (review), 783
Chrlstison, Sir Bobert, the Life of (review),
178

Christy, Mr. T., on Inhalation of ooal gaa as a
source of disease, 913

Chnrcb, Mr. A. H., Food Grains of India (re¬
view), 884

Church bell grievance, the, 1197
Ohurohee, the ventilation of, 184
Ghnrton, Dr. T„ Guy's Hospital Instructions
for Case-taking (review), 783
Chylous ascites, 23

Ciliary muscle fibroid, degeneration of, 677
Cirsoidanenrysm, 626

City, local government In the. 704; Dispensary,
246; Lying-In Hospital, 401; Truss Society,
1068

Civilisation, the physically deteriorating infin-
ences of, 1248
Civil war in 1643, the, 997

Clark, Dr. J. H„ recent Fastenrian deaths, 290

-, Mr. F. W„ on a remarkable case of

fibroma molluscum, 1183

-, Mr. H. M., on the treatment of malarial

diseases by pi era to of ammonia, 369
-. 8lr A., on management of simple con¬
stipation, 1; on a speedy and sometimes
successful method of treating hay fever, 1169
Clarke, Mr. W. B„ the Diagnosis of Diseases of
the Kidney amenable to Direct Surgtoat Inter¬
ference (review), 1238
Class mortality statistics, 845, 887
Clavicles, simultaneous fracture of both, 177
Cleft palate, two successful operations for, in
children of one year old, 1133
Clerical, Medical, and General Life Assurance
Society, 146

Olerkenwell, the sanitary condition of, 948
Clinical oases, unusual, 271

-reports, select, 373

-Society, the, 281, 1149 ; president’s

address at the, 269
CUtheroe district, 747
Clnb-foot, 210

Coal-gas, the Inhalation of, as a source of
disease. 828, 834, 913,996
Coates, Mr. W„ on surgical treatment of acute
abdominal disease, 118

Cocaine, 109; poisoning by, 17, 75; the Influ¬
ence of, on the action or eserine on the eye,
88; In dental surgeiw, 167; alleged toxic
effects of. In the bladder, 332; physiological
action of, 687; dangers Of, 780; In aural sur¬
gery, 1070; dosage, and cocaine addiction,
1024; removal of adenoma of the breast under
the use of, 1230; as a I ooal anaesthetic In
dental surgery, 1249; removal of breast
tumour with the aid of, 1315
Coccyx, a case of removal of the, 1088
Coffin, Mr. T. W., on treatment of placenta
previa, 851

Cohn, Mr. H., Hygiene of the Eye in 8chools,
(review), 274

Colborne, Mr. W. W„ on the pulse, 800
College election, the, 1244
Coller fracture, pathology of, 268
Collie, Dr. A., on Fevers: their History, Etio¬
logy, Diagnosis, Prognosis, and Treatment (re¬
view), 831

Collier, Dr. W„ on a doctor's income, 1168
Collins, Dr. M. C., on the relation of Insanity
to exophthalmic goitre, 68

-, Dr. W. J., on oonple rhythm of the

heart, 1229

-. Mr. E. T., on aotlon of hyoeoine on the

eye, 1159

Colonial practice, 967
Colorado, 402, 6o6

Oolotoray, early, 219; for malignant disease,
819, 822

Colson, Mr. B., on an enormous calculus, 623
Columbia College, New York, the centenary of,
1000

Coma, the nature of, 481, 647; a remarkable

osse of, dot to malignant pustnle, 821 ; from
anthrax, 843

Conder's sewage process, 1002
Conical cornea, treatment of, 271
Conjoint board, the Bngllsb, 462

-colleges, the, 1293

-examination, •• place* of study ” 91

Constipation, simple, management of, 1: obsti¬
nate, In an Infant, 360; In children, 828
Consumption and other diseases of the respira¬
tory organs, treatment by gaseous rectal In¬
jections, 761, 849,1008; the latest "cure"for,
1148

-, North London Hospital for, 1258

Contagion, free libraries and. 1252
Contagious Diseases 1 Act, 389; effects of the
suspension of the, 698; in India, 1168;
(Animals) Act, 1886. 23
Cookery, thrift In, 187
Cookridge, seml-oonvalesoent home at, 868
Copeman, Mr. 8. M„ on the blood in pernicious
anemia, 1076

Copper workers,chest diseases among. 1126
Corneld, Dr. W. H., Treatment and Utilisation
of Sewage (review), 1285
Cornea, calcareous film of, 271
Coroner’s censure on a medical student, 742

-court, reform of the, 79. 986, 990

-, the law relating to, 338

Comet* and tlght-laclng, 1296
Oosgrave, Dr. B. M.. pun of oase-maktng, 55
Country practice and practitioners, 84
“ Coup de vent,” 86

Courteney, Mr. L. T„ Travels In the Interior
(review), 1286
Court physicians. 1001

Cousins, Dr. J. W., new pelvic toumtqnet for
amputation at the hip joint and other opera¬
tions, 666

Coventry district, health of, 846
Cow. tubercle in the, 1001; disease of the, and
scarlet fever, 1192

Creighton. Dr. C., on the heredity of tubercu¬
losis, 1205
Cremation, 1212

Crichton Royal Institution, Dumfries, 286
OrickhoweU district, health of, 900
Criminals, instant and easy death for, 592
Cripps, Mr. H„ on colotoray for malignant
disease of the rectum, 819
Croly, Mr. H. G-, on primary sarcoma of the
tonsil, 1234

Orookshank, Mr. B. M., on the Cambridge
cholera fungus, 337; Photography of Bacteria
(review), 1238; recent researches In con¬
nexion with the etiology of scarlet fever,
1274

Croonlan trust, 741

Croup and asthma, the analogy between, 175
Crown Prince of Germany, illness of the, 1101,
1145, 1200, 1298; nature of the laryngeal
growth, 1302

Croydon sewage farm, 195
Cul.um, Dr. If.. on the Lunacy Acts Amend¬
ment Bill, 1887, 494
Cumberland, the Duchess of, 794
Curnow, Dr. J„ on the treatment of typhoid
fever by the cold wet pack and alcohol. 9
Curran, Brigade-Surgeon W„ on survivanoe
after gunshot wounds and other Injuries of
the heart, 673,723,850; on snicide of scorpions,
1071

Ourrell’s case, 852
Cut-throat, case of, 657
Cyclotoray In glaucoma, 1284
Cystic duct, gall-stones In the, 1282
Cystlcerous, Intra-ocular, 488
Cystotomy, perineal and suprapubic combined,
980

Dairy schools, 1297

Dale, Dr. F., a new style for facilitating the
treatment of stricture of the lacrymal duct,

30

Dalllnger's (Dr.) experiments, 383
Damascus, hospital at, 1068
Damp beds, 389, 455
Darenth hospital dispate, 186, 323
Darlington, Infections disease at. 704
Darning needle, snicide with a, 230
Davidson, Dr„ presentation to. 1163
Davtes-Colley, Mr. N., on an operation for the
cure of ectropion, 619
Deaf-mnte children, 138

Dean, Mr. G. F., cocaine In dental surgery, 157
Death, real and apparent, 238; what was the
cause of? 639; from ohloroform and fear,
1297

Death certificates, 540, 1144
Death-traps, 691

Deer, rabies among, 869, 899, 949, 996
Deep sea fishermen, medical aspects of the mis¬
sion to, 1196

Degrees In medicine and surgery for London
medical students, 1291
De Groote, Dr., on hot climate*. 1254
Denham, Dr. J„ obituary notloe of, 245
Denison, Mr. B. H., testimonial to, 562

Dental Irregularity, 639

-surgery, on the Continent, 189 ; ooealne

as a local aoeeaLhetlo in. 1219
Dentistry, cocaine In, 157, 334
Dentists and medical practitioners, 899
Dentist s' Register, the, and the MedtealCouncil*
1259, 1291

Derby urban district, health of, 1164
Dermatitis gangrenosa infantum, 1133
Dermoid tumour, 680
Devon and Btetor Hospital, 1114
Devonshire Hospital, 1067
Diabetic, a note of warning regarding the con¬
dition of articles of food sold for the use of
the, 493

-coma, 612

Diabetes, morphine. In, 186 ; albuminuria in,
843; phosphide, 125; Eustachian obstruction
In, 1264

Diaphragm, congenital defect In, 027; the
action of the, 910; aubpleural lipoma of.
1083

Diarrhcea, outbreak of. caused by the emanation
of noxious gases from tide-locked sewers, 76 ;
persistent, 55, 157, 208; epidemic, 986, 340.
396; Infantile, 1149

Dickinson, Mr. A. W., on the late Dr. Hatton.
861

Dictionary of National Biography (review).
129,683

" Difficult ” patients, treatment of, 181
Direct representative*, the cost ot the election
of, 286

Dirty and troublesome Incurable*, 592
Disease, prevention and treatment of, 1091
Disinfection, on, 70

Dispensaries and professional ethics, 1066 ;
cheap, attendance by unqualified aselstants-
at. 896

Diphtheria, 627; treatment of, 401; an out¬
break of. 882 ; paralysis of the diaphragm
after, 975; and milk, 341; and croup aa
endemic diseases, 656
Diploma, wanted an Inferior, 687
Doble, Mr. 8. L., on a case of poisoning by
tartar emetic, 773

“ Dr„” the title of, amongst dentists, 839
Doctor, fatal attack on a. In Roumanla. 423
Doctor's real holiday, a, 1118
Doctors, the income of, 849, 947, 1062.1158,13ft>
Dod’s Parliamentary Companion (review), 783
Dog laws, the, 1104

Dogs in London. 806; home for lost, 37; and
hydrophobia, 485
Dorset County Hospital, 217, 297
Dowdlug, Dr. A. W.,on cocaine in whooping-
cough, 202

Down. Dr. J.L., on mental affections of child¬
hood and youth, 62,163,256
Dressing, a new and Impervious, 1253
Drinking-troughs and glanders, 1268
Drinking-water and disease, 892
Drugs, Adulteration of, 1060; the utility of, las
the treatment of disease, 1063,1109,1167; the
value of, 1206

Drumrrond, Dr. D., on clinical and patho¬
logical illustrations of cerebral lesions, 12, 64-
Drunkenness in 1886,536
Druitt’s Surgeon's Vade-Mecum (review), 1138
Drysdale, Dr. 0. K„ on the disposal of London
sewage, 1016

Dublin, correspondence from, 102, pastim
honorary degrees of, 1254
Dubolsin, toxic effects of sulphate of, 75
Duckworth, Sir D„ case of psoriasis associated
with rheumatism, 731; on tropical abscess of
the liver, 811

Dudgeon, Dr. B. E„ on homaopathy, 349;

Dr. Bmnton and homoeopathy, 341
Dufferin fund, the. 297,331
Dukes, Dr. 0„ Health at School (review), 782
Dukes, relieving the, 291

Dulles, Dr. C„ the treatment of hydrophobia.

with the poison of the Tlper, 289
Dundee University College, 246
Dnnlop, Dr. A., on an overdose of eserine, 621
Dura mater, endothelioma of. 420
Durham County Hospital, 847
Dostman and the wind, the, 894
Dwellings, the air of, 1097
DysacusU, 1229

Dysmenorrhma, cystic ovaries removed for, 126
Dysentery, the etiology of, 691
Dyspepsia, intestinal displacement a oause of,
141; drowsiness accompanying, 352, 403
Dystocia caused by bydreorphalus and pelvlo
tumour, 882

Bating, the diphtheria epidemic at, 281.325
Esr, treatment of hsmswms of the, 388
Barly closing, 327

Earthquakes, after effects of the, on the
nervous system. 590

East, Mr. E., British Medical Benevolent Fund,
157

East London Hospital. Shsdwell, 1163
Ebstein, Dr. W., La Goutte, sa Nature et son
Traltement (review), 735

Digitized by ^3 ooQle

1630 ThbLawobt,]

INDEX.

[JrasftUMjVS-

Booles, Mr. S., on the physiological effects of
m a ssa g e, 134

Eccleshtll district, health of, 963
Bclampela, puerperal, 1330
Bctopia vesica, 481

Bctroptoa, an operation for the cure of, 619
Edinburgh, correspondence from, 48, patrim:
police emergency cases In, 188; prosecution
of original research in. 393; the University
of, 281, 324, 341, 396; Club, 1063
Elastic fibres, the genesis of, 689
Bibow, excision of, 219

Blder, Dr. Q.. on suppuration In the appendix
vermiformls, 149; abdominal section for pyo-
salplnx and subperltoneal myoma, 622

Electricity, prizes for, 847; In medical and
surgloal practice, 867
Electrolysis of an aneurysm In Spain, 540
BUiott, Dr. F. H„ on the treatment of lntus-
susoeptlon, 67

Bills, Mr. H. M., on Inhalation of coal gas as a
source of disease, 965

Bills's Irish Education Directory and Scholastic
Qulde for 1887 (review), 683
Bmin Pacha, 231

Eminent foreigners, deaths of, 334. passim
Bmmenagogue action of oxalic acid, 235,808
Bmmerson, Dr. J. B., nature of coma, 547
Bmpyema, 166,1035; with pulmonary gangrene
following euterio fever, treated by perflation.
533; perflation In, 595; free incision and
drainage at lowest point, recovery, 571; tube,
682

Bncephalocele (?), 1315

Endocarditis, ulcerative, 731; and nephritis,
malignant, 883

English surgery, a tribute to, 136
Bnterocele, partial, 311, 314 ; irreduoible, asso¬
ciated with double hernial sac, operation, 413
Bnteroraphy, 1109; experimental inquiry as to
the best method of, 980

Epilepsy, following an Injury to the leg, 472 ;
trephining for, 1091; and Paralysis, Bagent’s
Park Hospital for, 962, 1114 .

Epiphyses, diagnosis of traumatic separation
of the, 984

Bplstaxis, the treatment of, by oounter-irrlta-
tion over the hepatic region, 954
Epithelioma of the soft palate, 622
Epplng rural district, health of, 1154
Epsom College, 109, 1133, 1246
Epulis, ossified, 881

Erasmus Wilson bequest, 183.193. 639. 688,903

-lectures, abstracts of. 354, 304 , 405

Brgottne, 1186 ; In intermittent fever, 391, 809
Eserine, an overdose of, 621
Eruptive eccentricities, 366
Erysipelas, treatment of, 42; artificially pro¬
duced, relapse of. 330; after vaccination, 583 ;
metastasis in, 994
*• Brytbromelalgy," 445
Ether, under theinfluence of, 1000
Ether - Inhalers, suggested improvement in,
1109, 1206, 1307
Bucalyptol in phthisis, 391
Bve, Mr. F. S., on base of Intra-peri to neal ex¬
cision of the rectum, 575
Bvidenoe, no medical, 1149
Evolution, the place of health in, 719; in
pathology, 254, 304. 405

Ewart, Dr. J„ on fever oases In general hos¬
pitals. 195

-, Dr. W., on perflation in empyema, 595

-and Bonham, Messrs., on empyema, with

pulmonary gangrene, following enteric fever,
treated by perflation, 623
Examination Hall, the new, 540

-questions, 1266

-regulations, recent changes in, 739

Examinations, inspectorships of, 843
Examining Board of England, new regulation
of the. 891

Exeter, health of, 646; dispensary, the, 452
Exophthalmic goitre, on the relation of in¬
sanity to, 66; treated by the continuous
current, a case of. 264
Exploratory incisions, 109
Eye, etiology of constitutional diseases of the,
67 ; diseases of the, 765, 816; Insertion of
artificial globes Into Tenon’s capsule after
excising the, 983; gunshot wounds of tbs,
1019; action of byosdne on the, 1101, 1169
Eyeball, complete self-enucleation of, 984.1072;

and upper lid, associated movements of, 677
Eyelashes, removal of engrowing, by sleotro-

Bye speculum, a new, 1037
Byes, extirpation of both, for tubercular disease,
677; researches on the rafraotion of the. In
Stockholm, 690

FMe. plastic operations fov eeteopioa andoen-

Psoe, plastic operations

*s&kuT

Fallopian tubes, malformation of the, 983;
frequenoy of pathological conditions of the,
982 ; the morbid anatomy of the. 938
Fatting and poisons, 1052 •

Fatigue, pathology of, 1295 ' i

Fauces, tuberculosis of, 474
Fayrer, 81r 3., on disease In the Punjab, 306
Feet, sweating of the, 1168, 1214, 1269
Femoral artery, ligature of the, 46; high
aneurysm of, ligature of external lilac artery,
71; the effeot on the, of ligature at the apex of
Scarpa's triangle, 98,147 ; and vein from sup¬
purating bubo, perforation of, 526

-voln, common, wound of, 125; wound of

the, secondary tuemorrhagefrom the common
femoral artery, septicaemia, death. 268
Femur, ununited fracture of the, 214*; sarcoma
of the, 773; three cases of badly united frac¬
ture of the. 469; fracture tbrongh sarcoma of, •

! secondary deposits in skull and olavlole, death,
624; iuteaeapsular fracture of neek of. 1036
Fenwick. Dr. B., on the relation of phthisis to
ovarian cystic disease, 196

-, Dr. 8.. on functional diseases of the

liver, 1171. 1217, 1271

-, Mr. E. H., on olottage of the ureters,

576; a case of tubercular disease of the tibia
and ankle joint treated by scraping away the
medulla of the former and the synovial mem¬
brane of the latter, 771; corkage of the ureter
with clot incases of advanced cancer of the
kidney, 1280

Fergus, Dr. W., obituary notice of, 105
Ferrier, Dr. D., Functions of the Brain (review),
77

Fever, the isolation of, near Bradford, 229; on
the nature of. 507, 667. 612, 684
Fibroids, spaying for, 1298
Fibroma molluscum, a remarkable case of, 1183
Fll&rla sanguinis hominis, 100, 189; in South
Formosa, 732
Final examinations, 990
Finsbury Dispensary, 246
Fire on railways, death by, 324
Fires, deaths in the midst of, 1194
Firth, Mr. li. H., on the occurrence of a poison¬
ous ptomaine In milk, 218; on oontagious
diseases Acts in India, 1158
Fish, boracic acid as a preservative of, 387
Flshbourne, Dr. J. E., on survivanoe after gun¬
shot and other wounds of the heart, 851
Fissured lip, 248, 403

Fleming, Dr., on the etiology of placenta
prrnvia, 126

-, Dr. W. J., on a modified form of ure¬
throtome, 833

-, Mr. G. t Veterinary 8cienoe (review), 1238

Flint, Dr. A., A Treatise on the Principles and .

Practice of Medicine (review), 528
Flint, typhus in, 1055
Florence, sanitary condition of, 137
Foetal abnormality, 28
Fietation, extra-uterine, 268
Fogs, 232 ; the etiology of. 443
Folkestone, the sanitary state of, 89
Foochow. Hospital for Women, 141
Food of man. 89

— and Drugs Act. prosecution under the, 53;
remarkable magisterial decisions under the,
140

-exhibitions, 216

Foot, dislocation of the, backwards, 573 ;; and
ankle, conservative surgery in diseases of, 373.
Football fatalities, 217. 858 ; the perils of, 487
Forbes, Mr. J. G. T., death of, 1002
Foreign medical journals, new,39

-university intelligence, 40, passim

Fork swallowing, 1109
Formic acid as a disinfectant, 42
Fothergill. Dr. J. M., on the genesis of Bright's
disease, 767

Foulston, Mr. E. J.. presentation to. 300
Fountain, Mr. E. 0., the influence of alUtnde
on phthisis, 657
Four children at a birth, 551 .

Fowler, Dr. 3. K., on canoer of the body of the
uterus, 496. 595

-, Mr. W., on successful removal of india-

rubber tuning from the bladder; 131
Fowls, emasculation of.156,.394
Fox, Dr. C., Sanitary Examinations.of Water,
Air, and Food (review), 317 . . i

——, Dr. T. C., on an affection of the nervous
system during the exaathemstage of meaelee,

-, Dr. Wilson, the late,,939, 1071; obituary

notioeof, 1011; memorial to, 1191
Fraenkel, Dr. O., Gundrisa der Baktertenkunde
(review), 1285

France, rural, consultation fees tn, 1354; in¬
crease of alooholism in, 1394
Franklin’s spectacles, ®®*.. . w ■

{Franks, Dr. K., oh the Inhalation of ohlodds
of *nnn£otun in,di*es#e .oi tbs respiratory

Gabbett, Dr. H.

8 .. on rai

hd state

bacillus, 767
Galactorrhcea. 5

51

Gall-stone oaus
„ 111®.

M

m

&

i£"3

Tkb , Lancbt,]

INDBZ.

[June 26,1887. \m

Goodridge, Dr. H. F. A., on the result* of otca-
trlslng processes in the neighbourhood of the
•portal Amu re, J 326, 1377
Gordon boys' home, the, 337, 693.; mempriaJ,
the, 1146

Gorsuch, Mr. B. B., on inciting the tonsil,
1314

Goetelin, Prof. L4oa, obituary notioe of, 959
Goto’e, Dr., method of treating ISprosy, 108
Gould, Mr. A. P., on wound at the common
femoral vein, secondary haemorrhage from
the oommon femoral artery, septicsemia,
death, 258; on the College of Surgeons
examinations, 1107, 1150
Gouty knee joint with suppuration, 1084
- — parotitis and goaty orchitis, 523
Government emigration office. the, 90
Oracle, Mr. C. B., on oooaine in aural surgery,
1070 . . .,

Grmmthaw, Mr. H., on damp beds, 455
Grant, Mr. W. T., on the Great Northern
Central Hospital, 249
Granular lids, the coccus of, 899
Granuloma fungoidcs. 841
Graphic and Guy's Hospital, the, 333
Graves’ disease, 273; some clinical feature* of,
818 i acute, 1190

Grayling, Mr. A., on imperforate hymen. 109
Great Northern Central Hospital, 187 , 249
- Ormond-street Hospital for Sick Child¬
ren, 1163

-Yarmouth Hospital, 1009

Grenfell, Mr. H.. obituary notice of, 357
Greenook Infirmary, 463

Gresswell, Mr. A., on abnormal growths In men
and animals, 1083

Griffith, Dr., on extra-uterine foslatlon. 368
Gross, Dr. C., on general hospitals and parish
infirmaries, 395; on the Lunacy Act* Amend¬
ment BUI, 1887, -194
Grosvenor Gallery. 961

Griin, Mr. B. P., on removal of adenoma under
the use of cocaine, 1230

Gunshot injuries, case of, which ooonrred at
8 hwebo, Upper Burmah, 721
Guy's Hospital, the charge against, 686 ; the
assistant physlcUnships at 795; appoint-
ment at, 1050 ; fund, the, 231. 400, 690. 949,
1864

Gwillim, Mr. B. L., on accommodation for
prisoners awaiting trial, 590 ■

Gymnastics at school, 1195

Hackney, new mortuary for, 858
Hadden, Dr. Vf. B.. on a case of exophthalmic
goitre treated bv the continuous current. 204;
epilepsy following an injury to the leg, 472
Hematooele from a ruptured Graafian follicle.
126

Hxmatnria. profuse. In connexion with
granular kidneys, 472 ; endemlo, 1135
Hsmopericardium from ruptured coronary
artery, 1131

H.-emophllla.. a ease of, 1028; three cases of, hi
the same family, 874

Haemorrhage, transfusion for, in military
surgery, 141; value of the, in the treatment
of wounds. 947

Hemorrhagic parametritis, 982
Hailes, Dr. C.. on strophahthns. 964
Haldane, Dr. D. R., obituary notioe of, 850
Halifax, sub-townships and their medical
officer of health, 641 ‘

—-district, health of, 840

Hall. Dr. D., on pneumothorax, with reoovery,
In the apparently healthy, 574
Hallopeau. Dr. H., Traite Bis mental re de
Pathologic General* (review), 885
Hsman, Dr. W. A., on fho action and pro¬
perties of the white blood-cells, 671
Hamilton, Dr. J. B., on the value of drugs,
1206

Hammer toe, 1130

Hand, nxvus of, 219; horny growth on the,

' 369 : dislocation forwards of the, 1133
Handford, Dr., on lipoma of heart. 173
Hands and feet, Inherited congenital deformity

HuBKing a* a source of pleasure, 790
Hanley district, health of, 952
Hannen’s (Sir Jamas) court and the newspaper
press, 454

Ha*dd«. Dr. J., the Manchester venus the
London schools of medicine, 903
Harding, Mr. A. W., on the la** prevalence of
shingles, 147

Hardy, Mr.'H. N., on the provident principle
and the medical profession. 190
Harkin, Dr. A., on the treatment of eplstaxls
encounter-Irritation over the hepatic region.

Harris, Dr. J. B., on serious resalt from unin¬
tentional intra-nterlne medication, 1010
, Dr. J. R„ on sea-sickness, 403
Dr. V. D., on the University of London
»nd Its new regulations. 267
" • Mr. J., on epithelioma of the Up re¬

moved by the aid of cocaine, 60

Harris, Miss L.« Our. Young Ladies (review),

129

Harrison, Mr. R., on a median lithotomy. 1222

-and Cross, Messrs., on sloughing of the

scrotum, 1128

Harrogate Bath Hospital, 340
Harvey. Mr. W.. Prelect!ones Anatomic Uni¬
versalis (review). 1187
Haslar Boyal Naval Hospital. 090
Haschlsch purum and cannabinon, 543
Haslam, Dr. W. K.. on a modification of mid¬
wifery forceps. 477
Hastings, health of, 098

Hatch, Mr. W. K., on bilharzia hxmatobla, 876
Haviland, Mr. A., on Manx climate, 1301
Haward. Mr. W., on some forms of defective
speech, 111; cases of transfusion, 770, 1168,

1262 ,

Hay fever, a speedy and sometimes successful
method of treating. 1109
Hay, Mr. W., an Elementary Text-book of
British Fungi (review). 477
i Headache, the relation of a certain form of, to
the excretion of uric acid. 1083
Healing Art, the (review), 433
Health, a Minister of. 839
Health-seekers abroad, 484
Hearing, the sense of, 2

Heart, ulceration and endocarditis of right
side of, 21; syphiloma of, ib.; displacement
of the, to the right side, from purulent
effusion into the left pleura, 68; lipoma of.
173; survlvance after gunshot wounds and
other injuries of the, 073, 723, 850; hyper¬
trophy of, 832; couple rhythm of the, 1229
Heath, Mr. C-. cm the Boyal College of
Surgeons examinations, 1061
[Helder garrison, pneumonia in the, 1103
Heimsley district, health of, 747
Hemiplegia, case of, 26

Henderson, Mr. T., on ligature of the Innomi¬
nate. 876

Henley regatta, 1264; contamination of the
Thames by the, 1294

Henrtques, Mr. A. G., on the Hove infections
linspital. 1200 .

Hepatic abscess, 215
Hereditary tremors, 080
Heredfty, 996

Hereford combined district, health of, 098
General Infirmary, 003

Hernia, strangulated, radical cure after, 30;
inguinal and umbilical, cases of. 09 ; strangu¬
lated congenital, with rupture of the
intestine, herniotomy, entoraphy, cure, 521
1 Hernial' sac, partial enterocele, irreducible,
associated witii hydrocele of the, 596
Herniotomy in young children, 1039,1119
Herpes In phthisis, 1199

Hewitt, Dr. G., on sterility. 1973; retirement
of. from University College. 1364
Hicks, Dr. J. B.. on the treatment of placenta
prxvla, 046, 749; on puncture by trooar of
the tympanitic abdomen in puerperal oases,
848

Hill, Mr. B.. on the Apothecaries' Society and
the colleges, C99; the Essentials of Ban¬
daging (review). 1137

-, Mr. W., on sham patients in Reusing-

j ton, 810

Hilton’s Best and Pain (review). 934
Slip, excision of, 474; congenital 'dislocation of
the. 825

Hip joint, diseases of, in children, 475
Hips, dislocation of both. 474
Hobeon. Mr. M. C., on the treatment of taenia
solium. 1215
Hodgkin’s disease, 883
Hodgson, Mr. B., case of. 1104
Hogg's cocaine tablets, 044
Holmes, Mr. T., on the effect cm the femoral
artery of ligature at the apex of Scarpa’s
triangle, 98

Holsworthy, health of, 6-16
H ome Secretary, the, an d the oon viet Thom pson,
235 ; health of the, 949

■Homerton Infirmary, electric lighting in the,
844

Homceopathy. 203.249

Hood, Dr. D., Diseases and their Commsnoo-
1 ment (review), 629

i-. Dr. P.. on carbonate of lime in oanoeroua

tumours, 927

Hospital Saturday Fund. 38, 296, 445.704.1299;

and the contribution of working men, 826 ; at
; Blrmlnglmm, 1067

Sunday Fund. 236. 324, 1193, 1202, 1340,

1256.1299; misrepresentations about. 686
Hospitals, Christmas festivities in the, 44;
wants of, and the Queen’s jubilee, 140; jubilee
year and the, 388, 695, 1099 i the sick poor,
and all England, 235 . 290; taxation of, 641;
workmen's collection In aid of, 656

and dispensaries, medical treatment at.

394 ; and provident diet

of. 583, 898; consultative relations between,
.1212

-Association, the, 1014

Hot-air baths, effects of, on assimilation, 999 t
House of Commons, shorter hours in the, 379
Hove, infectious hospital of, 1306, 1245; ssna-
torium, allegation* against the, 1101
Hovell, Dr. De B., on the sleeping man, 808
Hoxton mimler case, 743
Huamanrlpa, 1356
Huddersfield, health of, 330
Hughes, Mr. A, W., presentation to, 704
Hull, health of, 46 ; Boyal Infirmary, 621
Human bone, transplantation of, m a oase of
ununlted fracture, 1103

-lives, an experiment on, 330

Humerus, acute traumatio suppurative osteo¬
myelitis of the, early employment of the
trephine. 824 ; disease of, 826
Humphry, Professor, address at the Anatomical
Society, 971

-Mr. L., on puncture of hydatid oysta of.

liver, 120

Hunter, Dr. W„ on the presence of blood in.

the peritoneal cavity, 342, 496
Hunterian chancre of lower lip, 218

-»chancres, induration of, in the female,

313

oration, the, 333, 363

Huntingdon County Hospital, 868
Hurry, De. J. B., oase of goitre, followed by
asphyxia, tracheotomy, death, 570
Hussey. Mr. B.L., on dislocation of the shoulder*
reduction after eight days by manipulation,
874

Hutchings’ filtering-paper, 221
Hutchinson, Mr. J., on a peculiar form of In¬
flammation of the lips and. mouth, 1233
Hutton. Dr. C.. obituary notioe of. 804; the
late, 861; fund, the, 1016,1315
Hydatid cyst, unusual alts of an, 231
Hydatids, on the treatment of, 1229
Hydrastis in uterine haemorrhage, 391
Hydrochloric acid, case of poisoning by, 875
HydromyeEtls, muscular atrophy caused by,
229

Hydrophobia, the prevalence of, 234 ; treat¬
ment of, with the poison of the viper. 249 ; in
a child, case of, 1027; a case of, 1149; in.
Bltypti 654; and reform of the dog laws,
Society for the Prevention of, 246
Hydrostatic pressure In inversion of the uterus,
1293

Hy&res, the sllmate of, 61
Hygiene of occupations, 743

-, the sixth international congress of, 1353

Hygienic Exhibition at Warsaw, 4W)

Hymen, imperforate, 109...

Hyoscine, hydriodate of, 1186
Kypnone, 391

Hypnotism and catalepsy, 736
Hypodermic injections in acute anxmla, 540
Hyrtl, Professor, 1103

Hysterectomy, note on, 18,27 ; for fibro-myoma
uteri, 073

Iehthyol in erysipelas, 191
Iddesleigh, Lord, tiie late, 135. 152
Ideal paralysis, 1235

Iliac artery, internal, absence of the. 733

-region, right, tumour of the, 883

Uiff, Dr. W. T m obituary notioe of, 960
Illingworth, Dr. O. R., on persistent diarrhoea,
65.203; on blrdodlfie of mercury as an em-.,
raenagogue, 250

Imihlsflh’s improved clinical thermometer, 318.
Imperforate anus, treatment of, 174
Inoome tax.the. 58, 809, 1106
India, abscess of the liver In, 110; brigade sur-
' geons in, 389; Contagious Diseases Acts ta,
792; sanitary condition of, J 243
Office medical board, 1104

Indian medical officers, scientific memoirs
by, 639

Industrial dwellings, 095
Inebriates, homes for, 658
Inebriety, the pathology of, 784
Infancy, alleged danger of ttaroh-oontaining
foods during the period of, 733
Infant, obstinate ooustipation in an, 249, 299,
506

Infection, rags as carriers of. 887.1009; an un¬
usual method of propagating, 1052; and dis¬
infection. 791 '

Infectious patient* in the metropolis,’transport <
and treatment of, 235, 464, 496; the compul¬
sory isolation of, 947
Inflammation and repair, 131
Influence of scarlet fever hospitals. 1291
Inhaler, anew, 692
Inhalers, extemporised, note on, 821
Innominate, ligature of the, 870
aneurysm, diffused, 928

Inoculations, preventive, 220
Inquests without necropsies, 86
Inquiry, a case for, 641, 649
Insane, Morfson prizes for meritorious attend¬
ance on the, 200
Insanity, notes on oases of, 882
Intacta, .casbollo acid as a safeguard against;

! hot ■ ■:

Diaiti2

by Google

1322 Thb lanckyJ

INDEX.

[Ionium,

Intellectual evolution, 1000
Inter-auricular .septum, Interstitial aneurysm
of, 633

Inter-oolonlal Medical Congress, 35, 888
Inter-muscular synovial cysts, 420
Internal strangulation, aoute, case of, 1081

-suppuration, acute and chronic, without

fever, #79

International Medical Congress, 333, 442, 611,
757, 833, 916

-Statistical Institute, 588

Interstitial nephritis, chronic, 1335
Intestinal catarrh, absorption of fat In aoute, 8#

- obstruction, diagnosis of, 374; from

impaction of a gallstone In the Ileum, 869
Intestine, rupture of the, 537; the treatment of
Injuries of the, 637
Intra-ocular growths, 628

Intra-peri to neal injury, abdominal section for
the treatment of, 915
Intra-tborado tumour, 883
Intra uterine amputation of forearm, 784

-death, pathology of, 769, 865

-medication, fatal result of, 793,1616

Intussusception, 627, 829; the treatment of, 67 ;
produced by atumour, 731; resection of bowel
for, 780; a complicated case of, In a child,
death, neoropsy, 1030; reseotion of an Irre¬
ducible and gangrenous, case of. 1124, 1177
Iodoform as an antiseptic, 338, 535, 695; a case
of lacerated wound treated with, 468; In
heart disease, 543
lodol, the use of, In Belgium, 542
Ipswich Inquest, the, 1199
Ireland, the Apotheoaries’ Hall of, and the
King and Queen’s College of Physicians, 640
Irish examining bodies, 1199
-Medical Association, 1239; and the prac¬
tical element in medical education, 1307

Medical Schools and Graduates’ Associa¬

tion, 646

Isle of Wight sanitary administration, 811
Italian beggars in London, 638

-hygienic societies, federation of, 844

-Medical Congress, 638

Italy, medical honours in, 510; the red cross
in, 898; the National Medical Congress of,
1261; new sanitary code for, 1315

Jacksonian epilepsy, 680
" Jacob ” testimonial, the, 189, 286, 593
Jagoe, Surgeon-Major H., on enteric and typho-
malarial fever, 119
Jamaica, small-pox in, 1014
Jamieson, Mr. B. A., on hydrophobia in a
child, 10i7

-and Edington’s researches on the con-

tagium of scarlet fever, 1193
Japan, sanitation in, 763
Japanese Pharmacopoeia, the, 613
Jarrow district, health of, 1106
Jaw disease, case of, 930

Jaw, multilocular cystic epithelioma of, 571;
lower, displacement of the, Inter-articular
cartilage of the, and its treatment by opera¬
tion, 411; lower, death following necrosis of
the. 774

Jeaffreson, Mr. C. S.,on a carious lacrymal
case, 339; on gunshot wounds of the eye,
1019

Jenner, Sir W., memorial portrait of, 1102,
1259, 1304

Jennings, Dr. 0., on morphia habitats, 110;
on persistent diarrhoea, 303

-, Dr. O., on the relief of the morphia

craving by sparteine and nltro-glyoerine,
1278

-, Mr. C. E„ on transfusion for hemor¬
rhage in military surgery. 144; on the pre¬
ventive treatment of syphilis and of hydro¬
phobia, 418; on extirpation of ruptured uterus,
913,

Jenny Lind Hospital for Children, 246
Jeqntrlty, 486

Jerusalem Hospital for Jews, 689
Jessett, Mr. P. B., on myeloid sarcoma, 1079
Jessup. Mr. T. B., on removal of the uterine
appendages. 118

John Lucas Walker student in pathology, the,
1296

John Beld medical prize, 806
Johnson, Mr. G., on arterial pressure, 147
Jordan, Mr. F., Anatomy and Physiology In
Character (review), 529, 696; testimonial to,
1068

Jones, Dr. M. H., two oases of acute complete
Inversion of the nterus after delivery, 1281

-, Mr. B., on bread-making, 666

-, Mr. T. W„ on the white corpuscle of

the Mood, 164

Jaunsel of Physiology (review), 682
JnMte, the, 818, 400, 601, 664,888, 763, 1064;
hospital, the pro po se d . M2, 227, 290 1 and
•hmafluv boepitnU, the, 688c 696;
ambulance arrangements for the.

. 1298, 1301; unqualified assistants and the,
1315

Jugular hum, the, 893

“ Kspunda" disaster, the lesson of the, 325
KeeUey. Mr. O. B.. on a new method of excising
the knee joint, 147; on transplantation by
exchange, 368; on the gymnastic treatment
of scoliosis, 575
Kendal district, health of, 952
Kendle, Mr. F. W., on nitrite of amyl, relief of
after'pains, 606

Kennedy, Dr., testimonial to, 794

, Mr. H., obituary notice of, 266; defence

fund, 965

Kensington, ah am patients In, 810; vestry
Bill. 601

Kerr, Dr. N.. on alcohol as medicine, 148; on
Sir James Hannen’s court and the newspaper
press, 464

Keetcven, Mr. W. H., on an improved triqyde,
351; on case of sudden death from pulmonary
apoplexy. 1132
Kettering, health of, 797
Kidderminster, sanitation at. 106
Kidney, surgical, 25; sacculated, containing
calculi, with disorganisation of the other
kidney, and associated with complete sup-

f ireesion, 625 ; cystic disease of the, 883; float-
ng, or spleen (?), 892; epithelioma of the, 998;
manipulation without incision as a possible
treatment in certain cases of stone in the,
1026; corkage of the ureter with clot in cases
of advanced cancer of the, 1280
Kleff, abdominal section in, 686
Kilmarnock Fever Hospital and Infirmary, 63
Kimberley, medical jurisprudence at, 995
King’s Norton district, health of, 697
Kingston-upon-Hull, the sanatorium buildings
Of, 341

Klrkman, Mr. J., death of. 814
Klebt, Dr. B., Die Allgemeine Pathologle (re¬
view), 1237

Knag|(s, Mr. L., case of intussusception, 1126,

Knee, sarcoma of, 932; reseotion of the, 632,
1091; destructive arthritis of, without suppu¬
ration, 931; foot and ear, cases of sarcoma in
connexion with, 1183

Knee joint, a new method of excising the, 147,
196; tubercular disease of. two cases illustra¬
ting the treatment of deformity following,
216 ; disease of the, diphtheria, followed by
extensive paralysis, recovery, 677
Knight, Dr. 0. F., on acute croupous pneu¬
monia. 207

Koch’s bacteriological water test, 726

Labium, large thrombus of right, 76
Labour, mechanism of the third stage of, 679,
779, 1186
Lacaze prize, 143
Lacrymal case, a curious, 339

- duct, a new style for facilitating the

treatment of stricture of the, 30
La flan, Mr. T., on the Boyal University and
union hospitals, 646; on the Irish MmIcuI
Association and the practical element In
medical education, 1307
Laing, Mr. B., on typhoid and hydrants, 261
Lambert. Dr. W. H.. on sudden death, 861
•• Lancet” Sanitary Commission : report on the
sanitary condition of Rochester, 40
Landlords'liabilities, bad drainage and, 1054
Landolt, Dr. B. f the Refraction and Accommo¬
dation of the Bye and their Anomalies (re¬
view), 128

lane, Mr. A., on a Case of intussusception pro¬
duced by a tumour, 781

Lang, Mr., on insertion of artificial globes into
Tenon’s capsule after excising the eye, 988
Langhome, Mr. T. G., on fissured lip, 403
Langmore defence fond, 796, 1215
Lankeater, Mr. B. B., on the future University
of London, 338

Laparotomy for gluteal and sciatic aneurysms,

630

Larydgeal diphtheria, intubation In, 842
Laryngismus, tetany, and convulsions, patho¬
logy and treatment of, 919,967
Laryngitis, syphilitic hyperplastic, 420
Larynx, extirpation of the, without prelimi¬
nary tracheotomy, 114 ; excision of the, 474,
925; Intubation of the, three cases of, 1232
Lateral curvature, 299

-— deviation, papillary movement in. 576

Latham, Mr. P. W., on Some Points in the
Pathology of Rheumatism, Gout, and
Diabetes (review), 682

Latimer, Mr. H.A., on Sheet diseases among
copper-workers, 1198

Laurenzl, Prof. Luigi, obituary Ootids ot, 886
Laroe,Pr..3h.J.,osL ano s nri a, |M .

Law, a victim eftha, 760 :

‘ ' “ .«%; m » tttifn Of the 3a»,

V

Lead, toxio effects of, 1068
Lead-poisoning, chronic, death from.
Leamington, the reopening of ktaape
and baths at, 1201

LBOTURBS. .

Bowlby, Mr. A. A.:—

Lectures on Injuries of the Mis
at the Boyal College of Ourg e e si a. ~
Lecture I., 868, 931; L suiui U IL.1W.
1021; Lecture III., 11»

Broadbsst, Dr. W. H.s—

Croonlan Lectures on the Poise, dsdeeueiaft
the Royal College of Phystdaoa.

Lecture^ M ; Lecture H„ 688 y l^jghws

Chava&sb, Dr. T. F. s— k

Clinical Lecture on Renal Surgery) JMfftksad
at the General Hospital, Binnioghmhu 0*

Chkadlk, Dr. W. B.:—

A Clinical Lecture on the
Treatment of laryngismus.

Convulsions, 919, 967
Clark, 8ir A. i—

Considerations respect in g tha
of Simple Constipation, 1
Cavendish Leo tore on a s
sncoessfnl method of
delivered before the West
Chfmrgioal Society, 1168

Down, Dr. J. L.

Lettsomlan Lectures (Abstract
some of the Mental Aff ec ti on#

and Youth.

Lecture I., 62; Lecture Uvlfw
III., 256

Duckworth, Sir D.:—

Clinical Lecture on Tropical
Liver, 811 • •»<

IfcWWTCK, Dr. 8.:— _

Clinical Lecture on Fun d/UMmt
the Liver, 1171.1217
Godi.ee, Mr. B. J, t—

Lectures on the Snrgical
monary Cavities, deli
tlon Hospital, Bromr
Lecture I., 467, 6ll
Lecture III., 714
Hawakd, Mr. W.;—

Clinical Lecture on some
8peech, delivered at St. i
111

Hewitt, Dr. G.

Clinical Notes on SterfIl&»18S8i/

Humphry, Prof.*1
Address delivered at a

formation of an Anaio
Jeaffresoe, Mr. C. S. r —

Clinical Lecture (Abs trac t
Wounds of the Bye, 1819 I .*

Keight, Dr. O. F.!— ,?s

Lecture on Acute
delivered at Meroar’e
207

MacAUWRR, Dr. D. r—

Gulstonian Lectures OH the
Lecture I„ 807; Lecture
III., 813

Mac Cobmac, Sir W. t—

An Oration on
Treatment of

llvered to the

916 ,

Paget, 8Ir Jams* j—

Address delivered at the
of London,169
Plate air. Dr. W.6. j—

A n A ddress on De fe a t l ye
of Puerperal Dlscaae,

Potter, Dr. J. B. t-*-

pBiMTLKY.Dr.W.fLf*— r*

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logy of . _

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Thx Lancet,]

INDEX.

[June 25,1887. 1323

Savory, Mr. W.S.:—

The Hunter!*n Oration, delivered at the Royal
College of Surgeons of Bngland. 353
Sutton, Mr. J. B.

Erasmus Wilson Lectures (Abstracts of the)
on Evolution in Pathology.

Lecture I., 354; Lecture II., 304 ; Lecture
III., 405

Taylor, Dr. C. B. i —

Clinical Lectures on Diseases of the Eye,
delivered at the Nottingham and Midland
Bye Infirmary.

Leoture V.,'705, 816
Tweedy, Mr. J.:—

Lecture on the .Etiology of Constitutional
Diseases of the Bye, 67
Warner, Dr. F. :—

Leotures (Abstract of) on the Action of Nerve
Centres and Modes of Growth.

Lectures I., II., 514 ; Lecture III., 581
Williams, Dr. J.

Harvelan Lectures on Cancer of the Uterus.

Lecture I., 6, 69; Lecture II., 160, 305;
Lecture III., 301, 368

Inaugural Address delivered before the Ob¬
stetrical Society of London, 663
Xeo. Dr. J.B.:—

A Lecture on the New Method of Treatment
of Consumption and other Diseases of the
Respiratory Organs by Gaseous Rectal In¬
jections, 78

Ledwich School of Medicine, 858
Leeds, Hospital for Women and Children at,
348; epidemic of measles in, 1050; and West
Riding Medico-Chirurgical Society, 1313
Leek, sanitary progress at, 898
Looming. Mr. R. W., on ununited fracture of
the femur, 314

Leg, multiple cavernous angiomata of, 73
Leicester Sick Benefit Sooiety. 795
Leonard r. Brown and Allat, the case of, 750
Lens, dislocation of, 1235
Lepra maculosa, the treatment of, 689
Leprosy, reported cure for, 39
Lettsomian lectures, abstract of, 358
Leukaemia, the blood in, 288
Leuckart, Mr. Rudolf, the Parasites of Han
and the Diseases which proceed from them
(review), 27

Leucocytoais and new growths, 1148
Lev6e, the, 909, 1115

liddel Provident Dispensary, Jarrow, 502
Life Insurance, 1054 ; in 1888, 694, 784
Lifeboat crews and life Insurance, 38
Lincoln County Asylum. 1104

-General Dispensary, 246

Lindsay, Dr. J. A , on climate as a therapeutic
agent in phthisis, 871; on New South Wales,
1167

Lip, chondroma of the, 40; epithelioma of the,
removed by the aid of cocaine, 66
Lips and mouth, a peculiar form of inflamma¬
tion. 1233

Lithgow, Mr. R. A., on obscure nervous affec¬
tion, 965 ; on obesity, lb.

Lithotomy, lateral, in a boy, cure, 71; supra¬
pubic. 1185, 1224 ; median, 1223
Llthotrity. catheter and calculi, removed by,
827 ; and lithotomy, 1220
Little, Mr. J. F., presentation to, 909
Liver, puncture of hydatid cysts of the, 120;
the surgical treatment of hydatid tumours
of the, 217, 277, 340 ; hydatid of, treated by
puncture; complete recovery, 266; hydatid
cyst of, resection of rib, removal of cyst wall,
624; tropical abscess of the. 811; on func¬
tional diseases of the. 1171, 1217, 1271; and
spleen, malarial diseases of, 524
Liverpool, the port of, 538
-City Hospital, 1014

— -Hospital for Women, 83, 335

-—;— Medical Institution, 200

Uoyd, Mr. J., on extirpation of the larynx,
without preliminary tracheotomy, 114

— -, Mr. R. W., suggested improvement in

ether Inhalers. 1109

Lobeline and inflatlne, 543
Local Government Board, ofllclal report of the
medical officer of the, 631
Locke, Mr. G., on a doctor’s Income, 1153
Lock hospitals, 1303 ,

Lockwood, Mr., on treatment of hemorrhage
from the tongue, 827

Locomotor ataxy, 75; with joint disease, 629
Logan, Mr. G. D., on a rare complication in a
cose of placenta pnevia, 1039
loudon. mortality In 1886,1 >5; house drainage
or. 138; the port of, 483; water supply, 377,
636, 1100, 1147; medical missionary Institu¬
tions in, 642; the district of, 690; sewage,
154,188, 1017. 1063

Hospital, 591, 643, 1063, 1104; students’
dinner, 656

r ' r *i ,e-« .imwa wn«iv,A ■—~ |

London medical students, degrees for, 34, 55,
100, 136 196, 383, 488, 635, 643, 739, 800

-poor-law infirmaries, 232

-Sanitary Protection Association. 502

-University, the. 142, 185, 276. 319, 684,

737, 995, 1006; and Its new regulations, 237,
380, 289, 1017, 1049; the jubilee and, 838
Long pepper as an adulterant, 899
Lowe, Mr. J., on Infant mortality at Working-
ton, 448

-, Mr. T. P., on Bath water and arsenious

acid, 100, 1282

Lowndes, Mr. F. W., on venereal diseases in

g rls of tender age, 168

A. as a doable qualification, 1215
Lucas, Dr. J., on obstinate constipation in an
infant, 350 ; on cases of gunshot injuries
which occurred at Shwebo, Upper Burmah, 721
Lunacy Acts Amendment Bill, 320, 447,493,846,
903, 1035, 1289

Lunatic asylum, Are at a, 1164
Lunatics, the custody of persons alleged to be,
444 ; moral discipline of, 742
Lund, Mr., 1149

Lung, sarcoma of the, following amputation of
the right thigh sixteen months previously,
case of, 727; and posterior mediastinum,
malignant disease of, producing complete
paraplegia, 928

Lupus, treatment of, 830; treated partly by
scraping and partly by salicylic paste, 1136
Lying-iu chamber, sanitation of the, 1236

hospitals in Germany, mortality in, 388

Lyon, Dr. T. G., on school-made chorea, 196

Lytham district, health of. 846

Hacalister, Dr. D„ on the nature of fever, 507,
557, 612

Macartney, Mr. T. L., presentation to, 1266

M'Cabe, Mr. W. A. B„ obituary notice of. 1265

Mac Cormac. Sir W„ on abdominal section, for
the treatment of lntra-perltoneal injury, 915

Macdermott, Mr. W. R„ on the place of health
in evolution, 719

MacDonald, Dr. G., on a new nvulatome, 935,
1168

-, Dr. G. C., on choleraic diarrhoea with

collapse, a case of, 468; on a case of purpura
rheumatloa, 772

-, Dr. R„ on the law relating to coroners,

338

Mace wen. Mr. W., on cerebral abscess due to
otitis media, 816

Mac Ivor. Mr. R. W. B„ on rags as carriers of
infection, 1009

Mackav, Mr. W. A., on abdominal section for
pelvfo suppuration, 310

Mackenzie,Mr. S.,on fllaria sanguinis hominls,
100

Mackinlay, Mr. J. G„ on complete self enu¬
cleation of an eyeball, 1072

Maolagan. Dr. T. J„ on pyrexia and hyper-
p rex la, 414. 465,516, 565.617, 619

Macnamars, Mr. O.. Diseases of Bones and
Joints (review), 682

Mr. R., on the College of Physicians,

the College of Surgeons, and the Apothe¬
caries'Society, 798
Macragloesia, 527
Madrid, new hospital for, 501
Magnl, Mr. F„ obituary notice of, 346
Malarial fevers, 844, 949,1004
Male breast, epithelioma of, 830
Malignant fever, canse of death in, 75
Mammary tumours, 628 ’

Manchester, correspondence from, 48, pamtn ;
open spaces In, 106 ; vertut the London
schools of medicine. 902; mortality in, 1296

-Central Medical Society, 042

-Children’s Hospital, 499

Medico-ethical Association, and coroner’s

inquests, 544

-Royal Infirmary. 13, 753

Mantle, Dr. A., on the occurrence cf menor¬
rhagia or metrorrhagia during the febrile
State. 1227

Manx climate, the, 1201
Margate, Boval Sea-bathing Infirmary, 753
Margaret-street Infirmary, 234, 393, 435, 639,
095, 794, 8-18

Marseilles, the meat supply of, 38; quarantine
at, 691

Marsh, Mr. H., Diseases of the Joints (review),
580

Marshall, Mr. A. M., a Junior Course of Prac¬
tical Zoology (review), 630

-, Mr. 37 on Neurectasy (review), 1189

-, Mr. J. G., on erupitlve eccentricities,

366 ; on economy in the wards, 1157
Marsupial heart, the, 732
Martin, Dr. J. W. H„ Ambulance Lectures, to
which is added a Nursing Lecture (review),
129

Mason, Mr. J. W„ on the sanatorium buildings
of Klngston-upon-Hull, 341 “

Massage, physiological effects of, 134,637 ' • |

Mastitis, treatment of, 780,1072; mastoid pro¬
cess, trepanation of the, 974

sli'.Aj ill i.; » - a s . it

Matanzas mortality of medical men at, 200 , ,
Maternal impressions, 55
Ma> hematlcal tripos, 1.887, the, 1252
Mattison, Dr. J. B., ou cocaine dosage and
cocaine addiction, 1024
Mauritius, health of, 187
Maxille. superior, removal of both, 372
Maxwell. Dr. T.. on the most extensively
quoted medical journals lu the world, 55; on
extemporiied inhalers, 821
May, Mr. B , on excision of tumonr of oere-
bellum, 76S

Meadows, Dr. A., obituary notice of, 903
Mean, Dr. W. R., Volunteer medical service. 901
Measles In a London workhouse Infirmary, 200;
epidemics of. 200,317,841; an affection of the
nervous system during the exanlhem stage
of. 771

Meckel’s diverticulum, 316
Mercurial peripheral (?) neuritis, 234
Medical Act In 1886, 914; Act, the new. and
students, 1214 ; registration under the, 746

-Annual (review), 835

-appointments In the Colonies, 222

attendance organisation committee.

287.347,486,5-10, 1057,1105

-charges. liability of agents for, 590

-charities, donation and legacies to, in

1886,43

-charity, abuse of, 743, 909

-coronerships, 396

-Defence Union, the, 1254

■ education, 707; the practical element in,

834,1263

-evidence, the value of, in life assurance,

95

-fees in Crown coses, 188

journals, the most extensively quoted.

iu the world, 65

• man. suicide of a, suffering from typhoid

fever, 233

men, the relation of, to their patients,

47; peerages for, 228, 1340; honours. 391,592;
vexatious charges against, 596, 1147; and
their widows, 1099; iu Prance, dispensing by,
286

-officers, penurious treatment of, 39

Officers of Health Society, 389, 841 ;

meeting at the, 580; Transactions of the
(review), 78

-practitioner as a correspondent, 1102

profession in exceliis, 438; the rush into

the, 887 ; and life assurance offices. 551

Register, 196, 941; the accuracy of the

new, 40

relief In Glasgow and the Charity

Organisation Society, 1299

MEDICAL SOCIETIES.

Academy of Medicine in Ireland.— Naroo-
lepsy; Myxcedema, 25 — Plaoenta pravia,
126 —Parasitic disease of lungs of sheep;
Stricture of oesophagus; Adenoma from
mammary gland of rat; Simultaneous
fracture of both clavicles; Cerebral taenin-

e tis and abscess, 177—Conservative surgery
diseases of foot and ankle; Addison s
- disease; Select clinical report*, 373—Ovarian
tumour; Treatment of Vsginismus; Porro’s
operation for rupture of the uterus, 627—
Aspergillus nigricans ; Dermoid tumour;
(Edema glottidis, 580—The marsupial heart;
Absence of the internal Iliac artery, 733-
Resection of the pylorus; (Esophagotomy to
remove a foreign body; Diphtheria; Notes
on insanity; Dystocia caused bv hydro¬
cephalus and pelvic tumour, 881—Malignant
disease of the stomach, Ac.; Fibro-sOrooma
of the orbit; Trephining for epUepey;
Nerve sutnre; Bxclsfon of knee joint; Pre¬
vention and treatment of diseoae; Typhoid
fever, 1090—Exhibition of specimens; Treat¬
ment of vesicovaginal and vesicouterine
flstul*, 1136—Malignant disease of tonsil;
Excision of wrist joint; Ideal paralysis;
Calculous pyelitis, followed by albuminoid
disease, 1234—Distribution of phthisis and
diseases of the respiratory organs in Ireland,
1284

Anatomical Society. — Propositions of m-
m it tee and election of officers, 1186
Ca mb ridge Medical Society. —Pseudohyper-
trophic paralysis ; General sarcomatosis ;
Death after washing out dilated Stomach. 74
—Abortion; Cystic ovaries removed for dys-
menorrhcea; Hematocele from a ruptured
Graafian follicle, 136—Severe injury to
thorax; Thrombi in pulmonary vessels;
Macroglossia ; Diphtheria. 637—Treatment
of quinsy; Stellwag’s symptom; Intra¬
uterine amputation of forearm, 734—Intus¬
susception of bowel; Cyst of eerebellum,
enclosed in four!* ventricle; Cerebellar
tumour, 829—Dislocation of lone j Puerperal
fever: Sanitation of the lytngdn chamber,

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by Google

1324 The Lancet,]

INDEX.

[Jt-NK 25,183?.'

Clinical 8ociety of London.— Athetosis aud
aphasia In a child; Treatment of cysts of
thyroid; Treatment of Imperforate anus,
174—President’s address; Nephro-Uthotomy;
Renal surgery, 369—Discussion on nephro¬
lithotomy, 370—Paralysis of left leg from
suboortical disease; Rheumatic hyperpyrexia
successfully treated by tlie cold bath; Epi¬
lepsy following an injury to the leg ; Profuse
hematuria in connexion with granular kid¬
neys, 471 — Pneumothorax with recovery In
tlie apparently healthy; Intra-peritoneal
excision of rectum ; 8collosls, 674—Contrac¬
tion of the mstatarso-phalangeal joint of the
great toe; Acute and chronic Internal sup¬
puration without ferer; Glandular swelling
curable by arsenic, 873—Inherited congenital
deformity of bands and feet; Psoriasis,
pityriasis, and rheumatism ; Symmetrical
gangrene following varicella; Intussusception
produced by a tumour, 729—Difficulties In
establishing natural respiration after tracheo¬
tomy ; Large omental lipoma successfully
treated by abdominal section ; Abdominal
exploration for chronic Intestinal obstruc¬
tion, artificial anus, removal of growth
involving splenic flexure of the colon, 879—
Abdominal cysts following injury; Spas¬
modic torticollis due to cerebral lesion;
Gouty knee joint with suppuration; Intra-
capsular fracture of neck of femur, 1034—
Acute cardiac dilatation from alcoholism;
Endemic hsematurla; Lupus treated partly
by scraping and partly by salicylic paste;
Hammertoe, 1135

Bpidemiolooical Society.— Typho-malarlal
fever, 73 — Preventive inoenfations, 220—
Cholera In India before 1817; Statistics of
the West Ham Small-pox Hospitals during
the epidemic of 1884 and 1886, 474—Ol no eva¬
sions on filaria sanguinis hominis In South
Formosa, 732—The presence of mould fungi
In connexion with diphtheria, 93.3—Tuber¬
cular Infective areas, 1035

Glasgow Obstetrical and Gynaecological
Society.— Injury In twin pregnancy. 27—A
review of thirteen years' private (obstetric)
practice, lb.. 316—Exhibition of specimens,
781 — Difficulties In private obstetric prac¬
tice, 1137

Habvelax Society. — Peripheral neuritis;
Paraplegia In Pott's disease ; Dyspnoea from

{ treasure of enlarged bronchial glands; Ohy-
ous ascites, 22—Analogy between croup and
asthma ; Suppurative peritonitis; Cancer and
its treatment, 175—Extirpation of the axil¬
lary gland, as necessary accompaniment of
removal of the breast for cancer, 627—Here¬
ditary syphilis; Habitual constipation in
children, 828

LEM 6 Axo W&bt Biding Medico-Chirubgi-
cal Society.— Oophorectomy; Removal of
ingrowing eyelashes by electrolysis; cata¬
ract; Hemiplegia, 26—Suprapublo lithotomy;
Toxic effects of sulphate of dubolsin, 75-
Palsy In limltod groups of muscles; Per¬
nicious amemia ; Primary nerve suture, 272-
Resection of bowel for intussusception; Hay-
naud's disease; Treatment of mastitis;
Dangers of cocaine, 780—Empyema, 1035—
Diphtheritic slough of vagina; Estimation
of the amount of urine voided by its weight;
Therapeutic memoranda ; Adenoid vegeta¬
tions in naso-pbaiynx; Aneurysm of thoracic
aorta, 1186

Manchester Pathological Society.— Ex¬
hibition of specimens. 25—Diseases of the hip
joint in children, 475—Thirty-seven calculi
removed by lateral lithotomy; Mammary
tumours; Chsmges In spinal cord uud peri¬
pheral nerves after amputation, 628—Exhibi¬
tion of specimens. 883

Medical Officers of Health Society.—
Contagious Diseases (Animals) Act, 1886;
Sanitary registration of buildings, 23—Legis¬
lation for the purification of rivers, and its
failure, 315 — Small-pox hospital influence,
421—The protective influence of vaccination,
686— Coal gas as a cause of sore-throat, 828
Medical Society of Loxdox.— Phosphatic
diabetes; Wound of oommon femoral vein,
125—Hunterian chancre of lower lip; Plastic
operations for ectropion and contraction of
faoe; Early colotomy, 218—Partial enterocele:
Parotitis after abdominal operation; Rupture
of aneurysm Into pericardium, 314—Removal
of both soperlor maxllbe, 372—The treatment
of syphilis by mercury; Excision of half of
larynx ; Tuberculosis of fauces ; Dislocation of
bothblps; Excision of hip; Trephining for
cerebral abscess, 473—Annual general meet¬
ing; Perforation of femoral artery and
vein from suppurating bubo, 626— “Clottsge”
of the ureters; Certain conditions of bladder
in children, 676— incision of swollen optio
nerve sheath; Solvent treatment of renal
calculus; Intussusception; Congenital defect
In diaphragm. 626 — Hereditary tremors ;
Random symptoms from oerebral syphilis;

Facial monoplegia; Post-hemlplegic chorea;
Jacksonian epilepsy ; Ulceration of palate;
Sarcoma of tonsil, 680 —Ulcerative endocar¬
ditis; Alleged dangers of starch-containing
foods during the period of infancy, 781—Treat¬
ment of hicmorrhage from the tongue;
Catheter and calculi removed by llthotnty;
Renal sarcoma In infancy, is surgery justifi¬
able ? 827—Blood cyst of tongue; Severe Injury
of wrist joint, with division of nerves, vessels,
and tendonB, treated by conservative surgery;
Excision of mcvold growth in neck, 881
Medico-Psychological Association. — The
Lunacy Acts Amendment Bill, 1036
Midlaxd Medical Bocikty. — Strangulated
hernia; Postal abnormality; The leg type of
progressive muscular atrophy, 26—Fracture
of spine; Meckel's diverticulum, 316—Gun¬
shot wound of vertebra; Fractured first rib;
Rupture of abdominal aorta, 374—Locomotor
ataxia with joint disease ; Tumour of bladder
treated by suprapubic cystotomy; Periosteal
sarooms ; Injury to shoulder, 629—Chronic
phlegmasia dolens ; Gastric ulcer; Syphilitic
stenosis of trachea; Epithelioma of male
breast, 830 — Talipes calcaneus; Ruptured
brachial plexus, 1092

Nottingham Mkdico-Chiruhgical Society.

—Hysterectomy ; pseudo-hypertrophic para¬
lysis, 27—On disinfection, 76—Treatment of
lupus; Removal of uterine appendages;
Athetosis, 830—Miscellaneous cases, 1092
Obstetrical 8ociety.— Midwifery among the
Burmese ; Stricture of the female urethra,
176—Unilateral galactorrhcea, 373—Oalactor-
rhoea, 679—Mechanism of the third stage of
labour, lb.. 779, 1185—Hsmorrhaglc para¬
metritis; Frequency of pathological condi¬
tions of the Fallopian tubes, 98?—Cesarean
section; Tubo-ovarian cysts, 1181
Opottialmological Society.— Treatment of
conical come*; Exostosis of skull, with
atrophy of optic nerves; Unusual clinical
oases; Acute cerebral disease, with ocular
symptoms, 27i—Ophthalmoplegia externa;
Pupillary movement In lateral deviation;
Tubercular (?) disease of choroid; Closure of
selerotlo wound by conjunctival sutures only;
Lateral nystagmus; Conjugate palsviof ocular
muscles and nystagmus, 576 — Franklin's
spectacles; Insertion of artificial globes Into
Tenon’s capsule after excising the eye; Night-
blindness; Complete self-enucleation of eye¬
ball, 983—Unlcular optic atrophy and tem¬
poral hemianopsia; Permeability of the sus¬
pensory ligament by organised substances;
Choroldo-retinltie; Cyclotomyln glaucoma,
1283

Pathological Society.— Ulceration and en¬
docarditis of right side of heart; Syphiloma
of heart; Hare aneurysm of undefended
space with cerebral tumour of brain
(? syphilitic); Alcoholic paralysis; Ulcersof
stomach In Infantile tuberculosis, 21—Mul¬
tiple cavernous angiomata; Melanotic
tumour of breast; (?) Recovery from tuber¬
cular meningitis; Raynaud's dtsoasc and
peripheral neuritis, 72 — Hypertrophy of
bladder; Lipoma of hoartSpontaneous
disintegration of vesical calculi; Infantile
palsy, 173 — Genito-urlnary dlsesso In ani¬
mals ; Pathology of Colies' fracture; Extra-
uterlno fcBtation ; Rupture of bladder;
Cerebral ' tumour ; Multiple perforative
necrosis of skull of tubercular origin, 268—
Shedding of teeth in tabes dorsalis; Inter- 1
muscular synovial cysts ; Endothelioma of
dura mater; Syphilitic hyperplastic laryn¬
gitis ; Mitral aneurysm In a child; Ectopia
vesica;; Retro-pharyngeal abscess; Horny
growth on penis, 420—Adcno-sarcoma of
tongue, with oAlclfvlng nodule In centre;
Alveolar sarcoma; Malarial diseases of liver 1
and spleen; Extra-uterine pregnancy; (?) Cir¬
soid aneurysm; Cholesteatoma at base of
brain, 524 — Fibroma of ovarian ligament;
Metastatic carcinoma of prostate; Large
dermoid cyst over sternum ; Oall-atonu
causing obstruction of bowel; Cystic disease
of testicle; Cystic epithelioma of neck, 673
—Alveolar nloeration In a child with general
tuberculosis ; Hypertrophic goitre, with
secondary tumours In bones of skull;
Tumour of pineal gland; Chronic inflam¬
matory disease of uterine appendages j
Meningeal cerebral hemorrhage, with
secondary degeneration of spinal cord, 777—*
Congenital dislocation of hip ; Disease of
humerus (? osteitis deformans, or osteon
matacla); Fibrous metaplasia of bone, 825-
Destructive arthritis of kne* without snpJ

E uratlon; Senile arthritis; (?) Sarcoma ol
nee; Carcinoma of spine and liver; Diffusa
sarcoma of spinal pla mater; Interstitial
aneurysm of inter-auricular septum ; Tubal
pregnancy, P31 — Multiple neurofibromata
andmolluscura flbroaum; Sarcoma of pelvid
fascia ; Cerebral hiemorrhage In a child with
thrombosis of sinuses ; Rickets In the skulls

of lions; Suprapubic abscess; Quit!ration
experiments with new growths, 1032
Plymouth and Deyoxport Medical Society.

—Treatment of typhoid fever, 376
Royal Medical and Chuuibgical Sociitt.—
Suture of divided nerves ; Physiological
effects of massage, 124—Surgical treatment
of hydatids 6f the liver, 217—“ Induration"
of Hunterian chancres In the female; Actino¬
mycosis homlnla, 313—Rupture Of urinary
btfcdder, 418 — Annual general meeting ;
President's address, 471—Gouty parotitis and
Gouty orchitis ; Empyema, with pulmonary
gangrene, following enteric ferer, treated
by perflation, 633—Obstruction of one ureter
by a calculus, associated with oornplete sup¬
pression ol urine ; Sacculated kidney con¬
taining calculi, with disorganisation of the
other kidney, and associated with complete
suppression, 635—Abdominal and thoracic
aneurysms treated by the introduction of
steal wire Into the sao, 775 — Chronic
syphilitic meningitis, causing progressive
dementia ; Analysis of 93 eases of writer!’
cramp, and Impaired writing power, 878—
Rectal IntnssusoeptlQn, doe to a new growth;
Experimental Inquiry as to the best method
of e a tore rap by. 980— Relation of a osrtaia
form of headache to the excretion of uric
acid; Alcoholic paralysis, 1088—Dermatitis
gangrenosa Infantum ; A form of Inflamma¬
tion of the lips and mouth usually attended
by some disease of the skin, 1233
S heff i el d Medico-Chiborgical Society.—
Large thrombus of the right labium;
Poisoning by cocaine ; Biliary oslculU
Locomotor ataxy ; Cause of death in malig¬
nant fever. 75—Malignant disease of pan¬
creas and liver; Graves' disease, 273-Tho-
raacic aneurysm ; Aortic disease; Supra
publo suppuration ; Plumbtsm, 681—Injury
of popliteal artery; Hodgkin's diMwae;
Tumour in right lilac region; Tntatiual
obstruction: Doable ophthalmoplegia; Acute
dilatation of stomach. 882 —Malignant tumour
bf the oesophagus ; Pemphigus neonatorum;
Sarcomatous tumour of the uterus. 1236
West Kent Mkpico-Chiruroical Society.—
Diagnosis of traumatlo separation of tbe
epiphyses, 934

West Loxdox Medtco-Chirtroicai. Society.
—Etiology of phthisis; 8urgieal treatment
of tuberculosis, 219—Urethral calculus. Ml—
Some of the rarer forms of rectal flitulie;
Selection and administration of annsthetlcs.
1089

Wigax MmiCl l Society. — Attendance of
medical witnesses at assize courts, 273
Wolverhampton and District Medical
Society. — Use of axis-traction forceps In
midwifery, 127—Adenoid bronchocele; Dia¬
gnosis of Intestinal obitruotion, 374
Yorkshire Association of Medical Office*
of Health— Outbreak of dlarrhura caused
by the emanation of noxious gates fro®
tide-locked sewors, 76

Medical Society of London, annual general
meeting at the, 526, 945

students’ statistics, relating to, daring

the quinquennium 1871-75,92

-titles, fine for false use of, 540

-trials, 601, 1359

-witnesses, attendance of, at

courts, 273

Medicine, the Conjoint Colleges and a d«g»*
in, 997; during the reign of Victoria, 1287
Medicines, parrel poet boxes for, 7o7
Medico-Psychological Association, 802
Melanotic sarcoma. 83. 367 . , ....

Melbourne, typhoid fever in, 640; hospital, the,
704

Melon root and oil of ben, 542
Membranes, significance of the retention or tw.
after labour. 536; separation and expoliioo

Meningeal cerebral hiemorrhage, with secon¬
dary degeneration of spinal cord, 777
Meningitis, tnbercular, recovery fro®-
acute sporadic cerebro-spinal, death on tw
fourth day. 312; case of, In which complete
recovery took place, 368
Menorrhagia, a frequent symptom of pyooe
phroais. 121; or metrorrhagia, tbe occurrence
of, daring the febrile stet», 1227
Mental affections of childhood. 62, 256

-- differences between men and worn®.

632

Menthol inhaler, 30
-plaster, 41

Mentholeate, 543 _

Mercer’s Hospital, the charges aprfoit, 0*
Mercurial Injections, 1296 . M

Metatarso-phalangeal joint of tbe great
contraction of the, 678

MetropoHUmAssociation's Improved DweMnp'
1194

——— Asylums Board, 483, 996,1143,139*

The Lancet,]

INDEX.

[June 25,1887. 1325

Metropolitan Board of Works, the power* of
the, 328; and London improvement*, 031

-charities, 90

-Free Hospital.1313

-- police, health of the, 193

-- Public Gardens Association, 30

MetschnlkoS on phagooytes, 482
Ilex bo rough, typhoid fever at, 541
Mickle, Dr. J., General Paralysis of the Insane
(review), 7#

-, Mr. A. F., on the necessity of obtaining

powers to detain in worxhouse* patient*
affected with venereal disease*, 954, lu63
Microbe* and suppuration, 897
Micrococcus pyogenes aureus, 587
Micro-organisms in the atmosphere, the dis¬
tribution of, 941

Midland Volunteers’ Medical Association, 858
Middlesex Hospital, 1008

-and Herts combined districts, health of,

1154

Midwifery, a remarkable case In, 69 j antiseptic,
9t4; forceps, 127, 477
Migraine, common salt in, 951
Mils, on the occurrence of a poisonous ptomaine
in, 213; uncooked, the use of, 680; a new
test for, 1200; added water in, 898; epidemic
of typhoid traced to, at York, 383
Millicau, Mr. K., Margaret-street Infirmary,
8J9

Mills, Dr. T., Outlinesof Lecture* on Physiology,
with an Introductory Chapter on General
Biology (review), 128
Milne, Dr. H., obituary notice of, 1311
Milner, Mr. H., on the treatment of syphilis by
mercury, 473

Minima vlsiblliaand sensory circles, 309,304

MIRROR OF HOSPITAL PRACTICE,
BRITISH AND FOBB1GN.

Birmingham General Hospital.— Cases of
ovariotomy, 1283

Bristol Royal Infirmary.— Three oases of
Intubation of the larynx. 1232
Buarox - oh- Trent Infirmary. — Crushed
pelvis; rupture of bladder; necropsy, 172
Cuabow-cbom Hospital. —Strangulated con¬
genital hernia with rupture of Intestine;
nemlotomy; entoraphy ; care, 531—Fracture
through aarooma of., femur; secondary de¬
posits m skull and clavicle; death; necropsy,
024—Sarcoma of lung following amputation;
of right thigh sixteen mouths previously, 737
Croydon Infirm ary.— Acute internal strangu¬
lation. 1031

Deaconesses’ Institution and Hospital.
Tottenham. — Cerebral embolism following
parturition; haemorrhage into lateral ven¬
tricle; death; necropsy, 19
Devon and Exeter Hospital.— Unilocular
ovarian cyst In a girl aged thirteen; ovari¬
otomy, 418

Dorset County Hospital. —Suprapubic litho¬
tomy, 1031

Dundee Royal Infirmary.—A oute sporadic
oerebro-spinal meningitis; death on fourth
day; necropsy, 313

Edinburgh Royal Infirmary. — Traumatic
tetanus cured Dy removal of the oioatrix
and surrounding parts, 21
General Lying-in Hospital. —Cervical em-
pbyeeina following parturition, 123
Guy s Hospital. —Seven conseoutive cases of
charbon treated successfully by excision, 307,
416—Sarcoma of the femur; death following
necrosis of the lower jaw, 773—Colotomy fpr
malignant disease, 822 —Fracture of tibia duo
to necrosis, lb.—Removal of foreign body from
antrum, 823—Popliteal aneurysm treated by
digital compression; cure after previous
fan ure with Esmaroh's bandage and electro¬
lysis, 1230—Round-celled sarcoma after pro¬
longed suppuration of antrum; partial
excision of superior maxilla, lb.

Hampstead Home Hospital.— Chronic renal
absoess; abdominal renal nephrectomy;
recovery, 1283

Hertford General Infirmary.—R emoval of
the ooocyx, 1088— Hypertrophy of spleen;
death; necropsy, 1184

Hospital for Sick Children, Great Or-
Mond-btrebt.— Disease of knee joint; diph¬
theria followed by extensive paralysis; re¬
covery, 677—Suprapubic lithotomy ; hteinor-
rhuge luto the bladder; recovery. 929
Leeds General Infirmary.— Compound frac¬
ture of skull; trephining; spasm of muscles
of face and arm; second trephining over
fissure of Rolando; recovery, 774
Leicester Infirmary.— 8upr*pubic lithotomy
in the adult; suture of bladder; primary
union, 267—Abdominal section for Internal
strangulation; formation of artificial anus;
enterectomy; cure, 728

Uondon Hospital, — General tuberculosis;
necropsy. 18—Hepatic abscess, 215—Foreign
body In the urethra; removal, 470

Manchester Royal Infirmary. — Hydatid
cyst of liver; resection of rib; removal of
cyst wall, 634— Active traumatic suppurative
osteomyelitis of humerus (early employment
of the trephine; recovery, 824—Rupture of
spoDgy urethra; suture; recovery, 877—Peri¬
neal and suprapubic cystotomy combined, 980
Middlesex Hospital.— Pylorectomy forcaroi-
noma; death; necropsy, 171 —Sarcoma of
scapula, thigh, and femur, 1030— Sarcoma of
knee, foot, and ear, 1183
Newcastle-on-Tyne Infirmary.— Two case*
of suprapubic lithotomy, 133— Hernia of
ovary, 312—Diffused traumatic aneurysm of
anterior tlblal artery; attempted ligature;
amputation, 523—Hpithelioma of soft palate,
lb.—Jaw cases, 930

North-Bastehx Hospital for Children.—
Two cases illustrating the treatment of the
deformity following tubercular disease of the
knee joint, 810—A oase of acute meningitis In
which complete recovery took place, 368
Nobth-Wk8t London Hospital.— Stricture of
urethra presenting unusual difficulties. 979
Norwood Oottaob Hospital.— Multllocular
ovarian tumour, with umbilical hernia, com¬
plicated with pelvic adhesion; recovery, 1087
Royal Hospital for Diseases of the Chest,
City-road.— Bmpyema; free Incision and
drainage at lowest point; rapid recovery, 571
St. Bartholomew's Hospital. —Sarcoma of
tongue; removal of half of tongue; reoovery,
023

St. George's Hospital. —Compound depressed
fracture of vault of skull; paralysis of right
arm; trephining; recovery. 122 — Cerebro¬
spinal meningitis; recovery, 571 — Compli¬
cated case of Intussusception In a child;
operation ; death; necropsy, 1030
8t. Mary's Hospital. — Fsrtial enterooele ;
gangrene; recovery, 311—Gall-stouts in the
cystic duct; cholecystotomy; recovery,
1282

St. Thomas's Hospital. —Case of Inguinal and
two of umbilical hernia, in which radical cure
was performed. 09—Suprapubic lithotomy in
a man aged seventy-two ; cure; death from
apoplexy, 205—Bullet wound of chest; wound
ot lung; removal of bullet; reoovery, 200—
Successful removal of right ovary for cystic
disease nine months after operation for
hydrosalpinx,. 870—Extravasation of blood
iuto the thigh; general tuberculosis; ne¬
cropsy, 877

St. Vincent's Hospital, Dublin.—Two case*
of abscess evacuated without any resulting
disfigurement, 217—Perforating ulcer of the
stomach, 207— A fatal oase of paraplegia;
necropsy, 470

Samabitax Hospital for Women, Notting¬
ham.— Cases of abdominal section, 1134
Seamen's Hospital, Greenwich.— Surgical
Cites of Interest. 573

South Devon and Bast Cornwall Hospital,
Plymouth.— Removal of upper extremity,
and later of soapula and part of clavicle, for
sarcoma, 30

Stamford Infirmary.— Calculus In a boy;
removal by lateral lithotomy; cure, 71—Cal¬
culus veslose ;. suprapubic operation; death;
necropsy, 1185

Swansea Hospital. — High aneurysm of
femoral artery; ligature of external lilac
artery; cure, 71

Unitersitt College Hospital. —Three cases
of badly united fracture of the femur, 469
Victoria Hospital for Children.— Opera¬
tion for cleft palate In children of twelve
months of age, 1133—Traumatic stricture in
a child aged three years, 1331
West London Hospital.— Partial paraplegia,
probably due to syphilitic meningitis; re¬
covery. 173

Westminster Hospital.— Case of Addison’s
disease ; necropsy, 070—Punctured wound of
brachial artery; arrest of haemorrhage by
pressure; seoondary bleeding; ligature or
vessel. 978

Wolverhampton General Hospital. —
Multiple aneurysms of the arch of the
aorta, 1033

Wolverhampton and South Staffordshire
General Hospital.— Rupture of popliteal
ariery and vein ; amputation, 623

Mitchell. Dr. 8. W., Wear and Tear (review), 783

-.Mr. H..on primary Hunterian chancre of

the cluek, 633

Mitra, Mr. A., on a oase of lacerated wound
treated with Iodoform, 468
Mitral aneurysm In a child, 421

-stenosis with gout and granular kidneys,

on the association of, 1090
Molluscum fibresum, multiple neuro-fibromata
and, 1033

Monaco, the sewers of, 549
Money, Dr. A., on aneurysm In undefended
spaoei32; on typhoid fever and meningitis,
1026 '

Monte Carlo Casino, 750
Montreal, proposed hospital at, 858
Moore, Dr. W., and the Brighton meeting of
the Association, 790

-, Dr. J., obituary notice of, 990

-, Dr. N. t on malarial disease of liver and

spleen, 525

Moore's treatment of aneurysm, a proposed
modification of. 1183
Moorish prisons, 895

More, Dr. J., on the utility of drugs In the
treatment of disease, 1157
More mind, more madness, 484
Morewuod, Mr. 8 . R , obituary notice of, 1113
Morphia habitue*, 110

-craving, relief of, by sparteine and nitro¬
glycerine, 1378

Morphlnomanla, the treatment of, 948
Morris, Mr.' H., on rupture of the urinary
bladder, 418

Morton, Dr. J., The Treatment of Spina Bifida
by a New Method (review), 934

-lectures ou cancer and caucerou* diseases,

917

Mosoow Medical Congress, the, 387
Mould fungi, the presence or, in connexion with
diphtheria, 933

Moxon, Dr. W., the memorial to, 231, 375, 333,
491, 605, 657, 808, 1071; Pilocereuo Senilis,
and other Papers ireview), 1030
Much Wool ton, sanitary work In, 840
Mumps and peripheral neuritis, 743
Munroe, Dr. H., obituary notice of, 345
Murder or homicide? 1099, 1150
Murlson. Mr. J. F„ on case of traumatic tetanus
successfully treated by the subcutaneous in¬
jection of morphia, 170

Murphy, Dr. J.. the treatment of placenta
prsevia, 547, 683

-, Mr. S. F., on the prevalence of winter

dlarrhtca, 1080

Murray, Dr. G. 8., on the Brown defence fond,
809, 905, 1071, 1118, 1316, 1309

-, Mr. M., presentation to, 901

Muscle, post-mortem, irritability of, 139
Muzzling, proposed systematic, 1000
Myelitis, acute diffused, notes of a case of,
covery, 15

Myeloid sarcoma, involving both superior
maxillary bones, together with the hard and
soft palate, 1079
Myositis, scute infections, 1351
Myrtol, 044

Myxcedema, 35, 593; hsomorrhaglc tendency
in, 075

Nancy, the faculty of, on the assistant pro¬
fessoriate ( agrtgalion), 589
Narcolepsy, 35
Nasal polypi, 543

Naso-pharynx, adenoid vegetations in, 1186

Natal, vaccination in, 1149

Nat tonal Health Society. 388, 553, 901, 1190

-Hospital, jubilee celebration of the, 1104

Naval Medical Service, 043
Navy, health of the, 391; temperance In the,
487 ; estimates, 645

Neale, Dr. H., on sea-sickness. 403; on Colorado,
000; on open-air treatment of phthisis, 914;
on herniotomy in young children, 1119
Neale's Medical Digest, 1148
Neck, cystic epithelioma of, 574; exolslon of
nevoid growth In, 881

Nedwill, Dr. C., on displacement of the heart
to the right tide from purulent effusion Into
the left pleura, 08

Nelson, Mr. G., case of cut-tliroat, 057
Nephritis, chronic Interstitial, 1131
Nephro-lltholomy. 370; discussion on, 370 ; in
Australia, 130. 1149

Nerve centres aiul modes of growth, action of,
514,501

Nerve suture. 134 ; primary, 373
Nerve*, injuries of, 803, 931, 968.1021,1131
Nervi nervorum periphericorum, 87
Nervous patients, treatment of, 235
NesAeld, Dr. S.. on puncturing the abdomen In
puerperal cases, 904
Neurasthenia—not hysteria, 389
Neuritis, peripheral. 23, 72; experimental, 1345
Neuroses, the field of visloh lu and during the
menstrual period, 1147

Neve. Mr. A., on a case of incision and free
drainage of the lung for phthisical cavities,
363 ,

New South Wales, 1118, 1107; cremation In,
383

- Sydenham Society’s Lexicon of Medicine

end the Allied Science* (review). 1138

-World, medical practice In the, 1119

Newcastle Children’s Hospital, 503
Newcastle-on-Tyne Infirmary, major amputa¬
tions In the, 1 20 ; health of, 953
Newington, medical officers of health, the,
1353

New Inventions.—A new style for facilitating
the treatment of stricture of the laoty mal
duct, 30—Bishop’s patent disinfectant autrf-

1326 Tint Lancrt,]

INDEX.

[3 rim 26,1887.

botor, lb.—Menthol Inhaler, lb.—Newflexlble
. glycerine ring pessary, 221—Hatchings’filter¬
ing paper, lb.—Pocket surgical Instrument
case, 318—Undone chloride of ammonium
Inhaler, lb.—The "unbreakable''clinlcal ther-
mometer In patent safety case, lb — Immisch's
Improved clinical thermometer, lb.—The
' “ matchless" self-lighting gas-burner. 433—
A new patent “brougham hansom,” lb.—
Modification of midwifery forceps, 477— Bm-
pyema-tube, 582—Scwer-alr destructor. 630—
An Improved catgut holder, lb.—A sdssors-
olamp for external bicmnrrholds or other
small tumours, 781—A new form of tooth¬
brush, lb. — The rubber stethoscope, lb.—
Atkinson’s " perfect” truss. 833—A modified
form of urethrotome, 831—Self-fixing absor¬
bent pads. 886— Automatic purifying closet,
lb.—A new sewage precipitant, 935—A new
uvulatome. lb.—Opaque glasa drainage tubes,
lb.—A new eye speculum, 1037—Bryant's
tonton forceps, 1094

Newspapers, medical advice through. 413
Newton Abbott, combined district, health of,
543

Nicholas, Dr. G. B., the Wandsworth Medical
Aid Societv. 553

Nicholson, br. W„ on arterial pressure, 98,
238 ; the pulse, 1009
Night blindness, 984
Nightmare, 505, 555, 697
Niirogenised air. antipyretic action of, 330
Nitro-glycerine, indications for the use of, 384
Nitrous oxide gas, physiological action of, 740
Nolloth, Mr. bT, obituary notice of. 1067
Non-saccharine alcoholic drinks. 1117
North, Mr. W., on malarial fevers, 844, 949,
1004

North-Western Association of Medical Officers
of Health, 300, 1063
North West London Hospital, 753
Norwich, measles In, 593
Nottingham borough asylum, 602
Nouveau Dtcllonnalre de MMectne et de
Chirurgie Pratiques (review), 29
Novelists and the medical profession, 1815
Nursery, science in the, 300
Nystagmus, lateral, 578

Oakhampton rural district, the sanitary state
of, 1204
Qbcslty, 913

Obitcahy.—A lfred Wiltshire, M D.. F.R.C.P.,
91—Thomas Walker, M.D., J.P., 52—Walter
Fergus, M.D., M.R.C.S.. 105— Lanchlan

Altken, M.D. Bdln.. lb.-W. A. N. Cattlln,
F.R.C.S.,106—Jno. Denham.M.D..F.B.C.8.I.,
245—Henry Munroe, M.D.. lb — 8ureeon Jas.
Pcdlow, M.D.Q.U I., lb.—Henry Kennedy,
MJB.. M.K.I.A., 295—Richard Forth Snape,
FJt.C.S.Rng.,lb.—Fran ecscoMagnl,346—Vin¬
cent Ambler. P.F.P.8.G.. lb.—Prof. B6clard,
399—Thomas Fraser, M.A., M.B., C.M.Bd.,
• 453—Nicola Gaaparri. 551—Professor Borodin,
601—Robert Bdmund Carrington ,-M.D. Lend.,
T.R.C.P.. 663—Robert Bryce GiUand, M.D.
Glas., Ao , Lb. — W. H. Thornton, J.P.,
M.R.C.9., 703—John Brady, F.R.C.S I..762-
Charles Hutton. M.D. St. And., M.K.C.P.,
804—Pietro Cipriani, 805—Jss. Barron, B.A.,
M.D.. lb.—G. Bacou 8weetlng. M.R.O.8.,
L.R.C.P. Lond., lb.—Professor Luigi Lau-
renrt, lb.—Daniel Rutherford Haldane. M.D.,
LL.D. Bdln., 856—Henry Grenfell. M.R.C.8.,

L. 8.A., 857-Dr. Daniel Wane, lb —Alfred
Meadows, M.D., F.R.C.P., 908—Charles Jaa.
Btmcey. M.B., lb.—The Chevalier Felice Gal¬
loon, 909—Leon Gosselin, 959—John Moore,

M. D., 960—W. Tiffin Illff, M.D. Lend., lb.—
Wilson Fox, M.D., F.B.C.P.L., F.R.8.. 1011-
Charles Robert Thompson, M.R.C.S.. L.S.A.,
1067—Bdward Nolloth, M.R.O.P., F.R.C.S..
lb.—James Troutbeek, M.B., 1113 — Karl
Friedlander, lb.—Samuel R. Morewood, A.B.,
M.B.T.C.D., lb.—W. A. B. MoCebe, F.R.O.8..
1265—Henry Milne. M D. Abend., 1811—J.
Philip Glover.IM.D. Lond., tb.—John Top-
ham, M J5. Load., 1312

Obscure nervous affection. 912
Obstetric practice, private, a review of thirteen
years, 27, 316; difficulties in private, 1137
Obstetrical Society of London, address
delivered at the, 459, 503

-Transactions (review), 582

Occipital bone and skin, absence of the. In a
newly born Infant, 1183
O'Connor, Dr. 11., on sweating of the feet.
1108

-, Mr. T. B., on epidemic dlarrhcpa. 396

Ocular muscles and nystagmus, conjugate
palsy of. 678
(Bdsma glottidls. 680

CEsophagotomy to remove a foreign body, case
of, 682

CBtophagus, stricture of, 177; tuberculosis of
the, 826; preparation of, from a recent case

of corroslvepolsonlng, 883: malignant tumour
of, 1236

O^Uvto, Mr. J. H., on professional etiquette,

Ogston, Mr. A., on electricity in medical snd
surgical practice, 807
OH and lard, adulteration of. 1148
Oldham poisoning case, the, 632
Oleomargarine, 602

Oliver, Mr. J„ on menorrhagia, a frequent
symptom of pyonephrosis, 121
Omentum, great cyst of the. 311
Omnibus and tramway companies, employe* of,
814

Ontario, diphtheria in, 1300
OOphorectomy, 20
Opaque glass drainage tubes, 936
Ophthalmic and anral practice abroad, 456

-neurology, 686

Ophtbalmological Society. 962
Ophthalmoplegia, externa, 676 ; double, 883
Optic nerve sheath, excision of swollen, 626
Orbit, fibro-sarcoma of the, lt>91
Orbital tumour, unusual case of, 129
Orchitis, the cotton compress in, 84
Osseous labyrinth of the right ear and Rs
removal as a sequestrum from the external
auditory canal, 212

Osteitis deformans or osteomalacia. 82T
Otitis media hemorrhagica, case of, 113*
Oughton, Brigade Surgeon T., on minima
vislbllla and sensory circles, 309, 364
Outlook for 1887. the, 31

Ovarian cyst, unilocular, in a girl aged thirteen,
ovariotomy, 418

-cystic disease, the relation of phthisis to,

196

-ligament, fibroma of, 673

-tumour. 527: following In jury, operation,

recovery, 1086 ; multilocuiar. with umbilleal
hernia, complicated with stroag pelvic ad¬
hesion, 1087

Ovariotomy, for the removal of a dermoid cyst,
215; Llsterian and non-Ueterian, 839; fol¬
lowed by secondary intra-pcrltoneal hemor¬
rhage, reopening of the abdomen, 1129; cases
of, 1283

Ovary, hernia of, 812; cystoma of the. 628:
successful removal of, for cystic disease, nine
months after operation for hydrosalpinx, 876;
flbro-myoma of tlie, 982
Overcrowding, death from, 1249
Overlain children, 1197
Over-pressure In elementary schools, 1190
Owen, Mr. K., on partial enterocele, 314
Owlea, Mr. J. A., ou suicide after taking
chloral, 166

Oxalle add, poisoning 1 by, 694
Oxford University, 910

Oxidising action of turpentine on alcohol,
1299

Oxley, Dr. M., of Liverpool, death of, 1168; on
the treatment of mastitis. 1079
Oxygen as an antipyretic, 1144
Otone, the boiling point of, 1061

Pads, self-fixing absorbent, 886
Page. Mr. F., on antiseptic treatment of major
amputations, 720

Page, Mr. H. W., on a case of hemophilia,

1028

Paget, Mr. 8., on parotitis after abdominal
section, 814; on repeated aspirations of the
bladder, 1063

-, Sir J., on science v. classics, 85 ; address

at the Pathological Sodety of London, 169;
on the Dental Hospital, 688
Palaoe of delight, a, 1061
Palate, ulceration of. 080

Palsy, infantile, 174 ; In limited groups of
muscles, 272

Panoreas and liver, malignant disease of, 278

Paraldehyde, 656

Paralysed and Bpfleptic, National Hospital for
the. 247

Paralysis, alcoholic, 22; pseudo-hypertrophic,
27

Para-myoclonus multiplex. 641
Paraplegia, a fatal case of, necropsy, 470;
partial, probably due to syphilitic meningitis,
recovery, case of, 172
Paris, water supply of, 91
Parish practice and its remuneration, 158
Parker. Dr. W. T., a New Clothing Case for
Soldiers (review), 885

-, Mr. G. W., on Dr. Goto's method of

treating leprosy, 108

-, Mr. R. W., on club-foot, 210; Congenital

Club-foot (review), 1137
Parkes Museum, the, 198,1116
Parliament, reported Illness o( Members of, 796
Parotid region, spontaneous disappearance of a
tumour in the, 604
Parotitis after abdominal section. 314
Parville, H. de, Cauteries Sdentifiqnea (re¬
view), 886

Pasteur. M., patients for, 601; the methods of,
749, 862. 1261 ; committee, the. 264; Institute,
704; hydrophobia and the, 1163

, Pasteur, Dr. W„ on syphiloma of heart. 91 j
on paralysis of the diaphragm alter diph¬
theria, 975

Pasteurian deaths, recent, 290
Partures new, to, 1216, 1268
Pntchett, Mr. W. A., a warning, 1119
Patella, fractured, treatment of, 331; treated
by wiring, sequel to a successful case of
fractured” 679

Pathological 8oclety. the, 89, 142, 186; pre¬
sidential address at the, 169
Pathology, the study of. 601
Paul Bert's science in politics, 80
Pavy, Mr. F. W., a note of warning regarding
the condition of articles of food sold for the
use of the diabetic, 498

Payne. Dr. F. J., on multiple neuro-fibroma!*
and molloscom flbrosum, 1039
Peabody Improved Dwellings Trust, the, 491
Peacan s (Dr.) treatment of cholera, 998
Pearse. Mr. H. R. H., on treament of tsroia
solium. 116$

Pedlow. Surgeon J., obituary notice of, 216
Pelvic fascia, sarcoma of. 1032

-suppuration, abdominal section for, 810

--tourniquet for amputation at the hip

joint and other operations, new. M6
Pelvis, crushed, rapture of the bladder,
necropsy, 172

Pemphigus neonatorum, 1236
Pen and Pencil (review), 1138
Penge ease, the, 964

Penis, horny growth on, 421; amputation of.

use of cocaine, 876
Penjeb sore, the, 1966

Penney, Mr. W. H.. on vaccine lymph in
tropical climates, 54
Pepper, the adulteration of, 998
Perkins, Mr. G., on the utility of drags In the
treatment of disease, 1109
Periosteal sarcoma, 629

Peritoneal cavity, absorption of blood from
the. 227

Peritoneum, the presence of blood in the. 496
Peritonitis, cases of, 409, 461; suppurative. 17*
Perityphlitis, calculus as a cause or. 488
Pernicious anemia, the blood In, 1076
Perth Infirmary, 746

Peru, goitre and cretinism in, 89; vacohtatten
in. 186

Pessary, new flexible, 291
Peterborough, sanitary work in, 1948
Petit’s canal, its existence questioned, 149
Phannaocutloal Conference, 1200
-Society, the examinations of the, 838

Pharmacology ai»d Therapeutics. — Bro-
midla; Different methods of treating eersleal
catarrh; Russian pepstne; antifebrinc In
typhoid; sallcylk) acid in food; ichtbyol
in erysipelas; Pulverised spleen In chlorosis.
190—Brgotine In intermittent fever ; s par-
tein ; eucalyptol in phthisis ; bydraaSto In
uterine hemorrhage; bypnone; bismuth
subiodide. 391 — Ofaapoteaut’s roorr h uolt
melon root and oil of ben (Morlnga system);
haschlsch pa rum and cannablnon; uae of
lodol in Belgian ; vaseline for hypodermic
medication; rhus aromatiaa for nocturnal
enuresis; salloylate of soda In go nei rl aa a;
mentholeate; iodoform in heart disease;
phenol mercury; lobeline and tnfiatiae;
nasal polypi. 642 — Tincture of stropfaan-
thus; sal of In medical and surgical practice ;
myrtol; Hogg’s cocaine tablets; saccharine
in diabetes, 644 — Methylal; fluid extract
of varatrum vlride; sulphate of sparteine;
common salt in migraine. 960—Tertiary
alcohols; antlpyrin and aoetaneUde in
phthisis; huamanripa, 1266

Pharmacy Bill, the new, 638
Pharyngo-laryngeal stenosis, 219
Pharynx, congenital oeculalon of the, 742
Phenol mercury, 643

Phillips, Mr. J.. on aeute epigastric pain in
puerperal albuminuria, 678
Philosophic breakages, the repair of, 738
Phlegmasia dolens, chronic. 830
Phosphatio diabetes, 411, 462
Phthisical cavities, on a case of, inedston and
free drainage of the lung for, 263

-lesions, the local distribution of, 125*

Phthisis, the high altitude treatment of, 93,
333, 543. 667. 667; the etiology of, and its
treatment from a hygienic standpoint. 219 ;
antipvrin In. 284 ; inherited, 483; new tre at
I ment’of, 485 ; the treatment of, 006; the ani¬
line treatment of. 096, 746 ; climate as a
therapeutic agent In, 871 ; artificial and
hyper-alimentation in, 894; open air treat¬
ment of, 914; gaseous rectal medication ha
1104; early diagnosis of, 1251; in the army.
192; and diseases of the respiratory organs,
distribution of, in Ireland, 1264
Physician and philanthropist. 331
Physiological chemistry, reosnt progrsM fat
767

Pictures of horrors, 893

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THS IiANOHT,]

Index.

[Junb 25,1887. 13^7

Pietro Cipriani, obituary notice of, 805
Pike, Mr. J. B., friendly societies' medical
associations, 913
Pineal gland, tumour of, 777
Pit women and their work, 1053
Pitt, Mr. G. N., on the cause of marked hyper¬
trophy of anterior wall of the bladder, 338
Pityriasis versicolor, 33

Placenta prcevia, 130,437,875, 10-16, 1132,1167,
1197, 1205, 1361; the treatment of, 479, 547,
616, 851; the theory and treatment of, 700,
749 ; a rare complication in a case of, 1029
Plaster, covering wounds with, 1147
Playfair, Dr. W. S., on defective sanitation as a
cause of puerperal disease, 351
“ Plebiscite," an objectionable, 386
Pleurisy, sudden death in, 329; a simple case
of, 1180
Plumbism, 682
Plumstead, small pox at, 843
Pneumonia, 977 ; an epidemic of, 90 ; quinine
In, 637; the microbes of, 1100; acute croupous,
207

Pneumothorax with recovery in the apparently
healthy, 574

Pocket surgical instrument case, 318
Poisons, the sale of, 1163

Police ambulance arrangements for Jubilee
Day, 1293

Poliizer, Professor, 643
Pool urban district, health of, 747
Poole, the sanitary condition of, 1014
Poor, medical attendance on the, 791, 886, 1071
Poore, Dr. G. V., on writer's cramp and im¬
paired writing power, cases of, 878
Poor-law infirmaries, 146

- medical officers, unreasonable charges

against, 137

-and sanitary hospitals, 793

Pope, Dr. H. C., on diphtheria and milk, 341
Poplar Hospital for Accidents, 1115
Popliteal aneurysm, ligature of the fomoral In,
897 ; cured by digital compression, 1230
—-—- artery, injury of, 882; and vein, rupture
of the, amputation, 623
Portal fissure, results of cicatrising processes in
the neighbourhood of the, 1226, 1377
Porrltt, Mr. N., a suggested improvement In
ether inhalers, 1306

Porro't operation for rupture of the uterus, 327
Porter, Surgeon-Major, the 8urgeon’s Pocket
Book (review), 317

Port Said, British hospital at, 106, 644
Portsmouth, the recent explosion at, 91; health
of, 96 ; Hospital, the lock wards of, 541
Portugal, medico-legal reform in, 334; asylum
accommodation in, 858
Post-graduate course, another, 238
Post-mortem haemorrhage, the management
of, 843

Post-office authorities and infectious disease,
837

Potter. Dr. J. B., address at the Obstetrical
Society of London, 459
Pott's disease, paraplegia in, 23
Poultry dealer’s den in the Bast-end, a, 1146
Power, Hr. D., on the pathology of Colics'
fracture, 368

-, Mr. W. H.. on diphtheria at Yorktown

and Camberley, 889

Practical education and pupilage, 1095; and
final examinations, 1142
Prager, Mr. I., presentation to, 347
Precaution and panic, 691

Pregnancy, complicated with ovarian tumours,
tapping, delivery, and subsequent removal of
cysts, 132; in an Imperfectly canalised
uterine cornu, 487; hemorrhage during,
probably due to separation of plaoenta, 469;
extra-uterine, 525

Preston Medico-Bthlcal Society, 796
Priapism, pere'Stent, oaseof, 978
Priestley, Dr. W. O., on puncture of the abdo-
domen for extreme flatulent distension in
puerperal cases, 718; on the pathology of
lntra-uterine death, 759, 814, 865
Prison dens of Bngland, 530
Prisoners awaiting trial, aooommodation for,
596 ; at the Central Criminal Court, accommo¬
dation for, 704

Pritchard, Dr. U., Handbook of Diseases of the
Bar (review), 179

Privy Council and the Medical Act of 1886, 744
Profession, the, provident diapensalres suicidal
to, 351; the over-stocking of, 7944 the Cabinet
and, 897; and the peerage, 1207
Professional etiquette, 604
Progressive muscular atrophy, the leg type of.

Prostate, metastatic oarciuoma of, 573
Provident dispensaries, the Wandsworth Medi¬
cal Aid Society, 566

-- principle and the medioal profession,

131.196

->— Surgical Appliance Society, 601, 923

Pseudo-hypertrophic paralysis, 74
Psoriasis, pityriasis, and rheumatism, 730
Psyohio and nervous influences in diseases of
women, 9M

Public health In 1886, the, 823

-Sanitary Inspectors, Association of, 1163

■ services, examinations for the, 390

-vaccinators, new instructions to, 635

Puerperal albuminuria, acute epigastric pains.
In, 676

-apoplexy in a young woman, 1129

-disease, defective sanitation as the cause

of, 251

- pyrexia, 1230,1235

Pulmonary abscess, pneumotomy, 324

-apoplexy, sudden death from, 1132

-cavities, surgical treatment of, 457, 511,

667. 714

-gangrene, the etiology of, 185

Pulse, the. 800 , 1009 ; lectures on the, 607, 659,
709; the teachings of the, 785; extreme
frequency of, after paracentesis, lu98
Punjab, disease in the, 306
Pupils, the inequality of the, in various dis¬
eases, 137; oaution in the administration of
faUoylio acid, 341; in health. 640
Purpura rheumatica, a case of, 772
Purulent euoephalltis with obscure symptoms
occurring in a pregnant woman at full term,
169

Pustule, malignant, and coma. 912
Pyloreotomy for caroinoma, death, neoropey,
171

Pylorus, resection of the, 881; Innervation of
the, 1103

Pyopneumothorax subphrenious, 1054
Pyosalpinx and subperitoneal myoma, abdo¬
minal section for, 622
Pyorrhma alveolar!», 945

Pyrexia, 800; and hyperpyrexia,-114, 465, 616,
565, 617,619

Qualifications under the new Act, 991
Quarterly Journal of Microscopical Science

(review), <>81

Queen’s College, Belfast, 961; Birmingham
Medioal Society, 487; Cork, 1068; Birming¬
ham, 1300

Queensland, the Contagious Diseases Acts in,
442

Quinby, Mr. II. C., What can a Mother do to
preserve her Children's Teeth ? (review), 1286
Quinsy, treatment of, 734
Qulllsja saponaria as an expectorant, 41

Babies, 296, 502; the discussion on, at the
french Academy, 189; Portuguese work on,
445

Radollffe, Dr. C. B., A New Departure in
Science (review), 476
Bags as disseminators of disease, 1097,1190
Bail ways carriage, warming, 283, 350

-servant*, mortality among, 941

Bake, Dr. B.. on a form of ulceration simulating
leprosy, 817; on puerperal eclampsia, cranio¬
tomy, 1330

Balfe, Dr. C. H., on phosphatlc diabetes, 411,462
Rankin, Dr. C. S., ergotine in intermittent
fever, 809

Bat poisons, 637 '

Baven, Mr. T. F., on the influence of salicylio
sold upon acute rheumatism, 623
Baynaua's disease, 308. 780; in adult life, 604;

and peripheral neuritis, 72
Beading district, health of, 1058
Beotai nstulss, some of the rarer forms of, 1089
-■ gaseous medication for emphysema. 446
Intussusception, due to a new growth.

excision of intussusception, enteroraphy, re¬
covery, 980

Becti, external, paralysis of. 577
Bectum, intra-peritoneal excision of the, 575 ;
oolotomy for malignant disease of the, with
nearly perfect oontrol over the artificial anus
a year after the operation. 819
Bed Bluff California, the climate of, 757
Kef use, disposal of, 893
Regina r, Baxter and Potts, 943
Registered, warning to those not, 836
Registrar-General, the annual report of, 283;

the annual summary of, 789
Registration under old diplomas, 744
“ Relative rank” question, the, 637, 688, 701,
903, 1006

Renal ealeuhis, solvent treatment of, 626

—■-sarcoma In infancy, Is surgery justifiable ?

827

secretion In the fcctus and the formation

of llqnor amnii, 443

• surgery, 270; lecture cn. 408

Resorcin In condyloraata Ac , 41
Besptratton, simple method of estimating the
effects of. 188

BetrtMBSophageal abscess, causing 'death by
pressure on the trachea, 17
Retro-pharyngeal abscess, 421

BBVIHWS AND NOTIOBS OP BOOK8.
The Parasites of Man arid the Di s eas es which
proceed from them: by Rudolf Leuckart;
translated from the German by Wm. B.
Hoyle, M.A.Oxon., M.B.C.S., 27—The Dis¬

eases of the Prostate; their Pathology and
Treatment (comprising the Jacksonian
Prize Essay for the year 1860): by Sir Henry
Thompson : sixth edition, 28—Nouveau Dlc-
tionnaire de Medecine et de Chirurgie Pra¬
tiques ; tome xl„ 29—General Paralysis of
the Insane: by Julius Mickle, M J)„ He.-,
second edition, 76—Functions of the Brain :
by David Ferrier, M.D., F.B.C.P.; second
edition, 77—Transactions of the Society of
Medical Offioers of Health, 78—Indian V ete¬
rinary Manuals. I. The Elephant: by John
Henry Steel. V.B., A.V.D.. ib.—Lectures on
Medical Pathology: by H. Gawen Sutton,
M.B., F.R.C.P., 1x7—The Befractiou and
Accommodation of the Eye and their Ano¬
malies : by E. Landolt, 51.D.; translated by
C. M. Culver. M.A., M.D., 128—Our Library
Table, 128, 581, 782, 1238—Life of Sir Bobert
Christlson, Bart., M.U., D.C-L. Oxen.,
LL.D.Edin., Ac ; edited by his Sons. Vol.
II.: Memoirs, 178—Handbook of Diseases of
the Bar: by Urban Pritchard, M.D.Ed.,
F.H.C.S. Eng., 179 — Lehrbuch der Verg-
leichenden Anatomic der Wirbelthlere:
bearbeitet von Prof. Dr. Robert Weiders-
heim, ib.—Our Temperaments; their Study
and Teaching: by Alex. Stewart, F.K-G.H.
Ed., ib.—The Healing of Arteries after Liga¬
ture in Man and Animals: by J. Collls
Warren, M.D., 373—Hygiene of the Bye in
8choolt: by Professor Hermann Cohn;
Bnglish translation; edited by W. P. Turn-
bull, 274—Minutes of the General Medical
Council, of its Bxeoutlve and Dental Com¬
mittees, and of its Branch Councils, for the
Year 1888; vol. 23, 275- The 8urgeon's
Pocket book : by Surgeon-Major J. H. Porter;
third edition; revised and edited by Brigade-
Snrgoou C. H. Y. Godwin, 317 — Sani¬
tary Examinations of Watere Air, and
Food: by Cornelius B. Fox, M.D., F.B.C.P.
Lond.; second edition, ib. — Outlines of
Quantitative Analysis: by A. Humbolt
Sexton, 318 — The Healing Art; or,
Chapters upon Medicine, Diseases, Remedies,
and Physlciatis — Historical, Biographical,
and Descriptive, 422—A Commentary on the
Diseases of India: by Norman Chevers, MJJ.,
F.R.C.S.Bng., ib.—The Asclepiad, 433,1094—
A New Departure In Science, being a Second
Hdltlon of a New Chapter in the Story of
Nature: by Charles Bland Radollffe, M.D.,
475—An Elementary Text-book of British
Fungi: by William Dellsle Ilay, F.K.G.8.,
477—A Treatise on the Principles and Prac¬
tice of Medicine: by Austin Flint, M.D.,
LL.D.; sixth edition, revised and largely re¬
written by the author, assisted by William
H. Welch, M.D., and Austin Flint, M.D.,
LL.D., 538 —Anatomy and Physiology in
Character: by Furneoux Jordan, FB.C.S..
529—Alexander Wood, M.D., F.B.O.I’-Eog.,
Ac. (a Sketch of his Life and Work): by.the
Bev. Thomas Brown, F.B.S.B.. lb.—Diseases
of the Joints: by Howard Marsh, F.B.C.S.,
580 — Lefons aur les Maladies du Systbme
Nerveux: par J. M. Cheroot; Recueflliee et

a ubliees par MM. Babinski, Bernard, Fere,
uinon, Marie, et Glilee de la Tourette;
tome ill., 681—Lehrbuch der Chirurgischen
Krankheiten des Obree: by Prof. Dr. Here
mann Schwartz©, 629—Diseases and their
Commencement; Lectures to Trained
Nurses; by Donald Hood, M.D.. ib.—A
Junior Course of Practical Zoology: by A. M.
Marshall, assisted by C. Herbert Hurst, 630
—The Croonian Lectures on some Points
In the Pathologyof Rheumatism, Gout, and
Diabetes: by P. W. Latham, M.D., 82—Dis¬
eases of Bones and Joints: by Charles N.
Macnamara, F.R.O.S. Eng.; third edition,
ib.—Treatment of Placenta Prssvia: by Ms.
Marphy, M.D., ib.—The Journal of Physio¬
logy ; vol. viii., No. 1, ib.—Bnrdett’s Official
Intelligence; vol. v„ lb. — A Text-book of
Pathological Anatomy and Pathogenesis:
by Erast Zeigler; translated and edited by
Donald MacAlister, M.A., M.D.; part 2:
Special Pathological Anatomy; sections 9 to
12, 734— Practical Medicine and Medical DM-

S iosls; by Byrom Bram well, M.D., 735—Iai
outte, sa Nature et son Traitement: par Dr.
W. Ebstein, ib.—Contributions to Practical
Medicine: by Jae. Sawyer, Knt., 786—Recent
Bssays by various Authors on Bacteria in
relation to Disease; selected and edited by
W. Watson Cheyne, M.B., F.B.O.8., 781—
Les Bactdrlee, et I ear Rflle dans l'Anatomte
et rHistologie Patbologiques dee Maladies
Infectieuses: par A. V. Oomll et V. Babes;
deni I ft me 6dttion, ib. — Health at School,
considered la Its Men Ml. Moral, and Phy¬
sical Aspects: by ClementDukee,M-DXona.,
783—On Fevers: their History, Etiology,
Diagnosis, Prognosis, and Treatment r ny
Alex. Collie, M.D., 831—Sputum; its Micro¬
scopy, and Diagnostic and ProKnoeUo Signifi¬
cation : by Francis Troup, UJ)^ ib. —The

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1328 Th* Lanckt,]

Man of Science, the Man of God—Sir Jai. Y.
Simpeon : by the Hev. Chas. Bullock, B.D.,
832—On Medical Climatology ; a Scheme for
Defining Local Climate* by combined
Meteorological and Pbenologjcal Observa¬
tion: by 0. Robert*, F.R.C.S., lb. — Food
Grain* of India: by A. H. Church. M.A.Ox..
F.G.8., 88-1—The Diagnoel* and Treatment
of Syphilis: by Tom Robinson, M.D., lb.—
De 1 Intervention Chirurglcale dan* le*
Affections du Rein: par Azarie Brodeur,
M.D., lb.—A Practical Treatise on the Cure
of Pulmonary Consumption: by Jaa. Weaver,
M.D., ib.—Traite Blementalre de Pathologie
Generate: par H. Hallopeau, 885—A New
Clothing Case for the Soldier: by W. Thorn¬
ton Parker, M .D., ib.—Causeries Scientiflques:
par Henri de Pnrville, ib.—The Treatment of
Spina Bifida by a New Method: by Jamea
Morton, M.D.. L.H.C.S.Bd.; with a paper on
the Pathology of Spina Bifida by Dr. Johu
Cleland, 934—Rest and Pain: by the late
John Hilton, F.K.S.. F.H.C.8.: edited by
H. A. Jacobson, M.B. Oxon., F.R.C.S.
fourth edition, ib. — Practical Pathology ;
an Introduction to the Practical Study of
Morbid Anatomy ana Histology: by John
Lindsay Steven, M.D., 935—Pllocereus Senilis,
and other Papers: by W. Moxon, M.D., 1036—
A Text-book of Medicine for Student* and
Practitioner*: by Dr. Adolf Striimpell;
translated by H. F. Vickery, M.D., and P.
Coombes Knapp, M.D., with Notes by F. C.
Bhattunk, M.D., 1093—Nervou* Disease* and
their Diagnosis: by H. C. Wood, M.D.,
LL.D. ib.—Diagnosis of Disease* of the
Nervous System : by C. W. Suckling, M.D.,
ib.—Tumeurs de l'Omblllo : par le Dr. Fran¬
cis Villar, 1094—The Kssentials of Bandaging,
with Directions for Managing Fractures and
Dislocations, for administering Bther and
Chloroform, and for using other Surgical
Apparatus: by Berkeley Hill, F.R.C.S.;
sixth edition, 1137 — Congenital Club-foot;
its Nature and Treatment, with especial re¬
ference to the Subcutaneous Division of the
Taraal Ligament*: by R. W. Parker, ib.—
Drultt’s Surgeon's Vade-Mecum ; a Manual
of Modern Surgery: edited by Stanley Boyd,
M.B., F.R.C.S.Bug.; twelfth edition, 1138—
A Treatise on Chemistry : by SirH. B. Roscoe,
F.R.S , and C. Sohorlemmer. F.R.S.; vol ill,
part 3. lb.—Brain; a Journal of Neurology:
edited by A. de Watteville ; part 87, ib.—Pro-
lectiones Anatomias Universalis: by William
Harvey; edited, with an autotype reproduc¬
tion o"f the original, by a committee of the
Royal College of Physicians, 1187—Neurectasy
fthe Bradsliawe Lecture of 1883): by John
Marshall, F.lt.S.. 1189 — Die AUgcmelne
Pathologic, oder die Lehre von dem ITraschen
und dem Wesen derKraukheltsprocesse : von
Dr. Bdwln Klebs, 1837—Photography of Bac¬
teria: by B. M. Orookshank, M.B., 1238—
Diagnosis and Treatment of Diseases of
the Kidney amenable to Direct Surgical
Interference: by W. Bruce Clarke, M.A.,
M.B. Oxou., F.R.C.S., 1238—Treatment and
Utilisation of Sewage: by W. H. Corfield.
M.A., M.D. Oxon.; third edition, revised
and enlarged by the Author and L. 0. Parkes,
M.D., 1285—Gundris* der Bakterienkunde:
von Dr. Carl Fraenkel, 1285—What can a
Mother do to preserve her Children's Teeth:
by H. C. Quinby. 1286—Travel* In the In¬
terior : by Luke Theophllus Courteney, lb.—
Variations of Fortune, ib.

Robinson, Dr. T.. the Diagnosis and Treatment
of Syphilis (review), 884
-, Mr. C. H.. case of poisoning by hydro¬
chloric acid, 875 ; case ol chrouio interstitial
nephritis. 1131

Robson. M r. A. W. M., treatment of thy roldcysts,
174, 238; treatment of imperforate anus,
174; on trephining for paralysis ol right arm.
cure of patieut, 404; on Terrier's nephrec¬
tomy, 1202

Rochester, the sanitary oondltlon of. 40, 143
Rockllffe, Mr. W. C., an unusual case of
orbital tumour, 129
Rodents, red and white muscles In. 232
Rogers, Dr. J., on the Lunacy Amendment Bill,
1887, 447

Roeooe and Schorlemmer. Messrs., a Treatise
on Chemist ry (review), 1138
Rotherham Hospital, 318
Royal Academy of Arts, 951

-Asylum of St. Anne’s Society, 442

—-College of Physicians of London, 244,

and medical degrees, 42;

femoral artery, 147; th<
delivered at the Royal

353

Sawtell. Dr. T. H.. on ps
the tympanitic abdomei
848 '

Sawyer, Sir J., on the caul
of backache, 17: Conti
Medicine (review), 728
Scarborough Sea-bathing I
Scarlatinal kidneys, 1253 !
Scarlet fever, the relation
1139 ; the contagium
measles, the prevalence
searches in connexion
1274 ; hospitals, influent
Schode’s method of dressU
Schlesinger, Dr., on lapai
Scholarships and prizes, 9|
School attendance, illness*

-closing, imporc&nti

- hygiene, 142, 699 I

Seliroeder, Professor, the 1
Schwartze, Dr. H.. Lehrbi
Krankheiten de* Ohree
Science, fasting for the sal

645, 746,908.1011. . .

the licence of the, a surgical qualification,
204; the presidency of the, 642, 740; the
College of Surgeons, and the Apothecaries'
Sooiety, 798

. College of Surgeons of Bngland, 29, 153,

345, 400, 451, 550, 634, 652, 804, 959. 1011, 1151 ;
fellows, members, and council of the,'83. 93,
339, 439, 447 ; the poll of the, 180; petition
of members of the, to the Privy Couooil, 238,
1206; Hunterian oration, delivered at the,
353 ; memorial of London surgeons to the
council of the. 535; proposed new charter for
the. 836, 892. 994; examinations, 2>X), 1061,
1107. 1156. 1211 ; election. J199; oonversa-
zioue at the, 1254; vacancies in the Council
of the, 1292

-College of Surgeons In Ireland, 1164,1212

-Colleges of Physicians and 8urgeons,

examining board In England by the. 2<W

-Colonial Institute, meeting of the, 154

-Free Hospital, 347

-General Dispensary, 400

-Hospital for Children and Women, 602,

1068

-Institution of Great Britain, 1007

-Maternity Charity. 290

-Medical and Cbirurgical Sooiety, pre¬
sident's address at the, 471

-Society. 1386

-University of Ireland, 1116

hospitals, 616

Rubber stethoscope, the, 783
Runcorn rural district, health of, 1154
Rural practice, perils of, 462
Russian pepsine, 190

Rutherford, Dr. W., on the sense of hearing, 2;
the University of Bdinbnrgb, 841

-, Surgeon-General W., death of, 896

Rutherfoord, Mr. H. T., on a rare condition of
veins In the anterior vaginal Wall, 1181

Saocharine In diabetes, 644

St. Andrews Graduates’ Association, 194

8t. Asaph district, 747

St. Bartholomew's Hospital, 489; the election
at, 281

St, George’s Hospital, 1105
St. John Ambulance Association, 230, 502,1063
8t. Marylebone Inflrmniy, 107
St. Mary’s Hospital, 1103; ophthalmic depart¬
ment, 1068 ; Manchester, 602
St. Pancras, health of, 96, 103

-and Northern Dlsensary, 501

St. Petersburg Medical Academy, speech day at
the. 88

St. Thomas’s Hospital. 806; medical school,

1000, 1002, 1021; Reports (review), 128
Sale of Food Act, reference cases under the,

1306

Salford, health of, 336; means of isolation at,
1251

Salicylate of so<la in gonorrhoea, 542
Salicylic acid in food. 191; uged for adulteration,
23»; the influence of, upon acute rheumatism,

623

-eruption, 286

Salisbury, the Marquis of, 640

Salol in medical and surgical practice, 614

Salter, Mr. A. B., on fracture of astragalus.

i-

1286 -
Sewer-air destructor, 630

consumption of, 668

Sewer ventilation, a new mw 1
SewllI, Mr. H., on the dendtyut
influenced by the food. 46
Sex. considerations in regard to

261,307

Sexton. Mr. A. H., Outline* of

and union

Sbelswell.Mr. C. B.. on hn-morrl
in myxa-dema, 675; prweDtall
Shingles, the late prevalence of.
Ships' holds, air in the. 793
Shop Hours Bill. the. 281
Shoulder, injury to. 621*; disltq
n duction after eight days by
874

Shovel shoe, the. 107 1 _

Shrewsbury. ailMMMM

Siberia and Ktuaia,
to), 1088' "

Wek peer ne* paupers, mK j. o
the, 1118

Revolver, the. 488

Revue Genera'e de Clinique et de Tberapeutique
(review). SS2

Reynolds, Dr. J., on the treatment of phthisis,
606

Rheumatic arthritis, chronic. 1119, 1167

-cerebro spinal Inflammation, 620

— hyperpvrexia, a cate of. 518; successfully
treated by the cold bath, 471
Rhinolith. a case of. 772
Rhus uromat ica for nocturnal enuresis, 642
Rib. fractured, case of. 374
Richards, Mr. V., on Pasteur's methods, 749,
1261

Richardson’s (Dr.) election fund, 1017
Rickets in t ho skulls of lions, 1033
Riddell fund. 55, 109

Ringworm, the spread of, 1048; the treatment
of. 1108, 1156

Rivers, legislation for the purification of, and
its failures. 315
Riviera in 1887, the, 801, 853
Roberts. Dr. L.. presentation to, 1163
•-. Dr. It. L., Illustrated Lectures on Am-

Siehnld. Mr.

for 1386 <rev:
Sllcock. Mr. €
llomaof neci
Silk, Mr. J. F

inflammat

Similia

Simmons. Dr.

an infant, 50
Sister Crump,
Sine curriculo

Skelton. Dr.

In the same
Skin, abaorptl
90; change
peratureof t

hospital

08 tods of

muscles of

west, of

Slaught4

Tara Langbt,]

INDEX.

Sleep of six days, the, 688
Sleeping man, the, 808

Slight, Dr. G„ on the jubilee and the hospital*.
Mb

Sloan, Dr. A.T., on goitre in animals, 1082
Small-pox, inoculation, 35; at Walsall, 153 ; in
Australia, 182, 287,1063; epidemic, the Dor-
cheater Town Council and the, 695; at Car¬
diff, 942; case of, arising in mid-ocean, 1028 ;
and quarantine, 86; and vaccination, 996,1290

-hospitals, the influence of, 319, 381, 421,

474 ; the expenditure of, 1198
Smith, Dr. F. A. A., on bread-making, 756; on
a scissors-clamp for external hemorrhoids,
784; treatment of tania solium, 1166

-, Mr. A., on sweating of the fett, 1214

-•, Mr. A., treatment of ringworm, 1156

-% Mr. F. J., on malignant disease of lung

and posterior mediastinum producing com¬
plete paraplegia, 928; on the Royal College
of Surgeons' examinations, 1166

-». Mr. F. P„ on Chinese pharmacology,

1269

--■, Mr. J. G., case of successful removal

per vaginam of a cancerous (and pregnant)
uterus, 14

-, Mr. P. B., a suggested Improvement In

ether Inhalers. 1307

Snake poison, 706; recent research on, 633
Snape, Mr. B. F., obituary notice of, 295
Snell, Mr. 8„ on some clinical feature* of
Graves' disease, 818
Snow, the removal of, 85
Society for Widows and Orphans of Medical
Men, 103, 247, 1115
Soda-water bottles, explosive, 894
Soul and conscience, on, 186
Southall, Mr. W„ the Organic Materia Medlca
of the British Pharmacopoeia (review), 1230
South-west of Bo gland, the climate of the,
300

Spain, new medical corporation in, 142 ; adul¬
teration of food in, 246; the climatology of,
642

Spanish pharmacists, impending ruin of, 286

-practitioner, death of an aged, 501

Sparteine, 391; sulphate of, 951
*' Spaying," the use of the word, 183, 238
Speaker, the health of the, 745
8raclal hospitals, multiplication of, 696
Specialism in txctltit, lo55, 1215
*' Spectacle mission,” the, 999
“ Spectator,” the, and the Erasmus Wilson
bequest, 231

Spectroscopic reaction, the delioacy of, in gases,
loOO

Speech, defective, some forms of. 111
Spencer, Mr. H., the factors of organic evolu¬
tion, 581

8pender, Dr, J, K., on some points In the
treatment of acne, especially of the face, 66
Sphygmograph in asylum patients, the, 233
Spilsby rural district, health of, 1106,1204
Spinal canal, successful removal of a tumour
from the, 1244

-cord, the course of the posterior roots of

the, 327 ; and peripheral nerves alter ampu¬
tation, 628

-disease and insanity. 89

•-meningocele, 982

• pia mater, diffuse sarcoma of, 932

-tumour, removal of a, 1299

Spine, fraoture of the, 316; and liver, carcinoma
of, 932 ; lateral curvature of the, 1275
Spltzly, Mr. J. H., on post-mortem irritability
of muscle. 129

Spleen, extirpation of the, 441; a case of hyper¬
trophy of the. death, 1184
Spranger, Mr. F. J., on the treatment of taenia
solium, 1166

Squire, Dr, J, B., on typho-malarial fever, 73

-—, Dr. W., on the transport and treatment

of infectious patients in the metropolis, 495;
on snake poison, 706
Stafford urban district, health of, 900
Stanley Hospital, Liverpool, 501
Stapleford, lever at, 1253
Stawell Hospital, 87

Steavenson, Dr. W. E., on a proposed modifica¬
tion of Moore's treatment of aneurysm, 1182
Steel, Mr. H., Indian Veterinary Manuals
(review), 78

Steele, Mr. D. A. K., on exploratory Incisions,
109

-— and EUIs, Messrs., the petition of mem¬
bers of the Boyal College of Surgeons, 238
Stellwag's symptom, 734
Sterility, notes on. 1073
Sternum, large dermoid cyst over, 673
Stethoscopes, flexible, 861
Steven, Dr. J.L.,Praotlool Pathology (review),
935

Stevenson, Mr. B. 8„ on ovariotomy for the
removal of a dermoid cyst, 215
Stewart, Mr. A., Our Temperaments, their
8tudy and Teaching (review), 179

--, Mr. F. G., on placenta prsevia, 1167

--, Mr. W. B. H.,on thyrotomy for epithe¬
lioma of the larynx, 1029

Stillbirth, a surgeon fined for certificate of. 39j
Stillborn infants, tbc non-registration of, 325
8tockhardt and Heaton. Messrs., Experimental
Chemistry (review), 123
Stockport Infirmary, 806

Stomsch,ulcers of, in infantile tuberculosis, 22;
dilated, death after washing out, 74; a case
of perforating ulcer of the, 267 ; coudurango
in cancer of the, 537 ; the gastric juice In
cancer of the, 840; scute dilatation of the,
883; fibrous contraction of, 1033; malignant
disease of the, 1090

Stone in boys, removal of, by suprapubic
cystotomy, 873

Stonyhurst College, epidemic of measles at, 501
Stradllng. Mr. A., on the administration of
carbonate of lime as a means of arresting the
growth of cancerous tumour, 1108
Straban. Dr. 8. A. K., on paraldehyde. 565
Strangulation, internal, abdominal section for
formation of artificial anus ; failure of plastic
operation, enterectomy, cure, 728
Street sewer ventilators, 606

-watering, sea water for, 1103

Street’s Indian and Colonial Directory (re¬
view), 885

Stretton, Mr. J. L., on herniotomy la a very
young child, 1029

-, Mr. 8., on damp beds, 454; on work¬
men's oolleotion in aid of hospitals, 666
Stricture, traumatic, In a child of three years,
1231

Strongylus glgas, case of, 264
Strophantbus, 964 ; tincture of, 644
Stroud urban district, health of, 697
Strlimpell, Dr. A., a Text-book of Medicine for
Students and Practitioners (review), 1094
Students’ Register, 35
Sturges, Dr. O., on school-made ohorea, 112
Suboortlcal disease, paralysis of tbe left leg
from, 471

Snbmaxlllary calculus, 366
Substantive verms honorary rank, 993.1061
8uckling, Dr. O. W., Diagnosis of Diseases of
the Nervous System (review), 1093
Sudden death, 861
Suicide, statistics of. 1247
Sumpter, Dr. W., on placenta pravla, 1046
Sunderland, health of, 45, 846; new infectious
diseases hospital, 1068
Supplementary charter, the, 1142
Suprapubic abscess. 1033

-lithotomy, 75, 1031, 1234; two cases of,

123; In a man aged seventy-two, cure, subse¬

quent death from apoplexy,295; In theadnlt,
suture of bladder, prinwiy union, 287;
h*morrhage into the bladder, case of, re¬
covery, 929

-suppuration. 681

Surgical cases of Interest, with remarks, 573

-mishaps, 11, 295

Sussex County Hospital, 452
Suspensory ligament, permeability of the, by
organised substances, 1283
Sutherland. Dr. H., on sea-sickness, 403
Sutton, Mr. F. A., a Systematic Handbook of
Volumetric Analvsls (review), 1239
-, Mr. H. G-, Lectures on Medical Patho¬
logy (review), 127

-, Mr. J„ on. suture of divided nerves. 124

-, Mr. J. B„ on evolution in pathology,

254. 304. 406

Sutton-Coldfield, health of, 646
Sweating system, 602

Sweden, paroxysmal hemoglobinuria In, 439
8weetlng. Mr. G. B„ obituary notice of, 805
Swing boats, dangers of, 966
8woro handle, a new, 1068
Syphilis, the treatment of, by mercury, 473;
carbolate of mercury in, 943; hereditary,
828; congenital, bones from, 1034 ; and
hydrophobia, the preventive treatment of,
448

Syphilitic bone affections ard precocious gum-
mata, 140

-card Iso aneurysm. 72

-meningitis causing progressive chronic

dementia, 878

-placenta, a, 843

-- patients, dry hot air baths for; 1300

Tabes dorsalis, shedding of teeth in, 420;

paralysis of convergence in, 1146
Tabetic arthropathy, Professor Virchow on, 32
Taenia solium, treatment of, 1119,1166, 1215
Tait, Mr. L„ a note on hysterectomy, 18; on
the term ‘•spaying,” 233; tbe mere presence
of blood In the peritoneum not a reason for
abdominal section, 290,397; on the pathology
of tubal pregnancy, 525; on chroDlc Inflam¬
matory disease of uterine appendages, 777
Talipes calcaneus, 1092

Tandy, Mr, B. L.. removal of breast tumour
With tbe aidof cocaine, 1315
Tangier as a health-resort. 955
Tartar emetic, case of poisoning by, 773
Taste, paralysis of tbe sense of, 943
Taunton urban district, health of, 1059
Taylor, Dr. C. B„ on diseases of the eye, 766,816

[June 25* 1887. 1329

Taylor, Dr. F„ on a case of rheumatic hyper¬
pyrexia, 518

-, Dr. S„ case of Raynaud's disease, 208

-, Mr. M. H., case of placenta prsjvla. 875

-, Mr. W., on the presence of roonld fungi

in connexion with diphtheria, 933
Tea, coffee, and cocoa, the Influence of, on
digestion, 946
Tea-amblyopia, 949

Teaching University for London, 338, 440, 482,
589, 1098

Teale, Mr. J. W., on stretching the sphincter in
apoplexy, 1021

-, Mr. T. P., on surgical mishaps, 11

“ Tear” of public life, the, 1103
Teetb, the density of the, as Influenced by the
food, 46; the effect of a diet without lime
upon the, 78; replantation, transplantation,
and implantation of, 331
Telegraph, consultations by, 230; and tele¬
phone wires, overhead, 40
Temperance Hospital, the, 1164
Temperature, extremes of, 1248
Tendo Achillls, suture of, 16
Terrier’s nephrectomy. 1145,1262
Tertiary alcohols, 1256
Testes and cord, tumours of, 22
Testicle, cystic disease of tbe, 573
Tetanus, successfully treated with chloral
hydrate, a case of, 204 ; traumatic, cured by
removal of the cicatrix and surrounding parts,
21; traumatic, successfully treated by the sub¬
cutaneous injection of morphia, 170; trau¬
matic, case of, 367

Thames, pollution of the, 1118; contamination
of the. by the Henley regatta, 1294

- Valley Drainage Board, another, 858
Theatres Bill, 899

Theatres, the vetotHat!on of. 82; panics In, 689;

- tbe regulation of, 692; luminous paint In, 1001
Thermometer, unbreakable clinical, 318
Thigh, fracture of the, during parturition, 505 ;

extravasation of blood into the, general tuber¬
culosis, necropsy, 877
Thlriar, Dr., on varicocele, 893
‘Thomas, Mr. D. H., presentation to. W6
-, Mr. W. B., on chronic rheumatic arth¬
ritis, 1167

Thompson, Dr. W. S., on vaccination and re-
vaocinatlon, 605

-, Mr. C. R., obituary notice of, 1067

-, Sir Henry, the Diseases of tbe Prostate,

tbetr Pathology and Treatment (review), 28

-, Thomas, respite of the convict, 390

Thomsen’s disease, cases of, 972,1047
Thoracic aneurysm, 681

-aorta, aneurysm of, 1188

Thorax, severe injury to, 527

Thornton, Mr. W. H.. obituary notice of, 703

Threadworm, 1119, 1167

Thrombi, the formation of, in pulmonary
vessels, 527

Thrush, polymorphism of the fungus of, 1099
Thurstan, Dr. E. P., on sea-sickness, 350 ; on a
doctor’s Income, 849,1062
Thyroid, treatment of cysts of, 174, 238; and
cerebral circulation, relations between the. 891
Thyrotomy for epithelioma of the larynx, 1029
Tibia, fracture ol the. due to necrosis, 822; and
ankle joint, a case of tubercular disease of
the, treated by scraping away the medulla of
the former and the synovial membrane of
the latter, 771

Tiblal artery (anterior), diffused traumatic
aneurysm of the, of ten weeks’ duration,
attempted ligature, amputation, 522
Tinned milk, decomposition in, 87 ; extensive
seizure of decomposed, 602
Tomes, Dr. A., on abscess of the liver in India,
110

-, Mr. 0. 8., on the effect of a diet without

lime upon the teeth, 78

Tongue, adeno-sarcoma of, calcifying nodule in
centre, 524 ; removal of half of, for sarcoma,
623; treatment of heemorrhage from the, 827 ^
blood cyst of the, 881

Tonsil, sarcoma of, 681; Incising the, 1214;

malignant disease of the, 1234
Tonsillitis, bicarbonate of soda In, 41; atul
diphtheria, 896

Tooth, torsion of an incisor, 232; pysemia after
extraction of a, 236

-brush, a new form of, 784

-extraction, conditions of successful pro¬
duction of local antestheslain, 589
-powders, 37

Topham, Dr. J., obituary notice of, 1312
Torquay, health of, 646

Torticollis, spasmodic, due to cerebral lesion,
1034

Total abstinence lodges and medical prescrip¬
tion, 139

Tottenham hospital, 1115
Toulon, sanitation at, 151
Town refuse In road-making, the use of, 444

-sanitation, 1314

Towyn. health of, 797

Toxteth Pork, health of, 797; poisoning case,
the, 892

Die

1$80 Th Tt LancbtJ

Toy, a dangerous, 791
Trachea, syphilitic stenosis of, 830
Tracheotomy, 873; difficulties In establishing
natural respiration after, 879
Trained nurses' annuity fund, 400
Training, 691

Trance, a case of, 740; burial during, 916
Transfusion, 770, 1969
Transplantation by exchange, 363
Travelling medical referees. 510
Trees from a sanitary aspect, 769
Trephining for paralysis of right arm, 461
Treves, Mr. F., a sixteenth century amputation,
63; on glandular swellings curable by arsenic, ’
679

Tricycle, an improved, 351 ; another dentil on
a. 1118

Trinidad, leprosy In, 692

Troup, Dr. F., Spilt urn, Its Mlcrosoopy, and
Diagnostic and Prognostic Signification (re¬
view), 831

Troutbeok, Mr. James, obituary notice of, 1113
Truss Society, the, 348
Tubal pregnancy, case of. 932
rrubcrclo bacillus, rapid staining of, 757
/Tubercular meningitis, inequality of the pupils
I In, 566. 619

/ -Infective areas, 1035

!-patleota. the operative treatment of Inter

current disease in, 219

Tuberculosis, a case of general, necropsy, 18 ;

the heredity of, 1110, 1305
Tubo-ovarian cysts, 1186
Tunbridge Wells district, health of, 953
Turner, Mr. G. R., on aplinsla following a de¬
pressed fracture of the left side of the head,
116

•-, Mr. P. D„ a case of -retro-cesophageal

abscess causing death by pressure on the
trachea.17

Turtles, torturing, 715

Turton. Mr. J„ on erysipelas after vacotnatfon,
649; on survlvance after gunshot and other
wounds of the heart, 851
Tweedy. Mr. J., on the etiology of oonstita-
tlonal diseases of the eye, 57
Twin pregnancy, injury in, 37
Tyne port, the. 487 !

Tynemouth Infirmary, TOW)

Typhoid bacillus. 111; cold and the, 145

--fever, treatment of, 375; treatment of,

by the cold wet pack and alcohol, 9; treat¬
ment of, by inhalation of cold air, 285; the
bowel lesion In. 810 ; sudamina In, 896 ; from
meningitis, will the knee jerk divide ? 1026;
and hydrants, 291

Typho-malarial fever, 73; and enteric fever,
notes on, 119

Typhus, in the Stourbridge union and neigh¬
bourhood. 330; and overcrowding, 693

Uloeratlon simulating leprosy, 817

Ulna, compound comminuted fracture of the.

Into the elbow joint, 572
Ulnar and median nerves, secondary suture of,
1091

Undefended space, aneurysm In, 22
Uniocular optic atrophy and temporal hemian¬
opsia, 1283
Unmuzzled, 142

United States, the medical profession and the
centenary of the, 483; army hospital corps
In the. 844

University College, London, 1199; and a teach¬
ing university for London, 1143; Hospital,
753, 910

-of Dublin Medical 8chool. 783

Unqualified assistants, 388 ; the legal aspect of
the services of. 1244

Ureter, obstruction of one. by a calculus, asso¬
ciated with complete suppression of urine,
625

Ureters, " clottage ” of the, 876
Urethra, foreign body In the. removal, 470;
spongy, rupture of the, suture, recovery, 877; -
stricture of the, presenting unusual diffi¬
culties, 979; female, stricture of the, 176
Urethral calculus, 681

-discharge, chronic, 794

Urethrotome, a modified form of, 833
Urgent case, an, 1119

Urinary bladder, on the cause of marked hyper¬
trophy of the anterior wall of the. 379;
rapture of the. 418; aspiration of the, 447
Urine, the significance or nrio add deposits In,
331; the existence of pepalue and trypslne In,
538; estimation of the amount of, voided by
1U weight, 1186; and urea, the effect of
fcydrochinone on, 792

Uterine appendages, removal of the. 148, 880,
982 ; chronic Inflammktory disease of, 777

- fibroids, the elastic ligature for, 189

■ souffle, on the etiology of the, 386
Uterus, cancer of the, 6, 687160, 207, 301 ; can¬
cerous (and pregnant), successful removal
pervngtnamof a, 14; cancer of the body of
the, 496, 595; extirpation of ruptured, 820,912;
anterior lip of, sarcomatous tumour of, 1386 ;
two cases of acute complete Inversion of the,
after delivery, 1281; hydrostatic pressure in
inversion of, 1293
Uvulatomes, 936, 1070, 1168
Vaccination, 992; erysipelas after, 649, 656;
alleged ill effects of. 741; under difficulties,
940; medical objections to, 1195; and dis¬
temper, 746; and revaooination, 005,706; and
smali-pox, 1990

-Officers' Association, 897

Vaccine lymph in tropical climates, 54
- shields, 142

Vachell, Dr. C. T.. the medical profession sad
life assurance offices, 554
Vagina, diphtheritic, slough of, 1186
Vaginal wall, anterior, a rarecondition of veins
la the, 1181

Vaginismus, treatment of, 637
Variations of Fortune (review), 886,1286
Varicella, symmetrical gangrene following,
730

Vaseline for hypodermic medication, 643
Vegetarian t>. mixed diet, 693
Venereal diseases. In girls of tender age, 168; on
the necessity of obtaining powers to detain
in workhouses and infirmaries patients
affected with, 954, 1002, 1063
Vent, not ventilation, 386
Ventnor Consumption Hospital. 858
Veratrum viride fluid extract, 951
Verdict, a curious, 1295
Vemeuil, M., at Brussels, 38
Verruga, ooileotlve investigation of, 90
Vertebra, gunshot wound of, 374
Vesical calculi, 628; spontaneous disintegration
of the, 173

Veslco-vaginal and vesico-utorine Astute, treat-
meat of, 1136

Veterinary profession, the, and public health,
1297

“ Victoria ” disaster, the, 843

-Hospital for Children, 976, 1X15

* - — reading olrele, the, 233

-. University, the, 688; and the .Yorkshire

College. 1055

Victorian jubilee and sanitary Improvements,
the. 288

Vienna Hospital, the, 154

Vlllar, Dr. F.. Tumeurs de l'Ombilio (review),
1094

Vincents, Mr. H. B., presentation to, 961
Viper’s oil, 657

Virchow, Professor, on tabetic arthropathy, 32;
on myrirdems, 440

Vision,'bests for, amongst rail wot servants,
691

Vitreous, new formation of, 677
Vivisection In 1886, 996
Volunteer ambulance corps, 1313

-medical officer*, instruction to, 1164

-m#d|o*l service, 384,1TD1

-medical staff corps, 246, 488, 501, 798

Wakley, Dr. J. G„ the Ikte, 1246
" Waking numbness,” 1146
Walker, Dr. T.. obituary notice of, 52

— ; -, Mr. B., on placenta prsevia, 1132. 1961

-, Mr. T., on removal of stone in boy* by

suprapubic cystotomy, 873
Wall. Dr. A. J., oa considerations In regard to
causation of sex. 961, 307
Wall-paper, antiseptic, 1189
Walter Moxon memorial, the, 140
Walters, M r. J., on Intestinal obstruction caused
by Impacted gall-stone, 1119
Wane, Dr. D.. obituary notice of, 857
Wanklyn, Mr. J. A., the Gas Bngineer’s
Chemical Manual (review), 1239
Wards, eoonomy in the, 1157
Waraeford Hospital, Leamington, 551
Warner, Dr. P., on the action of nerve centres
and mode* of growth, 514, 561
Warren, Dr. J. 0., the Healing of Arteries after
Ligature In Man and Animals (review), 273
Warsaw, the sanitary condition of, 1014
Water, the purification of, 893
Water-oolours, 952

Water-supply, stoppage Of, for non-payment,
894

Waters, Dr., presentation to, 593

Weaver, Dr. J., a PriBSMbfi!

cure of Pulmonary Consumption (review), 884
Well waters, natural history of, 1290
Welsh mediolne, early, 838
Wem district, health of, 1106
West, Dr. C., on medical treatment at hospitals
and dispensaries, 394

West Cornwall Dispensary and Infirmary, 946

-Derby Infectious Hospital, 443

-London Medico-Chirurgleal 8ociety, 1065

.. Sussex combination, health of. 386

Western States, medical practice In the, 606
Westminster, the new sewers of the paiaoe of,
921

Wheeler, Dr. J., on epidemic dlarrijcra, 398
Whelpton, Mr. J„ case of traumatic tetanus, 367
White blood cells, action and properties of the,
671

Whitechapel, health of, 1059
Whitehead, Mr. W., on tracheotomy, 873; on
suprapubic lithotomy, 1224
Whitlow, infecting, 690

Whooping-cough, nasal treatment of, 135; co¬
caine In. 202

Wiedersheim, Dr. R„ Lehrboch der Verglel-
chenden Anatomic dcr Wirbelthiere (review).
179

Wiesbaden, exhibition at, 1212
Wlesen as a health resort for phthisis, 810
Wlgmore, Mr. W., on a remarkable midwifery
case, 89

Wild West, health of the, 1315
Wilkinson. Dr. F. B., on the treatment of ring¬
worm, 1108

Wllleoden, infant mortality at, 999
Williams, Dr. A. G.. on death from Impaction
of gall-stones, 1081

-, Dr. J., on cancer of the uterus, 6, 58.

358; address at the Obstetrical Society of
London. 688

-, Mr. C., on trepanation of the mastoid

process, 974

———, Mr. W. B., on cancer and phthisis as
correlated diseases, 977

Williamson, Mr. J. M., on gaseous rectal In¬
jections tn consumption, 849
Wilson, Dr. J„ on ovarian tumour following
Injury, recovery, 1085

-, Mr. W., on fork swallowing, 1109

Wiltshire, Dr. A„ obituary notice of. 61
Wimbledon saarlet fever epidemic, 91,184
Winchester, diphtheria In, 1968
Windsor, sanitary condition of, 478; report on
the sanitary condition of, 489,584,585 ; boose
dost, 842; Royal Dispensary, 997
Wine, influence of time on colouration of, 935
Wines, medicated, 948

Winslow, Dr. L. P., on medioal ooronenhips,
396; on Onrrell's case, 852
Winter dlarrbma, prevalence of, 1080

-palaces of health at home, 1096

Wise, Dr. A. T., Alpine Winter In its Medical
Aspects (review). 129
Wolseley, Dr., death of, 92
Wolverhampton and Staffordshire General Hos¬
pital, 603

Women dentists, 442

Wood, Dr. A., a Sketch of his Life and Work
(review), 629

-, Dr. H. 0., Nervous Diseases and their

Diagnosis (review), 1093
Woolwich and Sandhurst. 85
Worcester Infirmary, 753
Workbonse pnflrmarles, nursing In, 841; over¬
crowding of, 689
Workhouses, alcohol In, 593
Workington, infant mortality at, 387,448
Worry not work, 587

Wrist joint, excision of the, 1934; severe injury

of the, 881

Writers’cramp, analysts of ninety-three eases
of, 878

Yeo, Dr. J. B., on the treatment of consumption
and other diseases of the respiratory organs
by gaseous rectal Injections, 761
York County Hospital, 654; Bye Institotkm.
602

Yorktown, diphtheria in, 842
Young, Mr. T. B.. a ease for Inquiry: a dis¬
claimer, 849

Ziegler, Mr. B„ a Text-book of Pathological
Anatomy and Pathogenesis (review), 784
Ziemsten on cold water treatment of typhoid,

1247

Zinc, the chemical equivalent of, 1300
“ Zoo.” the teaching at the, 796

END OP THE FIRST VOLUME POE 1887.

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No. XVI. ok Vni.. 1.1887.

No. 3320.

LONDON, SATURDAY, APRIL 16, 1887.

Phicb 7 d.; Poor Pmtit, 7

112 Pages.

766

LUMLEIAN LECTURES

(Abstract of) on the Patho¬
logy of Intra-uterlne Death,
delivered at the Royal College
of P^valoiaru. by W. O.
PRIKsTLKY, M.D., F.K.C.P.,

IiL.D . .

A LECTURE on the New
Method of Treatment of Con¬
sumption and other Disease*
of the Respiratory Organs by
Gaseous Rectal Injection*.

By I. BuiuniT Yro, M.D.,

K.B.O.P.— (fU uttrated .) . 761

CLINICAL LECTURES on
Disease* of the Bye. De¬
livered at the Nottingham
and Midland Bye Infirmary,
by 0. Biu Taylor, M.D.,
P.R.C.S.— (J Um t traUU .) . 766

ORIGINAL ARTICLES.

The Genesis of “ Bright’s Dis¬
ease." By J. M. Fotherglll,

M.D. 767

Kxoision of Tnmour of the
Cerebellum. By Beuoett May.

P.B.C.S. 768

Trees from a Sanitary Aspect.

By Charles Roberta, F.K.C.S. 769
On a Case of Transfusion.

By Warrington Ha ward.
F.B.O.S. Bng. 770

CLINICAL NOTES:

Medical, Surgical, Obstetrical,
and Therapeutical.

An Affection of the Nervous
System during the Be an them
Stage of Men*lex. By T.
Coleott Fox, M.B. Lond.,

M.R.O.P.771

Thbercular Disease of Tibia and
Ankle-joint, treated by scrap¬
ing away the Medulla of the
former and the Synovial
Membrane of the latter. By
H. Hurry Fenwick, F.R.0.8.

A Case of Purpura Rheumatic*.

By G. O. Macdonald, M.D....
Rhlnottth. By B. Cresswell

Baber .

Poisoning by Tnrtar Braetic.

By 8. L. Dobie.

771

773

773

773

A MIRROR OP HOSPITAL
PRACTICE.

Guy's Hospital i
S arcoma of the Femur.—
Death following Necrosis of

the Lower Jaw. 773

Leeds Geitehal Infirmary:
Compound Fracture of Skull;
Trephining; Spasm of Muscles
of Fkce and Arm; Seoond
Trephining over Fissure of
Rolando; Kecov

MEDICAL SOCIETIES.
Royal Medical and Chibuh-
oical Society :

Abdominal and Thoracic
Aneurysms treated by the in¬
troduction of Steel Wire iuto

the Sac. 775

Pathological Society:

Alveolar U Icermtion in a Child
with General Tuberoulosls.—
Hypertrophic Goitre, with
Secondary Tumours In Bones
of SkulL—Tumour of Pineal
Gland. — Obronlo Inflam¬
matory Disease of Uterine
Appendages. — Meningeal
Cerebral Hemorrhage, with
Secondary Degeneration of

Spinal Oord ...

Obstetrical Society:

The Mechantxib of the Third

Stage of Labour ...

Leeds A West Riding Mkdioo-
Chirurgical Society:
Resection of Bowel for Intus¬
susception.—Raynaud’s Dis¬
ease.—Treatment of Mastitis.

—Dangers of Cocaine. 780

Glasgow Obstetrical and
Gynaecological Society:
Exhibition of Specimens. 781

779

REVIEWS AND NOTICES
or boou.

Recent Assays by various
Authors on Bacteria in rela¬
tion to Disease. Selected and
edited by W. Watson Oheyne,

M.B.. F.R.C.S. 781

Los Bactdries, et leur B61e dans
l’Anatomle et I'HiSCologie
Pathologlqnes de* Maladies
Infeotieuses. ParA.V.Comll
et V. Babes. Deuxteme Edi¬
tion . 781

Health at School, considered in
Its Mental. Moral, and Phy¬
sical Aspects. By Clement

Dukes, M.D. Loud.. 783

Our Library Table . 783

New Inventions.—A Scistors-
ciamp for External Hemor¬
rhoids or otherSmall Tumours.
(Illustrated .)—A New Form
of Tooth-brush. ( [Illustrated.)
—The Bdbbnr Stethoscope ...

784

Dvery ...

774

LEADING ARTICLES.

Brcrnt Attempts at Sani¬
tary Legislation. 785

The Teachings op the Pulse 785
Recent progress in Physio¬
logical Chemistry...787

What m Bib* p.........788

Dr. Bbunton on Homckopathy 788

ANNOTATIONS.

The Regist rar General's Annual

Summary . 789

I)r. Withers Mooro and the
Brighton Meeting of the

Association. 790

The Practical Value of the

Qonocooous . 790

The "Doctor" . 790

Infection and Disinfection. 791

Medical Attendance on thoPoor 791
Perineal Ruptures In the

. Brussels Maternity... 791

The French Entrance Examina¬
tions for Medical Stndcnts ... 792
The Bffect of Hydrochinone on

Urine aod Urea. 792

Poor-Law and Sanitary Hos¬
pitals. 793

Tho Langinore Defence Fond... 796

Tha Service* .. —798

The Iiivicra in 1887. 8U1

Edinburgh. 803

Aberdeen.8Xt

Dublin.«<«

Paris.-. «M

Royal College of 8urgeons . 801

The Contagious Diseases Acts in
India.... 793

Fatal Resntt of Intra-Utcrine

Medication.793

Hanging as a Source of Pleasure 793

ThO Air In Ship*’ H<Ms. ?9n

Insanitary Bethnal Green. 793

Deaths of Eminent Foreign
Medical and Sclentlflo Meu... 71X1
Testimonial to Dr. Kennedy of

Mercer’s Hospital. 794

The Overstocking of the Pro¬
fession . 791

Chronic Urethral Discharge ... 794

The Duchess of Cumberland. 791

A Dangerous Toy . 794

The Margaret-street Infirmary 794
Reported IHneta of Member* of

Parliament . 795

The Asslstant-Phyticianships at

Guy’s . 795

The Leicester Sick Benefit

Society..... 795

Children's Teeth. 795

Foreign University Intelligence 796
Teaching at the “ Zoo”. 795

PUBLIC HEALTH AND POOR
LAW.

Local Government Depart¬
ment:

Report* of Medical Officers of

Health.:.

Vital Statistics:

Health of English Towns.797

Health of Scotch Towns .797

Health of Dublin...798

797

SPECIAL ARTICLES.

Life Assurance. 784

The Pathology of Inebriety ... 784
Volunteer Medical Staff Corps t
Easter March . 796

CORRESPONDENCE.

The College of Physicians, the
College of Surgeons, and the

Apothecaries’ Society .798

The Surgical Treatment of Pul¬
monary Cavities . 799

The Pulse i. 8 O 0

On Puncture of the Abdomen
for extreme Flatulent Disten¬
sion In Puerperal Oases.80u

Pyrexia . 800

Degree* for London Students... «ort

The Sleeping Man .1. 8 ok

Oxalio Ada ae an Einmena-

gogue . 808

Friendly Societies' Medical

Associations . 809

The Income Tax . 809

Ergotlne in Intermittent Fever 809

The Brown Defence Fund. 809

Wiesen ae a Health Resort for

Phthisis .810

Sham Patient* in Kensington 8)0

Obituary. — Charles H utton.
M.D. St. And., M.H.C.P-
Pietro Cipriani.—Jas. Barron.
Bi„ M.D.—G. Bacon Sweet¬
ing. M.R.G.8., L.R.O.P. Lond.

I ... 805

MEDICAL NEWS.

University of DabUn Medical

School.... 783

Preston Medico-Ethical Society 7K>

Pqss and Pluck in Brussels.790

New Hospital in Wttt Renfrew¬
shire.:..-U. —803

Pass-list* of the Royal College
of Physicians of Edinburgh
and Society of Apothecaries.
—Royalty at the London Hos¬
pital.—Stray Doge in London.
—The “John Held" Medical
Priie. -Wolverhampton Nurs¬
ing Institute. — Stockport
Infirmary.—St. Thomas’s Hos¬
pital.—The Jubilee ...805

for Index to Advertisement! aee next Page.

Appointments . «T 7

Vacancies . go;

Births, Marriages, and Deaths «o;

Medical Diary .Ron

Meteorological Readings.

Notes, Short Comments, and
Answers to Oomapondent*... 808

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Now ready, with Coloured Plates, crown 8vo. 8s. 8d.

On Fevers; their History, Etiology, Diagnosis, Prognosis, and Treatment. By

ALEXANDER COLLIE, H.D. Aberd., H.R.C.P. Lond., Medioal Superintendent of the Eastern Hospitals; Secretary of the Epidemio¬
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Elements of Materia Medica and Phar- j

MACY. By ALFRED W. GBRRARD, F.R.O.S.. Examiner to the ,
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Just published. Eighth Edition, demy 32mo, Is. 0d.

Syllabus of Materia Medica: for the Use

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Just published, Seooud Edition, Enlarged and Rewritten, 8vo, 400 pp., 14s.

General Paralysis of the Insane. By

WILLIAM JULIUS MIOKLB, M.D., M.R.C.P. Lond.

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Indigestion and Biliousness. By J. Milner

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Now ready. Seventh Edition, with 13 full-page Plates, A lieing Coloured,
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Obstetrics; The Theory and Practice:

Including the Diseases of Pregnancy and Parturition, Obstetrical
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Third Edition, crown 8vo, 3s. fid.'

Gout and its Relations to Diseases of

the LIVER and KIDNBYS. By ROBSON BOOSE, M.D., Fellow
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M ateria Medica: a Manual for the

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test value to the
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By the same Author.

A TREATISE on the DISEASES of the NERV|

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PEUTICS, considered with referenoe to artolss-gl,
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N otes on

specially del kited ftidktudeiiU ubepariift for
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NOTES OX MIDWIFERY. Second Edition. Fc

the. Diseases

eikited fferittudeiKS.'

3,L.a/C.J?:.M.B.Oj8.

T h s

dL

A

iasrnosis and Treatmei

OOkr oaai

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SYPHILIS. By TOM ROBINSON. MJ).. PhysWan to I
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Just publlshed7pa« Is.

S ome Phases of Cerebral “

(COMA and HEMIPLEGIA). Begg ah Vtdre
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NEW EDITION OF FINLAYSON’S “ CLINICAL MANUAL.”
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Alinical Manual for the Study of

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i, uwen, a uo.
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L ectures on Mental Disease. By

W. H. O. 8ANKEY, M.D. Loud., F.B.C.P, late Lecturer on
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CONGENITAL CLUB-FOOT:

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By ROBERT WILLIAM PARKER, Surgeon to the Bast London
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TRACHEOTOMY IN LARYNGEAL DIPHTHERIA.

COMPLICATIONS AND AFTRB-TRHAIMBNT.

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A NBW TBXT-BOOK FOR MEDICAL AND DIVINITY STUDENTS.

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f^Thts b a remarkable book. It has a gospel for the age. We wish

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London: Wymas A Soup, Great Queen-street, W.C.

_ Just published, crown 8vo, cloth, price 8s. 6d., post free, 3s. #d.

T^lectro-Magnetism and Massage in

J-J tlie treatment of Rheumatic Gout, Dyspepsia, Sleeplessness.
Nerve Prostration, and other Chronic Disorders. By J. BERKSFORD
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STERILITY IN WOMEN: Its Causes mid Cure.

__ Lon do n : Henry Kens hn w, 356. Strand ._

The Immediate and Painless Cure of

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By 0. EDGKLOW, X.D,

4th Edition. Is.

H. Renshaw, 360, Strand, V

- .C.

PRICE 12k 6d, IN 2 VOLUMES 8vo.

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WILLIAM HENRY BBOADBENT. M.D. Load., F.H.O.P.,
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_ London: Henry Renshaw, 860, Strand. __

” Sixth Edition, In fcap, price 12s. 0d.

A n Introduction to Pathology and

Jj. MORBID ANATOMY. The Sixth Edition, Enlarged. Improved,
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London t Henry Renshaw. 360, Strand.

Just published, Fifth Edition, prioe 3s. 6d.

The Prescriber’s Companion;

A oontaining a brief Description of all the Preparation* and Com¬
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_London: Henry Renshaw, 350, 8trand._

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D ruitt’s Surgeon’s Vade-Mecum. A

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brought up to the present t Ime. Illustrated with 373 Wood Engravings.

Henry Bsnshaw, 85fl, Strandtad
rebiU, 11.

> the prt
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How ready. Twelfth Edition, prioe 10B. 6d.

.Qpermatorrhoea; its Results and Com-

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London: Henry Renshaw, 350, Strand, W.C.

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R upture of the Perineum : its Causes,

PREVENTION, AND TREATMENT. By MICHAEL JOSEPH
MOLONY. L.B.O.P., L.R C.S., Surgeon to the Arklow Dispensary.
Medical Officer of Health for Arklow, Surgeon Arklow Quarries, to., to.

“An excellent treatise on a very practical subject.”— Proviso iai.
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“A valuable contribution . useful and interesting."— Mkpccal

Press ahd Circular. Dec. 8th, 1686.

Dublin: FRnnln k Oo.. Grafton-street.

London: Baillitre. Tindall, t Cox.

Works by

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of the British Qynsmologieal Society.

- s. A

DISEASES OP THE OVARIBS, 4th Bdition m. (Nett) 7 0

DISEASES OP WOMEN, 8rd Bdition . (Nett) 7 • '

A THOUSAND OASES OF ABDOMINAL SECTIONS _ I •
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HOSPITAL MORTALITY . . - - « •

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W^anted, current numbers of The

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0

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THE LANCET QEWCTAL AOfOmtfEH.

[Ana re, 1887 .

Fourth Edition, price 6a.

A Handbook on Diseases of the Skin,

with especial reference to Diagnosis and Trkatmmtt.

By ROBERT LIVEING, M.A. ft M.D. Cantab., P.E.CJ’. Load.,
Physician to the Department for Diseases of the Skin at the Middlesex
Hospital, formerly Physician to Middlesex Hospital.

London: Longmans, Green, 4 Co.

How ready, Tenth Edition, 3s. 6d. post-free.

G out and Rheumatic Gout. A New

Method of Cure. By J. W. FOAKB8, M.D.

“ We now pass from the deleterious nature of mercury and oolohlcn®
to the new practice of Dr. Foakci. This, of course, like most really great
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Medical Press ajtd Circular.

London : Simnkin. MarshalL 4 Co.. Stationers’ Hall-oonrfc.

A GRATUITOUS PRESENTATION.

The Mineral Waters of Kreuznach

JL (Rhenish Prussia).—Five Soolsprings, containing Iodine, Brom,
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strongest —the KarUhali. a thermal spring.

A copy and plans of an intended Sanatorium (Oranienbad) will be
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P atent “Swift” Reservoir Penholder.

Hard Vulcanite throughout. Holds a large supply of Ink. With
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_ Wholesale only of Tnos. Dk La Ruk 4 Co . London. __

DIPLOMA ENGRAVER AND PRINTER

To ST. BARTHOLOMEWS H08PITAL, ROYAL VHTBRINARY
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MORIN G, 323, High Holbora, London, W.C.

(Opposite Gray’s Inn Archway.)

Statements of Fees. Appointment Cards, Labels, and every description
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executed in the best style.

Professional Brass Door Plates. Card and Book Plates.

Monogram and Address Dies, Seal Engraving, Heraldic Painting and
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BOULTON & PAUL, NORWICH,

HORTICULTURAL BUILDERS AND
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Illustrated Catalogue of Conservatories and Oreenhouses
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GARDEN FRAMES OF EVERY DESCRIPTION,

STRONGEST AND BE8T MADH IN THB MARKET.

No. 75—Melon and Cucumber Frame.

SEDUCED CASH PRICES—Carriage Paid.

Length. Width. Price.

8 feet by 6 feet

2 LIGHT FRAME...
8 „ .

X : :: :::

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£3 6

4 13

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7 7

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... 12 feet by 8 feet

... .18, feet by f feet,

... 'SO feet by # feet
... 3t feet by 6 feet

Smaller Frames are made. 8ee Lists, post free.

Arealvtays in stock, ready to be sent oil on receipt of ordeiv
made of best sound red deal, sawn from the be*l t ree# in the forest to our
own requirenn nts. snd seasoned in a proper manner. The FRAMES
are of ljin. boards 24 fn. high at back, and 13in. high in front, bolted at
the corners easily taken to pieces if required. The LIGHTS are 2in.
thick, with iron bar across and one handle at the ton, and the whole
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and send, CARRIAGES PAi U, to any station in England and Wales also
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Picking Cases arc charged for, hut allowed in full if returned at
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It

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Stationers, Litbograpbio and Letterpress Printers,

191 & 192, FLEET STREET, LONDON.

PAPBR3 DIRECT FROM THB MILL#.
Samples and Illustrated Catalogue post free.
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THB COLUMBIA TYPB-WRITBR.

Messrs. P. 4 C. are the Sole Loxdos Agjettb for this little i
which has been recommended by many of the principal men fn the
Medical Profession for all who suffer from

WRITER S CRAMP.

Prospectus and sample post free. May be seen and tried at
193, FLEET STREET, LONDON.

SLINGER’S HUTMENT
SUPP08IT0ME8.

Consisting of nearly pure Peptone
and Extractive from the Artificial
M Digestion of Meat. Five Supposd-

3 tones contain the Extractive ad »

m ounces of Meat, in addition to thw

Peptone. R. H. BoacxmliKmL-
. SOB, Esq., Hull Infirmary, In aceee
JL of Gastrostomy, says i—*• Tbe beef
’ suppositories (made by Slfinn ft
Son, York) were of much benefit,
the man saying be felt greet com¬
fort from their use. Tbe man wee
saved the pangs of starvation, fieae-
whicb he was fast sinking when I
first saw him." Manufactured only by 8LINGBB ft SON, Wholesale
Druggists, York. Wholesale Agents > Messrs. Bunn ft So*. I, Khg
Bdward-street, Newga te stre et, London, B.O.

0IM0LITE (&.*?**)

Terra Cimolia (popularly known

1. “ WHITE FULLER* BAOTH*). A An* and'
variety of Steatite, composed principally ef SUIoate of ] _

reduoed by tbe most oaraful trituration and sifting to the
V08HBLX POWDXB.

Highly recommended by the most eminent Denaateleglsta. As a
Ousting Powder In Eczema it Is simply invaluable, and is Infinitely
superior to Oxide of Zinc, Prepared Calamine, Carbonate of BUmoUl,
Powdered Starch, or any other Amylaceous Compound; also in aQ eases at
Infantile Chafing, for most irritations of the Skin, and all Bxeo riattoao.
for the Profession s nly, in Tins, free per post, send 18 penny s t a mp s,
for tiis general public, port free, send 14 or 39 penny stamps.

Introduced Into medical practice bad prepared by John TayfiOr.
Chemist (many years with Squire, Oxford-street), U. Be
Portman-square, London. W.

NERVOUSNESS.

Prostration, Fatigue, &c^ daring the menstrual period of
women are speedily dissipated by taking two

DRAGEES GELINEAU

twice a day In thp middle of meals.

1 In bottles, 4s. 6d., of chemists, or of tbe Agents far Great
Britain, J. M. BROAD, Homsey-road, and

■ ROBERTS & CO., 76, New Bond-street London.

| on* of these ihgarettjs gives IMMEDIA TE RRL l W^m a fflli 'df
kftTHMA, CHRONIC BRONCHITIS, HAY FEVER, INFLUENZA.
DOUGH, and BHORTNM88 OF BREATH, and their (My me effect*
a COMPLETE CURB. The contraction of the air tubes, which came*

tightness of chest and, difficulty of breathing, Is at once Isss roeil by
In baling the medicated smoke of the Cigarette; a free expw tuixtlno
ensues, and the breathing organ* remime tbirir natural action. Persons
who suffer at night with COUGHING, PHIBGK, and SH ORT
BREATH find them invaluable, as they Instantly check the spam, js»

mote sleep, and allow the patient to pass a good night,_

These Cigarettes are perfectly harmless, and oaa be smoke d by Ml
children, and the most delicate patients, as they are pleasant to UrtiSBfi
contain no substance capable of deranging the system .

a Gxxtrixx tnns sioxxn ox Bo*. B. W. W Il f PCA

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The Sanitary Arrangements of Dwelling Ilou-es carefully examined, and such alterations as may De essential for
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A CBRTIFfCATS GIVEN ON COMPLETION.

THE SANITARY ENGINEERING & VENTILATION COMPANY. 115, Victoria Street, Westminster.-tBotablished 1876.]

Telegraphic Address: Sanitation. London.

EVANS & WORMULL’S “STANDARD” CLINICAL THERMOMETERS are made

with patent lent front and permanent Index,
Indelible engraving, and of standard precision.
They are constructed in a special manner, which
i iff actually prevents them altering or reading
oo high, as is the dase with ordinary-GUnkM
Thermometers. Price tf«, 6d., or with Kew certificate and corrections engraved thereon, lQg. fid. It u only B. Sf W.'t Sitatbied" UnalUmbU
Thermometer* that art applicable for hewing their correction* engraved fArrsea.— 81, STAMFORD 3T„ LONDON, and 89^ PARK 6T„ 8YDNHY. S.S.W.

Th*. LANCET,]

IMPROVED PORTABLE
OPHTHALMOSCOPE.

Suggested by CHARLES OLDHAM, F.R.C.S., of Brighton.
.. * ! _ P&wa^afo* •• ,

'*■ 4 most convenient and compact Ijiatnimeiat. Fitted with revolving
diaphragm, containing five convex and four concave glasses-^vi*.,
;+ 1,2,3,4, and 6, and -1,2,4, and 8, Site, 2$ in. by 1J in. Weight; 2 ox.

“We have used it repeatedly, and have been quite satisfied with its
action.”—Vide Ths Lancbt, Nov. 27th, 1888;,

Sole Makers - DOWN BROS., ’,

Surgical Instrument Manufacturers,

3, ST. THOMAS’S STREET, LONDON, BJL

(Opposite Guy’s Hospital.)

T ondon Sanitary Protection Assoeia-

Jj TION (President, the Duke of Alam, K.T., K.G.). 1, Adam-
atreet, W.O.—For inspecting and reporting upon the sanitary condition
•of Dwelling-houses.—For terms, apply to Seoretary.

Ttisinfection of Houses, Bedding,

CLOTHING, Ac.—All articles purified by High Pressure Steam
and returned Safe for Immediate use, and also free from Smell.

Wire to ARMFIBLD A SONS, Lower Belgrave-street, Pimlico, or
Church-street, Kensington.

Bedding Factory: Victoria-bridge-road, Albert Palace, S.W.

P afio.—Advertiser would be glad to

hear of a purchaser for his magniftoent 70-guinea upright Iron
Grand (nearly new), fell oblique overstrung, seven octaves, trichord
throughout, highest possible mechanism and finish, perfect repeti¬
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massive burr walnut case of newest design j condition absolutely fault¬
less. Will sacrifice for 30 guineas, and send safely packed on trial
within reasonable distance. Fifteen years’ warranty transferred.—Write
fort wether'particulars. Piano, U/£t«tyon-roed, Finsbury-pa^k,

To be Sold, Water-m^ttrese, 72 $6. by

X 36 in., as Fig. 13 Maw’s Catalogue^Jn use,oijhr,A fortnight; as good
as new.- Apply, Spong A Son, Chemists, Biggies wade, Beds.

SCARLET PEVER, &c. Mr. R, Weaver, O.E^ P.CA;

W , a T,1<W v ILL 8ANITABT BXPBRT > r.--.1 i. .

»‘ ws MW *) r (Author Of Th* Laxov Reports on Air; the"BuHderf Roparte on

1A RMUfORD ROAD ; Town*), *

WANDSWORTH, S.W. Advises upon the sanitary state of booses; fee from 1 guinea. SaofMry

aiBsas»

>UJ. J

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TkbLakcbx,]

THE LANCET GENERAL ADVERTISER,

[Aran. 16 , 1687 .

A CTtriWf A and other Maladies of the Respiratory
AOlIllliU ORGANS. — SLADE'S ANTI - ASTHMATIC
CIGARETTES are carefully prepared from Soothing and Antispasmodio
Medicinal Plants, slightly camphorated and aromatised; being safe,
efficient, and agreeable. Can be used by the most delicate Invalid
Ladies. Are prescribed at the Brompton and Victoria-park Hospitals,
and by many eminent Physicians in the United Kingdom, the Colonies,
and on the Continent. In sealed bottles only, whereby their virtues
remain unimpaired by time or climate. Price 2s. 9d., is. 6d., and 11s
A liberal discount. Samples free.

••Relief from the urgent symptom of a paroxysmal attack may often
be obtained bv these cigarettes. —Thk Las cut, Jan. 8th, 1876.

THOMAS SLADE, Phr.nnacian, 118, LONG-ACRE, LONDON^

.Husband’s Selected Capillary Tubes

for VACCINE LYMPH.

" We have no hesitation in strongly recommending them. The tubes
are excellent in calibre and strength, most reasonable in price, and well
adapted for practical employment."—'T hk Lanckt, February 3rd, 1872.

Price Is. per 100; by post. Is. Id. 500 for 5s. 2d.

R. SOMERVILLE. 9 and 10, Spring-gardens, Edinburgh.

accination. — Vaccine Institution,

Ifi, Bndell-street. Bloomsbury. Established in 1860 to supply the
Profession witti Pure Vaccine Lvmph. Personally collected and source
registered by W. FAULKNER, M.R.C.S., who hss numerous unsolicited
testimonials as to its excellent quality from the profession, Foreign
Governments, Institutions, Ac. Lymph collected on Tuesday and
Thursday, l’ure Vaccine in Tubes, two or three. 2s. 6d.; One Tube, Is.
Points, 3a. doz. Spontaneous Calf Lymph Points, Gd. each ; Tubes 2s.;
small tubes. Is. Sent only on receipt of stamps or P.O.O,

All lymph spoilt in transit or not approved of exchanged free.

PURE HUMAN VACCINE LYMPH.

Collected from Reliable Sources and Fresh
every Week.

Points, Is. 6d. doz.; Tubes Is. each, 10s. doz.

FERRIS, B00RNE. TOWNSEND, & BOUCHER,

WHOLESALE DRUGGISTS, DRISTOL.

SOL. MORPH. BIMEC.
(SQUIRE.)

This preparation, introduced by
Peter Squire in 1839, is prepared
direct from Opium by a process of
elimination. It differs considerably
from a solution of the salt, which [is
made by dissolving Morphia in a solu¬
tion of Meconic Acid. •

It is therefore necessary for pre¬
scribes to indicate SQUIRE’S when
they wish to order this old-establishfed
preparation.

\W prices ^

f glycerine.

TUT TTp*t|

2TiK lir.v ^

lft"O£C£lV£irTRE'HI 0 ME 8 i AWARDS M All THE
_bk ^u^ibitm s ^ - -

PRICE’S glycerine!

r. Renner’s Establishment

for VACCINATION with CALP LYMPH,

228, Marylebone-road, London, N.W.

Vaccination from the Calf daily from 11 to 12 o'clock.

Reduced price of Calf Lymph (daily fresh).

Vnbea-j
Point* J

barge

Small

2a. each or 3 for 6s. M.
la. each or 3 for 9a. 9d.
la. each or 3 for 9a. M.
9d.each or 3 for 9a.

2a. 6d. each.

Squares

Registered telegrsphio addreaa—“ Vaccine," London.

Sent on receipt of remittance addressed to the Manager of ths
Establishment or the following appointed Agents:—Messrs. Allen A
Hanburya, Wholesale Druggists, Plough-court, 37, Lombard-at., H.O.|
Mr. W. Martindale, Pharmaceutical Chemiat. 10, New Cavendish-
■treet, W.j Mr. F. K. Morrell, Chemist, 306, Kennington-park-road,
8.B.; Mr. J. H. Read, Chemist, 818, Holloway-road; Messrs. Rey¬
nolds A Branson, 13, Briggate, Leeds; Messrs. Brady A Martin, 29,
Mosley-st., Newcastle-on-Tyne; Mr. John Evans, Apothecary, 49, Daw-
•on-at., Dublin; Mr. A. Young, Surgical Instrument Maker, 67 A 61,
Forreet-rd., Edinburgh; Messrs. R. Sumner A Co., Wholesale Druggists.
60a, Lord-street, Liverpool; Messrs. Clay A Abraham, Pharmaceutical

74, Market-place.' Sheffield;
86, Petergate, York.

Messrs. Barnes A Oo., Pharmacists,

THE ASSOCIATION FOR THE SUPPLY OF
PURE VACCINE LYMPH.

12, PALL MALL EAST, LONDON, S.W.

Sole Agents for

DR. WARL0M0NTS CALF VACCINE.

Tubes 2s. each. Half tube*. Is. each. Pomade In vluls, 5s.

HUMAN VACCINE (from healthy children only, microscopically
examined and source quoted).—Three tubes, two-thirds full. 5s. Tubes,
one-third full and Lancet. Charged Point*, Is each; Pin-point*, Is. Id.
each. Eighteen Charged Small Points. 5*.

Tubes two-thirds full (same as those mentioned above, but without
source) in quantities for export, £5 per 100 tubes.

Pin-point* nncharged. Is. per dozen.

Vaccinations dally between tuo hours of 12 and 2 by the Consulting
Physician, at the uniform fee of a guinea.

Office hours, 10 to 4 ; Saturday 10 to 2 .

P.O.O.’s (including postage, and crossed London and Westminster
Bank) With orders, payable to_ Edwakd Datikk. Secretary.

SQUIRE & SONS

(HER MAJESTY'S CHEMISTS),

413, Oxford Street, London, W.l

J , RICE’sfATENT{ANDLE0)MPANYl 1 IMITE9« '

LONDON SEE

LIVERPOOL

Thi Lanckt,]

THE LANCET GENERAL ADVERTISER.

[Apkil 16,1887.

00MPAGN1E FERMIERE DE L’ETABLISSEMENT THERMAL DE

ATJJEB>1

VICHY

(FRANCE.

(Property of the French State.)

NATURAL MINERAL WATERS OF YICHY.

(STATE SPRING8.)

vCELESTINS.-A famous remedy for Kidney Disease, Gravel, Gout, Rheumatism, Diabetes, <fee.
HAUTEJUVE. —Strongly impregnated with natural Carbonic Add, which renders it very fit for
EXPORT. An excellent TABLE WATER, invaluable for Dyspepsia.
GRANDE-GRILLE. —For Diseases of the Liver and Biliary Organs, Ac.

A

HOFITAL. —For Stomach Complaints, Indigestion, Ac.

The VICHY WATERS are remarkable for their keeping' qualities, and even after a great lapse of time
the alteration that takes place is inconsiderable. They form an agreeable beverage, whether mixed with
wine or spirits or taken alone. They are bottled under the supervision of GOVERNMENT OFFICIALS,
thus giving a PERFECT GUARANTEE of their GENUINE CHARACTER

The VICHY WATERS are recommended and used by the greatest Medical Authorities.

When Prescribing VICHY WATERS, state the Spring required.

Annual Sale: Six Million Bottles.

VICHY

CURE INDIGESTION.

U

PASTILLES

CURE DYSPEPSIA,

Dure heartburn.

Write for Sample.

DIGESTIVE.’’

VICHY SALTS FOR BATHS AT HOME.

SOLE ENGLISH BRANCH,

INGRAM & ROYLE,

IMPORTERS OP ALL NATURAL MINERAL WATERS, SALTS, WINES SPIRITS AND OIOARS

LONDON: LIVERPOOL: BRISTOL:

52, Farringdon S t. Finney Lane, Atherton St Bath Bridge.

Pamphlet on “NATURAL MINERAL WATERS,” revised and considerably enlarged/aiid all
particulars in regard to the VICHY T HERMAL BAT AULTS H M km T sent. post free, on application
t* INGRAM & ROYLE.

NJ8.~ Messrs. INGRAM ft ROYLE beg to invite gentlemen of the Medical Profession to AP^LY TO
THEM for 8AMPLE8 and PARTICULARS of ANY NATURAL MINERAL WATER which they
may desire to prescribe, and the same will be obtained and forwarder) free,... ^

Digitized by LjOOQle

Thk LuTOKt,]

THE LANCET OENERAL AOVEATlStR

[April 18,1837.

The strongest known Mineral Water in the world. This remarkable Spa has been purchased by a syndicate of gentlemen, who have determine*
to nuike more widely known the extraordinary curative powers of this Spring, which contains more Iodine and Bromine than any Spring lm
Burape. '

Aml analysts o£ the water having been made in November, 1886, by Professor Wanklyn, M.K.C.S., corresponding member of the Royal
Bswrtto AMesty of Sciences, Professor ol Chemistry, a very Important discovery has been made—viz., the presence of Free or Elementary
Iodine. >

Prof. Wsn&tov cays c—“So far as I am aware, this is the first Instance In which free iodine has been found in appreciable quantity In a
natural water. For many years the Woodhall Spa has been celebrated as a valuable remedy in akin diseases. The fact that it is a solution of free
Iodine Is interesting in this connexion, and well worthy of the attention of t he medical profession.”

The Woodhall Bromo-Iodine Water is now being bottled at the Spring by the Sole Agents. BKOMLET A CO., Chemists, 333, High-street,
UssMin. & sad 6. The Grove, Buxton, and Woodhall. Alt communications to be addressed to them at the Spa. Woodhall, Homcastle.

THE NATURAL MINERAL SPRINGS OP

PALATABLE,

EMQADINE,

TARASP

APEBTENT.

SWITZERLAND.

EFFICACIOUS REMEDY FOR
'.'^77' GOUT,

OBESITY.

HEMORRHOIDS,

CONSTIPATION.

Sole Agent, RICHARD DAVIS,

■sal Mineral Witters, and Manufacturer (for home and expert)‘of Pure Aerated Waters, Soda Water Mo. 1 and Ho. 3 (B.P.),
abed SeMsar Water, Double Potass and Lithla Waters, Lemonade aad Ginger Ale. DAVIS'S Acidulated Tonio Water.

20, Maddox Street, Regent Street, London, W.

EAU D’AMBERT

<EAR DE MELISSE D’AMBERT MELISSA HORTENSIS),

THE GREAT FRENCH REMEDY

For Indigestion, Dyspepsia, Spasms, Heartburn, Colic,

Sea-Sickness, &c.

Price Is. 1*<1. & 2s. 9d. per Bottlev Of all Chemists.
WHOLESALE :\ 2 , FENCHUECII STREET, LONDON, E.C.

ROBINSON’S CONCENTRATED WATERS

Oae Oaane «f i&ooc Waters added to Forty Ounce* of Distilled Water form* a clear Medicated Water (without filtering), similar In every re* -ect te
those prepared *<se*rding to tho directions of the British Pharmacopcoia, and free from all Chemical Impurity. They are prepared to supply a *a at long
felt by Cbuarish; aad Modi cal Men, and by their use a fresh supply of any of the Medicinal Waters may be obtained at a moment’s notice. They are not
affsotsd by age in any climate. N.B.—Used In the proportion of one part to thirty-two of water, they represent the Medicinal Waters of the l'ml*

. 'J.. _ P * rIb - , _ Per lb. Per lb. I Per lb.

if \\ AqnaAnethi, Concent, to. AquaCinnam. Ver., Concent, 6s. Od. Aqua Fmnlcnli,Concent- to. Aq.Pimentss.Conc.to-Od.

C# Vv *• £ nlsl Y ” » Caesi*. « to.Od. .. Menth.Pip., „ to. „ Bos®, „ 8s.«d.

\L - Camphor*, „ to. „ Flor.Anrant, ,, 8a. 6d. ,, H Aug.Cone.,6s. n Bos* VIrg., 10s.fid.

« Carol, „ 4s. „ FIor.SambucL ,, 8s. 8d. " „ tfirid., * to.

P RAD© /TR\ (WarW *“ e a “ 0T ® are P®* n P > n bottles, of 1 lb. or I lb. and upwards, each of which has the Inventor's Protection Label over the cork.

/ L. £9 ig m From Tuk Laxckt, July loth. 1882:—" Conckxtratkd Waters (Robinson's, Pendleton. Manchester).—Among

- the samples sent to us we find Aq. Anethi, Anisi, Cinnam. Ver., Rosa*, and some dozen of others. Diluted with

forty parts of water they form the ordinary waters of the Pharmacopeia. They are excellent in quality, and will be
7 j j _ very useful, especially in country practice.' -

Whjfesale Agents: HBARON A CO.. London, and most Provincial Wholesale Druggists. PREPARED BY THE IXTENTOB,

or B. ROBINSON, Operative Chemist and Distiller, Pendleton, Manchester.

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The Lancet,]

THE LANCET GENERAL ADVERTISER.

[Aran. 16,188Z

“THE BEST NATURAL APERIENT.”

Persistent attempts are made by interested parties to deceive the public by offering Natural Mineral Aperient Waters
with marks, names, and designations very similar to those which are used by the APOLLINARIS COMPANY,

LIMITED, for the NATURAL MINERAL APERIENT WATERS imported by them.

• Under these circumstances the APOLLINARIS COMPANY, LIMITED, feel compelled to caution tftepofcfic that
the HUNGARIAN BITTER WATER sold by the COMPANY always bears the name of the APOLLINARIS
COMPANY, LIMITED, on the Label.

NATURAL MINERAL WATERS OF BUSSANG “VOSGES”

HIGHLY TONIC AND RESTORATIVE.

Blearboimted, Alkaline, containing Balts of Iron, Manganese, Arsenia, and Liihla, intimately combined with Carbonic Acid Qua.

1! ‘ A tbvteiwgb rimady in Ohio roil*, Ans-mia, Gastraloay, Dyspepsia;- Chronic Diarrheas, Yeeieil Catarrh, Dedal Oolio, Gravel, aad Gent. It*
“ Anti-Uthlque ’’ action U demonstrated by the fact tharTlt reduced to a fine powder a calcnlu* which fyad been submerged In It for • month, and
instead of producing the debilitating effects of purely Alkaline Water.it has the Inestimable virtue of entirely eliminating the arte add and
fortifying the stomach. It is a valuable adjunct in the treatment of Bright’s Disease, Diabetes, khd noted Id all cases Of Convalescence, and as a
preservative from epidemic and-infectlous maladies. ,

■ ' F. E. STURMFELB, 25, Oolemah Street, London, E.C. '' 1 '

SPA LABTGE2JSCHWALBACH (in the “Tannus”), Germany.

1 Gubernatorial District of Wiesbaden, .TOO metres above the level of the sea i two hours from the railway stations, Wiesbaden. IstrJlte. Strongest
among the pure frrrugiacms spring of Germany, large eoateuU' of carbonic acid, rlehly-wooded environs, refreshing mountain climate.
Drinking Springs, Wine, and Chalybeate Waters. Chufyboate and Moor Baths in the Royal Bathing House and in private catabtlshmenta.
Efficacious against Want of Blond, its consequences and complications 2 Nervous Diseases, Female Complaints. Debility of the Miracles. Lameneas,
Catarrhs of the Mucous Membrane*, especially of tho Baxnah and Urinary Organa. Entertainments: Kursaal, Beading Room*. Concerts.
Eeunlops, Excursions to the fthlne, Aar Valley. Whisper Valley, Ac. Lodgfngs in hotels, and In more than ICO villas and lodging-houses.
Pbft, telegraph, custom-bbusp, banking-Hctlses. American Consular Agency. First-class hotels: Alleosaal, Herzog von Naas an, Metropole,
<Jnen«nhof, Hotel Tarmue.*—Por Information apply to the StBdttsche Kurverwaltung. Opening of the season on 1st of May.

^nn.1 .. - - • ' . ■ 1 - -■ - - L - -

. i V B A D E N - I! A.D K N.

Old-renowned alkaline chlor. s4d: spring of 44^60° C. Ohlor. lithium spring of prepbndgtfiOs c oii M fi ta.

New Grand-ducal Bathing Establishment “ THE FREDERIC BATHS.”

OVEN THROUGHOUT THE WHOLE YEAR.

A model institution, unique for its perfection and elegance. Tulrbaths, Russian vapour hatlis, Turkish baths, electric tnthe, so-called
“ WilSiiider "(thermal water constantly running), swimming l«ths, rooms for cold-water treatment, inhalation df pulverised mineral water,
douches for the larynx, douches of all forms and temperature, medicinal baths of every description. Private Medical Institut ion* with thermal
baths. Pump-room with the mineral waters of all the most renowned springs, whey- and milk-cures, spring-cures with the juice of herbs, autumn-
cures with excellent gropes. Pneumatic Establishment with two chambers for four persons each. Establishment for physical treatments.
Expedition of the mineral water of pn-ponderou* contents of lithi um.

A. RUDIGER.

Bad-Homburg.

l iH\T.

SOLE CONSIGNEES:

This Salt is obtained from the NATURATj
W afer, and has all the 'properties of
the Natural Spring, which
are so efficient in
cases of

SQUIRE & SONS,

413, OXFORD STREET, LONDON.

Gout.

Conversation House with its splendid Concert-, Ball-, and Beading+ooms. Restaurant and Society-rooms open throughout ttie whole year.
Grand Concert L ^ymphonie- and Quartetto-soirecs. Special Concert* by renowned artists. Hals partis, reunions. Children’s festivals. Splendid
VTrchestra (18 musicians) with solo players, three concerts ilaily. Military concerts, lOpehu. «nd*doniediee. Fireworks and iliuminafkma.
Shooting and II-hlng. Grand races. Educational Institutions of high order.

BAPKi-RAirfcy, surrounded on all sides by luxuriant pine and l>ee< h wood-, offerspjipiDi &jnities tpr,*he..mcat eliarrrting walij and excursion*
Bxcellent climate. Charming situation. Mean annual temperature :+| 7. 4 " R.

LA BOURBOULE

REGISTERED-

HOT MINERAL BATHS OF BATH.

Daily yield 507, COO gallons at 120° P. ' >

OUNDED by the Romans in the 1st century.

A PISTON MEN TAGP.

BATHERS DURING 1885 - 83,322.

These Baths are unrivalled In Europe lor luxury and extent, and contain all that modern Improvements (Including
Douche, Mussage, Thermal, Vapour, 4o.) can provide for the comfort and relief of the invalid, or the enjoyment of those
in health.

The Corporation of Bath solicit the attention of the Medical Profession to the advantage of these curative waters
to patients suffering from Gout, Rheumatism, Sciatica. Neuralgia, Paralysis. Dyspepsia. Eczema, and other forms of
skin affections, and to a perusal of the numerous testimonials received from the profession, and from patients who

have benefited.

Letters to the Superintendent will receive every attention.

I imminently Restorative Rtintral jtfattr I

A CONTAINS CHLORIDE OF SODA, BICARBONATES. ARSENIC A
(iK milig. of arseniate of soda per litre)

H| HALF A GLASS TO THREE GLASSES PER DAT ^

K Regenerator for Weakly Children. — General debilily
— Lymphalism: affections of the Skin and Respiratory
Organs. — Diabetes. — Rheumatism, and Intermittent
Fevers.

Jfounta/noas Conntry — 7«ry varied excursions
EVANGELICAL AND ANGLICAN DIVINE SERVICE ON SUNDAYS
sum «r

London : OAU.Ais to - ixoram t ROVLR
IIEKRY REST & SONS

_ Liverpool fc Bristol : ixflnAM ft royi.k

BLAKE’S LITHIA WATER. B.P.
BLAKE’S POTASH WATER. B.P.
BLAKE’S SODA WATER. B.P.

AND

MINERAL ACID WATER.

(Containing Httro-hydroohlorlo Acid.)

A most refreshing Tonlo and Hepatlo Stimulant.

To ensure the remedial effect of the above Alkaline Waters. It Is neces-
ry that they shoukl be of the fall official strength as guaranteed by the
Iginal makers.

BLAKE. SANDFORD, AND BLAKE,

47, PICCADILLY, LONDON.

HOGG & SON, Pharmaceutical Chemists,

MANUFACTURERS OF MINERAL WATERS,

LITHIA WATERS, SODA, AND POTASH

(Pharmacopoeia strength).

AERATED LIME WATER (Stevenson’s Process).

HOGG & SON, 1, Southwick-street,

HYDK PARK.

1 Absolutely Pure."

ELLIS’S

RUTHIN

WATERS.

Established 1825.

Soda, Potass, Seltzer, Lemonade, Aromatic Ginger Ale. FoK
Gout: Lithia Water, and Lithia and Potass Water.

ASK POR ELLIS’S.

Bold Everywhkke.

Sole Address—

R. ELLIS & SON, Ruthin, North Wales.

London Agents: W. BEST & SONS, Henrietta-street,
Cavendish-square.

The Laxckt,]

THE LANCET GENERAL ADVERTISER.

[April 16,1887.

Compound Syrup of the Phosphates.

SQUIRE’S t ' l ' lte PARRISH ’ S ) A PHOSFHATIC

CHEMIBAL “

formerly made by Edward Parrish can now be C fi H 11

obtained only from Squire & Sons, to whom he T U U U a

transferred by contract the manufacture.

To ensure the original preparation being supplied, orders should be written

“Squire’s Chemical Food.”

Can be obtained through any wholesale house, or direct from
SQUIRE & SONS, Her Majesty’s Chemists, 413, Oxford-street, London._

POTIN’S THERMO-ELECTRIC BATH, PATENT,

(A without shock, for the me of the Interrupted current, and the Copper Bath for the oonatant oorrent, have been recommended

\ W Mutclea and Jolnu, Lumbago, sciatica, Bptnai weaxne*.. u venae uwhumi, njivcru, aleuurraagia, ruraienw, ^onasipauoa.

WsT \f J and to eliminate from the body lead, mercuiy, araenlc. he. . _ „

— i-S Xheae Blectric Bath* are very agreeable, effectual, and entirely *afe. They are open for Ladle* and Gentlemen.

from 7 A M . to t* P.M., and may be followed by the TURKISH BATH, or Alkaline or Aold Bath. These and all other
SULPHUR and MBDIOATBD BATHS. Shower*, Douche*, and K&uage Treatment, «e under the direction of the Resident Phydeiaa.
Particular*, Pamphlet*, 4c., of the Secretary, at_

THE ROYAL YOR K BATHS. S4, YOBK TERRACE. IT. W. The Finest Baths in Louden.

-The Lancet,},

THE 4-AWCET GENERAL AQVEBTISER.j

B R 0 M I D I A.

FORMULA.—Every fluid draohm oont&ini 15 grs EACH, of pure Brom. Fotas, and purified Chloral,
and 1*8 gr* BACH, of gem. ext Cannabis Ind. and Hyosoyam.

DOSE.—One-half to one fluid draohm in WATER or 8TRUF every hour until sleep is produced.

BB09UDIA IS THE HYPNOTIC PAB EXCELLENCE.

It produces refreshing sleep, and is exceedingly valuable in sleeplessness, nervousness, neuralgia, headache, convul¬
sions, colics, &c., and will relieve when opiates tail. Unlike preparations of opium, it does not lock up the secretions.
In the restlessness and delirium of fevers it is absolutely invaluable.

Is sold in 4 os. Bottles at 40s. per dozen; 12 os. Bottles at 106s. per dosea.

BATTLE ft CO., St Louis.

General Depot for Great BritainROBERTS & CO. 76, Hew Bond Street, W.

TAMAR

INDIEN

GRILLON.

A laxative, refreshing, and medicated Fruit Lozenge, very agreeable to take, and
never causing irritation. Its physiological action assures the immediate
relief and effectual cure of *

CONSTIPATION,

Hemorrhoids, Bilk,

Cerebral Congestion, Headache,

LOSS OF ApPBTTfE,

Intestinal Obstructions, Ac.,

By augmenting the peristaltic movement of the intestine without producing undue secre¬
tion of the liquids. Unlike pills and the usual purgatives it does not predispose to intes¬
tinal sluggishness, and the same dose always produces the same effect, that is to say, never
needs increasing.

It is recommended by the most eminent Physicians of Paris, notably Drs. Bklin and
Tardieu, who prescribe it constantly for the above complaints and with most marked
success.

Wholesale—London: E. GRILLON, 69, Queen Street, Cheapride.

Sold by all Chemists and Druggists, 2s. 6d. a box stamp included.

TONGA

TONGA.

SPECIFIC FOR NEURALGIA.

FIXING A i* the name given to a remarkable remedy for Neuralgia. It is a fluid extract of a special combination of the
JL Barks, Roots, and Leaves of several plants, the peculiar efficacy of which was discovered by s resident in the South
Pacific whilst seeking relief from intense Neuralgia. The drug was first introduced to us during the summer of 1879. On
submitting it to a trial, it was at onoo found by competent medical authorities’ to possess extraordinary power in relieving
Neuralgic pains. (See papers in The Lancet of March 6th aud 20th, and May 20th, 1880, by Dr. Mukrkll, Dr.
Hinges, Dr. Lush, and C. Bader, Esq., for the record of severe Neuralgic pains removed by the use of TONGA)

"Tonr* maintains Its reputation In tba treatment of Neuralgia.’'—'Tsi Lawoat, July 13rd, 1881.

**loramable to Ikotol Neuralgia."—Mannas Pans in Cuonsaa, Deo. S9tb, 1880.

*Hm proved effective la all thoae oaaee of facial Neuralgia la which we have presented it It le an elegant and easily-taken remedy."— Msnioa*
fun a mo Ciaonxia. Jan. 98th, 1881.

Extract from a Letter In the Bunti Hnrau JouawiL, Kerch 98th, 1881.

* After trying quinine, arsenic, iron, morphia, and the pills above mentioned (gelaemlnom, oroton-chloral-hydrate and monobromide of camphor)
Tonga was need, and the effect was almost iniUoUaoeoua. " I am, Ac., KKNNE rtl W. MILLICAN, B.A., L3.C.P.ED."

TONGA, unlike opium aud other anodynes, produoes its remarkable specific action on the nerves without giving rise
to any derangement of the digestive or other organs.

DOSE: From half to one Teaspoonfol in water three times a day. Relief generally
follows the third or fourth dose. N.B.—Mo ill effects follow from larger doses.

Sole Consignees and Manufacturers :

A LT,RE ft HANBURYS, Plough Court, Lombard St., London, E.C.

WORKS t BETHNAL GREEN, LONDON, and LONGVA, NORWAY.

Pries List free on application.

# Q 17

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Tub DAifCWf'J

THE LANCET GENERAL ADVERTISER,

[April 16,1887.

PAPAIN (FUNKIER).

THE HEW DIGESTIVE
FERMENT.

USES —INTERNALLYi In Dyapeptia and Gastralgia. Geo. Herachel, M.D. Lond., writes In the British Medical Journal, April 3rd, 1886 “ I

find itohiefly TaluaUoiiKl) tbvOfcroaJo Stomach Catarrhs of Children, (2) Add Dyspepsia, and (8) Severe Gastric Pain oomta« on
shortly after eating."

EXTERNALLY: It Jus'taMd used try Bombut in cutaneous oardnotna, Bsssbaeh for dissolving the false membranes of Diphtheria (see
Zeitsch.fur Klin. Med., vl„ H. 0), by Jacobi of New York for the same purpose, and recently Prof. Tinkler himself has restored patency
to an cesophagus occluded by oarebmm by the continuous administration of a solution.

ll&nv&etwed by Dr. FIN£^S<j&,CO., Oodramstein (Palatinate).

Sole Agent for the United Kingdom and Export—

B. KUHN, 36, 8t Mary-at-Hill, London. 55, Bloom-street, Manchester.

Supplied by all Wholetale Druggists.

Specify "PINK1BR* in your prescription, as other makes of Papain have different effects.

A pamphlet on the treatment of Dyspepsia-and Diphtheria by Papain (Finkler) sent gratis on application to

B. KUHN, London.

DUSART’S SYRUP AND VINE

LACTO-PHOSPHATE OF LIME.

The properties of Lacto-Phosphate of Lime are scientifically founded on physiological experiments, aqd tfor many
years it has received the approval of the leading members of the Medieal Profession as the most valuable -recoastituect of
the tissues and bones IN ALL CASKS OF CACHEXIA OB ADYNAMIA where nutrition is impaired by acute or chronic
complaints.

LACTO-PHQSPHATE OP only differs from PHOSPHATE OF LIME (the natural restorer of muscular

fibre and bone) by being made assimilable by the action of its natural solvent, lactic acid.

It acts as a general excitant of the nutritive functions, ensures digestion, restores the appetite, enriches the milk of
the mother, and improves all the vital energies. In convalescence, teething, rickets, and imperfect growth it in especially
useful; whilst wounds, fractures, .and all affections of the osseous system are rapidly benefited by Ss-Jise.

DUSART’S SYRUP OP LACTO-PHOSPHATE OF Lt^F AND IEOH ia invnUafcla where *qy-of the

above cases are complicated by chloro-anaemia.

Dose—For Adults, 3 to 6 tablespoonfols a day; for Children, 3 to 6 dessertspoonfuls.

MIDY’S CAPSULES OF PURE SANDAL WOOD OIL.

Each Capsule contains 4 grains of .the purest distilled ESSENCE OF SANDAL. They have been adopted in the
Paris hospitals in place of copaiba and eubebs on.account of their inoffensive nature, even in strong doses. Complete relief
is obtained within forty-eight hours, and the discharge (whatever the abundance or colour of the secretion) is reduced te a
few drops of white muco-pus, which ultimately disappears altogether. MIDY’S PURE SANDAL causes neither indiges¬
tion, repulsive eructation, nor diarrhoea, and the urine is free from smell. Dose—10 to 12 Capsules.

CHAPOTEAUTS PEPSIC-PEPTONES.

PEPTONE POWDER—B^ng quite soluble, neutral, and pure, it affords nourishment to patients without the
addition of any other aliment; two taMespoonfuls contain 10 grammes of Peptone, and represent GO grammes of lean
beef. It can be t aken i n tea or broth.

PEPTONE WINE.—E»ch claret glassful contains 10 grammes of lean meat, and is recommended in a n aemia,
diabetes, during convalescence, and to persons in reduced health and suffering from loss of appetite, distaste to food, or
from gastritis or gastralgia. _

CHAPOTEAUT S PURE DIALYSED PEPSINE PEARLS.

These contain each 4 grains of absolutely pure Pepsine, the digestive powers of which are 100 times Its weight of
solid meat.

CHAPOTEAUTS MORIIHUOL.

M0RRHU0L contains all the active principles 6f Cod-liver 'OIT'wlth the exception of the fatty matters. It is
dispensed in small round capsules, each containing 20 centigrammes, equal to twenty-five tiipe* itfeWeight, or 5 grumes
of brown Cod-liver Oil.

PRINCIPAL EFFEOTSd^-Ihcfease:of Appetite—Abatement of Cough- Segulation jof the Digestion and of the

Bowels—Return of Strength and of Sleep.

THERAPEUTIC USESBronchitis -The First Stage of Tuberculosis—Rickets—Scrofula—Diseases of the
Lymphatics. . • ,

DOSES For Children, two to four capsules daily nt meal times. For Adults, four-to /light capsule*.

London: WILCOX, 289, 1 Oxford St.; WEWTOSBT & S0FS, l.Wlrig Edward St.

Wholesale: Parte, >9^00;, 8, Hue Vivienne,

fe

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Thx Lancet,]

THE. LANCET GENERAL ADVERTISER.

[APBft, 16,18g7. , t .

PERFECIIOM IN

SOLUBLE BILLS ANA QfcMIBtE8.

Highest and only Award for Fills at International Medical and

Sanitary Exhibition,, South Kensington, London, 1881.

Exhibition. 1881

Large reduction

rice.. See Price List.

These Pills and Granules are ih"Tasteless Transparent Coating,
Unequalicjd fbr Ptiriiy in Coxaptsitiou, SoliibUityin Coating,

Uniformity in Sih#, Perfection » Fofefi andFinish,

MANUFACTURED BY ..

W. H. SCHIEFEELIN & OU

Who desire to call the attention of Physicians and Pharmacists to the following points :—

1. The best materials are aped in their manufacture .

2. The Pills arc Coated while soft.

3. The Coating ia quickly and perfectly soluble, and there is no Buhcoating of any kind.

4. The Coating is so thin that the Pills are not perceptibly increased in size, and yet entirely protects them and effectual!

covers any nauseous taste .

6. The Coating is so transparent as to clearly reveal the colour of the mass, and its solnbility Is not impaired by age.

6. The mass is worked to the highest possible degree of uniform intermixture, and subdivided with scrupulous exactness.

7. Vegetable or organic matters are not charred, nor are volatile principles lost by the use of heat at any time throughout*

the process of manufacture.

8. The excipients are specially adapted to the permanent solubility of the mass and its efficient therapentic action.

SELECTED

A LOIN STRYCHNINE ET BELLA- I PHOS1

DONNIE PIL. 1-33 gr

("Aloin, 1-6 gr,V

•J Strychnia., 1-60 gr, V In 0 ni

(.Ext. foL Belladonna), 1-8 gr.J w ith the

(Dosau 1 Pill.) to effect ;

CALCII SULPHIDI PIL., 1-10 gr., Phospbo

i gr* i fo --. 1 ttr. (Dose: 1-10 to 1 gfj tl0 "-

Thissalt, which under ordinary circumstances 01 .

rapidlfspolln, keeps well in the solable ooated pill. t

CASOARnE SAGRADA5 EXTRACT, dilute th

Pil., 8 grs. which U

(Dose of the Extract: as a Laxative. 3 to parsed
4 grains; as a Cathartic, 0 to 14grs.) ‘i,® r “ n< j

EUONYMIN ET COLOC. COMP. different

EXT. PII* all of an

FORMULAE

PILLS.

PHOSPHORI PIL., 1-100 gr., 1-60 gr., preparation some ingredients of which are *
, , , K __ , ,,, ’ ° ° nowhere obtainable. The pill form ia the mos#..

1-33 gr., 1-Z6 gr.. i-zu gr. eligible for its administration, as it maybe sa J

(Dose: 1-100 to 1-20 gT.) taken without offence to the palate.

wift the 1 other i^er^E i’n "StSSXXA , ^atUnUon

to effect a uniiorm and thorough diffuelon. The % /“*«"?"« formula, wht& has put ty

Phosphorus is perfectly protected from oxida- ^Pjrrox^l oftMprofessto^w^r^ir presented,
tloi), which may be readily ascertained by cutting a " rf

one of the pillB however long It may have been | PIL. QUINIAt., FERRI ET ZIJ?CI

{ Euonymin,

Coloo. Comp. Eht., P.B.,

one of the pills however long it may have been
kept. At the same time the excipients with
which the Phosphorus is mixed sufficiently
dilate the mass to provent tho degree of irritation
which is liablo to follow when a mass strongly
charged with Phosphorus comes in contact with
the mucous surfaces. Henoe the several Phos-
pb'irus Pills, though rach containing email and
different quantities of the active ingredient, are
all of a medium else.

WARBURG’S TINCTURE (repre-

seuting one drachm each).

(Dose: lFill.)

PIL. QUINI.E, FERRI ET ZINd
VALERI AN AT.

{ Quinta Valerlanat., 1 gr .)

Ferri, „ I gtt>

(Zinci. .. 1 gr;)

Editor Mkdical Brief, St-Xouis. Mo., U.S.A.

“ The family doctor only knows how wide¬
spread Melancholia is in our countnr. Tho
many household cares develop this disease la
nervous women, who show its first symptoms
in fretfulness and worry. I have sought for a
remedy for years for this malady, and have at
last found it in the triple valerianates, which
work like a charm.”

(Dose: l Pill.) (Dose: IPill.) I M k i ! k oi "

FER ^S, I S?u US(EI ‘' ,,1 ’ ,) n I L, "VGOTliT" (EXT. ERGOTS)

f p®rfL b r’ .,',’ 7,1 £”* > Malarial Fevers that it* powers can scarcely be Pil., 1 gr., 3 grs. (Dose: 1 to 6 grs.)

l-rowiss. earn., zjgrb.j questioned. At first a proprietary medicine. The demand for our “Ergotin" Pills has been

(Dose : 1 to 3 Fills.) its formula was afterwards revealed by a volun- very great. We have manufactured for a long

These pills are admirably adapted for the taryact of ite inventor. Dr. Oaki, Warburg, time this “Ergotin,” which is more properly
e 68 imlhrtion of iron, aatbe ingredients react upon late of Vienna, bnt now of London. U.S.D., 1883. speaking a carefully prepared aqueous extraot.
each other to form protoxide of iron, which, Ours is prepared in accordance with the The “Ergotin" of the market Is of several
owing to the protection afforded by the soluble original formula, except that Confection of kinds, and generally unreliable,
coating, remains unaltered until freed for action Theriac. Ph.G., ia substituted for Confection Our 3-grain pill sttctually represents 15 to 17
by the stomach juices* Damocratis—an unoflioinal and impracticable grains of Ergot.

Private Formulae made and coated in quantities of 2000 and upwards.

Price List of PillB and Book of about 400 useful Formulas (including those of the British Pharmacopreia) sent free

on application to o

W. E. SICKER 79, FENCHURCH ST., LONDON, E.C.,

19_

tAry act of its inventor. Dr. Caki. Warburg,
late of Vienna, bnt now of London, U. 6 .D., 18*1.

Ours is prepared in accordance with the
original formula, except that Confection of
Theriac. Ph.G., is substituted for Confection
Damocratis—nn unoflioinal and impracticable

Pil„ 1 gr., 3 grs. (Dose: 1 to 6 grs.)

The demand for our “Ergotin" Pills has been
very great. We have manufactured for a long
time this “Ergotin,” which is more properly
speaking a carefully prepared aqueoas extraot.

The "Ergotin" of the market Is of several
kinds, and generally unreliable.

Our 3-grain pill ettctually represents 15 to 17
grains of Ergot.

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Th* Lancbt,]

THE LANCET GENERAL ADVERTISER

LAwm,'

W. J. BUSH & CO.’S

ENGLISH SANDAL WOOD OIL

ABSOLUTELY PURE AND ALWAYS UNIFORM.

DR. HENDERSON, of Glasgow, writes :—“ It is a pure Oil of a high character. I have tried it in
numerous cases of Gonorrhoea. It was rapidly successful in all. The Oil disagreed with no one.”

THE LANCET states :—“ It is admirably adapted for use as a medical agent.”

The BRITISH MEDICAL JOURNAL states :—“ It is unusually free from disagreeable taste.”

The CHEMIST AND DRUGGIST States :—“ The fact that Dr. Henderson speaks highly of. this
Oil is the beet proof of its therapeutic activity.”

_ ARTILLERY LANE, BISHOPSGATE, LONDON, E.0.

HOUDE’S PASTILS

with CHLORHYDRATE of cocaine.

Through the insensibility which they produce, our pastils with chlorhydrate of cocaine procure the greatest relief
snd soothe the pain in sickness of the throat, in hoarseness, extinction of the roioe, laryngitis, inflammation of
the throat, aad asthmatic oomplaints.

They contribute to do away with the pricking and titillation of the throat, and strengthen the vocal 000 b, also a
very useful agent in the diseases of the oesophagus and the stomach, sea-sickness, gastri t i s, gastralgia, vomiting, fee.
Don.—Take 6 to 8 pastils per diem, according to age, and at least one hour before meals.

Per Box 2s. 9<L poet free; gratis to Members of the Profession.

Depot.—A. HOUDE, late Vee & Duanesnel’s Pharmacy,

42 Sue du FAUBOURG ST. DENIS, PARIS, AND ALL C HEMISTS.

General Agent for England.—FRANCIS NEWBERY A SONS,

1, KING EDWARD STREET, NEWGATE STREET, LONDON.

COCA WINE

Thh Lawcrt.j

THE LANCET GENERAL ADVERTISER.

[April 16,1887..

£ CuoCP^Ooue, eClq. Q&t&y )

A trucliqueficd Cinchona
Bark; the first preparation

(T* ft m ex / / • * /V) // | of *** kind in wflich ***

rational^ principle of

an

Cui,CA/0*u g. elCe. Q&Ahy )

alkaloidal standard has
been officially recognised.

Cui,CA,0*ue tCf. C&eVy )

The entire process of per¬
colation and evaporation is

performed in vacuo, by
means of apparatus specially

fy. Cu4,CA/6tai' i

instructed for the purpose.
The organic constituents of

Cu*,Cdstnae, efco' fflefa y)

the Bark are thus protected
from the changes induced by

CuoCd,0*ae, elCy. (ffteVu /)

heat and oxidation, and their
peculiar properties preserved

< Zyf^. CuisCd/tHut, ifCy. ($e\h f)

intact. The Extract forms,
when diluted "with distilled

Ctu,Cd/Ofice eCy. ffleMp )

water, a permanently clear
solution, not to be distin-

5^. dlAUut r&y.\

guishedfrom fresh infusion
of Bark. Being of definite

GuoCd&ae, fflelA y)

strength, the dose of the Es>
tract may be determined with

scientific accuracy, and by its
use Cinchona Bark may be

Cui,C/vetac t&y,

administered with a pre¬
cision previously unknown.

Descriptive Pamphlet, with full Medical Reports, and other information, together
* with Trial Specimens, free on application to the Sole Manufacturers,

FLETCHER, FLETCHER, & STEVENSON , 1 Holloway, London, N.

&

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The Lanc*¥;]

TH£ fcAKtett Q^eftKL AtWefWHEit

[Aran. 16/1887.

ft HORSFORD’S ACID PHOSPHATE,

BE (LIQUID.)

Prepared according to the directions of Prof. E. N. Horsford, of Cambridge, Mass., U.S.A.

FORMULAIts analysis shows that, each fluid drachm contains 5 1-2 grains free Phosphoric Acid
(P,0 6 ), and nearly 4 grains Phosphate of Lime, Magnesia, Iron, and Potash.

Horsfordlfe A#9 Phosphate has been in'use by*>the medical fraternity of America and elsewhere for many years, with
the most satisfactory results, in

Dysflepaia, Indigestion, Mental and Physical Exhaustion, Insomnia,
Nervousness;. Diminished Vitality, &c.

It is a colourless liquid, acid to the taste, andedntattnrmrpyro'phosphate or meta-phosphate of any base whatever.

Among the numerous forms of phosphorus in combination, Horsford a Acid Phosphate seems best adapted for use as m
medicinal reniedy.

Especially serviceable as a menstruum for the administration of such alkaloids as strychnia, morphia, qninia, and other
organic basefrwhich are usually exhibited in acid combination.

It makett a refreshing and nutritions drink in fevers, and with water and sugar a delicious beverage.

Cable Address -*- 1 * RUMFOBD, PROVIDENCE.” BUMFORD CHEMICAL WOBKS-Pifdvidence, B.I., U.S.A.

Can be obtained from

i GORBYN. SXACKY, 4 CO. 300, High Holbora.

nnd Branches, 7, Poultry, B.O., 86 . New Bond-street, W., 153, Leadenhall-street, K.C., London.

JOHN BBLLA,CO..

SAVORY 4 MOORE...

ALLEN 4 HAN BUR YS ~ ..

FRANCIS NEWBERr* SONS.-

BARCLAY 4 SONS _ .„ „ J.

M'DOUGALL BROTHERS

JAMBS WOOLLEY, SONS, 4 00. ... *.

JOHN THOMPSON .„

SOUTHALL BROS. 4 BARCLAY

RAIMES4C0. .

DUNCAN. FLOCKHART, 4 CO.

GLASGOW APOTHECARIES - COMPANY ...

TH08. M*M ULLAN 4 CO.<.

HUNT 4 CO. .

BUTLER'S' MEDICAL HALL

nx iiikiiu ... ... ... ... 17UUIIII, iiviaira.

And by Chemists In London g e n er a lly, and throughout Great Britain.

... 225 (late 338), Oxford-street; 2,4, and'^-HillVplaoe,

.. 143, New Bond-street, London. (Oxford-circus, W.

.. Plough-oourt, Lombard-street, London.

.. 1, King Edward-street, London.

„ 95, Farringdon-street. London.

.. 10, Mark-lane,H.C.. London.

^ 69, Market-street, Manchester.

58, Hanover-stfeet, Liverpool. S v ■

.. Birmingham,

.. Edinburgh, Scotland.

.. Edinburgh. Scotland.

... Glasgow. Scotland.

.a Belfast, Ireland.

... Dublin, Ireland. v V T

Dublfn, IMand.

flP PHYSICIANS who have not used Horsford’s Acid Phosphate, and who wish to test It, will be furnished a sample on application to Corbyn.
Stacey, 4 Co., Pfanois Newbery 4 Sons, Barclay 4 Sons, London; James Woolley, Sons, 4 Co.. Manchester; or John Thompson, Liverpool; and
■ample will bdfaraiihed free Of charge, except the expense of packing and postage (sevenpenoe). which amount should acoovapany the application.

MALT O PEP S IN.

_

That many at the disease* from which mankind suffer during infant
and adult life gre caused by malnutrition, there can be ho doubt; and
the extent to which non-assimilation of the life-giving nroportie* of
food interferes dith recovery from severe illness, baffling the Desttlirecled
efforts of the physician, points to the necessity for an agent or combina¬
tion of agents Sufficiently potent to replace the deficient* principle and
aid nature in renewing tne-degenerateu tissues.

Kealising this heed', the science of chemistry produced Ptprint. Of
CHard TusoN, F.C.S., ProfeSsor of Chemistry, London,
the August 13th, 1870, number of The Lancet as

this remedy R:
speaks tiiroug’
follows:—

“ Since the
mentive Into
stomach of th
has been exte
According to
experience in
relative to its
reasoning. T

trodudtion of Corvisart and Boudault's poudre nutri-
Sdicine in the year 1854 , Pepslne obtained from the
>ig. odW; or sheep, in a state of greater or less impurity,
Tely prescribed in Dyspepsia and certain other affections,
e testimony of some authorities of high standing, long
ie use of this agent fully justifies Corvisart's predictions
s therapeutic value, which were based on physiological
litre are other authorities, however, who express’ doubts as
to the efficacy of Pepsine.

" This difference of opinion undoubtedly arises from the circumstance
that pharmaceutists supply medical men with various preparations, all
bearing the same specific name of Pepsine, bat differing very consider¬
ably in their digestive powers and other qualities. In fact, I find those
who speak favourably of its employment in the treatment of diseases
have prescribed that prepared bv the best makers; while thoBO who
express a doubtful opinion have been in the habit of prescribing those
varieties or makes which the experiments of myself and others have
proved to be practically without anv digestive activity worthless.

Under these circumstances it is absolutely necessary for the practitioner
to be certain of the make of Pepsine he uses. Pure Pepsine, thoroughly
triturated wita finely-powdCred sugar of milk (taeoha rated pepsine).
will undoubtedly produce the best results. Experience in diseases of the
stomach. Dyspepsia, 4c., has demonstrated in many cases the lack of
other agents required to promote a healthy digestion b-sides Pepsine—
namely, PancrSltine and Diastase, or vegetable P tyalm. Pancreatine,

ul power of emulsifying the f&tfi and crtO bT’food, rthdertng them easy

to assl full ate, and whicltare not affbfcffed bv Pepsine In the slightest
degree. Diastase,' Or vegetable Ptyalin.as obtahuM from malted barley
in the dry extract of malt, represents tile saliiw. end har the remarkable
property of converting the insoluble starchy portions Of food Into the
soluble glucose, thus rendering the said indigestible and Innutritions
article—starch—into the nutritive arffl'easlly assimilated food, glucose.

The value of these difft)rentingredients, and the difficulty of procuring
them of the right qffitlity; led Haieti Morse, chemist, late of Toronto,
now of Ontario, Canada, to experiment with various combinations,
during seven years' employment in the manufacture of Pepsine, on a
large scale; and, with the assistance of several prominent physicians,
he was finally enabled, to present to the profession the following
foannlsH— »*, . ^ \ '• • ,-v

S-cclmrntod Pepsin* ... .‘ ... 10 grains.

,, Pancreatine ... 5 „

Acid Lacto-phosphate of Lime ... 5 „

Exsiccated Extraet of Malt equaUto
oneteaspObnfulof Llq. Ext. of Malt. 10 „

and registered HrAt Ottowa, Canada, and London. England, under the
distinctive name

MALTOPEPSYN,

thus giving the phyHcians a guarantee of always procuring the same
standard preparatlorf ahd preventing their* being imposed upon by
imitations of inferior quality, at the same time putting It at as low a
figure (2s. 9d. for 1 ounce) as possible tor such a formula to be com¬
pounded, using.the ingredients of the best possible make.

Maltopepsyn has digestive power ten times greater than the best
Pepsine In the market, as it digests Fibrine and Caseine, emulsifies the
fat of food tokefi Into the stomach, thus rendering it assimilable, con¬
verts starch into glucose; In fact, it combines all the agents that act
Upon food, from mastication to Its conversion into chyle, digesting all
ailment used by mankind. while Ptpslhe dot* only on plastic food.
Maltopepsyn also combines with the above the nutMtive qualities of
Extract or'Malt. and the braTn- and uerve-ItTtnEjhenkig powers of the
Add Phosphates.

For full particulars, Sample Bottle free, Pamphlets, &<l, please address

BTJRGOYNE, BURBID6ES, & CO., 16, Coleman St., London, E.C.

THE M^NCCT GENERAL ADVERTISER,

EMi&u,4P, 1387.

LIQ. PODOPHYLLIN (HOCKIN).

Miscible (bright) in Aquos, Acids, or Alkaline Solutions, also with Decoctions,

Ethers, InfwhonB, Tinctures, Ac.

These preparations contain no colouring matter whatever.

Each Drachm is equal to Podophyllin Pur. J- grain.

The BRITISH MEDICAL JOURNAL, Feb. 12th, 1887, says

Although the value of Podophyllin as a cholagogue has long been recognised, much difficulty has been
experienced in prescribing it in a liquid form. Many patients cannot take pills, and prefer having a mixture.
The new preparation contains a quarter of a grain in a drachm, and is miscible not only with water, acid, and
alkaline solutions, but also with infusions and tinctures. It is active in very small doses, and undoubtedly
supplies a long-felt want.”

The MEDICAL PRESS and CIRCULAR, March 30th, 1887, says

“ Owing to its insolubility, podophyllin is mostly exhibited in the form of pill; and, as a consequence,
occasionally passes tlirough the intestinal canal more or less unabsorbed, and to the disappointment both of
patient and physician. This liquor contains one-quarter of a grain of podophyllin to the drachm, and when
added to water produces a clear solution the colour of sherry, and without any precipitation of the drug. In
cases of dyspqpsia occasioned by torpidity of the liver, I have obtained excellent results from the adminis¬
tration of a drachm of this liquor in an ounce of gentian mixture two or three times a day. Prom two to
four drachms of the liquor, together with an ounce of decoction of aloes and five minims of tincture of
capsicum, form a good cholagogue aperient.”

The EDINBURGH MEDICAL JOURNAL, April, 1887, says

“LIQ. PODOPHYLLIN (Hockin). Prepared only by Hockin, Wilson, & Co., London.—This is an
excellent preparation, containing two grains of podophyllin in every fluid ounce, and one which we can
recompKqdiJo it^e notice of the profession.”

LIQ. PODOPHYLLIN ET PEPSIN (HOCKIN),

A Soluble Preparation of Podophyllin and Pure Pepsin. Of great Digestive Power.

Dose :—One Drachm.

LIQ. PODOPHYLLIN ET

BELLADONNA 0. STRYCHNIA (HOCKIN),

(Synonymous LIQ. HOCKIN).

EACH DRACHM EQUALS— , ...

PodophylUn. Resin . 1-4 gr. -

Ext- belladonna Bad. Alch. .... . fofj. *.

Strychtfj* .| . ••• I-oO „ ,• 1 ,,

Acts most beneficially in torpid liver from defective nerve-influence, and also upon the alimentary canal. Tt increases
the tone and vascularity of the stomach, improves appetite and promotes digestion, f >Rariqqs

chronic catarrhal affections of the gastric muoous membrane it acts as an excellent tOftic, greatly Increasing tne mUsculir
tj*e intestinal tnh«y and counteracts constipation and fiscal accumulations. ]f

, i§ 9 ?kbpts., 7s.; Boz. bots., 4s.; 4qz. bots., 2s. 6d.; Winchester qts., 6s. 9d. per lb.

411 hot ties, and packing free, postage only charged, as follows:—16oz.bots.6d., 8 oz.bots. 6d., 4 oz. bote. 3d. extra.

PREPARED ONLY BY , . T •

HOCKIN, WILSON, & CO,

_ . miJwalBilhmgihita aoA ManaMotatARg

38, JfflXEvaUBEET, MANCHESTER SQUARE, WMWN, W.

Digitized by LjOOQle

The Lancet,] THE LANCET GENERAL ADVEfctlSER. [Aphil 16,1887.

ii ■ . r " ■ ~~ - - —. ■ ■ - ■

THE FILTER USED IN THE SOUDAN EXPEDITION.

“ It filtered the water both quickly and well, and was
much valued by our Soldiers.” VISCOUNT WOLSELEY.

UNPRECEDENTED SUCCESS ADD HONOURS.

GOLD.

HEALTH.

INVENTIONS.

MAIGNEN’S PATENT

FILTRE RAPIDE.”

POWER.

C Granular Oarbo-Calcis.
B Screen.

ALL PART8 LOOSE.

W The water is thoroughly
aerated whilst issuing within
the frame in a most minute
state of division.

RAPIDE and ANTI-CALCAIRE ^COHFANY, Limited,.

Contractor- to Li.M.’s Government, r * . **

32, St. Hary-at-HiU, Eastcheap, E.C., West-End Depot, 15, P&ltfUll,

PritmOnfr^Ui p artio H* # m Pi |
MAJGNEN’S FILTRE

m

lOO

al<

DESCRIPTION.

R Reservoir.

A Filter Case.

H Filtering Frame.

£ Asbestos Cloth.

D Layer of Powdered Carbo-
Calcis.

This Filter is guaranteed
to remove from water not
only the impurities in sus¬
pension, but also those in
solution, such as Sewage er
Lead.

Tk» Lancet,]

THE LANCET GENERAL ADVERTISER.

[April 16,1887.

BENBER’S FOOO

{PANCREA TIBER)

FOR

INFANTS,
CHILDREN,
AND INVALIDS.

GOLD MEDAL - International Health
Exhibition, London.

“ Mr. Benger’s admirable preparations. ” — The
Lancet, March 25th, 1882.

“ Deserving of the highest praise, and only require
to be made known to the profession to ensure their
extensive employment ."— The Practitioner, February,
1883.

“ Few modem improvements in pharmacy have done
so much as Benger's Preparations to assist the physician
in his treatment of the sick ."— The Medical Press,
June 13th, 1883.

“ Benger's Preparations have deservedly a very high
reputation, and are all largely used ."— The Medical
Tikes and Gazette, September 8th, 1883.

“ Undoubtedly a great advance on any previous
attempt in this direction. It is palatable and excellent
in every way. We have given it in very many cases
with the most marked benefit, patients frequently
retaining it after every other food had been rejected.
For children who throw up their food in curdled
masses it is invaluable ."— The London Medical
Record, March 16th, 1882.

NOTICE TO THE MEDICAL PROFESSION.

BENGER’S FOOD consists of a specially finely ground nitrogenous fari¬
naceous meal, cooked, and impregnated with a suitable proportion of the natural
digestive principles of the pancreas. When mixed with warm milk or milk and
water, as directed on each tin, these digestive principles not only fender the
starchy matter soluble (as in malted foods), but further, reduce the casein of the
milk to the same flocculent, digestible condition in which it exists in human
milk, so that hard indigestible masses of curd cannot be formed in the stomach.
In no other Food has this result been attained. It forms a delicate cream
entirely free from rough and irritating particles, but rich in all the elements
necessary to maintain vigorous health.

SURGEON BARNES, M.S., Sandown, Isle of Wight, writes, under date

June 0th, I860:—

“ Since I have used it the very best results have followed , and after a'lengthened
experience of Foods> both at home and in India , I consider Benger's Food incom¬
parably superior to any I have ever prescribed”

BENDER’S FOOD may be obtained in tins at Is. 0d., 2s. 0d., and 5s. each of Chemists,
&o., everywhere, or by Parcels Post direct from the Manufacturers—

XOTTERSHEAD & CO. (S..Paine & F. B. Benoer), Pharmaceutical Chemists,

7, EXCHANGE STRIVE, MANCHESTER. •

Digitized by LjOOQle

Thb Lancet,]

THE LANCET GENERAL AbVfltfmEft.

[ApbTL ie,1887:

SYRUP HYPOPHOSPH. 00. (LORIMER’S*

O^POUlM-D

cQ gains'.
2 ci

/ Sodl^\ - :
-US* ''> v

t Margane*f-| '•
fw^uimne
A Strychnine

hi a

Has the following advantages over all other
similar preparations :—

1st.— It is not a cftlaCk preparation oT secret nostrum, th&
formula being stated cm every label.

2nd . —The formnla is original, and baaed on sound
scientific theory, borne out by practice. There 7s

no other preparation of the Hypophosphites
which contains the same proportion, or SO large
proportions (about. 6 grains per fluid drachm) of
the various salts.

3rd.—It carries all its constituents in perfect solution,
** "the last dose being identical with the first. It offers

no danger by precipitation of strychnia, as is the case
with preparations that require shaking.to distribute
the do3e.

4th.—The formula being stated on every label, the Physician
is enabled to vary the dose, according to the indi¬
vidual requirements and idiosyncrasies of each
patient..

5th. —It is pleasant to take.

6th. —It is neutral, or very slightly alkaline, and can
be t a ke n -toy persons suffering from the most sensitive
stomach, without producing the slightest derange¬
ment thereof.

7th.— The price is not a fancy one , 1 lb. bottles, unstamped,
for dispensing, 4s. each ; stamped bottles, 24s. and
42s. per dozen.

A/sOVE rs FA C-srmlE OF LABEL. | 8th.- It may also be had “sine Strychnia.”

In prescribing please write "Syr. Hypopbosph. Co. (Lorimer).” j 9tb ._ It may be diluted with an equal volume of Sjwpu

P.B.

The product will contain about three grains Hypo-
phosphites per fluid drachm, be most pleasant for
children, and equal in themical and theraueu
tical value to either of the foreign nostrums, so
largely advertised.

10th. —There is not another preparation of a similar name
which is not either strongly acid, or of unknown
composition (generally varying from ± to grain*

Hypophosphites per fluid drachm), or deposits its
active ingredients, and many have all these faults.

LORIMER'S SYRUP HYPOPHOSPH CO. is therefore
superior to all other*, add free trial samples are

supplied to all members of the Medical Profession,
in order to enable them to judge of the fairness of
this claim.

IMPORTANT EVIDENCE.

The originals of these and many other similar Letters may
be seen at our Offices.

" M«ws. Lorimer & Co.

“ Dkar Sirs,—Y our Syrupof HypophoepUltea has proved of such
inestimable value in my own due that I can hardly say too much in its
fat-bur as a remedial agent.. For five weeks I laboured under great
nervous prostration, and was in a semi-aniemic condition, with debility
of tlie digestive organs, and such torpor of the bowels as necessitated the
constant use of aperieut medicine (a very unusual waut with me), which
I. aided by the infusions of columba, gentian, Ac., accompanied bypre- J

S rations of iron, with very little benefit, till I happened to see the 1
rmula of your Syrup looking over the "British Medical Journal.”
The action oi' your preparation has been all but magical; by the time I j
had taken five doses, the obstinate constipation was relieved, myappetite I
returned, and I felt stronger tlian I had done for many months pre-
I am happy to say these good results have* proved to be pertfta- !
Yours faithfully.

'• A PHYSICIAN.” |
“Dewsbury, April 25th. 1886.
"Au invaluaBlb reitiefly fn Pulfnbnffry TubertOIosfA—’he patients like
It, finding it an agreeable stimulant and tonic, and quickly improving |
the appetite. I shall in future use it more extensively. •• M.D." I

•* Kirkburtou, Yorkshire, March 23rd, 1886. j
‘‘YtMr Syrnpiof Hypophosphites is an elegant preparation, which is
something, and a very effective one, which is everything. I have used
It in-a number of cases with much success, and'shall use no other in
future. “M.D." i

“ Kidderminster, March 23rd, 1886. .

*' Lorimer’s Hypophosphites.—I liave given your Syrup Hypophosph.
Co. in several cases, and always with marked benefit.' I consider it an
elegant compound, and superior to all others.

'* Honorary Surgeon, Kidderminster Infirmary.”

“ Clifton, July 20 th, 1886. (

" I prefer it to any other. It appears to meet the desideratum long
■oughtdM-^-virv, an elegant, preparation, definite and stated formula,
and moderate price.

Sold

viously.
nent.

“Birmingham, June 30th, 1886.

SPECIAL NOTICE.

" With reference to tire foreign manufacturer who claimed tdbe the
inventor of Syrup Hypophosph. Comp., and declared all similar prepara¬
tions Inferior to, and imitations of his own, we have already publicly
challenged him to prove either statement, and offered a sum of £200 for
London Hospitals if be could succeed. This offer Is still open, aud we
are prepared at any moment to abide by the terms of our challenge."—See
M.D Tfnt LaxcW. Bnm*« MkntCAt Joouhal. Sm

SOLE PROPRIETORS AND MANUFACTURERS,

LORIMER & CO.. Hargrave Park Road, lonAtor, 9 .,

Awarded Six Vq liave Exhibited).

tThs kAjHjpa*]

imbmm o&m*& »wwqiaswr

[A?ai-L 16 , 1887 -

UQ. EUONYNUN

£T

(OPPEljrHEIHER’S).

GO

From the BRITISH MEDICAL JOURNAL, Feb. 14th, 1885.

“ An exceedingly valuable preparation, combining, in a very useful and palatable form, a valuable
hepatio and digestive agent. It meets * FftT* _^ f jifl the freatompt ^jL indjgestionand

flatulence due to deficient secretion of bile, jp> weH 0 of the 8%macj|\and Ji8uj|ciJbt'%;rfBo^ol

gastric juice. . . . In practice we fomfSift yery cppveniyt yd yalt^jjbKF; . ^ ‘1 .‘V

From the EDINBURGH MEDICAL JOURNAL, Kay 1st, 1886. ‘ ''

“We can confidently recommend it as api excellent preparation in dyspepsia depending on hepatic
derangements.”

m EUONYVIIN

€T fiftSGAR/E

• (OPFIWRPWTO’S). ; .

This combination of our Euonymin with Cascara Sagrada possesses the following
therapeutic action, in addition to the cholagogic action of Euonymin: It stimulates
m iJ#I ar apparatus *>f *the fcuP^eF ayd sma# »*tf%i«asing

IPf^Vr 4afli8 ; , regulating the foro^jthe bj"fdls $«£|tin|iij£* 'io act

naturally and regularly after the- "jpreparatian discontinued, and therefore Liq.
Euonymin et Cascar® Sagrad® Oo. will be found most useful in the treatment of
CHRONIC CONSTIPATION WITH HEPATIC DERANGEMENTS.

PREPARED ONLY BY

O'PWNWEIM^R BROS. /O©. ’CHiSSS*)

14 3, Sun-street, Finsbury-square, London, E.C.

{ ' ‘"V '' •I'l’ 1 "H rm—? " 'f d K TUh 0* pTOTT ;

PricjJVMfc ii^oun^ Pispe^j^g oj^y) in#®*,^ os., *4*0* Bottles.

27

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The Lancet,]

THE LAM&t <&NEftAL ADVERTISER.

[April 16,1887.

One Teaspoonful of
Pepsina Liquida (Schacht)
will Peptonise 1000 grains of Albumen.
A palatable, odourless liquid,
attractive to Patients, and
of guaranteed strength.

SCHACHTS

LIQUID

PEPSINE.

X-

PEPSINA

We prepare also

LIQUIDA

C.

BISMUTHO

(SCHACHT).

Each drachm contains in a concentrated form, besides the liquid pepsine,
a full dose of Sqhacht’s Liquor Bismuthi.

PEPSINA LIQUIDA * EUONYMIN

(SCHACHT).

Each drachm contains one grain of soluble Eupnymm.

THE FORMULA ARE GIVEN ON EVERY LABEL.

Price of each remedy:—One pooid bottles, 7& each', half-wands.
3s. 9d.; 4 oz. bottles retail at 2s. 6d.

_ • ' -| ■ <L*y

To be obtained of all the Wholesale Houses; or will be sent direct, post free, or carriage
paid, to any address on receipt of remittance by

98

GILES, SCHACHT, & "CO., CLIPTON, BRISTOL.

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-Tirel^ cig.] THE LANCEIQ E MER^ ADVE RTISER, -• [Apbil 16,188y t[

A NEW THROAT CASE,

REPLETE WITH IMPROVED PRODUCTS.

Voice and Throat.

Of all the diseases which afflict mankind, perhaps
none are more prevalent than those of the throat.
While in the majority of instances they may not be
dangerous, they are none the less annoying to the
patient, and relief is none the less earnestly sought.
In not a few cases the success with which slight
ailments of the throat are treated is the criterion
by which patients will form their opinion of a
physician's skill. As contributing to the physician’s
convenience, we have prepared a throat case which
may be filled with the following, prepared in the
most desirable form.

ZINC ‘ TABLETS."

(i grain.) __ _

These are most convenient, as the amount re¬
quired can be: dissolved at once tvithout weighing
or measuring.

ABSORBENT COTTON.

This will absorb over a dozen times its weight of
water. “ It is beautifully soft, really absorbent, and
quite free from chemicals .”—The Lancet.

Supplied in packets, 2 oz., 4 oz., and r lb. each,
to Physicians at 0 / 8 , i/'o, and 3 / 0 .

AMMONIUM CHLORIDE ‘ TABLETS."

“ Ammonium chloride considerably increases the
secretion from the mucous membrane,” and prevents
the formation of a thick tenacious mucus. Aside
from its value in neuralgia, its usefulness-in catarrhal
conditions of the throat and lungs is well known.
For the throat, it should be dissolved on the middle
of the tongue—not near the tip.

Dose.—One to six tablets in plenty of water.

HAZELINE.

“ It is useful in ozsena, and, snuffed up the
nose, for catarrh” (Ringer’s Therapeutics). Pre¬
scribed for epistaxis.

Price to physicians, 3/6 per lb.; 1/2 per 4 oz.
bottle.

EUCALYPTINE.

Eucalyptine is found very efficient in cold in the
head, and in nasal catarrh, by simply smelling con¬
stantly some cotton on which it has been dropped;
even where there is a profuse offensive catarrhal
discharge it removes the feetor and checks the se¬
cretion.

PURE TEREBENE (BURROUGHS).

The value of this special preparation in chronic
catarrhal affections of the throat and lungs is widely

known. ,

COMPRESSED CHLORATE OF POTASH “TABLET8."

In acute sore throat, Chlorate of Potash “usually
relieves the uneasiness in a few hours” (Cohen).

CHLORATE OF POTASH & BORAX “ TABLET8.”

Prescribed for aphthous ulceration, cracked
tongue, hoarseness,clergyman’s sore throat, aphonia,
and.diphtheria. “The Wyeth Tablets are manu¬
factured with the utmost neatness and perfection”
(British Medical Journal). i 1/

i VOICE, “TABLOIDS.” . !j ' J(

These contain, Cocaine, Chlorate of Potash and
Borax, and are highly praised by many.

I • 1 • •*

TRYPSIN (FAIRCHILD).

This has been found very active in digesting off
the membrane in diphtheria, by Dr. J. Lewis Smith
and others.

PULV. IPECAC “TABLETS ’ (6 ge).

These are always ready for use; three or more of
them may be crushed, and taken in a little water,
for croup, etc.

POTASSIUM PERMANGANATE “ TABLET8." I

“ In cases of ozsena it is employed to wash the
nose, and as a lotion or gargle to the mouth in
ulceration with feetor, such as mercurial stomatitis,
and also in diphtheria” (Brunton).

BISMUTH SUBNITRATE “TABLETS.” ‘

One of these may be quickly powdered for pur¬
poses of insufflation into the nares.

VALOID FLUID EXTRACT HYDRASTIS.

“ Stomatitis, both mercurial and aphthous, is
much improved by local application of the f}uid
extract of hydrastis. When this preparation causes
much smarting, it may be diluted with water. Folli¬
cular pharyngitis, chronic coryza, and eVen syphilitic
affections of the mouth, throat and nares, may be
much benefited or even cured by the same appli¬
cation ”, (Bartholow). ,

VALOID FLUID EXTRACT ACONITE ROOT.

“ In membranous croup,” says Phillips, “ I have
seen decided relief from aconite in the early stages. 7 ’
He strongly recommends it in follicular and simple
tonsillitis. Dose.—One-eighth of a drop.

VALOID FLUID EXTRACT BELLADONNA.

“ Belladonna may be given with aconite internally
in severe inflammatory diseases, especially where
the throat and tonsils are acutely inflamed and
much swollen ” (Ringer).

The Phyaielaa’a Throat Case It of Flexible Fine Calf, containing 18 tPdraehm Vial*, Price,‘Htted 27«. M.

BURROUGHS/jWEfcTXIWEr* ©o./. Sno-w> HiU JLONDON, E.C

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L . s

Tfla LurCfCT,]

[nuct^iKr.

THE tAlWJET O^KH M. ADVBfflaElt^

v v. j •». iA.

n KICH IN
PHOSPHATES AXE
ALBUMINOIDS.

' -At tbe .Interaatioixal Health Exhibition, London, 1884, all the principal Exlnwtocf
Malt at present before the Profession were examined by a Jury of the highest fldetUtfc
attainments, and the Only Gold Medal was awarded to Maltine. We submit that tlis
affords irrefragable proof of the superiority of Maltine (extract of malted whe*t, **te,
andjbarley) to the ordinary extract of malt made from barley only.

' SCIENTIFIC OPINIONS ON MALTINE.

Prof. ATTFtELD“ Maltine contains unimpaired, and in a highly concentrated form, ths-vrimletOf.-ithslmllB^is

- "« materials that it is possible to extract from either malted whwst,WhMsAs—NS*

|,, , , )U i .malted, .barley, ; It contains from three to five times as much diastase as Mf st h i r

Extract of Malt in the market. Its flavour and odoortnre'd&She of aAlstom
sweetmeat.” eirfT

Pr-nf J reim ftBNl Having exemined tiieTpripcipal unfermented Extracts of Malt in the market* I fiad^N
* 11 — the richest in two of the most important ingredients in these foods^-MpM

phosphates, or bone-formers, and that peculiar farinaceous digestive odllefi*«

1 ' : ' In this combination of barley, wheat, and oats, we get a food which id

digested for use, a condition of immemse value to the physician.” , ,.. ^ ^

Prof MAC ATI AM E dinb urgh“ I have carefully analysed Maltine,«nd contrasted the teetilte

« ■ » J ' ■ i " ‘ - knowtt 'Kitracts of Malt in all the digestive and notittivepiopertios? hSWhe

materially exceeds in power and efficacy any of the others.” • '' •• -

■ '■ , • - ' . • .. |, fTC-M

Prof STTITZER, Bonn:—“The nitrogenous substances which,Mdltfne containe ane ce as MgraM jf richer

- 1 —:- other Extract of Malt in the market. Asto diaataae-convwfcing .pom* HlWprk

. far superior to the best Extracts of Malt I have ever seen.”.. .. , j *-

0. ffllHTJ, PAPiS: ^“Tfae Maltine■is,perf#ctlyprepared and of easy preservation; repeated
1 ' 1 that the Maltine converts 25 to 30 times its own weight of starch into ngpr*

Prof SXPAIRE. Brussels“ One part of Maltine dissolves 27 to 29 parts of starch, It contains ’tUihf. ^

•Tl ,7 .. • • and bone-prp4uomff substance than othe* Extracts-bflfalt. ‘■tt» 4ai|P

. importance itoj those who use Extract of Malt.” • ^

THE LAJTCET“Maltine exhibits in an eminent degree the starch-dissolving power of diastase; in ^

> spoonful is capable of converting instantaneously a surprising amount of stiff Msreh

paste into a thln limpid liquid.”

f.\ II I MI

Bwrfi i. P. YAHDELL r—“ la ecptvaleeeanee it i* a delightful and effleamous cordikl. W#‘h

• Imou [y.i-. 'n.i:: ■- ■ ■ .iiksdbJ'^WWwi” ••

it

ivn.:

,ii'.

.A^lirlO'JAJ j3'

Jovi . •' -jnd* u>/

■f-ti.' . AThibn

W- ,■

H : ■

TO MEDICAL. ^ y

Luii.ik

THE .N.AT fT lN y ' ^MAwiiWjfC 1

.M .pi. puii ,w! .WfcFT-apnwiPiL wmr.

3HLT 1

*»! un.-'l* fi.-l To jU r “./ odf
ill

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Th"K'Lancet,]

iHt amtm oowr*l Asvwtrisn

[A9exul6^MV7,

SAVORY & MOORE'S SPECIALITIES.

Gold Medal, Health EMbitio#, IS 8 A.. ’■Gold Medal, EivwpoM Exhibition, 1886.

The Best Pood for Infants.

Used in (he Royal Nurseries.

Tins, Is., 2s., 5s., 10a.

A Self-Digesting Food, supplying the highest
amount of bone and flesh-forming constituents.

“ This is an admirable preparation, and I am confident'
that to it matoy ia facts owe their liwifl.”—See^G^ASoow
Medical Journal, May, 1886.

“ The constant employment by medical men of 'Savory *
Moore’s Malted Food .ip rearing their own families is itself
a sufficient indication of the estimation in which it is held
by those who can best judge of. its merits.’’— Medical
Press, August J3th, 188G..

“ A great -knpravsrment *m thoi or#narje kigds.”-4THE
Lancet. ’ % - * " '

“It can be taken when nothing else can." - Medical
PRK8S. •

Meat Peptone.

In. Jars, 3*^ 5s. 6d„ a»d 10s. .

“ The objection commonly, made to i aU .preparations.,of
Meat Peptones is that they have a nauseous, sickly taste.
The difficulty has at last been overcome" by Messrs. Savory &
Moore, who have recently introduced a Meat Peptone which
fulfils all the reftuirementaQf the sick room.”— The Lancet,
June Mb, -188ft.

“Messrs..Savory & Mood’s Meat Peptone is an admirable
preparation for invalids. When tbe teeth are decayed, or
the digestion is impaired, it may be spread on breaa-and-
butter, or oaten in tho fyrpa 4>f a sandwich, Jn cases of
greatpealiauetian ittjs valuable* as ^veetoVative |gent. We
can cordially mcoramend 1 L”—ABbitish MtoDiCAi. Journal,
March 13th, 1886.

Pancreatic Emulsion.

The Essential Form of Nutriment in all Cases of
Consumption, Wasting, loss of Appetite, Strength,
and Digestive Power.

Ia Bottles, 2s-6<L, 4s. (ft., 8s.

Pancreatine Essence.

Pepsine Essence.

“ Savory's Essences are preferable to other liquid pre¬
parations. — British Medicax Journal.

_ _ Bottles, 2s. 6d„ 4s. 6d., 8 s. 8d.

Pancreatine Wine.' '

-UAnaiiimA \i/ i WW A

jl yiFBiiiv Tt XUvfl

Pnre Peptone.

In Bottles, 3s. 6d.

Peptic Salt,

A very convenient and efficacious digestive agent, to bo
taken freely at meals,’in the same Way as ordinary Salt.

Dottles, Bs.fft., 7s. tft.

Bottles, 3s., 5b, j 10s.

Datura TaXula for Asthma.

€%ara and QlgarsttesHBoseg 3s., fe., 8s., 16s.

, Tobaoso— 1 Tins, 2ft 6d.,i>s.,iQB.,

Pastilles and Towdef (for'^Non^Sn

2s. 6d., 6s., 10s.

(for^on^Smokers’ use)—Boxes,

Dr. Jeimer’s Absorbent Lozenges,

For Acidity and Indigestion.

Speedily and effectually oorteot Heartburn, Flatulence,
and other evils attendant on a superabundance of add in
the stomach.

They are eminently samiotable in relieving that form of
Hbartbuhn so e&nsmett with ladies during pregnancy.

Boms, Is. lid., 2* 8d„ anddQs.Ad.

Peptonising Pellets.

“ Tbe peptonising Pellets are excellent, andiWfll 3bS f#ond
mafnl A ef qiredigeeting milk."— The Lancet, June 5th, 1886.

“ They, amvery active^aixl do-USV’feqig 1 ' 6 W 4rge excess
ef-alknli, which? W copeideriwfearafe of-muehimportance,
eapadaliy fee bn font feeding . Thu milk peptonised by the
pttliP-tfl i«nf vAry Ann flavour RnmHH Medical JOURNAL.
April 3rd, 1886.

• : ' > Bottles, 2s. 6d.

• - a-/ * •» . » ' 4 L ---

Peptone Lazauges.

Peptone and ‘Coca Lozenges. -

Afford an excellent and convenient concentrated sus¬
tenance.

Ia Bases at 2s. 6d.

Coca Wine.

Possesses in an eminent degree the valuable tonic-and
invigorating properties of BtytMoxylOn Coca, the celebrated
Peruvian restorative.

Bottl«8,,4s..6d. v

143,

SAVORY

NEW BOND

: T

$T*RE£T t W.

f*31

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The LanchtJ

THE IANOET QENBtftt A&VBRTiaBfc

[Aran. 16, 1887.

J. F. MACFARLAN & CO.,

MANUFACTURERS OF

ANTISEPTIC DRESSINGS AND APPLIANCES USED IN THE
LISTERIAN SYSTEM OF SURGERY.

Our Lifiterian Dressings were the first in the Market, and were prepared under the guidance of Professor
Bir Joseph Lister and according to his private Formula, which have since been published. These Dressings
are now known and used wherever the Antiseptic Method is employed in Surgical Practioe. The demand
which followed their introduction, and which has since continued steadily to increase, warrants us in believing
that the accuracy with which, for the last fifteen years,they have been prepared has secured the confidence of
the Profession.

PRICE LISTS ON APPLICATION.

Edinburgh address—17, NORTH BRIDGE. London address—71, COLEMAN ST., E.C.

Telegram address—“ Morphia,” Edinburgh or London.

OBSTETRIC CONES »»

Cocaine, Boric Acid, and Cocao Butter.

Specially recommended by Mr. E. Head Moore, L.R.C.S., &c., in primiparsa and
cases of rigid os. ...

These Cones are made hollow, and of a size that will fit the index finger; they
possess great advantages over the existing methods of applying Cocaine to the os uteri, &c.
They can be introduced without the patient’s knowledge, and Cocaine in this form is
applied without the use of a speculum and the consequent exposure of the patient,
whilst the Cocao Butter acts as a lubricator to the parts.

May be obtained, containing 1, 2, or 3 grains of Cocaine in each Cone, in boxes
of 12 and 6.

MAKUVAOrtTBBD ONLY BY

GALE & COMFY., 15, Bonverie-street, Fleet-street, London. E.C.

Vaginal Paaaariaa of aU kinds made on the hollow principle, if required.

FERRIS & CO.’S

ANODYNE AMYL COLLOID.

(Registered under the Trade Marks Act.)

Messrs. FERRIS <6 COMPANY beg to direct attention to the following important and unsolicited Testi¬
monial recently received from Dr. RICHARD LOWTHER, Fernleigh, Grange-over-Sanda

Sept. 26th, 1886.

Dbab Sms,—It will be a satisfaction to yeu tp learn that in a case of most severe intercostal neuralgia, complicating
an attack of shingles, which was rapidly exhausting an Aged patient of mine, instant relief resulted from the first appli¬
cation of your Anodyne Amjrl Colloid, after'numerous other remedies had been tried without benefit. I have found it
also the best of all remedies in chilblains, I shall be glad if its beneficial effects become' mote generally known.

Yours faithfully, KIOHD. LOWTHER, M.D.

Jh bottles stamped, Bs. 9d^ 4$. 6d., 8s., and 15s. each.; price to Surgeons, ts* 3s. 6th, 6i.6<L, and IBs, 6d. Med. Bottles and

stamps included.

IMPORTANT CAUTION .—Medical Gentlemen are earnest!? and respectfully desired to observe that they are
supplied with FBB BIB A CO.’S ANODYNE AMYL COLLOID. This preparation differs essentially from all others. Some
UH RETJABI . E amt MWT 1 EIII Inti aMUiui are being advertised, whisk -bearawraseMblanas either in composition or effbot
to Ferris * Co.’s ■ venal formula. See that every bottle bears FER&B A CO.% Registered Trade Mark.

FERRIS, BOORNE, TOWNSEND, & BOUCHER

Wholesale And fefcport Dfu^gUts abd HaikTattnAng Cheadiats, BRISTOL.

Digitized by AjOOQle

Thu IaANCBT,}

THE LANCET'

ADVERTISER.

[April 16,1887.

SENIER’S ASTHMA REMEDY.

THB ORIGINAL AKBRIOAH SHXRD7.

ipto and InafanaUana fw to any Mtdtad Man by end wing <Mrd to London Depot—A. BHNINR * OO., 88, Rorwood-nwd, London. 8.R.
Price, per box, li. 9d. i by poet, la. lid. A merlo c n 1+borutorj, Mllwujcee, U.8JL

1886. GOLD Jtf&DALSj Liverpool and ‘^Paiais <? Industrie, Paris. 1886.

For Bodily & Mental
Overwork its Cura¬
tive Properties are
Unrivalled.

BOK0L

ri & 2 %V!

. (REGISTERED.) - ~

A. NORWEGIAN BEVERAGE, RICH IN MALTOSE AND PRACTICALLY NON-INTOXICATING.

AWARDS: Paris, Amsterdam, Nice, Antwerp, Beauvais, Edinburgh, and TLM. King Oscar II.’s Prize Medal.
DAVIS, BERGENDAHL, & CO., Newcastle-on-Tyne, Bole Importers; or, Agents, INGRAM & ROYLE, 52, Farringdon-st., London, E.C.

CONDY’S NEW DISINFECTING- POWDER.

(lib. in tin, with perforated lid, Is.)

POWERFUL, INODOROUS, NON-POISONOUS, CONVENIENT,

ECONOMICAL, SOLUBLE IN WATER.

Condy’s Powder combines the active oxidating properties of Condy's Fluid, with
powerful boric sulphate antiseptic base.

77u lightest sprinkle of Condi/t Powder suffices to render inoffensive any of tKe ordinary domestic n ui s an ces without disguising one smell by another.

■ Tin forwarded free bo Medical Men on application to

COHDY A MITCHELL (Limited), 87 and 68, Tnrnmill Street, London, E.G., the K&ken of Candy's Fluid.

WRIGHTS

Prescribed for Skin Disease for the past quarter century.
Made from the purest fat, saponified and incorporated with a
powerful Alcoholic Solution of Coal Tar, the black inert
matter being rejected.

Sold by all Druggists.

The Medical Profession is invited to discourage the sale of spurious
imitations of WRIGHT’S COAL TAR SOAP.

TAR

A refreshing

Toilet Soap.

Proprietors: W. V. WRIGHT & CO., Southwark, London.

SOAP.

pearsmsoSp

'* ■ S - iff 7<

* . v •

‘ Port* Fragrant, Refreshing.

^ Sir ER ARMII S WIJjSONV late President of the Ttftyal 'df SlirgedflB of

PJ&llis’ SOAP is of the nicest and most careful toanufactnre/and
ne most refresMng and agreeable of balms for the skin/*

..-•tv ii • :• '’•W -ii*wj* • 'Il iV•" ii# •*. Mc« *?*>»« nl

.. v.c.f£. T ETpjglWtfipR ™

,,88

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This ELIXIR is the most powerful and. vat
uiniue as a s! renalben: ;ig endjintt-iubrUe
Ifcissnt taste, and has teen employed in I
tooeas ia oases of Weakness and General De

INTERNATIONAL and UNIVERSAL BXftlBITIOlf, L0NBON, !8»4—TIBOT-CLABS ONKTIFIOATB and GOLD UDiL t i
• jp^PtiiTiow~JiaaT-ciiAfl§ os gr impair and tiBvttR MTHIAJ. fwjuw em*rtoritr otm* SWoHimWfMF

PURE TEREBENE (Hewlett’s).

PURI? TEREBENE is strongly recommended in “ Winter Cough,” Chronic Bronchitis, Emphysema,.Phthisis, Bronchorrh, J
aggravnted with a dyspeptic element, it controls the complication at onoe. Or. Mr khki.i. says : •• It cheoks the formation of flap
is so efficacious in expellingauv that may remain In the stomach or intestines, that I constantly employit in oases of Djrsp«.«fa
is a prominent symptom. Patients like It, and often continue taking it for months or years. It acts as an antiseplio. protiWy j

is a prominent symptom. Patients like it. and often continue taking it for months or years. It acts as an antiseptic:. prot-V thaw I

way as glycerine, oil of cajeput, and oil of eucalyptus. I am surprised that it has not come more largely into use in the tmia- nt of da f

Pure Terebene is of such value in winter cough that I rarely experience the necessity of resorting to other remedies, ft is a psW experSan
and if inhaled the first tiling in the morning, when the mucous membrauee are covered with thick viscid secretion, will give very great rr.>-
Pure Terebene is a valuable remedy, and will in time come largely into use."—Vida British Medical Journal, Dec. 13th, 1&S5, page 1103.

TEREBENE (Hewlett’s) is pleasant to take, and has the agreeable odour of fresh sawn pine. The dose is ten drops on a pices of sugar t Lr- •
four tlmes.a day. It is so effective that its remedial value is apparent ina day or two.

We would warn the Medical Profession against the common Terebem-s placed on the market, which, owing to the impurities they oontar
the patient harm. We guarantee our Terebene to be pure, having the most delicate fragrance of pine—a proof of its purity. We invite ootnpi-.»
by the Medical Profession and Pliannaceutical Chemists.

Packed in 5-os., 10-oz., 22-ag., and 90-oz. bottles. Physicians will oblige by luriting “ Terebene Pure (Jleielett* .

Prepared by C. J. HEWLETT & SON, 40, 41, and 42, Charlotte-street, London, E.C

Tasteless. Pure. Active.

Sold everywhere at 6d., i/, 1/9 & 3/*

PRIZE OF 16,600 FRANCS DE L’INSTITUT DE FRANCE.

QUINA LA KOCH

LAROCHE’S TRIPLE QUININE WINE.

digestion, ChMgesof Life, Nervousness, Hxbaustioi
Fevers, and the After Effected Fevers which have

of the preparations of
rntive. It. has a very
ospitfljs with immense
. Lose,of Appetite, In-
u. Slow Convalescence,
resisted all Quinine.

ALSO prepared with IRON—

For Purifying the Blood,

For Scrofnlons Affections,

For Chlorosis. *

Paris 1 23, rue Drouat. London

BBS ■ a 11 mssj a See Recommendatory Notices of Medical Press and Opinions of the leading Dermatoltfut;

M K II LJ I Extract from the Proceedings of the Royal Society, Edinburgh.

It flaltlHi P IN •• Experiments «n t lie Chief Disinfectants,* Commerce with a view of ascertaining their Passw o( Osstr. •

* " ■ ■ ■ ■ ■ ■ wW ing the Spores of the Anthrax Bacillus, by a Medical Officer of Health ana Public Analyst.

"LIQUOR CAKBONIS DETBBGBNS—This Is a solution of certain coal-tar products In spirit. It forms with water an emnl aksa. ASM
to water in the proportion of 5 per cent., _ a mm hours, distinctly retarded growth, for the spores, whether on gelatin

it had but feeble. Influence in preven i uiiirm p° k or in the broth, did not commence developing for twenty-fc -

the subsequent growth of anthrax. A I IIIIIHI hours. Undiluted Liquor Carbonis Detergan*. sating for four b

10 per cent, solution, acting for four ■■ ■ W W W ■ ■ arrested future growth.”

T Hk PRACTITIONER of September, 1881"Itching, which owes its origin .to too slow, a
example is that seen In Eczema connected with varicose veins of

the leg—also Pruritus Scroti, Labiorum and Ani—Is beat relieved by A A I

weak tarry lotions, one of the best of which Is Wright’s Liquor I . ft fN wC I I IU
Carbonis Detergens; a weU-made alcoholic solution of coal tar | | | N

suitably diluted.'

other kinds
our list of si

at of Mood, of which the i

Prom THE LANCET,__

CARBONIS I

psoriasis, which had resisted wS
M» Liquor Carbonis Dotergens. We esteem it a very valuabte addition to

nCTCDPCilO

iquoris a^arUde^fg'reat \j £ I ELllUllllWB

Inds^of treatment^speedily got well under the application of the Liquor Carbonis Detergens. We esteem it a very
m th<- MEDICAL TIMES AND GAZETTE. Janaary 19tb, 1867:—"We have more than |^h |WBspMflM M 4

and oan affirm its value as a detergent agent,
utility.”

•hromc ecsema. __ ,

ieptember 32nd, 1871 " We haveteeted It,

e consider the Liquor is an article of great

Kept In (took and sold by all Draggles (Wholesale and Retail) throughout the United Kingdom and Colonies.

Proprietors: W, V. WRIGHT ft 00., Southwark, London, S.E.

T*r» LlANCBT.J

THE LANCET GENERAL ADVERTISER.

[Apbh, 16,186T.

Trade Mark

Trade Mark

Trade Mark

Cologne

Annual Consumption exceeds 25,000,000 lb.

Sold Retail Evkbywhsrx

FOE

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BREAKFAST.

32 PRIZE MEDALS.

DR MICHAELIS’

TONIC COCOA.

Made from Pure Cocoa of the finest quality combined with a soluble Extract

of Acorns and free from Cellulose.

for Catarrhal Affections at the Digestive •• Hm a pleasant flavour like chocolate, never palta upon the pal«e,

dInfantile Diarrhoea. A Tonic, Nutritious, rapidly improved the oondition of the children fn owe* d
e for children ahd persona of all ages, and I and their state of nutrition. In extensive use in Germany as a beverage

Ueoommended especially for Catarrhal A uc ti ons at the Digestive 11 Has a pleasant flavour like chocolate, never paus
Omm, Ako for Chronic scid Infantile Diarrhoea. A Tonic, Nutritious, rapidly improved the oondition of the children in c*
andDifestfve Daily Beverage for children and persons of all ages, and i and their state of nutrition. In extensive use toQer™#
eanec^T wwful m oonv3esoenoe and for persons suffering from 1 both for childrenandforadulU.”-BBiT I flHMKDlCAi. Jovwrai., July 31
Debility. 1»M.

Manufactured only by

STO'lt'WRRCX BROS., Cologne.

SOLB AGKIWB PC« (htBAT BbTTXIB—

KUHNER, HEMJSCfitEE, ft- CO., 146, Cannon-street, liondon, E.G

tr Samples f6r trial win be forwarded on application to Medical Men and Public Institutions.

Fry’s Cocoa

FEY’S PURE CONCENTRATED SOLUBLE COCOA.

Prepared by a New and Special Scientific Process , securing extreme Solubility:

A large number of Testimonials, approving in the highest terms of this article, have been received from the Medical 1
Faculty, who state that they have not only adopted it for family use, but have also recommended it in many cases to
their patients. Apply for Samples and Copy of Testimonials to the Manufacturers,

Ji Si FEY" & SOB'S, Bristol, and 252, City Road, London, X.C.

GOLD MEDALS, EDINBURGH and LIVERPOOL EXHIBITIONS,1886. 88 PRIZE MEDALS awarded to the Firm._

Tub Lanckt,]

THE LANCET

ADVERTISER.

[April 16,1887.

(REGISTERED),

A NOURISHING HEAT AND HALT WINE.

Largely prescribed by the Medical Faculty in all cases of weakened constitution, and particularly useful in ea
whilst nursing, and delicate children, or in ailments where a stimulating—digestive—tonic nutrient is ind ica t ed.

DOSB: i TO 2 ODNCBS TWICB DAILT. IB BOTTLES, 2s. 6d., 6s., and 7s. fid.
SAMPLES FREE TO THE PROFESSION.

•Mates

Of all Chemists and Wine Merchants, and the Manufacturers—

HOOFER & COMFY., Chemists, &c., 65, Grosvenor St., and 26, Davies
also at 7, Pall Mall East, London, S.W. Laboratory—Mitcham, Surrey.

DIABETES.

Blatchley’s Celebrated Diabetic Breads &

are supplied to the following HospitalsGuy’s; St. Bartholomew's; 8*. Thaaurfk;
Middlesex; Royal Free; Great Northern; King's College; The London; Charing Qrous,
i; Victoria, Chelsea; Westminster; Bvelina Hospital. 8outhwar1c; Bye Hospital,;

St. Mary’s, Paddington; Consumption; Victoria, Chelsea; Westminster; Bvellna Hospital, Southwark; Bye Hospital,;

Grove Hall Asylnm ; Hospital for Convalescent Children, HIgbgate; Addenbrooke’s, Cambridge; All Saints, Bastbourne; Aj
Ashton-under-Lyne; Bury St. Edmunds; Bristol General; Birmingham General; Buckingham General; Buckingham; H‘ —" *
Yorkshire; Chatham; Colchester; Cumberland Infirmary; Coventry and Warwick; CoHt; Carlisle; Convalescent Home,
Coventry; Derby General Infirmart ; Dorset County; Gloucester; Greenock Infirmary; Glasgow; Hereford; Hafif Hastingssuadte.
Kent and Canterbury ; Kidderminster; Liverpool; Lincoln County ; Leicester Infirmary; Leeds; Louth. Ireland? Lynn; UtasHrj
Nottingham; Norfolk and Norwich; Northampton; North Cambridge; North Staffordshire; Oxford Infirmary; Presto* "
Queen’s, Birmingham; Royal Naval; Radcliffe. Oxford; Royal Isle of Wight; Royal Windsor; Royal Surrey, Guildford,
Liverpool; Royal United, Bath; Royal North Hants, Winchester; Royal South Hants Infirmary, Southampton; Royal Infl
Royal Haalar, Gosport; Royal Hospital, Portsmouth ; Reigate; Riga, Preston; Saffron Walden Hospital; Suffolk; Stamford;

Tunbridge Weus; Taunton and Somerset; Victoria Hospital, Burnley; West Norfolk and Lynn; Waggestoo'a, Leicester;
Worcester; Wisbeach ; Warneford Hospital, Leamington; Yarmouth ; York, and many Hospitals in the Colonies.— B. BLA!
street, London. Price lists of all Foods, post free.

BLATOHLHT.

CARNABYN

BARFF BORO-GLYCERIDE.

POE MEDICAL AMD SUBGICAL PURPOSES.

BY ROYAL LETTERS PATENT.

From Thx Labcbt :— '* Nothing oan be better than the action of thia compound."

From British Mbmcal Journal :—" The simplicity of arrangement, the freedom from enmbame— apfami
reader it particularly well adapted for military aurgery and for pcmotioe in rural diutriet"

“In Cyatitis . . . thk oompoxmd acta aa a charm. "—Richard Baxwrll, Bkl, F.R.O.S., Soafar i S>M
Obttfng-oroaa Hospital., \ •

KREO CHYLE BAEFF ft WIRE LIQUID JCEAT— Food apd Stimulant for Invalids and Tfiftafc

Roar 1^11 pattia^amand aamplaa apply to ■

THX XXXOOHTUS C0„ BOAD. LONDON, U

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_ ■•'*£*.*

Phi IiAjt<urr,j

THE LANCET GENERAL ADVERnsER:

[Ana id, 1867.

KEF.

The New Dietetic Effervescing

MILK DRINK.

The most easily assimilated Food in Wasting Diseases.

Must be taken fresh. Prepared daily.

MANUFACTURERS— _

SPRING & GO., 21, Blenheim Road, N.W.

KEF

130333^ -VAN ABBOTT & SON’S GLUTEN BREAD

and all other suitable Foods for Diabetic Patients. Dietary Table* and Price Lists port free on application.

VAN ABBOTT’S CONCENTRATED BEEF TEA. In Bottles, 2s. each.

Made by an entirely New Frooeat.

G. VAlf ABBOTT k BON, 5, Princes-street. Cavendish-square, W. — Telegraphic Address, “Glutens,” London.

’s Pale or Bitter Ale.—Messrs.

KINAHAN’S

LL

WHISKY

“THE CREAM

. OF

OLD IRISH WHISKIES”
Pure, Mild, Mellow,
Delicious, Wholesome.

The Prize Medal,
Dublin Exhibition, 1865.

20, GREAT T1TCHFIKLD 8T.,
LONDON, W.

A USODD

XX SAMUE1

CARLTON WHISKEY

(HIGHLAND MALT).

ELEVEN YEARS OLD.

Gold Medal, Calcutta Exhibition, 1884.

*25$. the gallon; 50s. the dozen. Carriage paid. Cash only.

RICHD. MATHEWS & CO.,

24 and 25, Hart-street, Bloomsbury, W.C.

(Late of Albany-street, N.W.)

Agenta for India—CUTLER. PALMHR, k CO.

I iebig Company’s Extract of Meat.

U For Improved and Economic Cookery.

LIEBIG COMPANY’S EXTRACT OF MEAT.

Only tort guaranteed GENUINE by Baron Liebig.

LIEBIG COMPANY’S EXTRACT OF MEAT. The Finest

Meat-Flavouring Stock. USB it for Soup., Sauce., and Made
Dishea.

LIEBIG COMPANY’S EXTRACT OF MEAT. Efficient

TONIC far all oases of Weakness and Digestive Disorders.

LIEBIG COMP ANTS EXTRACT OF MEAT.

Highly recommended as a Nightcap instead of alcoholic drinks.

^ LIEBIG COMPANY’S EXTRACT OF MEAT.

" GENUINE ONLY with facsimile of Baron Liebig’s slgnatnrejnjjhielnk
across label.

. LIEBIG COMPANY’S EXTRACT OF MEAT.

| Cookery Books post free on application to the Company,

| 9, Feooburch-avenue. London. B.C. _

' In oonsegnenoe of

LEA

k

[ PERKINS’

Whlohare calculated todeoelve
| Original 1 *^ attentJon U»a

I and Genuine

WoroMtanhir*

Imitations of

drosse and
. t Export Oil¬
men generally. Retail by Dealers
In Sauces throngbout the World.

SAUCE,

the Public, Lha k Pnom
fact that each Bottle at tbs

S&UM

bean their Signature, thus—

prletors, Worcester; (
Blackwell, London; k

eg to in

TRADE that they nre now Registering Orders for the SEASON-BREWED-
PALE ALE, in casks of 6 gallons and upwards, at the Brewery, BURTON
ON-TRENT, and at the undermentioned Branch Establishment
61, KINO WILLIAM STREET. LONDON. E.O.

s

Guaranteed
Pure and Soluble

Cocoa

WM. WOOLLAHS ft CO..

ORIGINAL MANUFACTURERS,

ARTISTIC WALL-PAPERS
Guaranteed free from Arsenic.

HO. High-street (near Manchester-square), London,
W. (Sole Address.)

Of all Decorators A Contractors. Seventeen Medals. In¬
cluding Gold Medal. International Health Exhibition.

HUXLEY’S

3s. 6d. each.

Qpiral Abdominal Belts,

7 k-/ for Pregnancy, Obesity, Ovarian Disease,
° and with Air-pads' for Hernia. Made on Prin-
ciples approved bv the first Fhysldan-
" Accoucheurs and Surgeons. Directions for
measurements: Circumference at a be; depth,
from a to e. Huxley's Obstetric Binder,
Discount to the profession 20pcr cent. Illustrated and

rloed Circulars on application to ED. H
’ svendish-street, Oxford-street.

v per cen
UxLBY,

13 (Ute of 12), Old

SALMON, ODY, & CO.’S PATENT SELF-
ADJUSTING TRUSSES

are considered by the leading members of the profession to be the most
effectual for Hernia. The principle of these Trusses are the Ball and
Socket adaption of the front pad, which, while retaining Its position on
the Hemia, oscillates with every movement of the body, and require*
no straps to hold them in position. Price list post free.—292, Strand.
London, W.C.

Digitized t

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87

e

SEaSffifi

THbLANW.3

THE UAMOBT

BBOCEELBANK’S CARRIAGE & ]

26 & ^p r JSWNQTOM GBfll
vU KTtf »»K8 61<n kinds, in STOCK and .BUILT to ORDER, will
improved construction. To Let on Job, with or without option of pi

47, HOLBORN VIADUCT, E.0.

BATH (
£1 5a.
Beading 1
from il,.
Consulting

Th^New Heart DU- ‘^"•STBES^UbSIP ort^le Tori

Hxereising lial Chairs, Illustrated Catalogues ( 208 pages) post free. The Dry Platt
£5 5s. - SpongittrJtafcl

ALFRED CARTER, 47, Holborn Viaduct, S&

No connexion with any other Vim. ..

H orse for Sale or Hire,

bay; aged five; stontish built; ride or i
i No blemishes, sound, perfectly quiet, and good
I month, owned if retained Bine months ; or L

H ansom Cab, Brougham, and Victoria.

These carriages are light, in nearly new condition, and are for
Saleatagreat reduction, or can be hired.—Apply, K. KE8TERTON A CO.,
9 3 and 94 . Long-acre, London.__ _

P ivate Hansom, circular front, by

Kesterton ; nearly new. Cost 120 guineas ; to be sold for 60 guineas,
Trial allowed.—Can bo seen at 4, Gaspar-inews, Courtfield-gardens.

Address, Frederick Orchard, UtS,

South Kensington.

NEW PATENT

O W. & °F. THORN

Til- m.wi luxurious Close
Carriage, on two wheels,
GVer Rented, an d ^ cwt.
) V.-_ '' J*f?hter than any ordinary

Particulars and Price from

W. & F. THORN, 19, Gt. Portland-st., London, W.

A nswty-invented Carriage for the Mi
with safety and comfort combined, i
Painted to choice; lined with cloth am
Illustrated Catalogues sent free.

C. FUGE, Taunton.

"Chineral Reform. —

1 and perfect burials. Bxplanatoi
NECROPOLIS COMPANY, 2, Lancasi
to Barth perishable coffins. The Arohbl
the Church of England Funeral Reform
object of your association—vii„ to simp
mouial, and to encourage burial in perisr
has my full concurrence and sympathy.

J. MAYTHORN & SON, BIGGLESWADE,

Builders of Carriages of every description, of
HIGHEST QUALITY ONLY.

ESTABLISHED 1812.

LINED THROUGHOUT WITH SILK.
FIVE GUINEAS CASH.

uein Lon e

Tailori

prices.

raeasui

to any part of the* li

HAMIL TON & CO.,

VIL 6r COURT TAILORS.
INDIA AND COLONIAL OUTFITT: 5.

MAYTHORN‘8 QI RGUliAK-iGlGNT BROUGHAMS are roomy, com
fortable m*v of draught., nnd perfectly ventilated.

At STAND No. 24,

SPORTSMANS EXHIBITION, OLYMPIA,

From 20th to 30th of April. 1887. J. M. A Son will exhibit seven speci
mens of their celebrated Carriages, Including tlie above, and
earnestly invite a catefttl inspection ofthe same.

HB LaNCXI,]

THE L/WQET GENERAL ADVERTISER,

[April 16.1887,

For MeamrGmetr£i Circumference of Abdomen at the largest
[part [and [Mips.—(Special Department for Ladies.)

No. 1. FOR GENERAL SUPPORT.

No. 2. FOR PREGNANCY,

No. 3. FOR PROLAPSUS UTERI (as fig.)

With Improved Indiarubbor Perineal Pads and Bepulatlnff Straps,

No. 4. FOR UMBILICAL HERNIA.

N<n5. GENT'S RIDING BELT

RUSTICAL THERMOMETERS

NOTICE. —We do not sell any Thermometers in which the Index can
be shaken down into the bulb, and so rendered useless.

Every Thermometer is guaranteed of Standard precision. Government

Jertindate from the KoyslKe* Observatory can be had wfoheanistf desired.
Price Is. 6d. extra. Any one can be had in Silver Case at 2s. 6d. extra.

1.—Hospital 4-in., with Indestructible Index eadh

- Indo et m o tibl e flat b a ck , to prevent

FOR INVOLUNTARY
EVACUATIONS.

Disease

of the

Conveying

Accidents,

Evacuations

Debility,

> Old Age,

Paralysis,

SOLB PROPRIETORS AND MANUFACTURERS:

HOOPER & COMP T ' 7, Pall Mall East, S.W., & 55, Orosvenor-st., W.,

ORDERS BY, POST OR TELEGRAM EXE CUTED IMMEDIATELY.

lAlLEY'S PATENT ABDOMINAL BELTS.

This Lancbt,]

THE LANCET

Salmon’s Obstetrio

W ter buMdiateoMifUrdalfvary.Sa.Sd.!

87, Wlmpoto-ft., OmodklMfiiaia,
London, W^oomar of WlgmorMi.)

[April 16,1887.

Obstetrio Binder,

■ftar daltrary, 8a. Ad.; by port Sa. Md.

The Binder la a aobatitata for tlia Inraf
generally naad Immediately after labour. H
u m a d e of strong linen, and diapenaaa wttfc
the oroal pinning. The advantages of the
Binder are facility of ap p lication. oaaUaaC
artth oo mfort and greater eAoleooy. Mae ante
ment r eq uir e d , ordinary afaa of too watrt.

Bash ooa atamped with name and aiUraaa

Him R. SALKOV,

IT. Wtmpo l e atr ee t , Oarandhb agnaia,
L o n don. W. (ooanar of Wlgaaoao a t .).

INTERNATIONAL MEDICAL AND SANITARY EXHIBITION, LONDON, 1881.

"Certificate of Merit in Section I. for Bandages, Lint and Cotton Wool.”

R. J. WINTER & CO., Manufacturers of

IMPROVED BANDAGES FOR HOSPITAL & GENERAL USE.

Tbeae Ban dag ea are manufactured from oar Patent Bandage doth, which enablea oa to prodooe a greatly Improved Bandage at n very
low prloe.

The following are alwaya kept in etook, unbleached, for boepUal oae, in two qualities, cloae and open wore (absorbent) i—* and 6 yarda lone,
by 3* inohea wide; 6 yarda long, by 3, 3, and 6 inches wide; 8 yarda long, by 3. 3}, and 8 inobea wide.

Adsorbent, Water-dressing, Muslin, White Oalloo, Flannel, and Domette, 6 yarda long, by 3}, 3, and 6 Inohea wide.

Cotton Wools and Lint at Low Prices. Price Lists, with samples, free by post.

SPECIAL ORDERS EXECUTED ON THE SHORTEST NOTICE.

Post and Telegraphic address—

WINTER, GO 0 DO E STREET, LONDON.

THE PERFECTION OF CLEANLINESS,
UTILITY, AND SIMPLICITY.

TWYFORD’S

Combining W.C. BASIN and TRAP, URINAL
and 8L0P SINK, has the following Special
Advantages

Unlike ordinary W.C. Basins, it is not enclosed toith wood¬
work, but is fully exposed, so that no filth, nor anything
causing offensive smells can accumulate, or escape detection.

All joints and connexions being in sight, any leakage or
other defect can be easily detected and remedied.

No Wood Fittings are required except a hinged seat,
which being raised, the Basin can be used as a Urinal or
a Slop Sink, the "wetting” so objectionable in Closets
having permanent seats being avoided. Free access can
thus be had to all parts of tne Basin and Trap, so that
everything about the Closet can be easily kept clean.

Made with or without Slop Top in three ways.

No. 1. With raised Ornamentation, Oak or Florentine
Pattern (White or Ivory).

No. 2. Plain, White or Ivory, or with Printed Pattern.

No. 3. In strong Fire Clay, specially adapted for Factories,
Workhouses, Asylums, Infirmaries, Hospitals, &c. &c.

The flushing arrangements are so perfect, that with a flush
of two gallons of water, it is guaranteed that all the soil and
paper will be completely removed from the Basin, and

The Lancet,

THE LANCET GENERAL ADVERTISER.

[Aran. ie f 1887.

S t. Bartholomew’s Hospital and Qt. George’s Hospital Medical School,

COLLBGB. kJ HYDB-PARK-CORNER, 8.W.

The SUMMBR SESSION begin* on Monday, May 3nd.

The Hospital comprise* a lervioe of 760 bed* (Including 76 for con¬
valescents, at Swanley).

Student* may reaide in the College within the Hospital wall*, subject
to the collegiate regulation*.

For particulars, apply personally, or by letter, to the Warden of the
College, St. Bartholomew* Hospital, B.C. A handbook forwarded on
application.

S t. Bartholomew’s Hospital and

COLLBOB.

OPBN SCHOLARSHIPS IN 8CIBNCB.

Two Scholarships at the value of £180 each, tenable for one year, will
be competed for on September 37th and three succeeding days. One of
the value of £130 will be awarded to the beet candidate at this Examina¬
tion under twenty years of age, if of sufficient merit. For the other,
the candidate* moat be under twonty-flv* year* of age.

The subject* of examination are Physios, Chemistry, Botany, Zoology
and Physiology. No candidate to take more than four subject*.

The Jeaffreson Exhibition will be competed for at the same time. The
•abject* of Examination are Latin, Mathematic*, and any two of the
three following language*: Greek. French, and German. This is an
open Exhibition of the value of £60.

Candidates must not have entered to the Medloal or Surgical Practioe
of any Metropolitan Medical School.

The successful candidates will be required to enter at St. Bartholo¬
mew’s Hospital In the October succeeding the Examination, and are
eligible for the other Hospital Scholarships.

For particulars, application may be made to the Warden of the College,
at St. Bartholomew's Hospital, B.C.

^The Royal Westminster Ophthalmic

J. HOSPITAL. King William- street, Oharluf-oross.

The Practioe of this Hospital is open to Practitioner* and Student*
from 1 to 4 p.m. daily.

Spe cial I nstruction Is given in the Diagnosis, Pathology, and Treatment
of all BYBAFFBCTION8, Including the Operations on the Bye, the
Treatment of Error* of Refraction, and the use of the Ophthalmoscope.

Tb* next Clinical Bvening, Friday, May 6th, at 8 p.m.: Mr. Rouse
and Mr. HaRtridge.

Terms for six months, £3 3s. Perpetual, £3 6s.

For particular* apply to Mr. Juler, 77, W1 in pole-street, W.

Westminster Hospital Medical School,

▼ T Carton-street, 8.W.—The SUMMBR SBS8ION commence* on
May 1st. A Science Scholarship, value £40, Is offered for competition.
The examination will be in Chemistry (Organlo and Inorganio) and
Physics, and will be held on April 30tb. In September Bn trance
Scholarships, value £30 and £40, will be offered for competition.

Student* entering in the summer (except those who have already
obtained a Scholarship) are allowed to compete for the Bntranoe Exhi¬
bitions in the following September.

Feet: £100 In one sum on entrance, or 100 guineas in two payments,
or £116 in five payments. No extras, except parts for Dissection and
Class of Experimental Physics.

For prospectus and particular* apply to

P. de HimuxD Haix, M.D., Dean.

(^haring-cross Hospital Medical

\J SCHOOL.

SUMMBB SESSION, 1887.

lectures and Clinical Instruction In the Wards will commence on
Monday, May 2nd, at 0 a.m.

Gentlemen can enter to any Course of Lecture*, or to Hospital Prac¬
tice only.

The Hospital has a service of 330 beds for Clinical Teaching, including
those of the adjoining Royal Westminster Ophthalmic Hospital, to
which General Students are free.

Two Entrance Scholarships of £30 and £30 respectively, for whioh
General Students now entering can oompete, are awarded annually in
October.

The Llewklltv Scholarship of £95 and the Goldies Scholarship
of £15 are open to General Students who have completed their third and
first academical year* respectively.

The Pereira Prize of £5 is open to all General Students, and is
awarded for the best Clinical Reports.

8tuJent* are eligible for the appointments of Resident Medical,
8urgical, and Obstetrical Officer, for Clinical Clerkships, Surgical
Dreesershlps. and for Assistant Demonstratorships of Anatomy,
Physiology. Ac., without additional fee.

Fem—F or the curriculum of Study required by the various examin¬
ing bodies and hospital practice, 90 guineas in oae sum. or 100 guineas
In fire Instalments. The Composition fee for Dental Student* is M3 3s..
payable in two instalments.

• « The hours of Lecture* have been specially rearranged to suit the
convenience of Dental Student*. C ha ring-crow Hospital Is within three
minutes' walk of the Dental Hospital of Lone}on.

Preliminary Science Instruction. —Arrangements have been made
for Students desirous of undergoing a Course of Instruction in Science,
such as that required for the Preliminary Scientific (M.B.) Examination
of the University of London, to attend at the Normal School of Science,
South Kensington.

A Prospectus containing every Information will be forwarded on appli¬
cation to the Librarian and Secretary, Mr. J. Francis Pink, who attend*
dally at the Office of the School, Chando*-street, Charing-croas, between
the hour* of 10 and 4.

' 1. Mitchell Bmtrcir, MJL, M.D., Dm. •

The 8UMMSR SESSION will oommenoe on Monday, May 2nd.

The Fee* for Perpetual Student* are £136 on entrance, or £130 paid by
instalments extending over three yean.

£10 10s. will be deducted from these fee* in the oaae of Stodent* who,
under the Conjoint Scheme, do not require Instruction in Chemistry and
Materia Mcdica.

Second and third-year Students are received upon payment of £90 and
£86 respectively.

Dr o ss c nhlp*. Clerkships, and all the House Appointment* are
awarded without extra fees, and the latter on the result of competi¬
tion.

The William Brown £100 Exhibition, tenable for two yean, and
the £40 Exhibition, tenable for three yean, are open to all Perpetual
Students.

The following Bntranoe Scholanhlps are offered for competition in
October, and Students entering in the Summer Session are eligible to
compete for them

1. A Scholarship, value £136, for the 8ons of Medloal Men who have
entered the School during the current year.

3. Two Scholarships, value £60 each, open to all students commencing
their studies in May or October. Subjects: Latin, French or German,
and Elementary Physics.

3. A Scholarship, value £00, open to all students who have entered the
School daring the current year, naving passed the Cambridge 1st M.B.
since the previous October. Subjects: Practical Chemistry and
Blcraentary Biology, Physiology and Anatomy.

4. A Scholarship, value £66, open to all student* who have entered the
school during the current year, having been previously signed up for or
passed the Oxford 1st M.B. or Cambridge 2nd M.B. Subjects: Anatomy
and Physiology.

Other Prizes of the value of £150 are offered for competition annually.

The Appointment* of Obstetric Assistant, with a salary of £100 a year -
and board and lodging; Curator, £60; Medical and Surgical Registrars,
£50 eaah, are awardedyearly upon the recommendation of the Medical
School Committee.

The New Physiological Laboratories are now finished, and have been
placed under the superintendence of Dr. Dellplne.

Prospectuses and farther details may be obtained by application to
WILLIAM Wadham, M.D., Dean.

S t Mary’s Hospital Medical School.—

The SUMMBB 8BS8ION will oommenoe on May 2nd. The Hos¬
pital contains 381 beds, is situated In one of the most pleasant district*
ef London, and is in direct communication by rail with all parts of the
Metropolis. Several Scholarships in Natural Science will be offered for
competition in September. Students entering in May are eligible to
compete for these Scholarships. Special cloams are held for tne Pre¬
liminary Scientific Examination of the University of London. Pee
£10 10 *., which will be returned to any member of the class who enter*
as a Perpetual Pupil. Gentlemen who enter for tAls course count their
medloal studies from the time at which they commence their attendance

on the Lecture* on Anatomy and Physiology,
read- The School buildings, to which large auditions were made in 1883,
Bxhf- especially as regards the laboratories for the teaching of Physiology and
Chemistry, have been further enlarged this year by the addition of a
wing containing a new Library, Pathological Laboratory with arrange¬
ments for Bacteriological research, and various class-rooms for Anatomy,
Physiology, and Chemistry. In the Student*’ Club a larger Dining
Hall and Heading Room bare been added.

The course of teaching at this School Insure* careful and complete

E reparation for all the Examining Boards, the Public Services, and the
Igher University examinations.

in addition to the clinical instruction and lectures given in the wards
dally, distinct Clinical Lectures will be given on Fridays throughout the
academical year at 4 P.M.

The medical, surgical, and obstetric tutors assist the students in pre¬
paring for the final examinations.

Post-Graduate Coarse.—These lectures and demonstrations are given
on Saturdays, at 4 p.m.

All the Medloal Appointments in Hospital, including the seven Honse-
Sur^eoncies, are open to pupils without additional fee or expense of any

For prospectus and further Information, apply personally at 4 p.m. or
by letter to

George P. Field, Dean.

Sidney Phillips, M.D., 8nb-Dean.

The medical, surgical, and obstet
paring for the final examinations.
Post-Graduate Coarse.—These 1«

RESIDENCE FOR STUDENTS.

S t. Mary’s Hospital Medical College,

33 and 35, Westbourne-terrace, W.

Students may reside in the College under the supervision of the
Warden, Dr. Robert Maguire.

Terms, 00 guineas for the academical year, payable 30 guineas In
advance on (Sat.. 1, Jan. 1, and May 1, to include special instruction by
the demonstrators on four days a week. The Warden will be happy to
show the arrangements of the College, or to give any further Information
concerning it.

purriculum of the M.D. Degree,

LONDON.—8tudents who have matriculated and are intending to
enter, or who have already entered, at any one of the London Medical
Schools for the purely Medical portion c4 their studies can prepare for
the PRELIMINARY SCIENTIFIC EXAMINATION at Unlvenity
College, under Professor Williamson, LL.D., F.B.S., Professor Carey
Potter, F.B.8., Professor Oliver, F.B.8., *nd Professor Lank ester,
LL.D., P.R.8.

Fee for the complete course of study required, Including lecture* and
laboratory work, 36 guineas.

For particular*, apply to the Secretary, Unlvareity College, Gower-
street. - -

)y Google

Thb Lancet,]

THE LANCET GENERAL ADVERTISER.

{Anttt/16, , fB67.

Qociety of Apothecaries of London.—

KJ The next Examination in Art* will be held at their Hall. Bloek-
f rinrs, B.C., on Friday end Saturday, the 3rd and 4th of June. 1887.

This examination will qualify candidate* for registration as Medical
Students.

A Syllabus of the subjects, which, according to the regulations of the
Genera! Medical Council, may be passed at one or more examinations,
can be had on application.

An Bxsml nation In Arts will again be held on the 2nd and 3rd of
September, 1887.

T. PxKxaxrxx, MJ).. Secretary to the Board of Hxaminers.

(Cambridge Examination in Public

HEALTH.—A Special Class, to Include Laboratory Instruction,
will be formed in May to prepare for the October examination.—Address,
Hygiene, The Lancrt Office, 423, Strand, W.C.

s Hospital Medical School—

^NIVEBSITT OF LONDON" PRELIMINARY SCIENTIFIC
(M.B.) EXAMINATION.—luitroetton ts given in all the Subject* of the
above Examination at GtTY'8 HOSPITAL, during the winter and
streamer sessions. The fee for the whole coarse is ten guineas. The class is
not confined to Students of the Hospital.—For further particulars, apply
to the Dean, Ouy'i Hospital, Southwark, S.B.

U niversity College, London.

OBOANIO CHEMISTRY.

Assistant Professor—H. FORSTER MOBLEY, M A., D.Sc.

The following Courses of Lecture* will be given In May, June, and
July:—(a) Elementary; Tuesdays, Wednesdays, and Fridays, at 11.
(fi) Special Course, Including subjects required by candidate* for Int.
M.B.: 3 lecture* a week, (e) Advanced, including the more Important
results of recent research In organic chemistry, and in the study of the
physical constant* of organic bodies; 2 lectures a week. Dates erf
beginning: (a) May 3rd; (0) May 4th, at 9 a.m. ; (c) April 19th, at 9 ajc
J. M. Horsbubqh. M.A., Secretary.

T>esearch Scholarships of the Grocers’

XL COMPANY.

The following Lectures on “ Malarial ” Fevers will be given, by per¬
mission of the Board of Managers, in the theatre of the London
Institution, Finsbury-circus, by W. North, Bsq„ one of the Company's
Research Scholars.

Lecture I.

Monday, April 18th, 5 p.m. Subject: Their Distribution, and the
general conditions under which they prevail. History of them in the
province of Rome.

Lecture II.

Monday, April 25th, 5 p.m. 8 ubject s Local Conditions affecting their
distribution as studied in the province of Boms.

Lecture III.

Thursday. April 28th, 5 P.M. Subject: Recent Researches into their
otiology and pathology. The possibility at prevention In the individual,
and ofimprovlng the conditions of malarious countries.

TTniversity of Durham College of

vJ MEDICINE, Newcastle-upon-Tyne.

The SUMMER SESSION will commence on Monday, May 2nd.

Licwcn and Dhros or Mkdicdui, Suboeuy, and Sajotabt
Science.— 1 Three Li canoe* and four Degrees are oonf erred by the
University of Durham—viz.. Licences in Medicine, in Surgery, and in
Sanitary Science; the Degree* of Bachelor In Medicine, Master in
Surgery, Bachelor in Surgery, and Doctor in Medicine. Attendance at
the University of Durham College of Medicine during one of the four
years at professional study, or subsequently to qualification elsewhere, is
required as part of the curriculum for the Degrees, except in the case of
Practitioner* of more than fifteen years' standing, who have attained
the age of forty years, who can obtain the Degree after examination
only.

The first and second examinations for the Degree of M.B. may be
passed prior to attendance at Newcastle.

The extra Preliminary In Art* may be passed at any time previously
to the candidate’s entry, for his Pinal Examination for the Degree.
Candidates who have passed the First Examination of the Conjoint
Board in England of the Royal Oolleges of Physician* and Surgeons will
be admitted to the Second Examination for the Degree of M.B. without
farther examination, except In Chemistry, with Chemtoal Physios, and
Botany with Medical Botany. Candidates who may pass the First and
Second Examination for the Degree of M.B. will be exempt from the
First and Second Examinations of the OonjoiatBoard.

8cKhDAR3HiPS, Ac.—A. University of Durham' Scholarship,valtia £100,
for Proficiency In Art*, awarded annually to Students In their first year
only. The Dickinson Scholarship, value £15, annually, together with a
Gold Medal, for Medicine, Surgery, Midwifery, ana Pathology. The
Tulloch Scholarship, value £20. annually, for Anatomy, Physiology, and
Chemistry. The Chariton Scholarship, value £35, annually. for Medi-
clne. Tne Gibb Scholarship, value £25, annually, for Patho¬
logy, The Govder Memorial Scholarship (at. the Infirmary, Newcastle),
value £16, for proficiency in Clinical Medicine and Clinical 8ur|
At-the end "off each Sehsiog a Silver Modal ADdlCertificates of r H
are awarded 'in ea6h of the regular chvsSes. An Assistant' C
of the Museum Is annaalfy appointed I rem oolong the Senior Sti
and re c e i ves an honorarium at £12.' Four. Assistant DemotutratdHs of
Anatomy (eaoh receiving su honorar i um of £6), two AsaiMant'Physio¬
logists, and two Pathological Assistants are also sleeted. Four Basident
Assistants, tbses non-resident Clarks, and sixteen non-resident Dressers
are chosen every throe months.—Further particular* with regard to
Examinations may be obtained from- Lake Armstrong, M.D., 1, SMen-
square, Newcastleupon- Tyne: or. on all other .matters! connected with
the College, from Mr. Henry l.Acaatretig, doling* of Medicine, New.
castle-npon-Tyne.

The Yorkshire College, Leeds: Medical

X Department.—The Fifty-sixth SUMMER SESSION of the Leeds
~ ‘ .tin ” * ** -.v.

School of Medloine will beg’
Registrar.

on May 2nd. Prospectus free from the

U niversity College, Bristol,

MEDICAL SCHOOL.

The Bummer Session will oommence on Monday, May 2nd. Pro¬
spectuses may be obtained on application to

B. Markham Skbrritt, M.D., Dean.

VICTORIA UNIVERSITY.

|Jniversity College, Liverpool.

Medical Faculty.

The SUMMER TERM will COMMENCE on MONDAY, MAY 2 nd.

LECTURES AND CLASSES.

Materia Medica ......Dr. Carter.

Medical Jurisprudence ...Mr. Paul.

Botany.Dr. Shearer.

Practical Chemistry™........Dr. Campbell Brown.

Operative Surgery.Mr. Rushton Parker.

Practical Pathology .Dr. Davidson and Dr. Barron.

Practical Anatomy..Mr. Banks and Dr. Boas.

Practical Physiology.Dr. Caton and Mr. Larkin.

Hygiene ......Dr. Hope.

Comparative Anatomy......Dr. Herdman.

I Julies..........

Fh

.Dr. Oliver Lodge.

DENTAL LBOTURBS.

Surgery...Mr. Phillips. I Anatomy.Mr. Paul.

Mechanics.Mr. Councell. | Metallurgy.Mr. Roys ton.

For Prospectus and information apply to the Vioe-Dean, Mr. PAUL,
38, Rodney-* tree t.

0

wens College, Victoria University,

MANCHESTER.

MHDICAL DEPARTMENT.—SUMMER SESSION.

Principal—J. G. G berk wood, LL.D.

Dean—ProfessorA ltrkd H. Youno, M.B., F.R.C.S.

PROTKOBORS AMD LECTURERS.

Practical Anatomy—Professor Alfred H. Youug, M.B., F.K.C.B.
Practical Histology—Brackenbury Professor, William Sterling, M.D.,
D.Sc.

Practical Chemistry—-Professor Harold B. Dixon, M.A., F.R.8.

Botany—Professor W. C. Williamson, LL.D., F.R.S.

Zoology and Embryology—Professor A. Milne* Marshall, M.D., M*A.,
DTSc., F.B.8.

Comparative Osteology—O. Herbert Hurst.

Materia Medica and Therapeutics; Practical Pharmacy—Professor D.J.
Leech, M.D., F.R.G.P.

Practical Morbid Histology—Professor Julius Dreeohfeld.M.D., F.B.C.P.
Operative Surgery—Thoe. Jones, M.B.. B.S., F.R.C.8.

Practical Surreal Pathology—Alfred H. Young, M.B., F.R.C.S.
Obstetric* and Gynooology—'Professor Charles J. Oulllngworth, M.D.,
M.R.C.P.

Clinical Obstetric* and Gynscology— Professor Charles J. Oulllngworth,
M.D., M.R.C.P.; D. Lloyd Robert*. M.D., F.R.C.P., F.E.S.B.
Diseases of Children—Henry Ashby, M.D., M.R.C.P.

Medical Jurisprudence and Practical Toxicology—J. Dixon Mann, M.D..
M.R.C.P.

Hygiene—Arthur Ransome, M.D., M.A..F.BB.

Mental Diseases—George Wm, Mould, M.R.C.S-
Ophthalmology—David Little, M.D.

OUuioal Ophthalmology—David Little, M.D.; Charles K. Glaseott, M.D.
Dental 8urgery—Leonard Matheson, L.D.S.

Dental Anatomy and Physiology—A. M. Paterson, M.D., M.R.C.S.
Dental Metallurgy—C. A. Burghsrdt, Ph.D,

With Assistant Lecturers in all the principal subjects.

The Session commences May 2nd.

The Classes at the College qualify for Degrees in the Victoria Univer¬
sity, for many of the Degree Examinations of the University of Londsn;
and for the Diploma* of the Royal Colleges of Physician* and Surgeons
of London, Ac. Ac.

Prospectus will be forwarded on application to the Registrar.

Henry Wm. Holder, M.A., Registrar.

“MORITINGSIDE,”

LAV ON .SPAA HASTINGS

HOME SCHOOL

For Delicate Girls.

Qpeech for the Dumb.—The Associa-

M TIONforthe ORAL INSTRUCTION of the DEAF andJDUMB,
11, FI twoy-squore.W,, wider the pfesideqcyOfHARIsClKANVj: LLBiK.fi.,
educates children upon the pure Oral or Gennao.system (by which they
are taught to speak add t& understand what others Say by means of lip-
reading), and trains teacher* on that system, both tor pufelio institution*
and private families.

Members of the medical profession are oordially invited to visit the
sohool and oollege of the Association any time by appointment, or to
attend the publio lessons on Wednesday alternoons.at 3 o'clock.

For terms and particulars, apply to William Van Praagh, Esq.,
Director, 11, Fltzroy-square, W., any morning between 11 and f'

GoogI

e

Thb Lanckt,)

THE LANCET GENERAL ADVERTISER.

IApkil 1G, 1887.

O inique on Diseases of the Skin.—

Professor McCALL ANDERSON’S Clinique on Diseases of -the
Skin (at the Hospital for Skin Diseases, 8. Blmbank-street, Glasgow)
will commence on Wednesday, May 4th, and be continued during the
Bummer Session every Monday and Wednesday, at half-past 2 p.m.
Students enrolled at the hospital. Fee 1 guinea. The directors offer the
■am of £5, to be expended in a prise or prize* to the most deserving
students. __

U niversity of Edinburgh.

SUMMBB SESSION, 1887.

The Summer Session will commence on Tuesday, May 3rd, 1887.
Principal—Sir William Muib, K.C.8.I., D.C.L., LL.D.

The Classes for the different Branches of Stud; will be opened as
, follow*:— t

CUuiei. Day nf Opening and Sours of Attendance. Trqfessore.
Medical Jarispradence (for*)

Law and Medical [ Tost, May 3,11 a.x.

' Students). )

Botany .Toes., May 3, 8 ajc.

*58siuiaso

Field Demonstrations on Saturday*.

Obstetrical and Gyntcco-'i
logical OpcraHon8 (Toes- > Tues., May 3,10 a x.

day and Friday). )

Practical Materia Medioa) T a in ■ «

(including Pharmacy) ... / TaeB - MttJ * 10 AJt
Practical Chemistry ... { x * J S ' 9 ** aDd } Prof - Crum Brown.

’StM&V Anat0m . y } T.C.. 3. 11 A.X."' Prof. Greenfield.

Anatomical Demonstrations Wed May 4, 11 a.x.J

d»Uy ... ... ...«< Hepburn. M.B.,

Demonstrator.

Prof. Sir Douglas

Madagan.

•Prof. Dickson.

Prof. Simpaon.

{ Professor Thomas R.
Fraser.

d„ May 4, 11 a.x. (

ally.<

Practical Anatomy. Tees., May 3, dally. 1

"»»■

3

Prof. Annandale.
f Profit.

I Grainger Stewart,
1 T. B, Fraser, and
1 Greenfield.

I Prof. Simpson, on
l» Diseases of Women.

Taea n May 3,1 p.x. Prof. Cram Brown.

Toes., May 3, 3 r.x.
Toes., May 3, 8 p.x.

Chemistry (Organic) Ad¬
vanced Class (Tues.

Wed., and Thors.)

Natural History .

Practical Natural History
Practical Physiology, in -\ T M o o
eluding Histology ... j TaM - MaJ 3 * 3 ”*•
Operative Surgery and > T M o . p M
Surgical Appliances. ) Tuwt ’ May 4 PM ’
Practical Hygiene ... Tues., May 3. 2 P.M. j

| Prof. Ewart.

Prof. Butherford.
Prof. Chienr.

Prof. Sir Douglas
Haclagao.

Lecturers.

Wed , May 1, 3 r.x.

Thomas 8. Clouston.
M.D.

Argyll Robert¬
son, M.D.

{ D ;

('James Andrew, M.D.
■JJames Carmichael,
l M.U.

Mr. George B,-ook.

Mental Diseases, with*)

Practical Iustruction nt
Mornlngside Asylum.

(Mon., Wed., Frld.) J

Diseases of the Eye. Wed., May 4, 9 a.x.

Clinical Instruction on"\

Diseases of CoUdren at( TnMI
Royal Hospital for Sick f TnM -' May 3 ’ 10A M -
Children. J

Comparative Embryology Tues., May 3, 3 p.m.

Royal Infirmar*, daily, at noon.

Summer Session ends July 32nd. Graduation Ceremonial In Medicine,
Ac.. Monday, August 1st.

The classes In the Faculty of Medicine, except Botany, Natural His¬
tory. Clinical Medicine, ana Clinical Surgery, meet in the University
New Buildings.

Faoulty ol Arts.—Tutorial Claasea In Latin, Greek. Mathematics,
Natural Philosophy, Loglo and Psychology, and Moral Philosophy, will
meet on Tuesday, May 3rd. Fees payable to the Class Assistants.

Practical inatruction it affirded in laboratories furnished with all the
necessary appliances, and In Tutorial and Practical Classes in connexion
with the above chain, and under the superintendence of the professors.

Information relative to Matriculation and the Curricula of Study for
Degrees, Examinations, Ac., may be obtained on application to the
respective Deans, or at the Secretary’s Office, and full details are also

S ven In the University Calendar, published by James Thin, to, South
ridge. By authority of the Senatus.

March 1887. Joxx Ki KILPATRICK, Sec. Sen. Acad.

"[Edinburgh.— Students.— Boarding.—

-La A Physician residing In a healthy locality within a short distance
from the University and Hospitals, Ac., can receive one ortwo Stud-nt*
attending classes during the summer session, beginning early in May.
Studies superintended and control maintained over junior* to prevent
Idleness. Home comforts ensured.—Particulars forwarded on addressing
Physician, care of Messrs. Keith A Co., Advertising Agents, to, George-
street. Edinburgh. ____

COLWYN BAY, NOBTH WALES.

CLIMATE MILD, DRY. BRACING.

First-class SCHOOL for Young Gentlewomen. Most highly reeom
mended by several physicians. Principal, Miss Barlow.

Individual attention is given, and a healthy, natural, moral tone is
aimed at, a tone befitting GOOD WOMEN.

Colwyn Bay has lovely oountry walks, good sea bathing, and mild
winter*.

44

K ing Ed ward VI.’s School,B arkhamsted,

Herts, twenty-eight miles from Button. Good Scholarships and
Exhibitions. Laboratory, heated Swimming Bath, Fives Courts, Work-
thope, Ac. £8? per annum.—Address, Head Master. __

Education.—To Professional Men of

Li Limited Inoome.—A few BOYS, sons of the above, are admitted
from time to time Into a well-known school of high tone, on greatly
reduced fees.—For full particular*, address, in strict confidence. Ho,
care of Main. Belfe Brothers, ft. Charter house-buildings, Aldeoigate,
Lon don, B.C. _

T^psom College Preparatory School.—

-Li For Sons of Medical Men. Under the patronage of the CoundL—
Mr. Jeffery, twenty year* Assistant-master, prepares bovs, under fourteen,
for Epsom College'.'Latin, Greek, German. French, thorough English,
Arithmetic, Algebra, Euclid. Cricket and football during the seasons.—
Prospectus of J. Jeffery, Parade, E p som. ____

Aral Education of the Deaf.—Mr. H. N

Vy DIXON, M.A.Lond. and Cambridge, FX.8., give* a thorough an

high class education to deaf children, baaed u]
For Prospectus, apply to H. N. Dixon,
amptou.

_ R»d

the Oral Me
it. Paul’s-road, North-

DEFECTS OF SPEECH.

Mr. WILLIAM VAN PRAAGH’S System for the Cure of all Defects
of Speech, both acquired and congenital.

For information, apply to Mr. William Van Praagh, 11, Fitzroy-
squnre, London, W. Person al interviews by appointment.

and Dumb Children of the higher

Classes educated on a Pure Oral System. Private and select
school for limited number. Special home comforts.—Address. Harry
W. White (formerly Vice-principal Ealing Training College for Teacher*
of the Deaf), 115. Holland-roed, Kensington. Next Term April 25th.
" By this method alone It the intellect of the mute enabled to travel
beyond the range of a few who are skilled in the manual sign language,
and to c onverse freely with all.’’—T he Laxckt, July 11th, 1886.

(Jollegf

e for Daughters of Medical

M

Pelican House College (in connexion with Pelican House School),
Grove park, Denmark-hlll, S.B., for the Education of the Daughters of
Medical Men, at fixed. Inclusive, and moderate terms, varying oooordlag
to age, as at the Epsom College for Boys.

The educational advantages will be equal, to those of the best high
schools; but the College, being designed for the Daughters of Pro¬
fessions! Men only, will offer the further desideratum of suitable com¬
panionship.

Applications must bs made to the Secretary, Captain Peed, Ivyhurat.
Dulsnch-grove. Dulwich, S R. _"_

M assage.—Lectures and Demonstra-

TIONfl at the Weekend HOSPITAL for DISEASES of the
NBBVOUS SYSTEM, Welbeck-street, W.—Particulars.apply to Matron.

MASSAGE AND ELECTRICAL TREATMENT.

LECTURES end DEMONSTRATIONS will be delivered at the
SCHOOL of MAS8AGR and ELECTRICITY, West-End Hostrttal for
Paralysis, Epilepsy, and Diseases of the Nervous System, 73, welbeck-
street, Cavendish-square, W., by Herbert Tibbits, M.D.. F.B.C.P.
Bdln., and Thomas Stretch Dowse, M.D., F.R.O.P. Edln., Physicians
to the Hospital. Ladies and Nurses admitted to the School for training.
Trained Masseuses and Blectriclan* sent to all parts of the United King¬
dom. For particulars, apply to the Lady Superintendent.

By order.

H Ai.kx. Dowell. Hon. S ee.

PROFESSIONAL & ARMY EXAMINATIONS.

M.D. (London) reads with Gentlemen for all the Professional Examina¬
tions. Small classes are held for the College of Physician*, Licenoe.
and Membership, the Hall, and College of 8urgeons. 10 out of 18 passed
(or the servioes. Tuition by correspondence.—04, Gnllford-street, W.O.

"Drussels, Army, Navy, and all Exami-

AJ nations.—Candidates prepared forthe above, either individually ar
by correspondence, by a double-first man. Next Brussels examinations-
May and June. Last exam, papers 3s.—For particulars, apply to M.D.,
60 a, Lincoln’s-inn-fields, W.O.

nr. A. C. Maybury, D.Sc., M.R.C.S.,

L/ A.B.8.M., Ac., IP, Bloomsbury-square, W.O., prepares for all
Medical and Science Examinations. Classes are now forming for PRE¬
LIMINARY SCIENTIFIC. 1st M.B. Lond., and L-B.C-P/BPECIAL
INSTRUCTION IN HYGIENE.

Now ready, Student’s Chemistry, Part I., Non-Metals, 400 pages;
prioe 4s., post free. All bookseller*.

and Successful Coaching for

MEDICAL PRELIM IN ABIES.

Mr. W. P. Strahoways, B.A. (Honours T.C.D.), who hAt had thirteen
yean’ experience, receives a very limited number of gentlemen's Sons,
preparing for the above.

Large staff of highly qualified tutors. The utmost attention to indi¬
vidual requirements. Large house and grounds, tennis, boating, even¬
ing study. Strictly moderate term*.

Prospectus, reference*, Ac., on application.

CLARENCE HOUSE, BARNES, SURREY.

JJapid

Digitize

dbyGoogle

The Lancet,]

THE LANCET GENERAL ADVERTISER,

[April 16,1887.

INTERHATIOHAL MEDICAL CONGRESS AT
Washington, September 5th, 1887.

Messrs. THOS. COOK A 80N have pleasure in announcing that, at the
request of the Council of the above Congress, they have undertaken the
travelling and hotel arrangements for the benefit of the members. A full
programme will be sent on application, allowing feres to the United
States by all Mrates.

TH Q8. OO OK 4 BON, Lndgate Circus, London._

Exhibition in Warsaw.

yj'ealth

Under the protection of the Countess Auguste Potocka. and the
asslstanoe of the most eminent Polish Physicians and Engineers, a
Hygienic Bxhibition will be opened in Warsaw on the 15th of May, and
remain open until the 1st of July. The Exhibition will consist of the
following sections:—

POOD.

ARTICLES OP CLOTHING.

DWELLINGS.

HYGIENE OP SCHOOLS, WORK8HOP8. AND HOSPITALS.
STATISTICS AND MBTHOBOLOaY.

Programmes and all information may be had at

Messr*. SCHBNKHR A OO.’s. At. Moorgate-street, E.O.,
who also undertake the forwarding of all goods to Mr. Maukvov
L ux km bubo, Warsaw, who is the agent for the mid Exhibition.

Mr. Maorycy Luxemburg attends to the Customs Normalities, placing
of the articles to be exhibited, and selling of the same free of com-
mission. __

fFhe Rt. Hon. G. J. Goschen, M.P.,

X will Preside at the ANNUAL FESTIVAL DINNER in Aid of the
Ponds of the NORTH LONDON or UNIVERSITY COLLEGE
HOSPITAL (supported by voluntary contributions), which will be held
in the Grand Hall at the Criterion. Piccadilly, W., on Wednesday.
April 37th, at 7 p.m. Dinner tickets, fit Is. each inclusive, may be ob
tamed at the Criterion, or of the Secretary of the Hospital.

N ewtom H. Niros, Se cretary.

R oyal Statistical Society.—The Sixth

brdinary Meeting of the present Session will be held on Tuesday,
at the Royal School of Mines, Jenny n-street, London,
a paper will be read on “ Class Mortality Statistics,” by

the 10 th Inst.

8.W., when . .

N. A. Humpti'evs. Esq.

The chair will betaken at 7.45 P.M.

plasses are now being formed in

Theoretical and Practical Chemistry, rhyilcs. Materia Medica,

Pharmacy, Ac., and also lh Osteology, Anatomy, and Physiology, as

required for the first, second, and third parts of the first examinations
dT the Roval Colleges of Surgeons and Physicians.—For partlcuhun,
' to Orestes V. Pisapl, Savoy Hoyae. U5. Strand. W.C,

t

rtl l/irww fsl—fl»l ASM, UKSOUMS » .V. ,

M.B. (honours), practising in Kent,

*-spared to take a pupil. Studies supervised and assisted.

borne. Premium required. References exchanged.—Apply,
r. H„ 3. Kellett-road, Brixton._

Is prepared to^ take a pi
Comfortable
by letter. Dr

I ondon Matriculation. — 37th half

XJ yearly course of Special Preparation. All last class passed except
one. Two in honours. Also for other Preliminary Medical Examina¬
tions.—Address, H. SERGEANT, 8, High-street, Camden Town, not far
from King's-cross and Huston Stations.

T- ondon Matriculation, College of Pre-

XJ OBPTORS. and at! MEDICAL PRELIMINARIES. Rapid and
thorough Preparation for these Examinations by Private or Glass
Lessons. Also special Postal Tuition. Highest references to Students
stftoesafully prepared in short periods. Experienced in Coaching back¬
ward Students.—For particulars, address, A. H. DAWES, First B.A.Lond.,
Adders tone, Vardens-road, New Wandsworth, S.W. (dose to Clapham
function Station).

Matriculation.—Medical and Law Pre-

liA 11 mi nary Examinations. Fifteenth year’s oonnk J. BBCKTOH,
O.M., eontinoss to prepare for the above with his usual success. " It
se e m s impossible to fall under your tuition.” “ The greatest dullard need
not despair.” Boarders received j terms moderate.—Address, 41, Tarring-
ten-square, Russell-square, W.O.

"Matriculation.—Apothecaries’ Hall and

Ail. College of Preceptors Preliminary Arts Examinations. Payments
based on results. The dullest or most backward got through. Beferenos
to students passed in periods varying from three weeks to three months.
1 meaning daily in Mechanics, Biology, and Chemistry. For list

es.j^ess and honours, scholarships woo, Ac., apply at any bow

tqH.WAH

.Strand. W.O.

i nstruction in Professional Subjects.—•

Classes are about to be formed in the following snhjeats:—Surgery,
stions on the dead, subject.; Medicine, Pathology and
Ustdogr, Physiology (Senior awl Junior), Htitetogy,
Anatomy (Senior and Junior), Physics and Materia Medica, Chemistry
(Theoretical and Practical).

Gentlemen can at tend all or any single class. Special arrangements
made with men reading for Honours, and In the case of brothers.—
£Hr<M, Uaivsrtlty Medical Sobbfer. T*» Usopr> Office, 423^ Strand,

Medical and Law Preliminaries, and

ILL MATRICULATION.—Mr. H. CRA88WELLBR, B.A. Lend. (First
Division), continues his suooessfol preparation of Candidates for these and
other Examinations. Resident Pupils received. Special attention given
to backward youths:—U, Aberdeen-read, Highbury, N. (near Canon-
bury, H ighbury, and Finsbury Park Stations). _

Preliminary, Medical, and Law, and

JL LONDON MATRICULATION EXAMINATIONS. — JOHN
GIBSON, M.A., of Queramore, Bromley, Kent, brings out the
Questions and Answers to the above directly after each examination.
Tuition at Bromley, London, and Bonnon-R hinc.

Preliminary Examinations.—Mr. Thos

JL LYLE, M.A., F.B.Hlst.8. (Dublin and Lond. Univ.), oootfnoes to
prepare Gentlemen for the above Examinations of the Apothecaries’
Hall, College of Preceptors, and the Universities of London end
Cambridge.—Por terms, Ac., address, Grove House. Bbaeklewell-Iane,
London, H. A few Resident Pupils received. More than 800 Qwntlsnira
have succeeded under Mr. Lvle’s tuition.

A 11 Preliminary Exams.—Preceptors’,

<lX Apothecaries’ Hall, Lond. Metric., Oxford, Camb., ana Durham
Entrances.—Mr. MAINWAK1NG, B.A., First M.B.Cantab., sometime
Private Tutor in Camb. University, continues to prepare Gentlemen for
the above. Individual tuition to each pupil, bo failures at last five
Rxsms. Four Scholarships gained during last twelve months. Boarders
received. Moderate terms.—115. Bdith-rosd. West Kensington.

Desident Pupils. — M.D. Lond. and

it B.So., high honours in Medicine and Science, Gold Medalllst,-
Inte Scholar, House-Surgeon and Demonstrator at a London hospital,
experienced and successful in coaching, can receive into hit house
(London, W.) four Pupils requiring oomfortable home and assistance In
studies. Practical work. Handy for hospitals. Metropolitan and District
Railway, and River. Two tennlx courts.—Address, Germ, May’s, 159.
Piccadilly, W._____

Excursions to Italy, Egypt, Australia,

XJ New Zealand, and Tasmania, by ORIENT LINE. Return tickets
at special reduoed fares are Issued by this line, with facilities to passengers
for breaking the journey at all ports of call.—F. Gredn A Co., 13, Fen-
ehuroh-avenue, and Anderson, Anderson, A Co., 6, Penohurch-avenue,
London. B.C. For particulars of fares, Ao., apply to the latter firm, or to
the Agents in Naples, Holme A Co.; Port 8s3d and Suez, W. Stapledon.

"Drazil and River Plate.—Voyages from

JLJ England in the spring months for health’s sake can be made by
the fine steamers of the Royal Mall Steam Packet Company, enabling
p as s enger s to spend the spring months in Brazil and the River Plate, the*
cool season there.—For particulars apply at the Company's Offices, 18,
Moorgatc -streef. London , or to Henderson Br os.. A Rege nt-street. S .W.

T and fc of the Midnight Sun.-^The

Xi steam yacht " Ceylon.” 3200 tons register, R. D. Lunham, com¬
mander, will leave Gravetend on Thursday, June 9th next, for a twenty-
five days' pleasure ernise among the Norw e gian Fjord* and rounding the
North Cape. This will be followed by a similar cruise In July.—For
particulars of these and of subsequent cruises io August and September,
apply to Manager. S. Y. “ Ceylon ” Office, 7. Pall-mall, S.W.

pheap Return Tickets to the East.—

The PENINSULAR and ORIENTAL COMPANY are now Issuing
RETURN TICKETS, at reduoed fares, to India, China, Australia, and

*tIonian can be obtained at the offioes of the Company, 133,
Ls a d e nn a U -st., B.C., and 36, Oookapur-et., London, S.W., or 80, Boulevard
dee Italians (for passage only), and 57 and 69, Rue d’Hsuteville. Paris. *

THE ILFRACOMBE HOTEL.

Newly decorated throughout, and to a great extent refurnished. Two
hundred and fifty Apartments. Magnificent Dining Rooms, Elegant
Drawing Rooms, Largo Heading Hoorn, Capacious Billiard Room CTwo
Tables), and Oomfortable Smoking Room. All on the ground floor.
SPECIAL PREPARATIONS FOR EASTER. Full descriptive Tariff on
application to Manager, Ilfraoombe, North Devon.

. ILFRACOMBE.

PRIVATE MEDICAL HOME, S. BEV0S COAST,

For the reoeptlon of Nervous fir Intemperate Patients. Arrangements
havealso been made in a separate house for Ladles suffering from Nervous
or Spinal ailments. Careful medical supervision, good nursing, cheerful
surroundings. Thirteen yean’ experience. Every care given to home
oomforts. Terms moderate.—Address, Physician, 11, Springfield-read,
Ilfracombe. ____

e St. John Ambulance Association.—

This Association has a Staff of Trained Attendants with invalid
carriages and hand litters of improved construction, and is now pre¬
pared to undertake the transport Of patients (infectious bases excepted)
either in the metropolis or provinces.—For terms and particulars apply
to John Furlsy, Esq., St. John’s Gate, Clerkenwell, B.C, Special rates
for invalids of small means.

Letters should be merited “ Ambulance Corps.”

T h :

A n Invalid requiring Trained Nursing

and every eemfort, on strictly moderate and inoiusivs-fenas, era
have same sn-appUoatlo n to OakfiJUL-Westbourne-road. ?orast-htfi r 8.B.

G<

O

Tot Lanom,]

THE LANCET GENERAL ADVERTISER.

[April 16,18874

ADDRESS AND TESTIMONIAL

TO

DR. B. BURKE KENNEDY.

■HBoi H itieuea^,.
kbtjb n ja ag31g i v
KRica nmajiy*
■n Kmn n r ■ ■ ■ g ■

ElE 1181*11®

mm Ellia[

cib ci liaoirili

ffil&JEl Ij J U j 11 • I -j i;

An absolutely
secure place.

access for

Documents,
Wills, Deeds,

leases, and
all kinds of
Valuables.

At a meeting held at the She]bourne Hotel, Sir Chahlxs Camrbon in the chair, it was resolved to open a “ Defence
Fund” to pay the heavy legal expenses incurred by Dr. Bbrnabd Burk* Kxnnkdy, Resident Surgeon, Mercer’s Hospital,
against whom a charge of manslaughter was recently brought, and which charge was proved to be groundless, before a
legal tribunal, on the evidence given for thn prosecution, the jury having stopped the case, retimed a verdict pf acquittal,
and added the following rider 44 We consider that, according to the evidence. Dr. Kennedy should not have been subjected
to the hardship of a prosecution.”

Mr. Justice Murphy expressed his concurrence with the view taken by the jury. Dr. Ebnnudy wonM not have been,
warranted in leaving a delirious man amongst the other patients in the ward, for if anything- had, through his doing so.
happened to the other patients, censure would undoubtedly be passed on him. They could not say on the evidence that
lie had used any unnecessary violence. No complaint had been made to the hospital authorities. This case was brought
against Dr. Kennedy by witnesses being got here and there, and suggestions being made; however, it was muoh.tbebest,
thing for Dr. Kennedy that the open investigation in this court should have been made. <:: : !; j:: e

The man died in August, 1886. The Legal Process was not commenced until January, 1887.*' • n« :...

COMMITTEE.

Sir JAMBS PAGET. Bart. Sir THOMA8 CHAWPORD. K.O.B., Blrectoc-GaaeaL A.M.D.

Sir GEORGE BURROW8. Bart. Sir CHARLES A. CAMERON. Chairman.

. Sir PRESCOTT G. HEWETT. B*rt. Sir WILLIAM MAO CORMAC. .

I, Sir JAMES ARTHUR HANBURY. K.C B. The Right Hon. The LORD MAYCR'. '

Sir GEORGE EDWARD PAGET. K.C.B.

WILLIAM ALLINGHAM, P.R.C.S. f KENDAL FRANKS. M.D., FJLC.S.L JOHN FRANCIS McJVBAGH. M.D. y

A. W. W. BAKER, M.B., Ch.M. i FRED. GALLAGHER. E»q. WILLIAM MONTGOMERY. B*q.

JOHN T. BANKS. M.D., D.Sc. H. DWYER GRAY. M.P. F. AUMCK NIXON, F.R.C.8.I/

J. KELLOCK BARTON, M.D., F.R.O.S.I. I JOHN GRIFFIN, E«q. ALDERMAN JOHN O’CONNOR,'M.P.

ARTHUR II. BENSON, M.B.. F.K.C.S.I. I NATHANIEL J. HOBART, M.D. ! R. D. PUREFOY, M.B .F.B.C.S.I.

J. HAWTRBY BENSON. M.D.. P.R.C.S.I. GEORGE H. KIDD. M.D.. F.R.C.S.I. i JOSEPH M. REOMOXD. P.K.Q.C.P.L

MILES VERNON BOURKB. M.D. CHARLES FREDERICK KNIGHT. M.D. I DAVIDSON ROGBRSON. J.P.

LENNOX BROWNE, F.R.C.8. I EDWARD L'E. I.BDWICH. L.R.C.S.I. ! W. G. TBRNAN. L.R.O.S.I.

WILLIAM BRUCE, M.D. THOMAS PETER MASON, M.B., F.R.C.S.I. PATRICK THOMPSON, H*q. _ .

LOUIS A. BYRNE, L.R.C.S.I. PETER MCDONALD. M.P. 1 ROBERT WADE, T.C.. L.R.C.S.I.

THOMAS A. CUSACK. Esq. ROBERT McDONNBLL, M.D., F.R.C.S.I. MONTGOMERY A. WARD. M.D.. F.R.C.S.I.

MERVYN DRAKE, Esq. I I

Subscriptions to the “ Defence Fund’’are invited from all members of the Profession, and should he for warded to the
Honorary Treasurer, John Francis MoVragh, M.D., 1, Rutland-equare East, Dublin, by whom they will be acknowledged.
Cheques should be crossed 44 Royal Bank.” GEORGE H. KIDD, M.D., F.R C.S.I. 1

ARTHUR IT. BENSON. M.D., F RC.S.I. j Jr „ :

KENDAL FRANKS. M.D.. FJLC.S.L
FRED. GALLAGHER. E»q.

H. DWYER GRAY. M.P.

JOHN GRIFPIN, E«q.

NATHANIEL J. HOBART, M.D.

GEORGE H. KIDD. M.D.. F.R.C.S.I.
CHARLES FREDERICK KNIGHT, M.D.
EDWARD L'E. I.BDWICH. L.R.C.S.I.
THOMAS PETER MASON, M.B., F.R.C.S.I.
PETER MCDONALD. M.P.

Robert McDonnell, m.d., f.b.c.s.i.

JOHN riRAXCfS MOTBAGII. JJ-D- y,
WILLIAM MONTGOMERY. B*q.

F. ALC »CK NIXON, F.U.O.S.I? ,
ALDERMAN JOHN O’CONNOR, M.P-
R. D PUREFOY, M B .F.B.C.S.I.

JOSEPH M. BRDMOND. F.K.U.C.P.L
DAVIDSON ROGBRSON. J.P.

W. G. TBRNAN. L.R.O.S.I.

PATRICK THOMPSON. H*q. _ .

ROBERT WADE. T.C.. L.R.C.S.I.
MONTGOMERY A. WARD. M.D., F.B.C.S.I.

ROBERT WADE, T.C., L.R.C.S.I.
F. ALCOCK NIXON, F.R.C.S.I.

lion. Secs,

THE CHANCERY LANE SAFE DEPOSIT

CONTAINS OVER 6000 SAFES AND STRONG ROOMS.

proof and l
Fire* proof*»

Guarded Night and Day. Reading, Writing, and Telephone Rooms. Annual Rent of Safes* ONE to FIV$
Guineas. Strong Rooms, EIGHT to NINETY Guineas. Lighted throughout by Electric Light, p
Each Renter has a separate Safe or Strong Room, and is possessed of the only key to it in existence*

thus ensuring complete Privacy and Security.

Prospectus and Curds of . tdmission to -eieto se,it rout Free on application to the Mcmftgtr,

THE CHANCERY LANE SAFE DEPOSIT, 61 & 62, CHANCERY LANE, LONDON.

Ttra JLanckt,] THE LANCET GENERAL ADVERTISER. [April 16,1887.

"Prudential Assurance Company I

A (LIMITHD). HOLBORN BARS, LONDON. '

Founded 1818.

Invested funds, £6.500,000. Claims paid, £8,000,000.

LVee Convalescent Home for Surgical

T PATIENTS, Women and Children.—Apply, Miss L. Schrocter,
The Village Homo, Fimlon, near Worthing.

ACCIDENTS AT HOME AND ABROAD,

RAILWAY ACCIDENTS, EMPLOYERS' LIABILITY,

ItiSUKKl) AGAINST BY THIS

Pailway Passengers’ Assurance

All COMPANY, 64, CORNHILL, LONDON.

Income, £216.000. Compensation paid for 118,000 accidents, £2,350,000.
Moderate Premiums—Favourable Conditions.

Prompt and Liberal Settlement of Claims.

Chairman: Harvik M. Fahquhar, Esq.

Weat-Bnd Office, 8, Grand Hotel Buildings, W.C.

Head Office, 64, Gomhili, London, E.C.

William J. Vian, Secretary.

reserved in the General Wards into which Patients are admitted
at 21s. a week, wliere they receive all the advantages of the hospital.—
For particulars, apply to the Superintendent.

Qurgical and Medical Home,29,Devon-

k_y shire-street, Portland-place. Arranged with every comfort for the
reception of Ladies and Gentlemen requiring skilled nursing. Patients
attended by their own medical men.

A special feature of this Home is a Ward (detached from house) for
Children suffering from chronic joint disease. Terms moderate, and in¬
clusive.—Address. Mrs. Mann.

Massage Treatment combined with

111. BATHS. Private Medicated, and Vapour Baths. Uterine Douches
(continuous gentle stream) carefully carried out under physician’s
orders, at 6, Grosvenor-street, Grosvenor-square. Principal, Mrs. Mait¬
land. Inquiries answered on receipt of stamped envelope. Special
Baths for Rheumatism and Neuralgia. Masseuses and Masseurs supplied.
Resilient Patients taken, surgical or Weir-Mitchell treatment.

('lash Advances to Physicians, Sur-

goons, or General Practitioners residing In London or in any
part of England or Wales. No banking account need be opened.—
Oxon and Berks Bank. Oxford. Established 1851.

Partners' or Successors' or Patients’ Bills cashed.

OPTIONS ! OPTIONS ! !

Theae favourite Stock Exchange operations often yield highly lucrative
results In a few days. The System clearly explained in Book sent free
t>y GBO. EVANS Sc CO., Stockbrokers, Gresham House, London, E.C.
Established 1881.

ROTHESAY HOUSE 317, Clapham-rd., London, S.W.

Private Home for Invalids. Established 1873.

Patients ntteuded by their own physicians. Every care and attention
is given, combined with good nursing. Medical and private reference
given on application to Mr. Cliapinan; also hospital-trained nurses
supplied on the shortest notice. Application to be made either at the

Chims of £20 upwards Lent to the

kJ MEDICAL PROFESSION.

And Gentlemen in employment whose yearly incomes reach £200, on
advantageous terms, with unusual facilities, immediately, on their pro¬
missory note alone. As no other name is required, or any kind oi
security or reference, no charges are incurred. (Confidential.) London
and Suburbs only. The office founded 1845.

RICHARDS & CO.. HO. Cannon-street. E.C.

PRIVY COUNCILLOR DR. LEVINSTEIN’S

MAISON DE SANTE,

SCHONEBERG, BERLIN, W.

PRIVATE SANATORIUM.

Medical Attendant — Dr. JASTROWITZ, M.D.

1. For Patients affected with bodily ailments. Electro-therapeutic Treat¬
ment and Massage.

3. For Nervous Affections, with separate department for Morplilum
disease (Morphiumsucht).

3. For melancholic patients (Gemiithskranke).

CASH ADVANCED!!

To anv amount upon modern Surgical Instruments of every description.
Highest value on first-class goods.

Instruments, Microscopes, and Osteology, bought, sold, and ex¬
changed.

WALTER LAWLEY,

78. FARRINGDON ST., LONDON, E.C.

[n a delightful Seaside Health Resort,

JL RESIDENT PATIENTS and CONVALESCENTS

from non-infections diseases, medical and surgical, are received.

The house commands extensive views of the Solent and Isle of Wight.
Every luxury and comfort.

For Inclusive terms and particulars, address.

Physician, Wallis's Library, Soutlisea.

Money. — Imperial Deposit Bank, 18,

til Adam-street, Strand. London.—ADVANCES made privately at
a day’s notice, from £20 to £2000, to male or female, in town or country,
upon promissory notes, without bill of sale, on the following terms :—
Advance £20 Twelve monthly payments of £1 15 0
„ SO „ „ „ 2 12 6

„ 60 4 7 6

100 ., ,. ,. 8 15 0

Larger amounts the same In proportion, and, if desired, the capital
can remain so long vs the interest is paid.

AiWauces also made upon the mortgage of Furniture, Stock, Crops,
Deeds, and Life Policies. Distance no object. Send for prospectus to

Chas. J. Knightley, Manager.

(Cheltenham Private Hospital, 5, Royal

Parade, is provided with every comfort for the reception of
Medical and Surgical cases or both sexes requiring skilled nursing.
Terms on application.

A Medical Man, married, offers a

XjL comfortable HOME, in the outskirts of Bath, to an Invalid
Gentleman or Lady, or would take charge of weak-minded children.

Hampden Residential Club, London,

1 1 N.W.—President : Lord Hampden, G.C.B. Treasurer: Thos.

Eccleston Gibb, M.P. The residential head-quarters of medioal men
visiting London. Send post-card to Secretary for prospectus.

To Physicians, Parents, Guardians. —

JL A Lady, living in a pleasant detached house six miles from
Loudon, desires the CARS of a Lady, or Delicate Children requiring kind
care or supervision. Paralytic not objected to. Good references.:—
Address, S. S.. Thk Lancet Office. 423, Strand. W.C.

TV. Rayner’s Hydropathic Establish-

AJ MENT and WINTER RBSIDlAcE, GRBAT MALVERN.—
Hydropathy. Electricity in every form, Massage, Droitwich Brino and
Medicated Baths, and other curative agents. Separate terms to Visitors
not requiring medical treatment. Late dinner.—For prospectus, apply
to T. Rayner, M.D., as above.

A London M.D., married, living in a

XJL pleasant part of W.C. district, conveniently situated for principal
hospitals, offers comfortable HOME to Student, or Lady or Gentleman
requiring slight supervision.—Address, G. H., The Lancet Office, 423,
Strand. W.C.

HYDRO PATHY-SMEDLEY’S-MATLOCK.

Railway Station—MATLOCK BRIDGE.

Telegraph Office — MATLOCK BANK.
Physiciana-W. B. HUNTER, M.D., and G. TENNANT, M.B.

Hoard and Residence in a Doctor’s

D family required by a I.sdv with her son, aged twenty-three, who
1ms epileptic fits. Would require an attendant to sleep in his room.—
State full particulars and terms to Mrs. Dearmer, Bycott, Selivyn-roud,
Eastbourne.

Turkish, Russian, and other Baths.
Weir-Mitchell method and electric treatment available.
Covered Balconies.

Terms—to 4 guineas a week.

( Comfortable Home for an Invalid Lady

\j or Delicate Biickward Child with a Clergyman's Daughter used*to
sickness, living in west suburb of London, btrongly recommended by
several eminent medical men. clergymen, and others. Has had charge
of paralytic lady nine years.—Address, In first Instance, R. M. E., The
Lancet Office, 423, Strand, W.C.

WIESBADEN.

HOTEL AND BATHS.

"ZUM ENGLISCHEN HOF”

(Korsnun 1423. Rkstorbd 1882-83.)

Old-renowned, first-class Hotel, with magnificent, comfortable tdthlng
Installations.

Table dTifite. Mmlerate terms. Boarding. Bedrooms from 2 marks.
Lift.

A Physician wishes to recommend the

£.JL well-furnished and appointed HOUSE of a lady. It Is most
charmingly situated near a fashionable seaside resort in South Wales.
Mild climate in winter and cool in summer. Very highly recommended
lor bronchial affections. Sanitary arrangements perfect. Two sitting-
nnd five lied-rooins. Garden ami good out-houses. £150 per annum, or
3$ guineas per week.—Address, Edelweiss, Thk Laxckt Office, 423.
Strand, W.C.

The Lancet,]

THE LANCET GENERAL ADVERTISER,

[Apbjl 16,1887.

TUNBRIDGE WELLS, THE SPA, HYDRO-THERAPEUTIC INSTITU-

TION and SANATOBIUM for INVALIDS and VISITORS. Beautifully situated on sandy toll, in ite own ground* of sixty mom*
TURKISH, VAPOUR, KREUTZNACH, BRINK, MEDICATED, and all forma of BATH DOUCHES and HYDRO-THERAPEUTIC Application.
Trained Masseurs and Maaacusea for Massage treatment under direct medical aupervislen.

For term* and prospectus, apjily to the Secretary.

TTOLLOWAY SANATORIUM, VIRGINIA WATER.—A Registered Hospital

U- for the CURE and CARE of the INSANE of the UPPER CLASSES only.—This Institution ia situated in a beautiful
and healthy locality, within easy reach of London. It is fitted with every comfort. Patients can have Private Rooms
and Special Attendants, as well as the use of Geueral Sitting Rooms, at moderate rates of payment. Boarders not under
certificates are admitted. Accommodation for friends who wish to reside with or near patients for short or long periods
is also provided.—For terms, apply to the Resident Medical Superintendent, S. Rkks Philipps, M.D., St. Ann's Heath,
Virginia Water, Egham.

N0RTHW00DS HOUSE,

WINTERBOURNE, near Bristol.

FRIYATE ASYLUM for LADIES and GENTLEMEN.
Situated in a large park in a healthy and picturesque

locality, easily accessible by rail via Bristol, Patchway, or
Yate.

The building is Fireproof.— For further information, see
Medical Directory, page 1611; and for terms, &c., apply to
Dr. EAGER, Resident Physician. •

MENTAL AFFE CTIONS.

HALLIFORD HOUSE.

STJXBUB7-0H-THA1EB,

Bitted Non non Loitooe.

(Established IMS.)

Thla beautiful residence, surround ad by ert entire end flnefy-wooded
(round*, la appropriated to the reception at a limited man her of Mental
Invalid*, those especially who, tinder oars and treatment, may reasonably
be deemed curable. They are under the personal care of Dr. Seaton ana
hi* family, assisted by a duly qualified Medical Superintendent, and
the non-restraint system It carried out to the tallest extent. Senna nan
be learned upon application to Dr. Beaton.

INTEMPERANCE.

TOWER HOUSE RETREAT

AND SANATORIUM, Lim ited.

WE8TGATE-0N-SEA, KENT. •

Licenced under the Habitual Drunkard* Act,
1879. The only K*tabll»hment In the United
Kingdom specially erected for the Reception and
Treatment of Ladies and Gentlemen desirous
of overcoming habits of intemperance.

The house stand* in It* own ground* of nearly
three acres, and la replete with every oonvenlenoe,
containing a large Billiard-room, spacious Draw¬
ing-rooms, Smoking-room*, Bath-room*. Ac.

Patient* can be received under the H. D. Act
or privately. Term*—from 2 to 6 guinea* per
week. All servants and attendants total ab¬
stainers. For prospectus and further particular*,
address, J. H. Browjc Managing Director.
Telegraphic address. Brown. Weatgate-on-Sea. VUiting Phjsldan-Alfred F. Street. M.A., M.D.. B.8.Cantab.

INEBRIETY, THE MORPHIA HABIT, AND THE ABUSE
OF DRUGS.

Private Home, established 1864,

for the Treatment and Cure of Ladle* of the Upper and Higher
Middle Classes suffering from the above. Highly successful result*.
Carriage kept. Private sitrting-rooras If required. Medical Attendant—
DB. J. ST. T. CLARKE. Leicester.—For term*. Ac., apply to the Prin¬
cipal, Mrs. THBUBALD, Tower House, Leicester.

48

HIGH SHOT HOUSE, Twickenham, S.W.

FOR THB TREATMENT AND CURB OF INEBRIETY.

(Licensed under the Act.)

A limited number (Gentlemen only) taken. A good library, larva
billiard-room, lawn tennis court, bowl*, Ac.

The staff, male servants only, pledged abstainers.

Terms, 3 to 6 guineas.

For papers required for admission, address,

H. Bra.nthwaitk, F.B.C.S. Ed., Medical Superintendent

A HOME FOR THE CURE OF INTEMPERANCE

Park Hall, near Walsall, Staff.

0 ld

(Licensed under the Habitual Drunkard* Act),
for reception of Male and Female Patient*, Is a beautiful mansion
situated in a park of thirty-six acres, In the centre of which Is a lake
well stocked with fish, and on which Is a boat. There are lawns for
Bowl*, Cricket, and Tennis, a splendid Billiard-room and Smoking-
room*. Airangement* for several patients ef the labouring (dost Ban
be made.—Apply to Mr. Fred. John Gray, Medical Licensee.

Digitized by

Tub IaAnCat.J

THE LANCET GENERAL ADVERTISER.

[April 16,1887.

"I ntemperance. — Private Home for

J- Ladies, where only six are received. Term, from If to 3 guineas
weekly. Highest professional references given, for which, and other
particulars, apply to Miss Pudney, Buxton House, Bari’s Colne, Bseex.

I nsanity, Inebriety, and Nervous Dis¬
orders.—Private Retreats ana Homes for the cure and care of the
above. In town and country, from If to 10 guineas a week.

Medical Homes’ Association and Temperance Agency,

35. Rssex-street. Strand. London.

SPRINGFIELD HOUSE ASYLUM, BEDFORD.

K

l^xceptionally superior

-U Residence offered* in strictly private
Sole occupants, two ladles; Professed cook
Good bath-room; perfect sanitation; healthiest situation in London.
Short distance from Notting-hill-gate; charming secluded garden;
tennis. Accommodation for from two to lour persona. Private sitting-
room. Inclusive terms from two and n half to five and a half guineas.
Reply, by letter, to Rus in Urba, May's Advertising Offices, lift,
Piccadilly. __

ent County Asylum, Barming-heath,

. near Maidstone.—PR1VATB PATIENTS are admitted into thl.
Asylum at the rate of seventeen shillings a week, everything included.—
For particulars apply to F. Pritchard Davies, Superintendent.

Mental and Nervous.—A charming

Ill. HOME, with every comfort and careful supervision, in the
private house of a married medical man of inrge experience. In S.W.
suburb. Beautiful garden, tennis lawn, billiard table, carriage and
horses. Highest references.—Address, A. B., The Lancet Office, 423,
Strand, W.O. ___ ■

H arpenden Hall, Herts.—Twenty-five

miles from London, on the Midland Railway. Established 1846
for the treatment and cure of Ladles mentally afflicted. Carriage exer¬
cise, lawn tennis, and other amusement* are provided. Four quiet
ladies can be taken, at one guinea a week.—For terms, Ac., apply to
A. Mac Loan, Proprietor and Medical Superintendent.

Qtretton House Private Asylum, Church

L/ Stratton, Salop. (For Gentlemen only.)—Thl* Asylum pm*raw*
many natural advantage* i beautiful scenery, bracing atmosphere,
txteiialve grounds, and fad title* for every sort of recreation.

Special oar* and treatment of Insanity arising from or oomplloated
with Inebriety. Apply to Campbell Htslop, Snpt.

_ Dr. Cecil A. P. Obbpbwe, Modloal Consultant. __

Wye House Asylum, Buxton, Derby-

T T shire, for the Middle and Upper Classes of both sxzbb, Is beaw-
andbrm.

shire, for the Middle and U;
dfully situated In the healthy

. ble

racing climate of the Derbyshire
by the Midland and the London and

One hour from London by Midland. Elevated and healthy situation.
Extensive grounds (30 acres). “ Employment system.” Carriage drives.
Billiards, Tennis, Boating, Ac.

For forms of admission address DAVID BOWER. M.D.. as above.

(Dr. B. attends at 35, Easex-street. Strand, on Thursdays, from 11 to 1.)

Terms, 2 guineas. No extras. In villas from £200 to £400

A quieit Lady Patient could he taken at 1$ guinea.

N.B.—Two new wings having been erected on plans approved by the
Commissioner* in Lunacy, there are now Vacancies for both Ladles nnd
Gentlemen.

T o Resident Patients.—A Lady re¬

quiring care ami a comfortable-home can be received by a Medical
Man of experience. House well appointed, and pleasantly situated in a
South Hanipslead district. Terms from ill guineas a month, according
to requirements.—Address. G.B., Boones Library, Swiss-terrace, Bebi/e-
road, N-W ._

To Members of Parliament and Ladies I ft

L and Gentlemcnof Position.—Two BEDROOMS and BATH ROOM U
and one or more SITTING-ROOMS offered in well-furnished, strict'}
private house, with charming garden, near Holland-park. Board it
desired. First-rate cooking and attendance. Best air in London. Sani¬
tation perfect.—Address, H. U., care ol Messrs. Kiloart. 40. Cliane.-r\-
l ane. K.C. ______

"Wanted by a Doctor and wife, residing

it in one of the most healthy and beautiful parts of Devonshire, a
Resident Gentleman ns PATIENT, mental or otherwise. He will get
carriage exercise, ami l>e treated with every consideration. The
climate i* very suitable for any form of lung disease.—Full particulars to
1* obtained at M.W., 81, Oakley-square, Regent s-park, N.W.

A Medical Man (married) would

receive into his family either a l,ady or Gentleman, invalid or
otherwise. Large house and garden, well furnished ami newly deco¬
rated; sanitary arrangements perfect; about an hour from London.

Good library, tennis lawn, bowls, billiards, carriages kept, agreeable
society, and charming neighbourhood. Terms three guineas weekly.
References to local clergy, Ae.—Address, M.D., care of John Sellers, Esq.,

9, Farringdon-road, E.C.

Board v and

tiy private and well-appointed house.
Professed cooking and superior servants.

hills, and Is directly aooessib
North-Western Railways.—For terms and other particular* address the
Resident Physicia n and Pro pie tor. Dr. F . K. D icebox.__

Uamwood House Hospital for the

U INSANE of the MIDDLB and ckPBR OLAS8B8, Bamwood,
near Gloucester.—An Institution for the care and treatment of Patient*
of both *exe*. who can have private rooms and special attendants, as
well sa the use of general sitting-rooms, at moderate rate* of payment.

Patients can also be accommodated In detached villas, and in the
Branch Convalescent Establishment on the hills.

Information as to terms, Ac., may be obtained on application to Dr.
Needham, the Medical Superintendent. _

I Dundee Royal Asylum, West-green.—

JL/ This new and commodious building, reoently erected about four
miles from Dundee, in s healthy situation, and commanding extensive
and beautiful views of the Valley of the Tay, affords superior accommo¬
dation for Private Patients, at low rates of board.

Dr. Mitchell, H.M. Commissioner in Lunaey, reports "the accommo¬
dation provided for Private Patients is excellent, both as regards those
who pay from 15s. to 21s. per week and as regards those who pay higher
rates, and the amusements are frequent and varied."

For further Information, apply to Dr. Rorie at the Asylum.

H ay dock Lodge Retreat, for the Cara

and Cure of Persons of Unsound Mind, AJhton, near Newton-le-
Willows, Lancashire, about two miles from Newton Bridge Station on
the London and North-Western Railway. Terms; First-class patlento
from £1 10s. to £6 fls. per week, according to accommodation, attend¬
ance, Ac.; middle-class from £1 Is. to £1 10s. per week, according to the
nature of the case. Suites of private rooms for a gentleman ana a lady
now at liberty.—Apply to E. It. Beaman, M.R.C.S.E. and L.8.A;Lond.,
resident medical proprietor, or to the Medical Superintendent,

t. Andrew’s Hospital for Merita!

DISEASES, NORTHAMPTON.

For the Middle and Upper Classes only.

President—The Right Honourable the Bari Spencer. K.G.
Chairman of the Committee of Management—The Most Honourable the
Marquis of Northampton? KG.

The main object of this Institution is to provide accommodation and
eomlorta suitable to the former social and present mental condition of
persons belonging to the Upper and Middle Classes at moderate rate* of
payment.

The terms of admission vary from £1 5s. to £3 3s. per week, according
to the requirements of the case.

There termi may be reduced, after the flnt quarter, if the friend* can
satiety the Committee of Management that to much cannot be afforded.

Patients paying higher rates can have private rooms, and special
attendants, carriages, horse*. Ac.-

There are also houses at Moulton-park, a branch establishment, two
mile* from the Hospital, bat in telephonic communication ; and a sea¬
side house, to which Patieifts can be sent. 1'

For further information apply to the Medical Superintendent.

priohton Royal Institution, Dumfries,

V . endowed by the late James Crichton, Bso., of Frier's Cane, end
Inoorporated by Act of Parliament, as a Hospital for the Insane and a
Home for Mental and Nervous Invalids of the Higher and Middle Classes.

The Trueteet and Director* tf the Crichton Royal Institution, in order te
meet the requirement* ef a large tectum tf the community, home instituted am
Intermediate Department for the care and treatment tf ptrt t u * tf toe-
teund mind, at rate* •/ board, of £40 and £62 per annum.

Information regarding higher olaes rate*Jo be bed on applica tion.

Communlse tto ps to bo addressed to Dr. Rutherford, j

TTendon Grove Asylum for Ladies,

UL Hendon. Middlesex. Beautifully situated in extensive grounds
end e park, half a mlie from the Hendon Station on the Midland Railway,
endless than six miles from Hyde and Regent’s Parks. Inclusive terras
from £4 4s. a week.—Apply to Dr, H. Hicks, Resident Physician and
Proprietor. _ . __

THE COPPICE, NOTTINGHAM.

HOSPITAL FOB THE INSANE OF THE MIDDLE AND UPPH&
CLASS BS.

President—The Right Hon. the Earl Man vert.

This Institution having been considerably enlarged, there era bow
F aoaooies for Patients of both sexes, at moderate rates of payment.
Particulars as to terms. Am, may be obtained from Dr. Tan, Medical
Superintendent. _

rjrove House, All Stretton, Church

VJ STRETTON, SHROPSHIRE.

A Private Asylum for the Care and Treatment of a limited number of
LADIBS-of the Middle and Upper Classes.

For terms and particular* apply to Mrs. MoLlntock (widow of the lato
Dr. MoLlntock), the Residen t Pr op rie tre ss, or to tbs Medical B e perttt-
teodent. 1

49

The Lancet,]

THE LANCET

ADVEBT1SER-

[April *6, 1887.

private Home for the Treatment of

X INSANB LADIES,

ASHBBOOK HALL. HOLLINGTON,
within half an hour's walk of St, Leonards-on-Sea, oondooted by th«

Widow of the late Samuel Hitch, M.D., formerly of Sandy well-park
near Cheltenham, for many yean Phytloian to aha General Lunatic
Asylnm for the County of Gloucester.

Station: Warrior-aqua re, St. Leonard*. Telegraph Office: Silver hilL ^

For particular* and term*, apply to | 1 6 II

_ Mn. LBTITIA A. HITCH. _\JC

\Torthgrove, Hawkhurst, Kent (1839). H0SP *

-L' This Asylum, »ltuate midway between Tunbridge Well* and Medical, si
Hastings, stands In extensive grounds, and hat an extra house for special Institute, o
cases and convalescents; alto a Cottage Hospital. This Asylum Is an moment's r
exoellent home for middle-aged and elderly patients, being replete with Male Att
all the comforts and advantages necessary for the treatment of mental Telegraphic

diseases. Patients can keep their own carriages and horses. Terms _

strictly moderate. Railway station: Btchingham, 8.B.R.—For full rrii
particula r *, ap ply to F.R.O.P., PhTslci an-Snperlntend rnt. _______ I ’110

FOB MENTAL AND NERVOUS INVALIDS. 1 Chief

W est Mailing Place, Kent.—A Family SSSSTS

MANSION, standing on its own extensive grounds, beautifully Attendants

TRAINED MALE KUEHES.

THB HAMILTON ASSOCIATION supplies trained Male Noma f*r
Medical, Surgical, and Mental Nurses in town or oeuntry. Terms, ofte
Guinea per week and upwards. Also skilled masseurs. Last annual
Report, Report of Annual Meeting, Rulea, Ac., post free on application to
the Medical Superintendent, 60, South-street, Park-lana, London, W.
Registered Telegraphic Address:— Hamilto n A w^wtloni

G eneral Nursing Institute,

6 and 4. Henrletta-atreet, Govent-garden, W.C.

Established 1862. Solely under Medical Direction.
HOSPITAL-TRAINBD NURSES for every description of disease—
Medical, Surgical, Mental, and Midwifery—can be obtained at this
Institute, on application to the Secretary or Lady Superintendent, at a
moment's notice, being resident in the Home.

Male Attendants and Nurse* specially for Fever oases sent to all parts.
Telegraphic address, “ Nursing Institute, London.’*

and healthfully situated among picturesque scenery, for Residence,
Care, and Home Treatment of a limited number of ladfe* and gentlemen.
Carriage exercise, billiards, lawn-tennis, seaside residence. Twenty -
«lght mile* by road from London. Station on L.C. A Dover Railway.
Terms strictly moderate.—Letter or telegram addressed to Dr. Adam,
JKesident physietsn. will receive Immediate attention.

The London Association of Nurses.

1- Chief Office—62, New Bond-street. W. Branch Office—86, Ken-
nington-park-road, 8.B. Supplies superior Hospital-trained Monthly,
Mental, Medical, 8urglcal. Fever, and Small-pox Nursee. Also Male
Attendants and Medical Rubbers. Rooms are provided for Invalids
where patients can be received under t he care of their own physicians.—
Telegraphic nddress. Firth's Association London.

(general Lying-in Hospital, York-road,

U Lambeth.—Respectable WET NUR8ES and Certificated MONTHLY

illoatAon. Female

HAVISBANK HOUSE, near Edinburgh.

A Hospital lor the Insane, and a Home for Mental and Nervous
Invalids.

Ohalrman of the Board of Direction—The Right Honourable 8lr Thomas
Clark, Bart., Lord Provost of the City of Edinburgh.
Mavlsbank House is about six miles from Edinburgh, In the beantiful
neighbourhood of Roslin. It is a comfortably furnished old mansion,
containing large and handsome dining- and drawlng-rooms, billiard-
room. library, conservatory, and private parlours.

The estate Is upwards of 12U acres In extent, with stabling, large flower
and fruit gardens, hot houses, and vineries.

The Directors have arranged to receive a limited number of patients at
Orb Guiska a week, who will reside in the comfortable farm house ou
the estate. They will receive careful supervision and every comfort.

Tht termi are inclusive, clothing only excepted.

Ms vis bank House is five minutes’ walk from Polton Station, on the
North British Railway.

For farther Information apply to the Resident Medical Superintendent.
Dr. Kbat. Mavlsbank House. Polton. Midlothian.

VA Lambeth.—Respectable WBT NURSES and Certificated MONTHLY
NURSES,also Certificated MIDWIVES, supplied on anplloatkm. Female
Pupils are trained in Midwifery and Monthly Nairing.—Address,
K. Atkinson. Matron.

MR. D. E. WILSON’S

INSTITUTION

for supplying the Medical Profession and the Public with.

HOSPITAL TRAINED 1
NURSES

For Medical, Surgical, Monthly, Medical Rubbing, Mental,
Dipsomania, Fever Cases, ho.

The nature of the ease and sex should be described personally, or by
letter or telegram, to Mr. wnaoir, or to the Lady Superintendent.

Bone* sent to all parts of England and abroad.

Haring the largest and most experienced staff of Nunes in Lnoi—.
srery application can be supplied.

Also

MALE ATTENDANTS.

Respectable and experienced Mentor all nests.

Female and Male Nurse* especially adapted for accompanying Tatties,
Gentlemen, or Children to the Seaside or abroad.

Established 1867. 40,000 families nav* been provided by Mr. WEton
with hit own Resident Nurses, reoommended ry the most eminent of
the Medloal Profession, continually nursing under their instraottoua.

96. 97, 98a, WIMPOLE STREET,

Cavendish Square, London, W.

Chester General Infirmary.—Wanted, rWs Hospital Trained Nurses’ Insti-

‘ SSSSeSSS VJ tution.—MBDH)ALand SURGICAL NUR8BSsupplied.—Addrem,

testimonial* will be required of moral conduct. The candidate* must
possess a double qualification, and be duly registered. Salary to com-
■mence at £80 per annum, with residence and maintenance in the house.

Testimonials to be tent In, addressed to the Chairman of the Board, on
■or before the 29th Inst.

The successful candidate will be required to enter on his duties im¬
mediately. By order.

April 5th, 1MP7._ J. R. Edwar ds. Se cretary.

VA tution.—MBDICALand SURGICAL NUR8BS supplied.—Addrem.
tody Superintendent, 19, St. Thomas’s-street, 8.B.

N urses (thoroughly trained) for

Medical, Surgical, Monthly, Medical, and Fever Game, supplied
at the shortest notioe.—Address, Lady Superintendent, Nursing Institu¬
tion, Leicester.

^Tottenham Loeal Board of Health.— The Queen’s Hospital, Birmingham.—

A To AMBULANCE MAKBRS.-Tbe Local Board Invite tenders for There u B Vacancy in the office of OBSTETRIC and OPHTHALMIC

_JL To AMBULANCE MAKERS.—The Local Board invtte tenders for
an Ambulance Carriage suitable for the conveyance of persons suffering
from Infectious disease.

Pall details and price of the Ambulance proposed to be supplied to be
went to me at the Boerd’s offices, Coombes Croft House, High-road,
'Tottenham, on or before the 96th Inst.

The Board will not be bound to accept the lowest or any tender.

By order.

Edward Cbowjte, Clerk to the Board.

Tottenham. April 14th, 1887.

C ounty and County of the Borough of

CABJ^ABTHBN INFIRMAR’y.—W anted, a HOUSE-SURGEON
for this institution, who must be registered to practise both In Medicine
and Surgery. He must be unmarried and free from the care of a family.
Salary £100 per annnm, with board, lodging, fire, light, and washing.
He will have the privilege of taking two apprentice*. It Is desirable
'that he shall have a knowledge of the Welsh language, and must pro¬
duce testimonials as to ability and character.

The successful candidate will be required to enter Into an agreement
not to practise In the County of the Borough of Carmarthen for a period
of five years from the day of hi* election.

Applications to be sent to the Secretsiy, Mr. H. Howells, H, Morley-
Btreet, Carmarthen, on or before May 13th, 1887.

50 _

A There U a Vacancy In the office of OBSTETRIC and OPHTHALMIC
HOUSE-SURGEON.

The appointment carries with it board, lodging, Ac., and is tenable (or
six months.

Candidates, who must hold a registered cmaliflcatlon, are requested to
send In their applications, testimonials, and certlfiaates of registration,
to the Secretary of the Hospital, on or before Saturday, April 38rd,
1887, from w hom all further information may be obtained.

By order of the Committee.

Arthur House, Secretary.

The Queen’s Hospital, Birmingham, March 80th, 1887.

T/ldderminster Infirmary. — Wanted,

JL\- a HOUSE-SURGEON. Salary £140 (Increasing by £10 per annum
to £170), with rooms in the Infirmary aDd attendance. Candidates
must be unmarried. Duties, which will Include the Dispensing of all
medicines, to commence on Saturday, the 7th day of May. Selected
candidate* will be required to attend before the Committee on Friday,
the 99th day of April, at 19 o’clock, and the gentleman appointed to
enter into a bond not to practise within six miles of Kidderminster
until after the expiration of five years from the time of the termination
of hi* engagement.—Further Information may be obtained from the
Secretary, to whom application* should be sent on or before April 964h«

by Google

Thu Lahobt,]

THE LANCET GENERAL ADVERTISER,

[April If., 1887,

The Hospital for Sick Children.—

X There are vaoradea for CLINICAL ASSISTANTS la the Out¬
patient Department (Dr. Robert Lee).—Application* to be made to
Great Ormond-itreet. Bloomsbury. Adrian Hopk. Secretary.

1 nfirmary for Consumption and Diseases

X OP THB CHEST AND THROAT, Margaret-street, Cavendish
sqoare, W.-An appointment as HONORARY VISITING PHYSICIAN
la now vacant. Candidate* must reside within one mile of the Institu¬
tion. Particular*of qualification to be obtained at the Iufirmarv.

Francis Bailt. Secretary.

(^ity of London Hospital for Diseases

OP THB 01IBST, Victoria-park, K.—Application*, with testi¬
monials. for the office of RESIDENT CLINICAL ASSISTANT are
Invited to be aent to the Secretary, at the Office, 24, Fiimbury-circus.
B.C., not later than April 21*t. The appointment will be for a period of
si* months, commencing July 1st. 1.387.

A gratuity of £20 Is usually awarded at the olo?e Of the terra of office.
Candidates must be qualified.

_Ap ril 4th. 1887. _ T. Stomur 8«i th , Secre tary.

The Great Northern Central Hospital,

I Caledonian-read. N.—A vacancy ha* occurred ip the office of AURAL
8UBGBON. by the resignation of Mr. A. E. Curaberbutch. Candi.latea
for the appointment, who mutt be graduate* of one of the British
Universities, nr Fellows or Metpbern of any of the Royal Colleges of
Surgeons of England, Scotland, or Ireland, are desired to forward their
applications, with copies of testimonials, to the Secretary, at the Hos¬
pital, on or before April 22nd, 1887.

_April 4th, 1887._ _Wn.LTAM T. Grant, Sec retar y.

TJoIbom Union. — Assistant Medical

XX OFPIOBR wanted.—The Guardians of the Poor of the llolborn
Union require the services of a fully qualified (according to the order of
the Local Government Board) Assistant Medical Officer at their Infir¬
mary, Archway-road. Upper Holloway, N. Salary £100 per annum, with
board, lodging, and washing.—Applications, stating qualifications, with
not mors than three testimonial*, must be delivered at this office on or
before Thursday, the 21st Inst., endorsed ''Application for Assistant
Medical Officer. -1 ’

Candidates will have notice to attend when required.

By order.

Jambs W. Hill, Clerk to the Guardians.
Clerk’s Office, Workhouse, flmy's inn-r oad. W.O__

e Chelsea, Brompton, and Belgraye

DISPENSARY. 417 Sloane-square, S.W.

, A Vacancy having occurred In the office of SURGEON to the above
Institution, the Governors will proceed, on Thursday, May 12th, to
All it up by election. Candidates must possess the diploma of one of the
Boyal Colleges of Surgeons.

The Ballot will be open from 10 a.m. to 1 P.M.

Gentlemen desirous of becoming candidates are requested td send hi
their testimonials and certificate'of registration on or before Thursday,
April 28th, on which day their personal attendance will be required at
7 p.m. No Governor Is entitled to vote whose subscription is In
snw, or who has not been a Governor three months previous to this
date.

By order of the Committee.

-April 7th, 1887. Albtusd Hepburn, Secretary.

A ssistant Medical Officer (Resident)

wanted, at the WHITRCHAPBL UNION INFIRMARY. Salary
£IS0 per annum, with furnished apartments, coal, gas. and washing.

Forms of application may be obtained of me or et my Office up to
Saturday, the lflth of April.

Canvassing the GuAraians is strictly prohibited.

William Vallanck, Clerk to the Guardians.
Union Office*. Baker’s-row, Whitechapel, E., April 5th, 1887.

rp h

B

"CVelina Hospital for Sick Children,

XX Southwafk-bridge-road. 8.B.—The office of HOUSE-SURGEON
will shortly be vacant. Salary £70 per annum, with board, washing, and
residence. Candidates, who must possess e recognised qualification, are
requested to send In their applications, with testimonials, on or before
Monday, the 26th Inst., addressed to the Committee of Management, at
the Hospital.

elgrave Hospital for Children, 79,

1 Gloucesterslreet, Ffmlico, S.W.—NURSE wanted. Must be
hospital trained, and a member of the Church of England.—Apply by
letter to the Ledy Superintendent.

A ssistant Matron.—The Guardians of

the Poor Of the Parish of St. MARYLBBONB desire to receive
applications lor the appointment of SBOOND ASSISTANT MATRON
at their Infirmary, Notting-hlll. Salary £36, rising £6per annum to £60.
with resldenoe, rations, washing, and two salts of uniform annually.

Candidates must not qxceed thirty-five years of age. and must have
hpd not less than ono year's training In a general hoapltaL
Applications, In own bandwriting, stating age andpreVloua occupation,
together with testimonials as to character and efficiency, tn be for¬
warded to me, on or before the 23rd April Instant.

Perecmal canvassing la strictly prohibited.

• - . By Older.

. Jobkph Bhdford. Clerk.

- Gwaiman ■’Offices, Northomherland-street,

Marylebone-road, W., April 13th, 1887.

0_reat Northern Central Hospital,

VX Caledonian-road, N.—Two CLINICAL ASSISTANTS required.
Candidates must forward their applications, on or before April 23rd,
1887, to the Secretary. __

r ondon Temperance Hospital, Hamp*

X_J stead-road. N.W.—A vacancy has occurred in the office of JUNIOR
HOUSE-SURGEON.

Candidates must have one reglstrablequallfloatlon.—Applications, wltb
copies of testimonials, to be forwarded to the Secretary uol, later than the
23rd Inst. Bo ar d and residence In the hosp ital.__ _____

Wanted, the Address o t‘James Heming-

* Y WAY CLAY, late Snrgeon of Nottingham.—Address, T. H„
Thk Lancet Office. 423. Strand. W.C. _

R equired, by Attendant, Re-engage*

ment; Mental or Invalid Gentleman. Good medical testimonial*.
No obj ection to travel.—Q. G.. 8, Nutford-plaoe, Hyde-park, W. _

Wanted immediately, thoroughly

TT Trained Hospital NURSES.—Apply, Miss Minks, 39, Royal-.

avenue. Chelsea.

T h

e Matron of West Bromwich Hos*

pltal recommends a Lady, Certificated In Surgical Nursing, who

wishes to enter a hospital for
work. No salary.

months' further experience in medical

Wanted, Head Nurse, Hospital for

T T Women and Children, at Leeds. £25 and uniform.—Apply at
once to th e Sec retary. ___

VVanted, Situation as Attendant-Com-

* * PANION to a mentally afflicted lady, with entire care. Expe¬

rienced. Medical reference. Age twenty-eight.—Address, M., Heathcr-
slde. Q srrard 's- cross, S lough.___

Wanted immediately, four Trained

I T NUR8ES and one PROBATIONER, for Private Nursing.—Apply
to Lady Superintendent , Nunes' Institu te, Canterbury.

Wanted, Charge Nurse; 10 beds;

* T male; one accustomed to Medical and Surgical work. Com¬
mencing salary £20, uniform and all found.—Address, Matron, Great
Nort hern Central Hospita l. Caledonian-road. N.

V ictoria Hospital, Burnley.—Wanted,

PROBATIONERS. Salary £12 first year, with uniform.—For
furth er particula rs, apply Ma tron.__ ,

Wanted, a Trained Surgical Nurse.

" * Salary £20 and uniform.—Apply, Matron, Royal Hospital for
Childr en and Women . Waterl oo -brid ge-road.__

Wanted, for the LJaneJly Hospital

• T (twenty beds), a Trained NURSE for the Wards. Salary £25-
per annum.—Ai
instant.

Llanelly.

D istrict Nursing. — North London

Nursing Association.—Ladles are wanted for work a mono tho

ppUcatioQs to be sent in on or before the 13th'April
John Jknnhos, Hon. 8ec.

Nursing Association.—Ladies are wanted for work among the*
Candidates must be educated gentlewomen, and of good training
and experience as Nurses.—Apply, by letter, to Miss de Liittichau, 413,
Hollowav-road.

poor.

Wanted,

Y Y CONVAl

a Matron at St. Catherine’s

CONVALESCENT HOME for WOMEN and CHILDREN, Penn,
near Wolverhampton. Twelve beds. Salary £30 perannom, with board.
Candidates moat have received hospital training, and not be under thirty'
years of age. Applications, with testimonials, to be sent In to Mlm B. J.
Sparrow, Penn, near Wolverhampton, not later than April 23rd.

J unior House-Surgeon wanted, for the

Boyal Albert Bdw*fd Infirmary and Dispensary. Wigan. Salary
£80 per year, apartramta, find rations (exclusive of wines, spirits.
and washing). Candidates must be doubly qualified, and prepared to
enter Into an agreement, not to practise In the Wigan Union Tor a period
of three years from the date of appointment.

Applications, stating age and qualifications, with oopies of testi¬
monials, must be delivered to the undersigned not later tnan the 36th
April, 1887. William Taurrxkr, Secretary.

L iverpool Infirmary for Children,

Myrtle-street.—A HOUSE-SURGEON 1* wanted at the above
institution. Salary £85 per annum, with board and lodging.—Applica¬
tions, with testimonials, to be sent In on or before the 30th Inst, to

O. W. Cabvkr, Hon. Sec.

Cumberland Infirmar

\J HOUSB-SURGBON.—Wanted Immediately, a duly qualified
gentleman as above. Salary £40 per annum, with board and lodging.,
The appointment will be for one year.—Applications and testimonials to
be sent, on or before the 22nd Inst., to the Secretary, Cumberland
Infirmary, Carlisle.

Ty. — Assistant

a doly qoallfi
lfodglt

a

ed byLjOOgle

Tech Lancrt,]

THE LANOET GENERAL ADVERTISER,

[April 16,1887.

The Infirmary, Rochdale.—Wanted, a

jL Trained SURGICAL KUJiSB (or alternate day and night duty.
Salary £22, with uniform, board, and washing. No •timuIanU allowed.—
Apply, with copies of testimonial*, to the Matron.

T\/anted,

T T Nursing,
five to thirty. A
Lady Superintendent, 44, Rlvers-street

trained Nurses for Private

Nursing. Medical, Surgical, and Monthly. Age from twenty-
five to thirty. Also one for District tyurstng, age about thirty.—Apply,
eet, Bath.

.—Trained Nurses

"Midwifery Training

ILL will receive three months' t

training free. Binding
year*.—Personal application to be made to the Hon. Sec., Miss Wilson,
Workhouse Nursing Association. 44, Bern era-street, W. Fridays and
Mondays, 11 to 1. Letters requiring answers must encloee a stamped
envelope. _

TMrmingham Boro’ Asylum.—In con-

JLJ sequence of the appointment of Dr. Harold Shaw as Assistant
Medical Officer of Gloucester County Asylum, there is a vacancy In this
Asylum fora RESIDENT CLINICAL ASSISTANT. Board and residence
are given, but no salary.—Apply to K. B. Whltcombe, Medical Superin¬
tendent;_

E ast Suffolk Hospital, Ipswich.—

Wanted, TWO TRAINED NIGHT NURSES for Male Medical
and Female Surgical Wards. 8alary £20, with uniform and laundry.—
Application*, stating age and experience, with testimonials, to Lady
Superintendent.

B

Wanted immediately, a Trained Nurse

T? for the FEVER HOSPITAL, Newcastle-upon-Tyne. Salary £25
a year and £2 a year increase to £35. with board, washing, and uniform.
Application, in the handwriting of the applicant, stating age, experience,
Ac., with original testimonials, to be forwarded to the Medical Officer of
Health, Town Hall. Newca st le-upon-Tyne. _

M etropol i ta n A sy lums Board.—Eastern

FEVER HOSPITALS, The Grove, Homerton. B.—Wanted, an
ASSISTANT MEDICAL OFFICER (Clinical Assistant) for a period o
three months. Part iculars may bee btainrd from the Medical Superintend¬
ent at the Hospitals.—Applications for the appointment should I* sent to
the Clerk to the Metropoiittn Asylums Board. Norfolk House, Norfolk-
Bt reet. W.C . <>n o r before^April 20 th In s t. _

pounty Hospital, Durham.— Wanted,

a HEAD Nl'llSE, thoroughly trained, and accustomed to train
Probationers. Salary £2.1, with uniform. Also a TRAINED NURSE
for Children's Ward. 8alary £20 and unlform^-AppllcatlODs, with tes-
t hn onials, Ac., to the House-Surgeon, _ '

ristol Royal Infirmary.—An Assistant

1 RESIDENT MEDICAL OFFICBR and PATHOLOGIST wanted.
Candidates must possess a registered qualification. Salary £*<> per
annum, with board, lodging, and washing.—Applications, accompanied
by testimonials, to he sent to the Secretary on or before Tuesday,
May 3rd, and the elected candidate will be expected to enter upon his
duties on June 1st.

Lieut.-Colonel Charles L. Graham. Secretary B.R.I._

S cottish Medical Agency.

JAMBS LOGAN, IBS, St. VinoenUstreet, Glasgow.

Transfers of PRACTICES and PARTNBBSHIPS arranged.
OUTSTANDING ACCOUNTS collected in town or oountry.
ASSISTANTS supplied free of oharge.

LOCUM TBNBNS on shortest notice.

_I nquiries fre e._

M r. Armstrong’s Medical Agency, 27,

Bnuennose-street, Manchester.—Iligh-elnss NUCLEI'S within ten
mile* of Manchester, returning abont £150 per annum. Good prospects
of increase. Good house, stabling, every convenience; built for
medical gentleman.—Premium, and further particulars, apply, J.
Armstrong. ____

Birmingham Medical Agency.

LEE & MA~RTIN,

LINCOLN’S INN, CORPORATION STREET.

PRACTICES of £100 and upwards can find ready
purchasers through the agency, Lee A Martin
having many clients desiring such.

PURCHASERS.—List of Practices for Disposal free.

LOCUM TBNKNS and ASSISTANTS at short notice.

Telegraphic Address: “Locum, Birmingham.”_

BLAKE & CO., ^

3, UPPER FOUNTAINE STREET, LEEDS,

MEDICAL AGENTS AND ACCOUNTANTS.
PARTNERSHIPS AND TRANSFERS OP PRACTICES
ARRANGED.

LOCUM TBNBNS AT THB SHORTBST NOTICE.
ASSISTANTS INTRODUCED FREE OF ALL CHARGE TO
PRINCIPALS.

SPECIAL NOTE.—Gentlemen desiring appointments as LOCUM
TBNBNS and ASSISTANTS are not placed on oar Books until after
reasonable inquiries as to antecedents and abilities have been satis¬
factorily replied to.

MEDICAL TRANSFER AND PARTNERSHIP,

32, Lud gate-bill.

M essrs. Orridge and Co., Medical

Transfer Agents, Referees, and Valuers, in offering their services
to the Profession have pleasure in referring to the fact that for ABOUT
HALF A CENTURY the name of Mr. Orridgk has boon known in the
advertising columns oi the leading medical journals as that of one to whom
a very large proportion of the Medical Men throughout the kingdom
htve "confided their interests in the adjustment of Partnerships and
Transfers.

Purchasers who will communicate (confidentially) the katitrk and
extent of their wishes regarding investment can be apprised of appro¬
priate opportunities as they occur.

On occasions where advice Is required in forming a correct conclusion
as to the worth or eligibility of a Practice, Messrs. Orridge and Co. trust
that their (amtllaritv with the various contingencies that govern value
will be found of considerable service to those by whom they are employed.

Dadnorshire.—Partner required in an

-LL old-established PRACTICE, of good clsss. Share for Disposal
equal to about £500, with considerable advantages. Locality good and
attractive. About £850 to £400 premium required. Full particulars on
personal application, or, if by letter, please enc'ose reference*.—Apply at
Messrs. Orridok k Co.’s Offices, 82. Ludgate-hlU, London, H.O.

T ondon Suburb, N.W.—Within 7 miles

-Ls of town, attractive and good-class locality, NUCLEUS of select
Private Practice for Disposal. Receipts at present about £110 (can
easily be doubled). Visiting fees, lowest, 6s. Midwifery one guinea
to three guineas. No horse required. Large attractive house, and small
garden. Six months' introduction will be given. Premium about £400,
Full particulars at *

Messrs. Orridgk k Co.’s Offices, 82, Ludgste-hlll, London, B.C.

pambridgeshire. — Rural Practice,

\J unopposed, for immediate Disposal. Receipts (Increasing
yearly) at present nearly £u>) yearly. Includes Clubs, but no Union.
'Good nouse. with stabling, lawn, dc. ; rent low. Introduction to bo
arranged. Premium about £250. Part can be paid by instalments if
iwished. Vendor having purchased a larger Practice will arrange easy
terms with a suitable gentleman.

Apply at Messrs. Orridgk k Co.’s Offices, 32, Ludgate-biil, London, E.C.

Midland

ILL PARTNE1

Countv.—Good Locality.-

PA.RTNER required for the third share of a very old established
good-clsss Practice. Held by vendor many years. About £200 to £a&o
required.—Full particulars. In strict confidence, at

Mersra. Orridgk k Co.’s Offices, 32, Lndgate-hill, London, B.C.

Qouth of • England. — Fashionable

k_/ Watering-place. — For Disposal, an old-established good-class
PRACTICE. Receipts at present about £500 yearly. Capable of great
extension. Good bouse; moderate rent. No horae required. Six
months’introduction. Premium about £500. Full particulars at
Messrs. Okbidgk k Co.’s Offices. 32, Ludgale-hili, London, E.C.

MEDICAL TRAN8FER OFFICES,

19, Craven-street, Strand, W.O.

Established 1808.

Mr. W. T. Peacock, Medical Transfer

ILL and PARTNERSHIP AGENT, inform the Profession that he has
special facilities for introducing Successors and arranging Partnerships,
that If Members who are desirous of Disposing of their Practices will
forward him full particulars (and which will be received In strict con¬
fidence) an immediate Transfer will probab'sy be effected.

Gentlemen requiring Practices or Partnerships can. on application,
select and obtain lull particulars of those on Mr. Peaoock’s books which
are open for negotiation.

ASSISTANTS and LOCUM TBNBN8. with satisfactory testimonials as
to sobriety and general abilities, oan be eugaged at very short notice.

No oharge made to purchasers or (or inquiries.

Office boors from 10 to 6; Saturdays 10 to 2.

MEDICAL BOOKKEEPING AND ACCOUNTS.

r. W. T. Peacock also makes this

a special branch of his business, and is prepared to undertake the
posting and balancing of Books annually or otherwise by thoroughly
efficient Clerks at his own Offices, or, if preferred, at the Residence ot
Medical Gentlemen (in Town or Country), and, when desired, will like¬
wise make and send out the accounts.

Not*.—O utstanding aooounte in Town or Country also promptly
oollected.

Prospectus of Terms, ko., whloh an strictly moderate, s® be seat,
post free, or oea be obtained on appl i cati on to Mr. Peaoook’s Offiom,
19, Graven-street. Strand, W.O.

M

S urgeons. —Sea.—Abroad.—Surgeons

with families or friends going abroad will find an Immense saving
by obtaining their passage* through Moore A Co. All passage* booked
free of charge. Surgeons as medical officers to ships or for the outward
voyage only to the Colonies are all obtained through MOORB k Co.,
the recognised agents to all shipping firms.

Stamped envelope to MOOKK k
Druggists, 125, Houndsditch.E.C.

CO., Medical Agents, Wholesale

Digitized by

Thm Lancet,]

THE LANCET GENERAL ADVERTISER,

[Apbil 16,1887.

Established IMS.

MEDICAL AND PROFESSIONAL AGENCY,

60a, LinoolnVlnn-Aelda, London.

Baxter Langley, LL.D^ who passed

• the Royal College of Burgeons in 1813, and took honour* In two
subjects at the University of London, personally conducts this agency
on the same principles as he has done for more than twenty-five years.
COMPETENT ASSISTANTS Introduced without cost to principals.
IX)GUM TBNHNS at short notioe. Fee 10s. fid. 1000 references.
SOUND PBACTICBS always on hand. Office hours 10 to 4; Saturdays
10 to 1.

MEDICAL DEPARTMENT.

MEDICAL PARTNERSHIP AND CONVEYANCING
AGENCY.

1. ADAM-9TREET, ADELPHI. W.C.

r. J. C. Needes begs to inform

members of the Profession desirous of Disposing of their Practices
that they can on application to him be promptly introduced to Successors.
All matters connected with the Transfer of Practices and Partnerships.
Medical Arbitrations, Valuations. Ac., receive Mr. Needes’ immediate per¬
sonal attention, and negotiations are conducted by him in the strictest
confidence.

Trustworthy LOCUM TENEN8 and ASSISTANTS can be had at a few
hours’ notice.

N.B.—No charge made to Purchasers or to Gentlemen seeking In¬
formation. _ _ _

Clerical, and Medical

ASSOCIATION, LIMITED.

Transfer of PRACTICES and PARTNERSHIPS arranged.

MEDICAL ACCOUNTANCY In all Its branches. PRACTICES care¬
fully Investigated on behalf of Purchasers by the Association’s Competent
Accountants. Valuations of PRACTICES and PARTNERSHIPS. Books
posted and Bills sent out. A clear statement of terms sent oil appli¬
cation.

LOCUM TENBNS and ASSISTANTS introduced.
Descriptive pamphlet of the Association, with names of the Directors,
sent on application.

• Managing Director: G. B. Stockier.

(No. 1.) LONDON SUBURB.—High-class PRACTICE of over £1300 per
annum; all good-class patients; good fees; very little night-
work. Premium £1800 to £3000 cash, according to length of
introduction (six to eighteen months). Large house In a good
position.

(No. 2) LONDON SUBUBB.—Very good middle-class PRACTICE of
£1060 per annum. Fees mostly 6s.; Midwifery £J 3s. Expenses
light. Large house, well -situated. Premium £1.">00 cash.

(No. 3.) SOUTH-WESTERN COUNTY.—Country town PRAOTICE of
over £3000 per annum. Easily worked. Very good house,
stabling, and garden. The Practice and neighbourhood offer
many attractions, and nearly two year*' purchase will be required,
with ample introduction.

(No. 4.) WESTERN COUNTY.—A good-class PRACTICE of nearly £1100
per annum. Two horses required; no assistant. Rent of fair-
sized house, with stabling, gardens, Ac., £46. Premium £1360.

(No. 5.) SOUTH COAST.—In a large and first-rate town, a high-class
PRACTICE of £1000 per annum. Old established; non-dis¬
pensing. Bxocllent freehold house, adapted to receiving resident
patients, which must be bought. Hardly any Midwifery or
night-work.

(No. 6.) LONDON SUBURB.—PARTNERSHIP In a Practice of £3000.
A third or fourth share will be sold at two years' purchase to an
Oxford or Cambridge man.

(No. 7.) HOMB COUNTIES.—Unopposed Country PRACTICB of about
£700 per annum, including appointments. Near a good town.
Excellent house. Premium for goodwill, with introduction as
deeired, £1000.

(No. 8.) SOUTH.—Good COUNTRY PRACTICE In one of the Home
counties. Reoeipts last year over £800. No Union appointment.
Introduction as desired. Beautiful district. Good society.

(No. 9.) MIDLANDS.—Old-established unopposed PRACTICB of over
£435 per annum, including nearly £150 from appointments.
First-rate hunting district. Expenses light. Small house.
Premium £400.

(No. 10.) LONDON.—Half-share In a well-established Dispensary
PRACTICB of about £1300 per annum. Would oceupr only
three days a week, and admit of Private Practice in addition.
Premium £900.

(No. 11.) LONDON SUBURB.—PARTNERSHIP In a good Practice,
with appointments, in a pleasant suburb. Share would yield
at first £300 per annum. The opening is suited only to a well-
qualified man, who must be energetic (though the work would
not be hard at first), and have some private Income.

(No. 12.) SCOTLAND.—In a large town, a high-class PRACTICB of £1000
per annum. Good fees. No Midwifery or night-work. House
well and pleasantly situated. Price £700.

(Ho. 13.) SBA COAST, in a good town, a mixed PRACTICB of over
£1300 per annum, with a year’s partnership introduction. Pre¬
mium one and a half year's receipts.

(No. 14.) MIDLANDS.—Old-established unopposed Country PRACTICB
of £460 per annum, including over £300 from appointments.
Practice very easily worked; nardly any Midwifery or night-
work ; no long distances. Rent of house, with field, £80. Pre¬
mium one and a half year’s inoome.

(Ho. 15.) HOMB COUNTIES.—Increasing PRACTICE of over £800per
annum, In a town within forty minutes of London. Unqualified
Assis t ant kept; other expenses very light. Bent of house £33.
Vendor hat held the Practice ten yean. Premium, to include
drugs, £800.

(No. 16.) SOUTHERN COUNTY.—Share (about £800 per annum gross)
of a Country PRACTICB for £500. Bent of house £35.

(No. 17.) PRACTICB IN A NORTHERN MANUFACTURING TOWN
of £1300 per annum. Bxocllent house. A purchaser will require
a capital of about £3000, and will at once receive an income of
the amount stated.

ASSISTANTS AND LOCUM TBNHNS PROVIDED.

Telegraph address: “ Triform, London.”

Apply Sec., Med., &c., Am* Ld* 8, Lanoaster-place, Strand.

I

n a beautiful residential district and

health resort, within easy distance of Brighton, a well-established
PRACTICB, worth between £100 and £500 per annum. Fees 3s. 0d. to
10s. fid. Midwifery one to five guineas. Commodious residence, with
large garden.—Apply to J. C. fieedes, 1, Adam-street, Adelphl, W.C.

J?800 a* year.—Fifty miles south of

London.—The Practice Is very old established, and situate in a
pretty village containing a railway station ou a direct line of rail. On*
horse only required. Good family residence at a moderate rental.
Premium one year’s purchase.—Apply to J. O. Needes, 1, Adam-street,
Adelphl, W.O. _

VV/ anted, by a M.D., a good-class

T T PBACTIOE, Dot less than £1300 a year, situated In a provincial
town. The full marketable value will be paid, aodnn immediate arrange¬
ment can be entered Into.—Particulars received, in confidence, by S\ C.
Needes, 1, Adam-street, Adelphl, W.C.

J unior Partnership.—A Share yielding

£300 a year (with immediate prospects of increase; Is offered to a
well-qualified gentleman at the usual rate of purchase. The Practice is
old-established, and situated in one of the Best residential suburbs of
London.—Ajqfiy to J. C. Needes, 1, Adam-street, Adelphl, W.C.

D eath Vacancy.—£1200 a year;

appointments £500. — An unopposed PRACTICB, hold by fate
incumbent over forty years, sitaate within seventy miles of London.
An efficient qualified gentleman carrying on the Practice, who has been
associated with It for some time past. As there is no opposition within
six miles, the whole of the Practice can reasonably be expected to be
transferred to an active gentleman. A. portion of the premium can
be paid by Instalments.—Apply to J. C. Needes, 1, Adam-st„ Adelphl, W.C.

Vorkshire.—In a small town in a good

A hunting district, a well-established PRACTICB worth about £450
per annum. Several appointments held. Good-olass patients; forty cases
of Midwifery yearly. This investment offers good prospects of future in¬
crease, the other medical man In the town (who ha* a good practice) being
advanced in years.—Apply to J. O. Needes, 1, Adam-street, Adelphl, W.C.

PI500 a year.—Within an hour of

C’W London, a very old established PRACTICB, averaging for some
years past the above amount. The connexion Is situate in a small town
with good district around, and there is every reason to believe it could
be transferred to a doubly qualified energetic gentleman not less than
thirty years of age, as the opposition, as compared with the number of
inhabitants, Is below the average. Reference can be given to several

S ntlemen on the staff of one of the London hospitals. A partnership
troduction given to meet wishes of purchaser.—Apply to J. 0. Needes,
1, Adam-street, Adelphl, W.O.

panada, near Niagara. — £1250 per

Vy annum; unopposed, the nearest Medical Man residing eight
miles distant. Railway station in place. Area of Practice about ten
miles. Expenses small. The house, which is suitable for a family,
and stands In two acres of ground, Is vendor’s freehold, valued at £700,
and will be disposed of, together with the Praotioe, for the moderate sum at
1000 guineas, of which 600 guineas can remain on mortgage. OHmate
mild. Reference given to a Medical Man in London, who can give thefnllest
information.—Apply to J. 0. Needes, 1, Adam-street, Adelphl, W.O.

T ondon, S.W.—A mixed Private and

-Li Dispensary PRACTICB, the cash receipt* of which last year were
£630, inclusive of appointments worth £140, which may reasonably be
expected to be transferred to a doubly qualified successor. Present In¬
cumbent has been in delicate health, and has avoided nearly all night-
work.—Apply to J. C. Needes, 1, Adam-street, Adelphl, W.C.

W est of England.—£900 a year.—In

a large town, an old-established and lucrative PRACTICE!
averaging over £900 per annum. The connexion la nearly all good
middle-class, and the Visiting fees range from 2s. fid. to 10s., exclusive
of medicine. Very easily worked, only one horse required. Convenient
family residence can be secured by the successor at a moderate renthT.
Premium one year’s purchase.—Apply to J. 0. Needes, 1, Adam-street,
Adelphl, W.O.

THie Lancet,]

THE LANCET GENERAL ADVERTISER,

[Apjul 16,1887.

M essrs. H. Wilson and Son,

36, CHABLBS-STREBT, ST. JAMBS'S-SQUABB, S.W.
Established half a century.

S UALIFIKD ASSISTANTS PROVIDED.

NS.—Suitable qualified Gentlemen can be engaged at a
moment’s notice.

1. N.W. Suburbs.—A well-established

PRACTICE, about £600 per annum; has been conducted by the
present practitioner about ten years, who can give most satis¬
factory rea-ons for relinquishing. A good house ; rent £60. It is
proposed to give three mouths’ introduction. Premium one year's
purchase. This is a good opport unity for any active practitioner
seeking a connexion capable of iucreasc.

2. In a leading thoroughfare, within

tv.o miles of the Hank, a NUCLBUS.abous £250 to £300. including
an appointment ef £00. A good house, been the residence of a
medical practitioner for half a century.

• 3. On easy terms, a mixed-class Prac-

TICE, chiefly Catholic, for immediate disposal, with short Intro¬
duction, at present wort h about £100 per annum, capable of great
increase. Good opportunity for an active Catholic gentleman.
Easy terms can be arranged, to include furniture, drugs, and
surgery fittings.

4 . Partnership. — London Suburbs. —

A JUNIOR PARTNER required in a mixed-class Practice, Jn a
populous and increasing district. Present amount of income £1500
per annum. The incoming Partner should be well up iu Mid¬
wifery, there being some 2oO cases a year. Working expenses
light, and a convenient house can be obtained. The Practice has
been conducted by the present practitioner some twelve year*.

5. Seaside Town.—A General Practice,

which produced in cash last year £333 and booked £371. A semi¬
detached villa residence held at a moderate rental; working
expenses v ery light. Midwifery from 1 guinea; about sixty cates
n year. Tlds is suitable for any active Practitioner wlsldng a
Practice capable of increase. The town it much frequented by
visitors, and an improving one. An efficient introduction ; good
educational advantages.

6. W.C. District.—A General Practice,

. about £250 per annum. Good house, held on lease. Premium
£250. A good introduction given.

7. In a good residential district, four

miles from a large and important town. Income between £600 and
£700 per annum, which can be very considerably extended by an
active gentleman fond of work. Good detached house; large
garden and stabling. Good class of patients. No U nioa or Ciube.

8. In a large town in the North of

England.—PRACTlCB for disposal In consequence of the present
practitioner being desirous of retiring for a time from the pro¬
fession. Income about £16o0 per annum, including appointmeuts.
A good house, stabling, aud every convenience for a professional
residence. Premium oue year's purchase ; part can remain over
provided security is gtveu. The vendor has conducted it twenty
years, and has saved money sufficient to retire upon.

9. Devonshire.—Partnership Introduc¬
tion. A General Practitioner who has conducted a Practice situate
lna town for some years, aud which is producing about £500 per
annum, including appointments about £170. Good house ; rent
£45. Midwifery from £2 2s. It is proposed to give twelve or
eighteen months' introduction.

10. Nucleus.—In a good and increasing

suburban district, S.W. A good detached house, with garden. An
introduction can be given to many good families. Suitable for a
gentleman with private means wishing a good-class Practice capable
of Increase.

11. Near the Crystal Palace.—A

NUCLEUS, about £200 per annum. Convenient house In a main
thoroughfare ; rent £56. An introduction can be given to many
good families.

PRACTICES REQUIRED.

Practice wanted, by a Gentleman

fully qualified, in a oountry town within sixty miles of Town.
Premium oan be paid down.—Apply, H. S.

Practice wanted, by a Gentleman

(married), F.R.C.S. Bng., L.R.GP., who wishes to purchase a
PRACTICE, £500 to £7<XI per annum, in a country town Bob leas
than 3000 population.—Apply, B. F.

Practice wanted in the Eastern Coun-

tles. bv a Gentleman. M.B., M li.C^., Ac., in a town, from £500
to £700. Is prepared (o carry out an immediate arrangement.—
Address, in confidence, M.Ii.

- MEDICAL VACANCIES.

Qualified Resident.—Eastern County,

£70 to £? 0 ; Midland Counties, £ 00 ; plenty of lime for reading?

A qualified Practitioner wanted to con-

. duot an open Sureery in the S.W. district.

Personal application only.

Mrs. Needes’ Medical Agency

aU- p, bustom-road. b.w.

(Opposite Great Northern Railway Station, KingVcroaa.)
Established 1680.

The Business carried on for the past eighteen years by Mrs. Ifewd.^
(widow of J. W. Needes), at 17, Beigrave-street, has been removed to r 1 ,-
above address, where it is conducted by her as usual. No ooanexic-i
with any ot her agency advertised under the same name, this being u»
original business established by her late husband in 1660.

LOCUM TENKNS.—Reliable Gentlemen alwayi on the books.
ASSISTANTS provided free of expense to principals.

No charge made to purchasers.

Twelve Months’ Partnership Introduc¬
tion given to au old-established rood-clsss PRACTlCB, situate in a
pleasant country town, and held by the Incumbent many years. The
receipts last year amounted to over £1150, including ippsknonu.
Expenses moderate. Commodious family residence to be had
lease. Premium required, about one and a half year's poreba*:.
£600 to be paid on entry.

For immediate Disposal, the Vendor

having other engagements, an old-established, unopposed country
PRACTlCB, with freehold residenoe standing in about three-quart- r*
of an acre of ground. Annual income £500. inclusive of appoint¬
ments of £25o. About £1250 will be required, part of which mar
remain on mortgage. The Practice is situate Us a pleasant dtatnr-
within 100 miles.

London. — Old-established Practice,

situate In a good open distric f , and held by the vendor many ysrs.
The income, including valuable appointments, transferable to a suit¬
able nun, averages over £700 per annum. About forty eases o.'
Midwifery yearly, from a guinea. Comfortable house, fitted more
esprciallv fora bachelor. Premium, with an efficient introduction,
one year's purcliase. liorsc and brougham kept, but not necessary.

London. —- General Practice (chiefly

reu.ly money), held by the incumbent many year*, and retnmii^
about £60<> per annum. Capable of considerable in err aw by :cb
active gentleman. Good house, held at a moderate rental. At
effleient introduction given and less than a year's purchase aeoeptol.

Cathedral Town.—Small and increasing

PRACTICE of about £100 per annum. Including £80 from appoint¬
ments. Visits 2s. 6*1. to £1 Is. No Midwifery under a guinea.
Good society, with educational advantages. Convenient house, rent
£50. An excellent opening for a well-qualified active gwit!ema:i
commencing practice, there being plenty oi scope.

Midland.—Rapidly increasing Practice,

situate in a rising town, and realising nearly £650 per annum. In¬
cluding £350 from transferable appointments. There are only there
other medical men in the district, to a population of over 1S.(M>.
and an active man, well np in Midwifery, would find this sa
excellent opportunity for practice. Premium; with six months’ in¬
troduction, £600.

Required, by a married Gentleman, of

independent means, a good-class PRACTlCB tn a London sobor 1 .
or at the Seaside. South or West coast preferred. Inrome from
£600 to £600. A comfortable but not large house noo e ssa r y.

Required, a genuine Country Practice,

unopposed preferred, of from£500 to£o00a ynas, with appointment*,
good house and garden, and not too far from a railway statio-i
Would prefer South or West, but has n,o particular objection at t-
locality.

Required, a Practice of about £800

& year. In a country or seaside district. Lancashire preferred. Or
would ent-rfain a Partnership, with smaller income. m a provlnci*.
town. Advertiser is ready to enter npon sn investment at onoe.

Required, Partnership, or long Intro¬
duction. to a good-cites Practice, in kite- \V. or S.W. dhtaiet of
London. Income Irom £400 np to.£600. . Advert iser is •coustoofc-d
to the best society, and has ample meaiisnt command.

Required, within miles of London.

ahlncreasing PRACTICE «T £500 upwards, with appointments, in s
town preferred. Advertiser is a graduate of considerable experience,
and is most anxious, to' invest without Luther delay. Means at
command.

Required in the S.W. of England, or the

Midlands, a good-class PRACTICE ora Partnership of from £*<*»: »
£300, in a nioo town.' wberd a Bunn Catholic would be wvli
received. Advertiser it a.married graduate, age thirty-two, and can
Invest up to £U>00<, ;

Required, at, once* a qualified resident

ASSISTANT, for an extensive country Practice Iti Sooth Wai—
Must be able to ride. One able to speak Welsh preferred. Salt it
£60.—Apply to Mrs. Suedes, •

9, Etfstfo a Rojuj, N.W.

Offices,

Digitized by GoO^lC

mflrL4»cWr,]'

. . {Atom. i({.-l887-‘

,ii , : ;.■ ; ; i;, o; i,l .MfWIMMl 1KI> ?1

M ft Percival Turner \s~ x -f

’’ ' >,[', (Ssmhfq.woII-knqwji prWliloneriy ‘ •

Telegraphic A<Wre«s— .. „ , ^..Adaiu-xtccet, A4clphLh4KM<ffl,.n,<V,

- •• EftKjMlAX, Lonpoh.” (cltwv ;o The LA^ , K?-0»re). . . ,

■irf r.. TtBtNBltfe Uffi AL JJIST W*Lt APPBAR NflCT

- . BjSVJIOUR CftAMBBHS, , ,

•° ’ ““ No. 0, DLKK-STafiitT. ApKLPttix.I-Oitbp^W.Pn

— - .’ (Near Charing-ops* Station, Ra^Lstd^.’) ' f ,-

TtT^ssrs. Slsiddeh, Soby. ^ild ’^h^so^,;

1t1 : _ MEDICAL AGENT0 AND ARBITRATORS,; "■

ItBGOTIATB and ARRANGE (privately) the SALE and PUBCMAB*.
of PRACTICES, PARTffBRSHIPS.LONATIC A8YLUM9, Ac., ani
«tooVi8»«e.30BSTIT0^ *94 N*M«i 1 J

i PRACTICES valued and Parfpecship difference* adjusted. .,

... %* Atbeadaoooifroca.ntim, QaSaturd^jrtWilU. /.

Immediate.^—Deaih-Y ac&pcy,——London

, PRACTICB for Sftle to a thickly populated neighbourhood, average
ing about £700 a year, cliit-Hy ca^h. Can be managed , by au
Assistant. £200 of purchase-money should Ibo paid -down.—Apply
to Messrs. Sladdeu, Son, & Johnson, 6, Duke-street, Ad el phi, W.O.

Country Pr&etio^ wanted, of 4rom£()0b

The' British and Colonial Agency!

! A. (LloaH*d)*Mln*tracted t 0 Iieta.BBSIDBN'CS, London, WA which'
(has been occupied by a medical man as a consultant for a considerable.
tfme. There is arr opening for. General Pr<ytji'<x amti fhediohae cap be
I obtained at W V0ry Moa*. Tent.—Address; jw. 87,-aWrRdrAt-*CTeet,

| Cave pdisR- sq uare.'Loridpn.A'iL ... ____■

I Q .. Upper • -Wimpole-street, W.—

-Lf-'j To' bp Sold (with possession) on Tde-May, April 28th, 188T. at'

-nr i* '7 m n - j ti ’-i* -d ' -I-V./S To'bp Sold (with possession) on Tnestlay, April 28th, 188T. at

IVl edical XraJlSjer' and- A roiessioiiat !the,5rfiT. Tokenhou#e-y^-d. « aoWot^j-Kflr.pbrtlcuiarjii «ec T*b

XtL,AGBNCY.l7.BLOOMSBURY-STREBT.OXFORD-STRBBT,W.O. !tAdyUiO^c^^*^^ *** ' L * nr<t80 "’ A«etionear«,

JXI-.AGENCrY.W.BLOOMSBURY-STBEBT. OXFORD-STREET, W.O.
Transfer of Practices and Partnerships arranged.

T/wr|m Tenenaand Assistants introduced. .Reliable gentlemen, fully
qualified, with unexceptionable testimonials, bu the list.

No charge to purchasers or to gentlemen seeking information.

Gloucestershire, — Practice unopposed

for five miles. Good house and grounds (the, old Manor-house),
pleasantly situated in: u lovely country; rent and taxes £13.
Receipts over £200, and may lie ineroosmldn ;befcw«n £f»o0 and
£600. Price of practice, furniture, fixtures, and drugs, £560. .

London. — North-. — Practice coti*

veniently situated in an improviug neighbourhood. Receipts in
1885 £l3b, but decreas'd last year owing to Illness. £200 cash will
be taken, as the veudoj must go abroad. Rent £42.

South Ccast 1 .— 1 -Sirialt Select Practice!

annual Income £200. but may be largely increased. Price £150, pari
- down and rest f^easy Instalments. Ample introduction given.

Suburban. — Walthamstow. —Small

PRACTICE.- with plenty of fc-opr. No immediate. resWrat ouposl-
tjon. Receipt* tfom £150 to C?oo.' SO gulneasprethtum will be taken
on aocount of illnesii.' Rent £34.

Country unopposed Practice, in a pretty

idii« g« in Rnou-g. Average receipts between£360 and £400.. Various
Clubs, transferable, ^bout"£73. Midwifery feus up to. £3 3s. , Fab-
village house, tvltfh oeoelihobsf, stable, \md largo garden; rent anfl
tastes £35. Meld by vendor for twelve years. Pi ice £350. •

Yorkshire—Village Practice, inexpert-

< dlvely worked, aril with good scope for inormse. Cash receipts
£330; indadtti^ transferable club* about £60. Rent of bouse, ooach-
boose, stable, qiid garden, £26., Fremjum about/^S50.

Nottinghamshire.—Fltst-class Nucleus,

with good opening. Receipt* at the rote of £380. Efficient Intro¬
duction, Including some of the best county families. Price £100, or
payment by results. Good house; rent £36. Furniture may be

taken by arrangement.

Market Town (15,000 inhabitants in

town atid neighbourhood).—RUCt-BUS. £2lot. weeklyi andinofesl-
ing dally. Fees 3a. 6d. at home. Visits A good opening.', ftioe

AssiSt^ntships wanted by fully qualified;

registered, and experlencod gentlemen, with recent superior testi¬
monials. 1

Apply, to . WM. HOBNIBROOK. Me^llcal Transfer and Professional
Agency. 17, Bloomsbury-street. Oxford-st.reet. W.O.

Devon.—^To. be Let, one mile;

from Newton .Abbot, ei^ from" Torquay, a -nicely furnished
Country HOL'tjB. Two siultig, seven bedrooms, vbry good kitchens,
stabling lot two hor<a». large iatchea gapde(i» two orchhrds. For twelve
nionths from May, £5 per week.—Apply, Mrs. MeUand, Westwoods^

Ni:wt on Al l frit .■ ,, . . 1 ;

tlZantcd, a Country .Practice ot pvet ,£

,* ? . £50d;p*r aunaia, Iiy a jhldfUe-ageil,'tspeAciicek pdoAfftiWer,
dpuhjyqiuhlied <St- JJsrt.'s). .Good house «nul gaitl'i«>»equir»id. Pur¬
chaser has ample means.—Apply, Mr. G. B. Stocker. MaMsgingf
Director. Medical , Ac.. Assn., La., 8, Lancaster-place, Strand, ft, 0.

Wanted, an , unopp6sed- J. Country

T i PRACTICE, rixrnt £50o per annum. Midlands or whst of

which jJuwtt boar full iJiuestlkatRaw An enrly arfnngepj«>i* iltkIWd.-r
| Address; Q. U. D-, TirK'LA^ekr Office, 423 . Stra nd, WC,

P ractice or Partnership wanted.

Mr. Pe-cival Turner has at present an unusual number of appli*
cations on his register for good genuine PRACTICES and PARTPfBli-
$UIPS in almost any iparb of Eqgland..and he ,wii< be hjppy yi hear
from Practitioners contemplating p-tifement or the assistance of *i
ssitablo Partner. All negotiations are cmdncted privately, and n'o
expense Incimrd unless busfneM ddhe: The foil valvi* can in all y««ci bo
secured tor vendo rs.--A d( ^es* .4: Afiam-street. Adclplij, London. w.C,

VoTkabire—Wanted, an. u^cthie^xperi-

JL' ' #nceif dhnhly qballfiefl wan'epmppf.cn't. fo. take sole cliarge (Phy-

plane. No Club or Poor-law work. State agq. height, weight, what
experience, and where gained. Siihin* Required,In- or out-,, and enclose
photo. 8honld above not be engaged, n' sober, actft-e, experienced,
unqualified man might-answer. Can only give very email sdlal-y. So that
it is most sninable to a manaeekirfg a vert- easy and cotnioctable place,—
Addrefcs, L. M-. THE Laxcm' Offldo. 433, Strand, W.C. • -

E astern Coimties.^-For Disposal a

well-established General PRACTICE, Inasmnllcountry town'on a
line of rail. 1 ncome £600 a year, and good prosiiccts of increase. iQne
Ijirso jufif-ientt' ^rji^stfery iVt'bl 21 s. KJddd ncABe. with oi<fhl bidrbW*
gar<hn, orehanf, Ac, . Pleasant reflideutiai district.. Ill hwUMi the iplfe
entire of lc.svmg. iVemlum 1 . £500, ^ jib an efflcteut infrckluctiqn.—
Addre.ss, Bust, Ti^k CAXckT Office, 423, Sf(-and, W.C.'

Apply so. rr at. nunruenuoa, aieoicaj rransior iuu rraraiiomu __ . rr . ■ ■ . . . . . f

Agenc y. H, Bioomsbnry-sLreet, Oxford -street, W.O. _ L^Or IranSier, an- lHCl'eaSlUg miX6a

Wanted to Purchase, a West London

g MidUiuLtov*!

f T or Suburban PRACTICE of £.V>0 to £1000 a year. Must be good Bqual sliare of Income during Introduction, lasting according to pilrr

class. Capitol ready for a geuulne; thing. Purchaser is an Edinburgh
graduate, and ha* bton praotisiog in Edinburgh.—Apply., Mr, Q. B.
Stocker. Managing Director, Medioal, Ac., Assn.; Lrf.i 8, Lancaster^
place, 8t rand, W.C. ___ , , , _.

TUanted to Purchase, a good-class

' * T PRACTICE, town of pbuntry. Purchaser Is M.B.C.8.; L.S.A.
(Guy’s), aged thirty-five, and,haviug ample private means, could enter¬
tain either a large Praotlce or a small one (hot less than £500 per
annum), where there would l»e scope for Increase.—Apply, Mr. G. B.
Stocker, Managing Director, MedlOaf, Ao., Assn., Ld„ 8, Lancaster-place,
Strand, W.C.

fticludlugirppolntnfents'. ‘Ys in a goo«i aridlarge thriving MidUiuLtow<n.
Equal eliare of Income during tiitrnduetion, lasting according to pur¬
chaser's wishes. "Expenses light, mid appointments not t.r.uisferred
deducted from premium, which is moderate.—Address, Alpha, The
LA wcrr OfHce, «3,.8ttand; W.O. ' ' '

Ald-established; Practice in a Country

Ls Town In Sotd IV Watea. £36Q per animm, Appolnfanant* £100,
Union. Pramium £200. hy i natal mint*. One pony. Hunting, ahoot-
ing. fishing, Ao. Knowledge Of Welsh not at alt tequlred. Every ln-
v..!.t,lgation; Choice ofcapital houses from £26 per annum. Leaving for
better facilities ; of education.—Address, Lax, THE LxxcET 08860,423,
St rand, W.C.

55

Thb Lancbt,]

THE LANCET GENERAL ADVERTISER.

[April 18,1887.

partnership.—A doubly qualified, regis-

JL tered practitioner desire* to meet with a suitable Country Part¬
nership or Intreduction where the present holder contemplates retire¬
ment. Practice must bear the strictest Investigation, so that worthless
ones need not be offered. No agents.—Address, with full particulars, In
confidence, Modious, 7, Oower-street, W.C,

partnership in a small Practice

JL (capable of great Immediate development by anyone of energetic
disposition) In a populous town, within thirty minutes by rail from
London. Prior £100 to a good worker. Income guaranteed.—Address,
M.D., care of B. Ayres, lbq., Dentist, II, Prlnoes-street, Oavendiah-
square, W.

"Wanted, by a M.B., C.M. Edin., an

T y A8SI8TANT8HIP, with a view to early Buoocsslon. In an easily

worked Country Practioe, returning about
Trocar, Thb Lancet Office, 433, Strand. W.C.

per annum.—Address,

The British and Colonial Agency

JL (Limited) are requested to secure for one of their clients a bonft-
fide PARTNERSHIP, preferably in the country, where from £300 to
£600 can be paid down at once, and the rest by annual instalments. He
is thoroughly qualified, and well up in his profession. Replies will be
treated in the strlotest confidence.—Address, The Secretary, 27, Margaret-
street. Cavendi sh-sq uare, L ou don, W .___

A n Excellent Opening.—A Gentleman

is obliged to relinquish a place which he is fitting up as a DIS¬
PENSARY in one of the most oentral parts of London. An active man
oould make an immediate lucrative practioe there. 8hould be seen at
once. Fixtures £30.—Call at 309, Holloway-road, N-, before 13,

F

or immediate Disposal, a small Prac-

amuim. chiefly

TIOB in S.B. Suburb, retumli
oeah. Small i

for leaving. Populous neighbourhood.—Particulars of Messrs. Hewlett
A 8on, Druggists, Charlotte-street, Great Bsstem-street, B.O.

;ng over £300 per

urn. Introduction if required. Satisfactory

'Wanted, a Practice, by a M.D.,

T T M.R.C.S. (South of Bngland preferred); or a Nucleus enter¬
tained. Means at command. No agents.—Apply, M.D., care of P. O.
Cooper, Bsq., 4, Waterloo-place. Pall-mall. London.

pash Practice for Sale, doing £6 per

\J week. North of England. Will accept £200, on easy terms.
Vendor leaving for health.—Address, W. O., Thb Lancet Office, 433.
Strand, W.O. _

Immediate.—£300 a year.—Six years

JL established. Nice class PRACTICE in large Midland town. Small
house, well situated, £360 cash. No agents. Full particulars on appUoa-
tlo n.—A d dress, A. D. M ., Thb L ancet Office, 43 3, St rand, W.O. _

A Surgeon would be glad to pay a

good premium for satisfactory information respecting a good

A Physician and Surgeon, wishing to

XjL go abroad, would sell his PRACTICE for £50. Books can be
inspected. Receipts realise £3 per week. A rare opening for a young
‘ " s. M.D.. “ *

man.—Address,

, The I.avcbt Offioe. 423, 8trand. W.O.

'Wanted, by experienced, fully qualified,

▼ » married Churchman, an unopposed Country PRACTICE, about
£460 (with at least £130appointments), and scope. Dry climate Indis¬
pensable.— Sond fullest particulars (to save time) to M.B., 7, Arbutus-
place, Dublin.__

Wanted to Purchase, a small Practice,

I* or SHARE (Increasing) in a Practice. In or near London (North),
by a fully qualified man willing to work. Premium must be small.—
9. El

A ddress, J. Harold . Post-offi ce. Enfield.___

T ondon Suburb.— Good Opening for

AJ PRACTICE In a rising neighbourhood In the 8.W. district.
Small premium required. An introduction can be given to a few good
patients.—Address. Statlm. The Lancet Office. 433. Strand. W.C.

TjV)r immediate Disposal, a good Nucleus,

A with first-class opening. In a small market town in Midlands. A
nominal sum of £50 will be taken, as vendor must leave in three weeks.
Furniture at valuation. Reasons given for leaving.—Please address,
Immediate, Thb Lancet Office. 423. 8trend. W.C.

XjV>r immediate Disposal, a select and

A easily worked PRACTICE In the"best part of a popular oounty. Cash
receipts over £600 a year. An excellent detached residence, with garden,
orchard, stabling, Ac., on lease at a low real. Premium moderate
Address, R. H.. 21. Btowe-road. Shepherd's-bush. London. W._

To be Sold immediately, Vendor having

JL accepted an appointment, a thoroughly genuine Cash PRACTICE,
situate Id an aristocratic neighbourhood, and can be f
amount. It Is requested that only those with means i
who intend business will apply. Would suit a young
dress. J. W. Q- Thb Lancet Office, 433, Strand. W.O.

can be Increased to any
means at command and
man well.—Ad-

LJL good premium for satisfactory in'
ipening for PRACTICE, or would act In
practitioner.— Address. Surgeon, Thb La?

information respecting a

conjunction with an elderi^

Lancet Office. 433. Strsnd.'

I? 100. — Incumbent, having obtained

old-established, ready-money
purchaser.—Address, H. S., Thb

Aut-door Assistancy or Management

of Branch, by an M.D., M.Oh., and L.M. Of large experience.
Good references. Married. Disengaged at present.—Address, K..
16, Hawley crescent, Camden-town, N.W.

A ssistants and Locum Tenens supplied

aL on the shortest notloe. Apply to Mr. G- B. Btooker/Secretary,
Medical, Ac., Assn., Ld„ 8, Lancaster place. Strand, W.O. The rule of

the Association Is that no Assistant shall be reoo mm ended till direct

Inquiries have been made as to his antecedents. Names of the Oommlttee

of Management and descriptive pamphlet on app li catio n .—Telegraphic

address, •* Triform, London.

L ocum Tenens.—Wanted, a re-engage-

raent by M.R.C.S., L.R.O.P.Lond. Age thirty-four. Thoroughly
reliable nnd experienced.—Address, B. B., The Lancet Office, 423,
Strand. W.C .__

I ocum Tenency wanted by a Gentle-

A Branch Practice for Disposal in one

of the Midland Counties. On line of rail. An hour from
London. Beoelpts over £300. £50 transferable. A good opening for
young man. Basy terms.— Address, Sains, The Lancet Offioe, 423,
Strand. W.O.

Chemist’s Retail, old - established,

nloely fitted and stocked. Returns for twenty years average from
£500 to £000 when managed by principal. Under assistant thev have
dropped, but surgeon oould make a return of £800. Cause of sale, pro¬
prietor unable to attend to It. Prloe £255.—Address, Chemlcus, The
Lancet Office. 433, Strand, W.O.

The British and Colonial Agency,

-L Limited. 37. Margaret-street. Cavendish-square, Loudon, W„ are
Instructed to Dispose of a PRACTICR (1040) situate In a large town in
Kent. ReoeipU about £3.V). It Is an excellent opportunity for a man
deslrin^scope and small working expenses. Less than a year's purchase

Qmall Country Practice for Sale.

terras would be offered which would prove the investment bont fide.—
Address, N. O. G. B.. The Lancet Office, 438, Strand, London.

06

I A man, doubly qualified. Extensive experience in all kinds of .Prac¬
tice. At present doing looum. Aged thirty. Average height and
weight. Good horseman. High-class references. Disengaged May 1st.
Address, Modicus, care of John Gil l, Bsq., Welshpool. _

L ocum, or in-door Assistancy, desired

by a qualified and registered gentleman. B.C. Practical experience
In all branches. Dispensary. Club, Union, and General Practioe. Good
Accoucheur. Can ride and drive. Bxoellent references.—Addreas. Jack,
8 5, Pimlico-road, Belgravia, S.W. _

L ocum Tenency required by a regis¬
tered Bngllah gentleman, used to every olass of Practice. Bober,
hard-working, well up in his work, and exceptionally well received by
patient*. Capital references. Terms, five guineas a week and expenses.
Would suit those preferring to pay well and leave Practioe in safe
keeping.—Address, Practical, The Lancet Office, 433, Strand. W.C.

L ocum Tenens.—A doubly-qualified

Medloal Gentleman (registered), now disengaged, seeks an Appoint¬
ment in town or country. Has frequently acted In sole charge, and is
aoenstomed to all kinds of practioe—Private, Club, and Union. Satis¬
factory recent references and testimonials. Can ride and drive.—Tele¬
grams or letters to Medicus, Rutland House, 101, Sackville-road, Hove,
Brig hton. ______

L ocum Tenency or Assistantship (out¬
door), or to Manage a Branch, wanted Immediately in londoo, er
near, by a doubly-qualified gentleman, M.R.C.S. Kng.,L.R.C.P. Load.
(Bart.’s). Two years’ experience since qualifying In town and country
practice. Late house-surgeon to Western London Public Dispensary.
Recent excellent testimonial*, thoroughly rolls*>le. Abstainer ; not
afraid of work. Age twenty-seven; height Oft. Would not object to
Liverpool, Manchester, Leeds, Dublin, or other large town. Very
moderate salary required, as little time for hospital Is required.—Addreas,
Dr. D., The Lancet Office, 433, Strand. W.C. __

Aualified Assistants wanted(1) London, •

V3fc/ 8.W., temporary engagement, £10 a month, ln-door. (2) Essex,
single, £140, out-. (3) Bssex, ont-door, for May and June. (4) Wales.
£100, rooms and attendance. (5) Sussex, country town, £00. in-door.
(0) London, Branch Surgery, salary by commission, with fixed minimum,
rooms. Ac. (7) Lancs., for Branch Dispensary.

UNQUALIFIED ASSISTANTS wanted (8) Lines.. £52, In-. <9>
London, N.W., £100, out-. (10) Lancs.. £M>. In-. (11) Yorks., town,
out-door. (12) Birmingham. £75, with unfurnished rooms and go*.
(13) Staffs., high-class Practice, £10 to £55. In-door.

The Oommlttee have a constant succession of Asslstaneles to offer, ami
invite applications for the same to the Managing DirectorMr. G. B.
Stooker, Medical, Ac., Assn,, Ld., 8, Lancaster-pi ace, Strand, W.O.

Thk Lancet,] THE LANCET GENERAL ADVERTISER. [April 10,1887.

TT/’anted, a qualified, experienced, in-

T V door AS8I8TANT7 with a view to permanence.— Address, stating
a&larv expected, Greenbank House. Leeds-road, Bradford.

W anted, a Gentleman to Assist at a

V T Branch. One with means for Partnership preferred. Qualifica¬
tion necessary.—Address. J. M., Physician, Thk Lancet Office, 423,
S l ^^*nd, W.O.

"Hispenser wanted.—Testimonials, age,

A/ and salary required to T. W. F„ Wycombe House, Coventry.

TAispenser wanted, from 6 till 10 p.m.—

\J Apply by letter only, stating experience and salary required, to
Dr. Kirk, 4, Columbia-road, B.—Convenient to Bart.'s and London
Hospitals.

Qualified Assistant required at once,

XjU in-door, for Open Surgery. Must be accustomed to Private and
Club Prsotloe. Age not under thirty. Usoal bond.—Apply, A. M. C.,
1, Westbourne-street, Baton-square. London, S.W.

TTnqualified Assistant wanted, to Dis-

vJ pease and keep Books. Must be able to attend an ordinary case
of Midwifery and Visit occasionally.—Address, Nelson, Thk Lancet
O ffice, 423, Strand, W.O.

\\7anted, in a fortnight, an in-door

TV Dispensing and Visiting ASSISTANT. Character must bear the
strictest Investigation.—Apply, personally, if possible, after six in the
evening, at S3, Camltcmell-road, 8.E. ;

VlTanted an Assistant (in-doors). One

V " qualification necessary. Afternoons free. 8ulfable for a gen¬
tleman reading for a seoond qualification.—Address, B.A., 10, Cotslde-
Cerrace, Lavender-hill. 8.W.

1 lispenser wanted, competent, experi-

enced. nnd reliahle.—Address applications, with recent refer¬
ences and full particulars as to age, experience, salary (out-door),
Ac., to S„ Thk Lancet Office. 423. Strand. W.C.

TA/anted, by a General Practitioner,

* Y within easy Uistance of most of the London hospitals, a

gentleman (qualified) who requires time for study and can give part
tKnefor board and lodging.—Apply by letter, C. W., 38, Wessboume-
road, Barnsbury, N.

T n-door Assistant wanted, immediately,

JL in a small town, forty-one miles from London. Single ; registered
qualification. Must he of quiet hnblts, and desire permanency. Duties
light Amide time for reading.—Apply, C. K. Wluckworth, Sliefford,
R.S.O.. Beds.

"Wfanted, a Gentleman, as in-door

T T ASSISTANT, one qualification preferred, to Visit. Dispense,
attend Midwifery (must be able to use forcejsi), and assist with the
Hooks occasionally.—AddreM, 6latiog age. experience, and salary re¬
quired. R. B. H., A3. Aston-road North. Birmingham._

YA/anted, in a North of England

T T manufacturing town, an unqualified ASSISTANT (single).
Must be well np in his profession, willing to work, and able to
V-lsit, Dispense, attend Midwifery, Ac. House. Ac., found, but will be
required to board himself.—Address. statlDg height, age, religion, and
salary required, also, reierences, X. Y. Z„ The Lancet Office, 423,
Strand, W.C.

TVTanted, an Assistant.*ship, by an un-

V T qualified gentleman. Full curriculum. Excellent testimonials.
Apply, W. P. O’M.. 1, Mount-place. Whitechapel. B.

IVTanaging Assistant wanted, for large

1TJL Cash PRACTICE In City. Must be over thirty, and have lirat-
chus testimonials. Liberal terms. Or a portion would be sold to
managing partner on easy terms. Open Surgery attached, under care of
Dispensing Assistant.—Apply, personally, if possible. The British and
Colonial Agency, Limited, 27, Margaret-street, Carendish-square,
London, W.

A Medical Man wishes to highly

■LjL recommend his late ASSISTANT, who was with him about three
years. He Is thoroughly competent to Visit, Dispense, attend Midwifery,
and is well received by'patients, and Is a very superior and gentlemanly
man. and perfectly trustworthy.—AddreM, 64, Durning-road. Liverpool

"Wanted, by a Gentleman, aged 24,

YY M B., C.M., married, registered, an ASSISTANOY (out-<loor).
Country preferred. Can Visit, Dispense, and attend Midwifery. Good
references.—Address, J. H. M., Thk Lancet Office, 423, Strand, W.C.

"Wanted, an Assistancy, to Dispense,

1 Y keep Books, and Visit occasionally, with time for lectures. Four
years’ experience. Board, lodging, and season-tieket required in lien of
salary.—Address. H. 8. B„ 91, Hollund-road. Brixton. 8.W.

Trout Fishing.—In exchange for the

JL above, with comfortable quarters, a Graduate often years’ experi¬
ence would assist a gentleman for a few weeks, or take charge of a small
Practice.—Address. Z„ Thk Lancet Office, 423. Strand, W.C.

TUie Advertiser, M.R.C.S., L.S.A., is

JL anxious to Araist London Practitioner in return for board, Ac.
Time for hospital practice required.—AddreM, H. H., Thk Laxckt
O ffice, 423, Strand, W.C.

"’Wanted, an Assistantship, by a Fourth-

T T year’s and Final M.B. man with full curriculum. Time for
reading and small salary. Good testimonials.—AddreM, Wood, Thk
Lanckt Offioe, 423, Strand. W.O.

A ssistantship or Locum Teneney

Xl. wanted, by M.B., Ch.M., registered, who is eminently well
qualified to advance the interests of any Practice, being a capital
worker and universally liked by patients.—B. M., 16, Norfolk-street,

"Wanted to Dispense for Surgeon or

* * Physician, during evening or afternoon and evening. References
and testimonials on application. Age twenty-three. Experienced.—
AddreM, J. M., 32, Churion-street, Belgmve-rokd, 8.W.

D A., M.D., M.Ch., aged 33 years,

JL/* desires to assist an elderly or delicate practitioner. Habits quiet,
and very temperate. Country 'preferred.—Address, Dr. Courtney, 429,
Strand, W.C,

Wanted, in the Country, a Situation as

? Y DISPBN8BR and BOOKKEBPB1L Advertiser, aged thirty, is
a qualified Dispenser, can Visit, and take ordinary Midwifery if required,
flood referenoes. A permanency required. — Address, John Howe, Grove
Lodge, Balham, London, 8.W.

partial Assistance. — A Medical Man, in

JL a small practice in Kensington, Is able to assist another, within a
moderate distance, Who wishes to be relieved of some of t-he work.
Personal interview desired.—Address, D. M., Thk Lanckt Office, 423,
Strand, W.C.

"Wanted, by a doubly qualified, regis-

Y I tered gentleman, aged forty, married, no children, steady and
reliable, a LOCUM TENBNCY, the Management of a Branch or Dis¬
pensary, or as out-door Assistant. Now disengaged. Good references. —
Address, D. B., 654, King’s-road, Fulham, London, 8.W.

"Voung Gentleman desires Situation as

JL DISPBNSBR, Ac., for a few hours daily. In-door or out-door.
Time for hospital and study. Or would gladly undertake Private
Tuition, or Superintend Lessons.—AddreM, V. N„ care of Dr. Brett,
Watford, Herts.

w-v • , • .1 . •

"Wanted, bv a Gentleman, sine diploma,

Y T an ASSIST’aNOY. Aocustomed to all kinds of Practice.
Attiiulad several hundred oases of Midwifery. Twelve years’ experi¬
ence. Ride and drive. Strictly temperate. Good referenoes.—AddreM,
A. B., care of Mr. Williams, Post-office, Dunravea-plmoe, Bridgend,
Glamorganshire.

1 iispenser to a surgeon, witn time tor

study. Three and a half years' experience at chemist's Retail
and Dispensing in West-end. Age nineteen and a half ; height 6 ft. 7 in.
Excellent reference. — Address, B. Ward, 4, Graham-road, New
Wimbledon.

Assistantship wanted by a Fourth-

XjL year's man, aged twenty-four, in London, or any town where
there is a medical sohool. He can Dispense, Visit, and attend Midwifery,
and has taken sole charge, and has exoelient testimonials. A comfort¬
able home, with the privilege of attending one or two lectures, to com¬
plete his curriculum, will be considered equivalent to a salary.—
AddreM, R. N., The Lanckt Office, 423, Strand, W.C.

"Wanted, Assistantship (sine diploma),

i » town or country, in- or out-door, to Visit, Dispense, and attend
Midwifery. More than twelve years’ practical experience In General
Practice. Good Aooouoheur. First-class testimonials and references
from present and past employers.—AddreM, Medicos, 117, Day-street,
Hull.

pharge of Branch wanted immediately,

\J by a steady, energetic gentleman, a registered L.S.A., with very
large experience, unexceptionable testimonials, middle-aged, married,
no family. Furnished residence, with ooals and gas. A permanent en¬
gagement desired, witli a fair salary. Advertiser nas had twenty years’
experience in Colliery Practice, and is of very active habits.—AddreM,
l Scalpel, Thk Lanckt Office, 423, Strand, W. C.

57

Digitized by CjOO^Ic

Wanted, by married Man, aged 28

Y 1 (one child), part time A89I9TANCY, in suburbs or London pre¬
ferred. Time for reading; an opportunity of attending Coach twice a week.
Full curriculum. Good Dispenser and Acoouchenr. Well recommended.
Bide and drive. Personal interview.—AddreM, Stethoscope, Th*
Lancet Office, 4», Strand, W.C.

The Lancet,]

THE LANCET GENERAL ADVERTISER.

[Apru. 1$, ISSL

A registered M.R.C.S. Eng., L.R,C.P.

XA. Eiiln. CGn v*fi). wants an ASSISTANCY for about three months, in
London. Mrist'have a few hours to attend hospital. In-door preferred.
Would like to see patients or Visit. Excellent testimonials. Aged
tWcnty-fiwir.—Addisss, Cardiac, M. Wolverhampton-road. Stafford. ,

TV) Medical Men and Firms.—Wanted,

-L Re-engagement ns DISPENSER, or Dispenser and Bookkeeper.
Thoroughly experienced In .fU hrtuiehes of rilspcfwlng. neat, quick, and
accurate. First-rlass testimonials and references. Salary moderate,
outrdoor. Age twenty-eight.—Address, Peritus, 26, Stanshaw-ioad,
Heading. ,_

Qurgerj Assistant and Dispenser,

two yenrs’experience, passed first LR.O.P., offers services and
small weekly payment in return for comfortable home in London, with
time for Hospital lectures, &c. Abstainer. Good medical references as
to ability and character.—Address, A. E. A., Thu La.vckt Office, 423.
Strtuid, WXI. _ ' __ __ ' ■ ' iri

Graduate in Medicine and Surgery,

aged twenty-eight, with high class lestimonials and references,
offers his sendees as in-door ASSISTANT to a gentleman in practice for
one or two rnonths. without remuneration. Ho is a light weight, can
ride and drive, and is ready and able for active work.—Address, Sigma,
The Laxckt Office, 423, Strand. W.C.

D isengaged. — Good Assistancy re¬
quired. Ago thirty. Eight years’ experience, for three years
Visiting Assistant, in extensive and high-clsss Practice, taking a round
of patients ami attending 100 Midwifery cases per annum. Passed most
of examinations for M.R.C.S. nml L.R.O.P. Temporary work not
declined.—Address, Cantab., 46, Cross-street, Eurton-o.n-Trent.

A

•’ — A;

SURGICAL INSTRUMENT!

. ev, UP EVERY DESCRIPTION. .

NEW AN ° SEC0NDHAND *

WALTER LAWLEY,

78, Farringdon Street, E.C.;
And at 8 , Coventry Street, Hajmsrket, London, W.

IIjust rated Calalogno upon Application.

'HACUE’S CLINICAL THERMOMETERS.

Are easily adjusted, have plain, easily-read scale and index that
oannot be put wrong. Sent complete in case, with Kew certificate, for
4s. 6 d. The same without certificate 39 . Magnified Index. 3s. 6 d. extra.

Every kind of clinical and surgical instrument and appliance of best
workmanship at most moderate prices.

J. J. HAGUE, 138, Ball's Pond-road, London.

INF A L LI B LE

CAS ELLA'S INFALLIBLE CLINICAL THERMOMETER, with
PATENT BOLD MAGNIFIED INDEX, for saving time and trouble
In taking observations. Errors or loss of Index Impossible. * and 6 in.,
7i. 6 d. each. STANDARD HOSPITAL CLINICAL THBEMOMETEB,
4 and 6 in., 4a. 6 d. and 69 , 6 d. (Inland pottage fru.)

L. CAS ELLA, 147, H0LB0RN BARS, LONDON, E.C.

CLINICAL

THERMOMETERS

best'English make, accuracy guaranteed.

THE PHG.NIX THERMOMETER, imperishable index, 4 in.

5 in., and 6 in., in Metal Cases, price 5g. ( post free.

THE PIKENIX THERMOMETER, with Lens Front, 4 in.

and 6 In.. In Metal Case*, price 6 s. 6 d., post free.

THE “ONE MIJHJTE’ PIKENIX THERMOMETER, with

Lena Front, 4 im, in Casa, price 7s. 6 d., I>ost free.

TEMPERATURE "CHART FUltMh, once of Visiting List

0d. dozen; Is. book of 26; 2s. book of 60 La*ger Charts for Hospitals

REYNOLDS & BRANSON,

; Original Makers of Dr.EffortThermometers. .

58

ARTIFICIAL LIMBS 6 EYES;

SPRING, and other CRUTCHES.

1 . .M. MASTERS & SONS,

210, New Xent-road, London, 8.E.

Illustrated Catalogue free on application.

Medals: London, 1851,1862, 1873. Paris, 1867. Broweh, 1175.
Cutlers’ Hall, 1879.

BY ROYAL LETTERS PATENT.

“GAMGEE TISSUE

(Absorbent Gauze and Cotton Tissue).

Sole Proprietors and Manufacturers,

ROBINSON & SONS,
Chesterfield.

»»

SECONDHAND SURGICAL INSTRUMENTS and 06TB0L0GT
nought, Sold, Exchanged. Liatof New and Secondhand Instil 4 stamps.

STUDENTS’ £5 6a. SET of OSTEOLOGY mm-

§ rises complete Skeleton and Disarticulated Skull, la box.

uperior, kA 6s.. £7 7s., *8 8s., £» 9$., £10 10s. Dt—nntlng
Oases. 12 s. 6 d., 2ls. Secondhand Osteology pnmhaeed

STUDENTS’ HALF SET of OSTEOLOGY, £3 2s.. 8310a.

£3 3s. Disarticulated Skulls, £1 10s., £2 2a.. £3 3a.

Illustrated Catalogue of Osteology and New and Second-
hand Surgical Instruments, Microeoopea, te., 4 1 '

MILLIKTN * LAWLEY, 166, Strand, London.

mo 8T*xi Barrs.

Patent Im-

e"’

PBO^HD TRUSS, In which the metal
is entirely dlepeueed with, ta aekmew-
by hundreds of wearer* to be the most
comfortable and efficacious Truss yet J s Th sl.
Prices to the Profession only i Single, ta. sat
13s.: Double, 14s. 3d. and 17s. oat.

ED. HUXLEY, 18 (late of IS), Old Oma>
dish-street, Oxford-street.

Agente for Calcutta, Messrs. Bsthgatah Oo.
Bombay, Treacher It Oe. Montreal. K. Mths.

ir. Martin’s Rubber Bandages

. awdot

for the Radical Cure of Variooee Veins, Ulcert, Bcsesna, staToUvr
Diseases of the Leg (GENUINE), by tar superior to

any of t he numerous Imitations, are now being Sold at leas coat than
those of other manufacture.

No. 1 B, h>4 feet by 3 inches. No. 38 Wire Gauge, price 4a. Sd.

No. 8 . 14 feet by 3 inches, No. 28 Wire Gauge, „ 6a.

No. 9 B, 21 feet by 3 inches. No. 38 Wire Gauge, 8s. Sd.

No. 1 A, 10 t feet "by 3 inches, No. >4 Wire Gauge, „ 6s.

No. 7, 14 feet by 3 inches, No. 34 Wire Gauge. „ 7s. M.

CAUTION, — Please order the Gtnuint
Mart in's Bandages, each being stamped with
Dr. Henry A. Martin’s signature.

All others are spurious imitations.

Complete Price List, also Dr. H. A. Martin's Pamphlet 4i—c^g
Mei hod of Treatment, post free on application to the Sole Agent*—
ILR0HNE A SESEMANN, Surgical Instrument Makars, 8k Duke-
street, M inchested square, London.

ANTISEPTIC
DRESSINGS.

COATED PILLS.
PURE OXIDE of

(Registered Trade M&rk.y > ZINC.

CONCENTRATED MIXTURES

(to facilitate dispensing).

MEDICAL SPECIALITIES.

Upon receipt of name and address, price list of above will be
sent poet free.

PHILIP HARRIS & CO.

(LIMITED),

WHOLESALE AND MAN UFA C TURING CHEMISTS.

BULL RING, BIRMINGHAM.

TV

G

Thk Lancet,]

THE LANCET GENERAL ADVERTISER. [Apbii. ic, 1887._

ow&r

i iremfise.

\rpMrMf*,

mates. ch
\naiesnt

UuSHMS.n

\us orr/ci
WC/tOUS£S\

A ccurate Standard Solutions for \ olu-

MBTKIC ANALYSIS In Medicine and Physiological work,
also Special Chemical, and Verified Graduated Instruments, may be
liad of a V'

FRANCIS SUTTON A CO., Norwich,
who supply many of the Professor, in the Universities and Colleges
throughout the United Kingdom.

Prick List Fuse to ast Address.

Army and Navy House Furnishing

COMPANY (Limited), 20, Regent-street, Waterloo-place, 8.W.
CAPITAL, £50,000.

Established and directed by Officers of the Army and Navy for the

Three Years’ Hire Purchase System, in Furnishing their Houses or
Chambers in any part of the United Kingdom. Prospectus on applica¬
tion to the Managing Director. _. .

ESTABLISHED 1830.

B ennett & Co. (late T. S. Bennett),

MEDICAL BOTTLE MANUFACTURERS A DRUGGISTS
SUN DRIES MEN,

r nnrinn Address—35 and*37 a *' T HICOBALD’s"' ROAD. LONDON. W.C.
L Corks that will fit sent with all orders at the following low prices:-

• . a. o. oj x I k nr AT. 18. TV 1, 1

3 and 4 or., at 8s. 3d. .

6 „ 8 „ 9s. Od. [ Plain or

10 „ 13s. Od. (Graduated.

12 „ 14s. fid.;

If oorks are not required, fid. per

4s. fid. "I
5s. fid. [
6s. Od. r
6s. fid.'

\ oz., at 4s. fid.

1 ‘

1*

rose allowed off above prices.

Best White
Vials.

If oorks are not required, fid. per gross allowed on aw™
Poisou and all other kinds of bottles at same cheap rates.

MEDICINE BOTTLES AND PHIALS.

nphe Islington Glass Bottle Company.

A. WORKS. LONDON and YORKSHIRB.-Thls Company supply
only the very best MEDICAL GLASS BOTTLES and PHlALS, at th.
lowest prices. London Warehouse, 158, Upper Thames-streot, C y,
London, B.C.-H. HARP’S and CO., Proprietors.

REDUCED PRICES.

3 and 4 or., any shape, plain or graduated

6 and 8 or. ditto ditto — —

4 or. Moulded Phials, ordinary, 3s. 4d., best 4s. Od.

lor .. .. 3s. 9d., ..

it :: :: :: :: 8:4 ::

(Plain or graduated to tea-spoons).

Immediate attention to Country orders. Country Pacaages Is. aac •
Goods delivered free within 7 miles. Post-office orders ]payeMe
HARRIS A CO., at the Chief Office, London. Bankers. London ano
Westminster Bank.—Established upwards of 50 years.

7s. fid. per gross.
8s. fid.

DISPENSING BOTTLES.

“ The best value in the market.

Green Flint.

White Flint Vials
(Ordinary).

3/4
3/9
4/5

ty¬
per Gross net.

DELIVERED TO RAILS IN LONDON.

KILNER BROTHERS,

No 8, Great Northern Goods Station,

KING’S GROSS, LONDON.

3 or.

... 7/6

4 oz.

... 7/6

60 s.

... 8/6

8 of.

... 8/6

TAimish on Norman & Stacey’s System.

I ' r,., . 1 i« admitted to be the most

A This simple and economical system is admitted
satisfactory method. Deposit not necessary^One.twoor three years
credit. Sixty genuine wholesale firms. Gooda dtdiveTed free. Head
Offices, 78, Queen Victoria-street, H.C. Branches at 121, Pall Mall,
S.W., and 9, Liverpool-street, E.C.

SPECIAL NOTICE.

mhe North London Glass Bottle

1 COMPANY (I ISAACS A CO.. Proprietors. London Wandiousai

Dispensing Bottles and Phials as follows
:! and 1 o/.., any shape, plain or graduated ...

I oz. White Moulded Phials (Ordinary) ...

7s. fid. per gross.
8s. 6<L >.

3s. Id.

:is. Pd. ,.

is. fill. ..

5b. 0d.

4s. Od. .,

4 s, 0<1. ,,

6s. Oil. „

fis. Od.

1 or. ,
li or.

2 y/„ ,• " ***

4 or. White Moulded Pliials (Best) .

I or.

Ho*. .. . ;;;

. 2 "j ctiykTW ill UK-TINTED BOTTLES are (he HANDSOMEST
SBwSl) COLOUR and CLEAR GLASS.

We supply them:— _ > ,

3 and 1 or., any shape, plain or graduated... ... 8s. 0 d. per gross.

Tho^requ^lnga'iirst-cUiM bottle should see'a sample of the ItoVe. cent

free on application. i

Prompt attention to Country order, P ^“^ 0 ^ r ^a 5 afie to

•• London and Westminster Bank.

Established 50 Years.

TAirnish your Houses

1? or APARTMENTS

THROUGHOUT on
I MOEDEH’S HIKE SYSTEM.
The original, best, and most liberal.
Founded a.d. 1868.

Cash prices.

I Ko extra chargo for time given.
Particulars, estimates, Press opinions,
testimonials, poet free.

i F. MOKDER, 248, 249, and 250,
Tottenham-court-road ; and 19,20, ana
21, Morwell street, W.

Established 1882.

ALSO for HIRE ONLY.

RUST HAVANA CIGARS AT IMPORT PRICKS,

riuSlhipmi-nt. of

oiled toArmy and Navy Messes. Club.ffipr. with

five for is. (fourteen . B 'f ( L fl ^ I i2fSdates and oonsiitutlons.

oharacter and flavour, to suit the most delicate pai»w»

Send for Oatalogre and Treatise. T

BENSON A CO.. 61, St. Paul’! Churchward, London^

Digitized by L.OOQ Le

The Lancet,]

THE LANCET GENERAL ADVERTISER.

[Apmjp. 16,

tAllen & Hanburys

INFANTS’ FOOD.

SPECIAL NOTICE. -THE MALTED FARINACEOUS FOOD (Patentedi
manufactnred by Allen & Hanburys, is the result of a practical application of tlia
advice of Liebig, and the benefits accruing from its use verify in a remarkable manner
bis predictions of the value aDd efficacy of such a Food.

It is partially predigested, having as a basis a carefully cooked wheaten flour,
especially rich in gluten, to which are added the active and nutritive constituents of pure
malt in a soluble form. It thus contains all that is valuable in Malt, whilst all that
is irritating and indigestible is rejected.

When this Food is prepared for use, by mixing with warm milk or milk-and-water,
as indicated in the directions, the diastasic action on the already broken starch granules
is very rapid, whilst the milk is prevented from forming indigestible curds in the
stomach, partly by the mechanical action of the Malted Food, as described in a leading
article in The Lancet of Nov. 20th, 1886, and partly by the power of Malt Extract to
prevent the aggregation of the caseine.

This Food is not so entirely predigested as to leave frothing fot the infant’s stemaeb
to perform, and it is believed that the excellent practical results obtained are largely due
to the special proportion maintained between the predigested and the unaltered portions.

NOTE .—Where Medical Men have an opportunity of making comparative experiments 'with this Food as in oricb?^
children’s hospitals, &c., Allen & Hanburys will gladly supply a reasonable quantity for such purpOMe, lie*
of charge.

Sold only in Tint, at 6<L, Is., 2s., 5a, and 10a each.

MANUFACTURED BY

ALLEN & HANBURYS, Plough Court, Lombard Street, LONDON

Uf St. Martte-hrtfc*-

Brltaia and Ireland and

St^FaoI, Cavont“K»rd«n, W<

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